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Answer the following medical question with one of the provided options:
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Q:A 65-year-old woman presents to her physician with a persistent and debilitating cough which began 3 weeks ago, and chest pain accompanied by shortness of breath for the past week. Past medical history is significant for breast carcinoma 10 years ago treated with mastectomy, chemotherapy and radiation, a hospitalization a month ago for pneumonia that was treated with antibiotics, hypertension, and diabetes mellitus. Medications include chlorthalidone and metformin. She does not smoke but her husband has been smoking 3 packs a day for 30 years. Today her respiratory rate is 20/min and the blood pressure is 150/90 mm Hg. Serum Na is 140 mmol/L, serum K is 3.8 mmol/L and serum Ca is 12.2 mg/dL. A chest X-ray (shown in image) is performed. Which of the following is the most likely diagnosis?? {'A': 'Bacterial pneumonia', 'B': 'Viral pneumonia', 'C': 'Small cell carcinoma lung', 'D': 'Squamous cell carcinoma lung', 'E': 'Tuberculosis'},
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D: Squamous cell carcinoma lung
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Answer the following medical question with one of the provided options:
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Q:An investigator is developing a drug for muscle spasms. The drug inactivates muscular contraction by blocking the site where calcium ions bind to the myocyte actin filament. Which of the following is the most likely site of action of this drug?? {'A': 'Myosin-binding site', 'B': 'Myosin head', 'C': 'Ryanodine receptor', 'D': 'Acetylcholine receptor', 'E': 'Troponin C'},
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E: Troponin C
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Answer the following medical question with one of the provided options:
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Q:A 72-year-old woman is brought to the emergency department by ambulance after an unexpected fall at home 1 hour ago. She was resuscitated at the scene by paramedics before being transferred to the hospital. She has a history of ischemic heart disease and type 2 diabetes mellitus. She has not taken any sedative medications. Her GCS is 6. She is connected to a mechanical ventilator. Her medical records show that she signed a living will 5 years ago, which indicates her refusal to receive any type of cardiopulmonary resuscitation, intubation, or maintenance of life support on mechanical ventilation. Her son, who has a durable power-of-attorney for her healthcare decisions, objects to the discontinuation of mechanical ventilation and wishes that his mother be kept alive without suffering in the chance that she might recover. Which of the following is the most appropriate response to her son regarding his wishes for his mother?? {'A': '“Based on her wishes, mechanical ventilation must be discontinued.”', 'B': '“Further management decisions will be referred to the hospital’s ethics committee.”', 'C': '“She may be eligible for hospice care.”', 'D': '“The opinion of her primary care physician must be obtained regarding further steps in management.”', 'E': '“We will take every measure necessary to prolong her life.”'},
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A: “Based on her wishes, mechanical ventilation must be discontinued.”
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Answer the following medical question with one of the provided options:
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Q:A 54-year-old male carpenter accidentally amputated his right thumb while working in his workshop 30 minutes ago. He reports that he was cutting a piece of wood, and his hand became caught up in the machinery. He is calling the emergency physician for advice on how to transport his thumb and if it is necessary. Which of the following is the best information for this patient?? {'A': 'Place thumb directly into cooler of ice', 'B': 'Place thumb in cup of cold milk', 'C': 'Wrap thumb in sterile gauze and submerge in a cup of saline', 'D': 'Wrap thumb in saline-moistened, sterile gauze and place in sterile bag', 'E': 'There is no need to save the thumb'},
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D: Wrap thumb in saline-moistened, sterile gauze and place in sterile bag
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Answer the following medical question with one of the provided options:
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Q:A 45-year-old diabetic man presents to your office for routine follow-up. One year ago, the patient’s hemoglobin A1C was 7.2% and the patient was encouraged to modify his diet and increase exercise. Six months ago, the patient’s HA1C was 7.3%, and you initiated metformin. Today, the patient has no complaints. For which of the following co-morbidities would it be acceptable to continue metformin?? {'A': 'Hepatitis C infection', 'B': 'Mild chronic obstructive pulmonary disease', 'C': 'Recent diagnosis of NYHA Class II congestive heart failure', 'D': 'Prior hospitalization for alcoholic hepatitis', 'E': 'Headache and family history of brain aneurysms requiring CT angiography'},
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B: Mild 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 4-year-old boy is brought to the emergency department with difficulty breathing. His mother reports that he developed a fever last night and began to have trouble breathing this morning. The boy was born at 39 weeks gestation via spontaneous vaginal delivery. He is unvaccinated (conscientious objection by the family) and is meeting all developmental milestones. At the hospital, his vitals are temperature 39.8°C (103.6°F), pulse 122/min, respiration rate 33/min, blood pressure 110/66 mm Hg, and SpO2 93% on room air. On physical examination, he appears ill with his neck hyperextended and chin protruding. His voice is muffled and is drooling. The pediatrician explains that there is one particular bacteria that commonly causes these symptoms. At what age should the patient have first received vaccination to prevent this condition from this particular bacteria?? {'A': 'At birth', 'B': 'At 2-months-old', 'C': 'At 6-months-old', 'D': 'Between 9- and 12-months-old', 'E': 'Between 12- and 15-months-old'},
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B: At 2-months-old
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Answer the following medical question with one of the provided options:
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Q:A 57-year-old man comes to the physician two weeks after a blood pressure of 160/92 mm Hg was measured at a routine health maintenance examination. Subsequent home blood pressure measurements since the last visit have been: 159/98 mm Hg, 161/102 mm Hg, and 152/95 mm Hg. Over the past 3 years, the patient has had a 10-kg (22-lb) weight gain. He has type 2 diabetes mellitus. He does not follow any specific diet; he usually eats sandwiches at work and fried chicken or burger for dinner. He says that he has been struggling with a stressful project at work recently. His mother was diagnosed with hypertension at the age of 45. The patient's only medication is metformin. His pulse is 82/min, and blood pressure now is 158/98 mm Hg. The patient is 178 cm (5 ft 10 in) tall and weighs 133 kg (293 lb); BMI is 42 kg/m2. Physical examination shows no other abnormalities except for significant central obesity. Fasting serum studies show: Total cholesterol 220 mg/dL HDL-cholesterol 25 mg/dL Triglycerides 198 mg/dL Glucose 120 mg/dL Which of the following is the most important factor in the development of this patient's condition?"? {'A': 'Release of proinflammatory cytokines', 'B': 'Accumulation of fat in visceral tissue', 'C': 'Resistance to insulin', 'D': 'Increased dietary salt intake', 'E': 'Elevation of blood lipids'},
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C: Resistance to insulin
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Answer the following medical question with one of the provided options:
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Q:A 67-year-old man is brought to the emergency department because of increasing shortness of breath that began while playing outdoors with his grandson. He has a history of asthma but does not take any medications for it. On arrival, he is alert and oriented. He is out of breath and unable to finish his sentences. His pulse is 130/min, respirations are 23/min and labored, and blood pressure is 110/70 mm Hg. Physical examination shows nasal flaring and sternocleidomastoid muscle use. Pulmonary exam shows poor air movement bilaterally but no wheezing. Cardiac examination shows no abnormalities. Oxygen is administered via non-rebreather mask. He is given three albuterol nebulizer treatments, inhaled ipratropium, and intravenous methylprednisolone. The patient is confused and disoriented. Arterial blood gas analysis shows: pH 7.34 Pco2 44 mm Hg Po2 54 mm Hg O2 saturation 87% Which of the following is the most appropriate next step in management?"? {'A': 'Endotracheal intubation', 'B': 'Intravenous theophylline therapy', 'C': 'Continuous albuterol nebulizer therapy', 'D': 'Intravenous magnesium sulfate therapy', 'E': 'Flexible bronchoscopy\n"'},
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A: Endotracheal intubation
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Answer the following medical question with one of the provided options:
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Q:A 52-year-old male with ischemic cardiomyopathy presents to his cardiologist for worsening shortness of breath on exertion. He denies any recent episodes of chest pain and has been compliant with his medications, which include metoprolol, lisinopril, spironolactone, and furosemide. The patient’s vitals signs are as follows: Temperature is 98.7 deg F (37.1 deg C), blood pressure is 163/78 mmHg, pulse is 92/min, respirations are 14/min, and oxygen saturation is 98% on room air. A repeat echocardiogram reveals a stable LVEF of 25-35%. The physician decides to start hydralazine and isosorbide dinitrate. Which of the following is true regarding this medication combination?? {'A': 'Has anti-inflammatory properties to reduce the risk of coronary artery thrombosis', 'B': 'Increases the volume of blood that enters the heart to improve ventricular contraction', 'C': 'Improves symptoms but do not have an overall mortality benefit in patients with congestive heart failure', 'D': 'Decreases the volume and work placed on the left ventricle', 'E': 'Has positive effects on cardiac remodeling'},
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D: Decreases the volume and work placed on the left ventricle
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Answer the following medical question with one of the provided options:
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Q:A 16-year-old girl comes to the physician with her mother because of intermittent abdominal cramps, fatigue, and increased urination over the past 3 months. She has no history of serious illness. She reports that she has not yet had her first menstrual period. Her mother states that she receives mostly A and B grades in school and is very active in school athletics. Her mother has type 2 diabetes mellitus and her maternal aunt has polycystic ovary syndrome. Her only medication is a daily multivitamin. The patient is 150 cm (4 ft 11 in) tall and weighs 50 kg (110 lb); BMI is 22.2 kg/m2. Vital signs are within normal limits. A grade 2/6 early systolic murmur is heard best over the pulmonic area and increases with inspiration. The abdomen is diffusely tender to palpation and a firm mass is felt in the lower abdomen. Breast and pubic hair development are at Tanner stage 5. Which of the following is the most appropriate next step in management?? {'A': 'Pelvic ultrasound', 'B': 'Fasting glucose and lipid panel', 'C': 'Serum fT4', 'D': 'Serum β-hCG', 'E': 'Karyotyping'},
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D: Serum β-hCG
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Answer the following medical question with one of the provided options:
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Q:A 30-year-old woman presents to the clinic because of fever, joint pain, and a rash on her lower extremities. She admits to intravenous drug use. Physical examination reveals palpable petechiae and purpura on her lower extremities. Laboratory results reveal a negative antinuclear antibody, positive rheumatoid factor, and positive serum cryoglobulins. Which of the following underlying conditions in this patient is responsible for these findings?? {'A': 'Dermatomyositis', 'B': 'Hepatitis B infection', 'C': 'Hepatitis C infection', 'D': 'HIV infection', 'E': 'Systemic lupus erythematosus (SLE)'},
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C: Hepatitis C infection
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Answer the following medical question with one of the provided options:
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Q:A 30-year-old woman with a 1-year history of medically-managed Graves disease visits her endocrinologist to discuss her desire to become pregnant and whether pregnancy is safe with her medications. Her temperature is 98.4°F (36.9°C), blood pressure is 110/66 mmHg, pulse is 78/min, respirations are 12/min. The endocrinologist advises that the patient may pursue pregnancy, but first needs to be switched to a new medication for her Graves disease. Which of the following is a possible side effect in this new medication that is not a risk in her old medication?? {'A': 'Agranulocytosis', 'B': 'Aplastic anemia', 'C': 'Fulminant hepatic necrosis', 'D': 'Skin rash', 'E': 'Thyroid storm'},
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C: Fulminant hepatic necrosis
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Answer the following medical question with one of the provided options:
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Q:A 58-year-old man comes to the physician because of a 5-day history of progressively worsening shortness of breath and fatigue. He has smoked 1 pack of cigarettes daily for 30 years. His pulse is 96/min, respirations are 26/min, and blood pressure is 100/60 mm Hg. An x-ray of the chest is shown. Which of the following is the most likely cause of this patient's findings?? {'A': 'Left ventricular failure', 'B': 'Tricuspid regurgitation', 'C': 'Acute respiratory distress syndrome', 'D': 'Pulmonary embolism', 'E': 'Interstitial pneumonia'},
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A: Left ventricular failure
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Answer the following medical question with one of the provided options:
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Q:A 33-year-old woman comes to the physician because of left leg pain and swelling for 1 day. She has had two miscarriages but otherwise has no history of serious illness. Physical examination shows stiff, swollen finger joints. The left calf circumference is larger than the right and there is a palpable cord in the left popliteal fossa. Laboratory studies show a prothrombin time of 12 seconds and an activated partial thromboplastin time of 51 seconds. Which of the following is most likely to confirm the diagnosis?? {'A': 'Anti-nuclear antibodies', 'B': 'Anti-ribonucleoprotein antibodies', 'C': 'Anti-cyclical citrullinated peptide antibodies', 'D': 'Anti-β2 glycoprotein antibodies', 'E': 'Anti-synthetase antibodies'},
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D: Anti-β2 glycoprotein antibodies
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Answer the following medical question with one of the provided options:
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Q:A 50-year-old male presents to the emergency with abdominal pain. He reports he has had abdominal pain associated with meals for several months and has been taking over the counter antacids as needed, but experienced significant worsening pain one hour ago in the epigastric region. The patient reports the pain radiating to his shoulders. Vital signs are T 38, HR 120, BP 100/60, RR 18, SpO2 98%. Physical exam reveals diffuse abdominal rigidity with rebound tenderness. Auscultation reveals hypoactive bowel sounds. Which of the following is the next best step in management?? {'A': 'Abdominal ultrasound', 'B': 'Chest radiograph', 'C': 'Abdominal CT scan', 'D': '12 lead electrocardiogram', 'E': 'Admission and observation'},
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B: Chest radiograph
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Answer the following medical question with one of the provided options:
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Q:A 31-year-old woman presents to your office with one week of recurrent fevers. The highest temperature she recorded was 101°F (38.3°C). She recently returned from a trip to Nigeria to visit family and recalls a painful bite on her right forearm at that time. Her medical history is significant for two malarial infections as a child. She is not taking any medications. On physical examination, her temperature is 102.2°F (39°C), blood pressure is 122/80 mmHg, pulse is 80/min, respirations are 18/min, and pulse oximetry is 99% on room air. She has bilateral cervical lymphadenopathy and a visible, enlarged, mobile posterior cervical node. Cardiopulmonary and abdominal examinations are unremarkable. She has an erythematous induration on her right forearm. The most likely cause of this patient's symptoms can be treated with which of the following medications?? {'A': 'Chloroquine', 'B': 'Primaquine', 'C': 'Atovaquone and azithromycin', 'D': 'Suramin and melarsoprol', 'E': 'Sulfadiazine and pyrimethamine'},
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D: Suramin and melarsoprol
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Answer the following medical question with one of the provided options:
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Q:A 36-year-old man presents with soreness and dryness of the oral mucosa for the past 3 weeks. No significant past medical history. The patient reports that he has had multiple bisexual partners over the last year and only occasionally uses condoms. He denies any alcohol use or history of smoking. The patient is afebrile and his vital signs are within normal limits. On physical examination, there is a lesion noted in the oral cavity, which is shown in the exhibit. Which of the following is the next best step in the treatment of this patient?? {'A': 'Change the patient’s toothbrush and improve oral hygiene', 'B': 'HAART therapy', 'C': 'Nystatin', 'D': 'Surgical excision', 'E': 'Topical corticosteroids'},
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A: Change the patient’s toothbrush and improve oral hygiene
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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 presents to her primary care physician for an annual checkup. She reports that she has been feeling well and has no medical concerns. Her past medical history is significant for childhood asthma but she has not experienced any symptoms since she was a teenager. Physical exam reveals a 1-centimeter hard mobile mass in the left upper outer quadrant of her breast. A mammogram was performed and demonstrated calcifications within the mass so a biopsy was obtained. The biopsy shows acinar proliferation with intralobular fibrosis. Which of the following conditions is most likely affecting this patient?? {'A': 'Cystic hyperplasia', 'B': 'Fibroadenoma', 'C': 'Infiltrating ductal carcinoma', 'D': 'Invasive lobular carcinoma', 'E': 'Sclerosing adenosis'},
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E: Sclerosing adenosis
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Answer the following medical question with one of the provided options:
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Q:A 3-year-old boy is brought to his pediatrician’s office because of prolonged ear pulling and discomfort. The condition started a week ago and his parents are concerned that he has developed another ear infection. He has had multiple minor respiratory tract infections with productive cough and ear infections over the last year; he has also been hospitalized once with community-acquired pneumonia. During his last ear infection, there was some discussion of myringotomy. The boy was born at 39 weeks gestation via spontaneous vaginal delivery. He is up to date on all vaccines and is meeting all developmental milestones. Today, the vital signs include: temperature 39.0°C (102.0°F), blood pressure 100/65 mm Hg, heart rate 110/min, and respiratory rate 30/min. His left ear is tender and appears red and irritated. Examination with an otoscope reveals a swollen canal and a bulging tympanic membrane. A review of previous medical records reveals the following chest X-ray taken 2 months ago. What is the underlying cause of his recurrent infections?? {'A': 'Cystic fibrosis', 'B': 'Common variable immune deficiency', 'C': 'X-linked agammaglobulinemia', 'D': 'Otitis media', 'E': 'Kartagener syndrome'},
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E: Kartagener syndrome
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Answer the following medical question with one of the provided options:
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Q:A 30-year-old woman, gravida 2, para 1, at 12 weeks' gestation comes to the physician for a prenatal visit. She feels well. Pregnancy and vaginal delivery of her first child were uncomplicated. Five years ago, she was diagnosed with hypertension but reports that she has been noncompliant with her hypertension regimen. The patient does not smoke or drink alcohol. She does not use illicit drugs. Medications include methyldopa, folic acid, and a multivitamin. Her temperature is 37°C (98.6°F), pulse is 80/min, and blood pressure is 145/90 mm Hg. Physical examination shows no abnormalities. Laboratory studies, including serum glucose level, and thyroid-stimulating hormone concentration, are within normal limits. The patient is at increased risk of developing which of the following complications?? {'A': 'Uterine rupture', 'B': 'Spontaneous abortion', 'C': 'Polyhydramnios', 'D': 'Abruptio placentae', 'E': 'Placenta previa'},
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D: Abruptio placentae
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Answer the following medical question with one of the provided options:
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Q:A 42-year-old woman, gravida 1, para 0, at 10 weeks' gestation comes to the physician for a prenatal examination. She has no history of significant medical illness. Physical examination shows a uterus consistent with a 10-week gestation. Cell-free fetal DNA testing shows a karyotype of 47,XXY. If the fetus's condition had not been diagnosed until puberty, which of the following sets of hormonal changes would most likely be found at that time? $$$ Follicle-stimulating hormone %%% Luteinizing hormone %%% Testosterone %%% Estrogen $$$? {'A': '↑ ↑ ↓ ↑', 'B': '↓ ↓ ↓ ↓', 'C': '↑ ↑ normal normal', 'D': '↑ ↑ ↑ ↓', 'E': '↓ ↓ normal ↑'},
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A: ↑ ↑ ↓ ↑
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Answer the following medical question with one of the provided options:
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Q:A 44-year-old man is brought to the emergency department 45 minutes after being involved in a high-speed motor vehicle collision in which he was the restrained driver. On arrival, he has left hip and left leg pain. His pulse is 135/min, respirations are 28/min, and blood pressure is 90/40 mm Hg. Examination shows an open left tibial fracture with active bleeding. The left lower extremity appears shortened, flexed, and internally rotated. Femoral and pedal pulses are decreased bilaterally. Massive transfusion protocol is initiated. An x-ray of the pelvis shows an open pelvis fracture and an open left tibial mid-shaft fracture. A CT scan of the head shows no abnormalities. Laboratory studies show: Hemoglobin 10.2 g/dL Leukocyte count 10,000/mm3 Platelet count <250,000/mm3 Prothrombin time 12 sec Partial thromboplastin time 30 sec Serum Na+ 125 mEq/L K+ 4.5 mEq/L Cl- 98 mEq/L HCO3- 25 mEq/L Urea nitrogen 18 mg/dL Creatinine 1.2 mg/dL The patient is taken emergently to interventional radiology for exploratory angiography and arterial embolization. Which of the following is the most likely explanation for this patient's hyponatremia?"? {'A': 'Physiologic aldosterone secretion', 'B': 'Pathologic aldosterone secretion', 'C': 'Adrenal crisis', 'D': 'Pathologic ADH (vasopressin) secretion', 'E': 'Physiologic ADH (vasopressin) secretion'},
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E: Physiologic ADH (vasopressin) secretion
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Answer the following medical question with one of the provided options:
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Q:A 67-year old woman is brought to the emergency department after she lost consciousness while at home. Her daughter was with her at the time and recalls that her mother was complaining of a diffuse headache and nausea about 2 hours before the incident. The daughter says that her mother has not had any recent falls and was found sitting in a chair when she lost consciousness. She has hypertension. Current medications include amlodipine, a daily multivitamin, and acetaminophen. She has smoked 1/2 pack of cigarettes daily for the past 45 years. Her pulse is 92/min, respirations are 10/min, and blood pressure is 158/100 mm Hg. She is disoriented and unable to follow commands. Examination shows nuchal rigidity. She has flexor posturing to painful stimuli. Fundoscopic examination is notable for bilateral vitreous hemorrhages. Laboratory studies are within normal limits. An emergent non-contrast CT scan of the head is obtained and shows a diffuse hemorrhage at the base of the brain that is largest over the left hemisphere. Which of the following is the most likely cause of this patient's symptoms?? {'A': 'Ruptured mycotic aneurysm', 'B': 'Ruptured saccular aneurysm', 'C': 'Intracranial arteriovenous malformation', 'D': 'Intracranial arterial dissection', 'E': 'Spinal arteriovenous malformation'},
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B: Ruptured saccular aneurysm
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Answer the following medical question with one of the provided options:
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Q:A 58-year-old man with liver cirrhosis presents to his primary care physician complaining of increased abdominal girth and early satiety. He drinks 2–4 glasses of wine with dinner and recalls having had abnormal liver enzymes in the past. Vital signs include a temperature of 37.1°C (98.7°F), blood pressure of 110/70 mm Hg, and a pulse of 75/min. Physical examination reveals telangiectasias, mild splenomegaly, palpable firm liver, and shifting dullness. Liver function is shown: Total bilirubin 3 mg/dL Aspartate aminotransferase (AST) 150 U/L Alanine aminotransferase (ALT) 70 U/L Total albumin 2.5 g/dL Abdominal ultrasonography confirms the presence of ascites. Diagnostic paracentesis is performed and its results are shown: Polymorphonuclear cell count 10 cells/mm Ascitic protein 1 g/dL Which of the following best represent the mechanism of ascites in this patients?? {'A': 'Peritoneal carcinomatosis', 'B': 'Serositis', 'C': 'Peritoneal tuberculosis', 'D': 'High sinusoidal pressure', 'E': 'Pancreatic disease'},
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D: High sinusoidal pressure
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Answer the following medical question with one of the provided options:
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Q:A 48-year-old man is brought to the emergency department with a stab wound to his chest. The wound is treated in the emergency room. Three months later he develops a firm 4 x 3 cm nodular mass with intact epithelium over the site of the chest wound. On local examination, the scar is firm, non-tender, and there is no erythema. The mass is excised and microscopic examination reveals fibroblasts with plentiful collagen. Which of the following processes is most likely related to the series of events mentioned above?? {'A': 'Foreign body response from suturing', 'B': 'Poor wound healing from diabetes mellitus', 'C': 'Keloid scar formation', 'D': 'Staphylococcal wound infection', 'E': 'Development of a fibrosarcoma'},
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C: Keloid scar formation
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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 to the emergency department for chest pain. He states that the pain started last night and has persisted until this morning. He describes the pain as in his chest and radiating into his back between his scapulae. The patient has a past medical history of alcohol abuse and cocaine abuse. He recently returned from vacation on a transatlantic flight. The patient has smoked 1 pack of cigarettes per day for the past 20 years. His temperature is 99.5°F (37.5°C), blood pressure is 167/118 mmHg, pulse is 120/min, and respirations are 22/min. Physical exam reveals tachycardia and clear air movement bilaterally on cardiopulmonary exam. Which of the following is also likely to be found in this patient?? {'A': 'Asymmetric blood pressures in the upper extremities', 'B': 'Coronary artery thrombus', 'C': 'Coronary artery vasospasm', 'D': 'Elevated lipase', 'E': 'Pulmonary artery thrombus'},
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A: Asymmetric blood pressures in the upper extremities
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Answer the following medical question with one of the provided options:
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Q:A 45-year-old woman comes to the physician because of right foot pain for 3 months. She has a burning sensation in the plantar area between the third and fourth metatarsals that radiates to the third and fourth digits. She had a right distal radius fracture that was treated with a splint and physical therapy three months ago. She is an account executive and wears high heels to work every day. Vital signs are within normal limits. Examination of the right lower extremity shows intact skin. The posterior tibial and dorsalis pedis pulses are palpable. When pressure is applied to the sole of the foot between the metatarsal heads the patient feels pain and there is an audible click. Tapping on the affected area causes pain that shoots into the third and fourth digits. Which of the following is the most likely diagnosis?? {'A': 'Third metatarsal stress fracture', 'B': 'Metatarsal osteochondrosis', 'C': 'Intermetatarsal neuroma', 'D': 'Ganglion cyst', 'E': 'Osteomyelitis\n"'},
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C: Intermetatarsal neuroma
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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 because of fever, cough, and ear pain over the past 2 days. He has had recurrent respiratory tract infections and several episodes of giardiasis and viral gastroenteritis since he was 6 months of age. Examination shows decreased breath sounds over both lung fields and bilateral purulent otorrhea. His palatine tonsils and adenoids are hypoplastic. Quantitative flow cytometry of his blood shows decreased levels of cells that express CD19, CD20, and CD21. Which of the following is the most likely cause of this patient's condition?? {'A': 'Mutation in WAS gene', 'B': 'Mutation in tyrosine kinase gene', 'C': 'Microdeletion on the long arm of chromosome 22', 'D': 'Mutation in NADPH oxidase gene', 'E': 'Defect in beta-2 integrin'},
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B: Mutation in tyrosine kinase gene
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Answer the following medical question with one of the provided options:
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Q:A 30-year-old woman, gravida 2, para 1, abortus 1, comes to the physician because of failure to conceive for 12 months. She is sexually active with her husband 2–3 times per week. Her first child was born at term after vaginal delivery 2 years ago. At that time, the postpartum course was complicated by hemorrhage from retained placental products, and the patient underwent dilation and curettage. Menses occur at regular 28-day intervals and previously lasted for 5 days with normal flow, but now last for 2 days with significantly reduced flow. She stopped taking oral contraceptives 1 year after the birth of her son. Her vital signs are within normal limits. Speculum examination shows a normal vagina and cervix. The uterus is normal in size, and no adnexal masses are palpated. Which of the following is the most appropriate next step in management?? {'A': 'Measurement of antisperm antibody concentration', 'B': 'Estrogen/progestin withdrawal test', 'C': 'Measurement of serum FSH and LH concentrations', 'D': 'Hysteroscopy with potential adhesiolysis', 'E': 'Dilation and curettage'},
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D: Hysteroscopy with potential adhesiolysis
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Answer the following medical question with one of the provided options:
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Q:A 50-year-old man presents with a complaint of pain and swelling of his right leg for the past 2 days. He remembers hitting his leg against a table 3 days earlier. Since then, the pain and swelling of the leg have gradually increased. His past medical history is significant for atopy and pulmonary tuberculosis. The patient reports a 20-pack-year smoking history and currently smokes 2 packs of cigarettes per day. His pulse is 98/min, respiratory rate is 15/min, temperature is 38.4°C (101.2°F), and blood pressure is 100/60 mm Hg. On physical examination, his right leg is visibly swollen up to the groin with moderate erythema and 2+ pitting edema. The peripheral pulses are 2+ in the right leg and there is no discomfort. There is no increased resistance or pain in the right calf in response to forced dorsiflexion of the right foot. Which of the following is the best next step in the management of this patient?? {'A': 'Reassurance and supportive treatment', 'B': 'Outpatient management with furosemide', 'C': 'D-dimer level', 'D': 'Ultrasound of the right leg', 'E': 'CT pulmonary angiography'},
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D: Ultrasound of the right leg
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Answer the following medical question with one of the provided options:
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Q:A 35-year-old Caucasian female presents with anemia, malaise, bloating, and diarrhea. Past genetic testing revealed that this patient carries the HLA-DQ2 allele. The physician suspects that the patient's presentation is dietary in cause. Which of the following findings would definitively confirm this diagnosis?? {'A': 'CT scan showing inflammation of the small bowel wall', 'B': 'Biopsy of the duodenum showing atrophy and blunting of villi', 'C': 'Biopsy of the colon showing epithelial cell apoptosis', 'D': 'Liver biopsy showing apoptosis of hepatocytes', 'E': 'Esophageal endoscopy showing lower esophageal metaplasia'},
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B: Biopsy of the duodenum showing atrophy and blunting of villi
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Answer the following medical question with one of the provided options:
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Q:A 20-year-old woman presents to the emergency department with painful abdominal cramping. She states she has missed her menstrual period for 5 months, which her primary care physician attributes to her obesity. She has a history of a seizure disorder treated with valproic acid; however, she has not had a seizure in over 10 years and is no longer taking medications for her condition. She has also been diagnosed with pseudoseizures for which she takes fluoxetine and clonazepam. Her temperature is 98.0°F (36.7°C), blood pressure is 174/104 mmHg, pulse is 88/min, respirations are 19/min, and oxygen saturation is 98% on room air. Neurologic exam is unremarkable. Abdominal exam is notable for a morbidly obese and distended abdomen that is nontender. Laboratory studies are ordered as seen below. Serum: hCG: 100,000 mIU/mL Urine: Color: Amber hCG: Positive Protein: Positive During the patient's evaluation, she experiences 1 episode of tonic-clonic motions which persist for 5 minutes. Which of the following treatments is most appropriate for this patient?? {'A': 'Lorazepam', 'B': 'Magnesium', 'C': 'Phenobarbital', 'D': 'Phenytoin', 'E': 'Propofol'},
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B: Magnesium
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Answer the following medical question with one of the provided options:
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Q:A 65-year-old woman presents with severe abdominal pain and bloody diarrhea. Past medical history is significant for a myocardial infarction 6 months ago. The patient reports a 25-pack-year smoking history and consumes 80 ounces of alcohol per week. Physical examination shows a diffusely tender abdomen with the absence of bowel sounds. Plain abdominal radiography is negative for free air under the diaphragm. Laboratory findings show a serum amylase of 115 U/L, serum lipase 95 U/L. Her clinical condition deteriorates rapidly, and she dies. Which of the following would most likely be the finding on autopsy in this patient?? {'A': 'Small bowel obstruction', 'B': 'Small bowel ischemia', 'C': 'Ulcerative colitis', 'D': 'Perforated appendicitis', 'E': 'Acute pancreatitis'},
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B: Small bowel ischemia
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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 left flank pain and nausea for 2 hours. The pain comes in waves and radiates to his groin. Over the past year, he has had intermittent pain in the bilateral flanks and recurrent joint pain in the toes, ankles, and fingers. He has not seen a physician in over 10 years. He takes no medications. He drinks 3–5 beers daily. His sister has rheumatoid arthritis. Vital signs are within normal limits. Physical examination shows marked tenderness bilaterally in the costovertebral areas. A photograph of the patient's left ear is shown. A CT scan of the abdomen shows multiple small kidney stones and a 7-mm left distal ureteral stone. A biopsy of the patient's external ear findings is most likely to show which of the following?? {'A': 'Cholesterol', 'B': 'Ammonium magnesium phosphate', 'C': 'Monosodium urate', 'D': 'Palisading granulomas', 'E': 'Calcium oxalate'},
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C: Monosodium urate
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Answer the following medical question with one of the provided options:
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Q:A 63-year-old female enrolls in a research study evaluating the use of iron studies to screen for disease in a population of post-menopausal women. Per study protocol, past medical history and other identifying information is unknown. The patient's iron studies return as follows: Serum iron: 200 µg/dL (normal 50–170 µg/dL) TIBC: 220 µg/dL (normal 250–370 µg/dL) Transferrin saturation: 91% (normal 15–50%) Serum ferritin: 180 µg/L (normal 15-150 µg/L) Which of the following is the most likely cause of these findings?? {'A': 'Chronic inflammation', 'B': 'Excess iron absorption', 'C': 'Iron deficiency', 'D': 'Lead poisoning', 'E': 'Pregnancy'},
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B: Excess iron absorption
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Q:A 36-year-old woman with HIV comes to the physician because of a 3-day history of pain and watery discharge in her left eye. She also has blurry vision and noticed that she is more sensitive to light. Her right eye is asymptomatic. She had an episode of shingles 7 years ago. She was diagnosed with HIV 5 years ago. She admits that she takes her medication inconsistently. She wears contact lenses. Current medications include abacavir, lamivudine, efavirenz, and a nutritional supplement. Her temperature is 37°C (98.6°F), pulse is 89/min, and blood pressure is 110/70 mm Hg. Examination shows conjunctival injection of the left eye. Visual acuity is 20/20 in the right eye and 20/80 in the left eye. Extraocular movements are normal. Her CD4+ T-lymphocyte count is 90/mm3. A photograph of the left eye after fluorescein administration is shown. Which of the following is the most likely diagnosis?? {'A': 'Neurotrophic keratopathy', 'B': 'Pseudomonas keratitis', 'C': 'Herpes zoster keratitis', 'D': 'Fusarium keratitis', 'E': 'Herpes simplex keratitis'},
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E: Herpes simplex keratitis
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Q:While testing various strains of Streptococcus pneumoniae, a researcher discovers that a certain strain of this bacteria is unable to cause disease in mice when deposited in their lungs. What physiological test would most likely deviate from normal in this strain of bacteria as opposed to a typical strain?? {'A': 'Bile solubility', 'B': 'Optochin sensitivity', 'C': 'Quellung reaction', 'D': 'Hemolytic reaction when grown on sheep blood agar', 'E': 'Motility'},
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C: Quellung reaction
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Q:A 38-year-old man comes to the physician because of progressive pain and swelling of his left knee for the past 2 days. He has been taking ibuprofen for the past 2 days without improvement. Four days ago, he scraped his left knee while playing baseball. He has a 2-month history of progressive pain and stiffness in his back. The pain starts after waking up and lasts for 20 minutes. He has type 2 diabetes mellitus. His older sister has rheumatoid arthritis. He is 170 cm (5 ft 7 in) tall and weighs 91 kg (201 lb); BMI is 31.5 kg/m2. Temperature is 39°C (102.2°F), pulse is 90/min, and blood pressure is 135/85 mm Hg. Examination shows an erythematous, tender, and swollen left knee; range of motion is limited. There are abrasions over the lateral aspect of the left knee. The remainder of the examination shows no abnormalities. Laboratory studies show a leukocyte count of 13,500/mm3 and an erythrocyte sedimentation rate of 70 mm/h. Which of the following is the most appropriate next step in management?? {'A': 'Bone scan', 'B': 'MRI of the left knee', 'C': 'Blood cultures', 'D': 'Arthrocentesis of the left knee', 'E': 'Continued ibuprofen intake'},
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D: Arthrocentesis of the left knee
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Q:A 62-year-old man with a past medical history notable for α-thalassemia now presents for urgent care with complaints of increased thirst and urinary frequency. Physical examination is grossly unremarkable, although there is a bronze discoloration of his skin. His vital signs include: temperature 36.7°C (98.0°F), blood pressure 126/74 mm Hg, heart rate 74/min, and respiratory rate 14/min. Laboratory analysis reveals fasting blood glucose of 192 mg/dL and subsequently, HbA1c of 8.7. Given the following options, what is the definitive treatment for the patient’s underlying disease?? {'A': 'Metformin', 'B': 'Basal insulin', 'C': 'Basal and bolus insulin', 'D': 'Recurrent phlebotomy', 'E': 'Deferoxamine'},
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D: Recurrent phlebotomy
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Q:A 47-year-old woman complains of weight gain and irregular menses for the past 2 years. She has gained 13 kg (28,6 lb) and feels that most of the weight gain is in her abdomen and face. She has type 2 diabetes and hypertension for 1 year, and they are difficult to control with medications. Vital signs include a temperature of 36.9°C (98.4°F), blood pressure of 160/100 mm Hg, and pulse of 95/min. The patient late-night salivary cortisol is elevated. Morning plasma ACTH is high. Brain magnetic resonance imaging shows a 2 cm pituitary adenoma. Which of the following is the optimal therapy for this patient?? {'A': 'Pituitary radiotherapy', 'B': 'Medical therapy', 'C': 'Unilateral adrenalectomy', 'D': 'Bilateral adrenalectomy', 'E': 'Transsphenoidal pituitary adenoidectomy'},
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E: Transsphenoidal pituitary adenoidectomy
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Q:A 14-year-old boy is brought to the emergency department by his mom after she found him complaining of headaches, nausea, lightheadedness, and muscle pain. He has had type I diabetes for 3 years with very well managed blood sugars, and he is otherwise healthy. He recently returned from a boy scout skiing trip where he drank from a mountain stream, ate unusual foods, and lived in a lodge with a wood-fired fireplace and cooking stove. On physical exam he has a diffuse redness of his skin. Which of the following changes to this patient's pulmonary system would cause oxygen to exhibit similar transport dynamics as the most likely cause of this patient's symptoms?? {'A': 'Interstitial fibrosis', 'B': 'Interstitial thinning', 'C': 'Increasing capillary transit time', 'D': 'Increasing capillary length', 'E': 'Nitrous oxide administration'},
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A: Interstitial fibrosis
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Q:A patient suffering from Graves' disease is given thiocyanate by his physician. Thiocyanate helps in the treatment of Graves' disease by:? {'A': 'Inhibiting thyroid peroxidase', 'B': "Inhibiting 5'-deiodinase", 'C': 'Inhibiting thyroid deiodinase', 'D': 'Inhibiting beta-adrenergic receptors', 'E': 'Inhibiting iodide follicular uptake'},
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E: Inhibiting iodide follicular uptake
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Q:A 16-month-old male patient, with no significant past medical history, is brought into the emergency department for the second time in 5 days with tachypnea, expiratory wheezes and hypoxia. The patient presented to the emergency department initially due to rhinorrhea, fever and cough. He was treated with nasal suctioning and discharged home. The mother states that, over the past 5 days, the patient has started breathing faster with chest retractions. His vital signs are significant for a temperature of 100.7 F, respiratory rate of 45 and oxygen saturation of 90%. What is the most appropriate treatment for this patient?? {'A': 'Humidified oxygen, racemic epinephrine and intravenous (IV) dexamethasone', 'B': 'Albuterol, ipratropium and IV methylprednisolone', 'C': 'Intubation and IV cefuroxime', 'D': 'IV cefotaxime and IV vancomycin', 'E': 'Nasal suctioning, oxygen therapy and IV fluids'},
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E: Nasal suctioning, oxygen therapy and IV fluids
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Q:A 67-year-old man with type 2 diabetes mellitus comes to the emergency department because of lightheadedness over the past 2 hours. He reports that he has had similar episodes of lightheadedness and palpitations over the past 3 days. His only medication is metformin. His pulse is 110/min and irregularly irregular. An ECG shows a variable R-R interval and absence of P waves. The patient undergoes transesophageal echocardiography. During the procedure, the tip of the ultrasound probe is angled posteriorly within the esophagus. This view is most helpful for evaluating which of the following conditions?? {'A': 'Thrombus in the left pulmonary artery', 'B': 'Myxoma in the left atrium', 'C': 'Aneurysm of the descending aorta', 'D': 'Thrombus in the left ventricular apex', 'E': 'Tumor in the right main bronchus'},
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C: Aneurysm of the descending aorta
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Answer the following medical question with one of the provided options:
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Q:A 21-year-old female presents to her psychiatrist for ongoing management of major depressive disorder. She has previously tried cognitive behavioral therapy as well as selective serotonin reuptake inhibitors, but neither treatment has been very effective. She also states that she has been smoking two packs per day for the last three months and would like to stop smoking. Based on these concerns, her psychiatrist prescribes a medication that addresses both depression and smoking cessation. Which of the following if present, would be a contraindication for the drug that was most likely prescribed in this case?? {'A': 'Patient also takes monoamine oxidase inhibitors', 'B': 'Patient is elderly', 'C': 'Patient is bulimic', 'D': 'Patient works as a wine taster', 'E': 'Patient is pregnant'},
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C: Patient is bulimic
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Answer the following medical question with one of the provided options:
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Q:A 10-month-old boy is being treated for a rare kind of anemia and is currently being evaluated for a bone marrow transplant. The patient’s mother presents to an appointment with their pediatrician after having done some online research. She has learned that the majority of patients inherit this condition as an autosomal dominant mutation. As a result of the genetic mutation, there is impaired erythropoiesis, leading to macrocytic red blood cells without hypersegmented neutrophils. She also read that children who survive will eventually present with short stature and craniofacial abnormalities. Which of the following is true about this patient’s condition?? {'A': 'Splenectomy is a treatment option', 'B': 'Occurs due to an inability to convert orotic acid to uridine monophosphate (UMP)', 'C': 'Fetal hemoglobin level is elevated', 'D': 'Occurs due to auto-antibodies against the parietal cells of the stomach', 'E': 'Occurs due to a defect in lymphoblasts and erythroid progenitor cells'},
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C: Fetal hemoglobin level is elevated
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Q:A 44-year-old woman comes to the physician for the evaluation of a 1-month history of fatigue and difficulty swallowing. During this period, she has also had dry skin, thinning hair, and rounding of her face. She has type 1 diabetes mellitus and rheumatoid arthritis. Her father had a thyroidectomy for papillary thyroid cancer. The patient had smoked one pack of cigarettes daily for 20 years but quit 3 years ago. She drinks 2–3 glasses of wine daily. Her current medications include insulin, omeprazole, and daily ibuprofen. She appears well. Her temperature is 36.3°C (97.3°F), pulse is 62/min, and blood pressure is 102/76 mm Hg. Examination of the neck shows a painless, diffusely enlarged thyroid gland. Cardiopulmonary examination shows no abnormalities. Further evaluation is most likely to show which of the following?? {'A': 'Large irregular nuclei, nuclear grooves, and Psammoma bodies on thyroid biopsy', 'B': 'Increased uptake on radioactive iodine scan in discrete 1-cm area', 'C': 'Diffusely increased uptake on a radioactive iodine scan', 'D': 'Positive immunohistochemical stain for calcitonin on thyroid biopsy', 'E': 'Positive thyroid peroxidase antibodies and thyroglobulin antibodies in serum'},
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E: Positive thyroid peroxidase antibodies and thyroglobulin antibodies in serum
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Answer the following medical question with one of the provided options:
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Q:A 64-year-old man presents to his primary care provider after noticing the development of a blistering rash. The patient states that his symptoms began 1 week ago after he noticed a blister develop on the inside of his mouth that eventually ruptured. Over the past several days, he has noticed several more blisters on his torso. The patient denies a fever or any other symptoms. He has a history of high blood pressure, for which he takes hydrochlorothiazide. He is otherwise healthy and denies any recent changes to his medication. Today, the patient’s temperature is 99.0°F (37.2°C), blood pressure is 124/84 mmHg, pulse is 66/min, and respirations are 12/min. On exam, the patient’s mouth is notable for a previously ruptured blister on his left buccal mucosa. On his left flank and anterior abdomen are scattered 10-15-cm bullae that appear flaccid and filled with serous fluid. The lesions are erythematous but there is no surrounding erythema. On manual rubbing of the skin near the lesions, new blisters form within minutes. Which of the following is involved in the pathogenesis of this disease?? {'A': 'Autoantibodies against hemidesmosomes', 'B': 'Exotoxin destroying keratinocyte attachments', 'C': 'IgA antibodies depositing in the dermal papillae', 'D': 'IgG against transmembrane proteins between cells', 'E': 'Viral infection of skin'},
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D: IgG against transmembrane proteins between cells
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Answer the following medical question with one of the provided options:
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Q:An investigator is attempting to develop a blood test to diagnose sporadic Creutzfeld-Jacob disease (CJD). She has collected several tissue samples from adults who were diagnosed with CJD. After performing a comprehensive tissue analysis, she has identified two amino acid sequences on the affected proteins that are highly consistent across samples. She then creates antibodies that are highly specific to those amino acid sequences and is interested in using those antibodies to identify similar sequences in individuals suspected of having CJD. Which of the following tests would be most helpful in identifying these individuals?? {'A': 'Southern blot', 'B': 'Western blot', 'C': 'Northern blot', 'D': 'Southwestern blot', 'E': 'Polymerase chain reaction'},
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B: Western blot
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Q:A 52-year-old woman presents to her primary care physician for her annual checkup. She lost her job 6 months ago and since then she has been feeling worthless because nobody wants to hire her. She also says that she is finding it difficult to concentrate, which is exacerbated by the fact that she has lost interest in activities that she used to love such as doing puzzles and working in the garden. She says that she is sleeping over 10 hours every day because she says it is difficult to find the energy to get up in the morning. She denies having any thoughts about suicide. Which of the following neurotransmitter profiles would most likely be seen in this patient?? {'A': 'Decreased acetylcholine', 'B': 'Decreased gamma-aminobutyric acid', 'C': 'Decreased serotonin and norepinephrine', 'D': 'Increased dopamine', 'E': 'Increased norepinephrine'},
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C: Decreased serotonin and norepinephrine
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Q:A 46-year-old woman presents to a psychiatrist for evaluation. Three months prior, the patient moved to a new apartment building, and since then, she has become increasingly convinced that her doorman has been stealing her packages and going into her apartment while she is not home. She states that objects do not stay where she leaves them, and sometimes she expects mail but never receives it. She has filed numerous complaints with her leasing company. The building has 24-hour security footage, however, which has never shown any other person entering her apartment. On further questioning, the patient denies audiovisual hallucinations or changes in sleep, mood, energy levels, or eating. The family reports that her behavior and affect have not changed. The patient works as a pharmacist. She has no psychiatric history, although her father had a history major depressive disorder. Which of the following is the likely diagnosis?? {'A': 'Adjustment disorder', 'B': 'Delusional disorder', 'C': 'Narcissistic personality disorder', 'D': 'Paranoid personality disorder', 'E': 'Schizotypal personality disorder'},
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B: Delusional disorder
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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 colorectal cancer comes to the physician for follow-up examination after undergoing a sigmoid colectomy. The physician recommends adjuvant chemotherapy with an agent that results in single-stranded DNA breaks. This chemotherapeutic agent most likely has an effect on which of the following enzymes?? {'A': 'Telomerase', 'B': 'Topoisomerase II', 'C': 'Helicase', 'D': 'DNA polymerase III', 'E': 'Topoisomerase I'},
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E: Topoisomerase I
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Answer the following medical question with one of the provided options:
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Q:A previously healthy 10-year-old boy is brought to the emergency department 15 minutes after he had a seizure. His mother reports that he complained of sudden nausea and seeing “shiny lights,” after which the corner of his mouth and then his face began twitching. Next, he let out a loud scream, dropped to the floor unconscious, and began to jerk his arms and legs as well for about two minutes. On the way to the hospital, the boy regained consciousness, but was confused and could not speak clearly for about five minutes. He had a fever and sore throat one week ago which improved after treatment with acetaminophen. He appears lethargic and cannot recall what happened during the episode. His vital signs are within normal limits. He is oriented to time, place, and person. Deep tendon reflexes are 2+ bilaterally. There is muscular pain at attempts to elicit deep tendon reflexes. Physical and neurologic examinations show no other abnormalities. Which of the following is the most likely diagnosis?? {'A': 'Focal to bilateral tonic-clonic seizure', 'B': 'Convulsive syncope', 'C': 'Sydenham chorea', 'D': 'Generalized myoclonic seizure', 'E': 'Generalized tonic-clonic seizure\n"'},
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A: Focal to bilateral tonic-clonic seizure
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Q:A 45-year-old woman is in a high-speed motor vehicle accident and suffers multiple injuries to her extremities and abdomen. In the field, she was bleeding profusely bleeding and, upon arrival to the emergency department, she is lethargic and unable to speak. Her blood pressure on presentation is 70/40 mmHg. The trauma surgery team recommends emergency exploratory laparotomy. While the patient is in the trauma bay it is noted in the chart that the patient is a Jehovah's witness, and you are aware that her religion does not permit her to receive a blood transfusion. No advanced directives are available, but her ex-husband is contacted by phone and states that although they haven't spoken in a while, he thinks she would not want a transfusion. Which of the following is an appropriate next step?? {'A': 'Provide transfusions as needed', 'B': 'Ask ex-husband to bring identification to the trauma bay', 'C': "Withhold transfusion based on ex-husband's request", 'D': 'Obtain an ethics consult', 'E': 'Obtain a court order for transfusion'},
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A: Provide transfusions as needed
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Q:A 14-year-old boy is brought to the office by his mother with the complaint of increasing bilateral nasal obstruction for the past 5 months. He also complains of continuous bilateral nasal discharge. He adds that he no longer has any sense of smell of foods. Past medical history is significant for growth retardation and chronic bronchitis at the age of 6 years. Anterior rhinoscopy reveals multiple semi-transparent, soft and mobile masses in the middle meatus. Which of the following is the most likely etiology of this patient’s condition?? {'A': 'Septal deviation', 'B': 'Nasal polyposis', 'C': 'Foreign body', 'D': 'Nonallergic rhinopathy', 'E': 'Juvenile nasopharyngeal angiofibroma'},
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B: Nasal polyposis
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Answer the following medical question with one of the provided options:
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Q:A 46-year-old man presents to a clinic with a complaint of intermittent flank pain bilaterally for 5 days. The pain is colicky in nature and radiates to the groin. The patient took an old prescription (hyoscyamine) and got some relief. He has nausea, but had not vomited until now. Although he has a history of renal stones, he denies any blood in the urine or stool and gives no history of fevers, changes in bowel habits, or abdominal distension. He does not have joint pain. On examination of the abdomen, the is no organomegaly and the bowel sounds are normal. The blood test report reveals the following: Serum calcium 8.9 mg/dL Serum uric acid 8.9 mg/dL Serum creatinine 1.1 mg /dL The urinalysis shows the following: pH 6.0 Pus cells none RBCs 1–2/HPF Epithelial cells 1/HPF Protein negative Ketones negative Crystals oxalate (plenty) An abdominal ultrasound shows echogenic medullary pyramids with multiple dense echogenic foci in both kidneys, that cast posterior acoustic shadows. Which of the following best describes the pathogenesis of the disease process?? {'A': 'Usually idiopathic in nature', 'B': 'Acquired condition secondary to dialysis', 'C': 'Developmental anomaly characterized by cystic dilatation of the collecting tubules in the renal pyramids', 'D': 'Neoplastic changes in the proximal tubular cells of the kidneys', 'E': 'Vascular anomalies and genetic mutations leading to maldevelopment of the kidneys'},
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C: Developmental anomaly characterized by cystic dilatation of the collecting tubules in the renal pyramids
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Answer the following medical question with one of the provided options:
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Q:A 44-year-old man comes to the physician because of fatigue and increased straining during defecation for 3 months. During this time, he has lost 5 kg (12 lb) despite no change in appetite. He has a family history of colon cancer in his maternal uncle and maternal grandfather. His mother died of ovarian cancer at the age of 46. Physical examination shows conjunctival pallor. His hemoglobin concentration is 11.2 g/dL, hematocrit is 34%, and mean corpuscular volume is 76 μm3. Colonoscopy shows an exophytic mass in the ascending colon. Pathologic examination of the resected mass shows a poorly differentiated adenocarcinoma. Genetic analysis shows a mutation in the MSH2 gene. Which of the following is the most likely diagnosis?? {'A': 'Familial adenomatous polyposis', 'B': 'Turcot syndrome', 'C': 'Peutz-Jeghers syndrome', 'D': 'Gardner syndrome', 'E': 'Lynch syndrome'},
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E: Lynch syndrome
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Answer the following medical question with one of the provided options:
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Q:A 45-year-old woman presents to the emergency department with a headache, fevers with chills, rigors, and generalized joint pain for the past week. She also complains of a progressive rash on her left arm. She says that a few days ago she noticed a small, slightly raised lesion resembling an insect bite mark, which had a burning sensation. The medical and surgical histories are unremarkable. She recalls walking in the woods 2 weeks prior to the onset of symptoms, but does not recall finding a tick on her body. On examination, the temperature is 40.2°C (104.4°F). A circular red rash measuring 10 cm x 5 cm in diameter is noted on the left arm, as shown in the accompanying image. The remainder of her physical examination is unremarkable. The tick causing her disease is also responsible for the transmission of which of the following pathogens?? {'A': 'Plasmodium vivax', 'B': 'Babesia microti', 'C': 'Ehrlichia', 'D': 'Rickettsia rickettsii', 'E': 'Rickettsia typhi'},
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B: Babesia microti
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Q:A 30-year-old man comes to the physician because of recurrent episodes of right-sided jaw pain over the past 3 months. The patient describes the pain as dull. He says it worsens throughout the day and with chewing, and that it can also be felt in his right ear. He also reports hearing a cracking sound while eating. Over the past 2 months, he has had several episodes of severe headache that improves slightly with ibuprofen intake. Vital signs are within normal limits. Physical examination shows limited jaw opening. Palpation of the face shows facial muscle spasms. Which of the following is the most likely underlying cause of this patient's symptoms?? {'A': 'Dental abscess', 'B': 'Trigeminal nerve compression', 'C': 'Infection of the mandible', 'D': 'Dysfunction of the temporomandibular joint', 'E': 'Chronic inflammation of the sinuses\n"'},
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D: Dysfunction of the temporomandibular joint
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Answer the following medical question with one of the provided options:
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Q:A 55-year-old male is hospitalized for acute heart failure. The patient has a 20-year history of alcoholism and was diagnosed with diabetes mellitus type 2 (DM2) 5 years ago. Physical examination reveals ascites and engorged paraumbilical veins as well as 3+ pitting edema around both ankles. Liver function tests show elevations in gamma glutamyl transferase and aspartate transaminase (AST). Of the following medication, which most likely contributed to this patient's presentation?? {'A': 'Glargine', 'B': 'Glipizide', 'C': 'Metformin', 'D': 'Pioglitazone', 'E': 'Pramlintide'},
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D: Pioglitazone
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Q:A 67-year-old man with hypertension comes to the physician because of a 5-month history of a facial rash. He occasionally feels burning or stinging over the affected area. His only medication is lisinopril. Physical examination shows the findings in the photograph. Which of the following is the strongest predisposing factor for this patient's skin condition?? {'A': 'Cutibacterium colonization', 'B': 'Lisinopril therapy', 'C': 'Alcohol consumption', 'D': 'Filaggrin gene mutation', 'E': 'Complement component 1q deficiency'},
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C: Alcohol consumption
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Q:A 65-year-old woman comes to the physician for the evaluation of sharp, stabbing pain in the lower back for 3 weeks. The pain radiates to the back of her right leg and is worse at night. She reports decreased sensation around her buttocks and inner thighs. During the last several days, she has had trouble urinating. Three years ago, she was diagnosed with breast cancer and was treated with lumpectomy and radiation. Her only medication is anastrozole. Her temperature is 37°C (98.6°F), pulse is 80/min, respirations are 12/min, and blood pressure is 130/70 mm Hg. Neurologic examination shows 4/5 strength in the left lower extremity and 2/5 strength in her right lower extremity. Knee and ankle reflexes are 1+ on the right. The resting anal sphincter tone is normal but the squeeze tone is reduced. Which of the following is the most likely diagnosis?? {'A': 'Conus medullaris syndrome', 'B': 'Cauda equina syndrome', 'C': 'Central cord syndrome', 'D': 'Brown-sequard syndrome', 'E': 'Anterior spinal cord syndrome'},
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B: Cauda equina syndrome
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Answer the following medical question with one of the provided options:
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Q:A 9-year-old boy presents to the emergency department with a 12 hour history of severe vomiting and increased sleepiness. He experienced high fever and muscle pain about 5 days prior to presentation, and his parents gave him an over the counter medication to control the fever at that time. On presentation, he is found to be afebrile though he is still somnolent and difficult to arouse. Physical exam reveals hepatomegaly and laboratory testing shows the following results: Alanine aminotransferase: 85 U/L Aspartate aminotransferase: 78 U/L Which of the following is the most likely cause of this patient's neurologic changes?? {'A': 'Bacterial sepsis', 'B': 'Cerebral edema', 'C': 'Drug overdose', 'D': 'Subarachnoid hemorrhage', 'E': 'Viral meningitis'},
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B: Cerebral edema
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Answer the following medical question with one of the provided options:
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Q:A 15-year-old boy presents to the emergency room with severe lower abdominal pain that awoke him from sleep about 3 hours ago. The pain is sharp and radiates to his left thigh. While in the emergency room, the patient experiences one episode of vomiting. His temperature is 99.3°F (37.4°C), blood pressure is 126/81 mmHg, pulse is 119/min, respirations are 14/min, and oxygen saturation is 99% on room air. Abdominal examination reveals no tenderness in all 4 quadrants. Scrotal examination reveals an elevated left testicle that is diffusely tender. Stroking of the patient's inner thigh on the left side does not result in elevation of the testicle. What is the next step in the management of this patient?? {'A': 'CT scan of abdomen and pelvis', 'B': 'IV antibiotics', 'C': 'Observation and morphine', 'D': 'Surgical exploration', 'E': 'Testicular doppler ultrasound'},
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D: Surgical exploration
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Q:A 62-year-old man comes to the physician because of increasing pain in his right leg for 2 months. The pain persists throughout the day and is not relieved by rest. He tried taking acetaminophen, but it provided no relief from his symptoms. There is no family history of serious illness. He does not smoke. He occasionally drinks a beer. Vital signs are within normal limits. On examination, the right tibia is bowing anteriorly; range of motion is limited by pain. An x-ray of the right leg shows a deformed tibia with multiple lesions of increased and decreased density and a thickened cortical bone. Laboratory studies show markedly elevated serum alkaline phosphatase and normal calcium and phosphate levels. This patient is most likely to develop which of the following complications?? {'A': 'Renal insufficiency', 'B': 'High-output cardiac failure', 'C': 'Osteosarcoma', 'D': 'Impaired hearing', 'E': 'Pancytopenia\n"'},
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D: Impaired hearing
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Q:A 37-year-old woman presents to her primary care physician for bilateral nipple discharge. The patient states that she has observed a milky discharge coming from her nipples for the past month. On review of systems, the patient states that she has felt fatigued lately and has experienced decreased libido. She also endorses headaches that typically resolve by the middle of the day and a 5 pound weight gain this past month. The patient has a past medical history of obesity, schizophrenia, and constipation. Her temperature is 99.5°F (37.5°C), blood pressure is 145/95 mmHg, pulse is 60/min, respirations are 15/min, and oxygen saturation is 98% on room air. On physical exam, you note an obese, fatigued-appearing woman. Dermatologic exam reveals fine, thin hair over her body. Cardiopulmonary exam is within normal limits. Neurological exam reveals cranial nerves II-XII as grossly intact. The patient exhibits 1+ sluggish reflexes. Which of the following is the most likely diagnosis?? {'A': 'Viral infection of the thyroid gland', 'B': 'Autoimmune destruction of the thyroid gland', 'C': 'Protein-secreting CNS mass', 'D': 'Dopamine blockade in the tuberoinfundibular pathway', 'E': 'Normal pregnancy'},
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C: Protein-secreting CNS mass
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Q:A 29-year-old woman presents to a medical office complaining of fatigue, nausea, and vomiting for 1 week. Recently, the smell of certain foods makes her nauseous. Her symptoms are more pronounced in the mornings. The emesis is clear-to-yellow without blood. She has had no recent travel out of the country. The medical history is significant for peptic ulcer, for which she takes pantoprazole. The blood pressure is 100/60 mm Hg, the pulse is 70/min, and the respiratory rate is 12/min. The physical examination reveals pale mucosa and conjunctiva, and bilateral breast tenderness. The LMP was 9 weeks ago. What is the most appropriate next step in the management of this patient?? {'A': 'Abdominal CT with contrast', 'B': 'Beta-HCG levels and a transvaginal ultrasound', 'C': 'Beta-HCG levels and a transabdominal ultrasound', 'D': 'Beta-HCG levels and a pelvic CT', 'E': 'Abdominal x-ray'},
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B: Beta-HCG levels and a transvaginal ultrasound
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Q:A 57-year-old immigrant from Nigeria presents to the emergency department for sudden, severe pain and swelling in her lower extremity. She was at a rehabilitation hospital when her symptoms became apparent. The patient has a past medical history of obesity, diabetes, bipolar disorder, and tonic-clonic seizures. Her current medications include metformin, insulin, lisinopril, and valproic acid. The patient is a prominent IV drug and alcohol user who has presented to the ED many times for intoxication. On physical exam you note anasarca and asymmetric lower extremity swelling. Based on the results of a doppler ultrasound of her swollen lower extremity, heparin is started. The patient is then transferred to the general medicine floor for continued management. Laboratory studies are shown below. Serum: Na+: 137 mEq/L K+: 5.5 mEq/L Cl-: 100 mEq/L HCO3-: 24 mEq/L Urea nitrogen: 22 mg/dL Ca2+: 5.7 mg/dL Creatinine: 1.7 mg/dL Glucose: 70 mg/dL What is the most likely diagnosis?? {'A': 'Factor V Leiden', 'B': 'Antithrombin III deficiency', 'C': 'Prothrombin gene mutation', 'D': 'Liver failure', 'E': 'Nephrotic syndrome'},
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E: Nephrotic syndrome
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Q:A 41-year-old woman presents to the emergency room with chest pain. She has had progressive substernal chest pain accompanied by weakness and mild shortness of breath for the past 2 hours. Her past medical history is notable for poorly controlled systemic lupus erythematosus (SLE), Sjogren syndrome, and interstitial lung disease. She was hospitalized last year with pericarditis presumed to be from SLE. Her temperature is 98.6°F (37°C), blood pressure is 106/56 mmHg, pulse is 132/min, and respirations are 26/min. On exam, the skin overlying the internal jugular vein fills at 9 cm above the sternal angle and distant heart sounds are appreciated. There is no friction rub. She is given 1000cc of intravenous fluids with no appreciable change in her blood pressure. An electrocardiogram in this patient would most likely reveal which of the following findings?? {'A': 'Peaked T waves', 'B': 'ST elevations in leads II, III, and aVF', 'C': 'Polymorphic P waves', 'D': 'Wide QRS complexes with no P waves', 'E': 'QRS complex height variation'},
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E: QRS complex height variation
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Q:A 14-year-old girl is brought to the emergency department because of a 3-day history of worsening confusion, high-grade fever, and a productive cough. She has had recurrent respiratory infections and bulky, foul-smelling, oily stools since infancy. She is at the 14th percentile for height and 8th percentile for weight. Despite appropriate care, the patient dies 2 days after admission. Autopsy of the lungs shows bronchial mucus plugging and bronchiectasis. Which of the following is the most likely underlying cause of this patient's condition?? {'A': 'Deletion of phenylalanine codon on chromosome 7', 'B': 'Deficiency in adenosine deaminase', 'C': 'Mutation of DNAI1 gene on chromosome 9', 'D': 'Deficiency in apolipoprotein B-48', 'E': 'Deficiency in alpha-1 antitrypsin'},
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A: Deletion of phenylalanine codon on chromosome 7
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Q:A 25-year-old woman presents to a physician for a new patient physical exam. Aside from occasional shin splints, she has a relatively unremarkable medical history. She takes oral contraceptive pills as scheduled and a multivitamin daily. She reports no known drug allergies. All of her age appropriate immunizations are up to date. Her periods have been regular, occurring once every 28 to 30 days with normal flow. She is sexually active with two partners, who use condoms routinely. She works as a cashier at the local grocery store. Her mother has diabetes and coronary artery disease, and her father passed away at age 45 after being diagnosed with colon cancer at age 40. Her grand-aunt underwent bilateral mastectomies after being diagnosed with breast cancer at age 60. Her physical exam is unremarkable. Which of the following is the best recommendation for this patient?? {'A': 'Colonoscopy in 5 years', 'B': 'Colonoscopy in 10 years', 'C': 'Pap smear with human papillomavirus (HPV) DNA testing now', 'D': 'Pap smear in 5 years', 'E': 'Mammogram now'},
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A: Colonoscopy in 5 years
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Q:A 35-year-old computer programmer presents to the psychiatrist at the request of his mother for his oddities. He explains that he wears an aluminum foil cap while he works because he does not want extraterrestial life to steal his thoughts. He spends his free time building a radio transmitter to contact distant planets. He denies any delusions or hallucinations. He claims that nothing is wrong with his eccentricities and is happy the way his life is. Which of the following personality disorders does this male most likely have?? {'A': 'Schizoid', 'B': 'Schizotypal', 'C': 'Paranoid', 'D': 'Narcissistic', 'E': 'Borderline'},
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B: Schizotypal
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Q:A 45-year-old homeless man is brought to the emergency department after he was found unconscious at the park. The patient's past medical history is unknown; however, he was admitted to the emergency department 2 times over the past year for severe pain treated with hydromorphone and IV fluids. His temperature is 100°F (37.8°C), blood pressure is 97/48 mmHg, pulse is 140/min, respirations are 18/min, and oxygen saturation is 99% on room air. The patient smells of alcohol and is covered in emesis. Basic laboratory values are ordered as seen below. Hemoglobin: 6 g/dL Hematocrit: 20% Leukocyte count: 6,500/mm^3 with normal differential Platelet count: 197,000/mm^3 Reticulocyte count: 0.4% Which of the following is associated with the most likely diagnosis?? {'A': 'Benign genetic carrier condition', 'B': 'Folate deficiency', 'C': 'Iron deficiency', 'D': 'Parvovirus B19 infection', 'E': 'Vitamin B12 deficiency'},
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D: Parvovirus B19 infection
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Q:A 48-year-old patient with congestive heart failure is brought into the emergency room after an attempted suicide. He was found by his daughter whom he lives with while trying to suffocate himself. He had recently moved in with his daughter after his house went into foreclosure. The daughter lives in a small two-bedroom apartment that was recently baby proofed for her daughter. She cares for him and tries to help him with all of his medical appointments and taking his medications on time. He is noted to still consume moderate amounts of alcohol. She is concerned her father might try this again because his aunt died from suicide. Which of the circumstances is protective for this patient?? {'A': 'Having a support system', 'B': 'Lack of access to sharp objects', 'C': 'Compliance with his medication', 'D': 'Lack of illicit drug use', 'E': 'Lack of immediate family history of suicide'},
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A: Having a support system
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Q:A 52-year-old woman complains of severe vomiting for the past 2 hours. She recently had a chemotherapy session for breast cancer. She denies a history of any relevant gastrointestinal diseases, including GERD. The physical exam does not demonstrate any epigastric or abdominal tenderness. The last bowel movement was yesterday and was normal. What is the primary mechanism of the drug which would be prescribed to treat her chief complaint?? {'A': 'D1 blocker', 'B': '5-HT2 blocker', 'C': '5-HT4 blocker', 'D': '5-HT1 blocker', 'E': '5-HT3 blocker'},
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E: 5-HT3 blocker
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Q:A 25-year-old male visits his primary care physician with complaints of hemoptysis and dysuria. Serum blood urea nitrogen and creatinine are elevated, blood pressure is 160/100 mm Hg, and urinalysis shows hematuria and RBC casts. A 24-hour urine excretion yields 1 gm/day protein. A kidney biopsy is obtained, and immunofluorescence shows linear IgG staining in the glomeruli. Which of the following antibodies is likely pathogenic for this patient’s disease?? {'A': 'Anti-DNA antibody', 'B': 'Anti-neutrophil cytoplasmic antibody (C-ANCA)', 'C': 'Anti-neutrophil perinuclear antibody (P-ANCA)', 'D': 'Anti-glomerular basement membrane antibody (Anti-GBM)', 'E': 'Anti-phospholipid antibody'},
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D: Anti-glomerular basement membrane antibody (Anti-GBM)
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Q:A 31-year-old woman with multiple sclerosis comes to the physician because of a 4-day history of cramps in her left leg. Physical examination shows flexion of the left hip and increased tone in the thigh muscles. A local anesthetic block of which of the following nerves would most likely improve this patient's condition the most?? {'A': 'Obturator nerve', 'B': 'Sciatic nerve', 'C': 'Inferior gluteal nerve', 'D': 'Femoral nerve', 'E': 'Superior gluteal nerve'},
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D: Femoral nerve
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Q:A 64-year-old male with a history of coronary artery disease, hypertension, hyperlipidemia, and type II diabetes presents to his primary care physician with increasing shortness of breath and ankle swelling over the past month. Which of the following findings is more likely to be seen in left-sided heart failure and less likely to be seen in right-sided heart failure?? {'A': 'Increased ejection fraction on echocardiogram', 'B': 'Basilar crackles on pulmonary auscultation', 'C': 'Hepatojugular reflex', 'D': 'Lower extremity edema', 'E': 'Abdominal fullness'},
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B: Basilar crackles on pulmonary auscultation
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Q:A 27-year-old woman, gravida 1, para 1, presents to the obstetrics and gynecology clinic because of galactorrhea, fatigue, cold intolerance, hair loss, and unintentional weight gain for the past year. She had placenta accreta during her first pregnancy with an estimated blood loss of 2,000 mL. Her past medical history is otherwise unremarkable. Her vital signs are all within normal limits. Which of the following is the most likely cause of her symptoms?? {'A': 'Addison’s disease', 'B': 'Cushing syndrome', 'C': 'Hashimoto thyroiditis', 'D': 'Pituitary adenoma', 'E': 'Sheehan’s syndrome'},
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E: Sheehan’s syndrome
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Answer the following medical question with one of the provided options:
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Q:A 54-year-old man is referred to a tertiary care hospital with a history of 5 months of progressive difficulty in walking and left leg numbness. He first noticed mild gait unsteadiness and later developed gradual right leg weakness. His left leg developed progressive numbness and tingling. His blood pressure is 138/88 mm Hg, the heart rate is 72/min, and the temperature is 36.7°C (98.2°F). On physical examination, he is alert and oriented to person, place, and time. Cranial nerves are intact. Muscle strength is 5/5 in both upper extremities and left lower extremity, but 3/5 in the right leg with increased tone. The plantar reflex is extensor on the right. Pinprick sensation is decreased on the left side below the umbilicus. Vibration and joint position senses are decreased in the right foot and leg. All sensations are normal in the upper extremities. Finger-to-nose and heel-to-shin testing are normal. This patient’s lesion is most likely located in which of the following parts of the nervous system?? {'A': 'Left frontal lobe', 'B': 'Left hemi-spinal cord', 'C': 'Right frontal lobe', 'D': 'Right hemi-spinal cord', 'E': 'Right pons'},
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D: Right hemi-spinal cord
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Q:An 18-year-old woman presents to the emergency department with severe right lower quadrant discomfort and stomach pain for the past day. She has no significant past medical history. She states that she is sexually active and uses oral contraceptive pills for birth control. Her vital signs include: blood pressure 127/81 mm Hg, pulse 101/min, respiratory rate 19/min, and temperature 39.0°C (102.2°F). Abdominal examination is significant for focal tenderness and guarding in the right lower quadrant. Blood is drawn for lab tests which reveal the following: Hb% 13 gm/dL Total count (WBC) 15,400 /mm3 Differential count Neutrophils: Segmented 70% Band Form 5% Lymphocytes 20% Monocytes 5% What is the next best step in the management of this patient?? {'A': 'Pelvic exam', 'B': 'Ultrasound of the pelvis', 'C': 'Ultrasound of the appendix', 'D': 'Upper gastrointestinal series', 'E': 'Upper gastrointestinal endoscopy'},
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C: Ultrasound of the appendix
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Answer the following medical question with one of the provided options:
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Q:A group of neurologists develop a new blood test for Alzheimer's. They are optimistic about the test, as they have found that for any given patient, the test repeatedly produces very similar results. However, they find that the new test results are not necessarily consistent with the gold standard of diagnosis. How would this new test most accurately be described?? {'A': 'Valid', 'B': 'Reliable', 'C': 'Biased', 'D': 'Valid and reliable', 'E': 'Neither valid nor reliable'},
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B: Reliable
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Q:A 6-year-old boy presents with fever, sore throat, hoarseness, and neck enlargement. The symptoms started 3 days ago and progressed gradually with an elevated temperature and swollen lymph nodes. His family immigrated recently from Honduras. He was born via spontaneous vaginal delivery at 39 weeks after an uneventful gestational period and he is now on a catch-up vaccination schedule. He lives with several family members, including his parents, in a small apartment. No one in the apartment smokes tobacco. On presentation, the patient’s blood pressure is 110/75 mm Hg, heart rate is 103/min, respiratory rate is 20/min, and temperature is 39.4°C (102.9°F). On physical examination, the child is acrocyanotic and somnolent. There is widespread cervical edema and enlargement of the cervical lymph nodes. The tonsils are covered with a gray, thick membrane which spreads beyond the tonsillar bed and reveals bleeding, erythematous mucosa with gentle scraping. The lungs are clear to auscultation. Which of the following is the target of the virulence factor produced by the pathologic organism infecting this child?? {'A': 'SNAP-25', 'B': 'ADP-ribosylation factor 6', 'C': 'Eukaryotic elongation factor-2 (eEF-2)', 'D': 'Desmoglein', 'E': 'RNA polymerase II'},
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C: Eukaryotic elongation factor-2 (eEF-2)
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Answer the following medical question with one of the provided options:
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Q:A 45-year-old unconscious man is brought to the emergency department by a friend who witnessed him collapse. They were working in a greenhouse spraying the vegetables when the man started to complain of blurred vision and nausea. On the way to the hospital, the man lost consciousness and lost bladder continence. The patient’s vital signs are as follows: blood pressure 95/60 mm Hg; heart rate 59/min; respiratory rate 22/min; and temperature 36.0℃ (96.8℉). On examination, he is unconscious with a GCS score of 7. His pupils are contracted and react poorly to light. Lung auscultation reveals diffuse wheezing. Cardiac auscultation is significant for bradycardia. Abdominal auscultation reveals increased bowel sounds. A cardiac monitor shows bradycardia with grade 2 AV-block. Which of the following leads to the cardiac manifestations seen in this patient?? {'A': 'Activation of M2-cholinergic receptors', 'B': 'Inhibition of β1-adrenergic receptors', 'C': 'Activation of β2-adrenergic receptors', 'D': 'Activation of M1-cholinergic receptors', 'E': 'Inhibition of M2-cholinergic receptors'},
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A: Activation of M2-cholinergic receptors
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Q:A 10-year-old boy is brought to the physician by his mother because of a 2-day history of fever and productive cough. He has had similar episodes sporadically in the past with frequent episodes of thick, discolored nasal discharge. Physical examination shows diffuse crackles and rhonchi. An x-ray of the chest is shown. The most likely cause of recurrent infections in this patient is a dysfunction of which of the following cell types?? {'A': 'Alveolar macrophages', 'B': 'Ciliated columnar cells', 'C': 'Type I pneumocytes', 'D': 'Club cells', 'E': 'Type II pneumocytes'},
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B: Ciliated columnar cells
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Answer the following medical question with one of the provided options:
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Q:A study is conducted in a hospital to estimate the prevalence of handwashing among healthcare workers. All of the hospital staff members are informed that the study is being conducted for 1 month, and the study method will be a passive observation of their daily routine at the hospital. A total of 89 medical staff members give their consent for the study, and they are followed for a month. This study could most likely suffer from which of the following biases?? {'A': 'Confounding bias', 'B': 'Observer-expectancy bias', 'C': 'Berksonian bias', 'D': 'Attrition bias', 'E': 'Hawthorne effect'},
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E: Hawthorne effect
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Q:A 59-year-old man with angina pectoris comes to the physician because of a 6-month history of shortness of breath on exertion that improves with rest. He has hypertension and hyperlipidemia. Current medications include aspirin, metoprolol, and nitroglycerine. Echocardiography shows left ventricular septal and apical hypokinesis. Cardiac catheterization shows 96% occlusion of the left anterior descending artery. The patient undergoes angioplasty and placement of a stent. The patient's shortness of breath subsequently resolves and follow-up echocardiography one week later shows normal regional contractile function. Which of the following is the most accurate explanation for the changes in echocardiography?? {'A': 'Unstable angina pectoris', 'B': 'Stress cardiomyopathy', 'C': 'Hibernating myocardium', 'D': 'Myocardial scarring', 'E': 'Cardiac remodeling'},
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C: Hibernating myocardium
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Answer the following medical question with one of the provided options:
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Q:A 25-year-old woman is brought to the emergency department 12 hours after ingesting 30 tablets of an unknown drug in a suicide attempt. The tablets belonged to her father, who has a chronic heart condition. She has had nausea and vomiting. She also reports blurring and yellowing of her vision. Her temperature is 36.7°C (98°F), pulse is 51/min, and blood pressure is 108/71 mm Hg. Abdominal examination shows diffuse tenderness with no guarding or rebound. Bowel sounds are normal. An ECG shows prolonged PR-intervals and flattened T-waves. Further evaluation is most likely to show which of the following electrolyte abnormalities?? {'A': 'Increased serum Na+', 'B': 'Decreased serum K+', 'C': 'Increased serum Ca2+', 'D': 'Decreased serum Na+', 'E': 'Increased serum K+'},
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E: Increased serum K+
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Q:A 78-year-old man presents with fatigue and exertional dyspnea. The patient says that symptoms onset gradually 4 weeks ago and have not improved. He denies any history of anemia or nutritional deficiency. Past medical history is significant for ST-elevation myocardial infarction 6 months ago, status post coronary artery bypass graft, complicated by recurrent hemodynamically unstable ventricular tachycardia. Current medications are rosuvastatin, aspirin, and amiodarone. His blood pressure is 100/70 mm Hg, the pulse is 71/min, the temperature is 36.5°C (97.7°F), and the respiratory rate is 16/min. On physical examination, patient appears lethargic and tired. Skin is dry and coarse, and there is generalized pitting edema present. A complete blood count (CBC) and a peripheral blood smear show evidence of normochromic, normocytic anemia. Additional laboratory tests reveal decreased serum level of iron, decreased TIBC (total iron-binding capacity) and increased serum level of ferritin. Which of the following is the most likely etiology of the anemia in this patient?? {'A': 'Iron deficiency anemia', 'B': 'Hemolytic anemia', 'C': 'Anemia of chronic disease', 'D': 'Pernicious anemia', 'E': 'Thalassemia'},
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C: Anemia of chronic disease
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Q:A 72-year-old man presents to the emergency department after a fall. The patient was found lying down on the floor in his room in his retirement community. The patient has a past medical history of Alzheimer dementia and a prosthetic valve. His current medications include donepezil and warfarin. His temperature is 97.7°F (36.5°C), blood pressure is 85/50 mmHg, pulse is 160/min, respirations are 13/min, and oxygen saturation is 97% on room air. That patient is started on IV fluids and a type and screen is performed. Laboratory values are ordered as seen below. Hemoglobin: 13 g/dL Hematocrit: 39% Leukocyte count: 5,500 cells/mm^3 with normal differential Platelet count: 225,000/mm^3 INR: 2.5 AST: 10 U/L ALT: 12 U/L A chest radiograph and EKG are performed and are within normal limits. A full physical exam is within normal limits. The patient’s vitals are repeated. His temperature is 99.5°F (37.5°C), blood pressure is 110/70 mmHg, pulse is 90/min, respirations are 10/min, and oxygen saturation is 98% on room air. Which of the following is the best next step in management?? {'A': 'CT scan', 'B': 'Exploratory laparoscopy', 'C': 'Exploratory laparotomy', 'D': 'Fresh frozen plasma', 'E': 'Urgent blood transfusion'},
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A: CT scan
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Q:A 46-year-old woman presents to her primary care physician for her annual examination. At her prior exam one year earlier, she had a Pap smear which was within normal limits. Which of the following health screenings is recommended for this patient?? {'A': 'Blood glucose and/or HbA1c screening', 'B': 'Yearly Pap smear', 'C': 'Bone mineral density screening', 'D': 'Colorectal screening', 'E': 'Blood pressure at least once every 3 years'},
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A: Blood glucose and/or HbA1c screening
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Q:A 75-year-old woman comes to the physician because of a 3-month history of involuntary weight loss and a painless lump on her neck. Physical examination shows a firm, irregular swelling on the right side of the neck. Ultrasonography of the thyroid gland shows a 2-cm nodule with irregular margins and microcalcifications in the right thyroid lobe. A biopsy of the thyroid nodule is performed. Which of the following changes would be most consistent with anaplasia?? {'A': 'Negative staining of tumor cells for thyroglobulin', 'B': 'Replacement of thyroid cells by normal squamous epithelium', 'C': 'Reduced number of functional thyroid cells', 'D': 'Disorganized proliferation of mature thyroid cells', 'E': 'Increased expression of thyroid transcription factor-1'},
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A: Negative staining of tumor cells for thyroglobulin
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Q:A 13-year-old boy with a history of asthma and seasonal allergies is currently using albuterol to manage his asthma symptoms. Recently, his use of albuterol increased from 1–2 days/week to 4 times/week over the past several weeks, though he does not experience his symptoms daily. The vital signs include: temperature 36.7°C (98.0°F), blood pressure 126/74 mm Hg, heart rate 74/min, and respiratory rate 14/min. His physical examination shows clear, bilateral breath sounds and normal heart sounds. What change should be made to his current treatment regimen?? {'A': 'Add salmeterol twice daily', 'B': 'Add montelukast 10 mg daily', 'C': 'Add fluticasone daily', 'D': 'Add formoterol + budesonide twice daily', 'E': 'Add tiotropium'},
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C: Add fluticasone daily
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Q:A 32-year-old woman comes to her physician because of increasing back pain for the past 10 months. The pain is worse in the morning when she wakes up and improves with activity. She used to practice yoga, but stopped 5 months ago as bending forward became increasingly difficult. She has also had bilateral hip pain for the past 4 months. She has not had any change in urination. She has celiac disease and eats a gluten-free diet. Her temperature is 37.1°C (98.8°F), pulse is 65/min, respirations are 13/min, and blood pressure is 116/72 mmHg. Examination shows the range of spinal flexion is limited. Flexion, abduction, and external rotation of bilateral hips produces pain. An x-ray of her pelvis is shown. Further evaluation of this patient is likely to show which of the following?? {'A': 'High levels of rheumatoid factor', 'B': 'HLA-B27 positive genotype', 'C': 'Presence of anti-dsDNA antibodies', 'D': 'High levels of creatine phosphokinase', 'E': 'Presence of anti-Ro and anti-La antibodies'},
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B: HLA-B27 positive genotype
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Answer the following medical question with one of the provided options:
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Q:A 65-year-old G2P2 presents to her physician for a routine gynecologic check-up. She has been menopausal since 54 years of age, but has not been on hormone replacement therapy. Both pregnancies and deliveries were uneventful. Her husband has been her only sexual partner for the past 30 years. At 45 years of age she underwent a myomectomy for a submucosal uterine fibroid. She has never had any menstrual cycle disturbances. She does not smoke cigarettes and drinks alcohol occasionally. She has had normal Pap smears for the past 30 years. She also had HPV screening 5 years ago with the Pap smear. The co-test results were negative. Her Pap smear at 42 years of age showed a low-grade intraepithelial lesion, but the colposcopy was normal, and the subsequent Pap smear were normal. The screening tests obtained at the current presentation show the following results: Pap test HPV test Specimen adequacy: satisfactory for evaluation Interpretation: negative for intraepithelial lesion or malignancy Comments: atrophic cellular pattern negative Which of the following would be the most appropriate consideration regarding further screening of this patient?? {'A': 'Pap smear and HPV co-testing should be performed every 5 years', 'B': 'The Pap smear should be repeated every 3 years', 'C': 'Discontinuing screening in this patient should be considered', 'D': 'Pap smears should be repeated every 5 years', 'E': 'The Pap smear should be repeated after 1 week of vaginal estrogen cream application, and a definitive decision should be made based on the results of the re-testing'},
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C: Discontinuing screening in this patient should be considered
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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 undergoes a diagnostic hysteroscopy for a 6-month history of small volume intermenstrual bleeding with no other complaints. There is no history of pelvic pain, painful intercourse, or vaginal discharge other than blood. During the procedure, a red beefy pedunculated mass is seen arising from the endometrium of the anterior wall of the uterus that has well-demarcated borders. This mass is resected and sent for histopathological examination. Which of the following is the most likely diagnosis?? {'A': 'Endometrial polyp', 'B': 'Endometrial carcinoma', 'C': 'Uterine leiomyoma', 'D': 'Uterine adenomyosis', 'E': 'Endometrial hyperplasia'},
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A: Endometrial polyp
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Answer the following medical question with one of the provided options:
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Q:A 63-year-old man with a history of hypertension and atrial fibrillation is brought into the emergency room and found to have a ventricular tachyarrhythmia. Ibutilide is discontinued and the patient is switched to another drug that also prolongs the QT interval but is associated with a decreased risk of torsades de pointes. Which drug was most likely administered in this patient?? {'A': 'Sotalol', 'B': 'Digoxin', 'C': 'Esmolol', 'D': 'Amiodarone', 'E': 'Quinidine'},
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D: Amiodarone
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Answer the following medical question with one of the provided options:
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Q:A 45-year-old-man presents to the physician with complaints of intermittent episodes of severe headaches and palpitations. During these episodes, he notices that he sweats profusely and becomes pale in complexion. He describes the episodes as coming and going within the past 2 months. His temperature is 99.3°F (37.4°C), blood pressure is 165/118 mmHg, pulse is 126/min, respirations are 18/min, and oxygen saturation is 90% on room air. Which of the following would be the first medication given to treat this patient’s most likely diagnosis?? {'A': 'Phenoxybenzamine', 'B': 'Phentolamine', 'C': 'Pilocarpine', 'D': 'Prazosin', 'E': 'Propanolol'},
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A: Phenoxybenzamine
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Answer the following medical question with one of the provided options:
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Q:A 57-year-old woman presents to her physician’s office because she is coughing up blood. She says that she first observed a somewhat reddish sputum a few months ago. However, over the past couple of weeks, the amount of blood she coughs has significantly increased. She has been smoking for the past 30 years. She says that she smokes about 2 packs of cigarettes daily. She does not have fever, night sweats, weight loss, or chills. She reports progressive difficulty in breathing. On examination, her vital signs are stable. On auscultation of her chest, she has an expiratory wheeze. Oxygen saturation is 98%. Which of the following would be the next best step in the management of this patient?? {'A': 'Oxygen supplementation', 'B': 'Chest radiograph', 'C': 'CT scan', 'D': 'Endoscopy', 'E': 'Bronchoscopy'},
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B: Chest radiograph
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Answer the following medical question with one of the provided options:
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Q:A 72-year-old man presents to a physician with multiple skin lesions on his trunk, face, neck, and extremities. The lesions are painless, but they itch mildly. He mentions that 3 weeks ago, his skin was completely normal. The lesions developed all over his body just over the past few days. Although he says that he has lost some weight over the last few weeks, there is no history of any other symptoms or known medical disorder. Physical examination reveals the presence of multiple lesions in different areas of his body. The lesions on the back are shown in the image. Further diagnostic evaluation suggests that the skin lesions are associated with internal malignancy, and they are not due to metastases. Which of the following malignancies does the patient most likely have?? {'A': 'Glioblastoma multiforme', 'B': 'Anaplastic astrocytoma', 'C': 'Medullary carcinoma of thyroid', 'D': 'Cardiac angiosarcoma', 'E': 'Adenocarcinoma of stomach'},
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E: Adenocarcinoma of stomach
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