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Answer the following medical question with one of the provided options:
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Q:A 59-year-old woman comes to the emergency department because of a 2-day history of worsening fever, chills, malaise, productive cough, and difficulty breathing. Three days ago, she returned from a trip to South Africa. She has type 2 diabetes mellitus, hypertension, and varicose veins. Her current medications include metformin, lisinopril, and atorvastatin. Her temperature is 39.4°C (102.9°F), pulse is 102/minute, blood pressure is 94/68 mm Hg, and respirations are 31/minute. Pulse oximetry on 2 L of oxygen via nasal cannula shows an oxygen saturation of 91%. Examination reveals decreased breath sounds and dull percussion over the left lung base. The skin is very warm and well-perfused. The remainder of the examination shows no abnormalities. Laboratory studies show: Hemoglobin 11.6 g/dL Leukocyte count 15,400/mm3 platelet count 282,000/mm3 Serum Na+ 144 mEq/L Cl- 104 mEq/L K+ 4.9 mEq/L Creatinine 1.5 mg/dL Blood and urine for cultures are obtained. Intravenous fluid resuscitation is begun. Which of the following is the next best step in management?"? {'A': 'Intravenous ceftriaxone and azithromycin', 'B': 'Erythromycin', 'C': 'External cooling and intravenous acetaminophen', 'D': 'Intravenous vancomycin and ceftriaxone', 'E': 'CT of the chest with contrast'},
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D: Intravenous vancomycin and ceftriaxone
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Answer the following medical question with one of the provided options:
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Q:A 30-year-old woman, gravida 1, para 0, at 30 weeks' gestation is brought to the emergency department because of progressive upper abdominal pain for the past hour. The patient vomited once on her way to the hospital. She said she initially had dull, generalized stomach pain about 6 hours prior, but now the pain is located in the upper abdomen and is more severe. There is no personal or family history of any serious illnesses. She is sexually active with her husband. She does not smoke or drink alcohol. Medications include folic acid and a multivitamin. Her temperature is 38.5°C (101.3°F), pulse is 100/min, and blood pressure is 130/80 mm Hg. Physical examination shows right upper quadrant tenderness. The remainder of the examination shows no abnormalities. Laboratory studies show a leukocyte count of 12,000/mm3. Urinalysis shows mild pyuria. Which of the following is the most appropriate definitive treatment in the management of this patient?? {'A': 'Appendectomy', 'B': 'Cefoxitin and azithromycin', 'C': 'Biliary drainage', 'D': 'Intramuscular ceftriaxone followed by cephalexin', 'E': 'Laparoscopic removal of ovarian cysts'},
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A: Appendectomy
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Answer the following medical question with one of the provided options:
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Q:A 59-year-old male with a 1-year history of bilateral knee arthritis presents with epigastric pain that intensifies with meals. He has been self-medicating with aspirin, taking up to 2,000 mg per day for the past six months. Which of the following medications, if taken instead of aspirin, could have minimized his risk of experiencing this epigastric pain?? {'A': 'Ketorolac', 'B': 'Indomethacin', 'C': 'Naproxen', 'D': 'Ibuprofen', 'E': 'Celecoxib'},
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E: Celecoxib
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Answer the following medical question with one of the provided options:
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Q:A 29-year-old woman comes to the physician because of a 2-day history of intermittent dark urine and mild flank pain. She has also had a cough, sore throat, and runny nose for the past 5 days. She has not had dysuria. She takes no medications. She has no known allergies. Her temperature is 37°C (98.6°F). Examination of the back shows no costovertebral angle tenderness. Laboratory studies show: Hemoglobin 10.4 g/dL Leukocyte count 8,000/mm3 Platelet count 200,000/mm3 Serum Na+ 135 mEq/L K+ 4.9 mEq/L Cl- 101 mEq/L HCO3- 22 mEq/L Urea nitrogen 18 mg/dL Creatinine 1.1 mg/dL Urine Color yellow Blood 3+ Protein 1+ Leukocyte esterase negative An ultrasound of the kidney and bladder shows no abnormalities. Which of the following is the most likely cause of this patient's symptoms?"? {'A': 'Interstitial renal inflammation', 'B': 'Renal papillary necrosis', 'C': 'Renal glomerular damage', 'D': 'Ischemic tubular injury', 'E': 'Urothelial neoplasia'},
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C: Renal glomerular damage
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Answer the following medical question with one of the provided options:
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Q:A study is being conducted on depression using the Patient Health questionnaire (PHQ-9) survey data embedded within a popular social media network with a response size of 500,000 participants. The sample population of this study is approximately normal. The mean PHQ-9 score is 14, and the standard deviation is 4. How many participants have scores greater than 22?? {'A': '12,500', 'B': '17,500', 'C': '25,000', 'D': '160,000', 'E': '175,000'},
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A: 12,500
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Answer the following medical question with one of the provided options:
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Q:A 77-year-old woman is brought to the physician for gradually increasing confusion and difficulty walking for the past 4 months. Her daughter is concerned because she has been forgetful and seems to be walking more slowly. She has been distracted during her weekly bridge games and her usual television shows. She has also had increasingly frequent episodes of urinary incontinence and now wears an adult diaper daily. She has hyperlipidemia and hypertension. Current medications include lisinopril and atorvastatin. Her temperature is 36.8°C (98.2°F), pulse is 84/min, respirations are 15/min, and blood pressure is 139/83 mmHg. She is confused and oriented only to person and place. She recalls 2 out of 3 words immediately and 1 out of 3 after five minutes. She has a broad-based gait and takes short steps. Sensation is intact and muscle strength is 5/5 throughout. Laboratory studies are within normal limits. Which of the following is the most likely diagnosis in this patient?? {'A': 'Dementia with Lewy-bodies', 'B': 'Pseudodementia', 'C': 'Frontotemporal dementia', 'D': 'Normal pressure hydrocephalus', 'E': 'Creutzfeldt-Jakob disease'},
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D: Normal pressure hydrocephalus
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Answer the following medical question with one of the provided options:
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Q:A 1-year-old boy is brought to the physician for the evaluation of swelling around the eyelids. He was born at term after an uncomplicated pregnancy. He is at the 95th percentile for weight and 60th percentile for length. His blood pressure is 130/86 mm Hg. Physical examination shows an empty scrotal sac and a left-sided abdominal mass. Ophthalmologic examination shows no abnormalities. Urinalysis shows a proteinuria of 3+ and fatty casts. Abdominal ultrasound shows a hypervascular mass at the upper pole of the kidney. Which of the following best describes the pathogenesis of this patient's disease?? {'A': 'Inhibition of hypoxia-inducible factor 1a', 'B': 'Deficiency of 17α-hydroxylase', 'C': 'Increased expression of insulin-like growth factor 2', 'D': 'Deletion of the WT1 gene on chromosome 11', 'E': 'Loss of function of zinc finger transcription factor'},
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E: Loss of function of zinc finger transcription factor
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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 complaining of right upper quadrant pain over the last 6 months. Pain is worst after eating and feels like intermittent squeezing. She also admits to lighter colored stools and a feeling of itchiness on her skin. Physical exam demonstrates a positive Murphy's sign. The vitamin level least likely to be affected by this condition is associated with which of the following deficiency syndromes?? {'A': 'Night blindness', 'B': 'Scurvy', 'C': 'Rickets and osteomalacia', 'D': 'Hemolytic anemia', 'E': 'Increased prothrombin time and easy bleeding'},
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B: Scurvy
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Answer the following medical question with one of the provided options:
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Q:On morning labs, a patient's potassium comes back at 5.9 mEq/L. The attending thinks that this result is spurious, and asks the team to repeat the electrolytes. Inadvertently, the medical student, intern, and resident all repeat the electrolytes that same morning. The following values are reported: 4.3 mEq/L, 4.2 mEq/L, and 4.2 mEq/L. What is the median potassium value for that patient that day including the first value?? {'A': '4.2 mEq/L', 'B': '4.25 mEq/L', 'C': '4.3 mEq/L', 'D': '4.65 mEq/L', 'E': '1.7 mEq/L'},
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B: 4.25 mEq/L
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Answer the following medical question with one of the provided options:
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Q:A 24-year-old woman presents to a medical office for a follow-up evaluation. The medical history is significant for type 1 diabetes, for which she takes insulin. She was recently hospitalized for diabetic ketoacidosis following a respiratory infection. Today she brings in a list of her most recent early morning fasting blood glucose readings for review. Her glucose readings range from 126 mg/dL–134 mg/dL, except for 2 readings of 350 mg/dL and 380 mg/dL, taken at the onset of her recent hospitalization. Given this data set, which measure(s) of central tendency would be most likely affected by these additional extreme values?? {'A': 'Mean', 'B': 'Median', 'C': 'Mode', 'D': 'Mean and median', 'E': 'Median and mode'},
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A: Mean
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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 6-week history of fatigue and weakness. Examination shows marked pallor of the conjunctivae. The spleen tip is palpated 2 cm below the left costal margin. Her hemoglobin concentration is 9.5 g/dL, serum lactate dehydrogenase concentration is 750 IU/L, and her serum haptoglobin is undetectable. A peripheral blood smear shows multiple spherocytes. When anti-IgG antibodies are added to a sample of the patient's blood, there is clumping of the red blood cells. Which of the following is the most likely predisposing factor for this patient's condition?? {'A': 'Hereditary spectrin defect', 'B': 'Bicuspid aortic valve', 'C': 'Epstein-Barr virus infection', 'D': 'Mycoplasma pneumoniae infection', 'E': 'Systemic lupus erythematosus'},
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E: Systemic lupus erythematosus
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Answer the following medical question with one of the provided options:
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Q:A 4-month-old girl is seen for ongoing lethargy and vomiting. She was born to a 31-year-old G2P2 mother with a history of hypertension. She has had 7 episodes of non-bloody, non-bilious vomiting and 3 wet diapers over the last 24 hours. Laboratory results are shown below. Serum: Na+: 132 mEq/L Cl-: 100 mEq/L K+: 3.2 mEq/L HCO3-: 27 mEq/L BUN: 13 mg/dL Glucose: 30 mg/dL Lactate: 2 mmol/L Urine ketones: < 20 mg/dL Which of the following is the most likely diagnosis?? {'A': 'Glucose-6-phosphatase deficiency', 'B': 'Glucocerebrosidase deficiency', 'C': 'Sphingomyelinase deficiency', 'D': 'Medium chain acyl-CoA dehydrogenase deficiency', 'E': 'Galactose-1-phosphate uridyltransferase deficiency'},
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D: Medium chain acyl-CoA dehydrogenase deficiency
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Answer the following medical question with one of the provided options:
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Q:A previously healthy 6-month-old boy is brought to the emergency department because of irritability and poor feeding for 6 days. He has also not had a bowel movement in 9 days and has been crying less than usual. He is bottle fed with formula and his mother has been weaning him with mashed bananas mixed with honey for the past 3 weeks. His immunizations are up-to-date. He appears weak and lethargic. He is at the 50th percentile for length and 75th percentile for weight. Vital signs are within normal limits. Examination shows dry mucous membranes and delayed skin turgor. There is poor muscle tone and weak head control. Neurological examination shows ptosis of the right eye. Which of the following is the most appropriate initial treatment?? {'A': 'Human-derived immune globulin', 'B': 'Intravenous gentamicin', 'C': 'Equine-derived antitoxin', 'D': 'Plasmapheresis', 'E': 'Pyridostigmine'},
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A: Human-derived immune globulin
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Answer the following medical question with one of the provided options:
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Q:A 68-year-old man comes to the emergency department 12 hours after the appearance of tender, purple discolorations on his thighs and lower abdomen. He began taking a medication 4 days ago after failed cardioversion for atrial fibrillation, but he cannot remember the name. Physical examination shows a tender bluish-black discoloration on the anterior abdominal wall. A photograph of the right thigh is shown. Which of the following is the most likely explanation for this patient's skin findings?? {'A': 'Deficiency of vitamin K', 'B': 'Decreased synthesis of antithrombin III', 'C': 'Antibodies against platelet factor 4', 'D': 'Increased levels of protein S', 'E': 'Reduced levels of protein C'},
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E: Reduced levels of protein C
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Answer the following medical question with one of the provided options:
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Q:An 8-year-old girl is brought to the physician for a well-child examination. Since the age of 2 years, she has had multiple fractures after minor trauma. During the past year, she has fractured the left humerus and right clavicle after falls. Her father also has a history of recurrent fractures. She is at the 5th percentile for height and 20th percentile for weight. Vital signs are within normal limits. Physical examination shows increased convexity of the thoracic spine. Forward bend test demonstrates asymmetry of the thoracolumbar region. There is a curvature of the tibias bilaterally, and the left leg is 2 cm longer than the right. There is increased mobility of the joints of the upper and lower extremities. Which of the following is the most likely additional finding?? {'A': 'Dislocated lens', 'B': 'Hearing impairment', 'C': 'Widely spaced permanent teeth', 'D': 'Cerebral berry aneurysm', 'E': 'Increased head circumference'},
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B: Hearing impairment
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Answer the following medical question with one of the provided options:
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Q:A 59-year-old healthy woman presents to her primary care physician’s office six weeks after undergoing an elective breast augmentation procedure in the Dominican Republic. She was told by her surgeon to establish post-operative care once back in the United States. Today she is bothered by nausea and early satiety. Her past medical history is significant only for GERD for which she takes ranitidine. Since the surgery, she has also taken an unknown opioid pain medication that was given to her by the surgeon. She reports that she has been taking approximately ten pills a day. On examination she is afebrile with normal vital signs and her surgical incisions are healing well. Her abdomen is distended and tympanitic. The patient refuses to stop her pain medicine and laxatives are not effective; what medication could be prescribed to ameliorate her gastrointestinal symptoms?? {'A': 'Metoclopramide', 'B': 'Pantoprazole', 'C': 'Senna', 'D': 'Naloxegol', 'E': 'Naproxen'},
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D: Naloxegol
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Answer the following medical question with one of the provided options:
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Q:A 32-year-old man presents to his primary care provider reporting weakness. He recently noticed that he has difficulty letting go of a doorknob or releasing his hand after shaking hands with others. His past medical history is notable for diabetes, for which he takes metformin. He drinks 2-3 beers per day, uses marijuana occasionally, and works as a security guard. His family history is notable for an early cardiac death in his father. His temperature is 98.6°F (37°C), blood pressure is 130/85 mmHg, pulse is 85/min, and respirations are 18/min. On exam, there is notable muscle atrophy in his hands, feet, and neck. He has delayed hand grip release bilaterally and is slow to return from a smile to a neutral facial expression. His gait is normal, and Romberg's test is negative. He also has frontal balding. This patient’s condition is caused by a mutation in which of the following genes?? {'A': 'DMPK', 'B': 'DPC', 'C': 'Dystrophin', 'D': 'Frataxin', 'E': 'SMN1'},
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A: DMPK
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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 presents to the emergency department for shortness of breath. The patient was returning from a business trip to China, when he suddenly felt short of breath during the taxi ride home from the airport. The patient has a past medical history of poorly controlled diabetes mellitus and a 50 pack-year smoking history. The patient is non-compliant with his medications and is currently only taking ibuprofen. An initial ECG demonstrates sinus tachycardia. A chest radiograph is within normal limits. Laboratory values are notable for a creatinine of 2.4 mg/dL and a BUN of 32 mg/dL as compared to his baseline creatinine of 0.9 mg/dL. His temperature is 98.8°F (37.1°C), pulse is 122/min, blood pressure is 145/90 mmHg, respirations are 19/min, and oxygen saturation is 93% on room air. On physical exam, you note an older gentleman in distress. Cardiac exam is notable only for tachycardia. Pulmonary exam is notable for expiratory wheezes. Which of the following is the best confirmatory test for this patient?? {'A': 'Arterial blood gas', 'B': 'CT angiogram', 'C': 'D-dimer', 'D': 'Lower extremity ultrasound with Doppler', 'E': 'Ventilation perfusion scan'},
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E: Ventilation perfusion scan
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Answer the following medical question with one of the provided options:
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Q:A 2-week-old boy presents to the emergency department because of unusual irritability and lethargy. The patient is admitted to the pediatric intensive care unit and minutes later develops metabolic encephalopathy. This progressed to a coma, followed by death before any laboratory tests are completed. The infant was born at home via vaginal delivery at 39 weeks' of gestation. His mother says that the symptoms started since the infant was 4-days-old, but since he only seemed ‘tired’, she decided not to seek medical attention. Further testing during autopsy shows hyperammonemia, low citrulline, and increased orotic acid. Which of the following enzymes is most likely deficient in this patient?? {'A': 'Branched-chain alpha-ketoacid dehydrogenase', 'B': 'Cystathionine synthase deficiency', 'C': 'Homogentisic acid dioxygenase', 'D': 'Ornithine transcarbamylase', 'E': 'Propionyl-CoA carboxylase'},
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D: Ornithine transcarbamylase
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Answer the following medical question with one of the provided options:
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Q:A 29-year-old woman, gravida 2, para 1, at 30 weeks' gestation comes to the emergency department because of severe right-sided back pain for the last hour. The pain is colicky and radiates to the right groin. The patient also reports nausea and pain with urination. Pregnancy has been uncomplicated and the patient reports that she has been following up with her gynecologist on a regular basis. There is no personal or family history of serious illness. She does not smoke or drink alcohol. Medications include folic acid and a multivitamin. Temperature is 37°C (98.6°F), pulse is 90/min, and blood pressure is 130/80 mm Hg. Examination of the back shows costovertebral angle tenderness on the right side. Laboratory studies show: Urine Protein negative RBC casts negative RBC 5–7/hpf WBC casts negative WBC 1–2/hpf Which of the following is the most likely diagnosis?"? {'A': 'Cholecystitis', 'B': 'Nephrolithiasis', 'C': 'Pelvic inflammatory disease', 'D': 'Pyelonephritis', 'E': 'Appendicitis'},
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B: Nephrolithiasis
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Answer the following medical question with one of the provided options:
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Q:An 18-year-old man is brought to the emergency department after his mother found him locked in his room stammering about a government conspiracy to brainwash him in subterranean tunnels. His mother says that he has never done this before, but 6 months ago he stopped going to classes and was subsequently suspended from college. She reports that he has become increasingly taciturn over the course of the past month. He drinks one to two beers daily and has smoked one pack of cigarettes daily for 3 years. He occasionally smokes marijuana. His father was diagnosed with schizophrenia at the age of 25 years. The patient has had no friends or social contacts other than his mother since he was suspended. He appears unkempt and aloof. On mental status examination, he is disorganized and shows poverty of speech. He says his mood is “good.” He does not hear voices and has no visual or tactile hallucinations. Toxicology screening is negative. Which of the following is a favorable prognostic factor for this patient's condition?? {'A': 'Predominance of negative symptoms', 'B': 'Acute onset of symptoms', 'C': 'Lack of social support', 'D': 'Male sex', 'E': 'Cannabis use'},
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B: Acute onset of symptoms
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Answer the following medical question with one of the provided options:
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Q:An investigator studying patients with symptoms of arthritis detects a nonenveloped virus with a single-stranded DNA genome in the serum of a pregnant patient. Fetal infection with this pathogen is most likely to cause which of the following manifestations?? {'A': 'Hydrops fetalis', 'B': 'Chorioretinitis', 'C': 'Microcephaly', 'D': 'Notched teeth', 'E': 'Vesicular rash'},
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A: Hydrops fetalis
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Answer the following medical question with one of the provided options:
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Q:A 32-year-old man comes to the Veterans Affairs hospital because of difficulty sleeping for the past 9 weeks. He is a soldier who returned from a deployment in Afghanistan 12 weeks ago. Fifteen weeks ago, his unit was ambushed in a deserted street, and a fellow soldier was killed. He wakes up frequently during the night from vivid dreams of this incident. He blames himself for being unable to save his friend. He also has trouble falling asleep and gets up earlier than desired. During this period, he has started to avoid walking in deserted streets. Vital signs are within normal limits. Physical examination shows no abnormalities. He refuses cognitive behavioral therapy and is started on sertraline. Five weeks later, he returns to the physician and complains about persistent nightmares and difficulty sleeping. Which of the following is the most appropriate next step in management?? {'A': 'Diazepam therapy', 'B': 'Triazolam therapy', 'C': 'Phenelzine therapy', 'D': 'Prazosin therapy', 'E': 'Supportive psychotherapy'},
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D: Prazosin therapy
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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 is brought into the emergency department at 5 AM because of chest pain that woke her up at 3 AM. The pain is constant and has not decreased in intensity during this time. She has no history of any similar episodes. She has systemic lupus erythematosus without major organ involvement. She takes prednisone, calcium, alendronate, and hydroxychloroquine. The blood pressure is 120/75 mm Hg, pulse is 85/min, respirations are 19/min, and the temperature is 36.5°C (97.7°F). An examination of the chest including the heart and lungs shows no abnormalities. The electrocardiogram (ECG) shows no abnormalities. Computed tomography (CT) scan of the chest shows esophageal thickening near the mid-portion. Which of the following is the most likely diagnosis?? {'A': 'Diffuse esophageal spasm', 'B': 'Esophageal perforation', 'C': 'Esophageal stricture', 'D': 'Gastroesophageal reflux disease', 'E': 'Pill esophagitis'},
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E: Pill esophagitis
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Answer the following medical question with one of the provided options:
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Q:Six hours after near-total thyroidectomy for Graves disease, a 58-year-old man has not had any urine output. The surgery was successful and the patient feels well except for slight neck pain. He has type 2 diabetes mellitus and hypertension. His father had autosomal dominant polycystic kidney disease. Prior to the surgery, the patient was taking metformin and lisinopril regularly and ibuprofen as needed for headaches. His current medications include acetaminophen and codeine. His temperature is 36.2°C (97.2°F), pulse is 82/min, and blood pressure is 122/66 mm Hg. Physical examination shows a 7-cm surgical wound on the anterior neck with mild swelling, but no reddening or warmth. The remainder of the examination shows no abnormalities. Which of the following is the most appropriate next step in management?? {'A': 'Obtain renal scintigraphy', 'B': 'Obtain urinalysis', 'C': 'Perform bedside bladder scan', 'D': 'Obtain renal biopsy', 'E': 'Administer furosemide\n"'},
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C: Perform bedside bladder scan
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Answer the following medical question with one of the provided options:
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Q:A 45-year-old man presents to his primary care physician because of abdominal pain. He has had this pain intermittently for several years but feels that it has gotten worse after he started a low carbohydrate diet. He says that the pain is most prominent in the epigastric region and is also associated with constipation and foul smelling stools that float in the toilet bowl. He has a 15-year history of severe alcoholism but quit drinking 1 year ago. Laboratory studies are obtained showing a normal serum amylase and lipase. Both serum and urine toxicology are negative. His physician starts him on appropriate therapy and checks to make sure that his vitamin and mineral levels are appropriate. Which of the following deficiency syndromes is most closely associated with the cause of this patient's abdominal pain?? {'A': 'Cheilosis and corneal vascularization', 'B': 'Encephalopathy, ophthalmoplegia, and gait ataxia', 'C': 'Microcytic anemia', 'D': 'Megaloblastic anemia without neurologic changes', 'E': 'Osteomalacia'},
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E: Osteomalacia
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Answer the following medical question with one of the provided options:
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Q:A 67-year-old man comes to the physician because of a 6-month history of increasing shortness of breath on exertion, dry cough, and fatigue. He has not had any fevers or night sweats. He worked in a glass manufacturing factory for 15 years and retired 2 years ago. Pulmonary examination shows diffuse crackles bilaterally. An x-ray of the chest shows well-defined calcification of the rims of hilar lymph nodes and scattered nodules in both upper lung fields. This patient is most likely to develop which of the following complications?? {'A': 'Malignant mesothelioma', 'B': 'Invasive aspergillosis', 'C': 'Pneumocystis pneumonia', 'D': 'Spontaneous pneumothorax', 'E': 'Pulmonary tuberculosis'},
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E: Pulmonary tuberculosis
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Answer the following medical question with one of the provided options:
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Q:A 47-year-old woman comes to the physician because of fatigue, difficulty falling asleep, and night sweats for the past 6 months. Over the past year, her menstrual cycle has become irregular and her last menstrual period was 2 months ago. She quit smoking 2 years ago. Pelvic exam shows vulvovaginal atrophy. A pregnancy test is negative. Which of the following changes is most likely to occur in this patient's condition?? {'A': 'Decreased luteinizing hormone', 'B': 'Increased estrogen', 'C': 'Increased inhibin B', 'D': 'Decreased gonadotropin-releasing hormone', 'E': 'Increased follicle-stimulating hormone'},
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E: Increased follicle-stimulating hormone
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Answer the following medical question with one of the provided options:
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Q:A 41-year-old woman presents with back pain for the past 2 days. She says that the pain radiates down along the posterior right thigh and leg. She says the pain started suddenly after lifting a heavy box 2 days ago. Past medical history is irrelevant. Physical examination reveals a straight leg raise (SLR) test restricted to 30°, inability to walk on her toes, decreased sensation along the lateral border of her right foot, and diminished ankle jerk on the same side. Which of the following nerve roots is most likely compressed?? {'A': 'Fifth lumbar nerve root (L5)', 'B': 'First sacral nerve root (S1)', 'C': 'Third sacral nerve root (S3)', 'D': 'Fourth lumbar nerve root (L4)', 'E': 'Second sacral nerve root (S2)'},
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B: First sacral nerve root (S1)
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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 comes to the physician because of a 3-day history of redness and swelling of her right leg and fever. She says the leg is very painful and the redness over it has become larger. She appears ill. Her temperature is 39.3°C (102.7°F), pulse is 103/min, and blood pressure is 138/90 mm Hg. Cardiopulmonary examination shows no abnormalities. Examination shows an area of diffuse erythema and swelling over her anterior right lower leg; it is warm and tender to touch. Squeezing of the calf does not elicit tenderness. There is swelling of the right inguinal lymph nodes. Pedal pulses are palpable bilaterally. Which of the following is the strongest predisposing factor for this patient's condition?? {'A': 'Rheumatoid arthritis', 'B': 'Graves disease', 'C': 'Cigarette smoking', 'D': 'Immobility', 'E': 'Tinea pedis\n"'},
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E: Tinea pedis "
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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 the emergency room complaining of diarrhea and dehydration. She has been experiencing severe watery diarrhea for the past 3 days. She reports that she has been unable to leave the bathroom for more than a few minutes at a time. She noticed earlier today that there was some blood on her toilet paper after wiping. She recently returned from a volunteer trip to Yemen where she worked at an orphanage. Her past medical history is notable for psoriasis for which she takes sulfasalazine. The patient drinks socially and does not smoke. Her temperature is 99°F (37.2°C), blood pressure is 100/55 mmHg, pulse is 130/min, and respirations are 20/min. Mucus membranes are dry. Her eyes appear sunken. Capillary refill is 4 seconds. The patient is started on intravenous fluid resuscitation. Which of the following processes is capable of transmitting the genetic material for the toxin responsible for this patient’s condition?? {'A': 'Endospore formation', 'B': 'Transformation', 'C': 'Conjugation', 'D': 'Transduction', 'E': 'Transposition'},
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D: Transduction
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Answer the following medical question with one of the provided options:
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Q:A 3-year-old toddler was rushed to the emergency department after consuming peanut butter crackers at daycare. The daycare staff report that the patient has a severe allergy to peanut butter and he was offered the crackers by mistake. The patient is in acute distress. The vital signs include: blood pressure 60/40 mm Hg and heart rate 110/min. There is audible inspiratory stridor and the respiratory rate is 27/min. Upon examination, his chest is covered in a maculopapular rash. Intubation is attempted and failed due to extensive laryngeal edema. The decision for cricothyrotomy is made. Which of the following is the most likely mechanism of this pathology?? {'A': 'C5a production', 'B': 'Release of IL-4', 'C': 'Deposition of antigen-antibody complexes', 'D': 'IL-2 secretion', 'E': 'C3b interaction'},
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B: Release of IL-4
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Answer the following medical question with one of the provided options:
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Q:A 32-year-old G2P0 presents at 37 weeks gestation with a watery vaginal discharge. The antepartum course was remarkable for an abnormal ultrasound finding at 20 weeks gestation. The vital signs are as follows: blood pressure, 110/80 mm Hg; heart rate, 91/min; respiratory rate, 13/min; and temperature, 36.4℃ (97.5℉). The fetal heart rate is 141/min. On speculum examination, there were no vaginal or cervical lesions, but there is a continuous watery vaginal discharge with traces of blood. The discharge is fern- and nitrite-positive. Soon after the initial examination, the bleeding increases. Fetal monitoring shows a heart rate of 103/min with late decelerations. Which of the following ultrasound findings was most likely present in the patient and predisposed her to the developed condition?? {'A': 'Loss of the normal retroplacental hyperechogenic region', 'B': 'Velamentous cord insertion', 'C': 'Retroplacental hematoma', 'D': 'Subchorionic cyst', 'E': 'Placental edge-internal os distance of 3 cm'},
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B: Velamentous cord insertion
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Q:An experimental drug, ES 62, is being studied. It prohibits the growth of vancomycin-resistant Staphylococcus aureus. It is highly lipid-soluble. The experimental design is dependent on a certain plasma concentration of the drug. The target plasma concentration is 100 mmol/dL. Which of the following factors is most important for calculating the appropriate loading dose? ? {'A': 'Rate of administration', 'B': 'Clearance of the drug', 'C': 'Half-life of the drug', 'D': 'Therapeutic index', 'E': 'Volume of distribution'},
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E: Volume of distribution
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Q:A 24-year-old male graduate student comes to the physician for a two-month history of repeated thoughts and anxiety that he is going to be harmed by someone on the street. The anxiety worsened after witnessing a pedestrian getting hit by a car two weeks ago. He says, “That was a warning sign.” On his way to school, he now often leaves an hour earlier to take a detour and hide from people that he thinks might hurt him. He is burdened by his coursework and fears that his professors are meaning to fail him. He says his friends are concerned about him but that they do not understand because they were not present at the accident. The patient has no known history of psychiatric illness. On mental status exam, he is alert and oriented, and shows full range of affect. Thought processes and speech are organized. His memory and attention are within normal limits. He denies auditory, visual, or tactile hallucinations. Urine toxicology screening is negative. Which of the following is the most likely diagnosis in this patient?? {'A': 'Avoidant personality disorder', 'B': 'Schizotypal personality disorder', 'C': 'Delusional disorder', 'D': 'Generalized anxiety disorder', 'E': 'Schizoid personality disorder'},
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C: Delusional disorder
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Q:A 58-year-old male presents to the clinic for a follow-up visit. He takes metformin every day and says that he is compliant with his medication but can not control his diet. Three months prior, his HbA1c was 8.2% when he was started on metformin. He does not have any complaints on this visit. His temperature is 37°C (98.6°F), respirations are 15/min, pulse is 67/min and blood pressure is 122/88 mm Hg. His BMI is 33. Physical examination is within normal limits. Blood is drawn for laboratory tests and the results are given below: Fasting blood glucose 150 mg/dL Glycated hemoglobin (HbA1c) 7.2 % Serum Creatinine 1.1 mg/dL BUN 12 mg/dL The physician wants to initiate another medication for his blood glucose control, specifically one that does not carry a risk of weight gain. Addition of which of the following drugs would be most suitable for this patient?? {'A': 'Glimepiride', 'B': 'Rosiglitazone', 'C': 'Pioglitazone', 'D': 'Sitagliptin', 'E': 'Glyburide'},
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D: Sitagliptin
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Q:A 24-year-old man presents to the college campus clinic worried that he is having a nervous breakdown. The patient was diagnosed with attention-deficit/hyperactivity disorder (ADHD) during his freshman year and has been struggling to keep his grades up. He has recently become increasingly worried that he might not be able to graduate on time. For the past 2-months, he has been preoccupied with thoughts of his dorm room burning down and he finds himself checking all the appliances and outlets over and over even though he knows he already checked everything thoroughly. This repetitive behavior makes him late to class and has seriously upset his social activities. The patient is afebrile and vital signs are within normal limits. Physical examination is unremarkable. Which of the following psychiatric disorders is most associated with this patient’s condition?? {'A': 'Tourette syndrome', 'B': 'Obsessive-compulsive personality disorder', 'C': 'Schizophrenia', 'D': 'Delusional disorder', 'E': 'Not related to other disorders'},
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A: Tourette syndrome
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Q:A 49-year-old male complains of abdominal discomfort that worsens following meals. A gastric biopsy reveals a 2 cm gastric ulcer, and immunohistochemical staining demonstrates the presence of a rod-shaped bacterium in the gastric mucosa. Which of the following is used by the infiltrating pathogen to neutralize gastric acidity?? {'A': 'Flagella', 'B': 'Mucinase', 'C': 'Bismuth', 'D': 'Urease', 'E': 'LT toxin'},
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D: Urease
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Q:A 7-year-old boy is brought to the emergency department by his mother 1 hour after falling off his bike and landing head-first on the pavement. His mother says that he did not lose consciousness but has been agitated and complaining about a headache since the event. He has no history of serious illness and takes no medications. His temperature is 37.1°C (98.7°F), pulse is 115/min, respirations are 20/min, and blood pressure is 100/65 mm Hg. There is a large bruise on the anterior scalp. Examination, including neurologic examination, shows no other abnormalities. A noncontrast CT scan of the head shows a non-depressed linear skull fracture with a 2-mm separation. Which of the following is the most appropriate next step in management?? {'A': 'Inpatient observation', 'B': 'Discharge home', 'C': 'Contact child protective services', 'D': 'MRI of the brain', 'E': 'CT angiography\n"'},
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A: Inpatient observation
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Q:A 67-year-old man presents to the emergency department with altered mental status. The patient is non-verbal at baseline, but his caretakers at the nursing home noticed he was particularly somnolent recently. The patient has a past medical history of diabetes and Alzheimer dementia. His temperature is 99.7°F (37.6°C), blood pressure is 157/98 mmHg, pulse is 150/min, respirations are 16/min, and oxygen saturation is 98% on room air. Laboratory values are obtained and shown below. Hemoglobin: 9 g/dL Hematocrit: 33% Leukocyte count: 8,500/mm^3 with normal differential Platelet count: 197,000/mm^3 Serum: Na+: 139 mEq/L Cl-: 102 mEq/L K+: 4.3 mEq/L HCO3-: 25 mEq/L BUN: 37 mg/dL Glucose: 99 mg/dL Creatinine: 2.4 mg/dL Ca2+: 12.2 mg/dL The patient has lost 20 pounds over the past month. His parathyroid hormone is within normal limits, and his urinary calcium is increased. Physical exam demonstrates discomfort when the patient's lower back and extremities are palpated. Which of the following is the most accurate diagnostic test for this patient's underlying diagnosis?? {'A': 'Bone marrow biopsy', 'B': 'Peripheral blood smear', 'C': 'Radiograph of the lumbar spine', 'D': 'Urine, blood, and cerebrospinal fluid cultures', 'E': 'Urine protein levels'},
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A: Bone marrow biopsy
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Q:A 31-year-old G1P0 woman is brought into the emergency room by the police after a failed suicide attempt. She jumped off a nearby bridge but was quickly rescued by some nearby locals. The height of the bridge was not significant, so the patient did not sustain any injuries. For the 3 weeks before this incident, the patient says she had been particularly down, lacking energy and unable to focus at home or work. She says she no longer enjoys her usual hobbies or favorite meals and is not getting enough sleep. Which of the following is the best course of treatment for this patient?? {'A': 'Electroconvulsive therapy', 'B': 'Paroxetine', 'C': 'Phenelzine', 'D': 'Combination of SSRI and SNRI', 'E': 'Bupropion'},
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A: Electroconvulsive therapy
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Q:A 35-year-old woman is brought into the emergency room by her boyfriend with a superficial cut to the wrist. Her vital signs are normal. On physical examination, the laceration is superficial and bleeding has stopped. She says that the injury was self-inflicted because her boyfriend canceled a dinner date due to his mother being unexpectedly hospitalized. She had tried to call, email, and text him to make sure he kept the date, but he eventually stopped replying to her messages. She loves her boyfriend and says she cannot live without him. However, she was worried that he might be cheating on her and using his mother as an excuse. She admits, however, that he actually has never cheated on her in the past. While she says that she usually feels emotionally empty, she is furious during the interview as she describes how much she hates her boyfriend. Which of the following defense mechanisms is this patient exhibiting?? {'A': 'Splitting', 'B': 'Repression', 'C': 'Suppression', 'D': 'Regression', 'E': 'Transference'},
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A: Splitting
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Q:A 29-year-old female presents to the family physician concerned over the blue-black discoloration of her sclera and skin. She notes that at the end of her day, there are black stains in her underwear. The incomplete breakdown of which of the following amino acids is responsible for this presentation?? {'A': 'Tyrosine', 'B': 'Valine', 'C': 'Leucine', 'D': 'Isoleucine', 'E': 'Methionine'},
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A: Tyrosine
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Q:A 35-year-old woman presents as a new patient to a primary care physician. She hasn't seen a doctor in many years and came in for a routine check-up. She has no specific complaints, although she has occasional shortness of breath with mild activity. On physical exam, her vital signs are as follows: HR 80, BP 110/70, RR 14. On auscultation, her lungs are clear with equal breath sounds bilaterally. When listening over the precordium, the physician hears a mid-systolic click followed by a late systolic murmur that is loudest over the apex. Valsalva increases the murmur. Which of the following is NOT a possible complication of this patient's underlying problem?? {'A': 'Atrial fibrilation', 'B': 'Infective endocarditis', 'C': 'Bleeding from acquired von Willebrand disease', 'D': 'Cerebral embolism', 'E': 'Sudden death'},
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C: Bleeding from acquired von Willebrand disease
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Q:A 30-year-old woman seeks evaluation at a clinic complaining of shaking, chills, fevers, and headaches for the last 3 days. She recently returned from a trip to India, where she was visiting her family. There is no history of loss of consciousness or respiratory distress. The vital signs include temperature 38.9℃ (102.0℉), respiratory rate 19/min, blood pressure 120/80 mm Hg, and pulse 94/min (rapid and thready). On general examination, she is pale and the sclera is jaundiced. Laboratory studies show: Hematocrit (Hct) 30% Total bilirubin 2.6 mg/dL Direct bilirubin 0.3 mg/dL A peripheral smear is shown below. What is the most severe complication of this condition?? {'A': 'Heart block', 'B': 'Facial paralysis', 'C': 'Cerebral edema', 'D': 'Aplastic crisis', 'E': 'Rheumatoid arthritis'},
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C: Cerebral edema
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Q:A 13-year-old girl is brought to the physician by her mother because of a 1-year history of worsening clumsiness. Initially, she swayed while walking; over the past 3 months, she has fallen 4 times. Ophthalmic examination shows a horizontal nystagmus. Proprioception and vibratory sensation are decreased in the distal extremities. Deep tendon reflexes are 1+ bilaterally. Further evaluation of the patient shows a genetic disorder involving an iron-binding mitochondrial protein encoded on chromosome 9. Which of the following findings is most likely to also be seen in this patient?? {'A': 'Hyperpigmented skin', 'B': 'Telangiectasias', 'C': 'Hammer toes', 'D': 'Myoclonic jerks', 'E': 'Adenoma sebaceum'},
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C: Hammer toes
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Q:A 36-year-old man comes to the physician because of a 2-day history of malaise and a painful, pruritic rash on his lower back and thighs. His temperature is 37.8°C (100°F). Physical examination shows the findings in the photograph. Skin scrapings from the thigh grow neutral colonies on MacConkey agar. The colony-producing bacteria are oxidase-positive. Which of the following is the greatest risk factor for the patient's condition?? {'A': 'Swimming in pool', 'B': 'Unprotected sexual intercourse', 'C': 'Rose pruning', 'D': 'Skin-to-skin contact', 'E': 'Outdoor camping'},
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A: Swimming in pool
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Q:A 2-month-old baby boy and his mother present to his pediatrician for vaccination as per the immunization schedule. His mother denies any active complaints but mentions that he has not smiled yet. The boy was born at 39 weeks gestation via spontaneous vaginal delivery. His mother received minimal prenatal care. On physical examination, his vitals are stable, but a general examination shows the presence of generalized hypotonia. His face is characterized by upwardly slanting palpebral fissures, small dysplastic ears, and a flat face. His little fingers are short, with clinodactyly, and both palms have single palmar creases. The results of a karyotype are shown in the image. If this infant has also inherited a mutation in the GATA1 gene, for which of the following conditions is he most likely to be at increased risk?? {'A': 'Acute megakaryoblastic leukemia', 'B': 'Celiac disease', 'C': 'Congenital hypothyroidism', 'D': 'Congenital cataracts', 'E': 'Endocardial cushion defect'},
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A: Acute megakaryoblastic leukemia
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Q:A 28-year-old woman presents to the emergency department with fever, cough, and difficulty in breathing for the last 6 hours. She also mentions that she noticed some blood in her sputum an hour ago. She denies nasal congestion or discharge, sneezing, wheezing, chest pain, or palpitation. Her past history does not suggest any chronic medical condition, including respiratory disease, cardiovascular disease, or cancer. There is no history of pulmonary embolism or deep vein thrombosis in the past. Her temperature is 38.3°C (101.0°F ), the pulse is 108/min, the blood pressure is 116/80 mm Hg, and the respirations are 28/min. Auscultation of her lungs reveals the presence of localized crackles over the right inframammary region. Edema is present over her left leg and tenderness is present over her left calf region. When her left foot is dorsiflexed, she complains of calf pain. The emergency department protocol mandates the use of a modified Wells scoring system in all patients presenting with the first episode of breathlessness when there is no history of a cardiorespiratory disorder in the past. Using the scoring system, the presence of which of the following risk factors would suggest a high clinical probability of pulmonary embolism?? {'A': 'Use of oral contraceptives within last 90 days', 'B': 'Intravenous drug use within last 14 days', 'C': 'History of travel of 2 hours in 30 days', 'D': 'History of surgery within the last 30 days', 'E': 'History of smoking for more than 1 year'},
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D: History of surgery within the last 30 days
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Q:A 62-year-old man comes to the physician because of a 5-day history of swelling in his left arm. Two months ago, he was diagnosed with a deep venous thrombosis in the left calf. He has had a 7-kg (15-lb) weight loss in the last 3 months. He has smoked 1 pack of cigarettes daily for the past 25 years. His only medication is warfarin. Physical examination shows warm edema of the left forearm with overlying erythema and a tender, palpable cord-like structure along the medial arm. His lungs are clear to auscultation bilaterally. Duplex sonography shows thrombosis of the left basilic and external jugular veins. Which of the following is the most appropriate next step to confirm the underlying diagnosis?? {'A': 'X-ray of the chest', 'B': 'Transesophageal echocardiography', 'C': 'CT scan of the abdomen', 'D': 'Serum antiphospholipid antibody level', 'E': 'Serum D-dimer level'},
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C: CT scan of the abdomen
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Q:A 24-day-old infant girl is brought to the emergency department because of a 2-hour history of fever, vomiting, and diarrhea. She has fed less and has had decreased urine output for 1 day. She was born at 33 weeks' gestation and weighed 1400-g (3-lb 1-oz). Her diet consists of breast milk and cow milk protein-based formula. Examination shows abdominal rigidity, distention, and absent bowel sounds. Test of the stool for occult blood is positive. An x-ray of the abdomen shows gas within the intestinal wall and the peritoneal cavity. Which of the following is the most likely diagnosis?? {'A': 'Meckel diverticululum', 'B': 'Cow milk protein allergy', 'C': 'Hirschsprung disease', 'D': 'Hypertrophic pyloric stenosis', 'E': 'Necrotizing enterocolitis'},
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E: Necrotizing enterocolitis
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Q:A previously healthy 42-year-old woman comes to the physician because of a 7-month history of diffuse weakness. There is no cervical or axillary lymphadenopathy. Cardiopulmonary and abdominal examination shows no abnormalities. A lateral x-ray of the chest shows an anterior mediastinal mass. Further evaluation of this patient is most likely to show which of the following?? {'A': 'Acetylcholine receptor antibodies', 'B': 'Smoking history of 30 pack years', 'C': 'Elevated serum alpha-fetoprotein level', 'D': 'History of fever, night sweats, and weight loss', 'E': 'Increased urinary catecholamines'},
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A: Acetylcholine receptor antibodies
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Q:A 17-year-old patient presents to the emergency department with left wrist pain after falling off of his bike and landing on his left hand. On physical exam the thenar eminence is red, swollen, and tender to palpation, so a radiograph is ordered. The patient is worried because he learned in biology class that radiography can cause cancer through damaging DNA but the physician reassures him that radiographs give a very minor dose of radiation. What is the most common mechanism by which ionizing radiation damages DNA?? {'A': 'Thymidine dimer formation', 'B': 'Microsatellite instability', 'C': 'Cytosine deamination', 'D': 'Strand breakage', 'E': 'Cyclobutane pyrimidine dimer formation'},
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D: Strand breakage
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Q:A 34-year-old G3P2 presents at 33 weeks gestation with vaginal bleeding that started last night while she was asleep. She denies uterine contractions or abdominal pain. She had a cesarean delivery in her previous pregnancy. She also reports a 10 pack-year smoking history. The vital signs are as follows: blood pressure, 130/80 mm Hg; heart rate, 84/min; respiratory rate, 12/min; and temperature, 36.8℃ (98.2℉). The physical examination is negative for abdominal tenderness or palpable uterine contractions. The perineum is mildly bloody. On speculum examination, no vaginal or cervical lesions are seen. A small amount of blood continues to pass through the cervix. Which of the following findings would you expect on ultrasound examination?? {'A': 'Partial covering of the internal cervical os by the placental edge', 'B': 'Retroplacental blood accumulation', 'C': 'Placental calcification', 'D': 'Cysts on the placental surface', 'E': 'Loss of the clear retroplacental space'},
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A: Partial covering of the internal cervical os by the placental edge
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Q:A group of scientists is conducting an experiment on the human cells involved in the immune response. They genetically modify B cells so they do not express the cluster of differentiation 21 (CD21) on their cell surfaces. The pathogenesis of which of the following organisms would most likely be affected by this genetic modification?? {'A': 'Epstein-Barr virus (EBV)', 'B': 'Measles virus', 'C': 'Human immunodeficiency virus (HIV)', 'D': 'Human papillomavirus', 'E': 'Parvovirus B19'},
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A: Epstein-Barr virus (EBV)
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Q:A 13-year-old boy is brought to the physician by his parents, who are concerned about recurrent muscle cramps he experiences while playing soccer. The boy has always loved sports and has been playing in a soccer league for the past 3 years. He now complains of severe cramping pain in his legs after intense practice sessions. He has no significant medical history. His physical examination is unremarkable. A battery of laboratory tests is ordered and they are all normal. Imaging studies yield no abnormalities as well. Which of the following is most likely deficient in this patient?? {'A': 'Carnitine palmitoyltransferase I', 'B': 'Carnitine palmitoyltransferase II', 'C': 'Medium-chain acyl-coenzyme A dehydrogenase', 'D': 'Myophosphorylase', 'E': 'Reye syndrome'},
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B: Carnitine palmitoyltransferase II
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Q:A 40-year-old male presents to his primary care physician for a regularly scheduled check-up. Physical examination reveals nontender cervical lymphadenopathy. A biopsy of the lymph node reveals aggregates of follicular architecture, and cytogenic analysis shows a t(14;18) translocation. The protein most likely responsible for the patient’s condition does which of the following:? {'A': 'Regulates passage through the cell cycle', 'B': 'Activates DNA repair proteins', 'C': 'Provides mitotic cytoskeleton', 'D': 'Inhibits apoptosis', 'E': 'Regulates cell growth through signal transduction'},
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D: Inhibits apoptosis
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Q:A 25-year-old woman comes to the physician for the evaluation of blindness in her right eye that suddenly started 1 hour ago. She has no feeling of pain, pressure, or sensation of a foreign body in the right eye. She has a history of major depressive disorder treated with fluoxetine. The patient attends college and states that she has had a lot of stress lately due to relationship problems with her partner. She does not smoke or drink alcohol. She does not use illicit drugs. She appears anxious. Her vital signs are within normal limits. Ophthalmologic examination shows a normal-appearing eye with no redness. Slit lamp examination and fundoscopy show no abnormalities. A visual field test shows nonspecific visual field defects. An MRI of the brain shows no abnormalities. Which of the following is the most likely diagnosis?? {'A': 'Malingering', 'B': 'Factitious disorder', 'C': 'Retinal detachment', 'D': 'Somatic symptom disorder', 'E': 'Conversion disorder'},
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E: Conversion disorder
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Q:A 52-year-old woman presents to the clinic with several days of vomiting and diarrhea. She also complains of headaches, muscle aches, and fever, but denies tenesmus, urgency, and bloody diarrhea. Past medical history is insignificant. When asked about any recent travel she says that she just came back from a cruise ship vacation. Her temperature is 37°C (98.6° F), respiratory rate is 15/min, pulse is 67/min, and blood pressure is 122/98 mm Hg. Physical examination is non-contributory. Microscopic examination of the stool is negative for ova or parasites. What is the most likely diagnosis?? {'A': 'Giardiasis', 'B': 'C. difficile colitis', 'C': 'Irritable bowel syndrome', 'D': 'Norovirus infection', 'E': 'Traveler’s diarrhea due to ETEC'},
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D: Norovirus infection
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Q:A 34-year-old female presents to the emergency room with headache and palpitations. She is sweating profusely and appears tremulous on exam. Vital signs are as follows: HR 120, BP 190/110, RR 18, O2 99% on room air, and Temp 37C. Urinary metanephrines and catechols are positive. Which of the following medical regimens is contraindicated as a first-line therapy in this patient?? {'A': 'Phenoxybenzamine', 'B': 'Nitroprusside', 'C': 'Propranolol', 'D': 'Labetalol', 'E': 'Lisinopril'},
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C: Propranolol
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Q:A 9-year-old boy is brought to the physician for evaluation of short stature. He is at the 5th percentile for height, 65th percentile for weight, and 95th percentile for head circumference. Examination shows midface retrusion, a bulging forehead, and flattening of the nose. The extremities are disproportionately short. He was adopted and does not know his biological parents. The patient’s condition is an example of which of the following genetic phenomena?? {'A': 'Anticipation', 'B': 'Variable expressivity', 'C': 'Imprinting', 'D': 'Complete penetrance', 'E': 'Codominance'},
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D: Complete penetrance
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Q:A 33-year-old woman comes to the physician for week-long episodes of headaches that have occurred every four weeks for the last year. During these episodes she also has bouts of lower abdominal pain and breast tenderness. She is often irritable at these times. Her menses occur at regular 28-day intervals with moderate flow. Her last menstrual period was 3 weeks ago. She drinks two to five beers on social occasions and used to smoke a pack of cigarettes daily, but stopped 6 months ago. Her mother and sister have hypothyroidism. Physical examination shows no abnormalities. Which of the following is most likely to confirm the diagnosis?? {'A': 'Detailed psychosocial assessment', 'B': 'Therapeutic trial with nicotine gum', 'C': 'Assessment of thyroid hormones', 'D': 'Serial measurements of gonadotropin levels', 'E': 'Maintaining a menstrual diary'},
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E: Maintaining a menstrual diary
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Q:A 51-year-old woman presents for her annual wellness visit. She says she feels healthy and has no specific concerns. Past medical history is significant for bipolar disorder, hypertension, and diabetes mellitus type 2, managed with lithium, lisinopril, and metformin, respectively. Her family history is significant for hypertension and diabetes mellitus type 2 in her father, who died from lung cancer at age 67. Her vital signs include: temperature 36.8°C (98.2°F), pulse 97/min, respiratory rate 16/min, blood pressure 120/75 mm Hg. Physical examination is unremarkable. Mammogram findings are labeled breast imaging reporting and data system-3 (BIRADS-3) (probably benign). Which of the following is the next best step in management in this patient?? {'A': 'Follow-up mammogram in 1 year', 'B': 'Follow-up mammogram in 6 months', 'C': 'Breast MRI', 'D': 'Biopsy', 'E': 'Treatment'},
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B: Follow-up mammogram in 6 months
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Q:A 37-year-old woman comes to the physician because of right-sided inguinal pain for the past 8 weeks. During this period, the patient has had increased pain during activities such as walking and standing. She has no nausea, vomiting, or fever. Her temperature is 36.8°C (98.2°F), pulse is 73/min, and blood pressure is 132/80 mm Hg. The abdomen is soft and nontender. There is a visible and palpable groin protrusion above the inguinal ligament on the right side. Bulging is felt during Valsalva maneuver. Which of the following is the most likely diagnosis?? {'A': 'Lipoma', 'B': 'Indirect inguinal hernia', 'C': 'Inguinal lymphadenopathy', 'D': 'Direct inguinal hernia', 'E': 'Strangulated hernia'},
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B: Indirect inguinal hernia
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Answer the following medical question with one of the provided options:
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Q:A 45-year-old man presents to the emergency department with decreased exercise tolerance and shortness of breath which has progressed slowly over the past month. The patient recalls that shortly before the onset of these symptoms, he had a low-grade fever, malaise, and sore throat which resolved after a few days with over the counter medications. He does not have any chronic illnesses and denies recent travel or illicit habits. His vital signs include: blood pressure 120/80 mm Hg, temperature 37.0°C (98.6°F), and regular radial pulse 90/min. While checking his blood pressure manually, the difference between the systolic pressure at which the first Korotkoff sounds are heard during expiration and the pressure at which they are heard throughout the respiratory cycle is less than 10 mm Hg. On physical examination, he is in mild distress with jugular venous pressure (JVP) of 13 cm, and his heart sounds are muffled. His echocardiography shows a fluid collection in the pericardial sac with no evidence of right ventricular compression. Which of the following is the best initial step for the treatment of this patient?? {'A': 'Pericardiocentesis', 'B': 'Surgical drainage', 'C': 'Pericardiectomy', 'D': 'Observation and anti-inflammatory medicines', 'E': 'Prednisone'},
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D: Observation and anti-inflammatory medicines
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Q:A 5-year-old boy is brought to the physician for excessive weight gain. The mother reports that her son has been “chubby” since he was a toddler and that he has gained 10 kg (22 lbs) over the last year. During this period, he fractured his left arm twice from falling on the playground. He had cryptorchidism requiring orchiopexy at age 2. He is able to follow 1-step instructions and uses 2-word sentences. He is at the 5th percentile for height and 95th percentile for weight. Vital signs are within normal limits. Physical examination shows central obesity. There is mild esotropia and coarse, dry skin. In addition to calorie restriction, which of the following is the most appropriate next step in management of this patient?? {'A': 'Fluoxetine', 'B': 'Octreotide', 'C': 'Laparoscopic gastric banding', 'D': 'Growth hormone and testosterone', 'E': 'Levothyroxine'},
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D: Growth hormone and testosterone
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Q:A 40-year-old man comes to the physician because of a 2-year history of gradually worsening shortness of breath. He smoked half a pack of cigarettes daily for 10 years but stopped 8 years ago. His pulse is 72/min, blood pressure is 135/75 mm Hg, and respirations are 20/min. Examination shows an increased anteroposterior diameter of the chest. Diminished breath sounds are heard on auscultation of the chest. An x-ray of the chest shows widened intercostal spaces, a flattened diaphragm, and bilateral hyperlucency of the lung bases. This patient's condition puts him at greatest risk for which of the following conditions?? {'A': 'Antineutrophil cytoplasmic antibody-positive vasculitis', 'B': 'Hepatocellular carcinoma', 'C': 'Bronchiolitis obliterans', 'D': 'IgA nephropathy', 'E': 'Bronchogenic carcinoma'},
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B: Hepatocellular carcinoma
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Q:A 3-year-old boy presents to an urgent care clinic with his mother. She states that his behavior has been lethargic for the past 3 days. She also notes that he has had a runny nose, mild cough, and sore throat during this time. She does not believe that he has been febrile. His temperature is 99.1°F (37.2°C), blood pressure is 105/67 mmHg, pulse is 100/min, respirations are 18/min, and SpO2 97% on room air. Which nucleic acid structure most accurately describes the most likely virus responsible for this boy’s clinical condition?? {'A': 'Single-stranded, positive-sense RNA', 'B': 'Single-stranded, negative-sense RNA', 'C': 'Double-stranded RNA', 'D': 'Single-stranded DNA', 'E': 'Double-stranded DNA'},
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A: Single-stranded, positive-sense RNA
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Q:A 26-year-old male with no significant past medical history goes camping with several friends in Virginia. Several days after returning, he begins to experience fevers, headaches, myalgias, and malaise. He also notices a rash on his wrists and ankles (FIgure A). Which of following should be initiated for treatment of his condition?? {'A': 'Pyrazinamide', 'B': 'Praziquantel', 'C': 'Vancomycin', 'D': 'Azithromycin', 'E': 'Doxycycline'},
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E: Doxycycline
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Q:An obese 63-year-old man comes to the physician because of 3 episodes of red urine over the past week. He has also had recurrent headaches and intermittent blurry vision during the past month. He has benign prostatic hyperplasia. He works as an attendant at a gas station. The patient has smoked one pack of cigarettes daily for the last 40 years. He does not drink alcohol. Current medications include tamsulosin. His temperature is 37.4°C (99.4°F), pulse is 90/min, and blood pressure is 152/95 mm Hg. Examination shows a flushed face. Cardiopulmonary examination shows no abnormalities. The abdomen is soft and non-tender. Digital rectal examination shows an enlarged prostate with no nodules. Urinalysis shows: Blood 3+ Glucose negative Protein negative WBC 1-2/hpf RBC 40-45/hpf RBC casts none Which of the following is the most likely diagnosis?"? {'A': 'Nephrolithiasis', 'B': 'IgA nephropathy', 'C': 'Transitional cell bladder carcinoma', 'D': 'Renal oncocytoma', 'E': 'Renal cell carcinoma'},
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E: Renal cell carcinoma
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Q:A 24-year-old man presents to the emergency department after a suicide attempt. He is admitted to the hospital and diagnosed with schizoaffective disorder. A review of medical records reveals a history of illicit drug use, particularly cocaine and amphetamines. He is started on aripiprazole, paroxetine, and trazodone. At the time of discharge, he appeared more coherent and with a marked improvement in positive symptoms of hallucinations and delusions but still with a flat effect. During the patient’s first follow-up visit, his mother reports he has become increasingly agitated and restless despite compliance with his medications. She reports that her son’s hallucinations and delusions have stopped and he does not have suicidal ideations, but he cannot sit still and continuously taps his feet, wiggles his fingers, and paces in his room. When asked if anything is troubling him, he stands up and paces around the room. He says, “I cannot sit still. Something is happening to me.” A urine drug screen is negative. What is the next best step in the management of this patient?? {'A': 'Add lithium', 'B': 'Add propranolol', 'C': 'Increase the aripiprazole dose', 'D': 'Stop aripiprazole and switch to clozapine', 'E': 'Stop paroxetine'},
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B: Add propranolol
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Q:A 55-year-old man visits the clinic with his wife. He has had difficulty swallowing solid foods for the past 2 months. His wife adds that his voice is getting hoarse but they thought it was due to his recent flu. His medical history is significant for type 2 diabetes mellitus for which he is on metformin. He suffered from many childhood diseases due to lack of medical care and poverty. His blood pressure is 125/87 mm Hg, pulse 95/min, respiratory rate 14/min, and temperature 37.1°C (98.7°F). On examination, an opening snap is heard over the cardiac apex. An echocardiogram shows an enlarged cardiac chamber pressing into his esophagus. Changes in which of the following structures is most likely responsible for this patient’s symptoms?? {'A': 'Left ventricle', 'B': 'Left atrium', 'C': 'Right atrium', 'D': 'Right ventricle', 'E': 'Patent ductus arteriosus'},
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B: Left atrium
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Q:A 2-year-old boy is brought to the physician for generalized fatigue and multiple episodes of abdominal pain and vomiting for the past week. His last bowel movement was 4 days ago. He has been having behavioral problems at home for the past few weeks as well. He can walk up stairs with support and build a tower of 3 blocks. He cannot use a fork. He does not follow simple instructions and speaks in single words. His family emigrated from Bangladesh 6 months ago. He is at the 40th percentile for height and weight. His temperature is 37°C (98.6°F), pulse is 115/min, and blood pressure is 84/45 mm Hg. Examination shows pale conjunctivae and gingival hyperpigmentation. His hemoglobin concentration is 10.1 g/dL, mean corpuscular volume is 68 μm3, and mean corpuscular hemoglobin is 24.5 pg/cell. The patient is most likely going to benefit from administration of which of the following?? {'A': 'Succimer and calcium disodium edetate', 'B': 'Thiosulfate and hydroxocobalamin', 'C': 'Vitamin B12 and folate', 'D': 'Penicillamine', 'E': 'Iron'},
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A: Succimer and calcium disodium edetate
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Q:A 74-year-old man presents to the emergency department by paramedics for slurred speech and weakness in the left arm and leg for 1 hour. The patient was playing with his grandson when the symptoms started and his wife immediately called an ambulance. There is no history of head trauma or recent surgery. The patient takes captopril for hypertension. The vital signs include: pulse 110/min, respiratory rate 22/min, and blood pressure 200/105 mm Hg. The physical examination shows that the patient is alert and conscious, but speech is impaired. Muscle strength is 0/5 in the left arm and leg and 5/5 in the right arm and leg. A non-contrast CT of the head shows no evidence of intracranial bleeding. The lab results are as follows: Serum glucose 90 mg/dL Sodium 140 mEq/L Potassium 4.1 mEq/L Chloride 100 mEq/L Serum creatinine 1.3 mg/dL Blood urea nitrogen 20 mg/dL Cholesterol, total 240 mg/dL HDL-cholesterol 38 mg/dL LDL-cholesterol 100 mg/dL Triglycerides 190 mg/dL Hemoglobin (Hb%) 15.3 g/dL Mean corpuscular volume (MCV) 83 fL Reticulocyte count 0.8% Erythrocyte count 5.3 million/mm3 Platelet count 130,000/mm3 Partial thromboplastin time (aPTT) 30 sec Prothrombin time (PT) 12 sec Although he is within the time frame for the standard therapy of the most likely condition, the treatment cannot be started because of which of the following contraindications?? {'A': 'Creatinine level of 1.3 mg/dL', 'B': 'A platelet count of 130,000/mm3', 'C': 'Cholesterol level of 240 mg/dL', 'D': 'Systolic blood pressure of 200 mm Hg', 'E': 'Age of 74 years'},
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D: Systolic blood pressure of 200 mm Hg
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Q:A 33-year-old African American woman presents to the office complaining of blurry vision and headache for the past 2 weeks. She states that she has not been feeling herself lately and also fell down once after a dizzy episode. Her medical history is remarkable for hypertension and pulmonary sarcoidosis treated with hydralazine and prednisone respectively. She had a recent bout of acute optic neuritis, requiring high-dose IV methylprednisolone. Her temperature is 37°C (98.6°F), the blood pressure is 112/76 mm Hg, the pulse is 78/min, and the respirations are 14/min. On examination, the patient is mildly disoriented. Head and neck examination reveals a soft, supple neck and a right-sided facial droop. There is 5/5 muscle strength in all extremities. VDRL test is negative. A head MRI is pending. What is the most appropriate next step in the management of this patient? ? {'A': 'Methotrexate', 'B': 'Methylprednisolone and methotrexate', 'C': 'Heparin', 'D': 'Plasmapheresis', 'E': 'Methotrexate and azathioprine'},
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B: Methylprednisolone and methotrexate
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Q:A 54-year-old man comes to the emergency department because of episodic palpitations for the past 12 hours. He has no chest pain. He has coronary artery disease and type 2 diabetes mellitus. His current medications include aspirin, insulin, and atorvastatin. His pulse is 155/min and blood pressure is 116/77 mm Hg. Physical examination shows no abnormalities. An ECG shows monomorphic ventricular tachycardia. An amiodarone bolus and infusion is given, and the ventricular tachycardia converts to normal sinus rhythm. He is discharged home with oral amiodarone. Which of the following is the most likely adverse effect associated with long-term use of this medication?? {'A': 'Hepatic adenoma', 'B': 'Shortened QT interval on ECG', 'C': 'Chronic interstitial pneumonitis', 'D': 'Angle-closure glaucoma', 'E': 'Progressive multifocal leukoencephalopathy'},
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C: Chronic interstitial pneumonitis
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Q:A 24-year-old woman is brought to the hospital by her mother because she has "not been herself" for the past 3 months. The patient says she hears voices in her head. The mother said that when she is talking to her daughter she can’t seem to make out what she is saying; it is as if her thoughts are disorganized. When talking with the patient, you notice a lack of energy and an apathetic affect. Which of the following is the most likely diagnosis for this patient?? {'A': 'Major depressive disorder', 'B': 'Brief psychotic disorder', 'C': 'Schizotypal disorder', 'D': 'Schizophreniform disorder', 'E': 'Schizophrenia'},
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D: Schizophreniform disorder
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Q:A 4-year-old girl is brought to the emergency department by her parents because of a painful rash of her hands and lower arms. According to the mother, she developed blisters and redness on her arms 2 days ago. Both parents claim there is no recent history of fever, itching, or trauma. Physical examination shows erythema and multiple fluid-filled bullae on the hands and arms up to the elbows with intermittent stripes of normal skin seen on the palmar aspect of the hand. The lesions are symmetrical in distribution and are sharply delineated. Which of the following is the most appropriate next step in management?? {'A': 'Schedule a follow-up examination for further evaluation', 'B': 'Notify Child Protective Services', 'C': 'Ask both parents to leave the examination room to perform a forensic interview of the child', 'D': 'Talk to both parents individually', 'E': 'Obtain a biopsy specimen of the skin lesions for histopathological examination\n"'},
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B: Notify Child Protective Services
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Q:A 53-year-old man is brought to the emergency department for confusion. He was in his usual state of health until about 3 hours ago when he tried to use his sandwich to turn off the TV. He also complained to his wife that he had a severe headache. Past medical history is notable for hypertension, which has been difficult to control on multiple medications. His temperature is 36.7°C (98°F), the pulse is 70/min, and the blood pressure is 206/132 mm Hg. On physical exam he is alert and oriented only to himself, repeating over and over that his head hurts. The physical exam is otherwise unremarkable and his neurologic exam is nonfocal. The noncontrast CT scan of the patient’s head is shown. Which of the following diagnostic tests is likely to reveal the diagnosis for this patient?? {'A': 'CT angiography of the brain', 'B': 'CT angiography of the neck', 'C': 'Electroencephalogram (EEG)', 'D': 'Lumbar puncture', 'E': 'MRI of the brain'},
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E: MRI of the brain
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Q:A 66-year-old man is brought into the emergency department by his daughter for a change in behavior. Yesterday the patient seemed more confused than usual and was asking the same questions repetitively. His symptoms have not improved over the past 24 hours, thus the decision to bring him in today. Last year, the patient was almost completely independent but he then suffered a "series of falls," after which his ability to care for himself declined. After this episode he was no longer able to cook for himself or pay his bills but otherwise had been fine up until this episode. The patient has a past medical history of myocardial infarction, hypertension, depression, diabetes mellitus type II, constipation, diverticulitis, and peripheral neuropathy. His current medications include metformin, insulin, lisinopril, hydrochlorothiazide, sodium docusate, atorvastatin, metoprolol, fluoxetine, and gabapentin. On exam you note a confused man who is poorly kept. He has bruises over his legs and his gait seems unstable. He is alert to person and place, and answers some questions inappropriately. The patient's pulse is 90/minute and his blood pressure is 170/100 mmHg. Which of the following is the most likely diagnosis?? {'A': 'Normal aging', 'B': "Alzheimer's dementia", 'C': 'Lewy body dementia', 'D': 'Vascular dementia', 'E': 'Presbycusis'},
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D: Vascular dementia
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Q:A 33-year-old woman presents to her primary care physician for a wellness check-up. She states that recently she has been feeling well other than headaches that occur occasionally, which improve with ibuprofen and rest. She has a past medical history of hypertension and headaches and is currently taking hydrochlorothiazide. Her temperature is 99.2°F (37.3°C), blood pressure is 157/108 mmHg, pulse is 90/min, respirations are 14/min, and oxygen saturation is 98% on room air. Physical exam reveals a young woman who appears healthy. A normal S1 and S2 are auscultated on cardiac exam, and her lungs are clear with good air movement bilaterally. From her previous visit, it was determined that she has an elevated aldosterone and low renin level. Laboratory values are ordered as seen below. Serum: Na+: 139 mEq/L Cl-: 100 mEq/L K+: 3.7 mEq/L HCO3-: 29 mEq/L BUN: 20 mg/dL Creatinine: 1.1 mg/dL Which of the following is the most likely diagnosis?? {'A': 'Benign essential hypertension', 'B': 'Cushing syndrome', 'C': 'Narrowing of the renal arteries', 'D': 'Pheochromocytoma', 'E': 'Primary hyperaldosteronism'},
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E: Primary hyperaldosteronism
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Q:A 42-year-old man is brought to the physician 25 minutes after an episode of violent jerky movements of his hands and legs that lasted for 5 minutes. After the episode, he had difficulty conversing. For the past 10 days, he has had a left-sided headache and nausea. Apart from a history of recurrent ear infections treated with antibiotics, he reports no other personal or family history of serious illness. He works as an assistant at a veterinarian clinic. He appears ill and is oriented to place and person only. His temperature is 37.8°C (100°F), pulse is 102/min, and blood pressure 112/78 mm Hg. Examination shows bilateral optic disc swelling. There is no lymphadenopathy. Muscle strength and tone is normal in all extremities. Deep tendon reflexes are 2+ bilaterally. Plantar reflex shows a flexor response bilaterally. Laboratory studies show a CD4 count within the reference range. An MRI of the brain is shown. Intravenous mannitol and levetiracetam are administered. Which of the following is the most appropriate next step in management?? {'A': 'Ciprofloxacin and metronidazole therapy', 'B': 'Metronidazole and cefotaxime therapy', 'C': 'Aspiration and surgical drainage', 'D': 'Albendazole therapy', 'E': 'Pyrimethamine and sulfadiazine therapy\n"'},
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C: Aspiration and surgical drainage
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Q:A 12-year-old girl is brought to the physician by her mother because of high fever and left ankle and knee joint swelling. She had a sore throat 3 weeks ago. There is no family history of serious illness. Her immunizations are up-to-date. She had an episode of breathlessness and generalized rash when she received dicloxacillin for a skin infection 2 years ago. She appears ill. Her temperature is 38.8°C (102.3°F), pulse is 87/min, and blood pressure is 98/62 mm Hg. Examination shows left ankle and knee joint swelling and tenderness; range of motion is limited. Breath sounds over both lungs are normal. A grade 3/6 holosytolic murmur is heard best at the apex. Abdominal examination is normal. Which of the following is the most appropriate pharmacotherapy?? {'A': 'Clarithromycin', 'B': 'High-dose glucocorticoids', 'C': 'Amoxicillin', 'D': 'Methotrexate', 'E': 'Ciprofloxacin'},
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A: Clarithromycin
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Q:A 58-year-old woman with HIV infection is brought to the emergency department because of a 2-week history of headaches, blurred vision, and confusion. Her current medications include antiretroviral therapy and trimethoprim-sulfamethoxazole. Neurological examination shows ataxia and memory impairment. Her CD4+ T-lymphocyte count is 90/μL. Analysis of her cerebrospinal fluid analysis shows lymphocytic predominant pleocytosis, and PCR is positive for Epstein-Barr virus DNA. An MRI of the brain with contrast shows a solitary, weakly ring-enhancing lesion with well-defined borders involving the corpus callosum. Which of the following is the most likely diagnosis?? {'A': 'AIDS dementia', 'B': 'Cerebral toxoplasmosis', 'C': 'Primary cerebral lymphoma', 'D': 'Progressive multifocal leukoencephalopathy', 'E': 'Glioblastoma multiforme'},
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C: Primary cerebral lymphoma
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Q:A 19-year-old man presents to a psychiatrist for the management of substance abuse. He reports that he started using the substance 2 years ago and that he smokes it after sprinkling it on his cigarette. He describes that after smoking the substance, he feels excited and as if he does not belong to himself. He also reports that when he is in his room, he sees vivid colors on the walls after using the substance; if he listens to his favorite music, he clearly sees colors and shapes in front of his eyes. There is no history of alcohol or nicotine abuse. The psychiatrist goes through his medical records and notes that he had presented with acute substance intoxication 1 month prior. At that point, his clinical features included delusions, amnesia, generalized erythema of his skin, tachycardia, hypertension, dilated pupils, dysarthria, and ataxia. Which of the following signs is also most likely to have been present on physical examination while the man was intoxicated with the substance?? {'A': 'Nystagmus', 'B': 'Generalized hypotonia', 'C': 'Increased sensitivity to pain', 'D': 'Hyporeflexia', 'E': 'Excessive perspiration'},
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A: Nystagmus
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Q:An experimental infusable drug, X729, is currently being studied to determine its pharmacokinetics. The drug was found to have a half life of 1.5 hours and is eliminated by first order kinetics. What is the minimum number of hours required to reach a steady state concentration of >90%?? {'A': '1.5', 'B': '3', 'C': '4.5', 'D': '6', 'E': '7.5'},
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D: 6
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Q:A 67-year-old man comes to the physician for a follow-up examination. He feels well. His last visit to a physician was 3 years ago. He has chronic obstructive pulmonary disease, coronary artery disease, and hypertension. Current medications include albuterol, atenolol, lisinopril, and aspirin. He has smoked one pack of cigarettes daily for 18 years but stopped 20 years ago. He had a right lower extremity venous clot 15 years ago that required 3 months of anticoagulation therapy. A colonoscopy performed 3 years ago demonstrated 2 small, flat polyps that were resected. He is 175 cm (5 ft 9 in) tall and weighs 100 kg (220 lb); BMI is 32.5 kg/m2. His pulse is 85/min, respirations are 14/min, and blood pressure is 150/80 mm Hg. Examination shows normal heart sounds and no carotid or femoral bruits. Scattered minimal expiratory wheezing and rhonchi are heard throughout both lung fields. Which of the following health maintenance recommendations is most appropriate at this time?? {'A': 'Pulmonary function testing', 'B': 'Abdominal ultrasonography', 'C': 'CT scan of the chest', 'D': 'Lower extremity ultrasonography', 'E': 'Bone densitometry scan'},
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B: Abdominal ultrasonography
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Q:A 72-year-old retired shipyard worker received a chest x-ray as part of a routine medical work-up. The radiologist reported incidental findings suggestive of an occupational lung disease. Which of the following descriptions is most consistent with this patient's film?? {'A': 'Enlarged hilar lymph nodes', 'B': 'Fibrocalcific parietal pleural plaques on the diaphragm', 'C': 'Hyperinflated lungs with a loss of lung markings', 'D': 'Nodular calcium lesions in the apex of the lung', 'E': 'No specific radiographic findings'},
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B: Fibrocalcific parietal pleural plaques on the diaphragm
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Q:A 32-year-old man presents to the clinic with a dull low back pain radiating to the buttocks. He first noted it about 2 years ago and it has; progressed since then. He notes that it is worse in the morning and improves later in the day after physical activity. The patient also reports morning stiffness lasting up to 30 minutes and blurred vision, which started about 7 months ago. The patient’s vital signs include: blood pressure 130/80 mm Hg, heart rate 88/min, respiratory rate 16/min, and temperature 36.8°C (98.2°F). Physical examination reveals tenderness over the sacroiliac joints and limitation of the lumbar spine movements in the sagittal plane. The patient’s X-ray is shown in the picture below. Which of the following HLA variants is associated with this patient’s condition?? {'A': 'HLA-DQ2', 'B': 'HLA-DR4', 'C': 'HLA-B47', 'D': 'HLA-B27', 'E': 'HLA-DR3'},
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D: HLA-B27
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Q:A 60-year-old man who was admitted for a fractured hip and is awaiting surgery presents with acute onset altered mental status. The patient is noted by the nurses to be shouting and screaming profanities and has already pulled out his IV and urine catheter. He says he believes he is being kept against his will and does not recall falling or fracturing his hip. The patient must be restrained by the staff to prevent him from getting out of bed. He is refusing a physical exam. Initial examination reveals an agitated elderly man with a trickle of blood flowing down his left arm. He is screaming and swinging his fists at the staff. The patient is oriented x 1. Which of the following is the next, best step in the management of this patient?? {'A': 'Administer an Antipsychotic', 'B': 'Repair the fractured hip', 'C': 'Change his medication', 'D': 'Order 24-hour restraints', 'E': 'Order CMP and CBC'},
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A: Administer an Antipsychotic
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Q:A 34-year-old woman comes to the physician for evaluation of a breast lump she noticed 2 days ago while showering. She has no history of major illness. Her mother died of ovarian cancer at age 38, and her sister was diagnosed with breast cancer at age 33. Examination shows a 1.5-cm, nontender, mobile mass in the upper outer quadrant of the left breast. Mammography shows pleomorphic calcifications. Biopsy of the mass shows invasive ductal carcinoma. The underlying cause of this patient's condition is most likely a mutation of a gene involved in which of the following cellular events?? {'A': 'Activity of cytoplasmic tyrosine kinase', 'B': 'Arrest of cell cycle in G1 phase', 'C': 'Repair of double-stranded DNA breaks', 'D': 'Inhibition of programmed cell death', 'E': 'Regulation of intercellular adhesion'},
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C: Repair of double-stranded DNA breaks
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Q:A 9-month-old boy is brought to the physician because of abnormal crawling and inability to sit without support. A 2nd-trimester urinary tract infection that required antibiotic use and a spontaneous preterm birth via vaginal delivery at 36 weeks’ gestation both complicated the mother’s pregnancy. Physical examination shows a scissoring posture of the legs when the child is suspended by the axillae. Examination of the lower extremities shows brisk tendon reflexes, ankle clonus, and upward plantar reflexes bilaterally. When encouraged by his mother, the infant crawls forward by using normal reciprocal movements of his arms, while his legs drag behind. A brain MRI shows scarring and atrophy in the white matter around the ventricles with ventricular enlargement. Which of the following is most likely associated with the findings in this child?? {'A': 'Antenatal injury', 'B': 'Genetic defect', 'C': 'Intrapartum asphyxia', 'D': 'Postnatal head trauma', 'E': 'Preterm birth'},
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A: Antenatal injury
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Q:A 69-year-old man is brought to the emergency room by his wife 30 minutes after losing consciousness while they were working in their garden together. The patient says that time seemed to slow down, his vision went dark, and he had a sensation of falling. After 3–5 seconds, he awoke slightly disoriented but quickly regained his baseline mental status. The patient says he has had a few similar episodes that occurred 1–2 months ago for which he did not seek any medical treatment. He says overall he has been more tired than usual and feeling out of breath on his morning walks. He denies any chest pain or palpitations. Past medical history is significant for type 1 diabetes mellitus. Current medications are atorvastatin and insulin. His family history is significant for his father who died of myocardial infarction in his 70’s. His blood pressure is 110/85 mm Hg and pulse is 82/min. On physical examination, there is a 3/6 systolic murmur best heard over the right sternal border with radiation to the carotids. S1 is normal but there is a soft unsplit S2. The lungs are clear to auscultation bilaterally. The remainder of the exam is unremarkable. Which of the following physical exam findings would also most likely be present in this patient?? {'A': 'A decrease in systolic blood pressure ≥ 10 mmHg during inspiration', 'B': 'A slow-rising and delayed upstroke of the carotid pulse', 'C': 'Distant heart sounds', 'D': 'Increased capillary pulsations of the fingertips', 'E': 'A carotid biphasic pulse'},
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B: A slow-rising and delayed upstroke of the carotid pulse
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Q:A 69-year-old man comes to the physician because of a 1-week history of blood in the urine and fatigue. He also has had a 5.0-kg (11-lb) weight loss during the past month. Physical examination shows pallor and cachexia. A nontender right flank mass is palpated. A CT scan of the chest, abdomen, and pelvis shows a 5-cm right upper pole renal mass and several pulmonary lesions. A biopsy specimen of an affected area of the lung is obtained. A photomicrograph of the biopsy specimen is shown. Molecular evaluation of the specimen is most likely to show which of the following genetic changes?? {'A': 'NF1 gene inactivation', 'B': 'PKD1 gene mutation', 'C': 'VHL gene deletion', 'D': 'TSC1 gene insertion', 'E': 'WT1 gene deletion'},
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C: VHL gene deletion
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Q:A 72-year-old man is brought to the emergency department by his daughter because he was found to have decreased alertness that has gotten progressively worse. Three weeks ago he was diagnosed with an infection and given an antibiotic, though his daughter does not remember what drug was prescribed. His medical history is also significant for benign prostatic hyperplasia and hypertension, for which he was prescribed tamsulosin, a thiazide, and an ACE inhibitor. He has not sustained any trauma recently, and no wounds are apparent. On presentation, he is found to be confused. Labs are obtained with the following results: Serum: Na+: 135 mEq/L BUN: 52 mg/dL Creatinine: 2.1 mg/dL Urine: Osmolality: 548 mOsm/kg Na+: 13 mEq/L Creatinine: 32 mg/dL Which of the following etiologies would be most likely given this patient's presentation?? {'A': 'Allergic reaction to antibiotic', 'B': 'Forgetting to take tamsulosin', 'C': 'Hemorrhage', 'D': 'Overdiuresis by thiazides', 'E': 'Toxic reaction to antibiotic'},
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D: Overdiuresis by thiazides
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Q:Steroid hormone synthesis, lipid synthesis, and chemical detoxification are activities of which of the following?? {'A': 'Rough Endoplasmic Reticulum', 'B': 'Golgi bodies', 'C': 'Peroxisomes', 'D': 'Smooth Endoplasmic Reticulum', 'E': 'Nucleolus'},
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D: Smooth Endoplasmic Reticulum
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Q:A 60-year-old woman presents to the emergency department due to progressive shortness of breath and a dry cough for the past week. She notes that her symptoms are exacerbated by physical activity and relieved by rest. The woman was diagnosed with chronic kidney disease 2 years ago and was recently started on regular dialysis treatment. Her pulse rate is 105/min, blood pressure is 110/70 mm Hg, respiratory rate is 30/min, and temperature is 37.8°C (100.0°F). On examination of the respiratory system, there is dullness on percussion, decreased vocal tactile fremitus, and decreased breath sounds over the right lung base. The rest of the physical exam is within normal limits. Which of the following is the most likely cause of this patient’s symptoms?? {'A': 'Primary spontaneous pneumothorax (PSP)', 'B': 'Pleural effusion', 'C': 'Pulmonary tuberculosis (TB)', 'D': 'Pneumonia', 'E': 'Acute bronchitis'},
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B: Pleural effusion
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Q:A 22-year-old female is brought to the emergency department by her roommate with a one day history of fever and malaise. She did not feel well after class the previous night and has been in her room since then. She has not been eating or drinking due to severe nausea. Her roommate checked on her one hour ago and was alarmed to find a fever of 102°F (38.9°C). On physical exam temperature is 103°F (40°C), blood pressure is 110/66 mmHg, pulse is 110/min, respirations are 23/min, and pulse oximetry is 98% on room air. She refuses to move her neck and has a rash on her trunk. You perform a lumbar puncture and the CSF analysis is shown below. Appearance: Cloudy Opening pressure: 180 mm H2O WBC count: 150 cells/µL (93% PMN) Glucose level: < 40 mg/dL Protein level: 50 mg/dL Gram stain: gram-negative diplococci Based on this patient's clinical presentation, which of the following should most likely be administered?? {'A': 'Ceftriaxone', 'B': 'Rifampin', 'C': 'Erythromycin', 'D': 'Acyclovir', 'E': 'Dexamethasone'},
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A: Ceftriaxone
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Q:A 65-year-old man is brought to the emergency department because of a fall that occurred while he was taking a shower earlier that morning. His wife heard him fall and entered the bathroom to find all four of his extremities twitching. The episode lasted approximately 30 seconds. He was unsure of what had happened and was unable to answer simple questions on awakening. He has regained orientation since that time. He has hypertension and hyperlipidemia. Current medications include metoprolol and atorvastatin. His temperature is 37.1°C (98.8°F), pulse is 72/min, respirations are 19/min, and blood pressures is 130/80 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 98%. Cranial nerve examination shows no abnormalities. He has 5/5 strength in all extremities. Examination shows full muscle strength. Sensation to pinprick, light touch, and vibration is normal and symmetrical. A noncontrast head CT is performed and shows a slightly hyperdense mass. Follow-up MRI shows a homogeneous, well-circumscribed 4-cm mass with compression of the adjacent white matter, and a hyperintense rim around the mass on T2 weighted imaging. Which of the following is the most likely diagnosis?? {'A': 'Glioblastoma multiforme', 'B': 'Oligodendroglioma', 'C': 'Schwannoma', 'D': 'Hemangioblastoma', 'E': 'Meningioma'},
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E: Meningioma
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Answer the following medical question with one of the provided options:
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Q:A 48-year-old woman comes to the physician because of a 6-month history of excessive fatigue and a 1-month history of progressively increasing generalized pruritus. She has hypothyroidism, for which she receives thyroid replacement therapy. Physical examination shows jaundice. The liver is palpated 4 cm below the right costal margin. Serum studies show a direct bilirubin concentration of 2.9 mg/dL, alkaline phosphatase activity of 580 U/L, and increased titers of antimitochondrial antibodies and anti-thyroid peroxidase antibodies. Which of the following is the most likely cause of this patient's condition?? {'A': 'Idiopathic hepatocellular accumulation of fat', 'B': 'Neoplasia of the ampulla of Vater', 'C': 'Destruction of intrahepatic bile ducts', 'D': 'Autoimmune-mediated destruction of hepatocytes', 'E': 'Inflammation and fibrosis of the biliary tree'},
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C: Destruction of intrahepatic bile ducts
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