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Answer the following medical question with one of the provided options:
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Q:A 1-day-old infant presents to the office because the mother noticed “blood” in the diaper of her child. She has brought the diaper with her which shows a small reddish marking. The pregnancy was without complications, as was the delivery. The patient presents with no abnormal findings on physical examination. The laboratory analysis shows uric acid levels in the blood to be 5 mg/dL. Which of the following should be the next step in management?? {'A': 'Allopurinol', 'B': 'Febuxostat', 'C': 'No therapy is required', 'D': 'Rasburicase', 'E': 'Sodium bicarbonate'},
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C: No therapy is required
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Answer the following medical question with one of the provided options:
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Q:A 65-year-old man presents to the emergency department because of a sudden loss of vision in his left eye for 2 hours. He has no pain. He had a similar episode 1 month ago which lasted only seconds. He has no history of a headache or musculoskeletal pain. He has had ischemic heart disease for 8 years and hypertension and diabetes mellitus for 13 years. His medications include metoprolol, aspirin, insulin, lisinopril, and atorvastatin. He has smoked 1 pack of cigarettes for 39 years. The vital signs include: blood pressure 145/98 mm Hg, pulse 86/min, respirations 16/min, and temperature 36.7°C (98.1°F). Physical examination of the left eye shows a loss of light perception. After illumination of the right eye and conceptual constriction of the pupils, illumination of the left eye shows pupillary dilation. A fundoscopy image is shown. Which of the following best explains these findings?? {'A': 'Central retinal artery occlusion', 'B': 'Demyelinating optic neuritis', 'C': 'Retinal detachment', 'D': 'Temporal arteritis', 'E': 'Wet macular degeneration'},
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A: Central retinal artery occlusion
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Answer the following medical question with one of the provided options:
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Q:A 29-year-old woman presents with low mood and tearfulness on most days for the past 4 weeks. She says that she has been struggling to cope with her life and feels that everything that is going wrong is her fault. She also says that there are nights when she cries herself to sleep as the burden of the whole day is too overwhelming for her. In the last 3 weeks, she cannot recall a day when she felt interested in going out and participating in her daily activities. She also says she doesn’t seem to have much energy and feels fatigued all day. She has lost her appetite and feels that she is losing weight. Over the past month, she also reports experiencing frequent and often unbearable migraine headaches. No significant past medical history. The patient has prescribed a drug for her symptoms which is known to be cardiotoxic and may result in ECG changes. Which of the following is the mechanism of action of the drug most likely prescribed to this patient?? {'A': 'Blocks the reuptake of serotonin, increasing its concentration in the synaptic cleft', 'B': 'Non-selectively inhibits monoamine oxidase A and B', 'C': 'Stimulates the release of norepinephrine and dopamine in the presynaptic terminal', 'D': 'Inhibits the uptake of serotonin and norepinephrine at the presynaptic terminal', 'E': 'Acts as an antagonist at the dopamine and serotonin receptors'},
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D: Inhibits the uptake of serotonin and norepinephrine at the presynaptic terminal
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Answer the following medical question with one of the provided options:
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Q:A 46-year-old man comes to the clinic complaining of abdominal pain for the past month. The pain comes and goes and is the most prominent after meals. He reports 1-2 episodes of black stools in the past month, a 10-lbs weight loss, fevers, and a skin rash on his left arm. A review of systems is negative for any recent travel, abnormal ingestion, palpitations, nausea/vomiting, diarrhea, or constipation. Family history is significant for a cousin who had liver failure in his forties. His past medical history is unremarkable. He is sexually active with multiple partners and uses condoms intermittently. He admits to 1-2 drinks every month and used to smoke socially during his teenage years. His laboratory values are shown below: Serum: Na+: 138 mEq/L Cl-: 98 mEq/L K+: 3.8 mEq/L HCO3-: 26 mEq/L BUN: 10 mg/dL Glucose: 140 mg/dL Creatinine: 2.1 mg/dL Thyroid-stimulating hormone: 3.5 µU/mL Ca2+: 10 mg/dL AST: 53 U/L ALT: 35 U/L HBsAg: Positive Anti-HBc: Positive IgM anti-HBc: Positive Anti-HBs: Negative What findings would you expect to find in this patient?? {'A': 'Diffuse bridging fibrosis and regenerative nodules at the liver', 'B': 'PAS-positive macrophages in the intestinal lamina propria', 'C': 'Presence of anti-proteinase 3', 'D': 'Segmental ischemic necrosis of various ages at the mesenteric arteries', 'E': 'Ulcers at the gastric mucosa'},
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D: Segmental ischemic necrosis of various ages at the mesenteric arteries
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Answer the following medical question with one of the provided options:
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Q:An investigator is studying the effects of zinc deprivation on cancer cell proliferation. It is hypothesized that because zinc is known to be a component of transcription factor motifs, zinc deprivation will result in slower tumor growth. To test this hypothesis, tumor cells are cultured on media containing low and high concentrations of zinc. During the experiment, a labeled oligonucleotide probe is used to identify the presence of a known transcription factor. The investigator most likely used which of the following laboratory techniques?? {'A': 'Western blot', 'B': 'Northern blot', 'C': 'PCR', 'D': 'ELISA', 'E': 'Southwestern blot'},
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E: Southwestern blot
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Answer the following medical question with one of the provided options:
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Q:A 64-year-old female presents with acute right wrist pain after she lost her balance while reaching overhead and fell from standing height. Her right wrist radiographs shows a fracture of her right distal radius. A follow-up DEXA bone density scan is performed and demonstrates a T-score of -3.5 at the femoral neck and spine. Her medical history is significant for hypertension, for which she is not currently taking any medication. She has not had a previous fracture. Which of the following antihypertensive agents would be preferred in this patient?? {'A': 'Hydrochlorothiazide', 'B': 'Furosemide', 'C': 'Lisinopril', 'D': 'Propranolol', 'E': 'Amlodipine'},
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A: Hydrochlorothiazide
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Answer the following medical question with one of the provided options:
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Q:An 18-month-old boy is brought to the physician because of walking difficulties. His mother says that he cannot walk unless he is supported. She has also noted orange, sandy residues in his diapers. Over the past year, she has frequently caught him pulling his toenails and chewing the tips of his fingers. Examination shows scarring of his fingertips. Muscle tone is decreased in the upper and lower extremities. He cannot pick up and hold small objects between the tips of the index finger and the thumb. The most appropriate pharmacotherapy for this patient's condition inhibits which of the following conversions?? {'A': 'Hypoxanthine to inosine monophosphate', 'B': 'Ornithine to citrulline', 'C': 'Orotate to uridine monophosphate', 'D': 'Adenosine to inosine', 'E': 'Xanthine to urate\n"'},
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E: Xanthine to urate "
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Answer the following medical question with one of the provided options:
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Q:A 37-year-old man, otherwise healthy, has a routine CBC done prior to donating blood for the first time. The results are as follows: Hemoglobin 10.8 g/dL Mean corpuscular volume (MCV) 82 μm3 Mean corpuscular hemoglobin concentration (MCHC) 42% Reticulocyte count 3.2% White blood cell count 8,700/mm3 Platelet count 325,000/mm3 The patient is afebrile and his vital signs are within normal limits. On physical examination, his spleen is just palpable. A peripheral blood smear is shown in the exhibit (see image). A direct antiglobulin test (DAT) is negative. Which of the following best describes the etiology of this patient’s most likely diagnosis?? {'A': 'Bone marrow hypocellularity', 'B': 'Inherited membrane abnormality of red cells', 'C': 'Microangiopathic process', 'D': 'Immune-mediated hemolysis', 'E': 'Oxidant hemolysis'},
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B: Inherited membrane abnormality of red cells
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Answer the following medical question with one of the provided options:
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Q:A 43-year-old man is brought to the emergency department because of severe retrosternal pain radiating to the back and left shoulder for 4 hours. The pain began after attending a farewell party for his coworker at a local bar. He had 3–4 episodes of nonbilious vomiting before the onset of the pain. He has hypertension. His father died of cardiac arrest at the age of 55 years. He has smoked one pack of cigarettes daily for the last 23 years and drinks 2–3 beers daily. His current medications include amlodipine and valsartan. He appears pale. His temperature is 37° C (98.6° F), pulse is 115/min, and blood pressure is 90/60 mm Hg. There are decreased breath sounds over the left base and crepitus is palpable over the thorax. Abdominal examination shows tenderness to palpation in the epigastric region; bowel sounds are normal. Laboratory studies show: Hemoglobin 16.5 g/dL Leukocyte count 11,100/mm3 Serum Na+ 133 mEq/L K+ 3.2 mEq/L Cl- 98 mEq/L HCO3- 30 mEq/L Creatinine 1.4 mg/dL An ECG shows sinus tachycardia with left ventricular hypertrophy. Intravenous fluid resuscitation and antibiotics are begun. Which of the following is the most appropriate test to confirm the diagnosis in this patient?"? {'A': 'Esophagogastroduodenoscopy', 'B': 'Aortography', 'C': 'CT scan of the chest', 'D': 'Abdominal ultrasound', 'E': 'Transthoracic echocardiography\n"'},
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C: CT scan of the chest
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Answer the following medical question with one of the provided options:
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Q:A 4430-g (9-lb 10-oz) male newborn is delivered at term to a 27-year-old woman, gravida 2, para 1. The second stage of labor was prolonged and required vacuum-assisted vaginal delivery. Apgar scores are 9 and 10 at 1 and 5 minutes, respectively. Examination of the neonate 2 hours later shows a soft, nonpulsatile swelling over the left parietal bone that does not cross suture lines. Vital signs are within normal limits. The pupils are equal and reactive to light. The lungs are clear to auscultation. Heart sounds are normal. The spine is normal. Which of the following is the most likely diagnosis?? {'A': 'Lipoma', 'B': 'Cephalohematoma', 'C': 'Subgaleal hemorrhage', 'D': 'Epidermoid cyst', 'E': 'Encephalocele'},
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B: Cephalohematoma
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Answer the following medical question with one of the provided options:
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Q:A 19-year-old university student presents to the student clinic with painful joints. He states that over the past week his right wrist has become increasingly stiff. This morning he noticed pain and stiffness in his left ankle and left knee. The patient has celiac disease and takes a daily multivitamin. He says he is sexually active with multiple male and female partners. He smokes marijuana but denies intravenous drug abuse. He recently traveled to Uganda to volunteer at a clinic that specialized in treating patients with human immunodeficiency virus (HIV). He also went on an extended hiking trip last week in New Hampshire. Physical exam reveals swelling of the right wrist and a warm, swollen, erythematous left knee. The left Achilles tendon is tender to palpation. There are also multiple vesicopustular lesions on the dorsum of the right hand. No penile discharge is appreciated. Arthrocentesis of the left knee is performed. Synovial fluid results are shown below: Synovial fluid: Appearance: Cloudy Leukocyte count: 40,000/mm^3 with neutrophil predominance Gram stain is negative. A synovial fluid culture is pending. Which of the following is the patient’s most likely diagnosis?? {'A': 'Dermatitis herpetiformis', 'B': 'Disseminated gonococcal infection', 'C': 'Lyme disease', 'D': 'Reactive arthritis', 'E': 'Septic arthritis'},
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B: Disseminated gonococcal infection
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Answer the following medical question with one of the provided options:
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Q:A 56-year-old man comes to the physician because of lower back pain for the past 2 weeks. The pain is stabbing and shooting in quality and radiates down the backs of his legs. It began when he was lifting a bag of cement at work. The pain has been getting worse, and he has started to notice occasional numbness and clumsiness while walking. He has hypertension and peripheral artery disease. Medications include hydrochlorothiazide and aspirin. His temperature is 37°C (98.6°F), pulse is 82/min, and blood pressure is 133/92 mm Hg. Peripheral pulses are palpable in all four extremities. Neurological examination shows 5/5 strength in the upper extremities and 3/5 strength in bilateral foot dorsiflexion. Sensation to light touch is diminished bilaterally over the lateral thigh area and the inner side of lower legs. Passive raising of either the right or left leg causes pain radiating down the ipsilateral leg. Which of the following is the most appropriate next step in management?? {'A': 'X-ray of the lumbar spine', 'B': 'Erythrocyte sedimentation rate', 'C': 'MRI of the lumbar spine', 'D': 'Therapeutic exercise regimen', 'E': 'PSA measurement'},
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C: MRI of the lumbar spine
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Answer the following medical question with one of the provided options:
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Q:A 12-year-old boy is brought to the emergency department after a motor vehicle collision. He was being carpooled to school by an intoxicated driver and was involved in a high velocity head-on collision. The patient is otherwise healthy and has no past medical history. His temperature is 99.2°F (37.3°C), blood pressure is 80/45 mmHg, pulse is 172/min, respirations are 36/min, and oxygen saturation is 100% on room air. A FAST exam demonstrates free fluid in Morrison pouch. The patient’s parents arrive and state that they are Jehovah’s witnesses. They state they will not accept blood products for their son but will allow him to go to the operating room to stop the bleeding. Due to poor understanding and a language barrier, the parents are also refusing IV fluids as they are concerned that this may violate their religion. The child is able to verbalize that he agrees with his parents and does not want any treatment. Which of the following is the best next treatment for this patient?? {'A': 'Blood products and emergency surgery', 'B': 'IV fluids alone as surgery is too dangerous without blood product stabilization', 'C': 'IV fluids and emergency surgery', 'D': 'IV fluids and vasopressors followed by emergency surgery', 'E': 'Observation and monitoring and obtain a translator'},
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A: Blood products and emergency surgery
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Answer the following medical question with one of the provided options:
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Q:A 57-year-old male presents to his primary care physician with upper abdominal pain. He reports a 3-month history of mild epigastric pain that improves with meals. He has lost 15 pounds since his symptoms started. His past medical history is notable for gynecomastia in the setting of a prolactinoma for which he underwent surgical resection over 10 years prior. He has a 15-pack-year smoking history, a history of heroin abuse, and is on methadone. His family history is notable for parathyroid adenoma in his father. His temperature is 98.8°F (37.1°C), blood pressure is 125/80 mmHg, pulse is 78/min, and respirations are 18/min. This patient’s symptoms are most likely due to elevations in a substance with which of the following functions?? {'A': 'Decrease gastric acid secretion', 'B': 'Decrease gastrin secretion', 'C': 'Increase pancreatic bicarbonate secretion', 'D': 'Increase pancreatic exocrine secretion', 'E': 'Promote gastric mucosal growth'},
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E: Promote gastric mucosal growth
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Answer the following medical question with one of the provided options:
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Q:A 65-year-old male with a history of hypertension presents to his primary care physician complaining of multiple episodes of chest pain, palpitations, and syncope. Episodes have occurred twice daily for the last week, and he is asymptomatic between episodes. Electrocardiogram reveals a narrow-complex supraventricular tachycardia. He is treated with diltiazem. In addition to its effects on cardiac myocytes, on which of the following channels and tissues would diltiazem also block depolarization?? {'A': 'L-type Ca channels in skeletal muscle', 'B': 'L-type Ca channels in smooth muscle', 'C': 'P-type Ca channels in Purkinje fibers', 'D': 'N-type Ca channels in the peripheral nervous system', 'E': 'T-type Ca channels in bone'},
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B: L-type Ca channels in smooth muscle
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Answer the following medical question with one of the provided options:
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Q:A 32-year-old G2P1 female at 30 weeks gestation presents to the emergency department with complaints of vaginal bleeding and severe abdominal pain. She states that she began feeling poorly yesterday with a stomach-ache, nausea, and vomiting. She first noted a small amount of spotting this morning that progressed to much larger amounts of vaginal bleeding with worsened abdominal pain a few hours later, prompting her to come to the emergency department. Her previous pregnancy was without complications, and the fetus was delivered at 40 weeks by Cesarean section. Fetal heart monitoring shows fetal distress with late decelerations. Which of the following is a risk factor for this patient's presenting condition?? {'A': 'Hyperlipidemia', 'B': 'Hypertension', 'C': 'Patient age', 'D': 'Prior Cesarean section', 'E': 'Singleton pregnancy'},
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B: Hypertension
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Answer the following medical question with one of the provided options:
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Q:A 48-year-old woman presents to her family practitioner complaining of tremulousness of both hands for the past few years that have deteriorated over the past 7 months. She sometimes spills coffee while holding a full cup. She is a receptionist and her symptoms have led to difficulties with typing at work. She denies weight loss, diarrhea, fatigue, blurring of vision, walking difficulties, and heat intolerance. The past medical history is significant for well-controlled bronchial asthma. She does not smoke or use illicit drugs, but she drinks one cup of coffee daily. She drinks alcohol only socially and has noticed a decrease in her tremors afterward. She reports that her father had a head tremor, and her mother had hyperthyroidism. The patient is oriented to person, place, time and situation. On physical examination, the eye movements are normal and there is no nystagmus. She has a prominent rhythmic tremor of both hands that increase when hands are stretched with abducted fingers. The muscle strength, tone, and deep tendon reflexes are normal in all 4 limbs. The sensory examination and gait are normal. The laboratory test results are as follows: Hemoglobin 14.8 g/dL Leukocytes 5,500/mm3 Platelets 385,000/mm3 BUN 18 mg/dL Creatinine 0.9 mg/dL Na+ 143 mmol/L K+ 4.2 mmol/L Which of the following is the most appropriate management for this patient? ? {'A': 'Clonazepam', 'B': 'Levodopa/Carbidopa', 'C': 'Primidone', 'D': 'Propranolol', 'E': 'Reassurance'},
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C: Primidone
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Answer the following medical question with one of the provided options:
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Q:A 29-year-old man presents to his primary care provider after complaining of a rash on his penis. He describes it as small painless growths that have developed over the past several months. They have slowly increased in size over time. His medical history is unremarkable. He has had several sexual partners and uses condoms inconsistently. He describes himself as having generally good health and takes no medication. On physical exam, his vital signs are normal. There are multiple cauliflower-like papular eruptions just under the glans penis. They are tan-pink and raised. Examination of the scrotum, perineum, and anus shows no abnormalities. There is no inguinal lymphadenopathy. The remainder of the physical exam shows no abnormalities. Which of the following is the most appropriate initial management?? {'A': 'Cryotherapy', 'B': 'Interferon ɑ', 'C': 'Laser therapy', 'D': 'Quadrivalent vaccine', 'E': 'Topical imiquimod'},
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A: Cryotherapy
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Answer the following medical question with one of the provided options:
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Q:A 19-year-old man presents with painful oral ulcers and rash. He says that his symptoms started 1 week ago with a low-grade fever, malaise, and cough. Then, 3 days ago, he noted small painful red bumps on his hands and feet, which quickly worsened and spread to involve his extremities and upper torso. At the same time, multiple painful oral ulcers appeared, which have not improved. He denies any trouble breathing, pruritus, hemoptysis, hematochezia, or similar symptoms in the past. Past medical history is significant for a recent methicillin-resistant staphylococcus aureus (MRSA) skin infection 2 weeks ago secondary to a laceration on his left leg for which he has been taking trimethoprim-sulfamethoxazole. No other current medications. The patient is afebrile, and his vital signs are within normal limits. Physical examination reveals multiple raised, erythematous, circular papules averaging 1–2 cm in diameter with a central bulla, as shown in the exhibit (see image below). The cutaneous lesions occupy < 10% of his total body surface area (BSA). Nicolsky sign is negative. Multiple mucosal erosions are noted in the oral cavity. Generalized lymphadenopathy is present. A well-healing laceration is present on the left leg with no evidence of drainage or fluctuance. A cutaneous punch biopsy of one of the lesions is performed. Which of the following histopathologic features would most likely be found on this patient’s biopsy?? {'A': 'Scant dermal inflammatory infiltrate, predominantly composed of macrophages and dendritic cells', 'B': 'Rich dermal inflammatory infiltrate, predominantly composed of CD4+ T cells', 'C': 'Presence of intradermal blister and separation of suprabasal epidermal cells from basal cells', 'D': 'Presence of a subepidermal blister and a polymorphous inflammatory infiltrate with an eosinophilic predominance', 'E': 'Mucin deposition in the dermal layer'},
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B: Rich dermal inflammatory infiltrate, predominantly composed of CD4+ T cells
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Answer the following medical question with one of the provided options:
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Q:A 52-year-old woman presents to her gynecologist's office with complaints of frequent hot flashes and significant sweating episodes, which affect her sleep at night. She complains that she has to change her clothes in the middle of the night because of the sweating events. She also complains of irritability, which is affecting her relationships with her husband and daughter. She reports vaginal itchiness and pain with intercourse. Her last menstrual period was eight months ago. She was diagnosed with breast cancer 15 years ago, which was promptly detected and cured successfully via mastectomy. The patient is currently interested in therapies to help control her symptoms. Which of the following options is the most appropriate medical therapy in this patient for symptomatic relief?? {'A': 'Conjugated estrogen orally', 'B': 'Conjugated estrogen and medroxyprogesterone acetate orally', 'C': 'Low-dose vaginal estrogen', 'D': 'Transdermal estradiol-17B patch', 'E': 'This patient is not a candidate for hormone replacement therapy.'},
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C: Low-dose vaginal estrogen
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Answer the following medical question with one of the provided options:
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Q:An investigator is studying a hereditary defect in the mitochondrial enzyme succinyl-CoA synthetase. In addition to succinate, the reaction catalyzed by this enzyme produces a molecule that is utilized as an energy source for protein translation. This molecule is also required for which of the following conversion reactions?? {'A': 'Acetaldehyde to acetate', 'B': 'Fructose-6-phosphate to fructose-1,6-bisphosphate', 'C': 'Glucose-6-phosphate to 6-phosphogluconolactone', 'D': 'Oxaloacetate to phosphoenolpyruvate', 'E': 'Pyruvate to acetyl-CoA'},
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D: Oxaloacetate to phosphoenolpyruvate
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Answer the following medical question with one of the provided options:
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Q:A 68-year-old man comes to the physician because of a 1-month history of fatigue, low-grade fevers, and cough productive of blood-tinged sputum. He has type 2 diabetes mellitus and chronic kidney disease and underwent kidney transplantation 8 months ago. His temperature is 38.9°C (102.1°F) and pulse is 98/min. Examination shows rhonchi in the right lower lung field. An x-ray of the chest shows a right-sided lobar consolidation. A photomicrograph of specialized acid-fast stained tissue from a blood culture is shown. Which of the following is the strongest predisposing factor for this patient's condition?? {'A': 'Poor oral hygiene', 'B': 'Exposure to contaminated soil', 'C': 'Exposure to contaminated air-conditioning unit', 'D': 'Sharing of unsterile IV needles', 'E': 'Crowded living situation'},
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B: Exposure to contaminated soil
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Answer the following medical question with one of the provided options:
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Q:A 2-day-old male newborn born at 39 weeks' gestation is brought to the physician because of yellowing of his skin. His mother received no prenatal care and the delivery was uncomplicated. She has no history of serious medical illness and has one other son who is healthy. Physical examination shows jaundice, hepatomegaly, and decreased muscle tone. Laboratory studies show: Hemoglobin 9.4 g/dL Maternal blood type O Patient blood type O Serum Bilirubin Total 16.3 mg/dL Direct 0.4 mg/dL Which of the following is the most likely underlying cause of this patient's condition?"? {'A': 'Glucose-6-phosphate dehydrogenase deficiency', 'B': 'IgM antibody formation against A and B antigens', 'C': 'Biliary duct malformation', 'D': 'UDP-glucuronosyltransferase deficiency', 'E': 'IgG antibody formation against Rh antigen'},
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E: IgG antibody formation against Rh antigen
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Answer the following medical question with one of the provided options:
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Q:A 36-year-old man is brought to the emergency department by a neighbor with signs of altered mental status. He was found 6 hours ago stumbling through his neighbor's bushes and yelling obscenities. The neighbor helped him home, but found him again 1 hour later slumped over on his driveway in a puddle of vomit. He is oriented to self, but not to place or time. His vitals are as follows: temperature, 36.9°C (98.5°F); pulse, 82/min; respirations, 28/min; and blood pressure, 122/80 mm Hg. Cardiopulmonary examination indicates no abnormalities. He is unable to cooperate for a neurological examination. Physical examination reveals muscle spasms involving his arms and jaw. Laboratory studies show: Na+ 140 mEq/L K+ 5.5 mEq/L CI- 101 mEq/L HCO3- 9 mEq/L Urea nitrogen 28 mg/dL Creatinine 2.3 mg/dL Glucose 75 mg/dL Calcium 7.2 mg/dL Osmolality 320 mOsm/kg The calculated serum osmolality is 294 mOsm/kg. The arterial blood gas shows a pH of 7.25 and a lactate level of 3.2 mmol/L. Urine examination shows oxalate crystals and the absence of ketones. What is the most appropriate treatment indicated for this patient experiencing apparent substance toxicity?? {'A': 'Ethanol', 'B': 'Fomepizole', 'C': 'Hydroxocobalamin', 'D': 'Methylene blue', 'E': 'N-acetyl cysteine'},
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B: Fomepizole
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Answer the following medical question with one of the provided options:
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Q:A 23-year-old woman from Texas is transferred to the intensive care unit after delivering a child at 40 weeks gestation. The pregnancy was not complicated, and there was some blood loss during the delivery. The patient was transferred for severe hypotension refractory to IV fluids and vasopressors. She is currently on norepinephrine and vasopressin with a mean arterial pressure of 67 mmHg. Her past medical history is notable only for a recent bout of asthma treated with albuterol and a prednisone taper over 5 days for contact dermatitis. Physical exam is notable for abnormally dark skin for a Caucasian woman. The patient states she feels extremely weak. However, she did experience breastmilk letdown and was able to breastfeed her infant. Laboratory values are ordered as seen below. Serum: Na+: 127 mEq/L Cl-: 92 mEq/L K+: 6.1 mEq/L HCO3-: 22 mEq/L BUN: 20 mg/dL Creatinine: 1.1 mg/dL Ca2+: 10.2 mg/dL Which of the following is the most likely diagnosis?? {'A': 'Acute kidney injury', 'B': 'Mycobacteria tuberculosis', 'C': 'Primary adrenal insufficiency', 'D': 'Sheehan syndrome', 'E': 'Withdrawal from prednisone use'},
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C: Primary adrenal insufficiency
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Answer the following medical question with one of the provided options:
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Q:A 22-year-old man is evaluated for abdominal discomfort he has had for the past 6 days and fever for the past 2 weeks. He also notes that his right upper abdomen is bothering him. He states that he does not drink alcohol or use illicit drugs. His medical history is insignificant and family history is negative for any liver disease. On physical examination, his temperature is 38.0°C (100.4°F), blood pressure is 120/80 mm Hg, pulse rate is 102/min, and respiratory rate is 22/min. He is alert and oriented. Scleral icterus and hepatomegaly are noted. Laboratory results are as follows: Anti-hepatitis A IgM positive Anti-hepatitis A IgG negative Hepatitis B surface Ag negative Hepatitis B surface AB negative Alanine aminotransferase 1544 U/L Aspartate aminotransferase 1200 U/L Which of the following transcription factors is required for the B cells to differentiate into plasma cells in this patient?? {'A': 'Paired box protein 5 (PAX5)', 'B': 'B cell lymphoma 6 (BCL6)', 'C': 'Microphthalmia-associated transcription factor (MITF)', 'D': 'Metastasis-associated 1 family, member 3 (MTA-3)', 'E': 'B lymphocyte induced maturation protein 1 (BLIMP1)'},
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E: B lymphocyte induced maturation protein 1 (BLIMP1)
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Answer the following medical question with one of the provided options:
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Q:A 53-year-old woman presents to her primary care provider complaining of fatigue for the last several months. She reports feeling tired all day, regardless of her quality or quantity of sleep. On further questioning, she has also noted constipation and a 4.5 kg (10 lb) weight gain. She denies shortness of breath, chest pain, lightheadedness, or blood in her stool. At the doctor’s office, the vital signs include: pulse 58/min, blood pressure 104/68 mm Hg, and oxygen saturation 98% on room air. The physical exam shows only slightly dry skin. The complete blood count (CBC) is within normal limits. Which of the following best describes the pathogenesis of this patient's condition?? {'A': 'Autoimmune attack on endocrine tissue', 'B': 'Bone marrow failure', 'C': 'Chronic blood loss', 'D': 'Iatrogenesis', 'E': 'Nutritional deficiency'},
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A: Autoimmune attack on endocrine tissue
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Answer the following medical question with one of the provided options:
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Q:A 67-year-old woman is brought to the emergency department for evaluation of fever, chest pain, and a cough that has produced a moderate amount of greenish-yellow sputum for the past 2 days. During this period, she has had severe malaise, chills, and difficulty breathing. Her past medical history is significant for hypertension, hypercholesterolemia, and type 2 diabetes, for which she takes lisinopril, atorvastatin, and metformin. She has smoked one pack of cigarettes daily for 20 years. Her vital signs show her temperature is 39.0°C (102.2°F), pulse is 110/min, respirations are 33/min, and blood pressure is 143/88 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 94%. Crackles are heard on auscultation of the right upper lobe. Laboratory studies show a leukocyte count of 12,300/mm3, an erythrocyte sedimentation rate of 60 mm/h, and urea nitrogen of 15 mg/dL. A chest X-ray is shown. Which of the following is the most appropriate next step to manage this patient’s symptoms?? {'A': 'ICU admission and administration of ampicillin-sulbactam and levofloxacin', 'B': 'Inpatient treatment with azithromycin and ceftriaxone', 'C': 'Inpatient treatment with cefepime, azithromycin, and gentamicin', 'D': 'Inpatient treatment with cefepime, azithromycin, and gentamicin', 'E': 'Outpatient treatment with moxifloxacin'},
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B: Inpatient treatment with azithromycin and ceftriaxone
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Answer the following medical question with one of the provided options:
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Q:A previously healthy 68-year-old woman is brought to the emergency department because of a 3-day history of nausea, anorexia, polyuria, and confusion. Her only medication is acetaminophen, which she takes daily for back pain that started 6 weeks ago. Physical examination shows conjunctival pallor. She is oriented to person but not to time or place. Laboratory studies show a hemoglobin concentration of 9.3 g/dL, a serum calcium concentration of 13.8 mg/dL, and a serum creatinine concentration of 2.1 mg/dL. Her erythrocyte sedimentation rate is 65 mm/h. Which of the following is the most likely underlying cause of this patient's condition?? {'A': 'Excessive intake of calcium', 'B': 'Overproliferation of plasma cells', 'C': 'Ectopic release of PTHrP', 'D': 'Decreased renal excretion of calcium', 'E': 'Excess PTH secretion from parathyroid glands'},
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B: Overproliferation of plasma cells
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Q:A 40-year-old man with alcohol use disorder is brought to the emergency department because of sudden-onset blurry vision, severe upper abdominal pain, and vomiting that started one day after he drank a bottle of paint thinner. Physical examination shows epigastric tenderness without rebound or guarding. Ophthalmologic examination shows a visual acuity of 20/200 bilaterally despite corrective lenses. Arterial blood gas analysis on room air shows: pH 7.21 Sodium 135 mEq/L Chloride 103 mEq/L Bicarbonate 13 mEq/L An antidote with which of the following mechanisms of action is the most appropriate therapy for this patient's condition?"? {'A': 'Activation of acetyl-CoA synthetase', 'B': 'Inhibition of acetaldehyde dehydrogenase', 'C': 'Inhibition of acetyl-CoA synthetase', 'D': 'Activation of acetaldehyde dehydrogenase', 'E': 'Inhibition of alcohol dehydrogenase'},
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E: Inhibition of alcohol dehydrogenase
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Q:One week after delivery, a 3550-g (7-lb 13-oz) newborn has multiple episodes of bilious vomiting and abdominal distention. He passed urine 14 hours after delivery and had his first bowel movement 3 days after delivery. He was born at term to a 31-year-old woman. Pregnancy was uncomplicated and the mother received adequate prenatal care. His temperature is 37.1°C (98.8°F), pulse is 132/min, and respirations are 50/min. Examination shows a distended abdomen. Bowel sounds are hypoactive. Digital rectal examination shows a patent anus and an empty rectum. The remainder of the examination shows no abnormalities. An x-ray of the abdomen is shown. Which of the following is the underlying cause of these findings?? {'A': 'Defective migration of neural crest cells', 'B': 'Disruption of blood flow to the fetal jejunum', 'C': 'Mutation in the CFTR gene', 'D': 'Abnormal rotation of the intestine', 'E': 'Failed recanalization of the fetal duodenum'},
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A: Defective migration of neural crest cells
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Q:A 35-year-old man presents with erectile dysfunction. Past medical history is significant for diabetes mellitus type 1 diagnosed 25 years ago, managed with insulin, and for donating blood 6 months ago. The patient denies any history of smoking or alcohol use. He is afebrile, and his vital signs are within normal limits. Physical examination shows a bronze-colored hyperpigmentation on the dorsal side of the arms bilaterally. Nocturnal penile tumescence is negative. Routine basic laboratory tests are significant for a moderate increase in glycosylated hemoglobin and hepatic enzymes. Which of the following is the most likely diagnosis in this patient?? {'A': 'Hemochromatosis', 'B': 'Psychogenic erectile dysfunction', 'C': "Wilson's disease", 'D': 'Porphyria cutanea tarda', 'E': 'Chronic hepatitis'},
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A: Hemochromatosis
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Q:A 55-year-old woman sees her family doctor for a follow-up appointment to discuss her imaging studies. She previously presented with chest pain and shortness of breath for the past 2 months. Her CT scan shows a 3.5 cm mass in the lower lobe of her right lung. The mass has irregular borders. Saddle/hilar lymph nodes are enlarged. No distant metastases are identified with PET imaging. The patient has been a smoker for over 35 years (1.5 packs per day), but she has recently quit. This patient is referred to the Pulmonary Diseases Center. What is the most effective step in appropriately managing her case?? {'A': 'Tissue biopsy', 'B': 'Sputum cytology', 'C': 'CT scan in 3 months', 'D': 'Paclitaxel', 'E': 'Radiotherapy'},
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A: Tissue biopsy
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Q:A researcher discovers a new inhibitor for 3-hydroxy-3-methyl-glutaryl-coenzyme A reductase that she believes will be more effective than current drugs. The compound she discovers uses the same mechanism of inhibiting the target enzyme as current drugs of this class; however, it has fewer off target effects and side effects. Therefore, she thinks that this drug can be used at higher concentrations. In order to study the effects of this compound on the enzyme, she conducts enzyme kinetics studies. Specifically, she plots the substrate concentration of the enzyme on the x-axis and its initial reaction velocity on the y-axis. She then calculates the Michaelis-Menten constant (Km) as well as the maximum reaction velocity (Vmax) of the enzyme. Compared to values when studying the enzyme alone, what will be the values seen after the inhibitor is added?? {'A': 'Higher Km and lower Vmax', 'B': 'Higher Km and same Vmax', 'C': 'Same Km and higher Vmax', 'D': 'Same Km and lower Vmax', 'E': 'Same Km and same Vmax'},
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B: Higher Km and same Vmax
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Q:A 37-year-old G1P1 woman gives birth to a male infant at 36 weeks gestation. The patient had an uncomplicated Caesarean delivery and gave birth to a 6-pound infant. The patient has a past medical history of cocaine and heroine use but states she quit 8 years ago. She also suffers from obesity and type II diabetes mellitus. Her blood sugar is well-controlled with diet and exercise alone during the pregnancy. Her temperature is 98.4°F (36.9°C), blood pressure is 167/102 mmHg, pulse is 90/min, respirations are 13/min, and oxygen saturation is 98% on room air. Laboratory values for her infant are ordered as seen below. Hemoglobin: 22 g/dL Hematocrit: 66% Leukocyte count: 6,500/mm^3 with normal differential Platelet count: 197,000/mm^3 Which of the following is the most likely cause of this infant's laboratory abnormalities?? {'A': 'Advanced maternal age', 'B': 'Caesarean section delivery', 'C': 'Gestational age', 'D': 'Maternal diabetes', 'E': 'Maternal hypertension'},
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E: Maternal hypertension
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Q:A 26-year-old patient presents to your office with rhinorrhea that you believe to be viral in origin. He respectfully requests treatment with antibiotics, and he demonstrates an understanding of the risks, benefits, and alternatives to treatment. His mental status is intact, and you believe him to have full decision-making capacity. Which of the following is the best course of action?? {'A': 'Prescribe ciprofloxacin', 'B': 'Prescribe amoxicillin', 'C': 'Prescribe zidovudine', 'D': 'Refer the patient to an infectious disease specialist', 'E': "Deny the patient's request"},
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E: Deny the patient's request
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Q:A 42-year-old man is discovered unconscious by local police while patrolling in a park. He is unresponsive to stimulation. Syringes were found scattered around him. His heart rate is 70/min and respiratory rate is 6/min. Physical examination reveals a disheveled man with track marks on both arms. His glasgow coma scale is 8. Pupillary examination reveals miosis. An ambulance is called and a reversing agent is administered. Which of the following is most accurate regarding the reversal agent most likely administered to this patient?? {'A': 'Results in acute withdrawal', 'B': 'Has a short half-life', 'C': 'Works on dopamine receptors', 'D': 'Is a non-competitive inhibitor', 'E': 'Can be given per oral'},
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A: Results in acute withdrawal
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Q:A 35-year-old pregnant woman gives birth to a baby at term. The antepartum course was uneventful. She was compliant with all prenatal examinations and was given a prophylactic tetanus vaccine. While performing the neonatal examination, the pediatrician reports Apgar scores of 9 and 10 at 1 and 5 min, respectively. The pediatrician notices that the baby has ambiguous genitalia and blood pressure that is high for a neonate. The notable laboratory results are as follows: Renin 0.4 nmoL/L/h Aldosterone 70 pmoL/L Cortisol 190 nmoL/L Serum creatinine 1.0 mg/dL Sex hormones are higher than the normal values at this age. Which of the following is responsible for the neonate's hypertension?? {'A': 'Increased concentration of sex hormones', 'B': 'Decreased amount of aldosterone', 'C': 'Increased amount of 11-deoxycorticosterone', 'D': 'Decreased amount of cortisol', 'E': 'Decreased angiotensin response'},
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C: Increased amount of 11-deoxycorticosterone
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Q:A 64-year-old woman comes to the physician because of a 7-month history of abdominal discomfort, fatigue, and a 6.8-kg (15-lb) weight loss. Physical examination shows generalized pallor and splenomegaly. Laboratory studies show anemia with pronounced leukocytosis and thrombocytosis. Cytogenetic analysis shows a BCR-ABL fusion gene. A drug with which of the following mechanisms of action is most appropriate for this patient?? {'A': 'Tyrosine kinase inhibitor', 'B': 'Topoisomerase II inhibitor', 'C': 'Monoclonal anti-CD20 antibody', 'D': 'Monoclonal anti-HER-2 antibody', 'E': 'Ribonucleotide reductase inhibitor'},
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A: Tyrosine kinase inhibitor
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Q:A 72-year-old man is brought to the emergency room by his daughter with complaints of a productive cough, rust-colored sputum, and fever for 1 week. He denies any breathlessness or chest pain. The past medical history is unremarkable. The vital signs include a pulse rate of 103/min, respiratory rate of 34/min, and blood pressure of 136/94 mm Hg, with an axillary temperature of 38.9°C (102.0°F). The SaO2 is 86% on room air. The chest examination revealed a dull percussion note and coarse crepitations over the left mid-chest. The patient was admitted to the medical unit and intravenous antibiotics were started. He responded well, but after 2 days an elevated temperature was noted. The patient deteriorated and he was transferred to the intensive care unit. A few days later, his temperature was 39.0°C (103.2°F), the respiratory rate was 23/min, the blood pressure was 78/56 mm Hg, and the SaO2 was 78%. He also had a delayed capillary refill time with a pulse of 141/min. Blood was drawn for the white cell count, which revealed a total count of 17,000/µL. The attending physician decides to begin therapy for the low blood pressure, which brings about a change in the cardiovascular physiology, as shown in the graph with the post-medication represented by a dashed line. Which of the following medications was most likely administered to the patient?? {'A': 'Captopril', 'B': 'Phenoxybenzamine', 'C': 'Low-dose dopamine', 'D': 'Isoproterenol', 'E': 'Norepinephrine'},
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E: Norepinephrine
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Q:A 64-year-old man presents with a complaint of prominent stiffness in his legs which is causing a difficulty in ambulation. He is not able to relax his trunk area and has frequent, painful muscle spasms. He denies diplopia, swallowing difficulties, and urinary or bowel problems. He has a medical history of stage IV lung cancer. He has received 4 sessions of chemotherapy. The neurological examination reveals an increased generalized muscle tone. He has a spastic gait with exaggerated lumbar lordosis. The needle electromyography (EMG) studies show continuous motor unit activity that persists at rest. Which paraneoplastic antibody is most likely associated with the symptoms of this patient?? {'A': 'Amphiphysin', 'B': 'Anti-Hu', 'C': 'Anti-Ri', 'D': 'Glutamic acid decarboxylase', 'E': 'Voltage-gated calcium channel'},
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A: Amphiphysin
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Q:A 45-year-old man comes to the physician for the evaluation of difficulty swallowing that has worsened over the past year. He also reports some hoarseness and generalized bone, muscle, and joint pain. During the past six months, he has had progressive constipation and two episodes of kidney stones. He also reports recurrent episodes of throbbing headaches, diaphoresis, and palpitations. He does not smoke or drink alcohol. He takes no medications. His vital signs are within normal limits. Physical examination and an ECG show no abnormalities. Laboratory studies show calcium concentration of 12 mg/dL, phosphorus concentration of 2 mg/dL, alkaline phosphatase concentration of 100 U/L, and calcitonin concentration of 11 pg/mL (N < 8.8). Ultrasonography of the neck shows hypoechoic thyroid lesions with irregular margins and microcalcifications. Which of the following is the most likely underlying cause of this patient's condition?? {'A': 'Mutated NF1 gene', 'B': 'Exposure to ionizing radiation', 'C': 'Deleted VHL gene', 'D': 'Altered RET proto-oncogene expression', 'E': 'Disrupted menin protein function'},
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D: Altered RET proto-oncogene expression
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Q:A 5-year-old boy presents with bilateral conjunctivitis and pharyngitis. The patient’s mother says that symptoms acutely onset 3 days ago and include itchy red eyes, a low-grade fever, and a sore throat. She says that the patient recently attended a camp where other kids were also ill and were completely healthy before going. No significant past medical history. Which of the following is the most likely cause of this patient’s symptoms?? {'A': 'Enterovirus', 'B': 'Metapneumovirus', 'C': 'Influenza virus', 'D': 'Rhinovirus', 'E': 'Adenovirus'},
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E: Adenovirus
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Q:A 3-year-old boy is brought to the emergency department after the sudden onset of a rash that started on the head and progressed to the trunk and extremities. Over the past week, he has had a runny nose, a cough, and red, crusty eyes. He recently immigrated with his family from Yemen and immunization records are unavailable. The patient appears malnourished. His temperature is 40.0°C (104°F). Examination shows generalized lymphadenopathy and a blanching, partially confluent maculopapular exanthema. Administration of which of the following is most likely to improve this patient's condition?? {'A': 'Valacyclovir', 'B': 'Penicillin V', 'C': 'Retinol', 'D': 'Live-attenuated vaccine', 'E': 'Intravenous immunoglobulin'},
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C: Retinol
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Q:A 38-year-old man presents with a 1-year history of resting tremor and clumsiness in his right hand. He says his symptoms are progressively worsening and are starting to interfere with his work. He has no significant past medical history and is not currently taking any medications. The patient denies any smoking history, alcohol, or recreational drug use. Family history is significant for his grandfather, who had a tremor, and his father, who passed away at a young age. Neither his brother nor his sister have tremors. Vital signs include: pulse 70/min, respiratory rate 15/min, blood pressure 124/70 mm Hg, and temperature 36.7°C (98.1°F). Physical examination reveals decreased facial expression, hypophonia, resting tremor in the right hand, rigidity in the upper limbs, and normal deep tendon reflexes. No abnormalities of posture are seen and gait is normal except for decreased arm swing on the right. The remainder of the exam is unremarkable. Which of the following medications would be most effective in treating this patient’s movement problems and his depression?? {'A': 'Benztropine', 'B': 'Selegiline', 'C': 'Entacapone', 'D': 'Bromocriptine', 'E': 'Levodopa/carbidopa'},
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B: Selegiline
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Q:A 53-year-old woman presented to her PCP with one week of difficulty falling asleep, despite having good sleep hygiene. She denies changes in her mood, weight loss, and anhedonia. She has had difficulty concentrating and feels tired throughout the day. Recently, she was fired from her previous job. What medication would be most helpful for this patient?? {'A': 'Quetiapine', 'B': 'Zolpidem', 'C': 'Diphenhydramine', 'D': 'Diazepam', 'E': 'Citalopram'},
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B: Zolpidem
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Q:A 35-year-old male patient is brought into the emergency department by emergency medical services. The patient has a history of schizophrenia and is on medication per his mother. His mother also states that the dose of his medication was recently increased, though she is not sure of the specific medication he takes. His vitals are HR 110, BP 170/100, T 102.5, RR 22. On exam, he cannot respond to questions and has rigidity. His head is turned to the right and remains in that position during the exam. Labs are significant for a WBC count of 14,000 cells/mcL, with a creatine kinase (CK) level of 3,000 mcg/L. What is the best treatment for this patient?? {'A': 'Diazepam', 'B': 'Morphine', 'C': 'Dantrolene', 'D': 'Valproate', 'E': 'Lamotrigine'},
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C: Dantrolene
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Q:A 35-year-old woman presents to the clinic for a several-month history of heat intolerance. She lives in a small apartment with her husband and reports that she always feels hot and sweaty, even when their air conditioning is on high. On further questioning, she's also had a 4.5 kg (10 lb) unintentional weight loss. The vital signs include: heart rate 102/min and blood pressure 150/80 mm Hg. The physical exam is notable for warm and slightly moist skin. She also exhibits a fine tremor in her hands when her arms are outstretched. Which of the following laboratory values is most likely low in this patient?? {'A': 'Calcitonin', 'B': 'Glucose', 'C': 'Triiodothyronine (T3)', 'D': 'Thyroxine (T4)', 'E': 'Thyroid-stimulating hormone'},
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E: Thyroid-stimulating hormone
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Q:A 26-year-old man presents to the emergency room with a complaint of lower abdominal pain that started about 5 hours ago. The pain was initially located around the umbilicus but later shifted to the right lower abdomen. It is a continuous dull, aching pain that does not radiate. He rates the severity of his pain as 7/10. He denies any previous history of similar symptoms. The vital signs include heart rate 100/min, respiratory rate 20/min, temperature 38.0°C (100.4°F), and blood pressure 114/77 mm Hg. On physical examination, there is severe right lower quadrant tenderness on palpation. Deep palpation of the left lower quadrant produces pain in the right lower quadrant. Rebound tenderness is present. The decision is made to place the patient on antibiotics and defer surgery. Two days later, his abdominal pain has worsened. Urgent computed tomography (CT) scan reveals new hepatic abscesses. The complete blood count result is given below: Hemoglobin 16.2 mg/dL Hematocrit 48% Leukocyte count 15,000/mm³ Neutrophils 69% Bands 3% Eosinophils 1% Basophils 0% Lymphocytes 24% Monocytes 3% Platelet count 380,000/mm³ Which of the following complications has this patient most likely experienced?? {'A': 'Pylephlebitis', 'B': 'Intestinal obstruction', 'C': 'Peritonitis', 'D': 'Perforation', 'E': 'Appendiceal abscess'},
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A: Pylephlebitis
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Q:A 37-year-old man comes to the physician for a follow-up examination. He is being evaluated for high blood pressure readings that were incidentally recorded at a routine health maintenance examination 1 month ago. He has no history of serious illness and takes no medications. His pulse is 88/min and blood pressure is 165/98 mm Hg. Physical examination shows no abnormalities. Serum studies show: Na+ 146 mEq/L K+ 3.0 mEq/L Cl- 98 mEq/L Glucose 77 mg/dL Creatinine 0.8 mg/dL His plasma aldosterone concentration (PAC) to plasma renin activity (PRA) ratio is 36 (N = < 10). A saline infusion test fails to suppress aldosterone secretion. A CT scan of the adrenal glands shows bilateral adrenal abnormalities. An adrenal venous sampling shows elevated PACs from bilateral adrenal veins. Which of the following is the most appropriate next step in management?"? {'A': 'Amiloride therapy', 'B': 'Propranolol therapy', 'C': 'Unilateral adrenalectomy', 'D': 'Eplerenone therapy', 'E': 'Bilateral adrenalectomy'},
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D: Eplerenone therapy
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Q:A 73-year-old woman is brought to the emergency department because of a 1-day history of skin lesions. Initially, she experienced pain in the affected areas, followed by discoloration of the skin and formation of blisters. Four days ago, the patient was started on a new medication by her physician after failed cardioversion for intermittent atrial fibrillation. She lives alone and does not recall any recent falls or trauma. She has hypertension treated with metoprolol and diabetes mellitus treated with insulin. Her temperature is 37°C (98.6°F), pulse is 108/min and irregularly irregular, and blood pressure is 145/85 mm Hg. Examination of her skin shows well-circumscribed purple maculae, hemorrhagic blisters, and areas of skin ulceration over the breast, lower abdomen, and gluteal region. Which of the following is the strongest predisposing factor for this patient's condition?? {'A': 'Mutation in clotting factor V', 'B': 'Deficiency of a natural anticoagulant', 'C': 'Damaged aortic valve', 'D': 'Formation of antibodies against a platelet antigen', 'E': 'Major neurocognitive disorder\n"'},
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B: Deficiency of a natural anticoagulant
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Q:A 34-year-old man presents with multiple painful ulcers on his penis. He says that the ulcers all appeared suddenly at the same time 3 days ago. He reports that he is sexually active with multiple partners and uses condoms inconsistently. He is afebrile and his vital signs are within normal limits. Physical examination reveals multiple small shallow ulcers with an erythematous base and without discharge. There is significant inguinal lymphadenopathy present. Which of the following is the most likely etiologic agent of this patient’s ulcers?? {'A': 'Human papillomavirus', 'B': 'Chlamydia trachomatis', 'C': 'Treponema pallidum', 'D': 'Haemophilus ducreyi', 'E': 'Herpes simplex virus'},
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E: Herpes simplex virus
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Answer the following medical question with one of the provided options:
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Q:A 71-year-old male is admitted to the hospital with a Staphylococcal aureus infection of his decubitus ulcers. He is diabetic and has a body mass index of 45. His temperature is 37°C (98.6°F), respirations are 15/min, pulse is 67/min and blood pressure is 122/98 mm Hg. The nurse is monitoring his blood glucose and records it as 63 mg/dL. She then asks the resident on call if the patient should receive glargine insulin as ordered seeing his glucose levels. Which of the following would be the most appropriate response by the resident?? {'A': 'Yes, glargine insulin is a long-acting insulin and should still be given to control his blood glucose over the next 24 hours.', 'B': 'No, glargine insulin should not be given during an episode of hypoglycemia as it will further lower blood glucose.', 'C': 'No, glargine insulin was probably ordered in error as it is not recommended in type 2 diabetes.', 'D': 'No, due to his S. aureus infection he is more likely to have low blood glucose and glargine insulin should be held until he has recovered.', 'E': 'No, glargine insulin should be stopped and replaced with lispro insulin until his blood glucose increases.'},
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A: Yes, glargine insulin is a long-acting insulin and should still be given to control his blood glucose over the next 24 hours.
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Q:A 10-year-old boy presents to your office with puffy eyes. The patient's mother states that his eyes seem abnormally puffy and thinks he may have an eye infection. Additionally, he had a sore throat a week ago which resolved with over the counter medications. The mother also thought that his urine was darker than usual and is concerned that blood may be present. His temperature is 99.5°F (37.5°C), blood pressure is 107/62 mmHg, pulse is 100/min, respirations are 17/min, and oxygen saturation is 98% on room air. Physical exam is notable for bilateral periorbital edema. Cranial nerves are grossly intact bilaterally. Which of the following is the most likely finding on renal biopsy for this patient? {'A': 'Alternating thickening and thinning of basement membrane with splitting of the lamina densa', 'B': 'Linear Ig deposits along the basement membrane', 'C': 'No abnormalities', 'D': 'Podocyte fusion on electron microscopy', 'E': 'Sub-epithelial electron dense deposits on electron microscopy'},
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E: Sub-epithelial electron dense deposits on electron microscopy
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Q:A 65-year-old man presents to his primary care provider after noticing increasing fatigue over the past several weeks. He now becomes short of breath after going up 1 flight of stairs. He was previously healthy and has not seen a doctor for several years. He denies any fever or changes to his bowel movements. On exam, his temperature is 98.8°F (37.1°C), blood pressure is 116/76 mmHg, pulse is 74/min, and respirations are 14/min. On basic labs, his hemoglobin is found to be 9.6 g/dL and MCV is 75 fL. Fecal blood testing is positive for occult blood. Imaging is notable for a mass in the cecum that is partially obstructing the lumen, as well as several small lesions in the liver. Which of the following structures is most at risk for involvement in this patient’s disease?? {'A': 'Inferior mesenteric vein', 'B': 'Inferior rectal vein', 'C': 'Right gonadal vein', 'D': 'Right renal vein', 'E': 'Superior mesenteric vein'},
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E: Superior mesenteric vein
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Q:A 24-year-old woman is brought to the emergency department by her roommate because of bizarre behavior and incoherent talkativeness for the past week. Her roommate reports that the patient has been rearranging the furniture in her room at night and has ordered a variety of expensive clothes online. The patient says she feels “better than ever” and has a lot of energy. She had absence seizures as a child and remembers that valproate had to be discontinued because it damaged her liver. She has been otherwise healthy and is not taking any medication. She is sexually active with her boyfriend. She does not smoke, drink alcohol, or use illicit drugs. Physical and neurologic examinations show no abnormalities. Her pulse is 78/min, respirations are 13/min, and blood pressure is 122/60 mm Hg. Mental status examination shows pressured and disorganized speech, flight of ideas, lack of insight, and affective lability. Which of the following is the best initial step before deciding on a therapy for this patient's condition?? {'A': 'Obtain CBC, liver function studies, and beta-HCG', 'B': 'Assess for suicidal ideation and obtain echocardiography', 'C': 'Obtain TSH, β-hCG, and serum creatinine concentration', 'D': 'Perform urine drug testing and begin cognitive behavior therapy', 'E': 'Obtain BMI, HbA1c, lipid levels, and prolactin levels'},
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C: Obtain TSH, β-hCG, and serum creatinine concentration
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Q:A 36-year-old woman comes to the physician because of a 12-month history of upper abdominal pain. The pain is worse after eating, which she reports as 7 out of 10 in intensity. Over the last year, she has also had nausea, heartburn, and multiple episodes of diarrhea with no blood or mucus. Eight months ago, she underwent an upper endoscopy, which showed several ulcers in the gastric antrum, the pylorus, and the duodenum, as well as thick gastric folds. The biopsies from these ulcers were negative for H. pylori. Current medications include pantoprazole and over-the-counter antacids. She appears anxious. Vital signs are within normal limits. Cardiopulmonary examination shows no abnormalities. The abdomen is soft and there is tenderness to palpation in the epigastric and umbilical areas. Test of the stool for occult blood is positive. A repeat upper endoscopy shows persistent gastric and duodenal ulceration with minimal bleeding. Which of the following is the most appropriate next step in diagnosis?? {'A': 'Secretin stimulation test', 'B': 'Urea breath test', 'C': '24-hour esophageal pH monitoring', 'D': 'Fasting serum gastrin level', 'E': 'CT scan of the abdomen and pelvis\n"'},
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D: Fasting serum gastrin level
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Q:A 65-year-old Caucasian woman comes to the clinic with complaints of fatigability and persistent headaches for the last month. Her headache is dull, encompassing her whole head, and has been getting worse lately. She has associated diplopia and progressively diminishing peripheral vision. She also complains of difficulty losing weight despite trying to control her diet and exercising regularly. She weighs 91 kg (200 lb) at present and reports having gained 9 kg (20 lb) in the past month. Past medical history is insignificant. Blood pressure is 110/70 mm Hg, pulse rate is 60/min, respiratory rate is 12/min, temperature is 36.5°C (97.7°F). Physical examination shows bilateral papilledema. There is some pedal edema and her deep tendon reflexes are slow. CT scan shows suprasellar calcifications. Laboratory studies show: Na+ 140 mEq/L K+ 3.8 mEq/L Serum calcium 9.5 mg/dL TSH 0.05 U/mL Free T4 0.2 ng/mL Which of the following is the most probable diagnosis?? {'A': 'Craniopharyngioma', 'B': 'Primary hypothyroidism', 'C': 'Optic nerve atrophy', 'D': 'Glioblastoma', 'E': 'Pituitary adenoma'},
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A: Craniopharyngioma
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Answer the following medical question with one of the provided options:
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Q:A 22-year-old man is brought to the emergency department by his roommate 20 minutes after being discovered unconscious at home. On arrival, he is unresponsive to painful stimuli. His pulse is 65/min, respirations are 8/min, and blood pressure is 110/70 mm Hg. Pulse oximetry shows an oxygen saturation of 75%. Despite appropriate lifesaving measures, he dies. The physician suspects that he overdosed. If the suspicion is correct, statistically, the most likely cause of death is overdose with which of the following groups of drugs?? {'A': 'Opioid analgesics', 'B': 'Amphetamines', 'C': 'Heroin', 'D': 'Antidepressants', 'E': 'Acetaminophen'},
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A: Opioid analgesics
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Answer the following medical question with one of the provided options:
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Q:A 45-year-old woman presents with fever, chills, nausea, and dysuria. She says her symptoms started 4 days ago and have progressively worsened. Her past medical history is significant for recurrent UTIs for the past 6 months and for diabetes mellitus type 2, diagnosed 5 years ago and treated with metformin. Her vital signs include: temperature 39.5°C (103.1°F), blood pressure 100/70 mm Hg, pulse 90/min, and respiratory rate 23/min. On physical examination, moderate right costovertebral angle tenderness is noted. Laboratory findings are significant for the following: WBC 9,500/mm3 RBC 4.20 x 106/mm3 Hematocrit 41.5% Hemoglobin 13.0 g/dL Platelet count 225,000/mm3 Urinalysis: Color Dark yellow Clarity Turbid pH 5.5 Specific gravity 1.021 Glucose None Ketones None Nitrites Positive Leukocyte esterase Positive Bilirubin Negative Urobilirubin 0.6 mg/dL Protein Trace Blood None WBC 25/hpf Bacteria Many Urine culture and sensitivities are pending. Which of the following is the best next step in the management of this patient?? {'A': 'Contrast MRI of the abdomen and pelvis', 'B': 'Discharge with outpatient antibiotic therapy', 'C': 'Admit for prompt percutaneous nephrostomy', 'D': 'Renal ultrasound', 'E': 'Admit for IV antibiotic therapy'},
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E: Admit for IV antibiotic therapy
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Q:A 29-year-old woman presents with progressive vision loss in her right eye and periorbital pain for 5 days. She says that she has also noticed weakness, numbness, and tingling in her left leg. Her vital signs are within normal limits. Neurological examination shows gait imbalance, positive Babinski reflexes, bilateral spasticity, and exaggerated deep tendon reflexes in the lower extremities bilaterally. FLAIR MRI is obtained and is shown in the image. Which of the following is the most likely cause of this patient’s condition?? {'A': 'Acute disseminated encephalomyelitis', 'B': 'Amyotrophic lateral sclerosis', 'C': 'Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephaly (CADASIL)', 'D': 'Lead intoxication', 'E': 'Multiple sclerosis'},
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E: Multiple sclerosis
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Q:A 3-month-old girl is brought to the emergency department by her parents after she appeared to have a seizure at home. On presentation, she no longer has convulsions though she is still noted to be lethargic. She was born through uncomplicated vaginal delivery and was not noted to have any abnormalities at the time of birth. Since then, she has been noted by her pediatrician to be falling behind in height and weight compared to similarly aged infants. Physical exam reveals an enlarged liver, and laboratory tests reveal a glucose of 38 mg/dL. Advanced testing shows that a storage molecule present in the cells of this patient has abnormally short outer chains. Which of the following enzymes is most likely defective in this patient?? {'A': 'Branching enzyme', 'B': 'Debranching enzyme', 'C': 'Glucose-6-phosphatase', 'D': 'Hepatic phosphorylase', 'E': 'Muscle phosphorylase'},
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B: Debranching enzyme
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Answer the following medical question with one of the provided options:
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Q:A scientist is studying the mechanisms by which bacteria become resistant to antibiotics. She begins by obtaining a culture of vancomycin-resistant Enterococcus faecalis and conducts replicate plating experiments. In these experiments, colonies are inoculated onto a membrane and smeared on 2 separate plates, 1 containing vancomycin and the other with no antibiotics. She finds that all of the bacterial colonies are vancomycin resistant because they grow on both plates. She then maintains the bacteria in liquid culture without vancomycin while she performs her other studies. Fifteen generations of bacteria later, she conducts replicate plating experiments again and finds that 20% of the colonies are now sensitive to vancomycin. Which of the following mechanisms is the most likely explanation for why these colonies have become vancomycin sensitive?? {'A': 'Gain of function mutation', 'B': 'Plasmid loss', 'C': 'Point mutation', 'D': 'Loss of function mutation', 'E': 'Viral infection'},
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B: Plasmid loss
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Q:A 35-year-old woman presents to clinic in emotional distress. She states she has been unhappy for the past couple of months and is having problems with her sleep and appetite. Additionally, she reports significant anxiety regarding thoughts of dirtiness around the house. She states that she cleans all of the doorknobs 5-10 times per day and that, despite her actions, the stress related to cleaning is becoming worse. What is this patient's diagnosis?? {'A': 'Obsessive compulsive disorder (OCD)', 'B': 'Tic disorder', 'C': 'Panic Disorder (PD)', 'D': 'Generalized anxiety disorder (GAD)', 'E': 'Obsessive compulsive personality disorder (OCPD)'},
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A: Obsessive compulsive disorder (OCD)
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Q:A 22-year-old woman presents to the emergency department with a chief concern of shortness of breath. She was hiking when she suddenly felt unable to breathe and had to take slow deep breaths to improve her symptoms. The patient is a Swedish foreign exchange student and does not speak any English. Her past medical history and current medications are unknown. Her temperature is 99.5°F (37.5°C), blood pressure is 127/68 mmHg, pulse is 120/min, respirations are 22/min, and oxygen saturation is 90% on room air. Physical exam is notable for poor air movement bilaterally and tachycardia. The patient is started on treatment. Which of the following best describes this patient's underlying pathology? FEV1 = Forced expiratory volume in 1 second FVC = Forced vital capacity DLCO = Diffusing capacity of carbon monoxide? {'A': 'Decreased airway tone', 'B': 'Increased FEV1', 'C': 'Increased FEV1/FVC', 'D': 'Increased FVC', 'E': 'Normal DLCO'},
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E: Normal DLCO
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Q:A mother brings her 1-week-old son to the pediatrician because she is concerned about the child’s umbilicus. She notes that there appears to be fluid draining from the child’s umbilicus several times a day. The child has been breastfeeding normally. On exam, a small amount of clear light yellow fluid drains from the child’s umbilical stump when pressure is applied to the child’s lower abdomen. No bilious or feculent drainage is noted. Which of the following embryologic structures is associated with this patient’s condition?? {'A': 'Omphalomesenteric duct', 'B': 'Umbilical vein', 'C': 'Paramesonephric duct', 'D': 'Urachus', 'E': 'Ductus venosus'},
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D: Urachus
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Q:A 28-year-old woman, gravida 1, para 0, at 32 weeks' gestation is admitted to the hospital for the management of elevated blood pressures. On admission, her pulse is 81/min, and blood pressure is 165/89 mm Hg. Treatment with an intravenous drug is initiated. Two days after admission, she has a headache and palpitations. Her pulse is 116/min and regular, and blood pressure is 124/80 mm Hg. Physical examination shows pitting edema of both lower extremities that was not present on admission. This patient most likely was given a drug that predominantly acts by which of the following mechanisms?? {'A': 'Inhibition of β1, β2, and α1 receptors', 'B': 'Activation of α2 adrenergic receptors', 'C': 'Inhibition of angiotensin II production', 'D': 'Inhibition of sodium reabsorption', 'E': 'Direct dilation of the arterioles'},
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E: Direct dilation of the arterioles
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Q:A 36-year-old G3P2002 presents to her obstetrician’s office for her first prenatal visit at ten weeks and two days gestation. She notes that she has felt nauseous the last several mornings and has been especially tired for a few weeks. Otherwise, she feels well. The patient has had two uncomplicated spontaneous vaginal deliveries at full term with her last child born six years ago. She is concerned about the risk of Down syndrome in this fetus, as her sister gave birth to an affected child at age 43. The patient has a history of generalized anxiety disorder, atopic dermatitis, and she is currently on escitalopram. At this visit, this patient’s temperature is 98.6°F (37.0°C), pulse is 70/min, blood pressure is 121/67 mmHg, and respirations are 13/min. The patient appears anxious, but overall comfortable, and cardiopulmonary and abdominal exams are unremarkable. Pelvic exam reveals normal female external genitalia, a closed and slightly soft cervix, a ten-week-sized uterus, and no adnexal masses. Which of the following is the best next step for definitively determining whether this patient’s fetus has Down syndrome?? {'A': 'Amniocentesis', 'B': 'Chorionic villus sampling', 'C': 'Anatomy ultrasound', 'D': 'Genetic testing of patient’s sister', 'E': 'Nuchal translucency test'},
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B: Chorionic villus sampling
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Q:A 48-year-old woman is transferred from her primary care physician's office to the emergency department for further evaluation of hypokalemia to 2.5 mEq/L. She was recently diagnosed with hypertension 2 weeks ago and started on medical therapy. The patient said that she enjoys all kinds of food and exercises regularly, but has not been able to complete her workouts as she usually does. Her temperature is 97.7°F (36.5°C), blood pressure is 107/74 mmHg, pulse is 80/min, respirations are 15/min, and SpO2 is 94% on room air. Her physical exam is unremarkable. Peripheral intravenous (IV) access is obtained. Her basic metabolic panel is obtained below. Serum: Na+: 135 mEq/L Cl-: 89 mEq/L K+: 2.2 mEq/L HCO3-: 33 mEq/L BUN: 44 mg/dL Glucose: 147 mg/dL Creatinine: 2.3 mg/dL Magnesium: 2.0 mEq/L What is the next best step in management?? {'A': 'Obtain an electrocardiogram', 'B': 'Administer potassium bicarbonate 50mEq per oral', 'C': 'Administer potassium chloride 40mEq via peripheral IV', 'D': 'Administer isotonic saline 1 liter via peripheral IV', 'E': 'Obtain urine sodium and creatinine'},
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D: Administer isotonic saline 1 liter via peripheral IV
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Q:Nine days after being treated for a perforated gastric ulcer and sepsis, a 78-year-old woman develops decreased urinary output and malaise. She required emergency laparotomy and was subsequently treated in the intensive care unit for sepsis. Blood cultures grew Pseudomonas aeruginosa. The patient was treated with ceftazidime and gentamicin. She has type 2 diabetes mellitus, arterial hypertension, and osteoarthritis of the hips. Prior to admission, her medications were insulin, ramipril, and ibuprofen. Her temperature is 37.3°C (99.1°F), pulse is 80/min, and blood pressure is 115/75 mm Hg. Examination shows a healing surgical incision in the upper abdomen. Laboratory studies show: Hemoglobin count 14 g/dL Leukocyte count 16,400 mm3 Segmented neutrophils 60% Eosinophils 2% Lymphocytes 30% Monocytes 6% Platelet count 260,000 mm3 Serum Na+ 137 mEq/L Cl- 102 mEq/L K+ 5.1 mEq/L Urea nitrogen 25 mg/dL Creatinine 4.2 mg/dL Fractional excretion of sodium is 2.1%. Which of the following findings on urinalysis is most likely associated with this patient's condition?"? {'A': 'WBC casts', 'B': 'Pigmented casts', 'C': 'Muddy brown casts', 'D': 'RBC casts', 'E': 'Waxy casts'},
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C: Muddy brown casts
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Q:A 50-year-old woman comes to the physician because of palpitations and irritability. Over the past 4 months, she has had several episodes of heart racing and skipping beats that lasted between 30 seconds and several hours. She has also been arguing with her husband more, often about the temperature being too warm. The patient has also lost 8.8-kg (19.4-lb) over the past 4 months, despite being less strict with her diet. She has mild asthma treated with inhaled bronchodilators. Her pulse is 102/min and blood pressure is 148/98 mm Hg. On physical examination, the skin is warm and moist. A mass is palpated in the anterior neck area. On laboratory studies, thyroid stimulating hormone is undetectable and there are antibodies against the thyrotropin-receptor. Thyroid scintigraphy shows diffusely increased iodine uptake. Two weeks later, a single oral dose of radioactive iodine is administered. This patient will most likely require which of the following in the long-term?? {'A': 'Near-total thyroidectomy', 'B': 'Estrogen replacement therapy', 'C': 'Methimazole therapy', 'D': 'Propranolol therapy', 'E': 'L-thyroxine therapy'},
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E: L-thyroxine therapy
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Answer the following medical question with one of the provided options:
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Q:A 30-year-old woman presents to the office with complaints of pain in her right breast for 5 days. The pain is moderate-to-intense and is localized to the upper quadrant of the right breast, and mainly to the areola for the past 48 hours. She adds that there is some nipple discharge on the same side and that the right breast is red. She was diagnosed with type 1 diabetes at the age of 10 years of age, for which she takes insulin. The family history is negative for breast and ovarian cancers, and endometrial disorders. She smokes one-half pack of cigarettes every day and binge drinks alcohol on the weekends. Two weeks ago she was hit by a volleyball while playing at the beach. There is no history of fractures or surgical procedures. The physical examination reveals a swollen, erythematous, and warm right breast with periareolar tenderness and nipple discharge. There are no palpable masses or lymphadenopathy. Which of the following is the most important risk factor for the development of this patient’s condition?? {'A': 'Age', 'B': 'Trauma', 'C': 'Smoking', 'D': 'Diabetes', 'E': 'Parity'},
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C: Smoking
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Q:A previously healthy 33-year-old woman comes to the physician because of pain and sometimes numbness in her right thigh for the past 2 months. She reports that her symptoms are worse when walking or standing and are better while sitting. Three months ago, she started going to a fitness class a couple times a week. She is 163 cm (5 ft 4 in) tall and weighs 88 kg (194 lb); BMI is 33.1 kg/m2. Her vital signs are within normal limits. Examination of the skin shows no abnormalities. Sensation to light touch is decreased over the lateral aspect of the right anterior thigh. Muscle strength is normal. Tapping the right inguinal ligament leads to increased numbness of the affected thigh. The straight leg test is negative. Which of the following is the most appropriate next step in management of this patient?? {'A': 'MRI of the lumbar spine', 'B': 'Blood work for inflammatory markers', 'C': 'Advise patient to wear looser pants', 'D': 'X-ray of the hip', 'E': 'Reduction of physical activity'},
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C: Advise patient to wear looser pants
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Q:A 68-year-old man presents to the office with progressive shortness of breath and cough. A chest X-ray shows prominent hilar lymph nodes and scattered nodular infiltrates. Biopsy of the latter reveals noncaseating granulomas. This patient most likely as a history of exposure to which of the following?? {'A': 'Organic dust', 'B': 'Coal dust', 'C': 'Beryllium', 'D': 'Silica', 'E': 'Asbestos'},
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C: Beryllium
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Q:A 67-year-old man presents to the emergency department acutely confused. The patient's wife found him mumbling incoherently in the kitchen this morning as they were preparing for a hike. The patient was previously healthy and only had a history of mild forgetfulness, depression, asthma, and seasonal allergies. His temperature is 98.5°F (36.9°C), blood pressure is 122/62 mmHg, pulse is 119/min, and oxygen saturation is 98% on room air. The patient is answering questions inappropriately and seems confused. Physical exam is notable for warm, flushed, and dry skin. The patient's pupils are dilated. Which of the following is also likely to be found in this patient?? {'A': 'Coronary artery vasospasm', 'B': 'Hypoventilation', 'C': 'Increased bronchial secretions', 'D': 'QRS widening', 'E': 'Urinary retention'},
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E: Urinary retention
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Q:A 61-year-old male presents to your office with fever and dyspnea on exertion. He has been suffering from chronic, non-productive cough for 1 year. You note late inspiratory crackles on auscultation. Pulmonary function tests reveal an FEV1/FVC ratio of 90% and an FVC that is 50% of the predicted value. Which of the following would you most likely see on a biopsy of this patient's lung?? {'A': 'Subpleural cystic enlargement', 'B': 'Charcot-Leyden crystals', 'C': 'Hyaline membranes', 'D': 'Arteriovenous malformations', 'E': 'Anti-GBM antibodies'},
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A: Subpleural cystic enlargement
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Q:A team of intensivists working in a private intensive care unit (ICU) observe that the clinical efficacy of vancomycin is low, and proven nosocomial infections have increased progressively over the past year. A clinical microbiologist is invited to conduct a bacteriological audit of the ICU. He analyzes the microbiological reports of all patients treated with vancomycin over the last 2 years and takes relevant samples from the ICU for culture and antibiotic sensitivity analysis. The audit concludes that there is an increased incidence of vancomycin-resistant Enterococcus fecalis infections. Which of the following mechanisms best explains the changes that took place in the bacteria?? {'A': 'Protection of the antibiotic-binding site by Qnr protein', 'B': 'Replacement of the terminal D-ala in the cell wall peptidoglycan by D-lactate', 'C': 'Increased expression of efflux pumps which extrude the antibiotic from the bacterial cell', 'D': 'Decreased number of porins in the bacterial cell wall leading to decreased intracellular entry of the antibiotic', 'E': 'Production of an enzyme that hydrolyzes the antibiotic'},
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B: Replacement of the terminal D-ala in the cell wall peptidoglycan by D-lactate
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Q:A 46-year-old male with a history of recurrent deep venous thromboses on warfarin presents to his hematologist for a follow-up visit. He reports that he feels well and has no complaints. His INR at his last visit was 2.5 while his current INR is 4.0. His past medical history is also notable for recent diagnoses of hypertension, hyperlipidemia, and gastroesophageal reflux disease. He also has severe seasonal allergies. He reports that since his last visit, he started multiple new medications at the recommendation of his primary care physician. Which of the following medications was this patient likely started on?? {'A': 'Omeprazole', 'B': 'Lisinopril', 'C': 'Hydrochlorothiazide', 'D': 'Atorvastatin', 'E': 'Cetirizine'},
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A: Omeprazole
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Answer the following medical question with one of the provided options:
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Q:A 67-year-old man presents to his physician with increased thirst and polyuria for the past 4 months. Patient also notes a decrease in his vision for the past 6 months and tingling in his feet. The medical history is significant for a chronic pyelonephritis and stage 2 chronic kidney disease. The current medications include losartan and atorvastatin. He reports a daily alcohol intake of 3 glasses of whiskey. The blood pressure is 140/90 mm Hg and the heart rate is 63/min. The BMI is 35.4 kg/m2. On physical examination, there is 2+ pitting edema of the lower legs and face. The pulmonary, cardiac, and abdominal examinations are within normal limits. There is no costovertebral angle tenderness noted. Ophthalmoscopy shows numerous microaneurysms and retinal hemorrhages concentrated in the fundus. The neurological examination reveals a symmetric decrease in vibration and 2 point discrimination in the patient’s feet and legs extending up to the lower third of the calves. The ankle-deep tendon reflexes are decreased bilaterally. The laboratory test results are as follows: Serum glucose (fasting) 140 mg/dL HbA1c 8.5% BUN 27 mg/dL Serum creatinine 1.3 mg/dL eGFR 55 mL/min The patient is prescribed the first-line drug recommended for his condition. Which of the following side effect is associated with this drug?? {'A': 'Iron deficiency anemia', 'B': 'Hypoglycemia', 'C': 'Lactic acidosis', 'D': 'Infections', 'E': 'Hyperkalemia'},
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C: Lactic acidosis
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Answer the following medical question with one of the provided options:
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Q:A 59-year-old man comes to the physician for evaluation of a progressively enlarging, 8-mm skin lesion on the right shoulder that developed 1 month ago. The patient has a light-skinned complexion and has had several dysplastic nevi removed in the past. A photograph of the lesion is shown. The lesion is most likely derived from cells that are also the embryological origin of which of the following tumors?? {'A': 'Neuroblastoma', 'B': 'Liposarcoma', 'C': 'Medullary thyroid cancer', 'D': 'Adrenal adenoma', 'E': 'Basal cell carcinoma'},
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A: Neuroblastoma
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Q:A 33-year-old woman comes to the physician because of a 14-hour history of left flank pain associated with dark urine. Her temperature is 37.2°C (99°F). The abdomen is soft with normal bowel sounds. There is guarding on the left lateral side and tenderness to palpation over the left costophrenic angle. An x-ray of the abdomen shows an 8-mm kidney stone. In addition to adequate hydration, which of the following diets should be advised for this patient?? {'A': 'High-oxalate diet', 'B': 'Vitamin C supplementation', 'C': 'Low-protein diet', 'D': 'Low-calcium diet', 'E': 'High-sodium diet'},
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C: Low-protein diet
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Q:A 35-year-old woman presents to her primary care physician for recurrent deep venous thrombosis (DVT) of her left lower extremity. She is a vegetarian and often struggles to maintain an adequate intake of non-animal based protein. She currently smokes 1 pack of cigarettes per day, drinks a glass of wine per day, and currently denies any illicit drug use, although she endorses a history of heroin use (injection). Her past medical history is significant for 4 prior admissions for lower extremity swelling and pain that resulted in diagnoses of deep venous thrombosis. Her vital signs include: temperature, 36.7°C (98.0°F); blood pressure, 126/74 mm Hg; heart rate, 87/min; and respiratory rate, 16/min. On physical examination, her pulses are bounding, the patent’s complexion is pale, breath sounds are clear, and heart sounds are normal. The spleen is mildly enlarged. She is admitted for DVT treatment and a full hypercoagulability workup. Which of the following is the best initial management for this patient?? {'A': 'Begin heparin', 'B': 'Begin heparin and warfarin', 'C': 'Begin warfarin, target INR 2.0–3.0', 'D': 'Begin warfarin, target INR 2.5–3.5', 'E': 'Consult IR for IVC filter placement'},
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B: Begin heparin and warfarin
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Answer the following medical question with one of the provided options:
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Q:A 10-year-old woman presents to the clinic, with her mother, complaining of a circular, itchy rash on her scalp for the past 3 weeks. Her mother is also worried about her hair loss. The girl has a past medical history significant for asthma. She needs to use her albuterol inhaler once per week on average. Her blood pressure is 112/70 mm Hg; the heart rate is 104/min; the respiratory rate is 20/min, and the temperature is 37.0°C (98.6°F). On exam, the patient is alert and interactive. Her lungs are clear on bilateral auscultation. On palpation, a tender posterior cervical node is present on the right side. Examination of the head is shown in the image. Which of the following is the best treatment option for the patient?? {'A': 'Subcutaneous triamcinolone', 'B': 'Ketoconazole shampoo', 'C': 'Oral doxycycline', 'D': 'Oral terbinafine', 'E': 'Topical betamethasone'},
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D: Oral terbinafine
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Answer the following medical question with one of the provided options:
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Q:A 66-year-old man is brought to the emergency department by his daughter because of 3 days of fever, chills, cough, and shortness of breath. The cough is productive of yellow sputum. His symptoms have not improved with rest and guaifenesin. His past medical history is significant for hypertension, for which he takes hydrochlorothiazide. He has a 30-pack-year history of smoking. His temperature is 38.9 C (102.0 F), blood pressure 88/56 mm Hg, and heart rate 105/min. Following resuscitation with normal saline, his blood pressure improves to 110/70 mm Hg. His arterial blood gas is as follows: Blood pH 7.52, PaO2 74 mm Hg, PaCO2 28 mm Hg, and HCO3- 21 mEq/L. Which of the following acid-base disturbances best characterizes this patient's condition?? {'A': 'Normal acid-base status', 'B': 'Metabolic acidosis', 'C': 'Metabolic alkalosis', 'D': 'Respiratory acidosis', 'E': 'Respiratory alkalosis'},
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E: Respiratory alkalosis
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Answer the following medical question with one of the provided options:
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Q:A 59-year-old patient presented to his family physician 8 years ago with initial complaints of increasing generalized stiffness with trouble initiating movement and worsening micrographia. He was started on levodopa after further evaluation led to a suspected diagnosis of Parkinson's disease; however, this therapy ultimately failed to improve the patient's symptoms. Additionally, over the ensuing 8 years since his initial presentation, the patient also developed symptoms including worsening balance, orthostatic hypotension, urinary incontinence, and impotence. The patient's overall condition deteriorated ever since this initial diagnosis with increasing disability from his motor symptoms, and he recently passed away at the age of 67, 8 years after his first presentation to his physician. The family requests an autopsy. Which of the following would be expected on autopsy evaluation of this patient's brain tissue?? {'A': 'Astrocytosis and caudate atrophy', 'B': 'Glial cytoplasmic inclusions', 'C': 'Round intracellular tau protein aggregates', 'D': 'Beta-amyloid plaques', 'E': 'Periventricular white matter plaques'},
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B: Glial cytoplasmic inclusions
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Q:A newborn girl is delivered vaginally at term to a healthy 25-year-old G1P1. The pregnancy was uncomplicated. On examination, she was found to have a slight anal invagination, but no opening. Further examination shows a vestibular fistula and normally developed external genitalia. Which of the following statements about this condition is correct?? {'A': 'Such abnormal anatomy is formed after week 12 of intrauterine development.', 'B': 'The presence of an associated perineal or vestibular fistula is more likely in females with trisomy 21.', 'C': 'There is a failure of the division of the embryonic cloaca into the urogenital sinus and rectoanal canal.', 'D': 'There is a failure of the invagination and rupture of the dorsal portion of the cloacal membrane.', 'E': 'Other congenital abnormalities are extremely rare in patients with this condition.'},
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D: There is a failure of the invagination and rupture of the dorsal portion of the cloacal membrane.
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Q:A 71-year-old man comes to the physician because of decreased sexual performance for the past 2 years. He reports that it takes longer for his penis to become erect, and he cannot maintain an erection for as long as before. His ejaculations have become less forceful. Once he has achieved an orgasm, he requires several hours before he can have another orgasm. He has been happily married for 40 years and he has no marital conflicts. His only medication is esomeprazole for gastroesophageal reflux disease. Examination shows coarse dark pubic and axillary hair. The skin of his lower extremity is warm to the touch; pedal pulses and sensation are intact. Rectal examination shows a symmetrically enlarged prostate with no masses. His fasting serum glucose is 96 mg/dL and his prostate-specific antigen is 3.9 ng/mL (N < 4). Which of the following etiologies is the most likely cause of the patient's symptoms?? {'A': 'Vascular', 'B': 'Psychogenic', 'C': 'Neoplastic', 'D': 'Neurogenic', 'E': 'Physiologic'},
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E: Physiologic
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Answer the following medical question with one of the provided options:
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Q:A 33-year-old man comes to the otolaryngologist for the evaluation of a 6-month history of difficulty breathing through his nose and clear nasal discharge. He has a history of seasonal atopic rhinosinusitis. Anterior rhinoscopy shows a nasal polyp obstructing the superior nasal meatus. A CT scan of the head is most likely to show opacification of which of the following structures?? {'A': 'Pterygopalatine fossa and middle ethmoidal sinus', 'B': 'Maxillary sinus and anterior ethmoidal sinus', 'C': 'Sphenoidal sinus and posterior ethmoidal sinuses', 'D': 'Nasolacrimal duct and eustachian tube', 'E': 'Frontal sinus and anterior ethmoidal sinus'},
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C: Sphenoidal sinus and posterior ethmoidal sinuses
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Q:A 21-year-old man presents to a physician with repeated episodes of syncope and dizziness over the last month. On physical examination, his pulse is 64/min while all other vital signs are normal. His 24-hour ECG monitoring suggests a diagnosis of sinus node dysfunction. His detailed genetic evaluation shows that he carries a copy of a mutated gene “X” that codes for an ion channel, which is the most important ion channel underlying the automaticity of the sinoatrial node. This is the first ion channel to be activated immediately after hyperpolarization. Which of the following ion channels does the gene “X” code for?? {'A': 'HCN-channels', 'B': 'L-type voltage-dependent calcium channels', 'C': 'T-type voltage-dependent calcium channels', 'D': 'Fast delayed rectifier (IKr) voltage-dependent K+ channels', 'E': 'Stretch-activated cationic channels'},
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A: HCN-channels
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Q:A 25-year-old man presents the office for a 3-day history of fever and fatigue. Upon further questioning, he says that he also had constant muscular pain, headaches, and fever during these days. He adds additional information by giving a history of regular unprotected sexual relationship with multiple partners. He is a non-smoker and drinks alcohol occasionally. The heart rate is 102/min, respiratory rate is 18/min, temperature is 38.0°C (100.4°F), and blood pressure is 120/80 mm Hg. On physical examination, he is icteric and hepatosplenomegaly is evident with diffuse muscular and abdominal tenderness particularly in the right upper quadrant. The serologic markers show the following pattern: Anti-HAV IgM negative HBsAg positive Anti-HBs negative IgM anti-HBc positive Anti-HCV negative Anti-HDV negative What is the most likely diagnosis?? {'A': 'Viral hepatitis D', 'B': 'Viral hepatitis A', 'C': 'Viral hepatitis E', 'D': 'Viral hepatitis C', 'E': 'Viral hepatitis B'},
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E: Viral hepatitis B
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Q:After a year of trying to conceive, a young couple in their early twenties decided to try in vitro fertilization. During preliminary testing of fertility, it was found that the male partner had dysfunctional sperm. Past medical history revealed that he had frequent sinus and lung infections throughout his life. The physician noted an abnormal exam finding on palpation of the right fifth intercostal space at the midclavicular line. What would be the most likely diagnosis responsible for this patient's infertility?? {'A': 'Chédiak-Higashi syndrome', 'B': 'Williams syndrome', 'C': 'Cystic fibrosis', 'D': 'Adenosine deaminase deficiency', 'E': 'Kartagener syndrome'},
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E: Kartagener syndrome
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Answer the following medical question with one of the provided options:
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Q:A 62-year-old man presents to the office because of painless rectal bleeding for the past 3 months. He describes intermittent streaks of bright red blood on the toilet paper after wiping and blood on but not mixed within the stool. Occasionally, he has noted a small volume of blood within the toilet bowl, and he associates this with straining. For the past 2 weeks, he has noticed an 'uncomfortable lump' in his anus when defecating, which goes away by itself immediately afterwards. He says he has no abdominal pain, weight loss, or fevers. He is a well-appearing man that is slightly obese. Digital rectal examination shows bright red blood on the examination glove following the procedure. Anoscopy shows enlarged blood vessels above the pectinate line. Which of the following is the most likely cause?? {'A': 'Grade 1 external hemorrhoids', 'B': 'Grade 1 internal hemorrhoids', 'C': 'Grade 2 external hemorrhoids', 'D': 'Grade 2 internal hemorrhoids', 'E': 'Grade 3 external hemorrhoids'},
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D: Grade 2 internal hemorrhoids
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Answer the following medical question with one of the provided options:
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Q:A 2755-g (6-lb 1-oz) baby boy is delivered at 37 weeks' gestation to a 29-year-old woman who is gravida 3, para 3. His mother received no prenatal care during her pregnancy. 12 hours after birth, he is evaluated for jaundice and lethargy. Laboratory studies show a hemoglobin concentration of 9.6 g/dL and a serum total bilirubin concentration of 10 mg/dL. The results of a direct Coombs test are positive. Further evaluation is most likely to show which of the following?? {'A': 'Hyposthenuria', 'B': 'Positive eosin-5-maleimide binding test', 'C': 'Petechial rash', 'D': 'Hepatosplenomegaly', 'E': 'Elevated urinary coproporphyrins'},
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D: Hepatosplenomegaly
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Answer the following medical question with one of the provided options:
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Q:A 45-year-old woman presents to her primary care provider complaining of daytime drowsiness and fatigue. She reports that she can manage at most a couple of hours of work before needing a nap. She has also noted impaired memory and a 6.8 kg (15 lb) weight gain. She denies shortness of breath, chest pain, lightheadedness, or blood in her stool. At the doctor’s office, the vital signs include: pulse 58/min, blood pressure 104/68 mm Hg, and oxygen saturation 99% on room air. The physical exam is notable only for slightly dry skin. The complete blood count (CBC) is within normal limits. Which of the following is a likely additional finding in this patient?? {'A': 'Anxiety', 'B': 'Hypercholesterolemia', 'C': 'Lid lag', 'D': 'Palpitations', 'E': 'Tremor'},
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B: Hypercholesterolemia
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Answer the following medical question with one of the provided options:
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Q:A 5-month-old male infant is brought to the physician by his mother because of a generalized pruritic rash for 2-weeks. The itchiness often causes the infant to wake up at night. He was strictly breastfed until 4 months of age, when he was transitioned to formula feeding. His father has a history of asthma. His immunizations are up-to-date. He is at the 75th percentile for length and the 70th percentile for weight. Examination shows dry and scaly patches on the face and extensor surfaces of the extremities. The groin is spared. Which of the following is the most appropriate next step in management?? {'A': 'Topical coal tar', 'B': 'Oral acyclovir', 'C': 'Oral vitamin A', 'D': 'Tar-containing shampoo', 'E': 'Topical emollient\n"'},
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E: Topical emollient "
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Answer the following medical question with one of the provided options:
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Q:A 74-year-old man is rushed to the emergency department with left-sided weakness, facial deviation, and slurred speech. His wife first noticed these changes about an hour ago. The patient is having difficulty communicating. He can answer questions by nodding his head, and his wife is providing detailed information. He denies fever, loss of consciousness, head injury, bleeding, or seizures. Past medical history is significant for diabetes mellitus, hypertension, hyperlipidemia, ischemic heart disease, chronic kidney disease, and osteoarthritis. He had a heart attack 6 weeks ago. Baseline creatinine is 2.5 mg/dL, and he is not on hemodialysis. Medications include aspirin, clopidogrel, metoprolol, ramipril, rosuvastatin, and insulin detemir. Blood pressure is 175/95 mm Hg and the heart rate is 121/min. Muscle strength is decreased in both the upper and lower extremities on the left-side. A forehead sparing left sided facial weakness is also appreciated. An ECG reveals atrial fibrillation. An urgent head CT shows a hypodense area in the right parietal cortex with no indication of hemorrhage. Treatment with tissue plasminogen activator (tPA) is deferred due to which condition?? {'A': 'Aspirin and clopidogrel use', 'B': 'Atrial fibrillation on electrocardiogram', 'C': 'Chronic kidney disease', 'D': 'History of myocardial infarction 6 weeks ago', 'E': 'Raised blood pressures'},
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D: History of myocardial infarction 6 weeks ago
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Answer the following medical question with one of the provided options:
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Q:A 59-year-old woman is brought to the emergency room after collapsing at home. She had been sitting on her couch reading, when she started feeling lightheaded and lost consciousness. According to her husband, she was unconscious for approximately 30 seconds. Since regaining consciousness, she has continued to be lightheaded and dizzy. She has not had palpitations. Her only medication is simvastatin for hyperlipidemia. Her pulse is 37/min, respirations are 18/min, and blood pressure is 92/50 mm Hg. Her ECG is shown. Which of the following is the most appropriate next step in management?? {'A': 'Administration of dopamine', 'B': 'Administration of atropine', 'C': 'Administration of norepinephrine', 'D': 'Administration of epinephrine', 'E': 'Transcutaneous pacemaker placement'},
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B: Administration of atropine
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Answer the following medical question with one of the provided options:
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Q:A 78-year-old man presents to the hospital because of shortness of breath and chest pain that started a few hours ago. 3 weeks ago he had surgery for a total hip replacement with a prosthesis. The patient was treated with prophylactic doses of low-weight heparin until he was discharged. He did not have a fever, expectoration, or any accompanying symptoms. He has a history of right leg deep vein thrombosis that occurred 5 years ago. His vital signs include: heart rate 110/min, respiratory rate 22/min, and blood pressure 150/90 mm Hg. There were no significant findings on the physical exam. Chest radiography was within normal limits. What is the most likely diagnosis?? {'A': 'Pneumothorax', 'B': 'Pneumonia', 'C': 'Myocardial infarction', 'D': 'Pulmonary thromboembolism', 'E': 'Exacerbation of chronic lung disease'},
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D: Pulmonary thromboembolism
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Answer the following medical question with one of the provided options:
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Q:A 41-year-old woman with a past medical history significant for asthma and seasonal allergies presents with a new rash. She has no significant past surgical, social, or family history. The patient's blood pressure is 131/90 mm Hg, the pulse is 77/min, the respiratory rate is 17/min, and the temperature is 36.9°C (98.5°F). Physical examination reveals a sharply demarcated area of skin dryness and erythema encircling her left wrist. Review of systems is otherwise negative. Which of the following is the most likely diagnosis?? {'A': 'Tinea corporis', 'B': 'Scabies', 'C': 'Atopic dermatitis', 'D': 'Psoriasis', 'E': 'Contact dermatitis'},
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E: Contact dermatitis
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Answer the following medical question with one of the provided options:
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Q:A 3-year-old male is brought to the pediatrician for a check-up. The patient has a history of recurrent ear infections and several episodes of pneumonia. His mother reports the presence of scaly skin lesions on the face and in the antecubital and popliteal fossa since the patient was 2 months old. Physical examination also reveals bruising of the lower extremities and petechiae distributed evenly over the boy's entire body. A complete blood count reveals normal values except for a decreased platelet count of 45,000/mL. Which of the following findings would be expected on follow-up laboratory work-up of this patient's condition?? {'A': 'Decreased CD18 expression on flow cytometry', 'B': 'Decreased CD43 expression on flow cytometry', 'C': 'Decreased CD8/CD4 ratio on flow cytometry', 'D': 'Increased IgM on quantitative immunoglobulin serology', 'E': 'Decreased IgE on quantitative immunoglobulin serology'},
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B: Decreased CD43 expression on flow cytometry
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