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A 67-year-old woman comes to the physician for a follow-up examination. She had a pulmonary embolism and required treatment in the hospital for 3 weeks. She had a retroperitoneal hemorrhage; anticoagulant therapy was temporarily discontinued, and she underwent placement of an inferior vena cava (IVC) filter. She had a hematoma that was resolving on discharge from the hospital 2 weeks ago. Today, she says she has had a persistent sensation of tingling and numbness of her left thigh that she did not report in the hospital because she thought it would go away; the sensation has improved somewhat during the past week. Her only medication is warfarin. Vital signs are within normal limits. Examination of the skin shows no abnormalities. Muscle strength is normal. Sensation to light touch is decreased over a 5 x 5-cm area on the lateral aspect of the left anterior thigh. Which of the following is the most likely cause of this patient's decreased sensation? | [
"Cerebral infarction during the hospitalization",
"Complication of the IVC filter placement",
"Compression of the lateral femoral cutaneous nerve",
"Hematoma of the left thigh"
] | 2C
|
A 25-year-old gravida 3 para 2 female is admitted to the hospital at 39 weeks' gestation in active labor. She had been having regular contractions every 4 minutes, but is now having only a few intermittent, weak contractions. She has received medication for pain twice in the past 6 hours. Examination shows no reason for obstructed labor. The fetal head is engaged, the membranes are intact, the fetal heart tones are normal, and the cervix is 100% effaced and 7 cm dilated. The most likely diagnosis is | [
"Braxton Hicks contractions",
"lower uterine retraction ring",
"hypotonic uterine dysfunction",
"primary dysfunctional labor"
] | 2C
|
A 9-year-old boy is brought to the office by his parents for a well-child examination. The patient and his family immigrated to the United States 2 months ago and he has not been evaluated by a physician in 4 years. He has been generally healthy. Medical history is significant for pneumonia at age 3 years. He takes no medications. He is at the 25th percentile for height, weight, and BMI. Vital signs are temperature 37.0°C (98.6°F), pulse 82/min, respirations 20/min, and blood pressure 112/74 mm Hg. Cardiac examination discloses a grade 3/6 systolic murmur audible along the left sternal border at the third and fourth intercostal spaces. Femoral pulses are weak and brachial pulses are strong; there is a radiofemoral delay. Chest xray discloses mild cardiomegaly with left ventricular prominence. ECG shows left ventricular hypertrophy. This patient is at greatest risk for which of the following complications? | [
"Atrial fibrillation",
"Cor pulmonale",
"Systemic hypertension",
"Tricuspid valve regurgitation"
] | 2C
|
A 25-year-old woman comes to the physician because of a 2-month history of numbness in her right hand. During this period, she has had tingling in the right ring and small fingers most of the time. She has no history of serious illness and takes no medications. She is employed as a cashier and uses a computer at home. She played as a pitcher in a softball league for 5 years until she stopped 2 years ago. Vital signs are within normal limits. Examination shows full muscle strength. Palpation of the right elbow produces a jolt of severe pain in the right ring and small fingers. Sensation to pinprick and light touch is decreased over the medial half of the right ring finger and the entire small finger. The most likely cause of these findings is entrapment of which of the following on the right? | [
"Median nerve at the wrist",
"Musculocutaneous nerve at the forearm",
"Radial nerve at the forearm",
"Ulnar nerve at the elbow"
] | 3D
|
A 72-year-old woman with advanced ovarian cancer metastatic to the liver is brought to the physician by her son because she cries all the time and will not get out of bed. On a 10-point scale, she rates the pain as a 1 to 2. She also has hypertension and major depressive disorder. She has received chemotherapy for 2 years. Current medications also include oxycodone (10 mg twice daily), hydrochlorothiazide (25 mg/d), and fluoxetine (20 mg/d). She is 165 cm (5 ft 5 in) tall and weighs 66 kg (145 lb); BMI is 24 kg/m2 . Her temperature is 37°C (98.6°F), pulse is 110/min, respirations are 12/min, and blood pressure is 120/80 mm Hg. Examination shows a firm, distended abdomen with moderate tenderness over the liver. On mental status examination, she is oriented to person, place, and time. She has good eye contact but appears sad and cries easily. Which of the following is the most appropriate next step in management? | [
"Reassurance",
"Assess for suicidal ideation",
"Begin dextroamphetamine therapy",
"Increase oxycodone dosage"
] | 1B
|
A 51-year-old man comes to the office because of a 6-month history of a lump on his tongue that is interfering with his speech and eating; he also has had a 6.8-kg (15-lb) weight loss during this period. He has smoked 1 pack of cigarettes daily and has consumed six 12-oz bottles of beer on weekend nights during the past 30 years. His vital signs are within normal limits. Physical examination shows a 1.5-cm mass on the apex of the tongue. Further evaluation of the mass confirms squamous cell carcinoma. It is most appropriate to evaluate which of the following lymph nodes first for evidence of metastasis in this patient? | [
"Inferior deep cervical",
"Parotid",
"Retropharyngeal",
"Submental"
] | 3D
|
A 42-year-old man comes to the physician for a follow-up examination 1 week after he passed a renal calculus. X-ray crystallographic analysis of the calculus showed calcium as the primary cation. Physical examination today shows no abnormalities. A 24-hour collection of urine shows increased calcium excretion. Which of the following is the most appropriate pharmacotherapy? | [
"Carbonic anhydrase inhibitor",
"Na+ –Cl− symport inhibitor",
"Na+ –K + –2Cl− symport inhibitor",
"Osmotic diuretic"
] | 1B
|
While you are on rounds at a local nursing facility, the nurse mentions that your patient, a 79-year-old woman, appears to be a "poor eater." She was admitted to the nursing facility 3 months ago from the hospital where she was treated for congestive heart failure. Her daughter had moved away from the area, and nursing home placement was necessary because the patient could no longer function independently. Her present medications include furosemide and digoxin. Physical examination is normal except for a weight loss of 3.5 kg (7 lb) during the past 3 months. In your conversation with the patient, she says, "No, I'm not depressed, I just don't have an appetite anymore. Nothing tastes good to me. I have a little bit of nausea most of the time." Which of the following is the most appropriate initial diagnostic study? | [
"Chest x-ray",
"Complete blood count",
"Determination of serum albumin concentration",
"Determination of serum digoxin level"
] | 3D
|
A 15-year-old boy is brought to the emergency department by his parents because of a 2-hour history of confusion and agitation. He also has had fever, headache, stiff neck, and vomiting since he returned from summer camp 2 days ago. His parents say he does not use illicit drugs. On arrival, he is combative and there is evidence of hallucinations. His temperature is 40°C (104°F), pulse is 80/min, respirations are 17/min, and blood pressure is 100/70 mm Hg. A lumbar puncture is performed. Results of cerebrospinal fluid analysis show cysts and trophozoites. The most likely portal of pathogen entry into this patient's central nervous system is which of the following? | [
"Facial nerve",
"Frontal sinus",
"Mastoid sinus",
"Olfactory nerve"
] | 3D
|
A 19-year-old male presents to the office for evaluation after he was hit from behind below the right knee while playing football. Gait analysis reveals a lack of fluid motion. Standing flexion test results are negative. Cruciate and collateral knee ligaments appear intact. Foot drop on the right is noted. The most likely diagnosis is | [
"anteriorly deviated distal femur",
"plantar flexed cuboid",
"posteriorly deviated fibular head",
"unilateral sacral shear"
] | 2C
|
A 5-year-old boy is admitted to the hospital because of a 1-week history of fever and increasingly severe abdominal discomfort. At the age of 7 months, he was treated for osteomyelitis caused by Aspergillus fumigatus. He has been admitted to the hospital three times during the past 4 years for severe pneumonia. He appears moderately ill. His temperature is 39°C (102.2°F). Abdominal examination shows an enlarged, tender liver. Ultrasonography of the abdomen shows an intrahepatic abscess. Culture of the abscess fluid grows Staphylococcus aureus. Further analysis shows failure of the neutrophils to undergo an oxidative burst when exposed to S. aureus. This patient has an increased susceptibility to infection as a result of which of the following abnormalities? | [
"Failure of leukocytes to migrate between endothelial cells",
"Failure of leukocytes to roll along the endothelial surface",
"Inability of leukocytes to ingest microorganisms",
"Inability of leukocytes to kill intracellular microorganisms"
] | 3D
|
A 2-year-old boy is brought to the emergency department by his babysitter because of a 30-minute history of respiratory distress. The babysitter reports that she is 15 years old and has cared for the patient on numerous occasions during the past year. The child's mother, who is a single parent, is currently out of town for business but will return later tonight. The babysitter says, "He has had a runny nose since I started babysitting yesterday, but this afternoon he awoke from a nap with a barking sound and he was breathing real heavy." She does not know the child's prior health history, nor does she know if the boy takes any medications on a regular basis. The child looks tired and sits upright on the babysitter's lap. He is obviously comfortable with his caregiver. Vital signs are temperature 38.7°C (101.7°F), pulse 110/min, respirations 28/min and labored, and blood pressure 85/50 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 89%. Physical examination discloses inspiratory stridor. Neck is supple, tympanic membranes are normal, and there is a profuse nasal discharge. Examination of the pharynx discloses no abnormalities. Auscultation of the chest discloses equal air entry on both sides and no crackles. The remainder of the examination shows no abnormalities. Treatment with 40% oxygen via venturi mask and intravenous fluids is initiated. Despite continued supplemental oxygen and hydration, the child remains tachypneic and stridorous at rest. Oxygen saturation is now 93%. In addition to administering racemic epinephrine by nebulizer, which of the following is the most appropriate next step? | [
"Intravenous aminophylline therapy",
"Intravenous antibiotic therapy",
"Intubation",
"Oral dexamethasone therapy"
] | 3D
|
A 16-year-old boy is brought to the physician because of a 3-day history of abdominal pain and vomiting; he also has had decreased appetite during this period. The pain was initially on the right but now has become generalized. His temperature is 38.8°C (101.8°F), pulse is 100/min, respirations are 20/min, and blood pressure is 143/83 mm Hg. Abdominal examination shows guarding with diffuse rebound tenderness. There are no palpable masses. A CT scan of the abdomen shows a perforated appendix. Examination of peritoneal fluid from this patient will most likely show which of the following organisms? | [
"Candida albicans",
"Citrobacter freundii",
"Escherichia coli",
"Staphylococcus aureus"
] | 2C
|
A 52-year-old woman comes to the emergency department because of a 1-week history of low-grade fever and increasing abdominal cramps that are exacerbated by bowel movements. She began a course of amoxicillin-clavulanate and metronidazole 2 days ago but has had no relief of her symptoms. She has had intermittent constipation for the past 12 years. She has not had nausea, vomiting, urinary symptoms, or bloody stools. She has a 3-year history of hypertension. She underwent total abdominal hysterectomy and bilateral salpingo-oophorectomy 5 years ago because of leiomyomata uteri. She is 165 cm (5 ft 5 in) tall and weighs 86 kg (190 lb); BMI is 32 kg/m2 . Her temperature is 38.1°C (100.6°F), pulse is 75/min, and blood pressure is 150/80 mm Hg. The lungs are clear to auscultation. Cardiac examination shows no abnormalities. The abdomen is soft, and there is tenderness to palpation of the left lower quadrant with guarding but no rebound. Bowel sounds are normal. The stool is brown, and test for occult blood is negative. Her hemoglobin concentration is 14.5 g/dL, leukocyte count is 15,000/mm3 , and platelet count is 280,000/mm3 ; serum studies and urinalysis show no abnormalities. Which of the following is the most appropriate next step in diagnosis? | [
"Test of the stool for Clostridium difficile toxin",
"Endoscopic retrograde cholangiopancreatography",
"Pelvic ultrasonography",
"CT scan of the abdomen with contrast"
] | 3D
|
A 42-year-old woman comes to the physician because of a 1-year history of vaginal bleeding for 2 to 5 days every 2 weeks. The flow varies from light to heavy with passage of clots. Menses previously occurred at regular 25- to 29-day intervals and lasted for 5 days with normal flow. She has no history of serious illness and takes no medications. She is sexually active with one male partner, and they use condoms inconsistently. Her mother died of colon cancer, and her maternal grandmother died of breast cancer. She is 163 cm (5 ft 4 in) tall and weighs 77 kg (170 lb); BMI is 29 kg/m2 . Her temperature is 36.6°C (97.8°F), pulse is 90/min, respirations are 12/min, and blood pressure is 100/60 mm Hg. The uterus is normal sized. The ovaries cannot be palpated. The remainder of the examination shows no abnormalities. Test of the stool for occult blood is negative. Which of the following is the most appropriate next step in diagnosis? | [
"Progesterone challenge test",
"Colposcopy",
"Cystoscopy",
"Endometrial biopsy"
] | 3D
|
A 77-year-old man is brought to the physician because of a 12-hour history of word-finding difficulty and weakness and sensory loss of the right arm and leg. He has no history of similar symptoms. He has type 2 diabetes mellitus, hypertension, and atrial fibrillation. Current medications include metformin, lisinopril, and aspirin. He is alert. His pulse is 80/min and irregular, respirations are 16/min, and blood pressure is 170/90 mm Hg. He follows commands but has nonfluent aphasia. There is moderate weakness and decreased sensation of the right upper and lower extremities. Deep tendon reflexes are 2+ bilaterally. Babinski sign is present on the right. His serum glucose concentration is 162 mg/dL. Which of the following is the most appropriate next step in diagnosis? | [
"Carotid duplex ultrasonography",
"CT scan of the head",
"EEG",
"Lumbar puncture"
] | 1B
|
A 16-year-old high school student, whose prenatal course you have managed, delivers a 3256-g (7-lb 3-oz) baby girl during the night with the assistance of your associate. On morning rounds you note that the delivery records report that she had mildly elevated blood pressure during labor and sustained an estimated third-stage blood loss of 500 mL. Today blood pressure is 132/84 mm Hg, she is afebrile, and deep tendon reflexes are normal. The uterine fundus is firm and at the level of the umbilicus, and her perineum is slightly edematous. Hematocrit is 33%. She is cuddling her infant and normal bonding seems to be occurring. Which of the following is the most important next step in management? | [
"Begin oral methyldopa",
"Institute fundal massage",
"Order daily sitz baths",
"Provide education for well-baby care"
] | 3D
|
A previously healthy 17-year-old girl comes to the physician because of a 2-month history of exercise-induced cough and nasal congestion. She plays field hockey and has noticed she coughs when running up and down the field. The cough is nonproductive and resolves with rest. She has not had chest pain or palpitations. She takes no medications and does not smoke. Her sister has asthma. The patient appears well. Her pulse is 68/min, respirations are 16/min, and blood pressure is 100/75 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 99%. Cardiopulmonary examination shows no abnormalities. An x-ray of the chest shows no abnormalities. Spirometry shows an FEV1:FVC ratio of 90% and an FEV1 of 90% of predicted. Which of the following is the most likely diagnosis? | [
"Asthma",
"Chronic bronchitis",
"Gastroesophageal reflux disease",
"Postnasal drip syndrome"
] | 0A
|
A 23-year-old woman comes to the physician for genetic counseling prior to conception. Her brother and maternal uncle had Duchenne muscular dystrophy (DMD) and died at the ages of 28 and 17 years, respectively. Genetic analysis was not performed on either relative prior to death. Serum studies show a muscle creatine kinase concentration of 120 U/L (N=22– 198). The patient's 50-year-old mother has a serum muscle creatine kinase concentration of 300 U/L. Which of the following is the most appropriate assessment of this patient's carrier status for this disease? | [
"The patient has a 50% risk of having a child with DMD",
"The patient is a carrier of the disease based on her family history of DMD",
"The patient is not a carrier of the DMD based on her normal creatine kinase concentration",
"The patient's DMD carrier status is uncertain because of random X inactivation"
] | 3D
|
A 3-year-old white girl is brought to the office by her parents for a follow-up visit 48 hours after receiving a 5-TU PPD skin test. The test was done as part of a routine screening for enrollment in a homeless shelter. Physical examination shows 10 mm of induration at the puncture site; the examination is otherwise normal. The parents tell you they are shocked by this finding since both of their skin tests were nonreactive. They say they were born in this country and tell you that their daughter has always been in good health. She has not had much medical care in the past 2 years but she has been healthy. Until moving into this shelter they had been "squatters" in vacant buildings. Which of the following is the most appropriate step at this time? | [
"Call her previous physician to obtain more history",
"Order a chest x-ray",
"Order a test for HIV antibody",
"Repeat the PPD skin test"
] | 1B
|
A 65-year-old female is admitted to the hospital after experiencing aphasia and right-sided hemiparesis. She subsequently develops urinary incontinence. There is no evidence of urinary tract infection and no prior history of urinary pathology. The most likely diagnosis is | [
"autonomic neurogenic bladderv",
"motor paralytic bladder",
"reflex neurogenic bladder",
"uninhibited neurogenic bladder"
] | 3D
|
A 35-year-old woman comes to the office because of a 3-day history of severe right back pain. She has not had any fever, chills, or weight loss. She has no history of major medical illness. Musculoskeletal and neurologic examinations show no abnormalities. When told that her examination is normal, the patient becomes tearful and demands an MRI of her back because her mother just died from breast cancer metastatic to bone and she fears that she may also have cancer. The patient already contacted her insurance company, who told her that if she has neurologic abnormalities an MRI may be covered by her plan. The patient asks the physician to order the MRI indicating that she has neurologic findings. Which of the following is the most appropriate initial action by the physician? | [
"Advise the patient to change insurance companies as soon as she is able so that she can receive more comprehensive medical care",
"Explain that the patient does not need the MRI and that it is not appropriate to misrepresent her examination findings",
"Immediately inform the patient's insurance company about what the patient has asked the physician to do",
"Order the MRI as the patient requests"
] | 1B
|
A 32-year-old man is brought to the emergency department 30 minutes after being struck by a car while driving his motorcycle. He reports severe pelvic pain. On examination, there is bruising of the perineum and pain is elicited with motion of his pelvis. Blood is noted at the urethral meatus. There is no other penile trauma. A plain x-ray shows a fracture of the superior pubic ramus and retrograde urethrography is done to evaluate for a urethral disruption. Which of the following portions of the urethra would be at greatest risk for injury in this patient? | [
"Intramural (pre-prostatic)",
"Membranous",
"Prostatic",
"Spongy"
] | 1B
|
A 33-year-old female presents to the office with the complaint of chronic pelvic pain that began after she underwent a hysterectomy 6 months ago. Following a physical examination, a CT scan of the pelvis is ordered. After the scan is complete, the radiologist calls to report that the patient has a surgical sponge in her pelvis. In a subsequent malpractice suit, the plaintiff establishes that the sponge could not have been left unless there was negligence. The most appropriate term to represent the legal concept invoked by the patient is | [
"collateral estoppel",
"proximate cause",
"res ipsa loquitur",
"respondeat superior"
] | 2C
|
A 35-year-old man comes to the office for follow-up of sarcoidosis. His only new complaint is pain in his legs that increases with weight-bearing. He has been taking glucocorticoid therapy for the past 6 months. Vital signs now are temperature 37.0°C (98.6°F), pulse 78/min, respirations 14/min, and blood pressure 110/70 mm Hg. The patient is thin and is in no acute distress. Auscultation of the chest discloses scattered bilateral basilar crackles. There is mild left hip pain present with both active and passive range of motion. Dorsalis pedis pulse is intact. Neurologic examination is normal. Which of the following is the most likely cause of this patient's symptoms? | [
"Avascular necrosis of the femoral head",
"Herniated nucleus pulposus",
"Narrowing of the hip joint",
"Osteoporosis"
] | 0A
|
A 67-year-old man with Parkinson disease is admitted to the hospital for treatment of pneumonia. The patient's daughter, who is visiting the patient, says he has had increased lethargy for the past day and decreased ambulation during the past 6 months. She also says that there are times during the day when his tremors increase in severity, although he continues to care for himself at home. Medical history is also remarkable for hypertension. Medications include hydrochlorothiazide, atenolol, levodopa, and carbidopa. He is 168 cm (5 ft 6 in) tall and weighs 78 kg (172 lb); BMI is 28 kg/m2 . Vital signs are temperature 38.9°C (102.0°F), pulse 60/min supine and 68/min standing, respirations 22/min, and blood pressure 100/60 mm Hg supine and 80/50 mm Hg standing. The patient appears ill and older than his stated age. He is fully oriented but lethargic. Auscultation of the chest discloses rhonchi in the right mid lung field. Abdominal examination discloses no abnormalities. Neurologic examination discloses masked facies, bradykinesia, and cogwheel rigidity; gait was not assessed on admission. Chest x-ray shows a right lower lobe infiltrate. ECG shows no abnormalities. Appropriate intravenous antibiotic therapy is initiated. Prior to discharge, which of the following is the most appropriate step? | [
"Obtain CT scan of the chest",
"Obtain a swallowing evaluation",
"Place a percutaneous endoscopic gastrostomy (PEG) tube",
"Prescribe fludrocortisone"
] | 1B
|
A 64-year-old woman comes to the physician because of a 5-month history of increasing shortness of breath, sore throat, and a cough productive of a small amount of white phlegm. Over the past week, she has had nausea related to excess coughing. Over the past year, she has had a 3.2-kg (7-lb) weight loss. She has asthma treated with theophylline and inhaled β-adrenergic agonists and corticosteroids. She has smoked one pack of cigarettes daily for 44 years and drinks one alcoholic beverage daily. She appears thin. Examination shows a 2-cm, nontender lymph node in the right supraclavicular area. Examination shows no other abnormalities. An x-ray of the chest shows a large right lower lobe density. A CT scan of the chest shows a 7.5 x 7.5 x 6-cm right lower lobe mass with some scattered calcifications. The lesion abuts the posterior chest wall without clear invasion. There are right lower peritracheal, precarinal, right hilar, and subcarinal lymph nodes. There is a 1.5-cm mass in the right adrenal gland. A biopsy specimen of the lung mass is most likely to show which of the following? | [
"Mesothelioma",
"Metastatic adenocarcinoma of the breast",
"Multiple endocrine neoplasia",
"Non-small cell lung carcinoma"
] | 3D
|
A 46-year-old woman, gravida 1, para 1, comes to the office because of a 2-week history of black discharge from her right nipple. The patient had mammography and ultrasonography of the breasts 2 months ago for evaluation of increased glandularity, palpated in the upper outer quadrant of the right breast, noted at her most recent annual examination. The studies showed likely benign findings with recommended follow-up in 6 months. Medical history is otherwise unremarkable and she takes no medications. BMI is 30 kg/m2 . Vital signs are normal. Palpation of the right breast discloses glandularity in the upper outer quadrant but no other masses. There is scant, black discharge from the right nipple. Which of the following is the most appropriate next step in diagnosis? | [
"Ductography",
"Excisional biopsy of glandular tissue",
"Repeat mammography",
"Repeat ultrasonography of the right breast"
] | 0A
|
A 37-year-old woman with AIDS comes to the physician because of a 1-month history of progressive diarrhea and a 1.8- kg (4-lb) weight loss. During the past week, she has had six large watery stools daily. She is currently receiving triple antiretroviral therapy. She is employed as a flight attendant and works regularly on domestic flights throughout the USA. She also flies to Asia at least once monthly. She is 163 cm (5 ft 4 in) tall and weighs 59 kg (130 lb); BMI is 22 kg/m2 . Her temperature is 37°C (98.6°F), pulse is 88/min, and blood pressure is 112/64 mm Hg. The abdomen is scaphoid. The remainder of the examination shows no abnormalities. Her CD4+ T-lymphocyte count is 400/mm3 (Normal≥500). Which of the following is the most likely causal organism? | [
"Cryptosporidium parvum",
"Cytomegalovirus",
"Mycobacterium avium-intracellulare complex",
"Salmonella enteritidis"
] | 0A
|
A healthy 22-year-old man participates in a study of glucose metabolism. At the beginning of the study, his serum glucose concentration is within the reference range. He consumes an 800-calorie meal consisting of protein, fat, and carbohydrates. He then sleeps through the night without additional food or drink. Twelve hours later, his serum glucose concentration remains within the reference range. Which of the following mechanisms is most likely involved in maintaining this man's serum glucose concentration? | [
"Continued gut absorption of calories from the ingested meal",
"Glucose release from skeletal muscle",
"Glycogenolysis in the liver",
"Increased leptin release from adipose tissues"
] | 2C
|
A 35-year-old man comes to the office because of 1-week history of mid low back pain that radiates down his right leg. The pain began after the patient lifted a heavy box onto his truck. He rates his current pain as an 8 on a 10-point scale. He has been unable to find a comfortable position and has been sleeping in a recliner. Medical history is unremarkable and he takes no medications. He has smoked one pack of cigarettes daily for the past 25 years, and he drinks a six-pack of beer on Friday and Saturday nights. BMI is 27 kg/m2 . He appears uncomfortable and stands during the physical examination. Vital signs are normal. Straight-leg raise test is positive on the right, with loss of right ankle reflex. The remainder of the physical examination discloses no abnormalities. Which of the following is the most likely explanation for this patient’s symptoms? | [
"Displacement of the nucleus pulposus",
"Hypertrophy of the facet joints",
"Osteophyte formation",
"Spondylolisthesis"
] | 0A
|
A 42-year-old man comes to the physician for a follow-up examination. Four months ago, he underwent repair of a Dupuytren contracture. Physical examination shows decreased range of motion in the affected hand. The patient is upset that his hand has not fully healed, and he files a malpractice suit against the physician. Which of the following is the most likely precipitating factor in this patient's decision to file a malpractice suit? | [
"The patient's perception that the physician is incompetent",
"The patient's perception that the physician is uncaring",
"The patient's socioeconomic status",
"The physician's amount of experience in the medical field"
] | 1B
|
A 30-year-old woman, gravida 2, para 0, aborta 1, at 28 weeks' gestation comes to the office for a prenatal visit. She has had one previous pregnancy resulting in a spontaneous abortion at 12 weeks' gestation. Today, her vital signs are within normal limits. Physical examination shows a uterus consistent in size with a 28-week gestation. Fetal ultrasonography shows a male fetus with no abnormalities. Her blood group is O, Rh-negative. The father's blood group is B, Rh-positive. The physician recommends administration of Rho | [
"immune globulin to the patient. This treatment is most likely to prevent which of the following in this mother?",
"Development of natural killer cells",
"Development of polycythemia",
"Formation of antibodies to RhD"
] | 2C
|
A 46-year-old man with Marfan syndrome, aortic insufficiency, and mitral regurgitation comes to the emergency department because he has had severe substernal chest pain for the past 3 hours. He describes the pain as tearing in quality and radiating to the neck. One week earlier he experienced similar but less severe chest pain and treated himself with aspirin. Which of the following is the most likely underlying cause for his worsening symptoms? | [
"Acute bacterial endocarditis",
"Acute myocardial infarction",
"Dissection of the aorta",
"Esophageal reflux with spasm"
] | 2C
|
A 47-year-old man is admitted to the hospital through the emergency department because of the sudden onset of palpitations, left-sided chest pain, light-headedness, and shortness of breath that began while he was watching television 2 hours ago. Medical history is remarkable for paroxysmal atrial fibrillation. The patient is 180 cm (5 ft 11 in) tall and weighs 82 kg (180 lb); BMI is 25 kg/m2 . ECG obtained in the emergency department showed atrial fibrillation with narrow QRS complex. Pulse was 146/min. Physical examination was remarkable for rapid heart rate. The patient was given oxygen via nasal cannula and intravenous metoprolol 5 mg every 5 minutes for a total of 15 mg. His pulse slowed to 90/min. Two hours after admission, he is pain free but his pulse is now 160/min. Blood pressure is 122/78 mm Hg. In order to decrease the patient's pulse, which of the following should be administered intravenously? | [
"Digoxin",
"Enalapril",
"Lidocaine",
"Metoprolol"
] | 3D
|
A 73-year-old woman comes to the physician because of a 2-month history of diffuse weakness and tingling of her arms and legs. Neurologic examination shows weakness of the extensor and flexor muscles of the lower extremities. Knee and ankle deep tendon reflexes are exaggerated. Sensation to vibration and position is decreased in all extremities, but the decrease is more prominent in the lower extremities than in the upper extremities. This patient most likely has a deficiency of which of the following vitamins? | [
"Vitamin B1 (thiamine)",
"Vitamin B2 (riboflavin)",
"Vitamin B6 (pyridoxine)",
"Vitamin B12 (cyanocobalamin)"
] | 3D
|
A 25-year-old man comes to the emergency department because he developed chest pain and shortness of breath 1 hour ago, shortly after snorting cocaine for the first time. He rates the chest pain as a 7 on a 10-point scale and notes that the pain is radiating down his left arm. Medical history is unremarkable and the patient takes no medications or any other illicit drugs. He is 178 cm (5 ft 10 in) tall and weighs 70 kg (154 lb); BMI is 22 kg/m2 . The patient is diaphoretic. Vital signs are temperature 37.5°C (99.5°F), pulse 110/min, respirations 16/min, and blood pressure 200/100 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 95%. Pupils are equal, round, and reactive to light and accommodation. Lungs are clear to auscultation and percussion. Auscultation of the heart discloses an audible S1 and S2. There is no edema, cyanosis, or clubbing of the digits. The patient is fully oriented. He is treated with supplemental oxygen, a 325-mg aspirin tablet, and intravenous nitroglycerin and lorazepam. Despite therapy, he continues to have chest pain and shortness of breath. ECG shows sinus tachycardia with no ST-segment or T-wave abnormalities. Which of the following is the most appropriate additional pharmacotherapy to initiate at this time? | [
"Carvedilol",
"Furosemide",
"Metoprolol",
"Phentolamine"
] | 3D
|
A phase 2, multicenter trial was conducted to determine the efficacy of a new vaccine for prevention of HIV infection. The study enrolled 4000 subjects, aged 20 to 65 years. Of these subjects, 2100 were men and 1900 were women; 2500 were white, 1000 were African American, 300 were Hispanic, and 200 were Asian/Pacific Islanders. Results of the trial showed no overall benefit of the vaccine. However, post hoc analysis disclosed a small but statistically significant vaccine protection among African American subjects. Which of the following is the most accurate rationale for questioning the validity of efficacy analysis of the HIV vaccine among the African American study subjects? | [
"HIV infection is more prevalent among African American populations",
"The study was not blinded",
"There was a Type II error",
"Vaccine response among African American subjects was not the primary outcome measure"
] | 3D
|
A 33-year-old male physician reports for a shift in the emergency department. A nurse alerts you that he noticed a faint odor of alcohol near the physician. When approached, the physician appears tired and more disheveled than usual. There is an odor of alcohol on his breath. He is a skilled and talented physician with no known history of substance or alcohol use disorder. He is married with three children, and his wife is pregnant with twins. The physician was recently hired and has had no actions on his license by any state medical board. Which of the following is the most appropriate next step? | [
"Ask the physician if he is sober, and if he says yes, allow him to complete his shift",
"Explain to the physician that you suspect he is intoxicated and ask him to submit to a blood sample to check his blood alcohol concentration",
"Relieve the physician of duty and alert the hospital's patient safety officer",
"Tell the physician that you can cover the remainder of the shift alone, so that he can sleep in his office"
] | 2C
|
A 22-year-old man comes to the physician for a routine health maintenance examination. He feels well. He has had a painless left scrotal mass since childhood. Examination shows a 6-cm, soft, nontender left scrotal mass that transilluminates; there are no bowel sounds in the mass. Examination of the testis shows no abnormalities. Which of the following is the most likely cause of the mass? | [
"Accumulation of scrotal adipose tissue",
"Cryptorchidism of the left testis",
"Dilation of the pampiniform plexus of veins around the testis",
"Persistence of a patent processus vaginalis"
] | 3D
|
A 35-year-old man with spina bifida is admitted to the hospital for a urologic procedure. He has been functionally independent in activities of daily living and is employed doing inventory control in a local sporting goods store. He has maintained continence through periodic self-catheterization. The patient is paraplegic, has recurrent calcium oxalate kidney stones, and recent onset of incontinence secondary to detrusor and bladder neck dysfunction. Vital signs are normal. Physical examination shows a well-developed, well-nourished man in no acute distress. Aside from paraplegia, lower extremity muscle atrophy, and lower abdominal surgical scars, the physical examination discloses no abnormalities. He had an episode of anaphylaxis secondary to latex allergy during a previous operation for functional expansion of his bladder through a bowel anastomosis. Which of the following is most important to consider in the care of this patient? | [
"Administration of injectable medications with disposable syringes",
"Preparation of food by outside contractors",
"Type of cleaning agents used to sterilize bed linens",
"Use of rubber urethral catheters"
] | 3D
|
A 6-month-old male Hispanic infant is brought to the office by his parents because of intermittent swelling of his right scrotum that is more pronounced when he cries. The swelling has never been red or "stuck." Vital signs are normal. A right inguinal hernia is confirmed on physical examination. In discussing repair of the hernia with the parents, it is most appropriate to inform them of which of the following? | [
"Herniorrhaphy can be postponed until age 2 years because many hernias close spontaneously",
"Herniorrhaphy can be postponed until age 12 years because oligospermia does not develop before age 12",
"Herniorrhaphy should be scheduled at the earliest convenient time",
"Herniorrhaphy should be scheduled as an emergency operation"
] | 2C
|
A 67-year-old woman comes to the physician because of dizziness for 6 weeks. When she stands up suddenly, she becomes light-headed and has to steady herself for approximately 1 to 2 minutes before she is able to walk. She has hypertension and type 2 diabetes mellitus. Current medications include glyburide, a diuretic, a β-adrenergic blocking agent, and an angiotensinconverting enzyme (ACE) inhibitor. Her pulse is 55/min. Her blood pressure is 110/70 mm Hg in the right arm and 70/50 mm Hg in the left arm while supine; her blood pressure is 70/50 mm Hg in the right arm and 50/30 mm Hg in the left arm immediately after standing. Neurologic examination shows no focal findings. An ECG shows sinus bradycardia with no evidence of ischemia. Carotid duplex ultrasonography shows reverse flow in the left vertebral artery with no evidence of occlusion. Which of the following is the most appropriate next step in management? | [
"Cardiac stress scintigraphy",
"Adjusting her medication regimen",
"Warfarin therapy",
"Transesophageal echocardiography"
] | 1B
|
A 17-year-old girl is brought to the physician by her mother because she has not had a menstrual period for 6 months. The patient is unconcerned about the lack of menses. Menarche occurred at the age of 12 years, and menses had occurred at regular 28-day intervals until they became irregular 1 year ago. She is a member of her high school gymnastics team. She appears emaciated. She is 163 cm (5 ft 4 in) tall and weighs 40 kg (88 lb); BMI is 15 kg/m2 . Her pulse is 54/min, and blood pressure is 80/50 mm Hg. Which of the following is the most likely cause of this patient's amenorrhea? | [
"Hyperthyroidism",
"Hypogonadotropic hypogonadism",
"Hypothyroidism",
"Polycystic ovarian syndrome"
] | 1B
|
A 2-year-old boy is brought to the physician for a well-child examination. He was delivered at term after an uncomplicated pregnancy. His birth weight was 3500 g (7 lb 11 oz), and Apgar scores were 8 and 10 at 1 and 5 minutes, respectively. At the age of 15 months, physical examination showed no abnormalities, but he was not yet talking. Both of his parents had learning difficulties in school, and his mother stopped attending after the 10th grade. He has a maternal uncle with cognitive disabilities. He is at the 25th percentile for height, 15th percentile for weight, and 90th percentile for head circumference. He appears irritable, he resists making eye contact, and he is flapping his hands. Which of the following is the most likely cause of this patient's condition? | [
"Frameshift mutation",
"Missense mutation",
"Nonsense mutation",
"Trinucleotide repeat expansion"
] | 3D
|
A 20-year-old man has had frequent upper respiratory tract infections over the past 4 years. He has daily purulent sputum and has noted decreased exercise tolerance over the past 2 years. He and his wife have been unable to conceive because of his low sperm count. Scattered expiratory wheezing and rhonchi are heard throughout both lung fields. An x-ray of the chest shows hyperinflation. Spirometry shows a decreased FEV1:FVC ratio. Which of the following is most likely to confirm the diagnosis? | [
"Arterial blood gas analysis",
"Examination of sputum for eosinophils",
"Sweat chloride test",
"Sputum cytology"
] | 2C
|
A 32-year-old woman, gravida 3, para 2, at 41 weeks' gestation is admitted to the hospital in active labor. Pregnancy has been complicated by mild asthma treated with inhaled bronchodilators. At the beginning of the second stage of labor, the cervix is 100% effaced and 10 cm dilated; the vertex is at -1 station. The fetal heart rate is reactive with no decelerations. After 10 minutes of pushing, there is a prolonged deceleration to 60/min. The patient has the acute onset of shortness of breath, rapidly develops cyanosis, and becomes unresponsive. Her pulse and blood pressure cannot be detected. Immediate resuscitation is started. Five minutes later, there is bleeding from the nose, mouth, and intravenous sites. Which of the following is the most likely diagnosis? | [
"Amniotic fluid embolism",
"Intracerebral hemorrhage",
"Myocardial infarction",
"Status asmaticus"
] | 0A
|
A 32-year-old woman, gravida 2, para 1, at 8 weeks' gestation comes to the physician for her first prenatal visit. She delivered her first child spontaneously at 34 weeks' gestation; pregnancy was complicated by iron deficiency anemia. She has no other history of serious illness. Her blood pressure is 100/70 mm Hg. Examination shows no abnormalities. Ultrasonography shows a dichorionic-diamniotic twin intrauterine pregnancy consistent in size with an 8-week gestation. This patient is at increased risk for which of the following complications? | [
"Abruptio placentae",
"Fetal chromosome abnormality",
"Hyperthyroidism",
"Preterm labor and delivery"
] | 3D
|
A 46-year-old woman with active ankylosing spondylitis comes to the office for a follow-up examination. The use of various conventional nonsteroidal anti-inflammatory drugs has been ineffective. Sulfasalazine treatment also has not resulted in improvement. The most appropriate next step in treatment is administration of a drug that inhibits which of the following? | [
"Cytotoxic T-lymphocyte antigen 4",
"Epidermal growth factor",
"Interleukin-1 (IL-1)",
"Tumor necrosis factor α"
] | 3D
|
An 18-year-old man is brought to the emergency department 10 minutes after he sustained a stab wound to his chest. On arrival, he is unresponsive to painful stimuli. His pulse is 130/min, respirations are 8/min and shallow, and palpable systolic blood pressure is 60 mm Hg. He is intubated and mechanically ventilated, and infusion of 0.9% saline is begun. After 5 minutes, his pulse is 130/min, and blood pressure is 70/40 mm Hg. Examination shows a 2-cm wound at the left sixth intercostal space at the midclavicular line. There is jugular venous distention. Breath sounds are normal. The trachea is at the midline. Heart sounds are not audible. Which of the following is the most appropriate next step in management? | [
"Chest x-ray",
"Echocardiography",
"Bronchoscopy",
"Pericardiocentesis"
] | 3D
|
A 55-year-old male presents to the emergency department with a 2-day history of severe epigastric pain and vomiting. Past medical history is negative for any similar episodes. He does not take any medications. He smokes cigarettes, has a 40 pack-year history, and consumes more than 8 cans of beer per day. Abdominal examination reveals epigastric tenderness. Laboratory studies reveal a serum amylase level of 467 U/L (reference range: 28-100 U/L) and a γ-glutamyltransferase level of 212 U/L (reference range: < 55 U/L). Referred pain in this patient is transmitted to the spinal cord by which of the following nerves? | [
"anterior rami of T1-T5",
"anterior rami of T6-T10",
"anterior rami of T11-T12",
"posterior rami of T1-T5"
] | 1B
|
A 23-year-old woman with bone marrow failure is treated with a large dose of rabbit antithymocyte globulin. Ten days later, she develops fever, lymphadenopathy, arthralgias, and erythema on her hands and feet. Which of the following is the most likely cause of these symptoms? | [
"Cytokine secretion by natural killer cells",
"Eosinophil degranulation",
"Immune complex deposition in tissues",
"Polyclonal T-lymphocyte activation"
] | 2C
|
An epidemic involving 10 individuals of all ages occurs in a migrant worker camp. None of the patients has had any form of immunization. Most cases present with fever, chills, tachypnea, sore throat, swollen glands, and severe malaise. One patient dies from respiratory complications, and another dies from myocardial involvement. A gram-positive rod is isolated from the respiratory tracts of 7 of the patients. The most likely cause of the outbreak is | [
"Bordetella pertussis",
"Corynebacterium diphtheriae",
"Epstein-Barr virus",
"Haemophilus influenzae"
] | 1B
|
A 29-year-old male presents to the office with the complaints of a pounding heart, poor sleep, and a generalized feeling of restlessness. He relocated 2 months ago to take a promotion and has found himself unable to concentrate on his new duties. He worries about his ability to adapt to his increase in responsibility at work and states that he has called in sick 3 days within the past 2 weeks. The most likely diagnosis is | [
"adjustment disorder with anxious mood",
"generalized anxiety disorder",
"major depressive disorder, single episode, moderate",
"obsessive-compulsive personality disorder"
] | 0A
|
A 55-year-old man who is a business executive is admitted to the hospital for evaluation of abdominal pain. He is polite to the physician but berates the nurses and other staff. The patient's wife and two of his three adult children arrive for a visit. The patient says with disgust that the missing child is and always has been worthless. Which of the following is the most likely explanation for this patient's behavior? | [
"Projection",
"Projective identification",
"Reaction formation",
"Splitting"
] | 3D
|
A previously healthy 37-year-old woman comes to the physician because of a 3-month history of episodes of severe anxiety, shortness of breath, palpitations, and numbness in her hands and feet. Her vital signs are within normal limits. Physical examination shows no abnormalities. Thyroid function studies and an ECG show no abnormalities. Which of the following is the most appropriate pharmacotherapy? | [
"Lithium carbonate",
"Methylphenidate",
"Olanzapine",
"Paroxetine"
] | 3D
|
A 30-year-old nulliparous female presents to the office with the complaint of mood changes. She says that for the past several months she has been anxious, hyperactive, and unable to sleep 3 to 4 days prior to the onset of menses. She further reports that on the day her menses begins she becomes acutely depressed, anorectic, irritable, and lethargic. She has no psychiatric history. Physical examination findings are normal. She and her husband have been trying to conceive for over 2 years. History reveals a tuboplasty approximately 1 year ago to correct a closed fallopian tube. The most likely diagnosis is | [
"adjustment disorder with depressed mood",
"bipolar I disorder, mixed",
"cyclothymic personality",
"generalized anxiety disorder"
] | 0A
|
A 54-year-old woman comes to the emergency department because of severe jaw pain since undergoing a painful dental procedure 1 day ago. The patient was prescribed codeine after the procedure and instructed to take the medication every 4 hours, but she has continued pain despite adherence to this analgesic regimen. Other members of her family also have experienced poor pain control with codeine. Which of the following is the most likely explanation for this therapeutic failure? | [
"Decreased absorption of codeine",
"Decreased metabolism of codeine to morphine",
"Deficiency of κ receptors",
"Increased plasma protein-binding of codeine"
] | 1B
|
A healthy 4-year-old girl is brought for a well-child examination. A grade 2/6 systolic ejection murmur is heard along the upper left sternal border. S2 is widely split and does not vary with respiration. A soft mid-diastolic murmur is heard along the lower left sternal border. Examination shows no other abnormalities. Which of the following is the most likely diagnosis? | [
"Aortic stenosis",
"Atrial septal defect",
"Coarctation of the aorta",
"Mitral valve prolapse"
] | 1B
|
A 75-year-old woman comes to the office because she has band-like, burning pain in her right upper abdomen extending from the epigastrium around to the midline of the back. Physical examination discloses no abdominal tenderness to palpation. Findings on ultrasonography of the gallbladder are normal. Serum amylase concentration is within the reference range. Which of the following is the most likely diagnosis? | [
"Acalculous cholecystitis",
"Chronic relapsing pancreatitis",
"Diverticulitis of the cecum",
"Herpes zoster"
] | 3D
|
A 36-year-old man comes to the office because of headaches that began 2 weeks ago. The headaches are moderately severe, are present when he awakens in the morning, and are relieved with over-the-counter analgesics. He has no prior history of headaches. He tells you he was promoted to an upper-level managerial position in his accounting firm about 8 months ago, which necessitated relocating. Physical examination now discloses no abnormalities except for blurring of the optic disc margins bilaterally. Which of the following is the most appropriate next step? | [
"Begin a trial of a β-blocking medication",
"Order CT scan of the head",
"Order EEG",
"Refer him for consultation with a neurologist"
] | 1B
|
A 19-year-old Asian female college student comes to the university health center because of a 1-week history of nasal stuffiness, occasional clear rhinorrhea, and a mild sore throat. Two days ago, she began to feel hot, but she has not taken her temperature. Medical history is unremarkable and her only medication is an oral contraceptive. She has no history of allergies. She does not smoke cigarettes. BMI is 22 kg/m2 . Vital signs are temperature 38.1°C (100.6°F), pulse 88/min, respirations 16/min, and blood pressure 116/74 mm Hg. Physical examination discloses tenderness over the left maxillary sinus without purulent drainage. There is clear fluid behind the left tympanic membrane, enlarged tonsils bilaterally, and pain with tapping of the left upper incisors. Left frontal sinus does not transilluminate. Cardiopulmonary examination discloses no abnormalities. Which of the following is the most likely underlying mechanism of this patient's sinusitis? | [
"Eustachian tube dysfunction",
"Mucosal edema",
"Nasal polyps",
"Oral contraceptive use"
] | 1B
|
A 47-year-old woman comes to the physician because of persistent nonproductive cough for 6 weeks. She has not had fever or weight loss. She has hypertension treated with enalapril for the past 3 months. She does not smoke. There is no history of lung disease. She weighs 54 kg (120 lb) and is 163 cm (64 in) tall. Her temperature is 37°C (98.6°F), blood pressure is 130/80 mm Hg, pulse is 70/min, and respirations are 12/min. Examination and an x-ray of the chest show no abnormalities. Which of the following is the most likely mechanism of this patient's cough? | [
"Decreased plasma renin activity",
"Decreased serum angiotensin II concentrations",
"Increased serum angiotensin I concentrations",
"Increased serum bradykinin concentrations"
] | 3D
|
A 49-year-old man, who is recovering in the hospital 2 days after uncomplicated left femoral-popliteal bypass grafting for claudication, has now developed increasing pain in his left foot. Until now, the patient's postoperative course had been unremarkable and he has been treated with low-dose morphine for pain control. Medical history is remarkable for type 2 diabetes mellitus controlled with metformin and diet. Vital signs now are temperature 36.8°C (98.2°F), pulse 80/min and regular, respirations 20/min, and blood pressure 150/92 mm Hg. The surgical incision appears clean and well approximated without abnormal erythema or swelling. The left lower extremity and foot appear pale. Palpation of the left lower extremity discloses a strong femoral pulse, a weak popliteal pulse, and a cool, pulseless foot. Which of the following is the most appropriate management? | [
"Bedside compartment pressure measurements",
"Doppler ultrasonography of the left lower extremity",
"Intra-arterial tissue plasminogen activator (tPA) therapy",
"Intraoperative angiography"
] | 3D
|
A 9-year-old boy is brought to the physician because of progressive weakness and a purple-red discoloration over his cheeks and upper eyelids over the past 8 weeks. His symptoms began shortly after a camping trip, and he now is unable to climb stairs, walk long distances, comb his hair, or dress himself. His mother says that she was careful to apply his sunscreen on the trip and can recall no tick bites or exposure to poisonous plants. His only medication is a topical corticosteroid for several dry, scaly patches of the skin. He appears weak and lethargic. He is at the 75th percentile for height and 25th percentile for weight; he has had no change in his weight since his last examination 9 months ago. His temperature is 37.7°C (99.8°F), blood pressure is 110/68 mm Hg, pulse is 105/min, and respirations are 28/min. Examination of the skin shows a purple-red discoloration over the cheeks and eyelids, periorbital edema, erythematous plaques and scales over the elbows and knees, and flat-topped red papules over all knuckles. There is generalized weakness and atrophy of the proximal muscles. Which of the following is the most likely diagnosis? | [
"Dermatomyositis",
"Duchenne's muscular dystrophy",
"Eczema",
"Lyme disease"
] | 0A
|
A 52-year-old man comes to the physician with his wife because of a 1-year history of excessive daytime sleepiness. He does not think the symptoms are problematic, but his wife is concerned because he sometimes falls asleep on the sofa early in the evening when guests are present. He also once fell asleep while driving at night and drove off the road, narrowly avoiding injury. His wife says that he has always snored loudly, and over the past year, he has had episodes of choking or gasping for breath while sleeping. He is 178 cm (5 ft 10 in) tall and weighs 105 kg (231 lb); BMI is 33 kg/m2 . His pulse is 76/min, respirations are 14/min, and blood pressure is 150/76 mm Hg. Physical and neurologic examinations show no other abnormalities. Which of the following is most likely to confirm the diagnosis? | [
"24-Hour ambulatory ECG monitoring",
"Multiple sleep latency test",
"Polysomnography",
"CT scan of the head"
] | 2C
|
A 47-year-old man is brought to the emergency department 2 hours after the sudden onset of shortness of breath, severe chest pain, and sweating. He has no history of similar symptoms. He has hypertension treated with hydrochlorothiazide. He has smoked one pack of cigarettes daily for 30 years. His pulse is 110/min, respirations are 24/min, and blood pressure is 110/50 mm Hg. A grade 3/6, diastolic blowing murmur is heard over the left sternal border and radiates to the right sternal border. Femoral pulses are decreased bilaterally. An ECG shows left ventricular hypertrophy. Which of the following is the most likely diagnosis? | [
"Acute myocardial infarction",
"Aortic dissection",
"Esophageal rupture",
"Mitral valve prolapse"
] | 1B
|
A 42-year-old woman with a history of multiple sclerosis comes to the office because she had a sudden loss of vision in the right eye. She has no history of diplopia. External ocular movements are normal but funduscopic examination shows pallor of the optic disk. This patient's condition is most likely a result of demyelination of which of the following? | [
"Medial longitudinal fasciculus",
"Oculomotor nerve",
"Optic nerve",
"Trigeminal nerve"
] | 2C
|
A 26-year-old woman is brought to the emergency department because of an 8-hour history of severe back and abdominal pain and mild but persistent vaginal bleeding. Ultrasonography of the abdomen shows a 2-cm ectopic pregnancy in the ampulla. The ampulla has ruptured into the surrounding tissue. Fluid from this rupture will most likely be found in which of the following locations? | [
"Lesser peritoneal cavity",
"Mesometrium",
"Pouch of Douglas",
"Uterine cavity"
] | 2C
|
A 36-year-old female advertising executive is referred to the office for evaluation of a fasting serum total cholesterol concentration of 249 mg/dL. She has a family history of early coronary artery disease (CAD) and her father died suddenly at age 46 years of myocardial infarction. She tells you that she has never had chest pain. She is not currently sexually active and has no children. She claims that her high-stress lifestyle makes it impossible for her to eat regular meals or to follow a special diet, and she usually eats fast food. She exercises two or three times a week for about 20 minutes on a treadmill. She has smoked one pack of cigarettes daily for the past 20 years. Her only medication is acetaminophen for tension headaches. She is 165 cm (5 ft 5 in) tall and weighs 76 kg (167 lb); BMI is 28 kg/m2 . Vital signs today are normal. Physical examination discloses no abnormalities except for mild obesity. Institution of which of the following is the most essential step in the prevention of CAD in this patient? | [
"Biofeedback-based stress reduction program",
"More rigorous and consistent exercise program",
"Smoking cessation program",
"Strict low-calorie diet"
] | 2C
|
A 39-year-old woman, gravida 2, para 2, comes to the community-based health center because of a 6-month history of a copious, foul-smelling vaginal discharge. She also reports spotting that began 6 months ago and has progressed to heavy bleeding during the past 3 weeks. Medical history is significant for an abnormal Pap smear in her 20s; her most recent Pap smear was done 12 years ago during her second pregnancy, and she recalls the results as being normal. She takes no medications. The patient was married for 18 years; her husband died 4 years ago and had undergone vasectomy after the birth of their last child. The patient has not had any new sexual partners since her husband's death. BMI is 32 kg/m2 . Vital signs are temperature 37.2°C (99.0°F), pulse 90/min, respirations 14/min, and blood pressure 155/96 mm Hg. Speculum examination discloses normal vaginal mucosa. The cervix is friable with a 1-cm exophytic mass lateral to the cervical os at the nine o'clock position. Which of the following is the most critical factor in formulating a management plan for this patient? | [
"Hypertension",
"Obesity",
"Patient age",
"Stage of disease"
] | 3D
|
A 64-year-old male presents to the emergency room with a bloody nose that has been dripping out his nares for the past 2 hours. He denies any trauma, recent upper respiratory illness, or history of prior bloody nose. Past medical history is unremarkable, and he takes no medications. He has a blood pressure of 180/90 mmHg. Examination of the nasal passages reveals that the site of the bleeding is on the septal mucosa of the right naris. The most appropriate next step in management includes | [
"anterior packing",
"placing an ice compress over the nose",
"catheter balloon tamponade",
"pinching the nares together for 5 minutes"
] | 3D
|
A 55-year-old man comes to the physician because of a 2-week history of recurrent, widespread blister formation. Physical examination shows lesions that are most numerous in the flexural areas including the axillae and groin. The blisters do not break easily, and there are no oral lesions. These blisters are most likely the result of adhesion failure involving which of the following? | [
"Basement membrane",
"Dermal papillae",
"Langerhans cells",
"Melanocytes"
] | 0A
|
A 40-year-old female secretary comes to the office because of a 2-month history of fatigue, and generalized aching and weakness of the proximal muscles of all four extremities. The patient initially noticed the weakness only while she was getting in and out of her car, but during the past 2 weeks, the weakness has progressed, so that she now has difficulty combing her hair. Since the symptoms began, she also has had aching of the joints in her hands that has responded partially to ibuprofen. She was adopted and family history is unknown. She has two teenaged children who are well. She appears uncomfortable. She is 170 cm (5 ft 7 in) tall and weighs 68 kg(150 lb); BMI is 24 kg/m2 . Vital signs are temperature 37.7°C (99.8°F), pulse 90/min, respirations 20/min, and blood pressure 110/70 mm Hg. The patient is alert and fully oriented. Physical examination discloses cracking of the skin of both hands that involves the tips and lateral sides of several fingers. The muscles of the upper arms and legs are somewhat tender to pressure. Results of serum laboratory studies show a creatine kinase concentration of 600 U/L and a lactate dehydrogenase concentration of 800 U/L. Results of complete blood count are within the reference ranges. Which of the following is the most likely diagnosis? | [
"Fibromyalgia",
"Myasthenia gravis",
"Polymyositis",
"Scleroderma"
] | 2C
|
A 16-year-old male is brought to the emergency department with sudden-onset swelling of the right knee. He denies any trauma. Past medical history reveals cystic fibrosis. Examination of the knee reveals fluctuance on palpation of the joint but no increased warmth; mild restriction in range of motion due to the swelling is also noted. Numerous bruises are noted in various stages of resolution. Further history reveals easy bruising and bleeding from the gums over the past month. The most likely explanation for these findings is | [
"acquired factor VIII deficiency",
"diffuse intravascular coagulation secondary to infection",
"hypocomplementemia",
"malabsorption of vitamins A, D, E, and K"
] | 3D
|
A 65-year-old man who is quadriplegic as a result of multiple sclerosis is hospitalized for treatment of left lower lobe pneumonia. His temperature is 38.1°C (100.5°F), pulse is 95/min, respirations are 12/min, and blood pressure is 120/80 mm Hg. He appears malnourished. Rhonchi are heard at the left lower lobe of the lung on auscultation. Examination of the heart, lymph nodes, abdomen, and extremities shows no abnormalities. There is a 1-cm area of erythema over the sacrum with intact skin and no induration. Neurologic examination shows quadriparesis. Test of the stool for occult blood is negative. Which of the following is the most effective intervention for this patient's skin lesion? | [
"Frequent turning",
"Use of wet to dry dressings",
"Whirlpool therapy",
"Broad-spectrum antibiotic therapy"
] | 0A
|
A 60-year-old man had a total thyroidectomy and excision of enlarged left jugular lymph nodes for follicular carcinoma. The operation was uncomplicated. He is receiving intravenous 5% dextrose and 0.45% saline with potassium. Twelve hours after the operation he develops circumoral numbness and paresthesias in his fingertips, and he becomes very anxious. Vital signs are temperature 37.6°C (99.7°F), pulse 90/min, respirations 16/min, and blood pressure 140/90 mm Hg. Physical examination discloses a dry neck dressing and no stridor. Extremities are warm, with brisk capillary refill time. Additional physical examination is most likely to show which of the following? | [
"Babinski sign present bilaterally",
"Chvostek sign",
"Deviation of the tongue to the left side",
"A drooping left shoulder"
] | 1B
|
A 44-year-old woman with a 10-year history of arthritis comes to the office because she has had increasing pain and stiffness in her hands, wrists, and knees during the past several months. She also has had increasing fatigue for the past month, along with a weight loss of 1.8 to 2.2 kg (4 to 5 lb). She has seen numerous physicians for her arthritis in the past and has tried various medications and devices, including copper bracelets from Mexico given to her by friends. Review of her medical records confirms that the initial diagnosis of rheumatoid arthritis is correct. She says, "I had several drop attacks during the past 3 months." She characterizes these attacks as episodes of weakness and loss of feeling in her legs for several minutes. During one of these episodes, she became incontinent. She currently takes aspirin approximately four times daily and ibuprofen occasionally. Physical examination shows facial plethora and swollen and painful metacarpophalangeal and knee joints, bilaterally. There is moderate ulnar deviation of the fingers. The remainder of the examination discloses no abnormalities. Which of the following is the most likely cause of her "drop attacks?" | [
"Adrenal insufficiency",
"Anxiety",
"Atlanto-axial instability",
"Cardiac arrhythmia"
] | 2C
|
Three days after hospitalization for diabetic ketoacidosis, an 87-year-old woman refuses insulin injections. She says that her medical condition has declined so much that she no longer wishes to go on living; she is nearly blind and will likely require bilateral leg amputations. She reports that she has always been an active person and does not see how her life will be of value anymore. She has no family and most of her friends are sick or deceased. On mental status examination, she is alert and cooperative. She accurately describes her medical history and understands the consequences of refusing insulin. There is no evidence of depression. She dismisses any attempts by the physician to change her mind, saying that the physician is too young to understand her situation. She says, "I know I will die, and this is what I want." Which of the following is the most appropriate next step in management? | [
"Discharge the patient after she has signed an \"against medical advice\" form",
"Seek a court order to appoint a legal guardian",
"Offer insulin but allow the patient to refuse it",
"Admit to the psychiatric unit"
] | 2C
|
An 8-year-old boy is brought to the office by his mother because of a 3-day history of fever, sore throat, and itchy eyes. He just returned from a weeklong summer camp that included hiking trips and swimming lessons in the camp-owned swimming pool. He has no history of major medical illness and receives no medications. He appears tired. His temperature is 39.4°C (102.9°F); other vital signs are within normal limits. Physical examination shows conjunctival injection and discharge and oropharyngeal erythema. The public health department reports an outbreak of similar symptoms among the other campers and camp volunteers. Which of the following is the most likely cause of this patient’s symptoms? | [
"Adenovirus",
"Cytomegalovirus",
"Epstein-Barr virus",
"Influenza virus"
] | 0A
|
A 24-year-old recent college graduate comes to the office because of a 3-year history of increased frequency of urination and occasional incontinence whenever she travels. She says the urinary symptoms typically begin a few days before she is going to fly and they stop the day after she arrives at her destination. She says she is anxious about flying and even slightly "panicky." She reports having had similar but milder symptoms prior to examinations before graduating. Medical history is otherwise unremarkable. Her only medication is an oral contraceptive. Vital signs are normal. Physical examination discloses no abnormalities. Urinalysis and urine culture are normal. Which of the following is the most appropriate next step? | [
"Recommend behavioral therapy",
"Recommend psychoanalytic psychotherapy",
"Recommend that the patient avoid any stressful activities that cause the problem",
"Review the patient's sexual history"
] | 0A
|
A 54-year-old man comes to the physician because of episodes of fainting for 3 months. He also has had difficulty performing daily tasks because he is easily fatigued. He had a myocardial infarction 12 years ago. His pulse is 40/min, respirations are 18/min, and blood pressure is 138/85 mm Hg. Physical examination shows evidence of cannon a waves. An ECG shows a P-wave rate of 90/min, and an R-wave rate of 40/min, with no apparent relation between the two. Which of the following is the most likely diagnosis? | [
"Right bundle branch block",
"Second-degree atrioventricular block, type I",
"Second-degree atrioventricular block, type II",
"Third-degree atrioventricular block"
] | 3D
|
A 22-year-old woman contacts a medical student and asks if he would like to join her for dinner. The student met the woman when he was assigned to her care during her 2-week hospitalization for treatment of major depressive disorder. He has not treated or seen the patient since she was discharged from the hospital. He is attracted to this former patient and would be interested in dating her. Which of the following is the most appropriate action by the medical student regarding this patient's invitation? | [
"He can date her because he was a medical student, not a physician, when he contributed to her care",
"He can date her because she is no longer his patient",
"He can date her, but only after at least 1 year has passed since he treated her",
"He cannot date her because she was once his psychiatric patient"
] | 3D
|
A 45-year-old woman has a 2-week history of increased anxiety, abdominal discomfort, irritability, and difficulty concentrating; she was robbed at knifepoint in a parking lot 3 weeks ago. She takes levothyroxine for hypothyroidism and uses an over-the-counter inhaler as needed for exercise-induced asthma. Her blood pressure is 140/80 mm Hg, and pulse is 100/min. Examination shows dry skin and hair. She is cooperative but appears anxious, glancing around quickly when a loud noise is heard outside the office. Leukocyte count is 12,000/mm3 , and serum thyroid-stimulating hormone concentration is 5.0 μU/mL. An ECG shows sinus tachycardia. Which of the following is the most likely diagnosis? | [
"Acute stress disorder",
"Agoraphobia",
"Generalized anxiety disorder",
"Hypothyroidism"
] | 0A
|
A 29-year-old Hispanic woman, gravida 3, para 3, comes to the office because of recurrent low back pain during the past year. Rest and analgesics usually eradicate the pain within 2 weeks. However, the pain seems to recur every 2 to 3 months. Medical history is remarkable for gestational diabetes mellitus during her pregnancies. She takes no medications except for an oral contraceptive. She walks 3 miles daily for exercise and works as a sales representative for a computer software company. She is 165 cm (5 ft 5 in) tall and weighs 100 kg (220 lb); BMI is 37 kg/m2 . Vital signs are normal, and physical examination discloses no abnormalities. Which of the following is the most appropriate next step? | [
"Administer an epidural injection of methylprednisolone",
"Order MRI of the lumbosacral spine",
"Order x-rays of the lumbosacral spine",
"Recommend beginning a weight loss program"
] | 3D
|
A 37-year-old man with type 1 diabetes mellitus is admitted to the hospital because of inadequate control of his glucose concentrations for the past 2 months. Despite his poor control, he demands that he be discharged. He reports that he has had a 3-month history of fatigue, irritability, and feelings of hopelessness. He says that he has been noncompliant with his diabetic regimen, adding, "Sometimes I forget." He has been avoiding his family and friends because he is not in the mood to see them but admits that he is lonely. He did not get out of bed for 2 days, which prompted his wife to call an ambulance and have him admitted to the hospital. Prior to admission to the hospital, his only medication was insulin, although he often missed doses. He does not drink alcohol. He is 168 cm (5 ft 6 in) tall and weighs 100 kg (220 lb); BMI is 36 kg/m2 . His temperature is 37°C (98.6°F), pulse is 68/min, respirations are 18/min, and blood pressure is 150/85 mm Hg. Physical examination shows no abnormalities. On mental status examination, he is tired and has a restricted affect. There is no evidence of suicidal ideation. Cognition is intact. His fasting serum glucose concentration is 120 mg/dL. Which of the following is the most appropriate next step in management? | [
"Adhere to the patient's wishes and discuss home-care options",
"Adhere to the patient's wishes on the condition that he agree to home nursing care",
"Schedule neuropsychological testing",
"Seek a court order to appoint a legal guardian"
] | 0A
|
A 7-month-old infant, who was recently discharged from the hospital following an episode of enteritis and dehydration, has persistent watery diarrhea. His mother feeds him cow-milk formula and a variety of strained fruits and vegetables. On physical examination, his temperature is 37.4°C (99.3°F), his mucous membranes are dry, and his abdomen is slightly distended. No other abnormalities are seen. The problem is most likely related to which of the following? | [
"Fructose intolerance",
"Transient lactase deficiency",
"Magnesium deficiency",
"Regional enteritis"
] | 1B
|
A 25-year-old gravida 3 para 2 female is admitted to the hospital at 39 weeks' gestation in active labor. She had been having regular contractions every 4 minutes, but is now having only a few intermittent, weak contractions. She has received medication for pain twice in the past 6 hours. Examination shows no reason for obstructed labor. The fetal head is engaged, the membranes are intact, the fetal heart tones are normal, and the cervix is 100% effaced and 7 cm dilated. The most appropriate management is to | [
"administer an epidural anesthetic",
"administer tocolytic therapy",
"apply cervical topical corticosteroids",
"augment the labor with oxytocin"
] | 3D
|
A 15-year-old girl comes to the emergency department because, she says, "something has been sticking out of my bottom since I had a bowel movement this morning." She has not had previous episodes, although for more than 1 year she has had occasional difficulty passing stools. She is not in pain but is afraid to move her bowels for fear that the problem will worsen. She tells you that she moved away from home more than a year ago and that her parents contribute nothing to her support. She has a 6-month-old child and lives with a 28-year-old female cousin. She has never been married and does not work or attend school. She has no other symptoms. In order to follow the correct procedure for treating a minor, which of the following is the most appropriate step prior to evaluating this patient's rectal problem? | [
"Accept the girl's consent as sufficient",
"Obtain a court order permitting evaluation",
"Obtain the written consent of at least two licensed physicians",
"Obtain written consent from at least one of her parents"
] | 0A
|
A 37-year-old woman is brought to the emergency department 45 minutes after she was found unconscious on her apartment floor. Her coworkers became concerned when she did not arrive for work. On arrival, she is unable to provide a history. Her pulse is 96/min, respirations are 12/min, and blood pressure is 124/58 mm Hg. Examination shows erythema, warmth, and induration of the upper back, buttocks, and posterior thighs. Her serum creatine kinase activity is 10,300 U/L. Urine toxicology screening is positive for opiates and cocaine. Urine dipstick is strongly positive for blood. Microscopic examination of the urine shows pigmented granular casts and rare erythrocytes. This patient is at increased risk for which of the following conditions over the next 24 hours? | [
"Acute respiratory distress syndrome",
"Acute tubular necrosis",
"Cerebral edema",
"Cerebral hemorrhage"
] | 1B
|
A 34-year-old white woman comes to the emergency department because of a persistent dull headache for the past 3 days. She has been taking acetaminophen without relief. She says, "I haven't slept in 3 days and I am having trouble focusing at work." There is no history of trauma and she takes no medications. She has smoked one pack of cigarettes daily for 14 years but does not drink alcoholic beverages. Vital signs are temperature 37.5°C (99.5°F), pulse 86/min, respirations 19/min, and blood pressure 182/100 mm Hg. Examination of the head shows no abnormalities. Pupils are equal, round, and reactive to light; there is mild photophobia. Funduscopic examination is normal. A serous effusion is noted on examination of the left tympanic membrane. Neck is stiff with painful flexion; when the patient's neck is flexed forward, she reports and electric shock sensation. Mild expiratory wheezes are heard on auscultation of the chest. A midsystolic click is heard best at the left sternal border; there are no murmurs or gallops. Abdominal examination shows striae, but is otherwise noncontributory. Examination of the lower extremities shows varicosities bilaterally and 1+ edema; muscle strength is 4/5. Neurologic examination shows no other abnormalities. Which of the following physical findings is most indicative of the need for immediate further evaluation? | [
"Abdominal striae",
"Expiratory wheezes",
"Midsystolic click",
"Neck stiffness"
] | 3D
|
A 14-year-old girl is brought to the physician after her mother learned that she began having sexual intercourse with various partners 1 month ago. She does not use condoms or other contraception. The mother is concerned about her behavior. The patient's parents separated 3 months ago. She had been an honor student and excelled in sports and leadership positions at school before the separation. Since the separation, however, she has become sullen, defiant, and rebellious. She has begun smoking cigarettes, disobeying her curfew, and being truant from school. This patient is most likely using which of the following defense mechanisms? | [
"Acting out",
"Displacement",
"Projection",
"Reaction formation"
] | 0A
|
A previously healthy 27-year-old man comes to the physician 4 weeks after noticing three nontender lesions on his penis. He says they have not changed in size. He is sexually active with multiple male and female partners and uses condoms inconsistently. He takes no medications. He drinks two to five beers on social occasions. He occasionally smokes marijuana. His temperature is 36.9°C (98.4°F). There is no lymphadenopathy. Examination shows three sessile, flesh-colored lesions on the shaft of the penis that are 10 mm in diameter. On application of a dilute solution of acetic acid, the lesions turn white. The remainder of the examination shows no abnormalities. Which of the following is the most appropriate next step in management? | [
"Oral acyclovir therapy",
"Oral doxycycline therapy",
"Intramuscular penicillin therapy",
"Cryotherapy"
] | 3D
|
A 27-year-old man is admitted to the hospital 45 minutes after being involved in a motor vehicle collision. Physical examination shows a sluggish response to stimuli. Neurologic examination shows no other abnormalities. A skull x-ray shows a linear, nondepressed basal skull fracture. Two weeks later, the patient develops polyuria and polydipsia. Laboratory studies show a serum glucose concentration within the reference range, increased serum osmolality, and decreased urine osmolality. Following the administration of desmopressin, urine osmolality increases. The beneficial effect of this drug is most likely due to activation of which of the following? | [
"Adenylyl cyclase",
"Ca2+ channels",
"Janus kinase",
"Serine kinase"
] | 0A
|
A 35-year-old female develops nausea and vomiting after she underwent a cholecystectomy for protracted ileus. Her body mass index was 23 kg/m2 before surgery, and, except for the cholecystitis, she was in good health. The patient remains unable to eat 6 days after surgery. Which of the following forms of nutritional support is most appropriate for this patient? | [
"central hyperalimentation",
"feeding through a nasogastric feeding tube",
"oral fat-free modular diet",
"peripheral hyperalimentation"
] | 3D
|
A 27-year-old nurse comes to the emergency department because of nervousness, dizziness, palpitations, and excess perspiration for the past 3 hours. She has had similar episodes over the past 6 months. The symptoms improve following ingestion of orange juice or soft drinks. She says that she has had a great deal of stress. She has been drinking two alcoholic beverages daily for the past month; before this time, she seldom drank alcohol. Examination shows no abnormalities. Her serum glucose concentration is 30 mg/dL. Intravenous glucose is administered, and the patient's symptoms improve. Which of the following is the most appropriate next step in diagnosis? | [
"Measurement of serum proinsulin and insulin antibodies",
"Measurement of serum cortisol and ACTH concentrations",
"Measurement of serum growth hormone and plasma somatomedin-C concentrations",
"Measurement of serum insulin and C-peptide concentrations"
] | 3D
|
A 54-year-old woman comes to the office because she has had intermittent shooting pain over her right cheek and jaw during the past 3 weeks. Each episode of pain lasts for 1 second or less. The pain is often triggered by cold air, chewing, tactile stimulation, and brushing her teeth. She has had no trauma to the face or head. Medical history is remarkable for tension headaches, obesity, and gastric bypass surgery. She is 165 cm (5 ft 5 in) tall and weighs 62 kg (137 lb); BMI is 23 kg/m2 . Vital signs are normal. The patient cannot tolerate touch over the right side of the face. There is no facial weakness or loss of sensation. The remainder of the physical examination shows no abnormalities. CT scan of the head with and without contrast shows no abnormalities. Which of the following is the most appropriate pharmacotherapy at this time? | [
"Carbamazepine",
"Lamotrigine",
"Levetiracetam",
"Topiramate"
] | 0A
|
A 12-year-old boy with sickle cell disease and type 1 diabetes mellitus is brought to the office by his mother for an initial visit. The family recently moved to the area. Type 1 diabetes mellitus was diagnosed in the patient 6 years ago. Since that time, he has been treated with insulin and dietary management. His insulin regimen has not changed during the past year; however, his mother says he has been only marginally compliant with his insulin and dietary regimens. His diabetic diary shows home fingerstick blood glucose concentrations ranging from 140–200 mg/dL during the past 3 months. He admits to checking his glucose concentrations infrequently. Measurement of hemoglobin A1c obtained last week was 5.4%. The patient's vital signs are temperature 36.8°C (98.2°F), pulse 72/min, respirations 24/min, and blood pressure 110/64 mm Hg. Physical examination shows no abnormalities. Which of the following is the most likely explanation for the discrepancy between the patient's home fingerstick blood glucose concentrations and his hemoglobin A1c? | [
"His daily glucose control is better than recorded",
"His glucometer is reading falsely high and should be replaced",
"His hemoglobin A1c is likely a result of laboratory error and should be repeated",
"His sickle cell disease is affecting his hemoglobin A1c"
] | 3D
|
A 55-year-old woman with small cell carcinoma of the lung is admitted to the hospital to undergo chemotherapy. Six days after treatment is started, she develops a temperature of 38°C (100.4°F). Physical examination shows no other abnormalities. Laboratory studies show a leukocyte count of 100/mm3 (5% segmented neutrophils and 95% lymphocytes). Which of the following is the most appropriate pharmacotherapy to increase this patient's leukocyte count? | [
"Darbepoetin",
"Dexamethasone",
"Filgrastim",
"Interferon alfa"
] | 2C
|
A 14-year-old girl has had nausea, intermittent diarrhea, and a 2.2-kg (5-lb) weight loss over the past 4 weeks. Examination shows a migrating serpiginous pruritic perianal rash. Her leukocyte count is 8000/mm3 with 20% eosinophils. Which of the following tests is most likely to yield an accurate diagnosis? | [
"Blood smear",
"Bone marrow biopsy",
"KOH preparation",
"Microscopic examination of the stool"
] | 3D
|
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