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Answer the following medical question with one of the provided options:
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Q:A 58-year-old man comes to the emergency department with complaints of abdominal pain, swelling, and fever for the last few days. Pain is situated in the right upper quadrant (RUQ) and is dull and aching. He scores it as 6/10 with no exacerbating or relieving factors. He also complains of anorexia for the same duration. The patient experiences a little discomfort while lying flat and has been sleeping in a recliner for the past 2 days. There has been no chest pain, nausea, vomiting, or change in bowel or bladder habit. He does not use tobacco, alcohol, or any recreational drug. He is suffering from polycythemia vera and undergoes therapeutic phlebotomy every 2 weeks, but he has missed several appointments. The patient’s mother died of a heart attack, and his father died from a stroke. Temperature is 38.2°C (100.8°F), blood pressure is 142/88 mm Hg, pulse is 106/min, respirations are 16/min, and BMI is 20 kg/m2. On physical examination, his heart and lungs appear normal. Abdominal exam reveals tenderness to palpation in the RUQ and shifting dullness. Laboratory test Hemoglobin 20.5 g/dL Hematocrit 62% WBC 16,000/mm3 Platelets 250,000/mm3 Albumin 3.8 g/dL Diagnostic paracentesis Albumin 2.2 g/dL WBC 300/µL (reference range: < 500 leukocytes/µL) What is the best next step in management of the patient?? {'A': 'Echocardiography', 'B': 'Ultrasound', 'C': 'Liver biopsy', 'D': 'MRI', 'E': 'Venography'},
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B: Ultrasound
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Answer the following medical question with one of the provided options:
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Q:A 42-year-old female complains of feeling anxious and worrying about nearly every aspect of her daily life. She cannot identify a specific cause for these symptoms and admits that this tension is accompanied by tiredness and difficulty falling asleep. To treat this problem, the patient is prescribed sertraline. She endorses a mild improvement with this medication, and over the next several months, her dose is increased to the maximum allowed dose with modest improvement. Her psychiatrist adds an adjunctive treatment, a medication which notably lacks any anticonvulsant or muscle relaxant properties. This drug most likely acts at which of the following receptors?? {'A': 'GABA receptor', 'B': 'Alpha adrenergic receptor', 'C': 'Glycine receptor', 'D': '5HT-1A receptor', 'E': 'Beta adrenergic receptor'},
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D: 5HT-1A receptor
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Answer the following medical question with one of the provided options:
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Q:An 81-year-old woman presents to your office accompanied by her husband. She has been doing well except for occasional word finding difficulty. Her husband is concerned that her memory is worsening over the past year. Recently, she got lost twice on her way home from her daughter’s house, was unable to remember her neighbor’s name, and could not pay the bills like she usually did. She has a history of hypertension and arthritis. She has no significant family history. Her medications include a daily multivitamin, hydrochlorothiazide, and ibuprofen as needed. Physical exam is unremarkable. Which of the following is associated with an increased risk of this patient’s disease?? {'A': 'ApoE2', 'B': 'ApoE4', 'C': 'Presenilin-2', 'D': 'Frontotemporal lobe degeneration', 'E': 'Intracellular aggregates of alpha-synuclein'},
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B: ApoE4
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Answer the following medical question with one of the provided options:
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Q:A 36-year-old man is brought to the emergency department for right upper quadrant abdominal pain that began 3 days ago. The pain is nonradiating and has no alleviating or exacerbating factors. He denies any nausea or vomiting. He immigrated from Mexico 6 months ago and currently works at a pet shop. He has been healthy except for 1 week of bloody diarrhea 5 months ago. He is 182 cm (5 ft 11 in) tall and weighs 120 kg (264 lb); BMI is 36 kg/m2. His temperature is 101.8°F (38.8°C), pulse is 85/min, respirations are 14/min, and blood pressure is 120/75 mm Hg. Lungs are clear to auscultation. He has tenderness to palpation in the right upper quadrant. Laboratory studies show: Hemoglobin 11.7 g/dL3 Leukocyte Count 14,000/mm Segmented neutrophils 74% Eosinophils 2% Lymphocytes 17% Monocytes 7% Platelet count 140,000/mm3 Serum Na+ 139 mEq/L Cl- 101 mEq/L K+ 4.4 mEq/L HCO3- 25 mEq/L Urea nitrogen 8 mg/dL Creatinine 1.6 mg/dL Total bilirubin 0.4 mg/dL AST 76 U/L ALT 80 U/L Alkaline phosphatase 103 U/L Ultrasonography of the abdomen shows a 4-cm round, hypoechoic lesion in the right lobe of the liver with low-level internal echoes. Which of the following is the most likely diagnosis?"? {'A': 'Amebiasis', 'B': 'Hepatic hydatid cyst', 'C': 'Liver hemangioma', 'D': 'Pyogenic liver abscess', 'E': 'Hepatocellular carcinoma'},
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A: Amebiasis
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Answer the following medical question with one of the provided options:
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Q:A 4-year-old boy with a rash is brought in by his mother. The patient’s mother says that his symptoms started acutely a few hours ago after they had eaten shellfish at a restaurant which has progressively worsened. She says that the rash started with a few bumps on his neck and chest but quickly spread to involve his arms and upper torso. The patient says the rash makes him uncomfortable and itches badly. He denies any fever, chills, night sweats, dyspnea, or similar symptoms in the past. Past medical history is significant for a history of atopic dermatitis at the age of 9 months which was relieved with some topical medications. The patient is afebrile and his vital signs are within normal limits. On physical examination, the rash consists of multiple areas of erythematous, raised macules that blanch with pressure as shown in the exhibit (see image). There is no evidence of laryngeal swelling and his lungs are clear to auscultation. Which of the following is the best course of treatment for this patient’s most likely condition?? {'A': 'No treatment necessary', 'B': 'Topical corticosteroids', 'C': 'Cetirizine', 'D': 'Prednisone', 'E': 'IM epinephrine'},
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C: Cetirizine
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Answer the following medical question with one of the provided options:
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Q:A 40-year-old woman comes to the physician for a 6-month history of recurrent episodes of chest pain, racing pulse, dizziness, and difficulty breathing. The episodes last up to several minutes. She also reports urinary urgency and two episodes of loss of consciousness followed by spontaneous recovery. There is no personal or family history of serious illness. She does not smoke or drink alcohol. Vitals signs are within normal limits. Cardiopulmonary examination shows no abnormalities. Holter monitoring is performed. ECG recordings during episodes of tachycardia show a QRS duration of 100 ms, regular RR-interval, and absent P waves. Which of the following is the most likely underlying cause of this patient's condition?? {'A': 'Macroreentrant rhythm in the right atria through cavotricuspid isthmus', 'B': 'AV node with slow and fast pathway', 'C': 'Pre-excitation of the ventricles', 'D': 'Fibrosis of the sinoatrial node and surrounding myocardium', 'E': 'Mutations in genes that code for myocyte ion channels'},
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B: AV node with slow and fast pathway
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Answer the following medical question with one of the provided options:
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Q:A 19-year-old man is brought to the emergency department 35 minutes after being involved in a high-speed motor vehicle collision. On arrival, he is alert, has mild chest pain, and minimal shortness of breath. He has one episode of vomiting in the hospital. His temperature is 37.3°C (99.1°F), pulse is 108/min, respirations are 23/min, and blood pressure is 90/70 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 92%. Examination shows multiple abrasions over his trunk and right upper extremity. There are coarse breath sounds over the right lung base. Cardiac examination shows no murmurs, rubs, or gallop. Infusion of 0.9% saline is begun. He subsequently develops increasing shortness of breath. Arterial blood gas analysis on 60% oxygen shows: pH 7.36 pCO2 39 mm Hg pO2 68 mm Hg HCO3- 18 mEq/L O2 saturation 81% An x-ray of the chest shows patchy, irregular infiltrates over the right lung fields. Which of the following is the most likely diagnosis?"? {'A': 'Pneumothorax', 'B': 'Pulmonary contusion', 'C': 'Pulmonary embolism', 'D': 'Aspiration pneumonia', 'E': 'Acute respiratory distress syndrome'},
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B: Pulmonary contusion
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Answer the following medical question with one of the provided options:
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Q:A 17-year-old male with a history of bipolar disorder presents to clinic with a rash (Image A) that he noticed one week after starting a medication to stabilize his mood. The medication blocks voltage-gated sodium channels and can be used to treat partial simple, partial complex, and generalized tonic-clonic seizures. Regarding the patient's rash, what is the next step in management?? {'A': 'Reassure the patient that it is normal to have a rash in the first week and to continue the drug as directed', 'B': 'Begin diphenhydramine and continue the drug as directed', 'C': 'Begin a short course of oral steroids and continue the drug as directed', 'D': 'Decrease the dose by 50% and continue', 'E': 'Immediately discontinue the drug'},
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E: Immediately discontinue the drug
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Answer the following medical question with one of the provided options:
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Q:A 63-year-old woman comes to the physician for a routine health maintenance examination. She reports feeling tired sometimes and having itchy skin. Over the past 2 years, the amount of urine she passes has been slowly decreasing. She has hypertension and type 2 diabetes mellitus complicated with diabetic nephropathy. Her current medications include insulin, furosemide, amlodipine, and a multivitamin. Her nephrologist recently added erythropoietin to her medication regimen. She follows a diet low in salt, protein, potassium, and phosphorus. Her temperature is 37°C (98.6°F), pulse is 80/min, and blood pressure is 145/87 mm Hg. Physical examination shows 1+ edema around the ankles bilaterally. Laboratory studies show: Hemoglobin 9.8 g/dL Serum Glucose 98 mg/dL Albumin 4 g/dL Na+ 145 mEq/L Cl– 100 mEq/L K+ 5.1 mEq/L Urea nitrogen 46 mg/dL Creatinine 3.1 mg/dL Which of the following complications is the most common cause of death in patients receiving long-term treatment for this patient's renal condition?"? {'A': 'Malignancy', 'B': 'Discontinuation of treatment', 'C': 'Anemia', 'D': 'Gastrointestinal bleeding', 'E': 'Cardiovascular disease'},
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E: Cardiovascular disease
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Answer the following medical question with one of the provided options:
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Q:A 36-year-old nulligravid woman comes to the physician because of a 1-year history of pelvic discomfort and heavy menstrual bleeding. The pain is dull and pressure-like and occurs intermittently; the patient is asymptomatic between episodes. Menses occur at regular 30-day intervals and last 8 days with heavy flow. Her last menstrual period ended 5 days ago. She is sexually active and does not use contraception. Her temperature is 36.8°C (98.8°F), pulse is 76/min, and blood pressure is 106/68 mm Hg. Pelvic examination shows white cervical mucus and a firm, irregularly-shaped uterus consistent in size with a 5-week gestation. A spot urine pregnancy test is negative. Which of the following is the most appropriate next step in diagnosis?? {'A': 'Pelvic radiograph', 'B': 'Laparoscopy', 'C': 'Pelvic MRI', 'D': 'Pelvic ultrasound', 'E': 'Repeat β-HCG test'},
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D: Pelvic ultrasound
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Answer the following medical question with one of the provided options:
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Q:A 63-year-old man presents to the emergency department complaining of sudden-onset severe dyspnea and right-sided chest pain. The patient has a history of chronic obstructive pulmonary disease, hypertension, peptic ulcer disease, and hyperthyroidism. He has smoked a pack of cigarettes daily for 20 years, drinks socially, and does not take illicit drugs. The blood pressure is 130/80 mm Hg, the pulse is 98/min and regular, and the respiratory rate is 20/min. Pulse oximetry shows 90% on room air. On physical examination, he is in mild respiratory distress. Tactile fremitus and breath sounds are decreased on the right, with hyperresonance on percussion. The trachea is midline and no heart murmurs are heard. Which of the following is the most likely underlying mechanism of this patient's current condition?? {'A': 'Compression of a main bronchus due to neoplasia', 'B': 'Formation of an intimal flap in the aorta', 'C': 'Perforation of a peptic ulcer', 'D': 'Increased myocardial oxygen demand', 'E': 'Rupture of an apical alveolar bleb'},
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E: Rupture of an apical alveolar bleb
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Answer the following medical question with one of the provided options:
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Q:An investigator is studying genetic mutations of coagulation factors from patient samples. Genetic sequencing of one patient's coagulation factors shows a DNA point mutation that substitutes guanine for adenine. The corresponding mRNA codon forms a glutamine in place of arginine on position 506 at the polypeptide cleavage site. This patient's disorder is most likely to cause which of the following?? {'A': 'Petechiae', 'B': 'Cerebral vein thrombosis', 'C': 'Hemarthrosis', 'D': 'Iron deficiency', 'E': 'Ischemic stroke'},
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B: Cerebral vein thrombosis
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Answer the following medical question with one of the provided options:
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Q:A 29-year-old woman presents to the primary care office for a recent history of falls. She has fallen 5 times over the last year. These falls are not associated with any preceding symptoms; she specifically denies dizziness, lightheadedness, or visual changes. However, she has started noticing that both of her legs feel weak. She's also noticed that her carpet feels strange beneath her bare feet. Her mother and grandmother have a history of similar problems. On physical exam, she has notable leg and foot muscular atrophy and 4/5 strength throughout her bilateral lower extremities. Sensation to light touch and pinprick is decreased up to the mid-calf. Ankle jerk reflex is absent bilaterally. Which of the following is the next best diagnostic test for this patient?? {'A': 'Ankle-brachial index', 'B': 'Electromyography (including nerve conduction studies)', 'C': 'Hemoglobin A1c', 'D': 'Lumbar puncture', 'E': 'MRI brain'},
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B: Electromyography (including nerve conduction studies)
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Answer the following medical question with one of the provided options:
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Q:An 8-year-old African-American boy is brought into the emergency department by his mother due to intense abdominal pain and pain in his thighs. The mother states that she also suffers from the same disease and that the boy has been previously admitted for episodes such as this. On exam, the boy is in 10/10 pain. His vitals are HR 110, BP 100/55, T 100.2F, RR 20. His CBC is significant for a hemoglobin of 9.5 and a white blood cell count of 13,000. His mother asks if there is anything that can help her child in the long-term. Which of the following can decrease the frequency and severity of these episodes?? {'A': 'Oxygen', 'B': 'Opiates', 'C': 'Hydroxyurea', 'D': 'Normal saline', 'E': 'Exchange transfusion'},
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C: Hydroxyurea
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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 comes to the emergency department because of a diffuse, itchy rash and swollen face for 6 hours. That morning, she was diagnosed with an abscess of the lower leg. She underwent treatment with incision and drainage as well as oral antibiotics. She has no history of serious illness. She is not in acute distress. Her temperature is 37.2°C (99°F), pulse is 78/min, and blood pressure is 128/84 mm Hg. Physical examination shows mild swelling of the eyelids and lips. There are multiple erythematous patches and wheals over her upper extremities, back, and abdomen. The lungs are clear to auscultation. Cardiac examination shows no abnormalities. After discontinuing all recently administered drugs and beginning continuous vital sign monitoring, which of the following is the most appropriate next step in management?? {'A': 'Watchful waiting and regular reassessments', 'B': 'Intravenous ranitidine administration', 'C': 'Intravenous methylprednisolone, ranitidine, and diphenhydramine administration', 'D': 'Intramuscular epinephrine and intravenous hydrocortisone administration', 'E': 'Endotracheal intubation and mechanical ventilation'},
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C: Intravenous methylprednisolone, ranitidine, and diphenhydramine administration
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Answer the following medical question with one of the provided options:
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Q:An 86-year-old male is admitted to the hospital under your care for management of pneumonia. His hospital course has been relatively uneventful, and he is progressing well. While making morning rounds on your patients, the patient's cousin approaches you in the hallway and asks about the patient's prognosis and potential future discharge date. The patient does not have an advanced directive on file and does not have a medical power of attorney. Which of the following is the best course of action?? {'A': 'Explain that the patient is progressing well and should be discharged within the next few days.', 'B': "Provide the cousin with the patient's most recent progress notes and a draft of his discharge summary.", 'C': "Direct the cousin to the patient's room, telling him that you will be by within the hour to discuss the plan.", 'D': "Refer the cousin to ask the patient's wife about these topics.", 'E': "Explain that you cannot discuss the patient's care without explicit permission from the patient themselves."},
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E: Explain that you cannot discuss the patient's care without explicit permission from the patient themselves.
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Answer the following medical question with one of the provided options:
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Q:A first time mother of a healthy, full term, newborn girl is anxious about sudden infant death syndrome. Which of the following pieces of advice can reduce the risk of SIDS?? {'A': 'Sleep supine in a crib without bumpers, use a pacifier after 1 month of age, and avoidance smoking', 'B': 'Sleep supine in a crib without bumpers, use a pacifier after 1 month of age, and use a home apnea monitor', 'C': 'Sleep supine in a crib with bumpers, head propped up on a pillow, and wrapped in a warm blanket', 'D': 'Sleep supine in a crib with bumpers, head propped up on a pillow, and wrapped in an infant sleeper', 'E': "Sleep supine in the parent's bed and use a pacifier after 1 month of age"},
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A: Sleep supine in a crib without bumpers, use a pacifier after 1 month of age, and avoidance smoking
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Answer the following medical question with one of the provided options:
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Q:A 70-year-old man presents to his primary care physician for a general checkup. He states that he has been doing well and taking his medications as prescribed. He recently started a new diet and supplement to improve his health and has started exercising. The patient has a past medical history of diabetes, a myocardial infarction, and hypertension. He denies any shortness of breath at rest or with exertion. An ECG is performed and is within normal limits. Laboratory values are ordered as seen below. Serum: Na+: 139 mEq/L Cl-: 100 mEq/L K+: 6.7 mEq/L HCO3-: 25 mEq/L Glucose: 133 mg/dL Ca2+: 10.2 mg/dL Which of the following is the most likely cause of this patient's presentation?? {'A': 'Acute renal failure', 'B': 'Dietary changes', 'C': 'Hemolysis', 'D': 'Medication', 'E': 'Rhabdomyolysis'},
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D: Medication
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Answer the following medical question with one of the provided options:
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Q:A 51-year-old woman presents to the emergency department with a 2-day history of bilateral lower extremity swelling. She says that her legs do not hurt, but she noticed she was gaining weight and her legs were becoming larger. Her past medical history is significant for morbid obesity, hypertension, and hypercholesterolemia. She says the swelling started after she was recently started on a new medication to help her blood pressure, but she does not remember the name of the medication. Which of the following is the most likely the mechanism of action for the drug that was prescribed to this patient?? {'A': 'Inhibition of calcium channels', 'B': 'Inhibition of enzyme in the lung', 'C': 'Inhibition of hormone receptor', 'D': 'Potassium-sparing diuretic', 'E': 'Potassium-wasting diuretic'},
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A: Inhibition of calcium channels
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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 emergency room by his parents after slipping on a rug at home and experiencing exquisite pain and swelling of his arms. Radiographs reveal a new supracondylar fracture of the humerus, as well as indications of multiple, old fractures that have healed. His parents note that an inherited disorder is present in their family history. A comprehensive physical exam also reveals blue-tinted sclera and yellow-brown, discolored teeth. What is the etiology of the patient’s disorder?? {'A': 'Defect in the glycoprotein that forms a sheath around elastin', 'B': 'Defect in the hydroxylation step of collagen synthesis', 'C': 'Deficiency of type 1 collagen', 'D': 'Deficiency of type 3 procollagen', 'E': 'Deficiency of type 5 collagen'},
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C: Deficiency of type 1 collagen
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Answer the following medical question with one of the provided options:
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Q:A 27-year-old male presents to urgent care complaining of pain with urination. He reports that the pain started 3 days ago. He has never experienced these symptoms before. He denies gross hematuria or pelvic pain. He is sexually active with his girlfriend, and they consistently use condoms. When asked about recent travel, he admits to recently returning from a “boys' trip" in Cancun where he had unprotected sex 1 night with a girl he met at a bar. The patient’s medical history includes type I diabetes that is controlled with an insulin pump. His mother has rheumatoid arthritis. The patient’s temperature is 99°F (37.2°C), blood pressure is 112/74 mmHg, and pulse is 81/min. On physical examination, there are no lesions of the penis or other body rashes. No costovertebral tenderness is appreciated. A urinalysis reveals no blood, glucose, ketones, or proteins but is positive for leukocyte esterase. A urine microscopic evaluation shows a moderate number of white blood cells but no casts or crystals. A urine culture is negative. Which of the following is the most likely cause for the patient’s symptoms?? {'A': 'Chlamydia trachomatis', 'B': 'Herpes simplex virus', 'C': 'Mycobacterium tuberculosis', 'D': 'Systemic lupus erythematosus', 'E': 'Treponema pallidum'},
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A: Chlamydia trachomatis
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Answer the following medical question with one of the provided options:
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Q:A 26-year-old woman, gravida 2, para 1, at 9 weeks' gestation comes to the physician with her 16-month-old son for her first prenatal visit. Her son has had low-grade fever, headache, and arthralgia for 5 days. He has also had a generalized rash that started on the cheeks 2 days ago and has since spread to his body. The woman has some mild nausea but is feeling well. Her first pregnancy was uneventful. Her son was delivered at 40 weeks' gestation via lower segment transverse cesarean section because of a nonreassuring fetal heart rate. Current medications include prenatal vitamins with folic acid. Preconception rubella and varicella titers were recorded as adequate. His immunizations are up-to-date. His temperature is 36.8°C (98.2°F), pulse is 85/min, respirations are 13/min, and blood pressure is 114/65 mm Hg. Pelvic examination of the woman shows a uterus consistent in size with a 9-week gestation. An image of the woman's son is shown. A complete blood cell count is within normal limits. Which of the following is the most appropriate next step in management?? {'A': 'Report the disease to health authorities', 'B': 'Maternal serologic assays for virus-specific IgG and IgM', 'C': 'Antibiotics for the child', 'D': 'Serial fetal ultrasounds', 'E': 'Isolation precautions for the child'},
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B: Maternal serologic assays for virus-specific IgG and IgM
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Answer the following medical question with one of the provided options:
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Q:A 5-year-old is presented to the emergency department after being involved in an accident on the way to school. According to the paramedics, the patient was hit by a motor vehicle and his right leg was crushed. The parents were immediately contacted, and the physician explains that a limb-saving operation is the best treatment. The parents decline medical treatment to save the child’s leg. The parents explain that they heard that a child died in a similar scenario and would have lived if the limb had not been amputated. What is the next best step?? {'A': "Take the parents' wishes into account", 'B': 'Ask for a court order', 'C': 'Contact the next of kin', 'D': 'Take into account the child’s wishes', 'E': 'Inform the hospital Ethics Committee, state authority, and child protective services, and try to get a court order if it takes too long to proceed with the physician’s treatment plan.'},
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E: Inform the hospital Ethics Committee, state authority, and child protective services, and try to get a court order if it takes too long to proceed with the physician’s treatment plan.
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Answer the following medical question with one of the provided options:
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Q:An investigator is studying the relationship between suicide and unemployment using data from a national health registry that encompasses 10,000 people who died by suicide, as well as 100,000 matched controls. The investigator finds that unemployment was associated with an increased risk of death by suicide (odds ratio = 3.02; p < 0.001). Among patients with a significant psychiatric history, there was no relationship between suicide and unemployment (p = 0.282). Likewise, no relationship was found between the two variables among patients without a psychiatric history (p = 0.32). These results are best explained by which of the following?? {'A': 'Matching', 'B': 'Selection bias', 'C': 'Effect modification', 'D': 'Stratification', 'E': 'Confounding'},
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E: Confounding
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Answer the following medical question with one of the provided options:
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Q:A 7-month-old girl is brought to the hospital by her mother, who complains of a lesion on the infant’s labia for the past 5 days. The lesion is 2 x 2 cm in size and red in color with serosanguinous fluid oozing out of the right labia. The parents note that the girl has had a history of recurrent bacterial skin infections with no pus but delayed healing since birth. She also had delayed sloughing of the umbilical cord at birth. Complete blood count results are as follows: Neutrophils on admission Leukocytes 19,000/mm3 Neutrophils 83% Lymphocytes 10% Eosinophils 1% Basophils 1% Monocytes 5% Hemoglobin 14 g/dL Which of the following compounds is most likely to be deficient in this patient?? {'A': 'Cellular adhesion molecule', 'B': 'Selectin', 'C': 'vWF', 'D': 'Integrin subunit', 'E': 'TNF-alpha'},
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D: Integrin subunit
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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 visits the office with complaints of severe pain with urination for 5 days. In addition, he reports having burning discomfort and itchiness at the tip of his penis. He is also concerned regarding a yellow-colored urethral discharge that started a week ago. Before his symptoms began, he states that he had sexual intercourse with multiple partners at different parties organized by the hotel he was staying at. Physical examination shows edema and erythema concentrated around the urethral meatus accompanied by a mucopurulent discharge. Which of the following diagnostic tools will best aid in the identification of the causative agent for his symptoms?? {'A': 'Urethral biopsy', 'B': 'Leukocyte esterase dipstick test', 'C': 'Nucleic acid amplification tests (NAATs)', 'D': 'Tzanck smear', 'E': 'Gram stain'},
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C: Nucleic acid amplification tests (NAATs)
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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 receives a kidney transplant for autosomal dominant polycystic kidney disease (ADPKD). Three weeks later, the patient experiences acute, T-cell mediated rejection of the allograft and is given sirolimus. Which of the following are side effects of this medication?? {'A': 'Nephrotoxicity, hypertension', 'B': 'Pancreatitis', 'C': 'Hyperlipidemia, thrombocytopenia', 'D': 'Cytokine release syndrome, hypersensitivity reaction', 'E': 'Nephrotoxicity, gingival hyperplasia'},
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C: Hyperlipidemia, thrombocytopenia
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Answer the following medical question with one of the provided options:
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Q:A 39-year-old woman, gravida 5, para 4, at 41 weeks' gestation is brought to the hospital because of regular uterine contractions that started 2 hours ago. Pregnancy has been complicated by iron deficiency anemia treated with iron supplements. Pelvic examination shows the cervix is 90% effaced and 7-cm dilated; the vertex is at -1 station. Fetal heart tracing is shown. The patient is repositioned, O2 therapy is initiated, and amnioinfusion is done. A repeat assessment after 20 minutes shows a similar cervical status, and no changes in the fetal heart tracing, and less than 5 contractions in a period of 10 minutes.What is the most appropriate next step in management?? {'A': 'Begin active pushing', 'B': 'Retry maternal repositioning', 'C': 'Administer tocolytics', 'D': 'Monitor without intervention', 'E': 'Emergent cesarean delivery'},
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E: Emergent cesarean delivery
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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 is brought to the physician for pain and increasing swelling over her scalp for 1 month. She has not had any trauma to the area. There is no family or personal history of serious illness. Vital signs are within normal limits. Examination shows a 3-cm solitary, tender mass over the right parietal bone. X-ray of the skull shows a solitary osteolytic lesion. Laboratory studies show: Hemoglobin 10.9 g/dL Leukocyte count 7300/mm3 Serum Na+ 136 mEq/L K+ 3.7 mEq/L Cl- 103 mEq/L Ca2+ 9.1 mg/dL Glucose 71 mg/dL Which of the following is the most likely diagnosis?"? {'A': 'Multiple myeloma', 'B': 'Langerhans cell histiocytosis', 'C': 'Ewing sarcoma', 'D': 'Aneurysmal bone cyst', 'E': 'Giant-cell tumor of bone'},
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B: Langerhans cell histiocytosis
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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 with a history of biliary colic presents with one-day of intractable nausea, vomiting, and abdominal pain radiating to the back. Temperature is 99.7 deg F (37.6 deg C), blood pressure is 102/78 mmHg, pulse is 112/min, and respirations are 22/min. On abdominal exam, he has involuntary guarding and tenderness to palpation in the right upper quadrant and epigastric regions. Laboratory studies show white blood cell count 18,200/uL, alkaline phosphatase 650 U/L, total bilirubin 2.5 mg/dL, amylase 500 U/L, and lipase 1160 U/L. Which of the patient's laboratory findings is associated with increased mortality?? {'A': 'White blood cell count', 'B': 'Alkaline phosphatase', 'C': 'Total bilirubin', 'D': 'Amylase', 'E': 'Lipase'},
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A: White blood cell count
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Answer the following medical question with one of the provided options:
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Q:A 4-year-old girl is brought to the emergency department by her parents with a sudden onset of breathlessness. She has been having similar episodes over the past few months with a progressive increase in frequency over the past week. They have noticed that the difficulty in breathing is more prominent during the day when she plays in the garden with her siblings. She gets better once she comes indoors. During the episodes, she complains of an inability to breathe and her parents say that she is gasping for breath. Sometimes they hear a noisy wheeze while she breathes. The breathlessness does not disrupt her sleep. On examination, she seems to be in distress with noticeable intercostal retractions. Auscultation reveals a slight expiratory wheeze. According to her history and physical findings, which of the following mechanisms is most likely responsible for this child’s difficulty in breathing?? {'A': 'Chronic mucus plugging and inflammation leading to impaired mucociliary clearance', 'B': 'Destruction of the elastic layers of bronchial walls leading to abnormal dilation', 'C': 'Defective chloride channel function leading to mucus plugging', 'D': 'Inflammation leading to permanent dilation and destruction of alveoli', 'E': 'Airway hyperreactivity to external allergens causing intermittent airway obstruction'},
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E: Airway hyperreactivity to external allergens causing intermittent airway obstruction
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Answer the following medical question with one of the provided options:
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Q:During an experiment, the immunophenotypes of different cells in a sample are determined. The cells are labeled with fluorescent antibodies specific to surface proteins, and a laser is then focused on the samples. The intensity of fluorescence created by the laser beam is then plotted on a scatter plot. The result shows most of the cells in the sample to be positive for CD8 surface protein. Which of the following cell types is most likely represented in this sample?? {'A': 'Dendritic cells', 'B': 'Activated regulatory T lymphocytes', 'C': 'Mature cytotoxic T lymphocytes', 'D': 'Inactive B lymphocytes', 'E': 'Mature helper T lymphocytes'},
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C: Mature cytotoxic T lymphocytes
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Q:A 59-year-old truck driver presents to the emergency department after returning from his usual week-long trucking trip with excruciating pain around his anus. The patient admits to drinking beer when not working and notes that his meals usually consist of fast food. He has no allergies, takes no medications, and his vital signs are normal. On examination, he was found to have a tender lump on the right side of his anus that measures 1 cm in diameter. The lump is bluish and surrounded by edema. It is visible without the aid of an anoscope. It is soft and tender with palpation. The rest of the man’s history and physical examination are unremarkable. Which vein drains the vessels responsible for the formation of this lump?? {'A': 'Internal hemorrhoids', 'B': 'Internal pudendal', 'C': 'Inferior mesenteric', 'D': 'Superior rectal', 'E': 'Middle rectal'},
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B: Internal pudendal
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Q:A 42-year-old man comes to the emergency department complaining of chest pain. He states that he was at the grocery store when he developed severe, burning chest pain along with palpitations and nausea. He screamed for someone to call an ambulance. He says this has happened before, including at least 4 episodes in the past month that were all in different locations including once at home. He is worried that it could happen at work and affect his employment status. He has no significant past medical history, and reports that he does not like taking medications. He has had trouble in the past with compliance due to side effects. The patient’s temperature is 98.9°F (37.2°C), blood pressure is 133/74 mmHg, pulse is 110/min, and respirations are 20/min with an oxygen saturation of 99% on room air. On physical examination, the patient is tremulous and diaphoretic. He continually asks to be put on oxygen and something for his pain. An electrocardiogram is obtained that shows tachycardia. Initial troponin level is negative. A urine drug screen is negative. Thyroid stimulating hormone and free T4 levels are normal. Which of the following is first line therapy for the patient for long-term management?? {'A': 'Alprazolam', 'B': 'Buspirone', 'C': 'Cognitive behavioral therapy', 'D': 'Fluoxetine', 'E': 'Imipramine'},
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C: Cognitive behavioral therapy
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Q:A 29-year-old woman presents to the emergency department with a broken arm after she tripped and fell at work. She says that she has no history of broken bones but that she has been having bone pain in her back and hips for several months. In addition, she says that she has been waking up several times in the middle of the night to use the restroom and has been drinking a lot more water. Her symptoms started after she fell ill during an international mission trip with her church and was treated by a local doctor with unknown antibiotics. Since then she has been experiencing weight loss and muscle pain in addition to the symptoms listed above. Urine studies are obtained showing amino acids in her urine. The pH of her urine is also found to be < 5.5. Which of the following would most likely also be seen in this patient?? {'A': 'Decreased serum creatinine', 'B': 'Hypernatremia', 'C': 'Hyperkalemia', 'D': 'Hypocalcemia', 'E': 'Metabolic alkalosis'},
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D: Hypocalcemia
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Q:A 33-year-old pilot is transported to the emergency department after she was involved in a cargo plane crash during a military training exercise in South Korea. She is conscious but confused. She has no history of serious illness and takes no medications. Physical examination shows numerous lacerations and ecchymoses over the face, trunk, and upper extremities. The lower extremities are cool to the touch. There is continued bleeding despite the application of firm pressure to the sites of injury. The first physiologic response to develop in this patient was most likely which of the following?? {'A': 'Increased heart rate', 'B': 'Decreased urine output', 'C': 'Increased capillary refill time', 'D': 'Decreased systolic blood pressure', 'E': 'Increased respiratory rate'},
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A: Increased heart rate
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Q:A 61-year-old man comes to the physician for shortness of breath and chest discomfort that is becoming progressively worse. He has had increasing problems exerting himself for the past 5 years. He is now unable to walk more than 50 m on level terrain without stopping and mostly rests at home. He has smoked 1–2 packs of cigarettes daily for 40 years. He appears distressed. His pulse is 85/min, blood pressure is 140/80 mm Hg, and respirations are 25/min. Physical examination shows a plethoric face and distended jugular veins. Bilateral wheezing is heard on auscultation of the lungs. There is yellow discoloration of the fingers on the right hand and 2+ lower extremity edema. Which of the following is the most likely cause of this patient's symptoms?? {'A': 'Elevated pulmonary artery pressure', 'B': 'Increased left atrial pressure', 'C': 'Chronic respiratory acidosis', 'D': 'Coronary plaque deposits', 'E': 'Decreased intrathoracic gas volume'},
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A: Elevated pulmonary artery pressure
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Q:A previously healthy 36-year-old man is brought to the physician by a friend because of fatigue and a depressed mood for the past few weeks. During this time, he has not been going to work and did not show up to meet his friends for two bowling nights. The friend is concerned that he may lose his job. He spends most of his time alone at home watching television on the couch. He has been waking up often at night and sometimes takes 20 minutes to go back to sleep. He has also been drinking half a pint of whiskey per day for 1 week. His wife left him 4 weeks ago and moved out of their house. His vital signs are within normal limits. On mental status examination, he is oriented to person, place and time. He displays a flattened affect and says that he “doesn't know how he can live without his wife.” He denies suicidal ideation. Which of the following is the next appropriate step in management?? {'A': 'Prescribe a short course of alprazolam', 'B': 'Initiate cognitive behavioral therapy', 'C': 'Prescribe a short course of duloxetine', 'D': 'Initiate disulfiram therapy', 'E': 'Hospitalize the patient\n"'},
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B: Initiate cognitive behavioral therapy
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Q:A 64-year-old homeless man comes to the emergency department with right ear pain and difficulty hearing for 2 weeks. Over the last 5 days, he has also noticed discharge from his right ear. He does not recall the last time he saw a physician. His temperature is 39.0°C (102.2°F), blood pressure is 153/92 mm Hg, pulse is 113/minute, and respirations are 18/minute. He appears dirty and is malodorous. Physical examination shows mild facial asymmetry with the right corner of his mouth lagging behind the left when the patient smiles. He experiences severe ear pain when the right auricle is pulled superiorly. On otoscopic examination, there is granulation tissue at the transition between the cartilaginous and the osseous part of the ear canal. Which of the following is most likely associated with this patient's condition?? {'A': 'Malignant epithelial growth of the external auditory canal', 'B': 'Condylar degeneration', 'C': 'Opacified mastoid air cells', 'D': 'Streptococcus pneumoniae', 'E': 'Elevated HBA1c'},
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E: Elevated HBA1c
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Q:A 1-year-old girl is brought to the pediatrician because of a 6-month history of diarrhea. She has not received recommended well-child examinations. Her stools are foul-smelling and nonbloody. There is no family history of serious illness. She is at the 15th percentile for height and 5th percentile for weight. Physical examination shows abdominal distension. Her serum triglyceride concentration is 5 mg/dL. Genetic analysis shows a mutation in the gene that encodes microsomal triglyceride transfer protein. Which of the following is the most appropriate treatment for this patient's condition?? {'A': 'Nicotinic acid supplementation', 'B': 'Avoidance of dietary gluten', 'C': 'Restriction of long-chain fatty acids', 'D': 'Long-term antibiotic therapy', 'E': 'Pancreatic enzyme replacement'},
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C: Restriction of long-chain fatty acids
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Q:A 33-year-old man presents to the emergency department with back pain. He is currently intoxicated but states that he is having severe back pain and is requesting morphine and lorazepam. The patient has a past medical history of alcohol abuse, drug seeking behavior, and IV drug abuse and does not routinely see a physician. His temperature is 102°F (38.9°C), blood pressure is 127/68 mmHg, pulse is 120/min, respirations are 17/min, and oxygen saturation is 98% on room air. Physical exam is notable for tenderness over the thoracic and lumbar spine. The pain is exacerbated with flexion of the spine. The patient’s laboratory values are notable for the findings below. Hemoglobin: 12 g/dL Hematocrit: 36% Leukocyte count: 16,500/mm^3 with normal differential Platelet count: 197,000/mm^3 Serum: Na+: 139 mEq/L Cl-: 100 mEq/L K+: 4.3 mEq/L HCO3-: 25 mEq/L BUN: 20 mg/dL Glucose: 99 mg/dL Creatinine: 1.1 mg/dL Ca2+: 10.2 mg/dL CRP: 5.2 mg/L Further imaging is currently pending. Which of the following is the most likely diagnosis?? {'A': 'Herniated nucleus pulposus', 'B': 'Malingering', 'C': 'Musculoskeletal strain', 'D': 'Spinal epidural abscess', 'E': 'Spinal epidural hematoma'},
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D: Spinal epidural abscess
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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 headache, blurring of vision, and numbness of the right leg for the past 2 hours. He has hypertension and type 2 diabetes mellitus. Current medications include enalapril and metformin. He is oriented only to person. His temperature is 37.3°C (99.1°F), pulse is 99/min and blood pressure is 158/94 mm Hg. Examination shows equal pupils that are reactive to light. Muscle strength is normal in all extremities. Deep tendon reflexes are 2+ bilaterally. Sensation to fine touch and position is decreased over the right lower extremity. The confrontation test shows loss of the nasal field in the left eye and the temporal field in the right eye with macular sparing. He is unable to read phrases shown to him but can write them when they are dictated to him. He has short-term memory deficits. Which of the following is the most likely cause for this patient's symptoms?? {'A': 'Infarct of the right middle cerebral artery', 'B': 'Infarct of the right posterior cerebral artery', 'C': 'Infarct of the right anterior cerebral artery', 'D': 'Herpes simplex encephalitis', 'E': 'Infarct of the left posterior cerebral artery'},
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E: Infarct of the left posterior cerebral artery
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Q:A 12-year-old girl presents to her primary care physician for a well-child visit. She has a history of asthma and uses her inhaler 1-2 times per week when she exercises. She does not smoke and is not currently sexually active; however, she does have a boyfriend. She lives with her mother in an apartment and is doing well in school. Her temperature is 97.6°F (36.4°C), blood pressure is 124/75 mmHg, pulse is 80/min, respirations are 12/min, and oxygen saturation is 98% on room air. Physical exam is notable for a healthy young girl with no findings. Which of the following is most appropriate for this patient at this time?? {'A': 'HPV vaccine', 'B': 'Human papilloma virus PCR', 'C': 'Hypertension screening', 'D': 'Pelvic examination', 'E': 'Serum lipids and cholesterol'},
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A: HPV vaccine
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Q:A 3500-g (7.7-lbs) girl is delivered at 39 weeks' gestation to a 27-year-old woman, gravida 2, para 1. Apgar scores are 8 and 9 at 1 and 5 minutes, respectively. The mother had regular prenatal visits throughout the pregnancy. She did not smoke or drink alcohol. She took multivitamins as prescribed by her physician. The newborn appears active. The girl's temperature is 37°C (98.6°F), pulse is 120/min, and blood pressure is 55/35 mm Hg. Examination in the delivery room shows clitoromegaly. One day later, laboratory studies show: Hemoglobin 12.8 g/dL Leukocyte count 6,000/mm3 Platelet count 240,000/mm3 Serum Na+ 133 mEq/L K+ 5.2 mEq/L Cl− 101 mEq/L HCO3− 21 mEq/L Urea nitrogen 15 mg/dL Creatinine 0.8 mg/dL Ultrasound of the abdomen and pelvis shows normal uterus and normal ovaries. Which of the following is the most appropriate next step in the management of this newborn patient?"? {'A': 'Hydrocortisone and fludrocortisone therapy', 'B': 'Estrogen replacement therapy', 'C': 'Genital reconstruction surgery', 'D': 'Dexamethasone therapy', 'E': 'Spironolactone therapy'},
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A: Hydrocortisone and fludrocortisone therapy
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Q:A 35-year-old male with a history of hypertension presents with hematuria and abdominal discomfort. Ultrasound and CT scan reveal large, bilateral cysts in all regions of the kidney. The patient’s disease is most commonly associated with:? {'A': 'Aortic stenosis', 'B': 'Berger’s disease', 'C': 'Diabetes mellitus', 'D': 'Berry aneurysm', 'E': 'Henoch-Schonlein purpura'},
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D: Berry aneurysm
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Q:A 62-year-old man presents to the emergency department for evaluation of a 2-year history of increasing shortness of breath. He also has an occasional nonproductive cough. The symptoms get worse with exertion. The medical history is significant for hypertension and he takes chlorthalidone. He is a smoker with a 40-pack-year smoking history. On physical examination, the patient is afebrile; the vital signs include: blood pressure 125/78 mm Hg, pulse 90/min, and respiratory rate 18/min. The body mass index (BMI) is 31 kg/m2. The oxygen saturation is 94% at rest on room air. A pulmonary examination reveals decreased breath sounds bilaterally, but is otherwise normal with no wheezes or crackles. The remainder of the examination is unremarkable. A chest radiograph shows hyperinflation of both lungs with mildly increased lung markings, but no focal findings. Based on this clinical presentation, which of the following is most likely?? {'A': 'FEV1/FVC of 65%', 'B': 'Decreased total lung capacity', 'C': 'Increased DLCO', 'D': 'Metabolic acidosis', 'E': 'FEV1/FVC of 80% with an FEV1 of 82%'},
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A: FEV1/FVC of 65%
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Q:A 61-year-old woman comes to the physician because of a 6-month history of left knee pain and stiffness. Examination of the left knee shows tenderness to palpation along the joint line; there is crepitus with full flexion and extension. An x-ray of the knee shows osteophytes with joint-space narrowing. Arthrocentesis of the knee joint yields clear fluid with a leukocyte count of 120/mm3. Treatment with ibuprofen during the next week significantly improves her condition. The beneficial effect of this drug is most likely due to inhibition of which of the following?? {'A': 'Conversion of dihydroorotate to orotate', 'B': 'Conversion of hypoxanthine to urate', 'C': 'Conversion of prostaglandin H2 to thromboxane A2', 'D': 'Conversion of arachidonic acid to prostaglandin G2', 'E': 'Conversion of phospholipids to arachidonic acid'},
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D: Conversion of arachidonic acid to prostaglandin G2
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Q:A 55-year-old woman presents to a physician’s clinic for a diabetes follow-up. She recently lost weight and believes the diabetes is ‘winding down’ because the urinary frequency has slowed down compared to when her diabetes was "at its worst". She had been poorly compliant with medications, but she is now asking if she can decrease her medications as she feels like her diabetes is improving. Due to the decrease in urinary frequency, the physician is interested in interrogating her renal function. Which substance can be used to most accurately assess the glomerular filtration rate (GFR) in this patient?? {'A': 'Creatinine', 'B': 'Inulin', 'C': 'Urea', 'D': 'Glucose', 'E': 'Para-aminohippurate (PAH)'},
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B: Inulin
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Q:A 67-year-old man presents to the emergency department for altered mental status. The patient is a member of a retirement community and was found to have a depressed mental status when compared to his baseline. The patient has a past medical history of Alzheimer dementia and diabetes mellitus that is currently well-controlled. His temperature is 103°F (39.4°C), blood pressure is 157/108 mmHg, pulse is 110/min, respirations are 17/min, and oxygen saturation is 98% on room air. Physical exam is notable for a somnolent elderly man who is non-verbal; however, his baseline status is unknown. Musculoskeletal exam of the patient’s lower extremities causes him to recoil in pain. Head and neck exam reveals a decreased range of motion of the patient's neck. Flexion of the neck causes discomfort in the patient. No lymphadenopathy is detected. Basic labs are ordered and a urine sample is collected. Which of the following is the best next step in management?? {'A': 'Ceftriaxone and vancomycin', 'B': 'Ceftriaxone, vancomycin, and ampicillin', 'C': 'Ceftriaxone, vancomycin, ampicillin, and steroids', 'D': 'CT scan of the head', 'E': 'Trimethoprim-sulfamethoxazole'},
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C: Ceftriaxone, vancomycin, ampicillin, and steroids
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Q:A 58-year-old man with type 2 diabetes mellitus comes to the emergency department because of a 2-day history of dysphagia and swelling in the neck and lower jaw. He has had tooth pain on the left side over the past week, which has made it difficult for him to sleep. Four weeks ago, he had a 3-day episode of flu-like symptoms, including sore throat, that resolved without treatment. He has a history of hypertension. Current medications include metformin and lisinopril. He appears distressed. He is 180 cm (5 ft 11 in) tall and weighs 100 kg (220 lbs); his BMI is 31.6 kg/m2. His temperature is 38.4°C (101.1°F), pulse is 90/min, and blood pressure is 110/80 mm Hg. Oral cavity examination shows a decayed lower left third molar with drainage of pus. There is submandibular and anterior neck tenderness and swelling. His leukocyte count is 15,600/mm3, platelet count is 300,000/mm3, and fingerstick blood glucose concentration is 250 mg/dL. Which of the following is the most likely diagnosis?? {'A': 'Angioedema', 'B': 'Lymphadenitis', 'C': 'Peritonsillar abscess', 'D': 'Sublingual hematoma', 'E': 'Ludwig angina\n"'},
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E: Ludwig angina "
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Q:A previously healthy 19-year-old man is brought to the emergency department by his girlfriend after briefly losing consciousness. He passed out while moving furniture into her apartment. She said that he was unresponsive for a minute but regained consciousness and was not confused. The patient did not have any chest pain, palpitations, or difficulty breathing before or after the episode. He has had episodes of dizziness when exercising at the gym. His blood pressure is 125/75 mm Hg while supine and 120/70 mm Hg while standing. Pulse is 70/min while supine and 75/min while standing. On examination, there is a grade 3/6 systolic murmur at the left lower sternal border and a systolic murmur at the apex, both of which disappear with passive leg elevation. Which of the following is the most likely cause?? {'A': 'Prolonged QT interval', 'B': 'Hypertrophic cardiomyopathy', 'C': 'Bicuspid aortic valve', 'D': 'Mitral valve prolapse', 'E': 'Mitral valve stenosis'},
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B: Hypertrophic cardiomyopathy
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Q:A 33-year-old woman comes to the emergency department because of a 1-hour history of severe pelvic pain and nausea. She was diagnosed with a follicular cyst in the left ovary 3 months ago. The cyst was found incidentally during a fertility evaluation. A pelvic ultrasound with Doppler flow shows an enlarged, edematous left ovary with no blood flow. Laparoscopic evaluation shows necrosis of the left ovary, and a left oophorectomy is performed. During the procedure, blunt dissection of the left infundibulopelvic ligament is performed. Which of the following structures is most at risk of injury during this step of the surgery?? {'A': 'Ureter', 'B': 'Bladder trigone', 'C': 'Kidney', 'D': 'Cervical os', 'E': 'Uterine artery'},
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A: Ureter
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Q:A 31-year-old unresponsive man is admitted to the emergency department after a single-vehicle roll-over accident. On primary assessment by paramedics, he was unresponsive. On admission, he opened his eyes to painful stimuli, was not responsive to verbal commands, his arms were flexed and the legs were straight with no reaction to pain. The patient was intubated and examined. The blood pressure is 150/90 mm Hg; the heart rate, 56/min; the respiratory rate, 14/min; the temperature, 37.5℃ (99.5℉), and the SpO2, 94% on room air. The examination shows a depressed fracture of the left temporal bone and ecchymoses and scratches over his abdomen and extremities. His pupils are round, equal, and show a poor response to light. There is no disconjugate eye deviation. His lungs are clear to auscultation and the heart sounds are normal. Abdominal examination reveals normal bowel sounds and no fluid wave. There are no meningeal signs. Focused assessment with sonography for trauma is negative for blood in the abdominal cavity. Head CT scan is shown in the picture. Which procedure is required to guide further management?? {'A': 'Lumbar puncture', 'B': 'Placement of an intraventricular catheter', 'C': 'Placement of an arterial line', 'D': 'Diagnostic peritoneal lavage', 'E': 'Brain MRI'},
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B: Placement of an intraventricular catheter
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Q:A 38-year-old male is brought to the emergency department by ambulance after a motor vehicle collision. He is found to have a broken femur and multiple soft tissue injuries and is admitted to the hospital. During the hospital course, he is found to have lower extremity swelling, redness, and pain, so he is given an infusion of a medication. The intravenous medication is discontinued in favor of an oral medication in preparation for discharge; however, the patient leaves against medical advice prior to receiving the full set of instructions. The next day, the patient is found to have black lesions on his trunk and his leg. The protein involved in this patient's underlying abnormality most likely affects the function of which of the following factors?? {'A': 'Factor II only', 'B': 'Factors II and X', 'C': 'Factors II, VII, IX, and X', 'D': 'Factor V only', 'E': 'Factors V and VIII'},
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E: Factors V and VIII
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Q:A 19-year-old male college student is brought to the emergency department by his girlfriend complaining of intense pain. They had been playing outside in the snow when the patient started to have severe hand and feet pain. He says the pain is 9 out of 10 and causing him to have trouble moving his fingers and toes. He also reports some difficulty “catching his breath.” He notes that he has been tiring easily for the past month but thought it was because he was studying and going out late. On physical examination, the patient appears uncomfortable. Bilateral conjunctivae are pale. His hands are swollen and tender to palpation. Cardiopulmonary examination is normal. Hemoglobin is 9.0 g/dL. An electrocardiogram shows mild sinus tachycardia. Hemoglobin electrophoresis is performed, which confirms sickle cell disease. The patient’s pain is managed, and he is discharged on hydroxyurea. Which of the following is the most likely to occur as a result of the new medication?? {'A': 'Decrease in hemoglobin A', 'B': 'Decrease in fetal hemoglobin', 'C': 'Decrease in hemoglobin with higher oxygen affinity', 'D': 'Increase in hemoglobin A', 'E': 'Increase in hemoglobin with higher oxygen affinity'},
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E: Increase in hemoglobin with higher oxygen affinity
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Q:A 43-year-old woman comes to the physician because of a 3-month history of a painless ulcer on the sole of her right foot. There is no history of trauma. She has been dressing the ulcer once daily at home with gauze. She has a 15-year history of poorly-controlled type 1 diabetes mellitus and hypertension. Current medications include insulin and lisinopril. Vital signs are within normal limits. Examination shows a 2 x 2-cm ulcer on the plantar aspect of the base of the great toe with whitish, loose tissue on the floor of the ulcer and a calloused margin. A blunt metal probe reaches the deep plantar space. Sensation to vibration and light touch is decreased over both feet. Pedal pulses are intact. An x-ray of the right foot shows no abnormalities. Which of the following is the most appropriate initial step in management?? {'A': 'Total contact casting of right foot', 'B': 'Amputation of the right forefoot', 'C': 'Intravenous antibiotic therapy', 'D': 'Sharp surgical debridement of the ulcer', 'E': 'Surgical revascularization of the right foot'},
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D: Sharp surgical debridement of the ulcer
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Q:A 9-year-old boy is brought to the office due to exertional dyspnea and fatigability. He tires easily when walking or playing. His parents say that he was diagnosed with a congenital heart disease during his infancy, but they refused any treatment. They do not remember much about his diagnosis. The patient also had occasional respiratory infections throughout childhood that did not require hospitalization. He takes no medications. The patient has no family history of heart disease. His vital signs iclude: heart rate 98/min, respiratory rate 16/min, temperature 37.2°C (98.9°F), and blood pressure of 110/80 mm Hg. Physical examination shows toe cyanosis and clubbing but no finger abnormalities. Cardiac auscultation reveals a continuous machine-like murmur. All extremity pulses are full and equal. Which of the following is the most likely diagnosis?? {'A': 'Atrial septal defect', 'B': 'Coarctation of the aorta', 'C': 'Patent ductus arteriosus', 'D': 'Tetralogy of Fallot', 'E': 'Ventricular septal defect'},
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C: Patent ductus arteriosus
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Q:A 16-year-old teenager presents to the pediatrician with his mother. After she leaves the room he tells the physician that he is worried about puberty. All of his friends have had growth spurts, started building muscle mass, and their voices have changed while he still feels underdeveloped. The physician takes a complete history and performs a thorough physical examination. He goes through the patient’s past medical records and growth charts and notes physical findings documented over the last five years, concluding that the patient has delayed puberty. Which of the following findings supports his conclusion?? {'A': 'The absence of penile enlargement by age of 12 years', 'B': 'The absence of linear growth acceleration by age of 13 years', 'C': 'The absence of testicular enlargement by age of 14 years', 'D': 'Presence of gynecomastia at age of 15 years', 'E': 'The absence of an adult type of pubic hair distribution by age of 16 years'},
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C: The absence of testicular enlargement by age of 14 years
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Q:A 62-year-old man is brought to the physician by his wife for increased forgetfulness and unsteady gait over the past 3 months. He is a journalist and has had difficulty concentrating on his writing. He also complains of urinary urgency recently. His temperature is 36.8°C (98.2°F) and blood pressure is 139/83 mm Hg. He is oriented only to person and place. He is able to recall 2 out of 3 words immediately and 1 out of 3 after five minutes. He has a slow, broad-based gait and takes short steps. Neurological examination is otherwise normal. Urinalysis is normal. Which of the following is the most likely diagnosis?? {'A': 'Alzheimer disease', 'B': 'Normal pressure hydrocephalus', 'C': 'Vascular dementia', 'D': 'Frontotemporal dementia', 'E': 'Lewy body dementia'},
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B: Normal pressure hydrocephalus
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Q:A 19-year-old woman presents with worsening pain in her neck for the past 5 days. She says she is not able to wear her tie for her evening job because is it too painful. She also reports associated anxiety, palpitations, and lethargy for the past 10 days. Past medical history is significant for a recent 3-day episode of flu-like symptoms about 20 days ago which resolved spontaneously. She is a non-smoker and occasionally drinks beer with friends on weekends. Her vital signs include: blood pressure 110/80 mm Hg, pulse 118/min. On physical examination, her distal extremities are warm and sweaty. There is severe bilateral tenderness to palpation of her thyroid gland, as well as mild symmetrical swelling noted. No nodules palpated. An ECG is normal. Laboratory findings are significant for low thyroid-stimulating hormone (TSH), elevated T4 and T3 levels, and an erythrocyte sedimentation rate (ESR) of 30 mm/hr. Which of the following is the most appropriate treatment for this patient’s most likely diagnosis?? {'A': 'Levothyroxine administration', 'B': 'Aspirin', 'C': 'Atropine injection', 'D': 'Increase dietary intake of iodine', 'E': 'Reassurance'},
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B: Aspirin
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Q:A 68-year-old man with atrial fibrillation comes to the emergency department with acute-onset severe upper abdominal pain. He takes no medications. He is severely hypotensive. Despite maximal resuscitation efforts, he dies. Autopsy shows necrosis of the proximal portion of the greater curvature of the stomach caused by an embolic occlusion of an artery. The embolus most likely passed through which of the following vessels?? {'A': 'Superior mesenteric artery', 'B': 'Inferior mesenteric artery', 'C': 'Right gastroepiploic artery', 'D': 'Splenic artery', 'E': 'Left gastric artery'},
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D: Splenic artery
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Q:A 65-year-old woman was referred to a specialist for dysphagia and weight loss. She has a history of difficulty swallowing solid foods, which has become worse over the past year. She has unintentionally lost 2.3 kg (5 lb). A previous gastroscopy showed mild gastritis with a positive culture for Helicobacter pylori. A course of triple antibiotic therapy and omeprazole was prescribed. Follow-up endoscopy appeared normal with no H. pylori noted on biopsy. Her heartburn improved but the dysphagia persisted. She had a myocardial infarction four years ago, complicated by acute mitral regurgitation. Physical examination revealed a thin woman with normal vital signs. Auscultation of the heart reveals a 3/6 blowing systolic murmur at the apex radiating to the axilla. Breath sounds are reduced at the base of the right lung. The abdomen is mildly distended but not tender. The liver and spleen are not enlarged. Electrocardiogram shows sinus rhythm with a non-specific intraventricular block. Chest X-ray shows an enlarged cardiac silhouette with mild pleural effusion. What is the most probable cause of dysphagia?? {'A': 'Thoracic aortic aneurysm', 'B': 'Achalasia', 'C': 'Left atrium enlargement', 'D': 'Diffuse esophageal spasm', 'E': 'Benign stricture'},
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C: Left atrium enlargement
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Answer the following medical question with one of the provided options:
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Q:A 46-year-old man presents to his primary care provider for an ulcerating skin lesion on his leg for the past week. He says that the week prior he slipped while hiking and scraped his left leg. Over the course of the next week, he noticed redness and swelling of the scraped area and the development of a nodule that eventually ulcerated. On exam, his temperature is 99.5°F (37.5°C), blood pressure is 136/92 mmHg, pulse is 88/min, and respirations are 12/min. Over his left lateral leg is an erythematous patch with a 2-cm nodule with central ulceration. Staining of a sample from the nodule demonstrates gram-positive organisms that are also weakly acid-fast. Morphologically, the organism appears as branching filaments. Which of the following should be used to treat this infection?? {'A': 'Clindamycin', 'B': 'Doxycycline', 'C': 'Penicillin', 'D': 'Streptomycin', 'E': 'Trimethoprim-sulfamethoxazole'},
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E: Trimethoprim-sulfamethoxazole
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Answer the following medical question with one of the provided options:
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Q:A 33-year-old man presents with a darkening of the skin on his neck over the past month. Past medical history is significant for primary hypothyroidism treated with levothyroxine. His vital signs include: blood pressure 130/80 mm Hg, pulse 84/min, respiratory rate 18/min, temperature 36.8°C (98.2°F). His body mass index is 35.3 kg/m2. Laboratory tests reveal a fasting blood glucose of 121 mg/dL and a thyroid-stimulating hormone level of 2.8 mcU/mL. The patient’s neck is shown in the exhibit. Which of the following is the best initial treatment for this patient?? {'A': 'Adjust the dose of levothyroxine', 'B': 'Cyproheptadine', 'C': 'Exercise and diet', 'D': 'Isotretinoin', 'E': 'Surgical excision'},
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C: Exercise and diet
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Q:A 33-year-old woman is brought to the emergency department after she was involved in a high-speed motor vehicle collision. She reports severe pelvic pain. Her pulse is 124/min and blood pressure is 80/56 mm Hg. Physical examination shows instability of the pelvic ring. As part of the initial emergency treatment, she receives packed red blood cell transfusions. Suddenly, the patient starts bleeding from peripheral venous catheter insertion sites. Laboratory studies show decreased platelets, prolonged prothrombin time and partial thromboplastin time, and elevated D-dimer. A peripheral blood smear of this patient is most likely to show which of the following findings?? {'A': 'Erythrocytes with irregular, thorny projections', 'B': 'Crescent-shaped, fragmented erythrocytes', 'C': 'Grouped erythrocytes with a stacked-coin appearance', 'D': 'Erythrocytes with a bullseye appearance', 'E': 'Erythrocytes with cytoplasmic hemoglobin inclusions'},
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B: Crescent-shaped, fragmented erythrocytes
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Q:A 45-year-old man with a 15-pack-year smoking history is referred for pulmonary function testing. On physical exam, he appears barrel-chested and mildly overweight, but breathes normally. Which of the following tests will most accurately measure his total lung capacity?? {'A': 'Spirometry', 'B': 'Open-circuit nitrogen washout', 'C': 'Body plethysmography', 'D': 'Closed-circuit helium dilution', 'E': 'Exhaled nitric oxide'},
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C: Body plethysmography
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Q:A 24-year-old man is brought to the emergency department after being involved in a motor vehicle accident as an unrestrained driver. He was initially found unconscious at the scene but, after a few minutes, he regained consciousness. He says he is having difficulty breathing and has right-sided pleuritic chest pain. A primary trauma survey reveals multiple bruises and lacerations on the anterior chest wall. His temperature is 36.8°C (98.2°F), blood pressure is 100/60 mm Hg, pulse is 110/min, and respiratory rate is 28/min. Physical examination reveals a penetrating injury just below the right nipple. Cardiac examination is significant for jugular venous distention. There is also an absence of breath sounds on the right with hyperresonance to percussion. A bedside chest radiograph reveals evidence of a collapsed right lung with depression of the right hemidiaphragm and tracheal deviation to the left. Which of the following is the most appropriate next step in the management of this patient?? {'A': 'Needle thoracostomy at the 5th intercostal space, midclavicular line', 'B': 'Needle thoracostomy at the 2nd intercostal space, midclavicular line', 'C': 'Tube thoracostomy at the 2nd intercostal space, midclavicular line', 'D': 'Tube thoracostomy at the 5th intercostal space, midclavicular line', 'E': 'Tube thoracostomy at the 5th intercostal space, anterior axillary line'},
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B: Needle thoracostomy at the 2nd intercostal space, midclavicular line
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Q:A 30-year-old man is brought to the emergency department by the police after starting a fight at a local bar. He has several minor bruises and he appears agitated. He talks incessantly about his future plans. He reports that he has no history of disease and that he is "super healthy" and "never felt better". His temperature is 38.0°C (100.4°F), pulse is 110/min, respirations are 16/min, and blood pressure is 155/80 mm Hg. On physical examination reveals a euphoric and diaphoretic man with slightly dilated pupils. An electrocardiogram is obtained and shows tachycardia with normal sinus rhythm. A urine toxicology screen is positive for cocaine. The patient is held in the ED for observation. Which of the following symptoms can the patient expect to experience as he begins to withdraw from cocaine?? {'A': 'Increased appetite', 'B': 'Increased sympathetic stimulation', 'C': 'Lacrimation', 'D': 'Psychosis', 'E': 'Seizures'},
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A: Increased appetite
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Q:A young couple expecting their first child present to the obstetrician for routine follow up at 16 weeks gestation. The father suffers from Leber hereditary optic neuropathy and wants to know if is possible that he has passed down the disease to his unborn daughter. The correct response is:? {'A': 'Yes, the father can pass the disease to daughters only.', 'B': 'No, the father cannot pass the disease to any offpring.', 'C': 'Yes, the father can pass the disease to sons and daughters as equal frequencies.', 'D': 'Yes, the father will pass the disease to all of his offspring, but the severity of disease can very.', 'E': 'No, the father can pass the disease to sons only.'},
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B: No, the father cannot pass the disease to any offpring.
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Q:A 65-year-old homeless man with a history of hospitalization for alcohol intoxication is brought in confused. His serum glucose is 39mg/dl. Which of the following is likely true?? {'A': 'He has also been using cocaine', 'B': 'He has decreased activity of alcohol dehydrogenase', 'C': 'Hepatic gluconeogenesis is elevated', 'D': 'The next step in management is glucose repletion', 'E': 'His hepatic NADH/NAD+ ratio is high'},
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E: His hepatic NADH/NAD+ ratio is high
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Q:A 72-year-old man is brought to the physician for the evaluation of severe nosebleeds and two episodes of bloody vomit over the past 40 minutes. He reports that he has had recurrent nosebleeds almost daily for the last 3 weeks. The nosebleeds last between 30 and 40 minutes. He appears pale. His temperature is 36.5°C (97.7°F), pulse is 95/min, and blood pressure is 110/70 mm Hg. Examination of the nose with a speculum does not show an anterior bleeding source. The upper body of this patient is elevated and his head is bent forward. Cold packs are applied and the nose is pinched at the nostrils for 5–10 minutes. Topical phenylephrine is administered. Despite all measures, the nosebleed continues. Anterior and posterior nasal packing is placed, but bleeding persists. Which of the following is the most appropriate next step in management?? {'A': 'Endoscopic ligation of the sphenopalatine artery', 'B': 'Endoscopic ligation of the posterior ethmoidal artery', 'C': 'Endoscopic ligation of the anterior ethmoidal artery', 'D': 'Endoscopic ligation of the lesser palatine artery', 'E': 'Endoscopic ligation of the greater palatine artery'},
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A: Endoscopic ligation of the sphenopalatine artery
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Q:A 50-year-old man comes to the physician for his annual health maintenance examination. The patient feels well. He has a history of hypertension, for which he currently takes lisinopril. He has smoked a pack of cigarettes daily for 20 years. He drinks 5–6 beers on weekends. He is 181 cm tall (5 ft 11 in), weighs 80 kg (176.4 lbs); BMI is 24.6 kg/m2. His pulse is 75/min, blood pressure is 140/85 mm Hg, and respirations are 18/min. Physical examination is unremarkable. Laboratory studies show: Total cholesterol 263 mg/dL High-density lipoprotein cholesterol 36 mg/dL Triglycerides 180 mg/dL In addition to dietary and lifestyle modification, administration of which of the following agents is the most appropriate next step in management?"? {'A': 'Cholesterol absorption inhibitor', 'B': 'Proprotein convertase subtilisin kexin 9 inhibitor', 'C': 'HMG-CoA reductase inhibitor', 'D': 'Bile acid resins', 'E': 'Peroxisome proliferator-activated receptor alpha activator'},
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C: HMG-CoA reductase inhibitor
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Answer the following medical question with one of the provided options:
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Q:A 68-year-old man presents to the emergency department because of difficulty breathing and chest tightness for the last 3 days. He also has a productive cough with excessive amounts of green sputum. He has had chronic obstructive pulmonary disease for the past 10 years, but says that the cough and sputum are different compared to his baseline. He took 2 doses of nebulized albuterol and ipratropium at home, but that did not completely relieve his symptoms. He has a 50 pack-year smoking history and drinks alcohol occasionally. His vital signs include a blood pressure of 110/60 mm Hg, a temperature of 37.2 °C (98.9°F), a respiratory rate of 26/min, an irregular radial pulse at a rate of 110–120/min, and an oxygen saturation of 88%. On physical examination, the patient appears drowsy, crackles are heard on chest auscultation bilaterally, and the heart sounds are irregular. A chest X-ray shows hyperinflation of the lungs bilaterally, and the diaphragm is flattened. An ECG is ordered and shown in the accompanying image. Which of the following is the best initial treatment for this patient’s arrhythmia?? {'A': 'Diltiazem', 'B': 'Reversing bronchoconstriction and correction of electrolyte abnormalities', 'C': 'Synchronized cardioversion', 'D': 'Catheter ablation of the cavotricuspid isthmus (CTI)', 'E': 'Metoprolol'},
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B: Reversing bronchoconstriction and correction of electrolyte abnormalities
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Q:A 65-year-old man presents with low-grade fever and malaise for the last 4 months. He also says he has lost 9 kg (20 lb) during this period and suffers from extreme fatigue. Past medical history is significant for a mitral valve replacement 5 years ago. His temperature is 38.1°C (100.6°F), respirations are 22/min, pulse is 102/min, and blood pressure is 138/78 mm Hg. On physical examination, there is a new onset 2/6 holosystolic murmur loudest in the apical area of the precordium. Which of the following organisms is the most likely cause of this patient’s condition?? {'A': 'Candida albicans', 'B': 'Coagulase-negative Staphylococcus spp.', 'C': 'Pseudomonas aeruginosa', 'D': 'Enterococcus', 'E': 'Escherichia coli'},
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B: Coagulase-negative Staphylococcus spp.
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Q:A 55-year-old man comes to the physician with a 3-month history of headache, periodic loss of vision, and easy bruising. Physical examination shows splenomegaly. His hemoglobin concentration is 13.8 g/dL, leukocyte count is 8000/mm3, and platelet count is 995,000/mm3. Bone marrow biopsy shows markedly increased megakaryocytes with hyperlobulated nuclei. Genetic analysis shows upregulation of the JAK-STAT genes. The pathway encoded by these genes is also physiologically responsible for signal transmission of which of the following hormones?? {'A': 'Cortisol', 'B': 'Insulin', 'C': 'Oxytocin', 'D': 'Prolactin', 'E': 'Adrenocorticotropic hormone'},
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D: Prolactin
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Q:A 71-year-old man presents to the emergency department with severe substernal chest pain. An initial EKG demonstrates ST elevation in leads V2, V3, V4, and V5 with reciprocal changes. The patient is started on aspirin and heparin and is transferred to the cardiac catheterization lab. The patient recovers over the next several days. On the floor, the patient complains of feeling very fatigued and feels too weak to ambulate even with the assistance of physical therapy. Chest radiography reveals an enlarged cardiac silhouette with signs of fluid bilaterally in the lung bases. His temperature is 98.4°F (36.9°C), blood pressure is 85/50 mmHg, pulse is 110/min, respirations are 13/min, and oxygen saturation is 97% on room air. Which of the following would be expected to be seen in this patient?? {'A': 'Decreased systemic vascular resistance', 'B': 'Decreased tissue oxygen extraction', 'C': 'Increased ejection fraction', 'D': 'Increased pulmonary capillary wedge pressure', 'E': 'Increased venous oxygen content'},
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D: Increased pulmonary capillary wedge pressure
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Q:A 55-year-old African American man presents to the emergency department with central chest pressure. His symptoms started the day before. The pain was initially intermittent in nature but has become constant and radiates to his jaw and left shoulder. He also complains of some difficulty breathing. The patient was diagnosed with essential hypertension a year ago, but he is not taking any medications for it. The patient denies smoking, alcohol, or drug use. Family history is unremarkable. His blood pressure is 230/130 mm Hg in both arms, the temperature is 36.9°C (98.4°F), and the pulse is 90/min. ECG shows diffuse T wave inversion and ST depression in lateral leads. Laboratory testing is significant for elevated troponin. Which of the following is the first-line antihypertensive agent for this patient?? {'A': 'Labetalol', 'B': 'Esmolol and intravenous nitroglycerin', 'C': 'Fenoldopam', 'D': 'Diazepam', 'E': 'Hydralazine'},
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B: Esmolol and intravenous nitroglycerin
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Answer the following medical question with one of the provided options:
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Q:A 27-year-old African American man presents to a primary care physician for a routine checkup as a new patient. The patient states that he has been doing well lately and recently was promoted at his job. He states that 2 weeks ago he went to the ED for severe pain and was treated with morphine and oral fluids and discharged home that night. This had happened once before and he was treated similarly. The patient states that he drinks 7 to 8 alcoholic beverages per night and smokes 1 pack of cigarettes per day. The patient states that he has been gaining weight recently due to a diet consisting mostly of fast food. Basic labs are ordered as seen below. Hemoglobin: 8 g/dL Hematocrit: 28% Mean corpuscular volume: 72 um^3 Leukocyte count: 6,500/mm^3 with normal differential Platelet count: 157,000/mm^3 Serum: Na+: 139 mEq/L Cl-: 100 mEq/L K+: 4.3 mEq/L HCO3-: 25 mEq/L BUN: 20 mg/dL Glucose: 99 mg/dL Creatinine: 1.1 mg/dL LDH: 540 U/L Ca2+: 10.2 mg/dL AST: 12 U/L ALT: 10 U/L Which of the following is the best explanation of this patient's laboratory abnormalities?? {'A': 'Chronic inflammation', 'B': 'Extravascular hemolysis', 'C': 'Folate deficiency', 'D': 'Ineffective erythropoiesis', 'E': 'Vitamin B12 deficiency'},
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B: Extravascular hemolysis
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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 comes to the physician for a routine health maintenance examination. He feels well. He underwent appendectomy at the age of 25 years. He has a history of hypercholesterolemia that is well controlled with atorvastatin. He is an avid marathon runner and runs 8 miles per day four times a week. His father died of myocardial infarction at the age of 42 years. The patient does not smoke or drink alcohol. His vital signs are within normal limits. Cardiopulmonary examination shows no abnormalities. His abdomen is soft and nontender with a surgical scar in the right lower quadrant. Laboratory studies are within normal limits. An ECG is shown. Which of the following is the most likely diagnosis?? {'A': 'Third-degree AV block', 'B': 'Mobitz type II AV block', 'C': 'Mobitz type I AV block', 'D': 'Atrial fibrillation', 'E': 'First-degree AV block'},
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C: Mobitz type I AV block
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Answer the following medical question with one of the provided options:
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Q:A 54-year-old man comes to the emergency department because of severe pain in his right leg that began suddenly 3 hours ago. He has had repeated cramping in his right calf while walking for the past 4 months, but it has never been this severe. He has type 2 diabetes mellitus, hypercholesterolemia, and hypertension. Current medications include insulin, enalapril, aspirin, and simvastatin. He has smoked one pack of cigarettes daily for 33 years. He does not drink alcohol. His pulse is 103/min and blood pressure is 136/84 mm Hg. Femoral pulses are palpable bilaterally. The popliteal and pedal pulses are absent on the right. Laboratory studies show: Hemoglobin 16.1 g/dL Serum Urea nitrogen 14 mg/dL Glucose 166 mg/dL Creatinine 1.5 mg/dL A CT angiogram of the right lower extremity is ordered. Which of the following is the most appropriate next step in management?"? {'A': 'Remote ischemic preconditioning', 'B': 'Administer mannitol', 'C': 'Administer ionic contrast', 'D': 'Administer normal saline', 'E': 'Administer sodium bicarbonate'},
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D: Administer normal saline
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Q:A 27-year-old G2P1 woman is diagnosed with an HIV infection after undergoing routine prenatal blood work testing. Her estimated gestational age by first-trimester ultrasound is 12 weeks. Her CD4 count is 150 cells/mm^3 and her viral load is 126,000 copies/mL. She denies experiencing any symptoms of HIV infection. Which of the following is appropriate management of this patient's pregnancy?? {'A': 'Avoidance of antibiotic prophylaxis', 'B': 'Breastfeeding', 'C': 'HAART', 'D': 'HAART after delivery', 'E': 'Vaginal delivery'},
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C: HAART
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Answer the following medical question with one of the provided options:
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Q:A 16-year-old boy presents to the emergency department after a skateboarding accident. He fell on a broken bottle and received a 4 cm wound on the dorsal aspect of his left hand. His vitals are stable and he was evaluated by the surgeon on call who determined to suture was not required. After several weeks the wound has almost completely healed (see image). Which of the following is the correct description of this patient’s wound before healing?? {'A': 'Incised wound', 'B': 'Abrasion', 'C': 'Laceration', 'D': 'Avulsion', 'E': 'Puncture'},
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A: Incised wound
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Q:A 44-year-old female with a 3-year history of biliary colic presents with acute cholecystitis. After further evaluation, she undergoes a laparoscopic cholecystectomy without complication. Which of the following is true following this procedure?? {'A': 'Lipid absorption is decreased', 'B': 'Lipid absorption is increased', 'C': 'Lipid absorption is unaffected', 'D': 'The composition of the bile acid pool is altered', 'E': 'The overall amount of bile acids is reduced'},
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C: Lipid absorption is unaffected
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Q:A 56-year-old man with type 2 diabetes mellitus comes to the physician for a follow-up examination. Three months ago, the patient was started on metformin therapy after counseling on diet, exercise, and weight reduction failed to reduce his hyperglycemia. Physical examination shows no abnormalities. His hemoglobin A1c is 8.4%. Pioglitazone is added to the patient's medication regimen. Which of the following cellular changes is most likely to occur in response to this new drug?? {'A': 'Decreased breakdown of glucagon-like peptide 1', 'B': 'Decreased sodium-dependent glucose cotransport', 'C': 'Depolarization of pancreatic β-cells', 'D': 'Autophosphorylation of receptor tyrosine kinase', 'E': 'Increased transcription of adipokines'},
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E: Increased transcription of adipokines
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Answer the following medical question with one of the provided options:
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Q:A 60-year-old man presents to the emergency department with pleuritic chest pain. He recently returned from a vacation in Germany and noticed he felt short of breath and had chest pain the following morning. The patient is generally healthy but did have surgery on his ankle 3 weeks ago and has been less ambulatory. His temperature is 99.0°F (37.2°C), blood pressure is 137/88 mm Hg, pulse is 120/min, respirations are 22/min, and oxygen saturation is 96% on room air. Physical exam is notable for a warm and swollen lower extremity. The physician has high clinical suspicion for pleuritis given a recent cough the patient experienced. Which of the following findings would warrant further workup with a CT angiogram?? {'A': 'Bilateral wheezing', 'B': 'Decreased breath sounds over area of the lung', 'C': 'Hemoptysis', 'D': 'Increased breath sounds over area of the lung', 'E': 'Green sputum'},
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C: Hemoptysis
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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 presents to the emergency room for epistaxis. He reports having frequent nosebleeds over the past 48 hours. He also reports a constant pounding headache over the same timeframe. He is accompanied by his wife who reports that he has seemed “off” lately, frequently forgetting recent events and names of his friends. His past medical history is notable for hypertension and rheumatoid arthritis. He takes lisinopril and methotrexate. He has a 10 pack-year smoking history and drinks 2-3 beers per day. His temperature is 101.1°F (37.3°C), blood pressure is 145/90 mmHg, pulse is 110/min, and respirations are 18/min. On exam, he appears pale, diaphoretic, and has mild scleral icterus. His spleen is palpable but non-tender. Laboratory analysis is shown below: Hemoglobin: 8.9 g/dL Hematocrit: 26% Leukocyte count: 4,900/mm^3 with normal differential Platelet count: 25,000/mm^3 Prothrombin time: 14 seconds Partial thromboplastin time (activated): 27 seconds International normalized ratio: 1.1 Bleeding time: 9 minutes This patient has a condition that is caused by a defect in which of the following processes?? {'A': 'Metalloproteinase-mediated protein degradation', 'B': 'Nucleotide excision repair', 'C': 'Platelet binding to fibrinogen', 'D': 'Platelet binding to von Willebrand factor', 'E': 'Porphobilinogen metabolism'},
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A: Metalloproteinase-mediated protein degradation
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Q:A 65-year-old man comes to his primary care physician for a routine health maintenance examination. He takes no medications. Physical examination and laboratory studies show no abnormalities. Compared to a healthy adolescent, this patient is most likely to have which of the following changes in immune function?? {'A': 'Decreased autoimmunity', 'B': 'Decreased number of neutrophil precursors', 'C': 'Decreased responsiveness to vaccines', 'D': 'Increased number of circulating B cells', 'E': 'Increased complement protein production'},
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C: Decreased responsiveness to vaccines
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Answer the following medical question with one of the provided options:
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Q:Two hours after undergoing elective cholecystectomy with general anesthesia, a 41-year-old woman is evaluated for decreased mental status. BMI is 36.6 kg/m2. Respirations are 18/min and blood pressure is 126/73 mm Hg. Physical examination shows the endotracheal tube in normal position. She does not respond to sternal rub and gag reflex is absent. Arterial blood gas analysis on room air shows normal PO2 and PCO2 levels. Which of the following anesthetic properties is the most likely cause of these findings?? {'A': 'Low cytochrome P450 activity', 'B': 'Low brain-blood partition coefficient', 'C': 'High minimal alveolar concentration', 'D': 'High lipid solubility', 'E': 'Low blood solubility'},
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D: High lipid solubility
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Answer the following medical question with one of the provided options:
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Q:A 58-year-old woman presents with a 2-week history of fever, fatigue, generalized weakness, and bleeding gums. Past medical history is significant for type 2 diabetes mellitus, managed with metformin. The patient is afebrile, and her vitals are within normal limits. On physical examination, she has bilateral cervical lymphadenopathy and hepatosplenomegaly. A complete blood count and peripheral blood smear reveal normocytic anemia and leukocytosis. A bone marrow biopsy is performed, which shows > 20 % myeloperoxidase positive myeloblasts with splinter-shaped structures in the cytosol. The patient is started on a vitamin A derivative. Which of the following chromosomal translocations is most likely responsible for this patient’s condition?? {'A': 't(9;22)', 'B': 't(14;18)', 'C': 't(15;17)', 'D': 't(11;14)', 'E': 't(8;14)'},
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C: t(15;17)
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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 comes to the physician because of severe left knee pain and swelling. He has hypercholesterolemia and hypertension. Current medications include pravastatin and captopril. He eats a low-fat diet that includes fish and leafy green vegetables. He drinks 4–6 cups of coffee daily. He has smoked one pack of cigarettes daily for 26 years and drinks 2–3 beers daily. Vital signs are within normal limits. Examination of the left knee shows swelling, warmth, and severe tenderness to palpation. Arthrocentesis is performed. Gram stain is negative. Analysis of the synovial fluid shows monosodium urate crystals. Which of the following health maintenance recommendations is most appropriate to prevent symptom recurrence?? {'A': 'Discontinue captopril', 'B': 'Start aspirin', 'C': 'Reduce fish intake', 'D': 'Discontinue pravastatin', 'E': 'Start colchicine\n"'},
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C: Reduce fish intake
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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 is brought to the emergency department by his wife because of fever, cough, diarrhea, and confusion for 2 days. He recently returned from a cruise to the Caribbean. He has a history of chronic obstructive pulmonary disease. He has smoked one pack of cigarettes daily for 40 years. His temperature is 39.1°C (102.4°F), pulse is 83/min, and blood pressure is 111/65 mm Hg. He is confused and oriented only to person. Physical examination shows coarse crackles throughout both lung fields. His serum sodium concentration is 125 mEq/L. Culture of the most likely causal organism would require which of the following mediums?? {'A': 'Charcoal yeast extract agar', 'B': 'Eosin-methylene blue agar', 'C': 'Chocolate agar', 'D': 'Mannitol salt agar', 'E': 'Eaton agar'},
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A: Charcoal yeast extract agar
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Q:A 70-year-old male visits his primary care physician because of progressive weight loss. He has a 20-year history of smoking 2 packs of cigarettes a day and was diagnosed with diabetes mellitus 6 years ago. After physical examination, the physician tells the patient he suspects adenocarcinoma at the head of the pancreas. Which of the following physical examination findings would support the diagnosis:? {'A': 'Lymphadenopathy of the umbilicus', 'B': 'Acanthosis nigricans', 'C': 'Palpable gallbladder', 'D': 'Renal artery bruits', 'E': 'Splenomegaly'},
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C: Palpable gallbladder
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Answer the following medical question with one of the provided options:
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Q:A 48-year-old woman is brought to the emergency department by police because of confusion and agitation. Her medical record indicates that she has peptic ulcer disease that is treated with omeprazole. The patient's brother arrives shortly after. He reports that she drinks around 17 oz. of vodka daily. Neurological examination shows horizontal nystagmus. Her gait is wide-based with small steps. Her hemoglobin concentration is 9.1 g/dL. A peripheral blood smear mean shows hypersegmented neutrophils. Homocysteine levels are elevated. Methylmalonic acid levels are within normal limits. Which of the following is the most likely direct cause of this patient's anemia?? {'A': 'Folate deficiency', 'B': 'Vitamin E deficiency', 'C': 'Alcohol toxicity', 'D': 'Vitamin B12 deficiency', 'E': 'Vitamin B1 deficiency'},
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A: Folate deficiency
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Q:A 17-year-old girl presents to her pediatrician for a wellness visit. She currently feels well but is concerned that she has not experienced menarche. She reports to recently developing headaches and describes them as pulsating, occurring on the left side of her head, associated with nausea, and relieved by ibuprofen. She is part of the school’s rugby team and competitively lifts weights. She is currently sexually active and uses condoms infrequently. She denies using any forms of contraception or taking any medications. Her temperature is 98.6°F (37°C), blood pressure is 137/90 mmHg, pulse is 98/min, and respirations are 17/min. On physical exam, she has normal breast development and pubic hair is present. A pelvic exam is performed. A urine hCG test is negative. Which of the following is the best next step in management?? {'A': 'MRI of the head', 'B': 'Pelvic ultrasound', 'C': 'Serum T3 and T4', 'D': 'Serum estradiol', 'E': 'Serum testosterone'},
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B: Pelvic ultrasound
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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 presents to his physician after his routine screening revealed that he has elevated liver enzymes. He complains of occasional headaches during the past year, but otherwise feels well. The patient reports that he was involved in a serious car accident in the 1980s. He does not smoke or drink alcohol. He has no history of illicit intravenous drug use. He does not currently take any medications and has no known allergies. His father had a history of alcoholism and died of liver cancer. The patient appears thin. His temperature is 37.8°C (100°F), pulse is 100/min, and blood pressure is 110/70 mm Hg. The physical examination reveals no abnormalities. The laboratory test results show the following: Complete blood count Hemoglobin 14 g/dL Leukocyte count 10,000/mm3 Platelet count 146,000/mm3 Comprehensive metabolic profile Glucose 150 mg/dL Albumin 3.2 g/dL Total bilirubin 1.5 mg/dL Alkaline phosphatase 75 IU/L AST 95 IU/L ALT 73 IU/L Other lab tests HIV negative Hepatitis B surface antigen negative Hepatitis C antibody positive HCV RNA positive HCV genotype 1 A liver biopsy is performed and shows mononuclear infiltrates localized to portal tracts that reveal periportal hepatocyte necrosis. Which of the following is the most appropriate next step in management?? {'A': 'Interferon and ribavirin therapy', 'B': 'Peginterferon alpha therapy', 'C': 'Sofosbuvir and ledipasvir therapy', 'D': 'Tenofovir and entecavir therapy', 'E': 'Tenofovir and velpatasvir therapy'},
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C: Sofosbuvir and ledipasvir therapy
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Answer the following medical question with one of the provided options:
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Q:Four days after being admitted to the hospital for widespread second-degree burns over his arms and thorax, a 29-year-old man develops a fever and wound discharge. His temperature is 38.8°C (101.8°F). Examination shows a discolored burn eschar with edema and redness of the surrounding skin. The wounds have a sickly, sweet odor. A culture of the affected tissue grows an aerobic, gram-negative rod. The causal pathogen most likely produces which of the following substances?? {'A': 'Tetanospasmin', 'B': 'Streptolysin O', 'C': 'Phospholipase C', 'D': 'Alpha toxin', 'E': 'Protein A'},
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C: Phospholipase C
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Answer the following medical question with one of the provided options:
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Q:A 73-year-old woman recently diagnosed with colonic adenocarcinoma comes to the physician because of a 1-week history of nausea and multiple episodes of vomiting. These symptoms started shortly after her first infusion of oxaliplatin and fluorouracil. The patient is started on an appropriate medication. Three weeks later, at a follow-up appointment, she states that she has developed headaches and constipation. The patient was most likely treated with a drug with which of the following mechanisms of action?? {'A': 'H1 receptor antagonist', 'B': 'M2 receptor antagonist', 'C': 'NK1 receptor antagonist', 'D': '5-HT3 receptor antagonist', 'E': 'Cannabinoid receptor agonist'},
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D: 5-HT3 receptor antagonist
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Answer the following medical question with one of the provided options:
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Q:A 11-year-old girl comes to the physician for evaluation of recurrent nosebleeds since childhood. She has multiple, small dilated capillaries on the lips, nose, and fingers on exam. Her father has a similar history of recurrent nosebleeds. Which of the following conditions is this patient at increased risk for?? {'A': 'Gastrointestinal polyps', 'B': 'High-output heart failure', 'C': 'Pheochromocytoma', 'D': 'Glaucoma', 'E': 'Renal cell carcinoma'},
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B: High-output heart failure
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Answer the following medical question with one of the provided options:
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Q:A 16-year-old boy is brought to the emergency department after being tackled at a football game. Per his mom, he is the quarterback of his team and was head-butted in the left shoulder region by the opposing team. Shortly after, the mother noticed that his left arm was hanging by his torso and his hand was “bent backwards and facing the sky.” The patient denies head trauma, loss of consciousness, sensory changes, or gross bleeding. A physical examination demonstrates weakness in abduction, lateral rotation, flexion, and supination of the left arm and tenderness of the left shoulder region with moderate bruising. Radiograph of the left shoulder and arm is unremarkable. Which of the following is most likely damaged in this patient?? {'A': 'C5-C6 nerve roots', 'B': 'C8-T1 nerve roots', 'C': 'Radial nerve', 'D': 'Long thoracic nerve', 'E': 'Ulnar nerve'},
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A: C5-C6 nerve roots
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Answer the following medical question with one of the provided options:
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Q:A 58-year-old man comes to the physician because of a 4-day history of abdominal pain and vomiting. Initially, the vomitus was food that he had recently eaten, but it is now bilious. He has had similar complaints several times in the past 6 years. He has smoked 1 pack of cigarettes daily for the past 25 years and drinks 24 oz of alcohol daily. He is 160 cm (5 ft 3 in) tall and weighs 48 kg (105 lb); BMI is 19 kg/m2. His vital signs are within normal limits. Physical examination shows an epigastric mass. The remainder of the examination shows no abnormalities. Which of the following is the most likely diagnosis?? {'A': 'Chronic cholecystitis', 'B': 'Retroperitoneal fibrosis', 'C': 'Hypertrophic pyloric stenosis', 'D': 'Pancreatic pseudocyst', 'E': 'Gastric adenocarcinoma'},
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D: Pancreatic pseudocyst
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