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MedQA_New3423 | [
{
"role": "user",
"content": "You are a medical doctor taking the US Medical Licensing Examination. You need to demonstrate your understanding of basic and clinical science, medical knowledge, and mechanisms underlying health, disease, patient care, and modes of therapy. Show your ability to apply the knowledge essential for medical practice. For the following multiple-choice question, select one correct answer from A to E. Base your answer on the current and standard practices referenced in medical guidelines.\nQuestion: In a healthy patient with no renal abnormalities, several mechanisms are responsible for moving various filtered substances into and out of the tubules. Para-aminohippurate (PAH) is frequently used to estimate renal blood flow when maintained at low plasma concentrations. The following table illustrates the effect of changing plasma PAH concentrations on PAH excretion:\nPlasma PAH concentration (mg/dL) Urinary PAH concentration (mg/dL)\n0 0\n10 60\n20 120\n30 150\n40 180\nWhich of the following mechanisms best explains the decrease in PAH excretion with the increase in plasma concentration greater than 20 mg/dL?\nOptions: A: Saturation of PAH transport carriers, B: Increased diffusion rate of PAH, C: Decreased glomerular filtration of PAH, D: Increased flow rate of tubular contents, E: Increased rate of PAH reabsorption.\nAnswer:\n"
},
{
"role": "assistant",
"content": "A"
}
] | You are a medical doctor taking the US Medical Licensing Examination. You need to demonstrate your understanding of basic and clinical science, medical knowledge, and mechanisms underlying health, disease, patient care, and modes of therapy. Show your ability to apply the knowledge essential for medical practice. For the following multiple-choice question, select one correct answer from A to E. Base your answer on the current and standard practices referenced in medical guidelines.
Question: In a healthy patient with no renal abnormalities, several mechanisms are responsible for moving various filtered substances into and out of the tubules. Para-aminohippurate (PAH) is frequently used to estimate renal blood flow when maintained at low plasma concentrations. The following table illustrates the effect of changing plasma PAH concentrations on PAH excretion:
Plasma PAH concentration (mg/dL) Urinary PAH concentration (mg/dL)
0 0
10 60
20 120
30 150
40 180
Which of the following mechanisms best explains the decrease in PAH excretion with the increase in plasma concentration greater than 20 mg/dL?
Options: A: Saturation of PAH transport carriers, B: Increased diffusion rate of PAH, C: Decreased glomerular filtration of PAH, D: Increased flow rate of tubular contents, E: Increased rate of PAH reabsorption.
Answer:
|
MedQA_New4435 | [
{
"role": "user",
"content": "You are a medical doctor taking the US Medical Licensing Examination. You need to demonstrate your understanding of basic and clinical science, medical knowledge, and mechanisms underlying health, disease, patient care, and modes of therapy. Show your ability to apply the knowledge essential for medical practice. For the following multiple-choice question, select one correct answer from A to E. Base your answer on the current and standard practices referenced in medical guidelines.\nQuestion: A 55-year-old man comes to the physician for a follow-up examination. During the past month, he has had mild itching. He has alcoholic cirrhosis, hypertension, and gastroesophageal reflux disease. He used to drink a pint of vodka and multiple beers daily but quit 4 months ago. Current medications include ramipril, esomeprazole, and vitamin B supplements. He appears thin. His temperature is 36.8°C (98.2°F), pulse is 68/min, and blood pressure is 115/72 mm Hg. Examination shows reddening of the palms bilaterally and several telangiectasias over the chest, abdomen, and back. There is symmetrical enlargement of the breast tissue bilaterally. His testes are small and firm on palpation. The remainder of the examination shows no abnormalities. Laboratory studies show:\nHemoglobin 10.1 g/dL\nLeukocyte count 4300/mm3\nPlatelet count 89,000/mm3\nProthrombin time 11 sec (INR = 1)\nSerum\nAlbumin 3 g/dL\nBilirubin\nTotal 2.0 mg/dL\nDirect 0.2 mg/dL\nAlkaline phosphatase 43 U/L\nAST 55 U/L\nALT 40 U/L\nα-Fetoprotein 8 ng/mL (N < 10)\nAnti-HAV IgG antibody positive\nAnti-HBs antibody negative\nAbdominal ultrasonography shows a nodular liver surface with atrophy of the right lobe of the liver. An upper endoscopy shows no abnormalities. Which of the following is the most appropriate next step in management?\"\nOptions: A: Measure serum α-fetoprotein levels in 3 months, B: Administer hepatitis A vaccine now, C: Obtain CT scan of the abdomen now, D: Repeat abdominal ultrasound in 6 months, E: Perform liver biopsy now.\nAnswer:\n"
},
{
"role": "assistant",
"content": "D"
}
] | You are a medical doctor taking the US Medical Licensing Examination. You need to demonstrate your understanding of basic and clinical science, medical knowledge, and mechanisms underlying health, disease, patient care, and modes of therapy. Show your ability to apply the knowledge essential for medical practice. For the following multiple-choice question, select one correct answer from A to E. Base your answer on the current and standard practices referenced in medical guidelines.
Question: A 55-year-old man comes to the physician for a follow-up examination. During the past month, he has had mild itching. He has alcoholic cirrhosis, hypertension, and gastroesophageal reflux disease. He used to drink a pint of vodka and multiple beers daily but quit 4 months ago. Current medications include ramipril, esomeprazole, and vitamin B supplements. He appears thin. His temperature is 36.8°C (98.2°F), pulse is 68/min, and blood pressure is 115/72 mm Hg. Examination shows reddening of the palms bilaterally and several telangiectasias over the chest, abdomen, and back. There is symmetrical enlargement of the breast tissue bilaterally. His testes are small and firm on palpation. The remainder of the examination shows no abnormalities. Laboratory studies show:
Hemoglobin 10.1 g/dL
Leukocyte count 4300/mm3
Platelet count 89,000/mm3
Prothrombin time 11 sec (INR = 1)
Serum
Albumin 3 g/dL
Bilirubin
Total 2.0 mg/dL
Direct 0.2 mg/dL
Alkaline phosphatase 43 U/L
AST 55 U/L
ALT 40 U/L
α-Fetoprotein 8 ng/mL (N < 10)
Anti-HAV IgG antibody positive
Anti-HBs antibody negative
Abdominal ultrasonography shows a nodular liver surface with atrophy of the right lobe of the liver. An upper endoscopy shows no abnormalities. Which of the following is the most appropriate next step in management?"
Options: A: Measure serum α-fetoprotein levels in 3 months, B: Administer hepatitis A vaccine now, C: Obtain CT scan of the abdomen now, D: Repeat abdominal ultrasound in 6 months, E: Perform liver biopsy now.
Answer:
|
MedQA_New7259 | [
{
"role": "user",
"content": "You are a medical doctor taking the US Medical Licensing Examination. You need to demonstrate your understanding of basic and clinical science, medical knowledge, and mechanisms underlying health, disease, patient care, and modes of therapy. Show your ability to apply the knowledge essential for medical practice. For the following multiple-choice question, select one correct answer from A to E. Base your answer on the current and standard practices referenced in medical guidelines.\nQuestion: A study is performed to determine whether cognitive behavioral therapy (CBT) increases compliance to dietary regimens. In order to test this hypothesis, a random group of volunteers who want to lose weight are selected from the community and subsequently randomized to no intervention and CBT groups. They are asked to record what they ate every day in a food journal and these recordings are correlated with objective serum and urine biomarkers for food intake. Surprisingly, it was found that even the group with no intervention had much higher rates of compliance to dietary regimens than the general population. Multivariate analysis showed no significant demographic or medical differences between the two groups. Which of the following most likely explains this finding from the study?\nOptions: A: Confounding effect, B: Hawthorne effect, C: Procedure bias, D: Pygmalion effect, E: Recall bias.\nAnswer:\n"
},
{
"role": "assistant",
"content": "B"
}
] | You are a medical doctor taking the US Medical Licensing Examination. You need to demonstrate your understanding of basic and clinical science, medical knowledge, and mechanisms underlying health, disease, patient care, and modes of therapy. Show your ability to apply the knowledge essential for medical practice. For the following multiple-choice question, select one correct answer from A to E. Base your answer on the current and standard practices referenced in medical guidelines.
Question: A study is performed to determine whether cognitive behavioral therapy (CBT) increases compliance to dietary regimens. In order to test this hypothesis, a random group of volunteers who want to lose weight are selected from the community and subsequently randomized to no intervention and CBT groups. They are asked to record what they ate every day in a food journal and these recordings are correlated with objective serum and urine biomarkers for food intake. Surprisingly, it was found that even the group with no intervention had much higher rates of compliance to dietary regimens than the general population. Multivariate analysis showed no significant demographic or medical differences between the two groups. Which of the following most likely explains this finding from the study?
Options: A: Confounding effect, B: Hawthorne effect, C: Procedure bias, D: Pygmalion effect, E: Recall bias.
Answer:
|
MedQA_New6093 | [
{
"role": "user",
"content": "You are a medical doctor taking the US Medical Licensing Examination. You need to demonstrate your understanding of basic and clinical science, medical knowledge, and mechanisms underlying health, disease, patient care, and modes of therapy. Show your ability to apply the knowledge essential for medical practice. For the following multiple-choice question, select one correct answer from A to E. Base your answer on the current and standard practices referenced in medical guidelines.\nQuestion: A 37-year-old G1P1001 presents for her 6-week postpartum visit after delivering a male infant by spontaneous vaginal delivery at 41 weeks and 5 days gestation. She notes that five days ago, her right breast began to hurt, and the skin near her nipple turned red. She also states that she has felt feverish and generally achy for 2 days but thought she was just sleep deprived. The patient’s son has been having difficulty latching for the last 2 weeks and has begun receiving formula in addition to breast milk, though the patient wishes to continue breastfeeding. She is generally healthy with no past medical history but has smoked half a pack per day for the last 15 years. Her mother died from breast cancer at the age of 62, and her father has hypertension and coronary artery disease. At this visit, her temperature is 100.6° F (38.1° C), blood pressure is 116/73 mmHg, pulse is 80/min, and respirations are 14/min. She appears tired and has a slightly flat affect. Examination reveals a 4x4 cm area of erythema on the lateral aspect near the nipple on the right breast. In the center of this area, there is a fluctuant, tender mass that measures 2x2 cm. The overlying skin is intact. The remainder of her exam is unremarkable. Which of the following is the best next step in management?\nOptions: A: Mammogram, B: Incision and drainage, C: Cessation of breastfeeding, D: Needle aspiration and oral dicloxacillin, E: Cessation of smoking.\nAnswer:\n"
},
{
"role": "assistant",
"content": "D"
}
] | You are a medical doctor taking the US Medical Licensing Examination. You need to demonstrate your understanding of basic and clinical science, medical knowledge, and mechanisms underlying health, disease, patient care, and modes of therapy. Show your ability to apply the knowledge essential for medical practice. For the following multiple-choice question, select one correct answer from A to E. Base your answer on the current and standard practices referenced in medical guidelines.
Question: A 37-year-old G1P1001 presents for her 6-week postpartum visit after delivering a male infant by spontaneous vaginal delivery at 41 weeks and 5 days gestation. She notes that five days ago, her right breast began to hurt, and the skin near her nipple turned red. She also states that she has felt feverish and generally achy for 2 days but thought she was just sleep deprived. The patient’s son has been having difficulty latching for the last 2 weeks and has begun receiving formula in addition to breast milk, though the patient wishes to continue breastfeeding. She is generally healthy with no past medical history but has smoked half a pack per day for the last 15 years. Her mother died from breast cancer at the age of 62, and her father has hypertension and coronary artery disease. At this visit, her temperature is 100.6° F (38.1° C), blood pressure is 116/73 mmHg, pulse is 80/min, and respirations are 14/min. She appears tired and has a slightly flat affect. Examination reveals a 4x4 cm area of erythema on the lateral aspect near the nipple on the right breast. In the center of this area, there is a fluctuant, tender mass that measures 2x2 cm. The overlying skin is intact. The remainder of her exam is unremarkable. Which of the following is the best next step in management?
Options: A: Mammogram, B: Incision and drainage, C: Cessation of breastfeeding, D: Needle aspiration and oral dicloxacillin, E: Cessation of smoking.
Answer:
|
MedQA_New2455 | [
{
"role": "user",
"content": "You are a medical doctor taking the US Medical Licensing Examination. You need to demonstrate your understanding of basic and clinical science, medical knowledge, and mechanisms underlying health, disease, patient care, and modes of therapy. Show your ability to apply the knowledge essential for medical practice. For the following multiple-choice question, select one correct answer from A to E. Base your answer on the current and standard practices referenced in medical guidelines.\nQuestion: A 40-year-old female presents to her gynecologist with dysmenorrhea, menorrhagia, and pelvic pain. The patient is not taking any medication and has no evidence of fever. Transvaginal sonogram reveals an enlarged, soft, and tender uterus, and uterine biopsy shows normal-appearing endometrial glands within the myometrium. Which of the following is the most likely diagnosis in this patient:\nOptions: A: Adenomyosis, B: Endometriosis, C: Endometritis, D: Leiomyoma, E: Endometrial carcinoma.\nAnswer:\n"
},
{
"role": "assistant",
"content": "A"
}
] | You are a medical doctor taking the US Medical Licensing Examination. You need to demonstrate your understanding of basic and clinical science, medical knowledge, and mechanisms underlying health, disease, patient care, and modes of therapy. Show your ability to apply the knowledge essential for medical practice. For the following multiple-choice question, select one correct answer from A to E. Base your answer on the current and standard practices referenced in medical guidelines.
Question: A 40-year-old female presents to her gynecologist with dysmenorrhea, menorrhagia, and pelvic pain. The patient is not taking any medication and has no evidence of fever. Transvaginal sonogram reveals an enlarged, soft, and tender uterus, and uterine biopsy shows normal-appearing endometrial glands within the myometrium. Which of the following is the most likely diagnosis in this patient:
Options: A: Adenomyosis, B: Endometriosis, C: Endometritis, D: Leiomyoma, E: Endometrial carcinoma.
Answer:
|
MedQA_New1385 | [
{
"role": "user",
"content": "You are a medical doctor taking the US Medical Licensing Examination. You need to demonstrate your understanding of basic and clinical science, medical knowledge, and mechanisms underlying health, disease, patient care, and modes of therapy. Show your ability to apply the knowledge essential for medical practice. For the following multiple-choice question, select one correct answer from A to E. Base your answer on the current and standard practices referenced in medical guidelines.\nQuestion: An 81-year-old man comes to the emergency department because of left-sided visual loss that started 1 hour ago. He describes initially seeing jagged edges, which was followed by abrupt, complete loss of central vision in the left eye. He has hypertension and type 2 diabetes mellitus. Blood pressure is 145/89 mm Hg. Neurologic examination shows no abnormalities. A photograph of the fundoscopic findings is shown. Which of the following tests is most likely to confirm this patient's underlying condition?\nOptions: A: Glycated hemoglobin concentration, B: Carotid artery duplex ultrasonography, C: Erythrocyte sedimentation rate, D: CD4+ T-cell count, E: Optic tonometer.\nAnswer:\n"
},
{
"role": "assistant",
"content": "B"
}
] | You are a medical doctor taking the US Medical Licensing Examination. You need to demonstrate your understanding of basic and clinical science, medical knowledge, and mechanisms underlying health, disease, patient care, and modes of therapy. Show your ability to apply the knowledge essential for medical practice. For the following multiple-choice question, select one correct answer from A to E. Base your answer on the current and standard practices referenced in medical guidelines.
Question: An 81-year-old man comes to the emergency department because of left-sided visual loss that started 1 hour ago. He describes initially seeing jagged edges, which was followed by abrupt, complete loss of central vision in the left eye. He has hypertension and type 2 diabetes mellitus. Blood pressure is 145/89 mm Hg. Neurologic examination shows no abnormalities. A photograph of the fundoscopic findings is shown. Which of the following tests is most likely to confirm this patient's underlying condition?
Options: A: Glycated hemoglobin concentration, B: Carotid artery duplex ultrasonography, C: Erythrocyte sedimentation rate, D: CD4+ T-cell count, E: Optic tonometer.
Answer:
|
MedQA_New3746 | [
{
"role": "user",
"content": "You are a medical doctor taking the US Medical Licensing Examination. You need to demonstrate your understanding of basic and clinical science, medical knowledge, and mechanisms underlying health, disease, patient care, and modes of therapy. Show your ability to apply the knowledge essential for medical practice. For the following multiple-choice question, select one correct answer from A to E. Base your answer on the current and standard practices referenced in medical guidelines.\nQuestion: An asymptomatic 15-year-old high school wrestler with no family history of renal disease is completing his preseason physical exam. He submits a urine sample for a dipstick examination, which tests positive for protein. What is the next appropriate step in management?\nOptions: A: Repeat dipstick on a separate occasion, B: Urine culture, C: Renal ultrasound, D: 24 hour urine collection, E: Spot urine-protein-to-creatinine ratio.\nAnswer:\n"
},
{
"role": "assistant",
"content": "A"
}
] | You are a medical doctor taking the US Medical Licensing Examination. You need to demonstrate your understanding of basic and clinical science, medical knowledge, and mechanisms underlying health, disease, patient care, and modes of therapy. Show your ability to apply the knowledge essential for medical practice. For the following multiple-choice question, select one correct answer from A to E. Base your answer on the current and standard practices referenced in medical guidelines.
Question: An asymptomatic 15-year-old high school wrestler with no family history of renal disease is completing his preseason physical exam. He submits a urine sample for a dipstick examination, which tests positive for protein. What is the next appropriate step in management?
Options: A: Repeat dipstick on a separate occasion, B: Urine culture, C: Renal ultrasound, D: 24 hour urine collection, E: Spot urine-protein-to-creatinine ratio.
Answer:
|
MedQA_New420 | [
{
"role": "user",
"content": "You are a medical doctor taking the US Medical Licensing Examination. You need to demonstrate your understanding of basic and clinical science, medical knowledge, and mechanisms underlying health, disease, patient care, and modes of therapy. Show your ability to apply the knowledge essential for medical practice. For the following multiple-choice question, select one correct answer from A to E. Base your answer on the current and standard practices referenced in medical guidelines.\nQuestion: A 27-year-old woman presents to the emergency department for sudden, bilateral, painful loss of vision. She states that her symptoms started last night and have persisted until this morning. The patient has a past medical history of peripheral neuropathy which is currently treated with duloxetine and severe anxiety. Her temperature is 99.5°F (37.5°C), blood pressure is 100/60 mmHg, pulse is 100/min, respirations are 15/min, and oxygen saturation is 98% on room air. On physical exam, the patient demonstrates 4/5 strength in her upper and lower extremities with decreased sensation in her fingers bilaterally. Towards the end of the exam, the patient embarrassingly admits to having an episode of urinary incontinence the previous night. An MRI is obtained and is within normal limits. Which of the following is the best next step in management and most likely finding for this patient?\nOptions: A: A repeat MRI 3 days later demonstrating periventricular lesions, B: A high resolution CT demonstrating hyperdense lesions, C: A lumbar puncture demonstrating oligoclonal bands, D: Urine toxicology panel demonstrating cocaine use, E: A psychiatric evaluation revealing multiple acute life stressors.\nAnswer:\n"
},
{
"role": "assistant",
"content": "C"
}
] | You are a medical doctor taking the US Medical Licensing Examination. You need to demonstrate your understanding of basic and clinical science, medical knowledge, and mechanisms underlying health, disease, patient care, and modes of therapy. Show your ability to apply the knowledge essential for medical practice. For the following multiple-choice question, select one correct answer from A to E. Base your answer on the current and standard practices referenced in medical guidelines.
Question: A 27-year-old woman presents to the emergency department for sudden, bilateral, painful loss of vision. She states that her symptoms started last night and have persisted until this morning. The patient has a past medical history of peripheral neuropathy which is currently treated with duloxetine and severe anxiety. Her temperature is 99.5°F (37.5°C), blood pressure is 100/60 mmHg, pulse is 100/min, respirations are 15/min, and oxygen saturation is 98% on room air. On physical exam, the patient demonstrates 4/5 strength in her upper and lower extremities with decreased sensation in her fingers bilaterally. Towards the end of the exam, the patient embarrassingly admits to having an episode of urinary incontinence the previous night. An MRI is obtained and is within normal limits. Which of the following is the best next step in management and most likely finding for this patient?
Options: A: A repeat MRI 3 days later demonstrating periventricular lesions, B: A high resolution CT demonstrating hyperdense lesions, C: A lumbar puncture demonstrating oligoclonal bands, D: Urine toxicology panel demonstrating cocaine use, E: A psychiatric evaluation revealing multiple acute life stressors.
Answer:
|
MedQA_New6309 | [
{
"role": "user",
"content": "You are a medical doctor taking the US Medical Licensing Examination. You need to demonstrate your understanding of basic and clinical science, medical knowledge, and mechanisms underlying health, disease, patient care, and modes of therapy. Show your ability to apply the knowledge essential for medical practice. For the following multiple-choice question, select one correct answer from A to E. Base your answer on the current and standard practices referenced in medical guidelines.\nQuestion: A 28-year-old man comes to the physician for the evaluation of five episodes of painful oral ulcers over the past year. During this period, he has also had two painful genital ulcers that healed without treatment. He reports frequently having diffuse joint pain, malaise, and low-grade fever. There is no personal or family history of serious illness. He emigrated to the US from Syria with his family four years ago. He is sexually active with one female partner and they do not use condoms. He takes no medications. His temperature is 38°C (100.4°F), pulse is 90/min, and blood pressure is 130/80 mm Hg. Physical examination shows three painful ulcers on the oral buccal mucosa. Pelvic examination shows that the external genitalia has several healing scars. The remainder of the examination shows no abnormalities. Which of the following is the most likely diagnosis?\nOptions: A: Chancroid, B: Herpes simplex virus infection, C: Ankylosing spondylitis, D: Behcet disease, E: Systemic lupus erythematosus.\nAnswer:\n"
},
{
"role": "assistant",
"content": "D"
}
] | You are a medical doctor taking the US Medical Licensing Examination. You need to demonstrate your understanding of basic and clinical science, medical knowledge, and mechanisms underlying health, disease, patient care, and modes of therapy. Show your ability to apply the knowledge essential for medical practice. For the following multiple-choice question, select one correct answer from A to E. Base your answer on the current and standard practices referenced in medical guidelines.
Question: A 28-year-old man comes to the physician for the evaluation of five episodes of painful oral ulcers over the past year. During this period, he has also had two painful genital ulcers that healed without treatment. He reports frequently having diffuse joint pain, malaise, and low-grade fever. There is no personal or family history of serious illness. He emigrated to the US from Syria with his family four years ago. He is sexually active with one female partner and they do not use condoms. He takes no medications. His temperature is 38°C (100.4°F), pulse is 90/min, and blood pressure is 130/80 mm Hg. Physical examination shows three painful ulcers on the oral buccal mucosa. Pelvic examination shows that the external genitalia has several healing scars. The remainder of the examination shows no abnormalities. Which of the following is the most likely diagnosis?
Options: A: Chancroid, B: Herpes simplex virus infection, C: Ankylosing spondylitis, D: Behcet disease, E: Systemic lupus erythematosus.
Answer:
|
MedQA_New8712 | [
{
"role": "user",
"content": "You are a medical doctor taking the US Medical Licensing Examination. You need to demonstrate your understanding of basic and clinical science, medical knowledge, and mechanisms underlying health, disease, patient care, and modes of therapy. Show your ability to apply the knowledge essential for medical practice. For the following multiple-choice question, select one correct answer from A to E. Base your answer on the current and standard practices referenced in medical guidelines.\nQuestion: A 28-year-old man presents to his psychiatrist for continuing cognitive behavioral therapy for bipolar disorder. At this session, he reveals that he has had fantasies of killing his boss because he feels he is not treated fairly at work. He says that he has been stalking his boss and has made detailed plans for how to kill him in about a week. He then asks his psychiatrist not to reveal this information and says that he shared it only because he knew these therapy sessions would remain confidential. Which of the following actions should the psychiatrist take in this scenario?\nOptions: A: Ask for the patient's permission to share this information and share only if granted, B: Contact the police to warn them about this threat against the patient's wishes, C: Refer the patient to the ethics board of the hospital that meets in 1 week, D: Respect patient confidentiality and do not write down this information, E: Write the information in the note but do not contact the police.\nAnswer:\n"
},
{
"role": "assistant",
"content": "B"
}
] | You are a medical doctor taking the US Medical Licensing Examination. You need to demonstrate your understanding of basic and clinical science, medical knowledge, and mechanisms underlying health, disease, patient care, and modes of therapy. Show your ability to apply the knowledge essential for medical practice. For the following multiple-choice question, select one correct answer from A to E. Base your answer on the current and standard practices referenced in medical guidelines.
Question: A 28-year-old man presents to his psychiatrist for continuing cognitive behavioral therapy for bipolar disorder. At this session, he reveals that he has had fantasies of killing his boss because he feels he is not treated fairly at work. He says that he has been stalking his boss and has made detailed plans for how to kill him in about a week. He then asks his psychiatrist not to reveal this information and says that he shared it only because he knew these therapy sessions would remain confidential. Which of the following actions should the psychiatrist take in this scenario?
Options: A: Ask for the patient's permission to share this information and share only if granted, B: Contact the police to warn them about this threat against the patient's wishes, C: Refer the patient to the ethics board of the hospital that meets in 1 week, D: Respect patient confidentiality and do not write down this information, E: Write the information in the note but do not contact the police.
Answer:
|
MedQA_New1936 | [
{
"role": "user",
"content": "You are a medical doctor taking the US Medical Licensing Examination. You need to demonstrate your understanding of basic and clinical science, medical knowledge, and mechanisms underlying health, disease, patient care, and modes of therapy. Show your ability to apply the knowledge essential for medical practice. For the following multiple-choice question, select one correct answer from A to E. Base your answer on the current and standard practices referenced in medical guidelines.\nQuestion: A 75-year-old man presents to the physician because of bloody urine, which has occurred several times over the past month. He has no dysuria, flank pain, nausea, or vomiting. He has no history of serious illness and takes no medications. He is a 40-pack-year smoker. The vital signs are within normal limits. Physical exam shows no abnormalities except generalized lung wheezing. The laboratory test results are as follows:\nUrine\nBlood 3+\nRBC > 100/hpf\nWBC 1–2/hpf\nRBC casts Negative\nBacteria Not seen\nWhich of the following is the most appropriate diagnostic study at this time?\nOptions: A: Chest X-ray, B: Computed tomography (CT) urogram, C: Cystoscopy, D: Intravenous (IV) pyelography, E: Ureteroscopy.\nAnswer:\n"
},
{
"role": "assistant",
"content": "C"
}
] | You are a medical doctor taking the US Medical Licensing Examination. You need to demonstrate your understanding of basic and clinical science, medical knowledge, and mechanisms underlying health, disease, patient care, and modes of therapy. Show your ability to apply the knowledge essential for medical practice. For the following multiple-choice question, select one correct answer from A to E. Base your answer on the current and standard practices referenced in medical guidelines.
Question: A 75-year-old man presents to the physician because of bloody urine, which has occurred several times over the past month. He has no dysuria, flank pain, nausea, or vomiting. He has no history of serious illness and takes no medications. He is a 40-pack-year smoker. The vital signs are within normal limits. Physical exam shows no abnormalities except generalized lung wheezing. The laboratory test results are as follows:
Urine
Blood 3+
RBC > 100/hpf
WBC 1–2/hpf
RBC casts Negative
Bacteria Not seen
Which of the following is the most appropriate diagnostic study at this time?
Options: A: Chest X-ray, B: Computed tomography (CT) urogram, C: Cystoscopy, D: Intravenous (IV) pyelography, E: Ureteroscopy.
Answer:
|
MedQA_New4089 | [
{
"role": "user",
"content": "You are a medical doctor taking the US Medical Licensing Examination. You need to demonstrate your understanding of basic and clinical science, medical knowledge, and mechanisms underlying health, disease, patient care, and modes of therapy. Show your ability to apply the knowledge essential for medical practice. For the following multiple-choice question, select one correct answer from A to E. Base your answer on the current and standard practices referenced in medical guidelines.\nQuestion: A 48-year-old woman with a history of type 2 diabetes mellitus presents to her primary care physician with complaints of headaches, fatigue, dry cough, and frequent episodes of bronchospasm. She was diagnosed with moderate nonproliferative diabetic retinopathy by an ophthalmologist last month. Her blood pressure measured in the clinic is 158/95 mmHg. A 24-hour urine collection is obtained and reveals 9.5 g of protein. On physical examination, the patient has diffuse wheezing, jugular venous distention, and 2+ pitting pretibial edema. Labs are notable for a potassium level of 5.2 mEq/L. Which of the following medications is most likely contributing to this patient’s current presentation?\nOptions: A: Amlodipine, B: Hydralazine, C: Hydrochlorothiazide, D: Lisinopril, E: Losartan.\nAnswer:\n"
},
{
"role": "assistant",
"content": "D"
}
] | You are a medical doctor taking the US Medical Licensing Examination. You need to demonstrate your understanding of basic and clinical science, medical knowledge, and mechanisms underlying health, disease, patient care, and modes of therapy. Show your ability to apply the knowledge essential for medical practice. For the following multiple-choice question, select one correct answer from A to E. Base your answer on the current and standard practices referenced in medical guidelines.
Question: A 48-year-old woman with a history of type 2 diabetes mellitus presents to her primary care physician with complaints of headaches, fatigue, dry cough, and frequent episodes of bronchospasm. She was diagnosed with moderate nonproliferative diabetic retinopathy by an ophthalmologist last month. Her blood pressure measured in the clinic is 158/95 mmHg. A 24-hour urine collection is obtained and reveals 9.5 g of protein. On physical examination, the patient has diffuse wheezing, jugular venous distention, and 2+ pitting pretibial edema. Labs are notable for a potassium level of 5.2 mEq/L. Which of the following medications is most likely contributing to this patient’s current presentation?
Options: A: Amlodipine, B: Hydralazine, C: Hydrochlorothiazide, D: Lisinopril, E: Losartan.
Answer:
|
MedQA_New9753 | [
{
"role": "user",
"content": "You are a medical doctor taking the US Medical Licensing Examination. You need to demonstrate your understanding of basic and clinical science, medical knowledge, and mechanisms underlying health, disease, patient care, and modes of therapy. Show your ability to apply the knowledge essential for medical practice. For the following multiple-choice question, select one correct answer from A to E. Base your answer on the current and standard practices referenced in medical guidelines.\nQuestion: A 6-month-old boy is referred to a geneticist after he is found to have persistent hypotonia and failure to thrive. He has also had episodes of what appears to be respiratory distress and has an enlarged heart on physical exam. There is a family history of childhood onset hypertrophic cardiomyopathy, so a biopsy is performed showing electron dense granules within the lysosomes. Genetic testing is performed showing a defect in glycogen processing. A deficiency in which of the following enzymes is most likely to be responsible for this patient's symptoms?\nOptions: A: Glucose-6-phosphatase, B: Lysosomal alpha 1,4-glucosidase, C: Debranching enzyme, D: Branching enzyme, E: Muscle phosphorylase.\nAnswer:\n"
},
{
"role": "assistant",
"content": "B"
}
] | You are a medical doctor taking the US Medical Licensing Examination. You need to demonstrate your understanding of basic and clinical science, medical knowledge, and mechanisms underlying health, disease, patient care, and modes of therapy. Show your ability to apply the knowledge essential for medical practice. For the following multiple-choice question, select one correct answer from A to E. Base your answer on the current and standard practices referenced in medical guidelines.
Question: A 6-month-old boy is referred to a geneticist after he is found to have persistent hypotonia and failure to thrive. He has also had episodes of what appears to be respiratory distress and has an enlarged heart on physical exam. There is a family history of childhood onset hypertrophic cardiomyopathy, so a biopsy is performed showing electron dense granules within the lysosomes. Genetic testing is performed showing a defect in glycogen processing. A deficiency in which of the following enzymes is most likely to be responsible for this patient's symptoms?
Options: A: Glucose-6-phosphatase, B: Lysosomal alpha 1,4-glucosidase, C: Debranching enzyme, D: Branching enzyme, E: Muscle phosphorylase.
Answer:
|
MedQA_New7081 | [
{
"role": "user",
"content": "You are a medical doctor taking the US Medical Licensing Examination. You need to demonstrate your understanding of basic and clinical science, medical knowledge, and mechanisms underlying health, disease, patient care, and modes of therapy. Show your ability to apply the knowledge essential for medical practice. For the following multiple-choice question, select one correct answer from A to E. Base your answer on the current and standard practices referenced in medical guidelines.\nQuestion: A 23-year-old man presents to the emergency room with right flank pain. On physical examination, there is no rebound tenderness, guarding, and rigidity. The pain is radiating to the groin region and is associated with nausea. Plain X-ray of the kidney, ureter, and bladder is normal. Urinalysis showed the presence of mild hematuria, an absence of pus cells, and the following crystals (refer to image). What is the most likely composition of these crystals?\nOptions: A: Calcium carbonate, B: Magnesium phosphate, C: Uric acid, D: Cysteine stones, E: Calcium oxalate.\nAnswer:\n"
},
{
"role": "assistant",
"content": "C"
}
] | You are a medical doctor taking the US Medical Licensing Examination. You need to demonstrate your understanding of basic and clinical science, medical knowledge, and mechanisms underlying health, disease, patient care, and modes of therapy. Show your ability to apply the knowledge essential for medical practice. For the following multiple-choice question, select one correct answer from A to E. Base your answer on the current and standard practices referenced in medical guidelines.
Question: A 23-year-old man presents to the emergency room with right flank pain. On physical examination, there is no rebound tenderness, guarding, and rigidity. The pain is radiating to the groin region and is associated with nausea. Plain X-ray of the kidney, ureter, and bladder is normal. Urinalysis showed the presence of mild hematuria, an absence of pus cells, and the following crystals (refer to image). What is the most likely composition of these crystals?
Options: A: Calcium carbonate, B: Magnesium phosphate, C: Uric acid, D: Cysteine stones, E: Calcium oxalate.
Answer:
|
MedQA_New3075 | [
{
"role": "user",
"content": "You are a medical doctor taking the US Medical Licensing Examination. You need to demonstrate your understanding of basic and clinical science, medical knowledge, and mechanisms underlying health, disease, patient care, and modes of therapy. Show your ability to apply the knowledge essential for medical practice. For the following multiple-choice question, select one correct answer from A to E. Base your answer on the current and standard practices referenced in medical guidelines.\nQuestion: A patient presents to the emergency department with arm pain. The patient recently experienced an open fracture of his radius when he fell from a ladder while cleaning his house. Surgical reduction took place and the patient's forearm was put in a cast. Since then, the patient has experienced worsening pain in his arm. The patient has a past medical history of hypertension and asthma. His current medications include albuterol, fluticasone, loratadine, and lisinopril. His temperature is 99.5°F (37.5°C), blood pressure is 150/95 mmHg, pulse is 90/min, respirations are 19/min, and oxygen saturation is 99% on room air. The patient's cast is removed. On physical exam, the patient's left arm is tender to palpation. Passive motion of the patient's wrist and fingers elicits severe pain. The patient's left radial and ulnar pulse are both palpable and regular. The forearm is soft and does not demonstrate any bruising but is tender to palpation. Which of the following is the next best step in management?\nOptions: A: Ibuprofen and reassurance, B: Replace the cast with a sling, C: Radiography, D: Measurement of compartment pressure, E: Emergency fasciotomy.\nAnswer:\n"
},
{
"role": "assistant",
"content": "E"
}
] | You are a medical doctor taking the US Medical Licensing Examination. You need to demonstrate your understanding of basic and clinical science, medical knowledge, and mechanisms underlying health, disease, patient care, and modes of therapy. Show your ability to apply the knowledge essential for medical practice. For the following multiple-choice question, select one correct answer from A to E. Base your answer on the current and standard practices referenced in medical guidelines.
Question: A patient presents to the emergency department with arm pain. The patient recently experienced an open fracture of his radius when he fell from a ladder while cleaning his house. Surgical reduction took place and the patient's forearm was put in a cast. Since then, the patient has experienced worsening pain in his arm. The patient has a past medical history of hypertension and asthma. His current medications include albuterol, fluticasone, loratadine, and lisinopril. His temperature is 99.5°F (37.5°C), blood pressure is 150/95 mmHg, pulse is 90/min, respirations are 19/min, and oxygen saturation is 99% on room air. The patient's cast is removed. On physical exam, the patient's left arm is tender to palpation. Passive motion of the patient's wrist and fingers elicits severe pain. The patient's left radial and ulnar pulse are both palpable and regular. The forearm is soft and does not demonstrate any bruising but is tender to palpation. Which of the following is the next best step in management?
Options: A: Ibuprofen and reassurance, B: Replace the cast with a sling, C: Radiography, D: Measurement of compartment pressure, E: Emergency fasciotomy.
Answer:
|
MedQA_New1096 | [
{
"role": "user",
"content": "You are a medical doctor taking the US Medical Licensing Examination. You need to demonstrate your understanding of basic and clinical science, medical knowledge, and mechanisms underlying health, disease, patient care, and modes of therapy. Show your ability to apply the knowledge essential for medical practice. For the following multiple-choice question, select one correct answer from A to E. Base your answer on the current and standard practices referenced in medical guidelines.\nQuestion: A 4-year-old girl is brought to the pediatrician's office by her parents with a complaint of foul-smelling discharge from one side of her nose for the past 2 weeks. There is no history of trauma to the nose and she was completely fine during her well-child visit last month. She was born at 39 weeks gestation via spontaneous vaginal delivery. She is up to date on all vaccines and is meeting all developmental milestones. Her vital signs are within normal limits. Examination of the nose reveals a mucoid discharge oozing out from the left nostril. The girl panics when the physician tries to use a nasal speculum. Palpation over the facial bones does not reveal any tenderness. An X-ray image of the paranasal sinuses shows no abnormality. Which of the following is the most likely cause of this condition?\nOptions: A: Nasal foreign body, B: Bilateral maxillary sinusitis, C: Nasal polyp, D: Septal hematoma, E: Nasal tumor.\nAnswer:\n"
},
{
"role": "assistant",
"content": "A"
}
] | You are a medical doctor taking the US Medical Licensing Examination. You need to demonstrate your understanding of basic and clinical science, medical knowledge, and mechanisms underlying health, disease, patient care, and modes of therapy. Show your ability to apply the knowledge essential for medical practice. For the following multiple-choice question, select one correct answer from A to E. Base your answer on the current and standard practices referenced in medical guidelines.
Question: A 4-year-old girl is brought to the pediatrician's office by her parents with a complaint of foul-smelling discharge from one side of her nose for the past 2 weeks. There is no history of trauma to the nose and she was completely fine during her well-child visit last month. She was born at 39 weeks gestation via spontaneous vaginal delivery. She is up to date on all vaccines and is meeting all developmental milestones. Her vital signs are within normal limits. Examination of the nose reveals a mucoid discharge oozing out from the left nostril. The girl panics when the physician tries to use a nasal speculum. Palpation over the facial bones does not reveal any tenderness. An X-ray image of the paranasal sinuses shows no abnormality. Which of the following is the most likely cause of this condition?
Options: A: Nasal foreign body, B: Bilateral maxillary sinusitis, C: Nasal polyp, D: Septal hematoma, E: Nasal tumor.
Answer:
|
MedQA_New925 | [
{
"role": "user",
"content": "You are a medical doctor taking the US Medical Licensing Examination. You need to demonstrate your understanding of basic and clinical science, medical knowledge, and mechanisms underlying health, disease, patient care, and modes of therapy. Show your ability to apply the knowledge essential for medical practice. For the following multiple-choice question, select one correct answer from A to E. Base your answer on the current and standard practices referenced in medical guidelines.\nQuestion: A 3-year-old male presents with his parents to a pediatrician for a new patient visit. The child was recently adopted and little is known about his prior medical or family history. The parents report that the child seems to be doing well, but they are concerned because the patient is much larger than any of the other 3-year-olds in his preschool class. They report that he eats a varied diet at home, and that they limit juice and snack foods. On physical exam, the patient is in the 73rd percentile for weight, 99th percentile for height, and 86th percentile for head circumference. He appears mildly developmentally delayed. He has a fair complexion and tall stature with a prominent sternum. The patient also has joint hypermobility and hyperelastic skin. He appears to have poor visual acuity and is referred to an ophthalmologist, who diagnoses downward lens subluxation of the right eye.\n\nThis child is most likely to develop which of the following complications?\nOptions: A: Aortic dissection, B: Medullary thyroid cancer, C: Osteoarthritis, D: Thromboembolic stroke, E: Wilms tumor.\nAnswer:\n"
},
{
"role": "assistant",
"content": "D"
}
] | You are a medical doctor taking the US Medical Licensing Examination. You need to demonstrate your understanding of basic and clinical science, medical knowledge, and mechanisms underlying health, disease, patient care, and modes of therapy. Show your ability to apply the knowledge essential for medical practice. For the following multiple-choice question, select one correct answer from A to E. Base your answer on the current and standard practices referenced in medical guidelines.
Question: A 3-year-old male presents with his parents to a pediatrician for a new patient visit. The child was recently adopted and little is known about his prior medical or family history. The parents report that the child seems to be doing well, but they are concerned because the patient is much larger than any of the other 3-year-olds in his preschool class. They report that he eats a varied diet at home, and that they limit juice and snack foods. On physical exam, the patient is in the 73rd percentile for weight, 99th percentile for height, and 86th percentile for head circumference. He appears mildly developmentally delayed. He has a fair complexion and tall stature with a prominent sternum. The patient also has joint hypermobility and hyperelastic skin. He appears to have poor visual acuity and is referred to an ophthalmologist, who diagnoses downward lens subluxation of the right eye.
This child is most likely to develop which of the following complications?
Options: A: Aortic dissection, B: Medullary thyroid cancer, C: Osteoarthritis, D: Thromboembolic stroke, E: Wilms tumor.
Answer:
|
MedQA_New1948 | [
{
"role": "user",
"content": "You are a medical doctor taking the US Medical Licensing Examination. You need to demonstrate your understanding of basic and clinical science, medical knowledge, and mechanisms underlying health, disease, patient care, and modes of therapy. Show your ability to apply the knowledge essential for medical practice. For the following multiple-choice question, select one correct answer from A to E. Base your answer on the current and standard practices referenced in medical guidelines.\nQuestion: A 45-year-old woman presents to the emergency department with a headache, fevers with chills, rigors, and generalized joint pain for the past week. She also complains of a progressive rash on her left arm. She says that a few days ago she noticed a small, slightly raised lesion resembling an insect bite mark, which had a burning sensation. The medical and surgical histories are unremarkable. She recalls walking in the woods 2 weeks prior to the onset of symptoms, but does not recall finding a tick on her body. On examination, the temperature is 40.2°C (104.4°F). A circular red rash measuring 10 cm x 5 cm in diameter is noted on the left arm, as shown in the accompanying image. The remainder of her physical examination is unremarkable. The tick causing her disease is also responsible for the transmission of which of the following pathogens?\nOptions: A: Plasmodium vivax, B: Babesia microti, C: Ehrlichia, D: Rickettsia rickettsii, E: Rickettsia typhi.\nAnswer:\n"
},
{
"role": "assistant",
"content": "B"
}
] | You are a medical doctor taking the US Medical Licensing Examination. You need to demonstrate your understanding of basic and clinical science, medical knowledge, and mechanisms underlying health, disease, patient care, and modes of therapy. Show your ability to apply the knowledge essential for medical practice. For the following multiple-choice question, select one correct answer from A to E. Base your answer on the current and standard practices referenced in medical guidelines.
Question: A 45-year-old woman presents to the emergency department with a headache, fevers with chills, rigors, and generalized joint pain for the past week. She also complains of a progressive rash on her left arm. She says that a few days ago she noticed a small, slightly raised lesion resembling an insect bite mark, which had a burning sensation. The medical and surgical histories are unremarkable. She recalls walking in the woods 2 weeks prior to the onset of symptoms, but does not recall finding a tick on her body. On examination, the temperature is 40.2°C (104.4°F). A circular red rash measuring 10 cm x 5 cm in diameter is noted on the left arm, as shown in the accompanying image. The remainder of her physical examination is unremarkable. The tick causing her disease is also responsible for the transmission of which of the following pathogens?
Options: A: Plasmodium vivax, B: Babesia microti, C: Ehrlichia, D: Rickettsia rickettsii, E: Rickettsia typhi.
Answer:
|
MedQA_New1390 | [
{
"role": "user",
"content": "You are a medical doctor taking the US Medical Licensing Examination. You need to demonstrate your understanding of basic and clinical science, medical knowledge, and mechanisms underlying health, disease, patient care, and modes of therapy. Show your ability to apply the knowledge essential for medical practice. For the following multiple-choice question, select one correct answer from A to E. Base your answer on the current and standard practices referenced in medical guidelines.\nQuestion: An x-ray of the chest shows an extensive consolidation within the right lower lobe consistent with lobar pneumonia. Sputum and blood cultures are sent to the laboratory for analysis, and empiric antibiotic treatment with intravenous cefotaxime is begun. Which of the following is most likely to have prevented this patient's pneumonia?\nOptions: A: Incentive spirometry, B: Rapid sequence induction, C: Prolonged bed rest, D: Perioperative antibiotic prophylaxis, E: Smoking cessation.\nAnswer:\n"
},
{
"role": "assistant",
"content": "A"
}
] | You are a medical doctor taking the US Medical Licensing Examination. You need to demonstrate your understanding of basic and clinical science, medical knowledge, and mechanisms underlying health, disease, patient care, and modes of therapy. Show your ability to apply the knowledge essential for medical practice. For the following multiple-choice question, select one correct answer from A to E. Base your answer on the current and standard practices referenced in medical guidelines.
Question: An x-ray of the chest shows an extensive consolidation within the right lower lobe consistent with lobar pneumonia. Sputum and blood cultures are sent to the laboratory for analysis, and empiric antibiotic treatment with intravenous cefotaxime is begun. Which of the following is most likely to have prevented this patient's pneumonia?
Options: A: Incentive spirometry, B: Rapid sequence induction, C: Prolonged bed rest, D: Perioperative antibiotic prophylaxis, E: Smoking cessation.
Answer:
|
MedQA_New5669 | [
{
"role": "user",
"content": "You are a medical doctor taking the US Medical Licensing Examination. You need to demonstrate your understanding of basic and clinical science, medical knowledge, and mechanisms underlying health, disease, patient care, and modes of therapy. Show your ability to apply the knowledge essential for medical practice. For the following multiple-choice question, select one correct answer from A to E. Base your answer on the current and standard practices referenced in medical guidelines.\nQuestion: A 32-year-old woman presents to her primary care physician for an annual checkup. She reports that she has been feeling well and has no medical concerns. Her past medical history is significant for childhood asthma but she has not experienced any symptoms since she was a teenager. Physical exam reveals a 1-centimeter hard mobile mass in the left upper outer quadrant of her breast. A mammogram was performed and demonstrated calcifications within the mass so a biopsy was obtained. The biopsy shows acinar proliferation with intralobular fibrosis. Which of the following conditions is most likely affecting this patient?\nOptions: A: Cystic hyperplasia, B: Fibroadenoma, C: Infiltrating ductal carcinoma, D: Invasive lobular carcinoma, E: Sclerosing adenosis.\nAnswer:\n"
},
{
"role": "assistant",
"content": "E"
}
] | You are a medical doctor taking the US Medical Licensing Examination. You need to demonstrate your understanding of basic and clinical science, medical knowledge, and mechanisms underlying health, disease, patient care, and modes of therapy. Show your ability to apply the knowledge essential for medical practice. For the following multiple-choice question, select one correct answer from A to E. Base your answer on the current and standard practices referenced in medical guidelines.
Question: A 32-year-old woman presents to her primary care physician for an annual checkup. She reports that she has been feeling well and has no medical concerns. Her past medical history is significant for childhood asthma but she has not experienced any symptoms since she was a teenager. Physical exam reveals a 1-centimeter hard mobile mass in the left upper outer quadrant of her breast. A mammogram was performed and demonstrated calcifications within the mass so a biopsy was obtained. The biopsy shows acinar proliferation with intralobular fibrosis. Which of the following conditions is most likely affecting this patient?
Options: A: Cystic hyperplasia, B: Fibroadenoma, C: Infiltrating ductal carcinoma, D: Invasive lobular carcinoma, E: Sclerosing adenosis.
Answer:
|
MedQA_New2841 | [
{
"role": "user",
"content": "You are a medical doctor taking the US Medical Licensing Examination. You need to demonstrate your understanding of basic and clinical science, medical knowledge, and mechanisms underlying health, disease, patient care, and modes of therapy. Show your ability to apply the knowledge essential for medical practice. For the following multiple-choice question, select one correct answer from A to E. Base your answer on the current and standard practices referenced in medical guidelines.\nQuestion: A 52-year-old African American man presents to his primary care physician with a chief complaint of leg swelling. He says that the swelling began about 2 weeks ago and he cannot recall anything that may have provoked the episode. Otherwise he has had joint pain, headaches, frothy urine, and some tingling in his fingers and toes though he doesn't feel that any of this is related to his swelling. He denies any shortness of breath, back pain, or skull pain. His past medical history is significant for mild rheumatoid arthritis, diabetes, and hypertension all of which are well controlled. Physical exam reveals 3+ pitting edema in his legs bilaterally. A chest radiograph reveals mild enlargement of the cardiac shadow. Urinalysis reveals 3+ protein and casts with a cross appearance under polarized light. A renal biopsy is taken with a characteristic finding seen only under polarized light. Which of the following is associated with the most likely cause of this patient's edema?\nOptions: A: Abnormally shaped red blood cells, B: Altered kappa to lambda ratio, C: Antibodies to phospholipase A2 receptor, D: Elevated levels of hemoglobin A1c, E: Elevated levels of IL-6.\nAnswer:\n"
},
{
"role": "assistant",
"content": "E"
}
] | You are a medical doctor taking the US Medical Licensing Examination. You need to demonstrate your understanding of basic and clinical science, medical knowledge, and mechanisms underlying health, disease, patient care, and modes of therapy. Show your ability to apply the knowledge essential for medical practice. For the following multiple-choice question, select one correct answer from A to E. Base your answer on the current and standard practices referenced in medical guidelines.
Question: A 52-year-old African American man presents to his primary care physician with a chief complaint of leg swelling. He says that the swelling began about 2 weeks ago and he cannot recall anything that may have provoked the episode. Otherwise he has had joint pain, headaches, frothy urine, and some tingling in his fingers and toes though he doesn't feel that any of this is related to his swelling. He denies any shortness of breath, back pain, or skull pain. His past medical history is significant for mild rheumatoid arthritis, diabetes, and hypertension all of which are well controlled. Physical exam reveals 3+ pitting edema in his legs bilaterally. A chest radiograph reveals mild enlargement of the cardiac shadow. Urinalysis reveals 3+ protein and casts with a cross appearance under polarized light. A renal biopsy is taken with a characteristic finding seen only under polarized light. Which of the following is associated with the most likely cause of this patient's edema?
Options: A: Abnormally shaped red blood cells, B: Altered kappa to lambda ratio, C: Antibodies to phospholipase A2 receptor, D: Elevated levels of hemoglobin A1c, E: Elevated levels of IL-6.
Answer:
|
MedQA_New156 | [
{
"role": "user",
"content": "You are a medical doctor taking the US Medical Licensing Examination. You need to demonstrate your understanding of basic and clinical science, medical knowledge, and mechanisms underlying health, disease, patient care, and modes of therapy. Show your ability to apply the knowledge essential for medical practice. For the following multiple-choice question, select one correct answer from A to E. Base your answer on the current and standard practices referenced in medical guidelines.\nQuestion: The human body obtains vitamin D either from diet or from sun exposure. Darker-skinned individuals require more sunlight to create adequate vitamin D stores as the increased melanin in their skin acts like sunscreen; thus, it blocks the necessary UV required for vitamin D synthesis. Therefore, if these individuals spend inadequate time in the light, dietary sources of vitamin D are necessary. Which of the following requires sunlight for its formation?\nOptions: A: 7-dehydrocholestrol, B: Cholecalciferol (D3), C: 25-hydroxyvitamin D, D: 1,25-dihydroxyvitamin D, E: Ergocalciferol (D2).\nAnswer:\n"
},
{
"role": "assistant",
"content": "B"
}
] | You are a medical doctor taking the US Medical Licensing Examination. You need to demonstrate your understanding of basic and clinical science, medical knowledge, and mechanisms underlying health, disease, patient care, and modes of therapy. Show your ability to apply the knowledge essential for medical practice. For the following multiple-choice question, select one correct answer from A to E. Base your answer on the current and standard practices referenced in medical guidelines.
Question: The human body obtains vitamin D either from diet or from sun exposure. Darker-skinned individuals require more sunlight to create adequate vitamin D stores as the increased melanin in their skin acts like sunscreen; thus, it blocks the necessary UV required for vitamin D synthesis. Therefore, if these individuals spend inadequate time in the light, dietary sources of vitamin D are necessary. Which of the following requires sunlight for its formation?
Options: A: 7-dehydrocholestrol, B: Cholecalciferol (D3), C: 25-hydroxyvitamin D, D: 1,25-dihydroxyvitamin D, E: Ergocalciferol (D2).
Answer:
|
MedQA_New5938 | [
{
"role": "user",
"content": "You are a medical doctor taking the US Medical Licensing Examination. You need to demonstrate your understanding of basic and clinical science, medical knowledge, and mechanisms underlying health, disease, patient care, and modes of therapy. Show your ability to apply the knowledge essential for medical practice. For the following multiple-choice question, select one correct answer from A to E. Base your answer on the current and standard practices referenced in medical guidelines.\nQuestion: A 73-year-old man presents to your clinic for a routine checkup. His medical history is notable for a previous myocardial infarction. He states that he has not seen a doctor in \"many years\". He has no complaints. When you auscultate over the cardiac apex with the bell of your stethoscope, you notice an additional sound immediately preceding S1. This extra heart sound is most likely indicative of which of the following processes?\nOptions: A: Increased left ventricular compliance, B: Decreased left ventricular compliance, C: Increased left ventricular filling volume, D: Decreased left ventricular filling volume, E: Increased pulmonary compliance.\nAnswer:\n"
},
{
"role": "assistant",
"content": "B"
}
] | You are a medical doctor taking the US Medical Licensing Examination. You need to demonstrate your understanding of basic and clinical science, medical knowledge, and mechanisms underlying health, disease, patient care, and modes of therapy. Show your ability to apply the knowledge essential for medical practice. For the following multiple-choice question, select one correct answer from A to E. Base your answer on the current and standard practices referenced in medical guidelines.
Question: A 73-year-old man presents to your clinic for a routine checkup. His medical history is notable for a previous myocardial infarction. He states that he has not seen a doctor in "many years". He has no complaints. When you auscultate over the cardiac apex with the bell of your stethoscope, you notice an additional sound immediately preceding S1. This extra heart sound is most likely indicative of which of the following processes?
Options: A: Increased left ventricular compliance, B: Decreased left ventricular compliance, C: Increased left ventricular filling volume, D: Decreased left ventricular filling volume, E: Increased pulmonary compliance.
Answer:
|
MedQA_New4109 | [
{
"role": "user",
"content": "You are a medical doctor taking the US Medical Licensing Examination. You need to demonstrate your understanding of basic and clinical science, medical knowledge, and mechanisms underlying health, disease, patient care, and modes of therapy. Show your ability to apply the knowledge essential for medical practice. For the following multiple-choice question, select one correct answer from A to E. Base your answer on the current and standard practices referenced in medical guidelines.\nQuestion: A 28-year-old primigravid woman at 36 weeks' gestation comes to the emergency department because of worsening pelvic pain for 2 hours. Three days ago, she had a burning sensation with urination that resolved spontaneously. She has nausea and has vomited fluid twice on her way to the hospital. She appears ill. Her temperature is 39.7°C (103.5°F), pulse is 125/min, respirations are 33/min, and blood pressure is 130/70 mm Hg. Abdominal examination shows diffuse tenderness. No contractions are felt. Speculum examination shows pooling of nonbloody, malodorous fluid in the vaginal vault. The cervix is not effaced or dilated. Laboratory studies show a hemoglobin concentration of 14 g/dL, a leukocyte count of 16,000/mm3, and a platelet count of 250,000/mm3. Fetal heart rate is 148/min and reactive with no decelerations. Which of the following is the most appropriate next step in management?\nOptions: A: Administer intravenous ampicillin and gentamicin and perform C-section, B: Expectant management, C: Administer oral azithromycin and induce labor, D: Administer intravenous ampicillin and gentamicin and induce labor, E: Perform C-section.\nAnswer:\n"
},
{
"role": "assistant",
"content": "D"
}
] | You are a medical doctor taking the US Medical Licensing Examination. You need to demonstrate your understanding of basic and clinical science, medical knowledge, and mechanisms underlying health, disease, patient care, and modes of therapy. Show your ability to apply the knowledge essential for medical practice. For the following multiple-choice question, select one correct answer from A to E. Base your answer on the current and standard practices referenced in medical guidelines.
Question: A 28-year-old primigravid woman at 36 weeks' gestation comes to the emergency department because of worsening pelvic pain for 2 hours. Three days ago, she had a burning sensation with urination that resolved spontaneously. She has nausea and has vomited fluid twice on her way to the hospital. She appears ill. Her temperature is 39.7°C (103.5°F), pulse is 125/min, respirations are 33/min, and blood pressure is 130/70 mm Hg. Abdominal examination shows diffuse tenderness. No contractions are felt. Speculum examination shows pooling of nonbloody, malodorous fluid in the vaginal vault. The cervix is not effaced or dilated. Laboratory studies show a hemoglobin concentration of 14 g/dL, a leukocyte count of 16,000/mm3, and a platelet count of 250,000/mm3. Fetal heart rate is 148/min and reactive with no decelerations. Which of the following is the most appropriate next step in management?
Options: A: Administer intravenous ampicillin and gentamicin and perform C-section, B: Expectant management, C: Administer oral azithromycin and induce labor, D: Administer intravenous ampicillin and gentamicin and induce labor, E: Perform C-section.
Answer:
|
MedQA_New1230 | [
{
"role": "user",
"content": "You are a medical doctor taking the US Medical Licensing Examination. You need to demonstrate your understanding of basic and clinical science, medical knowledge, and mechanisms underlying health, disease, patient care, and modes of therapy. Show your ability to apply the knowledge essential for medical practice. For the following multiple-choice question, select one correct answer from A to E. Base your answer on the current and standard practices referenced in medical guidelines.\nQuestion: One day after undergoing surgery for a traumatic right pelvic fracture, a 73-year-old man has pain over his buttocks and scrotum and urinary incontinence. Physical examination shows right-sided perineal hypesthesia and absence of anal sphincter contraction when the skin around the anus is touched. This patient is most likely to have which of the following additional neurological deficits?\nOptions: A: Paralysis of hip adductors, B: Absent reflex erection, C: Impaired hip flexion, D: Impaired psychogenic erection, E: Absent cremasteric reflex.\nAnswer:\n"
},
{
"role": "assistant",
"content": "B"
}
] | You are a medical doctor taking the US Medical Licensing Examination. You need to demonstrate your understanding of basic and clinical science, medical knowledge, and mechanisms underlying health, disease, patient care, and modes of therapy. Show your ability to apply the knowledge essential for medical practice. For the following multiple-choice question, select one correct answer from A to E. Base your answer on the current and standard practices referenced in medical guidelines.
Question: One day after undergoing surgery for a traumatic right pelvic fracture, a 73-year-old man has pain over his buttocks and scrotum and urinary incontinence. Physical examination shows right-sided perineal hypesthesia and absence of anal sphincter contraction when the skin around the anus is touched. This patient is most likely to have which of the following additional neurological deficits?
Options: A: Paralysis of hip adductors, B: Absent reflex erection, C: Impaired hip flexion, D: Impaired psychogenic erection, E: Absent cremasteric reflex.
Answer:
|
MedQA_New5545 | [
{
"role": "user",
"content": "You are a medical doctor taking the US Medical Licensing Examination. You need to demonstrate your understanding of basic and clinical science, medical knowledge, and mechanisms underlying health, disease, patient care, and modes of therapy. Show your ability to apply the knowledge essential for medical practice. For the following multiple-choice question, select one correct answer from A to E. Base your answer on the current and standard practices referenced in medical guidelines.\nQuestion: A 44-year-old man presents to urgent care with severe vomiting. He states that he was at a camping ground for a party several hours ago and then suddenly began vomiting profusely. He denies experiencing any diarrhea and otherwise states he feels well. The patient only has a past medical history of lactose intolerance and hypertension managed with exercise and a low salt diet. His temperature is 99.3°F (37.4°C), blood pressure is 123/65 mmHg, pulse is 110/min, respirations are 14/min, and oxygen saturation is 98% on room air. Physical exam is notable only for tachycardia and diffuse abdominal discomfort. Which of the following foods is associated with the most likely cause of this patient's presentation?\nOptions: A: Egg salad, B: Fish, C: Home-made ice cream, D: Refried rice, E: Unfiltered stream water.\nAnswer:\n"
},
{
"role": "assistant",
"content": "A"
}
] | You are a medical doctor taking the US Medical Licensing Examination. You need to demonstrate your understanding of basic and clinical science, medical knowledge, and mechanisms underlying health, disease, patient care, and modes of therapy. Show your ability to apply the knowledge essential for medical practice. For the following multiple-choice question, select one correct answer from A to E. Base your answer on the current and standard practices referenced in medical guidelines.
Question: A 44-year-old man presents to urgent care with severe vomiting. He states that he was at a camping ground for a party several hours ago and then suddenly began vomiting profusely. He denies experiencing any diarrhea and otherwise states he feels well. The patient only has a past medical history of lactose intolerance and hypertension managed with exercise and a low salt diet. His temperature is 99.3°F (37.4°C), blood pressure is 123/65 mmHg, pulse is 110/min, respirations are 14/min, and oxygen saturation is 98% on room air. Physical exam is notable only for tachycardia and diffuse abdominal discomfort. Which of the following foods is associated with the most likely cause of this patient's presentation?
Options: A: Egg salad, B: Fish, C: Home-made ice cream, D: Refried rice, E: Unfiltered stream water.
Answer:
|
MedQA_New574 | [
{
"role": "user",
"content": "You are a medical doctor taking the US Medical Licensing Examination. You need to demonstrate your understanding of basic and clinical science, medical knowledge, and mechanisms underlying health, disease, patient care, and modes of therapy. Show your ability to apply the knowledge essential for medical practice. For the following multiple-choice question, select one correct answer from A to E. Base your answer on the current and standard practices referenced in medical guidelines.\nQuestion: A 5-month-old male presents to the pediatrician with his mother for a well visit. The patient was born at 35 weeks gestation to a 30-year-old gravida 2 via vaginal delivery. The pregnancy and labor were uncomplicated. The patient required no resuscitation after delivery and was discharged from the hospital on day two of life. His mother now reports that the patient has been exclusively breastfed since birth, and she says that feedings have been going well, and that the patient appears satisfied afterwards. The patient feeds for 30 minutes every two hours and urinates 8-10 times per day. The patient’s mother reports that she eats a varied diet that includes animal products, but she worries that the patient is not meeting his nutritional needs with breastmilk alone. The patient’s height and weight at birth were in the 15th and 20th percentile, respectively. His height and weight are now in the 20th and 25th percentile, respectively. His temperature is 98.1°F (36.7°C), blood pressure is 58/46 mmHg, pulse is 128/min, and respirations are 34/min. On physical exam, the patient appears well-developed and well-nourished. He has mild conjunctival pallor.\n\nWhich of the following is the most appropriate guidance regarding this patient’s nutritional needs?\nOptions: A: No changes are necessary to his diet, B: Add cow's milk to his diet, C: Add pureed foods to his diet, D: Supplement his diet with formula, E: Supplement his diet with iron and vitamin D.\nAnswer:\n"
},
{
"role": "assistant",
"content": "E"
}
] | You are a medical doctor taking the US Medical Licensing Examination. You need to demonstrate your understanding of basic and clinical science, medical knowledge, and mechanisms underlying health, disease, patient care, and modes of therapy. Show your ability to apply the knowledge essential for medical practice. For the following multiple-choice question, select one correct answer from A to E. Base your answer on the current and standard practices referenced in medical guidelines.
Question: A 5-month-old male presents to the pediatrician with his mother for a well visit. The patient was born at 35 weeks gestation to a 30-year-old gravida 2 via vaginal delivery. The pregnancy and labor were uncomplicated. The patient required no resuscitation after delivery and was discharged from the hospital on day two of life. His mother now reports that the patient has been exclusively breastfed since birth, and she says that feedings have been going well, and that the patient appears satisfied afterwards. The patient feeds for 30 minutes every two hours and urinates 8-10 times per day. The patient’s mother reports that she eats a varied diet that includes animal products, but she worries that the patient is not meeting his nutritional needs with breastmilk alone. The patient’s height and weight at birth were in the 15th and 20th percentile, respectively. His height and weight are now in the 20th and 25th percentile, respectively. His temperature is 98.1°F (36.7°C), blood pressure is 58/46 mmHg, pulse is 128/min, and respirations are 34/min. On physical exam, the patient appears well-developed and well-nourished. He has mild conjunctival pallor.
Which of the following is the most appropriate guidance regarding this patient’s nutritional needs?
Options: A: No changes are necessary to his diet, B: Add cow's milk to his diet, C: Add pureed foods to his diet, D: Supplement his diet with formula, E: Supplement his diet with iron and vitamin D.
Answer:
|
MedQA_New8498 | [
{
"role": "user",
"content": "You are a medical doctor taking the US Medical Licensing Examination. You need to demonstrate your understanding of basic and clinical science, medical knowledge, and mechanisms underlying health, disease, patient care, and modes of therapy. Show your ability to apply the knowledge essential for medical practice. For the following multiple-choice question, select one correct answer from A to E. Base your answer on the current and standard practices referenced in medical guidelines.\nQuestion: A scientist in Chicago is studying a new blood test to detect Ab to the EBV virus with increased sensitivity and specificity. So far, her best attempt at creating such an exam reached 82% sensitivity and 88% specificity. She is hoping to increase these numbers by at least 2 percent for each value. After several years of work, she believes that she has actually managed to reach a sensitivity and specificity much greater than what she had originally hoped for. She travels to China to begin testing her newest blood test. She finds 2,000 patients who are willing to participate in her study. Of the 2,000 patients, 1,200 of them are known to be infected with the EBV virus. The scientist tests these 1,200 patients’ blood and finds that only 120 of them tested negative with her new exam. Of the patients who are known to be EBV-free, only 20 of them tested positive. Given these results, which of the following correlates with the exam’s specificity?\nOptions: A: 82%, B: 84%, C: 86%, D: 90%, E: 98%.\nAnswer:\n"
},
{
"role": "assistant",
"content": "E"
}
] | You are a medical doctor taking the US Medical Licensing Examination. You need to demonstrate your understanding of basic and clinical science, medical knowledge, and mechanisms underlying health, disease, patient care, and modes of therapy. Show your ability to apply the knowledge essential for medical practice. For the following multiple-choice question, select one correct answer from A to E. Base your answer on the current and standard practices referenced in medical guidelines.
Question: A scientist in Chicago is studying a new blood test to detect Ab to the EBV virus with increased sensitivity and specificity. So far, her best attempt at creating such an exam reached 82% sensitivity and 88% specificity. She is hoping to increase these numbers by at least 2 percent for each value. After several years of work, she believes that she has actually managed to reach a sensitivity and specificity much greater than what she had originally hoped for. She travels to China to begin testing her newest blood test. She finds 2,000 patients who are willing to participate in her study. Of the 2,000 patients, 1,200 of them are known to be infected with the EBV virus. The scientist tests these 1,200 patients’ blood and finds that only 120 of them tested negative with her new exam. Of the patients who are known to be EBV-free, only 20 of them tested positive. Given these results, which of the following correlates with the exam’s specificity?
Options: A: 82%, B: 84%, C: 86%, D: 90%, E: 98%.
Answer:
|
MedQA_New597 | [
{
"role": "user",
"content": "You are a medical doctor taking the US Medical Licensing Examination. You need to demonstrate your understanding of basic and clinical science, medical knowledge, and mechanisms underlying health, disease, patient care, and modes of therapy. Show your ability to apply the knowledge essential for medical practice. For the following multiple-choice question, select one correct answer from A to E. Base your answer on the current and standard practices referenced in medical guidelines.\nQuestion: A 51-year-old man presents to his primary care physician with 3 months of increasing fatigue. He says that he has been feeling short of breath while walking to his office from the parking lot and is no longer able to participate in recreational activities that he enjoys such as hiking. His wife also comments that he has been looking very pale even though they spend a lot of time outdoors. His past medical history is significant for acute kidney injury after losing blood during a car accident as well as alcoholic hepatitis. Physical exam reveals conjunctival pallor, and a peripheral blood smear is obtained with the finding demonstrate in figure A. Which of the following is associated with the most likely cause of this patient's symptoms?\nOptions: A: Abnormal triglyceride handling, B: Increased production of platelet derived growth factor, C: Inhibition of metalloproteinase activity, D: Mutation in cytoskeletal proteins, E: Mutation in glycolysis pathway protein.\nAnswer:\n"
},
{
"role": "assistant",
"content": "B"
}
] | You are a medical doctor taking the US Medical Licensing Examination. You need to demonstrate your understanding of basic and clinical science, medical knowledge, and mechanisms underlying health, disease, patient care, and modes of therapy. Show your ability to apply the knowledge essential for medical practice. For the following multiple-choice question, select one correct answer from A to E. Base your answer on the current and standard practices referenced in medical guidelines.
Question: A 51-year-old man presents to his primary care physician with 3 months of increasing fatigue. He says that he has been feeling short of breath while walking to his office from the parking lot and is no longer able to participate in recreational activities that he enjoys such as hiking. His wife also comments that he has been looking very pale even though they spend a lot of time outdoors. His past medical history is significant for acute kidney injury after losing blood during a car accident as well as alcoholic hepatitis. Physical exam reveals conjunctival pallor, and a peripheral blood smear is obtained with the finding demonstrate in figure A. Which of the following is associated with the most likely cause of this patient's symptoms?
Options: A: Abnormal triglyceride handling, B: Increased production of platelet derived growth factor, C: Inhibition of metalloproteinase activity, D: Mutation in cytoskeletal proteins, E: Mutation in glycolysis pathway protein.
Answer:
|
MedQA_New9604 | [
{
"role": "user",
"content": "You are a medical doctor taking the US Medical Licensing Examination. You need to demonstrate your understanding of basic and clinical science, medical knowledge, and mechanisms underlying health, disease, patient care, and modes of therapy. Show your ability to apply the knowledge essential for medical practice. For the following multiple-choice question, select one correct answer from A to E. Base your answer on the current and standard practices referenced in medical guidelines.\nQuestion: A 13-year-old boy is brought to the emergency department after being involved in a motor vehicle accident in which he was a restrained passenger. He is confused and appears anxious. His pulse is 131/min, respirations are 29/min, and blood pressure is 95/49 mm Hg. Physical examination shows ecchymosis over the upper abdomen, with tenderness to palpation over the left upper quadrant. There is no guarding or rigidity. Abdominal ultrasound shows free intraperitoneal fluid and a splenic rupture. Intravenous fluids and vasopressors are administered. A blood transfusion and exploratory laparotomy are scheduled. The patient's mother arrives and insists that her son should not receive a blood transfusion because he is a Jehovah's Witness. The physician proceeds with the blood transfusion regardless of the mother's wishes. The physician's behavior is an example of which of the following principles of medical ethics?\nOptions: A: Justice, B: Nonmaleficence, C: Beneficence, D: Informed consent, E: Autonomy.\nAnswer:\n"
},
{
"role": "assistant",
"content": "C"
}
] | You are a medical doctor taking the US Medical Licensing Examination. You need to demonstrate your understanding of basic and clinical science, medical knowledge, and mechanisms underlying health, disease, patient care, and modes of therapy. Show your ability to apply the knowledge essential for medical practice. For the following multiple-choice question, select one correct answer from A to E. Base your answer on the current and standard practices referenced in medical guidelines.
Question: A 13-year-old boy is brought to the emergency department after being involved in a motor vehicle accident in which he was a restrained passenger. He is confused and appears anxious. His pulse is 131/min, respirations are 29/min, and blood pressure is 95/49 mm Hg. Physical examination shows ecchymosis over the upper abdomen, with tenderness to palpation over the left upper quadrant. There is no guarding or rigidity. Abdominal ultrasound shows free intraperitoneal fluid and a splenic rupture. Intravenous fluids and vasopressors are administered. A blood transfusion and exploratory laparotomy are scheduled. The patient's mother arrives and insists that her son should not receive a blood transfusion because he is a Jehovah's Witness. The physician proceeds with the blood transfusion regardless of the mother's wishes. The physician's behavior is an example of which of the following principles of medical ethics?
Options: A: Justice, B: Nonmaleficence, C: Beneficence, D: Informed consent, E: Autonomy.
Answer:
|
MedQA_New3156 | [
{
"role": "user",
"content": "You are a medical doctor taking the US Medical Licensing Examination. You need to demonstrate your understanding of basic and clinical science, medical knowledge, and mechanisms underlying health, disease, patient care, and modes of therapy. Show your ability to apply the knowledge essential for medical practice. For the following multiple-choice question, select one correct answer from A to E. Base your answer on the current and standard practices referenced in medical guidelines.\nQuestion: A 12-year-old girl is brought to the physician because of a 2-hour history of severe epigastric pain, nausea, and vomiting. Her father has a history of similar episodes of abdominal pain and developed diabetes mellitus at the age of 30 years. Abdominal examination shows guarding and rigidity. Ultrasonography of the abdomen shows diffuse enlargement of the pancreas; no gallstones are visualized. Which of the following is the most likely underlying cause of this patient's condition?\nOptions: A: Elevated serum amylase levels, B: Increased β-glucuronidase activity, C: Premature activation of trypsinogen, D: Defective elastase inhibitor, E: Impaired cellular copper transport.\nAnswer:\n"
},
{
"role": "assistant",
"content": "C"
}
] | You are a medical doctor taking the US Medical Licensing Examination. You need to demonstrate your understanding of basic and clinical science, medical knowledge, and mechanisms underlying health, disease, patient care, and modes of therapy. Show your ability to apply the knowledge essential for medical practice. For the following multiple-choice question, select one correct answer from A to E. Base your answer on the current and standard practices referenced in medical guidelines.
Question: A 12-year-old girl is brought to the physician because of a 2-hour history of severe epigastric pain, nausea, and vomiting. Her father has a history of similar episodes of abdominal pain and developed diabetes mellitus at the age of 30 years. Abdominal examination shows guarding and rigidity. Ultrasonography of the abdomen shows diffuse enlargement of the pancreas; no gallstones are visualized. Which of the following is the most likely underlying cause of this patient's condition?
Options: A: Elevated serum amylase levels, B: Increased β-glucuronidase activity, C: Premature activation of trypsinogen, D: Defective elastase inhibitor, E: Impaired cellular copper transport.
Answer:
|
MedQA_New5108 | [
{
"role": "user",
"content": "You are a medical doctor taking the US Medical Licensing Examination. You need to demonstrate your understanding of basic and clinical science, medical knowledge, and mechanisms underlying health, disease, patient care, and modes of therapy. Show your ability to apply the knowledge essential for medical practice. For the following multiple-choice question, select one correct answer from A to E. Base your answer on the current and standard practices referenced in medical guidelines.\nQuestion: A 45-year-old man comes to the physician for a routine health maintenance examination. He feels well. He has type 2 diabetes mellitus. There is no family history of serious illness. He works as an engineer at a local company. He does not smoke. He drinks one glass of red wine every other day. He does not use illicit drugs. His only medication is metformin. He is 180 cm (5 ft 11 in) tall and weighs 100 kg (220 lb); BMI is 31 kg/m2. His vital signs are within normal limits. Examination shows a soft, nontender abdomen. The liver is palpated 2 to 3 cm below the right costal margin. Laboratory studies show an aspartate aminotransferase concentration of 100 U/L and an alanine aminotransferase concentration of 130 U/L. Liver biopsy shows hepatocyte ballooning degeneration, as well as inflammatory infiltrates with scattered lymphocytes, neutrophils, and Kupffer cells. Which of the following is the most likely diagnosis?\nOptions: A: Primary biliary cirrhosis, B: Alcoholic fatty liver disease, C: Viral hepatitis, D: Nonalcoholic steatohepatitis, E: Autoimmune hepatitis.\nAnswer:\n"
},
{
"role": "assistant",
"content": "D"
}
] | You are a medical doctor taking the US Medical Licensing Examination. You need to demonstrate your understanding of basic and clinical science, medical knowledge, and mechanisms underlying health, disease, patient care, and modes of therapy. Show your ability to apply the knowledge essential for medical practice. For the following multiple-choice question, select one correct answer from A to E. Base your answer on the current and standard practices referenced in medical guidelines.
Question: A 45-year-old man comes to the physician for a routine health maintenance examination. He feels well. He has type 2 diabetes mellitus. There is no family history of serious illness. He works as an engineer at a local company. He does not smoke. He drinks one glass of red wine every other day. He does not use illicit drugs. His only medication is metformin. He is 180 cm (5 ft 11 in) tall and weighs 100 kg (220 lb); BMI is 31 kg/m2. His vital signs are within normal limits. Examination shows a soft, nontender abdomen. The liver is palpated 2 to 3 cm below the right costal margin. Laboratory studies show an aspartate aminotransferase concentration of 100 U/L and an alanine aminotransferase concentration of 130 U/L. Liver biopsy shows hepatocyte ballooning degeneration, as well as inflammatory infiltrates with scattered lymphocytes, neutrophils, and Kupffer cells. Which of the following is the most likely diagnosis?
Options: A: Primary biliary cirrhosis, B: Alcoholic fatty liver disease, C: Viral hepatitis, D: Nonalcoholic steatohepatitis, E: Autoimmune hepatitis.
Answer:
|
MedQA_New9211 | [
{
"role": "user",
"content": "You are a medical doctor taking the US Medical Licensing Examination. You need to demonstrate your understanding of basic and clinical science, medical knowledge, and mechanisms underlying health, disease, patient care, and modes of therapy. Show your ability to apply the knowledge essential for medical practice. For the following multiple-choice question, select one correct answer from A to E. Base your answer on the current and standard practices referenced in medical guidelines.\nQuestion: A 65-year-old man comes to the physician because of a 10-month history of crampy left lower extremity pain that is exacerbated by walking and relieved by rest. The pain is especially severe when he walks on an incline. He has a 20-year history of type 2 diabetes mellitus, for which he takes metformin. He has smoked 1 pack of cigarettes daily for 40 years. His blood pressure is 140/92 mm Hg. Physical examination shows dry and hairless skin over the left foot. Which of the following is the most likely underlying cause of this patient's symptoms?\nOptions: A: Osteophytic compression of the lumbar spinal canal, B: Thrombosing vasculitis of the popliteal artery, C: Intimal plaque in the posterior tibial artery, D: Fibrin clot in the left popliteal vein, E: Systemic hyperplastic arteriolosclerosis.\nAnswer:\n"
},
{
"role": "assistant",
"content": "C"
}
] | You are a medical doctor taking the US Medical Licensing Examination. You need to demonstrate your understanding of basic and clinical science, medical knowledge, and mechanisms underlying health, disease, patient care, and modes of therapy. Show your ability to apply the knowledge essential for medical practice. For the following multiple-choice question, select one correct answer from A to E. Base your answer on the current and standard practices referenced in medical guidelines.
Question: A 65-year-old man comes to the physician because of a 10-month history of crampy left lower extremity pain that is exacerbated by walking and relieved by rest. The pain is especially severe when he walks on an incline. He has a 20-year history of type 2 diabetes mellitus, for which he takes metformin. He has smoked 1 pack of cigarettes daily for 40 years. His blood pressure is 140/92 mm Hg. Physical examination shows dry and hairless skin over the left foot. Which of the following is the most likely underlying cause of this patient's symptoms?
Options: A: Osteophytic compression of the lumbar spinal canal, B: Thrombosing vasculitis of the popliteal artery, C: Intimal plaque in the posterior tibial artery, D: Fibrin clot in the left popliteal vein, E: Systemic hyperplastic arteriolosclerosis.
Answer:
|
MedQA_New9230 | [
{
"role": "user",
"content": "You are a medical doctor taking the US Medical Licensing Examination. You need to demonstrate your understanding of basic and clinical science, medical knowledge, and mechanisms underlying health, disease, patient care, and modes of therapy. Show your ability to apply the knowledge essential for medical practice. For the following multiple-choice question, select one correct answer from A to E. Base your answer on the current and standard practices referenced in medical guidelines.\nQuestion: A 63-year-old man comes to the physician for the evaluation of a skin lesion on his chest. He first noticed the lesion 2 months ago and thinks that it has increased in size since then. The lesion is not painful or pruritic. He has type 2 diabetes mellitus, hypercholesterolemia, and glaucoma. The patient has smoked 1 pack of cigarettes daily for the last 40 years and drinks two to three beers on the weekend. Current medications include metformin, atorvastatin, topical timolol, and a multivitamin. Vital signs are within normal limits. The lesion is partly elevated on palpation and does not change its form on pinching. A photograph of the lesion is shown. Which of the following is the most likely diagnosis?\nOptions: A: Malignant melanoma, B: Keratoacanthoma, C: Lentigo maligna, D: Seborrheic keratosis, E: Basal cell carcinoma.\nAnswer:\n"
},
{
"role": "assistant",
"content": "A"
}
] | You are a medical doctor taking the US Medical Licensing Examination. You need to demonstrate your understanding of basic and clinical science, medical knowledge, and mechanisms underlying health, disease, patient care, and modes of therapy. Show your ability to apply the knowledge essential for medical practice. For the following multiple-choice question, select one correct answer from A to E. Base your answer on the current and standard practices referenced in medical guidelines.
Question: A 63-year-old man comes to the physician for the evaluation of a skin lesion on his chest. He first noticed the lesion 2 months ago and thinks that it has increased in size since then. The lesion is not painful or pruritic. He has type 2 diabetes mellitus, hypercholesterolemia, and glaucoma. The patient has smoked 1 pack of cigarettes daily for the last 40 years and drinks two to three beers on the weekend. Current medications include metformin, atorvastatin, topical timolol, and a multivitamin. Vital signs are within normal limits. The lesion is partly elevated on palpation and does not change its form on pinching. A photograph of the lesion is shown. Which of the following is the most likely diagnosis?
Options: A: Malignant melanoma, B: Keratoacanthoma, C: Lentigo maligna, D: Seborrheic keratosis, E: Basal cell carcinoma.
Answer:
|
MedQA_New2723 | [
{
"role": "user",
"content": "You are a medical doctor taking the US Medical Licensing Examination. You need to demonstrate your understanding of basic and clinical science, medical knowledge, and mechanisms underlying health, disease, patient care, and modes of therapy. Show your ability to apply the knowledge essential for medical practice. For the following multiple-choice question, select one correct answer from A to E. Base your answer on the current and standard practices referenced in medical guidelines.\nQuestion: An investigator is attempting to assess the glomerular filtration rate (GFR) of a healthy adult volunteer. The volunteer's inulin clearance is evaluated under continuous inulin infusion and urine collection and compared to the creatinine clearance. It is found that the estimated GFR based on the volunteer's creatinine clearance is 129 mL/min and the estimated GFR calculated using the inulin clearance is 122 mL/min. Which of the following is the best explanation for the difference in these measurements?\nOptions: A: Creatinine is not freely filtered, B: Inulin is actively secreted, C: Inulin is not freely filtered, D: Creatinine is passively reabsorbed, E: Creatinine is actively secreted.\nAnswer:\n"
},
{
"role": "assistant",
"content": "E"
}
] | You are a medical doctor taking the US Medical Licensing Examination. You need to demonstrate your understanding of basic and clinical science, medical knowledge, and mechanisms underlying health, disease, patient care, and modes of therapy. Show your ability to apply the knowledge essential for medical practice. For the following multiple-choice question, select one correct answer from A to E. Base your answer on the current and standard practices referenced in medical guidelines.
Question: An investigator is attempting to assess the glomerular filtration rate (GFR) of a healthy adult volunteer. The volunteer's inulin clearance is evaluated under continuous inulin infusion and urine collection and compared to the creatinine clearance. It is found that the estimated GFR based on the volunteer's creatinine clearance is 129 mL/min and the estimated GFR calculated using the inulin clearance is 122 mL/min. Which of the following is the best explanation for the difference in these measurements?
Options: A: Creatinine is not freely filtered, B: Inulin is actively secreted, C: Inulin is not freely filtered, D: Creatinine is passively reabsorbed, E: Creatinine is actively secreted.
Answer:
|
MedQA_New3121 | [
{
"role": "user",
"content": "You are a medical doctor taking the US Medical Licensing Examination. You need to demonstrate your understanding of basic and clinical science, medical knowledge, and mechanisms underlying health, disease, patient care, and modes of therapy. Show your ability to apply the knowledge essential for medical practice. For the following multiple-choice question, select one correct answer from A to E. Base your answer on the current and standard practices referenced in medical guidelines.\nQuestion: A 74-year-old man presents to the emergency department with sudden-onset abdominal pain that is most painful around the umbilicus. The pain began 16 hours ago and has no association with meals. He has not been vomiting, but he has had several episodes of bloody loose bowel movements. He was hospitalized 1 week ago for an acute myocardial infarction. He has had diabetes mellitus for 35 years and hypertension for 20 years. He has smoked 15–20 cigarettes per day for the past 40 years. His temperature is 36.9°C (98.42°F), blood pressure is 95/65 mm Hg, and pulse is 95/min. On physical examination, the patient is in severe pain, there is mild periumbilical tenderness, and a bruit is heard over the epigastric area. Which of the following is the definitive test to assess the patient condition?\nOptions: A: Mesenteric angiography, B: CT scanning, C: Plain abdominal X-rays, D: Colonoscopy, E: Complete blood count.\nAnswer:\n"
},
{
"role": "assistant",
"content": "A"
}
] | You are a medical doctor taking the US Medical Licensing Examination. You need to demonstrate your understanding of basic and clinical science, medical knowledge, and mechanisms underlying health, disease, patient care, and modes of therapy. Show your ability to apply the knowledge essential for medical practice. For the following multiple-choice question, select one correct answer from A to E. Base your answer on the current and standard practices referenced in medical guidelines.
Question: A 74-year-old man presents to the emergency department with sudden-onset abdominal pain that is most painful around the umbilicus. The pain began 16 hours ago and has no association with meals. He has not been vomiting, but he has had several episodes of bloody loose bowel movements. He was hospitalized 1 week ago for an acute myocardial infarction. He has had diabetes mellitus for 35 years and hypertension for 20 years. He has smoked 15–20 cigarettes per day for the past 40 years. His temperature is 36.9°C (98.42°F), blood pressure is 95/65 mm Hg, and pulse is 95/min. On physical examination, the patient is in severe pain, there is mild periumbilical tenderness, and a bruit is heard over the epigastric area. Which of the following is the definitive test to assess the patient condition?
Options: A: Mesenteric angiography, B: CT scanning, C: Plain abdominal X-rays, D: Colonoscopy, E: Complete blood count.
Answer:
|
MedQA_New2145 | [
{
"role": "user",
"content": "You are a medical doctor taking the US Medical Licensing Examination. You need to demonstrate your understanding of basic and clinical science, medical knowledge, and mechanisms underlying health, disease, patient care, and modes of therapy. Show your ability to apply the knowledge essential for medical practice. For the following multiple-choice question, select one correct answer from A to E. Base your answer on the current and standard practices referenced in medical guidelines.\nQuestion: A 7-year-old boy is brought to the physician because his parents are concerned about his early sexual development. He has no history of serious illness and takes no medications. His brother was diagnosed with testicular cancer 5 years ago and underwent a radical orchiectomy. The patient is at the 85th percentile for height and 70th percentile for weight. Examination shows greasy facial skin. There is coarse axillary hair. Pubic hair development is at Tanner stage 3 and testicular development is at Tanner stage 2. The remainder of the examination shows no abnormalities. An x-ray of the wrist shows a bone age of 10 years. Basal serum luteinizing hormone and follicle-stimulating hormone are elevated. An MRI of the brain shows no abnormalities. Which of the following is the most appropriate next step in management?\nOptions: A: Radiation therapy, B: Cortisol supplementation, C: Leuprolide therapy, D: Testicular ultrasound, E: Observation.\nAnswer:\n"
},
{
"role": "assistant",
"content": "C"
}
] | You are a medical doctor taking the US Medical Licensing Examination. You need to demonstrate your understanding of basic and clinical science, medical knowledge, and mechanisms underlying health, disease, patient care, and modes of therapy. Show your ability to apply the knowledge essential for medical practice. For the following multiple-choice question, select one correct answer from A to E. Base your answer on the current and standard practices referenced in medical guidelines.
Question: A 7-year-old boy is brought to the physician because his parents are concerned about his early sexual development. He has no history of serious illness and takes no medications. His brother was diagnosed with testicular cancer 5 years ago and underwent a radical orchiectomy. The patient is at the 85th percentile for height and 70th percentile for weight. Examination shows greasy facial skin. There is coarse axillary hair. Pubic hair development is at Tanner stage 3 and testicular development is at Tanner stage 2. The remainder of the examination shows no abnormalities. An x-ray of the wrist shows a bone age of 10 years. Basal serum luteinizing hormone and follicle-stimulating hormone are elevated. An MRI of the brain shows no abnormalities. Which of the following is the most appropriate next step in management?
Options: A: Radiation therapy, B: Cortisol supplementation, C: Leuprolide therapy, D: Testicular ultrasound, E: Observation.
Answer:
|
MedQA_New6360 | [
{
"role": "user",
"content": "You are a medical doctor taking the US Medical Licensing Examination. You need to demonstrate your understanding of basic and clinical science, medical knowledge, and mechanisms underlying health, disease, patient care, and modes of therapy. Show your ability to apply the knowledge essential for medical practice. For the following multiple-choice question, select one correct answer from A to E. Base your answer on the current and standard practices referenced in medical guidelines.\nQuestion: A 16-year-old Mexican female presents with symptoms of the common cold after the patient's respiratory epithelial cells were infected with Rhinovirus. Due to the presence of the virus, her respiratory epithelial cells begin producing interferon. Which is of the following is LEAST likely to be an outcome of the activation of the interferon response?\nOptions: A: Decreased viral replication within the cell, B: A rhinovirus-specific, cell-mediated immune response, C: Upregulation of NK cell ligands on the infected cell, D: Activation of NK cells, E: Interferon binding to nearby uninfected epithelial cells.\nAnswer:\n"
},
{
"role": "assistant",
"content": "B"
}
] | You are a medical doctor taking the US Medical Licensing Examination. You need to demonstrate your understanding of basic and clinical science, medical knowledge, and mechanisms underlying health, disease, patient care, and modes of therapy. Show your ability to apply the knowledge essential for medical practice. For the following multiple-choice question, select one correct answer from A to E. Base your answer on the current and standard practices referenced in medical guidelines.
Question: A 16-year-old Mexican female presents with symptoms of the common cold after the patient's respiratory epithelial cells were infected with Rhinovirus. Due to the presence of the virus, her respiratory epithelial cells begin producing interferon. Which is of the following is LEAST likely to be an outcome of the activation of the interferon response?
Options: A: Decreased viral replication within the cell, B: A rhinovirus-specific, cell-mediated immune response, C: Upregulation of NK cell ligands on the infected cell, D: Activation of NK cells, E: Interferon binding to nearby uninfected epithelial cells.
Answer:
|
MedQA_New5951 | [
{
"role": "user",
"content": "You are a medical doctor taking the US Medical Licensing Examination. You need to demonstrate your understanding of basic and clinical science, medical knowledge, and mechanisms underlying health, disease, patient care, and modes of therapy. Show your ability to apply the knowledge essential for medical practice. For the following multiple-choice question, select one correct answer from A to E. Base your answer on the current and standard practices referenced in medical guidelines.\nQuestion: A 57-year-old man is brought to the emergency department for crushing substernal chest pain at rest for the past 2 hours. The pain began gradually while he was having an argument with his wife and is now severe. He does not take any medications. He has smoked 1 pack of cigarettes daily for 35 years. He is diaphoretic. His temperature is 37.1°C (98.8°F), pulse is 110/min, respirations are 21/min, and blood pressure is 115/65 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 97%. Cardiac examination shows an S4 gallop. The lungs are clear to auscultation. An ECG is shown. Which of the following is the most likely underlying cause of this patient's condition?\nOptions: A: Occlusion of the left anterior descending artery, B: Thromboembolism to the right interlobar pulmonary artery, C: Diffuse coronary vasospasm, D: Occlusion of the left circumflex artery, E: Tear in the intimal lining of the aorta.\nAnswer:\n"
},
{
"role": "assistant",
"content": "A"
}
] | You are a medical doctor taking the US Medical Licensing Examination. You need to demonstrate your understanding of basic and clinical science, medical knowledge, and mechanisms underlying health, disease, patient care, and modes of therapy. Show your ability to apply the knowledge essential for medical practice. For the following multiple-choice question, select one correct answer from A to E. Base your answer on the current and standard practices referenced in medical guidelines.
Question: A 57-year-old man is brought to the emergency department for crushing substernal chest pain at rest for the past 2 hours. The pain began gradually while he was having an argument with his wife and is now severe. He does not take any medications. He has smoked 1 pack of cigarettes daily for 35 years. He is diaphoretic. His temperature is 37.1°C (98.8°F), pulse is 110/min, respirations are 21/min, and blood pressure is 115/65 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 97%. Cardiac examination shows an S4 gallop. The lungs are clear to auscultation. An ECG is shown. Which of the following is the most likely underlying cause of this patient's condition?
Options: A: Occlusion of the left anterior descending artery, B: Thromboembolism to the right interlobar pulmonary artery, C: Diffuse coronary vasospasm, D: Occlusion of the left circumflex artery, E: Tear in the intimal lining of the aorta.
Answer:
|
MedQA_New7019 | [
{
"role": "user",
"content": "You are a medical doctor taking the US Medical Licensing Examination. You need to demonstrate your understanding of basic and clinical science, medical knowledge, and mechanisms underlying health, disease, patient care, and modes of therapy. Show your ability to apply the knowledge essential for medical practice. For the following multiple-choice question, select one correct answer from A to E. Base your answer on the current and standard practices referenced in medical guidelines.\nQuestion: A 28-year-old woman presents with weight gain and a milky-white discharge from her breasts. Patient says she noticed herself gaining weight and a milky white discharge from her breasts. Past medical history is significant for schizophrenia, recently diagnosed and treated with risperidone. No history of headache, nausea, and vomiting. No other current medications. Her last menstrual period was 2 months ago. Review of systems is significant for decreased libido. Patient is afebrile and vital signs are within normal limits. On physical examination, patient had a weight gain of 3 kg (6.6 lb) over the past month. There is bilateral breast tenderness present. A urine pregnancy test is negative. Which of the following is the most likely etiology of this patient’s symptoms?\nOptions: A: Decrease in dopamine activity in mesolimbic pathway, B: Increase in dopamine activity in mesolimbic pathway, C: Decrease in dopamine activity in tuberoinfundibular pathway, D: Increase in dopamine activity in tuberoinfundibular pathway, E: Decrease in dopamine activity in nigrostriatal pathway.\nAnswer:\n"
},
{
"role": "assistant",
"content": "C"
}
] | You are a medical doctor taking the US Medical Licensing Examination. You need to demonstrate your understanding of basic and clinical science, medical knowledge, and mechanisms underlying health, disease, patient care, and modes of therapy. Show your ability to apply the knowledge essential for medical practice. For the following multiple-choice question, select one correct answer from A to E. Base your answer on the current and standard practices referenced in medical guidelines.
Question: A 28-year-old woman presents with weight gain and a milky-white discharge from her breasts. Patient says she noticed herself gaining weight and a milky white discharge from her breasts. Past medical history is significant for schizophrenia, recently diagnosed and treated with risperidone. No history of headache, nausea, and vomiting. No other current medications. Her last menstrual period was 2 months ago. Review of systems is significant for decreased libido. Patient is afebrile and vital signs are within normal limits. On physical examination, patient had a weight gain of 3 kg (6.6 lb) over the past month. There is bilateral breast tenderness present. A urine pregnancy test is negative. Which of the following is the most likely etiology of this patient’s symptoms?
Options: A: Decrease in dopamine activity in mesolimbic pathway, B: Increase in dopamine activity in mesolimbic pathway, C: Decrease in dopamine activity in tuberoinfundibular pathway, D: Increase in dopamine activity in tuberoinfundibular pathway, E: Decrease in dopamine activity in nigrostriatal pathway.
Answer:
|
MedQA_New9027 | [
{
"role": "user",
"content": "You are a medical doctor taking the US Medical Licensing Examination. You need to demonstrate your understanding of basic and clinical science, medical knowledge, and mechanisms underlying health, disease, patient care, and modes of therapy. Show your ability to apply the knowledge essential for medical practice. For the following multiple-choice question, select one correct answer from A to E. Base your answer on the current and standard practices referenced in medical guidelines.\nQuestion: A randomized controlled trial was initiated to evaluate a novel DPP-4 inhibitor for blood glucose management in diabetic patients. The study used a commonly prescribed sulfonylurea as the standard of care treatment. 2,000 patients were enrolled in the study with 1,000 patients in each arm. One of the primary outcomes was the development of diabetic nephropathy during treatment. This outcome occurred in 68 patients on the DPP-4 inhibitor and 134 patients on the sulfonylurea. What is the relative risk reduction (RRR) for patients using the DPP-4 inhibitor compared with the sulfonylurea?\nOptions: A: 23%, B: 33%, C: 43%, D: 49%, E: 59%.\nAnswer:\n"
},
{
"role": "assistant",
"content": "D"
}
] | You are a medical doctor taking the US Medical Licensing Examination. You need to demonstrate your understanding of basic and clinical science, medical knowledge, and mechanisms underlying health, disease, patient care, and modes of therapy. Show your ability to apply the knowledge essential for medical practice. For the following multiple-choice question, select one correct answer from A to E. Base your answer on the current and standard practices referenced in medical guidelines.
Question: A randomized controlled trial was initiated to evaluate a novel DPP-4 inhibitor for blood glucose management in diabetic patients. The study used a commonly prescribed sulfonylurea as the standard of care treatment. 2,000 patients were enrolled in the study with 1,000 patients in each arm. One of the primary outcomes was the development of diabetic nephropathy during treatment. This outcome occurred in 68 patients on the DPP-4 inhibitor and 134 patients on the sulfonylurea. What is the relative risk reduction (RRR) for patients using the DPP-4 inhibitor compared with the sulfonylurea?
Options: A: 23%, B: 33%, C: 43%, D: 49%, E: 59%.
Answer:
|
MedQA_New1828 | [
{
"role": "user",
"content": "You are a medical doctor taking the US Medical Licensing Examination. You need to demonstrate your understanding of basic and clinical science, medical knowledge, and mechanisms underlying health, disease, patient care, and modes of therapy. Show your ability to apply the knowledge essential for medical practice. For the following multiple-choice question, select one correct answer from A to E. Base your answer on the current and standard practices referenced in medical guidelines.\nQuestion: Please refer to the summary above to answer this question\nIn the study, all participants who were enrolled and randomly assigned to treatment with pulmharkimab were analyzed in the pulmharkimab group regardless of medication nonadherence or refusal of allocated treatment. A medical student reading the abstract is confused about why some participants assigned to pulmharkimab who did not adhere to the regimen were still analyzed as part of the pulmharkimab group. Which of the following best reflects the purpose of such an analysis strategy?\"\n\"Impact of pulmharkimab on asthma control and cardiovascular disease progression in patients with coronary artery disease and comorbid asthma\nIntroduction:\nActive asthma has been found to be associated with a more than two-fold increase in the risk of myocardial infarction, even after adjusting for cardiovascular risk factors. It has been suggested that the inflammatory mediators and accelerated atherosclerosis characterizing systemic inflammation may increase the risk of both asthma and cardiovascular disease. This study evaluated the efficacy of the novel IL-1 inhibitor pulmharkimab in improving asthma and cardiovascular disease progression.\nMethods:\nIn this double-blind, randomized controlled trial, patients (N=1200) with a history of coronary artery disease, myocardial infarction in the past 2 years, and a diagnosis of comorbid adult-onset asthma were recruited from cardiology clinics at a large academic medical center in Philadelphia, PA. Patients who were immunocompromised or had a history of recurrent infections were excluded.\nPatients were subsequently randomly assigned a 12-month course of pulmharkimab 75 mg/day, pulmharkimab 150 mg/day, or a placebo, with each group containing 400 participants. All participants were included in analysis and analyzed in the groups to which they were randomized regardless of medication adherence. Variables measured included plaque volume, serum LDL-C levels, FEV1/FVC ratio, and Asthma Control Questionnaire (ACQ) scores, which quantified the severity of asthma symptoms. Plaque volume was determined by ultrasound.\nAnalyses were performed from baseline to month 12.\nResults:\nAt baseline, participants in the two groups did not differ by age, gender, race, plaque volume, serum LDL-C levels, FEV1/FVC ratio, and ACQ scores (p > 0.05 for all). A total of 215 participants (18%) were lost to follow-up. At 12-month follow-up, the groups contained the following numbers of participants:\nPulmharkimab 75 mg/d: 388 participants\nPulmharkimab 150 mg/d: 202 participants\nPlacebo: 395 participants\nTable 1: Association between pulmharkimab and both pulmonary and cardiovascular outcomes. Models were adjusted for sociodemographic variables and medical comorbidities. All outcome variables were approximately normally distributed.\nPulmharkimab 75 mg/d, (Mean +/- 2 SE) Pulmharkimab 150 mg/d, (Mean +/- 2 SE) Placebo, (Mean +/- 2 SE) P-value\nPlaque volume (mm3), change from baseline 6.6 ± 2.8 1.2 ± 4.7 15.8 ± 2.9 < 0.01\nLDL-C levels, change from baseline -9.4 ± 3.6 -11.2 ± 14.3 -8.4 ± 3.9 0.28\nFEV1/FVC ratio, change from baseline 0.29 ± 2.21 0.34 ± 5.54 -0.22 ± 3.21 0.27\nACQ scores, change from baseline 0.31 ± 1.22 0.46 ± 3.25 0.12 ± 1.33 0.43\nConclusion:\nPulmharkimab may be effective in reducing plaque volume but does not lead to improved asthma control in patients with a history of myocardial infarction and comorbid asthma.\nSource of funding: Southeast Institute for Advanced Lung and Cardiovascular Studies, American Center for Advancement of Cardiovascular Health\"\nOptions: A: To increase internal validity of study, B: To increase sample size, C: To assess treatment efficacy more accurately, D: To reduce selection bias, E: To minimize type 2 errors.\nAnswer:\n"
},
{
"role": "assistant",
"content": "D"
}
] | You are a medical doctor taking the US Medical Licensing Examination. You need to demonstrate your understanding of basic and clinical science, medical knowledge, and mechanisms underlying health, disease, patient care, and modes of therapy. Show your ability to apply the knowledge essential for medical practice. For the following multiple-choice question, select one correct answer from A to E. Base your answer on the current and standard practices referenced in medical guidelines.
Question: Please refer to the summary above to answer this question
In the study, all participants who were enrolled and randomly assigned to treatment with pulmharkimab were analyzed in the pulmharkimab group regardless of medication nonadherence or refusal of allocated treatment. A medical student reading the abstract is confused about why some participants assigned to pulmharkimab who did not adhere to the regimen were still analyzed as part of the pulmharkimab group. Which of the following best reflects the purpose of such an analysis strategy?"
"Impact of pulmharkimab on asthma control and cardiovascular disease progression in patients with coronary artery disease and comorbid asthma
Introduction:
Active asthma has been found to be associated with a more than two-fold increase in the risk of myocardial infarction, even after adjusting for cardiovascular risk factors. It has been suggested that the inflammatory mediators and accelerated atherosclerosis characterizing systemic inflammation may increase the risk of both asthma and cardiovascular disease. This study evaluated the efficacy of the novel IL-1 inhibitor pulmharkimab in improving asthma and cardiovascular disease progression.
Methods:
In this double-blind, randomized controlled trial, patients (N=1200) with a history of coronary artery disease, myocardial infarction in the past 2 years, and a diagnosis of comorbid adult-onset asthma were recruited from cardiology clinics at a large academic medical center in Philadelphia, PA. Patients who were immunocompromised or had a history of recurrent infections were excluded.
Patients were subsequently randomly assigned a 12-month course of pulmharkimab 75 mg/day, pulmharkimab 150 mg/day, or a placebo, with each group containing 400 participants. All participants were included in analysis and analyzed in the groups to which they were randomized regardless of medication adherence. Variables measured included plaque volume, serum LDL-C levels, FEV1/FVC ratio, and Asthma Control Questionnaire (ACQ) scores, which quantified the severity of asthma symptoms. Plaque volume was determined by ultrasound.
Analyses were performed from baseline to month 12.
Results:
At baseline, participants in the two groups did not differ by age, gender, race, plaque volume, serum LDL-C levels, FEV1/FVC ratio, and ACQ scores (p > 0.05 for all). A total of 215 participants (18%) were lost to follow-up. At 12-month follow-up, the groups contained the following numbers of participants:
Pulmharkimab 75 mg/d: 388 participants
Pulmharkimab 150 mg/d: 202 participants
Placebo: 395 participants
Table 1: Association between pulmharkimab and both pulmonary and cardiovascular outcomes. Models were adjusted for sociodemographic variables and medical comorbidities. All outcome variables were approximately normally distributed.
Pulmharkimab 75 mg/d, (Mean +/- 2 SE) Pulmharkimab 150 mg/d, (Mean +/- 2 SE) Placebo, (Mean +/- 2 SE) P-value
Plaque volume (mm3), change from baseline 6.6 ± 2.8 1.2 ± 4.7 15.8 ± 2.9 < 0.01
LDL-C levels, change from baseline -9.4 ± 3.6 -11.2 ± 14.3 -8.4 ± 3.9 0.28
FEV1/FVC ratio, change from baseline 0.29 ± 2.21 0.34 ± 5.54 -0.22 ± 3.21 0.27
ACQ scores, change from baseline 0.31 ± 1.22 0.46 ± 3.25 0.12 ± 1.33 0.43
Conclusion:
Pulmharkimab may be effective in reducing plaque volume but does not lead to improved asthma control in patients with a history of myocardial infarction and comorbid asthma.
Source of funding: Southeast Institute for Advanced Lung and Cardiovascular Studies, American Center for Advancement of Cardiovascular Health"
Options: A: To increase internal validity of study, B: To increase sample size, C: To assess treatment efficacy more accurately, D: To reduce selection bias, E: To minimize type 2 errors.
Answer:
|
MedQA_New5994 | [
{
"role": "user",
"content": "You are a medical doctor taking the US Medical Licensing Examination. You need to demonstrate your understanding of basic and clinical science, medical knowledge, and mechanisms underlying health, disease, patient care, and modes of therapy. Show your ability to apply the knowledge essential for medical practice. For the following multiple-choice question, select one correct answer from A to E. Base your answer on the current and standard practices referenced in medical guidelines.\nQuestion: Six days after falling in the shower, a 75-year-old man with COPD is brought to the emergency department because of progressively worsening left-sided chest pain and shortness of breath. He has smoked one pack of cigarettes daily for 50 years. His temperature is 36.5°C (97.7°F), pulse is 110/min, respirations are 30/min, and blood pressure is 115/58 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 88%. Examination shows dullness to percussion and decreased fremitus over the left lung base. There are faint expiratory wheezes throughout the lungs. An x-ray of the chest is shown. Which of the following is the most likely cause of this patient’s current condition?\nOptions: A: Air between the pleura and chest wall, B: Bacteria in the pulmonary parenchyma, C: Fluid in alveoli, D: Neoplastic cells in the bronchi, E: Blood in the pleural space.\nAnswer:\n"
},
{
"role": "assistant",
"content": "E"
}
] | You are a medical doctor taking the US Medical Licensing Examination. You need to demonstrate your understanding of basic and clinical science, medical knowledge, and mechanisms underlying health, disease, patient care, and modes of therapy. Show your ability to apply the knowledge essential for medical practice. For the following multiple-choice question, select one correct answer from A to E. Base your answer on the current and standard practices referenced in medical guidelines.
Question: Six days after falling in the shower, a 75-year-old man with COPD is brought to the emergency department because of progressively worsening left-sided chest pain and shortness of breath. He has smoked one pack of cigarettes daily for 50 years. His temperature is 36.5°C (97.7°F), pulse is 110/min, respirations are 30/min, and blood pressure is 115/58 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 88%. Examination shows dullness to percussion and decreased fremitus over the left lung base. There are faint expiratory wheezes throughout the lungs. An x-ray of the chest is shown. Which of the following is the most likely cause of this patient’s current condition?
Options: A: Air between the pleura and chest wall, B: Bacteria in the pulmonary parenchyma, C: Fluid in alveoli, D: Neoplastic cells in the bronchi, E: Blood in the pleural space.
Answer:
|
MedQA_New5939 | [
{
"role": "user",
"content": "You are a medical doctor taking the US Medical Licensing Examination. You need to demonstrate your understanding of basic and clinical science, medical knowledge, and mechanisms underlying health, disease, patient care, and modes of therapy. Show your ability to apply the knowledge essential for medical practice. For the following multiple-choice question, select one correct answer from A to E. Base your answer on the current and standard practices referenced in medical guidelines.\nQuestion: A 27-year-old woman G2P1 at 34 weeks estimated gestational age presents with bouts of sweating, weakness, and dizziness lasting a few minutes after lying down on the bed. She says symptoms resolve if she rolls on her side. She reports that these episodes have occurred several times over the last 3 weeks. On lying down, her blood pressure is 90/50 mm Hg and her pulse is 50/min. When she rolls on her side, her blood pressure slowly increases to 120/65 mm Hg, and her pulse increases to 72/min. Which of the following best describes the mechanism which underlies this patient’s most likely condition?\nOptions: A: Aortocaval compression, B: Progesterone surge, C: Increase in plasma volume, D: Peripheral vasodilation, E: Renin-angiotensin system activation.\nAnswer:\n"
},
{
"role": "assistant",
"content": "A"
}
] | You are a medical doctor taking the US Medical Licensing Examination. You need to demonstrate your understanding of basic and clinical science, medical knowledge, and mechanisms underlying health, disease, patient care, and modes of therapy. Show your ability to apply the knowledge essential for medical practice. For the following multiple-choice question, select one correct answer from A to E. Base your answer on the current and standard practices referenced in medical guidelines.
Question: A 27-year-old woman G2P1 at 34 weeks estimated gestational age presents with bouts of sweating, weakness, and dizziness lasting a few minutes after lying down on the bed. She says symptoms resolve if she rolls on her side. She reports that these episodes have occurred several times over the last 3 weeks. On lying down, her blood pressure is 90/50 mm Hg and her pulse is 50/min. When she rolls on her side, her blood pressure slowly increases to 120/65 mm Hg, and her pulse increases to 72/min. Which of the following best describes the mechanism which underlies this patient’s most likely condition?
Options: A: Aortocaval compression, B: Progesterone surge, C: Increase in plasma volume, D: Peripheral vasodilation, E: Renin-angiotensin system activation.
Answer:
|
MedQA_New3811 | [
{
"role": "user",
"content": "You are a medical doctor taking the US Medical Licensing Examination. You need to demonstrate your understanding of basic and clinical science, medical knowledge, and mechanisms underlying health, disease, patient care, and modes of therapy. Show your ability to apply the knowledge essential for medical practice. For the following multiple-choice question, select one correct answer from A to E. Base your answer on the current and standard practices referenced in medical guidelines.\nQuestion: An 18-month-old girl is brought to the emergency department because of the stiffening of her body and unresponsiveness that occurred 1 hour ago. Her symptoms lasted < 10 minutes. She has had coryza for 24 hours without any fever. She had an episode of a febrile generalized tonic-clonic seizure 6 months ago. Her past medical history has otherwise been unremarkable. Her vaccination history is up to date. Her uncle has epilepsy. Her temperature is 38.9°C (102.0°F). Other than nasal congestion, physical examination shows no abnormal findings. Which of the following factors most strongly indicates the occurrence of subsequent epilepsy?\nOptions: A: Family history of epilepsy, B: Focal seizure, C: History of prior febrile seizure, D: Recurrence of seizure within 24 hours, E: Seizure within 1 hour of fever onset.\nAnswer:\n"
},
{
"role": "assistant",
"content": "B"
}
] | You are a medical doctor taking the US Medical Licensing Examination. You need to demonstrate your understanding of basic and clinical science, medical knowledge, and mechanisms underlying health, disease, patient care, and modes of therapy. Show your ability to apply the knowledge essential for medical practice. For the following multiple-choice question, select one correct answer from A to E. Base your answer on the current and standard practices referenced in medical guidelines.
Question: An 18-month-old girl is brought to the emergency department because of the stiffening of her body and unresponsiveness that occurred 1 hour ago. Her symptoms lasted < 10 minutes. She has had coryza for 24 hours without any fever. She had an episode of a febrile generalized tonic-clonic seizure 6 months ago. Her past medical history has otherwise been unremarkable. Her vaccination history is up to date. Her uncle has epilepsy. Her temperature is 38.9°C (102.0°F). Other than nasal congestion, physical examination shows no abnormal findings. Which of the following factors most strongly indicates the occurrence of subsequent epilepsy?
Options: A: Family history of epilepsy, B: Focal seizure, C: History of prior febrile seizure, D: Recurrence of seizure within 24 hours, E: Seizure within 1 hour of fever onset.
Answer:
|
MedQA_New9314 | [
{
"role": "user",
"content": "You are a medical doctor taking the US Medical Licensing Examination. You need to demonstrate your understanding of basic and clinical science, medical knowledge, and mechanisms underlying health, disease, patient care, and modes of therapy. Show your ability to apply the knowledge essential for medical practice. For the following multiple-choice question, select one correct answer from A to E. Base your answer on the current and standard practices referenced in medical guidelines.\nQuestion: A 57-year-old woman presents to her primary care physician with complaints of nausea, vomiting, abdominal pain, and bloating that have increased in severity over the past several months. She reports that she occasionally vomits after eating. She states that the emesis contains undigested food particles. Additionally, the patient states that she often is satiated after only a few bites of food at meals. Her medical history is significant for hypertension and type II diabetes mellitus. Initial laboratory values are notable only for a hemoglobin A1c of 14%. Which of the following is the best initial treatment for this patient?\nOptions: A: Dietary modification, B: Erythromycin, C: Metoclopramide, D: Myotomy, E: Surgical resection.\nAnswer:\n"
},
{
"role": "assistant",
"content": "A"
}
] | You are a medical doctor taking the US Medical Licensing Examination. You need to demonstrate your understanding of basic and clinical science, medical knowledge, and mechanisms underlying health, disease, patient care, and modes of therapy. Show your ability to apply the knowledge essential for medical practice. For the following multiple-choice question, select one correct answer from A to E. Base your answer on the current and standard practices referenced in medical guidelines.
Question: A 57-year-old woman presents to her primary care physician with complaints of nausea, vomiting, abdominal pain, and bloating that have increased in severity over the past several months. She reports that she occasionally vomits after eating. She states that the emesis contains undigested food particles. Additionally, the patient states that she often is satiated after only a few bites of food at meals. Her medical history is significant for hypertension and type II diabetes mellitus. Initial laboratory values are notable only for a hemoglobin A1c of 14%. Which of the following is the best initial treatment for this patient?
Options: A: Dietary modification, B: Erythromycin, C: Metoclopramide, D: Myotomy, E: Surgical resection.
Answer:
|
MedQA_New8739 | [
{
"role": "user",
"content": "You are a medical doctor taking the US Medical Licensing Examination. You need to demonstrate your understanding of basic and clinical science, medical knowledge, and mechanisms underlying health, disease, patient care, and modes of therapy. Show your ability to apply the knowledge essential for medical practice. For the following multiple-choice question, select one correct answer from A to E. Base your answer on the current and standard practices referenced in medical guidelines.\nQuestion: A 55-year-old man comes to the physician because of increasing shortness of breath for 1 month. Initially, he was able to climb the 3 flights of stairs to his apartment, but he now needs several breaks to catch his breath. He has no chest pain. He has rheumatic heart disease and type 2 diabetes mellitus. He emigrated from India about 25 years ago. The patient's current medications include carvedilol, torsemide, and insulin. He appears uncomfortable. His temperature is 37.3°C (99.1°F), pulse is 72/min and regular, respirations are 18/min, and blood pressure is 130/80 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 96%. Examination shows bilateral crackles at the lung bases. There is an opening snap followed by a low-pitched diastolic murmur at the fifth left intercostal space at the mid-clavicular line. An x-ray of the chest shows left atrial enlargement, straightening of the left cardiac border and increased vascular markings. Which of the following is the preferred intervention to improve this patient's symptoms?\nOptions: A: Tricuspid valve repair, B: Mitral valve replacement, C: Percutaneous mitral balloon commissurotomy, D: Transcatheter aortic valve replacement, E: Enalapril therapy\n\".\nAnswer:\n"
},
{
"role": "assistant",
"content": "C"
}
] | You are a medical doctor taking the US Medical Licensing Examination. You need to demonstrate your understanding of basic and clinical science, medical knowledge, and mechanisms underlying health, disease, patient care, and modes of therapy. Show your ability to apply the knowledge essential for medical practice. For the following multiple-choice question, select one correct answer from A to E. Base your answer on the current and standard practices referenced in medical guidelines.
Question: A 55-year-old man comes to the physician because of increasing shortness of breath for 1 month. Initially, he was able to climb the 3 flights of stairs to his apartment, but he now needs several breaks to catch his breath. He has no chest pain. He has rheumatic heart disease and type 2 diabetes mellitus. He emigrated from India about 25 years ago. The patient's current medications include carvedilol, torsemide, and insulin. He appears uncomfortable. His temperature is 37.3°C (99.1°F), pulse is 72/min and regular, respirations are 18/min, and blood pressure is 130/80 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 96%. Examination shows bilateral crackles at the lung bases. There is an opening snap followed by a low-pitched diastolic murmur at the fifth left intercostal space at the mid-clavicular line. An x-ray of the chest shows left atrial enlargement, straightening of the left cardiac border and increased vascular markings. Which of the following is the preferred intervention to improve this patient's symptoms?
Options: A: Tricuspid valve repair, B: Mitral valve replacement, C: Percutaneous mitral balloon commissurotomy, D: Transcatheter aortic valve replacement, E: Enalapril therapy
".
Answer:
|
MedQA_New5305 | [
{
"role": "user",
"content": "You are a medical doctor taking the US Medical Licensing Examination. You need to demonstrate your understanding of basic and clinical science, medical knowledge, and mechanisms underlying health, disease, patient care, and modes of therapy. Show your ability to apply the knowledge essential for medical practice. For the following multiple-choice question, select one correct answer from A to E. Base your answer on the current and standard practices referenced in medical guidelines.\nQuestion: An overweight 57-year-old woman comes to her primary care physician for a routine checkup. She has no current complaints and takes no medications. Her mother and brother have type 2 diabetes mellitus and hypertension. Vital signs show a blood pressure of 145/95 mmHg, temperature of 37°C (98.6°F), and a pulse of 85/minute. Her lab results are shown:\nFasting blood glucose 158 mg/dL\n HbA1c 8.6%\n Low-density lipoprotein 210 mg/dL\n High-density lipoprotein 27 mg/dL\n Triglycerides 300 mg/dL\nWhich of the following tests is recommended for this patient?\nOptions: A: Albumin-to-creatinine ratio after 5 years, then yearly follow-up, B: Monofilament test after 5 years, then yearly follow-up, C: Fasting lipid profile every 5 years, D: Digital fundus photography after 5 years, then yearly follow-up, E: Digital fundus photography now, then yearly follow-up.\nAnswer:\n"
},
{
"role": "assistant",
"content": "E"
}
] | You are a medical doctor taking the US Medical Licensing Examination. You need to demonstrate your understanding of basic and clinical science, medical knowledge, and mechanisms underlying health, disease, patient care, and modes of therapy. Show your ability to apply the knowledge essential for medical practice. For the following multiple-choice question, select one correct answer from A to E. Base your answer on the current and standard practices referenced in medical guidelines.
Question: An overweight 57-year-old woman comes to her primary care physician for a routine checkup. She has no current complaints and takes no medications. Her mother and brother have type 2 diabetes mellitus and hypertension. Vital signs show a blood pressure of 145/95 mmHg, temperature of 37°C (98.6°F), and a pulse of 85/minute. Her lab results are shown:
Fasting blood glucose 158 mg/dL
HbA1c 8.6%
Low-density lipoprotein 210 mg/dL
High-density lipoprotein 27 mg/dL
Triglycerides 300 mg/dL
Which of the following tests is recommended for this patient?
Options: A: Albumin-to-creatinine ratio after 5 years, then yearly follow-up, B: Monofilament test after 5 years, then yearly follow-up, C: Fasting lipid profile every 5 years, D: Digital fundus photography after 5 years, then yearly follow-up, E: Digital fundus photography now, then yearly follow-up.
Answer:
|
MedQA_New3016 | [
{
"role": "user",
"content": "You are a medical doctor taking the US Medical Licensing Examination. You need to demonstrate your understanding of basic and clinical science, medical knowledge, and mechanisms underlying health, disease, patient care, and modes of therapy. Show your ability to apply the knowledge essential for medical practice. For the following multiple-choice question, select one correct answer from A to E. Base your answer on the current and standard practices referenced in medical guidelines.\nQuestion: A 53-year-old woman presents to her primary care physician in order to discuss the results of a biopsy. Two weeks ago, her mammogram revealed the presence of suspicious calcifications in her right breast, and she subsequently underwent biopsy of these lesions. Histology of the lesions revealed poorly cohesive cells growing in sheets with a nuclear to cytoplasmic ratio of 1:1. Furthermore, these cells were found to undergo invasion into the surrounding tissues. Given these findings, the patient is referred to an oncologist for further evaluation. Upon further imaging, the patient is found to have no lymph node adenopathy and no distant site metastases. Which of the following would most properly describe the lesions found in this patient?\nOptions: A: High grade and high stage, B: High grade and no stage, C: High grade and low stage, D: Low grade and high stage, E: Low grade and low stage.\nAnswer:\n"
},
{
"role": "assistant",
"content": "C"
}
] | You are a medical doctor taking the US Medical Licensing Examination. You need to demonstrate your understanding of basic and clinical science, medical knowledge, and mechanisms underlying health, disease, patient care, and modes of therapy. Show your ability to apply the knowledge essential for medical practice. For the following multiple-choice question, select one correct answer from A to E. Base your answer on the current and standard practices referenced in medical guidelines.
Question: A 53-year-old woman presents to her primary care physician in order to discuss the results of a biopsy. Two weeks ago, her mammogram revealed the presence of suspicious calcifications in her right breast, and she subsequently underwent biopsy of these lesions. Histology of the lesions revealed poorly cohesive cells growing in sheets with a nuclear to cytoplasmic ratio of 1:1. Furthermore, these cells were found to undergo invasion into the surrounding tissues. Given these findings, the patient is referred to an oncologist for further evaluation. Upon further imaging, the patient is found to have no lymph node adenopathy and no distant site metastases. Which of the following would most properly describe the lesions found in this patient?
Options: A: High grade and high stage, B: High grade and no stage, C: High grade and low stage, D: Low grade and high stage, E: Low grade and low stage.
Answer:
|
MedQA_New302 | [
{
"role": "user",
"content": "You are a medical doctor taking the US Medical Licensing Examination. You need to demonstrate your understanding of basic and clinical science, medical knowledge, and mechanisms underlying health, disease, patient care, and modes of therapy. Show your ability to apply the knowledge essential for medical practice. For the following multiple-choice question, select one correct answer from A to E. Base your answer on the current and standard practices referenced in medical guidelines.\nQuestion: A 43-year-old man is brought to the emergency department because of severe epigastric pain and vomiting for 6 hours. The pain radiates to his back and he describes it as 9 out of 10 in intensity. He has had 3–4 episodes of vomiting during this period. He admits to consuming over 13 alcoholic beverages the previous night. There is no personal or family history of serious illness and he takes no medications. He is 177 cm (5 ft 10 in) tall and weighs 55 kg (121 lb); BMI is 17.6 kg/m2. He appears uncomfortable. His temperature is 37.5°C (99.5°F), pulse is 97/min, and blood pressure is 128/78 mm Hg. Abdominal examination shows severe epigastric tenderness to palpation. Bowel sounds are hypoactive. The remainder of the physical examination shows no abnormalities. Laboratory studies show:\nHemoglobin 13.5 g/dL\nHematocrit 62%\nLeukocyte count 13,800/mm3\nSerum\nNa+ 134 mEq/L\nK+ 3.6 mEq/L\nCl- 98 mEq/L\nCalcium 8.3 mg/dL\nGlucose 180 mg/dL\nCreatinine 0.9 mg/dL\nAmylase 150 U/L\nLipase 347 U/L (N = 14–280)\nTotal bilirubin 0.8 mg/dL\nAlkaline phosphatase 66 U/L\nAST 19 U/L\nALT 18 U/L\nLDH 360 U/L\nWhich of the following laboratory studies is the best prognostic indicator for this patient's condition?\"\nOptions: A: Hematocrit, B: Lipase, C: AST/ALT ratio, D: Alkaline phosphatase, E: Total bilirubin.\nAnswer:\n"
},
{
"role": "assistant",
"content": "A"
}
] | You are a medical doctor taking the US Medical Licensing Examination. You need to demonstrate your understanding of basic and clinical science, medical knowledge, and mechanisms underlying health, disease, patient care, and modes of therapy. Show your ability to apply the knowledge essential for medical practice. For the following multiple-choice question, select one correct answer from A to E. Base your answer on the current and standard practices referenced in medical guidelines.
Question: A 43-year-old man is brought to the emergency department because of severe epigastric pain and vomiting for 6 hours. The pain radiates to his back and he describes it as 9 out of 10 in intensity. He has had 3–4 episodes of vomiting during this period. He admits to consuming over 13 alcoholic beverages the previous night. There is no personal or family history of serious illness and he takes no medications. He is 177 cm (5 ft 10 in) tall and weighs 55 kg (121 lb); BMI is 17.6 kg/m2. He appears uncomfortable. His temperature is 37.5°C (99.5°F), pulse is 97/min, and blood pressure is 128/78 mm Hg. Abdominal examination shows severe epigastric tenderness to palpation. Bowel sounds are hypoactive. The remainder of the physical examination shows no abnormalities. Laboratory studies show:
Hemoglobin 13.5 g/dL
Hematocrit 62%
Leukocyte count 13,800/mm3
Serum
Na+ 134 mEq/L
K+ 3.6 mEq/L
Cl- 98 mEq/L
Calcium 8.3 mg/dL
Glucose 180 mg/dL
Creatinine 0.9 mg/dL
Amylase 150 U/L
Lipase 347 U/L (N = 14–280)
Total bilirubin 0.8 mg/dL
Alkaline phosphatase 66 U/L
AST 19 U/L
ALT 18 U/L
LDH 360 U/L
Which of the following laboratory studies is the best prognostic indicator for this patient's condition?"
Options: A: Hematocrit, B: Lipase, C: AST/ALT ratio, D: Alkaline phosphatase, E: Total bilirubin.
Answer:
|
MedQA_New3780 | [
{
"role": "user",
"content": "You are a medical doctor taking the US Medical Licensing Examination. You need to demonstrate your understanding of basic and clinical science, medical knowledge, and mechanisms underlying health, disease, patient care, and modes of therapy. Show your ability to apply the knowledge essential for medical practice. For the following multiple-choice question, select one correct answer from A to E. Base your answer on the current and standard practices referenced in medical guidelines.\nQuestion: A 35-year-old female comes to the physician because of a 2-year history of progressive fatigue and joint pain. She has a 1-year history of skin problems and a 4-month history of episodic pallor of her fingers. She reports that the skin of her face, neck, and hands is always dry and itchy; there are also numerous “red spots” on her face. She has become more “clumsy” and often drops objects. She has gastroesophageal reflux disease treated with lansoprazole. She does not smoke. She occasionally drinks a beer or a glass of wine. Her temperature is 36.5°C (97.7°F), blood pressure is 154/98 mm Hg, and pulse is 75/min. Examination shows hardening and thickening of the skin of face, neck, and hands. There are small dilated blood vessels around her mouth and on her oral mucosa. Mouth opening is reduced. Active and passive range of motion of the proximal and distal interphalangeal joints is limited. Cardiopulmonary examination shows no abnormalities. Her creatinine is 1.4 mg/dL. The patient is at increased risk for which of the following complications?\nOptions: A: Dental caries, B: Antiphospholipid syndrome, C: Lung cancer, D: Urolithiasis, E: Dactylitis.\nAnswer:\n"
},
{
"role": "assistant",
"content": "C"
}
] | You are a medical doctor taking the US Medical Licensing Examination. You need to demonstrate your understanding of basic and clinical science, medical knowledge, and mechanisms underlying health, disease, patient care, and modes of therapy. Show your ability to apply the knowledge essential for medical practice. For the following multiple-choice question, select one correct answer from A to E. Base your answer on the current and standard practices referenced in medical guidelines.
Question: A 35-year-old female comes to the physician because of a 2-year history of progressive fatigue and joint pain. She has a 1-year history of skin problems and a 4-month history of episodic pallor of her fingers. She reports that the skin of her face, neck, and hands is always dry and itchy; there are also numerous “red spots” on her face. She has become more “clumsy” and often drops objects. She has gastroesophageal reflux disease treated with lansoprazole. She does not smoke. She occasionally drinks a beer or a glass of wine. Her temperature is 36.5°C (97.7°F), blood pressure is 154/98 mm Hg, and pulse is 75/min. Examination shows hardening and thickening of the skin of face, neck, and hands. There are small dilated blood vessels around her mouth and on her oral mucosa. Mouth opening is reduced. Active and passive range of motion of the proximal and distal interphalangeal joints is limited. Cardiopulmonary examination shows no abnormalities. Her creatinine is 1.4 mg/dL. The patient is at increased risk for which of the following complications?
Options: A: Dental caries, B: Antiphospholipid syndrome, C: Lung cancer, D: Urolithiasis, E: Dactylitis.
Answer:
|
MedQA_New2213 | [
{
"role": "user",
"content": "You are a medical doctor taking the US Medical Licensing Examination. You need to demonstrate your understanding of basic and clinical science, medical knowledge, and mechanisms underlying health, disease, patient care, and modes of therapy. Show your ability to apply the knowledge essential for medical practice. For the following multiple-choice question, select one correct answer from A to E. Base your answer on the current and standard practices referenced in medical guidelines.\nQuestion: A 61-year-old man presents to the emergency department for the evaluation of polyuria, polydipsia, and confusion. He has a history of the psychiatric disease but is unable to provide additional details. He is admitted to the hospital and his home medications are continued. Routine testing is unrevealing for the etiology of his symptoms. Desmopressin acetate (DDAVP) is given, but no effect is seen on urine output or urine osmolarity. Which of the following medications could have induced this syndrome?\nOptions: A: Ranitidine, B: Omeprazole, C: Nitrofurantoin, D: Nafcillin, E: Lithium.\nAnswer:\n"
},
{
"role": "assistant",
"content": "E"
}
] | You are a medical doctor taking the US Medical Licensing Examination. You need to demonstrate your understanding of basic and clinical science, medical knowledge, and mechanisms underlying health, disease, patient care, and modes of therapy. Show your ability to apply the knowledge essential for medical practice. For the following multiple-choice question, select one correct answer from A to E. Base your answer on the current and standard practices referenced in medical guidelines.
Question: A 61-year-old man presents to the emergency department for the evaluation of polyuria, polydipsia, and confusion. He has a history of the psychiatric disease but is unable to provide additional details. He is admitted to the hospital and his home medications are continued. Routine testing is unrevealing for the etiology of his symptoms. Desmopressin acetate (DDAVP) is given, but no effect is seen on urine output or urine osmolarity. Which of the following medications could have induced this syndrome?
Options: A: Ranitidine, B: Omeprazole, C: Nitrofurantoin, D: Nafcillin, E: Lithium.
Answer:
|
MedQA_New5911 | [
{
"role": "user",
"content": "You are a medical doctor taking the US Medical Licensing Examination. You need to demonstrate your understanding of basic and clinical science, medical knowledge, and mechanisms underlying health, disease, patient care, and modes of therapy. Show your ability to apply the knowledge essential for medical practice. For the following multiple-choice question, select one correct answer from A to E. Base your answer on the current and standard practices referenced in medical guidelines.\nQuestion: A 62-year-old woman with type 2 diabetes mellitus comes to the physician because of a 1-year history of progressively worsening paresthesias in her upper limbs. She has accidentally burned her fingers on hot dishes several times. She was involved in a motor vehicle collision 3 years ago. Neurologic examination shows absent temperature sensation with normal fine touch sensation over the upper extremities and chest. Without treatment, this patient is at increased risk of developing which of the following?\nOptions: A: Exaggerated biceps reflex, B: Decreased Mini-Mental State Examination score, C: Absent anal wink reflex, D: Drooping of the eyelid, E: Absent knee-jerk reflex.\nAnswer:\n"
},
{
"role": "assistant",
"content": "D"
}
] | You are a medical doctor taking the US Medical Licensing Examination. You need to demonstrate your understanding of basic and clinical science, medical knowledge, and mechanisms underlying health, disease, patient care, and modes of therapy. Show your ability to apply the knowledge essential for medical practice. For the following multiple-choice question, select one correct answer from A to E. Base your answer on the current and standard practices referenced in medical guidelines.
Question: A 62-year-old woman with type 2 diabetes mellitus comes to the physician because of a 1-year history of progressively worsening paresthesias in her upper limbs. She has accidentally burned her fingers on hot dishes several times. She was involved in a motor vehicle collision 3 years ago. Neurologic examination shows absent temperature sensation with normal fine touch sensation over the upper extremities and chest. Without treatment, this patient is at increased risk of developing which of the following?
Options: A: Exaggerated biceps reflex, B: Decreased Mini-Mental State Examination score, C: Absent anal wink reflex, D: Drooping of the eyelid, E: Absent knee-jerk reflex.
Answer:
|
MedQA_New3917 | [
{
"role": "user",
"content": "You are a medical doctor taking the US Medical Licensing Examination. You need to demonstrate your understanding of basic and clinical science, medical knowledge, and mechanisms underlying health, disease, patient care, and modes of therapy. Show your ability to apply the knowledge essential for medical practice. For the following multiple-choice question, select one correct answer from A to E. Base your answer on the current and standard practices referenced in medical guidelines.\nQuestion: A 78-year-old male comes to the physician’s office for a routine check-up. He complains of increased lower extremity swelling, inability to climb the one flight of stairs in his home, and waking up in the middle of the night 2-3 times gasping for breath. He has had to increase the number of pillows on which he sleeps at night. These symptoms started 9 months ago and have been progressing. The doctor starts him on a medication regimen, one of which changes his Starling curve from A to B as shown in the Figure. Which of the following medications is most consistent with this mechanism of action?\nOptions: A: Metoprolol, B: Furosemide, C: Hydrochlorothiazide, D: Aspirin, E: Digoxin.\nAnswer:\n"
},
{
"role": "assistant",
"content": "E"
}
] | You are a medical doctor taking the US Medical Licensing Examination. You need to demonstrate your understanding of basic and clinical science, medical knowledge, and mechanisms underlying health, disease, patient care, and modes of therapy. Show your ability to apply the knowledge essential for medical practice. For the following multiple-choice question, select one correct answer from A to E. Base your answer on the current and standard practices referenced in medical guidelines.
Question: A 78-year-old male comes to the physician’s office for a routine check-up. He complains of increased lower extremity swelling, inability to climb the one flight of stairs in his home, and waking up in the middle of the night 2-3 times gasping for breath. He has had to increase the number of pillows on which he sleeps at night. These symptoms started 9 months ago and have been progressing. The doctor starts him on a medication regimen, one of which changes his Starling curve from A to B as shown in the Figure. Which of the following medications is most consistent with this mechanism of action?
Options: A: Metoprolol, B: Furosemide, C: Hydrochlorothiazide, D: Aspirin, E: Digoxin.
Answer:
|
MedQA_New452 | [
{
"role": "user",
"content": "You are a medical doctor taking the US Medical Licensing Examination. You need to demonstrate your understanding of basic and clinical science, medical knowledge, and mechanisms underlying health, disease, patient care, and modes of therapy. Show your ability to apply the knowledge essential for medical practice. For the following multiple-choice question, select one correct answer from A to E. Base your answer on the current and standard practices referenced in medical guidelines.\nQuestion: A 17-year-old girl presents to her pediatrician for a wellness visit. She currently feels well but is concerned that she has not experienced menarche. She reports to recently developing headaches and describes them as pulsating, occurring on the left side of her head, associated with nausea, and relieved by ibuprofen. She is part of the school’s rugby team and competitively lifts weights. She is currently sexually active and uses condoms infrequently. She denies using any forms of contraception or taking any medications. Her temperature is 98.6°F (37°C), blood pressure is 137/90 mmHg, pulse is 98/min, and respirations are 17/min. On physical exam, she has normal breast development and pubic hair is present. A pelvic exam is performed. A urine hCG test is negative. Which of the following is the best next step in management?\nOptions: A: MRI of the head, B: Pelvic ultrasound, C: Serum T3 and T4, D: Serum estradiol, E: Serum testosterone.\nAnswer:\n"
},
{
"role": "assistant",
"content": "B"
}
] | You are a medical doctor taking the US Medical Licensing Examination. You need to demonstrate your understanding of basic and clinical science, medical knowledge, and mechanisms underlying health, disease, patient care, and modes of therapy. Show your ability to apply the knowledge essential for medical practice. For the following multiple-choice question, select one correct answer from A to E. Base your answer on the current and standard practices referenced in medical guidelines.
Question: A 17-year-old girl presents to her pediatrician for a wellness visit. She currently feels well but is concerned that she has not experienced menarche. She reports to recently developing headaches and describes them as pulsating, occurring on the left side of her head, associated with nausea, and relieved by ibuprofen. She is part of the school’s rugby team and competitively lifts weights. She is currently sexually active and uses condoms infrequently. She denies using any forms of contraception or taking any medications. Her temperature is 98.6°F (37°C), blood pressure is 137/90 mmHg, pulse is 98/min, and respirations are 17/min. On physical exam, she has normal breast development and pubic hair is present. A pelvic exam is performed. A urine hCG test is negative. Which of the following is the best next step in management?
Options: A: MRI of the head, B: Pelvic ultrasound, C: Serum T3 and T4, D: Serum estradiol, E: Serum testosterone.
Answer:
|
MedQA_New8088 | [
{
"role": "user",
"content": "You are a medical doctor taking the US Medical Licensing Examination. You need to demonstrate your understanding of basic and clinical science, medical knowledge, and mechanisms underlying health, disease, patient care, and modes of therapy. Show your ability to apply the knowledge essential for medical practice. For the following multiple-choice question, select one correct answer from A to E. Base your answer on the current and standard practices referenced in medical guidelines.\nQuestion: A child presents to his pediatrician’s clinic for a routine well visit. He can bend down and stand back up without assistance and walk backward but is not able to run or walk upstairs. He can stack 2 blocks and put the blocks in a cup. He can bring over a book when asked, and he will say “mama” and “dada” to call for his parents, as well as 'book', 'milk', and 'truck'. How old is this child if he is developmentally appropriate for his age?\nOptions: A: 9 months, B: 12 months, C: 15 months, D: 18 months, E: 24 months.\nAnswer:\n"
},
{
"role": "assistant",
"content": "C"
}
] | You are a medical doctor taking the US Medical Licensing Examination. You need to demonstrate your understanding of basic and clinical science, medical knowledge, and mechanisms underlying health, disease, patient care, and modes of therapy. Show your ability to apply the knowledge essential for medical practice. For the following multiple-choice question, select one correct answer from A to E. Base your answer on the current and standard practices referenced in medical guidelines.
Question: A child presents to his pediatrician’s clinic for a routine well visit. He can bend down and stand back up without assistance and walk backward but is not able to run or walk upstairs. He can stack 2 blocks and put the blocks in a cup. He can bring over a book when asked, and he will say “mama” and “dada” to call for his parents, as well as 'book', 'milk', and 'truck'. How old is this child if he is developmentally appropriate for his age?
Options: A: 9 months, B: 12 months, C: 15 months, D: 18 months, E: 24 months.
Answer:
|
MedQA_New9374 | [
{
"role": "user",
"content": "You are a medical doctor taking the US Medical Licensing Examination. You need to demonstrate your understanding of basic and clinical science, medical knowledge, and mechanisms underlying health, disease, patient care, and modes of therapy. Show your ability to apply the knowledge essential for medical practice. For the following multiple-choice question, select one correct answer from A to E. Base your answer on the current and standard practices referenced in medical guidelines.\nQuestion: A 38-year-old man presents to his physician for difficulty swallowing for 2 months. He describes food getting stuck down his windpipe and has been feeling very anxious around meal time because he is thinking that he may have esophageal cancer. He has had an influenza-like infection that lasted about 6 weeks in the past 3 months which exacerbated his asthma attacks. He used his puffers to relieve his symptoms and did not seek medical treatment. He is otherwise healthy. On examination, his blood pressure is 118/75 mm Hg, respirations are 17/min, pulse is 78/min, and temperature is 36.7°C (98.1°F). There is no evidence of enlarged lymph nodes or a sore throat. On palpation, the thyroid gland is enlarged and tender. He is a non-smoker with a BMI of 25 kg/m2. He has not used any medications recently. Which of the following is the most likely diagnosis?\nOptions: A: Silent thyroiditis, B: Lymphoma, C: Chronic lymphocytic thyroiditis, D: Subacute granulomatous thyroiditis, E: Fibrous thyroiditis.\nAnswer:\n"
},
{
"role": "assistant",
"content": "D"
}
] | You are a medical doctor taking the US Medical Licensing Examination. You need to demonstrate your understanding of basic and clinical science, medical knowledge, and mechanisms underlying health, disease, patient care, and modes of therapy. Show your ability to apply the knowledge essential for medical practice. For the following multiple-choice question, select one correct answer from A to E. Base your answer on the current and standard practices referenced in medical guidelines.
Question: A 38-year-old man presents to his physician for difficulty swallowing for 2 months. He describes food getting stuck down his windpipe and has been feeling very anxious around meal time because he is thinking that he may have esophageal cancer. He has had an influenza-like infection that lasted about 6 weeks in the past 3 months which exacerbated his asthma attacks. He used his puffers to relieve his symptoms and did not seek medical treatment. He is otherwise healthy. On examination, his blood pressure is 118/75 mm Hg, respirations are 17/min, pulse is 78/min, and temperature is 36.7°C (98.1°F). There is no evidence of enlarged lymph nodes or a sore throat. On palpation, the thyroid gland is enlarged and tender. He is a non-smoker with a BMI of 25 kg/m2. He has not used any medications recently. Which of the following is the most likely diagnosis?
Options: A: Silent thyroiditis, B: Lymphoma, C: Chronic lymphocytic thyroiditis, D: Subacute granulomatous thyroiditis, E: Fibrous thyroiditis.
Answer:
|
MedQA_New3876 | [
{
"role": "user",
"content": "You are a medical doctor taking the US Medical Licensing Examination. You need to demonstrate your understanding of basic and clinical science, medical knowledge, and mechanisms underlying health, disease, patient care, and modes of therapy. Show your ability to apply the knowledge essential for medical practice. For the following multiple-choice question, select one correct answer from A to E. Base your answer on the current and standard practices referenced in medical guidelines.\nQuestion: A 66-year-old man presents to the emergency department with a 3-hour history of crushing chest pain radiating to the left shoulder and neck. Patient states that the pain began suddenly when he was taking a walk around the block and has not improved with rest. He also mentions difficulty breathing and prefers to sit leaning forward. He denies ever having similar symptoms before. Past medical history is significant for hypertension, diagnosed 10 years ago, and hyperlipidemia diagnosed 8 years ago. Current medications are atorvastatin. Patient is also prescribed hydrochlorothiazide as an antihypertensive but is not compliant because he says it makes him urinate too often.\nVitals show a blood pressure of 152/90 mm Hg, pulse of 106/min, respirations of 22/min and oxygen saturation of 97% on room air. On physical exam, patient is profusely diaphoretic and hunched over in distress. Cardiac exam is unremarkable and lungs are clear to auscultation. During your examination, the patient suddenly becomes unresponsive and a pulse cannot be palpated. A stat ECG shows the following (see image). Which of the following is the next best step in management?\nOptions: A: Administer epinephrine, B: Administer amiodarone, C: Synchronized cardioversion, D: Unsynchronized cardioversion, E: Urgent echocardiography.\nAnswer:\n"
},
{
"role": "assistant",
"content": "D"
}
] | You are a medical doctor taking the US Medical Licensing Examination. You need to demonstrate your understanding of basic and clinical science, medical knowledge, and mechanisms underlying health, disease, patient care, and modes of therapy. Show your ability to apply the knowledge essential for medical practice. For the following multiple-choice question, select one correct answer from A to E. Base your answer on the current and standard practices referenced in medical guidelines.
Question: A 66-year-old man presents to the emergency department with a 3-hour history of crushing chest pain radiating to the left shoulder and neck. Patient states that the pain began suddenly when he was taking a walk around the block and has not improved with rest. He also mentions difficulty breathing and prefers to sit leaning forward. He denies ever having similar symptoms before. Past medical history is significant for hypertension, diagnosed 10 years ago, and hyperlipidemia diagnosed 8 years ago. Current medications are atorvastatin. Patient is also prescribed hydrochlorothiazide as an antihypertensive but is not compliant because he says it makes him urinate too often.
Vitals show a blood pressure of 152/90 mm Hg, pulse of 106/min, respirations of 22/min and oxygen saturation of 97% on room air. On physical exam, patient is profusely diaphoretic and hunched over in distress. Cardiac exam is unremarkable and lungs are clear to auscultation. During your examination, the patient suddenly becomes unresponsive and a pulse cannot be palpated. A stat ECG shows the following (see image). Which of the following is the next best step in management?
Options: A: Administer epinephrine, B: Administer amiodarone, C: Synchronized cardioversion, D: Unsynchronized cardioversion, E: Urgent echocardiography.
Answer:
|
MedQA_New3392 | [
{
"role": "user",
"content": "You are a medical doctor taking the US Medical Licensing Examination. You need to demonstrate your understanding of basic and clinical science, medical knowledge, and mechanisms underlying health, disease, patient care, and modes of therapy. Show your ability to apply the knowledge essential for medical practice. For the following multiple-choice question, select one correct answer from A to E. Base your answer on the current and standard practices referenced in medical guidelines.\nQuestion: A 42-year-old man comes to the physician because of fatigue and decreased urination for the past 3 days. His creatinine is 2.5 mg/dL. A photomicrograph of a biopsy specimen of the right kidney is shown. Which of the following mechanisms most likely contributed to this patient's biopsy findings?\nOptions: A: Fibrin formation in Bowman space, B: Segmental collapse of glomerular capillaries, C: Effacement of podocyte foot processes, D: Expansion of the mesangial matrix, E: Deposition of immunoglobulin light chains.\nAnswer:\n"
},
{
"role": "assistant",
"content": "A"
}
] | You are a medical doctor taking the US Medical Licensing Examination. You need to demonstrate your understanding of basic and clinical science, medical knowledge, and mechanisms underlying health, disease, patient care, and modes of therapy. Show your ability to apply the knowledge essential for medical practice. For the following multiple-choice question, select one correct answer from A to E. Base your answer on the current and standard practices referenced in medical guidelines.
Question: A 42-year-old man comes to the physician because of fatigue and decreased urination for the past 3 days. His creatinine is 2.5 mg/dL. A photomicrograph of a biopsy specimen of the right kidney is shown. Which of the following mechanisms most likely contributed to this patient's biopsy findings?
Options: A: Fibrin formation in Bowman space, B: Segmental collapse of glomerular capillaries, C: Effacement of podocyte foot processes, D: Expansion of the mesangial matrix, E: Deposition of immunoglobulin light chains.
Answer:
|
MedQA_New63 | [
{
"role": "user",
"content": "You are a medical doctor taking the US Medical Licensing Examination. You need to demonstrate your understanding of basic and clinical science, medical knowledge, and mechanisms underlying health, disease, patient care, and modes of therapy. Show your ability to apply the knowledge essential for medical practice. For the following multiple-choice question, select one correct answer from A to E. Base your answer on the current and standard practices referenced in medical guidelines.\nQuestion: An 11-month-old boy is brought to a pediatrician by his parents for evaluation of vomiting and watery diarrhea over the last day. The mother informs the pediatrician that the boy had consumed an apple bought from a fruit vendor on the previous day, but that otherwise there has been no recent change in his diet. There is no history of blood in the stool, flatulence, irritability, or poor appetite. There is no history of recurrent or chronic diarrhea or any other gastrointestinal symptoms. On physical examination, his temperature is 37.6°C (99.6°F), pulse is 120/min, respirations are 24/min, and blood pressure is 92/60 mm Hg. General examination reveals a playful infant with normal skin turgor and no sunken eyes. The pediatrician explains to the parents that he most likely has acute gastroenteritis and that no specific medication is indicated at present. He also instructs the parents about his diet during the illness and reviews the danger signs of dehydration. He suggests a follow-up evaluation after 48 hours or earlier if any complications arise. Which of the following dietary recommendations did the pediatrician make?\nOptions: A: Age-appropriate diet, B: BRAT diet, C: Plenty of juices and carbonated sodas, D: Diluted formula milk, E: Lactose-free diet.\nAnswer:\n"
},
{
"role": "assistant",
"content": "A"
}
] | You are a medical doctor taking the US Medical Licensing Examination. You need to demonstrate your understanding of basic and clinical science, medical knowledge, and mechanisms underlying health, disease, patient care, and modes of therapy. Show your ability to apply the knowledge essential for medical practice. For the following multiple-choice question, select one correct answer from A to E. Base your answer on the current and standard practices referenced in medical guidelines.
Question: An 11-month-old boy is brought to a pediatrician by his parents for evaluation of vomiting and watery diarrhea over the last day. The mother informs the pediatrician that the boy had consumed an apple bought from a fruit vendor on the previous day, but that otherwise there has been no recent change in his diet. There is no history of blood in the stool, flatulence, irritability, or poor appetite. There is no history of recurrent or chronic diarrhea or any other gastrointestinal symptoms. On physical examination, his temperature is 37.6°C (99.6°F), pulse is 120/min, respirations are 24/min, and blood pressure is 92/60 mm Hg. General examination reveals a playful infant with normal skin turgor and no sunken eyes. The pediatrician explains to the parents that he most likely has acute gastroenteritis and that no specific medication is indicated at present. He also instructs the parents about his diet during the illness and reviews the danger signs of dehydration. He suggests a follow-up evaluation after 48 hours or earlier if any complications arise. Which of the following dietary recommendations did the pediatrician make?
Options: A: Age-appropriate diet, B: BRAT diet, C: Plenty of juices and carbonated sodas, D: Diluted formula milk, E: Lactose-free diet.
Answer:
|
MedQA_New7706 | [
{
"role": "user",
"content": "You are a medical doctor taking the US Medical Licensing Examination. You need to demonstrate your understanding of basic and clinical science, medical knowledge, and mechanisms underlying health, disease, patient care, and modes of therapy. Show your ability to apply the knowledge essential for medical practice. For the following multiple-choice question, select one correct answer from A to E. Base your answer on the current and standard practices referenced in medical guidelines.\nQuestion: Ten days after undergoing left hip replacement, a 73-year-old hospitalized man develops a fever, dyspnea, cough productive of yellow sputum, confusion, nausea, and diarrhea. Several patients in the hospital report similar symptoms. Physical examination shows decreased breath sounds on the left side and inspiratory crackles over the left lung. An x-ray of the chest shows opacities in the lower lobe of the left lung. Treatment with ampicillin does not improve his symptoms. Subsequent evaluation of the patient's urine detects a pathogen-specific antigen, confirming the diagnosis. Which of the following sources of infection is most likely responsible for this local disease outbreak?\nOptions: A: Transmission via infectious respiratory droplets, B: Contamination of reheated hospital food, C: Colonization of the air conditioning system, D: Entry through colonized intravenous catheters, E: Insufficient adherence to hand hygiene measures.\nAnswer:\n"
},
{
"role": "assistant",
"content": "C"
}
] | You are a medical doctor taking the US Medical Licensing Examination. You need to demonstrate your understanding of basic and clinical science, medical knowledge, and mechanisms underlying health, disease, patient care, and modes of therapy. Show your ability to apply the knowledge essential for medical practice. For the following multiple-choice question, select one correct answer from A to E. Base your answer on the current and standard practices referenced in medical guidelines.
Question: Ten days after undergoing left hip replacement, a 73-year-old hospitalized man develops a fever, dyspnea, cough productive of yellow sputum, confusion, nausea, and diarrhea. Several patients in the hospital report similar symptoms. Physical examination shows decreased breath sounds on the left side and inspiratory crackles over the left lung. An x-ray of the chest shows opacities in the lower lobe of the left lung. Treatment with ampicillin does not improve his symptoms. Subsequent evaluation of the patient's urine detects a pathogen-specific antigen, confirming the diagnosis. Which of the following sources of infection is most likely responsible for this local disease outbreak?
Options: A: Transmission via infectious respiratory droplets, B: Contamination of reheated hospital food, C: Colonization of the air conditioning system, D: Entry through colonized intravenous catheters, E: Insufficient adherence to hand hygiene measures.
Answer:
|
MedQA_New1973 | [
{
"role": "user",
"content": "You are a medical doctor taking the US Medical Licensing Examination. You need to demonstrate your understanding of basic and clinical science, medical knowledge, and mechanisms underlying health, disease, patient care, and modes of therapy. Show your ability to apply the knowledge essential for medical practice. For the following multiple-choice question, select one correct answer from A to E. Base your answer on the current and standard practices referenced in medical guidelines.\nQuestion: A 46-year-old woman comes to the physician for a cognitive evaluation. She is an office manager. She has had increasing difficulties with multitasking and reports that her job performance has declined over the past 1 year. On mental status examination, short-term memory is impaired and long-term memory is intact. Laboratory studies, including thyroid-stimulating hormone and vitamin B12, are within the reference range. An MRI of the brain shows generalized atrophy, most pronounced in the bilateral medial temporal lobes and hippocampi. If this patient's condition has a genetic etiology, which of the following alterations is most likely to be found on genetic testing?\nOptions: A: Noncoding hexanucleotide repeats, B: Deletion of chromosome 21q, C: Mutation in presenilin 1, D: Expansion of CAG trinucleotide repeat, E: Presence of ApoE ε4 allele.\nAnswer:\n"
},
{
"role": "assistant",
"content": "C"
}
] | You are a medical doctor taking the US Medical Licensing Examination. You need to demonstrate your understanding of basic and clinical science, medical knowledge, and mechanisms underlying health, disease, patient care, and modes of therapy. Show your ability to apply the knowledge essential for medical practice. For the following multiple-choice question, select one correct answer from A to E. Base your answer on the current and standard practices referenced in medical guidelines.
Question: A 46-year-old woman comes to the physician for a cognitive evaluation. She is an office manager. She has had increasing difficulties with multitasking and reports that her job performance has declined over the past 1 year. On mental status examination, short-term memory is impaired and long-term memory is intact. Laboratory studies, including thyroid-stimulating hormone and vitamin B12, are within the reference range. An MRI of the brain shows generalized atrophy, most pronounced in the bilateral medial temporal lobes and hippocampi. If this patient's condition has a genetic etiology, which of the following alterations is most likely to be found on genetic testing?
Options: A: Noncoding hexanucleotide repeats, B: Deletion of chromosome 21q, C: Mutation in presenilin 1, D: Expansion of CAG trinucleotide repeat, E: Presence of ApoE ε4 allele.
Answer:
|
MedQA_New3816 | [
{
"role": "user",
"content": "You are a medical doctor taking the US Medical Licensing Examination. You need to demonstrate your understanding of basic and clinical science, medical knowledge, and mechanisms underlying health, disease, patient care, and modes of therapy. Show your ability to apply the knowledge essential for medical practice. For the following multiple-choice question, select one correct answer from A to E. Base your answer on the current and standard practices referenced in medical guidelines.\nQuestion: A newborn infant is born at 42 weeks gestation to a healthy 36-year-old G1P0. The delivery was complicated by prolonged labor and shoulder dystocia. The child is in the 87th and 91st percentiles for height and weight at birth, respectively. The mother’s past medical history is notable for diabetes mellitus and obesity. Immediately after birth, the child’s temperature is 99°F (37.2°C), blood pressure is 90/50 mmHg, pulse is 120/min, and respirations are 24/min. The child demonstrates a strong cry and pink upper and lower extremities bilaterally. The right arm is adducted and internally rotated at the shoulder and extended at the elbow. Flexion and extension of the wrist and digits appear to be intact in the right upper extremity. Which of the following muscles would most likely have normal strength in this patient?\nOptions: A: Teres minor, B: Brachialis, C: Brachioradialis, D: Biceps, E: Triceps.\nAnswer:\n"
},
{
"role": "assistant",
"content": "E"
}
] | You are a medical doctor taking the US Medical Licensing Examination. You need to demonstrate your understanding of basic and clinical science, medical knowledge, and mechanisms underlying health, disease, patient care, and modes of therapy. Show your ability to apply the knowledge essential for medical practice. For the following multiple-choice question, select one correct answer from A to E. Base your answer on the current and standard practices referenced in medical guidelines.
Question: A newborn infant is born at 42 weeks gestation to a healthy 36-year-old G1P0. The delivery was complicated by prolonged labor and shoulder dystocia. The child is in the 87th and 91st percentiles for height and weight at birth, respectively. The mother’s past medical history is notable for diabetes mellitus and obesity. Immediately after birth, the child’s temperature is 99°F (37.2°C), blood pressure is 90/50 mmHg, pulse is 120/min, and respirations are 24/min. The child demonstrates a strong cry and pink upper and lower extremities bilaterally. The right arm is adducted and internally rotated at the shoulder and extended at the elbow. Flexion and extension of the wrist and digits appear to be intact in the right upper extremity. Which of the following muscles would most likely have normal strength in this patient?
Options: A: Teres minor, B: Brachialis, C: Brachioradialis, D: Biceps, E: Triceps.
Answer:
|
MedQA_New1822 | [
{
"role": "user",
"content": "You are a medical doctor taking the US Medical Licensing Examination. You need to demonstrate your understanding of basic and clinical science, medical knowledge, and mechanisms underlying health, disease, patient care, and modes of therapy. Show your ability to apply the knowledge essential for medical practice. For the following multiple-choice question, select one correct answer from A to E. Base your answer on the current and standard practices referenced in medical guidelines.\nQuestion: A 70-year-old man presents to his primary care physician for a general checkup. He states that he has been doing well and taking his medications as prescribed. He recently started a new diet and supplement to improve his health and has started exercising. The patient has a past medical history of diabetes, a myocardial infarction, and hypertension. He denies any shortness of breath at rest or with exertion. An ECG is performed and is within normal limits. Laboratory values are ordered as seen below.\n\nSerum:\nNa+: 139 mEq/L\nCl-: 100 mEq/L\nK+: 6.7 mEq/L\nHCO3-: 25 mEq/L\nGlucose: 133 mg/dL\nCa2+: 10.2 mg/dL\n\nWhich of the following is the most likely cause of this patient's presentation?\nOptions: A: Acute renal failure, B: Dietary changes, C: Hemolysis, D: Medication, E: Rhabdomyolysis.\nAnswer:\n"
},
{
"role": "assistant",
"content": "D"
}
] | You are a medical doctor taking the US Medical Licensing Examination. You need to demonstrate your understanding of basic and clinical science, medical knowledge, and mechanisms underlying health, disease, patient care, and modes of therapy. Show your ability to apply the knowledge essential for medical practice. For the following multiple-choice question, select one correct answer from A to E. Base your answer on the current and standard practices referenced in medical guidelines.
Question: A 70-year-old man presents to his primary care physician for a general checkup. He states that he has been doing well and taking his medications as prescribed. He recently started a new diet and supplement to improve his health and has started exercising. The patient has a past medical history of diabetes, a myocardial infarction, and hypertension. He denies any shortness of breath at rest or with exertion. An ECG is performed and is within normal limits. Laboratory values are ordered as seen below.
Serum:
Na+: 139 mEq/L
Cl-: 100 mEq/L
K+: 6.7 mEq/L
HCO3-: 25 mEq/L
Glucose: 133 mg/dL
Ca2+: 10.2 mg/dL
Which of the following is the most likely cause of this patient's presentation?
Options: A: Acute renal failure, B: Dietary changes, C: Hemolysis, D: Medication, E: Rhabdomyolysis.
Answer:
|
MedQA_New4550 | [
{
"role": "user",
"content": "You are a medical doctor taking the US Medical Licensing Examination. You need to demonstrate your understanding of basic and clinical science, medical knowledge, and mechanisms underlying health, disease, patient care, and modes of therapy. Show your ability to apply the knowledge essential for medical practice. For the following multiple-choice question, select one correct answer from A to E. Base your answer on the current and standard practices referenced in medical guidelines.\nQuestion: A previously healthy 39-year-old man comes to the physician because of a 1-month history of fatigue and red-colored urine. His vital signs are within normal limits. Physical examination shows pallor and jaundice. His platelet count is 90,000/mm3 and creatinine concentration is 1.0 mg/dL. A direct Coombs test is negative. Flow cytometry shows erythrocytes deficient in CD55 and CD59 surface antigens. This patient is at greatest risk for which of the following complications?\nOptions: A: Radiolucent gallstones, B: Acrocyanosis, C: Venous thrombosis, D: Hepatocellular carcinoma, E: Chronic lymphocytic leukemia.\nAnswer:\n"
},
{
"role": "assistant",
"content": "C"
}
] | You are a medical doctor taking the US Medical Licensing Examination. You need to demonstrate your understanding of basic and clinical science, medical knowledge, and mechanisms underlying health, disease, patient care, and modes of therapy. Show your ability to apply the knowledge essential for medical practice. For the following multiple-choice question, select one correct answer from A to E. Base your answer on the current and standard practices referenced in medical guidelines.
Question: A previously healthy 39-year-old man comes to the physician because of a 1-month history of fatigue and red-colored urine. His vital signs are within normal limits. Physical examination shows pallor and jaundice. His platelet count is 90,000/mm3 and creatinine concentration is 1.0 mg/dL. A direct Coombs test is negative. Flow cytometry shows erythrocytes deficient in CD55 and CD59 surface antigens. This patient is at greatest risk for which of the following complications?
Options: A: Radiolucent gallstones, B: Acrocyanosis, C: Venous thrombosis, D: Hepatocellular carcinoma, E: Chronic lymphocytic leukemia.
Answer:
|
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