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Answer the following medical question with one of the provided options:
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Q:A 65-year-old man presents with acute abdominal pain accompanied by chills, nausea, and vomiting. His past medical history is significant for benign prostatic hyperplasia and diabetes mellitus type 2. His medications are tamsulosin and metformin. His last HbA1c, 5 months ago, was 6.7. He had a screening colonoscopy 5 years ago which was normal. He denies blood in the stool or urine and has had no change in bowel habits. Throughout the encounter, the patient has difficulty getting comfortable on the exam table. His temperature is 38.2°C (100.7°F), the heart rate is 103/min, the respiratory rate is 15/min, and the blood pressure is 105/85 mm Hg. Physical exam is significant for left costovertebral angle tenderness. Peritoneal signs are absent. CBC, CMP, and urinalysis results are pending. Abdominal X-ray is shown. Which of the following is the next best step in management?? {'A': 'Observation with hydration, bed rest, and analgesics', 'B': 'Amlodipine', 'C': 'Antibiotics', 'D': 'Surgical removal and antibiotics', 'E': 'Urine alkalinization'},
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D: Surgical removal and antibiotics
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Answer the following medical question with one of the provided options:
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Q:A 74-year-old man returns to his physician to follow-up on laboratory studies obtained for anemia 2 weeks ago. He has no complaints. He has a 20-year history of hypertension and several years of knee osteoarthritis. He walks 2 miles a day. He does not smoke. He drinks alcohol moderately. He takes hydrochlorothiazide, losartan, and pain killers, including ibuprofen. The vital signs include: temperature 37.1°C (98.8°F), pulse 68/min, respiratory rate 12/min, and blood pressure 110/70 mm Hg. The physical examination shows no abnormalities. The laboratory studies show the following: Laboratory test Hemoglobin 10 g/dL Mean corpuscular volume 75 μm3 Leukocyte count 5,000/mm3 Platelet count 350,000/mm3 ESR 18 mm/hr Serum Ferritin 5 μg/L Iron 30 μg/L Total iron-binding capacity 500 μg/dL Calcium (Ca+) 9 mg/dL Albumin 4 g/dL Urea nitrogen 14 mg/dL Creatinine 0.9 mg/dL Monoclonal protein on serum electrophoresis is 12 g/L (non-IgM). Clonal bone marrow plasma cells comprise 4% of the total number of cells. Skeletal survey with magnetic resonance imaging reveals no pathologic findings. In addition to iron deficiency anemia, which of the following diagnosis is most appropriate to consider?? {'A': 'Monoclonal gammopathy of undetermined significance', 'B': 'Smoldering (asymptomatic) multiple myeloma', 'C': 'Solitary plasmacytoma', 'D': 'Symptomatic multiple myeloma', 'E': 'Waldenstrom’s macroglobulinemia'},
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A: Monoclonal gammopathy of undetermined significance
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Answer the following medical question with one of the provided options:
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Q:A 2-year-old boy is brought to the physician because of fever, productive cough, and shortness of breath. Since birth, he has had multiple respiratory infections requiring treatment with antibiotics. His immunizations are up-to-date. He is in the 10th percentile for height and weight. His temperature is 38°C (100.3°F). Examination detects diffuse bilateral wheezing and cervical lymphadenopathy. Flow cytometric analysis of a serum sample from the patient fails to fluoresce after incubation with dihydrorhodamine. This patient is at greatest risk of infection with which of the following organisms?? {'A': 'Enterococcus faecium', 'B': 'Serratia marcescens', 'C': 'Streptococcus pneumoniae', 'D': 'Clostridioides difficile', 'E': 'Streptococcus pyogenes'},
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B: Serratia marcescens
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Answer the following medical question with one of the provided options:
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Q:A 23-year-old woman presented to the clinic for her first prenatal appointment with fatigue and pain in the perineum for the past 8 days. The past medical history is benign and she claimed to have only had unprotected intercourse with her husband. She had a documented allergic reaction to amoxicillin 2 years ago. The vaginal speculum exam revealed a clean, ulcerated genital lesion, which was tender and non-exudative. No lymphadenopathy was detected. A rapid plasma reagin (RPR) test revealed a titer of 1:64 and the fluorescent treponemal antibody absorption (FTA- abs) test was positive. What is the next best step in the management of this patient?? {'A': 'Parenteral ceftriaxone, 1 g x 10 days', 'B': 'Penicillin desensitization, then intramuscular benzathine penicillin, G 2.4 million units', 'C': 'Oral tetracycline, 500 mg 4 times daily x 1 week', 'D': 'Doxycycline, 100 mg twice daily x 14 days', 'E': 'Delay treatment until delivery'},
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B: Penicillin desensitization, then intramuscular benzathine penicillin, G 2.4 million units
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Answer the following medical question with one of the provided options:
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Q:A 63-year-old woman is brought to the emergency department by one of her neighbors because of fever and confusion. She has a 10-year history of diabetes mellitus and hemorrhoids. Her medications include insulin and metformin. Her blood pressure is 90/70 mm Hg, the pulse is 115/min, the respirations are 21/min, and the temperature is 39.5℃ (103.1℉). The cardiopulmonary examination shows no other abnormalities. The serum creatinine level is 2.5 mg/dL. An MRI shows swelling of subcutaneous soft tissue and gas. She is resuscitated with IV fluids. Broad-spectrum empiric IV antibiotics are administered. Which of the following is the most appropriate next step in management?? {'A': 'Culture-based antibiotic therapy', 'B': 'High-dose IV steroids', 'C': 'Image-guided needle aspiration', 'D': 'Surgical debridement', 'E': 'No further management is indicated at this time'},
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D: Surgical debridement
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Answer the following medical question with one of the provided options:
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Q:A previously healthy 14-year-old boy is brought to the physician for evaluation because of loss of appetite, sleeplessness, and extreme irritability for 3 weeks. He recently quit the school's football team after missing many practices. He has also been avoiding his family and friends because he is not in the mood to see them but admits that he is lonely. He has not left his room for 2 days, which prompted his father to bring him to the physician. He has no medical conditions and does not take any medications. He does not drink alcohol or use recreational drugs. While the father is in the waiting room, mental status examination is conducted, which shows a constricted affect. Cognition is intact. He says that he would be better off dead and refuses to be treated. He says he wants to use his father's licensed firearm to “end his misery” over the weekend when his parents are at church. Which of the following is the most appropriate next step in management?? {'A': 'Involuntary hospitalization after informing the parents', 'B': 'Agree to his wish for no further treatment', 'C': 'Reassure the patient that he will feel better', 'D': 'Begin paroxetine therapy', 'E': 'Start outpatient psychotherapy'},
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A: Involuntary hospitalization after informing the parents
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Answer the following medical question with one of the provided options:
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Q:A 58-year-old man comes to the clinic complaining of increased urinary frequency for the past 3 days. The patient reports that he has had to get up every few hours in the night to go to the bathroom, and says "whenever I feel the urge I have to go right away.” Past medical history is significant for a chlamydial infection in his twenties that was adequately treated. He endorses lower back pain and subjective warmth for the past 2 days. A rectal examination reveals a slightly enlarged prostate that is tender to palpation. What is the most likely explanation for this patient’s symptoms?? {'A': 'Benign prostatic hyperplasia', 'B': 'Chemical irritation of the prostate', 'C': 'Infection with Escherichia coli', 'D': 'Prostatic adenocarcinoma', 'E': 'Reinfection with Chlamydia trachomatis'},
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C: Infection with Escherichia coli
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Answer the following medical question with one of the provided options:
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Q:A 21-year-old woman presents with right eye irritation, redness, and watery discharge. These symptoms started abruptly 4 days ago. She is on summer vacation and does not report any contacts with evidently ill patients. However, during the vacation, she frequently visited crowded places. The patient denies any other symptoms. At the presentation, the patient’s vital signs include: blood pressure 125/80 mm Hg, heart rate 75/min, respiratory rate 14/min, and temperature 36.7℃ (98℉). The physical examination shows conjunctival injection, watery discharge, and mild follicular transformation of the conjunctiva of the right eye. There are no corneal lesions. Ipsilateral preauricular lymph nodes are enlarged. Which of the following would be a proper medical therapy for this patient? {'A': 'Oral erythromycin', 'B': 'Acyclovir ointment', 'C': 'No medical treatment required', 'D': 'Levofloxacin drops', 'E': 'Tetracycline ointment'},
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C: No medical treatment required
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Answer the following medical question with one of the provided options:
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Q:A 30-year-old man presents with a 1-month history of frequent intermittent headaches. He says the headaches typically occur between 3–4 times/day, mostly at night, each lasting minutes to 1–2 hours. He describes the pain as severe, stabbing, unilateral, and localized to the left periorbital region. He says he frequently notes increased tear production and conjunctival injection in the left eye and rhinorrhea during these headaches. He mentions that he had a similar 3-week episode of these same, frequent intermittent headaches 3 months ago which stopped completely until 1 month ago. He denies any seizures, loss of consciousness, nausea, vomiting, photophobia, or phonophobia. His past medical history is significant for stable angina secondary to coronary artery disease diagnosed on a stress echocardiogram 1 year ago. He reports occasional alcohol use, which he says precipitates the headaches, but denies any smoking or recreational drug use. The patient is afebrile, and his vital signs are within normal limits. A physical examination is unremarkable. A noncontrast computed tomography (CT) scan of the head is normal. Which of the following is the best abortive treatment for this patient?? {'A': 'Sumatriptan', 'B': 'Dihydroergotamine', 'C': 'High-flow 100% oxygen', 'D': 'Hydrocodone', 'E': 'Intranasal lidocaine'},
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C: High-flow 100% oxygen
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Answer the following medical question with one of the provided options:
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Q:A 28-year-old man comes to the physician because of skin lesions on and around his anus. He noticed them 3 days ago. The lesions are not painful and he does not have any urinary complaints. He has smoked one pack of cigarettes daily for 10 years and he drinks 6–7 beers on weekends. He is sexually active with two male partners and uses condoms inconsistently. He appears healthy. A photograph of the perianal region is shown. The lesions turn white after application of a dilute acetic acid solution. The remainder of the examination shows no abnormalities. An HIV test is negative. Which of the following is the most appropriate next step in management?? {'A': 'Oral acyclovir', 'B': 'Topical mometasone', 'C': 'Radiotherapy', 'D': 'Parenteral benzathine penicillin', 'E': 'Curettage'},
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E: Curettage
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Answer the following medical question with one of the provided options:
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Q:A 28-year-old woman presents with severe diarrhea and abdominal pain. She says she has had 10 watery stools since the previous morning and is experiencing severe cramping in her abdomen. She reports similar past episodes of diarrhea with excruciating abdominal pain and mentions that she has taken diphenoxylate and atropine before which had helped her diarrhea and pain but resulted in severe constipation for a week. Which of the following receptors does diphenoxylate activate to cause the effects mentioned by this patient?? {'A': 'NK1 receptor', 'B': 'H2 receptor', 'C': '5-HT3 receptor', 'D': 'D2 receptor', 'E': 'µ receptor'},
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E: µ receptor
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Answer the following medical question with one of the provided options:
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Q:A 29-year-old woman comes to the physician because of poor balance and recurrent falls for the past month. She has also had blurry vision in her right eye for the past 2 weeks. She reports worsening of her symptoms after taking warm baths. Physical examination shows generalized hyperreflexia and an intention tremor. Romberg sign is positive. Visual acuity is 20/50 in the left eye and 20/100 in the right eye, and she is unable to distinguish red from green colors. The cells primarily affected by this patient's condition are most likely derived from which of the following embryologic structures?? {'A': 'Mesoderm', 'B': 'Endoderm', 'C': 'Neuroectoderm', 'D': 'Neural crest', 'E': 'Notochord'},
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C: Neuroectoderm
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Answer the following medical question with one of the provided options:
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Q:A 4-year-old boy is brought to the emergency department for a right ankle injury sustained during a fall earlier that morning. His parents report that he is 'clumsy' when he runs and has fallen multiple times in the last year. He has reached most of his developmental milestones but did not walk until the age of 17 months. He is an only child and was adopted at age 1. He appears tearful and in mild distress. His temperature is 37.2°C (98.9°F), pulse is 72/min, respirations are 17/min, and blood pressure is 80/50 mm Hg. His right ankle is mildly swollen with no tenderness over the medial or lateral malleolus; range of motion is full with mild pain. He has marked enlargement of both calves. Patellar and Achilles reflexes are 1+ bilaterally. Strength is 4/5 in the deltoids, knee flexors/extensors, and 5/5 in the biceps and triceps. Babinski sign is absent. When standing up from a lying position, the patient crawls onto his knees and slowly walks himself up with his hands. Which of the following is the most likely underlying mechanism of this patient's condition?? {'A': 'SMN1 gene defect', 'B': 'Loss of the ATM protein', 'C': 'Myotonin protein kinase defect', 'D': 'Absence of dystrophin protein', 'E': 'Arylsulfatase A deficiency'},
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D: Absence of dystrophin protein
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Answer the following medical question with one of the provided options:
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Q:A group of 6 college students with multiple sclerosis (MS) was evaluated for flares in a neurology clinic. The results are shown in the figure. Each row represents a patient. The gray bars represent the duration of the flare. The arrowheads indicate that disease was already present before and/or persisted beyond the timeframe of the study. Based on the figure, which of the following is the most valid statement about MS flares in this group of students?? {'A': 'Incidence from April 1st to June 1st was 3', 'B': 'Incidence during the month of May was 2', 'C': 'Incidence during the month of February was 3', 'D': 'The year-long prevalence was 4/6', 'E': 'Prevalence of the disease on May 15 was 4/6'},
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B: Incidence during the month of May was 2
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Answer the following medical question with one of the provided options:
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Q:A 33-year-old man presents to the emergency department with sudden onset right hand and right leg weakness. The patient was at home cleaning when his symptoms began. He also complains of diffuse and severe pain throughout his entire body which he states he has experienced before. The patient is an immigrant from South America, and his medical history is not known. His temperature is 98.9°F (37.2°C), blood pressure is 128/67 mmHg, pulse is 80/min, respirations are 16/min, and oxygen saturation is 99% on room air. CT of the head demonstrates no bleeding. Physical exam is notable for 2/5 strength in the patient's right arm and right leg. Which of the following is the best management in this patient?? {'A': 'Aspirin', 'B': 'Exchange transfusion', 'C': 'Heparin', 'D': 'Morphine and IV fluids', 'E': 'Tissue plasminogen activator'},
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B: Exchange transfusion
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Answer the following medical question with one of the provided options:
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Q:A 28-year-old man presents to his primary care physician because he has been experiencing constipation for the last 6 days. He says that the constipation started 1 day after he started taking an over the counter medication for sinus congestion and a chronic cough. He has no other findings associated with the constipation. His past medical history is significant for seasonal allergies but he is not currently taking any other medications besides the one he reported. Which of the following drugs was most likely responsible for this patient's symptoms?? {'A': 'Dextromethorphan', 'B': 'Diphenhydramine', 'C': 'Guaifenesin', 'D': 'Loratadine', 'E': 'N-acetylcysteine'},
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A: Dextromethorphan
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Answer the following medical question with one of the provided options:
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Q:A 28-year-old woman follows up at an outpatient surgery clinic with an abnormal scarring of her incisional wound from an abdominal surgical procedure 6 months ago. She gives a history of a wound infection with a purulent discharge 1 week after surgery. On examination of the scar, a dense, raised, healed lesion is noted at the incision site. She also complains of an occasional itching sensation over the scar. There is no history of such scar changes in her family. An image of the lesion is given below. Which of the following statements best describe the scar abnormality?? {'A': 'The scar has hair follicles and other adnexal glands within.', 'B': 'There is excessive scar tissue projecting beyond the level of the surrounding skin, but not extending into the underlying subcutaneous tissue.', 'C': 'This type of scar does not have claw-like projections.', 'D': 'Increased prevalence of this type of scar has no genetic basis or linkage.', 'E': 'This scar tissue is limited within the borders of the traumatized area.'},
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B: There is excessive scar tissue projecting beyond the level of the surrounding skin, but not extending into the underlying subcutaneous tissue.
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Answer the following medical question with one of the provided options:
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Q:You are attempting to quantify the degree of infectivity of a novel respiratory virus. You assess 1,000 patients who have been exposed to the virus and find that 500 ultimately are found positive for the virus within a 1-year follow up period. Conversely, from a 1,000 patient control group who has not been exposed to carriers of the virus, only 5 became positive over the same 1-year period. What is the relative risk of a contracting this virus if exposed?? {'A': '[5 / (500 + 500)] / [5 / (995 + 995)]', 'B': '[995 / (995 + 5)] / [500 / (500 + 500)]', 'C': '[500/ (500 + 500)] / [5 / (5 + 995)]', 'D': '(500 * 995) / (500 * 5)', 'E': '(500 * 5) / (500 * 995)'},
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C: [500/ (500 + 500)] / [5 / (5 + 995)]
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Answer the following medical question with one of the provided options:
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Q:A 19-year-old man comes to the physician because of recurrent yellowing of his eyes over the past 2 years. He reports that each episode lasts 1–2 weeks and resolves spontaneously. He has no family history of serious illness. He recently spent a week in Mexico for a vacation. He is sexually active with two partners and uses condoms inconsistently. He does not drink alcohol or use illicit drugs. His vital signs are within normal limits. Physical examination shows jaundice of the conjunctivae and the skin. The abdomen is soft with no organomegaly. The remainder of the physical examination shows no abnormalities. Laboratory studies show: Serum Total bilirubin 4.0 mg/dL Direct bilirubin 3.0 mg/dL Alkaline phosphatase 75 U/L AST 12 U/L ALT 12 U/L Anti-HAV IgG positive HBsAg negative Anti-HBsAg positive HCV RNA negative Urine Bilirubin present Urobilinogen normal Which of the following is the most likely underlying cause of this patient's condition?"? {'A': 'Destruction of the intralobular bile ducts', 'B': 'Inflammation of intra- and extrahepatic bile ducts', 'C': 'Impaired hepatic storage of bilirubin', 'D': 'Excess cellular bilirubin release', 'E': 'Defective bilirubin conjugation'},
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C: Impaired hepatic storage of bilirubin
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Answer the following medical question with one of the provided options:
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Q:A 49-year-old man presents to his primary care provider complaining of weakness and fatigue. He reports that he has started moving slower than normal and has noticed difficulty buttoning up his pants or tying his tie. He is accompanied by his wife who reports that he has started to move more slowly over the past 2 years. He has also become increasingly irritable and has had trouble sleeping. His past medical history is notable for hypertension, diabetes mellitus, and obesity. He takes enalapril and metformin. His family history is notable for multiple strokes in his mother and father. His temperature is 99°F (37.2°C), blood pressure is 140/90 mmHg, pulse is 90/min, and respirations are 17/min. On exam, strength is 4+/5 bilaterally in his upper extremities and 4/5 in his lower extremities. Some muscle atrophy is noted in his legs and feet. Patellar reflexes are 3+ bilaterally. He has a tremor in his right hand that diminishes when he is instructed to hold a pen in his hand. He is oriented to person, place and time. He states that he feels depressed but denies suicidal ideation. His physician prescribes multiple medications including a drug that is also indicated in the treatment of prolactinomas. Which of the following is the mechanism of action of this medication?? {'A': 'Activate dopamine receptors', 'B': 'Increase dopamine release', 'C': 'Inhibit dopamine receptors', 'D': 'Prevent dopamine degradation into 3,4-dihydroxyphenylacetic acid', 'E': 'Prevent dopamine degradation into 3-O-methyldopa'},
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A: Activate dopamine receptors
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Answer the following medical question with one of the provided options:
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Q:A 1-year-old boy is brought to his pediatrician for a follow-up appointment. He was recently diagnosed with failure to thrive and developmental delay. His weight is 7 kg (15.4 lb), height is 61 cm (24 in), and head circumference is 42 cm (16.5 in). The patient’s father had a younger sister who suffered from mental and physical delay and died at a very young age. The patient was able to raise his head at the age of 7 months and began to sit alone only recently. He babbles, coos, and smiles to other people. On presentation, his blood pressure is 75/40 mm Hg, heart rate is 147/min, respiratory rate is 28/min, and temperature is 36.4°C (97.5°F). He has a coarse face with small deep orbits, proptotic eyes, big lips, and gingival hyperplasia. His skin is pale with decreased elasticity. His lung and heart sounds are normal. Abdominal examination reveals diminished anterior abdominal wall muscle tone and hepatomegaly. Muscle tone is increased in all groups of muscles on both upper and lower extremities. The physician becomes concerned and performs testing for the suspected hereditary disease. A blood test shows increased lysosomal enzyme concentration in the serum and decreased N-acetylglucosamine-1-phosphotransferase (GlcNAc phosphotransferase) activity within the leukocytes. Which of the statements listed below describes the mechanism of the patient’s condition?? {'A': 'The patient’s symptoms are due to dysfunctional metabolism of sphingomyelin, which accumulates within the lysosomes.', 'B': 'There is impaired hydrolysis of GM2-ganglioside, which accumulates in the cytoplasm.', 'C': 'The lysosomal enzymes are secreted from the cells instead of being targeted to lysosomes because of lack of mannose phosphorylation on N-linked glycoproteins.', 'D': 'Due to enzyme deficiency, glycogen is extensively accumulated within the hepatocytes.', 'E': 'The symptoms result from defective glycolysis, which results in a total energy deficiency.'},
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C: The lysosomal enzymes are secreted from the cells instead of being targeted to lysosomes because of lack of mannose phosphorylation on N-linked glycoproteins.
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Answer the following medical question with one of the provided options:
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Q:A 13-year-old girl presents with a right infected ingrown toenail. On examination, the skin on the lateral side of the toe is red, warm, swollen, and severely tender to touch. When gentle pressure is applied, pus oozes out. Culture and sensitivity analysis of the pus shows methicillin-resistant Staphylococcus aureus (MRSA). Which of the following antibiotics is most effective against this organism?? {'A': 'Cefotetan', 'B': 'Oral vancomycin', 'C': 'Clindamycin', 'D': 'Cefuroxime', 'E': 'Aztreonam'},
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C: Clindamycin
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Answer the following medical question with one of the provided options:
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Q:A 39-year-old man comes to the physician for a follow-up examination. He was diagnosed with latent tuberculosis infection 3 months ago. He has had generalized fatigue and dyspnea on exertion for the past 6 weeks. He does not smoke and drinks 2–3 beers on weekends. Vital signs are within normal limits. Examination shows conjunctival pallor. Laboratory studies show: Hemoglobin 7.8 g/dL Mean corpuscular volume 72 μm3 Red cell distribution width 17% (N = 13–15) Reticulocyte count 0.7% Leukocyte count 6,800/mm3 Platelet count 175,000/mm3 Serum Creatinine 0.8 mg/dL Iron 246 μg/dL Ferritin 446 ng/mL Total iron-binding capacity 212 μg/dL (N = 250–450) Which of the following is the most likely cause of this patient's symptoms?"? {'A': 'Iron deficiency', 'B': 'Chronic inflammation', 'C': 'Beta thalessemia minor', 'D': 'Adverse effect of medication', 'E': 'Vitamin B12 deficiency\n"'},
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D: Adverse effect of medication
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Answer the following medical question with one of the provided options:
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Q:A 33-year-old woman comes to the physician for a follow-up examination. She was treated for a urinary stone 1 year ago with medical expulsive therapy. There is no personal or family history of serious illness. Her only medication is an oral contraceptive pill that she has been taking for 12 years. She appears healthy. Physical examination shows no abnormalities. A complete blood count, serum creatinine, and electrolytes are within the reference range. Urinalysis is within normal limits. An ultrasound of the abdomen shows a well-demarcated hyperechoic 3-cm (1.2-in) hepatic lesion. A contrast-enhanced CT of the abdomen shows a well-demarcated 3-cm hepatic lesion with peripheral enhancement and subsequent centripetal flow followed by rapid clearance of contrast. There is no hypoattenuating central scar. In addition to stopping the oral contraceptive pill, which of the following is the most appropriate next step in management?? {'A': 'Embolization of the mass', 'B': 'Percutaneous liver biopsy', 'C': 'Reimage in 6 months', 'D': 'Radiofrequency ablation of the mass', 'E': 'Surgical resection of the mass'},
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C: Reimage in 6 months
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Answer the following medical question with one of the provided options:
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Q:A 73-year-old man is brought to the emergency department because of fever, malaise, dyspnea, and a productive cough with purulent sputum for the past day. His temperature is 39.2°C (102.6°F). Pulmonary examination shows crackles over the right upper lung field. Sputum Gram stain shows gram-positive cocci. Despite the appropriate treatment, the patient dies 5 days later. At autopsy, gross examination shows that the right lung has a pale, grayish-brown appearance and a firm consistency. Microscopic examination of the tissue is most likely to show which of the following?? {'A': 'Fibrinopurulent leukocytic exudate with lysed erythrocytes', 'B': 'Fibrinous exudate with erythrocytes, leukocytes, and bacteria', 'C': 'Resorbed exudate with aerated alveoli', 'D': 'Neutrophilic infiltrate in the bronchiolar walls and adjacent alveoli', 'E': 'Dilation of alveolar capillaries and serous exudate with abundant bacteria'},
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A: Fibrinopurulent leukocytic exudate with lysed erythrocytes
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Answer the following medical question with one of the provided options:
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Q:A 27-year-old woman presents to the clinic with a runny nose and productive cough for the past two weeks. She also complains of headaches and lethargy. She was started on sertraline after she was diagnosed with major depressive disorder 2 months ago and had the dosage periodically increased to achieve symptom control. She is afraid of starting any other medication because of possible side-effects or life-threatening drug interactions. What advice is the most accurate regarding possible complication to her current pharmacotherapy?? {'A': 'Migraine medication can trigger a life-threatening complication.', 'B': 'Sertraline cannot be used concurrently with neuroleptics', 'C': 'Monoamine-oxidase-inhibitors are safe for concurrent use.', 'D': 'Over-the-counter (OTC) medications are safe for her to use.', 'E': 'Treat life-threatening complication with gradual drug withdrawal.'},
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A: Migraine medication can trigger a life-threatening complication.
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Answer the following medical question with one of the provided options:
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Q:A 24-year-old man presents to the office, complaining of a rash and “not feeling well.” The patient reports fatigue, a headache, and a possible fever. He says he has felt this way since a camping trip with his family in North Carolina, but he denies any contact with sick individuals. On examination, his vital signs include: temperature 38.5°C (101.3°F), blood pressure 100/60 mm Hg, heart rate 82 beats per minute, respiratory rate 14 breaths per minute, and O2 saturation 99% on room air. The patient appears unwell. He has a maculopapular rash on his upper and lower extremities, including the palms of his hands and soles of his feet. He says he started feeling sick a few days before he got the rash, which prompted him to come into the office. The patient denies itching but admits to some nausea and vomiting. He also admits to unprotected sex with a single female partner for the past three years. What is the most likely causative agent of this patient’s presentation? ? {'A': 'A sexually transmitted spirochete', 'B': 'A protozoan transmitted via the Ixodes tick', 'C': 'A gram-negative bacteria transmitted via the Dermacentor tick', 'D': 'A gram-negative bacterium transmitted via the Ixodes tick', 'E': 'A positive-sense, single-stranded RNA virus that is non-enveloped'},
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C: A gram-negative bacteria transmitted via the Dermacentor tick
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Answer the following medical question with one of the provided options:
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Q:A 67-year-old man presents to the emergency department with anxiety and trouble swallowing. He states that his symptoms have slowly been getting worse over the past year, and he now struggles to swallow liquids. He recently recovered from the flu. Review of systems is notable only for recent weight loss. The patient has a 33 pack-year smoking history and is a former alcoholic. Physical exam is notable for poor dental hygiene and foul breath. Which of the following is the most likely diagnosis?? {'A': 'Achalasia', 'B': 'Globus hystericus', 'C': 'Squamous cell carcinoma', 'D': 'Viral-induced gastroparesis', 'E': 'Zenker diverticulum'},
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C: Squamous cell carcinoma
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Answer the following medical question with one of the provided options:
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Q:A group of scientists studied the effects of cytokines on effector cells, including leukocytes. They observed that interleukin-12 (IL-12) is secreted by antigen-presenting cells (APCs) in response to bacterial lipopolysaccharide. When a CD4+ T cell is exposed to this interleukin, which of the following responses will it have?? {'A': 'Cell-mediated immune responses', 'B': 'Activate B cells', 'C': 'Secrete IL–4', 'D': 'Releases granzymes', 'E': 'Responds to extracellular pathogens'},
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A: Cell-mediated immune responses
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Answer the following medical question with one of the provided options:
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Q:A 36-year-old woman presents with a whitish vaginal discharge over the last week. She also complains of itching and discomfort around her genitals. She says her symptoms are getting progressively worse. She has been changing her undergarments frequently and changed the brand of detergent she uses to wash her clothes, but it did not resolve her problem. Additionally, she admits to having painful urination and increased urinary frequency for the past one month, which she was told are expected side effects of her medication. The patient denies any recent history of fever or malaise. She has 2 children, both delivered via cesarean section in her late twenties. Past medical history is significant for hypertension and diabetes mellitus type 2. Current medications are atorvastatin, captopril, metformin, and empagliflozin. Her medications were changed one month ago to improve her glycemic control, as her HbA1c at that time was 7.5%. Her vital signs are a blood pressure of 126/84 mm Hg and a pulse of 78/min. Her fingerstick glucose is 108 mg/dL. Pelvic examination reveals erythema and mild edema of the vulva. A thick, white, clumpy vaginal discharge is seen. The vaginal pH is 4.0. Microscopic examination of a KOH-treated sample of the discharge demonstrates lysis of normal cellular elements with branching pseudohyphae. Which of the following is the next best step in the management of this patient?? {'A': 'Start metronidazole.', 'B': 'Stop empagliflozin.', 'C': 'Advise her to drink lots of cranberry juice.', 'D': 'Switch her from oral antidiabetic medication to insulin.', 'E': 'Start fluconazole.'},
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E: Start fluconazole.
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Answer the following medical question with one of the provided options:
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Q:A 44-year-old female patient comes to the physician’s office with her husband with complaints of abdominal pain. For the past 4 months, she has experienced cramping right upper quadrant pain that starts after meals. The physician performs a right upper quadrant ultrasound that shows round echogenic masses in the gallbladder. The physician offers an elective cholecystectomy to the patient to improve her symptoms and explains the procedure in detail to the patient including potential risks and complications. The patient acknowledges and communicates her understanding of her diagnosis as well as the surgery and decides to proceed with the surgery in one month. The patient signs a form indicating her consent to this procedure. Which of the following must also be communicated to the patient at this time?? {'A': 'A family member must also provide consent for this procedure', 'B': 'The patient must give consent again before the procedure', 'C': 'The patient has the right to revoke her consent at any time before the procedure', 'D': 'The patient’s consent was not necessary for this procedure', 'E': 'The results of the procedure must be disclosed to her husband'},
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C: The patient has the right to revoke her consent at any time before the procedure
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Q:A patient presents to the clinic with symptoms of dizziness on standing up. He says it started soon after he was diagnosed with hypertension and started taking treatment for it. He has no other medical history. The physician decides to switch to another antihypertensive that does not cause orthostatic hypotension. Which of the following should be the drug of choice for this patient?? {'A': 'Enalapril', 'B': 'Methyldopa', 'C': 'Clonidine', 'D': 'Amlodipine', 'E': 'Propanolol'},
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E: Propanolol
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Answer the following medical question with one of the provided options:
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Q:A 42-year-old woman comes to the physician with a 6-month history of breast tenderness and menstrual irregularities. Physical examination shows no abnormalities. An ultrasound of the pelvis shows a right adnexal mass. A laparoscopic right salpingo-oophorectomy is performed. Histologic examination of the adnexal mass shows small cuboidal cells arranged in clusters surrounding a central cavity with eosinophilic secretions. These cells resemble primordial follicles. Which of the following laboratory values was most likely increased in this patient at the time of presentation?? {'A': 'Estradiol', 'B': 'Lactate dehydrogenase', 'C': 'α-fetoprotein', 'D': 'β-human chorionic gonadotropin', 'E': 'Follicle stimulating hormone'},
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A: Estradiol
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Q:A 50-year-old man presents to the emergency department complaining of chest pain and drooling that started immediately after eating a steak. His past medical history is significant for lye ingestion 5 years ago during a suicidal attempt. He also suffers from hypertension and diabetes mellitus, type 2. He takes fluoxetine, lisinopril, and metformin every day. He also regularly sees a counselor to cope with his previous suicide attempt. Both of his parents are still alive and in good health. His heart rate is 96/min, temperature is 36.7°C (98.1°F).On physical examination, the patient can talk normally and breaths without effort. He is drooling. The chest pain is vague and constant. A chest X-ray shows no subcutaneous emphysema. An endoscopy confirms the presence of a retained bolus of meat 24 cm beyond the incisors where a stricture is identified. The bolus is removed and the stricture is dilated. Which of the following anatomic spaces contains the stricture?? {'A': 'The superior mediastinum', 'B': 'The diaphragm', 'C': 'The anterior mediastinum', 'D': 'The posterior mediastinum', 'E': 'The epigastrium'},
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A: The superior mediastinum
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Answer the following medical question with one of the provided options:
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Q:A 45-year-old man presents with a chief complaint of pain in the great toe. He has a history of gout, which is under control. He was diagnosed with diabetes 5 years ago and is currently taking metformin. He was recently diagnosed with hypertension and was placed on a hypertensive drug. He is a non-smoker and does not abuse alcohol. The family history is significant for ischemic heart disease in his father. His current blood pressure is 136/84 mm Hg and the pulse is 78/min. The physical examination did not reveal any abnormalities. He uses over-the-counter multivitamin supplements. Which of the following drugs could have resulted in these symptoms?? {'A': 'Angiotensin II receptor blockers (ARBs)', 'B': 'Thiazide diuretics', 'C': 'Calcium channel blockers (CCBs)', 'D': 'Angiotensin-converting enzyme (ACE) inhibitors', 'E': 'Beta-blockers'},
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B: Thiazide diuretics
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Q:A 15-year-old girl is brought to the physician for a school physical examination. She feels well. She is performing well in school and getting good grades. She is 147 cm (4 ft 10 in) tall and weighs 60 kg (132 lbs); BMI is 27.6 kg/m2. Her temperature is 37°C (98.6°F), pulse is 82/min, respirations are 16/min, and blood pressure is 138/82 mm Hg in the left arm and 110/74 mm Hg in the left leg. Physical examination shows an unusually short and broad neck with bilateral excess skin folds that extend to the shoulders and low-set ears. There is an increased carrying angle when she fully extends her arms at her sides. An x-ray of the chest shows inferior rib notching. Which of the following additional findings is most likely in this patient?? {'A': 'Horseshoe adrenal gland on abdominal CT', 'B': 'Prolonged activated partial thromboplastin time', 'C': 'Uterine agenesis on pelvic exam', 'D': 'Mutation of FBN1 on genetic testing', 'E': 'Streak ovaries on pelvic ultrasound\n"'},
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E: Streak ovaries on pelvic ultrasound "
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Answer the following medical question with one of the provided options:
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Q:A 27-year-old woman, gravida 2, para 1, at 32 weeks' gestation comes to the physician for a prenatal visit. She feels that her baby's movements have decreased recently. She says that she used to feel 10–12 movements/hour earlier, but that it has recently decreased to about 7–8/hour. Pregnancy and delivery of her first child were uncomplicated. Medications include folic acid and a multivitamin. Her temperature is 37.2°C (99°F), and blood pressure is 108/60 mm Hg. Pelvic examination shows a uterus consistent in size with a 32-week gestation. The fetus is in a transverse lie presentation. The fetal heart rate is 134/min. A 14-minute recording of the nonstress test is shown. Which of the following is the most appropriate next step in managing this patient?? {'A': 'Repeat the nonstress test weekly', 'B': 'Provide reassurance to the mother', 'C': 'Administer intravenous oxytocin', 'D': 'Perform vibroacoustic stimulation', 'E': 'Extend the nonstress test by 20 minutes'},
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B: Provide reassurance to the mother
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Q:А 41-уеаr-old woman рrеѕеnts to thе offісе wіth a сomрlаіnt of а hеаdасhе for 1 month and a еріѕodе of аbnormаl bodу movеmеnt. The headaches are more severe іn thе mornіng, moѕtlу after waking up. Ѕhе doеѕn’t give a history of any mајor іllnеѕѕ or trauma in the past. Неr vіtаlѕ ѕіgnѕ include: blood рrеѕѕurе 160/80 mm Нg, рulѕе 58/mіn, tеmреrаturе 36.5°C (97.8°F), аnd rеѕріrаtorу rаtе 11/mіn. Оn fundoscopic ехаmіnаtіon, mіld раріllеdеmа is present. Her рuріlѕ аrе еquаl аnd rеасtіvе to lіght. No foсаl nеurologісаl dеfісіt сan bе еlісіtеd. A contrast computed tomography scan of the head is shown in the picture. Which of the following is the most likely biopsy finding in this case?? {'A': 'Oligodendrocytes with round nuclei and clear surrounding cytoplasm giving a fried-egg appearance', 'B': 'Closely arranged thin walled capillaries with minimal intervening parenchyma', 'C': 'Pseudopalisading pleomorphic tumor cells', 'D': 'Spindle cells concentrically arranged in whorled pattern with laminated calcification', 'E': 'Large quantities of lymphocytes without a particular growth pattern'},
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D: Spindle cells concentrically arranged in whorled pattern with laminated calcification
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Q:A 40-year-old woman has complaints of dyspnea, cough, and arthritis in her ankle joints. A CT scan reveals multiples granulomas in both lungs, as well as bilateral hilar lymphadenopathy. On examination, cutaneous nodules over the trunk are found. Erythrocyte sedimentation rate, angiotensin-converting enzyme, and serum calcium levels are elevated. She is treated with steroids. What is the most likely diagnosis?? {'A': "Hodgkin's lymphoma", 'B': 'Tuberculosis', 'C': 'Silicosis', 'D': 'Adenocarcinoma of the lung', 'E': 'Sarcoidosis'},
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E: Sarcoidosis
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Q:A cell biologist is studying the activity of a novel chemotherapeutic agent against a cancer cell line. After incubation with the agent and cell detachment from the tissue culture plate, the DNA is harvested from the cells and run on a gel. Of note, there are large bands at every multiple of 180 base pairs on the gel. Which of the following explains the pathophysiology of this finding?? {'A': 'ATP depletion', 'B': 'Caspase activation', 'C': 'Cellular swelling', 'D': 'Protein denaturation', 'E': 'Release of lysosomal enzymes'},
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B: Caspase activation
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Q:A 2-week-old newborn is brought to the physician because of worsening feeding difficulty since birth. Examination shows a grade 2/6 harsh holosystolic murmur, heard most clearly at the left lower sternal border, and a soft mid-diastolic rumble over the cardiac apex. Echocardiography shows shunting of blood through the ventricular septum during systole. The patient undergoes surgery for closure of the defect. Which of the following sets of changes are expected after successful repair of this cardiac defect? $$$ Left atrial pressure %%% Left ventricular pressure %%% Right ventricular pressure $$$? {'A': '↓ ↑ no change', 'B': '↓ ↑ ↓', 'C': '↑ ↑ ↑', 'D': '↓ ↓ ↓', 'E': '↑ ↑ ↓'},
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B: ↓ ↑ ↓
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Q:A 77-year-old man with a history of advanced dementia, hypertension, Parkinson’s disease, and diabetes mellitus type 2 is brought to the hospital from a nursing home after several days of non-bloody diarrhea and vomiting. The patient is evaluated and admitted to the hospital. Physical examination shows a grade 2/6 holosystolic murmur over the left upper sternal border, clear lung sounds, a distended abdomen with normal bowel sounds, a resting tremor, and 2+ edema of the lower extremities up to the ankle. Over the next few hours, the nurse records a total of 21 cc of urine output over the past 5 hours. Which of the following criteria suggest pre-renal failure?? {'A': 'Urine osmolarity of 280 mOsm/kg', 'B': 'Urine Na of 80 mEq/L', 'C': 'Urine/plasma creatinine ratio of 10', 'D': 'Fractional excretion of sodium of 0.5%', 'E': 'Urine/plasma osmolarity ratio of 0.8'},
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D: Fractional excretion of sodium of 0.5%
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Q:A 7-year-old boy is brought to the physician by his mother because of a 2-week history of intermittent shortness of breath and a dry cough that is worse at night. He had an upper respiratory tract infection 3 weeks ago. Lungs are clear to auscultation. Spirometry shows normal forced vital capacity and peak expiratory flow rate. The physician administers a drug, after which repeat spirometry shows a reduced peak expiratory flow rate. Which of the following drugs was most likely administered?? {'A': 'Atenolol', 'B': 'Methacholine', 'C': 'Ipratropium bromide', 'D': 'Methoxyflurane', 'E': 'Epinephrine'},
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B: Methacholine
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Q:А 42-уеаr-old woman рrеѕеntѕ wіth fасіаl аѕуmmеtrу. The patient says yesterday she noticed that her face appeared to be dеvіаted to the rіght. Ѕhе dеnіеѕ аnу trаumа or rесеnt trаvеl. Неr раѕt mеdісаl hіѕtorу іѕ nonсontrіbutorу. Her vitals are blood pressure 110/78 mm Hg, temperature 36.5°C (97.8°F), pulse 78/min, and respiratory rate 11/min. Оn рhуѕісаl ехаmіnаtіon, thеrе іѕ drooріng of thе left ѕіdе of thе fасе. Тhе left nаѕolаbіаl fold іѕ аbѕеnt, аnd ѕhе іѕ unаblе to сloѕе hеr left еуе or wrinkle thе left ѕіdе of hеr forеhеаd. Whеn the patient аѕkеd to ѕmіlе, thе resulting аѕуmmеtrу is shown in the given photograph. The remainder of the nеurologіс ехаm іѕ normаl. A noncontrast CT scan of the head is unremarkable. Which of the following is the most likely cause of her presentation?? {'A': 'Varicella-Zoster infection', 'B': 'Lyme disease', 'C': 'Idiopathic', 'D': 'Cerebrovascular accident', 'E': 'Malignancy'},
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C: Idiopathic
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Q:You are the intern on the labor and delivery floor. Your resident asks you to check on the patient in Bed 1. She is a 27-year-old prima gravida with no significant past medical history. She has had an uncomplicated pregnancy and has received regular prenatal care. You go to her bedside and glance at the fetal heart rate tracing (Image A). What is the most likely cause of this finding?? {'A': 'Fetal head compression', 'B': 'Utero-placental insufficiency', 'C': 'Cord compression', 'D': 'Fetal distress', 'E': 'Congenital heart block'},
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A: Fetal head compression
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Q:A 22-year-old woman presents to her primary care provider with an unrelenting headache accompanied by fever, chills, and malaise for the past 4 days. She also complains of an earache and dry hacking cough. Past medical history is noncontributory. She takes oral contraceptives and a multivitamin with calcium daily. She drinks alcohol socially and smokes occasionally. Today, her temperature is 37.9°C (100.2°F), pulse is 104/min, respiratory rate is 20/min and blood pressure is 102/82 mm Hg. On physical exam, she appears uncomfortable, but not ill. Her heart rate is elevated with a regular rhythm and her lungs have mild rhonchi in the lower lobes bilaterally. A chest X-ray shows patchy, diffuse infiltrates of the interstitium bilaterally that is worse in the lower lobes. A sputum culture is taken for stereomicroscopy. The pathogen organism appears small, pleomorphic, and lacks a cell wall. Which of the following is the most likely pathogen?? {'A': 'Streptococcus pneumonia', 'B': 'Legionella pneumophila', 'C': 'Staphylococcus pneumonia', 'D': 'Mycoplasma pneumonia', 'E': 'Haemophilus influenza'},
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D: Mycoplasma pneumonia
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Q:One day after doctors helped a 28-year-old primigravid woman deliver a 4,700 g (10 lb 6 oz) boy, the newborn has bluish discoloration of the lips and fingernails. His temperature is 37.3°C (99.1°F), the pulse is 166/min, the respirations are 63/min, and the blood pressure is 68/44 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 81%. Examination shows central cyanosis. A grade 2/6 holosystolic murmur is heard over the left lower sternal border. A single second heart sound is present. Supplemental oxygen does not improve cyanosis. An X-ray of the chest shows an enlarged cardiac silhouette with a narrowed mediastinum. Which of the following cardiac defects would be associated with this newborn’s diagnosis?? {'A': 'Alignment of infundibular septum', 'B': 'Division of aorta and pulmonary artery', 'C': 'Fusion of endocardial cushion', 'D': 'Separation of tricuspid valve tissue from myocardium', 'E': 'Ventricular septal defect'},
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E: Ventricular septal defect
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Q:A 44-year-old woman is admitted after an episode of dizziness and palpitations with a subsequent loss of consciousness. At the time of admission, the patient is alert, but then quickly becomes lethargic and reports reoccurrence of palpitations. Past medical history is significant for an episode of ventricular tachycardia 4 months ago, now managed with pharmacologic antiarrhythmic prophylaxis. An ECG is obtained and is shown on the image. Which of the following antiarrhythmic drugs below is most likely responsible for this patient's condition?? {'A': 'Lidocaine', 'B': 'Sotalol', 'C': 'Propranolol', 'D': 'Verapamil', 'E': 'Diltiazem'},
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B: Sotalol
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Q:A 62-year-old woman presents to the clinic with a lacerated wound on her left forearm. She got the wound accidentally when she slipped in her garden and scraped her hand against some nails sticking out of the fence. The patient has rheumatoid arthritis and takes methylprednisolone 16 mg/day. She cannot recall her vaccination history. On physical examination her blood pressure is 140/95 mm Hg, heart rate is 81/min, respiratory rate is 16/min, and temperature is 36.9°C (98.4°F). The wound is irregularly shaped and lacerated and measures 4 × 5 cm with a depth of 0.5 cm. It is contaminated with dirt. The physician decides to administer both the tetanus toxoid and immunoglobulin after wound treatment. What is true regarding the tetanus prophylaxis in this patient?? {'A': 'It does not make sense to administer tetanus toxoid as it will fail to induce sufficient immunity in a patient who takes oral glucocorticoids.', 'B': 'The immunoglobulin is given to this patient to promote the action of the toxoid and antibody production.', 'C': 'The immunoglobulin administration will provide sufficient levels of anti-tetanus toxin antibodies until the production of the patient’s own antibodies starts.', 'D': 'It does not make sense to administer tetanus toxoid as it will fail to induce sufficient immunity in patients aged more than 60 years.', 'E': 'Immunoglobulin administration can provide constant levels of antibodies in the patient’s blood for more than 4 months.'},
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C: The immunoglobulin administration will provide sufficient levels of anti-tetanus toxin antibodies until the production of the patient’s own antibodies starts.
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Answer the following medical question with one of the provided options:
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Q:A 50-year-old man is brought to the emergency department because of a 3-day history of left flank pain. The patient has had two episodes of urolithiasis during the last year. He initially had pain with urination that improved with oxycodone. Over the past day, the pain has worsened and he has additionally developed fever and chills. He has hypertension and type 2 diabetes mellitus. He has smoked one pack of cigarettes daily for 20 years. He does not drink alcohol. His current medications include metformin and lisinopril. The patient appears ill and uncomfortable. His temperature is 39.1°C (102.3°F), pulse is 108/min, respirations are 22/min, and blood pressure is 90/62 mm Hg. The lungs are clear to auscultation. Cardiac examination shows no murmurs, rubs, or gallops. Examination of the back shows left costovertebral angle tenderness. Physical and neurologic examinations show no other abnormalities. Laboratory studies show: Hemoglobin 14.2 g/dL Leukocyte count 13,900/mm3 Hemoglobin A1c 8.2% Serum Na+ 138 mEq/L K+ 3.8 mEq/L Cl- 98 mEq/L Calcium 9.3 mg/dL Glucose 190 mg/dL Creatinine 2.1 mg/dL Urine pH 8.3 Urine microscopy Bacteria moderate RBC 6–10/hpf WBC 10–15/hpf WBC casts numerous Ultrasound shows enlargement of the left kidney with a dilated pelvis and echogenic debris. CT scan shows a 16-mm stone at the left ureteropelvic junction, dilation of the collecting system, thickening of the wall of the renal pelvis, and signs of perirenal inflammation. Intravenous fluid resuscitation and intravenous ampicillin, gentamicin, and morphine are begun. Which of the following is the most appropriate next step in the management of this patient?"? {'A': 'Percutaneous nephrostomy', 'B': 'Tamsulosin therapy', 'C': 'Ureteroscopy and stent placement', 'D': 'Shock wave lithotripsy', 'E': 'Intravenous pyelography'},
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A: Percutaneous nephrostomy
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Answer the following medical question with one of the provided options:
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Q:A 48-year-old homeless man is brought to the emergency department 2 hours after his right arm was burned by a fire. He is diagnosed with extensive third-degree burns of the right forearm and upper arm and is admitted to the hospital for debridement and grafting. During his stay in the hospital, he suddenly develops confusion and agitation. Neurologic examination shows horizontal nystagmus and a broad-based gait. Laboratory studies show decreased erythrocyte transketolase activity. Administration of which of the following most likely caused this patient's current condition?? {'A': 'Cobalamin', 'B': 'Glucose', 'C': 'Aspirin', 'D': 'Hypertonic saline', 'E': 'Haloperidol'},
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B: Glucose
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Q:An 11-year-old girl comes to the physician with her mother because of a 2-day history of passing “cola-colored“ urine. During the past week, her mother noticed episodes of facial swelling. The patient had a rash on her face about 4 weeks ago. A renal biopsy after immunofluorescence is shown. Which of the following is the most likely diagnosis?? {'A': 'Poststreptococcal glomerulonephritis', 'B': 'IgA nephropathy', 'C': 'Membranoproliferative glomerulonephritis', 'D': 'Diffuse proliferative glomerulonephritis', 'E': 'Rapidly progressive glomerulonephritis'},
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A: Poststreptococcal glomerulonephritis
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Q:A 69-year-old woman with type 2 diabetes mellitus has an HbA1c of 3.9% and has been using basal-bolus insulin to manage her diabetes for the past 5 years. She has been maintaining a healthy diet, taking her insulin as scheduled but her records show morning hyperglycemia before eating breakfast. To determine the cause of this hyperglycemia, you ask her to set an alarm and take her blood glucose at 3 am. At 4 am her blood glucose is 49 mg/dL. Which of the following statements best describes the management of this patient’s current condition?? {'A': 'She is experiencing dawn phenomenon so her nighttime insulin should be increased', 'B': 'She is experiencing dawn phenomenon so her nighttime insulin should be decreased', 'C': 'She is experiencing Somogyi effect so her nighttime insulin should be increased', 'D': 'She is experiencing Somogyi effect so her nighttime insulin should be decreased', 'E': 'Hyperosmolar hyperglycemic state; increase nighttime insulin'},
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D: She is experiencing Somogyi effect so her nighttime insulin should be decreased
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Answer the following medical question with one of the provided options:
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Q:A 37-year-old man is brought to the emergency department after being attacked with a knife. Physical examination shows a 4-cm laceration in the midline of the right forearm. An MRI of the right arm shows damage to a nerve that runs between the superficial and deep flexor digitorum muscles. Loss of sensation over which of the following areas is most likely in this patient?? {'A': 'Palmar surface of the little finger', 'B': 'Lateral aspect of the forearm', 'C': 'Fingertip of the index finger', 'D': 'Medial aspect of the forearm', 'E': 'Dorsum of the thumb'},
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C: Fingertip of the index finger
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Answer the following medical question with one of the provided options:
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Q:A 25-year-old nulliparous woman at 8 weeks' gestation comes to her physician accompanied by her husband for her first prenatal visit. She has no personal or family history of serious illness. Her vaccinations are up-to-date and she takes no medications. She has no history of recreational drug use and does not drink alcohol. Her vital signs are within normal limits. She is 167 cm (5 ft 6 in) tall and weighs 68 kg (150 lb); BMI is 24.3 kg/m2. She tested negative for HIV, Chlamydia trachomatis, and Neisseria gonorrhoeae 4 years ago. Which of the following tests should be done at this visit?? {'A': 'Culture for group B streptococci, hepatitis C serology, and PPD skin test', 'B': 'Serum TSH, CMV serology, and PCR for HSV-2', 'C': 'PCR for HSV-2, culture for group B streptococci, and Western blot for HIV', 'D': 'VDRL, Western blot for HIV, and serum HBsAg', 'E': 'ELISA for HIV, rapid plasma reagin test, and serum HBsAg'},
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E: ELISA for HIV, rapid plasma reagin test, and serum HBsAg
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Q:A 24-year-old woman presents with generalized edema, hematuria, and severe right-sided flank pain. Her vital signs are normal. A 24-hour urine collection shows >10 grams of protein in her urine. Serum LDH is markedly elevated. Contrast-enhanced spiral CT scan shows thrombosis of the right renal vein. Which of the following is the most likely mechanism behind this thrombosis?? {'A': 'Severe dehydration', 'B': 'Urinary loss of antithrombin III', 'C': 'Hepatic synthetic failure', 'D': 'Oral contraceptive pills', 'E': 'Hereditary factor VIII deficiency'},
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B: Urinary loss of antithrombin III
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Answer the following medical question with one of the provided options:
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Q:Ten days after undergoing left hip replacement, a 73-year-old hospitalized man develops a fever, dyspnea, cough productive of yellow sputum, confusion, nausea, and diarrhea. Several patients in the hospital report similar symptoms. Physical examination shows decreased breath sounds on the left side and inspiratory crackles over the left lung. An x-ray of the chest shows opacities in the lower lobe of the left lung. Treatment with ampicillin does not improve his symptoms. Subsequent evaluation of the patient's urine detects a pathogen-specific antigen, confirming the diagnosis. Which of the following sources of infection is most likely responsible for this local disease outbreak?? {'A': 'Transmission via infectious respiratory droplets', 'B': 'Contamination of reheated hospital food', 'C': 'Colonization of the air conditioning system', 'D': 'Entry through colonized intravenous catheters', 'E': 'Insufficient adherence to hand hygiene measures'},
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C: Colonization of the air conditioning system
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Answer the following medical question with one of the provided options:
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Q:A group of scientists is studying various methods of bacterial reproduction. They find out that bacteria also exchange genetic material via these reproductive processes. They are about to study one such method known as bacterial conjugation. Which of the following occurs through bacterial conjugation?? {'A': 'Two Pseudomonas aeruginosa bacteria with identical copies of a plasmid after sharing DNA through sex pili.', 'B': 'Helicobacter pylori producing a prophage-encoded toxin.', 'C': 'A strain of MRSA acquiring the gene of capsulation from another encapsulated strain via DNA extraction.', 'D': 'A multidrug-resistant Shigella species passing resistance factor R to a Streptococcus species.', 'E': 'A single E. coli bacteria with resistance to gentamicin splits into two E. coli bacteria, both of which have resistance to gentamicin.'},
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A: Two Pseudomonas aeruginosa bacteria with identical copies of a plasmid after sharing DNA through sex pili.
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Q:An 81-year-old man is brought in by his neighbor with altered mental status. The patient’s neighbor is unsure exactly how long he was alone, but estimates that it was at least 3 days. The neighbor says that the patient usually has his daughter at home to look after him but she had to go into the hospital recently. The patient is unable to provide any useful history. Past medical history is significant for long-standing hypercholesterolemia and hypertension, managed medically with rosuvastatin and hydrochlorothiazide, respectively. His vital signs include: blood pressure, 140/95 mm Hg; pulse, 106/min; temperature, 37.2°C (98.9°F); and respiratory rate, 19/min. On physical examination, the patient is confused and unable to respond to commands. His mucus membranes are dry and he has tenting of the skin. The remainder of the exam is unremarkable. Laboratory findings are significant for the following: Sodium 141 mEq/L Potassium 4.1 mEq/L Chloride 111 mEq/L Bicarbonate 21 mEq/L BUN 40 mg/dL Creatinine 1.4 mg/dL Glucose (fasting) 80 mg/dL Magnesium 1.9 mg/dL Calcium 9.3 mg/dL Phosphorous 3.6 mg/dL 24-hour urine collection Urine Sodium 169 mEq/24 hr (ref: 100–260 mEq/24 hr) Urine Creatinine 79.5 g/24 hr (ref: 1.0–1.6 g/24 hr) Which of the following is the most likely cause of this patient’s acute renal failure?? {'A': 'Acute tubular necrosis', 'B': 'Dehydration', 'C': 'Sepsis', 'D': 'NSAID use', 'E': 'UTI due to obstructive nephrolithiasis'},
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B: Dehydration
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Answer the following medical question with one of the provided options:
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Q:A 52-year-old man is brought to the emergency department by a friend because of a 5-day history of fever and cough productive of purulent sputum. One week ago, he was woken up by an episode of heavy coughing while lying on his back. He drinks large amounts of alcohol daily and has spent most of his time in bed since his wife passed away 2 months ago. His temperature is 38°C (100.4°F), pulse is 96/min, respirations are 24/min, and blood pressure is 110/84 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 87%. Physical examination shows poor dentition and swollen gums. A CT scan of the chest is most likely to show a pulmonary infiltrate in which of the following locations?? {'A': 'Posterior basal segment of the right lower lobe', 'B': 'Apicoposterior segment of the left upper lobe', 'C': 'Superior segment of the right lower lobe', 'D': 'Posterior basal segment of the left lower lobe', 'E': 'Posterior segment of the right upper lobe'},
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C: Superior segment of the right lower lobe
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Answer the following medical question with one of the provided options:
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Q:A 42-year-old man is brought to the emergency department because his neck was fixed in lateral flexion. For the past week, the patient has been complaining of low-grade fever, head pain, and neck pain. His partner has also noticed him behaving erratically. His family and personal medical history are not relevant. Upon admission, he is found with a body temperature of 38.6°C (101.5°F), and physical examination is unremarkable except for neck pain and fixed lateral flexion of the neck. He is confused, but there are no motor or sensory deficits. Deep tendon reflexes are accentuated. Magnetic resonance imaging of the brain shows leptomeningeal and gyral enhancement. Which of the following explains this patient’s condition?? {'A': 'Genetic mutation', 'B': 'Exposure to D2-antagonists', 'C': 'Trochlear nerve palsy', 'D': 'Viral infection', 'E': 'Acid-fast resistant bacilli infection'},
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D: Viral infection
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Q:A 36-year-old software professional consults a physician to discuss his concerns about small-vessel vasculitis as his mother and sister both have autoimmune small-vessel vasculitides. He has read about vasculitides and recently he came across an article which stated that an analgesic that he often uses for relief from a headache can cause small-vessel vasculitis. Due to his positive family history, he is especially concerned about his risk of developing small-vessel vasculitis. Which of the following clinical presentations is most likely to occur in this man?? {'A': 'Absence of pulses in the upper extremity', 'B': 'Infarction of an internal organ', 'C': 'Stroke', 'D': 'Aneurysm of an artery', 'E': 'Palpable purpura'},
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E: Palpable purpura
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Q:A 22-year-old man with no significant medical history presents with a two day history of bilateral eye redness, irritation, and watery mucous discharge as seen in the photograph provided. He has crusting of his eyes in the mornings without adhesion of his eyelids. He does not wear contact lenses and has had a sore throat the last three days. On physical exam, a left preauricular lymph node is enlarged and tender. An ophthalmologic exam reveals no additional abnormalities. Which of the following is the most appropriate treatment for this patient?? {'A': 'Topical erythromycin ointment', 'B': 'Oral azithromycin', 'C': 'Topical moxifloxacin', 'D': 'Warm compresses', 'E': 'Topical glucocorticoids'},
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D: Warm compresses
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Q:A 58-year-old man with an unknown previous medical history is found on the floor at home by his daughter. During the initial assessment, the patient has right-sided arm weakness and incomprehensible speech. The patient is admitted to the hospital where he is diagnosed with an ischemic stroke where his magnetic resonance image (MRI) scan showed diffusion restriction in the right middle cerebral artery (MCA) territory. Further evaluation reveals the patient had been on the floor for about 2 days before he was found by his daughter. At presentation to the hospital, the blood pressure is 161/88 mm Hg and the heart rate is 104/min and regular. His laboratory values at the time of admission are shown: BUN 40 mg/dL Creatinine 1.9 mg/dL Potassium 5.3 mEq/dL Sodium 155 mEq/dL Chloride 100 mEq/dL HCO3 24 mmol/L Hemoglobin 13.8 g/dL Hematocrit 40% Leukocytes 11,000/mL Platelets 300,000/µL Serum creatine kinase 40,000 U/L Which of the following is most indicated in this patient?? {'A': 'Forced diuresis with intravenous (IV) fluids', 'B': 'Stress echocardiography', 'C': 'Intravenous n-acetyl-cysteine', 'D': 'Transfusion of fresh frozen plasma (FFP)', 'E': 'Rhythm control with metoprolol'},
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A: Forced diuresis with intravenous (IV) fluids
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Q:A 16-year-old girl is brought to the emergency department by her parents because of fever, vomiting, rash, and worsening confusion since this morning. On questioning, her mother reports that her last menstrual period was 1 week ago and that she recently started using tampons. She appears lethargic and is only oriented to person. Her temperature is 40.4°C (104.7°F), pulse 174/minute, and blood pressure is 62/44 mm Hg. Examination shows oropharyngeal hyperemia and diffuse macular erythroderma. Which of the following is the most likely cause of this patient's condition?? {'A': 'Erythrogenic toxin production', 'B': 'Lipooligosaccharide expression', 'C': 'Unregulated B cell proliferation', 'D': 'Generalized mast cell degranulation', 'E': 'Polyclonal T cell activation'},
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E: Polyclonal T cell activation
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Q:A 27-year-old man is brought to the emergency department after a motor vehicle accident. He complains of tingling of his legs, and he is unable to move them. His temperature is 36.5°C (97.7°F), the blood pressure is 110/75 mm Hg, and the pulse is 88/min. On physical examination, pinprick sensation is absent below the umbilicus and there is no rectal tone. Muscle strength in the lower extremities is 1/5 bilaterally. He has 5/5 strength in his bilateral upper extremities. Plain films and computerized tomography (CT) show the displacement of the lumbar vertebrae. Which of the following is the best next step in the management of this patient?? {'A': 'Positron emission tomography (PET) scan of the spine', 'B': 'Intravenous methylprednisolone', 'C': 'CT myelography', 'D': 'Radiation therapy', 'E': 'Intravenous antibiotics'},
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B: Intravenous methylprednisolone
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Q:A 40-year-old Indian female is hospitalized with exertional dyspnea and lower extremity edema. The patient immigrated to the United States at age 15 and does not use tobacco, alcohol, or drugs. A mid-diastolic murmur is present and heard best at the apex. Which of the following symptoms would be most consistent with the rest of the patient’s presentation?? {'A': 'Hoarseness', 'B': 'Pulsus parodoxus', 'C': 'Asymmetric ventricular hypertrophy', 'D': 'Increased intracranial pressure', 'E': 'Hirsutism'},
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A: Hoarseness
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Q:A 14-year-old Caucasian girl presents to the pediatrician for poor balance. She reports a 7-month history of frequent falls that has progressively worsened. She has fallen 3 times in the past week and feels like she cannot walk normally. She was born full-term and spent 2 days in the neonatal intensive care unit for respiratory distress. She has had an otherwise normal childhood. Her family history is notable for multiple cardiac deaths before the age of 60. Her mother had a posterior spinal fusion for kyphoscoliosis as an adolescent. On exam, the patient has 4/5 strength in her bilateral upper and lower extremities. She walks with a staggering gait. Pes cavus is appreciated bilaterally. Skin examination is normal. This patient has a condition that is caused by a trinucleotide repeat of which of the following nucleotides?? {'A': 'CAG', 'B': 'CGG', 'C': 'CTG', 'D': 'GAA', 'E': 'GAC'},
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D: GAA
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Q:A 47-year-old farmer presents to his primary care physician for the first time appointment. The patient has never seen a doctor and states that he is in good health. He has worked as a farmer for the past 30 years and has no complaints. His temperature is 98.9°F (37.2°C), blood pressure is 197/118 mmHg, pulse is 90/min, respirations are 14/min, and oxygen saturation is 98% on room air. Physical exam is notable for an obese man in no current distress. Laboratory values are seen below. Serum: Na+: 139 mEq/L Cl-: 101 mEq/L K+: 5.2 mEq/L HCO3-: 25 mEq/L BUN: 34 mg/dL Glucose: 179 mg/dL Creatinine: 2.1 mg/dL Ca2+: 10.2 mg/dL Which of the following is the best management of this patient's blood pressure?? {'A': 'Carvedilol', 'B': 'Hydrochlorothiazide', 'C': 'Lisinopril', 'D': 'Metoprolol', 'E': 'Nicardipine'},
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C: Lisinopril
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Q:A 26-year-old woman presents to the office complaining of bloating and consistent fatigue. Past medical notes on her record show that she has seen several doctors at the clinic in the past year for the same concerns. During the discussion, she admits that coming to the doctor intensifies her anxiety and she does not enjoy it. However, she came because she fears that she has colon cancer and says, “There’s gotta be something wrong with me, I can feel it.” Past medical history is significant for obsessive-compulsive disorder (OCD). She sees a therapist a few times a month. Her grandfather died of colon cancer at 75. Today, her blood pressure is 120/80 mm Hg, heart rate is 90/min, respiratory rate is 18/min, and temperature is 37.0°C (98.6°F). Physical examination reveals a well-nourished, well-developed woman who appears anxious and tired. Her heart has a regular rhythm and her lungs are clear to auscultation bilaterally. Her abdomen is soft, non-tender, and non-distended. No masses are palpated, and a digital rectal examination is unremarkable. Laboratory results are as follows: Serum chemistry Hemoglobin 13 g/dL Hematocrit 38% MCV 90 fl TSH 4.1 μU/mL Fecal occult blood test negative Which of the following is the most likely diagnosis?? {'A': 'Malingering', 'B': 'Somatic symptoms disorder', 'C': 'Body dysmorphic disorder', 'D': 'Illness anxiety disorder', 'E': 'Generalized anxiety disorder'},
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D: Illness anxiety disorder
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Q:A 45-year-old man presents to his primary care physician for lower extremity pain and unsteadiness. He describes the pain as severe and stabbing and affecting his lower extremities. These episodes of pain last for minutes at a time. He also reports knocking into furniture regularly. Medical history is significant for streptococcal pharyngitis, where he had a severe allergic reaction to appropriate treatment. He is currently sexually active with men and does not use condoms. On physical exam, his pupils are miotic in normal and low light. The pupils do not constrict further when exposed to the penlight and there is no direct or consensual pupillary dilation when the penlight is removed. The pupils constrict further when exposed to a near object. He has decreased vibration and proprioception sense in his lower extremities, absent lower extremity deep tendon reflexes, and a positive Romberg test. Which of the following is the best next step in management?? {'A': 'Intramuscular penicillin', 'B': 'Intramuscular ceftriaxone', 'C': 'Intravenous doxycycline', 'D': 'Intravenous penicillin', 'E': 'Oral doxycycline'},
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D: Intravenous penicillin
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Q:A 25-year-old male wrestler presents to his primary care physician for knee pain. He was in a wrestling match yesterday when he was abruptly taken down. Since then, he has had pain in his left knee. The patient states that at times it feels as if his knee locks as he moves it. The patient has a past medical history of anabolic steroid abuse; however, he claims to no longer be using them. His current medications include NSAIDs as needed for minor injuries from participating in sports. On physical exam, you note medial joint tenderness of the patient’s left knee, as well as some erythema and bruising. The patient has an antalgic gait as you observe him walking. Passive range of motion reveals a subtle clicking of the joint. There is absent anterior displacement of the tibia relative to the femur on an anterior drawer test. The rest of the physical exam, including examination of the contralateral knee is within normal limits. Which of the following structures is most likely damaged in this patient?? {'A': 'Medial meniscus', 'B': 'Lateral meniscus', 'C': 'Medial collateral ligament', 'D': 'Lateral collateral ligament', 'E': 'Anterior cruciate ligament'},
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A: Medial meniscus
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Q:A 71-year-old woman comes to the physician because of progressive shortness of breath and swollen legs for 4 weeks. She has tried sleeping in a raised position using 2 pillows but still wakes up occasionally from a choking sensation. She returned from a safari tour in Tanzania 3 months ago. She has type 2 diabetes mellitus, arterial hypertension, and gastroesophageal reflux disease. Her sister has polymyalgia rheumatica. Her current medications include insulin, enalapril, and omeprazole. She has smoked one half-pack of cigarettes daily for 45 years. Her temperature is 37°C (98.6°F), pulse is 112/min, respirations are 22/min, and blood pressure is 119/76 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 90%. Examination shows pitting edema below the knees and jugular venous distention. Crackles are heard at both lung bases. A photograph of her tongue is shown. Her hemoglobin concentration is 10.0 g/dL, leukocyte count is 6,100/mm3, and erythrocyte sedimentation rate is 62 mm/h. ECG shows sinus rhythm and low-voltage QRS complexes. Echocardiography shows symmetrical left ventricular hypertrophy, reduced diastolic filling, and an ejection fraction of 55%. Which of the following is the most likely cause of this patient's symptoms?? {'A': 'Endocardial fibroelastosis', 'B': 'Systemic sclerosis', 'C': 'Multiple myeloma', 'D': 'Tuberculosis', 'E': 'Rheumatoid arthritis'},
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C: Multiple myeloma
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Q:A 6-year-old boy is brought to the pediatrician by his mother for diarrhea and a skin rash. His mother reports that he had a cough, sore throat, and runny nose 1 week ago. Although his upper respiratory symptoms improved after two days, he started having multiple watery bowel movements 3 days ago. He also developed a red pruritic rash on his arms, legs, and neck at that time. His mother also reports that he has had similar symptoms in the past that have occurred after the boy gets sick. His temperature is 98.8°F (37.1°C), blood pressure is 109/68 mmHg, pulse is 92/min, and respirations are 19/min. The child is alert and oriented to person but not place or time. He is unable to count to 10 even though his mother says he can normally count to 100 easily. He walks with a wide-based gait. An erythematous patchy rash is noted on his upper and lower extremities bilaterally. A complete blood count and basic metabolic panel are within normal limits. A urinalysis reveals elevated levels of neutral amino acids. Which of the following is the most appropriate acute treatment for this patient?? {'A': 'Nicotinic acid', 'B': 'Phenylbutyrate', 'C': 'Pyridoxine', 'D': 'Tryptophan', 'E': 'Tyrosine'},
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A: Nicotinic acid
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Q:A 49-year-old man comes to the physician because of a 5-month history of progressive fatigue and exertional dyspnea. Cardiac examination shows a loud S2 in the 2nd left intercostal space. Right heart catheterization shows a pulmonary artery pressure of 32 mm Hg. Treatment with bosentan is initiated. The beneficial effect of this drug is due to binding to which of the following?? {'A': 'L-type voltage-gated calcium channels', 'B': 'Phosphodiesterase-5', 'C': 'Prostacyclin receptor', 'D': 'Adenosine receptors', 'E': 'Endothelin receptors'},
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E: Endothelin receptors
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Q:A 2-week-old newborn girl is brought to the physician for a follow-up examination after the initial newborn examination showed asymmetry of the legs. She was born at term to a 26-year-old woman, gravida 3, para 2. Pregnancy was complicated by a breech presentation and treated with an emergency lower-segment transverse cesarean section. The newborn's head circumference is 35 cm (13.7 in). She is at the 60th percentile for length and 75th percentile for weight. Cardiac examination shows no abnormalities. The spine and overlying skin do not indicate significant abnormalities. Abduction of the right hip after cupping the pelvis and flexing the right hip and knee causes a palpable clunk. The feet exhibit no deformities. Ultrasonography of the hip revealed a 50° angle between the lines along the bone acetabulum and the ilium. Which of the following is the most appropriate next step in management?? {'A': 'Immobilize the hips with a spica cast', 'B': 'Obtain an MRI of the right hip', 'C': 'Obtain an X-ray of the right hip', 'D': 'Reassure the mother and schedule follow-up appointment in 4 weeks', 'E': 'Treat using a harness'},
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E: Treat using a harness
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Q:A 26-year-old woman comes to the physician because of a progressive swelling in her mouth that she first noticed 5 years ago. Initially, the swelling was asymptomatic but has now caused some difficulty while chewing food for the past month. She has no pain. She has not undergone any dental procedures in the past 5 years. She has bronchial asthma. Her only medication is an albuterol inhaler. She appears healthy. Her temperature is 37°C (98.6°F), pulse is 70/min, and blood pressure is 110/70 mm Hg. Examination shows a 1.5-cm smooth, unilobular, bony hard, nontender mass in the midline of the hard palate. There is no cervical or submandibular lymphadenopathy. The remainder of the examination shows no abnormalities. Which of the following is the most likely diagnosis?? {'A': 'Palatal pleomorphic adenoma', 'B': 'Necrotizing sialometaplasia', 'C': 'Nasopalatine duct cyst', 'D': 'Palatal abscess', 'E': 'Torus palatinus\n"'},
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E: Torus palatinus "
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Q:A 54-year-old man presents to the emergency department after vomiting blood an hour ago. He says this happens to him occasionally but denies feeling pain in these episodes. The man is disheveled and has slurred speech as he describes his symptoms. He is reluctant to give further history and wants immediate treatment of his condition. Upon examination, the patient has evidence of tortuous veins visible on his abdomen plus a yellow tinge to his sclerae. He suddenly begins vomiting copious amounts of blood and soon becomes unresponsive. His blood pressure drops to 70/40 mm Hg. He is given 3 units of whole blood but passes away shortly after the incident. Which of the following was the most likely cause of his vomiting of blood?? {'A': 'Increased pressure in the distal esophageal vein due to increased pressure in the left gastric vein', 'B': 'Lacerations of the mucosa at the gastroesophageal junction', 'C': 'Perforation of the gastric mucosa', 'D': 'Decreased GABA activity due to downregulation of receptors', 'E': 'Inflammation of the portal tract due to a chronic viral illness'},
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A: Increased pressure in the distal esophageal vein due to increased pressure in the left gastric vein
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Q:A 60-year-old man is brought to the emergency room because of fever and increasing confusion for the past 2 days. He has paranoid schizophrenia treated with chlorpromazine. He appears diaphoretic. His temperature is 40°C (104°F), pulse is 130/min, respirations are 29/min, and blood pressure is 155/100 mm Hg. Neurologic examination shows psychomotor agitation and incoherent speech. There is generalized muscle rigidity. His deep tendon reflexes are decreased bilaterally. Serum laboratory analysis shows a leukocyte count of 11,300/mm3 and serum creatine kinase concentration of 833 U/L. The most appropriate drug for this patient acts by inhibiting which of the following?? {'A': 'Cholinesterase', 'B': 'Postsynaptic dopamine D2 receptors and serotonin 2A receptors', 'C': 'Ryanodine receptor on the sarcoplasmic reticulum', 'D': 'Histamine H1 receptor and serotonin 2 receptors', 'E': 'Beta adrenergic receptors'},
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C: Ryanodine receptor on the sarcoplasmic reticulum
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Q:A 10-month-old infant is brought to the emergency by his parents after a seizure. The parents report no history of trauma, fever, or a family history of seizures. However, they both say that the patient fell while he was running. Neurologic examination was normal. A head CT scan was ordered and is shown in figure A. Which of the following is most likely found in this patient?? {'A': 'Slipped capital femoral epiphysis', 'B': 'Retinal hemorrhages', 'C': 'Microcephaly', 'D': 'Rupture of middle meningeal artery', 'E': 'Intact bridging veins'},
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B: Retinal hemorrhages
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Q:An 80-year-old woman presents to her cardiologist for a scheduled appointment. She was shown to have moderate atrial dilation on echocardiography 3 years ago and was started on oral medications. The patient insists that she does not want aggressive treatment because she wants her remaining years to be peaceful. She has not been compliant with her medications and declines further investigations. Her heart rate today is 124/min and irregular. Which of the following organs is least likely to be affected by complications of her condition if she declines further management?? {'A': 'Brain', 'B': 'Eyes', 'C': 'Kidneys', 'D': 'Liver', 'E': 'Spleen'},
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D: Liver
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Q:A 3-year-old girl is brought in by her parents to her pediatrician for concerns about their child’s behavior. Since the parents started taking their child to daycare, they have become concerned that their daughter has not been behaving like other children her age. Most notably, she seldom responds when her name is called at home or at daycare. Additionally, she has been getting in trouble with the day care staff for not following directions but instead demanding to play with the train set at all times. She has been asked numerous times to share the toys, but the patient does not play with the other children. The parents state that the patient was born vaginally following a normal pregnancy, and the patient had been meeting developmental milestones all along. While she does not speak much, she is able to construct sentences up to 4-5 words. On exam, the patient’s temperature is 98.2°F (36.8°C), blood pressure is 106/60 mmHg, pulse is 76/min, and respirations are 14/min. The patient does not cooperate with gross or fine motor testing, but she appears to have no trouble running around the room and draws very detailed trains with crayons. While drawing and standing, she frequently makes flapping motions with her hands. The patient has ample vocabulary, but speaks in a singsong voice mostly to herself and does not engage during the exam. Which of the following is the most likely diagnosis?? {'A': 'Attention-deficit hyperactivity disorder', 'B': 'Autism spectrum disorder', 'C': 'Normal development', 'D': 'Rett syndrome', 'E': 'Tourette syndrome'},
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B: Autism spectrum disorder
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Q:A 27-year-old man comes to the physician because of multiple, dry, scaly lesions on his elbows. The lesions appeared 4 months ago and have progressively increased in size. They are itchy and bleed when he scratches them. There is no associated pain or discharge. He was diagnosed with HIV infection 6 years ago. He has smoked a pack of cigarettes daily for the past 10 years. Current medications include raltegravir, lamivudine, abacavir, and cotrimoxazole. An image of the lesions is shown. His CD4+ T-lymphocyte count is 470/mm3 (normal ≥ 500). Which of the following is the most likely cause of this patient's skin findings?? {'A': 'HPV-2 infection', 'B': 'Malassezia furfur infection', 'C': 'Neoplastic T-cell Infiltration', 'D': 'Increased keratinocyte proliferation', 'E': 'Autoimmune melanocyte destruction\n"'},
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D: Increased keratinocyte proliferation
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Q:A 45-year-old African-American woman presents with dyspnea, cough, and non-radiating chest pain. Her chest pain is relieved by leaning forward and worsens upon leaning backwards. A scratchy rub is heard best with the patient leaning forward. Physical examination did not elucidate evidence of a positive Kussmaul's sign, pulsus paradoxus, or pericardial knock. The patient most likely is suffering from which of the following?? {'A': 'Cardiac tamponade', 'B': 'Constrictive pericarditis', 'C': 'Acute pericarditis', 'D': 'Libman-Sacks endocarditis', 'E': 'Acute myocardial infarction'},
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C: Acute pericarditis
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Q:Shortly after the removal of a subclavian venous catheter by a surgical resident in an academic medical center, a 50-year-old man develops tachycardia, respiratory distress, and hypotension. Despite appropriate lifesaving treatment, the patient dies. Examination of the lungs during autopsy shows air in the main pulmonary artery. A root cause analysis is performed to prevent similar events occurring in the future. Which of the following actions is a primary approach for this type of error analysis?? {'A': 'Schedule a required lecture on central venous catheter removal for all residents', 'B': 'Examine the central line placement curriculum used for all surgical residents', 'C': 'Research other cases of catheter-associated venous air embolisms that have occurred nationally', 'D': "Conduct interviews with all staff members involved in the patient's care", 'E': 'Review all possible causes of venous air embolism'},
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D: Conduct interviews with all staff members involved in the patient's care
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Q:A 63-year-old woman comes to the physician because of a skin lesion on her neck for 7 months. It is neither pruritic nor painful. She has tried using over-the-counter topical medications, but none have helped. She has hypertension, hypothyroidism, and gastroesophageal reflux disease. Current medications include amlodipine, hydrochlorothiazide, levothyroxine, and pantoprazole. She is a farmer and lives with her two children. Her temperature is 37.7°C (98.8°F), pulse is 80/min, respirations are 15/min, and blood pressure is 128/84 mm Hg. Examination shows a 5-mm (0.2-in) nontender, indurated, nodular lesion with rolled-out edges on the anterolateral aspect of the neck. There is a central area of ulceration. There is no cervical lymphadenopathy. The lungs are clear to auscultation. Cardiac examination shows no abnormalities. In addition to dermoscopy, which of the following is the most appropriate next step in management?? {'A': 'Perform a punch biopsy of the center of the lesion', 'B': 'Perform an excisional biopsy of the entire lesion', 'C': 'Schedule external beam radiotherapy sessions', 'D': 'Perform cryotherapy on the lesion', 'E': 'Perform a wedge biopsy of the lesion and surrounding tissue'},
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B: Perform an excisional biopsy of the entire lesion
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Q:A 45-year-old man comes to the physician for a follow-up examination after being diagnosed with hypertension 6 months ago. He has cut salt out of his diet and started exercising regularly, but home blood pressure measurements continue to be elevated. His blood pressure is 160/85 mm Hg. An antihypertensive medication is prescribed that decreases blood pressure by decreasing the transmembrane calcium current across vascular smooth muscle cells. Side effects include peripheral edema and flushing. Which of the following best describes why this drug does not affect skeletal muscle contraction?? {'A': 'Skeletal muscle lacks voltage-gated L-type calcium channels', 'B': 'Skeletal muscle contraction occurs independently of extracellular calcium influx', 'C': 'Skeletal muscle ryanodine receptor activation occurs independently of membrane depolarization', 'D': 'Skeletal muscle preferentially expresses N-type and P-type calcium channels', 'E': 'Skeletal muscle calcium channels do not undergo conformational change when bound to this drug'},
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B: Skeletal muscle contraction occurs independently of extracellular calcium influx
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Q:A 10-year-old boy presents with sudden shortness of breath. The patient’s mother says he was playing in the school garden 2 hours ago and suddenly started to complain of abdominal pain and vomited a few times. An hour later, he slowly developed a rash that involved his chest, arms, and legs, and his breathing became faster, with audible wheezing. He has no significant past medical history. His temperature is 37.0°C (98.6°F), blood pressure is 100/60 mm Hg, pulse is 130/min, and respirations are 25/min. On physical examination, there is a rash on his right arm (shown in the image, below). Which of the following cells will mainly be found in this patient if a histological sample is taken from the site of the skin lesion 4 hours from now?? {'A': 'Mast cells', 'B': 'Basophils', 'C': 'Fibroblasts', 'D': 'Plasma cells', 'E': 'Neutrophils'},
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E: Neutrophils
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Q:A 60-year-old man comes to the emergency department because of a 2-day history of sharp chest pain and a nonproductive cough. The pain worsens with deep inspiration and improves when he leans forward. Three weeks ago, the patient was diagnosed with an ST-elevation myocardial infarction and underwent stent implantation of the right coronary artery. His temperature is 38.4°C (101.1°F) and blood pressure is 132/85 mm Hg. Cardiac auscultation shows a high-pitched scratching sound during expiration. An x-ray of the chest shows enlargement of the cardiac silhouette and a left-sided pleural effusion. Which of the following is the most likely underlying cause of this patient's current condition?? {'A': 'Outpouching of ventricular wall', 'B': 'Occlusion of coronary artery stent', 'C': 'Embolism to left pulmonary artery', 'D': 'Immune response to cardiac antigens', 'E': 'Rupture of interventricular septum'},
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D: Immune response to cardiac antigens
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Q:Which of the following correctly pairs a neurotransmitter with its location of synthesis?? {'A': 'Norepinephrine -- Caudate nucleus', 'B': 'GABA -- Ventral tegmentum', 'C': 'Dopamine -- Locus ceruleus', 'D': 'Serotonin -- Raphe nucleus', 'E': 'Acetylcholine -- Nucleus accumbens'},
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D: Serotonin -- Raphe nucleus
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Q:A 22-year-old man presents to the emergency department with abdominal pain. The patient states that he has had right lower quadrant abdominal pain for "a while now". The pain comes and goes, and today it is particularly painful. The patient is a college student studying philosophy. He drinks alcohol occasionally and is currently sexually active. He states that sometimes he feels anxious about school. The patient's father died of colon cancer at the age of 55, and his mother died of breast cancer when she was 57. The patient has a past medical history of anxiety and depression which is not currently treated. Review of systems is positive for bloody diarrhea. His temperature is 99.5°F (37.5°C), blood pressure is 100/58 mmHg, pulse is 120/min, respirations are 17/min, and oxygen saturation is 98% on room air. Cardiopulmonary exam is within normal limits. Abdominal exam reveals diffuse tenderness. A fecal occult blood test is positive. Which of the following is the most likely diagnosis?? {'A': 'Appendicitis', 'B': 'Colon cancer', 'C': 'Infectious colitis', 'D': 'Inflammatory bowel syndrome', 'E': 'Irritable bowel syndrome'},
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D: Inflammatory bowel syndrome
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Q:A 12-year-old girl is brought to the physician because of fatigue, dyspnea, and mild chest pain on exertion for 1 week. She does not have a fever or a rash. She had an upper respiratory infection 3 weeks ago. She returned from summer camp in Colorado 3 days ago. She says they went hiking and camping as part of their activities. Her temperature is 36.9°C (98.4°F), heart rate is 96/min, and blood pressure is 106/74 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 96%. Physical examination reveals jugular venous distention and 1+ pitting edema on both ankles. A few scattered inspiratory crackles are heard in the thorax and an S3 is heard at the apex. Abdominal examination is unremarkable. Her hemoglobin concentration is 11.6 g/dL, leukocyte count is 8900/mm3, and ESR is 10 mm/hr. An x-ray of the chest shows mild cardiac enlargement. Which of the following is the most likely cause of this patient's symptoms?? {'A': 'Acute rheumatic fever', 'B': 'Giant cell myocarditis', 'C': 'Borrelia burgdorferi infection', 'D': 'Coxsackie virus infection', 'E': 'Rhinovirus infection'},
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D: Coxsackie virus infection
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Answer the following medical question with one of the provided options:
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Q:A 2-year-old boy is brought to a pediatrician for recurrent respiratory infections. The parents explain that their child has gotten sick every month since 2 months of age. The boy had multiple upper respiratory infections and has been treated for pneumonia twice. He coughs frequently, and a trial of salbutamol has not helped much. The parents also mention that the child has bulky, irregular stools. The boy was started late on his vaccinations as his parents were in Asia on missionary work when he was born, but his vaccinations are now up to date. The patient's brother and sister are both healthy and have no medical concerns. The boy's delivery was unremarkable. A sweat chloride test is positive. Genetic testing shows the absence of the typical deletion in the implicated gene, but the gene length appears to be shortened by one base pair. Which mutation could account for this finding?? {'A': 'Frameshift', 'B': 'Insertion', 'C': 'Missense', 'D': 'Nonsense', 'E': 'Silent'},
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A: Frameshift
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Answer the following medical question with one of the provided options:
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Q:A 43-year-old man comes to the physician for evaluation of a headache he has had for the last 6 months. The patient reports that nothing helps to relieve the headache and that it is more severe in the morning. Throughout the last 2 months, he has been unable to maintain an erection and states that his sexual desire is low. There is no personal or family history of serious illness. His temperature is 37°C (98.6°F), pulse is 80/min, and blood pressure is 150/90 mm Hg. Examination shows an enlarged nose, forehead, and jaw and widened hands, fingers, and feet. His hands are sweaty. His serum glucose concentration is 260 mg/dL. Which of the following is the most appropriate next step in diagnosis?? {'A': 'Serum IGF-1 measurement', 'B': 'MRI of the brain', 'C': 'Oral glucose tolerance test', 'D': 'Basal prolactin measurement', 'E': '24-hour urine cortisol measurement\n"'},
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A: Serum IGF-1 measurement
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Answer the following medical question with one of the provided options:
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Q:A 68-year-old male presents with several years of progressively worsening pain in his buttocks. Pain is characterized as dull, worse with exertion especially when ascending the stairs. He has a history of diabetes mellitus type II, obesity, coronary artery disease with prior myocardial infarction, and a 44 pack-year smoking history. Current medications include aspirin, atorvastatin, metoprolol, lisinopril, insulin, metformin, and varenicline. Upon further questioning, the patient's wife states that her husband has also recently developed impotence. His temperature is 99.5°F (37.5°C), pulse is 90/min, blood pressure is 150/90 mmHg, respirations are 12/min, and oxygen saturation is 96% on room air. Which of the following is the best initial step in management?? {'A': 'Cilostazol', 'B': 'Pentoxifylline', 'C': 'Guided exercise therapy', 'D': 'Ankle-brachial index', 'E': 'Angiography'},
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D: Ankle-brachial index
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Answer the following medical question with one of the provided options:
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Q:A 27-year-old man presents to the emergency department following a motor vehicle accident. Having been found as a restrained driver, he did not suffer from any chest injuries; nevertheless, his legs were pinned in position by the front of the highly damaged vehicle. After a prolonged extrication, the man sustained multiple fractures on his left femur and tibia. That same night, he underwent surgery to address his left leg fractures. In the next morning, the man suddenly developed severe dyspnea. Upon examination, he is noted to have a diffuse petechial rash. His vital signs are the following: blood pressure is 111/67 mm Hg, pulse rate is 107/min, respiratory rate is 27/min, oxygen saturation level is 82%, and his body temperature is normal. What is the most likely mechanism of his respiratory distress?? {'A': 'Pulmonary edema', 'B': 'Cardiac tamponade', 'C': 'Bacterial pneumonia', 'D': 'Spontaneous pneumothorax', 'E': 'Fat embolism'},
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E: Fat embolism
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Answer the following medical question with one of the provided options:
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Q:A 3-year-old is brought to the pediatrician by by his mother. She is concerned that he appears fatigued all the time. She also mentions that he struggles to get out of his seat after eating his meals and when he waddles when he walks now. The child was born at 39 weeks via spontaneous vaginal delivery. He is up to date on all his vaccines and meeting all developmental goals. A maternal uncle with similar symptoms that started in early childhood. He has a heart rate of 90/min, respiratory rate of 22/min, blood pressure of 110/65 mm Hg, and temperature of 37.0°C (98.6°F). The child appears lethargic. He was much more active during his previous well-child visit. Upon examination, the child has thick calves and uses his hands to support himself as he stands up from a sitting position. His reflexes are decreased bilaterally. Lab studies show elevated creatinine phosphokinase (CPK) and lactate dehydrogenase (LDH). Which of the following is the most likely cause of this patient’s condition?? {'A': 'Missense mutation in β-thalassemia gene', 'B': 'Missense mutation in DMD gene', 'C': 'Nonsense mutation in DMD gene', 'D': 'Nonsense mutation in DMPK gene', 'E': 'Mutation in WT gene'},
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C: Nonsense mutation in DMD gene
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Answer the following medical question with one of the provided options:
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Q:A 5-month-old boy is brought to the physician by his parents because of difficulty breathing for the past hour. The parents report noisy breathing and bluish discoloration of their son's lips. During the past two months, the patient has had several upper respiratory tract infections and poor weight gain. Pregnancy and delivery were uncomplicated. His immunizations are up-to-date. He is at the 20th percentile for length and 5th percentile for weight. His temperature is 38°C (100.4°F), pulse is 160/min, respirations are 40/min, and blood pressure is 80/55 mm Hg. Crackles are heard over both lung fields. An x-ray of the chest shows bilateral interstitial infiltrates. Intubation is performed and methylprednisolone is administered. Methenamine silver staining of bronchial lavage fluid shows aggregates of 2 to 8 cysts with central spores. Serum IgA titers are decreased. Which of the following is the most likely underlying cause of this patient's condition?? {'A': 'Defective WAS gene', 'B': 'Defective CD40 ligand', 'C': 'Impaired lysosomal trafficking regulator gene', 'D': 'Tyrosine kinase gene mutation', 'E': 'Impaired NADPH oxidase'},
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B: Defective CD40 ligand
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Answer the following medical question with one of the provided options:
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Q:A 68-year-old man presents to his primary care physician for fatigue. He is accompanied by his granddaughter who is worried that the patient is depressed. She states that over the past 2 months he has lost 15 lbs. He has not come to some family events because he complains of being “too tired.” The patient states that he tries to keep up with things he likes to do like biking and bowling with his friends but just tires too easily. He does not feel like he has trouble sleeping. He does agree that he has lost weight due to a decreased appetite. The patient has coronary artery disease and osteoarthritis. He has not been to a doctor in “years” and takes no medications, except acetaminophen as needed. Physical examination is notable for hepatomegaly. Routine labs are obtained, as shown below: Leukocyte count: 11,000/mm^3 Hemoglobin: 9 g/dL Platelet count: 300,000/mm^3 Mean corpuscular volume (MCV): 75 µm^3 Serum iron: 35 mcg/dL An abdominal ultrasound reveals multiple, hypoechoic liver lesions. Computed tomography of the abdomen confirms multiple, centrally-located, hypoattenuated lesions. Which of the following is the next best step in management?? {'A': 'Citalopram', 'B': 'Colonoscopy', 'C': 'Fine-needle aspiration', 'D': 'Fluorouracil, leucovorin, and oxaliplatin', 'E': 'Surgical resection'},
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B: Colonoscopy
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Answer the following medical question with one of the provided options:
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Q:Eighteen hours after undergoing surgery for a splenic rupture and liver laceration following a high-speed motor vehicle collision, a 23-year-old man's pulse is 140/min, blood pressure is 80/50 mm Hg, and central venous pressure is 19 cm H2O. He was transfused with 6 units of packed red blood cells during surgery. Examination shows jugular venous distention. There is a midline surgical incision with no erythema or discharge. The abdomen is tense and distended. The total urine output over the past 6 hours is 90 mL. Serum studies show: Urea nitrogen 80 mg/dL Creatinine 3.0 mg/dL HCO3- 29 mEq/L Which of the following is the most appropriate next step in management?"? {'A': 'Administration of fresh frozen plasma', 'B': 'Reopen abdomen and cover with plastic', 'C': 'Administration of intravenous antibiotics', 'D': 'Angiographic embolization', 'E': 'Hemicolonic resection'},
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B: Reopen abdomen and cover with plastic
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