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Answer the following medical question with the correct letter choice:
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<<Question:>> A 5-year-old boy is brought to the physician because of facial swelling that started 5 days ago. Two weeks ago, he had a sore throat that resolved spontaneously. His temperature is 37°C (98.6°F), pulse is 107/min, and blood pressure is 94/67 mm Hg. Examination shows pitting edema of the upper and lower extremities as well as periorbital edema. The abdomen is mildly distended. Laboratory studies show: Hemoglobin 13.1 g/dL Serum Albumin 2.1 g/dL Total cholesterol 270 mg/dL Triglycerides 175 mg/dL Urine Blood negative Glucose negative Protein 4+ Leukocyte esterase negative A renal biopsy of this patient is most likely to show which of the following findings?" ---- <<Choices:>> A) Mesangial proliferation on light microscopy B) Subepithelial dense deposits on electron microscopy C) Deposits of IgG and C3 at the glomerular basement membrane on immunofluoresence D) Normal light microscopy findings ---- <<Answer:>>
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D
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 60-year-old man is referred to a dermatologist by his family physician for management of a rare case of dermatitis that has not responded to standard therapy with corticosteroids. The patient’s medical history is unremarkable, and he is currently working reduced hours at his job as an accountant. Physical examination reveals confluent scaly patches, plaques, and generalized erythroderma along the torso and lower extremities (see image). There is also a solid skin lesion with a diameter greater than 1 cm. The dermatologist suspects a malignancy and orders a biopsy. Which of the following is the most accurate description of this condition? ---- <<Choices:>> A) Vascular tumor containing spindle cells B) Tumor arising from the folliculosebaceous–apocrine germ C) Tumor arising from cutaneous T cells D) Tumor arising from epidermal keratinocytes ---- <<Answer:>>
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C
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 35-year-old woman comes to the physician because she has been feeling very stressed over the past several months. During this period, she has found it difficult to relax. She states that her head is full of worries. She works at an accountant's office and reports difficulty in concentrating on her work. She has been working longer shifts because one of her coworkers is on vacation and reports feeling more tired than usual. She is married and frequently fights with her husband. The patient states that in order to deal with her stress, she goes shopping. While shopping, she steals small trivial items and feels immediately relieved thereafter. She discards the objects she steals and has feelings of shame and guilt about her actions. Her husband is concerned about her behavior, but she is unable to stop shoplifting. Her vital signs are within normal limits. On mental status examination, she is oriented to person, place, and time. She reports feeling anxious. Physical examination shows no abnormalities. Which of the following is the most appropriate next step in management? ---- <<Choices:>> A) Administration of lithium B) Interpersonal therapy C) Psychodynamic psychotherapy D) Cognitive behavioral therapy ---- <<Answer:>>
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D
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 65-year-old man presents to his primary care physician for a change in his behavior over the past few months. Initially, the patient was noted to be behaving inappropriately including using foul language and grabbing people unexpectedly. This has progressed to a worsening of his memory and trouble caring for himself. His temperature is 98.1°F (36.7°C), blood pressure is 162/103 mmHg, pulse is 83/min, respirations are 13/min, and oxygen saturation is 98% on room air. Physical exam is notable for an elderly man who laughs inappropriately at times and who is a poor historian. When he is engaged in conversation, he exhibits word finding difficulty and is rather inattentive. Which of the following is the most likely diagnosis? ---- <<Choices:>> A) Alzheimer dementia B) Frontotemporal dementia C) Kluver-Bucy syndrome D) Vascular dementia ---- <<Answer:>>
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B
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Answer the following medical question with the correct letter choice:
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<<Question:>> An 11-month-old boy is brought to the clinic by his mother for a rash on his trunk, which he has had for the past 2 days. She notes that he is eating less and is more cranky than usual. His birth history is insignificant, and his immunizations are up to date. Vital signs include: temperature is 37.8°C (100.0°F), pulse is 98/min, and respiratory rate is 16/min. The rash features thin-walled, fluid-filled blisters that rupture easily. Fluid samples from the lesions are sent for analysis to a microbiology lab. The results reveal an infection by the gram-positive bacterium Staphylococcus aureus. The patient is diagnosed with staphylococcal scalded skin syndrome. Which of the following is involved with the primary defense in response to the bacteria and toxins produced by this organism? ---- <<Choices:>> A) Immunoglobulin- IgG B) Immunoglobulin- IgD C) Immunoglobulin- IgA D) Immunoglobulin- IgM ---- <<Answer:>>
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D
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 52-year-old man is brought to the emergency department with dry cough, shortness of breath, and low-grade fever that began 6 days ago. He also reports that he has had 3 episodes of watery diarrhea per day for the last 2 days. He appears slightly pale. His temperature is 38.0°C (100.4°F), pulse is 65/min, respirations are 15/min, and blood pressure is 140/78 mm Hg. Diffuse crackles are heard over bibasilar lung fields. Laboratory studies show: Hemoglobin 13.8 g/dL Leukocyte count 16,000/mm3 Platelet count 150,000/mm3 Serum Na+ 131 mEq/L Cl- 102 mEq/L K+ 4.7 mEq/L HCO3- 26 mEq/L Urea nitrogen 18 mg/dL Creatinine 1.2 mg/dL An x-ray of the chest shows patchy infiltrates in both lungs. Which of the following is the most appropriate pharmacotherapy?" ---- <<Choices:>> A) Levofloxacin B) Trimethoprim/sulfamethoxazole C) Amoxicillin D) Rifampin ---- <<Answer:>>
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A
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Answer the following medical question with the correct letter choice:
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<<Question:>> A transvaginal ultrasound shows an intrauterine heteroechoic mass with numerous anechoic spaces and no identifiable fetus or amniotic fluid. Both the ovaries are enlarged and have multiple thin-walled, septated cysts with clear content. Which of the following is the most likely cause of the ovarian findings? ---- <<Choices:>> A) Chocolate cysts B) Corpus luteum cysts C) Yolk sac tumor D) Theca leutein cysts ---- <<Answer:>>
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D
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 75-year-old woman is brought to the emergency department by her son because of a 2-day history of fever, headache, malaise, and dry cough. The patient lives with her son and his family and her son reports that other members of the family have had similar symptoms during the past week but that he has not had any symptoms. The result of a polymerase chain reaction test confirms that the woman is infected with a virus that has a helical capsid and a segmented genome. Which of the following is the most likely explanation for the son being free of symptoms? ---- <<Choices:>> A) Serum antibodies against hemagglutinin B) Downregulation of ICAM-1 expression C) Protease-resistant antibodies in nasal secretions D) Homozygous mutation in the CCR5 gene ---- <<Answer:>>
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A
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 71-year-old man comes to the physician for a routine visit. His psychiatric history is significant for major depression with psychotic features. He was diagnosed after his wife died from pancreatic cancer four years earlier. Three years ago, he deliberately overdosed on sleeping pills. Today, he feels well but still wakes up frequently at night and cannot sleep through the night. He lives alone in his apartment and has no children. He does not possess a firearm at home but has access to weapons at a local hunting club. The patient currently denies suicidal thoughts or thoughts of self-harm. He takes sertraline and olanzapine. He does not smoke or drink alcohol. Which of the following is the strongest risk factor for suicide in this patient? ---- <<Choices:>> A) Previous suicide attempt B) History of psychosis C) Sleeping disorder D) Age " ---- <<Answer:>>
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A
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 4-year-old boy is brought to the physician because of a generalized rash for 3 days. During this period, he has had severe itching and was not able to sleep well. He has also had fever, headache, and some muscle pain. Five days ago, he had a runny nose which subsided with over-the-counter medications. He returned from a camping trip 1 week ago. He attends a daycare center. The patient is at the 55th percentile for height and at the 50th percentile for weight. His temperature is 38.2°C (100.7°F), pulse is 97/min, and blood pressure is 96/60 mm Hg. Examination of the skin shows several macules, papules, and crusted lesions over his face, trunk, and extremities. There are a few fluid-filled vesicles over his abdomen and back. There is no cervical lymphadenopathy. The remainder of the examination shows no abnormalities. Which of the following is the most likely diagnosis? ---- <<Choices:>> A) Measles B) Urushiol-induced dermatitis C) Chickenpox D) Rubella ---- <<Answer:>>
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C
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 19-year-old man is brought to the emergency department by ambulance because of unusual behavior that started 3 hours ago while he was at a party. He has a history of major depressive disorder and seasonal allergies. His mother has a history of anxiety. He drinks 5 beers on the weekends. Current medications include amitriptyline and diphenhydramine. The patient does not respond to questions and repeatedly says, ""The government is following me everywhere."" His temperature is 37.9°C (100.2°F), pulse is 115/min, respirations are 24/min, and blood pressure is 160/89 mm Hg. He is diaphoretic. He is not oriented to place or time. Neurologic examination shows dilated pupils bilaterally and diffuse hyperreflexia. His feet are cold, and capillary refill time is 3 seconds. After the examination, the patient starts screaming and tries to bite the physician. Urine toxicology screening is positive for ethyl glucuronide. Which of the following is the most likely explanation for this patient's symptoms?" ---- <<Choices:>> A) Brief psychotic disorder B) Neuroleptic malignant syndrome C) Anticholinergic toxicity D) Synthetic cathinone intoxication ---- <<Answer:>>
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D
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 22-year-old male presents to the emergency room complaining of neck stiffness. He reports that his neck started “locking” three hours ago. He is now unable to move it. His past medical history is notable for schizophrenia and asthma and he currently takes albuterol as well as another medication whose name he does not remember. His temperature is 99.0°F (37.2°C), blood pressure is 130/90 mmHg, pulse is 105/min, and respirations are 18/min. On physical examination, the patient appears anxious and diaphoretic. He speaks in full sentences and is oriented to person, place, and time. The patient’s neck is flexed and rotated to the right approximately 40 degrees. The right sternocleidomastoid and trapezius are firm and contracted. Extraocular movements are full and intact. Upon further questioning, he reports that he took more medication four hours ago because he was hearing voices. Which of the following should most likely be administered to this patient? ---- <<Choices:>> A) Glycopyrrolate B) Benztropine C) Levodopa D) Dantrolene ---- <<Answer:>>
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B
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 13-month-old boy is brought to the physician for a well-child examination. Physical examination shows hepatosplenomegaly. A venous blood sample obtained for routine screening tests is milky. After refrigeration, a creamy supernatant layer appears on top of the sample. Genetic analysis shows a mutation in the apolipoprotein C-II gene (APOC2) on chromosome 19. This patient is at greatest risk for developing which of the following complications? ---- <<Choices:>> A) Acute pancreatitis B) Myocardial infarction C) Corneal arci D) Cerebrovascular accident ---- <<Answer:>>
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A
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 41-year-old man comes to the emergency department with nausea, abdominal discomfort, and diarrhea for the past 2 days. His abdominal discomfort is worse shortly after meals. He has also had progressive perioral numbness and upper-extremity muscle cramping for the past 24 hours. Six months ago, he underwent a Roux-en-Y gastric bypass to treat obesity. He underwent a total thyroidectomy to treat a Hurthle cell lesion 4 days ago. His mother died of lung cancer at age 68. He has smoked 1 pack of cigarettes daily for 22 years. His only current medication is a multivitamin supplement. He appears fatigued. His temperature is 36°C (96.8°F), pulse is 72/min, respirations are 20/min, and blood pressure is 130/70 mm Hg. While measuring the patient's blood pressure, the nurse observes spasm of the patient's hand. Physical examination shows a well-healing surgical wound on the neck. The abdomen is mildly tender to palpation with well-healed laparoscopic incisional sites. The remainder of the examination shows no abnormalities. Serum studies show: Na+ 138 mEq/L K+ 4.2 mEq/L Cl- 102 mEq/L HCO3- 25 mEq/L Mg2+ 1.7 mEq/L Phosphorus 4.3 mg/dL 25-hydroxyvitamin D 20 ng/mL (N: 20-100 ng/mL) Parathyroid hormone 115 pg/mL Total bilirubin, serum 0.7 mg/dL Alanine aminotransferase, serum 14 U/L Aspartate aminotransferase, serum 15 U/L Alkaline phosphatase, serum 42 U/L Which of the following is the most appropriate initial step in the management of this patient?" ---- <<Choices:>> A) Obtain abdominal CT B) Begin rehydration therapy C) Administer calcium gluconate D) Supplementation with vitamin D ---- <<Answer:>>
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C
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 9-year-old boy is brought to a physician by his mother for evaluation of generalized weakness, increased urination, and increased thirst. The mother mentions that her boy is always tired, and seems to be getting worse. He prefers watching television rather than going out and playing with other kids. Furthermore, he has had frequent episodes of constipation since birth. Except for frequent cravings for salty foods, the boy eats a regular diet. The patient was delivered healthy and is fully immunized. The medical history is unremarkable, and he takes no medications. He has no siblings. His father is a banker and his mother is a librarian. The pulse is 90/min, the blood pressure is 110/75 mm Hg, and the respiratory rate is 15/min. He is in the bottom 10th percentile for height and weight according to his age. The remainder of the physical examination is unremarkable. He recently had a urinalysis that showed elevated urinary calcium excretion. Additional lab testing results are as follows: Serum electrolytes Sodium 135 mEq/L Potassium 3.2 mEq/L Chloride 95 mEq/L Plasma renin activity 10 ng/mL/hr (normal, 0.5–3.3 ng/mL/hr) Plasma aldosterone concentration 20 ng/dL (normal, 2–9 ng/dL) What is the most likely diagnosis? ---- <<Choices:>> A) Renal artery stenosis B) Bartter's syndrome C) Pheochromocytoma D) Gitelman's syndrome ---- <<Answer:>>
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B
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 5-year-old boy of African descent is presented to the emergency department by his parents. The child is clutching his abdomen and crying about pain in his belly. His mother reports intermittent episodes of jaundice with joint and bone pain since he was 5 months old. At presentation, the patient’s vital signs are within normal limits. Physical examination reveals slight jaundice and pale conjunctiva. The spleen is tender and easily palpable. After a complete blood count with differential and an abdominal ultrasound, the patient is found to have sickle-cell disease with splenic infarct. A partial splenectomy is performed. After the operation, the physician provides vaccines against Neisseria meningitidis, Haemophilus influenzae, and Streptococcus pneumoniae. The picture shows a slide obtained from the resected portion of the patient’s spleen. Dysfunction of the zone marked with which number predisposes the patient to the aforementioned infections? ---- <<Choices:>> A) 2 only B) 1 only C) 1 and 2 D) 1, 2, and 3 ---- <<Answer:>>
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C
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 51-year-old woman presents to her primary care physician complaining of months of dry mouth and dry eyes. She says the dryness has become so severe that she has difficulty swallowing food. She has a history of hypertension, for which she takes hydrochlorothiazide (HCTZ), but she has no other medical problems. Family history is significant for her grandmother having systemic lupus erythematosus. The vital signs include: blood pressure 118/76 mm Hg, heart rate 78/min, and respiratory rate 15/min. On physical exam, she has tender parotid glands bilaterally and dries mucous membranes. The presence of serum anti-Ro and anti-La autoantibodies is confirmed at high titers. In addition to her primary diagnosis, which of the following is this patient most at risk for developing in the future? ---- <<Choices:>> A) Gastric carcinoma B) Non-Hodgkin lymphoma C) Invasive ductal carcinoma of the breast D) Adenocarcinoma of the lung ---- <<Answer:>>
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B
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 59-year-old man presents to his primary care provider with fatigue, a progressively worsening cough with flecks of blood, shortness of breath, and dark urine. He reports feeling ill for the past 3 weeks. Past medical history is significant for hypertension and hyperlipidemia. He takes chlorthalidone and atorvastatin. Family history is noncontributory. He has smoked 20–30 cigarettes daily for the past 26 years. Anti-glomerular basement membrane serologies are positive. Which of the following is a specific feature for this patient’s condition? ---- <<Choices:>> A) Granulomatous inflammation and necrotizing vasculitis B) Positive cryoglobulins C) Linear IgG staining on immunofluorescence D) Longitudinal splitting and thickening of the glomerular basement membrane ---- <<Answer:>>
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C
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 32-year-old man with HIV infection is brought to the emergency department by his roommate because of a 2-week history of progressively worsening headache and vomiting. Current medications include trimethoprim-sulfamethoxazole, dolutegravir, and tenofovir-emtricitabine. His temperature is 38.5°C (101.3°F). Physical examination shows nuchal rigidity. Kernig and Brudzinski signs are present. A lumbar puncture is performed and shows an opening pressure of 32 cm H2O (N: < 20). The pathogen isolated from the cerebrospinal fluid (CSF) can be cultured on Sabouraud agar. Further evaluation of this patient's CSF is most likely to show which of the following additional findings? ---- <<Choices:>> A) Positive latex agglutination test B) Positive PCR for HSV-2 DNA C) Presence of tachyzoites D) Increased adenosine deaminase concentration ---- <<Answer:>>
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A
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 70-year-old woman comes to the physician for the evaluation of back pain. For the past six days, she has had a burning pain in her upper right back and chest. She cannot recall any recent injury and has no prior history of back pain. She has a history of hypertension and gastroesophageal reflux. The patient volunteers at an animal shelter three times a week. She does not smoke or drink alcohol. Current medications include ramipril and pantoprazole. The patient appears healthy and well nourished. Her temperature is 36.9°C (98.42°F), pulse is 76/min, and blood pressure is 145/92 mm Hg. Examination shows a long erythematous rash covered with multiple clear vesicles and crusty lesions extending from her back to below her right breast. Which of the following is the most likely underlying mechanism of the disease? ---- <<Choices:>> A) Viral reactivation in dorsal root ganglia B) IgA deposits in the upper dermis C) Bacterial lymphatic infection of the epidermis D) Infestation with bloodsucking parasites ---- <<Answer:>>
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A
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Answer the following medical question with the correct letter choice:
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<<Question:>> A type of fatal adrenal cancer has an average survival rate of 3 years after the onset of clinically significant symptoms. It is determined that patients have a 4-year asymptomatic period prior to developing clinical symptoms from this adrenal cancer. A new screening test is developed, and the cancer can now be detected 2 years prior to developing clinical symptoms. A new observational case-control study of screened and unscreened patients measures the median 5-year survival of patients who decline medical and surgical treatment. The screened population has statistically better outcomes. Which step should be undertaken to prevent bias in these conclusions? ---- <<Choices:>> A) Using survival rates in the analysis B) Using mortality rates in the analysis C) Increasing the number of screened individuals D) Decreasing the number of screened individuals ---- <<Answer:>>
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B
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 60-year-old man presents to the office for shortness of breath. The shortness of breath started a year ago and is exacerbated by physical activity. He has been working in the glass manufacturing industry for 20 years. His vital signs include: heart rate 72/min, respiratory rate 30/min, and blood pressure 130/80 mm Hg. On physical exam, there are diminished respiratory sounds on both sides. On the chest radiograph, interstitial fibrosis with reticulonodular infiltrate is found on both sides, and there is also an eggshell calcification of multiple adenopathies. What is the most likely diagnosis? ---- <<Choices:>> A) Berylliosis B) Silicosis C) Asbestosis D) Talcosis ---- <<Answer:>>
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B
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 43-year-old woman is brought to the emergency department by her brother for severe chest pain. The patient recently lost her husband in a car accident and is still extremely shocked by the event. On physical examination, her blood pressure is 105/67 mm Hg, the heart rate is 96/min and regular, breathing rate is 23/min, and the pulse oximetry is 96%. An S3 heart sound and rales in the lower right and left lung lobes are heard. A 12-lead ECG shows no significant findings. Echocardiography shows an enlarged left ventricle and left atrium. The patient is stabilized and informed about the diagnosis and possible treatment options. Which of the following is the most likely diagnosis? ---- <<Choices:>> A) Atrial fibrillation B) Constrictive pericarditis C) Takotsubo cardiomyopathy D) Restrictive cardiomyopathy ---- <<Answer:>>
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C
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 56-year-old man is brought to the emergency department. He was found unconscious on the street. The staff recognizes him as a local homeless man with a long history of alcoholism. At the hospital, his pulse is 95/min, the blood pressure is 110/70 mm Hg, the respirations are 20/min, and the oxygen saturation is 98% on room air. On physical exam, the unconscious man is covered in bloody vomit with small clots and food particles. He smells of alcohol. A digital exam reveals black tarry stool in the rectal vault. The patient is given oxygen, IV fluids, and an NG-tube is placed and set to intermittent suction. Labs are sent and the patient is prepared for a procedure. Which of the following is the most appropriate next step in his management? ---- <<Choices:>> A) Undergo colonoscopy B) Undergo upper GI endoscopy C) Proton pump inhibitors with anti-H.pylori regimen D) Surgery for peptic ulcer disease ---- <<Answer:>>
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B
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Answer the following medical question with the correct letter choice:
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<<Question:>> An 8-year-old girl comes to the physician because of a 2-day history of hematuria. Two weeks ago, she had a sore throat that resolved without treatment. Physical examination shows 1+ pitting edema of the lower legs and ankles. Urinalysis shows numerous RBCs and 3+ proteinuria. Her antistreptolysin O titer is elevated. Formation of which of the following is most likely involved in the underlying mechanism of this patient's symptoms? ---- <<Choices:>> A) Antigen-specific IgE binding to mast cells B) Tissue-specific antibodies C) Antigen-antibody complexes D) Presensitized CD8+ cytotoxic T-cells ---- <<Answer:>>
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C
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 25-year-old man presents to the emergency department with altered mental status. He was found down in the middle of the street. His past medical history is unknown. His temperature is 99.0°F (37.2°C), blood pressure is 104/64 mmHg, pulse is 70/min, respirations are 5/min, and oxygen saturation is 91% on room air. The patient is being resuscitated in the trauma bay. Which of the following was most likely to be found on exam? ---- <<Choices:>> A) Ataxia B) Conjunctival injection C) Miosis D) Nystagmus ---- <<Answer:>>
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C
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 38-year-old G4P3 presents to her obstetrician’s office for her 20-week anatomy ultrasound. She reports that she feels well and has not experienced any contractions or vaginal bleeding. She also reports good fetal movement. The patient declined prenatal screening earlier in the pregnancy for religious reasons but would now like an anatomy ultrasound to ensure the fetus is growing appropriately. The patient’s previous pregnancies were uncomplicated, and she delivered three healthy babies at full term. On the ultrasound, the technician observes a male fetus with likely intrauterine growth restriction (IUGR). She also notes microcephaly, convex-rounded feet, and clenched fists with overlapping fingers. The technician further notes a medium-sized ventricular septal defect (VSD). The amniotic fluid index (AFI) is 26 cm. Which of the following additional findings is most likely to be observed in this fetus? ---- <<Choices:>> A) Cleft palate B) Epicanthal folds C) Micropthlamia D) Prominent occiput ---- <<Answer:>>
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D
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Answer the following medical question with the correct letter choice:
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<<Question:>> An 83-year-old man is admitted to the hospital with fever, weakness, and decreased responsiveness. He is diagnosed with urosepsis based on urinalysis and culture and started on ceftriaxone and intravenous fluids. By hospital day 3, he is clinically improving. During the evening, the patient becomes irritable. He is talking to someone despite nobody being present in the room. He is easily agitated and attempts to strike a nurse with a remote control to his TV. Subsequently, the patient keeps getting out of bed and trying to walk away despite being a fall risk. Which of the following is the most appropriate next step in management? ---- <<Choices:>> A) Diphenhydramine B) Lorazepam C) Olanzapine D) Physical restraints ---- <<Answer:>>
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C
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 26-year-old woman comes to the physician because of fatigue, weight loss, and muscle aches during the past 2 months. There is no personal or family history of serious illness. Her only medication is a multivitamin. A metyrapone stimulation test is performed and the results rule out a diagnosis of adrenal insufficiency. Which of the following changes in laboratory findings are most likely to have been observed in this patient following the administration of the drug? ---- <<Choices:>> A) Increase in serum ACTH B) Decrease in urinary 17-hydroxycorticosteroids C) Decrease in serum 11-deoxycortisol D) Increase in serum cortisol ---- <<Answer:>>
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A
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<<Question:>> An investigator conducts a study to determine whether earlier detection of glioblastoma multiforme (GBM) in patients increases survival time. One subset of study participants consists of asymptomatic individuals who were diagnosed with GBM after undergoing a screening MRI of the brain. The other subset of study participants was diagnosed with GBM only after they developed symptoms. Results from the study show that the asymptomatic patients who were diagnosed with screening MRI had an average survival time that was 6 weeks longer than that of the patients who were diagnosed after symptom onset. Which of the following statistical biases is most likely to have occurred as a result of the endpoint selected for this study? ---- <<Choices:>> A) Observer-expectancy bias B) Length-time bias C) Surveillance bias D) Lead-time bias ---- <<Answer:>>
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D
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 23-year-old man is brought to the emergency department 25 minutes after being involved in a high-speed motor vehicle collision in which he was the restrained driver. On questioning by the paramedics, he reported severe chest pain and mild dyspnea. On arrival, he is confused and unable to provide a history. His pulse is 93/min, respirations are 28/min, and blood pressure is 91/65 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 88%. He is able to move his extremities in response to commands. He opens his eyes spontaneously. Pupils are equal and reactive to light. Examination shows multiple bruises over the trunk and extremities. There is a 3-cm (1.2-in) wound at the left fifth intercostal space at the midclavicular line. There is jugular venous distention. Decreased breath sounds and hyperresonance on percussion are noted on the left. Which of the following is the most appropriate next step in management? ---- <<Choices:>> A) CT scan of the chest B) Bronchoscopy C) Emergency thoracotomy D) Needle decompression ---- <<Answer:>>
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D
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<<Question:>> A novel type of PET radiotracer is being developed to evaluate patients with Parkinson’s disease. A clinical research study has enrolled 1,200 patients, half of whom have the disease. The scan is found to be positive in 590 of the 600 patients with known PD, and positive in 20 of the 600 patients without PD. What is the test’s overall specificity? ---- <<Choices:>> A) 580 / (20 + 590) B) 580 / (10 + 580) C) 590 / (590 + 10) D) 580 / (580 + 20) ---- <<Answer:>>
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D
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<<Question:>> A 55-year-old man presents to a rheumatologist with bilateral wrist and knee pain that has been present for the last 10 years. The patient was a professional athlete who retired at age 50. He also notes morning stiffness in his joints that lasts approx. 50 minutes. He denies joint swelling, color changes in his digits, dryness of mucous membranes, and constitutional symptoms such as fever and chills. On physical exam, the physician notes several non-tender nodules on the left 1st, 3rd, and 4th distal interphalangeal joints. There is also tenderness with palpation at the base of both thumbs. The patient’s knees are enlarged, bilaterally, and he has pain and crepitus on passive range of motion. Which of the following is the most likely diagnosis? ---- <<Choices:>> A) Ankylosing spondylitis B) Gout C) Osteoarthritis D) Fibromyalgia ---- <<Answer:>>
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C
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<<Question:>> A 40-year-old businessman who was previously well is brought into the emergency department by his assistant with a complaint of left-sided weakness after a chiropractic neck manipulation. He has never felt like this before. Past medical history is insignificant. His blood pressure is 125/75 mm Hg, pulse 86/min, respiratory rate 13/min, temperature 36.8°C (98.2°F). A T2-weighted MRI shows a left C5 hemicord lesion. The patient is treated with cervical immobilization, a course of steroids, and physical therapy. What other finding will most likely be seen in this patient? ---- <<Choices:>> A) Spastic paralysis at the level of lesion B) Right-sided Horner's syndrome C) Contralateral corticospinal tract involvement D) Right-sided analgesia ---- <<Answer:>>
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D
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<<Question:>> A previously healthy 19-year-old man comes to the physician with right-sided, dull, throbbing scrotal pain for 12 hours. He has also had a burning sensation on urination and increased urinary frequency for the past 3 days. He has not had urethral discharge. He is sexually active with one female partner and does not use condoms. Vital signs are within normal limits. Physical examination shows a tender right testicle; lifting it provides relief. The penis appears normal, with no discharge at the meatus. Laboratory studies show a normal complete blood count; urinalysis shows 3 WBC/hpf. A Gram stain of a urethral swab shows polymorphonuclear leukocytes but no organisms. Testicular ultrasound shows increased blood flow to the right testicle compared to the left. Which of the following is the most likely cause of this patient's symptoms? ---- <<Choices:>> A) Neisseria gonorrhoeae infection B) Testicular tumor C) Chlamydia trachomatis infection D) Varicocele ---- <<Answer:>>
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C
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 4-month-old infant is brought to the office by his parents due to sudden nose bleeding without trauma of any kind. He has a 1-month history of multiple bruising that measures 1 cm in diameter each in the hands and feet, and tiny red spots that appeared in the upper and lower extremities without any trauma either. He has no prior bleeding history nor any relevant family history. The vital signs include: heart rate 190/min, respiratory rate 40/min, blood pressure 99/42 mm Hg, and temperature 36.6 °C (97.9 °F). His physical exam shows pale skin color, petechiae in the soft palate and in the upper and lower extremities as well as ecchymosis in the back of the hands and feet. The complete blood count results are as follows: Hemoglobin 8.9 g/dL Hematocrit 41% Leukocyte count 10,500/mm3 Neutrophils 53% Bands 2% Eosinophils 1% Basophils 0% Lymphocytes 33% Monocytes 2% Platelet count 450,000/mm3 The coagulation test results are as follows: Partial thromboplastin time (activated) 30.0 sec Prothrombin time 13.6 sec International normalized ratio 0.99 Fibrinogen 364.9 mg/dL The blood smear shows hypochromia, poikilocytosis, and large platelets, while a platelet aggregation test with ristocetin is normal. The overall bleeding time is increased. What is the most likely cause of this patient’s condition? ---- <<Choices:>> A) Von Willebrand disease B) Glanzmann’s thrombasthenia C) Bernard-Soulier disease D) Scurvy ---- <<Answer:>>
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B
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<<Question:>> A 6-year-old boy is brought to the physician by his mother because of a 2-day history of dysuria and increased urinary frequency. Vital signs are within normal limits. Urinalysis shows cloudy, red urine. This patient's clinical presentation is best explained by an infection with a virus with which of the following features? ---- <<Choices:>> A) Non-enveloped with linear, single-stranded DNA B) Non-enveloped with linear, single-stranded RNA C) Enveloped with linear, single-stranded RNA D) Non-enveloped with linear, double-stranded DNA ---- <<Answer:>>
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D
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<<Question:>> A 13-year-old boy is brought to his pediatrician due to a left breast lump under his nipple. He noticed it last month and felt that it has increased slightly in size. It is tender to touch but has no overlying skin changes. There is no breast discharge. The patient has cryptorchidism as an infant and underwent a successful orchiopexy. In addition, he was recently diagnosed with ADHD and is currently on methylphenidate with improvement in his symptoms. He has a family history of type I diabetes in his father and breast fibroadenoma in his mother. On exam, the patient is at the 82nd percentile for height, 79th percentile for weight, and 80th percentile for BMI. He has tanner IV pubic hair. Testicular volume is 7 mL on each side, and both testes are smooth and freely mobile. Breast exam shows a normal right breast and a 3-centimeter round, firm, and slightly tender discrete mass under the left nipple. Which of the following is the most likely etiology of this patient’s condition? ---- <<Choices:>> A) Klinefelter syndrome B) Glandular tissue enlargement C) Lipomastia (pseudogynecomastia) D) Testicular cancer ---- <<Answer:>>
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B
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<<Question:>> A 35-year-old Caucasian female presents to the emergency room with unilateral leg swelling. She reports that she developed painful left-sided leg swelling and redness earlier in the day. She is otherwise healthy and takes no medications. She denies any recent prolonged travel. She experienced a similar episode affecting the opposite leg one year ago and was diagnosed with a thrombus in the right femoral vein. On examination, the left leg is erythematous and swollen. Passive dorsiflexion of the left ankle elicits pain in the left calf. Ultrasound of the leg reveals a thrombus in the left popliteal vein. A genetic workup reveals that she has an inherited condition. What is the most likely pathophysiology of this patient’s condition? ---- <<Choices:>> A) Elevated serum homocysteine B) Thrombin inhibitor deficiency C) Auto-antibodies directed against phospholipids D) Resistance to clotting factor degradation ---- <<Answer:>>
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D
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<<Question:>> A 78-year-old man is brought to the physician by his daughter because of increasing forgetfulness over the past 5 weeks. He had been living independently but came to live with his daughter temporarily after he complained that he was unable to perform some of his daily activities. He has left the front door wide open and tap water running on multiple occasions. He does not sleep well and wakes up 6–7 times during the night. He does not leave his room and rarely makes conversation with his daughter. He says that he used to enjoy playing the piano but has not played for several months. He has hypertension treated with amlodipine. Vital signs are within normal limits. Mental status examination shows orientation to person, place, and time and psychomotor retardation. He has a blunted affect. Short- and long-term memory is impaired. Attention and concentration are impaired. Neurologic examination shows no focal findings. Serum concentration of electrolytes, thyroid-stimulating hormone, and vitamin B12 are within the reference range. He is very concerned about his memory lapses. Which of the following is the most appropriate treatment for this patient? ---- <<Choices:>> A) Fluoxetine B) Aspirin C) Ventriculoperitoneal shunt D) Memantine ---- <<Answer:>>
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A
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<<Question:>> A previously healthy 18-month-old boy is brought to the physician by his parents for evaluation of an abdominal mass noticed a few days ago. He appears markedly pale and lethargic. Examination shows a 6-cm, nonmobile mass in the left upper quadrant that crosses the midline. 24-hour urine collection shows elevated homovanillic acid and vanillylmandelic acid. Further evaluation including biopsy confirms the diagnosis of intermediate-risk neuroblastoma. The physician recommends the established standard treatment, which is initiation of neoadjuvant chemotherapy followed by surgical resection, if possible. After a thorough discussion of the risks and benefits of chemotherapy, the likelihood of unresectability without neoadjuvant treatment, and the prognosis without it, the patient's parents steadily refuse chemotherapy because they do not want their son to suffer the side effects. They prefer to take their son home for supportive care only. Which of the following is the most appropriate action by the physician? ---- <<Choices:>> A) Help the parents to arrange supportive care at home B) Refer the patient to another oncologist C) Recommend for parents to take 2 weeks to think about decision D) Seek a court order for neoadjuvant chemotherapy ---- <<Answer:>>
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D
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<<Question:>> A laboratory primarily involved with studying cellular proofreading mechanisms is investigating the question of whether the ribosome can recognize a mischarged amino acid and still be incorporated into the growing peptide. In order to do so, they biochemically charge a Lys-tRNA with valine instead of lysine and insert the tRNA into the cell. They design an mRNA sequence that contains only codons for lysine. Which of the following will most likely occur? ---- <<Choices:>> A) The ribosome will recognize the mischarged tRNA and prevent its incorporation by removing the valine B) The mischarged tRNA with valine will be incorporated in the codons that specificy for lysine C) The mischarged tRNA will be degraded by the proteasome D) The mischarged tRNA will be removed by the lysyl-tRNA synthetase ---- <<Answer:>>
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B
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<<Question:>> A 65-year-old man with metastatic lung cancer has been experiencing severe, unremitting pain. He has required escalating doses of oral morphine, but is now having dose limiting side-effects. His pain management team recommends using a medication that can reduce his opioid need through interaction with the NMDA-receptor. Which of the following was the most likely recommended agent? ---- <<Choices:>> A) Propofol B) Ketamine C) Fentanyl D) Midazolam ---- <<Answer:>>
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B
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<<Question:>> A 27-year-old man presents to the emergency room complaining of left shoulder pain for several weeks. He says that the pain often worsens when he tries to sleep on his left side. Although he tried several pain medications, none of the pain medications helped. He is an amateur tennis player who practices on weekends. He denies any trauma during his practice sessions. On examination of the shoulder joint, severe tenderness was present localized to the greater tuberosity of the left shoulder joint along with biceps tendon tenderness over the bicipital groove. The range of motion was limited to the left side. An X-ray of the joint showed narrowing of the acromiohumeral space with sclerosis and spurring of the acromion. Routine blood test results are normal except for the rheumatoid factor, which is positive. What is the most likely diagnosis? ---- <<Choices:>> A) Trauma B) Rheumatoid arthritis C) Osteoarthritis D) Rotator cuff injury ---- <<Answer:>>
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D
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<<Question:>> A 17-year-old woman presents to your office concerned that she has not had her menstrual period in 4 months. She states that menses began at age of 13 and has been regular until two months ago. She denies sexual activity, and urine pregnancy test is negative. On exam, she appears well-nourished with a BMI of 21 kg/m^2, but you note that she has enlarged cheeks bilaterally and has calluses on the dorsum of her hands. She says that she has been very stressed with school and has recently been binge eating. What other finding do you expect to see in this patient? ---- <<Choices:>> A) Malar rash B) Increased blood glucose level C) Erosion of tooth enamel D) Elevated estrogen levels ---- <<Answer:>>
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C
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<<Question:>> A 23-year-old college student presents to the clinic with a history of intermittent chest discomfort. He reports that, about once per month for the past 8 or 9 months, he's had episodes of "feeling like my chest is going to explode." During these episodes, he also feels shortness of breath, feels shakiness throughout his arms and legs, and sweats so heavily that he needs to change his shirt. He is unsure of any clear precipitating factors but thinks they may occur more often around important exams or when big school projects are due. He shares that, as these episodes continue to recur, he has had mounting anxiety about having one when he is in class or at a restaurant. As a result, he is leaving the house less and less. He has no past medical history; the physical exam is unremarkable. Which of the following is the best medication for the long-term management of this patient's condition? ---- <<Choices:>> A) Citalopram B) Lithium C) Propranolol D) Quetiapine ---- <<Answer:>>
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A
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<<Question:>> A stillborn infant is delivered at 38 weeks' gestation to a 32-year-old woman. The mother had no prenatal care. Examination of the stillborn shows a small pelvis, shallow intergluteal cleft, and club feet. An x-ray shows the absence of the sacrum and lumbar vertebrae. Which of the following is the strongest predisposing factor for this patient's condition? ---- <<Choices:>> A) Maternal oligohydramnios B) Intrauterine alcohol exposure C) Maternal diabetes D) Chromosome 18 trisomy ---- <<Answer:>>
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C
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<<Question:>> Please refer to the summary above to answer this question The authors of the study have decided to conduct a follow-up analysis on their data. They decide to stratify their results by CD4+T-lymphocyte count at the time of diagnosis. Among patients with CD4+ cell counts below 200/mm3, cART adherence was a significant predictor of DLBCL risk (RR = 0.52, p = 0.01). However, among patients with CD4+ cell counts above 200/mm3, no relationship was found between DLBCL risk and cART adherence (RR = 0.96, p = 0.36). Which of the following explains for the difference observed between the two strata?" ---- <<Choices:>> A) Poor generalizability B) Stratified sampling C) Random error D) Effect modification ---- <<Answer:>>
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D
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<<Question:>> During a Mycobacterium tuberculosis infection, Th1 cells secrete a factor capable of stimulating phagosome-lysosome fusion within macrophages. In addition, the secreted factors help activate macrophages to produce mediators such as NO, which are capable of destroying the invading pathogen. Furthermore, activation of the macrophages by the secreted factor eventually leads to the formation of a tubercle. Which of the following factors is secreted by Th1 cells and responsible for these actions? ---- <<Choices:>> A) IL-4 B) TNF-alpha C) IFN-gamma D) Histamine ---- <<Answer:>>
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C
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<<Question:>> A 3-year-old boy is brought to the pediatrician because of abdominal pain and constipation for 3 weeks. His mother says he has been increasingly irritable recently. His vocabulary consists of 50 words and he does not use sentences. Physical examination shows pale conjunctivae and abdominal tenderness. He refers to himself by name but is unable to name body parts or count to three. Peripheral blood smear shows small, pale red blood cells with basophilic stippling. Which of the following processes is most likely impaired in this patient? ---- <<Choices:>> A) Conversion of ferrous iron to ferric iron B) Conversion of porphobilinogen to hydroxymethylbilane C) Conversion of aminolevulinic acid to porphobilinogen D) Conversion of uroporphyrinogen III to coproporphyrinogen III ---- <<Answer:>>
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C
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<<Question:>> A group of researchers conducted a study to determine whether there is an association between folic acid supplementation before pregnancy and autism spectrum disorder (ASD) in offspring. The researchers retrospectively surveyed 200 mothers with children diagnosed with ASD during the first 4 years of life and 200 mothers with healthy children. All participants were interviewed about their prenatal consumption of folic acid using standardized questionnaires. A 94% response rate was obtained from the surveys. The study ultimately found that folic acid supplementation was associated with lower rates of ASD in offspring (OR = 0.3, p < 0.01). Which of the following type of bias is most likely to have influenced these results? ---- <<Choices:>> A) Interviewer bias B) Latency period C) Recall bias D) Survival bias ---- <<Answer:>>
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C
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<<Question:>> A student studying pharmacology is a member of a team that is conducting research related to the elimination of multiple anticoagulant medications. His duty as a member of the team is to collect serum samples of the subjects every 4 hours and send them for analysis of serum drug levels. He is also supposed to collect, document and analyze the data. For one of the subjects, he notices that the subject is eliminating 0.5 mg of the drug every 4 hours. Which of the following anticoagulants did this patient most likely consume? ---- <<Choices:>> A) Warfarin B) Enoxaparin C) Fondaparinux D) Apixaban ---- <<Answer:>>
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A
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<<Question:>> A 40-year-old woman presents to her primary care physician for a checkup. She has felt weaker lately and has lost some weight. She denies any urinary issues. Her BUN at her last visit 4 months ago was 45 mg/dL, and her creatinine was 2.0 mg/dL. Her laboratory studies this visit are seen below: Hemoglobin: 8 g/dL Hematocrit: 29% Leukocyte count: 9,500/mm^3 with normal differential Platelet count: 197,000/mm^3 Serum: Na+: 139 mEq/L Cl-: 100 mEq/L K+: 5.9 mEq/L HCO3-: 17 mEq/L BUN: 59 mg/dL Glucose: 99 mg/dL Creatinine: 2.3 mg/dL Ca2+: 9.0 mg/dL Which of the following is the most likely diagnosis? ---- <<Choices:>> A) Acute kidney failure B) Chronic kidney failure C) Obstructive uropathy D) Renal cell carcinoma ---- <<Answer:>>
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B
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<<Question:>> A 28-year-old woman comes to the obstetrics and gynecology clinic because she has been unsuccessfully trying to conceive with her husband for the last 2 years. He has had 2 children from a previous marriage and has been tested for causes of male infertility. She has had prior abdominal surgery as well as a family history of endocrine abnormalities. Based on this history, a panel of tests are obtained and treatment is started. This treatment will be administered intermittently one week before her normal menstrual cycle. If the most likely drug prescribed in this case was administered in a different manner, which of the following conditions may also be treated by this drug? ---- <<Choices:>> A) Diabetes B) Parkinson disease C) Polycystic ovarian syndrome D) Prostate cancer ---- <<Answer:>>
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D
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<<Question:>> A 2-year-old girl with recurrent urinary tract infections is brought to the physician for a follow-up examination. Renal ultrasound shows bilateral dilation of the renal pelvis. A voiding cystourethrography shows retrograde flow of contrast into the ureters during micturition. Histologic examination of a kidney biopsy specimen is most likely to show which of the following findings? ---- <<Choices:>> A) Glomerular crescents with macrophages B) Matrix expansion with mesangial proliferation C) Cortical thinning with tubular atrophy D) Thickened glomerular capillary loops ---- <<Answer:>>
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C
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<<Question:>> An unconscious 55-year-old man is brought to the Emergency Department by ambulance. He had recently lost his job and his house was about to begin foreclosure. His adult children were concerned for his well being and called the police requesting a welfare check. He was found unresponsive in his gurague. There were several empty bottles of vodka around him and one half empty container of antifreeze. A review of his medical records reveals that he was previously in good health. Upon arrival to the ED he regains consciousness. His blood pressure is 135/85 mmHg, heart rate 120/min, respiratory rate 22/min, and temperature 36.5°C (97.7°F). On physical exam his speech is slurred and he has difficulty following commands. His abdomen is diffusely tender to palpation with no rebound tenderness. Initial laboratory tests show an elevated serum creatinine (Cr) of 1.9 mg/dL, and blood urea nitrogen (BUN) of 29 mg/dL. Which of the following findings would be expected in this patient’s urine? ---- <<Choices:>> A) Calcium oxalate crystals B) Hyaline casts C) Urine ketones D) Urate crystals ---- <<Answer:>>
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A
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<<Question:>> A 17-year-old girl comes to the physician because of an 8-month history of severe acne vulgaris over her face, upper back, arms, and buttocks. Treatment with oral antibiotics and topical combination therapy with benzoyl peroxide and retinoid has not completely resolved her symptoms. Examination shows oily skin with numerous comedones, pustules, and scarring over the face and upper back. Long-term therapy is started with combined oral contraceptive pills. This medication decreases the patient's risk developing of which of the following conditions? ---- <<Choices:>> A) Hypertension B) Ovarian cancer C) Cervical cancer D) Breast cancer ---- <<Answer:>>
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B
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<<Question:>> A 48-year-old female presents for a follow-up appointment to discuss her ultrasound results. She presented with a lump in her neck 2 weeks ago. On examination, a thyroid nodule was present; the nodule was fixed, immobile, and non-tender. Ultrasound showed a hypoechoic nodule with a size of 2 cm. Histological examination of a fine needle biopsy was performed and cytological examination reported a likely suspicion of neoplasia. CT scan is performed to check for any lesions in the bones and/or lungs, common metastatic sites in this condition. Treatment with radioiodine therapy is planned after near-total thyroidectomy. Considering this tumor, which of the following is the most likely initial metastatic site in this patient? ---- <<Choices:>> A) Trachea B) Cervical lymph nodes C) Inferior thyroid arteries D) Thyrohyoid muscle ---- <<Answer:>>
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C
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<<Question:>> A 39-year-old man presents to his primary care physician because he has been having severe headaches and fever for the last 2 days. He also says his right eyelid has been painlessly swelling and is starting to block his vision from that eye. He recently returned from a tour of the world where he visited Thailand, Ethiopia, and Brazil. Otherwise his past medical history is unremarkable. On presentation, his temperature is 102°F (38.8°C), blood pressure is 126/81 mmHg, pulse is 125/min, and respirations are 13/min. Physical exam reveals a nontender swelling of the right eyelid, lymphadenopathy, and an indurated red patch with surrounding erythema and local swelling on his left leg. Which of the following drugs should be used to treat this patient's condition? ---- <<Choices:>> A) Benznidazole B) Ivermectin C) Mebendazol D) Sodium stibogluconate ---- <<Answer:>>
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A
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<<Question:>> A 10-year-old Caucasian female with Turner's syndrome underwent an abdominal imaging study and was discovered that the poles of her kidneys were fused inferiorly. Normal ascension of kidney during embryological development would be prevented by which of the following anatomical structures? ---- <<Choices:>> A) Superior mesenteric artery B) Inferior mesenteric artery C) Celiac artery D) Splenic artery ---- <<Answer:>>
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B
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<<Question:>> A 34-year-old woman is assaulted and suffers a number of stab wounds to her abdomen. Bystanders call paramedics and she is subsequently taken to the nearest hospital. On arrival to the emergency department, her vitals are T: 36 deg C, HR: 110 bpm, BP: 100/60, RR: 12, SaO2: 99%. A FAST and abdominal CT are promptly obtained which are demonstrated in Figures A and B, respectively. Her chart demonstrates no other medical problems and vaccinations/boosters up to date. The patient is diagnosed with a Grade V splenic laceration and is immediately brought to the OR for emergent splenectomy. The splenectomy is successfully performed with removal of the damaged spleen (Figure C). Following the operation, the patient should receive which of the following vaccines: (I) H. influenzae (II) Tetanus (III) N. meningitidis (IV) S. pneumoniae (V) Hepatitis B ---- <<Choices:>> A) I, II B) I, III, IV C) I, V D) III, IV ---- <<Answer:>>
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B
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<<Question:>> Researchers are studying the inheritance pattern of mutations in the cystic fibrosis transmembrane regulator (CFTR) gene, the gene responsible for cystic fibrosis. It is believed that, in addition to the commonly found ΔF508 mutation, a novel mutation in this gene is found in a particular population under study. Which of the following would most likely suggest that these two loci have a high probability of being closely linked? ---- <<Choices:>> A) LOD Score < 1 B) LOD Score < 2 C) LOD Score > 3 D) LOD Score = 0 ---- <<Answer:>>
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C
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<<Question:>> A 28-year-old woman returns to the clinic to follow up on a recent abnormal cervical biopsy that demonstrated cervical intraepithelial neoplasia (CIN) I. The patient is quite anxious about the implications of this diagnosis. Her physical examination is within normal limits. Her vital signs do not show any abnormalities at this time. Her past medical, family, and social histories are all non-contributory. Which of the following is the appropriate management of a newly diagnosed CIN I in a 24-year-old patient? ---- <<Choices:>> A) Close observation, pap smear screening at 6 and 12 months, and HPV DNA testing at 12 months B) Cryotherapy ablation C) Loop electrosurgical excision (LEEP) D) Hysterectomy ---- <<Answer:>>
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A
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<<Question:>> A clinical researcher is interested in creating a new drug for HIV patients. Darunavir has been particularly efficacious in recent patients; however, some have experienced an increased incidence of hyperglycemia. A new drug called DN501 is developed with the same mechanism of action as darunavir but fewer side effects. Which of the following is the mechanism of action of DN501? ---- <<Choices:>> A) Prevents viral transcription B) Inhibits viral assembly C) Inhibits viral entry D) Prevents T-cell binding ---- <<Answer:>>
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B
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<<Question:>> A 58-year-old white man with hypertension and type 2 diabetes mellitus comes to the physician because of a 3-month history of a painless lesion on his lower lip. He has smoked one pack of cigarettes daily for 20 years. He has worked as a fruit picker for the past 25 years. His current medications include captopril and metformin. Examination of the oral cavity shows a single ulcer near the vermillion border. Which of the following is the most likely diagnosis? ---- <<Choices:>> A) Squamous cell carcinoma B) Aphthous stomatitis C) Actinic keratosis D) Traumatic ulcer ---- <<Answer:>>
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A
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<<Question:>> An investigator is studying the effect of drug X on the retinoblastoma (Rb) gene on chromosome 13 in endometrial cells. Endometrial cells obtained from study participants are plated on growth media and the distribution of cell cycle phase is measured with flow cytometry. Drug X, which is known to activate cyclin-dependent kinase 4, is administered to all the cells, and the distribution of cell cycle phase is measured again 1 hour later. Which of the following is most likely to result from the action of drug X on the Rb gene? ---- <<Choices:>> A) G1 phase arrest B) Prophase I arrest C) Initiation of S phase D) Completion of G2 phase ---- <<Answer:>>
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C
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 65-year-old man presents with painless swelling of the neck over the past week. He also says he has been having intermittent fevers and severe night sweats which require a change of bed sheets the next day. His past medical history is significant for human immunodeficiency virus (HIV) diagnosed 10 years ago with which he admits to not always being compliant with his antiretroviral medication. The patient reports a 20-pack-year smoking history but no alcohol or recreational drug use. A review of systems is significant for a 6 kg (13.2 lb) unintentional weight loss over the past 2 months. The vital signs include: temperature 37.8℃ (100.0℉) and blood pressure 120/75 mm Hg. On physical examination, there are multiple non-tender swollen lymph nodes averaging 2 cm in diameter that is palpable in the anterior and posterior triangles of the neck bilaterally. Axillary and inguinal lymphadenopathy is present on the right side. A cardiopulmonary exam is unremarkable. The spleen size is 16 cm on percussion. Laboratory studies show the following: Hemoglobin 9 g/dL Mean corpuscular volume 88 μm3 Leukocyte count 18,000/mm3 Platelet count 130,000/mm3 Serum creatinine 1.1 mg/dL Serum lactate dehydrogenase 1,000 U/L An excisional biopsy of a superficial axillary lymph node on the right is performed and a histopathologic analysis confirms the most likely diagnosis. Which of the following is the next best diagnostic step in the workup of this patient? ---- <<Choices:>> A) Antinuclear antibody B) Hepatitis C virus antibodies C) JAK-2 mutation D) Tartrate-resistant acid phosphatase (TRAP) test ---- <<Answer:>>
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B
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<<Question:>> In order to assess the feasibility and evaluate the outcomes of cerclage wiring as a supportive approach to osteosynthesis in femur fractures, a group of orthopedic surgeons studied 14 patients with primary and periprosthetic fractures of the thigh bone. Parameters such as patient demographic, type of implant, number of wires used, fracture union rate, and potential complications were thoroughly recorded and analyzed in all the patients, with a mean duration of patient follow-up of 16 months. Union was achieved in all patients with a mean duration of 90 days, and there were no complications found in patients included in the study. The authors were satisfied with their findings and, due to the prospective nature of their research, submitted their study to a journal as a cohort study (which they noted in the study title as well). However, the journal editor returned the article, suggesting that it should be submitted as a case series instead. The editor made this suggestion to the authors for which of the following reasons? ---- <<Choices:>> A) No prevalence assessment B) Low number of patients C) Ascertainment bias D) Lack of risk calculation ---- <<Answer:>>
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D
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<<Question:>> A 67-year-old woman presents from home hospice with a change in her mental status. She has seemed more confused lately and is unable to verbalize her symptoms. Her temperature is 102°F (38.9°C), blood pressure is 117/65 mmHg, pulse is 110/min, respirations are 19/min, and oxygen saturation is 95% on room air. Physical exam is notable for a right upper quadrant mass that elicits discomfort when palpated. Ultrasound is notable for pericholecystic fluid and gallbladder wall thickening without any gallstones. Which of the following is the most likely diagnosis? ---- <<Choices:>> A) Acalculous cholecystitis B) Calculous cholescystitis C) Choledocholithiasis D) Emphysematous cholecystitis ---- <<Answer:>>
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A
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<<Question:>> A 35-year-old female is brought to the emergency department after being found unconscious. The patient is found to have a blood glucose level of 35 mg/dL. Hgb A1c was found to be 5.1%. C-peptide level was found to be decreased. The patient returned to her baseline after glucose replacement. She states that she has never had an episode like this before. She has no significant past medical history but reports a family history of diabetes in her mother. She states that she has been undergoing a difficult divorce over the past few months. What is the likely cause of this patient's condition? ---- <<Choices:>> A) Insulinoma B) Factitious disorder C) Hypothyroidism D) Somatization disorder ---- <<Answer:>>
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B
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<<Question:>> A 45-year-old man presents to the physician with complaints of increased urinary frequency and decreasing volumes for the past 2 months. He does not complain of any pain during urination. He is frustrated that he has to wake up 2 or 3 times per night to urinate even though he tried reducing the amount of water he consumes before bed and made some other dietary changes without any improvement. He has no family history of prostate disease. Physical examination is negative for any suprapubic mass or tenderness, and there is no costovertebral angle tenderness. Which of the following is the best next step in the management of this patient? ---- <<Choices:>> A) Urinalysis and serum creatinine B) Reassurance C) Digital rectal examination D) Prostate-specific antigen ---- <<Answer:>>
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C
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 48-year-old woman with chronic tension headaches comes to the physician because of several episodes of bilateral flank pain and reddish urine within the past month. Current medications include aspirin, which she takes almost daily for headaches. Her temperature is 37.4°C (99.3°F) and her blood pressure is 150/90 mm Hg. Physical examination shows costovertebral tenderness to percussion bilaterally. Laboratory studies show a hemoglobin concentration of 10.2 g/dL and serum creatinine concentration of 2.4 mg/dL. Urine studies show: Urine Protein 3+ RBC > 16/hpf WBC 2/hpf There are no casts or dysmorphic RBCs visualized on microscopic analysis of the urine. Which of the following is the most likely underlying cause of this patient's hematuria?" ---- <<Choices:>> A) Tubular lumen obstruction by protein casts B) Necrotizing inflammation of the renal glomeruli C) Bacterial infection of the renal parenchyma D) Vasoconstriction of the medullary vessels ---- <<Answer:>>
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D
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 37-year-old primigravid woman at 12 weeks' gestation comes to the emergency department because of vaginal bleeding and dull suprapubic pain for 3 hours. She has had spotting during the last 3 days. Her medications include folic acid and a multivitamin. She has smoked one pack of cigarettes daily for 15 years. Her temperature is 37°C (98.6°F), pulse is 110/min, and blood pressure is 89/65 mm Hg. Pelvic examination shows a dilated cervical os and a uterus consistent in size with an 11-week gestation. Ultrasonography shows an embryo of 4 cm in crown-rump length and no fetal cardiac activity. Which of the following is the most appropriate next step in management? ---- <<Choices:>> A) Misoprostol therapy B) Methotrexate therapy C) Dilation and curettage D) Complete bed rest ---- <<Answer:>>
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C
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 17-year-old female accidentally eats a granola bar manufactured on equipment that processes peanuts. She develops type I hypersensitivity-mediated histamine release, resulting in pruritic wheals on the skin. Which of the following layers of this patient's skin would demonstrate histologic changes on biopsy of her lesions? ---- <<Choices:>> A) Stratum corneum B) Stratum granulosum C) Stratum basale D) Dermis ---- <<Answer:>>
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D
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 4-year-old girl is brought to the emergency department with a persistent cough, fever, and vomiting. The past year the child has been admitted to the hospital 3 times with pneumonia. For the past 1 week, the child has been experiencing thick purulent cough and says that her chest feels ‘heavy’. Her stools have been loose and foul-smelling over the past week. Her parents are also concerned that she has not gained much weight due to her frequent hospital visits. She was born at 39 weeks gestation via spontaneous vaginal delivery and is up to date on all vaccines and is meeting all developmental milestones. On physical exam, the temperature is 39.1°C (102.4°F). She appears lethargic and uncomfortable. Crackles are heard in the lower lung bases, with dullness to percussion. A small nasal polyp is also present on inspection. Which of the following is the most likely cause for the girl’s symptoms? ---- <<Choices:>> A) Dysfunction in a transmembrane regulator B) Inefficient breakdown of leucine, isoleucine, and valine C) Dysfunction in the motility of respiratory cilia D) Deficiency in lymphocytic activity ---- <<Answer:>>
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A
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 48-year-old man seeks evaluation at a clinic with a complaint of breathlessness for the past couple of weeks. He says that he finds it difficult to walk a few blocks and has to rest. He also complains of a cough for the past 3 months, which is dry and hacking in nature. The medical history is relevant for an idiopathic arrhythmia for which he takes amiodarone daily. He is a non-smoker and does not drink alcohol. He denies any use of illicit drugs. The vital signs are as follows: heart rate 98/min, respiratory rate 16/min, temperature 37.6°C (99.68°F), and blood pressure 132/70 mm Hg. The physical examination is significant for inspiratory crackles over the lung bases. An echocardiogram shows a normal ejection fraction. A chest radiograph is performed and shown below. Which of the following findings will most likely be noted on spirometry? ---- <<Choices:>> A) Decreased FEV1 and normal FVC B) Decreased FEV1 and FVC with decreased FEV1/FVC ratio C) Decreased FEV1 and FVC with normal FEV1/FVC ratio D) Increased FEV1 and FVC ---- <<Answer:>>
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C
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 2,300 g (5 lb) 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 were 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 the management of this infant? ---- <<Choices:>> A) Administer zidovudine B) HIV DNA testing C) HIV RNA testing D) Reassurance and follow-up ---- <<Answer:>>
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A
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 60-year-old woman presents to a physician for worsening shortness of breath and increasing abdominal distention over the last 3 months. She says that the shortness of breath is worse on exertion and improves with rest. While she could previously walk to the nearby store for her groceries, she now has to drive because she gets ''winded'' on the way. The patient was diagnosed with diabetes 5 years ago and is compliant with her medications. The medical history is otherwise unremarkable. The physical examination reveals gross ascites and visibly engorged periumbilical veins. Bilateral pitting edema is noted around the ankles. The finger-prick blood glucose level is 100 mg/dL. What is the mechanism of action of the anti-diabetic medication this patient is most likely taking? ---- <<Choices:>> A) Binding to the alpha subunit of the insulin receptor B) Closure of ATP-sensitive K-channels in the pancreatic beta-cell C) Increased gene expression of GLUT-4 D) Glucagon-like peptide-1 receptor agonist ---- <<Answer:>>
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C
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 15-year-old girl comes to the physician because of episodic pelvic pain radiating to her back and thighs for 4 months. The pain occurs a few hours before her menstrual period and lasts for 2 days. She has been taking ibuprofen, which has provided some relief. Menses have occurred at regular 28-day intervals since menarche at the age of 12 years and last for 5 to 6 days. She is sexually active with two male partners and uses condoms inconsistently. Vital signs are within normal limits. Physical examination shows no abnormalities. Which of the following is the most likely cause of this patient's symptoms? ---- <<Choices:>> A) Endometrial sloughing and uterine contractions mediated by prostaglandin B) Ascending infection of the uterus, fallopian tubes, ovaries, or surrounding tissue C) Fluid-filled sac within the ovary D) Hormone-sensitive smooth muscle tumor of the myometrium ---- <<Answer:>>
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A
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 25-year-old male is hospitalized for acute agitation, photophobia, and dysphagia. His parents report that he has been experiencing flu-like symptoms for one week prior to hospital admission. Five weeks ago, the patient was in Mexico, where he went on several spelunking expeditions with friends. The patient ultimately becomes comatose and dies. Autopsy of brain tissue suggests a viral infection. The likely causal virus spreads to the central nervous system (CNS) in the following manner: ---- <<Choices:>> A) Hematogenous dissemination to the meninges B) Retrograde migration up peripheral nerve axons C) Reactivation of virus previously latent in dorsal root ganglia D) Infection of oligodendrocytes and astrocytes ---- <<Answer:>>
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B
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 19-year-old Caucasian male presents to your office with hypopigmented skin. He undergoes a skin biopsy and is found to have an absence of melanocytes in the epidermis. Which of the following is the most likely diagnosis? ---- <<Choices:>> A) Tinea versicolor B) Albinism C) Vitiligo D) Melanoma ---- <<Answer:>>
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C
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 51-year-old man presents for a routine check-up. He has no complaints. At his last annual visit, his physical and laboratory tests were unremarkable. His past medical history is significant for hypercholesterolemia, well managed with rosuvastatin, and hypertension, well managed with hydrochlorothiazide. His current medications also include aspirin. The patient is afebrile, and his vital signs are within normal limits. Physical examination is unremarkable. His laboratory tests are significant for the following: WBC 29,500/mm3 Hematocrit 26.1% Hemoglobin 9.1 g/dL Platelet count 298,000/mm3 A peripheral blood smear and differential shows 92% small normocytic lymphocytes. The patient’s diagnosis in confirmed by bone marrow biopsy and flow cytometry. He is monitored through regular follow-up visits. Three years after the initial diagnosis, the patient presents with swollen cervical and axillary lymph nodes, unintentional weight loss of 4.5 kg (approx. 10 lb), and “rib pain” on his right side. On physical examination, there is palpable, firm, non-tender cervical and axillary lymphadenopathy bilaterally. He also has moderate splenomegaly, which, when palpated, elicits pain. Which of the following is the best treatment for this patient’s most likely diagnosis? ---- <<Choices:>> A) Bleomycinrn B) Imatinib C) Fludarabinern D) Vincristinern ---- <<Answer:>>
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C
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 62-year-old woman is evaluated because of a 3-day history of headache, nausea, and decreased urination. Laboratory studies show: Serum Na+ 136 mEq/L K+ 3.2 mEq/L Cl- 115 mEq/L Mg2+ 1.4 mEq/L Urine pH 7.0 Arterial blood gas analysis on room air shows a pH of 7.28 and a HCO3- concentration of 14 mEq/L. Prolonged treatment with which of the following drugs would best explain this patient's findings?" ---- <<Choices:>> A) Trimethoprim-sulfamethoxazole B) Eplerenone C) Amphotericin B D) Heparin ---- <<Answer:>>
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C
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 21-year-old male presents to his primary care provider for fatigue. He reports that he graduated from college last month and returned 3 days ago from a 2 week vacation to Vietnam and Cambodia. For the past 2 days, he has developed a worsening headache, malaise, and pain in his hands and wrists. The patient has a past medical history of asthma managed with albuterol as needed. He is sexually active with both men and women, and he uses condoms “most of the time.” On physical exam, the patient’s temperature is 102.5°F (39.2°C), blood pressure is 112/66 mmHg, pulse is 105/min, respirations are 12/min, and oxygen saturation is 98% on room air. He has tenderness to palpation over his bilateral metacarpophalangeal joints and a maculopapular rash on his trunk and upper thighs. Tourniquet test is negative. Laboratory results are as follows: Hemoglobin: 14 g/dL Hematocrit: 44% Leukocyte count: 3,200/mm^3 Platelet count: 112,000/mm^3 Serum: Na+: 142 mEq/L Cl-: 104 mEq/L K+: 4.6 mEq/L HCO3-: 24 mEq/L BUN: 18 mg/dL Glucose: 87 mg/dL Creatinine: 0.9 mg/dL AST: 106 U/L ALT: 112 U/L Bilirubin (total): 0.8 mg/dL Bilirubin (conjugated): 0.3 mg/dL Which of the following is the most likely diagnosis in this patient? ---- <<Choices:>> A) Chikungunya B) Dengue fever C) Epstein-Barr virus D) Hepatitis A ---- <<Answer:>>
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A
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Answer the following medical question with the correct letter choice:
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<<Question:>> Three days after admission to the intensive care unit for septic shock and bacteremia from a urinary tract infection, a 34-year-old woman has persistent hypotension. Her blood cultures are positive for Escherichia coli, for which she has been receiving appropriate antibiotics since admission. She has no history of any serious illness. She does not use illicit drugs. Current medications include norepinephrine, ceftriaxone, and acetaminophen. She appears well. Her temperature is 37.5°C (99.5°F), heart rate is 96/min, and blood pressure is 85/55 mm Hg. Examination of the back shows costovertebral tenderness bilaterally. Examination of the thyroid gland shows no abnormalities. Laboratory studies show: Hospital day 1 Hospital day 3 Leukocyte count 18,500/mm3 10,300/mm3 Hemoglobin 14.1 mg/dL 13.4 mg/dL Serum Creatinine 1.4 mg/dL 0.9 mg/dL Fasting glucose 95 mg/dL 100 mg/dL TSH 1.8 µU/mL T3, free 0.1 ng/dL T4, free 0.9 ng/dL Repeat blood cultures are negative. A chest X-ray shows no abnormalities. Which of the following is the most appropriate treatment? ---- <<Choices:>> A) Bromocriptine B) Levothyroxine C) Removing toxic drugs D) Treating the underlying illness ---- <<Answer:>>
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D
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Answer the following medical question with the correct letter choice:
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<<Question:>> An 11-year-old child complains of pain in the leg while playing. Blood pressure in the upper limb is 140/90 mm Hg and lower limbs are 110/70 mm Hg. There is a brachiofemoral delay in the pulse. Auscultation shows a loud S1, loud S2, and S4. There is a presence of an ejection systolic murmur in the interscapular area. Chest X-ray reveals the notching of the ribs. What is the most likely diagnosis in this patient? ---- <<Choices:>> A) Pulmonic stenosis B) Coarctation of the aorta C) Aortic stenosis D) Transposition of great vessels ---- <<Answer:>>
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B
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 59-year-old man comes to the emergency department because of excruciating left knee pain for 4 days. He underwent a total knee arthroplasty of his left knee joint 4 months ago. He has hypertension and osteoarthritis. Current medications include glucosamine, amlodipine, and meloxicam. His temperature is 38.1°C (100.6°F), pulse is 97/min, and blood pressure is 118/71 mm Hg. Examination shows a tender, swollen left knee joint; range of motion is limited by pain. Analysis of the synovial fluid confirms septic arthritis, and the prosthesis is removed. Which of the following is the most likely causal organism? ---- <<Choices:>> A) Staphylococcus epidermidis B) Escherichia coli C) Staphylococcus aureus D) Pseudomonas aeruginosa ---- <<Answer:>>
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A
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 47-year-old man presents to the emergency department with fever, fatigue, and loss of appetite for 1 week, followed by right shoulder pain, generalized abdominal pain, and paroxysmal cough. He has had diabetes mellitus for 15 years, for which he takes metformin and gliclazide. His vital signs include a temperature of 38.3°C (101.0°F), pulse of 85/min, and blood pressure of 110/70 mm Hg. On examination, he is ill-appearing, and he has a tender liver edge that is palpable approx. 2 cm below the right costal margin. Percussion and movement worsens the pain. Abdominal ultrasonography is shown. Stool is negative for Entamoeba histolytica antigen. Which of the following is the best initial step in management of this patient condition? ---- <<Choices:>> A) Metronidazole and paromomycin B) Cholecystectomy C) Antibiotics and drainage D) Endoscopic retrograde cholangiopancreatography (ERCP) ---- <<Answer:>>
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C
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<<Question:>> A 36-year-old recent immigrant from India presents with a face similar to that seen in the image A. Examination of his face reveals skin that is thick and contains many lesions. The patient complains that he has experienced a loss of sensation in his toes and fingertips, which has caused him to injure himself often. Biopsy of the skin is likely to reveal bacteria that are: ---- <<Choices:>> A) Acid-fast B) Catalase-negative C) Thermophiles D) Tennis-racket shaped ---- <<Answer:>>
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A
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<<Question:>> A 55-year-old man comes to the physician because of a 3-month history of a progressively growing mass in his axilla. During this period, he has had recurrent episodes of low-grade fever lasting for 7 to 10 days, and an 8-kg (18-lb) weight loss. His only medication is a multivitamin. Physical examination shows nontender, right axillary, cervical, and inguinal lymphadenopathy. His serum calcium concentration is 15.1 mg/dL and parathyroid hormone (PTH) concentration is 9 pg/mL. A lymph node biopsy shows granuloma formation and large CD15-positive, CD30-positive cells with bilobed nuclei. Which of the following is the most likely explanation for this patient's laboratory findings? ---- <<Choices:>> A) Excessive intake of dietary ergocalciferol B) Induction of focal osteolysis by tumor cells C) Secretion of γ-interferon by activated T-lymphocytes D) Production of PTH-related peptide by malignant cells ---- <<Answer:>>
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C
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<<Question:>> A 32-year-old man comes to the physician for a pre-employment examination. He recently traveled to Guatemala. He feels well but has not seen a physician in several years, and his immunization records are unavailable. Physical examination shows no abnormalities. Serum studies show: Anti-HAV IgM Positive Anti-HAV IgG Negative HBsAg Negative Anti-HBs Positive HBcAg Negative Anti-HBc Negative HBeAg Negative Anti-HBe Negative Anti-HCV Negative Which of the following best explains this patient's laboratory findings?" ---- <<Choices:>> A) Active hepatitis A infection B) Previous hepatitis A infection C) Chronic hepatitis B infection D) Chronic hepatitis C infection ---- <<Answer:>>
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A
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 7-month-old male infant is brought to the pediatrician by his mother. She reports that the child develops severe sunburns every time the infant is exposed to sunlight. She has applied copious amounts of sunscreen to the infant but this has not helped the problem. On examination, there are multiple areas of reddened skin primarily in sun exposed areas. The child’s corneas appear irritated and erythematous. Which of the following processes is likely impaired in this patient? ---- <<Choices:>> A) Nucleotide excision repair B) Non-homologous end joining C) Homologous recombination D) Mismatch repair ---- <<Answer:>>
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A
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 65-year-old man presents to his primary care physician with a neck mass. He first noticed a firm mass on the anterior aspect of his neck approximately 4 months ago. The mass is painless and has not increased in size since then. He has also noticed occasional fatigue and has gained 10 pounds in the past 4 months despite no change in his diet or exercise frequency. His past medical history is notable for gout for which he takes allopurinol. He denies any prior thyroid disorder. He runs 4 times per week and eats a balanced diet of mostly fruits and vegetables. He does not smoke and drinks a glass of wine with dinner. His family history is notable for medullary thyroid cancer in his maternal uncle. His temperature is 97.8°F (36.6°C), blood pressure is 127/72 mmHg, pulse is 87/min, and respirations are 19/min. On exam, he has a firm, symmetric, and stone-firm thyroid. A biopsy of this patient's lesion would most likely demonstrate which of the following findings? ---- <<Choices:>> A) Diffuse infiltrate of lymphoid cells destroying thyroid follicles B) Dense fibroinflammatory infiltrate C) Pleomorphic undifferentiated infiltrative cells with necrosis D) Stromal amyloid deposition ---- <<Answer:>>
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B
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Answer the following medical question with the correct letter choice:
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<<Question:>> A group of researchers decided to explore whether the estimates of incidence and prevalence rates of systemic lupus erythematosus (SLE) were influenced by the number of years it took to examine administrative data. These estimates were not only based on hospital discharges, but also on physician billing codes. For study purposes, the researchers labeled incident cases at the initial occurrence of SLE diagnosis in the hospital database, while prevalent cases were those that were coded as harboring SLE at any time, with patients maintaining their diagnosis until death. Which statement is true regarding the relationship between incidence and prevalence rates during the time period that might be chosen for this specific study? ---- <<Choices:>> A) Incidence rates will be higher during shorter time periods than longer periods. B) The prevalence of SLE during consecutively shorter time windows will be overestimated. C) The inclusion of attack rates would increase incidence estimates in longer time periods. D) The inclusion of attack rates would decrease incidence estimates in shorter time periods. ---- <<Answer:>>
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A
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 48-year-old Caucasian female presents to her primary care physician for evaluation of progressive weakness and shortness of breath. She has had progressive shortness of breath over the last year with an intermittent non-productive cough. In addition, she complains of difficulty raising her arms to brush her hair. Her temperature is 99.6°F (37.6°C), pulse is 80/min, blood pressure is 130/85 mmHg, respirations are 18/min, and oxygen saturation is 95% on room air. Neurologic exam shows 4/5 strength in the deltoid muscles bilaterally. Diffuse dry crackles are heard on lung auscultation. A faint erythematous rash is noted on the malar cheeks, periorbital areas, lateral proximal thighs, and the elbows. Which of the following tests is most likely to confirm the diagnosis? ---- <<Choices:>> A) Muscle biopsy B) CT scan C) Serum ANA titer D) Skin biopsy ---- <<Answer:>>
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A
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 46-year-old man presents to the physician with a complaint of a cough for 6 months. He has been taking over-the-counter cough medications, but they have not helped much. He adds that he expectorated bloody sputum the previous night. He denies breathlessness but mentions that he frequently experiences fatigue after little physical exertion. There is no past history of any specific medical disorder. His father died of lung cancer at the age of 54 years. His temperature is 37.0°C (98.6°F), the pulse rate is 82/min, the blood pressure is 118/80 mm Hg, and the respiratory rate is 18/min. Auscultation of his chest reveals the presence of localized rhonchi over the interscapular region. A plain radiograph of the chest shows a coin-like opacity in the right lung. Further diagnostic evaluation confirms the diagnosis of small cell carcinoma of the lung. If his blood were to be sent for laboratory evaluation, which of the following proteins is most likely to be elevated in his serum? ---- <<Choices:>> A) Bence-Jones protein B) Calcitonin C) CA 15-3 D) Neuron-specific enolase ---- <<Answer:>>
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D
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 41-year-old man presents to his primary care provider with abdominal pain. He says that the pain “comes and goes” throughout the day and usually lasts 20-30 minutes per episode. He can point to the spot 1-2 inches above the umbilicus where he feels the pain. He denies any feeling of regurgitation or nighttime cough but endorses nausea. He reports that he used to eat three large meals per day but has found that eating more frequently improves his pain. He tried a couple pills of ibuprofen with food over the past couple days and thinks it helped. He has gained four pounds since his past appointment three months ago. The patient denies any diarrhea or change in his stools. He has no past medical history. He drinks 5-6 beers on the weekend and has a 20 pack-year smoking history. He denies any family history of cancer. On physical exam, he is tender to palpation above the umbilicus. Bowel sounds are present. A stool guaiac test is positive. The patient undergoes endoscopy with biopsy to diagnose his condition. Which of the following is most likely to be found on histology? ---- <<Choices:>> A) Mucosal defect in the stomach B) Urease-producing organism in the small intestine C) PAS-positive material in the small intestine D) Crypt abscesses in the large intestine ---- <<Answer:>>
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B
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 5-year-old female presents to the pediatrician for a routine office visit. The patient is in kindergarten and doing well in school. She is learning to read and is able to write her first name. Her teacher has no concerns. The patient’s mother is concerned that the patient is a picky eater and often returns home from school with most of her packed lunch uneaten. The patient’s past medical history is significant for moderate persistent asthma, which has required three separate week-long courses of prednisone over the last year and recently diagnosed myopia. The patient’s mother is 5’7”, and the patient’s father is 5’10”. The patient’s weight and height are in the 55th and 5th percentile, respectively, which is consistent with her growth curve. On physical exam, the patient has a low hairline and a broad chest. Her lungs are clear with a mild expiratory wheeze. The patient’s abdomen is soft, non-tender, and non-distended. She has Tanner stage I breast development and pubic hair. This patient is most likely to have which of the following additional findings? ---- <<Choices:>> A) Absent Barr bodies on buccal smear B) Elevated serum alkaline phosphatase level C) Elevated serum TSH level D) Mass in the sella turcica ---- <<Answer:>>
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A
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 61-year-old man was started on rosuvastatin 40 mg 8 weeks ago and presents today for a follow-up. He complains of pain in his legs and general weakness. On physical exam, he has full range of motion of his extremities but complains of pain. His blood pressure is 126/84 mm Hg and heart rate is 74/min. The decision is made to stop the statin and return to the clinic in 2 weeks to assess any changes in symptoms. After stopping the statin, his muscular symptoms resolve. What is the next best course of action to take regarding his LDL control? ---- <<Choices:>> A) Restart rosuvastatin at a lower dose B) Initiate fenofibrate C) Initiate a different statin D) Initiate fish oils ---- <<Answer:>>
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A
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Answer the following medical question with the correct letter choice:
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<<Question:>> An unidentified surgical specimen is received for histopathologic analysis. A portion of the specimen is cut and stained with hematoxylin and eosin. The remainder is analyzed and is found to contains type II collagen and chondroitin sulfate. Which of the following structures is most likely the origin of this surgical specimen? ---- <<Choices:>> A) Blood vessel B) Pinna C) Lens D) Larynx ---- <<Answer:>>
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D
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