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Answer the following medical question with one of the provided options:
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Q:An investigator is studying muscle tissue in high-performance athletes. He obtains blood samples from athletes before and after a workout session consisting of short, fast sprints. Which of the following findings is most likely upon evaluation of blood obtained after the workout session?? {'A': 'Increased concentration of insulin', 'B': 'Increased concentration of H+', 'C': 'Decreased concentration of lactate', 'D': 'Increased concentration of ATP', 'E': 'Decreased concentration of NADH'},
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B: Increased concentration of H+
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Answer the following medical question with one of the provided options:
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Q:A 23-year-old man college student visits the Health Services Office complaining of an intense and painful rash involving his axillae, waist, periumbilical skin, and inner thighs. The pruritus is worse at night. He noticed the rash and onset of symptoms after a recent fraternity party 4 weeks ago. The physical examination is unremarkable, except for multiple excoriated small papules with burrows distributed in a serpiginous pattern. An image of the lesions is shown below. Which of the following best describes the mechanism of action of the first-line agent for this patient’s condition?? {'A': 'Inhibition of acetylcholinesterase', 'B': 'Blockade of GABA-A receptors', 'C': 'Blockade of voltage-gated Na+ channels', 'D': 'Formation of pores in membranes', 'E': 'Formation of free radicals'},
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C: Blockade of voltage-gated Na+ channels
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Answer the following medical question with one of the provided options:
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Q:A 75-year-old male presents to the emergency room complaining of severe lower abdominal pain and an inability to urinate. He reports that he last urinated approximately nine hours ago. When asked to urinate, only a few drops dribble from the tip of his penis. Further questioning reveals that the patient has experienced progressively worsening difficulty with urinating over the past two years. He has lived alone for five years since his wife passed away. He has not seen a doctor in that time. His temperature is 98.8°F (37.1°C), blood pressure is 145/90 mmHg, pulse is 115/min, and respirations are 22/min. He appears to be in severe pain. Physical examination reveals a distended bladder and significant tenderness to palpation over the inferior aspect of his abdomen. Which of the following sets of lab values would most likely be found in a urinalysis of this patient?? {'A': 'Urine osmolality 400 mOsmol/kg H2O, Urine Na+ 25 mEq/L, FENa 1.5%, no casts', 'B': 'Urine osmolality 200 mOsmol/kg H2O, Urine Na+ 35 mEq/L, FENa 3%, muddy brown casts', 'C': 'Urine osmolality 550 mOsmol/kg H2O, Urine Na+ 15 mEq/L, FENa 0.9%, red blood cell casts', 'D': 'Urine osmolality 600 mOsmol/kg H2O, Urine Na+ 15 mEq/L, FENa 0.8%, hyaline casts', 'E': 'Urine osmolality 300 mOsmol/kg H2O, Urine Na+ 45 mEq/L, FENa 5%, no casts'},
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E: Urine osmolality 300 mOsmol/kg H2O, Urine Na+ 45 mEq/L, FENa 5%, no casts
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Answer the following medical question with one of the provided options:
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Q:A 27-year-old male presents to the emergency department after being brought in from a house fire. The patient has extensive burns covering his body and is conscious but in severe pain. The patient has a past medical history notable for marijuana use. He is not currently on any medications. Physical exam is notable for extensive burns covering the patients back, chest, thighs, and legs. The patient's oropharynx reveals no signs of damage or extensive smoke inhalation. The patient is breathing on his own and has normal breath sounds bilaterally. His temperature is 99.5°F (37.5°C), pulse is 145/min, blood pressure is 100/70 mmHg, respirations are 27/min, and oxygen saturation is 93% on room air. Which of the following interventions is most likely to reduce mortality in this patient?? {'A': 'IV fluids', 'B': 'Oral antibiotics', 'C': 'Topical antibiotics', 'D': 'Normal saline soaked dressings', 'E': 'Oxygen administration'},
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A: IV fluids
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Answer the following medical question with one of the provided options:
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Q:A 7-month-old boy is brought to the physician for a well-child examination. He was born at 36 weeks' gestation and has been healthy since. He is at the 60th percentile for length and weight. Vital signs are within normal limits. The abdomen is soft and nontender. The external genitalia appear normal. Examination shows a single palpable testicle in the right hemiscrotum. The scrotum is nontender and not enlarged. There is a palpable mass in the left inguinal canal. Which of the following is the most appropriate next best step in management?? {'A': 'Gondadotropin therapy', 'B': 'Orchidopexy', 'C': 'Exploration under anesthesia', 'D': 'Serum testosterone level', 'E': 'Reassurance'},
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B: Orchidopexy
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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 a clinic with oliguria. Four weeks ago, he had a kidney transplant. Postoperative follow-up was normal. He is currently on cyclosporine and admits that sometimes he forgets to take his medication. On physical examination, the vital signs include: temperature 37.1°C (98.8°F), blood pressure 165/110 mm Hg, heart rate 80/min, and respiratory rate 16/min. There is mild tenderness on renal palpation. His serum creatinine level is 4 mg/dL, well above his baseline level after the transplant. Which of the following best describes the histological finding if a biopsy is taken from the transplanted kidney?? {'A': 'Thickening of blood vessels, fibrosis of graft vessels, and parenchymal atrophy', 'B': 'Necrosis with granulation tissue', 'C': 'Atherosclerosis on angiography', 'D': 'Thrombosis and occlusion of vessels', 'E': 'Lymphocytic infiltration of graft vessels and endothelial damage'},
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E: Lymphocytic infiltration of graft vessels and endothelial damage
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Answer the following medical question with one of the provided options:
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Q:A young woman from the Ohio River Valley in the United States currently on corticosteroid therapy for ulcerative colitis presented to a clinic complaining of fever, sweat, headache, nonproductive cough, malaise, and general weakness. A chest radiograph revealed patchy pneumonia in the lower lung fields, together with enlarged mediastinal and hilar lymph nodes. Skin changes suggestive of erythema nodosum (i.e. an acute erythematous eruption) were noted. Because the patient was from a region endemic for fungal infections associated with her symptoms and the patient was in close contact with a person presenting similar symptoms, the attending physician suspected that systemic fungal infection might be responsible for this woman’s illness. Which of the following laboratory tests can the physician use to ensure early detection of the disease, and also effectively monitor the treatment response?? {'A': 'Culture method', 'B': 'Antibody testing', 'C': 'Fungal staining', 'D': 'Antigen detection', 'E': 'Skin tests'},
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D: Antigen detection
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Answer the following medical question with one of the provided options:
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Q:A 14-year-old boy is brought to the clinic by his mother for temper tantrums for the past year. She is concerned as he gets abnormally irritated and angry towards the smallest things. After asking the mother to leave the room, the patient reports that he is simply annoyed by his mother’s constant nagging. He denies any violent tendencies, suicidal ideations, depressive symptoms, or intention to hurt others. The patient states he finds the physician irritating and that he reminds her of his mother in his mannerisms and demeanor. Without provocation, the patient shouts at the physician saying that he does not understand or really care about him and he never would. What is the likely explanation for this patient’s behavior toward the physician?? {'A': 'Acting out', 'B': 'Displacement', 'C': 'Passive aggression', 'D': 'Projection', 'E': 'Transference'},
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E: Transference
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Answer the following medical question with one of the provided options:
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Q:An investigator studying hormone synthesis and transport uses immunocytochemical techniques to localize a carrier protein in the central nervous system of an experimental animal. The investigator finds that this protein is synthesized together with a specific hormone from a composite precursor. The protein is involved in the transport of the hormone from the supraoptic and paraventricular nuclei to its destination. The hormone transported by these carrier proteins is most likely responsible for which of the following functions?? {'A': 'Hyperplasia of the adrenal zona fasciculata', 'B': 'Maturation of primordial germ cells', 'C': 'Increased insulin-like growth factor 1 production', 'D': 'Upregulation of renal aquaporin-2 channels', 'E': 'Stimulation of thyroglobulin cleavage'},
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D: Upregulation of renal aquaporin-2 channels
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Answer the following medical question with one of the provided options:
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Q:A 33-year-old man with HIV comes to the physician because of a nonproductive cough and shortness of breath for 3 weeks. He feels tired after walking up a flight of stairs and after long conversations on the phone. He appears chronically ill. His temperature is 38.5°C (101.3°F), and pulse is 110/min. Pulse oximetry on room air shows an oxygen saturation of 95%. Upon walking, his oxygen saturation decreases to 85%. Cardiopulmonary examination is normal. Laboratory studies show a CD4+ T-lymphocyte count of 176/mm3 (N > 500). Results of urine Legionella antigen testing are negative. A CT scan of the chest shows diffuse, bilateral ground-glass opacities. Microscopic examination of fluid obtained from bronchoalveolar lavage will most likely show which of the following findings?? {'A': 'Gram-positive, catalase-positive cocci', 'B': 'Silver-staining, disc-shaped cysts', 'C': 'Intracellular, acid-fast bacteria', 'D': 'Septate, acute-branching hyphae', 'E': 'Silver-staining, gram-negative bacilli'},
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B: Silver-staining, disc-shaped cysts
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Answer the following medical question with one of the provided options:
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Q:A 46-year-old woman presents to the clinic complaining that she “wets herself.” She states that over the past year she has noticed increased urinary leakage. At first it occurred only during her job, which involves restocking shelves with heavy appliances. Now she reports that she has to wear pads daily because leakage of urine will occur with simply coughing or sneezing. She denies fever, chills, dysuria, hematuria, or flank pain. She has no significant medical or surgical history, and takes no medications. Her last menstrual period was 8 months ago. She has 3 healthy daughters that were born by vaginal delivery. Which of the following tests, if performed, would most likely identify the patient’s diagnosis?? {'A': 'Estrogen level', 'B': 'Methylene blue dye', 'C': 'Post-void residual volume', 'D': 'Q-tip test', 'E': 'Urodynamic testing'},
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D: Q-tip test
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Answer the following medical question with one of the provided options:
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Q:A 2-day-old male is seen in the newborn nursery for repeated emesis and lethargy. He was born at 39 weeks to a 24-year-old mother following an uncomplicated pregnancy and birth. He has been breastfeeding every 2 hours and has 10 wet diapers per day. His father has a history of beta-thalassemia minor. Laboratory results are as follows: Hemoglobin: 12 g/dL Platelet count: 200,000/mm^3 Mean corpuscular volume: 95 µm^3 Reticulocyte count: 0.5% Leukocyte count: 5,000/mm^3 with normal differential Serum: Na+: 134 mEq/L Cl-: 100 mEq/L K+: 3.3 mEq/L HCO3-: 24 mEq/L Urea nitrogen: 1 mg/dL Creatinine: 0.6 mg/dL Which of the following is the most likely diagnosis?? {'A': 'Ornithine transcarbamylase deficiency', 'B': 'Orotic aciduria', 'C': 'Beta-thalassemia minor', 'D': 'Phenylketonuria', 'E': 'Alkaptonuria'},
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A: Ornithine transcarbamylase deficiency
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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 emergency department because of chills and numerous skin lesions for 1 week. He has also had watery diarrhea, nausea, and abdominal pain for the past 2 weeks. The skin lesions are nonpruritic and painless. He was diagnosed with HIV infection approximately 20 years ago. He has not taken any medications for over 5 years. He sleeps in homeless shelters and parks. Vital signs are within normal limits. Examination shows several bright red, friable nodules on his face, trunk, extremities. The liver is palpated 3 cm below the right costal margin. His CD4+ T-lymphocyte count is 180/mm3 (N ≥ 500). A rapid plasma reagin test is negative. Abdominal ultrasonography shows hepatomegaly and a single intrahepatic 1.0 x 1.2-cm hypodense lesion. Biopsy of a skin lesion shows vascular proliferation and abundant neutrophils. Which of the following is the most likely causal organism?? {'A': 'HHV-8 virus', 'B': 'Treponema pallidum', 'C': 'Candida albicans', 'D': 'Mycobacterium avium', 'E': 'Bartonella henselae'},
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E: Bartonella henselae
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Answer the following medical question with one of the provided options:
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Q:A 70-year-old man is brought to the emergency department unconscious after a fall. He appears pale and is pulseless. A 12-lead EKG reveals wide, monomorphic sawtooth-like QRS complexes. He undergoes synchronized cardioversion three times at increasing voltage with no effect. Epinephrine is administered with minimal effect. Which drug will minimize his risk of developing multifocal ventricular tachycardia?? {'A': 'Amiodarone', 'B': 'Ibutilide', 'C': 'Dofetilide', 'D': 'Sotalol', 'E': 'Procainamide'},
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A: Amiodarone
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Answer the following medical question with one of the provided options:
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Q:A molecular biologist is studying the roles of different types of ion channels regulating cardiac excitation. He identifies a voltage-gated calcium channel in the sinoatrial node, which is also present throughout the myocardium. The channel is activated at ~ -40 mV of membrane potential, undergoes voltage-dependent inactivation, and is highly sensitive to nifedipine. Which of the following phases of the action potential in the sinoatrial node is primarily mediated by ion currents through the channel that the molecular biologist is studying?? {'A': 'Phase 0', 'B': 'Phase 1', 'C': 'Phase 2', 'D': 'Phase 3', 'E': 'Phase 4'},
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A: Phase 0
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Answer the following medical question with one of the provided options:
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Q:A 77-year-old woman presents to her physician because of fatigue and progressive dyspnea despite receiving optimal treatment for heart failure. Her medical history is positive for heart failure, active tuberculosis, and chronic renal failure, for which she has been in long-term hemodialysis (13 years). The woman currently takes rifampin and isoniazid. Her physical exam shows the presence of hepatomegaly (a jugular venous distention that fails to subside on inspiration) and an impalpable apical impulse. Her pulse is 122/min, respiratory rate 16/min, temperature 36.0°C (97.4°F), and blood pressure 120/60 mm Hg. Her cardiac monitor shows a prominent y descent in her jugular venous pulse. A cardiac ultrasound shows pericardial calcifications and small tubular-shaped ventricles. Which of the following is the most likely cause of this patient’s current condition?? {'A': 'Atrial fibrillation', 'B': 'Constrictive pericarditis', 'C': 'Dilated cardiomyopathy', 'D': 'Hypertrophic cardiomyopathy', 'E': 'Restrictive cardiomyopathy'},
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B: Constrictive pericarditis
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Answer the following medical question with one of the provided options:
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Q:An at-home recreational drug screening test kit is currently being developed. They consult you for assistance with determining an ideal cut-off point for the level of the serum marker in the test kit. This cut-off point will determine what level of serum marker is associated with a positive or negative test, with serum marker levels greater than the cut-off point indicative of a positive test and vice-versa. The cut-off level is initially set at 4 mg/uL, which is associated with a sensitivity of 92% and a specificity of 97%. How will the sensitivity and specificity of the test change if the cut-off level is raised to 6 mg/uL?? {'A': 'Sensitivity decreases, specificity decreases', 'B': 'Sensitivity increases, specificity decreases', 'C': 'Sensitivity decreases, specificity increases', 'D': 'Sensitivity increases, specificity increases', 'E': 'Sensitivity decreases, specificity may increase or decrease'},
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C: Sensitivity decreases, specificity increases
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Answer the following medical question with one of the provided options:
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Q:A 7-year-old boy is brought to the physician because of a 5-day history of fever, malaise, and joint pain. He had a sore throat 4 weeks ago that resolved without treatment. His temperature is 38.6°C (101.5°F) and blood pressure is 84/62 mm Hg. Physical examination shows several firm, painless nodules under the skin near his elbows and the dorsal aspect of both wrists. Cardiopulmonary examination shows bilateral basilar crackles and a blowing, holosystolic murmur heard best at the cardiac apex. Both knee joints are warm. Laboratory studies show an erythrocyte sedimentation rate of 129 mm/h. The immune response seen in this patient is most likely due to the presence of which of the following?? {'A': 'Hyaluronic acid capsule', 'B': 'TSST-1', 'C': 'IgA protease', 'D': 'CAMP factor', 'E': 'M protein\n"'},
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E: M protein "
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Answer the following medical question with one of the provided options:
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Q:A 5-year-old boy is brought to the physician by his mother because he claims to have spoken to his recently-deceased grandfather. The grandfather, who lived with the family and frequently watched the boy for his parents, died 2 months ago. The boy was taken out of preschool for 3 days after his grandfather's death but has since returned. His teachers report that the boy is currently doing well, completing his assignments, and engaging in play with other children. When asked about how he feels, the boy becomes tearful and says, “I miss my grandpa. I sometimes talk to him when my mom is not around.” Which of the following is the most likely diagnosis?? {'A': 'Brief psychotic disorder', 'B': 'Adjustment disorder', 'C': 'Normal grief', 'D': 'Schizophreniform disorder', 'E': 'Major depressive disorder'},
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C: Normal grief
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Answer the following medical question with one of the provided options:
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Q:A previously healthy 16-year-old boy is brought to the physician by his parents for evaluation because of extreme irritability, fatigue, and loss of appetite for 3 weeks. Five months ago, his grandfather, whom he was very close to, passed away from chronic lymphocytic leukemia. He used to enjoy playing soccer but quit his soccer team last week. When he comes home from school he goes straight to bed and sleeps for 11–12 hours each night. He previously had good grades, but his teachers report that he has been disrespectful and distracted in class and failed an exam last week. He tried alcohol twice at a party last year and he has never smoked cigarettes. Vital signs are within normal limits. On mental status examination, he avoids making eye contact but cooperates with the exam. His affect is limited and he describes an irritable mood. He is easily distracted and has a difficult time focusing for an extended conversation. Which of the following is the most likely diagnosis?? {'A': 'Substance abuse', 'B': 'Major depressive disorder', 'C': 'Attention deficit hyperactivity disorder', 'D': 'Adjustment disorder with depressed mood', 'E': 'Persistent depressive disorder'},
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B: Major depressive disorder
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Answer the following medical question with one of the provided options:
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Q:An 18-year-old woman is brought to the emergency department by her coach, 30 minutes after injuring her left knee while playing field hockey. She was tackled from the left side and has been unable to bear weight on her left leg since the accident. She fears the left knee may be unstable upon standing. There is no personal or family history of serious illness. The patient appears uncomfortable. Vital signs are within normal limits. Examination shows a swollen and tender left knee; range of motion is limited by pain. The medial joint line is tender to touch. The patient's hip is slightly flexed and abducted, and the knee is slightly flexed while the patient is in the supine position. Gentle valgus stress is applied across the left knee and medial joint laxity is noted. The remainder of the examination shows no further abnormalities. Which of the following is the most likely diagnosis?? {'A': 'Posterior cruciate ligament injury', 'B': 'Medial meniscus injury', 'C': 'Anterior cruciate ligament injury', 'D': 'Lateral collateral ligament injury', 'E': 'Medial collateral ligament injury'},
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E: Medial collateral ligament injury
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Answer the following medical question with one of the provided options:
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Q:A 54-year-old woman comes to the physician for a follow-up examination after presenting with elevated blood pressure readings during her last two visits. After her last visit 2 months ago, she tried controlling her hypertension with weight loss before starting medical therapy, but she has since been unable to lose any weight. Her pulse is 76/min, and blood pressure is 154/90 mm Hg on the right arm and 155/93 mm Hg on the left arm. She agrees to start treatment with a thiazide diuretic. In response to this treatment, which of the following is most likely to decrease?? {'A': 'Serum uric acid levels', 'B': 'Urinary calcium excretion', 'C': 'Urinary sodium excretion', 'D': 'Serum glucose levels', 'E': 'Urinary potassium excretion'},
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B: Urinary calcium excretion
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Answer the following medical question with one of the provided options:
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Q:A 58-year-old man presents to his physician with breathlessness on exertion for the last 2 years. He mentions that initially, he used to become breathless upon climbing 2 flights of stairs, but now he becomes breathless after walking a couple of blocks. He has no known medical condition except obesity (most recent BMI of 36 kg/m2); he has been obese for the last 10 years. There is no history of substance abuse. His temperature is 36.9°C (98.4°F), the pulse is 90/min, the blood pressure is 130/88 mm Hg, and the respirations are 20/min. Auscultation of the chest reveals a loud pulmonic component of the second heart sound. Auscultation over the lung fields does not reveal any specific abnormality. His chest radiogram shows enlargement of the central pulmonary arteries, attenuation of the peripheral pulmonary vessels, and oligemic lung fields. In addition to measures for weight reduction, which of the following medications is most likely to decrease breathlessness in this patient?? {'A': 'Ranolazine', 'B': 'Riociguat', 'C': 'Rivaroxaban', 'D': 'Roflumilast', 'E': 'Rolapitant'},
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B: Riociguat
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Answer the following medical question with one of the provided options:
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Q:A 67-year-old man presents to his primary care physician with constant and gnawing lower abdominal pain for 2 days. The pain has been steadily worsening in intensity. He says the pain occasionally radiates to his lower back and groin bilaterally. While he cannot identify any aggravating factors, he feels that the pain improves with his knees flexed. His medical history is notable for hypertension which is well controlled with medications. He has smoked 40–50 cigarettes daily for 35 years. On examination, there is a palpable pulsatile mass just left of midline below the umbilicus. He is immediately referred for definitive management but during transfer, he becomes hypotensive and unresponsive. Which of the following is the most likely diagnosis?? {'A': 'Diverticulitis', 'B': 'Gastrointestinal hemorrhage', 'C': 'Ruptured abdominal aortic aneurysm', 'D': 'Appendicitis', 'E': 'Irritable bowel syndrome'},
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C: Ruptured abdominal aortic aneurysm
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Answer the following medical question with one of the provided options:
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Q:A previously healthy 18-year-old woman comes to the physician because of a 2-day history of swelling and itchiness of her mouth and lips. It decreases when she eats cold foods such as frozen fruit. Four days ago, she underwent orthodontic wire-placement on her upper and lower teeth. Since then, she has been taking ibuprofen twice daily for the pain. For the past 6 months, she has been on a strict vegan diet. She is sexually active with one partner and uses condoms consistently. She had chickenpox that resolved spontaneously when she was 6 years old. Her vitals are within normal limits. Examination shows diffuse erythema and edema of the buccal mucosa with multiple serous vesicles and shallow ulcers. Stroking the skin with pressure does not cause blistering of the skin. The remainder of the examination shows no abnormalities. Which of the following is the most likely cause of these symptoms?? {'A': 'Dermatitis herpetiformis', 'B': 'Vitamin deficiency', 'C': 'Herpes labialis', 'D': 'Allergic contact dermatitis', 'E': 'Reactivation of varicella zoster virus'},
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D: Allergic contact dermatitis
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Answer the following medical question with one of the provided options:
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Q:Two separate investigators have conducted cohort studies to calculate the risk of lymphoma in rheumatoid arthritis patients taking anti-TNF alpha medications. They each followed patients with rheumatoid arthritis for a number of years and tracked the number of patients who were diagnosed with lymphoma. The results of the two studies are summarized in the table. Number of patients Follow-up period Number of new cases of lymphoma Study 1 3000 10 years 30 Study 2 300 30 years 9 Based on these results, which of the following statements about the risk of lymphoma is most accurate?"? {'A': 'The risk is higher in study 1, with an incidence rate of 30 cases per 10 person-years', 'B': 'The risks are equivalent, with a prevalence of 39 cases per 3300 persons', 'C': 'The risks are equivalent, with an incidence rate of 1 case per 1000 person-years', 'D': 'The risk is higher in study 1, with a prevalence of 30 cases per 3000 patients', 'E': 'The risk is higher in study 2, with a cumulative incidence of 9 cases per 300 patients'},
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C: The risks are equivalent, with an incidence rate of 1 case per 1000 person-years
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Answer the following medical question with one of the provided options:
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Q:An investigator is studying vitamin D metabolism in mice. He induces a gene mutation that interferes with the function of an enzyme in the renal proximal tubules that is required for vitamin D activation. He then measures serum levels of various metabolites. Production of which of the following will be impaired in this mouse?? {'A': 'Ergocalciferol', 'B': '25-hydroxyvitamin D', 'C': 'Cholecalciferol', 'D': '1,25-hydroxyvitamin D', 'E': '7-dehydrocholesterol'},
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D: 1,25-hydroxyvitamin D
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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 7-day history of fever and abdominal pain for the past 4 days. Past medical history is significant for an exchange transfusion for neonatal hyperbilirubinemia and recurrent attacks of pallor during the course of upper respiratory tract infections. His vital signs include: blood pressure 120/70 mm Hg, pulse 105/min, respiratory rate 40/min, and temperature 37.0℃ (98.6℉). On physical examination, the patient is ill-looking. Conjunctivae are pale and the sclera is icteric. The liver is palpable 2 cm below the costal margin and the spleen is palpable 3 cm below the left costal margin. Laboratory findings show hemoglobin of 5.9 gm/dL, Hct of 20%, and haptoglobin of 28 gm/dL. A peripheral blood smear shows hypochromic anemia, polychromasia, anisocytosis, and occasional Heinz bodies. The reticulocyte count was 15%. A direct Coombs test was negative. Which of the following is the most likely diagnosis in this patient?? {'A': 'Hereditary spherocytosis', 'B': 'Glucose-6-phosphate-dehydrogenase deficiency', 'C': 'Sickle cell disease', 'D': 'Gilbert syndrome', 'E': 'IgG mediated autoimmune hemolytic anemia'},
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B: Glucose-6-phosphate-dehydrogenase deficiency
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Answer the following medical question with one of the provided options:
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Q:A 66-year-old man presents to the emergency department with dyspnea. Two days ago, he hosted his grandchild's birthday party, and since has noticed general malaise, fever, and dry cough. He does not know if he feels more dyspneic while supine or standing but has noticed difficulty breathing even while watching television. He has a past medical history of congestive heart failure and hypertension, for which he takes aspirin, metoprolol, furosemide, lisinopril, and spironolactone as prescribed. His blood pressure is 90/50 mmHg, pulse is 120/min, and respirations are 30/min. His radial pulse is barely palpable, and his wrists and ankles are cold and clammy. Physical exam reveals a S3 and S4 with a soft holosystolic murmur at the apex, decreased breath sounds up to the middle lung fields, jugular venous distention to the auricles, and 3+ pitting edema to the mid thighs. EKG shows ST depressions consistent with demand ischemia. Bedside echocardiogram shows global akinesis with an ejection fraction (EF) of 20%; previous reports show EF at 40%. A portable chest radiograph shows bilateral pulmonary edema. Metoprolol is held, dobutamine and furosemide drips are started, and BiPAP is started at 20/5 cm H2O. After 15 minutes, the nurse reports that urine output is minimal and blood pressure is now 75/40 mmHg and pulse is 130/min. What is the best next step in management?? {'A': 'Resume home metoprolol', 'B': 'Decrease furosemide rate', 'C': 'Decrease dobutamine rate', 'D': 'Decrease positive inspiratory pressure', 'E': 'Decrease positive end-expiratory pressure'},
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D: Decrease positive inspiratory pressure
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Answer the following medical question with one of the provided options:
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Q:A 28-year-old primigravid woman at 31 weeks' gestation comes to the physician because of fever, myalgia, abdominal pain, nausea, and diarrhea for 3 days. Her pregnancy has been uncomplicated. Her only medication is a prenatal vitamin. Her temperature is 39.4°C (102.9°F). Physical examination shows diffuse abdominal pain. Blood cultures incubated at 4°C (39.2°F) grow a gram-positive, catalase-positive organism. The pathogen responsible for this patient's presentation was most likely transmitted via which of the following modes?? {'A': 'Blood transfusion', 'B': 'Sexual contact', 'C': 'Consumption of soft cheese', 'D': 'Ingestion of cat feces', 'E': 'Drinking contaminated water'},
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C: Consumption of soft cheese
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Answer the following medical question with one of the provided options:
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Q:A 47-year-old woman comes to the physician because of a 3-week history of a dry cough. She does not smoke or use illicit drugs. Physical examination shows mild conjunctival hyperemia. Chest auscultation shows fine crackles in both lung fields. Laboratory studies show a total calcium concentration of 10.8 mg/dL. The results of spirometry are shown (dashed loop shows normal for comparison). Further evaluation of this patient is most likely to show an increase in which of the following?? {'A': 'Monoclonal IgG titers', 'B': 'Mast cell tryptase activity', 'C': 'Neutrophil elastase activity', 'D': 'Angiotensin-converting enzyme activity', 'E': 'Cold agglutinin titers\n"'},
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D: Angiotensin-converting enzyme activity
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Answer the following medical question with one of the provided options:
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Q:A 72-year-old female presents to the emergency department following a syncopal episode while walking down several flights of stairs. The patient has not seen a doctor in several years and does not take any medications. Your work-up demonstrates that she has symptoms of angina and congestive heart failure. Temperature is 36.8 degrees Celsius, blood pressure is 160/80 mmHg, heart rate is 81/min, and respiratory rate is 20/min. Physical examination is notable for a 3/6 crescendo-decrescendo systolic murmur present at the right upper sternal border with radiation to the carotid arteries. Random blood glucose is 205 mg/dL. Which of the following portends the worst prognosis in this patient?? {'A': 'Syncope', 'B': 'Angina', 'C': 'Congestive heart failure (CHF)', 'D': 'Hypertension', 'E': 'Diabetes'},
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C: Congestive heart failure (CHF)
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Q:A 69-year-old white man comes to the physician because of a 15-day history of fatigue and lower leg swelling. Over the past 8 months, he has had a 3.8-kg (8.3-lb) weight loss. He has smoked one pack of cigarettes daily for 48 years. Vital signs are within normal limits. He appears thin. Examination shows 2+ pretibial edema bilaterally. An x-ray of the chest shows a right upper lobe density. Laboratory studies show: Hemoglobin 11.3 g/dL Leukocyte count 8600/mm3 Platelet count 140,000/mm3 Serum Urea nitrogen 25 mg/dL Glucose 79 mg/dL Creatinine 1.7 mg/dL Albumin 1.6 mg/dL Total cholesterol 479 mg/dL Urine Blood negative Glucose negative Protein 4+ WBC 0–1/hpf Fatty casts numerous Light microscopic examination of a kidney biopsy reveals thickening of glomerular capillary loops and the basal membrane. Which of the following is the most likely diagnosis?"? {'A': 'Granulomatosis with polyangiitis', 'B': 'Membranoproliferative glomerulonephritis', 'C': 'Focal segmental glomerulosclerosis', 'D': 'Rapidly progressive glomerulonephritis', 'E': 'Membranous nephropathy'},
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E: Membranous nephropathy
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Q:A 33-year-old man comes to the physician because of right scrotal swelling for the past 2 weeks. He has had mild lower abdominal discomfort for the past 3 weeks. There is no personal or family history of serious illness. He appears healthy. Vital signs are within normal limits. Examination shows gynecomastia. There is no inguinal lymphadenopathy. There is a firm nontender nodule over the right testicle. When a light is held behind the scrotum, it does not shine through. When the patient is asked to cough, the nodule does not cause a bulge. The abdomen is soft and nontender. The liver is palpated 2 cm below the right costal margin. Digital rectal examination is unremarkable. Serum alpha-fetoprotein, LDH, and hCG levels are markedly elevated. An x-ray of the chest shows no abnormalities. Ultrasound of the testis shows a cystic 3-cm mass with variable echogenicity. A CT of the abdomen shows multiple hypoattenuating lesions on the liver and retroperitoneal lymph nodes. A radical inguinal orchiectomy with retroperitoneal lymph node dissection is performed. Which of the following is the most appropriate next step in management?? {'A': 'Radiation therapy', 'B': 'Cisplatin, etoposide, and bleomycin therapy', 'C': 'Leucovorin, 5-fluorouracil and oxaliplatin therapy', 'D': 'Active surveillance', 'E': 'Stem cell transplant'},
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B: Cisplatin, etoposide, and bleomycin therapy
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Q:A 56-year-old man with chronic kidney disease and type 2 diabetes mellitus is brought to the emergency department by his neighbor because of impaired consciousness and difficulty speaking for 1 hour. A diagnosis of acute ischemic stroke is made. Over the next three days after admission, the patient’s renal function slowly worsens and hemodialysis is considered. He is not alert and cannot communicate. The neighbor, who has been a close friend for many years, says that the patient has always emphasized he would refuse dialysis or any other life-prolonging measures. He also reports that the patient has no family besides his father, who he has not seen for many years. His wife died 2 years ago. Which of the following is the most appropriate action by the physician?? {'A': "Avoid dialysis in line with the patient's wishes", 'B': 'Start dialysis when required', 'C': 'Try to contact the father for consent', 'D': 'File for legal guardianship', 'E': 'Consult ethics committee'},
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C: Try to contact the father for consent
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Q:A 6-year-old boy presents to your office with hematuria. Two weeks ago the patient had symptoms of a sore throat and fever. Although physical exam is unremarkable, laboratory results show a decreased serum C3 level and an elevated anti-DNAse B titer. Which of the following would you most expect to see on renal biopsy?? {'A': 'Large, hypercellular glomeruli on light microscopy', 'B': 'Polyclonal IgA deposition on immunofluorescence', 'C': 'Immune complex deposits with a "spike and dome" appearance on electron microscopy', 'D': 'Wirelooping and hyaline thrombi on light microscopy', 'E': 'Antibodies to GBM resulting in a linear immunofluorescence pattern'},
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A: Large, hypercellular glomeruli on light microscopy
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Q:A 76-year-old Spanish speaking male comes to the health clinic with his daughter for a routine health maintenance visit. The physician speaks only basic Spanish and is concerned about communicating directly with the patient. The patient's daughter is fluent in both English and Spanish and offers to translate. The clinic is very busy, but there are usually Spanish medical interpreters available. What is the best course of action for the physician?? {'A': 'Use the daughter as an interpreter', 'B': 'Request one of the formal interpreters from the clinic', 'C': "Attempt to communicate using the physician's basic Spanish", 'D': 'Converse with the patient in English', 'E': 'Suggest that the patient finds a Spanish speaking physician'},
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B: Request one of the formal interpreters from the clinic
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Q:A 3-year-old boy is brought to his pediatrician by his parents for a follow-up visit. Several concerning traits were observed at his last physical, 6 months ago. He had developmental delay, a delay in meeting gross and fine motor control benchmarks, and repetitive behaviors. At birth, he was noted to have flat feet, poor muscle tone, an elongated face with large, prominent ears, and enlarged testicles. He takes a chewable multivitamin every morning. There is one other member of the family, on the mother’s side, with a similar condition. Today, his blood pressure is 110/65 mm Hg, heart rate is 90/min, respiratory rate is 22/min, and temperature of 37.0°C (98.6°F). On physical exam, the boy repetitively rocks back and forth and has difficulty following commands. His heart has a mid-systolic click, followed by a late systolic murmur and his lungs are clear to auscultation bilaterally. Several vials of whole blood are collected for analysis. Which of the following studies should be conducted as part of the diagnostic screening protocol?? {'A': 'Northern blot with DNA probes', 'B': 'Southern blot with DNA probes', 'C': 'Two-dimensional gel electrophoresis', 'D': 'PCR followed by northern blot with DNA probes', 'E': 'Western blot'},
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B: Southern blot with DNA probes
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Q:A 3-month-old girl is brought to the emergency department because of a 2-day history of progressive difficulty breathing and a dry cough. Five weeks ago, she was diagnosed with diffuse hemangiomas involving the intrathoracic cavity and started treatment with prednisolone. She appears uncomfortable and in moderate respiratory distress. Her temperature is 38°C (100.4°F), pulse is 150/min, respirations are 50/min, and blood pressure is 88/50 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 87%. Oral examination shows a white plaque covering the tongue that bleeds when scraped. Chest examination shows subcostal and intercostal retractions. Scattered fine crackles and rhonchi are heard throughout both lung fields. Laboratory studies show a leukocyte count of 21,000/mm3 and an increased serum beta-D-glucan concentration. An x-ray of the chest shows symmetrical, diffuse interstitial infiltrates. Which of the following is most likely to confirm the diagnosis?? {'A': 'Bronchoalveolar lavage', 'B': 'Urine antigen test', 'C': 'DNA test for CFTR mutation', 'D': 'CT scan of the chest', 'E': 'Tuberculin skin test'},
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A: Bronchoalveolar lavage
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Q:A recently published prospective cohort study of 1,000 men reports that smoking is significantly associated with higher rates of esophageal cancer. The next week, however, the journal publishes a letter to the editor in which a re-analysis of the study's data when accounting for the confounding effects of alcohol usage found no association between smoking and esophageal cancer. Which of the following statements is both necessary and sufficient to explain the change in result?? {'A': 'Men who smoke are more likely to drink', 'B': 'Men who drink are more likely to get esophageal cancer', 'C': 'Men who smoke are more likely to get esophageal cancer', 'D': 'Men who drink are both more likely to smoke and more likely to develop esophageal cancer', 'E': 'The change in result is impossible even after adjusting for the confounding effects of alcohol intake'},
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D: Men who drink are both more likely to smoke and more likely to develop esophageal cancer
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Q:Please refer to the summary above to answer this question Which of the following is the most appropriate pharmacotherapy?" "Patient Information Age: 30 years Gender: F, self-identified Ethnicity: unspecified Site of Care: office History Reason for Visit/Chief Concern: “I'm so anxious about work.” History of Present Illness: 7-month history of sensation that her heart is racing whenever she gives oral presentations at work she has also had moderate axillary sweating during these presentations and feels more anxious and embarrassed when this happens feels otherwise fine when she is interacting with her colleagues more casually around the workplace Past Medical History: alcohol use disorder, now abstinent for the past 2 years acute appendicitis, treated with appendectomy 5 years ago verrucae planae Medications: disulfiram, folic acid, topical salicylic acid Allergies: no known drug allergies Psychosocial History: does not smoke, drink alcohol, or use illicit drugs Physical Examination Temp Pulse Resp BP O2 Sat Ht Wt BMI 36.7°C (98°F) 82/min 18/min 115/72 mm Hg – 171 cm (5 ft 7 in) 58 kg (128 lb) 20 kg/m2 Appearance: no acute distress Pulmonary: clear to auscultation Cardiac: regular rate and rhythm; normal S1 and S2; no murmurs Abdominal: has well-healed laparotomy port scars; no tenderness, guarding, masses, bruits, or hepatosplenomegaly Extremities: no tenderness to palpation, stiffness, or swelling of the joints; no edema Skin: warm and dry; there are several skin-colored, flat-topped papules on the dorsal bilateral hands Neurologic: alert and oriented; cranial nerves grossly intact; no focal neurologic deficits Psychiatric: describes her mood as “okay”; speech has a rapid rate but normal rhythm; thought process is organized"? {'A': 'Propranolol', 'B': 'Olanzapine', 'C': 'Clonazepam', 'D': 'Venlafaxine', 'E': 'Sertraline\n"'},
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A: Propranolol
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Q:A 3-year-old boy is brought for general developmental evaluation. According to his parents he is playing alongside other children but not in a cooperative manner. He has also recently begun to ride a tricycle. Upon questioning you also find that he is toilet trained and can stack 9 blocks. Upon examination you find that he can copy a circle though he cannot yet copy a triangle or draw stick figures. In addition he is currently speaking in two word phrases but cannot yet use simple sentences. Based on these findings you tell the parents that their child's development is consistent with which of the following?? {'A': 'Normal social, normal motor, normal language', 'B': 'Delayed social, normal motor, normal language', 'C': 'Normal social, delayed motor, delayed language', 'D': 'Normal social, normal motor, delayed language', 'E': 'Delayed social, normal motor, delayed language'},
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D: Normal social, normal motor, delayed language
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Q:A 54-year-old woman comes to the clinic for an annual check-up. She has no other complaints except for some weight gain over the past year. Her last menstrual period was 8 months ago. “I started eating less since I get full easily and exercising more but just can’t lose this belly fat,” she complains. She is sexually active with her husband and does not use any contraception since “I am old.” She denies vaginal dryness, hot flashes, fevers, abdominal pain, or abnormal vaginal bleeding but does endorse intermittent constipation for the past year. Physical examination is unremarkable except for some mild abdominal distension with fluid wave. Laboratory findings are as follows: Serum: Na+: 138 mEq/L Cl-: 97 mEq/L K+: 3.9 mEq/L Urea nitrogen: 21 mg/dL Creatinine: 1.4 mg/dL Glucose: 120 mg/dL B-hCG: negative What is the most likely diagnosis for this patient?? {'A': 'Endometriosis', 'B': 'Menopause', 'C': 'Normal aging', 'D': 'Ovarian cancer', 'E': 'Pregnancy'},
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D: Ovarian cancer
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Q:A 67-year-old man presents to the emergency department after a suicide attempt. The patient was found in his apartment by his grandson with wrist lacerations. He was rushed to the emergency department and was resuscitated en route. The patient has a past medical history of ischemic heart disease and depression. His pulse is barely palpable and he is not responding to questions coherently. His temperature is 98.2°F (36.8°C), blood pressure is 107/48 mmHg, pulse is 160/min, respirations are 14/min, and oxygen saturation is 99% on room air. The patient is started on blood products and his blood pressure improves to 127/55 mmHg after 3 units of blood. On physical exam, the patient complains of numbness surrounding his mouth and pain in the location of the lacerations of his wrists. Which of the following best describes the laboratory findings in this patient?? {'A': 'Hypercalcemia', 'B': 'Hyperkalemia', 'C': 'Hypomagnesemia', 'D': 'Increased free iron', 'E': 'No lab abnormalities'},
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C: Hypomagnesemia
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Q:A 39-year-old woman, gravida 4, para 4, comes to the physician because of a 5-month history of painful, heavy menses. Menses previously occurred at regular 28-day intervals and lasted 3 days with normal flow. They now last 7–8 days and the flow is heavy with the passage of clots. Pelvic examination shows a tender, uniformly enlarged, flaccid uterus consistent in size with an 8-week gestation. A urine pregnancy test is negative. Which of the following is the most likely cause of this patient's findings?? {'A': 'Pedunculated endometrial mass', 'B': 'Endometrial tissue within the uterine wall', 'C': 'Malignant transformation of endometrial tissue', 'D': 'Endometrial tissue within the ovaries', 'E': 'Benign tumor of the myometrium'},
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B: Endometrial tissue within the uterine wall
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Q:After the administration of an erroneous dose of intravenous phenytoin for recurrent seizures, a 9-year-old girl develops bradycardia and asystole. Cardiopulmonary resuscitation was initiated immediately. After 15 minutes, the blood pressure is 120/75 mm Hg, the pulse is 105/min, and the respirations are 14/min and spontaneous. She is taken to the critical care unit for monitoring and mechanical ventilation. She follows commands but requires sedation due to severe anxiety. Which of the following terms most accurately describes the unexpected occurrence in this patient?? {'A': 'Near miss', 'B': 'Adverse event', 'C': 'Sentinel event', 'D': 'Latent error', 'E': 'Active error'},
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C: Sentinel event
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Q:A 30-year-old woman presents complaining of shortness of breath, chest pain, and fatigue. The patient complains of dyspnea upon exertion, generalized fatigue, lethargy, and chest pain associated with strenuous activities. Her history is notable for an atrial septal defect at birth. Her temperature is 99.5°F (37.5°C), blood pressure is 147/98 mmHg, pulse is 90/min, respirations are 17/min, and oxygen saturation is 98% on room air. On exam, she has a wide, fixed splitting of S2. Which of the following medications most directly treats the underlying pathophysiology causing this patient's presentation?? {'A': 'Bosentan', 'B': 'Epoprostenol', 'C': 'Lisinopril', 'D': 'Metoprolol', 'E': 'Nifedipine'},
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A: Bosentan
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Q:A 44-year-old man with HIV comes to the physician for a routine follow-up examination. He has been noncompliant with his antiretroviral medication regimen for several years. He appears chronically ill and fatigued. CD4+ T-lymphocyte count is 405/mm3 (N ≥ 500). Further evaluation of this patient is most likely to show which of the following findings?? {'A': 'Violaceous lesions on skin exam', 'B': 'Cotton-wool spots on fundoscopy', 'C': 'Multifocal demyelination on brain MRI', 'D': 'Ring-enhancing lesions on brain MRI', 'E': 'Ground-glass opacities on chest CT'},
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A: Violaceous lesions on skin exam
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Q:A 41-year-old male who takes NSAIDs regularly for his chronic back pain develops severe abdominal pain worse with eating. Upper endoscopy is performed and the medical student asks the supervising physician how the histological differentiation between a gastric ulcer and erosion is made. Which of the following layers of the gastric mucosa MUST be breached for a lesion to be considered an ulcer?? {'A': 'Epithelium', 'B': 'Epithelium, lamina propria', 'C': 'Epithelium, lamina propria, muscularis mucosa', 'D': 'Epithelium, lamina propria, muscularis mucosa, and submucosa', 'E': 'Epithelium, lamina propria, muscularis mucosa, submucosa, and adventitia'},
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D: Epithelium, lamina propria, muscularis mucosa, and submucosa
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Q:A 6-month-old male presents to the emergency department with his parents after his three-year-old brother hit him on the arm with a toy truck. His parents are concerned that the minor trauma caused an unusual amount of bruising. The patient has otherwise been developing well and meeting all his milestones. His parents report that he sleeps throughout the night and has just started to experiment with solid food. The patient’s older brother is in good health, but the patient’s mother reports that some members of her family have an unknown blood disorder. On physical exam, the patient is agitated and difficult to soothe. He has 2-3 inches of ecchymoses and swelling on the lateral aspect of the left forearm. The patient has a neurological exam within normal limits and pale skin with blue irises. An ophthalmologic evaluation is deferred. Which of the following is the best initial step?? {'A': "Ensure the child's safety and alert the police", 'B': 'Complete blood count and coagulation panel', 'C': 'Peripheral blood smear', 'D': 'Hemoglobin electrophoresis', 'E': 'Genetic testing'},
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B: Complete blood count and coagulation panel
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Q:A 30-year-old woman, gravida 2, para 1, at 31 weeks' gestation is admitted to the hospital because her water broke one hour ago. Pregnancy has been complicated by iron deficiency anemia and hypothyroidism treated with iron supplements and L-thyroxine, respectively. The patient followed-up with her gynecologist on a regular basis throughout the pregnancy. Pregnancy and delivery of her first child were uncomplicated. Pulse is 90/min, respirations are 17/min, and blood pressure is 130/80 mm Hg. The abdomen is nontender. She has had 8 contractions within the last hour. Pelvic examination shows cervical dilation of 3 cm. The fetal heart rate is 140/min with no decelerations. In addition to administration of dexamethasone and terbutaline, which of the following is the most appropriate next step in the management of this patient?? {'A': 'Emergency cesarean delivery', 'B': 'Cervical cerclage', 'C': 'Administration of anti-RhD immunoglobulin', 'D': 'Administration of magnesium sulfate', 'E': 'Administer prophylactic azithromycin\n"'},
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D: Administration of magnesium sulfate
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Q:A 53-year-old woman is brought to the emergency department by her husband because of difficulty walking, slurred speech, and progressive drowsiness. The husband reports that his wife has appeared depressed over the past few days. She has a history of insomnia and social anxiety disorder. She appears lethargic. Her temperature is 36.2°C (97.1°F), pulse is 88/min, respirations are 12/min, and blood pressure is 110/80 mm Hg. Neurologic examination shows normal pupils. There is diffuse hypotonia and decreased deep tendon reflexes. Administration of a drug that acts as a competitive antagonist at which of the following receptors is most likely to reverse this patient's symptoms?? {'A': '5-hydroxytryptamine2 receptor', 'B': 'Muscarinic acetylcholine receptor', 'C': 'D2 dopamine receptor', 'D': 'GABAA receptor', 'E': 'Ryanodine receptor'},
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D: GABAA receptor
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Q:At a counseling session, a 15-year-old boy recounts his childhood. He explained that his father was an angry, violent man who physically abused him and his younger brother every time he was drunk - which was almost every night. The boy said that the only way he could escape the situation was to believe that he himself was a superhero that would fight crime. Which of the following best describes the ego defense of this male?? {'A': 'Dissociation', 'B': 'Denial', 'C': 'Isolation of affect', 'D': 'Fantasy', 'E': 'Splitting'},
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D: Fantasy
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Q:A 9-month-old girl is brought to the physician because of a 1-month history of poor feeding and irritability. She is at the 15th percentile for height and 5th percentile for weight. Examination shows hypotonia and wasting of skeletal muscles. Cardiopulmonary examination shows no abnormalities. There is hepatomegaly. Her serum glucose is 61 mg/dL, creatinine kinase is 100 U/L, and lactic acid is within the reference range. Urine ketone bodies are elevated. Which of the following enzymes is most likely deficient in this patient?? {'A': 'Muscle phosphorylase', 'B': 'Acid alpha-glucosidase', 'C': 'Glucose-6-phosphatase', 'D': 'Glucocerebrosidase', 'E': 'Glycogen debrancher'},
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E: Glycogen debrancher
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Q:A 23-year-old woman is brought to the emergency department by her friend because of a 1-hour episode of confusion. Earlier that night, they were at a dance club, and the patient was very energetic and euphoric. Thirty minutes after arriving, she became agitated and nauseous. She no longer seemed to know where she was or how she got there, and she began talking to herself. She has no major medical illness. She is an undergraduate student at a local college. She does not smoke but drinks 10–14 mixed drinks each week. Her temperature is 38.3°C (100.9°F), pulse is 115/min and regular, respirations are 16/min, and blood pressure is 138/84 mm Hg. She oriented to self but not to time or place. Throughout the examination, she grinds her teeth. Her pupils are 7 mm in diameter and minimally reactive. Her skin is diffusely flushed and diaphoretic. Cardiopulmonary examination shows no abnormalities. Serum studies show: Na+ 129 mEq/L K+ 3.7 mEq/L HCO3- 22 mEq/L Creatinine 1.2 mg/dL Glucose 81 mg/dL Which of the following substances is the most likely cause of this patient's presentation?"? {'A': 'Cocaine', 'B': 'Diphenhydramine', 'C': 'Acetaminophen', 'D': 'Ecstasy', 'E': 'Codeine'},
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D: Ecstasy
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Q:A new drug X is being tested for its effect on renal function. During the experiments, the researchers found that in patients taking substance X, the urinary concentration of sodium decreases while urine potassium concentration increase. Which of the following affects the kidneys in the same way as does substance X?? {'A': 'Atrial natriuretic peptide', 'B': 'Hydrochlorothiazide', 'C': 'Spironolactone', 'D': 'Aldosterone', 'E': 'Furosemide'},
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D: Aldosterone
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Q:Two days after delivery, a 4300-g (9-lb 8-oz) newborn has difficulty feeding and has become increasingly lethargic. His cry has become weak. He was born at term. His mother has a history of intravenous drug use. His temperature is 36.4°C (96.5°F), pulse is 170/min, respirations are 62/min, and blood pressure is 70/48 mm Hg. Examination shows midfacial hypoplasia, diaphoresis, and tremor of the lower extremities. Macroglossia is present. There are folds in the posterior auricular cartilage. The left lower extremity is larger than the right lower extremity. Abdominal examination shows an umbilical hernia. The liver is palpated 4 cm below the right costal margin. Neurological examination shows decreased tone in all extremities. Which of the following is the most appropriate intervention?? {'A': 'Administer thyroxine', 'B': 'Administer 3% saline', 'C': 'Administer glucose', 'D': 'Administer ampicillin and gentamicin', 'E': 'Administer naloxone'},
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C: Administer glucose
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Q:A 55-year-old woman comes to the physician with a 6-month history of cough and dyspnea. She has smoked 1 pack of cigarettes daily for the past 30 years. Analysis of the sputum sample from bronchoalveolar lavage shows abnormal amounts of an isoform of elastase that is normally inhibited by tissue inhibitors of metalloproteinases (TIMPs). The cell responsible for secreting this elastase is most likely also responsible for which of the following functions?? {'A': 'Production of lactoferrin', 'B': 'Degradation of toxins', 'C': 'Diffusion of gases', 'D': 'Phagocytosis of foreign material', 'E': 'Secretion of mucus'},
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D: Phagocytosis of foreign material
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Q:A 4-day-old male infant is brought to the physician because of respiratory distress and bluish discoloration of his lips and tongue. He was born at term and the antenatal period was uncomplicated. His temperature is 37.3°C (99.1°F), pulse is 170/min, respirations are 65/min, and blood pressure is 70/46 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 82%. A grade 3/6 holosystolic murmur is heard over the left lower sternal border. A single S2 that does not split with respiration is present. Echocardiography shows defects in the interatrial and interventricular septae, as well as an imperforate muscular septum between the right atrium and right ventricle. Further evaluation of this patient is most likely to show which of the following?? {'A': 'Increased pulmonary vascular markings on chest x-ray', 'B': 'Tracheal bowing on chest x-ray', 'C': 'Left-axis deviation on electrocardiogram', 'D': 'Elfin facies', 'E': 'Delta wave on electrocardiogram'},
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C: Left-axis deviation on electrocardiogram
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Q:A 7-year-old girl presents with a low-grade fever, lethargy, and fatigue for the past week. The patient’s mother says she also complains of leg pain for the past couple of weeks. No significant past medical history. The patient was born at term via spontaneous transvaginal delivery with no complications. On physical examination, the patient shows generalized pallor. Cervical lymphadenopathy is present. A bone marrow biopsy is performed which confirms the diagnosis of acute lymphoblastic leukemia (ALL). The patient is started on a chemotherapy regimen consisting of vincristine, daunorubicin, L-asparaginase, and prednisolone for induction, followed by intrathecal methotrexate for maintenance. Following the 4th cycle of chemotherapy, she develops bilateral ptosis. Physical examination shows a normal pupillary reflex and eye movements. She is started on pyridoxine and pyridostigmine, and, in 7 days, she has complete resolution of the ptosis. Which of the following drugs is most likely associated with this patient’s adverse reaction?? {'A': 'Daunorubicin', 'B': 'Prednisolone', 'C': 'Methotrexate', 'D': 'Vincristine', 'E': 'Pyridoxine'},
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D: Vincristine
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Q:A 62-year-old woman presents to the clinic for a 2-month history of ‘fogginess’. She reports that for the last couple of months she feels like she has "lost a step" in her ability to think clearly, often forgetting where she parked her car or to lock the front door after leaving the house. She also feels that her mood has been low. On further questioning, she reports mild constipation and that she has had a bothersome, progressively worsening cough over the past couple of months, accompanied by 6.8 kg (15 lb) unintentional weight loss. She has a history of hypertension for which she takes amlodipine daily. She has smoked 1.5 packs of cigarettes per day for the last 40 years. Physical exam is unremarkable. Laboratory studies show: Na+ 138 mg/dL K+ 3.9 mg/dL Cl- 101 mg/dL HCO3- 24 mg/dL BUN 10 mg/dL Cr 0.6 mg/dL Glucose 86 mg/dL Ca2+ 13.6 mg/dL Mg2+ 1.9 mg/dL Parathyroid hormone (PTH) 2 pg/mL (10–65) 1,25-hydroxyvitamin D 15 pg/mL (20–45) Quantiferon-gold negative Which of the following best describes this patient's most likely underlying pathology?? {'A': 'Endocrine', 'B': 'Infectious', 'C': 'Inflammatory', 'D': 'Neoplastic', 'E': 'Toxicity (exogenous)'},
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D: Neoplastic
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Q:A 45-year-old female with no significant past medical history present to her primary care physician for her annual check up. She missed her several appointments in the past as she says that she does not like coming to the doctor's office. When she last presented 1 year ago, she was found to have an elevated blood pressure reading. She states that she has been in her usual state of health and has no new complaints. Vital signs in the office are as follows: T 98.8 F, BP 153/95 mmHg, HR 80 bpm, RR 14 rpm, SaO2 99% on RA. She appears very anxious during the exam. The remainder of the exam is unremarkable. She reports that her blood pressure was normal when she checked it at the pharmacy 3 months ago. What test would you consider in order to further evaluate this patient?? {'A': 'Measure TSH and free T4', 'B': 'Repeat vital signs at her next visit', 'C': 'Measure creatinine level', 'D': 'Ambulatory blood pressure monitoring', 'E': 'Obtain an EKG'},
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D: Ambulatory blood pressure monitoring
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Q:A 28-year-old man presents to the office with complaints of malaise, anorexia, and vomiting for the past 2 weeks. He also says that his urine is dark. The past medical history is unremarkable. The temperature is 36.8°C (98.2°F), the pulse is 72/min, the blood pressure is 118/63 mm Hg, and the respiratory rate is 15/min. The physical examination reveals a slightly enlarged, tender liver. No edema or spider angiomata are noted. Laboratory testing showed the following: HBsAg Positive IgM anti-HBc < 1:1,000 Anti-HBs Negative HBeAg Positive HBeAg antibody Positive HBV DNA 2.65 × 109 IU/L Alpha-fetoprotein 125 ng/mL What is the most likely cause of this patient’s condition?? {'A': 'Resolved HBV infection (innate immunity)', 'B': 'Acute exacerbation of chronic HBV infection', 'C': 'Acute HBV infection', 'D': 'Acute resolving infection', 'E': 'Passive immunity'},
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B: Acute exacerbation of chronic HBV infection
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Q:A 68-year-old woman comes to the physician because of a 3-month history of an oozing, red area above the left ankle. She does not recall any trauma to the lower extremity. She has type 2 diabetes mellitus, hypertension, atrial fibrillation, and ulcerative colitis. She had a myocardial infarction 2 years ago and a stroke 7 years ago. She has smoked 2 packs of cigarettes daily for 48 years and drinks 2 alcoholic beverages daily. Current medications include warfarin, metformin, aspirin, atorvastatin, carvedilol, and mesalamine. She is 165 cm (5 ft 4 in) tall and weighs 67 kg (148 lb); BMI is 24.6 kg/m2. Her temperature is 36.7°C (98°F), pulse is 90/min, respirations are 12/min, and blood pressure is 135/90 mm Hg. Examination shows yellow-brown spots and dilated tortuous veins over the lower extremities. The feet and the left calf are edematous. Femoral, popliteal, and pedal pulses are palpable bilaterally. There is a 3-cm (1.2-in) painless, shallow, exudative ulcer surrounded by granulation tissue above the medial left ankle. There is slight drooping of the right side of the face. Which of the following is the most likely cause of this patient's ulcer?? {'A': 'Decreased arterial blood flow', 'B': 'Peripheral neuropathy', 'C': 'Venous insufficiency', 'D': 'Chronic pressure', 'E': 'Drug-induced microvascular occlusion'},
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C: Venous insufficiency
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Q:An investigator is studying the efficiency of a new anti-gout drug in comparison to colchicine in an experimental animal model. The test group of animals is injected with the new drug, while the control group receives injections of colchicine. Which of the following cellular functions will most likely be impaired in the control subjects after the injection?? {'A': 'Stereocilia function', 'B': 'Muscle contraction', 'C': 'Nutrient absorption', 'D': 'Axonal transport', 'E': 'Intercellular adhesion'},
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D: Axonal transport
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Q:A 68-year-old man presents to the office with his wife complaining of difficulty in swallowing, which progressively worsened over the past month. He has difficulty in initiating swallowing and often has to drink water with solid foods. He has no problems swallowing liquids. His wife is concerned about her husband’s bad breath. Adding to his wife, the patient mentions a recent episode of vomiting where the vomit smelled ‘really bad’ and contained the food that he ate 2 days before. On examination, the patient’s blood pressure is 110/70 mm Hg, pulse rate is 72/min, with normal bowel sounds, and no abdominal tenderness to palpation. A barium swallow radiograph is taken which reveals a localized collection of contrast material in the cervical region suggestive of an outpouching. Which of the following statements best describes the lesion seen on the radiograph?? {'A': 'Persistence of an embryologic structure', 'B': 'Outpouching of all 3 layers of the esophageal mucosal tissue distal to the upper esophageal sphincter', 'C': 'Increased pressure above the upper esophageal sphincter resulting in a defect in the wall', 'D': 'Failure of neural crest migration into the Auerbach plexus', 'E': 'Inability to relax the lower esophageal sphincter'},
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C: Increased pressure above the upper esophageal sphincter resulting in a defect in the wall
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Q:A 63-year-old woman is brought to the emergency department because of a 2-day history of severe epigastric pain and nausea. She has a 20-year history of alcohol use disorder. Nine hours after admission, she becomes increasingly dyspneic and tachypneic. Pulse oximetry on supplemental oxygen shows an oxygen saturation of 81%. Physical examination shows diffuse lung crackles, marked epigastric tenderness, and a periumbilical hematoma. Laboratory studies show normal brain natriuretic peptide. An x-ray of the chest shows bilateral opacities in the lower lung fields. Which of the following pathomechanisms best explains this patient's pulmonary findings?? {'A': 'Alveolocapillary membrane leakage', 'B': 'Increased production of surfactant', 'C': 'Embolic obstruction of pulmonary arteries', 'D': 'Inflammation of the bronchial mucosa', 'E': 'Increased pulmonary capillary pressure'},
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A: Alveolocapillary membrane leakage
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Q:A 21-year-old woman comes to the physician because of a 4-day history of abdominal cramps and bloody diarrhea 5 times per day. Her symptoms began after she ate an egg sandwich from a restaurant. Her vital signs are within normal limits. Physical examination shows diffuse abdominal tenderness. Stool culture shows gram-negative rods that produce hydrogen sulfide and do not ferment lactose. Which of the following effects is most likely to occur if she receives antibiotic therapy?? {'A': 'Self-limiting systemic inflammatory response', 'B': 'Pruritic maculopapular rash on the extensor surface', 'C': 'Thrombocytopenia and hemolytic anemia', 'D': 'Orange discoloration of bodily fluids', 'E': 'Prolonged fecal excretion of the pathogen'},
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E: Prolonged fecal excretion of the pathogen
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Q:A 30-year-old woman comes to the physician because of difficulty sleeping. She is afraid of falling asleep and gets up earlier than desired. Four months ago, she was the driver in a car accident that resulted in the death of her unborn child. She has vivid nightmares of the event and reports that she frequently re-experiences the accident. She blames herself for the death of her child, has stopped working as an accountant, avoids driving in cars, and has withdrawn from her parents and close friends. Which of the following is the most likely diagnosis?? {'A': 'Acute stress disorder', 'B': 'Major depressive disorder', 'C': 'Post-traumatic stress disorder', 'D': 'Normal grief', 'E': 'Adjustment disorder'},
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C: Post-traumatic stress disorder
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Q:A 38-year-old woman is diagnosed with a stage IIIa infiltrating ductal carcinoma involving the left breast. The tumor is ER/PR positive, HER-2 negative, poorly differentiated Bloom-Richardson grade 3. 4/20 regional nodes are positive. The patient undergoes a lumpectomy with axillary lymph node dissection, followed by chemotherapy and radiation therapy to the left breast and axilla. Her chemotherapy regimen involves doxorubicin, cyclophosphamide, and paclitaxel. Following completion of the intensive phase, she is started on tamoxifen as an adjuvant therapy. 6 months later, she presents with increasing fatigue, orthopnea, and paroxysmal nocturnal dyspnea. Physical examination reveals the presence of an S3 gallop, jugular venous distension (JVD), pedal edema, and ascites. She is diagnosed with congestive cardiac failure and admitted for further management. An echocardiogram confirms the diagnosis of dilated cardiomyopathy with severe diastolic dysfunction and an ejection fraction of 10%. Her medical history prior to the diagnosis of breast cancer is negative for any cardiac conditions. The baseline echocardiogram prior to starting chemotherapy and a 12-lead electrocardiogram were normal. Which of the following is most likely responsible for her current cardiac condition?? {'A': 'Doxorubicin', 'B': 'Radiation therapy', 'C': 'Tamoxifen', 'D': 'Cyclophosphamide', 'E': 'Myocarditis'},
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A: Doxorubicin
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Q:A 4-day-old male newborn delivered at 39 weeks' gestation is evaluated because of poor feeding, recurrent vomiting, and lethargy. Physical examination shows tachypnea with subcostal retractions. An enzyme assay performed on a liver biopsy specimen shows decreased activity of carbamoyl phosphate synthetase I. This enzyme plays an important role in the breakdown and excretion of amino groups that result from protein digestion. Which of the following is an immediate substrate for the synthesis of the molecule needed for the excretion of amino groups?? {'A': 'N-acetylglutamate', 'B': 'Valine', 'C': 'Homocysteine', 'D': 'Phenylalanine', 'E': 'Aspartate\n"'},
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E: Aspartate "
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Q:A 60-year-old patient is at his physician’s office for a routine health maintenance exam. The patient has a past medical history of osteoarthritis in his right knee and GERD that is well-controlled with over the counter medication. On a fasting lipid profile, he is found to have high cholesterol. The patient is started on daily atorvastatin to reduce his risk of cardiovascular disease. What is the major apolipoprotein found on the lipoprotein most directly affected by his statin medication?? {'A': 'Apolipoprotein A-I', 'B': 'Apolipoprotein B-48', 'C': 'Apolipoprotein B-100', 'D': 'Apolipoprotein C-II', 'E': 'Apolipoprotein E'},
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C: Apolipoprotein B-100
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Q:A 19-year-old girl comes to the physician for evaluation after a minor motor vehicle collision. While driving down a residential street, a young boy ran out in front of her, chasing after a ball. She applied the brakes of her vehicle and avoided hitting the boy, but then she suddenly experienced generalized weakness that rendered her unable to operate the vehicle and collided at low speed with a parked car. One minute later, she recovered her strength. She was uninjured. She has had several similar episodes of transient generalized weakness over the past month, once during an argument with her mother and another time while watching her favorite comedy movie. She has also had excessive daytime sleepiness for 18 months despite 9 hours of sleep nightly and 2 daily naps. She has fallen asleep in class several times. She often sees intensely bright colors as she is falling asleep. During this time, she is often unable to move; this inability to move is very distressing to her. Which of the following is the most appropriate nighttime pharmacotherapy for this patient?? {'A': 'Guanfacine', 'B': 'Sodium oxybate', 'C': 'Amphetamine', 'D': 'Duloxetine', 'E': 'Fluoxetine'},
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B: Sodium oxybate
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Q:A 55-year-old man presents to the emergency department complaining of mild vision changes, dizziness, and severe pain in the chest for the past hour. He has also been experiencing nausea since this morning and has already vomited twice. Past medical history includes poorly controlled type 2 diabetes and end-stage renal disease requiring dialysis. His blood pressure is 210/100 mm Hg, pulse is 110/min, and respirations are 18/min. Ophthalmic examination of his eyes show papilledema and flame-shaped hemorrhages and he is diagnosed with hypertensive emergency. Treatment involves rapidly lowering his blood pressure, and he is started on intravenous sodium nitroprusside while emergent dialysis is arranged. Which of the following cardiac pressure-volume loops closely represents the action of the drug he has been administered, where blue represents before administration and purple represent after administration?? {'A': 'Diagram A', 'B': 'Diagram B', 'C': 'Diagram C', 'D': 'Diagram D', 'E': 'Diagram E'},
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B: Diagram B
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Q:A 21-year-old woman comes to the physician because of multiple painful, purulent ulcers she noticed on her vulva 2 days ago. The patient has not had fever or burning with urination. She has no history of similar lesions. She had a chlamydial infection at 17 years of age that was treated with antibiotics. Her immunizations are up-to-date. She is sexually active with her boyfriend of 2 months and uses an oral contraceptive; they use condoms inconsistently. Her temperature is 37.2°C (99.0°F), pulse is 94/min, and blood pressure is 120/76 mm Hg. Examination shows tender inguinal lymphadenopathy. There are 4 tender, purulent 1.5-cm ulcers with a necrotic base along the labia majora. Which of the following is the most likely diagnosis?? {'A': 'Chancroid', 'B': 'Granuloma inguinale', 'C': 'Genital herpes', 'D': 'Chancre', 'E': 'Lymphogranuloma venereum'},
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A: Chancroid
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Q:A 55-year-old woman presents to the clinic with joint pain and swelling of her hands. She reports that the pain lasts for about an hour in the morning and improves as her joints ‘loosen up’. This condition has been bothering her for about 2 years but has recently been impacting her daily routine. She has not seen a doctor in years. Past medical history is significant for hypertension and she takes hydrochlorothiazide daily. Her grandmother and aunt both had rheumatoid arthritis. She is a current smoker and has smoked a half of a pack of cigarettes a day for the last 20 years. The temperature is 37°C (98.6°F), the blood pressure is 125/85 mm Hg, the respiratory rate is 17/min, and the heart rate is 98/min. Physical examination reveals tender swollen joints in her hands and wrists. Laboratory work is presented below: Hemoglobin 10.7 g/dL Hematocrit 37.5% Leukocyte count 1,400/mm3 Mean corpuscular volume 81.4 μm3 Platelet count 200,000/mm3 Erythrocyte sedimentation rate 45 mm/h Anti-citrullinated protein antibody 55 (normal reference values: < 20) CT findings reveal osteopenia and erosions in the metacarpophalangeal joints. The patient is started on methotrexate. Which of the following is likely to be found in the synovial fluid analysis?? {'A': 'Ragocytes', 'B': 'Monosodium urate crystals', 'C': 'Calcium pyrophosphate', 'D': 'Calcium phosphate crystals', 'E': 'High lymphocyte count'},
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A: Ragocytes
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Q:A 17-year-old girl is brought to the emergency department by her father with fever, chills, and a body rash. Her father reports that 3 days ago, his daughter underwent surgery for a deviated nasal septum. Since then, she has been "sleepy" and in moderate pain. When the patient’s father came home from work today, he found the patient on the couch, shivering and complaining of muscle aches. He also noticed a rash all over her body. The patient says she feels “hot and cold” and also complains of lightheadedness. The patient has no other past medical history. She has been taking oxycodone for the post-surgical pain. She denies any recent travel. The father reports the patient’s brother had a minor “cold” last week. The patient’s mother has major depressive disorder. The patient denies tobacco or illicit drug use. She says she has tried beer before at parties. Her temperature is 103.2°F (39.6°C), blood pressure is 84/53, pulse is 115/min, respirations are 12/min, and oxygen saturation is 99% on room air. The patient is awake and oriented but slow to respond. There is no focal weakness or nuchal rigidity. Physical examination reveals nasal packing in both nostrils, tachycardia, and a diffuse, pink, macular rash that is also present on the palms and soles. Initial labs show a neutrophil-dominant elevation in leukocytes, a creatinine of 2.1 mg/dL, an aspartate aminotransferase of 82 U/L, and an alanine aminotransferase of 89 U/L. Which of the following is the most likely cause of the patient’s symptoms?? {'A': 'Bacterial lysis', 'B': 'Circulating endotoxin', 'C': 'Mast cell degranulation', 'D': 'Opioid receptor stimulation', 'E': 'Polyclonal T-cell activation'},
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E: Polyclonal T-cell activation
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Q:A 3-year-old girl is brought to the emergency department because of chest pain for 2 hours. Eight days ago, she was admitted to the hospital for treatment of low-grade fever, malaise, and sore throat. The hospitalization was complicated by pharyngitis with pseudomembrane formation and severe cervical lymphadenopathy briefly requiring intubation. She has not received any routine childhood vaccinations. Serum studies show elevated cardiac troponins. An ECG shows diffuse T wave inversions and prolonged PR interval. Administration of which of the following at the time of her previous admission is most likely to have prevented this patient's cardiac symptoms?? {'A': 'Denatured bacterial toxin that contains an intact receptor binding site', 'B': 'Electrolyte that reduces cardiomyocyte excitability', 'C': 'Antibiotic that binds to penicillin-binding protein 3', 'D': 'Salicylate that inhibits prostaglandin synthesis', 'E': 'Immunoglobulin that targets circulating proteins'},
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E: Immunoglobulin that targets circulating proteins
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Q:A 59-year-old man comes to the clinic for an annual well-exam. He was lost to follow-up for the past 3 years due to marital issues but reports that he feels fine. The patient reports, “I feel tired but it is probably because I am getting old. I do feel a little feverish today - I think I got a cold.” His past medical history is significant for hypertension that is controlled with hydrochlorothiazide. He reports fatigue, congestion, cough, and night sweats. He denies any sick contacts, recent travel, weight changes, chest pain, or dizziness. His temperature is 101°F (38.3°C), blood pressure is 151/98 mmHg, pulse is 97/min, and respirations are 15/min. His laboratory values are shown below: Hemoglobin: 13.5 g/dL Hematocrit: 41% Leukocyte count: 25,000/mm^3 Segmented neutrophils: 73% Bands: 8% Eosinophils: 1% Basophils: 2% Lymphocytes: 15% Monocytes: 2% Platelet count: 200,000/mm^3 What diagnostic test would be helpful in distinguishing this patient’s condition from pneumonia?? {'A': 'C-reactive protein', 'B': 'Erythrocyte sedimentation rate', 'C': 'Leukocyte alkaline phosphatase', 'D': 'Magnetic resonance imaging of the chest', 'E': 'Presence of smudge cells'},
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C: Leukocyte alkaline phosphatase
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Q:Which of the following cells in the body depends on dynein for its unique functioning?? {'A': 'Lower esophageal mucosal cell', 'B': 'Fallopian tube mucosal cell', 'C': 'Small intestinal mucosal cell', 'D': 'Skeletal muscle cell', 'E': 'Adipocyte'},
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B: Fallopian tube mucosal cell
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Q:A 36-year-old man comes to the clinical for “bumps under his nipples.” He is anxious that this could be breast cancer as his sister was just recently diagnosed. Past medical history is unremarkable except for an appendectomy at age 13. He currently works as a personal trainer and reports a diet that consists mainly of lean meat. The patient reports drinking 1-2 beers over the weekends. Physical examination demonstrates a muscular physique with mobile smooth masses below the areola bilaterally with no discharge. What other physical exam finding is most likely to be seen in this individual?? {'A': 'Bitemporal hemianopsia', 'B': 'Fluid wave', 'C': 'Palmar erythema', 'D': 'Spider angiomas', 'E': 'Testicular atrophy'},
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E: Testicular atrophy
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Q:A 60-year-old man comes to the emergency department because of recurrent episodes of fatigue, palpitations, nausea, and diaphoresis over the past 6 months. The episodes have become more frequent in the last 2 weeks and he has missed work several times because of them. His symptoms usually improve after he drinks some juice and rests. He has had a 2-kg (4.5-lb) weight gain in the past 6 months. He has a history of bipolar disorder, hypertension, and asthma. His sister has type 2 diabetes mellitus and his mother has a history of medullary thyroid carcinoma. His medications include lithium, hydrochlorothiazide, aspirin, and a budesonide inhaler. His temperature is 36.3°C (97.3°F), pulse is 92/min and regular, respirations are 20/min, and blood pressure is 118/65 mm Hg. Abdominal examination shows no abnormalities. Serum studies show: Na+ 145 mEq/L K+ 3.9 mEq/L Cl- 103 mEq/L Calcium 9.2 mg/dL Glucose 88 mg/dL Which of the following is the most appropriate next step in diagnosis?"? {'A': 'Oral glucose tolerance test', 'B': '24-hour urine catecholamine test', 'C': '72-hour fasting test', 'D': 'Water deprivation test', 'E': 'Corticotropin stimulation test'},
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C: 72-hour fasting test
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Q:A 75-year-old woman is brought to the emergency department by her daughter because of shortness of breath and a productive cough with blood-tinged sputum for the past 24 hours. Five days ago, she developed muscle aches, headache, fever, and clear rhinorrhea. These symptoms lasted 3 days. She lives in a house with her daughter. Her temperature is 39.3°C (102.8°F), pulse is 118/min, respirations are 22/min, and blood pressure is 100/60 mm Hg. She appears lethargic. Physical examination shows scattered crackles and rhonchi throughout both lung fields. An x-ray of the chest shows bilateral lobar opacities and several small, thin-walled cystic spaces with air-fluid levels within the pulmonary parenchyma. Which of the following is the most likely causal pathogen?? {'A': 'Mycobacterium tuberculosis', 'B': 'Staphylococcus aureus', 'C': 'Legionella pneumoniae', 'D': 'Klebsiella pneumoniae', 'E': 'Streptococcus agalactiae'},
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B: Staphylococcus aureus
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Q:An 11-year-old boy is brought to the emergency department with sudden and severe pain in the left scrotum that started 2 hours ago. He has vomited twice. He has no dysuria or frequency. There is no history of trauma to the testicles. The temperature is 37.7°C (99.9°F). The left scrotum is swollen, erythematous, and tender. The left testis is elevated and swollen with a transverse lie. The cremasteric reflex is absent. Ultrasonographic examination is currently pending. Which of the following is the most likely diagnosis?? {'A': 'Epididymitis', 'B': 'Germ cell tumor', 'C': 'Mumps orchitis', 'D': 'Spermatocele', 'E': 'Testicular torsion'},
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E: Testicular torsion
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Q:A 65-year-old woman who lives in New York City presents with headache, fever, and neck stiffness. She received a diagnosis of HIV infection 3 years ago and has been inconsistent with her antiretroviral medications. Recent interferon-gamma release assay testing for latent tuberculosis was negative. A computed tomography of her head is normal. A lumbar puncture shows a white blood cell count of 45/mm3 with a mononuclear predominance, the glucose level of 30 mg/dL, and a protein level of 60 mg/dL. A preparation of her cerebrospinal fluid is shown. Which of the following organisms is the most likely cause of her symptoms?? {'A': 'Aspergillus fumigatus', 'B': 'Blastomyces dermatitidis', 'C': 'Coccidioides immitis', 'D': 'Cryptococcus neoformans', 'E': 'Mycobacterium tuberculosis'},
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D: Cryptococcus neoformans
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Q:An 11-year-old boy is brought to the clinic by his parents for poor academic performance. The patient’s parents say that his teacher told them that he may have to repeat a grade because of his lack of progress, as he does not pay attention to the lessons, tends to fidget about in his seat, and often blurts out comments when it is someone else’s turn to speak. Furthermore, his after-school karate coach says the patient no longer listens to instructions and has a hard time focusing on the activity at hand. The patient has no significant past medical history and is currently not on any medications. The patient has no known learning disabilities and has been meeting all developmental milestones. The parents are vehemently opposed to using any medication with a potential for addiction. Which of the following medications is the best course of treatment for this patient?? {'A': 'Diazepam', 'B': 'Atomoxetine', 'C': 'Methylphenidate', 'D': 'Sertraline', 'E': 'Olanzapine'},
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B: Atomoxetine
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Q:A 4-year-old girl presents with recurrent abdominal pain and a low-grade fever for the past 2 months. The patient’s mother says that she has lost her appetite which has caused some recent weight loss. She adds that the patient frequently plays outdoors with their pet dog. The patient is afebrile and vital signs are within normal limits. On physical examination, conjunctival pallor is present. Abdominal examination reveals a diffusely tender abdomen and significant hepatomegaly. There is also a solid mass palpable in the right upper quadrant measuring about 3 x 4 cm. Laboratory findings are significant for the following: Hemoglobin (Hb%) 9.9 g/dL Total count (WBC) 26,300/µL Differential count Neutrophils 36% Lymphocytes 16% Eosinophils 46% Platelets 200,000/mm3 Erythrocyte sedimentation rate 56 mm/h C-reactive protein 2 mg/L Serum globulins 5 g/dL Laparoscopic resection of the mass is performed, and a tissue sample is sent for histopathology. Which of the following is the organism most likely responsible for this patient’s condition?? {'A': 'Toxocara canis', 'B': 'Ancylostoma braziliense', 'C': 'Ascaris lumbricoides', 'D': 'Trichuris trichiura', 'E': 'Toxocara cati'},
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A: Toxocara canis
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Q:A 69-year-old man is brought to the emergency room by his daughter due to confusion. She reports that her father did not remember who she was yesterday, and his refrigerator was completely empty when she tried to make him lunch. She states that he was acting like himself when she visited him last week. She also notes that he has struggled with alcoholism for many years and has not seen a doctor in over two decades. She is unsure if he has any other chronic medical conditions. In the emergency room, the patient’s temperature is 101.2°F (38.4°C), pulse is 103/min, respirations are 22/min, and O2 saturation is 92% on room air. His BMI is 17.1 kg/m^2. Physical exam reveals an extremely thin and frail man who is not oriented to person, place, or time. As he is being examined, he becomes unresponsive and desaturates to 84%. He is intubated and admitted to the intensive care unit for what is found to be pneumonia, and the patient is started on total parental nutrition as he is sedated and has a history of aspiration from a prior hospitalization. Two days later, physical exam is notable for new peripheral edema. Laboratory tests at that time reveal the following: Serum: Na+: 133 mEq/L Cl-: 101 mEq/L K+: 2.4 mEq/L HCO3-: 24 mEq/L BUN: 22 mg/dL Glucose: 124 mg/dL Creatinine: 1.1 mg/dL Phosphate: 1.1 mg/dL Mg2+: 1.0 mg/dL Which of the following could have prevented the complication seen in this patient?? {'A': 'Slow initiation of total parenteral nutrition (TPN)', 'B': 'Use of enteral nutrition', 'C': 'Initiation of furosemide', 'D': 'Initiation of intermittent dialysis', 'E': 'Use of low-sugar TPN'},
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A: Slow initiation of total parenteral nutrition (TPN)
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Q:A 75-year-old gentleman is brought to the ED with confusion that started earlier this morning. His family notes that he was complaining of feeling weak last night and also had a slight tremor at the time. He is afebrile and he has no known chronic medical conditions. Physical exam reveals a cooperative but confused gentleman. His mucous membranes are moist, he has no focal neurological deficits, and his skin turgor is within normal limits. His lab results are notable for: Serum Na+: 123 mEq/L Plasma osmolality: 268 mOsm/kg Urine osmolality: 349 mOsm/kg Urine Na+: 47 mEq/L Which of the following malignancies is most likely to be responsible for this patient's presentation?? {'A': 'Esophageal squamous cell carcinoma', 'B': 'Non-seminomatous germ cell tumor', 'C': 'Gastric adenocarcinoma', 'D': 'Rib osteosarcoma', 'E': 'Small cell lung cancer'},
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E: Small cell lung cancer
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Q:A 19-year-old woman presents to an outpatient psychiatrist after 2 weeks of feeling “miserable.” She has been keeping to herself during this time with no desire to socialize with her friends or unable to enjoy her usual hobbies. She also endorses low energy, difficulty concentrating and falling asleep, and decreased appetite. You diagnose a major depressive episode but want to screen for bipolar disorder before starting her on an anti-depressant. Which of the following cluster of symptoms, if previously experienced by this patient, would be most consistent with bipolar I disorder?? {'A': 'Auditory hallucinations, paranoia, and disorganized speech for 2 weeks', 'B': 'Elevated mood, insomnia, distractibility, and flight of ideas for 5 days', 'C': 'Impulsivity, insomnia, increased energy, irritability, and auditory hallucinations for 2 weeks', 'D': 'Impulsivity, rapid mood swings, intense anger, self-harming behavior, and splitting for 10 years', 'E': 'Insomnia, anxiety, nightmares, and flashbacks for 6 months'},
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C: Impulsivity, insomnia, increased energy, irritability, and auditory hallucinations for 2 weeks
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Answer the following medical question with one of the provided options:
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Q:A 13-year-old girl is brought to the physician by her parents for the evaluation of progressive hair loss over the past 2 months. The parents report that they have noticed increased number of hairless patches on their daughter's head. The patient denies any itching. There is no personal or family history of serious illness. The patient states that she has been feeling tense since her boyfriend broke up with her. She does not smoke or drink alcohol. She does not use illicit drugs. Her vital signs are within normal limits. Physical examination shows ill-defined patchy hair loss and hair of different lengths with no scaling or reddening of the scalp. Further examination shows poor hair growth of the eyebrows and eyelashes. The remainder of the examination shows no abnormalities. Which of the following is the most likely diagnosis?? {'A': 'Tinea capitis', 'B': 'Scarring alopecia', 'C': 'Telogen effluvium', 'D': 'Alopecia areata', 'E': 'Trichotillomania'},
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E: Trichotillomania
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Answer the following medical question with one of the provided options:
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Q:A 58-year-old woman visits a physician because of fever, chills, dry cough, and a few enlarging masses on her cheeks and neck. Wart-like lesions are present on the nose as shown in the photograph. She reports that she visited the Mississippi area a few months before on a business trip. Her temperature is 38.1°C (100.6°F), the pulse is 80/min, and the blood pressure is 121/78 mm Hg. A fine needle aspirate of the lymph node is sent for pathological investigation. Culture growth shows white colonies on Sabouraud glucose agar (SGA). Which of the following is the most likely causal organism?? {'A': 'Blastomyces dermatitidis', 'B': 'Malassezia furfur', 'C': 'Histoplasma capsulatum', 'D': 'Coccidioides immitis', 'E': 'Aspergillus fumigates'},
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A: Blastomyces dermatitidis
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Answer the following medical question with one of the provided options:
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Q:A 34-year-old woman comes to the emergency department because of a 2-hour history of abdominal pain, nausea, and vomiting that began an hour after she finished lunch. Examination shows abdominal guarding and rigidity; bowel sounds are reduced. Magnetic resonance cholangiopancreatography shows the dorsal pancreatic duct draining into the minor papilla and a separate smaller duct draining into the major papilla. The spleen is located anterior to the left kidney. A disruption of which of the following embryological processes is the most likely cause of this patient's imaging findings?? {'A': 'Fusion of the pancreatic buds', 'B': 'Rotation of the midgut', 'C': 'Proliferation of mesenchyme in the dorsal mesentery', 'D': 'Differentiation of the proximal hepatic diverticulum', 'E': 'Rotation of the ventral splenic bud'},
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A: Fusion of the pancreatic buds
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Answer the following medical question with one of the provided options:
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Q:A 14-year-old boy who has been otherwise healthy presents to his doctor complaining of feeling easily winded and light-headed at basketball practice. He has never felt this way before and is frustrated because he is good enough to make varsity this year. He denies smoking, alcohol, or recreational drug use. His mother is very worried because her oldest son and brother had both died suddenly while playing sports despite being otherwise healthy. The transthoracic echocardiogram confirms the suspected diagnosis, which demonstrates a preserved ejection fraction and systolic anterior motion of the mitral valve. The patient is advised that he will need to stay hydrated and avoid intense exercise, and he will likely need an ICD due to his family history. Which of the following physical exam findings is consistent with this patient’s most likely diagnosis?? {'A': 'S3 heart sound', 'B': 'Systolic ejection murmur that radiates to the carotids', 'C': 'Tricuspid regurgitation', 'D': 'Mitral regurgitation', 'E': 'Systolic ejection murmur that improves with the Valsalva maneuver'},
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D: Mitral regurgitation
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Answer the following medical question with one of the provided options:
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Q:A 26-year-old G1P0 presents to her first obstetric visit after having a positive urine pregnancy test at home. Her last menstrual period was 9 weeks ago. She has no past medical history, but her mother has rheumatoid arthritis. The patient states that for several weeks, she has felt especially warm, even when her co-workers do not, and had muscle weakness. She also complains of mood swings and fatigue. At this visit, her temperature is 99.0°F (37.2°C), blood pressure is 140/81 mmHg, pulse is 106/min, and respirations are 17/min. Physical exam is notable for 3+ deep tendon reflexes bilaterally and 4/5 strength in both hips and shoulders. Ultrasound confirms the presence of a heart beat and shows a crown rump length that is consistent with a gestational age of 9 weeks and 3 days. Which of the following is the best therapy for this patient?? {'A': 'Radioactive thyroid ablation (I-31)', 'B': 'Methimazole', 'C': 'Propylthiouracil', 'D': 'Prednisone', 'E': 'Intravenous immunoglobulin'},
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C: Propylthiouracil
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Answer the following medical question with one of the provided options:
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Q:A 3-day-old female newborn is brought to the emergency department because of fever, poor feeding, and irritability for 6 hours. She was delivered at home at 39 weeks' gestation and delivery was uncomplicated. The mother had no prenatal care. Her temperature is 39.8°C (103.6°F), pulse is 172/min, respirations are 58/min, and blood pressure is 74/45 mm Hg. She appears lethargic. Physical examination shows expiratory grunting and nasal flaring. Serum studies show elevated levels of interleukin-6. Which of the following is the most likely effect of this laboratory finding?? {'A': 'Decreased synthesis of hepcidin', 'B': 'Decreased expression of MHC class II', 'C': 'Increased production of IgE', 'D': 'Increased classical activation of macrophages', 'E': 'Increased release of fibrinogen'},
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E: Increased release of fibrinogen
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Answer the following medical question with one of the provided options:
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Q:A 47-year-old man visits the outpatient clinic with complaints of heartburn and chest pain for the past 6 months. His pain is retrosternal and was initially only associated with intake of solid foods, but it now occurs with liquids as well. Antacids do not relieve his pain anymore. He is worried about the pain as it is getting worse with time. He also had an unintentional weight loss of 2.7 kg (6 lb) during this period. Physical examination including the abdominal examination is normal. Laboratory investigations reveal: Hgb 10 mg/dL White blood cell total count 5 x 109/L Platelet count 168 x 109/ L Hematocrit 38% Red blood cell count 4.2 x 1012/ L Esophagogastroduodenoscopy reveals an exophytic mass in the lower third of the esophagus with ulcerations and mucous plugs. Which of the following is the most likely diagnosis in this patient?? {'A': 'Benign stricture', 'B': 'Squamous cell carcinoma', 'C': 'Achalasia', 'D': 'Gastric ulcers', 'E': 'Adenocarcinoma'},
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E: Adenocarcinoma
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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 presents to the clinic with severe pain in her left knee of 1-day duration. Physical examination reveals a red, swollen, warm, and tender left knee with a decreased range of motion. The patient affirms that she has been sexually active with several partners over the last year and that 1 of her partners has complained of dysuria and yellow urethral discharge. An arthrocentesis was performed and showed a WBC count of 60,000/µL, with 90% polymorphonuclear leukocytes. Visualization of the patient's synovial fluid is provided in the image. Which of the following is a characteristic feature of the organism causing this condition?? {'A': 'It is a gram-positive diplococcus', 'B': 'It produces a heat-labile toxin that prevents protein synthesis', 'C': 'It ferments maltose', 'D': 'It causes the Jarisch-Herxheimer reaction when treated with penicillin', 'E': 'It selectively grows on Thayer-Martin medium'},
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E: It selectively grows on Thayer-Martin medium
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Answer the following medical question with one of the provided options:
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Q:A 14-year-old boy is brought to the physician by his mother because of a 1-month history of pain in his right leg. His mother has been giving him ketorolac at night to improve his sleep, but the pain has not improved. Physical examination shows marked tenderness along the right mid-femur. An x-ray of the right lower extremity shows several lytic lesions in the diaphysis of the femur and a surrounding cortex covered by several layers of new bone. A biopsy of the right femur shows small round blue cells. Which of the following is the most likely diagnosis?? {'A': 'Ewing sarcoma', 'B': 'Chondroblastoma', 'C': 'Osteochondroma', 'D': 'Chondrosarcoma', 'E': 'Osteoid osteoma'},
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A: Ewing sarcoma
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Answer the following medical question with one of the provided options:
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Q:A 4-year-old Caucasian male suffers from cyanosis and dyspnea relieved by squatting. Which of the following abnormalities is most likely present?? {'A': 'Left ventricular hypertrophy', 'B': 'Atrial septal defect', 'C': 'Ventricular septal defect', 'D': 'Coarctation of the aorta', 'E': 'Bicuspid aortic valve'},
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C: Ventricular septal defect
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