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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 comes to the physician because of a 2-month history of a cough productive of clear mucoid sputum. He has smoked one pack of cigarettes daily for 33 years. Physical examination shows no abnormalities. Chest x-ray shows a 2-cm solid nodule in the periphery of the lower left lobe. A bronchial biopsy of the mass shows numerous mucin-filled epithelial cells lining the alveolar basement membrane. The cells have prominent nucleoli, coarse chromatin, and some cells have multiple nuclei. Which of the following is the most likely diagnosis?? {'A': 'Small cell carcinoma', 'B': 'Pulmonary hamartoma', 'C': 'Adenocarcinoma in situ', 'D': 'Carcinoid tumor', 'E': 'Endobronchial tuberculosis'},
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C: Adenocarcinoma in situ
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Answer the following medical question with one of the provided options:
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Q:A 67-year-old man with a history of diabetes mellitus type II and a previous myocardial infarction presents to your office for a routine examination. His blood pressure is found to be 180/100 mmHg. Which drug is the first-line choice of treatment for this patient's hypertension?? {'A': 'Amlodipine', 'B': 'Hydrochlorothiazide', 'C': 'Lisinopril', 'D': 'Prazosin', 'E': 'Isoproterenol'},
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C: Lisinopril
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Answer the following medical question with one of the provided options:
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Q:A 40-year-old overweight man presents to the office complaining of heartburn for 6 months. He describes burning in his chest brought on by meals. He has a 20 pack-year smoking history and drinks 2 glasses of red wine with dinner nightly. He denies dysphagia, odynophagia, weight loss, melena, and hematemesis. Over the past month, he has reduced his intake of fatty and spicy foods with some moderate relief of his symptoms; however, his symptoms are still present. He also has stopped smoking. Which of the following is the most appropriate next step in the care of this patient?? {'A': 'Esophagogastroduodenoscopy', 'B': 'Nissen fundoplication', 'C': 'Omeprazole', 'D': 'Pantoprazole, sucralfate, and amoxicillin', 'E': 'Ranitidine'},
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C: Omeprazole
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Answer the following medical question with one of the provided options:
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Q:A 34-year-old woman comes to the physician because of a 6-week history of depressed mood, loss of interest, and difficulty sleeping. She also has had a 4.5-kg (10-lb) weight loss during this period. She has not been as productive as before at work due to difficulty concentrating. There is no evidence of suicidal ideation. Laboratory studies including thyroid-stimulating hormone are within the reference range. The physician prescribes treatment with escitalopram. This drug targets a neurotransmitter that is produced in which of the following brain structures?? {'A': 'Locus coeruleus', 'B': 'Basal nucleus of Meynert', 'C': 'Nucleus accumbens', 'D': 'Raphe nucleus', 'E': 'Substantia nigra'},
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D: Raphe nucleus
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Answer the following medical question with one of the provided options:
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Q:Parkinson’s disease is a progressive neurodegenerative disease. It is characterized by a loss of dopaminergic neurons in the substantia nigra pars compacta and the formation of cellular inclusions called Lewy bodies. These are composed of α-synuclein that has been bound to ubiquitin. In healthy individuals, α-synuclein bound to ubiquitin would be degraded by which of the following?? {'A': 'Vesicle', 'B': 'Peroxisome', 'C': 'Proteasome', 'D': 'Ribosome', 'E': 'Lysosome'},
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C: Proteasome
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Answer the following medical question with one of the provided options:
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Q:A 23-year-old man presents to an outpatient psychiatrist complaining of anxiety and a persistent feeling that “something terrible will happen to my family.” He describes 1 year of vague, disturbing thoughts about his family members contracting a “horrible disease” or dying in an accident. He believes that he can prevent these outcomes by washing his hands of “the contaminants” any time that he touches something and by performing praying and counting rituals each time that he has unwanted, disturbing thoughts. The thoughts and rituals have become more frequent recently, making it impossible for him to work, and he expresses feeling deeply embarrassed by them. Which of the following is the most effective treatment for this patient's disorder?? {'A': 'Cognitive behavioral therapy and clonazepam', 'B': 'Cognitive behavioral therapy and fluoxetine', 'C': 'Cognitive behavioral therapy and haloperidol', 'D': 'Psychodynamic psychotherapy and citalopram', 'E': 'Psychodynamic psychotherapy and aripiprazole'},
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B: Cognitive behavioral therapy and fluoxetine
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Answer the following medical question with one of the provided options:
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Q:A 23-year-old man presents with a blunt force injury to the head from a baseball bat. He is currently unconscious, although his friends say he was awake and speaking with them en route to the hospital. He has no significant past medical history and takes no current medications. The vital signs include: temperature 37.0°C (98.6°F), blood pressure 165/85 mm Hg, pulse 50/min, and respiratory rate 19/min. On physical examination, there is a blunt force injury to the left temporoparietal region approximately 10.1–12.7 cm (4–5 in) in diameter. There is anisocoria of the left pupil, which is unresponsive to light. The patient is intubated and fluid resuscitation is initiated. A noncontrast computed tomography (CT) scan of the head is acquired and shown in the exhibit (see image). Which of the following is the most appropriate medical treatment for this patient?? {'A': 'Placing the head of the bed at 0 degrees', 'B': 'Mannitol', 'C': 'Maintain a PaCO2 of 24 mm Hg', 'D': 'Placement of a ventriculoperitoneal (VP) shunt', 'E': 'Acetazolamide'},
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B: Mannitol
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Answer the following medical question with one of the provided options:
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Q:A 5-month-old boy presents with increasing weakness for the past 3 months. The patient’s mother says that the weakness is accompanied by dizziness, sweating, and vertigo early in the morning. Physical examination shows hepatomegaly. Laboratory findings show an increased amount of lactate, uric acid, and elevated triglyceride levels. Which of the following enzymes is most likely deficient in this patient?? {'A': 'Debranching enzyme', 'B': 'Hepatic glycogen phosphorylase', 'C': 'Lysosomal α-1,4-glucosidase', 'D': 'Muscle glycogen phosphorylase', 'E': 'Glucose-6-phosphatase'},
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E: Glucose-6-phosphatase
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Answer the following medical question with one of the provided options:
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Q:A 35-year-old alcoholic patient presents with high-output cardiac failure, tachycardia, a bounding pulse, and warm extremities. Blood work reveals vitamin deficiency. Which of the following vitamin deficiencies is most likely associated with such a clinical presentation?? {'A': 'Vitamin B12', 'B': 'Thiamine', 'C': 'Niacin', 'D': 'Vitamin D', 'E': 'Riboflavin'},
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B: Thiamine
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Answer the following medical question with one of the provided options:
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Q:A 56-year-old male with a history of hepatitis C cirrhosis status post TIPS procedure is brought in by his wife to the emergency department because he has been acting disoriented, slurring his speech, and sleeping throughout the day. On arrival the patient is afebrile and his vital signs are pulse is 87/min, blood pressure is 137/93 mmHg, and respirations are 12/min with shallow breaths. Examination reveals a jaundiced male who appears older than stated age. Abdominal exam is positive for a fluid wave and shifting dullness to percussion. You note enlarged breasts, decreased facial hair, 3+ patellar reflexes bilaterally, and the following in the upper extremity (Video A). Paracentesis reveals ascitic fluid with neutrophil counts of < 100 cells/mcL. Serum creatinine is 1.0 and BUN is 15. Which of the following is the next best step in management?? {'A': 'IV albumin and antibiotic therapy with cefotaximine', 'B': 'Liver transplantation', 'C': 'Adminsiter rifaximin and glucose', 'D': 'Administer lactulose', 'E': 'Administer neomycin and glucose'},
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D: Administer lactulose
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Answer the following medical question with one of the provided options:
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Q:A 78-year-old woman with a history of cerebrovascular accident (CVA) presents to the emergency department with slurred speech, diplopia and dizziness that has persisted for eight hours. Upon further questioning you find that since her CVA one year ago, she has struggled with depression and poor nutrition. Her dose of paroxetine has been recently increased. Additionally, she is on anti-seizure prophylaxis due to sequelae from her CVA. CT scan reveals an old infarct with no acute pathology. Vital signs are within normal limits. On physical exam you find the patient appears frail. She is confused and has nystagmus and an ataxic gait. What would be an appropriate next step?? {'A': 'Administer tissue plasminogen activator (tPA)', 'B': 'Start trimethoprim-sulfamethoxazole (TMP-SMX)', 'C': 'Lower the dose of her anti-seizure medication', 'D': 'Start total parenteral nutrition (TPN)', 'E': 'Increase the dose of her anti-seizure medication'},
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C: Lower the dose of her anti-seizure medication
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Answer the following medical question with one of the provided options:
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Q:A 1-year-old previously healthy male presents to the emergency department with 3 hours of intermittent abdominal pain, vomiting, and one episode of dark red stools. On exam, his abdomen is tender to palpation and there are decreased bowel sounds. A CT scan reveals air fluid levels and a cystic mass in the ileum. Gross specimen histology reveals gastric tissue. What is the cause of this patient's problems?? {'A': 'Obstruction of the lumen of the appendix by a fecalith', 'B': 'Abnormal closure of the vitilline duct', 'C': 'Twisting of the midgut secondary to malrotation', 'D': 'Hypertrophy of the pylorus', 'E': 'Ingestion of contaminated water'},
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B: Abnormal closure of the vitilline duct
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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 her primary care physician for a worsening cough. She states that she has had a cough for 5 months. Over the past 2 weeks, the cough has become more frequent and produces yellow sputum. She has dyspnea on exertion at baseline, which she feels is also worsening. She denies fever, hemoptysis, or chest pain. She has chronic obstructive pulmonary disease and mild osteoarthritis. She uses inhaled ipratropium and takes ibuprofen as needed. She received the influenza vaccine 2 months ago. She smokes a half pack a day, and denies alcohol or recreational drug use. In addition to broad-spectrum antibiotics, which of the following is indicated?? {'A': 'Vaccination capable of replication within host cells', 'B': 'Vaccination composed of a protein-based surface antigen', 'C': 'Vaccination directed against a toxin', 'D': 'Vaccination to induce a B-cell response with moderate level affinity antibodies', 'E': 'Vaccination to induce a T-cell dependent B-cell response with high affinity antibodies'},
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D: Vaccination to induce a B-cell response with moderate level affinity antibodies
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Answer the following medical question with one of the provided options:
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Q:A 55-year-old man visits his primary care physician for a follow-up visit. He was diagnosed with asthma during childhood, but it has always been well controlled with an albuterol inhaler. He is hypertensive and admits that he is not compliant with his antihypertensive medication. He expresses his concerns about frequent headaches and blurry vision over the past few months. He has been taking acetaminophen for his headaches, but it has not made any difference. The blood pressure is 160/100 mm Hg, pulse rate is 77/min, and respiratory rate is 14/min. The BMI is 36.2 kg/m2. Physical examination is unremarkable. A urinalysis is notable for proteinuria. Funduscopic examination is shown on the right. Which pathologic mechanism best explains the changes seen in this patient’s fundoscopic examination?? {'A': 'Papilledema', 'B': 'Retinal hemorrhage', 'C': 'Optic nerve inflammation', 'D': 'Neovascularization', 'E': 'Microaneurysm formation'},
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A: Papilledema
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Answer the following medical question with one of the provided options:
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Q:A 29-year-old woman presents to the physician with a blurred vision of her right eye over the past day. She has pain around her right eye during eye movement. She has a history of tingling in her left leg 5 months ago, which spontaneously resolved after 2 weeks. She takes no medications. Her blood pressure is 110/70 mm Hg, the pulse is 72/min, the respirations are 15/min, and the temperature is 36.5℃ (97.7℉). On physical examination, after illumination of the left eye and bilateral pupillary constriction, illumination of the right eye shows pupillary dilation. Fundoscopic examination shows optic disk swelling in the right eye. A color vision test shows decreased perception in the right eye. The remainder of the physical examination shows no abnormalities. A brain MRI shows several foci of hyperintensity in the periventricular and juxtacortical regions. Which of the following is the most appropriate next step in management?? {'A': 'Acyclovir', 'B': 'Carbamazepine', 'C': 'Intravenous immunoglobulin (IVIG)', 'D': 'Methylprednisolone', 'E': 'Plasma exchange'},
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D: Methylprednisolone
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Answer the following medical question with one of the provided options:
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Q:A 27-year-old man presents with a 2-week history of fever, malaise, and occasional diarrhea. On physical examination, the physician notes enlarged inguinal lymph nodes. An HIV screening test is positive. Laboratory studies show a CD4+ count of 650/mm3. This patient is most likely currently in which of the following stages of HIV infection?? {'A': 'Latent HIV infection', 'B': 'Chronic HIV infection', 'C': 'AIDS', 'D': 'Acute HIV infection', 'E': 'Asymptomatic HIV infection'},
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D: Acute HIV infection
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Answer the following medical question with one of the provided options:
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Q:A 66-year old man with a 45-pack-year smoking history presents with abdominal pain and constipation. He reports that he has had a worsening cough for several months and has lost 20 pounds over this time period. You order a complete metabolic profile, which demonstrates hypercalcemia. A chest radiograph shows a centrally located mass suspicious for malignancy. Which of the following is the most likely explanation?? {'A': 'Squamous cell carcinoma producing parathyroid hormone', 'B': 'Squamous cell carcinoma producing a peptide with hormonal activity', 'C': 'Carcinoid tumor causing carcinoid syndrome', 'D': 'Metastatic abdominal cancer', 'E': 'Small cell carcinoma producing a peptide with hormonal activity'},
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B: Squamous cell carcinoma producing a peptide with hormonal activity
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Answer the following medical question with one of the provided options:
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Q:A scientist is researching the long term effects of the hepatitis viruses on hepatic tissue. She finds that certain strains are oncogenic and increase the risk of hepatocellular carcinoma. However, they appear to do so via different mechanisms. Which of the following answer choices correctly pairs the hepatitis virus with the correct oncogenic process?? {'A': 'Hepatitis A virus - chronic inflammation', 'B': 'Hepatitis A virus - integration of viral DNA into host hepatocyte genome', 'C': 'Hepatitis B virus - integration of viral DNA into host hepatocyte genome', 'D': 'Hepatitis C virus - integration of viral DNA into host hepatocyte genome', 'E': 'Hepatitis E virus - integration of viral DNA into host hepatocyte genome'},
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C: Hepatitis B virus - integration of viral DNA into host hepatocyte genome
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Answer the following medical question with one of the provided options:
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Q:A 62-year-old man is brought to the emergency department by his wife because she thinks he has had a stroke. He has hypertension and type 2 diabetes mellitus. Current medications include enalapril and metformin. He has smoked 1 pack of cigarettes per day for the past 35 years. His blood pressure is 162/95 mm Hg. A CT scan of the brain shows a lacunar stroke involving the left subthalamic nucleus. The patient most likely presented with which of the following findings on physical examination?? {'A': 'Cogwheel rigidity', 'B': 'Dystonia', 'C': 'Hemiballismus', 'D': 'Vertical gaze palsy', 'E': 'Hemispatial agnosia'},
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C: Hemiballismus
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Answer the following medical question with one of the provided options:
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Q:A 64-year-old woman presents to the surgical oncology clinic as a new patient for evaluation of recently diagnosed breast cancer. She has a medical history of type 2 diabetes mellitus for which she takes metformin. Her surgical history is a total knee arthroplasty 7 years ago. Her family history is insignificant. Physical examination is notable for an irregular nodule near the surface of her right breast. Her primary concern today is which surgical approach will be chosen to remove her breast cancer. Which of the following procedures involves the removal of a portion of a breast?? {'A': 'Vasectomy', 'B': 'Mastectomy', 'C': 'Lumpectomy', 'D': 'Arthroplasty', 'E': 'Laminectomy'},
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C: Lumpectomy
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Answer the following medical question with one of the provided options:
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Q:A 26-year-old male presents to the emergency room with weight loss, abdominal pain, and bloody diarrhea. He reports having intermittent bloody stools and crampy left lower quadrant abdominal pain over the past several days. He is otherwise healthy, does not smoke, and takes no medications. His family history is notable for colon cancer in his father. He subsequently undergoes a colonoscopy which demonstrates a hyperemic friable mucosa with inflammation extending continuously from the rectum proximally through the colon. A biopsy of the rectal mucosa is notable for crypt abscesses and pseudopolyps. This patient’s condition is most commonly associated with what other condition?? {'A': 'Primary biliary cirrhosis', 'B': 'Primary sclerosing cholangitis', 'C': 'Intestinal strictures', 'D': 'Perianal fistulae', 'E': 'Aphthous ulcers'},
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B: Primary sclerosing cholangitis
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Answer the following medical question with one of the provided options:
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Q:A 6-year-old boy is brought to the office by his mother. She reports that her son is well but has some concerns about his overall health: he is shorter and, physically, seems less developed compared to his siblings when they were the same age. He recently started school and the mother reports that the boy’s teachers are concerned with his learning capability. His height and weight are in the 10th and 15th percentiles, respectively. Lab results reveal: Hemoglobin 10 gm/dL Mean corpuscular volume 110 fL Multi-segmented neutrophils are seen on peripheral blood smear. Urinary orotic acid levels are found to be high. What is the most likely cause of this patient’s condition?? {'A': 'Deficiency of uridine monophosphate synthase', 'B': 'Overactivity of uridine monophosphate synthase', 'C': 'Inhibition of carbamoyl phosphate synthetase II', 'D': 'Activation of inosine monophosphate dehydrogenase', 'E': 'Deficiency of cobalamin'},
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A: Deficiency of uridine monophosphate synthase
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Answer the following medical question with one of the provided options:
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Q:An 8-year-old boy is shifted to a post-surgical floor following neck surgery. The surgeon has restricted his oral intake for the next 24 hours. He does not have diarrhea, vomiting, or dehydration. His calculated fluid requirement is 1500 mL/day. However, he receives 2000 mL of intravenous isotonic fluids over 24 hours. Which of the following physiological parameters in the boy’s circulatory system is most likely to be increased?? {'A': 'Capillary wall permeability', 'B': 'Capillary hydrostatic pressure', 'C': 'Interstitial hydrostatic pressure', 'D': 'Capillary oncotic pressure', 'E': 'Interstitial oncotic pressure'},
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B: Capillary hydrostatic pressure
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Answer the following medical question with one of the provided options:
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Q:A 42-year-old woman presents to the urgent care clinic with recurrent chest pain and pressure radiating to her jaw. ECG is obtained and shows ST-segment elevation, but her cardiac enzymes are repeatedly found to be within normal ranges. She has a heart rate of 82/min and a blood pressure of 128/76 mm Hg. Physical examination reveals regular heart sounds with no friction rub. Which of the following options is an acceptable treatment regimen for this patient’s suspected condition?? {'A': 'Nitrates only', 'B': 'Aspirin and clopidogrel', 'C': 'Calcium channel blockers and nitrates', 'D': 'Beta-blockers, nitrates and aspirin', 'E': 'Aspirin, clopidogrel, beta-blockers, and nitrates'},
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C: Calcium channel blockers and nitrates
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Answer the following medical question with one of the provided options:
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Q:A 35-year-old man presents to the physician’s clinic due to episodic chest pain over the last couple of months. He is currently pain-free. His chest pain occurs soon after he starts to exercise, and it is rapidly relieved by rest. He recently started training for a marathon after a decade of a fairly sedentary lifestyle. He was a competitive runner during his college years, but he has only had occasional exercise since then. He is concerned that he might be developing some heart disease. He has no prior medical issues and takes no medications. The family history is significant for hypertension and myocardial infarction in his father. His vital signs include: pulse 74/min, respirations 10/min, and blood pressure 120/74 mm Hg. The ECG test is normal. The physician orders an exercise tolerance test that has to be stopped after 5 minutes due to the onset of chest pain. Which of the following contributes most to the decreasing cardiac perfusion in this patient's heart?? {'A': 'Coronary vasoconstriction', 'B': 'Diastolic aortic pressure', 'C': 'Duration of diastole', 'D': 'Force of myocardial contraction', 'E': 'Ventricular blood volume'},
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C: Duration of diastole
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Answer the following medical question with one of the provided options:
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Q:A 56-year-old man with substernal chest pain calls 911. When paramedics arrive, they administer drug X sublingually for the immediate relief of angina. What is the most likely site of action of drug X?? {'A': 'Large arteries', 'B': 'Large veins', 'C': 'Arterioles', 'D': 'Cardiac muscle', 'E': 'Pulmonary arteries'},
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B: Large veins
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Answer the following medical question with one of the provided options:
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Q:A 74-year-old woman comes to the physician for a follow-up examination. Eight months ago, she underwent an emergency cardiac catheterization with stenting for myocardial infarction. At the time of discharge, her heart configuration was normal, end-diastolic volume was 300 mL and ejection fraction was 51%. For the past 8 weeks she has noticed increasing shortness of breath while playing with her 2-year-old grandson. She feels otherwise well. She has arterial hypertension, coronary artery disease, and hypercholesterolemia. She admits to rarely taking her medication as she usually feels well and has no symptoms. Her temperature is 37.3°C (99.1°F), pulse is 93/min, and blood pressure is 142/93 mm Hg. Examination shows no abnormalities. A complete blood count and serum concentrations of electrolytes, urea nitrogen, and creatinine are within the reference range. ECG shows broad, deep Q waves and T-wave inversion. Echocardiography shows left ventricular dilation and an end-diastolic volume of 370 mL; Ejection fraction is 40%. Which of the following is most likely to have prevented this patient's worsening of ventricular function?? {'A': 'Digoxin', 'B': 'Nifedipine', 'C': 'Diltiazem', 'D': 'Enalapril', 'E': 'Atorvastatin'},
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D: Enalapril
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Answer the following medical question with one of the provided options:
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Q:A 46-year-old woman presents to her family physician for a general wellness checkup with a chief complaint of high levels of anxiety over the past year. Her anxiety has started to affect her performance at work, making her even more anxious and concerned that she will lose her job. She started psychotherapy several months ago and has experienced minimal improvement in her symptoms from this treatment. The patient is vehemently opposed to beginning any pharmacologic treatment for anxiety; however, she is interested in potential herbal remedies and has started taking kava. She also takes vitamin D, a multivitamin, fish oil, protein powder, and drinks goat milk regularly. The patient works as a commercial sex worker and has a history of IV drug abuse and alcohol abuse which she states she has not used in over a year. She has chronic tension headaches for which she self-administers acetaminophen usually multiple times per day. Her last wellness appointment was unremarkable and these problems are new. Laboratory values are ordered as seen below. Hemoglobin: 13 g/dL Hematocrit: 38% Leukocyte count: 6,870/mm^3 with normal differential Platelet count: 227,000/mm^3 Serum: Na+: 138 mEq/L Cl-: 102 mEq/L K+: 4.1 mEq/L HCO3-: 25 mEq/L BUN: 20 mg/dL Glucose: 111 mg/dL Creatinine: 1.0 mg/dL Ca2+: 10.2 mg/dL AST: 82 U/L ALT: 90 U/L Which of the following is the most likely cause of this patient's lab derangements?? {'A': 'Acetaminophen', 'B': 'Acute hepatitis B infection', 'C': 'Alcoholic hepatitis', 'D': 'Chronic hepatitis C infection', 'E': 'Dietary supplement'},
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E: Dietary supplement
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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 is brought to the emergency department by ambulance after suffering a generalized tonic-clonic seizure. The seizure lasted 2 minutes, followed by a short period of unresponsiveness and loud breathing. Her blood pressure is 130/80 mm Hg, the heart rate is 76/min, and the respiratory rate is 15/min and regular. On physical examination, the patient is confused but follows commands and cannot recall recent events. The patient does not present with any other neurological deficits. T1/T2 MRI of the brain demonstrates a hypointense, contrast-enhancing mass within the right frontal lobe, surrounded by significant cerebral edema. Which of the following would you expect in the tissue surrounding the described lesion?? {'A': 'Increased interstitial fluid low in protein', 'B': 'Replacement of interstitial fluid with cerebrospinal fluid (CSF)', 'C': 'Loss of endothelial tight junctions', 'D': 'Increased intracellular concentrations of osmolytes', 'E': 'Upregulation of aquaporin-4'},
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C: Loss of endothelial tight junctions
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Answer the following medical question with one of the provided options:
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Q:A 22-year-old nulligravid woman comes to the physician for evaluation of irregular periods. Menarche was at the age of 12 years. Her menses have always occurred at variable intervals, and she has spotting between her periods. Her last menstrual period was 6 months ago. She has diabetes mellitus type 2 and depression. She is not sexually active. She drinks 3 alcoholic drinks on weekends and does not smoke. She takes metformin and sertraline. She appears well. Her temperature is 37°C (98.6°F), pulse is 82/min, respirations are 15/min, and blood pressure is 118/75 mm Hg. BMI is 31.5 kg/m2. Physical exam shows severe cystic acne on her face and back. There are dark, velvet-like patches on the armpits and neck. Pelvic examination is normal. A urine pregnancy test is negative. Which of the following would help determine the cause of this patient's menstrual irregularities?? {'A': 'Measurement of follicle-stimulating hormone', 'B': 'Progesterone withdrawal test', 'C': 'Measurement of thyroid-stimulating hormone', 'D': 'Measurement of prolactin levels', 'E': 'Administration of estrogen'},
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B: Progesterone withdrawal test
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Answer the following medical question with one of the provided options:
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Q:A 52-year-old man comes to the physician because of increasing weakness of his arms and legs over the past year. He has also had difficulty speaking for the past 5 months. He underwent a partial gastrectomy for gastric cancer 10 years ago. His temperature is 37.1°C (98.8°F), pulse is 88/min, and blood pressure is 118/70 mm Hg. Examination shows dysarthria. There is mild atrophy and twitching of the tongue. Muscle strength is decreased in all extremities. Muscle tone is decreased in the right lower extremity and increased in the other extremities. Deep tendon reflexes are absent in the right lower extremity and 4+ in the other extremities. Plantar reflex shows an extensor response on the left. Sensation is intact in all extremities. Which of the following is the most appropriate pharmacotherapy for this patient?? {'A': 'Vitamin B12', 'B': 'Nusinersen', 'C': 'Glatiramer acetate', 'D': 'Riluzole', 'E': 'Corticosteroids\n"'},
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D: Riluzole
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Answer the following medical question with one of the provided options:
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Q:A 38-year-old woman, gravida 2, para 1, at 24 weeks' gestation comes to the physician for a routine prenatal evaluation. She has no history of major medical illness and takes no medications. Fetal ultrasonography shows a cardiac defect resulting from abnormal development of the endocardial cushions. This defect is most likely to result in which of the following?? {'A': 'Atrioventricular septal defect', 'B': 'Sinus venosus defect', 'C': 'Transposition of the great vessels', 'D': 'Dextrocardia', 'E': 'Patent foramen ovale'},
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A: Atrioventricular septal defect
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Answer the following medical question with one of the provided options:
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Q:Many large clinics have noticed that the prevalence of primary biliary cholangitis (PBC) has increased significantly over the past 20 years. An epidemiologist is working to identify possible reasons for this. After analyzing a series of nationwide health surveillance databases, the epidemiologist finds that the incidence of PBC has remained stable over the past 20 years. Which of the following is the most plausible explanation for the increased prevalence of PBC?? {'A': 'Increased exposure to environmental risk factors for PBC', 'B': 'Improved quality of care for PBC', 'C': 'Increased availability of diagnostic testing for PBC', 'D': 'Increased average age of the population at risk for PBC', 'E': 'Increased awareness of PBC among clinicians'},
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B: Improved quality of care for PBC
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Q:A 35-year-old man presents to his primary care provider in Philadelphia with a skin rash on his right thigh. He reports that the rash appeared 3 days ago. He recently returned from a weeklong trip to his vacation home in central Pennsylvania. He denies pain, numbness, paresthesias, itchiness, or burning around the rash. He does not recall finding any ticks on his body. He otherwise feels well. His past medical history is notable for gout. He takes allopurinol. He is an avid hiker and spends 3 months out of the year hiking. He does not smoke and drinks alcohol socially. On exam, he has a bullseye-like circular erythematous rash on the anterolateral aspect of his right thigh. The doctor decides to perform a new serum test for Lyme disease that was trialed at the same hospital in Philadelphia, where it was shown to have a sensitivity of 91% and specificity of 94%. The prevalence of Lyme disease in the area is among the highest in the country. How would the sensitivity and specificity of this new test change if it were performed on a patient in Texas, an area with a very low prevalence of Lyme disease?? {'A': 'A', 'B': 'B', 'C': 'C', 'D': 'D', 'E': 'E'},
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A: A
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Answer the following medical question with one of the provided options:
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Q:A 14-year-old female with no past medical history presents to the emergency department with nausea and abdominal pain. On physical examination, her blood pressure is 78/65, her respiratory rate is 30, her breath has a fruity odor, and capillary refill is > 3 seconds. Serum glucose is 820 mg/dL. After starting IV fluids, what is the next best step in the management of this patient?? {'A': 'Intravenous regular insulin', 'B': 'Subcutaneous insulin glargine', 'C': 'Subcutaneous insulin lispro', 'D': 'Intravenous Dextrose in water', 'E': 'Intravenous glucagon'},
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A: Intravenous regular insulin
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Answer the following medical question with one of the provided options:
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Q:A group of investigators are studying the effects of transcranial direct current stimulation (tDCS) on cognitive performance in patients with Alzheimer disease. A cohort of 50 patients with mild Alzheimer disease were randomized 1:1 to either tDCS or sham tDCS over the temporoparietal cortex. Both procedures were conducted so that patients experienced the same sensations while receiving treatment. After 1 week of observation during which no treatments were delivered, the two groups were switched. Neuropsychiatric testing was subsequently conducted to assess differences in recognition memory between the two groups. Which of the following best describes the study design?? {'A': 'Pretest-posttest', 'B': 'Crossover', 'C': 'Meta-analysis', 'D': 'Parallel group', 'E': 'Factorial\n"'},
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B: Crossover
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Answer the following medical question with one of the provided options:
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Q:A 65-year-old man is referred by his primary care provider to a neurologist for leg pain. He reports a 6-month history of progressive bilateral lower extremity pain that is worse in his left leg. The pain is 5/10 in severity at its worst and is described as a "burning" pain. He has noticed that the pain is acutely worse when he walks downhill. He has started riding his stationary bike more often as it relieves his pain. His past medical history is notable for hypertension, diabetes mellitus, and a prior myocardial infarction. He also sustained a distal radius fracture the previous year after falling on his outstretched hand. He takes aspirin, atorvastatin, metformin, glyburide, enalapril, and metoprolol. He has a 30-pack-year smoking history and drinks 2-3 glasses of wine with dinner every night. His temperature is 99°F (37.2°C), blood pressure is 145/85 mmHg, pulse is 91/min, and respirations are 18/min. On exam, he is well-appearing and in no acute distress. A straight leg raise is negative. A valsalva maneuver does not worsen his pain. Which of the following is the most appropriate test to confirm this patient's diagnosis?? {'A': 'Ankle-brachial index', 'B': 'Computerized tomography myelography', 'C': 'Electromyography', 'D': 'Magnetic resonance imaging', 'E': 'Radiography'},
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D: Magnetic resonance imaging
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Q:A 27-year-old woman, gravida 2, para 1, at 36 weeks' gestation comes to the physician for a prenatal visit. She feels well. Fetal movements are adequate. This is her 7th prenatal visit. She had an ultrasound scan performed 1 month ago that showed a live intrauterine pregnancy consistent with a 32-week gestation with no anomalies. She had a Pap smear performed 1 year ago, which was normal. Vital signs are within normal limits. Pelvic examination shows a uterus consistent in size with a 36-week gestation. Her blood group and type is A negative. Which of the following is the most appropriate next step in management?? {'A': 'Complete blood count', 'B': 'Transabdominal doppler ultrasonography', 'C': 'Serum PAPP-A and HCG levels', 'D': 'Swab for GBS culture', 'E': 'Rh antibody testing\n"'},
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D: Swab for GBS culture
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Q:A 25-year-old man presents with jaw discomfort and the inability to open his mouth fully for about 3 days. About a week ago, he says he cut himself while preparing a chicken dinner but did not seek medical assistance. Five days after the original injury, he started noticing jaw discomfort and an inability to open his mouth completely. He has no history of a serious illness or allergies and takes no medications. The patient says he had received his primary tetanus series in childhood, and that his last booster was more than 10 years ago. His blood pressure is 125/70 mm Hg and temperature is 36.9℃ (98.5°F). On physical examination, the patient is unable to open his jaw wider than 2.5 cm. Head and neck examinations are otherwise unremarkable. There is a 5 cm linear shallow laceration with some granulation tissue on the right index finger without necrosis, erythema, or pus. After wound care and initiation of metronidazole, which of the following is the next best step in the management of this patient?? {'A': 'Tdap ', 'B': 'Td', 'C': 'No further treatment is required', 'D': 'Tetanus immunoglobulin (TIG) ', 'E': 'DTaP'},
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D: Tetanus immunoglobulin (TIG)
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Q:A 69-year-old woman is brought to the physician by her husband because of multiple falls and difficulty maintaining balance while standing or walking over the past year. During this period, she has had blurred vision and diplopia. Her husband has had difficulty understanding her speech for the past 3 months. She has become withdrawn and now refuses to go to social gatherings. Examination shows a broad-based gait and dysarthria. The visual acuity is 20/20 in each eye. There is conjugate limitation of both eyes while looking down. Muscle tone is increased in bilateral upper extremities. Bradykinesia is present. Mental status examination shows apathy. She responds to questions with 1–2 words after a delay of several seconds. Grasp reflex is present. An MRI of the brain is most likely to show which of the following?? {'A': 'Atrophy of cerebellum and brainstem', 'B': 'Asymmetric focal cortical atrophy', 'C': 'Midbrain atrophy with intact pons', 'D': 'Frontal atrophy with intact hippocampi', 'E': 'Enlarged ventricles with mild cortical atrophy'},
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C: Midbrain atrophy with intact pons
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Q:A 22-year-old G2P1 female presents to the clinic at the beginning of her third trimester for a fetal ultrasound. The sonographer is unable to visualize any of the structures arising from the mesonephric duct. This infant is at risk for malformation of which of the following?? {'A': 'Fallopian tubes', 'B': 'Uterus', 'C': 'Upper 1/3 of vagina', 'D': 'Lower 2/3 of vagina', 'E': 'No malformation would be expected'},
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E: No malformation would be expected
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Q:A 29-year-old female is hospitalized 1 day after an endoscopic retrograde cholangiopancreatography (ERCP) because of vomiting, weakness, and severe abdominal pain. Physical examination findings include abdominal tenderness and diminished bowel sounds. A CT scan demonstrates fluid around the pancreas. Serum levels of which of the following are likely to be low in this patient?? {'A': 'Calcium', 'B': 'Glucose', 'C': 'Amylase', 'D': 'Lipase', 'E': 'Triglycerides'},
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A: Calcium
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Q:A 22-year-old woman comes to the urgent care clinic with sudden onset of severe vomiting. She had been at a picnic with her boyfriend a few hours earlier, enjoying barbecue, potato salad, and cake. Shortly thereafter, she began vomiting and has vomited 5 times in the last 3 hours. She has no prior history of symptoms. After a few hours of observation, her symptoms abate, and she is safely discharged home. Which of the following is the most likely cause of her vomiting?? {'A': 'Viral infection', 'B': 'Hepatitis', 'C': 'Gallstones', 'D': 'Toxin ingestion from spore-forming organism', 'E': 'Toxin ingestion from non-spore-forming organism'},
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E: Toxin ingestion from non-spore-forming organism
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Q:A 3-day-old boy is brought to the physician by his mother because of irritability and feeding intolerance for 1 day. His temperature is 39.2°C (102.6°F). Physical examination shows a bulging anterior fontanelle. A photomicrograph of a Gram stain of the cerebrospinal fluid is shown. Further evaluation shows that the organism expresses the K1 capsular polysaccharide. Which of the following is the most likely causal pathogen?? {'A': 'Escherichia coli', 'B': 'Listeria monocytogenes', 'C': 'Pseudomonas aeruginosa', 'D': 'Salmonella typhi', 'E': 'Streptococcus agalactiae'},
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A: Escherichia coli
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Q:A 56-year-old man comes to the physician for a follow-up examination one week after a chest x-ray showed a solitary pulmonary nodule. He has no history of major medical illness. He has smoked 1 pack of cigarettes daily for the past 30 years. Physical examination shows no abnormalities. A tuberculin skin test is negative. A CT scan of the chest shows a 2.1-cm well-circumscribed, calcified nodule in the periphery of the right lower lung field. A CT-guided biopsy of the lesion is performed. Histological examination of the biopsy specimen shows regions of disorganized hyaline cartilage interspersed with myxoid regions and clefts of ciliated epithelium. Which of the following is the most likely diagnosis?? {'A': 'Pulmonary hamartoma', 'B': 'Eosinophilic granuloma', 'C': 'Mature teratoma', 'D': 'Small cell lung carcinoma', 'E': 'Bronchogenic cyst'},
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A: Pulmonary hamartoma
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Q:A 74-year-old man with a history of encephalomyelitis, ataxia, and nystagmus a new diagnosis of small cell carcinoma of the lung (T2, N1, Mn/a) is admitted to the hospital due to painless loss of vision in his right eye. A full workup reveals optic neuritis and uveitis in the affected eye. Which of the following antibodies is most likely to be present in the serum of the patient?? {'A': 'Anti-Yo', 'B': 'Anti-amphiphysin', 'C': 'Anti-Hu', 'D': 'Anti-Ri', 'E': 'Anti-CV2 (CRMP5)'},
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E: Anti-CV2 (CRMP5)
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Q:A previously healthy 24-year-old man is brought to the emergency department 30 minutes after an episode of loss of consciousness. He was standing in line at a bus stop when he suddenly became tense, fell down, and lost consciousness; this was followed by 4 minutes of violent jerky movements of his arms and legs. He was confused after the episode. He has no recollection of the event or its immediate aftermath. On arrival, he is alert and oriented to time, place, and person. His temperature is 37.7°C (99.4°F), pulse is 98/min, and blood pressure is 130/70 mm Hg. Physical examination shows blood in the mouth. Neurologic examination shows no focal findings. A CT scan of the head shows no abnormalities. Further evaluation of this patient is most likely to show which of the following laboratory findings?? {'A': 'Increased serum calcium', 'B': 'Reduced serum creatine kinase', 'C': 'Increased serum sodium', 'D': 'Reduced serum bicarbonate', 'E': 'Increased serum magnesium'},
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D: Reduced serum bicarbonate
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Q:A 21-year-old woman comes to the physician for a routine physical examination. She feels well. She is 163 cm (5 ft 4 in) tall and weighs 54 kg (120 lb); BMI is 20.3 kg/m2. Physical examination shows no abnormalities. Her fasting serum glucose concentration is 132 mg/dL. Serum insulin concentration 30 minutes after oral glucose administration is 20 mIU/L (N: 30–230). Her hemoglobin A1C concentration is 7.1%. After a thorough workup, the physician concludes that the patient has a chronic condition that can likely be managed with diet only and that she is not at a significantly increased risk of micro- or macrovascular complications. Which of the following is the most likely cause of the patient's condition?? {'A': 'Defect in expression of glucokinase gene', 'B': 'Increased endogenous cortisol production', 'C': 'Resistance to insulin-mediated glucose uptake', 'D': 'Autoantibodies to pancreatic beta cells', 'E': 'Mutation in hepatocyte nuclear factor 1\n"'},
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A: Defect in expression of glucokinase gene
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Q:A 67-year-old man comes to the physician because of urinary frequency, dysuria, and blood in his urine. He has also had a 4.5-kg (10-lb) weight loss over the past 3 months and has been feeling more fatigued than usual. He smoked one pack of cigarettes daily for 40 years but quit 2 years ago. A urinalysis shows 3+ blood. Cystoscopy shows an irregular mass on the bladder wall; a biopsy is taken. Which of the following histologic findings would indicate the worst survival prognosis?? {'A': 'Dysplastic cells extending into the lamina propria', 'B': 'Nests of atypical cells in the urothelium', 'C': 'Friable urothelium with ulcerations', 'D': 'Disordered urothelium lined with papillary fronds', 'E': 'Tubular glands with mucin secretions'},
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A: Dysplastic cells extending into the lamina propria
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Q:A 24-year-old woman comes to the physician for a routine health maintenance examination. She feels well. On questioning, she has had occasional morning dizziness and palpitations during the past year. She is a graduate student. She does not smoke and drinks 1–2 glasses of wine on the weekends. Her vital signs are within normal limits. Physical examination shows an irregular pulse. On auscultation of the chest, S1 and S2 are normal and there are no murmurs. An ECG is shown. Which of the following is the most appropriate next step in management?? {'A': 'Reassurance', 'B': 'Event recorder implantation', 'C': 'Stress echocardiography', 'D': 'Administration of metoprolol', 'E': 'Administration of flecainide'},
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A: Reassurance
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Q:A 25-year-old patient is brought into the emergency department after he was found down by the police in 5 degree celsius weather. The police state the patient is a heroin-user and is homeless. The patient's vitals are T 95.3 HR 80 and regular BP 150/90 RR 10. After warming the patient, you notice his left lower leg is now much larger than his right leg. On exam, the patient has a loss of sensation on his left lower extremity. There is a faint palpable dorsalis pedal pulse, but no posterior tibial pulse. The patient is unresponsive to normal commands, but shrieks in pain upon passive stretch of his left lower leg. What is the most probable cause of this patient's condition?? {'A': 'Cellulitis', 'B': 'Necrotizing fasciitis', 'C': 'Embolized clot', 'D': 'Reperfusion associated edema', 'E': 'Diabetes'},
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D: Reperfusion associated edema
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Q:A 24-year-old woman comes to the physician because of excessive hair growth. She has noticed increasing numbers of dark hairs on her upper lip and on her abdomen over the past 8 years. Menarche was at the age of 13 years. Menses occur at regular 28-day intervals and last 5–6 days with moderate flow. She is sexually active with one male partner. Her only medication is a combination oral contraceptive. She is 168 cm (5 ft 6 in) tall and weighs 88 kg (193 lb); BMI is 31 kg/m2. Vital signs are within normal limits. Physical examination shows coarse dark hair on the upper lip and periumbilical and periareolar skin. Her external genitalia appear normal. The remainder of the examination shows no abnormalities. Midcycle serum studies show: Fasting glucose 95 mg/dL Dehydroepiandrosterone sulfate 3.1 μg/mL (N = 0.5–5.4) Luteinizing hormone 95 mIU/mL Follicle-stimulating hormone 75 mIU/mL 17α-Hydroxyprogesterone 190 ng/dL (N = 20–300) Testosterone 1.1 nmol/L (N < 3.5) Dihydrotestosterone 435 pg/mL (N < 300) A urine pregnancy test is negative. Which of the following is the most likely underlying cause of this patient's symptom?"? {'A': 'Increased activity of 5-alpha reductase', 'B': 'Androgen-producing tumor of the adrenals', 'C': 'Deficiency of 21-hydroxylase', 'D': 'Peripheral insulin resistance', 'E': 'Tumor of granulosa-theca cells of the ovary\n"'},
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A: Increased activity of 5-alpha reductase
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Q:A 65-year-old woman comes to the physician for a 18-month history of gradual enlargement of her fingertips and a 2-month history of a hoarse voice. She has had decreased appetite after a respiratory tract infection 3 months ago and a 8-kg (17.6-lb) weight loss during this period. The patient has never smoked. She was diagnosed with obstructive sleep apnea 10 years ago and uses a CPAP mask at night. She retired from her job as an administrative assistant at a local college 5 years ago. She appears tired. Her vital signs are within normal limits. Physical examination shows increased convexity of the nail fold and painful swelling of the soft tissue of her fingers and ankles. There is no discoloration of her lips and oral mucosa. There is faint wheezing in the right upper lung field. This patient's condition is most likely associated with which of the following findings?? {'A': 'Increased serum ADH', 'B': 'Miosis', 'C': 'Increased serum ACE', 'D': 'Reticular opacities on chest x-ray', 'E': 'Peripheral cyanosis'},
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B: Miosis
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Q:A 72-year-old male with history of hypertension, diabetes mellitus, cluster headaches, and basal cell carcinoma presents with complaints of progressive dyspnea. He has had increasing shortness of breath, especially when going on walks or mowing the lawn. In addition, he had two episodes of extreme lightheadedness while moving some of his furniture. His temperature is 98.2°F (36.8°C), blood pressure is 135/92 mmHg, pulse is 70/min, respirations are 14/min, and oxygen saturation is 94% on room air. Physical exam is notable for clear lung fields and a 3/6 systolic ejection murmur best heard at the right 2nd intercostal space. In addition, the carotid pulses are delayed and diminished in intensity bilaterally. Which of the following would most likely be seen in association with this patient’s condition?? {'A': 'Cerebral artery aneurysm', 'B': 'Carotid atherosclerosis', 'C': 'Deep vein thrombosis', 'D': 'Colonic angiodysplasia', 'E': 'Erectile dysfunction'},
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D: Colonic angiodysplasia
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Q:A 43-year-old woman comes to the physician because of a 6-week history of hoarseness and difficulty swallowing. She also has a history of lower back pain treated with ibuprofen. She is 162 cm (5 ft 4 in) tall and weighs 77 kg (169 lb); BMI is 29 kg/m2. Her pulse is 64/min and blood pressure is 130/86 mm Hg. Physical examination shows dry skin, swelling of the lower extremities, and a hard nontender anterior neck swelling that does not move with swallowing. Femoral and pedal pulses are decreased bilaterally. A biopsy of the neck swelling is most likely to show which of the following findings?? {'A': 'Atypical nuclei and concentric lamellar calcifications', 'B': 'Spindle cells and areas of focal necrosis', 'C': 'Collagen deposition and decreased number of follicles', 'D': 'Giant cells and noncaseating granulomas', 'E': 'Lymphocytic infiltrate and germinal center formation'},
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C: Collagen deposition and decreased number of follicles
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Q:A 29-year-old man is being monitored at the hospital after cutting open his left wrist. He has a long-standing history of unipolar depressive disorder and multiple trials of antidepressants. The patient expresses thoughts of self-harm and does not deny suicidal intent. A course of electroconvulsive therapy is suggested. His medical history is not significant for other organic illness. Which of the following complications of this therapy is this patient at greatest risk for?? {'A': 'Intracranial hemorrhage', 'B': 'Amnesic aphasia', 'C': 'Acute kidney injury', 'D': 'Acute coronary syndrome', 'E': 'Retrograde amnesia\n"'},
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E: Retrograde amnesia "
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Q:A 770-g (1-lb 11-oz) female newborn delivered at 28 weeks' gestation develops rapid breathing, grunting, cyanosis, and subcostal retractions shortly after birth. Her mother did not receive any prenatal care. Breath sounds are decreased over both lung fields. An x-ray of the chest shows diffuse fine, reticular densities bilaterally. Antenatal administration of which of the following drugs would most likely have prevented this infant's current condition?? {'A': 'Epinephrine', 'B': 'Betamethasone', 'C': 'Thyrotropin-releasing hormone', 'D': 'Oxytocin', 'E': 'Insulin'},
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B: Betamethasone
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Q:A 52-year-old postmenopausal woman seeks evaluation at a medical clinic with complaints of back pain and increased fatigue for 6 months. For the past week, the back pain has radiated to her legs and is stabbing in nature (7/10 in intensity). There are no associated paresthesias. She unintentionally lost 4.5 kg (10.0 lb) in the past 6 months. There is no history of trauma to the back. The past medical history is insignificant and she does not take any medications. The physical examination is normal. The laboratory results are as follows: Hemoglobin 10 g/dL Hematocrit 30% Mean corpuscular volume 80 fL Serum creatinine 1.5 mg/dL Serum total protein 9 g/dL Serum albumin 4.2 g/dL Serum calcium 11.2 mg/dL A peripheral blood smear shows normocytic normochromic cells. An X-ray reveals multiple osteolytic lesions in the vertebrae and long bones. Serum protein electrophoresis shows a monoclonal spike. A bone marrow biopsy shows increased plasma cells making up greater than 50% of the total cell population. Which of the following is the most likely diagnosis in this patient?? {'A': 'Metastatic bone disease', 'B': 'Multiple myeloma', 'C': 'Waldenstrom macroglobulinemia', 'D': 'POEMS syndrome', 'E': 'Monoclonal gammopathy of unknown significance'},
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B: Multiple myeloma
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Q:A 74-year-old man is brought to the emergency department after he had copious amounts of blood-stained stools. Minutes later, he turned sweaty, felt light-headed, and collapsed into his wife’s arms. Upon admission, he is found to have a blood pressure of 78/40 mm Hg, a pulse of 140/min, and oxygen saturation of 98%. His family history is relevant for both gastric and colorectal cancer. His personal history is relevant for hypertension, for which he takes amlodipine. After an initial successful resuscitation with intravenous fluids, which of the following should be the first step in approaching this case?? {'A': 'Colonoscopy', 'B': 'Nasogastric lavage', 'C': 'Upper endoscopy', 'D': 'Mesenteric angiography', 'E': 'Radionuclide imaging'},
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B: Nasogastric lavage
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Q:A 40-year-old man with persistent moderate asthma presents for a pulmonary function test. His ratio of forced expiratory volume in one second (FEV1) to forced vital capacity (FVC) is 0.69, and his FEV1 is 65% of his predicted values. What other findings can be expected in the remainder of his pulmonary function test?? {'A': 'Decreased diffusion limitation of carbon monoxide (DLCO)', 'B': 'Increase in FEV1 with methacholine', 'C': 'Decrease in FEV1 with albuterol', 'D': 'Increase in fractional exhalation of nitric oxide', 'E': 'Decrease in total lung capacity'},
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D: Increase in fractional exhalation of nitric oxide
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Q:A 56-year-old man presents to his general practitioner with frequent episodes of facial flushing for the past 2 weeks. He says the episodes are associated with mild headaches and a sensation of fullness in his head and neck. Additionally, he has developed recurrent, often severe, itching after taking a hot shower. The patient denies any smoking history but says he drinks alcohol socially. His blood pressure is 160/90 mm Hg, and his temperature is 37.0°C (98.6°F). On physical examination, his face and neck appear red. Cardiac examination reveals a regular rate and rhythm. Lungs are clear to auscultation bilaterally. The spleen is noted to be palpable just below the costal margin. A complete blood count shows a hemoglobin level of 19.5 g/dL, a total leukocyte count of 12,000/mm3, and a platelet count of 450,000/mm3. Which of the following sets of abnormalities is most likely present in this patient?? {'A': '↑ Blood viscosity, ↓ blood flow with blast cells', 'B': '↑ Blood viscosity, ↓ blood flow with an M-spike of immunoglobulin G', 'C': '↓ Blood viscosity, ↑ blood flow, ↓erythropoietin, ↑ferritin', 'D': '↑ Blood viscosity, ↓ blood flow with an M-spike of immunoglobulin M', 'E': '↑ Blood viscosity, ↓ blood flow, ↓ erythropoietin'},
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E: ↑ Blood viscosity, ↓ blood flow, ↓ erythropoietin
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Q:An 8-day-old boy is brought to the physician by his mother because of vomiting and poor feeding. The pregnancy was uncomplicated, and he was born at full term. He appears pale and lethargic. Physical examination shows diffusely increased muscle tone. His urine is noted to have a sweet odor. This patient's symptoms are most likely caused by the accumulation of which of the following?? {'A': 'Isoleucine', 'B': 'Phytanic acid', 'C': 'Homogentisic acid', 'D': 'Homocysteine', 'E': 'Phenylalanine'},
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A: Isoleucine
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Q:A 55-year-old male smoker presents to your office with hemoptysis, central obesity, and a round face with a "moon-like" appearance. He is found to have a neoplasm near the hilum of his left lung. A biopsy of the tumor reveals small basophilic cells with finely granular nuclear chromatin (a "salt and pepper" pattern). Which of the following is the most appropriate treatment for this patient?? {'A': 'Tamoxifen', 'B': 'Prednisone', 'C': 'Surgical resection', 'D': 'Cisplatin and radiotherapy', 'E': 'Watchful waiting'},
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D: Cisplatin and radiotherapy
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Q:A 3-year-old girl swallowed a handful of pills after her grandmother dropped the bottle on the ground this afternoon. She presents to the ER in a very drowsy but agitated state. She is clutching her abdomen, as if in pain, her skin is dry and flushed, and she does not know her name or where she is. Her pupils are dilated. Her grandmother reports that she has not urinated in several hours. The grandmother's medical history is significant for allergic rhinitis and osteoarthritis, both of which are treated with over the counter medications. What is the appropriate treatment for this child?? {'A': 'Atropine', 'B': 'N-acetylcysteine', 'C': 'Naloxone', 'D': 'Physostigmine', 'E': 'Deferoxamine'},
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D: Physostigmine
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Q:A 49-year-old man was brought to the emergency department by ambulance with complaints of sudden-onset chest pain that radiates into his neck and down his left arm. This substernal pain started 2 hours ago while he was having dinner. His past medical history is remarkable for hypercholesterolemia that is responsive to therapy with statins and coronary artery disease. His temperature is 37.0°C (98.6°F), blood pressure is 155/90 mm Hg, pulse is 112/min, and respiratory rate is 25/min. Troponin I levels are elevated. A 12-lead ECG was performed (see image). What is the most likely etiology of this patient’s presentation?? {'A': 'Coronary vasospasm', 'B': 'Left main coronary artery occlusion', 'C': 'Left circumflex artery occlusion', 'D': 'Left anterior descending artery occlusion', 'E': 'Right main coronary artery occlusion'},
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E: Right main coronary artery occlusion
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Q:A 43-year-old man comes to the physician for a 1-week history of swelling around his eyes and decreased urination. His pulse is 87/min, and blood pressure is 152/95 mm Hg. Physical examination shows 1+ periorbital and pretibial edema. Serum studies show a urea nitrogen concentration of 21 mg/dL and a creatinine concentration of 1.4 mg/dL. Urinalysis shows 3+ blood and 1+ protein. Further evaluation of this patient is most likely to show which of the following?? {'A': 'Urinary rhomboid crystals', 'B': 'Hypoalbuminemia', 'C': 'Renal interstitial inflammation', 'D': 'Red blood cell casts', 'E': 'Detached renal tubular epithelial cells'},
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D: Red blood cell casts
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Q:A 62-year-old woman with hypertension and type 2 diabetes mellitus comes to the physician because of increasing shortness of breath and a dry cough over the past 6 months. She has smoked 1 pack of cigarettes daily for the past 40 years. Chest auscultation shows scattered expiratory wheezes in both lung fields. Spirometry shows an FEV1:FVC ratio of 65% and an FEV1 of 70% of predicted. Her diffusing capacity for carbon monoxide (DLCO) is 42% of predicted. Which of the following is the most likely diagnosis?? {'A': 'Pulmonary fibrosis', 'B': 'Emphysema', 'C': 'Bronchial asthma', 'D': 'Chronic bronchitis', 'E': 'Bronchiectasis'},
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B: Emphysema
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Q:A 55-year-old man presents to the emergency department with a concern of having sprayed a chemical in his eye. He states he was working on his car when his car battery sprayed a chemical on his face and eye. He states his eye is currently burning. His temperature is 99.0°F (37.2°C), blood pressure is 129/94 mmHg, pulse is 85/min, respirations are 14/min, and oxygen saturation is 98% on room air. Physical exam is notable for a teary and red left eye. Which of the following is the most appropriate next step in management?? {'A': 'CT orbits', 'B': 'Irrigation', 'C': 'Slit lamp exam', 'D': 'Surgical debridement', 'E': 'Visual acuity test'},
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B: Irrigation
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Q:A 45-year-old man presents with a persistent cough for the past month. He says it started off with a runny nose and fever, from which he recovered in a week, but he says that the cough persists after the resolution of the fever. The patient denies any expectoration, chest pain, weight loss, or breathlessness. He reports no history of recent travel or sick contacts. Past medical history is significant for chronic constipation. He reports a 15-pack-year smoking history but denies any alcohol or current recreational drug use. He says he did use intravenous drugs in his late twenties but quit after going through a drug rehabilitation program. Physical examination is unremarkable. Laboratory findings and a chest radiograph are normal. Which of the following would be the best choice as a cough suppressant in this patient?? {'A': 'Codeine', 'B': 'Dextromethorphan', 'C': 'Pseudoephedrine', 'D': 'Guaifenesin', 'E': 'Oxymetazoline'},
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B: Dextromethorphan
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Q:A 65-year-old man presents to the emergency department with shortness of breath. He was at home cleaning his yard when his symptoms began. The patient is a farmer and does not have regular medical care. He has smoked two packs of cigarettes every day for the past 40 years. The patient lives alone and admits to feeling lonely at times. His temperature is 99.5°F (37.5°C), blood pressure is 159/95 mmHg, pulse is 90/min, respirations are 19/min, and oxygen saturation is 86% on room air. On physical exam, you note a man in distress. Pulmonary exam reveals poor air movement, wheezing, and bibasilar crackles. Cardiac exam is notable for an S4 heart sound. The patient is started on appropriate therapy and his symptoms improve. Prior to discharge he is no longer distressed when breathing and his oxygen saturation is 90% on room air. Which of the following interventions could improve mortality the most in this patient?? {'A': 'Albuterol', 'B': 'Magnesium', 'C': 'Ipratropium', 'D': 'Home oxygen', 'E': 'Varenicline'},
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E: Varenicline
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Q:A 26-year-old African American man comes to the physician because of a 3-day history of fatigue, back pain, and dark urine. One week ago, he developed a headache and was treated with aspirin. He does not smoke or use illicit drugs. Physical examination shows conjunctival pallor. A peripheral blood smear shows erythrocytes with inclusions of denatured hemoglobin. Which of the following enzymes is essential for the production of nucleotides in this patient?? {'A': 'Pyruvate carboxylase', 'B': 'Carbamoyl phosphate synthetase I', 'C': 'Enolase', 'D': 'Glucose-6-phosphatase', 'E': 'Transaldolase'},
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E: Transaldolase
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Q:An investigator is studying the effect of a high-lipid diet on glucose metabolism in Wistar rats. The experimental rat group is fed a high-lipid diet while the control group is fed a low-lipid diet. Two month after initiation of the experiment, the rats in both groups are injected with insulin and serum glucose measurements are obtained. Compared to the control group, the high-lipid diet group has a significantly higher average serum glucose after receiving insulin. Which of the following intracellular changes is most likely involved in the pathogenesis of this finding?? {'A': 'Decreased expression of TP53', 'B': 'Increased activity of serine kinases', 'C': 'Increased exposure of nuclear localization signal', 'D': 'Decreased activation of caspase 8', 'E': 'Decreased production of protein kinase A'},
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B: Increased activity of serine kinases
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Answer the following medical question with one of the provided options:
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Q:A 26-year-old woman who is a medical student is undergoing evaluation after sticking herself with a needle while drawing blood from a patient. The patient’s medical history is unknown. A blood sample from the medical student is drawn and processed, and the results are presented below: Anti-HAV IgM negative Anti-HAV IgG positive HBsAg negative HBeAg negative Anti-HBs negative Anti-HBc IgG negative Anti-HBc IgM negative Anti-HBe negative Anti-HCV negative What is true about the student’s laboratory findings?? {'A': 'She has not been vaccinated against the hepatitis B virus.', 'B': 'She is an asymptomatic carrier of the hepatitis B virus.', 'C': 'She is infected with the hepatitis D virus.', 'D': 'She recovered from a hepatitis B virus infection.', 'E': 'She can transmit the hepatitis A virus.'},
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A: She has not been vaccinated against the hepatitis B virus.
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Q:A 47-year-old woman presents to the clinic for a regular health check-up. She is currently asymptomatic but gives a history of recurrent bouts of right upper abdominal pain for 3 years. She further describes the pain as intermittent and localized. She denies any fever, vomiting, difficulty breathing, abnormal bowel habits, hematemesis, or melena. She currently takes multivitamins only. She used to take combined oral contraceptive pills but stopped 3 years ago. Her temperature is 36.7°C (98.1°F), the blood pressure is 126/88 mm Hg, the pulse rate is 84/min, and the respiratory rate is 12/min. Her blood work is normal. An abdominal X-ray is shown in the picture. Based on the imaging findings, the patient is at risk for developing which of the following?? {'A': 'Hepatocellular carcinoma', 'B': 'Peritonitis secondary to hydatid cyst rupture', 'C': 'Aortic aneurysm rupture', 'D': 'Carcinoma of the gallbladder', 'E': 'Age-related changes (i.e., no risk)'},
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D: Carcinoma of the gallbladder
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Answer the following medical question with one of the provided options:
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Q:A 51-year-old man presents to the emergency department with an episode of syncope. He was at a local farmer's market when he fainted while picking produce. He rapidly returned to his baseline mental status and did not hit his head. The patient has a past medical history of diabetes and hypertension but is not currently taking any medications. His temperature is 97.5°F (36.4°C), blood pressure is 173/101 mmHg, pulse is 82/min, respirations are 14/min, and oxygen saturation is 98% on room air. Physical exam is notable for clear breath sounds and a S4 heart sound. Rectal exam reveals a firm and nodular prostate that is non-tender and a fecal-occult sample that is negative for blood. Which of the following is this patient's presentation most concerning for?? {'A': 'Benign prostatic hyperplasia', 'B': 'Normal physical exam', 'C': 'Prostate abscess', 'D': 'Prostate cancer', 'E': 'Prostatitis'},
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D: Prostate cancer
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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 is brought to the emergency department with a 30 minute history of difficulty breathing. He was playing basketball in gym class when he suddenly felt pain in the right side of his chest that got worse when he tried to take a deep breath. Physical exam reveals a tall, thin boy taking rapid shallow breaths. There are decreased breath sounds in the right lung fields and the right chest is hyperresonant to percussion. Which of the following is true of the lesions that would most likely be seen in this patient's lungs?? {'A': 'Related to liver failure', 'B': 'Related to smoking', 'C': 'Found in the lower lobes', 'D': 'Found in the upper lobes', 'E': 'Found near the pleura'},
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E: Found near the pleura
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Answer the following medical question with one of the provided options:
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Q:A 40-year-old woman visits her physician’s office with her husband. Her husband says that she has been complaining of recurring headaches over the past few months. A year ago she was diagnosed with diabetes and is currently on treatment for it. About 6 months ago, she was diagnosed with high blood pressure and is also taking medication for it. Her husband is concerned about the short span during which she has been getting all these symptoms. He also says that she occasionally complains of changes and blurring in her vision. In addition to all these complaints, he has observed changes in her appearance, more prominently her face. Her forehead and chin seem to be protruding more than usual. Suspecting a hormonal imbalance, which of the following initial tests would the physician order to indicate a possible diagnosis?? {'A': 'Pituitary magnetic resonance image (MRI)', 'B': 'Serum insulin-like growth factor-1 (IGF-1)', 'C': 'Serum growth hormone', 'D': 'Glucose suppression test', 'E': 'Chest X-ray'},
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B: Serum insulin-like growth factor-1 (IGF-1)
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Answer the following medical question with one of the provided options:
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Q:A Caucasian 32-year-old woman has an uncomplicated vaginal delivery, giving birth to male and female fraternal twins at term. At 2 days of life, the twin sister develops abdominal distension without emesis, and the mother states that she has not noticed the passage of stool for this infant. Genetic testing identifies deletion of an amino acid in a membrane channel for the girl. Both parents are healthy. Assuming that twin brother's disease status/symptomatology is unclear, which of the following best approximates the probability that the twin brother is a carrier of the disease allele?? {'A': '0%', 'B': '25%', 'C': '50%', 'D': '67%', 'E': '100%'},
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C: 50%
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Answer the following medical question with one of the provided options:
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Q:A 14-year-old male is brought to your psychiatric clinic after he was caught stealing his peers’ belongings multiple times by his teacher. He is a straight-A student with many friends and is an outstanding football player. He describes his family as very loving and gets along with his older siblings. He also states that he has no ill will towards anyone he stole from in class. Although never caught, he admits that he would often steal things in stores or locker rooms when no one was looking in order to satisfy an intense impulse. Which of the following is the best diagnosis for this patient?? {'A': 'Anger towards classmates', 'B': 'Manic episode', 'C': 'Conduct disorder', 'D': 'Kleptomania', 'E': 'Schizophrenia'},
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D: Kleptomania
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Answer the following medical question with one of the provided options:
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Q:A 56-year-old postmenopausal woman comes to the physician because of a 6-month history of worsening pain and swelling in her left knee. She has a history of peptic ulcer disease for which she takes cimetidine. Examination shows palpable crepitus and limited range of motion of the left knee. Which of the following is the most appropriate pharmacotherapy for this patient’s symptoms?? {'A': 'Ketorolac', 'B': 'Diclofenac', 'C': 'Acetylsalicylic acid', 'D': 'Celecoxib', 'E': 'Meloxicam'},
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D: Celecoxib
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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 brought into the emergency department with fever, lethargy, and confusion. He is a cachectic man in acute distress, unable to respond to questions or follow commands. His friend confides that the patient has been sexually active with multiple male partners and was diagnosed with HIV several months ago, but was lost to follow up. Based on prior records, his most recent CD4 count was 65 cells/uL. Which of the following is the most appropriate next step in management?? {'A': 'Recheck CD4 and HIV viral load serologies', 'B': 'Lumbar puncture', 'C': 'MRI brain with contrast', 'D': 'CT head without contrast', 'E': 'Neurological exam with fundoscopy'},
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E: Neurological exam with fundoscopy
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Answer the following medical question with one of the provided options:
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Q:A 5-year-old boy is brought to the physician’s office with complaints of being tired constantly, which has limited his ability to walk or play with his friends. Physical examination in the physician’s office is normal. Further testing reveals that the patient has a genetic mutation in an enzyme and muscle biopsy shows high levels of alpha-ketoglutarate and low levels of succinyl-CoA as compared to normal. The enzyme that is most likely deficient in this patient requires which of the following as a cofactor?? {'A': 'NADH', 'B': 'Carbon dioxide', 'C': 'Vitamin B6', 'D': 'Vitamin B1', 'E': 'ATP'},
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D: Vitamin B1
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Answer the following medical question with one of the provided options:
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Q:A 57-year-old man comes to the physician because of a 4-week history of constipation, episodic bloody stools, progressive fatigue, and a 5-kg (10.2-lb) weight loss. Digital rectal examination shows a hard, 1.5-cm rectal mass. A biopsy confirms the diagnosis of colorectal carcinoma. The patient begins treatment with a combination chemotherapy regimen that includes a drug that is also used in the treatment of wet age-related macular degeneration. This drug most likely acts by inhibiting which of the following substances?? {'A': 'Fibroblast growth factor', 'B': 'Epidermal growth factor', 'C': 'Metalloproteinase', 'D': 'Interferon-alpha', 'E': 'Vascular endothelial growth factor'},
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E: Vascular endothelial growth factor
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Answer the following medical question with one of the provided options:
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Q:A 17-year-old high school student presents to your office for recent mood and skin changes. The patient is a high school senior who is competing on the wrestling team and recently has lost weight to drop two weight classes over the past several months. He states he has dry, cracking, and irritated skin, as well as a sensation of tingling in his hands and feet. The patient also states that he has not been feeling himself lately. He finds himself more irritable and no longer enjoys many of the activities he once enjoyed. He finds that he often feels fatigued and has trouble concentrating. The patient does not have a significant past medical history and is not on any current medications. The patient admits to drinking alcohol and smoking marijuana on special occasions. He states that he uses supplements that his other team members use. Physical exam is significant for acne, dry, cracked skin around the patient's mouth in particular, and decreased sensation in his lower extremities. Laboratory values are as follows: Serum: Na+: 137 mEq/L Cl-: 101 mEq/L K+: 4.1 mEq/L HCO3-: 24 mEq/L BUN: 15 mg/dL Glucose: 79 mg/dL Creatinine: 0.9 mg/dL Ca2+: 9.2 mg/dL Mg2+: 1.5 mEq/L Homocysteine: 11.2 µmol/L (normal: 4.6 to 8.1 µmol/L) AST: 11 U/L ALT: 11 U/L Alkaline phosphatase: 27 U/L Albumin: 4.5 g/dL Total protein: 6.9 g/dL Total bilirubin: 0.5 mg/dL Direct bilirubin: 0.3 mg/dL Which of the following is the most likely diagnosis?? {'A': 'Water soluble vitamin deficiency', 'B': 'Anabolic steroid use', 'C': 'Dermatologic fungal infection', 'D': 'Depression secondary to dietary changes', 'E': 'Viral infection'},
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A: Water soluble vitamin deficiency
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Answer the following medical question with one of the provided options:
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Q:A 13-year-old girl is brought to the pediatrician due to a 4-month history of heavy vaginal bleeding during menstrual periods. She endorses episodes of bleeding gums after brushing her teeth and experienced prolonged bleeding after tonsillectomy 6 years ago. Her mother states that she bled significantly during childbirth and that the girl’s older brother has similar symptoms including easy bruising. Vitals were stable and physical exam was not revealing. Laboratory studies show: Platelet count: 72,000/mm^3 Bleeding time: 14 min Prothrombin time: 12 secs (INR = 1) Partial thromboplastin time: 40 secs Blood smear demonstrates increased megakaryocytes and enlarged platelets. Platelets do not aggregate to ristocetin. Which of the following is the most likely diagnosis?? {'A': 'von Willebrand disease (vWD)', 'B': 'Aspirin or NSAID use', 'C': 'Idiopathic thrombocytopenic purpura (ITP)', 'D': 'Glanzmann thrombasthenia', 'E': 'Bernard-Soulier syndrome'},
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E: Bernard-Soulier syndrome
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Answer the following medical question with one of the provided options:
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Q:A 55-year-old man is brought to the emergency department by ambulance from a long term nursing facility complaining of severe shortness of breath. He suffers from amyotrophic lateral sclerosis and lives at the nursing home full time. He has had the disease for 2 years and it has been getting harder to breath over the last month. He is placed on a rebreather mask and responds to questions while gasping for air. He denies cough or any other upper respiratory symptoms and denies a history of cardiovascular or respiratory disease. The blood pressure is 132/70 mm Hg, the heart rate is 98/min, the respiratory rate is 40/min, and the temperature is 37.6°C (99.7°F). During the physical exam, he begs to be placed in a sitting position. After he is repositioned his breathing improves a great deal. On physical examination, his respiratory movements are shallow and labored with paradoxical inward movement of his abdomen during inspiration. Auscultation of the chest reveals a lack of breath sounds in the lower lung bilaterally. At present, which of the following muscles is most important for inspiration in the patient?? {'A': 'External intercostal muscles', 'B': 'Sternocleidomastoid muscles', 'C': 'Muscles of anterior abdominal wall', 'D': 'Trapezium muscle', 'E': 'Internal intercostal muscles'},
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B: Sternocleidomastoid muscles
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Answer the following medical question with one of the provided options:
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Q:A 14-year-old girl is presented by her mother who says she has trouble focusing. The patient’s mother says that, over the past 2 months, the patient has lost interest in her normal activities and has become more withdrawn. She no longer participates in activities she enjoys and says that she has contemplated suicide. The patient’s mother says that, at other times, she is hyperactive and can’t ever seem to be still. Before the onset of her depression, she had an 8 day period where she did not sleep and was constantly on the go. She was so energetic at school that she was suspended for a month. The patient is afebrile and vitals are within normal limits. Physical examination is unremarkable. Routine laboratory tests and a noncontrast computed tomography (CT) of the head are normal. Which of the following would be the best course of treatment in this patient?? {'A': 'Chlorpromazine', 'B': 'Lithium', 'C': 'Ramelteon', 'D': 'Phenobarbital', 'E': 'Amitriptyline'},
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B: Lithium
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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 comes to the physician because of a 4-month history of urinary hesitancy and poor urinary stream. Digital rectal examination shows a symmetrically enlarged, nontender prostate. Serum studies show a prostate-specific antigen concentration of 2 ng/mL (N < 4). Pharmacotherapy with finasteride is initiated. Which of the following is the most likely effect of this drug?? {'A': 'Decreased internal urethral sphincter tone', 'B': 'Increased prostatic apoptosis', 'C': 'Decreased production of urine', 'D': 'Increased penile blood flow', 'E': 'Decreased bladder contractions'},
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B: Increased prostatic apoptosis
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Answer the following medical question with one of the provided options:
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Q:An 85-year-old man presents to his primary care provider after feeling "lightheaded." He said he helped his wife in the garden for the first time, but that while moving some bags of soil he felt like he was going to faint. He had a big breakfast of oatmeal and eggs prior to working in the garden. He has no significant past medical history and takes a baby aspirin daily. Physical exam reveals an elderly, well-nourished, well-built man with no evidence of cyanosis or tachypnea. Vital signs show normal temperature, BP 150/70, HR 80, RR 18. Cardiac exam reveals crescendo-decrescendo systolic murmur. What is the most likely cause of this patient's diagnosis?? {'A': 'Congenital defect', 'B': 'Calcification', 'C': 'Atherosclerosis', 'D': 'Infection', 'E': 'Malnutrition'},
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B: Calcification
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Answer the following medical question with one of the provided options:
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Q:A 32-year-old woman presents to the office with complaints of intense anal pain every time she has a bowel movement. The pain has been present for the past 4 weeks, and it is dull and throbbing in nature. It is associated with mild bright red bleeding from the rectum that is aggravated during defection. She has no relevant past medical history. When asked about her sexual history, she reports practicing anal intercourse. The vital signs include heart rate 98/min, respiratory rate 16/min, temperature 37.6°C (99.7°F), and blood pressure 110/66 mm Hg. On physical examination, the anal sphincter tone is markedly increased, and it’s impossible to introduce the finger due to severe pain. What is the most likely diagnosis?? {'A': 'Anorectal abscess', 'B': 'Deterioration of the connective tissue that anchors hemorrhoids', 'C': 'Rectal prolapse and paradoxical contraction of the puborectalis muscle', 'D': 'Local anal trauma', 'E': 'Inflammatory bowel disease'},
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D: Local anal trauma
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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 with history of ulcerative colitis presents to the emergency department with a severe flare. The patient reports numerous bloody loose stools, and has been febrile for two days. Vital signs are: T 101.9 HR 98 BP 121/86 RR 17 Sat 100%. Abdominal exam is notable for markedly distended abdomen with tympani and tenderness to palpation without guarding or rebound. KUB is shown in figure A. CT scan shows markedly dilated descending and sigmoid colon with no perforations. What is the next best step in management for this patient?? {'A': 'Oral prednisone', 'B': 'IV hydrocortisone', 'C': 'Rectal 5-ASA', 'D': 'IV Metoclopramide', 'E': 'IV Ondansetron'},
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B: IV hydrocortisone
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Answer the following medical question with one of the provided options:
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Q:A 26-year-old man presents into the emergency department complaining of hemoptysis for the past day. He has also experienced fatigue, weight loss (10 kg (22 lb) over the last 2 months), and occasional dry cough. He is a college student and works part-time as a cashier in a bookstore. He is sexually active with his girlfriend and uses condoms occasionally. He smokes 2–3 cigarettes on weekends and denies alcohol use. Today, his pulse is 97/min, the blood pressure is 128/76 mm Hg, the temperature is 36.7°C (98.0°F). On physical exam, the patient is well developed with mild gynecomastia. His heart has a regular rate and rhythm. Lung examination reveals vesicular sounds with occasional crepitations bilaterally. and his lungs are clear to auscultation bilaterally. The abdominal exam is non-contributory. His right testicle is tender and larger than the left. The swelling does not transilluminate and does not change in size after performing a Valsalva maneuver. His laboratory work is positive for elevated levels of beta-HCG. What is the most likely diagnosis in this patient?? {'A': 'Orchitis', 'B': 'Inguinal hernia', 'C': 'Spermatocele', 'D': 'Testicular malignancy', 'E': 'Hydrocele'},
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D: Testicular malignancy
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Answer the following medical question with one of the provided options:
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Q:A 46-year-old woman comes to the physician with a 4-month history of lethargy. She has had joint pain for the past 15 years and does not have a primary care physician. Her temperature is 37.4°C (99.3°F), pulse is 97/min, and blood pressure is 132/86 mm Hg. Physical examination shows pallor of the oral mucosa and nontender subcutaneous nodules on both elbows. The distal interphalangeal joints of both hands are flexed and the proximal interphalangeal joints appear hyperextended. Range of motion in the fingers is restricted. The liver span is 6 cm and the spleen tip is palpated 4 cm below the left costal margin. Laboratory studies show: Hematocrit 33% Leukocyte count 1,800/mm3 Segmented neutrophils 35% Lymphocytes 60% Platelet count 130,000/mm3 Increased serum titers of which of the following is most specific for this patient's condition?"? {'A': 'Anti-CCP antibody', 'B': 'Anti-Sm antibody', 'C': 'Antinuclear antibody', 'D': 'Rheumatoid factor', 'E': 'Anti-U1-RNP antibody\n"'},
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A: Anti-CCP antibody
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Answer the following medical question with one of the provided options:
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Q:A 59-year-old woman comes to the emergency department because of abdominal pain and bloody diarrhea that began 12 hours ago. Three days ago, she ate undercooked chicken at a local restaurant. Blood cultures grow spiral and comma-shaped, oxidase-positive organisms at 42°C. This patient is at greatest risk for which of the following complications?? {'A': 'Segmental myelin degeneration', 'B': 'Seizures', 'C': 'Toxic megacolon', 'D': 'Erythema nodosum', 'E': 'Peyer patch necrosis'},
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A: Segmental myelin degeneration
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Answer the following medical question with one of the provided options:
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Q:An 80-year-old woman presents with fatigue and a 30-lb weight loss over the past 3 months. The patient states that her symptoms started with mild fatigue about 4 months ago, which have progressively worsened. She noticed that the weight loss started about 1 month later, which has continued despite no changes in diet or activity level. The past medical history is significant for a total abdominal hysterectomy (TAH), and bilateral salpingo-oophorectomy at age 55 for stage 1 endometrial cancer. The patient takes no current medications but remembers taking oral (estrogen/progesterone) contraceptives for many years. The menarche occurred at age 10, and the menopause was at age 50. There is no significant family history. The vital signs include: temperature 37.0℃ (98.6℉), blood pressure 120/75 mm Hg, pulse 97/min, respiratory rate 17/min, and oxygen saturation 98% on room air. The physical examination is significant for a palpable mass in the upper outer quadrant of the left breast. The mass is hard and fixed with associated axillary lymphadenopathy. The mammography of the left breast shows a spiculated mass in the upper outer quadrant. An excisional biopsy of the mass is performed, and the histologic examination reveals the following significant findings (see image). Immunohistochemistry reveals that the cells from the biopsy are estrogen receptor (ER)/progesterone receptor (PR) and human epidermal growth factor receptor-2 (HER-2)/neu positive. Which of the following is the most important indicator of a poor prognosis for this patient?? {'A': 'Axillary lymphadenopathy', 'B': 'Increased age', 'C': 'ER positive', 'D': 'Inflammatory subtype', 'E': 'HER-2/neu positive'},
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A: Axillary lymphadenopathy
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Answer the following medical question with one of the provided options:
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Q:A 55-year-old caucasian man presents to his primary care physician with a complaint of double vision, which started suddenly with no precipitating trauma. Twelve years ago, he presented to his physician with painful vision loss, which has since resolved. Since that initial episode, he had numerous episodes early-on in his disease course: two additional episodes of painful vision loss, as well as three episodes of right arm weakness and three episodes of urinary retention requiring catheterization. All of his prior episodes responded to supportive therapy and steroids. Which of the following features of this patient's disease is linked to a more benign disease course?? {'A': 'Age at onset', 'B': 'Race', 'C': 'Initial presenting symptoms', 'D': 'Gender', 'E': 'Number of episodes early in the disease'},
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C: Initial presenting symptoms
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Answer the following medical question with one of the provided options:
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Q:A 30-year-old man presents with weakness in his right hand. He says he has been an avid cyclist since the age of 20. He denies any recent trauma. Physical examination reveals decreased sensations over the 4th and 5th digits with difficulty extending the 4th and 5th phalanges. Strength is 4 out of 5 in the extensor muscles of the right hand and wrist. When the patient is asked to extend his fingers, the result is shown in the image. Which of the following nerves is most likely damaged in this patient?? {'A': 'Musculocutaneous nerve', 'B': 'Ulnar nerve', 'C': 'Radial nerve', 'D': 'Median nerve', 'E': 'Axillary nerve'},
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B: Ulnar nerve
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Answer the following medical question with one of the provided options:
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Q:A 28-year-old homeless male with a past medical history significant for asthma comes to your clinic complaining of a chronic rash on his scalp and feet. He describes the rash as “dry and flaky,” and reports it has been present for at least a year. He was using a new dandruff shampoo he got over the counter, with little improvement. The patient reports it is extremely itchy at night, to the point that he can't sleep. On exam, you note a scaly patch of alopecia, enlarged lymph glands along the posterior aspect of his neck, and fine scaling in between his toes and on the heel and sides of his foot. His temperature is 99°F (37°C), blood pressure is 118/78 mmHg, and pulse is 81/min. Which of the following is the most accurate test for the suspected diagnosis?? {'A': "Wood's lamp", 'B': 'Culture in Sabouraud liquid medium', 'C': 'KOH preparation of scalp scraping', 'D': 'CBC and total serum IgE', 'E': 'Microscopic visualization of skin scraping'},
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B: Culture in Sabouraud liquid medium
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Answer the following medical question with one of the provided options:
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Q:A 40-year-old gravida 4 para 2 woman presents with urinary incontinence requesting definitive treatment. She started experiencing urinary incontinence when coughing, laughing, or exercising about three months ago. Symptoms have not improved with behavioral changes or Kegel exercises. Past medical history is significant for her last pregnancy which was complicated by an arrest of descent and a grade 3 episiotomy. She currently takes no medications. A review of systems is significant for constipation for the last few months. Rectal and vaginal exams are normal. Which of the following is the mechanism that underlies the best course of treatment for this patient?? {'A': 'Oral estrogen therapy', 'B': 'Reduction of detrusor muscle tone', 'C': 'Inhibition of DNA gyrase and topoisomerase', 'D': 'Dilation of a urethral or ureteral stricture', 'E': 'Anatomic elevation of the urethra'},
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E: Anatomic elevation of the urethra
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Answer the following medical question with one of the provided options:
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Q:A vaccination campaign designed to increase the uptake of HPV vaccine was instituted in chosen counties of a certain state in order to educate parents not only about the disease itself, but also about why children should be vaccinated against this viral sexually transmitted disease. At the end of the campaign, children living in counties in which it was conducted were 3 times more likely to receive the HPV vaccine compared with children living in counties where no campaign was instituted. As well, after evaluating only the counties that were part of the vaccination campaign, the researchers found that families with higher incomes were 2 times more likely to vaccinate their children against HPV compared with families with lower incomes. What conclusion can be drawn from these results?? {'A': 'Family income appears to be a confounder.', 'B': 'Family income appears to be an effect modifier.', 'C': 'The vaccination campaign appears to have been ineffective.', 'D': 'The vaccine uptake is the study exposure.', 'E': 'The vaccination campaign is the study outcome.'},
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B: Family income appears to be an effect modifier.
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