instruction
stringclasses 5
values | input
stringlengths 10
4.2k
| output
stringlengths 1
7.16k
|
---|---|---|
Answer the following medical question with one of the provided options:
|
Q:A 63-year-old man presents with a 2-month history of increasing sensation of fullness involving his left flank. The patient reports recent episodes of constant pain. The patient is hypertensive (145/90 mm Hg) and is currently on medications including losartan and hydrochlorothiazide. His past medical history is otherwise unremarkable. He is a 30-pack-year smoker. His temperature is 37.7°C (99.9°F); pulse, 76/min; and respiratory rate, 14/min. Palpation of the left flank shows a 10 x 10-cm mass. The patient’s laboratory parameters are as follows: Blood Hemoglobin 19.5 g/dL Leukocyte count 5,000/mm3 Platelet count 250,000/mm3 Urine Blood 2+ Urine negative RBC 45/hpf without dysmorphic features Abdominal CT scan confirms the presence of a large solid mass originating in the left kidney. These findings are pathognomonic for which of the following conditions?? {'A': 'Adenoma', 'B': 'Angiomyolipoma', 'C': 'Renal cell carcinoma', 'D': 'Transitional cell carcinoma', 'E': 'Wilms tumor'},
|
C: Renal cell carcinoma
|
Answer the following medical question with one of the provided options:
|
Q:A 25-year-old woman, gravida 2, para 1, at 24 weeks' gestation comes to the physician for a prenatal visit. She reports feeling fatigue and having swollen legs lately. One month ago, she had a low-grade fever, a runny nose, painful joints, and a sore throat that resolved spontaneously. Pregnancy and delivery of her first child were uncomplicated. She does not smoke or drink alcohol. She does not use illicit drugs. Medications include folic acid and a multivitamin. Vital signs are within normal limits. Pelvic examination shows a uterus consistent in size with a 24-week gestation. There is bilateral edema around the ankles. Pelvic ultrasonography shows fluid accumulation within the fetal scalp and signs of pleural effusions bilaterally. Which of the following is the most likely underlying cause of these findings?? {'A': 'Herpes simplex virus', 'B': 'Parvovirus B19', 'C': 'Listeria monocytogenes', 'D': 'Rubella virus', 'E': 'Toxoplasma gondii\n"'},
|
B: Parvovirus B19
|
Answer the following medical question with one of the provided options:
|
Q:A 44-year-old man presents to a family medical center for evaluation of multiple, painful lesions on the lower lip. He says that the lesions appeared 1 day ago after spending a weekend vacation at the beach. He reports a tingling sensation after the 2nd day. This is the 3rd time in the past year that the lesions have occurred. There are no past medical conditions to document. He appears well-nourished and does not exhibit poor hygiene. His vital signs include the following: the heart rate is 66/min, the respiratory rate is 14/min, the temperature is 37.3°C (99.2°F), and the blood pressure is 124/76 mm Hg. Inspection of the lips at the vermillion border reveals 2 vesicular lesions (refer to picture). Palpation of the neck reveals cervical lymphadenopathy. What is the most appropriate treatment at this time?? {'A': 'No treatment necessary', 'B': 'Docosanol cream', 'C': 'Imiquimod', 'D': 'Oral cidofovir', 'E': 'Penciclovir cream'},
|
E: Penciclovir cream
|
Answer the following medical question with one of the provided options:
|
Q:One week after starting a new medication, a 16-year-old girl is brought to the emergency department by her mother because of a painful, blistering rash. She has a history of bipolar disorder. Her temperature is 39°C (102°F). Physical examination shows numerous coalescing bullae with epidermal detachment covering the face, trunk, and extremities. There are hemorrhagic erosions on the hard palate and buccal mucosa. When lateral pressure is applied to healthy-appearing skin at the edge of a bulla, a blister starts to form. Which of the following drugs is most likely responsible for this patient's current condition?? {'A': 'Quetiapine', 'B': 'Topiramate', 'C': 'Valproic acid', 'D': 'Lamotrigine', 'E': 'Lithium'},
|
D: Lamotrigine
|
Answer the following medical question with one of the provided options:
|
Q:A 61-year-old woman comes to the physician for evaluation of numbness and a burning sensation in her feet for the past 5 months. She has type 2 diabetes mellitus and hypercholesterolemia. Her blood pressure is 119/82 mm Hg. Neurologic examination shows decreased sensation to pinprick, light touch, and vibration over the soles of both feet. There is a nontender ulcer on the plantar surface of her left foot. Pedal pulses are strong bilaterally. Her hemoglobin A1c concentration is 8.6%. Which of the following processes is most likely involved in the pathogenesis of this patient's current symptoms?? {'A': 'Demyelination of posterior columns and lateral corticospinal tracts', 'B': 'Accumulation of lipids and foam cells in arteries', 'C': 'Increased protein deposition in endoneural vessel walls', 'D': 'Osmotic damage to oligodendrocyte nerve sheaths', 'E': 'Elevated hydrostatic pressure in arteriolar lumen'},
|
C: Increased protein deposition in endoneural vessel walls
|
Answer the following medical question with one of the provided options:
|
Q:A 45-year-old woman presents to the office because of shortness of breath and chest tightness on exertion which she noticed for the past 2 months. She was diagnosed with asthma 1 month ago but says that the asthma medication has not improved her breathing. She does not smoke and works as a hotel manager. Examination shows mildly jaundiced conjunctivae, several spider nevi on her upper torso, and a barrel-chested appearance. A chest X-ray is obtained. Which of the following is the most likely diagnosis?? {'A': 'Alpha 1-antitrypsin deficiency', 'B': 'Bilateral pneumothorax', 'C': 'Kartagener syndrome', 'D': 'Pneumomediastinum', 'E': 'Pulmonary hypertension'},
|
A: Alpha 1-antitrypsin deficiency
|
Answer the following medical question with one of the provided options:
|
Q:A 15-year-old boy presents with a 3-month history of severe muscle cramps and pain. The patient first noticed these symptoms while attending tryouts for the high school football team. Following the tryout, he becomes easily fatigued and complains of severe muscle pain and swelling after 10 minutes of exercising. However, after a brief period of rest, the symptoms improve, and he is able to return to the game. Two days ago, he had an episode of reddish-brown urine after playing football. There is no family history of any serious illnesses. The patient appears healthy. Vital signs are within normal limits. Physical and neurological examinations show no abnormalities. Serum creatine kinase concentration is 333 U/L. Urinalysis shows the following results: Blood 2+ Protein Negative Glucose Negative RBC Negative WBC 1–2/hpf Which of the following is the most likely cause of this patient's symptoms?? {'A': 'Acid maltase deficiency', 'B': 'CTG repeat in the DMPK gene', 'C': 'Dystrophin gene mutation', 'D': 'Medium chain acyl CoA dehydrogenase deficiency', 'E': 'Myophosphorylase deficiency'},
|
E: Myophosphorylase deficiency
|
Answer the following medical question with one of the provided options:
|
Q:A 56-year-old homeless male presents to a free clinic for a health evaluation. He states that he has not seen a physician in over 25 years but finally decided to seek medical attention after he noticed recent chronic fatigue and weight gain. Upon questioning, he endorses drinking 2 handles of whiskey per day. On exam, the physician observes the findings shown in Figures A-D. Which of the following findings would also be expected to be observed in this patient?? {'A': '4-hertz hand tremor', 'B': 'Nystagmus', 'C': 'Direct hyperbiluribemia', 'D': 'Microcytic anemia', 'E': 'Testicular atrophy'},
|
E: Testicular atrophy
|
Answer the following medical question with one of the provided options:
|
Q:A previously healthy 20-year-old man comes to the physician because of a 6-month history of a painless mass in his left groin that has been gradually increasing in size. Physical examination shows a 3x3-cm oval, non-tender left inguinal mass and a fluctuant, painless left scrotal swelling that increase in size with coughing. Which of the following is the most likely cause of this patient's symptoms?? {'A': 'Failure of processus vaginalis to close', 'B': 'Obstruction of left spermatic vein', 'C': 'Reduced fluid reabsorption at tunica vaginalis', 'D': 'Widening of femoral ring', 'E': 'Weakening of transversalis fascia\n"'},
|
A: Failure of processus vaginalis to close
|
Answer the following medical question with one of the provided options:
|
Q:A 42-year-old homeless man presents to the emergency department complaining of pain in his right knee and fever. The patient is having difficulty walking and looks visibly uncomfortable. On examination, he is disheveled but his behavior is not erratic. The patient’s right knee is erythematous, edematous, and warm, with evidence of a 3 cm wound that is weeping purulent fluid. The patient has a decreased range of motion secondary to pain and swelling. The wound is cultured and empiric antibiotic therapy is initiated. Four minutes into the patient’s antibiotic therapy, he develops a red, pruritic rash on his face and neck. What is the most likely antibiotic this patient is being treated with?? {'A': 'Linezolid', 'B': 'Penicillin G', 'C': 'Vancomycin', 'D': 'Gentamicin', 'E': 'Erythromycin'},
|
C: Vancomycin
|
Answer the following medical question with one of the provided options:
|
Q:A 58-year-old man presents to the emergency department following a fall while walking in a grocery store. He has a history of at least 6 previous collapses to the ground with no warning. When these episodes occur, he becomes pale, diaphoretic, and recovers quickly within a few seconds. These episodes always occur when he is standing. His past medical history is significant for type 2 diabetes mellitus, hypercholesterolemia, and one myocardial infarction. His medication list includes aspirin, clopidogrel, bisoprolol, metformin, rosuvastatin, and valsartan. Further history reveals that he has constipation, early satiety, and recently lost 2.2 kg (5 lb) of weight. While lying down, his blood pressure is 145/64 mm Hg and the heart rate is 112/min. After 2 minutes of standing, the blood pressure is 120/65 mm Hg and the heart rate is 112/min. A 12-lead ECG showed Q waves in leads II, III, and aVF. Laboratory results are given below: Hemoglobin 13.8 g/dL White blood cell count 8500/mm3 Platelets 250,000/mm3 Sodium 142 mEq/L Potassium 4.4 mEq/L Calcium 9.1 mg/dL Creatinine 1.0 mg/dL TSH 1.4 U/mL HbA1c 10.2% What additional clinical feature would most likely be present in this patient?? {'A': 'Amyotrophy', 'B': 'Diplopia', 'C': 'Erectile dysfunction', 'D': 'Heat intolerance', 'E': 'Lipodystrophy'},
|
C: Erectile dysfunction
|
Answer the following medical question with one of the provided options:
|
Q:An otherwise healthy 13-year-old boy is brought to the physician for the evaluation of severe acne for the last 3 years. Topical retinoic acid and oral tetracycline did not improve his symptoms. He shaves his chin and mustache area every few days. His parents report that he grew 5 cm (2 in) during the last year. The onset of pubic hair growth was at age 8. He is at the 95th percentile for height and weight. Vital signs are within normal limits. Examination shows several pimples and pustules along the skin of the cheeks, chin, and neck. Genitals are Tanner stage 4 and pubic hair is Tanner stage 5. Early morning serum laboratory studies drawn 30 minutes after administration of ACTH show: Sodium 137 mEq/L Potassium 3.8 mEq/L Cortisol (0800 h) 4 μg/dL Aldosterone 10 ng/dL (N = 7–30) 17OH-Progesterone 230 ng/dL (N = 3–90) Deoxycorticosterone 2.7 ng/dL (N = 3.5–11.5) Androstenedione 350 ng/dL (N = 80–240) Dehydroepiandrosterone sulfate (DHEAS) 420 μg/dL (N = 29–412) Which of the following is the most likely underlying cause of this patient's symptoms?"? {'A': 'Leydig-cell tumor production of androgens', 'B': 'Exposure to exogenous steroids', 'C': '21β-hydroxylase deficiency', 'D': 'Constitutive activation of adenylyl cyclase', 'E': '17α-hydroxylase deficiency'},
|
C: 21β-hydroxylase deficiency
|
Answer the following medical question with one of the provided options:
|
Q:During the third week of development, the blastula undergoes a variety of differentiation processes responsible for the formation of the gastrula and, eventually, the embryo. This differentiation creates cell lineages that eventually become a variety of body systems. What cell lineage, present at this date, is responsible for the formation of the liver?? {'A': 'Syncytiotrophoblasts', 'B': 'Endoderm', 'C': 'Ectoderm', 'D': 'Mesoderm', 'E': 'Neuroectoderm'},
|
B: Endoderm
|
Answer the following medical question with one of the provided options:
|
Q:A 34-year-old poultry worker presents to his physician with a sore throat and a non-productive cough for 2 weeks. His cough is associated with fever. The vital signs include: blood pressure 120/80 mm Hg, heart rate 67/min, respiratory rate 18/min, and temperature 37.6°C (98.0°F). Physical examination shows oropharyngeal erythema and scattered, moist rales on lung auscultation. The patient’s X-ray demonstrates patchy reticular opacities in the perihilar regions of both lungs. After some additional tests, he is diagnosed with community-acquired pneumonia and is treated with cephalexin with modest improvement. Which of the following best describes the immune response elicited by the pathogen that is causing this patient’s condition?? {'A': 'It activates TLR5 on the surface of macrophages.', 'B': 'It primarily induces the Th1-cell response.', 'C': 'Peptidoglycan is its major antigen that induces an immune response.', 'D': 'Antibody-mediated immunity plays the leading role in the elimination of this pathogen.', 'E': 'This pathogen evades the immune response by encapsulation.'},
|
B: It primarily induces the Th1-cell response.
|
Answer the following medical question with one of the provided options:
|
Q:A 15-year-old boy is admitted to the emergency department with neck stiffness, maculopapular rash, fever, and a persistent headache. A blood culture shows encapsulated gram-negative diplococci. He has had this same infection before. Which of the following proteins is likely to be deficient in this patient?? {'A': 'Calcineurin', 'B': 'C1 esterase inhibitor', 'C': 'C9', 'D': 'CD55 (decay accelerating factor)', 'E': 'CD4'},
|
C: C9
|
Answer the following medical question with one of the provided options:
|
Q:A 27-year-old man comes to the physician because of intermittent right shoulder pain for the past 2 weeks. The pain awakens him at night and is worse when he lies on the right shoulder. He does not have any paresthesia or numbness in the right arm. He is a painter, and these episodes of pain have not allowed him to work efficiently. He appears healthy. Vital signs are within normal limits. Examination shows painful abduction of the arm above the shoulder. There is severe pain when the elbow is flexed and the right shoulder is internally rotated. Elevation of the internally rotated and outstretched arm causes pain over the anterior lateral aspect of the shoulder. An x-ray of the shoulder shows no abnormalities. Injection of 5 mL of 1% lidocaine into the right subacromial space relieves the pain and increases the range of motion of the right arm. Which of the following is the most appropriate next step in management?? {'A': 'MRI of the shoulder', 'B': 'Intraarticular glucocorticoids', 'C': 'Arthroscopic repair', 'D': 'Physical therapy', 'E': 'Thoracic outlet decompression'},
|
D: Physical therapy
|
Answer the following medical question with one of the provided options:
|
Q:One week after starting amoxicillin for sinusitis, a 4-year-old girl is brought to the emergency department with fever, rash, and myalgia. She has been hospitalized multiple times for recurrent streptococcal pneumonia and meningitis. She appears tired. Examination shows a diffuse urticarial rash. Her antibiotic is discontinued. Which of the following is the most likely underlying mechanism for her recurrent infections?? {'A': 'Impaired leukocyte adhesion', 'B': 'Accumulation of bradykinin', 'C': 'Defective superoxide production', 'D': 'Impaired opsonization', 'E': 'Absence of IgA antibodies'},
|
D: Impaired opsonization
|
Answer the following medical question with one of the provided options:
|
Q:A 9-year-old boy presents with polydipsia, polyuria, and a serum osmolality of 325 mOsm/L. A neurologic examination reveals bitemporal hemianopia. The lesion is believed to be derived from Rathke's pouch remnants. Which of the following is the most likely histologic finding?? {'A': 'Liquefactive necrosis', 'B': 'Cystic spaces', 'C': 'Lymphocytic infiltrate', 'D': 'Immune complex deposition', 'E': 'Branching papillae'},
|
B: Cystic spaces
|
Answer the following medical question with one of the provided options:
|
Q:A 43-year-old man comes to the physician because of nasal congestion and fatigue for 12 days. During this period, he has had fevers and severe pain over his cheeks. His nasal discharge was initially clear, but it has turned yellowish over the last couple of days. He has no visual complaints. He has been taking an over-the-counter nasal decongestant and acetaminophen without much relief. He has type 2 diabetes mellitus and hypertension. He underwent an appendectomy 23 years ago. He does not smoke or drink alcohol. His current medications include metformin, sitagliptin, and enalapril. He appears tired. His temperature is 38.5°C (101.3°F), pulse is 96/min, and blood pressure is 138/86 mm Hg. Examination shows purulent discharge in the nose and pharynx and normal appearing ears. The left maxillary sinus is tender to palpation. Laboratory studies show: Hemoglobin 14.6 g/dL Leukocyte count 10,800/mm3 Platelet count 263,000/mm3 ESR 22 mm/hr Serum Glucose 112 mg/dL Which of the following is the most appropriate next step in management?"? {'A': 'Intravenous amphotericin B', 'B': 'Oral amoxicillin-clavulanic acid', 'C': 'Oral levofloxacin', 'D': 'Reassurance and follow-up in 1 week', 'E': 'Oral loratadine'},
|
B: Oral amoxicillin-clavulanic acid
|
Answer the following medical question with one of the provided options:
|
Q:A 67-year-old man is referred to a dermatologist after a reddish mole appears on his nose. The mole’s size has changed over the last 2 years, and occasional bleeding is noted. The man’s medical history is unremarkable, and he does not take any medications. He retired from his construction job 15 years ago. Physical examination of his nose reveals a 2-cm pink papule with a pearly appearance and overlying telangiectasia on the ala of the nose (see image). Which of the following would be the best treatment modality if surgery is not an option?? {'A': 'Photodynamic therapy', 'B': 'Imiquimod', 'C': '5-fluorouracil', 'D': 'Radiation therapy', 'E': 'Interferon'},
|
D: Radiation therapy
|
Answer the following medical question with one of the provided options:
|
Q:A 51-year-old woman with AIDS presents to her primary care physician with fatigue and weakness. She has a history of type 2 diabetes mellitus, hypertension, infectious mononucleosis, and hypercholesterolemia. She currently smokes 1 pack of cigarettes per day, drinks a glass of wine per day, and denies any illicit drug use. Her temperature is 36.7°C (98.0°F), blood pressure is 126/74 mm Hg, pulse is 87/min, and respirations are 17/min. On physical examination, her pulses are bounding. The patent’s complexion is pale. She has an enlarged cervical lymph node, and breath sounds remain clear. Further lab and tissue diagnostic evaluation reveal and confirms Burkitt’s lymphoma with diffuse bulky disease. After receiving more information about her condition and treatment options, the patient agrees to start chemotherapy. Eight days after starting chemotherapy, she presents with decreased urinary output. Laboratory studies show: Creatinine 7.9 mg/dL BUN 41 mg/dL Serum uric acid 28 mg/dL Potassium 6.9 mEq/L Which therapy is most likely to reverse the patient’s metabolic abnormalities?? {'A': 'Intravenous saline with mannitol with the goal of a daily urinary output above 2.5 L/day', 'B': 'Hemodialysis', 'C': 'Intravenous sodium bicarbonate with the goal of urinary pH > 7.0', 'D': 'Allopurinol 300 mg/day', 'E': 'Intravenous recombinant uricase enzyme rasburicase'},
|
B: Hemodialysis
|
Answer the following medical question with one of the provided options:
|
Q:A 13-month-old girl is brought to the pediatric clinic by her mother due to progressive abdominal distension, poor feeding, and failure to thrive. The perinatal history was uneventful. The family emigrated from Sudan 8 years ago. The vital signs include: temperature 36.8°C (98.2°F), blood pressure 100/55 mm Hg, and pulse 99/min. The physical examination shows conjunctival pallor, hepatosplenomegaly, and parietal and frontal bossing of the skull. The laboratory test results are as follows: Hemoglobin 8.7 g/dL Mean corpuscular volume 62 μm3 Red cell distribution width 12.2% (normal value is 11.5–14.5%) Reticulocyte count 2.1 % Leucocyte count 10,200/mm3 Platelet count 392,000/mm3 The peripheral blood smear shows microcytic red cells, target cells, and many nucleated red cells. Which of the following is the most likely diagnosis?? {'A': 'Alpha-thalassemia major', 'B': 'Glucose-6-phosphate dehydrogenase deficiency', 'C': 'Sickle cell disease', 'D': 'Congenital dyserythropoietic anaemia', 'E': 'Beta-thalassemia major'},
|
E: Beta-thalassemia major
|
Answer the following medical question with one of the provided options:
|
Q:A 35-year-old man is admitted with an acute onset of dysphagia, odynophagia, slight retrosternal chest pain, hypersalivation, and bloody sputum. These symptoms appeared 3 hours ago during a meal when the patient ate fish. The patient’s past medical history is significant for repair of a traumatic esophageal rupture 5 years ago. The patient’s vital signs are as follows: blood pressure 140/90 mm Hg, heart rate 87/min, respiratory rate 16/min, and temperature 36.8℃ (98.2℉). On exam, the patient is pale and breathing deeply. The oral cavity appears normal. The pharynx is erythematous but with no visible lesions. Lungs are clear to auscultation. Cardiovascular examination shows no abnormalities. The abdomen is nondistended and nontender. Which of the following interventions are indicated in this patient?? {'A': 'IV administration of glucagon', 'B': 'Bougienage', 'C': 'Foley catheter removal', 'D': 'Emergency endoscopy', 'E': 'Removal with Magill forceps'},
|
D: Emergency endoscopy
|
Answer the following medical question with one of the provided options:
|
Q:An 8-year-old boy presents to his pediatrician accompanied by his father with a complaint of chronic cough. For the past 2 months he has been coughing up yellow, foul-smelling sputum. He has been treated at a local urgent care center for multiple episodes of otitis media, sinusitis, and bronchitis since 2 years of age. His family history is unremarkable. At the pediatrician's office, his temperature is 99.2°F (37.3°C), blood pressure is 110/84 mmHg, pulse is 95/min, and respirations are 20/min. Inspection shows a young boy who coughs occasionally during examination. Pulmonary exam demonstrates diffuse wheezing and crackles bilaterally. Mild clubbing is present on the fingers. The father has brought an electrocardiogram (ECG) from the patient’s last urgent care visit that shows pronounced right axis deviation. Which of the following is the most likely etiology of this patient’s condition?? {'A': 'Decreased motility of cilia', 'B': 'Defective maturation of B-lymphocytes', 'C': 'Failure of neural crest cell migration', 'D': 'Maldevelopment of pharyngeal pouches', 'E': 'Transient bronchoconstriction'},
|
A: Decreased motility of cilia
|
Answer the following medical question with one of the provided options:
|
Q:A researcher is studying physiologic and hormonal changes that occur during pregnancy. Specifically, they examine the behavior of progesterone over the course of the menstrual cycle and find that it normally decreases over time; however, during pregnancy this decrease does not occur in the usual time frame. The researcher identifies a circulating factor that appears to be responsible for this difference in progesterone behavior. In order to further examine this factor, the researcher denatures the circulating factor and examines the sizes of its components on a western blot as compared to several other hormones. One of the bands the researcher identifies in this circulating factor is identical to that of another known hormone with which of the following sites of action?? {'A': 'Adipocytes', 'B': 'Adrenal gland', 'C': 'Bones', 'D': 'Kidney tubules', 'E': 'Thyroid gland'},
|
E: Thyroid gland
|
Answer the following medical question with one of the provided options:
|
Q:A 73-year-old woman comes to the physician because of recurrent episodes of losing consciousness for several seconds upon standing. She has a history of hypertension, which has been treated with hydrochlorothiazide. Her blood pressure is 130/87 mm Hg in the supine position and 100/76 mm Hg 30 seconds after standing up. Cardiac examination shows no abnormalities. Which of the following sets of changes is most likely to occur when the patient stands up? $$$ Venous return %%% Carotid sinus baroreceptor activity %%% Cerebral blood flow $$$? {'A': '↓ ↓ ↓', 'B': '↑ ↑ ↑', 'C': 'No change ↓ ↓', 'D': '↑ ↑ ↓', 'E': '↓ ↑ ↓'},
|
A: ↓ ↓ ↓
|
Answer the following medical question with one of the provided options:
|
Q:A 27-year-old Caucasian female presents complaining of recent weight loss and weakness. She reports that she feels dizzy and lightheaded every morning when she gets out of bed, and often at work whenever she must rise from her desk. Physical exam reveals several areas of her skin including her elbows and knees are more pigmented than other areas. Which of the following would be consistent with the patient's disease?? {'A': 'Hyperglycemia', 'B': 'Hyperkalemia', 'C': 'Hypernatremia', 'D': 'Central obesity', 'E': 'Pretibial myxedema'},
|
B: Hyperkalemia
|
Answer the following medical question with one of the provided options:
|
Q:A 52-year-old man comes to the physician because of a 1-month history of fatigue and blurry vision. Pulse oximetry on room air shows an oxygen saturation of 99%. Laboratory studies show a hemoglobin concentration of 17.5 g/dL, mean corpuscular volume of 88 μm3, red cell volume of 51.6 mL/kg, and plasma volume of 38 mL/kg. Erythropoietin concentration is elevated. Which of the following is the most likely explanation for these findings?? {'A': 'Polycythemia vera', 'B': 'Chronic obstructive pulmonary disease', 'C': 'Excessive diuretic use', 'D': 'Chronic myelogenous leukemia', 'E': 'Hepatocellular carcinoma'},
|
E: Hepatocellular carcinoma
|
Answer the following medical question with one of the provided options:
|
Q:A recently deceased 92-year-old woman with a history of arrhythmia was discovered to have amyloid deposition in her atria upon autopsy. Upon further examination, there was no amyloid found in any other organs. The peptide at fault was identified and characterized by the pathologist performing the autopsy. Before its eventual deposition in the cardiac atria, which of the following functions was associated with the peptide?? {'A': 'Reduction of blood calcium concentration', 'B': 'Antigen recognition', 'C': 'Vasodilation', 'D': 'Slowing of gastric emptying', 'E': 'Stimulation of lactation'},
|
C: Vasodilation
|
Answer the following medical question with one of the provided options:
|
Q:A 26-year-old male engineer presents to a reproductive specialist due to the inability to conceive after 2 years of trying with his 28-year-old wife. He reports that he is healthy without any significant medical history, surgeries, or medications. He was adopted at 17 years-old. On exam, he is well appearing without dysmorphic features. He has a high pitched voice, absent facial hair, is 5 feet 8 inches tall, and has a BMI of 19 kg/m^2. On genitourinary exam, his testicles are descended bilaterally without varicoceles, and testicular volume is 8cc bilaterally. He has a stretched penile length of 6cm. He has labwork from his primary care physician that is significant for low LH, FSH, and testosterone. What is the most likely cause of his infertility?? {'A': 'Fragile X Syndrome', 'B': 'Kallman Syndrome', 'C': 'Kleinfelter Syndrome', 'D': 'Prader-Willi Syndrome', 'E': 'Primary Hypogonadism'},
|
B: Kallman Syndrome
|
Answer the following medical question with one of the provided options:
|
Q:A 4-year-old male is brought into your office because his mother states he has been fatigued. He has not been acting like himself and has been getting tired easily while running around and playing with other children. As of last week, he has also been complaining of being short of breath. His vitals are temperature 98.6 deg F (37.2 deg C), blood pressure 100/75 mmHg, pulse 98/min, and respirations 22/min. On exam, the patient is short of breath, and there is a holosystolic murmur with an appreciable thrill along the left sternal border. There are no other noticeable abnormalities, and the mother states that the child's prenatal course along with genetic testing was normal. What is the most likely diagnosis?? {'A': 'Endocardial cushion defect', 'B': 'Tetrology of Fallot', 'C': 'Patent ductus arteriosus (PDA)', 'D': 'Ventricular septal defect (VSD)', 'E': 'Atrial septal defect (ASD)'},
|
D: Ventricular septal defect (VSD)
|
Answer the following medical question with one of the provided options:
|
Q:You are culturing bacteria on lactose-rich and glucose-free media. These bacteria regulate gene expression via the lac operon to ferment lactose into glucose and galactose for their metabolic needs. You add free glucose to the media. The addition of glucose reduces lactose fermentation secondary to which of the following changes?? {'A': 'Increased binding by the repressor to the operator', 'B': 'Decreased binding by the repressor to the operator', 'C': 'Increased binding to CAP', 'D': 'Increased level of cAMP', 'E': 'Decreased level of cAMP'},
|
E: Decreased level of cAMP
|
Answer the following medical question with one of the provided options:
|
Q:A 71-year-old man arrives to the emergency room appearing cyanotic and having weak, shallow respirations. He is brought in by his home care nurse, who reports that the patient has a history of myasthenia gravis and frequent urinary tract infections. The patient was in his normal state of health until 5 days ago when he developed a urinary tract infection. He was prescribed gentamicin with improvement of his urinary symptoms. This morning, while trying to eat breakfast, he began complaining of poor grip strength and progressive difficulty breathing. The patient’s medications include pyridostigmine and aspirin, both of which his nurse reports he takes every day as prescribed. The patient’s temperature is 99°F (37.2°C), blood pressure is 128/78 mmHg, pulse is 92/min, and respirations are 28/min with an oxygen saturation of 86% O2 on room air. Upon physical exam, the patient is noted to have gray-blue skin, hypophonia, weak upper extremities, and normal leg strength. An arterial blood gas is drawn with results as shown below: PO2: 55 mmHg PCO2: 60 mmHg pH: 7.30 The patient is intubated. Which of the following is the next best step in management?? {'A': 'Atropine', 'B': 'Edrophonium', 'C': 'Neostigmine', 'D': 'Plasmapheresis', 'E': 'Thymectomy'},
|
D: Plasmapheresis
|
Answer the following medical question with one of the provided options:
|
Q:A 2720-g (6-lb) female newborn delivered at 35 weeks’ gestation starts vomiting and becomes inconsolable 48 hours after birth. The newborn has not passed her first stool yet. Examination shows abdominal distention and high-pitched bowel sounds. A water-soluble contrast enema study shows microcolon. Serum studies show increased levels of immunoreactive trypsinogen. Which of the following is the most likely additional laboratory finding?? {'A': 'Decreased hydrogen ion concentration in renal collecting duct', 'B': 'Increased chloride concentration in alveolar fluid', 'C': 'Increased serum calcium concentration', 'D': 'Increased bicarbonate concentration in pancreatic secretions', 'E': 'Increased sodium concentration in sweat'},
|
E: Increased sodium concentration in sweat
|
Answer the following medical question with one of the provided options:
|
Q:Two weeks after undergoing allogeneic stem cell transplant for multiple myeloma, a 55-year-old man develops a severely pruritic rash, abdominal cramps, and profuse diarrhea. He appears lethargic. Physical examination shows yellow sclerae. There is a generalized maculopapular rash on his face, trunk, and lower extremities, and desquamation of both soles. His serum alanine aminotransferase is 115 U/L, serum aspartate aminotransferase is 97 U/L, and serum total bilirubin is 2.7 mg/dL. Which of the following is the most likely underlying cause of this patient's condition?? {'A': 'Donor T cells in the graft', 'B': 'Newly formed anti-HLA antibodies', 'C': 'Proliferating transplanted B cells', 'D': 'Activated recipient T cells', 'E': 'Preformed cytotoxic anti-HLA antibodies'},
|
A: Donor T cells in the graft
|
Answer the following medical question with one of the provided options:
|
Q:A 28-year-old African American woman presents to her primary care physician with two weeks of nausea, abdominal pain, and increased urination. She states she has had kidney stones in the past and is concerned because her current pain is different in character from what she had experienced then. In addition she reports increasing weakness and fatigue over the past several months as well as mild shortness of breath. Chest radiography shows bilateral hilar adenopathy. Which of the following processes is most likely responsible for her current symptoms?? {'A': 'Osteoclast-driven bone resorption', 'B': 'Increased production of parathyroid hormone', 'C': 'Ectopic parathyroid hormone release', 'D': 'Increased intestinal absorption of calcium', 'E': 'Increased renal calcium reabsorption'},
|
D: Increased intestinal absorption of calcium
|
Answer the following medical question with one of the provided options:
|
Q:A 38-year-old man comes to the physician for a follow-up examination. He has quadriparesis as a result of a burst fracture of the cervical spine that occurred after a fall from his roof 1 month ago. He has urinary and bowel incontinence. He appears malnourished. His temperature is 37.1°C (98.8°F), pulse is 88/min, and blood pressure is 104/60 mm Hg. Examination shows spasticity in all extremities. Muscle strength is decreased in proximal and distal muscle groups bilaterally. Deep tendon reflexes are 4+ bilaterally. Plantar reflex shows extensor response bilaterally. Sensation to pinprick and temperature is absent below the neck. Sensation to vibration, position, and light touch is normal bilaterally. Rectal tone is decreased. There is a 1-cm area of erythema over the sacrum. Which of the following is the most likely cause of this patient's symptoms?? {'A': 'Cavitation within the spinal cord', 'B': 'Occlusion of the posterior spinal artery', 'C': 'Hemi-transection of the spinal cord', 'D': 'Damage to the anterior spinal artery', 'E': 'Injury to gray matter of the spinal cord'},
|
D: Damage to the anterior spinal artery
|
Answer the following medical question with one of the provided options:
|
Q:A 55-year-old woman with poorly controlled type 2 diabetes mellitus comes to the emergency department because of a 5-day history of a severely painful, blistering rash. The rash began over the right forehead, and spread to the chest, back, and bilateral upper extremities over the next 2 days. She is diagnosed with disseminated cutaneous herpes zoster and hospitalized for further management. Prior to admission, her only medication was insulin. On the second day of her stay, she develops bilateral episodic, cramping flank pain and nausea. Her temperature is 36.7°C (98°F), pulse is 80/min, and blood pressure is 128/76 mm Hg. Examination shows a healing rash over the forehead, chest, and extremities, with no evidence of new blisters. Her serum blood urea nitrogen is 33 mg/dL and serum creatinine is 3.5 mg/dL. On admission, her serum urea nitrogen was 18 mg/dL and her serum creatinine was 1.1 mg/dL. Which of the following is the most likely cause of this patient's laboratory findings?? {'A': 'Glycosylation of glomerular basement membrane', 'B': 'Formation of anti-GBM antibodies', 'C': 'Coagulative necrosis of renal papilla', 'D': 'Deposition of glomerular immune complexes', 'E': 'Obstruction of renal tubule\n"'},
|
E: Obstruction of renal tubule "
|
Answer the following medical question with one of the provided options:
|
Q:A 32-year-old man is brought to the emergency department with fever, dyspnea, and impaired consciousness. His wife reports that he has also had an episode of dark urine today. Two weeks ago, he returned from a trip to the Republic of Congo. His temperature is 39.4°C (103°F), pulse is 114/min, and blood pressure is 82/51 mm Hg. Physical examination shows scleral icterus. Decreased breath sounds and expiratory crackles are heard on auscultation of the lungs bilaterally. His hemoglobin concentration is 6.3 g/dL. A blood smear shows red blood cells with normal morphology and ring-shaped inclusions. Further laboratory testing shows normal rates of NADPH production. Which of the following is the most appropriate pharmacotherapy for this patient?? {'A': 'Proguanil', 'B': 'Chloroquine', 'C': 'Atovaquone', 'D': 'Dapsone', 'E': 'Artesunate'},
|
E: Artesunate
|
Answer the following medical question with one of the provided options:
|
Q:A 39-year-old man is admitted to the hospital with profuse diarrhea. His wife says that it started yesterday and since then the patient has passed over 15 liters of watery stools which have become progressively clear and odorless. Over the past 2 days, the patient has only eaten homemade food. His wife and daughter do not have any symptoms. His wife says that he returned from a trip to rural India 2 days before the symptoms began. He has a history of gastroesophageal reflux disease. His vitals are as follows: blood pressure 95/70 mm Hg, heart rate 100/min, respiratory rate 21/min, and temperature 35.8°C (96.4°F). The patient appears fatigued and pale. His skin elasticity and turgor are decreased. Cardiac auscultation reveals a holosystolic murmur that changes characteristics with changes in the patient’s position. The chronic intake of which of the following drugs could predispose the patient to this condition?? {'A': 'Ibuprofen', 'B': 'Aspirin', 'C': 'Pantoprazole', 'D': 'Propranolol', 'E': 'Levocetirizine'},
|
C: Pantoprazole
|
Answer the following medical question with one of the provided options:
|
Q:A 36-year-old man is brought to the emergency department because of facial spasm and an inability to speak for 2 hours. He has had no loss of consciousness or rhythmic movements. He has a history of schizophrenia and was recently put on clozapine for resistant symptoms. He appears to be aware of his surroundings. At the hospital, his blood pressure is 135/85 mm Hg, the pulse is 86/min, the respirations are 16/min, and the temperature is 36.7°C (98.1°F). Physical examination shows the superior deviation of both eyes to the right side, trismus, and spasm of the neck muscles with a deviation of the head to the left. He follows directions without hesitation. The remainder of the physical examination shows no abnormalities. The most appropriate next step is to administer which of the following?? {'A': 'Calcium gluconate', 'B': 'Diphenhydramine', 'C': 'Flumazenil', 'D': 'Labetalol', 'E': 'Morphine'},
|
B: Diphenhydramine
|
Answer the following medical question with one of the provided options:
|
Q:A 2-week-old boy is brought to the emergency department after he was found to have blood in his stool. The mother says the baby was born by home birth at 38 weeks without complications. The mother denies fever, vomiting, or rash but says the baby has been fussier recently. The mother denies a family history of any similar problems. On exam, the patient is well-developed and meets all developmental markers. His heart rate is tachycardic but with regular rhythms. There is oozing blood from the umbilical site which has not fully healed. A guaiac stool test is positive. What is the underlying cause of this presentation?? {'A': 'Factor VIII deficiency', 'B': 'Bacterial infection', 'C': 'Factor IX deficiency', 'D': 'Vitamin K deficiency', 'E': 'Vitamin B12 deficiency'},
|
D: Vitamin K deficiency
|
Answer the following medical question with one of the provided options:
|
Q:A 35-year-old G4P1 woman presents for follow-up after her 3rd miscarriage. All 3 miscarriages occurred during the 2nd trimester. Past medical history is significant for systemic lupus erythematosus (SLE) and a deep vein thrombosis (DVT) in her right lower leg 3 years ago. Her current medication is hydroxychloroquine. The patient denies any tobacco, alcohol, and illicit substance use. Her vitals include: temperature 36.8℃ (98.2℉), blood pressure 114/76 mm Hg, pulse 84/min, respiration rate 12/min. Physical examination reveals a lacy, violaceous discoloration on her lower legs. Which of the following autoantibodies would this patient most likely test positive for?? {'A': 'Anti-centromere', 'B': 'Anti-Scl-70', 'C': 'Anti-Ro', 'D': 'Anti-smooth muscle', 'E': 'Anti-phospholipid'},
|
E: Anti-phospholipid
|
Answer the following medical question with one of the provided options:
|
Q:A 70-year-old woman is brought to the office after her nurse noticed her being apathetic, easily distracted, and starting to urinate in bed. Her medical history is relevant for hypertension, under control with medication. Physical examination reveals a blood pressure of 138/76 mm Hg, a heart rate of 70/min, and a respiratory rate 14/min and regular. On neurological examination, she has a broad-based shuffling gait, and increased muscle tone in her limbs that is reduced by distracting the patient. There is decreased coordination with exaggerated deep tendon reflexes, decreased attention and concentration, and postural tremor. Which of the following additional features would be expected to find in this patient?? {'A': 'Accumulation amyloid plaques and neurofibrillary tangles in the cerebral cortex', 'B': 'Dilation of the ventricular system', 'C': 'Degeneration of the substantia nigra pars compacta', 'D': 'Accumulation of Lewy bodies in cortical cells', 'E': 'Caudate head atrophy'},
|
B: Dilation of the ventricular system
|
Answer the following medical question with one of the provided options:
|
Q:A previously healthy 49-year-old woman comes to the emergency department because of chest pain that radiates to her back. The pain started 45 minutes ago while she was having lunch. Over the past 3 months, she has frequently had the feeling of food, both liquid and solid, getting “stuck” in her chest while she is eating. The patient's vital signs are within normal limits. An ECG shows a normal sinus rhythm with no ST-segment abnormalities. An esophagogram is shown. Further evaluation is most likely to show which of the following?? {'A': 'Simultaneous multi-peak contractions on manometry', 'B': 'Multiple mucosal erosions on endoscopy', 'C': 'Elevated lower esophageal sphincter pressure on manometry', 'D': 'Gastroesophageal junction mass on endoscopy', 'E': 'Hypertensive contractions on manometry'},
|
A: Simultaneous multi-peak contractions on manometry
|
Answer the following medical question with one of the provided options:
|
Q:A 65-year-old man presents to the emergency department due to an episode of lightheadedness. The patient was working at his garage workbench when he felt like he was going to faint. His temperature is 98.8°F (37.1°C), blood pressure is 125/62 mmHg, pulse is 117/min, respirations are 14/min, and oxygen saturation is 98% on room air. Laboratory values are ordered as seen below. Hemoglobin: 7 g/dL Hematocrit: 22% Leukocyte count: 6,500/mm^3 with normal differential Platelet count: 197,000/mm^3 The patient is started on blood products and a CT scan is ordered. Several minutes later, his temperature is 99.5°F (37.5°C), blood pressure is 87/48 mmHg, and pulse is 180/min. The patient's breathing is labored. Which of the following is also likely to be true?? {'A': 'A past medical history of repeat GI and respiratory infections', 'B': 'Autoimmune reaction against red blood cell antigens', 'C': 'Diffuse whiting out of the lungs on chest radiograph', 'D': 'Relaxation of smooth muscle in the vasculature caused by bacterial antigens', 'E': 'Sudden rupture of a vessel'},
|
A: A past medical history of repeat GI and respiratory infections
|
Answer the following medical question with one of the provided options:
|
Q:An 84-year-old man presents to the emergency department for a loss of consciousness. The patient states that he was using the bathroom when he lost consciousness and fell, hitting his head on the counter. The patient has a past medical history of diabetes, hypertension, obesity, factor V leiden, constipation, myocardial infarction, and vascular claudication. His current medications include lisinopril, atorvastatin, valproic acid, propranolol, insulin, metformin, and sodium docusate. The patient denies use of illicit substances. His temperature is 99.5°F (37.5°C), blood pressure is 167/98 mmHg, pulse is 90/min, respirations are 15/min, and oxygen saturation is 98% on room air. Physical exam reveals an elderly man sitting comfortably in his stretcher. Cardiac exam reveals a systolic murmur heard at the right upper sternal border that radiates to the carotids. Pulmonary exam reveals mild bibasilar crackles. Neurological exam reveals 5/5 strength in his upper and lower extremities with normal sensation. The patient's gait is mildly unstable. The patient is unable to give a urine sample in the emergency department and states that he almost fainted again when he tried to. Which of the following is the most likely diagnosis?? {'A': 'Transient ischemic attack', 'B': 'Postural hypotension', 'C': 'Seizure', 'D': 'Cardiac arrhythmia', 'E': 'Situational syncope'},
|
E: Situational syncope
|
Answer the following medical question with one of the provided options:
|
Q:A 50-year-old woman comes to the physician for the evaluation of fatigue over the past 6 months. During this period, the patient has also had a 5 kg (11-lb) weight loss. She has a history of Hashimoto thyroiditis. She is sexually active with her husband only. She does not smoke. She drinks one glass of wine per day. She does not use illicit drugs. Her only medication is levothyroxine. Temperature is 37°C (98.6°F), pulse is 70/min, and blood pressure is 110/70 mm Hg. Abdominal examination shows tenderness in the right upper quadrant with no rebound or guarding. Laboratory studies show a serum alanine aminotransferase level of 190 U/L, serum aspartate aminotransferase level of 250 U/L, and serum total bilirubin level of 0.6 mg/dL. Liver biopsy shows plasma cell infiltration and areas of periportal piecemeal necrosis. Further evaluation of this patient is most likely to show which of the following findings?? {'A': 'Positive anti-smooth muscle antibodies', 'B': 'Positive anti-mitochondrial antibodies', 'C': 'Positive HBV surface antigen', 'D': 'Elevated serum transferrin saturation', 'E': 'Positive anti-HCV antibodies'},
|
A: Positive anti-smooth muscle antibodies
|
Answer the following medical question with one of the provided options:
|
Q:A 35-year-old woman from San Francisco has been refusing to vaccinate her children due to the claims that vaccinations may cause autism in children. Her 10-year-old male child began developing a low-grade fever with a rash that started on his face; as the rash began to spread to his limbs, it slowly disappeared from his face. When the child was taken to a clinic, the physician noticed swollen lymph nodes behind the ears of the child. Which of the following are characteristics of the virus causing these symptoms?? {'A': 'Enveloped, DS linear DNA', 'B': 'Nonenveloped, SS linear DNA', 'C': 'Enveloped, SS + nonsegmented RNA', 'D': 'Enveloped, SS - nonsegmented RNA', 'E': 'Nonenveloped, DS segmented RNA'},
|
C: Enveloped, SS + nonsegmented RNA
|
Answer the following medical question with one of the provided options:
|
Q:A 6-year-old girl is brought to the emergency department because of abdominal pain, vomiting, and fatigue for the past 4 hours. Over the past month, she has had a 4-kg (8.8-lb) weight loss, increased thirst, and increased urinary frequency. Examination shows dry mucous membranes, decreased skin turgor, and hyperventilation with a fruity odor. Laboratory studies show a blood glucose level of 420 mg/dL and acetoacetate in the urine. Which of the following is the most likely inheritance pattern of this patient's underlying condition?? {'A': 'Autosomal recessive', 'B': 'Mitochondrial', 'C': 'X-linked recessive', 'D': 'Imprinted', 'E': 'Polygenic'},
|
E: Polygenic
|
Answer the following medical question with one of the provided options:
|
Q:A 69-year-old African American man is brought to the emergency department with sudden onset lower limb paralysis and back pain. He has had generalized bone pain for 2 months. He has no history of severe illnesses. He takes ibuprofen for pain. On examination, he is pale. The vital signs include: temperature 37.1°C (98.8°F), pulse 68/min, respiratory rate 16/min, and blood pressure 155/90 mm Hg. The neurologic examination shows paraparesis. The 8th thoracic vertebra is tender to palpation. An X-ray of the thoracic vertebrae confirms a compression fracture at the same level. The laboratory studies show the following: Laboratory test Hemoglobin 9 g/dL Mean corpuscular volume 95 μm3 Leukocyte count 5,000/mm3 Platelet count 240,000/mm3 ESR 85 mm/hour Serum Na+ 135 mEq/L K+ 4.2 mEq/L Cl− 113 mEq/L HCO3− 20 mEq/L Ca+ 11.5 mg/dL Albumin 4 g/dL Urea nitrogen 18 mg/dL Creatinine 1.2 mg/dL Serum electrophoresis shows a monoclonal protein level of 38 g/L. To reduce the likelihood of fracture recurrence, it is most appropriate to administer which of the following?? {'A': 'Calcitonin', 'B': 'Calcitriol', 'C': 'Fluoride', 'D': 'Pamidronate', 'E': 'Testosterone'},
|
D: Pamidronate
|
Answer the following medical question with one of the provided options:
|
Q:A 5-week-old male infant is brought to the Emergency Department with the complaint of vomiting. His parents state he has been unable to keep normal feedings down for the past week and now has projectile non-bilious vomiting after each meal. He was given a short course of oral erythromycin at 4 days of life for suspected bacterial conjunctivitis. Physical examination is significant for sunken fontanelles and dry mucous membranes. A palpable, ball shaped mass is noted just to the right of the epigastrum. Which of the following conditions is most likely in this patient?? {'A': 'Gastroesophageal reflux', 'B': 'Hypertrophic pyloric stenosis', 'C': 'Milk-protein allergy', 'D': 'Midgut volvulus', 'E': 'Intussusception'},
|
B: Hypertrophic pyloric stenosis
|
Answer the following medical question with one of the provided options:
|
Q:A 67-year-old gentleman with a history of poorly controlled diabetes presents to his primary care physician for a routine examination. He is found to be hypertensive on physical exam and is started on a medication that is considered first-line therapy for his condition. What should the physician warn the patient about before the patient takes his first dose of the medication?? {'A': 'Hypertensive episodes', 'B': 'Hypotensive episodes', 'C': 'Hyperthermic episodes', 'D': 'Hypothermic episodes', 'E': 'Anuric episodes'},
|
B: Hypotensive episodes
|
Answer the following medical question with one of the provided options:
|
Q:A 72-year-old man with chronic lymphocytic leukemia (CLL) comes to the physician with a 2-day history of severe fatigue and dyspnea. He regularly visits his primary care physician and has not required any treatment for his underlying disease. His temperature is 36.7°C (98.1°F), pulse is 105/min, respiratory rate is 22/min, and blood pressure is 125/70 mm Hg. The conjunctivae are pale. Examination of the heart and lungs shows no abnormalities. The spleen is palpable 3 cm below the costal margin. No lymphadenopathy is palpated. Laboratory studies show: Hemoglobin 7 g/dL Mean corpuscular volume 105 μm3 Leukocyte count 80,000/mm3 Platelet count 350,000/mm3 Serum Bilirubin Total // Direct 6 mg/dL / 0.8 mg/dL Lactate dehydrogenase 650 U/L (Normal: 45–90 U/L) Based on these findings, this patient’s recent condition is most likely attributable to which of the following?? {'A': 'Autoimmune hemolytic anemia', 'B': 'Bone marrow involvement', 'C': 'Diffuse large B cell lymphoma', 'D': 'Evan’s syndrome', 'E': 'Splenomegaly'},
|
A: Autoimmune hemolytic anemia
|
Answer the following medical question with one of the provided options:
|
Q:A 67-year-old man comes to the physician for a follow-up examination. He has had lower back pain for several months. The pain radiates down the right leg to the foot. He has no history of any serious illness and takes no medications. His pain increases after activity. The straight leg test is positive on the right. The results of the laboratory studies show: Laboratory test Hemoglobin 14 g/d Leukocyte count 5,500/mm3 with a normal differential Platelet count 350,000/mm3 Serum Calcium 9.0 mg/dL Albumin 3.8 g/dL Urea nitrogen 14 mg/dL Creatinine 0.9 mg/dL Serum immunoelectrophoresis shows an immunoglobulin G (IgG) type monoclonal component of 40 g/L. Bone marrow plasma cells return at 20%. Skeletal survey shows no bone lesions. Magnetic resonance imaging (MRI) shows a herniated disc at the L5. Which of the following is the most appropriate next step?? {'A': 'Autologous stem cell transplantation', 'B': 'Dexamethasone', 'C': 'Physical therapy', 'D': 'Plasmapheresis', 'E': 'Thalidomide'},
|
C: Physical therapy
|
Answer the following medical question with one of the provided options:
|
Q:A 3-week-old neonate in the neonatal intensive care unit (NICU) has bilious vomiting. He was born at 31 weeks gestation by cesarean section due to maternal preeclampsia. The birth weight was 1100 g (2.4 lb). Meconium was passed on the 2nd day after birth, and he had an adequate number of wet diapers. He is on continuous nasogastric formula feeds. The vital signs include: temperature 34.4°C (94.0°F), blood pressure 80/40 mm Hg, pulse 120/min, and respiratory rate 62/min. The pulse oximetry is 96% on room air. The examination reveals a lethargic neonate with abdominal distension. There is frank blood in his diaper. Laboratory studies show metabolic acidosis. Which of the following is the most likely finding in this patient?? {'A': 'Diffuse microcolon on barium enema', 'B': 'No air in the rectum on abdominal X-ray', 'C': 'Air in the bowel wall on abdominal X-ray', 'D': 'Double bubble sign on abdominal X-ray', 'E': 'Epigastric olive-shaped mass on abdominal sonography'},
|
C: Air in the bowel wall on abdominal X-ray
|
Answer the following medical question with one of the provided options:
|
Q:A patient is in the ICU for diabetic ketoacidosis and is currently on an insulin drip. His electrolytes are being checked every hour and his potassium is notable for the following measures: 1. 5.1 mEq/L 2. 5.8 mEq/L 3. 6.1 mEq/L 4. 6.2 mEq/L 5. 5.9 mEq/L 6. 5.1 mEq/L 7. 4.0 mEq/L 8. 3.1 mEq/L Which of the following is the median potassium value of this data set?? {'A': '3.10', 'B': '5.10', 'C': '5.16', 'D': '5.45', 'E': '6.05'},
|
D: 5.45
|
Answer the following medical question with one of the provided options:
|
Q:A 66-year-old man was referred for endoscopic evaluation due to iron deficiency anemia. He has had anorexia and weight loss for two months. Three years ago, the patient had coronary artery bypass grafting and aortic mechanical valve replacement. He has a 12-year history of diabetes mellitus and hypertension. He takes warfarin, lisinopril, amlodipine, metformin, aspirin, and carvedilol. His blood pressure is 115/65 mm Hg, pulse is 68/min, respirations are 14/min, temperature is 36.8°C (98.2°F), and blood glucose is 220 mg/dL. Conjunctivae are pale. Heart examination reveals a metallic click just before the carotid pulse. Which of the following is the most appropriate switch in this patient’s drug therapy before the endoscopy?? {'A': 'Amlodipin to diltiazem', 'B': 'Aspirin to clopidogrel', 'C': 'Lisinopril to losartan', 'D': 'Metformin to empagliflozin', 'E': 'Warfarin to heparin'},
|
E: Warfarin to heparin
|
Answer the following medical question with one of the provided options:
|
Q:A 27-year-old woman gives birth to a boy at 36 weeks gestational age. The infant weighs 4022 grams at birth, is noted to have a malformed sacrum, and appears to be in respiratory distress. Apgar scores are 5 and 7 at 1 minute and 5 minutes respectively. Hours after birth, the infant is found to be irritable, bradycardic, cyanotic, and hypotonic, and the infant's serum is sent to the laboratory for evaluation. Which of the following abnormalities would you expect to observe in this infant?? {'A': 'Hypoinsulinemia', 'B': 'Hyperglycemia', 'C': 'Hypoglycemia', 'D': 'Hypercalcemia', 'E': 'Hypermagnesemia'},
|
C: Hypoglycemia
|
Answer the following medical question with one of the provided options:
|
Q:Two healthy adults have only one child. He has Friedrich ataxia (FA). They are considering having more children, but are uncertain of their risk of having another child with the condition. What should they do?? {'A': 'See a genetic counselor; risk of having another child with FA is 25%', 'B': 'See a genetic counselor; risk of having another child with FA is 50%', 'C': 'See a genetic counselor; risk of having another child with FA is 66%', 'D': 'Proceed with conception; risk of having another child with FA is 0%', 'E': 'Proceed with conception; risk of having another child with FA is unpredictable'},
|
A: See a genetic counselor; risk of having another child with FA is 25%
|
Answer the following medical question with one of the provided options:
|
Q:A 72-year-old man is brought in by ambulance to the hospital after being found down at home. On presentation, he appears cachectic and is found to be confused. Specifically, he does not answer questions appropriately and is easily distracted. His wife says that he has been losing weight over the last 3 months and he has a 40 pack-year history of smoking. His serum sodium is found to be 121 mEq/L and his urine osmolality is found to be 415 mOsm/kg. Chest radiograph shows a large central mass in the right lung. Which of the following treatments would be effective in addressing this patient's serum abnormality?? {'A': 'Antidiuretic hormone', 'B': 'Antipsychotic', 'C': 'Demeclocycline', 'D': 'Normal saline', 'E': 'Renin'},
|
C: Demeclocycline
|
Answer the following medical question with one of the provided options:
|
Q:A 5-year-old girl accompanied by her mother presents to the emergency department after suffering a fall on the elementary school playground. Her mother reports that a child on the playground pushed her daughter who fell on her right side, after which she screamed and was found clutching her right leg. The girl's past medical history is significant for a fracture of the left femur and right radius over the past 2 years and an auditory deficit requiring hearing aid use starting 6 months ago. Inspection reveals a relatively short girl in moderate distress. She has brown opalescent teeth. She refuses to bear weight on her right lower extremity. Radiography of the right lower extremity reveals a femoral midshaft fracture. Which of the following is the most likely etiology of the patient's condition?? {'A': 'Decreased cystathionine beta synthase activity', 'B': 'Defective type I collagen production', 'C': 'Fibrillin gene defect', 'D': 'Type III collagen gene defect', 'E': 'Vitamin D deficiency'},
|
B: Defective type I collagen production
|
Answer the following medical question with one of the provided options:
|
Q:A new imaging modality is being tested to study vitelline duct morphology. A fetus at 20 weeks' gestation is found to have partial obliteration of this duct. Which of the following is the most likely sequela of this condition?? {'A': 'Protrusion of abdominal viscera into the umbilical cord', 'B': 'Swelling in the genital region', 'C': 'Dilation of the descending colon', 'D': 'Discharge of urine from the umbilicus', 'E': 'Bleeding from the gastrointestinal tract\n"'},
|
E: Bleeding from the gastrointestinal tract "
|
Answer the following medical question with one of the provided options:
|
Q:A 15-year-old boy is brought to the emergency department by his parents because of lethargy, repeated vomiting, and abdominal pain for 6 hours. Over the past 2 weeks, he has reported increased urinary frequency to his parents that they attributed to his increased oral fluid intake. Examination shows dry mucous membranes and rapid, deep breathing. Laboratory studies show the presence of acetoacetate in the urine. Which of the following cells is unable to use this molecule for energy production?? {'A': 'Adipocyte', 'B': 'Thrombocyte', 'C': 'Neuron', 'D': 'Hepatocyte', 'E': 'Myocyte\n"'},
|
D: Hepatocyte
|
Answer the following medical question with one of the provided options:
|
Q:A 45-year-old man comes to the physician because of worsening shortness of breath and dry cough for 6 months. The patient's symptoms get worse when he walks more than about 150 yards. He also reports fatigue and difficulty swallowing solid foods. In cold weather, his fingers occasionally turn blue and become painful. He occasionally smokes cigarettes on weekends. His temperature is 37°C (98.6°F), and respirations are 22/min, pulse is 87/min, and blood pressure is 126/85 mm Hg. The skin over his trunk and arms is thickened and tightened. Fine inspiratory crackles are heard over bilateral lower lung fields on auscultation. Which of the following additional findings is most likely in this patient?? {'A': 'Decreased right atrial pressure', 'B': 'Increased lung compliance', 'C': 'Decreased diffusing capacity', 'D': 'Increased airway resistance', 'E': 'Decreased A-a gradient'},
|
C: Decreased diffusing capacity
|
Answer the following medical question with one of the provided options:
|
Q:A 26-year-old female with AIDS (CD4 count: 47) presents to the emergency department in severe pain. She states that over the past week she has been fatigued and has had a progressively worse headache and fever. These symptoms have failed to remit leading her to seek care in the ED. A lumbar puncture is performed which demonstrates an opening pressure of 285 mm H2O, increased lymphocytes, elevated protein, and decreased glucose. The emergency physician subsequently initiates treatment with IV amphotericin B and PO flucytosine. What additional treatment in the acute setting may be warranted in this patient?? {'A': 'Fluconazole', 'B': 'Serial lumbar punctures', 'C': 'Mannitol', 'D': 'Chloramphenicol', 'E': 'Acetazolamide'},
|
B: Serial lumbar punctures
|
Answer the following medical question with one of the provided options:
|
Q:A 10-year-old boy is brought to the physician by his parents because they are concerned about his “strange behavior”. The parents state that he has always been a lonely kid without many friends, but recently he has been having behavioral problems that seem to be unprovoked and are occurring more frequently. The child throws tantrums for no reason and does not respond to punishment or reward. He also has a “strange obsession” with collecting rocks that he finds on his way to and from school to the point where his room is filled with rocks. He plays alone in his room, lining the rocks up, organizing them by size, shape, or color, and he will randomly bark or make high-pitched noises without provocation. His teachers say he daydreams a lot and is very good at art, being able to recreate his favorite cartoon characters in great detail. On physical assessment, the patient does not make eye contact with the physician but talks incessantly about his rock collection. The child’s grammar and vocabulary seem normal but his speech is slightly labored, and he can’t seem to tell that the physician is not really interested in hearing about his rock collection. Which of the following is the most likely diagnosis?? {'A': 'Autism spectrum disorder', 'B': 'Attention deficit hyperactivity disorder', 'C': 'Tourette’s syndrome', 'D': 'Obsessive-compulsive disorder', 'E': 'Pick disease'},
|
A: Autism spectrum disorder
|
Answer the following medical question with one of the provided options:
|
Q:A 56-year-old man presents to the physician for the evaluation of excess snoring over the past year. He has no history of a serious illness and takes no medications. He does not smoke. His blood pressure is 155/95 mm Hg. BMI is 49 kg/m2. Oropharyngeal examination shows an enlarged uvula. Examination of the nasal cavity shows no septal deviation or polyps. Examination of the lungs and heart shows no abnormalities. Polysomnography shows an apnea-hypopnea index of 2 episodes/h with a PCO2 of 51 mm Hg during REM sleep. Arterial blood gas analysis in room air shows: pH 7.33 PCO2 50 mm Hg PO2 92 mm Hg HCO3− 26 mEq/L Which of the following best explains these findings?? {'A': 'Obstructive sleep apnea-hypopnea syndrome', 'B': 'Obesity hypoventilation syndrome with obstructive sleep apnea', 'C': 'Obesity hypoventilation syndrome', 'D': 'Central hypoventilation syndrome', 'E': 'Central hypoventilation syndrome with obstructive sleep apnea'},
|
C: Obesity hypoventilation syndrome
|
Answer the following medical question with one of the provided options:
|
Q:A 55-year-old woman comes to the physician because of increased blurring of vision in both eyes for the past 4 months. She has tried using over-the-counter reading glasses, but they have not helped. She has a history of hypertension, type 2 diabetes mellitus, and chronic obstructive pulmonary disease. Current medications include lisinopril, insulin, metformin, and a fluticasone-vilanterol inhaler. Vital signs are within normal limits. Examination shows visual acuity of 20/70 in each eye. A photograph of the fundoscopic examination of the right eye is shown. Which of the following is the most appropriate next step in management?? {'A': 'Topical timolol therapy', 'B': 'Laser photocoagulation', 'C': 'Oral ganciclovir therapy', 'D': 'Ocular massage', 'E': 'Surgical vitrectomy'},
|
B: Laser photocoagulation
|
Answer the following medical question with one of the provided options:
|
Q:A 67-year-old man presents to his primary care physician because of a dry cough and shortness of breath for 2 months. He notes that recently he has had easy bruising of the skin without obvious trauma. He has a past history of chronic obstructive pulmonary disease and recently diagnosed with type 2 diabetes. Family history is non-contributory. He has smoked 1 pack of cigarettes daily for 35 years but quit 3 years ago. His temperature is 37.1°C (98.7°F), blood pressure is 170/80 mm Hg, and pulse is 85/min. On physical examination, the patient's face is round and plethoric and there are large supraclavicular fat pads. Breath sounds are diminished all over the chest without focal rales or wheezes. Chest X-ray is shown in the picture. Which of the following is the most likely etiology of this patient's condition?? {'A': 'Small cell lung cancer', 'B': 'Adenocarcinoma of the lung', 'C': 'Squamous cell carcinoma of the lung', 'D': 'Large cell carcinoma of the lung', 'E': 'Wegener granulomatosis'},
|
A: Small cell lung cancer
|
Answer the following medical question with one of the provided options:
|
Q:A 14-year-old girl is brought to the physician because she frequently experiences cramping and pain in her legs during school sports. She is at the 10th percentile for height. Her blood pressure is 155/90 mm Hg. Examination shows a high-arched palate with maloccluded teeth and a low posterior hairline. The patient has a broad chest with widely spaced nipples. Pelvic examination shows normal external female genitalia with scant pubic hair. Without appropriate treatment, this patient is at the greatest risk of developing which of the following complications?? {'A': 'Pulmonary stenosis', 'B': 'Osteoporosis', 'C': 'Severe acne', 'D': 'Hyperphagia', 'E': 'Alzheimer disease'},
|
B: Osteoporosis
|
Answer the following medical question with one of the provided options:
|
Q:A 2-month-old boy presents to the clinic with his mother for evaluation of crusty, greasy patches on the skin of the scalp that appeared 1 week ago. The mother states that the patient has been acting normally and is feeding well. She had a vaginal birth with no complications. On examination, the patient is smiling and playful in his mother’s arms. He can hold his head up and focus on faces and is happily gurgling. Vital signs are stable and weight, length, and head circumference measurements are all within normal limits. The skin on the scalp appears greasy, with yellow, scaly patches and evidence of inflammation. What is the most likely diagnosis?? {'A': 'Group B streptococcal colonization', 'B': 'Seborrheic dermatitis', 'C': 'Atopic dermatitis', 'D': 'Impetigo', 'E': 'Chickenpox'},
|
B: Seborrheic dermatitis
|
Answer the following medical question with one of the provided options:
|
Q:A 28-year-old male presents to his primary care physician with complaints of intermittent abdominal pain and alternating bouts of constipation and diarrhea. His medical chart is not significant for any past medical problems or prior surgeries. He is not prescribed any current medications. Which of the following questions would be the most useful next question in eliciting further history from this patient?? {'A': '"Please rate your abdominal pain on a scale of 1-10, with 10 being the worst pain of your life"', 'B': '"Is the diarrhea foul-smelling?"', 'C': '"Can you tell me more about the symptoms you have been experiencing?"', 'D': '"Does the diarrhea typically precede the constipation, or vice-versa?"', 'E': '"Are the symptoms worse in the morning or at night?"'},
|
C: "Can you tell me more about the symptoms you have been experiencing?"
|
Answer the following medical question with one of the provided options:
|
Q:A 74-year-old woman presents with severe and progressively worsening shortness of breath. She says that her breathing has been difficult for many years but now it is troubling her a lot. She reports a 50-pack-year smoking history and drinks at least 2 alcoholic beverages daily. On physical examination, the patient is leaning forward in her seat and breathing with pursed lips. Which of the following mechanisms best explains the benefit of oxygen supplementation in this patient?? {'A': 'Aids in smoking cessation', 'B': 'Better binding of oxygen to hemoglobin', 'C': 'Decreases respiratory rate and work of breathing', 'D': 'Free radical formation killing pathogens', 'E': 'Increased oxygen diffusion into capillary'},
|
E: Increased oxygen diffusion into capillary
|
Answer the following medical question with one of the provided options:
|
Q:A 14-month-old African American boy is brought to the emergency department because of fever, lethargy, and lack of appetite for 6 days. The patient’s mother says he fell off the changing table 10 days ago and landed on his left side, which she says has been tender since then. His vital signs include: temperature 38.0°C (100.4°F), blood pressure 85/41 mm Hg, pulse 132/min. Physical examination reveals conjunctival pallor and reduced range of motion at the left hip. C-reactive protein (CRP) is raised. A magnetic resonance imaging (MRI) scan shows signs of infection in the medullary canal of the left femoral bone and surrounding soft tissues. Blood cultures are positive for Salmonella. Which of the following would most likely confirm the underlying diagnosis in this patient?? {'A': 'Peripheral blood smear', 'B': 'Hemoglobin electrophoresis', 'C': 'Antinuclear antibodies', 'D': 'Full blood count', 'E': 'Iron studies'},
|
B: Hemoglobin electrophoresis
|
Answer the following medical question with one of the provided options:
|
Q:A pharmaceutical corporation has asked you to assist in the development of a randomized controlled trial (RCT) to evaluate the response of renal cell carcinoma to a novel chemotherapeutic agent. Despite all of the benefits that an RCT has to offer, which of the following would make an RCT unacceptable with regard to study design?? {'A': 'Proper treatment response is very common', 'B': 'The treatment is not widespread in use', 'C': 'The treatment does not represent the best known option', 'D': 'The treatment has a known, adverse outcome', 'E': 'The treatment is expensive'},
|
D: The treatment has a known, adverse outcome
|
Answer the following medical question with one of the provided options:
|
Q:A 55-year-old man, who was recently diagnosed with tuberculosis, presents to his primary care provider as part of his routine follow-up visit every month. He is currently in the initial phase of anti-tubercular therapy. His personal and medical histories are relevant for multiple trips to Southeast Asia as part of volunteer activities and diabetes of 5 years duration, respectively. A physical examination is unremarkable except for a visual abnormality on a color chart; he is unable to differentiate red from green. The physician suspects the visual irregularity as a sign of toxicity due to one of the drugs in the treatment regimen. Which of the following is the mechanism by which this medication acts in the treatment of Mycobacterium tuberculosis?? {'A': 'Inhibition of mycolic acid synthesis', 'B': 'Inhibition of DNA-dependent RNA polymerase', 'C': 'Induction of free radical metabolites', 'D': 'Inhibition of protein synthesis by binding to the 30S ribosomal subunit', 'E': 'Inhibition of arabinosyltransferase'},
|
E: Inhibition of arabinosyltransferase
|
Answer the following medical question with one of the provided options:
|
Q:A 33-year-old G2P2 woman presents with a history of fatigue and difficulty breathing upon exertion. She was not able to tolerate antenatal vitamin supplements due to nausea and constipation. Her vital signs include: temperature 37.0°C (98.6°F), blood pressure 112/64 mm Hg, and pulse 98/min. Physical examination reveals conjunctival pallor and spoon nails. Laboratory findings are significant for the following: Hemoglobin 9.1 g/dL Hematocrit 27.3% Mean corpuscular volume (MCV) 73 μm3 Mean corpuscular hemoglobin (MCH) 21 pg/cell Red cell distribution width (RDW) 17.5% (ref: 11.5–14.5%) Serum ferritin 9 ng/mL Which of the following would most likely be seen on a peripheral blood smear in this patient?? {'A': 'Basophilic stippling', 'B': 'Teardrop cells', 'C': 'Degmacytes', 'D': 'Anisopoikilocytosis', 'E': 'Echinocytes'},
|
D: Anisopoikilocytosis
|
Answer the following medical question with one of the provided options:
|
Q:A 43-year-old man is brought to the emergency department because of severe epigastric pain and vomiting for 6 hours. The pain radiates to his back and he describes it as 9 out of 10 in intensity. He has had 3–4 episodes of vomiting during this period. He admits to consuming over 13 alcoholic beverages the previous night. There is no personal or family history of serious illness and he takes no medications. He is 177 cm (5 ft 10 in) tall and weighs 55 kg (121 lb); BMI is 17.6 kg/m2. He appears uncomfortable. His temperature is 37.5°C (99.5°F), pulse is 97/min, and blood pressure is 128/78 mm Hg. Abdominal examination shows severe epigastric tenderness to palpation. Bowel sounds are hypoactive. The remainder of the physical examination shows no abnormalities. Laboratory studies show: Hemoglobin 13.5 g/dL Hematocrit 62% Leukocyte count 13,800/mm3 Serum Na+ 134 mEq/L K+ 3.6 mEq/L Cl- 98 mEq/L Calcium 8.3 mg/dL Glucose 180 mg/dL Creatinine 0.9 mg/dL Amylase 150 U/L Lipase 347 U/L (N = 14–280) Total bilirubin 0.8 mg/dL Alkaline phosphatase 66 U/L AST 19 U/L ALT 18 U/L LDH 360 U/L Which of the following laboratory studies is the best prognostic indicator for this patient's condition?"? {'A': 'Hematocrit', 'B': 'Lipase', 'C': 'AST/ALT ratio', 'D': 'Alkaline phosphatase', 'E': 'Total bilirubin'},
|
A: Hematocrit
|
Answer the following medical question with one of the provided options:
|
Q:A 6-year-old boy is brought to the physician because of a 2-week history of fever and pain in his right thigh that is causing him to limp. The mother thinks he may have hurt himself during soccer practice. He has no history of rash or joint pain. His older sister has systemic lupus erythematosus. His immunizations are up-to-date. The patient is at the 40th percentile for height and 45th percentile for weight. His temperature is 39°C (102.2°F), pulse is 100/min, respirations are 18/min, and blood pressure is 110/70 mm Hg. Examination shows swelling, tenderness, warmth, and mild erythema over the right upper thigh; range of motion is limited by pain. He has a right-sided antalgic gait. His leukocyte count is 12,300/mm3 and erythrocyte sedimentation rate is 40 mm/h. X-rays of the hips and lower extremities are unremarkable. An MRI of the right lower extremity shows increased T2 and decreased T1 signals over the right femur with periosteal elevation, multiple osteolytic areas in the femoral metaphysis, and bone marrow edema. Which of the following is the most appropriate next step in management?? {'A': 'Nafcillin therapy', 'B': 'Nuclear scan of the right upper leg', 'C': 'Femoral osteotomy', 'D': 'Arthrocentesis', 'E': 'Bone biopsy of the right femur'},
|
E: Bone biopsy of the right femur
|
Answer the following medical question with one of the provided options:
|
Q:A 28-year-old woman comes to the physician because of a 2-month history of multiple right inframammary lumps. They are tender and have a foul-smelling odor. She has had previous episodes of painful swellings in the axillae 12 months ago that resolved with antibiotic therapy, leaving some scarring. She has Crohn disease. Menses occur at irregular 18- to 40-day intervals and last 1–5 days. The patient's only medication is mesalamine. She appears anxious. She is 162 cm (5 ft 4 in) tall and weighs 87 kg (192 lb); BMI is 33 kg/m2. Vital signs are within normal limits. Examination of the right inframammary fold shows multiple tender, erythematous nodules and fistulas with purulent discharge. Hirsutism is present. Her fasting glucose concentration is 136 mg/dL. Which of the following areas is most likely to also be affected by this patient's condition?? {'A': 'Forehead', 'B': 'Central face', 'C': 'Groin', 'D': 'Shin', 'E': 'Back\n"'},
|
C: Groin
|
Answer the following medical question with one of the provided options:
|
Q:A 62-year-old man comes to the physician because of an oozing skin ulceration on his foot for 1 week. He has a history of type 2 diabetes mellitus and does not adhere to his medication regimen. Physical exam shows purulent discharge from an ulcer on the dorsum of his left foot. Pinprick sensation is decreased bilaterally to the level of the mid-tibia. A culture of the wound grows beta-hemolytic, coagulase-positive cocci in clusters. The causal organism most likely produces which of the following virulence factors?? {'A': 'Protein A', 'B': 'P fimbriae', 'C': 'Exotoxin A', 'D': 'IgA protease', 'E': 'M protein'},
|
A: Protein A
|
Answer the following medical question with one of the provided options:
|
Q:A 62-year-old man comes to the physician for the evaluation of nocturia and a weak urinary stream. These symptoms began 1 year ago, but have progressively worsened over the past 6 months. He now wakes up 3–5 times every night to urinate. He has hypertension treated with hydrochlorothiazide and lisinopril. The patient has smoked a half-pack of cigarettes daily for the past 30 years. He appears well. His temperature is 37.3°C (99.1°F), pulse is 77/min, and blood pressure is 128/77 mm Hg. Cardiopulmonary examination shows no abnormalities. His abdomen is soft and nontender. Digital rectal examination shows a diffusely enlarged prostate with a firm nodule in the right posterior lobe. Urinalysis is within normal limits. Prostate-specific antigen (PSA) level is 6.5 ng/mL (N = 0–4). Which of the following is the most appropriate next step in management?? {'A': 'Cystoscopy', 'B': 'Repeat PSA level in one year', 'C': 'Transrectal ultrasound-guided prostate biopsy', 'D': 'CT scan of the abdomen and pelvis', 'E': 'Simple prostatectomy'},
|
C: Transrectal ultrasound-guided prostate biopsy
|
Answer the following medical question with one of the provided options:
|
Q:A 25-year-old G2P1001 at 32 weeks gestation presents to the hospital with painless vaginal bleeding. The patient states that she was taking care of laundry at home when she experienced a sudden sensation of her water breaking and saw that her groin was covered in blood. Her prenatal history is unremarkable according to the clinic records, but she has not seen an obstetrician for the past 14 weeks. Her previous delivery was by urgent cesarean section for placenta previa. Her temperature is 95°F (35°C), blood pressure is 125/75 mmHg, pulse is 79/min, respirations are 18/min, and oxygen saturation is 98% on room air. Cervical exam shows gross blood in the vaginal os. The fetal head is not palpable. Fetal heart rate monitoring demonstrates decelerations and bradycardia. Labs are pending. IV fluids are started. What is the best next step in management?? {'A': 'Betamethasone', 'B': 'Cesarean section', 'C': 'Lumbar epidural block', 'D': 'Red blood cell transfusion', 'E': 'Vaginal delivery'},
|
B: Cesarean section
|
Answer the following medical question with one of the provided options:
|
Q:A 75-year-old man presents to the emergency department because of pain in his left thigh and left calf for the past 3 months. The pain occurs at rest, worsens with walking, and is slightly improved by hanging his foot off the bed. He has had hypertension for 25 years and type 2 diabetes mellitus for 30 years. He has smoked 30–40 cigarettes per day for the past 45 years. On examination, the femoral, popliteal, and dorsalis pedis pulses are diminished, but detectable on both sides. The patient’s foot is shown in the image. Which of the following is the most likely diagnosis?? {'A': 'Critical limb ischemia', 'B': 'Venous ulcer', 'C': 'Raynaud’s phenomenon', 'D': 'Pseudogout', 'E': 'Cellulitis'},
|
A: Critical limb ischemia
|
Answer the following medical question with one of the provided options:
|
Q:A previously healthy 6-month-old girl is brought to the physician by her mother for occasional “eye crossing.” Her mother says that the symptoms have become worse, especially before bedtime. The patient was born via cesarean delivery at 37-weeks' gestation and has met all developmental milestones. The patient's immunizations are up-to-date. She is at the 50th percentile for both length and weight. Her temperature is 36.7°C (98°F), pulse is 130/min, respirations are 40/min, and blood pressure is 90/60 mm Hg. Visual acuity is 20/20 in both eyes. There is an asymmetric corneal light reflection. When the left eye is covered, the right eye moves laterally. The remainder of the examination shows no abnormalities. Which of the following is the most appropriate next step in the management of this patient?? {'A': 'Urgent surgery', 'B': 'Patching of the right eye', 'C': 'Measurement of intraocular pressure', 'D': 'Cyclopentolate eye drops on the left', 'E': 'Reassurance and follow-up'},
|
D: Cyclopentolate eye drops on the left
|
Answer the following medical question with one of the provided options:
|
Q:A scientist is designing a study to determine whether eating a new diet is able to lower blood pressure in a group of patients. In particular, he believes that starting the diet may help decrease peak blood pressures throughout the day. Therefore, he will equip study participants with blood pressure monitors and follow pressure trends over a 24-hour period. He decides that after recruiting subjects, he will start them on either the new diet or a control diet and follow them for 1 month. After this time, he will switch patients onto the other diet and follow them for an additional month. He will analyze the results from the first month against the results from the second month for each patient. This type of study design is best at controlling for which of the following problems with studies?? {'A': 'Confounding', 'B': 'Hawthorne effect', 'C': 'Pygmalion effect', 'D': 'Recall bias', 'E': 'Selection bias'},
|
A: Confounding
|
Answer the following medical question with one of the provided options:
|
Q:A 65-year-old male with a history of COPD presents to the emergency department with dyspnea, productive cough, and a fever of 40.0°C (104.0°F) for the past 2 days. His respiratory rate is 20/min, blood pressure is 125/85 mm Hg, and heart rate is 95/min. A chest X-ray is obtained and shows a right lower lobe infiltrate. Sputum cultures are pending and he is started on antibiotics. The patient has not received any vaccinations in the last 20 years. The physician discusses with him the importance of getting a vaccine that can produce immunity via which of the following mechanisms?? {'A': 'T cell-independent B cell response', 'B': 'T cell-dependent B cell response', 'C': 'Natural killer cell response', 'D': 'Mast cell degranulation response', 'E': 'No need to vaccinate, as the patient has already had a pneumonia vaccine'},
|
B: T cell-dependent B cell response
|
Answer the following medical question with one of the provided options:
|
Q:A 32-year-old woman comes to the physician because of a 3-month history of fatigue and myalgia. Over the past month, she has had intermittent episodes of nausea. She has a history of intravenous drug use, but she has not used illicit drugs for the past five years. She has smoked one pack of cigarettes daily for 14 years and drinks one alcoholic beverage daily. She takes no medications. Her last visit to a physician was 4 years ago. Her temperature is 37°C (98.6°F), pulse is 90/min, respirations are 20/min, and blood pressure is 110/70 mm Hg. Physical examination shows jaundice and hepatosplenomegaly. There are also blisters and erosions on the dorsum of both hands. The remainder of the examination shows no abnormalities. Laboratory studies show: Hemoglobin 12 g/dL Leukocyte count 8,300/mm3 Platelet count 250,000/mm3 Serum Glucose 170 mg/dL Albumin 3.0 g/dL Total bilirubin 2.2 mg/dL Alkaline phosphatase 80 U/L AST 92 U/L ALT 76 U/L Hepatitis B surface antigen negative Hepatitis B surface antibody positive Hepatitis B core antibody positive Hepatitis C antibody positive Which of the following is the most appropriate next step in diagnosis?"? {'A': 'Western blot for HIV', 'B': 'PCR for viral RNA', 'C': 'Serology for anti-HAV IgM', 'D': 'PCR for viral DNA', 'E': 'Liver biopsy'},
|
B: PCR for viral RNA
|
Answer the following medical question with one of the provided options:
|
Q:A 52-year-old man comes to the physician because of a 4-month history of fatigue, weakness, constipation, decreased appetite, and intermittent flank pain. He takes ibuprofen for knee and shoulder pain. Physical examination shows mild tenderness bilaterally in the costovertebral areas. His serum calcium concentration is 11.2 mg/dL, phosphorus concentration is 2.5 mg/dL, and N-terminal parathyroid hormone concentration is 830 pg/mL. Which of the following steps in vitamin D metabolism is most likely increased in this patient?? {'A': 'Cholecalficerol → 25-hydroxycholecalciferol', 'B': '25-hydroxycholecalciferol → 1,25-dihydroxycholecalciferol', 'C': 'Ergocalciferol → 25-hydroxyergocalciferol', 'D': '7-dehydrocholesterol → cholecalciferol', 'E': '25-hydroxycholecalciferol → 24,25-dihydroxycholecalciferol'},
|
B: 25-hydroxycholecalciferol → 1,25-dihydroxycholecalciferol
|
Answer the following medical question with one of the provided options:
|
Q:A 23-year-old male is brought by police officers from a social gathering due combative behavior and altered mental status. The police say that phencyclidine was found on the premises. The patient is alone, and acquiring an accurate history proves difficult. However, you do learn that the patient is having visual hallucinations. Vital signs show a blood pressure of 155/95 mmHg, pulse is 103/min, respirations is 20/min, oxygen saturation of 99%. Airway, breathing, and circulation are intact. The patient appears violent, and is trying to remove his clothes. Multiple hospital staff are needed to restrain the patient in bed. A finger-stick glucose show 93 mg/dL. The team is unable to place an IV, and thus intramuscular midazolam is administered to achieve sedation; however, he is still agitated. What is the mechanism of action of the best alternative sedative drug for this patient?? {'A': 'Increases duration of chloride channel opening of GABA-A receptors', 'B': 'Alpha-2 and H1 receptor antagonist', 'C': 'Competitive opioid receptor antagonist', 'D': 'Antagonist of D2 receptors', 'E': 'Mu-opioid receptor partial agonist'},
|
D: Antagonist of D2 receptors
|
Answer the following medical question with one of the provided options:
|
Q:A 37-year-old man previously treated with monotherapy for latent tuberculosis develops new-onset cough, night sweats and fever. He produces a sputum sample that is positive for acid-fast bacilli. Resistance testing of his isolated bacteria finds a mutation in the DNA-dependent RNA polymerase. To which of the following antibiotics might this patient's infection be resistant?? {'A': 'Isoniazid', 'B': 'Ethambutol', 'C': 'Rifampin', 'D': 'Streptomycin', 'E': 'Pyrazinamide'},
|
C: Rifampin
|
Answer the following medical question with one of the provided options:
|
Q:A 4-year-old boy is brought to the physician because of non-fluent speech. His mother worries that his vocabulary is limited for his age and because he cannot use simple sentences to communicate. She says he enjoys playing with his peers and parents, but he has always lagged behind in his speaking and communication. His speech is frequently not understood by strangers. He physically appears normal. His height and weight are within the normal range for his age. He responds to his name, makes eye contact, and enjoys the company of his mother. Which of the following is the most appropriate next step in management?? {'A': 'Audiology testing', 'B': 'Evaluate response to methylphenidate', 'C': 'Psychiatric evaluation', 'D': 'Referral to speech therapist', 'E': 'Thyroid-stimulating hormone'},
|
A: Audiology testing
|
Answer the following medical question with one of the provided options:
|
Q:A 19-year-old recent ROTC male recruit presents to the university clinic with left foot pain. He reports that the pain started a week ago while running morning drills. The pain will improve with rest but will occur again during exercises or during long periods of standing. He denies any recent trauma. His medical history is consistent for partial color blindness. He has no other chronic medical conditions and takes no medications. He denies any surgical history. His family history is significant for schizophrenia in his father and breast cancer in his mother. He denies tobacco, alcohol, or illicit drug use. On physical examination, there is tenderness to palpation of the second metatarsal of the left foot. An radiograph of the left foot shows no abnormalities. Which of the following is the best next step in management?? {'A': 'Casting', 'B': 'Internal fixation', 'C': 'MRI', 'D': 'Rest and ibuprofen', 'E': 'Splinting'},
|
D: Rest and ibuprofen
|
Answer the following medical question with one of the provided options:
|
Q:A previously healthy 52-year-old woman comes to the physician because of a 1-week history of productive cough, fevers, and malaise. She has smoked one pack of cigarettes daily for 35 years. Her temperature is 39°C (102.2°F). Diffuse inspiratory crackles are heard bilaterally. Her leukocyte count is 14,300/mm3. Sputum analysis shows numerous polymorphonuclear leukocytes and a few squamous epithelial cells. An x-ray of the chest shows bilateral patchy consolidations. Which of the following findings on sputum culture is most consistent with this patient's respiratory symptoms?? {'A': 'Encapsulated, pleomorphic, gram-negative coccobacilli', 'B': 'Gram-positive, catalase-positive, coagulase-negative cocci in clusters', 'C': 'Anaerobic gram-positive, branching, filamentous bacilli', 'D': 'Pseudohyphae with budding yeasts at 20°C', 'E': 'Gram-positive, alpha-hemolytic, optochin-resistant cocci in chains'},
|
A: Encapsulated, pleomorphic, gram-negative coccobacilli
|
Answer the following medical question with one of the provided options:
|
Q:A 44-year-old man presents to the clinic worried about his risk for bladder cancer. His best friend who worked with him as a painter for the past 20-years died recently after being diagnosed with transitional cell carcinoma. He is worried that their long and heavy cigarette smoking history might have contributed to his death. He also reports that he has been feeling down since his friend's death 2 months ago and has not been eating or sleeping as usual. He took time off from work but now is running past due on some of his bills. He feels like he is moving a lot slower than usual. He would like to stop smoking but feels like it's impossible with just his willpower. What side-effect is most likely if this patient were started on his appropriate pharmacotherapy?? {'A': 'Can decrease seizure threshold', 'B': 'Can cause restlessness at initiation or termination', 'C': 'Can worsen uncontrolled hypertension', 'D': 'Can cause sedation and weight gain', 'E': 'Can treat overdose with sodium bicarbonate'},
|
A: Can decrease seizure threshold
|
Answer the following medical question with one of the provided options:
|
Q:A 32-year-old woman who recently emigrated to the USA from Japan comes to the physician because of a 3-month history of night sweats, malaise, and joint pain. During this time, she has also had a 6-kg (13-lb) weight loss. Physical examination shows weak brachial and radial pulses. There are tender subcutaneous nodules on both legs. Carotid bruits are heard on auscultation bilaterally. Laboratory studies show an erythrocyte sedimentation rate of 96 mm/h. A CT scan of the chest shows thickening and narrowing of the aortic arch. Microscopic examination of the aortic arch is most likely to show which of the following findings?? {'A': 'Fibrinoid necrosis of the intima and media', 'B': 'Granulomatous inflammation of the media', 'C': 'Subendothelial hyaline deposition', 'D': 'Subendothelial immune complex deposition', 'E': 'Calcification of the media'},
|
B: Granulomatous inflammation of the media
|
Answer the following medical question with one of the provided options:
|
Q:A 35-year-old man comes to the physician for evaluation of a neck mass and hoarseness. He has no history of major medical illness. Physical examination shows a 2.5-cm fixed, irregular thyroid nodule. His serum calcitonin concentration is elevated. The nodule is most likely comprised of cells that are embryologically derived from which of the following structures?? {'A': 'Third branchial pouch', 'B': 'Fourth branchial arch', 'C': 'Lateral endodermal anlage', 'D': 'Surface ectoderm', 'E': 'Second branchial pouch'},
|
C: Lateral endodermal anlage
|
Answer the following medical question with one of the provided options:
|
Q:A 20-year-old man presents with a tremor involving his upper limbs for the past 3 weeks. He says his symptoms have been progressively worsening. Past medical history is significant for 2 episodes of undiagnosed jaundice over the last year. No significant family history. His temperature is 36.9°C (98.4°F), the pulse is 82/min, the blood pressure is 116/78 mm Hg, and the respiratory rate is 12/min. On physical examination, there is excessive salivation, and he has an expressionless face. He has an ataxic gait accompanied by asymmetric resting and kinetic tremors. Hepatomegaly is evident. There is a greenish-gold limbal ring in both corneas. After laboratory findings confirm the diagnosis, the patient is prescribed a medication that he is warned may worsen his tremors. The patient is also instructed to return in a week for a complete blood count and urinalysis. Which of the following additional adverse effects may be expected in this patient while taking this medication?? {'A': 'Pulmonary fibrosis', 'B': 'Constipation', 'C': 'Weight gain', 'D': 'Myasthenia gravis', 'E': 'Sensorineural deafness'},
|
D: Myasthenia gravis
|
Answer the following medical question with one of the provided options:
|
Q:A biostatistician is processing data for a large clinical trial she is working on. The study is analyzing the use of a novel pharmaceutical compound for the treatment of anorexia after chemotherapy with the outcome of interest being the change in weight while taking the drug. While most participants remained about the same weight or continued to lose weight while on chemotherapy, there were smaller groups of individuals who responded very positively to the orexic agent. As a result, the data had a strong positive skew. The biostatistician wishes to report the measures of central tendency for this project. Just by understanding the skew in the data, which of the following can be expected for this data set?? {'A': 'Mean > median = mode', 'B': 'Mean > median > mode', 'C': 'Mean < median = mode', 'D': 'Mean < median < mode', 'E': 'Mean = median = mode'},
|
B: Mean > median > mode
|
Subsets and Splits
No community queries yet
The top public SQL queries from the community will appear here once available.