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Answer the following medical question with one of the provided options:
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Q:A 19-year-old Caucasian college student is home for the summer. Her parents note that she has lost quite a bit of weight. The daughter explains that the weight loss was unintentional. She also notes an increase in thirst, hunger, and urine output. Her parents decide to take her to their family physician, who suspects finding which of the following?? {'A': 'Evidence of amyloid deposition in pancreatic islets', 'B': 'High T4 and T3 levels', 'C': 'Elevated ketone levels', 'D': 'Hypoglycemia', 'E': 'Hyperinsulinemia'},
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C: Elevated ketone levels
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Answer the following medical question with one of the provided options:
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Q:An 84-year-old woman with Alzheimer's disease is brought to the physician by her son for a follow-up examination. The patient lives with her son, who is her primary caregiver. He reports that it is becoming gradually more difficult to care for her. She occasionally has tantrums and there are times when she does not recognize him. She sleeps 6–8 hours throughout the day and is increasingly agitated and confused at night. When the phone, television, or oven beeps she thinks she is at the dentist's office and becomes very anxious. She eats 2–3 meals a day and has a good appetite. She has not fallen. She has not left the home in weeks except for short walks. She has a history of hypertension, hyperlipidemia, atrial fibrillation, and hypothyroidism. She takes levothyroxine, aspirin, warfarin, donepezil, verapamil, lisinopril, atorvastatin, and a multivitamin daily. Her temperature is 37°C (98.4°F), pulse is 66/min, respirations are 13/min, and blood pressure is 126/82 mm Hg. Physical examination shows no abnormalities. It is important to the family that the patient continues her care in the home. Which of the following recommendations is most appropriate at this time?? {'A': 'Start quetiapine daily', 'B': 'Start lorazepam as needed', 'C': 'Adhere to a regular sleep schedule', 'D': 'Frequently play classical music', 'E': 'Schedule frequent travel\n"'},
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C: Adhere to a regular sleep schedule
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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 is hospitalized for an elective gastrointestinal surgery 24 hours before the scheduled day of surgery. The surgeon has ordered food and fluids to be withheld from the patient from 12 hours before the surgery and the administration of intravenous isotonic saline. Based on his body weight, his fluid requirement for 12 hours is 900 mL. However, the following day, the surgeon finds that 3 pints of isotonic fluid (1 pint = 500 mL) were administered over the preceding last 12 hours. Which of the following options best describes the resulting changes in the volume of intracellular fluid (ICF) and the body osmolality of the patient?? {'A': 'Increased ICF volume, no change in body osmolality', 'B': 'Increased ICF volume, decreased body osmolality', 'C': 'Decreased ICF volume, no change in body osmolality', 'D': 'Decreased ICF volume, increased body osmolality', 'E': 'No change in ICF volume, no change in body osmolality'},
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E: No change in ICF volume, no change in body osmolality
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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 presents to the emergency department with a complaint of crushing chest pain. The pain started suddenly 30 minutes ago while he was walking his dog. The patient also complains of difficulty breathing and palpitations. The pain is described as starting behind the sternum and moving towards the left jaw. Medical history includes recently diagnosed hypercholesterolemia and peptic ulcer disease. He currently takes atorvastatin and omeprazole. The patient has smoked a pack of cigarettes per day for 10 years and consumes 2–3 beers on the weekends. His blood pressure is 148/90 mm Hg, the pulse is 106/min, and the respiratory rate is 22/min. Examination shows him to be visibly distressed, diaphoretic, and slightly hunched over. Aspirin is administered and blood work is sent to the laboratory. His ECG is shown in the picture. What is the best next step for this patient?? {'A': 'Start heparin infusion and ICU admission', 'B': 'Perform an urgent bedside echocardiography', 'C': 'Urgent percutaneous coronary intervention', 'D': 'Monitor closely and wait for cardiac troponin levels', 'E': 'Order an urgent chest CT scan and provide analgesia'},
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C: Urgent percutaneous coronary intervention
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Answer the following medical question with one of the provided options:
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Q:A 25-year-old man is brought to the emergency department by his wife for evaluation of abnormal behavior that began 2 weeks ago. The patient has not slept in over a week and has been partying each night. He has never done this before. The patient has also been skipping work and purchased a car last week with money they had saved for their vacation to Italy. He has a past medical history of major depressive disorder and systemic lupus erythematosus. He normally drinks 2 beers per week but has been drinking 6–10 beers per day for the past two weeks. Current medications include hydroxychloroquine. He appears agitated and is wearing bright-colored mismatched clothing. His temperature is 36°C (96.8°F), pulse is 94/min, respirations are 18/min, and blood pressure is 130/85 mm Hg. Physical examination shows no abnormalities. On mental status examination, his speech is pressured and his thought process is tangential. A complete blood count, serum electrolytes, and liver enzyme activities are within the reference range; his serum creatinine is 1.8 mg/dL. Urinalysis shows 2+ proteinuria, and WBC casts. Toxicology screening is negative. This patient would most likely benefit from which of the following long-term treatments?? {'A': 'Dialectical behavioral therapy', 'B': 'Valproate', 'C': 'Clonazepam', 'D': 'Lithium', 'E': 'Escitalopram\n"'},
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B: Valproate
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Answer the following medical question with one of the provided options:
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Q:A 30-year-old caucasian female comes to the physician because of chronic diarrhea and abdominal bloating that started 6 months ago. She also reports increasing fatigue and intermittent tingling in her hands and feet. She lost 5 kg (11 lb) of weight over the past 6 months without changing her diet or trying to lose weight. She and her husband have been trying to conceive for over a year without any success. Menses have been irregular at 28–45 day intervals and last for 1–2 days. She has generalized anxiety disorder for which she takes sertraline. Her height is 151 cm and weight is 50 kg; BMI is 22 kg/m2. Examination shows generalized pallor. Cardiopulmonary examination is normal. Test of the stool for occult blood is negative. Laboratory studies show: Hemoglobin 9.5 g/dL Leukocyte count 3900/mm3 Platelet count 130,000/mm3 Serum Glucose 100 mg/dL Creatinine 0.6 mg/dL Thyroid-stimulating hormone 3.3 μU/mL Vitamin B12 80 pg/mL (N > 200) IgA anti-tissue transglutaminase antibody negative Serum IgA decreased Which of the following is the most appropriate next step in diagnosis?"? {'A': 'Plasma zinc concentration', 'B': 'Fecal fat test', 'C': 'IgG deamidated gliadin peptide test', 'D': 'IgA endomysial antibody', 'E': 'Skin prick test'},
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C: IgG deamidated gliadin peptide test
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Answer the following medical question with one of the provided options:
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Q:A 7-year-old boy presents with difficulty swallowing, diarrhea, itching, and weakness. He also complains of episodes of headaches, sweating, and palpitations, which are accompanied by fear and tend to end with micturition. His mother is concerned about the strange nodules on his lips and eyelids. The boy's younger brother had similar nodules and died at 10 years of age of unknown causes. The patient’s vital signs are as follows: blood pressure 130/80 mm Hg, heart rate 107/min, respiratory rate 14/min, and temperature 36.9℃ (98.4℉). The child is tall, thin, has disproportionately long arms and legs, and increased thoracic spine kyphosis. There are multiple yellow-white, sessile, painless nodules on the patient’s lips, and buccal and eyelid mucosa. There is a painless lump in the area of the left thyroid lobe and enlargement of the posterior cervical lymph nodes on the left side. What is the most probable embryonic origin of the cells in the lump?? {'A': 'First pharyngeal groove', 'B': 'First pharyngeal pouch', 'C': 'Lateral plate mesoderm', 'D': 'Neurogenic placodes', 'E': 'Neural crest cells'},
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E: Neural crest cells
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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 with well-controlled HIV on antiretroviral therapy comes to the physician because of a 2-week history of a painless lesion on her right calf. Many years ago, she had a maculopapular rash over her trunk, palms, and soles that resolved spontaneously. Physical examination shows a 4-cm firm, non-tender, indurated ulcer with a moist, dark base and rolled edges. There is a similar lesion at the anus. Results of rapid plasma reagin testing are positive. Which of the following findings is most likely on microscopic examination of these lesions?? {'A': 'Epithelioid cell infiltrate surrounding acellular, granular core', 'B': 'Epidermal hyperplasia with dermal lymphocytic infiltrate', 'C': 'Lichenoid hyperplasia with superficial neutrophilic infiltrate', 'D': 'Ulcerated epidermis with plasma cell infiltrate', 'E': 'Coagulative necrosis surrounded by fibroblast and macrophage infiltrate'},
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E: Coagulative necrosis surrounded by fibroblast and macrophage infiltrate
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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 presents to his primary care physician with a 3-week history of increasing pain in his legs and feet. Specifically, he says that he has been getting electric shock sensations that started in his feet, but have progressed up his leg. In addition, the pain is accompanied by numbness and tingling in his hands and feet bilaterally. His past medical history is significant for poorly controlled type 2 diabetes mellitus. Given these symptoms, his physician prescribes a new drug to help him cope with these symptoms. Which of the following is the mechanism of action for the medication that was most likely prescribed in this case?? {'A': 'Binding to mu opioid receptors', 'B': 'Increased duration of GABA channel opening', 'C': 'Increased frequency of GABA channel opening', 'D': 'Selective serotonin reuptake inhibitor', 'E': 'Serotonin norepinephrine reuptake inhibitor'},
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E: Serotonin norepinephrine reuptake inhibitor
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Answer the following medical question with one of the provided options:
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Q:A 22-year-old soldier sustains a stab wound to his chest during a military attack in Mali. He is brought to the combat medic by his unit for a primary survey. The soldier reports shortness of breath. He is alert and oriented to time, place, and person. His pulse is 99/min, respirations are 32/min, and blood pressure is 112/72 mm Hg. Examination shows a 2-cm wound at the left fourth intercostal space at the midclavicular line. Bubbling of blood is seen with each respiration at the wound site. There is no jugular venous distention. There is hyperresonance to percussion and decreased breath sounds on the left side. The trachea is at the midline. Which of the following is the most appropriate next step in management?? {'A': 'Partially occlusive dressing', 'B': 'Emergency pericardiocentesis', 'C': 'Emergency echocardiography', 'D': 'Needle thoracostomy', 'E': 'Supplemental oxygen\n"'},
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A: Partially occlusive dressing
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Answer the following medical question with one of the provided options:
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Q:A 22-year-old G1P1 woman comes to the clinic asking about “the morning after pill.” She reports that she had sexual intercourse with her boyfriend last night and she thinks the condom broke. She is not using any other form of contraception. She reports her last menstrual period was 10 days ago, and they are normally regular. The patient’s medical history is significant for obesity, asthma and allergic rhinitis. Her medications include albuterol and occasional intranasal corticosteroids. She has no history of sexually transmitted diseases and is sexually active with only her current boyfriend of 5 years. The patient denies genitourinary symptoms. Her temperature is 98°F (36.7°C), blood pressure is 112/74 mmHg, pulse is 63/min, and respirations are 12/min with an oxygen saturation of 99% O2 on room air. Physical examination, including a pelvic exam, shows no abnormalities. The patient is worried because she is back in graduate school and cannot afford another child. Which of the following is the most effective emergency contraception?? {'A': 'Copper intrauterine device', 'B': 'High-dose oral contraceptive therapy', 'C': 'Levonorgesterel pill', 'D': 'Levonorgesterel-releasing intrauterine device', 'E': 'Ulipristal pill'},
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A: Copper intrauterine device
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Answer the following medical question with one of the provided options:
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Q:A 15-year-old adolescent boy presents to his pediatrician for his scheduled follow-up after he was prescribed low-dose methylphenidate for treatment of attention-deficit/hyperactivity disorder 4 weeks ago. On follow-up, his mother reports mild improvement in his symptoms, but she also notes that his appetite has decreased significantly after starting the medication. This has led to a 1.6 kg (3.5 lb) weight loss over the last 4 weeks. His mother also reports that she no longer wants to continue the drug. Which of the following is the next drug of choice for pharmacological management of the condition?? {'A': 'Atomoxetine', 'B': 'Clonidine', 'C': 'Dexmethylphenidate', 'D': 'Dextroamphetamine', 'E': 'Imipramine'},
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A: Atomoxetine
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Answer the following medical question with one of the provided options:
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Q:An investigator is studying the metabolism of an experimental drug that is known to have first order kinetics. Immediately after administering an intravenous dose of the drug to a patient, the serum concentration is 60 U/L. 3 hours later, the serum concentration of the drug is 30 U/L. 9 hours after administration, the serum concentration of the drug is most likely to be which of the following?? {'A': '5 U/L', 'B': '3.75 U/L', 'C': '7.5 U/L', 'D': '15 U/L', 'E': '0 U/L'},
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C: 7.5 U/L
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Answer the following medical question with one of the provided options:
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Q:A 26-year-old gravida-1-para-0 (G-1-P-0) presents for a routine prenatal check-up at 16 weeks gestation. The patient has no concerns but is excited to learn the gender of the baby. Genetic testing was performed that showed an XY genotype; however, an ultrasound does not reveal the development of external male genitalia. Which of the following is responsible for the initial step of the development of male characteristics?? {'A': 'Formation of the genital ridge', 'B': 'Formation of the paramesonephric duct', 'C': 'Conversion of testosterone to DHT', 'D': 'SRY gene product', 'E': 'Production of anti-Mullerian hormone'},
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D: SRY gene product
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Answer the following medical question with one of the provided options:
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Q:An 82-year-old woman presents to the emergency department after a fall. Imaging reveals diffuse trauma to the left humerus from the midshaft to the olecranon process with shearing of the periosteum. The orthopedic surgeon suggests a follow-up in 2 weeks. In that time, the patient develops worsening pain. At follow-up, she is found to have diffuse bone necrosis from the midshaft of the left humerus to the olecranon process. with no involvement of the distal arm structures. Which of the following structures must have been damaged to cause this diffuse bone necrosis?? {'A': 'Haversian canal', 'B': 'Brachial artery', 'C': 'Volkmann’s canal', 'D': 'Ulnar nerve', 'E': 'Epiphyseal plate'},
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C: Volkmann’s canal
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Answer the following medical question with one of the provided options:
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Q:A 7-year-old boy with a sore throat, fever, and generalized malaise is admitted to the pediatric floor. On physical examination, he has diffuse white exudate on both tonsils, and also a palpable spleen with mild hepatomegaly. His blood smear shows large and abundant lymphocytes with blue-gray cytoplasm, irregular nuclei, and dark chromatin with inconspicuous nucleoli. Which of the following is the most likely diagnosis?? {'A': 'Infectious mononucleosis', 'B': 'Cytomegalovirus infection', 'C': 'Toxoplasmosis', 'D': "Graves' disease", 'E': 'Viral hepatitis'},
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A: Infectious mononucleosis
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Answer the following medical question with one of the provided options:
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Q:A 71-year-old man is brought to the emergency department because of severe, progressive left leg pain and tingling for 8 hours. The symptoms began while he was watching television. For several months, the patient has noticed calf cramping when going for long walks, as well as occasional foot tingling and numbness, but did not seek medical attention. He has no history of recent injuries. He has poorly-controlled hypertension, hyperlipidemia, type 2 diabetes mellitus, and osteoarthritis. He smoked one pack of cigarettes daily for 35 years but quit 15 years ago. He drinks three beers every night. Current medications include lisinopril, metoprolol succinate, atorvastatin, metformin, and ibuprofen. He appears to be in severe pain and is clutching his left leg. His temperature is 37.4°C (99.3°F), pulse is 110/min, respirations are 18/min, and blood pressure is 163/94 mm Hg. The lungs are clear to auscultation. There is a harsh II/VI systolic ejection murmur best heard at the right upper sternal border. The abdomen is soft and nontender. The left leg is cool to the touch with decreased popliteal, posterior tibial, and dorsalis pedis pulses. There is 5/5 strength on left hip, knee, and ankle testing. The left hip, knee, and ankle show no gross effusion, erythema, or tenderness to palpation. The remainder of the examination shows no abnormalities. Which of the following is most likely to confirm the diagnosis?? {'A': 'Creatine kinase concentration', 'B': 'Digital subtraction angiography', 'C': 'Fibrin degradation products', 'D': 'Ankle-brachial index', 'E': 'Compartment pressures\n"'},
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B: Digital subtraction angiography
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Answer the following medical question with one of the provided options:
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Q:A 28-year-old gravida 2 para 1 is receiving care from her obstetrician at 28 weeks. She states that she has been having suprapubic pain and urinary frequency for the past week. Her past medical history is significant for dermatomyositis for which she takes prednisone every day. She does not smoke cigarettes or drinks alcohol. Her vital signs are within normal limits. Physical examination of the patient is within normal limits. A urine sample from the patient shows > 100,000 CFU of Escherichia coli. Urinalysis results are provided as follows: Leukocyte esterase positive WBC 50-100 cells/HPF Nitrite positive RBC 2 cells/HPF Epithelial cells 2 cells/HPF Urine pH 5.2 Which of the following is the best pharmacotherapy for this patient’s condition?? {'A': 'Trimethoprim-sulfamethoxazole', 'B': 'Nitrofurantoin', 'C': 'Tetracycline', 'D': 'Cephalexin', 'E': 'Amoxicillin'},
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B: Nitrofurantoin
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Answer the following medical question with one of the provided options:
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Q:A 43-year-old woman visits her primary care physician complaining of abdominal pain for the past 6 months. She reports that the pain is localized to her lower abdomen and often resolves with bowel movements. She states that some days she has diarrhea while other times she will go 4-5 days without having a bowel movement. She started a gluten-free diet in hopes that it would help her symptoms, but she has not noticed much improvement. She denies nausea, vomiting, hematochezia, or melena. Her medical history is significant for generalized anxiety disorder and hypothyroidism. Her father has a history of colon cancer. The patient takes citalopram and levothyroxine. Physical examination reveals mild abdominal tenderness with palpation of lower quadrant but no guarding or rebound. A guaiac test is negative. A complete blood count is pending. Which of the following is the next best step in management?? {'A': 'Anti-endomysial antibody titer', 'B': 'Colonoscopy', 'C': 'High fiber diet', 'D': 'Loperamide', 'E': 'Thyroid ultrasound'},
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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:A 26-year-old woman comes to the physician because of severe pain in her right wrist one day after falling onto her hands and knees while rollerskating. Physical examination shows abrasions over the knees and bruising over the volar aspect of the right wrist. There is swelling and tenderness on palpation of the volar wrist joint, as well as restricted range of motion due to pain. An x-ray of the hand shows volar dislocation of the lunate bone. Further evaluation is most likely to show which of the following?? {'A': 'Paresthesia over the volar aspect of the first 3 fingers on wrist flexion', 'B': 'Anesthesia over the dorsal aspect of the first 3 fingers', 'C': 'Tenderness to palpation of the anatomic snuffbox', 'D': 'Involuntary flexion of the 4th and 5th interphalangeal joints when extending all fingers', 'E': 'Pale skin color on the volar surface when pressure is applied to the radial artery'},
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A: Paresthesia over the volar aspect of the first 3 fingers on wrist flexion
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Answer the following medical question with one of the provided options:
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Q:A 56-year-old man with hypertension comes to the physician for a follow-up examination. His blood pressure is 165/92 mm Hg on the left arm and 162/90 mm Hg on the right arm. He reports that he is compliant with his medication and exercise regimen. The physician adds a drug to his antihypertensive medication regimen. This drug increases serum renin, angiotensin I, and angiotensin II levels, and decreases serum aldosterone levels, without affecting bradykinin levels. Which of the following drugs was most likely added to this patient's medication regimen?? {'A': 'Candesartan', 'B': 'Aliskiren', 'C': 'Lisinopril', 'D': 'Triamterene', 'E': 'Metoprolol'},
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A: Candesartan
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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 comes to the physician because of a 6-month history of muscle weakness. During this period, the patient has had low energy, intermittent nosebleeds, and a 5-kg (11-lb) weight loss. He also reports progressive hearing and vision problems. He has a history of pins-and-needles sensation, numbness, and pain in his feet. Vital signs are within normal limits. Physical examination shows a palpable liver tip 2–3 cm below the right costal margin. There is nontender lympadenopathy in the groins, axillae, and neck. Laboratory studies show: Hemoglobin 8.8 g/dL White blood cells 6,300/mm3 Platelet count 98,000/mm3 Erythrocyte sedimentation rate 70 mm/h Serum Na+ 136 mmol/L K+ 3.6 mmol/L Cr 1.3 mg/dL Ca2+ 8.6 mg/dL Aspartate aminotransferase 32 U/L Alanine aminotransferase 36 U/L Alkaline phosphatase 100 U/L Lactate dehydrogenase 120 U/L A serum protein electrophoresis exhibits a sharp, narrow spike of monoclonal IgM immunoglobulin. Which of the following is the most likely diagnosis?"? {'A': 'Hairy cell leukemia', 'B': 'Multiple myeloma', 'C': 'Waldenstrom macroglobulinemia', 'D': 'Monoclonal gammopathy of undetermined significance', 'E': 'Mantle cell lymphoma\n"'},
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C: Waldenstrom macroglobulinemia
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Answer the following medical question with one of the provided options:
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Q:A previously healthy 6-week-old infant is brought to the emergency department because of fever, fatigue, and dry cough for one day. She has been feeding poorly and had difficulty latching on to breastfeed since yesterday. She has had nasal congestion. The mother reports that her daughter has not been going through as many diapers as usual. She was born by uncomplicated vaginal delivery at 42 weeks' gestation. Her mother is a cystic fibrosis carrier. The patient has been treated with acetaminophen for the last 24 hours, and vitamin D drops since birth. She appears irritable, pale, and lethargic. She is at the 25th percentile for both length and weight; she had the same percentiles at birth. Her temperature is 38.2°C (100.7°F) and respirations are 64/min. Pulse oximetry on room air shows an oxygen saturation of 92%. Examination shows an ill-appearing infant with a cough and nasal flaring. Mucous membranes are dry. Chest examination shows intercostal and supraclavicular retractions. Expiratory wheezes are heard on auscultation. Which of the following is the most likely causal organism?? {'A': 'Listeria monocytogenes', 'B': 'Respiratory syncytial virus', 'C': 'Rhinovirus', 'D': 'Coronavirus', 'E': 'Streptococcus pneumoniae'},
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B: Respiratory syncytial virus
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Answer the following medical question with one of the provided options:
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Q:A 38-year-old woman presents to the physician’s clinic with a 6-month history of generalized weakness that usually worsens as the day progresses. She also complains of the drooping of her eyelids and double vision that is worse in the evening. Physical examination reveals bilateral ptosis after a sustained upward gaze and loss of eye convergence which improves upon placing ice packs over the eyes and after the administration of edrophonium. Which of the following is an intrinsic property of the muscle group affected in this patient?? {'A': 'High myoglobin content', 'B': 'Increased amount of ATP generated per molecule of glucose', 'C': 'A small mass per motor unit', 'D': 'High ATPase activity', 'E': 'High density of mitochondria'},
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D: High ATPase activity
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Answer the following medical question with one of the provided options:
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Q:A 24-year-old professional wrestler recently participated in a charitable tournament event in Bora Bora, a tropical island that is part of the French Polynesia Leeward Islands. During his stay, he wore tight-fitting clothes and tight bathing trunks for extended periods. After 6 days, he observed symmetric, erythematous itchy rash in his groin, with a significant amount of moisture and scales. Central areas of the rash were hyperpigmented, and the border was slightly elevated and sharply demarcated. His penis and scrotum were not affected. He immediately visited a local dermatology clinic where a specialist conducted a Wood lamp examination to exclude the presence of a bacterial infection (primary infection due to Corynebacterium minutissimum). The working diagnosis was a fungal infection. Which topical agent should be recommended to treat this patient?? {'A': 'Nystatin', 'B': 'Ketoconazole', 'C': 'Terbinafine', 'D': 'Betamethasone/clotrimazole combination', 'E': 'Miconazole'},
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C: Terbinafine
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Answer the following medical question with one of the provided options:
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Q:A 59-year-old woman comes to the clinic complaining of an intermittent, gnawing epigastric pain for the past 2 months. The pain is exacerbated with food and has been getting progressively worse. The patient denies any weight changes, nausea, vomiting, cough, or dyspepsia. Medical history is significant for chronic back pain for which she takes ibuprofen. Her father passed at the age of 55 due to pancreatic cancer. Labs were unremarkable except for a mild decrease in hemoglobin. To what medication is most appropriate to be switched from the current medication at this time?? {'A': 'Acetaminophen', 'B': 'Aspirin', 'C': 'Naproxen', 'D': 'Omeprazole', 'E': 'Ranitidine'},
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A: Acetaminophen
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Answer the following medical question with one of the provided options:
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Q:A 57-year-old woman presents to the emergency department for laboratory abnormalities detected by her primary care physician. The patient went to her appointment complaining of difficulty using her hands and swelling of her arms and lower extremities. The patient has notably smooth skin that seems to have not aged considerably. Upon seeing her lab values, her physician sent her to the ED. The patient has a past medical history of multiple suicide attempts, bipolar disorder, obesity, diabetes, and anxiety. Her current medications include lithium, insulin, captopril, and clonazepam. The patient's laboratory values are below. Serum: Na+: 140 mEq/L K+: 5.2 mEq/L Cl-: 100 mEq/L HCO3-: 20 mEq/L BUN: 39 mg/dL Glucose: 127 mg/dL Creatinine: 2.2 mg/dL Ca2+: 8.4 mg/dL The patient is restarted on her home medications. Her temperature is 99.5°F (37.5°C), pulse is 80/min, blood pressure is 155/90 mmHg, respirations are 11/min, and oxygen saturation is 97% on room air. Which of the following is the best next step in management?? {'A': 'Continue medications and start metformin', 'B': 'Continue medications and start furosemide', 'C': 'Continue medications and add nifedipine', 'D': 'Start lisinopril and discontinue captopril', 'E': 'Start valproic acid and discontinue lithium'},
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E: Start valproic acid and discontinue lithium
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Answer the following medical question with one of the provided options:
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Q:A 7-year-old patient is brought in by his mother for a routine check-up for school. The child is cooperative throughout the visit and excitedly talks about school. The mother congratulates her son on his behavior, and mentions that when he was being treated for leukemia three years ago, he would start crying in the parking lot even before they arrived at the clinic for his blood checks. The mother notes that since his remission, he has been better tolerating physician visits. She has occasionally been giving him candy before clinic visits to reward his good behavior after she noticed he stopped crying. Since getting these rewards, the patient has sometimes remarked that he enjoys visiting the clinic now. Which of the following best explains why this patient no longer cries at physician visits?? {'A': 'Classical conditioning', 'B': 'Positive reinforcement', 'C': 'Extinction', 'D': 'Acting out', 'E': 'Reaction formation'},
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C: Extinction
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Answer the following medical question with one of the provided options:
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Q:A previously healthy 3-week-old infant is brought to the emergency department 6 hours after the onset of fever and persistent irritability. He had been well until 2 days ago, when he started feeding poorly and sleeping more than usual. He appears lethargic and irritable when roused for examination. His temperature is 39°C (102°F). He cries when he is picked up and when his neck is flexed. The remainder of the physical and neurological examinations show no other abnormalities. His serum glucose is 115 mg/mL. His total serum bilirubin is 6.3 mg/dL. Cerebrospinal fluid analysis shows: Pressure 255 mm H2O Erythrocytes 2/mm3 Leukocyte count 710/mm3 Segmented neutrophils 95% Lymphocytes 5% Protein 86 mg/dL Glucose 22 mg/dL Gram stain results of the cerebrospinal fluid are pending. Which of the following is the most appropriate initial antibiotic regimen for this patient?"? {'A': 'Ampicillin and ceftriaxone', 'B': 'Gentamicin and cefotaxime', 'C': 'Ampicillin, gentamicin, and cefotaxime', 'D': 'Vancomycin, ampicillin, and cefotaxime', 'E': 'Vancomycin, ampicillin, and doxycycline'},
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C: Ampicillin, gentamicin, and cefotaxime
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Answer the following medical question with one of the provided options:
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Q:A 27-year-old primigravida presents at 16 weeks gestation for a check-up. She has no co-existing diseases. Currently, she has no subjective complaints, but she worries about the results of her triple screen. She takes 400 mg of folic acid and 30 mg of iron daily. The results of the triple screen are shown below. Measured values Reference values Maternal serum alpha-fetoprotein 2.9 MoM 0.85-2.5 MoM Beta-hCG 1.1 MoM 0.5-1 MoM Unconjugated estriol 1 MoM 0.5-3 MoM What would be the most proper next step in the management of this patient?? {'A': 'Perform amniocentesis', 'B': 'Recommend additional inhibit A test', 'C': 'Perform ultrasound examination', 'D': 'Test for CMV infection, rubella, and toxoplasmosis', 'E': 'Arrange a chorionic villus sampling procedure'},
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C: Perform ultrasound examination
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Answer the following medical question with one of the provided options:
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Q:A 71-year-old woman comes to the physician because of a 4-month history of worsening cough and a 4.5-kg (10-lb) weight loss. She has smoked one pack of cigarettes daily for 35 years. Physical examination shows wheezing over the right lung fields. Laboratory studies show a serum calcium concentration of 12.5 mg/dL. X-rays of the chest are shown. Which of the following is the most likely diagnosis?? {'A': 'Lobar pneumonia', 'B': 'Small cell lung carcinoma', 'C': 'Tuberculosis', 'D': 'Sarcoidosis', 'E': 'Squamous cell lung carcinoma'},
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E: Squamous cell lung carcinoma
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Q:A 12-year-old boy presents with recurrent joint pain that migrates from joint to joint and intermittent fever for the last several weeks. He also says that he has no appetite and has been losing weight. The patient is afebrile, and vital signs are within normal limits. On physical examination, he is pale with diffuse petechial bleeding and bruises on his legs. An abdominal examination is significant for hepatosplenomegaly. Ultrasound of the abdomen confirms hepatosplenomegaly and also shows multiple enlarged mesenteric lymph nodes. A complete blood count (CBC) shows severe anemia and thrombocytopenia with leukocytosis. Which of the following is the most likely diagnosis in this patient?? {'A': 'Acute leukemia', 'B': 'Tuberculosis of the bone marrow', 'C': 'Aplastic anemia', 'D': 'Immunologic thrombocytopenic purpura', 'E': 'Chronic leukemia'},
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A: Acute leukemia
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Q:A 56 year old female comes to the ED complaining of moderate right eye pain, headache, and acute onset of blurry vision, which she describes as colored halos around lights. She was watching a movie at home with her husband about an hour ago when the pain began. On physical exam of her right eye, her pupil is mid-dilated and unresponsive to light. Her right eyeball is firm to pressure. Intraocular pressure (IOP) measured with tonometer is elevated at 36mmHg. Which of the following is the most appropriate emergency treatment?? {'A': 'Timolol ophthalmic solution', 'B': 'Epinephrine ophthalmic solution', 'C': 'Laser peripheral iridotomy', 'D': 'Anti-cholinergic ophthalmic solution', 'E': 'NSAID ophthalmic solution'},
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A: Timolol ophthalmic solution
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Q:A 6-year-old boy is brought to the emergency department because of worsening confusion for the last hour. He has had high-grade fever, productive cough, fatigue, and malaise for the past 2 days. He has not seen a physician in several years. His temperature is 38.9°C (102°F), pulse is 133/min, respirations are 33/min, and blood pressure is 86/48 mm Hg. He is lethargic and minimally responsive. Mucous membranes are dry. Pulmonary examination shows subcostal retractions and coarse crackles bilaterally. Laboratory studies show a hemoglobin concentration of 8.4 g/dL and a leukocyte count of 16,000/mm3. A peripheral blood smear shows sickled red blood cells. Which of the following pathogens is the most likely cause of this patient's current condition?? {'A': 'Salmonella paratyphi', 'B': 'Streptococcus pneumoniae', 'C': 'Neisseria meningitidis', 'D': 'Staphylococcus aureus', 'E': 'Nontypeable Haemophilus influenzae'},
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B: Streptococcus pneumoniae
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Q:A 2-year-old female with abdominal pain undergoes laparoscopic surgery. An outpouching of tissue is excised from the ileum and sent to the laboratory for evaluation. The pathologist notes inflammation and the presence of mucosa, submucosa, and muscle in the walls of the specimen. Which of the following is the most likely diagnosis?? {'A': "Hirschprung's disease", 'B': "Crohn's disease", 'C': "Meckel's diverticulum", 'D': 'Appendicitis', 'E': 'Henoch-Schonlein purpura'},
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C: Meckel's diverticulum
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Q:A 33-year-old woman schedules an appointment at an outpatient clinic for the first time after moving to the US from Peru a few months ago. She complains of easy fatigability and shortness of breath with minimal exertion for the past 6 months. She further adds that her breathlessness is worse when she goes to bed at night. She is also concerned about swelling in her legs. As a child, she says she always had sore throats. She does not smoke or drink alcohol. Medical records are unavailable, but the patient says that she has always been healthy apart from her sore throats. The blood pressure is 114/90 mm Hg, the pulse is 109/min, the respiratory rate is 26/min, and the temperature is 36.7°C (98°F). On examination, she is icteric with distended jugular veins. Bilateral basal crepitations are audible on auscultation of the lungs. Also, a high-pitched apical holosystolic murmur is audible that radiates to the left axilla. A transthoracic echocardiogram reveals mitral regurgitation with an ejection fraction of 25%. Treatment should focus on which of the following?? {'A': 'Decrease total peripheral resistance', 'B': 'Increase inotropy of cardiac muscle', 'C': 'Increase left ventricular end diastolic pressure', 'D': 'Increase the rate of SA node discharge', 'E': 'Increase coronary blood flow'},
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A: Decrease total peripheral resistance
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Q:A 56-year-old man with chronic kidney failure is brought to to the emergency department by ambulance after he passed out during dinner. On presentation, he is alert and complains of shortness of breath as well as chest palpitations. An EKG is obtained demonstrating an irregular rhythm consisting of QT amplitudes that vary in height over time. Other findings include uncontrolled contractions of his muscles. Tapping of his cheek does not elicit any response. Over-repletion of the serum abnormality in this case may lead to which of the following?? {'A': 'Bradycardia', 'B': 'Diffuse calcifications', 'C': 'Kidney stones', 'D': 'Peaked T-waves', 'E': 'Seizures'},
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A: Bradycardia
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Q:A 55-year-old man with recurrent pneumonia comes to the physician for a follow-up examination one week after hospitalization for pneumonia. He feels well but still has a productive cough. He has smoked 1 pack of cigarettes daily for 5 years. His temperature is 36.9°C (98.4°F) and respirations are 20/min. Cardiopulmonary examination shows coarse crackles at the right lung base. Microscopic examination of a biopsy specimen of the right lower lung parenchyma shows proliferation of clustered, cuboidal, foamy-appearing cells. These cells are responsible for which of the following functions?? {'A': 'Lecithin production', 'B': 'Cytokine release', 'C': 'Toxin degradation', 'D': 'Gas diffusion', 'E': 'Mucus secretion'},
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A: Lecithin production
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Q:A pediatrician is called to examine a recently born dysmorphic boy. The birth weight was 1.6 kg (3.5 lb). On physical examination of the face and skull, the head was shown to be microcephalic with a prominent occiput and a narrow bifrontal diameter. The jaw was comparatively small with short palpebral fissures. The nose was narrow and the nasal ala was hypoplastic. Examination of the upper limbs revealed closed fists with the index fingers overlapping the 3rd fingers, and the 5th fingers overlapping the 4th fingers. The fingernails and toenails were hypoplastic and he had rocker-bottom feet. Based on these details, you suspect a particular chromosomal anomaly. Which of the following statements best describes this patient’s condition?? {'A': 'This condition is associated with teenage mothers.', 'B': '95% of these patients die in the 1st year of life.', 'C': 'The condition is more common in males.', 'D': 'Thrombocytopenia is the least common hematologic abnormality in these patients.', 'E': 'The most common congenital heart disease is patent ductus arteriosus.'},
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B: 95% of these patients die in the 1st year of life.
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Q:A 60-year-old man comes to the emergency department because of nausea, headache, and generalized fatigue for 2 days. He has not vomited. He was diagnosed with small cell lung cancer and liver metastases around 3 months ago and is currently receiving chemotherapy with cisplatin and etoposide. His last chemotherapy cycle ended one week ago. He has chronic obstructive lung disease and type 2 diabetes mellitus. Current medications include insulin and a salmeterol-fluticasone inhaler. He appears malnourished. He is oriented to time, place, and person. His temperature is 37.1°C (98.8°F), pulse is 87/min, respirations are 13/min, and blood pressure is 132/82 mm Hg. There is no edema. Examination shows decreased breath sounds over the left lung. Cardiac examination shows an S4. The abdomen is soft and nontender. Neurological examination shows no focal findings. Laboratory studies show: Hemoglobin 11.6 g/dL Leukocyte count 4,300/mm3 Platelet count 146,000/mm3 Serum Na+ 125 mEq/L Cl− 105 mEq/L K+ 4.5 mEq/L HCO3− 24 mEq/L Glucose 225 mg/dL Total bilirubin 1.1 mg/dL Alkaline phosphatase 80 U/L Aspartate aminotransferase (AST, GOT) 78 U/L Alanine aminotransferase (ALT, GPT) 90 U/L Further evaluation of this patient is likely to show which of the following laboratory findings? Serum osmolality Urine osmolality Urinary sodium excretion (A) 220 mOsm/kg H2O 130 mOsm/kg H2O 10 mEq/L (B) 269 mOsm/kg H2O 269 mOsm/kg H2O 82 mEq/L (C) 255 mOsm/kg H2O 45 mOsm/kg H2O 12 mEq/L (D) 222 mOsm/kg H2O 490 mOsm/kg H2O 10 mEq/L (E) 310 mOsm/kg H2O 420 mOsm/kg H2O 16 mEq/L"? {'A': '(A)', 'B': '(B)', 'C': '(C)', 'D': '(D)', 'E': '(E)\n"'},
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B: (B)
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Q:A 45-year-old woman repetitively visits the general surgery clinic worried that her inguinal hernia is incarcerated. 2 months ago, she was seen in the emergency department where she presented with a left lower abdominal swelling. The mass was easily reduced and the patient was referred to the general surgery clinic for elective surgical repair. Because her condition was deemed not urgent, she was informed that she was down on the surgical waiting list. Despite this, she continues to visit the clinic and the ED worried that her bowels are ‘trapped and dying.’ Each time she is reassured and any protrusion present is quickly reduced. She has previously frequently visited her primary care physician for complaints of abdominal pain and inconsistent bowel habits, but no etiology could be identified. She continues to intermittently have these symptoms and spends hours every day worrying about what may be going on. She has no other significant past medical history. Which of the following is the most appropriate diagnosis?? {'A': 'Conversion disorder', 'B': 'Malingering disorder', 'C': 'Factitious disorder', 'D': 'Illness anxiety disorder', 'E': 'Somatic symptom disorder'},
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E: Somatic symptom disorder
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Q:A 3-year-old boy is brought to the physician by his parents for a well-child examination. The boy was born at term via vaginal delivery and has been healthy except for impaired vision due to severe short-sightedness. He is at the 97th percentile for height and 25th percentile for weight. Oral examination shows a high-arched palate. He has abnormally long, slender fingers and toes, and his finger joints are hyperflexible. The patient is asked to place his thumbs in the palms of the same hand and then clench to form a fist. The thumbs are noted to protrude beyond the ulnar border of the hand. Slit lamp examination shows lens subluxation in the superotemporal direction bilaterally. Which of the following is the most likely underlying cause of this patient's condition?? {'A': 'Mutation in fibrillin-1 gene', 'B': 'Defective collagen cross-linking', 'C': 'Nondisjunction of sex chromosomes', 'D': 'Mutation of the FMR1 gene', 'E': 'Mutation in RET gene'},
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A: Mutation in fibrillin-1 gene
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Q:A patient presents to the emergency department with abdominal pain. While having dinner, the patient experienced pain that prompted the patient to come to the emergency department. The patient states that the pain is episodic and radiates to the shoulder. The patient's temperature is 98°F (36.7°C), blood pressure is 120/80 mmHg, pulse is 80/min, respirations are 13/min, and oxygen saturation is 98% on room air. Laboratory values are ordered and return as below. Hemoglobin: 12 g/dL Hematocrit: 36% Leukocyte count: 4,500 cells/mm^3 with normal differential Platelet count: 247,000/mm^3 Serum: Na+: 140 mEq/L Cl-: 100 mEq/L K+: 4.6 mEq/L HCO3-: 24 mEq/L BUN: 15 mg/dL Glucose: 90 mg/dL Creatinine: 0.8 mg/dL Ca2+: 10.0 mg/dL AST: 11 U/L ALT: 11 U/L On physical exam, the patient demonstrates abdominal tenderness that is most prominent in the right upper quadrant. Which of the following represents the most likely demographics of this patient?? {'A': 'A middle-aged male with a positive urea breath test', 'B': 'A middle-aged overweight mother', 'C': 'A middle-aged patient with a history of bowel surgery', 'D': 'An elderly diabetic with vascular claudication', 'E': 'An elderly smoker with painless jaundice'},
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B: A middle-aged overweight mother
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Q:A 62-year-old man comes to the physician for evaluation of multiple red spots on his trunk. He first noticed these several months ago, and some appear to have increased in size. One day ago, he scratched one of these spots, and it bled for several minutes. Physical examination shows the findings in the photograph. Which of the following is the most likely diagnosis?? {'A': 'Cherry angioma', 'B': 'Amelanotic melanoma', 'C': 'Spider angioma', 'D': 'Seborrheic keratosis', 'E': 'Pyogenic granuloma'},
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A: Cherry angioma
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Q:A 25-year-old man is brought by his wife to the emergency department due to sudden onset confusion that started 40 minutes ago. The patient’s wife says that he came home from work complaining of pain in his arms and legs. While resting on the couch, he mentioned feeling nauseous and then became quite confused. He has no previous medical history and takes no medications. He does not smoke and only drinks alcohol occasionally. His vital signs include pulse 80/min, respiratory rate 12/min, blood pressure 120/84 mm Hg, and SaO2 99% on room air. On physical examination, the patient is oriented x 0 and unable to answer questions or follow commands. Generalized pallor is present. There are also multiple scratches on the face and neck due to constant itching. Assuming this patient’s symptoms are due to his employment, he most likely works as which of the following?? {'A': 'Bird keeper', 'B': 'Diving instructor', 'C': 'Farmer', 'D': 'Fireman', 'E': 'Shipyard worker'},
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B: Diving instructor
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Q:A 3-year-old boy goes camping with his parents in the Appalachian mountains of Western North Carolina. While on the hiking trip, he is exposed to an antigen. After the exposure, this antigen is phagocytosed by a CD4+ T helper cell and is presented on an MHC class II molecule. This CD4+ T helper cell encounters a B cell in the lymph node shown in the image below. The mature B cell proliferates and differentiates to produce antibodies to target this antigen. In which of the following numbered sections of the lymph node does this B cell differentiation and proliferation most likely occur?? {'A': '1', 'B': '2', 'C': '3', 'D': '4', 'E': '5'},
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C: 3
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Q:A 73-year-old woman is brought to the physician by her son because of increasing forgetfulness over the past 2 years. Initially, she used to misplace keys and forget her dog's name or her phone number. Now, she often forgets about what she has seen on television or read about the day before. She used to go for a walk every morning but stopped one month ago after she became lost on her way back home. Her son has prevented her from cooking because she has had episodes of leaving the gas stove oven on after making a meal. She becomes agitated when asked questions directly but is unconcerned when her son reports her history and says he is overprotective of her. She has hypertension, coronary artery disease, and hypercholesterolemia. Current medications include aspirin, enalapril, carvedilol, and atorvastatin. She is alert and oriented to place and person but not to time. Vital signs are within normal limits. Short- and long-term memory deficits are present. Her speech rhythm is normal but is frequently interrupted as she thinks of words to frame her sentences. She makes multiple errors while performing serial sevens. Her clock drawing is impaired and she draws 14 numbers. Which of the following is the most likely diagnosis?? {'A': 'Normal pressure hydrocephalus', 'B': 'Lewy-body dementia', 'C': 'Frontotemporal dementia', 'D': 'Creutzfeld-Jakob disease', 'E': 'Alzheimer disease'},
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E: Alzheimer disease
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Q:A 32-year-old woman is brought to the emergency department by her husband because of an episode of hematemesis 2 hours ago. She has had dyspepsia for 2 years. Her medications include occasional ibuprofen for headaches. After initial stabilization, the risks and benefits of upper endoscopy and alternative treatments, including no therapy, are explained thoroughly. She shows a good understanding of her condition and an appreciation of endoscopic treatment and its complications. She decides that she wants to have an endoscopy to find the source of bleeding and appropriately manage the ulcer. Her medical records show advance directives that she signed 3 years ago; her sister, who is a nurse, has a durable power of attorney. Regarding obtaining informed consent, which of the following is the most accurate conclusion for providing endoscopic treatment for this patient?? {'A': 'Documentation of her decision prior to treatment is required', 'B': 'Endoscopic treatment may be performed without further action', 'C': 'Her decision to have an endoscopy is not voluntary', 'D': 'Her sister must sign the consent form', 'E': 'There are reasons to believe that she may not have decision-making capacity'},
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A: Documentation of her decision prior to treatment is required
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Q:A 25-year-old man is admitted to the hospital after a severe motor vehicle accident as an unrestrained front-seat passenger. Appropriate life-saving measures are given, and the patient is now hemodynamically stable. Physical examination shows a complete loss of consciousness. There are no motor or ocular movements with painful stimuli. The patient has bilaterally intact pupillary light reflexes. The patient is placed in a 30° semi-recumbent position for further examination. What is the most likely finding on the examination of this patient's right ear?? {'A': 'Cold water causing ipsilateral saccadic movement.', 'B': 'Warm water causing ipsilateral slow pursuit.', 'C': 'Warm water causing ipsilateral saccadic movement.', 'D': 'Warm water mimicking the head turning left.', 'E': 'Cold water causing contralateral slow pursuit.'},
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C: Warm water causing ipsilateral saccadic movement.
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Q:A 68-year-old man presents to the emergency department with palpitations. He also feels that his exercise tolerance has reduced over the previous week. His past history is positive for ischemic heart disease and he has been on multiple medications for a long time. On physical examination, his temperature is 36.9°C (98.4°F), pulse rate is 152/min and is regular, blood pressure is 114/80 mm Hg, and respiratory rate is 18/min. Auscultation of the precordial region confirms tachycardia, but there is no murmur or extra heart sounds. His ECG is obtained, which suggests a diagnosis of atrial flutter. Which of the following findings is most likely to be present on his electrocardiogram?? {'A': 'Atrial rate above 400 beats per minute', 'B': 'Slurred upstroke of R wave', 'C': 'Atrioventricular block', 'D': 'No discernible P waves', 'E': 'Wenckebach phenomenon'},
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C: Atrioventricular block
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Answer the following medical question with one of the provided options:
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Q:A 55-year-old man presents to the physician with a cough which he has had for the last 5 years. He also mentions that he has been feeling breathless when playing any active sport for the last 1 year. He is a manager in a corporate company and has been a regular smoker for 10 years. He has visited multiple physicians and undergone multiple diagnostic evaluations, without permanent benefit. On physical examination his temperature is 37.0°C (98.6°F), the heart rate is 88/min, the blood pressure is 122/80 mm Hg, and the respiratory rate is 20/min. Inspection suggests a barrel chest and auscultation reveals the presence of bilateral end-expiratory wheezing and scattered rhonchi. He undergoes a detailed diagnostic evaluation which includes a complete blood count, chest radiogram, arterial blood gas analysis, and pulmonary function tests, all of which confirm a diagnosis of chronic obstructive lung disease. After analyzing all the clinical information and diagnostic workup, the physician differentiates between emphysema and chronic bronchitis based on a single clue. Which of the following is the most likely clue that helped the physician in making the differential diagnosis?? {'A': 'History of long-term exposure to cigarette smoke', 'B': 'Increased hematocrit in hematologic evaluation', 'C': 'Flattened diaphragm on chest X-ray', 'D': 'Presence of chronic respiratory acidosis in arterial blood gas analysis', 'E': 'Decreased diffusion capacity of the lung for carbon monoxide (DLCO)'},
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E: Decreased diffusion capacity of the lung for carbon monoxide (DLCO)
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Q:A 24-year-old male is rushed to the emergency department after sustaining several gunshot wounds to the chest. He was found nonresponsive in the field and was intubated en route to the hospital. His vital signs are as follows: temperature is 98.8 deg F (37.1 deg C), blood pressure is 87/52 mmHg, pulse is 120/min, and respirations are 16/min. Physical examination is significant for decreased breath sounds and dullness to percussion over the right lung. A chest radiograph in the emergency department shows a large fluid collection in the right thoracic cavity. After aggressive fluid resuscitation is initiated, an emergent chest-tube was placed in the emergency department. The chest tube puts out 700 cc of frank blood and 300 cc/hr over the next 5 hours. A follow up post-chest tube insertion chest radiograph demonstrates significant residual right hemothorax. Which of the following is the next best step in management of this patient?? {'A': 'Clamp the chest tube', 'B': 'Place the chest tube to water seal', 'C': 'Remove the chest tube', 'D': 'Open thoracotomy', 'E': 'Tracheostomy'},
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D: Open thoracotomy
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Q:A 5-year-old is brought into your office by his mother. His mother states that he is having 10-20 episodes per day where he stops responding to his mother and is found staring out of the window. During these periods, he blinks more frequently than normal, but returns to his normal self afterwards. These episodes last 30 to 60 seconds. His mother states that all of his milestones have been normal and he had an uncomplicated birth. His mother also denies any other recent illness. On exam, his vitals are normal. During one of these episodes in the office, his EEG shows three-per-second spike and wave discharge. What is the most likely diagnosis?? {'A': 'Febrile seizure', 'B': 'Benign focal epilepsy', 'C': 'Juvenile myoclonic epilepsy', 'D': 'Absence seizure', 'E': 'Hearing deficits'},
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D: Absence seizure
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Q:A 19-year-old woman presents to the ED after multiple episodes of vomiting in the last 6 hours. The vomitus is non-bloody and non-bilious. The vomiting started shortly after she began having a throbbing, unilateral headache and associated photophobia. She has had several similar headaches in the past. Her vital signs are unremarkable. Which of the following is an appropriate therapy for this patient's vomiting?? {'A': 'Propranolol', 'B': 'Amitriptyline', 'C': 'Ergonovine', 'D': 'Chlorpromazine', 'E': 'Calcium channel blockers'},
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D: Chlorpromazine
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Q:A 22-year-old woman is brought to the emergency department by her roommate for unusual behavior. They were at a party where alcohol and recreational drugs were consumed, but her roommate is unsure of what she may have taken or had to drink. She is otherwise healthy and does not take any medications. The patient appears anxious. Her temperature is 37.5°C (99.5°F), pulse is 110/min, respiratory rate is 16/min, and blood pressure is 145/82 mmHg. Examination shows dry mucous membranes and bilateral conjunctival injection. Breath sounds are normal. The abdomen is soft and nontender. Further evaluation will most likely reveal which of the following?? {'A': 'Respiratory depression', 'B': 'Decreased appetite', 'C': 'Increased libido', 'D': 'Pupillary constriction', 'E': 'Impaired reaction time'},
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E: Impaired reaction time
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Q:A 62-year-old woman presents to her primary care physician for her annual check-up. She has no current complaints and says that she has been healthy over the last year. Her past medical history is significant for obesity and diabetes that is well controlled on metformin. She does not smoke and drinks socially. Selected lab results are shown below: High-density lipoprotein: 48 mg/dL Low-density lipoprotein: 192 mg/dL Triglycerides: 138 mg/dL Given these results, the patient is placed on the drug that will be the best therapy for these findings. Which of the following is a potential side effect of this treatment?? {'A': 'Gallstones', 'B': 'Gastrointestinal upset', 'C': 'Hepatotoxicity', 'D': 'Malabsorption', 'E': 'Pruritus'},
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C: Hepatotoxicity
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Q:A 67-year-old man presents to his primary care physician for fatigue. This has persisted for the past several months and has been steadily worsening. The patient has a past medical history of hypertension and diabetes; however, he is not currently taking any medications and does not frequently visit his physician. The patient has lost 20 pounds since his last visit. His laboratory values are shown below: Hemoglobin: 9 g/dL Hematocrit: 29% Mean corpuscular volume: 90 µm^3 Serum: Na+: 139 mEq/L Cl-: 100 mEq/L K+: 4.3 mEq/L Ca2+: 11.8 mg/dL Which of the following is the most likely diagnosis?? {'A': 'Bone marrow aplasia', 'B': 'Intravascular hemolysis', 'C': 'Iron deficiency', 'D': 'Malignancy', 'E': 'Vitamin B12 and folate deficiency'},
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D: Malignancy
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Q:A 19-year-old male soccer player undergoes an exercise tolerance test to measure his maximal oxygen uptake during exercise. Which of the following changes are most likely to occur during exercise?? {'A': 'Increased pulmonary vascular resistance', 'B': 'Decreased physiologic dead space', 'C': 'Decreased alveolar-arterial oxygen gradient', 'D': 'Increased arterial partial pressure of oxygen', 'E': 'Increased apical ventilation-perfusion ratio'},
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B: Decreased physiologic dead space
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Answer the following medical question with one of the provided options:
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Q:A 15-year-old Caucasian female presents with Parkinson-like symptoms. Serum analysis shows increased levels of free copper and elevated liver enzymes. What test would prove most helpful in diagnosing the patient's underlying disease?? {'A': 'Serum detection of anti-myelin antibodies', 'B': 'Slit lamp examination', 'C': 'Vitamin B12 test', 'D': 'CT scan', 'E': 'Reflex test'},
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B: Slit lamp examination
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Q:A 60-year-old male comes to the emergency department because of a 3-day history of intermittent shortness of breath and palpitations. The episodes are unprovoked and occur randomly. The day before, he felt lightheaded while walking and had to sit down abruptly to keep from passing out. He has hypertension and coronary artery disease. Cardiac catheterization 5 years ago showed occlusion of the left anterior descending artery, and he underwent placement of a stent. Current medications include aspirin, metoprolol, lisinopril, and clopidogrel. He does not drink alcohol or use any illicit drugs. He has smoked one-half pack of cigarettes daily for 20 years. He appears well. His temperature is 37°C (98.6°F), pulse is 136/min, respirations are 18/min, and blood pressure is 110/85 mm Hg. The lungs are clear to auscultation. Cardiac examination shows a rapid, irregular rhythm. Shortly after, an ECG is performed. Which of the following is the most likely cause of this patient's findings?? {'A': 'Premature ventricular contractions', 'B': 'Abnormal automaticity within the ventricle', 'C': 'Degeneration of sinoatrial node automaticity', 'D': 'Dissociation of the atria and ventricles', 'E': 'Wandering atrial pacemaker'},
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C: Degeneration of sinoatrial node automaticity
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Q:A 32-year-old woman presents to her primary care doctor complaining of increased fatigue and cold intolerance after her recent delivery. The patient delivered a healthy 39-week-old boy 3 weeks ago via spontaneous vaginal delivery. Delivery was complicated by postpartum hemorrhage requiring admission to the intensive care unit with blood transfusions. Pregnancy was otherwise uneventful, and the baby is healthy. The mother has had some difficulty with lactation, but is able to supplement her breast milk with formula feeds. On exam, her temperature is 97.7°F (36.5°C), blood pressure is 112/78 mmHg, pulse is 62/min, and respirations are 12/min. The patient does not have any neck masses or lymphadenopathy; however, her skin appears dry and rough. Which of the following serum lab abnormalities may be expected?? {'A': 'Decreased prolactin', 'B': 'Decreased thyroid releasing hormone', 'C': 'Increased follicle stimulating hormone', 'D': 'Increased glucocorticoids', 'E': 'Increased luteinizing hormone'},
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A: Decreased prolactin
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Q:A 24-year-old woman comes to the physician because of progressively worsening joint pain. She has had diffuse, aching pain in her knees, shoulders, and hands bilaterally for the past few months, but the pain has become much more severe in the past few weeks. She also reports night sweats and generalized malaise. On physical examination, radial and pedal pulses are weak. There are erythematous nodules over the legs that measure 3–5 cm. Laboratory studies show: Hematocrit 33.2% Hemoglobin 10.7 g/dL Leukocyte count 11,300/mm3 Platelet count 615,000/mm3 Erythrocyte sedimentation rate 94 mm/h Serum C-reactive protein 40 mg/dL (N=0.08–3.1) Which of the following is the most likely diagnosis?"? {'A': 'Temporal arteritis', 'B': 'Polyarteritis nodosa', 'C': 'Microscopic polyangiitis', 'D': 'Thromboangiitis obliterans', 'E': 'Takayasu arteritis'},
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E: Takayasu arteritis
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Answer the following medical question with one of the provided options:
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Q:A 19-year-old college student is brought to the emergency department with persistent vomiting overnight. He spent all day drinking beer yesterday at a college party according to his friends. He appears to be in shock and when asked about vomiting, he says that he vomited up blood about an hour ago. At the hospital, his vomit contains streaks of blood. His temperature is 37°C (98.6°F), respirations are 15/min, pulse is 107/min, and blood pressure is 90/68 mm Hg. A physical examination is performed and is within normal limits. Intravenous fluids are started and a blood sample is drawn for typing and cross-matching. An immediate upper gastrointestinal endoscopy reveals a longitudinal mucosal tear in the distal esophagus. What is the most likely diagnosis?? {'A': 'Boerhaave syndrome', 'B': 'Mallory-Weiss tear', 'C': 'Pill esophagitis', 'D': 'Esophageal candidiasis', 'E': "Dieulafoy's lesion"},
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B: Mallory-Weiss tear
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Q:A 40-year-old woman presents to her primary care physician with a 2-month history of joint pain and morning stiffness that improves through the course of the day. Her left knee also sometimes bothers her. She has taken ibuprofen and tylenol without relief, and the pain is starting to upset her daily routine. On physical examination, the joints of her fingers and wrists are swollen and tender to touch. Her left knee also feels warm. The strength in both hands is reduced but the sensation is intact. On auscultation, the heart sounds are regular and the lungs are clear. Laboratory findings are presented below: Hemoglobin 12.7 g/dL Hematocrit 37.5% Leukocyte count 5,500/mm3 Mean corpuscular volume 82.2 μm3 Platelet count 190,000/mm3 Erythrocyte sedimentation rate 45 mm/h C-reactive protein 14 mg/dL Anti-citrullinated protein antibody 43 (normal reference values: < 20) Which of the following is the most appropriate treatment for this patient?? {'A': 'Ibuprofen', 'B': 'Hydroxychloroquine', 'C': 'Infliximab', 'D': 'Methotrexate', 'E': 'Etanercept'},
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D: Methotrexate
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Q:A 6-year-old boy is brought to the pediatrician by his foster father because he is concerned about the boy's health. He states that at seemingly random times he will have episodes of severe difficulty breathing and wheezing. Upon questioning, the pediatrician learns that these episodes do not appear to be associated with exercise, irritants, or infection. The pediatrician suspects the child has a type of asthma that is associated with eosinophils. In this type of asthma, what is released by the eosinophils to cause bronchial epithelial damage?? {'A': 'IL-5', 'B': 'Major basic protein', 'C': 'IgM', 'D': 'IL-8', 'E': 'Interferon-gamma'},
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B: Major basic protein
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Q:A 55-year-old man presents with fever, chills, fatigue, cough, sore throat, and breathlessness for the past 7 days. He describes the cough as productive and says he is fatigued all the time. He says he is a farmer with daily contact with rabbits, horses, sheep, pigeons, and chickens and reports cleaning the barn 3 days before his symptoms started. The patient denies any history of tick bites. Past medical history is irrelevant. His temperature is 39.4°C (103.0°F), pulse is 110/min, and respirations are 26/min. On physical examination, there are decreased breath sounds on the right side. A large tender node is palpable in the right axilla. A chest radiograph reveals multiple homogenous opacities in the lower lobe of the right lung and a right-sided pleural effusions. Gram staining of a sputum sample is negative for any organism. Serology tests are negative. Which of the following is the most likely causative organism for this patient’s condition?? {'A': 'Francisella tularensis', 'B': 'Bacillus anthracis', 'C': 'Staphylococcus aureus ', 'D': 'Yersinia pestis', 'E': 'Mycoplasma pneumoniae'},
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A: Francisella tularensis
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Q:Two days after undergoing an uncomplicated total thyroidectomy, a 63-year-old woman has acute, progressive chest pain. The pain is sharp and burning. She feels nauseated and short of breath. The patient has a history of hypertension, type 1 diabetes mellitus, medullary thyroid cancer, multiple endocrine neoplasia type 2A, anxiety, coronary artery disease, and gastroesophageal reflux disease. She smoked half a pack of cigarettes daily for 24 years but quit 18 years ago. Current medications include lisinopril, insulin glargine, insulin aspart, sertraline, aspirin, ranitidine, and levothyroxine. She appears anxious and diaphoretic. Her temperature is 37.4°C (99.3°F), pulse is 64/min, respirations are 17/min, and blood pressure is 148/77 mm Hg. The lungs are clear to auscultation. Examination shows a 3-cm linear incision over the anterior neck with 1 mm of surrounding erythema and mild serous discharge. The chest wall and abdomen are nontender. There is 5/5 strength in all extremities and decreased sensation to soft touch on the feet bilaterally. The remainder of the examination shows no abnormalities. Which of the following is the most appropriate next step in management?? {'A': 'Obtain an ECG and troponin T levels', 'B': 'Administer IV pantoprazole and schedule endoscopy', 'C': 'Discontinue levothyroxine and obtain fT4 levels', 'D': 'Administer IV levofloxacin and obtain chest radiograph', 'E': 'Obtain urine and plasma metanephrine levels'},
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A: Obtain an ECG and troponin T levels
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Q:A young researcher is studying the structure of class I and class II major histocompatibility complex (MHC) molecules. He understands that these molecules are proteins, but the structures of class I MHC molecules are different from those of class II. Although all these molecules consist of α and β chains, some of their domains are polymorphic, meaning they are different in different individuals. He calls them ‘P’ domains. The other domains are nonpolymorphic, which remain invariant in all individuals. He calls these domains ‘N’ domains. Which of the following are examples of ‘N’ domains?? {'A': 'β2-microglobulin in class I molecules and β1 domain in class II molecules', 'B': 'α1 domain in class I molecules and α1 domain in class II molecules', 'C': 'α2 domain in class I molecules and β2 domain in class II molecules', 'D': 'α1-α2 domains in class I molecules and α1-β1 domains in class II molecules', 'E': 'α3 domain in class I molecules and β2 domain in class II molecules'},
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E: α3 domain in class I molecules and β2 domain in class II molecules
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Q:A 17-year-old boy is brought to the physician by his mother because of increasingly withdrawn behavior for the last two years. His mother reports that in the last 2–3 years of high school, her son has spent most of his time in his room playing video games. He does not have any friends and has never had a girlfriend. He usually refuses to attend family dinner and avoids contact with his siblings. The patient states that he prefers being on his own. When asked how much playing video games means to him, he replies that “it's okay.” When his mother starts crying during the visit, he appears indifferent. Physical and neurologic examinations show no other abnormalities. On mental status examination, his thought process is organized and logical. His affect is flattened. Which of the following is the most likely diagnosis?? {'A': 'Schizophreniform disorder', 'B': 'Schizoid personality disorder', 'C': 'Antisocial personality disorder', 'D': 'Avoidant personality disorder', 'E': 'Paranoid personality disorder'},
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B: Schizoid personality disorder
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Q:A 42-year-old man presents with an oral cavity lesion, toothache, and weight loss. He is known to have been HIV-positive for 6 years, but he does not follow a prescribed antiretroviral regimen because of personal beliefs. The vital signs are as follows: blood pressure 110/80 mm Hg, heart rate 89/min, respiratory rate 17/min, and temperature 37.1°C (100.8°F). The physical examination revealed an ulcerative lesion located on the lower lip. The lesion was friable, as evidenced by contact bleeding, and tender on palpation. A CT scan showed the lesion to be a solid mass (7 x 6 x 7 cm3) invading the mandible and spreading to the soft tissues of the oral cavity floor. A biopsy was obtained to determine the tumor type, which showed a monotonous diffuse lymphoid proliferation of large cells with plasmablastic differentiation, and oval-to-round vesicular nuclei with fine chromatin. The cells are immunopositive for VS38c. DNA of which of the following viruses is most likely to be identified in the tumor cells?? {'A': 'CMV', 'B': 'EBV', 'C': 'HHV-8', 'D': 'HHV-1', 'E': 'HPV-16'},
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B: EBV
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Q:A 58-year old man comes to his physician because of a 1-month history of increased thirst and nocturia. He is drinking a lot of water to compensate for any dehydration. His brother has type 2 diabetes mellitus. Physical examination shows dry mucous membranes. Laboratory studies show a serum sodium of 151 mEq/L and glucose of 121 mg/dL. A water deprivation test shows: Serum osmolality (mOsmol/kg H2O) Urine osmolality (mOsmol/kg H2O) Initial presentation 295 285 After 3 hours without fluids 305 310 After administration of antidiuretic hormone (ADH) analog 280 355 Which of the following is the most likely diagnosis?"? {'A': 'Nephrogenic diabetes insipidus', 'B': 'Partial central diabetes inspidus', 'C': 'Complete central diabetes insipidus', 'D': 'Primary polydipsia', 'E': 'Osmotic diuresis'},
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B: Partial central diabetes inspidus
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Q:A previously healthy 13-year-old girl is brought to the physician by her parents because of a 2-day history of low-grade fever, headache, nausea, and a sore throat. Examination of the oral cavity shows enlarged, erythematous tonsils with exudates and palatal petechiae. There is cervical lymphadenopathy. Her parents agree to her participating in a study of microbial virulence factors. A culture of the girl's throat is obtained and an organism is cultivated. The physician finds that the isolated organism is able to withstand phagocytosis when placed in fresh blood. The most likely explanation for this finding is the expression of which of the following?? {'A': 'IgA protease', 'B': 'Protein A', 'C': 'Streptolysin O', 'D': 'Hyaluronidase', 'E': 'M Protein'},
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E: M Protein
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Q:A 40-year-old man comes to the physician for the evaluation of episodic headaches for 5 months. The headaches involve both temples and are 4/10 in intensity. The patient has been taking acetaminophen, but the headaches did not subside. He has also had visual disturbances, including double vision. He has no nausea, temperature intolerance, or weight changes. The patient does not smoke. He drinks 2–3 beers on weekends. He appears pale. His temperature is 37°C (98.6°F), pulse is 75/min, and blood pressure 125/80 mm Hg. Ophthalmologic examination shows impaired peripheral vision bilaterally. An MRI scan of the head with contrast shows a 16 × 11 × 9 mm intrasellar mass. Further evaluation is most likely to show which of the following findings?? {'A': 'Galactorrhea', 'B': 'Coarse facial features', 'C': 'Diffuse goiter', 'D': 'Erectile dysfunction', 'E': 'Abdominal striae'},
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D: Erectile dysfunction
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Q:A 4-year-old boy is brought to the physician because of frequent falls, worsening muscle pain, and poor vision in low light conditions. His mother reports that he has been on a low-fat diet since infancy because of persistent diarrhea. He is at the 5th percentile for height and weight. Physical examination shows bilateral proximal muscle weakness and a wide ataxic gait. His serum cholesterol level is 21 mg/dL. Peripheral blood smear shows red blood cells with irregular spiny projections of varying size. Further evaluation of this patient is most likely to show which of the following findings?? {'A': 'GAA trinucleotide repeats on chromosome 9', 'B': 'Post-prandial lipid-laden enterocytes', 'C': 'Sweat chloride levels > 60 mmol/L', 'D': 'IgA anti-tissue transglutaminase antibodies', 'E': 'Fibrofatty replacement of muscle tissue'},
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B: Post-prandial lipid-laden enterocytes
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Q:A 52-year-old man presents to his primary care physician complaining of a blistering rash in his inguinal region. Upon further questioning, he also endorses an unintended weight loss, diarrhea, polydipsia, and polyuria. A fingerstick glucose test shows elevated glucose even though this patient has no previous history of diabetes. After referral to an endocrinologist, the patient is found to have elevated serum glucagon and is diagnosed with glucagonoma. Which of the following is a function of glucagon?? {'A': 'Inhibition of insulin release', 'B': 'Increased glycolysis', 'C': 'Decreased glycogenolysis', 'D': 'Increased lipolysis', 'E': 'Decreased ketone body producttion'},
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D: Increased lipolysis
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Q:A 38-year-old woman is brought to the emergency department because of 3 1-hour episodes of severe, sharp, penetrating abdominal pain in the right upper quadrant. During these episodes, she had nausea and vomiting. She has no diarrhea, dysuria, or hematuria and is asymptomatic between episodes. She has hypertension and hyperlipidemia. Seven years ago, she underwent resection of the terminal ileum because of severe Crohn's disease. She is 155 cm (5 ft 2 in) tall and weighs 79 kg (175 lb). Her BMI is 32 kg/m2. Her temperature is 36.9°C (98.5°F), pulse is 80/min, and blood pressure is 130/95 mm Hg. There is mild scleral icterus. Cardiopulmonary examination shows no abnormalities. The abdomen is soft, and there is tenderness to palpation of the right upper quadrant without guarding or rebound. Bowel sounds are normal. The stool is brown, and a test for occult blood is negative. Laboratory studies show: Laboratory test Blood Hemoglobin 12.5 g/dL Leukocyte count 9,500 mm3 Platelet count 170,000 mm3 Serum Total bilirubin 4.1 mg/dL Alkaline phosphatase 348 U/L AST 187 U/L ALT 260 U/L Abdominal ultrasonography shows a normal liver, a common bile duct caliber of 10 mm (normal < 6 mm), and gallbladder with multiple gallstones and no wall thickening or pericholecystic fluid. Which of the following is the most likely cause of these findings?? {'A': 'Acute hepatitis A', 'B': 'Cholangitis', 'C': 'Cholecystitis', 'D': 'Choledocholithiasis', 'E': 'Pancreatitis'},
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D: Choledocholithiasis
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Q:In a recently conducted case-control study that aimed to elucidate the causes of myelomeningocele (a neural tube defect in which there is an incomplete formation of the spinal bones), 200 mothers of infants born with the disease and 200 mothers of infants born without the disease were included in the study. Among the mothers of infants with myelomeningocele, 50% reported having experienced pharyngitis (sore throat) during pregnancy, compared with 5% of the mothers whose infants did not develop the condition. The researchers concluded that there is an association between pharyngitis during pregnancy and myelomeningocele; this conclusion was backed up by statistical analysis of the obtained results. Which type of bias may hamper the validity of the researchers’ conclusions?? {'A': 'Surveillance bias', 'B': 'Attrition bias', 'C': 'Recall bias', 'D': 'Assessment bias', 'E': 'Neyman bias'},
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C: Recall bias
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Q:A 66-year-old woman presents to the primary care physician with complaints of involuntary loss of urine. This has been occurring over the past month for no apparent reason while suddenly feeling the need to urinate. History reveals triggers that stimulate the desire to pass urine, such as running water, handwashing, and cold weather. There is no family history of similar symptoms in her mother or any of her 8 children. Her blood pressure is 130/80 mm Hg, heart rate is 72/min, respiratory rate is 22/min, and temperature is 36.6°C (98.0°F). Physical examination is unremarkable. Urinalysis reveals the following: Color Yellow Clarity/turbidity Clear pH 5.5 Specific gravity 1.015 Nitrites Negative Leukocyte esterase Negative Which of the following is the best next step in the management of this patient?? {'A': 'Administer antimuscarinics', 'B': 'Bladder training', 'C': 'Administer antibiotics', 'D': 'Posterior tibial nerve stimulation', 'E': 'Surgery'},
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B: Bladder training
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Q:A 40-year-old woman with a recent history of carcinoma of the breast status post mastectomy and adjuvant chemotherapy one week ago presents for follow-up. She reports adequate pain control managed with the analgesic drug she was prescribed. Past medical history is significant for hepatitis C and major depressive disorder. The patient denies any history of smoking or alcohol use but says she is currently using intravenous heroin and has been for the past 10 years. However, she reports that she has been using much less heroin since she started taking the pain medication, which is confirmed by the toxicology screen. Which of the following is the primary mechanism of action of the analgesic drug she was most likely prescribed?? {'A': 'Mixed agonist-antagonist at opioid receptors', 'B': 'Pure antagonist at opioid receptors', 'C': 'Inhibits prostaglandin synthesis', 'D': 'Pure agonist at the µ-opioid receptor', 'E': 'Central action via blockade of serotonin reuptake'},
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A: Mixed agonist-antagonist at opioid receptors
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Q:A 68-year-old man is brought to the emergency department by ambulance from a homeless shelter. The report from the shelter describes the man as a loner expressing symptoms of depression. He has been living at the shelter for approximately 10 months and has no family or friends and few visitors. He spends most of his evenings drinking alcohol and being by himself. Which of the following statements is most accurate regarding this patient?? {'A': 'Males are more likely to die from suicide than females.', 'B': 'Males attempt suicide more than females.', 'C': 'Males are more likely to use drug overdose as a means of suicide.', 'D': 'Females are more likely to self-inflict fatal injuries.', 'E': 'Suicide risk is highest among middle-age white women.'},
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A: Males are more likely to die from suicide than females.
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Q:A 65-year-old man with a history of hypertension visits your office. His blood pressure on physical examination is found to be 150/90. You prescribe him metoprolol. Which of the following do you expect to occur as a result of the drug?? {'A': 'Decreased PR interval on EKG', 'B': 'Decreased serum renin levels as consequence of ß2 antagonism', 'C': 'Increased serum renin levels as a consequence of ß2 receptor antagonism', 'D': 'Decreased serum renin levels as a consequence of ß1 receptor antagonism', 'E': 'Increased serum renin levels as a consequence of ß1 receptor antagonism'},
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D: Decreased serum renin levels as a consequence of ß1 receptor antagonism
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Q:A 5-year-old boy is brought to the physician because of a nonpruritic rash on his face that began 5 days ago. It started as a bug bite on his chin that then developed into small pustules with surrounding redness. He has not yet received any routine childhood vaccinations. Physical examination shows small, clustered lesions with gold crusts along the lower lip and chin and submandibular lymphadenopathy. At a follow-up examination 2 weeks later, his serum anti-deoxyribonuclease B antibody titer is elevated. This patient is at greatest risk for which of the following complications?? {'A': 'Reactive arthritis', 'B': 'Shingles', 'C': 'Glomerulonephritis', 'D': 'Orchitis', 'E': 'Myocarditis'},
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C: Glomerulonephritis
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Q:A 29-year-old G2P1 woman presents at 24 weeks gestation with complaints of blurred vision and headaches. Her symptoms have increased in frequency over the past several weeks. Her medical history is significant only for occasional tension headaches. She takes no medications besides an oral folic acid supplement. The vital signs are: blood pressure, 159/90 mm Hg; pulse, 89/min; and respiratory rate, 18/min. She is afebrile. She states that her husband, a nurse, took her blood pressure 2 days earlier and found it to be 154/96 mm Hg at the time. Previously, her blood pressures have always been < 120/80 mm Hg. What is the next best step to solidify the diagnosis?? {'A': 'Electrocardiogram', 'B': 'Non-contrast enhanced head CT', 'C': 'Serum CBC and electrolytes', 'D': '24-hour urine collection', 'E': 'Fetal ultrasound'},
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D: 24-hour urine collection
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Q:A 45-year-old male presents to the emergency room for toe pain. He reports that his right great toe became acutely painful, red, and swollen approximately five hours prior. He has had one similar prior episode six months ago that resolved with indomethacin. His medical history is notable for obesity, hypertension, and alcohol abuse. He currently takes hydrochlorothiazide (HCTZ). On physical examination, his right great toe is swollen, erythematous, and exquisitely tender to light touch. The patient is started on a new medication that decreases leukocyte migration and mitosis, and his pain eventually resolves; however, he develops nausea and vomiting as a result of therapy. Which of the following underlying mechanisms of action is characteristic of this patient’s new medication?? {'A': 'Inhibits microtubule polymerization', 'B': 'Prevents conversion of xanthine to uric acid', 'C': 'Decreases phospholipase A2-induced production of arachidonic acid', 'D': 'Decreases cyclooxygenase-induced production of prostaglandins', 'E': 'Metabolizes uric acid to water-soluble allantoin'},
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A: Inhibits microtubule polymerization
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Q:A 24-year-old man is referred to an endocrinologist for paroxysms of headaches associated with elevated blood pressure and palpitations. He is otherwise healthy, although he notes a family history of thyroid cancer. His physical examination is significant for the findings shown in Figures A, B, and C. His thyroid is normal in size, but there is a 2.5 cm nodule palpable in the right lobe. On further workup, it is found that he has elevated plasma-free metanephrines and a normal TSH. Fine-needle aspiration of the thyroid nodule stains positive for calcitonin. The endocrinologist suspects a genetic syndrome. What is the most likely inheritance pattern?? {'A': 'Autosomal dominant', 'B': 'Autosomal recessive', 'C': 'Mitochondrial', 'D': 'X-linked dominant', 'E': 'X-linked recessive'},
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A: Autosomal dominant
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Q:A previously healthy 29-year-old man comes to the emergency department because of a 4-day history of abdominal pain and confusion. Prior to the onset of the abdominal pain, he visited a festival where he consumed large amounts of alcohol. Examination shows a distended abdomen, decreased bowel sounds, and diffuse tenderness to palpation. There is motor weakness in the upper extremities. Sensation is decreased over the upper and lower extremities. Laboratory studies show no abnormalities. Which of the following is the most appropriate therapy for this patient's condition?? {'A': 'Intravenous immunoglobulin', 'B': 'Hemin', 'C': 'Ethylenediaminetetraacetic acid', 'D': 'Chlordiazepoxide', 'E': 'Chloroquine'},
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B: Hemin
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Q:A 4-year-old Caucasian male patient presents with recurrent infections. During examination of his CD4 T-cells, it is noticed that his T-cells lack CD40 ligand. Which type of immunoglobulin is likely to be present in excess?? {'A': 'IgA', 'B': 'IgE', 'C': 'IgG', 'D': 'IgM', 'E': 'IgD'},
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D: IgM
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Q:A 22-year-old woman is in her last few months at community college. She has a very important essay due in 2 weeks that will play a big part in determining her final grades. She decides to focus on writing this essay instead and not to worry about her grades until her essay is completed. Which of the following defense mechanisms best explains her behavior?? {'A': 'Repression', 'B': 'Suppression', 'C': 'Blocking', 'D': 'Dissociation', 'E': 'Denial'},
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B: Suppression
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Q:A 93-year-old woman is brought to the physician because of a purple area on her right arm that has been growing for one month. She has not had any pain or itching of the area. She has hyperlipidemia, a history of basal cell carcinoma treated with Mohs surgery 2 years ago, and a history of invasive ductal carcinoma of the right breast treated with radical mastectomy 57 years ago. She has had chronic lymphedema of the right upper extremity since the mastectomy. Her only medication is simvastatin. She lives in an assisted living facility. She is content with her living arrangement but feels guilty that she is dependent on others. Vital signs are within normal limits. Physical examination shows extensive edema of the right arm. Skin exam of the proximal upper right extremity shows three coalescing, 0.5–1.0 cm heterogeneous, purple-colored plaques with associated ulceration. Which of the following is the most likely diagnosis?? {'A': 'Lymphangiosarcoma', 'B': 'Cellulitis', 'C': 'Thrombophlebitis', 'D': 'Lichen planus', 'E': 'Kaposi sarcoma'},
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A: Lymphangiosarcoma
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Q:A boy born vaginally in the 36th week of gestation to a 19-year-old woman (gravida 3, para 1) is assessed on his 2nd day of life. His vitals include: blood pressure is 85/40 mm Hg, pulse is 161/min, axillary temperature is 36.6°C (98.0°F), and respiratory rate is 44/min. He appears to be lethargic; his skin is jaundiced and slight acrocyanosis with several petechiae is noted. Physical examination reveals nystagmus, muffled heart sounds with a continuous murmur, and hepatosplenomegaly. The boy’s birth weight is 1.93 kg (4.25 lb) and Apgar scores at the 1st and 5th minutes were 5 and 8, respectively. His mother is unaware of her immunization status and did not receive any antenatal care. She denies any history of infection, medication use, or alcohol or illicit substance use during pregnancy. Serology for suspected congenital TORCH infection shows the following results: Anti-toxoplasma gondii IgM Negative Anti-toxoplasma gondii IgG Positive Anti-CMV IgM Negative Anti-CMV IgG Positive Anti-Rubella IgM Positive Anti-Rubella IgG Positive Anti-HSV IgM Negative Anti-HSV IgG Negative Which cardiac abnormality would be expected in this infant on echocardiography?? {'A': 'Pulmonary valve stenosis', 'B': 'Patent ductus arteriosus', 'C': 'Ventricular septal defect', 'D': 'Atrial septal defect', 'E': 'Atrialization of the right ventricle'},
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B: Patent ductus arteriosus
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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 presents to the emergency department with severe abdominal pain. She states that the pain has been dull and progressive, but became suddenly worse while she was exercising. The patient's past medical history is notable for depression, anxiety, and gonococcal urethritis that was appropriately treated. The patient states that she is sexually active and does not use condoms. She admits to drinking at least 5 standard alcoholic drinks a day. The patient also recently lost a large amount of weight for a fitness show she planned on entering. The patient's current medications include oral contraceptive pills, fluoxetine, alprazolam, ibuprofen, acetaminophen, and folate. On physical exam you note an athletic young woman with burly shoulders, a thick neck, and acne on her forehead and back. On abdominal exam you note diffuse tenderness with 10/10 pain upon palpation of the right upper quadrant. Blood pressure is 80/40 mmHg, pulse is 110/minute, temperature is 99.5°F (37.5°C) and respirations are 15/minute with an oxygen saturation of 96% on room air. Intravenous fluids are started and labs are sent. A urinary ß-hCG has been ordered. Which of the following is most likely the diagnosis?? {'A': 'Obstruction of the common bile duct by radio-opaque stones', 'B': 'Obstruction of blood flow through the hepatic vein', 'C': 'Vascular ectasia within the liver', 'D': 'Ectopic implantation of a blastocyst', 'E': 'Inflammation of the pancreas'},
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C: Vascular ectasia within the liver
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Q:A 22-year-old immigrant presents to his primary care physician for a general checkup. This is his first time visiting a physician, and he has no known past medical history. The patient’s caretaker states that the patient has experienced episodes of syncope and what seems to be seizures before but has not received treatment. His temperature is 98.1°F (36.7°C), blood pressure is 121/83 mmHg, pulse is 83/min, respirations are 14/min, and oxygen saturation is 98% on room air. Physical exam is notable for sensorineural deafness. Which of the following ECG changes is most likely to be seen in this patient?? {'A': 'Increased voltages', 'B': 'Peaked T waves', 'C': 'Prolonged QRS interval', 'D': 'Prolonged QT interval', 'E': 'QT shortening'},
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D: Prolonged QT interval
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Q:A 29-year-old nulliparous woman is found upon transthoracic echocardiography to have a dilated aorta and mitral valve prolapse. The patient has a history of joint pain, and physical examination reveals pectus excavatum and stretch marks on the skin. She does not take any medications and has no history of past drug use. The patient’s findings are most likely associated with which of the following underlying diagnoses?? {'A': 'Ehlers-Danlos syndrome', 'B': 'Turner syndrome', 'C': 'DiGeorge syndrome', 'D': 'Friedrich’s ataxia', 'E': 'Marfan syndrome'},
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E: Marfan syndrome
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Q:A 34-year-old woman comes to the physician with fever and malaise. For the past 2 days, she has felt fatigued and weak and has had chills. Last night, she had a temperature of 40.8°C (104.2°F). She has also had difficulty swallowing since this morning. The patient was recently diagnosed with Graves disease and started on methimazole. She appears uncomfortable. Her temperature is 38.3°C (100.9°F), pulse is 95/min, and blood pressure is 134/74 mm Hg. The oropharynx is erythematous without exudate. The lungs are clear to auscultation. Laboratory studies show: Hematocrit 42% Hemoglobin 13.4 g/dL Leukocyte count 3,200/mm3 Segmented neutrophils 9% Basophils < 1% Eosinophils < 1% Lymphocytes 79% Monocytes 11% Platelet count 230,000/mm3 Which of the following is the most appropriate next step in management?"? {'A': 'Bone marrow biopsy', 'B': 'Discontinue methimazole', 'C': 'Switch to propylthiouracil', 'D': 'Test for EBV, HIV, and CMV', 'E': 'Decrease methimazole dose'},
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B: Discontinue methimazole
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Answer the following medical question with one of the provided options:
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Q:A 6-year-old refugee with delayed growth and weakness is brought to the physician. Her family has been displaced several times over the last few years, and nutrition and housing were frequently inadequate. Examination of the lower limbs shows bowing of the legs with reduced proximal muscle strength. The abdomen is protruded. Inspection of the chest shows subcostal grooving during inspiration. An image of the patient’s wrist is shown. Which of the following is the most likely cause of this patient’s condition?? {'A': 'Defective collagen synthesis', 'B': 'Insufficient protein consumption', 'C': 'Low-calorie intake', 'D': 'Osteoclast hyperactivity', 'E': 'Vitamin D deficiency'},
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E: Vitamin D deficiency
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Q:A 16-year-old boy presents with a long-standing history of anemia. Past medical history is significant for prolonged neonatal jaundice and multiple episodes of jaundice without fever. On physical examination, the patient shows generalized pallor, scleral icterus, and splenomegaly. His hemoglobin is 10 g/dL, and examination of a peripheral blood smear shows red cell basophilic stippling. Which of the following is the most likely diagnosis in this patient?? {'A': 'Pyruvate kinase deficiency', 'B': 'Cytochrome b5 reductase deficiency', 'C': 'Lead poisoning', 'D': 'Pyrimidine 5’-nucleotidase deficiency', 'E': 'Glucose-6-phosphate dehydrogenase deficiency'},
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D: Pyrimidine 5’-nucleotidase deficiency
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Answer the following medical question with one of the provided options:
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Q:A 19-year-old woman with a history of poorly controlled asthma presents to her pulmonologist for a follow-up visit. She was recently hospitalized for an asthma exacerbation. It is her third hospitalization in the past five years. She currently takes inhaled salmeterol and medium-dose inhaled budesonide. Her past medical history is also notable for psoriasis. She does not smoke and does not drink alcohol. Her temperature is 98.6°F (37°C), blood pressure is 110/65 mmHg, pulse is 75/min, and respirations are 20/min. Physical examination reveals bilateral wheezes that are loudest at the bases. The patient’s physician decides to start the patient on zileuton. Which of the following is the most immediate downstream effect of initiating zileuton?? {'A': 'Decreased production of leukotrienes', 'B': 'Decreased signaling via the leukotriene receptor', 'C': 'Decreased IgE-mediated pro-inflammatory activity', 'D': 'Decreased mast cell degranulation', 'E': 'Decreased signaling via the muscarinic receptor'},
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A: Decreased production of leukotrienes
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Answer the following medical question with one of the provided options:
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Q:A 6-year-old boy is brought to the emergency department with acute intermittent umbilical abdominal pain that began that morning. The pain radiates to his right lower abdomen and occurs every 15–30 minutes. During these episodes of pain, the boy draws up his knees to the chest. The patient has had several episodes of nonbilious vomiting. He had a similar episode 3 months ago. His temperature is 37.7°C (99.86°F), pulse is 99/min, respirations are 18/min, and blood pressure is 100/60 mm Hg. Abdominal examination shows periumbilical tenderness with no masses palpated. Abdominal ultrasound shows concentric rings of bowel in transverse section. Laboratory studies show: Leukocyte Count 8,000/mm3 Hemoglobin 10.6 g/dL Hematocrit 32% Platelet Count 180,000/mm3 Serum Sodium 143 mEq/L Potassium 3.7 mEq/L Chloride 88 mEq/L Bicarbonate 28 mEq/L Urea Nitrogen 19 mg/dL Creatinine 1.3 mg/dL Which of the following is the most likely underlying cause of this patient's condition?"? {'A': 'Intestinal adhesions', 'B': 'Meckel diverticulum', 'C': 'Acute appendicitis', 'D': 'Malrotation with volvulus', 'E': 'Intestinal polyps\n"'},
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B: Meckel diverticulum
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Answer the following medical question with one of the provided options:
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Q:A lung mass of a 50 pack-year smoker is biopsied. If ADH levels were grossly increased, what would most likely be the histologic appearance of this mass?? {'A': 'Tall columnar cells bordering the alveolar septum', 'B': 'Sheets of small round cells with hyperchromatic nuclei', 'C': 'Layered squamous cells with keratin pearls', 'D': 'Hyperplasia of mucin producing glandular tissue', 'E': 'Pleomorphic giant cells with leukocyte fragments in cytoplasm'},
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B: Sheets of small round cells with hyperchromatic nuclei
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Answer the following medical question with one of the provided options:
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Q:A 26-year-old man presents to his primary care physician for a routine physical exam. He is concerned about a burning sensation that he feels in his throat whenever he eats large meals and is concerned he may have esophageal cancer like his uncle. The patient has a past medical history of irritable bowel syndrome and constipation. His current medications include whey protein supplements, fish oil, a multivitamin, and sodium docusate. The patient is concerned about his performance in school and fears he may fail out. He recently did poorly on an exam and it has caused him significant stress. He also is worried that his girlfriend is going to leave him. The patient claims that he thought he was going to be an incredible doctor some day, but now he feels like a terrible person. The patient also states that he feels guilty about his grandfather's death which occurred 1 year ago and he often reexperiences the funeral in his mind. He regularly has trouble sleeping for which he takes melatonin. The patient has been praying every 4 hours with the hopes that this will make things go better for him. Which of the following is the most likely diagnosis?? {'A': 'Acute stress disorder', 'B': 'Depression', 'C': 'Generalized anxiety disorder', 'D': 'Obsessive compulsive disorder', 'E': 'Post traumatic stress disorder'},
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C: Generalized anxiety disorder
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