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Answer the following medical question with one of the provided options:
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Q:An investigator is studying the effects of drugs on the cardiac action potential. Cardiomyocytes are infused with a pharmacological agent and incubated for 5 minutes, after which the action potential is registered on a graph in real time for 2 minutes. The black line represents an action potential following the infusion of the pharmacological agent. The results shown in the graph are most likely caused by an agent that inhibits which of the following?? {'A': 'Opening of voltage-gated calcium channels', 'B': 'Opening of voltage-gated potassium channels', 'C': 'Closure of voltage-gated sodium channels', 'D': 'Opening of voltage-gated sodium channels', 'E': 'Closure of voltage-gated potassium channels'},
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D: Opening of voltage-gated sodium channels
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Answer the following medical question with one of the provided options:
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Q:A 23-year-old man presents to the emergency department with severe pain. The patient, who is a construction worker, was at work when he suddenly experienced severe pain in his arms, legs, chest, and back. He has experienced this before and was treated 2 months ago for a similar concern. His temperature is 100°F (37.8°C), blood pressure is 127/68 mmHg, pulse is 120/min, respirations are 17/min, and oxygen saturation is 98% on room air. Physical exam is notable for tenderness to palpation of the patient's legs, chest, abdomen, and arms. Laboratory values are obtained and shown below. Hemoglobin: 10 g/dL Hematocrit: 30% Leukocyte count: 8,500/mm^3 with normal differential Platelet count: 199,000/mm^3 Serum: Na+: 139 mEq/L Cl-: 100 mEq/L K+: 4.9 mEq/L HCO3-: 25 mEq/L BUN: 23 mg/dL LDH: 327 U/L Glucose: 99 mg/dL Creatinine: 1.1 mg/dL Ca2+: 10.2 mg/dL AST: 12 U/L ALT: 10 U/L Which of the following is the most likely diagnosis?? {'A': 'Autoimmune hemolysis', 'B': 'Avascular necrosis', 'C': 'Infarction of a major organ', 'D': 'Infection of the bone', 'E': 'Microvascular occlusion'},
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E: Microvascular occlusion
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Answer the following medical question with one of the provided options:
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Q:A 73-year-old man comes to the physician because of progressive fatigue and shortness of breath on exertion for 3 weeks. He has swelling of his legs. He has not had nausea or vomiting. His symptoms began shortly after he returned from a trip to Cambodia. He occasionally takes ibuprofen for chronic back pain. He has a history of arterial hypertension and osteoarthritis of both knees. He had an episode of pneumonia 4 months ago. His current medications include lisinopril and hydrochlorothiazide. He has no history of drinking or smoking. His temperature is 37°C (98.6°F), pulse is 101/min, and blood pressure is 135/76 mm Hg. Examination shows pitting edema of the upper and lower extremities. Laboratory studies show: Hemoglobin 14.1 g/dL Leukocyte count 6,800/mm3 Platelet count 216,000/mm3 Serum Urea nitrogen 26 mg/dL Creatinine 2.9 mg/dL Albumin 1.6 g/L Urine Blood negative Protein 4+ Glucose negative Renal biopsy with Congo red stain shows apple-green birefringence under polarized light. Further evaluation of this patient is most likely to show which of the following findings?"? {'A': 'Positive HLA-B27 test', 'B': 'Rouleaux formation on peripheral smear', 'C': 'Elevated anti-citrullinated peptide antibodies', 'D': 'Positive interferon-γ release assay', 'E': 'Dilated bronchi on chest CT\n"'},
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B: Rouleaux formation on peripheral smear
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Answer the following medical question with one of the provided options:
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Q:An investigator is studying the effect of antihypertensive drugs on cardiac output and renal blood flow. For comparison, a healthy volunteer is given a placebo and a continuous infusion of para-aminohippuric acid (PAH) to achieve a plasma concentration of 0.02 mg/ml. His urinary flow rate is 1.5 ml/min and the urinary concentration of PAH is measured to be 8 mg/ml. His hematocrit is 50%. Which of the following values best estimates cardiac output in this volunteer?? {'A': '3 L/min', 'B': '6 L/min', 'C': '8 L/min', 'D': '1.2 L/min', 'E': '4 L/min'},
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B: 6 L/min
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Answer the following medical question with one of the provided options:
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Q:29-year-old construction worker is brought to the emergency department after falling 10 ft (3 m) from the scaffolding at a construction site. He reports that he landed on his outstretched arms, which are now in severe pain (10/10 on a numeric scale). He has a history of opioid use disorder and is currently on methadone maintenance treatment. His pulse is 100/min, respirations are 20/min, and blood pressure is 140/90 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 98%. He is diaphoretic and in distress. Physical examination shows a hematoma on the patient's right forearm. X-ray of the right arm shows a nondisplaced fracture of the ulna. A CT of the abdomen and pelvis shows no abnormalities. The patient requests pain medication. In addition to managing the patient's injury, which of the following is the most appropriate next step in management?? {'A': 'Urine toxicology screening', 'B': 'Increase of outpatient methadone regimen', 'C': 'Psychiatric evaluation for drug-seeking behavior', 'D': 'Scheduled short-acting opioid administration', 'E': 'Administration of buprenorphine\n"'},
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D: Scheduled short-acting opioid administration
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Answer the following medical question with one of the provided options:
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Q:A 23-year-old woman presents to the emergency department with acute onset of shortness of breath, wheezing, and chest tightness. This is her 4th visit for these symptoms in the last 5 years. She tells you she recently ran out of her normal "controller" medication. Concerned for an asthma exacerbation, you begin therapy with a short-acting beta2-agonist. What is the expected cellular response to your therapy?? {'A': 'Gs protein coupled receptor activates adenylyl cyclase and increases intracellular cAMP', 'B': 'Gs protein coupled receptor activates phospholipase C and increases intracellular calcium', 'C': 'Gq protein coupled receptor activates phospholipase C and increases intracellular calcium', 'D': 'Gq protein coupled receptor activates adenylyl cyclase and increases intracellular cAMP', 'E': 'Gi protein coupled receptor inhibits adenylyl cyclase and decreases cAMP'},
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A: Gs protein coupled receptor activates adenylyl cyclase and increases intracellular cAMP
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Answer the following medical question with one of the provided options:
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Q:A 5-year-old boy is brought to the clinic by his mother for an annual check-up. The family recently moved from Nebraska and is hoping to establish care. The patient is home schooled and mom is concerned about her son’s development. He is only able to say 2 to 3 word sentences and has been “behind on his alphabet." He always seems to be disinterested and "just seems to be behind.” The patient is observed to be focused on playing with his cars during the interview. Physical examination demonstrate a well-nourished child with poor eye contact, a prominent jaw, a single palmar crease, and bilaterally enlarged testicles. What is the most likely mechanism of this patient’s findings?? {'A': 'CGG trinucleotide repeat expansion', 'B': 'CTG trinucleotide repeat expansion', 'C': 'Meiotic nondisjunction of chromosome 21', 'D': 'Microdeletion of the short arm of chromosome 5', 'E': 'Microdeletion of the long arm of chromosome 7'},
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A: CGG trinucleotide repeat expansion
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Answer the following medical question with one of the provided options:
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Q:A previously healthy 21-year-old woman is brought to the physician because of weight loss and fatigue. Over the past 12 months she has lost 10.5 kg (23.1 lb). She feels tired almost every day and says that she has to go running for 2 hours every morning to wake up. She had been a vegetarian for 2 years but decided to become a vegan 6 months ago. She lives with her mother, who has obsessive-compulsive disorder. The mother reports that her daughter refuses to eat with the family and only eats food that she has prepared herself. When asked about her weight, the patient says that despite her weight loss, she still feels “chubby”. She is 160 cm (5 ft 3 in) tall and weighs 42 kg (92.6 lb); BMI is 16.4 kg/m2. Her temperature is 35.7°C (96.3°F), pulse is 39/min, and blood pressure is 100/50 mm Hg. Physical examination shows emaciation. There is dry skin, covered by fine, soft hair all over the body. On mental status examination, she is oriented to person, place, and time. Serum studies show: Na+ 142 mEq/L Cl 103 mEq/L K+ 4.0 mEq/L Urea nitrogen 10 mg/dL Creatinine 1.0 mg/dL Glucose 65 mg/dL Which of the following is the most appropriate next step in management?"? {'A': 'Inpatient nutritional rehabilitation', 'B': 'Food diary and outpatient follow-up', 'C': 'Hospitalization and topiramate therapy', 'D': 'Outpatient psychodynamic psychotherapy', 'E': 'Hospitalization and fluoxetine therapy'},
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A: Inpatient nutritional rehabilitation
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Answer the following medical question with one of the provided options:
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Q:A 20-year-old man presents to the emergency department. The patient was brought in by his coach after he fainted during a competition. This is the second time this has happened since the patient joined the track team. The patient has a past medical history of multiple episodes of streptococcal pharyngitis which were not treated in his youth. He is not currently on any medications. He is agreeable and not currently in any distress. His temperature is 99.5°F (37.5°C), blood pressure is 132/68 mmHg, pulse is 90/min, respirations are 12/min, and oxygen saturation is 98% on room air. On physical exam, you note a young man in no current distress. Neurological exam is within normal limits. Pulmonary exam reveals clear air movement bilaterally. Cardiac exam reveals a systolic murmur best heard at the lower left sternal border that radiates to the axilla. Abdominal exam reveals a soft abdomen that is non-tender in all 4 quadrants. The patient's cardiac exam is repeated while he squats. Which of the following is most likely true for this patient?? {'A': 'Decreased murmur in hypertrophic obstructive cardiomyopathy', 'B': 'Increased murmur in hypertrophic obstructive cardiomyopathy', 'C': 'Increased murmur in mitral stenosis', 'D': 'Decreased murmur in mitral stenosis', 'E': 'Increased murmur in aortic stenosis'},
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A: Decreased murmur in hypertrophic obstructive cardiomyopathy
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Answer the following medical question with one of the provided options:
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Q:A 2-year-old boy is brought to the physician by his parents for a well-child visit. During his last well-child visit 9 months ago, the patient had not begun talking. The parents report that their son frequently avoids eye contact and has no friends at daycare. He was born at term and has been healthy except for an episode of otitis media 6 months ago, which was treated with amoxicillin. His immunizations are up-to-date. He is at the 95 percentile for height, 20 percentile for weight, and 95 percentile for head circumference. He appears shy. His temperature is 37°C (98.6°F), pulse is 120/min, and blood pressure is 100/55 mm Hg. Examination shows elongated facial features and large ears. The patient does not speak. He does not follow instruction to build a stack of 2 blocks. Throughout the examination, he continually opens and closes his mother's purse and does not maintain eye contact. Which of the following findings is most likely to confirm the diagnosis?? {'A': 'An additional X chromosome', 'B': 'Mutation on chromosome 15', 'C': 'CGG trinucleotide repeats on x-chromosome', 'D': 'Defective phenylalanine hydroxlyase activity', 'E': 'Three copies of the same chromosome'},
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C: CGG trinucleotide repeats on x-chromosome
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Answer the following medical question with one of the provided options:
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Q:A 37-year-old G1P0 woman presents to her primary care physician for a routine checkup. She has a history of diabetes and hypertension but has otherwise been healthy with no change in her health status since the last visit. She is expecting her first child 8 weeks from now. She also enrolled in a study about pregnancy where serial metabolic panels and arterial blood gases are obtained. Partial results from these studies are shown below: Serum: Na+: 141 mEq/L Cl-: 108 mEq/L pH: 7.47 pCO2: 30 mmHg HCO3-: 21 mEq/L Which of the following disease processes would most likely present with a similar panel of metabolic results?? {'A': 'Anxiety attack', 'B': 'Diarrheal disease', 'C': 'Ingestion of metformin', 'D': 'Living at high altitude', 'E': 'Loop diuretic abuse'},
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D: Living at high altitude
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Answer the following medical question with one of the provided options:
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Q:A 29-year-old woman is recovering on the obstetrics floor after vaginal delivery of 8 pound twin boys born at 42 weeks gestation. The patient is very fatigued but states that she is doing well. Currently she is complaining that her vagina hurts. The next morning, the patient experiences chills and a light red voluminous discharge from her vagina. She states that she feels pain and cramps in her abdomen. The patient's past medical history is notable for diabetes which was managed during her pregnancy with insulin. Her temperature is 99.5°F (37.5°C), blood pressure is 107/68 mmHg, pulse is 97/min, respirations are 16/min, and oxygen saturation is 98% on room air. Laboratory values are obtained and shown below. Hemoglobin: 12 g/dL Hematocrit: 36% Leukocyte count: 9,750/mm^3 with normal differential Platelet count: 197,000/mm^3 Serum: Na+: 139 mEq/L Cl-: 101 mEq/L K+: 4.2 mEq/L HCO3-: 23 mEq/L BUN: 20 mg/dL Glucose: 111 mg/dL Creatinine: 1.1 mg/dL Ca2+: 10.2 mg/dL AST: 12 U/L ALT: 10 U/L Which of the following interventions is associated with the best outcome for this patient?? {'A': 'Vancomycin and gentamicin', 'B': 'Vancomycin and clindamycin', 'C': 'Clindamycin and gentamicin', 'D': 'Cefoxitin and doxycycline', 'E': 'Supportive therapy only'},
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E: Supportive therapy only
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Answer the following medical question with one of the provided options:
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Q:A 57-year-old man is brought to the physician for worsening mental status over the past 2 months. His wife reports he was initially experiencing lapses in memory and over the past 3 weeks he has begun having difficulties performing activities of daily living. Yesterday, he became lost heading to the post office down the street. He has hypertension treated with lisinopril and hydrochlorothiazide. Vital signs are within normal limits. He is alert but verbally uncommunicative. Muscle strength is normal. Reflexes are 2+ in bilateral upper and lower extremities. He has diffuse involuntary muscle jerking that can be provoked by loud noises. Mental status examination shows a blunt affect. A complete blood count and serum concentrations of glucose, creatine, and electrolytes are within the reference range. Which of the following is the most likely diagnosis?? {'A': "Alzheimer's disease", 'B': "Parkinson's disease", 'C': "Huntington's disease", 'D': 'Creutzfeldt-Jakob disease', 'E': 'Normal pressure hydrocephalus'},
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D: Creutzfeldt-Jakob disease
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Answer the following medical question with one of the provided options:
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Q:A 51-year-old Indian man visits his physician because of blisters that have appeared on both hands over the past 2 months. The patient states that he works outdoors on freeways and highways, re-paving cracked or otherwise damaged roads. Three months ago, he was working with his crew and felt a sharp pain in his thighs and lower back, which he assumed was caused by the large loads of cement he was carrying to and from his truck. He has been self-medicating with over-the-counter non-steroidal anti-inflammatories, specifically naproxen, twice daily since then. He states that the naproxen relieves his back pain, but he now has blisters on both hands that worry him. On examination, the skin on his face and extremities is healthy and normal-appearing. There are a number of 2-mm-diameter hyperpigmented scars and several bullae overlying normal skin on the dorsal surface of both hands (see image). There are also several small white papules surrounding the hyperpigmented scars. Which of the following is the next step in this patient’s management?? {'A': 'Consider removing gluten from this patient’s diet', 'B': 'Check the patient’s anti-Ro and anti-La antibody titers', 'C': 'Perform a stool guaiac test', 'D': 'Check the patient’s urine uroporphyrin level', 'E': 'Check the patient’s antinuclear antibody levels and renal panel'},
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D: Check the patient’s urine uroporphyrin level
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Answer the following medical question with one of the provided options:
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Q:A 32-year-old man comes to the physician because of a 1-month history of intermittent tingling of his hand. He is an avid cyclist and has recently started training for a cycle marathon. Physical examination shows decreased grip strength in the right hand and wasting of the hypothenar eminence. On asking the patient to grasp a piece of paper between his right thumb and right index finger in the first web space, there is hyperflexion of the right thumb interphalangeal joint. Which of the following additional findings is most likely in this patient?? {'A': 'Inability to flex the index finger at the interphalangeal joints', 'B': 'Loss of sensation over the dorsum of the medial half of the hand', 'C': 'Loss of sensation over the palmar aspect of the middle finger', 'D': 'Inability to extend the ring finger at the metacarpophalangeal joint', 'E': 'Inability to extend the little finger at the proximal interphalangeal joints'},
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E: Inability to extend the little finger at the proximal interphalangeal joints
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Answer the following medical question with one of the provided options:
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Q:A 40-year-old man presents to the office complaining of chills, fever, and productive cough for the past 24 hours. He has a history of smoking since he was 18 years old. His vitals are: heart rate of 85/min, respiratory rate of 20/min, temperature 39.0°C (102.2°F), blood pressure 110/70 mm Hg. On physical examination, there is dullness on percussion on the upper right lobe, as well as bronchial breath sounds and egophony. The plain radiograph reveals an increase in density with an alveolar pattern in the upper right lobe. Which one is the most common etiologic agent of the suspected disease?? {'A': 'Streptococcus pneumoniae', 'B': 'Chlamydia pneumoniae', 'C': 'Legionella pneumophila', 'D': 'Haemophilus influenzae', 'E': 'Mycoplasma pneumoniae'},
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A: Streptococcus pneumoniae
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Answer the following medical question with one of the provided options:
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Q:A 65-year-old male with a history of coronary artery disease and myocardial infarction status post coronary artery bypass graft (CABG) surgery presents to his cardiologist for a routine appointment. On physical exam, the cardiologist appreciates a holosystolic, high-pitched blowing murmur heard loudest at the apex and radiating towards the axilla. Which of the following is the best predictor of the severity of this patient's murmur?? {'A': 'Enhancement with hand grip maneuver', 'B': 'Enhancement with expiration', 'C': 'Presence of audible S3', 'D': 'Enhancement with inspiration', 'E': 'Presence of audible S4'},
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C: Presence of audible S3
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Answer the following medical question with one of the provided options:
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Q:A 72-year-old woman is brought to the emergency department because of lethargy and weakness for the past 5 days. During this period, she has had a headache that worsens when she leans forward or lies down. Her arms and face have appeared swollen over the past 2 weeks. She has a history of hypertension and invasive ductal carcinoma of the left breast. She underwent radical amputation of the left breast followed by radiation therapy 4 years ago. She has smoked two packs of cigarettes daily for 40 years. Current medications include aspirin, hydrochlorothiazide, and tamoxifen. Her temperature is 37.2°C (99°F), pulse is 103/min, and blood pressure is 98/56 mm Hg. Examination shows jugular venous distention, a mastectomy scar over the left thorax, and engorged veins on the anterior chest wall. There is no axillary or cervical lymphadenopathy. There is 1+ pitting edema in both arms. Which of the following is the most likely cause of this patient's symptoms?? {'A': 'Pulmonary tuberculosis', 'B': 'Pulmonary embolism', 'C': 'Constrictive pericarditis', 'D': 'Lung cancer', 'E': 'Nephrotic syndrome\n"'},
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D: Lung cancer
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Answer the following medical question with one of the provided options:
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Q:A 50-year-old man presents to his primary care provider complaining of double vision and trouble seeing out of his right eye. His vision started worsening about 2 months ago and has slowly gotten worse. It is now severely affecting his quality of life. Past medical history is significant for poorly controlled hypertension and hyperlipidemia. He takes amlodipine, atorvastatin, and a baby aspirin every day. He smokes 2–3 cigarettes a day and drinks a glass of wine with dinner every night. Today, his blood pressure is 145/85 mm Hg, heart rate is 90/min, respiratory rate is 14/min, and temperature is 37.0°C (98.6°F). On physical exam, he appears pleasant and talkative. His heart has a regular rate and rhythm and his lungs are clear to auscultation bilaterally. Examination of the eyes reveals a dilated left pupil that is positioned inferolateral with ptosis. An angiogram of the head and neck is performed and he is referred to a neurologist. The angiogram reveals a 1 cm berry aneurysm at the junction of the posterior communicating artery and the posterior cerebral artery compressing the ocular nerve. Which of the following statements best describes the mechanism behind the oculomotor findings seen in this patient?? {'A': 'The parasympathetic nerve fibers of this patient’s eye are activated.', 'B': 'The unopposed superior oblique muscle rotates the eye downward.', 'C': 'The unopposed inferior oblique muscle rotates the eye downward.', 'D': 'The sympathetic nerve fibers of this patient’s eye are inhibited.', 'E': 'The unopposed medial rectus muscle rotates the eye in the lateral direction.'},
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B: The unopposed superior oblique muscle rotates the eye downward.
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Answer the following medical question with one of the provided options:
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Q:A 45-year-old woman presents to her primary care physician for abdominal pain. Her pain began approximately 1 week prior to presentation and is located in the epigastric region. She has noticed that the pain worsens with eating and improves when she is not eating. Medical history is significant for rheumatoid arthritis, which she is being treated with methotrexate and ibuprofen. An endoscopy is performed and findings are shown in figure A. The patient is negative for Helicobacter pylori infection. Which of the following is the best treatment for facilitating the healing of this lesion found on endoscopy?? {'A': 'Aluminum hydroxide', 'B': 'Bismuth', 'C': 'Dexlansoprazole', 'D': 'Nizatidine', 'E': 'Sucralfate'},
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C: Dexlansoprazole
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Answer the following medical question with one of the provided options:
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Q:A 68-year-old female presents to your office for her annual check-up. Her vitals are HR 85, T 98.8 F, RR 16, BP 125/70. She has a history of smoking 1 pack a day for 35 years, but states she quit five years ago. She had her last pap smear at age 64 and states all of her pap smears have been normal. She had her last colonoscopy at age 62, which was also normal. Which is the following is the next best test for this patient?? {'A': 'Abdominal ultrasound', 'B': 'Chest CT scan', 'C': 'Pap smear', 'D': 'Colonoscopy', 'E': 'Chest radiograph'},
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B: Chest CT scan
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Answer the following medical question with one of the provided options:
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Q:A 65-year-old woman presents to her primary care provider for shoulder pain. She reports that she initially thought the pain was due to "sleeping funny" on the arm, but that the pain has now lasted for 4 weeks. She denies trauma to the joint and says that the pain is worse when reaching overhead to retrieve things from her kitchen cabinets. On physical exam, the patient's shoulders are symmetric, and the right lateral shoulder is tender to palpation. The shoulder has full passive and active range of motion, although pain is reproduced on active abduction of the right arm above 90 degrees. Pain is also reproduced on passively internally rotating and then lifting the shoulder. The patient is able to resist elbow flexion without pain, and she otherwise has 5/5 strength. Which of the following is the most likely diagnosis?? {'A': 'Adhesive capsulitis', 'B': 'Biceps tendinopathy', 'C': 'Glenohumeral osteoarthritis', 'D': 'Rotator cuff tear', 'E': 'Rotator cuff tendinopathy'},
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E: Rotator cuff tendinopathy
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Answer the following medical question with one of the provided options:
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Q:A 57-year-old presents to your clinic complaining of baldness. He is overweight, has been diagnosed with BPH, and is currently taking atorvastatin for hyperlipidemia. The patient has tried several over-the-counter products for hair-loss; however, none have been effective. After discussing several options, the patient is prescribed a medication to treat his baldness that has the additional benefit of treating symptoms of BPH as well. Synthesis of which of the following compounds would be expected to decrease in response to this therapy?? {'A': 'GnRH', 'B': 'DHT', 'C': 'LH', 'D': 'Testosterone', 'E': 'FSH'},
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B: DHT
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Answer the following medical question with one of the provided options:
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Q:A 26-year-old woman comes to the emergency department because of a 3-day history of nausea and vomiting. Her last menstrual period was 9 weeks ago. A urine pregnancy test is positive. Ultrasonography shows an intrauterine pregnancy consistent in size with a 7-week gestation. The hormone that was measured in this patient's urine to detect the pregnancy is also directly responsible for which of the following processes?? {'A': 'Maintenance of the corpus luteum', 'B': 'Inhibition of ovulation', 'C': 'Development of breast tissue', 'D': 'Inhibition of preterm uterine contractions', 'E': 'Preparation of the uterine endometrium for implantation'},
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A: Maintenance of the corpus luteum
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Answer the following medical question with one of the provided options:
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Q:A 54-year-old man is brought by his family to the emergency department because of severe pain and weakness in his right leg. His symptoms have been gradually worsening over the past 5 weeks, but he did not seek medical care until today. He has a history of lower back pain and has no surgical history. He denies tobacco or alcohol use. His temperature is 37°C (98.6°F), the blood pressure is 140/85 mm Hg, and the pulse is 92/min. On physical examination, pinprick sensation is absent in the perineum and the right lower limb. Muscle strength is 2/5 in the right lower extremity and 4/5 in the left lower extremity. Ankle and knee reflexes are absent on the right side but present on the left. In this patient, magnetic resonance imaging (MRI) of the lumbar spine will most likely show which of the following?? {'A': 'Compression of the cauda equina', 'B': 'Compression of the conus medullaris', 'C': 'Focal demyelination of the spinal cord', 'D': 'Decreased spinal canal diameter', 'E': 'Sacroiliitis and enthesitis'},
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A: Compression of the cauda equina
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Answer the following medical question with one of the provided options:
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Q:An 8-year-old boy presents to his pediatrician for a well visit. His parents state that he has been doing well in school and has many friends. The patient is a member of the chess club and enjoys playing video games. He has a past medical history of asthma which is treated with albuterol. The patient is in the 99th percentile for weight and 30th percentile for height. His temperature is 99.5°F (37.5°C), blood pressure is 122/88 mmHg, pulse is 90/min, respirations are 11/min, and oxygen saturation is 98% on room air. The patient's body mass index is 39.1 kg/m^2 at this visit. On physical exam, you note a young boy who maintains eye contact and is excited to be at the doctor's office. Cardiopulmonary exam is within normal limits. Abdominal exam reveals normal bowel sounds and is non-tender in all 4 quadrants. Neurological and musculoskeletal exams are within normal limits. Which of the following is the most likely outcome in this patient?? {'A': 'Atherosclerotic heart disease', 'B': 'Constitutional growth delay', 'C': 'Hypertension', 'D': 'Precocious puberty', 'E': 'Slipped capital femoral epiphysis'},
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D: Precocious puberty
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Answer the following medical question with one of the provided options:
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Q:A 49-year-old woman presents to the family medicine clinic with concerns about her weight. She has been constantly gaining weight for a decade now as she has not been able to control her diet. She has tried exercising but says that she is too lazy for this method of weight loss to work. Her temperature is 37° C (98.6° F), respirations are 15/min, pulse is 67/min, and blood pressure is 122/88 mm Hg. Her BMI is 30. Her labs from her past visit show: Fasting blood glucose: 149 mg/dL Glycated hemoglobin (HbA1c): 9.1% Triglycerides: 175 mg/dL LDL-Cholesterol: 102 mg/dL HDL-Cholesterol: 35 mg/dL Total Cholesterol: 180 mg/dL Serum creatinine: 1.0 mg/dL BUN: 12 mg/dL Serum: Albumin: 4.2 gm/dL Alkaline phosphatase: 150 U/L Alanine aminotransferase: 76 U/L Aspartate aminotransferase: 88 U/L After discussing the long term issues that will arise if her health does not improve, she agrees to modify her lifestyle and diet. Which of the following would be the best pharmacotherapy for this patient?? {'A': 'Dietary modification alone', 'B': 'Insulin', 'C': 'Metformin', 'D': 'Glipizide', 'E': 'Sitagliptin'},
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C: Metformin
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Answer the following medical question with one of the provided options:
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Q:A 2-year-old girl who emigrated from Pakistan 2 weeks ago is brought to the emergency department because of lower limb weakness for one-day. One week ago, she had a 3-day episode of flu-like symptoms that resolved without treatment. She has not yet received any routine childhood vaccinations. Deep tendon reflexes are 1+ in the right lower extremity and absent in the left lower extremity. Analysis of cerebrospinal fluid shows a leukocyte count of 38 cells/mm3 (68% lymphocytes), a protein concentration of 49 mg/dL, and a glucose concentration of 60 mg/dL. Which of the following is the most likely diagnosis in this patient?? {'A': 'Poliomyelitis', 'B': 'HSV encephalitis', 'C': 'Botulism', 'D': 'Tetanus', 'E': 'Guillain-Barre syndrome\n"'},
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A: Poliomyelitis
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Answer the following medical question with one of the provided options:
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Q:A previously healthy 50-year-old woman is brought to the emergency department 30 minutes after she was observed having a seizure. On arrival, she is conscious and reports that she feels drowsy. An MRI of the brain shows a 4-cm, round, sharply demarcated mass. She undergoes resection of the mass. A photomicrograph of a section of the resected specimen is shown. This patient's mass is most likely derived from which of the following?? {'A': 'Neurons', 'B': 'Astrocytes', 'C': 'Schwann cells', 'D': 'Arachnoid cells', 'E': 'Oligodendrocytes'},
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D: Arachnoid cells
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Answer the following medical question with one of the provided options:
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Q:A 33-year-old man with a history of IV drug and alcohol abuse presents to the emergency department with back pain. He states that his symptoms started 3 days ago and have been gradually worsening. His temperature is 102°F (38.9°C), blood pressure is 127/68 mmHg, pulse is 120/min, respirations are 17/min, and oxygen saturation is 98% on room air. Physical exam is notable for tenderness over the mid thoracic spine. Laboratory values are only notable for a leukocytosis and an elevated ESR and CRP. Which of the following is the most likely diagnosis?? {'A': 'Degenerative spine disease', 'B': 'Herniated nucleus pulposus', 'C': 'Musculoskeletal strain', 'D': 'Osteomyelitis', 'E': 'Spinal epidural hematoma'},
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D: Osteomyelitis
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Answer the following medical question with one of the provided options:
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Q:A 33-year-old woman is brought to the emergency department 15 minutes after being stabbed in the chest with a screwdriver. Her pulse is 110/min, respirations are 22/min, and blood pressure is 90/65 mm Hg. Examination shows a 5-cm deep stab wound at the upper border of the 8th rib in the left midaxillary line. Which of the following structures is most likely to be injured in this patient?? {'A': 'Intercostal nerve', 'B': 'Spleen', 'C': 'Lower lung lobe', 'D': 'Left ventricle', 'E': 'Left kidney'},
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C: Lower lung lobe
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Q:A 12-day-old male newborn is brought to the emergency department because of a high-grade fever for 3 days. He has been lethargic and not feeding well during this period. He cries incessantly while passing urine. There is no family history of serious illness. He was delivered at 37 weeks' gestation and pregnancy was complicated by mild oligohydramnios. His immunizations are up-to-date. He is at the 35th percentile for length and 40th percentile for weight. His temperature is 39°C (102.2°F), pulse is 165/min, respirations are 60/min, and blood pressure is 55/30 mm Hg. Examination shows open anterior and posterior fontanelles. There is a midline lower abdominal mass extending 2–3 cm above the symphysis. Cardiopulmonary examination shows no abnormalities. The child is diagnosed with a urinary tract infection and broad spectrum antibiotic therapy is begun. This patient will most likely benefit the most from which of the following interventions?? {'A': 'Meatotomy', 'B': 'Urethral diverticulectomy', 'C': 'Endoscopic dextranomer gel injection', 'D': 'Vesicostomy', 'E': 'Ablation of urethral valves\n"'},
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E: Ablation of urethral valves "
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Q:An 8-year-old boy is brought in by his mother who is concerned about her child’s behavior. She says his teachers have complained about him bullying other students at school, starting fights, and stealing other children’s lunch money. She also says that a neighbor down the street called her 6 months ago and reported that the patient had entered her yard and started viciously kicking her dog. He has no significant past medical history. He is in the 90th percentile for height and weight and has been meeting all developmental milestones. The patient is afebrile and his vital signs are within normal limits. Which of the following adult personality disorders does this patient’s diagnosis most likely predict?? {'A': 'Avoidant personality disorder', 'B': 'Paranoid personality disorder', 'C': 'Antisocial personality disorder', 'D': 'Schizoid personality disorder', 'E': 'Schizotypal personality disorder'},
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C: Antisocial personality disorder
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Q:A 4-day-old newborn is presented to the physician because of a generalized rash for the past day. He was born at term. The mother had no prenatal care and has a history of gonorrhea, which was treated 4 years ago. The newborn is at the 50th percentile for head circumference, 60th percentile for length, and 55th percentile for weight. The vital signs include: temperature 36.8°C (98.2°F), pulse 152/min, and respirations 51/min. Examination shows an erythematous maculopapular rash and pustules with an erythematous base over the trunk and extremities, sparing the palms and soles. The remainder of the examination shows no abnormalities. Which of the following is the most likely diagnosis?? {'A': 'Acropustulosis', 'B': 'Congenital syphilis', 'C': 'Erythema toxicum', 'D': 'Milia', 'E': 'Pustular melanosis'},
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C: Erythema toxicum
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Q:A 38-year-old woman presents to her primary care physician concerned about her inability to get pregnant for the past year. She has regular menstrual cycles and has unprotected intercourse with her husband daily. She is an immigrant from Australia and her past medical history is not known. She is currently taking folic acid and multivitamins. The patient's husband has had a sperm count that was determined to be within the normal range twice. She is very concerned about her lack of pregnancy and that she is too old. Which of the following is the most appropriate next step in management for this patient?? {'A': "Advise against pregnancy given the patient's age", 'B': 'Assess ovulation with an ovulation calendar', 'C': 'Continue regular intercourse for 1 year', 'D': 'Perform hysterosalpingogram', 'E': 'Repeat semen count'},
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D: Perform hysterosalpingogram
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Q:A 60-year-old female sought a routine consultation in your clinic. She is diabetic and hypertensive. She had a history of myocardial infarction 2 years ago and is maintained on anticoagulants. When changing anticoagulants from heparin to warfarin, warfarin therapy is usually continued with heparin for the first 1–2 days. What is the rationale underlying the concurrent use of anticoagulants?? {'A': 'To achieve supraoptimal anticoagulation during critical periods of illness because warfarin and heparin have synergistic effects', 'B': 'To prevent bleeding because heparin partially counteracts the warfarin hemorrhagic property', 'C': 'Heparin decreases the clearance of warfarin, thus achieving a greater plasma drug concentration of warfarin.', 'D': 'To compensate for the initial prothrombotic property of warfarin', 'E': 'Warfarin is metabolized slowly, thus leading to a delay in anticoagulation if heparin is not also administered.'},
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D: To compensate for the initial prothrombotic property of warfarin
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Q:A 71-year-old man presents to his primary care physician with complaints of fatigue, weight loss, and early satiety for 3 weeks. Before this, he felt well overall. He is a former smoker, but otherwise has no past medical history. On examination, the patient appears fatigued and thin; his stool is guaiac positive. He is referred to a gastroenterologist who performs an esophagogastroduodonoscopy that reveals a mass in the antrum of the stomach. Pathology consistent with adenocarinoma. Which of the following is the most appropriate next step in management:? {'A': 'CT abdomen/pelvis', 'B': 'PET-CT', 'C': 'Obtain CEA, CA 125 antigen, and CA 19-9', 'D': 'MRI abdomen/pelvis', 'E': 'Endoscopic ultrasound (EUS)'},
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A: CT abdomen/pelvis
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Q:A 56-year-old male with a history of hypertension, asthma, intravenous drug use, and recent incarceration 2 months ago presents to your office with an erythematous, itchy rash on his arms and chest. He does not recall exactly when the rash first started but he believes it was several days ago. Review of symptoms is notable for cough, runny nose, and diarrhea for several weeks. He is currently taking medications for a cough that he developed while he was incarcerated. He does not know the name of his medications and does not remember his diagnosis. Temperature is 99°F (37.2°C), blood pressure is 145/90 mmHg, pulse is 90/min, respirations are 20/min. He has difficulty remembering his history and appears thin. There is a scaly, symmetrical rash on his arms and neck with areas of dusky brown discoloration. He has mild abdominal tenderness to palpation but no rebound or guarding. Physical exam is otherwise unremarkable. Which of the following is associated with this disease syndrome?? {'A': 'Increased tryptophan', 'B': 'Facial flushing', 'C': 'Thiamine deficiency', 'D': 'Homocystinuria', 'E': 'Malignant carcinoid syndrome'},
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E: Malignant carcinoid syndrome
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Q:A 37-year-old woman comes to the physician because of a 2-week history of generalized fatigue and malaise. During this period, she has had a non-productive cough with a low-grade fever. Over the past 6 months, she has had a 13-kg (28.6-lb) weight loss and intermittent episodes of watery diarrhea. She has generalized anxiety disorder and hypothyroidism. She has a severe allergy to sulfa drugs. She is sexually active with 3 male partners and uses condoms inconsistently. She has smoked one pack of cigarettes daily for 20 years and drinks 2–3 beers daily. She does not use illicit drugs. Current medications include paroxetine, levothyroxine, and an etonogestrel implant. She is 162.5 cm (5 ft 4 in) tall and weighs 50.3 kg (110.2 lbs); BMI is 19 kg/m2. She appears pale. Her temperature is 38.7°C (101.6°F), pulse is 110/min, and blood pressure is 100/75 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 94%. Examination of the lungs shows bilateral crackles and rhonchi. She has white plaques on the lateral aspect of the tongue that cannot be scraped off. A chest x-ray shows symmetrical, diffuse interstitial infiltrates. Which of the following is the most appropriate pharmacotherapy?? {'A': 'Intravenous fluconazole', 'B': 'Intravenous clindamycin and oral primaquine', 'C': 'Intravenous trimethoprim-sulfamethoxazole', 'D': 'Intravenous trimethoprim-sulfamethoxazole and oral prednisone', 'E': 'Oral pentamidine'},
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B: Intravenous clindamycin and oral primaquine
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Q:A mother brings her 4-year-old boy to the physician, as the boy has a 7-day history of foul-smelling diarrhea, abdominal cramps, and fever. The mother adds that he has been vomiting as well, and she is very much worried. The child is in daycare, and the mother endorses sick contacts with both family and friends. The boy has not been vaccinated as the parents do not think it is necessary. On physical exam, the child appears dehydrated. Stool examination is negative for blood cells, pus, and ova or parasites. What is the most likely diagnosis?? {'A': 'Cryptosporidiosis', 'B': 'C. difficile colitis', 'C': 'Irritable bowel syndrome', 'D': 'Norovirus infection', 'E': 'Rotavirus infection'},
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E: Rotavirus infection
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Q:An 18-year-old man is known to be allergic to peanuts, and he mistakenly eats biscuits containing some traces of peanuts. Within 15 minutes, he develops generalized redness of the skin and urticaria, associated with shortness of breath and diffuse wheezing. His blood pressure is 80/55 mm Hg and heart rate is 124/min. He is given intramuscular epinephrine and transported emergently to the local hospital. This patient’s presentation is an example of which of the following hypersensitivity reactions?? {'A': 'Immediate hypersensitivity', 'B': 'Type II hypersensitivity', 'C': 'Serum sickness', 'D': 'Contact dermatitis', 'E': 'Delayed hypersensitivity'},
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A: Immediate hypersensitivity
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Q:A 58-year-old man comes to the physician for a 3-month history of progressive shortness of breath on exertion and tiredness throughout the day. His wife reports that he snores at night and that he sometimes chokes in his sleep. He has a history of hypertension treated with enalapril. His blood pressure is 149/96 mmHg. There is jugular venous distention and 2+ lower extremity edema bilaterally. The lungs are clear to auscultation bilaterally. An ECG shows right axis deviation. Which of the following is the most likely underlying cause of this patient's condition?? {'A': 'Coronary artery disease', 'B': 'Chronic hypoxia', 'C': 'Left ventricular hypertrophy', 'D': 'Alveolar destruction', 'E': 'Hypertensive nephropathy\n"'},
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B: Chronic hypoxia
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Q:A student is experimenting with the effects of nitric oxide in the body. He used a variety of amino acid isolates and measured the resulting nitric oxide levels and the physiological effects on the body. The amino acids function as substrates for nitric oxide synthase. After supplement administration, blood vessels dilated, and the systemic blood pressure decreased. Which of the following amino acids was used in this study?? {'A': 'Histidine', 'B': 'Arginine', 'C': 'Methionine', 'D': 'Leucine', 'E': 'Tyrosine'},
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B: Arginine
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Q:A 21-year-old college student comes to the physician because of left knee pain. The pain started when he fell off his bike one year ago; since then he has had intermittent stabbing pain and tingling in his knee. The patient says that the pain is caused by a device that was implanted by the US government to control his thoughts and actions. Every time he does something they do not want him to do, the device will send an electromagnetic impulse to his knee. He maintains the device was also responsible for the bicycle accident. Over the past 6 months, it has caused him to hear voices telling him to harm himself or others; he does not listen to these commands because he does not want to “play by their rules.” He has avoided meeting his family and friends since the voices started. He drinks 2 beers a day but does not use illicit drugs. Vital signs are within normal limits. The left knee is nontender and nonerythematous with no swelling. Range of motion is normal. Neurologic examination shows no abnormalities. On mental status examination, the patient appears expressionless. Which of the following is the most appropriate long-term treatment?? {'A': 'Quetiapine', 'B': 'Clonidine', 'C': 'Midazolam', 'D': 'Lithium carbonate', 'E': 'Valproic acid'},
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A: Quetiapine
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Q:A 55-year-old homeless man is presented to the emergency department by a group of volunteers after they found him coughing up blood during 1 of the beneficiary dinners they offer every week. His medical history is unknown as he recently immigrated from Bangladesh. He says that he has been coughing constantly for the past 3 months with occasional blood in his sputum. He also sweats a lot at nights and for the past 2 days, he has been thirsty with increased frequency of urination and feeling hungrier than usual. The respiratory rate is 30/min and the temperature is 38.6°C (101.5°F). He looks emaciated and has a fruity smell to his breath. The breath sounds are reduced over the apex of the right lung. The remainder of the physical exam is unremarkable. Biochemical tests are ordered, including a hemoglobin A1c (HbA1c) (8.5%) and chest radiography reveals cavitations in the apical region of the right lung. Which of the following cells is critical in the development and maintenance of this structure that led to the formation of these cavitations?? {'A': 'Th1 lymphocytes', 'B': 'B lymphocytes', 'C': 'Epithelioid cells', 'D': 'Treg lymphocytes', 'E': 'Th2 lymphocytes'},
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A: Th1 lymphocytes
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Q:A G1P0 34-year-old woman presents to the clinic complaining of difficulty breathing and coughing up blood for 2 days. Past medical history is significant for molar pregnancy 6 months ago. The patient was lost to follow up as she was abruptly laid off and had to stay at a homeless shelter for the past few months. She endorses nausea and vomiting, abdominal discomfort, and “feeling hot all the time.” The patient is a past smoker of 1 pack per day for 10 years. Vital signs are within normal limits except for tachycardia. What is the disease process that most likely explains this patient’s symptoms?? {'A': 'Acute infection with campylobacter jejuni', 'B': 'Excessive production of thyroid hormone', 'C': 'Infectious process by mycobacterium tuberculosis', 'D': 'Malignant proliferation of squamous cells in the lung', 'E': 'Malignant proliferation of trophoblastic tissue'},
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E: Malignant proliferation of trophoblastic tissue
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Q:A homeless woman presents with shortness of breath on exertion and pedal edema. Cardiac workup performed shows evidence of dilated cardiomyopathy and increased cardiac output. She also has decreased sensation over both extremities bilaterally. Which vitamin deficiency most likely caused these symptoms?? {'A': 'Vitamin C', 'B': 'Vitamin B1', 'C': 'Vitamin B3', 'D': 'Vitamin B6', 'E': 'Vitamin A'},
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B: Vitamin B1
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Q:A 67-year-old man presents to the emergency department with increased fatigue. He states that he has been feeling very tired lately but today lost consciousness while walking up the stairs. He report mild abdominal distension/discomfort, weight loss, a persistent cough, and multiple episodes of waking up drenched in sweat in the middle of the night. The patient does not see a primary care physician but admits to smoking 2 to 3 packs of cigarettes per day and drinking 1 to 3 alcoholic beverages per day. He recently traveled to Taiwan and Nicaragua. His temperature is 99.5°F (37.5°C), blood pressure is 177/98 mmHg, pulse is 100/min, respirations are 17/min, and oxygen saturation is 98% on room air. On physical exam, you note a fatigued appearing elderly man who is well-groomed. Cardiopulmonary exam reveals mild expiratory wheezes. Abdominal exam is notable for a non-pulsatile mass in the left upper quadrant. Laboratory values are ordered as seen below. Hemoglobin: 12 g/dL Hematocrit: 36% Leukocyte count: 105,500/mm^3 Platelet count: 197,000/mm^3 Serum: Na+: 139 mEq/L Cl-: 100 mEq/L K+: 4.3 mEq/L HCO3-: 25 mEq/L BUN: 20 mg/dL Glucose: 92 mg/dL Creatinine: 1.4 mg/dL Ca2+: 10.2 mg/dL Leukocyte alkaline phosphatase score: 25 (range 20 - 100) AST: 12 U/L ALT: 17 U/L Which of the following is the most likely diagnosis?? {'A': 'Acute lymphoblastic leukemia', 'B': 'Acute myelogenous leukemia', 'C': 'Chronic myeloid leukemia', 'D': 'Leukemoid reaction', 'E': 'Tuberculosis'},
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C: Chronic myeloid leukemia
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Q:A 71-year-old man with colon cancer presents to his oncologist because he has been experiencing photosensitivity with his current chemotherapeutic regimen. During the conversation, they decide that his symptoms are most likely a side effect of the 5-fluorouracil he is currently taking and decide to replace it with another agent. The patient is curious why some organs appear to be especially resistant to chemotherapy whereas others are particularly susceptible to chemotherapy. Which of the following cell types would be most resistant to chemotherapeutic agents?? {'A': 'Cardiac myocytes', 'B': 'Enterocytes', 'C': 'Hair follicle cells', 'D': 'Hematopoietic cells', 'E': 'Liver hepatocytes'},
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A: Cardiac myocytes
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Q:A 25-year-old woman comes to the physician because of a 2-week history of episodic bleeding from the nose and gums and one episode of blood in her urine. She was treated with chloramphenicol 1 month ago for Rickettsia rickettsii infection. Her pulse is 130/min, respirations are 22/min, and blood pressure is 105/70 mm Hg. Examination shows mucosal pallor, scattered petechiae, and ecchymoses on the extremities. Laboratory studies show: Hemoglobin 6.3 g/dL Hematocrit 26% Leukocyte count 900/mm3 (30% neutrophils) Platelet count 50,000/mm3 The physician recommends a blood transfusion and informs her of the risks and benefits. Which of the following red blood cell preparations will most significantly reduce the risk of transfusion-related cytomegalovirus infection?"? {'A': 'Leukoreduction', 'B': 'Warming', 'C': 'Washing', 'D': 'Irradiation', 'E': 'Centrifugation\n"'},
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A: Leukoreduction
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Q:A 3-week-old boy has non-bilious projectile vomiting that occurred after feeding. After vomiting, the infant is still hungry. The infant appears dehydrated and malnourished. A firm, “olive-like” mass of about 1.5 cm in diameter is palpated in the right upper quadrant, by the lateral edge of the rectus abdominus muscle. On laboratory testing, the infant is found to have a hypochloremic, hypokalemic metabolic alkalosis. Which of the following is most likely the cause of this patient’s symptoms?? {'A': 'Intussusception', 'B': 'Duodenal atresia', 'C': 'Hypertrophy of the pylorus muscle', 'D': 'Aganglionic colon segment', 'E': 'Achalasia'},
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C: Hypertrophy of the pylorus muscle
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Q:A 20-year-old female college student comes to the student clinic for an annual physical examination. She has no complaints. On further questioning, she admits to having only two friends on campus, which she attributes to her shyness, and has been present for as long as she can remember. She intentionally enrolls in large classes that do not require participation, due to her fear of being criticized. She works part time as a library shelver and has turned down promotions for a front desk job. She lives alone because she is concerned that others will find her unappealing. She turns down invitations to parties and prefers spending time with her cat. She worries that she may not be able to find a boyfriend who thinks she is good enough. The patient most likely has which of the following primary diagnoses?? {'A': 'Avoidant Personality Disorder', 'B': 'Schizoid personality disorder', 'C': 'Social anxiety disorder', 'D': 'Adjustment disorder with depressed mood', 'E': 'Dependent personality disorder'},
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A: Avoidant Personality Disorder
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Q:An 11-month-old girl presents to a pediatrician with her mother who is concerned about a red discoloration with a rectangular shape over the child’s left buttock presenting since the previous night. The mother also mentions that her daughter has been crying excessively. There is no history of decreased breast feeding, fever, joint swelling, vomiting, decreased urine output, or change in color of urine or stools. The mother denies any history of injury. However, she mentions that the infant had suffered from a self-limiting upper respiratory infection three weeks before. There is no history of bruising or bleeding in the past. The mother informs the doctor that she has a brother (the patient’s maternal uncle) with hemophilia A. On physical examination, the girl’s temperature is 37.0°C (98.6°F), pulse rate is 160/min, and respiratory rate is 38/min. The lesion presents over the left buttock and is tender on palpation. What is the most likely diagnosis?? {'A': 'Idiopathic thrombocytopenic purpura', 'B': 'Hemophilia', 'C': 'Abusive bruise', 'D': 'Erythema multiforme minor', 'E': 'Diaper dermatitis'},
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C: Abusive bruise
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Q:A 34-year-old Ethiopian woman who recently moved to the United States presents for evaluation to a surgical outpatient clinic with painful ulceration in her right breast for the last 2 months. She is worried because the ulcer is increasing in size. On further questioning, she says that she also has a discharge from her right nipple. She had her 2nd child 4 months ago and was breastfeeding the baby until the pain started getting worse in the past few weeks, and is now unbearable. According to her health records from Africa, her physician prescribed antimicrobials multiple times with a diagnosis of mastitis, but she did not improve significantly. Her mother and aunt died of breast cancer at 60 and 58 years of age, respectively. On examination, the right breast is enlarged and firm, with thickened skin, diffuse erythema, edema, and an ulcer measuring 3 × 3 cm. White-Gray nipple discharge is present. The breast is tender with axillary and cervical adenopathy. Mammography is ordered, which shows a mass with a large area of calcifications, parenchymal distortion, and extensive soft tissue and trabecular thickening in the affected breast. The patient subsequently undergoes core-needle and full-thickness skin punch biopsies. The pathology report states a clear dermal lymphatic invasion by tumor cells. Which of the following is the most likely diagnosis?? {'A': 'Lobular carcinoma in situ (LCIS)', 'B': 'Inflammatory breast cancer', 'C': 'Ductal carcinoma in situ (DCIS)', 'D': 'Infiltrating lobular carcinoma', 'E': 'Infiltrating ductal carcinoma'},
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B: Inflammatory breast cancer
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Q:A 28-year-old man comes to the physician because of a 1-year history of chronic back pain. He explains that the pain started after getting a job at a logistics company. He does not recall any trauma and does not have morning stiffness or neurological symptoms. He has been seen by two other physicians for his back pain who did not establish a diagnosis. The patient also has abdominal bloating and a feeling of constipation that started 3 weeks ago. After doing extensive research on the internet, he is concerned that the symptoms might be caused by pancreatic cancer. He would like to undergo a CT scan of his abdomen for reassurance. He has a history of episodic chest pain, for which he underwent medical evaluation with another healthcare provider. Tests showed no pathological results. He does not smoke or drink alcohol. He reports that he is under significant pressure from his superiors due to frequent performance evaluations. He takes daily multivitamins and glucosamine to prevent arthritis. His vital signs are within normal limits. Examination shows a soft, non-tender, non-distended abdomen and mild bilateral paraspinal muscle tenderness. The remainder of the examination, including a neurologic examination, shows no abnormalities. Laboratory studies are within the reference range. An x-ray of the spine shows no abnormalities. Which of the following is the most likely explanation for this patient's symptoms?? {'A': 'Malignant neoplasm', 'B': 'Atypical depression', 'C': 'Irritable bowel syndrome', 'D': 'Somatic symptom disorder', 'E': 'Acute stress disorder'},
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D: Somatic symptom disorder
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Q:A 3-year-old boy is brought to the physician because of a 1-week history of yellowish discoloration of his eyes and skin. He has had generalized fatigue and mild shortness of breath for the past month. Three weeks ago, he was treated for a urinary tract infection with antibiotics. His father underwent a splenectomy during childhood. Examination shows pale conjunctivae and jaundice. The abdomen is soft and nontender; there is nontender splenomegaly. Laboratory studies show: Hemoglobin 9.1 g/dL Mean corpuscular volume 89 μm3 Mean corpuscular hemoglobin 32 pg/cell Mean corpuscular hemoglobin concentration 37.8% Hb/cell Leukocyte count 7800/mm3 Platelet count 245,000/mm3 Red cell distribution width 22.8% (N=13%–15%) Serum Bilirubin Total 13.8 mg/dL Direct 1.9 mg/dL Lactate dehydrogenase 450 U/L Which of the following is the most likely pathophysiology of these findings?"? {'A': 'Increased hemoglobin S', 'B': 'Decreased spectrin in the RBC membrane', 'C': 'Deficient glucose-6 phosphate dehydrogenase', 'D': 'Decreased synthesis of alpha chains of hemoglobin', 'E': 'Deficiency of pyruvate kinase'},
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B: Decreased spectrin in the RBC membrane
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Q:An 18-month-old boy is brought to the physician by his mother because of concern that he has not yet begun to walk. He was born at term and exclusively breastfed until 15 months of age. His mother says he has been well, apart from an episode of high fever and seizure 4 months ago for which she did not seek medical attention. He has an older brother who is currently receiving medical treatment for failure to thrive. His parents have no history of serious illness; they are of normal height. His last vaccine was at the age of 4 months. He is at the 20th percentile for length, 10th percentile for weight, and 50th percentile for head circumference. Physical examination shows dry mucous membranes and erosion of the enamel on the lingual surface of the incisors and carious molars. He has frontal bossing. His wrists are widened, his legs seem bent, and there is beading of the ribs. Which of the following is the most likely underlying cause of this patient's delay in walking?? {'A': 'Defect in type I collagen', 'B': 'Defective growth plate mineralization', 'C': 'Mutation of fibroblast growth factor receptor 3', 'D': 'Deficiency of osteoclasts to reabsorb bone', 'E': 'Osteoid proliferation in the subperiosteal bone\n"'},
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B: Defective growth plate mineralization
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Q:A 52-year-old man comes to the physician because of progressive abdominal distention and weight gain over the last 2 months. He was diagnosed with alcoholic liver cirrhosis with large ascites 1 year ago. He has congestive heart failure with a depressed ejection fraction related to his alcohol use. For the last 6 months, he has abstained from alcohol and has followed a low-sodium diet. His current medications include propranolol, spironolactone, and furosemide. His temperature is 36.7°C (98°F), pulse is 90/min, and blood pressure is 109/56 mm Hg. Physical examination shows reddening of the palms, telangiectasias on the face and trunk, and prominent blood vessels around the umbilicus. The abdomen is tense and distended; there is no abdominal tenderness. On percussion of the abdomen, there is dullness that shifts when the patient moves from the supine to the right lateral decubitus position. When the patient stretches out his arms with the wrists extended, a jerky, flapping motion of the hands is seen. Mental status examination shows a decreased attention span. Serum studies show: Sodium 136 mEq/L Creatinine 0.9 mg/dL Albumin 3.6 mg/dL Total bilirubin 1.9 mg/dL INR 1.0 Which of the following is the most appropriate next step in treatment?"? {'A': 'Refer for transjugular intrahepatic portosystemic shunt', 'B': 'Refer for liver transplantation', 'C': 'Refer for peritoneovenous shunt', 'D': 'Change propranolol to carvedilol', 'E': 'Perform large-volume paracentesis\n"'},
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E: Perform large-volume paracentesis "
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Q:A 53-year-old male presents to your office for abdominal discomfort. The patient states he first noticed pain on his right flank several months ago, and it has been gradually getting worse. For the past week, he has also noticed blood in his urine. Prior to this episode, he has been healthy and does not take any medications. The patient denies fever, chills, and dysuria. He has a 40 pack-year smoking history. Vital signs are T 37 C, HR 140/90 mmHg, HR 84/min, RR 14/min, O2 98%. Physical exam is unremarkable. CBC reveals a hemoglobin of 17 and hematocrit of 51%, and urinalysis is positive for red blood cells, negative for leukocytes. Which of the following is the most likely diagnosis?? {'A': 'Renal cell carcinoma', 'B': 'Polycystic kidney disease', 'C': 'Abdominal aortic aneurysm', 'D': 'Pyelonephritis', 'E': 'Renal oncocytoma'},
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A: Renal cell carcinoma
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Q:A 32-year-old woman comes to the physician for genetic consultation. She has a history of recurrent generalized seizures, diffuse muscular weakness, and multiple episodes of transient left-sided paresis. She has been hospitalized several times for severe lactic acidosis requiring intravenous fluid hydration. Her 10-year-old daughter also has seizures and muscle weakness. Her 7-year-old son has occasional muscle weakness and headaches but has never had a seizure. Pathologic examination of a biopsy specimen from the woman's soleus muscle shows ragged-appearing muscle fibers. Genetic analysis of the patient's son is most likely to show which of the following?? {'A': 'Silenced paternal gene copy', 'B': 'Heterogenous mitochondrial DNA', 'C': 'Mutation in DNA repair gene', 'D': 'Genetically distinct cell lines', 'E': 'Altered allele on the X chromosome'},
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B: Heterogenous mitochondrial DNA
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Q:A 1-week-old infant presents to the ED with seizures that are very difficult to control despite loading with fosphenytoin. The parents note that the child was born at home and has been like this since birth. They note that it has been a difficult week trying to get any response from the infant. Upon examination the infant has poor muscle tone, severe difficulties with sucking and swallowing, corneal opacities, and hepatomegaly. Based on clinical suspicion, a genetic test is performed that reveals the diagnosis. The geneticist counsels that the infant has a rare disorder that causes the accumulation of very long chain fatty acids, adversely affecting myelination and leading to neurological symptoms. Most patients with this disorder die within 1 year. The most likely condition in this patient primarily affects which subcellular compartment?? {'A': 'Lysosome', 'B': 'Peroxisome', 'C': 'Golgi apparatus', 'D': 'Mitochondria', 'E': 'Endoplasmic reticulum'},
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B: Peroxisome
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Q:A 51-year-old man with alcohol use disorder comes to the physician because of a fever and productive cough. An x-ray of the chest shows a right lower lobe consolidation and a diagnosis of aspiration pneumonia is made. The physician prescribes a drug that blocks peptide transfer by binding to the 50S ribosomal subunit. Which of the following drugs was most likely prescribed?? {'A': 'Doxycycline', 'B': 'Metronidazole', 'C': 'Clindamycin', 'D': 'Azithromycin', 'E': 'Ceftriaxone'},
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C: Clindamycin
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Answer the following medical question with one of the provided options:
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Q:A 69-year-old man undergoes modified radical neck dissection for an oropharyngeal tumor. During the procedure, he requires multiple blood transfusions. Four hours after the surgery, examination shows that the right and left pupils do not constrict when a light is shone into the left eye. When light is shone into the right eye, both pupils constrict. Fundoscopic examination shows no abnormalities. Which of the following is the most likely location of the lesion?? {'A': 'Optic nerve', 'B': 'Pretectal nuclei', 'C': 'Superior cervical ganglion', 'D': 'Edinger-Westphal nucleus', 'E': 'Ciliary ganglion'},
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A: Optic nerve
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Answer the following medical question with one of the provided options:
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Q:A 7-year-old girl is brought to the physician by her mother because of a 5-day history of fever, fatigue, and red spots on her body. Her temperature is 38.3°C (101.1°F), pulse is 115/min, and blood pressure is 100/60 mm Hg. Physical examination shows pallor and petechiae over the trunk and lower extremities. Laboratory studies show a hemoglobin concentration of 7 g/dL, a leukocyte count of 2,000/mm3, a platelet count of 40,000/mm3, and a reticulocyte count of 0.2%. Peripheral blood smear shows normochromic, normocytic cells. A bone marrow aspirate shows hypocellularity. Which of the following is the most likely cause of this patient's findings?? {'A': 'Aplastic anemia', 'B': 'Multiple myeloma', 'C': 'Primary myelofibrosis', 'D': 'Idiopathic thrombocytopenic purpura', 'E': 'Acute lymphoblastic leukemia'},
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A: Aplastic anemia
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Answer the following medical question with one of the provided options:
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Q:A 45-year-old man is brought to the emergency department after being found down in the middle of the street. Bystanders reported to the police that they had seen the man as he exited a local bar, where he was subsequently assaulted. He sustained severe facial trauma, including multiple lacerations and facial bone fractures. The man is taken to the operating room by the ENT team, who attempted to reconstruct his facial bones with multiple plates and screws. Several days later, he complains of the inability to open his mouth wide or to completely chew his food, both of which he seemed able to do prior to the surgery. Where does the affected nerve exit the skull?? {'A': 'Foramen ovale', 'B': 'Foramen rotundum', 'C': 'Superior orbital fissue', 'D': 'Jugular foramen', 'E': 'Inferior orbital fissue'},
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A: Foramen ovale
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Answer the following medical question with one of the provided options:
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Q:A 39-year-old man comes to the physician for a follow-up examination. He was treated for a urinary tract infection with trimethoprim-sulfamethoxazole 2 months ago. He is paraplegic as a result of a burst lumbar fracture that occurred after a fall 5 years ago. He has hypertension and type 2 diabetes mellitus. Current medications include enalapril and metformin. He performs clean intermittent catheterization daily. He has smoked one pack of cigarettes daily for 19 years. His temperature is 37.1°C (98.8°F), pulse is 95/min, respirations are 14/min, and blood pressure is 120/80 mm Hg. He appears malnourished. Examination shows palpable pedal pulse. Multiple dilated tortuous veins are present over both lower extremities. There is a 2-cm wound surrounded by partial-thickness loss of skin and a pink wound bed over the right calcaneum. Neurologic examination shows paraparesis. His hemoglobin A1c is 6.5%, and fingerstick blood glucose concentration is 134 mg/dL. Which of the following is most likely to have prevented this patient's wound?? {'A': 'Cessation of smoking', 'B': 'Frequent position changes', 'C': 'Topical antibiotic therapy', 'D': 'Broad-spectrum antibiotic therapy', 'E': 'Heparin therapy\n"'},
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B: Frequent position changes
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Answer the following medical question with one of the provided options:
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Q:A 56-year-old man presents to the emergency room after being in a motor vehicle accident. He was driving on an icy road when his car swerved off the road and ran head on into a tree. He complains of severe pain in his right lower extremity. He denies loss of consciousness during the accident. His past medical history is notable for poorly controlled hypertension, hyperlipidemia, and major depressive disorder. He takes enalapril, atorvastatin, and sertraline. His temperature is 99.1°F (37.3°C), blood pressure is 155/85 mmHg, pulse is 110/min, and respirations are 20/min. On exam, he is alert and fully oriented. He is unable to move his right leg due to pain. Sensation is intact to light touch in the sural, saphenous, tibial, deep peroneal, and superficial peroneal distributions. His leg appears adducted, flexed, and internally rotated. An anteroposterior radiograph of his pelvis would most likely demonstrate which of the following findings?? {'A': 'Femoral head larger than contralateral side and inferior to acetabulum', 'B': 'Femoral head smaller than contralateral side and posterior to acetabulum', 'C': 'Fracture line extending between the greater and lesser trochanters', 'D': 'Fracture line extending through the femoral neck', 'E': 'Fracture line extending through the subtrochanteric region of the femur'},
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B: Femoral head smaller than contralateral side and posterior to acetabulum
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Q:A 33-year-old woman presents to her primary care provider for a normal check-up. She reports she has been feeling intermittently fatigued over the past 3 months, but she attributes it to her work as a corporate lawyer and balancing family life. She is otherwise healthy and takes no medications. She was adopted and has no information about her biological family. She has 2 children and has been married for 7 years. She drinks 4-5 glasses of wine per week and does not smoke. Her temperature is 99.2°F (37.3°C), blood pressure is 125/65 mmHg, pulse is 78/min, and respirations are 18/min. On exam, she is well-appearing and in no acute distress. A complete blood count is within normal limits. Additional workup is shown below: Serum: Na+: 139 mEq/L Cl-: 99 mEq/L K+: 3.9 mEq/L HCO3-: 23 mEq/L BUN: 18 mg/dL Glucose: 110 mg/dL Creatinine: 1.1 mg/dL Ca2+: 11.1 mg/dL Parathyroid hormone: 700 pg/mL Urine: Na+: 100 mEq/L/24h Ca2+: 100 mg/24h Osmolality: 400 mOsmol/kg H2O Which of the following is the most likely underlying cause of this patient's condition?? {'A': 'Decreased sensitivity to parathyroid hormone', 'B': 'Gain-of-function mutation in the parathyroid hormone receptor gene', 'C': 'Impaired tubular calcium reabsorption', 'D': 'Loss-of-function mutation in the calcium-sensing receptor', 'E': 'Over-secretion of parathyroid hormone'},
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D: Loss-of-function mutation in the calcium-sensing receptor
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Q:Six days after undergoing an elective hip replacement surgery, a 79-year-old man develops dysuria, flank pain, and fever. His temperature is 38.5°C (101.3°F). Examination shows marked tenderness in the right costovertebral area. Treatment with an antibiotic is begun, but his symptoms do not improve. Further evaluation shows that the causal organism produces an enzyme that inactivates the antibiotic via phosphorylation. An agent from which of the following classes of antibiotics was most likely administered?? {'A': 'Aminoglycosides', 'B': 'Tetracyclines', 'C': 'Glycopeptides', 'D': 'Fluoroquinolones', 'E': 'Macrolides'},
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A: Aminoglycosides
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Q:A 48-year-old man comes to the emergency department because of a 2-hour history of severe left-sided colicky flank pain that radiates towards his groin. He has vomited twice. Last year, he was treated with ibuprofen for swelling and pain of his left toe. He drinks 4-5 beers most days of the week. Examination shows left costovertebral angle tenderness. An upright x-ray of the abdomen shows no abnormalities. A CT scan of the abdomen and pelvis shows an 9-mm stone in the proximal ureter on the left. Which of the following is most likely to be seen on urinalysis?? {'A': 'Red blood cell casts', 'B': 'Rhomboid-shaped crystals', 'C': 'Wedge-shaped crystals', 'D': 'Coffin-lid-like crystals', 'E': 'Hexagon-shaped crystals\n"'},
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B: Rhomboid-shaped crystals
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Q:A 40-year-old woman visits your office with her pathology report after being subjected to total abdominal hysterectomy a month ago. She explains that she went through this procedure after a long history of lower abdominal pain that worsened during menses and heavy menstrual bleeding. She is a mother of 5 children, and they are all delivered by cesarean section. The pathology gross examination report and microscopic examination report from the specimen from surgery describes an enlarged, globular uterus with invading clusters of endometrial tissue within the myometrium. What is the most likely diagnosis for this patient?? {'A': 'Endometrial carcinoma', 'B': 'Uterine leiomyoma', 'C': 'Uterine adenomyosis', 'D': 'Endometrial polyp', 'E': 'Endometrial hyperplasia'},
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C: Uterine adenomyosis
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Answer the following medical question with one of the provided options:
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Q:A 31-year-old male traveler in Thailand experiences fever, headache, and excessive sweating every 48 hours. Peripheral blood smear shows trophozoites and schizonts indicative of Plasmodia infection. The patient is given chloroquine and primaquine. Primaquine targets which of the following Plasmodia forms:? {'A': 'Merozoite', 'B': 'Trophozoite', 'C': 'Schizont', 'D': 'Sporozoite', 'E': 'Hypnozoite'},
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E: Hypnozoite
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Answer the following medical question with one of the provided options:
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Q:A 45-year-old woman presents to the emergency department after sustaining a gunshot wound to her shoulder. During the course of the physical exam, the physician notes her spleen is palpable 10 cm below the left costal margin. Additionally, radiography of her shoulder showed several 'punched-out' areas of lytic bone. While this was considered an incidental finding at the time, she was referred to her primary care physician for further workup. Subsequent biopsy of the spleen demonstrated that this patient’s splenomegaly was caused by an infiltrative process. Which of the following processes would most likely result in splenomegaly in this patient?? {'A': 'Budd-Chiari syndrome', 'B': 'Multiple myeloma', 'C': 'Infectious mononucleosis', 'D': 'Beta-thalassemia', 'E': 'Myelofibrosis'},
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B: Multiple myeloma
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Answer the following medical question with one of the provided options:
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Q:A 17-year-old girl comes to the physician because of a 4-month history of fatigue. She has not had any change in weight. She had infectious mononucleosis 4 weeks ago. Menses occur at regular 28-day intervals and last 5 days with moderate flow. Her last menstrual period was 3 weeks ago. Her mother has Hashimoto thyroiditis. Examination shows pale conjunctivae, inflammation of the corners of the mouth, and brittle nails. The remainder of the examination shows no abnormalities. Laboratory studies show: Hemoglobin 10.3 g/dL Mean corpuscular volume 74 μm3 Platelet count 280,000/mm3 Leukocyte count 6,000/mm3 Which of the following is the most appropriate next step in evaluating this patient's illness?"? {'A': 'Hemoglobin electrophoresis', 'B': 'Direct Coombs test', 'C': 'Ferritin levels', 'D': 'Peripheral blood smear', 'E': 'Bone marrow biopsy'},
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C: Ferritin levels
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Q:A 55-year-old woman presents to the physician because of a fever 4 days after discharge from the hospital following induction chemotherapy for acute myeloid leukemia (AML). She has no other complaints and feels well otherwise. Other than the recent diagnosis of AML, she has no history of a serious illness. The temperature is 38.8°C (101.8°F), the blood pressure is 110/65 mm Hg, the pulse is 82/min, and the respirations are 14/min. Examination of the catheter site, skin, head and neck, heart, lungs, abdomen, and perirectal area shows no abnormalities. The results of the laboratory studies show: Hemoglobin 9 g/dL Leukocyte count 800/mm3 Percent segmented neutrophils 40% Platelet count 85,000/mm3 Which of the following is the most appropriate pharmacotherapy at this time?? {'A': 'Caspofungin', 'B': 'Ciprofloxacin', 'C': 'Imipenem', 'D': 'Valacyclovir', 'E': 'Vancomycin'},
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C: Imipenem
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Q:A 65-year-old man is brought to the emergency department with central chest pain for the last hour. He rates his pain as 8/10, dull in character, and says it is associated with profuse sweating and shortness of breath. He used to have heartburn and upper abdominal pain associated with food intake but had never experienced chest pain this severe. He has a history of diabetes, hypertension, and hypercholesterolemia. His current medication list includes amlodipine, aspirin, atorvastatin, insulin, valsartan, and esomeprazole. He has smoked 1 pack of cigarettes per day for the past 35 years. Physical examination reveals: blood pressure 94/68 mm Hg, pulse 112/min, oxygen saturation 95% on room air, and BMI 31.8 kg/m2. His lungs are clear to auscultation. An electrocardiogram (ECG) is done and shown in the picture. The patient is discharged home after 3 days on aspirin, clopidogrel, and atenolol in addition to his previous medications. He is advised to get an exercise tolerance test (ETT) in one month. A month later at his ETT, his resting blood pressure is 145/86 mm Hg. The pre-exercise ECG shows normal sinus rhythm with Q waves in the inferior leads. After 3 minutes of exercise, the patient develops chest pain that is gradually worsening, and repeat blood pressure is 121/62 mm Hg. No ischemic changes are noted on the ECG. What is the most appropriate next step?? {'A': 'Continue exercise since ECG does not show ischemic changes', 'B': 'Repeat exercise tolerance testing after one month', 'C': 'Stop exercise and order a coronary angiography', 'D': 'Stop exercise and order a pharmacological stress test', 'E': 'Stop exercise and order an echo stress test'},
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C: Stop exercise and order a coronary angiography
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Answer the following medical question with one of the provided options:
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Q:A 27-year-old woman G2P1 at 34 weeks estimated gestational age presents with bouts of sweating, weakness, and dizziness lasting a few minutes after lying down on the bed. She says symptoms resolve if she rolls on her side. She reports that these episodes have occurred several times over the last 3 weeks. On lying down, her blood pressure is 90/50 mm Hg and her pulse is 50/min. When she rolls on her side, her blood pressure slowly increases to 120/65 mm Hg, and her pulse increases to 72/min. Which of the following best describes the mechanism which underlies this patient’s most likely condition?? {'A': 'Aortocaval compression', 'B': 'Progesterone surge', 'C': 'Increase in plasma volume', 'D': 'Peripheral vasodilation', 'E': 'Renin-angiotensin system activation'},
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A: Aortocaval compression
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Q:A 22-year-old man comes to the physician because of a 3-week history of abdominal pain, loose, non-bloody stools, and intermittent nausea. He also reports intermittent fever. He has not had vomiting, tenesmus, or rectal pain. He has no history of serious illness and takes no medications. His vital signs are within normal limits. Rectal exam is unremarkable. Laboratory studies show a leukocyte count of 15,200/mm3 and an erythrocyte sedimentation rate of 44 mm/h. Test of the stool for occult blood and stool studies for infection are negative. A CT scan of the abdomen shows mural thickening and surrounding fat stranding of discrete regions of the terminal ileum and transverse colon. A colonoscopy is performed and biopsy specimens of the affected areas of the colon are taken. Which of the following findings is most specific for this patient's most likely diagnosis?? {'A': 'Neutrophilic inflammation of the crypts', 'B': 'Inflammation of the terminal ileum', 'C': 'Intranuclear and cytoplasmic inclusion bodies', 'D': 'Neutrophil-rich pseudomembranes', 'E': 'Non-caseating granulomas'},
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E: Non-caseating granulomas
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Answer the following medical question with one of the provided options:
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Q:A 57-year-old nulliparous woman comes to the physician 2 weeks after noticing a lump in her right breast. Her last mammogram was performed 4 years ago and showed no abnormalities. Menopause began 2 years ago, during which time the patient was prescribed hormone replacement therapy for severe hot flashes and vaginal dryness. Vital signs are within normal limits. Examination of the right breast shows a firm, nontender mass close to the nipple. There are no changes in the skin or nipple, and there is no palpable axillary adenopathy. The abdomen is soft and nontender; there is no organomegaly. Mammography shows a suspicious 2-cm mass adjacent to the nipple. Which of the following is the most appropriate next step in management?? {'A': 'Fine needle aspiration', 'B': 'Bone scan', 'C': 'Measurement of serum CA 15–3', 'D': 'Mastectomy', 'E': 'Core needle biopsy\n"'},
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E: Core needle biopsy "
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Answer the following medical question with one of the provided options:
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Q:An investigator studying mechanisms of acquired antibiotic resistance in bacteria conducts a study using isolated strains of Escherichia coli and Staphylococcus aureus. The E. coli strain harbors plasmid pRK212.1, which conveys resistance to kanamycin. The S. aureus strain is susceptible to kanamycin. Both bacterial strains are mixed in a liquid growth medium containing deoxyribonuclease. After incubation for 2 days and subsequent transfer to a solid medium, the S. aureus colonies show no lysis in response to the application of kanamycin. Analysis of chromosomal DNA from the kanamycin-resistant S. aureus strain does not reveal the kanamycin-resistance gene. Which of the following mechanisms is most likely responsible for this finding?? {'A': 'Transformation', 'B': 'Conjugation', 'C': 'Transposition', 'D': 'Secretion', 'E': 'Transduction'},
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B: Conjugation
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Q:A 57-year-old woman comes to the clinic complaining of decreased urine output. She reports that over the past 2 weeks she has been urinating less and less every day. She denies changes in her diet or fluid intake. The patient has a history of lupus nephritis, which has resulted in end stage renal disease. She underwent a renal transplant 2 months ago. Since then she has been on mycophenolate and cyclosporine, which she takes as prescribed. The patient’s temperature is 99°F (37.2°C), blood pressure is 172/102 mmHg, pulse is 88/min, and respirations are 17/min with an oxygen saturation of 97% on room air. Labs show an elevation in serum creatinine and blood urea nitrogen. On physical examination, she has 2+ pitting edema of the bilateral lower extremities. Lungs are clear to auscultation. Urinalysis shows elevated protein. A post-void bladder scan is normal. A renal biopsy is obtained, which shows lymphocyte infiltration and intimal swelling. Which of the following is the next best step in management?? {'A': 'Add ceftriaxone', 'B': 'Add diltiazem', 'C': 'Discontinue cyclosporine', 'D': 'Nephrectomy', 'E': 'Start intravenous steroids'},
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E: Start intravenous steroids
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Q:A 47-year-old homeless man is brought to the emergency department by police, who found him sleeping by the side of the street. He is somnolent and confused and is unable to give a reliable history. His medical history is unobtainable. Vital signs include: temperature 36.9°C (98.4°F), blood pressure 112/75 mm Hg, and pulse 85/min. Physical examination reveals that he has severe truncal ataxia and horizontal gaze palsy with impaired vestibulo-ocular reflexes. Muscle stretch reflexes and motor strength are normal. He has no sensory deficits. Which of the following best represents the most likely etiology of this patient’s condition?? {'A': 'Delirium tremens', 'B': 'Miller-Fisher syndrome', 'C': 'Vitamin B1 deficiency', 'D': 'Vitamin B12 deficiency', 'E': 'Ethylene glycol intoxication'},
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C: Vitamin B1 deficiency
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Answer the following medical question with one of the provided options:
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Q:An 8-year-old boy is brought to the hospital because of blurred vision and headache for 3 months. During this period, the father has noticed that the child has been tilting his head back to look straight ahead. The patient has also had difficulty falling asleep for 2 months. He has had a 3.5 kg (7.7 lb) weight loss over the past 6 months. His temperature is 37.7°C (99.8°F), pulse is 105/min, and blood pressure is 104/62 mm Hg. Examination shows equal pupils that are not reactive to light. The pupils constrict when an object is brought near the eye. His upward gaze is impaired; there is nystagmus and eyelid retraction while attempting to look upwards. Neurologic examination shows no other focal findings. Which of the following is the most likely sequela of this patient's condition?? {'A': 'Blindness', 'B': 'Subarachnoid hemorrhage', 'C': 'Precocious puberty', 'D': 'Diabetic ketoacidosis', 'E': 'Diabetes insipidus\n"'},
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C: Precocious puberty
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Q:A 6-year-old girl is brought to the emergency department with difficulty in breathing. Her parents mention that the child has been experiencing an increasing difficulty in breathing over the past few weeks. It is more prominent when she plays outside in the garden. She has similar episodes about twice a week. She has had a slight difficulty in breathing in the past, but it used to subside once she was rested. During the last month, she has also woken up breathless a couple of times at night, the last episode having occurred last night. A pulmonologist suspects an intermittent obstructive lung disease and orders a pulmonary function test. Her forced expiratory volume is assessed before and after the administration of inhaled albuterol. Her readings are plotted in the graph below. Based on the graph below, which of the following percentage changes in her expiratory volumes would indicate a reversible obstructive pulmonary condition?? {'A': '12%', 'B': '9%', 'C': '50%', 'D': '75%', 'E': '85%'},
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A: 12%
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Answer the following medical question with one of the provided options:
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Q:A 55-year-old man presents to the emergency department with a 3-week history of shortness of breath. It started as exertional only, but progressed and is now present at rest. He says it's worse when he lies down; he has had a couple of episodes of waking up because of this shortness of breath with a choking sensation. He has not had any fever, cough, wheezing, or chest pain, but has noticed new swelling in his legs that has never happened before. He has also noticed that his hands and feet feel ‘weird’. Past medical history is unremarkable and social history is notable for drinking 4 vodka beverages per night for "as long as I can remember." On physical exam, his lungs have crackles up to the mid-lung fields. His bilateral lower extremities have 2+ pitting edema up to the mid-calf and he has jugular venous distension up to the angle of mandible. His bilateral hands and feet have sensory loss to pinprick and light touch with 4/5 strength on handgrip, wrist flexion and extension, ankle plantar flexion, and ankle dorsiflexion. This patient's presentation is most likely related to which of the following micronutrients?? {'A': 'Vitamin A', 'B': 'Vitamin B1', 'C': 'Vitamin B2', 'D': 'Vitamin B3', 'E': 'Vitamin B12'},
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B: Vitamin B1
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Answer the following medical question with one of the provided options:
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Q:A 38-year-old woman presents to the clinic complaining of fatigue and recurrent stomach pain for the past 3 years. She reports an intermittent, dull ache at the epigastric region that is not correlated with food intake. Antacids seem to help a little, but the patient still feels uncomfortable during the episodes. She reports that she has been getting increasingly tired over the past week. The patient denies fevers, chills, nausea, vomiting, melena, hematochezia, or diarrhea but does endorse intermittent abdominal bloating. Her past medical history is significant for type 1 diabetes that is currently managed with an insulin pump. Physical examination demonstrates pale conjunctiva and mild abdominal tenderness at the epigastric region. Laboratory studies are shown below: Leukocyte count: 7,800/mm^3 Segmented neutrophils: 58% Bands: 4% Eosinophils: 2% Basophils: 0% Lymphocytes: 29% Monocytes: 7% Hemoglobin: 10 g/dL Platelet count: 170,000/mm^3 Mean corpuscular hemoglobin concentration: 36 g/dL Mean corpuscular volume: 103 µm^3 Homocysteine: 15 mmol/L (Normal = 4.0 – 10.0 mmol/L) Methylmalonic acid: 0.6 umol/L (Normal = 0.00 – 0.40 umol/L) What substance would you expect to be decreased in this patient?? {'A': 'Gastrin', 'B': 'Helicobacter pylori', 'C': 'Intrinsic factor', 'D': 'Lactase', 'E': 'Lipase'},
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C: Intrinsic factor
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Q:A 42-year-old woman presents to the emergency department complaining of abdominal pain, nausea, and vomiting for the last 4 hours. She says that symptoms onset right after she had 2 generous portions of pizza. She notes that she had prior similar episodes which resolved spontaneously within an hour. However, the pain today has persisted for 5 hours and is much more severe. She says the pain is located in the right upper quadrant of her abdomen and radiates to her upper back. She describes the pain as dull and cramping. She has had hypertension for the past 10 years, managed medically. Her vital signs are a blood pressure of 148/96 mm Hg, a pulse of 108/min, a respiratory rate of 18/min, and a temperature of 37.7°C (99.9°F). Her BMI is 28 kg/m2. On physical examination, the patient appears uncomfortable and is clutching her abdomen in pain. Abdominal exam reveals severe tenderness to palpation in the right upper quadrant with guarding. A positive Murphy’s sign is present. Her serum chemistry levels, including amylase, lipase, bilirubin, and liver function tests and urinalysis are normal. Urine hCG level is < 0.5 IU/L. Abdominal ultrasound reveals a large stone lodged in the neck of the gallbladder. Which of the following is the most likely pathway for referred pain in this patient?? {'A': 'Lumbar plexus and greater splanchnic nerves to the spinal cord', 'B': 'The pain endings of the visceral peritoneum', 'C': 'Right thoraco-abdominal intercostal nerves', 'D': 'Left greater splanchnic nerve', 'E': 'The phrenic nerve'},
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E: The phrenic nerve
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Answer the following medical question with one of the provided options:
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Q:A 44-year-old woman comes to the physician because of progressively worsening shortness of breath with exertion and intermittent palpitations over the last 2 months. She has had neither chest pain nor a cough. Her pulse is 124/min and irregular. Physical examination shows a grade 4/6 high-pitched holosystolic murmur that is best heard at the apex and radiates to the back. The murmur increases in intensity when she clenches her hands into fists. The lungs are clear to auscultation. Further evaluation of this patient is most likely to show which of the following findings?? {'A': 'Pulmonary artery thrombus on computed tomography scan', 'B': 'Diffuse ST elevations on electrocardiogram', 'C': 'Obstruction of the right marginal artery on coronary angiogram', 'D': 'Reversible area of myocardial ischemia on nuclear stress test', 'E': 'Dilation of left atrium on echocardiogram'},
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E: Dilation of left atrium on echocardiogram
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Answer the following medical question with one of the provided options:
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Q:A 41-year-old woman comes to the physician because of bleeding from the nipple of her right breast for 3 months. There is no bleeding from the other breast. Menses occur at regular 30-day intervals and lasts for 5 days with moderate flow. Her last menstrual period was 1 week ago. Her mother died of breast cancer at the age of 53 years. She does not smoke or drink alcohol. She appears healthy. Her temperature is 37°C (98.7°F), pulse is 76/min, and blood pressure is 118/70 mm Hg. Cardiopulmonary examination shows no abnormalities. The abdomen is soft and nontender. Breast examination shows bleeding of the right breast on application of pressure with no palpable mass. The left breast shows no abnormalities. There is no palpable axillary lymphadenopathy. Pelvic examination shows a normal vagina and cervix. Ultrasonography shows a dilated duct enclosing a well-defined solitary mass. Which of the following is the most likely diagnosis?? {'A': 'Invasive ductal carcinoma', 'B': 'Paget disease of the breast', 'C': 'Phyllodes tumor', 'D': 'Papillary carcinoma', 'E': 'Intraductal papilloma'},
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E: Intraductal papilloma
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Answer the following medical question with one of the provided options:
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Q:A 32-year-old man comes to the emergency department for acute pain in the left eye. He reports having awoken in the morning with a foreign body sensation. He had forgotten to remove his contact lenses before sleeping. Following lens removal, he experienced immediate pain, discomfort, and tearing of the left eye. He reports that the foreign body sensation persists and that rinsing with water has not improved the pain. He has been wearing contact lenses for 4 years and occasionally forgets to remove them at night. He has no history of serious medical illness. On examination, the patient appears distressed with pain and photophobia in the left eye. Administration of a topical anesthetic relieves the pain. Visual acuity is 20/20 in both eyes. Ocular motility and pupillary response are normal. The corneal reflex is normal and symmetric in both eyes. Which of the following is most likely to establish the diagnosis in this patient?? {'A': 'Fluorescein examination', 'B': 'Ocular ultrasonography', 'C': 'Gonioscopy', 'D': 'CT scan of the orbit', 'E': 'Cultures of ocular discharge'},
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A: Fluorescein examination
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Q:A 3-year-old male child is found to have a disease involving DNA repair. Specifically, he is found to have a defect in the endonucleases involved in the nucleotide excision repair of pyrimidine dimers. Which of the following is a unique late-stage complication of this child's disease?? {'A': 'Colorectal cancer', 'B': 'Endometrial cancer', 'C': 'Lymphomas', 'D': 'Telangiectasia', 'E': 'Malignant melanoma'},
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E: Malignant melanoma
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Q:A 58-year-old man comes to the physician because of a 3-month history of intermittent pain in his right calf that occurs after walking up more than 2 flights of stairs. He reports that the pain is associated with a tingling sensation and lasts for about 10 minutes. He is otherwise healthy. He has smoked 2 packs of cigarettes daily for 30 years and drinks 1 alcoholic beverage daily. He currently takes no medications. His pulse is 78/min, and blood pressure is 180/110 mm Hg. Physical examination shows yellow plaques below the lower eyelids bilaterally, loss of hair on the distal third of the right leg, and brittle toenails on the right foot. Femoral pulses are palpable bilaterally; right popliteal and pedal pulses are absent. Which of the following is the most appropriate management to prevent future morbidity and mortality of this patient's condition?? {'A': 'Pentoxifylline therapy', 'B': 'Cilostazol therapy', 'C': 'Clopidogrel therapy', 'D': 'Percutaneous transluminal angioplasty', 'E': 'Graded exercise therapy'},
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C: Clopidogrel therapy
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Answer the following medical question with one of the provided options:
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Q:A 36-year-old woman comes to the emergency department because of an itchy lesion on her skin. The rash developed shortly after she took an antibiotic for a urinary tract infection. Her temperature is 37.5°C (99.3°F), pulse is 99/min, and blood pressure is 100/66 mm Hg. Physical examination shows swelling of the face and raised, erythematous plaques on her trunk and extremities. Which of the following is the most likely cause of this patient's current condition?? {'A': 'Deficiency of C1 inhibitor', 'B': 'Activation of complement cascade', 'C': 'Release of a vasoactive amine', 'D': 'Secretion of cytokines by T cells', 'E': 'Deposition of immune complexes'},
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C: Release of a vasoactive amine
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Answer the following medical question with one of the provided options:
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Q:A 10-year-old boy is brought to the physician because of recurring episodes of achy muscle pain in his legs. He has a history of poor school performance despite tutoring and has been held back two grades. He is at the 40th percentile for height and 30th percentile for weight. Examination shows ptosis, a high-arched palate, and muscle weakness in the face and hands; muscle strength of the quadriceps and hamstrings is normal. Sensation is intact. Percussion of the thenar eminence causes the thumb to abduct and then relax slowly. Which of the following is the most likely underlying cause?? {'A': 'Apoptosis of lower motor neurons', 'B': 'Defect of voltage-gated sodium channels of the sarcolemmal membrane', 'C': 'Complete impairment of the dystrophin protein', 'D': 'Humoral immune attack against the endomysial blood vessels', 'E': 'CTG trinucleotide expansion in the DMPK gene'},
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E: CTG trinucleotide expansion in the DMPK gene
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Answer the following medical question with one of the provided options:
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Q:An 80-year-old woman is brought to the emergency department for left hip pain 30 minutes after she fell while walking around in her room. Examination shows left groin tenderness. The range of motion of the left hip is limited because of pain. An x-ray of the hip shows a linear fracture of the left femoral neck with slight posterior displacement of the femur. Which of the following arteries was most likely damaged in the patient's fall?? {'A': 'Deep femoral artery', 'B': 'Medial circumflex femoral', 'C': 'Deep circumflex iliac', 'D': 'Obturator', 'E': 'Superior gluteal artery'},
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B: Medial circumflex femoral
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Answer the following medical question with one of the provided options:
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Q:A 68-year-old woman comes to the physician for evaluation of diminished vision for several months. Twenty-eight years ago, she was diagnosed with systemic lupus erythematosus, which has been well controlled with hydroxychloroquine. Fundoscopic examination shows concentric rings of hypopigmentation and hyperpigmentation surrounding the fovea bilaterally. Visual field examination of this patient is most likely to show which of the following findings?? {'A': 'Bitemporal hemianopia', 'B': 'Right monocular blindness', 'C': 'Paracentral scotoma', 'D': 'Homonymous hemianopia', 'E': 'Binasal hemianopia'},
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C: Paracentral scotoma
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Answer the following medical question with one of the provided options:
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Q:A 54-year-old woman presents for follow-up care for her type 2 diabetes mellitus. She was diagnosed approximately 2 years ago and was treated with dietary modifications, an exercise regimen, metformin, and glipizide. She reports that her increased thirst and urinary frequency has not improved with her current treatment regimen. Her hemoglobin A1c is 8.5% at this visit. She is started on a medication that will result in weight loss but places her at increased risk of developing urinary tract infections and vulvovaginal candidiasis. Which of the following is the mechanism of action of the prescribed medication?? {'A': 'Alpha-glucosidase inhibitor', 'B': 'Dipeptidyl peptidase-4 inhibitor', 'C': 'Glucagon-like protein-1 receptor agonist', 'D': 'Peroxisome proliferator-activated receptor activator', 'E': 'Sodium-glucose co-transporter-2 inhibitor'},
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E: Sodium-glucose co-transporter-2 inhibitor
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Answer the following medical question with one of the provided options:
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Q:A 65-year-old woman presents to a dermatology clinic complaining about a couple of well-demarcated, dark, round skin lesions on her face. She claims she has had these lesions for 3 or 4 years. The lesions are painless, not pruritic, and have never bled. However, she is moderately distressed about the potential malignancy of these lesions after she heard that a close friend was just diagnosed with a melanoma. The medical history is unremarkable. Physical examination reveals a few well-demarcated, round, verrucous lesions, with a stuck-on appearance, distributed on the patient’s back and face (see image). Under a dermatoscope, the lesions showed multiple comodo-openings, milia cysts, and a cerebriform pattern. What is the best next step of management?? {'A': 'Excisional biopsy', 'B': 'Reassure the patient and provide general recommendations', 'C': 'Cryotherapy', 'D': 'Shave excision', 'E': 'Topical fluorouracil'},
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B: Reassure the patient and provide general recommendations
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Answer the following medical question with one of the provided options:
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Q:A 38-year-old woman comes to the physician because of a 1-month history of progressively worsening dyspnea, cough, and hoarseness of voice. Her pulse is 92/min and irregularly irregular, respirations are 20/min, and blood pressure is 110/75 mm Hg. Cardiac examination shows a rumbling mid-diastolic murmur that is best heard at the apex in the left lateral decubitus position. Which of the following is the most likely underlying cause of this patient's condition?? {'A': 'Myxomatous degeneration', 'B': 'Hematogenous spread of bacteria', 'C': 'Antibody cross-reactivity', 'D': 'Sarcomeric gene mutation', 'E': 'Congenital valvular defect'},
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C: Antibody cross-reactivity
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Answer the following medical question with one of the provided options:
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Q:A group of scientists developed a mouse model to study nondisjunction in meiosis. Their mouse model produced gametes in the following ratio: 2 gametes with 24 chromosomes each and 2 gametes with 22 chromosomes each. In which of the following steps of meiosis did the nondisjunction occur?? {'A': 'Metaphase I', 'B': 'Metaphase II', 'C': 'Anaphase I', 'D': 'Anaphase II', 'E': 'Telophase I'},
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C: Anaphase I
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