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Answer the following medical question with one of the provided options:
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Q:A 25-year-old man presents to his primary care provider complaining of scrotal swelling. He is a college student and plays basketball with his friends regularly. Two days ago, he sustained an injury close to his thigh. He does not have any significant past medical history. Today, his vitals are normal. A focused scrotal examination reveals a firm painless lump on the right testicle which is irregular and small. Ultrasound of the scrotum reveals a vascular 0.6 x 0.5 cm testicular mass. A pelvic lymph node exam is negative. He undergoes a radical orchiectomy and subsequent histopathological examination reveals sheets of small cuboidal cells, multinucleated cells, and large eosinophilic cells with pleomorphic nuclei consistent with choriocarcinoma. Which of the following tumor marker is most likely elevated in this patient?? {'A': 'Carcinoembryonic antigen', 'B': 'Beta-human chorionic gonadotropin', 'C': 'Prostate-specific antigen', 'D': 'Placental alkaline phosphatase', 'E': 'Testosterone'},
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B: Beta-human chorionic gonadotropin
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Answer the following medical question with one of the provided options:
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Q:A 7-year-old boy presents to his primary care physician for a general checkup. The patient has been feeling poorly for the past several weeks and has been losing weight. He states that he often feels weak and too tired to play with his friends. He is no longer interested in many recreational activities he used to be interested in. The patient's parents state that a few of their child's friends have been sick lately. His temperature is 102°F (38.9°C), blood pressure is 77/48 mmHg, pulse is 110/min, respirations are 24/min, and oxygen saturation is 98% on room air. On exam, you note a fatigued appearing child who has lost 10 pounds since his last appointment. Left upper quadrant tenderness and a mass is noted on abdominal exam. Which of the following best describes the most likely diagnosis?? {'A': 'Auer rods on peripheral smear', 'B': 'Infection sensitive to oseltamivir', 'C': 'Parental mistreatment of the child', 'D': 'Smudge cells on peripheral smear', 'E': 'TdT positive cells'},
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E: TdT positive cells
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Answer the following medical question with one of the provided options:
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Q:A 27-year-old woman is admitted to the emergency room with dyspnea which began after swimming and progressed gradually over the last 3 days. She denies cough, chest pain, or other respiratory symptoms. She reports that for the past 4 months, she has had several dyspneic episodes that occurred after the exercising and progressed at rest, but none of these were as long as the current one. Also, she notes that her tongue becomes ‘wadded’ when she speaks and she tires very quickly during the day. The patient’s vital signs are as follows: blood pressure 125/60 mm Hg, heart rate 92/min, respiratory rate 34/min, and body temperature 36.2℃ (97.2℉). Blood saturation on room air is initially 92% but falls to 90% as she speaks up. On physical examination, the patient is slightly lethargic. Her breathing is rapid and shallow. Lung auscultation, as well as cardiac, and abdominal examinations show no remarkable findings. Neurological examination reveals slight bilateral ptosis increased by repetitive blinking, and easy fatigability of muscles on repeated movement worse on the face and distal muscles of the upper and lower extremities. Which arterial blood gas parameters would you expect to see in this patient?? {'A': 'PaCO2 = 34 mm Hg, PaO2 = 61 mm Hg', 'B': 'PaCO2 = 43 mm Hg, PaO2 = 55 mm Hg', 'C': 'PaCO2 = 31 mm Hg, PaO2 = 67 mm Hg', 'D': 'PaCO2 = 51 mm Hg, PaO2 = 58 mm Hg', 'E': 'PaCO2 = 37 mm Hg, PaO2= 46 mm Hg'},
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D: PaCO2 = 51 mm Hg, PaO2 = 58 mm Hg
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Answer the following medical question with one of the provided options:
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Q:A 47-year-old woman presents to her primary care physician because of pain on urination, urinary urgency, and urinary frequency for 4 days. This is the third time for her to have these symptoms over the past 7 months. She was recently treated for candidal intertrigo. Vital signs reveal a temperature of 36.7°C (98.0°F), blood pressure of 110/70 mm Hg and pulse of 75/min. Physical examination is unremarkable except for morbid obesity. Her father has type 2 diabetes complicated by end-stage chronic kidney disease. A1C is found to be 8.5%. The patient is given a prescription for her urinary symptoms. Which of the following is the best next step for this patient?? {'A': 'Metformin', 'B': 'Sulphonylurea added to metformin', 'C': 'Basal-bolus insulin', 'D': 'Repeating the A1c test', 'E': 'Bariatric surgery'},
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D: Repeating the A1c test
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Answer the following medical question with one of the provided options:
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Q:A 6-year-old boy presents to the pediatrician with his parents. He fully vaccinated and met most developmental milestones. His fine motor milestones are delayed; at present, he cannot eat by himself and has difficulty in self-dressing. His intelligence quotient (IQ) is 65. He listens quietly while spoken to and engages in play with his classmates. He neither talks excessively nor remains mute, but engages in normal social conversation. There is no history of seizures and he is not on any long-term medical treatment. On his physical examination, his vital signs are stable. His height and weight are normal for his age and sex, but his occipitofrontal circumference is less than the 3rd percentile for his age and sex. His neurologic examination is also normal. Which of the following is the most likely diagnosis?? {'A': 'Autism', 'B': 'Tic disorder', 'C': 'Attention deficit hyperactivity disorder', 'D': 'Intellectual disability', 'E': 'Obsessive-compulsive disorder'},
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D: Intellectual disability
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Answer the following medical question with one of the provided options:
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Q:A 37-year-old woman presents to the Emergency Department after 8 hours of left sided flank pain that radiates to her groin and pelvic pain while urinating. Her medical history is relevant for multiple episodes of urinary tract infections, some requiring hospitalization, and intravenous antibiotics. In the hospital, her blood pressure is 125/83 mm Hg, pulse of 88/min, a respiratory rate of 28/min, and a body temperature of 36.5°C (97.7°F). On physical examination, she has left costovertebral tenderness and lower abdominal pain. Laboratory studies include a negative pregnancy test, mild azotemia, and a urinary dipstick that is positive for blood. Which of the following initial tests would be most useful in the diagnosis of this case?? {'A': 'Fractional excretion of sodium (FeNa+)', 'B': 'Renal ultrasonography', 'C': 'Contrast abdominal computed tomography', 'D': 'Urine osmolality', 'E': 'Blood urea nitrogen (BUN): serum creatinine (SCr) ratio'},
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B: Renal ultrasonography
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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 from India visits his physician complaining of worsening respiratory symptoms. He states that he was diagnosed with emphysema 4 years ago and that, over the past several months, he has developed a chronic productive cough, dyspnea, fatigue, unexplained weight loss, and night sweats. He notes that he also has other complaints aside from his lung problems, including sharp, intermittent chest pain and joint pain in his elbows and knees. There is also an erythematous rash on both the lower extremities that features raised lesions; it is determined to be erythema nodosum. Cardiac examination reveals a friction rub, and a computed tomography (CT) scan of the chest reveals cavitation of both lung apices. The patient is isolated for the suspicion of active tuberculosis (TB) infection. A purified protein derivative (PPD) test is negative. Sputum sample staining fails to reveal acid-fast bacilli, but it does reveal yeast forms that are replicating by narrow-based budding. Which of the following would aid in making a correct diagnosis in this patient?? {'A': 'Urine histoplasma antigen', 'B': 'Fungal blood cultures', 'C': 'India ink stain of sputum', 'D': 'Coccidioidomycosis serology', 'E': 'HIV antibody screening'},
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A: Urine histoplasma antigen
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Answer the following medical question with one of the provided options:
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Q:A 45-year-old African American woman presents to her primary care physician for not feeling well. She states she has had a cough for the past week. In addition, she also has abdominal pain and trouble focusing that has been worsening. She states that she has also lost 5 pounds recently and that her gastroesophageal reflux disease (GERD) has been very poorly controlled recently. The patient is a non-smoker and has a history of GERD for which she takes antacids. Laboratory studies are ordered and are below: Serum: Na+: 139 mEq/L K+: 4.1 mEq/L Cl-: 101 mEq/L HCO3-: 24 mEq/L Urea nitrogen: 12 mg/dL Glucose: 70 mg/dL Creatinine: 0.9 mg/dL Ca2+: 12.5 mg/dL Alkaline phosphatase: 35 U/L Phosphorus: 2.0 mg/dL Urine: Color: amber Nitrites: negative Sodium: 5 mmol/24 hours Red blood cells: 0/hpf Which of the following is the most likely explanation of this patient's current presentation?? {'A': 'Increased parathyroid hormone (PTH)', 'B': 'Increased 1,25-dihydroxyvitamin D', 'C': 'Malignancy', 'D': 'Antacid overuse', 'E': 'Viral illness'},
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A: Increased parathyroid hormone (PTH)
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Answer the following medical question with one of the provided options:
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Q:A 6-month-old boy is brought to the emergency department because of fever, fast breathing, and difficulty feeding for 2 days. His mother reports that he has had recurrent pneumonia and has been hospitalized for severe dehydration secondary to acute gastroenteritis caused by rotavirus infection three times in the past 4 months. He is at the 3rd percentile for both height and weight. Examination shows a generalized, erythematous, scaly rash and white patches on the tongue and buccal mucosa that bleed when scraped. The remainder of the examination shows no abnormalities. An x-ray of the chest shows bilateral interstitial infiltrates and an absent thymic shadow. Which of the following is the most likely cause of this patient's condition?? {'A': 'Chromosome 22q11.2 microdeletion', 'B': 'Integrin beta-2 defect', 'C': 'Microtubular dysfunction', 'D': 'WAS gene mutation', 'E': 'IL-2 receptor gamma chain defect'},
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E: IL-2 receptor gamma chain defect
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Answer the following medical question with one of the provided options:
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Q:A 67-year-old woman who was diagnosed with cancer 2 months ago presents to her oncologist with a 6-day history of numbness and tingling in her hands and feet. She is concerned that these symptoms may be related to progression of her cancer even though she has been faithfully following her chemotherapy regimen. She is not currently taking any other medications and has never previously experienced these symptoms. On physical exam, she is found to have decreased sensation to pinprick and fine touch over hands, wrists, ankles, and feet. Furthermore, she is found to have decreased reflexes throughout. Her oncologist assures her that these symptoms are a side effect from her chemotherapy regimen rather than progression of the cancer. The drug most likely responsible for her symptoms has which of the following mechanisms?? {'A': 'Alkylation of DNA', 'B': 'DNA strand breaking', 'C': 'Inhibit folate metabolism', 'D': 'Inhibit microtubule formation', 'E': 'Prevention of nucleotide synthesis'},
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D: Inhibit microtubule formation
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Answer the following medical question with one of the provided options:
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Q:A 24-year-old female comes to the physician because of flu-like symptoms and a new rash for 2 days. She denies contacts with sick individuals or recent travel abroad, but recently went camping in Vermont. Vital signs are within normal limits. Examination of the lateral right thigh shows a circular red ring with central clearing. Which of the following is the natural reservoir of the pathogen responsible for this patient's symptoms?? {'A': 'Rat', 'B': 'Mouse', 'C': 'Rabbit', 'D': 'Tick', 'E': 'Flea'},
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B: Mouse
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Answer the following medical question with one of the provided options:
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Q:A 32-year-old female presents to her gynecologist complaining of heavy and irregular vaginal bleeding. One month ago, she underwent a dilation and curettage procedure to remove a hydatidiform mole. On examination, her uterus appears enlarged. Serum ß-hCG is highly elevated. Biopsy of her uterus reveals avillous proliferation of cytotrophoblasts and syncytiotrophoblasts. She is eventually diagnosed with choriocarcinoma and initiates treatment with a medication known to affect folate metabolism. Which of the following complications should this patient most likely be monitored for following initiation of the medication?? {'A': 'Hemorrhagic cystitis', 'B': 'Peripheral neuropathy', 'C': 'Pulmonary fibrosis', 'D': 'Acoustic nerve damage', 'E': 'Cardiotoxicity'},
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C: Pulmonary fibrosis
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Answer the following medical question with one of the provided options:
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Q:A day after percutaneous coronary intervention for stable angina, a 63-year-old woman develops severe pain in her right small toe. She has no history of a similar episode. She has had diabetes mellitus for 16 years. After the procedure, her blood pressure is 145/90 mm Hg, the pulse is 65/min, the respiratory rate is 15/min, and the temperature is 36.7°C (98.1°F). Physical examination of the femoral artery access site shows no abnormalities. Distal pulses are palpable and symmetric. A photograph of the toe is shown. Which of the following is the most likely diagnosis?? {'A': 'Atheroembolism', 'B': 'Burger’s syndrome', 'C': 'Cellulitis', 'D': 'Diabetic foot', 'E': 'Reynaud’s phenomenon'},
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A: Atheroembolism
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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 with a bacterial infection is prescribed a drug that binds the dipeptide D-Ala-D-Ala. Which of the following drugs was this patient prescribed?? {'A': 'Penicillin', 'B': 'Chloramphenicol', 'C': 'Nalidixic acid', 'D': 'Vancomycin', 'E': 'Polymyxin B'},
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D: Vancomycin
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Answer the following medical question with one of the provided options:
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Q:A 40-year-old male with a history of chronic alcoholism recently received a liver transplant. Two weeks following the transplant, the patient presents with a skin rash and frequent episodes of bloody diarrhea. A colonoscopy is performed and biopsy reveals apoptosis of colonic epithelial cells. What is most likely mediating these symptoms?? {'A': 'Donor T-cells', 'B': 'Recipient T-cells', 'C': 'Donor B-cells', 'D': 'Recipient B-cells', 'E': 'Recipient antibodies'},
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A: Donor T-cells
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Answer the following medical question with one of the provided options:
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Q:A 78-year-old woman presents to the ophthalmologist with complaints of painless, blurry vision that has worsened in the past year. She says that she sees halos around lights, and that she particularly has trouble driving at night because of the glare from headlights. On physical exam, the patient has an absence of a red reflex. What is the most likely pathology that is causing this patient’s visual symptoms?? {'A': 'Corneal edema', 'B': 'Degeneration of the retina', 'C': 'Hardening of the lens', 'D': 'Neovascularization of the retina', 'E': 'Optic nerve head damage'},
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C: Hardening of the lens
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Answer the following medical question with one of the provided options:
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Q:A 48-year-old man comes to the emergency room for a persistent painful erection for the last 4 hours. Three weeks ago, he had a deep vein thrombosis following a 13-hour flight. He also has a history of sickle cell trait, gastroesophageal reflux disease, major depressive disorder, and hypertension. He has smoked 1 pack of cigarette daily for the past 9 years. He takes warfarin, propranolol, citalopram, trazodone, lisinopril, and omeprazole. He is alert and oriented but in acute distress. His temperature is 37°C(98.6°F), pulse is 109/min, and blood pressure is 139/88 mm Hg. Examination shows a rigid erection with no evidence of trauma, penile discharge, injection, or prosthesis. Which of the following is the most likely cause of his condition?? {'A': 'Warfarin', 'B': 'Cigarette smoking', 'C': 'Trazodone', 'D': 'Sickle cell trait', 'E': 'Citalopram'},
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C: Trazodone
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Answer the following medical question with one of the provided options:
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Q:A microbiology student was given a swab containing an unknown bacteria taken from the wound of a soldier and asked to identify the causative agent. She determined that the bacteria was a gram-positive, spore-forming bacili, but had difficulty narrowing it down to the specific bacteria. The next test she performed was the Nagler's test, in which she grew the bacteria on a plate made from egg yolk, which would demonstrate the ability of the bacteria to hydrolyze phospholipids and produce an area of opacity. Half the plate contained a specific antitoxin which prevented hydrolysis of phospholipids while the other half did not contain any antitoxin. The bacteria produced an area of opacity only on half of the plate containing no antitoxin. Which of the following toxins was the antitoxin targeting?? {'A': 'Alpha toxin', 'B': 'Tetanus toxin', 'C': 'Botulinum toxin', 'D': 'Exotoxin A', 'E': 'Diphtheria toxin'},
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A: Alpha toxin
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Answer the following medical question with one of the provided options:
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Q:A 28-year-old male presents to trauma surgery clinic after undergoing an exploratory laparotomy, femoral intramedullary nail, and femoral artery vascular repair 3 months ago. He suffered multiple gunshot wounds as a victim of a drive-by shooting. He is progressing well with well-healed surgical incisions on examination. He states during his clinic visit that he has been experiencing 6 weeks of nightmares where he "relives the day he was shot." The patient also endorses 6 weeks of flashbacks to "the shooter pointing the gun at him" during the daytime as well. He states that he has had difficulty sleeping and cannot concentrate when performing tasks. Which of the following is the most likely diagnosis?? {'A': 'Acute stress disorder', 'B': 'Normal reaction to trauma', 'C': 'Post-traumatic stress disorder (PTSD)', 'D': 'Schizophrenia', 'E': 'Schizophreniform disorder'},
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C: Post-traumatic stress disorder (PTSD)
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Answer the following medical question with one of the provided options:
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Q:You are conducting a study comparing the efficacy of two different statin medications. Two groups are placed on different statin medications, statin A and statin B. Baseline LDL levels are drawn for each group and are subsequently measured every 3 months for 1 year. Average baseline LDL levels for each group were identical. The group receiving statin A exhibited an 11 mg/dL greater reduction in LDL in comparison to the statin B group. Your statistical analysis reports a p-value of 0.052. Which of the following best describes the meaning of this p-value?? {'A': 'There is a 95% chance that the difference in reduction of LDL observed reflects a real difference between the two groups', 'B': 'There is a 5% chance of observing a difference in reduction of LDL of 11 mg/dL or greater even if the two medications have identical effects', 'C': 'Though A is more effective than B, there is a 5% chance the difference in reduction of LDL between the two groups is due to chance', 'D': 'This is a statistically significant result', 'E': 'If 100 permutations of this experiment were conducted, 5 of them would show similar results to those described above'},
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B: There is a 5% chance of observing a difference in reduction of LDL of 11 mg/dL or greater even if the two medications have identical effects
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Answer the following medical question with one of the provided options:
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Q:A 33-year-old woman is brought to the the ED via ambulance for sudden onset of blindness. Her past medical history is significant only for smoking, and her only home medication is oral contraception pills. The patient is remarkably calm. On exam, her temperature is 98.2 deg F (36.8 deg C), and pulse is 95/min, blood pressure is 130/72 mmHg. Her pupils are equally round and reactive to light and accommodation. Blink to threat is intact and neurologic exam is unremarkable. MRI head is shown below (Figure 1). Other MRI views are normal. On history, it is revealed that the patient recently broke up with her fiancé. What is the most likely diagnosis?? {'A': 'Acute ischemic stroke', 'B': 'Pituitary adenoma', 'C': 'Conversion disorder', 'D': 'Malingering', 'E': 'Factitious disorder'},
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C: Conversion disorder
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Answer the following medical question with one of the provided options:
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Q:A 53-year-old diabetic man with cellulitis of the right lower limb presents to the emergency department because of symptoms of fever and chills. His pulse is 122/min, the blood pressure is 76/50 mm Hg, the respirations are 26/min, and the temperature is 40.0°C (104.0°F). His urine output is < 0.5mL/kg/h. He has warm peripheral extremities. The hemodynamic status of the patient is not improving in spite of the initiation of adequate fluid resuscitation. He is admitted to the hospital. Which of the following is the most likely laboratory profile?? {'A': 'WBC count: 6670/mm3; low central venous pressure (CVP); blood culture: gram-positive bacteremia; blood lactate level: 1.1 mmol/L', 'B': 'WBC count: 8880/mm3; high CVP; blood culture: gram-positive bacteremia; blood lactate level: 2.1 mmol/L', 'C': 'WBC count: 11,670/mm3; low CVP; blood culture: gram-negative bacteremia; blood lactate level: 0.9 mmol/L', 'D': 'WBC count: 16,670/mm3; low CVP; blood culture: gram-negative bacteremia; blood lactate level: 2.2 mmol/L', 'E': 'WBC count: 1234/mm3; high CVP; blood culture: gram-negative bacteremia; blood lactate level: 1.6 mmol/L'},
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D: WBC count: 16,670/mm3; low CVP; blood culture: gram-negative bacteremia; blood lactate level: 2.2 mmol/L
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Answer the following medical question with one of the provided options:
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Q:A 69-year-old man with hypertension and congestive heart failure is brought to the emergency department because of a 9-day history of worsening shortness of breath and swelling of his legs. His respirations are 25/min, and blood pressure is 160/98 mm Hg. Pulse oximetry on 5 L O2 via nasal cannula shows an oxygen saturation of 92%. Examination shows 2+ pretibial edema bilaterally. Crackles are heard at both lung bases. The patient's symptoms are due in part to an increase in the rate of bradykinin breakdown. The substance responsible for bradykinin breakdown is primarily produced in which of the following?? {'A': 'Pulmonary endothelium', 'B': 'Liver', 'C': 'Atria', 'D': 'Zona glomerulosa', 'E': 'Juxtaglomerular cells'},
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A: Pulmonary endothelium
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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 for the evaluation of infertility. He has a history of recurrent lower respiratory tract infections, productive cough, abdominal pain, and diarrhea. Physical examination reveals clubbing and bilateral crackles on chest auscultation. Chest X-ray reveals increased pulmonary markings and peripheral bronchi with a ‘tram track’ appearance. Which of the following pathophysiologies is responsible for the patient’s condition?? {'A': 'Bronchial hypersensitivity', 'B': 'Fibrosis of the lung parenchyma', 'C': 'Defective chloride transport', 'D': 'Abnormal ciliary motion', 'E': 'Gluten hypersensitivity'},
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C: Defective chloride transport
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Answer the following medical question with one of the provided options:
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Q:A 3-week-old male infant is brought to the physician for evaluation of poor feeding and recurrent episodes of facial grimacing. He was delivered at term after an uncomplicated pregnancy. He is at the 3rd percentile for length and 5th percentile for weight. Physical examination shows yellow discoloration of skin, a broad nasal bridge, hepatomegaly, and decreased muscle tone in the extremities. Serum studies show increased concentrations of very long-chain fatty acids. Examination of the liver cells from this neonate is most likely to show which of the following findings?? {'A': 'Presence of centrilobular necrosis', 'B': 'Presence of eosinophilic apoptotic bodies', 'C': 'Absence of peroxisomes', 'D': 'Accumulation of foam cells', 'E': 'Absence of bile ducts'},
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C: Absence of peroxisomes
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Answer the following medical question with one of the provided options:
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Q:A 24-year-old woman presents to her primary care physician with a 3 day history of pain with urination. She says that this pain has been accompanied by abdominal pain as well as a feeling like she always needs to use the restroom. She has no past medical history and no family history that she can recall. She is currently sexually active with a new partner but has tested negative for sexually transmitted infections. Physical exam reveals suprapubic tenderness and urine culture reveals gram-positive cocci. Which of the following best describes the organism that is most likely causing this patient's symptoms?? {'A': 'Catalase negative and alpha-hemolytic', 'B': 'Catalase negative and beta-hemolytic', 'C': 'Catalase positive and coagulase positive', 'D': 'Coagulase negative and novobiocin resistant', 'E': 'Coagulase negative and novobiocin sensitive'},
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D: Coagulase negative and novobiocin resistant
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Answer the following medical question with one of the provided options:
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Q:A 3-year-old girl is brought to the physician for a well-child examination. She was born at term and has been healthy since. She can climb up and down the stairs and can pedal a tricycle. She has difficulty using a spoon to feed herself but can copy a line. She speaks in 2- to 3-word sentences that can be understood by most people. She is selfish while playing with children her age and throws tantrums quite often. She cannot put on her own shoes and socks. She does not tolerate separation from her parents. She is at 60th percentile for height and weight. Physical examination including neurologic examination reveals no abnormalities. Which of the following is the most appropriate assessment of her development?? {'A': 'Fine motor: Delayed | Gross motor: Delayed | Language: Normal | Social skills: Normal', 'B': 'Fine motor: Normal | Gross motor: Delayed | Language: Normal | Social skills: Delayed', 'C': 'Fine motor: Delayed | Gross motor: Normal | Language: Normal | Social skills: Delayed', 'D': 'Fine motor: Normal | Gross motor: Normal | Language: Delayed | Social skills: Delayed', 'E': 'Fine motor: Normal | Gross motor: Delayed | Language: Delayed | Social skills: Normal'},
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C: Fine motor: Delayed | Gross motor: Normal | Language: Normal | Social skills: Delayed
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Answer the following medical question with one of the provided options:
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Q:A 22-year-old woman presents to the emergency department with a 3-day history of fever and abdominal pain. She says that the pain is located in the left lower quadrant of the abdomen and feels crampy in nature. The pain has been associated with bloody diarrhea and joint tenderness. She has no past medical history but says that she returned 2 weeks ago from vacation in Asia where she tried many new foods. Her family history is significant for multiple cancers in close relatives. Physical exam reveals swollen ulcers on her legs, and colonoscopy reveals contiguous ulcerations from the rectum through the descending colon. Which of the following is associated with the most likely cause of this patient's symptoms?? {'A': 'Gram-negative rod', 'B': 'HLA-DQ2 positivity', 'C': 'Noncaseating granulomas', 'D': 'Perinuclear anti-neutrophil cytoplasmic antibodies', 'E': 'Severe aortic stenosis'},
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D: Perinuclear anti-neutrophil cytoplasmic antibodies
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Answer the following medical question with one of the provided options:
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Q:A 45-year-old man presents with a 2-week history of night sweats, cough, and a fever. Past medical history includes HIV infection diagnosed 10 years ago, managed with HAART. He says he hasn’t been compliant with his HAART therapy as prescribed because it is too expensive and he is currently unemployed without insurance. A chest radiograph is performed and reveals a cavity in the right upper lobe of his lung. Which of the following lung infections is most likely causing this patient’s symptoms?? {'A': 'Mycobacterium avium complex', 'B': 'Cytomegalovirus', 'C': 'M. tuberculosis', 'D': 'Pneumocystis jirovecii', 'E': 'Histoplasmosis'},
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C: M. tuberculosis
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Answer the following medical question with one of the provided options:
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Q:Research is being conducted on embryoblasts. The exact date of fertilization is unknown. There is the presence of a cytotrophoblast and syncytiotrophoblast, marking the time when implantation into the uterus would normally occur. Within the embryoblast, columnar and cuboidal cells are separated by a membrane. Which of these cell layers begins to line the blastocyst cavity?? {'A': 'Epiblast', 'B': 'Inner cell mass', 'C': 'Hypoblast', 'D': 'Endoderm', 'E': 'Syncytiotrophoblast'},
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C: Hypoblast
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Answer the following medical question with one of the provided options:
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Q:A 62-year-old man is brought to the emergency department because of right-sided weakness and subjective decreased sensation that started 30 minutes ago. The patient reports that his symptoms started to ease 5 minutes after onset and have now completely resolved. He has hypertension, hyperlipidemia, and type 2 diabetes mellitus. He has smoked one pack of cigarettes daily for 40 years. His current medications include lisinopril, metformin, and sitagliptin. He is 183 cm (6 ft 0 in) tall and weighs 105 kg (220 lb); BMI is 32 kg/m2. He appears well. His temperature is 36.5°C (97.7°F), pulse is 80/min, and blood pressure is 150/88 mm Hg. Neurological examination shows no abnormalities. Cardiac examination shows regular rate and rhythm and a left-sided carotid bruit. Complete blood count, serum glucose, and electrolytes are within the reference ranges. An ECG shows sinus rhythm and left axis deviation. A CT scan of the head without contrast shows no abnormalities. Carotid doppler ultrasound shows 45% stenosis in the left carotid artery and 15% stenosis in the right. Which of the following is the most appropriate next step in management?? {'A': 'Carotid endarterectomy', 'B': 'Transthoracic echocardiogram', 'C': 'Antiplatelet therapy', 'D': 'Intravenous alteplase therapy', 'E': 'Carotid artery stenting\n"'},
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C: Antiplatelet therapy
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Answer the following medical question with one of the provided options:
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Q:A 6-year-old girl with no significant past medical, surgical, social, or family history presents to urgent care for a new itchy rash on the fingers of her right hand. When questioned, the patient notes that she recently received a pair of beloved silver rings from her aunt as a birthday present. She denies any history of similar rashes. The patient's blood pressure is 123/76 mm Hg, pulse is 67/min, respiratory rate is 16/min, and temperature is 37.3°C (99.1°F). Physical examination reveals erythematous scaly plaques at the base of her right middle and ring finger. What metal alloy is most likely contained within the patient’s new rings?? {'A': 'Cobalt', 'B': 'Mercury', 'C': 'Thorium', 'D': 'Nickel', 'E': 'Gold'},
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D: Nickel
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Q:An investigator is studying a drug that acts on the thyroid hormone pathway. Levels of serum free T3 and T4 in healthy participants are measured before and after administration of the drug. After administration, there is a decrease in the average serum free T3 level, while the average serum free T4 level is increased compared to initial serum studies. Inhibition of which of the following is the most likely mechanism of action of this drug?? {'A': 'Follicular thyroid proteases', 'B': 'Thyroid-stimulating hormone', 'C': 'Follicular iodotyrosine deiodinase', 'D': 'Follicular thyroid peroxidase', 'E': "Peripheral 5'-deiodinase"},
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E: Peripheral 5'-deiodinase
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Answer the following medical question with one of the provided options:
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Q:A 9-year-old girl is brought to the emergency department for sudden-onset slurring of speech and weakness of her right arm and leg. She has a mild intellectual disability. She is at the 10th percentile for weight and at the 85th percentile for height. Physical examination shows bilateral inferonasal subluxation of the lens and a high-arched palate. Her fingers are long and slender. Neurological examination shows an extensor plantar response on the left. This patient is most likely to respond to treatment with which of the following?? {'A': 'Supplementation of methionine', 'B': 'Restriction of phenylalanine', 'C': 'Alkalinization of urine', 'D': 'Supplementation of vitamin B6', 'E': 'Restriction of cysteine'},
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D: Supplementation of vitamin B6
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Answer the following medical question with one of the provided options:
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Q:A 23-year-old G1P0 woman presents to the emergency department with regular and painful contractions that occur every 3 minutes. She was at home cooking dinner when she experienced a deluge of clear fluid between her legs followed by painful contractions. The patient has a past medical history of obesity. Her pregnancy was not followed by an obstetrician, but she notes that she experienced abdominal pain and headaches frequently towards the end of her pregnancy. Her temperature is 99.5°F (37.5°C), blood pressure is 187/128 mmHg, pulse is 110/min, respirations are 17/min, and oxygen saturation is 98% on room air. The patient is started on magnesium sulfate and labetalol. The patient delivers her baby vaginally 2 hours later. On the labor and delivery floor, the patient is notably somnolent. Vitals are notable for respirations of 6 per minute. Physical exam reveals a somnolent woman who is minimally responsive. Cardiopulmonary exam is notable for hypopnea. Neurological exam reveals absent deep tendon reflexes and 3/5 strength in her upper and lower extremities. Which of the following is the next best step in management?? {'A': 'CT scan of the head', 'B': 'Discontinue current drug infusion', 'C': 'Remove retained fetal parts', 'D': 'Supportive therapy', 'E': 'Ultrasound'},
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B: Discontinue current drug infusion
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Answer the following medical question with one of the provided options:
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Q:A 50-year-old woman presents to the emergency department with mild chest pressure that does not radiate to her left arm or jaw. These episodes have been ongoing several times over the last 24 hours. Her medical history is significant for diabetes mellitus type II and HTN for which she takes metformin and lisinopril. Her physical exam is significant for a middle aged woman appearing as stated age in moderate distress. Her heart and lung sounds are within normal limits. On laboratory examination, her troponin level is elevated, and her heart rate waivers around 47/min. Note this patient’s EKG in the exhibit. Which pacemaker site is likely in use in this patient?? {'A': 'SA node', 'B': 'AV node', 'C': 'Atrial myocardium', 'D': 'Purkinje fibers', 'E': 'Ventricular myocardium'},
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B: AV node
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Q:A 56-year-old man is brought to the emergency department 25 minutes after the sudden onset of severe pain in the middle of his chest. He describes the pain as tearing in quality; it radiates to his jaw. He has hypertension. He has smoked one pack of cigarettes daily for the 25 years. Current medications include enalapril. His blood pressure is 154/95 mm Hg in his right arm and 181/105 mm Hg in his left arm. A CT scan of the chest is shown. The structure indicated by the arrow is a derivative of which of the following?? {'A': 'Truncus arteriosus', 'B': 'Right common cardinal vein', 'C': 'Bulbus cordis', 'D': 'Primitive atrium', 'E': 'Right horn of sinus venosus'},
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A: Truncus arteriosus
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Q:A tall, 25-year-old man is brought to the ED by his friend after sudden difficulty breathing while smoking a cigarette. In the trauma bay he is tachypneic, but able to talk to you. Vital signs show that he is afebrile and tachycardic with blood pressure of 115/60. Physical exam reveals hyperresonance and absent breath sounds over the left upper lung. A chest x-ray is obtained and shown below. What is the most likely diagnosis?? {'A': 'Tension pneumothorax', 'B': 'Left lower lobe pneumonia', 'C': 'Left upper lobe cavitation', 'D': 'Spontaneous pneumothorax', 'E': 'Nondiagnostic, further imaging required'},
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D: Spontaneous pneumothorax
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Answer the following medical question with one of the provided options:
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Q:A 23-year-old woman makes an appointment with a dermatologist for treatment of acne. As a result, she feels uncomfortable in public and feels as though everyone is looking at the pimples on her face. She cleans her face several times a day with face wash and avoids using make-up. She has tried many face creams and scar removal creams to help improve the condition of her skin, but nothing has worked. On examination, she has pustular acne on her cheeks and forehead. The physician prescribes an antibiotic along with isotretinoin. Which of the following drugs would you recommend in conjunction with isotretinoin?? {'A': 'Statins', 'B': 'Oral contraceptives', 'C': 'Folic acid', 'D': 'Antihypertensives', 'E': 'Vitamin B6'},
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B: Oral contraceptives
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Answer the following medical question with one of the provided options:
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Q:A group of environmental health scientists recently performed a nationwide cross-sectional study that investigated the risk of head and neck cancers in patients with a history of cigar and pipe smoking. In collaboration with three teams of epidemiologists that have each conducted similar cross-sectional studies in their respective countries, they have agreed to contribute their data to an international pooled analysis of the relationship between non-cigarette tobacco consumption and prevalence of head and neck cancers. Which of the following statements regarding the pooled analysis in comparison to the individual studies is true?? {'A': 'It overcomes limitations in the quality of individual studies.', 'B': 'It is able to provide evidence of causality.', 'C': 'The results are less precise.', 'D': 'The likelihood of type II errors is decreased.', 'E': 'The level of clinical evidence is lower.'},
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D: The likelihood of type II errors is decreased.
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Q:A 2-month-old girl is brought to the physician for a well-child examination. She was born at 32 weeks' gestation and weighed 1616 g (3 lb 9 oz); she currently weighs 2466 g (5 lb 7 oz). She is exclusively breastfed and receives vitamin D supplementation. Physical examination shows no abnormalities apart from low height and weight. This patient is at increased risk for which of the following complications?? {'A': 'Iron deficiency anemia', 'B': 'Intussusception', 'C': 'Scurvy', 'D': 'Subacute combined degeneration', 'E': 'Hemorrhage'},
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A: Iron deficiency anemia
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Q:A 3-year-old boy is brought to the physician because of a 3-day history of a pruritic skin rash on his chest. His mother says that he has no history of dermatological problems. He was born at term and has been healthy except for recurrent episodes of otitis media. His immunizations are up-to-date. He appears pale. His temperature is 37°C (98.6°F), pulse is 110/min, respirations are 26/min, and blood pressure is 102/62 mm Hg. Examination shows vesicles and flaccid bullae with thin brown crusts on the chest. Lateral traction of the surrounding skin leads to sloughing. Examination of the oral mucosa shows no abnormalities. Complete blood count is within the reference range. Which of the following is the most likely diagnosis?? {'A': 'Bullous impetigo', 'B': 'Dermatitis herpetiformis', 'C': 'Stevens-Johnson syndrome', 'D': 'Bullous pemphigoid', 'E': 'Pemphigus vulgaris'},
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A: Bullous impetigo
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Q:A 37-year-old woman comes to the physician for a 6-month history of headaches, anorexia, and vomiting. She has had a 10-kg (22-lb) weight loss during this period. She has type 1 diabetes mellitus for which she takes insulin. The patient's mother and sister have hypothyroidism. Her blood pressure is 80/60 mm Hg. Physical examination shows hyperpigmentation of the lips and oral mucosa. Serum studies show a parathyroid hormone level of 450 pg/mL and antibodies directed against 17α-hydroxylase. Which of the following is the most likely diagnosis?? {'A': 'Multiple endocrine neoplasia type 2B', 'B': 'Sheehan syndrome', 'C': 'Multiple endocrine neoplasia type 2A', 'D': 'Autoimmune polyendocrine syndrome type 2', 'E': 'Cushing syndrome\n"'},
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D: Autoimmune polyendocrine syndrome type 2
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Answer the following medical question with one of the provided options:
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Q:A 2350-g (5-lb 3-oz) male newborn delivered at 28 weeks’ gestation develops rapid breathing, grunting, and subcostal retractions 2 hours after delivery. The mother did not receive prenatal care. His temperature is 36.5°C (97.7°F), pulse is 168/min, respirations are 88/min, and blood pressure is 70/40 mm Hg. Physical examination shows cyanosis and nasal flaring. Breath sounds are decreased bilaterally. An x-ray of the chest shows diffuse reticulonodular ground-glass opacities with air bronchograms. Which of the following best describes the pathogenesis of this patient's disease?? {'A': 'Abnormal budding of the foregut', 'B': 'Low concentration of lamellar bodies', 'C': 'Defect in α1 antitrypsin', 'D': 'Hypersensitivity of the bronchial epithelium', 'E': 'Aspiration of meconium'},
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B: Low concentration of lamellar bodies
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Answer the following medical question with one of the provided options:
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Q:A 9-month-old boy is brought to the pediatrician for evaluation of blue discoloration of the fingernails. His parents recently immigrated from Venezuela. No prior medical records are available. His mother states that during breastfeeding, he sweats and his lips turn blue. Recently, he has begun to crawl and she has noticed a similar blue discoloration in his fingers. The vital signs include: temperature 37℃ (98.6℉), blood pressure 90/60 mm Hg, pulse 100/min, and respiratory rate 26/min. On examination, he appeared to be in mild distress and cyanotic. Both fontanelles were soft and non-depressed. Cardiopulmonary auscultation revealed normal breath sounds and a grade 2/6 systolic ejection murmur at the left upper sternal border with a single S-2. He is placed in the knee-chest position. This maneuver is an attempt to improve this patient's condition by which of the following mechanisms?? {'A': 'Decreased obstruction of the choanae', 'B': 'Decreased pulmonary vascular resistance', 'C': 'Decreased systemic vascular resistance', 'D': 'Increased systemic vascular resistance', 'E': 'Increased systemic venous return'},
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D: Increased systemic vascular resistance
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Answer the following medical question with one of the provided options:
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Q:A 26-day-old newborn is brought to the physician because of poor feeding and lethargy for 2 weeks. During this period, he has had a raspy cry. The child was delivered at term at home and has not yet been evaluated by a physician. He is at the 90th percentile for head circumference, 50th percentile for length, and 60th percentile for weight. Vital signs are within normal limits. Examination shows scleral icterus and an enlarged tongue. The abdomen is distended and there is a reducible, soft protruding mass at the umbilicus. Muscle tone is decreased in all extremities. Which of the following is the most likely cause of these findings?? {'A': 'Thyroid dysgenesis', 'B': 'Acid maltase deficiency', 'C': 'Trisomy 21', 'D': 'α-L-iduronidase deficiency', 'E': 'Chromosome 11p alteration'},
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A: Thyroid dysgenesis
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Q:A 49-year-old man with HIV comes to the physician because of a 1-month history of intermittent diarrhea and abdominal pain. Abdominal examination shows mild, diffuse tenderness throughout the lower quadrants. His CD4+ T-lymphocyte count is 180/mm3 (normal ≥ 500/mm3). Colonoscopy shows multiple hemorrhagic nodules in the rectum and descending colon. Polymerase chain reaction of the lesions is positive for HHV-8. Histologic examination of the lesions is most likely to show which of the following findings?? {'A': 'Cords of atypical cells with extracellular mucin', 'B': 'Enlarged cells with intranuclear inclusion bodies', 'C': 'Polygonal cells with racket-shaped organelles', 'D': 'Spindle-shaped cells with leukocytic infiltration', 'E': 'Mucin-filled cell with peripheral nucleus'},
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D: Spindle-shaped cells with leukocytic infiltration
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Q:A 36-year-old female presents to her primary care provider for tremor. She reports that she has always had a mild tremor but that she has begun noticing it more since learning to paint. She feels that she has trouble dipping her paintbrush in the paint and making precise strokes on the canvas. She has taken to painting while drinking wine, as she notices that the wine seems to improve her tremor. Her temperature is 97.6°F (36.4°C), blood pressure is 105/61 mmHg, pulse is 58/min, and respirations are 12/min. On exam, she has a high frequency bilateral hand tremor elicited on finger-to-nose testing. Her neurological exam is otherwise unremarkable. The patient is started on a new medication for her symptoms. One week later, she returns with a new complaint of abdominal pain for one day. She reports that she has noticed a darkening of her urine and now has difficulty raising her arms over her head to brush her hair. This patient was most likely treated with which of the following medications?? {'A': 'Topiramate', 'B': 'Propranolol', 'C': 'Primidone', 'D': 'Alprazolam', 'E': 'Clozapine'},
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C: Primidone
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Q:A 62-year-old woman presents to her oncologist to discuss the chemotherapy options for her newly diagnosed breast cancer. During the meeting, they discuss a drug that inhibits the breakdown of mitotic spindles in cells. Her oncologist explains that this will be more toxic to cancer cells because those cells are dividing more rapidly. Which of the following side effects is closely associated with the use of this chemotherapeutic agent?? {'A': 'Hemorrhagic cystitis', 'B': 'Paralytic ileus', 'C': 'Peripheral neuropathy', 'D': 'Photosensitivity', 'E': 'Pulmonary fibrosis'},
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C: Peripheral neuropathy
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Answer the following medical question with one of the provided options:
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Q:A 15-year-old female presents to her family physician for an annual school physical exam and check-up. She is accompanied by her mother to the visit and is present in the exam room. The patient has no complaints, and she does not have any past medical problems. She takes no medications. The patient reports that she remains active, exercising 5 times a week, and eats a healthy and varied diet. Which of the following would be the best way for the physician to obtain a more in-depth social history, including sexual history and use of alcohol, tobacco, or recreational drugs?? {'A': 'Ask the patient the questions directly, with her mother still in the exam room', 'B': 'Ask the mother to step outside into the hall for a portion of the visit', 'C': 'Give the patient a social history questionnaire to fill out in the exam room', 'D': 'Speak softly to the patient so that the mother does not hear and the patient is not embarrased', 'E': 'Disallow the mother to be present in the examination room throughout the entirety of the visit'},
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B: Ask the mother to step outside into the hall for a portion of the visit
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Q:A 56-year-old man with a history of HIV presents with diarrhea. The patient has had diarrhea for the past week and it has been gradually worsening. The patient describes it as profuse and watery. He has lost 15 pounds during this time frame and feels very weak. The patient is not currently taking his antiretroviral medications and historically has been non-compliant with his medications. His temperature is 98.5°F (36.9°C), blood pressure is 122/58 mmHg, pulse is 127/min, respirations are 14/min, and oxygen saturation is 99% on room air. Physical exam is notable for an emaciated man who is tachycardic. Stool exam with a modified acid-fast stain reveals organisms. The patient is started on IV fluids. Which of the following is the best treatment for this patient?? {'A': 'Ciprofloxacin', 'B': 'Mesalamine enema', 'C': 'Metronidazole', 'D': 'Nitazoxanide', 'E': 'Supportive therapy only'},
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D: Nitazoxanide
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Answer the following medical question with one of the provided options:
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Q:A 46-year-old woman comes to the physician because of increasingly severe lower back pain for the past week. The pain is constant, and she describes it as 9 out of 10 in intensity. Six months ago, she underwent a lumpectomy for hormone receptor-negative lobular carcinoma of the right breast. She has undergone multiple cycles of radiotherapy. Vital signs are within normal limits. Examination shows a well-healed surgical incision over the right breast. There is severe tenderness to palpation over the 12th thoracic vertebra. The straight-leg raise test is negative. The remainder of the examination shows no abnormalities. Serum studies show: Glucose 76 mg/dL Creatinine 1 mg/dL Total bilirubin 0.8 mg/dL Alkaline phosphatase 234 U/L Aspartate aminotransferase (AST, GOT) 16 U/L Alanine aminotransferase (ALT, GPT) 12 U/L γ-Glutamyltransferase (GGT) 40 U/L (N=5–50) Which of the following is the most appropriate next step in management?"? {'A': 'Positron emission tomography', 'B': 'Bone biopsy', 'C': 'X-ray of the spine', 'D': 'MRI of the spine', 'E': 'Bone scintigraphy'},
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D: MRI of the spine
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Q:A 28-year-old woman with a past medical history of fibromyalgia presents to her primary care provider for her annual well visit. She reports that her pain has become more severe over the last several weeks and is no longer well-controlled by NSAIDs. She notes that the pain is beginning to interfere with her sleep and that she feels she no longer has energy to take care of her 2-year-old son. Upon questioning, the patient also endorses feeling more down than usual recently, little interest in seeing friends, and difficulty concentrating on her work. She admits to feeling that she would be “better off dead.” The patient feels strongly that the worsening pain is driving these changes in her mood and that she would feel better if her pain was better controlled. Which of the following is the best next step in management?? {'A': 'Add acetaminophen and gabapentin to the patient’s pain regimen', 'B': 'Ask the patient if she would voluntarily enter a psychiatric hospital', 'C': 'Ask the patient if she has an idea about how she might hurt herself', 'D': 'Initiate pharmacotherapy with duloxetine and refer for psychotherapy', 'E': 'Initiate pharmacotherapy with amitriptyline and refer for psychotherapy'},
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C: Ask the patient if she has an idea about how she might hurt herself
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Answer the following medical question with one of the provided options:
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Q:A 22-year-old man comes to the physician because of yellow eyes and malaise for the past several hours. His symptoms began after he had cried at his father’s funeral this morning. He says that his father’s death was unexpected. He had a similar episode a year ago when he returned from a 2-day hiking trip. He has no history of any serious illness and takes no medications. His vital signs are within normal limits. His sclera are icteric. The remainder of the physical examination shows no abnormalities. Laboratory studies show: Hemoglobin 15 g/dL Mean corpuscular volume 95 μm3 Leukocyte count 6000/mm3 with a normal differential Serum bilirubin, total 3.8 mg/dL Direct bilirubin 0.5 mg/dL Lactate dehydrogenase 320 U/L Alkaline phosphatase 70 U/L Aspartate aminotransferase (AST, GOT) 22 U/L Alanine aminotransferase (ALT, GPT) 19 U/L γ-Glutamyltransferase (GGT) 43 U/L (N=5-50 U/L) Which of the following is the most appropriate next step in management?? {'A': 'Prednisone', 'B': 'Packed cell transfusion', 'C': 'Phenobarbital', 'D': 'Reassurance', 'E': 'Refer for liver transplantation'},
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D: Reassurance
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Q:A 25-year-old man is brought to the emergency department by paramedics with a seizure lasting over 30 minutes. The patient's neighbors found him outside his apartment with all four limbs flailing and not responding to his name. No significant past medical history. On physical examination, the patient continues to be unresponsive and slightly cyanotic with irregular breathing. His teeth are clenched tightly. Intravenous glucose and an anticonvulsant medication are administered. Which of the following is the mechanism of action of the drug that was most likely administered to stop this patient’s seizure?? {'A': 'Prolongation of chloride channel opening', 'B': 'Increase in frequency of chloride channel opening', 'C': 'Blockage of voltage-gated calcium channels', 'D': 'Inactivation of sodium channels', 'E': 'Blockage of T-type calcium'},
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B: Increase in frequency of chloride channel opening
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Answer the following medical question with one of the provided options:
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Q:A 26-year-old man presents to the emergency department with complaints of intractable, 10/10 abdominal pain without nausea or vomiting. His CT is unremarkable, and other aspects of his history and physical examination suggest that his complaints may not be organic in etiology. His medical record is notable for previous ED visits with similar complaints that had resolved on one occasion with narcotic agents. A previous psychiatric evaluation reports a long history of migraines, depression, and characteristics of antisocial personality disorder. Which of the following best explains his abdominal symptoms?? {'A': 'Antisocial personality disorder', 'B': 'Conversion disorder', 'C': 'Malingering', 'D': 'Münchhausen syndrome', 'E': 'Opioid withdrawal'},
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C: Malingering
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Answer the following medical question with one of the provided options:
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Q:A healthy, full-term 1-day-old female infant is evaluated after birth. She is noted to have a cleft palate and a systolic ejection murmur at the left intercostal space. Low-set ears and micrognathia are also noted on examination. A chest radiograph is obtained which reveals a boot-shaped heart and absence of thymus. Vital signs are unremarkable. Echocardiography is performed which demonstrates a ventricular septal defect, pulmonary valve stenosis, a misplaced aorta, and a thickened right ventricular wall. Family history is non-contributory; not much is known about the father. Of the following, which might the baby likely have?? {'A': 'Seizures', 'B': 'Catlike cry', 'C': 'Hyperthyroidism', 'D': 'Webbing of the neck', 'E': 'Increased phenylalanine in the blood'},
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A: Seizures
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Q:A scientist is trying to design a drug to modulate cellular metabolism in the treatment of obesity. Specifically, he is interested in understanding how fats are processed in adipocytes in response to different energy states. His target is a protein within these cells that catalyzes catabolism of an energy source. The products of this reaction are subsequently used in gluconeogenesis or ß-oxidation. Which of the following is true of the most likely protein that is being studied by this scientist?? {'A': 'It is inhibited by acetylcholine', 'B': 'It is inhibited by cortisol', 'C': 'It is inhibited by glucagon', 'D': 'It is stimulated by epinephrine', 'E': 'It is stimulated by insulin'},
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D: It is stimulated by epinephrine
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Answer the following medical question with one of the provided options:
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Q:A scientist is studying the anatomy and function of bone growth. He is able to create a cell line of osteocytes with a mutation that prevents the osteocytes from exchanging nutrients and waste products within neighboring lamellae. This mutation most likely affected which of the following cell structures?? {'A': 'Gap junctions', 'B': 'Plasma membrane', 'C': 'Kinesin', 'D': 'Dynein', 'E': 'Endoplasmic reticulum'},
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A: Gap junctions
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Q:A 40-year-old woman presents to clinic with multiple complaints. She complains of swelling around her eyes (Image A) and generalized weakness. A complete blood count reveals eosinophilia. She recently returned from a trip to Asia where she reports having eaten street food, including pork. If this patient's disease is explained by a parasite that causes inflammation of skeletal muscle, what would be the appropriate treatment?? {'A': 'Niridazole', 'B': 'Diethylcarbamazine', 'C': 'Ivermectin', 'D': 'Praziquantel', 'E': 'Bendazole'},
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E: Bendazole
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Answer the following medical question with one of the provided options:
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Q:A 5-year-old girl is brought to the physician for evaluation of a pruritic rash on her face and extremities for the last year that increases with sun exposure. Her parents report that she often seems clumsy and has had several falls in the last two weeks. Physical examination shows an erythematous, scaly rash with hyperpigmentation over the nasal bridge and cheeks as well as on the dorsal forearms and hands. Urinalysis shows high levels of neutral amino acids. The most appropriate treatment for this patient's condition includes administration of an agent that is associated with which of the following adverse effects?? {'A': 'Nephrocalcinosis', 'B': 'Facial flushing', 'C': 'Pseudotumor cerebri', 'D': 'Irreversible retinopathy', 'E': 'Calcium oxalate kidney stones'},
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B: Facial flushing
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Q:A 69-year-old man comes to the physician because of progressive difficulty swallowing and a 5-kg (11-lb) weight loss over the past 3 months. He first had trouble swallowing solid foods and then also developed difficulty swallowing liquids over the past week. Endoscopy shows a large mass 3 cm proximal to the esophagogastric junction. Biopsy of the mass shows significant distortion of glandular architecture. Which of the following is the strongest predisposing factor for this patient's condition?? {'A': 'Consumption of hot liquids', 'B': 'Chronic alcohol use', 'C': 'Visceral obesity', 'D': 'Chewing of betel nuts', 'E': 'Consumption of cured meats'},
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C: Visceral obesity
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Answer the following medical question with one of the provided options:
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Q:A 2-year-old boy is brought to the emergency department by his parents because of facial swelling that has now progressed to total body swelling. He also complains of nausea and abdominal pain. The child was in his usual state of health a week ago when they first notice swelling around his eyes. A few days later his legs started to swell. The boy was born at 39 weeks gestation via spontaneous vaginal delivery. He is up to date on all vaccines and is meeting all developmental milestones. Today, his blood pressure is 104/60 mm Hg, the heart rate is 90/min, the respiratory rate is 25/min, and the temperature is 37.1°C (98.8°F). On examination, he has facial edema, abdominal shifting dullness, and bilateral leg edema up to the knees. Urine dipstick shows 4+ protein and urinalysis shows fatty casts. Serum albumin is 2.2 g/dL. Which of the following is the most likely etiology of this patient condition?? {'A': 'Minimal change disease', 'B': 'Acute glomerulonephritis', 'C': 'Congestive heart failure', 'D': 'Kwashiorkor', 'E': 'Protein-losing enteropathy'},
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A: Minimal change disease
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Answer the following medical question with one of the provided options:
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Q:A 39-year-old man comes to the physician because of frequent urination for the past 2 months. He has been urinating 10–12 times during the day and 3–4 times during the night. He says he is drinking a lot of water to compensate for any dehydration. He has no history of serious illness and takes no medications. Vital signs are within normal limits. Physical examination shows no abnormalities. He is concerned he may have diabetes mellitus like his parents. Laboratory studies show: Hemoglobin 14.3 g/dL Serum Na+ 149 mEq/L K+ 3.9 mEq/L Cl- 102 mEq/L Glucose 90 mg/dL Osmolality 306 mOsmol/kg H2O Urine Osmolality 210 mOsmol/kg H2O A water deprivation test is conducted. After 2 hours of fluid restriction, his plasma osmolality is 315 mOsmol/kg H2O and his urine osmolality is 210 mOsmol/kg H2O. One hour after an ADH analog injection, his plasma osmolality is 276 mOsmol/kg H2O and his urine osmolality is 425 mOsmol/kg H2O. Which of the following is the most appropriate next step in management?"? {'A': 'Desmopressin therapy', 'B': 'Hydrochlorothiazide therapy', 'C': 'Tolvaptan therapy', 'D': 'Amiloride therapy', 'E': 'Fluid restriction\n"'},
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A: Desmopressin therapy
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Answer the following medical question with one of the provided options:
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Q:An epidemiologist is evaluating the efficacy of Noxbinle in preventing HCC deaths at the population level. He examines the survival data featured in the Noxbinle advertisement and wants to estimate how likely it is that Noxbinle will help an individual HCC patient. Based on the information provided in the drug advertisement, how many patients need to be treated with Noxbinle 100 mg in order to prevent, on average, one death from HCC?? {'A': '73', 'B': '50', 'C': '20', 'D': '100', 'E': '10'},
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E: 10
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Answer the following medical question with one of the provided options:
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Q:A 52-year-old man is diagnosed with chronic renal failure. He is on hemodialysis. The physicians have advised him that he needs a renal transplant. The human leukocyte antigen (HLA) genotype is A7/A5, B2/B9, and C8/C3. For each locus, the maternal allele is listed 1st and the paternal allele is listed 2nd. There are several potential donors available for the renal graft. Which of the following donors would be the closest match?? {'A': 'Donor D: A4/A7, B1/B8, C8/C3', 'B': 'Donor E: A7/A8, B9/B27, C3/C4', 'C': 'Donor A: A7/A5, B8/B2, C3/C8', 'D': 'Donor B: A5/A12, B22/9, C4/C3', 'E': 'Donor C: A7/A4, B2/B4, C8/C3'},
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C: Donor A: A7/A5, B8/B2, C3/C8
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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 presents with exertional dyspnea and fatigue for the past 3 weeks. She says there has been an acute worsening of her dyspnea in the past 5 days. On physical examination, the mucous membranes show pallor. Cardiac exam is significant for the presence of a mid-systolic murmur loudest in the 2nd left intercostal space. A CBC and peripheral blood smear show evidence of microcytic, hypochromic anemia. Which of the following parts of the GI tract is responsible for the absorption of the nutrient whose deficiency is most likely responsible for this patient’s condition?? {'A': 'Duodenum', 'B': 'Jejunum', 'C': 'Terminal ileum', 'D': 'Antrum of the stomach', 'E': 'Body of the stomach'},
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A: Duodenum
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Answer the following medical question with one of the provided options:
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Q:A 45-year-old woman diagnosed with a meningioma localized to the tuberculum sellae undergoes endonasal endoscopic transsphenoidal surgery to resect her tumor. Although the surgery had no complications and the patient is recovering well with no neurological sequelae, she develops intense polydipsia and polyuria. Her past medical history is negative for diabetes mellitus, cardiovascular disease, or malignancies. Urine osmolality is 240 mOsm/L (300–900 mOsm/L), and her serum sodium level is 143 mEq/L (135–145 mEq/L). The attending decides to perform a water deprivation test. Which of the following results would you expect to see after the administration of desmopressin in this patient?? {'A': 'Reduction in urine osmolality to 125 mOsm/L', 'B': 'Increase in urine osmolality to 250 mOsm/L', 'C': 'Reduction in urine osmolality to 80 mOsm/L', 'D': 'Increase in urine osmolality to greater than 264 mOsm/L', 'E': 'No changes in urine osmolality values'},
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D: Increase in urine osmolality to greater than 264 mOsm/L
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Q:A 24-year-old woman comes to the emergency department because of a 4-hour history of headaches, nausea, and vomiting. During this time, she has also had recurrent dizziness and palpitations. The symptoms started while she was at a friend's birthday party, where she had one beer. One week ago, the patient was diagnosed with a genitourinary infection and started on antimicrobial therapy. She has no history of major medical illness. Her pulse is 106/min and blood pressure is 102/73 mm Hg. Physical examination shows facial flushing and profuse sweating. The patient is most likely experiencing adverse effects caused by treatment for an infection with which of the following pathogens?? {'A': 'Chlamydia trachomatis', 'B': 'Trichomonas vaginalis', 'C': 'Herpes simplex virus', 'D': 'Neisseria gonorrhoeae', 'E': 'Candida albicans'},
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B: Trichomonas vaginalis
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Q:A 47-year-old woman comes to the physician because of progressive pain and stiffness in her hands and wrists for the past several months. Her hands are stiff in the morning; the stiffness improves as she starts her chores. Physical examination shows bilateral swelling and tenderness of the wrists, metacarpophalangeal joints, and proximal interphalangeal joints. Her range of motion is limited by pain. Laboratory studies show an increased erythrocyte sedimentation rate. This patient's condition is most likely associated with which of the following findings?? {'A': 'IgG antibodies with a TNF-α binding domain on the Fc region', 'B': 'HLA-DQ2 proteins on white blood cells', 'C': 'HLA-B27 protein on white blood cells', 'D': 'HLA-A3 proteins on white blood cells', 'E': 'IgM antibodies against the Fc region of IgG'},
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E: IgM antibodies against the Fc region of IgG
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Answer the following medical question with one of the provided options:
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Q:Which of the following is most likely to have prevented this patient's condition?? {'A': 'High-fiber diet', 'B': 'Long-term use of aspirin', 'C': 'Anticoagulation with warfarin', 'D': 'Different antibiotic regimen for bronchitis', 'E': 'Sitz baths and nifedipine suppositories'},
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A: High-fiber diet
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Q:A 44-year-old man comes to the emergency department because of persistent palpitations for the past 2 hours. The day before, he was at a wedding, where he drank several glasses of wine and 9–10 vodka cocktails. He has never had similar symptoms before. He is a manager at a software company and has recently had a lot of work-related stress. He is otherwise healthy and takes no medications. His temperature is 36.5°C (97.7°F), pulse is 90/min and irregularly irregular, respirations are 13/min, and his blood pressure is 128/60 mm Hg. Physical examination shows no other abnormalities. An ECG is performed; no P-waves can be identified. Echocardiography shows no valvular abnormalities and normal ventricular function. One hour later, a repeat ECG shows normal P waves followed by narrow QRS complexes. He is still experiencing occasional palpitations. Which of the following is the most appropriate next step in management?? {'A': 'Observation', 'B': 'Adenosine injection', 'C': 'Defibrillation', 'D': 'Catheter ablation', 'E': 'Electrical cardioversion\n"'},
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A: Observation
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Q:A previously healthy 29-year-old man comes to the emergency department for a 2-day history of abdominal pain, vomiting, and watery diarrhea. Bowel movements occur every 3 hours and are non-bloody. He recently returned from a backpacking trip in Central America. He does not take any medications. Stool culture shows gram-negative, rod-shaped bacteria that ferment lactose. Which of the following toxins is most likely to be involved in the pathogenesis of this patient's symptoms?? {'A': 'Cereulide', 'B': 'Heat-labile toxin', 'C': 'Toxin A', 'D': 'Enterotoxin B', 'E': 'Shiga toxin'},
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B: Heat-labile toxin
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Q:A 40-year-old woman presents with abdominal pain and yellow discoloration of the skin for the past 4 days. She says that her symptoms onset gradually and progressively worsened. Past medical history is unremarkable. She has been taking oral contraceptive pills for 4 years. Her vitals include: pulse 102/min, respiratory rate 15/min, temperature 37.5°C (99.5°F), and blood pressure 116/76 mm Hg. Physical examination reveals abdominal pain on palpation, hepatomegaly 4 cm below the right costal margin, and shifting abdominal dullness with a positive fluid wave. Hepatitis viral panel is ordered which shows: Anti-HAV IgM Negative HBsAg Negative Anti-HBs Negative IgM anti-HBc Negative Anti-HCV Negative Anti-HDV Negative Anti-HEV Negative An abdominal ultrasound reveals evidence of hepatic vein thrombosis. A liver biopsy is performed which shows congestion and necrosis in the central zones. Which of the following is the most likely diagnosis in this patient?? {'A': 'Budd-Chiari syndrome', 'B': 'Hemochromatosis', 'C': 'Viral hepatitis', 'D': 'Nonalcoholic fatty liver disease', 'E': 'Drug-induced hepatitis'},
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A: Budd-Chiari syndrome
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Q:During a study on gastrointestinal hormones, a volunteer is administered the hormone secreted by S cells. Which of the following changes most likely represent the effect of this hormone on gastric and duodenal secretions? $$$ Gastric H+ %%% Duodenal HCO3- %%% Duodenal Cl- $$$? {'A': '↑ ↑ ↓', 'B': '↓ ↓ ↓', 'C': '↓ no change no change', 'D': '↓ ↑ ↓', 'E': '↑ ↓ no change'},
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D: ↓ ↑ ↓
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Q:A 56-year-old man is brought to the emergency department after 4 hours of severe abdominal pain with an increase in its intensity over the last hour. His personal history is relevant for peptic ulcer disease and H. pylori infection that is being treated with clarithromycin triple therapy. Upon admission his vital signs are as follows: pulse of 120/min, a respiratory rate of 20/min, body temperature of 39°C (102.2°F), and blood pressure of 90/50 mm Hg. Physical examination reveals significant tenderness over the abdomen. A chest radiograph taken when the patient was standing erect is shown. Which of the following is the next best step in the management of this patient?? {'A': 'Abdominal computed tomography', 'B': 'Emergency endoscopy', 'C': 'Emergency abdominal surgery', 'D': 'Abdominal ultrasound', 'E': 'Nasogastric tube placement followed by gastric lavage'},
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C: Emergency abdominal surgery
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Q:A 28-year-old medical student presents to the student health center with the complaint being unable to sleep. Although he is a very successful student, over the past few months he has become increasingly preoccupied with failing. The patient states that he wakes up 10-15 times per night to check his textbooks for factual recall. He has tried unsuccessfully to suppress these thoughts and actions, and he has become extremely anxious and sleep-deprived. He has no past medical history and family history is significant for a parent with Tourette's syndrome. He is started on cognitive behavioral therapy. He is also started on a first-line medication for his disorder, but after eight weeks of use, it is still ineffective. What drug, if added to his current regimen, may help improve his symptoms?? {'A': 'Propranolol', 'B': 'Sertraline', 'C': 'Methylphenidate', 'D': 'Phenelzine', 'E': 'Risperidone'},
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E: Risperidone
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Q:A 15-year-old male presents to his pediatrician after school for follow-up after an appendectomy one week ago. The patient denies any abdominal pain, fevers, chills, nausea, vomiting, diarrhea, or constipation. He eats solids and drinks liquids without difficulty. He is back to playing basketball for his school team without any difficulty. He notes that his urine appears more amber than usual but suspects that it is due to dehydration. His physical exam is unremarkable; his laparoscopic incision sites are all clean without erythema. The pediatrician orders an urinalysis, which is notable for the following: Urine: Epithelial cells: Scant Glucose: Negative Protein: 3+ WBC: 3/hpf Bacteria: None Leukocyte esterase: Negative Nitrites: Negative The patient is told to return in 3 days for a follow up appointment; however, his urinalysis at that time is similar. What is the best next step in management?? {'A': 'Basic metabolic panel', 'B': 'Renal biopsy', 'C': 'Repeat urinalysis', 'D': 'Urine dipstick in the morning and in the afternoon', 'E': 'Urine electrolytes and creatinine'},
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D: Urine dipstick in the morning and in the afternoon
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Q:A 29-year-old woman presents to her gynecologist for a routine check-up. She is sexually active with multiple partners and intermittently uses condoms for contraception. She denies vaginal discharge, burning, itching, or rashes in her inguinal region. Pelvic examination is normal. Results from a routine pap smear are shown. The cellular changes seen are attributable to which of the following factors?? {'A': 'Inhibition of p53', 'B': 'Activation p53', 'C': 'Activation of Rb', 'D': 'Activation of K-Ras', 'E': 'Inhibition of p16'},
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A: Inhibition of p53
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Q:An investigator is developing a drug that results in contraction of the pupillary dilator muscle when instilled topically. The drug works by increasing neurotransmitter release from the presynaptic nerve terminal. When administered intravenously, this drug is most likely to have which of the following additional effects?? {'A': 'Contraction of skeletal muscles', 'B': 'Acceleration of gut peristalsis', 'C': 'Relaxation of the bladder neck sphincter', 'D': 'Release of epinephrine by the adrenal medulla', 'E': 'Increase in pyloric sphincter tone'},
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E: Increase in pyloric sphincter tone
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Q:A previously healthy 7-month-old boy presents with fever, chills, cough, runny nose, and watery eyes. He has a blood pressure of 115/76 mm Hg, heart rate of 84/min, and respiratory rate of 14/min. Physical examination reveals clear lung sounds bilaterally. His mother reports that his brother has been having similar symptoms. A nasal swab is obtained, and he is diagnosed with influenza. Assuming that this is the child’s first exposure to the influenza virus, which of the following immune mechanisms will most likely function to combat the viral infection?? {'A': 'Eosinophil-mediated lysis of infected cells', 'B': 'Virus-specific immunoglobulins to remove free virus', 'C': 'Complement-mediated lysis of infected cells', 'D': 'Presentation of viral peptides on MHC-II of CD4+ T cells', 'E': 'Natural killer cell-induced lysis of infected cells'},
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E: Natural killer cell-induced lysis of infected cells
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Q:A 57-year-old man presents with an ongoing asymptomatic rash for 2 weeks. A similar rash is seen in both axillae. He has a medical history of diabetes mellitus for 5 years and dyspepsia for 6 months. His medications include metformin and aspirin. His vital signs are within normal limits. His BMI is 29 kg/m2. The physical examination shows conjunctival pallor. The cardiopulmonary examination reveals no abnormalities. The laboratory test results are as follows: Hemoglobin 9 g/dL Mean corpuscular volume 72 μm3 Platelet count 469,000/mm3 Red cell distribution width 18% HbA1C 6.5% Which of the following is the most likely underlying cause of this patient’s condition?? {'A': 'Diabetes mellitus', 'B': 'Gastric cancer', 'C': 'Metformin', 'D': 'Sarcoidosis', 'E': 'Tinea capitis'},
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B: Gastric cancer
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Q:During a humanitarian mission to southeast Asia, a 42-year-old man is brought to the outpatient clinic for a long history (greater than 2 years) of progressive, painless, enlargement of his scrotum. The family history is negative for malignancies and inheritable diseases. The personal history is relevant for cigarette smoking (up to 2 packs per day for the last 20 years) and several medical consultations for an episodic fever that resolved spontaneously. The physical examination is unremarkable, except for an enlarged left hemiscrotum that transilluminates. Which of the following accounts for the underlying mechanism in this patient's condition?? {'A': 'Idiopathic', 'B': 'Autoimmune', 'C': 'Invasive neoplasm', 'D': 'Decreased lymphatic fluid absorption', 'E': 'Patent processus vaginalis'},
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D: Decreased lymphatic fluid absorption
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Q:A 25-year-old African-American woman visits the doctor’s office complaining of fatigue for a couple of months. She says that she feels exhausted by the end of the day. She works as a dental assistant and is on her feet most of the time. However, she eats well and also tries to walk for 30 minutes every morning. She also says that she sometimes feels breathless and has to gasp for air, especially when she is walking or jogging. Her past medical history is insignificant, except for occasional bouts of cold during the winters. Her physical exam findings are within normal limits except for moderate conjunctival pallor. Complete blood count results and iron profile are as follows: Hemoglobin 9 g/dL Hematocrit 28.5% RBC count 5.85 x 106/mm3 WBC count 5,500/mm3 Platelet count 212,000/mm3 MCV 56.1 fl MCH 20.9 pg/cell MCHC 25.6 g/dL RDW 11.7% Hb/cell Serum iron 170 mcg/dL Total iron-binding capacity (TIBC) 458 mcg/dL Transferrin saturation 60% A peripheral blood smear is given. When questioned about her family history of anemia, she says that all she remembers is her dad was never allowed to donate blood as he was anemic. Which of the following most likely explains her cell counts and blood smear results?? {'A': 'Iron-deficiency anemia', 'B': 'Thalassemia', 'C': 'B12 deficiency', 'D': 'Hemolysis', 'E': 'Folate deficiency'},
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B: Thalassemia
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Q:A 32-year-old woman comes to the emergency department with a 2-day history of abdominal pain and diarrhea. She has had about 8 voluminous stools per day, some of which were bloody. She visited an international food festival three days ago. She takes no medications. Her temperature is 39.5°C (103.1°F), pulse is 90/min, and blood pressure is 110/65 mm Hg. Examination shows a tender abdomen, increased bowel sounds, and dry mucous membranes. Microscopic examination of the stool shows polymorphonuclear leukocytes. Stool culture results are pending. Which of the following most likely caused the patient's symptoms?? {'A': 'Reheated rice', 'B': 'Yogurt dip', 'C': 'Toxic mushrooms', 'D': 'Home-canned vegetables', 'E': 'Omelette'},
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E: Omelette
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Q:A 72-year-old man goes to his primary care provider for a checkup after some blood work showed lymphocytosis 3 months ago. He says he has been feeling a bit more tired lately but doesn’t complain of any other symptoms. Past medical history is significant for hypertension and hyperlipidemia. He takes lisinopril, hydrochlorothiazide, and atorvastatin. Additionally, his right hip was replaced three years ago due to osteoarthritis. Family history is noncontributory. He drinks socially and does not smoke. Today, he has a heart rate of 95/min, respiratory rate of 17/min, blood pressure of 135/85 mm Hg, and temperature of 36.8°C (98.2°F). On physical exam, he looks well. His heartbeat has a regular rate and rhythm and lungs that are clear to auscultation bilaterally. Additionally, he has mild lymphadenopathy of his cervical lymph nodes. A complete blood count with differential shows the following: Leukocyte count 5,000/mm3 Red blood cell count 3.1 million/mm3 Hemoglobin 11.0 g/dL MCV 95 um3 MCH 29 pg/cell Platelet count 150,000/mm3 Neutrophils 40% Lymphocytes 40% Monocytes 5% A specimen is sent for flow cytometry that shows a population that is CD 5, 19, 20, 23 positive. Which of the following is the most likely diagnosis?? {'A': 'Aplastic anemia', 'B': 'Chronic lymphocytic leukemia', 'C': 'Tuberculosis', 'D': 'Acute lymphoblastic leukemia', 'E': 'Immune thrombocytopenic purpura'},
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B: Chronic lymphocytic leukemia
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Q:If the genetic material were isolated and injected into the cytoplasm of a human cell, which of the following would produce viable, infectious virions?? {'A': 'Rhinovirus', 'B': 'Rabies virus', 'C': 'Mumps virus', 'D': 'Influenza virus', 'E': 'Lassa fever virus'},
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A: Rhinovirus
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Q:A 57-year-old man comes to the physician because of a 2-year history of fatigue, worsening shortness of breath, and a productive cough for 2 years. He has smoked 1 pack of cigarettes daily for the past 40 years. Examination shows pursed-lip breathing and an increased anteroposterior chest diameter. There is diffuse wheezing bilaterally and breath sounds are distant. Which of the following parameters is most likely to be decreased in this patient?? {'A': 'Work of breathing', 'B': 'Lung elastic recoil', 'C': 'Lower airway resistance', 'D': 'Thickness of small airways', 'E': 'Pulmonary vascular pressure'},
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B: Lung elastic recoil
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Q:A 3255-g (7-lb) female newborn is delivered at term. Pregnancy and delivery were uncomplicated. On the day of her birth, she is given a routine childhood vaccine that contains a noninfectious glycoprotein. This vaccine will most likely help prevent infection by which of the following pathogens?? {'A': 'Haemophilus influenzae type b', 'B': 'Poliovirus', 'C': 'Bordetella pertussis', 'D': 'Rotavirus', 'E': 'Hepatitis D virus\n"'},
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E: Hepatitis D virus "
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Q:A 47-year-old woman comes to the physician for a mass in her left breast she noticed 2 days ago during breast self-examination. She has hypothyroidism treated with levothyroxine. There is no family history of breast cancer. Examination shows large, moderately ptotic breasts. The mass in her left breast is small (approximately 1 cm x 0.5 cm), firm, mobile, and painless. It is located 4 cm from her nipple-areolar complex at the 7 o'clock position. There are no changes in the skin or nipple, and there is no palpable axillary adenopathy. No masses are palpable in her right breast. A urine pregnancy test is negative. Mammogram showed a soft tissue mass with poorly defined margins. Core needle biopsy confirms a low-grade infiltrating ductal carcinoma. The pathological specimen is positive for estrogen receptors and negative for progesterone and human epidermal growth factor receptor 2 (HER2) receptors. Staging shows no distant metastatic disease. Which of the following is the most appropriate next step in management?? {'A': 'Nipple-sparing mastectomy with axillary lymph node dissection followed by hormone therapy', 'B': 'Nipple-sparing mastectomy with axillary lymph node dissection, followed by radiation and hormone therapy', 'C': 'Lumpectomy with sentinel lymph node biopsy followed by hormone therapy', 'D': 'Radical mastectomy followed by hormone therapy', 'E': 'Lumpectomy with sentinel lymph node biopsy, followed by radiation and hormone therapy\n"'},
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E: Lumpectomy with sentinel lymph node biopsy, followed by radiation and hormone therapy "
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Q:A 50-year-old male is brought to the dermatologist's office with complaints of a pigmented lesion. The lesion is uniformly dark with clean borders and no asymmetry and has been increasing in size over the past two weeks. He works in construction and spends large portions of his day outside. The dermatologist believes that this mole should be biopsied. To prepare the patient for the biopsy, the dermatologist injects a small amount of lidocaine into the skin around the lesion. Which of the following nerve functions would be the last to be blocked by the lidocaine?? {'A': 'Sympathetic stimulation', 'B': 'Pain', 'C': 'Temperature', 'D': 'Touch', 'E': 'Pressure'},
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E: Pressure
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Q:A 36-year-old man is brought to the emergency department 3 hours after the onset of progressively worsening upper abdominal pain and 4 episodes of vomiting. His father had a myocardial infarction at the age of 40 years. Physical examination shows tenderness and guarding in the epigastrium. Bowel sounds are decreased. His serum amylase is 400 U/L. Symptomatic treatment and therapy with fenofibrate are initiated. Further evaluation of this patient is most likely to show which of the following findings?? {'A': 'Salt and pepper skull', 'B': 'Decreased serum ACTH levels', 'C': 'Eruptive xanthomas', 'D': 'Separate dorsal and ventral pancreatic ducts', 'E': 'Elevated serum IgG4 levels'},
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C: Eruptive xanthomas
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Answer the following medical question with one of the provided options:
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Q:A 40-year-old man presents to the emergency department with a chief complaint of chest pain for the last 3 hours. His ECG shows normal sinus rhythm with ST-segment elevation in leads II, III, and aVF and reciprocal segment depression in leads V1–V6. On physical examination, cardiac sounds are normal on auscultation. His blood pressure is 92/64 mm Hg and heart rate was 93/min. A tissue plasminogen activator is administered to the patient intravenously within 1 hour of hospital arrival due to a lack of available percutaneous coronary intervention. After 6 hours of therapy, the patient’s clinical condition starts to deteriorate. ECG on the monitor shows accelerated idioventricular rhythm, which within a couple of minutes changes to ventricular fibrillation. Before any measures could be started, the patient deteriorates further and must be transferred to the ICU. What is the most likely etiology of the ECG findings in this patient?? {'A': 'Increase in cellular pH', 'B': 'Increased production of superoxide dismutase', 'C': 'Calcium efflux', 'D': 'Inhibition of lipid peroxidation', 'E': 'Free radical formation'},
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E: Free radical formation
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Answer the following medical question with one of the provided options:
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Q:A 31-year-old woman comes to the physician for evaluation of worsening pain, swelling, and erythema in her left leg for the past 4 hours. She returned from a trip to Taiwan to celebrate her sister's wedding 2 days ago. She has no history of serious illness. She is sexually active with one male partner and uses a combined oral contraceptive pill (OCP). She does not smoke, drink, or use illicit drugs. Her only other medication is a multivitamin. Her temperature is 37.2°C (99°F), pulse is 67/min, respirations are 16/min, and blood pressure is 90/60 mm Hg. Examination shows swelling in her left calf and pain behind her left knee when she is asked to dorsiflex her left foot. Laboratory results show elevated D-dimers. Which of the following is the most likely cause of this patient's clinical presentation?? {'A': 'Increased protein C', 'B': 'Decreased fibrinogen', 'C': 'ADAMTS13 deficiency', 'D': 'Vitamin K supplementation', 'E': 'Decreased protein S\n"'},
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E: Decreased protein S "
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Answer the following medical question with one of the provided options:
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Q:A 9-year-old male presents to your office with an indurated rash on his face. You diagnose erythema infectiosum. Which of the following is characteristic of the virus causing this patient's disease?? {'A': 'Enveloped virus with double-stranded DNA', 'B': 'Enveloped virus with single-stranded DNA', 'C': 'Enveloped virus with single-stranded RNA', 'D': 'Non-enveloped virus with double-stranded DNA', 'E': 'Non-enveloped virus with single-stranded DNA'},
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E: Non-enveloped virus with single-stranded DNA
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Answer the following medical question with one of the provided options:
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Q:A 5-year-old boy is brought to the physician because of behavioral problems. His mother says that he has frequent angry outbursts and gets into fights with his classmates. He constantly complains of feeling hungry, even after eating a full meal. He has no siblings, and both of his parents are healthy. He is at the 25th percentile for height and is above the 95th percentile for weight. Physical examination shows central obesity, undescended testes, almond-shaped eyes, and a thin upper lip. Which of the following genetic changes is most likely associated with this patient's condition?? {'A': 'Microdeletion of long arm of chromosome 7', 'B': 'Mutation of FBN-1 gene on chromosome 15', 'C': 'Mitotic nondisjunction of chromosome 21', 'D': 'Deletion of Phe508 on maternal chromosome 7', 'E': 'Methylation of maternal chromosome 15'},
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E: Methylation of maternal chromosome 15
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Answer the following medical question with one of the provided options:
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Q:A 55-year-old woman with type 1 diabetes mellitus comes to the physician because of a 3-month history of progressively worsening urinary incontinence. She has started to wear incontinence pads because of frequent involuntary dribbling of urine that occurs even when resting. She has the sensation of a full bladder even after voiding. Her only medication is insulin. Physical examination shows a palpable suprapubic mass. Urinalysis is unremarkable. Urodynamic studies show an increased post-void residual volume. Which of the following interventions is most likely to benefit this patient?? {'A': 'Intermittent catheterization', 'B': 'Amitriptyline therapy', 'C': 'Prazosin therapy', 'D': 'Duloxetine therapy', 'E': 'Oxybutynin therapy'},
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A: Intermittent catheterization
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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 with a past medical history of diabetes and hypertension presents to the emergency department with crushing substernal chest pain. He was given aspirin and nitroglycerin en route and states that his pain is currently a 2/10. The patient’s initial echocardiogram (ECG) is within normal limits, and his first set of cardiac troponins is 0.10 ng/mL (reference range < 0.10 ng/mL). The patient is sent to the observation unit. The patient is given dipyridamole, which causes his chest pain to recur. Which of the following is the most likely etiology of this patient’s current symptoms?? {'A': 'Cardiac sarcoidosis', 'B': 'Coronary steal', 'C': 'Dislodged occlusive thrombus', 'D': 'Stress induced cardiomyopathy', 'E': 'Vasospastic vessel disease'},
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B: Coronary steal
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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 parents to the emergency department for lethargy and vomiting. The patient was fine until this afternoon, when his parents found him in the garage with an unlabeled open bottle containing an odorless liquid. On exam, the patient is not alert or oriented, but is responsive to touch and pain. The patient is afebrile and pulse is 90/min, blood pressure is 100/60 mmHg, and respirations are 20/min. Which of the following is an antidote for the most likely cause of this patient’s presentation?? {'A': 'Glucagon', 'B': 'Fomepizole', 'C': 'Succimer', 'D': 'Epinephrine', 'E': 'Sodium bicarbonate'},
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B: Fomepizole
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Answer the following medical question with one of the provided options:
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Q:A 27-year-old woman was found lying unconscious on the side of the street by her friend. He immediately called the ambulance who were close to this neighborhood. On initial examination, she appears barely able to breathe. Her pupils are pinpoint. The needles she likely used were found on site but the drug she injected was unknown. The first responders were quick to administer a drug which is effectively used in these situations and her symptoms slowly began to reverse. She was taken to the nearest emergency department for further workup. Which of the following best describes the mechanism of action of the drug administered by the first responders?? {'A': 'Kappa receptor pure agonist', 'B': 'NMDA receptor antagonist', 'C': 'Alpha 2 receptor agonist', 'D': 'Mu receptor antagonist', 'E': 'Delta receptor antagonist'},
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D: Mu receptor antagonist
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