instruction
stringclasses 5
values | input
stringlengths 10
4.2k
| output
stringlengths 1
7.16k
|
|---|---|---|
Answer the following medical question with one of the provided options:
|
Q:A 55-year-old man comes to the physician because of increasing shortness of breath for 1 month. Initially, he was able to climb the 3 flights of stairs to his apartment, but he now needs several breaks to catch his breath. He has no chest pain. He has rheumatic heart disease and type 2 diabetes mellitus. He emigrated from India about 25 years ago. The patient's current medications include carvedilol, torsemide, and insulin. He appears uncomfortable. His temperature is 37.3°C (99.1°F), pulse is 72/min and regular, respirations are 18/min, and blood pressure is 130/80 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 96%. Examination shows bilateral crackles at the lung bases. There is an opening snap followed by a low-pitched diastolic murmur at the fifth left intercostal space at the mid-clavicular line. An x-ray of the chest shows left atrial enlargement, straightening of the left cardiac border and increased vascular markings. Which of the following is the preferred intervention to improve this patient's symptoms?? {'A': 'Tricuspid valve repair', 'B': 'Mitral valve replacement', 'C': 'Percutaneous mitral balloon commissurotomy', 'D': 'Transcatheter aortic valve replacement', 'E': 'Enalapril therapy\n"'},
|
C: Percutaneous mitral balloon commissurotomy
|
Answer the following medical question with one of the provided options:
|
Q:A 70-year-old male presents to his primary care physician for complaints of fatigue. The patient reports feeling tired during the day over the past 6 months. Past medical history is significant for moderately controlled type II diabetes. Family history is unremarkable. Thyroid stimulating hormone and testosterone levels are within normal limits. Complete blood cell count reveals the following: WBC 5.0, hemoglobin 9.0, hematocrit 27.0, and platelets 350. Mean corpuscular volume is 76. Iron studies demonstrate a ferritin of 15 ng/ml (nl 30-300). Of the following, which is the next best step?? {'A': 'MRI abdomen', 'B': 'Blood transfusion', 'C': 'CT abdomen', 'D': 'Gel electrophoresis', 'E': 'Colonoscopy'},
|
E: Colonoscopy
|
Answer the following medical question with one of the provided options:
|
Q:A 52-year-old woman presents with involuntary passage of urine and occasional watery vaginal discharge. She associates the onset of these symptoms with her discharge from the hospital for an abdominal hysterectomy and bilateral salpingo-oophorectomy for endometrial carcinoma and a left ovary cyst 2 months ago. The incontinence occurs during both day and night and is not related to physical exertion. She denies urgency, incomplete voiding, painful urination, or any other genitourinary symptoms. She is currently on hormone replacement therapy. Her vital signs are as follows: blood pressure, 120/80 mm Hg; heart rate, 77/min; respiratory rate, 13/min; and temperature, 36.6℃ (97.9℉). On physical examination, there is no costovertebral or suprapubic tenderness. The surgical scar is normal in appearance. The gynecologic examination revealed a small opening in the upper portion of the anterior wall of the vagina. No discharge was noted. How would you confirm the diagnosis?? {'A': 'Transabdominal ultrasound', 'B': 'Cystometry', 'C': 'Voiding cystourethrography', 'D': 'Antegrade pyelography', 'E': 'Urine flow test'},
|
C: Voiding cystourethrography
|
Answer the following medical question with one of the provided options:
|
Q:A 73-year-old man noted a rapid onset of severe dizziness and difficulty swallowing while watching TV at home. His wife reports that he had difficulty forming sentences and his gait was unsteady at this time. Symptoms were severe within 1 minute and began to improve spontaneously after 10 minutes. He has had type 2 diabetes mellitus for 25 years and has a 50 pack-year smoking history. On arrival to the emergency department 35 minutes after the initial development of symptoms, his manifestations have largely resolved with the exception of a subtle nystagmus and ataxia. His blood pressure is 132/86 mm Hg, the heart rate is 84/min, and the respiratory rate is 15/min. After 45 minutes, his symptoms are completely resolved, and neurological examination is unremarkable. Which of the following is the most likely cause of this patient’s condition?? {'A': 'Anterior cerebral artery occlusion', 'B': 'Vertebral artery occlusion', 'C': 'Middle cerebral artery occlusion', 'D': 'Posterior cerebral artery occlusion', 'E': 'Lenticulostriate artery occlusion'},
|
B: Vertebral artery occlusion
|
Answer the following medical question with one of the provided options:
|
Q:A 72-year-old man is brought to the emergency department with increasing fever and abdominal pain over the past week. The pain is constant and limited to the lower right part of his abdomen. He has nausea but no vomiting or diarrhea. His past medical history is unremarkable for any serious illnesses. He takes acetaminophen for knee arthritis. He is fully alert and oriented. His temperature is 39.5°C (103.1°F), pulse is 89/min, respirations are 15/min, and blood pressure is 135/70 mm Hg. Abdominal examination shows a tender mass in the right lower quadrant. CT shows obstruction of the appendiceal neck with a fecalith and the appendiceal tip leading to an irregular walled-off fluid collection. Stranding of the surrounding fat planes is also noted. Intravenous hydration is initiated. Which of the following is the most appropriate next step in management?? {'A': 'Antibiotics + CT-guided drainage', 'B': 'Antibiotics + interval appendectomy', 'C': 'Appendectomy within 12 hours', 'D': 'Early surgical drainage + interval appendectomy', 'E': 'Emergency appendectomy'},
|
A: Antibiotics + CT-guided drainage
|
Answer the following medical question with one of the provided options:
|
Q:A 40-day-old child presents to a physician for the first time for a well-child visit. The mother is a 22-year-old college student who opted for a home birth. Upon examination, the child weighs 4.0 kg (8.8 lbs) and has intact reflexes. The umbilical cord is still attached and looks erythematous and indurated. A complete blood cell count reveals leukocytosis. Immunoglobulin levels are normal. A flow cytometry analysis is performed. Which of the following markers will most likely be deficient in this child?? {'A': 'CD21', 'B': 'CD1a', 'C': 'CD3', 'D': 'CD56', 'E': 'CD18'},
|
E: CD18
|
Answer the following medical question with one of the provided options:
|
Q:A 27-year-old woman presents for her routine annual examination. She has no complaints. She has a 3-year-old child who was born via normal vaginal delivery with no complications. She had a Pap smear during her last pregnancy and the findings were normal. Her remaining past medical history is not significant, and her family history is also not significant. Recently, one of her close friends was diagnosed with breast cancer at the age of 36, and, after reading some online research, she wants to be checked for all types of cancer. Which of the following statements would be the best advice regarding the most appropriate screening tests for this patient?? {'A': '“We should do a Pap smear now. Blood tests are not recommended for screening purposes.”', 'B': '“You need HPV (human papillomavirus) co-testing only.”', 'C': '“Yes, you are right to be concerned. Let us do a mammogram and a blood test for CA-125.”', 'D': '“Your last Pap smear 3 years ago was normal. We can repeat it after 2 more years.”', 'E': "“Remember that information on the internet is vague and unreliable. You don't need any screening tests at this time.”"},
|
A: “We should do a Pap smear now. Blood tests are not recommended for screening purposes.”
|
Answer the following medical question with one of the provided options:
|
Q:A 59-year-old woman presents to the physician for a 3-month history of progressively worsening shortness of breath on exertion and swelling of her legs. She has a history of breast cancer that was treated with surgery, followed by doxorubicin and cyclophosphamide therapy 4 years ago. Cardiac examination shows an S3 gallop, but there are no murmurs or rubs. Examination of the lower extremities shows pitting edema below the knees. Echocardiography is most likely to show which of the following sets of changes in this patient? Aorto-ventricular pressure gradient Diastolic function Ventricular cavity size Ventricular wall thickness A Normal ↓ Normal Normal B Normal Normal ↑ ↑ C Normal ↓ ↑ ↑ D ↑ ↓ ↑ ↑ E Normal Normal ↑ ↓? {'A': 'A', 'B': 'B', 'C': 'C', 'D': 'D', 'E': 'E'},
|
E: E
|
Answer the following medical question with one of the provided options:
|
Q:A 19-year-old girl with a history of immune thrombocytopenic purpura (ITP), managed with systemic corticosteroids, presents with bruising, acne, and weight gain. Patient says that 3 months ago she gradually began to notice significant weight gain and facial and truncal acne. She says these symptoms progressively worsened until she discontinued her corticosteroid therapy 4 weeks ago. This week, she began to notice multiple bruises all over her body. Past medical history is significant for ITP, diagnosed 11 years ago, managed until recently with systemic corticosteroid therapy. The patient is afebrile and vital signs are within normal limits. On physical examination, there are multiple petechiae and superficial bruises on her torso and extremities bilaterally. There is moderate truncal obesity and as well as a mild posterior cervical adipose deposition. Multiple deep comedones are present on the face and upper torso. Which of the following is the best course of treatment in this patient?? {'A': 'Transplantation of stem cells', 'B': 'Administration of intravenous immunoglobulin', 'C': 'Continuation of systemic corticosteroid therapy', 'D': 'Splenectomy', 'E': 'Transfusion of thrombocytes'},
|
D: Splenectomy
|
Answer the following medical question with one of the provided options:
|
Q:A 30-year-old boxer seeks evaluation by his physician after he noticed swelling at the angle of his jaw a few days ago. He recalls a recent boxing match when he was punched in his face. He says that his jaw is very painful. On examination, a firm mass is palpated, measuring 4 x 4 cm. An ultrasound was performed, which shows a thin, encapsulated, well-circumscribed, predominantly solid mass with occasional cystic areas. The mass is surgically excised, after which he develops a hoarse voice for a few days, but recovers within 1 week. The histopathologic evaluation of the surgical specimen reports a pseudocapsule with a hypocellular stromal component consisting of a myxoid background and cartilage arranged in clusters and a hypercellular epithelial component with cells arranged in sheets and trabeculae. From which of the following structures did the mass most likely arise?? {'A': 'Minor salivary gland', 'B': 'Thyroid', 'C': 'Parotid gland', 'D': 'Salivary duct', 'E': 'Seventh cranial nerve'},
|
C: Parotid gland
|
Answer the following medical question with one of the provided options:
|
Q:A 32-year-old woman comes to the physician because of a 2-week history of involuntary loss of urine. She loses small amounts of urine in the absence of an urge to urinate and for no apparent reason. She also reports that she has an intermittent urinary stream. Two years ago, she was diagnosed with multiple sclerosis. Current medications include glatiramer acetate and a multivitamin. She works as a librarian. She has 2 children who attend middle school. Vital signs are within normal limits. The abdomen is soft and nontender. Pelvic examination shows no abnormalities. Neurologic examination shows a slight hypesthesia in the lower left arm and absent abdominal reflex, but otherwise no abnormalities. Her post-void residual urine volume is 131 mL. Bladder size is normal. Which of the following is the most likely cause of the patient's urinary incontinence?? {'A': 'Cognitive impairment', 'B': 'Vesicovaginal fistula', 'C': 'Detrusor sphincter dyssynergia', 'D': 'Bladder outlet obstruction', 'E': 'Impaired detrusor contractility'},
|
C: Detrusor sphincter dyssynergia
|
Answer the following medical question with one of the provided options:
|
Q:A 55-year-old female comes to see her doctor for a rapidly enlarging abdomen and swelling of both legs. She was hospitalized 2 weeks ago for an upper gastrointestinal bleeding episode. On that occasion, her esophagogastroduodenoscopy showed grade 1 esophageal varices and a 1 cm clean-based antral ulcer. The patient was discharged on omeprazole. Review of symptoms shows that the patient is forgetful, does not sleep well, and is drowsy and fatigued during the day which prevents her from working full-time. She denies abdominal pain. The patient has a 10-year history of type 2 diabetes mellitus, hypertension, and hypercholesterolemia but no history of angina or coronary heart disease. She drank alcohol moderately heavy in her twenties and currently drinks less than 3 drinks per week and does not smoke. Her family history is unremarkable. On physical examination, her blood pressure is 132/82 mm Hg, pulse is 88/min, and her temperature is 37.0°C (98.6°F). She weighs 106.6 kg (235 lb) and her BMI is 33. She is alert, oriented to person, place, year, and month but not to the day. Her sclerae are nonicteric. Her pulmonary and cardiovascular exam are normal but her abdomen is distended with a fluid wave and mild tenderness to palpation. There is no hepatosplenomegaly. There is a 2+ edema to mid-calf and pedal pulses are barely palpable. Her neurological exam is without motor or sensory deficits but she demonstrates flapping tremor of her hands while asked to hold them in front of her for a few seconds and her skin exam shows a few spider telangiectasias on her face and upper chest. After an initial evaluation, lab tests were obtained: Serum sodium 133 mEq/L Serum potassium 3.8 mEq/L BUN 8 mg/dL Serum creatinine 1.0 mg/dL Serum albumin 2.5 mg/dL Aspartate aminotransferase 68 IU/ml Alanine aminotransferase 46 IU/ml Alkaline phosphatase 130 IU/ml Total bilirubin 1.8 mg/dL WBC count 4,200/mm3 Platelets 94,000/mm3 Hematocrit 35.5% Prothrombin time (INR) 1.5 A liver biopsy is performed and the results are pending. The hepatocytes causing her acute issue are predominantly located in which area of the hepatic lobule? ? {'A': 'The zone where gluconeogenesis is predominant', 'B': 'The zone receiving the most oxygenated blood from the hepatic artery', 'C': 'The zone with little or no cytochrome P450 enzymes', 'D': 'The zone closest to the centrolobular vein', 'E': 'The zone involved in cholesterol synthesis'},
|
D: The zone closest to the centrolobular vein
|
Answer the following medical question with one of the provided options:
|
Q:A 34-year-old woman comes to the physician because of a 6-week history of fever and productive cough with blood-tinged sputum. She has also had a 4-kg (8.8-lb) weight loss during the same time period. Examination shows enlarged cervical lymph nodes. An x-ray of the chest shows a 2.5-cm pulmonary nodule in the right upper lobe. A biopsy specimen of the lung nodule shows caseating granulomas with surrounding multinucleated giant cells. Which of the following is the most likely underlying cause of this patient's pulmonary nodule?? {'A': 'IgE-mediated mast cell activation', 'B': 'Delayed T cell-mediated reaction', 'C': 'Antibody-mediated cytotoxic reaction', 'D': 'Combined type III/IV hypersensitivity reaction', 'E': 'Immune complex deposition\n"'},
|
B: Delayed T cell-mediated reaction
|
Answer the following medical question with one of the provided options:
|
Q:A 26-year-old man comes to the emergency department because of a 1-week history of fever, throat pain, and difficulty swallowing. Head and neck examination shows an erythematous pharynx with purulent exudates overlying the palatine tonsils. Microscopic examination of a throat culture shows pink, spherical bacteria arranged in chains. Treatment with amoxicillin is initiated. A day later, a physician colleague from another department approaches the physician in the lobby of the hospital and asks about this patient, saying, “Did you see him? What does he have? He’s someone I play football with and he hasn’t come to play for the past 5 days. I’m worried about him.” Which of the following is the most appropriate action by the physician?? {'A': 'Inform the colleague that she cannot divulge any information about the patient', 'B': "Inform the colleague that he should ask the patient's attending physician", 'C': 'Tell her colleague that she cannot tell him the diagnosis but that his friend was treated with antibiotics', 'D': "Tell her colleague the patient's case file number so he can look it up himself", 'E': 'Ask the colleague to meet in her office so they can discuss the patient in private'},
|
A: Inform the colleague that she cannot divulge any information about the patient
|
Answer the following medical question with one of the provided options:
|
Q:A 32-year-old African American woman comes to the physician because of fatigue and difficulty swallowing for 6 weeks. She also complains of painful discoloration in her fingers when exposed to cold weather. She has smoked one pack of cigarettes daily for 4 years. She appears younger than her stated age. Physical examination shows smooth, swollen fingers with small white calcifications on her fingertips bilaterally. This patient is at increased risk for which of the following complications?? {'A': 'Liver cirrhosis', 'B': 'Chronic obstructive pulmonary disease', 'C': 'Pulmonary hypertension', 'D': 'Aortic aneurysm', 'E': 'Chondrocalcinosis'},
|
C: Pulmonary hypertension
|
Answer the following medical question with one of the provided options:
|
Q:A 61-year-old man presents to the emergency room with a painful, swollen left leg. He states that his symptoms began that morning after a long flight from Australia. He denies shortness of breath, chest pain, or cough. On review of systems, he notes that he has been constipated recently and had several episodes of bright red blood per rectum. He has not noticed any weight loss, fevers, or night sweats. He has a past medical history of a deep vein thrombosis 4 years ago during a hospitalization for community acquired pneumonia and was treated with warfarin for 3 months afterward. He also has chronic hepatitis C from previous intravenous drug use. The patient has a 30 pack-year smoking history and has never had a colonoscopy. His father is 84-years-old and has chronic kidney disease from diabetes, and his mother passed away from a massive pulmonary embolus when pregnant with his younger sister. In the emergency room, his temperature is 98.7°F (37.1°C), blood pressure is 142/85 mm/Hg, pulse is 79/min, and respirations are 14/min. On exam, he is in no acute distress. His left calf is larger in caliber than the right calf which is red and tender to palpation. Dorsiflexion of the foot worsens the pain. His abdomen is soft, nontender, and nondistended without hepatomegaly. The remainder of the physical exam is unremarkable. Labs are shown below: Hemoglobin: 13.0 g/dL Leukocyte count: 6,000/mm^3 Platelets: 160,000/mm^3 Aspartate aminotransferase: 15 U/L Alanine aminotransferase: 19 U/L Alkaline phosphatase: 81 IU/L Hepatitis C antibody: reactive Hepatitis C titer: 0 copies/mL Which of the following is the most likely cause of this patient’s condition?? {'A': 'Protein C deficiency', 'B': 'Increased estrogen levels', 'C': 'Loss of antithrombin III in urine', 'D': 'Resistance of factor V to inactivation by protein C', 'E': 'Malignancy'},
|
D: Resistance of factor V to inactivation by protein C
|
Answer the following medical question with one of the provided options:
|
Q:A 58-year-old woman with breast cancer presents to her primary care physician for referral to a medical oncologist. She denies any personal history of blood clots in her past. Her past medical history is significant for preeclampsia, hypertension, polycystic ovarian syndrome, and hypercholesterolemia. She currently smokes 1 pack of cigarettes per day, drinks a glass of wine per day, and she currently denies any illicit drug use, despite a history of cocaine use. The vital signs include: temperature 36.7°C (98.0°F), blood pressure 126/74 mm Hg, heart rate 111/min and irregular, and respiratory rate 17/min. On physical examination, she has a grade 2/6 holosystolic murmur heard best at the left upper sternal border, bilateral bibasilar crackles on the lungs, and a normal abdominal examination. At her follow-up with the oncologist, they subsequently plan to start the patient on a highly emetic chemotherapeutic regimen. Which of the following regimens for the treatment of chemotherapy-induced emesis is most appropriate for patients on the same day of treatment?? {'A': 'Dronabinol + dexamethasone', 'B': 'Aprepitant + dexamethasone + 5-HT3 receptor antagonist', 'C': 'Dexamethasone + 5-HT3 receptor antagonist', 'D': 'Prochlorperazine + dexamethasone + dronabinol', 'E': 'Aprepitant + dronabinol'},
|
B: Aprepitant + dexamethasone + 5-HT3 receptor antagonist
|
Answer the following medical question with one of the provided options:
|
Q:A parent presents to her pediatrician requesting information about immunizations for her newborn. The pediatrician explains about basic principles of immunization, types of vaccines, possible adverse effects, and the immunization schedule. Regarding how immunizations work, the pediatrician explains that there are mainly 2 types of vaccines. The first type of vaccine provides stronger and more lasting immunity as it induces both cellular and humoral immune responses. The second type of vaccine produces mainly a humoral response only, and its overall efficacy is less as compared to the first type. Which of the following vaccines belongs to the first type of vaccine that the pediatrician is talking about?? {'A': 'Yellow fever vaccine', 'B': 'Rabies vaccine', 'C': 'Hepatitis A vaccine', 'D': 'Polio vaccine (Salk)', 'E': 'Hepatitis B vaccine'},
|
A: Yellow fever vaccine
|
Answer the following medical question with one of the provided options:
|
Q:A 22-year-old man, accompanied by his brother, presents to the emergency department with palpitations for the past 30 minutes and nausea for the past hour. When the patient meets the physician, he says, “Doctor, I am the happiest person in the world because I have the best brain possible. It’s just that my heart is saying something, so I came to check with you to see what it is”. The brother says the patient was diagnosed with attention-deficit/hyperactivity disorder (ADHD) 5 years ago. When the doctor asks the patient about his ADHD treatment, he replies, “Doctor, the medicine is wonderful, and I love it very much. I often take one or two tablets extra!” He has no history of a known cardiovascular disorder, alcohol abuse, or smoking. The patient’s temperature is 99.2ºF (37.3ºC), heart rate is 116/minute, respiratory rate is 18/minute, and blood pressure is 138/94 mm Hg. Generalized perspiration is present. Which of the following signs is most likely to be present on ocular examination?? {'A': 'Dilated pupils', 'B': 'Rotatory nystagmus', 'C': 'Conjunctival injection', 'D': 'Bilateral foveal yellow spots', 'E': 'Bilateral optic disc edema'},
|
A: Dilated pupils
|
Answer the following medical question with one of the provided options:
|
Q:A 68-year-old man comes to the emergency department because of a 1-week history of worsening bouts of shortness of breath at night. He has had a cough for 1 month. Occasionally, he has coughed up frothy sputum during this time. He has type 2 diabetes mellitus and long-standing hypertension. Two years ago, he was diagnosed with Paget disease of bone during a routine health maintenance examination. He has smoked a pack of cigarettes daily for 20 years. His temperature is 37°C (98.6°F), pulse is 110/min, respirations are 25/min, and blood pressure is 145/88 mm Hg. Current medications include metformin, alendronate, hydrochlorothiazide, and enalapril. Examination shows bibasilar crackles. Cardiac examination shows a dull, low-pitched sound during late diastole that is best heard at the apex. There is no jugular venous distention or peripheral edema. Arterial blood gas analysis on room air shows: pH 7.46 PCO2 29 mm Hg PO2 83 mm Hg HCO3- 18 mEq/L Echocardiography shows a left ventricular ejection fraction of 55%. Which of the following is the most likely underlying cause of this patient’s current condition?"? {'A': 'Destruction of alveolar walls', 'B': 'Decreased myocardial contractility', 'C': 'Diuretic overdose', 'D': 'Systemic arteriovenous fistulas', 'E': 'Impaired myocardial relaxation'},
|
E: Impaired myocardial relaxation
|
Answer the following medical question with one of the provided options:
|
Q:A 62-year-old man comes to the physician for hematemesis and progressive heartburn over the past 5 days. Ten days ago, he was started on a medication to treat a condition that causes hearing difficulties and pain of the lower legs. He has no other history of serious illness. He has smoked 1 pack of cigarettes daily for the past 20 years. Physical examination shows bowing of the tibias. Upper endoscopy shows inflammation of the mucosa and a 1-cm punched-out ulcer in the distal esophagus. Which of the following drugs is the most likely cause of the patient's current condition?? {'A': 'Calcium citrate', 'B': 'Denosumab', 'C': 'Risedronate', 'D': 'Prednisolone', 'E': 'Acetaminophen'},
|
C: Risedronate
|
Answer the following medical question with one of the provided options:
|
Q:A 56-year-old male died in a motor vehicle accident. Autopsy reveals extensive atherosclerosis of his left anterior descending artery marked by intimal smooth muscle and collagen proliferation. Which of the following is implicated in recruiting smooth muscle cells from the media to intima in atherosclerotic lesions?? {'A': 'IgE', 'B': 'Prostacyclin', 'C': 'Vascular endothelial growth factor', 'D': 'Factor V Leiden', 'E': 'Platelet-derived growth factor'},
|
E: Platelet-derived growth factor
|
Answer the following medical question with one of the provided options:
|
Q:A 29-year-old man presents to the emergency room with severe abdominal pain. He states that for the entire day, he has had pain in his lower right abdomen in addition to a loss of appetite accompanied by nausea and vomiting. His temperature is 101.3°F (38.5°C), blood pressure is 125/98 mmHg, pulse is 78/min, and respirations are 15/min. On physical examination, he exhibits increased abdominal pain in his right lower quadrant upon deep palpation of the left lower quadrant. What is the next step in the management of this patient?? {'A': 'Abdominal radiograph', 'B': 'Abdominal ultrasound', 'C': 'Colonoscopy', 'D': 'Laparoscopic surgery', 'E': 'Stool ova and parasite examination'},
|
D: Laparoscopic surgery
|
Answer the following medical question with one of the provided options:
|
Q:A 2400-g (5.29-lb) male newborn is delivered at term to a 26-year-old woman. Physical examination shows a sloping forehead, a flat nasal bridge, increased interocular distance, low-set ears, and a protruding tongue. There is a single palmar crease and an increased gap between the first and second toe. The abdomen is distended. An x-ray of the abdomen shows two large air-filled spaces in the upper quadrant. Karyotype analysis shows 46 chromosomes in all tested cells. Which of the following is the most likely underlying cause of this patient's findings?? {'A': 'Balanced translocation', 'B': 'Meiotic nondisjunction', 'C': 'Mitotic nondisjunction', 'D': 'Unbalanced translocation', 'E': 'Uniparental disomy'},
|
D: Unbalanced translocation
|
Answer the following medical question with one of the provided options:
|
Q:A 3-year-old boy is brought to his pediatrician for a regular checkup by his mother. The patient’s mother is concerned about a slight deviation of his left eye and she also notes that her child’s left eye looks strange on the photos, especially if there is a flash. The patient is the first child in the family born to a 31-year-old woman. The boy was born at 39 weeks gestation via spontaneous vaginal delivery. He is up to date on all vaccines and is meeting all developmental milestones. Family history is unremarkable. The eye examination shows left eye converging strabismus. The pupillary reflex cannot be elicited from an illumination of the left eye. Fundal examination reveals are shown in the picture. On testing, visual evoked potential cannot be elicited from the left retina but is normal from the right retina. MRI of the orbits shows a retina-derived tumor in the left eye with an initial spread along the intrabulbar part of the optic nerve and vitreous seeding. The other eye is completely intact. Which of the following methods of treatment is indicated for this patient?? {'A': 'Brachytherapy', 'B': 'Chemotherapy', 'C': 'Eye enucleation', 'D': 'Cryotherapy', 'E': 'Laser coagulation'},
|
C: Eye enucleation
|
Answer the following medical question with one of the provided options:
|
Q:A 21-year-old man comes to the physician because of a 3-day history of yellowing of his eyes. He has also noticed a decrease in his exercise capacity and gets quickly exhausted after minor physical activity. Examination shows scleral icterus and pale mucous membranes. He has splenomegaly. His hemoglobin concentration is 7.9 mg/dL, leukocyte is count 8500/mm3, and platelet count is 187,000/mm3. Direct antiglobulin and heterophile antibody tests are positive. Which of the following additional laboratory findings are most likely present in this patient?? {'A': 'Decreased reticulocyte count', 'B': 'Decreased haptoglobin levels', 'C': 'Decreased mean corpuscular volume', 'D': 'Increased direct to total bilirubin ratio', 'E': 'Increased bleeding time'},
|
B: Decreased haptoglobin levels
|
Answer the following medical question with one of the provided options:
|
Q:A previously healthy 24-year-old woman comes to the physician because of a 1-day history of painful rash after spending several hours in the sun. Skin examination shows well-demarcated areas of erythema with some scaling on the face, chest, upper back, and arms. The affected areas are hot and sensitive to touch. The oral mucosa appears normal. Which of the following is the most likely underlying mechanism of this patient's skin findings?? {'A': 'Vascular endothelial cell injury in the superficial dermis', 'B': 'Immune complex deposits at the dermoepidermal junction', 'C': 'Mast cell activation in the superficial dermis', 'D': 'Apoptosis of keratinocytes in the epidermis', 'E': 'T-cell-mediated inflammatory reaction in the dermis'},
|
D: Apoptosis of keratinocytes in the epidermis
|
Answer the following medical question with one of the provided options:
|
Q:Sixteen hours after delivery, a newborn develops respiratory distress. She was born at 38 weeks' gestation with a birth weight of 3200 g (7 lb 1 oz). Pregnancy was complicated by polyhydramnios. Physical examination shows tachypnea and bluish discoloration of the extremities. Auscultation of the chest shows diffuse crackles in the lung fields and a harsh holosystolic murmur at the left lower sternal border. Abdominal x-ray shows absence of bowel gas. Which of the following best explains the pathogenesis of this newborn's condition?? {'A': 'Defect in the pleuroperitoneal membrane', 'B': 'Deletion in the long arm of chromosome 7', 'C': 'Defect in mesodermal differentiation', 'D': 'Absence of dynein', 'E': 'Deletion in the long arm of chromosome 22'},
|
C: Defect in mesodermal differentiation
|
Answer the following medical question with one of the provided options:
|
Q:A 46-year-old male presents to his dermatologist for routine follow-up of his psoriasis. He was last seen in the office six months prior, at which time he started undergoing ultraviolet light therapy. He reports that he initially noticed an improvement in his symptoms but the effects were transient. He has also started noticing pain and stiffness in his fingers. His past medical history is notable for obesity and diabetes mellitus. He takes metformin. His temperature is 99°F (37.2°C), blood pressure is 130/80 mmHg, pulse is 80/min, and respirations are 16/min. Multiple plaques with scaling are noted on the extensor surfaces of the upper and lower extremities. The patient’s physician suggests stopping the ultraviolet light therapy and starting an injectable medication that acts as a decoy receptor for a pro-inflammatory cytokine. Which of the following is an adverse effect associated with the use of this medication?? {'A': 'Reactivation of latent tuberculosis', 'B': 'Nephrotoxicity', 'C': 'Myelosuppression', 'D': 'Cushing’s syndrome', 'E': 'Retinopathy'},
|
A: Reactivation of latent tuberculosis
|
Answer the following medical question with one of the provided options:
|
Q:A 72-year-old man comes to the physician because of a lesion on his eyelid for 6 months. The lesion is not painful or pruritic. He initially dismissed it as a 'skin tag' but the lesion has increased in size over the past 3 months. He has type 2 diabetes mellitus, coronary artery disease, and left hemiplegia from a stroke 3 years ago. Current medications include sitagliptin, metformin, aspirin, and simvastatin. He used to work as a construction contractor and retired 3 years ago. Examination shows a 1-cm (0.4-in) flesh-colored, nodular, nontender lesion with rolled borders. There is no lymphadenopathy. Cardiopulmonary examination shows no abnormalities. Muscle strength is reduced in the left upper and lower extremities. Visual acuity is 20/20. The pupils are equal and reactive to light. A shave biopsy confirms the diagnosis. Which of the following is the most appropriate next step in management?? {'A': 'Wide local excision', 'B': 'Cryotherapy', 'C': 'Topical chemotherapy', 'D': 'Mohs micrographic surgery', 'E': 'Laser ablation\n"'},
|
D: Mohs micrographic surgery
|
Answer the following medical question with one of the provided options:
|
Q:A 65-year-old man comes to the physician because of a 2-week history of dizziness, fatigue, and shortness of breath. He has noticed increased straining with bowel movements and decreased caliber of his stools over the past 3 months. He has no history of medical illness and takes no medications. He appears pale. Physical examination shows mild tachycardia and conjunctival pallor. Test of the stool for occult blood is positive. His hemoglobin concentration is 6.4 g/dL, and mean corpuscular volume is 74 μm3. A double-contrast barium enema study in this patient is most likely to show which of the following?? {'A': 'Thumbprint sign of the transverse colon', 'B': 'Lead pipe sign of the descending colon', 'C': 'Diverticula in the sigmoid colon', 'D': 'Filling defect of the rectosigmoid colon', 'E': 'String sign in the terminal ileum'},
|
D: Filling defect of the rectosigmoid colon
|
Answer the following medical question with one of the provided options:
|
Q:A 55-year-old man is brought to the emergency department 30 minutes after the sudden onset of severe, migrating anterior chest pain, shortness of breath, and sweating at rest. He has hypertension, hypercholesterolemia, and type 2 diabetes mellitus. Medications include atorvastatin, hydrochlorothiazide, lisinopril, and metformin. He has smoked one pack of cigarettes daily for 25 years. He is in severe distress. His pulse is 110/min, respirations are 20/min, and blood pressure is 150/85 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 98%. Cardiac examination shows a grade 3/6, high-pitched, blowing, diastolic murmur heard best over the right sternal border. The lungs are clear to auscultation. Femoral pulses are decreased bilaterally. An ECG shows sinus tachycardia and left ventricular hypertrophy. Which of the following is the most likely diagnosis?? {'A': 'Pulmonary embolism', 'B': 'Esophageal rupture', 'C': 'Aortic dissection', 'D': 'Spontaneous pneumothorax', 'E': 'Papillary muscle rupture'},
|
C: Aortic dissection
|
Answer the following medical question with one of the provided options:
|
Q:A 19-year-old woman undergoes an laparoscopic appendectomy for acute appendicitis. During the procedure, a black, discolored liver is noted. Other than the recent appendicitis, the patient has no history of serious illness and takes no medications. She has no medication allergies. She does not drink alcohol or use illicit drugs. She has an uncomplicated postoperative course. At her follow-up visit 3 weeks later, her vital signs are within normal limits. Examination shows scleral icterus, which the patient states has been present for many years. Abdominal examination shows healing scars without drainage or erythema. Serum studies show: Aspartate aminotransferase 30 IU/L Alanine aminotransferase 35 IU/L Alkaline phosphatase 47 mg/dL Total bilirubin 5.2 mg/dL Direct bilirubin 4.0 mg/dL Which of the following is the most likely diagnosis?"? {'A': 'Type II Crigler-Najjar syndrome', 'B': 'Dubin-Johnson syndrome', 'C': 'Gilbert syndrome', 'D': 'Rotor syndrome', 'E': 'Wilson disease'},
|
B: Dubin-Johnson syndrome
|
Answer the following medical question with one of the provided options:
|
Q:A 55-year-old man with atrial fibrillation is brought to the emergency department by his wife 6 hours after the acute onset of right arm weakness and slurred speech. An MRI of the brain shows a thrombus in the left middle cerebral artery. Twelve hours later, the patient develops ventricular tachycardia. Despite appropriate care, he dies. Which of the following histopathologic changes are most likely to be seen on a biopsy specimen from the affected brain tissue?? {'A': 'Neutrophilic infiltration with central necrosis', 'B': 'Reactive gliosis with vascular proliferation', 'C': 'Glial scarring with fibrous tissue hypertrophy', 'D': 'Eosinophilic neuronal cytoplasm with pyknotic nuclei', 'E': 'Normal brain parenchyma'},
|
D: Eosinophilic neuronal cytoplasm with pyknotic nuclei
|
Answer the following medical question with one of the provided options:
|
Q:A 54-year-old woman is diagnosed with locally-advanced invasive ductal adenocarcinoma of the breast. She undergoes surgical resection, radiation therapy, and is now being started on adjunctive chemotherapy with cyclophosphamide and doxorubicin. The patient is scheduled for follow up by her primary care provider. Which of the following tests should be performed regularly to monitor her current treatment regimen?? {'A': 'Cardiac MRI', 'B': 'Chest radiograph', 'C': 'ECG', 'D': 'Echocardiography', 'E': 'No regular monitoring indicated'},
|
D: Echocardiography
|
Answer the following medical question with one of the provided options:
|
Q:A 55-year-old man presents to his primary care physician for a new patient appointment. The patient states that he feels well and has no concerns at this time. The patient has a past medical history of hypertension, an elevated fasting blood glucose, and is not currently taking any medications. His blood pressure is 177/118 mmHg, pulse is 90/min, respirations are 16/min, and oxygen saturation is 97% on room air. Physical exam is notable for an obese man with atrophy of his limbs and striae on his abdomen. Laboratory values are notable for a blood glucose of 175 mg/dL. Which of the following is the best initial step in management?? {'A': 'Dexamethasone suppression test', 'B': 'Hydrochlorothiazide', 'C': 'Metformin', 'D': 'MRI of the head', 'E': 'Weight loss'},
|
A: Dexamethasone suppression test
|
Answer the following medical question with one of the provided options:
|
Q:A 25-year-old man presents with abdominal pain and bloody diarrhea. His symptoms have been recurrent for the past few months, and, currently, he says he is having on average four bowel movements daily, often bloody. He describes the pain as cramping and localized to the left side of his abdomen. He also says that he has lost around 4.5 kg (10 lb) over the past 3 months. There is no other significant past medical history and the patient is not on current medications. His temperature is 37.7° C (100.0° F), pulse rate is 100/min, respiratory rate is 18/min, and blood pressure is 123/85 mm Hg. On physical examination, there is mild tenderness to palpation in the lower left quadrant of the abdomen with no rebound or guarding. Laboratory studies show anemia and thrombocytosis. Colonoscopy is performed, which confirms the diagnosis of ulcerative colitis (UC). What is the mechanism of action of the recommended first-line medication for the treatment of this patient’s condition?? {'A': 'Inhibition of leukotriene synthesis and lipoxygenase', 'B': 'TNF-⍺ antagonism', 'C': 'Suppression of cellular and humoral immunity', 'D': 'Inhibition of enzyme phospholipase A2', 'E': 'Cross-linking of DNA of the bacteria causing UC'},
|
A: Inhibition of leukotriene synthesis and lipoxygenase
|
Answer the following medical question with one of the provided options:
|
Q:A 5-year-old boy is brought to the emergency department by his mother because of a 2-hour history of word-finding difficulty, speech slurring, and weakness and sensory loss of his right arm and leg. He has not had fever, nausea, headache, or diarrhea. His mother reports an episode of severe pain and soft tissue swelling of the dorsum of his hands and feet when he was 12 months old, which self-resolved after 2 weeks. His temperature is 37.7°C (99.8°F), pulse is 90/min, and blood pressure is 110/80 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 91%. He follows commands but has nonfluent aphasia. Examination shows marked weakness and decreased sensation of the right upper and lower extremities. Deep tendon reflexes are 2+ bilaterally. Babinski sign is present on the right. An MRI scan of the brain shows signs of an evolving cerebral infarction on the patient's left side. Which of the following is the most appropriate initial step in management?? {'A': 'Exchange transfusion therapy', 'B': 'Intravenous tissue plasminogen activator therapy', 'C': 'Hydroxyurea therapy', 'D': 'Heparin therapy', 'E': 'Aspirin therapy\n"'},
|
A: Exchange transfusion therapy
|
Answer the following medical question with one of the provided options:
|
Q:A 9-year-old girl presents with dyspnea, palpitations, joint pain, and fever for the past week. She says that her symptoms started 2 weeks ago with bilateral knee pain which has shifted to both ankles over the past week. She says she noticed bilateral leg swelling since yesterday. Past medical history is significant for a severe sore throat, fever, chills, and myalgia 1 month ago which resolved after a week. Her vital signs include: respiratory rate 22/min, temperature 37.7°C (100.0°F), blood pressure 90/60 mm Hg, pulse 90/min, and SpO2 88% on room air. On physical examination, the patient is ill-appearing with pallor and bilateral pitting edema of legs. The apex beat is prominently located in the 5th intercostal space in the mid-axillary line. Crepitus is noted over both lung bases bilaterally. A loud 3/6 pansystolic murmur is heard at the apex radiating towards the axilla. S3 and S4 sounds are noted at the left sternal border and cardiac apex. Which of the following is the most likely diagnosis in this patient?? {'A': 'Acute rheumatic fever', 'B': 'Mitral stenosis', 'C': 'Aortic regurgitation', 'D': 'Tricuspid regurgitation', 'E': 'Aortic stenosis'},
|
A: Acute rheumatic fever
|
Answer the following medical question with one of the provided options:
|
Q:A 62-year-old woman with type 2 diabetes mellitus comes to the physician because of a 3-month history of fatigue and weakness. Her hemoglobin A1c concentration was 13.5% 12 weeks ago. Her blood pressure is 152/92 mm Hg. Examination shows lower extremity edema. Serum studies show: K+ 5.1 mEq/L Phosphorus 5.0 mg/dL Ca2+ 7.8 mg/dL Urea nitrogen 60 mg/dL Creatinine 2.2 mg/dL Which of the following is the best parameter for early detection of this patient’s renal condition?"? {'A': 'Urinary red blood cell casts', 'B': 'Serum total protein', 'C': 'Urinary albumin', 'D': 'Serum urea nitrogen', 'E': 'Serum creatinine'},
|
C: Urinary albumin
|
Answer the following medical question with one of the provided options:
|
Q:A 10-year-old boy is brought to the pediatrician by his father because of recent changes in his behavior. His father states that he has noticed that the boy has begun to appear less coordinated than normal and has had frequent falls. On exam, the pediatrician observes pes cavus and hammer toes. The pediatrician makes a presumptive diagnosis based on these findings and recommends a formal echocardiogram. The pediatrician is most likely concerned about which of the following cardiovascular defects?? {'A': 'Tetrology of fallot', 'B': 'Coarctation of the aorta', 'C': 'Endocardial cushion defect', 'D': 'Hypertrophic cardiomyopathy', 'E': 'Aortic cystic medial necrosis'},
|
D: Hypertrophic cardiomyopathy
|
Answer the following medical question with one of the provided options:
|
Q:A 3-year-old girl presents to the emergency department with skin desquamation over her hips and buttocks and right arm; she also has conjunctivitis and fever. The patient was previously seen by her pediatrician for symptoms of impetigo around the nasal folds, and she was treated with topical fusidic acid. She was born at 39 weeks’ gestation via spontaneous vaginal delivery, is up to date on all vaccines, and is meeting all developmental milestones. Medical history and family history are unremarkable. She is admitted to the hospital and started on IV antibiotics. Today, her blood pressure is 100/60 mm Hg, heart rate is 100 beats per minute, respiratory rate is 22 breaths per minute, and temperature is 39.4°C (102.9°F). The total area of desquamation exceeds 20%, sparing the mucous membranes. She is transferred to the pediatric intensive care unit. What is the most likely cause of the disease?? {'A': 'Herpes simplex virus infection', 'B': 'Stevens-Johnson syndrome', 'C': 'Staphylococcus aureus infection', 'D': 'Bullous pemphigoid', 'E': 'Psoriasis'},
|
C: Staphylococcus aureus infection
|
Answer the following medical question with one of the provided options:
|
Q:A 22-year-old woman comes to the emergency department because of chest and epigastric pain that started just after vomiting 30 minutes ago. She does not take any medications and does not drink alcohol or smoke cigarettes. While in the emergency department, the patient experiences two episodes of forceful, bloody emesis. Her temperature is 99.1°F (37.3°C), pulse is 110/minute, and blood pressure is 105/60 mm Hg. Physical examination shows dental enamel erosion and calluses on the dorsal aspect of her right hand. There is tenderness to palpation in the epigastrium. An x-ray of the chest is normal. Further evaluation of this patient is most likely to show which of the following findings?? {'A': 'Dilated veins in the esophageal submucosa', 'B': 'Rupture of the distal esophagus', 'C': 'Clean-based gastric ulcer', 'D': 'Mucosal lacerations at the gastroesophageal junction', 'E': 'Friable mass in the distal esophagus'},
|
D: Mucosal lacerations at the gastroesophageal junction
|
Answer the following medical question with one of the provided options:
|
Q:An 86-year-old man is admitted to the hospital for management of pneumonia. His hospital course has been relatively uneventful, and he is progressing well. On morning rounds nearing the end of the patient's hospital stay, the patient's cousin finally arrives to the hospital for the first time after not being present for most of the patient's hospitalization. He asks about the patient's prognosis and potential future discharge date as he is the primary caretaker of the patient and needs to plan for his arrival home. The patient is doing well and can likely be discharged in the next few days. Which of the following is the most appropriate course of action?? {'A': 'Bring the cousin to the room and ask the patient if it is acceptable to disclose his course', 'B': 'Bring the cousin to the room and explain the plan to both the patient and cousin', 'C': "Explain that you cannot discuss the patient's care at this time", 'D': 'Explain the plan to discharge the patient in the next few days', 'E': "Tell the cousin that you do not know the patient's course well"},
|
C: Explain that you cannot discuss the patient's care at this time
|
Answer the following medical question with one of the provided options:
|
Q:A 58-year-old man presents with an occasional tremor in his left hand. While the tremor disappears when he moves his hand, he finds it increasingly difficult to type and feels his handwriting has gotten much smaller. He finds the tremor is more pronounced when he is stressed out at work. He also complains of a decrease in his sense of smell, mild constipation, difficulty sleeping, and increased urinary frequency – all of which he feels is him ‘just getting older’. No significant past medical history and no current medications. Vital signs are a pulse of 74/min, a respiratory rate of 14/min, a blood pressure of 130/70 mm Hg, and a temperature of 36.7°C (98.0°F). On physical examination, a resting tremor in the left hand is noted with mild rigidity in the upper limbs and mask-like faces. While performing finger-to-nose and rapid alternating movements, he has some difficulty. All his movements are slow. The sensation is intact. Gait is normal except for a decreased arm swing. Which of the following drugs acts directly on the receptors responsible for this patient’s condition?? {'A': 'Selegiline', 'B': 'Bromocriptine', 'C': 'Carbidopa', 'D': 'Benztropine', 'E': 'Entacapone'},
|
B: Bromocriptine
|
Answer the following medical question with one of the provided options:
|
Q:A 10-year-old boy is brought to the physician by his father, who is concerned because his son has been less interested in playing soccer with him recently. They used to play every weekend, but his son has started to tire easily and has complained of pain in his lower legs while running around on the soccer field. The boy has no personal or family history of serious illness. Cardiac examination shows a systolic ejection murmur best heard over the left sternal border that radiates to the left paravertebral region. An x-ray of the chest shows erosions of the posterior aspects of the 6th to 8th ribs. If left untreated, this patient is at greatest risk for which of the following?? {'A': 'Intracranial hemorrhage', 'B': 'Central cyanosis', 'C': 'Paradoxical embolism', 'D': 'Abdominal aortic aneurysm', 'E': 'Right heart failure'},
|
A: Intracranial hemorrhage
|
Answer the following medical question with one of the provided options:
|
Q:A 45-year-old woman comes to the physician because of progressive difficulty swallowing solids and liquids over the past 4 months. She has lost 4 kg (9 lb) during this period. There is no history of serious illness. She emigrated to the US from Panama 7 years ago. She does not smoke cigarettes or drink alcohol. Cardiopulmonary examination shows a systolic murmur and an S3 gallop. A barium radiograph of the chest is shown. Endoscopic biopsy of the distal esophagus is most likely to show which of the following?? {'A': 'Atrophy of esophageal smooth muscle cells', 'B': 'Presence of intranuclear basophilic inclusions', 'C': 'Infiltration of eosinophils in the epithelium', 'D': 'Absence of myenteric plexus neurons', 'E': 'Presence of metaplastic columnar epithelium'},
|
D: Absence of myenteric plexus neurons
|
Answer the following medical question with one of the provided options:
|
Q:A 51-year-old man is admitted to the hospital because of a 2-day history of fever, nausea, and abdominal pain. His temperature is 39.4°C (102.9°F) and pulse is 106/min. Physical examination shows tenderness in the right upper quadrant. Blood cultures grow nonhemolytic, gram-positive cocci that grow in hypertonic saline. Antibiotic sensitivity testing of the isolated organism shows that gentamicin has a minimum inhibitory concentration (MIC) of 16 μg/mL. The addition of ampicillin, which has an MIC of 2 μg/mL alone, decreases the MIC of gentamicin to 0.85 μg/mL. The decrease in the MIC of gentamicin with the addition of ampicillin is most likely due to which of the following mechanisms?? {'A': 'Additive bacteriostatic effect of ampicillin', 'B': 'Increase in the intracellular uptake of gentamicin', 'C': 'Stabilization of gentamicin binding at the target site', 'D': 'Inhibition of the acetylation of gentamicin', 'E': 'Sequential block of essential micronutrient synthesis'},
|
B: Increase in the intracellular uptake of gentamicin
|
Answer the following medical question with one of the provided options:
|
Q:A 5-year-old boy is brought to the physician because of a painful, burning rash on his left arm for 3 days. Three years ago, he was diagnosed with heart failure due to congenital heart disease and received an allogeneic heart transplantation. He takes cyclosporine to prevent chronic transplant rejection. He has not received any routine childhood vaccinations. A photograph of the rash is shown. Microscopic examination of a skin biopsy specimen is most likely to show which of the following findings?? {'A': 'Eosinophilic spongiosis and subepidermal blister formation', 'B': 'Multinucleated epidermal giant cells and intranuclear inclusions', 'C': 'Papillary microabscesses and granular deposits of IgA', 'D': 'Fungal hyphae and hyperkeratosis', 'E': 'Gram-positive cocci and spongiotic dermatitis'},
|
B: Multinucleated epidermal giant cells and intranuclear inclusions
|
Answer the following medical question with one of the provided options:
|
Q:A 58-year-old woman with refractory gastrointestinal complaints undergoes a bowel biopsy. On histology, the pathologist observes that submucosal glands of Brunner are present in the specimen. Which portion of the bowel was most likely biopsied?? {'A': 'Duodenum', 'B': 'Jejunum', 'C': 'Ileum', 'D': 'Cecum', 'E': 'Descending colon'},
|
A: Duodenum
|
Answer the following medical question with one of the provided options:
|
Q:A 65-year-old man is brought to the emergency department because of a 3-day history of increasing shortness of breath and chest pain. He has had a productive cough with foul-smelling sputum for 1 week. He has gastritis as well as advanced Parkinson disease and currently lives in an assisted-living community. He smoked one pack of cigarettes daily for 40 years but quit 5 years ago. He has a 30-year history of alcohol abuse but has not consumed any alcohol in the past 5 years. His temperature is 39.3°C (102.7°F), he is tachycardic and tachypneic and his oxygen saturation is 77% on room air. Auscultation of the lung shows rales and decreased breath sounds over the right upper lung field. Examination shows a resting tremor. Laboratory studies show: Hematocrit 38% Leukocyte count 17,000/mm3 Platelet count 210,000/mm3 Lactic acid 4.1 mmol/L (N=0.5–1.5) A x-ray of the chest shows infiltrates in the right upper lobe. Which of the following is the most significant predisposing factor for this patient's respiratory symptoms?"? {'A': 'Living in an assisted-living community', 'B': 'Tobacco use history', 'C': 'Past history of alcohol abuse', 'D': 'Gastritis', 'E': 'Parkinson disease\n"'},
|
E: Parkinson disease "
|
Answer the following medical question with one of the provided options:
|
Q:A 34-year-old man comes to the physician because of palpitations, shortness of breath, diarrhea, and abdominal cramps for 2 months. Physical examination shows cutaneous flushing of the face. Auscultation of the chest shows bilateral wheezing. A 24-hour urine collection shows increased 5-hydroxyindoleacetic acid (5-HIAA) concentration. A contrast-enhanced CT scan of the abdomen shows an intestinal tumor with extensive metastasis to the liver. A diagnosis of an inoperable disease is made and the patient is started on treatment with octreotide. Six weeks later, the patient's symptoms have improved except for his abdominal pain and frequent loose stools. The physician suggests enrolling the patient in a trial to test additional treatment with a new drug that has been shown to improve symptoms in other patients with the same condition. The expected beneficial effect of this new drug is most likely caused by inhibition of which of the following?? {'A': 'Dopamine β-hydroxylase', 'B': 'Vasoactive intestinal peptide', 'C': 'Plasma kallikrein', 'D': 'Histidine decarboxylase', 'E': 'Tryptophan hydroxylase'},
|
E: Tryptophan hydroxylase
|
Answer the following medical question with one of the provided options:
|
Q:A 16-year-old girl is brought to the physician because she has not attained menarche. There is no personal or family history of serious illness. She is 165 cm (5 ft 5 in) tall and weighs 60 kg (132 lb); BMI is 22 kg/m2. Breast development is Tanner stage 4, and pubic hair development is Tanner stage 1. Pelvic examination shows a blind vaginal pouch. This patient is most likely to have which of the following karyotypes?? {'A': '45,XO', 'B': '47,XYY', 'C': '46,XX', 'D': '46,XY', 'E': '47,XXY'},
|
D: 46,XY
|
Answer the following medical question with one of the provided options:
|
Q:A 22-year-old woman is brought to the emergency department after being struck by a car while crossing the street. She has major depressive disorder with psychosis. Current medications include sertraline and haloperidol. Vital signs are within normal limits. X-ray of the lower extremity shows a mid-shaft femur fracture. The patient is taken to the operating room for surgical repair of the fracture. As the surgeon begins the internal fixation, the patient shows muscle rigidity and profuse diaphoresis. Her temperature is 39°C (102.2°F), pulse is 130/min, respirations are 24/min, and blood pressure is 146/70 mm Hg. The pupils are equal and reactive to light. The end tidal CO2 is 85 mm Hg. Which of the following is the most appropriate treatment for this patient's condition?? {'A': 'Dantrolene therapy', 'B': 'Fat embolectomy', 'C': 'Cyproheptadine therapy', 'D': 'Bromocriptine therapy', 'E': 'Propranolol therapy'},
|
A: Dantrolene therapy
|
Answer the following medical question with one of the provided options:
|
Q:A previously healthy 10-year-old girl is brought to the physician because of severe malaise, pink eyes, cough, and a runny nose for 3 days. She recently immigrated from Sudan and immunization records are unavailable. Her temperature is 40.1°C (104.1°F). Examination shows bilateral conjunctival injections. There are multiple bluish-gray lesions on an erythematous buccal mucosa and soft palate. This patient is at increased risk for which of the following complications?? {'A': 'Immune thrombocytopenic purpura', 'B': 'Subacute sclerosing panencephalitis', 'C': 'Non-Hodgkin lymphoma', 'D': 'Transient arrest of erythropoiesis', 'E': 'Glomerular immune complex deposition\n"'},
|
B: Subacute sclerosing panencephalitis
|
Answer the following medical question with one of the provided options:
|
Q:A 54-year-old man with known end-stage liver disease from alcoholic cirrhosis presents to the emergency department with decreased urinary output and swelling in his lower extremities. His disease has been complicated by ascites and hepatic encephalopathy in the past. Initial laboratory studies show a creatinine of 1.73 mg/dL up from a previous value of 1.12 one month prior. There have been no new medication changes, and no recent procedures performed. A diagnostic paracentesis is performed that is negative for infection, and he is admitted to the hospital for further management and initiated on albumin. Two days later, his creatinine has risen to 2.34 and he is oliguric. Which of the following is the most definitive treatment for this patient's condition?? {'A': 'Cessation of alcohol use', 'B': 'Peritoneovenous shunt', 'C': 'Transjugular intrahepatic portosystemic shunt (TIPS)', 'D': 'Liver transplantation', 'E': 'Hemodialysis'},
|
D: Liver transplantation
|
Answer the following medical question with one of the provided options:
|
Q:A 37-year-old machinist presents to his primary care physician with eye problems. The patient states that he has had a mass in his eye that has persisted for the past month. The patient has a past medical history of blepharitis treated with eye cleansing and squamous cell carcinoma of the skin treated with Mohs surgery. His temperature is 99.5°F (37.5°C), blood pressure is 157/102 mmHg, pulse is 90/min, respirations are 17/min, and oxygen saturation is 98% on room air. Physical exam is notable for a firm and rubbery nodule palpable inside the patient's left eyelid. Physical exam does not elicit any pain. Which of the following is the most likely diagnosis?? {'A': 'Chalazion', 'B': 'Foreign body', 'C': 'Hordeolum', 'D': 'Ingrown eyelash follicle', 'E': 'Meibomian cell carcinoma'},
|
A: Chalazion
|
Answer the following medical question with one of the provided options:
|
Q:An 8-year-old boy is brought to the physician for evaluation of developmental delay and recurrent tonic-clonic seizures. There is no family history of seizures or other serious illness. Current medications include risperidone for hyperactivity. He is at the 17th percentile for head circumference. Examination shows protrusion of the mandible, strabismus, and a laughing facial expression. His gait is unsteady. He has a vocabulary of about 200 words and cannot speak in full sentences. Karyotype analysis shows a 46, XY karyotype without chromosomal deletions. Which of the following genetic mechanisms best explains this patient's findings?? {'A': 'Chromosome 22q11 microdeletion', 'B': 'De novo mutation of MECP2 on the X chromosome', 'C': 'Nondisjunction of chromosome 21 during meiosis I', 'D': 'Uniparental disomy of chromosome 15', 'E': 'Trinucleotide repeat in FMR1 gene'},
|
D: Uniparental disomy of chromosome 15
|
Answer the following medical question with one of the provided options:
|
Q:Twelve days after undergoing a cadaveric renal transplant for adult polycystic kidney disease, a 23-year-old man has pain in the right lower abdomen and generalized fatigue. During the past 4 days, he has had decreasing urinary output. Creatinine concentration was 2.3 mg/dL on the second postoperative day. Current medications include prednisone, cyclosporine, azathioprine, and enalapril. His temperature is 38°C (100.4°F), pulse is 103/min, and blood pressure is 168/98 mm Hg. Examination reveals tenderness to palpation on the graft site. Creatinine concentration is 4.3 mg/dL. A biopsy of the transplanted kidney shows tubulitis. C4d staining is negative. Which of the following is the most likely cause of this patient's findings?? {'A': 'Drug-induced nephrotoxicity', 'B': 'Donor T cells from the graft', 'C': 'Allorecognition with T cell activation', 'D': 'Irreversible fibrosis of the glomerular vessels', 'E': 'Preformed cytotoxic antibodies against class I HLA'},
|
C: Allorecognition with T cell activation
|
Answer the following medical question with one of the provided options:
|
Q:A 60-year-old man is rushed to the emergency room after he was found unconscious in bed that afternoon. The patient’s wife says he has been confused and irritable for the past several days. She says he has a history of chronic daily alcohol abuse and has been hospitalized multiple times with similar symptoms His temperature is 37°C (98.6°F), the blood pressure is 110/80 mm Hg, the pulse is 90/min, and the respiratory rate is 14/min. On physical examination, the patient is minimally responsive to painful stimuli. His abdomen is distended with positive shifting dullness. Laboratory results are as follows: Complete blood count Hematocrit 35% Platelets 100,000/mm3 White blood cells 5000/mm3 Liver function studies Serum Albumin 2 g/dL Alkaline phosphatase (ALP) 200 IU/L Aspartate aminotransferase (AST) 106 IU/L Alanine aminotransferase (ALT) 56 IU/L The patient is admitted to the hospital and started on the appropriate treatment to improve his mental status. Which of the following best describes the mechanism of action of the drug that is most likely used to treat this patient’s symptoms?? {'A': 'Prevents the conversion of ammonia into ammonium', 'B': 'Decreases the colonic concentration of bacteria', 'C': 'Increases ammonia production and absorption', 'D': 'Increases pH in the gastrointestinal lumen', 'E': 'Decreases pH in the gastrointestinal lumen'},
|
E: Decreases pH in the gastrointestinal lumen
|
Answer the following medical question with one of the provided options:
|
Q:A 41-year-old homeless man is brought to the emergency department complaining of severe fever, dizziness, and a persistent cough. The patient has a history of long-standing alcohol abuse and has frequently presented to the emergency department with acute alcohol intoxication. The patient states that his cough produces ‘dark brown stuff’ and he provided a sample for evaluation upon request. The patient denies having any other underlying medical conditions and states that he has no other symptoms. He denies taking any medications, although he states that he knows he has a sulfa allergy. On observation, the patient looks frail and severely fatigued. The vital signs include: blood pressure 102/72 mm Hg, pulse 98/min, respiratory rate 15/min, and temperature 37.1°C (98.8°F). Auscultation reveals crackles in the left upper lobe and chest X-ray reveals an infiltrate in the same area. Which of the following is the most appropriate treatment for this patient?? {'A': 'Vancomycin', 'B': 'Piperacillin-tazobactam', 'C': 'Clindamycin', 'D': 'Ciprofloxacin', 'E': 'Trimethoprim-sulfamethoxazole'},
|
D: Ciprofloxacin
|
Answer the following medical question with one of the provided options:
|
Q:A 28-year-old man is brought to the emergency department by ambulance after developing an altered mental state following blunt trauma to the head. The patient was competing at a local mixed martial arts competition when he was struck in the head and lost consciousness. A few minutes later, upon regaining consciousness, he had a progressive decline in mental status. Past medical history is noncontributory. Upon arrival at the hospital, the temperature is 37.0°C (98.6°F), the blood pressure is 145/89 mm Hg, the pulse is 66/min, the respiratory rate is 14/min, and the oxygen saturation is 99% on room air. He is alert now. A noncontrast CT scan is performed, and the result is provided in the image. Which of the following structures is most likely affected in this patient?? {'A': 'Bridging veins', 'B': 'Middle Meningeal artery', 'C': 'Subarachnoid space', 'D': 'Suprasellar cistern', 'E': 'Ventricular system'},
|
B: Middle Meningeal artery
|
Answer the following medical question with one of the provided options:
|
Q:An investigator is studying the efficacy of a new bisphosphonate analog in preventing hip fractures in patients above 60 years of age with risk factors for osteoporosis but no confirmed diagnosis. Participating patients were randomized to either pharmacologic therapy with the new bisphosphonate analog or a placebo. The results show: Hip fracture No hip fracture Pharmacologic therapy 3 97 No pharmacologic therapy 10 190 Based on this information, which of the following best represents the proportionate reduction in the risk of hip fractures brought about due to pharmacologic therapy, in comparison to the control group?"? {'A': '3%', 'B': '5%', 'C': '40%', 'D': '2%', 'E': '60%'},
|
C: 40%
|
Answer the following medical question with one of the provided options:
|
Q:A 44-year-old man presents to the emergency department with weakness. He states that he has felt progressively more weak over the past month. He endorses decreased libido, weight gain, and headaches. His temperature is 97.0°F (36.1°C), blood pressure is 177/108 mmHg, pulse is 80/min, respirations are 17/min, and oxygen saturation is 98% on room air. Physical exam is notable for an obese man who appears fatigued. He has abdominal striae, atrophied arms, and limbs with minimal muscle tone. His ECG is notable for a small upward deflection right after the T wave. A fingerstick blood glucose is 225 mg/dL. The patient is treated appropriately and states that he feels much better several hours later. Which of the following treatments could prevent this patient from presenting again with a similar chief complaint?? {'A': 'Eplerenone', 'B': 'Hydrochlorothiazide', 'C': 'Insulin', 'D': 'Metoprolol', 'E': 'Torsemide'},
|
A: Eplerenone
|
Answer the following medical question with one of the provided options:
|
Q:A 1-year-old boy is brought to the physician for a well-child examination. He has no history of serious illness. His older sister had an eye disease that required removal of one eye at the age of 3 years. Examination shows inward deviation of the right eye. Indirect ophthalmoscopy shows a white reflex in the right eye and a red reflex in the left eye. The patient is at increased risk for which of the following conditions?? {'A': 'Neuroblastoma', 'B': 'Basal cell carcinoma', 'C': 'Osteosarcoma', 'D': 'Gastric cancer', 'E': 'Wilms tumor'},
|
C: Osteosarcoma
|
Answer the following medical question with one of the provided options:
|
Q:A 67-year-old Caucasian female presents to her primary care physician after a screening DEXA scan reveals a T-score of -3.0. Laboratory work-up reveals normal serum calcium, phosphate, vitamin D, and PTH levels. She smokes 1-2 cigarettes per day. Which of the following measures would have reduced this patient's risk of developing osteoporosis?? {'A': 'Reduced physical activity to decrease the chance of a fall', 'B': 'Initiating a swimming exercise program three days per week', 'C': 'Intranasal calcitonin therapy', 'D': 'Calcium and vitamin D supplementation', 'E': 'Weight loss'},
|
D: Calcium and vitamin D supplementation
|
Answer the following medical question with one of the provided options:
|
Q:A 43-year-old man is brought to the emergency department 45 minutes after his wife found him on the floor sweating profusely. On arrival, he is lethargic and unable to provide a history. He vomited multiple times on the way to the hospital. His temperature is 37.3°C (99.1°F), pulse is 55/min, respirations are 22/min, and blood pressure is 98/65 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 80%. Examination shows profuse diaphoresis and excessive salivation. He withdraws his extremities sluggishly to pain. The pupils are constricted and reactive. Scattered expiratory wheezing and rhonchi are heard throughout both lung fields. Cardiac examination shows no abnormalities. There are fine fasciculations in the lower extremities bilaterally. Muscle strength is reduced and deep tendon reflexes are 1+ bilaterally. His clothes are soaked with urine and feces. Which of the following is the mechanism of action of the most appropriate initial pharmacotherapy?? {'A': 'Urine alkalization', 'B': 'Enteral binding', 'C': 'Competitive antagonism of mACh receptors', 'D': 'Non-selective α-adrenergic antagonism', 'E': 'Alkaloid emesis-induction'},
|
C: Competitive antagonism of mACh receptors
|
Answer the following medical question with one of the provided options:
|
Q:An 82-year-old woman visits her primary care provider complaining of a vague cramping pain on the right side of her abdomen for the past 6 hours. She is also and had an episode of vomiting earlier today and two episodes yesterday. Past medical history includes third-degree heart block, gastroesophageal reflux disease, hypertension, hypothyroidism and chronic cholecystitis with cholelithiasis. She is not a good candidate for cholecystectomy due to cardiac disease and is treated with analgesics and ursodeoxycholic acid. Her medications include chlorthalidone, omeprazole, levothyroxine, and occasional naproxen for pain. Vitals are normal. A supine abdominal X-ray reveals air in the gallbladder and biliary tree (saber sign), small bowel obstruction, and a large a radiolucent gallstone impacted in the small bowel. What is the most likely diagnosis?? {'A': 'Cholecystitis', 'B': 'Choledocolithiasis', 'C': 'Gallstone ileus', 'D': 'Primary biliary cholangitis', 'E': 'Small bowel perforation'},
|
C: Gallstone ileus
|
Answer the following medical question with one of the provided options:
|
Q:A 60-year-old man with a long-standing history of type 2 diabetes and hypertension managed with lisinopril and metformin presents with itchy skin. He also describes moderate nausea, vomiting, muscle weakness, and fatigue. The vital signs include: temperature 36.8°C (98.2°F), heart rate 98/min, respiratory rate 15/min, blood pressure 135/85 mm Hg, oxygen saturation 100% on room air. Physical exam is notable for pale conjunctivae, pitting edema, and ascites. Laboratory findings are shown below: BUN 78 mg/dL pCO2 25 mm Hg Creatinine 7.2 mg/dL Glucose 125 mg/dL Serum chloride 102 mmol/L Serum potassium 6.3 mEq/L Serum sodium 130 mEq/L Total calcium 1.3 mmol/L Magnesium 1.2 mEq/L Phosphate 1.9 mmol/L Hemoglobin 9.5 g/dL MCV 86 μm3 Bicarbonate (HCO3) 10 mmol/L Shrunken kidneys are identified on renal ultrasound. The doctor explains to the patient that he will likely need dialysis due to his significant renal failure until a renal transplant can be performed. The patient is concerned because he is very busy and traveling a lot for work. What is a potential complication of the preferred treatment?? {'A': 'Hypoglycemia', 'B': 'Hypotension', 'C': 'Muscle cramping', 'D': 'Hypertriglyceridemia', 'E': 'Excessive bleeding'},
|
D: Hypertriglyceridemia
|
Answer the following medical question with one of the provided options:
|
Q:A 35-year-old man is brought to the emergency department because of a 2-week history of abdominal cramps, vomiting, and constipation. He also reports having to urinate frequently and occasional leg pain. He has had similar episodes in the past. He has hypertension and peptic ulcer disease. Current medications include captopril and ranitidine. He appears depressed. Physical examination shows weakness in the extremities. Abdominal examination shows mild epigastric tenderness. There is no rebound or guarding. He has a restricted affect. Laboratory studies show elevated serum parathyroid hormone levels; serum calcium is 14.2 mg/dL. Abdominal ultrasonography shows multiple small calculi in the right kidney. Which of the following is most likely to provide rapid relief in this patient?? {'A': 'Intravenous pamidronate therapy', 'B': 'Reduction of dietary intake of calcium', 'C': 'Normal saline and intravenous furosemide therapy', 'D': 'Normal saline and intravenous fentanyl therapy', 'E': 'Normal saline and intravenous calcitonin therapy'},
|
E: Normal saline and intravenous calcitonin therapy
|
Answer the following medical question with one of the provided options:
|
Q:An obese 37-year-old woman is brought to the emergency department 2 hours after the onset of weakness in her left arm and leg. She fell from the stairs the day prior but did not have any loss of consciousness or nausea after the fall. She travels to Asia regularly on business; her last trip was 4 days ago. She has no history of serious illness. Her only medication is an oral contraceptive. Her temperature is 37.8°C (100°F), pulse is 113/min and regular, and blood pressure is 162/90 mm Hg. Examination shows decreased muscle strength on the left side. Deep tendon reflexes are 4+ on the left. Babinski sign is present on the left. The right lower leg is swollen, erythematous, and tender to palpation. Further evaluation is most likely to show which of the following?? {'A': 'Ventricular septal defect', 'B': 'Carotid artery dissection', 'C': 'Atrial fibrillation', 'D': 'Patent foramen ovale', 'E': 'Atrial myxoma'},
|
D: Patent foramen ovale
|
Answer the following medical question with one of the provided options:
|
Q:A 21-year-old female was brought to the emergency room after losing large amounts of blood from slicing her wrists longitudinally. A few days later, she was interviewed by the psychiatrist and discussed with him why she had tried to kill herself. "My evil boyfriend of 2 months left me because I never let him leave my side for fear that he would cheat on me and leave me...now I feel so empty without him." Which of the following personality disorders does this female most likely have?? {'A': 'Histrionic', 'B': 'Dependent', 'C': 'Avoidant', 'D': 'Borderline', 'E': 'Paranoid'},
|
D: Borderline
|
Answer the following medical question with one of the provided options:
|
Q:A 40-year-old man comes to the physician because of weight gain over the past 3 months. During this period, he has gained 10 kg (22 lb) unintentionally. He also reports decreased sexual desire, oily skin, and sleeping difficulties. There is no personal or family history of serious illness. He has smoked one pack of cigarettes daily for the past 10 years. The patient appears lethargic. His temperature is 37°C (98.6°F), pulse is 80/min, and blood pressure is 150/90 mm Hg. Physical examination shows central obesity, acne, and thin, easily bruisable skin with stretch marks on the abdomen. There is darkening of the mucous membranes and the skin creases. Examination of the muscles shows atrophy and weakness of proximal muscle groups. His serum glucose concentration is 240 mg/dL. Which of the following findings would most likely be present on imaging?? {'A': 'Pituitary microadenoma', 'B': 'Decreased thyroid size', 'C': 'Multiple kidney cysts', 'D': 'Adrenal carcinoma', 'E': 'Kidney tumor'},
|
A: Pituitary microadenoma
|
Answer the following medical question with one of the provided options:
|
Q:A 23-year-old man is brought to the emergency department by the police after attempting to assault a waiter with a broom. The patient states that the FBI has been following him his entire life and that this man was an agent spying on him. The patient has a past medical history of irritable bowel syndrome. His temperature is 98.0°F (36.7°C), blood pressure is 137/68 mmHg, pulse is 110/min, respirations are 15/min, and oxygen saturation is 99% on room air. Physical exam is deferred due to patient combativeness. The patient is given haloperidol and diphenhydramine. The patient is later seen in his room still agitated. Intraosseous access is obtained. Which of the following is the best next step in management?? {'A': 'Assess for suicidal ideation', 'B': 'Complete blood count', 'C': 'Syphilis screening', 'D': 'Thyroid stimulating hormone level', 'E': 'Urine toxicology'},
|
E: Urine toxicology
|
Answer the following medical question with one of the provided options:
|
Q:A 58-year-old woman presents to a physician with a painless swelling behind her right ear, which she noticed 1 month ago. She has no other complaint nor does she have any specific medical condition. On physical examination, her vital signs are stable. An examination of the right post-auricular area shows enlarged lymph nodes, which are non-tender and rubbery in consistency, with normal overlying skin. A detailed general examination reveals the presence of one enlarged axillary lymph node on the left side with similar features. Complete blood counts are within normal limits but atypical lymphocytes are present on the peripheral blood smear. The patient’s serum lactate dehydrogenase level is slightly elevated. Excisional biopsy of the lymph node is performed and histopathological examination of the tissue yields a diagnosis of follicular lymphoma. Further cytogenetic studies reveal that the condition is associated with overexpression of the BCL-2 gene. Which of the following cytogenetic abnormalities is most likely to be present?? {'A': 't(3;3)(q27;27)', 'B': 't(9;14)(p13;q32)', 'C': 't(11;14)(q13;q32)', 'D': 't(11;18)(q21;q21)', 'E': 't(14;18)(q32;q21)'},
|
E: t(14;18)(q32;q21)
|
Answer the following medical question with one of the provided options:
|
Q:A 72-year-old woman is brought in to the emergency department after her husband noticed that she appeared to be choking on her dinner. He performed a Heimlich maneuver but was concerned that she may have aspirated something. The patient reports a lack of pain and temperature on the right half of her face, as well as the same lack of sensation on the left side of her body. She also states that she has been feeling "unsteady" on her feet. On physical exam you note a slight ptosis on the right side. She is sent for an emergent head CT. Where is the most likely location of the neurological lesion?? {'A': 'Internal capsule', 'B': 'Midbrain', 'C': 'Pons', 'D': 'Medulla', 'E': 'Cervical spinal cord'},
|
D: Medulla
|
Answer the following medical question with one of the provided options:
|
Q:A 2300-g (5-lb 1-oz) male newborn is delivered to a 29-year-old primigravid woman. The mother has HIV and received triple antiretroviral therapy during pregnancy. Her HIV viral load was 678 copies/mL 1 week prior to delivery. Labor was uncomplicated. Apgar scores are 7 and 8 at 1 and 5 minutes respectively. Physical examination of the newborn shows no abnormalities. Which of the following is the most appropriate next step in management of this infant?? {'A': 'HIV antibody testing', 'B': 'Administer zidovudine, lamivudine and nevirapine', 'C': 'Administer lamivudine and nevirapine', 'D': 'Administer nevirapine', 'E': 'Administer zidovudine'},
|
E: Administer zidovudine
|
Answer the following medical question with one of the provided options:
|
Q:A 33-year-old woman comes to the physician 1 week after noticing a lump in her right breast. Fifteen years ago, she was diagnosed with osteosarcoma of her left distal femur. Her father died of an adrenocortical carcinoma at the age of 41 years. Examination shows a 2-cm, firm, immobile mass in the lower outer quadrant of the right breast. A core needle biopsy of the mass shows adenocarcinoma. Genetic analysis in this patient is most likely to show a defect in which of the following genes?? {'A': 'KRAS', 'B': 'TP53', 'C': 'BRCA1', 'D': 'PTEN', 'E': 'Rb'},
|
B: TP53
|
Answer the following medical question with one of the provided options:
|
Q:A 46-year-old African American man presents to the physician with dyspnea on exertion for the past 2 months. He also has occasional episodes of coughing at night. He says that he has been healthy most of his life. He is a non-smoker and a non-alcoholic. He does not have hypercholesterolemia or ischemic heart disease. His father died due to congestive heart failure. On physical examination, the pulse rate was 116/min, the blood pressure was 164/96 mm Hg, and the respiratory rate was 20/min. Chest auscultation reveals bilateral fine crepitations at the lung bases. A complete diagnostic work-up suggests a diagnosis of hypertension with heart failure due to left ventricular dysfunction. Which of the following drug combinations is most likely to benefit the patient?? {'A': 'Amlodipine-Atenolol', 'B': 'Amlodipine-Valsartan', 'C': 'Atenolol-Hydrochlorothiazide', 'D': 'Isosorbide dinitrate-Hydralazine', 'E': 'Metoprolol-Atorvastatin'},
|
D: Isosorbide dinitrate-Hydralazine
|
Answer the following medical question with one of the provided options:
|
Q:A 26-year-old woman comes to the physician for a pre-employment examination. She has no complaints. She has a history of polycystic ovarian syndrome. She exercises daily and plays soccer recreationally on the weekends. Her mother was diagnosed with hypertension at a young age. She does not smoke and drinks 2 glasses of wine on the weekends. Her current medications include an oral contraceptive pill and a daily multivitamin. Her vital signs are within normal limits. Cardiac examination shows a grade 1/6 decrescendo diastolic murmur heard best at the apex. Her lungs are clear to auscultation bilaterally. Peripheral pulses are normal and there is no lower extremity edema. An electrocardiogram shows sinus rhythm with a normal axis. Which of the following is the most appropriate next step in management?? {'A': 'Exercise stress test', 'B': 'No further testing', 'C': 'Transthoracic echocardiogram', 'D': 'X-ray of the chest', 'E': 'CT scan of the chest with contrast'},
|
C: Transthoracic echocardiogram
|
Answer the following medical question with one of the provided options:
|
Q:A 54-year-old man comes to the emergency department because of burning oral mucosal pain, chest pain, and shortness of breath that started one hour ago. He reports that the pain is worse when swallowing. Two years ago, he was diagnosed with major depressive disorder but does not adhere to his medication regimen. He lives alone and works as a farmer. He smokes 1 pack of cigarettes and drinks 6 oz of homemade vodka daily. The patient is oriented to person, place, and time. His pulse is 95/min, respirations are 18/min, and blood pressure is 130/85 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 95%. Examination of the oropharynx shows profuse salivation with mild erythema of the buccal mucosa, tongue, and epiglottis area. This patient has most likely sustained poisoning by which of the following substances?? {'A': 'Potassium hydroxide', 'B': 'Parathion', 'C': 'Morphine', 'D': 'Ethylene glycol', 'E': 'Amitriptyline'},
|
A: Potassium hydroxide
|
Answer the following medical question with one of the provided options:
|
Q:A 23-year-old man comes to the emergency department with an open wound on his right hand. He states that he got into a bar fight about an hour ago. He appears heavily intoxicated and does not remember the whole situation, but he does recall lying on the ground in front of the bar after the fight. He does not recall any history of injuries but does remember a tetanus shot he received 6 years ago. His temperature is 37°C (98.6°F), pulse is 77/min, and blood pressure is 132/78 mm Hg. Examination shows a soft, nontender abdomen. His joints have no bony deformities and display full range of motion. There is a 4-cm (1.6-in) lesion on his hand with the skin attached only on the ulnar side. The wound, which appears to be partly covered with soil and dirt, is irrigated and debrided by the hospital staff. Minimal erythema and no purulence is observed in the area surrounding the wound. What is the most appropriate next step in management?? {'A': 'Apposition of wound edges under tension + rifampin', 'B': 'Surgical treatment with skin graft + tetanus vaccine', 'C': 'Tension-free apposition of wound edges + sterile dressing', 'D': 'Application of moist sterile dressing + tetanus vaccine', 'E': 'Surgical treatment with skin flap + ciprofloxacin'},
|
D: Application of moist sterile dressing + tetanus vaccine
|
Answer the following medical question with one of the provided options:
|
Q:A 55-year-old man comes to the physician because of a 3-week history of intermittent burning epigastric pain. His pain improves with antacid use and eating but returns approximately 2 hours following meals. He has a history of chronic osteoarthritis and takes ibuprofen daily. Upper endoscopy shows a deep ulcer located on the posterior wall of the duodenal bulb. This ulcer is most likely to erode into which of the following structures?? {'A': 'Splenic vein', 'B': 'Pancreatic duct', 'C': 'Descending aorta', 'D': 'Gastroduodenal artery', 'E': 'Transverse colon'},
|
D: Gastroduodenal artery
|
Answer the following medical question with one of the provided options:
|
Q:A 29-year-old woman with Wolff-Parkinson-White syndrome presents to her cardiologist’s office for a follow-up visit. She collapsed at her job and made a trip to the emergency department 1 week ago. At that time, she received a diagnosis of atrial fibrillation with rapid ventricular response and hemodynamic instability. While in the emergency department, she underwent direct-current cardioversion to return her heart to sinus rhythm. Her current medications include procainamide. At the cardiologist’s office, her heart rate is 61/min, respiratory rate is 16/min, the temperature is 36.5°C (97.7°F), and blood pressure is 118/60 mm Hg. Her cardiac examination reveals a regular rhythm and a I/VI systolic ejection murmur best heard at the right upper sternal border. An ECG obtained in the clinic is shown. Which of the following is the most appropriate treatment to prevent further episodes of tachyarrhythmia?? {'A': 'Begin anticoagulation with warfarin', 'B': 'Begin anticoagulation with dabigatran', 'C': 'Add verapamil to her medication regimen', 'D': 'Refer her for electrophysiology (EP) study and ablation', 'E': 'Refer her for right heart catheterization'},
|
D: Refer her for electrophysiology (EP) study and ablation
|
Answer the following medical question with one of the provided options:
|
Q:A 43-year-old woman is brought to the emergency department for evaluation of worsening abdominal pain that suddenly started 2 hours ago. The patient also has nausea and has vomited twice. She has hypothyroidism, systemic lupus erythematosus, major depressive disorder, and chronic right knee pain. Current medications include levothyroxine, prednisone, fluoxetine, naproxen, and a chondroitin sulfate supplement. She appears distressed. Her temperature is 37.9°C (100.2°F), pulse is 101/min, and blood pressure is 115/70 mm Hg. Examination shows a rigid abdomen with rebound tenderness; bowel sounds are hypoactive. Laboratory studies show a leukocyte count of 13,300/mm3 and an erythrocyte sedimentation rate of 70 mm/h. An x-ray of the chest is shown. Which of the following is the most appropriate next step in management?? {'A': 'Peritoneal lavage', 'B': 'Esophagogastroduodenoscopy', 'C': 'Endoscopic retrograde cholangiopancreatography', 'D': 'Abdominal CT with contrast', 'E': 'Exploratory laparotomy'},
|
E: Exploratory laparotomy
|
Answer the following medical question with one of the provided options:
|
Q:A 67-year-old man is brought to the emergency department because of severe dyspnea and orthopnea for 6 hours. He has a history of congestive heart disease and an ejection fraction of 40%. The medical history is otherwise unremarkable. He appears confused. At the hospital, his blood pressure is 165/110 mm Hg, the pulse is 135/min, the respirations are 48/min, and the temperature is 36.2°C (97.2°F). Crackles are heard at both lung bases. There is pitting edema from the midtibia to the ankle bilaterally. The patient is intubated and admitted to the critical care unit for mechanical ventilation and treatment. Intravenous morphine, diuretics, and nitroglycerine are initiated. Which of the following is the most effective method to prevent nosocomial infection in this patient?? {'A': 'Condom catheter placement', 'B': 'Daily urinary catheter irrigation with antimicrobial agent', 'C': 'Daily oropharynx decontamination with antiseptic agent', 'D': 'Nasogastric tube insertion', 'E': 'Suprapubic catheter insertion'},
|
A: Condom catheter placement
|
Answer the following medical question with one of the provided options:
|
Q:A 24-year-old woman with no past medical history is post operative day 2 from a cesarean section that resulted in the birth of her first child. She begins to cry when she's told that today's lunch will be gluten-free. Although the patient feels "exhausted" and has had trouble sleeping, she deeply desires to return home and take care of her newborn. The patient denies any changes in concentration or suicidal thoughts now or during the pregnancy. What is the diagnosis and likely outcome?? {'A': 'Postpartum "blues"; her symptoms are likely self-limited', 'B': 'Postpartum depression; the patient will likely remain depressed for at least six more months', 'C': 'Major depressive episode; this patient is at high risk of recurrence', 'D': 'Postpartum psychosis; symptoms will resolve in time, but she needs treatment with antipsychotics, lithium, and/or antidepressants', 'E': 'Postpartum bipolar disorder; this patient will likely have future bipolar episodes'},
|
A: Postpartum "blues"; her symptoms are likely self-limited
|
Answer the following medical question with one of the provided options:
|
Q:A 48-year-old man comes to the physician because of a hypopigmented skin lesion on his finger. He first noticed it 4 weeks ago after cutting his finger with a knife while preparing food. He did not feel the cut. For the past week, he has also had fever, fatigue, and malaise. He has not traveled outside the country since he immigrated from India to join his family in the United States 2 years ago. His temperature is 38.7°C (101.7°F). Physical examination shows a small, healing laceration on the dorsal aspect of the left index finger and an overlying well-defined, hypopigmented macule with raised borders. Sensation to pinprick and light touch is decreased over this area. Which of the following is the most likely causal pathogen of this patient's condition?? {'A': 'Pseudomonas aeruginosa', 'B': 'Epidermophyton floccosum', 'C': 'Mycobacterium leprae', 'D': 'Leishmania donovani', 'E': 'Malassezia furfur'},
|
C: Mycobacterium leprae
|
Answer the following medical question with one of the provided options:
|
Q:A 57-year-old man presents to his primary care provider with progressive right foot swelling, redness, and malaise. He reports seeing a blister on his forefoot several months ago after he started using new work boots. He has dressed the affected area daily with bandages; however, healing has not occurred. He has a history of type 2 diabetes mellitus and stage 2 chronic kidney disease. He has smoked 20 to 30 cigarettes daily for the past 25 years. Vital signs are a temperature of 38.1°C (100.58°F), blood pressure of 110/70 mm Hg, and pulse of 102/minute. On physical examination, there is a malodorous right foot ulcer overlying the first metatarsophalangeal joint. Fluctuance and erythema extend 3 cm beyond the ulcer border. Moderate pitting edema is notable over the remaining areas of the foot and ankle. Which of the following is the best initial step for this patient?? {'A': 'Graded compression stockings', 'B': 'Superficial swabs', 'C': 'Antibiotics and supportive care', 'D': 'Endovascular intervention', 'E': 'Minor amputation'},
|
C: Antibiotics and supportive care
|
Answer the following medical question with one of the provided options:
|
Q:A 22-year-old woman presents to the doctor's office seeking evaluation for her recurrent urinary tract infections. She admits to urinary frequency and a burning sensation when urinating. This is her 3rd UTI in the past year. She has a history of generalized anxiety disorder for which she takes paroxetine. She is sexually active and has had multiple partners during the past year. The patient’s blood pressure is 116/72 mm Hg, the heart rate is 76/min, the respiratory rate is 12/min and the temperature is 36.8°C (98.2°F). On physical examination, she is alert and oriented to time, place, and person. There is no murmur. Her lungs are clear to auscultation bilaterally. Her abdomen is soft and non-tender to palpation. The distance from the urethra to anus is shorter than the average female her age. Urinalysis and urine culture results are provided: Urine culture results 200 CFUs of Escherichia coli (normal < 100 if symptomatic) Leukocyte esterase positive WBC 50-100 cells/hpf Nitrite positive RBC 3 cells/hpf Epithelial cells 2 cells/hpf pH 5.2 (normal 4.5–8) Which of the following recommendations would be most appropriate for this patient?? {'A': 'Trimethoprim-sulfamethoxazole, and urinating before and after intercourse', 'B': 'Urinating before and after intercourse', 'C': 'Cephalexin', 'D': 'Cranberry juice', 'E': 'Trimethoprim-sulfamethoxazole'},
|
A: Trimethoprim-sulfamethoxazole, and urinating before and after intercourse
|
Answer the following medical question with one of the provided options:
|
Q:A primary care physician who focuses on treating elderly patients is researching recommendations for primary, secondary, and tertiary prevention. She is particularly interested in recommendations regarding aspirin, as she has several patients who ask her if they should take it. Of the following, which patient should be started on lifelong aspirin as monotherapy for atherosclerotic cardiovascular disease prevention?? {'A': 'A 75-year-old male who had a drug-eluting coronary stent placed 3 days ago', 'B': 'A 67-year-old female who has diabetes mellitus and atrial fibrillation', 'C': 'A 45-year-old female with no health problems', 'D': 'An 83-year-old female with a history of a hemorrhagic stroke 1 year ago without residual deficits', 'E': 'A 63-year-old male with a history of a transient ischemic attack'},
|
E: A 63-year-old male with a history of a transient ischemic attack
|
Answer the following medical question with one of the provided options:
|
Q:A 60-year-old man presents with breathlessness for the past 3 months. His symptoms have been getting progressively worse during this time. He denies any history of cough, fever, or chest pain. He works at a local shipyard and is responsible for installing the plumbing aboard the vessels. His past medical history is significant for hypertension for which he takes metoprolol every day. He denies smoking and any illicit drug use. His pulse is 74/min, respiratory rate is 14/min, blood pressure is 130/76 mm Hg, and temperature is 36.8°C (98.2°F). Physical examination is significant for fine bibasilar crackles at the end of inspiration without digital clubbing. Which of the following additional findings would most likely be present in this patient?? {'A': 'Decreased diffusion lung capacity of CO', 'B': 'Decreased pulmonary arterial pressure', 'C': 'Increased pulmonary capillary wedge pressure', 'D': 'Increased residual lung volume', 'E': 'Reduced FEV1/FVC ratio'},
|
A: Decreased diffusion lung capacity of CO
|
Answer the following medical question with one of the provided options:
|
Q:A 2-year-old boy is presented to the pediatrician due to poor weight gain and easy fatigability. His mother states that the patient barely engages in any physical activity as he becomes short of breath easily. The prenatal and birth histories are insignificant. Past medical history includes a few episodes of upper respiratory tract infection that were treated successfully. The patient is in the 10th percentile for weight and 40th percentile for height. The vital signs include: heart rate 122/min and respirations 32/min. Cardiac auscultation reveals clear lungs and a grade 2/6 holosystolic murmur loudest at the left lower sternal border. The remainder of the physical examination is negative for clubbing, cyanosis, and peripheral edema. Which of the following is the most likely diagnosis in this patient?? {'A': 'Patent ductus arteriosus (PDA)', 'B': 'Atrial septal defect (ASD)', 'C': 'Ventricular septal defect (VSD)', 'D': 'Coarctation of aorta', 'E': 'Tetralogy of Fallot (TOF)'},
|
C: Ventricular septal defect (VSD)
|
Answer the following medical question with one of the provided options:
|
Q:On cardiology service rounds, your team sees a patient admitted with an acute congestive heart failure exacerbation. In congestive heart failure, decreased cardiac function leads to decreased renal perfusion, which eventually leads to excess volume retention. To test your knowledge of physiology, your attending asks you which segment of the nephron is responsible for the majority of water absorption. Which of the following is a correct pairing of the segment of the nephron that reabsorbs the majority of all filtered water with the means by which that segment absorbs water?? {'A': 'Distal convoluted tubule via aquaporin channels', 'B': 'Collecting duct via aquaporin channels', 'C': 'Thick ascending loop of Henle via passive diffusion following ion reabsorption', 'D': 'Proximal convoluted tubule via passive diffusion following ion reabsorption', 'E': 'Distal convoluted tubule via passive diffusion following ion reabsorption'},
|
D: Proximal convoluted tubule via passive diffusion following ion reabsorption
|
Answer the following medical question with one of the provided options:
|
Q:A 58-year-old male presents to his primary care physician for a check-up. He reports that he visited an urgent care clinic last week for seasonal allergies; he was instructed at that encounter to follow-up with his primary care doctor because his blood pressure measured at that time was 162/88. He denies any bothersome symptoms and reports that he feels well overall. The patient denies any past history of medical problems other than cholecystitis that was surgically treated over 30 years ago. On further probing through review of symptoms, the patient reports that he often feels 'shaky' when performing tasks; he reports that his hands shake whenever he attempts to eat or drink something and also when he writes. Vital signs obtained at the visit are as follows: T 37.2 C, HR 88, BP 154/96, RR 20, SpO2 98%. A second blood pressure reading 10 minutes after the first set of vitals shows a blood pressure of 150/94. Physical examination is overall unremarkable and does not reveal a resting tremor in either hand; however, when the patient is asked to pick up a pen to fill out insurance paperwork, you note a fine shaking in his right hand. Which of the following is the next best step in the management of this patient?? {'A': 'Instruction to begin a diet and exercise regimen', 'B': 'Referral to a neurologist', 'C': 'Initiate levodopa', 'D': 'Prescribe losartan', 'E': 'Start propranolol'},
|
E: Start propranolol
|
Answer the following medical question with one of the provided options:
|
Q:A 68-year-old man presents with a 3-month history of difficulty starting urination, weak stream, and terminal dribbling. The patient has no history of serious illnesses and is not under any medications currently. The patient’s father had prostate cancer at the age of 58 years. Vital signs are within normal range. Upon examination, the urinary bladder is not palpable. Further examination reveals normal anal sphincter tone and a bulbocavernosus muscle reflex. Digital rectal exam (DRE) shows a prostate size equivalent to 2 finger pads with a hard nodule and without fluctuance or tenderness. The prostate-specific antigen (PSA) level is 5 ng/mL. Image-guided biopsy indicates prostate cancer. MRI shows tumor confined within the prostate. Radionuclide bone scan reveals no abnormalities. Which of the following interventions is the most appropriate next step in the management of this patient?? {'A': 'Chemotherapy + androgen deprivation therapy', 'B': 'Finasteride + tamsulosin', 'C': 'Radiation therapy + androgen deprivation therapy', 'D': 'Radical prostatectomy + chemotherapy', 'E': 'Radical prostatectomy + radiation therapy'},
|
C: Radiation therapy + androgen deprivation therapy
|
Answer the following medical question with one of the provided options:
|
Q:A 55-year-old woman recently underwent kidney transplantation for end-stage renal disease. Her early postoperative period was uneventful, and her serum creatinine is lowered from 4.3 mg/dL (preoperative) to 2.5 mg/dL. She is immediately started on immunosuppressive therapy. On postoperative day 7, she presents to the emergency department (ED) because of nausea, fever, abdominal pain at the transplant site, malaise, and pedal edema. The vital signs include: pulse 106/min, blood pressure 167/96 mm Hg, respirations 26/min, and temperature 40.0°C (104.0°F). The surgical site shows no signs of infection. Her urine output is 250 mL over the past 24 hours. Laboratory studies show: Hematocrit 33% White blood cell (WBC) count 6700/mm3 Blood urea 44 mg/dL Serum creatinine 3.3 mg/dL Serum sodium 136 mEq/L Serum potassium 5.6 mEq/L An ultrasound of the abdomen shows collection of fluid around the transplanted kidney with moderate hydronephrosis. Which of the following initial actions is the most appropriate?? {'A': 'Continue with an ultrasound-guided biopsy of the transplanted kidney', 'B': 'Consider hemodialysis', 'C': 'Start on pulse steroid treatment or OKT3', 'D': 'Re-operate and remove the failed kidney transplant', 'E': 'Supportive treatment with IV fluids, antibiotics, and antipyretics'},
|
A: Continue with an ultrasound-guided biopsy of the transplanted kidney
|
Answer the following medical question with one of the provided options:
|
Q:A 40-year-old African American female with a past obstetrical history of para 5, gravida 4 with vaginal birth 4 weeks ago presents with the chief complaint of shortness of breath. On examination, the patient has an elevated jugular venous pressure, an S3, respiratory crackles, and bilateral pedal edema. Chest X-ray shows bronchial cuffing, fluid in the fissure, and a pleural effusion. Her ejection fraction is 38% on echocardiogram. Which of the following is a characteristic of the most likely diagnosis?? {'A': 'Conduction disorder', 'B': 'Hypertrophy', 'C': 'Infarction', 'D': 'Pericarditis', 'E': 'Ventricular dilatation'},
|
E: Ventricular dilatation
|
Answer the following medical question with one of the provided options:
|
Q:A 59-year-old man presents to a clinic with exertional chest pain for the past several months. He says the pain is central in his chest and relieved with rest. The physical examination is unremarkable. An electrocardiogram is normal, but an exercise tolerance test revealed ST-segment depression in chest leads V1-V4. He is prescribed nitroglycerin to be taken in the first half of the day. Which of the following statements best describes the reason behind the timing of this medication?? {'A': 'To prevent collapse', 'B': 'To avoid nitrate headache', 'C': 'More effective in patients with angina due to anemia', 'D': 'To prevent methemoglobinemia', 'E': 'To avoid nitrate tolerance'},
|
E: To avoid nitrate tolerance
|
Answer the following medical question with one of the provided options:
|
Q:A 39-year-old woman comes to the physician for difficulty sleeping and poor concentration at work. She sleeps with the lights turned on and wakes up frequently during the night with palpitations and profuse sweating. Three weeks ago she was sexually assaulted in her car. Since the assault she has avoided using her car and only uses public transportation. She also has nightmares of her attacker. She has been sent home from work for yelling at her coworkers. She has Hashimoto thyroiditis. Current medications include levothyroxine. She has been treated for pelvic inflammatory disease in the past. She has tried alcohol and melatonin to help her sleep. Mental status examination shows a depressed mood and a negative affect. Which of the following is the most likely diagnosis?? {'A': 'Acute stress disorder', 'B': 'Adjustment disorder', 'C': 'Post-traumatic stress disorder', 'D': 'Persistent complex bereavement disorder', 'E': 'Adverse effect of medication\n"'},
|
A: Acute stress disorder
|
Subsets and Splits
No community queries yet
The top public SQL queries from the community will appear here once available.