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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 undergoes uncomplicated laparascopic cholecystectomy for acute cholecystitis and is admitted to the surgical ward for postoperative management. On postoperative day 1, routine laboratory studies reveal an increase in serum creatinine to 1.46 mg/dL from 0.98 mg/dL before the operation; BUN is 37 mg/dL, increased from 18 mg/dL on prior measurement; K is 4.8 mEq/L and CO2 is 19 mEq/L. The patient has an indwelling urinary catheter in place, draining minimal urine over the last few hours. Which of the following is the most appropriate next step in management?? {'A': 'Obtain urinalysis', 'B': 'Evaluate urinary catheter for obstruction', 'C': 'Administer IV fluid bolus', 'D': 'Obtain bilateral renal ultrasonography', 'E': 'Initiate emergent hemodialysis'},
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B: Evaluate urinary catheter for obstruction
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Answer the following medical question with one of the provided options:
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Q:A 23-year-old male presents to the emergency room following a gunshot wound to the leg. On arrival his temperature is 99°F (37.2°C), blood pressure is 90/60 mmHg, pulse is 112/min, respirations are 21/min, and pulse oximetry is 99% on room air. Two large bore IVs are placed and he receives crystalloid fluid replacement followed by 2 units of crossmatched packed red blood cells. Immediately following transfusion, his temperature is 102.2°F (39°C), blood pressure is 93/64 mmHg, pulse is 112/min, respirations are 21/min, and pulse oximetry is 99% on room air. There is oozing from his IV sites. You check the records and realize there was a clerical error with the blood bank. What is the mechanism for his current condition?? {'A': 'Preformed antibodies', 'B': 'Deposition of immune complexes', 'C': 'T lymphocyte reaction', 'D': 'IgE mediated reaction', 'E': 'Production of leukotrienes'},
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A: Preformed antibodies
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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 the emergency department for evaluation of fever and cough for one week. The mother reports that her son has muscle rigidity and difficulty breathing. He has also had a generalized skin rash for the past 4 days. His symptoms began shortly after returning from a trip to India. His immunizations are up-to-date. His temperature is 38.5°C (101.3°F), pulse is 108/min, respirations are 30/min, and blood pressure is 80/60 mm Hg. Examination shows small, erythematous pustules with hemorrhagic necrosis over the trunk and shoulders and generalized lymphadenopathy. There is dullness to percussion and decreased breath sounds over the right lung base. The liver is palpated 2 to 3 cm below the right costal margin. An x-ray of the chest shows small 1–4 mm pulmonary nodules scattered throughout the lungs, and a right-sided pleural effusion with interstitial infiltrates. Blood smear shows acid-fast bacilli. Further evaluation of this patient is most likely to show which of the following?? {'A': 'Decreased IFN-γ levels', 'B': 'Mutation in WAS gene', 'C': 'Absent B cells with normal T cell count', 'D': 'Decreased PTH levels', 'E': 'Decreased T-cell receptor excision circles on PCR'},
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A: Decreased IFN-γ levels
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Answer the following medical question with one of the provided options:
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Q:A 60-year-old woman with a history of emphysema has been referred by her pulmonologist for follow-up pulmonary function testing. During the test, the patient reaches a point where her airway pressure is equal to the atmospheric pressure. Which of the following is most likely to be found during this respiratory state?? {'A': 'Pulmonary vascular resistance is at a maximum', 'B': 'Pulmonary vascular resistance is at a minimum', 'C': 'Transmural pressure of the chest wall is at a minimum', 'D': 'Transmural pressure of the lung-chest wall system is at a maximum', 'E': 'Transmural pressure of the lung-chest wall system is at a minimum'},
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B: Pulmonary vascular resistance is at a minimum
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Answer the following medical question with one of the provided options:
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Q:A 51-year-old woman is brought to the emergency department after not being able to urinate for the past 12 hours. She also complains of a headache that is sharp in nature, 9/10, without radiation, and associated with nausea and vomiting. She neither smokes cigarettes nor drinks alcohol. She complains that her fingers have become numb and very painful on exposure to cold weather during the last few months. She has also noticed her fingers change color from blue to pale to red on cold exposure. Her face looks shiny with thickened, wrinkle-free skin. She has had joint pain and stiffness for the last 20 years. She takes over-the-counter omeprazole for heartburn, which she says improves her symptoms. She has unintentionally lost 9 kg (20 lb) in the last 6 months. She has no previous history of diabetes, hypertension, chest pain, orthopnea, or paroxysmal nocturnal dyspnea. Her mother has rheumatoid arthritis for which she takes methotrexate, and her father takes medications for hypertension and hypercholesterolemia. Her temperature is 37°C (98.6°F), blood pressure is 210/120 mm Hg, pulse is 102/min, respiratory rate is 18/min, and BMI is 22 kg/m2. Laboratory test Complete blood count: Hemoglobin 9.5 g/dL Leukocytes 15,500/mm3 Platelets 90,000/mm3 Serum haptoglobin 20 mg/dL (30–200 mg/dL) Serum creatinine 2.3 mg/dL Blood urea nitrogen 83.5 mg/dL The peripheral blood film of the patient shows the following. Which of the following would be the most appropriate treatment for this patient?? {'A': 'Nitroprusside', 'B': 'Labetalol', 'C': 'Dialysis', 'D': 'Ramipril', 'E': 'Renal transplantation'},
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D: Ramipril
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Answer the following medical question with one of the provided options:
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Q:A 70-year-old man comes to the physician because of a 6-month-history of worsening shortness of breath on exertion and bouts of coughing while sleeping. He has hypertension, hyperlipidemia, and type 2 diabetes mellitus. Current medications include lisinopril, simvastatin, and insulin. The patient appears tired but in no acute distress. His pulse is 70/min, blood pressure is 140/85 mm Hg, and respirations are 25/min. He has crackles over both lower lung fields and 2+ pitting edema of the lower extremities. An ECG shows T wave inversions in leads V1 to V4. Which of the following agents is most likely to improve the patient's long-term survival?? {'A': 'Gemfibrozil', 'B': 'Metoprolol', 'C': 'Digoxin', 'D': 'Amlodipine', 'E': 'Dobutamine'},
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B: Metoprolol
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Answer the following medical question with one of the provided options:
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Q:A 52-year-old woman comes to the physician because of a 1-month history of mild fever, fatigue, and shortness of breath. She has no history of serious medical illness and takes no medications. Cardiopulmonary examination shows a mid-diastolic plopping sound heard best at the apex and bilateral rales at the base of the lungs. Echocardiography shows a pedunculated, heterogeneous mass in the left atrium. A biopsy of the mass shows clusters of mesenchymal cells surrounded by gelatinous material. Further evaluation of this patient is most likely to show which of the following?? {'A': 'Increased IL-6 serum concentration', 'B': 'Increased S100 protein serum concentration', 'C': 'Axillary lymphadenopathy', 'D': 'Malignant pleural effusion', 'E': 'Ash-leaf skin lesions'},
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A: Increased IL-6 serum concentration
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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 with a history of coronary artery disease has been brought to the emergency department due to the sudden onset of chest pain. He was diagnosed with hypertension 12 years ago and takes enalapril regularly. The patient is hypotensive to 70/42 mm Hg, and on further examination his skin is cold and clammy. He is diagnosed with a life-threatening condition that resulted from inadequate circulation of blood, with decreased cardiac output and high pulmonary capillary wedge pressure. Which of the conditions below can cause the same disorder? I. Acute myocardial infarction II. Atrial fibrillation III. Hemorrhage IV. Valvular stenosis V. Pulmonary embolism VI. Sepsis? {'A': 'I, II, III', 'B': 'I, IV, VI', 'C': 'I, IV, V', 'D': 'I, II, IV, V', 'E': 'I, II, IV'},
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E: I, II, IV
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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 comes to the emergency department because of a severely painful right eye. The pain started an hour ago and is accompanied by frontal headache and nausea. The patient has vomited twice since the onset of the pain. He has type 2 diabetes mellitus. He immigrated to the US from China 10 years ago. He works as an engineer at a local company and has been under a great deal of stress lately. His only medication is metformin. Vital signs are within normal limits. The right eye is red and is hard on palpation. The right pupil is mid-dilated and nonreactive to light. The left pupil is round and reactive to light and accommodation. Which of the following agents is contraindicated in this patient?? {'A': 'Topical pilocarpine', 'B': 'Topical timolol', 'C': 'Topical epinephrine', 'D': 'Topical apraclonidine', 'E': 'Oral acetazolamide'},
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C: Topical epinephrine
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Answer the following medical question with one of the provided options:
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Q:A 19-year-old male arrives to student health for an annual check up. He is up to date on his infant and childhood vaccinations up to age 10. At age 12, he received a single dose of the tetanus, diphtheria, and acellular pertussis vaccine, and a quadrivalent meningococcal conjugate vaccine. A month ago, he received the influenza vaccine. The patient has no significant medical history. He takes over the counter ibuprofen for occasional headaches. He has a father with hypertension and hyperlipidemia, and his brother has asthma. He is sexually active with his current girlfriend. He denies tobacco use, illicit drug use, and recent or future travel. The patient’s temperature is 98°F (36.7°C), blood pressure is 118/78 mmHg, pulse is 70/min, and respirations are 14/min with an oxygen saturation of 99% O2 on room air. A physical examination is normal. What of the following is the best recommendation for vaccination?? {'A': 'Hepatitis A vaccine', 'B': 'Herpes zoster vaccine', 'C': 'Human papilloma virus', 'D': 'Pneumococcal vaccine', 'E': 'Tetanus and reduced diphtheria toxoid booster'},
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C: Human papilloma virus
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Answer the following medical question with one of the provided options:
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Q:A 12-year-old girl is brought to the emergency department by her parents due to severe shortness of breath that started 20 minutes ago. She has a history of asthma and her current treatment regime includes a beta-agonist inhaler as well as a medium-dose corticosteroid inhaler. Her mother tells the physician that her daughter was playing outside with her friends when she suddenly started experiencing difficulty breathing and used her inhaler without improvement. On examination, she is struggling to breathe and with subcostal and intercostal retractions. She is leaning forward, and gasping for air and refuses to lie down on the examination table. Her blood pressure is 130/92 mm Hg, the respirations are 27/min, the pulse is 110/min and O2 saturation is 87%. There is prominent expiratory wheezes in all lung fields. The patient is put on a nonrebreather mask with 100% oxygen. An arterial blood gas is collected and sent for analysis. Which of the following is the most appropriate next step in the management of this patient?? {'A': 'Inhaled albuterol', 'B': 'Intramuscular epinephrine', 'C': 'Intravenous corticosteroid', 'D': 'Inhaled ipratropium bromide', 'E': 'Inhaled theophylline'},
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A: Inhaled albuterol
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Answer the following medical question with one of the provided options:
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Q:Over the course of a year, 5 children with identical congenital heart defects were referred to a pediatric cardiac surgeon for evaluation. All 5 children had stable vital signs and were on appropriate medication. Upon review of medical records, all of them had a loud holosystolic murmur over the third intercostal space at the left sternal border. The surgeon ordered echocardiograms for all 5 children and recommended surgical closure of the defect in one of them. Which of the following patients required surgical repair of their defect?? {'A': 'A 4-month-old male infant with a 12-mm muscular defect, without heart failure, pulmonary hypertension or growth failure', 'B': 'An 11-month-old female infant with a 6-mm membranous defect, without heart failure, pulmonary hypertension, or growth failure', 'C': 'A 2-year-old boy with a 2-mm supracristal defect, without heart failure, pulmonary hypertension, or growth failure', 'D': 'A 5-year-old girl with a 2-mm membranous defect, no heart failure, a Qp:Qs ratio less than 2:1, and no growth failure', 'E': 'A 7-year-old boy with an 11-mm muscular defect and severe pulmonary vascular disease non-responsive to pulmonary vasodilators'},
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C: A 2-year-old boy with a 2-mm supracristal defect, without heart failure, pulmonary hypertension, or growth failure
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Answer the following medical question with one of the provided options:
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Q:A 35-year-old woman is presenting for a general wellness checkup. She is generally healthy and has no complaints. The patient does not smoke, drinks 1 alcoholic drink per day, and exercises 1 day per week. She recently had silicone breast implants placed 1 month ago. Her family history is notable for a heart attack in her mother and father at the age of 71 and 55 respectively. Her father had colon cancer at the age of 70. Her temperature is 99.0°F (37.2°C), blood pressure is 121/81 mmHg, pulse is 77/min, respirations are 14/min, and oxygen saturation is 98% on room air. Physical exam is unremarkable. Which of the following is the most appropriate initial step in management?? {'A': 'Alcohol cessation', 'B': 'Colonoscopy at age 60', 'C': 'Colonoscopy now', 'D': 'Mammography at age 50', 'E': 'Mammography now'},
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D: Mammography at age 50
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Answer the following medical question with one of the provided options:
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Q:A 13-year-old boy is brought to the emergency department because of a 2-day history of fever, headache, and irritability. He shares a room with his 7-year-old brother, who does not have any symptoms. The patient appears weak and lethargic. His temperature is 39.1°C (102.4°F) and blood pressure is 99/60 mm Hg. Physical examination shows several purple spots over the trunk and extremities. A lumbar puncture is performed. Gram stain of the cerebrospinal fluid shows numerous gram-negative diplococci. Administration of which of the following is most likely to prevent infection of the patient's brother at this time?? {'A': 'Penicillin G', 'B': 'Cephalexin', 'C': 'Conjugated vaccine', 'D': 'Rifampin', 'E': 'Doxycycline'},
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D: Rifampin
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Answer the following medical question with one of the provided options:
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Q:A 75-year-old male presents to his primary care physician complaining of epigastric pain. He has developed progressively worsening epigastric pain, heartburn, and nausea over the past five months. The pain does not change with meals and is not positional. He also reports that he is rarely hungry and has lost ten pounds. The patient immigrated from Japan two years ago to live with his son in the United States. He worked as a fisherman and dock worker for most of his life. His past medical history is notable for gout and gastroesophageal reflux disease. He takes allopurinol and cimetidine. He has a 30 pack-year smoking history and drinks 1-2 alcoholic beverages per day. Physical examination reveals mild epigastric tenderness to palpation and a hard lymph node near his left shoulder. Which of the following substances is most strongly associated with this patient’s condition?? {'A': 'Nitrosamine', 'B': 'Vinyl chloride', 'C': 'Aflatoxin', 'D': 'Naphthalene', 'E': 'Asbestos'},
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A: Nitrosamine
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Answer the following medical question with one of the provided options:
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Q:A mother brings her 1-year-old daughter who has had several seizures in the past 2 weeks to the pediatrician. The mother explains that the child is unable to crawl, sit, or even hold up her own head. She thinks the weakness is getting worse. The parents of the child are first cousins, and the mother's sister had one child who died before the age of 3 with similar symptoms. Hexosaminidase A activity was assayed in the blood and found to be absent. Which of the following will be found on fundoscopic examination of the child?? {'A': 'Papilledema', 'B': 'Arteriovenous nicking', 'C': 'Cotton wool spots', 'D': 'Hollenhorst plaque', 'E': 'Cherry red spot'},
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E: Cherry red spot
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Answer the following medical question with one of the provided options:
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Q:A 61-year-old man presents to the emergency department with severe left flank pain radiating to the left groin and severe nausea. His condition started suddenly 3 hours earlier. His past medical history is significant for chronic migraine headaches and type 2 diabetes mellitus. He takes metformin and glyburide for his diabetes and a tablet containing a combination of acetaminophen, aspirin, and caffeine for his headaches. He denies smoking or alcohol use. Today his vital signs reveal: temperature 36.6°C (97.8°F), blood pressure 165/110 mm Hg, and pulse 90/min. The physical examination is unremarkable except for left flank tenderness. A urinalysis reports cola-colored urine with 1+ proteinuria and 2+ hematuria. Intravenous urography shows the classic ‘ring sign’ in the kidneys. Which of the following is the most likely cause of this patient’s condition?? {'A': 'Nephrolithiasis', 'B': 'Benign prostatic hyperplasia', 'C': 'Renal cell carcinoma', 'D': 'Renal papillary necrosis', 'E': 'Polycystic kidney disease'},
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D: Renal papillary necrosis
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Answer the following medical question with one of the provided options:
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Q:A 33-year-old man is evaluated by paramedics after being found unconscious outside of his home. He has no palpable pulses. Physical examination shows erythematous marks in a fern-leaf pattern on his lower extremities. An ECG shows ventricular fibrillation. Which of the following is the most likely cause of this patient's findings?? {'A': 'Lightning strike', 'B': 'Cholesterol emboli', 'C': 'Hypothermia', 'D': 'Opioid overdose', 'E': 'Infective endocarditis'},
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A: Lightning strike
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Answer the following medical question with one of the provided options:
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Q:A 34-year-old female presents to a counselor at the urging of her parents because they are concerned that she might be depressed. After recently breaking up with her long-term boyfriend, she moved back in with her parents because she could not handle making decisions alone. Soon after their breakup, she started going on 5–7 dates a week. She has been unemployed for 3 years, as her boyfriend took care of all the bills. In the past year, she thought of looking for a job but never felt confident enough to start the process. Her mom arranges her doctors appointments and handles her car maintenance. She describes feeling uneasy when she is alone. She has hypothyroidism treated with levothyroxine. She does not smoke or drink alcohol. Vital signs are normal. Mental status exam shows a neutral affect. Neurologic examination shows no focal findings. Which of the following is the most likely diagnosis?? {'A': 'Avoidant personality disorder', 'B': 'Separation anxiety disorder', 'C': 'Dependent personality disorder', 'D': 'Histrionic personality disorder', 'E': 'Borderline personality disorder'},
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C: Dependent personality disorder
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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 delivers a healthy boy at 38 weeks gestation. The delivery is vaginal and uncomplicated. The pregnancy was unremarkable. On examination of the newborn, it is noted that his head is tilted to the left and his chin is rotated to the right. Palpation reveals no masses or infiltration in the neck. The baby also shows signs of left hip dysplasia. Nevertheless, the baby is active and exhibits no signs of other pathology. What is the most probable cause of this patient's condition?? {'A': 'Congenital infection', 'B': 'Basal ganglia abnormalities', 'C': 'Antenatal trauma', 'D': 'Accessory nerve palsy', 'E': 'Intrauterine malposition'},
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E: Intrauterine malposition
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Answer the following medical question with one of the provided options:
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Q:A healthy 30-year-old woman comes to the physician with her husband for preconception counseling. Her husband is healthy but she is concerned because her brother was recently diagnosed with a genetic liver condition for which he takes penicillamine. Her father-in-law has liver cirrhosis and a tremor. The results of genetic testing show that both the patient and her husband are carriers of a mutation in the ATP7B gene. Which of the following is the chance that this patient’s offspring will eventually develop the hereditary condition?? {'A': '0%', 'B': '100%', 'C': '75%', 'D': '25%', 'E': '50%'},
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D: 25%
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Answer the following medical question with one of the provided options:
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Q:A 20-year-old man who is a biology major presents to his physician for a simple check-up. He is informed that he hasn’t received a hepatitis B vaccine. When the first injection is applied, the medical professional informs him that he will need to come back 2 more times on assigned days, since the vaccine is given in 3 doses. Which of the following antibodies is the physician trying to increase in the college student as a result of the first vaccination?? {'A': 'IgG', 'B': 'IgA', 'C': 'IgM', 'D': 'IgD', 'E': 'IgE'},
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C: IgM
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Answer the following medical question with one of the provided options:
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Q:A 28-year-old woman presents with an abnormal vaginal discharge for the past week. She maintains a monogamous relationship but denies the use of barrier protection with her partner. She is 5 weeks late for her menstrual cycle. Subsequent testing demonstrates a positive pregnancy test. A wet mount demonstrates motile, pear-shaped organisms. Which of the following is the most appropriate treatment for this patient?? {'A': 'Azithromycin', 'B': 'Fluconazole', 'C': 'Metronidazole', 'D': 'Ceftriaxone', 'E': 'Tinidazole'},
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C: Metronidazole
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Answer the following medical question with one of the provided options:
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Q:A 53-year-old woman presents to her primary care physician with complaints of pain and swelling in her hands and fingers. She states that she has had these symptoms since she was in her 20s, but they have recently become more severe. She states that her wedding ring no longer fits, due to increased swelling of her fingers. She is a 30-pack-year smoker with a body mass index (BMI) of 31 kg/m2. The vital signs include: blood pressure 122/78 mm Hg, heart rate 72/min, and respiratory rate 15/min. On physical exam, a mild systolic murmur is heard over the apex, and her lungs are clear bilaterally. There is swelling of all the digits bilaterally, and a yellow-white plaque is noted beneath 3 of her nail beds. When asked about the plaques, she states that she was given itraconazole for them about 3 weeks ago; however, the plaques did not resolve. When asked further about joint pain, she notes that she has had shoulder and knee pain for the last several years, although she has not sought medical care for this. Which of the following is the best initial step in this patient’s therapeutic management?? {'A': 'Administer indomethacin and sulfasalazine', 'B': 'Administer indomethacin and methotrexate', 'C': 'Administer sulfasalazine', 'D': 'Administer indomethacin', 'E': 'Administer methotrexate'},
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B: Administer indomethacin and methotrexate
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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 comes to the physician for the evaluation of progressive difficulty climbing stairs for the last 2 years. During this period, he has also had problems running and standing up from a seated position. He is at the 50th percentile for height and weight. Examination shows enlarged calf muscles bilaterally and a waddling gait. Which of the following is the most likely cause of this patient's condition?? {'A': 'Nonsense mutation', 'B': 'Missense mutation', 'C': 'Trinucleotide repeat expansions', 'D': 'Splice site mutation', 'E': 'Frameshift mutation'},
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B: Missense mutation
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Answer the following medical question with one of the provided options:
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Q:A 71-year-old man is admitted to the hospital one hour after he was found unconscious. His pulse is 80/min and systolic blood pressure is 98 mm Hg; diastolic blood pressure cannot be measured. He is intubated and mechanically ventilated with supplemental oxygen at a tidal volume of 450 mL and a respiratory rate of 10/min. Arterial blood gas analysis shows: PCO2 43 mm Hg O2 saturation 94% O2 content 169 mL/L Pulmonary artery catheterization shows a pulmonary artery pressure of 15 mm Hg and a pulmonary capillary wedge pressure of 7 mm Hg. Bedside indirect calorimetry shows a rate of O2 tissue consumption of 325 mL/min. Given this information, which of the following additional values is sufficient to calculate the cardiac output in this patient?"? {'A': 'End-tidal carbon dioxide pressure', 'B': 'Total peripheral resistance', 'C': 'Partial pressure of inspired oxygen', 'D': 'Left ventricular end-diastolic volume', 'E': 'Pulmonary artery oxygen content'},
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E: Pulmonary artery oxygen content
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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 presents to the office with complaints of perianal pain during defecation and perineal heaviness for 1 month. He also complains of discharge around his anus, and bright red bleeding during defecation. The patient provides a history of having a sexual relationship with other men without using any methods of protection. The physical examination demonstrates edematous verrucous anal folds that are of hard consistency and painful to the touch. A proctosigmoidoscopy reveals an anal canal ulcer with well defined, indurated borders on a white background. A biopsy is taken and the results are pending. What is the most likely diagnosis?? {'A': 'Anal fissure', 'B': 'Hemorrhoids', 'C': 'Anal cancer', 'D': 'Proctitis', 'E': 'Polyps'},
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C: Anal cancer
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Answer the following medical question with one of the provided options:
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Q:A 64-year-old male retired farmer presents to the orthopaedic surgery clinic with chronic left knee pain. Radiographic imaging demonstrates severe tricompartmental osteoarthritis. The patient has a history of diabetes mellitus, chronic kidney disease, hypertension, hyperlipidemia, and congestive heart failure. He undergoes a left knee replacement without complications. A Foley catheter was placed in the operating room and removed in the post-anesthesia care unit. He receives subcutaneous heparin and has sequential compression devices in place to prevent deep venous thromboses. On post-operative day 1, he develops suprapubic pain and dysuria and is subsequently found to have a urinary tract infection. He is discharged on post-operative day 2 with an appropriate antibiotic regimen. However, he presents to the emergency room on post-operative day 6 with severe left leg pain. Venous dopplers demonstrate an occlusive thrombus in the popliteal vein. He is readmitted for anticoagulation and monitoring. A quality improvement team in the hospital estimates that the probability of getting both a urinary tract infection and a deep venous thrombosis is 0.00008 in patients undergoing routine total knee replacement. Furthermore, they estimate that the probability of getting a urinary tract infection in a similar patient population is 0.04. Assuming that the development of urinary tract infections and deep venous thromboses are independent, what is the risk of developing a deep venous thrombosis following total knee replacement?? {'A': '0.02', 'B': '0.002', 'C': '0.0002', 'D': '0.00002', 'E': 'Cannot be determined'},
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B: 0.002
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Answer the following medical question with one of the provided options:
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Q:A 52-year-man is brought to the physician because of a 2-week history of memory loss. Three weeks ago, he had a cardiac arrest that required cardiopulmonary resuscitation and intravenous epinephrine. On mental status examination, he cannot recall objects shown to him 20 minutes earlier but vividly recalls memories from before the incident. The remainder of the examination shows no abnormalities. Which of the following structures of the brain is most likely affected?? {'A': 'Purkinje cells of the cerebellum', 'B': 'Microglial cells of dorsal midbrain', 'C': 'Internal pyramidal layer of the amygdala', 'D': 'Pyramidal cells of the hippocampus', 'E': 'Astroglial cells of the putamen'},
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D: Pyramidal cells of the hippocampus
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Answer the following medical question with one of the provided options:
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Q:A 28-year-old woman comes to the physician because she had a positive pregnancy test at home. She reports feeling nauseated and has vomited several times over the past week. During this period, she has also had increased urinary frequency. She is sexually active with her boyfriend and they use condoms inconsistently. Her last menstrual period was 5 weeks ago. Physical examination shows no abnormalities. A urine pregnancy test is positive. A pap smear is positive for a high-grade squamous intraepithelial lesion. Colposcopy shows cervical intraepithelial neoplasia grade II and III. Which of the following is the most appropriate next step in the management of this patient?? {'A': 'Reevaluation with cytology and colposcopy 6 weeks after birth', 'B': 'Colposcopy and cytology at 6-month intervals for 12 months', 'C': 'Endocervical curettage', 'D': 'Perform loop electrosurgical excision', 'E': 'Diagnostic excisional procedure\n"'},
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A: Reevaluation with cytology and colposcopy 6 weeks after birth
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Answer the following medical question with one of the provided options:
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Q:A 55-year-old woman presents to the emergency department with retrosternal pain that started this evening. The patient states that her symptoms started as she was going to bed after taking her medications. She describes the pain as sudden in onset, worse with swallowing, and not associated with exertion. The patient has a past medical history of diabetes, anemia, and congestive heart failure and is currently taking metoprolol, insulin, metformin, iron, and lisinopril. Her temperature is 99.2°F (37.3°C), blood pressure is 125/63 mmHg, pulse is 90/min, respirations are 14/min, and oxygen saturation is 100% on room air. Physical exam is notable for an obese woman who appears uncomfortable. An initial electrocardiogram (ECG) demonstrates sinus rhythm, and a set of troponins are pending. Which of the following is the most likely diagnosis?? {'A': 'Esophageal rupture', 'B': 'Esophagitis', 'C': 'Myocardial infarction', 'D': 'Pulmonary embolism', 'E': 'Spontaneous pneumothorax'},
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B: Esophagitis
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Answer the following medical question with one of the provided options:
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Q:A 28-year-old man comes to the physician for a follow-up examination after a previous visit showed an elevated serum calcium level. He has a history of bipolar disorder. His mother had a parathyroidectomy in her 30s. The patient does not drink alcohol or smoke. Current medications include lithium and a daily multivitamin. His vital signs are within normal limits. Physical examination shows no abnormalities. Laboratory studies show: Serum Sodium 146 mEq/L Potassium 3.7 mEq/L Calcium 11.2 mg/dL Magnesium 2.3 mEq/L PTH 610 pg/mL Albumin 4.2 g/dL 24-hour urine Calcium 23 mg Which of the following is the most likely cause of this patient’s findings?"? {'A': 'Excess calcium intake', 'B': 'Abnormal calcium sensing receptors', 'C': 'Excess vitamin D intake', 'D': 'Lithium toxicity', 'E': 'Parathyroid adenoma'},
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B: Abnormal calcium sensing receptors
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Answer the following medical question with one of the provided options:
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Q:A 55-year-old woman with type 2 diabetes mellitus presents to her physician with intermittent nausea for the past 2 months. Her symptoms are exacerbated within one hour after eating. She has no other history of a serious illness. She takes metformin and injects insulin. Her vitals are normal. Abdominal examination is normal. An ECG shows normal sinus rhythm with no evidence of ischemia. Hemoglobin A1c is 7%. A gastric emptying scan shows 60% of her meal in the stomach 75 minutes after eating. Which of the following is the most appropriate pharmacotherapy at this time?? {'A': 'Dimenhydrinate', 'B': 'Lorazepam', 'C': 'Metoclopramide', 'D': 'Octreotide', 'E': 'Ondansetron'},
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C: Metoclopramide
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Answer the following medical question with one of the provided options:
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Q:A 7-year-old boy is brought by his parents to his pediatrician with a one-day history of fever, chills, and pain in the right upper extremity. The patient’s mother says that he has injured his right index finger while playing in the garden 3 days earlier. His temperature is 38.8°C (101.8°F), pulse is 120/min, respiratory rate is 24/min, and blood pressure is 102/70 mm Hg. On physical examination, there is an infected wound present on the tip of the right index finger. Irregular and subcutaneous linear subcutaneous red streaks are seen on the ventral surface of the right forearm, which is warm and tender to palpation. There is painful right infraclavicular lymphadenopathy present. Which of the following is the most common microorganism known to cause this patient’s condition?? {'A': 'Aeromonas hydrophila', 'B': 'Group A β-hemolytic Streptococcus', 'C': 'Pasteurella multocida', 'D': 'Pseudomonas aeruginosa', 'E': 'Staphylococcus aureus'},
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B: Group A β-hemolytic Streptococcus
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Q:A 7-year-old boy is brought to the emergency department by his parents. He is complaining of left-sided knee pain which has progressively increased in severity over the past 2 days. It started when he was playing football with his brothers but he does not recall falling or getting any injury. Past medical history is significant for prolonged bleeding and easy bruising. His maternal uncle has similar problems. Physical exam reveals swollen and painful left knee. His laboratory investigations reveal: Hemoglobin 11.8 g/dL WBC count 7,000/mL Platelets 250,000/mL INR 0.9 aPTT 62 sec, fully corrected with a mixing study Which of the following disorders have the same mode of inheritance as this patient’s disease?? {'A': 'Alkaptonuria', 'B': 'Hereditary spherocytosis', 'C': 'Sickle cell disease', 'D': 'Duchenne muscular dystrophy', 'E': "Huntington's disease"},
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D: Duchenne muscular dystrophy
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Q:A 34-year-old woman presents to her primary care provider after intermittently passing bright pink urine over several days. She is concerned this discoloration is due to blood. Her medical history is unremarkable, she denies being sick in the past weeks and has only taken a couple of diclofenac capsules for pelvic pain associated to her menstrual period. She does not drink alcohol or smoke cigarettes. At the doctor’s office, her blood pressure is 150/90 mm Hg, pulse is 80/min, respiratory rate is 18/min, and temperature is 36.5°C (97.7°F). On physical exam, she has 2+ pitting edema up to her knees. A urinalysis is taken which shows red blood cells, red blood cell casts, and acanthocytes. No proteinuria was detected. Her serum creatinine is 2.4 mg/dL, blood urea nitrogen 42 mg/dL, serum potassium 4.8 mEq/L, serum sodium 140 mEq/L, serum chloride 102 mEq/L. Which of the following is the most appropriate next step in the management of this case?? {'A': 'Discontinuation of NSAID', 'B': 'Fomepizole', 'C': 'Intravenous fluid therapy and electrolyte correction', 'D': 'Renal biopsy', 'E': 'Noncontrast computed tomography'},
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D: Renal biopsy
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Q:A 32-year-old man comes to the physician because of a 3-month history of progressively worsening shortness of breath on exertion. He is concerned that he has asthma and would like to be started on albuterol. Which of the following findings is most likely to indicate a different diagnosis in this patient?? {'A': 'Bipyramidal crystals measuring 50 μm on sputum analysis', 'B': '129% of the predicted diffusion capacity of the lung for carbon monoxide', 'C': 'Decrease in systolic blood pressure by 16 mm Hg during inspiration', 'D': 'Decrease in FEV1 by 6% after administration of high-dose methacholine', 'E': 'Visibility of 11 posterior ribs in the midclavicular line above the diaphragm on chest x-ray'},
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D: Decrease in FEV1 by 6% after administration of high-dose methacholine
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Q:A 25-year-old man is brought to the emergency department by the police after a motor vehicle accident. He was reportedly speeding in a residential area and collided with a tree. He was later found by police naked in the street, screaming "shoot me so the devil will leave". A review of his medical record is unremarkable. At the hospital, he continues to act agitated and bizarre. His temperature is 37.0°C (98.6°F), the blood pressure is 140/86 mm Hg, and the heart rate is 90/min. The physical exam is notable for agitation, pacing around the room, occasionally yelling at the staff to help him "kill the devil". An ocular exam is significant for mild horizontal nystagmus. The patient appears to be drooling and has some difficulty with coordination. Which of the following is the most likely cause of this patient's presentation?? {'A': 'Cocaine intoxication', 'B': 'Central nervous system infection', 'C': 'Metabolic abnormality', 'D': 'Phencyclidine (PCP) intoxication', 'E': 'Serotonin syndrome'},
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D: Phencyclidine (PCP) intoxication
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Q:A 28-year-old man comes to the physician because of a 6-month history of progressive fatigue and intermittent diarrhea. During this time, he has had a 6-kg (13-lb) weight loss. Physical examination shows pale conjunctivae. Abdominal examination shows tenderness to palpation in the lower quadrants. An image from a colonoscopy of the descending colon is shown. Further evaluation is most likely to show which of the following findings?? {'A': 'Positive lactose hydrogen breath test', 'B': 'Anti-Saccharomyces cerevisiae antibodies', 'C': 'Perinuclear antineutrophil cytoplasmic antibodies', 'D': 'PAS-positive cytoplasmic granules', 'E': 'Anti-tissue transglutaminase antibodies'},
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C: Perinuclear antineutrophil cytoplasmic antibodies
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Q:A 51-year-old woman comes to the physician because of a 6-month history of fatigue and increased thirst. She has no history of serious medical illness and takes no medications. She is 163 cm (5 ft 4 in) tall and weighs 72 kg (160 lb); BMI is 28 kg/m2. Her fasting serum glucose concentration is 249 mg/dL. Treatment with an oral hypoglycemic agent is begun. Which of the following best describes the mechanism of action of the drug that was most likely prescribed for this patient?? {'A': 'Decreased glucagon release', 'B': 'Increased insulin release', 'C': 'Decreased carbohydrate hydrolysis', 'D': 'Increased renal glucose elimination', 'E': 'Decreased hepatic gluconeogenesis'},
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E: Decreased hepatic gluconeogenesis
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Q:An investigator is conducting an experiment to study different pathways of glucose metabolism. He obtains cells cultured from various tissues to study the effect of increased extracellular glucose concentration. Following the incubation of these cells in 5% dextrose, he measures the intracellular fructose concentration. The concentration of fructose is expected to be highest in cells obtained from which of the following tissues?? {'A': 'Ovary', 'B': 'Kidney', 'C': 'Myelin sheath', 'D': 'Lens', 'E': 'Retina'},
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A: Ovary
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Q:A 21-year-old primigravid woman comes to the physician at 10 weeks' gestation because of progressive fatigue for the past 3 weeks. She reports that she has had a 3.2-kg (7-lb) weight loss after conceiving despite an increase in appetite. She has become increasingly anxious and has trouble falling asleep. There is no personal or family history of serious illness. Medications include folic acid and a multivitamin. She is 165 cm (5 ft 5 in) tall and weighs 55 kg (120 lb); BMI is 20 kg/m2. Her temperature is 37.4°C (99.4°F), pulse is 120/min, respirations are 18/min, and blood pressure is 150/70 mm Hg. The globes of the eyes are prominent. The thyroid gland is firm and diffusely enlarged. Neurologic examination shows a fine resting tremor of the hands. There is a midsystolic click at the apex and a grade 2/6 early systolic murmur at the upper left sternal border. Serum thyroid-stimulating hormone concentration is 0.1 μU/mL. An ECG is normal except for sinus tachycardia. Which of the following is the most appropriate next step in management?? {'A': "Lugol's iodine", 'B': 'Thyroidectomy', 'C': 'Propylthiouracil', 'D': 'Radioactive iodine ablation', 'E': 'Atenolol'},
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C: Propylthiouracil
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Q:A 52-year-old unconscious man is brought to the emergency department. He was found unresponsive on the sidewalk in the snow. He is recognized by the staff as a local homeless man and IV drug user. Rapid warming procedures are initiated. At physical examination, he is dirty and disheveled and unrousable with a blood pressure of 100/76 mm Hg and a temperature of 37.2°C (99°F). He is thin with apparent weight loss. Both arms have indications of recent IV injection stigmata. A head MRI reveals multiple hyperintense signals in the meninges with multiple tiny contrast-enhancing lesions in the cerebellum and cerebral cortex. A chest X-ray is within normal limits. Mild dilatation of the ventricles is also appreciated. Cerebrospinal analysis fluid (CSF) analysis reveals: CSF opening pressure 25 cm H20 CSF total leukocyte count 580/mm3 Lymphocytes 90% Neutrophils 10% CSF protein 176 mg/dL CSF glucose 21 mg/dL A specimen stains are positive for acid-fast bacilli. CSF culture is pending. Appropriate antibacterial medication is initiated. Which of the following is true regarding the immediate future management of this patient?? {'A': 'Acyclovir should be started empirically as well', 'B': 'Check liver enzymes regularly', 'C': 'Verify response to antibiotic therapy', 'D': 'Avoid steroids', 'E': 'Treatment should only be started after CSF culture results'},
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B: Check liver enzymes regularly
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Q:A 23-year-old male presents to the emergency department. He was brought in by police for shouting on a subway. The patient claims that little people were trying to kill him, and he was acting within his rights to defend himself. The patient has a past medical history of marijuana and IV drug use as well as multiple suicide attempts. He is currently homeless. While in the ED, the patient is combative and refuses a physical exam. He is given IM haloperidol and diphenhydramine. The patient is transferred to the inpatient psychiatric unit and is continued on haloperidol throughout the next week. Though he is no longer aggressive, he is seen making "armor" out of paper plates and plastic silverware to defend himself. The patient is switched onto risperidone. The following week the patient is still seen gathering utensils, and muttering about people trying to harm him. The patient's risperidone is discontinued. Which of the following is the best next step in management?? {'A': 'Chlorpromazine', 'B': 'Fluphenazine', 'C': 'Thioridazine', 'D': 'Olanzapine', 'E': 'Clozapine'},
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E: Clozapine
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Q:An 18-year-old man presents to his primary care provider before leaving for college. He has no complaints. His past medical history is significant for asthma, acne vulgaris, and infectious mononucleosis at age 16. His home medications include doxycycline and albuterol as needed. His family history is significant for colon cancer in his father at age 50, his paternal grandfather at age 55, and an uncle at age 45. His father underwent testing for mutations in the APC gene, which were negative. There is no family history of dental abnormalities or other malignancy. The patient denies any recent weight loss, abdominal pain, hematochezia, melena, or other changes in the appearance of his stools. This patient should be screened for colorectal cancer (CRC) under which of the following protocols?? {'A': 'Colonoscopy every 1-2 years beginning at age 25', 'B': 'Colonoscopy every 5 years beginning at age 40', 'C': 'Colonoscopy every 10 years beginning at age 40', 'D': 'Colonoscopy every 10 years beginning at age 50', 'E': 'Prophylactic colectomy'},
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A: Colonoscopy every 1-2 years beginning at age 25
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Q:A 57-year-old woman with a long-standing history of liver cirrhosis presents to her primary care provider with a complaint of unintended weight loss of 8.2 kg (18.0 lb) within the last month. She has a history of intermittent right upper quadrant pain in her abdomen with decreased appetite for a few years and occasional shortness of breath. The past medical history is significant for hepatitis E infection during her first pregnancy when she was 28 years old, and a history of blood transfusion after an accident 25 years ago. She drinks about 2–3 pints of beer every week on average and does not use tobacco. The vital signs include: blood pressure 110/68 mm Hg, pulse rate 82/min, respiratory rate 11/min, and temperature 37.7 °C (99.9°F). The physical exam is normal except for moderate icterus and tender hepatomegaly. The blood tests show mild anemia with decreased iron stores. Serum electrolytes, blood sugar, and renal function are normal. The chest X-ray is normal. An ultrasound of the abdomen revealed a mass in the liver, which was confirmed with a biopsy to be hepatocellular carcinoma. Which of the following is the strongest causative factor that can be linked to her diagnosis?? {'A': 'History of hepatitis E', 'B': 'Shortness of breath', 'C': 'History of alcoholism', 'D': 'History of blood transfusion', 'E': 'Hemochromatosis'},
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D: History of blood transfusion
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Q:A 79-year-old man presents to a physician’s office for a routine appointment. He had a myocardial infarction 3 years ago and was started on aspirin, carvedilol, captopril, and high-dose atorvastatin. He denies shortness of breath or cough. He exercises regularly and is on a healthy diet that is good for his heart. The vital signs include: pulse 80/min, respirations 16/min and blood pressure 122/80 mm Hg. The physical examination reveals an overweight male with a body mass index (BMI) of 28 kg/m2. The fasting lipid profile is as follows: Total cholesterol 200 mg/dL High-density lipoprotein (HDL) 35 mg/dL Low-density lipoprotein (LDL) 140 mg/dL Triglycerides 120 mg/dL Which of the following drugs should be added to his regimen?? {'A': 'Furosemide', 'B': 'Orlistat', 'C': 'Niacin', 'D': 'Ezetimibe', 'E': 'Losartan'},
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D: Ezetimibe
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Q:A 69-year-old man comes to the physician because of a 4-month history of progressive fatigue, cough, shortness of breath, and a 6.6-kg (14.5-lb) weight loss. For the past week, he has had blood-tinged sputum. He is a retired demolition foreman. There is dullness to percussion and decreased breath sounds over the left lung base. A CT scan of the chest shows a left-sided pleural effusion and circumferential pleural thickening with calcifications on the left hemithorax. Pathologic examination of a biopsy specimen of the thickened tissue is most likely to show which of the following findings?? {'A': 'Synaptophysin-positive dark blue cells with hyperchromatic nuclei and scarce cytoplasm', 'B': 'Calretinin-positive polygonal cells with numerous long surface microvilli', 'C': 'Napsin-positive cells in an acinar growth pattern with intracytoplasmatic mucin', 'D': 'Keratin-producing large polygonal cells with intercellular bridges', 'E': 'Large polygonal cells with prominent nucleoli and abundant pale cytoplasm'},
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B: Calretinin-positive polygonal cells with numerous long surface microvilli
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Q:A 57-year-old man presents with acute-onset nausea and left flank pain. He says his symptoms suddenly started 10 hours ago and have not improved. He describes the pain as severe, colicky, intermittent, and localized to the left flank. The patient denies any fever, chills, or dysuria. His past medical history is significant for nephrolithiasis, incidentally diagnosed 10 months ago on a routine ultrasound, for which he has not been treated. His family history is unremarkable. The patient is afebrile, and his vital signs are within normal limits. On physical examination, he is writhing in pain and moaning. Severe left costovertebral angle tenderness is noted. Gross hematuria is present on urinalysis. A non-contrast CT of the abdomen and pelvis reveals a 12-mm obstructing calculus at the left ureterovesical junction. Initial management, consisting of IV fluid resuscitation, antiemetics, and analgesia, is administered. Which of the following is the best next step in the management of this patient?? {'A': 'Percutaneous nephrostomy', 'B': 'Ureteroscopy', 'C': 'Percutaneous nephrostolithotomy (PCNL)', 'D': 'Extracorporeal shockwave lithotripsy (ESWL)', 'E': '24-hour urine chemistry'},
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B: Ureteroscopy
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Answer the following medical question with one of the provided options:
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Q:A 27-year-old woman is brought to the physician by her parents because they are concerned about her mood. They say that she has “not been herself” since the death of her friend, who was killed 3 weeks ago when the fighter jet he piloted was shot down overseas. She says that since the incident, she feels sad and alone. She reports having repeated nightmares about her friend's death. Her appetite has decreased, but she is still eating regularly and is otherwise able to take care of herself. She does not leave her home for any social activities and avoids visits from friends. She went back to work after taking 1 week off after the incident. Her vital signs are within normal limits. Physical examination shows no abnormalities. On mental status examination, she appears sad, has a full range of affect, and is cooperative. In addition to taking measures to evaluate this patient's anxiety, which of the following is the most appropriate statement by the physician at this time?? {'A': '"""I am worried that you may be having an abnormally severe reaction to what is an understandably stressful event. I recommend attending behavioral therapy sessions to help you deal with this challenge."""', 'B': '"""I understand that the sudden loss of your friend has affected you deeply. Sometimes in situations like yours, people have thoughts that life is not worth living; have you had such thoughts?"""', 'C': '"""Your grief over the loss of your friend appears to have a negative effect on your social and functional capabilities. I recommend starting antidepressants to help you deal with this challenge."""', 'D': '"""I can see that you have gone through a lot recently, but I think that your reaction is especially severe and has persisted for longer than normal. Would you be open to therapy or medication to help you manage better?"""', 'E': '"""I\'m so sorry, but the loss of loved ones is a part of life. Let\'s try to find better ways for you to deal with this event."""\n"'},
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B: """I understand that the sudden loss of your friend has affected you deeply. Sometimes in situations like yours, people have thoughts that life is not worth living; have you had such thoughts?"""
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Answer the following medical question with one of the provided options:
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Q:A 25-year-old man is rushed to the emergency department following a motor vehicle accident. After an initial evaluation, he is found to have bilateral femoral fractures. After surgical fixation of his fractures, he suddenly starts to feel nauseated and becomes agitated. Past medical history is significant for a thyroid disorder. His temperature is 40.0°C (104°F), blood pressure is 165/100 mm Hg, pulse is 170/min and irregularly irregular, and respirations are 20/min. On physical examination, the patient is confused and delirious. Oriented x 0. Laboratory studies are significant for the following: Thyroxine (T4), free 5 ng/dL Thyroid stimulating hormone (TSH) 0.001 mU/L The patient is started on propranolol to control his current symptoms. Which of the following best describes the mechanism of action of this new medication?? {'A': 'Inhibition of thyroid peroxidase enzyme', 'B': 'Inhibition of an underlying autoimmune process', 'C': 'Decrease the peripheral conversion of T4 to T3', 'D': 'Inhibition of release of thyroid hormones', 'E': 'Interference with enterohepatic circulation and recycling of thyroid hormones'},
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C: Decrease the peripheral conversion of T4 to T3
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Q:A 25-year-old medical student returns from a volunteer mission trip in Nicaragua with persistent cough and occasional hemoptysis for 3 weeks. A purified protein derivative test revealing a 20 mm wheal and a chest radiograph with hilar lymphadenopathy support a diagnosis of active tuberculosis. The patient is started on appropriate therapy. Among the prescribed medications, one drug inhibits carbohydrate polymerization of the pathogen's cell wall. What is the most likely complaint that the patient may present with because of this drug?? {'A': 'Joint pain', 'B': 'Leg numbness', 'C': 'Nausea and vomiting', 'D': 'Orange colored urine', 'E': 'Vision changes'},
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E: Vision changes
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Q:A 23-year-old man presents to the emergency department with a chief complaint of being assaulted on the street. The patient claims that he has been followed by the government for quite some time and that he was assaulted by a government agent but was able to escape. He often hears voices telling him to hide. The patient has an unknown past medical history and admits to smoking marijuana frequently. On physical exam, the patient has no signs of trauma. When interviewing the patient, he is seen conversing with an external party that is not apparent to you. The patient states that he is afraid for his life and that agents are currently pursuing him. What is the best initial response to this patient’s statement?? {'A': 'I don’t think any agents are pursuing you.', 'B': 'I think you are safe from the agents here.', 'C': 'It sounds like you have been going through some tough experiences lately.', 'D': 'You have a mental disorder but don’t worry we will help you.', 'E': 'What medications are you currently taking?'},
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C: It sounds like you have been going through some tough experiences lately.
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Q:A 35-year-old Caucasian female with a history of rheumatoid arthritis presents to your clinic with pleuritic chest pain that improves while leaning forward. Which of the following additional findings would you expect to observe in this patient?? {'A': 'Increase in jugular venous pressure on inspiration', 'B': 'Exaggerated amplitude of pulse on inspiration', 'C': 'Pulsatile abdominal mass', 'D': 'Continuous machine-like murmur', 'E': 'S3 heart sound'},
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A: Increase in jugular venous pressure on inspiration
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Q:A 27-year-old man presents to his primary care physician after a recent illness. For the past 48 hours the patient has experienced constant vomiting and diarrhea with a high fever. He is feeling better today and wants to be seen to ensure he is healthy. The patient has a past medical history of schizophrenia well controlled with risperidone and lithium. He takes ibuprofen for knee pain and attempts to stay well hydrated. Laboratory values are ordered as seen below. Serum: Na+: 123 mEq/L Cl-: 90 mEq/L K+: 3.8 mEq/L HCO3-: 29 mEq/L BUN: 42 mg/dL Glucose: 109 mg/dL Creatinine: 1.9 mg/dL Ca2+: 10.2 mg/dL Which of the following is the most likely explanation for this patient’s laboratory derangements?? {'A': 'Aldosterone-secreting mass', 'B': 'Intrarenal injury', 'C': 'Psychogenic polydipsia', 'D': 'Syndrome of inappropriate antidiuretic hormone secretion', 'E': 'Volume depletion'},
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E: Volume depletion
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Q:A 46-year-old woman comes to the emergency department because of intermittent abdominal pain and vomiting for 2 days. The abdominal pain is colicky and diffuse. The patient's last bowel movement was 3 days ago. She has had multiple episodes of upper abdominal pain that radiates to her scapulae and vomiting over the past 3 months; her symptoms subsided after taking ibuprofen. She has coronary artery disease, type 2 diabetes mellitus, gastroesophageal reflux disease, and osteoarthritis of both knees. Current medications include aspirin, atorvastatin, rabeprazole, insulin, and ibuprofen. She appears uncomfortable. Her temperature is 39°C (102.2°F), pulse is 111/min, and blood pressure is 108/68 mm Hg. Examination shows dry mucous membranes. The abdomen is distended and tympanitic with diffuse tenderness; bowel sounds are high-pitched. Rectal examination shows a collapsed rectum. Her hemoglobin concentration is 13.8 g/dL, leukocyte count is 14,400/mm3, and platelet count is 312,000/mm3. An x-ray of the abdomen is shown. Which of the following is the most likely cause of this patient's findings?? {'A': 'Cholecystoenteric fistula', 'B': 'Cecal torsion', 'C': 'Bowel infarction', 'D': 'Viscus perforation', 'E': 'Colonic diverticuli inflammation'},
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A: Cholecystoenteric fistula
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Q:A 41-year-old woman comes to the physician because of a 1-year history of fatigue, irregular menstrual cycles, and recurrent sinus infections. Examination shows hirsutism and hypopigmented linear striations on the abdomen. Serum studies show hypernatremia, hypokalemia, and metabolic alkalosis. A 24-hour urinary cortisol level is elevated. Serum ACTH is also elevated. High-dose dexamethasone does not suppress serum cortisol levels. Which of the following is the most likely underlying cause of this patient's condition?? {'A': 'Adrenal carcinoma', 'B': 'Adrenal adenoma', 'C': 'Pituitary adenoma', 'D': 'Pheochromocytoma', 'E': 'Small cell lung cancer'},
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E: Small cell lung cancer
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Q:A group of investigators is studying thermoregulatory adaptations of the human body. A subject is seated in a thermally insulated isolation chamber with an internal temperature of 48°C (118°F), a pressure of 1 atmosphere, and a relative humidity of 10%. Which of the following is the primary mechanism of heat loss in this subject?? {'A': 'Evaporation', 'B': 'Conduction', 'C': 'Convection', 'D': 'Piloerection', 'E': 'Radiation'},
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A: Evaporation
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Q:A 52-year-old woman sees you in her office with a complaint of new-onset headaches over the past few weeks. On exam, you find a 2 x 2 cm dark, irregularly shaped, pigmented lesion on her back. She is concerned because her father recently passed away from skin cancer. What tissue type most directly gives rise to the lesion this patient is experiencing?? {'A': 'Ectoderm', 'B': 'Neuroectoderm', 'C': 'Mesoderm', 'D': 'Neural crest cells', 'E': 'Endoderm'},
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D: Neural crest cells
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Q:A 19-year-old man is brought to the emergency department following a high-speed motor vehicle collision in which he was a restrained passenger. He complains of pelvic pain and involuntary loss of urine, with constant dribbling. Examination shows perineal bruising and there is pain with manual compression of the pelvis. Pelvic ultrasound shows a normal bladder. Injury to which of the following structures is most likely responsible for this patient's urinary incontinence?? {'A': 'Pelvic splanchnic nerves', 'B': 'Genitofemoral nerve', 'C': 'Superior gluteal nerve', 'D': 'Ilioinguinal nerve', 'E': 'Obturator nerve'},
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A: Pelvic splanchnic nerves
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Q:A 29-year-old woman comes to the physician because of a 4-day history of fever with chills, nausea, myalgias, and malaise. One week ago, she returned from a trip to Rhode Island, where she participated in a month-long program to become an assistant park ranger. Laboratory studies show a leukocyte count of 1,400/mm3. A peripheral blood smear shows dark purple, mulberry-like inclusions inside the granulocytes. A presumptive diagnosis is made and pharmacotherapy is initiated with the drug of choice for this condition. The bacteriostatic effect of this drug is most likely due to inhibition of which of the following processes?? {'A': 'Transcription of bacterial DNA by RNA-polymerase', 'B': 'Bacterial peptidyl transferase activity at the 50S subunit', 'C': 'Bacterial topoisomerase II and topoisomerase IV activity', 'D': 'Peptidoglycan crosslinking and bacterial cell wall synthesis', 'E': 'Binding of bacterial tRNA to the acceptor site of ribosomes'},
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E: Binding of bacterial tRNA to the acceptor site of ribosomes
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Q:A 32-year-old Caucasian woman presents with a three-month history of weight loss, anxiety, and tremors. She recalls frequent heart palpitations and new discomfort while being outside in the heat. Her labs include a TSH level of 0.1 mIU/L. Additionally, the patient’s serum is positive for antibodies that stimulate the TSH receptor. What process is unique to this patient’s diagnosis?? {'A': 'Hyperplasia of thyroid follicular cells', 'B': 'Lymphocyte-mediated destruction of the thyroid gland', 'C': 'Binding of thyroid hormones to cardiac myocytes', 'D': 'Elevated levels of cholesterol and low density lipoprotein (LDL)', 'E': 'Stimulation of retroorbital fibroblasts'},
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E: Stimulation of retroorbital fibroblasts
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Q:A 59-year-old Caucasian man presents with a one-month history of left flank fullness and pain. The patient has stable angina, which is controlled with medications including atorvastatin, metoprolol, and aspirin. His vital signs are within normal limits. BMI is 32 kg/m2. Clinical examination reveals a 10 x 10-cm palpable mass in the left flank. Testicular examination indicates left varicocele. Laboratory parameters are as follows: Urine Blood 3+ WBC none RBC 65/hpf without dysmorphic features Abdominal CT scan confirms the presence of a large solid mass originating in the left kidney with impingement on the left renal vein. Based on the most likely diagnosis, which of the following is considered a risk factor in this patient?? {'A': 'Atorvastatin', 'B': 'Caucasian race', 'C': 'Lynch syndrome', 'D': 'Obesity', 'E': 'Varicocele'},
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D: Obesity
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Q:Two hours after undergoing laparoscopic roux-en-Y gastric bypass surgery, a 44-year-old man complains of pain in the site of surgery and nausea. He has vomited twice in the past hour. He has hypertension, type 2 diabetes mellitus, and hypercholesterolemia. Current medications include insulin, atorvastatin, hydrochlorothiazide, acetaminophen, and prophylactic subcutaneous heparin. He drinks two to three beers daily and occasionally more on weekends. He is 177 cm (5 ft 10 in) tall and weighs 130 kg (286 lb); BMI is 41.5 kg/m2. His temperature is 37.3°C (99.1°F), pulse is 103/min, and blood pressure is 122/82 mm Hg. Examination shows five laparoscopic incisions with no erythema or discharge. The abdomen is soft and non-distended. There is slight diffuse tenderness to palpation. Bowel sounds are reduced. Laboratory studies show: Hematocrit 45% Serum Na+ 136 mEq/L K+ 3.5 mEq/L Cl- 98 mEq/L Urea nitrogen 31 mg/dL Glucose 88 mg/dL Creatinine 1.1 mg/dL Arterial blood gas analysis on room air shows: pH 7.28 pCO2 32 mm Hg pO2 74 mm Hg HCO3- 14.4 mEq/L Which of the following is the most likely cause for the acid-base status of this patient?"? {'A': 'Uremia', 'B': 'Vomiting', 'C': 'Early dumping syndrome', 'D': 'Hypoxia', 'E': 'Late dumping syndrome'},
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D: Hypoxia
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Answer the following medical question with one of the provided options:
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Q:A 31-year-old man presents with a headache, myalgias, nausea, irritability, and forgetfulness. He developed these symptoms gradually over the past 3 months. He is a motor mechanic, and he changed his place of work 4 months ago. He smokes a half a pack of cigarettes per day. His vaccinations are up to date. On presentation, his vital signs are as follows: blood pressure is 145/70 mm Hg, heart rate is 94/min, respiratory rate is 17/min, and temperature is 36.8℃ (98.2℉). Physical examination reveals diffuse erythema of the face and chest and slight abdominal distention. Neurological examination shows symmetrical brisk upper and lower extremities reflexes. Blood tests show the following results: pH 7.31 Po2 301 mm Hg Pco2 28 mm Hg Na+ 141 mEq/L K+ 4.3 mEq/L Cl- 109 mEq/L HCO3- 17 mEq/L Base Excess -3 mEq/L Carboxyhemoglobin 38% Methemoglobin 1% Serum cyanide 0.35 mcg/mL (Reference range 0.5–1 mcg/mL) Which of the following statements about the patient’s condition is true?? {'A': 'The patient’s symptoms are a consequence of his essential hypertension.', 'B': 'Chronic cyanide exposure is the main cause of patient’s condition.', 'C': 'This patient’s symptoms are due to CO-induced inactivation of cytochrome oxidase and carboxyhemoglobin formation.', 'D': 'Viral infection should be suspected in this patient.', 'E': 'This patient has disrupted glycolysis due to inactivation of fructose-bisphosphate aldolase.'},
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C: This patient’s symptoms are due to CO-induced inactivation of cytochrome oxidase and carboxyhemoglobin formation.
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Q:A 38-year-old woman was brought to the emergency department after she experienced dizziness and shortness of breath while walking with her friend. She recently immigrated to the United States and is unable to report her previous medical history. Physical exam reveals pallor underneath her eyelids. Labs are obtained with the following results: Hemoglobin: 8.4 g/dL Platelet count: 62,000/mm^3 Mean corpuscular volume: 89 µm^3 Reticulocyte count: 0.1% Lactate dehydrogenase: 175 U/L Which of the following is associated with the most likely cause of this patient's symptoms?? {'A': 'Administration of a 50S ribosomal inhibitor', 'B': 'Chronic alcohol abuse', 'C': 'Living in an old house', 'D': 'Recent infection with a toxin producing gram-negative rod', 'E': 'Vegan diet'},
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A: Administration of a 50S ribosomal inhibitor
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Q:A 68-year-old man presents to the office for his annual physical examination. He has no current complaints. Past medical history is unremarkable. He reports a 30-pack-year smoking history but no alcohol or drug use. Review of systems is only remarkable for thicker mucous production that is worse in the morning when he coughs. A non-contrast CT scan of his chest is performed, and the doctor informs him that a 2 cm nodule has been identified in his upper lobe of the left lung near the left main bronchus and that further testing is required to rule out malignancy. The patient is surprised by this news since he has never experienced any alarming symptoms. The doctor informs him that lung cancers don’t usually present with symptoms until late in the course of the disease. The doctor says that sometimes it may take several years before it becomes severe enough to cause symptoms, which is why patients with risk factors for developing lung cancer are screened at an earlier age than the general public. Which of the following concepts is being described by the doctor to this patient?? {'A': 'Surveillance bias', 'B': 'Confounding bias', 'C': 'Induction period', 'D': 'Latent period', 'E': 'Lead time bias'},
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D: Latent period
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Q:A 32-year-old woman presents with a 3-month history of intermittent blurred vision and problems walking. The patient states that she often feels “pins and needles” in her legs that cause her problems when she’s walking. The patient is afebrile, and her vital signs are within normal limits. An autoimmune disorder is suspected. Which of the following findings would most likely be present in this patient?? {'A': 'Decreased cerebrospinal fluid due to destruction of cells', 'B': 'Destruction of blood-brain barrier', 'C': 'Failure of cells that myelinate individual axons', 'D': 'Damaged myelin sheath and myelin-producing cells', 'E': 'Absence of interneurons'},
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D: Damaged myelin sheath and myelin-producing cells
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Q:A 2-year-old girl is brought to the physician by her mother for a well-child examination. She is at the 55th percentile for height and the 40th percentile for weight. Vital signs are within normal limits. Physical examination shows no abnormalities. She is able to follow simple commands, such as “close your eyes, then stick out your tongue,” but she is unable to follow 3-step commands. She knows approximately 75 words, and half of her speech is understandable. She can say 2-word phrases, and she is able to name many parts of the body. Assuming normal development, which of the following milestones would be expected in a patient this age?? {'A': 'Builds a tower of 6 cubes', 'B': 'Engages in role-playing', 'C': 'Hops on one foot', 'D': 'Pedals a tricycle', 'E': 'Separates easily from parents'},
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A: Builds a tower of 6 cubes
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Q:A 23-year-old primigravida presents to her physician’s office at 12 weeks gestation complaining of increased sweating and palpitations for the last week. She does not have edema or dyspnea, and had no pre-existing illnesses. The patient says that the symptoms started a few days after several episodes of vomiting. She managed the vomiting at home and yesterday the vomiting stopped, but the symptoms she presents with are persistent. The pre-pregnancy weight was 54 kg (119 lb). The current weight is 55 kg (121 lb). The vital signs are as follows: blood pressure 130/85 mm Hg, heart rate 113/min, respiratory rate 15/min, and temperature 37.0℃ (98.6℉). The physical examination is significant for diaphoresis, an irregular heartbeat, and a fine resting tremor of the hands. The neck is not enlarged and the thyroid gland is not palpable. The ECG shows sinus tachyarrhythmia. The thyroid panel is as follows: Thyroid stimulating hormone (TSH) < 0.1 mU/L Total T4 178 nmol/L Free T4 31 pmol/L Which of the following is indicated?? {'A': 'Ensure proper hydration and prescribe a beta-blocker', 'B': 'Manage with propylthiouracil', 'C': 'Schedule a subtotal thyroidectomy', 'D': 'Prescribe methimazole', 'E': 'Recommend iodine radioablation'},
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A: Ensure proper hydration and prescribe a beta-blocker
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Q:A 61-year-old man comes to the physician because of a 6-month history of epigastric pain and a 9-kg (20-lb) weight loss. He feels full and bloated even after eating small portions of food. His hemoglobin concentration is 9.5 g/dL with a mean corpuscular volume of 78 μm3. Test of the stool for occult blood is positive. Esophagogastroduodenoscopy shows a 2-cm raised lesion with central ulceration on the lesser curvature of the stomach. Histologic examination of a gastric biopsy specimen from the lesion is most likely to show which of the following?? {'A': 'Neutrophilic infiltration with pit abscesses', 'B': 'Foveolar and smooth muscle hyperplasia', 'C': 'Gland-forming cuboidal cells', 'D': 'Lymphocytic aggregates with noncaseating granulomas', 'E': 'Mucin-filled round cells'},
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C: Gland-forming cuboidal cells
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Q:A 62-year-old man comes to the physician because of a growth on his penis that has been gradually increasing in size over the last year. He was diagnosed with HIV 10 years ago. He has been divorced for 25 years and has had “at least 30 sexual partners” since. Physical examination shows a nontender 2.5-cm ulcerated lesion with an erythematous base on the dorsum of the glans. There is firm left inguinal lymphadenopathy. A biopsy of the lesion shows small uniform basophilic cells with central necrosis that invade into the corpus cavernosum. This patient's condition is most likely associated with which of the following pathogens?? {'A': 'Human papillomavirus', 'B': 'Epstein-Barr virus', 'C': 'Haemophilus ducreyi', 'D': 'Neisseria gonorrhoeae', 'E': 'Chlamydia trachomatis\n"'},
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A: Human papillomavirus
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Q:A 32-year-old G2P0A1 woman presents at 36 weeks of gestation for the first time during her pregnancy. The patient has no complaints, currently. However, her past medical history reveals seizure disorder, which is under control with valproic acid and lithium. She has not seen her neurologist during the past 2 years, in the absence of any complaints. She also reports a previous history of elective abortion. The physical examination is insignificant. Her blood pressure is 130/75 mm Hg and pulse is 80/min. The patient is scheduled to undergo regular laboratory tests and abdominal ultrasound. Given her past medical history, which of the following conditions is her fetus most likely going to develop?? {'A': 'Trisomy 21', 'B': 'Neural tube defects (NTDs)', 'C': 'Iron deficiency anemia', 'D': 'Intrauterine growth restriction', 'E': 'Limb anomalies'},
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B: Neural tube defects (NTDs)
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Q:A 36-year-old woman comes to the physician for a follow-up visit after she had a PET scan that showed a nodule on the thyroid gland. She has no difficulty or pain while swallowing. She was treated for non-Hodgkin lymphoma at the age of 28 years, which included external beam radiation to the head and neck and 4 cycles of chemotherapy. She appears healthy. Vital signs are within normal limits. Physical examination shows no abnormalities. Serum studies show: Glucose 82 mg/dL Creatinine 0.7 mg/dL Thyroid-stimulating hormone 3 μU/mL Ultrasound of the neck shows a 1.2-cm (0.5-in) nodule on the left lobe of the thyroid with irregular margins and microcalcifications. A fine-needle aspiration biopsy shows Psammoma bodies and cells with clear, ground-glass, empty nuclei. Which of the following is the most appropriate next step in management?"? {'A': 'Percutaneous radiotherapy', 'B': 'Radioiodine therapy', 'C': 'Observation and follow-up in 3 months', 'D': 'Thyroid scintigraphy', 'E': 'Total thyroidectomy\n"'},
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E: Total thyroidectomy "
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Q:A 25-year-old woman with a history of moderate persistent asthma presents to the emergency department with tachypnea, shortness of breath, and cough. She also mentions that she has recently started to notice red flecks in the sputum that she coughs up. The vital signs include: temperature 36.7°C (98.0°F), blood pressure 126/74 mm Hg, heart rate 74/min, and respiratory rate 26/min. Her physical examination is significant for moderate bilateral wheezes and poor air movement. The forced expiratory volume-1 (FEV-1) is less than 50% of the predicted value, and she is found to have a concurrent upper respiratory tract infection. She is given oxygen, albuterol, and corticosteroids for her exacerbation, and she starts to feel better after a few hours of monitoring in the emergency department. She is ultimately discharged home on a 14-day prednisone taper. Which of the following is a side effect she could experience on this short course of steroids?? {'A': 'Emotional instability', 'B': 'Fat deposits in the face', 'C': 'Impaired wound healing', 'D': 'Cushing’s syndrome', 'E': 'Amenorrhea'},
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A: Emotional instability
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Q:A 55-year-old woman comes to the physician because of fevers for 2 weeks. She works as a nurse and recently returned from a charity work trip to India, where she worked in a medically-underserved rural community. A tuberculin skin test 3 months ago prior to her trip showed an induration of 3 mm. Physical examination is unremarkable. An x-ray of the chest shows right-sided hilar lymphadenopathy. A sputum culture shows acid-fast bacilli. Which of the following immunologic processes most likely occurred first?? {'A': 'Transportation of bacterial peptides to regional lymph nodes', 'B': 'Formation of a nodular tubercle in the lung', 'C': 'Replication of bacteria within alveolar macrophages', 'D': 'Production of interferon-gamma by T-helper cells', 'E': 'Migration of T-helper cells to the lungs'},
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C: Replication of bacteria within alveolar macrophages
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Q:A 35-year-old woman is brought to the emergency department 45 minutes after being rescued from a house fire. On arrival, she appears confused and has shortness of breath. The patient is 165 cm (5 ft 5 in) tall and weighs 55 kg (121 lb); BMI is 20 kg/m2. Her pulse is 125/min, respirations are 29/min, and blood pressure is 105/65 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 97%. Examination shows second and third-degree burns over the anterior surfaces of the chest and abdomen, and the anterior surface of the upper extremities. There is black debris in the mouth and nose. There are coarse breath sounds over the lung bases. Cardiac examination shows no murmurs, rubs, or gallop. Femoral and pedal pulses are palpable bilaterally. Which of the following is the most appropriate fluid regimen for this patient according to the Parkland formula?? {'A': 'Administer 6 liters of intravenous crystalloids over the next 24 hours', 'B': 'Administer 4 liters of intravenous colloids over the next 8 hours', 'C': 'Administer 8 liters of intravenous colloids over the next 12 hours', 'D': 'Administer 5 liters of intravenous crystalloids over the next 6 hours', 'E': 'Administer 5 liters of intravenous colloids over the next 6 hours'},
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A: Administer 6 liters of intravenous crystalloids over the next 24 hours
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Q:Where does the only cranial nerve without a thalamic relay nucleus enter the skull?? {'A': 'Foramen rotundum', 'B': 'Jugular foramen', 'C': 'Internal auditory meatus', 'D': 'Superior orbital fissure', 'E': 'Cribriform plate'},
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E: Cribriform plate
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Q:A 13-year-old female comes to your office complaining of dry, scaling skin (FIgure A). She is particularly concerned about the appearance of her skin around her peers. She indicates that she did not start having problems until she was 5 years of age, after which her skin has progressively become drier and scalier. She has tried all types of over-the-counter moisturizers with no resolution. What is the most likely diagnosis?? {'A': 'Ichthyosis vulgaris', 'B': 'Atopic dermatitis', 'C': 'Psoriasis', 'D': 'Miliaria', 'E': 'Suborrheic dermatitis'},
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A: Ichthyosis vulgaris
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Q:A 35-year-old woman is brought to the emergency department by her coworkers after a sudden onset of vision loss. She is a lawyer and lost 3 cases in the past week. Yesterday, she experienced weakness and paralysis of her left wrist. Past medical history is significant for acid reflux. Physical examination reveals 2/4 in reflexes and 5/5 in muscular strength in all extremities. She appears indifferent to her current situation and presents with a flat affect. Slurring of words is absent. CT without contrast and MRI of the brain are unremarkable. Which of the following is the most likely diagnosis?? {'A': 'Factitious disorder', 'B': 'Transient ischemic attack', 'C': 'Somatization disorder', 'D': 'Major depressive disorder', 'E': 'Conversion disorder'},
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E: Conversion disorder
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Q:A 63-year-old female recovering from a total shoulder arthroplasty completed 6 days ago presents complaining of joint pain in her repaired shoulder. Temperature is 39 degrees Celsius. Physical examination demonstrates erythema and significant tenderness around the incision site. Wound cultures reveal Gram-positive cocci that are resistant to nafcillin. Which of the following organisms is the most likely cause of this patient's condition?? {'A': 'Streptococcus viridans', 'B': 'Escherichia coli', 'C': 'Staphylococcus epidermidis', 'D': 'Staphylococcus aureus', 'E': 'Streptococcus pyogenes'},
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D: Staphylococcus aureus
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Q:A 55-year-old woman presents to the emergency room with severe abdominal pain for the past 24 hours. She has also noticed blood in her urine. She does not have any significant past medical history. Family history is significant for her mother having cholecystitis status post cholecystectomy at age 45. Her vital signs include: temperature 36.8°C (98.2°F), pulse 103/min, respiratory rate 15/min, blood pressure 105/85 mm Hg. Physical examination is significant for a woman continuously moving on the exam table in an attempt to get comfortable. Laboratory findings are significant for the following: Serum electrolytes Na 138 mEq/L N: 135–145 mEq/L K 4.0 mEq/L N: 3.5–5.0 mEq/L Cl 102 mEq/L N: 98–108 mEq/L CO2 27 mEq/L N: 22–32 mEq/L Ca 9.2 mEq/dL N: 8.4–10.2 mEq/dL PO4 3.5 mg/dL N: 3.0–4.5 mg/dL A 24-hour urine collection is performed and reveals a urinary calcium of 345 mg/day (ref: < 300 mg/day in men; < 250 mg/day in women). A non-contrast CT of the abdomen is performed and is shown in the exhibit. The patient’s symptoms pass within the next 12 hours with hydration and acetaminophen for pain management. She is prescribed a medication to prevent subsequent episodes. At which of the following parts of the nephron does this medication most likely work?? {'A': 'Proximal tubule', 'B': 'Distal convoluted tubule', 'C': 'Thick ascending limb of the loop of Henle', 'D': 'Collecting ducts', 'E': 'Descending limb of the loop of Henle'},
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B: Distal convoluted tubule
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Q:A 70-year-old male is brought to the emergency department from a nursing home due to worsening mental status. His nurse reports that the patient has been very lethargic and sleeping more than usual for the past week. She found him confused and difficult to arouse this morning and decided to bring him to the ER. His past medical history is significant for small cell carcinoma of the lung for which he is receiving chemotherapy. He is also on lithium and bupropion for bipolar disorder. Other medications include metoprolol, valsartan, metformin, and insulin. On admission, blood pressure is 130/70 mm Hg, pulse rate is 100 /min, respiratory rate is 17/min, and temperature is 36.5°C (97.7ºF). He is drowsy and disoriented. Physical examination is normal. Finger-stick glucose level is 110 mg/dl. Other laboratory studies show: Na+ 120 mEq/L (136—145 mEq/L) K+ 3.5 mEq/L (3.5—5.0 mEq/L) CI- 107 mEq/L (95—105 mEq/L) Creatinine 0.8 mg/dL (0.6—1.2 mg/dL) Serum osmolality 250 mOsm/kg (275—295 mOsm/kg) Urine Na+ 70 mEq/L Urine osmolality 195 mOsm/kg He is admitted to the hospital for further management. Which of the following is the most likely cause of this patient’s condition?? {'A': 'Carcinoma', 'B': 'Bupropion', 'C': 'Psychogenic polydipsia', 'D': 'Infection', 'E': 'Lithium'},
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A: Carcinoma
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Q:A 70-year-old male presents for an annual exam. His past medical history is notable for shortness of breath when he sleeps, and upon exertion. Recently he has experienced dyspnea and lower extremity edema that seems to be worsening. Both of these symptoms have resolved since he was started on several medications and instructed to weigh himself daily. Which of the following is most likely a component of his medical management?? {'A': 'Ibutilide', 'B': 'Lidocaine', 'C': 'Aspirin', 'D': 'Carvedilol', 'E': 'Verapamil'},
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D: Carvedilol
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Answer the following medical question with one of the provided options:
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Q:A 40-year-old man presents to the physician for a pre-employment medical check-up. He has no symptoms and his past medical history is insignificant. He is a non-smoker. His temperature is 36.9°C (98.4°F), the heart rate is 76/min, the blood pressure is 124/82 mm Hg, and the respiratory rate is 16/min. His general and systemic examination does not reveal any abnormality. Laboratory evaluation is completely normal; however, his chest radiogram shows a single irregularly shaped nodule in the upper lobe of his right lung. The nodule has circumscribed margins and appears to be surrounded by normally aerated lung parenchyma. The nodule is approx. 7 mm (0.28 in) in diameter. The pattern of calcification is nonspecific and there are no signs of atelectasis or pneumonitis. The physician compares the radiogram with another radiogram which was obtained 5 years back. However, there was no pulmonary nodule in the previous radiogram. No other radiograms are available for comparison. Which of the following is the next best step in the diagnostic evaluation of this patient?? {'A': 'Thin-section computed tomography (CT) through the nodule', 'B': 'Positron emission tomography (PET) scan', 'C': 'Single-photon emission CT (SPECT) scan', 'D': 'CT-guided transthoracic needle aspiration (TTNA)', 'E': 'Transbronchial needle aspiration (TBNA)'},
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A: Thin-section computed tomography (CT) through the nodule
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Q:A 33-year-old Caucasian female presents to her primary care provider for skin problems and difficulty breathing. She has not sought medical care in over 10 years due to anxiety around physicians. However, she has experienced gradual onset of diffuse pruritus, skin induration, and limited finger mobility over the past 5 years that has negatively impacted her work as an accountant. More recently, she has developed exertional shortness of breath and is concerned that it may impact her ability to care for her 3-year-old son. She reports no prior medical conditions and takes fish oil. She smokes 1 pack of cigarettes per day and drinks socially. Her temperature is 98.6°F (37°C), blood pressure is 145/85 mmHg, pulse is 85/min, and respirations are 22/min. On exam, she appears anxious with minimally increased work of breathing. Dry rales are heard at her lung bases bilaterally. Her fingers appear shiny and do not have wrinkles on the skin folds. A normal S1 and S2 are heard on cardiac auscultation. This patient’s lung disease is caused by increased secretion of which of the following substances within the lungs?? {'A': 'Interferon gamma', 'B': 'Interleukin 1', 'C': 'Interleukin 2', 'D': 'Tumor necrosis factor alpha', 'E': 'Transforming growth factor beta'},
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E: Transforming growth factor beta
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Q:A 2-year-old boy is brought to the emergency department by his mother for evaluation of severe abdominal pain that began one hour ago. On examination, the patient is afebrile and has diffuse rebound tenderness with acute epigastric pain. A stool guaiac test is positive. A small bowel perforation is suspected. What is the embryologic structure that is the underlying cause of this patient’s presentation?? {'A': 'Vermiform appendix', 'B': 'Anal membrane', 'C': 'Fibrous cord remnant', 'D': 'Vitelline duct', 'E': 'Cloaca'},
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D: Vitelline duct
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Q:A 32-year-old man comes to the physician because of a 2-week history of diarrhea. During this period, he has had about 10 bowel movements per day. He states that his stools are light brown and watery, with no blood or mucus. He also reports mild abdominal pain and nausea. Over the past year, he has had 6 episodes of diarrhea that lasted several days and resolved spontaneously. Over this time, he also noticed frequent episodes of reddening in his face and neck. He returned from a 10-day trip to Nigeria 3 weeks ago. There is no personal or family history of serious illness. He has smoked a pack of cigarettes daily for the past 13 years. His temperature is 37°C (98.6°F), pulse is 110/min, and blood pressure is 100/60 mm Hg. Physical examination shows dry mucous membranes. The abdomen is tender with no rebound or guarding. The remainder of the examination shows no abnormalities. Serum studies show: Na+ 136 mEq/L Cl- 102 mEq/L K+ 2.3 mEq/L HCO3- 22 mEq/L Mg2+ 1.7 mEq/L Ca2+ 12.3 mg/dL Glucose (fasting) 169 mg/dL Nasogastric tube aspiration reveals significantly decreased gastric acid production. Which of the following is the most likely underlying cause of this patient's symptoms?"? {'A': 'Excessive accumulation of mast cells', 'B': 'Functional gastrointestinal disorder', 'C': 'Elevated serum VIP concentration', 'D': 'Increased conversion of 5-hydroxytryptophan to serotonin', 'E': 'Transmural inflammation of the intestinal walls'},
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C: Elevated serum VIP concentration
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Answer the following medical question with one of the provided options:
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Q:A 22-year-old man presents to the emergency department with a fever and a sore throat. He has had these symptoms for the past 2 weeks and has felt progressively more fatigued. His temperature is 102°F (38.9°C), blood pressure is 120/68 mmHg, pulse is 100/min, respirations are 17/min, and oxygen saturation is 98% on room air. Physical exam is notable for tonsillar exudates, posterior cervical lymphadenopathy, and splenomegaly. Which of the following is the most appropriate next step in management for this patient?? {'A': 'Amoxicillin', 'B': 'Monospot test', 'C': 'No further workup needed', 'D': 'Oseltamivir', 'E': 'Rapid strep test'},
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B: Monospot test
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Q:A 32-year-old woman presents to her gynecologist for an annual visit. She is currently sexually active with 3 men and reports the consistent use of condoms. She denies abnormal vaginal odor, discharge, or dysuria. A routine Pap test is performed, which shows atypical squamous cells of undetermined significance (ASC-US). Her last Pap test was normal. A reflex human papillomavirus (HPV) test is negative. What is the best next step in the management of this patient?? {'A': 'Routine screening: repeat Pap test every 3 years', 'B': 'Colposcopy', 'C': 'Cervical biopsy', 'D': 'Repeat cytology and HPV testing in 3 years', 'E': 'Excisional treatment'},
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D: Repeat cytology and HPV testing in 3 years
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Q:A 13-year-old girl is brought to the physician because she has suddenly withdrawn from her close friends and has been displaying anger and hostility toward her friends at school, as well as toward her parents at home over the past month. She has also begun to skip classes and has been absent from school several times during this time period. Her mother says that she has been making up stories about her new art teacher touching her inappropriately. However, she believes that her daughter's behavior is the result of recent divorce issues in the family. Which of the following is the most appropriate next step in the evaluation of this patient?? {'A': 'Obtaining STD screening', 'B': 'Performing a thorough genitourinary exam', 'C': 'Prescribing oral contraceptive pills', 'D': 'Referring the patient for confirmation of sexual abuse', 'E': 'Referring the patient and her parents for family therapy'},
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D: Referring the patient for confirmation of sexual abuse
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Q:A 32-year-old man comes to the physician because of a 2-week history of a cough and shortness of breath. He also noted several episodes of blood-tinged sputum over the last 4 days. He has a 3-month history of progressive fatigue. His temperature is 37.5°C (98.6°F), pulse is 86/min, respirations are 17/min, and blood pressure is 150/93 mm Hg. Examination shows pale conjunctivae. Crackles are heard on auscultation of the chest. Laboratory studies show: Hemoglobin 10.2 g/dL Leukocyte count 9200/mm3 Platelet count 305,000/mm3 Serum Na+ 136 mEq/L Cl- 101 mEq/L K+ 4.5 mEq/L HCO3- 25 mEq/L Urea nitrogen 28 mg/dL Creatinine 2.3 mg/dL Anti-GBM antibodies positive Antinuclear antibodies negative Urine Blood 2+ Protein 2+ RBC 11–13/hbf RBC casts rare He is started on prednisone and cyclophosphamide. Which of the following is the most appropriate next step in management?"? {'A': 'Administer inhalative fluticasone', 'B': 'Perform hemodialysis', 'C': 'Administer immune globulins', 'D': 'Perform plasmapheresis', 'E': 'Administer enalapril'},
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D: Perform plasmapheresis
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Answer the following medical question with one of the provided options:
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Q:An investigator is conducting a phase 1 trial for a novel epoxide reductase inhibitor with favorable pharmacokinetic properties for cerebrovascular accident prophylaxis. Two days after the trial starts, a subject begins to notice pain and erythema over the right thigh. It rapidly progresses to a purpuric rash with the development of necrotic bullae over the next 24 hours. Laboratory studies show a partial thromboplastin time of 29 seconds, prothrombin time of 28 seconds, and INR of 2.15. Which of the following best describes the pathogenesis of the disease process in the patient?? {'A': 'Decreased platelet count', 'B': 'Increased factor VII activity', 'C': 'Increased factor VIII activity', 'D': 'Decreased plasmin activity', 'E': 'Decreased antithrombin III activity'},
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C: Increased factor VIII activity
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Answer the following medical question with one of the provided options:
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Q:A 47-year-old man presents to the physician’s office with an inability to maintain an erection. He can achieve an erection, but it is brief and decreases soon after the penetration. His erectile dysfunction developed gradually over the past 2 years. He denies decreased libido, depressed mood, or anhedonia. He does not report any chronic conditions. He has a 20-pack-year history of smoking and drinks alcohol occasionally. He weighs 120 kg (264.5 lb), his height is 181 cm (5 ft 11 in), and his waist circumference is 110 cm (43 in). The blood pressure is 145/90 mm Hg and the heart rate is 86/min. Physical examination is performed including a genitourinary and rectal examination. It reveals no abnormalities besides central obesity. Which of the following laboratory tests is indicated to investigate for the cause of the patient’s condition?? {'A': 'Plasma calcium', 'B': 'Fasting serum glucose', 'C': '24-hour urine cortisol', 'D': 'Total serum bilirubin', 'E': 'Follicle-stimulating hormone'},
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B: Fasting serum glucose
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Answer the following medical question with one of the provided options:
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Q:Part of the success of the Streptococcus pyogenes bacterium lies in its ability to evade phagocytosis. Which of the following helps in this evasion?? {'A': 'M protein', 'B': 'Streptolysin O', 'C': 'Streptolysin S', 'D': 'Pyrogenic toxin', 'E': 'Streptokinase'},
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A: M protein
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Q:A 39-year-old woman with type 1 diabetes mellitus comes to the physician because of a 2-month history of fatigue and hair loss. She has smoked one pack of cigarettes daily for the past 15 years. Her only medication is insulin. Her pulse is 59/min and blood pressure is 102/76 mm Hg. Physical examination shows dry skin, coarse hair, and a nontender, diffuse neck swelling in the anterior midline. Further evaluation of this patient is most likely to show which of the following findings?? {'A': 'Diffusely increased uptake on a radioactive iodine scan', 'B': 'Antimicrosomal antibodies in serum', 'C': 'Biphasic spindle cells on biopsy of the swelling', 'D': 'DR5 subtype on HLA haplotype analysis', 'E': 'B8 subtype on HLA haplotype analysis'},
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B: Antimicrosomal antibodies in serum
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Q:A 23-year-old man presents to the emergency room with right flank pain. On physical examination, there is no rebound tenderness, guarding, and rigidity. The pain is radiating to the groin region and is associated with nausea. Plain X-ray of the kidney, ureter, and bladder is normal. Urinalysis showed the presence of mild hematuria, an absence of pus cells, and the following crystals (refer to image). What is the most likely composition of these crystals?? {'A': 'Calcium carbonate', 'B': 'Magnesium phosphate', 'C': 'Uric acid', 'D': 'Cysteine stones', 'E': 'Calcium oxalate'},
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C: Uric acid
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Q:A research team is working on a new assay meant to increase the sensitivity of testing in cervical cancer. Current sensitivity is listed at 77%. If this research team’s latest work culminates in the following results (listed in the table), has the sensitivity improved, and, if so, then by what percentage? Research team’s latest results: Patients with cervical cancer Patients without cervical cancer Test is Positive (+) 47 4 Test is Negative (-) 9 44? {'A': 'No, the research team has not seen any improvement in sensitivity according to the new results listed.', 'B': 'Yes, the research team has seen an improvement in sensitivity of more than 10% according to the new results listed.', 'C': 'Yes, the research team has seen an improvement in sensitivity of almost 7% according to the new results listed.', 'D': 'No, the research team has seen a decrease in sensitivity according to the new results listed.', 'E': 'Yes, the research team has seen an improvement in sensitivity of less than 2% according to new results listed; this improvement is negligible and should be improved upon for significant contribution to the field.'},
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C: Yes, the research team has seen an improvement in sensitivity of almost 7% according to the new results listed.
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Q:A 10-year-old boy presents to the emergency department accompanied by his parents with a swollen and painful right knee after he fell from his bicycle a few hours ago. The patient’s mother says he fell off the bike and struck the ground with his whole weight on his right knee. Immediately, his right knee swelled significantly, and he experienced severe pain. The patient’s past medical history is significant for previous episodes of easy bruising that manifest as small bluish spots, but not nearly as severe. The family history is significant for an uncle who had similar symptoms, and who was diagnosed at the age of 13 years old. The patient is afebrile, and the vital signs are within normal limits. On physical examination, a large bruise is present over the right knee that is extending several inches down the leg. The right tibiofemoral joint is warm to the touch and severely tender to palpation. Which of the following is the most likely diagnosis in this patient?? {'A': 'Hemophilia A', 'B': 'Factor V Leiden', 'C': 'Homocystinuria', 'D': 'von Willebrand disease', 'E': 'Protein C deficiency'},
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A: Hemophilia A
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Q:A 29-year-old woman presents to the clinic regularly with her young daughter and complains that ever since her last delivery 5 years ago, she has been having intermittent light vaginal bleeding. She has seen several doctors so far and even some ‘specialist doctors.’ Her menstrual history also appears to be variable. Physical examination is within normal limits. Her urine analysis always seems to have > 10 RBCs/hpf. Which of the following is the most likely diagnosis?? {'A': 'Munchausen disorder with a primary gain', 'B': 'Malingering disorder with a secondary gain', 'C': 'Factitious disorder with a primary gain', 'D': 'Factitious disorder with a secondary gain', 'E': 'Factitious disorder by proxy'},
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C: Factitious disorder with a primary gain
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