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Answer the following medical question with one of the provided options:
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Q:A 53-year-old woman presents to her primary care physician with joint pain. She reports a 6-month history of progressive pain in her hands that is worse around her knuckles. The pain is symmetric bilaterally and seems to improve after she starts working in the morning at her job in a local grocery store. She has also lost 10 pounds over the past 6 months despite no changes in her weight or exercise regimen. Her past medical history is notable for seasonal allergies, hypertension, and intermittent constipation. She takes losartan and a laxative as needed. She had adolescent idiopathic scoliosis as a child and underwent a spinal fusion at the age of 14. She does not smoke or drink alcohol. Her temperature is 98.6°F (37°C), blood pressure is 135/75 mmHg, pulse is 92/min, and respirations are 16/min. On examination, she appears well and is appropriately interactive. Strength is 5/5 and sensation to light touch is intact in the bilateral upper and lower extremities. An examination of her hands demonstrates symmetric swelling of the metacarpophalangeal joints bilaterally. This patient’s condition is most strongly characterized by which of the following?? {'A': 'HLA-B27', 'B': 'HLA-B8', 'C': 'HLA-DR2', 'D': 'HLA-DR3', 'E': 'HLA-DR4'},
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E: HLA-DR4
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Answer the following medical question with one of the provided options:
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Q:A 3100-g (6.9-lb) male newborn is brought to the emergency department by his mother because of fever and irritability. The newborn was delivered at home 15 hours ago. He was born at 39 weeks' gestation. The mother's last prenatal visit was at the beginning of the first trimester. She received all standard immunizations upon immigrating from Mexico two years ago. Seven weeks ago, she experienced an episode of painful, itching genital vesicles, which resolved spontaneously. Four hours before going into labor she noticed a gush of blood-tinged fluid from her vagina. The newborn is ill-appearing and lethargic. His temperature is 39.9°C (103.8°F), pulse is 170/min, respirations are 60/min, and blood pressure is 70/45 mm Hg. His skin is mildly icteric. Expiratory grunting is heard on auscultation. Skin turgor and muscle tone are decreased. Laboratory studies show: Hemoglobin 15 g/dL Leukocyte count 33,800/mm3 Platelet count 100,000/mm3 Serum glucose 55 mg/dL Which of the following is the most likely causal organism?"? {'A': 'Staphylocccus aureus', 'B': 'Clostridium botulinum', 'C': 'Staphylococcus epidermidis', 'D': 'Neisseria meningitidis', 'E': 'Streptococcus agalactiae'},
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E: Streptococcus agalactiae
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Answer the following medical question with one of the provided options:
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Q:A 10-year-old boy is brought in by his parents with increasing breathlessness. He was diagnosed with asthma about 2 years ago and has been on treatment since then. He was initially observed to have breathlessness, cough and chest tightness 2 or 3 times a week. He would wake up once or twice a month in the nighttime with breathlessness. At that time, his pediatrician started him on a Ventolin inhaler to be used during these episodes. His symptoms were well controlled until a few months ago when he started to experience increased nighttime awakenings due to breathlessness. He is unable to play outside with his friends as much because he gets winded easily and has to use his inhaler almost daily to help him breathe easier. He is able to walk and perform other routine activities without difficulty, but playing or participating in sports causes significant struggles. Based on his symptoms, his pediatrician adds an inhaled formoterol and budesonide combination to his current regime. During spirometry, which of the following peak expiratory flow rates will most likely be observed in this patient?? {'A': '40%', 'B': '55%', 'C': '65%', 'D': '85%', 'E': '90%'},
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C: 65%
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Answer the following medical question with one of the provided options:
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Q:A 17-year-old girl is brought to the physician by her mother because she has not had her menstrual period yet. At birth, she had ambiguous genitalia. The mother reports that during the pregnancy she had noticed abnormal hair growth on her chin. A year ago, the girl broke her distal radius after a minor trauma. She is at the 95th percentile for height and 50th percentile for weight. Physical examination shows nodulocystic acne on the face, chest, and upper back. Breast development is at Tanner stage I. Pelvic examination reveals normal pubic hair with clitoromegaly. A pelvic ultrasound shows ovaries with multiple cysts and a normal uterus. Which of the following is the most likely diagnosis?? {'A': 'Aromatase deficiency', 'B': 'Kallmann syndrome', 'C': 'Congenital adrenal hyperplasia', 'D': 'Mullerian agenesis', 'E': 'Polycystic ovary syndrome'},
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A: Aromatase deficiency
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Answer the following medical question with one of the provided options:
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Q:A 56-year-old woman is referred to a plastic surgeon for breast reconstruction approximately 18 months after undergoing right modified radical mastectomy for breast cancer. Physical exam demonstrates atrophy of the lower lateral pectoralis major muscle. Damage to which of the following nerves during mastectomy is the most likely cause of her atrophy?? {'A': 'Long thoracic', 'B': 'Intercostobrachial', 'C': 'Medial pectoral', 'D': 'Lateral pectoral', 'E': 'Lateral intercostal'},
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C: Medial pectoral
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Answer the following medical question with one of the provided options:
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Q:A 4-year-old boy is brought to the physician in December for episodic shortness of breath and a nonproductive cough for 3 months. These episodes frequently occur before sleeping, and he occasionally wakes up because of difficulty breathing. His mother also reports that he became short of breath while playing with his friends at daycare on several occasions. He is allergic to peanuts. He is at the 55th percentile for height and weight. Vital signs are within normal limits. Examination shows mild scattered wheezing in the thorax. An x-ray of the chest shows no abnormalities. Which of the following is the most likely diagnosis?? {'A': 'Cystic fibrosis', 'B': 'Asthma', 'C': 'Cardiac failure', 'D': 'Primary ciliary dyskinesia', 'E': 'Tracheomalacia'},
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B: Asthma
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Answer the following medical question with one of the provided options:
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Q:An investigator is studying membranous transport proteins in striated muscle fibers of an experimental animal. An electrode is inserted into the gluteus maximus muscle and a low voltage current is applied. In response to this, calcium is released from the sarcoplasmic reticulum of the muscle fibers and binds to troponin C, which results in a conformational change of tropomyosin and unblocking of the myosin-binding site. The membranous transport mechanism underlying the release of calcium into the cytosol most resembles which of the following processes?? {'A': 'Reabsorption of glucose by renal tubular cells', 'B': 'Secretion of doxorubicin from dysplastic colonic cells', 'C': 'Uptake of fructose by small intestinal enterocytes', 'D': 'Removal of calcium from cardiac myocytes', 'E': 'Absorption of LDL-cholesterol by hepatocytes'},
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C: Uptake of fructose by small intestinal enterocytes
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Answer the following medical question with one of the provided options:
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Q:A 5-year-old boy is brought to the emergency room lapsing in and out of consciousness. The mother reports that 30 minutes ago, the young boy was found exiting the garage severely confused. A container of freshly spilled antifreeze was found on the garage floor. The next appropriate step would be to administer:? {'A': 'Dimercaprol', 'B': 'N-acetylcysteine', 'C': 'Ammonium chloride', 'D': 'Flumazenil', 'E': 'Fomepizole'},
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E: Fomepizole
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Answer the following medical question with one of the provided options:
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Q:A 39-year-old man comes to the emergency department because of a 2-day history of fever, chills, dyspnea, and a non-bloody productive cough. He was diagnosed with HIV infection 4 years ago and has been on highly active antiretroviral therapy since then. His temperature is 38.8°C (101.8°F). Examination shows crackles over the left lower lung base. His CD4+ T-lymphocyte count is 520/mm3 (N ≥ 500). An x-ray of the chest shows an infiltrate in the left lower lobe. Sputum cultures grow colonies with a narrow zone of green hemolysis without clearing on blood agar. The most likely causal pathogen of this patient's condition produces which of the following virulence factors?? {'A': 'M protein', 'B': 'Lipopolysaccharide', 'C': 'Type III secretion system', 'D': 'Polysaccharide capsule', 'E': 'Protein A'},
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D: Polysaccharide capsule
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Answer the following medical question with one of the provided options:
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Q:A 38-year-old woman, gravida 3, para 2, at 12 weeks' gestation comes to her obstetrician for a prenatal visit. Screening tests in the first trimester showed a decreased level of pregnancy-associated plasma protein and an increased level of β-hCG. A genetic disorder is suspected. Which of the following results from an additional diagnostic test is most likely to confirm the diagnosis?? {'A': 'Increased nuchal translucency on ultrasound', 'B': 'Additional chromosome in placental tissue', 'C': 'Decreased estriol in maternal serum', 'D': 'Triploidy in amniotic fluid', 'E': 'Decreased inhibin A in maternal serum'},
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B: Additional chromosome in placental tissue
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Answer the following medical question with one of the provided options:
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Q:A 82-year-old woman is brought to the emergency department from a retirement community after she was found down during the evening. On presentation, she complains that she experienced several hours of nausea, vomiting, crampy abdominal pain, and diarrhea prior to blacking out. She said that she cannot recall any factors that may have triggered her symptoms; however, she recalls that some of her friends with whom she eats also had similar symptoms earlier in the day and were brought to the hospital. They often go for walks and occasionally cook for themselves from a garden that they keep in the woods behind the facility. One of the residents on the team recalls seeing other patients from this facility earlier today, one of whom presented with kidney failure and scleral icterus prior to passing away. The enzyme most likely affected in this case has which of the following functions?? {'A': 'Synthesis of 5S ribosomal RNA', 'B': 'Synthesis of large ribosomal RNA', 'C': 'Synthesis of small nucleolar RNA', 'D': 'Synthesis of small ribosomal RNA', 'E': 'Synthesis of transfer RNA'},
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C: Synthesis of small nucleolar RNA
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Answer the following medical question with one of the provided options:
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Q:A 6-month-old boy presents with decreased growth, pigmented retinopathy, hemolytic anemia, and peripheral neuropathy. You suspect that these signs are the result of a vitamin deficiency leading to increased fatty acid oxidation. Which of the following is most likely responsible for this patient's symptoms?? {'A': 'Pernicious anemia', 'B': 'Abetalipoproteinemia', 'C': 'Goat milk ingestion', 'D': 'Hartnup disease', 'E': 'Excessive boiling of formula'},
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B: Abetalipoproteinemia
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Answer the following medical question with one of the provided options:
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Q:A 2-year-old boy is brought to the emergency department after his mother noticed maroon-colored stools in his diaper. He has not had any diarrhea or vomiting. The prenatal and birth histories are unremarkable, and he has had no recent trauma. He tolerates solid foods well. The vital signs include: temperature 37.0℃ (98.6℉), blood pressure 90/60 mm Hg, pulse 102/min, and respiratory rate 16/min. The weight is at the 50th percentile. The examination revealed an alert boy with pallor. The abdomen was mildly tender at the right iliac region without masses. There were no anal fissures or hemorrhoids. A stool guaiac test was positive. The laboratory results are as follows: Complete blood count (CBC) Leukocytes 7,500/uL Hemoglobin 9 g/dL Hematocrit 24% Platelets 200,000/uL Which of the following is the most appropriate next step in the management of this patient?? {'A': 'Stool culture and leukocytes', 'B': 'Elimination of cow’s milk from the diet', 'C': 'Colonoscopy', 'D': 'Technetium-99m pertechnetate scan', 'E': 'Abdominal ultrasound'},
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D: Technetium-99m pertechnetate scan
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Answer the following medical question with one of the provided options:
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Q:A 14-year-old boy presents to his pediatrician with weakness and frequent episodes of dizziness. He had chronic mucocutaneous candidiasis when he was 4 years old and was diagnosed with autoimmune hypoparathyroidism at age 8. On physical examination, his blood pressure is 118/70 mm Hg in the supine position and 96/64 mm Hg in the upright position. Hyperpigmentation is present over many areas of his body, most prominently over the extensor surfaces, elbows, and knuckles. His laboratory evaluation suggests the presence of antibodies to 21-hydroxylase and a mutation in the AIRE (autoimmune regulator) gene. The pediatrician explains to his parents that his condition is due to the failure of immunological tolerance. Which of the following mechanisms is most likely to have failed in the child?? {'A': 'Positive selection', 'B': 'Negative selection', 'C': 'Anergy', 'D': 'Inhibition of the inactivation of harmful lymphocytes by regulatory T cells', 'E': 'Deletion of mature lymphocytes'},
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B: Negative selection
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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 is brought to the emergency department because of progressively worsening shortness of breath and fatigue for 3 days. During the last month, he has also noticed dark colored urine. He had an upper respiratory infection 6 weeks ago. He underwent a cholecystectomy at the age of 30 years. He has hypertension, hyperlipidemia, and type 2 diabetes mellitus. He immigrated to the US from Italy 50 years ago. Current medications include simvastatin, lisinopril, and metformin. He appears pale. His temperature is 37.1°C (98.8°F), pulse is 96/min, respirations are 21/min, and blood pressure is 150/80 mm Hg. Auscultation of the heart shows a grade 4/6 systolic murmur over the right second intercostal space that radiates to the carotids. Laboratory studies show: Leukocyte count 9,000/mm3 Hemoglobin 8.3 g/dL Hematocrit 24% Platelet count 180,000/mm3 LDH 212 U/L Haptoglobin 15 mg/dL (N=41–165) Serum Na+ 138 mEq/L K+ 4.5 mEq/L CL- 102 mEq/L HCO3- 24 mEq/L Urea nitrogen 20 mg/dL Creatinine 1.2 mg/dL Total bilirubin 1.8 mg/dL Stool testing for occult blood is negative. Direct Coombs test is negative. Echocardiography shows an aortic jet velocity of 4.2 m/s and a mean pressure gradient of 46 mm Hg. Which of the following is the most appropriate next step in management to treat this patient's anemia?"? {'A': 'Administration of corticosteroids', 'B': 'Administration of hydroxyurea', 'C': 'Supplementation with iron', 'D': 'Aortic valve replacement', 'E': 'Discontinuation of medication\n"'},
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D: Aortic valve replacement
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Answer the following medical question with one of the provided options:
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Q:A 62-year-old man with gastroesophageal reflux disease and osteoarthritis is brought to the emergency department because of a 1-hour history of severe, stabbing epigastric pain. For the last 6 months, he has had progressively worsening right knee pain, for which he takes ibuprofen several times a day. He has smoked half a pack of cigarettes daily for 25 years. The lungs are clear to auscultation. An ECG shows sinus tachycardia without ST-segment elevations or depressions. This patient is most likely to have referred pain in which of the following locations?? {'A': 'Right scapula', 'B': 'Left shoulder', 'C': 'Umbilicus', 'D': 'Left jaw', 'E': 'Right groin'},
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B: Left shoulder
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Answer the following medical question with one of the provided options:
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Q:A 57-year-old woman comes to the physician because of a 2-week history of swelling of both her feet. It improves a little bit with elevation but is still bothersome to her because her shoes no longer fit. She has type 2 diabetes mellitus treated with metformin and linagliptin. She was diagnosed with hypertension 6 months ago and started treatment with amlodipine. Subsequent blood pressure measurements on separate occasions have been around 130/90 mm Hg. She otherwise feels well. Today, her pulse is 80/min, respirations are 12/min, and blood pressure is 132/88 mm Hg. Cardiovascular examination shows no abnormalities. There is pitting edema of both ankles. Which of the following would have been most likely to reduce the risk of edema in this patient?? {'A': 'Addition of enalapril', 'B': 'Addition of chlorpheniramine', 'C': 'Addition of furosemide', 'D': 'Use of compression stockings', 'E': 'Use of nifedipine instead'},
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A: Addition of enalapril
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Answer the following medical question with one of the provided options:
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Q:A 50-year-old woman comes to the physician for the evaluation of excessive hair growth on her chin over the past 2 weeks. She also reports progressive enlargement of her gums. Three months ago, she underwent a liver transplantation due to Wilson disease. Following the procedure, the patient was started on transplant rejection prophylaxis. She has a history of poorly-controlled type 2 diabetes mellitus. Temperature is 37°C (98.6°F), pulse is 80/min, respirations are 22/min, and blood pressure is 150/80 mm Hg. Physical examination shows dark-pigmented, coarse hair on the chin, upper lip, and chest. The gingiva and the labial mucosa are swollen. There is a well-healed scar on her right lower abdomen. Which of the following drugs is the most likely cause of this patient's findings?? {'A': 'Daclizumab', 'B': 'Cyclosporine', 'C': 'Sirolimus', 'D': 'Tacrolimus', 'E': 'Methotrexate'},
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B: Cyclosporine
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Answer the following medical question with one of the provided options:
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Q:A 24-year-old man presents to the clinic with the complaint of a new rash. The lesions are not bothersome, but he is worried as he has never seen anything like this on his body. Upon further questioning the patient states has been generally healthy except for a one time "horrible" flu-like episode two months ago in June. He has since gotten better. On physical exam the following rash is observed (Figure 1). What is the cause of this patient's rash?? {'A': 'Staphylococcus aureus cellulitis', 'B': 'Molluscum contagiosum virus', 'C': 'Human immunodeficiency virus (HIV)', 'D': 'Human papilloma virus (HPV)', 'E': 'Varicella zoster virus (VZV)'},
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B: Molluscum contagiosum virus
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Answer the following medical question with one of the provided options:
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Q:An HIV-positive 48-year-old man comes to the emergency department because of a 3-month history of recurrent, painful mouth ulcers. This time, the pain is so severe that the patient cannot eat. He has a history of a seizure disorder but currently does not take any medications. He appears very ill. His temperature is 39.0°C (102.2°F). Physical examination shows numerous vesicular ulcerations on the lips and sloughing of the gums, buccal mucosa, and hard palate. Genetic analysis of the pathogen isolated from the lesions shows a mutation in a gene encoding viral phosphotransferases. Which of the following drugs is the most appropriate treatment?? {'A': 'Foscarnet', 'B': 'Acyclovir', 'C': 'Cidofovir', 'D': 'Ganciclovir', 'E': 'Famciclovir'},
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C: Cidofovir
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Answer the following medical question with one of the provided options:
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Q:A 28-year-old woman presents to an outpatient clinic for a routine gynecologic examination. She is concerned about some swelling on the right side of her vagina. She senses that the right side is larger than the left and complains that sometimes that area itches and there is a dull ache. She denies any recent travel or history of trauma. She mentions that she is sexually active in a monogamous relationship with her husband; they use condoms inconsistently. On physical examination her vital signs are normal. Examination of the pelvic area reveals a soft, non-tender, mobile mass that measures approximately 2 cm in the greatest dimension at the 8 o’clock position on the right side of the vulva, just below the vaginal wall. Which of the following is the most likely diagnosis?? {'A': 'Condylomata acuminata', 'B': 'Bartholin duct cyst', 'C': 'Vulvar hematoma', 'D': 'Molluscum contagiosum', 'E': 'Squamous cell carcinoma'},
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B: Bartholin duct cyst
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Answer the following medical question with one of the provided options:
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Q:A 64-year-old woman presents to the physician’s office to find out the results of her recent abdominal CT. She had been complaining of fatigue, weight loss, and jaundice for 6 months prior to seeing the physician. The patient has a significant medical history of hypothyroidism, generalized anxiety disorder, and hyperlipidemia. She takes levothyroxine, sertraline, and atorvastatin. The vital signs are stable today. On physical examination, her skin shows slight jaundice, but no scleral icterus is present. The palpation of the abdomen reveals no tenderness, guarding, or masses. The CT results shows a 3 x 3 cm mass located at the head of the pancreas. Which of the following choices is most appropriate for delivering bad news to the patient?? {'A': 'Set aside an appropriate amount of time in your schedule, and ensure you will not have any interruptions as you explain the bad news to the patient', 'B': 'Ask that a spouse or close relative come to the appointment, explain to them the bad news, and see if they will tell the patient since they have a closer relationship', 'C': 'Call the patient over the phone to break the bad news, and tell them they can make an office visit if they prefer', 'D': 'Train one of the nursing staff employees on this matter, and delegate this duty as one of their job responsibilities', 'E': 'Refer the patient to an oncologist without informing the patient of their cancer'},
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A: Set aside an appropriate amount of time in your schedule, and ensure you will not have any interruptions as you explain the bad news to the patient
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Answer the following medical question with one of the provided options:
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Q:An investigator studying DNA replication in Campylobacter jejuni inoculates a strain of this organism into a growth medium that contains radiolabeled thymine. After 2 hours, the rate of incorporation of radiolabeled thymine is measured as a proxy for the rate of DNA replication. The cells are then collected by centrifugation and suspended in a new growth medium that contains no free uracil. After another 2 hours, the rate of incorporation of radiolabeled thymine is measured again. The new growth medium directly affects the function of which of the following enzymes?? {'A': 'Telomerase', 'B': 'DNA polymerase I', 'C': 'DNA polymerase II', 'D': 'Ligase', 'E': 'Primase'},
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E: Primase
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Answer the following medical question with one of the provided options:
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Q:A 22-year-old woman presents to the emergency department feeling lightheaded and states that her heart is racing. She does not have a history of any chronic medical conditions. She is a college sophomore and plays club volleyball. Although she feels stressed about her upcoming final exams next week, she limits her caffeine intake to 3 cups of coffee per day to get a good night sleep. She notes that her brother takes medication for some type of heart condition, but she does not know the name of it. Both her parents are alive and well. She denies recent illness, injuries, or use of cigarettes, alcohol, or recreational drugs. The pertinent negatives from the review of systems include an absence of fever, nausea, vomiting, sweating, fatigue, or change in bowel habits. The vital signs include: temperature 36.8°C (98.2°F), heart rate 125/min, respiratory rate 15/min, blood pressure 90/75 mm Hg, and oxygen saturation of 100% on room air. The laboratory results are within normal limits. The ECG is significant for a shortened PR interval and widened QRS. Which of the following medications should the patient avoid in this scenario?? {'A': 'Procainamide', 'B': 'Verapamil', 'C': 'Ablation', 'D': 'Synchronized cardioversion', 'E': 'Amlodipine'},
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B: Verapamil
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Answer the following medical question with one of the provided options:
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Q:A 13-year-old boy is brought to the physician because of a 4-month history of worsening dizziness, nausea, and feeling clumsy. An MRI of the brain shows a well-demarcated, 4-cm cystic mass in the posterior fossa. The patient undergoes complete surgical resection of the mass. Pathologic examination of the surgical specimen shows parallel bundles of cells with eosinophilic, corkscrew-like processes. Which of the following is the most likely diagnosis?? {'A': 'Medulloblastoma', 'B': 'Ependymoma', 'C': 'Pilocytic astrocytoma', 'D': 'Craniopharyngioma', 'E': 'Pinealoma'},
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C: Pilocytic astrocytoma
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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 comes to the physician for a 2-day history of headache and breathlessness on exertion. During the same period, he has vomited twice and not passed urine. He also reports pain and stiffness in his fingers that has worsened progressively over the past 2 years. He has no history of serious illness and takes no medications. He does not smoke or drink alcohol. He is in moderate distress. His temperature is 37.2°C (98.9°F), pulse is 88/min, blood pressure is 170/100 mm Hg, and respirations are 24/min. Pulse oximetry on room air shows an oxygen saturation of 91%. Examination reveals pallor, 2+ pretibial edema, and jugular venous distention. The skin on the arms, chest, and upper back is coarse and thickened. Diffuse cutaneous hyperpigmentation and hypopigmented patches with perifollicular hypopigmentation are noted. Contractures are present in the proximal interphalangeal joints of both hands. Diffuse crackles are heard on auscultation of the chest. There is dullness to percussion and decreased breath sounds over both lung bases. S1 and S2 are normal. An S3 gallop is heard at the apex. The remainder of the examination shows no abnormalities. His hemoglobin concentration is 8.1 g/dL, and his serum creatinine is 5.3 mg/dL. Further evaluation of this patient is most likely to show which of the following?? {'A': 'Increased anticentromere antibody titers', 'B': 'Decreased serum haptoglobin levels', 'C': 'Decreased serum complement levels', 'D': 'Increased total iron binding capacity', 'E': 'Increased anti-CCP antibody titers\n"'},
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B: Decreased serum haptoglobin levels
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Answer the following medical question with one of the provided options:
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Q:A 62-year-old woman presents to the emergency department complaining of fever, worsening fatigue, and muscle weakness for the previous 48 hours. The patient describes her muscle weakness as symmetric and worse in the upper limbs. Her past medical history is significant for long-standing diabetes type 2 complicated by stage 5 chronic kidney disease (CKD) on hemodialysis. She takes lisinopril, verapamil, metformin, and glargine. Today, the patient’s vital signs include: temperature 38.6°C (101.5°F), pulse 80/min, blood pressure 155/89 mm Hg, respirations 24/min, and 95% oxygen saturation on room air. The cardiac and pulmonary exams are unremarkable. The abdomen is soft and non-tender. Her strength is 3/5 in the upper extremities and 4/5 in the lower extremities and her sensation is intact. Deep tendon reflexes are absent in both the upper and lower limbs. A 12-lead electrocardiogram (ECG) is shown in the image below. Blood work is drawn and the patient is admitted and started on continuous cardiac monitoring. Based on the available information, what is the next best step in managing this patient?? {'A': 'Administer IV calcium gluconate', 'B': 'Order a stat serum potassium level', 'C': 'Emergency dialysis', 'D': 'Administer regular insulin and 50% dextrose in water', 'E': 'Administer IV sodium bicarbonate'},
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A: Administer IV calcium gluconate
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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 with recently diagnosed small-cell lung cancer sees his physician because of increasing weakness over the past 3 months. He is unable to climb stairs or comb his hair. His weakness is worse after inactivity and improves with exercise. He is a former smoker with a 30-pack-year history. He is currently preparing for initiation of chemotherapy. His vital signs are within normal limits. On examination, ptosis of both eyelids is seen. Dry oral mucosa is notable. Significant weakness is detected in all four proximal extremities. The patellar and biceps reflexes are absent. Auscultation of the lungs reveals generalized wheezing and rhonchi. Which of the following is the most likely underlying mechanism for this patient’s weakness?? {'A': 'Acute autoimmune demyelination of axons', 'B': 'Autoantibody-impaired acetylcholine release from nerve terminals', 'C': 'Endomysial CD8+ T cell infiltration with vacuoles and inclusion bodies', 'D': 'Necrotizing vasculitis with granuloma formation', 'E': 'Reduced number of available postsynaptic acetylcholine receptors'},
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B: Autoantibody-impaired acetylcholine release from nerve terminals
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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 is brought to the emergency department for increasing colicky lower abdominal pain and distention for 4 days. He has nausea. He has not passed flatus for the past 2 days. His last bowel movement was 4 days ago. He has hypertension, type 2 diabetes mellitus, and left hemiplegia due to a cerebral infarction that occurred 2 years ago. His current medications include aspirin, atorvastatin, hydrochlorothiazide, enalapril, and insulin. His temperature is 37.3°C (99.1°F), pulse is 90/min, and blood pressure is 126/84 mm Hg. Examination shows a distended and tympanitic abdomen. There is mild tenderness to palpation over the lower abdomen. Bowel sounds are decreased. Digital rectal examination shows an empty rectum. Muscle strength is decreased in the left upper and lower extremities. Deep tendon reflexes are 3+ on the left and 2+ on the right. The remainder of the examination shows no abnormalities. Laboratory studies are within normal limits. An x-ray of the abdomen in left lateral decubitus position is shown. The patient is kept nil per os and a nasogastric tube is inserted. Intravenous fluids are administered. Which of the following is the most appropriate next step in the management of this patient?? {'A': 'Metoclopramide therapy', 'B': 'Endoscopic detorsion', 'C': 'Intravenous antibiotic therapy', 'D': 'Colonoscopy', 'E': 'Rectal tube insertion'},
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B: Endoscopic detorsion
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Answer the following medical question with one of the provided options:
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Q:A 27-year-old woman, gravida 2, para 1, at 38 weeks' gestation comes to the emergency department in active labor. She received all of her prenatal care for this pregnancy. Pregnancy and delivery of her first child were uncomplicated. The patient's blood type is Rh-negative. Four hours after arrival, a healthy 3650-g (8-lb) female newborn is delivered. Delivery of the fetus is followed by placental retention and heavy vaginal bleeding. One hour later, the placenta is manually removed and the bleeding ceases. The mother's temperature is 36.7°C (98.1°F), pulse is 90/min, and blood pressure is 110/60 mm Hg. Examination shows blood on the vulva, the introitus, and on the medial aspect of each thigh. The neonate's blood type is Rh-positive. A single dose of anti-D immune globulin is administered. Which of the following is the most appropriate next step in management?? {'A': 'Perform flow cytometry', 'B': 'Perform rosette test', 'C': 'Perform Kleihauer-Betke test', 'D': 'Administer additional dose of anti-D immune globulin', 'E': 'Perform Coombs test'},
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B: Perform rosette test
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Answer the following medical question with one of the provided options:
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Q:A 5-year-old boy is brought to the emergency department because of a generalized pruritic rash for 14 hours. Five days ago, he had pink eyes that resolved spontaneously. He has acute lymphoblastic leukemia. He has received 3 cycles of chemotherapy with vincristine, asparaginase, dexamethasone, and doxorubicin. His last treatment cycle was 2 weeks ago. The patient's other medications include multivitamin supplements. His temperature is 38°C (100.4°F), pulse 90/min, and blood pressure is 105/65 mm Hg. Examination of the skin shows multiple crops of macules and papules over the face, trunk, and extremities. There are also excoriation marks and crusted lesions. The remainder of the examination shows no abnormalities. Which of the following is the most appropriate next step in the treatment of this patient?? {'A': 'Vitamin A administration', 'B': 'Immunoglobulin administration', 'C': 'Symptomatic therapy', 'D': 'Acyclovir administration', 'E': 'Penicillin V administration'},
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D: Acyclovir administration
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Answer the following medical question with one of the provided options:
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Q:A 17-year-old adolescent male is brought to the emergency department by fire and rescue after being struck by a moving vehicle. The patient reports that he was running through his neighborhood when a car struck him while turning right on a red light. He denies any loss of consciousness. His temperature is 99.0°F (37.2°C), blood pressure is 88/56 mmHg, pulse is 121/min, respirations are 12/min, and SpO2 is 95% on room air. The patient is alert and oriented to person, place and time and is complaining of pain in his abdomen. He has lacerations on his face and extremities. On cardiac exam, he is tachycardic with normal S1 and S2. His lungs are clear to auscultation bilaterally, and his abdomen is soft but diffusely tender to palpation. The patient tenses his abdomen when an abdominal exam is performed. Bowel sounds are present, and he is moving all 4 extremities spontaneously. His skin is cool with delayed capillary refill. After the primary survey, 2 large-bore IVs are placed, and the patient is given a bolus of 2 liters of normal saline. Which of the following is the best next step in management?? {'A': 'Abdominal CT', 'B': 'Focused Abdominal Sonography for Trauma (FAST) exam', 'C': 'Diagnostic peritoneal lavage', 'D': 'Diagnostic laparoscopy', 'E': 'Emergency laparotomy'},
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B: Focused Abdominal Sonography for Trauma (FAST) exam
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Q:An investigator is examining tissue samples from various muscle tissue throughout the body. She notices that biopsies collected from a specific site have a high concentration of sarcoplasmic reticulum, mitochondria, and myoglobin; they also stain poorly for ATPase. Additionally, the cell surface membranes of the myocytes in the specimen lack voltage-gated calcium channels. These myocytes are found in the greatest concentration at which of the following sites?? {'A': 'Ventricular myocardium', 'B': 'Semispinalis muscle', 'C': 'Glandular myoepithelium', 'D': 'Tunica media', 'E': 'Lateral rectus muscle'},
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B: Semispinalis muscle
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Q:A 36-year-old woman comes to the physician for a 2-month history of urinary incontinence and a vaginal mass. She has a history of five full-term normal vaginal deliveries. She gave birth to a healthy newborn 2-months ago. Since then she has felt a sensation of vaginal fullness and a firm mass in the lower vagina. She has loss of urine when she coughs, sneezes, or exercises. Pelvic examination shows an irreducible pink globular mass protruding out of the vagina. A loss of integrity of which of the following ligaments is most likely involved in this patient's condition?? {'A': 'Infundibulopelvic ligament', 'B': 'Uterosacral ligament', 'C': 'Cardinal ligament of the uterus', 'D': 'Broad ligament of the uterus', 'E': 'Round ligament of uterus'},
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B: Uterosacral ligament
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Q:A 23-year-old woman presents to the emergency department with an acute exacerbation of her 3-month history of low back and right leg pain. She says she has had similar symptoms in the past, but this time the pain was so excruciating, it took her breath away. She describes the pain as severe, shock-like, and localized to her lower back and radiating straight down the back of her right thigh and to her calf, stopping at the ankle. Her pain is worse in the morning, and, sometimes, the pain wakes her up at night with severe buttock and posterior thigh pain but walking actually makes the pain subside somewhat. The patient reports no smoking history or alcohol or drug use. She has been working casually as a waitress and does find bending over tables a strain. She is afebrile, and her vital signs are within normal limits. On physical examination, her left straight leg raise test is severely limited and reproduces her buttock pain at 20° of hip flexion. Pain is worsened by the addition of ankle dorsiflexion. The sensation is intact. Her L4 and L5 reflexes are normal, but her S1 reflex is absent on the right side. A CT of the lumbar spine shows an L5–S1 disc protrusion with right S1 nerve root compression. Which of the following muscle-nerve complexes is involved in producing an S1 reflex?? {'A': 'Tibialis posterior-tibial nerve', 'B': 'Quadriceps femoris-femoral nerve', 'C': 'Sartorius-femoral nerve', 'D': 'Adductors-obturator nerve', 'E': 'Gastrocnemius/soleus-tibial nerve'},
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E: Gastrocnemius/soleus-tibial nerve
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Q:A 36-year-old man comes to the physician because of a 2-week history of productive cough, weight loss, and intermittent fever. He recently returned from a 6-month medical deployment to Indonesia. He appears tired. Physical examination shows nontender, enlarged, palpable cervical lymph nodes. An x-ray of the chest shows right-sided hilar lymphadenopathy. A sputum smear shows acid-fast bacilli. A diagnosis of pulmonary tuberculosis is made from PCR testing of the sputum. The patient requests that the physician does not inform anyone of this diagnosis because he is worried about losing his job. Which of the following is the most appropriate initial action by the physician?? {'A': 'Inform the local public health department of the diagnosis', 'B': "Request the patient's permission to discuss the diagnosis with an infectious disease specialist", 'C': 'Assure the patient that his diagnosis will remain confidential', 'D': 'Confirm the diagnosis with a sputum culture', 'E': "Notify all of the patient's household contacts of the diagnosis"},
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A: Inform the local public health department of the diagnosis
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Q:A 32-year-old African American woman presents to her family physician complaining of fevers, fatigue, weight loss, joint pains, night sweats and a rash on her face that extends over the bridge of her nose. She has also had multiple sores in her mouth over the past few weeks. She recently had a root canal procedure done without complications. She has no significant past medical history, but has recently had a urinary tract infection. She denies tobacco, alcohol, and illicit drug use. Laboratory evaluation reveals hemolytic anemia. If she were found to have a cardiac lesion, what would be the most likely pathogenetic cause?? {'A': 'Bacteremia secondary to a recent dental procedure', 'B': 'Abberent flow causing platelet-fibrin thrombus formation secondary to hypercoagulability and malignancy.', 'C': 'Bacteremia secondary to a urinary tract infection', 'D': 'Immune complex deposition and subsequent inflammation', 'E': 'Left atrial mass causing a ball valve-type outflow obstruction'},
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D: Immune complex deposition and subsequent inflammation
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Q:A 38-year-old woman comes to the physician for a follow-up examination. Two years ago, she was diagnosed with multiple sclerosis. Three weeks ago, she was admitted and treated for right lower leg weakness with high-dose methylprednisone for 5 days. She has had 4 exacerbations over the past 6 months. Current medications include interferon beta and a multivitamin. Her temperature is 37°C (98.6°F), pulse is 90/min, and blood pressure is 116/74 mm Hg. Examination shows pallor of the right optic disk. Neurologic examination shows no focal findings. She is anxious about the number of exacerbations and repeated hospitalizations. She is counseled about the second-line treatment options available to her. She consents to treatment with natalizumab. However, she has read online about its adverse effects and is concerned. This patient is at increased risk for which of the following complications?? {'A': 'Syndrome of inappropriate antidiuretic hormone', 'B': 'Progressive multifocal leukoencephalopathy', 'C': 'Parkinsonism', 'D': 'Tuberculosis', 'E': 'Aplastic anemia'},
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B: Progressive multifocal leukoencephalopathy
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Q:A 2-day-old male newborn is brought to the emergency department by his mother because of irritability and vomiting for two hours. During this period, he has vomited bilious fluid three times. He has not yet passed stool. The mother has breastfed the newborn every two hours. He has wet two diapers during the last two days. He was born at term and was delivered at home. Pregnancy and delivery were uncomplicated. The mother had no prenatal care during pregnancy. The patient currently weighs 3100 g (6 lb 13 oz) and is 50 cm (19.6 in) in length. The newborn appears restless. His temperature is 37.3°C (99.14°F), pulse is 166/min, respirations are 60/min, and blood pressure is 60/45 mm Hg. There is no redness or warmth around the umbilical cord stump. Cardiopulmonary examination shows no abnormalities. Bowel sounds are sparse. The abdomen is distended. Digital rectal examination shows no abnormalities. An x-ray of the abdomen with contrast shows dilated small bowel loops, a microcolon, a mixture of gas and meconium located in the right lower quadrant. A nasogastric tube is placed and fluid resuscitation is begun. Which of the following is the most appropriate next step in the management of this patient?? {'A': 'Reassurance and follow-up in 2 weeks', 'B': 'Gastrografin enema', 'C': 'Exploratory laparotomy', 'D': 'Rectal suction biopsy', 'E': 'Colonoscopy'},
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B: Gastrografin enema
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Q:A 40-year-old woman comes to the physician for the evaluation of fatigue, poor appetite, and an unintentional 10-kg (22-lb) weight loss over the past 6 months. The patient also reports several episodes of nausea and two episodes of non-bloody vomiting. There is no personal or family history of serious illness. Menses occur at regular 27-day intervals and last 6 days. Her last menstrual period was 3 weeks ago. She is sexually active with her husband, but states that she has lost desire in sexual intercourse lately. Her temperature is 37°C (98.6°F), pulse is 100/min, and blood pressure is 96/70 mm Hg. Physical examination shows no abnormalities. Laboratory studies show: Hemoglobin 13.5 g/dL Leukocyte count 7,000/mm3 Serum Na+ 128 mEq/L Cl- 96 mEq/L K+ 5.8 mEq/L HCO3- 23 mEq/L Glucose 70 mg/dL AM Cortisol 2 μg/dL Which of the following is the most appropriate next step in management?"? {'A': 'TSH measurement', 'B': 'Urine aldosterone level measurement', 'C': 'Hydrocortisone administration', 'D': 'Adrenal imaging', 'E': 'Cosyntropin administration\n"'},
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E: Cosyntropin administration "
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Q:A 22-year-old Caucasian male is stabbed in his left flank, injuring his left kidney. As the surgeon undertakes operative repair, she reviews relevant renal anatomy. All of the following are correct regarding the left kidney EXCEPT?? {'A': 'The left kidney has a longer renal vein than the right kidney', 'B': 'The left kidney has a longer renal artery than the right kidney', 'C': 'The left kidney lies between T12 and L3', 'D': 'The left kidney underlies the left 12th rib', 'E': 'The left kidney moves vertically during deep breathing'},
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B: The left kidney has a longer renal artery than the right kidney
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Q:An 82-year-old male with a history of congestive heart failure presented with new-onset atrial fibrillation. He was initially started on carvedilol, but he now requires an additional agent for rate control. He is started on a medicine and is warned by his physician of the following potential side effects associated with this therapy: nausea, vomiting, confusion, blurry yellow vision, electrolyte abnormalities, and potentially fatal arrhythmia. Which of the following is most likely to increase this patient's susceptibility to the toxic effects associated with this medication?? {'A': 'Hyponatremia', 'B': 'Elevated AST and ALT', 'C': 'Hypokalemia', 'D': 'Increased GFR with normal creatinine', 'E': 'Hyperkalemia'},
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C: Hypokalemia
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Q:A 25-year-old woman with a psychiatric history of bipolar disorder is brought into the emergency department by emergency medical services. The patient is unconscious, but the mother states that she walked into the patient's room with the patient lying on the floor and an empty bottle of unknown pills next to her. The patient has previously tried to commit suicide 2 years ago. Upon presentation, the patient's vitals are HR 110, BP 105/60, T 99.5, RR 22. The patient soon has 5 episodes non-bilious non-bloody vomiting. Upon physical exam, she has pain in the right upper quadrant and her liver function tests are AST 1050 U/L, ALT 2050 U/L, ALP 55 U/L, Total Bilirubin 0.8 mg/dL, Direct Bilirubin 0.2 mg/dL. You are awaiting her toxicology screen. What is the most likely diagnosis?? {'A': 'Beta-blocker ingestion', 'B': 'Acetaminophen ingestion', 'C': 'Tricyclic antidepressant ingestion', 'D': 'Opiate ingestion', 'E': 'Salicylate ingestion'},
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B: Acetaminophen ingestion
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Q:A 25-year-old woman presents into the clinic complaining of worsening malaise, hair loss, and a rash on her face. The patient states that she has been avoiding daylight because the rash becomes painful, and she has not been able to go to classes because of debilitating arthralgia in her fingers and ankles. No significant past medical history. She takes no medication. At the time of the consult, the patient has a fever of 39.0°C (102.2 °F). The presence of which of the following is most commonly seen on diagnostic labs in this patient’s most likely condition?? {'A': 'Anti-smith antibody', 'B': 'Anti-dsDNA', 'C': 'Anti-histone antibody', 'D': 'Anti-Ro antibody', 'E': 'Antinuclear antibody'},
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E: Antinuclear antibody
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Q:A 45-year-old woman presents to your office with a serum glucose of 250 mg/dL and you diagnose diabetes mellitus type II. You intend to prescribe the patient metformin, but you decide to order laboratory tests before proceeding. Which of the following basic metabolic panel values would serve as a contraindication to the use of metformin?? {'A': 'K+ > 4.0', 'B': 'Na+ > 140', 'C': 'HCO3- > 30', 'D': 'Glucose > 300', 'E': 'Creatinine > 2.0'},
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E: Creatinine > 2.0
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Q:You are reading through a recent article that reports significant decreases in all-cause mortality for patients with malignant melanoma following treatment with a novel biological infusion. Which of the following choices refers to the probability that a study will find a statistically significant difference when one truly does exist?? {'A': 'Type I error', 'B': 'Type II error', 'C': 'Power', 'D': 'Confidence interval', 'E': 'p-value'},
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C: Power
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Q:A 17-year-old girl comes to the physician because of a 2-day history of pain in her right knee. Last week she had right wrist pain. She has no history of recent trauma. She returned from summer camp in Connecticut 2 weeks ago. She is sexually active with one male partner and uses an oral contraceptive. Her temperature is 38°C (100.4°F). Examination shows several painless vesiculopustular lesions on the back and one lesion on the right sole of the foot. There is swelling of the right knee with tenderness to palpation. Passive extension of the right wrist and fingers elicits pain. Which of the following is the most likely diagnosis?? {'A': 'Reactive arthritis', 'B': 'Staphylococcus aureus arthritis', 'C': 'Systemic lupus erythematosus', 'D': 'Disseminated gonococcal infection', 'E': 'Acute rheumatic fever'},
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D: Disseminated gonococcal infection
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Q:A 25-year-old man comes to the physician because of an 8-hour history of painful leg cramping, runny nose, chills, diarrhea, and abdominal pain. Examination shows cool, damp skin with piloerection. The pupils are 7 mm in diameter and equal in size. Deep tendon reflexes are 3+ bilaterally. The diagnosis of opioid withdrawal is made. After the patient is stabilized, the physician initiates a withdrawal regimen with methadone. Which of the following characteristics makes this drug a suitable substance for the treatment of this patient's addiction?? {'A': 'Low dependence risk', 'B': 'Rapid onset of action', 'C': 'Limited potency', 'D': 'Long elimination half-life', 'E': 'Low tolerance potential'},
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D: Long elimination half-life
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Answer the following medical question with one of the provided options:
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Q:A 55-year-old man presents with intense pain in his left knee that started after returning from a camping trip 2 days ago, during which he consumed copious amounts of alcohol and red meat. He says he has had similar episodes in the past that resolved spontaneously usually over a period of about 10 days. His past medical history is significant for essential hypertension managed with hydrochlorothiazide 20 mg/day. The patient is afebrile, and his vital signs are within normal limits. Physical examination shows edema, warmth, and erythema of the left knee, which is also severely tender to palpation; The range of motion at the left knee joint is limited. A joint arthrocentesis of the left knee is performed, and synovial fluid analysis reveals 20,000 neutrophils and the following image is seen under polarized light microscopy (see image). Which of the following is the best course of treatment for this patient’s condition?? {'A': 'Colchicine', 'B': 'Nonsteroidal antiinflammatory drugs', 'C': 'Uricosuric drug', 'D': 'Intra-articular steroid injection', 'E': 'Xanthine oxidase inhibitor'},
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B: Nonsteroidal antiinflammatory drugs
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Q:A 9-month-old male infant is brought to his pediatrician by his mother with lethargy and decreased oral intake for one day. His mother also mentions that he did not sleep well the previous night. A review of the medical record reveals several missed appointments and that the boy was born at 36 weeks gestation via spontaneous vaginal delivery. At the clinic, his temperature is 37.2ºC (99.0ºF), pulse rate is 140/minute, respirations are 44/minute, and blood pressure is 92/60 mm Hg. On physical exam the infant is awake but irritable and the rest of the physical is within normal limits for his age. On ophthalmologic examination, there are multiple retinal hemorrhages that extend to the periphery in both eyes. Which of the following investigations is most likely to be helpful in the management of the infant?? {'A': 'Hemoglobin electrophoresis', 'B': 'Peripheral blood smear', 'C': 'Noncontrast computed tomography of head', 'D': 'Lumbar puncture', 'E': 'Bone marrow aspiration'},
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C: Noncontrast computed tomography of head
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Answer the following medical question with one of the provided options:
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Q:A 21-year-old girl with a history of bipolar disorder, now in a depressive episode, presents to the emergency in distress. She reports that she wanted to "end it all" and swallowed a full bottle of acetaminophen. However, regretting what it would do to her parents, and she decided that she wants to live. She appears in no acute distress and clearly states she swallowed the pills one hour ago. What is the most appropriate next step in management?? {'A': 'Give activated charcoal and draw a serum acetaminophen level now', 'B': 'Give activated charcoal and draw a serum acetaminophen level in three hours', 'C': 'Give activated charcoal and test the urine for an acetaminophen level', 'D': 'Draw a serum acetaminophen level now', 'E': 'Give activated charcoal and draw a serum acetaminophen in two hours'},
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B: Give activated charcoal and draw a serum acetaminophen level in three hours
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Q:A 7-year-old boy presents to an urgent care clinic from his friend’s birthday party after experiencing trouble breathing. His father explains that the patient had eaten peanut butter at the party, and soon after, he developed facial flushing and began scratching his face and neck. This has never happened before but his father says that they have avoided peanuts and peanut butter in the past because they were worried about their son having an allergic reaction. The patient has no significant medical history and takes no medications. His blood pressure is 94/62 mm Hg, heart rate is 125/min, and respiratory rate is 22/min. On physical examination, his lips are edematous and he has severe audible stridor. Of the following, which type of hypersensitivity reaction is this patient experiencing?? {'A': 'Type I hypersensitivity reaction', 'B': 'Type II hypersensitivity reaction', 'C': 'Type III hypersensitivity reaction', 'D': 'Type IV hypersensitivity reaction', 'E': 'Combined type I and type III hypersensitivity reactions'},
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A: Type I hypersensitivity reaction
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Q:You conduct a medical research study to determine the screening efficacy of a novel serum marker for colon cancer. The study is divided into 2 subsets. In the first, there are 500 patients with colon cancer, of which 450 are found positive for the novel serum marker. In the second arm, there are 500 patients who do not have colon cancer, and only 10 are found positive for the novel serum marker. What is the overall sensitivity of this novel test?? {'A': '450 / (450 + 50)', 'B': '490 / (10 + 490)', 'C': '490 / (50 + 490)', 'D': '450 / (450 + 10)', 'E': '490 / (450 + 490)'},
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A: 450 / (450 + 50)
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Answer the following medical question with one of the provided options:
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Q:A 43-year-old man comes to the physician because of weight loss and swelling on the left side of his neck. Physical examination shows a firm, enlarged left upper cervical lymph node that is immobile. Immunohistochemical testing performed on a biopsy specimen from the lymph node stains positive for cytokeratin. Which of the following is the most likely site of the primary neoplasm in this patient?? {'A': 'Skin', 'B': 'Brain', 'C': 'Nerve sheath', 'D': 'Bone', 'E': 'Muscle'},
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A: Skin
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Q:A 32-year-old woman presents to the clinic with the complaint of excessive fatigue for the past few weeks. After returning home from the office, she feels too tired to climb up the stairs, comb her hair, or chew her food. She has occasionally experienced double vision. She denies any history of fever, cough, weight loss, night sweats, or snoring. Past history is unremarkable. Physical examination reveals: blood pressure 124/86 mm Hg, heart rate 85/min, respiratory rate 14/min, temperature 37.0°C (98.6°F), and body mass index (BMI) 22.6 kg/m2. On examination, the right upper eyelid is slightly drooping when compared to the left side. Her eye movements are normal. Flexion of the neck is mildly weak. Muscle strength is 5/5 in all 4 limbs. When she is asked to alternately flex and extend her shoulder continuously for 5 minutes, the power in the proximal upper limb muscles becomes 4/5. The muscle tone and deep tendon reflexes are normal. What is the most appropriate test to diagnose this condition?? {'A': 'CT scan chest', 'B': 'Plasmapheresis', 'C': 'Presynaptic calcium channel antibodies', 'D': 'Single-fiber electromyography', 'E': 'Tensilon test'},
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D: Single-fiber electromyography
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Answer the following medical question with one of the provided options:
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Q:A 30-month-old toddler presents with his mother to the pediatrician for a scheduled follow-up. She is concerned that his appetite has been poor since the death of his father, approximately one year ago. She denies any history of vomiting, refusal of food, diarrhea, constipation, recurrent cough and colds, recurrent wheezing, fast breathing, recurrent fever, or recurrent infections. The boy was born at full term by vaginal delivery with an uneventful neonatal period and infancy. His vaccines are up to date. On physical examination, his vital signs are stable. His complete physical examination does not suggest a specific medical disorder or congenital abnormality. His detailed diagnostic evaluation, including complete blood counts, serum protein, liver function tests, and urinalysis are normal. The pediatrician reviews the patient’s growth chart. At the age of 18 months he was at the 90th percentile for weight and 75th for height. After plotting his current growth parameters on the growth charts, the pediatrician suspects failure to thrive with psychosocial etiology. Based on which of the following findings on the growth charts did the pediatrician suspect the condition?? {'A': 'Present gender-specific weight for age between 90 and 75 percentile markers', 'B': 'Present gender-specific weight for age between 75 and 50 percentile markers', 'C': 'Present gender-specific height for age between 90 and 75 percentile markers', 'D': 'Present gender-specific height for age between 75 and 50 percentile markers', 'E': 'Present gender-specific weight for height between 90 and 95 percentile markers'},
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B: Present gender-specific weight for age between 75 and 50 percentile markers
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Answer the following medical question with one of the provided options:
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Q:A 28-year-old woman presents to her primary care physician complaining of intense thirst and frequent urination for the past 2 weeks. She says that she constantly feels the urge to drink water and is also going to the bathroom to urinate frequently throughout the day and multiple times at night. She was most recently hospitalized 1 month prior to presentation following a motor vehicle accident in which she suffered severe impact to her head. The physician obtains laboratory tests, with the results shown below: Serum: Na+: 149 mEq/L Cl-: 103 mEq/L K+: 3.5 mEq/L HCO3-: 24 mEq/L BUN: 20 mg/dL Glucose: 105 mg/dL Urine Osm: 250 mOsm/kg The patient’s condition is most likely caused by inadequate hormone secretion from which of the following locations?? {'A': 'Adrenal cortex', 'B': 'Anterior pituitary', 'C': 'Posterior pituitary', 'D': 'Preoptic nucleus of the hypothalamus', 'E': 'Suprachiasmatic nucleus of the hypothalamus'},
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C: Posterior pituitary
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Answer the following medical question with one of the provided options:
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Q:A 28-year-old man presents with one week of redness and discharge in his eyes, pain and swelling in his left second and third toes, and rash on the soles of his feet. He is sexually active with multiple partners and uses condoms occasionally. He denies any recent travel or illness and does not take any medications. Review of systems is otherwise unremarkable. On physical exam, he has bilateral conjunctivitis, dactylitis of the left second and third toes, and crusty yellow-brown vesicles on his plantar feet. Complete blood count and chemistries are within normal limits. Erythrocyte sedimentation rate (ESR) is 40 mm/h. Toe radiographs demonstrate soft tissue swelling but no fractures. Which diagnostic test should be performed next?? {'A': 'Rheumatoid factor', 'B': 'Anti-cyclic citrullinated peptide antibody assay', 'C': 'Antinuclear antibody assay', 'D': 'HLA-B27', 'E': 'Nucleic acid amplification testing for Chlamydia trachomatis'},
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E: Nucleic acid amplification testing for Chlamydia trachomatis
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Answer the following medical question with one of the provided options:
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Q:An 18-year old college freshman presents to his university clinic because he has not been feeling well for the past two weeks. He has had a persistent headache, occasional cough, and chills without rigors. The patient’s vital signs are normal and physical exam is unremarkable. His radiograph shows patchy interstitial lung infiltrates and he is diagnosed with atypical pneumonia. The patient is prescribed azithromycin and takes his medication as instructed. Despite adherence to his drug regimen, he returns to the clinic one week later because his symptoms have not improved. The organism responsible for this infection is likely resistant to azithromycin through which mechanism?? {'A': 'Presence of a beta-lactamase', 'B': 'Insertion of drug efflux pumps', 'C': 'Decreased binding to RNA polymerase', 'D': 'Mutation in topoisomerase II', 'E': 'Methylation of ribosomal binding site'},
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E: Methylation of ribosomal binding site
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Answer the following medical question with one of the provided options:
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Q:A group of researchers is studying various inhaled substances to determine their anesthetic properties. In particular, they are trying to identify an anesthetic with fast onset and quick recovery for use in emergencies. They determine the following data: Inhalational anesthetic Blood-gas partition coefficient A 0.15 B 0.92 C 5.42 Which of the following statements is accurate with regard to these inhaled anesthetic substances?? {'A': 'Agent A is the most potent', 'B': 'Agent A has the fastest onset of action', 'C': 'Agent B is the most potent', 'D': 'Agent B has the fastest onset of action', 'E': 'Agent C has the fastest onset of action'},
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B: Agent A has the fastest onset of action
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Answer the following medical question with one of the provided options:
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Q:A 14-year-old boy presents to the office for a checkup. He is well-nourished and meets all developmental milestones. He denies any complaints, and you offer him counseling on adolescent issues. On examination, he appears to be a normal, healthy teenager. The only significant finding is the bilateral swelling of the tibial tuberosities. When asked about them, the patient denies trauma and states they are sore, especially when he runs or squats. Which of the following is the underlying cause of this finding?? {'A': 'Osteopetrosis', 'B': 'Osteitis fibrosa cystica', 'C': 'Paget disease', 'D': 'Ewing sarcoma', 'E': 'Osgood-Schlatter disease'},
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E: Osgood-Schlatter disease
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Answer the following medical question with one of the provided options:
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Q:A 23-year-old female presents to the emergency department with monocular blindness. She states that early this morning she lost her vision seemingly "out of nowhere." She denies trauma or any precipitating factors. She does state though that over the past year she has had occasional episodes of weakness and even an episode of urinary incontinence, which always resolve on their own. On exam, pain is elicited with eye movement and nystagmus is appreciated. The emergency physician performs a lumbar puncture. What is most likely to be observed in the CSF of this patient?? {'A': 'Increased opening pressure', 'B': 'Oligoclonal bands', 'C': 'Albuminocytologic dissociation', 'D': 'Increased lymphocyte count', 'E': 'Normal findings'},
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B: Oligoclonal bands
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Answer the following medical question with one of the provided options:
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Q:ََA 22-month-old girl is brought to the emergency department with a 24-hour history of fever, irritability, and poor feeding. The patient never experienced such an episode in the past. She met the normal developmental milestones, and her vaccination history is up-to-date. She takes no medications, currently. Her temperature is 38.9°C (102.0°F). An abdominal examination reveals general tenderness without organomegaly. The remainder of the physical examination shows no abnormalities. Laboratory studies show the following results: Urine Blood 1+ WBC 10–15/hpf Bacteria Many Nitrite Positive Urine culture from a midstream collection reveals 100,000 CFU/mL of Escherichia coli. Which of the following interventions is the most appropriate next step in evaluation?? {'A': 'Dimercaptosuccinic acid renal scan', 'B': 'Intravenous pyelography', 'C': 'Renal and bladder ultrasonography', 'D': 'Voiding cystourethrography', 'E': 'No further testing'},
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C: Renal and bladder ultrasonography
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Answer the following medical question with one of the provided options:
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Q:A 34-year-old woman presents to her primary care physician for a routine check-up. She complains that she is not feeling her normal self, but has no specific complaints. After a routine examination, the physician orders a full thyroid workup, including TSH, T3, and free T4. He also refers her directly to an oncologist for an initial consultation. Which type of lymphadenopathy was most likely present during the physical examination that made the primary care physician react this way?? {'A': 'Generalized painful lymphadenopathy', 'B': 'Generalized painless lymphadenopathy', 'C': 'Reactive lymphadenitis', 'D': 'Localized painful lymphadenopathy', 'E': 'Localized painless lymphadenopathy'},
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E: Localized painless lymphadenopathy
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Answer the following medical question with one of the provided options:
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Q:A 52-year-old man presents to his primary care physician to discuss laboratory results that were obtained during his annual checkup. He has no symptoms or concerns and denies changes in eating or urination patterns. Specifically, the physician ordered a panel of metabolic laboratory tests to look for signs of diabetes, hyperlipidemia, or other chronic disorders. A spot glucose check from a random blood sample showed a glucose level of 211 mg/dL. A hemoglobin A1c level was obtained at the same time that showed a level of 6.3%. A fasting blood glucose was obtained that showed a blood glucose level of 125 mg/dL. Finally, a 2-hour glucose level was obtained after an oral glucose tolerance test that showed a glucose level of 201 mg/dL. Which of the following statements is most accurate for this patient?? {'A': 'This patient does not have type 2 diabetes', 'B': 'This patient has type 2 diabetes as diagnosed by his fasting blood glucose', 'C': 'This patient has type 2 diabetes as diagnosed by his hemoglobin A1c', 'D': 'This patient has type 2 diabetes as diagnosed by his oral tolerance blood glucose', 'E': 'This patient has type 2 diabetes as diagnosed by his random blood glucose'},
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D: This patient has type 2 diabetes as diagnosed by his oral tolerance blood glucose
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Q:A 35-year-old man is brought to the emergency department from a kitchen fire. The patient was cooking when boiling oil splashed on his exposed skin. His temperature is 99.7°F (37.6°C), blood pressure is 127/82 mmHg, pulse is 120/min, respirations are 12/min, and oxygen saturation is 98% on room air. He has dry, nontender, and circumferential burns over his arms bilaterally, burns over the anterior portion of his chest and abdomen, and tender spot burns with blisters on his shins. A 1L bolus of normal saline is administered and the patient is given morphine and his pulse is subsequently 80/min. A Foley catheter is placed which drains 10 mL of urine. What is the best next step in management?? {'A': 'Additional fluids and admission to the ICU', 'B': 'Additional fluids and escharotomy', 'C': 'Continuous observation', 'D': 'Escharotomy', 'E': 'Moist dressings and discharge'},
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B: Additional fluids and escharotomy
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Q:An 8-year-old girl is brought to the physician by her parents for the evaluation of an episode of unconsciousness while at the playground that morning. She was unconscious for about 15 seconds and did not shake, bite her tongue, or lose bowel or bladder control. Her grandfather died suddenly at the age of 29 of an unknown heart condition; her parents are both healthy. An ECG shows sinus rhythm and a QT interval corrected for heart rate (QTc) of 470 milliseconds. Laboratory studies are within normal limits. Which of the following is the most likely additional finding in this patient?? {'A': 'Oblique palpebral fissures', 'B': 'Sensorineural hearing loss', 'C': 'Skin folds between the mastoid process and acromion', 'D': 'Brachial-femoral pulse delay', 'E': 'Subvalvular ventricular outflow obstruction murmur'},
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B: Sensorineural hearing loss
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Q:A 42-year-old woman presents to the emergency department with abdominal pain. Her pain started last night during dinner and has persisted. This morning, the patient felt very ill and her husband called emergency medical services. The patient has a past medical history of obesity, diabetes, and depression. Her temperature is 104°F (40°C), blood pressure is 90/65 mmHg, pulse is 160/min, respirations are 14/min, and oxygen saturation is 98% on room air. Physical exam is notable for a very ill appearing woman. Her skin is mildly yellow, and she is in an antalgic position on the stretcher. Laboratory values are ordered as seen below. Hemoglobin: 13 g/dL Hematocrit: 38% Leukocyte count: 14,500 cells/mm^3 with normal differential Platelet count: 257,000/mm^3 Alkaline phosphatase: 227 U/L Bilirubin, total: 11.3 mg/dL Bilirubin, direct: 9.8 mg/dL AST: 42 U/L ALT: 31 U/L The patient is started on antibiotics and IV fluids. Which of the following is the best next step in management?? {'A': 'Emergency cholecystectomy', 'B': 'Endoscopic retrograde cholangiopancreatography', 'C': 'FAST exam', 'D': 'Nasogastric tube and NPO', 'E': 'Supportive therapy followed by elective cholecystectomy'},
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B: Endoscopic retrograde cholangiopancreatography
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Q:A 45-year-old female is undergoing renal transplantation for management of chronic renal failure secondary to glomerulonephritis. The transplant surgeon placed the donor kidney in the recipient and anastamosed the donor renal artery to the recipient's external iliac artery as well as the donor ureter to the recipient's bladder. After removing the clamps on the external iliac artery, the recipient's blood is allowed to perfuse the transplanted kidney. Within 3 minutes, the surgeon notes that the kidney does not appear to be sufficiently perfused. Upon further investigation, an inflammatory reaction is noted that led to clotting off of the donor renal artery, preventing blood flow to the transplanted organ. Which of the following best describes the pathophysiology of this complication?? {'A': 'Type I hypersensitivity reaction', 'B': 'Type II hypersensitivity reaction', 'C': 'Type III hypersensitivity reaction', 'D': 'Type IV hypersensitivity reaction', 'E': 'Graft-versus-host disease'},
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B: Type II hypersensitivity reaction
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Q:A 68-year-old man is brought to the emergency department 30 minutes after the onset of uncontrollable jerking movements of his arms and legs followed by loss of consciousness. His wife says that he seemed confused this morning and had a headache. Immediately before the shaking episode, he said that he smelled rotten eggs. He is unresponsive. Cerebrospinal fluid (CSF) analysis shows a leukocyte count of 700/μL (70% lymphocytes), a glucose concentration of 60 mg/dL, and a protein concentration of 80 mg/dL. Despite appropriate lifesaving measures, the man dies. Which of the following is most likely to be found on postmortem examination of this patient?? {'A': 'Hemorrhage into the adrenal glands', 'B': 'Necrosis of the temporal lobes', 'C': 'Atrophy of the mammillary bodies', 'D': 'Spore-forming, obligate anaerobic rods', 'E': 'Cytoplasmic inclusions in cerebellar Purkinje cells'},
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B: Necrosis of the temporal lobes
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Q:A 54-year-old man presents to the emergency department complaining of shortness of breath and fatigue for 1 day. He reports feeling increasingly tired. The medical records show a long history of intravenous drug abuse, and a past hospitalization for infective endocarditis 2 years ago. The echocardiography performed at that time showed vegetations on the tricuspid valve. The patient has not regularly attended his follow-up appointments. The visual inspection of the neck shows distension of the neck veins. What finding would you expect to see on this patient’s jugular venous pulse tracing?? {'A': 'Absent a waves', 'B': 'Prominent y descent', 'C': 'Obliterated x descent', 'D': 'Decreased c waves', 'E': 'Large a waves'},
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C: Obliterated x descent
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Q:A 68-year-old man is brought to the emergency department by his wife because of a 2-week history of progressive disorientation and a 1-day history of left-sided weakness and difficulty speaking. The wife reports that the patient had a minor fall 4 months ago, during which he may have hit his head. He has hypertension and hyperlipidemia. He drinks 3–4 bottles of beer daily. He is only oriented to person. Neurological examination shows moderate spastic weakness, decreased sensation, and increased deep tendon reflexes in the left upper and lower extremities. A CT scan of the head is shown. Which of the following is the most likely cause of this patient's condition?? {'A': 'Damage to lenticulostriate arteries', 'B': 'Injury to middle meningeal artery', 'C': 'Embolus to middle cerebral artery', 'D': 'Tearing of bridging veins', 'E': 'Bleeding from intraventricular vascular malformation'},
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D: Tearing of bridging veins
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Q:A 5-year-old boy with Down syndrome presents with his mother. The patient’s mother says that he isn’t playing or eating as much as he used to and seems lethargic. Expected developmental delays are present and stable. Physical examination reveals dry mucous membranes and abdominal distention with no tenderness to palpation. An abdominal radiograph is shown in the image below. Which of the following is the most likely diagnosis in this patient?? {'A': 'Pyloric stenosis', 'B': 'Ulcerative colitis', 'C': 'Anal atresia', 'D': 'Incarcerated hernia', 'E': "Hirschsprung's disease"},
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E: Hirschsprung's disease
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Q:A 27-year-old man with an unknown past medical history is brought to the emergency department acutely intoxicated. The patient was found passed out in a park covered in vomit and urine. His temperature is 99.0°F (37.2°C), blood pressure is 107/68 mm Hg, pulse is 120/min, respiratory rate is 13/min, and oxygen saturation is 95% on room air. Physical exam is notable for wheezing in all lung fields without any crackles. The patient is started on 2L/min nasal cannula oxygen and IV fluids. His laboratory values are notable for an AST of 200 U/L and an ALT of 100 U/L. An initial chest radiograph is unremarkable. Which of the following is the most likely explanation for this patient's pulmonary symptoms?? {'A': 'Aspiration event', 'B': 'Bacterial infection', 'C': 'Clot in pulmonary vasculature', 'D': 'Elastic tissue destruction', 'E': 'Environmental antigen'},
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E: Environmental antigen
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Q:A 24-year-old man presents to the emergency department for bloody stools. The patient states that he has had bloody diarrhea for the past 3 days without improvement. He recently returned from a camping trip where he drank stream water and admits to eating undercooked meats which included beef, chicken, pork, and salmon. The patient's father died at age 40 due to colon cancer, and his mother died of breast cancer at the age of 52. The patient lives alone and drinks socially. The patient has unprotected sex with multiple male partners. His temperature is 98.3°F (36.8°C), blood pressure is 107/58 mmHg, pulse is 127/min, respirations are 12/min, and oxygen saturation is 99% on room air. Laboratory values are ordered as seen below. Hemoglobin: 9.2 g/dL Hematocrit: 29% Leukocyte count: 9,500/mm^3 with normal differential Platelet count: 87,000/mm^3 Lactate dehydrogenase: 327 IU/L Haptoglobin: 5 mg/dL Serum: Na+: 139 mEq/L Cl-: 100 mEq/L K+: 5.9 mEq/L HCO3-: 19 mEq/L BUN: 39 mg/dL Glucose: 99 mg/dL Creatinine: 1.1 mg/dL Ca2+: 10.2 mg/dL Which of the following is the most likely cause of this patient's presentation?? {'A': 'Campylobacter jejuni', 'B': 'Colon cancer', 'C': 'Entamoeba histolytica', 'D': 'Escherichia coli', 'E': 'Giardia lamblia'},
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D: Escherichia coli
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Q:A 53-year-old woman is brought to the emergency department because of an episode of lightheadedness and left arm weakness for the last hour. Her symptoms were preceded by tremors, palpitations, and diaphoresis. During the past 3 months, she has had increased appetite and has gained 6.8 kg (15 lbs). She has hypertension, hyperlipidemia, anxiety disorder, and gastroesophageal reflux. She works as a nurse in an ICU and has been under more stress than usual. She does not smoke. She drinks 5 glasses of wine every week. Current medications include enalapril, atorvastatin, fluoxetine, and omeprazole. She is 168 cm (5 ft 6 in) tall and weighs 100 kg (220 lb); BMI is 36 kg/m2. Her temperature is 37°C (98.8°F), pulse is 78/min, and blood pressure is 130/80 mm Hg. Cardiopulmonary examination shows no abnormalities. The abdomen is soft and nontender. Fasting serum studies show: Na+ 140 mEq/L K+ 3.5 mEq/L HCO3- 22 mEq/L Creatinine 0.8 mg/dL Glucose 37 mg/dL Insulin 280 μU/mL (N=11–240) Thyroid-stimulating hormone 2.8 μU/mL C-peptide 4.9 ng/mL (N=0.8–3.1) Urine screen for sulfonylurea is negative. Which of the following is the most likely diagnosis?"? {'A': 'Polycystic ovarian syndrome', 'B': 'Insulinoma', 'C': 'Exogenous hypoglycemia', 'D': 'Binge eating disorder', 'E': 'Cushing\'s syndrome\n"'},
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B: Insulinoma
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Q:A 56-year-old man presents to his primary care doctor to discuss his plans for diet and exercise. He currently has hypertension treated with thiazide diuretics but is otherwise healthy. On exam, his temperature is 98.8°F (37.1°C), blood pressure is 122/84 mmHg, pulse is 70/min, and respirations are 12/min. His weight is 95.2 kilograms and his BMI is 31.0 kg/m^2. The patient is recommended to follow a 2000 kilocalorie diet with a 30:55 caloric ratio of fat to carbohydrates. Based on this patient’s body mass index and weight, he is recommended to consume 75 grams of protein per day. Which of the following represents the approximate number of grams of carbohydrates the patient should consume per day?? {'A': '67', 'B': '122', 'C': '232', 'D': '275', 'E': '324'},
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D: 275
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Q:A 19-year-old man is rushed to the emergency department 30 minutes after diving head-first into a shallow pool of water from a cliff. He was placed on a spinal board and a rigid cervical collar was applied by the emergency medical technicians. On arrival, he is unconscious and withdraws all extremities to pain. His temperature is 36.7°C (98.1°F), pulse is 70/min, respirations are 8/min, and blood pressure is 102/70 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 96%. The pupils are equal and react sluggishly to light. There is a 3-cm (1.2-in) laceration over the forehead. The lungs are clear to auscultation. Cardiac examination shows no abnormalities. The abdomen is soft and nontender. There is a step-off palpated over the cervical spine. Which of the following is the most appropriate next step in management?? {'A': 'CT scan of the spine', 'B': 'X-ray of the cervical spine', 'C': 'Rapid sequence intubation', 'D': 'Rectal tone assessment', 'E': 'MRI of the spine\n"'},
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C: Rapid sequence intubation
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Q:A 72-year-old male with a past medical history significant for aortic stenosis and hypertension presents to the emergency department complaining of weakness for the past 3 weeks. He states that, apart from feeling weaker, he also has noted lightheadedness, pallor, and blood-streaked stools. The patient's vital signs are stable, and he is in no acute distress. Laboratory workup reveals that the patient is anemic. Fecal occult blood test is positive for bleeding. EGD was performed and did not reveal upper GI bleeding. Suspecting a lower GI bleed, a colonoscopy is performed after prepping the patient, and it is unremarkable. What would be an appropriate next step for localizing a lower GI bleed in this patient?? {'A': 'Nasogastric tube lavage', 'B': 'Technetium-99 labelled erythrocyte scintigraphy', 'C': 'Ultrasound of the abdomen', 'D': 'CT of the abdomen', 'E': 'Flexible sigmoidoscopy'},
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B: Technetium-99 labelled erythrocyte scintigraphy
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Q:A 46-day-old baby is admitted to the pediatric ward with an elevated temperature, erosive periumbilical lesion, clear discharge from the umbilicus, and failure to thrive. She is the first child of a consanguineous couple born vaginally at 38 weeks gestation in an uncomplicated pregnancy. She was discharged home from the nursery within the first week of life without signs of infection or jaundice. The umbilical cord separated at 1 month of age with an increase in temperature and periumbilical inflammation that her mother treated with an herbal decoction. The vital signs are blood pressure 70/45 mm Hg, heart rate 129/min, respiratory rate 26/min, and temperature, 38.9°C (102.0°F). The baby's weight is between the 10th and 5th percentiles and her length is between the 50th and 75th percentiles for her age. The physical examination shows an erosive lesion with perifocal erythema in the periumbilical region with drainage but no pus. The rest of the examination is within normal limits for the patient’s age. The complete blood count shows the following results: Erythrocytes 3.4 x 106/mm3 Hb 11 g/dL Total leukocyte count Neutrophils Lymphocyte Eosinophils Monocytes Basophils 49.200/mm3 61% 33% 2% 2% 2% Platelet count 229,000/mm3 The umbilical discharge culture shows the growth of Staphylococcus aureus. Flow cytometry is performed for suspected primary immunodeficiency. The patient is shown to be CD18-deficient. Which of the following statements best describes the patient’s condition?? {'A': 'The patient’s neutrophils fail to produce reactive oxygen species to destroy engulfed bacteria.', 'B': 'The patient’s leukocytes cannot interact with selectins expressed on the surface of endothelial cells.', 'C': 'The patient’s leukocytes fail to adhere to the endothelium during their migration to the site of infection.', 'D': 'There is excessive secretion of IL-2 in this patient.', 'E': 'The patient has impaired formation of membrane attack complex.'},
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C: The patient’s leukocytes fail to adhere to the endothelium during their migration to the site of infection.
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Q:An 8-year-old boy is brought to the physician because of a 7-day history of a progressively worsening cough. The cough occurs in spells and consists of around 5–10 coughs in succession. After each spell he takes a deep, noisy breath. He has vomited occasionally following a bout of coughing. He had a runny nose for a week before the cough started. His immunization records are unavailable. He lives in an apartment with his father, mother, and his 2-week-old sister. The mother was given a Tdap vaccination 11 years ago. The father's vaccination records are unavailable. His temperature is 37.8°C (100.0°F). Examination shows no abnormalities. His leukocyte count is 42,000/mm3. Throat swab culture and PCR results are pending. Which of the following are the most appropriate recommendations for this family?? {'A': 'Administer oral azithromycin to the baby and father and Tdap vaccination to the father', 'B': 'Administer oral azithromycin to all family members and Tdap vaccination to the father and mother', 'C': 'Administer oral erythromycin to all family members and Tdap vaccination to the father', 'D': 'Administer oral trimethoprim-sulfamethaxazole to the father and baby and Tdap vaccination to the father', 'E': 'Administer oral azithromycin to all family members and Tdap vaccination to the father'},
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B: Administer oral azithromycin to all family members and Tdap vaccination to the father and mother
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Q:An investigator is studying the recycling of heme proteins in various cell types. Heat denaturation and high-performance liquid chromatography are used to carry out and observe the selective destruction of hemoglobin molecules in red blood cells. It is found that these cells are unable to regenerate new heme molecules. A lack of which of the following structures is the most likely explanation for this observation?? {'A': 'Golgi apparatus', 'B': 'Mitochondria', 'C': 'Smooth endoplasmic reticulum', 'D': 'Nucleus', 'E': 'Peroxisomes'},
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B: Mitochondria
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Q:A 7-year-old boy is brought to the emergency department by his parents for worsening symptoms. The patient recently saw his pediatrician for an acute episode of sinusitis. At the time, the pediatrician prescribed decongestants and sent the patient home. Since then, the patient has developed a nasal discharge with worsening pain. The patient has a past medical history of asthma which is well controlled with albuterol. His temperature is 99.5°F (37.5°C), blood pressure is 90/48 mmHg, pulse is 124/min, respirations are 17/min, and oxygen saturation is 98% on room air. On physical exam, you note a healthy young boy. Cardiopulmonary exam is within normal limits. Inspection of the patient's nose reveals a unilateral purulent discharge mixed with blood. The rest of the patient's exam is within normal limits. Which of the following is the most likely diagnosis?? {'A': 'Bleeding and infected vessel of Kiesselbach plexus', 'B': 'Foreign body obstruction', 'C': 'Nasopharyngeal carcinoma', 'D': 'Septal perforation', 'E': 'Sinusitis with bacterial superinfection'},
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B: Foreign body obstruction
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Q:A 24-year-old woman delivers a girl by normal vaginal delivery, Apgar scores are 8 and 9 at 1 and 5 minutes respectively. The newborn’s vitals are normal. On examination, the attending pediatrician finds a circular skin defect that measures 0.5 cm in diameter. The defect is hairless and extends into the dermis. The delivery was atraumatic and there were no surgical instruments in the area. The pediatric team believes this is a congenital defect. The remaining examination is normal. The mother gives past history of having constant diarrhea for 3 months about 2 years ago, weight loss of 5 kg (11 lb) in 3 months, palpitations, and sensitivity to heat. She visited a community hospital and was prescribed a medication for this problem. She did not visit the hospital for any of her routine check-ups and continued taking her medications. Which drug can predispose the newborn to this condition?? {'A': 'Propylthiouracil', 'B': 'Methimazole', 'C': 'Propranolol', 'D': 'Levothyroxine', 'E': 'Octreotide'},
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B: Methimazole
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Q:A 63-year-old man comes to the physician because of a 2-day history of a painful rash on his right flank. Two years ago, he underwent cadaveric renal transplantation. Current medications include tacrolimus, mycophenolate mofetil, and prednisone. Examination shows an erythematous rash with grouped vesicles in a band-like distribution over the patient's right flank. This patient is at greatest risk for which of the following complications?? {'A': 'Sensory neuropathy', 'B': 'Ascending paralysis', 'C': 'Urinary retention', 'D': 'Loss of vision', 'E': 'Temporal lobe inflammation'},
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A: Sensory neuropathy
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Q:A 16-year-old girl is brought to the emergency room with hyperextension of the cervical spine caused by a trampoline injury. After ruling out the possibility of hemorrhagic shock, she is diagnosed with quadriplegia with neurogenic shock. The physical examination is most likely to reveal which of the following constellation of findings?? {'A': 'Pulse: 110/min; blood pressure: 88/50 mm Hg; respirations: 26/min; normal rectal tone on digital rectal examination (DRE); normal muscle power and sensations in the limbs', 'B': 'Pulse: 99/min; blood pressure: 188/90 mm Hg; respirations: 33/min; loss of rectal tone on DRE; reduced muscle power and absence of sensations in the limbs', 'C': 'Pulse: 56/min; blood pressure: 88/40 mm Hg; respirations: 22/min; loss of rectal tone on DRE; reduced muscle power and absence of sensations in the limbs', 'D': 'Pulse: 54/min; blood pressure: 88/44 mm Hg; respirations: 26/min; increased rectal tone on DRE; normal muscle power and sensations in the limbs', 'E': 'Pulse: 116/min; blood pressure: 80/40 mm Hg; respirations: 16/min; loss of rectal tone on DRE; reduced muscle power and absence of sensations in the limbs'},
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C: Pulse: 56/min; blood pressure: 88/40 mm Hg; respirations: 22/min; loss of rectal tone on DRE; reduced muscle power and absence of sensations in the limbs
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Q:A 64-year-old woman presents to the clinic with a history of 3 fractures in the past year with the last one being last month. Her bone-density screening from last year reported a T-score of -3.1 and she was diagnosed with osteoporosis. She was advised to quit smoking and was asked to adapt to a healthy lifestyle to which she complied. She was also given calcium and vitamin D supplements. After a detailed discussion with the patient, the physician decides to start her on weekly alendronate. Which of the following statements best describes this patient’s new therapy?? {'A': 'It is typically used as a second-line therapy for her condition after raloxifene', 'B': 'It must be taken with the first meal of the day due to the significant risk of GI upset', 'C': 'The patient must stay upright for at least 30 minutes after taking this medication', 'D': 'It can cause hot flashes, flu-like symptoms, and peripheral edema', 'E': 'It should be stopped after 10 years due to the risk of esophageal cancer'},
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C: The patient must stay upright for at least 30 minutes after taking this medication
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Q:A 27-year-old woman comes to the physician for a routine health maintenance examination. She feels well. She had a chlamydia infection at the age of 22 years that was treated. Her only medication is an oral contraceptive. She has smoked one pack of cigarettes daily for 6 years. She has recently been sexually active with 3 male partners and uses condoms inconsistently. Her last Pap test was 4 years ago and results were normal. Physical examination shows no abnormalities. A Pap test shows atypical squamous cells of undetermined significance. Which of the following is the most appropriate next step in management?? {'A': 'Perform cervical biopsy', 'B': 'Perform loop electrosurgical excision procedure', 'C': 'Perform HPV testing', 'D': 'Repeat cytology in 6 months', 'E': 'Perform laser ablation'},
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C: Perform HPV testing
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Q:A 26-year-old pregnant woman (gravida 2, para 1) presents on her 25th week of pregnancy. Currently, she has no complaints. Her previous pregnancy was unremarkable. No abnormalities were detected on the previous ultrasound (US) examination at week 13 of pregnancy. She had normal results on the triple test. She is human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV)-negative. Her blood type is III(B) Rh+, and her partner has blood type I(0) Rh-. She and her husband are both of Sardinian descent, do not consume alcohol, and do not smoke. Her cousin had a child who died soon after the birth, but she doesn't know the reason. She does not report a history of any genetic conditions in her family, although notes that her grandfather “was always yellowish-pale, fatigued easily, and had problems with his gallbladder”. Below are her and her partner’s complete blood count and electrophoresis results. Complete blood count Patient Her husband Erythrocytes 3.3 million/mm3 4.2 million/mm3 Hb 11.9 g/dL 13.3 g/dL MCV 71 fL 77 fL Reticulocyte count 0.005 0.008 Leukocyte count 7,500/mm3 6,300/mm3 Platelet count 190,000/mm3 256,000/mm3 Electrophoresis HbA1 95% 98% HbA2 3% 2% HbS 0% 0% HbH 2% 0% The patient undergoes ultrasound examination which reveals ascites, liver enlargement, and pleural effusion in the fetus. Further evaluation with Doppler ultrasound shows elevated peak systolic velocity of the fetal middle cerebral artery. Which of the following procedures can be performed for both diagnostic and therapeutic purposes in this case?? {'A': 'Fetoscopy', 'B': 'Amniocentesis', 'C': 'Chorionic villus sampling', 'D': 'Cordocentesis', 'E': 'Percutaneous fetal thoracentesis'},
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D: Cordocentesis
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Q:DNA replication is a highly complex process where replication occurs on both strands of DNA. On the leading strand of DNA, replication occurs uninteruppted, but on the lagging strand, replication is interrupted and occurs in fragments called Okazaki fragments. These fragments need to be joined, which of the following enzymes is involved in the penultimate step before ligation can occur?? {'A': 'DNA ligase', 'B': 'DNA gyrase', 'C': 'DNA helicase', 'D': 'DNA polymerase I', 'E': 'DNA polymerase III'},
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D: DNA polymerase I
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Q:A 3-day-old boy develops several episodes of complete body shaking while at the hospital. The episodes last for about 10–20 seconds. He has not had fever or trauma. He was born at 40 weeks' gestation and has been healthy. The mother did not follow-up with her gynecologist during her pregnancy on a regular basis. There is no family history of serious illness. The patient appears irritable. Vital signs are within normal limits. Physical examination shows reddening of the face. Peripheral venous studies show a hematocrit of 68%. Neuroimaging of the head shows several cerebral infarctions. Which of the following is the most likely cause of this patient's findings?? {'A': 'Maternal diabetes', 'B': 'Neonatal listeria infection', 'C': 'Neonatal JAK2 mutation', 'D': 'Neonatal factor V mutation', 'E': 'Maternal alcohol use during pregnancy'},
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A: Maternal diabetes
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Q:A 3-month-old boy is brought to the physician by his mother because of poor weight gain. She also reports a dusky blue discoloration to his skin during feedings and when crying. On examination, there is a harsh, systolic murmur heard over the left upper sternal border. An x-ray of the chest is shown below. Which of the following is the most likely cause of his symptoms?? {'A': 'Persistent connection between the aorta and pulmonary artery', 'B': 'Hypoplasia of the left ventricle', 'C': 'Narrowing of the distal aortic arch', 'D': 'Right ventricular outflow obstruction', 'E': 'Anatomic reversal of aorta and pulmonary artery'},
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D: Right ventricular outflow obstruction
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Q:A 35-year-old male presents to his primary care physician with pain along the bottom of his foot. The patient is a long-time runner but states that the pain has been getting worse recently. He states that when running and at rest he has a burning and aching pain along the bottom of his foot that sometimes turns to numbness. Taking time off from training does not improve his symptoms. The patient has a past medical history of surgical repair of his Achilles tendon, ACL, and medial meniscus. He is currently not taking any medications. The patient lives with his wife and they both practice a vegan lifestyle. On physical exam the patient states that he is currently not experiencing any pain in his foot but rather is experiencing numbness/tingling along the plantar surface of his foot. Strength is 5/5 and reflexes are 2+ in the lower extremities. Which of the following is the most likely diagnosis?? {'A': 'Vitamin B12 deficiency', 'B': 'Common fibular nerve compression', 'C': 'Herniated disc', 'D': 'Tarsal tunnel syndrome', 'E': 'Plantar fasciitis'},
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D: Tarsal tunnel syndrome
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Q:A previously healthy 64-year-old woman comes to the physician because of a dry cough and progressively worsening shortness of breath for the past 2 months. She has not had fever, chills, or night sweats. She has smoked one pack of cigarettes daily for the past 45 years. She appears thin. Examination of the lung shows a prolonged expiratory phase and end-expiratory wheezing. Spirometry shows decreased FEV1:FVC ratio (< 70% predicted), decreased FEV1, and a total lung capacity of 125% of predicted. The diffusion capacity of the lung (DLCO) is decreased. Which of the following is the most likely diagnosis?? {'A': 'Bronchial asthma', 'B': 'Bronchiectasis', 'C': 'Hypersensitivity pneumonitis', 'D': 'Interstitial lung disease', 'E': 'Chronic obstructive pulmonary disease'},
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E: Chronic obstructive pulmonary disease
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Answer the following medical question with one of the provided options:
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Q:A 33-year-old man presents to the clinic complaining of multiple painful joints for the past 2 weeks. The patient notes no history of trauma or any joint disorders. The patient states that he is generally healthy except for a recent emergency room visit for severe bloody diarrhea, which has resolved. On further questioning, the patient admits to some discomfort with urination but notes no recent sexual activity. On examination, the patient is not in acute distress, with no joint deformity, evidence of trauma, swelling, or erythema. He has a decreased range of motion of his right knee secondary to pain. Vital signs are as follows: heart rate 75/min, blood pressure 120/78 mm Hg, respiratory rate 16/min, and temperature 37.3°C (99.0°F). What is the next step in the treatment of this patient?? {'A': 'Intravenous (IV) antibiotics', 'B': 'Nonsteroidal anti-inflammatory drugs (NSAIDs) or immunosuppressants', 'C': 'Positron emission tomography (PET) scan', 'D': 'Serology for rheumatoid factor', 'E': 'Prostate biopsy'},
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B: Nonsteroidal anti-inflammatory drugs (NSAIDs) or immunosuppressants
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Answer the following medical question with one of the provided options:
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Q:A 28-year-old woman presents to the emergency department with lateral knee pain that started this morning. The patient is a college student who is currently on the basketball team. She states her pain started after she twisted her knee. Her current medications include albuterol and ibuprofen. The patient's vitals are within normal limits and physical exam is notable for tenderness to palpation over the lateral right knee. When the patient lays on her left side and her right hip is extended and abducted it does not lower to the table in a smooth fashion and adduction causes discomfort. The rest of her exam is within normal limits. Which of the following is the most likely diagnosis?? {'A': 'Iliotibial band syndrome', 'B': 'Lateral collateral ligament injury', 'C': 'Musculoskeletal strain', 'D': 'Patellofemoral syndrome', 'E': 'Pes anserine bursitis'},
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A: Iliotibial band syndrome
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Answer the following medical question with one of the provided options:
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Q:A 56-year-old man comes to the physician for a follow-up examination. One month ago, he was diagnosed with a focal seizure and treatment with a drug that blocks voltage-gated sodium channels was begun. Today, he reports that he has not had any abnormal body movements, but he has noticed occasional double vision. His serum sodium is 132 mEq/L, alanine aminotransferase is 49 U/L, and aspartate aminotransferase is 46 U/L. This patient has most likely been taking which of the following drugs?? {'A': 'Carbamazepine', 'B': 'Levetiracetam', 'C': 'Gabapentin', 'D': 'Lamotrigine', 'E': 'Topiramate'},
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A: Carbamazepine
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Answer the following medical question with one of the provided options:
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Q:A 22-year-old woman comes to the physician to discuss the prescription of an oral contraceptive. She has no history of major medical illness and takes no medications. She does not smoke cigarettes. She is sexually active with her boyfriend and has been using condoms for contraception. Physical examination shows no abnormalities. She is prescribed combined levonorgestrel and ethinylestradiol tablets. Which of the following is the most important mechanism of action of this drug in the prevention of pregnancy?? {'A': 'Thickening of cervical mucus', 'B': 'Inhibition of rise in luteinizing hormone', 'C': 'Suppression of ovarian folliculogenesis', 'D': 'Increase of sex-hormone binding globulin', 'E': 'Prevention of endometrial proliferation'},
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B: Inhibition of rise in luteinizing hormone
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Answer the following medical question with one of the provided options:
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Q:A 13-year-old boy is brought to the emergency department by his mother because of vomiting and severe testicular pain for 3 hours. The boy has had 4–5 episodes of vomiting during this period. He has never had a similar episode in the past and takes no medications. His father died of testicular cancer at the age of 50. His immunizations are up-to-date. He appears anxious and uncomfortable. His temperature is 37°C (98.6°F), pulse is 90/min, respirations are 14/min, and blood pressure is 100/60 mm Hg. Cardiopulmonary examination shows no abnormalities The abdomen is soft and nondistended. The left scrotum is firm, erythematous, and swollen. There is severe tenderness on palpation of the scrotum that persists on elevation of the testes. Stroking the inner side of the left thigh fails to elicit elevation of the scrotum. Which of the following is the most appropriate next step in management?? {'A': 'Urine dipstick', 'B': 'Surgical exploration of the scrotum', 'C': 'Close observation', 'D': 'CT scan of the abdomen and pelvis', 'E': 'Ceftriaxone and doxycycline therapy'},
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B: Surgical exploration of the scrotum
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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 for a screening health examination that is required for scuba diving certification. The physician asks her to perform a breathing technique: following deep inspiration, she is instructed to forcefully exhale against a closed airway and contract her abdominal muscles while different cardiovascular parameters are evaluated. Which of the following effects is most likely after 10 seconds in this position?? {'A': 'Increased venous return to left atrium', 'B': 'Decreased systemic vascular resistance', 'C': 'Decreased left ventricular stroke volume', 'D': 'Decreased intra-abdominal pressure', 'E': 'Decreased pulse rate'},
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C: Decreased left ventricular stroke volume
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