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Answer the following medical question with one of the provided options:
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Q:A 21-year-old G3P2 woman presents to her obstetrician at 6 weeks gestation for routine prenatal care. Her past medical history includes obesity and gestational diabetes. She has had two spontaneous vaginal deliveries at term. One infant was macrosomic with hypoglycemia, but otherwise, she has had no complications. Her physician informs her that she must start taking a multivitamin with folic acid daily. The defect that folic acid supplementation protects against arises in tissue that is derived from which germ cell layer?? {'A': 'Notocord', 'B': 'Mesenchyme', 'C': 'Mesoderm', 'D': 'Ectoderm', 'E': 'Endoderm'},
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D: Ectoderm
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Answer the following medical question with one of the provided options:
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Q:A 49-year-old man presents to the clinic with skin lesions and chronic diarrhea. His wife also reports that he has become more irritable and forgetful in the past year. His medical history is significant for a gastroenterostomy performed 4 years ago due to gastric outlet obstruction caused by hyperplastic polyposis, which was complicated by afferent loop syndrome. He became a vegan a year ago, and currently, his diet consists of starchy foods such as potatoes, corn, and leafy vegetables. The patient’s vital signs include blood pressure 100/75 mm Hg, heart rate 55/min, respiratory rate 14/min, and temperature 36.3℃ (97.3℉). His skin is pale, dry, and thin, with areas of desquamation and redness on the sun-exposed areas. His lymph nodes are not enlarged and breath sounds are normal. The cardiac apex beat is located in the 5th left intercostal space 2 cm lateral to the midclavicular line. Heart sounds are diminished and S3 is present. His abdomen is slightly distended and nontender to palpation. The liver and spleen are not enlarged. Neurologic examination reveals symmetrical hypesthesia for all types of sensation in both upper and lower extremities in a 'gloves and socks' distribution. On a mini-mental status examination, the patient scores 25 out of 30. Production of which substance is most likely to be impaired in this patient?? {'A': 'Menaquinone', 'B': 'Coenzyme Q10', 'C': 'Flavin mononucleotide', 'D': 'Biotin', 'E': 'NAD+'},
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E: NAD+
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Answer the following medical question with one of the provided options:
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Q:Cardiac surgery is consulted on a newborn with a large ventricular septal defect. The child has poor weight gain and feeding difficulties. He requires furosemide and captopril to avoid dyspnea. On physical examination his temperature is 36.9°C (98.4°F), pulse rate is 158/min, respiratory rate is 30/min, and blood pressure is 94/62 mm Hg. Chest auscultation reveals a holosystolic murmur along the left lower sternal border and a mid-diastolic low-pitched rumble at the apex. Abdominal examination reveals the presence of hepatomegaly. An echocardiogram confirms a diagnosis of a membranous VSD while hemodynamic studies show a Qp:Qs ratio of 2.8:1. Which of the following is the best management option?? {'A': 'Continue medical treatment and provide reassurance about spontaneous closure of the defect', 'B': 'Addition of digoxin to the current medical regimen with regular follow-up until spontaneous closure occurs', 'C': 'Surgical closure of the defect', 'D': 'Transcatheter occlusion of the defect', 'E': 'Hybrid surgery using both transcatheter device and surgical repair'},
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C: Surgical closure of the defect
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Answer the following medical question with one of the provided options:
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Q:A 15-year-old boy is brought to the physician with excessive daytime sleepiness over the past year. His parents are concerned with his below-average school performance over the last 3 months. He goes to bed around midnight and wakes up at 7 am on school days, but sleeps in late on weekends. He exercises regularly after school. He usually has a light snack an hour before bed. He does not snore or have awakenings during sleep. He has no history of a serious illness and takes no medications. The boy was born at 39 weeks gestation via spontaneous vaginal delivery. He is up to date on all vaccines and is meeting all developmental milestones. He does not smoke or drink alcohol. There is no history of a similar problem in the family. His vital signs are within normal limits. His BMI is 22 kg/m2. Physical examination shows no abnormal findings. Which of the following is the most appropriate recommendation at this time?? {'A': 'Avoid snacks before bedtime', 'B': 'Decrease exercise intensity', 'C': 'Increase nighttime sleep hours', 'D': 'Take a nap in the afternoon', 'E': 'Take melatonin before bedtime'},
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C: Increase nighttime sleep hours
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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 presents with sudden onset abdominal pain and undergoes an emergent laparoscopic appendectomy. The procedure is performed quickly, without any complications, and the patient is transferred to the post-operative care unit. A little while later, the patient complains of seeing people in his room and hearing voices talking to him. The patient has no prior medical or psychiatric history and does not take any regular medications. What is the mechanism of action of the anesthetic most likely responsible for this patient’s symptoms?? {'A': 'Increased duration of GABA-gated chloride channel opening', 'B': 'N-methyl-D-aspartate receptor antagonism', 'C': 'Stimulation of μ-opioid receptors', 'D': 'Blocking the fast voltage-gated Na+ channels', 'E': 'Increased frequency of GABA-gated chloride channel opening'},
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B: N-methyl-D-aspartate receptor antagonism
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Answer the following medical question with one of the provided options:
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Q:A 15-year-old girl comes to the physician with her father for evaluation of her tall stature. She is concerned because she is taller than all of her friends. Her birth weight and height were within normal limits. Her father is 174 cm (5 ft 7 in) tall; her mother is 162 cm (5 ft 3 in) tall. She is at the 98th percentile for height and 90th percentile for BMI. She has not had her menstrual period yet. Her mother has Graves disease. Vital signs are within normal limits. Examination shows a tall stature with broad hands and feet. There is frontal bossing and protrusion of the mandible. Finger perimetry is normal. The remainder of the examinations shows no abnormalities. Serum studies show a fasting serum glucose of 144 mg/dL. An x-ray of the left hand and wrist shows a bone age of 15 years. Which of the following is most likely to have prevented this patient's condition?? {'A': 'Transsphenoidal adenomectomy', 'B': 'Letrozole therapy', 'C': 'Methimazole therapy', 'D': 'Leuprolide therapy', 'E': 'Caloric restriction'},
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A: Transsphenoidal adenomectomy
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Answer the following medical question with one of the provided options:
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Q:A 38-year-old woman comes to the physician because of a 3-week history of involuntary movements of her extremities. One year ago, she was fired from her position as an elementary school teacher because she had stopped preparing lessons and was frequently absent without notice. She now lives with her mother. She appears emaciated and malodorous. Examination shows rapid, nonrepetitive jerks of her limbs and face that frequently end with the patient covering her face and yawning. She has an unsteady gait. Genetic testing shows a mutation on chromosome 4. This patient's condition is most likely associated with increased levels of which of the following substances?? {'A': 'Glutamate', 'B': 'Gamma-aminobutyric acid', 'C': 'Acetylcholine', 'D': 'Dopamine', 'E': 'N-acetyl aspartate'},
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D: Dopamine
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Answer the following medical question with one of the provided options:
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Q:A 52-year-old man arrives to the clinic for arthritis and leg swelling. The patient reports that the joint pains began 8 months ago. He has tried acetaminophen and ibuprofen without significant improvement. He reports the leg swelling began within the past 2 months and has gotten progressively worse. The patient’s medical history is significant for diabetes. His medications include metformin and aspirin. The patient works as an accountant. He smokes cigars socially. The patient’s temperature is 99°F (37.2°C), blood pressure is 130/78 mmHg, pulse is 70/min, and respirations are 14/min with an oxygen saturation of 98% on room air. Physical examination notes a tan, overweight male with 2+ edema of bilateral lower extremities. Which of the following tumor markers is most likely to be associated with this patient’s condition?? {'A': 'Alpha fetoprotein', 'B': 'Alkaline phosphatase', 'C': 'CA 19-9', 'D': 'Carcinoembryonic antigen', 'E': 'Chromogranin'},
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A: Alpha fetoprotein
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Answer the following medical question with one of the provided options:
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Q:A 20-year-old woman presents for a follow-up visit with her physician. She has a history of cystic fibrosis and is currently under treatment. She has recently been struggling with recurrent bouts of cough and foul-smelling, mucopurulent sputum over the past year. Each episode lasts for about a week or so and then subsides. She does not have a fever or chills during these episodes. She has been hospitalized several times for pneumonia as a child and continues to struggle with diarrhea. Physically she appears to be underweight and in distress. Auscultation reveals reduced breath sounds on the lower lung fields with prominent rhonchi. Which of the following infectious agents is most likely associated with the recurrent symptoms this patient is experiencing?? {'A': 'Histoplasmosis', 'B': 'Mycobacterium avium', 'C': 'Pneumococcus', 'D': 'Pseudomonas', 'E': 'Listeria'},
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D: Pseudomonas
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Answer the following medical question with one of the provided options:
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Q:A 24-year-old woman presents to the clinic with chronic abdominal discomfort and cramping. She seeks medical attention now as she is concerned about the diarrhea that she has developed that is occasionally mixed with tiny streaks of blood. Her medical history is significant for lactose intolerance and asthma. She has a family history of wheat allergy and reports that she has tried to make herself vomit on several occasions to lose weight. After counseling the patient about the dangers of bulimia, physical examination reveals the rectum is red, inflamed, tender, and a perirectal abscess is seen draining purulent material. Colonoscopy demonstrates scattered mucosal lesions involving the colon and terminal ileum. A complete blood count is given below: Hb%: 10 gm/dL Total count (WBC): 12,500/mm3 Differential count: Neutrophils: 50% Lymphocytes: 40% Monocytes: 5% ESR: 22 mm/hr What is the most likely diagnosis?? {'A': 'Irritable bowel syndrome', 'B': 'Celiac disease', 'C': 'Ulcerative colitis', 'D': 'Crohn’s disease', 'E': 'Laxative abuse'},
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D: Crohn’s disease
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Answer the following medical question with one of the provided options:
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Q:An 8-year-old boy presents with a skin lesion on his back as shown in the picture. On physical examination, there are synchronous spasmodic movements of the neck, trunk, and extremities. The physician explains that this is likely due to a genetic condition, and further testing would be necessary to confirm the diagnosis. Which of the following genes is involved in the development of this patient’s condition?? {'A': 'TSC1', 'B': 'NF1', 'C': 'NF2', 'D': 'VHL', 'E': 'GNAQ'},
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A: TSC1
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Answer the following medical question with one of the provided options:
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Q:A 42-year-old man with a history of tuberculosis presents to your office complaining of fatigue for two months. Serum laboratory studies reveal the following: WBC 7,000 cells/mm^3, Hb 9.0 g/dL, Hct 25%, MCV 88 fL, Platelet 450,000 cells/mm^3, Vitamin B12 500 pg/mL (200-800), and Folic acid 17 ng/mL (2.5-20). Which of the following is the most appropriate next step in the management of anemia in this patient?? {'A': 'Iron studies', 'B': 'Erythropoeitin administration', 'C': 'Colonoscopy', 'D': 'Bone marrow biopsy', 'E': 'Observation'},
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A: Iron studies
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Answer the following medical question with one of the provided options:
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Q:A 37-year-old man comes to the physician because of a 6-month history of progressive breast enlargement. Two years ago, he was diagnosed with HIV infection and started treatment with antiretroviral medications. Examination shows a soft, non-tender, ill-defined swelling at the nape of the neck. The cheeks appear hollowed. Serum studies show increased total cholesterol and LDL concentration. Which of the following medications is the most likely cause of these findings?? {'A': 'Nevirapine', 'B': 'Enfuvirtide', 'C': 'Indinavir', 'D': 'Raltegravir', 'E': 'Abacavir'},
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C: Indinavir
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Answer the following medical question with one of the provided options:
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Q:A 21-year-old woman, gravida 1, para 0, at 39 weeks' gestation comes to the physician for a prenatal visit. She has some mild edema and tiredness but generally feels well. She recently had a nephew visiting for 1 week who became ill and was diagnosed with the chickenpox. She has no history of chickenpox and is not vaccinated against the varicella zoster virus. Current medications include folic acid supplements and a prenatal vitamin. Her temperature is 37°C (98.6°F), pulse is 82/min, respirations are 15/min, and blood pressure is 116/64 mm Hg. Pelvic examination shows a uterus consistent in size with 39 weeks' gestation. IgG antibody titers for varicella zoster virus are negative. Which of the following is the most appropriate next step in management?? {'A': 'Varicella vaccine', 'B': 'Serial ultrasounds', 'C': 'Reassurance', 'D': 'Ganciclovir therapy', 'E': 'Varicella zoster immune globulin'},
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E: Varicella zoster immune globulin
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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 by his parents after 10 days of fever, varying from 38.0–40.0°C (100.4–104.0°F). On physical examination, the child is ill-looking with an extensive rash over his trunk with patchy desquamation. His hands are swollen, and he also shows signs of a bilateral conjunctivitis. The laboratory test results are as follows: Hemoglobin 12.9 g/dL Hematocrit 37.7% Mean corpuscular volume 82.2 μm3 Leukocyte count 10,500/mm3 Neutrophils 65% Lymphocytes 30% Monocytes 5% Platelet count 290,000/mm3 Erythrocyte sedimentation rate (ESR) 35 mm/h What is the next best step in the management of this patient’s condition?? {'A': 'Echocardiography', 'B': 'Low-dose aspirin', 'C': 'High-dose aspirin', 'D': 'Corticosteroids', 'E': 'Influenza vaccine'},
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C: High-dose aspirin
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Answer the following medical question with one of the provided options:
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Q:A 45-year-old man comes to the physician for a routine health maintenance examination. He feels well. He has type 2 diabetes mellitus. There is no family history of serious illness. He works as an engineer at a local company. He does not smoke. He drinks one glass of red wine every other day. He does not use illicit drugs. His only medication is metformin. He is 180 cm (5 ft 11 in) tall and weighs 100 kg (220 lb); BMI is 31 kg/m2. His vital signs are within normal limits. Examination shows a soft, nontender abdomen. The liver is palpated 2 to 3 cm below the right costal margin. Laboratory studies show an aspartate aminotransferase concentration of 100 U/L and an alanine aminotransferase concentration of 130 U/L. Liver biopsy shows hepatocyte ballooning degeneration, as well as inflammatory infiltrates with scattered lymphocytes, neutrophils, and Kupffer cells. Which of the following is the most likely diagnosis?? {'A': 'Primary biliary cirrhosis', 'B': 'Alcoholic fatty liver disease', 'C': 'Viral hepatitis', 'D': 'Nonalcoholic steatohepatitis', 'E': 'Autoimmune hepatitis'},
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D: Nonalcoholic steatohepatitis
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Answer the following medical question with one of the provided options:
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Q:A 49-year-old woman is admitted to the hospital for the evaluation of postprandial colicky pain in the right upper quadrant of the abdomen. Abdominal ultrasound shows multiple round, hyperechoic structures within the gallbladder lumen. She undergoes a cholecystectomy. A photograph of the content of her gallbladder is shown. This patient is most likely to have which of the following additional conditions?? {'A': 'Diabetes mellitus', 'B': 'Primary hyperparathyroidism', 'C': 'Chronic hemolytic anemia', 'D': 'Menopausal symptoms', 'E': 'Morbid obesity'},
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C: Chronic hemolytic anemia
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Answer the following medical question with one of the provided options:
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Q:A 42-year-old woman comes to the physician for a follow-up appointment. Two months ago, she was diagnosed with asthma after a 1-year history of a chronic cough and dyspnea with exertion. Her symptoms have improved since starting inhaled albuterol and beclomethasone, but she still coughs most nights when she is lying in bed. Over the past 2 weeks, she has also had occasional substernal chest pain. She does not smoke. She is 158 cm (5 ft 2 in) tall and weighs 75 kg (165 lb); BMI is 30 kg/m2. Vital signs are within normal limits. She has a hoarse voice and frequently clears her throat during the examination. The lungs are clear to auscultation. Pulmonary function tests show a FEV1 of 78% of expected. Which of the following is the most appropriate next step in management?? {'A': 'Order a transthoracic echocardiogram', 'B': 'Add a salmeterol inhaler', 'C': 'Add oral prednisone', 'D': 'Add a proton pump inhibitor', 'E': 'Order total serum IgE levels'},
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D: Add a proton pump inhibitor
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Answer the following medical question with one of the provided options:
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Q:A 72-year-old man presents to his primary care physician for his annual exam. He has a very stoic personality and says that he is generally very healthy and has "the normal aches and pains of old age." On further probing, you learn that he does have pretty significant back and hip pain that worsens throughout the day. On physical exam you note bony enlargement of the distal interphalangeal joints bilaterally. Which of the following is the likely cause of his symptoms?? {'A': 'Gout', 'B': 'Pseudogout', 'C': 'Rheumatoid arthritis', 'D': 'Osteoarthritis', 'E': 'Osteopaenia'},
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D: Osteoarthritis
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Answer the following medical question with one of the provided options:
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Q:A 13-month-old girl is brought to the physician for a well-child examination. She was born at 38 weeks' gestation. There is no family history of any serious illnesses. She cannot pull herself to stand from a sitting position. She can pick an object between her thumb and index finger but cannot drink from a cup or feed herself using a spoon. She comes when called by name and is willing to play with a ball. She cries if she does not see her parents in the same room as her. She coos “ma” and “ba.” She is at the 50th percentile for height and weight. Physical examination including neurologic examination shows no abnormalities. Which of the following is the most appropriate assessment of her development?? {'A': 'Fine motor: delayed | Gross motor: normal | Language: delayed | Social skills: normal', 'B': 'Fine motor: normal | Gross motor: delayed | Language: normal | Social skills: delayed', 'C': 'Fine motor: delayed | Gross motor: normal | Language: normal | Social skills: delayed', 'D': 'Fine motor: delayed | Gross motor: delayed | Language: normal | Social skills: normal', 'E': 'Fine motor: normal | Gross motor: delayed | Language: delayed | Social skills: normal'},
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E: Fine motor: normal | Gross motor: delayed | Language: delayed | Social skills: normal
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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 an 8-month history of upper abdominal pain. During this period, he has also had nausea, heartburn, and multiple episodes of diarrhea with no blood or mucus. He has smoked one pack of cigarettes daily for the past 18 years. He does not use alcohol or illicit drugs. Current medications include an antacid. The abdomen is soft and there is tenderness to palpation in the epigastric and umbilical areas. Upper endoscopy shows several ulcers in the duodenum and the upper jejunum as well as thick gastric folds. Gastric pH is < 2. Biopsies from the ulcers show no organisms. Which of the following tests is most likely to confirm the diagnosis?? {'A': '24-hour esophageal pH monitoring', 'B': 'Fasting serum gastrin level', 'C': 'Urine metanephrine levels', 'D': 'Urea breath test', 'E': 'Serum vasoactive intestinal polypeptide level'},
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B: Fasting serum gastrin level
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Answer the following medical question with one of the provided options:
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Q:A 23-year-old woman is brought to the emergency department by her friends because she thinks that she is having an allergic reaction. The patient is visibly distressed and insists on immediate attention as she feels like she is going to die. Her friends say they were discussing future plans while dining at a new seafood restaurant when her symptoms started. The patient has no history of allergies. She takes no medications and has no significant medical history. Her vitals include: pulse 98/min, respiratory rate 30/min, and blood pressure 120/80 mm Hg. On physical examination, she is tachypneic and in distress. Cardiopulmonary examination is unremarkable. No rash is seen on the body and examination of the lips and tongue reveals no findings. Which of the following would most likely present in this patient?? {'A': 'Decreased alveolar pCO2 and increased alveolar pO2', 'B': 'Decreased alveolar pCO2 and decreased alveolar pO2', 'C': 'Decreased alveolar pCO2 and unchanged alveolar pO2', 'D': 'Increased alveolar pCO2 and increased alveolar pO2', 'E': 'Increased alveolar pCO2 and decreased alveolar pO2'},
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A: Decreased alveolar pCO2 and increased alveolar pO2
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Answer the following medical question with one of the provided options:
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Q:A 2-year-old girl is brought to the emergency department by her mother because the girl has had a cough and shortness of breath for the past 2 hours. Her symptoms began shortly after she was left unattended while eating watermelon. She appears anxious and mildly distressed. Examination shows intercostal retractions and unilateral diminished breath sounds with inspiratory wheezing. Flexible bronchoscopy is most likely to show a foreign body in which of the following locations?? {'A': 'Left main bronchus', 'B': 'Left lower lobe bronchus', 'C': 'Right middle lobe bronchus', 'D': 'Right intermediate bronchus', 'E': 'Left upper lobe bronchus'},
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D: Right intermediate bronchus
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Answer the following medical question with one of the provided options:
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Q:A 77-year-old man with a history of hypertension and a 46 pack-year smoking history presents to the emergency department from an extended care facility with acute onset of headache, nausea, vomiting, and neck pain which started 6 hours ago and has persisted since. He is alert, but his baseline level of consciousness is slightly diminished per the nursing home staff. His temperature is 99.0°F (37.2°C), blood pressure is 164/94 mmHg, pulse is 90/min, respirations are 16/min, and oxygen saturation is 98% on room air. The patient's neurological exam is unremarkable with cranial nerves II-XII grossly intact and with stable gait with a walker. He is immediately sent for a head CT which is normal. What is the most appropriate next step in management?? {'A': 'Alteplase', 'B': 'Ibuprofen, acetaminophen, metoclopramide, and diphenhydramine', 'C': 'Lumbar puncture', 'D': 'MRI', 'E': 'Ultrasound'},
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C: Lumbar puncture
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Answer the following medical question with one of the provided options:
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Q:A 65-year-old man comes to the clinic complaining of abdominal pain for the past 2 months. He describes the pain as a dull, aching, 6/10 pain that is diffuse but worse in the right upper quadrant (RUQ). His past medical history is significant for diabetes controlled with metformin and a cholecystectomy 10 years ago. He reports fatigue and a 10-lb weight loss over the past month that he attributes to poor appetite; he denies fever, nausea/vomiting, palpitations, chest pain, or bowel changes. Physical examination is significant for mild scleral icterus and tenderness at the RUQ. Further workup reveals a high-grade malignant vascular neoplasm of the liver. What relevant detail would you expect to find in this patient’s history?? {'A': 'Chronic alcohol abuse', 'B': 'Heavy ingestion of acetaminophen', 'C': 'Infection with the hepatitis B virus', 'D': 'Obesity', 'E': 'Prior occupation in a chemical plastics manufacturing facility'},
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E: Prior occupation in a chemical plastics manufacturing facility
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Answer the following medical question with one of the provided options:
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Q:A 61-year-old man comes to the physician because of fatigue and a 5-kg (11-lb) weight loss over the past 6 months. He experimented with intravenous drugs during his 20s and has hepatitis C. His father died of colon cancer. He has smoked one pack of cigarettes daily for 35 years. Physical examination shows scleral icterus and several telangiectasias on the abdomen. The liver is firm and nodular. Laboratory studies show: Hemoglobin 10.9 g/dL Mean corpuscular volume 88 μm3 Leukocyte count 10,400/mm3 Platelet count 260,000/mm3 Ultrasonography of the liver is shown. Which of the following additional findings is most likely?"? {'A': 'Bacteremia', 'B': 'Elevated antimitochondrial antibodies', 'C': 'Elevated α-fetoprotein', 'D': 'Lesion with eccentric calcification on chest CT', 'E': 'Elevated carcinoembryonic antigen'},
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C: Elevated α-fetoprotein
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Answer the following medical question with one of the provided options:
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Q:A 70-year-old female with a history of congestive heart failure presents to the emergency room with dyspnea. She reports progressive difficulty breathing which began when she ran out of her furosemide and lisinopril prescriptions 1-2 weeks ago. She states the dyspnea is worse at night and when lying down. She denies any fever, cough, or GI symptoms. Her medication list reveals she is also taking digoxin. Physical exam is significant for normal vital signs, crackles at both lung bases and 2+ pitting edema of both legs. The resident orders the medical student to place the head of the patient's bed at 30 degrees. Additionally, he writes orders for the patient to be given furosemide, morphine, nitrates, and oxygen. Which of the following should be checked before starting this medication regimen?? {'A': 'Basic metabolic panel', 'B': 'Complete blood count', 'C': 'Chest x-ray', 'D': 'Brain natriuretic peptide', 'E': 'Urinalysis'},
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A: Basic metabolic panel
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Q:A 26-year-old woman thinks poorly of herself and is extremely sensitive to criticism. She is socially inhibited and has never had a romantic relationship, although she desires one. Which of the following is the most likely diagnosis?? {'A': 'Paranoid personality disorder', 'B': 'Avoidant personality disorder', 'C': 'Schizoid personality disorder', 'D': 'Depression', 'E': 'Dysthmia'},
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B: Avoidant personality disorder
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Q:A 19-year-old woman is brought to the emergency room by her mother. She found her daughter pale, cold to the touch, and collapsed next to her bed earlier this morning. The patient has no previous medical or psychiatric history, but the mother does report that her daughter has not had her periods for the last 3 months. In the emergency department, the patient is alert and oriented. Her vitals include: blood pressure 80/60 mm Hg supine, heart rate 55/min. On physical examination, the patient appears pale and emaciated. A urine pregnancy test is negative. She is suspected of having an eating disorder. Which of the following treatment options would be contraindicated in this patient?? {'A': 'Bupropion', 'B': 'High caloric food', 'C': 'Cognitive-behavioral therapy', 'D': 'Selective serotonin reuptake inhibitors', 'E': 'Olanzapine'},
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A: Bupropion
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Q:A 75-year-old woman presents with a sudden onset of weakness and difficulty walking. She also complains of nausea and palpitations. She was working in her garden about an hour ago when her problems started. The patient says she is feeling warm even though the emergency room is air-conditioned. Past medical history is significant for major depressive disorder (MDD), diagnosed 5 years ago, hypertension, and osteoporosis. Current medications are aspirin, lisinopril, alendronate, calcium, venlafaxine, and a vitamin D supplement. Her pulse is 110/min, respiratory rate is are 22/min, and blood pressure is 160/100 mm Hg. Physical examination is unremarkable. A noncontrast CT scan of the head, electrocardiogram (ECG), and routine laboratory tests are all normal. Which of the following most likely accounts for this patient’s condition?? {'A': 'Ischemic stroke', 'B': 'Dehydration due to physical activity', 'C': 'Aspirin overdose', 'D': 'Missed dose of venlafaxine', 'E': 'Missed dose of lisinopril'},
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D: Missed dose of venlafaxine
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Q:A 80-year-old woman is brought to the emergency department from a senior living home with a chief complaint of acute onset and severe abdominal pain with 5 episodes of bloody diarrhea. She has a history of having chronic constipation, and postprandial abdominal pain which subsides after taking nitroglycerin. The abdominal pain that she is currently experiencing did not subside using her medication. A week ago, she had a percutaneous intervention for an inferior wall STEMI. On physical examination, the patient looks pale and confused. The vital signs include: blood pressure 80/40 mm Hg, heart rate 108/min, respiratory rate 22/min, and temperature 35.6°C (96.0°F). The patient receives an aggressive treatment consisting of intravenous fluids and vasopressors, and she is transferred to the ICU. Despite all the necessary interventions, the patient dies. During the autopsy, a dark hemorrhagic appearance of the sigmoid colon is noted. What is the most likely pathology related to her death?? {'A': 'Transmural infarction', 'B': 'Mucosal infarct', 'C': 'Twisting of sigmoid colon around its mesentery', 'D': 'Toxic megacolon', 'E': 'Adenocarcinoma'},
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A: Transmural infarction
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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 1-month history of progressive shortness of breath. She can no longer walk one block without stopping to catch her breath. Her last menstrual period was 3 months ago. Menarche occurred at the age of 12 years, and menses had occurred at regular 28-day intervals. Cardiac examination shows a grade 3/6, rumbling diastolic murmur at the apex. Laboratory studies show an elevated β-hCG concentration. Which of the following is the most likely explanation for this patient's worsening dyspnea?? {'A': 'Increased peripheral vascular resistance', 'B': 'Decreased right ventricular preload', 'C': 'Decreased minute ventilation', 'D': 'Increased intravascular volume', 'E': 'Increased right ventricular afterload'},
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D: Increased intravascular volume
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Answer the following medical question with one of the provided options:
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Q:A 52-year-old obese man is brought to the emergency department 30 minutes after he was involved in a high-speed motor vehicle collision. He was the unrestrained driver. On arrival, he is lethargic. His pulse is 112/min, respirations are 10/min and irregular, and blood pressure is 94/60 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 91%. The pupils are equal and react sluggishly to light. He withdraws his extremities to pain. There are multiple bruises over his face, chest, and abdomen. Breath sounds are decreased over the left lung base. Two large bore peripheral venous catheters are inserted and 0.9% saline infusion is begun. Rapid sequence intubation is initiated and endotracheal intubation is attempted without success. Bag and mask ventilation is continued. Pulse oximetry shows an oxygen saturation of 84%. The patient has no advance directive and family members have not arrived. Which of the following is the most appropriate next step in the management of this patient?? {'A': 'Video laryngoscopy', 'B': 'Comfort measures only', 'C': 'Tracheostomy', 'D': 'Nasotracheal intubation', 'E': 'Cricothyrotomy\n"'},
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E: Cricothyrotomy "
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Q:A 21-year-old man presents to the emergency room requesting surgery to remove "microchips," which he believes were implanted in his brain by "Russian spies" 6 months ago to control his thoughts. He also reports hearing the "spies" talk to each other through embedded "microspeakers." You notice that his hair appears unwashed and some of his clothes are on backward. Urine toxicology is negative for illicit drugs. Which of the following additional findings are you most likely to see in this patient during the course of his illness?? {'A': 'Amnesia, multiple personality states, and de-realization', 'B': 'Anhedonia, guilty rumination, and insomnia', 'C': 'Asociality, flat affect, and alogia', 'D': 'Grandiose delusions, racing thoughts, and pressured speech', 'E': 'Intrusive thoughts, ritualized behaviors, and anxious mood'},
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C: Asociality, flat affect, and alogia
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Q:A 41-year-old woman is brought to the emergency department by ambulance because of a sudden onset severe headache. On presentation, the patient also says that she is not able to see well. Physical examination shows ptosis of the right eye with a dilated pupil that is deviated inferiorly and laterally. Based on the clinical presentation, neurosurgery is immediately consulted and the patient is taken for an early trans-sphenoidal surgical decompression. Which of the following will also most likely need to be supplemented in this patient?? {'A': 'Aldosterone', 'B': 'Corticosteroids', 'C': 'Erythropoietin', 'D': 'Insulin', 'E': 'Parathyroid hormone'},
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B: Corticosteroids
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Q:A 77-year-old woman, gravida 2, para 2, is brought to the physician by staff of the nursing home where she resides because of involuntary loss of urine and increased frequency of urination over the past 2 weeks. She reports that she has very little time to get to the bathroom after feeling the urge to urinate. “Accidents” have occurred 4–6 times a day during this period. She has never had urinary incontinence before. She has also been more tired than usual. She drinks 3 cups of coffee daily. Her last menstrual period was 15 years ago. She takes no medications. Vital signs are within normal limits. The abdomen is soft and nontender. Pelvic examination shows a normal-appearing vagina and cervix; uterus and adnexa are small. Which of the following is the most appropriate next step in management?? {'A': 'Caffeine abstinence', 'B': 'Vaginal estrogen cream', 'C': 'Urinalysis and culture', 'D': 'Pad test', 'E': 'MRI of the pelvis'},
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C: Urinalysis and culture
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Q:A 64-year-old woman with a history of rheumatic fever presents to her primary care clinician complaining of excessive fatigue with walking and difficulty lying flat. She had no prior physical limitations, but recently has been unable to walk more than 3 blocks without needing to stop and rest. Her cardiac exam is notable for a late diastolic murmur heard best at the apex in the left lateral decubitus position with no radiation. What is the most likely diagnosis?? {'A': 'Mitral Regurgitation', 'B': 'Aortic Stenosis', 'C': 'MItral Stenosis', 'D': 'Aortic Regurgitation', 'E': 'Tricuspid Regurgitation'},
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C: MItral Stenosis
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Q:A 62-year-old man comes to the physician because of progressive fatigue and dyspnea on exertion for 3 months. During this time, he has also had increased straining during defecation and a 10-kg (22-lb) weight loss. He has no personal or family history of serious medical illness. Physical examination shows conjunctival pallor. Laboratory studies show microcytic anemia. Test of the stool for occult blood is positive. Colonoscopy shows an exophytic mass in the ascending colon. Pathologic examination of the mass shows a well-differentiated adenocarcinoma. A gain-of-function mutation in which of the following genes is most likely involved in the pathogenesis of this patient's condition?? {'A': 'DCC', 'B': 'TP53', 'C': 'MLH1', 'D': 'APC', 'E': 'KRAS'},
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E: KRAS
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Q:A 67-year-old man presents to the emergency department for a headache. The patient states his symptoms started thirty minutes ago. He states he experienced a sudden and severe headache while painting his house, causing him to fall of the ladder and hit his head. He has also experienced two episodes of vomiting and difficulty walking since the fall. The patient has a past medical history of hypertension, obesity, and atrial fibrillation. His current medications include lisinopril, rivaroxaban, atorvastatin, and metformin. His temperature is 99.5°F (37.5°C), blood pressure is 150/105 mmHg, pulse is 90/min, respirations are 15/min, and oxygen saturation is 98% on room air. On physical exam, the patient localizes his headache to the back of his head. Cardiac exam reveals a normal rate and rhythm. Pulmonary exam reveals minor bibasilar crackles. Neurological exam is notable for minor weakness of the muscles of facial expression. Examination of cranial nerve three reveals a notable nystagmus. Heel to shin exam is abnormal bilaterally. The patient's gait is notably ataxic. A non-contrast CT scan of the head is currently pending. Which of the following is the most likely diagnosis?? {'A': 'Cerebellar hemorrhage', 'B': 'Pontine hemorrhage', 'C': 'Thalamic hemorrhage', 'D': 'Subarachnoid hemorrhage', 'E': 'Subdural hematoma'},
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A: Cerebellar hemorrhage
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Q:A 28-year-old G2P1 female is concerned that she may give birth to another child with Down syndrome. She states that she may not be able to take care of another child with this disorder. Which of the following tests can confirm the diagnosis of Down syndrome in utero?? {'A': 'Triple marker test', 'B': 'Quadruple marker test', 'C': 'Integrated test', 'D': 'Ultrasound', 'E': 'Amniocentesis'},
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E: Amniocentesis
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Q:A 9-year-old boy is brought to the physician by his mother to establish care after moving to a new city. He lives at home with his mother and older brother. He was having trouble in school until he was started on ethosuximide by a previous physician; he is now performing well in school. This patient is undergoing treatment for a condition that most likely presented with which of the following symptoms?? {'A': 'Limited attention span and poor impulse control', 'B': 'Overwhelming daytime sleepiness and hypnagogic hallucinations', 'C': 'Episodic jerky movements of the arm and impaired consciousness', 'D': 'Frequent episodes of blank staring and eye fluttering', 'E': 'Recurrent motor tics and involuntary obscene speech'},
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D: Frequent episodes of blank staring and eye fluttering
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Q:A 33-year-old man is brought to a psychiatric emergency room in St. Louis by policemen who report that they found him loitering at the main bus station. The patient is unable to recall why he was at the bus station, but he does have a bus ticket in his pocket from Chicago to St. Louis. When asked what his name is, he replies “I don’t know.” He has no source of identification and cannot recall his own past medical history or medications. His temperature is 98.8°F (37.1°C), blood pressure is 130/75 mmHg, pulse is 85/min, and respirations are 20/min. On examination, the patient is alert but is not oriented to person, place, or time. He appears anxious and upset but is appropriately conversant and cooperative with the examination. His pupils are equally round and reactive to light. The rest of the examination is normal. A urine toxicology screen is negative. A family member of the patient contacts the hospital the next morning and reports that the patient is a soldier who recently returned from a deployment in Afghanistan. He was last seen at his home in Chicago. Which of the following is most consistent with this patient’s condition?? {'A': 'Bipolar I disorder', 'B': 'Depersonalization disorder', 'C': 'Dissociative fugue disorder', 'D': 'Dissociative identity disorder', 'E': 'Post-traumatic stress disorder'},
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C: Dissociative fugue disorder
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Q:A 62-year-old female is brought to the hospital by her daughter. Six hours ago, she was at a wedding giving a speech when she suddenly experienced difficulty finding words and a right facial droop. She denies any extremity weakness, paresthesias, or sensory deficits. She has a history of hypertension and type 2 diabetes. She takes hydrochlorothiazide and insulin. Her last HbA1c was 10.3% four months ago. Vital signs are within normal limits. There is right lower facial droop on exam, but she is able to raise her eyebrows symmetrically. Speech is slow and slightly dysarthric. She has difficulty naming some objects. Her exam is otherwise unremarkable. Brain MRI shows a 3.2-cm infarct in the left frontal region. The patient is admitted to the neurology service for further management. On hospital day three her laboratory results show the following: Serum Na+ 131 mEq/L Osmolality 265 mOsmol/kg H2O Urine Na+ 46 mEq/L Osmolality 332 mOsmol/kg H2O This patient is most likely to have which of the following additional findings?"? {'A': 'Increased hydrostatic pressure', 'B': 'Decreased serum uric acid', 'C': 'Increased blood urea nitrogen', 'D': 'Increased serum bicarbonate', 'E': 'Increased urinary frequency'},
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B: Decreased serum uric acid
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Answer the following medical question with one of the provided options:
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Q:A 15-year-old boy is brought to the Emergency department by ambulance from school. He started the day with some body aches and joint pain but then had several episodes of vomiting and started complaining of a terrible headache. The school nurse called for emergency services. The boy was born at 39 weeks gestation via spontaneous vaginal delivery. He is up to date on all vaccines and is meeting all developmental milestones. Past medical history is noncontributory. He is a good student and enjoys sports. At the hospital, his blood pressure is 120/80 mm Hg, heart rate is 105/min, respiratory rate is 21/min, and his temperature is 38.9°C (102.0°F). On physical exam, he appears drowsy with neck stiffness and sensitivity to light. Kernig’s sign is positive. An ophthalmic exam is performed followed by a lumbar puncture. An aliquot of cerebrospinal fluid is sent to microbiology. A gram stain shows gram-negative diplococci. A smear is prepared on blood agar and grows round, smooth, convex colonies with clearly defined edges. Which of the following would identify the described pathogen?? {'A': 'Growth in anaerobic conditions', 'B': 'No growth on Thayer-Martin medium', 'C': 'Growth in colonies', 'D': 'Oxidase-positive and ferments glucose and maltose', 'E': 'Oxidase-positive test and ferments glucose only'},
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D: Oxidase-positive and ferments glucose and maltose
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Q:A medical student is reading about a specific type of T cells that plays an important role in immunologic tolerance. Most of these cells develop in the thymus, but some of them also develop in peripheral lymphoid organs. Usually, they are CD4+ cells and also express CD25 molecules. The functions of these cells are dependent on forkhead box P3 (Foxp3). Their function is to block the activation of lymphocytes that could react with self-antigens in a potentially harmful manner. Which of the following interleukins is secreted by these cells?? {'A': 'Interleukin-2', 'B': 'Interleukin-6', 'C': 'Interleukin-10', 'D': 'Interleukin-12', 'E': 'Interleukin-17'},
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C: Interleukin-10
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Q:A 3-year-old boy is brought to the emergency department with a history of unintentional ingestion of seawater while swimming in the sea. The amount of seawater ingested is not known. There is no history of vomiting. On physical examination, the boy appears confused and is asking for more water to drink. His serum sodium is 152 mmol/L (152 mEq/L). Which of the following changes in volumes and osmolality of body fluids are most likely to be present in this boy?? {'A': 'Decreased ECF volume, unaltered ICF volume, unaltered body osmolality', 'B': 'Decreased ECF volume, decreased ICF volume, increased body osmolality', 'C': 'Increased ECF volume, unaltered ICF volume, unaltered body osmolality', 'D': 'Increased ECF volume, increased ICF volume, decreased body osmolality', 'E': 'Increased ECF volume, decreased ICF volume, increased body osmolality'},
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E: Increased ECF volume, decreased ICF volume, increased body osmolality
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Q:An 87-year-old male presents to his neurologist for a follow-up visit. He is being followed for an inoperable tumor near his skull. He reports that he recently noticed that food has started to lose its taste. He also notes increasing difficulty with swallowing. He has a history of myocardial infarction, diabetes mellitus, hyperlipidemia, hypertension, and presbycusis. He takes aspirin, metoprolol, metformin, glyburide, atorvastatin, lisinopril, and hydrochlorothiazide. On examination, the patient is a frail-appearing male sitting in a wheelchair. He is oriented to person, place, and time. Gag reflex is absent on the right side. A taste evaluation is performed which demonstrates a decreased ability to detect sour and bitter substances on the right posterior tongue. The nerve responsible for this patient’s loss of taste sensation also has which of the following functions?? {'A': 'Parasympathetic innervation to the parotid gland', 'B': 'Parasympathetic innervation to the submandibular gland', 'C': 'Parasympathetic innervation to the trachea', 'D': 'Somatic sensory innervation to the lower lip', 'E': 'Somatic sensory innervation to the roof of the pharynx'},
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A: Parasympathetic innervation to the parotid gland
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Q:A 49-year-old woman with a history of intravenous drug use comes to the physician because of a 6-month history of fatigue, joint pain, and episodic, painful discoloration in her fingers when exposed to cold weather. She takes no medications. She has smoked one pack of cigarettes daily for the past 22 years. She appears tired. Physical examination shows palpable, nonblanching purpura over the hands and feet. Neurological examination shows weakness and decreased sensation in all extremities. Serum studies show: Alanine aminotransferase 78 U/L Aspartate aminotransferase 90 U/L Urea nitrogen 18 mg/dL Creatinine 1.5 mg/dL Which of the following processes is the most likely explanation for this patient's current condition?"? {'A': 'Immune complex formation', 'B': 'Spirochete infection', 'C': 'Tobacco hypersensitivity', 'D': 'Fibroblast proliferation', 'E': 'Plasma cell malignancy'},
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A: Immune complex formation
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Q:A 38-year-old man presents to his physician for difficulty swallowing for 2 months. He describes food getting stuck down his windpipe and has been feeling very anxious around meal time because he is thinking that he may have esophageal cancer. He has had an influenza-like infection that lasted about 6 weeks in the past 3 months which exacerbated his asthma attacks. He used his puffers to relieve his symptoms and did not seek medical treatment. He is otherwise healthy. On examination, his blood pressure is 118/75 mm Hg, respirations are 17/min, pulse is 78/min, and temperature is 36.7°C (98.1°F). There is no evidence of enlarged lymph nodes or a sore throat. On palpation, the thyroid gland is enlarged and tender. He is a non-smoker with a BMI of 25 kg/m2. He has not used any medications recently. Which of the following is the most likely diagnosis?? {'A': 'Silent thyroiditis', 'B': 'Lymphoma', 'C': 'Chronic lymphocytic thyroiditis', 'D': 'Subacute granulomatous thyroiditis', 'E': 'Fibrous thyroiditis'},
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D: Subacute granulomatous thyroiditis
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Answer the following medical question with one of the provided options:
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Q:A 28-year-old man comes to the emergency department for an injury sustained while doing construction. Physical examination shows a long, deep, irregular laceration on the lateral aspect of the left forearm with exposed fascia. Prior to surgical repair of the injury, a brachial plexus block is performed using a local anesthetic. Shortly after the nerve block is performed, he complains of dizziness and then loses consciousness. His radial pulse is faint and a continuous cardiac monitor shows a heart rate of 24/min. Which of the following is the most likely mechanism of action of the anesthetic that was administered?? {'A': 'Inactivation of potassium channels', 'B': 'Inactivation of sodium channels', 'C': 'Activation of acetylcholine receptors', 'D': 'Inactivation of ryanodine receptors', 'E': 'Activation of GABA receptors'},
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B: Inactivation of sodium channels
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Answer the following medical question with one of the provided options:
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Q:A 67-year-old woman comes to the emergency department because of a 4-month history of fatigue, shortness of breath with exertion, and dizziness. She has a history of atrial fibrillation and had a single-chamber pacemaker placed five years ago after an episode of syncope. Her pulse is 66/min and blood pressure is 98/66 mm Hg. An x-ray of the chest is shown. The x-ray confirms termination of the pacemaker lead in which of the following structures?? {'A': 'Superior vena cava', 'B': 'Left ventricle', 'C': 'Right ventricle', 'D': 'Left atrium', 'E': 'Right atrium'},
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C: Right ventricle
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Q:A 21-year-old college student is admitted to the emergency department with complaints of pharyngitis, headache, and a persistent, non-productive, dry, hacking cough. The patient complains of feeling tired and fatigued and denies fever/chills. On physical examination, her mucosa is pale. A complete blood count is remarkable for decreased hemoglobin. The physician suspects viral pneumonia, but the sputum culture tests come back with the following description: ‘fried-egg shaped colonies on sterol-containing media, and mulberry-shaped colonies on media containing sterols’. A direct Coombs test comes back positive. Which of the following statements is true regarding the complications associated with Mycoplasma pneumoniae?? {'A': 'Red blood cells bind to IgG in warm temperatures > 37°C (98.6°F)', 'B': 'It is similarly associated with systemic lupus erythematosus', 'C': 'Red blood cells bind to IgG in warm temperatures > 37°C (98.6°F)', 'D': 'Red blood cells bind to IgM in cold temperatures < 37°C (98.6°F)', 'E': 'The underlying mechanism is complement-independent.'},
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D: Red blood cells bind to IgM in cold temperatures < 37°C (98.6°F)
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Q:A previously healthy 29-year-old Taiwanese woman comes to the emergency department with vaginal bleeding and pelvic pressure for several hours. Over the past 2 weeks, she had intermittent nausea and vomiting. A home urine pregnancy test was positive 10 weeks ago. She has had no prenatal care. Her pulse is 80/min and blood pressure is 150/98 mm Hg. Physical examination shows warm and moist skin. Lungs are clear to auscultation bilaterally. Her abdomen is soft and non-distended. Bimanual examination shows a uterus palpated at the level of the umbilicus. Her serum beta human chorionic gonadotropin concentration is 110,000 mIU/mL. Urine dipstick is positive for protein and ketones. Transvaginal ultrasound shows a central intrauterine mass with hypoechoic spaces; there is no detectable fetal heart rate. An x-ray of the chest shows no abnormalities. Which of the following is the most appropriate next step in management?? {'A': 'Bed rest and doxylamine therapy', 'B': 'Insulin therapy', 'C': 'Serial beta-hCG measurement', 'D': 'Suction curettage', 'E': 'Methotrexate therapy'},
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D: Suction curettage
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Answer the following medical question with one of the provided options:
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Q:A 10-year-old boy from Sri Lanka suffers from an autosomal dominant condition, the hallmark of which is hyperimmunoglobulinemia E and eosinophilia. He suffers from recurrent infections and takes antibiotic chemoprophylaxis. A STAT3 mutation analysis has been performed to confirm the diagnosis of Job syndrome. Eosinophilia Eczema Hay fever Atopic dermatitis Recurrent skin and lung infections Bronchial asthma What combination of symptoms above is characteristic of this condition? ? {'A': 'I, II, III', 'B': 'I, II, V', 'C': 'I, II, IV, V', 'D': 'I, III, IV', 'E': 'IV, V, VI'},
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B: I, II, V
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Answer the following medical question with one of the provided options:
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Q:A 5-day-old male presents to the pediatrician for a well visit. The patient has been exclusively breastfed since birth. His mother reports that he feeds for 30 minutes every two hours. She also reports that she often feels that her breasts are not completely empty after each feeding, and she has started using a breast pump to extract the residual milk. She has been storing the extra breastmilk in the freezer for use later on. The patient urinates 6-8 times per day and stools 3-4 times per day. His mother describes his stools as dark yellow and loose. The patient was born at 41 weeks gestation via cesarean section for cervical incompetence. His birth weight was 3527 g (7 lb 12 oz, 64th percentile), and his current weight is 3315 (7 lb 5 oz, 40th percentile). His temperature is 97.3°F (36.3°C), blood pressure is 62/45 mmHg, pulse is 133/min, and respirations are 36/min. His eyes are anicteric, and his abdomen is soft and non-distended. Which of the following is the best next step in management?? {'A': 'Continue current breastfeeding regimen', 'B': 'Increase frequency of breastfeeding', 'C': 'Modification of the mother’s diet', 'D': 'Offer stored breastmilk between feedings', 'E': 'Supplement breastfeeding with conventional formula'},
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A: Continue current breastfeeding regimen
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Q:A 56-year-old woman visits her primary care provider complaining of fatigue, weight gain, increased thirst, hair loss, and headaches. She has been perimenopausal for 3 years. She was diagnosed with rheumatoid arthritis 4 years ago and prescribed oral prednisolone. Currently, she takes prednisolone and omeprazole daily. Her vital signs are as follows: blood pressure 150/90 mm Hg, heart rate 70/min, respiratory rate 13/min, and temperature 36.6°C (97.9°F). Her weight is 95 kg (209.4 lb), height is 165 cm (5 ft 4 in), BMI is 34.9 kg/m2, waist circumference is 109 cm (42.9 in), and hip circumference is 93 cm (36.6 in). At physical exam, the patient has abdominal obesity, round red face, and increased fat deposition on the back and around the neck. Her skin elasticity is diminished. Cardiac auscultation reveals fixed splitting of S2 with an increased aortic component. The rest of the exam is unremarkable. Blood analysis shows the following findings: Total serum cholesterol 204.9 mg/dL HDL 50.3 mg/dL LDL 131.4 mg/dL Triglycerides 235.9 mg/dL Fasting serum glucose 192.0 mg/dL Which of the following options describes the pathogenesis of the patient’s hyperglycemia?? {'A': 'Glucocorticoids activate surface membrane sodium channels in the islet beta-cells, which leads to Na+ influx and inhibition of insulin synthesis.', 'B': 'Binding of glucocorticoids to surface G-protein-coupled corticosteroid receptors leads to activation of the inositol-3-phosphate pathway and consequent transcription of gluconeogenic enzymes.', 'C': 'Upon activation of intracellular corticosteroid receptors in hepatocytes, its DNA-binding domain binds to glucocorticoid response elements and triggers transcription of gluconeogenic enzymes.', 'D': 'Glucocorticoids bind to surface receptors of the glomerular endothelial cells and inhibit filtration of glucose.', 'E': 'Extensive gluconeogenic enzyme transcription is activated by glucocorticoids via the cAMP pathway.'},
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C: Upon activation of intracellular corticosteroid receptors in hepatocytes, its DNA-binding domain binds to glucocorticoid response elements and triggers transcription of gluconeogenic enzymes.
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Q:A 6-day-old newborn girl is brought into the hospital by her mother because of excessive vomiting and poor feeding. The mother did not have antenatal care. Her temperature is 36.8°C (98.2°F), blood pressure is 50/30 mm Hg, and pulse is 150/min. On examination, the infant is dehydrated and demonstrates signs of shock. Her genitalia are ambiguous, with fused labia and an enlarged clitoris. Laboratory results are shown: Serum sodium (Na) 125 mEq/L Serum potassium (K) 6 mEq/L Serum 17-hydroxyprogesterone 100,000 ng/dL (normal level is 1,000–3,000 ng/dL) Which of the following is the most likely cause of this infant's condition?? {'A': 'Deficiency of 21-hydroxylase', 'B': 'Deficiency of 11-beta-hydroxylase', 'C': 'Deficiency of 17-alpha-hydroxylase', 'D': 'Deficiency of 5-alpha reductase', 'E': 'Deficiency of placental aromatase'},
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A: Deficiency of 21-hydroxylase
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Answer the following medical question with one of the provided options:
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Q:A 29-year-old G1P0 female at 32 weeks gestation presents to the emergency department with vaginal bleeding. She has had minimal prenatal care to-date with only an initial visit with an obstetrician after a positive home pregnancy test. She describes minimal spotting that she noticed earlier today that has progressed to larger amounts of blood; she estimates 30 mL of blood loss. She denies any cramping, pain, or contractions, and she reports feeling continued movements of the baby. Ultrasound and fetal heart rate monitoring confirm the presence of a healthy fetus without any evidence of current or impending complications. The consulted obstetrician orders blood testing for Rh-status of both the mother as well as the father, who brought the patient to the hospital. Which of the following represents the best management strategy for this situation?? {'A': 'If mother is Rh-negative and father is Rh-positive then administer RhoGAM', 'B': 'If mother is Rh-negative and father is Rh-negative then administer RhoGAM', 'C': 'If mother is Rh-positive and father is Rh-negative then administer RhoGAM', 'D': 'If mother is Rh-negative and father is Rh-positive, RhoGAM administration is not needed', 'E': 'After 28 weeks gestation, administration of RhoGAM will have no benefit'},
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A: If mother is Rh-negative and father is Rh-positive then administer RhoGAM
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Answer the following medical question with one of the provided options:
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Q:A 29-year-old G2P1 in her 22nd week of pregnancy presents with a primary complaint of peripheral edema. Her first pregnancy was without any major complications. Evaluation reveals a blood pressure of 160/90 and urinalysis demonstrates elevated levels of protein; both of these values were within normal limits at the patient's last well check-up 1 year ago. Further progression of this patient’s condition would immediately place her at greatest risk for developing which of the following?? {'A': 'Diabetes mellitus', 'B': 'Seizures', 'C': 'Myocardial infarction', 'D': "Crohn's Disease", 'E': 'Tubulointerstitial nephritis'},
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B: Seizures
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Answer the following medical question with one of the provided options:
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Q:A 12-year-old boy is brought to the physician for a well-child examination. He feels well. He has no history of serious illness. He has received all age-appropriate screenings and immunizations. His 7-year-old brother was treated for nephrotic syndrome 1 year ago. He is at 50th percentile for height and 60th percentile for weight. His temperature is 37°C (98.6°F), pulse is 90/min, and blood pressure is 96/54 mm Hg. Physical examination shows no abnormalities. Urine dipstick shows 1+ protein. A subsequent urinalysis of an early morning sample shows: Blood negative Glucose negative Protein trace Leukocyte esterase negative Nitrite negative RBC none WBC 0–1/hpf Protein/creatinine ratio 0.2 (N ≤ 0.2) Which of the following is the most appropriate next step in management?"? {'A': 'Repeat urine dipstick in 1 year', 'B': 'Lipid profile', 'C': '24-hour urine protein collection', 'D': 'Measure serum creatinine and urea nitrogen', 'E': 'Anti-nuclear antibody level'},
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A: Repeat urine dipstick in 1 year
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Answer the following medical question with one of the provided options:
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Q:A 6-year-old child presents for evaluation of a medical condition associated with recurrent infections. After reviewing all of the medical history, gene therapy is offered to treat a deficiency in adenosine deaminase (ADA). ADA deficiency is the most common autosomal recessive mutation in which of the following diseases?? {'A': 'DiGeorge Syndrome', 'B': 'Severe Combined Immunodeficiency', 'C': 'Hyper-IgM Syndrome', 'D': 'Wiskott-Aldrich Syndrome', 'E': "Bruton's Agammaglobulinemia"},
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B: Severe Combined Immunodeficiency
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Answer the following medical question with one of the provided options:
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Q:A 44-year-old man seeks evaluation at a clinic because he is experiencing a problem with his sexual health for the past month. He says he does not get erections like he used to, despite feeling the urge. In addition to heart failure, he has angina and hypertension. His regular oral medications include amlodipine, atorvastatin, nitroglycerine, spironolactone, and losartan. After a detailed evaluation of his current medications, it is concluded that he has drug-induced erectile dysfunction. Which one of the following medications may have caused this patient’s symptom?? {'A': 'Amlodipine', 'B': 'Atorvastatin', 'C': 'Nitroglycerine', 'D': 'Spironolactone', 'E': 'Losartan'},
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D: Spironolactone
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Answer the following medical question with one of the provided options:
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Q:A previously healthy 2-year-old girl is brought to the physician because of a 1-week history of yellow discoloration of her skin, loss of appetite, and 3 episodes of vomiting. Her parents also report darkening of her urine and light stools. During the last 2 days, the girl has been scratching her abdomen and arms and has been crying excessively. She was born at 38 weeks' gestation after an uncomplicated pregnancy and delivery. Her family emigrated from Japan 8 years ago. Immunizations are up-to-date. Her vital signs are within normal limits. Examination shows jaundice of her skin and sclerae. Abdominal examination shows a mass in the right upper abdomen. Serum studies show: Bilirubin (total) 5 mg/dL Direct 4.2 mg/dL Aspartate aminotransferase (AST) 20 U/L Alanine aminotransferase (ALT) 40 U/L γ-Glutamyltransferase (GGT) 110 U/L Abdominal ultrasonography shows dilation of the gall bladder and a fusiform dilation of the extrahepatic bile duct. Which of the following is the most likely diagnosis?"? {'A': 'Biliary cyst', 'B': 'Mirizzi syndrome', 'C': 'Biliary atresia', 'D': 'Hepatic abscess', 'E': 'Pancreatic pseudocyst'},
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A: Biliary cyst
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Answer the following medical question with one of the provided options:
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Q:A previously healthy 26-year-old woman comes to the physician because of a 2-day history of pain with urination. She has been sexually active with two partners over the past year. She uses condoms for contraception. Vital signs are within normal limits. Physical examination shows suprapubic tenderness. Urinalysis shows neutrophils and a positive nitrite test. Urine culture grows gram-negative, oxidase-negative rods that form greenish colonies on eosin-methylene blue agar. Which of the following virulence factors of the causal organism increases the risk of infection in this patient?? {'A': 'Lipoteichoic acid', 'B': 'Fimbriae', 'C': 'Biofilm production', 'D': 'Lecithinase', 'E': 'IgA protease'},
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B: Fimbriae
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Answer the following medical question with one of the provided options:
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Q:A 50-year-old man presents to the urgent care clinic for 3 hours of worsening cough, shortness of breath, and dyspnea. He works as a long-haul truck driver, and he informs you that he recently returned to the west coast from a trip to Arkansas. His medical history is significant for gout, hypertension, hypercholesterolemia, diabetes mellitus type 2, chronic obstructive pulmonary disease (COPD), and mild intellectual disability. He currently smokes 1 pack of cigarettes/day, drinks a 6-pack of beer/day, and he endorses a past history of injection drug use but currently denies any illicit drug use. The vital signs include: temperature 36.7°C (98.0°F), blood pressure 126/74 mm Hg, heart rate 87/min, and respiratory rate 23/min. His physical examination shows mild, bilateral, coarse rhonchi, but otherwise clear lungs on auscultation, grade 2/6 holosystolic murmur, and a benign abdominal physical examination. He states that he ran out of his albuterol inhaler 6 days ago and has been meaning to follow-up with his primary care physician (PCP) for a refill. Complete blood count (CBC) and complete metabolic panel are within normal limits. He also has a D-dimer result within normal limits. Which of the following is the most appropriate next step in evaluation?? {'A': 'Arterial blood gas', 'B': 'Sputum gram stain and culture', 'C': 'Pulmonary function tests', 'D': 'Chest radiographs', 'E': 'Chest computed tomography (CT) with contrast'},
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D: Chest radiographs
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Q:A 54-year-old man comes to the physician for the evaluation of difficulty swallowing of both solids and liquids for 1 month. During the past 5 months, he has also had increased weakness of his hands and legs. He sails regularly and is unable to hold the ropes as tightly as before. Ten years ago, he was involved in a motor vehicle collision. Examination shows atrophy of the tongue. Muscle strength is decreased in the right upper and lower extremities. There is muscle stiffness in the left lower extremity. Deep tendon reflexes are 1+ in the right upper and lower extremities, 3+ in the left upper extremity, and 4+ in the left lower extremity. Plantar reflex shows an extensor response on the left foot. Sensation to light touch, pinprick, and vibration is intact. Which of the following is the most likely diagnosis?? {'A': 'Syringomyelia', 'B': 'Amyotrophic lateral sclerosis', 'C': 'Inclusion-body myositis', 'D': 'Subacute combined degeneration of spinal cord', 'E': 'Cervical spondylosis with myelopathy\n"'},
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B: Amyotrophic lateral sclerosis
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Q:A study is performed to determine whether cognitive behavioral therapy (CBT) increases compliance to dietary regimens. In order to test this hypothesis, a random group of volunteers who want to lose weight are selected from the community and subsequently randomized to no intervention and CBT groups. They are asked to record what they ate every day in a food journal and these recordings are correlated with objective serum and urine biomarkers for food intake. Surprisingly, it was found that even the group with no intervention had much higher rates of compliance to dietary regimens than the general population. Multivariate analysis showed no significant demographic or medical differences between the two groups. Which of the following most likely explains this finding from the study?? {'A': 'Confounding effect', 'B': 'Hawthorne effect', 'C': 'Procedure bias', 'D': 'Pygmalion effect', 'E': 'Recall bias'},
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B: Hawthorne effect
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Q:A 22-year-old woman presents to the emergency department because of agitation and sweating. History shows she is currently being treated for depression with citalopram. She also takes tramadol for back pain. Her temperature is 38.6°C (97.9°F), the pulse is 108/min, the respirations are 18/min, and the blood pressure is 165/110 mm Hg. Physical examination shows hyperreflexia and mild tremors in all 4 extremities. Which of the following should be used in the next step of management for this patient?? {'A': 'Chlorpromazine', 'B': 'Cyproheptadine', 'C': 'Diazepam', 'D': 'Discontinue tramadol and citalopram', 'E': 'Selegiline'},
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D: Discontinue tramadol and citalopram
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Q:A 54-year-old female presents to her primary care physician with complaints of fatigue, constipation, and what the patient describes as "aching in her bones." Her medical history is significant for hypertension, well-controlled on lisinopril, and two prior kidney stones that both passed spontaneously without need for surgery. Vital signs are within normal limits, and physical exam is not significant for any notable findings. Preliminary lab work is ordered and reveals: calcium 11.6 mg/dL (normal range 8.5 - 10.9 mg/dL), phosphorus 2.1 mg/dL (normal range 2.4 - 4.1 mg/dL), and an elevated parathyroid hormone (PTH) level. Which of the following findings would most likely be expected on radiographic evaluation of this patient's hands?? {'A': 'Joint space narrowing at the proximal and distal interphalangeal joints', 'B': 'Osteoid matrix accumulation around bony trabeculae', 'C': 'Subperiosteal cortical thinning', 'D': 'Ulnar deviation of the metacarpophalangeal joints', 'E': 'Dense bone filling the medullary cavity of the phalanges and metacarpals'},
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C: Subperiosteal cortical thinning
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Q:A 55-year-old woman presents with acute onset abdominal pain radiating to her back, nausea, and vomiting. CT scan suggests a diagnosis of acute pancreatitis. The pathogenesis of acute pancreatitis relates to inappropriate activation of trypsinogen to trypsin. Which of the following activates trypsin in normal digestion?? {'A': 'Amylase', 'B': 'Lipase', 'C': 'Cholecystokinin', 'D': 'Enterokinase', 'E': 'Secretin'},
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D: Enterokinase
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Q:A mutant stem cell was created by using an inducible RNAi system, such that when doxycycline is added, the siRNA targeting DNA helicase is expressed, effectively knocking down the gene for DNA helicase. Which of the following will occur during DNA replication?? {'A': 'DNA is not unwound', 'B': 'DNA supercoiling is not relieved', 'C': 'The two melted DNA strands reanneal', 'D': 'The RNA primer is not created', 'E': 'Newly synthesized DNA fragments are not ligated'},
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A: DNA is not unwound
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Q:A 52-year-old man is on a week-long cruise vacation with his family to celebrate his mother's 80th birthday. He has a very important presentation at work to give in one month, which will in part determine whether he receives a promotion. He decides to focus on enjoying the vacation and not to worry about the presentation until the cruise is over. Which of the following psychological defense mechanisms is he demonstrating?? {'A': 'Isolation of affect', 'B': 'Introjection', 'C': 'Inhibition', 'D': 'Regression', 'E': 'Suppression\n"'},
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E: Suppression "
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Q:A 16-year-old boy comes to the physician because of painless enlargement of his left testis for the past 2 weeks. The patient reports that the enlargement is worse in the evenings, especially after playing soccer. He has not had any trauma to the testes. There is no personal or family history of serious illness. Vital signs are within normal limits. Examination shows multiple cord-like structures above the left testes. The findings are more prominent while standing. The cord-like structures disappear in the supine position. The testes are normal on palpation. The patient is at greatest risk of developing which of the following complications?? {'A': 'Bowel strangulation', 'B': 'Testicular torsion', 'C': 'Testicular tumor', 'D': 'Infertility', 'E': 'Erectile dysfunction'},
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D: Infertility
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Q:Two months after giving birth to a boy, a 27-year-old woman comes to the physician with her infant for a well-child examination. She was not seen by a physician during her pregnancy. Physical examination of the mother and the boy shows no abnormalities. Laboratory studies show elevated titers of hepatitis B surface antigen in both the mother and the boy. Which of the following statements regarding the infant's condition is most accurate?? {'A': 'Hepatitis B e antigen titer is likely undetectable', 'B': 'Chronic infection is unlikely', 'C': 'Lifetime risk of hepatocellular carcinoma is low', 'D': 'The viral replication rate is low', 'E': 'Significant elevation of transaminases is not expected'},
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E: Significant elevation of transaminases is not expected
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Q:An experiment to determine the effects of gravity on blood pressure is conducted on 3 individuals of equal height and blood pressure oriented in different positions in space. Participant A is strapped in a supine position on a bed turned upside down in a vertical orientation with his head towards the floor and his feet towards the ceiling. Participant B is strapped in a supine position on a bed turned downwards in a vertical orientation with his head towards the ceiling and his feet just about touching the floor. Participant C is strapped in a supine position on a bed in a horizontal orientation. Blood pressure readings are then taken at the level of the head, heart, and feet from all 3 participants. Which of these positions will have the lowest recorded blood pressure reading?? {'A': 'Participant A: at the level of the head', 'B': 'Participant B: at the level of the feet', 'C': 'Participant C: at the level of the heart', 'D': 'Participant A: at the level of the feet', 'E': 'Participant B: at the level of the head'},
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D: Participant A: at the level of the feet
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Q:A new study is investigating the effects of an experimental drug, Exerzisin, on the duration and intensity of exercise. In the treatment group participants are given daily Exerzisin at the main treatment facility and instructed to exercise as much as they would like on the facility's exercise equipment. Due to an insufficient number of exercise units at the main treatment center, the control subjects are given free access to an outside, private gym. The duration and intensity of exercise in both groups is measured with a pedometer. The perspicacious undergraduate, hired to input all the data, points out that the treatment group may be more motivated to exercise harder and longer because their exercising can be observed by the investigators. To which form of bias is he alluding?? {'A': 'Selection bias', 'B': 'Hawthorne effect', 'C': 'Recall bias', 'D': 'Pygmalion effect', 'E': 'Lead time bias'},
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B: Hawthorne effect
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Q:A 13-year-old Hispanic boy is brought to the physician by his mother because of left groin pain for 1 month. The pain radiates to his left knee and is aggravated on walking. He fell during soccer practice 5 weeks ago but did not see a doctor about it and does not recall any immediate and persistent pain after the event. He has hypothyroidism. His only medication is levothyroxine. His immunizations are up-to-date. He appears uncomfortable. He is at the 50th percentile for height and at the 95th percentile for weight. His temperature is 37.1°C (98.9°F), pulse is 77/min, respirations are 14/min, and blood pressure is 100/70 mm Hg. The patient has a left-sided, antalgic gait. The left lower extremity is externally rotated. The left hip is tender to palpation and internal rotation is limited by pain. Laboratory studies show: Hemoglobin 13.1 g/dL Leukocyte count 9,100/mm3 Platelet count 250,000/mm3 Serum TSH 3.6 μU/mL Which of the following is the most likely diagnosis?"? {'A': 'Septic arthritis of the left hip', 'B': 'Slipped capital femoral epiphysis', 'C': 'Osteomyelitis of the left hip', 'D': 'Transient synovitis', 'E': 'Developmental dysplasia of the left hip'},
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B: Slipped capital femoral epiphysis
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Q:A 38-year-old woman presents with generalized weakness and dizziness for the past 3 weeks. Past medical history is significant for systemic lupus erythematosus diagnosed 15 years ago, for which she takes hydroxychloroquine and methotrexate. No significant family history. Her vital signs include: temperature 37.1°C (98.7°F), blood pressure 122/65 mm Hg, pulse 100/min. Physical examination reveals generalized pallor; sclera are icteric. Her laboratory results are significant for the following: Hemoglobin 7.3 g/dL Mean corpuscular hemoglobin (MCH) 45 pg/cell Reticulocyte count 6% Direct antiglobulin test Positive Peripheral blood smear 7 spherocytes Which of the following best represents the most likely cause of this patient's condition?? {'A': 'Methotrexate side effect', 'B': 'Red cell membrane defect', 'C': 'IgG-mediated hemolysis', 'D': 'IgM-mediated hemolysis', 'E': 'Chronic inflammation'},
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C: IgG-mediated hemolysis
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Q:A 46-year-old man presents after he accidentally got splashed with a liquid insecticide that was stored in a bucket in the storeroom one hour ago. He says that he can’t stop coughing and is having problems breathing. He also says he has a pain in his thighs which is unbearable, and his vision is blurry. His temperature is 36.7°C (98.1°F), the pulse is 130/min, the blood pressure is 144/92 mm Hg, and the respiratory rate is 20/min. On physical examination, the patient shows mild generalized pallor, moderate respiratory distress, excessive salivation, and diaphoresis. Cough is non-productive. Pupils are constricted (pinpoint). The cardiopulmonary exam reveals bilateral crepitus. The patient is administered atropine and pralidoxime, which help improve his symptoms. Which of the following is most likely to improve in this patient with the administration of atropine?? {'A': 'Bronchospasm', 'B': 'Tachycardia', 'C': 'Muscle cramps', 'D': 'Hypertension', 'E': 'Pallor'},
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A: Bronchospasm
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Q:A female infant is born with a mutation in PKD1 on chromosome 16. An abdominal ultrasound performed shortly after birth would most likely reveal which of the following?? {'A': 'Bilateral kidney enlargement', 'B': 'Microscopic cysts', 'C': 'Horseshoe kidney', 'D': 'Adrenal atrophy', 'E': 'Normal kidneys'},
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E: Normal kidneys
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Q:A 28-year-old man is admitted to the hospital for the evaluation of symmetric, ascending weakness that started in his feet and has become progressively worse over the past 5 days. A lumbar puncture is performed to confirm the diagnosis. As the needle is advanced during the procedure, there is resistance just before entering the epidural space. This resistance is most likely due to which of the following structures?? {'A': 'Ligamentum flavum', 'B': 'Superficial fascia', 'C': 'Interspinous ligament', 'D': 'Dura mater', 'E': 'Supraspinous ligament'},
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A: Ligamentum flavum
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Q:A 32-year-old woman comes to the emergency department because of a 5-day history of anxiety, irritability, insomnia, and abdominal pain that began after a weekend of partying. She also reports “bloody” urine as well as a tingling sensation in her hands and feet. She has never experienced similar symptoms. She does not smoke but says that she tends to drink too much (5 or more drinks) when partying with friends. Her temperature is 37°C (98.6°F), pulse is 123/min, and blood pressure is 124/70 mm Hg. Examination shows slightly decreased power in the shoulders (3/5) and thighs (4/5), along with hyporeflexia. Urine dipstick shows: Blood Negative Protein Negative WBC Negative Bilirubin Negative Urobilinogen 3+ This patient's condition is most likely caused by a defect in which of the following enzymes?"? {'A': 'Homogentisic acid dioxygenase', 'B': 'Aminolevulinic acid synthase', 'C': 'Uroporphyrinogen decarboxylase', 'D': 'Ferrochelatase', 'E': 'Porphobilinogen deaminase'},
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E: Porphobilinogen deaminase
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Q:A 26-year-old immigrant from Mexico presents to your clinic for a physical. He tells you that several weeks ago, he noticed a lesion on his penis which went away after several weeks. It was nontender and did not bother him. He currently does not have any complaints. His temperature is 97.9°F (36.6°C), blood pressure is 139/91 mmHg, pulse is 87/min, respirations are 14/min, and oxygen saturation is 98% on room air. Physical exam is unremarkable and shows no evidence of any rash. A VDRL and FTA-ABS test are both positive. What is the most appropriate management of this patient?? {'A': 'Acyclovir', 'B': 'Azithromycin and ceftriaxone', 'C': 'Doxycycline', 'D': 'No treatment indicated', 'E': 'Penicillin'},
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E: Penicillin
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Q:A 10-year-old male presents with his mother with multiple complaints. A few weeks ago, he had a sore throat for several days that improved without specific therapy. Additionally, over the past several days he has experienced pain in his ankles and wrists and, more recently, his left knee. His mother also noted several bumps on both of his elbows, and he has also had some pain in his center of his chest. He thinks the pain is better when he leans forward. On physical examination, he is noted to be mildly febrile, and a pericardial friction rub is auscultated. Which of the following histopathologic findings is most likely associated with this patient's condition?? {'A': 'Atypical lymphocytes noted on peripheral blood smear with an initial positive heterophil antibody test', 'B': 'Plasmodium falciparum ring forms in red blood cells on peripheral blood smear', 'C': 'Needle-shaped, negatively birefringent crystal deposits surrounded by palisading histiocytes in the synovial fluid of an affected joint', 'D': 'Interstitial myocardial granulomas containing plump macrophages with nuclei incorporating central wavy ribbons of chromatin', 'E': 'Sterile vegetations on both the ventricular and atrial aspects of the mitral valve, a proliferative glomerulonephritis, and serum anti-dsDNA and anti-Sm positivity'},
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D: Interstitial myocardial granulomas containing plump macrophages with nuclei incorporating central wavy ribbons of chromatin
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Q:A 75-year-old man is brought to the emergency department by his son. He is suffering from left-sided weakness. The symptoms started 2 hours ago with sudden left-sided weakness. The patient is a known hypertensive, who is inconsistently compliant with his 2 antihypertensive medications and a heavy smoker, with a 40 pack year history. Physical examination shows an elderly male in mild distress. The vital signs include: blood pressure 140/95 mm Hg, pulse 89/min and SpO2 98% on room air. Neurological examination shows left-sided hemiparesis, with no sensory, cognitive, or brain stem abnormalities. A CT scan of the head without IV contrast shows a right-sided ischemic infarct. What other finding is most likely to develop in this patient as his condition progresses?? {'A': 'Flaccid paresis', 'B': 'Loss of deep tendon reflexes', 'C': 'Fasciculations', 'D': 'Muscle atrophy', 'E': 'Positive Babinski sign'},
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E: Positive Babinski sign
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Q:A 32-year-old woman, gravida 2, para 2, comes to the physician for the evaluation of a palpable mass in her right breast that she first noticed 1 week ago. She has no associated pain. She has never had a mammogram previously. She has type II diabetes mellitus treated with metformin. She has no family history of breast cancer. She has smoked half a pack of cigarettes daily for 15 years. Her temperature is 37°C (98.6°F), pulse is 78/min, respirations are 14/min, and blood pressure is 125/75 mm Hg. Examination shows a firm, nonpainful, nonmobile mass in the right upper quadrant of the breast. There is no nipple discharge. Examination of the skin and lymph nodes shows no abnormalities. No masses are palpated in the left breast. Which of the following is the most appropriate next step in the management of this patient?? {'A': 'MRI scan of the breast', 'B': 'Mammography', 'C': 'Core needle biopsy', 'D': 'BRCA gene testing', 'E': 'Monthly self-breast exams'},
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B: Mammography
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Q:A 70-year-old female presents to you for an office visit with complaints of forgetfulness. The patient states that over the last several years, the patient has stopped cooking for herself even though she lives alone. Recently, she also forgot how to drive back home from the grocery store and has difficulty paying her bills. The patient says she has been healthy over her whole life and does not take any medications. Her vitals are normal and her physical exam does not reveal any focal neurological deficits. Her mini-mental status exam is scored 19/30 and her MRI reveals diffuse cortical atrophy. What is the best initial treatment for this patient's condition?? {'A': 'Bromocriptine', 'B': 'Pramipexole', 'C': 'Ropinirole', 'D': 'Rivastigmine', 'E': 'Memantine'},
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D: Rivastigmine
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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 presents to the emergency department with hematuria and hemoptysis that started in the morning. He notes that he has had frequent lung infections throughout his adult life, the most recent being 2 weeks ago. He also mentions that he has had hematuria twice before but never as severe as he is having currently. His medical history is otherwise non-significant, and his only medication is acetaminophen as needed. His blood pressure is 136/92 mm Hg, heart rate is 86/min, respiratory rate is 16/min, and temperature is 37.0°C (98.6°F). Chest radiography shows a resolving right middle lobe airspace opacity. His initial laboratory tests are notable for elevated erythrocyte sedimentation rate and C-reactive protein level. While in the examination room, the patient develops a spontaneous nosebleed. What is the most likely diagnosis?? {'A': 'Post-streptococcal glomerulonephritis', 'B': 'IgA nephropathy', 'C': 'Goodpasture syndrome', 'D': 'Minimal change disease', 'E': 'Granulomatosis with polyangiitis'},
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E: Granulomatosis with polyangiitis
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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 ED complaining of back and left leg pain. He was lifting heavy furniture while helping his daughter move into college when all of sudden he felt a sharp pain at his back. The pain is described as severe, worse with movement, and shoots down his lateral thigh. The patient denies any bowel/urinary incontinence, saddle anesthesia, weight loss, or weakness. He denies any past medical history but endorses a family history of osteoporosis. He has been smoking 1 pack per day for the past 20 years. Physical examination demonstrated decreased sensation at the left knee, decreased patellar reflex, and a positive straight leg test. There is diffuse tenderness to palpation at the lower back but no vertebral step-offs were detected. What is the most likely etiology for this patient’s pain?? {'A': 'Disc herniation at the L3/L4 vertebra', 'B': 'Disc herniation at the L4/L5 vertebra', 'C': 'Lumbar muscle sprain', 'D': 'Spinal metastasis from lung cancer', 'E': 'Vertebral compression fracture'},
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A: Disc herniation at the L3/L4 vertebra
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Q:A 20-year-old man presents to his primary care provider with a history of recurrent cough, wheezing, and breathlessness since early childhood. He previously diagnosed with allergic rhinitis and bronchial asthma. For his allergic rhinitis, he uses intranasal fluticasone. For his asthma, he uses an albuterol inhaler as a rescue inhaler. It is decided to initiate a new medication for daily use. Which of the following medications, with its corresponding mechanism, is the next best step in therapy?? {'A': 'β2-agonists reverse bronchoconstriction but do not control the underlying inflammation.', 'B': 'Antileukotrienes (such as montelukast and zafirlukast) exert their beneficial effects in bronchial asthma by blocking CysLT2-receptors.', 'C': 'Omalizumab acts by blocking both circulating and mast cell-bound IgE.', 'D': 'Theophylline activates histone acetyltransferase.', 'E': 'Mitogen-activated protein (MAP) kinase phosphatase-1 expression is upregulated by inhaled corticosteroids.'},
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E: Mitogen-activated protein (MAP) kinase phosphatase-1 expression is upregulated by inhaled corticosteroids.
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Answer the following medical question with one of the provided options:
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Q:A 24-year-old woman comes to the physician for a routine pelvic examination. She feels well. Menses occur at 30-day intervals and last 7 days. Her last menstrual period was 6 days ago. She has no history of abnormal Pap smears; her last Pap smear was 13 months ago. She is sexually active with three male partners and uses condoms consistently. She has never been tested for sexually transmitted infections. Her 54-year-old mother has breast cancer. She is up-to-date on her Tdap, MMR, and varicella vaccinations. Her temperature is 37.1°C (98.8°F), pulse is 68/min, and blood pressure is 108/68 mm Hg. Physical examination shows no abnormalities. In addition to HIV, gonorrhea, and chlamydia testing, which of the following is the most appropriate recommendation at this time?? {'A': 'HPV vaccination', 'B': 'Syphilis testing', 'C': 'Mammography', 'D': 'Pregnancy test', 'E': 'HPV testing'},
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A: HPV vaccination
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Q:Two weeks after being hospitalized for acute pancreatitis, a 36-year-old man comes to the physician for a follow-up examination. Multiple family members have coronary artery disease. Physical examination shows multiple, yellow papular lesions on both upper eyelids. Fasting serum lipid studies show: Total cholesterol 280 mg/dl HDL-cholesterol 40 mg/dl LDL-cholesterol 185 mg/dl Triglycerides 1080 mg/dl Treatment with gemfibrozil is initiated. The expected beneficial effect of this drug is most likely due to which of the following mechanisms of action?"? {'A': 'Inhibition of HMG-CoA reductase', 'B': 'Inhibition of intestinal cholesterol absorption', 'C': 'Deactivation of peroxisome proliferator-activated receptors', 'D': 'Upregulation of lipoprotein lipase', 'E': 'Formation of bile acid complex'},
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D: Upregulation of lipoprotein lipase
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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 with type 2 diabetes mellitus comes to the physician for a follow-up evaluation. He was recently diagnosed with hyperlipidemia, for which he takes several medications. His serum total cholesterol concentration is 295 mg/dL and serum high-density lipoprotein concentration is 19 mg/dL (N: > 40 mg/dL). The physician prescribes an additional drug that decreases hepatic production of triglycerides and reduces the release of VLDL and LDL through the inhibition of diacylglycerol acyltransferase 2. This patient should be advised to do which of the following?? {'A': 'Take aspirin shortly before taking the new drug to reduce pruritus', 'B': 'Schedule a follow-up appointment in 2 weeks to check serum creatine kinase levels', 'C': 'Take diphenhydramine with the new drug to prevent skin rash', 'D': "Avoid smoking because of the new drug's increased risk of thrombosis", 'E': 'Check blood glucose levels after taking the new drug to detect hypoglycemia'},
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A: Take aspirin shortly before taking the new drug to reduce pruritus
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Q:A 69-year-old smoker presents to physician after noticing that his face seems to be more swollen than usual. Upon further questioning, he reports increasing shortness of breath and cough over the past 6 months. On exam, his physician notices venous distention in his neck and distended veins in the upper chest and arms. Chest radiograph shows a right upper lobe mass. What is the embryologic origin of the vessel being compressed by this patient's tumor?? {'A': 'Truncus arteriosus', 'B': 'Bulbis cordis', 'C': 'Primitive ventricle', 'D': 'Left horn of sinus venosus', 'E': 'Cardinal veins'},
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E: Cardinal veins
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Q:A 57-year-old man comes to the emergency department for the evaluation of worsening fatigue, urinary frequency, and constipation over the past 5 days. He was recently diagnosed with metastatic bladder cancer and is currently awaiting treatment. He has smoked 1 pack of cigarettes daily for 35 years. Physical examination shows dry mucous membranes and diffuse abdominal tenderness. An ECG shows a shortened QT interval. Which of the following sets of serum findings is most likely in this patient? $$$ Calcium %%% Phosphorus %%% Parathyroid hormone %%% 1,25-dihydroxyvitamin D $$$? {'A': '↓ ↑ ↑ ↓', 'B': '↑ ↑ ↓ ↑', 'C': '↑ ↑ ↑ ↓', 'D': '↑ ↓ ↑ ↑', 'E': '↑ ↓ ↓ ↓'},
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E: ↑ ↓ ↓ ↓
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Answer the following medical question with one of the provided options:
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Q:A 2-year-old boy had increased bleeding during a circumcision. His birth and delivery were uncomplicated, and his mother had no issues with prolonged bleeding during labor. Of note, his maternal grandfather has a history of bleeding complications. The boy's vital signs are stable and physical examination is notable for scattered bruises on his lower extremities. The lab results are as follows: Hemoglobin 12.8 gm % Hematocrit 35.4% WBC 8400/mm3 Platelets 215 x 109/L PT 14 s PTT 78 s What is the most likely diagnosis?? {'A': 'Von Willebrand disease', 'B': 'Glanzmann thrombasthenia', 'C': 'Bernard-Soulier syndrome', 'D': 'Hemophilia A', 'E': 'Scurvy'},
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D: Hemophilia A
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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 is brought to the emergency department for a severe, sudden-onset headache, light-sensitivity, and neck stiffness that began 30 minutes ago. A CT scan of the head shows hyperdensity between the arachnoid mater and the pia mater. The patient undergoes an endovascular procedure. One week later, she falls as she is returning from the bathroom. Neurologic examination shows 3/5 strength in the right lower extremity and 5/5 in the left lower extremity. Treatment with which of the following drugs is most likely to have prevented the patient's current condition?? {'A': 'Enalapril', 'B': 'Nimodipine', 'C': 'Fresh frozen plasma', 'D': 'Fosphenytoin', 'E': 'Nitroglycerin'},
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B: Nimodipine
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Q:An experimental compound added to a protein disrupts both alpha helices as well as beta-pleated sheets. Which of the following has the experimental compound affected?? {'A': 'The primary structure of the protein', 'B': 'Hydrogen bonds between amino acids', 'C': 'Covalent peptide bonds between amino acids', 'D': 'Ionic bonds between amino acids', 'E': 'Disulfide bonds between amino acids'},
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B: Hydrogen bonds between amino acids
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Q:A 28-year-old woman and her husband are admitted to the office due to difficulties conceiving a child for the past year. Her menarche was at the age of 15 years, and her periods have been regular since then. Her medical history is positive for an abortion with curettage 5 years ago. A spermogram on the partner is performed, and it shows motile sperm cells. An ultrasound is performed on the patient and it is unremarkable. The laboratory results show that the FSH, LH, TSH, and prolactin levels are within normal ranges. A hysteroscopy is additionally performed and multiple adhesions are found in the uterus (refer to the image). Which of the following is the most likely composition of the scar tissue present in the uterus?? {'A': 'Type 1 collagen', 'B': 'Type 2 collagen', 'C': 'Type 3 collagen', 'D': 'Type 4 collagen', 'E': 'Elastin'},
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A: Type 1 collagen
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Answer the following medical question with one of the provided options:
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Q:A 36-year-old woman is brought to the emergency room by her husband for “weird behavior" for the past several weeks. He reports that her right arm has been moving uncontrollably in a writhing movement and that she has been especially irritable. She has a history of depression, which was diagnosed 4 years ago and is currently being treated with sertraline. She denies any recent fever, trauma, infections, travel, weakness, or sensory changes. She was adopted so is unsure of her family history. Which of the following is the most likely explanation for her symptoms?? {'A': 'CAG triplet expansion on chromosome 4', 'B': 'Development of intracellular eosinophilic inclusions', 'C': 'Frontotemporal lobe degeneration', 'D': 'GAA triplet expansion on chromosome 9', 'E': 'Presence of misfolded proteins in the brain'},
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A: CAG triplet expansion on chromosome 4
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