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Answer the following medical question with one of the provided options:
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Q:Two weeks after returning from vacation in Mexico, a 21-year-old man comes to the emergency department because of malaise, nausea, vomiting, fever, and abdominal pain. He has no history of serious illness and takes no medications. Physical examination shows scleral icterus and right upper quadrant tenderness. The liver is palpated 1.5 cm below the right costal margin. A biopsy specimen of this patient's liver would most likely show which of the following findings?? {'A': 'Ground glass hepatocytes and apoptotic bodies', 'B': 'Dysplastic hepatocytes with intracellular bile', 'C': 'Ballooning degeneration and bridging necrosis', 'D': 'Lymphocytic infiltration and progressive ductopenia', 'E': 'Piecemeal necrosis and fatty changes'},
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C: Ballooning degeneration and bridging necrosis
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Answer the following medical question with one of the provided options:
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Q:A 40-year-old woman comes to the physician because of a 2 week history of anorexia and a feeling of dryness in the mouth; she has had a 5.8-kg (12.8-lb) weight loss during this period. She also complains of fatigue and inability to carry out daily chores. One year ago, she was diagnosed with advanced cervical carcinoma, metastatic to the pancreas, and is being treated with combination chemotherapy. She is 157 cm (5 ft 2 in) tall and weighs 47 kg (103.6 lb); BMI is 19.1 kg/m2. She appears thin and pale. Her temperature is 37.7°C (99.8°F), blood pressure is 110/68 mm Hg, pulse is 105/min, and respirations are 28/min. There is generalized weakness and atrophy of the skeletal muscles. Which of the following is the most appropriate next step in management?? {'A': 'Dronabinol', 'B': 'Mirtazapine', 'C': 'Megestrol acetate', 'D': 'Cyproheptadine', 'E': 'Cognitive behavioral therapy'},
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C: Megestrol acetate
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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 is brought to the psychiatric emergency room after she was found naked in the street proclaiming that she was a prophet sent down from heaven to save the world. A review of the electronic medical record reveals that she has a history of an unspecified coagulation disorder. On exam, she speaks rapidly and makes inappropriate sexual comments about the physician. She is alert and oriented to person but not place, time, or situation. She is easily distracted and reports that she has not slept in 3 days. She is involuntarily admitted and is treated appropriately. Her symptoms improve and she is discharged 4 days later. She misses multiple outpatient psychiatric appointments after discharge. She is seen 5 months later and reports feeling better and that she is 3 months pregnant. Her fetus is at an increased risk for developing which of the following?? {'A': 'Atrialized right ventricle', 'B': 'Cleft palate', 'C': 'Failure of vertebral arch fusion', 'D': 'Phocomelia', 'E': 'Sirenomelia'},
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A: Atrialized right ventricle
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Answer the following medical question with one of the provided options:
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Q:A 10-year-old boy is brought to the emergency department by his parents because of a dull persistent headache beginning that morning. He has nausea and has vomited twice. During the past four days, the patient has had left-sided ear pain and fever, but his parents did not seek medical attention. He is from Thailand and is visiting his relatives in the United States for the summer. There is no personal or family history of serious illness. He is at the 45th percentile for height and 40th percentile for weight. He appears irritable. His temperature is 38.5°C (101.3°F), pulse is 110/min, and blood pressure is 98/58 mm Hg. The pupils are equal and reactive to light. Lateral gaze of the left eye is limited. The left tympanic membrane is erythematous with purulent discharge. There is no nuchal rigidity. Which of the following is the most appropriate next step in management?? {'A': 'Intravenous ceftriaxone and clindamycin therapy', 'B': 'Intravenous cefazolin and metronidazole therapy', 'C': 'MRI of the brain', 'D': 'Cranial burr hole evacuation', 'E': 'Lumbar puncture'},
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C: MRI of the brain
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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 is brought to his pediatrician's office by his mother with a new onset rash. His mother says that the rash appeared suddenly yesterday. He is otherwise well. His medical history is unremarkable except for a recent upper respiratory infection that resolved without intervention two weeks ago. His temperature is 98.2°F (36.8°C), blood pressure is 110/74 mmHg, pulse is 84/min, and respirations are 18/min. Physical exam shows a well appearing child with a diffuse petechial rash. Complete blood count shows the following: Hemoglobin: 12.6 g/dL Hematocrit: 37% Leukocyte count: 5,100/mm^3 Platelet count: 65,000/mm^3 Which of the following is the best choice in management?? {'A': 'Dexamethasone', 'B': 'Intravenous immunoglobulin (IVIg)', 'C': 'Observation', 'D': 'Rituximab', 'E': 'Splenectomy'},
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C: Observation
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Answer the following medical question with one of the provided options:
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Q:A 38-year-old man presents to his physician with recurrent episodes of facial swelling and abdominal pain. He reports that these episodes started when he was approximately 16 years of age. His mother also has similar episodes of swelling accompanied by swelling of her extremities. The vital signs include: blood pressure 140/80 mm Hg, heart rate 74/min, respiratory rate 17/min, and temperature 36.6℃ (97.8℉). His physical examination is unremarkable. The laboratory work-up shows the following findings: Test Result Normal range C1 esterase inhibitor 22% > 60% Complement C4 level 9 mg/dL 14–40 mg/dL Complement C2 level 0.8 mg/dL 1.1–3.0 mg/dL Complement component 1q 17 mg/dL 12–22 mg/dL Which of the following anti-hypertensive medications is contraindicated in this patient?? {'A': 'Amlodipine', 'B': 'Valsartan', 'C': 'Fosinopril', 'D': 'Atenolol', 'E': 'Indapamide'},
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C: Fosinopril
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Answer the following medical question with one of the provided options:
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Q:A 5-year-old boy undergoes MRI neuroimaging for the evaluation of worsening headaches and intermittent nausea upon awakening. He receives a bolus of intravenous thiopental for sedation during the procedure. Ten minutes after the MRI, the patient is awake and responsive. Which of the following pharmacological properties is most likely responsible for this patient's rapid recovery from this anesthetic agent?? {'A': 'First-pass metabolism', 'B': 'Redistribution', 'C': 'Zero-order elimination', 'D': 'Ion trapping', 'E': 'Cytochrome P450 oxidation'},
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B: Redistribution
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Answer the following medical question with one of the provided options:
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Q:A 65-year-old woman with osteoarthritis comes to the physician because of severe lower back and left leg pain. She has chronic lower back pain that is usually well-controlled with ibuprofen, but 3 hours ago her back pain acutely worsened after she picked up her 3-year-old granddaughter. The pain radiates from her lower back over her left outer thigh and knee towards the top of her big toe. Physical examination shows a diminished posterior tibial reflex on the left side. Muscle strength is 5/5 in all extremities and there are no sensory deficits. Steroid injection into which of the following anatomical locations is most likely to relieve her symptoms?? {'A': 'Inferior facet joint', 'B': 'Intervertebral disc', 'C': 'Subdural space', 'D': 'Subarachnoid space', 'E': 'Intervertebral foramen'},
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E: Intervertebral foramen
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Answer the following medical question with one of the provided options:
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Q:A 68-year-old man presents to the emergency department complaining of difficulty in breathing for the past 2 days. He has had recurrent episodes of bacterial pneumonia in the right lower lobe during the last 6 months. His last episode of pneumonia started 7 days ago for which he is being treated with antibiotics. He has a 35-pack-year smoking history. Past medical history is significant for hypertension for which he takes lisinopril. Physical examination reveals decreased breath sounds and dullness to percussion in the right lung base. Chest X-ray reveals a large right-sided pleural effusion, and chest CT scan shows a large mass near the hilum of the right lung. Cytologic examination of pleural fluid shows evidence of malignancy. Which of the following is the most likely diagnosis of this patient?? {'A': 'Pulmonary hamartoma', 'B': 'Mesothelioma', 'C': 'Non-small cell lung cancer', 'D': 'Small cell lung cancer', 'E': 'Metastatic lung disease'},
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D: Small cell lung cancer
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Answer the following medical question with one of the provided options:
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Q:A 37-year-old man comes to the physician because of a 3-day history of fatigue and yellowish discoloration of his eyes and skin. Physical examination shows mild right upper quadrant abdominal tenderness. The course of different serum parameters over the following 4 months is shown. Which of the following is the most likely explanation for the course of this patient's laboratory findings?? {'A': 'Chronic hepatitis B infection with low infectivity', 'B': 'Chronic hepatitis B infection with high infectivity', 'C': 'Adverse reaction to hepatitis B vaccination', 'D': 'Acute exacerbation of previous hepatitis B infection', 'E': 'Resolved acute hepatitis B infection'},
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E: Resolved acute hepatitis B infection
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Answer the following medical question with one of the provided options:
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Q:A 68-year-old man comes to the physician because of fatigue and muscle cramps for the past 4 weeks. He has also noticed several episodes of tingling in both hands. He has not had fever or nausea. He has had a chronic cough for 10 years. He has chronic bronchitis, hypertension, and osteoarthritis of both knees. His father died from lung cancer. Current medications include salbutamol, ibuprofen, and ramipril. He has smoked 1 pack of cigarettes daily for 45 years. He is 175 cm (5 ft 9 in) tall and weighs 68 kg (163 lb); BMI is 22 kg/m2. His temperature is 36.7°C (98°F), pulse is 60/min, and blood pressure is 115/76 mm Hg. While measuring the patient's blood pressure, the physician observes carpopedal spasm. Cardiopulmonary examination shows no abnormalities. His hematocrit is 41%, leukocyte count is 5,800/mm3, and platelet count is 195,000/mm3. Serum alkaline phosphatase activity is 55 U/L. An ECG shows sinus rhythm with a prolonged QT interval. Which of the following is the most likely underlying cause of this patient's symptoms?? {'A': 'Multiple endocrine neoplasia', 'B': 'Ectopic hormone production', 'C': 'Medication side effect', 'D': 'Destruction of parathyroid glands', 'E': 'Vitamin D deficiency'},
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D: Destruction of parathyroid glands
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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 rate of multiplication of hepatitis C virus in hepatocytes. The viral genomic material is isolated, enzymatically cleaved into smaller fragments and then separated on a formaldehyde agarose gel membrane. Targeted probes are then applied to the gel and visualized under x-ray. Which of the following is the most likely structure being identified by this test?? {'A': 'Ribonucleic acids', 'B': 'Deoxyribonucleic acids', 'C': 'Polypeptides', 'D': 'Transcription factors', 'E': 'Lipid-linked oligosaccharides'},
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A: Ribonucleic acids
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Answer the following medical question with one of the provided options:
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Q:A 72-year-old male is brought from his nursing home to the emergency department for fever, chills, dyspnea, productive cough, and oliguria over the past 72 hours. He was in his normal state of health and slowly developed breathing problems and fever. His past medical history is significant for hepatitis C, hypertension, and hypercholesterolemia. His medications include bisoprolol, hydrochlorothiazide, and atorvastatin. Upon arrival to the ED, his blood pressure is 80/48 mm Hg, pulse is 120/min, a respiratory rate of 28/min, and body temperature of 39.0°C (102.2°F). Physical examination reveals decreased breathing sounds in the base of the left lung, along with increased vocal resonance, and pan-inspiratory crackles. The abdomen is mildly distended with a positive fluid wave. The patient’s level of consciousness ranges from disoriented to drowsiness. He is transferred immediately to the ICU where vasoactive support is initiated. Laboratory tests show leukocytosis, neutrophilia with bands. Since admission 6 hours ago, the patient has remained anuric. Which of additional findings would you expect in this patient?? {'A': 'Urinary osmolality > 500 mOsmol/kg', 'B': 'Urinary osmolality < 350 mOsmol/kg', 'C': 'Blood urea nitrogen (BUN):Serum creatinine ratio (Cr) > 20:1', 'D': 'Blood urea nitrogen (BUN):Serum creatinine ratio (SCr) <15:1', 'E': 'Urine sodium > 40 mEq/L'},
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D: Blood urea nitrogen (BUN):Serum creatinine ratio (SCr) <15:1
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Answer the following medical question with one of the provided options:
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Q:A 70-year-old Caucasian male presents to the emergency room following a fall. The patient's past medical history is significant for myocardial infarction and atrial fibrillation. His home medications are unknown. The patient's head CT is shown in Image A. Laboratory results reveal an International Normalized Ratio (INR) of 6. Which of the following is the most appropriate pharmacologic therapy for this patient?? {'A': 'Vitamin K', 'B': 'Cryoprecipitate', 'C': 'Protamine', 'D': 'Platelet transfusion', 'E': 'Fresh frozen plasma'},
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A: Vitamin K
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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 presents to her gynecologist with complaints of pain with her menses and during intercourse. She also complains of chest pain that occurs whenever she has her menstrual period. The patient has a past medical history of bipolar disorder and borderline personality disorder. Her current medications include lithium and haloperidol. Review of systems is notable only for pain when she has a bowel movement relieved by defecation. Her temperature is 98.2°F (36.8°C), blood pressure is 114/74 mmHg, pulse is 70/min, respirations are 14/min, and oxygen saturation is 98% on room air. Pelvic exam is notable for a tender adnexal mass. The patient's uterus is soft, boggy, and tender. Which of the following is the most appropriate method of confirming the diagnosis in this patient?? {'A': 'Clinical diagnosis', 'B': 'Endometrial biopsy', 'C': 'Laparoscopy', 'D': 'MRI', 'E': 'Transvaginal ultrasound'},
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C: Laparoscopy
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Answer the following medical question with one of the provided options:
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Q:A 47-year-old man is brought to the emergency department by police. He was forcibly removed from a bar for lewd behavior. The patient smells of alcohol, and his speech is slurred and unintelligible. The patient has a past medical history of alcohol abuse, obesity, diabetes, and Wernicke encephalopathy. The patient's currently prescribed medications include insulin, metformin, disulfiram, atorvastatin, a multi-B-vitamin, and lisinopril; however, he is non-compliant with his medications. His temperature is 98.5°F (36.7°C), blood pressure is 150/97 mmHg, pulse is 100/min, respirations are 15/min, and oxygen saturation is 96% on room air. Physical exam is notable for a palpable liver edge 2 cm inferior to the rib cage and increased abdominal girth with a positive fluid wave. Laboratory values are ordered and return as below: Hemoglobin: 10 g/dL Hematocrit: 33% Leukocyte count: 7,500 cells/mm^3 with normal differential Platelet count: 245,000/mm^3 Serum: Na+: 136 mEq/L Cl-: 102 mEq/L K+: 4.1 mEq/L HCO3-: 24 mEq/L BUN: 24 mg/dL Glucose: 157 mg/dL Creatinine: 1.5 mg/dL Ca2+: 9.6 mg/dL Which of the following are the most likely laboratory values that would be seen in this patient in terms of aspartate aminotransferase (AST), alanine aminotransferase (ALT) and gamma-glutamyl transferase (GGT) (in U/L)?? {'A': 'AST: 225, ALT: 245, GGT: 127', 'B': 'AST: 255, ALT: 130, GGT: 114', 'C': 'AST: 265, ALT: 205, GGT: 50', 'D': 'AST: 425, ALT: 475, GGT: 95', 'E': 'AST: 455, ALT: 410, GGT: 115'},
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B: AST: 255, ALT: 130, GGT: 114
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Answer the following medical question with one of the provided options:
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Q:A 72-year-old man is seen in the hospital for a sacral rash. The patient has been hospitalized for the past 3 weeks for a heart failure exacerbation. When the nurse went to bathe him this morning, she noticed a red rash over his sacrum. The patient reports mild discomfort and denies pruritus. The patient has chronic kidney disease, urinary incontinence, ischemic cardiomyopathy, gout, and poor mobility. His current medications include aspirin, furosemide, metoprolol, lisinopril, spironolactone, and prednisone that was started for a recent gout flare. The patient’s temperature is 97°F (37.2°C), blood pressure is 110/62 mmHg, pulse is 68/min, and respirations are 13/min with an oxygen saturation of 98% on room air. On physical examination, there is a 4 cm x 6 cm patch of non-blanchable erythema over the patient’s sacrum that is mildly tender to palpation. Labs are obtained, as shown below: Leukocyte count: 10,000/mm^3 with normal differential Hemoglobin: 15.2 g/dL Platelet count: 400,000/mm^3 Serum: Na: 138 mEq/L K+: 4.3 mEq/L Cl-: 104 mEq/L HCO3-: 25 mEq/L BUN: 26 mg/dL Creatinine: 1.5 mg/dL Glucose: 185 mg/dL A hemoglobin A1c is pending. Which of the following is the best management for the patient’s most likely diagnosis?? {'A': 'Metformin', 'B': 'Prophylactic oral ciprofloxacin', 'C': 'Repositioning', 'D': 'Surgical debridement', 'E': 'Topical silver sulfadiazine'},
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C: Repositioning
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Answer the following medical question with one of the provided options:
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Q:A 70-year-old man with a long-standing history of diabetes mellitus type 2 and hypertension presents with complaints of constant wrist and shoulder pain. Currently, the patient undergoes hemodialysis 2 to 3 times a week and is on the transplant list for a kidney. The patient denies any recent traumas. Which of the following proteins is likely to be increased in his plasma, causing the patient’s late complaints?? {'A': 'Ig light chains', 'B': 'Amyloid A (AA)', 'C': 'Amyloid precursor protein', 'D': 'Urine tests will only be diagnostic of end-stage kidney disease', 'E': 'β2-microglobulin'},
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E: β2-microglobulin
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Answer the following medical question with one of the provided options:
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Q:A 25-year-old woman presents to the clinic with complaints of dysuria and increased urinary frequency. Her urinalysis results are negative for nitrites. Urine microscopy shows the findings in figure A. What is the most likely cause underlying her symptoms?? {'A': 'E. coli infection', 'B': 'S. saprophyticus infection', 'C': 'Acute tubular necrosis', 'D': 'Renal calculi', 'E': 'Enterococci infection'},
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B: S. saprophyticus infection
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Answer the following medical question with one of the provided options:
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Q:A newborn infant is born at 42 weeks gestation to a healthy 36-year-old G1P0. The delivery was complicated by prolonged labor and shoulder dystocia. The child is in the 87th and 91st percentiles for height and weight at birth, respectively. The mother’s past medical history is notable for diabetes mellitus and obesity. Immediately after birth, the child’s temperature is 99°F (37.2°C), blood pressure is 90/50 mmHg, pulse is 120/min, and respirations are 24/min. The child demonstrates a strong cry and pink upper and lower extremities bilaterally. The right arm is adducted and internally rotated at the shoulder and extended at the elbow. Flexion and extension of the wrist and digits appear to be intact in the right upper extremity. Which of the following muscles would most likely have normal strength in this patient?? {'A': 'Teres minor', 'B': 'Brachialis', 'C': 'Brachioradialis', 'D': 'Biceps', 'E': 'Triceps'},
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E: Triceps
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Answer the following medical question with one of the provided options:
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Q:A 28-year-old woman, gravida 2, para 1, at 30 weeks' gestation comes to the physician because of headache for the past 5 days. Her pregnancy has been uncomplicated to date. Pregnancy and vaginal delivery of her first child were uncomplicated. The patient does not smoke or drink alcohol. She does not use illicit drugs. Medications include folic acid and a multivitamin. Her temperature is 37°C (98.6°F), pulse is 82/min, and blood pressure is 150/92 mm Hg. Physical examination reveals 2+ pitting edema in the lower extremities. Laboratory studies show: Hemoglobin 11.8 g/dL Platelet count 290,000/mm3 Urine pH 6.3 Protein 2+ WBC negative Bacteria occasional Nitrites negative The patient is at increased risk of developing which of the following complications?"? {'A': 'Placenta previa', 'B': 'Abruptio placentae', 'C': 'Spontaneous abortion', 'D': 'Uterine rupture', 'E': 'Polyhydramnios'},
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B: Abruptio placentae
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Answer the following medical question with one of the provided options:
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Q:A 16-year-old boy with history of seizure disorder is rushed to the Emergency Department with multiple generalized tonic-clonic seizures that have spanned more than 30 minutes in duration. He has not regained consciousness between these episodes. In addition to taking measures to ensure that he maintains adequate respiration, which of the following is appropriate for initial pharmacological therapy?? {'A': 'Phenytoin', 'B': 'Carbamazepine', 'C': 'Gabapentin', 'D': 'Valproic acid', 'E': 'Lorazepam'},
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E: Lorazepam
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Answer the following medical question with one of the provided options:
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Q:A 35-year-old woman presents to an outpatient clinic during winter for persistant rhinorrhea. She states it is persistent and seems to be worse when she goes outside. Otherwise, she states she is generally healthy and only has a history of constipation. Her temperature is 98.7°F (37.1°C), blood pressure is 144/91 mmHg, pulse is 82/min, respirations are 14/min, and oxygen saturation is 98% on room air. Nasal sputum cytology reveals eosinophilia and boggy turbinates. Which of the following is the most likely diagnosis?? {'A': 'Cold weather', 'B': 'Coronavirus', 'C': 'Environmental allergen', 'D': 'Staphylococcus aureus', 'E': 'Streptococcus pneumonia'},
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C: Environmental allergen
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Answer the following medical question with one of the provided options:
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Q:A 21-year-old male presents to your office with hematuria 3 days after the onset of a productive cough and fever. Following renal biopsy, immunofluorescence shows granular IgA deposits in the glomerular mesangium. Which of the following do you suspect in this patient?? {'A': 'Lipoid nephrosis', 'B': 'Berger’s disease', 'C': 'Poststreptococcal glomerulonephritis', 'D': 'Systemic lupus erythematosus', 'E': 'HIV infection'},
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B: Berger’s disease
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Answer the following medical question with one of the provided options:
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Q:A 73-year-old man presents to the office, complaining of “weird blisters” on his right hand, which appeared 2 weeks ago. The patient says that he initially had a rash, which progressed to blisters. He denies any trauma or known contact with sick people. He is worried because he hasn’t been able to garden since the rash appeared, and he was planning on entering his roses into an annual competition this month. His vital signs are stable. On physical exam, the patient has multiple bullae accompanied by red, papular lesions on his right hand, which progress to his forearm. The right axillary lymph nodes are swollen and tender. What is the treatment for the most likely diagnosis of this patient?? {'A': 'Potassium iodide solution', 'B': 'Azithromycin', 'C': 'Doxycycline', 'D': 'Itraconazole', 'E': 'Topical corticosteroids'},
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D: Itraconazole
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Answer the following medical question with one of the provided options:
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Q:A 60-year-old male presents to the emergency room complaining of substernal chest pain. He reports a three-hour history of dull substernal chest pain that radiates into his left arm and jaw. He had a similar incident two months ago after walking one mile, but this pain is more severe. His past medical history is notable for hypertension and hyperlipidemia. An EKG demonstrates non-specific changes. Serum troponins are normal. In addition to aspirin, oxygen, and morphine, he is started on a medication that generates endothelial nitric oxide. Which of the following is a downstream effect of this molecule?? {'A': 'Guanylyl cyclase activation', 'B': 'cAMP production', 'C': 'Prostaglandin synthesis inhibition', 'D': 'ß1-adrenergic antagonism', 'E': 'L-type calcium channel inhibition'},
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A: Guanylyl cyclase activation
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Answer the following medical question with one of the provided options:
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Q:A 3-year-old male is brought by his mother to the pediatrician because she is concerned about a lump in his neck. She reports that the child was recently ill with a cough, nasal congestion, and rhinorrhea. She also noticed that a small red lump developed on the patient’s neck while he was sick. Although his cough and congestion subsided after a few days, the neck lump has persisted. The child has no notable past medical history. He was born at 39 weeks gestation and is in the 55th percentiles for both height and weight. His temperature is 98.6°F (37°C), blood pressure is 105/65 mmHg, pulse is 90/min, and respirations are 18/min. Physical examination reveals a small, soft, rounded mass at the midline of the neck inferior to the hyoid bone. The mass is warm and tender to palpation. It moves superiorly when the patient drinks water. Histologic examination of this lesion would most likely reveal which of the following?? {'A': 'Follicular cells surrounding colloid and admixed with a neutrophilic infiltrate', 'B': 'Cyst-like structure lined by stratified squamous epithelium and containing mucoid material', 'C': 'Randomly oriented papillae with fibrovascular cores and empty-appearing nuclei', 'D': 'Diffuse hyperplasia and hypertrophy of follicular cells', 'E': 'Stratified squamous epithelium associated with hair follicles and sebaceous glands'},
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A: Follicular cells surrounding colloid and admixed with a neutrophilic infiltrate
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Q:A 50-year-old woman presents to the outpatient clinic because of a swollen and enlarged right breast. Clinical examination shows no evidence of mass or axillary lymphadenopathy. There is no history of trauma or inflammation. Her past medical and surgical history is positive for breast augmentation with a textured implant 15 years ago. Magnetic resonance imaging (MRI) shows an accumulation of fluid around the right breast implant with intact implant integrity. Which of the following is the most appropriate next step in the management?? {'A': 'Mastectomy', 'B': 'Surgical replacement of textured implant with a smooth implant', 'C': 'Mammogram', 'D': 'Cytological analysis for CD30 and ALK', 'E': 'Chemotherapy'},
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D: Cytological analysis for CD30 and ALK
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Answer the following medical question with one of the provided options:
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Q:A 48-year-old man presents to his primary care physician with diarrhea and weight loss. He states he has had diarrhea for the past several months that has been worsening steadily. The patient recently went on a camping trip and drank unfiltered stream water. Otherwise, the patient endorses a warm and flushed feeling in his face that occurs sporadically. His temperature is 97.2°F (36.2°C), blood pressure is 137/68 mmHg, pulse is 110/min, respirations are 14/min, and oxygen saturation is 98% on room air. Physical exam is notable for a murmur heard best over the left lower sternal border and bilateral wheezing on pulmonary exam. Which of the following is the best initial step in management?? {'A': 'Echocardiography', 'B': 'Plasma free metanephrine levels', 'C': 'Pulmonary function tests', 'D': 'Stool culture and ova and parasite analysis', 'E': 'Urinary 5-hydroxyindoleacetic acid level'},
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E: Urinary 5-hydroxyindoleacetic acid level
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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 presents to the emergency department after a motor vehicle accident. He was the unrestrained front seat driver in a head on collision. The patient is unresponsive and his medical history is unknown. His temperature is 99.5°F (37.5°C), blood pressure is 67/38 mmHg, pulse is 190/min, respirations are 33/min, and oxygen saturation is 98% on room air. The patient is started on IV fluids, blood products, and norepinephrine. A FAST exam is performed and a pelvic binder is placed. One hour later, his temperature is 98.3°F (36.8°C), blood pressure is 119/66 mmHg, pulse is 110/min, respirations are 15/min, and oxygen saturation is 97% on room air. The patient is currently responsive. Management of the patient's pelvic fracture is scheduled by the orthopedic service. While the patient is waiting in the emergency department he suddenly complains of feeling hot, aches, and a headache. The patient's temperature is currently 101°F (38.3°C). He has not been given any pain medications and his past medical history is still unknown. Which of the following is the most likely diagnosis?? {'A': 'Acute hemolytic transfusion reaction', 'B': 'Febrile non-hemolytic transfusion reaction', 'C': 'Leukoagglutination reaction', 'D': 'Minor blood group incompatibility', 'E': 'Sympathetic response to pain'},
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B: Febrile non-hemolytic transfusion reaction
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Answer the following medical question with one of the provided options:
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Q:A newborn is rushed to the neonatal ICU after becoming cyanotic shortly after birth. An ultrasound is performed which shows the aorta coming off the right ventricle and lying anterior to the pulmonary artery. The newborn is given prostaglandin E1 and surgery is planned to correct the anatomic defect. Which of the following developmental processes failed to occur in the newborn?? {'A': 'Failure of the septum primum to fuse with the septum secundum', 'B': 'Failure of the membranous ventricular septum to fuse with the muscular interventricular septum', 'C': 'Failure of the ductus arteriosus to close', 'D': 'Failure of the ductus venosus to close', 'E': 'Failure of the aorticopulmonary septum to spiral'},
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E: Failure of the aorticopulmonary septum to spiral
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Answer the following medical question with one of the provided options:
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Q:A 48-year-old woman underwent a thyroidectomy with central neck dissection due to papillary thyroid carcinoma. On day 2 postoperatively, she developed irritability, dysphagia, difficulty breathing, and spasms in different muscle groups in her upper and lower extremities. The vital signs include blood pressure 102/65 mm Hg, heart rate 93/min, respiratory rate 17/min, and temperature 36.1℃ (97.0℉). Physical examination shows several petechiae on her forearms, muscle twitching in her upper and lower extremities, expiratory wheezes on lung auscultation, decreased S1 and S2 and the presence of an S3 on cardiac auscultation, and positive Trousseau and Chvostek signs. Laboratory studies show: Ca2+ 4.4 mg/dL Mg2+ 1.7 mEq/L Na+ 140 mEq/L K+ 4.3 mEq/L Cl- 107 mEq/L HCO3- 25 mEq/L Administration of which of the following agents could prevent the patient’s condition?? {'A': 'Anticonvulsants prior to and for 1 week after the operation', 'B': 'Magnesium sulfate intraoperatively', 'C': 'Vitamin D and ionic calcium prior to and 2 weeks after the operation', 'D': 'Calcium gluconate intraoperatively', 'E': 'Potassium supplementation prior to and 2 weeks after the operation'},
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C: Vitamin D and ionic calcium prior to and 2 weeks after the operation
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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 presents with sudden-onset severe eye pain and blurred vision. He says the symptoms onset an hour ago and his vision has progressively worsened. Physical examination reveals a cloudy cornea and decreased visual acuity. Timolol is administered into the eyes to treat this patient’s symptoms. Which of the following best describes the mechanism of action of this drug in the treatment of this patient’s condition?? {'A': 'Increased outflow via dilatation of the uveoscleral veins', 'B': 'It suppresses the ciliary epithelium from producing aqueous humor', 'C': 'It increases the transit of aqueous humor into the vitreous humor for absorption into the choroid', 'D': 'It leads to opening of the trabecular meshwork', 'E': 'It decreases the production of aqueous humor by decreasing levels of bicarbonate through a cAMP-mediated pathway'},
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B: It suppresses the ciliary epithelium from producing aqueous humor
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Q:Four days after undergoing a craniotomy and evacuation of a subdural hematoma, a 56-year-old man has severe pain and swelling of his right leg. He has chills and nausea. He has type 2 diabetes mellitus and chronic kidney disease, and was started on hemodialysis 2 years ago. Prior to admission, his medications were insulin, enalapril, atorvastatin, and sevelamer. His temperature is 38.3°C (101°F), pulse is 110/min, and blood pressure is 130/80 mm Hg. Examination shows a swollen, warm, and erythematous right calf. Dorsiflexion of the right foot causes severe pain in the right calf. The peripheral pulses are palpated bilaterally. Cardiopulmonary examination shows no abnormalities. Laboratory studies show: Hemoglobin 10.1 g/dL Leukocyte count 11,800/mm3 Platelet count 230,000/mm3 Serum Glucose 87 mg/dL Creatinine 1.9 mg/dL Which of the following is the most appropriate next step in treatment?"? {'A': 'Iliac stenting', 'B': 'Unfractionated heparin therapy', 'C': 'Inferior vena cava filter', 'D': 'Urokinase therapy', 'E': 'Warfarin therapy\n"'},
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C: Inferior vena cava filter
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Q:A 10-year-old boy is presented to the hospital for a kidney transplant. In the operating room, the surgeon connects an allograft kidney renal artery to the aorta, and after a few moments, the kidney becomes cyanotic, edematous, and dusky with mottling. Which of the following in the recipient’s serum is responsible for this rejection?? {'A': 'IgA', 'B': 'IgG', 'C': 'CD8+ T cells', 'D': 'CD4+ T cells', 'E': 'Macrophages'},
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B: IgG
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Answer the following medical question with one of the provided options:
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Q:Background: Beta-blockers reduce mortality in patients who have chronic heart failure, systolic dysfunction, and are on background treatment with diuretics and angiotensin-converting enzyme inhibitors. We aimed to compare the effects of carvedilol and metoprolol on clinical outcome. Methods: In a multicenter, double-blind, and randomized parallel group trial, we assigned 1,511 patients with chronic heart failure to treatment with carvedilol (target dose 25 mg twice daily) and 1,518 to metoprolol (metoprolol tartrate, target dose 50 mg twice daily). Patients were required to have chronic heart failure (NYHA II-IV), previous admission for a cardiovascular reason, an ejection fraction of less than 0.35, and to have been treated optimally with diuretics and angiotensin-converting enzyme inhibitors unless not tolerated. The primary endpoints were all-cause mortality, the composite endpoint of all-cause mortality, or all-cause admission. Analysis was done by intention to treat Findings: The mean study duration was 58 months (SD 6). The mean ejection fraction was 0.26 (0.07) and the mean age was 62 years (11). The all-cause mortality was 34% (512 of 1,511) for carvedilol and 40% (600 of 1,518) for metoprolol (hazard ratio 0.83 [95% CI 0.74-0.93], p = 0.0017). The reduction of all-cause mortality was consistent across predefined subgroups. Incidence of side effects and drug withdrawals did not differ by much between the 2 study groups. Which of the following represents the number of patients needed to treat to save one life?? {'A': '1/(0.40 - 0.34)', 'B': '1/(0.34 - 0.40)', 'C': '1/(40 - 34)', 'D': '1/(34 - 40)', 'E': '1/0.83'},
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A: 1/(0.40 - 0.34)
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Q:A 52-year-old man who was recently hospitalized with a pulmonary embolism is put on an unfractionated heparin drip as a bridge to chronic warfarin therapy. During morning rounds, he is found to have diffuse bruising despite minimal trauma, and his heparin infusion rate is found to be faster than prescribed. A coagulation panel is obtained, which shows a aPTT of 130 seconds (therapeutic 70-120 seconds), and the decision is made to reverse the effects of heparin. Which of the following would most likely be administered in order to do this?? {'A': 'Aminocaproic acid', 'B': 'Fresh frozen plasma', 'C': 'Platelets', 'D': 'Protamine sulfate', 'E': 'Vitamin K'},
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D: Protamine sulfate
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Q:A new formula for an anti-wrinkle cream is being tested for efficacy in a group of 362 healthy 40- to 60-year-old female volunteers. The marketing team randomizes the volunteers. Half receive the new formula and the other half of the volunteers receive the original formula. The mean age in the test group is 48 (95% CI 42-56), and the average age of the control group is 49 (95% CI 42-55). The volunteers are unaware of which formula they receive. The research and development team then compares before and after photographs of the volunteers following 6 weeks of at home application twice daily. For simplicity, the marketing team labels the photographs with "new formula" or "original formula." 98% of volunteers in the test group complete the study, and 97% of volunteers in the control group complete the study. The researchers conclude that there is improved wrinkle reduction with 6 weeks of use of the new formula. Which of the following potential biases most likely impacted this conclusion?? {'A': 'Selection bias', 'B': 'Hawthorn effect', 'C': 'Observer bias', 'D': 'Procedure bias', 'E': 'Recall bias'},
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C: Observer bias
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Q:A 49-year-old woman comes to the physician because of a 1-year history of bloating and constipation alternating with diarrhea. She eats a balanced diet, and there are no associations between her symptoms and specific foods. She had been a competitive swimmer since high school but stopped going to training 4 months ago because her fingers hurt and turned blue as soon as she got into the cold water. She drinks one to two glasses of wine daily. Physical examination shows swollen hands and fingers with wax-like thickening of the skin. There are numerous small, superficial, dilated blood vessels at the tips of the fingers. The abdomen is distended and mildly tender with no guarding or rebound. Further evaluation is most likely to show which of the following findings?? {'A': 'Bilateral pupillary constriction', 'B': 'Outpouchings of the sigmoid colon', 'C': 'Villous atrophy in the duodenum', 'D': 'Periumbilical dilation of subcutaneous veins', 'E': 'Calcium deposits in the skin'},
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E: Calcium deposits in the skin
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Q:A 20-year-old woman is brought to the emergency department because of severe muscle soreness, nausea, and darkened urine for 2 days. The patient is on the college track team and has been training intensively for an upcoming event. One month ago, she had a urinary tract infection and was treated with nitrofurantoin. She appears healthy. Her temperature is 37°C (98.6°F), pulse is 64/min, and blood pressure is 110/70 mm Hg. Cardiopulmonary examination shows no abnormalities. The abdomen is soft and non-tender. There is diffuse muscle tenderness over the arms, legs, and back. Laboratory studies show: Hemoglobin 12.8 g/dL Leukocyte count 7,000/mm3 Platelet count 265,000/mm3 Serum Creatine kinase 22,000 U/L Lactate dehydrogenase 380 U/L Urine Blood 3+ Protein 1+ RBC negative WBC 1–2/hpf This patient is at increased risk for which of the following complications?"? {'A': 'Acute kidney injury', 'B': 'Compartment syndrome', 'C': 'Metabolic alkalosis', 'D': 'Myocarditis', 'E': 'Hemolytic anemia'},
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A: Acute kidney injury
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Q:A 56-year-old man presents for a follow-up regarding his management for type 2 diabetes mellitus (DM). He was diagnosed with type 2 DM about 7 years ago and was recently started on insulin therapy because oral agents were insufficient to control his glucose levels. He is currently following a regimen combining insulin lispro and neutral protamine Hagedorn (NPH) insulin. He is taking insulin lispro 3 times a day before meals and NPH insulin once in the morning. He has been on this regimen for about 2 months. He says that his glucose reading at night averages around 200 mg/dL and remains close to 180 mg/dL before his shot of NPH in the morning. The readings during the rest of the day range between 100–120 mg/dL. The patient denies any changes in vision or tingling or numbness in his hands or feet. His latest HbA1C level was 6.2%. Which of the following adjustments to his insulin regimen would be most effective in helping this patient achieve better glycemic control?? {'A': 'Add another dose of insulin lispro in the evening.', 'B': 'Add another dose of NPH in the evening.', 'C': 'Add insulin glargine to the current regime.', 'D': 'Replace lispro with insulin aspart.', 'E': 'Reduce a dose of insulin lispro.'},
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B: Add another dose of NPH in the evening.
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Q:A 17-year-old high school student presents to the physician’s office for a health maintenance examination. He is a recent immigrant from Venezuela and has no complaints at this time. Past medical history is significant for appendicitis at age 10, treated with an appendectomy. He denies the use of alcohol and cigarettes. He admits to occasionally smoking marijuana with his friends. He is sexually active with 1 woman partner and uses condoms inconsistently. The vital signs are within normal limits. Physical examination is unremarkable except for a laparoscopic surgical scar on the right iliac region. Routine blood tests are pending. What is the most appropriate next step in management?? {'A': 'Ceftriaxone and azithromycin as prophylaxis', 'B': 'Azithromycin as prophylaxis only', 'C': 'HPV vaccine', 'D': 'HPV vaccine as a legal adult at age 18', 'E': 'Urine toxicology'},
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C: HPV vaccine
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Q:A group of researchers aimed to study the association between phosphate levels in plasma and renal function decline in pre-dialysis patients. The study started in 2018 by including incident pre-dialysis patients (with chronic kidney disease in stage IV or V) who were already included in pre-dialysis care procedures between 2014 and 2016. These patients were subsequently found in the records of the hospitals participating in the study, and patient files were used to note the laboratory measurements at baseline. The medical courses of those patients were then followed through the medical charts (most notably their decline in renal function) until the start of dialysis, their death, or January 1, 2018. From this data, the researchers calculated that faster declines in renal function were linked to higher phosphate levels at baseline. Moreover, a relative risk for dying (1.5-fold) could be calculated for every mg/dL increase in phosphate levels. Hence, a high plasma phosphate level was shown to be an independent risk factor for not only a more rapid decline in renal function but also for higher mortality rates during the pre-dialysis phase. What is the main limitation of this type of observational study approach?? {'A': 'Significant time commitment', 'B': 'Hypotheses generation', 'C': 'Selection based on the exposure status', 'D': 'Inability to control for specific factors', 'E': 'Lack of inter-rater reliability'},
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D: Inability to control for specific factors
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Q:A 56-year-old man comes to the office complaining of a dry cough for 2 months. His medical history includes a recent myocardial infarction (MI), after which he was placed on several medications. He is currently on ramipril, clopidogrel, digoxin, lovastatin, and nitroglycerin. He does not smoke cigarettes and does not drink alcohol. He denies a history of bronchial asthma. Examination of the chest is within normal limits. Which of the following medications may have caused his symptom?? {'A': 'Ramipril', 'B': 'Clopidogrel', 'C': 'Nitroglycerin', 'D': 'Lovastatin', 'E': 'Digoxin'},
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A: Ramipril
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Q:An investigator is studying the effect of extracellular pH changes on the substrates for the citric acid cycle. Which of the following substances is required for the reaction catalyzed by the enzyme marked by the arrow in the overview of the citric acid cycle?? {'A': 'Thiamine', 'B': 'Pantothenic acid', 'C': 'Lipoic acid', 'D': 'Niacin', 'E': 'Riboflavin'},
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B: Pantothenic acid
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Q:A 60-year-old woman and her son are visited at her home by a health aid. He is her caregiver but has difficulty getting her out of the house. Her son is concerned about continuous and repetitive mouth and tongue movements that started about 2 weeks ago and have become more evident ever since. She is non-verbal at baseline and can complete most activities of daily living. She suffers from an unspecified psychiatric disorder. Her medications include fluphenazine. Today, her heart rate is 90/min, respiratory rate is 17/min, blood pressure is 125/87 mm Hg, and temperature is 37.0°C (98.6°F). On physical exam, she appears gaunt and anxious. She is drooling and her mouth is making a chewing motion that is occasionally disrupted by wagging her tongue back and forth. She seems to be performing these motions absentmindedly. Her heart has a regular rate and rhythm and her lungs are clear to auscultation bilaterally. CMP, CBC, and TSH are normal. A urine toxicology test is negative. What is the next best step in her management?? {'A': 'Start clozapine', 'B': 'Switch to chlorpromazine', 'C': 'Reduce the dosage', 'D': 'Expectant management', 'E': 'Stop the medication'},
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E: Stop the medication
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Q:A 52-year-old woman presents to her primary care physician complaining of 3 weeks of persistent thirst despite consumption of increased quantities of water. She also admits that she has had increased frequency of urination during the same time period. A basic metabolic panel is performed which reveals mild hypernatremia and a normal glucose level. Urine electrolytes are then obtained which shows a very low urine osmolality that does not correct when a water deprivation test is performed. Blood tests reveal an undetectable level of antidiuretic hormone (ADH). Based on this information, what is the most likely cause of this patient's symptoms?? {'A': 'Primary polydipsia', 'B': 'Diabetes mellitus', 'C': 'Nephrogenic diabetes insipidus', 'D': 'Central diabetes insipidus', 'E': 'Surreptitious diuretic use'},
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D: Central diabetes insipidus
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Q:A 19-year-old woman with no known past medical history presents to the emergency department with increasing lower pelvic pain and vaginal discharge over the last several days. She endorses some experimentation with marijuana and cocaine, drinks liquor almost daily, and smokes 2 packs of cigarettes per day. The patient's blood pressure is 84/66 mm Hg, pulse is 121/min, respiratory rate is 16/min, and temperature is 39.5°C (103.1°F). Physical examination reveals profuse yellow-green vaginal discharge and severe cervical motion tenderness. What is the most appropriate definitive treatment for this patient’s presumed diagnosis?? {'A': 'Levofloxacin and metronidazole × 14 days', 'B': 'Single-dose ceftriaxone IM', 'C': 'Exploratory laparotomy', 'D': 'Cefoxitin × 14 days', 'E': 'Clindamycin + gentamicin × 14 days'},
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C: Exploratory laparotomy
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Q:A 5-year-old boy presents to your office with his mother. The boy has been complaining of a sore throat and headache for the past 2 days. His mother states that he had a fever of 39.3°C (102.7°F) and had difficulty eating. On examination, the patient has cervical lymphadenopathy and erythematous tonsils with exudates. A streptococcal rapid antigen detection test is negative. Which of the following is the most likely causative agent?? {'A': 'A gram-negative, pleomorphic, obligate intracellular bacteria', 'B': 'A naked, double-stranded DNA virus', 'C': 'A gram-positive, beta-hemolytic cocci in chains', 'D': 'An enveloped, single-stranded, negative sense RNA virus', 'E': 'An enveloped, double-stranded DNA virus'},
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B: A naked, double-stranded DNA virus
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Q:A 57-year-old man presents to his family physician for a checkup. He has had type 2 diabetes mellitus for 13 years, for which he has been taking metformin and vildagliptin. He has smoked 10–15 cigarettes daily for 29 years. Family history is irrelevant. Vital signs include: temperature 36.6°C (97.8°F), blood pressure 152/87 mm Hg and pulse 88/min. Examination reveals moderate abdominal obesity with a body mass index of 32 kg/m². The remainder of the examination is unremarkable. His fasting lipid profile is shown: Total cholesterol (TC) 280 mg/dL Low-density lipoprotein (LDL)-cholesterol 210 mg/dL High-density lipoprotein (HDL)-cholesterol 40 mg/dL Triglycerides (TGs) 230 mg/dL Which of the following is the mechanism of action of the best initial therapy for this patient?? {'A': 'Inhibition of cholesterol absorption', 'B': 'Bile acid sequestration', 'C': 'Inhibition of adipose tissue lipolysis', 'D': 'Inhibition of cholesterol synthesis', 'E': 'Activation of PPAR-alpha'},
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D: Inhibition of cholesterol synthesis
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Q:A 69-year-old man comes to the physician with a 2-year history of progressive hearing loss. His hearing is worse in crowded rooms, and he has noticed that he has more difficulty understanding women than men. He has no history of serious illness and does not take any medications. A Rinne test shows air conduction is greater than bone conduction bilaterally. This condition is most likely associated with damage closest to which of the following structures?? {'A': 'External acoustic meatus', 'B': 'Tympanic membrane', 'C': 'Basal turn of the cochlea', 'D': 'Round window', 'E': 'Base of the stapes'},
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C: Basal turn of the cochlea
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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 growth of an organism in different media. The organism is inoculated on a petri dish that contains heated sheep blood, vancomycin, nystatin, trimethoprim, and colistin. The resulting growth medium is incubated at 37°C. Numerous small, white colonies are seen after incubation for 48 hours. This organism is most likely to cause which of the following conditions?? {'A': 'Pseudomembranous colitis', 'B': 'Pontiac fever', 'C': 'Hemolytic uremic syndrome', 'D': 'Oral thrush', 'E': 'Gonorrhea'},
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E: Gonorrhea
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Q:The parents of a 4-year-old present to the pediatrician because they are concerned about the poor growth and odd behavior of their son. Their son has been at the 10th percentile for growth since birth and they have noticed that his skin seems to have a bluish hue to it whenever he cries or is agitated. Recently, they have noticed that when he squats it seems to relieve these symptoms. What was the embryologic cause of this patient's current symptoms?? {'A': 'Failure of the aorticopulmonary septum to spiral', 'B': 'Failure of the ductus arteriosus to obliterate', 'C': 'Partial aorticopulmonary septum development', 'D': 'Failure of septum primum and septum secundum to fuse', 'E': 'Anterosuperior displacement of aorticopulmonary septum'},
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E: Anterosuperior displacement of aorticopulmonary septum
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Q:A 5-year-old boy is brought to the physician because of early morning headaches for the past 6 months. During this period, he has had severe nausea and occasional episodes of vomiting. For the past month, he has had difficulty walking and intermittent double vision. He was born at term and has been healthy apart from an episode of sinusitis 8 months ago that resolved spontaneously. He is at the 60th percentile for height and 50th percentile for weight. His temperature is 37.1°C (98.8°F), pulse is 80/min, and blood pressure is 105/64 mm Hg. Examination shows normal muscle strength and 2+ deep tendon reflexes bilaterally. He has a broad-based gait and impaired tandem gait. Fundoscopy shows bilateral swelling of the optic disc. There is esotropia of the left eye. Which of the following is the most likely diagnosis?? {'A': 'Optic glioma', 'B': 'Schwannoma', 'C': 'Hemangioblastoma', 'D': 'Meningioma', 'E': 'Medulloblastoma\n"'},
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E: Medulloblastoma "
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Answer the following medical question with one of the provided options:
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Q:An 82-year-old male visits his primary care physician for a check-up. He reports that he is in his usual state of health. His only new complaint is that he feels as if the room is spinning, which has affected his ability to live independently. He is currently on lisinopril, metformin, aspirin, warfarin, metoprolol, and simvastatin and says that he has been taking them as prescribed. On presentation, his temperature is 98.8°F (37°C), blood pressure is 150/93 mmHg, pulse is 82/min, and respirations are 12/min. On exam he has a left facial droop and his speech is slightly garbled. Eye exam reveals nystagmus with certain characteristics. The type of nystagmus seen in this patient would most likely also be seen in which of the following diseases?? {'A': 'Aminoglycoside toxicity', 'B': 'Benign paroxysmal positional vertigo', 'C': 'Meniere disease', 'D': 'Multiple sclerosis', 'E': 'Vestibular neuritis'},
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D: Multiple sclerosis
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Q:A 56-year-old man comes to the physician because of a painless blistering rash on his hands, forearms, and face for 2 weeks. The rash is not itchy and seems to get worse in the sunlight. He has also noticed that his urine is darker than usual. His aunt and sister have a history of similar skin lesions. Examination of the skin shows multiple fluid-filled blisters and oozing erosions on the forearms, dorsal side of both hands, and forehead. There are areas of hyperpigmented scarring and patches of bald skin along the sides of the blisters. Which of the following is the most appropriate pharmacotherapy to treat this patient's condition?? {'A': 'Hemin', 'B': 'Prednisone', 'C': 'Fexofenadine', 'D': 'Acyclovir', 'E': 'Hydroxychloroquine'},
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E: Hydroxychloroquine
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Answer the following medical question with one of the provided options:
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Q:A 34-year-old man presents with a 2-day history of loose stools, anorexia, malaise, and abdominal pain. He describes the pain as moderate, cramping in character, and diffusely localized to the periumbilical region. His past medical history is unremarkable. He works as a wildlife photographer and, 1 week ago, he was in the Yucatan peninsula capturing the flora and fauna for a magazine. The vital signs include blood pressure 120/60 mm Hg, heart rate 90/min, respiratory rate 18/min, and body temperature 38.0°C (100.4°F). Physical examination is unremarkable. Which of the following is a characteristic of the microorganism most likely responsible for this patient’s symptoms?? {'A': 'Production of lecithinase', 'B': 'Inactivation of the 60S ribosomal subunit', 'C': 'Presynaptic vesicle dysregulation', 'D': 'Overactivation of guanylate cyclase', 'E': 'Disabling Gi alpha subunit'},
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D: Overactivation of guanylate cyclase
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Q:A young Caucasian couple in their late twenties present for an infertility evaluation after trying to conceive over 2 years. On physical exam, the female appears healthy and states that she has regular menstrual cycles. The male partner is noted to have long extremities with wide hips, low muscle mass, gynecomastia, sparse facial or chest hair, and small, firm testes. Laboratory tests of the male partner reveal elevated serum LH and FSH and low testosterone levels. If cytogenetic tests were performed, which of the following would be seen in this male?? {'A': 'Presence of a barr body', 'B': 'Absence of a barr body', 'C': 'Absence of a second sex chromosome', 'D': 'Trisomy of chromosome 13', 'E': 'Trisomy of chromosome 18'},
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A: Presence of a barr body
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Q:A 21-year-old female presents to the family physician with 3 weeks of headaches, sweating, and palpitations. Her BP was 160/125 mmHg, and a 24-hour urine test revealed elevated vanillylmandelic acid (VMA) and normetanephrine. Past medical history is notable for bilateral retinal hemangioblastomas, and family history is significant for three generations (patient, mother, and maternal grandfather) with similar symptoms. Genetic analysis revealed a mutation of a gene on chromosome 3p. Which of the following is the patient at risk of developing?? {'A': 'Clear cell renal cell carcinoma', 'B': 'Retinoblastoma', 'C': 'Osteosarcoma', 'D': 'Breast cancer', 'E': 'Ovarian cancer'},
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A: Clear cell renal cell carcinoma
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Q:A 25-year-old female presents to a physician's office with complaints of having no energy for the last 2 weeks and sometimes feeling like staying home all day. She works for a technology start-up company and is attending graduate school part-time in the evening. She is very concerned about her health and tries to eat a balanced diet. She runs daily and takes yoga classes 3 times a week. She gets together with her friends every weekend and has continued to do so the last few weeks. Her schedule is quite hectic, and she is always on the go. There have been no changes in her sleep, appetite, or daily routine. She denies having flu-like symptoms, headaches, body aches, indigestion, weight loss, agitation, or restlessness. She admits to moderate drinking and marijuana use but has never smoked cigarettes. The medical history is unremarkable, and she takes no medications other than vitamin C for cold prevention. A friend suggested she take an herbal product containing ginseng and St. John's wort for her decreased energy levels. Her body mass index (BMI) is 22 kg/m2. The physical examination reveals no findings and lab testing shows the following: Sodium 138 mEq/L Potassium 3.9 mEq/L Chloride 101 mEq/L Thyroid stimulating hormone 3.5 μU/mL Hemoglobin (Hb%) 13.5 g/dL Mean corpuscular hemoglobin (MCH) 31 pg Mean corpuscular volume (MCV) 85 fL Leucocyte count 5000/mm3 Platelet count 250,000/mm3 The physician advises her to reduce the alcohol consumption and marijuana use. What else should she be advised?? {'A': "She should not take St. John's wort because of potential drug interactions with antidepressants.", 'B': 'She should start with the herbal product and return if her energy level does not improve in 2 weeks.', 'C': 'She should increase her diet so that she has more energy to go about her day.', 'D': 'She is likely over-exerted and taking the herbal supplements has no proven medical benefit.', 'E': 'She is taking excessive vitamin C and it is causing her low energy levels.'},
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D: She is likely over-exerted and taking the herbal supplements has no proven medical benefit.
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Answer the following medical question with one of the provided options:
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Q:A 40-year-old man is brought to the emergency department by police officers due to inappropriate public behavior. He was at a pharmacy demanding to speak with the manager so he could discuss a business deal. Two weeks ago, he left his wife of 10 years and moved from another city in order to pursue his dreams of being an entrepreneur. He has not slept for more than 3-4 hours a night in the last 2 weeks. He has a history of bipolar disorder and diabetes. He has been hospitalized three times in the last year for mood instability. Current medications include lithium and insulin. Mental status examination shows accelerated speech with flight of ideas. His serum creatinine concentration is 2.5 mg/dL. Which of the following is the most appropriate next step in management with respect to his behavior?? {'A': 'Carbamazepine only', 'B': 'Clozapine only', 'C': 'Lithium and valproic acid', 'D': 'Valproic acid and quetiapine', 'E': 'Lithium and olanzapine'},
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D: Valproic acid and quetiapine
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Q:A 37-year-old woman undergoes diagnostic laparoscopy under general anesthesia for evaluation of chronic pelvic pain. Postoperatively, the patient requires prolonged intubation. Neostigmine is administered. Results of acceleromyography during train-of-four ulnar nerve stimulation are shown. Which of the following drugs is most likely to have been used preoperatively in this patient?? {'A': 'Clonazepam', 'B': 'Ropivacaine', 'C': 'Rocuronium', 'D': 'Tizanidine', 'E': 'Succinylcholine'},
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E: Succinylcholine
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Q:A 45-year-old woman is found to have multiple masses in her liver while performing abdominal ultrasonography for recurrent right upper quadrant abdominal pain. Biopsy of one of the masses discloses large plates of adenoma cells, which are larger than normal hepatocytes and contain glycogen and lipid. Regular septa, portal tracts, and bile ductules are absent. Which of the following is associated with this patient's condition?? {'A': 'Polyvinyl chloride', 'B': 'Carbon tetrachloride', 'C': 'Aflatoxin', 'D': 'Oral contraceptive pills', 'E': 'Smoking'},
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D: Oral contraceptive pills
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Answer the following medical question with one of the provided options:
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Q:An investigator is following a 4-year-old boy with Duchenne muscular dystrophy. Western blot of skeletal muscle cells from this boy shows that the dystrophin protein is significantly smaller compared to the dystrophin protein of a healthy subject. Further evaluation shows that the boy's genetic mutation involves a sequence that normally encodes leucine. The corresponding mRNA codon has the sequence UUG. Which of the following codons is most likely present in this patient at the same position of the mRNA sequence?? {'A': 'GUG', 'B': 'AUG', 'C': 'UAG', 'D': 'UUU', 'E': 'UCG'},
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C: UAG
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Answer the following medical question with one of the provided options:
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Q:A 31-year-old woman gives birth to a boy in the labor and delivery ward of the local hospital. The child is immediately assessed and found to be crying vigorously. He is pink in appearance with blue extremities that appear to be flexed. Inducing some discomfort shows that both his arms and legs move slightly but remain largely flexed throughout. His pulse is found to be 128 beats per minute. What is the most likely APGAR score for this newborn at this time?? {'A': '5', 'B': '6', 'C': '7', 'D': '8', 'E': '9'},
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C: 7
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Q:A 68-year-old man comes to his physician because of fatigue, night sweats, chills, and a 5-kg (11-lb) weight loss during the past 3 weeks. Eight years ago, he was treated for a hematological malignancy after biopsy of a neck swelling showed CD15+ and CD30+ cells. Physical examination shows conjunctival pallor and scattered petechiae. A peripheral blood smear is shown. Which of the following is the most likely explanation for this patient's current condition?? {'A': 'Accelerated phase of chronic myeloid leukemia', 'B': 'Leukemic transformation of T-cell lymphoma', 'C': 'Richter transformation of small lymphocytic lymphoma', 'D': 'Leukemic transformation of myelodysplastic syndrome', 'E': 'Radiation-induced myeloid leukemia'},
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E: Radiation-induced myeloid leukemia
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Q:A 45-year-old male presents to his primary care doctor complaining of abdominal pain. He reports a three-month history of intermittent burning pain localized to the epigastrium that worsens 2-3 hours after a meal. He attributes this pain to increased stress at his job. He is otherwise healthy and takes no medications. He does not smoke or drink alcohol. His temperature is 98.8°F (37.1°C), blood pressure is 130/85 mmHg, pulse is 90/min, and respirations are 18/min. Physical examination reveals mild epigastric tenderness to palpation. A urease breath test is positive. Which of the following treatments is most appropriate first-line therapy for this patient?? {'A': 'Octreotide', 'B': 'Sulfasalazine', 'C': 'Pantoprazole', 'D': 'Amoxicillin, clarithromycin, and omeprazole', 'E': 'Tetracycline, omeprazole, bismuth, and metronidazole'},
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D: Amoxicillin, clarithromycin, and omeprazole
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Q:A previously healthy 23-year-old woman comes to the physician because of a 1-week history of vaginal discharge. She has no pain or pruritus. She is sexually active with one male partner and uses condoms inconsistently. Pelvic examination shows a malodorous gray vaginal discharge. Microscopic examination of the vaginal discharge is shown. Which of the following is the most likely diagnosis?? {'A': 'Bacterial vaginosis', 'B': 'Chlamydia', 'C': 'Gonorrhea', 'D': 'Syphilis', 'E': 'Vaginal candidiasis'},
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A: Bacterial vaginosis
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Q:A 27-year-old man presents to the emergency department after he was assaulted and shot during a robbery. The patient was beaten with a baseball bat and has a bullet entry wound in his neck. He is currently complaining of diffuse pains but is able to speak. His voice sounds muffled, and he is requesting pain medications. An initial resuscitation is begun in the trauma bay. The patient's general appearance reveals ecchymosis throughout his body and minor scrapes and cuts, and possible multiple facial bone fractures. There is another bullet wound found in the left side of his back without an exit wound. Which of the following is the best next step in management?? {'A': 'Administration of 100% oxygen', 'B': 'Cricothyroidotomy', 'C': 'Laryngeal mask', 'D': 'Nasotracheal intubation', 'E': 'Orotracheal intubation'},
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E: Orotracheal intubation
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Answer the following medical question with one of the provided options:
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Q:A 42-year-old G3P3003 presents to her gynecologist for an annual visit. She complains of urinary incontinence when jogging since the birth of her last child three years ago. Her periods are regular every 30 days. The patient also has cramping that is worse before and during her period but always present at baseline. She describes a feeling of heaviness in her pelvis that is exacerbated by standing for several hours at her job as a cashier. The patient has had two spontaneous vaginal deliveries, one caesarean section, and currently uses condoms for contraception. She is obese and smokes a pack of cigarettes a day. Her mother died of breast cancer at age 69, and her aunt is undergoing treatment for endometrial cancer. The patient’s temperature is 98.6°F (37.0°C), pulse is 70/min, blood pressure is 142/81 mmHg, and respirations are 13/min. Pelvic exam is notable for a uterine fundus palpated just above the pubic symphysis and a boggy, smooth texture to the uterus. There is no tenderness or mass in the adnexa, and no uterosacral nodularity is noted. Which of the following is a classic pathological feature of this patient’s most likely diagnosis?? {'A': 'Presence of endometrial tissue outside of the uterus', 'B': 'Presence of endometrial tissue within the myometrium', 'C': 'Focal hyperplasia of the myometrium', 'D': 'Nuclear atypia of endometrial cells', 'E': 'No pathognomonic findings expected'},
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B: Presence of endometrial tissue within the myometrium
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Answer the following medical question with one of the provided options:
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Q:An 8-year-old girl is brought to the physician by her parents for a 10-month history of disturbing dreams and daytime sleepiness. She has difficulty falling asleep and says she sometimes sees ghosts just before falling asleep at night. She has had a 7-kg (15-lb) weight gain during this period despite no changes in appetite. She is alert and oriented, and neurologic examination is unremarkable. During physical examination, she spontaneously collapses after the physician drops a heavy book, producing a loud noise. She remains conscious after the collapse. Polysomnography with electroencephalogram is most likely to show which of the following?? {'A': 'Periodic sharp waves', 'B': 'Slow spike-wave pattern', 'C': 'Rapid onset of beta waves', 'D': 'Decreased delta wave sleep duration', 'E': 'Diffuse slowing of waves'},
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C: Rapid onset of beta waves
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Q:A 58-year-old woman presents to the office after receiving a bone mineral density screening test result with a T score of -4.1 and a Z score of -3.8. She is diagnosed with osteoporosis. A review of her medical history reveals that she has taken estrogen-containing oral contraceptive pills from the age of 20 to 30. She suffered from heartburn from the age of 45 and took lansoprazole and ranitidine often for her symptoms. She also was on lithium for 2 years after being diagnosed with bipolar disorder at the age of 54. Last year she was diagnosed with congestive heart failure and was started on low dose hydrochlorothiazide. Which of her medications most likely contributed to the development of her osteoporosis?? {'A': 'Lansoprazole', 'B': 'Hydrochlorothiazide', 'C': 'Ranitidine', 'D': 'Lithium', 'E': 'Estrogen'},
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A: Lansoprazole
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Q:A 27-year-old woman, gravida 3, para 2, at 41 weeks' gestation is admitted to the hospital in active labor. Her pregnancy has been uncomplicated. Both of her prior children were delivered by vaginal birth. She has a history of asthma. Current medications include iron and vitamin supplements. After a prolonged labor, she undergoes vaginal delivery. Shortly afterwards, she begins to have heavy vaginal bleeding with clots. Her temperature is 37.2°C (98.9°F), pulse is 90/min, respirations are 17/min, and blood pressure is 130/72 mm Hg. Examination shows a soft, enlarged, and boggy uterus on palpation. Laboratory studies show: Hemoglobin 10.8 g/dL Hematocrit 32.3% Leukocyte Count 9,000/mm3 Platelet Count 140,000/mm3 Prothrombin time 14 seconds Partial thromboplastin time 38 seconds Her bleeding continues despite bimanual uterine massage and administration of oxytocin. Which of the following is the most appropriate next step in management?"? {'A': 'Perform hysterectomy', 'B': 'Perform curettage', 'C': 'Administer carboprost tromethamine', 'D': 'Tranfuse blood', 'E': 'Administer tranexamic acid'},
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E: Administer tranexamic acid
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Answer the following medical question with one of the provided options:
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Q:A 2-year-old male is brought to his pediatrician by his mother because of abdominal pain and blood in the stool. Scintigraphy reveals uptake in the right lower quadrant of the abdomen. Persistence of which of the following structures is the most likely cause of this patient's symptoms?? {'A': 'Urachus', 'B': 'Omphalomesenteric duct', 'C': 'Paramesonephric duct', 'D': 'Allantois', 'E': 'Ureteric bud'},
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B: Omphalomesenteric duct
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Answer the following medical question with one of the provided options:
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Q:An otherwise healthy 25-year-old primigravid woman at 31 weeks' gestation comes to the physician with a 2-day history of epigastric pain and nausea that is worse at night. Three years ago, she was diagnosed with a peptic ulcer and was treated with a proton pump inhibitor and antibiotics. Medications include folic acid and a multivitamin. Her pulse is 92/min and blood pressure is 139/90 mm Hg. Pelvic examination shows a uterus consistent in size with a 31-week gestation. Laboratory studies show: Hemoglobin 8.2 g/dL Platelet count 87,000/mm3 Serum Total bilirubin 1.4 mg/dL Aspartate aminotransferase 75 U/L Lactate dehydrogenase 720 U/L Urine pH 6.1 Protein 2+ WBC negative Bacteria occasional Nitrites negative Which of the following best explains this patient's symptoms?"? {'A': 'Bacterial invasion of the renal parenchyma', 'B': 'Break in gastric mucosal continuity', 'C': 'Acute inflammation of the pancreas', 'D': 'Inflammation of the gallbladder', 'E': 'Stretching of Glisson capsule'},
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E: Stretching of Glisson capsule
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Answer the following medical question with one of the provided options:
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Q:A 6-day-old newborn is brought to the emergency department by his mother due to a high fever that started last night. His mother says that he was born via an uneventful vaginal delivery at home at 38 weeks gestation and was doing fine up until yesterday when he became disinterested in breastfeeding and spit up several times. His temperature is 39.5°C (103.1°F), pulse is 155/min, respirations are 45/min, and O2 sats are 92% on room air. He is lethargic and minimally responsive to stimuli. While on his back, his head is quickly lifted towards his chest which causes his legs to flex. The mother had only a few prenatal care visits and none at the end of the pregnancy. What is the most likely source of this patients infection?? {'A': 'Contaminated food', 'B': 'Tick bite', 'C': 'During birth', 'D': 'Mother’s roommate', 'E': 'Infection from surgery'},
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C: During birth
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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 is brought to the emergency department due to right-sided facial and upper extremity weakness and aphasia. The patient was in his usual state of health until two hours prior to presentation, when he was eating breakfast with a friend and acutely developed the aforementioned symptoms. Medical history is unremarkable except for mild palpitations that occur during times of stress or when drinking coffee. Physical examination is consistent with the clinical presentation. Laboratory testing is unremarkable and a 12-lead electrocardiogram is normal. A non-contrast head CT and diffusion-weighted MRI shows no intracranial hemorrhage and an isolated superficial cerebral infarction. Transthoracic echocardiography with agitated saline mixed with air shows microbubbles in the left heart. There is a possible minor effusion surrounding the heart and the ejection fraction is within normal limits. Which of the following is most likely the cause of this patient's clinical presentation?? {'A': 'Amyloid deposition within vessels', 'B': 'Aortic embolism', 'C': 'Berry aneurysm rupture', 'D': 'Cardiac arrhythmia', 'E': 'Patent foramen ovale'},
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E: Patent foramen ovale
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Answer the following medical question with one of the provided options:
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Q:A 24-year-old woman comes to the physician because of a 1-year history of intermittent episodes of shortness of breath, chest tightness, palpitation, dizziness, sweaty hands, and a feeling of impending doom. She says that her symptoms occur when she goes for a walk or waits in line for coffee. She reports that she no longer leaves the house by herself because she is afraid of being alone when her symptoms occur. She only goes out when her boyfriend accompanies her. She does not smoke or use illicit drugs. Within a few hours after each episode, physical examination and laboratory studies have shown no abnormalities. Which of the following is the most likely diagnosis?? {'A': 'Agoraphobia', 'B': 'Separation anxiety disorder', 'C': 'Panic disorder', 'D': 'Somatic symptom disorder', 'E': 'Generalized anxiety disorder'},
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A: Agoraphobia
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Answer the following medical question with one of the provided options:
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Q:A 20-year-old woman presents with chest pain for the last 20 minutes. She describes a ''squeezing'' sensation in the chest and can feel her heart ''racing''. Worried that she might be having a heart attack, she took aspirin before coming to the hospital. Five days ago, she says she had similar symptoms, but they resolved within 10 minutes. Her medical and family history is unremarkable. She denies any drug and alcohol use. Vital signs show a temperature of 37.0°C (98.6°F), a pulse of 110/min, a respiratory rate of 28/min, and blood pressure of 136/80 mm Hg. On physical examination, the patient appears fidgety and restless. An echocardiogram (ECG) shows sinus tachycardia but is otherwise normal. Which of the following is the next best step in treatment of this patient?? {'A': 'Alprazolam', 'B': 'Nitroglycerin', 'C': 'Propranolol', 'D': 'Buspirone', 'E': 'Sertraline'},
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A: Alprazolam
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Answer the following medical question with one of the provided options:
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Q:An 8-year-old boy is brought to the emergency department by his parents because of sudden onset of abdominal pain beginning an hour ago. The parents report that their son has also had an episode of dark urine earlier that morning. Three days ago, he was diagnosed with a urinary tract infection and was treated with trimethoprim-sulfamethoxazole. He emigrated from Liberia to the US with his family 3 years ago. There is no personal history of serious illness. His immunizations are up-to-date. Vital signs are within normal limits. Examination shows diffuse abdominal tenderness and scleral icterus. The spleen is palpated 1–2 cm below the left costal margin. Laboratory studies show: Hemoglobin 10 g/dL Mean corpuscular volume 90 μm3 Reticulocyte count 3% Serum Bilirubin Total 3 mg/dL Direct 0.5 mg/dL Haptoglobin 20 mg/dL (N=41–165 mg/dL) Lactate dehydrogenase 160 U/L Urine Blood 3+ Protein 1+ RBC 2–3/hpf WBC 2–3/hpf Which of the following is the most likely underlying cause of this patient's symptoms?"? {'A': 'Production of hemoglobin S', 'B': 'Cold agglutinins', 'C': 'Lead poisoning', 'D': 'Deficient glucose-6-phosphate dehydrogenase', 'E': 'Defective RBC membrane proteins'},
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D: Deficient glucose-6-phosphate dehydrogenase
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Answer the following medical question with one of the provided options:
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Q:A 23-year-old man comes to the emergency department because of a rash on his neck and back for the past 6 hours. He says that he first noticed some reddening of the skin on his back the previous evening, which turned into a blistering, red rash overnight. He went surfing the previous day and spent 5 hours at the beach. He reports having applied at least 1 oz of water-resistant SPF 30 sunscreen 30 minutes before leaving his home. His vitals are within normal limits. Physical examination shows erythema of the skin over the upper back and dorsum of the neck, with 3 vesicles filled with clear fluid. The affected area is edematous and tender to touch. Which of the following recommendations is most appropriate to prevent a recurrence of this patient's symptoms in the future?? {'A': 'Reapply sunscreen after water exposure', 'B': 'Apply sunscreen directly before getting into water', 'C': 'Use SPF 50 sunscreen', 'D': 'Apply at least 3 oz of sunscreen', 'E': 'Use waterproof sunscreen'},
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A: Reapply sunscreen after water exposure
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Q:A 34-year-old woman comes to the physician because she has not had her period for 4 months. Menses had previously occurred at regular 28-day intervals with moderate flow. A home pregnancy test was negative. She also reports recurrent headaches and has noticed that when she goes to the movies she cannot see the outer edges of the screen without turning her head to each side. This patient's symptoms are most likely caused by abnormal growth of which of the following?? {'A': 'Astrocytes', 'B': 'Adenohypophysis', 'C': 'Arachnoid cap cells', 'D': 'Schwann cells', 'E': 'Pineal gland'},
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B: Adenohypophysis
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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 comes to the physician because of discoloration of the toenails. He has a history of peptic ulcer disease treated with pantoprazole. The physician prescribes oral itraconazole for a fungal infection and temporarily discontinues pantoprazole. Which of the following best describes the reason for discontinuing pantoprazole therapy?? {'A': 'Increased toxicity of itraconazole due to cytochrome p450 induction', 'B': 'Decreased therapeutic effect of itraconazole due to cytochrome p450 inhibition', 'C': 'Decreased therapeutic effect of itraconazole due to decreased absorption', 'D': 'Decreased therapeutic effect of itraconazole due to cytochrome p450 induction', 'E': 'Increased toxicity of itraconazole due to decreased protein binding'},
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C: Decreased therapeutic effect of itraconazole due to decreased absorption
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Answer the following medical question with one of the provided options:
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Q:A 15-year-old girl comes to the physician for a routine health maintenance examination. She recently became sexually active with her boyfriend and requests a prescription for an oral contraception. She lives with her parents. She has smoked half a pack of cigarettes daily for the past 2 years. Physical examination shows no abnormalities. A urine pregnancy test is negative. Which of the following is the most appropriate response?? {'A': '"""I would recommend performing a Pap smear, since you have become sexually active."""', 'B': '"""I would like to discuss the various contraceptive options that are available."""', 'C': '"""I would need your parent\'s permission before I can provide information about contraceptive therapy."""', 'D': '"""I cannot prescribe oral contraceptives if you are currently a smoker."""', 'E': '"""I would recommend a multiphasic combination of ethinyl estradiol and norgestimate."""'},
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B: """I would like to discuss the various contraceptive options that are available."""
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Answer the following medical question with one of the provided options:
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Q:A 53-year-old woman comes to the physician for evaluation of a 5-month history of painful sexual intercourse. She also reports vaginal dryness and occasional spotting. She has no pain with urination. She has hypertension, type 2 diabetes mellitus, and hypercholesterolemia. Her last menstrual period was 8 months ago. She is sexually active with her husband and has two children. Current medications include ramipril, metformin, atorvastatin, and aspirin. Her temperature is 37°C (98.6°F), pulse is 85/min, and blood pressure is 140/82 mm Hg. Pelvic examination shows decreasing labial fat pad, receding pubic hair, and clear vaginal discharge. Which of the following is the most appropriate pharmacotherapy?? {'A': 'Oral fluconazole', 'B': 'Topical nystatin', 'C': 'Topical estrogen cream', 'D': 'Oral metronidazole', 'E': 'Topical corticosteroids\n"'},
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C: Topical estrogen cream
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Answer the following medical question with one of the provided options:
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Q:A 36-year-old man is brought to the emergency department by his wife 20 minutes after having a seizure. Over the past 3 days, he has had a fever and worsening headaches. This morning, his wife noticed that he was irritable and demonstrated strange behavior; he put the back of his fork, the salt shaker, and the lid of the coffee can into his mouth. He has no history of serious illness and takes no medications. His temperature is 39°C (102.2°F), pulse is 88/min, and blood pressure is 118/76 mm Hg. Neurologic examination shows diffuse hyperreflexia and an extensor response to the plantar reflex on the right. A T2-weighted MRI of the brain shows edema and areas of hemorrhage in the left temporal lobe. Which of the following is most likely the primary mechanism of the development of edema in this patient?? {'A': 'Release of vascular endothelial growth factor', 'B': 'Cellular retention of sodium', 'C': 'Breakdown of endothelial tight junctions', 'D': 'Degranulation of eosinophils', 'E': 'Increased hydrostatic pressure'},
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C: Breakdown of endothelial tight junctions
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Answer the following medical question with one of the provided options:
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Q:A 30-year-old woman presents to her primary care provider with blood in her urine and pain in her left flank. She has a 5-year history of polycystic ovarian syndrome managed with oral contraceptives and metformin. She is single and is not sexually active and denies a history of kidney stones or abdominal trauma. She has a 15-pack-year smoking history but denies the use of other substances. Her family history is significant for fatal lung cancer in her father at age 50, who also smoked, and recently diagnosed bladder cancer in her 45-year-old brother, who never smoked. On review of systems, she denies weight loss, fever, fatigue, paresthesia, increased pain with urination, or excessive bleeding or easy bruising. She is admitted to the hospital for a workup and observation. Her vital signs and physical exam are within normal limits. A urine pregnancy test is negative. PT is 14 sec and PTT is 20 sec. The rest of the laboratory results including von Willebrand factor activity and lupus anticoagulant panel are pending. A CT angiogram is ordered and is shown in the picture. What is indicated at this time to prevent a potential sequela of this patient’s condition?? {'A': 'Surgery', 'B': 'Administer heparin', 'C': 'Administer streptokinase', 'D': 'Thrombectomy', 'E': 'Administer warfarin'},
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B: Administer heparin
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Answer the following medical question with one of the provided options:
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Q:A 57-year-old man is brought to the emergency department for crushing substernal chest pain at rest for the past 2 hours. The pain began gradually while he was having an argument with his wife and is now severe. He does not take any medications. He has smoked 1 pack of cigarettes daily for 35 years. He is diaphoretic. His temperature is 37.1°C (98.8°F), pulse is 110/min, respirations are 21/min, and blood pressure is 115/65 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 97%. Cardiac examination shows an S4 gallop. The lungs are clear to auscultation. An ECG is shown. Which of the following is the most likely underlying cause of this patient's condition?? {'A': 'Occlusion of the left anterior descending artery', 'B': 'Thromboembolism to the right interlobar pulmonary artery', 'C': 'Diffuse coronary vasospasm', 'D': 'Occlusion of the left circumflex artery', 'E': 'Tear in the intimal lining of the aorta'},
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A: Occlusion of the left anterior descending artery
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Q:A 60-year-old man presents to the office for a scheduled follow-up visit. He has had hypertension for the past 30 years and his current anti-hypertensive medications include lisinopril (40 mg/day) and hydrochlorothiazide (50 mg/day). He follows most of the lifestyle modifications recommended by his physician, but is concerned about his occasional occipital headaches in the morning. His blood pressure is 160/98 mm Hg. The physician adds another drug to his regimen that acts centrally as an α2-adrenergic agonist. Which of the following second messengers is involved in the mechanism of action of this new drug?? {'A': 'Cyclic adenosine monophosphate', 'B': 'Cyclic guanosine monophosphate', 'C': 'Inositol triphosphate', 'D': 'Diacylglycerol', 'E': 'Calcium ions'},
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A: Cyclic adenosine monophosphate
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Answer the following medical question with one of the provided options:
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Q:A 61-year-old woman comes to her physician for a burning sensation and numbness in her right hand for 4 weeks. The burning sensation is worse at night and is sometimes relieved by shaking the wrist. In the past week, she has noticed an exacerbation of her symptoms. She has rheumatoid arthritis and type 2 diabetes mellitus. Her medications include insulin, methotrexate, and naproxen. Her vital signs are within normal limits. Examination shows swan neck deformities of the fingers on both hands and multiple subcutaneous nodules over bilateral olecranon processes. There is tingling and numbness over the right thumb, index finger, and middle finger when the wrist is actively flexed. The remainder of the examination shows no abnormalities. Which of the following is the most appropriate next best step in management?? {'A': 'Physiotherapy', 'B': 'Initiate sulfasalazine therapy', 'C': 'Initiate azathioprine therapy', 'D': 'Volar splinting', 'E': 'Vitamin B6 supplementation\n"'},
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D: Volar splinting
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Answer the following medical question with one of the provided options:
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Q:A 32-year-old man with a history of chronic alcoholism presents to the emergency department with vomiting and diarrhea for 1 week. He states he feels weak and has had poor oral intake during this time. The patient is a current smoker and has presented many times to the emergency department for alcohol intoxication. His temperature is 97.5°F (36.4°C), blood pressure is 102/62 mmHg, pulse is 135/min, respirations are 25/min, and oxygen saturation is 99% on room air. On physical exam, he is found to have orthostatic hypotension and dry mucus membranes. Laboratory studies are ordered as seen below. Serum: Na+: 139 mEq/L Cl-: 101 mEq/L K+: 3.9 mEq/L HCO3-: 25 mEq/L BUN: 20 mg/dL Glucose: 99 mg/dL Creatinine: 1.1 mg/dL Ca2+: 9.8 mg/dL The patient is given normal saline, oral potassium, dextrose, thiamine, and folic acid. The following day, the patient seems confused and complains of diffuse weakness and muscle/bone pain. An ECG and head CT are performed and are unremarkable. Which of the following is the most likely explanation for this patient's new symptoms?? {'A': 'Hypocalcemia', 'B': 'Hypoglycemia', 'C': 'Hypomagnesemia', 'D': 'Hyponatremia', 'E': 'Hypophosphatemia'},
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E: Hypophosphatemia
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Answer the following medical question with one of the provided options:
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Q:A 2-year-old boy from a rural community is brought to the pediatrician after his parents noticed a white reflection in both of his eyes in recent pictures. Physical examination reveals bilateral leukocoria, nystagmus, and inflammation. When asked about family history of malignancy, the father of the child reports losing a brother to an eye tumor when they were children. With this in mind, which of the following processes are affected in this patient?? {'A': 'DNA mismatch repair', 'B': 'Nucleotide excision repair', 'C': 'Regulation of the G1-S transition', 'D': 'Base excision repair', 'E': 'Stem cell self-renewal'},
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C: Regulation of the G1-S transition
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Answer the following medical question with one of the provided options:
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Q:A scientist is studying the excretion of a novel toxin X by the kidney in order to understand the dynamics of this new substance. He discovers that this new toxin X has a clearance that is half that of inulin in a particular patient. This patient's filtration fraction is 20% and his para-aminohippuric acid (PAH) dynamics are as follows: Urine volume: 100 mL/min Urine PAH concentration: 30 mg/mL Plasma PAH concentration: 5 mg/mL Given these findings, what is the clearance of the novel toxin X?? {'A': '60 ml/min', 'B': '120 ml/min', 'C': '300 ml/min', 'D': '600 ml/min', 'E': '1,500 ml/min'},
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A: 60 ml/min
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Answer the following medical question with one of the provided options:
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Q:A 31-year-old male with bipolar disorder comes to the physician because of erectile dysfunction for the past month. He cannot maintain an erection during intercourse and rarely wakes up with an erection. He says he is happy in his current relationship, but admits to decreased desire for sex and feeling embarrassed about his sexual performance. He sustained a lumbar vertebral injury one year ago following a motor vehicle accident. He takes medication for his bipolar disorder but does not remember the name. Physical examination shows testicular atrophy with otherwise normal genitalia. Which of the following is the most likely cause of this patient's symptoms?? {'A': 'Decreased testosterone levels', 'B': 'Peyronie disease', 'C': 'Microvascular disease', 'D': 'Peripheral nerve injury', 'E': 'Psychologic stressors'},
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A: Decreased testosterone levels
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Q:A scientist is designing experiments to better appreciate how the lung expands. He acquires two sets of cat lungs and fills one set with saline. He plots changes in the lungs' volume with respect to pressure as shown in Image A. The pressure-volume loop of the liquid-ventilated lung is different from the gas-ventilated lung because of what property?? {'A': 'Reduced airway resistance', 'B': 'Increased residual volume', 'C': 'More pronounced hysteresis', 'D': 'Increased compliance', 'E': 'Increased inspiratory pressure'},
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D: Increased compliance
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Q:A 58-year-old man with a history of alcoholism is hospitalized with acute onset nausea and hematemesis. On admission, his vitals are as follows: blood pressure 110/70 mm Hg, heart rate 88/min, respiratory rate 16/min, and temperature 37.8℃ (100.0℉). Physical examination shows jaundice, palmar erythema, widespread spider angiomata, abdominal ascites, and visibly distended superficial epigastric veins. Abdominal ultrasound demonstrates portal vein obstruction caused by liver cirrhosis. Where in the liver would you find the earliest sign of fibrous deposition in this patient?? {'A': 'Portal field', 'B': 'Lumen of sinusoids', 'C': 'Perisinusoidal space', 'D': 'Interlobular connective tissue', 'E': 'Lumen of bile ducts'},
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C: Perisinusoidal space
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Answer the following medical question with one of the provided options:
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Q:A 54-year-old gardener with diabetes mellitus from the Northeast Jillin Province in China acquired a small scratch from a thorn while working in his flower garden. After 3 weeks, he noticed a small pink, painless bump at the site of a scratch. He was not concerned by the bump; however, additional linearly-distributed bumps that resembled boils began to appear 1 week later that were quite painful. When the changes took on the appearance of open sores that drained clear fluid without any evidence of healing (as shown on the image), he finally visited his physician. The physician referred to the gardener for a skin biopsy to confirm his working diagnosis and to start treatment as soon as possible. Which of the following is the most likely diagnosis for this patient?? {'A': 'Paracoccidioidomycosis', 'B': 'Blastomycosis', 'C': 'Cat scratch disease', 'D': 'Leishmaniasis', 'E': 'Sporotrichosis'},
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E: Sporotrichosis
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Answer the following medical question with one of the provided options:
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Q:A 5-year-old girl is brought to her pediatrician by her mother. The mother is concerned about a fine, red rash on her daughter’s limbs and easy bruising. The rash started about 1 week ago and has progressed. Past medical history is significant for a minor cold two weeks ago. The girl was born at 39 weeks gestation via spontaneous vaginal delivery. She is up to date on all vaccines and is meeting all developmental milestones. Today, she has a heart rate of 90/min, respiratory rate of 22/min, blood pressure of 110/65 mm Hg, and temperature of 37.0°C (98.6°F). On physical exam, the girl has a petechial rash on her arms and legs. Additionally, there are several bruises on her shins and thighs. A CBC shows thrombocytopenia (20,000/mm3). Other parameters of the CBC are within expected range for her age. Prothrombin time (PT), partial thromboplastin time (PTT), and metabolic panels are all within reference range. What is the most likely blood disorder?? {'A': 'Hemophilia B', 'B': 'Hemophilia A', 'C': 'Immune thrombocytopenic purpura (ITP)', 'D': 'Von Willebrand disease', 'E': 'Acute lymphoblastic leukemia (ALL)'},
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C: Immune thrombocytopenic purpura (ITP)
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Answer the following medical question with one of the provided options:
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Q:An otherwise healthy 45-year-old woman comes to the physician because of a 1-year history of episodic abdominal cramps, bloating, and flatulence. The symptoms worsen when she has pizza or ice cream and have become more frequent over the past 4 months. Lactose intolerance is suspected. Which of the following findings would most strongly support the diagnosis of lactose intolerance?? {'A': 'Partial villous atrophy with eosinophilic infiltrates', 'B': 'Periodic acid-Schiff-positive foamy macrophages', 'C': 'Tall villi with focal collections of goblet cells', 'D': 'Duodenal epithelium with dense staining for chromogranin A', 'E': 'Noncaseating granulomas with lymphoid aggregates'},
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C: Tall villi with focal collections of goblet cells
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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 with an unremitting cough and swelling of the lower limbs for the past 2 weeks. He says he has had a chronic cough for years, however, he feels it is getting worse. He reports a 30-pack-year smoking history. Physical examination reveals mild central cyanosis and expiratory wheezes throughout the chest. Oxygen therapy is ordered immediately but, soon after administering it, his respiratory rate starts to slow down and he becomes drowsy. Dysfunction of which of the following receptors most likely led to this patient’s current condition?? {'A': 'Airway stretch receptors', 'B': 'Central chemoreceptors', 'C': 'Peripheral chemoreceptors', 'D': 'Pleural pain receptors', 'E': 'Pulmonary stretch receptors'},
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B: Central chemoreceptors
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