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Answer the following medical question with one of the provided options:
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Q:A 55-year-old man presents with burning and shooting in his feet and lower legs, which becomes more severe at night. In the past 6 months, the pain has become much worse and disturbs his sleep. He has a history of type 2 diabetes mellitus and essential hypertension. Which of the following best represent the etiology of this patient’s condition?? {'A': 'Autonomic neuropathy', 'B': 'Isolated cranial nerve neuropathy', 'C': 'Isolated peripheral nerve neuropathy', 'D': 'Distal symmetric sensorimotor polyneuropathy', 'E': 'Radiculopathy'},
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D: Distal symmetric sensorimotor polyneuropathy
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Answer the following medical question with one of the provided options:
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Q:A 51-year-old gentleman presents with new onset bilateral paresthesias of his feet. He also admits that he has not been able to exercise as much as previously and his friends have commented that he looks pale. Upon physical exam you find that he has conjunctival pallor and mildly decreased sensation and proprioception on his feet bilaterally. Based on your suspicions you decide to obtain a blood smear where you see megaloblasts as well as hypersegmented neutrophils. Given these findings you decide to investigate the cause of his disorder by injecting an intramuscular vitamin, then feeding him a radiolabeled version of the same vitamin orally. After waiting 24 hours you see that no radiolabeled vitamin appears in the urine so you repeat the test with intrinsic factor added to the oral mixture, at which point 20% of the radiolabeled vitamin appears in the urine. Which of the following is the most likely etiology of this gentleman's symptoms?? {'A': 'Insufficient vitamin intake', 'B': 'Pancreatic insufficiency', 'C': 'Pernicious anemia', 'D': 'Overgrowth of intestinal bacterial', 'E': 'Folate deficiency'},
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C: Pernicious anemia
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Answer the following medical question with one of the provided options:
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Q:A 51-year-old homeless man presents to the emergency department with severe abdominal pain and cramping for the past 3 hours. He endorses radiation to his back. He adds that he vomited multiple times. He admits having been hospitalized repeatedly for alcohol intoxication and abdominal pain. His temperature is 103.8° F (39.8° C), respiratory rate is 15/min, pulse is 107/min, and blood pressure is 100/80 mm Hg. He refuses a physical examination due to severe pain. Blood work reveals the following: Serum: Albumin: 3.2 gm/dL Alkaline phosphatase: 150 U/L Alanine aminotransferase: 76 U/L Aspartate aminotransferase: 155 U/L Gamma-glutamyl transpeptidase: 202 U/L Lipase: 800 U/L What is the most likely diagnosis of this patient?? {'A': 'Cholecystitis', 'B': 'Pancreatitis', 'C': 'Choledocholithiasis', 'D': 'Duodenal peptic ulcer', 'E': 'Gallbladder cancer'},
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B: Pancreatitis
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Answer the following medical question with one of the provided options:
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Q:A previously healthy 24-year-old woman comes to the physician because of recurrent episodes of a choking sensation, palpitations, diffuse sweating, and shortness of breath over the past 3 months. These episodes occur without warning and last for about 10 minutes before gradually resolving. One episode occurred while at a shopping center, and she now avoids busy areas for fear of triggering another. She has been evaluated in the emergency department twice during these episodes; both times her ECG showed normal sinus rhythm and serum cardiac enzymes and thyroid hormone levels were normal. She does not currently have symptoms but is concerned that the episodes could occur again at any time and that there may be something wrong with her heart. She does not smoke or drink alcohol. Her only medication is an oral contraceptive. Vital signs are within normal limits. Physical examination shows no abnormalities. Urine toxicology screening is negative. Which of the following is the most appropriate next step in management?? {'A': 'Prescribe fluoxetine', 'B': 'D-dimer measurement', 'C': 'Administer propranolol', 'D': 'Echocardiography', 'E': 'Administer lorazepam\n"'},
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A: Prescribe fluoxetine
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Answer the following medical question with one of the provided options:
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Q:A 22-year-old woman presents to an outpatient clinic complaining of an increasing vaginal discharge over the last week. The discharge is foul-smelling. The menstrual cycles are regular and last 4–5 days. The patient denies postcoital or intermenstrual bleeding. The last menstrual period was 2 weeks ago. She mentions that she has been sexually active with 2 new partners for the past 2 months, but they use condoms inconsistently. The patient has no chronic conditions, no previous surgeries, and does not take any medications. She is afebrile. The blood pressure is 125/82 mm Hg, the pulse is 102/min, and the respiratory rate is 19/min. The physical examination reveals a thin, yellow-green discharge accompanied by a pink and edematous vagina and a red-tan cervix. Which of the following is the most likely diagnosis?? {'A': 'Latex allergy', 'B': 'Physiologic leukorrhea', 'C': 'Candida vaginitis', 'D': 'Trichomonas vaginalis infection', 'E': 'Bacterial vaginosis'},
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D: Trichomonas vaginalis infection
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Answer the following medical question with one of the provided options:
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Q:A 57-year-old woman presents to her primary care physician with a chief complaint of epigastric pain that has worsened over the past three weeks. She describes it as sudden “gnawing” sensations that last for up to half a minute before subsiding. She finds some relief after a glass of water, but does not associate relief or exacerbation around mealtimes. The patient denies any radiation of the pain, fever, weight loss, fatigue, or change in stool color and quality. She does not take any medications, and says her diet includes lots of spicy and smoked foods. The physician refers her for an upper endoscopy, which reveals evidence of duodenal ulcers and mild gastroesophageal reflux. The pathology report reveals focal intestinal metaplasia and gastric dysplasia in the stomach, but no Helicobacter pylori infection. How should the physician advise this patient?? {'A': '"Intestinal metaplasia and gastric dysplasia are irreversible, requiring immediate surgery."', 'B': '"Intestinal metaplasia is reversible, but gastric dysplasia is irreversible, requiring immediate surgery."', 'C': '"Intestinal metaplasia and gastric dysplasia are irreversible; there is no cure."', 'D': '"Intestinal metaplasia and gastric dysplasia are reversible, requiring immediate medical therapy."', 'E': '"Intestinal metaplasia and gastric dysplasia are irreversible, requiring immediate medical therapy."'},
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D: "Intestinal metaplasia and gastric dysplasia are reversible, requiring immediate medical therapy."
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Answer the following medical question with one of the provided options:
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Q:A 14-year-old girl presents with pain in her right lower abdomen. She says the pain is sudden, severe, colicky, and associated with nausea and vomiting. Physical examination reveals tachycardia, point tenderness, and rebound tenderness in the right iliac region. Emergency laparotomy reveals an inflamed appendix. Her blood pressure is 128/84, heart rate is 92/min, and respiratory rate is 16/min. Her complete blood cell count shows an increase in the number of cells seen in the provided picture. What is the main function of these cells?? {'A': 'Phagocytosis', 'B': 'Allergic reaction', 'C': 'Blood clotting', 'D': 'Transplant rejection', 'E': 'Antigen presentation'},
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A: Phagocytosis
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Answer the following medical question with one of the provided options:
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Q:A 42-year-old man comes to the physician because of fatigue and decreased urination for the past 3 days. His creatinine is 2.5 mg/dL. A photomicrograph of a biopsy specimen of the right kidney is shown. Which of the following mechanisms most likely contributed to this patient's biopsy findings?? {'A': 'Fibrin formation in Bowman space', 'B': 'Segmental collapse of glomerular capillaries', 'C': 'Effacement of podocyte foot processes', 'D': 'Expansion of the mesangial matrix', 'E': 'Deposition of immunoglobulin light chains'},
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A: Fibrin formation in Bowman space
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Answer the following medical question with one of the provided options:
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Q:An immunologist is studying the stages of development of T lymphocytes in the thymus. He knows that double-negative T cells do not express CD4 or CD8 molecules. After undergoing development within the subcapsular zone in the thymus, double-negative T cells begin to move towards the medulla. While en route within the outer cortex, they upregulate CD4 and CD8 molecules and become double-positive T cells. At this stage, which of the following CD molecules is most likely to be present on the cell surface?? {'A': 'CD3', 'B': 'CD10', 'C': 'CD14', 'D': 'CD32', 'E': 'CD44'},
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A: CD3
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Answer the following medical question with one of the provided options:
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Q:An otherwise healthy 66-year-old man comes to the physician for evaluation of rough skin over his forehead and the back of his hands. He has tried applying different types of moisturizers with no improvement. He has worked on a farm all his life. Physical examination shows two erythematous papules with a gritty texture and central scale over the left temple and three similar lesions over the dorsum of his hands. This patient's skin lesions increase his risk of developing a skin condition characterized by which of the following findings on histopathology?? {'A': 'Keratin pearls', 'B': 'Atypical melanocytes', 'C': 'Noncaseating granulomas', 'D': 'Basaloid cells', 'E': 'Intraepidermal acantholysis'},
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A: Keratin pearls
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Answer the following medical question with one of the provided options:
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Q:A neurology resident sees a stroke patient on the wards. This 57-year-old man presented to the emergency department after sudden paralysis of his right side. He was started on tissue plasminogen activator within 4 hours, as his wife noticed the symptoms and immediately called 911. When the resident asks the patient how he is doing, he replies by saying that his apartment is on Main St. He does not seem to appropriately answer the questions being asked, but rather speaks off topic. He is able to repeat the word “fan.” His consciousness is intact, and his muscle tone and reflexes are normal. Upon striking the lateral part of his sole, his big toe flexes and the other toes flare down. Which of the following is the area most likely affected in his condition?? {'A': 'Caudate nucleus', 'B': 'Cuneus gyrus', 'C': 'Broca’s area', 'D': 'Temporal lobe', 'E': 'Arcuate fasciculus'},
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D: Temporal lobe
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Answer the following medical question with one of the provided options:
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Q:A 1-week-old male newborn is brought to the physician for the evaluation of persistent irritability and crying. He was born at 36 weeks' gestation. Pregnancy was complicated by polyhydramnios. His mother reports that she nurses him frequently and changes his diapers 18–20 times per day. He is at the 5th percentile for length and 10th percentile for weight. Physical examination shows a triangular face with a prominent forehead and large, protruding ears. Serum studies show: Na+ 129 mEq/L K+ 2.8 mEq/L Cl- 90 mEq/L Ca2+ 8.0 mg/dL HCO3- 32 mEq/L Arterial blood gas analysis shows a pH of 7.51. The effects of this patient's condition are most similar to the long-term administration of which of the following drugs?"? {'A': 'Triamterene', 'B': 'Bumetanide', 'C': 'Tolvaptan', 'D': 'Acetazolamide', 'E': 'Mannitol'},
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B: Bumetanide
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Answer the following medical question with one of the provided options:
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Q:A 78-year-old woman is brought to the physician by her son because of progressive memory loss for the past year. She feels tired and can no longer concentrate on her morning crossword puzzles. She has gained 11.3 kg (25 lb) in the last year. Her father died from complications of Alzheimer disease. She has a history of drinking alcohol excessively but has not consumed alcohol for the past 10 years. Vital signs are within normal limits. She is oriented but has short-term memory deficits. Examination shows a normal gait and delayed relaxation of the achilles reflex bilaterally. Her skin is dry and she has brittle nails. Which of the following is the most likely underlying etiology of this woman’s memory loss?? {'A': 'Thiamine deficiency', 'B': 'Autoimmune thyroid disease', 'C': 'Normal pressure hydrocephalus', 'D': 'Vitamin B12 deficiency', 'E': 'Alzheimer disease'},
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B: Autoimmune thyroid disease
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Answer the following medical question with one of the provided options:
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Q:A 22-year-old man presents with abdominal cramps and diarrhea over the last few weeks. He notes that several of his bowel movements have a small amount of blood. Past medical history is significant for an intermittent cough that has been persistent since returning from Mexico last month. The patient takes no current medications. On physical examination, there is diffuse tenderness to palpation. Which of the following medications is indicated for this patient’s condition?? {'A': 'Mebendazole', 'B': 'Ivermectin', 'C': 'Albendazole', 'D': 'Pyrantel', 'E': 'Praziquantel'},
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B: Ivermectin
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Answer the following medical question with one of the provided options:
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Q:You are called to a hemodialysis suite. The patient is a 61-year-old man with a history of hypertension, hypercholesterolemia, and type-2 diabetes mellitus-induced end-stage renal disease who has required hemodialysis for the past year. His current hemodialysis session is nearing the end when the nurse notices that his blood pressure has dropped to 88/60 mm Hg from his normal of 142/90 mm Hg. The patient denies any shortness of breath or chest pain. He took his daily bisoprolol, metformin, and insulin this morning before coming to the hospital. On examination, the patient’s blood pressure is 92/60 mm Hg, and his heart rate is 119/min. Chest auscultation is unremarkable. What is the most appropriate next management step?? {'A': 'Stop ultrafiltration and decrease blood flow into the machine', 'B': 'Infuse 1 liter of 0.9% saline', 'C': 'Administer intravenous calcium gluconate', 'D': 'Start the patient on an epinephrine drip', 'E': 'Transfuse the patient with 1 unit of packed red blood cells'},
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A: Stop ultrafiltration and decrease blood flow into the machine
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Answer the following medical question with one of the provided options:
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Q:A 49-year-old man with hypertension comes to the hospital because of 4 days of left-sided chest pain, cough, and fever. The chest pain worsens upon inspiration and coughing. His temperature is 38.5°C (101.3° F), pulse is 110/min, respirations are 29/min. There is dullness to percussion at the left base of the lung. An x-ray of the chest shows blunting of the left costophrenic angle. Evaluation of the pleural fluid is most likely to show which of the following findings?? {'A': 'Increased lymphocyte concentration', 'B': 'Decreased glucose concentration', 'C': 'Increased pH', 'D': 'Increased triglyceride concentration', 'E': 'Decreased sodium concentration'},
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B: Decreased glucose concentration
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Answer the following medical question with one of the provided options:
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Q:A 17-year-old boy presents to the emergency department of a hospital located in the town of Recuay (which is situated at 3,400 meters above mean sea level [MAMSL]) in the Ancash Region (Peru), 48 hours after returning from a 21-day stay in Lima (the capital city of Peru at 0 MAMSL). The patient has no previous medical history. His current complaints include cough, dyspnea at rest, hemoptysis, chest pain, and vomiting. His vital signs include: blood pressure 90/60 mm Hg; heart rate 149/min; respiratory rate 37/min; temperature 36.5°C (97.7°F); and O2 saturation 71%. Physical examination reveals polypnea, perioral cyanosis, intercostal retractions, and diffuse pulmonary crackles. His laboratory results are as follows: Hemoglobin 19.2 g/dL Hematocrit 60% Leukocytes 13,000 (Bands: 12%, Seg: 78%, Eos: 0%, Bas: 0%, Mon: 6%) Urea 25 mg/dL Creatinine 0.96 mg/dL A chest X-ray is shown. Which of the following statements is true and most likely regarding this patient’s condition? ? {'A': 'Following a rapid and sustained increase in altitude, decreased sympathetic activity transiently increases cardiac output, blood pressure, heart rate, and venous tone', 'B': 'Hypoxic stimulation of the peripheral chemoreceptors results in increased minute ventilation', 'C': 'Marked increase in pressure gradient can lead to tissue hypoxia', 'D': 'The net change in response to hypoxia results in decreased cerebral blood flow', 'E': 'The pulmonary vasculature relaxes in response to hypoxia'},
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C: Marked increase in pressure gradient can lead to tissue hypoxia
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Answer the following medical question with one of the provided options:
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Q:A 45-year-old woman presents to her primary care physician with complaints of muscle pains, poor sleep, and daytime fatigue. When asked about stressors she states that she "panics" about her job, marriage, children, and finances. When asked to clarify what the "panics" entail, she states that it involves severe worrying. She has had these symptoms since she last saw you one year ago. What is the most likely diagnosis?? {'A': 'Generalized anxiety disorder', 'B': 'Social phobia', 'C': 'Adjustment disorder', 'D': 'Panic disorder', 'E': 'Obsessive-compulsive disorder'},
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A: Generalized anxiety disorder
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Answer the following medical question with one of the provided options:
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Q:A 17-year-old is brought to his primary care provider by his mother. They are concerned that his acne is getting worse and may leave scars. They have tried several over the counter products without success. He is otherwise healthy and without complaint. The boy was born at 39 weeks gestation via spontaneous vaginal delivery. He is up to date on all vaccines with some delay in reaching developmental milestones, especially in language development. He is having trouble with school and has a history of detentions for misbehavior and acting out. On examination, he stands 6 ft 3 inches tall, considerably taller than either parent or other family members with inflamed pustular acne on his face, shoulders, and chest. He is otherwise healthy. Which of the following karyotypes is most likely associated with this patient’s clinical features?? {'A': '45 X0', 'B': '47 XXY', 'C': '47 XYY', 'D': '47, XY, +21', 'E': '46 XY'},
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C: 47 XYY
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Answer the following medical question with one of the provided options:
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Q:A 53-year-old man is brought to the emergency department by his wife because of a 1-day history of headache, blurry vision, and confusion. His wife also says that he hasn't urinated in the past 24 hours. Despite appropriate measures, the patient dies shortly after admission. A photomicrograph of a section of the kidney obtained at autopsy is shown. Which of the following is the most likely explanation for the findings indicated by the arrow?? {'A': 'Mycotic aneurysm', 'B': 'Severe hypertension', 'C': 'Chronic hyperglycemia', 'D': 'Necrotizing vasculitis', 'E': 'Atherosclerotic plaque rupture'},
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B: Severe hypertension
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Answer the following medical question with one of the provided options:
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Q:A 37-year-old woman with a history of anorectal abscesses complains of pain in the perianal region. Physical examination reveals mild swelling, tenderness, and erythema of the perianal skin. She is prescribed oral ampicillin and asked to return for follow-up. Two days later, the patient presents with a high-grade fever, syncope, and increased swelling. Which of the following would be the most common mechanism of resistance leading to the failure of antibiotic therapy in this patient?? {'A': 'Use of an altered metabolic pathway', 'B': 'Drug efflux pump', 'C': 'Production of beta-lactamase enzyme', 'D': 'Intrinsic absence of a target site for the drug', 'E': 'Altered structural target for the drug'},
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C: Production of beta-lactamase enzyme
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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 comes to see her primary care physician for a physical for school. She states she has not had any illnesses last year and is on her school's volleyball team. She exercises daily, does not use any drugs, and has never smoked cigarettes. On physical exam you note bruising around the patients neck, and what seems to be burn marks on her back and thighs. The physician inquires about these marks. The patient explains that these marks are the result of her sexual activities. She states that in order for her to be aroused she has to engage in acts such as hitting, choking, or anything else that she can think of. The physician learns that the patient lives with her boyfriend and that she is in a very committed relationship. She is currently monogamous with this partner. The patient is studying with the hopes of going to law school and is currently working in a coffee shop. The rest of the patient’s history and physical is unremarkable. Which of the following is the most likely diagnosis?? {'A': 'Domestic abuse', 'B': 'Dependent personality disorder', 'C': 'Avoidant personality disorder', 'D': 'Sexual masochism', 'E': 'Sexual sadism'},
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D: Sexual masochism
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Answer the following medical question with one of the provided options:
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Q:A 25-year-old man comes to the physician because of a 4-day history of bloody stools. During this time, he has not had nausea, vomiting, abdominal cramps, or pain while defecating. He has had recurrent episodes of non-bloody diarrhea for the past 6 months. His father died of colon cancer at the age of 39 years. His vital signs are within normal limits. Physical examination shows small, painless bony swellings on the mandible, forehead, and right shin. There are multiple non-tender, subcutaneous nodules with central black pores present over the trunk and face. Fundoscopic examination shows multiple, oval, darkly pigmented lesions on the retina. Colonoscopy shows approximately 150 colonic polyps. Which of the following is the most likely diagnosis?? {'A': 'Cronkhite-Canada syndrome', 'B': 'Lynch syndrome', 'C': 'Peutz-Jeghers syndrome', 'D': 'Gardner syndrome', 'E': 'Cowden syndrome'},
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D: Gardner syndrome
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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 office by his step-parents because he was recently caught beating a stray cat in an alley near his home. He has a police record which includes vandalism, shoplifting, and running away on two occasions. He has also received several detentions and threats of expulsion from school due to bullying and being too aggressive with the younger students. Past medical history is significant for a history of ADHD previously treated with methylphenidate, but now he does not take anything. His biological family placed him and his sister into the foster care system. His step-parents try to provide support and nurturing home life but the patient is very resistant and often acts out. What is the most likely diagnosis for this patient?? {'A': 'Antisocial personality disorder', 'B': 'Attention deficit hyperactivity disorder', 'C': 'Conduct disorder', 'D': 'Oppositional defiant disorder', 'E': 'Schizoid personality disorder'},
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C: Conduct disorder
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Answer the following medical question with one of the provided options:
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Q:A group of investigators discovers a novel monomeric enzyme that cleaves glutamate-valine bonds in a bacterial exotoxin. The substrate binding site of the enzyme is rich in aspartate. A sample of the enzyme is added to two serum samples containing the bacterial exotoxin. One sample is assigned a test condition while the other is maintained as the control. The averaged results of several trials comparing Vmax and Km between control serum and test serum are shown. Vmax (μmol/min) Km (mM) Control serum 13.2 81.2 Test serum 28.8 80.9 Which of the following conditions in the test serum would best explain these findings?"? {'A': 'Increased serum pH', 'B': 'Increased enzyme concentration', 'C': 'Increased exotoxin concentration', 'D': 'Presence of a reversible competitive inhibitor', 'E': 'Presence of an irreversible competitive inhibitor\n"'},
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B: Increased enzyme concentration
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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 Room as a code trauma after being shot in the neck. En route, the patient’s blood pressure is 127/73 mmHg, pulse is 91/min, respirations are 14/min, and oxygen saturation is 100% on room air with GCS of 15. On physical exam, the patient is in no acute distress; however, there is an obvious entry point with oozing blood near the left lateral neck above the cricoid cartilage with a small hematoma that is non-pulsatile and stable since arrival. The rest of the physical exam is unremarkable. Rapid hemoglobin returns back at 14.1 g/dL. After initial resuscitation, what is the next best step in management?? {'A': 'MRI', 'B': 'Plain radiography films', 'C': 'Conventional angiography', 'D': 'CT angiography', 'E': 'Bedside neck exploration'},
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D: CT angiography
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Answer the following medical question with one of the provided options:
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Q:A 53-year-old woman presents to the physician with palpitations and increasing swelling of the legs over the past 3 months. During this time, she has also had generalized pruritus. She has dyspnea on exertion. She has no history of asthma. She occasionally takes ibuprofen for chronic headaches she has had for several years. She does not smoke or drink alcohol. The pulse is 92/min and irregular, blood pressure is 115/65 mm Hg, temperature is 36.7°C (98.1°F), and respiratory rate are 16/min. On physical examination, the skin shows papules and linear scratch marks on the limbs and trunk. She has 2+ pitting edema. Auscultation of the heart shows irregular heartbeats. Examination of the lungs shows no abnormalities. The spleen is palpated 5 cm (1.9 in) below the costal margin. No lymphadenopathy is palpated. The results of the laboratory studies show: Hemoglobin 14 g/dL Leukocyte count 17,500/mm3 Percent segmented neutrophils 25.5% Lymphocytes 16.5% Eosinophils 52% Basophils 2% Platelet count 285,000/mm3 Echocardiography is consistent with restrictive-pattern cardiomyopathy and shows thickening of the mitral valve and a thrombus in the left ventricular apex. Abdominal ultrasound confirms splenomegaly and shows ascites. Which of the following best explains these findings?? {'A': 'Drug rash with eosinophilia and systemic symptoms (DRESS)', 'B': 'Eosinophilic granulomatosis with polyangiitis', 'C': 'Hodgkin’s lymphoma', 'D': 'Hypereosinophilic syndrome', 'E': 'Strongyloidiasis eosinophilia'},
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D: Hypereosinophilic syndrome
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Answer the following medical question with one of the provided options:
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Q:A 69-year-old man is scheduled to undergo radical retropubic prostatectomy for prostate cancer in 2 weeks. He had a myocardial infarction at the age of 54 years. He has a history of GERD, unstable angina, hyperlipidemia, and severe osteoarthritis in the left hip. He is unable to climb up stairs or walk fast because of pain in his left hip. He had smoked one pack of cigarettes daily for 30 years but quit 25 years ago. He drinks one glass of wine daily. Current medications include aspirin, metoprolol, lisinopril, rosuvastatin, omeprazole, and ibuprofen as needed. His temperature is 36.4°C (97.5°F), pulse is 90/min, and blood pressure is 136/88 mm Hg. Physical examination shows no abnormalities. A 12-lead ECG shows Q waves and inverted T waves in leads II, III, and aVF. His B-type natriuretic protein is 84 pg/mL (N < 125). Which of the following is the most appropriate next step in management to assess this patient's perioperative cardiac risk?? {'A': '24-hour ambulatory ECG monitoring', 'B': 'Radionuclide myocardial perfusion imaging', 'C': 'Resting echocardiography', 'D': 'No further testing', 'E': 'Treadmill stress test'},
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B: Radionuclide myocardial perfusion imaging
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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 is brought to the emergency department 20 minutes after he fell from the roof of his house. On arrival, he is unresponsive to verbal and painful stimuli. His pulse is 72/min and blood pressure is 132/86 mm Hg. A CT scan of the head shows a fracture in the anterior cranial fossa and a 1-cm laceration in the left anterior orbital gyrus. If the patient survives, which of the following would ultimately be the most common cell type at the injured region of the frontal lobe?? {'A': 'Schwann cells', 'B': 'Neurons', 'C': 'Astrocytes', 'D': 'Microglia', 'E': 'Oligodendrocytes'},
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C: Astrocytes
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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 comes to the physician because of an itchy rash on her leg 3 days after she returned from a camping trip with her grandchildren. Examination shows a linear, erythematous, maculopapular rash on the left lower extremity. Treatment with a drug is begun that is also effective for motion sickness. One hour later, she reports dry mouth. This adverse effect is most likely mediated through which of the following?? {'A': 'Antagonism at serotonin receptors', 'B': 'Antagonism at acetylcholine receptors', 'C': 'Agonism at β-adrenergic receptors', 'D': 'Antagonism at histamine receptors', 'E': 'Antagonism at α-adrenergic receptors'},
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B: Antagonism at acetylcholine receptors
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Answer the following medical question with one of the provided options:
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Q:A 52-year-old man is brought to the emergency department after being found by police confused and lethargic in the park. The policemen report that the patient could not recall where he was or how he got there. Medical history is significant for multiple prior hospitalizations for acute pancreatitis. He also has scheduled visits with a psychiatrist for managing his depression and substance abuse. On physical examination, the patient was found to have horizontal nystagmus and a wide-based gait with short-spaced steps. The patient is started on appropriate medication and admitted to the medicine floor. He was re-evaluated after treatment implementation and currently does not appear confused. When asked how he got to the hospital, the patient says, "I remember leaving my wallet here and thought I should pick it up." On cognitive testing the patient is noted to have impairments in judgement, sequencing tasks, and memory. Which of the following enzymes was most likely impaired in this patient?? {'A': 'Methylmalonyl-CoA mutase', 'B': 'Methionine synthase', 'C': 'Transketolase', 'D': 'Pyruvate carboxylase', 'E': 'Dopamine-ß-hydroxylase'},
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C: Transketolase
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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 rushed to the urgent care department from a friend’s birthday party with breathing trouble. He is immediately placed on supplemental oxygen therapy. The patient’s father explains that peanut butter treats were served at the event, but he reported not having witnessed his son actually eat one. During the party, the patient approached his father with facial flushing, difficulty breathing, and itching of his face and neck. The patient was born at 40 weeks gestation via spontaneous vaginal delivery. He has met all age-related developmental milestones and is fully vaccinated. His past medical history is significant for peanut allergy and asthma. He carries an emergency inhaler. Family history is noncontributory. The patient’s vitals signs include a blood pressure of 110/85 mm Hg, a heart rate of 110/min, a respiratory rate of 25/min, and a temperature of 37.2°C (99.0°F). Physical examination reveals severe facial edema and severe audible stridor in both lungs. Which of the following types of hypersensitivity reaction is the most likely in this patient?? {'A': 'Type 1–anaphylactic hypersensitivity reaction', 'B': 'Type 2–cytotoxic hypersensitivity reaction', 'C': 'Type 3–immune complex-mediated hypersensitivity reaction', 'D': 'Type 4–cell-mediated (delayed) hypersensitivity reaction', 'E': 'Mixed anaphylactic and cytotoxic hypersensitivity reaction'},
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A: Type 1–anaphylactic hypersensitivity reaction
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Answer the following medical question with one of the provided options:
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Q:A 27-year-old man is brought to the emergency department 45 minutes after being involved in a motor vehicle collision. He is agitated. He has pain in his upper right arm, which he is cradling in his left arm. His temperature is 36.7°C (98°F), pulse is 135/min, respirations are 25/min, and blood pressure is 145/90 mm Hg. His breathing is shallow. Pulse oximetry on 100% oxygen via a non-rebreather face mask shows an oxygen saturation of 83%. He is confused and oriented only to person. Examination shows multiple bruises on the right anterior thoracic wall. The pupils are equal and reactive to light. On inspiration, his right chest wall demonstrates paradoxical inward movement while his left chest wall is expanding. There is pain to palpation and crepitus over his right anterior ribs. The remainder of the examination shows no abnormalities. An x-ray of the chest is shown. Two large-bore IVs are placed. After fluid resuscitation and analgesia, which of the following is the most appropriate next step in management?? {'A': 'Placement of a chest tube', 'B': 'Intubation with positive pressure ventilation', 'C': 'Bedside thoracotomy', 'D': 'CT scan of the chest', 'E': 'Surgical fixation of right third to sixth ribs'},
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B: Intubation with positive pressure ventilation
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Q:A 76-year-old man comes to the emergency department because of an episode of seeing jagged edges followed by loss of central vision in his right eye. The episode occurred 6 hours ago and lasted approximately 5 minutes. The patient has no pain. He has a 3-month history of intermittent blurriness out of his right eye and reports a 10-minute episode of slurred speech and left-sided facial droop that occurred 2 months ago. He has hypercholesterolemia, stable angina pectoris, hypertension, and a 5-year history of type 2 diabetes mellitus. Medications include glyburide, atorvastatin, labetalol, isosorbide, lisinopril, and aspirin. He feels well. He is oriented to person, place, and time. His temperature is 37°C (98.6°F), pulse is 76/min, respirations are 12/min, and blood pressure is 154/78 mm Hg. The extremities are well perfused with strong peripheral pulses. Ophthalmologic examination shows visual acuity of 20/30 in the left eye and 20/40 in the right eye. Visual fields are normal. Fundoscopic examination shows two pale spots along the supratemporal and inferotemporal arcade. Neurologic examination shows no focal findings. Cardiopulmonary examination shows systolic rumbling at the right carotid artery. The remainder of the examination shows no abnormalities. An ECG shows normal sinus rhythm with no evidence of ischemia. Which of the following is the most appropriate next step in management?? {'A': 'Echocardiography', 'B': 'Fluorescein angiography', 'C': 'Reassurance and follow-up', 'D': 'Temporal artery biopsy', 'E': 'Carotid duplex ultrasonography'},
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E: Carotid duplex ultrasonography
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Q:A 34-year-old man presents to a clinic with complaints of abdominal discomfort and blood in the urine for 2 days. He has had similar abdominal discomfort during the past 5 years, although he does not remember passing blood in the urine. He has had hypertension for the past 2 years, for which he has been prescribed medication. There is no history of weight loss, skin rashes, joint pain, vomiting, change in bowel habits, and smoking. On physical examination, there are ballotable flank masses bilaterally. The bowel sounds are normal. Renal function tests are as follows: Urea 50 mg/dL Creatinine 1.4 mg/dL Protein Negative RBC Numerous The patient underwent ultrasonography of the abdomen, which revealed enlarged kidneys and multiple anechoic cysts with well-defined walls. A CT scan confirmed the presence of multiple cysts in the kidneys. What is the most likely diagnosis?? {'A': 'Autosomal dominant polycystic kidney disease (ADPKD)', 'B': 'Autosomal recessive polycystic kidney disease (ARPKD)', 'C': 'Medullary cystic disease', 'D': 'Simple renal cysts', 'E': 'Acquired cystic kidney disease'},
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A: Autosomal dominant polycystic kidney disease (ADPKD)
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Q:A 15-year-old boy is brought to the physician because his urine has been pink since that morning. During the past 2 days, he has had a sore throat and difficulty swallowing. He also reports having a low-grade fever. He has no pain with urination or changes in urinary frequency. He has had 2 similar episodes involving a sore throat and pink urine over the past 2 years. His older sister has systemic lupus erythematosus. His temperature is 38.3°C (101°F), pulse is 76/min, and blood pressure is 120/80 mm Hg. Oral examination shows an erythematous pharynx and enlarged tonsils. The remainder of the examination shows no abnormalities. Laboratory studies show: Leukocyte count 20,000/mm3 Serum Urea nitrogen 8 mg/dL Creatinine 1.4 mg/dL Urine Blood 3+ Protein 1+ RBC 15–17/hpf with dysmorphic features RBC casts numerous Ultrasound of both kidneys shows no abnormalities. A renal biopsy is most likely to show which of the following findings?"? {'A': 'Capillary wire looping', 'B': 'Splitting of the glomerular basement membrane', 'C': 'Crescents of fibrin and plasma proteins', 'D': 'IgA mesangial deposition', 'E': 'Granular deposits of IgG, IgM, and C3 complement\n"'},
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D: IgA mesangial deposition
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Q:A 49-year-old man presents to your clinic with “low back pain”. When asked to point to the area that bothers him the most, he motions to both his left and right flank. He describes the pain as deep, dull, and aching for the past few months. His pain does not change significantly with movement or lifting heavy objects. He noted dark colored urine this morning. He has a history of hypertension managed with hydrochlorothiazide; however, he avoids seeing the doctor whenever possible. He drinks 3-4 beers on the weekends but does not smoke. His father died of a sudden onset brain bleed, and his mother has diabetes. In clinic, his temperature is 99°F (37.2°C), blood pressure is 150/110 mmHg, pulse is 95/min, and respirations are 12/min. Bilateral irregular masses are noted on deep palpation of the abdomen. The patient has full range of motion in his back and has no tenderness of the spine or paraspinal muscles. Urine dipstick in clinic is notable for 3+ blood. Which chromosome is most likely affected by a mutation in this patient?? {'A': 'Chromosome 4', 'B': 'Chromosome 6', 'C': 'Chromosome 7', 'D': 'Chromosome 15', 'E': 'Chromosome 16'},
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E: Chromosome 16
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Q:A 26-year-old woman, gravida 1, para 0, at 22 weeks' gestation is brought to the emergency department by her husband because of a 2-day history of confusion and falls. Pregnancy has been complicated by excessive vomiting and an 8-kg (17-lb) weight loss over the past 10 weeks. Physical examination shows vertical nystagmus and a wide-based gait. Muscle tone and tendon reflexes are diminished in all extremities. An MRI of the brain shows periventricular diffusion abnormalities. Treatment is initiated with a vitamin followed by a dextrose infusion. The primary reason to administer the vitamin first is to ensure the function of which of the following enzymes?? {'A': 'Pyruvate carboxylase', 'B': 'Methionine synthase', 'C': 'α-Ketoglutarate dehydrogenase', 'D': 'Fatty acid synthase', 'E': 'Succinate dehydrogenase'},
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C: α-Ketoglutarate dehydrogenase
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Q:A 25-year-old professional surfer presents to the emergency room with leg pain and a headache. He recently returned from a surf competition in Hawaii and has been feeling unwell for several days. He regularly smokes marijuana and drinks 6-7 beers during the weekend. He is otherwise healthy and does not take any medications. His temperature is 102.2°F (39°C), blood pressure is 121/78 mmHg, pulse is 120/min, and respirations are 18/min saturating 99% on room air. He is sitting in a dim room as the lights bother his eyes and you notice scleral icterus on physical exam. Cardiopulmonary exam is unremarkable. Which of the following findings would most likely be seen in this patient?? {'A': 'Granulocytes with morulae in the cytoplasm', 'B': 'Treponemes on dark-field microscopy', 'C': 'Monocytes with morulae in the cytoplasm', 'D': 'Epithelial cells covered with gram-variable rods', 'E': 'Question mark-shaped bacteria on dark-field microscopy'},
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E: Question mark-shaped bacteria on dark-field microscopy
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Q:A 58-year-old man presents to the emergency department following a motor vehicle accident where he was an unrestrained passenger. On initial presentation in the field, he had diffuse abdominal tenderness and his blood pressure is 70/50 mmHg and pulse is 129/min. Following administration of 2 L of normal saline, his blood pressure is 74/58 mmHg. He undergoes emergency laparotomy and the source of the bleeding is controlled. On the second post-operative day, his blood pressure is 110/71 mmHg and pulse is 90/min. There is a midline abdominal scar with no erythema and mild tenderness. Cardiopulmonary examination is unremarkable. He has had 300 mL of urine output over the last 24 hours. Urinalysis shows 12-15 RBC/hpf, 2-5 WBC/hpf, and trace protein. What additional finding would you expect to see on urinalysis?? {'A': 'WBC casts', 'B': 'RBC casts', 'C': 'Hyaline casts', 'D': 'Muddy brown casts', 'E': 'Fatty casts'},
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D: Muddy brown casts
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Q:A 69-year-old man presents with progressive malaise, weakness, and confusion. The patient’s wife reports general deterioration over the last 3 days. He suffers from essential hypertension, but this is well controlled with amlodipine. He also has type 2 diabetes mellitus that is treated with metformin. On physical examination, the patient appears severely ill, weak and is unable to speak. His neck veins are distended bilaterally. His skin is mottled and dry with cool extremities, and he is mildly cyanotic. The respiratory rate is 24/min, the pulse is 94/min, the blood pressure is 87/64 mm Hg, and the temperature is 35.5°C (95.9°F). Auscultation yields coarse crackles throughout both lung bases. Which of the following best represents the mechanism of this patient’s condition?? {'A': 'Loss of intravascular volume', 'B': 'Failure of vasoregulation', 'C': 'Barrier to cardiac flow', 'D': 'Restriction of cardiac filling', 'E': 'Cardiac pump dysfunction'},
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E: Cardiac pump dysfunction
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Q:A graduate student in public health is conducting a study on population health and is comparing different demographic models. He is particularly interested in investigating health care interventions in societies with the demographic distribution shown. Which of the following measures is most likely to ensure a healthy demographic transition in this population?? {'A': 'Invest in workplace health and safety measures', 'B': 'Invest in childhood immunization programs', 'C': 'Invest in type II diabetes research programs', 'D': 'Invest in prostate cancer screening programs', 'E': 'Invest in long-term care facilities'},
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B: Invest in childhood immunization programs
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Q:A 30-year-old woman presents to the office with chief complaints of skin pigmentation and fragility of the extensor sides of both hands for a month. The lesions are progressive and are not directly sensitive to light. The patient is otherwise healthy and only uses an oral contraceptive. There is no skin disease or similar skin symptoms in family members. She consumes 1 glass of wine twice a week. Dermatological examination reveals erosions, erythematous macules, pigmentation, and atrophic scarring. Blood analysis reveals elevated CRP (34 mg/L), AST (91 U/L), ALT (141 U/L), and serum ferritin (786 ng/mL compared to the normal value of 350 ng/mL). Her BMI is 21 kg/m2. Urine porphyrin test results are negative. Autoimmune laboratory analysis, hepatic panel, and HIV serology are negative with a normal liver ultrasound. Genetic analysis shows a homozygous missense mutation of the HFE gene. What could be the long-term effect of her condition to her liver?? {'A': 'Hepatocellular carcinoma', 'B': 'Fatty liver', 'C': 'Copper accumulation', 'D': 'Alcoholic cirrhosis', 'E': 'OCP related hepatitis'},
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A: Hepatocellular carcinoma
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Q:In a routine medical examination, a young man is noted to be tall with slight scoliosis and pectus excavatum. He had been told that he was over the 95% percentile for height as a child. Auscultation reveals a heart murmur, and transthoracic echocardiography shows an enlarged aortic root and mitral valve prolapse. Blood screening for fibrillin-1 (FBN1) gene mutation is positive and plasma homocysteine is normal. This patient is at high risk for which of the following complications?? {'A': 'Infertility', 'B': 'Rupture of blood vessels or organs', 'C': 'Mucosal neuromas', 'D': 'Aortic dissection', 'E': 'Intravascular thrombosis'},
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D: Aortic dissection
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Q:Four days after delivery, a 1400-g (3-lb 1-oz) newborn has a tonic seizure that lasts for 30 seconds. Over the past 24 hours, he has become increasingly lethargic. He was born at 31 weeks' gestation. Antenatal period was complicated by chorioamnionitis. Apgar scores were 4 and 5 at 1 and 5 minutes, respectively. He appears ill. His pulse is 130/min, respirations are 53/min and irregular, and blood pressure is 67/35 mm Hg. Examination shows a bulging anterior fontanelle. The pupils are equal and react sluggishly to light. Examination shows slow, conjugate back and forth movements of the eyes. Muscle tone is decreased in all extremities. The lungs are clear to auscultation. Which of the following is the most likely underlying cause?? {'A': 'Galactose-1-phosphate uridylyltransferase deficiency', 'B': 'Apoptosis of lower motor neurons', 'C': 'Congenital hydrocephalus', 'D': 'Phenylalanine hydroxylase deficiency', 'E': 'Germinal matrix hemorrhage'},
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E: Germinal matrix hemorrhage
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Q:A 44-year-old woman presents with palpitations and lightheadedness. She says that symptoms onset 3 days ago and have not improved. She denies any similar episodes in this past. Her blood pressure is 140/90 mm Hg, heart rate is 150/min, respiratory rate is 16/min, and temperature is 36.6℃ (97.9℉). An ECG is performed and the results are shown in the picture. For cardioversion, it is decided to use an antiarrhythmic agent which has a use-dependent effect. Which of the following medications was most probably used?? {'A': 'Flecainide', 'B': 'Amiodarone', 'C': 'Diltiazem', 'D': 'Propranolol', 'E': 'Verapamil'},
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A: Flecainide
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Q:Two days after undergoing left hemicolectomy for a colonic mass, a 62-year-old man develops shortness of breath. His temperature is 38.1°C (100.6°F), pulse is 80/min, respirations are 22/min, and blood pressure is 120/78 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 88%. Cardiopulmonary examination shows decreased breath sounds and decreased fremitus at both lung bases. Arterial blood gas analysis on room air shows: pH 7.35 PaO2 70 mm Hg PCO2 40 mm Hg An x-ray of the chest shows a collapse of the bases of both lungs. Which of the following is the most likely underlying mechanism of this patient's hypoxemia?"? {'A': 'Increased anatomic dead space', 'B': 'Decreased hemoglobin oxygen-binding capacity', 'C': 'Increased tidal volume', 'D': 'Decreased ratio of ventilated alveoli', 'E': 'Decreased chest wall compliance'},
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D: Decreased ratio of ventilated alveoli
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Q:A 45-year-old man is brought to the emergency department because of severe abdominal pain for the past 2 hours. He has a 2-year history of burning epigastric pain that gets worse with meals. His pulse is 120/min, respirations are 22/min, and blood pressure is 60/40 mm Hg. Despite appropriate lifesaving measures, he dies. At autopsy, examination shows erosion of the right gastric artery. Perforation of an ulcer in which of the following locations most likely caused this patient's findings?? {'A': 'Anterior duodenum', 'B': 'Posterior duodenum', 'C': 'Fundus of the stomach', 'D': 'Greater curvature of the stomach', 'E': 'Lesser curvature of the stomach'},
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E: Lesser curvature of the stomach
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Q:A primigravida, 29-year-old woman presents in her 28th week of pregnancy for evaluation of 3 hours of vaginal bleeding and abdominal pain. She denies any trauma and states that this is the first time she has had such symptoms. Her prenatal care has been optimal and all of her antenatal screenings have been within normal limits. Her vital signs are unremarkable. Physical examination reveals a small amount of blood in the vaginal canal and the cervical os is closed. Ultrasound imaging demonstrates positive fetal cardiac activity. What is the most likely diagnosis?? {'A': 'Complete abortion', 'B': 'Incomplete abortion', 'C': 'Inevitable abortion', 'D': 'Missed abortion', 'E': 'Threatened abortion'},
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E: Threatened abortion
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Q:A 36-year-old man presents to his primary care physician because of shortness of breath. He is an office worker who has a mostly sedentary lifestyle; however, he has noticed that recently he feels tired and short of breath when going on long walks with his wife. He also has had a hacking cough that seems to linger, though he attributes this to an upper respiratory tract infection he had 2 months ago. He has diabetes that is well-controlled on metformin and has smoked 1 pack per day for 20 years. Physical exam reveals a large chested man with wheezing bilaterally and mild swelling in his legs and abdomen. The cause of this patient's abdominal and lower extremity swelling is most likely due to which of the following processes?? {'A': 'Damage to kidney tubules', 'B': 'Defective protein folding', 'C': 'Excessive protease activity', 'D': 'Hyperplasia of mucous glands', 'E': 'Smoking associated dysfunction'},
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B: Defective protein folding
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Q:A 42-year-old man with a history of gout and hypertension presents to his family physician with a complaint of increased left knee pain over the past 2 days. He also reports swelling and redness of the left knee and is unable to bear weight on that side. He denies any prior surgery or inciting trauma to the knee. His temperature is 97.0°F (36.1°C), blood pressure is 137/98 mm Hg, pulse is 80/min, respirations are 13/min, and oxygen saturation is 98% on room air. Physical examination reveals a left knee that is erythematous, swollen, warm-to-touch, and extremely tender to palpation and with attempted flexion/extension movement. His left knee range of motion is markedly reduced compared to the contralateral side. Joint aspiration of the left knee is performed with synovial fluid analysis showing turbid fluid with a leukocyte count of 95,000/mm^3, 88% neutrophils, and a low glucose. Gram stain of the synovial fluid is negative. Results from synovial fluid culture are pending. Which of the following is the best treatment regimen for this patient?? {'A': 'Acetaminophen and ibuprofen', 'B': 'Ceftriaxone', 'C': 'Indomethacin and colchicine', 'D': 'Piperacillin-tazobactam', 'E': 'Vancomycin and ceftazidime'},
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E: Vancomycin and ceftazidime
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Q:A 72-year-old male presents to a cardiac surgeon for evaluation of severe aortic stenosis. He has experienced worsening dyspnea with exertion over the past year. The patient also has a history of poorly controlled hypertension, diabetes mellitus, and hyperlipidemia. An echocardiogram revealed a thickened calcified aortic valve. The surgeon is worried that the patient will be a poor candidate for open heart surgery and decides to perform a less invasive transcatheter aortic valve replacement. In order to perform this procedure, the surgeon must first identify the femoral pulse just inferior to the inguinal ligament and insert a catheter into the vessel in order to gain access to the arterial system. Which of the following structures is immediately lateral to this structure?? {'A': 'Sartorius muscle', 'B': 'Femoral vein', 'C': 'Femoral nerve', 'D': 'Lymphatic vessels', 'E': 'Pectineus muscle'},
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C: Femoral nerve
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Q:A 26-year-old woman presents to the medicine clinic with swelling around the right side of her chin and neck (Image A). She reports pain when moving her jaw and chewing. Her symptoms developed two days after receiving an uncomplicated tonsillectomy. She has been followed by a general medical physician since birth and has received all of her standard health maintenance procedures. Vital signs are stable with the exception of a temperature of 38.4 degrees Celcius. The area in question on the right side is exquisitely tender. The remainder of his exam is benign. What is the most likely diagnosis?? {'A': 'Mumps', 'B': 'Pleomorphic adenoma', 'C': "Sjogren's syndrome", 'D': 'Acute bacterial parotitis', 'E': 'Superior vena cava syndrome'},
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D: Acute bacterial parotitis
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Q:A 72-year-old man is brought to the emergency department from hospice. The patient has been complaining of worsening pain over the past few days and states that it is no longer bearable. The patient has a past medical history of pancreatic cancer which is being managed in hospice. The patient desires no "heroic measures" to be made with regards to treatment and resuscitation. His temperature is 98.8°F (37.1°C), blood pressure is 107/68 mmHg, pulse is 102/min, respirations are 22/min, and oxygen saturation is 99% on room air. Physical exam reveals an uncomfortable elderly man who experiences severe pain upon abdominal palpation. Laboratory values reveal signs of renal failure, liver failure, and anemia. Which of the following is the best next step in management?? {'A': 'Morphine', 'B': 'Morphine and fentanyl patch', 'C': 'No intervention warranted', 'D': 'Ketorolac', 'E': 'Ketorolac and fentanyl'},
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B: Morphine and fentanyl patch
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Q:A 58-year-old woman comes to the physician for evaluation of vaginal dryness and pain during sexual intercourse with her husband. Four months ago, she was diagnosed with metastatic breast cancer and is currently undergoing chemotherapy. She has smoked one pack of cigarettes daily for 15 years but quit when she was diagnosed with breast cancer. Physical examination shows thinning of the vaginal mucosa. A dual-energy x-ray absorptiometry (DXA) study of her hip shows a T-score of -2.6. Six months ago, her T-score was -1.6. Which of the following drugs is most likely exacerbating this patient's symptoms?? {'A': 'Raloxifene', 'B': 'Palbociclib', 'C': 'Paclitaxel', 'D': 'Tamoxifen', 'E': 'Exemestane'},
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E: Exemestane
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Q:An investigator is studying physiologic renal responses to common medical conditions. She measures urine osmolalities in different parts of the nephron of a human subject in the emergency department. The following values are obtained: Portion of nephron Osmolality (mOsmol/kg) Proximal convoluted tubule 300 Loop of Henle, descending limb 1200 Loop of Henle, ascending limb 250 Distal convoluted tubule 100 Collecting duct 1200 These values were most likely obtained from an individual with which of the following condition?"? {'A': 'Gitelman syndrome', 'B': 'Dehydration', 'C': 'Psychogenic polydipsia', 'D': 'Furosemide overdose', 'E': 'Diabetes insipidus'},
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B: Dehydration
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Q:A 76-year-old woman presents to the primary care physician for a regular check-up. History reveals that she has had episodes of mild urinary incontinence over the past 2 years precipitated by sneezing or laughing. However, over the past week, her urinary incontinence has occurred during regular activities. Her blood pressure is 140/90 mm Hg, heart rate is 86/min, respiratory rate is 22/min, and temperature is 37.7°C (99.9°F). Physical examination is remarkable for suprapubic tenderness. Urinalysis reveals 15 WBCs/HPF, positive nitrites, and positive leukocyte esterase. Which of the following is the best next step for this patient?? {'A': 'Ultrasound scan of the kidneys, urinary tract, and bladder', 'B': 'Cystoscopy', 'C': 'Urine culture', 'D': 'Pelvic floor muscle training', 'E': 'Reassurance'},
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C: Urine culture
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Q:A 76-year-old man is admitted to the hospital for evaluation of sudden-onset chest pain. Three days after admission, he develops severe shortness of breath. Despite appropriate care, the patient dies. The heart at autopsy is shown. Which of the following most likely contributed to this patient's cause of death?? {'A': 'Occlusion of the posterior descending artery', 'B': 'Exudative inflammation of the pericardium', 'C': 'Pseudoaneurysmatic dilation of the left ventricle', 'D': 'Rupture of the interventricular septum', 'E': 'Bacterial infection of the mitral valve endocardium'},
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A: Occlusion of the posterior descending artery
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Q:A 42-year-old woman comes to the physician with a rash on the dorsal surfaces of her hands and feet for the past month. The rash began as blisters that developed a few days after she had been sunbathing on the beach. Photographs of the rash are shown. She has no history of similar symptoms, takes no medications, and has no history of recent travels. She has consumed excess alcohol several times over the past 2 months. Her temperature is 37.1°C (98.8°F). The remainder of the physical examination shows no abnormalities. Laboratory studies show elevated plasma porphyrins, with normal urinary 5-aminolevulinic acid and porphobilinogen. Which of the following is the most appropriate next step in management?? {'A': 'Afamelanotide', 'B': 'Carbohydrate loading', 'C': 'Intravenous hemin', 'D': 'Phlebotomy', 'E': 'Splenectomy'},
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D: Phlebotomy
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Q:A 31-year old man presents to the emergency department for blood in his stool. The patient states that he saw a small amount of bright red blood on his stool and on the toilet paper this morning, which prompted his presentation to the emergency department. The patient denies any changes in his bowel habits or in his weight. The patient has a past medical history of asthma managed with albuterol and fluticasone. The patient has a family history of alcoholism in his father and suicide in his mother. His temperature is 97°F (36.1°C), blood pressure is 120/77 mmHg, pulse is 60/min, respirations are 12/min, and oxygen saturation is 98% on room air. On physical exam, the patient has a cardiac and pulmonary exam that are within normal limits. On abdominal exam, there is no tenderness or guarding and normal bowel sounds. Laboratory values are ordered and return as below. Hemoglobin: 15 g/dL Hematocrit: 42% Leukocyte count: 4,500 cells/mm^3 with normal differential Platelet count: 230,000/mm^3 Serum: Na+: 139 mEq/L Cl-: 100 mEq/L K+: 4.3 mEq/L HCO3-: 24 mEq/L BUN: 20 mg/dL Glucose: 92 mg/dL Creatinine: 1.0 mg/dL Ca2+: 9.9 mg/dL Which of the following is the next best step in management?? {'A': 'Anoscopy', 'B': 'Colonoscopy', 'C': 'CT scan', 'D': 'Mesalamine enema', 'E': 'Stool culture and analysis for red blood cells and leukocytes'},
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A: Anoscopy
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Q:A 40-year-old woman comes to the physician with a 5-day history of mild shortness of breath with exertion. She has also had a cough for 5 days that became productive of whitish non-bloody sputum 3 days ago. Initially, she had a runny nose, mild headaches, and diffuse muscle aches. She has not had fevers or chills. Three weeks ago, her 9-year-old son had a febrile illness with a cough and an exanthematous rash that resolved without treatment 1 week later. The patient has occasional migraine headaches. Her sister was diagnosed with antiphospholipid syndrome 12 years ago. The patient does not smoke; she drinks 3–4 glasses of wine per week. Her current medications include zolmitriptan as needed. Her temperature is 37.1°C (99°F), pulse is 84/min, respirations are 17/min, and blood pressure is 135/82 mm Hg. Scattered wheezes are heard at both lung bases. There are no rales. Egophony is negative. Which of the following is the most appropriate next step in management?? {'A': 'Supportive treatment only', 'B': 'Obtain D-dimer', 'C': 'Perform Bordetella pertussis PCR', 'D': 'Conduct a high-resolution chest CT', 'E': 'Administer clarithromycin'},
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A: Supportive treatment only
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Q:A 42-year-old woman comes to the physician because of episodic abdominal pain and fullness for 1 month. She works as an assistant at an animal shelter and helps to feed and bathe the animals. Physical examination shows hepatomegaly. Abdominal ultrasound shows a 4-cm calcified cyst with several daughter cysts in the liver. She undergoes CT-guided percutaneous aspiration under general anesthesia. Several minutes into the procedure, one liver cyst spills, and the patient's oxygen saturation decreases from 95% to 64%. Her pulse is 136/min, and blood pressure is 86/58 mm Hg. Which of the following is the most likely causal organism of this patient's condition?? {'A': 'Strongyloides stercoralis', 'B': 'Trichinella spiralis', 'C': 'Schistosoma mansoni', 'D': 'Clonorchis sinensis', 'E': 'Echinococcus granulosus'},
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E: Echinococcus granulosus
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Q:One day after giving birth to a 4050-g (8-lb 15-oz) male newborn, a 22-year-old woman experiences involuntary loss of urine. The urine loss occurs intermittently in the absence of an urge to urinate. It is not exacerbated by sneezing or coughing. Pregnancy was uncomplicated except for two urinary tract infections that were treated with nitrofurantoin. Delivery was complicated by prolonged labor and severe labor pains; the patient received epidural analgesia. Her temperature is 36.2°C (97.2°F), pulse is 70/min, and blood pressure is 118/70 mm Hg. The abdomen is distended and tender to deep palpation. Pelvic examination shows a uterus that extends to the umbilicus; there is copious thick, whitish-red vaginal discharge. Neurologic examination shows no abnormalities. Which of the following is the most likely cause of this patient's urinary incontinence?? {'A': 'Prolonged labor', 'B': 'Current urinary tract infection', 'C': 'Damage to nerve fibers', 'D': 'Recurrent urinary tract infections', 'E': 'Inadequate intermittent catheterization'},
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E: Inadequate intermittent catheterization
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Q:A 62-year-old man comes to the physician because of easy bruising and recurrent nosebleeds over the past 4 months. During the same time period, the patient has felt weak and has had a 10-kg (22-lb) weight loss. Physical examination shows mucosal pallor and bruising on the upper and lower extremities in various stages of healing. The spleen is palpated 4 cm below the left costal margin. Laboratory studies show anemia and thrombocytopenia. A photomicrograph of a peripheral blood smear is shown. Histologic examination of a bone marrow biopsy in this patient is most likely to show which of the following findings?? {'A': 'Neoplastic granulocytes with low leukocyte alkaline phosphatase score', 'B': 'Neoplastic lymphocytes that stain positive for tartrate-resistant acid phosphatase', 'C': 'Neoplastic myeloid cells that stain positive for myeloperoxidase', 'D': 'Dysplastic erythroid cells that stain positive for iron', 'E': 'Neoplastic lymphoid cells that stain positive for terminal deoxynucleotidyl transferase activity'},
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B: Neoplastic lymphocytes that stain positive for tartrate-resistant acid phosphatase
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Q:A new mother brings in her 2-week-old son because of a painful itchy rash on his trunk. Vital signs are within normal limits. A basic chemistry panel reveal sodium 135 mmol/L, potassium 4.1 mmol/L, chloride 107 mmol/L, carbon dioxide 22, blood urea nitrogen 30 mg/dL, creatinine 1.1 mg/dL, and glucose 108 mg/dL. On physical examination of the newborn, there are confluent erythematous patches with tiny vesicles and scaling. His mother notes that she has been bathing the patient twice a day. Which of the following is the most likely diagnosis?? {'A': 'Impetigo', 'B': 'Atopic dermatitis', 'C': 'Eczema herpeticum', 'D': 'Staphylococcal scalded skin syndrome', 'E': 'Seborrheic dermatitis'},
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B: Atopic dermatitis
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Q:Three days after being admitted to the hospital for an appendectomy, a 69-year-old woman develops cough and dyspnea. The cough is productive of small amounts of green sputum. Her temperature is 39.0°C (102.2°F), pulse is 107/min, respirations are 31/min, and blood pressure is 89/68 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 87%. Pulmonary examination shows diffuse crackles and rhonchi. An X-ray of the chest shows a left upper-lobe infiltrate of the lung. Two sets of blood cultures are obtained. While waiting for the results of the blood cultures, which of the following is the most appropriate pharmacotherapy?? {'A': 'Amoxicillin-clavulanate and clarithromycin', 'B': 'Azithromycin and ceftriaxone', 'C': 'Cefepime and vancomycin', 'D': 'Colistin', 'E': 'Ertapenem and gentamicin'},
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C: Cefepime and vancomycin
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Q:A 55-year-old woman seeks evaluation of difficult and incomplete voiding and spontaneous urine leakage that occurs continuously during the day and night. The symptoms are not associated with physical exertion. She denies any urethral or vaginal discharge. She is menopausal and does not take hormone replacement therapy. At 33 years of age, she had a right salpingectomy as treatment for an ectopic pregnancy. She has a 2-year history of a major depressive disorder and takes amitriptyline (100 mg before the bedtime). She was also diagnosed 5 years ago with arterial hypertension, which is controlled with enalapril (20 mg daily) and metoprolol (50 mg daily). The weight is 71 kg (156.5 lb) and the height is 155 cm (5 ft). The vital signs are as follows: blood pressure 135/80 mm Hg, heart rate 67/min, respiratory rate 13/min, and temperature 36.4℃ (97.5℉). The physical examination is significant for a palpable urinary bladder. The neurologic examination is within normal limits. The gynecologic examination shows grade 1 uterine prolapse. Which of the following is the most probable cause of the patient’s symptoms?? {'A': 'Blockage of β-adrenoreceptors', 'B': 'Urethral hypermobility', 'C': 'Blockage of M-cholinoreceptors', 'D': 'Activation of α1-adrenoceptors', 'E': 'Urethral strictures'},
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C: Blockage of M-cholinoreceptors
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Q:A 3200-g (7.1-lb) female newborn is delivered at 38 weeks' gestation to a 24-year-old woman. The mother had regular prenatal visits throughout the pregnancy. The newborn's blood pressure is 53/35 mm Hg. Examination in the delivery room shows clitoromegaly and posterior labial fusion. One day later, serum studies show: Na+ 131 mEq/L K+ 5.4 mEq/L Cl− 102 mEq/L Urea nitrogen 15 mg/dL Creatinine 0.8 mg/dL Ultrasound of the abdomen and pelvis shows a normal uterus and ovaries. Further evaluation of the newborn is most likely to show which of the following findings?"? {'A': 'Decreased dehydroepiandrosterone', 'B': 'Increased 17-hydroxyprogesterone', 'C': 'Increased 11-deoxycorticosterone', 'D': 'Increased corticosterone', 'E': 'Decreased renin activity'},
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B: Increased 17-hydroxyprogesterone
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Q:A 62-year-old man seeks evaluation at a local walk-in clinic for mid-low back pain of several weeks. He has tried different rehabilitation therapies and medications with no improvement. He was prescribed some pain medications and sent home last week, but the patient presents today with difficulty walking and worsening of his back pain. He was referred to the ER, where he was examined and found to have hypoesthesia from T12 to S4–S5, significant muscle weakness in both lower limbs, and reduced knee and ankle deep tendon reflexes. A hypotonic anal sphincter with conserved deep anal pressure was demonstrated on digital rectal examination, as well as a multinodular, asymmetric prostate. Imaging studies showed multiple sclerotic bone lesions along the spine. Subsequently, a prostate core biopsy was obtained which confirmed the diagnosis of prostate cancer. Which of the following characteristics would you expect in the specimen?? {'A': 'Prostatic intraepithelial neoplasia', 'B': 'Well-formed glands with an increase in interglandular stroma', 'C': 'Perineural invasion', 'D': 'Fat invasion', 'E': 'Small, closely-packed, well-formed glands'},
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C: Perineural invasion
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Q:A 27-year-old G1P0 at 12 weeks gestation presents to her obstetrician for her first prenatal visit. She and her husband both have achondroplasia, and she is curious what are the chances that they will have a child of average height. What percent of pregnancies between two individuals with achondroplasia that result in a live birth will be expected to be offspring that are unaffected by this condition?? {'A': '25%', 'B': '33%', 'C': '50%', 'D': '75%', 'E': '0%'},
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B: 33%
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Q:A 21-year-old woman has frequent sexual fantasies about female coworkers. When she is with her friends in public, she never misses an opportunity to make derogatory comments about same-sex couples she sees. Which of the following psychological defense mechanisms is she demonstrating?? {'A': 'Reaction formation', 'B': 'Acting out', 'C': 'Sublimation', 'D': 'Sexualization', 'E': 'Intellectualization\n"'},
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A: Reaction formation
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Q:A 35-year-old woman presents to the emergency department for evaluation of severe central chest pain of 2 hours. She says the pain is heavy in nature and radiates to her jaw. She has no relevant past medical history. The vital signs and physical examination are non-contributory. Echocardiography is performed. Mitral valve leaflet thickening is observed with several masses attached to both sides. The coronary arteries appear normal on coronary angiography. Which of the following is most likely associated with this patient’s condition?? {'A': 'Churg-Strauss syndrome', 'B': 'Dermatomyositis', 'C': 'Fibromyalgia', 'D': 'Systemic lupus erythematosus', 'E': 'Temporal arteritis'},
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D: Systemic lupus erythematosus
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Q:A 32-year-old man comes to the physician because of a 1-week history of fever, weakness, diffuse abdominal pain, and multiple lumps on his body. He has recently returned to the USA from a 3-month agricultural internship in South America. Physical examination shows enlarged superficial cervical and inguinal lymph nodes. There is tender hepatomegaly. A photomicrograph of a liver biopsy sample after methenamine silver staining is shown. Which of the following is the most likely diagnosis?? {'A': 'Histoplasmosis', 'B': 'Blastomycosis', 'C': 'Malaria', 'D': 'Paracoccidioidomycosis', 'E': 'Aspergillosis'},
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D: Paracoccidioidomycosis
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Q:A 40-year-old Caucasian male presents to the emergency room after being shot in the arm in a hunting accident. His shirt is soaked through with blood. He has a blood pressure of 65/40, a heart rate of 122, and his skin is pale, cool to the touch, and moist. This patient is most likely experiencing all of the following EXCEPT:? {'A': 'Confusion and irritability', 'B': 'Decreased preload', 'C': 'Increased stroke volume', 'D': 'Decreased sarcomere length in the myocardium', 'E': 'Increased thromboxane A2'},
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C: Increased stroke volume
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Q:A 22-year-old woman presents to her physician with an increased vaginal discharge. She has no other complaints. She has recently changed her sexual partner, who claims to have no genitourinary symptoms. They do not use condoms. Her vital signs are as follows: blood pressure, 110/80 mm Hg; heart rate, 65/min; respiratory rate, 11/min; and temperature, 36.6℃ (97.9℉). Her physical examination is unremarkable. The gynecologic examination shows increased production of a white-yellow vaginal discharge. Wet mount microscopy shows the below picture. Which of the following treatments is indicated in this patient?? {'A': 'Peroral metronidazole', 'B': 'Vaginal clindamycin gel', 'C': 'Peroral cephalexin', 'D': 'No treatment required in the patient with minor symptoms', 'E': 'Vaginal probiotics'},
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A: Peroral metronidazole
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Q:A 50-year-old man comes to the physician for the evaluation of recurrent episodes of chest pain, difficulty breathing, and rapid heart beating over the past two months. During this period, he has had a 4-kg (8.8-lb) weight loss, malaise, pain in both knees, and diffuse muscle pain. Five years ago, he was diagnosed with chronic hepatitis B infection and was started on tenofovir. His temperature is 38°C (100.4°F), pulse is 110/min, and blood pressure is 150/90 mm Hg. Cardiopulmonary examination shows no abnormalities except for tachycardia. There are several ulcerations around the ankle and calves bilaterally. Laboratory studies show: Hemoglobin 11 g/dL Leukocyte count 14,000/mm3 Erythrocyte sedimentation rate 80 mm/h Serum Perinuclear anti-neutrophil cytoplasmic antibodies negative Hepatitis B surface antigen positive Urine Protein +2 RBC 6-7/hpf Which of the following is the most likely diagnosis?"? {'A': 'Takayasu arteritis', 'B': 'Giant cell arteritis', 'C': 'Polyarteritis nodosa', 'D': 'Thromboangiitis obliterans', 'E': 'Granulomatosis with polyangiitis'},
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C: Polyarteritis nodosa
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Answer the following medical question with one of the provided options:
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Q:A 42-year-old man who is employed as a construction worker presents to his primary care physician with complaints of moderate headaches and profuse sweating. He reports the need to carry up to 3 additional shirt changes to work because they drench quickly even with tasks of low physical exertion. His coworkers have commented about his changing glove and boot sizes, which have increased at least 4 times since he joined the company 10 years ago. Physical examination is unremarkable except for blood pressure of 160/95 mm Hg, hyperhidrosis, noticeably large pores, hypertrichosis, widely spaced teeth, and prognathism. Which of the following best explains the patient’s clinical manifestations?? {'A': 'Increased serum metanephrines', 'B': 'Increased serum insulin-like growth factor 1 (IGF-1)', 'C': 'Increased serum cortisol', 'D': 'Increased thyroid-stimulating hormone', 'E': 'Increased serum testosterone'},
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B: Increased serum insulin-like growth factor 1 (IGF-1)
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Q:A 37-year-old man with a history of IV drug use presents to the ED with complaints of fevers, chills, and malaise for one week. He admits to recently using IV and intramuscular heroin. Vital signs are as follows: T 40.0 C, HR 120 bpm, BP 110/68 mmHg, RR 14, O2Sat 98%. Examination reveals a new systolic murmur that is loudest at the lower left sternal border. Initial management includes administration of which of the following regimens?? {'A': 'IV Vancomycin', 'B': 'IV Vancomycin, IV levofloxacin', 'C': 'IV Vancomycin, IV ceftriaxone', 'D': 'IV Vancomycin, IV gentamycin, PO rifampin', 'E': 'IV Vancomycin, IV ceftriaxone, IV fluconazole'},
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C: IV Vancomycin, IV ceftriaxone
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Q:An ECG from an 8-year-old male with neurosensory deafness and a family history of sudden cardiac arrest demonstrates QT-interval prolongation. Which of the following is this patient most at risk of developing?? {'A': 'Hypertrophic cardiac myopathy', 'B': 'Essential hypertension', 'C': 'Cardiac tamponade', 'D': 'Torsades de pointes', 'E': 'First degree atrioventricular block'},
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D: Torsades de pointes
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Q:A 50-year-old man presents to his primary care physician for management of a lung nodule. The nodule was discovered incidentally when a chest radiograph was performed to rule out pneumonia. The nodule is 8.5 mm in size and was confirmed by CT. The patient is otherwise healthy, has never smoked, and exercises regularly. The patient works in a dairy factory. He has had no symptoms during this time. His temperature is 97.6°F (36.4°C), blood pressure is 122/81 mmHg, pulse is 83/min, respirations are 12/min, and oxygen saturation is 98% on room air. Physical exam including auscultation of the lungs is unremarkable. Which of the following is the most appropriate next step in management?? {'A': 'Biopsy and lymph node dissection', 'B': 'CT scan in 6 months', 'C': 'No further workup indicated', 'D': 'PET scan', 'E': 'Surgical excision'},
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D: PET scan
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Q:A 32-year-old man is brought to the emergency department after a car accident; he was extricated after 4 hours. He did not lose consciousness and does not have headache or nausea. He is in severe pain. He sustained severe injuries to both arms and the trauma team determines that surgical intervention is needed. Urinary catheterization shows dark colored urine. His temperature is 38°C (100.4°F), pulse is 110/min, and blood pressure is 90/60 mm Hg. The patient is alert and oriented. Examination shows multiple injuries to the upper extremities, contusions on the trunk, and abdominal tenderness. Laboratory studies show: Hemoglobin 9.2 g/dL Leukocyte count 10,900/mm3 Platelet count 310,000/mm3 Serum Na+ 137 mEq/L K+ 6.8 mEq/L Cl- 97 mEq/L Glucose 168 mg/dL Creatinine 1.7 mg/dL Calcium 7.7 mg/dL Arterial blood gas analysis on room air shows a pH of 7.30 and a serum bicarbonate of 14 mEq/L. An ECG shows peaked T waves. A FAST scan of the abdomen is negative. Two large bore cannulas are inserted and intravenous fluids are administered. Which of the following is the most appropriate next step in management?"? {'A': 'Intravenous calcium gluconate', 'B': 'Intravenous mannitol', 'C': 'Intravenous sodium bicarbonate', 'D': 'Intravenous insulin', 'E': 'Packed red blood cell transfusion'},
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A: Intravenous calcium gluconate
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Q:A 42-year-old man is brought to the emergency room because of confusion. His wife says he has been urinating more frequently than usual for the past 3 days. He has not had fever or dysuria. He has bipolar disorder, for which he takes lithium. His pulse is 105/min, and respirations are 14/min. He is lethargic and oriented only to person. Physical examination shows dry mucous membranes and increased capillary refill time. Laboratory studies show a serum sodium concentration of 158 mEq/L and an antidiuretic hormone (ADH) concentration of 8 pg/mL (N = 1–5). Which of the following is the most likely site of dysfunction in this patient?? {'A': 'Posterior pituitary gland', 'B': 'Hypothalamic supraoptic nucleus', 'C': 'Descending loop of Henle', 'D': 'Collecting duct', 'E': 'Juxtaglomerular apparatus'},
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D: Collecting duct
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Q:Two studies are reviewed for submission to an oncology journal. In Sudy A, a novel MRI technology is evaluated as a screening tool for ovarian cancer. The authors find that the mean survival time is 4 years in the control group and 10 years in the MRI-screened group. In Study B, cognitive behavioral therapy (CBT) and a novel antidepressant are used to treat patients with comorbid pancreatic cancer and major depression. Patients receiving the new drug are told that they are expected to have quick resolution of their depression, while those who do not receive the drug are not told anything about their prognosis. Which of the following describes the likely type of bias in Study A and Study B?? {'A': 'Lead time bias; Pygmalion effect', 'B': 'Lead time bias; Golem effect', 'C': 'Latency bias; Pygmalion effect', 'D': 'Latency Bias; Golem effect', 'E': 'Confounding; Golem effect'},
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A: Lead time bias; Pygmalion effect
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Q:An epidemiologist is interested in studying the clinical utility of a free computerized social skills training program for children with autism. A total of 125 participants with autism (mean age: 12 years) were recruited for the study and took part in weekly social skills training sessions for 3 months. Participants were recruited from support groups in a large Northeastern US city for parents with autistic children. Parents in the support group were very eager to volunteer for the study, and over 300 children were placed on a waiting list while the study was conducted. At baseline and at the end of the 3-month period, participants were observed during a videotaped social play exercise and scored on a social interaction rating scale by their parents. Social interaction rating scores following the 3-month intervention were more than twice as high as baseline scores (p < 0.001). During exit interviews, one parent commented, ""I knew from the start that this program was going to be life-changing for my son!"" This sentiment was echoed by a number of other parents. Which of the following is the most likely explanations for the study's result?"? {'A': 'Social desirability bias', 'B': 'Recall bias', 'C': 'Observer bias', 'D': 'Sampling bias', 'E': 'Confounding bias'},
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C: Observer bias
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Q:A 52-year-old man presents to the office for a diabetes follow-up visit. He currently controls his diabetes through lifestyle modification only. He monitors his blood glucose at home with a glucometer every day. He gives the doctor a list of his most recent early morning fasting glucose readings from the past 8 days which are: 128 mg/dL, 130 mg/dL, 132 mg/dL, 125 mg/dL, 134 mg/dL, 127 mg/dL, 128 mg/dL, and 136 mg/dL. Which of the following values is the median of this data set?? {'A': '128 mg/dL', 'B': '127 mg/dL', 'C': '129 mg/dL', 'D': '132 mg/dL', 'E': '130 mg/dL'},
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C: 129 mg/dL
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Q:A 67-year-old man presents to his primary care physician because of weak urine stream, and increasing difficulty in initiating and stopping urination. He also reports of mild generalized body aches and weakness during the day. The past medical history includes diabetes mellitus type 2 for 35 years and essential hypertension for 19 years. The medication list includes metformin, vildagliptin, and enalapril. The vital signs include: temperature 36.7°C (98.1°F), blood pressure 151/82 mm Hg, and pulse 88/min. The physical examination is remarkable for markedly enlarged, firm prostate without nodules. The laboratory test results are as follows: Serum sodium 142 mEq/L Serum potassium 5.7 mEq/L Serum chloride 115 mEq/L Serum bicarbonate 17 mEq/L Serum creatinine 0.9 mg/dL Arterial pH 7.31 Urine pH 5.3 Urine sodium 59 mEq/L Urine potassium 6.2 mEq/L Urine chloride 65 mEq/L Which of the following most likely explains the patient’s findings?? {'A': 'Type 1 renal tubular acidosis', 'B': 'Type 4 renal tubular acidosis', 'C': 'Type 2 renal tubular acidosis', 'D': 'Fanconi syndrome', 'E': 'End-stage renal disease'},
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B: Type 4 renal tubular acidosis
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Q:A 55-year-old man presents to the family medicine clinic after noticing a gradually enlarging smooth and symmetrical bump on his left forearm at the site of his PPD placement 2 days ago. The patient takes lisinopril for hypertension and metformin for diabetes mellitus type 2. He was screened for tuberculosis 2 days ago as a requirement for work. He works as a guard at the county prison. He smokes a half-pack of cigarettes per day and has done so for the last 5 years. His heart rate is 88/min, respiratory rate is 16/min, temperature is 37.3°C (99.2°F), and blood pressure is 142/86 mm Hg. The patient appears clean and overweight. The bleb from the screening test is measured at 12 mm. Acid-fast smear of a sputum sample is negative. Which of the following is recommended for the patient at this time?? {'A': 'Rifampin, isoniazid, pyrazinamide, ethambutol', 'B': 'Isoniazid for 6 months', 'C': 'No treatment', 'D': 'Isoniazid for 9 months', 'E': 'Isoniazid for 3 months'},
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D: Isoniazid for 9 months
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Answer the following medical question with one of the provided options:
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Q:A 20-year-old male is involuntarily admitted to the county psychiatric unit for psychotic behavior over the past three months. The patient's mother explained to the psychiatrist that her son had withdrawn from family and friends, appeared to have no emotions, and had delusions that he was working for the CIA. When he spoke, his sentences did not always seem to have any connection with each other. The mother finally decided to admit her son after he began stating that he "revealed too much information to her and was going to be eliminated by the CIA." Which of the following diagnoses best fits this patient's presentation?? {'A': 'Brief psychotic disorder', 'B': 'Schizophreniform disorder', 'C': 'Schizophrenia', 'D': 'Schizoid personality disorder', 'E': 'Schizotypal peronsality disorder'},
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B: Schizophreniform disorder
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Answer the following medical question with one of the provided options:
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Q:A 21-year-old female is brought by her brother to the emergency department after having a generalized tonic-clonic seizure one hour ago. She is slightly confused and has no recollection of her seizure. Her brother relayed that the patient has a history of severe anxiety for which she takes medication. For the past several days, he noticed that his sister exhibited body tremors, appeared to be agitated with quick mood changes, and, at times, was delirious. He states his sister recently ran out of her medications while visiting from out of town. Which of the following would best treat the patient's condition?? {'A': 'Diazepam', 'B': 'Methadone', 'C': 'Naloxone', 'D': 'Varenicline', 'E': 'Flumazenil'},
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A: Diazepam
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Q:A 2-year-old girl is brought to the emergency department by her mother after an episode of turning blue on the playground. The mother states that the girl starting crying, and her fingers and hands turned blue. On examination, the patient is playful and in no apparent distress. She is afebrile and the vital signs are stable. The lungs are clear to auscultation bilaterally with no evidence of respiratory distress. There is a fixed, split S2 heart sound on cardiac exam without the presence of a S3 or S4. The peripheral pulses are equal bilaterally. What is the underlying cause of this patient’s presentation?? {'A': 'Patent foramen ovale', 'B': 'Lithium use by mother during the first trimester', 'C': 'Failure of the ductus arteriosus to regress', 'D': 'Failure of the aorticopulmonary septum to spiral', 'E': 'Failed formation of the septum secundum'},
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E: Failed formation of the septum secundum
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Q:A 12-year-old girl is brought to the physician by her mother because she has been waking up multiple times at night to go to the bathroom even though she avoids drinking large amounts of water close to bedtime. She has no significant medical history apart from 3 episodes of lower urinary tract infections treated with nitrofurantoin in the past 2 years. Her family emigrated from Nigeria 10 years ago. Physical examination shows no abnormalities. Laboratory studies show: Hemoglobin 14.2 g/dL MCV 92 fL Reticulocytes 1.5% Serum Osmolality 290 mOsmol/kg H2O Urine Leukocytes negative Nitrite negative Glucose negative Osmolality 130 mOsmol/kg H2O Hemoglobin electrophoresis shows: HbA 56% HbS 43% HbF 1% This patient is at greatest risk for which of the following conditions?"? {'A': 'Necrosis of the renal papillae', 'B': 'Pigment stones in the biliary tract', 'C': 'Autoinfarction of the spleen', 'D': 'Sickling in the cerebral vessels', 'E': 'Transient arrest of erythropoiesis'},
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A: Necrosis of the renal papillae
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Q:A 17-year-old girl comes to the urgent care center after testing negative for HIV. She recently had sexual intercourse for the first time and had used a condom with her long-term boyfriend. She has no personal history of serious illness and no history of sexually transmitted infections. However, the patient is still worried about the possibility she has HIV despite the negative HIV test. She states that the package insert of the HIV test shows that of 100 patients who are found to be HIV-positive on PCR, 91 tested positive via the HIV test. Later in the day, a 23-year-old woman with a history of genitourinary chlamydia infection also comes to the urgent care center after testing negative for HIV. She states that she recently had unprotected intercourse with “someone who might have HIV.” If the test is conducted a second time on the 23-year-old patient, how will its performance compare to a second test conducted on the 17-year-old patient?? {'A': 'Increased sensitivity', 'B': 'Increased validity', 'C': 'Increased specificity', 'D': 'Decreased positive predictive value', 'E': 'Decreased negative predictive value'},
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E: Decreased negative predictive value
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Answer the following medical question with one of the provided options:
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Q:A 42-year-old man presents to a free dermatology clinic, complaining of itchy skin over the past several days. He has no insurance and lives in a homeless shelter. The patient has no significant medical history. Physical evaluation reveals 2 mm erythematous papules and vesicles on his back and groin, with linear excoriation marks. Careful observation of his hands reveals serpiginous, grayish, threadlike elevations in the superficial epidermis, ranging from 3–9 mm in length in the webbing between several digits. What should be the suggested treatment in this case?? {'A': 'No medication should be administered, only proper hygiene.', 'B': 'Antiviral medication', 'C': 'Permethrin', 'D': 'Antifungal medication', 'E': 'Broad-spectrum antibiotic'},
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C: Permethrin
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Q:A 60-year-old man comes to the physician because of a 1-week history of lower back pain. He has had several episodes of painless hematuria over the past 2 months. Physical examination shows localized tenderness over the lumbar spine. A CT scan shows multiple osteolytic lesions in the body of the lumbar vertebrae. Cystoscopy shows a 4-cm mass in the right lateral wall of the bladder. A photomicrograph of a biopsy specimen is shown. Which of the following is the strongest risk factor for this patient's condition?? {'A': 'Alcohol consumption', 'B': 'Cigarette smoking', 'C': 'Schistosoma infection', 'D': 'Vinyl chloride exposure', 'E': 'Nitrosamine ingestion'},
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B: Cigarette smoking
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Q:Eight hours after undergoing an open right hemicolectomy and a colostomy for colon cancer, a 52-year-old man has wet and bloody surgical dressings. He has had episodes of blood in his stools during the past 6 months, which led to the detection of colon cancer. He has hypertension and ischemic heart disease. His younger brother died of a bleeding disorder at the age of 16. The patient has smoked one pack of cigarettes daily for 36 years and drinks three to four beers daily. Prior to admission, his medications included aspirin, metoprolol, enalapril, and simvastatin. Aspirin was stopped 7 days prior to the scheduled surgery. He appears uncomfortable. His temperature is 36°C (96.8°F), pulse is 98/min, respirations are 14/min, and blood pressure is 118/72 mm Hg. Examination shows a soft abdomen with a 14-cm midline incision that has severe oozing of blood from its margins. The colostomy bag has some blood collected within. Laboratory studies show: Hemoglobin 12.3 g/dL Leukocyte count 11,200/mm3 Platelet count 210,000/mm3 Bleeding time 4 minutes Prothrombin time 15 seconds (INR=1.1) Activated partial thromboplastin time 36 seconds Serum Urea nitrogen 30 mg/dL Glucose 96 mg/dL Creatinine 1.1 mg/dL AST 48 U/L ALT 34 U/L γ-Glutamyltransferase 70 U/L (N= 5–50 U/L) Which of the following is the most likely cause of this patient's bleeding?"? {'A': 'Liver dysfunction', 'B': 'Platelet dysfunction', 'C': 'Factor VIII deficiency', 'D': 'Insufficient mechanical hemostasis', 'E': 'Erosion of blood vessels'},
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D: Insufficient mechanical hemostasis
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Answer the following medical question with one of the provided options:
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Q:A 12-year-old boy follows up with his primary care physician for ongoing management of a urinary tract infection. He recently started middle school and has been having a difficult time navigating the school since he ambulates with leg braces and crutches. Consequently, he has not had sufficient time to use his urinary catheter appropriately. Otherwise, he has been unchanged from the previous visit with both sensory and motor defects in his lower extremities. He has had these defects since birth and has undergone surgeries to repair a bony defect in his spine with protrusion of a membrane through the defect. During what days of embryonic development did the defect responsible for this patient's symptoms most likely occur?? {'A': 'Days 0-7', 'B': 'Days 8-20', 'C': 'Days 21-35', 'D': 'Days 36-90', 'E': 'Days 90-birth'},
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C: Days 21-35
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Answer the following medical question with one of the provided options:
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Q:A 62-year-old man is brought to the emergency department after his wife found him unresponsive 1 hour ago. He had fallen from a flight of stairs the previous evening. Four years ago, he underwent a mitral valve replacement. He has hypertension and coronary artery disease. Current medications include aspirin, warfarin, enalapril, metoprolol, and atorvastatin. On arrival, he is unconscious. His temperature is 37.3°C (99.1°F), pulse is 59/min, respirations are 7/min and irregular, and blood pressure is 200/102 mm Hg. The right pupil is 5 mm and fixed. The left pupil is 4 mm and reactive to light. There is extension of the extremities to painful stimuli. The lungs are clear to auscultation. Cardiac examination shows a systolic click. The abdomen is soft and nontender. He is intubated and mechanically ventilated. A mannitol infusion is begun. A noncontrast CT scan of the brain shows a 6-cm subdural hematoma on the right side with an 18-mm midline shift. Which of the following is the most likely early sequela of this patient's current condition?? {'A': 'Right eye esotropia and elevation', 'B': 'Bilateral lower limb paralysis', 'C': 'Left-side facial nerve palsy', 'D': 'Multifocal myoclonus', 'E': 'Right-sided hemiplegia'},
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E: Right-sided hemiplegia
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Answer the following medical question with one of the provided options:
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Q:A 51-year-old man presents to his physician with increased thirst, frequent urination, and fatigue. These symptoms have increased gradually over the past 3 years. He has no past medical history or current medications. Also, he has no family history of endocrinological or cardiovascular diseases. The blood pressure is 140/90 mm Hg, and the heart rate is 71/min. The patient is afebrile. The BMI is 35.4 kg/m2. On physical examination, there is an increased adipose tissue over the back of the neck, and hyperpigmentation of the axilla and inguinal folds. Which of the following laboratory results is diagnostic of this patient’s most likely condition?? {'A': 'HbA1c 5.9%', 'B': 'Fasting plasma glucose 123 mg/dL', 'C': 'Plasma glucose of 209 mg/dL 2 hours after the oral glucose load', 'D': 'Random plasma glucose 167 mg/dL', 'E': 'Serum insulin level of 10 μU/mL'},
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C: Plasma glucose of 209 mg/dL 2 hours after the oral glucose load
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Answer the following medical question with one of the provided options:
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Q:A 35-year-old man presents to his primary care physician for a routine visit. He is in good health but has a 15 pack-year smoking history. He has tried to quit multiple times and expresses frustration in his inability to do so. He states that he has a 6-year-old son that was recently diagnosed with asthma and that he is ready to quit smoking. What is the most effective method of smoking cessation?? {'A': "Quitting 'cold-turkey'", 'B': 'Bupropion in conjunction with nicotine replacement therapy and cognitive behavioral therapy', 'C': 'Buproprion alone', 'D': 'Participating in a smoking-cessation support group', 'E': 'Nicotine replacement therapy alone'},
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B: Bupropion in conjunction with nicotine replacement therapy and cognitive behavioral therapy
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Answer the following medical question with one of the provided options:
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Q:A pathologist receives a patient sample for analysis. Cells in the sample are first labeled with fluorescent antibodies and then passed across a laser beam in a single file of particles. The light scatter and fluorescent intensity of the particles are plotted on a graph; this information is used to characterize the sample. This laboratory method would be most useful to establish the diagnosis of a patient with which of the following?? {'A': 'Pancytopenia and deep vein thrombosis with intermittent hemoglobinuria', 'B': 'Ventricular septal defect and facial dysmorphism with low T-lymphocyte count', 'C': 'Multiple opportunistic infections with decreased CD4 counts', 'D': 'Vesicular lesions with dermatomal distribution and dendritic corneal ulcers', 'E': 'Painless generalized lymphadenopathy with monomorphic cells and interspersed benign histiocytes on histology'},
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A: Pancytopenia and deep vein thrombosis with intermittent hemoglobinuria
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