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Answer the following medical question with the correct letter choice:
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<<Question:>> A 52-year-old man comes to the physician because of generalized pruritus and raised, erythematous plaques on the skin over his hands, chest, and legs for 6 hours. He reports having clear liquid discharge from his nose and sneezing. He says that his symptoms began suddenly the previous night, 30 minutes after he had dinner at a seafood restaurant. He has had similar symptoms occasionally in the past as well. Four months ago, he had an episode of narrow-angle glaucoma. He takes no medications. His vital signs are within normal limits. Nasal exam shows clear, serous secretions, with edematous and erythematous mucosa and turbinates. Paranasal sinuses are not tender to palpation. Which of the following is the most appropriate pharmacotherapy? ---- <<Choices:>> A) Diphenhydramine B) Fexofenadine C) Vitamin K D) Calamine lotion ---- <<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 man in a 3-month relationship with a woman experiences frequent sexual fantasies about male coworkers. He lives in a conservative community and does not know any openly gay men. Two days ago, he joined a local group considered by many organizations to be a hate group. Together with the other members, he attacked a gay couple on their way home from dinner. Which of the following psychological defense mechanisms is he demonstrating? ---- <<Choices:>> A) Sublimation B) Reaction formation C) Intellectualization D) Projection ---- <<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 66-year-old woman presents to her primary care provider with several days of left flank pain radiating to the abdomen and groin. The patient states that she has noticed a pink tinge to her urine as well. Of note, she has not had any fevers, but endorses several months of fatigue and constipation. The patient was previously healthy except for mild untreated hypertension. On exam, her temperature is 98.6°F (37.0°C), blood pressure is 130/84 mmHg, pulse is 76/min, and respirations are 12/min. On further workup, the patient is found to have calcium oxalate nephrolithiasis with hypercalciuria. Blood studies demonstrate increased parathyroid hormone (PTH) and hypercalcemia. Which of the following is the most likely cause? ---- <<Choices:>> A) Primary hyperparathyroidism B) Pseudopseudohypoparathyroidism C) Secondary hyperparathyroidism D) Tertiary hyperparathyroidism ---- <<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 23-year-old woman presents to her psychiatrist concerned about her mood. She has felt tired and unwilling to engage in any activities lately. She states that her limbs feel heavy all the time and that completing any activity takes tremendous effort. She no longer finds any happiness in activities that she previously enjoyed. She also states that she really struggles to sleep and at times can't sleep for several days. The patient is started on appropriate first-line therapy and sent home. She returns 1 week later stating that her symptoms have not improved. She is requesting help as her performance at work and school is suffering. Which of the following is the best next step in management? ---- <<Choices:>> A) Add lithium to treatment regimen B) Change treatment to lithium C) Continue current therapy D) Electroconvulsive therapy ---- <<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 16-year-old patient presents to the physician’s office with an absence of menstruations. Her last period was 6 months ago. Since almost a year and a half ago, she intentionally restricted her diet at the expense of carbohydrates, exercised intensively, and lost 18.0 kg (39.7 lb). She had her menarche at the age of 12 and menstruated normally until last year. She is not sexually active. On physical examination, the vital signs include blood pressure 100/60 mm Hg, heart rate 55/min, respiratory rate 12/min, and temperature 35.9°C (96.6°F). Her weight is 55.0 kg (121.3 lb), and her height is 166 cm (5 ft 5 in). Physical examination reveals the good development of muscles and decreased adiposity. A bone scan shows decreased calcium mineral deposits. Which statement about this patient’s condition is correct? ---- <<Choices:>> A) This patient has insulin resistance B) Decreased adiposity contributes to hypoestrogenemia in this patient C) The patient is likely to have decreased blood estrogen concentration due to increased liver metabolism D) The patient should be checked for hyperthyroidism because such extensive lipolysis is likely to result from thyroid hyperfunction ---- <<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 7-year-old girl is brought to the emergency department with a 10-day history of fever and sore throat that acutely worsened over the past 2 days. Her sore throat is worse on the right side. She has difficulty swallowing and opening her mouth due to pain. She has also noticed a change in the quality of her voice over the last day. Her temperature is 38.2°C (100.8°F), pulse is 86/min, respirations are 18/min, and blood pressure is 110/75 mm Hg . Examination shows cervical lymphadenopathy. Oropharyngeal examination shows erythematous tonsils and swelling of the right tonsillar pillar. The uvula is deviated to the left. Laboratory studies show: Hemoglobin 13.0 g/dL Hematocrit 39% Leukocyte count 12,000/mm3 Platelet Count 200,000/mm3 Serum Na+ 138 mEq/L Cl- 100 mEq/L K+ 4.5 mEq/L HCO3- 24 mEq/L Urea nitrogen 14.0 mg/dL Creatinine 1.1 mg/dL Which of the following is the most appropriate next step in management?" ---- <<Choices:>> A) Intravenous dexamethasone therapy B) Incision and drainage with intravenous ampicillin-sulbactam therapy C) Needle aspiration and oral clindamycin therapy D) Intravenous ampicillin-sulbactam therapy ---- <<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 26-year-old nurse comes to the physician because of a 2-month history of fatigue. She has had a lot of stress at work and has been on sick leave for 2 weeks, but states that she would like to return to work. She has had several episodes of lower abdominal pain. She says, ""I know I have cancer."" She requests a diagnostic laparoscopy. She was diagnosed with peptic ulcer disease 6 months ago. Her only medication is omeprazole. The patient appears pale. Her temperature is 36.5° C (97.7° F), pulse is 120/min, and blood pressure is 90/65 mm Hg. On mental status examination she is tired and has a depressed mood. Physical examination shows pale conjunctivae and dry mucous membranes. There are numerous crusts along the course of her left arm veins. A grade 2/6 systolic ejection murmur is heard along the right-upper sternal border. Abdominal examination shows no abnormalities. There is generalized weakness of the proximal muscles. Laboratory studies show: Hemoglobin 7.5 g/dL Mean corpuscular volume 89 μm3 Reticulocyte count 13.3% Serum Sodium 139 mEq/L Potassium 3.9 mEq/L Calcium 8.5 mg/dL Test of the stool for occult blood is negative. Abdominal ultrasonography show no abnormalities. Which of the following is the most likely diagnosis?" ---- <<Choices:>> A) Factitious disorder B) Somatic symptom disorder C) Conversion disorder D) Acute small bowel hemorrhage ---- <<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:>> Five days after undergoing an emergency appendectomy under general inhalational anesthesia while on a trip to Haiti, a 43-year-old woman develops low-grade fever, vomiting, and abdominal pain. During the surgery, she received a transfusion of 1 unit of packed red blood cells. Three days after the surgery, she was stable enough to be transported back to the United States. She has no history of serious illness and takes no medications. Her temperature is 38.3°C (100.9°F), pulse is 80/min, and blood pressure is 138/76 mm Hg. Examination shows jaundice of the skin and conjunctivae. Abdominal examination shows moderate tenderness over the liver. The liver is palpated 2 to 3 cm below the right costal margin. Laboratory studies show: Hemoglobin count 12.0 g/dL Leukocyte count 10,400 mm3 Segmented neutrophils 55% Bands 1% Eosinophils 13% Lymphocytes 28% Monocytes 3% Platelet count 160,000 mm3 Serum Alkaline phosphatase 102 U/L Aspartate aminotransferase 760 U/L Bilirubin Total 3.8 mg/dL Direct 3.1 mg/dL Anti-HAV IgG positive Anti-HAV IgM negative Anti-HBs positive HBsAg negative Anti-HCV antibodies negative Abdominal ultrasonography shows an enlarged liver. A biopsy of the liver shows massive centrilobular necrosis. Which of the following is the most likely underlying cause of this patient's condition?" ---- <<Choices:>> A) Adverse effect of anesthetic B) Gram negative bacteria in the bloodstream C) Acalculous inflammation of the gallbladder D) Excessive lysis of red blood cells ---- <<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 56-year-old woman comes to the physician because of a 2-week history of fatigue and painless bruising over her arms and trunk. She has also had several episodes of nosebleeds that resolved with compression after a few minutes. She recently completed treatment for a urinary tract infection. She has had no changes in her weight. She has type 2 diabetes mellitus and hypertension. Her last menstrual cycle was 5 years ago. She does not smoke or drink alcohol. Home medications include metformin, amlodipine, and enalapril. Her vital signs are within normal limits. Physical examination shows pale conjunctivae. There are ecchymoses and petechiae over the upper extremities, chest, and back. There is no lymphadenopathy. The remainder of the physical examination is unremarkable. Laboratory studies show: Hemoglobin 8.7 mg/dL Leukocyte count 1100/mm3 Platelet count 54,000/mm3 Reticulocyte count 0.1% Mean corpuscular volume 93 μm3 Serum Total bilirubin 1.1 mg/dL LDH 80 U/L Which of the following is most likely to confirm the diagnosis?" ---- <<Choices:>> A) Serum transferrin level B) Bone marrow biopsy C) Peripheral blood smear D) Serum porphobilinogen level ---- <<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 35-year-old man returns to the clinic to follow up for his chronic stomach pain. At the last visit a few months ago, he explained that he had been experiencing discomfort in his upper abdomen for awhile. He had never vomited up any blood and had not had any substantial weight loss. He did not take any medications, did not smoke, and had no family history of gastric cancer. At that time, the doctor empirically started him on a proton pump inhibitor (PPI). Today, despite the PPI, the patient says he is still experiencing discomfort. Hearing this, the doctor decides to order a urease breath test. What is the most likely cause of this patient's chronic stomach pain? ---- <<Choices:>> A) Gastroesophgeal sphincter dysfunction B) Nonsteroidal anti-inflammatory drugs C) Heliobacter pylori infection D) Excessive gastrin ---- <<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 G1P1 patient presents to her obstetrician after having a positive pregnancy test at home. She reports that she and her husband had been trying to have a child for the past three months. She has no history of sexually transmitted disease, intravenous drug use, or blood transfusions, and she has never traveled outside of the United States. She was up-to-date on all immunizations before her pregnancy. Ultrasound is consistent with an 8-week gestational sac. The patient requests as few tests as possible, although she does not want to compromise the health of her fetus. Which of the following screening tests should be performed on all pregnant women? ---- <<Choices:>> A) HIV, syphilis, and hepatitis B B) HIV, syphilis, and N. gonorrhea C) HIV, hepatitis B, and hepatitis C D) HIV, syphilis, hepatitis B, N. gonorrhea, and C. trachomatis ---- <<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 29-year-old man is referred by his marriage counselor to the outpatient psychiatry clinic. The patient’s wife is with him and states that her husband is always complaining and critical of others. He was recently fired from his job to which he claims that his boss was jealous of his hard work. He also does not trust his neighbors and thinks they are out to get all the nice things he has. His wife also says that he has begun to doubt her fidelity and believes that even the marriage counselor is on her side. Which of the following psychiatric disorders also belongs to the same cluster of symptoms? ---- <<Choices:>> A) Schizotypal personality disorder B) Obsessive-compulsive personality disorder C) Antisocial personality disorder D) Personality disorder not otherwise specified ---- <<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 24-year-old man is brought to the emergency department by the police. He was found unconscious and covered in bruises outside of a local bar. The patient has a past medical history of polysubstance abuse, depression, multiple suicide attempts, neuropathic pain, and schizophrenia. As part of the patient’s initial workup, a head CT is performed which is unremarkable, and an arterial blood gas is performed as seen below: pH: 7.29 PaCO2: 95 mm Hg PaO2: 70 mm Hg Bicarbonate: 24 mEq/L Which of the following is the most likely etiology of this patient’s current presentation? ---- <<Choices:>> A) Amitriptyline B) Cocaine C) Ethylene glycol D) Heroin ---- <<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 3-year-old girl is brought to the emergency department by her parents for an acute arm injury. The mother reports that they were walking in the park and the patient’s dad was swinging the patient in the air by her arms. The dad reports he then heard a click and the patient immediately began to cry. On examination, the patient is holding her right forearm in a pronated position and her elbow slightly flexed. Pain is localized to the lateral aspect of the elbow. She refuses to use the affected limb. She does allow passive flexion and extension with full range of motion but supination is limited and causes pain. Which of the following is the next step in management? ---- <<Choices:>> A) Immobilization B) Moderate flexion then hyperpronation C) Radiograph D) Supination then maximal extension ---- <<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 40-year-old male presents to your office complaining that he is too weak to climb stairs or brush his hair. He denies any headaches or change in vision. A muscle biopsy reveals CD8+ lymphocyte infiltration in the endomysium. Which of the following is the most likely diagnosis? ---- <<Choices:>> A) Systemic lupus erythematosus B) Polymyalgia rheumatica C) Polymyositis D) Dermatomyositis ---- <<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 6-month-old boy presents to his pediatrician for a wellness examination. The mother reports that her child has difficulty rolling from his back to his front and sitting unsupported. The patient is able to smile and furrow his brow normally, but she has noticed that he has a weak cry and suck. He was born at 38 weeks gestation via a spontaneous vaginal delivery without any complications. The mother said that the patient appeared "normal" until the past few weeks. On physical exam, his extraocular muscle movements are intact, and a symmetric smile is seen. He has symmetric flaccid weakness of both his upper and lower extremities. He also has a bell-shaped chest. Deep tendon reflexes are diminished. Which of the following is the most likely cause of this patient's symptoms? ---- <<Choices:>> A) Anterior horn cell degeneration B) Axonal demyelination C) Decreased acetylcholine receptor density D) Myonecrosis ---- <<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 6-day-old male newborn is brought to the physician because he has become increasingly irritable and restless over the past 2 days. During this period, he has had 12 bowel movements. He feeds 10 to 12 times a day. He was born at 38 weeks' gestation and weighed 1800 g (3 lb 15 oz); he currently weighs 1700 g (3 lb 12 oz). His mother has Graves' disease and received propylthiouracil during the last trimester of pregnancy. She has a history of intravenous heroin use. His temperature is 36.9°C (98.4°F), pulse is 180/min, and respirations are 50/min. Examination shows mild diaphoresis and a firm 2-cm midline neck swelling. The lungs are clear to auscultation. Which of the following is the most appropriate next step in management? ---- <<Choices:>> A) Methimazole and propranolol therapy B) Potassium iodide therapy C) Naloxone therapy D) Calcium gluconate therapy ---- <<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 previously healthy 29-year-old man comes to the emergency department because of burning with urination for several days. He has also had pain in the right ankle for 3 days and pain and swelling in the left knee for 1 day. Two weeks ago, he had several days of fever and bloody diarrhea, for which he was treated with antibiotics. Examination shows a small left knee effusion and bilateral conjunctival injection. Which of the following is the most likely additional finding in this patient? ---- <<Choices:>> A) Circular erythematous rash with central clearing B) Pain on passive extension of the fingers C) Palpable mass in the right lower quadrant D) Tenderness at the insertion of the Achilles tendon ---- <<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 36-year-old woman comes to the physician because of a painless lump on her neck for 3 months that has increased in size. She appears healthy. Examination shows a 2.5-cm (1-in) firm, irregular swelling on the left side of the neck that moves with swallowing. There is painless cervical lymphadenopathy. Ultrasound of the neck shows a solitary left lobe thyroid mass with increased vascularity and hyperechogenic punctate regions. A fine needle aspiration biopsy is scheduled for the following week. Which of the following is the most likely diagnosis? ---- <<Choices:>> A) Follicular carcinoma of the thyroid B) Hürthle cell carcinoma of the thyroid C) Papillary carcinoma of the thyroid D) Anaplastic carcinoma of the thyroid ---- <<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 34-year-old man currently staying at an addiction center presents to the staff psychiatrist with diarrhea and painful muscle cramps. He has been discontinuing heroin over the last month as part of his treatment plan. He is HIV positive, hepatitis B (HBV) positive, and was recently treated for an infection with Streptococcus pneumoniae. He reports pain over his abdomen, knees, and shoulder. To comprehensively treat these symptoms, which of the following would be the best therapy? ---- <<Choices:>> A) Methadone B) Naloxone C) Alvimopan D) Loperamide ---- <<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 26-year-old man presents to his physician with a history of diarrhea and vomiting for the past 24 hours. On physical examination, his temperature is 36.9ºC (98.4ºF), pulse rate is 110/min, blood pressure is 102/74 mm Hg, and respiratory rate is 16/min. A resident working under the physician plots a Darrow-Yannet diagram for the patient. The diagram is shown in the picture where the green dotted line represents the new fluid status. Which of the following is most likely to show increased secretion in this patient? ---- <<Choices:>> A) B-type natriuretic peptide B) Bradykinin C) Renin D) Vasoactive intestinal peptide ---- <<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 28-year-old female comes to the physician’s office with a complaint of episodic chest pain. She describes the pain as squeezing and tightness in her chest. This pain has been happening every few days for 3 months. She says there is no association of the pain with food or exercise. She is able to climb up to her fourth floor apartment daily without issue. Her only past medical history is migraines for which she takes appropriate medication. Here temperature is 98.6°F (37°C), blood pressure is 120/68 mmHg, pulse is 60/min, respirations are 16/min, and oxygen saturation is 98% on room air. She has no known family history. The patient is not in pain on presentation and EKG in the office is normal. 24-hour ECG monitoring shows transient ST elevations during the episodes of pain that resolve completely. The mechanism of this patient’s chest pain is most similar to the mechanism behind which of the following? ---- <<Choices:>> A) Raynaud's phenomenon B) Myocardial infarction C) Aortic dissection D) Costochondritis ---- <<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 22-year-old gravida 1 presents to her physician at 15 weeks gestation for a prenatal appointment. She complains of a rash involving her chest, face, and arms, a watery nasal discharge, and mild bilateral knee pain. She has had these symptoms for about 5 days. The symptoms do not seem to bother her too much, but she is concerned for the baby. She had contact with her younger sister, who also had a rash and was diagnosed with rubella infection about 10 days ago at a family gathering. She cannot confirm her vaccination history. Her vital signs are as follows: blood pressure, 110/70 mmHg; heart rate, 89/min; respiratory rate, 12/min; and temperature, 37.6℃ (99.7℉). Examination shows a moderately dense maculopapular lacy rash spread over the patient’s trunk, extremities, and face. No lymph node, liver, or spleen enlargement is noted. The knee joints appear normal. Serology performed 1 year ago Current serology Rubella IgM - negative Rubella IgM - negative Rubella IgG - 1:128 Rubella IgG - 1:64 Rubella IgG avidity - high Rubella IgG avidity - high What is the proper next step in the management of this woman? ---- <<Choices:>> A) Reassure and recommend vaccination against rubella postpartum B) Recommend pregnancy termination C) Arrange a chorionic villus sampling D) Recommend additional serologic testing for parvovirus B19 ---- <<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 20-year-old woman presents with vaginal discharge, pruritus, and painful micturition for the past 5 days. She is sexually active with multiple partners and admits to using barrier protection inconsistently. Her last menstrual period was 2 weeks ago. The patient denies any fever, chills, abdominal pain, menorrhagia, or flank pain. She is afebrile and the vital signs are within normal limits. Speculum examination reveals vaginal erythema with a profuse, greenish-yellow, purulent, malodorous discharge. The vaginal pH is 5.5. Vaginal swab and urine samples are obtained for microscopy and culture, and results are pending. Which of the following is the most likely diagnosis in this patient based on her presentation? ---- <<Choices:>> A) Urinary tract infection B) Bacterial vaginosis C) Trichomonal vaginitis D) Chlamydia infection ---- <<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 47-year-old female undergoes a thyroidectomy for treatment of Graves' disease. Post-operatively, she reports a hoarse voice and difficulty speaking. You suspect that this is likely a complication of her recent surgery. What is the embryologic origin of the damaged nerve that is most likely causing this patient's hoarseness? ---- <<Choices:>> A) 1st pharyngeal arch B) 2nd pharyngeal arch C) 3rd pharyngeal arch D) 6th pharyngeal arch ---- <<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 15-year-old boy with poorly controlled asthma presents to the emergency room complaining of severe shortness of breath. His mother reports that he had trouble breathing soon after he started playing soccer with some friends and was unable to use his inhaler as it was empty. His family history is notable for emphysema in his paternal uncle and cirrhosis in his maternal grandfather. The child’s temperature is 99.0°F (37.2°C), blood pressure is 130/90 mmHg, pulse is 130/min, respirations are 28/min, and oxygen saturation is 91% on room air. Physical examination demonstrates wheezing bilaterally in all lung fields. The child is started on supplemental oxygen and a nebulized bronchodilator. Which of the following is a downstream effect of this medication? ---- <<Choices:>> A) Decreased leukotriene activity B) Activation of muscarinic receptors C) Decreased phosphodiesterase activity D) Increased adenylate cyclase activity ---- <<Answer:>>
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D
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<<Question:>> A 55-year-old man presents with a 2-month history of an increasing sensation of fullness in the upper left side of his abdomen. He complains of increasing fatigue and dyspnea. He has no history of serious illness and takes no medications. His temperature is 36.7°C (98.1°F), pulse is 90/min, respiratory rate is 18/min, and blood pressure is 125/70 mm Hg. His conjunctivae are pale. The examination of the heart and lungs shows no abnormalities. The splenic margin is palpable 8 cm (3.1 in) below the costal margin. No abnormal lymph nodes are found. Laboratory studies show: Hemoglobin 8 g/dL Mean corpuscular volume 90 μm3 Leukocyte count 3,000/mm3 Platelet count 85,000/mm3 Peripheral blood smear shows small lymphocytes with cell membrane projections. Bone marrow aspiration is unsuccessful. Cell immunophenotyping is positive for CD25. Which of the following is the most effective pharmacotherapy at this time? ---- <<Choices:>> A) Cladribine B) Fludarabine C) Prednisone D) Thalidomide ---- <<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 57-year-old man presents to the emergency department with confusion. His symptoms started a few days ago and have been gradually worsening. Initially, the patient had a fever and a cough which has progressed to abdominal pain, diarrhea, and confusion. His temperature is 102°F (38.9°C), blood pressure is 127/68 mmHg, pulse is 120/min, respirations are 17/min, and oxygen saturation is 94% on room air. Physical exam is notable for localized crackles and decreased breath sounds in the left lower lung field. The patient is confused and is answering questions inappropriately. Laboratory studies are ordered as seen below. Hemoglobin: 12 g/dL Hematocrit: 36% Leukocyte count: 16,500/mm^3 with normal differential Platelet count: 190,000/mm^3 Serum: Na+: 130 mEq/L Cl-: 100 mEq/L K+: 4.3 mEq/L HCO3-: 25 mEq/L BUN: 20 mg/dL Glucose: 99 mg/dL Creatinine: 1.1 mg/dL Ca2+: 10.2 mg/dL Which of the following is the best diagnostic test to guide current therapy in this patient? ---- <<Choices:>> A) Chest radiography B) Lung biopsy C) Sputum culture D) Urine antigen test ---- <<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 45-year-old man presents to the physician because of a 1-day history of progressive pain and blurry vision in his right eye. He is struggling to open this eye because of the pain. His left eye is asymptomatic. He wears contact lenses. He has bronchial asthma treated with inhaled salbutamol. He works as a kindergarten teacher. The vital signs include: temperature 37.0°C (98.6°F), pulse 85/min, and blood pressure 135/75 mm Hg. The examination shows a visual acuity in the left eye of 20/25 and the ability to count fingers at 3 feet in the right eye. A photograph of the right eye is shown. Which of the following is the most likely diagnosis? ---- <<Choices:>> A) Angle-closure glaucoma B) Epidemic keratoconjunctivitis C) Herpes simplex keratitis D) Pseudomonas keratitis ---- <<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 50-year-old man presents to his physician with chronic cough, aching joints in his hips and lower back, and malaise over the past 2 months. He describes himself as being “generally healthy” before the cough began. Past medical history includes hypertension. The patient takes clopamide and a multivitamin daily. His parents are both well and living in a senior living facility. He does not smoke and only drinks alcohol occasionally. During a review of symptoms, the patient described a hiking trip in and around the desert near Phoenix, Arizona, 4 months ago. At the office, his temperature is 38.6°C (101.4°F), heart rate is 102/min, respirations are 20/min, and blood pressure is 120/82 mm Hg. A focused chest exam reveals mild fremetus and dullness with percussion on the right side. A chest X-ray shows a right-sided consolidation of the lower right lung, and a chest CT shows an irregular opacity measuring 3.8 cm x 3.0 cm in the sub-plural region of the right middle lobe, a small right-sided pleural effusion, and mild right-sided hilar adenopathy. A lung biopsy is performed to rule out cancer and reveals necrotic granulomatous inflammation with multinucleated giant cells and spherules with endospores in the surrounding tissues. The laboratory tests show the following results: Hemoglobin 12.9 mg/dL Leukocyte count 9,300/mm3 Platelet count 167,000/mm3 Erythrocyte sedimentation rate 43 mm/hr Periodic acid-Schiff and silver methenamine Positive Acid-fast stain Negative Which of the following is the most likely diagnosis? ---- <<Choices:>> A) Histoplasmosis B) Mycetoma C) Blastomycosis D) Valley fever ---- <<Answer:>>
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D
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<<Question:>> A 22-year-old man with sickle cell disease is brought to the emergency room for acute onset facial asymmetry and severe pain. He was in school when his teacher noted a drooping of his left face. His temperature is 99.9°F (37.7°C), blood pressure is 122/89 mmHg, pulse is 110/min, respirations are 19/min, and oxygen saturation is 98% on room air. Physical exam is notable for facial asymmetry and 4/5 strength in the patient's upper and lower extremity. A CT scan of the head does not demonstrate an intracranial bleed. Which of the following is the most appropriate treatment for this patient? ---- <<Choices:>> A) Alteplase B) Exchange transfusion C) Heparin D) Warfarin ---- <<Answer:>>
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B
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<<Question:>> A 3-month-old girl is brought to the physician because of a productive cough for 5 days. Over the past month, she has had several episodes of watery stools. She is exclusively breastfed every 3–4 hours for 15–20 minutes. She was delivered vaginally at 38 weeks' gestation at home and has not yet been evaluated by a physician. The mother reports that her child is not gaining weight. The mother had no prenatal care. The infant is at the 5th percentile for height and weight. The infant has not received any immunizations. Her temperature is 38.5°C (101.3°F), pulse is 155/min, respirations are 45/min, and blood pressure is 88/50 mm Hg. Oral examination shows white plaques covering the tongue and the palate. Rales are heard bilaterally on cardiopulmonary examination. Cervical and inguinal lymphadenopathy is present. Which of the following is most likely to confirm the diagnosis? ---- <<Choices:>> A) Karyotyping of infant's chromosomes B) DNA test for CFTR mutation C) Fluorescent treponemal antibody absorption test D) Polymerase chain reaction for viral genes ---- <<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 30-year-old primigravid woman at 22 weeks' gestation is brought to the emergency department by her husband for lethargy, nausea, and vomiting for 4 days. This morning she became drowsy. She returned from a business trip to Sudan 3 weeks ago. She denies eating any seafood while traveling. Medications include iron supplements and a multivitamin. Her immunizations are up-to-date and she has never received blood products. Her temperature is 38.9°C (102°F), pulse is 92/min, and blood pressure is 122/76 mm Hg. She is oriented to person and place. Examination shows jaundice and mild asterixis. Pelvic examination shows a uterus consistent in size with a 22-week gestation. Laboratory studies show: Hemoglobin 11.2 g/dL Prothrombin time 18 sec (INR=2.0) Serum Total bilirubin 4.4 mg/dL Alkaline phosphatase 398 U/L AST 4,702 U/L ALT 3,551 U/L Lactate dehydrogenase 3,412 U/L Anti-nuclear antibody negative Anti-smooth muscle antibody negative Anti-CMV antibody negative Anti-EBV nuclear antigen antibody negative An ELISA for HIV is negative. Which of the following is most likely to confirm the diagnosis?" ---- <<Choices:>> A) HBsAg B) Anti-HAV IgG C) Anti-HCV IgG D) Anti-HEV 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 36-year-old man is brought to the emergency department because of multiple episodes of nonbilious emesis for 3 days. The vomitus consists of undigested food and he has also had dark brown emesis twice today. He has been having early satiety during this period. He has had progressive severe episodic epigastric pain and dyspepsia for the past week. The pain is partially relieved with food or over-the-counter antacids, but worsens at night and several hours after eating. He has also had a weight gain of 2 kg (4.4 lbs) during this period. His father underwent surgery for colon cancer 3 years ago. He has smoked one pack of cigarettes daily for the last 15 years. He drinks two to three beers daily. His temperature is 37.1°C (98.8°F), pulse is 106/min and blood pressure is 108/68 mm Hg. Examination shows dry mucous membranes. The abdomen is mildly tender to palpation in the left upper quadrant; there is a tympanitic mass in the epigastrium. A succussion splash is heard with a stethoscope when the patient is rocked back and forth at the hips. Bowel sounds are reduced. Rectal examination is unremarkable. Test of the stool for occult blood is positive. The remainder of the examination shows no abnormalities. Serum studies show: Na+ 135 mEq/L K+ 3.3 mEq/L Cl- 97 mEq/L Urea nitrogen 46 mg/dL Glucose 77 mg/dL Creatinine 1.4 mg/dL Which of the following is the underlying cause of this patient's vomiting?" ---- <<Choices:>> A) Inflammation and edema B) Abnormal gastric rotation C) Neoplastic growth D) Walled-off pancreatic fluid collection ---- <<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 52-year-old man is brought to the emergency department because of worsening shortness of breath for 6 hours. For the past 5 days, he has had intermittent stabbing pain in the middle of his chest that worsens with lying down or taking deep breaths. He has also had a runny nose and a dry cough for the past 2 weeks. He has hypercholesterolemia and hypertension. He has smoked a pack of cigarettes daily for 34 years. His current medications include atorvastatin, enalapril, and hydrochlorothiazide. He appears pale and sweaty. His temperature is 38.3°C (100.9°F), pulse is 105/min, and respirations are 25/min. Blood pressure is 107/72 mm Hg during expiration and 86/65 mm Hg during inspiration. Examination shows jugular venous distention and pitting edema below the knees. Which of the following is the most likely cause of this patient's findings? ---- <<Choices:>> A) Dilation of the atria and ventricles B) Occlusion of a coronary artery C) Accumulation of fluid in the pericardial space D) Fibrous thickening of the pericardium ---- <<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 70-year-old obese male presents to the emergency department with shortness of breath and cough of sudden onset. The patient states that his symptoms came on while he was sleeping. The patient has a past medical history of type II diabetes and is currently taking lisinopril, metformin, insulin, and fish oil. On physical exam, you note bipedal edema and jugular venous distention (JVD). An EKG and chest radiographs are obtained (Figures A and B). The patient is started on BIPAP and medical therapy and his symptoms improve rapidly. Lab values are as follows. Serum: Na+: 137 mEq/L K+: 3.2 mEq/L Cl-: 100 mEq/L HCO3-: 31 mEq/L BUN: 20 mg/dL Glucose: 120 mg/dL Creatinine: 1.2 mg/dL Ca2+: 10.9 mg/dL Which of the following is the best explanation of this patient's current presentation? ---- <<Choices:>> A) Furosemide B) Hydrochlorothiazide C) Renal tubular acidosis type II D) Renal tubular acidosis type IV ---- <<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 23-year-old woman is seen by her primary care physician for fatigue. She says that she has always felt a little short of breath compared to her friends; however, she did not think that it was abnormal until she started trying a new exercise regimen. On physical exam, she is found to have mild conjunctival pallor and a peripheral blood smear is obtained showing echinocytes but no intracellular accumulations. Upon further questioning, she recalls that several relatives have had similar issues with fatigue and pallor in the past. Which of the following is true about the rate limiting enzyme of the biochemical pathway that is affected by this patient's most likely condition? ---- <<Choices:>> A) It is stimulated by ATP B) It is stimulated by citrate C) It is inhibited by protein kinase A activity D) It is inhibited by AMP ---- <<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 woman comes to the physician because she feels depressed, has difficulty sleeping, a poor appetite, and low concentration for the past 3 months. During this time, she has also had low energy and lost interest in playing the guitar. During high school, the patient went through similar episodes of low mood and poor sleep. At that time, she would repeatedly engage in binge eating and purging behavior, for which she was referred to therapy. There is no evidence of suicidal ideation. The physician offers to prescribe a medication for her current symptoms. Treatment with which of the following drugs should most be avoided in this patient? ---- <<Choices:>> A) Duloxetine B) Trazodone C) Bupropion D) Citalopram ---- <<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 5-month-old boy is brought to the physician with a 3-day history of fever and cough. His mother reports that he has had multiple episodes of loose stools over the past 3 months. He has been treated for otitis media 4 times and bronchiolitis 3 times since birth. He was born at 37 weeks' gestation, and the neonatal period was uncomplicated. He is at the 10th percentile for height and 3rd percentile for weight. His temperature is 38.3°C (100.9°F), pulse is 126/min, and respirations are 35/min. Examination shows an erythematous scaly rash over his trunk and extremities. The white patches on the tongue and buccal mucosa bleed when scraped. Inspiratory crackles are heard in the right lung base. An X-ray of the chest shows an infiltrate in the right lower lobe and an absent thymic shadow. Which of the following is the most likely definitive treatment for this patient’s condition? ---- <<Choices:>> A) Hematopoietic cell transplantation B) Intravenous immune globulin C) Leucovorin supplementation D) Thymic transplantation ---- <<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:>> Six days after undergoing an aortic valve replacement surgery, a 68-year-old woman has bluish discolorations around the peripheral intravenous catheters and severe right leg pain. She has a history of hypertension and major depressive disorder. She drinks 3 beers daily. Current medications include hydrochlorothiazide, aspirin, prophylactic unfractionated heparin, and fluoxetine. Her temperature is 37.3°C (99.1°F), pulse is 90/min, and blood pressure is 118/92 mm Hg. Examination shows multiple hematomas on the upper extremities around the peripheral intravenous access sites. There is a healing sternal incision. The lungs are clear to auscultation. Cardiac examination shows an aortic click. The right calf is tender, erythematous and swollen. Laboratory studies show: Hemoglobin 13.1 g/dL Leukocyte count 9,900/mm3 Platelet count 48,000/mm3 Prothrombin time 15 seconds Activated partial thromboplastin time 40 seconds Serum Urea nitrogen 19 mg/dL Creatinine 1.1 mg/dL Alkaline phosphatase 33 U/L AST 26 U/L ALT 33 U/L γ-Glutamyl transferase 45 U/L (N=5–50 U/L) Which of the following is the most likely underlying mechanism of this patient's symptoms?" ---- <<Choices:>> A) Deficiency of vitamin K-dependent clotting factors B) Phagocytosis of autoantibody-opsonized platelets C) Excess circulating thrombin D) Autoantibody-mediated platelet activation ---- <<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 55-year-old man with chronic hepatitis B virus infection comes to the physician because of generalized fatigue and a 5.4 kg (12 lb) weight loss over the past 4 months. Physical examination shows hepatomegaly. Laboratory studies show an α-fetoprotein concentration of 380 ng/ml (N < 10 ng/mL). A CT scan of the abdomen with contrast shows a solitary mass in the left lobe of the liver that enhances in the arterial phase. Which of the following is the most likely underlying pathogenesis of this patient's current condition? ---- <<Choices:>> A) Overexpression of secretory hepatitis antigen B) Intracellular accumulation of misfolded protein C) Gain of function mutation of a proto-oncogene D) Integration of foreign DNA into host genome " ---- <<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 28-year-old woman with no significant past medical history presents to her primary care physician with increased menstrual bleeding over the past three months. She also notes easy bruising and bleeding from her gums when brushing her teeth. She is sexually active with multiple partners and has no history of intravenous drug use. Physical exam is remarkable for petechiae and scattered ecchymoses on the patient's bilateral upper and lower extremities. Urine beta-HCG is negative. Laboratory results are as follows: Hgb 13.0 g/dL, WBCs 6,000/mL, platelets 95,000/mL, PT 13.2s, aPTT 30s. Peripheral blood smear shows normocytic, normochromic red blood cells and few platelets with no morphologic abnormalities. Which diagnostic study should be performed next? ---- <<Choices:>> A) Serum factor VIII levels and von Willebrand factor activity B) Measurement of ADAMTS13 activity C) HIV and HCV testing D) Bone marrow aspiration ---- <<Answer:>>
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C
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<<Question:>> A 6-year-old boy is brought in by his parents to a pediatrician’s office for persistent fever. His temperature has ranged from 38.6°C–39.5°C (101.5°F–103.1°F) over the past week. He was diagnosed with a gene defect on chromosome 7, which has caused dysfunction in a transmembrane protein. This defect has resulted in several hospitalizations for various respiratory infections. At the present time, he is struggling with a cough with thick purulent sputum. A sputum sample is sent for culture and the patient is started on vancomycin.The pediatrician tells the patient’s family that there is a collection of mucus in the respiratory tree which increases the patient's chances of future infections. He will have to undergo chest physiotherapy and they should report any signs of infection immediately to a medical professional. Which of the following pathogens will most likely infect this patient in adulthood? ---- <<Choices:>> A) Staphylococcus B) Pseudomonas C) Burkholderia D) Candida ---- <<Answer:>>
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B
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<<Question:>> An 8-week-old male presents with his mother to the pediatrician for a well visit. The patient has been breastfed since birth, and usually feeds for 30 minutes every 2-3 hours. The patient’s mother is concerned that her milk production is not keeping up with the patient’s nutritional requirements. She reports that about two weeks ago the patient began regurgitating breastmilk through his nose and mouth after some feeds. She reports that he seems mildly upset during the episodes of regurgitation but usually settles down quickly and is hungry again soon afterwards. The patient’s mother has already tried limiting the volume of each feed, which seems to have reduced the frequency of the regurgitation. She denies any diarrhea, hematochezia, or family history of food allergies. Her older son had a similar problem with vomiting that resolved around 12 months of age. Four weeks ago, the patient’s height and weight were in the 40th and 34th percentiles, respectively. His height and weight are now respectively in the 37th and 36th percentiles. On physical exam, the patient is cooing in his mother’s lap and smiles reciprocally with her. He lifts his head and shoulders off the examination table when placed in the supine position. His abdomen is soft, non-tender and non-distended. Bowel sounds are normoactive. Which of the following is the best next step in management? ---- <<Choices:>> A) Initiate proton pump inhibitor B) Obtain abdominal ultrasound C) Reassurance and counseling on positioning D) Recommend modification of mother’s diet ---- <<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 27-year-old gentleman is brought into the ED after being stabbed in the back by a knife. In addition to the pain from the wound, he complains of weakness in his left leg. Upon physical examination you find that he has no other visible injuries; however, he has 2/5 strength in the left lower extremity. Complete neurologic exam also finds a deficit in vibration sense and light touch on the left lower extremity as well as a loss of pain and temperature sensation in the right lower extremity. Which of the following lesions would result in the syndrome described? ---- <<Choices:>> A) Anterior cord lesion B) Posterior cord lesion C) Right cord hemisection D) Left cord hemisection ---- <<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 58-year-old African American man presents for his yearly wellness visit. He says he has been unsuccessful at losing weight and would like help. His last colonoscopy was 8 years previously, which was normal. Past medical history is significant for obstructive sleep apnea (OSA) and hypertension. Current medications are isosorbide dinitrate/hydralazine and aspirin 81 mg orally daily. He is also on CPAP to manage his OSA. The patient denies any history of smoking or recreational drug use and drinks 1 or 2 beers on weekends. Family history is significant for prostate cancer in his father and hypertension and diabetes mellitus type 2 in his mother. His vital signs include: temperature 36.8°C (98.2°F), pulse 97/min, respiratory rate 16/min, blood pressure 120/75 mm Hg. BMI is 30 kg/m2. Physical examination is unremarkable. Fasting blood glucose is 90 mg/dL. Which of the following preventative screening tests would be most appropriate for this patient at this time? ---- <<Choices:>> A) PSA B) Digital rectal exam C) Abdominal ultrasound D) Flexible sigmoidoscopy ---- <<Answer:>>
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A
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<<Question:>> A 34-year-old patient is brought to the emergency room after a motor vehicle accident. An EKG shows sinus tachycardia and chest radiograph reveals an enlarged cardiac silhouette. While observing sinus tachycardia on the patient's telemetry, you note that the radial pulse cannot be palpated during inspiration. What should be the next step in management of this patient? ---- <<Choices:>> A) Pericardiocentesis B) Chest CT scan C) Pericardial window D) Insert chest tube ---- <<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 previously healthy 60-year-old man comes to his physician because of progressively worsening shortness of breath for the past 2 months. He does not experience shortness of breath at rest. He also occasionally has a dry cough. He has not had fever, chills, or night sweats. He has smoked a pack of cigarettes daily for the past 40 years. He drinks a beer daily and occasionally more on weekends. He does not use illicit drugs. He is 183 cm (6 ft 0 in) tall and weighs 66 kg (145 lbs); BMI is 19.7 kg/m2. His temperature is 37°C (98.6°F), pulse is 94/min, respirations are 21/min, and blood pressure is 136/88 mm Hg. Lung auscultation reveals a prolonged expiratory phase and end-expiratory wheezing. Spirometry shows an FEV1:FVC ratio of 62%, an FEV1 of 60% of predicted, and a total lung capacity of 125% of predicted. The diffusion capacity of the lung (DLCO) is decreased. Which of the following is the most likely diagnosis? ---- <<Choices:>> A) Interstitial lung disease B) Hypersensitivity pneumonitis C) Chronic obstructive pulmonary disease D) Bronchiectasis ---- <<Answer:>>
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C
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<<Question:>> A 29-year-old G1P0 woman is giving birth at 38 weeks gestation to a boy via vaginal delivery. As soon as the infant is clear of the vagina, a congenital malformation of the abdomen is observed. The infant is removed from the delivery room for further evaluation. Visual inspection shows loops of intestine protruding out of his abdomen on the right side. His APGAR scores are 7 at 1 minute and 9 at 5 minutes. His heart rate is 125/min, and his respirations are 45/min. All reflexes appear normal. There are no other visible defects. Which of the following is the most appropriate next step in management? ---- <<Choices:>> A) Wrap the intestines in a sterile bowel bag B) Transfer the newborn to the NICU C) Start IV fluids D) Transfer the newborn for immediate surgery ---- <<Answer:>>
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A
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<<Question:>> A 54-year-old woman presents with fatigue, malaise, and shortness of breath over the past 5 months. Past medical history is significant for rheumatoid arthritis diagnosed 23 years ago for which she takes naproxen as needed. Her vital signs include: temperature 36.9°C (98.4°F), blood pressure 135/88 mm Hg, pulse 92/min. Physical examination is significant for conjunctival pallor and bilateral ulnar deviation of the metacarpophalangeal joints. Laboratory findings are significant for the following: Hemoglobin 9.2 g/dL Mean corpuscular volume 76 fL Leukocyte count 7,000/mm3 Platelet count 220,000/mm3 Serum ferritin 310 ng/mL Erythrocyte sedimentation rate 85 mm/h Which of the following is a feature of this patient's anemia? ---- <<Choices:>> A) ↑ serum transferrin receptors B) ↑ transferrin saturation C) Upregulation of hepcidin D) ↑ reticulocyte count ---- <<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 six-year-old boy with a history of asthma currently uses an albuterol inhaler as needed to manage his asthma symptoms. His mother brings him into your office because she feels she has had to increase the patient’s use of his inhaler to four times per week for the past month. She also reports that he has woken up three times during the night from his symptoms this month. The boy reports that he is upset because he can’t always keep up with his friends in the playground. His past medical history is significant for allergic rhinitis. The patient’s temperature is 98°F (36.6°C), blood pressure is 110/70 mmHg, pulse is 88/min, and respirations are 18/min with an oxygen saturation of 98% O2 on room air. Auscultation of his lungs reveals bilateral late expiratory wheezes. What changes should be made to his current asthma treatment regimen? ---- <<Choices:>> A) Maintain current therapy B) Add fluticasone daily C) Add salmeterol twice daily D) Add zileuton twice daily ---- <<Answer:>>
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B
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<<Question:>> A 25-year-old woman comes to the office complaining of pelvic pain and feeling “off” for the past few weeks. She has not had any changes in diet or lifestyle but reports weight loss despite an increase in appetite. In addition, she has been experiencing chest palpitations, increased frequency of diarrhea, and heat intolerance. Physical exam of her thyroid is unremarkable but her TSH was found to be 0.21 mIU/L. A complex structure in her right ovary was detected on ultrasound. Her symptoms can be explained by which of the following? ---- <<Choices:>> A) Meigs syndrome B) Jod-Basedow phenomenon C) Dermoid cyst D) Struma ovarii ---- <<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 otherwise healthy 15-year-old boy presents to the emergency department with extreme fatigue and shortness of breath. His temperature is 36.5°C (97.7°F), the blood pressure is 100/60 mm Hg and the pulse is 100/min. Past medical history is noncontributory and he takes no medication. His father and aunt both suffer from mild anemia. On examination, he is very pale and his spleen is enlarged. His hemoglobin is 5 g/dL and platelet count is slightly reduced. His peripheral blood smear is shown in the picture. Over the next 2 weeks, the patient recovers, and his hemoglobin is 11 g/dL. Which of the following best represents the pattern of inheritance of this patient underlying disorder? ---- <<Choices:>> A) Autosomal dominant B) X-linked recessive C) X-linked dominant D) Multifactorial ---- <<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 male presents to the emergency department from his home complaining of dyspnea. He is alert and oriented. The following arterial blood gas readings are drawn: pH: 7.33 (Normal: 7.35-7.45), pCO2: 70 mmHg (Normal: 35-45 mmHg), HCO3 33 (Normal: 21-26 mEq/L) Which of the following is most likely to have produced this patient’s condition? ---- <<Choices:>> A) Panic attack B) Mechanical ventilation C) Pulmonary embolus D) Chronic obstructive bronchitis ---- <<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 admitted to the hospital with fever, chest discomfort, tachypnea, pain, needle-like sensations in the upper extremities, and profuse sweating. He also complains of a gradual decrease in vision over the past 3 months. He is a bodybuilding competitor and has a competition coming up in 1 week. The man reports that his symptoms appeared suddenly, 30 minutes after he took 2 foreign-manufactured fat-burning pills instead of the 1 he usually takes. His blood pressure is 140/90 mm Hg, heart rate is 137/min, respiratory rate is 26/min, and temperature is 39.9°C (103.8°F). Physical examination reveals a reddish maculopapular rash over the patient’s trunk, diminished lung and heart sounds, tenderness to palpation in his abdomen, and rotational bilateral nystagmus with an alternating gaze-dependent fast component. Ophthalmologic examination shows bilateral cataracts. The patient’s total blood count is as follows: Erythrocytes 4.4 x 109/mm3 Hb 12 g/dL Total leukocyte count 3750/mm3 Neutrophils 57% Lymphocyte 37% Eosinophil 1% Monocyte 5% Basophil 0% Platelet count 209,000/mm3 Which of the following statements best describes the pathogenesis of this patient’s condition? ---- <<Choices:>> A) The patient’s symptoms are caused by an increased concentration of epinephrine released by the adrenal glands in response to the consumed substance. B) The drug caused uncoupling of the electron transport chain and oxidative phosphorylation. C) The patient has a pyretic reaction due to bacterial contamination of the pills. D) The drug has stimulated the hypothalamic temperature center to produce hyperthermia. ---- <<Answer:>>
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B
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<<Question:>> A 23-year-old woman comes to the physician because of progressive fatigue and painful swelling of her right knee for 3 weeks. She works as a professional ballet dancer and says, “I'm always trying to be in shape for my upcoming performances.” She is 163 cm (5 ft 4 in) tall and weighs 45 kg (99 lb); BMI is 17 kg/m2. Physical examination shows tenderness and limited range of motion in her right knee. Oral examination shows bleeding and swelling of the gums. There are diffuse petechiae around hair follicles on her abdomen and both thighs. Laboratory studies show a prothrombin time of 12 seconds, an activated partial thromboplastin time of 35 seconds, and a bleeding time of 11 minutes. Arthrocentesis of the right knee shows bloody synovial fluid. The patient’s condition is most likely associated with a defect in a reaction that occurs in which of the following cellular structures? ---- <<Choices:>> A) Lysosomes B) Rough endoplasmic reticulum C) Nucleus D) Extracellular space ---- <<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 24-year-old woman comes to the physician because she had unprotected intercourse with her boyfriend the previous day. She has had regular menses since menarche at the age of 12. Her last menstrual period was 3 weeks ago. She has no history of serious illness but is allergic to certain jewelry and metal alloys. She takes no medications. A urine pregnancy test is negative. She does not wish to become pregnant until she finishes college in six months. Which of the following is the most appropriate next step in management? ---- <<Choices:>> A) Insert copper-containing intra-uterine device B) Administer mifepristone C) Administer ulipristal acetate D) Administer depot medroxyprogesterone acetate ---- <<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 27-year-old woman with a history of bipolar disorder presents for a 3-month follow-up after starting treatment with lithium. She says she has been compliant with her medication but has experienced no improvement. The patient has no other significant past medical history and takes no other medications. She reports no known allergies. The patient is afebrile, and her vital signs are within normal limits. A physical examination is unremarkable. The patient is switched to a different medication. The patient presents 2 weeks later with an acute onset rash on her torso consisting of targetoid lesions with a vesicular center. She says the rash developed 2 days ago which has progressively worsened. She also says that 1 week ago she developed fever, lethargy, myalgia, and chills that resolved in 3 days. Which of the following drugs was this patient most likely prescribed? ---- <<Choices:>> A) Lamotrigine B) Valproate C) Olanzapine-fluoxetine combination (OFC) D) Paroxetine ---- <<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 6-year-old boy is brought to the physician by his mother because of a 6-month history of mild episodic abdominal pain. The episodes occur every 1–2 months and last for a few hours. The pain is located in the epigastrium, radiates to his back, and is occasionally associated with mild nausea. His mother is concerned that his condition might be hereditary because his older sister was diagnosed with congenital heart disease. He is otherwise healthy and has met all developmental milestones. He is at the 75th percentile for height and the 65th percentile for weight. Physical examination shows no abdominal distention, guarding, or rebound tenderness. Which of the following congenital conditions would best explain this patient's symptoms? ---- <<Choices:>> A) Hypertrophic pyloric stenosis B) Biliary cyst C) Intestinal malrotation D) Pancreas divisum ---- <<Answer:>>
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D
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<<Question:>> A healthy, full-term 1-day-old female is being evaluated after birth and is noted to have a cleft palate and a systolic ejection murmur at the second left intercostal space. A chest radiograph is obtained which reveals a boot-shaped heart and absence of a thymus. An echocardiogram is done which shows pulmonary stenosis with a hypertrophic right ventricular wall, ventricular septal defect, and overriding of the aorta. Which of the following additional features is expected to be seen in this patient? ---- <<Choices:>> A) Seizures due to hypocalcemia B) Catlike cry C) Hyperthyroidism from transplacental antibodies D) Increased phenylalanine in the blood ---- <<Answer:>>
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A
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<<Question:>> A 58-year-old male with a history of obesity and hypertension presents to his primary care physician for a follow-up visit. He reports that he feels well and has no complaints. He currently takes hydrochlorothiazide. His temperature is 98.6°F (37°C), blood pressure is 135/80 mmHg, pulse is 86/min, and respirations are 17/min. His BMI is 31 kg/m2. Results of a lipid panel are: Total cholesterol is 280 mg/dl, triglycerides are 110 mg/dl, HDL cholesterol is 40 mg/dl, and LDL cholesterol is 195 mg/dl. Her physician considers starting her on atorvastatin. Which of the following will most likely decrease after initiating this medication? ---- <<Choices:>> A) Mevalonate B) Acetoacetyl-CoA C) Diacyglycerol D) High-density lipoprotein ---- <<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 54-year-old man presents with the acute onset of seizures and hallucinations. The patient’s wife says that he had been on a camping trip a few months earlier to study bats but otherwise has not traveled recently. Past medical history is significant for hypertension, managed medically with hydralazine and enalapril. The patient’s condition rapidly deteriorates, and he passes away. An autopsy is performed and a histologic stained section of the brain is shown in the image. Which of the following receptors are targeted by the pathogen most likely responsible for this patient’s condition? ---- <<Choices:>> A) CCR5 B) Acetylcholine receptor C) ICAM-1 D) GABA ---- <<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 female patient with a history of hypertension presents to an outpatient office for regular check-up and is found to have hypertriglyceridemia. Her physician prescribes high-dose niacin and recommends taking the medication along with aspirin. The side effect the physician is trying to avoid is thought to be mediated by what mechanism? ---- <<Choices:>> A) Bile deposition in the dermis B) Release of prostaglandins C) Mast cell degranulation D) T cell activation ---- <<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 42-year-old man comes to the physician after elevated liver function tests were found after a routine screening. He has had occasional headaches over the past year, but otherwise feels well. The patient reports that he was involved in a severe car accident 30 years ago. He does not smoke or drink alcohol. He has never used illicit intravenous drugs. He takes no medications and has no known allergies. His father had a history of alcoholism and died of liver cancer. The patient appears thin. His temperature is 37.8°C (100°F), pulse is 100/min, and blood pressure is 110/70 mm Hg. Physical examination shows no abnormalities. Laboratory studies show: Hemoglobin 14 g/dL Leukocyte count 10,000/mm3 Platelet count 146,000/mm3 Serum Glucose 150 mg/dL Albumin 3.2 g/dL Total bilirubin 1.5 mg/dL Alkaline phosphatase 75 U/L AST 95 U/L ALT 73 U/L HIV negative Hepatitis B surface antigen negative Hepatitis C antibody positive HCV RNA positive HCV genotype 1 A liver biopsy is performed and shows mononuclear infiltrates that are limited to portal tracts and periportal hepatocyte necrosis. Which of the following is the most appropriate next step in management?" ---- <<Choices:>> A) Sofosbuvir and ledipasvir therapy B) Tenofovir and velpatasvir therapy C) Interferon and ribavirin therapy D) Tenofovir and entecavir therapy ---- <<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 44-year-old woman with hypothyroidism comes to the physician because of a 1-month history of tingling in her feet and poor balance. Her only medication is levothyroxine. Physical examination shows conjunctival pallor and an ataxic gait. Proprioception and sense of vibration are decreased in her toes bilaterally. Laboratory studies show macrocytic anemia and normal thyroid hormone levels. Histological evaluation of tissue samples obtained by esophagogastroduodenoscopy reveals atrophic changes of the gastric body and fundus with normal antral mucosa. Which of the following structures is most likely being targeted by antibodies in this patient? ---- <<Choices:>> A) Islet cell cytoplasm B) Deamidated gliadin peptide C) Parietal cells D) Smooth muscle ---- <<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 female complains of frequent, large volume urination. This negatively affects her sleep, as she has to frequently wake up at night to urinate. She also complains of increased thirst. Her past medical history is significant for bipolar disorder that is treated with lithium for 3 years. Serum osmolality is 425 mOsm/kg, and urine osmolality is 176 mOsm/kg. Which of the following best explains this patient’s serum and urine osmolality? ---- <<Choices:>> A) Hypothalamic over-production of antidiuretic hormone (ADH) B) Decreased production of ADH C) ADH resistance in the renal collecting ducts D) Increased sodium reabsorption and potassium excretion ---- <<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:>> An 8-year-old girl presents to her pediatrician with intensely pruritic lesions over her buttocks, as shown. These lesions occur intermittently but have worsened over time. Her medical history is remarkable for iron deficiency, for which she is on ferrous sulfate. The patient has also experienced intermittent episodes of mild diarrhea, previously diagnosed as lactose intolerance. Her height is at the 30th percentile and weight is at the 25th percentile for age and sex. An immunoglobulin A (IgA) tissue transglutaminase titer is 5 times the upper limit of normal. Which of the following is the most likely cause of this patient's condition? ---- <<Choices:>> A) Crohn’s disease B) Celiac disease C) Common variable immune deficiency D) Henoch-Schonlein purpura ---- <<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 64-year-old man comes to the emergency department because of a 2-day history of lower back pain, fever, and chills. He has had nausea but no vomiting during this time. He has hypertension, chronic kidney disease, and type 2 diabetes mellitus. Three months ago, he underwent amputation of his left third toe because of a non-healing ulcer. He has smoked a pack of cigarettes daily for 48 years. Current medications include hydrochlorothiazide, metoprolol, and insulin. His temperature is 39.4°C (102.9°F), pulse is 102/min, blood pressure is 150/94 mm Hg, and respirations are 18/min. Examination shows a 1-cm (0.4-in) round ulcer on the sole of his right foot. There is costovertebral angle tenderness on the left side. The abdomen is soft. Laboratory studies show: Hemoglobin 11.5 g/dL Leukocyte count 19,000/mm3 Serum Na+ 140 mEq/L Cl− 102 mEq/L K+ 5.0 mEq/L HCO3− 25 mEq/L Urea nitrogen 65 mg/dL Creatinine 2.4 mg/dL Glucose 240 mg/dL Urine Blood 1+ Protein 1+ WBC 100/hpf Nitrite 2+ WBC casts numerous Urine and blood samples for culture and sensitivity tests are obtained. Which of the following is the most appropriate next step in management?" ---- <<Choices:>> A) Inpatient treatment with intravenous ciprofloxacin B) Outpatient treatment with oral levofloxacin C) Outpatient treatment with trimethoprim-sulfamethoxazole D) Initiate hemodialysis ---- <<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 56-year-old man with a history of pancreatic cancer presents to the surgical intensive care unit following a pancreaticoduodenectomy. Over the next 3 days, the patient's drainage output is noted to exceed 1 liter per day. In the early morning of postoperative day 4, the nurse states that the patient is difficult to arouse. His temperature is 99.5°F (37.5°C), blood pressure is 107/88 mmHg, pulse is 120/min, respirations are 17/min, and oxygen saturation is 98% on room air. His skin and mucous membranes are dry on physical exam. Laboratory values are ordered as seen below. Serum: Na+: 154 mEq/L Cl-: 100 mEq/L K+: 4.3 mEq/L HCO3-: 27 mEq/L BUN: 20 mg/dL Glucose: 99 mg/dL Creatinine: 1.1 mg/dL Which of the following is the best next step in management? ---- <<Choices:>> A) 0.9% saline IV B) 5% dextrose IV C) 5% dextrose IV with 0.45% saline IV D) Oral free water replacement ---- <<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 woman comes to the physician because of a 3-day history of diarrhea, moderate abdominal pain, and weakness. Her symptoms began on the return flight from a 2-week yoga retreat in India, where she stayed at a resort. She was mildly nauseous as she boarded the flight, and diarrhea followed immediately after eating the in-flight meal. Since then, she has had up to five watery stools daily. She has a 1-year history of gastroesophageal reflux disease and is allergic to shellfish. Her only medication is ranitidine. She appears lethargic. Her temperature is 37°C (98.6°F), pulse is 70/min, and blood pressure is 115/72 mm Hg. Abdominal examination shows diffuse tenderness with no guarding or rebound. Bowel sounds are hyperactive. Which of the following is the most likely pathogen? ---- <<Choices:>> A) Giardia intestinalis B) Shigella species C) Staphylococcus aureus D) Enterotoxigenic Escherichia coli ---- <<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 research group has created a novel screening test for a rare disorder. A robust clinical trial is performed in a group of 100 subjects comparing the new screening test against the gold standard. The results are given in the table below: Screening test\gold standard Disease present Disease absent Positive 45 15 Negative 5 35 Which of the following is most correct regarding the statistical power of this new screening test? ---- <<Choices:>> A) Repeating the study would have no effect on the statistical power of the screening test. B) The power of the test is 0.8. C) If the specificity of this screening test were increased, the statistical power would increase. D) If the sensitivity of this screening test were decreased, the statistical power would decrease. ---- <<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 25-year-old woman presents to her new family physician for a follow-up appointment. She previously presented with itching, as well as frequent and painful urination. A vaginal swab was taken and sent to the laboratory to confirm the diagnosis. Diplococci were seen on Gram stain and were grown on Thayer-Martin agar. When discussing her infection, the patient says that she uses safe sex practices. Her history is significant for meningitis and for infection with Streptococcus pneumoniae. The physician discusses that the reason behind these infections comes from a defect in the innate immune system. Which of the following best describes the component that is likely deficient in this patient? ---- <<Choices:>> A) Plays a role in angioedema B) Degraded by C1 esterase inhibitor C) Creates pores in the cell membrane D) Induces the alternative complement pathway ---- <<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 55-year-old woman with papillary thyroid carcinoma underwent total thyroidectomy. She has no significant medical history. On postoperative day 1, she develops perioral numbness and a tingling sensation, along with paresthesia of the hands and feet. The physical examination reveals that she is anxious and confused. Her pulse is 90/min, the blood pressure is 110/80 mm Hg, the respirations are 22/min, and the temperature is 36.7°C (98.0°F). Latent tetany (carpal spasm) is evident in the right arm. This is observed when the sphygmomanometer cuff pressure is raised above the systolic blood pressure and held for 3 minutes. The laboratory test results are as follows: Serum calcium 6.7 mg/dL Serum sodium 143 mEq/L Serum potassium 4.4 mEq/L Serum creatinine 0.9 mg/dL Blood urea 16 mg/dL Serum magnesium 1.1 mEq/L What is the most likely cause of this condition? ---- <<Choices:>> A) Inadvertent surgical removal of parathyroid glands B) DiGeorge syndrome C) Chronic hypomagnesemia D) Hungry bone syndrome ---- <<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 16-year-old boy is brought to the physician by his parents for the evaluation of fatigue for several weeks. The parents report that their son quit doing sports at school because of low energy. The patient's academic performance has declined recently. He spends most of his time in the basement playing video games and eating bowls of cereal. He has no history of serious illness. His mother has Hashimoto's thyroiditis and his father has major depressive disorder. The patient does not smoke or drink alcohol. His vital signs are within normal limits. Examination shows conjunctival pallor, inflammation and fissuring of the corners of the mouth, and concavity of the finger nails. The remainder of the examination shows no abnormalities. Laboratory studies show: Hemoglobin 11.5 g/dL Mean corpuscular volume 76 μm3 Platelet count 290,000/mm3 Red cell distribution width 18% (N = 13%–15%) Leukocyte count 7,000/mm3 Which of the following is the most appropriate initial step in treatment?" ---- <<Choices:>> A) Regular blood transfusions B) Methylphenidate C) Iron supplementation D) Allogenic stem cell transplantation ---- <<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 78-year-old man is brought to the emergency department because of a 1-day history of painful enlarging bruises and skin ulceration over his thighs and external genitalia. He has type 2 diabetes mellitus, mitral regurgitation, and atrial fibrillation. Three days ago, he was started on treatment with warfarin. His only other medications are metformin and lisinopril. His temperature is 37.8°C (100.0°F), pulse is 108/min and irregularly irregular, and blood pressure is 155/89 mm Hg. Examination of the skin shows large purpura, hemorrhagic bullae, and areas of skin necrosis over his anterior legs, gluteal region, and penis. This patient is most likely to benefit from treatment with which of the following? ---- <<Choices:>> A) Hyperbaric oxygen B) Protein C concentrate C) Argatroban D) Tranexamic acid ---- <<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 15-year-old boy is brought to the physician for evaluation of a learning disability. His teachers have reported hyperactivity during class, difficulties with social interaction, and poor scores on reading and writing assessments. Molecular analysis shows an increased number of CGG trinucleotide repeats. Which of the following findings are most likely to be seen on physical examination of this patient? ---- <<Choices:>> A) Frontal balding and cataracts B) Long face and large everted ears C) Almond-shaped eyes and downturned mouth D) Thin upper lip and receding chin ---- <<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 65-year-old woman presented to the emergency room due to progressive dyspnea. She is a known hypertensive but is poorly compliant with medications. The patient claims to have orthopnea, paroxysmal nocturnal dyspnea, and easy fatigability. On physical examination, the blood pressure is 80/50 mm Hg. There is prominent neck vein distention. An S3 gallop, bibasilar crackles, and grade 3 bipedal edema were also detected. A 2d echo was performed, which showed a decreased ejection fraction (32%). Which of the following drugs should not be given to this patient? ---- <<Choices:>> A) Furosemide B) Nesiritide C) Metoprolol D) Digoxin ---- <<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 49-year-old woman is brought to the emergency department with progressive dyspnea and cough which she developed approx. 8 hours ago. 2 weeks ago she had a prophylactic ovariectomy because of a family history of ovarian cancer. She is known to have type 2 diabetes mellitus and stage 1 hypertension, but she does not take her antihypertensives because she is not concerned about her blood pressure. Also, she has a history of opioid abuse. She takes metformin 1000 mg and aspirin 81 mg. She has been smoking 1 pack of cigarettes per day for 22 years. Her vital signs are as follows: blood pressure 155/80 mm Hg, heart rate 101/min, respiratory rate 31/min, and temperature 37.9℃ (100.2℉). Blood saturation on room air is 89%. On examination, the patient is dyspneic and acrocyanotic. Lung auscultation reveals bilateral rales over the lower lobes. A cardiac examination is significant for S2 accentuation best heard in the second intercostal space at the left sternal border and S3 presence. There is no leg edema. Neurological examination is within normal limits. Arterial blood gases analysis shows the following results: pH 7.49 PaO2 58 mm Hg PaCO2 30 mm Hg HCO3- 22 mEq/L Based on the given data, which of the following could cause respiratory failure in this patient? ---- <<Choices:>> A) Increased alveolar dead space due to absent perfusion of certain alveoli B) Alveolar fibrosis C) Depression of the respiratory center via opioid receptors activation D) Decreased V/Q due to bronchial obstruction ---- <<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 27-year-old woman presents to the emergency department with acute onset bloody diarrhea. The patient has had severe abdominal pain throughout her entire life with occasional episodes of bloody diarrhea. She has recently lost 7 pounds and has felt generally ill for the past 2 days. She has a past medical history of generalized seizures with her most recent one having occurred 5 days ago. One month ago, the patient was treated for impetigo. The patient admits to occasional cocaine use and binge drinking. Her temperature is 98.7°F (37.1°C), blood pressure is 107/58 mmHg, pulse is 127/min, respirations are 16/min, and oxygen saturation is 99% on room air. Physical exam is notable for diffuse abdominal tenderness and guaiac positive stools. Laboratory values are ordered as seen below. Hemoglobin: 9 g/dL Hematocrit: 30% Leukocyte count: 9,400/mm^3 with normal differential Platelet count: 199,000/mm^3 Serum: Na+: 139 mEq/L Cl-: 101 mEq/L K+: 4.9 mEq/L HCO3-: 25 mEq/L BUN: 37 mg/dL Glucose: 99 mg/dL Creatinine: 1.8 mg/dL AST: 62 U/L ALT: 80 U/L Blood alcohol: .15 g/dL Urine: Color: Yellow Protein: Positive Cocaine: Positive Marijuana: Positive Which of the following is the best explanation for this patient's laboratory findings? ---- <<Choices:>> A) Alcohol-induced liver injury B) Immune response to streptococcal infection C) Intestinal IgA deficiency D) Protein deposition ---- <<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 45-year-old Caucasian male presents to a gastroenterologist complaining of heartburn and difficulty swallowing. He recalls that he has been told by his primary care physician that he suffers from gastroesophageal reflux disease (GERD). The gastroenterologist decides to perform an upper endoscopy with biopsy. Which of the following findings would be consistent with Barrett's esophagus? ---- <<Choices:>> A) Presence of Paneth cells in the lower esophagus B) Metaplasia in the upper esophagus C) A small region of red, velvet-like mucosa in the lower esophagus D) Esophageal varices ---- <<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 16-year-old female patient with a history of mental retardation presents to your clinic with her mother. The mother states that she wants her daughter to have a bilateral tubal ligation after she recently discovered her looking at pornographic materials. She states that her daughter is not capable of understanding the repercussions of sexual intercourse, and that she does not want her to be burdened with a child that she would not be able to raise. Upon discussions with the patient, it is clear that she is not able to understand that sexual intercourse can lead to pregnancy. What should your next step be? ---- <<Choices:>> A) Schedule the patient for the requested surgery B) Wait until the patient is 18 years old, and then schedule for surgery C) Refuse the procedure because it violates the ethical principle of autonomy D) Refuse the procedure because it is unlikely that the patient will get pregnant ---- <<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 to his primary care provider complaining of malaise. He returned from a research trip to Madagascar 2 weeks ago and has since developed a worsening fever with a maximum temperature of 102.2°F (39°C). He also reports some swelling around his neck and groin. He works as a zoologist and was in rural Madagascar studying a rare species of lemur. His past medical history is notable for hypertension and gout. He takes lisinopril and allopurinol. His temperature is 101.9°F (38.3°C), blood pressure is 145/85 mmHg, pulse is 110/min, and respirations are 22/min. On exam, he has painful erythematous cervical, axillary, and inguinal lymphadenopathy. Black hemorrhagic eschars are noted on his fingertips bilaterally. The pathogen responsible for this patient’s condition produces a virulence factor that has which of the following functions? ---- <<Choices:>> A) Cleave immunoglobulin B) Inhibit phagocytosis C) Inhibit ribosomal function D) Trigger widespread inflammation ---- <<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 45-year-old African-American male presents to the family medicine physician to assess the status of his diabetes. After reviewing the laboratory tests, the physician decides to write the patient a prescription for miglitol and states that it must be taken with the first bite of the meal. Which of the following bonds will no longer be cleaved when the patient takes miglitol? ---- <<Choices:>> A) Phosphodiester bonds B) Glycosidic bonds C) Cystine bonds D) Hydrogen bonds ---- <<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 previously healthy 24-year-old man comes to the physician 1 day after the onset of burning pain, swelling, and multiple blisters over the left index finger. He works as a dental assistant and is concerned about not being able to work. The patient wonders if the symptoms might be related to a hunting trip he returned from 1 week ago because he remembers seeing a lot of poison oak. He is sexually active with one female partner, and they do not use condoms. His father has a history of thromboangiitis obliterans. He has smoked one pack of cigarettes daily for 5 years. He drinks two to four beers on social occasions. Vital signs are within normal limits. Physical examination shows swelling and erythema of the pulp space of the left index finger; there are multiple 3-mm vesicles. Laboratory studies show a leukocyte count of 12,000 cells/mm3. In addition to supportive therapy, which of the following is the most appropriate next step in management? ---- <<Choices:>> A) Oral acyclovir B) Oral cephalexin C) Smoking cessation D) Washing thoroughly " ---- <<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 63-year-old man presents to the ambulatory medical clinic with symptoms of dysphagia and ‘heartburn’, which he states have become more troublesome over the past year. His past medical history is significant for hypertension and GERD. He takes lisinopril for hypertension and has failed multiple different therapies for his GERD. On physical exam, he is somewhat tender to palpation over his upper abdomen. Barium swallow demonstrates a subdiaphragmatic gastroesophageal junction, with herniation of the gastric fundus into the left hemithorax. Given the following options, what is the most appropriate next step in the management of this patient’s underlying condition? ---- <<Choices:>> A) Lifestyle modification B) Combined antacid therapy C) Continue on Omeprazole D) Surgical gastropexy ---- <<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 63-year-old man is admitted to the intensive care unit for hemodynamic instability. Several days prior, he had been swimming in the Gulf coast when he stepped on a sharp rock and cut his right foot. Three days ago, the patient presented to the emergency room after noticing painful redness spreading along his skin up from his right foot and was subsequently admitted for antibiotic treatment. Currently, his temperature is 101.8°F (38.8°C), blood pressure is 84/46 mmHg with a mean arterial pressure of 59 mmHg, pulse is 104/min, and respirations are 14/min. His telemetry shows sinus tachycardia. His blood cultures are pending, but Gram stain demonstrated gram-negative bacilli. Which of the following best describes the form of shock and the skin exam? ---- <<Choices:>> A) Distributive shock with warm skin B) Hypovolemic shock with warm skin C) Neurogenic shock with cold skin D) Obstructive shock with cold skin ---- <<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 24-year-old female presents to the emergency department with a chief complaint of an inability to urinate. She states that this has been one of many symptoms she has experienced lately. At times she has had trouble speaking and has noticed changes in her vision however these episodes occurred over a month ago and have resolved since then. Two days ago she experienced extreme pain in her face that was exacerbated with brushing her teeth and plucking out facial hairs. The patient has no relevant past medical history, however, the patient admits to being sexually abused by her boyfriend for the past year. Her current medications include ibuprofen for menstrual cramps. On physical exam it is noted that leftward gaze results in only the ipsilateral eye gazing leftward. The patient's initial workup is started in the emergency department. Her vital signs are within normal limits and you note a pale and frightened young lady awaiting further care. Which of the following is the best initial test for this patient's chief complaint? ---- <<Choices:>> A) Head CT B) Head MRI C) Lumbar puncture D) Domestic abuse screening and exploring patient's life stressors ---- <<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 54-year-old woman is brought to the physician by her brother for confusion and agitation. She is unable to personally give a history. Her brother says she has a problem with alcohol use and that he found an empty bottle of vodka on the counter at her home. She appears disheveled. Her temperature is 37°C (98.6°F), pulse is 85/min, and blood pressure is 140/95 mm Hg. On mental status examination, she is confused and oriented only to person. She recalls 0 out of 3 words after 5 minutes. She cannot perform serial sevens and is unable to repeat seven digits forward and five in reverse sequence. Neurologic examination shows horizontal nystagmus on lateral gaze. She has difficulty walking without assistance. Laboratory studies show: Hemoglobin 11 g/dL Mean corpuscular volume 110 μm3 Platelet count 280,000/mm3 Which of the following is most appropriate initial treatment for this patient?" ---- <<Choices:>> A) Intravenous thiamine B) Oral naltrexone C) Intravenous vitamin B12 D) Intravenous glucose " ---- <<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 18-year-old woman makes an appointment with a gynecologist for her first gynecologic examination. She did not disclose her past medical history, but her sexual debut occurred with her boyfriend 3 weeks ago. She is now complaining of a yellow-green, diffuse, malodorous vaginal discharge that she noticed 1 week ago for the first time. She also reported mild pelvic and abdominal pain. cervical motion tenderness was noted during the pelvic examination. The gynecologist also noticed a pink and inflamed nulliparous cervix with a preponderance of small red punctate spots. There was a frothy white discharge with a malodorous odor in the vaginal vault. A wet mount was prepared for a light microscopic examination, which revealed numerous squamous cells and motile organisms. The gynecologist concluded that this was a sexually-transmitted infection. What is the causative organism? ---- <<Choices:>> A) Chlamydia trachomatis B) Ureaplasma urealyticum C) Trichomonas vaginalis D) Enterobius vermicularis ---- <<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 70-year-old man is brought to the physician by his daughter because of increasing forgetfulness over the past 3 years. Initially, he used to forget his children's names or forget to lock the house door. During the past year, he has gotten lost twice while returning from the grocery store and was unable to tell passersby his address. One time, he went to the park with his granddaughter and returned home alone without realizing he had forgotten her. His daughter says that over the past year, he has withdrawn himself from social gatherings and avoids making conversation. He does not sleep well at night. His daughter has hired a helper to cook and clean his home. On mental status examination, he is oriented only to person. He describes his mood as fair. Short- and long-term memory deficits are present. He appears indifferent about his memory lapses and says this is normal for someone his age. The most appropriate initial pharmacotherapy for this patient is a drug that acts on which of the following neurotransmitters? ---- <<Choices:>> A) γ-aminobutyric acid B) Acetylcholine C) Dopamine D) Glutamate ---- <<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 45-year-old mechanic presents to the emergency department complaining of acute-onset shortness of breath while repairing a plowing tractor for his neighbor. The patient denies having any history of asthma or respiratory symptoms, and does not smoke. His temperature is 99.8°F (37.7°C), pulse is 65/min, blood pressure is 126/86 mmHg, and respirations are 20/min. His oxygen saturation is 97%. On exam, he is pale and diaphoretic. His pupils are contracted. Diffuse wheezes are noted in all lung fields. What is the best treatment for his condition? ---- <<Choices:>> A) Succinylcholine B) Inhaled ipratropium and oxygen C) Atropine and pralidoxime D) Inhaled albuterol and oxygen ---- <<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 3-year-old male is brought in to his pediatrician by his mother because she is concerned that he is not growing appropriately. Physical examination is notable for frontal bossing and shortened upper and lower extremities. His axial skeleton appears normal. He is at the 7th percentile for height and 95th percentile for head circumference. He demonstrates normal intelligence and is able to speak in three-word sentences. He first sat up without support at twelve months and started walking at 24 months. Genetic analysis reveals an activating mutation in a growth factor receptor. Which of the following physiologic processes is most likely disrupted in this patient’s condition? ---- <<Choices:>> A) Intramembranous ossification B) Osteoblast maturation C) Endochondral ossification D) Production of type I collagen ---- <<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 59-year-old woman comes to the physician 2 weeks after noticing a lump in her left breast. Examination of the left breast shows a firm, nontender mass close to the nipple. Mammography shows an irregular calcified mass. A core needle biopsy shows invasive ductal carcinoma. Genetic analysis of this patient's cancer cells is most likely to show overexpression of which of the following genes? ---- <<Choices:>> A) HER2 B) BCR-ABL C) BRCA-2 D) BCL-2 ---- <<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 45-year-old man comes to his primary-care doctor with his wife for a 4-week history of constipation. The patient reports that his bowel habits have changed from every day to every 3 or 4 days. He also now has to strain to pass stool. On further questioning, his wife has also noticed that he has seemed fatigued, with little interest in going on their usual afternoon walks. Medical history is notable for hypertension and hyperlipidemia, both managed medically. He was last seen for follow-up of these conditions 1 month ago. Physical examination is unremarkable. Which of the following is the cellular target of the medicine that is most likely responsible for this patient's symptoms? ---- <<Choices:>> A) Angiotensin-II receptors in the membranes of vascular smooth muscle cells B) Angiotensin-converting enzyme C) Na+/Cl- cotransporter in the membranes of epithelial cells in the distal convoluted tubule D) Na+/K+/2Cl- transporters in the membranes of epithelial cells in the ascending loop of Henle ---- <<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 23-year-old man presents to the office for a circular, itchy rash over the abdomen that has been slowly getting worse for the past 2 weeks. The patient has a medical history of chronic dermatitis and chronic sinusitis for which he has prescriptions of topical hydrocortisone and fexofenadine. He smokes one-half pack of cigarettes every day. His vital signs include: blood pressure 128/76 mm Hg, heart rate 78/min, and respirations 12/min. On physical examination, the patient appears tired but oriented. Examination of the skin reveals a 2 x 2 cm round and erythematous, annular plaque on the abdomen 3 cm to the left of the umbilicus. There are no vesicles, pustules, or papules. Auscultation of the heart reveals a 1/6 systolic murmur. Breath sounds are mildly coarse at the bases. A KOH preparation from the skin scraping confirms the presence of hyphae. Which of the following is the next best step in the management of this patient? ---- <<Choices:>> A) Itraconazole B) Griseofulvin C) Topical clindamycin D) Doxycycline ---- <<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 12-year-old boy is brought to the emergency department for the evaluation of persistent bleeding from his nose over the past hour. The bleeding started spontaneously. He has no history of a similar episode. He takes no medications. There is no history of abnormal bleeding in the family. His vital signs are within normal limits. On examination, he is pressing a gauze against his left nostril while hyperextending his head. The gauze is stained with blood and upon withdrawal of the gauze blood slowly drips out of his left nostrils. There is no bleeding from the right nostril. The remainder of the physical examination shows no abnormalities. Which of the following is the most appropriate initial therapy? ---- <<Choices:>> A) Anterior packing and topical antibiotics B) Oxymetazoline nasal spray C) Placement of an epinephrine gauze in the left nostril D) Squeezing the nostrils manually for 10 minutes with the head elevated ---- <<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 40-year-old female presents to your office complaining of a tender neck and general lethargy. Upon further questioning, she reports decreased appetite, fatigue, constipation, and jaw pain. Her pulse is 60 bpm and her blood pressure is 130/110 mm Hg. Biopsy of her thyroid reveals granulomatous inflammation and multinucleate giant cells surrounding fragmented colloid. Which of the following likely precipitated the patient’s condition: ---- <<Choices:>> A) Iodine deficiency B) Thryoglossal duct cyst C) Infection D) Chronic renal disease ---- <<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 24-year-old man is brought to the emergency room by the police after a fall. The patient smells of alcohol and is slurring his words. You find out that he has recently been fired from his job as a salesperson for months of tardiness and poor performance. The police tell you that his girlfriend, who was there at the time of the fall, mentioned that the patient has been struggling with alcohol for at least a year. Upon physical examination, the patient becomes agitated and starts yelling. He accuses his ex-boss of being a cocaine addict and says he couldn’t keep up sales percentages compared to someone using cocaine. Which of the following psychiatric defense mechanisms is the patient demonstrating? ---- <<Choices:>> A) Denial B) Displacement C) Projection D) Regression ---- <<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 woman presents to a physician with painful ankles for 2 days. Her symptoms began 1 week ago with a severe fever (40℃ (104℉)) for 3 days. When the fever subsided, she developed a maculopapular rash over the trunk and extremities with painful wrists and fingers. She also reports abdominal pain, nausea, vomiting, and headaches. Last week she returned from a trip to Africa where she spent several weeks, mostly in rural areas. Her temperature is 37.5℃ (99.5℉); pulse is 75/min; respiratory rate is 13/min, and blood pressure is 115/70 mm Hg. A maculopapular rash is observed over the trunk and limbs. Both ankles are swollen and painful to active and passive motion. The abdomen is soft without organomegaly. Laboratory studies show the following: Laboratory test Hemoglobin 11.4 g/d Mean corpuscular volume 90 µm3 Leukocyte count 4,500/mm3 Segmented neutrophils 70% Lymphocytes 15% Platelet count 250,000/mm3 Ring-form trophozoites are absent on the peripheral blood smear. Which of the following organisms is the most likely cause of this patient’s illness? ---- <<Choices:>> A) Babesia babesia B) Chikungunya virus C) Dengue virus D) Leishmania major ---- <<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 61-year-old man complaining of unexplained bleeding by from the mouth is escorted to the emergency department by corrections officers. Upon examination patient states he feels nauseated as he begins to retch violently and vomit bright red blood. His past medical history is remarkable for cirrhosis secondary to alcohol abuse and untreated hepatitis C. His current blood pressure is 90/50 mm Hg, heart rate is 128/min, and oxygen saturation in room air is 88%. On further questioning, he states that he is scared to die and wants everything done to save his life. IV fluids are initiated and packed RBCs are ordered. You begin to review his labs and notice and he has elevated beta-hydroxybutyrate, ammonia, and lactate. What would be the appropriate response to the patient? ---- <<Choices:>> A) Consult an ethics committee to determine whether to resuscitate the patient B) Accept the patient's wishes and appoint and get a psych evaluation. C) Accept the patient's wishes and ensure he receives appropriate care. D) Obtain an emergency order from a judge to initiate resuscitation. ---- <<Answer:>>
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C
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