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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 is brought to the emergency department because of severe abdominal pain and vomiting for 3 hours. She had previous episodes of abdominal pain that lasted for 10–15 minutes and resolved with antacids. She lives with her daughter and grandchildren. She divorced her husband last year. She is alert and oriented. Her temperature is 37.3°C (99.1°F), pulse is 134/min, and blood pressure is 90/70 mm Hg. The abdomen is rigid and diffusely tender. Guarding and rebound tenderness are present. Rectal examination shows a collapsed rectum. Infusion of 0.9% saline is begun and a CT of the abdomen shows intestinal perforation. The surgeon discusses the need for emergent exploratory laparotomy with the patient and she agrees to it. Written informed consent is obtained. While in the holding area awaiting emergent transport to the operating room, she calls for the surgeon and informs him that she no longer wants the surgery. He explains the risks of not performing the surgery to her and she indicates she understands but is adamant about not proceeding with surgery. Which of the following is the most appropriate next step in management?? {'A': 'Consult hospital ethics committee', 'B': 'Cancel the surgery', 'C': 'Continue with emergency life-saving surgery', 'D': "Obtain consent from the patient's daughter", 'E': "Obtain consent from the patient's ex-husband"},
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B: Cancel the surgery
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Answer the following medical question with one of the provided options:
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Q:A 1-year-old boy is brought to the physician by his mother because he has become increasingly pale over the past several months. He has otherwise been healthy. Apart from his maternal grandfather, who had a blood disorder and required frequent blood transfusions since birth, the rest of his family, including his parents and older sister, are healthy. Examination shows conjunctival pallor. Laboratory studies show: Hemoglobin 7.7 g/dL Mean corpuscular volume 64.8 μm3 Serum Iron 187 μg/dL Ferritin 246 ng/mL A bone marrow aspirate shows numerous ringed sideroblasts. The patient is most likely deficient in an enzyme responsible for which of the following reactions?"? {'A': 'Aminolevulinic acid → porphobilinogen', 'B': 'Glycine + succinyl-CoA → aminolevulinic acid', 'C': 'Glucose-6-phosphate → 6-phosphogluconate', 'D': 'Protoporphyrin → heme', 'E': 'Uroporphyrinogen III → coproporphyrinogen III'},
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B: Glycine + succinyl-CoA → aminolevulinic acid
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Answer the following medical question with one of the provided options:
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Q:A 21-year-old man presents to an outpatient psychiatrist with chief complaints of fatigue and “hearing voices.” He describes multiple voices which sometimes call his name or say nonsensical things to him before he falls asleep at night. He occasionally awakes to see “strange people” in his room, which frighten him but then disappear. The patient is particularly worried by this because his uncle developed schizophrenia when he was in his 20s. The patient also thinks he had a seizure a few days ago, saying he suddenly fell to the ground without warning, though he remembers the episode and denied any abnormal movements during it. He is in his 3rd year of college and used to be a top student, but has been getting C and D grades over the last year, as he has had trouble concentrating and fallen asleep during exams numerous times. He denies changes in mood and has continued to sleep 8 hours per night and eat 3 meals per day recently. Which of the following medications will be most beneficial for this patient?? {'A': 'Haloperidol', 'B': 'Levetiracetam', 'C': 'Modafinil', 'D': 'Risperidone', 'E': 'Valproic acid'},
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C: Modafinil
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Answer the following medical question with one of the provided options:
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Q:A 57-year-old man was brought into the emergency department unconscious 2 days ago. His friends who were with him at that time say he collapsed on the street. Upon arrival to the ED, he had a generalized tonic seizure. At that time, he was intubated and is being treated with diazepam and phenytoin. A noncontrast head CT revealed hemorrhages within the pons and cerebellum with a mass effect and tonsillar herniation. Today, his blood pressure is 110/65 mm Hg, heart rate is 65/min, respiratory rate is 12/min (intubated, ventilator settings: tidal volume (TV) 600 ml, positive end-expiratory pressure (PEEP) 5 cm H2O, and FiO2 40%), and temperature is 37.0°C (98.6°F). On physical examination, the patient is in a comatose state. Pupils are 4 mm bilaterally and unresponsive to light. Cornea reflexes are absent. Gag reflex and cough reflex are also absent. Which of the following is the next best step in the management of this patient?? {'A': 'Apnea test', 'B': 'Withdraw ventilation support and mark time of death', 'C': 'Electroencephalogram', 'D': 'Repeat examination in several hours', 'E': 'Second opinion from a neurologist'},
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D: Repeat examination in several hours
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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 office because of a 2-year history of upper and lower extremity weakness and neck pain that is worse with sneezing. She has had difficulty swallowing and speaking for the past 8 months. Musculoskeletal examination shows spasticity and decreased muscle strength in all extremities. There is bilateral atrophy of the trapezius and sternocleidomastoid muscles. Neurologic examination shows an ataxic gait and dysarthria. Deep tendon reflexes are 4+ bilaterally. Babinski sign is positive. Sensation is decreased below the C5 dermatome bilaterally. An MRI of the neck and base of the skull is shown. Which of the following is the most likely cause of this patient's symptoms?? {'A': 'Foramen magnum meningioma', 'B': 'Cerebral glioblastoma multiforme', 'C': 'Cerebellar astrocytoma', 'D': 'Amytrophic lateral sclerosis', 'E': 'Syringomyelia\n"'},
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A: Foramen magnum meningioma
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Answer the following medical question with one of the provided options:
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Q:A 20-year-old man is brought to the emergency room for evaluation of a back injury sustained while at work. A CT scan of the lumbar spine shows an incidental 2-cm mass adjacent to the inferior vena cava. Histologic examination of a biopsy specimen of the mass shows clusters of chromaffin cells. This mass is most likely to secrete which of the following substances?? {'A': 'Norepinephrine', 'B': 'Cortisol', 'C': 'Estrogen', 'D': 'Dehydroepiandrosterone', 'E': 'Aldosterone'},
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A: Norepinephrine
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Answer the following medical question with one of the provided options:
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Q:A 1-week-old infant that was birthed at home is rushed to the emergency room by his parents. His parents are recent immigrants who do not speak English. Through a translator, the child's parents say that during play with the infant, the infant's body became rigid and his mouth 'locked up'. The child likely suffered from a(n):? {'A': 'Infection of a foot ulcer', 'B': 'Infection of the colon', 'C': 'Intrauterine infection', 'D': 'Infection of the umbilical stump', 'E': 'Dental infection'},
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D: Infection of the umbilical stump
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Answer the following medical question with one of the provided options:
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Q:A 42-year-old male presents to his primary care physician with complaints of fatigue and occasionally darkened urine over the past 3 months. Upon further questioning, the patient reveals that he has regularly had dark, 'cola-colored' urine when he has urinated at night or early in the morning. However, when he urinates during the day, it appears a much lighter yellow color. Laboratory work-up is initiated and is significant for a hemoglobin of 10.1 g/dL, elevated LDH, platelet count of 101,000/uL, and leukopenia. Urinalysis, taken from an early morning void, reveals brown, tea-colored urine with hemoglobinuria and elevated levels of hemosiderin. Which of the following is responsible for this patient's presentation?? {'A': 'Deficiency of C1 esterase-inhibitor', 'B': 'Autosomal dominant deficiency of spectrin protein in the RBC membrane', 'C': 'Presence of a temperature-dependent IgG autoantibody', 'D': 'Deficiency of CD-55 and CD-59 cell membrane proteins', 'E': 'Autosomal recessive deficiency of platelet Glycoprotein IIb/IIIa receptor'},
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D: Deficiency of CD-55 and CD-59 cell membrane proteins
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Answer the following medical question with one of the provided options:
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Q:A 48-year-old man presents to the emergency department with complaints of substernal chest pain for the past 1 hour. The pain is crushing in nature and radiates to his neck and left arm. He rates the pain as 7/10. He gives a history of similar episodes in the past that resolved with rest. He is a non-smoker and drinks alcohol occasionally. On physical examination, the temperature is 37.0°C (98.6°F), the pulse rate is 130/min and irregular, the blood pressure is 148/92 mm Hg, and the respiratory rate is 18/min. The physician immediately orders an electrocardiogram, the findings of which are consistent with an acute Q-wave myocardial infarction (MI). After appropriate emergency management, he is admitted to the medical floor. He develops atrial fibrillation on the second day of admission. He is given a β-adrenergic blocking agent for the arrhythmia. On discharge, he is advised to continue the medication for at least 2 years. Which of the following β-adrenergic blocking agents was most likely prescribed to this patient?? {'A': 'Acebutolol', 'B': 'Celiprolol', 'C': 'Atenolol', 'D': 'Penbutolol', 'E': 'Pindolol'},
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C: Atenolol
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Answer the following medical question with one of the provided options:
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Q:A 19-year-old woman presents with abdominal pain and diarrhea for the last week. She has missed 3 days of school and is extremely stressed about the effect of this absence on her academic performance. She has had a couple of similar though less intense episodes in the past. She says that the diarrhea alternates with constipation and is associated with bloating and flatus. She describes the abdominal pain as spasmodic and episodic, sometimes radiating to the legs, with each episode lasting for 10–15 minutes and relieved by defecation. The patient denies any change in the color of her feces, increased frequency of urination or burning during micturition, loss of appetite or weight loss. No significant past medical history. No significant family history. Physical examination is unremarkable. Laboratory investigations are normal. Which of the following would the best choice to manage the diarrheal symptoms in this patient?? {'A': 'Norfloxacin + metronidazole', 'B': 'Metronidazole', 'C': 'Dicyclomine', 'D': 'Sulfasalazine', 'E': 'Loperamide'},
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E: Loperamide
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Answer the following medical question with one of the provided options:
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Q:A 57-year-old woman undergoes an operation for a long-term toxic multinodular goiter. 13 hours after the procedure, she complains of tingling around her lips and difficulty breathing. While measuring her blood pressure, her hand turned as seen in the picture. On physical examination, she looks anxious and her chest is wheezy on both sides. Which of the following is the best initial treatment of this patient?? {'A': 'Oral calcium and calcitriol', 'B': 'Human recombinant parathyroid hormone (PTH)', 'C': 'Oral magnesium', 'D': 'Intravenous calcium gluconate', 'E': 'Thiazide diuretic'},
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D: Intravenous calcium gluconate
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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 with history of heart failure with preserved ejection fraction (HFpEF) and COPD presents to his cardiologist for a right heart catheterization procedure after a recent echocardiogram revealed pulmonary artery pressure (PAP) of 55 mmHg. Intraoperative administration of intravenous adenosine causes the PAP to decrease to 35 mmHg. What pharmacological therapy is most likely to provide long-term benefit for this patient?? {'A': 'Epoprostenol', 'B': 'Adenosine', 'C': 'Bosentan', 'D': 'Amlodipine', 'E': 'Sildenafil'},
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D: Amlodipine
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Answer the following medical question with one of the provided options:
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Q:A 15-year-old male presents to the emergency department with fever, malaise, and shortness of breath for 1 week. Further history reveals that the patient experiences swelling in his face in the morning that disappears as the day progresses. Physical exam reveals hepatosplenomegaly. A complete blood count shows WBC 84,000 cells/mL. Most of this patient's leukocytes are likely to express which of the following cell surface markers?? {'A': 'CD2', 'B': 'CD10', 'C': 'CD19', 'D': 'CD20', 'E': 'CD16'},
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A: CD2
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Answer the following medical question with one of the provided options:
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Q:A 42-year-old man presents to his physician with dark urine and intermittent flank pain. He has no significant past medical history and generally is healthy. His temperature is 97.5°F (36.4°C), blood pressure is 182/112 mmHg, pulse is 85/min, respirations are 15/min, and oxygen saturation is 98% on room air. Physical examination is significant for bilateral palpable flank masses and discomfort to percussion of the costovertebral angle. Urinalysis is positive for red blood cells without any bacteria or nitrites. Which of the following diagnostic modalities should be used to screen members of this patient's family to assess if they are affected by the same condition?? {'A': 'Abdominal CT', 'B': 'Genetic sequencing', 'C': 'Renal biopsy', 'D': 'Renal ultrasound', 'E': 'Voiding cystourethrogram'},
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D: Renal ultrasound
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Answer the following medical question with one of the provided options:
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Q:A 2-year-old boy is brought to the physician because of the rash shown in the picture for 2 days. Her mother says that the rash initially appeared on his face and neck. He has had fever, cough, and poor appetite for 5 days. The boy’s family recently immigrated from Asia and is unable to provide his vaccination records. His temperature is 38.8°C (102.0°F), pulse is 105/min, and respiratory rate is 21/min. Physical examination shows fading of the rash over the face and neck without any desquamation. Examination of the oropharynx shows tiny rose-colored lesions on the soft palate. Enlarged tender lymph nodes are palpated in the suboccipital, postauricular and anterior cervical regions. The clinical presentation in this patient is most compatible with which of the following diseases?? {'A': 'Measles', 'B': 'Mumps', 'C': 'Roseola', 'D': 'Rubella', 'E': 'Parvovirus B19 infection'},
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D: Rubella
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Answer the following medical question with one of the provided options:
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Q:A 15-year-old boy is sent from gym class with a chief complaint of severe muscle aches. In class today he was competing with his friends and therefore engaged in weightlifting for the first time. A few hours later he was extremely sore and found that his urine was red when he went to urinate. This concerned him and he was sent to the emergency department for evaluation. Upon further questioning, you learn that since childhood he has always had muscle cramps with exercise. Physical exam was unremarkable. Upon testing, his creatine kinase level was elevated and his urinalysis was negative for blood and positive for myoglobin. Thinking back to biochemistry you suspect that he may be suffering from a hereditary glycogen disorder. Given this suspicion, what would you expect to find upon examination of his cells?? {'A': 'Glycogen without normal branching pattern', 'B': 'Normal glycogen structure', 'C': 'Accumulation of glycogen in lysosomes forming dense granules', 'D': 'Short outer glycogen chains', 'E': 'Absence of glycogen in muscles'},
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B: Normal glycogen structure
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Answer the following medical question with one of the provided options:
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Q:A previously healthy 30-year-old man comes to the physician because of a 2-week history of lesions on his elbows. He has no history of serious illness and takes no medications. Physical examination shows skin lesions on bilateral elbows. A photograph of his right elbow is shown. Which of the following is the most appropriate treatment for this patient's skin condition?? {'A': 'Dapsone', 'B': 'Terbinafine', 'C': 'Ketoconazole', 'D': 'Calcipotriene', 'E': 'Diphenhydramine'},
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D: Calcipotriene
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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 is brought to the emergency department 30 minutes after stepping on a piece of broken glass. Physical examination shows a 3-cm, ragged laceration on the plantar aspect of the left foot. The physician uses hydrogen peroxide to clean the wound. Which of the following is the most likely mechanism of action of this disinfectant?? {'A': 'Halogenation of nucleic acids', 'B': 'Crosslinking of proteins', 'C': 'Formation of free radicals', 'D': 'Intercalation of DNA', 'E': 'Congealing of cytoplasm'},
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C: Formation of free radicals
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Answer the following medical question with one of the provided options:
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Q:A 49-year-old man is brought to the emergency department after being discovered unconscious in a field near the county fair. Several empty bottles of vodka were found near him. On arrival, he is mumbling incoherently. He appears malodorous and disheveled. Serum studies show: Na+ 150 mEq/L K+ 3.3 mEq/L Cl- 115 mEq/L HCO3- 13 mEq/L Urea nitrogen 30 mg/dL Glucose 75 mg/dL Creatinine 1.4 mg/dL Lactic acid 6 mmol/L (N < 2) Which of the following changes to enzyme activity best explains this patient's laboratory findings?"? {'A': 'Decreased activity of glucose-6-phosphate dehydrogenase', 'B': 'Increased activity of α-ketoglutarate dehydrogenase', 'C': 'Increased activity of phenylalanine hydroxylase', 'D': 'Decreased activity of phosphofructokinase-2', 'E': 'Decreased activity of pyruvate dehydrogenase'},
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E: Decreased activity of pyruvate dehydrogenase
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Answer the following medical question with one of the provided options:
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Q:A 63-year-old woman presents to the outpatient clinic complaining of severe vulvar itching. The pruritus started 1 year ago and became worse over the last several months. She has tried over-the-counter topical steroids without relief. She is not currently sexually active. Her medical history is notable for long-standing lichen sclerosus. The physical examination reveals an ulcerated small nodule on the right labium majus, as well as dry, thin, white lesions encircling the genital and perianal areas. Which of the following is the most likely diagnosis?? {'A': 'Bartholin gland cyst', 'B': 'Bartholin gland carcinoma', 'C': 'Squamous cell carcinoma', 'D': 'Melanoma', 'E': "Vulvar Paget's disease"},
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C: Squamous cell carcinoma
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Answer the following medical question with one of the provided options:
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Q:A 34-year-old man is admitted to the hospital because of a 3-week history of abdominal distention and yellowing of the skin. He also has a 2-year history of progressively worsening breathlessness and cough. Three days after admission, he suddenly develops peritonitis and sepsis. Despite appropriate care, he dies. At autopsy, histopathological examination of liver and lung tissue shows periodic acid-Schiff-positive (PAS-positive) globules within periportal hepatocytes and low levels of a protein that is responsible for the recoil of the lungs during expiration. Which of the following processes most likely contributes to the elastic properties of this protein?? {'A': 'Oxidative deamination of lysine residues', 'B': 'Hydroxylation of proline residues', 'C': 'Arrangement in a triple helical structure', 'D': 'Formation of disulfide bridges', 'E': 'N-glycosylation of serine residues'},
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A: Oxidative deamination of lysine residues
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Answer the following medical question with one of the provided options:
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Q:A stock trader was reprimanded by his boss for making a series of miscalculated trades that almost cost him his job and the firm a significant amount of money. After leaving work, the trader went to donate his time by tutoring math at the local public school. When his tutee arrived for the session, the trader realized the tutee did not complete the assignment from the previous session. The trader then proceeds to scold the tutee more than is necessary resulting in the tutee leaving in tears. Which of the following ego defenses was exemplified by the trader?? {'A': 'Projection', 'B': 'Reaction formation', 'C': 'Displacement', 'D': 'Passive aggression', 'E': 'Acting out'},
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C: Displacement
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Answer the following medical question with one of the provided options:
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Q:A 32-year-old woman comes to the clinic for a routine evaluation. This is her first time visiting this office. Her medical history is significant for cystic medial necrosis of the aorta. Her vital signs include: heart rate 85/min, respiratory rate 15/min, temperature 36.0°C (96.8°F), and blood pressure 110/80 mm Hg. Physical examination shows she is thin and tall with abnormally long extremities and spider-like fingers. Which of the following disorders does the patient most likely have?? {'A': 'Cystic fibrosis', 'B': 'Fabry disease', 'C': 'Marfan syndrome', 'D': 'Tay-Sachs disease', 'E': 'Von Hippel-Lindau disease'},
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C: Marfan syndrome
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Answer the following medical question with one of the provided options:
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Q:A 1-year-old male presents to his pediatrician for a well-child visit. Through a history from the mother and physical examination, the pediatrician learns that the baby babbles non-specifically, takes several steps independently, and picks up his cereal using two fingers. His weight is currently 22 lbs (birth-weight 6 lbs, 9 oz), and his height is 30 inches (birth length 18 inches). Are there any aspects of this child's development that are delayed?? {'A': 'Inadequate growth', 'B': 'Language delay', 'C': 'Gross motor skill delay', 'D': 'Fine motor skill delay', 'E': 'There are no developmental concerns'},
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B: Language delay
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Answer the following medical question with one of the provided options:
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Q:An investigator is studying DNA repair processes in an experimental animal. The investigator inactivates a gene encoding a protein that physiologically excises nucleotides from damaged, bulky, helix-distorting DNA strands. A patient with a similar defect in this gene is most likely to present with which of the following findings?? {'A': 'Malignant breast and ovarian growths', 'B': 'Dry skin and increased photosensitivity', 'C': 'Colorectal and endometrial cancers', 'D': 'Leukocoria and a painful bone mass', 'E': 'Ataxic gait and facial telangiectasias'},
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B: Dry skin and increased photosensitivity
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Answer the following medical question with one of the provided options:
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Q:A 27-year-old man comes to the physician because of a 4-month history of recurrent episodes of headaches, palpitations, and sweating. He was adopted shortly after birth and does not know his biological parents. His pulse is 103/min and blood pressure is 160/105 mm Hg. Physical examination shows multiple soft, yellow papules on the tip of the tongue. There is a 2-cm, firm thyroid nodule. He has long and slender upper extremities, and his elbows and knees can be hyperextended. The most likely cause of this patient's condition is a mutation in which of the following genes?? {'A': 'RET', 'B': 'FBN1', 'C': 'TSC2', 'D': 'COL5A1', 'E': 'MEN1'},
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A: RET
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Answer the following medical question with one of the provided options:
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Q:A 50-year-old man presents to the emergency department complaining of blood in his stool. He reports that this morning he saw bright red blood in the toilet bowl. He denies fatigue, headache, weight loss, palpitations, constipation, or diarrhea. He has well-controlled hypertension and takes hydrochlorothiazide. His father has rheumatoid arthritis, and his mother has Graves disease. The patient’s temperature is 98°F (36.7°C), blood pressure is 128/78 mmHg, and pulse is 70/min. He appears well. No source for the bleeding is appreciated upon physical examination, including a digital rectal exam. A fecal occult blood test is positive. Which of the following is the most appropriate initial diagnostic test to rule out malignancy?? {'A': 'Anoscopy', 'B': 'Barium enema', 'C': 'Colonoscopy', 'D': 'Computed tomography', 'E': 'Upper endoscopy'},
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C: Colonoscopy
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Answer the following medical question with one of the provided options:
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Q:A 52-year-old man is brought to the emergency department with a 2-hour history of severe, sudden-onset generalized headache. He has since developed nausea and has had one episode of vomiting. The symptoms began while he was at home watching television. Six days ago, he experienced a severe headache that resolved without treatment. He has hypertension and hyperlipidemia. The patient has smoked two packs of cigarettes daily for 30 years. His current medications include lisinopril-hydrochlorothiazide and simvastatin. His temperature is 38.1°C (100.6°F), pulse is 82/min, respirations are 16/min, and blood pressure is 162/98 mm Hg. The pupils are equal, round, and reactive to light. Fundoscopic examination shows no swelling of the optic discs. Cranial nerves II–XII are intact. He has no focal motor or sensory deficits. Finger-to-nose and heel-to-shin testing are normal. A CT scan of the head shows no abnormalities. Which of the following is the most appropriate next step in management?? {'A': 'Repeat CT scan in 24 hours', 'B': 'Obtain a lumbar puncture', 'C': 'Administer 100% oxygen and intranasal sumatriptan', 'D': 'Place ventriculoperitoneal shunt', 'E': 'Obtain an MRI scan of the head'},
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B: Obtain a lumbar puncture
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Answer the following medical question with one of the provided options:
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Q:A 44-year-old woman presents for her annual physical checkup. She says she first noticed a mass in her right breast while taking a shower 3 months ago, which has progressively increased in size. She denies any weight loss, fever, night sweats, discharge from or change in her nipples. Her family history is negative for breast, ovarian, and endometrial cancer. She is afebrile, and her vital signs are within normal limits. Physical examination reveals a smooth, multinodular, firm 5 cm x 5 cm mass in the right breast that is mobile and painless. The skin over the mass appears to be stretched and shiny without ulcerations, erythema, or vascular demarcation. On follow-up 6 weeks later, an interval ultrasound of the right breast reveals a well-circumscribed hypoechoic mass with some cystic components that now measures 8 cm x 7 cm. A core needle biopsy of the mass is performed. Which of the following diagnosis is most likely expected to be confirmed by the core needle biopsy in this patient?? {'A': 'Fibroadenoma', 'B': 'Breast abscess', 'C': 'Phyllodes tumor', 'D': 'Duct ectasia', 'E': 'Fat necrosis'},
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C: Phyllodes tumor
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Answer the following medical question with one of the provided options:
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Q:A 35-year-old female presents to your office with complaints of painful bleeding between regular menstrual cycles, pain during sexual intercourse, and postcoital bleeding for the past 6 months. She also gives a long history of mild, crampy, vague, lower abdominal pain, but has never sought medical attention. She underwent surgical sterilization after her first and only child 7 years ago with no other significant events in her medical history. The last Pap smear, 1 year ago, was reported as reactive inflammation and negative for malignancy. Upon pelvic examination, you note a mucopurulent discharge, cervical motion tenderness, and endocervical bleeding when passing a cotton swab through the cervical os. Which of the following is the most likely diagnosis?? {'A': 'Endometrial polyps', 'B': 'Endometritis', 'C': 'Ovulatory dysfunction', 'D': 'Ectropion', 'E': 'Endometriosis'},
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B: Endometritis
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Answer the following medical question with one of the provided options:
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Q:A longstanding patient of yours has been hospitalized for a week with pneumonia. You have taken care of her while she was in the hospital. At the end of her hospitalization, she tells you how grateful she is for your care and gives you a small gift basket with homemade food, which you accept. However, when you get home, you realize that the basket also contains a $250 gift certificate to an expensive restaurant. Which of the following is an appropriate response to this situation?? {'A': 'Return both the food and gift certificate because it is never acceptable to take gifts from patients', 'B': 'Keep both the food and gift certificate', 'C': 'Keep the food, but return the gift certificate', 'D': 'Report the gifts to your hospital ethics committee', 'E': "Return the gift certificate for cash, and donate the cash to the hospital's free clinic"},
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C: Keep the food, but return the gift certificate
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Answer the following medical question with one of the provided options:
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Q:A 29-year-old man presents to his primary care provider complaining of testicular pain. He reports a four-day history of dull chronic pain in his left testicle that is worse with standing. His past medical history is notable for asthma and major depressive disorder. He takes inhaled albuterol as needed and sertraline. He is sexually active with a single female partner and always uses barrier protection. His temperature is 99.2°F (37.3°C), blood pressure is 125/75 mmHg, pulse is 85/min, and respirations are 17/min. Physical examination reveals a non-tender twisted mass along the left spermatic cord that disappears when the patient lies supine. This patient’s condition most likely stems from decreased laminar flow at which of the following vascular junctions?? {'A': 'Left testicular vein – Left renal vein', 'B': 'Left testicular vein – Inferior vena cava', 'C': 'Left testicular vein – Left suprarenal vein', 'D': 'Descending aorta – Left testicular artery', 'E': 'Left testicular vein – Left internal iliac vein'},
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A: Left testicular vein – Left renal vein
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Answer the following medical question with one of the provided options:
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Q:A 26-year-old African American woman presents to the clinic with burning upon urination. The patient describes increased frequency, urgency, and a painful sensation at the urethra when urinating for the past 3 days. She also reports increased vaginal discharge and abnormal odor during the same time. The patient denies fever, flank pain, or hematuria (though the patient does report a dark brown color of the urine). Her past medical history is significant for Crohn disease that is controlled with sulfasalazine. Vital signs are within normal limits. What is the definitive treatment of the described condition?? {'A': 'Bactrim', 'B': 'IM ceftriaxone and oral azithromycin', 'C': 'Increase in sulfasalazine dose', 'D': 'IV ceftriaxone', 'E': 'Surgery'},
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E: Surgery
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Answer the following medical question with one of the provided options:
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Q:A 62-year-old woman is brought to the emergency department because of the sudden onset of severe left eye pain, blurred vision, nausea, and vomiting. She has had an upper respiratory tract infection for the past 2 days and has been taking phenylephrine to control symptoms. Examination shows a rock-hard, injected left globe and a fixed, mid-dilated pupil on the left. Gonioscopy shows that the iris meets the cornea at an angle of 10° (N = 20–45°). Systemic pharmacotherapy is initiated. Which of the following is most likely to occur in this patient?? {'A': 'Epithelial keratopathy', 'B': 'Xerostomia', 'C': 'Bradycardia', 'D': 'Metabolic acidosis', 'E': 'Diaphoresis'},
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D: Metabolic acidosis
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Answer the following medical question with one of the provided options:
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Q:A 46-year-old woman presents to her primary care physician with complaints of increasing left upper quadrant discomfort. She has a known history of type 1 Gaucher disease. On physical examination, her spleen is palpable 8 cm below the costal margin. Routine laboratory work reveals severe pancytopenia. After consultation with the patient on the risks of her condition, the patient decides to undergo a splenectomy. Which of the following is more likely to occur as a consequence of splenectomy in this patient?? {'A': 'Anemia', 'B': 'Pneumococcal septicemia', 'C': 'Thrombocytopenia', 'D': 'Staphylococcal septicemia', 'E': 'Leukopenia'},
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B: Pneumococcal septicemia
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Answer the following medical question with one of the provided options:
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Q:An investigator is studying growth patterns of various fungal pathogens. Incubation of an isolated fungus at 25°C shows branching hyphae with rosettes of conidia under light microscopy. After incubation at 37°C, microscopic examination of the same organism instead shows smooth, white colonies with rounded, elongated cells. Infection with the investigated pathogen is most likely to cause which of the following conditions?? {'A': 'Cryptococcosis', 'B': 'Pityriasis versicolor', 'C': 'Candidiasis', 'D': 'Coccidioidomycosis', 'E': 'Sporotrichosis'},
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E: Sporotrichosis
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Answer the following medical question with one of the provided options:
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Q:A group of scientists discovered a neurotoxin that prevents neurons from releasing neurotransmitters. They performed a series of experiments to determine the protein that the neurotoxin affected. They used a fluorescent molecule that localizes to synaptic vesicles. In the control experiment, they observed the movement of vesicles from the cell body down the axon and finally to the synapse, and they saw movement from the synapse back to the cell body. When the neurotoxin was applied, the vesicles stopped moving down the axon, but movement back to the cell body still occurred. They also applied tetanospasmin and botulinuum toxin to see if these toxins exhibited similar behavior but they did not. Which of the following proteins is most likely affected by this neurotoxin?? {'A': 'Kinesin', 'B': 'Dynein', 'C': 'Synaptobrevin', 'D': 'SNAP-25', 'E': 'Alpha/Beta tubulin'},
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A: Kinesin
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Q:An investigator is studying nosocomial infections in hospitals. The weekly incidence of hospital-acquired pulmonary infections within the pediatric wards of eight different hospitals is recorded. The results are shown. Which of the following values best represents the median value of these incidence rates?? {'A': '7.0', 'B': '5.5', 'C': '2.73', 'D': '6.0', 'E': '8.0'},
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D: 6.0
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Q:A 58-year old man comes to the emergency department because of progressively worsening shortness of breath and fatigue for 3 days. During the last month, he has also noticed dark colored urine. One month ago, he underwent mechanical aortic valve replacement for high-grade aortic stenosis. A photomicrograph of a peripheral blood smear from the patient is shown. Which of the following findings is most likely to be seen in this patient?? {'A': 'Low unconjugated bilirubin', 'B': 'Elevated lactate dehydrogenase', 'C': 'Low ferritin', 'D': 'Low platelets', 'E': 'Elevated haptoglobin'},
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B: Elevated lactate dehydrogenase
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Q:A 30-year-old woman comes to the physician for a pelvic examination and Pap smear. Menses have occurred at regular 28-day intervals since menarche at the age of 11 years and last for 5 days. The first day of her last menstrual period was 3 weeks ago. She is sexually active with her husband and takes oral contraceptive pills. Her last Pap smear was 3 years ago. She has never had a mammography. Her mother and maternal aunt died of breast cancer. Pelvic examination shows a normal vagina and cervix. Bimanual examination shows a normal-sized uterus and no palpable adnexal masses. Which of the following health maintenance recommendations is most appropriate at this time?? {'A': 'Pap smear and human papillomavirus testing now and every year, mammography at age 40', 'B': 'Pap smear and human papillomavirus testing now and every year, mammography at age 65', 'C': 'Pap smear every 5 years, mammography at age 40', 'D': 'Pap smear only every year, mammography at age 50', 'E': 'Pap smear and human papillomavirus testing now and every 5 years, mammography at age 40'},
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E: Pap smear and human papillomavirus testing now and every 5 years, mammography at age 40
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Q:A 29-year-old man is outside his home doing yard work when a bee stings him in the right arm. Within 10 minutes, he reports breathlessness and multiple, circular, pruritic rashes over his right arm. He drives to his family physician’s office for evaluation. His past medical history is significant for hypertension and he takes lisinopril. Known allergies include latex, Hymenoptera, and aspirin. His blood pressure is 118/68 mm Hg; heart rate is 104/min and regular; respiratory rate is 22/min; temperature is 37.7°C (99.8°F). There is non-pitting edema but erythema with raised wheels are present in the region of the right arm. Auscultation of the lungs reveals mild wheezing at the lung bases. Which of the following is the best course of action in the management of this patient?? {'A': 'Diphenhydramine and go to the emergency department', 'B': 'Methylprednisolone and go to the emergency department', 'C': 'Go to the emergency department', 'D': 'Albuterol and go to the emergency department', 'E': 'Epinephrine and go to the emergency department'},
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E: Epinephrine and go to the emergency department
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Q:A 45-year-old woman is brought to the Emergency Department by her husband due to increasing confusion. He reports that she has been urinating a lot for the past month or so, especially at night, and has also been constantly drinking water and tea. Lately, she has been more tired than usual as well. Her past medical history is significant for bipolar disorder. She takes lithium and a multivitamin. She has a levonorgestrel IUD. Her blood pressure is 140/90 mmHg, pulse rate is 95/min, respiratory rate is 16/min, and temperature is 36°C (96.8°F). At physical examination, she is drowsy and disoriented. Her capillary refill is delayed and her mucous membranes appear dry. The rest of the exam is nondiagnostic. Laboratory studies show: Na+: 148 mEq/L K+: 4.2 mEq/L Serum calcium: 11.0 mg/dL Creatinine: 1.0 mg/dL Urine osmolality: 190 mOsm/kg Serum osmolality: 280 mOsm/kg Finger-stick glucose: 120 mg/dL Fluid resuscitation is initiated. Which of the following is the most likely diagnosis?? {'A': 'SIADH', 'B': 'Psychogenic polydipsia', 'C': 'Diabetes Mellitus', 'D': 'Nephrogenic diabetes insipidus', 'E': 'Central diabetes insipidus'},
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D: Nephrogenic diabetes insipidus
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Q:A 27-year-old man presents to the emergency department with severe dyspnea and sharp chest pain that suddenly started an hour ago after he finished exercising. He has a history of asthma as a child, and he achieves good control of his acute attacks with Ventolin. On examination, his right lung field is hyperresonant along with diminished lung sounds. Chest wall motion during respiration is asymmetrical. His blood pressure is 105/67 mm Hg, respirations are 22/min, pulse is 78/min, and temperature is 36.7°C (98.0°F). The patient is supported with oxygen, given corticosteroids, and has had analgesic medications via a nebulizer. Considering the likely condition affecting this patient, what is the best step in management?? {'A': 'Chest X-rays', 'B': 'ABG', 'C': 'Tube insertion', 'D': 'Sonogram', 'E': 'CT scan'},
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C: Tube insertion
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Q:A 40-year-old woman presents with an acute loss of vision in her right eye. Past medical history is significant for depression diagnosed 2 years ago and well-managed medically. Further history reveals that the patient recently came to know that her trusted neighbor was sexually abusing her younger daughter. Physical examination is unremarkable and reveals no abnormality that can explain her acute unilateral blindness. Which of the following features is most characteristic of this patient’s condition?? {'A': 'La belle indifference', 'B': 'Pseudologia fantastica', 'C': 'Desire for the sick-role', 'D': 'Seeking tangible reward', 'E': 'Hyperactive insula'},
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A: La belle indifference
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Q:A 33-year-old man presents to his primary care physician for numbness and tingling in his hands. He does not typically see a physician, but states that he has had some worsening numbness and weakness in his hands that has been progressing over the past month. His temperature is 99°F (37.2°C), blood pressure is 120/66 mmHg, pulse is 80/min, respirations are 16/min, and oxygen saturation is 99% on room air. Physical exam is notable for a man with strange facial features including an enlarged mandible. The patient is tall and has very large hands with symptoms of numbness and pain reproduced when tapping over the flexor retinaculum of the wrist. Routine laboratory values demonstrate a fasting blood glucose of 155 mg/dL. Which of the following is the most likely cause of mortality in this patient?? {'A': 'Adrenal failure', 'B': 'Congestive heart failure', 'C': 'Kidney failure', 'D': 'Malignancy', 'E': 'Stroke'},
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B: Congestive heart failure
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Q:A 1-year-old boy is brought to the physician by his parents for the evaluation of recurrent seizures. He is at the 5th percentile for height and 10th percentile for weight. Examination shows coarse pale hair, inelastic hypopigmented skin, and generalized hypotonia. Laboratory studies show low serum ceruloplasmin levels. Decreased activity of which of the following enzymes is most likely responsible for this patient's condition?? {'A': 'Phenylalanine hydroxylase', 'B': 'Prolyl hydroxylase', 'C': 'Lysyl oxidase', 'D': 'Glucocerebrosidase', 'E': 'Homogentisate oxidase'},
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C: Lysyl oxidase
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Q:A 55-year-old woman presents to her primary care physician with diarrhea. She states that it has persisted for the past several weeks and has not been improving. She also endorses episodes of feeling particularly flushed in the face. Her temperature is 99°F (37.2°C), blood pressure is 125/63 mmHg, pulse is 100/min, respirations are 15/min, and oxygen saturation is 97% on room air. Physical exam is notable for wheezing on pulmonary exam. The patient is discharged with medications for her symptoms. She returns 2 weeks later with symptoms of diarrhea, dry skin, a non-specific rash, and a notable decline in her memory. Which of the following is the most likely cause of this patient’s most recent presentation?? {'A': 'Increased catecholamine levels', 'B': 'Increased serotonin levels', 'C': 'Increased vasoactive intestinal peptide levels', 'D': 'Niacin deficiency', 'E': 'Vitamin B12 deficiency'},
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D: Niacin deficiency
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Q:A previously healthy 36-year-old woman comes to the emergency department because of a progressively worsening headache for 5 days. She vomited twice after waking up this morning. She does not smoke or drink alcohol. She is sexually active with one male partner and uses an oral contraceptive. Her temperature is 37.5°C (99.5°F), pulse is 105/min, and blood pressure is 125/80 mm Hg. Examination shows tearing of the right eye. The pupils are equal and reactive to light; right lateral gaze is limited. Fundoscopic examination shows bilateral optic disc swelling. The remainder of the examination shows no abnormalities. An MR venography of the head shows a heterogeneous intensity in the left lateral sinus. Which of the following is the most appropriate next step in management?? {'A': 'Administer dalteparin', 'B': 'Analyze cerebrospinal fluid', 'C': 'Administer intravenous antibiotics', 'D': 'Measure D-dimer levels', 'E': 'Perform endovascular thrombolysis'},
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A: Administer dalteparin
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Q:A 38-year-old woman comes to the physician because of a 1-month history of fatigue and pruritus. Examination of the abdomen shows an enlarged, nontender liver. Serum studies show an alkaline phosphatase level of 140 U/L, aspartate aminotransferase activity of 18 U/L, and alanine aminotransferase activity of 19 U/L. Serum antimitochondrial antibody titers are elevated. A biopsy specimen of this patient's liver is most likely to show which of the following findings?? {'A': 'Fibrous, concentric obliteration of small and large bile ducts', 'B': 'Intracytoplasmic eosinophilic inclusions in hepatocytes and cellular swelling', 'C': 'Macrovesicular fatty infiltration and necrosis of hepatocytes', 'D': 'Ballooning degeneration and apoptosis of hepatocytes', 'E': 'Lymphocytic infiltration of portal areas and periductal granulomas\n"'},
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E: Lymphocytic infiltration of portal areas and periductal granulomas "
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Q:A 68-year-old man presents to the physician for a follow-up examination, accompanied by his spouse. Two years ago, he was diagnosed with localized prostate cancer, for which he underwent radiation therapy. He was recently diagnosed with osteoblastic metastases to the spine and is scheduled to initiate physical therapy next week. In private, the patient’s spouse says that he has been losing weight and wetting the bed, and she tearfully asks the physician if his prostate cancer has returned. She says that her husband has not spoken to her about his health recently. The patient has previously expressed to the physician that he does not want his spouse to know about his condition because she “would worry too much”. Which of the following initial statements by the physician is most appropriate?? {'A': '"I\'m sorry, I can\'t discuss any information with you without his permission. I recommend that you have an open discussion with your husband."', 'B': '"It concerns me that he\'s not speaking openly with you. I recommend that you seek medical power of attorney for your husband. Then, we can legally discuss his diagnosis and treatment options together."', 'C': '“It’s difficult to deal with couples who are aging, but I have experience helping families cope. We should sit down with your husband and discuss this situation together.”', 'D': '“Sorry, but because your husband’s condition is not classified as a notifiable disease, I’m not permitted to discuss his medical information with you without first obtaining his consent.”', 'E': "“Your husband is very ill and may not want you to know the details. I can imagine it's frustrating for you, but you have to respect his discretion.”"},
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A: "I'm sorry, I can't discuss any information with you without his permission. I recommend that you have an open discussion with your husband."
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Q:A mother brings her 3-day-old son to the pediatrician with a concern over drops of a clear yellow discharge from the clamped umbilical cord. These drops have formed every few hours every day. The vital signs are within normal limits and a cursory physical shows no abnormalities. On closer examination, the discharge is shown to be urine. The skin around the umbilical cord appears healthy and healing. The umbilical cord is appropriately discolored. An ultrasound shows a fistula tract that connects the urinary bladder and umbilicus. Which of the following structures failed to form in this patient?? {'A': 'Lateral umbilical ligament', 'B': 'Round ligament of the liver', 'C': 'Medial umbilical ligament', 'D': 'Median umbilical ligament', 'E': 'Falciform ligament'},
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D: Median umbilical ligament
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Q:A 5-year-old boy is taken to his pediatrician by his mother for evaluation of painless testicular swelling. His mother says that it became apparent at 1 year of age and has been progressively increasing in size. There is no history of infectious diseases other than the seasonal flu. The boy has no history of trauma or surgery. He has not visited any tropical countries and his vaccinations are up to date. The vital signs are normal for the patient’s age. The physical examination reveals non-tender, fluctuating testicular swelling bilaterally with positive translucency. The swelling decreases slightly in the supine position and there is a positive cough impulse sign. A sonographic image is shown below. Which of the following statements about the patient’s condition is correct?? {'A': 'Puncture of this structure will yield blood.', 'B': 'It is most likely a result of viral replication within testicular tissue.', 'C': 'The structure shown does not communicate with the peritoneal cavity.', 'D': 'Impaired lymphatic drainage from the scrotum is the cause of the patient’s condition.', 'E': 'A similar condition in girls could involve the canal of Nuck.'},
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E: A similar condition in girls could involve the canal of Nuck.
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Q:A 35-year-old man from Thailand presents with low-grade fever, chronic cough, and night sweats for 3 months. He describes the cough as productive and producing white sputum that is sometimes streaked with blood. He also says he has lost 10 lb in the last 3 months. Past medical history is unremarkable. The patient denies any smoking history, alcohol, or recreational drug use. The vital signs include blood pressure 115/75 mm Hg, heart rate 120/min, respiratory rate 20/min, and temperature 36.6℃ (97.8℉). On physical examination, the patient is ill-looking and thin with no pallor or jaundice. Cardiopulmonary auscultation reveals some fine crackles in the right upper lobe. A chest radiograph reveals a right upper lobe homogeneous density. Which of the following tests would be most helpful in making a definitive diagnosis of active infection in this patient?? {'A': 'Gram stain', 'B': 'Ziehl-Neelsen stain', 'C': 'Silver stain', 'D': 'PPD test', 'E': 'Interferon-gamma assay'},
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B: Ziehl-Neelsen stain
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Answer the following medical question with one of the provided options:
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Q:A 70-year-old male comes to the emergency department complaining of severe back pain. The pain started 20 minutes ago when he was sitting and watching TV. He describes the pain as intense, epigastric, and radiating to his back. His vitals on presentation to the emergency department are blood pressure is 150/75 mmHg, pulse is 110/min, and respirations are 24/min with an oxygen saturation of 98% on room air. His body mass index is 35 kg/m^2 and he appears pale and in visible pain. On abdominal exam, his abdomen is tender and a pulsatile mass is felt in the midline during deep palpation. His past medical history includes diabetes, hypertension well-controlled on medications, and a history of benign prostatic hyperplasia. His social history is notable for consuming 2-3 beers per night and a smoking history of ½ pack per day. Which of the following is considered the greastest risk factor for this patient’s condition?? {'A': 'Obesity', 'B': 'Smoking', 'C': 'Diabetes', 'D': 'Alcohol consumption', 'E': 'Benign prostatic hyperplasia'},
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B: Smoking
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Q:A 32-year-old woman presents with new left-arm pain. She was previously well but for 2 months has had episodes of low-grade fever, night sweats, and dizziness. She works as a stock assistant and has noticed left arm pain when she stocks shelves. She is taking a multivitamin but no other medications. On physical examination, her blood pressure is 126/72 in her right arm, but it cannot be measured in her left arm. The left radial pulse is not detectable. There is a bruit over the left subclavian area. Femoral and pedal pulses are normal and no abdominal bruits are heard. The left hand is cool but has no other evidence of ischemia. Which of the following is the most likely etiology of this patient’s condition?? {'A': 'Subclavian steal syndrome', 'B': 'Raynaud’s phenomenon', 'C': 'Fibromuscular dysplasia', 'D': 'Kawasaki disease', 'E': 'Aortic coarctation'},
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A: Subclavian steal syndrome
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Answer the following medical question with one of the provided options:
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Q:An 18-year-old female is brought to the emergency department by her boyfriend. She is screaming uncontrollably. Eventually, she states that she is afraid that "death is near" but cannot give a rational reason for this thought. She reports both seeing colors "coming out of other people's mouths" and "hearing" these colors. The patient's boyfriend experienced similar sensory symptoms a few hours ago; he explains they were trying to have a "spiritual experience." Physical exam is significant for mydriasis, hypertension, hyperthermia, piloerection, tachycardia, and sweating. Upon which of the following receptors does the most likely drug she ingested act?? {'A': 'Cannabinoid', 'B': '5-hydroxytryptamine', 'C': 'NMDA', 'D': 'GABA', 'E': 'Mu opioid'},
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B: 5-hydroxytryptamine
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Answer the following medical question with one of the provided options:
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Q:A 12-year-old boy is brought to the emergency department because of acute onset abdominal pain. On arrival, he also complains of nausea and shortness of breath in addition to epigastric pain. He has previously been admitted to the hospital several times for respiratory infections with Pseudomonas species and uses a nebulizer and a chest wall oscillation vest at home. The patient's acute condition is found to be due to premature activation of an enzyme that normally interacts with the brush border. Which of the following describes the activity of this enzyme?? {'A': 'Activates phospholipase A2', 'B': 'Breaks down elastin molecules', 'C': 'Digests triglycerides', 'D': 'Exclusively performs digestive proteolysis', 'E': 'Hydrolyzes phospholipids'},
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A: Activates phospholipase A2
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Answer the following medical question with one of the provided options:
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Q:A 2-year-old boy has a history of recurrent bacterial infections, especially of his skin. When he has an infection, pus does not form. His mother reports that, when he was born, his umbilical cord took 5 weeks to detach. He is ultimately diagnosed with a defect in a molecule in the pathway that results in neutrophil extravasation. Which of the following correctly pairs the defective molecule with the step of extravasation that molecule affects?? {'A': 'ICAM-1; margination', 'B': 'LFA-1 (integrin); margination', 'C': 'LFA-1 (integrin); tight adhesion', 'D': 'E-selectin; tight adhesion', 'E': 'E-selectin; transmigration'},
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C: LFA-1 (integrin); tight adhesion
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Q:A patient presents to his primary care physician with complaints of regular headaches and upper abdominal pain. On physical examination, his spleen and liver seem enlarged, and his face is plethoric. Gastroendoscopy reveals several gastric ulcers ranging from 5–3 mm in greatest dimension. A bone marrow aspirate shows hypercellularity with fibrosis and serum erythropoietin is low. The patient is informed about a new treatment with ruxolitinib for the main cause of his symptoms. Which of the conditions below can develop due to the same mutation that is causing this patient’s symptoms?? {'A': 'Acute monocytic leukemia', 'B': 'Mantle cell lymphoma', 'C': 'Chronic myelogenous leukemia', 'D': "Burkitt's lymphoma", 'E': 'Essential thrombocythemia'},
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E: Essential thrombocythemia
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Answer the following medical question with one of the provided options:
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Q:A 68-year-old male with a history of congestive heart failure presents to his cardiologist complaining of mild dyspnea on exertion and swollen ankles. His past medical history is also significant for hypertension and alcohol abuse. He has a 50 pack-year smoking history. He currently takes lisinopril, aspirin, and metoprolol. His temperature is 99°F (37.2°C), blood pressure is 135/85 mmHg, pulse is 85/min, and respirations are 18/min. An echocardiogram reveals an ejection fraction of 35%. His cardiologist adds an additional medication to the patient’s regimen. Two weeks later, the patient notices yellow halos in his vision. Which of the following medications did this patient most likely start taking?? {'A': 'Hydralazine', 'B': 'Furosemide', 'C': 'Dobutamine', 'D': 'Digoxin', 'E': 'Nitroprusside'},
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D: Digoxin
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Answer the following medical question with one of the provided options:
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Q:A 20-year-old female presents to your clinic for evaluation. She complain of months of daily rhinorrhea, which she describes as watery and clear, as well as nasal congestion bilaterally. In addition, she reports frequent watery and itchy eyes, as well as daily sneezing. Her temperature is 100.1 deg F (37.8 deg C), blood pressure is 120/70 mmHg, pulse is 70/min, and respirations are 15/min. On exam, you note edematous, boggy turbinates with watery rhinorrhea. Which of the following is a treatment for the patient’s condition?? {'A': 'Intravenous penicillin', 'B': 'Oral amoxicillin', 'C': 'Oral acetaminophen', 'D': 'Intranasal fluticasone', 'E': 'Intravenous vancomycin'},
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D: Intranasal fluticasone
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Answer the following medical question with one of the provided options:
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Q:A 39-year-old man comes to the physician with a 4-week history of lesions on his penis and scrotum. He has no pain or discharge from the lesions. Two years ago, he was diagnosed with chronic myeloid leukemia and was treated with imatinib. He takes no medications. He has smoked one pack of cigarettes daily for 20 years and drinks one to two beers on the weekends. He is sexually active and had unprotected intercourse with a woman about 4 months ago while abroad on business. He appears well. His temperature is 37°C (98°F), pulse is 85/min, and blood pressure is 128/82 mm Hg. Examination shows 3 nontender lesions up to 1 cm in size. A photograph of the lesions is shown. There is no inguinal lymphadenopathy. Which of the following is the most likely causal organism?? {'A': 'Treponema pallidum', 'B': 'Klebsiella granulomatis', 'C': 'Herpes simplex virus', 'D': 'Haemophilus ducreyi', 'E': 'Chlamydia trachomatis'},
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B: Klebsiella granulomatis
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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 clinic by his daughter for poor memory. She states that over the past two years his memory has been slowly declining though he has been able to take care of himself, pay his own rent, and manage his finances. However, two months ago she noticed a sharp decline in his cognitive functioning as well as his gait. Then one month ago, she noticed a similar decline in his functioning again that came on suddenly. The patient has a past medical history of diabetes mellitus type II, hypertension, obesity, and dyslipidemia. Current medications include hydrochlorothiazide, lisinopril, metformin, and glipizide. His blood pressure is 165/95 mmHg, pulse is 82/minute, he is afebrile, and oxygen saturation is 98% on room air. Cardiac exam reveals a crescendo-decrescendo murmur heard in the left upper sternal border that radiates to the carotids. Abdominal exam is benign, and neurologic exam reveals an unsteady gait. Which of the following findings is associated with the most likely diagnosis?? {'A': 'Neurofibrillary tangles and hyperphosphorylated tau', 'B': 'Fronto-temporal degeneration', 'C': 'Multiple lacunar infarcts', 'D': 'Lewy bodies found on biopsy', 'E': 'Diffuse, subtle atrophy of the brain, subtle ventricular enlargement'},
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C: Multiple lacunar infarcts
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Answer the following medical question with one of the provided options:
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Q:A 57-year-old man calls his primary care physician to discuss the results of his annual laboratory exams. The results show that he has dramatically decreased levels of high-density lipoprotein (HDL) and mildly increased levels of low-density lipoprotein (LDL). The physician says that the HDL levels are of primary concern so he is started on the lipid level modifying drug that most effectively increases serum HDL levels. Which of the following is the most likely a side effect of this medication that the patient should be informed about?? {'A': 'Flushing', 'B': 'Gallstones', 'C': 'Hepatotoxicity', 'D': 'Malabsorption', 'E': 'Myalgia'},
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A: Flushing
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Q:A 23-year-old woman and her husband come to a genetic counselor because she is concerned about the chance of having an inherited defect if they had a child. Family history reveals no significant family history in her husband; however, her sister had a son who has seizures, failure to thrive, and neurodegeneration. She does not remember the name of the disease but remembers that her nephew had sparse, brittle hair that kinked in odd directions. She does not think that any other members of her family including her sister's husband have had this disorder. If this couple had a son, what is the most likely chance that he would have the same disorder that affected the patient's nephew?? {'A': 'Close to 0%', 'B': '12.5%', 'C': '25%', 'D': '50%', 'E': '100%'},
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C: 25%
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Answer the following medical question with one of the provided options:
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Q:An 8-year-old boy is brought to the physician by his father because of abnormal movements of his limbs. For the past four days, he has had uncontrolled jerking movements of his arms and legs and has been dropping cups and toys. His symptoms are worse when he is excited and improve while he is asleep. During the same time period, he has become increasingly irritable and tearful. He had a sore throat 6 weeks ago that resolved without treatment. His temperature is 37.3°C (99.2°F). Examination shows occasional grimacing with involuntary jerking movements of his limbs. Muscle strength and tone are decreased in all extremities. When he grips the physician's index and middle fingers with his hands, his grip increases and decreases continuously. This patient is at increased risk for which of the following complications?? {'A': 'Extraneural metastasis', 'B': 'Early-onset dementia', 'C': 'Attention deficit hyperactivity disorder', 'D': 'Diabetes mellitus', 'E': 'Mitral regurgitation'},
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E: Mitral regurgitation
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Answer the following medical question with one of the provided options:
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Q:A prospective cohort study was conducted to evaluate the effectiveness of transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR) for treatment of aortic stenosis in adults 65 years of age and older. Three hundred patients who received TAVR and another 300 patients who received SAVR were followed for 5 years and monitored for cardiovascular symptoms and all-cause mortality. The study found that patients who received TAVR had a higher risk of death at the end of a 5-year follow-up period (HR = 1.21, p < 0.001). Later, the researchers performed a subgroup analysis by adjusting their data for ejection fraction. After the researchers compared risk of death between the TAVR and SAVR groups among patients of the same ejection fraction, they found that TAVR was no longer associated with a higher risk of death. They concluded that ejection fraction was a potential confounding variable. Which of the following statements would be most supportive of this conclusion?? {'A': 'The prevalence of low ejection fraction is higher in the TAVR group', 'B': 'The increase in risk of death conferred by TAVR is higher in patients with low ejection fraction', 'C': 'TAVR correlates with increased risk of death, but the magnitude of effect differs based on ejection fraction', 'D': 'Ejection fraction influences both probability of receiving TAVR and risk of death', 'E': 'Patients who receive TAVR and SAVR have similar ejection fractions'},
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D: Ejection fraction influences both probability of receiving TAVR and risk of death
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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 is brought to the physician because of a 5-day history of sore throat and a painful swelling on the left side of his neck that has become progressively larger. He has had pain during swallowing and has refused to eat solid foods for the past 3 days. He immigrated to the United States one year ago from India. His immunization records are unavailable. His family keeps 2 cats as pets. He appears well. He is at the 60th percentile for height and 50th percentile for weight. His temperature is 37.7°C (99.9°F), pulse is 103/min, and blood pressure is 92/60 mm Hg. The oropharynx is erythematous; the tonsils are enlarged with exudates. There is a 3-cm warm, tender, nonfluctuant cervical lymph node on the left side of the neck. His hemoglobin is 12.6 g/dL, leukocyte count is 11,100/mm3, and platelet count is 180,000/mm3. In addition to obtaining a throat swab and culture, which of the following is the most appropriate next step in management?? {'A': 'Sulfadiazine and pyrimethamine therapy', 'B': 'Incision and drainage', 'C': 'Fine-needle aspiration biopsy', 'D': 'Clindamycin therapy', 'E': 'Immunoglobulin therapy'},
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D: Clindamycin therapy
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Q:A 52-year-old man with a history of hypertension and hyperlipidemia comes to the physician because of a 10-month history of substernal chest pain on exertion that is relieved with rest. His pulse is 82/min and blood pressure is 145/82 mm Hg. He is prescribed a drug that acts by forming free radical nitric oxide. The patient is most likely to experience which of the following adverse effects as a result of this drug?? {'A': 'Pulsating headaches', 'B': 'Hypertensive urgency', 'C': 'Nonproductive cough', 'D': 'Lower extremity edema', 'E': 'Erectile dysfunction'},
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A: Pulsating headaches
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Answer the following medical question with one of the provided options:
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Q:A 26-year-old man is brought to the emergency department by ambulance after being involved in a motor vehicle collision. He does not open his eyes on command or respond to verbal cues. A CT scan of the head shows a hyperdense fluid collection in the right medial temporal lobe with medial displacement of the uncus and parahippocampal gyrus of the temporal lobe. Which of the following cranial nerves is most likely to be injured as a result of this patient's lesion?? {'A': 'Facial', 'B': 'Vagus', 'C': 'Abducens', 'D': 'Oculomotor', 'E': 'Trigeminal'},
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D: Oculomotor
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Q:A 70-year-old male immigrant from Asia is brought to the emergency room with complaints of palpitations and light-headedness for 1 hour. The patient was sitting in his chair watching television when he felt his heart racing and became dizzy. He was unable to stand up from his chair because of weakness and light-headedness. His past medical history is notable for mitral stenosis secondary to rheumatic fever as a child. On arrival to the emergency department, the patient's temperature is 99.7°F (37.6°C), blood pressure is 110/55 mmHg, pulse is 140/min, and respirations are 15/min. The patient appears comfortable but anxious. Electrocardiogram shows atrial fibrillation with rapid ventricular response. The patient is started on dofetilide. Which of the following would be expected in this patient’s cardiac action potential as a result of this drug?? {'A': 'Decreased slope of phase 0', 'B': 'Decreased slope of phase 4', 'C': 'Decreased calcium current', 'D': 'Decreased conduction velocity', 'E': 'Increased QT interval'},
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E: Increased QT interval
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Q:A 74-year-old woman is brought by ambulance to the emergency department and presents with a complaint of excruciating chest pain that started about 45 minutes ago. The patient was sitting in the garden when she 1st noticed the pain in the upper abdomen. The pain has persisted and now localizes underneath of the sternum and the left shoulder. Milk of magnesia and aspirin were tried with no relief. The patient had previous episodes of chest pain that were of lesser intensity and rarely lasted more than 10 minutes. She is diabetic and has been managed for hypertension and rheumatoid arthritis in the past. On examination, the patient is breathless and sweating profusely. The vital signs include blood pressure 140/90 mm Hg and heart rate 118/min. The electrocardiogram (ECG) shows Q waves in leads V2 and V3 and raised ST segments in leads V2, V3, V4, and V5. Laboratory studies (including cardiac enzymes at 6 hours after admission show: Hematocrit 45% Troponin T 1.5 ng/mL Troponin I 0.28 ng/mL Creatine kinase (CK)-MB 0.25 ng/mL The patient is admitted and started on analgesia and reperfusion therapy. She shows initial signs of recovery until the 6th day of hospitalization when she starts vomiting and complaining of dizziness. Physical examination findings at this time included heart rate 110/min, temperature 37.7°C (99.9°F), blood pressure 90/60 mm Hg. Jugular venous pressure is 8 cm. A harsh pansystolic murmur is present at the left lower sternal border. ECG shows sinus tachycardia and ST-segment elevation with terminal negative T waves. Laboratory studies show: Hematocrit 38% Troponin T 1.15ng/mL Troponin I 0.18 ng/mL CK-MB 0.10 ng/mL Which of the following best explains the patient's current clinical condition?? {'A': 'A new myocardial infarction (re-infarction)', 'B': 'Acute pericarditis complicating myocardial infarction', 'C': 'Acute ventricular septal rupture complicating myocardial infarction', 'D': 'Aortic dissection complicating myocardial infarction', 'E': 'Cardiac tamponade complicating myocardial infarction'},
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C: Acute ventricular septal rupture complicating myocardial infarction
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Q:A 53-year-old male presents to his primary care provider for tremor of his right hand. The patient reports that the shaking started a few months ago in his right hand but that he worries about developing it in his left hand as well. He reports that the shaking is worse when he is sitting still or watching television and improves as he goes about his daily activities. The patient has a past medical history of hypertension, hyperlipidemia, and diabetes mellitus, and his home medications are hydrochlorothiazide, lisinopril, and atorvastatin. He works as an accountant and drinks 1-2 beers per week. He has a 15-pack-year smoking history but quit ten years ago. On physical exam, the patient has bilateral hand tremors with a frequency of 4-5 Hz. The tremor improves on finger-to-nose testing. His upper extremities also display a mild resistance to passive movement, and he has 2+ reflexes throughout. He has no gait abnormalities, and he scores 29/30 on the Mini-Mental State Examination (MMSE). This patient should be started on which of the following classes of medications?? {'A': 'Anticholinergic', 'B': 'Acetylcholinesterase inhibitor', 'C': 'Beta-blocker', 'D': 'Sodium channel antagonist', 'E': 'GABA receptor modulator'},
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A: Anticholinergic
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Q:A 45-year-old man presents with lethargy, muscle aches, and dry skin. He is underweight and has very particular eating habits. Physical examination reveals swollen bleeding gums, cracked lips, petechiae, perifollicular hemorrhage, and corkscrew hairs. Laboratory tests reveal a nutritional deficiency. Which of the following is the key function of the most likely deficient nutrient?? {'A': 'Precursor of serotonin', 'B': 'Hydroxylation of lysine and proline residues in collagen synthesis', 'C': 'Component of the visual pigment rhodopsin', 'D': 'Cofactor in carboxylase reactions', 'E': 'Gamma-carboxylation of glutamate residues in clotting factors'},
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B: Hydroxylation of lysine and proline residues in collagen synthesis
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Q:A 24-year-old woman is brought to the emergency department after being assaulted. The paramedics report that the patient was found conscious and reported being kicked many times in the torso. She is alert and able to respond to questions. She denies any head trauma. She has a past medical history of endometriosis and a tubo-ovarian abscess that was removed surgically two years ago. Her only home medication is oral contraceptive pills. Her temperature is 98.5°F (36.9°C), blood pressure is 82/51 mmHg, pulse is 136/min, respirations are 10/min, and SpO2 is 94%. She has superficial lacerations to the face and severe bruising over her chest and abdomen. Her lungs are clear to auscultation bilaterally and her abdomen is soft, distended, and diffusely tender to palpation. Her skin is cool and clammy. Her FAST exam reveals fluid in the perisplenic space. Which of the following is the next best step in management?? {'A': 'Abdominal radiograph', 'B': 'Abdominal CT', 'C': 'Emergency laparotomy', 'D': 'Fluid resuscitation', 'E': 'Diagnostic peritoneal lavage'},
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D: Fluid resuscitation
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Q:A 59-year-old woman comes to the physician because of upper extremity weakness and fatigue for the past 4 months. She has had difficulty combing her hair and lifting objects. She has also had difficulty rising from her bed in the mornings for 2 months. Over the past month, she started using over-the-counter mouth rinses for dry mouth. She has smoked 1 pack of cigarettes daily for 40 years. Examination shows decreased deep tendon reflexes. Repetitive muscle tapping shows increased reflex activity. There are no fasciculations or muscle atrophy. A low-dose CT scan of the chest shows a 3-cm mass with heterogeneous calcifications in the center of the right lung. Which of the following is the most likely underlying mechanism responsible for this patient’s current symptoms?? {'A': 'Metastasis', 'B': 'Inflammation', 'C': 'Autoimmunity', 'D': 'Invasion', 'E': 'Infection'},
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C: Autoimmunity
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Q:A 75-year-old man comes to the emergency department because of fatigue and black sticky stools during the past 3 days. He also complains of nausea and has had a 2-kg (4.4-lb) weight loss over the past month. He has a history of polycystic kidney disease, hypertension, and hyperlipidemia. He does not smoke or drink alcohol. Current medications include hydrochlorothiazide, furosemide, valsartan, and atorvastatin. He is thin and appears tired. His temperature is 37.0°C (98.6°F), pulse is 75/min, and blood pressure is 110/65 mm Hg. Examination shows conjunctival pallor and numerous excoriations on the extensor surfaces of his upper extremities. Abdominal examination shows no abnormalities. There is a flapping tremor when both wrists are flexed. Laboratory studies show: Hemoglobin 8.5 mg/dL Platelets 109,000/mm3 Mean corpuscular volume 81 μm3 Prothrombin time 11 sec Partial thromboplastin time 34 sec Serum Creatinine 6.1 mg/dL Which of the following is the most likely underlying cause of this patient’s current condition?"? {'A': 'Inherited antithrombin deficiency', 'B': 'Dysfunctional platelet aggregation', 'C': 'Decreased levels of von Willebrand factor', 'D': 'Acquired factor VII deficiency', 'E': 'Impaired production of thrombopoietin'},
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B: Dysfunctional platelet aggregation
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Q:A 56-year-old man with coronary artery disease agrees to participate in a pharmacological study. He takes an oral medication that leads to dephosphorylation of myosin light chains in venous smooth muscle cells. An investigator measures the plasma concentration of the drug over time after intravenous and then after oral administration. There is no statistically significant difference in the dose-corrected area under the curve for the 2 routes of administration. The patient most likely ingested which of the following drugs?? {'A': 'Isosorbide mononitrate', 'B': 'Nimodipine', 'C': 'Nitroglycerine', 'D': 'Nifedipine', 'E': 'Nitroprusside'},
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A: Isosorbide mononitrate
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Q:A 50-year-old woman presents with sudden onset right upper quadrant abdominal pain. She says her symptoms started 6 hours ago after she had dinner. She describes the pain as cramping, radiating to her shoulders. She had similar episodes in the past, but they were less severe and resolved with over-the-counter analgesics. Her medical history is significant for hypertension and coronary artery disease. Her current medications include warfarin, hydrochlorothiazide, and fibrates. Her temperature is 37.7°C (99.9°F), blood pressure is 110/80 mm Hg, pulse is 80/min, and respirations are 15/min. Abdominal exam reveals severe right upper quadrant tenderness, and she catches her breath when palpated deeply just below the right costal margin. Surgical consult determines her to be surgically unfit for any intervention due to her high risk of bleeding. After treating her pain with appropriate analgesics, which of the following is the next best step in the management of this patient?? {'A': 'Hydrophilic bile acids', 'B': 'Discontinue fibrates', 'C': 'No need for further treatment', 'D': 'Initiate stronger analgesic medications such as morphine', 'E': 'Re-evaluate after few hours and perform laparoscopic cholecystectomy'},
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A: Hydrophilic bile acids
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Q:A 33-year-old man comes to the emergency department because of repeated episodes of severe headache for the past 3 days. He is currently having his 2nd episode of the day. He usually has his first episode in the mornings. The pain is severe and localized to his right forehead and right eye. He had similar symptoms last summer. He works as an analyst for a large hedge fund management company and spends the majority of his time at the computer. He has been under a lot of stress because of overdue paperwork. He also has chronic shoulder pain. He has been using indomethacin every 6 hours for the pain but has had no relief. He has smoked one pack of cigarettes daily for 15 years. He appears restless. Vital signs are within normal limits. Physical examination shows drooping of the right eyelid, tearing of the right eye, and rhinorrhea. The right pupil is 2 mm and the left pupil is 4 mm. There is localized tenderness to his right supraspinatus muscle. The remainder of the examination shows no abnormalities. Which of the following is the most likely diagnosis?? {'A': 'Migraine headache', 'B': 'Cluster headache', 'C': 'Giant cell arteritis', 'D': 'Subarachnoid hemorrhage', 'E': 'Medication overuse headache'},
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B: Cluster headache
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Q:A 7-year-old boy is brought to the clinic by his mother due to a sudden onset of puffiness of the eyes. His mother is also concerned about his abdominal distention which she first noticed 5 days ago. There is no history of a recent upper respiratory tract infection, decreased urination, or gross hematuria. His vaccinations are up to date. His vitals include: heart rate 86/min, respiratory rate 16/min, temperature 37.6°C (99.7°F), and blood pressure 100/70 mm Hg. Physical examination findings include periorbital edema and abdominal distention with a fluid thrill. Laboratory evaluation reveals the following findings: Urinalysis Protein 4+ Urinary protein 4 g/L Creatinine ratio 2.6 Red blood cells Nil White blood cells Nil Urinary casts Fatty casts Serum creatinine 0.4 mg/dL > Serum albumin 1.9 g/dL Serum cholesterol 350 mg/dL Ultrasonogram of the abdomen reveals kidneys with normal morphology and gross ascites. Which of the following statements best describes the complications that this boy may develop?? {'A': 'Spontaneous bacterial peritonitis caused by Haemophilus influenzae', 'B': 'Urinary loss of calcium leading to hypocalcemia', 'C': 'Prophylactic anticoagulation is indicated due to the risk of thromboembolism.', 'D': 'Acute renal failure due to intrinsic renal failure', 'E': 'Microcytic hypochromic anemia responding poorly to oral iron therapy'},
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E: Microcytic hypochromic anemia responding poorly to oral iron therapy
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Q:A 3-year-old patient is brought to the emergency department by her mother due to inability to walk. The child has been limping recently and as of this morning, has refused to walk. Any attempts to make the child walk or bear weight result in crying. She was recently treated for impetigo and currently takes a vitamin D supplement. Physical exam is remarkable for an anxious appearing toddler with knee swelling, erythema, and limited range of motion due to pain. Her mother denies any recent trauma to the child's affected knee. Temperature is 103°F (39.4°C), pulse is 132/min, blood pressure is 90/50 mmHg, respirations are 18/min, and oxygen saturation is 99% on room air. Which of the following is the best initial step in management?? {'A': 'Radiograph', 'B': 'MRI', 'C': 'Ultrasound', 'D': 'Broad spectrum antibiotics', 'E': 'Synovial fluid analysis'},
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E: Synovial fluid analysis
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Q:A 42-year-old man comes to the physician because he is concerned that he is balding. Over the past few months, he has noticed patchy areas of hair loss on his head. He also mentions that he has felt depressed since the death of his wife last year and has unintentionally lost about 18 kg (40 lbs). He is constantly fatigued. He has little appetite because he feels food does not taste the same way anymore. He also has occasional episodes of watery diarrhea. He drinks 5–6 cans of beer daily. Vital signs are within normal limits. Examination shows dry, scaly skin on both feet. There is patchy alopecia of the scalp, axillae, chest, and mons pubis. Which of the following is most likely to directly improve this patient's alopecia?? {'A': 'Finasteride', 'B': 'Griseofulvin', 'C': 'Restriction of vitamin A-rich foods', 'D': 'Zinc supplementation', 'E': 'Behavioral therapy'},
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D: Zinc supplementation
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Q:A 62-year-old woman referred to the cardiology clinic for the evaluation of fatigue and dyspnea for 4 months. She also has loose stools (2–4 per day), palpitations, and non-pitting edema up to her mid-calf. On examination, vital signs are unremarkable, but she appears to be flushed with mild bilateral wheezes can be heard on chest auscultation. Cardiovascular examination reveals a grade 2/6 holosystolic murmur at the left mid-sternal area, which is louder during inspiration. Basic laboratory investigations are unremarkable. Echocardiography reveals moderate to severe right ventricular dilatation with severe right ventricular systolic dysfunction. A CT of the chest and abdomen reveals a solid, non-obstructing 2 cm mass in the small intestine and a solid 1.5 cm mass in the liver. What is the most likely cause of her symptoms?? {'A': 'Systemic mastocytosis', 'B': 'Carcinoid tumor', 'C': 'Bronchial asthma', 'D': 'Whipple’s disease', 'E': 'Irritable bowel syndrome'},
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B: Carcinoid tumor
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Q:A 2-year-old boy is brought to the physician because of an increasing productive cough with a moderate amount of white phlegm for the past week. He has been treated for pneumonia with antibiotic therapy four times over the past year. A chest x-ray performed 3 months ago showed no anatomical abnormalities. He has had multiple episodes of bulky greasy stools that don't flush easily. He is at 3rd percentile for height and at 5th percentile for weight. His temperature is 38°C (100.4°F), pulse is 132/min, and respirations are 44/min. A few inspiratory crackles are heard in the thorax. The abdomen is soft and nontender. The remainder of the examination shows no abnormalities. Which of the following is the best initial test to determine the underlying etiology of this patient's illness?? {'A': 'X-ray of the chest', 'B': 'Serum immunoglobulin level', 'C': 'Sweat chloride test', 'D': 'Stool analysis', 'E': 'DNA phenotyping\n"'},
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C: Sweat chloride test
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Q:A 25-year-old woman comes to the physician because of irregular menstrual bleeding. Menarche occurred at the age of 12 years and menses have occurred at 45 to 90-day intervals. Her last menstrual period was 8 weeks ago. She is not sexually active. Serum studies show: Fasting glucose 178 mg/dL Fasting insulin 29 mcIU/mL (N = 2.6–24.9 mcIU/mL) Luteinizing hormone 160 mIU/mL Total testosterone 3.2 ng/dL (N = 0.06–1.06 ng/dL) Serum electrolytes are within the reference range. Further evaluation of this patient is most likely to show which of the following findings?"? {'A': 'Elevated serum beta-HCG level', 'B': 'Adrenal tumor on abdominal MRI', 'C': 'Enlarged ovaries on transvaginal ultrasound', 'D': 'Intrasellar mass on cranial contrast MRI', 'E': 'Elevated serum TSH level'},
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C: Enlarged ovaries on transvaginal ultrasound
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Q:A 77-year-old man with hypertension, type 2 diabetes mellitus, and atrial fibrillation is admitted to the hospital because of a 3-hour history of nausea and flank pain. Two days after admission, he suddenly develops aphasia and left-sided paralysis. Despite appropriate life-saving measures, he dies. A photograph of a section of the kidney obtained at autopsy is shown. Microscopic examination of the pale region in the photograph shows preserved cellular architecture with eosinophilic cytoplasm and no visible nuclei. Which of the following pathological changes is most likely responsible for the renal findings on autopsy?? {'A': 'Coagulative necrosis', 'B': 'Non-enzymatic fat necrosis', 'C': 'Gangrenous necrosis', 'D': 'Liquefactive necrosis', 'E': 'Caseous necrosis\n"'},
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A: Coagulative necrosis
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Q:A 38-year-old man presents with concerns after finding out that his father was recently diagnosed with colon cancer. Family history is only significant for his paternal grandfather who also had colon cancer. A screening colonoscopy is performed, and a polyp is found in the ascending (proximal) colon, which on biopsy shows adenocarcinoma. A mutation in a gene that is responsible for which of the following cellular functions is the most likely etiology of this patient’s cancer?? {'A': 'Inhibitor of apoptosis', 'B': 'Inhibits progression from G1 to S phase', 'C': 'Cytoskeletal stability', 'D': 'DNA mismatch repair', 'E': 'RAS cycle transduction inhibitor'},
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D: DNA mismatch repair
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Q:A 57-year-old woman presents to an outpatient clinic with lower extremity weakness and lower back pain. The patient says that her symptoms began 2 weeks ago when she was working in her garden and have progressively worsened to the extent she currently is unable to walk on her own. She describes the pain as sharp, severe and descending bilaterally from her lower back to her lateral ankles along the posterior surface of her thighs and legs. She also states that she has had several episodes of urinary incontinence for the past couple of days. The patient denies having any similar pain or incontinence in the past. No other significant past medical history. Current medications are alendronate 5 mg orally daily and a daily multivitamin. Her temperature is 37.0℃ (98.6℉), the blood pressure is 110/70 mm Hg, the pulse is 72/min, the respiratory rate is 15/min, and oxygen saturation is 99% on room air. On physical examination, the patient appears to be in significant distress. Strength is ⅗ in her thighs bilaterally and ⅖ in the legs bilaterally left greater than right. Muscle tone is decreased in the lower extremities. The patellar reflex is 1+ bilaterally and plantar reflex is 0+ bilaterally. Fine touch and pain and temperature sensation are decreased in the lower extremities bilaterally, left greater than right. Saddle anesthesia is present. Which of the following is the next, best step in the management of this patient?? {'A': 'Outpatient management with a 3-day course of meloxicam and tolperisone and reassess', 'B': 'Outpatient management with 3 days of strict bed rest and reassess', 'C': 'Outpatient management with a 3-day course of diclofenac and gabapentin and reassess', 'D': 'Recommend non-emergent inpatient spinal manipulation program', 'E': 'Immediate transfer to the emergency department for management'},
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E: Immediate transfer to the emergency department for management
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Q:A 71-year-old man comes to the physician for a routine health maintenance examination. He has occasional fatigue but otherwise feels well. He has a history of hypertension and type 2 diabetes mellitus. He is a retired chemist. His only medication is ramipril. His temperature is 37.8°C (100°F), pulse is 72/min, respirations are 18/min, and blood pressure is 130/70 mm Hg. Physical examination shows nontender cervical and axillary lymphadenopathy. The spleen is palpated 7 cm below the costal margin. Laboratory studies show a leukocyte count of 12,000/mm3 and a platelet count of 210,000/mm3. Further evaluation is most likely to show which of the following?? {'A': 'Ringed sideroblasts', 'B': 'Rouleaux formation', 'C': 'Teardrop cells', 'D': 'Smudge cells', 'E': 'Polycythemia\n"'},
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D: Smudge cells
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Q:A 64-year-old woman presents to an urgent care clinic with edema of her lips and difficulty breathing. She reports that she had multiple root canals performed earlier today, and she started to notice swelling of her lips 2 hours ago. The symptoms have now progressed to where she is having trouble breathing. She notes similar episodes in the past after minor procedures such as this. The blood pressure is 118/76 mm Hg, the heart rate is 84/min, and the respiratory rate is 16/min. Physical examination is remarkable for edema of her lips and mild inspiratory stridor. The laboratory results are remarkable for a low level of C1 esterase inhibitor. Of the following options, which is the most likely diagnosis?? {'A': 'Hereditary angioedema', 'B': 'Contact dermatitis', 'C': 'Drug-induced angioedema', 'D': 'Hypothyroidism', 'E': 'Allergic reaction'},
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A: Hereditary angioedema
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Answer the following medical question with one of the provided options:
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Q:A 56-year-old African American presents to the emergency department due to abdominal pain, fatigue, and weight loss over the past 3 months. He has a long-standing history of chronic hepatitis B virus infection complicated by cirrhosis. On examination, he has jaundice, leg edema, and a palpable mass in the right upper abdominal quadrant. Abdominal ultrasound shows a 3-cm liver mass with poorly defined margins and coarse, irregular internal echoes. Blood investigations are shown: Aspartate aminotransferase (AST) 90 U/L Alanine aminotransferase (ALT) 50 U/L Total bilirubin 2 mg/dL Albumin 3 g/dL Alkaline phosphatase 100 U/L Alpha fetoprotein 600 micrograms/L Which of the following targeted agents is approved for advanced-stage hepatoma?? {'A': 'Daclizumab', 'B': 'Ustekinumab', 'C': 'Palivizumab', 'D': 'Abciximab', 'E': 'Sorafenib'},
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E: Sorafenib
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Q:A 29-year-old G1P1 woman presents to her primary care physician with unilateral breast pain. She is currently breastfeeding her healthy 3-month-old baby boy. She has been breastfeeding since her child's birth without any problems. However, 3 days prior to presentation, she developed left breast pain, purulent nipple discharge, and malaise. Her past medical history is notable for obesity and generalized anxiety disorder. She takes sertraline. She does not smoke or drink alcohol. Her temperature is 100.8°F (38.2°C), blood pressure is 128/78 mmHg, pulse is 91/min, and respirations are 17/min. On exam, she appears lethargic but is able to answer questions appropriately. Her right breast appears normal. Her left breast is tender to palpation, warm to the touch, and swollen relative to the right breast. There is a visible fissure in the left nipple that expresses minimal purulent discharge. Which of the following pathogens is the most likely cause of this patient's condition?? {'A': 'Bacteroides fragilis', 'B': 'Candida albicans', 'C': 'Staphylococcus aureus', 'D': 'Staphylococcus epidermidis', 'E': 'Streptococcus pyogenes'},
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C: Staphylococcus aureus
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Q:A 61-year-old man is brought to the emergency department by ambulance because of severe retrosternal chest pain and shortness of breath for 30 minutes. Paramedics report that an ECG recorded en route to the hospital showed ST-segment elevation in I, aVL, and the precordial leads. On arrival, the patient is unresponsive to painful stimuli. Examination shows neither respiration nor pulse. Despite appropriate lifesaving measures, he dies 10 minutes later. Which of the following is the most likely cause of death in this patient?? {'A': 'Left ventricular failure', 'B': 'Ventricular aneurysm', 'C': 'Hemorrhagic stroke', 'D': 'Cardiac free wall rupture', 'E': 'Ventricular fibrillation'},
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E: Ventricular fibrillation
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Q:A 7-month-old Caucasian male presents with recurrent sinusitis and pharyngitis. The parents say that the child has had these symptoms multiple times in the past couple of months and a throat swab sample reveals the presence of Streptoccocus pneumoniae. Upon workup for immunodeficiency it is noted that serum levels of immunoglobulins are extremely low but T-cell levels are normal. Which of the following molecules is present on the cells that this patient lacks?? {'A': 'CD4', 'B': 'CD8', 'C': 'CD3', 'D': 'CD19', 'E': 'NKG2D'},
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D: CD19
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Q:A 1-year-old boy is brought to the physician because of irritability and poor feeding that began 2 days ago. His mother reports that he has been crying more than usual during this period. He refused to eat his breakfast that morning and has not taken in any food or water since that time. He has not vomited. When changing the boy's diapers this morning, the mother noticed his urine had a strong smell and pink color. He has not passed urine since then. He was born at term and has been healthy. He appears ill. His temperature is 36.8°C (98.2°F), pulse is 116/min, and blood pressure is 98/54 mm Hg. The boy cries when the lower abdomen is palpated. Which of the following is the most appropriate next step in management?? {'A': 'Perform renal ultrasound', 'B': 'Perform voiding cystourethrogram', 'C': 'Obtain clean catch urine sample', 'D': 'Perform transurethral catheterization', 'E': 'Administer cefixime'},
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D: Perform transurethral catheterization
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Q:A 55-year-old male with a 60 pack-year smoking history presents to his oncologist for ongoing management of his recently diagnosed small cell lung cancer. His oncologist discusses several options and decides to start the chemotherapeutic medication, etoposide. The patient is warned that one side effect of this drug is myelosuppression so he should be vigilant for development of any infectious symptoms. The beneficial effect of this drug in treating cancer is most likely due to which of the following effects?? {'A': 'Alkylation of DNA', 'B': 'Crosslinking of DNA', 'C': 'DNA intercalation', 'D': 'Inhibition of supercoil relaxation', 'E': 'Stabilization of microtubules'},
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D: Inhibition of supercoil relaxation
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Q:A 40-year-old pregnant woman presents to the clinic at her 12th week of gestation. She does not have any complaints during this visit but comes to discuss her lab reports from her last visit. Her blood test results are within normal limits, but the abdominal ultrasound reports nuchal thickening with a septated cystic hygroma. Chorionic villus sampling is performed for a suspected chromosomal anomaly. Which of the following features can be expected to be present at the time of birth of this fetus?? {'A': 'Congenital lymphedema of the hands and feet', 'B': 'Anal atresia', 'C': 'Port-wine stain on the forehead', 'D': 'Microphthalmia', 'E': 'Pectus carinatum'},
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A: Congenital lymphedema of the hands and feet
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Q:A 32-year-old man is brought to the physician by his wife for a 3-day history of fever, headaches, and myalgias. He returned from a camping trip in Oklahoma 10 days ago. He works as a computer salesman. His temperature is 38.1°C (100.6°F). Neurologic examination shows a sustained clonus of the right ankle following sudden passive dorsiflexion. He is disoriented to place and time but recognizes his wife. Laboratory studies show a leukocyte count of 1,700/mm3 and a platelet count of 46,000/mm3. A peripheral blood smear shows monocytes with intracytoplasmic morulae. Which of the following is the most likely causal organism?? {'A': 'Coxiella burnetii', 'B': 'Rickettsia rickettsii', 'C': 'Anaplasma phagocytophilum', 'D': 'Ehrlichia chaffeensis', 'E': 'Borrelia burgdorferi'},
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D: Ehrlichia chaffeensis
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Q:A 34-year-old woman presents with blurred vision and ringing in her ears. She says she has a 6-month history of recurrent worsening bilateral pulsatile headaches that she manages with ibuprofen, which does very little to relieve the pain. For the past week, she says she has vomited nearly every morning and missed work due to the pain in her head. She first noticed vision problems 3 months ago that has occurred several times since then. Past medical history is significant for uncomplicated urinary tract infection for which she has just finished a course of antibiotics. She has a history of a mild urticarial reaction when she takes penicillin. Her vital signs include: blood pressure 115/74 mm Hg, pulse 75/min, and respiratory rate 16/min. Her body mass index (BMI) is 36 kg/m2. Physical examination is significant for bilateral peripheral visual field loss with preservation of visual acuity. Fundoscopic examination reveals blurring of the disc margins with vessel tortuosity. The remainder of her physical examination is unremarkable. A magnetic resonance image (MRI) of the brain is normal. Lumbar puncture (LP) is remarkable for a markedly elevated opening pressure. Which of the following is the next best step in the treatment of her condition?? {'A': 'Furosemide', 'B': 'Counseling for weight loss', 'C': 'Acetazolamide', 'D': 'Optic nerve sheath fenestration', 'E': 'Ventriculoperitoneal shunting'},
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C: Acetazolamide
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