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Answer the following medical question with one of the provided options:
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Q:A 30-year-old man comes to the physician because of an episode of bloody vomiting this morning and a 1-week history of burning upper abdominal pain. Two weeks ago, he sustained a head injury and was in a coma for 3 days. An endoscopy shows multiple, shallow hemorrhagic lesions predominantly in the gastric fundus and greater curvature. Biopsies show patchy loss of epithelium and an acute inflammatory infiltrate in the lamina propria that does not extend beyond the muscularis mucosa. Which of the following is the most likely diagnosis?? {'A': 'Type B gastritis', 'B': 'Dieulafoy lesion', 'C': 'Cushing ulcer', 'D': 'Penetrating ulcer', 'E': 'Erosive gastritis'},
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E: Erosive gastritis
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Answer the following medical question with one of the provided options:
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Q:A 26-year-old medical student comes to the physician for a chest x-ray to rule out active pulmonary tuberculosis. He needs a medical and radiological report before starting a medical internship in South Africa. He has no history of serious illness and does not complain of any symptoms. He has smoked 1 pack of cigarettes daily for the past 6 years. He does not drink alcohol. He is 190 cm (6 ft 3 in) tall and weighs 75 kg (165 lbs); BMI is 20.8 kg/m2. His temperature is 37°C (98.6°F), pulse is 80/min, respirations are 18/min, and blood pressure is 128/89 mm Hg. The lungs are clear to auscultation. Cardiac examination shows no abnormalities. The x-ray of the chest shows a small pneumothorax (rim of < 2 cm) between the upper left lung margin and the chest wall. Which of the following is the most appropriate next step in management of this patient?? {'A': 'Emergent needle thoracostomy', 'B': 'Observation and follow-up x-ray', 'C': 'Immediate intubation and assisted ventilation', 'D': 'CT of the chest', 'E': 'Urgent chest tube placement'},
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B: Observation and follow-up x-ray
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Answer the following medical question with one of the provided options:
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Q:A 47-year-old woman presents to her physician for a routine checkup. She is in good health and has no complaints. Past medical history is significant for type 2 diabetes mellitus and obesity. She recently started metformin and is tolerating the mild side effects, but her fasting blood glucose levels range from 160–190 mg/dL. Today, her blood pressure is 125/82 mm Hg, the heart rate is 90/min, the respiratory rate is 17/min, and the temperature is 37.0°C (98.6°F). On physical exam, she appears well developed and obese. Her heart has a regular rate and rhythm and his lungs are clear to auscultation bilaterally. Her fasting glucose level is 175 mg/dL and her A1c is 7.1%. Her physician decides to add canagliflozin to her current treatment regimen. Which of the following should be evaluated before starting this medication?? {'A': 'γ-glutamyltransferase', 'B': 'β-hCG levels', 'C': 'Alanine aminotransferase', 'D': 'Serum creatinine', 'E': 'Atrial natriuretic peptide'},
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D: Serum creatinine
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Answer the following medical question with one of the provided options:
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Q:A 28-year-old primigravid woman comes to the emergency department because of a 12-hour history of lower abdominal pain and vaginal bleeding. She also had nausea and fatigue for the past 3 weeks. Her last menstrual period was 8 weeks ago. Prior to that, her menses occurred regularly at 30-day intervals and lasted for 4 days. There is no history of medical illness, and she takes no medications. Her temperature is 37°C (98.6°F), pulse is 95/min, and blood pressure is 100/70 mm Hg. Pelvic examination is painful and shows a uterus consistent in size with a 13-week gestation. A urine pregnancy test is positive. β-HCG level is 106,000 mIU/mL (N < 5 mIU/mL). Transvaginal ultrasonography shows unclear, amorphous fetal parts and a large placenta with multiple cystic spaces. Which of the following is the most likely cause of this patient's condition?? {'A': 'Placenta implantation into myometrium', 'B': 'Malignant transformation of trophoblastic tissue', 'C': 'Trophoblastic proliferation with chorionic villi distention', 'D': 'Malpositioned placenta overlying the cervix', 'E': 'Embryonic death with cervical dilation'},
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C: Trophoblastic proliferation with chorionic villi distention
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Answer the following medical question with one of the provided options:
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Q:A 28-year-old man presents with a 3-day history of cough and fever. He says that he recently became a factory worker in a huge plant that is involved in the polyvinyl chloride (PVC) polymerization process. Because he has heard about occupational diseases specifically related to this particular industry, he asks the physician whether his new job is associated with any serious conditions. His physician mentions that polyvinyl chloride is a known chemical carcinogen and that workers who have been exposed to it are known to be at increased risk of developing a particular type of cancer. Which of the following cancers is the physician most likely talking about?? {'A': 'Adenocarcinoma of the small intestine', 'B': 'Bronchogenic carcinoma', 'C': 'Hepatic angiosarcoma', 'D': 'Urothelial carcinoma', 'E': 'Malignant lymphoma'},
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C: Hepatic angiosarcoma
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Answer the following medical question with one of the provided options:
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Q:A previously healthy 29-year-old African-American male comes to the physician with a 2-week history of progressive fatigue and shortness of breath on exertion. Last week he noticed that his eyes were gradually turning yellow and his urine was dark. He has a family history of type II diabetes. He denies changes in urinary frequency, dysuria, or nocturia. His temperature is 37°C (98.6° F), blood pressure is 120/80 mmHg, and heart rate is 80/min. Examination shows pale conjunctivae, splenomegaly, and jaundice. There is no lymphadenopathy. Laboratory studies show: Hematocrit 19.5% Hemoglobin 6.5 g/dL WBC count 11,000/mm3 Platelet count 300,000/mm3 Reticulocyte count 8% Serum Total bilirubin 6 mg/dL Direct bilirubin 1.0 mg/dL Urea nitrogen 9 mg/dL Creatinine 1 mg/dL Lactate dehydrogenase 365 U/L Peripheral blood smear shows gross polychromasia with nucleated red blood cells and spherocytes. Direct Coombs' test is positive. Which of the following is the most likely diagnosis?"? {'A': 'Hereditary spherocytosis', 'B': 'Paroxysmal nocturnal hemoglobinuria', 'C': 'Alpha thalassemia', 'D': 'Spur cell hemolytic anemia', 'E': 'Autoimmune hemolytic anemia\n"'},
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E: Autoimmune hemolytic anemia "
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Answer the following medical question with one of the provided options:
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Q:A 25-year-old woman is admitted to the intensive care unit (ICU) with hematemesis and shock. Five days ago she had a severe fever 40.0℃ (104.0℉), retro-orbital pain, nausea, and myalgias. The high temperatures decreased over a few days, but she developed severe abdominal pain and bleeding gums. A single episode of hematemesis occurred prior to ICU admission. She travels to Latin America every winter. Two weeks ago, she traveled to Brazil and spent most of her time outdoors. She is restless. The temperature is 38.0℃ (100.4℉), the pulse is 110/min, the respiration rate is 33/min, and the blood pressure is 90/70 mm Hg. Conjunctival suffusion is seen. The extremities are cold. A maculopapular rash covers the trunk and extremities. Ecchymoses are observed on the lower extremities. The lung bases reveal absent sounds with dullness to percussion. The abdomen is distended. The liver edge is palpable and liver span is 15 cm. Shifting dullness is present. The laboratory studies show the following: Laboratory test Hemoglobin 16.5 g/dL Leukocyte count 3500/mm3 Segmented neutrophils 55% Lymphocytes 30% Platelet count 90,000/mm3 Serum Alanine aminotransferase (ALT) 75 U/L Aspartate aminotransferase (AST) 70 U/L Total bilirubin 0.8 mg/dL Direct bilirubin 0.2 mg/dL Which of the following is the most likely diagnosis?? {'A': 'Chikungunya virus infection', 'B': 'Dengue fever', 'C': 'Chagas disease', 'D': 'Yellow fever', 'E': 'Zika virus infection'},
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B: Dengue fever
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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 he vomited and said he was having double vision in school. He also says that he has been experiencing morning headaches, nausea, and dizziness over the last month. He has no past medical history and is not taking any medications. Physical exam reveals a broad-based gait, dysmetria on finger-to-nose testing, and nystagmus. Both serum and urine toxicology are negative, and radiography reveals a solid mass in the midline cerebellum that enhances after contrast administration. Biopsy of this lesion reveals cells of primitive neuroectodermal origin. Which of the following would most likely be seen on histology of this lesion?? {'A': 'Eosinophilic corkscrew fibers', 'B': 'Foamy cells and high vascularity', 'C': 'Perivascular pseudorosettes', 'D': 'Rosettes with small blue cells', 'E': 'Tooth enamel-like calcification'},
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D: Rosettes with small blue cells
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Answer the following medical question with one of the provided options:
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Q:A 16-year-old boy is brought to the emergency department following a car accident in which he suffered multiple injuries. He is accompanied by his mother. She reports that his medical history is notable only for recurrent sinusitis and otitis as a child. He lost a significant amount of blood from the accident, and he is transfused two units of O-negative blood on arrival at the emergency department. Shortly thereafter, he complains of itching and increasing shortness of breath. He develops stridor. Which of the following could have prevented this reaction?? {'A': 'Pre-transfusion acetaminophen', 'B': 'Pre-transfusion diphenhydramine', 'C': 'Administering type-specific blood', 'D': 'Administering IVIG with transfusion', 'E': 'Administering washed blood products'},
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E: Administering washed blood products
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Answer the following medical question with one of the provided options:
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Q:Three hours after undergoing a total right hip replacement, a 71-year-old woman has tingling around the lips and numbness in her fingertips. Her surgery was complicated by unintentional laceration of the right femoral artery that resulted in profuse bleeding. She appears uncomfortable. Examination shows an adducted thumb, extended fingers, and flexed metacarpophalangeal joints and wrists. Tapping on the cheeks leads to contraction of the facial muscles. Which of the following is the most likely cause of this patient's symptoms?? {'A': 'Acute kidney injury', 'B': 'Calcium chelation', 'C': 'Intravascular hemolysis', 'D': 'Parathyroid ischemia', 'E': 'Metabolic acidosis'},
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B: Calcium chelation
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Answer the following medical question with one of the provided options:
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Q:A 34-year-old man presents to the office for evaluation of a lesion on his upper arm that appeared a few months ago and has not healed. A patient appears healthful but has a history of cardiovascular disease. He states that his friend at the industrial ammunition factory where he works told him he should “get it looked at.” The patient admits to some nausea, vomiting, and diarrhea over the past year, but he states that he “feels fine now.” On physical examination, the lesion is an erythematous, scaly, ulcerated plaque on the flexor surface of his upper arm. The rest of the exam is within normal limits. What is the most likely diagnosis?? {'A': 'Squamous cell carcinoma (SCC)', 'B': 'Actinic keratosis', 'C': 'Erysipelas', 'D': 'Contact dermatitis', 'E': 'Erythema multiforme'},
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A: Squamous cell carcinoma (SCC)
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Answer the following medical question with one of the provided options:
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Q:A 30-year-old man is brought to the emergency department with complaints of fevers to 39.0℃ (102.2℉) and diarrhea for the past 12 hours. There is no history of headaches, vomiting, or loss of consciousness. The past medical history is unobtainable because the patient recently immigrated from abroad and has a language barrier, but his wife says that her husband had a motor vehicle accident when he was a teenager that required emergent surgery. He is transferred to the ICU after a few hours in the ED due to dyspnea, cyanosis, and hemodynamic collapse. There are no signs of a meningeal infection. The blood pressure is 70/30 mm Hg at the time of transfer. A chest X-ray at the time of admission shows interstitial infiltrates without homogeneous opacities. The initial laboratory results reveal metabolic acidosis, leukopenia with a count of 2000/mm3, thrombocytopenia (15,000/mm3), and a coagulation profile suggesting disseminated intravascular coagulation. A peripheral smear is performed as shown in the accompanying image. Despite ventilatory support, administration of intravenous fluids, antibiotics, and vasopressor agents, the patient dies the next day. The gram stain from the autopsy specimen of his lungs reveals gram-positive, lancet-shaped diplococci occurring singly and in chains. Which of the following organisms is the most likely cause for the patient’s condition?? {'A': 'Staphylococcus aureus', 'B': 'Streptococcus pyogene', 'C': 'Streptococcus pneumoniae', 'D': 'Neisseria meningitidis', 'E': 'Non-typeable H. influenzae'},
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C: Streptococcus pneumoniae
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Answer the following medical question with one of the provided options:
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Q:A 79-year-old woman is brought to the emergency department by her husband 20 minutes after losing consciousness. She was walking briskly with her husband when she collapsed suddenly. Her husband says that she regained consciousness after 1 minute. She has had episodes of mild chest pain for the past 2 months, especially when working in the garden. Physical examination shows a grade 3/6 systolic ejection murmur. The intensity of the murmur decreases with the handgrip maneuver and does not change with inspiration. Which of the following is the most likely cause of this patient's symptoms?? {'A': 'Cystic medial degeneration of the aortic root', 'B': 'Sterile platelet thrombi on the mitral valve', 'C': 'Infected fibrin aggregates on the tricuspid valve', 'D': 'Dystrophic calcification on the aortic valve', 'E': 'Granulomatous nodules on the mitral valve'},
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D: Dystrophic calcification on the aortic valve
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Answer the following medical question with one of the provided options:
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Q:A researcher is studying receptors that respond to epinephrine in the body and discovers a particular subset that is expressed in presynaptic adrenergic nerve terminals. She discovers that upon activation, these receptors will lead to decreased sympathetic nervous system activity. She then studies the intracellular second messenger changes that occur when this receptor is activated. She records these changes and begins searching for analogous receptor pathways. Which of the following receptors would cause the most similar set of intracellular second messenger changes?? {'A': 'Aldosterone receptors in the kidney', 'B': 'Dopamine receptors in the brain', 'C': 'Growth hormone receptors in the musculoskeletal system', 'D': 'Muscarinic cholinoreceptors in the gastrointestinal tract', 'E': 'Vasopressin receptors in the kidney'},
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B: Dopamine receptors in the brain
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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 emergency department because of a dry mouth and blurred vision for the past 30 minutes. Prior to this, he was on a road trip and started to feel nauseous, dizzy, and fatigued, so his friend gave him a drug that had helped in the past. Physical examination shows dry mucous membranes and dilated pupils. The remainder of the examination shows no abnormalities. Administration of which of the following drugs is most likely to cause a similar adverse reaction in this patient?? {'A': 'Oxycodone', 'B': 'Oxybutynin', 'C': 'Pilocarpine', 'D': 'Phenylephrine', 'E': 'Loratadine'},
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B: Oxybutynin
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Answer the following medical question with one of the provided options:
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Q:An inconsolable mother brings her 2-year-old son to the emergency room after finding a large amount of bright red blood in his diaper, an hour ago. She states that for the past week her son has been having crying fits while curling his legs towards his chest in a fetal position. His crying resolves either after vomiting or passing fecal material. Currently, the child is in no apparent distress. Physical examination with palpation in the gastric region demonstrates no acute findings. X-ray of the abdominal area demonstrates no acute findings. His current temperature is 36.5°C (97.8°F), heart rate is 93/min, blood pressure is 100/64 mm Hg, and respiratory rate is 26/min. His weight is 10.8 kg (24.0 lb), and height is 88.9 cm (35.0 in). Laboratory tests show the following: RBC count 5 million/mm3 Hematocrit 36% Hemoglobin 12 g/dL WBC count 6,000/mm3 Mean corpuscular volume 78 fL What is the most likely cause of this condition?? {'A': 'Failure of the vitelline duct to open', 'B': 'Failure of the vitelline duct to close', 'C': 'Problem with bilirubin conjugation', 'D': 'Problem with bilirubin uptake', 'E': 'Elevated anti-mitochondrial uptake'},
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B: Failure of the vitelline duct to close
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Answer the following medical question with one of the provided options:
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Q:A 25-year-old man is brought to the emergency department by police for abnormal behavior in a mini-market. The patient was found passed out in the aisle, and police were unable to arouse him. The patient has a past medical history of alcohol abuse and is not currently taking any medications according to his medical records. His temperature is 99.5°F (37.5°C), blood pressure is 120/87 mmHg, pulse is 50/min, respirations are 5/min, and oxygen saturation is 93% on room air. On physical exam, the patient is minimally responsive. He responds to painful stimuli by retracting his limbs and groaning, but otherwise does not answer questions or obey commands. Which of the following is most likely to be found in this patient?? {'A': 'Conjunctival hyperemia', 'B': 'Hyperactive bowel sounds', 'C': 'Miosis', 'D': 'Mydriasis', 'E': 'Visual hallucinations'},
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C: Miosis
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Answer the following medical question with one of the provided options:
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Q:An 8-year-old boy with asthma is brought to the physician because of a 2-week history of facial pain and congestion. His mother states that the nasal discharge was initially clear, but it has become thicker and more purulent over the last week. He has tried multiple over-the-counter oral decongestants and antihistamines, with minimal relief. Current medications include cetirizine, intranasal oxymetazoline, and albuterol. His temperature is 37.7°C (99.8°F), pulse is 100/min, respirations are 14/min, and blood pressure is 110/70 mm Hg. Examination shows congested nasal mucosa with purulent discharge from the nares bilaterally. There is tenderness to palpation over the cheeks, with no transillumination over the maxillary sinuses. Which of the following is the most likely predisposing factor for this patient's current condition?? {'A': 'Nasal polyps', 'B': 'Viral upper respiratory tract infection', 'C': 'Asthma', 'D': 'Foreign body', 'E': 'Recent use of antihistamines\n"'},
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B: Viral upper respiratory tract infection
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Answer the following medical question with one of the provided options:
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Q:A 76-year-old woman is brought to the physician because of lesions on her left arm. She first noticed them 3 months ago and they have grown larger since that time. She has not had any pain or pruritus in the area. She has a history of invasive ductal carcinoma of the left breast, which was treated with mastectomy and radiation therapy 27 years ago. Since that time, she has had lymphedema of the left arm. Physical examination shows extensive edema of the left arm. There are four coalescing, firm, purple-blue nodules on the left lateral axillary region and swelling of the surrounding skin. Which of the following is the most likely diagnosis?? {'A': 'Cellulitis', 'B': 'Thrombophlebitis', 'C': 'Angiosarcoma', 'D': 'Melanoma', 'E': 'Kaposi sarcoma'},
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C: Angiosarcoma
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Answer the following medical question with one of the provided options:
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Q:A 39-year-old female presents to the clinic with the complaints of dry skin for a few months. She adds that she also has constipation for which she started eating vegetables and fruits but with no improvement. She lives with her husband and children who often complain when she turns the air conditioning to high as she cannot tolerate low temperatures. She has gained 5 kgs (11.2 lb) since her last visit 2 months back although her diet has not changed much. Her past medical history is relevant for cardiac arrhythmias and diabetes. She is on several medications currently. Her temperature is 98.6° F (37° C), respirations are 15/min, pulse is 57/min and blood pressure is 132/98 mm Hg. A physical examination is within normal limits. Thyroid function test results are given below: Serum TSH: 13.0 μU/mL Thyroxine (T4): 3.0 μg/dL Triiodothyronine (T3): 100 ng/dL Which of the following medications is most likely to be responsible for her symptoms?? {'A': 'Digoxin', 'B': 'Amiodarone', 'C': 'Metformin', 'D': 'Theophylline', 'E': 'Warfarin'},
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B: Amiodarone
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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 with a past medical history of previous myocardial infarction, angina, hypertension, hyperlipidemia, diabetes mellitus, peripheral vascular disease, and below knee amputation has developed new chest pain. His medication includes insulin, hydrochlorothiazide, lisinopril, metoprolol, daily aspirin, atorvastatin, and nitroglycerin as needed. His vitals include: blood pressure 135/87 mm Hg, pulse 52/min, and respirations 17/min. Coronary arteriography shows a reduced ejection fraction, a 65% stenosis of the left anterior descending artery, and a 75% stenosis of the left circumflex artery. Which of the following is the recommended treatment for the patient?? {'A': 'Coronary artery bypass grafting (CABG)', 'B': 'Heparin', 'C': 'Increased beta blocker dosage', 'D': 'Extended release nitrate therapy', 'E': 'Angioplasty with stent placement'},
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A: Coronary artery bypass grafting (CABG)
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Answer the following medical question with one of the provided options:
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Q:A newborn infant is born at 41 weeks gestation to a healthy G1P0 mother. The delivery was complicated by shoulder dystocia. The infant is in the 89th and 92th percentiles for height and weight, respectively. The mother's past medical history is notable for diabetes mellitus and obesity. Immediately after birth, the child's temperature is 99°F (37.2°C), blood pressure is 90/50 mmHg, pulse is 120/min, and respirations are 24/min. The child demonstrates a strong cry and pink upper and lower extremities bilaterally. The left arm is adducted and internally rotated at the shoulder and extended at the elbow. Extension at the elbow and flexion and extension of the wrist appear to be intact in the left upper extremity. The right upper extremity appears to have normal strength and range of motion in all planes. Which of the following sets of nerves or nerve roots is most likely affected in this patient?? {'A': 'Axillary nerve only', 'B': 'C5 and C6 nerve roots', 'C': 'C5, C6, and C7 nerve roots', 'D': 'Musculocutaneous nerve only', 'E': 'Suprascapular nerve only'},
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B: C5 and C6 nerve roots
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Answer the following medical question with one of the provided options:
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Q:Activation of the renin-angiotensin-aldosterone system yields a significant physiological effect on renal blood flow and filtration. Which of the following is most likely to occur in response to increased levels of Angiotensin-II?? {'A': 'Increased renal plasma flow, decreased filtration fraction', 'B': 'Increased renal plasma flow, increased filtration fraction', 'C': 'Decreased renal plasma flow, decreased filtration fraction', 'D': 'Decreased renal plasma flow, increased filtration fraction', 'E': 'Decreased renal plasma flow, increased glomerular capillary oncotic pressure'},
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D: Decreased renal plasma flow, increased filtration fraction
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Answer the following medical question with one of the provided options:
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Q:A 57-year-old woman presents to her family physician because of sinusitis and nasal drainage for 3 months. The nasal drainage is purulent and occasionally hemorrhagic. She has only temporary improvement after trying multiple over the counter medications. Over the last 2 weeks, she also has fatigue and joint pain, mainly affecting the ankles, knees, and wrists. Vital signs include: temperature 36.9°C (98.4°F), blood pressure 142/91 mm Hg, and pulse 82/min. On examination, there is inflammation and bleeding of the nasal mucosa, along with tenderness to percussion over the maxillary sinuses. Urine dipstick reveals 4+ microscopic hematuria and 2+ proteinuria. Which of the following is the most likely diagnosis?? {'A': 'Polyarteritis nodosa', 'B': 'Churg-Strauss syndrome', 'C': 'Granulomatosis with polyangiitis', 'D': 'Immunoglobulin A nephropathy', 'E': 'Sarcoidosis'},
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C: Granulomatosis with polyangiitis
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Answer the following medical question with one of the provided options:
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Q:A 64-year-old male presents to the emergency room complaining of chest pain. He reports a pressure-like sensation over his sternum that radiates into his jaw. The pain came on suddenly 2 hours ago and has been constant since then. His past medical history is notable for a stable abdominal aortic aneurysm, hypertension, diabetes, and hyperlipidemia. He takes aspirin, enalapril, spironolactone, atorvastatin, canagliflozin, and metformin. His temperature is 99.1°F (37.3°C), blood pressure is 155/85 mmHg, pulse is 115/min, and respirations are 22/min. On exam, he is diaphoretic and in moderate distress. He is admitted for further management and does well after initial stabilization. He is seen two days later by the admitting team. This patient is at increased risk for a complication that is characterized by which of the following?? {'A': 'Friction rub', 'B': 'Cardiac tamponade', 'C': 'Intra-cardiac shunt', 'D': 'Mitral insufficiency', 'E': 'Ventricular fibrillation'},
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A: Friction rub
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Answer the following medical question with one of the provided options:
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Q:A 69-year-old woman is rushed to the emergency room by her daughter after she found her unconscious. Bruises are visible on the patient’s torso and limbs, and it is evident that she has epistaxis. Her daughter says that the patient was diagnosed with immune thrombocytopenic purpura at 61 years of age and has not had a normal thrombocyte count since the time of diagnosis. She was treated with corticosteroids, which were discontinued several weeks ago. Her current platelet count is 4,000/mm3. Which of the following is the best next step in the treatment of this patient?? {'A': 'Splenectomy', 'B': 'Platelet transfusion', 'C': 'Administration of intravenous immunoglobulins', 'D': 'Continuation of corticosteroids', 'E': 'Stem cell transplantation'},
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C: Administration of intravenous immunoglobulins
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Answer the following medical question with one of the provided options:
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Q:A 9-year-old girl is admitted to the hospital with a one-day history of acute abdominal pain and vomiting. She also has a two-day history of fever, headache, and neck pain. Her immunizations are up-to-date. She is confused and oriented only to place and person. Her temperature is 39.7°C (103.5°F), pulse is 148/min, blood pressure is 90/50 mm Hg, and respiratory rate is 28/min. Cervical range of motion is limited by pain. The remainder of the neurologic examination shows no abnormalities. Laboratory studies show: Hemoglobin 10.9 g/dL Leukocyte count 44,000/mm3 Serum pH 7.33 Na+ 130 mEq/L Cl- 108 mEq/L K+ 6.1 mEq/L HCO3- 20 mEq/L Urea nitrogen 34 mg/dL Glucose 180 mg/dL Creatinine 2.4 mg/dL Urine ketones negative A CT scan of the head shows enhancement of the arachnoid and pia mater. Cerebrospinal fluid analysis shows a leukocyte count of 3,400/μL (90% neutrophils), a glucose concentration of 50 mg/dL, protein concentration of 81 mg/dL, and no erythrocytes. Gram stain of the CSF shows gram-negative diplococci. This patient is at increased risk for which of the following complications?"? {'A': 'Pancreatitis', 'B': 'Adrenal hemorrhage', 'C': 'Vesicular skin eruptions', 'D': 'Temporal lobe inflammation', 'E': 'Deep neck abscess'},
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B: Adrenal hemorrhage
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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 comes to the physician because of a 6-month history of muscle stiffness, myalgia, and a 7-kg (15-lb) weight gain. Her last menstrual period was 4 months ago. Physical examination shows cold, dry skin, and proximal muscle weakness. Deep tendon reflexes are 2+ bilaterally, with delayed relaxation. The creatine kinase level is 2,940 U/L. Which of the following is the most appropriate next step in diagnosis?? {'A': 'Thyroid function tests', 'B': 'Serum assay for muscle specific tyrosine kinase antibody', 'C': 'Muscle biopsy', 'D': 'Serum electrolytes', 'E': 'Repetitive nerve stimulation'},
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A: Thyroid function tests
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Answer the following medical question with one of the provided options:
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Q:A 73-year-old man presents to the emergency department with acute substernal chest pain that began a few hours ago. The pain is described as a “pressure” that radiates to his left arm. His past medical history is significant for hypertension and hyperlipidemia. He is on chlorthalidone for his hypertension and simvastatin for hyperlipidemia. He has a 30 pack-year history of smoking and drinks 1-2 beers on weekends. His EKG shows ST depressions in the anterior precordial leads and he is given the proper medications and sent for emergency revascularization. Seven days later, he develops dyspnea that worsens in the supine position. Bibasilar crackles are heard on pulmonary auscultation. Cardiac exam reveals a new 3/6 holosystolic murmur best heard at the left sternal border. What is the most likely etiology of this patient’s new symptoms?? {'A': 'Aortic stenosis', 'B': 'Ventricular wall aneurysm', 'C': 'Restrictive pericarditis', 'D': 'Papillary muscle rupture', 'E': 'Arrhythmia'},
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D: Papillary muscle rupture
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Answer the following medical question with one of the provided options:
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Q:A 31-year-old woman is brought to the emergency department for a severe throbbing headache, nausea, and photophobia for 3 hours. She has severe occipital pain and chest tightness. Prior to onset of symptoms, she had attended a networking event where she had red wine and, shortly after, a snack consisting of salami and some dried fruits. The patient has recurrent migraine headaches and depression, for which she takes medication daily. She is mildly distressed, diaphoretic, and her face is flushed. Her temperature is 37.0°C (98.6 F), pulse is 90/min, respirations are 20/min, and blood pressure is 195/130 mmHg. She is alert and oriented. Deep-tendon reflexes are 2+ bilaterally. This patient's symptoms are most likely caused by a side effect of which of the following medications?? {'A': 'Ibuprofen', 'B': 'Verapamil', 'C': 'Phenelzine', 'D': 'Topiramate', 'E': 'Valproic acid'},
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C: Phenelzine
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Answer the following medical question with one of the provided options:
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Q:A group of scientists is verifying previous research on DNA replication. The diagram below illustrates the theoretical DNA replication process in bacteria such as E. coli. Which of the following enzymes would need to be decreased to prevent the removal of RNA primers formed in the lagging strand?? {'A': 'Helicase', 'B': 'DNA polymerase I 3’ to 5’ exonuclease activity', 'C': 'DNA polymerase III 3’ to 5’ exonuclease activity', 'D': 'DNA polymerase I 5’ to 3’ exonuclease activity', 'E': 'DNA ligase'},
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D: DNA polymerase I 5’ to 3’ exonuclease activity
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Answer the following medical question with one of the provided options:
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Q:A 58-year-old man is brought to the emergency department by his family because of severe upper back pain, which he describes as ripping. The pain started suddenly 1 hour ago while he was watching television. He has hypertension for 13 years, but he is not compliant with his medications. He denies the use of nicotine, alcohol or illicit drugs. His temperature is 36.5°C (97.7°F), the heart rate is 110/min and the blood pressure is 182/81 mm Hg in the right arm and 155/71 mm Hg in the left arm. CT scan of the chest shows an intimal flap limited to the descending aorta. Intravenous opioid analgesia is started. Which of the following is the best next step in the management of this patient condition?? {'A': 'Emergency surgical intervention', 'B': 'Oral metoprolol and/or enalapril', 'C': 'Sublingual nitroglycerin', 'D': 'Intravascular ultrasound', 'E': 'Intravenous esmolol'},
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E: Intravenous esmolol
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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 comes to the physician because of several episodes of painless bloody urine over the past 6 months. The episodes are not related to physical activity. He has had frequent nosebleeds since early childhood and an episode of heavy bleeding after a tooth extraction one year ago. He smokes one pack of cigarettes daily. He drinks 1 to 2 beers on social occasions. He appears pale. His vital signs are within normal limits. Physical examination shows several small hematomas in different stages of healing over his arms and legs. Examination of the extremities shows decreased passive range of motion with crepitus in both ankles. His abdomen is soft and nontender. Laboratory studies show: Hemoglobin 9.5 mg/dL Leukocyte count 5000/mm3 Platelet count 240,000/mm3 Bleeding time 5 minutes Prothrombin time 14 seconds Partial thromboplastin time 68 seconds Urine RBC 30–40/hpf RBC casts negative WBC none Protein negative An x-ray of the pelvis shows no abnormalities. Further evaluation of this patient is most likely to show which of the following findings?"? {'A': 'Evasive behavior when asked about the hematomas', 'B': 'Palpable spleen below the left costal margin', 'C': 'Nephrolithiasis', 'D': 'Intraarticular iron deposition', 'E': 'Hemosiderin-laden alveolar macrophages\n"'},
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D: Intraarticular iron deposition
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Q:A 45-year-old man comes to the physician because of a 3-week history of progressive diarrhea and a 2.2-kg (5-lb) weight loss. During the past week, he has had six small bloody stools daily. He is employed as a sales manager and regularly flies to South America. He has HIV, gastroesophageal reflux disease, and hypertension. Current medications include chlorthalidone, omeprazole, emtricitabine, tenofovir, and efavirenz. He reports taking efavirenz irregularly. He is 175 cm (5 ft 9 in) tall and weighs 64 kg (143 lb); BMI is 22 kg/m2. His temperature is 38.1°C (100.6°F), pulse is 91/min, and blood pressure is 116/69 mm Hg. The abdomen is scaphoid. Bowel sounds are normal. His CD4+ T-lymphocyte count is 44/mm3 (N ≥ 500), leukocyte count is 6,000/mm3, and erythrocyte sedimentation rate is 12 mm/h. Colonoscopy shows areas of inflammation scattered throughout the colon with friability, granularity, and shallow linear ulcerations. The intervening mucosa between areas of inflammation appears normal. A biopsy specimen is shown. Which of the following is the most likely cause of this patient's symptoms?? {'A': 'Cytomegalovirus', 'B': 'Hepatitis A virus', 'C': 'Adverse effect of medications', 'D': 'Cryptosporidium parvum', 'E': 'Clostridioides difficile'},
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A: Cytomegalovirus
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Q:A 43-year-old female presents to her primary care physician complaining of a gradually enlarging neck mass. She reports that she first developed a firm nodular midline mass on the anterior aspect of her neck two months ago. She is otherwise healthy and takes no medications. A fine-needle aspiration is performed and a histological sample of the specimen is shown. Which of the following is the most likely diagnosis?? {'A': 'Medullary thyroid carcinoma', 'B': 'Follicular thyroid carcinoma', 'C': 'Papillary thyroid carcinoma', 'D': 'B-cell lymphoma', 'E': 'Anaplastic thyroid carcinoma'},
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C: Papillary thyroid carcinoma
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Q:A 25-year-old G1P0 female of Middle Eastern descent gives birth to a male infant at 38 weeks’ gestation. The child is in the 15th percentile for both height and weight. Over the course of the first six months of the child’s life, he develops multiple severe skin and mucosal infections characterized by dramatically elevated white blood cell counts. The patient also demonstrates mental retardation soon after birth. A thorough hematologic analysis via flow cytometry reveals that the child's neutrophils that lack Sialyl-Lewis X. Which of the following processes is likely deficient in this patient?? {'A': 'Chemoattraction', 'B': 'Rolling', 'C': 'Tight adhesion', 'D': 'Diapedesis', 'E': 'Transmigration through the extracellular matrix'},
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B: Rolling
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Q:A 15-year-old girl is brought to the physician by her mother for a 2-day history of abdominal pain, nausea, vomiting, diarrhea, and decreased appetite. Her last menstrual period was 3 weeks ago. Her temperature is 37.6°C (99.7°F). Abdominal examination shows tenderness to palpation with guarding in the right lower quadrant. Laboratory studies show a leukocyte count of 12,600/mm3. Which of the following is the most likely underlying cause of this patient's condition?? {'A': 'Bacterial mesenteric lymphadenitis', 'B': 'Pseudomembranous plaque formation in the colon', 'C': 'Diverticular inflammation', 'D': 'Congenital anomaly of the omphalomesenteric duct', 'E': 'Lymphatic tissue hyperplasia'},
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E: Lymphatic tissue hyperplasia
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Q:A 55-year-old man presents to the emergency department with a headache, blurry vision, and abdominal pain. He states that his symptoms started several hours ago and have been gradually worsening. His temperature is 99.3°F (37.4°C), blood pressure is 222/128 mmHg, pulse is 87/min, respirations are 16/min, and oxygen saturation is 99% on room air. Physical exam is notable for an uncomfortable and distressed man. The patient is started on an esmolol and a nitroprusside drip thus lowering his blood pressure to 200/118 mmHg. The patient states that he feels better, but complains of feeling warm and flushed. An hour later, the patient seems confused and states his headache has resurfaced. Laboratory values are ordered as seen below. Serum: Na+: 138 mEq/L Cl-: 101 mEq/L K+: 4.4 mEq/L HCO3-: 17 mEq/L BUN: 31 mg/dL Glucose: 199 mg/dL Creatinine: 1.4 mg/dL Ca2+: 10.2 mg/dL Which of the following is the best treatment for this patient?? {'A': 'Amyl nitrite', 'B': 'Hydroxocobalamin', 'C': 'Insulin', 'D': 'IV fluids', 'E': 'Labetalol'},
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B: Hydroxocobalamin
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Q:An 18-year-old man presents to his primary care physician with a complaint of excessive daytime sleepiness. He denies any substance abuse or major changes in his sleep schedule. He reports frequently dozing off during his regular daily activities. On further review of systems, he endorses falling asleep frequently with the uncomfortable sensation that there is someone in the room, even though he is alone. He also describes that from time to time, he has transient episodes of slurred speech when experiencing heartfelt laughter. Vital signs are stable, and his physical exam is unremarkable. This patient is likely deficient in a neurotransmitter produced in which part of the brain?? {'A': 'Thalamus', 'B': 'Pons nucleus', 'C': 'Hippocampus', 'D': 'Hypothalamus', 'E': 'Midbrain'},
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D: Hypothalamus
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Q:A 35-year-old man presents to the primary care office with a recent history of frequent falls. He had been able to walk normally until about a year ago when he started noticing that both of his legs felt weak. He's also had some trouble with feeling in his feet. These 2 problems have caused multiple falls over the last year. On physical exam, he has notable leg and foot muscular atrophy and 4/5 strength throughout his bilateral lower extremities. Sensation to light touch and pinprick is absent up to the mid-calf. Ankle jerk reflex is absent bilaterally. A photo of the patient's foot is shown. Which of the following best describes the etiology of this patient's condition?? {'A': 'Autoimmune', 'B': 'Genetic', 'C': 'Ischemic', 'D': 'Infectious', 'E': 'Metabolic'},
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B: Genetic
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Q:A 60-year-old man is brought to the emergency department because of a 1-hour history of disorientation and slurred speech. He has a 10-year history of hypertension and hypercholesterolemia. His blood pressure is 210/110 mm Hg, and pulse is 90/min. Once the patient is stabilized, an MRI of the brain is performed, which shows an infarct of the left precentral gyrus involving the region that supplies the facial nerve. Given the MRI findings, which of the following neurological findings would most be expected?? {'A': 'Loss of taste in the posterior third of the right half of the tongue', 'B': 'Flattening of the right nasolabial fold', 'C': 'Decreased lacrimation of the left eye', 'D': 'Drooping of the left eyelid', 'E': 'Inability to raise the right eyebrow\n"'},
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B: Flattening of the right nasolabial fold
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Q:A 5-year-old boy presents to the pediatrician for a well child visit. He is meeting his developmental milestones and is in the 15th percentile for height and 70th percentile for weight. His parents report that he complains of fatiguing easily and having trouble participating in sports. They are concerned he is not getting enough sleep and state that sometimes they hear him snore. The patient has a past medical history of a supracondylar fracture of the humerus, which was appropriately treated. He is doing well in school but is sometimes bullied for being small. The patient eats a balanced diet of milk, fruit, and some vegetables. His parents have been trying to get him to drink more milk so he can grow taller. His temperature is 99.5°F (37.5°C), blood pressure is 90/48 mmHg, pulse is 100/min, respirations are 19/min, and oxygen saturation is 98% on room air. On physical exam, the patient appears well. HEENT exam is notable for conjunctival pallor and a unilateral clear middle ear effusion. Cardiac exam reveals a benign flow murmur. Pulmonary exam is clear to auscultation bilaterally. The patient's gait is stable and he is able to jump up and down. A full set of labs are ordered as requested by the parents including a serum vitamin D level, B12 level, and IGF level. A selection of these lab values are seen below. Serum: Na+: 139 mEq/L Cl-: 100 mEq/L K+: 4.3 mEq/L HCO3-: 25 mEq/L BUN: 20 mg/dL Glucose: 99 mg/dL Creatinine: 1.1 mg/dL Ca2+: 9.9 mg/dL AST: 12 U/L ALT: 10 U/L Which of the following would you expect to find in this patient?? {'A': 'Decreased IGF levels', 'B': 'Decreased oxygen saturation when the patient sleeps', 'C': 'Decreased vitamin D level', 'D': 'Increased RDW and TIBC', 'E': 'Increased MCV'},
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D: Increased RDW and TIBC
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Answer the following medical question with one of the provided options:
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Q:A 27-year-old man is brought to the emergency department because of a knife wound to his back. His pulse is 110/min, respirations are 14/min, and blood pressure is 125/78 mm Hg. Examination shows a 5-cm deep stab wound at the level of T9. He withdraws the right foot to pain but is unable to sense vibration or whether his right toe is flexed or extended. Sensation in the left leg is normal. Motor strength is 5/5 in all extremities. Rectal tone is normal. Which of the following spinal column structures was most likely affected?? {'A': 'Dorsal root', 'B': 'Posterior spinal artery', 'C': 'Central spinal cord grey matter', 'D': 'Lateral corticospinal tract', 'E': 'Artery of Adamkiewicz'},
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B: Posterior spinal artery
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Q:A 12-year-old girl is brought to the physician because of a 2-hour history of severe epigastric pain, nausea, and vomiting. Her father has a history of similar episodes of abdominal pain and developed diabetes mellitus at the age of 30 years. Abdominal examination shows guarding and rigidity. Ultrasonography of the abdomen shows diffuse enlargement of the pancreas; no gallstones are visualized. Which of the following is the most likely underlying cause of this patient's condition?? {'A': 'Elevated serum amylase levels', 'B': 'Increased β-glucuronidase activity', 'C': 'Premature activation of trypsinogen', 'D': 'Defective elastase inhibitor', 'E': 'Impaired cellular copper transport'},
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C: Premature activation of trypsinogen
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Q:A 24-year-old man is brought to your emergency department under arrest by the local police. The patient was found naked at a busy intersection jumping up and down on top of a car. Interviewing the patient, you discover that he has not slept in 2 days because he does not feel tired. He reports hearing voices. The patient was previously hospitalized 1 year ago with auditory hallucinations, paranoia, and a normal mood. What is the most likely diagnosis?? {'A': 'Schizophrenia', 'B': 'Schizotypal disorder', 'C': 'Schizoaffective disorder', 'D': 'Bipolar disorder', 'E': 'Unipolar mania'},
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C: Schizoaffective disorder
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Answer the following medical question with one of the provided options:
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Q:A 2-year-old boy is brought to the emergency department with an enlarged left knee. The patient’s parents state that his knee began to swell up a few hours ago while the family was indoors, watching TV. This has never happened before. The boy says his knee hurts when he puts weight on it. Past medical history is unremarkable. He was born at 39 weeks gestation via spontaneous vaginal delivery. He is up to date on all vaccines and is meeting all developmental milestones. Today, his vitals are normal for his age group with a blood pressure of 104/60 mm Hg, heart rate 90/min, respiratory rate 25/min, and temperature 37.1°C (98.8°F). On physical exam the child's left knee is indurated, erythematous, and painful to palpation. An ultrasound of the knee is consistent with hemarthrosis. A hematology workup is completed and the appropriate treatment was administered. Which of the following was the most likely treatment administered to this patient?? {'A': 'Fresh frozen plasma (FFP)', 'B': 'Cryoprecipitate', 'C': 'Desmopressin', 'D': 'vWF product', 'E': 'Factor IX replacement injections'},
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C: Desmopressin
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Q:A 69-year-old man is brought in by his wife with acute onset aphasia for the past 5 hours. The patient’s wife says that they were sitting having dinner when suddenly he was not able to speak. They delayed coming to the hospital because he had a similar episode 2 months ago which resolved within an hour. His past medical history is significant for hypercholesterolemia, managed with rosuvastatin, and a myocardial infarction (MI) 2 months ago, status post percutaneous transluminal coronary angioplasty complicated by residual angina. His family history is significant for his father who died of MI at age 60. The patient reports a 15-pack-year smoking history but denies any alcohol or recreational drug use. The vital signs include: temperature 37.0℃ (98.6℉), blood pressure 125/85 mm Hg, pulse 96/min, and respiratory rate 19/min. On physical examination, the patient has productive aphasia. There is a weakness of the right-sided lower facial muscles. The strength in his upper and lower extremities is 4/5 on the right and 5/5 on the left. There is also a decreased sensation on his right side. A noncontrast computed tomography (CT) scan of the head is unremarkable. CT angiography (CTA) and diffusion-weighted magnetic resonance imaging (MRI) of the brain are acquired, and the findings are shown in the exhibit (see image). Which of the following is the best course of treatment in this patient?? {'A': 'IV tPA', 'B': 'Aspirin', 'C': 'Low molecular weight heparin', 'D': 'Mechanical thrombectomy', 'E': 'Mannitol'},
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D: Mechanical thrombectomy
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Q:A 23-year-old woman presents with a painful lesion in her mouth. She denies tooth pain, bleeding from the gums, nausea, vomiting, diarrhea, or previous episodes similar to this in the past. She states that her last normal menstrual period was 12 days ago, and she has not been sexually active since starting medical school 2 years ago. On physical examination, the patient has good dentition with no signs of infection with the exception of a solitary ulcerated lesion on the oral mucosa. The nonvesicular lesion has a clean gray-white base and is surrounded by erythema. Which of the following is correct concerning the most likely etiology of the oral lesion in this patient?? {'A': "This lesion is due to a fungal infection and may mean you're immunocompromised.", 'B': 'This lesion is highly contagious and is due to reactivation of a dormant virus.', 'C': 'This lesion is associated with an autoimmune disease characterized by a sensitivity to gluten.', 'D': 'This lesion is non-contagious but will most likely recur.', 'E': 'This lesion may progress to squamous cell carcinoma.'},
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D: This lesion is non-contagious but will most likely recur.
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Q:A 29-year-old woman, gravida 1, para 1, comes to the physician for the evaluation of a painful mass in her left breast for several days. She has no fevers or chills. She has not noticed any changes in the right breast. She has no history of serious illness. Her last menstrual period was 3 weeks ago. She appears anxious. Her temperature is 37°C (98.6°F), pulse is 80/min, respirations are 13/min, and blood pressure is 130/75 mm Hg. Examination shows a palpable, mobile, tender mass in the left upper quadrant of the breast. Ultrasound shows a 1.75-cm, well-circumscribed anechoic mass with posterior acoustic enhancement. The patient says that she is very concerned that she may have breast cancer and wishes further diagnostic testing. Which of the following is the most appropriate next step in the management of this patient?? {'A': 'Fine needle aspiration', 'B': 'Mammogram', 'C': 'MRI scan of the left breast', 'D': 'Excisional biopsy', 'E': 'Core needle biopsy'},
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A: Fine needle aspiration
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Q:A 15-month-old girl is brought to the pediatrician by her mother with a history of 3 episodes of breath-holding spells. The patient’s mother says that this is a new behavior and she is concerned. The patient was born at full term by spontaneous vaginal delivery with an uneventful perinatal period. She is also up to date on her vaccines. However, after the age of 6 months, the patient’s mother noticed that she was not as playful as other children of similar age. She is also not interested in interacting with others and her eye contact is poor. Her growth charts suggest that her weight, length, and head circumference were normal at birth, but there have been noticeable decelerations in weight and head circumference. On physical examination, her vital signs are normal. A neurologic examination reveals the presence of generalized mild hypotonia. She also makes repetitive hand wringing motions. Which of the following clinical features is most likely to develop in this patient during the next few years?? {'A': 'Absence seizures', 'B': 'Hemiparesis', 'C': 'Intention tremor', 'D': 'Loss of purposeful use of her hands', 'E': 'Sensorineural deafness'},
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D: Loss of purposeful use of her hands
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Q:A 43-year-old woman presents to the physician with the complaint of worsening fatigue over the past several months. She has found that she requires nearly double the amount of coffee consumption each day to stay awake at work and that despite maintaining a balanced, healthy diet, she has experienced significant weight gain. A blood test confirms the presence of anti-thyroid peroxidase antibodies. Which of the following additional findings would be consistent with her condition?? {'A': 'Brisk deep tendon reflexes', 'B': 'Diarrhea', 'C': 'Galactorrhea', 'D': 'Heat intolerance', 'E': 'Proptosis of the globe'},
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C: Galactorrhea
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Q:A 65-year-old woman comes to the physician because of a 3-month history of progressive shortness of breath and a dry cough. She has also noticed gradual development of facial discoloration. She has coronary artery disease, hypertension, and atrial fibrillation. She does not remember which medications she takes. Her temperature is 37°C (98.6°F), pulse is 90/min, respirations are 18/min, and blood pressure is 150/85 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 95%. Examination shows blue-gray discoloration of the face and both hands. Diffuse inspiratory crackles are heard. An x-ray of the chest shows reticular opacities around the lung periphery and particularly around the lung bases. The most likely cause of this patient's findings is an adverse effect to which of the following medications?? {'A': 'Procainamide', 'B': 'Lisinopril', 'C': 'Metoprolol', 'D': 'Amiodarone', 'E': 'Warfarin'},
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D: Amiodarone
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Q:A 12-month-old boy is brought to the physician by his mother for a well-child examination. He was delivered at term after an uncomplicated pregnancy. His mother says he is breastfeeding well. He is at the 50th percentile for height and 65th percentile for weight. Physical examination shows no abnormalities. Urinalysis shows 3+ reducing substances. Compared to a healthy infant, giving this patient apple juice to drink will result in increased activity of which of the following enzymes?? {'A': 'Aldolase B', 'B': 'Galactokinase', 'C': 'Fructokinase', 'D': 'α-1,6-glucosidase', 'E': 'Hexokinase'},
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E: Hexokinase
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Q:A 15-year-old girl presents with menorrhagia for the last 4 months. The patient’s mother says that she just started getting her period 4 months ago, which have been heavy and prolonged. The patient does recall getting a tooth extracted 3 years ago that was complicated by persistent bleeding afterward. She has no other significant past medical history and takes no current medications. Her vital signs include: blood pressure 118/76 mm Hg, respirations 17/min, pulse 64/min, temperature 36.7°C (98.0°F). Physical examination is unremarkable. Which of the following laboratory tests is most likely to be of the greatest diagnostic value in the workup of this patient?? {'A': 'Factor IX assay', 'B': 'Partial thromboplastin time (PTT)', 'C': 'Anti-cardiolipin antibodies', 'D': 'Ro/La autoantibodies', 'E': 'Prothrombin time (PT)'},
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B: Partial thromboplastin time (PTT)
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Answer the following medical question with one of the provided options:
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Q:A 57-year-old man comes to the physician because of a 2-month history of worsening shortness of breath with walking. He has not had any cough, fevers, or recent weight loss. He has hypercholesterolemia, for which he takes simvastatin, but otherwise is healthy. For 35 years he has worked for a demolition company. He has smoked 1 pack of cigarettes daily for the past 33 years. Pulmonary examination shows fine bibasilar end-expiratory crackles. An x-ray of the chest shows diffuse bilateral infiltrates predominantly in the lower lobes and bilateral calcified pleural plaques. The patient is most likely to develop which of the following conditions?? {'A': 'Thyroid carcinoma', 'B': 'Tuberculosis', 'C': 'Sarcoidosis', 'D': 'Mesothelioma', 'E': 'Bronchogenic carcinoma\n"'},
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E: Bronchogenic carcinoma "
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Q:A 26-year-old woman comes to the physician because of painful paresthesias in her foot. Examination shows decreased sensation in the first interdigital space and a hallux valgus deformity. This patient's paresthesias are most likely caused by compression of which of the following nerves?? {'A': 'Superficial peroneal nerve', 'B': 'Deep peroneal nerve', 'C': 'Sural nerve', 'D': 'Saphenous nerve', 'E': 'Medial plantar nerve\n"'},
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B: Deep peroneal nerve
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Answer the following medical question with one of the provided options:
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Q:A 34-year-old male is brought to the emergency department by paramedics after being found down on the sidewalk. The paramedics are unable to provide any further history and the patient in unresponsive. On exam, the patient's vitals are: T: 36 deg C, HR: 65 bpm, BP: 100/66, RR: 4, SaO2: 96%. The emergency physician also observes the findings demonstrated in figures A and B. This patient most likely overdosed on which of the following?? {'A': 'Cocaine', 'B': 'Marijuana', 'C': 'Alcohol', 'D': 'Heroin', 'E': 'Phencyclidine'},
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D: Heroin
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Q:A retrospective study was conducted in a US county in order to determine the frequency of hypodontia (tooth agenesis), the most common craniofacial malformation in humans, as well as to assess the need for an interdisciplinary approach to managing subsequent functional and esthetic sequelae in a target population. Using a dental administration computer software tool, a total of 1498 patients who visited the outpatient clinic of a large specialist dental center between April 2017 and February 2018 were identified. The group comprised 766 women and 732 men. Hypodontia was found in 6.3% of the patients, a rate that was consistent with the average values found in the published medical literature. Which measure of frequency was used to describe the percentage of patients affected by hypodontia in this example?? {'A': 'Point prevalence', 'B': 'Period prevalence', 'C': 'Cumulative incidence', 'D': 'Incidence rate', 'E': 'Attack rate'},
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B: Period prevalence
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Q:A child is brought into the emergency room by her mother. Her mother states that the 7-year-old child was playing with their dog, who is up to date on his vaccinations. When the dog started playing more aggressively, the child suffered a bite on the hand with two puncture wounds from the dog's canines. The child is up-to-date on her vaccinations and has no medical history. Her vitals are within normal limits. If this bite becomes infected, what is the most likely organism to be the cause of infection?? {'A': 'Clostridium perfringens', 'B': 'Pseudomonas aeruginosa', 'C': 'Pasteurella multocida', 'D': 'Clostridium tetani', 'E': 'Fusobacterium'},
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C: Pasteurella multocida
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Answer the following medical question with one of the provided options:
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Q:A previously healthy 4-year-old boy is brought to the physician because of a 2-day history of fever and swelling of the neck. His mother says that he has been increasingly weak over the past month. He takes no medications. His vaccination history is complete. His temperature is 39.5°C (103.1°F), blood pressure is 115/70 mm Hg, pulse is 94/min, and respiratory rate is 16/min. Palpation reveals bilateral cervical lymphadenopathy. There are several petechiae on the distal lower extremities and on the soft palate. The spleen is palpable 3 cm below the costal margin. Laboratory studies show: Hemoglobin 8 g/dL Leukocyte 2400/mm3 Platelet 30,000/mm3 A peripheral blood smear is shown. Which of the following best explains these findings?? {'A': 'Acute lymphoid leukemia', 'B': 'Bacterial sepsis', 'C': 'Burkitt’s lymphoma', 'D': 'Infectious mononucleosis', 'E': 'Aplastic anemia'},
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A: Acute lymphoid leukemia
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Q:A 4-month-old male infant is brought to the physician by his father because of swelling of his left hemiscrotum. He has otherwise been healthy and is gaining weight appropriately. Physical examination shows a nontender left scrotal mass that transilluminates. The mass increases in size when the boy cries but is easily reducible. Which of the following is the most likely underlying cause of this patient's findings?? {'A': 'Lack of testicular fixation', 'B': 'Germ cell neoplasia', 'C': 'Sperm collection in epididymal duct', 'D': 'Patent processus vaginalis', 'E': 'Dilation of pampiniform plexus'},
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D: Patent processus vaginalis
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Q:A 19-year-old woman presents to the family medical center with a 2-week history of a sore throat. She says that she has felt increasingly tired during the day and has a difficult time staying awake during her classes at the university. She appears well-nourished with a low energy level. Her vital signs include the following: the heart rate is 82/min, the respiratory rate is 14/min, the temperature is 37.8°C (100.0°F), and the blood pressure is 112/82 mm Hg. Inspection of the pharynx is depicted in the picture. Palpation of the neck reveals posterior cervical lymphadenopathy. The membrane does not bleed upon scraping. What is the most specific finding for detecting the syndrome described in the vignette?? {'A': 'Positive monospot test', 'B': '> 10% atypical lymphocytes', 'C': 'Positive rapid strep test', 'D': 'Increased transaminase levels', 'E': 'Growth in Loffler’s medium'},
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A: Positive monospot test
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Q:A 64-year-old man is brought to the emergency department because of a 2-hour history of nausea, vomiting, and retrosternal pain that radiates to the back. Abdominal examination shows tenderness to palpation in the epigastric area. A CT scan of the patient's chest is shown. Which of the following is the most likely diagnosis?? {'A': 'Esophageal rupture', 'B': 'Pulmonary embolism', 'C': 'Pneumothorax', 'D': 'Mallory-Weiss syndrome', 'E': 'Aspiration pneumonia'},
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A: Esophageal rupture
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Q:A 45-year-old woman comes to the emergency department because of abdominal cramping, vomiting, and watery diarrhea for the past 4 hours. One day ago, she went to a seafood restaurant with her family to celebrate her birthday. Three of the attendees have developed similar symptoms. The patient appears lethargic. Her temperature is 38.8°C (101.8°F). Which of the following organisms is most likely responsible for this patient's current symptoms?? {'A': 'Campylobacter jejuni', 'B': 'Staphylococcus aureus', 'C': 'Vibrio parahaemolyticus', 'D': 'Listeria monocytogenes', 'E': 'Salmonella enterica'},
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C: Vibrio parahaemolyticus
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Q:A 25-year-old woman comes to the physician because of recurrent episodes of reddish discoloration of her urine. She also has a 3-month history of intermittent abdominal pain, yellowish discoloration of the skin and eyes, and fatigue. Physical examination shows pallor and scleral icterus. The spleen is not palpable. Her hemoglobin concentration is 7.8 g/dL, leukocyte count is 2,000/mm3, and platelet count is 80,000/mm3. Serum LDH and unconjugated bilirubin concentrations are elevated. Addition of a serum containing anti-human globulins to a blood sample shows no agglutination. A urine dipstick shows blood; urinalysis shows no RBCs. A CT scan of the abdomen shows a thrombus in a distal branch of the superior mesenteric vein. Which of the following is the most likely cause of this patient's condition?? {'A': 'Activation and consumption of platelets and coagulation factors', 'B': 'Endothelial cell dysfunction from bacterial toxin production', 'C': 'Absence of protective factors against destruction by complement', 'D': 'Formation of IgG antibodies against glycoprotein IIb/IIIa', 'E': 'Replacement of a single amino acid in a β-globin chain\n"'},
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C: Absence of protective factors against destruction by complement
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Q:A 47-year-old male presents to the emergency department with facial swelling and trouble breathing. These symptoms began this morning and progressively worsened over the past several hours. Vital signs are as follows: T 37.7, HR 108, BP 120/76, RR 20, and SpO2 96%. Physical examination reveals nonpitting swelling of the face, hands, and arms as well as edema of the tongue and mucus membranes of the mouth and pharynx. The patient reports several episodes of mild facial swelling that occurred during childhood between the ages of 5-18, but he does not recall seeing a physician or receiving treatment for this. His medical history is otherwise negative, except for mild hypertension for which his primary care physician initiated lisinopril 2 weeks ago. This patient most likely has which of the following underlying abnormalities?? {'A': 'MHC class I deficiency', 'B': 'Defective lysosomal storage proteins', 'C': 'Lack of NADPH oxidase', 'D': 'Defect in cytoskeletal glycoprotein', 'E': 'Deficiency of C1 esterase inhibitor'},
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E: Deficiency of C1 esterase inhibitor
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Q:A 23-year-old man comes to the emergency department with palpitations, sweating, and shortness of breath that began 10 minutes ago. He says, “Please help me, I don't want to die.” He has experienced several similar episodes over the past 2 months, which occurred without warning in situations including open spaces or crowds and resolved gradually after 5 to 10 minutes. He has been staying at home as much as possible out of fear of triggering another episode. He has no history of serious illness and takes no medications. He drinks 3 bottles of beer daily. He appears anxious and has a flushed face. His pulse is 104/min, respirations are 12/min, and blood pressure is 135/82 mm Hg. Cardiopulmonary examination shows no abnormalities. An ECG shows sinus tachycardia. Which of the following is the most appropriate initial step in management?? {'A': 'Oral propranolol', 'B': 'Oral buspirone', 'C': 'Oral alprazolam', 'D': 'Oral venlafaxine', 'E': 'Long-term ECG monitoring'},
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C: Oral alprazolam
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Q:A 22-year-old man presents to a physician with a single painless ulcer on his glans penis that he first noticed 2 weeks ago. He mentions that he is sexually active with multiple partners. There is no history of fevers. Initially, he thought that the ulcer would go away on its own, but decided to come to the clinic because the ulcer persisted. On palpation of the ulcer, the edge and base are indurated. There is no purulence. Multiple painless, firm, and non-fixed lymph nodes are present in the inguinal regions bilaterally. The physician orders a Venereal Disease Research Laboratory (VDRL) test, which is positive. The Treponema pallidum particle agglutination assay is also positive. Upon discussing the diagnosis, the patient informs the physician that he has a severe allergy to penicillin and he declines treatment with an injectable medicine. Which of the following drugs is most appropriate for this patient?? {'A': 'Azithromycin', 'B': 'Chloramphenicol', 'C': 'Ciprofloxacin', 'D': 'Metronidazole', 'E': 'Trimethoprim-sulfamethoxazole'},
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A: Azithromycin
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Q:A 5-year-old girl with an aortic stenosis correction comes to the office for a follow-up visit for acute lymphoblastic lymphoma. She initiated chemotherapy a week before through a peripherally inserted central line. She reports being ‘tired all the time’ and has been bruising easily. Her vital signs are within normal limits. Physical examination shows several tenders, non-blanching petechiae on the pads of the fingers and toes; several dark, non-tender petechiae on her palms and soles; and small, linear hemorrhages under her fingernails. Fundoscopic examination shows various small areas of hemorrhage on the retinae bilaterally. Cardiac examination is notable for a II/VI systolic ejection murmur that seems to have worsened in comparison to the last visit. Which of the following is the most likely cause?? {'A': 'Acute rheumatic fever', 'B': 'Bleeding diathesis secondary to thrombocytopenia', 'C': 'Dilated cardiomyopathy', 'D': 'Hypertrophic cardiomyopathy', 'E': 'Infective endocarditis'},
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E: Infective endocarditis
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Q:A 40-year-old pregnant woman, G4 P3, visits your office at week 30 of gestation. She is very excited about her pregnancy and wants to be the healthiest she can be in preparation for labor and for her baby. What vaccination should she receive at this visit?? {'A': 'Live attenuated influenza vaccine', 'B': 'Tetanus, diphtheria, and acellular pertussis (Tdap)', 'C': 'Varicella vaccine', 'D': 'Herpes zoster vaccine', 'E': 'Measles, mumps, and rubella (MMR)'},
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B: Tetanus, diphtheria, and acellular pertussis (Tdap)
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Q:A 62-year-old Caucasian male presents to your office with hemoptysis and hematuria. On physical exam you note a saddle nose deformity. Laboratory results show an elevated level of cytoplasmic antineutrophil cytoplasmic antibody. Which of the following interventions is most appropriate for this patient?? {'A': 'Smoking cessation', 'B': 'IV immunoglobulin', 'C': 'Corticosteroids', 'D': 'Isoniazid', 'E': 'Discontinuation of ibuprofen'},
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C: Corticosteroids
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Q:A 54-year-old man is brought to the emergency department 1 hour after the sudden onset of shortness of breath, severe chest pain, and sweating. He has hypertension and type 2 diabetes mellitus. He has smoked one pack and a half of cigarettes daily for 20 years. An ECG shows ST-segment elevations in leads II, III, and avF. The next hospital with a cardiac catheterization unit is more than 2 hours away. Reperfusion pharmacotherapy is initiated. Which of the following is the primary mechanism of action of this medication?? {'A': 'Blocking of adenosine diphosphate receptors', 'B': 'Conversion of plasminogen to plasmin', 'C': 'Prevention of thromboxane formation', 'D': 'Inhibition of glutamic acid residue carboxylation', 'E': 'Direct inhibition of thrombin activity'},
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B: Conversion of plasminogen to plasmin
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Q:A 70-year-old man presents to the outpatient clinic for a routine health checkup. He recently lost his hearing completely in both ears and has occasional flare-ups of osteoarthritis in his hands and hips. He is a non-diabetic and hypertensive for the past 25 years. His brother recently died due to prostate cancer. His current blood pressure is 126/84 mm Hg. His cholesterol and PSA levels are within normal limits. The flexible sigmoidoscopy along with stool guaiac test is negative. The serum calcium, phosphorus concentrations and liver function test results are within normal limits. However, the ALP levels are increased by more than thrice the upper limit. Radiography of the axial skeleton reveals cortical thickening. What is the most likely diagnosis?? {'A': 'Osteomalacia', 'B': "Paget's disease of the bone", 'C': 'Metastatic bone disease', 'D': 'Plasmacytoma', 'E': 'Primary hyperparathyroidism'},
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B: Paget's disease of the bone
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Q:A 35-year-old man is brought to the emergency room after suffering a catastrophic fall while skiing during a training session. He was found unconscious by the aeromedical emergency services team, who established an airway and cervical spine control measures. Upon arrival at the emergency department, ventilatory support is started followed by an evaluation of the patient by the neurosurgical team. His blood pressure is 210/125 mm Hg, the heart rate is 55/min, and the respiratory rate is 15/min with a Cheyne-Stokes breathing pattern. Neurological examination shows a Glasgow Coma Score of 4/15, with dilated, fixed pupils and a decerebrate posture. An MRI of the brain shows diffuse axonal injury to the brain with severe cerebral edema, multiple frontal and occipital lobe contusions and multiple flame-shaped hemorrhages in the brainstem. Despite the medical team efforts, the patient dies 24 hours later. What would be the most likely type of herniation found at this patient’s autopsy?? {'A': 'Uncal herniation', 'B': 'Subfalcine herniation', 'C': 'Central herniation', 'D': 'Downward cerebellar herniation', 'E': 'Upward cerebellar herniation'},
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C: Central herniation
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Q:An 11-year-old boy with Burkitt lymphoma is brought to the emergency department because of nausea, vomiting, flank pain, and dark urine for 1 day. Two days ago, he began induction chemotherapy with cyclophosphamide, vincristine, prednisolone, and doxorubicin. Urinalysis shows 3+ blood and abundant amber-colored, rhomboid crystals. Which of the following is most likely to have been effective in preventing this patient’s symptoms?? {'A': 'Water restriction', 'B': 'Administration of ceftriaxone', 'C': 'Alkalinization of the urine', 'D': 'Administration of probenecid', 'E': 'Administration of hydrochlorothiazide\n"'},
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C: Alkalinization of the urine
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Q:A 42-year-old male with a history significant for IV drug use comes to the emergency department complaining of persistent fatigue and malaise for the past three weeks. On physical exam, you observe a lethargic male with icteric sclera and hepatomegaly. AST and ALT are elevated at 600 and 750, respectively. HCV RNA is positive. Albumin is 3.8 g/dL and PT is 12. A liver biopsy shows significant inflammation with bridging fibrosis. What is the most appropriate treatment at this time?? {'A': 'Interferon', 'B': 'Ribavirin', 'C': 'Lamivudine', 'D': 'Combined interferon and ribavirin', 'E': 'Combined interferon and lamivudine'},
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D: Combined interferon and ribavirin
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Q:A 41-year-old woman comes to the doctor because of gradually progressive weakness in her right hand over the past few weeks. She goes to the gym to lift weights 5 times a week. With the dorsum of the right hand on a flat surface, the patient is unable to move her thumb to touch a pen held 2 cm above the interphalangeal joint of the thumb. An MRI of the right arm shows compression of a nerve that passes through the pronator teres muscle. Based on the examination findings, loss of innervation of which of the following muscles is most likely in this patient?? {'A': 'Adductor pollicis', 'B': 'Flexor pollicis longus', 'C': 'First dorsal interosseus', 'D': 'Abductor pollicis brevis', 'E': 'Opponens pollicis'},
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D: Abductor pollicis brevis
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Q:A 24-year-old woman presents to the emergency department because she started experiencing dyspnea and urticaria after dinner. Her symptoms began approximately 15 minutes after eating a new type of shellfish that she has never had before. On physical exam her breathing is labored, and pulmonary auscultation reveals wheezing bilaterally. Given this presentation, she is immediately started on intramuscular epinephrine for treatment of her symptoms. If part of this patient's symptoms were related to the systemic release of certain complement components, which of the following is another function of the responsible component?? {'A': 'Chemotaxis', 'B': 'Clearance of immune complexes', 'C': 'Direct cytolysis', 'D': 'Inhibition of kallikrein activation', 'E': 'Opsonization of pathogens'},
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A: Chemotaxis
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Q:A previously healthy 8-year-old boy is brought to the physician by his mother because of 6 months of progressive fatigue and weight loss. His mother reports that during this time, he has had decreased energy and has become a “picky eater.” He often has loose stools and complains of occasional abdominal pain and nausea. His family moved to a different house 7 months ago. He is at the 50th percentile for height and 25th percentile for weight. His temperature is 36.7°C (98°F), pulse is 116/min, and blood pressure is 85/46 mm Hg. Physical examination shows tanned skin and bluish-black gums. The abdomen is soft, nondistended, and nontender. Serum studies show: Na+ 134 mEq/L K+ 5.4 mEq/L Cl- 104 mEq/L Bicarbonate 21 mEq/L Urea nitrogen 16 mg/dL Creatinine 0.9 mg/dL Glucose 70 mg/dL Intravenous fluid resuscitation is begun. Which of the following is the most appropriate initial step in treatment?"? {'A': 'Levothyroxine', 'B': 'Fluoxetine', 'C': 'Glucocorticoids', 'D': 'Hyperbaric oxygen', 'E': 'Deferoxamine'},
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C: Glucocorticoids
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Q:A 10-year-old girl presents to your office with a fever and rash. Her mother first noticed the rash 2 days ago after a camping trip. The rash began on her wrists and ankles and has now spread to her palms and the soles of her feet. This morning, she was feeling unwell and complaining of a headache. She had a fever of 102°F (39°C) prompting her mother to bring her to your office. She is otherwise healthy and does not take any medications. Her medical history is significant for a broken arm at age 8. On physical exam her blood pressure is 120/80 mmHg, pulse is 110/min, and respirations are 22/min. You notice a petechial rash on the palms, soles, ankles, and wrists. Which of the following findings would confirm the most likely cause of this patient's symptoms?? {'A': 'Granulocytes with morulae in the cytoplasm', 'B': 'Cross-reactivity of serum with proteus antigens', 'C': 'Monocytes with morulae in the cytoplasm', 'D': 'Positive fluorescent treponemal antibody absorption test (FTA-ABS)', 'E': 'Positive Borrelia burgdorferi antibodies'},
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B: Cross-reactivity of serum with proteus antigens
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Q:A 54-year-old man suffered an anterior wall myocardial infarction that was managed in the cath lab with emergent coronary stenting and revascularization. The patient states that his wife, adult children, and cousins may be disclosed information regarding his care and health information. The patient has been progressing well without any further complications since his initial catheterization. On hospital day #3, a woman stops you in the hall outside of the patient's room whom you recognize as the patient's cousin. She asks you about the patient's prognosis and how the patient is progressing after his heart attack. Which of the following is the most appropriate next step?? {'A': 'Direct the woman to discuss these issues with the patient himself', 'B': "Discuss the patient's hospital course and expected prognosis with the woman", 'C': "Ask for identification confirming that the woman is truly the patient's cousin", 'D': 'Decline to comment per HIPAA patient confidentiality regulations', 'E': 'Ask the patient if it is acceptable to share information with this individual'},
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B: Discuss the patient's hospital course and expected prognosis with the woman
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Q:An otherwise healthy 28-year-old primigravid woman at 30 weeks' gestation comes to the physician with a 5-day history of epigastric pain and nausea that is worse at night. Two years ago, she was diagnosed with a peptic ulcer and was treated with a proton pump inhibitor and antibiotics. Medications include folic acid and a multivitamin. Her pulse is 90/min and blood pressure is 130/85 mm Hg. Pelvic examination shows a uterus consistent in size with a 30-week gestation. Laboratory studies show: Hemoglobin 8.6 g/dL Platelet count 95,000/mm3 Serum Total bilirubin 1.5 mg/dL Aspartate aminotransferase 80 U/L Lactate dehydrogenase 705 U/L Urine pH 6.2 Protein 2+ WBC negative Bacteria occasional Nitrates negative Which of the following best explains this patient's symptoms?"? {'A': 'Inflammation of the gall bladder', 'B': 'Bacterial infection of the kidney', 'C': 'Inflammation of the lower esophageal mucosa', 'D': 'Stretching of Glisson capsule', 'E': 'Acute inflammation of the pancreas'},
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D: Stretching of Glisson capsule
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Q:A 54-year-old man is brought to the emergency department because of progressive tingling and weakness in both of his legs for the past two days. The patient reports that his symptoms interfere with his ability to walk. Two weeks ago, he had an upper respiratory tract infection, which resolved spontaneously. His vital signs are within normal limits. Examination shows weakness in the lower extremities with absent deep tendon reflexes. Reflexes are 1+ in the upper extremities. Sensation to pinprick and light touch is intact. Romberg's test is negative. Laboratory studies show a leukocyte count of 12,000/mm3. Cerebrospinal fluid analysis results show: Opening pressure normal Protein 200 mg/dL Glucose 70 mg/dL White blood cells 4/mm3 This patient is at increased risk for which of the following conditions?"? {'A': 'Dementia', 'B': 'Thymoma', 'C': 'Urinary incontinence', 'D': 'Respiratory failure', 'E': 'Hypertrophic cardiomyopathy\n"'},
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D: Respiratory failure
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Q:A 44-year-old man comes to the physician because of a 3-week history of productive cough, fever, and lethargy. He also has several skin lesions over his body. His symptoms began 3 weeks after he returned from a camping trip in Kentucky. Three years ago, he underwent kidney transplantation for polycystic kidney disease. Current medications include sirolimus and prednisone. His temperature is 38°C (100.4°F). Diffuse crackles are heard over the lung fields. There are 4 white, verrucous skin patches over his chest and upper limbs. A photomicrograph of a skin biopsy specimen from one of the lesions is shown. Which of the following is the most likely diagnosis?? {'A': 'Histoplasmosis', 'B': 'Mucormycosis', 'C': 'Coccidioidomycosis', 'D': 'Cryptococcosis', 'E': 'Blastomycosis'},
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E: Blastomycosis
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Q:A 47-year-old woman presents for a routine wellness checkup. She complains of general fatigue and lethargy for the past 6 months. She does not have a significant past medical history and is currently not taking any medications. The patient reports that she drinks “socially” approx. 6 nights a week. She says she also enjoys a “nightcap,” which is 1–2 glasses of wine before bed every night. She denies any history of drug use or smoking. The patient is afebrile, and her vital signs are within normal limits. A physical examination reveals pallor of the mucous membranes. Her laboratory findings are significant for a mean corpuscular volume of 72 fL, leukocyte count of 5,300/mL, hemoglobin of 11.0 g/dL, and platelet count of 420,000/mL. Which of the following is the most likely cause of this patient’s thrombocytosis?? {'A': 'Iron deficiency anemia', 'B': 'Chronic alcohol abuse', 'C': 'Chronic myelogenous leukemia (CML)', 'D': 'Aplastic anemia', 'E': 'Essential thrombocytosis'},
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A: Iron deficiency anemia
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Q:A 39-year-old male is rushed to the emergency department after he developed a sudden-onset severe headache with ensuing nausea, vomiting, vision changes, and loss of consciousness. Past medical history is unattainable. He reports that the headache is worse than any he has experienced before. Noncontrast CT of the head is significant for an intracranial hemorrhage. Follow-up cerebral angiography is performed and shows a ruptured anterior communicating artery aneurysm. Which of the following has the strongest association with this patient's current presentation?? {'A': 'History of multiple hemangioblastomas of the retina and spine as well as pheochromocytoma', 'B': 'Brain MRI showing a butterfly glioma with a central necrotic core', 'C': 'Abdominal CT suggestive of renal cell carcinoma', 'D': 'Kidney ultrasound showing numerous bilateral renal cysts', 'E': 'History of renal transplantation at 8 years of age'},
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D: Kidney ultrasound showing numerous bilateral renal cysts
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Q:A 15-year-old girl comes to the physician for a well-child examination. She feels well. Her father has coronary artery disease and hypertension. Her mother has type 2 diabetes mellitus, hypercholesterolemia, and had a myocardial infarction at the age of 52 years. She is at the 25th percentile for height and above the 95th percentile for weight. Her BMI is 32 kg/m2. Her temperature is 37°C (98.6°F), pulse is 99/min, and blood pressure is 140/88 mm Hg. Physical examination shows no abnormalities. Random serum studies show: Glucose 160 mg/dL Creatinine 0.8 mg/dL Total cholesterol 212 mg/dL HDL-cholesterol 32 mg/dL LDL-cholesterol 134 mg/dL Triglycerides 230 mg/dL In addition to regular aerobic physical activity, which of the following is the most appropriate next step in management?"? {'A': 'Niacin therapy', 'B': 'Reduced-calorie diet', 'C': 'Fenofibrate therapy', 'D': 'Atorvastatin therapy', 'E': 'Metformin therapy'},
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B: Reduced-calorie diet
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Q:A 55-year-old woman who is an established patient presents to your office. She is complaining of increased urination and increased thirst. She has recently began taking several over-the-counter vitamins and supplements. On further review, she reports she has also been having abdominal pain and constipation. She denies significant weight changes. Her fingerstick blood glucose in your office is 96 mg/dL. Which of the following test is most likely to provide the diagnosis?? {'A': 'Pyridoxine levels', 'B': 'Niacin levels', 'C': 'Calcium level', 'D': 'Hemoglobin A1C', 'E': 'Free T4 levels'},
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C: Calcium level
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Q:A 9-year-old boy is brought to his primary care physician after his mom noticed that he was limping. He says that he has been experiencing significant hip and knee pain over the last 2 months but thought he may have just strained a muscle. Radiographs show a collapse of the femoral head, and he is diagnosed with Legg-Calve-Perthes disease. He undergoes surgery and is placed in a Petrie cast from his hips to his toes bilaterally so that he is unable to move his knees or ankles. Eight weeks later, the cast is removed, and he is found to have significantly smaller calves than before the cast was placed. Which process in myocytes is most likely responsible for this finding?? {'A': 'Decreased formation of double membrane bound vesicles', 'B': 'Increased formation of double membrane bound vesicles', 'C': 'Inhibition of gene transcription', 'D': 'Monoubiquitination of proteins', 'E': 'Polyubiquitination of proteins'},
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E: Polyubiquitination of proteins
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Q:A 36-year-old African American G1P0010 presents to her gynecologist for an annual visit. She has a medical history of hypertension, for which she takes hydrochlorothiazide. The patient’s mother had breast cancer at age 68, and her sister has endometriosis. At this visit, the patient’s temperature is 98.6°F (37.0°C), blood pressure is 138/74 mmHg, pulse is 80/min, and respirations are 13/min. Her BMI is 32.4 kg/m^2. Pelvic exam reveals a nontender, 16-week sized uterus with an irregular contour. A transvaginal ultrasound is performed and demonstrates a submucosal leiomyoma. This patient is at most increased risk of which of the following complications?? {'A': 'Infertility', 'B': 'Uterine prolapse', 'C': 'Endometrial cancer', 'D': 'Miscarriage', 'E': 'Iron deficiency anemia'},
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E: Iron deficiency anemia
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Q:A 56-year-old previously healthy woman with no other past medical history is post-operative day one from an open reduction and internal fixation of a fractured right radius and ulna after a motor vehicle accident. What is one of the primary ways of preventing postoperative pneumonia in this patient?? {'A': 'In-hospital intravenous antibiotics', 'B': 'Outpatient oral antibiotics', 'C': 'Hyperbaric oxygenation', 'D': 'Incentive spirometry', 'E': 'Shallow breathing exercises'},
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D: Incentive spirometry
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Q:A 28-year-old gravida-2-para-1 at 12 weeks gestation presents for a prenatal visit. Over the past week, she has felt increasingly tired, even after waking up in the morning. She is vegan and avoids all animal products. She was diagnosed with Graves’ disease 6 months ago. Before conception, methimazole was switched to propylthiouracil (PTU). Other medications include folic acid and a multivitamin. The vital signs include: temperature 37.1℃ (98.8℉), pulse 72/min, respiratory rate 12/min, and blood pressure 110/75 mm Hg. The conjunctivae and nail beds are pale. Petechiae are present over the distal lower extremities. The pelvic examination reveals a uterus consistent in size with a 12-week gestation. Examination of the neck, lungs, heart, and abdomen shows no abnormalities. The laboratory studies show the following: Laboratory test Hemoglobin 9.0 g/dL Mean corpuscular volume 90 μm3 Leukocyte count 4,000/mm3 Segmented neutrophils 55% Lymphocytes 40% Platelet count 110,000/mm3 Serum Thyroid-stimulating hormone 0.1 μU/mL Thyroxine (T-4) 8 μg/dL Lactate dehydrogenase 60 U/L Total bilirubin 0.5 mg/dL Iron 100 μg/dL Ferritin 110 ng/mL Total iron-binding capacity 250 μg/dL Which of the following best explains these findings?? {'A': 'Autoimmune hemolysis', 'B': 'Drug-induced marrow failure', 'C': 'Hemodilution of pregnancy', 'D': 'Excess antithyroid medication', 'E': 'Vitamin B12 deficiency'},
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B: Drug-induced marrow failure
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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 comes to the physician for a routine health maintenance examination. He has no history of serious illness. His mother has hypertension and his father died of testicular cancer at the age of 51 years. He does not smoke or drink. He is sexually active and uses condoms consistently. He takes no medications. His immunization records are unavailable. He works as a financial consultant and will go on a business trip to Mexico City in 2 weeks. His temperature is 36.7°C (98.7° F), pulse is 78/min, and blood pressure is 122/78 mm Hg. Cardiopulmonary examination shows no abnormalities. Laboratory studies show: Hemoglobin 13.4 g/dL Leukocyte count 9800/mm3 Platelet count 168,000/mm3 Serum Glucose 113 mg/dL Creatinine 1.1 mg/dL Which of the following recommendations is most appropriate at this time?"? {'A': 'Malaria chemoprophylaxis', 'B': 'Rabies vaccine', 'C': 'Cholera vaccine', 'D': 'Yellow fever vaccine', 'E': 'Hepatitis A vaccine'},
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E: Hepatitis A vaccine
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Q:A 39-year-old woman seeks evaluation from her gynecologist due to recent changes in her menstrual cycle. Her last menstrual period was greater than 12 months ago. She has 2 children and had regular menstrual periods in the past. She also complains of difficulty in falling and staying asleep, occasional hot flashes, vaginal dryness, and decreased libido. The physical examination is unremarkable, and the height and weight are 1.68 m (5 ft 6 in) and 70 kg (154 lb), respectively. She has the following hormonal panel from 2 months ago when she first sought help for her symptoms. Hormonal panel results Human Chorionic Gonadotropin 4 IU/L (0.8 - 7.3 IU/L) Thyroid Stimulating Hormone 2.5 mIU/L (0.4 - 4.2 mIU/L) Prolactin 5 ng/mL (2-29 ng/mL) Follicle Stimulating Hormone 45 mIU/mL (Follicular phase: 3.1-7.9 mIU/mL; Ovulation peak: 2.3-18.5 mIU/mL; Luteal phase: 1.4-5.5 mIU/mL) Estradiol 5 pg/mL (Mid-follicular phase: 27-123 pg/mL; Periovulatory: 96-436 pg/mL; Mid-luteal phase: 49-294 pg/mL) Which of the following is the most likely diagnosis in this patient?? {'A': 'Polycystic ovary syndrome (PCOS)', 'B': 'Breast cancer', 'C': 'Pituitary adenoma', 'D': 'Hyperthyroidism', 'E': 'Primary ovarian insufficiency (POI)'},
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E: Primary ovarian insufficiency (POI)
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Q:A 52-year-old female was found upon mammography to have branching calcifications in the right lower breast. Physical exam revealed a palpable nodularity in the same location. A tissue biopsy was taken from the lesion, and the pathology report diagnosed the lesion as comedocarcinoma. Which of the following histological findings is most likely present in the lesion?? {'A': 'Orderly rows of cells surrounding lobules', 'B': 'Disordered glandular cells invading the ductal basement membrane', 'C': 'Extensive lymphocytic infiltrate', 'D': 'Halo cells in epidermal tissue', 'E': 'Pleomorphic cells surrounding areas of caseous necrosis'},
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E: Pleomorphic cells surrounding areas of caseous necrosis
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Q:A 6-year-old male presents to the pediatrician with seizures. His mother reports that the patient has had two seizures lasting about 30 seconds each over the last three days. She reports that the patient has previously had seizures a few times per year since he was 12 months of age. The patient’s past medical history is otherwise notable for intellectual disability. He rolled over at 14 months of age and walked at 24 months of age. The patient’s mother denies any family history of epilepsy or other neurologic diseases. The patient is in the 3rd percentile for height and the 15th percentile for weight. On physical exam, he has a happy demeanor with frequent smiling. The patient has strabismus and an ataxic gait accompanied by flapping of the hands. He responds intermittently to questions with one-word answers. This patient is most likely to have which of the following genetic abnormalities?? {'A': 'Chromosomal macrodeletion on chromosome 5', 'B': 'Imprinting defect on chromosome 11', 'C': 'Maternal uniparental disomy of chromosome 15', 'D': 'Paternal uniparental disomy of chromosome 15', 'E': 'Trinucleotide repeat disorder'},
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D: Paternal uniparental disomy of chromosome 15
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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 comes to the physician for the evaluation of progressive loss of vision in her left eye and gradual blurring of vision in her right eye over the past 2 months. She also says that she has had occasional headaches and has noticed a decrease in her sense of smell lately. The patient's only medication is fexofenadine for seasonal allergies. She is 158 cm (5 ft 2 in) tall and weighs 61 kg (135 lbs); BMI is 24.7 kg/m2. Vital signs are within normal limits. Visual acuity is 20/40 in the right eye and there is minimal light perception in the left eye. In the swinging flashlight test, both of her eyes dilate as the light moves from the right to left eye. Fundoscopy shows papilledema in the right optic disc and a pale left optic disc. The remainder of the examination shows no abnormalities. Which of the following is the most likely diagnosis?? {'A': 'Hereditary optic neuropathy', 'B': 'Pseudotumor cerebri', 'C': 'Anterior ischemic optic neuropathy', 'D': 'Meningioma', 'E': 'Multiple sclerosis'},
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D: Meningioma
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Answer the following medical question with one of the provided options:
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Q:A 28-year-old man presents to his primary care physician for a general checkup. The patient is a healthy young man with no significant past medical history. He is a MD/PhD student and lives in New York City. He exercises frequently and is doing very well in school. He is currently sexually active with multiple female partners and does not use protection. His temperature is 98.9°F (37.2°C), blood pressure is 147/98 mmHg, pulse is 90/min, respirations are 14/min, and oxygen saturation is 99% on room air. Physical exam is notable for a very muscular young man. The patient has comedonal acne and palpable breast tissue. Testicular exam reveals small and symmetrical testicles. Which of the following laboratory changes is most likely to be found in this patient?? {'A': 'Decreased bone density', 'B': 'Decreased GnRH', 'C': 'Decreased LDL', 'D': 'Increased HDL', 'E': 'Increased sperm count'},
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B: Decreased GnRH
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Answer the following medical question with one of the provided options:
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Q:A 72-year-old man presents to the physician with blood in his sputum for 3 days. He also mentions that he has had a cough for the last 3 months but thought that it was because of the winter season. He also has often experienced fatigue recently. His temperature is 37.0°C (98.6°F), the respiratory rate is 15/min, the pulse is 67/min, and the blood pressure is 122/98 mm Hg. Auscultation of his chest reveals normal heart sounds but localized rhonchi over the right infrascapular region. A detailed diagnostic evaluation including a complete blood count and other serum biochemistry, chest radiogram, computed tomography of chest and abdomen, magnetic resonance imaging of the brain, bone scan, and pulmonary function tests are ordered, which confirm a diagnosis of limited-disease small cell lung cancer of 2.5 cm (1 in) in diameter, located in the lower lobe of the right lung, with the involvement of ipsilateral hilar lymph nodes and intrapulmonary lymph nodes. The mediastinal, subcarinal, scalene or supraclavicular lymph nodes are not involved, and there is no distant metastasis. There is no additional comorbidity and his performance status is good. The patient does not have any contraindication to any chemotherapeutic agents or radiotherapy. Which of the following is the best treatment option for this patient?? {'A': 'Lobectomy with adjuvant topotecan-based chemotherapy', 'B': 'Pneumonectomy with adjuvant platinum-based chemotherapy and thoracic radiation therapy', 'C': 'Platinum-based chemotherapy plus etoposide and thoracic radiation therapy', 'D': 'Topotecan-based chemotherapy plus thoracic radiation therapy', 'E': 'Thoracic radiation therapy followed by prophylactic cranial irradiation'},
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C: Platinum-based chemotherapy plus etoposide and thoracic radiation therapy
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Answer the following medical question with one of the provided options:
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Q:A 34-year-old man is brought to a psychiatric hospital by friends for erratic behavior. He has been up for the past several nights painting his apartment walls purple and reading the Bible out loud, as well as talking fast and making sexually provocative comments. Collateral information from family reveals 2 similar episodes last year. Mental status exam is notable for labile affect and grandiose delusions. Urine toxicology is negative. The patient is admitted and started on lithium for mania. His symptoms resolve within 2 weeks. How should this patient’s lithium be managed in anticipation of discharge?? {'A': 'Continue lithium lifelong', 'B': 'Continue lithium until a therapeutic serum lithium level is reached, then taper it', 'C': 'Cross-taper lithium to aripiprazole for maintenance therapy', 'D': 'Cross-taper lithium to valproic acid for maintenance therapy', 'E': 'Discontinue lithium, but re-start in the future if the patient has another manic episode'},
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A: Continue lithium lifelong
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