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usmle-12651 | A 44-year-old male presents to his primary care physician for a normal check-up. He reports that he feels well and has no complaints other than a few instances of lightheadedness over the past two months. His past medical history is notable for hypertension for which he takes metoprolol and nifedipine. His temperature is 99°F (37.2°C), blood pressure is 130/80 mmHg, pulse is 80/min, and respirations are 18/min. Physical examination reveals no significant findings. An telemetry strip of this patient is shown in Figure A. Where is the most likely defect in this patient’s conduction system? |
usmle-12652 | An 11-year-old boy is brought to the emergency department by his parents for confusion and fever. The patient began complaining of a headache yesterday afternoon that progressively got worse. After waking him up this morning, his mom noticed that “he seemed funny and wasn’t able to carry a conversation fully.” When asked about his past medical history, the dad claims that he’s been healthy except for 2-3 episodes of finger pain and swelling. Physical examination demonstrates a boy in moderate distress, altered mental status, and nuchal rigidity. A CSF culture reveals a gram-positive, diplococci bacteria. What characteristic would you expect in the organism most likely responsible for this patient’s symptoms? |
usmle-12653 | A 47-year-old male develops nonbloody emesis over the past 45 minutes. He presents to a walk-in clinic. The patient reports eating left-over reheated Chinese fried rice and chicken for lunch 3 hours ago. After 30 minutes of monitoring, the vomiting ceases, and the patient remains stable without any further symptoms or complications. Which of the following Gram stains represents the most likely causative organism in this patient's presentation? |
usmle-12654 | 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? |
usmle-12655 | A 35-year-old man returns from a trip from Mexico in good health. Soon after, he appears to your office due to complaints of diarrhea. His history is significant for bloating and flatulence. The patient states that he has trouble flushing his stool and is concerned that his diarrhea has not gone away. Peripheral smear of the patient's stool reveal a motile organism as shown in Figure A. What is the most likely cause of this patient's diarrhea? |
usmle-12656 | A 34-year-old woman presents to the clinic for a lump in her neck. She was showering the other day and felt a small, pea-sized nodule at her left neck. She denies any weight changes, heart palpitations, nail changes, fatigue, or diarrhea but does endorse constipation that she attributes to a change in her diet. Her past medical history is significant for non-Hodgkin lymphoma that was treated with radiation 21 years ago. A physical examination demonstrates an irregularly-shaped, pea-sized nodule that does not move when the patient swallows. A biopsy is performed and its results are shown in Figure A. What is a distinguishing factor that differentiates this condition from other thyroid cancers? |
usmle-12657 | A 32-year-old man presents to the emergency department with a severe headache. He says that the pain has been getting progressively worse over the last 24 hours and is located primarily in his left forehead and eye. The headaches have woken him up from sleep and it is not relieved by over-the-counter medications. He has been recovering from a sinus infection that started 1 week ago. His past medical history is significant for type 1 diabetes and he has a 10 pack-year history of smoking. Imaging shows thrombosis of a sinus above the sella turcica. Which of the following findings would most likely also be seen in this patient? |
usmle-12658 | A 59-year-old presents with right-sided hemiparesis, right-sided sensory loss, leftward eye deviation, and slurred speech. A head CT is performed which is significant for a hyperdense lesion affecting the putamen. The patient has a history of hypertension treated with hydrochlorothiazide, but is non-adherent. Which of the following is most likely associated with the cause of this patient’s neurological deficits? |
usmle-12659 | A 27-year-old female presents to her primary care physician because she is concerned about lighter colored patches on her skin. She recently went sunbathing and noticed that these areas also did not tan. Her doctor explains that she has a fungal infection of the skin that damages melanocytes by producing acids. She is prescribed selenium sulfide and told to follow-up in one month. Which of the following describes the appearance of the most likely infectious organism under microscopy? |
usmle-12660 | A 62-year-old woman presents to her primary care physician for her annual check-up. She has no current complaints and says that she has been healthy over the last year. Her past medical history is significant for obesity and diabetes that is well controlled on metformin. She does not smoke and drinks socially. Selected lab results are shown below:
High-density lipoprotein: 48 mg/dL
Low-density lipoprotein: 192 mg/dL
Triglycerides: 138 mg/dL
Given these results, the patient is placed on the drug that will be the best therapy for these findings. Which of the following is a potential side effect of this treatment? |
usmle-12661 | A 64-year-old woman presents to the emergency room with rapidly worsening chest pain and shortness of breath. She developed dull substernal chest pain 3 hours ago while watching a movie with her grandchildren. Her past medical history is notable for hyperlipidemia, hypertension, and knee osteoarthritis. She takes atorvastatin and lisinopril. She has a 15-pack-year smoking history and drinks 2-3 glasses of wine with dinner each night. She recently returned to the United States from a month-long trip to China. Her temperature is 98.6°F (37°C), blood pressure is 154/90 mmHg, pulse is 118/min, and respirations are 25/min. On exam, she appears uncomfortable but is able to respond to questions in complete sentences. A normal S1 and S2 are heard on cardiac auscultation. Her symptoms do not improve with sublingual nitroglycerin. Multiple troponin levels are taken and are normal. An electrocardiogram is shown in Figure A. What is the underlying cause of this patient’s condition? |
usmle-12662 | A 39-year-old man presents to his primary care physician with a 10-hour history of severe diarrhea. He says that he was recently at a company picnic and after returning home he began to experience severe watery diarrhea. He says that the diarrhea was accompanied by nausea and abdominal pain. His physician informs him that he was likely infected by a lactose-fermenting, gram-negative organism. Which of the following changes would be seen in a cell that was affected by the heat stable toxin produced by this organism? |
usmle-12663 | A 48-year-old woman with a history of obesity presents with acute onset of diffuse epigastric pain that began a few hours ago and then localized to the right upper quadrant. Further questioning reveals that the pain has been exacerbated by eating but has otherwise been unchanged in nature. Physical exam reveals severe right upper quadrant pain that is accompanied by arrest of respiration with deep palpation of the right upper quadrant. Which of the following symptoms is associated with the most likely etiology of this patient's presentation? |
usmle-12664 | A 62-year-old woman with a history of hypertension, hyperlipidemia, and rheumatoid arthritis presents for evaluation of elevated serum liver chemistries. She has had three months of intense, unremitting itching. Current medications include chlorthalidone, atorvastatin, and ibuprofen. Physical exam is unremarkable. Laboratory studies show aspartate aminotransferase (AST) 42 units/L, alanine aminotransferase (ALT) 39 units/L, alkaline phosphatase 790 units/L, total bilirubin 0.8 mg/dL, and antimitochondrial antibody titer 1:80. What do you expect to see on liver biopsy? |
usmle-12665 | A 51-year-old man presents to his primary care provider complaining of malaise. He returned from a research trip to Madagascar 2 weeks ago and has since developed a worsening fever with a maximum temperature of 102.2°F (39°C). He also reports some swelling around his neck and groin. He works as a zoologist and was in rural Madagascar studying a rare species of lemur. His past medical history is notable for hypertension and gout. He takes lisinopril and allopurinol. His temperature is 101.9°F (38.3°C), blood pressure is 145/85 mmHg, pulse is 110/min, and respirations are 22/min. On exam, he has painful erythematous cervical, axillary, and inguinal lymphadenopathy. Black hemorrhagic eschars are noted on his fingertips bilaterally. The pathogen responsible for this patient’s condition produces a virulence factor that has which of the following functions? |
usmle-12666 | A 12-year-old boy follows up with his primary care physician for ongoing management of a urinary tract infection. He recently started middle school and has been having a difficult time navigating the school since he ambulates with leg braces and crutches. Consequently, he has not had sufficient time to use his urinary catheter appropriately. Otherwise, he has been unchanged from the previous visit with both sensory and motor defects in his lower extremities. He has had these defects since birth and has undergone surgeries to repair a bony defect in his spine with protrusion of a membrane through the defect. During what days of embryonic development did the defect responsible for this patient's symptoms most likely occur? |
usmle-12667 | A 67-year-old male is seen by neurology after he was noticed to be speaking strangely by his family. After acute treatment with tissue plasminogen activator (tPA), the patient is able to recover most of his speech. Subsequent neurologic exam finds that the patient is fluent while speaking and is able to comprehend both one and two step instructions. Noticeably the patient remains unable to complete tasks involving verbal repetition. Residual damage to which of the following structures is most likely responsible for this patient's syndrome? |
usmle-12668 | A 53-year-old male presents to his primary care physician complaining of fatigue and joint and muscle pain. He reports a 6-month history of slowly progressive tiredness associated with dull achy pain in his knees, hips, and shoulders. His past medical history is notable for hypertension, diabetes, and stable angina. He takes lisinopril, metformin, glyburide, and aspirin. He has a history of intravenous drug use and was homeless in his early 30’s. He drinks alcohol socially and has a 30 pack-year smoking history. His temperature is 98.6°F (37°C), blood pressure is 130/85 mmHg, pulse is 95/min, and respirations are 18/min. Physical examination reveals a generally well-appearing male without evidence of ascites, peripheral edema, or jaundice. Results from laboratory tests are below:
Hepatitis A IgM: Negative
Hepatitis A IgG: Negative
Hepatitis B surface antigen: Negative
Hepatitis B E antigen: Negative
Hepatitis B core antigen: Negative
Hepatitis B surface IgG: Positive
Hepatitis B E IgG: Negative
Hepatitis B core IgG: Negative
Hepatitis C IgG: Positive
HCV RNA: 100,000,000 IU/ml
This patient should be started on which of the following medications? |
usmle-12669 | A 24-year-old man presents to the emergency department with shortness of breath and anxiety. He states that his symptoms started this morning and have not improved since then. The patient has a past medical history of intravenous drug abuse and recently started methadone but is otherwise healthy. Last night he was binge drinking and vomited twice. His temperature is 99.5°F (37.5°C), blood pressure is 97/58 mmHg, pulse is 120/min, respirations are 17/min, and oxygen saturation is 98% on room air. The patient's previous (top) and current (bottom) electrocardiogram (ECG) are seen in Figure A. Physical exam is notable for a rapid heart rate with cranial nerves II-XII grossly intact. Which of the following is the most likely predisposing etiology for this patient's current presentation? |
usmle-12670 | A 10-year-old girl presents to your office with a fever and rash. Her mother first noticed the rash 2 days ago after a camping trip. The rash began on her wrists and ankles and has now spread to her palms and the soles of her feet. This morning, she was feeling unwell and complaining of a headache. She had a fever of 102°F (39°C) prompting her mother to bring her to your office. She is otherwise healthy and does not take any medications. Her medical history is significant for a broken arm at age 8. On physical exam her blood pressure is 120/80 mmHg, pulse is 110/min, and respirations are 22/min. You notice a petechial rash on the palms, soles, ankles, and wrists. Which of the following findings would confirm the most likely cause of this patient's symptoms? |
usmle-12671 | A 35-year-old male nurse presents to the emergency room complaining of fever and malaise. He recently returned from a medical trip to Liberia to help with a deadly outbreak of a highly infectious disease. He reports severe generalized muscle pain, malaise, fatigue, and a sore throat. He has recently developed some difficulty breathing and a nonproductive cough. His past medical history is notable for asthma. He drinks alcohol socially and does not smoke. His temperature is 102.1°F (38.9°C), blood pressure is 115/70 mmHg, pulse is 115/min, and respirations are 24/min. On examination, a generalized maculopapular rash and bilateral conjunctival injection are noted. Laboratory testing reveals the presence of negative sense, singled-stranded linear genetic material with filaments of varying lengths. The pathogen responsible for this patient’s symptoms is most similar to which of the following? |
usmle-12672 | A 58-year-old man comes to the emergency department for complaints of crushing chest pain for 4 hours. He was shoveling snow outside when the pain started. It is rated 7/10 and radiates to his left arm. An electrocardiogram (ECG) demonstrates ST-segment elevation in leads V2-4. He subsequently undergoes percutaneous coronary intervention (PCI) and is discharged with aspirin, clopidogrel, carvedilol, atorvastatin, and lisinopril. Five days later, the patient is brought to the emergency department by his wife with complaints of dizziness. He reports lightheadedness and palpitations for the past 2 hours but otherwise feels fine. His temperature is 99.7°F (37.6°C), blood pressure is 95/55 mmHg, pulse is 105/min, and respirations are 17/min. A pulmonary artery catheter is performed and demonstrates an increase in oxygen concentration at the pulmonary artery. What finding would you expect in this patient? |
usmle-12673 | A 46-year-old man is brought to the emergency room by police after being found passed out on the sidewalk. He is intermittently alert and smells strongly of alcohol. He is unable to provide a history, but an electronic medical record search reveals that the patient has a history of alcohol abuse and was seen in the emergency room twice in the past year for alcohol intoxication. Further review of the medical record reveals that he works as a day laborer on a farm. His temperature is 98.8°F (37.1°C), blood pressure is 122/78 mmHg, pulse is 102/min, and respirations are 14/min. On examination, he is somnolent but arousable. He has vomitus on his shirt. He is given intravenous fluids and provided with supportive care. He vomits twice more and is discharged 6 hours later. However, 6 days after discharge, he presents to the emergency room again complaining of shortness of breath and fever. His temperature is 102°F (38.9°C), blood pressure is 100/58 mmHg, pulse is 116/min, and respirations are 24/min. The patient is actively coughing up foul-smelling purulent sputum. Which of the following is the most likely cause of this patient’s current symptoms? |
usmle-12674 | A 45-year-old male presents to your office following a diagnosis of an autosomal dominant disease. He has started therapy and has a strong family support system. He endorses a decrease in appetite over the last two weeks that he attributes to sadness surrounding his diagnosis and a depressed mood but denies any suicidal ideation. He continues to enjoy working in the yard and playing with his children. On physical examination you notice involuntary quick jerky movements of his hands and feet. Which of the following would you expect to see in this patient? |
usmle-12675 | A 2-year-old boy is brought in by his parents to his pediatrician. The boy was born by spontaneous vaginal delivery at 39 weeks and 5 days after a normal pregnancy. The boy has received all age-appropriate vaccinations as of his last visit at 18 months of age. Of note, the boy has confirmed sickle cell disease and the only medication he takes is penicillin prophylaxis. The parents state that they plan on enrolling their son in a daycare, which requires documentation of up-to-date vaccinations. The pediatrician states that their son needs an additional vaccination at this visit, which is a polysaccharide vaccine that is not conjugated to protein. Which of the following matches this description? |
usmle-12676 | A 44-year-old with a past medical history significant for human immunodeficiency virus infection presents to the emergency department after he was found to be experiencing worsening confusion. The patient was noted to be disoriented by residents and staff at the homeless shelter where he resides. On presentation he reports headache and muscle aches but is unable to provide more information. His temperature is 102.2°F (39°C), blood pressure is 112/71 mmHg, pulse is 115/min, and respirations are 24/min. Knee extension with hips flexed produces significant resistance and pain. A lumbar puncture is performed with the following results:
Opening pressure: Normal
Fluid color: Clear
Cell count: Increased lymphocytes
Protein: Slightly elevated
Which of the following is the most likely cause of this patient's symptoms? |
usmle-12677 | A 62-year-old man is brought to his primary care physician by his wife who is concerned about the patient's frequent falls. Approximately 6 months ago, she started noticing that he was walking more slowly than usual. He has fallen more than 6 times in the past month, and she is worried that he will sustain a serious injury if he does not stop falling. The patient is a retired banking executive and was active as a triathlete until the age of 60. He does not smoke and drinks 2-3 alcoholic beverages per day. His family history is notable for normal pressure hydrocephalus in his mother and Alzheimer dementia in his father. His temperature is 97.8°F (36.6°C), blood pressure is 131/81 mmHg, pulse is 68/min, and respirations are 19/min. On exam, his movements appear slowed and forced. He shuffles his feet when he walks. Tone is increased in his upper and lower extremities bilaterally. This patient's condition is most strongly associated with which of the following histologic findings on brain autopsy? |
usmle-12678 | A 63-year-old woman with a history of adult polycystic kidney disease and COPD presents to her optometrist after having difficulty watching a movie. She has no other complaints. She is accompanied by her daughter, who notes that her mother hasn’t been able to look at her since the previous day. On exam, her right eye has full range of motion, but her left eye is fixed in a down and outward position. What is the most likely cause of her symptoms? |
usmle-12679 | Physical exam of a 15-year-old female reveals impetigo around her mouth. A sample of the pus is taken and cultured. Growth reveals gram-positive cocci in chains that are bacitracin sensitive. Which of the following symptoms would be concerning for a serious sequelae of this skin infection? |
usmle-12680 | A 20-year-old male with no significant medical history comes to you with a urine positive for fructose. He does not have diabetes mellitus. Which enzyme is most likely to be deficient in this patient? |
usmle-12681 | A 59-year-old woman with a past medical history of atrial fibrillation currently on warfarin presents to the emergency department for acute onset dizziness. She was watching TV in the living room when she suddenly felt the room spin around her as she was getting up to go to the bathroom. She denies any fever, weight loss, chest pain, palpitations, shortness of breath, lightheadedness, or pain but reports difficulty walking and hiccups. A physical examination is significant for rotary nystagmus and decreased pin prick sensation throughout her left side. A magnetic resonance image (MRI) of the head is obtained and shows ischemic changes of the right lateral medulla. What other symptoms would you expect to find in this patient? |
usmle-12682 | A 67-year-old woman is brought to the clinic by her husband for changes in personality. He reports that 3 years ago she began to forget day-to-day things (e.g., where her keys are and the directions home). She would intermittently forget who her friends are and put the remote in the refrigerator. Recently, the husband noticed stark changes in her personality as she is more impatient, aggressive, and sometimes violent. She denies any fever, trauma, focal neurologic deficits, or sensory changes. Her past medical history is significant for diabetes and hypertension for which she takes metformin and lisinopril, respectively. A physical examination is unremarkable. Which of the following Figures is characteristic of her disease? |
usmle-12683 | A 45-year-old woman comes to the physician’s office with complaints of jaw pain. When she eats, yawns, or rubs her jaw, she gets intense, shooting pains down the left side of her jaw, including her lower lip and chin. These episodes last about 30 seconds and have recurred about 10 times per day for the last month. She finds these episodes extremely distressing and comes to the physician’s office in hope of finding a treatment. The patient denies any locking of her jaw. Physical exam is not notable for any tenderness to palpation over the jaw. She has no crepitus in her temporomandibular joint. The patient is able to open and close her jaw without pain. The nerve involved in this patient’s clinical presentation exits the skull through which of the following brain structures? |
usmle-12684 | A 24-year-old woman comes to her primary care physician complaining of a thick yellow-green vaginal discharge and mild pain with intercourse that has been present for the past 2 weeks. She is concerned about this as she has recently had a number of new sexual partners with whom she rarely uses barrier protection. The physician performs a pelvic examination and obtains a cervical culture that yields the organism shown in Figure A. The patient asks if there is a vaccine that she can receive to prevent future infections with this organism. The physicians explains that unfortunately no such vaccine exists. Which of the following properties of this organism accounts for this? |
usmle-12685 | A 27-year-old G2P1001 woman at 20 weeks 2 days of gestation presents to the clinic for her routine anatomy scan. She feels regular movement of her baby, denies any bleeding or discharge, and denies any other concerns. During the scan, ultrasound findings of the head are shown in Figure A. What presentation would you expect in this fetus once it is born? |
usmle-12686 | A 4-year-old child presents to the pediatrician with mental retardation, ataxia, and inappropriate laughter. The parents of the child decide to have the family undergo genetic testing to determine what the cause may be. The results came back and all three had no mutations that would have caused this constellation of symptoms in the child. Karyotyping was performed as well and showed no deletions, insertions, or gene translocations. Based on the symptoms, the child was diagnosed with Angelman syndrome. Which of the following genetic terms could best describe the mechanism for the disorder in the child? |
usmle-12687 | A 75-year-old man is brought to the emergency room after being found unconscious in his home. His medical history is unknown. On physical examination he does not demonstrate any spontaneous movement of his extremities and is unable to respond to voice or painful stimuli. You notice that he is able blink and move his eyes in the vertical plane. Based on these physical exam findings, you expect that magnetic resonance angiogram will most likely reveal an occlusion in which of the following vessels? |
usmle-12688 | A 14-year-old boy is brought to the emergency department for confusion and extreme fatigue since returning home from school today. His mother is also concerned because his personality has changed over the last 6 months with an increase in aggression and irritability. Further history reveals that he has been suffering from frequent nosebleeds as well as more bleeding than expected from minor trauma. Physical exam reveals splenomegaly and the finding shown in Figure A. Labs show an elevated serum ammonia level. A mutation in which of the following proteins is most likely to be responsible for this patient's symptoms? |
usmle-12689 | A 12-year-old African American boy presents to the emergency department with severe abdominal and joint pain. He has had these episodes twice before and has family members who have suffered similar symptoms. He is also found by CBC to have a hematocrit of 28%. After acute management he is referred for genetic counseling due to clinical suspicion and is found to have the mutation shown in Figure A. Which of the following types of mutations does this represent? |
usmle-12690 | A 71-year-old man is brought to the emergency room by ambulance after he was found down by his wife. Upon arrival he is unresponsive, and advanced cardiac life support procedures are initiated. His wife says that he has been recently complaining of chest pain but was unable to provide more details about the nature of the symptoms. His past medical history is significant for Marfan syndrome and rheumatic fever as a teenager. After recovery of a pulse, an electrocardiogram is obtained in this patient, and the results are shown in Figure A. Which of the following is the most likely mechanism of action for a treatment that is contraindicated given the pattern of this patient's disease process? |
usmle-12691 | An 11-year-old boy is brought to his pediatrician by his mother after he has complained of worsening left thumb pain for the last two weeks. The mother reports that the patient was previously healthy. Approximately 2 weeks ago, the family cat bit the patient’s thumb. The area around the bite wound then became red, hot, and slightly swollen and never healed. Earlier this week, the patient also started developing fevers that were recorded at home to be as high as 103.6°F. On exam, the patient's temperature is 102.2°F (39.0°C), blood pressure is 112/72 mmHg, pulse is 92/min, and respirations are 14/min. The patient’s left thumb is tender to touch over the proximal phalanx and the interphalangeal joint, but there is no obvious erythema or swelling. A radiograph performed in clinic is concerning for osteomyelitis at the proximal phalanx. Which of the following is the most likely cause of this patient’s condition? |
usmle-12692 | A 35-year-old man presents to the clinic complaining of skin lesions on his hands and face. The lesions started appearing after his vacation to Hawaii where he snorkeled, hiked, and sunbathed on the beach. He complains of itchiness and moderate pain around the skin lesions but denies fever, weight changes, headaches, mental status changes, abdominal pain, or bowel changes. His past medical history is significant for asthma and allergic rhinitis, both of which are well controlled with medications. A physical examination demonstrates skin blisters and hyperpigmentation concentrated on the hands and face (shown in Figure A). What enzyme is likely deficient in this patient? |
usmle-12693 | A 52-year-old man presents to a medical clinic to establish care. He has no known chronic illnesses but has not seen a physician in over 20 years. He generally feels well but occasionally has shortness of breath when he jogs and exercises. He smokes 2-5 cigarettes per day and uses IV heroin “now and then.” Physical exam is unremarkable. ECG shows prominent QRS voltage and left axis deviation. Trans-thoracic echocardiogram shows mild concentric left ventricular hypertrophy but is otherwise normal. Which of the following is the most likely etiology of the echocardiogram findings? |
usmle-12694 | A 2-year-old girl is brought to the emergency room by her parents for seizure-like activity earlier today. Her mother describes that she was napping when both of her arms began to twitch and she started foaming at the mouth. She was unresponsive during this time and the episode lasted a total of 30 seconds. The mother denies any fever, pain, recent trauma, changes in feeding, or gastrointestinal changes in her daughter. She states her daughter has recently been lethargic and is currently receiving antibiotics for an ear infection. The patient was born vaginally at home via a midwife without any complications. A physical examination is unremarkable. Results of her laboratory studies are shown below.
Hemoglobin: 13 g/dL
Hematocrit: 38%
Leukocyte count: 7,600/mm^3 with normal differential
Platelet count: 170,000/mm^3
Serum:
Na+: 136 mEq/L
Cl-: 101 mEq/L
K+: 3.9 mEq/L
HCO3-: 20 mEq/L
BUN: 25 mg/dL
Glucose: 34 mmol/L
Creatinine: 0.8 mg/dL
Thyroid-stimulating hormone: 3.2 µU/mL
Ca2+: 9.3 mg/dL
AST: 183 U/L
ALT: 220 U/L
What is the most likely explanation for this patient’s symptoms? |
usmle-12695 | A 27-year-old man presents to a physician for evaluation of 3 months of increased vertigo. He says that occasionally he will experience several seconds of intense vertigo that makes him lose his balance. He came in for evaluation because this symptom is affecting his ability to drive to work. He has also been occasionally experiencing tinnitus. Physical exam reveals rotatory nystagmus that is delayed in onset and stops with visual fixation. The nerve that is most likely causing these symptoms exits the skull at which of the following locations? |
usmle-12696 | A mother brings her six-year-old daughter to the pediatrician over concern of a new rash. The mother notes that her daughter began complaining of a headache four days ago. Since that time, she has been less active and has had intermittent nausea and diarrhea. The mother also noticed increasing facial redness as well as a blotchy rash across her body. On presentation, the patient's temperature is 101.5°F (38.6°C), blood pressure is 105/70 mmHg, pulse is 100/min, and respirations are 25/min. Physical exam reveals the finding shown in Figure A. The pathogen most likely responsible for this disorder has what type of genetic material? |
usmle-12697 | Two weeks after returning from a two month spelunking trip in Tennessee to observe the brown bat's living habitat, a 30-year-old female presents with a two-week history of fever, productive cough, weight loss, and dyspnea. A chest radiograph was performed showing very small miliary opacities (Figure A). A sputum sample was taken and stained with methenamine (Figure B) and a histopathological sample taken from one of the opacities in the chest radiograph (Figure C). Which of the following is the most likely causative agent of the patient's symptoms and clinical findings? |
usmle-12698 | A 53-year-old man presents to your Louisiana gulf coast community hospital with 48 hours of profuse watery diarrhea and 24 hours of vomiting and chills. The patient has a past medical history significant for hypertension and hypercholesterolemia. The patient denies sick contacts or any interaction with animals for the last month. Two days ago the patient attended a family crawfish boil where oysters, boiled crabs, and crawfish were consumed. Stool occult blood was negative. What is the most likely etiology of the patient's symptoms? |
usmle-12699 | A 72-year-old man presents to the emergency department by ambulance with altered mental status. The man has a history of prostate cancer which was treated with trans-urethral resection. He now has a chronic indwelling urethral catheter due to urethral strictures. In the emergency department, the man's vitals are: HR: 89; BP: 125/70 mmHg; T: 37.1C. Urinalysis demonstrates a leukocyte esterase positive result. Urine culture results are pending. A Gram stain of the urine is shown in Figure A. Which of the following is the most likely causative organism? |
usmle-12700 | A 52-year-old female immigrant presents to the emergency department with severe tearing chest pain radiating to the back. She was a sex-worker in her home country and has had little medical care since emigrating to the United States. She remains a heavy smoker. A notable physical exam finding is shown in Figure A. The patient is hypotensive upon arrival, and rapidly expires. Which of the following describes the pathogenesis underlying the immediate cause of death? |
usmle-12701 | A 54-year-old man presents to clinic complaining of swallowing difficulties. The patient states that the symptoms began slowly over the past year, but now he has become concerned that food seems to stay in his throat every time he swallows. The patient also reports a 15 pound weight loss in the past 2 years that he attributes to his swallowing difficulties. The patient has also noticed increased shortness of breath with exertion in recent months. Of note, the patient immigrated from Venezuela 6 months prior and has no other past medical history. His temperature is 98.4°F (36.9°C), blood pressure is 118/74 mmHg, pulse is 62/min, and respirations are 12/min. An esophagram is shown in Figure A. The patient also undergoes a cardiac workup for his shortness of breath, and a right bundle branch block is seen on the electrocardiogram. Which of the following may have played a role in the pathogenesis of this patient’s disease? |
usmle-12702 | A 10-year-old boy is brought in to the emergency room by his parents after he complained of being very weak during a soccer match the same day. The parents noticed that yesterday, the patient seemed somewhat clumsy during soccer practice and was tripping over himself. Today, the patient fell early in his game and complained that he could not get back up. The patient is up-to-date on his vaccinations and has no previous history of illness. The parents do report that the patient had abdominal pain and bloody diarrhea the previous week, but the illness resolved without antibiotics or medical attention. The patient’s temperature is 100.9°F (38.3°C), blood pressure is 110/68 mmHg, pulse is 84/min, and respirations are 14/min. On exam, the patient complains of tingling sensations that seem reduced in his feet. He has no changes in vibration or proprioception. Achilles and patellar reflexes are 1+ bilaterally. On strength testing, foot dorsiflexion and plantar flexion are 3/5 and knee extension and knee flexion are 4-/5. Hip flexion, hip extension, and upper extremity strength are intact. Based on this clinical history and physical exam, what pathogenic agent could have been responsible for the patient’s illness? |
usmle-12703 | You are seeing a 34-year-old male in clinic for a new-onset productive cough. The cough has been present for 2 month and is blood-tinged. The patient has also noticed that when he wakes up in the morning his bed sheets are soaked, and that he has recently had to tighten his belt to keep his pants from falling down. Upon further review, you discover that the patient is a recent immigrant from Nigeria. You get a sample of the patient's sputum and use a Ziehl-Neelsen stain, with its finding seen in Figure A. What therapeutic agent targets the cellular component responsible for this finding? |
usmle-12704 | A 56-year-old man comes to the emergency department complaining of substernal chest pain that radiates to the left shoulder. Electrocardiogram (EKG) demonstrates ST-elevations in leads II, III, and aVF. The patient subsequently underwent catheterization with drug-eluting stent placement with stabilization of his condition. On post-operative day 3, the patient experiences stabbing chest pain that is worse with inspiration, diaphoresis, and general distress. His temperature is 98.7°F (37.1°C), blood pressure is 145/97mmHg, pulse is 110/min, and respirations are 23/min. EKG demonstrates diffuse ST-elevations. What is the best treatment for this patient? |
usmle-12705 | A 6-year-old female child presents to the Emergency Department for the third time this year for fractures of the wrist and forearm. While questioning the father, the intern learns that the child's mother passed away a year ago, and the father has sole custody of the child. The father appeared rather annoyed that he had to bring the child to see the doctor again. When asked about the child's mother, the father recalls that the mother had a similar coloring of the whites of the eye as the child (Figure A) and both were "very hard of hearing." Which of the following steps, if corrected, would treat this disorder? |
usmle-12706 | A 5-year-old patient is brought to the emergency department by his parents for concerning behavior. His parents relate that over the past 3 weeks, he has had multiple episodes of staring into space, lip smacking, and clasping his hands together. The patient has his eyes open during these episode but does not respond to his parents’ voice or his name. These episodes last between 1-2 minutes after which the patient appears to return back to awareness. The patient is confused after these episodes and appears not to know where he is for about 15 minutes. These episodes occur once every few days and the most recent one happened about 10 minutes before the patient arrived to the emergency department. On arrival, the patient is mildly confused and does not know where he is or what recently happened. He is slow to respond to questions and appears tired. Which of the following is the most likely diagnosis in this patient? |
usmle-12707 | A 30-year-old woman presents to your office with decreased appetite, malaise, and fever. Serologic tests reveal positive Anti-HBsAg and Anti-HAV IgM antibodies. Which of the following is most likely responsible for this patient's presentation? |
usmle-12708 | A 43-year-old type 1 diabetic woman who is poorly compliant with her diabetes medications presented to the emergency department with hemorrhage from her nose. On exam, you observe the findings shown in figure A. What is the most likely explanation for these findings? |
usmle-12709 | A 61-year-old male dies in a motor vehicle accident. Autopsy of the heart reveals dilatation of the left atrium and expansion of the left ventricular cavity with associated eccentric hypertrophy. The structural changes in this patient's heart are most likely associated with which of the following? |
usmle-12710 | A 17-year-old male presents with seizure. He was feeling under the weather for the past 3 days. His mother reported that his symptoms began with a headache and malaise and progressed to severe nausea and vomiting. He was also rubbing his neck. Past surgical history is significant for a splenectomy after a car accident. Vital signs are stable with the exception of a temperature of 39°C (102°F). On physical exam, he is post-ictal but has no focal neurological deficits. Lumbar puncture is significant for low glucose, high protein, and an elevated white blood cell count with a polymorphonuclear neutrophil predominance. Gram stain shows the following in Figure A. What features describe the pathogen responsible for this patient's illness? |
usmle-12711 | A 39-year-old female presents to her gynecologist complaining of a breast lump. Two weeks ago, while performing a breast self-examination she noticed a small firm nodule in her left breast. She is otherwise healthy and takes no medications. Her family history is notable for a history of breast cancer in her mother and maternal aunt. On physical examination, there is a firm immobile nodular mass in the superolateral quadrant of her left breast. A mammogram of her left breast is shown. Genetic analysis reveals a mutation on chromosome 17. This patient is at increased risk for which of the following conditions? |
usmle-12712 | A 25-year-old man presents to the emergency department after fainting at his investment banking office. He states that he has experienced intermittent headaches since high school, but has never fainted. He reports eating multiple small meals regularly throughout the day. He further notes that multiple family members have frequently complained about headaches. Physical exam reveals a well-nourished, well-built, afebrile man with BP 170/80, HR 55, RR 10. Chemistries reveal Na 147, K 3, Cl 110, HCO3 30, BUN 25, Cr 1.1, glucose 120. A biopsy of the tissue most likely at issue in this patient will reveal the most abnormal cellular amounts of which of the following? |
usmle-12713 | A 2-year-old child is brought to the pediatrician's office by his mother, who reports that he has had a fever at home of 103.9F, and recently developed a rash that started on his face and now involves his chest (Figure A). Further history reveals the boy had a cough that started a few days earlier. Which of the following pathogens is mostly likely responsible for this child's illness? |
usmle-12714 | A 15-year-old boy is sent from gym class with a chief complaint of severe muscle aches. In class today he was competing with his friends and therefore engaged in weightlifting for the first time. A few hours later he was extremely sore and found that his urine was red when he went to urinate. This concerned him and he was sent to the emergency department for evaluation.
Upon further questioning, you learn that since childhood he has always had muscle cramps with exercise. Physical exam was unremarkable. Upon testing, his creatine kinase level was elevated and his urinalysis was negative for blood and positive for myoglobin.
Thinking back to biochemistry you suspect that he may be suffering from a hereditary glycogen disorder. Given this suspicion, what would you expect to find upon examination of his cells? |
usmle-12715 | A 30-year-old man presents to the emergency room complaining of malaise. Two hours prior to presentation, he developed muscle cramps and nausea. He has had 3 episodes of non-bloody watery stools since his symptoms started. He reports that he has experienced similar symptoms multiple times over the past 5 years since he started working at his local zoo as a reptilian caretaker. His medical history is unremarkable. He takes fish oil and a multivitamin daily. His temperature is 101°F (38.3°C), blood pressure is 130/90 mmHg, pulse is 90/min, and respirations are 17/min. On exam, he demonstrates sensitivity to bright light. He is tired-appearing but alert and fully oriented. A stool sample and culture demonstrates abundant non-lactose fermenting, oxidase-negative, and H2S-producing gram-negative bacilli. The pathogen responsible for this patient’s condition relies on a virulence factor with which of the following mechanisms of action? |
usmle-12716 | A 45-year-old female florist presents to the general medical clinic with a local pustule on the dorsal side of her left hand with nodules extending up the wrist (Figure A). She states that she stabbed herself with metal wiring when she was making flower bouquets. The pustule was drained and the pus was sent to pathology to be examined which showed a cigar-shaped budding yeast was observed. The patient was prescribed a medication that inhibits ergosterol synthesis. Which of the following medications must the prescribing physician be most aware of to prevent any serious drug interactions? |
usmle-12717 | A 53-year-old female presents to her primary care physician with a complaint of progressive pruritis and general malaise. She works as a waitress and has smoked 1/2 pack a day for the last 20 years. She endorses drinking 3-4 beers on weekends. On physical exam vital signs are HR 68 bpm, BP 120/77 mmHg, RR 13 rpm, O2 Sat 96% on room air. She appears run down, and you note scleral icterus but no other ophthalmic abnormalities; the rest of her exam is unremarkable. Routine labs are notable for elevated GGT, alkaline phosphatase, and elevated total bilirubin with a significant indirect hyperbilirubinemia. A biopsy of her liver shows marked portal inflammation with granulomatous lesions (Figure A). Which of the following would you expect to be elevated in this patient? |
usmle-12718 | A 35-year-old man with no known past medical history presents to his physician because he is applying for a job as a healthcare worker, which requires screening for the hepatitis B virus (HBV). The patient states that he is in good health and denies any symptoms. His vital signs and physical exam are unremarkable. Labs are drawn, and the patient's HBV serology shows the following:
HBsAg: positive
anti-HBsAg antibody: negative
HBcAg: positive
anti-HBcAg IgM: negative
anti-HBcAg IgG: positive
HBeAg: negative
anti-HBeAg antibody: positive
Which of the following best describes this patient's results? |
usmle-12719 | A 52-year-old man presents to an urgent care center in Missouri for evaluation of a lesion on his right hand, which initially appeared 4 days ago as a raised red bump. He denies trauma to the hand, other than a tick bite that he noticed last week. He also reports 3 days of headache, fatigue, myalgias and diaphoresis. He has no chronic medical conditions, takes no medications, lives alone, and has no pets. He works as a park ranger at a nearby state park, and likes to hike and hunt in his spare time. He eats a balanced diet of fruits, vegetables, eggs, and wild game. Physical exam is notable for a moderately ill-appearing man with tender lymphadenopathy of the right axilla, with overlying erythema. Temperature is 102°F (38.9°C), blood pressure is 120/75 mmHg, pulse is 109/min, and respirations are 21/min. A photograph of the patient’s right hand is shown below (Figure A). Which is the most likely causative agent of this patient’s illness? |
usmle-12720 | A 32-year-old man presents to his primary care physician with a 5-day history of high fevers. He says that the fevers occur intermittently, and he has not noticed a pattern for when they occur. The fevers are also accompanied by myalgias, chills, and night sweats. He lives on the northeastern coast of the United States but recently returned from a safari vacation in Africa. He does not have any previously known medical issues. On presentation, his temperature is 102.9°F (39.4°C), blood pressure is 118/76 mmHg, pulse is 105/min, and respirations are 16/min. A peripheral blood smear is obtained and shown in Figure A. Which of the following is true about the most likely cause of this patient's symptoms? |
usmle-12721 | A 60-year-old woman undergoes a lung transplant due to emphysema secondary to alpha-1 antitrypsin deficiency. Following the transplant, she develops a low-grade fever, dyspnea, and non-productive cough. A chest radiograph demonstrates diffuse ground-glass opacities. A biopsy taken during a bronchoscopy of the lung is shown in Figure A. What is the most appropriate treatment? |
usmle-12722 | A 27-year-old woman presents to a neurologist complaining of facial pain. She reports that over the past 6 months, she has developed intermittent burning unilateral facial pain that happens over 10 seconds to 3 minutes. The pain is severe enough to completely stop her from her activities. She is worried whenever she goes out that another attack will happen and she is sad that this has limited her ability to work as a lawyer. Her past medical history is notable for irritable bowel syndrome and polycystic ovarian syndrome. She takes an oral contraceptive pill. Her temperature is 98.6°F (37°C), blood pressure is 130/75 mmHg, pulse is 75/min, and respirations are 18/min. On exam, she is a well-appearing woman who is alert, oriented, and appropriately interactive. Her pupils are 2 mm and reactive to light bilaterally. Fundoscopic examination is unremarkable. Her strength and range of motion are full and symmetric in her upper and lower extremities. This patient’s symptoms are likely due to irritation of a nerve that passes through which of the following foramina? |
usmle-12723 | A 27-year-old man presents to the emergency department with general weakness and fatigue. He states that he has not felt well for several days and can't take care of himself anymore due to fatigue. The patient has a past medical history of IV drug abuse, alcohol abuse, and multiple minor traumas associated with intoxication. His temperature is 104°F (40°C), blood pressure is 127/68 mmHg, pulse is 120/min, respirations are 19/min, and oxygen saturation is 98% on room air. A murmur is heard on cardiac exam. The patient is treated appropriately and transferred to the inpatient floor and recovers over the next several days. The patient has been unable to eat solids, though he has been drinking large amounts of juice. On day 5 of his stay, the patient states he feels much better. He is no longer febrile. His only concern is profuse and watery diarrhea and severe abdominal pain which he has been experiencing since yesterday. The patient is started on IV fluids and given oral fluid replacement as well. Which of the following is associated with the most likely underlying diagnosis? |
usmle-12724 | A 51-year-old man presents to his primary care physician's office for a 6-week history of fatigue and diarrhea. He says that the diarrhea is frequent, small volume, and contains gross blood. Review of systems is significant for subjective fever and an unintentional 5-pound weight loss. He denies recent travel outside of the United States. His past medical history is significant for IV drug abuse, HIV infection with non-compliance, and osteoarthritis. His family history is significant for Crohn disease in his mother. His temperature is 100.7°F (38.2°C), pulse is 90/min, blood pressure is 129/72 mmHg, and respirations are 16/min. His abdominal exam shows mild right and left lower quadrant tenderness with no rebound or guarding. Laboratory results are significant for a CD4 count of 42/mm^3. Colonoscopy with tissue biopsy will most likely reveal which of the following? |
usmle-12725 | A 34-year-old female begins to experience fatigue and malaise one month after returning from vacation abroad. She has gotten several colds and frequent nose bleeds in the interim. A friend also remarked that she was looking pale. Further questioning reveals that she had gotten an infection while abroad and was treated with an unknown antibiotic. Physical exam reveals diffuse petechiae and conjunctival pallor. The bone marrow biopsy is shown in Figure A. Which of the following is the most likely antibiotic this patient received abroad? |
usmle-12726 | A 26-year-old man is brought to the emergency department due to right-sided facial and upper extremity weakness and aphasia. The patient was in his usual state of health until two hours prior to presentation, when he was eating breakfast with a friend and acutely developed the aforementioned symptoms. Medical history is unremarkable except for mild palpitations that occur during times of stress or when drinking coffee. Physical examination is consistent with the clinical presentation. Laboratory testing is unremarkable and a 12-lead electrocardiogram is normal. A non-contrast head CT and diffusion-weighted MRI shows no intracranial hemorrhage and an isolated superficial cerebral infarction. Transthoracic echocardiography with agitated saline mixed with air shows microbubbles in the left heart. There is a possible minor effusion surrounding the heart and the ejection fraction is within normal limits. Which of the following is most likely the cause of this patient's clinical presentation? |
usmle-12727 | A 32-year-old G2P2 woman gives birth to a boy at 39 weeks gestation. The mother recently immigrated from Somalia and had no prenatal care. She refused all intrapartum medications. The boy’s Apgar scores were 7 and 9 at 1 and 5 minutes, respectively. His height and weight were in the 20th and 15th percentiles, respectively. Mother and child were discharged the day after birth. However, 7 days later, the mother presents to the pediatrician because she noticed redness and discharge in her baby's eyes. His temperature is 98.8°F (37.1°C), blood pressure is 105/65 mmHg, pulse is 120/min, and respirations are 22/min. On exam, the boy has scant non-purulent mucoid bilateral eye discharge and conjunctival hyperemia. Which of the following is the most appropriate treatment for this patient? |
usmle-12728 | A 60-year-old male engineer who complains of shortness of breath when walking a few blocks undergoes a cardiac stress test because of concern for coronary artery disease. During the test he asks his cardiologist about what variables are usually used to quantify the functioning of the heart. He learns that one of these variables is stroke volume. Which of the following scenarios would be most likely to lead to a decrease in stroke volume? |
usmle-12729 | A 72-year-old man with longstanding history of diabetes mellitus and hypertension presents to the emergency department with sudden-onset numbness. On your neurological exam, you note that he has loss of sensation on the left side of his face, arm, and leg. His motor strength exam is normal, as are his cranial nerves. Which of the following is the most likely explanation for his presentation? |
usmle-12730 | A 54-year-old man with a past medical history significant for hypertension, type 2 diabetes, and chronic obstructive pulmonary disease presents with complaints of nausea and abdominal pain for the past month. The pain is located in the epigastric region and is described as “burning” in quality, often following food intake. The patient denies any changes in bowel movements, fever, or significant weight loss. Medications include metformin, lisinopril, hydrochlorothiazide, albuterol inhaler, and fluconazole for a recent fungal infection. Physical examination was unremarkable except for a mildly distended abdomen that is diffusely tender to palpation and decreased sensation at lower extremities bilaterally. A medication was started for the symptoms. Two days later, the patient reports heart palpitations. An EKG is shown below. Which of the following is the medication most likely prescribed? |
usmle-12731 | A 30-year-old man is diagnosed with multi-drug resistant tuberculosis after a recent trip to Eastern Europe. After drug susceptibility testing is completed, he is given a regimen of antibiotics as treatment. He returns two weeks later complaining of decreased visual acuity and color-blindness. Which drug of the following is the mechanism of action of the drug that is most likely to cause this side effect? |
usmle-12732 | A 37-year-old man comes to the emergency department with the chief complaint of a high fever for several days. In addition to the fever, he has had malaise, chest pain, and a dry cough. He recently went on vacation to South America but has returned to his job delivering packages. He has several friends who recently had influenza. Hi temperature is 102.8°F (39.3 °C), blood pressure is 137/80 mmHg, pulse is 104/min, respirations are 19/min, and oxygen saturation is 98%. Chest exam reveals a deep noise found bilaterally in the lung bases. Chest radiograph reveals a wider area of opacity near the heart and bilateral lung infiltrates. Which of the following is characteristic of the most likely organism responsible for this patient's symptoms? |
usmle-12733 | A 29-year-old female presents to the family physician concerned over the blue-black discoloration of her sclera and skin. She notes that at the end of her day, there are black stains in her underwear. The incomplete breakdown of which of the following amino acids is responsible for this presentation? |
usmle-12734 | A 6-year-old girl comes with her parents to the physician’s office to initiate care with a new physician. The patient was recently adopted and her parents do not know her birth history; however, she has had some issues with fatigue. They were told by the adoption agency that the patient has required blood transfusions for “low blood count” in the past but they are not aware of the reason for these transfusions. Her temperature is 37.8°C (99.8°F), blood pressure is 110/84 mmHg, and pulse is 95/min. Physical examination is notable for conjunctival pallor, pale skin, and mild splenomegaly. A complete blood count is taken in the office with the following results:
Hemoglobin: 6.8 g/dL
Leukocyte count: 5,000/mm^3
Platelet count: 190,000/mm^3
Peripheral smear shows echinocytes and further analysis reveals rigid red blood cells. The most likely cause of this patient's symptoms has which of the following modes of inheritance? |
usmle-12735 | A 27-year-old unconscious man is brought to the ED by EMS. He was found face down in the middle of the sidewalk at 2AM. The patient is disheveled and smells of alcohol. Physical exam reveals bruising and ecchymosis at the right temple and 1-mm pupils bilaterally. His temperature 97.1°F (36.3°C), blood pressure is 84/58 mmHg, pulse is 71/min, respirations are 8/min. Following initial stabilization and respiratory support, what is the best next step for this patient? |
usmle-12736 | A 25-year-old female presents to urgent care with complaints of one day of burning and pain with urination, urgency, and frequency. She denies having a fever but has experienced intermittent chills. She is sexually active and inconsistently uses condoms. The patient has no past medical history. She is allergic to sulfa drugs. Physical examination of the genitalia is normal. Urinalysis shows positive leukocyte esterase and nitrites. The urine culture demonstrates gram-negative rods that form pink colonies on MacConkey agar. She is treated with an antibiotic and her symptoms quickly improve. The mechanism of the antibiotic she was most likely treated with is which of the following? |
usmle-12737 | A 23-year-old woman presents to her primary care provider complaining of diarrhea. She reports a 2 month history of 3-4 bloody stools per day as well as 10 pounds of unexpected weight loss. She has also developed intermittent mild gnawing lower abdominal pain. Her past medical history is unremarkable. She takes no medications and denies any drug allergies. Her family history is notable for colon cancer in her maternal aunt, rheumatoid arthritis in her paternal aunt, and Sjogren syndrome in her paternal grandmother. Her temperature is 99.1°F (37.3°C), blood pressure is 120/85 mmHg, pulse is 85/min, and respirations are 18/min. On exam, she has mild hypogastric tenderness to palpation. A stool guaiac test is positive. Flexible sigmoidoscopy demonstrates hyperemic and friable rectal mucosa. She is started on a medication to address her condition but presents to her physician one week later with a severe sunburn and skin itchiness following limited exposure to sunlight. Which of the following is the mechanism of action of the medication she received? |
usmle-12738 | A 39-year-old man presents to his primary care physician with a high fever, cough, and malaise. One week ago, he returned from a vacation to Hawaii where he went waterskiing with his family. Three days before presentation, he started experiencing intermittent abdominal pain, which was followed by flu-like symptoms, itchiness in his eyes, and photosensitivity. On presentation, his temperature is 103°F (39.4°C), blood pressure is 114/72 mmHg, pulse is 105/min, and respirations are 18/min. Physical exam reveals conjunctivitis and mild jaundice. Which of the following treatments could be used to treat this patient's condition? |
usmle-12739 | A 60-year-old woman with a history of atrial arrhythmia arrives in the emergency department with complaints of tinnitus, headache, visual disturbances, and severe diarrhea. The patient is given oxygen by nasal cannula. ECG leads, pulse oximeter and an automated blood pressure cuff are applied. The patient suddenly faints. Her ECG indicates the presence of a multifocal ventricular tachycardia with continuous change in the QRS electrical axis. Which of the following drugs is most likely responsible for this patient's symptoms? |
usmle-12740 | A 12-year-old boy who is being treated with phenytoin for recurrent generalized tonic-clonic seizures presents to his neurologist for a check-up. The patient has no complaints, and has not had any recent seizure activity. On physical examination of the mouth and oropharynx, the physician notes the finding shown in Figure A. Which of the following is associated with the pathophysiology behind this adverse-effect? |
usmle-12741 | A 67-year-old man is brought to the emergency department by his wife due to dizziness, trouble with walking, and progressively worsening headache. These symptoms began approximately two hours prior to arriving to the hospital and were associated with nausea and one episode of vomiting. Medical history is significant for hypertension, hypercholesterolemia, and type II diabetes mellitus, which is managed with lisinopril, atorvastatin, and metformin. His temperature is 99°F (37.2°C), blood pressure is 182/106 mmHg, pulse is 102/min, and respirations are 20/min. On physical examination, the patient has right-sided dysmetria on finger-to-nose testing and right-sided dysrhythmia on rapid finger tapping. This patient's abnormal physical exam findings is best explained by decreased neuronal input into which of the following nuclei? |
usmle-12742 | A 22-year-old female college student presents to the clinic with complaints of intense vaginal itching and a painful sensation when urinating. She also notes that she has felt more lethargic and has additionally been experiencing recent fevers and headaches. She says that she is sexually active and occasionally uses condoms. On physical exam, she is found to have red, vesicular ulcers on her labia that are painful to palpation and tender inguinal lymphadenopathy. What is the most likely pathogen causing her presentation? |
usmle-12743 | A 62-year-old female presents to her primary care physician complaining of bloody stool. She reports several episodes of bloody stools over the past two months as well as a feeling of a mass near her anus. She has one to two non-painful bowel movements per day. She has a history of alcohol abuse and hypertension. Anoscopy reveals engorged vessels. Which of the following vessels most likely drains blood from the affected region? |
usmle-12744 | A 45-year-old man is brought to the emergency room for fever and headache for the past 6 days. He reports dizziness, forgetfulness, and cough, but denies chest pain, palpitations, abdominal pain, sensory changes, or weakness. His medical history is significant for HIV infection that is being treated. He does not recall his last CD4 count. A physical examination demonstrates a positive Brudzinski test. A computed tomography (CT) of the head is ordered and its results are shown in Figure A. Which of the following finding would you most likely find in this patient? |
usmle-12745 | A 59-year-old male with a past medical history of intravenous drug abuse presents with the following rash as seen in Figure A. He has laundry list of medical complaints. His symptoms initially started when he noticed his urine began appearing cola-colored. Subsequent workup with a nephrologist revealed an elevated creatinine, hematuria, and hypertension with an unknown etiology. He then began having joint pains and numbness in his fingers and toes. Strangely, his symptoms become worse in cold weather. His vital signs are within normal limits with the exception of a blood pressure of 170/95. On physical examination, in addition to the rash, you notice that his spleen and liver are mildly enlarged. Subsequent blood tests reveal decreased C4 levels and an increased ESR. In addition, you detect monoclonal IgM with rheumatoid factor activity and polyclonal IgG in his serum. You put together this patient's multiple symptoms in the context of these laboratory studies and deduce the following: |
usmle-12746 | A 25-year-old woman presents to her primary care provider for evaluation of a "painful mass in my left groin." She says that her symptoms began 4 days ago as a painful mass that slowly enlarged, ruptured, and ulcerated. However, she denies fever, chills, dysuria, or hematuria. Three weeks prior to her current symptoms she noted a small, painless ulcer on her labium majorum that resolved after a few days. She admits to having unprotected sex with a male partner a month ago while she was traveling in Southeast Asia. Temperature is 99°F (37.2°C), blood pressure is 139/84 mmHg, pulse is 76/min, and respirations are 18/min. Physical examination is significant for left-sided, tender, ulcerative lymph nodes with a dark discoloration. Which of the following is most likely to be seen in this patient's condition? |
usmle-12747 | A 54-year-old woman presents to the emergency department due to recent onset of a high fever, accompanied by severe headache and neck stiffness. Her past medical history is significant for rapidly progressive glomerulonephritis. She is currently on immunosuppressants after a kidney transplant performed 6 months ago. On presentation, her temperature is 102.2°F (39°C), blood pressure is 112/71 mmHg, pulse is 107/min, and respirations are 22/min. Physical exam reveals severe pain with neck flexion and reciprocal knee flexion. Laboratory tests reveal a gram-positive organism with endotoxin. Which of the following characteristics is true of the most likely cause of this patient's disorder? |
usmle-12748 | A 29-year-old man presents to the emergency room with facial weakness. He first noticed that he was having trouble smiling normally while at dinner with friends the night before. He also noticed that his food had less taste than usual during the dinner. He woke up on the day of presentation with a complete inability to move the right side of his face. He recently returned from an extended camping trip in the Appalachian Mountains, but he did not find any tick bites following the camping trip. His past medical history is notable for Achilles tendonitis and carpal tunnel syndrome. He works as a computer programmer. He smokes marijuana occasionally but does not smoke cigarettes. His temperature is 98.6°F (37°C), blood pressure is 120/75 mmHg, pulse is 80/min, and respirations are 18/min. On exam, he is well-appearing in no acute distress. There is loss of facial wrinkles along the forehead, eyelids, and nasolabial folds. He is unable to completely close his right eye, raise his eyebrows, or smile with the right side of his mouth. Sensation is intact to light touch along the forehead, maxilla, and mandible bilaterally. Where is the most likely source of this patient’s lesion? |
usmle-12749 | A 39-year-old male presents to your office with nodular skin lesions that progress from his right hand to right shoulder. The patient reports that the initial lesion, currently necrotic and ulcerative, developed from an injury he received while weeding his shrubs a couple weeks earlier. The patient denies symptoms of respiratory or meningeal disease. Which of the following most likely characterizes the pattern of this patient’s skin lesions: |
usmle-12750 | A 5-year-old patient presents to the pediatrician’s office with fatigue and swollen lymph nodes. Extensive work-up reveals a diagnosis of acute lymphoblastic leukemia. In an effort to better tailor the patient’s treatments, thousands of genes are arranged on a chip and a probe is made from the patient’s DNA. This probe is then hybridized to the chip in order to measure the gene expression of thousands of genes. The technology used to investigate this patient’s gene expression profile is the best for detecting which of the following types of genetic abnormalities? |