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Answer the following medical question with one of the provided options:
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Q:A 29-year-old homeless man visits his local walk-in-clinic complaining of shortness of breath, fatigability, malaise, and fever for the past month. His personal history is significant for multiple inpatient psychiatric hospitalizations for a constellation of symptoms that included agitation, diarrhea, dilated pupils, and restless legs. On physical examination, his blood pressure is 126/72 mm Hg, heart rate is 117/min, body temperature is 38.5°C (101.3°F), and saturating 86% on room air. Auscultation reveals a holosystolic murmur that is best heard at the left sternal border and noticeably enhanced during inspiration. What is the underlying pathophysiological mechanism in this patient’s heart condition?? {'A': 'Myxomatous degeneration', 'B': 'Chemical endothelial damage', 'C': 'Verrucous lesions', 'D': 'Fibrillin 1 (FBN1) mutations', 'E': 'Failed delamination'},
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B: Chemical endothelial damage
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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 comes to the emergency department because of a 2-week history of worsening shortness of breath, lower extremity swelling, and a 3-kg (6.6-lb) weight gain. Crackles are heard on auscultation of the chest. Cardiac examination shows a dull, low-pitched early diastolic sound at the 5th left intercostal space that becomes louder in the left lateral decubitus position at end-expiration. Which of the following is the most likely cause of these auscultation findings?? {'A': 'Decreased left myocardial compliance', 'B': 'Increased ventricular contractility', 'C': 'Increased left ventricular end-systolic volume', 'D': 'Decreased left-ventricular filling pressure', 'E': 'Increased capacity of the pulmonary circulation'},
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C: Increased left ventricular end-systolic volume
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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 comes to the physician because of a 2-month history of palpitations, diaphoresis, and a 5-kg (11-lb) weight loss. Her pulse is 101/min and blood pressure is 141/84 mm Hg. Physical examination shows a fine tremor when the fingers are outstretched. After confirmation of the diagnosis, treatment is begun with an antithyroid medication. The physician emphasizes the need for adequate contraception because of the increased risk of severe fetal malformations associated with the use of this medication, which is why its use is discouraged in the first trimester of pregnancy. Which of the following best describes the mechanism of action of this drug?? {'A': 'Suppression of thyroid-stimulating hormone release', 'B': 'Inhibition of thyroid hormone release', 'C': 'Decreased iodide uptake by follicular cells', 'D': 'Inhibition of iodide ion oxidation', 'E': 'Inhibition of peripheral conversion of T4 to T3'},
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D: Inhibition of iodide ion oxidation
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Answer the following medical question with one of the provided options:
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Q:An 18-year-old female college student is brought to the emergency department by ambulance for a headache and altered mental status. The patient lives with her boyfriend who is with her currently. He states she had not been feeling well for the past day and has vomited several times in the past 12 hours. Lumbar puncture is performed in the emergency room and demonstrates an increased cell count with a neutrophil predominance and gram-negative diplococci on Gram stain. The patient is started on vancomycin and ceftriaxone. Which of the following is the best next step in management?? {'A': 'Add ampicillin, dexamethasone, and rifampin to treatment regimen', 'B': 'Add ampicillin to treatment regimen', 'C': 'Add dexamethasone to treatment regimen', 'D': 'Treat boyfriend with ceftriaxone and vancomycin', 'E': 'Treat boyfriend with rifampin'},
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E: Treat boyfriend with rifampin
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Answer the following medical question with one of the provided options:
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Q:A concerned mother presents to clinic stating that her 14-year-old son has not gone through his growth spurt. She states that, although shorter, he had been growing at the same rate as his peers until the past year. There is no evidence of delayed puberty in the mother, but the father's history is unknown. The patient has no complaints. On physical exam, the patient is a healthy-appearing 14-year-old boy whose height is below the third percentile and whose weight is at the 50th percentile. His bone age is determined to be 11 years. A laboratory workup, including thyroid stimulating hormone (TSH), is unremarkable. What is the most likely diagnosis?? {'A': 'Constitutional growth delay', 'B': 'Familial short stature', 'C': 'Hypothyroidism', 'D': 'Celiac disease', 'E': 'Growth hormone deficiency'},
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A: Constitutional growth delay
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Answer the following medical question with one of the provided options:
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Q:A 41-year-old man comes to the emergency department because of fatigue, worsening abdominal discomfort, and progressive swelling of his legs for 3 months. The swelling is worse in the evenings. His only medication is ibuprofen for occasional joint pain. The patient does not smoke and drinks 2–3 beers each weekend. His temperature is 36°C (96.8°F), pulse is 88/min, respirations are 18/min, and blood pressure is 130/80 mm Hg. Pulmonary examination shows no abnormalities. Abdominal examination shows a mildly distended abdomen with shifting dullness. The liver is palpated 2–3 cm below the right costal margin. When pressure is applied to the right upper quadrant, the patient's jugular veins become visibly distended for 15 seconds. The 2nd and 3rd metacarpophalangeal joints of both hands are tender to palpation. There is 2+ edema in the lower extremities. Which of the following is the most likely underlying cause of this patient's edema?? {'A': 'Impaired hepatic protein synthesis', 'B': 'Impaired relaxation of the right ventricle', 'C': 'Reduced glomerular filtration rate', 'D': 'Dermal deposition of glycosaminoglycans', 'E': 'Macrovesicular steatosis of the liver'},
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B: Impaired relaxation of the right ventricle
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Answer the following medical question with one of the provided options:
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Q:A 19-year-old Caucasian male collapsed from sudden cardiac arrest while playing in a college basketball game. Attempts at resuscitation were unsuccessful. Post-mortem pathologic and histologic examination found asymmetric left ventricular hypertrophy and myocardial disarray. Assuming this was an inherited condition, the relevant gene most likely affects which of the following structures?? {'A': 'Cardiac cell sarcomere proteins', 'B': 'Membrane potassium channel proteins', 'C': 'Ryanodine receptors', 'D': 'Autoimmune beta-cell antibodies', 'E': 'Membrane sodium channels'},
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A: Cardiac cell sarcomere proteins
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Answer the following medical question with one of the provided options:
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Q:A 1-year-old infant is brought to the emergency department by his parents because of fever and rapid breathing for the past 2 days. He had a mild seizure on the way to the emergency department and developed altered sensorium. His mother states that the patient has had recurrent respiratory infections since birth. He was delivered vaginally at term and without complications. He is up to date on his vaccines and has met all developmental milestones. His temperature is 37.0°C (98.6°F), pulse rate is 200/min, and respirations are 50/min. He is lethargic, irritable, and crying excessively. Physical examination is notable for a small head, an elongated face, broad nose, low set ears, and cleft palate. Cardiopulmonary exam is remarkable for a parasternal thrill, grade IV pansystolic murmur, and crackles over both lung bases. Laboratory studies show hypocalcemia and lymphopenia. Blood cultures are drawn and broad-spectrum antibiotics are started, and the child is admitted to the pediatric intensive care unit. The intensivist suspects a genetic abnormality and a fluorescence in situ hybridization (FISH) analysis is ordered which shows 22q11.2 deletion. Despite maximal therapy, the infant succumbs to his illness. The parents of the child request an autopsy. Which of the following findings is the most likely to be present on autopsy?? {'A': "Hypertrophy of Hassall's corpuscles", 'B': 'Aplastic thymus', 'C': 'Hypercellular bone marrow', 'D': 'Absent follicles in the lymph nodes', 'E': 'Accessory spleen'},
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B: Aplastic thymus
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Answer the following medical question with one of the provided options:
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Q:A 62-year-old man is brought to the emergency department because of a 4-hour history of abdominal pain, nausea, vomiting, and confusion. His wife reports that he had blurry vision on the way to the hospital. Two weeks ago, he lost his job and since then has been extremely worried about their financial situation and future. He has congestive heart failure and atrial fibrillation well controlled with combination medical therapy. His temperature is 36.5°C (97.7°F), pulse is 57/min and irregular, respirations are 14/min, and blood pressure is 118/63 mm Hg. The patient is oriented only to person. Serum studies show: Na+ 138 mEq/L Cl− 100 mEq/L K+ 5.3 mEq/L HCO3− 25 mEq/L Blood urea nitrogen 14 mg/dL Creatinine 0.9 mg/dL An ECG shows premature ventricular beats. The drug most likely responsible for this patient's symptoms has which of the following mechanisms of action?"? {'A': 'Inhibition of funny channels', 'B': 'Inhibition of Na+-K+-2Cl--cotransporters', 'C': 'Blockade of aldosterone receptors', 'D': 'Inhibition of Na+/K+-ATPase', 'E': 'Blockade of beta-adrenergic receptors'},
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D: Inhibition of Na+/K+-ATPase
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Answer the following medical question with one of the provided options:
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Q:A 3-month-old girl is brought to the physician because of poor feeding, irritability and vomiting for 2 weeks. She was born at 36 weeks' gestation and pregnancy was uncomplicated. She is at 5th percentile for length and at 3rd percentile for weight. Her temperature is 36.8°C (98.2°F), pulse is 112/min and respirations are 49/min. Physical and neurologic examinations show no other abnormalities. Laboratory studies show: Serum Na+ 138 mEq/L K+ 3.1 mEq/L Cl- 115 mEq/L Ammonia 23 μmol/L (N <50 μmol/L) Urine pH 6.9 Blood negative Glucose negative Protein negative Arterial blood gas analysis on room air shows: pH 7.28 pO2 96 mm Hg HCO3- 12 mEq/L Which of the following is the most likely cause of these findings?"? {'A': 'Deficiency of 21β-hydroxylase', 'B': 'Impaired metabolism of branched-chain amino acids', 'C': 'Impaired CFTR gene function', 'D': 'Inability of the distal tubule to secrete H+', 'E': 'Deficiency of ornithine transcarbamylase'},
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D: Inability of the distal tubule to secrete H+
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Answer the following medical question with one of the provided options:
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Q:A 35-year-old woman presents to the emergency room with fever, diarrhea, and dysuria for the past day. She also complains of palpitations, poor concentration, and severe anxiety. She was diagnosed with Graves disease 6 months ago but admits that she has missed some doses of her prescribed medications in the past couple of months due to stress. Her temperature is 103°F (39°C) and pulse is 132/minute. A urine culture is obtained and grows Escherichia coli. Which of the following drugs would be most effective in treating this patient’s acute condition?? {'A': 'Amiodarone', 'B': 'Lithium', 'C': 'Methimazole', 'D': 'Nitrofurantoin', 'E': 'Propanolol'},
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E: Propanolol
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Answer the following medical question with one of the provided options:
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Q:A 9-year-old boy is brought to the emergency department because of progressively worsening shortness of breath for 3 days. He has had fever and malaise for the past 5 days. He had a sore throat 3 weeks ago that resolved without treatment. He appears ill. His temperature is 38.6°C (101.5°F), pulse is 98/min and blood pressure is 84/62 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 93%. Examination shows jugular venous distension and bilateral ankle edema. There are erythematous, ring-shaped macules and patches over his trunk that are well-demarcated. Auscultation of the chest shows crackles at the lung bases bilaterally. An S3 is heard on cardiac auscultation. His hemoglobin concentration is 12.2 g/dL, leukocyte count is 13,600/mm3, and platelet count is 280,000/mm3. A urinalysis is normal. An x-ray of the chest shows cardiac silhouette enlargement with prominent vascular markings in both the lung fields. Which of the following is the most likely etiology of this patient's symptoms?? {'A': 'Acute rheumatic fever', 'B': 'Viral myocarditis', 'C': 'Systemic lupus erythematosus', 'D': 'Infection with Borrelia burgdorferi', 'E': 'Kawasaki disease'},
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A: Acute rheumatic fever
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Answer the following medical question with one of the provided options:
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Q:A 52-year-old woman with type 2 diabetes mellitus comes to the physician because of a 2-day history of blisters on her forearms and pain during sexual intercourse. Her only medications are metformin and glyburide. Examination reveals multiple, flaccid blisters on the volar surface of the forearms and ulcers on the buccal, gingival, and vulvar mucosa. The epidermis on the forearm separates when the skin is lightly stroked. Which of the following is the most likely diagnosis?? {'A': 'Pemphigus vulgaris', 'B': 'Behcet disease', 'C': 'Lichen planus', 'D': 'Dermatitis herpetiformis', 'E': 'Toxic epidermal necrolysis'},
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A: Pemphigus vulgaris
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Answer the following medical question with one of the provided options:
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Q:A 37-year-old woman, gravida 4, para 3, at 35 weeks' gestation is admitted to the hospital in active labor. Her three children were delivered by Cesarean section. One hour after vaginal delivery, the placenta is not delivered. Manual separation of the placenta leads to profuse vaginal bleeding. Her pulse is 122/min and blood pressure is 90/67 mm Hg. A firm, nontender uterine fundus is palpated at the level of the umbilicus. Hemoglobin is 8.3 g/dL and platelet count is 220,000/mm3. Activated partial thromboplastin time and prothrombin time are within normal limits. Which of the following is the most likely underlying mechanism of this patient's postpartum bleeding?? {'A': 'Impaired uterine contractions', 'B': 'Consumption of intravascular clotting factors', 'C': 'Rupture of the uterine wall', 'D': 'Rupture of the fetal vessels', 'E': 'Defective decidual layer of the placenta'},
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E: Defective decidual layer of the placenta
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Answer the following medical question with one of the provided options:
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Q:A 4-year old boy is brought to the emergency department with fever, painful swallowing, headache, and neck spasm that began shortly after waking up. He has had a sore throat over the last week that acutely worsened this morning. He has no history of serious illness and takes no medications. He lives at home with his mother. His older brother has asthma. His immunizations are up-to-date. He appears acutely ill. His temperature is 38.4°C (101.2°F), pulse is 95/min, respirations are 33/min, and blood pressure is 93/60 mm Hg. Examination shows drooling. The neck is stiff and extension is limited. Respirations appear labored with accessory muscle use. Inspiratory stridor is heard on auscultation of the chest. Cardiac examination shows no abnormalities. Oropharyngeal examination shows a bulge in the posterior pharyngeal wall. Intravenous access is obtained and laboratory studies are ordered. Which of the following is the most appropriate next step in the management of this patient?? {'A': 'Endotracheal intubation', 'B': 'IV antibiotics', 'C': 'Blood cultures', 'D': 'IV corticosteroids', 'E': 'Nebulized albuterol'},
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A: Endotracheal intubation
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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 is brought to the emergency department by her daughter for fever and cough. She just returned from a cruise trip to the Bahamas with her family 5 days ago and reports that she has been feeling ill since then. She endorses fever, productive cough, and general malaise. Her daughter also mentions that the patient has been having some diarrhea but reports that the rest of her family has been experiencing similar symptoms. Physical examination was significant for localized crackles at the right lower lobe. Laboratory findings are as follows: Serum Na+: 130 mEq/L K+: 3.9 mEq/L Cl-: 98 mEq/L HCO3-: 27 mEq/L Mg2+: 1.8 mEq/L What findings would you expect in this patient?? {'A': 'Broad-based budding on fungal sputum culture', 'B': 'High titers of cold agglutinins', 'C': 'Gram-negative rod on chocolate agar with factors V and X', 'D': 'Gram-negative on silver stain', 'E': 'Gram-positive diplococci on Gram stain'},
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D: Gram-negative on silver stain
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Answer the following medical question with one of the provided options:
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Q:A 26-year-old G1P0 woman presents for her first prenatal visit. Past medical history reveals the patient is blood type O negative, and the father is type A positive. The patient refuses Rho(D) immune globulin (RhoGAM), because it is derived from human plasma, and she says she doesn’t want to take the risk of contracting HIV. Which of the following is correct regarding the potential condition her baby may develop?? {'A': 'Rho(D) immune globulin is needed both before and immediately after delivery to protect this baby from developing the condition', 'B': 'She should receive Rho(D) immune globulin to prevent the development of ABO incompatibility', 'C': 'She should receive Rho(D) immune globulin to prevent the development of Rh(D) alloimmunization', 'D': 'The Rho(D) immune globulin will also protect the baby against other Rh antigens aside from Rh(D)', 'E': 'The injection can be avoided because the risk of complications of this condition is minimal'},
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C: She should receive Rho(D) immune globulin to prevent the development of Rh(D) alloimmunization
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Answer the following medical question with one of the provided options:
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Q:An otherwise healthy 18-year-old girl comes to the physician because of a 1-year history of severe acne vulgaris over her face, upper back, and arms. Treatment with oral antibiotics and topical combination therapy with benzoyl peroxide and retinoid has not completely resolved her symptoms. Examination shows oily skin with numerous comedones, pustules, and scarring over the face and upper back. Long-term therapy is started with combined oral contraceptives. This medication significantly reduces the risk of developing which of the following conditions?? {'A': 'Endometrial cancer', 'B': 'Deep vein thrombosis', 'C': 'Hypertension', 'D': 'Malignant melanoma', 'E': 'Hepatic adenoma'},
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A: Endometrial cancer
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Answer the following medical question with one of the provided options:
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Q:A 25-year-old man presents to the emergency department complaining of palpitations, lightheadedness, and sweating. He just started working at an investment firm and has been working long hours to make a good impression. Today, he had a dozen cups of espresso to keep himself awake and working. He has never had such an episode before. His past medical history is unremarkable. His pulse is 150/min, blood pressure is 134/88 mm Hg, respirations are 12/min, and temperature is 36.7°C (98.0°F). ECG shows supraventricular tachycardia with sinus rhythm. Which of the following is the next best step in the management of this patient?? {'A': 'Adenosine infusion', 'B': 'Drinking coffee', 'C': 'Dipping his face in warm water', 'D': 'Synchronized cardioversion', 'E': 'Valsalva maneuver'},
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E: Valsalva maneuver
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Answer the following medical question with one of the provided options:
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Q:An 80-year-old African American male presents complaining of worsening shortness of breath that occurs during his weekly round of golf. He also notes he has been waking up at night "choking and gasping for air", though he has been able to gain some relief by propping his head on a stack of pillows before he goes to bed. Upon auscultation, a low frequency, early diastolic gallop is heard over the apex while the patient rests in the left lateral decubitus position. This finding is most consistent with which of the following?? {'A': 'Right atrial hypertrophy', 'B': 'Left atrial hypertrophy', 'C': 'Left ventricular concentric hypertrophy', 'D': 'Left ventricular eccentric hypertrophy', 'E': 'Mitral stenosis'},
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D: Left ventricular eccentric hypertrophy
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Answer the following medical question with one of the provided options:
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Q:A 25-year-old primigravida woman at 35 weeks estimated gestational age presents with a headache for the past 5 hours. She describes the headache as severe and incapacitating and showing no response to acetaminophen. In the emergency department, her blood pressure is found to be 150/100 mm Hg, pulse is 88/min, respiratory rate is 30/min, and temperature is 37.0°C (98.6°F). Her records show that her blood pressure was the same yesterday during her regular antenatal visit. Chest auscultation reveals bilateral crackles along the lung base. Abdominal examination reveals a gravid uterus consistent with a gestational age of 32 weeks and a floating fetus in a cephalic presentation. Pelvic examination is performed which shows a closed firm cervix with no evidence of bleeding or discharge. Moderate pitting edema is noted and neurologic examination shows generalized hyperreflexia. Laboratory findings are significant for the following: Hemoglobin 12.5 g/dL Platelets 185,000/μL Serum creatinine 0.4 mg/dL Spot urine creatinine 110 mg/dL Spot urine protein 360 mg/dL AST 40 IU/L Which of the following is the most likely diagnosis in this patient?? {'A': 'HELLP syndrome', 'B': 'Preeclampsia with severe features', 'C': 'Preeclampsia without severe features', 'D': 'Eclampsia', 'E': 'Gestational hypertension'},
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B: Preeclampsia with severe features
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Answer the following medical question with one of the provided options:
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Q:A 47-year-old taxi driver visits an ophthalmologist after failing a routine eye test for his driver’s license renewal. The patient reports a slight blurring of his vision, headaches, and occasional dizziness for the past month. On further questioning, he admits to feeling tired and out of sorts most of the time. He attributes it to working overtime and experiencing stress at home. He also complains of decreased libido, decreased appetite, and some weight loss over the past 2 months. There is no history of cold intolerance or hoarseness of voice. On examination, the patient appears malnourished. His vital signs are within normal limits. On physical examination, his thyroid gland is firm and normal in size. Genital examination reveals small, soft testes with patchy pubic hair. Ophthalmic examination reveals decreased visual acuity. The visual field of the patient is shown in the image (black indicates loss of vision while white indicates full vision). His laboratory results are significant for decreased serum ACTH, decreased serum cortisol, normal serum TSH, normal serum T4, decreased serum LH, decreased serum FSH, and decreased serum GH. On suspicions raised by the patient’s physical examination and lab studies, the clinician orders a brain MRI. The scan shows a pituitary macroadenoma impinging on and displacing the optic chiasm. Which of the following is the most likely diagnosis?? {'A': 'Hypothyroidism', 'B': 'Hypogonadism', 'C': 'Adrenal insufficiency', 'D': 'Hypopituitarism', 'E': 'Functional pituitary macroadenoma'},
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D: Hypopituitarism
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Answer the following medical question with one of the provided options:
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Q:A 75 year-old gentleman presents to the primary care physician with a 2 week history of right sided achilles tendon pain. He states that the pain has had a gradual onset and continues to worsen, now affecting the left side for the past 2 days. He denies any inciting event. Of note the patient performs self-catheterization for episodes of urinary retention and has been treated on multiple occasions for recurrent urinary tract infections. What is the most important next step in management for this patient's achilles tendon pain?? {'A': 'Refer patient to an orthopedic surgeon', 'B': 'Switch medication and avoid exercise', 'C': 'Place permanent urinary catheter', 'D': 'Perform MRI', 'E': 'Perform CT scan'},
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B: Switch medication and avoid exercise
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Answer the following medical question with one of the provided options:
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Q:A 30-year-old man comes to the clinic with complaints of increased frequency of urination, especially at night, for about a month. He has to wake up at least 5-6 times every night to urinate and this is negatively affecting his sleep. He also complains of increased thirst and generalized weakness. Past medical history is significant for bipolar disorder. He is on lithium which he takes regularly. Blood pressure is 150/90 mm Hg, pulse rate is 80/min, respiratory rate is 16/min, and temperature is 36°C (96.8°F). Physical examination is normal. Laboratory studies show: Na+: 146 mEq/L K+: 3.8 mEq/L Serum calcium: 9.5 mg/dL Creatinine: 0.9 mg/dL Urine osmolality: 195 mOsm/kg Serum osmolality: 305 mOsm/kg Serum fasting glucose: 90 mg/dL Which of the following is the best initial test for the diagnosis of his condition?? {'A': 'MRI scan of brain', 'B': 'CT thorax', 'C': 'Chest X-ray', 'D': 'Water deprivation test', 'E': 'Serum ADH level'},
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D: Water deprivation test
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Answer the following medical question with one of the provided options:
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Q:A 32-year-old woman, gravida 2, para 1, at 20 weeks' gestation comes to the physician for a prenatal visit. She feels well. Her first pregnancy was uncomplicated and the child was delivered vaginally. Medications include folic acid and an iron supplement. Her temperature is 37°C (98.6°F), pulse is 98/min, respirations are 18/min, and blood pressure is 108/76 mm Hg. Abdominal examination shows a uterus that is consistent with a 20-week gestation. The second-trimester scan shows no abnormalities. The patient intends to travel next month to Mozambique to visit her grandmother. Which of the following drugs is most suitable for pre-exposure prophylaxis against malaria?? {'A': 'Doxycycline', 'B': 'Mefloquine', 'C': 'Primaquine', 'D': 'Proguanil', 'E': 'Chloroquine'},
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B: Mefloquine
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Answer the following medical question with one of the provided options:
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Q:A 38-year-old man comes to the physician because of white lesions in his mouth for 4 days. He also has intense pain while chewing food. He was diagnosed with non-Hodgkin lymphoma around 8 months ago. He is undergoing chemotherapy and is currently on his fourth cycle. He was treated for herpes labialis 4 months ago with acyclovir. He has smoked half a pack of cigarettes daily for 15 years. He appears healthy. Vital signs are within normal limits. Cervical and axillary lymphadenopathy is present. Oral examination shows white plaques on his tongue and buccal mucosa that bleed when scraped off. The remainder of the examination shows no abnormalities. Which of the following is the next best step in management?? {'A': 'Intravenous fluconazole', 'B': 'Culture of the lesions', 'C': 'Topical nystatin', 'D': 'Biopsy of a lesion', 'E': 'Topical corticosteroids'},
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C: Topical nystatin
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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 comes to the physician because of a 2-day history of a pruritic rash on both arms. He returned from a 2-week hiking trip in North Carolina 1 day ago. He has ulcerative colitis. He works as a landscape architect. His only medication is a mesalazine suppository twice daily. He has smoked a pack of cigarettes daily for 4 years and drinks one alcoholic beverage daily. He does not use illicit drugs. His temperature is 36.8°C (98.2°F), pulse is 65/min, respirations are 16/min, and blood pressure is 127/74 mm Hg. A photograph of the rash is shown. The remainder of the examination shows no abnormalities. Which of the following is the most appropriate next step in management?? {'A': 'Administer oral ivermectin', 'B': 'Counsel patient on alcohol intake', 'C': 'Apply topical calamine preparation', 'D': 'Administer oral prednisone', 'E': 'Administer oral cetirizine'},
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C: Apply topical calamine preparation
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Answer the following medical question with one of the provided options:
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Q:A 24-year-old man comes to the emergency department because of progressive shortness of breath and intermittent cough with blood-tinged sputum for the past 10 days. During this time, he had three episodes of blood in his urine. Six years ago, he was diagnosed with latent tuberculosis after a positive routine tuberculin skin test, and he was treated accordingly. His maternal aunt has systemic lupus erythematosus. The patient does not take any medications. His temperature is 37°C (98.6°F), pulse is 92/min, respirations are 28/min, and blood pressure is 152/90 mm Hg. Diffuse crackles are heard at both lung bases. Laboratory studies show: Serum Urea nitrogen 32 mg/dL Creatinine 3.5 mg/dL Urine Protein 2+ Blood 3+ RBC casts numerous WBC casts negative A chest x-ray shows patchy, pulmonary infiltrates bilaterally. A renal biopsy in this patient shows linear deposits of IgG along the glomerular basement membrane. Which of the following is the most likely diagnosis?"? {'A': 'Goodpasture syndrome', 'B': 'Granulomatosis with polyangiitis', 'C': 'Reactivated tuberculosis', 'D': 'Microscopic polyangiitis', 'E': 'Lupus nephritis\n"'},
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A: Goodpasture syndrome
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Answer the following medical question with one of the provided options:
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Q:A 24-year-old male presents to the emergency room with a cough and shortness of breath for the past 3 weeks. You diagnose Pneumocystis jiroveci pneumonia (PCP). An assay of the patient's serum reveals the presence of viral protein p24. Which of the following viral genes codes for this protein?? {'A': 'gag', 'B': 'pol', 'C': 'env', 'D': 'tat', 'E': 'rev'},
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A: gag
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Answer the following medical question with one of the provided options:
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Q:A 40-year-old South Asian male presents to a primary care provider complaining of a chronic cough that is worse at night. Through a translator, he reports that he has had the cough for several years but that it has been getting worse over the last few months. He recently moved to the United States to work in construction. He attributes some weight loss of ten pounds in the last three months along with darker stools to difficulties adjusting to a Western diet. He denies any difficulty swallowing or feeling of food getting stuck in his throat. He drinks alcohol once or twice per week and has never smoked. He denies any family history of cancer. On physical exam, his lungs are clear to auscultation bilaterally without wheezing. His abdomen is soft and non-distended. He has no tenderness to palpation, and bowel sounds are present. He expresses concern that he will be fired from work if he misses a day and requests medication to treat his cough. Which of the following is the best next step in management?? {'A': 'Trial of lansoprazole', 'B': 'Helicobacter pylori stool antigen test', 'C': 'Barium swallow', 'D': 'Upper endoscopy', 'E': 'Colonoscopy'},
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D: Upper endoscopy
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Q:A 46-year-old man is brought to the emergency department for the onset of severe pain in his right knee that occurred when he tripped while descending a staircase. As he landed, he heard and felt an immediate popping sensation in his right knee. His medical history is positive for obesity, hypertension, type 2 diabetes mellitus, severe asthma, and hyperlipidemia. He currently takes lisinopril, hydrochlorothiazide, metformin, atorvastatin, an albuterol inhaler, and a fluticasone inhaler. He recently completed a hospitalization and week-long regimen of systemic corticosteroids for a severe exacerbation of his asthma. The patient’s family history is not significant. In the emergency department, his vital signs are normal. On physical examination, his right knee is warm and swollen and he rates the pain as 9/10. He cannot stand or walk due to pain. He is unable to extend his right leg or flex his right thigh. A knee X-ray is ordered. Which of the following would best describe the cause of this presenting condition?? {'A': 'Meniscal tear', 'B': 'Femoral fracture', 'C': 'Quadriceps tendon tear', 'D': 'Avascular necrosis of the femur', 'E': 'Traction apophysitis of the tibia'},
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C: Quadriceps tendon tear
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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 presents with hypertension that has been difficult to control with medications. His symptoms include fatigue, frequent waking at night for voiding, and pins and needles in the legs. His symptoms started 2 years ago. Family history is positive for hypertension in his mother. His blood pressure is 160/100 mm Hg in the right arm and 165/107 mm Hg in the left arm, pulse is 85/min, and temperature is 36.5°C (97.7°F). Physical examination reveals global hyporeflexia and muscular weakness. Lab studies are shown: Serum sodium 147 mEq/L Serum creatinine 0.7 mg/dL Serum potassium 2.3 mEq/L Serum bicarbonate 34 mEq/L Plasma renin activity low Which of the following is the most likely diagnosis?? {'A': 'Cushing syndrome', 'B': 'Essential hypertension', 'C': 'Coarctation of aorta', 'D': 'Primary aldosteronism', 'E': 'Renal artery stenosis'},
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D: Primary aldosteronism
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Q:A 16-year-old girl is brought to the physician because of a 6-month history of menstrual cramps, heavy menstrual flow, and fatigue; she has gained 5 kg (11 lb) during this period. Menses occur at regular 30-day intervals and last 8 to 10 days; during her period she uses 7 tampons a day and is unable to participate in any physical activities because of cramping. Previously, since menarche at the age of 11 years, menses had lasted 4 to 5 days with moderate flow. Her last menstrual period was 3 weeks ago. She has limited scleroderma with episodic pallor of the fingertips. She takes no medications. She is 160 cm (5 ft 3 in) tall and weighs 77 kg (170 lb); BMI is 30 kg/m2. Her temperature is 36.5°C (97.7°F), pulse is 56/min, respirations are 16/min, and blood pressure is 100/65 mm Hg. Physical examination shows a puffy face with telangiectasias and thinning of the eyebrows. Deep tendon reflexes are 1+ bilaterally with delayed relaxation. Pelvic examination shows a normal appearing vagina, cervix, uterus, and adnexa. Further evaluation of this patient is most likely to show which of the following findings?? {'A': 'Elevated TSH', 'B': 'Prolonged aPTT', 'C': 'Elevated midnight cortisol', 'D': 'Elevated LH:FSH ratio', 'E': 'Elevated androgens'},
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A: Elevated TSH
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Q:A 74-year-old man comes to the physician for evaluation of a skin lesion on his right arm. The lesion first appeared 3 months ago and has since been slowly enlarging. Physical examination shows a 1.5-centimeter, faintly erythematous, raised lesion with irregular borders on the dorsum of the right forearm. A biopsy specimen is obtained. If present, which of the following histopathological features would be most consistent with carcinoma in situ?? {'A': 'Pleomorphism of cells in the stratum corneum', 'B': 'Irreversible nuclear changes in the stratum basale', 'C': 'Full-thickness basal to apical cell polarity', 'D': 'Increased nuclear to cytoplasmic ratio in the stratum spinosum', 'E': 'Presence of epithelial cells in the dermis'},
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B: Irreversible nuclear changes in the stratum basale
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Q:An 8-year-old boy presents to his primary care pediatrician for routine check-up. During the visit, his mom says that she has noticed yellow bumps on his eyelids and was concerned about whether they were a problem. Upon hearing this concern, the physician inquires about parental health studies and learns that both parents have high cholesterol despite adhering to a statin regimen. Furthermore, other family members have suffered early myocardial infarctions in their 30s. Physical exam reveals flat yellow patches on the patient's eyelids bilaterally as well as hard yellow bumps around the patient's ankles. Based on clinical suspicion an LDL level is obtained and shows a level of 300 mg/dL. What protein is most likely defective in this patient causing these findings?? {'A': 'Lipoprotein lipase', 'B': 'LDL receptor', 'C': 'VLDL receptor', 'D': 'Apoprotein B48', 'E': 'Apoprotein E'},
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B: LDL receptor
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Q:A 6-year-old boy is brought to a primary care provider by his adoptive parents for evaluation of a 3-month history of jaw swelling. He has a travel history of recent immigration from equatorial Africa where his deceased mother was positive for HIV and died from related complications. On physical exam, extensive lymph node swelling on the left side of his jaw is noted. There is also an ulceration that appears to be infected. Fine needle biopsy of the lymph node yields a diagnosis of Burkitt’s lymphoma by the pathologist. Which of the following is most likely associated with the involvement of lymph nodes around his jaw?? {'A': 'Infected ulcer', 'B': 'Close family member with HIV', 'C': 'Recent immigration from equatorial Africa', 'D': 'Gender of the patient', 'E': 'Ethnicity of the patient'},
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C: Recent immigration from equatorial Africa
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Q:A 34-year-old woman visits a fertility clinic with her husband with concerns about their inability to conceive their first child. Originally from India, she met her present husband during a humanitarian mission in Nepal 10 years ago. In addition, she reports a long history of vague lower abdominal pain along with changes in her menstrual cycle such as spotting and irregular vaginal bleeding with passage of clots for the past few months. The patient denies pain during intercourse, postcoital bleeding, foul-smelling vaginal discharge, fever, and weight loss. Her physical examination is unremarkable with no signs of acute illness. During the physical examination, a healthy vagina and mild bleeding from the cervix are noted. The patient is subjected to a hysterosalpingogram as part of her infertility evaluation, which shows sinus formation and peritubal adhesions. Subsequently, a sample of menstrual fluid is taken to the microbiology lab. Which of the following pathogens is more likely to be the cause of this patient’s complaints?? {'A': 'Neisseria gonorrhoeae', 'B': 'Chlamydia trachomatis', 'C': 'Streptococcus agalactiae', 'D': 'Mycoplasma genitalium', 'E': 'Mycobacterium tuberculosis'},
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E: Mycobacterium tuberculosis
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Q:A 78-year-old woman is brought to the emergency department after she fell while gardening and experienced severe pain in her right arm. She has a history of well controlled hypertension and has been found to have osteoporosis. On presentation she is found to have a closed midshaft humerus fracture. No other major findings are discovered on a trauma survey. She is placed in a coaptation splint. The complication that is most associated with this injury has which of the following presentations?? {'A': 'Elbow flexion deficits', 'B': 'Flattened deltoid', 'C': 'Hand of benediction', 'D': 'Hypothenar atrophy', 'E': 'Wrist drop'},
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E: Wrist drop
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Q:A 17-year-old girl is brought to her pediatrician by her mother for a wellness checkup. The patient states she is doing well in school and has no concerns. She has a past medical history of anxiety and is currently taking clonazepam as needed. Her family history is remarkable for hypertension in her mother and father and renal disease in her grandparents and aunt. Her temperature is 98.6°F (37.0°C), blood pressure is 97/68 mmHg, pulse is 90/min, respirations are 9/min, and oxygen saturation is 99% on room air. The patient's BMI is 23 kg/m^2. Cardiac, pulmonary, and neurological exams are within normal limits. Laboratory values are ordered as seen below. Hemoglobin: 10 g/dL Hematocrit: 29% Leukocyte count: 6,500/mm^3 with normal differential Platelet count: 190,000/mm^3 Serum: Na+: 137 mEq/L Cl-: 97 mEq/L K+: 3.5 mEq/L HCO3-: 29 mEq/L BUN: 20 mg/dL Glucose: 67 mg/dL Creatinine: 1.1 mg/dL Ca2+: 10.2 mg/dL Urine: pH: 4.5 Color: yellow Glucose: none Chloride: 4 mEq/L Sodium: 11 mEq/L Which of the following is the most likely diagnosis?? {'A': 'Anorexia nervosa', 'B': 'Bartter syndrome', 'C': 'Bulimia nervosa', 'D': 'Diuretic abuse', 'E': 'Gitelman syndrome'},
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C: Bulimia nervosa
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Q:A 2-year-old girl is brought to the emergency department in the middle of the night because of difficulties breathing. Her parents say that the breathing noises have become progressively worse throughout the day and are mainly heard when she inhales. They say that a change in posture does not seem to have any effect on her breathing. For the last three days, she has also had a runny nose and a harsh cough. She has not had hemoptysis. The parents are worried she may have accidentally swallowed something while playing with her toys, since she tends to put small things in her mouth. Her immunizations are up-to-date. She appears lethargic, and high-pitched wheezing is heard at rest during inhalation. Her skin tone is normal. Her temperature is 38.7°C (101.7°F), pulse is 142/min, respirations are 33/min, and blood pressure is 110/70 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 97%. Examination shows supraclavicular and intercostal retractions. There is diminished air movement bilaterally. An x-ray of the neck and upper chest is shown. Which of the following is the most appropriate next step in management?? {'A': 'Noninvasive ventilation', 'B': 'Nebulized epinephrine', 'C': 'Albuterol and ipratropium inhaler', 'D': 'Nebulized glucocorticoids', 'E': 'Reassurance'},
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B: Nebulized epinephrine
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Q:A 25-year-old male presents to his primary care physician with a chief complaint of anxiety and fatigue. The patient states that during this past week he has had final exams and has been unable to properly study and prepare because he is so exhausted. He states that he has been going to bed early but has been unable to get a good night’s sleep. The patient admits to occasional cocaine and marijuana use. Otherwise, the patient has no significant past medical history and is not taking any medications. On physical exam you note a tired and anxious appearing young man. His neurological exam is within normal limits. The patient states that he fears he will fail his courses if he does not come up with a solution. Which of the following is the best initial step in management?? {'A': 'Zolpidem', 'B': 'Alprazolam', 'C': 'Melatonin', 'D': 'Sleep hygiene education', 'E': 'Polysomnography'},
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D: Sleep hygiene education
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Q:A 51-year-old woman comes to the physician because of a persistent cough and a 5-kg (11-lb) weight loss over the past 2 months. Yesterday, she coughed up bloody sputum. She does not smoke. Pulmonary examination shows decreased breath sounds over the right upper lobe. A CT scan of the chest shows a mass in the periphery of the right upper lobe. Histopathologic examination of a specimen obtained on CT-guided biopsy shows glandular cells with papillary components and signet ring cells that stain positive for mucin. An activating mutation of which of the following genes is most likely to have occurred in this patient?? {'A': 'TP53', 'B': 'ALK', 'C': 'APC', 'D': 'SMAD4 (DPC4)', 'E': 'MYCL1'},
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B: ALK
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Q:A 26-year-old woman is brought to the ED by her fiance with cyanosis and shortness of breath. Gradually over the last few days she has also experienced headaches, fatigue, and dizziness. Her past medical history is significant only for mild anemia attributed to menorrhagia, for which she takes an iron supplement. Per her fiance, she was recently laid-off, but is very excited about her new entrepreneurial endeavor of selling silk scarfs that she dyes in their basement. She is afebrile, tachypneic, and tachycardic, and her oxygen saturation is 85% on room air, which seems high for her perceived degree of cyanosis. An arterial blood gas is drawn and the patient's blood is chocolate-colored. After a few minutes on 6 liters nasal canula, her oxygen saturation is still 85%. In addition to maintaining her airway, breathing, and circulation, what treatment should this patient also receive?? {'A': 'Sodium bicarbonate', 'B': 'Pralidoxime', 'C': 'Deferoxamine', 'D': 'Dimercaprol', 'E': 'Methylene blue'},
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E: Methylene blue
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Q:A 45-year-old woman comes to the clinic for complaints of abdominal pain and repeated watery stools for the past 2 days. She has a history of bowel complaints for the past 2 years consisting of periods of intermittent loose stools followed by the inability to make a bowel movement. Her past medical history is significant for diabetes controlled with metformin. She denies any abnormal oral intake, weight loss, fever, nausea/vomiting, or similar symptoms in her family. When asked to describe her stool, she reports that “it is just very watery and frequent, but no blood.” The physician prescribes a medication aimed to alleviate her symptoms. What is the most likely mechanism of action of this drug?? {'A': 'D2 receptor antagonist', 'B': 'Enteric nerve stimulation', 'C': 'PGE1 analog', 'D': 'Substance P antagnoist', 'E': 'mu-opioid receptor agonist'},
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E: mu-opioid receptor agonist
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Q:A 37-year-old woman presents to the clinic to discuss various options for contraception. The patient has a past medical history of hypertension, Wilson’s disease, and constipation-dominant irritable bowel syndrome. The patient takes rivaroxaban and polyethylene glycol. The blood pressure is 152/98 mm Hg. On physical examination, the patient appears alert and oriented. The heart auscultation demonstrates regular rate and rhythm, and it is absent of murmurs. The lungs are clear to auscultation bilaterally without wheezing. The first day of the last menstrual period was 12 days ago. The urine hCG is negative. Given the patient’s history and physical examination, which of the following options form of contraception is the most appropriate?? {'A': 'Levonorgestrel', 'B': 'Ethinyl estradiol', 'C': 'Copper IUD', 'D': 'levonorgestrel/ethinyl estradiol', 'E': 'Depot-medroxyprogesterone acetate'},
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A: Levonorgestrel
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Q:A 21-year-old college student comes to the physician for intermittent palpitations. She does not have chest pain or shortness of breath. The symptoms started 2 days ago, on the night after she came back to her dormitory after a 4-hour-long bus trip from home. A day ago, she went to a party with friends. The palpitations have gotten worse since then and occur more frequently. The patient has smoked 5 cigarettes daily for the past 3 years. She drinks 4–6 alcoholic beverages with friends once or twice a week and occasionally uses marijuana. She is sexually active with her boyfriend and takes oral contraceptive pills. She does not appear distressed. Her pulse is 100/min and irregular, blood pressure is 140/85 mm Hg, and respirations are at 25/min. Physical examination shows a fine tremor in both hands, warm extremities, and swollen lower legs. The lungs are clear to auscultation. An ECG is shown below. Which of the following is the most appropriate next step in management?? {'A': 'Measure TSH levels', 'B': 'Observe and wait', 'C': 'Administer intravenous adenosine', 'D': 'Measure D-Dimer levels', 'E': 'Send urine toxicology'},
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A: Measure TSH levels
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Q:A 58-year-old man with a 10-year history of type 2 diabetes mellitus and hypertension comes to the physician for a routine examination. Current medications include metformin and captopril. His pulse is 84/min and blood pressure is 120/75 mm Hg. His hemoglobin A1c concentration is 9.5%. The physician adds repaglinide to his treatment regimen. The mechanism of action of this agent is most similar to that of which of the following drugs?? {'A': 'Linagliptin', 'B': 'Glyburide', 'C': 'Metformin', 'D': 'Pioglitazone', 'E': 'Miglitol'},
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B: Glyburide
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Q:A 27-year-old woman with a past medical history of rheumatoid arthritis and severe anemia of chronic disease presents to the emergency department for nausea, vomiting, and abdominal pain that started this morning. She has been unable to tolerate oral intake during this time. Her blood pressure is 107/58 mmHg, pulse is 127/min, respirations are 15/min, and oxygen saturation is 99% on room air. Physical exam is notable for left lower quadrant abdominal pain upon palpation. A urine pregnancy test is positive, and a serum beta-hCG is 1,110 mIU/mL. A transvaginal ultrasound demonstrates no free fluid and is unable to identify an intrauterine pregnancy. The patient states that she intends to have children in the future. Which of the following is the best next step in management?? {'A': 'CT scan of the abdomen', 'B': 'Methotrexate', 'C': 'Repeat beta-hCG in 2 days', 'D': 'Salpingectomy', 'E': 'Salpingostomy'},
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C: Repeat beta-hCG in 2 days
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Q:A 21-year-old male presents to the emergency department with generalized weakness and fatigue. His past medical history is significant for hypertension refractory to several medications but is otherwise unremarkable. He is afebrile,his pulse is 82/min, respirations are 18/min, and blood pressure is 153/94 mmHg. Labs are as follows: Sodium: 142 mEq/L Potassium: 2.7 mEq/L Bicarbonate: 36 mEq/L Serum pH: 7.5 pCO2: 50 mmHg Aldosterone: Decreased Based on clinical suspicion, a genetic screen is performed, confirming an underlying syndrome due to an autosomal dominant gain of function mutation. Which of the following medications can be given to treat the most likely cause of this patient's symptoms?? {'A': 'Acetazolamide', 'B': 'Amiloride', 'C': 'Loop diuretics', 'D': 'Mannitol', 'E': 'Thiazide diuretics'},
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B: Amiloride
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Q:A 69-year-old woman comes to the clinic for an annual well exam. She reports no significant changes to her health except for an arm fracture 3 weeks ago while she was lifting some heavy bags. Her diabetes is well controlled with metformin. She reports some vaginal dryness that she manages with adequate lubrication. She denies any weight changes, fevers, chills, palpitations, nausea/vomiting, incontinence, or bowel changes. A dual-energy X-ray absorptiometry (DEXA) scan was done and demonstrated a T-score of -2.7. She was subsequently prescribed a selective estrogen receptor modulator, in addition to vitamin and weight-bearing exercises, for the management of her symptoms. What is the mechanism of action of the prescribed medication?? {'A': 'Estrogen agonist in bone and breast', 'B': 'Estrogen antagonist in breast and agonist in bone', 'C': 'Estrogen antagonist in cervix and agonist in bone', 'D': 'Partial estrogen agonist in bone and antagonist in cervix', 'E': 'Partial estrogen agonist in endometrium and bone'},
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B: Estrogen antagonist in breast and agonist in bone
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Q:A 35-year-old female comes to the physician because of a 2-year history of progressive fatigue and joint pain. She has a 1-year history of skin problems and a 4-month history of episodic pallor of her fingers. She reports that the skin of her face, neck, and hands is always dry and itchy; there are also numerous “red spots” on her face. She has become more “clumsy” and often drops objects. She has gastroesophageal reflux disease treated with lansoprazole. She does not smoke. She occasionally drinks a beer or a glass of wine. Her temperature is 36.5°C (97.7°F), blood pressure is 154/98 mm Hg, and pulse is 75/min. Examination shows hardening and thickening of the skin of face, neck, and hands. There are small dilated blood vessels around her mouth and on her oral mucosa. Mouth opening is reduced. Active and passive range of motion of the proximal and distal interphalangeal joints is limited. Cardiopulmonary examination shows no abnormalities. Her creatinine is 1.4 mg/dL. The patient is at increased risk for which of the following complications?? {'A': 'Dental caries', 'B': 'Antiphospholipid syndrome', 'C': 'Lung cancer', 'D': 'Urolithiasis', 'E': 'Dactylitis'},
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C: Lung cancer
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Q:A 45-year-old man comes to the physician because of bright red blood in his stool for 5 days. He has had no pain during defecation and no abdominal pain. One year ago, he was diagnosed with cirrhosis after being admitted to the emergency department for upper gastrointestinal bleeding. He has since cut down on his drinking and consumes around 5 bottles of beer daily. Examination shows scleral icterus and mild ankle swelling. Palpation of the abdomen shows a fluid wave and shifting dullness. Anoscopy shows enlarged bluish vessels above the dentate line. Which of the following is the most likely source of bleeding in this patient?? {'A': 'Superior rectal vein', 'B': 'Inferior mesenteric artery', 'C': 'Inferior rectal vein', 'D': 'Internal iliac vein', 'E': 'Middle rectal artery'},
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A: Superior rectal vein
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Q:An 11-year-old girl presents to her primary care physician because she has been having difficulty hearing her teachers at school. She says that the difficulty hearing started about a year ago, and it has slowly been getting worse. Her past medical history is significant for multiple fractures in both her upper and lower extremities. She also recently had a growth spurt and says that her friends say she is tall and lanky. A mutation in which of the following genes is most likely associated with this patient's condition?? {'A': 'Fibrillin', 'B': 'Fibroblast growth factor receptor', 'C': 'Type 1 collagen', 'D': 'Type 3 collagen', 'E': 'Type 4 collagen'},
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C: Type 1 collagen
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Q:A 28-year-old woman gives birth to a male infant. During her third-trimester antenatal sonogram, the radiologist noted a suspected congenital heart defect, but the exact nature of the defect was not clear. The pediatrician orders an echocardiogram after making sure that the baby’s vital signs are stable. This reveals the following findings: atresia of the muscular tricuspid valve, pulmonary outflow tract obstruction, open patent ductus arteriosus, a small ventricular septal defect, and normally related great arteries. The pediatrician explains the nature of the congenital heart defect to the infant's parents. He also informs them about the probable clinical features that are likely to develop in the infant, the proposed management plan, and the prognosis. Which of the following signs is most likely to manifest first in this infant?? {'A': 'Hepatomegaly', 'B': 'Bluish discoloration of lips', 'C': 'Peripheral edema', 'D': 'Diaphoresis while sucking', 'E': 'Clubbing of finger nails'},
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B: Bluish discoloration of lips
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Q:Four days after being hospitalized, intubated, and mechanically ventilated, a 30-year-old man has no cough response during tracheal suctioning. He was involved in a motor vehicle collision and was obtunded on arrival in the emergency department. The ventilator is at a FiO2 of 100%, tidal volume is 920 mL, and positive end-expiratory pressure is 5 cm H2O. He is currently receiving vasopressors. His vital signs are within normal limits. The pupils are dilated and nonreactive to light. Corneal, gag, and oculovestibular reflexes are absent. There is no facial or upper extremity response to painful stimuli; the lower extremities show a triple flexion response to painful stimuli. Serum concentrations of electrolytes, urea, creatinine, and glucose are within the reference range. Arterial blood gas shows: pH 7.45 pCO2 41 mm Hg pO2 99 mm Hg O2 saturation 99% Two days ago, a CT scan of the head showed a left intracerebral hemorrhage with mass effect. The apnea test is positive. There are no known family members, advanced directives, or individuals with power of attorney. Which of the following is the most appropriate next step in management?"? {'A': 'Ethics committee consultation', 'B': 'Cerebral angiography', 'C': 'Court order for further management', 'D': 'Remove the ventilator', 'E': 'Repeat CT scan of the head'},
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D: Remove the ventilator
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Q:A 55-year-old woman with a 1-year history of left-sided tinnitus is diagnosed with a tumor of the left jugular fossa. Sialometry shows decreased production of saliva from the left parotid gland. The finding on sialometry is best explained by a lesion of the nerve that is also responsible for which of the following?? {'A': 'Protrusion of the tongue', 'B': 'Taste sensation of tip of the tongue', 'C': 'Afferent limb of the gag reflex', 'D': 'Afferent limb of the cough reflex', 'E': 'Equilibrium and balance'},
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C: Afferent limb of the gag reflex
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Answer the following medical question with one of the provided options:
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Q:A 67-year-old man is brought to the emergency department because of the sudden onset of severe substernal chest pain at rest. He has a history of hypertension, type 2 diabetes mellitus, and alcohol use disorder. He is diaphoretic and appears anxious. The lungs are clear to auscultation. An ECG shows ST-segment elevations in leads I, aVL, V5, and V6. One hour later, he develops dyspnea and a productive cough with frothy sputum. Which of the following best describes the most likely underlying pathophysiology of this patient's dyspnea?? {'A': 'Transudation of plasma into the alveoli', 'B': 'Localized constriction of the pulmonary vasculature', 'C': 'Bacterial infiltration into the pulmonary parenchyma', 'D': 'Acute obstruction of a pulmonary artery segment', 'E': 'Increased permeability of pulmonary vascular endothelial cells'},
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A: Transudation of plasma into the alveoli
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Q:A 67-year-old woman is brought by ambulance from home to the emergency department after she developed weakness of her left arm and left face droop. According to her husband, she has a history of COPD, hypertension, and hyperlipidemia. She takes hydrochlorothiazide, albuterol, and atorvastatin. She is not on oxygen at home. She is an active smoker and has smoked a pack a day for 20 years. Her mother died of a heart attack at age 60 and her father died of prostate cancer at age 55. By the time the ambulance arrived, she was having difficulty speaking. Once in the emergency department, she is no longer responsive. Her blood pressure is 125/85 mm Hg, the temperature is 37.2°C (99°F), the heart rate is 77/min, and her breathing is irregular, and she is taking progressively deeper inspirations interrupted with periods of apnea. Of the following, what is the next best step?? {'A': 'Intubate the patient', 'B': 'Obtain non-contrast enhanced CT of brain', 'C': 'Obtain an MRI of brain', 'D': 'Start tissue plasminogen activator (tPA)', 'E': 'Consult a cardiologist'},
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A: Intubate the patient
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Q:A 3-week-old firstborn baby girl is brought to the pediatric emergency room with projectile vomiting. She started vomiting while feeding 12 hours ago and has been unable to keep anything down since then. After vomiting, she appears well and hungry, attempting to feed again. The vomitus has been non-bloody and non-bilious. The last wet diaper was 10 hours ago. The child was born at 40 weeks gestation to a healthy mother. On examination, the child appears sleepy but has a healthy cry during the exam. The child has dry mucous membranes and delayed capillary refill. There is a palpable olive-shaped epigastric mass on palpation. Which of the following is the most likely cause of this patient's condition?? {'A': 'Failure of duodenal lumen recanalization', 'B': 'Failure of neural crest cell migration into the rectum', 'C': 'Hypertrophic muscularis externa', 'D': 'Patent tract between the trachea and esophagus', 'E': 'Telescoping of the small bowel into the large bowel'},
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C: Hypertrophic muscularis externa
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Q:A 64-year-old woman is brought to the emergency department 1 hour after the onset of acute shortness of breath and chest pain. The chest pain is retrosternal in nature and does not radiate. She feels nauseated but has not vomited. She has type 2 diabetes mellitus, hypertension, and chronic kidney disease. Current medications include insulin, aspirin, metoprolol, and hydrochlorothiazide. She is pale and diaphoretic. Her temperature is 37°C (98°F), pulse is 136/min, and blood pressure is 80/60 mm Hg. Examination shows jugular venous distention and absence of a radial pulse during inspiration. Crackles are heard at the lung bases bilaterally. Cardiac examination shows distant heart sounds. Laboratory studies show: Hemoglobin 8.3 g/dL Serum Glucose 313 mg/dL Urea nitrogen 130 mg/dL Creatinine 6.0 mg/dL Which of the following is the most appropriate next step in management?"? {'A': 'Pericardiocentesis', 'B': 'Hemodialysis', 'C': 'Furosemide therapy', 'D': 'Norepinephrine infusion', 'E': 'Aspirin therapy'},
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A: Pericardiocentesis
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Q:A 7-year-old boy with a history of cystic fibrosis is brought to the physician for evaluation of recurrent episodes of productive cough, wheezing, and shortness of breath over the past month. Physical examination shows coarse crackles and expiratory wheezing over both lung fields. Serum studies show elevated levels of IgE and eosinophilia. A CT scan of the lungs shows centrally dilated bronchi with thickened walls and peripheral airspace consolidation. Antibiotic therapy is initiated. One week later, the patient continues to show deterioration in lung function. A sputum culture is most likely to grow which of the following?? {'A': 'Dimorphic, broad-based budding yeast', 'B': 'Monomorphic, septate hyphae that branch at acute angles', 'C': 'Dimorphic, cigar-shaped budding yeast', 'D': 'Monomorphic, narrow budding encapsulated yeast', 'E': 'Monomorphic, broad, nonseptate hyphae that branch at wide angles'},
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B: Monomorphic, septate hyphae that branch at acute angles
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Q:A 45-year-old man comes to the physician because of persistent reddening of the face for the past 3 months. During this period he also had difficulty concentrating at work and experienced generalized fatigue. He has fallen asleep multiple times during important meetings. His mother has rheumatoid arthritis. He has hypertension and asthma. He has smoked one pack of cigarettes daily for 28 years and drinks one alcoholic beverage per day. Medications include labetalol and a salbutamol inhaler. He is 170 cm (5 ft 7 in) tall and weighs 88 kg (194 lb); BMI is 30.4 kg/m2. His temperature is 37.1°C (98.8°F), pulse is 88/min, respirations are 14/min, and blood pressure is 145/85 mm Hg. Physical examination shows erythema of the face that is especially pronounced around the cheeks, nose, and ears. His neck appears short and wide. The remainder of the examination shows no abnormalities. Which of the following is the most likely cause of this patient's facial discoloration?? {'A': 'Increased EPO production', 'B': 'Increased serotonin levels', 'C': 'Delayed-type hypersensitivity', 'D': 'Antibody-mediated vasculopathy', 'E': 'Increased cortisol levels'},
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A: Increased EPO production
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Q:The police are called to investigate a domestic disturbance. The neighbors report hearing a man shouting "I'm gonna kill you" for the past 30 minutes followed by occasional screaming. The house was only recently occupied by its new owner, a middle-aged lawyer. The police were greeted at the door by a man holding a broomstick. When asked what the disturbance was about, he admitted to being extremely afraid of spiders and had come across one as he was unpacking. What would be the single best course of treatment for this patient?? {'A': 'Cognitive behavioral therapy', 'B': 'Anxiolytics', 'C': 'Benzodiazepines', 'D': 'Antidepressants', 'E': 'Beta-blockers'},
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A: Cognitive behavioral therapy
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Q:A 22-year-old woman comes to the physician for a routine health maintenance examination. She has no history of serious illness. Pelvic examination shows a pink, 2 x 2-cm, fluctuant swelling at the right posterior vaginal introitus. The swelling is most likely derived from which of the following structures?? {'A': 'Vulvar epithelium', 'B': 'Paraurethral glands', 'C': 'Greater vestibular glands', 'D': 'Mesonephric duct remnants', 'E': 'Sebaceous glands'},
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C: Greater vestibular glands
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Q:A mother brings her 3-year-old son to the doctor because she is worried that he might be harming himself by constantly banging his head on the wall. He has been exhibiting this behavior for a few months. She is also worried because he has started to speak less than he used to and does not respond when his name is called. He seems aloof during playtime with other children and seems to have lost interest in most of his toys. What is the most likely diagnosis?? {'A': 'Attention deficit hyperactivity disorder', 'B': 'Generalized anxiety disorder', 'C': 'Bipolar disorder', 'D': 'Obsessive-compulsive disorder', 'E': 'Autism spectrum disorder'},
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E: Autism spectrum disorder
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Q:A 59-year-old man with chronic hepatitis C infection comes to the physician because of a 2-week history of ankle pain and nonpruritic skin lesions on his legs. He does not recall recent trauma or injury. He has not received treatment for hepatitis. Examination shows diffuse, violaceous lesions on both lower extremities. The lesions are 4–7 mm in size, slightly raised, and do not blanch with pressure. These skin lesions are best classified as which of the following?? {'A': 'Hemangioma', 'B': 'Purpura', 'C': 'Petechiae', 'D': 'Ecchymoses', 'E': 'Spider angioma'},
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B: Purpura
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Q:A 62-year-old man comes to the office complaining of dysphagia that started 4-5 months ago. He reports that he initially he had difficulty swallowing only solid foods. More recently, he has noticed some trouble swallowing liquids. The patient also complains of fatigue, a chronic cough that worsens at night, and burning chest pain that occurs after he eats. He says that he has used over-the-counter antacids for “years” with mild relief. He denies any change in diet, but says he has “gone down a pant size or 2.” The patient has hypertension and hyperlipidemia. He takes amlodipine and atorvastatin. He smoked 1 pack of cigarettes a day for 12 years while in the military but quit 35 years ago. He drinks 1-2 beers on the weekend while he is golfing with his friends. His diet consists mostly of pasta, pizza, and steak. The patient's temperature is 98°F (36.7°C), blood pressure is 143/91 mmHg, and pulse is 80/min. His BMI is 32 kg/m^2. Physical examination reveals an obese man in no acute distress. No masses or enlarged lymph nodes are appreciated upon palpation of the neck. Cardiopulmonary examination is unremarkable. An endoscopy is performed, which identifies a lower esophageal mass. Which of the following is the most likely diagnosis?? {'A': 'Adenocarcinoma', 'B': 'Nutcracker esophagus', 'C': 'Plummer-Vinson syndrome', 'D': 'Small cell carcinoma', 'E': 'Squamous cell carcinoma'},
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A: Adenocarcinoma
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Q:A 4-year-old girl presents to the office with her parents who are concerned about their daughter and slow, progressive changes in her behavior. The girl was born at 39 weeks gestation via spontaneous vaginal delivery. She is up to date on all vaccines and was meeting all developmental milestones until about 2 years ago. At one point she had a vocabulary of several words and now she verbalizes in grunts. She also flaps her hands in a repeated motion and has difficulty walking. Her parents have tried several home therapies to improve their daughter's symptoms including restricted diets, hydrotherapy, and a variety of nutritional supplements. The vital signs include: heart rate 90/min, respiratory rate 22/min, blood pressure 110/65 mm Hg, and temperature 36.9°C (98.4°F). On physical exam, she is well nourished and stares absently out the window. Her heart has a regular rate and rhythm and her lungs are clear to auscultation bilaterally. She has mild scoliosis. Which of the following is the most likely diagnosis?? {'A': 'Autistic spectrum disorder', 'B': 'Cerebral palsy', 'C': 'Phenylketonuria', 'D': 'Rett syndrome', 'E': 'Tourette syndrome'},
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D: Rett syndrome
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Q:A 42-year-old man presents to clinic complaining of increasing difficulty climbing stairs and standing up from sitting in his chair. On exam you perceive that his strength to be 5/5 distally, but only 3/5 in proximal muscle groups bilaterally. There is a distinctive rash on his upper eyelids and around his eyes. Examination of the fingers is most likely to reveal which of the following?? {'A': 'Dactylitis', 'B': 'Enlargement of the PIP', 'C': 'Ulnar deviation of the fingers', 'D': 'Nail pitting with oil spots', 'E': 'Violaceous papules over the MCP, PIP, and DIP'},
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E: Violaceous papules over the MCP, PIP, and DIP
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Q:A 42-year-old man presents to the emergency department with abdominal pain. The patient was at home watching television when he experienced sudden and severe abdominal pain that prompted him to instantly call emergency medical services. The patient has a past medical history of obesity, smoking, alcoholism, hypertension, and osteoarthritis. His current medications include lisinopril and ibuprofen. His temperature is 98.5°F (36.9°C), blood pressure is 120/97 mmHg, pulse is 130/min, respirations are 22/min, and oxygen saturation is 97% on room air. The patient is in an antalgic position on the stretcher. His abdomen is rigid and demonstrates rebound tenderness and hypoactive bowel sounds. What is the next best step in management?? {'A': 'Abdominal radiograph', 'B': 'CT of the abdomen', 'C': 'NPO, IV fluids, and analgesics', 'D': 'Urgent laparoscopy', 'E': 'Urgent laparotomy'},
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A: Abdominal radiograph
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Q:An 11-year-old boy is brought to the emergency room with acute abdominal pain and hematuria. Past medical history is significant for malaria. On physical examination, he has jaundice and a generalized pallor. His hemoglobin is 5 g/dL, and his peripheral blood smear reveals fragmented RBC, microspherocytes, and eccentrocytes (bite cells). Which of the following reactions catalyzed by the enzyme is most likely deficient in this patient?? {'A': 'D-glucose 6-phosphate → D-fructose-6-phosphate', 'B': 'Glucose-1-phosphate + UTP → UDP-glucose + pyrophosphate', 'C': 'Glucose-6-phosphate + H2O → glucose + Pi', 'D': 'D-glucose-6-phosphate + NADP+ → 6-phospho-D-glucono-1,5-lactone + NADPH + H+', 'E': 'Glucose + ATP → Glucose-6-phosphate + ADP + H+'},
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D: D-glucose-6-phosphate + NADP+ → 6-phospho-D-glucono-1,5-lactone + NADPH + H+
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Q:A 76-year-old woman comes to the physician for evaluation of a 3-month history of vulvar itching and pain. She was diagnosed with lichen sclerosus 4 years ago. She has smoked 1 pack of cigarettes daily for 35 years. Physical examination shows a 2.5-cm nodular, ulcerative lesion on the vaginal introitus and left labia minora with surrounding erythema. Punch biopsy shows squamous cell carcinoma. A CT scan of the chest, abdomen, and pelvis shows enlarged lymph nodes concerning for metastatic disease. Which of the following lymph node regions is the most likely primary site of metastasis?? {'A': 'Superficial inguinal', 'B': 'Para-aortic', 'C': 'Inferior mesenteric', 'D': 'External iliac', 'E': 'Internal iliac'},
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A: Superficial inguinal
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Q:A prospective cohort study was conducted to assess the relationship between LDL and the incidence of heart disease. The patients were selected at random. Results showed a 10-year relative risk of 2.3 for people with elevated LDL levels compared to individuals with normal LDL levels. The 95% confidence interval was 1.05-3.50. This study is most likely to have which of the following p values?? {'A': '0.04', 'B': '0.06', 'C': '0.08', 'D': '0.10', 'E': '0.20'},
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A: 0.04
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Q:A child is in the nursery one day after birth. A nurse notices a urine-like discharge being expressed through the umbilical stump. What two structures in the embryo are connected by the structure that failed to obliterate during the embryologic development of this child?? {'A': 'Pulmonary artery - aorta', 'B': 'Bladder - yolk sac', 'C': 'Bladder - small bowel', 'D': 'Liver - umbilical vein', 'E': 'Kidney - large bowel'},
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B: Bladder - yolk sac
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Q:A 26-year-old medical student who is preparing for Step 1 exams is woken up by her friend for breakfast. She realizes that she must have fallen asleep at her desk while attempting to study through the night. While walking with her friend to breakfast, she realizes that she has not eaten since breakfast the previous day. Using this as motivation to review some biochemistry, she pauses to consider what organs are responsible for allowing her to continue thinking clearly in this physiologic state. Which of the following sets of organs are associated with the major source of energy currently facilitating her cognition?? {'A': 'Liver only', 'B': 'Liver and muscle', 'C': 'Liver and kidney', 'D': 'Liver, muscle, and kidney', 'E': 'Muscle only'},
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C: Liver and kidney
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Q:A 16-year-old female is seen at her outpatient primary medical doctor's office complaining of a sore throat. Further history reveals that she has no cough and physical exam is notable for tonsillar exudates. Vitals in the office reveal HR 88, RR 16, and T 102.1. Using the Centor criteria for determining likelihood of Group A beta-hemolytic strep pharyngitis, the patient has a score of 3. A review of the primary literature yields the findings in Image A. What is the specificity of the Centor criteria using a score of 3 as a cutoff value?? {'A': '9/54 = 17%', 'B': '41/50 = 82%', 'C': '41/46 = 89%', 'D': '45/50 = 90%', 'E': 'Not enough information has been provided'},
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B: 41/50 = 82%
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Q:A 26-year-old woman presents to her physician with a complaint of milk reduction. 2 months ago, she delivered a healthy girl from an uncomplicated pregnancy. The baby was exclusively breastfed until 1.5 months when the patient had to return to the workforce. She cannot breastfeed her daughter at work so she had to leave her with her grandmother and incorporated baby formula into her diet. She reports breast engorgement shortly after she switched to the described regimen which subsided soon. A week after she switched to such a regimen, she started to notice that she has less milk to feed her baby when she is at home. The patient does not report any other symptoms including weight change or mood disturbances. She has breast implants installed submuscularly using the inframammary approach. At the age of 12 years, she had a blunt chest trauma with breast involvement. After the pregnancy, she had a short course of cetirizine due to hay fever. At presentation, the patient’s vital signs are within normal limits. The patient’s breasts are slightly engorged with no skin color changes. There is no discharge on breast compression. Which of the following statements describes the cause of the patient’s condition?? {'A': 'Insufficient amount of glandular breast tissue', 'B': 'Suppression of lactation by the medications', 'C': 'Insufficient breast emptying', 'D': 'Failure of lactogenic ducts to develop', 'E': 'Obliteration of the ducts due to trauma'},
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C: Insufficient breast emptying
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Q:A 61-year-old man presents to the clinic because of sinus congestion, dyspnea, fatigue, and a productive cough. He returned from a trip to Wuhan, China 3 weeks ago. He says that he received his annual influenza vaccine approximately 2 months ago and was in otherwise good health prior to the recent onset of symptoms. The heart rate is 92/min, respiratory rate is 20/min, temperature is 38.2°C (100.8°F), and blood pressure is 100/60 mm Hg. A chest X-ray shows a scant, bilateral patchy infiltrate. A sputum culture shows no gram-staining organisms and cold agglutinins are negative. Which of the following best describes the pathogen responsible for this patient’s case?? {'A': 'DNA | double-stranded | envelope: no | icosahedral', 'B': 'DNA | double-stranded | envelope: yes | icosahedral', 'C': 'DNA | single-stranded | envelope: no | icosahedral', 'D': 'RNA | single-stranded | envelope: no | positive-sense, icosahedral', 'E': 'RNA | single-stranded | envelope: yes | positive-sense, helical'},
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E: RNA | single-stranded | envelope: yes | positive-sense, helical
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Q:A 75-year-old man comes to the physician because of abdominal pain and nausea over the past 2 weeks and a 1-month history of pain in his knees and hips. He has smoked one pack of cigarettes daily for 30 years. Physical examination shows decreased muscle strength. Laboratory studies show: Hemoglobin 11.0 mg/dL Serum Creatinine 1.5 mg/dL Calcium 12.2 mg/dL Parathyroid hormone 115 pg/mL Parathyroid hormone-related peptide elevated Urine Blood 2+ Ultrasonography of his abdomen shows a 6-cm mass in his right kidney. Nephrectomy is performed. A photograph of the resected specimen is shown. The patient's tumor most likely originated from which of the following locations?"? {'A': 'Distal convoluted tubules', 'B': 'Proximal convoluted tubules', 'C': 'Glomerulus', 'D': 'Renal pelvis', 'E': 'Collecting tubules'},
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B: Proximal convoluted tubules
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Q:A 52-year-old woman presents with erosions in her mouth that are persistent and painful. She says that symptoms appeared gradually 1 week ago and have progressively worsened. She also notes that, several days ago, flaccid blisters appeared on her skin, which almost immediately transformed to erosions as well. Which of the following is the most likely diagnosis?? {'A': 'Pemphigus vulgaris', 'B': 'Psoriasis', 'C': 'Bullous pemphigoid', 'D': 'Molluscum contagiosum', 'E': 'Staphylococcal infection (scalded skin syndrome)'},
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A: Pemphigus vulgaris
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Q:A 33-year-old man comes to the physician because of gradually worsening bilateral foot pain for 2 months. The pain used to only occur after long walks and subside with rest. For the past week, the pain has been continuous and associated with burning sensations. He has also had transient painful nodules along the course of the leg veins for 4 months that resolve spontaneously. The patient is wearing an ankle brace for support because of a sprained left ankle that occurred three months ago. His mother was diagnosed with protein C deficiency as a teenager. He has smoked 2 packs of cigarettes daily for 15 years and does not drink alcohol. Vitals signs are within normal limits. Examination shows ulcers on the distal portion of his left great, second, and fifth toes. The feet are cool. Pedal pulses are barely palpable. Ankle-brachial pressure index is 0.3 in the left leg and 0.5 in the right leg. Which of the following interventions is most likely to reduce the risk of amputation in this patient?? {'A': 'Removing the ankle brace', 'B': 'Bypass grafting', 'C': 'Smoking cessation', 'D': 'Enoxaparin therapy', 'E': 'Simvastatin therapy'},
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C: Smoking cessation
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Q:A 17-year-old woman presents to an OBGYN clinic for evaluation of primary amenorrhea. She is a well-developed well-nourished woman who looks at her stated age. She has reached Tanner stage IV breast and pubic hair development. The external genitalia is normal in appearance. She has an older sister who underwent menarche at 12 years of age. A limited pelvic exam reveals a shortened vaginal canal with no cervix. No uterus is visualized during an ultrasound exam, but both ovaries are noted. What is the likely pathophysiology underlying this condition?? {'A': 'Failure of the mesonephric duct to degenerate', 'B': 'Failure of the ovaries to produce estrogen', 'C': 'Genotype 45 XO', 'D': 'Genotype 47 XXY', 'E': 'Failure of the paramesonephric duct to form'},
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E: Failure of the paramesonephric duct to form
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Q:A 35-year-old man with no known past medical history presents to his physician because he is applying for a job as a healthcare worker, which requires screening for the hepatitis B virus (HBV). The patient states that he is in good health and denies any symptoms. His vital signs and physical exam are unremarkable. Labs are drawn, and the patient's HBV serology shows the following: HBsAg: positive anti-HBsAg antibody: negative HBcAg: positive anti-HBcAg IgM: negative anti-HBcAg IgG: positive HBeAg: negative anti-HBeAg antibody: positive Which of the following best describes this patient's results?? {'A': 'Immune due to previous vaccination', 'B': 'Immune due to previous infection', 'C': 'Chronically infected, low infectivity', 'D': 'Chronically infected, high infectivity', 'E': 'Acutely infected'},
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C: Chronically infected, low infectivity
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Q:Four days after undergoing an elective total hip replacement, a 65-year-old woman develops a DVT that embolizes to the lung. Along with tachypnea, tachycardia, and cough, the patient would most likely present with a PaO2 of what?? {'A': '120 mmHg', 'B': '110 mmHg', 'C': '100 mmHg', 'D': '85 mmHg', 'E': '60 mmHg'},
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E: 60 mmHg
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Q:A randomized controlled trial was initiated to evaluate a novel DPP-4 inhibitor for blood glucose management in diabetic patients. The study used a commonly prescribed sulfonylurea as the standard of care treatment. 2,000 patients were enrolled in the study with 1,000 patients in each arm. One of the primary outcomes was the development of diabetic nephropathy during treatment. This outcome occurred in 68 patients on the DPP-4 inhibitor and 134 patients on the sulfonylurea. What is the relative risk reduction (RRR) for patients using the DPP-4 inhibitor compared with the sulfonylurea?? {'A': '23%', 'B': '33%', 'C': '43%', 'D': '49%', 'E': '59%'},
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D: 49%
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Answer the following medical question with one of the provided options:
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Q:A 51-year-old man comes to the physician because of a 1-day history of progressive pain, excessive tearing, and blurry vision of his right eye. He first noticed his symptoms last evening while he was watching a movie at a theater. His left eye is asymptomatic. He wears contact lenses. He has atopic dermatitis treated with topical hydrocortisone. His temperature is 37°C (98.6°F), pulse is 85/min, and blood pressure is 135/75 mm Hg. Examination shows a visual acuity in the left eye of 20/25 and 20/40 in the right eye. The right eye shows conjunctival injection and an edematous cornea with a whitish exudate at the bottom of the anterior chamber. Fluorescein staining shows a round corneal infiltrate. Which of the following is the most appropriate pharmacotherapy?? {'A': 'Topical ketorolac and artificial tears', 'B': 'Topical ofloxacin', 'C': 'Topical timolol and pilocarpine', 'D': 'Topical prednisolone', 'E': 'Topical ganciclovir'},
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B: Topical ofloxacin
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Q:A 54-year-old woman comes to the physician because of constant dull pain, swelling, and progressive stiffness of the right knee for 3 days. Use of over-the-counter analgesics has only provided minimal relief of her symptoms. She has not had any similar symptoms in the past. She takes hydrochlorothiazide for hypertension. Examination of the right knee shows a large effusion and mild erythema. There is moderate tenderness to palpation. Range of motion is limited by pain. Arthrocentesis of the right knee is performed, and microscopic examination of the synovial fluid under polarized light is shown. Further evaluation of this patient is most likely to show which of the following findings?? {'A': 'Human leukocyte antigen-B27 positivity', 'B': 'Knee joint space narrowing with subchondral sclerosis', 'C': 'Elevated serum uric acid concentration', 'D': 'Calcification of the meniscal cartilage', 'E': 'Chalky nodules on the external ear'},
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D: Calcification of the meniscal cartilage
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Q:A 45-year-old man comes to the physician because of a 6-month history of increasing fatigue and reduced libido. He also complains of joint pain in both of his hands. He has a history of hypertension that is controlled with enalapril. He does not smoke or use illicit drugs. He drinks 2–3 beers on the weekends. His vital signs are within normal limits. Physical examination shows a strongly-tanned patient and decreased size of the testes. The second and third metacarpophalangeal joints of both hands are tender to palpation and range of motion is limited. The liver is palpated 2 to 3 cm below the right costal margin. Laboratory studies show: Ferritin 250 μg/L Aspartate aminotransferase 70 U/L Alanine aminotransferase 80 U/L Glucose 250 mg/dL This patient is at greatest risk for developing which of the following complications?"? {'A': 'Non-Hodgkin lymphoma', 'B': 'Hepatocellular carcinoma', 'C': 'Progressive central obesity', 'D': 'Pancreatic carcinoma', 'E': 'Adrenal crisis'},
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B: Hepatocellular carcinoma
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Q:A 36-year-old woman comes to the physician because of a 3-month history of intermittent cough productive of thick, yellow phlegm and increasing shortness of breath. She especially becomes short of breath while playing with her children. She has worked as a farmer for 18 years. She has asthma treated with a salbutamol inhaler. She has smoked half a pack of cigarettes daily for 12 years. Her pulse is 65/min, respirations are 14/min, and blood pressure is 110/75 mm Hg. Scattered wheezing and decreased breath sounds are heard throughout both lung fields. Cardiac examination shows no abnormalities. The abdomen is soft and nondistended; liver span in midclavicular line is 14 cm.Spirometry shows a FEV1:FVC ratio of 66% and a FEV1 of 50% of predicted. An x-ray of the chest is shown. Which of the following is the most likely underlying cause of this patient's condition?? {'A': 'Alpha-1 antitrypsin deficiency', 'B': 'Constrictive bronchiolitis obliterans', 'C': 'Bronchial asthma', 'D': 'Hypersensitivity pneumonitis', 'E': 'Chronic obstructive lung disease'},
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A: Alpha-1 antitrypsin deficiency
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Q:The occupational health department at a hospital implements new safety precautions to prevent laboratory-acquired infections. One of the new precautions includes disinfecting the microbiology laboratory benches with 70% ethanol before and after use. This measure is most likely to be effective in preventing the transmission of which of the following viruses?? {'A': 'Hepatitis A virus', 'B': 'Parvovirus', 'C': 'Poliovirus', 'D': 'Polyomavirus', 'E': 'Herpes simplex virus'},
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E: Herpes simplex virus
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Q:A 36-year-old man is brought in by ambulance after being found down on the sidewalk. It is uncertain how long he was down before being found, and he did not have any forms of identification when he was found. On presentation, the man is found to still be unconscious with a disheveled and unkempt appearance. He is also found to be taking slow, shallow breaths that smell of alcohol. His temperature is 98.8°F (37.1°C), blood pressure is 106/67 mmHg, pulse is 119/min, respirations are 5/min, and oxygen saturation is 87% on room air. His pupils are found to be fixed and contracted, and he has multiple bruises and scars on his body. Which of the following sets of findings would most likely be seen in this patient?? {'A': 'Decreased bicarbonate and decreased carbon dioxide', 'B': 'Decreased bicarbonate and increased carbon dioxide', 'C': 'Increased bicarbonate and decreased carbon dioxide', 'D': 'Increased bicarbonate and increased carbon dioxide', 'E': 'Normal bicarbonate and normal carbon dioxide'},
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B: Decreased bicarbonate and increased carbon dioxide
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Q:A 72-year-old man comes to the physician for medical clearance for a molar extraction. He feels well. He reports he is able to climb 3 flights of stairs without experiencing any shortness of breath. He has hypertension, type 2 diabetes mellitus, and ischemic heart disease. He underwent an aortic valve replacement for severe aortic stenosis last year. 12 years ago, he underwent a cardiac angioplasty and had 2 stents placed. Current medications include aspirin, warfarin, lisinopril, metformin, sitagliptin, and simvastatin. His temperature is 37.1°C (98.8°F), pulse is 92/min, and blood pressure is 136/82 mm Hg. A systolic ejection click is heard at the right second intercostal space. Which of the following is the most appropriate next step in management?? {'A': 'Administer oral amoxicillin 1 hour before the procedure', 'B': 'Obtain echocardiography prior to procedure', 'C': 'Avoid nitrous oxide during the procedure', 'D': 'Discontinue aspirin and warfarin 72 hours prior to procedure', 'E': 'Administer oral clindamycin 1 hour before and 2 hours after the procedure'},
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A: Administer oral amoxicillin 1 hour before the procedure
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Q:A 63-year-old man is brought to the emergency department, 30 minutes after being involved in a high-speed motor vehicle collision. He is obtunded on arrival. He is intubated and mechanical ventilation is begun. The ventilator is set at a FiO2 of 60%, tidal volume of 440 mL, and positive end-expiratory pressure of 4 cm H2O. On the third day of intubation, his temperature is 37.3°C (99.1°F), pulse is 91/min, and blood pressure is 103/60 mm Hg. There are decreased breath sounds over the left lung base. Cardiac examination shows no abnormalities. The abdomen is soft and not distended. Arterial blood gas analysis shows: pH 7.49 pCO2 29 mm Hg pO2 73 mm Hg HCO3- 20 mEq/L O2 saturation 89% Monitoring shows a sudden increase in the plateau airway pressure. An x-ray of the chest shows deepening of the costophrenic angle on the left side. Which of the following is the most appropriate next step in management?"? {'A': 'Administer levofloxacin', 'B': 'Increase the PEEP', 'C': 'Insertion of a chest tube', 'D': 'CT scan of the chest', 'E': 'Close observation\n"'},
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C: Insertion of a chest tube
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Q:A 41-year-old woman comes to the emergency room because she has been taking phenelzine for a few years and her doctor warned her that she should not eat aged cheese while on the medication. That night, she unknowingly ate an appetizer at a friend's party that was filled with cheese. She is concerned and wants to make sure that everything is all right. What vital sign or blood test is the most important to monitor in this patient?? {'A': 'Heart rate', 'B': 'Oxygen saturation', 'C': 'Creatine phosphokinase', 'D': 'Blood pressure', 'E': 'Temperature'},
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D: Blood pressure
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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 presents to the emergency department after a motor vehicle collision. The patient was the back seat restrained passenger in a vehicle that was rear ended at 25 miles/hour. The patient has a past medical history of diabetes, hypertension, and chronic obstructive pulmonary disease (COPD). His temperature is 97.5°F (36.4°C), blood pressure is 97/68 mmHg, pulse is 130/min, respirations are 22/min, and oxygen saturation is 99% on room air. The patient is subsequently worked up receiving a chest radiograph, ECG, FAST exam, and serum chemistries. A cardiac catheterization reveals equilibration in diastolic pressure across all cardiac chambers. Which of the following is the most likely diagnosis?? {'A': 'Congestive heart failure', 'B': 'Hemorrhage', 'C': 'Septic shock', 'D': 'Tamponade', 'E': 'Tension pneumothorax'},
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D: Tamponade
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Q:A medical student is sampling serum triglyceride values for a study on the effect of gemfibrozil on lipid levels. He draws blood from 6 different patients who have been fasting for a period of 9 hours. Laboratory results show: Patient 1 175 mg/dL Patient 2 150 mg/dl Patient 3 196 mg/dL Patient 4 160 mg/dL Patient 5 170 mg/dL Patient 6 175 mg/dL Which of the following is the median of these serum triglyceride values?"? {'A': '172.5 mg/dL', 'B': '171.0 mg/dL', 'C': '175.0 mg/dL', 'D': '170.0 mg/dL', 'E': '160.0 mg/dL\n"'},
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A: 172.5 mg/dL
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Q:A 33-year-old woman presents to the urgent care center with 4 days of abdominal pain and increasingly frequent bloody diarrhea. She states that she is currently having 6 episodes of moderate volume diarrhea per day with streaks of blood mixed in. Her vital signs include: blood pressure 121/81 mm Hg, heart rate 77/min, and respiratory rate 15/min. Physical examination is largely negative. Given the following options, which is the most likely pathogen responsible for her presentation?? {'A': 'Clostridium difficile', 'B': 'Campylobacter', 'C': 'E. coli 0157:H7', 'D': 'Salmonella', 'E': 'Shigella'},
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B: Campylobacter
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Q:Three days after undergoing laparoscopic colectomy, a 67-year-old man reports swelling and pain in his right leg. He was diagnosed with colon cancer 1 month ago. His temperature is 38.5°C (101.3°F). Physical examination shows swelling of the right leg from the ankle to the thigh. There is no erythema or rash. Which of the following is likely to be most helpful in establishing the diagnosis?? {'A': 'D-dimer level', 'B': 'Transthoracic echocardiography', 'C': 'CT pulmonary angiography', 'D': 'Blood cultures', 'E': 'Compression ultrasonography'},
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E: Compression ultrasonography
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Answer the following medical question with one of the provided options:
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Q:A 45-year-old male is brought to the emergency department by emergency medical services after sustaining a gunshot wound to the abdomen. He is unresponsive. His temperature is 99.0°F (37.2°C), blood pressure is 95/58 mmHg, pulse is 115/min, and respirations are 20/min. Physical examination reveals an entry wound in the left abdominal quadrant just inferior to the left lateral costal border. Abdominal CT suggests that the bullet is lodged in a retroperitoneal structure. Which of the following structures has the bullet most likely penetrated?? {'A': 'Descending colon', 'B': 'Transverse colon', 'C': 'Ascending colon', 'D': 'Superior duodenum', 'E': 'Sigmoid colon'},
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A: Descending colon
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Answer the following medical question with one of the provided options:
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Q:A previously healthy 22-year-old man presents to the university clinic with increasing scrotal pain and swelling over the past 5 days. He also has dysuria and urinary frequency. He has never felt this type of pain before. The young man considers himself generally healthy and takes no medications. He is sexually active with one partner and uses condoms inconsistently. At the clinic, his temperature is 36.7℃ (98.1℉), the blood pressure is 115/70 mm Hg, the pulse is 84/min, and the respirations are 14/min. On examination, he has swelling and tenderness of the right scrotum, especially over the posterior aspect of the right testicle. The Prehn sign is positive. The remainder of the physical exam is unremarkable. Doppler sonography shows increased blood flow to the testis. Which of the following is the most appropriate next step in management?? {'A': 'IV ceftriaxone and oral doxycycline', 'B': 'Manual detorsion guided by Doppler sonography', 'C': 'Oral metronidazole for patient and sexual partner', 'D': 'Radical orchiectomy', 'E': 'Surgical exploration'},
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A: IV ceftriaxone and oral doxycycline
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