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Answer the following medical question with one of the provided options:
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Q:A 45-year-old homeless man is brought to the emergency department. He was found unconscious at the park. The patient has a past medical history of IV drug abuse, hepatitis C, alcohol abuse, schizophrenia, and depression. He does not receive normal medical follow up or care. His temperature is 102°F (38.9°C), blood pressure is 97/68 mmHg, pulse is 120/min, respirations are 22/min, and oxygen saturation is 98% on room air. Physical exam demonstrates a diffusely distended abdomen that is dull to percussion with a notable fluid wave. The abdominal exam causes the patient to contract his extremities. Cardiac and pulmonary exam are within normal limits. The patient responds to painful stimuli and smells heavily of alcohol. Which of the following is the best next step in management?? {'A': 'Cefotaxime', 'B': 'Ceftriaxone', 'C': 'CT abdomen', 'D': 'Paracentesis', 'E': 'Ultrasound'},
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D: Paracentesis
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Answer the following medical question with one of the provided options:
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Q:A 32-year-old woman comes to the physician because of a 4-day history of low-grade fever, joint pain, and muscle aches. The day before the onset of her symptoms, she was severely sunburned on her face and arms during a hike with friends. She also reports being unusually fatigued over the past 3 months. Her only medication is a combined oral contraceptive pill. Her temperature is 37.9°C (100.2°F). Examination shows bilateral swelling and tenderness of the wrists and metacarpophalangeal joints. There are multiple nontender superficial ulcers on the oral mucosa. The detection of antibodies directed against which of the following is most specific for this patient's condition?? {'A': 'Cell nucleus', 'B': 'Single-stranded DNA', 'C': 'Fc region of IgG', 'D': 'Nuclear Sm proteins', 'E': 'Histones\n"'},
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D: Nuclear Sm proteins
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Answer the following medical question with one of the provided options:
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Q:A 24-year-old primigravida presents at 36 weeks gestation with vaginal bleeding, mild abdominal pain, and uterine contractions that appeared after bumping into a handrail. The vital signs are as follows: blood pressure 130/80 mm Hg, heart rate 79/min, respiratory rate 12/min, and temperature 36.5℃ (97.7℉). The fetal heart rate was 145/min. Uterine fundus is at the level of the xiphoid process. Slight uterine tenderness and contractions are noted on palpation. The perineum is bloody. The gynecologic examination shows no vaginal or cervical lesions. The cervix is long and closed. Streaks of bright red blood are passing through the cervix. A transabdominal ultrasound shows the placenta to be attached to the lateral uterine wall with a marginal retroplacental hematoma (an approximate volume of 150 ml). The maternal hematocrit is 36%. What is the next best step in the management of this patient?? {'A': 'Urgent cesarean delivery', 'B': 'Induction of vaginal labor', 'C': 'Admit for maternal and fetal monitoring and observation', 'D': 'Corticosteroid administration and schedule a cesarean section after', 'E': 'Manage as an outpatient with modified rest'},
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C: Admit for maternal and fetal monitoring and observation
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Answer the following medical question with one of the provided options:
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Q:A 20-year-old man comes to the physician because of decreasing academic performance at his college for the past 6 months. He reports a persistent fear of “catching germs” from his fellow students and of contracting a deadly disease. He finds it increasingly difficult to attend classes. He avoids handshakes and close contact with other people. He states that when he tries to think of something else, the fears “keep returning” and that he has to wash himself for at least an hour when he returns home after going outside. Afterwards he cleans the shower and has to apply disinfectant to his body and to the bathroom. He does not drink alcohol. He used to smoke cannabis but stopped one year ago. His vital signs are within normal limits. He appears anxious. On mental status examination, he is oriented to person, place, and time. In addition to starting an SSRI, which of the following is the most appropriate next step in management?? {'A': 'Motivational interviewing', 'B': 'Cognitive-behavioral therapy', 'C': 'Psychodynamic psychotherapy', 'D': 'Interpersonal therapy', 'E': 'Group therapy\n"'},
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B: Cognitive-behavioral therapy
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Answer the following medical question with one of the provided options:
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Q:A 6-month-old girl presents with recurring skin infections. Past medical history is significant for 3 episodes of acute otitis media since birth. The patient was born at 39 weeks via an uncomplicated, spontaneous transvaginal delivery, but there was delayed umbilical cord separation. She has met all developmental milestones. On physical examination, the skin around her mouth is inflamed and red. Which of the following is most likely responsible for this child’s clinical presentation?? {'A': 'Defect in tyrosine kinase', 'B': 'A microtubule dysfunction', 'C': 'IL-12 receptor deficiency', 'D': 'Absence of CD18 molecule on the surface of leukocytes', 'E': 'Deficiency in NADPH oxidase'},
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D: Absence of CD18 molecule on the surface of leukocytes
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Answer the following medical question with one of the provided options:
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Q:An investigator is studying gastric secretions in human volunteers. Measurements of gastric activity are recorded after electrical stimulation of the vagus nerve. Which of the following sets of changes is most likely to occur after vagus nerve stimulation? $$$ Somatostatin secretion %%% Gastrin secretion %%% Gastric pH $$$? {'A': '↑ ↑ ↓', 'B': '↓ ↑ ↓', 'C': '↑ ↑ ↑', 'D': '↓ ↓ ↓', 'E': '↑ ↓ ↑'},
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B: ↓ ↑ ↓
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Answer the following medical question with one of the provided options:
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Q:A 44-year-old man comes to the physician because of progressive memory loss for the past 6 months. He reports that he often misplaces his possessions and has begun writing notes to remind himself of names and important appointments. He generally feels fatigued and unmotivated, and has poor concentration at work. He has also given up playing soccer because he feels slow and unsteady on his feet. He has also had difficulty swallowing food over the last two weeks. His temperature is 37.8°C (100°F), pulse is 82/min, respirations are 16/min, and blood pressure is 144/88 mm Hg. Examination shows confluent white plaques on the posterior oropharynx. Neurologic examination shows mild ataxia and an inability to perform repetitive rotary forearm movements. Mental status examination shows a depressed mood and short-term memory deficits. Serum glucose, vitamin B12 (cyanocobalamin), and thyroid-stimulating hormone concentrations are within the reference range. Upper esophagogastroduodenoscopy shows streaky, white-grayish lesions. Which of the following is the most likely underlying cause of this patient's neurological symptoms?? {'A': 'Cerebral toxoplasmosis', 'B': 'Pseudodementia', 'C': 'HIV-related encephalopathy', 'D': 'Frontotemporal dementia', 'E': 'Primary CNS lymphoma'},
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C: HIV-related encephalopathy
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Answer the following medical question with one of the provided options:
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Q:A 12-year-old male presents to the pediatrician after two days of tea-colored urine which appeared to coincide with the first day of junior high football. He explains that he refused to go back to practice because he was humiliated by the other players due to his quick and excessive fatigue after a set of drills accompanined by pain in his muscles. A blood test revealed elevated creatine kinase and myoglobulin levels. A muscle biopsy was performed revealing large glycogen deposits and an enzyme histochemistry showed a lack of myophosphorylase activity. Which of the following reactions is not occuring in this individuals?? {'A': 'Converting glucose-6-phosphate to glucose', 'B': 'Breaking down glycogen to glucose-1-phosphate', 'C': 'Cleaving alpha-1,6 glycosidic bonds from glycogen', 'D': 'Creating alpha-1,6 glycosidic bonds in glycogen', 'E': 'Converting galactose to galactose-1-phosphate'},
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B: Breaking down glycogen to glucose-1-phosphate
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Answer the following medical question with one of the provided options:
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Q:A 38-year-old woman presents with progressive muscle weakness. The patient says that symptoms onset a couple of weeks ago and have progressively worsened. She says she hasn’t been able to lift her arms to comb her hair the past few days. No significant past medical history and no current medications. Family history is significant for her mother with scleroderma and an aunt with systemic lupus erythematosus (SLE). On physical examination, strength is 2 out of 5 in the upper extremities bilaterally. There is an erythematous area, consisting of alternating hypopigmentation and hyperpigmentation with telangiectasias, present on the extensor surfaces of the arms, the upper chest, and the neck in a ‘V-shaped’ distribution. Additional findings are presented in the exhibit (see image). Laboratory tests are significant for a positive antinuclear antibody (ANA) and elevated creatinine phosphokinase. Which of the following is the most appropriate first-line treatment for this patient?? {'A': 'Hydroxychloroquine', 'B': 'Methotrexate', 'C': 'High-dose corticosteroids', 'D': 'Intravenous immunoglobulin', 'E': 'Infliximab'},
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C: High-dose corticosteroids
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Answer the following medical question with one of the provided options:
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Q:A 20-year-old college student comes to the physician because she has been extremely sad for the past 3 weeks and has to cry constantly. Three weeks ago, her boyfriend left her after they were together for 4 years. She has no appetite and has had a 2.3-kg (5.1-lb) weight loss. She has missed several classes because she could not stop crying or get out of bed. She thinks about her ex-boyfriend all the time. She says that she experienced similar symptoms for about 2 months after previous relationships ended. The patient is 158 cm (5 ft 2 in) tall and weighs 45 kg (100 lb); BMI is 18 kg/m2. Her temperature is 36.1°C (97°F), pulse is 65/min, and blood pressure is 110/60 mm Hg. Physical examination shows no abnormalities. On mental status examination she appears sad and cries easily. Which of the following is the most likely diagnosis?? {'A': 'Bereavement', 'B': 'Adjustment disorder with depressed mood', 'C': 'Major depressive disorder', 'D': 'Acute stress disorder', 'E': 'Anorexia nervosa'},
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B: Adjustment disorder with depressed mood
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Answer the following medical question with one of the provided options:
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Q:A 10-year-old child presents to your office with a chronic cough. His mother states that he has had a cough for the past two weeks that is non-productive along with low fevers of 100.5 F as measured by an oral thermometer. The mother denies any other medical history and states that he has been around one other friend who also has had this cough for many weeks. The patient's vitals are within normal limits with the exception of his temperature of 100.7 F. His chest radiograph demonstrated diffuse interstitial infiltrates. Which organism is most likely causing his pneumonia?? {'A': 'Mycoplasma pneumoniae', 'B': 'Staphylococcus aureus', 'C': 'Streptococcus pneumoniae', 'D': 'Pneumocystis jiroveci', 'E': 'Streptococcus agalactiae'},
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A: Mycoplasma pneumoniae
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Answer the following medical question with one of the provided options:
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Q:A 4-hour-old male newborn has perioral discoloration for the past several minutes. Oxygen by nasal cannula does not improve the cyanosis. He was delivered by cesarean delivery at 37 weeks' gestation to a 38-year-old woman, gravida 3, para 2. Apgar scores were 8 and 9 at 1 and 5 minutes, respectively. The mother has type 2 diabetes mellitus that was well-controlled during the pregnancy. She has not received any immunizations since her childhood. The newborn's temperature is 37.1°C (98.8°F), pulse is 170/min, respirations are 55/min, and blood pressure is 80/60 mm Hg. Pulse oximetry shows an oxygen saturation of 85%. Cardiopulmonary examination shows a 2/6 holosystolic murmur along the lower left sternal border. The abdomen is soft and non-tender. Echocardiography shows pulmonary arteries arising from the posterior left ventricle, and the aorta rising anteriorly from the right ventricle. Which of the following is the most appropriate next step in the management of this patient?? {'A': 'Reassurance', 'B': 'Prostaglandin E1 administration', 'C': 'Indomethacin administration', 'D': 'Surgical repair', 'E': 'Obtain a CT Angiography\n"'},
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B: Prostaglandin E1 administration
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Answer the following medical question with one of the provided options:
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Q:A 34-year-old woman, gravida 3, para 2, at 16 weeks' gestation comes to the physician because of nausea and recurrent burning epigastric discomfort for 1 month. Her symptoms are worse after heavy meals. She does not smoke or drink alcohol. Examination shows a uterus consistent in size with a 16-week gestation. Palpation of the abdomen elicits mild epigastric tenderness. The physician prescribes her medication to alleviate her symptoms. Treatment with which of the following drugs should be avoided in this patient?? {'A': 'Pantoprazole', 'B': 'Misoprostol', 'C': 'Magnesium hydroxide', 'D': 'Cimetidine', 'E': 'Sucralfate'},
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B: Misoprostol
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Answer the following medical question with one of the provided options:
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Q:A 71-year-old man develops worsening chest pressure while shoveling snow in the morning. He tells his wife that he has a squeezing pain that is radiating to his jaw and left arm. His wife calls for an ambulance. On the way, he received chewable aspirin and 3 doses of sublingual nitroglycerin with little relief of pain. He has borderline diabetes and essential hypertension. He has smoked 15–20 cigarettes daily for the past 37 years. His blood pressure is 172/91 mm Hg, the heart rate is 111/min and the temperature is 36.7°C (98.0°F). On physical examination in the emergency department, he looks pale, very anxious and diaphoretic. His ECG is shown in the image. Troponin levels are elevated. Which of the following is the best next step in the management of this patient condition?? {'A': 'Oral nifedipine', 'B': 'Fibrinolysis', 'C': 'Clopidogrel, atenolol, anticoagulation and monitoring', 'D': 'Echocardiography', 'E': 'CT scan of the chest with contrast'},
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C: Clopidogrel, atenolol, anticoagulation and monitoring
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Answer the following medical question with one of the provided options:
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Q:An obese 52-year-old man is brought to the emergency department because of increasing shortness of breath for the past 8 hours. Two months ago, he noticed a mass on the right side of his neck and was diagnosed with laryngeal cancer. He has smoked two packs of cigarettes daily for 27 years. He drinks two pints of rum daily. He appears ill. He is oriented to person, place, and time. His temperature is 37°C (98.6°F), pulse is 111/min, respirations are 34/min, and blood pressure is 140/90 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 89%. Examination shows a 9-cm, tender, firm subglottic mass on the right side of the neck. Cervical lymphadenopathy is present. His breathing is labored and he has audible inspiratory stridor but is able to answer questions. The lungs are clear to auscultation. Arterial blood gas analysis on room air shows: pH 7.36 PCO2 45 mm Hg PO2 74 mm Hg HCO3- 25 mEq/L He has no advanced directive. Which of the following is the most appropriate next step in management?"? {'A': 'Tracheal stenting', 'B': 'Tracheostomy', 'C': 'Intramuscular epinephrine', 'D': 'Comfort care measures', 'E': 'Cricothyroidotomy'},
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B: Tracheostomy
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Answer the following medical question with one of the provided options:
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Q:An 87-year-old woman is admitted to the intensive care unit after a neighbor found her lying on the floor at her home. Her respirations are 13/min and shallow. Despite appropriate therapy, the patient dies. Gross examination of the brain at autopsy shows neovascularization and liquefactive necrosis without cavitation in the distribution of the left middle cerebral artery. Histological examination of a brain tissue sample from the left temporal lobe shows proliferation of neural cells that stain positive for glial fibrillary acidic protein. Based on these findings, approximately how much time has most likely passed since the initial injury in this patient?? {'A': '10 days', 'B': '12 hours', 'C': '25 days', 'D': '2 hours', 'E': '2 days'},
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A: 10 days
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Answer the following medical question with one of the provided options:
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Q:A 34-year-old female with a past medical history of a gastric sleeve operation for morbid obesity presents for pre-surgical clearance prior to a knee arthroplasty. Work-up reveals a hemoglobin of 8.7 g/dL, hematocrit of 26.1%, and MCV of 106 fL. With concern for folate deficiency, she is started on high dose folate supplementation, and her follow-up labs are as follows: hemoglobin of 10.1 g/dL, hematocrit of 28.5%, and MCV of 96 fL. She is at risk for which long-term complication?? {'A': 'Neural tube defects', 'B': 'Macular degeneration', 'C': 'Peripheral neuropathy', 'D': 'Hypothyroidism', 'E': 'Microcytic anemia'},
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C: Peripheral neuropathy
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Answer the following medical question with one of the provided options:
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Q:A 50-year-old morbidly obese woman presents to a primary care clinic for the first time. She states that her father recently died due to kidney failure and wants to make sure she is healthy. She works as an accountant, is not married or sexually active, and drinks alcohol occasionally. She currently does not take any medications. She does not know if she snores at night but frequently feels fatigued. She denies any headaches but reports occasional visual difficulties driving at night. She further denies any blood in her urine or increased urinary frequency. She does not engage in any fitness program. She has her period every 2 months with heavy flows. Her initial vital signs reveal that her blood pressure is 180/100 mmHg and heart rate is 70/min. Her body weight is 150 kg (330 lb). On physical exam, the patient has droopy eyelids, a thick neck with a large tongue, no murmurs or clicks on cardiac auscultation, clear lungs, a soft nontender, albeit large abdomen, and palpable pulses in her distal extremities. She can walk without difficulty. A repeat measurement of her blood pressure shows 155/105 mmHg. Which among the following is part of the most appropriate next step in management?? {'A': 'Cortisol levels', 'B': 'Polysomnography', 'C': 'Renal artery doppler ultrasonography', 'D': 'Thyroid-stimulating hormone', 'E': 'Urinalysis'},
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E: Urinalysis
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Answer the following medical question with one of the provided options:
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Q:A 55-year-old male was picked up by police in the public library for harassing the patrons and for public nudity. He displayed disorganized speech and believed that the books were the only way to his salvation. Identification was found on the man and his sister was called to provide more information. She described that he recently lost his house and got divorced within the same week although he seemed fine three days ago. The man was sedated with diazepam and chlorpromazine because he was very agitated. His labs returned normal and within three days, he appeared normal, had no recollection of the past several days, and discussed in detail how stressful the past two weeks of his life were. He was discharged the next day. Which of the following is the most appropriate diagnosis for this male?? {'A': 'Brief psychotic disorder', 'B': 'Schizophreniform disoder', 'C': 'Schizophrenia', 'D': 'Schizoid personality disoder', 'E': 'Schizotypal personality disoder'},
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A: Brief psychotic disorder
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Answer the following medical question with one of the provided options:
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Q:A 56-year-old man comes to the clinic complaining of sexual dysfunction. He reports normal sexual function until 4 months ago when his relationship with his wife became stressful due to a death in the family. When asked about the details of his dysfunction, he claims that he is “able to get it up, but just can’t finish the job.” He denies any decrease in libido or erections, endorses morning erections, but an inability to ejaculate. He is an avid cyclist and exercises regularly. His past medical history includes depression and diabetes, for which he takes citalopram and metformin, respectively. A physical examination is unremarkable. What is the most likely explanation for this patient’s symptoms?? {'A': 'Autonomic neuropathy secondary to systemic disease', 'B': 'Damage to the pudendal nerve', 'C': 'Medication side effect', 'D': 'Psychological stress', 'E': 'Testosterone deficiency'},
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B: Damage to the pudendal nerve
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Answer the following medical question with one of the provided options:
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Q:A 3-year-old girl presents with delayed growth, anemia, and jaundice. Her mother denies any history of blood clots in her past, but she says that her mother has also had to be treated for pulmonary embolism and multiple episodes of unexplained pain in the past. Her prenatal history is significant for preeclampsia, preterm birth, and a neonatal intensive care unit (NICU) stay of 6 weeks. The vital signs include: temperature 36.7°C (98.0°F), blood pressure 102/54 mm Hg, heart rate 111/min, and respiratory rate 23/min. On physical examination, the pulses are bounding, the complexion is pale, but breath sounds remain clear. Oxygen saturation was initially 81% on room air, with a new oxygen requirement of 4 L by nasal cannula. Upon further examination, her physician notices that her fingers appear inflamed. A peripheral blood smear demonstrates sickle-shaped red blood cells (RBCs). What is the most appropriate treatment for this patient?? {'A': 'Hydroxyurea', 'B': 'Darbepoetin', 'C': 'Epoetin', 'D': 'Corticosteroids', 'E': 'Intravenous immunoglobulin'},
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A: Hydroxyurea
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Answer the following medical question with one of the provided options:
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Q:A 35-year-old woman presents for evaluation of symmetric proximal muscle weakness. The patient also presents with a blue-purple discoloration of the upper eyelids accompanied by rashes on the knuckles, as shown in the picture below. What is the most likely cause?? {'A': 'Polymyositis', 'B': 'Duchenne muscular dystrophy', 'C': 'Hypothyroidism', 'D': 'Inclusion body myositis', 'E': 'Dermatomyositis'},
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E: Dermatomyositis
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Answer the following medical question with one of the provided options:
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Q:A 26-year-old man comes to the physician because of a 1-week history of left-sided chest pain. The pain is worse when he takes deep breaths. Over the past 6 weeks, he had been training daily for an upcoming hockey tournament. He does not smoke cigarettes or drink alcohol but has used cocaine once. His temperature is 37.1°C (98.7°F), pulse is 75/min, and blood pressure is 128/85 mm Hg. Physical examination shows tenderness to palpation of the left chest. An x-ray of the chest is shown. Which of the following is the most appropriate initial pharmacotherapy?? {'A': 'Nitroglycerin', 'B': 'Alprazolam', 'C': 'Alteplase', 'D': 'Heparin', 'E': 'Naproxen'},
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E: Naproxen
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Answer the following medical question with one of the provided options:
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Q:A prospective cohort study is conducted to evaluate the risk of pleural mesothelioma in construction workers exposed to asbestos in Los Angeles. Three hundred construction workers reporting current occupational asbestos exposure were followed alongside 300 construction workers without a history of asbestos exposure. After 8 years of follow-up, no statistically significant difference in the incidence of pleural mesothelioma was observed between the two groups (p = 0.13), even after controlling for known mesothelioma risk factors such as radiation, age, and sex. Which of the following is the most likely explanation for the observed results of this study?? {'A': 'Length-time bias', 'B': 'Lead-time bias', 'C': 'Latency period', 'D': 'Observer effect', 'E': 'Berkson bias'},
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C: Latency period
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Answer the following medical question with one of the provided options:
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Q:A 70-year-old woman with history of coronary artery disease status-post coronary artery bypass graft presents with a stroke due to an infarction in the right middle cerebral artery territory. She is admitted to the intensive care unit for neurological monitoring following a successful thrombectomy. Overnight, the patient complains of difficulty breathing, chest pain, and jaw pain. Her temperature is 98.6°F (37°C), blood pressure is 160/80 mmHg, pulse is 100/min, respirations are 30/min, and oxygen saturation is 90% on 2L O2 via nasal cannula. Rales are heard in the lower lung bases. Electrocardiogram reveals left ventricular hypertrophy with repolarization but no acute ST or T wave changes. Troponin is 2.8 ng/mL. Chest radiograph reveals Kerley B lines. After administration of oxygen, aspirin, carvedilol, and furosemide, the patient improves. The next troponin is 3.9 ng/mL. Upon further discussion with the consulting cardiologist and neurologist, a heparin infusion is started. After transfer to a general medicine ward floor four days later, the patient complains of a headache. The patient's laboratory results are notable for the following: Hemoglobin: 11 g/dL Hematocrit: 36% Leukocyte count: 11,000 /mm^3 with normal differential Platelet count: 130,000 /mm^3 On admission, the patient's platelet count was 300,000/mm^3. What medication is appropriate at this time?? {'A': 'Argatroban', 'B': 'Enoxaparin', 'C': 'Dalteparin', 'D': 'Protamine', 'E': 'Tinzaparin'},
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A: Argatroban
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Answer the following medical question with one of the provided options:
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Q:A 45-day-old male infant is brought to a pediatrician by his parents with concerns of poor feeding and excessive perspiration for one week. On physical examination, his temperature is 37.7°C (99.8°F), pulse rate is 190/min, and respiratory rate is 70/min. Mild cyanosis is present over the lips, and over the nail beds. Oxygen is provided and his oxygen saturation is carefully monitored. The pediatrician orders a bedside echocardiogram of the infant. It reveals a single arterial trunk arising from 2 normally formed ventricles. The arterial trunk is separated from the ventricles by a single semilunar valve. There is a defect in the interventricular septum, and the arterial trunk overrides the defect. Which of the following congenital heart diseases can also present with similar clinical features?? {'A': 'Double-inlet ventricle with unobstructed pulmonary flow', 'B': 'Infracardiac total anomalous pulmonary venous return', 'C': 'Severe Ebstein anomaly', 'D': 'Transposition of the great arteries with ventricular septal defect and pulmonary stenosis', 'E': 'Pulmonary atresia with intact ventricular septum'},
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A: Double-inlet ventricle with unobstructed pulmonary flow
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Answer the following medical question with one of the provided options:
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Q:A 17-year-old white male is brought to the emergency department after being struck by a car. He complains of pain in his right leg and left wrist, and slowly recounts how he was hit by a car while being chased by a lion. In between sentences of the story, he repeatedly complains of dry mouth and severe hunger and requests something to eat and drink. His mother arrives and is very concerned about this behavior, noting that he has been withdrawn lately and doing very poorly in school the past several months. Notable findings on physical exam include conjunctival injection bilaterally and a pulse of 107. What drug is this patient most likely currently abusing?? {'A': 'Cocaine', 'B': 'Phencylidine (PCP)', 'C': 'Benzodiazepines', 'D': 'Marijuana', 'E': 'Heroin'},
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D: Marijuana
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Answer the following medical question with one of the provided options:
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Q:A 72-year-old woman with hypertension comes to the physician because of swelling and pain in both legs for the past year. The symptoms are worse at night and improve in the morning. Current medications include losartan and metoprolol. Her temperature is 36°C (96.8°F), pulse is 67/min, and blood pressure is 142/88 mm Hg. Examination shows normal heart sounds; there is no jugular venous distention. Her abdomen is soft and the liver edge is not palpable. Examination of the lower extremities shows bilateral pitting edema and prominent superficial veins. The skin is warm and there is reddish-brown discoloration of both ankles. Laboratory studies show a normal serum creatinine and normal urinalysis. Which of the following is the most likely underlying cause of this patient's symptoms?? {'A': 'Decreased lymphatic flow', 'B': 'Decreased intravascular oncotic pressure', 'C': 'Decreased arteriolar resistance', 'D': 'Increased venous valve reflux', 'E': 'Increased capillary permeability'},
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D: Increased venous valve reflux
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Answer the following medical question with one of the provided options:
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Q:A 60-year-old post-menopausal female presents to her gynecologist with vaginal bleeding. Her last period was over 10 years ago. Dilation and curettage reveals endometrial carcinoma so she is scheduled to undergo a total abdominal hysterectomy and bilateral salpingo-oophorectomy. During surgery, the gynecologist visualizes paired fibrous structures arising from the cervix and attaching to the lateral pelvic walls at the level of the ischial spines. Which of the following vessels is found within each of the paired visualized structure?? {'A': 'Superior vesical artery', 'B': 'Vaginal artery', 'C': 'Artery of Sampson', 'D': 'Uterine artery', 'E': 'Ovarian artery'},
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D: Uterine artery
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Answer the following medical question with one of the provided options:
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Q:A 56-year-old woman presents with sudden-onset severe headache, nausea, vomiting, and neck pain for the past 90 minutes. She describes her headache as a ‘thunderclap’, followed quickly by severe neck pain and stiffness, nausea and vomiting. She denies any loss of consciousness, seizure, or similar symptoms in the past. Her past medical history is significant for an episode 6 months ago where she suddenly had trouble putting weight on her right leg, which resolved within hours. The patient denies any history of smoking, alcohol or recreational drug use. On physical examination, the patient has significant nuchal rigidity. Her muscle strength in the lower extremities is 4/5 on the right and 5/5 on the left. The remainder of the physical examination is unremarkable. A noncontrast CT scan of the head is normal. Which of the following is the next best step in the management of this patient?? {'A': 'IV tPA', 'B': 'Lumbar puncture', 'C': 'T1/T2 MRI of the head', 'D': 'Diffusion-weighted magnetic resonance imaging of the brain', 'E': 'Placement of a ventriculoperitoneal (VP) shunt'},
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B: Lumbar puncture
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Answer the following medical question with one of the provided options:
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Q:A 1-minute-old newborn is being examined by the pediatric nurse. The nurse auscultates the heart and determines that the heart rate is 89/min. The respirations are spontaneous and regular. The chest and abdomen are both pink while the tips of the fingers and toes are blue. When the newborn’s foot is slapped the face grimaces and he cries loud and strong. When the arms are extended by the nurse they flex back quickly. What is this patient’s Apgar score?? {'A': '5', 'B': '6', 'C': '8', 'D': '9', 'E': '10'},
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C: 8
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Answer the following medical question with one of the provided options:
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Q:A 37-year-old man presents with back pain which began 3 days ago when he was lifting heavy boxes. The pain radiates from the right hip to the back of the thigh. The pain is exacerbated when he bends at the waist. He rates the severity of the pain as 6 out of 10. The patient has asthma and mitral insufficiency due to untreated rheumatic fever in childhood. He has a smoking history of 40 pack-years. His family history is remarkable for rheumatoid arthritis, diabetes, and hypertension. Vital signs are within normal limits. On physical examination, the pain is elicited when the patient is asked to raise his leg without extending his knee. The patient has difficulty walking on his heels. Peripheral pulses are equal and brisk bilaterally. No hair loss, temperature changes, or evidence of peripheral vascular disease is observed. Which of the following is considered the best management option for this patient?? {'A': 'Stenting', 'B': 'Observation', 'C': 'Referral for surgery', 'D': 'Prescription of opioids', 'E': 'Over-the-counter NSAIDs'},
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E: Over-the-counter NSAIDs
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Answer the following medical question with one of the provided options:
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Q:A 27-year-old man is brought to the emergency department with minor injuries sustained in a motor vehicle accident. He says that he is fine. He also witnessed the death of a teenage girl in the accident who was his sister’s friend. He is able to return to work within a few days. A month later, he presents being withdrawn and increasingly irritable. He says recently he has been experiencing depressed moods and higher anxiety than usual. He says that he feels guilty about the girl’s death, stating that he could have saved her if only he had acted quicker. He adds that he became extremely anxious while driving by a car accident on the freeway recently, and that, even when watching television or a movie, he feels panicked during a car crash scene. Which of the following is the most likely diagnosis in this patient?? {'A': 'Adjustment disorder', 'B': 'Acute stress disorder', 'C': 'Generalized anxiety disorder', 'D': 'Panic disorder', 'E': 'Post-traumatic stress disorder'},
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E: Post-traumatic stress disorder
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Answer the following medical question with one of the provided options:
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Q:A 25-year-old woman, gravida 2, para 1, at 36 weeks' gestation comes to the physician because of irritability, palpitations, heat intolerance, and frequent bowel movements for the last 5 months. She has received no prenatal care. Her pulse is 118/min and blood pressure is 133/80 mm Hg. She appears anxious. There is a fine tremor in the hands and ophthalmologic examination shows bilateral exophthalmos. The skin is warm and moist to touch. This patient’s child is most likely to have which of the following complications at birth?? {'A': 'Bradycardia and annular rash', 'B': 'Umbilical hernia and erosive scalp lesion', 'C': 'Macrosomia and shoulder dystocia', 'D': 'Mechanical holosystolic murmur and tetany', 'E': 'Microcephaly and stridor'},
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E: Microcephaly and stridor
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Q:A 53-year-old multiparous woman is scheduled to undergo elective sling surgery for treatment of stress incontinence. She has frequent loss of small amounts of urine when she coughs or laughs, despite attempts at conservative treatment. The physician inserts trocars in the obturator foramen bilaterally to make the incision and passes a mesh around the pubic bones and underneath the urethra to form a sling. During the procedure, the physician accidentally injures a nerve in the obturator foramen. The function of which of the following muscles is most likely to be affected following the procedure?? {'A': 'Obturator internus', 'B': 'Adductor longus', 'C': 'Tensor fascia latae', 'D': 'Transversus abdominis', 'E': 'Semitendinosus'},
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B: Adductor longus
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Answer the following medical question with one of the provided options:
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Q:A 70-year-old woman is on hospital day 2 in the medical intensive care unit. She was admitted from the emergency department for a 2-day history of shortness of breath and fever. In the emergency department, her temperature is 39.4°C (103.0°F), the pulse is 120/min, the blood pressure is 94/54 mm Hg, the respiratory rate is 36/min, and oxygen saturation was 82% while on 4L of oxygen via a non-rebreather mask. Chest X-ray shows a right lower lobe consolidation. She was intubated, sedated, and started on broad-spectrum antibiotics for sepsis of pulmonary origin and intravenous norepinephrine for blood pressure support. Since then, her clinical condition has been stable, though her vasopressor and oxygen requirements have not improved. Today, her physician is called to the bedside because her nurse noted some slow bleeding from her intravenous line sites and around her urinary catheter. Which of the following most likely represents the results of coagulation studies for this patient?? {'A': 'D-dimer: negative, fibrinogen level: normal, platelet count: normal', 'B': 'D-dimer: elevated, fibrinogen level: low, platelet count: low', 'C': 'D-dimer: negative, fibrinogen level: elevated, platelet count: elevated', 'D': 'D-dimer: elevated, fibrinogen level: normal, platelet count: normal', 'E': 'D-dimer: negative, fibrinogen level: low, platelet count: low'},
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B: D-dimer: elevated, fibrinogen level: low, platelet count: low
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Q:A newborn undergoing the standard screening tests is found to have a positive test for reducing sugars. Further testing is performed and reveals that the patient does not have galactosemia, but rather is given a diagnosis of fructosuria. What levels of enzymatic activity are altered in this patient?? {'A': 'Hexokinase increased; fructokinase decreased', 'B': 'Hexokinase decreased; fructokinase increased', 'C': 'Hexokinase increased; fructokinase increased', 'D': 'Hexokinase decreased; fructokinase decreased', 'E': 'Hexokinase unchanged; fructokinase unchanged'},
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A: Hexokinase increased; fructokinase decreased
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Answer the following medical question with one of the provided options:
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Q:A 53-year-old man is brought to the emergency department because of wheezing and shortness of breath that began 1 hour after he took a new medication. Earlier in the day he was diagnosed with stable angina pectoris and prescribed a drug that irreversibly inhibits cyclooxygenase-1 and 2. He has chronic rhinosinusitis and asthma treated with inhaled β-adrenergic agonists and corticosteroids. His respirations are 26/min. Examination shows multiple small, erythematous nasal mucosal lesions. After the patient is stabilized, therapy for primary prevention of coronary artery disease should be switched to a drug with which of the following mechanisms of action?? {'A': 'Inhibition of vitamin K epoxide reductase', 'B': 'Blockage of P2Y12 component of ADP receptors', 'C': 'Direct inhibition of Factor Xa', 'D': 'Sequestration of Ca2+ ions', 'E': 'Potentiation of antithrombin III'},
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B: Blockage of P2Y12 component of ADP receptors
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Q:A 6-year-old boy is brought to the physician by his parents because of right lower extremity weakness, worsening headaches, abdominal pain, dark urine, and a 5-kg (11-lb) weight loss for the past 2 months. His teachers report that he has not been paying attention in class and his grades have been worsening. He has a history of infantile seizures. Physical examination shows a palpable abdominal mass and left costovertebral angle tenderness. Neurological exam shows decreased strength of the right lower limb. He has several acne-like angiofibromas around the nose and cheeks. Further evaluation is most likely to show which of the following?? {'A': 'Port wine stain', 'B': 'Pheochromocytoma', 'C': 'Lisch nodules', 'D': 'Subependymal giant cell astrocytoma', 'E': 'Vestibular schwannoma'},
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D: Subependymal giant cell astrocytoma
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Q:A 60-year-old diabetic male presents to your clinic for right ear pain. The patient reports noting worsening right ear pain for three weeks, purulent otorrhea initially which has resolved, and facial asymmetry for the past several days. He reports being poorly compliant with his diabetes medication regimen. His temperature is 100.4 deg F (38 deg C), blood pressure is 140/90 mmHg, pulse is 90/min, and respirations are 18/min. On physical exam, the patient’s right external auditory canal is noted to have granulation tissue at the bony cartilaginous junction. He is also noted to have right facial droop. Which of the following is the best next step in treatment?? {'A': 'Oral amoxicillin-clavulanic acid for 10 days', 'B': 'Intravenous ciprofloxacin for 6 weeks', 'C': 'Topical polymyxin and neosporin for 14 days', 'D': 'Hyperbaric oxygen treatment for 4 weeks', 'E': 'Surgical intervention'},
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B: Intravenous ciprofloxacin for 6 weeks
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Q:A 66-year-old man weighing 50 kg (110 lb) is admitted to the hospital because of sepsis complicated by acute respiratory distress syndrome. The physician decides to initiate total parenteral nutrition and prescribes short-term hypocaloric intake of 20 kcal/kg/day with 20% of the total energy requirement provided by proteins and 30% provided by fats. The physician calculates that a total volume of 1100 mL/day should be infused during the parenteral nutrition therapy to maintain fluid balance. A colloid containing 10 g/dL of albumin and an emulsion with a fat concentration of 33 g/dL are used to prepare parenteral nutrition modules. Which of the following is the most appropriate module to meet the carbohydrate requirement in this patient over the next 24 hours?? {'A': '500 mL of 10% dextrose solution', 'B': '250 mL of 50% dextrose solution', 'C': '750 mL of 25% dextrose solution', 'D': '750 mL of 10% dextrose solution', 'E': '500 mL of 25% dextrose solution'},
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E: 500 mL of 25% dextrose solution
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Q: A 35-year-old woman who was recently ill with an upper respiratory infection presents to the emergency department with weakness in her lower limbs and difficulty breathing. Her symptoms began with a burning sensation in her toes along with numbness. She claims that the weakness has been getting worse over the last few days and now involving her arms and face. Currently, she is unable to get up from the chair without some assistance. Her temperature is 37.0°C (98.6°F), the blood pressure is 145/89 mm Hg, the heart rate is 99/min, the respiratory rate is 12/min, and the oxygen saturation is 95% on room air. On physical examination, she has diminished breath sounds on auscultation of bilateral lung fields with noticeably poor inspiratory effort. Palpation of the lower abdomen reveals a palpable bladder. Strength is 3 out of 5 symmetrically in the lower extremities bilaterally. The sensation is intact. What is the most likely diagnosis?? {'A': 'Acute disseminated encephalomyelitis', 'B': 'Adrenoleukodystrophy', 'C': 'Guillain-Barré syndrome', 'D': 'Multiple sclerosis', 'E': 'Myasthenia Gravis'},
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C: Guillain-Barré syndrome
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Answer the following medical question with one of the provided options:
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Q:A 75-year-old man is brought to the emergency department after 2 days of severe diffuse abdominal pain, nausea, vomiting, and lack of bowel movements, which has led him to stop eating. He has a history of type-2 diabetes mellitus, hypertension, and chronic pulmonary obstructive disease. Upon admission, his vital signs are within normal limits and physical examination shows diffuse abdominal tenderness, distention, lack of bowel sounds, and an empty rectal ampulla. After initial fluid therapy and correction of moderate hypokalemia, the patient’s condition shows mild improvement. His abdominal plain film is taken and shown. Which of the following is the most appropriate concomitant approach?? {'A': 'Initiate pain management with morphine', 'B': 'Initiate intravenous metoclopramide', 'C': 'Nasogastric decompression', 'D': 'Exploratory surgery', 'E': 'Gastrografin enema'},
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C: Nasogastric decompression
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Answer the following medical question with one of the provided options:
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Q:A 13-year-old girl is brought to the outpatient clinic by her parents with a complaint of episodic spasm in her fingers for the past few months. Upon further questioning, her mother notes that the girl has not been doing well at school. She also believes that the girl is shorter than the other children in her class. On examination, her pulse is 72/min, temperature 37.6°C (99.7°F), respiratory rate 16/min, and blood pressure 120/88 mm Hg. The girl has short 4th and 5th fingers on both hands, a round face, and discolored teeth. Her height is 135 cm (4 ft 5 in) and she weighs 60 kg (132 lb). Investigation reports show the following values: Hemoglobin (Hb%) 12.5 g/dL White blood cell total count 10,000/mm3 Platelets 260,000/mm3 Calcium, serum (Ca2+) 4.0 mg/dL Serum albumin 4.0 g/dL Alanine aminotransferase (ALT), serum 15 U/L Aspartate aminotransferase (AST), serum 8 U/L Serum creatinine 0.5 mg/dL Urea 27 mg/dL Sodium 137 mEq/L Potassium 4.5 mEq/L Magnesium 2.5 mEq/L Parathyroid hormone, serum, N-terminal 930 pg/mL (normal: 230-630 pg/mL) Serum vitamin D 45 ng/dL Which of the following is the mode of inheritance of the disease this patient has?? {'A': 'X-linked recessive', 'B': 'Autosomal dominant', 'C': 'Mitochondrial inheritance', 'D': 'X linked dominant', 'E': 'Autosomal recessive'},
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B: Autosomal dominant
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Q:A 27-year-old man presents to the emergency department for bizarre behavior. The patient had boarded up his house and had been refusing to leave for several weeks. The police were called when a foul odor emanated from his property prompting his neighbors to contact the authorities. Upon questioning, the patient states that he has been pursued by elves for his entire life. He states that he was tired of living in fear, so he decided to lock himself in his house. The patient is poorly kempt and has very poor dentition. The patient has a past medical history of schizophrenia which was previously well controlled with olanzapine. The patient is restarted on olanzapine and monitored over the next several days. Which of the following needs to be monitored long term in this patient?? {'A': 'CBC', 'B': 'ECG', 'C': 'HbA1c levels', 'D': 'Monitoring for acute dystonia', 'E': 'Renal function studies'},
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C: HbA1c levels
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Q:A 9-year-old boy with cystic fibrosis (CF) presents to the clinic with fever, increased sputum production, and cough. The vital signs include: temperature 38.0°C (100.4°F), blood pressure 126/74 mm Hg, heart rate 103/min, and respiratory rate 22/min. His physical examination is significant for short stature, thin body frame, decreased breath sounds bilateral, and a 2/6 holosystolic murmur heard best on the upper right sternal border. His pulmonary function tests are at his baseline, and his sputum cultures reveal Pseudomonas aeruginosa. What is the best treatment option for this patient?? {'A': 'Inhaled tobramycin for 28 days', 'B': 'Dornase alfa 2.5 mg as a single-use', 'C': 'Oral cephalexin for 14 days', 'D': 'Minocycline for 28 days', 'E': 'Sulfamethoxazole and trimethoprim for 14 days'},
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A: Inhaled tobramycin for 28 days
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Q:A 66-year-old man is brought to the emergency department after a motor vehicle accident. The patient was a restrained passenger in a car that was struck on the passenger side while crossing an intersection. In the emergency department, he is alert and complaining of abdominal pain. He has a history of hyperlipidemia, gastroesophageal reflux disease, chronic kidney disease, and perforated appendicitis for which he received an interval appendectomy four years ago. His home medications include rosuvastatin and lansoprazole. His temperature is 99.2°F (37.3°C), blood pressure is 120/87 mmHg, pulse is 96/min, and respirations are 20/min. He has full breath sounds bilaterally. He is tender to palpation over the left 9th rib and the epigastrium. He is moving all four extremities. His FAST exam reveals fluid in Morrison's pouch. This patient is most likely to have which of the following additional signs or symptoms?? {'A': 'Pain radiating to the back', 'B': 'Gross hematuria', 'C': 'Shoulder pain', 'D': 'Muffled heart sounds', 'E': 'Free air on chest radiograph'},
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C: Shoulder pain
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Q:A 4-year-old girl is brought to the physician because her mother is concerned that she has been talking to an imaginary friend for 2 months. The child calls her friend 'Lucy' and says “Lucy is my best friend”. The child has multiple conversation and plays with the 'Lucy' throughout the day. The girl attends preschool regularly. She can copy a circle, tells stories, and can hop on one foot. Her maternal uncle has schizophrenia. Her parents are currently divorcing. The child's father has a history of illicit drug use. Physical examination shows no abnormalities. The mother is concerned about whether the child is acting out because of the divorce. Which of the following is the most appropriate next best step in management?? {'A': 'Screen urine for drugs', 'B': 'Perform MRI of the brain', 'C': 'Inform Child Protective Services', 'D': 'Schedule psychiatry consult', 'E': 'Reassure the mother'},
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E: Reassure the mother
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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 after an episode of syncope. He states that for the past month ever since starting a new job he has experienced an episode of syncope or near-syncope every morning while he is getting dressed. The patient states that he now gets dressed, shaves, and puts on his tie sitting down to avoid falling when he faints. He has never had this before and is concerned it is stress from his new job as he has been unemployed for the past 5 years. He is wondering if he can get a note for work since he was unable to head in today secondary to his presentation. The patient has no significant past medical history and is otherwise healthy. His temperature is 99.2°F (37.3°C), blood pressure is 122/83 mmHg, pulse is 92/min, respirations are 16/min, and oxygen saturation is 100% on room air. Cardiopulmonary and neurologic exams are within normal limits. An initial ECG and laboratory values are unremarkable as well. Which of the following is the most likely diagnosis?? {'A': 'Anxiety', 'B': 'Aortic stenosis', 'C': 'Carotid hypersensitivity syndrome', 'D': 'Hypertrophic obstructive cardiomyopathy', 'E': 'Malingering'},
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C: Carotid hypersensitivity syndrome
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Q:A 42-year-old male presents to your office with cellulitis on his leg secondary to a dog bite. You suspect that the causative agent is a small, facultatively anaerobic, Gram-negative rod sensitive to penicillin with clavulanate. When you ask the patient how the bite occurred, the patient explains that he had a fight with his wife earlier in the day. Frustrated with his wife, he yelled at the family pet, who bit him on the leg. Which of the following defense mechanisms was this patient employing at the time of his injury?? {'A': 'Projection', 'B': 'Reaction formation', 'C': 'Regression', 'D': 'Repression', 'E': 'Displacement'},
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E: Displacement
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Q:A 12-year-old boy and his siblings are referred to a geneticist for evaluation of a mild but chronic hemolytic anemia that has presented with fatigue, splenomegaly, and scleral icterus. Coombs test is negative and blood smear does not show any abnormal findings. An enzymatic panel is assayed, and pyruvate kinase is found to be mutated on both alleles. The geneticist explains that pyruvate kinase functions in glycolysis and is involved in a classic example of feed-forward regulation. Which of the following metabolites is able to activate pyruvate kinase?? {'A': 'Glucose-6-phosphate', 'B': 'Fructose-1,6-bisphosphate', 'C': 'Glyceraldehyde-3-phosphate', 'D': 'ATP', 'E': 'Alanine'},
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B: Fructose-1,6-bisphosphate
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Q:A 63-year-old woman, gravida 0, para 0 comes to the physician because of a 3-month history of abdominal distension, constipation, and weight loss. She has a history of endometriosis. Pelvic examination shows a nontender, irregular, left adnexal mass. Her serum level of CA-125 is elevated. Serum concentrations of human chorionic gonadotropin and alpha-fetoprotein are within the reference ranges. Microscopic examination of the mass is most likely to show which of the following findings?? {'A': 'Large undifferentiated germ cells with clear cytoplasm', 'B': 'Flattened, cuboidal cells along with Schiller-Duval bodies', 'C': 'Small, round cells that form Call-Exner bodies', 'D': 'Atypical epithelial cells along with psammoma bodies', 'E': 'Spindle-shaped stromal cells along with signet ring cells'},
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D: Atypical epithelial cells along with psammoma bodies
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Q:Three days after undergoing open surgery to repair a bilateral inguinal hernia, a 66-year-old man has new, intermittent upper abdominal discomfort that worsens when he walks around. He also has new shortness of breath that resolves with rest. There were no complications during surgery or during the immediate postsurgical period. Ambulation was restarted on the first postoperative day. He has type 2 diabetes mellitus, hypercholesterolemia, and hypertension. He has smoked one pack of cigarettes daily for 25 years. Prior to admission, his medications included metformin, simvastatin, and lisinopril. His temperature is 37°C (98.6°F), pulse is 80/min, respirations are 16/min, and blood pressure is 129/80 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 98%. The abdomen is soft and shows two healing surgical scars with moderate serous discharge. Cardiopulmonary examination shows no abnormalities. An ECG at rest shows no abnormalities. Cardiac enzyme levels are within the reference range. An x-ray of the chest and abdominal ultrasonography show no abnormalities. Which of the following is the most appropriate next step in diagnosis?? {'A': 'Obtain serum D-dimer level', 'B': 'Magnetic resonance imaging of the abdomen', 'C': 'Culture swab from the surgical site', 'D': 'Coronary angiography', 'E': 'Cardiac pharmacological stress test'},
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E: Cardiac pharmacological stress test
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Answer the following medical question with one of the provided options:
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Q:A 69-year-old male presents to his primary care physician for a checkup. He has not seen a doctor in 15 years and thought he may need an exam. The patient’s past medical history is unknown and he is not currently taking any medications. The patient lives on a rural farm alone and has since he was 27 years of age. The patient works as a farmer and never comes into town as he has all his supplies delivered to him. The patient is oddly adorned in an all-denim ensemble, rarely makes eye contact with the physician, and his responses are very curt. A physical exam is performed and is notable for an obese man with a S3 heart sound on cardiac exam. The patient is informed that further diagnostic testing may be necessary and that it is recommended that he begin taking lisinopril and hydrochlorothiazide for his blood pressure of 155/95 mmHg. Which of the following is the most likely personality disorder that this patient suffers from?? {'A': 'Schizoid', 'B': 'Schizotypal', 'C': 'Paranoid', 'D': 'Avoidant', 'E': 'Antisocial'},
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A: Schizoid
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Q:You are developing a new diagnostic test to identify patients with disease X. Of 100 patients tested with the gold standard test, 10% tested positive. Of those that tested positive, the experimental test was positive for 90% of those patients. The specificity of the experimental test is 20%. What is the positive predictive value of this new test?? {'A': '90%', 'B': '10%', 'C': '11%', 'D': '95%', 'E': '20%'},
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C: 11%
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Answer the following medical question with one of the provided options:
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Q:A 70-year-old woman presents with substernal chest pain. She says that the symptoms began 2 hours ago and have not improved. She describes the pain as severe, episodic, and worse with exertion. She reports that she has had multiple similar episodes that have worsened and increased in frequency over the previous 4 months. Past medical history is significant for diabetes and hypertension, both managed medically. The vital signs include temperature 37.0°C (98.6°F), blood pressure 150/100 mm Hg, pulse 80/min, and respiratory rate 15/min. Her serum total cholesterol is 280 mg/dL and high-density lipoprotein (HDL) is 30 mg/dL. The electrocardiogram (ECG) shows ST-segment depression on multiple chest leads. Coronary angiography reveals 75% narrowing of her left main coronary artery. In which of the following anatomical locations is a mural thrombus most likely to form in this patient?? {'A': 'Left atrium', 'B': 'Aorta', 'C': 'Right atrium', 'D': 'Left ventricle', 'E': 'Right ventricle'},
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D: Left ventricle
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Q:A 5-month-old boy is brought to the physician because of fever and a cough for 3 days. His mother reports that he has had multiple episodes of loose stools over the past 3 months. He has been treated for otitis media 4 times and bronchiolitis 3 times during the past 3 months. He was born at 37 weeks' gestation and the neonatal period was uncomplicated. He is at the 10th percentile for height and 3rd percentile for weight. His temperature is 38.3°C (100.9°F), pulse is 126/min, and respirations are 35/min. Examination shows an erythematous scaly rash over the trunk and extremities. There are white patches on the tongue and buccal mucosa that bleed when scraped. Inspiratory crackles are heard in the right lung base. An x-ray of the chest shows an infiltrate in the right lower lobe and an absent thymic shadow. Which of the following is the most likely diagnosis?? {'A': 'Wiskott-Aldrich syndrome', 'B': 'Severe combined immunodeficiency', 'C': 'Leukocyte adhesion deficiency', 'D': 'Chronic granulomatous disease', 'E': 'X-linked agammaglobulinemia'},
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B: Severe combined immunodeficiency
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Q:A 57-year-old man presents the urgent care clinic with a one-week history of diffuse bone pain and generalized weakness. He was diagnosed with end-stage renal disease 6 months ago and is currently on dialysis. His wife, who is accompanying him today, adds that he is not compliant with his medicines. He has been diabetic for the last 10 years and hypertensive for the last 7 years. He has smoked 4–5 cigarettes per day for 30 years but does not drink alcohol. His family history is insignificant. On examination, the patient has a waddling gait. Hypotonia of all the limbs is evident on neurologic examination. Diffuse bone tenderness is remarkable. X-ray of his legs reveal osteopenia and osseous resorption. The final step of activation of the deficient vitamin in this patient occurs by which of the following enzymes?? {'A': '7-α-hydroxylase', 'B': '1-α-hydroxylase', 'C': 'α-1-antitrypsin', 'D': 'α-Glucosidase', 'E': '24,25 hydroxylase'},
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B: 1-α-hydroxylase
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Answer the following medical question with one of the provided options:
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Q:A 94-year-old woman is brought to the emergency department after she was found unresponsive and febrile at her home. Her son reports that she had an acute episode of coughing while having breakfast the day before. Six days after admission, the patient develops progressive tachypnea and a gradual decrease in oxygen saturation, despite ventilation with supplemental oxygen. Physical examination shows coarse bilateral breath sounds. An x-ray of the chest shows opacities in all lung fields. Despite appropriate care, the patient dies two days later. A photomicrograph of a specimen of the lung obtained at autopsy is shown. This patient's pulmonary condition is most likely associated with which of the following pathophysiologic changes?? {'A': 'Increased pulmonary shunt fraction', 'B': 'Increased pulmonary wedge pressure', 'C': 'Increased mixed venous oxygen saturation', 'D': 'Increased pulmonary compliance', 'E': 'Decreased pulmonary artery pressure\n"'},
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A: Increased pulmonary shunt fraction
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Answer the following medical question with one of the provided options:
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Q:A 31-year-old man comes to the emergency department because of chest pain for the last 3 hours. He describes the pain as a sharp, substernal chest pain that radiates to the right shoulder; he says “Please help me. I'm having a heart attack.” He has been admitted to the hospital twice over the past week for evaluation of shortness of breath and abdominal pain but left the hospital the following day on both occasions. The patient does not smoke or drink alcohol but is a known user of intravenous heroin. He has been living in a homeless shelter for the past 2 weeks after being evicted from his apartment for failure to pay rent. His temperature is 37.6°C (99.6°F), pulse is 90/min, respirations are 18/min, and blood pressure is 125/85 mm Hg. The patient seems anxious and refuses a physical examination of his chest. His cardiac troponin I concentration is 0.01 ng/mL (N = 0–0.01). An ECG shows a normal sinus rhythm with nonspecific ST-T wave changes. While the physician is planning to discharge the patient, the patient reports numbness in his arm and insists on being admitted to the ward. On the following day, the patient leaves the hospital without informing the physician or the nursing staff. Which of the following is the most likely diagnosis?? {'A': 'Conversion disorder', 'B': 'Factitious disorder', 'C': 'Malingering', 'D': 'Illness anxiety disorder', 'E': 'Somatic symptom disorder'},
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C: Malingering
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Answer the following medical question with one of the provided options:
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Q:A 56-year-old man presents to the emergency department with increasing shortness of breath and mild chest discomfort. One week ago he developed cold-like symptoms, including a mild fever, headache, and occasional night sweats. He noticed that he required 2 additional pillows in order to sleep comfortably. Approximately 1-2 nights ago, he was severely short of breath, causing him to awaken from sleep which frightened him. He reports gaining approximately 6 pounds over the course of the week without any significant alteration to his diet. He says that he feels short of breath after climbing 1 flight of stairs or walking less than 1 block. Previously, he was able to climb 4 flights of stairs and walk 6-7 blocks with mild shortness of breath. Medical history is significant for coronary artery disease (requiring a left anterior descending artery stent 5 years ago and dual antiplatelet therapy), heart failure with reduced ejection fraction, hypertension, hyperlipidemia, and type II diabetes. He drinks 2 alcoholic beverages daily and has smoked 1 pack of cigarettes daily for the past 35 years. His temperature is 98.6°F (37°C), blood pressure is 145/90 mmHg, pulse is 102/min, and respirations are 20/min. On physical exam, the patient has a positive hepatojugular reflex, a third heart sound, crackles in the lung bases, and pitting edema up to the mid-thigh bilaterally. Which of the following is the best next step in management?? {'A': 'Bumetanide', 'B': 'Carvedilol', 'C': 'Dopamine', 'D': 'Milrinone', 'E': 'Nitroprusside'},
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A: Bumetanide
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Q:A 62-year-old man presents to his primary care provider complaining of leg pain with exertion for the past 6 months. He notices that he has bilateral calf cramping with walking. He states that it is worse in his right calf than in his left, and it goes away when he stops walking. He has also noticed that his symptoms are progressing and that this pain is occurring sooner than before. His medical history is remarkable for type 2 diabetes mellitus and 30-pack-year smoking history. His ankle-brachial index (ABI) is found to be 0.80. Which of the following can be used as initial therapy for this patient's condition?? {'A': 'Endovascular revascularization', 'B': 'Duloxetine', 'C': 'Heparin', 'D': 'Cilostazol', 'E': 'Arthroscopic resection'},
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D: Cilostazol
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Q:A 59-year-old man presents to the health clinic for evaluation of severe itching for the past week. The itching is worse at night while lying in bed. The patient has a past medical history of hyperlipidemia, atrial fibrillation, and colon cancer. The patient takes rivaroxaban, simvastatin, and aspirin. The patient has a surgical history of colon resection, appendectomy, and tonsillectomy. He drinks a 6-pack of beer almost every night of the week. He smokes 2 packs of cigarettes daily and has been living at a homeless shelter for the past 6 months. Examination of the skin shows small crusted sores and superficial, wavy gray lines along the wrists and interdigital spaces of both hands as seen in the image. Small vesicles are also present along with excoriations. Which of the following is the most appropriate treatment option for this patient?? {'A': 'Permethrin', 'B': 'Ivermectin', 'C': 'Acyclovir', 'D': 'Penicillin G', 'E': 'Dicloxacillin'},
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A: Permethrin
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Q:A 26-year-old G1P0 woman is brought to the emergency room by her spouse for persistently erratic behavior. Her spouse reports that she has been sleeping > 1 hour a night, and it sometimes seems like she’s talking to herself. She has maxed out their credit cards on baby clothes. The patient’s spouse reports this has been going on for over a month. Since first seeing a physician, she has been prescribed multiple first and second generation antipsychotics, but the patient’s spouse reports that her behavior has failed to improve. Upon examination, the patient is speaking rapidly and occasionally gets up to pace the room. She reports she is doing “amazing,” and that she is “so excited for the baby to get here because I’m going to be the best mom.” She denies illicit drug use, audiovisual hallucinations, or suicidal ideation. The attending psychiatrist prescribes a class of medication the patient has not yet tried to treat the patient’s psychiatric condition. In terms of this new medication, which of the following is the patient’s newborn most likely at increased risk for?? {'A': 'Attention deficit hyperactivity disorder', 'B': 'Caudal regression syndrome', 'C': 'Ototoxicity', 'D': 'Renal defects', 'E': 'Right ventricular atrialization'},
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E: Right ventricular atrialization
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Q:A 45-year-old woman presents to her primary care physician for knee pain. She states that she has been experiencing a discomfort and pain in her left knee that lasts for several hours but tends to improve with use. She takes ibuprofen occasionally which has been minimally helpful. She states that this pain is making it difficult for her to work as a cashier. Her temperature is 98.6°F (37.0°C), blood pressure is 117/58 mmHg, pulse is 90/min, respirations are 14/min, and oxygen saturation is 97% on room air. Physical exam reveals a stable gait that the patient claims causes her pain. The patient has a non-pulsatile, non-erythematous, palpable mass over the posterior aspect of her left knee that is roughly 3 to 4 cm in diameter and is hypoechoic on ultrasound. Which of the following is associated with this patient's condition?? {'A': 'Artery aneurysm', 'B': 'Herniated nucleus pulposus', 'C': 'Inflammation of the pes anserine bursa', 'D': 'Type IV hypersensitivity', 'E': 'Venous valve failure'},
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D: Type IV hypersensitivity
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Q:One day after undergoing total knee replacement for advanced degenerative osteoarthritis, a 66-year-old man has progressive lower abdominal pain. The surgery was performed under general anesthesia and the patient was temporarily catheterized for perioperative fluid balance. Several hours after the surgery, the patient began to have decreasing voiding volumes, nausea, and progressive, dull lower abdominal pain. He has Sjögren syndrome. He is sexually active with his wife and one other woman and uses condoms inconsistently. He does not smoke and drinks beer occasionally. Current medications include pilocarpine eye drops. He appears uncomfortable and is diaphoretic. His temperature is 37.3°C (99.1°F), pulse is 90/min, and blood pressure is 130/82 mm Hg. Abdominal examination shows a pelvic mass extending to the umbilicus. It is dull on percussion and diffusely tender to palpation. His hemoglobin concentration is 13.9 g/dL, leukocyte count is 9,000/mm3, a platelet count is 230,000/mm3. An attempt to recatheterize the patient transurethrally is unsuccessful. Which of the following is the most likely underlying cause of this patient's symptoms?? {'A': 'Benign prostatic enlargement', 'B': 'Adverse effect of pilocarpine', 'C': 'Urethral stricture', 'D': 'Neurogenic bladder', 'E': 'Prostate cancer\n"'},
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A: Benign prostatic enlargement
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Q:A 25-day-old male infant presents to the emergency department because his mother states that he has been acting irritable for the past 2 days and has now developed a fever. On exam, the infant appears uncomfortable and has a temperature of 39.1 C. IV access is immediately obtained and a complete blood count and blood cultures are drawn. Lumbar puncture demonstrates an elevated opening pressure, elevated polymorphonuclear neutrophil, elevated protein, and decreased glucose. Ampicillin and cefotaxime are immediately initiated and CSF culture eventually demonstrates infection with a Gram-negative rod. Which of the following properties of this organism was necessary for the infection of this infant?? {'A': 'Fimbriae', 'B': 'LPS endotoxin', 'C': 'K capsule', 'D': 'IgA protease', 'E': 'M protein'},
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C: K capsule
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Q:A 23-year-old primigravida pregnant patient is in her 3rd trimester with twins. She complains of itching and skin lesions. The examination shows vesicular skin lesions on the abdomen but not on the face, palms, or soles. A picture of her abdomen is shown in the image. Her past medical history is insignificant. Her vital signs are all within normal limits. What is the next best step in management?? {'A': 'Begin treatment with systemic oral corticosteroids', 'B': 'Begin weekly antepartum testing to ensure fetal well-being', 'C': 'Biopsy the lesions to ensure proper diagnosis', 'D': 'Reassure her and provide symptomatic relief with topical steroids', 'E': 'Start treatment with an antihistamine'},
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D: Reassure her and provide symptomatic relief with topical steroids
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Q:A 67-year-old man is brought to the physician by his daughter because he frequently misplaces his personal belongings and becomes easily confused. His daughter mentions that his symptoms have progressively worsened for the past one year. On mental status examination, he is oriented to person, place, and time. He vividly recalls memories from his childhood but can only recall one of three objects presented to him after 5 minutes. His affect is normal. This patients' symptoms are most likely caused by damage to which of the following?? {'A': 'Substantia nigra', 'B': 'Amygdala', 'C': 'Ventral posterolateral nucleus', 'D': 'Hippocampus', 'E': 'Superior temporal gyrus'},
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D: Hippocampus
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Q:A 59-year-old woman comes to the physician because of a 1-year history of pain and stiffness in her fingers and knees. The stiffness lasts for about 10 minutes after she wakes up in the morning. She also reports that her knee pain is worse in the evening. She drinks one glass of wine daily. Her only medication is acetaminophen. She is 175 cm (5 ft 9 in) tall and weighs 102 kg (225 lb); BMI is 33 kg/m2. Physical examination shows firm nodules on the distal interphalangeal joints of the index, ring, and little fingers of both hands. Which of the following is the most likely diagnosis?? {'A': 'Pseudogout', 'B': 'Rheumatoid arthritis', 'C': 'Gout', 'D': 'Septic arthritis', 'E': 'Osteoarthritis'},
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E: Osteoarthritis
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Q:A 23-year-old man is brought to the emergency department from a college party because of a 1-hour history of a crawling sensation under his skin. He appears anxious and is markedly pale. His temperature is 38°C (100.4°F), pulse is 104/min, respirations are 18/min, and blood pressure is 145/90 mm Hg. Physical examination shows diaphoretic skin, moist mucous membranes, and dilated pupils. Which of the following substances is most likely the cause of this patient's symptoms?? {'A': 'Lysergic acid diethylamide', 'B': 'Phencyclidine', 'C': 'Cocaine', 'D': 'Scopolamine', 'E': 'Oxycodone'},
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C: Cocaine
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Q:A 68-year old woman presents with recurring headaches and pain while combing her hair. Her past medical history is significant for hypertension, glaucoma and chronic deep vein thrombosis in her right leg. Current medication includes rivaroxaban, latanoprost, and benazepril. Her vitals include: blood pressure 130/82 mm Hg, pulse 74/min, respiratory rate 14/min, temperature 36.6℃ (97.9℉). Physical examination reveals neck stiffness and difficulty standing up due to pain in the lower limbs. Strength is 5 out of 5 in the upper and lower extremities bilaterally. Which of the following is the next best step in the management of this patient?? {'A': 'Lumbar puncture', 'B': 'CK-MB', 'C': 'Erythrocyte sedimentation rate', 'D': 'Temporal artery biopsy', 'E': 'Fundoscopic examination'},
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C: Erythrocyte sedimentation rate
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Q:A 13-year-old boy with recently diagnosed schizophrenia presents with feelings of anxiety. The patient says that he has been having feelings of dread, especially since a friend of his has been getting bullied at school. He feels troubled by these feeling almost every day and makes it difficult for him to get ready to go to school. He also has been hallucinating worse lately. Past medical history is significant for schizophrenia diagnosed 1 year ago. Current medications are fluphenazine. The patient is afebrile and vital signs are within normal limits. Physical examination is unremarkable. Which of the following medications would most likely be a better course of treatment for this patient?? {'A': 'Chlorpromazine', 'B': 'Fluoxetine', 'C': 'Buspirone', 'D': 'Ziprasidone', 'E': 'Alprazolam'},
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D: Ziprasidone
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Q:A 39-year-old woman, gravida 3, para 2, at 32 weeks' gestation comes to the emergency department 1 hour after the sudden onset of severe abdominal pain and nausea. She has had one episode of nonbloody vomiting. Pregnancy has been uncomplicated, except for a blood pressure measurement of 150/90 mm Hg on her last prenatal visit. Her first child was delivered vaginally; her second child was delivered by lower segment transverse cesarean section because of a nonreassuring fetal heart rate. She appears anxious and pale. Her temperature is 36.1°C (96°F), pulse is 115/min, and blood pressure is 92/65 mm Hg. Extremities are cool and clammy. Pelvic examination shows a rigid, tender uterus. The cervix is 30% effaced and 1 cm dilated; the vertex is at -1 station. The fetal heart rate is 100/min. Which of the following is the most likely diagnosis?? {'A': 'Ruptured uterus', 'B': 'Ruptured vasa previa', 'C': 'Abruptio placentae', 'D': 'Placenta accreta', 'E': 'Placenta previa'},
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C: Abruptio placentae
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Q:A 24-year-old professional soccer player presents to the clinic with discomfort and pain while walking. He says that he has an unstable knee joint that started after an injury during a match last week. He adds that he heard a popping sound at the time of the injury. Physical examination of the knee reveals swelling of the knee joint with a positive anterior drawer test. Which of the following structures is most likely damaged in this patient?? {'A': 'Lateral collateral ligament', 'B': 'Medial collateral ligament', 'C': 'Anterior cruciate ligament', 'D': 'Posterior cruciate ligament', 'E': 'Ligamentum patellae'},
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C: Anterior cruciate ligament
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Q:A 42-year-old woman comes to the physician with acute, severe pain in the middle of her lower back. She also complains of constipation and trouble sleeping recently. Menses occur regularly at 28-day intervals. Examination shows localized tenderness to palpation over the lumbar spine. Serum calcium is 14 mg/dL and serum phosphorus is 1.5 mg/dL. An x-ray of the lumbar spine shows a compression fracture of the L4 vertebral body and osteopenia. Which of the following is the most likely underlying cause of this patient's decreased bone mineral density?? {'A': 'Decrease in ovarian estrogen production', 'B': 'Increase in calcitonin secretion', 'C': 'Increase in interleukin-1 secretion', 'D': 'Decrease in alkaline phosphatase secretion', 'E': 'Decrease in RANKL receptor expression'},
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C: Increase in interleukin-1 secretion
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Q:A 55-year-old man with a history of hypertension and benign prostate hyperplasia presents for follow-up 4 days into the treatment of a urinary tract infection with trimethoprim-sulfamethoxazole. His symptoms have resolved, and he reports no problems with urination, with the exception of a weak urine stream and hesitancy, which he has had for the past 2 years. At the time of this visit, the patient is afebrile; the blood pressure is 130/88 mm Hg and the heart rate is 80/min. There is no flank tenderness. A urinalysis reveals no leukocytes and is negative for esterase. The urinalysis reveals 2 red blood cells (RBCs)/ high power field (HPF), and there are no casts on urinary sediment analysis. The physician, however, notices the following abnormality: Prior treatment BUN 12 mg/dL Creatinine 1.2 mg/dL Today’s visit BUN 13 mg/dL Creatinine 2.1 mg/dL? {'A': 'Reassure the patient, stop trimethoprim-sulfamethoxazole and repeat the measurement in 1–2 weeks', 'B': 'Schedule an intravenous pyelography for urinary obstruction', 'C': 'Schedule a cystoscopy for urethral obstruction', 'D': 'Admit the patient for further management of acute interstitial nephritis', 'E': 'Admit the patient for further management of acute tubular necrosis'},
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A: Reassure the patient, stop trimethoprim-sulfamethoxazole and repeat the measurement in 1–2 weeks
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Q:An 18-year-old female presents to the clinic complaining of acute abdominal pain for the past couple of hours. The pain is concentrated at the right lower quadrant (RLQ) with no clear precipitating factor and is worse with movement. Acetaminophen seems to help a little but she is concerned as the pain has occurred monthly for the past 3 months. She denies any headache, chest pain, weight changes, diarrhea, nausea/vomiting, fever, or sexual activity. The patient reports a regular menstruation cycle with her last period being 2 weeks ago. A physical examination demonstrates a RLQ that is tender to palpation with a negative psoas sign. A urine beta-hCG test is negative. An ultrasound of the abdomen is unremarkable. What is the main function of the hormone that is primarily responsible for this patient’s symptoms?? {'A': 'Increases the activity of cholesterol desmolase to synthesize progesterone', 'B': 'Increases the activity of aromatase to synthesize 17-beta-estradiol', 'C': 'Induction of pulsatile release of follicle stimulating hormone (FSH) and luteinizing hormone (LH)', 'D': 'Inhibition of the anterior pituitary to decrease secretion of FSH and LH', 'E': 'Inhibition of the hypothalamus to decrease secretion of gonadotrophin releasing hormone (GnRH)'},
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A: Increases the activity of cholesterol desmolase to synthesize progesterone
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Q:A 5-year-old boy is brought to the emergency department by his stepmother because of multiple injuries. She says that he sustained these injuries while playing. Radiographic findings show multiple fractures in various stages of healing. Physical examination shows the findings in the image below. What is the most likely diagnosis in this patient?? {'A': 'Marfan syndrome', 'B': 'Wilson disease', 'C': 'Osteogenesis imperfecta', 'D': 'Osteochondritis dissecans', 'E': 'Child abuse'},
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C: Osteogenesis imperfecta
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Q:A 5-year-old boy is brought to the physician by his mother because he does not “listen to her” anymore. The mother also reports that her son cannot concentrate on any tasks lasting longer than just a few minutes. Teachers at his preschool report that the patient is more active compared to other preschoolers, frequently interrupts or bothers other children, and is very forgetful. Last year the patient was expelled from another preschool for hitting his teacher and his classmates when he did not get what he wanted and for being disruptive during classes. He was born at term via vaginal delivery and has been healthy except for 3 episodes of acute otitis media at the age of 2 years. He has met all developmental milestones. His mother has major depressive disorder and his father has Graves' disease. He appears healthy and well nourished. Examination shows that the patient does not seem to listen when spoken to directly. The remainder of the examination shows no abnormalities. Which of the following is the most appropriate next step in treatment?? {'A': 'Behavior therapy', 'B': 'Methimazole', 'C': 'Fluoxetine', 'D': 'Hearing aids', 'E': 'Methylphenidate'},
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A: Behavior therapy
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Q:At a routine exam, a 68-year-old woman is discovered to have a serum calcium level of 11.5 mg/dL. Follow-up laboratory tests show a high parathyroid hormone with low phosphorus and mildly elevated alkaline phosphatase. 24-hour urine calcium level is elevated. Review of symptoms includes complaints of fatigue, constipation, and diffuse bone pain for which she takes vitamin D. Past medical history is significant for type 2 diabetes mellitus for 25 years and essential hypertension for 15 years. The patient has a history of kidney stones. Family history is irrelevant. Which of the following radiologic findings is consistent with the patient's condition?? {'A': 'Subperiosteal bone resorption on hand X-ray', 'B': 'Hilar and/or paratracheal adenopathy with bilateral upper lobe lung infiltrates', 'C': 'Osteopenia, osteolytic lesions and pathological fractures', 'D': 'Lytic changes in early stage and sclerotic picture in later stage', 'E': 'Fibronodular opacities in upper lobes of the lung with or without cavitation'},
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A: Subperiosteal bone resorption on hand X-ray
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Q:A 29-year-old woman, gravida 1, para 0, at 36 weeks' gestation is brought to the emergency department after an episode of dizziness and vomiting followed by loss of consciousness lasting 1 minute. She reports that her symptoms started after lying down on her back to rest, as she felt tired during yoga class. Her pregnancy has been uncomplicated. On arrival, she is diaphoretic and pale. Her pulse is 115/min and blood pressure is 90/58 mm Hg. On examination, the patient is lying in the supine position with a fundal height of 36 cm. There is a prolonged fetal heart rate deceleration to 80/min. Which of the following is the most appropriate action to reverse this patient's symptoms in the future?? {'A': 'Performing the Muller maneuver', 'B': 'Lying in the supine position and elevating legs', 'C': 'Gentle compression with an abdominal binder', 'D': 'Lying in the left lateral decubitus position', 'E': 'Performing the Valsava maneuver'},
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D: Lying in the left lateral decubitus position
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Q:A 32-year-old man presents to an outpatient clinic for tuberculosis prophylaxis before leaving for a trip to Asia, where tuberculosis is endemic. The Mantoux test is positive, but the chest X-ray and AFB sputum culture are negative. He was started on isoniazid. What is the most likely mechanism of resistance to isoniazid?? {'A': 'Mutations in katG', 'B': 'Reduction of drug binding to RNA polymerase', 'C': 'Plasmid-mediated resistance', 'D': 'Methylation of the RNA binding site', 'E': 'Increased efflux from the cell'},
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A: Mutations in katG
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Q:A 33-year-old man with recently diagnosed testicular cancer visits his oncologist to discuss the treatment plan. His left testicle was removed after a thorough workup of a lump. A pelvic CT showed no enlarged lymph nodes and a simple orchiectomy and pelvic lymph node dissection was completed. The final diagnosis was stage IB non-seminoma testicular cancer (pT2N0Mn/a). A combination of different chemotherapeutic medications is recommended including bleomycin, etoposide, and cisplatin. Each of the antineoplastic drugs has a different mechanism of action; each drug targets cancer cells at a specific phase in the cell cycle and works by inhibiting a major cellular process. Which of the following enzymes would be affected by bleomycin?? {'A': 'DNA polymerase β', 'B': 'DNA polymerase III', 'C': 'Thymidylate synthase', 'D': 'Ribonucleotide reductase', 'E': 'Dihydrofolate reductase'},
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A: DNA polymerase β
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Q:A 67-year-old woman presents to the clinic with a 9-month history of seeing bright red blood in the toilet after defecating. Additional complaints include fatigue, shortness of breath, and mild lethargy. She denies the loss of weight, abdominal pain, or changes in dietary behavior. She consumes a balanced diet and takes multiple vitamins every day. The current vital signs include the following: temperature is 37.0°C (98.6°F), pulse rate is 68/min, blood pressure is 130/81 mm Hg, and the respiratory rate is 13/min. On physical examination, you notice increased capillary refill time and pale mucosa. What are the most likely findings for hemoglobin, hematocrit, red blood cell count, and mean corpuscular volume?? {'A': 'Hemoglobin: ↑, hematocrit: ↓, red blood cell count: ↓, mean corpuscular volume: ↑', 'B': 'Hemoglobin: ↓, hematocrit: ↑, red blood cell count: ↓, mean corpuscular volume: ↓', 'C': 'Hemoglobin: ↓, hematocrit: ↓, red blood cell count: ↑, mean corpuscular volume: ↑', 'D': 'Hemoglobin: ↓, hematocrit: ↓, red blood cell count: ↓, mean corpuscular volume: ↓', 'E': 'Hemoglobin: ↑, hematocrit: ↑, red blood cell count: ↑, mean corpuscular volume: ↑'},
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D: Hemoglobin: ↓, hematocrit: ↓, red blood cell count: ↓, mean corpuscular volume: ↓
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Q:A 20-year-old woman presents to student health for a 7-day history of sinus congestion. She has also had fever, sore throat, and infectious gastroenteritis. Upon further questioning, she has had similar problems 2 or 3 times a year for as long as she can remember. These have included sinus infections, ear infections, and lung infections. At the clinic, her temperature is 38.6°C (101.4°F), heart rate is 70/min, blood pressure is 126/78 mm Hg, respiratory rate is 18/min, and oxygen saturation is 98% on room air. Physical examination is notable for mucopurulent discharge from both nares and tenderness to palpation over her bilateral maxillae. Sputum gram stain shows gram-positive diplococci. Which of the following best describes the levels of immunoglobulins that would most likely be found upon testing this patient's serum?? {'A': 'IgM Level: Low, IgG Level: Low, IgA Level: Low', 'B': 'IgM Level: Normal, IgG Level: Low, IgA Level: Low', 'C': 'IgM Level: Elevated, IgG Level: Low, IgA Level: Low', 'D': 'IgM Level: Normal, IgG Level: Normal, IgA Level: Low', 'E': 'IgM Level: Normal, IgG Level: Normal, IgA Level: Normal'},
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D: IgM Level: Normal, IgG Level: Normal, IgA Level: Low
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Q:A 16-year-old girl is brought to the physician because menarche has not yet occurred. She has no history of serious illness and takes no medications. She is 162 cm (5 ft 3 in) tall and weighs 80 kg (176 lb); BMI is 31.2 kg/m2. Breast and pubic hair development is Tanner stage 4. She also has oily skin, acne, and hyperpigmentation of the intertriginous areas of her neck and axillae. The remainder of the examination, including pelvic examination, shows no abnormalities. Which of the following is the most likely explanation for this patient's amenorrhea?? {'A': 'XO chromosomal abnormality', 'B': 'Müllerian agenesis', 'C': 'Elevated LH:FSH ratio', 'D': 'Elevated β-hCG levels', 'E': 'Elevated serum cortisol levels\n"'},
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C: Elevated LH:FSH ratio
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Q:A 21-year-old man presents to the emergency department with acute back pain. The pain began a few hours prior to presentation and is located on the left lower back. The pain is described to be “shock-like,” 9/10 in pain severity, and radiates to the left groin. His temperature is 98.6°F (37°C), blood pressure is 120/75 mmHg, pulse is 101/min, and respirations are 18/min. The patient appears uncomfortable and is mildly diaphoretic. There is costovertebral angle tenderness and genitourinary exam is unremarkable. A non-contrast computerized tomography (CT) scan of the abdomen and pelvis demonstrates an opaque lesion affecting the left ureter with mild hydronephrosis. Straining of the urine with urine crystal analysis is demonstrated. Which of the following amino acids is most likely poorly reabsorbed by this patient’s kidney?? {'A': 'Aspartic acid', 'B': 'Histidine', 'C': 'Isoleucine', 'D': 'Lysine', 'E': 'Phenylalanine'},
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D: Lysine
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Q:A 29-year-old woman, gravida 2, para 1, at 10 weeks' gestation comes to the physician for a prenatal visit. Over the past two weeks, she has felt nauseous in the morning and has had vulvar pruritus and dysuria that started 5 days ago. Her first child was delivered by lower segment transverse cesarean section because of macrosomia from gestational diabetes. Her gestational diabetes resolved after the child was born. She appears well. Ultrasound confirms fetal heart tones and an intrauterine pregnancy. Speculum exam shows a whitish chunky discharge. Her vaginal pH is 4.2. A wet mount is performed and microscopic examination is shown. Which of the following is the most appropriate treatment?? {'A': 'Oral metronidazole', 'B': 'Intravaginal treatment with lactobacillus', 'C': 'Oral fluconazole', 'D': 'Topical nystatin', 'E': 'Intravaginal clotrimazole'},
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E: Intravaginal clotrimazole
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Answer the following medical question with one of the provided options:
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Q:A 31-year-old man is brought in to the clinic by his sister because she is concerned about his behavior since the death of their mother 2 months ago. The patient’s sister states that he has always been a ‘loner’ and preferred being by himself than socializing with others. His social isolation resulted in him being ‘socially awkward’, as described by his family. However, 2 months ago, when he found out about the death of their mother, he showed little emotion and attended her funeral in jeans and a dirty T-shirt which upset the rest of their family. When asked about it, he shrugged and said he was in a hurry to get to the funeral and “just left the house with what I had on.” He does not speak much during the interview, allowing his sister to speak on his behalf. His sister insists that he has ‘always been like this’, quiet and a complacent child who had no interest in playing with other children. The patient currently lives alone and spends his time repairing and building electrical appliances, and his sister is worried that his self-imposed isolation is making it ‘impossible for him to interact with other people normally’. Which of the following is the most likely diagnosis in this patient? ? {'A': 'Schizoid personality disorder', 'B': 'Schizophrenia', 'C': 'Social anxiety disorder', 'D': 'Depressive disorder', 'E': 'Asperger’s syndrome'},
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A: Schizoid personality disorder
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Answer the following medical question with one of the provided options:
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Q:A male newborn is born at 37 weeks' gestation after spontaneous vaginal delivery. The mother had no prenatal care. Physical examination shows a urethral opening on the dorsal aspect of the penis, 4 mm proximal to the glans. There is a 3-cm defect in the midline abdominal wall superior to the pubic symphysis with exposure of moist, erythematous mucosa. Which of the following is the most likely underlying cause of this patient's findings?? {'A': 'Persistence of the urogenital membrane', 'B': 'Incomplete union of the labioscrotal swellings', 'C': 'Malpositioning of the genital tubercle', 'D': 'Abnormal development of the gubernaculum', 'E': 'Failed fusion of the urethral folds'},
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C: Malpositioning of the genital tubercle
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Answer the following medical question with one of the provided options:
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Q:A 37-year-old obese woman presents to the neurology clinic complaining of severe pain in her left wrist and tingling sensation in her left thumb, index finger, and middle finger, and some part of her ring finger. The pain started as an occasional throb and she could ignore it or takes analgesics but now the pain is much worse and wakes her up at night. She is also concerned that these fingers are occasionally numb and sometimes tingle. She works as a typist and her pain mostly increases after typing all day. Her right wrist and fingers are fine. Nerve conduction studies reveal nerve compression. Which of the following additional clinical findings would most likely be present in this patient?? {'A': 'Inability to oppose thumb to other digits', 'B': 'Flattened hypothenar eminence', 'C': 'Inability to adduct the little finger', 'D': 'Atrophied adductor pollicis muscle', 'E': 'Paresthesia over the thenar eminence'},
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A: Inability to oppose thumb to other digits
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Q:An otherwise healthy 45-year-old man comes to the physician because of a painful ulcer on his tongue for 3 days. Examination shows a shallow, tender 5-mm wide ulcer on the lateral aspect of the tongue, adjacent to his left first molar. There is no induration surrounding the ulcer or cervical lymphadenopathy. A lesion of the cranial nerve responsible for the transmission of pain from this ulcer would most likely result in which of the following?? {'A': 'Decreased sensation in the upper lip', 'B': 'Difficulty chewing', 'C': 'Loss of taste from the supraglottic region', 'D': 'Inability to wrinkle the forehead', 'E': 'Lateral deviation of the tongue'},
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B: Difficulty chewing
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Q:A 60-year-old man has had intermittent pain in his right great toe for the past 2 years. Joint aspiration and crystal analysis shows thin, tapered, needle shaped intracellular crystals that are strongly negatively birefringent. Radiograph demonstrates joint space narrowing of the 1st metatarsophalangeal (MTP) joint with medial soft tissue swelling. What is the most likely cause of this condition?? {'A': 'Monosodium urate crystal deposition', 'B': 'Calcium pyrophosphate deposition', 'C': 'Uric acid crystal deposition', 'D': 'Tuberculosis', 'E': 'Rheumatoid arthritis'},
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A: Monosodium urate crystal deposition
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Q:A 53-year-old man comes to the physician because of a 3-month history of a nonpruritic rash, fatigue, and decreased urination. Physical examination shows multiple erythematous, purpuric papules on his trunk and extremities that do not blanch when pressed. Serum creatinine is elevated and urinalysis shows red blood cell casts and protein. Serum complement levels are decreased. Renal biopsy shows subendothelial immune complex deposits with granular immunofluorescence and tram-track basement membrane splitting. Further laboratory evaluation of this patient is most likely to show the presence of which of the following antibodies?? {'A': 'Anti-desmoglein antibodies', 'B': 'Anti-hepatitis C antibodies', 'C': 'Anti-DNA topoisomerase antibodies', 'D': 'Antineutrophil cytoplasmic antibodies', 'E': 'Anticardiolipin antibodies'},
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B: Anti-hepatitis C antibodies
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Q:A 75-year-old woman presents to the physician with a complaint of a frequent need to void at nighttime, which has been disrupting her sleep. She notes embarrassingly that she is often unable to reach the bathroom in time, and experiences urinary leakage throughout the night as well as during the day. The patient undergoes urodynamic testing and a urinalysis is obtained which is normal. She is instructed by the physician to perform behavioral training to improve her bladder control. Which of the following is the most likely diagnosis contributing to this patient’s symptoms?? {'A': 'Overflow incontinence', 'B': 'Stress incontinence', 'C': 'Total incontinence', 'D': 'Urge incontinence', 'E': 'Urinary tract infection'},
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D: Urge incontinence
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Answer the following medical question with one of the provided options:
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Q:A researcher is investigating whether there is an association between the use of social media in teenagers and bipolar disorder. In order to study this potential relationship, she collects data from people who have bipolar disorder and matched controls without the disorder. She then asks how much on average these individuals used social media in the 3 years prior to their diagnosis. This continuous data is divided into 2 groups: those who used more than 2 hours per day and those who used less than 2 hours per day. She finds that out of 1000 subjects, 500 had bipolar disorder of which 300 used social media more than 2 hours per day. She also finds that 400 subjects who did not have the disorder also did not use social media more than 2 hours per day. Which of the following is the odds ratio for development of bipolar disorder after being exposed to more social media?? {'A': '0.17', 'B': '0.67', 'C': '1.5', 'D': '2.25', 'E': '6'},
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E: 6
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Answer the following medical question with one of the provided options:
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Q:A 35-year-old female presents to her primary care physician because of chronic fatigue that has stopped her from gardening and walking with her friends. Upon further questioning, she elaborates that she feels fine after waking up but gradually becomes more tired and weak as the day progresses. This appears to be particularly problematic when she is engaged in physical activity or when eating. Review of systems elicits that she occasionally experiences double vision after spending a prolonged period looking at a computer screen. Testing confirms the diagnosis and the patient is prescribed a long-acting medication to alleviate her symptoms. The products of the enzyme that is inhibited by the prescribed drug are transported by a protein that is sensitive to which of the following chemicals?? {'A': 'Botulinum', 'B': 'Guanethidine', 'C': 'Hemicholinium', 'D': 'Reserpine', 'E': 'Vesamicol'},
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C: Hemicholinium
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Answer the following medical question with one of the provided options:
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Q:A 3-day-old newborn is brought to the physician because of abdominal distention, inconsolable crying, and 3 episodes of bilious vomiting since the previous evening. He was delivered at home at 40 weeks' gestation by a trained midwife. He has not passed meconium. Physical examination shows abdominal distention, a tight anal sphincter, and an explosive passage of air and feces on removal of the examining finger. Abnormal development of which of the following best explains this patient's condition?? {'A': 'Muscularis mucosae and serosa', 'B': 'Epithelium and lamina propria', 'C': 'Submucosa and muscularis externa', 'D': 'Epithelium and submucosa', 'E': 'Muscularis mucosae and lamina propria'},
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C: Submucosa and muscularis externa
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Answer the following medical question with one of the provided options:
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Q:Two days after undergoing porcine aortic valve replacement surgery for aortic valve stenosis, a 62-year-old patient develops yellow discoloration of the sclera. His vital signs are within normal limits. Physical examination shows scleral icterus. Abdominal examination shows no abnormalities. Laboratory studies show: Hematocrit 49% Reticulocyte count 1.2% Serum AST 15 U/L ALT 18 U/L Bilirubin, total 2.8 mg/dL Direct 0.3 mg/dL Lactate dehydrogenase 62 U/L Which of the following is the most likely underlying mechanism of this patient's laboratory findings?"? {'A': 'Impaired bilirubin conjugation', 'B': 'Mechanical erythrocyte damage', 'C': 'Drug-induced toxicity', 'D': 'Absent hepatic glucuronosyltransferase', 'E': 'Impaired bilirubin excretion'},
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A: Impaired bilirubin conjugation
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