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Answer the following medical question with one of the provided options:
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Q:A 36-year-old woman gravida 5, para 4 was admitted at 31 weeks of gestation with worsening fatigue and shortness of breath on exertion for the past month. She also has nausea and loss of appetite. No significant past medical history. The patient denies any smoking history, alcohol or illicit drug use. Her vital signs include: blood pressure 110/60 mm Hg, pulse 120/min, respiratory rate 22/min and temperature 35.1℃ (97.0℉). A complete blood count reveals a macrocytosis with severe pancytopenia, as follows: Hb 7.2 g/dL RBC 3.6 million/uL WBC 4,400/mm3 Neutrophils 40% Lymphocytes 20% Platelets 15,000/mm3 MCV 104 fL Reticulocytes 0.9% Serum ferritin and vitamin B12 levels were within normal limits. There was an elevated homocysteine level and a normal methylmalonic acid level. Which of the following is the most likely diagnosis in this patient?? {'A': 'Vitamin B12 deficiency', 'B': 'Iron deficiency anemia', 'C': 'Folate deficiency', 'D': 'Normal pregnancy', 'E': 'Aplastic anemia'},
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C: Folate deficiency
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Answer the following medical question with one of the provided options:
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Q:A 78-year-old Caucasian male actor presents to your office complaining of a dry, non-productive cough. He has a history of hypertension, diabetes, and coronary artery disease and he follows a complicated regimen of medications to treat his multiple co-morbidities. Which of the following medications is most likely to be associated with his chief complaint?? {'A': 'Aspirin', 'B': 'Lisinopril', 'C': 'Hydrochlorothiazide', 'D': 'Metoprolol', 'E': 'Nifedipine'},
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B: Lisinopril
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Answer the following medical question with one of the provided options:
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Q:An investigator studying viral mutation isolates a virus strain from the gastric contents of an infant with gastroenteritis. This virus has a nonenveloped RNA genome with 11 segments and a helical symmetrical capsid. The investigator finds that if 2 strains of this virus coinfect a single host cell, some of the resulting viral progeny have genome segments derived from both parental viruses. The observed phenomenon is most likely also seen in which of the following viral families?? {'A': 'Flaviviruses', 'B': 'Orthomyxoviruses', 'C': 'Caliciviruses', 'D': 'Picornaviruses', 'E': 'Retroviruses'},
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B: Orthomyxoviruses
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Answer the following medical question with one of the provided options:
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Q:Please refer to the summary above to answer this question Administration of which of the following is most likely to improve this patient's current symptoms?" "Patient information Age: 82 years Gender: M, self-identified Ethnicity: Caucasian Site of care: office History Reason for Visit/Chief Concern: “I have been getting these large bruises on my arms and legs.” History of Present Illness: his wife noticed 6 weeks ago that he had bruising on the bilateral lower extremities additional ecchymoses developed on the bilateral upper extremities 2 weeks ago feels increasingly fatigued has joint pain of the elbows, hips, and knees was unable to complete his final cycle of chemotherapy for non-small cell lung carcinoma because of the pain has not had trauma or prior episodes of significant bleeding Past Medical History: hypertension benign prostatic hyperplasia osteoarthritis non-small cell lung carcinoma: treated with resection, currently undergoing adjuvant chemotherapy Social History: lives with his wife has been eating sparingly has smoked 2 packs of cigarettes daily for 60 years Medications: amlodipine, lisinopril, tamsulosin, acetaminophen; currently undergoing cisplatin-based chemotherapy Allergies: no known drug allergies Physical Examination Temp Pulse Resp. BP O2 Sat Ht Wt BMI 36.6°C (97.8°F) 88/min 20/min 128/83 mm Hg 96% 175 cm (5 ft 9 in) 53 kg (117 lb) 17 kg/m2 Appearance: pale, tired-appearing, cachectic man, sitting in a wheelchair HEENT: mild mucosal bleeding Pulmonary: diminished breath sounds in the left lower lung field; moderate inspiratory wheezes bilaterally; no rales or rhonchi Cardiac: normal S1 and S2; no murmurs, rubs, or gallops Abdominal: soft; nontender; nondistended; normal bowel sounds Extremities: symmetrically cool; no edema Skin: coiled hairs with perifollicular hemorrhages; multiple ecchymoses of the bilateral upper and lower extremities Neurologic: symmetrically decreased sensation to pinprick, vibration, and fine touch in the distal lower extremities"? {'A': 'Vitamin C', 'B': 'Vitamin A', 'C': 'Vitamin B12', 'D': 'Vitamin B6', 'E': 'Vitamin K\n"'},
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A: Vitamin C
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Answer the following medical question with one of the provided options:
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Q:A 53-year-old woman comes to the emergency department because of weakness and abdominal pain for 24 hours. She has had three bowel movements with dark stool during this period. She has not had vomiting and has never had such episodes in the past. She underwent a tubal ligation 15 years ago. She has chronic lower extremity lymphedema, osteoarthritis, and type 2 diabetes mellitus. Her father died of colon cancer at the age of 72 years. Current medications include metformin, naproxen, and calcium with vitamin D3. She had a screening colonoscopy at 50 years of age which was normal. She appears pale and diaphoretic. Her temperature is 36°C (96.8°F), pulse is 110/min, respirations are 20/min, and blood pressure is 90/50 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 98%. The abdomen is soft and nondistended with mild epigastric tenderness. Rectal exam shows tarry stool. Two large bore IV lines are placed and fluid resuscitation with normal saline is initiated. Which of the following is the most appropriate next step in management?? {'A': 'CT scan of the abdomen with contrast', 'B': 'Diagnostic laparoscopy', 'C': 'Colonoscopy', 'D': 'Flexible sigmoidoscopy', 'E': 'Esophagogastroduodenoscopy'},
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E: Esophagogastroduodenoscopy
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Answer the following medical question with one of the provided options:
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Q:A 66-year-old woman with no significant past medical, past surgical, or family history presents with new symptoms of chest pain, an oral rash, and pain with swallowing. She lost her husband several months earlier and has moved into an elderly assisted living community. She states that her symptoms began several weeks earlier. Physical examination reveals numerous white plaques on her buccal mucosa and tongue. What is the next step in the patient’s management?? {'A': 'Single contrast esophagram with barium sulfate contrast', 'B': 'Modified barium swallow', 'C': 'Denture fitting assessment', 'D': 'CD4 count', 'E': 'Single contrast esophagram with water soluble iodine contrast'},
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D: CD4 count
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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 presents to the emergency department with a fever and fatigue. He states that he has not felt well since he returned from a hiking trip in Alabama. He is generally healthy and has no other medical conditions. His temperature is 101°F (38.3°C), blood pressure is 127/85 mmHg, pulse is 108/min, respirations are 14/min, and oxygen saturation is 99% on room air. Physical exam including a full dermatologic inspection is unremarkable. Laboratory studies are ordered as seen below. Hemoglobin: 13 g/dL Hematocrit: 39% Leukocyte count: 2,200/mm^3 with normal differential Platelet count: 77,000/mm^3 Serum: Na+: 139 mEq/L Cl-: 100 mEq/L K+: 4.3 mEq/L HCO3-: 24 mEq/L BUN: 19 mg/dL Glucose: 98 mg/dL Creatinine: 1.3 mg/dL Ca2+: 10.2 mg/dL AST: 92 U/L ALT: 100 U/L Which of the following is the most likely diagnosis?? {'A': 'Babesiosis', 'B': 'Ehrlichiosis', 'C': 'Influenza', 'D': 'Lyme disease', 'E': 'Rocky mountain spotted fever'},
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B: Ehrlichiosis
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Answer the following medical question with one of the provided options:
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Q:A 42-year-old woman comes to the physician for evaluation of a 6-month history of irregular menstrual periods. Her last period was 3 months ago. Previously, her periods occurred at regular 28-day intervals and lasted 4–5 days with moderate flow. She has also noticed breast tenderness and scant nipple discharge. She has type 2 diabetes mellitus and refractory bipolar I disorder. Current medications include metformin, glipizide, lithium, and risperidone. Physical examination shows no abnormalities. A urine pregnancy test is negative. Which of the following is the most likely cause of the changes in her menstrual cycle?? {'A': 'Dysregulation of theca and granulosa cell steroidogenesis', 'B': 'Reduced renal elimination of prolactin', 'C': 'Impaired production and release of thyroxine', 'D': 'Failure of ovaries to respond to gonadotropins', 'E': 'Blockade of pituitary dopamine receptors'},
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E: Blockade of pituitary dopamine receptors
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Answer the following medical question with one of the provided options:
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Q:A 15-year-old boy is brought to the physician by his mother for a well-child examination. He recently stopped attending his swim classes. The patient is at the 97th percentile for height and the 50th percentile for weight. Examination shows decreased facial hair, bilateral breast enlargement, and long extremities. Genital examination shows scant pubic hair, small testes, and a normal-sized penis. Further evaluation is most likely to show which of the following karyotypes?? {'A': '47,XYY', 'B': '46,XX/46,XY', 'C': '45,XO', 'D': '47,XXY', 'E': '45,XO/46,XX'},
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D: 47,XXY
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Answer the following medical question with one of the provided options:
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Q:A 14-year-old girl comes to the physician for exertional leg pain. The pain began last week when she started jogging to lose weight. She is at the 5th percentile for height and 80th percentile for weight. Physical examination shows a broad neck with bilateral excess skin folds that extend to the shoulders, as well as a low-set hairline and ears. There is an increased carrying angle when she fully extends her arms at her sides. Pulses are palpable in all extremities; lower leg pulses are delayed. Which of the following additional findings is most likely in this patient?? {'A': 'Ovarian dysgenesis', 'B': 'Absent uterus', 'C': 'Mitral valve prolapse', 'D': 'Triphalangeal thumb', 'E': 'Horseshoe adrenal gland'},
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A: Ovarian dysgenesis
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Answer the following medical question with one of the provided options:
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Q:A 5-year-old boy is brought to the physician because of recurrent respiratory infections and difficulty walking for 2 months. Physical examination shows numerous telangiectasias on the nose, ears, and neck. There is overshoot on the finger-to-nose test. He has a narrow-based gait. Genetic analysis shows a nonsense mutation in the ataxia-telangiectasia gene (ATM gene). Sequencing of the encoded truncated protein shows that the C-terminal amino acid is not methionine but another amino acid. The last correctly incorporated amino acid is most likely encoded by which of the following tRNA anticodons?? {'A': "3'AUU5'", 'B': "3'UAC5'", 'C': "3'ACC5'", 'D': "3'ACU5'", 'E': "3'AUC5'"},
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C: 3'ACC5'
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Answer the following medical question with one of the provided options:
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Q:An 8-year-old child with “elfin” facial features is very friendly with strangers. He has a history of mild mental retardation, and a hemizygous deletion on chromosome 7q11.23, that includes a portion of the elastin gene. Which of the following is most likely true in this patient?? {'A': 'Carpopedal spasm induced by sphygmomanometer inflation', 'B': 'Vitamin D supplementation is recommended', 'C': 'Holosystolic murmur heard at the apex with radiation to the axilla', 'D': 'Symptoms may develop secondary to left ventricular outflow tract obstruction', 'E': 'This patient is less likely to experience angina'},
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D: Symptoms may develop secondary to left ventricular outflow tract obstruction
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Answer the following medical question with one of the provided options:
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Q:A study aimed to evaluate the relationship between inflammatory markers and lipid metabolism in individuals with rheumatoid arthritis (RA) recruited 252 patients with RA in a tertiary care hospital. Fasting blood samples were taken for lipid profiling and for the assessment of inflammatory markers such as C-reactive protein (CRP) and erythrocyte sedimentation rate. The relationship between CRP and total cholesterol was assessed using Pearson’s correlation coefficient. A scatter plot between CRP and total cholesterol can be seen in the picture. Based on the scatter plot, which of the following can be correctly concluded about the value of the Pearson correlation coefficient, r, for CRP and total cholesterol?? {'A': 'r value is exactly +1', 'B': 'r value lies between 0 and +1', 'C': 'r value is exactly 0', 'D': 'r value lies between 0 and -1', 'E': 'r value is exactly -1'},
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D: r value lies between 0 and -1
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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, gravida 1, para 0, at 33 weeks' gestation comes to her doctor for a routine visit. Her pregnancy has been uncomplicated. She has systemic lupus erythematosus and has had no flares during her pregnancy. She does not smoke cigarettes, drink alcohol, or use illicit drugs. Current medications include iron, vitamin supplements, and hydroxychloroquine. Her temperature is 37.2°C (98.9°F), pulse is 70/min, respirations are 17/min, and blood pressure is 134/70 mm Hg. She appears well. Physical examination shows no abnormalities. Ultrasound demonstrates fetal rhythmic breathing for > 30 seconds, amniotic fluid with deepest vertical pocket of 1 cm, one distinct fetal body movement over 30 minutes, and no episodes of extremity extension over 30 minutes. Nonstress test is reactive and reassuring. Which of the following is the next best step in management?? {'A': 'Perform cesarean delivery', 'B': 'Discontinue hydroxychloroquine and continue close monitoring', 'C': 'Administer corticosteroids and continue close monitoring', 'D': 'Induction of labor', 'E': 'Reassurance with expectant management'},
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D: Induction of labor
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Answer the following medical question with one of the provided options:
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Q:A 15-year-old girl is brought to the physician by her parents because she has not had menstrual bleeding for the past 2 months. Menses had previously occurred at irregular 15–45 day intervals with moderate to heavy flow. Menarche was at the age of 14 years. Eight months ago, she was diagnosed with bipolar disorder and treatment with risperidone was begun. Her parents report that she is very conscious of her weight and appearance. She is 168 cm (5 ft 5 in) tall and weighs 76 kg (168 lb); BMI is 26.9 kg/m2. Pelvic examination shows a normal vagina and cervix. Serum hormone studies show: Prolactin 14 ng/mL Follicle-stimulating hormone 5 mIU/mL Luteinizing hormone 5.2 mIU/mL Progesterone 0.9 ng/mL (follicular N <3; luteal N >3–5) Testosterone 2.7 nmol/L (N <3.5) A urine pregnancy test is negative. Which of the following is the most likely cause of her symptoms?"? {'A': 'Primary ovarian insufficiency', 'B': 'Anovulatory cycles', 'C': 'Uterine leiomyomas', 'D': 'Adverse effect of medication', 'E': 'Self-induced vomiting'},
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B: Anovulatory cycles
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Answer the following medical question with one of the provided options:
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Q:A 52-year-old man is brought to the emergency department because of headaches, vertigo, and changes to his personality for the past few weeks. He was diagnosed with HIV 14 years ago and was started on antiretroviral therapy at that time. Medical records from one month ago indicate that he followed his medication schedule inconsistently. Since then, he has been regularly taking his antiretroviral medications and trimethoprim-sulfamethoxazole. His vital signs are within normal limits. Neurological examination shows ataxia and apathy. Mini-Mental State Examination score is 15/30. Laboratory studies show: Hemoglobin 12.5 g/dL Leukocyte count 8400/mm3 Segmented neutrophils 80% Eosinophils 1% Lymphocytes 17% Monocytes 2% CD4+ T-lymphocytes 90/μL Platelet count 328,000/mm3 An MRI of the brain with contrast shows a solitary ring-enhancing lesion involving the corpus callosum and measuring 4.5 cm in diameter. A lumbar puncture with subsequent cerebrospinal fluid analysis shows slight pleocytosis, and PCR is positive for Epstein-Barr virus DNA. Which of the following is the most likely diagnosis?"? {'A': 'AIDS dementia', 'B': 'CNS lymphoma', 'C': 'Progressive multifocal leukoencephalopathy', 'D': 'Bacterial brain abscess', 'E': 'Glioblastoma\n"'},
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B: CNS lymphoma
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Answer the following medical question with one of the provided options:
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Q:A 52-year-old man comes to the physician because of right shoulder pain that began after he repainted his house 1 week ago. Physical examination shows right subacromial tenderness. The pain is reproduced when the patient is asked to abduct the shoulder against resistance with the arm flexed forward by 30° and the thumb pointing downwards. The tendon of which of the following muscles is most likely to be injured in this patient?? {'A': 'Supraspinatus', 'B': 'Subscapularis', 'C': 'Infraspinatus', 'D': 'Teres minor', 'E': 'Deltoid'},
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A: Supraspinatus
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Answer the following medical question with one of the provided options:
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Q:A 19-year-old woman presents to the primary care clinic to establish care. She has no acute complaints or concerns. Upon further questioning, she shares that she gets frequent nosebleeds and often bleeds from her gums a little after brushing her teeth. She also typically has relatively heavy menstrual periods, soaking eight tampons per day. She has not had any serious bleeding events, and she has never had a blood transfusion. Physical exam is unremarkable. A complete blood count shows mild anemia with a normal platelet count. Which of the following is the next best step in the management of this patient?? {'A': 'Perform bone marrow biopsy', 'B': 'Start corticosteroids', 'C': 'Start desmopressin', 'D': 'Start intravenous immunoglobulin', 'E': 'Perform platelet aggregation tests'},
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E: Perform platelet aggregation tests
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Answer the following medical question with one of the provided options:
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Q:A 23-year-old woman is brought to the physician by her father because of irritability, mood swings, and difficulty sleeping over the past 10 days. A few days ago, she quit her job and spent all of her savings on supplies for a “genius business plan.” She has been energetic despite sleeping only 1–2 hours each night. She was diagnosed with major depressive disorder 2 years ago. Mental status examination shows pressured speech, a labile affect, and flight of ideas. Throughout the examination, she repeatedly states “I feel great, I don't need to be here.” Urine toxicology screening is negative. Which of the following is the most likely diagnosis?? {'A': 'Delusional disorder', 'B': 'Bipolar disorder type II', 'C': 'Bipolar disorder type I', 'D': 'Schizoaffective disorder', 'E': 'Attention-deficit hyperactivity disorder'},
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C: Bipolar disorder type I
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Answer the following medical question with one of the provided options:
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Q:A previously healthy 6-year-old girl is brought to the physician by her parents because of slowed growth and fatigue. Over the past year, she went from average height for her age group to the shortest in her class. She has also been having more problems concentrating in class and is less interested in playing. She has not had any change in appetite or diet. She is at the 10th percentile for height and the 90th percentile for weight. Vital signs are within normal limits. There is a nontender mass palpated on the anterior cervical examination. Serum laboratory studies show thyroid-stimulating hormone level of 6.7 μU/mL. Further evaluation is most likely to show which of the following findings?? {'A': 'Lymphocytic infiltration on fine needle aspiration', 'B': 'Positive serum thyroid stimulating hormone receptor antibody', 'C': 'Psammoma bodies on fine needle aspiration', 'D': 'Increased uptake on I-131 scan in a discrete 1-cm nodule', 'E': 'Low urine iodine levels\n"'},
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A: Lymphocytic infiltration on fine needle aspiration
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Answer the following medical question with one of the provided options:
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Q:A 5-year-old non-verbal child with a history of autism is brought into the emergency department by his grandmother. The patient’s grandmother is concerned her grandchild is being abused at home. The patient lives in an apartment with his mother, step-father, and two older brothers in low-income housing. The department of social services has an open case regarding this patient and his family. The patient is afebrile. His vital signs include: blood pressure 97/62 mm Hg, pulse 175/min, respiratory rate 62/min. Physical examination reveals a malnourished and dehydrated child in dirty and foul-smelling clothes. Which one of the following people is most likely abusing this patient?? {'A': 'Mother', 'B': 'Step-father', 'C': 'Brother', 'D': 'Neighbor', 'E': 'Stranger'},
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A: Mother
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Answer the following medical question with one of the provided options:
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Q:BACKGROUND: Aldosterone blockade reduces mortality and morbidity among patients with severe heart failure. We conducted a double-blind, placebo-controlled study evaluating the effect of eplerenone, a selective aldosterone blocker, on morbidity and mortality among patients with acute myocardial infarction complicated by left ventricular dysfunction and heart failure. METHODS: Patients were randomly assigned to eplerenone (25 mg per day initially, titrated to a maximum of 50 mg per day; 3,319 patients) or placebo (3,313 patients) in addition to optimal medical therapy. The study continued until 1,012 deaths occurred. The primary endpoints were death from any cause, death from cardiovascular causes, hospitalization for a heart failure exacerbation, acute myocardial infarction, stroke, or ventricular arrhythmia. RESULTS: During a mean follow-up of 16 months, there were 478 deaths in the eplerenone group and 554 deaths in the placebo group (relative risk, 0.85; 95% confidence interval, 0.75 to 0.96; p=0.008). Of these deaths, 407 in the eplerenone group and 483 in the placebo group were attributed to cardiovascular causes (relative risk, 0.83; 95% confidence interval, 0.72 to 0.94; p=0.005). The rate of the other primary endpoints, death from cardiovascular causes or hospitalization for cardiovascular events, was reduced by eplerenone (relative risk, 0.87; 95% confidence interval, 0.79 to 0.95; p=0.002), as was the secondary endpoint of death from any cause or any hospitalization (relative risk, 0.92; 95% confidence interval, 0.86 to 0.98; p=0.02). There was also a reduction in the rate of sudden death from cardiac causes (relative risk, 0.79; 95% confidence interval, 0.64 to 0.97; p=0.03). The rate of serious hyperkalemia was 5.5% in the eplerenone group and 3.9% in the placebo group (p=0.002), whereas the rate of hypokalemia was 8.4% in the eplerenone group and 13.1% in the placebo group (p<0.001). Which of the following represents the relative risk reduction (RRR) in all-cause mortality, the primary endpoint, in patients supplemented with eplerenone?? {'A': '0.15', 'B': '0.17', 'C': '0.13', 'D': '0.08', 'E': '0.21'},
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A: 0.15
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Answer the following medical question with one of the provided options:
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Q:A 20-year-old woman comes to the physician for the evaluation of fatigue and low energy levels for 2 months. She has not had fever or weight changes. She has no history of serious illness except for an episode of infectious mononucleosis 4 weeks ago. Menses occur at regular 28-day intervals and last 5 days with moderate flow. Her last menstrual period was 3 weeks ago. Her mother has Hashimoto's thyroiditis. Vital signs are within normal limits. Examination shows pale conjunctivae, inflammation of the corners of the mouth, and brittle nails. The remainder of the examination shows no abnormalities. Laboratory studies show: Hemoglobin 10.3 g/dL Mean corpuscular volume 74 μm3 Platelet count 280,000/mm3 Leukocyte count 6,000/mm3 Which of the following is the most appropriate initial step in management?"? {'A': 'Iron studies', 'B': 'Vitamin B12 levels', 'C': 'Hemoglobin electrophoresis', 'D': 'Peripheral blood smear', 'E': 'Direct Coombs test'},
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A: Iron studies
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Answer the following medical question with one of the provided options:
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Q:A 15-year-old boy is brought to the clinic by his father for complaints of “constant irritation.” His father explains that ever since his divorce with the son’s mother last year he has noticed increased irritability in his son. "He has been skipping out on his baseball practices which he has always enjoyed,” his dad complains. After asking the father to step out, the patient reports trouble concentrating at school and has been staying up late “just thinking about stuff.” When probed further, he states that he “feels responsible for his parents' divorce because he was being rebellious.” What is the best treatment for this patient at this time?? {'A': 'Buspirone', 'B': 'Escitalopram', 'C': 'Quetiapine', 'D': 'Methylphenidate', 'E': 'Venlafaxine'},
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B: Escitalopram
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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 room by his mother with complaints of abdominal pain and fever that started 24 hours ago. On further questioning, the mother says that her son vomited twice and has constipation that started approximately 1 and one-half days ago. The medical history is benign. The vital signs are as follows: heart rate 103/min, respiratory rate of 20/min, temperature 38.7°C (101.66°F), and blood pressure 109/69 mm Hg. On physical examination, there is severe right lower quadrant abdominal tenderness on palpation. Which of the following is the most likely cause for this patient’s symptoms?? {'A': 'Luminal obstruction due to a fecalith', 'B': 'Twisting of testes on its axis, hampering the blood supply', 'C': 'Ascending infection of the urinary tract', 'D': 'Luminal obstruction preventing passage of gastrointestinal contents', 'E': 'Immune-mediated vasculitis associated with IgA deposition'},
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A: Luminal obstruction due to a fecalith
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Q:A 32-year-old man comes to the emergency department because of a wound in his foot. Four days ago, he stepped on a nail while barefoot at the beach. Examination of the plantar surface of his right foot shows a purulent puncture wound at the base of his second toe with erythema and tenderness of the surrounding skin. The afferent lymphatic vessels from the site of the lesion drain directly into which of the following groups of regional lymph nodes?? {'A': 'Deep inguinal', 'B': 'Superficial inguinal', 'C': 'External iliac', 'D': 'Popliteal', 'E': 'Anterior tibial'},
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B: Superficial inguinal
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Answer the following medical question with one of the provided options:
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Q:A 60-year-old male is admitted to the ICU for severe hypertension complicated by a headache. The patient has a past medical history of insulin-controlled diabetes, hypertension, and hyperlipidemia. He smokes 2 packs of cigarettes per day. He states that he forgot to take his medications yesterday and started getting a headache about one hour ago. His vitals on admission are the following: blood pressure of 160/110 mmHg, pulse 95/min, temperature 98.6 deg F (37.2 deg C), and respirations 20/min. On exam, the patient has an audible abdominal bruit. After administration of antihypertensive medications, the patient has a blood pressure of 178/120 mmHg. The patient reports his headache has increased to a 10/10 pain level, that he has trouble seeing, and he can't move his extremities. After stabilizing the patient, what is the best next step to diagnose the patient's condition?? {'A': 'CT head with intravenous contrast', 'B': 'CT head without intravenous contrast', 'C': 'MRI head with intravenous constrast', 'D': 'MRI head without intravenous constrast', 'E': 'Doppler ultrasound of the carotids'},
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B: CT head without intravenous contrast
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Answer the following medical question with one of the provided options:
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Q:A 23-year-old nulligravida presents for evaluation 5 weeks after her last menstrual period. Her previous menstruation cycle was regular, and her medical history is benign. She is sexually active with one partner and does not use contraception. A urine dipstick pregnancy test is negative. The vital signs are as follows: blood pressure 120/80 mm Hg, heart rate 71/min, respiratory rate 13/min, and temperature 36.8°C (98.2°F). The physical examination is notable for breast engorgement, increased pigmentation of the nipples, and linea alba. The gynecologic examination demonstrates cervical and vaginal cyanosis. Measurement of which of the following substances is most appropriate in this case?? {'A': 'Blood estriol', 'B': 'Urinary human chorionic gonadotropin', 'C': 'Blood progesterone', 'D': 'Urinary estrogen metabolites', 'E': 'Blood human chorionic gonadotropin'},
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E: Blood human chorionic gonadotropin
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Answer the following medical question with one of the provided options:
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Q:A scientist wants to extract mRNA from a cell line of interest, amplify a specific mRNA, and insert it into a plasmid so that he can transfect it into a cell in order to over-express that protein. Which of the following proteins is required for the first step of amplification of this mRNA?? {'A': 'Taq DNA polymerase', 'B': 'Ligase', 'C': 'Reverse transcriptase', 'D': 'Restriction digestion enzymes', 'E': 'RNA polymerase'},
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C: Reverse transcriptase
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Q:A 33-year-old pregnant woman undergoes a routine quad-screen during her second trimester. The quad-screen results demonstrate the following: decreased alpha-fetoprotein, increased Beta-hCG, decreased estriol, and increased inhibin A. A presumptive diagnosis is made based upon these findings and is later confirmed with genetic testing. After birth, this child is at greatest risk for which of the following hematologic malignancies?? {'A': 'Chronic lymphocytic leukemia', 'B': 'Hairy cell leukemia', 'C': 'Acute promyelocytic leukemia', 'D': 'Acute lymphoblastic leukemia', 'E': 'Chronic myelogenous leukemia'},
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D: Acute lymphoblastic leukemia
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Answer the following medical question with one of the provided options:
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Q:A 2-year-old girl is brought to her pediatrician’s office with intermittent and severe stomach ache and vomiting for the last 2 days. Last week the whole family had a stomach bug involving a few days of mild fever, lack of appetite, and diarrhea but they have all made a full recovery since. This current pain is different from the type she had during infection. With the onset of pain, the child cries and kicks her legs up in the air or pulls them to her chest. The parents have also observed mucousy stools and occasional bloody stools that are bright red and mucousy. After a while, the pain subsides and she returns to her normal activity. Which of the following would be the next step in the management of this patient?? {'A': 'Air enema', 'B': 'Abdominal CT scan', 'C': 'Abdominal radiograph', 'D': 'Surgical reduction', 'E': 'Observe for 24 hours'},
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A: Air enema
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Q:A 23-year-old woman presents to the emergency department with a 3-day history of fever and headache. She says that the symptoms started suddenly after she woke up 3 days ago, though she has been feeling increasingly fatigued over the last 5 months. On presentation, her temperature is 102°F (38.9°C), blood pressure is 117/74 mmHg, pulse is 106/min, and respirations are 14/min. Physical exam reveals diffuse petechiae and conjunctival pallor and selected laboratory results are shown as follows: Bleeding time: 11 minutes Platelet count: 68,000/mm^3 Lactate dehydrogenase: 105 U/L Which of the following would also most likely be true for this patient?? {'A': 'Decreased platelet aggregation on peripheral blood smear', 'B': 'Immune production of anti-platelet antibodies', 'C': 'Increased prothrombin time and partial thromboplastin time', 'D': 'Increased serum von Willebrand factor multimers', 'E': 'Large platelets on peripheral blood smear'},
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D: Increased serum von Willebrand factor multimers
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Q:A 27-year-old healthy college student presents to the clinic with her boyfriend complaining of a productive cough with rust-colored sputum associated with breathlessness for the past week. She also reports symptoms of the common cold which began about 1 week ago. She reports that her weekly routine has not changed despite feelings of being sick and generally weak. The vitals signs include a blood pressure 120/80 mm Hg, pulse rate 68/min, respiratory rate 12/min, and temperature 36.6°C (97.9°F). On pulmonary examination, inspiratory crackles were heard. The cardiac examination revealed an S3 sound but was otherwise normal. A chest X-ray was performed and is shown in the picture below. What medication is known to be associated with the same condition that she is suffering from?? {'A': 'Quinidine', 'B': 'Anthracyclines', 'C': 'Metoprolol', 'D': 'Vincristine', 'E': 'Cisplatin'},
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B: Anthracyclines
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Q:A 40-year-old Caucasian woman presents to the physician with urinary frequency, urgency, and pelvic pain for 1 week. She has poor sleep quality because her symptoms persist throughout the night, as well as the day. Her pain partially subsides with urination. She does not have dysuria or urinary incontinence. Her menstrual cycles are regular. Over the past 6 months, she has had several similar episodes, each lasting 1–2 weeks. She has been relatively symptom-free between episodes. Her symptoms began 6 months ago after an established diagnosis of cystitis, for which she was treated with appropriate antibiotics. Since that time, urine cultures have consistently been negative. Her past history is significant for a diagnosis of fibromyalgia 2 years ago, multiple uterine fibroids, irritable bowel syndrome, and depression. She takes tramadol occasionally and sertraline daily. The vital signs are within normal limits. The neurologic examination showed no abnormalities. Examination of the abdomen, pelvis, and rectum was unremarkable. Cystoscopy reinspection after full distension and drainage reveals small, petechial hemorrhages throughout the bladder except for the trigone. Which of the following is the most appropriate next step in management?? {'A': 'Amitriptyline', 'B': 'Behavior modification', 'C': 'Bladder hydrodistention', 'D': 'Intravesical dimethyl sulfoxide', 'E': 'Oxybutynin'},
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B: Behavior modification
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Q:A mother brings her 6-month-old boy to the emergency department. She reports that her son has been breathing faster than usual for the past 2 days, and she has noted occasional wheezing. She states that prior to the difficulty breathing, she noticed some clear nasal discharge for several days. The infant was born full-term, with no complications, and no significant medical history. His temperature is 100°F (37.8°C), blood pressure is 60/30 mmHg, pulse is 120/min, respirations are 40/min, and oxygen saturation is 95% on room air. Physical exam reveals expiratory wheezing, crackles diffusely, and intercostal retractions. The child is currently playing with toys. Which of the following is the most appropriate next step in management?? {'A': 'Albuterol', 'B': 'Azithromycin and ceftriaxone', 'C': 'Chest radiograph', 'D': 'Intubation', 'E': 'Monitoring'},
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E: Monitoring
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Q:A patient presents to the emergency room in an obtunded state. The patient is a known nurse within the hospital system and has no history of any medical problems. A finger stick blood glucose is drawn showing a blood glucose of 25 mg/dL. The patient's daughter immediately arrives at the hospital stating that her mother has been depressed recently and that she found empty syringes in the bathroom at the mother's home. Which of the following is the test that will likely reveal the diagnosis?? {'A': 'Genetic testing', 'B': 'C-peptide level', 'C': '24 hr cortisol', 'D': 'Fasting blood glucose', 'E': 'Urine metanephrines'},
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B: C-peptide level
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Q:A 38-year-old project manager is told by her boss that her team will need to work on an additional project in the coming week for a very important client. This frustrates the woman, who already feels that she works too many hours. Instead of discussing her feelings directly with her boss, the woman leaves a voice message for her boss the next day and deceitfully says she cannot come to work for the next week because of a family emergency. Which of the following psychological defense mechanisms is this individual demonstrating?? {'A': 'Acting out', 'B': 'Displacement', 'C': 'Passive aggression', 'D': 'Malingering', 'E': 'Blocking'},
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C: Passive aggression
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Q:An 83-year-old woman with fever, malaise, and cough for the past 24 hours is brought to the emergency department. She lives in an assisted living facility, and several of her neighbors have had similar symptoms. She has a past medical history of hypertension treated with lisinopril. Her temperature is 38.9°C (102.2°F), pulse is 105/min, respirations are 22/min, and blood pressure is 112/62 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 88%. Her leukocyte count is 10,500/mm3, and serum creatinine is 0.9 mg/dL. An X-ray of the chest shows bilateral reticulonodular opacities in the lower lobes. Serum procalcitonin level is 0.06 µg/L (N < 0.06 µg/L). What mechanism of action is the appropriate next step to manage her condition?? {'A': 'Inhibition of DNA polymerase', 'B': 'Inhibition of neuraminidase', 'C': 'Inhibition of nucleoside reverse transcriptase', 'D': 'Inhibition of protease', 'E': 'Inhibition of proton translocation'},
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B: Inhibition of neuraminidase
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Q:A 36-year-old woman presents for a pre-employment health assessment. She has no complaints. Her last annual physical examination 8 months ago was normal. She has no significant past medical history. She is a nonsmoker and says she quit all alcohol consumption last year. A complete hepatic biochemistry panel is performed, which is significant for a serum alkaline phosphatase (ALP) level 5 times the upper limit of the normal range. Immunologic tests are positive for antimitochondrial antibodies. A liver biopsy is performed and reveals an inflammatory infiltrate surrounding the biliary ducts. Which of the following is the most likely diagnosis in this patient?? {'A': 'Hepatic amyloidosis', 'B': 'Fascioliasis', 'C': 'Primary biliary cholangitis', 'D': 'Pancreatic cancer', 'E': 'Choledocolithiasis'},
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C: Primary biliary cholangitis
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Q:A 60-year-old Caucasian man is brought to the emergency department by his roommate after he reportedly ingested a bottle of Tylenol. He reports being suddenly sad and very lonely and impulsively overdosed on some pills that he had laying around. He then immediately induced vomiting and regurgitated most of the pills back up and rushed to his roommate for help. The patient has a past medical history significant for hypertension and diabetes. He takes chlorthalidone, methadone, and glimepiride regularly. He lives in a room alone with no family and mostly keeps to himself. The patient’s vital signs are normal. Physical examination is unremarkable. The patient says that he still enjoys his life and regrets trying to overdose on the pills. He says that he will probably be fine for the next few days but has another bottle of pills he can take if he starts to feel sad again. Which of the following is the best predictor of this patient attempting to commit suicide again in the future?? {'A': 'He has a previous attempt', 'B': 'He has a plan', 'C': 'His age', 'D': 'His race', 'E': 'His lack of social support'},
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A: He has a previous attempt
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Q:A 59-year-old man is brought to the physician by his wife for a psychiatric evaluation. Over the past 12 months, his behavior has become increasingly disruptive. His wife no longer brings him along shopping because he has attempted to grope a female cashier on 2 occasions. He has begun to address the mail carrier using a racial epithet. Three years later, the patient dies. Light microscopy of sections of the frontal and temporal lobes shows intracellular inclusions of transactive response DNA binding protein (TDP-43). These proteins are bound to a regulatory molecule that usually marks them for degradation. The regulatory molecule in question is most likely which of the following?? {'A': 'Kinesin', 'B': 'Cyclin', 'C': 'Ubiquitin', 'D': 'Chaperone', 'E': 'Clathrin\n"'},
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C: Ubiquitin
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Q:A 73-year-old man presents to your office accompanied by his wife. He has been experiencing a tremor in his right hand for the last several months that seems to be worsening. He does not have any other complaints and says he’s “fine.” His wife thinks that he has also had more difficulty walking. His history is significant for hypertension and an ischemic stroke of the right middle cerebral artery 2 years ago. His medications include hydrochlorothiazide and daily aspirin. On physical exam you note that the patient speaks with a soft voice and has decreased facial expressions. He has a resting tremor that is worse on the right side. He has increased resistance to passive movement when you flex and extend his relaxed wrist. He has 5/5 strength bilaterally. Neuronal degeneration in which of the following locations is most likely responsible for the progression of this disease?? {'A': 'Substantia nigra pars compacta', 'B': 'Frontotemporal lobe', 'C': 'Subthalamic nucleus', 'D': 'Caudate and putamen', 'E': 'Vermis'},
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A: Substantia nigra pars compacta
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Q:A 42-year-old woman, gravida 3, para 3 comes to the physician because of a 14-month history of prolonged and heavy menstrual bleeding. Menses occur at regular 28-day intervals and last 7 days with heavy flow. She also feels fatigued. She is sexually active with her husband and does not use contraception. Vital signs are within normal limits. Pelvic examination shows a firm, irregularly-shaped uterus consistent in size with a 16-week gestation. Her hemoglobin concentration is 9 g/dL, hematocrit is 30%, and mean corpuscular volume is 92 μm3. Pelvic ultrasound shows multiple intramural masses in an irregularly enlarged uterus. The ovaries appear normal bilaterally. The patient has completed childbearing and would like definitive treatment for her symptoms. Operative treatment is scheduled. Which of the following is the most appropriate next step in management?? {'A': 'Progestin-only contraceptive pills', 'B': 'Leuprolide', 'C': 'Levonorgestrel-releasing intrauterine device', 'D': 'Tranexamic acid', 'E': 'Estrogen-progestin contraceptive pills'},
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B: Leuprolide
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Q:A 53-year-old man presents with swelling of the right knee. He says that the pain began the previous night and was reduced by ibuprofen and an ice-pack. The pain persists but is tolerable. He denies any recent fever, chills, or joint pains in the past. Past medical history includes a coronary artery bypass graft (CABG) a year ago for which he takes aspirin, atorvastatin, captopril, and carvedilol. The patient reports a 20-pack-year history of smoking but quits 5 years ago. He also says he was a heavy drinker for the past 30 years but now drinks only a few drinks on the weekends. On physical examination, the right knee is erythematous, warm, swollen, and mildly tender to palpation. Cardiac exam is significant for a mild systolic ejection murmur. The remainder of the examination is unremarkable. Arthrocentesis of the right knee joint is performed, which reveals the presence of urate crystals. Which of the following medications is most likely responsible for this patient's symptoms?? {'A': 'Aspirin', 'B': 'Vitamin C', 'C': 'Carvedilol', 'D': 'Atorvastatin', 'E': 'Captopril'},
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A: Aspirin
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Q:A 26-year-old woman presents with blood in her urine for the past 2 days. She says she has had increasing urinary frequency at night for the past several days and recently noticed a reddish tinge in her urine. She is also concerned that her feet are beginning to swell, and she has been feeling increasingly fatigued for the past week. She gives no history of joint pains, rashes, or skin changes. Past medical history is relevant for an occasional bluish discoloration of her fingers during exposure to cold. Her vital signs are a pulse of 80/min, a respiratory rate of 14/min, and blood pressure of 140/88 mm Hg. On physical examination, the patient has 1+ pitting edema of her feet bilaterally. Remainder of examination is unremarkable. Laboratory findings are significant for the following: Serum glucose (fasting) 88 mg/dL Sodium 143 mEq/L Potassium 3.7 mEq/L Chloride 102 mEq/L Serum creatinine 1.7 mg/dL Blood urea nitrogen 32 mg/dL Cholesterol, total 180 mg/dL HDL-cholesterol 43 mg/dL LDL-cholesterol 75 mg/dL Triglycerides 135 mg/dL Hemoglobin (Hb%) 12.5 g/dL Mean corpuscular volume (MCV) 80 fL Reticulocyte count 1% Erythrocyte count 5.1 million/mm3 Thyroid stimulating hormone 4.5 μU/mL Urinalysis: Glucose negative Protein +++ Ketones negative Nitrites negative RBCs negative Casts +++ A renal biopsy is performed which reveals findings consistent with lupus nephritis. Which of the following is the next best step in treatment of this patient?? {'A': 'Corticosteroids', 'B': 'Azathioprine', 'C': 'Cyclosporine', 'D': 'Mycophenolic acid', 'E': 'Cyclophosphamide'},
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A: Corticosteroids
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Q:A physician scientist is looking for a more efficient way to treat HIV. Patients infected with HIV mount a humoral immune response by producing antibodies against the HIV envelope proteins. These antibodies are the same antibodies detected by the ELISA and western blot assays used to diagnose the disease. The physician scientist is trying to generate a new, more potent antibody against the same HIV envelope proteins targeted by the natural humoral immune response. Of the following proteins, which is the most likely target of the antibody he is designing?? {'A': 'gp120', 'B': 'CXCR4', 'C': 'p24', 'D': 'p17', 'E': 'CCR5'},
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A: gp120
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Q:A previously healthy 21-year-old man is brought to the emergency department for the evaluation of an episode of unconsciousness that suddenly happened while playing football 30 minutes ago. He was not shaking and regained consciousness after about 30 seconds. Over the past three months, the patient has had several episodes of shortness of breath while exercising as well as sensations of a racing heart. He does not smoke or drink alcohol. He takes no medications. His vital signs are within normal limits. On mental status examination, he is oriented to person, place, and time. Cardiac examination shows a systolic ejection murmur that increases with valsalva maneuver and standing and an S4 gallop. The remainder of the examination shows no abnormalities. An ECG shows a deep S wave in lead V1 and tall R waves in leads V5 and V6. Echocardiography is most likely to show which of the following findings?? {'A': 'Abnormal movement of the mitral valve', 'B': 'Symmetric left ventricular wall thickening', 'C': 'Ventricular septum defect', 'D': 'Mitral valve leaflet thickening ≥ 5 mm', 'E': 'Reduced left ventricular ejection fraction'},
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A: Abnormal movement of the mitral valve
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Q:A 1-week-old baby is brought to the pediatrician’s office for a routine checkup. On examination, she is observed to have microcephaly with a prominent occiput. She also has clenched fists and rocker-bottom feet with prominent calcanei. A cardiac murmur is evident on auscultation. Based on the clinical findings, a diagnosis of nondisjunction of chromosome 18 is suspected. The pediatrician orders a karyotype for confirmation. He goes on to explain to the mother that her child will face severe growth difficulties. Even if her daughter progresses beyond a few months, she will not be able to reach developmental milestones at the appropriate age. In addition to the above, which of the following is most likely a consequence of this genetic disturbance?? {'A': 'Alzheimer’s disease', 'B': 'Supravalvular aortic stenosis', 'C': 'Death within the first year life', 'D': 'Cutis aplasia', 'E': 'Macroglossia'},
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C: Death within the first year life
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Q:A 42-year-old biochemist receives negative feedback from a senior associate on a recent project. He is placed on probation within the company and told that he must improve his performance on the next project to remain with the company. He is distraught and leaves his office early. When he gives an account of the episode to his wife, she says, “I'll always be proud of you no matter what because I know that you always try your best.” Later that night, he tearfully accuses her of believing that he is a failure. Which of the following psychological defense mechanisms is he demonstrating?? {'A': 'Denial', 'B': 'Projection', 'C': 'Transference', 'D': 'Displacement', 'E': 'Passive aggression'},
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B: Projection
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Q:A 43-year-old woman presents to the neurology clinic in significant pain. She reports a sharp, stabbing electric-like pain on the right side of her face. The pain started suddenly 2 weeks ago. The pain is so excruciating that she can no longer laugh, speak, or eat her meals as these activities cause episodes of pain. She had to miss work last week as a result. Her attacks last about 3 minutes and go away when she goes to sleep. She typically has 2–3 attacks per day now. The vital signs include: blood pressure 132/84 mm Hg, heart rate 79/min, and respiratory rate 14/min. A neurological examination shows no loss of crude touch, tactile touch, or pain sensations on the left side of the face. The pupillary light and accommodation reflexes are normal. There is no drooping of her mouth, ptosis, or anhidrosis noted. Which of the following is the most likely diagnosis?? {'A': 'Bell’s palsy', 'B': 'Cluster headache', 'C': 'Trigeminal neuralgia', 'D': 'Trigeminal cephalgia', 'E': 'Basilar migraine'},
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C: Trigeminal neuralgia
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Answer the following medical question with one of the provided options:
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Q:During a clinical study on an island with a population of 2540 individuals, 510 are found to have fasting hyperglycemia. Analysis of medical records of deceased individuals shows that the average age of onset of fasting hyperglycemia is 45 years, and the average life expectancy is 70 years. Assuming a steady state of population on the island with no change in environmental risk factors, which of the following is the best estimate of the number of individuals who would newly develop fasting hyperglycemia over 1 year?? {'A': '50', 'B': '10', 'C': '30', 'D': '40', 'E': '20'},
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E: 20
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Q:A 57-year-old woman is brought to the emergency department because of crampy abdominal pain and foul-smelling, watery diarrhea. One week ago, she underwent treatment of cellulitis with clindamycin. She has developed shortness of breath and urticaria after treatment with vancomycin in the past. Her temperature is 38.4°C (101.1°F). Abdominal examination shows mild tenderness in the left lower quadrant. Her leukocyte count is 12,800/mm3. An enzyme immunoassay is positive for glutamate dehydrogenase antigen and toxins A and B. Which of the following is the mechanism of action of the most appropriate pharmacotherapy for this patient's condition?? {'A': 'Inhibition of cell wall peptidoglycan formation', 'B': 'Blocking of protein synthesis at 50S ribosomal subunit', 'C': 'Inhibition of bacterial topoisomerases II and IV', 'D': 'Generation of toxic free radical metabolites', 'E': 'Inhibition of RNA polymerase sigma subunit'},
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E: Inhibition of RNA polymerase sigma subunit
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Answer the following medical question with one of the provided options:
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Q:A 52-year-old woman comes to the physician because of abdominal discomfort, anorexia, and mild fatigue. She has systemic lupus erythematosus and takes hydroxychloroquine. She does not drink alcohol or use illicit drugs. Physical examination shows no abnormalities. Laboratory studies show: Alanine aminotransferase 455 U/L Aspartate aminotransferase 205 U/L Hepatitis B surface antigen positive Hepatitis B surface antibody negative Hepatitis B envelope antigen positive Hepatitis B core antigen IgG antibody positive Which of the following is the most appropriate pharmacotherapy for this patient?"? {'A': 'Pegylated interferon-gamma', 'B': 'Acyclovir', 'C': 'Tenofovir', 'D': 'Dolutegravir', 'E': 'Sofosbuvir\n"'},
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C: Tenofovir
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Q:A 34-year-old man was brought into the emergency room after he was found running in the streets. Upon arrival to the emergency room, he keeps screaming, “they are eating me alive," and swatting his hands. He reports that there are spiders crawling all over him. His girlfriend, who arrives shortly after, claims that he has been forgetful and would forget his keys from time to time. He denies weight loss, fever, shortness of breath, abdominal pain, or urinary changes but endorses chest pain. His temperature is 98.9°F (37.2°C), blood pressure is 160/110 mmHg, pulse is 112/min, respirations are 15/min, and oxygen saturation is 98%. He becomes increasingly agitated as he believes the healthcare providers are trying to sacrifice him to the “spider gods.” What is the most likely explanation for this patient’s symptoms?? {'A': 'Cocaine use', 'B': 'Narcolepsy', 'C': 'Pick disease', 'D': 'Schizophrenia', 'E': 'Temporal lobe epilepsy'},
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A: Cocaine use
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Q:A 4-year-old boy is brought to the pediatrician with fever, diarrhea and bilateral red eye for 7 days. His parents noted that he has never had an episode of diarrhea this prolonged, but several other children at daycare had been ill. His immunization history is up to date. His vitals are normal except for a temperature of 37.5°C (99°F). A physical exam is significant for mild dehydration, preauricular adenopathy, and bilateral conjunctival injection with watery discharge. What is the most likely diagnosis? ? {'A': 'Rotavirus infection', 'B': 'C. difficile colitis', 'C': 'Adenovirus infection', 'D': 'Norovirus infection', 'E': 'Vibrio parahaemolyticus infection'},
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C: Adenovirus infection
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Q:Three hours after the onset of labor, a 39-year-old woman, gravida 2, para 1, at 40 weeks' gestation has sudden worsening of abdominal pain and vaginal bleeding. 18 months ago her first child was delivered by a lower segment transverse cesarean section because of cephalopelvic disproportion. Her temperature is 37.5°C (99.5°F), pulse is 120/min, respirations are 20/min, and blood pressure is 90/50 mm Hg. Examination shows abdominal tenderness and the absence of uterine contractions. The cervix is 100% effaced and 10 cm dilated; the vertex is at -3 station. An hour before, the vertex was at 0 station. Cardiotocography shows fetal bradycardia, late decelerations, and decreased amplitude of uterine contractions. Which of the following is the most specific feature of this patient's condition?? {'A': 'Loss of fetal station', 'B': 'Hemodynamic instability', 'C': 'Fetal distress', 'D': 'Absent uterine contractions', 'E': 'Abdominal tenderness'},
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A: Loss of fetal station
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Q:A 64-year-old man with longstanding ischemic heart disease presents to the clinic with complaints of increasing exercise intolerance and easy fatigability for the past 2 weeks. He further states that he has been experiencing excessive daytime somnolence and shortness of breath with exertion. His wife adds that his shortness of breath is more in the recumbent position, and after approximately 2 hours of sleep, after which he suddenly wakes up suffocating and gasping for breath. This symptom is relieved after assuming an upright position for more than 30 minutes. The vital signs are as follows: heart rate, 126/min; respiratory rate, 16/min; temperature, 37.6°C (99.6°F); and blood pressure, 122/70 mm Hg. The physical examination reveals a S3 gallop on cardiac auscultation and positive hepatojugular reflux with distended neck veins. An electrocardiogram shows ischemic changes similar to ECG changes noted in the past. An echocardiogram reveals an ejection fraction of 33%. Which of the following best describes the respiratory pattern abnormality which occurs in this patient while sleeping?? {'A': 'Increased pulmonary artery pressure', 'B': 'Decreased sympathetic activity', 'C': 'Decreased central hypercapnic ventilatory responsiveness', 'D': 'Increased partial pressure of oxygen', 'E': 'Shortened lung-to-brain circulation time'},
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A: Increased pulmonary artery pressure
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Q:A 35-year-old woman with a medical history significant for asthma, hypertension, and occasional IV drug use comes to the emergency department with fever. On physical exam, there are findings depicted in figure A, for which the patient cannot account. What test will be most helpful to establish the diagnosis?? {'A': 'Echocardiography', 'B': 'Chest X-ray', 'C': 'Pulmonary function tests', 'D': 'Electrocardiogram (EKG)', 'E': 'CT pulmonary angiography'},
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A: Echocardiography
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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 is brought to the emergency department because of progressive weakness of his lower extremities and urinary incontinence for the past 3 weeks. Over the past 2 months, he has also had increasing back pain. Physical examination shows an unsteady gait. Muscle strength is decreased in both lower extremities. Sensation to pain, temperature, and position sense is absent in the buttocks, perineum, and lower extremities. Ankle clonus is present. An x-ray of the spine shows multiple sclerotic lesions in the thoracic and lumbar vertebrae. Further evaluation of this patient is most likely to show which of the following?? {'A': 'Elevated prostate-specific antigen in the serum', 'B': 'Palpable thyroid nodule on neck examination', 'C': 'Bence Jones protein in the urine', 'D': 'Elevated carcinoembryonic antigen in the serum', 'E': 'Irregular, asymmetric mole on skin examination\n"'},
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A: Elevated prostate-specific antigen in the serum
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Q:A previously healthy 75-year-old woman comes to the physician because of fatigue and decreasing exercise tolerance over the past 6 weeks. She also has intermittent episodes of dizziness. She has never smoked and does not drink alcohol. She takes a daily multivitamin. She appears pale. Physical examination shows a smooth liver that is palpable 1 cm below the costal margin. The spleen is not palpable. Laboratory studies show: Hemoglobin 9.8 g/dL MCV 104 fL Reticulocyte count 0.2 % Folate 21 ng/mL (N = 2–20) Vitamin B12 789 pg/mL (N = 200–900) A peripheral blood smear shows anisocytosis and bone marrow aspirate shows ringed sideroblasts. This patient is most likely to develop which of the following?"? {'A': 'Sézary syndrome', 'B': 'Chronic lymphocytic leukemia', 'C': 'Burkitt lymphoma', 'D': 'Acute myelocytic leukemia', 'E': 'Hairy cell leukemia'},
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D: Acute myelocytic leukemia
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Answer the following medical question with one of the provided options:
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Q:A 28-year-old woman has a follow-up visit with her physician. She was diagnosed with allergic rhinitis and bronchial asthma at 11 years of age. Her regular controller medications include daily high-dose inhaled corticosteroids and montelukast, but she still needs to use a rescue inhaler 3–4 times a week following exercise. She also becomes breathless with moderate exertion. After a thorough evaluation, the physician explains that her medication dosages need to be increased. She declines taking oral corticosteroids daily due to concerns about side effects. The physician prescribes omalizumab, which is administered subcutaneously every 3 weeks. Which of the following best explains the mechanism of action of the new medication that has been added to the controller medications?? {'A': 'Inhibition of synthesis of interleukin-4 (IL-4)', 'B': 'Prevention of binding of IgE antibodies to mast cell receptors', 'C': 'Selective binding to interleukin-3 (IL-3) and inhibition of its actions', 'D': 'Prevention of binding of interleukin-5 (IL-5) to its receptors', 'E': 'Inhibition of synthesis of IgE antibodies'},
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B: Prevention of binding of IgE antibodies to mast cell receptors
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Q:A 26-year-old woman comes to the physician because of several days of fever, abdominal cramps, and diarrhea. She drank water from a stream 1 week ago while she was hiking in the woods. Abdominal examination shows increased bowel sounds. Stool analysis for ova and parasites shows flagellated multinucleated trophozoites. Further evaluation shows the presence of antibodies directed against the pathogen. Secretion of these antibodies most likely requires binding of which of the following?? {'A': 'CD8 to MHC I', 'B': 'CD40 to CD40 ligand', 'C': 'gp120 to CD4', 'D': 'CD28 to B7 protein', 'E': 'CD80/86 to CTLA-4'},
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B: CD40 to CD40 ligand
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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 in to his pediatrician for a routine checkup. The parents mention that the child has been developing appropriately, although they have been noticing that the child appears to have chronic constipation. The parents report that their child does not routinely have daily bowel movements, and they have noticed that his abdomen has become more distended recently. In the past, they report that the patient was also delayed in passing meconium, but this was not further worked up. On exam, his temperature is 98.6°F (37.0°C), blood pressure is 110/68 mmHg, pulse is 74/min, and respirations are 14/min. The patient is noted to have a slightly distended abdomen that is nontender. Eventually, this patient undergoes a biopsy. Which of the following layers most likely reveals the causative pathologic finding of this disease?? {'A': 'Lamina propria', 'B': 'Muscularis mucosa', 'C': 'Neural crest layer', 'D': 'Outer longitudinal layer of muscularis', 'E': 'Submucosa'},
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E: Submucosa
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Q:A 60-year-old rock musician presents to the office because he has been feeling increasingly tired for the past 6 months. He has a history of intravenous drug use and alcohol abuse. He states that he feels quite tired, but he otherwise has no complaints. Physical examination is noncontributory. His laboratory values are normal other than moderately elevated liver enzymes. Which of the following additional tests should you order first?? {'A': 'Hepatitis A virus-specific IgM antibodies', 'B': 'Hepatitis B surface antigen', 'C': 'Hepatitis C virus RNA', 'D': 'Hepatitis D virus-specific IgG antibody', 'E': 'Hepatitis E virus-specific IgM antibodies'},
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C: Hepatitis C virus RNA
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Q:A 54-year-old male has a history of gout complicated by several prior episodes of acute gouty arthritis and 3 prior instances of nephrolithiasis secondary to uric acid stones. He has a serum uric acid level of 11 mg/dL (normal range 3-8 mg/dL), a 24 hr urine collection of 1300 mg uric acid (normal range 250-750 mg), and a serum creatinine of 0.8 mg/dL with a normal estimated glomerular filtration rate (GFR). Which of the following drugs should be avoided in this patient?? {'A': 'Naproxen', 'B': 'Colchicine', 'C': 'Allopurinol', 'D': 'Indomethacin', 'E': 'Probenecid'},
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E: Probenecid
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Q:A 16-year-old woman is brought to the emergency department by her family for not being responsive. The patient had locked herself in her room for several hours after breaking up with her boyfriend. When her family found her, they were unable to arouse her and immediately took her to the hospital. The patient has a past medical history of anorexia nervosa, which is being treated, chronic pain, and depression. She is not currently taking any medications. The patient has a family history of depression in her mother and grandmother. IV fluids are started, and the patient seems to be less somnolent. Her temperature is 101°F (38.3°C), pulse is 112/min, blood pressure is 90/60 mmHg, respirations are 18/min, and oxygen saturation is 95% on room air. On physical exam, the patient is somnolent and has dilated pupils and demonstrates clonus. She has dry skin and an ultrasound of her bladder reveals 650 mL of urine. The patient is appropriately treated with sodium bicarbonate. Which of the following is the best indicator of the extent of this patient's toxicity?? {'A': 'Anion gap acidosis', 'B': 'Liver enzyme elevation', 'C': 'QRS prolongation', 'D': 'QT prolongation', 'E': 'Serum drug level'},
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C: QRS prolongation
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Q:After hospitalization for urgent chemotherapy to treat Burkitt’s lymphoma, a 7-year-old boy developed paresthesias of the fingers, toes, and face. Vital signs are taken. When inflating the blood pressure cuff, the patient reports numbness and tingling of the fingers. His blood pressure is 100/65 mm Hg. Respirations are 28/min, pulse is 100/min, and temperature is 36.2℃ (97.2℉). He has excreted 20 mL of urine in the last 6 hours. Laboratory studies show the following: Hemoglobin 15 g/dL Leukocyte count 6000/mm3 with a normal differential serum K+ 6.5 mEq/L Ca+ 6.6 mg/dL Phosphorus 5.4 mg/dL HCO3− 15 mEq/L Uric acid 12 mg/dL Urea nitrogen 54 mg/dL Creatinine 3.4 mg/dL Arterial blood gas analysis on room air: pH 7.30 PCO2 30 mm Hg O2 saturation 95% Which of the following is the most likely cause of this patient’s renal condition?? {'A': 'Deposition of calcium phosphate in the kidney', 'B': 'Direct tubular toxicity through filtered light chains', 'C': 'Intense renal vasoconstriction and volume depletion', 'D': 'Pigment-induced nephropathy', 'E': 'Precipitation of uric acid in renal tubules/tumor lysis syndrome'},
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E: Precipitation of uric acid in renal tubules/tumor lysis syndrome
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Q:A 16-year-old female presents to your clinic concerned that she has not had her menstrual cycle in 5 months. She has not been sexually active and her urine pregnancy test is negative. She states that she has been extremely stressed as she is in the middle of her gymnastics season and trying to get recruited for a college scholarship. Physical exam is remarkable for a BMI of 16, dorsal hand calluses, and fine hair over her cheeks. What other finding is likely in this patient?? {'A': 'Polycythemia', 'B': 'Elevated TSH', 'C': 'Normal menstrual cycles', 'D': 'Elevated estrogen levels', 'E': 'Low bone density'},
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E: Low bone density
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Q:A 43-year-old male with a history of thyroid cancer status post total thyroidectomy presents to his primary care physician after repeated bouts of headaches. His headaches are preceded by periods of anxiety, palpitations, and sweating. The patient says he is unable to pinpoint any precipitating factors and instead says the events occur without warning. Of note, the patient's father and uncle also have a history of thyroid cancer. On exam his vitals are: T 36.8 HR 87, BP 135/93, RR 14, and O2 Sat 100% on room air. The patient's TSH is within normal limits, and he reports taking his levothyroxine as prescribed. What is the next best step in diagnosing this patient's chief complaint?? {'A': 'Abdominal CT scan with and without IV contrast', 'B': '24-hour urine free cortisol', 'C': 'High dose dexamethasone suppression test', 'D': 'Plasma fractionated metanephrines', 'E': 'Plasma aldosterone/renin ratio'},
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D: Plasma fractionated metanephrines
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Q:A 25-year-old woman presents to her college campus clinic with the complaint of being unable to get up for her morning classes. She says that, because of this, her grades are being affected. For the past 6 weeks, she says she has been feeling depressed because her boyfriend dumped her. She finds herself very sleepy, sleeping in most mornings, eating more snacks and fast foods, and feeling drained of energy. She is comforted by her friend’s efforts to cheer her up but still feels guarded around any other boy that shows interest in her. The patient says she had similar symptoms 7 years ago for which she was prescribed several selective serotonin reuptake inhibitors (SSRIs) and a tricyclic antidepressant (TCA). However, none of the medications provided any long-term relief. She has prescribed a trial of Phenelzine to treat her symptoms. Past medical history is significant for a long-standing seizure disorder well managed with phenytoin. Which of the following statements would most likely be relevant to this patient’s new medication?? {'A': '“While taking this medication, you should avoid drinking red wine.”', 'B': '“You will have a risk for cardiotoxicity from this medication.”', 'C': '“While on this medication, you may have a decreased seizure threshold.”', 'D': '“This medication is known to cause anorgasmia during treatment.”', 'E': '“A common side effect of this medication is sedation.”'},
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A: “While taking this medication, you should avoid drinking red wine.”
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Q:A 9-year-old boy is brought to the physician for evaluation of 2 months of progressive clumsiness, falls, and increased urinary frequency. Physical examination shows bilateral temporal visual field loss. An MRI of the head shows a small calcified suprasellar mass. The patient undergoes surgery with complete removal of the mass. Pathological examination of the specimen shows a lobular tumor composed of cysts filled with oily, brownish-yellow fluid. This mass is most likely derived from which of the following structures?? {'A': 'Rathke pouch', 'B': 'Arachnoid cells', 'C': 'Astroglial cells', 'D': 'Lactotroph cells', 'E': 'Ventricular ependyma'},
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A: Rathke pouch
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Q:A 27-year-old male is brought to the emergency department with a 1-week history of worsening headache. Over the past 2 days, he has become increasingly confused and developed nausea as well as vomiting. One week ago, he struck his head while exiting a car, but did not lose consciousness. His maternal uncle had a bleeding disorder. He appears in moderate distress. He is oriented to person and time but not to place. His temperature is 37.1°C (98.8°F), pulse is 72/min, respirations are 20/min, and blood pressure is 128/78 mm Hg. Cardiopulmonary examination is unremarkable. His abdomen is soft and nontender. Muscle strength is 5/5 in left upper and left lower extremities, and 3/5 in right upper and right lower extremities. Laboratory studies show: Leukocyte Count 10,000/mm3 Hemoglobin 13.6 g/dL Hematocrit 41% Platelet Count 150,000/mm3 PT 13 seconds aPTT 60 seconds Serum Sodium 140 mEq/L Potassium 4.2 mEq/L Chloride 101 mEq/L Bicarbonate 24 mEq/L Urea Nitrogen 15 mg/dL Creatinine 1.0 mg/dL CT scan of the head is shown. Which of the following is the most likely cause of this patient's symptoms?"? {'A': 'Subgaleal hemorrhage', 'B': 'Cerebral sinus venous thrombosis', 'C': 'Epidural hematoma', 'D': 'Subdural hematoma', 'E': 'Intracerebral hemorrhage'},
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D: Subdural hematoma
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Q:A 63-year-old woman is brought to the clinic by her husband with complaints of cognitive decline. The patient’s husband says that she has had intermittent problems with her memory for the past few years. He says she has occasional ‘bad days’ where her memory deteriorates to the point where she cannot perform activities of daily living. She is also sometimes found conversing in an empty room and, when inquired, she confirms that she is talking to a friend. There have also been had some recent falls. There is no history of fever, recent head trauma, loss of consciousness, or illicit drug use. Past medical history is significant for bronchial asthma and osteoarthritis, both managed medically. Her mother died due to metastatic breast cancer at age 71 and her father was diagnosed with Alzheimer’s disease at age 65. The patient is afebrile and her vital signs are within normal limits. Physical examination reveals a tremor present in both her hands that attenuates with voluntary movement. Deep tendon reflexes are 2+ bilaterally. Romberg’s sign is negative. She has a slow gait with a mild stooped posture. Her laboratory findings are significant for the following: Hemoglobin 12.9 g/dL White cell count 8,520/mm³ Platelets 295,000/mm³ Serum creatinine 10 mg/dL Glucose 94 mg/dL Sodium 141 mEq/L Potassium 3.9 mEq/L Calcium 92 mg/dL Ferritin 125 ng/mL Serum B12 305 ng/L TSH 2.1 µU/mL Ceruloplasmin 45 mg/dL Which of the following is the most appropriate management for this patient?? {'A': 'Escitalopram', 'B': 'Haloperidol', 'C': 'Penicillamine', 'D': 'Rivastigmine', 'E': 'Ropinirole'},
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D: Rivastigmine
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Q:A 37-year-old woman presents for prenatal counseling at 18 weeks gestation. The patient tells you that her sister recently had a child with Down's syndrome, and the patient would like prenatal screening for Down's in her current pregnancy. Which of the following prenatal screening tests and results would raise concern for Down's syndrome?? {'A': 'Increased AFP, normal HCG, normal unconjugated estriol', 'B': 'Decreased AFP, increased HCG, decreased unconjugated estriol', 'C': 'Decreased AFP, decreased HCG, decreased unconjugated estriol', 'D': 'Normal AFP, increased HCG, decreased unconjugated estriol', 'E': 'Normal AFP, decreased HCG, decreased unconjugated estriol'},
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B: Decreased AFP, increased HCG, decreased unconjugated estriol
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Q:A 28-year-old woman gives birth to a 2.2 kg child while on vacation. The mother's medical records are faxed to the hospital and demonstrate the following on hepatitis panel: hepatitis B surface antigen (HbsAg) positive, anti-hepatitis B core antigen (anti-HbcAg) positive, hepatitis C RNA is detected, hepatitis C antibody is reactive. Which of the following should be administered to the patient's newborn child?? {'A': 'Hepatitis B vaccine, ledipisvir/sofosbuvir', 'B': 'Hepatitis B IVIG now, hepatitis B vaccine in one month', 'C': 'Hepatitis B IVIG, hepatitis B vaccine and ledipisvir/sofosbuvir', 'D': 'Hepatitis B IVIG and vaccine', 'E': 'Hepatitis B vaccine'},
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D: Hepatitis B IVIG and vaccine
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Q:A 19-year-old woman presents to the emergency department with chronic diarrhea, fatigue, and weakness. She also had mild lower extremity edema. On examination, she was noted to be pale. Blood testing revealed peripheral eosinophilia (60%) and a Hb concentration of 8 g/dL. The stool examination revealed Fasciolopsis buski eggs. Which of the following drugs would most likely be effective?? {'A': 'Bethional', 'B': 'Praziquantel', 'C': 'Albendazole', 'D': 'Niclosamide', 'E': 'Oxamniquine'},
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B: Praziquantel
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Q:An investigator studying influenza virus variability isolates several distinct influenza virus strains from the respiratory secretions of a study subject. Mass spectrometry analysis of one strain shows that it expresses neuraminidase on its surface. Subsequent sequencing of this strain shows that its genome lacks the neuraminidase gene. Which of the following is the most likely explanation for this finding?? {'A': 'Transduction', 'B': 'Reassortment', 'C': 'Recombination', 'D': 'Phenotypic mixing', 'E': 'Complementation'},
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D: Phenotypic mixing
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Q:A 67-year-old male presents with left hip pain. Examination reveals mild effusions in both knees, with crepitus in both patellofemoral joints. He states his hearing has worsened recently and that he feels like his hats don't fit anymore. Bone scan reveals diffuse uptake in the calvarium, right proximal femur, and left ilium. Which of the following laboratory abnormalities would be expected in this patient?? {'A': 'Decreased serum alkaline phosphatase', 'B': 'Increased serum alkaline phosphatase', 'C': 'Decreased serum parathyroid hormone', 'D': 'Increased serum parathyroid hormone', 'E': 'Increased serum calcium'},
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B: Increased serum alkaline phosphatase
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Q:A 21-year-old G2P1 woman presents to the clinic and is curious about contraception immediately after her baby is born. She is anxious about taking care of one child and does not believe that she can handle the responsibility of caring for another. She has no other questions or complaints today. Her past medical history consists of generalized anxiety disorder, antithrombin deficiency, and chronic deep vein thrombosis. She has been hospitalized for acute on chronic deep vein thrombosis. Her only medication is buspirone. Her blood pressure is 119/78 mm Hg and the heart rate is 78/min. BMI of the patient is 32 kg/m2. On physical examination, her fundal height is 21 cm from pubic symphysis. No ovarian masses are palpated during the bimanual examination. Ultrasound exhibits a monoamniotic, monochorionic fetus. Which of the following forms of contraception would be the most detrimental given her risk factors?? {'A': 'Norethindrone', 'B': 'Copper IUD', 'C': 'Depot medroxyprogesterone acetate', 'D': 'Levonorgestrel IUD', 'E': 'Transdermal contraceptive patch'},
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E: Transdermal contraceptive patch
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Q:A 1-year-old girl born to a 40-year-old woman is undergoing an examination by a pediatric resident in the hospital. The pregnancy was uneventful and there were no complications during the delivery. The physical examination reveals midface hypoplasia with a flat nasal bridge and upslanting palpebral fissures. She has a small mouth and chest auscultation reveals a blowing holosystolic murmur that is heard best along the sternal border. The family history is unremarkable. A karyotype analysis is ordered because the resident suspects a numerical chromosomal disorder. Which of the following phenomena leads to the infant’s condition?? {'A': 'Trinucleotide repeat', 'B': 'Meiotic non-disjunction', 'C': 'Uniparental disomy', 'D': 'Genomic imprinting', 'E': 'Partial deletion'},
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B: Meiotic non-disjunction
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Q:A 25-year-old man presents to the clinic with a midline swelling in his neck. He is unsure about when it appeared. He denies any difficulty with swallowing or hoarseness. His past medical history is insignificant. On physical examination, there is a 1 cm x 2 cm firm mildly tender nodule on the anterior midline aspect of the neck which moves with deglutition and elevates with protrusion of the tongue. Which of the following is the most likely embryologic origin of the nodule in this patient?? {'A': 'The branchial cleft', 'B': '1st and 2nd pharyngeal arch', 'C': '4th pharyngeal arch', 'D': '4th pharyngeal pouch', 'E': 'Midline endoderm of the pharynx'},
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E: Midline endoderm of the pharynx
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Q:A 13-year-old girl presents after losing consciousness during class 30 minutes ago. According to her friends, she was doing okay since morning, and nobody noticed anything abnormal. The patient’s mother says that her daughter does not have any medical conditions. She also says that the patient has always been healthy but has recently lost weight even though she was eating as usual. Her vital signs are a blood pressure of 100/78 mm Hg, a pulse of 89/min, and a temperature of 37.2°C (99.0°F). Her breathing is rapid but shallow. Fingerstick glucose is 300 mg/dL. Blood is drawn for additional lab tests, and she is started on intravenous insulin and normal saline. Which of the following HLA subtypes is associated with this patient’s most likely diagnosis?? {'A': 'A3', 'B': 'B8', 'C': 'DR3', 'D': 'B27', 'E': 'DR5'},
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C: DR3
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Q:A 58-year-old woman comes to the physician because of a 3-month history of recurring chest discomfort. The symptoms occur when walking up the stairs to her apartment or when walking quickly for 5 minutes on level terrain. She has not had shortness of breath, palpitations, or dizziness. She has hypertension and hyperlipidemia. Current medications include estrogen replacement therapy, metoprolol, amlodipine, lisinopril, hydrochlorothiazide, and rosuvastatin. She drinks 3–4 cups of coffee per day. She does not drink alcohol. Her pulse is 65/min, respirations are 21/min, and blood pressure is 145/90 mm Hg. Physical examination shows no abnormalities. A resting ECG shows normal sinus rhythm. She is scheduled for a cardiac exercise stress test in 2 days. Discontinuation of which of the following is the most appropriate next step in management at this time?? {'A': 'Metoprolol and amlodipine', 'B': 'Metoprolol and rosuvastatin', 'C': 'Estrogen and hydrochlorothiazide', 'D': 'Estrogen and amlodipine', 'E': 'Lisinopril and hydrochlorothiazide'},
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A: Metoprolol and amlodipine
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Q:A 13-year-old boy presents with several light brown macules measuring 4–5 cm located on his trunk. He has no other medical conditions, but his mother has similar skin findings. He takes no medications, and his vital signs are within normal limits. Ophthalmic examination findings are shown in the image below. What is the most likely neoplasm that can develop in this child?? {'A': 'Acoustic neuroma', 'B': 'Meningioma', 'C': 'Dermatofibroma', 'D': 'Neurofibroma', 'E': 'Retinoblastoma'},
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D: Neurofibroma
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Q:A 23-year-old woman is brought to the emergency room by her mother after she is found to have cut both of her wrists with razor blades. The patient admits to a history of self-mutilation and attributed this incident to a recent breakup with a man she had been seeing for the previous 2 weeks. On morning rounds, the patient reports that the nurses are incompetent but the doctors are some of the best in the world. The patient's vitals are stable and her wrist lacerations are very superficial requiring only simple dressings without sutures. The patient is discharged a few days later and she feels well. Which of the following is the most appropriate initial treatment for this patient?? {'A': 'Amitriptyline', 'B': 'Cognitive behavioral therapy', 'C': 'Dialectical behavior therapy', 'D': 'Fluoxetine', 'E': 'Lithium'},
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C: Dialectical behavior therapy
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Q:A 16-year-old boy is brought to the emergency department by ambulance with a visible deformity of the upper thigh after being involved in a motor vehicle collision. He is informed that he will require surgery and is asked about his medical history. He mentions that he had surgery to remove his tonsils several years ago and at that time suffered a complication during the surgery. Specifically, shortly after the surgery began, he began to experience severe muscle contractions and an increased body temperature. Based on this information, a different class of muscle relaxants are chosen for use during the upcoming surgery. If these agents needed to be reversed, the reversal agent should be administered with which of the following to prevent off-target effects?? {'A': 'Atropine', 'B': 'Echothiophate', 'C': 'Epinephrine', 'D': 'Methacholine', 'E': 'Phentolamine'},
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A: Atropine
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Q:A 47-year-old male presents to his primary care physician complaining of upper abdominal pain. He reports a four-month history of gnawing epigastric discomfort that improves with meals. He has lost 10 pounds over that same period. His past medical history is significant for a prolactinoma for which he underwent transphenoidal resection. He does not smoke or drink alcohol. His family history is notable for a paternal uncle and paternal grandmother with parathyroid neoplasms. His temperature is 99°F (37.2°C), blood pressure is 115/80 mmHg, pulse is 80/min, and respirations are 18/min. Upon further diagnostic workup, which of the following sets of laboratory findings is most likely?? {'A': 'Normal fasting serum gastrin', 'B': 'Elevated fasting serum gastrin that decreases with secretin administration', 'C': 'Elevated fasting serum gastrin that increases with somatostatin administration', 'D': 'Elevated fasting serum gastrin that decreases with cholecystokinin administration', 'E': 'Elevated fasting serum gastrin that increases with secretin administration'},
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E: Elevated fasting serum gastrin that increases with secretin administration
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Q:A 65-year-old man presents to the emergency department with a fever and weakness. He states his symptoms started yesterday and have been gradually worsening. The patient has a past medical history of obesity, diabetes, alcohol abuse, as well as a 30 pack-year smoking history. He lives in a nursing home and has presented multiple times in the past for ulcers and delirium. His temperature is 103°F (39.4°C), blood pressure is 122/88 mmHg, pulse is 129/min, respirations are 24/min, and oxygen saturation is 99% on room air. Physical exam is notable for a murmur. The patient is started on vancomycin and piperacillin-tazobactam and is admitted to the medicine floor. During his hospital stay, blood cultures grow Streptococcus bovis and his antibiotics are appropriately altered. A transesophageal echocardiograph is within normal limits. The patient’s fever decreases and his symptoms improve. Which of the following is also necessary in this patient?? {'A': 'Addiction medicine referral', 'B': 'Colonoscopy', 'C': 'Repeat blood cultures for contamination concern', 'D': 'Replace the patient’s central line and repeat echocardiography', 'E': 'Social work consult for elder abuse'},
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B: Colonoscopy
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Q:A 32-year-old man is brought to the emergency department by the police for examination. The police have reason to believe he may have swallowed a large number of cocaine-containing capsules during an attempt to smuggle the drug across the border. They request an examination of the patient to determine if this is actually the case. The patient has no history of any serious illnesses and takes no medications. He does not smoke, drinks, or consume any drugs. He appears upset. His vital signs are within normal limits. Despite the pressure by the police, he refuses to undergo any further medical evaluation. Which of the following is the most appropriate next step in the evaluation of this patient?? {'A': 'Examine the patient without his consent', 'B': 'Explain the risk of internal rupture to the patient', 'C': 'Obtain an abdominal X-ray', 'D': 'Refuse to examine the patient', 'E': 'Request a court order from the police'},
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B: Explain the risk of internal rupture to the patient
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Q:A 10-year-old boy presents to the emergency department with his parents. The boy complains of fever, neck stiffness, and drowsiness for the last several days. His past medical history is noncontributory. The boy was born at 39 weeks gestation via spontaneous vaginal delivery. He is up to date on all vaccines and is meeting all developmental milestones. There were no sick contacts at home or at school. The family did not travel out of the area recently. His heart rate is 100/min, respiratory rate is 22/min, blood pressure is 105/65 mm Hg, and temperature is 40.5ºC (104.9°F). On physical examination, he appears unwell and confused. His heart rate is elevated with a regular rhythm and his lungs are clear to auscultation bilaterally. During the examination, he experiences a right-sided focal seizure, which is controlled with lorazepam. A head CT reveals bilateral asymmetrical hypodensities of the temporal region. A lumbar puncture is performed and reveals the following: WBC count 25/mm3 Cell predominance lymphocytes Protein elevated The patient is started on a medication to treat the underlying cause of his symptoms. What is the mechanism of action of this medication?? {'A': 'Fusion inhibition', 'B': 'Binding with ergosterol in the cell membrane', 'C': 'Inhibition of DNA polymerase', 'D': 'Nucleoside reverse transcriptase inhibition', 'E': 'Cell wall synthesis inhibition'},
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C: Inhibition of DNA polymerase
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Q:A 52-year-old man is seen by his endocrinologist for routine followup of his type 2 diabetes. Although he has previously been on a number of medication regimens, his A1C has remained significantly elevated. In order to try to better control his glucose level, the endocrinologist prescribes a new medication. He explains that this new medication works by blocking the ability of his kidneys to reabsorb glucose and therefore causes glucose wasting in the urine. Which of the following medications has this mechanism of action?? {'A': 'Acarbose', 'B': 'Canagliflozin', 'C': 'Exenatide', 'D': 'Glyburide', 'E': 'Metformin'},
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B: Canagliflozin
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Answer the following medical question with one of the provided options:
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Q:A 56-year-old African-American man comes to the physician for intermittent episodes of dark urine and mild flank pain. The patient has had 3 episodes of frank reddish discoloration of his urine within 1 month. He has chronic headaches and back pain for which he has been taking aspirin and ibuprofen daily for 1 year. The patient has sickle cell trait. He has smoked a pack of cigarettes daily for 10 years. He appears well. His temperature is 37.4°C (99.3°F). His pulse is 66/min, and his blood pressure is 150/90 mm Hg. Physical exam shows mild, bilateral flank tenderness. Laboratory analysis shows a serum creatinine concentration of 2.4 mg/dL. Urine studies are shown below. Urine Blood 3+ Protein 2+ RBC > 10/hpf WBC 3/hpf Which of the following is the most likely underlying cause of this patient's hematuria?"? {'A': 'Chronic hemoglobin filtration', 'B': 'Purulent renal inflammation', 'C': 'Renal reperfusion injury', 'D': 'Renal papillary ischemia', 'E': 'Direct nephrotoxic injury'},
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D: Renal papillary ischemia
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Answer the following medical question with one of the provided options:
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Q:A 36-year-old woman comes to the physician because of painless lesions on the vulva that she first noticed 2 days ago. She does not have any urinary symptoms. She has gastroesophageal reflux disease for which she takes omeprazole. She has smoked one pack of cigarettes daily for 10 years. She is sexually active with multiple partners and uses condoms inconsistently. Examination shows clusters of several 3- to 5-mm raised lesions with a rough texture on the vulva. Application of a dilute acetic acid solution turns the lesions white. An HIV test is negative. Which of the following is the most appropriate next step in management?? {'A': 'Parenteral benzathine penicillin', 'B': 'Cryotherapy', 'C': 'Topical mometasone', 'D': 'Radiotherapy', 'E': 'Oral acyclovir'},
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B: Cryotherapy
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Answer the following medical question with one of the provided options:
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Q:A 24-year-old male is brought into the emergency department complaining of chills, headaches, and malaise for several days. He also states that he experiences shortness of breath when climbing two flights of stairs in his home. He admits to occasionally using intravenous drugs during the previous year. On exam, his vital signs are temperature 39.2° C, heart rate 108/min, blood pressure 124/82 mm Hg, respiratory rate 20/min, and oxygen saturation 98% on room air. A holosystolic murmur is heard near the lower left sternal border. An echocardiogram confirms vegetations on the tricuspid valve. What is the most likely causative organism of this patient's condition?? {'A': 'Streptococcus bovis', 'B': 'Staphylococcus epidermidis', 'C': 'Streptococcus mutans', 'D': 'Staphylococcus aureus', 'E': 'Candida albicans'},
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D: Staphylococcus aureus
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Answer the following medical question with one of the provided options:
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Q:A 55-year-old patient who immigrated from the Middle East to the United States 10 years ago presents to the emergency department because of excessive weakness, abdominal discomfort, and weight loss for the past 10 months. He has had type 2 diabetes mellitus for 10 years for which he takes metformin. He had an appendectomy 12 years ago in his home country, and his postoperative course was not complicated. He denies smoking and drinks alcohol socially. His blood pressure is 110/70 mm Hg, pulse is 75/min, and temperature is 37.1°C (98.7°F). On physical examination, the patient appears exhausted, and his sclerae are yellowish. A firm mass is palpated in the right upper abdominal quadrant. Abdominal ultrasonography shows liver surface nodularity, splenomegaly, and increased diameter of the portal vein. Which of the following is the most common complication of this patient condition?? {'A': 'Hepatic osteodystrophy', 'B': 'Hepatic encephalopathy', 'C': 'Hepatorenal syndrome', 'D': 'Hepatopulmonary syndrome', 'E': 'Ascites'},
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E: Ascites
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Q:A 9-year-old girl is brought to the physician by her father because of abnormal movements of her limbs for 4 days. She has had involuntary nonrhythmic movements of her arms and legs, and has been dropping drinking cups and toys. The symptoms are worse when she is agitated, and she rarely experiences them while sleeping. During this period, she has become increasingly irritable and inappropriately tearful. She had a sore throat 5 weeks ago. Her temperature is 37.2°C (99°F), pulse is 102/min, respirations are 20/min, and blood pressure is 104/64 mm Hg. Examination shows occasional grimacing with abrupt purposeless movements of her limbs. Muscle strength and muscle tone are decreased in all extremities. Deep tendon reflexes are 2+ bilaterally. She has a wide-based and unsteady gait. When the patient holds her arms in extension, flexion of the wrists and extension of the metacarpophalangeal joints occurs. When she grips the physician's index and middle fingers with her hands, her grip increases and decreases continuously. The remainder of the examination shows no abnormalities. Which of the following is the most likely underlying cause of these findings?? {'A': 'Cerebral viral infection', 'B': 'Tumor in the posterior fossa', 'C': 'Antibody cross-reactivity', 'D': 'Trinucleotide repeat mutation', 'E': 'Autosomal recessive genetic mutation\n"'},
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C: Antibody cross-reactivity
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Answer the following medical question with one of the provided options:
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Q:A 70-year-old man comes to the physician because of progressive fatigue and lower back pain for the past 4 months. The back pain worsened significantly after he had a minor fall while doing yard work the previous day. For the past year, he has had a feeling of incomplete emptying of his bladder after voiding. His vital signs are within normal limits. Examination shows bilateral paravertebral muscle spasm, severe tenderness over the second lumbar vertebra, and mild tenderness over the lower thoracic vertebrae. Neurologic examination shows no abnormalities. His hemoglobin is 10.5 g/dl, alkaline phosphatase is 110 U/L, and serum calcium is 11.1 mg/dl. An x-ray of the skull is shown. Which of the following is the most appropriate next step in diagnosis?? {'A': 'Bone marrow biopsy', 'B': 'Serum protein electrophoresis', 'C': 'Serum vitamin D levels', 'D': 'Prostate biopsy', 'E': 'Bone scan'},
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B: Serum protein electrophoresis
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Answer the following medical question with one of the provided options:
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Q:A 24-year-old man presents to his primary care provider with complaints of 2 days of profuse diarrhea. He states that his stool started to turn watery and lighter in color beginning yesterday, and he has not noticed any fevers. His diarrhea episodes have become more frequent and white-colored over the past day. He has also noticed dry mouth symptoms and darker urine today. He is otherwise healthy but recently returned from a trip with friends to South Asia. None of his friends have reported any symptoms. On exam, his temperature is 98.6°F (37.0°C), blood pressure is 110/68 mmHg, pulse is 80/min, respirations are 14/min. The patient has normal skin turgor, but he has noticeably dry oral mucosa and chapped lips. The patient has dull abdominal aching but no tenderness to palpation. The stool is found to contain large quantities of comma-shaped organisms. Fecal occult blood testing is negative and no steatorrhea is found. The provider recommends immediate oral rehydration therapy. Which of the following is the likely mechanism of this patient’s diarrhea?? {'A': 'Decreased cyclic AMP', 'B': 'Increased cyclic AMP', 'C': 'Increased cyclic GMP', 'D': 'Inhibition of protein synthesis', 'E': 'Shortening of intestinal villi'},
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B: Increased cyclic AMP
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Answer the following medical question with one of the provided options:
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Q:A 6-year-old boy is brought to the physician for a well-child examination. His mother has noticed he frequently falls while running. He was born at term and pregnancy was uncomplicated. He has a seizure disorder treated with phenytoin. He is at the 20th percentile for height and at 30th percentile for weight. Vital signs are within normal limits. Examination shows decreased muscle strength in the lower extremities. There is a deep groove below the costal margins bilaterally. An x-ray of the lower extremities is shown. Which of the following is the most likely cause of these findings?? {'A': 'Normal development', 'B': 'Proximal tibial growth plate disruption', 'C': 'Metabolic abnormality', 'D': 'Neoplastic growth', 'E': 'Heavy metal toxicity'},
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C: Metabolic abnormality
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Answer the following medical question with one of the provided options:
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Q:A 26-year-old woman presents with an 8-month history of insomnia and anxiety. She says that she has difficulty sleeping and has feelings of impending doom linked to her difficult financial situation. No significant family history and no current medications. The patient has prescribed an 8 week supply of medication. She follows up 4 weeks later saying that she has increased anxiety and needs a refill. She says that over the past month, due to increasing anxiety levels, she started taking extra doses of her medication to achieve an anxiolytic effect. Which of the following medications was most likely prescribed to this patient?? {'A': 'Hydroxyzine', 'B': 'Buspirone', 'C': 'Propranolol', 'D': 'Triazolam', 'E': 'Thiopental'},
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D: Triazolam
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