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Answer the following medical question with one of the provided options:
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Q:A 20-year-old male presents with confusion, asterixis, and odd behavior. Very early in the morning, his mother found him urinating on the floor of his bedroom. A detailed history taken from the mother revealed that he has been a vegetarian his entire life but decided to "bulk up" by working out and consuming whey protein several times a day. A blood test revealed increased levels of ammonia and orotic acid but a decreased BUN. The patient began hemodialysis and was given oral sodium benzoate and phenylbutyrate, which improved his condition. Gene therapy of the enzyme producing which product would correct his condition?? {'A': 'Uridine monophosphate', 'B': 'Citrulline', 'C': 'Homocysteine', 'D': 'Phenylalanine', 'E': 'Fructose-1-phosphate'},
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B: Citrulline
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Answer the following medical question with one of the provided options:
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Q:A 48-year-old woman visits the clinic with unintentional weight loss for the past 3 months. She is also concerned about difficulty swallowing solid food. She also has early satiety and mild abdominal discomfort. An upper gastrointestinal endoscopy is advised along with a biopsy. The histopathological report reveals gastric adenocarcinoma. She then undergoes a subtotal gastrectomy and is started on an adjuvant chemotherapy regimen with platinum and fluoropyrimidine. 2 weeks later she develops acute respiratory distress and chest pain. A D-dimer test is positive. Her blood pressure is 125/78, heart rate is 110/min, and oxygen saturation is 88%. CT scan of the chest reveals a clot in the anterior segmental artery in the right upper lung. Which of the following therapies should the patient be started on for her acute condition?? {'A': 'Warfarin', 'B': 'Clopidogrel', 'C': 'Low-molecular weight heparin', 'D': 'Ticagrelor', 'E': 'Aspirin'},
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C: Low-molecular weight heparin
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Answer the following medical question with one of the provided options:
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Q:A 14-month-old boy has iron-deficiency anemia refractory to iron therapy. His stool is repeatedly positive for occult blood. The parents bring the child to the emergency room after they notice some blood in his stool. Which of the following is the diagnostic gold standard for this patient's most likely condition?? {'A': 'Abdominal CT with contrast', 'B': 'Tagged red blood cell study', 'C': 'Technetium-99m pertechnetate scan', 'D': 'Colonoscopy', 'E': 'Capsule endoscopy'},
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C: Technetium-99m pertechnetate scan
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Answer the following medical question with one of the provided options:
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Q:A 65-year-old man presents to the diabetes clinic for a check-up. He has been successfully managing his diabetes through diet alone, and has not experienced any complications related to retinopathy, neuropathy, or nephropathy. He recently started a new exercise regimen and is eager to see whether his weight has declined since his last visit. The nurse measures his height to be 170 cm and his weight to be 165 lb (75 kg). What range does this patient’s body mass index currently fall into?? {'A': '< 18.5', 'B': '18.5 - 24.9', 'C': '25.0 - 29.9', 'D': '> 30.0', 'E': '> 40.0'},
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C: 25.0 - 29.9
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Answer the following medical question with one of the provided options:
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Q:A 68-year-old man comes to the physician because of a 4-month history of difficulty swallowing. During this time, he has also had a 7-kg (15-lb) weight loss. Esophagogastroduodenoscopy shows an exophytic mass in the distal third of the esophagus. Histological examination of a biopsy specimen shows a well-differentiated adenocarcinoma. The patient is scheduled for surgical resection of the tumor. During the procedure, the surgeon damages a structure that passes through the diaphragm along with the esophagus at the level of the tenth thoracic vertebra (T10). Which of the following structures was most likely damaged?? {'A': 'Vagus nerve', 'B': 'Inferior vena cava', 'C': 'Thoracic duct', 'D': 'Right phrenic nerve', 'E': 'Azygos vein\n"'},
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A: Vagus nerve
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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 1-month history of difficulty swallowing, low-grade fever, and weight loss. He has smoked one pack of cigarettes daily for 30 years. An esophagogastroduodenoscopy shows an esophageal mass just distal to the upper esophageal sphincter. Histological examination confirms the diagnosis of locally invasive squamous cell carcinoma. A surgical resection is planned. Which of the following structures is at greatest risk for injury during this procedure?? {'A': 'Esophageal branch of thoracic aorta', 'B': 'Left inferior phrenic artery', 'C': 'Inferior thyroid artery', 'D': 'Left gastric artery', 'E': 'Bronchial branch of thoracic aorta'},
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C: Inferior thyroid artery
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Answer the following medical question with one of the provided options:
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Q:A 36-year-old G4P3 is admitted to the obstetrics floor at 35 weeks gestation with painless vaginal spotting for a week. She had 2 cesarean deliveries. An ultrasound examination at 22 weeks gestation showed a partial placenta previa, but she was told not to worry. Today, her vital signs are within normal limits, and a physical examination is unremarkable, except for some blood traces on the perineum. The fetal heart rate is 153/min. The uterine fundus is at the xiphoid process and uterine contractions are absent. Palpation identifies a longitudinal lie. Transvaginal ultrasound shows an anterior placement of the placenta with a placental edge-to-internal os distance of 1.5 cm and a loss of the retroplacental space. Which of the following statements best describes the principle of management for this patient?? {'A': 'With such placental position, she should be managed with a scheduled cesarean in the lower uterine segment at 37 weeks’ pregnancy', 'B': 'She can be managed with an unscheduled vaginal delivery with a switch to cesarean delivery if needed', 'C': 'This patient without a significant prepartum bleeding is unlikely to have an intra- or postpartum bleeding', 'D': 'Any decision regarding the mode of delivery in this patient should be taken after an amniocentesis to determine the fetal lung maturity', 'E': 'Cesarean hysterectomy should be considered for the management of this patient'},
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E: Cesarean hysterectomy should be considered for the management of this patient
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Answer the following medical question with one of the provided options:
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Q:A 32-year-old man is admitted to the hospital for evaluation of a 3-month history of insomnia, odynophagia, and irritability. He works in a metal refinery. He appears distracted and irritable. Oral examination shows inflammation of the gums and buccal mucosa with excessive salivation. Neurological examination shows a broad-based gait and an intention tremor in both hands. After treatment with dimercaprol is begun, his symptoms slowly improve. This patient was most likely exposed to which of the following?? {'A': 'Lead', 'B': 'Mercury', 'C': 'Arsenic', 'D': 'Iron', 'E': 'Copper'},
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B: Mercury
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Answer the following medical question with one of the provided options:
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Q:A 31-year-old female presents to the emergency room complaining of fever and difficulty breathing. She first noticed these symptoms 3 days prior to presentation. Her past medical history is notable for well-controlled asthma. She does not smoke and drinks alcohol socially. Upon further questioning, she reports that her urine is tea-colored when she wakes up but generally becomes more yellow and clear over the course of the day. Her temperature is 100.8°F (38.2°C), blood pressure is 135/90 mmHg, pulse is 115/min, and respirations are 20/min. Lung auscultation reveals rales at the right lung base. Laboratory analysis is shown below: Hemoglobin: 9.4 g/dL Hematocrit: 31% Leukocyte count: 3,700 cells/mm^3 with normal differential Platelet count: 110,000/mm^3 Reticulocyte count: 3% A chest radiograph reveals consolidation in the right lung base and the patient is given oral antibiotics. Which of the following processes is likely impaired in this patient?? {'A': 'Inactivation of C3 convertase', 'B': 'Inactivation of C5 convertase', 'C': 'Erythrocyte cytoskeletal formation', 'D': 'Nicotinamide dinucleotide phosphate metabolism', 'E': 'Aminolevulinic acid metabolism'},
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A: Inactivation of C3 convertase
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Answer the following medical question with one of the provided options:
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Q:A 36-year-old G2-P1 woman in week 33 of gestation presents to the emergency department in acute respiratory distress. She works as a secretary for a local law firm, and she informs you that she recently returned from a trip to the beach. She currently smokes half-a-pack of cigarettes/day, drinks 1 glass of red wine/day, and she endorses a past history of injection drug use but currently denies any illicit drug use. The vital signs include: temperature 36.7°C (98.0°F), blood pressure 126/74 mm Hg, heart rate 87/min, and respiratory rate 23/min. Her physical examination shows minimal bibasilar rales, but otherwise clear lungs on auscultation, grade 2/6 holosystolic murmur, and a gravid uterus with no obvious abnormalities. A D-dimer is found to be elevated, and her V/Q scan reveals a high probability of pulmonary embolism (PE). Her medical history is significant for uterine fibroids, preeclampsia, hypercholesterolemia, diabetes mellitus type 1, and significant for heparin-induced thrombocytopenia. Which of the following is the most appropriate choice of management for her post-acute care?? {'A': 'Initiate long term heparin', 'B': 'Initiate dabigatran', 'C': 'Initiate apixaban', 'D': 'Initiate warfarin', 'E': 'Consult IR for IVC filter placement'},
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E: Consult IR for IVC filter placement
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Answer the following medical question with one of the provided options:
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Q:An 81-year-old man with a history of congestive heart failure presents to his cardiologist because he has been feeling increasingly short of breath while lying down. Specifically, he says that he is now no longer able to sleep flat on the bed and instead has to be propped up on multiple pillows. In addition, he has been experiencing increased swelling in his legs. Finally, he reports that he has been experiencing muscle cramping and weakness. He reports that he has been taking a diuretic as prescribed and adhering to a low-salt diet. Physical exam reveals crackles on lung auscultation bilaterally and 2+ pitting edema in his legs bilaterally. Left ventricular ejection fraction (LVEF) is measured by echocardiogram and found to be 36%. This is decreased from his last measurement of 41%. He is put on a second diuretic that is a channel blocker with an additional effect that corrects an electrolyte imbalance in this patient. Which of the following medications is consistent with this description?? {'A': 'Acetazolamide', 'B': 'Amiloride', 'C': 'Furosemide', 'D': 'Hydrochlorothiazide', 'E': 'Spironolactone'},
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B: Amiloride
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Answer the following medical question with one of the provided options:
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Q:A 34-year-old primigravida presents with progressive shortness of breath on exertion and while sleeping. The patient says that she uses 2 pillows to breathe comfortably while sleeping at night. These symptoms started in the 3rd week of the 2nd trimester of pregnancy. She does not have any chronic health problems. She denies smoking and alcohol intake. Vital signs include: blood pressure 110/50 mm Hg, temperature 36.9°C (98.4°F), and regular pulse 90/min. Previous physical examination in the 1st trimester had disclosed no cardiac abnormalities, but on current physical examination, she has a loud S1 and a 2/6 diastolic rumble over the cardiac apex. A transthoracic echocardiogram shows evidence of mitral valve stenosis. Which of the following is the best initial treatment for this patient?? {'A': 'No therapy is required', 'B': 'Loop diuretics', 'C': 'Percutaneous mitral balloon valvotomy (PMBV)', 'D': 'Open valve commissurotomy', 'E': 'Valve replacement'},
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B: Loop diuretics
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Answer the following medical question with one of the provided options:
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Q:A 28-year-old primigravid woman comes to the physician at 27 weeks' gestation with increased urinary frequency, a burning sensation when urinating, flank pain, and nausea. Her pregnancy has been uncomplicated. Glucose tolerance testing performed at 25 weeks' gestation was normal. She is sexually active with her husband. Her only medication is a prenatal vitamin. Her pulse is 90/min, respirations are 16/min, and blood pressure is 125/75 mm Hg. Physical examination shows marked tenderness in the right costovertebral area. Pelvic examination shows a uterus consistent with 27 weeks' gestation. Her urine dipstick is positive for leukocyte esterase and nitrites. The urine is sent for bacterial culture. Which of the following changes most likely contributed to this patient's condition?? {'A': 'Decreased ureteral smooth muscle tone', 'B': 'Increased body temperature', 'C': 'Decreased urine volume', 'D': 'Increased urinary pH', 'E': 'Decreased urine glucose concentration\n"'},
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A: Decreased ureteral smooth muscle tone
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Answer the following medical question with one of the provided options:
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Q:A 27-year-old Hispanic G2P1 presents for a routine antepartum visit at 26 weeks gestation. She has no complaints. The vital signs are normal, the physical examination is within normal limits, and the gynecologic examination corresponds to 25 weeks gestation. The oral glucose tolerance test (OGTT) with a 75-g glucose load is significant for a glucose level of 177 mg/dL at 1 hour and 167 mg/dL at 2 hour. The fasting blood glucose level is 138 mg/dL (7.7 mmol/L), and the HbA1c is 7%. Which of the following represents the proper initial management?? {'A': 'Dietary and lifestyle modification', 'B': 'Metformin', 'C': 'Insulin', 'D': 'Glyburide', 'E': 'Sitagliptin'},
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A: Dietary and lifestyle modification
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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 presents to a physician with a cough and dyspnea on exertion for 1 week. His symptoms worsen at night and he has noticed that his sputum is pink and frothy. He has a history of hypertension for the past 20 years and takes losartan regularly. There is no history of fever or chest pain. The pulse is 124/min, the blood pressure is 150/95 mm Hg, and the respirations are 20/min. On physical examination, bilateral pitting pedal edema is present. Chest auscultation reveals bilateral fine crepitations over the lung bases. A chest radiograph showed cardiomegaly, absence of air bronchograms, and presence of Kerley lines. The physician prescribes a drug that reduces preload and schedules the patient for follow-up after 2 days. During follow-up, the man reports significant improvement in symptoms, including the cough and edema. Which of the following medications was most likely prescribed by the physician?? {'A': 'Captopril', 'B': 'Carvedilol', 'C': 'Digoxin', 'D': 'Furosemide', 'E': 'Tolvaptan'},
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D: Furosemide
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Answer the following medical question with one of the provided options:
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Q:A 19-year-old woman comes to the physician because of a 2-day history of difficulty sleeping. She worries that the lack of sleep will ruin her career prospects as a model. She has been coming to the physician multiple times over the past year for minor problems. She is dressed very extravagantly and flirts with the receptionist. When she is asked to sit down in the waiting room, she begins to cry and says that no one listens to her. When she is called to the examination room, she moves close to the physician, repeatedly intends to touch his cheek, and makes inappropriate comments. She does not have a history of self-harm or suicidal ideation. Which of the following is the most likely diagnosis?? {'A': 'Dependent personality disorder', 'B': 'Histrionic personality disorder', 'C': 'Narcissistic personality disorder', 'D': 'Schizotypal personality disorder', 'E': 'Borderline personality disorder'},
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B: Histrionic personality disorder
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Answer the following medical question with one of the provided options:
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Q:A mother brings her 3-year-old daughter to the pediatrician because she is concerned about her development. She states that her daughter seemed to regress in her motor development. Furthermore, she states she has been having brief episodes of uncontrollable shaking, which has been very distressing to the family. During the subsequent work-up, a muscle biopsy is obtained which demonstrates red ragged fibers and a presumptive diagnosis of a genetic disease is made. The mother states that she has another 6-year-old son who does not seem to be affected or have any similar symptoms. What genetic term explains this phenomenon?? {'A': 'Allelic heterogeneity', 'B': 'Phenotypic heterogeneity', 'C': 'Genetic heterogeneity', 'D': 'Heteroplasmy', 'E': 'Locus heterogeneity'},
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D: Heteroplasmy
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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 a medical clinic with a complaint of a left foot deformity since birth. The clinical and radiologic evaluation suggested partial simple syndactyly between the 2nd and 3rd toes of the left foot. A radiograph revealed a bony fusion between the proximal phalanges of the 2nd and 3rd toes. There are no other congenital defects except for the toe findings. A failure in which of the following processes could lead to deformity as shown in the picture?? {'A': 'Chemotaxis', 'B': 'Necrosis', 'C': 'Opsonization', 'D': 'Phagocytosis', 'E': 'Apoptosis'},
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E: Apoptosis
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Answer the following medical question with one of the provided options:
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Q:A 77-year-old woman is brought by ambulance to the emergency department after she developed weakness of her right arm along with a right-sided facial droop. By the time the ambulance arrived, she was having difficulty speaking. Past medical history is significant for hypertension, diabetes mellitus type II, and hyperlipidemia. She takes lisinopril, hydrochlorothiazide, metformin, and atorvastatin. On arrival to the emergency department, her vital signs are within normal limits. On physical examination, she is awake and alert but the right side of her mouth is dropping, making it difficult for her to speak clearly. Her heart has a regular rate and rhythm and her lungs are clear to auscultation bilaterally. Fingerstick glucose is 85 mg/dL. Her right upper extremity strength is 2/5 and her left upper extremity strength is 5/5. Which of the following is the best next step in management?? {'A': 'Intubate the patient', 'B': 'Obtain noncontrast CT of the brain', 'C': 'Obtain transcranial doppler', 'D': 'Start tissue plasminogen activator (tPA)', 'E': 'Consult cardiology'},
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B: Obtain noncontrast CT of the brain
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Answer the following medical question with one of the provided options:
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Q:A 44-year-old man is brought to the emergency department after sustaining high-voltage electrical burns over his left upper limb. On examination, the tip of his left middle finger is charred, and there are 2nd-degree burns involving the whole of the left upper limb. Radial and ulnar pulses are strong, and there are no signs of compartment syndrome. An exit wound is present over the sole of his right foot. His temperature is 37.7°C (99.8°F), the blood pressure is 110/70 mm Hg, the pulse is 105/min, and the respiratory rate is 26/min. His urine is reddish-brown, and urine output is 0.3 mL/kg/h. Laboratory studies show: Hemoglobin 19.9 g/dL Hematocrit 33% Leukocyte count 11,111/mm3 Serum Creatinine 4.6 mg/dL Creatine phosphokinase 123 U/L K+ 7.7 mEq/L Na+ 143 mEq/L What is the most likely mechanism for this patient’s renal failure?? {'A': 'Fluid and electrolyte loss and hypovolemia', 'B': 'Rhabdomyolysis, myoglobinuria, and renal injury', 'C': 'Direct visceral electrical injury to the kidneys', 'D': 'Septicemia leading to acute pyelonephritis', 'E': 'Volume overload because of excessive intravenous fluid resuscitation'},
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B: Rhabdomyolysis, myoglobinuria, and renal injury
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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 comes to the physician for frequent and painful urination. He has also had progressive painful swelling of his right knee over the past week. He is sexually active with two female partners and uses condoms inconsistently. His mother has an autoimmune disease that involves a malar rash. Examination shows conjunctivitis bilaterally. The right knee is warm, erythematous, and tender to touch; range of motion is limited. Laboratory studies show an erythrocyte sedimentation rate of 62 mm/h. Urinalysis shows WBCs. Further evaluation of this patient is most likely to reveal which of the following?? {'A': 'Hiking trip two months ago', 'B': 'Recent norovirus gastroenteritis', 'C': 'Positive anti-dsDNA antibodies', 'D': 'Chondrocalcinosis of the left knee', 'E': 'HLA-B27 positive genotype'},
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E: HLA-B27 positive genotype
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Answer the following medical question with one of the provided options:
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Q:A 28-year-old man makes an appointment with his general practitioner for a regular check-up. He has recently been diagnosed with asthma and was given a short-acting β2-agonist to use during acute exacerbations. He said he usually uses the medication 1–2 times per week. Which of the following is the most appropriate treatment in this case?? {'A': 'Inhalatory corticosteroids should replace β2-agonists.', 'B': 'He should continue with current treatment.', 'C': 'Long-acting β2-agonists should be added to his treatment regimen.', 'D': 'Systemic corticosteroids should be added to his treatment regimen.', 'E': 'He should start using a short-acting β2-agonist every day, not just when he has symptoms.'},
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B: He should continue with current treatment.
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Answer the following medical question with one of the provided options:
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Q:A 29-year-old man presents to the clinic complaining of fatigue and loss of sensation in his lower legs. The patient notes no history of trauma or chronic disease but states that he spends a lot of time outside and often encounters wild animals. On examination, the patient has multiple dark lesions over the skin of his face and back, as well as a decreased sensation of fine touch and vibration bilaterally in the lower extremities. What is the morphology of the etiologic agent causing this patient’s symptoms?? {'A': 'A spirochete transmitted via tick', 'B': 'An acid-fast, intracellular bacillus', 'C': 'Gram-positive, branching anaerobe', 'D': 'Maltose-fermenting gram-negative diplococci', 'E': 'Reactivation of latent viral infection'},
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B: An acid-fast, intracellular bacillus
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Answer the following medical question with one of the provided options:
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Q:A 55-year-old man presents to his primary care physician for a wellness checkup. The patient has a past medical history of alcohol abuse and is currently attending alcoholics anonymous with little success. He is currently drinking roughly 1L of hard alcohol every day and does not take his disulfiram anymore. Which of the following findings is most likely to also be found in this patient?? {'A': 'Constipation', 'B': 'Decreased CNS NMDA activity', 'C': 'Dysdiadochokinesia', 'D': 'Increased transketolase activity', 'E': 'Microcytic anemia'},
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C: Dysdiadochokinesia
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Answer the following medical question with one of the provided options:
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Q:A 22-year-old woman comes to the physician because of a 1-month history of a light greenish, milky discharge from both breasts. There is no mastalgia. She has hypothyroidism and migraine headaches. Her mother has breast cancer and is currently undergoing chemotherapy. Menses occur at regular 28-day intervals with moderate flow; her last menstrual period was 1 week ago. Current medications include levothyroxine and propranolol. She appears anxious. Her temperature is 37.1°C (98.78F), pulse is 82/min, and blood pressure is 116/72 mm Hg. The lungs are clear to auscultation. Breast examination is unremarkable. Pelvic examination shows a normal vagina and cervix. Serum studies show: Thyroid-stimulating hormone 3.5 μU/mL Progesterone 0.7 ng/mL (Follicular phase: N < 3) Prolactin 18 ng/mL Follicle-stimulating hormone 20 mIU/mL A urine pregnancy test is negative. Which of the following is the most appropriate next step in management?"? {'A': 'Galactography of both breasts', 'B': 'Mammogram of both breasts', 'C': 'MRI of the head', 'D': 'Ultrasound of both breasts', 'E': 'Reassurance and recommend avoidance of nipple stimulation'},
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E: Reassurance and recommend avoidance of nipple stimulation
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Answer the following medical question with one of the provided options:
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Q:A 35-year-old woman is brought to the inpatient psychiatric unit by the police after she was found violating the conditions of her restraining order by parking on the side street of her "lover’s" home every night for the past week. Her "lover", a famous hometown celebrity, has adamantly denied any relationship with the patient over the past 6 months. The patient insists that ever since he signed a copy of his album at a local signing, she knew they were in love. Despite him having his own wife and children, the patient insists that he is in love with her and goes to his house to meet in secret. Physical examination of the patient is unremarkable. Urine toxicology is negative. Which of the following statements best describes this patient’s condition?? {'A': 'The patient will have concurrent psychotic disorders.', 'B': 'This disorder has a high prevalence rate.', 'C': 'Patients may have a contributing medical condition.', 'D': 'The disorder must meet 2 out of the 5 core criteria.', 'E': 'Symptoms must be present for at least 4 weeks.'},
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E: Symptoms must be present for at least 4 weeks.
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Answer the following medical question with one of the provided options:
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Q:A 22-year-old woman is brought to the emergency department because of diplopia, slurred speech, progressive upper extremity weakness, and difficulty swallowing for the past several hours. She had mild abdominal pain that resolved spontaneously after returning from her father's farm yesterday. Her temperature is 37°C (98.6°F), respirations are 11/min and labored, and blood pressure is 110/70 mm Hg. Examination shows bilateral nystagmus and ptosis. The pupils are dilated and not reactive to light or accommodation. Muscle strength of the facial muscles and bilateral upper extremities is decreased. Which of the following is the strongest risk factor for this patient's condition?? {'A': 'Oral ingestion of preformed toxin', 'B': 'Skin bite by Ixodes tick', 'C': 'Exposure to bacterial spores', 'D': 'Lack of immunization with polysaccharide fragments', 'E': 'Gastroenteritis caused by comma-shaped rod'},
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A: Oral ingestion of preformed toxin
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Answer the following medical question with one of the provided options:
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Q:A 48-year-old male dies in the intensive care unit following a severe Streptococcus pneumonia pneumonia and septic shock. Autopsy of the lung reveals a red, firm left lower lobe. What would you most likely find on microscopic examination of the lung specimen?? {'A': 'Eosinophilia in the alveolar septa', 'B': 'Vascular dilation and noncaseating granulomas', 'C': 'Fragmented erythrocytes', 'D': 'Alveolar exudate containing neutrophils, erythrocytes, and fibrin', 'E': 'Collagen whorls'},
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D: Alveolar exudate containing neutrophils, erythrocytes, and fibrin
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Answer the following medical question with one of the provided options:
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Q:A 50-year-old man presents to the emergency department with a severe headache. The patient reports that it started approx. 2 hours ago and has steadily worsened. He describes it as a stabbing pain localized behind his left eye. The patient reports that he has been having similar headaches several times a day for the past week, most often at night. He denies any nausea, vomiting, and visual or auditory disturbances. He has no significant past medical history. Current medications are a multivitamin and caffeine pills. The patient reports regular daily alcohol use but does not smoke. His temperature is 37.0°C (98.6°F), the blood pressure is 120/70 mm Hg, the pulse is 85/min, the respiratory rate is 18/min, and the oxygen saturation is 99% on room air. The patient is in moderate distress from the pain. The physical exam is significant for unilateral diaphoresis on the left forehead, left-sided rhinorrhea, and pronounced lacrimation of the left eye. The remainder of the physical exam is normal. Laboratory tests are normal. Non-contrast CT of the head shows no evidence of intracranial masses or hemorrhage. High flow oxygen and fluid resuscitation are initiated. Ibuprofen 200 mg orally is administered. Despite these interventions, the patient continues to be in significant pain. What is the next best step in management?? {'A': 'Verapamil', 'B': 'CT angiography', 'C': 'Administer subcutaneous sumatriptan', 'D': 'RF ablation of the left trigeminal nerve', 'E': 'Deep brain stimulation of the posterior inferior hypothalamus'},
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C: Administer subcutaneous sumatriptan
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Answer the following medical question with one of the provided options:
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Q:A 24-year-old primigravid woman at 38 weeks' gestation comes to the physician for a prenatal visit. At the last two prenatal visits, transabdominal ultrasound showed the fetus in breech presentation. She has no medical conditions and only takes prenatal vitamins. Her pulse is 95/min, respirations are 16/min, and blood pressure is 130/76 mm Hg. The abdomen is soft and nontender; no contractions are felt. Pelvic examination shows a closed cervical os and a uterus consistent with 38 weeks' gestation. The fetal rate tracing shows a baseline heart rate of 152/min and 2 accelerations over 10 minutes. Repeat ultrasound today shows a persistent breech presentation. The patient states that she would like to attempt a vaginal delivery. Which of the following is the most appropriate next step in management?? {'A': 'Recommend cesarean section', 'B': 'Observe until spontaneous labor', 'C': 'Repeat ultrasound in one week', 'D': 'Offer external cephalic version', 'E': 'Offer internal podalic version'},
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D: Offer external cephalic version
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Answer the following medical question with one of the provided options:
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Q:A 58-year-old man is rushed to the ER in the middle of the night with severe chest pain. He arrives in the ER short of breath, sweating, and looking terrified. His blood pressure is noted to be 250/140, and he is immediately administered nitroprusside. His blood pressure is controlled, but he soon develops confusion and lactic acidosis. Which of the following are potential side effects of nitroprusside administration?? {'A': 'Cough', 'B': 'Decreased intracranial pressure', 'C': 'Hyperkalemia', 'D': 'Hypoventilation', 'E': 'Cyanide toxicity'},
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E: Cyanide toxicity
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Answer the following medical question with one of the provided options:
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Q:During a clinical study evaluating the effects of exercise on muscle perfusion, 15 healthy individuals perform a 20-minute treadmill run at submaximal effort. Before and after the treadmill session, perfusion of the quadriceps muscle is evaluated with contrast-enhanced magnetic resonance imaging. The study shows a significant increase in muscle blood flow per unit of tissue mass. Which of the following local changes is most likely involved in the observed change in perfusion?? {'A': 'Increase in thromboxane A2', 'B': 'Decrease in prostacyclin', 'C': 'Increase in endothelin', 'D': 'Increase in adenosine', 'E': 'Decrease in potassium\n"'},
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D: Increase in adenosine
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Answer the following medical question with one of the provided options:
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Q:A 1-month-old infant is brought to the physician for a well-child examination. His mother reports that she had previously breastfed her son every 2 hours for 15 minutes but is now feeding him every 4 hours for 40 minutes. She says that the infant sweats a lot and is uncomfortable during feeds. He has 6 wet diapers and 2 stools daily. He was born at 36 weeks' gestation. He currently weighs 3500 g (7.7 lb) and is 52 cm (20.4 in) in length. He is awake and alert. His temperature is 37.1°C (98.8°F), pulse is 170/min, respirations are 55/min, and blood pressure is 80/60 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 99%. Cardiopulmonary examination shows a 4/6 continuous murmur along the upper left sternal border. After confirming the diagnosis via echocardiography, which of the following is the most appropriate next step in the management of this patient?? {'A': 'Prostaglandin E1 infusion', 'B': 'Percutaneous surgery', 'C': 'Digoxin and furosemide', 'D': 'Indomethacin infusion', 'E': 'X-ray of the chest'},
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D: Indomethacin infusion
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Answer the following medical question with one of the provided options:
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Q:A 43-year-old man with HIV comes to the physician because of fever and night sweats over the past 15 days. During this period, he has also had headaches and generalized weakness. He has no cough or shortness of breath. He has hypertension controlled with lisinopril and is currently receiving triple antiretroviral therapy. He has smoked one pack of cigarettes daily for the past 15 years and drinks one to two beers on weekends. He is a known user of intravenous illicit drugs. His temperature is 39°C (102°F), pulse is 115/min, respirations are 15/min, and blood pressure is 130/80 mm Hg. Examination shows several track marks on the forearms. The lungs are clear to auscultation. A holosystolic murmur that increases on inspiration is heard along the left sternal border. The remainder of the physical examination shows no abnormalities. Laboratory studies show a leukocyte count of 12,800/mm3 and an erythrocyte sedimentation rate of 52 mm/h. His CD4+ T-lymphocyte count is 450/mm3 (normal ≥ 500). Which of the following is the most likely sequela of the condition?? {'A': 'Pulmonary embolism', 'B': 'Painful nodules on pads of the fingers', 'C': 'Hemorrhages underneath fingernails', 'D': 'Hematuria', 'E': 'Retinal hemorrhages'},
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A: Pulmonary embolism
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Q:A 36-year-old woman, gravida 2, para 1, at 30 weeks' gestation comes to the physician for evaluation of increased urinary frequency. She has no history of major medical illness. Physical examination shows no abnormalities. Laboratory studies show an increased serum C-peptide concentration. Ultrasonography shows polyhydramnios and a large for gestational age fetus. Which of the following hormones is predominantly responsible for the observed laboratory changes in this patient?? {'A': 'Estrogen', 'B': 'Human placental lactogen', 'C': 'Human chorionic gonadotropin', 'D': 'Adrenocorticotropic hormone', 'E': 'Progesterone'},
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B: Human placental lactogen
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Q:For which patient would isoniazid monotherapy be most appropriate?? {'A': '37-year-old male with positive PPD and no clinical signs or radiographic evidence of disease', 'B': '41-year-old female with positive PPD and a Ghon complex on chest radiograph', 'C': '25-year-old female with positive PPD and acid-fast bacilli on sputum stain', 'D': '50-year-old male with positive PPD, active tuberculosis and poor compliance to multidrug regimens', 'E': '31-year-old male with negative PPD but recent exposure to someone with active tuberculosis'},
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A: 37-year-old male with positive PPD and no clinical signs or radiographic evidence of disease
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Q:A 32-year-old woman presents with progressive shortness of breath and a dry cough. She says that her symptoms onset recently after a 12-hour flight. Past medical history is unremarkable. Current medications are oral estrogen/progesterone containing contraceptive pills. Her vital signs include: blood pressure 110/60 mm Hg, pulse 101/min, respiratory rate 22/min, oxygen saturation 88% on room air, and temperature 37.9℃ (100.2℉). Her weight is 94 kg (207.2 lb) and height is 170 cm (5 ft 7 in). On physical examination, she is acrocyanotic. There are significant swelling and warmth over the right calf. There are widespread bilateral rales present. Cardiac auscultation reveals accentuation of the pulmonic component of the second heart sound (P2) and an S3 gallop. Which of the following ventilation/perfusion (V/Q) ratios most likely corresponds to this patient’s condition?? {'A': '0.3', 'B': '0.5', 'C': '1.3', 'D': '0.8', 'E': '1'},
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C: 1.3
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Q:A 77-year-old man presents to his primary care physician with lightheadedness and a feeling that he is going to "pass out". He has a history of hypertension that is treated with captopril. In the office, his temperature is 38.3°C (100.9°F), the pulse is 65/min, and the respiratory rate is 19/min. His sitting blood pressure is 133/91 mm Hg. Additionally, his supine blood pressure is 134/92 mm Hg and standing blood pressure is 127/88 mm Hg. These are similar to his baseline blood pressure measured during previous visits. An ECG rhythm strip is obtained in the office. Of the following, what is the likely cause of his presyncope?? {'A': 'Captopril', 'B': 'Hypertension', 'C': 'Orthostatic hypotension', 'D': 'Left bundle branch block', 'E': 'Right bundle branch block'},
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E: Right bundle branch block
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Q:A 31-year-old woman returns to her primary care provider for a follow-up visit. At a routine health maintenance visit 2 months ago, her blood pressure (BP) was 181/97 mm Hg. She has adhered to a low-salt diet and exercises regularly. On repeat examination 1 month later, her BP was 178/93, and she was prescribed hydrochlorothiazide and lisinopril. The patient denies any complaint, except for occasional headaches. Now, her BP is 179/95 in the right arm and 181/93 in the left arm. Physical examination reveals an abdominal bruit that lateralizes to the left. A magnetic resonance angiogram of the renal arteries is shown in the image. Which of the following is the best next step for the management of this patient condition?? {'A': 'Intravenous phentolamine', 'B': 'Add statin and aspirin', 'C': 'Surgical reconstruction', 'D': 'Stenting', 'E': 'Balloon angioplasty'},
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E: Balloon angioplasty
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Q:A 68-year-old woman with chronic idiopathic thrombocytopenic purpura (ITP) presents to her hematologist for routine follow-up. She has been on chronic corticosteroids for her ITP, in addition to several treatments with intravenous immunoglobulin (IVIG) and rituximab. Her labs today reveal a white blood cell count of 8, hematocrit of 35, and platelet count of 14. Given her refractory ITP with persistent thrombocytopenia, her hematologist recommends that she undergo splenectomy. What is the timeline for vaccination against encapsulated organisms and initiation of penicillin prophylaxis for this patient?? {'A': 'Vaccinate: 2 weeks prior to surgery; Penicillin: 2 weeks prior to surgery for an indefinite course', 'B': 'Vaccinate: 2 weeks prior to surgery; Penicillin: at time of surgery for an indefinite course', 'C': 'Vaccinate: 2 weeks prior to surgery; Penicillin: at time of surgery for 5 years', 'D': 'Vaccinate: at the time of surgery; Penicillin: 2 weeks prior to surgery for an indefinite course', 'E': 'Vaccinate: at the time of surgery; Penicillin: at time of surgery for 5 years'},
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C: Vaccinate: 2 weeks prior to surgery; Penicillin: at time of surgery for 5 years
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Q:A 76-year-old woman presents to her primary care physician with an intense, throbbing, right-sided headache. She has a history of migraine headaches and tried her usual medications this afternoon with no alleviation of symptoms. She states that this headache feels different because she also has pain in her jaw that is worse with chewing. The pain came on gradually and is getting worse. In addition, over the past few months, she has had some difficulty getting up out of chairs and raising both her arms over her head to put on her clothes. She has had no recent falls or injuries. On exam, the patient's temperature is 98.3°F (36.8°C), blood pressure is 115/70 mmHg, pulse is 93/min, and respirations are 15/min. The patient has tenderness over her right temple. She has no focal neurological deficits, and no abnormalities on fundoscopic exam. Her physical exam is otherwise within normal limits. Given the patient's most likely diagnosis, which of the following methods of treatment should be used in order to prevent any further complications?? {'A': 'Antibiotics', 'B': 'Thrombolytics', 'C': 'High dose steroids', 'D': 'Lumbar puncture', 'E': 'Craniotomy'},
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C: High dose steroids
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Q:A person is exercising strenuously on a treadmill for 1 hour. An arterial blood gas measurement is then taken. Which of the following are the most likely values?? {'A': 'pH 7.38, PaO2 100, PCO2 69 HCO3 42', 'B': 'pH 7.36, PaO2 100, PCO2 40, HCO3 23', 'C': 'pH 7.32, PaO2 42, PCO2 50, HCO3 27', 'D': 'pH 7.56, PaO2 100, PCO2 44, HCO3 38', 'E': 'pH 7.57 PaO2 100, PCO2 23, HCO3 21'},
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B: pH 7.36, PaO2 100, PCO2 40, HCO3 23
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Q:A professional golfer tees off on the first day of a tournament. On the first hole, his drive slices to the right and drops in the water. He yells at his caddy, then takes his driver and throws it at his feet, blaming it for his poor swing. Notably, the golfer had had a long fight with his wife last night over problems with family finances. The golfer's actions on the course represent which type of defense mechanism?? {'A': 'Sublimation', 'B': 'Displacement', 'C': 'Isolation of affect', 'D': 'Rationalization', 'E': 'Repression'},
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B: Displacement
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Q:A 22-year-old medical student decides to fast for 24 hours after reading about the possible health benefits of fasting. She read that blood glucose levels are maintained by metabolic processes such as hepatic glycogenolysis and hepatic gluconeogenesis during the initial 3 days of fasting. During the day, she did not suffer from the symptoms of hypoglycemia. Which of the following signaling molecules most likely stimulated the reaction which maintained her blood glucose after all her stored glucose was broken down and used up?? {'A': 'Adenosine monophosphate', 'B': 'Acetate', 'C': 'Adenosine diphosphate', 'D': 'Citrate', 'E': 'Acetyl CoA'},
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D: Citrate
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Q:A 13-year-old boy is brought to the emergency room 30 minutes after being hit in the face with a baseball at high velocity. Examination shows left periorbital swelling, posterior displacement of the left globe, and tenderness to palpation over the left infraorbital rim. There is limited left upward gaze and normal horizontal eye movement. Further evaluation is most likely to show which of the following as a result of this patient's trauma?? {'A': 'Injury to lacrimal duct system', 'B': 'Clouding of maxillary sinus', 'C': 'Pneumatization of frontal sinus', 'D': 'Cerebrospinal fluid leak', 'E': 'Disruption of medial canthal ligament'},
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B: Clouding of maxillary sinus
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Q:A 56-year-old male comes to the physician because of a 2-month history of excessive sleepiness. He reports that he has been sleeping for an average of 10 to 12 hours at night and needs to take multiple naps during the day. Six months ago, he was diagnosed with small cell lung carcinoma and underwent prophylactic cranial irradiation. This patient's symptoms are most likely caused by damage to which of the following structures?? {'A': 'Preoptic nucleus', 'B': 'Ventromedial nucleus', 'C': 'Suprachiasmatic nucleus', 'D': 'Supraoptic nucleus', 'E': 'Subthalamic nucleus\n"'},
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C: Suprachiasmatic nucleus
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Answer the following medical question with one of the provided options:
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Q:A 40-year-old man with AIDS comes to the physician because of a 3-week history of intermittent fever, abdominal pain, and diarrhea. He has also had a nonproductive cough and a 3.6-kg (8-lb) weight loss in this period. He was treated for pneumocystis pneumonia 2 years ago. He has had skin lesions on his chest for 6 months. Five weeks ago, he went on a week-long hiking trip in Oregon. Current medications include efavirenz, tenofovir, and emtricitabine. He says he has had trouble adhering to his medication. His temperature is 38.3°C (100.9°F), pulse is 96/min, and blood pressure is 110/70 mm Hg. Examination shows oral thrush on his palate and a white, non-scrapable plaque on the left side of the tongue. There is axillary and inguinal lymphadenopathy. There are multiple violaceous plaques on the chest. Crackles are heard on auscultation of the chest. Abdominal examination shows mild, diffuse tenderness throughout the lower quadrants. The liver is palpated 2 to 3 cm below the right costal margin, and the spleen is palpated 1 to 2 cm below the left costal margin. Laboratory studies show: Hemoglobin 12.2 g/dL Leukocyte count 4,800/mm3 CD4+ T-lymphocytes 44/mm3 (Normal ≥ 500 mm3) Platelet count 258,000/mm3 Serum Na+ 137 mEq/L Cl- 102 mEq/L K+ 4.9 mEq/L Alkaline phosphatase 202 U/L One set of blood culture grows acid-fast organisms. A PPD skin test shows 4 mm of induration. Which of the following is the most appropriate pharmacotherapy for this patient's condition?"? {'A': 'Amphotericin B and itraconazole', 'B': 'Rifampin and isoniazid', 'C': 'Voriconazole', 'D': 'Erythromycin', 'E': 'Azithromycin and ethambutol'},
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E: Azithromycin and ethambutol
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Q:A genetic counselor sees a family for the first time for genetic assessment. The 24-year-old businessman and his 19-year-old sister are concerned about having a mutant allele and have decided to get tested. Their grandfather and great aunt both have Huntington’s disease which became apparent when they turned 52. Their father who is 47 years old appears healthy. The geneticist discusses both the benefits and risks of getting tested and orders some tests. Which of the following tests would best provide evidence for whether the siblings are carriers or not?? {'A': 'Polymerase chain reaction', 'B': 'Restriction enzyme digestion products', 'C': 'Gel electrophoresis', 'D': 'Pyrosequencing', 'E': 'DNA isolation and purification'},
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C: Gel electrophoresis
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Q:A 54-year-old woman comes to the physician because of a 1-day history of fever, chills, and double vision. She also has a 2-week history of headache and foul-smelling nasal discharge. Her temperature is 39.4°C (103°F). Examination shows mild swelling around the left eye. Her left eye does not move past midline on far left gaze but moves normally when looking to the right. Without treatment, which of the following findings is most likely to occur in this patient?? {'A': 'Absent corneal reflex', 'B': 'Jaw deviation', 'C': 'Relative afferent pupillary defect', 'D': 'Hypoesthesia of the earlobe', 'E': 'Hemifacial anhidrosis'},
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A: Absent corneal reflex
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Q:A 10-year-old boy with bronchial asthma is brought to the physician by his mother because of a generalized rash for 2 days. He has also had a fever and sore throat for 4 days. The rash involves his whole body and is not pruritic. His only medication is a fluticasone-salmeterol combination inhaler. He has not received any routine childhood vaccinations. His temperature is 38.5°C (101.3°F) and pulse is 102/min. Examination shows dry mucous membranes and a flushed face except around his mouth. A diffuse, maculopapular, erythematous rash that blanches with pressure is seen over the trunk along with a confluence of petechiae in the axilla. Oropharyngeal examination shows pharyngeal erythema with a red beefy tongue. His hemoglobin is 13.5 mg/dL, leukocyte count is 11,200/mm3 (75% segmented neutrophils, 22% lymphocytes), and platelet count is 220,000/mm3. Which of the following is the most likely sequela of this condition?? {'A': 'Coronary artery aneurysms', 'B': 'Hemolytic anemia', 'C': 'Hodgkin lymphoma', 'D': 'Postinfectious glomerulonephritis', 'E': 'Encephalitis\n"'},
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D: Postinfectious glomerulonephritis
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Answer the following medical question with one of the provided options:
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Q:A 45-year-old man undergoes an esophagogastroduodenoscopy for his recurrent episodes of epigastric pain. He also lost a significant amount of weight in the last 6 months. He says that he has been taking a number of dietary supplements "to cope". His past medical history is insignificant, and a physical examination is within normal limits. The endoscopy shows a bleeding ulcer in the proximal duodenum. Lab tests reveal a serum iron level of 130 μg/dL. However, his stool guaiac test is negative for occult blood. Over-ingestion of which of the following substances is the most likely cause for this patient’s lab findings?? {'A': 'Folate', 'B': 'Thiamine', 'C': 'Ascorbic acid', 'D': 'Tocopherol', 'E': 'Red meat'},
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C: Ascorbic acid
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Q:A 25-year-old G1P0 woman at 22 weeks’ gestation presents to the emergency department with persistent vomiting over the past 8 weeks which has resulted in 5.5 kg (12.1 lb) of unintentional weight loss. She has not received any routine prenatal care to this point. She reports having tried diet modification and over-the-counter remedies with no improvement. The patient's blood pressure is 103/75 mm Hg, pulse is 93/min, respiratory rate is 15/min, and temperature is 36.7°C (98.1°F). Physical examination reveals an anxious and fatigued-appearing young woman, but whose findings are otherwise within normal limits. What is the next and most important step in her management?? {'A': 'Obtain a basic electrolyte panel', 'B': 'Obtain a beta hCG and pelvic ultrasound', 'C': 'Begin treatment with vitamin B6', 'D': 'Begin treatment with metoclopramide', 'E': 'Admit and begin intravenous rehydration'},
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B: Obtain a beta hCG and pelvic ultrasound
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Q:A 28-year-old man presents to the emergency department with lower extremity weakness. He was in his usual state of health until 10 days ago. He then began to notice his legs were “tiring out” during his workouts. This progressed to difficulty climbing the stairs to his apartment. He has asthma and uses albuterol as needed. He has no significant surgical or family history. He smokes marijuana daily but denies use of other recreational drugs. He is sexually active with his boyfriend of 2 years. He has never traveled outside of the country but was camping 3 weeks ago. He reports that he had diarrhea for several days after drinking unfiltered water from a nearby stream. On physical examination, he has 1/5 strength in his bilateral lower extremities. He uses his arms to get up from the chair. Achilles and patellar reflexes are absent. A lumbar puncture is performed, and results are as shown below: Cerebral spinal fluid: Color: Clear Pressure: 15 cm H2O Red blood cell count: 0 cells/µL Leukocyte count: 3 cells/ µL with lymphocytic predominance Glucose: 60 mg/dL Protein: 75 mg/dL A culture of the cerebral spinal fluid is pending. Which of the following is the part of the management for the patient’s most likely diagnosis?? {'A': 'Aspirin', 'B': 'Azithromycin', 'C': 'Doxycycline', 'D': 'Intravenous methylprenisolone', 'E': 'Plasmapheresis'},
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E: Plasmapheresis
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Q:A 72-year-old man is brought to the physician by his wife for forgetfulness, confusion, and mood changes for the past 4 months. His symptoms started with misplacing items such as his wallet and keys around the house. Two months ago, he became unable to manage their finances as it became too difficult for him. Last week, he became lost while returning home from the grocery store. His wife reports that he shows “no emotion” and that he is seemingly not concerned by his recent symptoms. He has hypertension, type 2 diabetes mellitus, and coronary artery disease. Current medications include aspirin, metoprolol, lisinopril, metformin, and rosuvastatin. His pulse is 56/min and blood pressure is 158/76 mm Hg. Neurologic examination shows loss of sensation on his right leg and an unsteady gait. When asked to stand with his eyes closed and palms facing upward, his right arm rotates inward. An MRI of the brain shows multiple deep white matter lesions. Which of the following is the most likely diagnosis?? {'A': 'Vascular dementia', 'B': 'Frontotemporal dementia', 'C': 'Alzheimer disease', 'D': 'Lewy body dementia', 'E': 'Vitamin B12 deficiency'},
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A: Vascular dementia
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Q:A medical student is studying digestive enzymes at the brush border of the duodenum. He isolates and inactivates an enzyme in the brush border that has a high affinity for the pancreatic proenzyme trypsinogen. When the enzyme is inactivated, trypsinogen is no longer converted to its active form. Which of the following is the most likely underlying mechanism of this enzyme?? {'A': 'Conjugation of ubiquitin to lysine residue', 'B': 'Phosphorylation of an amino acid side chain', 'C': 'Attachment of a carbohydrate to a side chain', 'D': 'Carboxylation of a glutamate residue', 'E': 'Cleavage of a propeptide from an N-terminus'},
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E: Cleavage of a propeptide from an N-terminus
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Q:A 5-year-old boy is brought to the emergency department by his grandmother because of difficulty breathing. Over the past two hours, the grandmother has noticed his voice getting progressively hoarser and occasionally muffled, with persistent drooling. He has not had a cough. The child recently immigrated from Africa, and the grandmother is unsure if his immunizations are up-to-date. He appears uncomfortable and is sitting up and leaning forward with his chin hyperextended. His temperature is 39.5°C (103.1°F), pulse is 110/min, and blood pressure is 90/70 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 95%. Pulmonary examination shows inspiratory stridor and scattered rhonchi throughout both lung fields, along with poor air movement. Which of the following is the most appropriate next step in management?? {'A': 'Nebulized albuterol', 'B': 'Intravenous administration of corticosteroids', 'C': 'Pharyngoscopy', 'D': 'Intravenous administration of antibiotics', 'E': 'Nasotracheal intubation'},
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E: Nasotracheal intubation
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Q:A 57-year-old man has worsening suprapubic discomfort 36 hours after undergoing a hemorrhoidectomy under spinal anesthesia. He reports that he has not urinated since the procedure. Examination shows a palpable bladder 4 cm above the symphysis pubis. He is treated with a drug that directly increases detrusor muscle tone. This patient is at increased risk for which of the following adverse effects of his treatment?? {'A': 'Constipation', 'B': 'Tachycardia', 'C': 'Muscle spasms', 'D': 'Diaphoresis', 'E': 'Mydriasis'},
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D: Diaphoresis
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Q:A 40-year-old woman presents with a lack of concentration at work for the last 3 months. She says that she has been working as a personal assistant to a manager at a corporate business company for the last 2 years. Upon asking why she is not able to concentrate, she answers that her colleagues are always gossiping about her during work hours and that it disrupts her concentration severely. Her husband works in the same company and denies these allegations. He says the other employees are busy doing their own work and have only formal conversations, yet she is convinced that they are talking about her. He further adds that his wife frequently believes that some advertisements in a newspaper are directed towards her and are published specifically to catch her attention even though they are routine advertisements. The patient denies any mood disturbances, anxiety or hallucinations. Past medical history is significant for a tingling sensation in her legs, 3+ patellar reflexes bilaterally, and absent ankle reflexes bilaterally. She says that she drinks alcohol once to twice a month for social reasons but denies any other substance use or smoking. On physical examination, the patient is conscious, alert, and oriented to time, place and person. A beefy red color of the tongue is noted. No associated cracking, bleeding, or oral lesions. Which of the following laboratory tests would be most helpful to identify this patient’s most likely diagnosis?? {'A': 'Serum ethanol level', 'B': 'Serum cobalamin level', 'C': 'Serum thiamine level', 'D': 'Serum thyroxine level', 'E': 'Serum folate level'},
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B: Serum cobalamin level
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Answer the following medical question with one of the provided options:
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Q:A 64-year-old man comes to the emergency department complaining of fatigue and abdominal distension. He has a remote history of intravenous drug use. Vital signs include a normal temperature, blood pressure of 120/80 mm Hg, and a pulse of 75/min. Physical examination reveals jaundice and a firm liver. Abdominal ultrasonography shows liver surface nodularity, moderate splenomegaly, and increased diameter of the portal vein. Complete blood count of the patient is shown: Hemoglobin 14 g/dL Mean corpuscular volume 90/μm3 Mean corpuscular hemoglobin 30 pg/cell Mean corpuscular hemoglobin concentration 34% Leukocyte count 7,000/mm3 Platelet count 50,000/mm3 Which of the following best represents the mechanism of low platelet count in this patient?? {'A': 'Bone marrow-based disorder', 'B': 'Platelet sequestration', 'C': 'Increased platelet clearance', 'D': 'Genetic disorder', 'E': 'Dilutional effect'},
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B: Platelet sequestration
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Q:A 7-year-old boy is brought into the emergency department after he was found at home by his mother possibly drinking bleach from under the sink. The child consumed an unknown amount and appears generally well. The child has an unremarkable past medical history and is not currently taking any medications. Physical exam reveals a normal cardiopulmonary and abdominal exam. Neurological exam is within normal limits and the patient is cooperative and scared. The parents state that the ingestion happened less than an hour ago. Which of the following is the best next step in management?? {'A': 'Close observation and outpatient endoscopy in 2 to 3 weeks', 'B': 'Induce emesis', 'C': 'Nasogastric tube', 'D': 'Titrate the alkali ingestion with a weak acid', 'E': 'Urgent endoscopy'},
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A: Close observation and outpatient endoscopy in 2 to 3 weeks
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Q:A 55-year-old man is discharged from the hospital after being treated for a ST-elevation myocardial infarction. The patient became hypotensive to 87/48 mmHg with a pulse of 130/min. He was properly resuscitated, and a cardiac catheterization with stent placement was performed. Upon being discharged, the patient was started on metoprolol, lisinopril, aspirin, atorvastatin, and nitroglycerin. Upon presentation to the patient’s primary care doctor today, his liver enzymes are elevated with an AST of 55 U/L and an ALT of 57 U/L. Which of the following is the most likely etiology of these laboratory abnormalities?? {'A': 'Atorvastatin', 'B': 'Ischemic hepatitis', 'C': 'Lisinopril', 'D': 'Metoprolol', 'E': 'Nitroglycerin'},
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A: Atorvastatin
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Q:A 16-year-old boy presents to his pediatrician because he has noticed white plaques forming on his tongue over the last 5 days. He recently returned from a boy scout trip where he traveled across the country and hiked through the woods. His past medical history is significant for asthma for which he uses an inhaler as needed. He says that during the trip he felt short of breath several times and had to use the inhaler. He also says that several of his friends appeared to get sick on the same trip and were coughing a lot. He has not experienced any other symptoms since returning from the trip. On presentation, he is found to have white plaques on the tongue that can be scraped off. Which of the following is a characteristic of the most likely cause of this patient's disease?? {'A': 'Acute angle branching', 'B': 'Broad-based budding', 'C': 'Germ tube formation', 'D': 'Latex agglutination', 'E': 'Virus'},
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C: Germ tube formation
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Q:A 45-year-old male is brought into the emergency room by emergency medical services due to a stab wound in the chest. The wound is located superior and medial to the left nipple. Upon entry, the patient appears alert and is conversational, but soon becomes confused and loses consciousness. The patient's blood pressure is 80/40 mmHg, pulse 110/min, respirations 26/min, and temperature 97.0 deg F (36.1 deg C). On exam, the patient has distended neck veins with distant heart sounds. What is the next best step to increase this patient's survival?? {'A': 'Intravenous fluids', 'B': 'Intravenous colloids', 'C': 'Heparin', 'D': 'Aspirin', 'E': 'Pericardiocentesis'},
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E: Pericardiocentesis
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Answer the following medical question with one of the provided options:
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Q:A 3-year-old boy is brought in by his mother because she is concerned that he has been “acting differently recently”. She says he no longer seems interested in playing with his friends from preschool, and she has noticed that he has stopped making eye contact with others. In addition, she says he flaps his hands when excited or angry and only seems to enjoy playing with objects that he can place in rows or rigid patterns. Despite these behaviors, he is meeting his language goals for his age (single word use). The patient has no significant past medical history. He is at the 90th percentile for height and weight for his age. He is afebrile and his vital signs are within normal limits. A physical examination is unremarkable. Which of the following is the most likely diagnosis in this patient?? {'A': 'Autism spectrum disorder', 'B': 'Asperger’s disorder', 'C': 'Rett’s disorder', 'D': 'Pervasive developmental disorder, not otherwise specified', 'E': 'Childhood disintegrative disorder'},
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A: Autism spectrum disorder
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Answer the following medical question with one of the provided options:
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Q:A 52 year-old woman comes to the physician because of intense retrosternal chest pain for the last three days. The pain is worse with breathing or coughing, and improves while sitting upright. She also reports a mild fever and shortness of breath. She was diagnosed with chronic kidney disease secondary to lupus nephritis 12 years ago and has been on hemodialysis since then, but she missed her last two appointments because of international travel. She also underwent a percutaneous coronary intervention eight months ago for a myocardial infarction. She takes azathioprine after hemodialysis. Her temperature is 37.8°C (100°F), pulse is 110/min, and blood pressure is 130/84 mm Hg. The lungs are clear to auscultation bilaterally with normal breath sounds. Cardiac examination reveals a high-pitched scratching that obscures both heart sounds. The remainder of the examination is otherwise unremarkable. Cardiac enzyme levels and anti-DNA antibodies are within normal limits. An x-ray of the chest shows no abnormalities. An ECG shows Q waves in the anterior leads. Which of the following is the most likely cause of these findings?? {'A': 'Low serum levels of thyroid hormone', 'B': 'Adverse effect of medication', 'C': 'Serositis from an immunologic reaction', 'D': 'Infarction of myocardial segment', 'E': 'Elevated serum levels of nitrogenous waste'},
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E: Elevated serum levels of nitrogenous waste
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Q:An 83-year-old man presents to the gastroenterologist to follow-up on results from a biopsy of a pancreatic head mass, which the clinician was concerned could be pancreatic cancer. After welcoming the patient and his wife to the clinic, the physician begins to discuss the testing and leads into delivering the results, which showed metastatic pancreatic adenocarcinoma. Before she is able to disclose these findings, the patient stops her and exclaims, "Whatever it is, I don't want to know. Please just make me comfortable in my last months alive. I have made up my mind about this." Which of the following is the most appropriate response on the part of the physician?? {'A': '"If that is your definite wish, then I must honor it"', 'B': '"As a physician, I am obligated to disclose these results to you"', 'C': '"If you don\'t know what condition you have, I will be unable to be your physician going forward"', 'D': '"The cancer has spread to your liver"', 'E': '"Please, sir, I strongly urge you to reconsider your decision"'},
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A: "If that is your definite wish, then I must honor it"
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Q:A 45-year-old woman has a history of mild epigastric pain, which seems to have gotten worse over the last month. Her pain is most severe several hours after a meal and is somewhat relieved with over-the-counter antacids. The patient denies abnormal tastes in her mouth or radiating pain. She does not take any other over-the-counter medications. She denies bleeding, anemia, or unexplained weight loss, and denies a family history of gastrointestinal malignancy. Which of the following is the best next step in the management of this patient?? {'A': 'Urease breath test', 'B': 'Empiric proton pump inhibitor therapy', 'C': 'Upper endoscopy with biopsy of gastric mucosa', 'D': 'Esophageal pH monitoring', 'E': 'Barium swallow'},
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A: Urease breath test
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Q:A 20-year-old girl presents to a physician following unprotected coitus with her boyfriend about 10 hours ago. She tells the doctor that although they usually use a barrier method of contraception, this time they forgot. She does not want to become pregnant. She also mentions that she has major depression and does not want to take an estrogen-containing pill. After necessary counseling, the physician prescribes an enteric-coated pill containing 1.5 mg of levonorgestrel. Which of the following is the primary mechanism of action of this drug?? {'A': 'Reduction in motility of cilia in the fallopian tubes', 'B': 'Mucosal hypertrophy and polyp formation in cervix', 'C': 'Atrophy of the endometrium', 'D': 'Delayed ovulation through inhibition of follicular development', 'E': 'Thickening of the cervical mucus'},
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D: Delayed ovulation through inhibition of follicular development
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Q:A 42-year-old man comes to his physician with a history of fever, non-bloody diarrhea, and headache for 10 days. He also complains of anorexia and abdominal pain. He returned from a trip to India 3 weeks ago. His temperature is 40.0°C (104.0°F), pulse is 65/min, respirations are 15/min, and blood pressure is 135/80 mm Hg. He has developed a blanchable rash on his chest and trunk. A photograph of the rash is shown. Examination of the heart, lungs, and abdomen show no abnormalities. Laboratory studies show: Hemoglobin 15 g/dL Mean corpuscular volume 95 μm3 White blood cell count 3400/mm3 Percent segmented neutrophils 40% Which of the following is the most likely diagnosis?? {'A': 'Dengue fever', 'B': 'Enteric fever', 'C': 'Leptospirosis', 'D': 'Malaria', 'E': 'Nontyphoidal salmonellosis'},
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B: Enteric fever
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Q:An otherwise healthy 25-year-old man comes to the physician because of a 3-month history of intermittent palpitations and worsening shortness of breath on exertion. He has not had chest pain or nocturnal dyspnea. The patient is 195 cm (6 ft 5 in) tall and weighs 70 kg (154 lbs); BMI is 18.4 kg/m2. His pulse is 110/min and blood pressure is 140/60 mm Hg. The lungs are clear to auscultation. Cardiac examination is shown. Which of the following is the most likely diagnosis?? {'A': 'Aortic regurgitation', 'B': 'Pulmonary regurgitation', 'C': 'Tricuspid stenosis', 'D': 'Aortic stenosis', 'E': 'Tricuspid regurgitation'},
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A: Aortic regurgitation
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Q:A 4-year-old boy is brought to the clinic by his mother with a history of fever for the past 3 days, yellow nasal discharge, and a severe earache in the right ear. He has no prior history of ear infections and is otherwise healthy. The physician suspects that the infectious agent is Streptococcus pneumoniae and prescribes the appropriate treatment. Which of the following is true about the mechanism of antigen processing in this example?? {'A': 'The pathway involved allows for recognition of extracellular antigens.', 'B': 'The antigen degradation occurs via the proteosome.', 'C': 'The antigen is directly bound to the MHC I.', 'D': 'The target cell involved is a CD8+ T cell.', 'E': 'The pathway involved allows for recognition of intracellular antigens.'},
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A: The pathway involved allows for recognition of extracellular antigens.
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Q:A 39-year-old woman is brought to the emergency room by her husband because of severe dyspnea and dizziness. Her symptoms started suddenly 30 minutes ago. She appears distressed. Arterial blood gas shows a pH of 7.51, pO2 of 100 mm Hg, and a pCO2 of 30 mm Hg. Which of the following is the most likely cause?? {'A': 'Panic attack', 'B': 'Opioid toxicity', 'C': 'Myasthenia gravis', 'D': 'Epiglottitis', 'E': 'Pulmonary fibrosis'},
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A: Panic attack
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Q:A 43-year-old man is brought to the emergency department 30 minutes after falling from the roof of a construction site. He reports abdominal and right-sided flank pain. His temperature is 37.1°C (98.8°F), pulse is 114/min, and blood pressure is 100/68 mm Hg. Physical examination shows numerous ecchymoses over the trunk and flanks and a tender right abdomen without a palpable mass. Focused assessment with sonography for trauma (FAST) shows no intraperitoneal fluid collections. His hemoglobin concentration is 7.6 g/dL. The most likely cause of his presentation is injury to which of the following organs?? {'A': 'Liver', 'B': 'Spleen', 'C': 'Kidney', 'D': 'Stomach', 'E': 'Small bowel'},
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C: Kidney
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Q:A 34-year-old female medical professional who works for a non-governmental organization visits her primary care provider for a routine health check-up. She made a recent trip to Sub-Saharan Africa where she participated in a humanitarian medical project. Her medical history and physical examination are unremarkable. A chest radiograph and a tuberculin skin test (PPD) are ordered. The chest radiograph is performed at the side and the PPD reaction measures 12 mm after 72 hours. Which of the following mechanisms is involved in the skin test reaction?? {'A': 'Formation of immune complexes', 'B': 'Opsonization', 'C': 'Complement activation', 'D': 'Th1-mediated cytotoxicity', 'E': 'IgE cross-linking'},
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D: Th1-mediated cytotoxicity
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Q:A 2-day-old newborn male delivered at 38 weeks' gestation is evaluated for poor feeding and irritability. His temperature is 35°C (95°F), pulse is 168/min, respirations are 80/min, and blood pressure is 60/30 mm Hg. Blood culture on sheep agar grows motile, gram-positive bacteria surrounded by a narrow clear zone. Further testing confirms the presence of a pore-forming toxin. Which of the following is the most important factor in successful clearance of the causal pathogen?? {'A': 'Secretion of interferon-α from infected cells', 'B': 'Formation of the membrane attack complex', 'C': 'Interferon-γ-induced macrophage activation', 'D': 'Secretion of interleukin 10 by regulatory T cells', 'E': 'Secretion of immunoglobulin G from plasma cells'},
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C: Interferon-γ-induced macrophage activation
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Q:A 25-year-old woman presents to the emergency department with sudden onset of lower limb weakness for the past 2 days. She says she also hasn’t been able to urinate for that same period. There is no history of trauma, fever, weight loss, recent respiratory tract infection, or diarrhea. She has a past medical history of left arm weakness 18 months ago that resolved spontaneously. Her father had type 2 diabetes mellitus, ischemic heart disease, and left-sided residual weakness secondary to an ischemic stroke involving the right middle cerebral artery. Her vital signs include: blood pressure 120/89 mm Hg, temperature 36.7°C (98.0°F), pulse 78/min, and respiration rate 16/min. Muscle strength is 3/5 in both lower limbs with increased tone and exaggerated deep tendon reflexes. The sensation is decreased up to the level of the umbilicus. Muscle strength, tone, and deep tendon reflexes in the upper limbs are normal. On flexion of the neck, the patient experiences electric shock-like sensations that travel down to the spine. Funduscopic examination reveals mildly swollen optic discs bilaterally. Which of the following is the next best step in management for this patient?? {'A': 'Interferon beta', 'B': 'Intravenous immunoglobulin', 'C': 'Intravenous methylprednisolone', 'D': 'Plasmapheresis', 'E': 'Riluzole'},
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C: Intravenous methylprednisolone
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Q:A 37-year-old man is brought to the emergency department because he was found down on a city sidewalk. Upon presentation he is found to be disheveled with multiple poorly healed wounds on his hands and feet. He has had dozens of previous presentations for alcohol intoxication and is currently known to be homeless. Physical examination reveals multiple minor wounds, alopecia, and decreased axillary hair. Upon being aroused, the patient reveals that he has had difficulty with taste and smell and has also had severe diarrhea over the last week. The deficient substance most likely responsible for this patient's symptoms is associated with which of the following proteins?? {'A': 'Hemoglobin', 'B': 'Glutathione peroxidase', 'C': 'RNA polymerase', 'D': 'Thyroid hormone', 'E': 'Tyrosinase'},
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C: RNA polymerase
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Q:A 31-year-old woman presents to the emergency department with a history of fever and vomiting for 2 days and severe headache for a day. Past medical history is significant for migraine diagnosed 10 years ago, but she reports that her current headache is different. She describes the pain as generalized, dull, continuous, severe in intensity, and exacerbated by head movements. Physical examination reveals a blood pressure of 110/76 mm Hg and a temperature of 39.1°C (102.4°F). The patient is awake but in great distress due to pain. A pink-purple petechial rash covers her chest and legs. Extraocular movements are normal. She complains of neck pain and asks you to turn off the lights. Muscle strength is normal in all 4 limbs. Fundoscopic examination is normal. Baseline laboratory investigations are shown: Laboratory test Sodium 145 mEq/L Potassium 3.2 mEq/L Glucose 87 mg/dL Creatinine 1.0 mg/dL White blood cell count 18,900/mm3 Hemoglobin 13.4 g/dL Platelets 165,000/mm3 INR 1.1 Aerobic and anaerobic blood cultures are taken and empiric antibiotics are started. A lumbar puncture is performed. Which of the following cerebrospinal fluid (CSF) findings are expected in this patient?? {'A': 'CSF: WBC 4 cells/mm3, protein 35 mg/dL, glucose 66 mg/dL', 'B': 'CSF: WBC 8,500 cells/mm3, neutrophil predominant, protein 112 mg/dL, glucose 15 mg/dL', 'C': 'CSF: WBC 145 cells/mm3, lymphocytic predominant, protein 42 mg/dL, glucose 60 mg/dL', 'D': 'CSF: WBC 640 cells/mm3, lymphocytic predominant, protein 180 mg/dL, glucose 24 mg/dL', 'E': 'CSF: WBC 2 cells/mm3, protein 142 mg/dL, glucose 70 mg/dL'},
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B: CSF: WBC 8,500 cells/mm3, neutrophil predominant, protein 112 mg/dL, glucose 15 mg/dL
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Q:A 48-year-old man is being evaluated for an acquired defect of the myeloid stem cell line with a mutation in the PIG-A gene. His diagnosis was first suspected due to anemia and recurrent pink-tinged urine. Which of the markers will be negative in the flow cytometry test for his condition?? {'A': 'CD19', 'B': 'CD18', 'C': 'CD40L', 'D': 'CD55', 'E': 'CD3'},
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D: CD55
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Q:A team of epidemiologists is investigating an outbreak of hemolytic uremic syndrome (HUS) caused by Shiga toxin-producing E. coli O104:H4. In Europe, multiple episodes of illness were reported in May 2017 within a large extended family of 16 family members, who all attended a family reunion in late April where they ate sprouts contaminated with E. coli. In the ensuing weeks, multiple family members were admitted to local hospitals for treatment of HUS. A graph depicting the course of the disease is shown. Each row represents a patient. The gray bars represent the duration of the disease. Based on the graph, which of the following is the attack rate among the individuals at risk in the month of May?? {'A': '6/15', 'B': '6/8', 'C': '7/8', 'D': '5/8', 'E': '7/16'},
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A: 6/15
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Q:A 25-year-old man is brought to the emergency department 6 hours after rescuing babies and puppies from a burning daycare center. He says that he has a severe headache, feels nauseous and dizzy. He is tachypneic. An arterial blood gas shows pH 7.3, PaCO2 49 mmHg, PaO2 80 mmHg. Serum lactate level is 6 mmol/L. What biochemical process explains these laboratory values?? {'A': 'High pyruvate dehydrogenase activity', 'B': 'Low pyruvate dehydrogenase activity', 'C': 'Low lactate dehydrogenase activity', 'D': 'Increased oxidation of NADH', 'E': 'Increased decarboxylation of pyruvate'},
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B: Low pyruvate dehydrogenase activity
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Q:A 49-year-old woman with a history of hepatitis C cirrhosis complicated by esophageal varices, ascites, and hepatic encephalopathy presents with 1 week of increasing abdominal discomfort. Currently, she takes lactulose, rifaximin, furosemide, and spironolactone. On physical examination, she has mild asterixis, generalized jaundice, and a distended abdomen with positive fluid wave. Diagnostic paracentesis yields a WBC count of 1196/uL with 85% neutrophils. Which of the following is the most appropriate treatment?? {'A': 'Large volume paracentesis with albumin', 'B': 'Increased furosemide and spironolactone', 'C': 'Transjugular intrahepatic portosystemic shunt placement', 'D': 'Cefotaxime', 'E': 'Metronidazole'},
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D: Cefotaxime
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Q:A 7-year-old girl is brought to the physician by her parents for the evaluation of pubic hair development. She has a history of a fracture in each leg and one fracture in her right arm. Her performance at school is good. There is no family history of serious illness. She takes no medications. Vital signs are within normal limits. Genital examination shows coarse, dark hair along the labia. The breast glands are enlarged and the breast bud extends beyond the areolar diameter. There are several hyperpigmented macules with rough, serpiginous borders of different sizes on the lower and upper extremities. The remainder of the examination shows no abnormalities. Which of the following is the most likely diagnosis?? {'A': 'Osteogenesis imperfecta', 'B': 'McCune-Albright syndrome', 'C': 'Neurofibromatosis type I', 'D': 'Congenital adrenal hyperplasia', 'E': 'Tuberous sclerosis'},
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B: McCune-Albright syndrome
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Q:A 63-year-old man with aortic valve disease is admitted to the hospital for a 3-week history of progressively worsening fatigue, fever, and night sweats. He does not smoke, drink alcohol, or use illicit drugs. Temperature is 38.2°C (100.8°F). Physical examination shows a systolic murmur and tender, erythematous nodules on the finger pads. Blood cultures show alpha-hemolytic, gram-positive cocci that are catalase-negative and optochin-resistant. Which of the following is the most likely causal organism?? {'A': 'Streptococcus pyogenes', 'B': 'Streptococcus gallolyticus', 'C': 'Streptococcus pneumonia', 'D': 'Staphylococcus epidermidis', 'E': 'Viridans streptococci'},
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E: Viridans streptococci
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Q:A 23-year-old woman presents to the emergency department after being found unresponsive by her friends. The patient is an IV drug user and her friends came over and found her passed out in her room. The patient presented to the emergency department 2 days ago after being involved in a bar fight where she broke her nose and had it treated and packed with gauze. Her temperature is 99.3°F (37.4°C), blood pressure is 90/48 mmHg, pulse is 150/min, respirations are 24/min, and oxygen saturation is 97% on room air. Physical exam is notable for an obtunded woman with nasal packing and EKG tags from her last hospital stay, as well as a purpuric rash on her arms and legs. Her arms have track marks on them and blisters. Which of the following is the best next step in management?? {'A': 'Nafcillin', 'B': 'Norepinephrine', 'C': 'Removal of nasal packing', 'D': 'Urine toxicology screen and empiric naloxone', 'E': 'Vancomycin'},
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C: Removal of nasal packing
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Q:A 25-year-old woman presents to her primary care physician with a chief complaint of diffuse muscle aches and pains. She states that she has trouble doing everyday tasks such as showering, cooking, and cleaning due to the pain. The patient has a past medical history of anxiety and bulimia nervosa and is currently not taking any medications. Upon further questioning, the patient states that her symptoms started last week when her boyfriend left her for another individual. The patient was quite upset, as she states she always had tended to all his needs and never argued with him. Since he has left, she has been unable to decide what she should do with herself during the day. The patient has been living with her mother for the past day and states that has helped greatly, as her mother helps her plan her days and gives her chores to do. Regardless, the patient states that her pain persists. The physician sets up a referral for the patient to work with a psychiatrist. Upon hearing this, the patient becomes visually bothered and questions if the physician is actually trying to help her. Which of the following personality disorder does this patient most likely suffer from?? {'A': 'Avoidant', 'B': 'Dependent', 'C': 'Borderline', 'D': 'Histrionic', 'E': 'Paranoid'},
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B: Dependent
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Q:A 22-year-old man presents with a history of lightheadedness, weakness, and palpitations when he assumes an upright position from a supine position. He is otherwise a healthy man without a history of alcohol or other substance abuse. His supine and standing blood pressures (measured at 3-minute intervals) were 124/82 mm Hg and 102/72 mm Hg, respectively. He was advised to perform a Valsalva maneuver while monitoring blood pressure and heart rate to assess the integrity of his baroreflex control. Which of the following statements is correct?? {'A': 'Phases III and IV are mediated by baroreceptor reflexes that require intact efferent parasympathetic responses', 'B': 'During late phase II, there is an increase in both blood pressure and heart rate', 'C': 'During early phase II, there is an increase in blood pressure and a decrease in heart rate', 'D': 'During phase I, the blood pressure decreases due to increased intrathoracic pressure', 'E': 'The Valsalva ratio is defined as the maximum phase II bradycardia divided by the minimum phase IV tachycardia'},
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B: During late phase II, there is an increase in both blood pressure and heart rate
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Q:A tall, slender 32-year-old man comes to the emergency room because of sudden chest pain, cough, and shortness of breath. On physical examination, he has decreased breath sounds on the right. Chest radiography shows translucency on the right side of his chest. His pCO2 is elevated and pO2 is decreased. What is the most likely cause of his symptoms?? {'A': 'Chronic obstructive pulmonary disease', 'B': 'Asthma', 'C': 'Pneumonia', 'D': 'Tension pneumothorax', 'E': 'Spontaneous pneumothorax'},
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E: Spontaneous pneumothorax
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Answer the following medical question with one of the provided options:
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Q:A 63-year-old woman presents with dyspnea on exertion. She reports that she used to work in her garden without any symptoms, but recently she started to note dyspnea and fatigue after working for 20–30 minutes. She has type 2 diabetes mellitus diagnosed 2 years ago but she does not take any medications preferring natural remedies. She also has arterial hypertension and takes torsemide 20 mg daily. The weight is 88 kg and the height is 164 cm. The vital signs include: blood pressure is 140/85 mm Hg, heart rate is 90/min, respiratory rate is 14/min, and the temperature is 36.6℃ (97.9℉). Physical examination is remarkable for increased adiposity, pitting pedal edema, and present S3. Echocardiography shows a left ventricular ejection fraction of 51%. The combination of which of the following medications would be a proper addition to the patient’s therapy?? {'A': 'Metoprolol and indapamide', 'B': 'Spironolactone and fosinopril', 'C': 'Enalapril and bisoprolol', 'D': 'Indapamide and amlodipine', 'E': 'Valsartan and spironolactone'},
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C: Enalapril and bisoprolol
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Q:A 77-year-old woman with congestive heart failure is admitted to the hospital for evaluation prior to cardiac transplantation. During her stay at the hospital, the physician prescribes a drug to improve cardiac contractility. The drug works by selectively inhibiting an isoenzyme that is responsible for the degradation of cyclic adenosine monophosphate. Which of the following is the most likely adverse effect of this drug?? {'A': 'QT interval prolongation', 'B': 'Hyperkalemia', 'C': 'Hypotension', 'D': 'Hyperglycemia', 'E': 'Bronchospasm'},
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C: Hypotension
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Q:A 24-year-old woman comes to her physician because of fatigue. She has been coming to the office multiple times a month for various minor problems over the past six months. During the appointments, she insists on a first name basis and flirts with her physician. She always dresses very fashionably. When his assistant enters the room, she tends to start fidgeting and interrupt their conversation. When the physician tells her politely that her behavior is inappropriate, she begins to cry, complaining that no one understands her and that if people only listened to her, she would not be so exhausted. She then quickly gathers herself and states that she will just have to keep looking for a physician who can help her, although she has doubts she will ever find the right physician. She does not have a history of self harm or suicidal ideation. Which of the following is the most likely diagnosis?? {'A': 'Schizoid personality disorder', 'B': 'Dependent personality disorder', 'C': 'Histrionic personality disorder', 'D': 'Borderline personality disorder', 'E': 'Schizotypal personality disorder'},
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C: Histrionic personality disorder
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Answer the following medical question with one of the provided options:
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Q:A 59-year-old man comes to the physician for evaluation of progressively worsening back pain that began about 2 months ago. It started as a dull pain that has now developed into a constant throbbing pain that makes falling asleep difficult. Ibuprofen and acetaminophen do not provide relief. The patient has not had any bowel incontinence, limb weakness, or paresthesias. He has metastatic prostate cancer with known metastasis to the sacrum and left ilium, but has had minimal pain related to these sites. He underwent bilateral orchiectomy two years ago, complicated by urinary incontinence. He currently takes no medications. Vital signs are within normal limits. There is midline tenderness to palpation over the lower lumbar spine. MRI scan of the spine shows a new sclerotic lesion at the L5 vertebral body. Which of the following is the most appropriate next step in management?? {'A': 'Flutamide', 'B': 'Spinal surgery', 'C': 'Prostatectomy', 'D': 'Local radiation', 'E': 'Denosumab'},
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D: Local radiation
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Q:A 62-year-old man comes to the physician because of fatigue and swelling of the lower legs for 3 weeks. One year ago, he had an 85% stenosis in the left anterior descending artery, for which he received 2 stents. He was diagnosed with hepatitis C 5 years ago. He has type 2 diabetes mellitus and arterial hypertension. Current medications include aspirin, metformin, and ramipril. He does not smoke or drink alcohol. His temperature is 37°C (98.6°F), pulse is 92/min, and blood pressure is 142/95 mm Hg. Examination shows 2+ pretibial edema bilaterally. The remainder of the examination shows no abnormalities. Laboratory studies show: Hemoglobin 10.2 g/dL Leukocyte count 6500/mm3 Platelet count 188,000/mm3 Serum Na+ 137 mEq/L Cl− 105 mEq/L K+ 5.2 mEq/L Urea nitrogen 60 mg/dL Glucose 110 mg/dL Creatinine 3.9 mg/dL Albumin 3.6 mg/dL HbA1C 6.8% Urine Blood negative Glucose 1+ Protein 3+ WBC 0–1/hpf A renal biopsy shows sclerosis in the capillary tufts and arterial hyalinosis. Which of the following is the most likely underlying mechanism of this patient's findings?"? {'A': 'Diabetes mellitus', 'B': 'Amyloidosis', 'C': 'Arterial hypertension', 'D': 'Membranous nephropathy', 'E': 'Membranoproliferative glomerulonephritis'},
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C: Arterial hypertension
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Answer the following medical question with one of the provided options:
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Q:A 17-year-old girl comes to the physician because of a 1-week history of severe itching in the area of her genitals. She reports that the itching is most severe at night. She has been sexually active with three partners over the past year; she uses condoms for contraception. Her current sexual partner is experiencing similar symptoms. Pelvic examination shows vulvar excoriations. A photomicrograph of an epilated pubic hair is shown. Which of the following is the most likely causal organism?? {'A': 'Phthirus pubis', 'B': 'Pediculus humanus', 'C': 'Enterobius vermicularis', 'D': 'Epidermophyton floccosum', 'E': 'Sarcoptes scabiei'},
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A: Phthirus pubis
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Answer the following medical question with one of the provided options:
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Q:An 15-year-old boy is brought to the emergency department after he passed out in the hallway. On presentation, he is alert but confused about why he is in the hospital. He says that he remembers seeing flashes of light to his right while walking out of class but cannot recall what happened next. His next memory is being woken up by emergency responders who wheeled him into an ambulance. A friend who was with him at the time says that he seemed to be swallowing repeatedly and staring out into space. He has never had an episode like this before, and his past medical history is unremarkable. Which of the following characteristics is most likely true of the cause of this patient's symptoms?? {'A': 'Begins with 10-15 seconds of muscle contraction', 'B': 'Demonstrates quick and repetitive jerks of extremities', 'C': 'Episodes with 3-4 hertz spike and wave discharges', 'D': 'Isolated to the left occipital lobe', 'E': 'Starts in the left occipital lobe and then generalizes'},
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E: Starts in the left occipital lobe and then generalizes
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Answer the following medical question with one of the provided options:
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Q:A clinical study is performed to examine the effect of smoking on the development of pulmonary hypertension (PAH) in a sample of 40-year-old women. A group of 1,000 matched healthy subjects (500 controls; 500 smokers) were monitored for the development of (PAH) from enrollment to death. The data from the study are shown in the table below: Group\PAH Yes No Smokers 35 465 Controls 20 480 Which of the following is correct regarding the risk of developing PAH from this study?? {'A': 'The absolute risk of developing PAH in smokers versus controls is 1.75.', 'B': 'The lifetime absolute risk of developing PAH in healthy nonsmoking women is 5.5%.', 'C': 'The increase in the absolute risk of developing PAH by quitting smoking is 75%.', 'D': 'The lifetime absolute risk increase of developing PAH in female smokers is 3%.', 'E': 'The lifetime absolute risk of developing PAH in healthy non-smoking women is 3%.'},
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D: The lifetime absolute risk increase of developing PAH in female smokers is 3%.
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Answer the following medical question with one of the provided options:
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Q:A 41-year-old man with a history of hypertension and hyperlipidemia is brought to the emergency department by his wife for difficulty breathing after choking on food at dinner. He is unconscious and pulseless on arrival. Despite appropriate life-saving measures, he dies. Examination of the heart shows a necrotic, pale yellow plaque in the left circumflex artery. Similar lesions are most likely to be found in which of the following locations?? {'A': 'Superficial temporal artery', 'B': 'Abdominal aorta', 'C': 'Thoracic aorta', 'D': 'Internal carotid artery', 'E': 'Pulmonary artery'},
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B: Abdominal aorta
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Answer the following medical question with one of the provided options:
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Q:A 6-month-old girl is brought to the emergency department by her father after he observed jerking movements of her arms and legs earlier in the day. She appears lethargic. Physical examination shows generalized hypotonia. The liver edge is palpable 3 cm below the right costophrenic angle. Her fingerstick glucose shows hypoglycemia. Serum levels of acetone, acetoacetate, and β-hydroxybutyrate are undetectable. Molecular genetic testing shows a mutation in the carnitine palmitoyltransferase II gene. This patient will most likely benefit from supplementation with which of the following?? {'A': 'Coenzyme A', 'B': 'Tetrahydrobiopterin', 'C': 'Medium-chain triglycerides', 'D': 'Thiamine', 'E': 'Methionine'},
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C: Medium-chain triglycerides
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Q:A 45-year-old male reports several years of asbestos exposure while working in the construction industry. He reports smoking 2 packs of cigarettes per day for over 20 years. Smoking and asbestos exposure increase the incidence of which of the following diseases?? {'A': 'Chronic bronchitis', 'B': 'Emphysema', 'C': 'Multiple myeloma', 'D': 'Malignant pulmonary mesothelioma', 'E': 'Bronchogenic carcinoma'},
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E: Bronchogenic carcinoma
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Answer the following medical question with one of the provided options:
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Q:A 19-year-old woman presents for a sports physical. She says he feels healthy and has no concerns. Past medical history is significant for depression and seasonal allergies. Current medications are fluoxetine and oral estrogen/progesterone contraceptive pills. Family history is significant for a sister with polycystic ovarian syndrome (PCOS). The patient denies current or past use of alcohol, recreational drugs, or smoking. She reports that she has been on oral birth control pills since age 14 and uses condoms inconsistently. No history of STDs. She is sexually active with her current boyfriend, who was treated for chlamydia 2 years ago. She received and completed the HPV vaccination series starting at age 11. Her vital signs include: temperature 36.8°C (98.2°F), pulse 97/min, respiratory rate 16/min, blood pressure 120/75 mm Hg. Physical examination is unremarkable. Which of the following are the recommended guidelines for cervical cancer screening for this patient at this time?? {'A': 'Cytology (pap smear) annually', 'B': 'Cytology (pap smear) every 3 years', 'C': 'Cytology (pap smear) and HPV DNA co-testing every 5 years', 'D': 'No cervical cancer screening is indicated at this time', 'E': 'Cytology (pap smear) and HPV DNA co-testing every 3 years'},
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D: No cervical cancer screening is indicated at this time
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