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Answer the following medical question with one of the provided options:
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Q:Fluorescein is an artificial dark orange colored organic molecule used in the diagnosis of corneal ulcers and herpetic corneal infections. It is observed that, in experimental animals, the fluorescein binds to receptors on certain B cells, but it does not stimulate them to produce fluorescein specific antibodies unless it is first attached to a larger molecule such as albumin. Which of the following terms best describes fluorescein?? {'A': 'Carrier', 'B': 'Hapten', 'C': 'Tolerogen', 'D': 'Adjuvant', 'E': 'Immunogen'},
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B: Hapten
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Answer the following medical question with one of the provided options:
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Q:A 65-year-old male is evaluated in clinic approximately six months after resolution of a herpes zoster outbreak on his left flank. He states that despite the lesions having resolved, he is still experiencing constant burning and hypersensitivity to touch in the distribution of the old rash. You explain to him that this complication can occur in 20-30% of patients after having herpes zoster. You also explain that vaccination with the shingles vaccine in individuals 60-70 years of age can reduce the incidence of this complication. What is the complication?? {'A': 'Ramsay-Hunt syndrome', 'B': 'Acute herpetic neuralgia', 'C': 'Post-herpetic neuralgia', 'D': 'Secondary bacterial infection', 'E': 'Recurrent zoster'},
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C: Post-herpetic neuralgia
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Answer the following medical question with one of the provided options:
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Q:An 11-year-old boy who recently emigrated from Nigeria is brought to the physician for evaluation of jaw swelling. He has no history of serious illness and takes no medications. Examination shows a 5-cm solid mass located above the right mandible and significant cervical lymphadenopathy. A biopsy specimen of the mass shows sheets of lymphocytes with interspersed tingible body macrophages. Serology for Epstein-Barr virus is positive. Which of the following chromosomal translocations is most likely present in cells obtained from the tissue mass?? {'A': 't(11;22)', 'B': 't(11;14)', 'C': 't(8;14)', 'D': 't(12;21)', 'E': 't(15;17)'},
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C: t(8;14)
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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 comes to the physician because of a 3-month history of a nonpruritic rash. He has been feeling more tired than usual and occasionally experiences pain in his wrists and ankles. He does not smoke or drink alcohol. His temperature is 37.6°C (99.7°F), pulse is 98/min, respirations are 18/min, and blood pressure is 130/75 mm Hg. Physical examination shows multiple, erythematous, purpuric papules on his trunk and extremities that do not blanch when pressed. The remainder of the examination shows no abnormalities. The patient's hemoglobin is 14 g/dL, leukocyte count is 9,500/mm3, and platelet count is 228,000/mm3. Urinalysis and liver function tests are within normal limits. The test for rheumatoid factor is positive. Serum ANA is negative. Serum complement levels are decreased. Serum protein electrophoresis and immunofixation shows increased gammaglobulins with pronounced polyclonal IgM and IgG bands. Testing for cryoglobulins shows no precipitate after 24 hours. Chest x-ray and ECG show no abnormalities. Which of the following is the most appropriate next step in management?? {'A': 'Rapid plasma reagin test', 'B': 'Bone marrow biopsy', 'C': 'Hepatitis C serology', 'D': 'pANCA assay', 'E': 'Bence Jones protein test\n"'},
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C: Hepatitis C serology
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Answer the following medical question with one of the provided options:
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Q:A 65-year-old African-American woman comes to the physician because of severe lower back pain. She has had dull lower back pain for several months, which suddenly become sharp in nature after lifting a heavy bucket of water 2 days ago. The pain is midline and does not radiate. She has had frequent vaginal dryness and hot flashes since menopause at the age of 55 years, for which she is on hormone replacement therapy. She has hypertension, hypercholesterolemia, and hypothyroidism. Her other medications include hydrochlorothiazide, simvastatin, and levothyroxine. She attends a 30-minute power walking class twice a week. She has smoked a pack of cigarettes daily for 40 years. She does not drink alcohol. She does not appear in distress. She is 165 cm (5 ft 5 in) tall and weighs 75 kg (165 lb); her BMI is 27.6 kg/m2. Vital signs are within normal limits. Examination shows midline lumbar tenderness. Muscle strength is full and deep tendon reflexes are 2+. Straight-leg raising is negative but painful. MRI of the spine shows an acute compression fracture of the L3 vertebral body and an old compression fracture of the L4 vertebra. Which of the following parts of this patient's history is the strongest predisposing factor for her condition?? {'A': 'Age at menopause', 'B': 'Exercise activity', 'C': 'Smoking history', 'D': 'Hormone replacement therapy', 'E': 'Ancestry'},
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C: Smoking history
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Answer the following medical question with one of the provided options:
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Q:A 5-year-old girl is brought to the hospital by her parents with a persistent fever of 41°C (105.8°F), which is not relieved by tylenol. Her birth history is unremarkable. On general examination, the child is agitated and looks ill. Her heart rate is 120/min and the respiratory rate is 22/min. The parents told the physician that she developed a rash, which started on her trunk and now is present everywhere, including the palms and soles. Her feet and hands are swollen. The pharynx is hyperemic, as shown in the picture. Generalized edema with non-palpable cervical lymphadenopathy is noted. The muscle tone is normal. The chest and heart examinations are also normal. No hepatosplenomegaly was noted. Laboratory test results are as follows: Hb, 9 gm/dL; RBC, 3.3/mm3; neutrophilic leukocytosis 28,000/mm3, normal platelet count of 200,000/mm3, increased ɣ-GT, hyperbilirubinemia, 2.98 mg/dL; hypoalbuminemia; AST and ALT are normal; markedly increased CRP; ANA, p-ANCA, and c-ANCA, negative; and rheumatoid factor, negative. Which of the following tests should be obtained due to its mortality benefit?? {'A': 'Rapid direct fluorescent antigen testing', 'B': 'Rapid antigen test', 'C': 'Tzanck smear', 'D': 'Coronary angiography', 'E': 'Echocardiography'},
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E: Echocardiography
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Answer the following medical question with one of the provided options:
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Q:A 7-year-old boy is brought to the emergency department with a high fever and oxygen desaturation. He had a tracheostomy placed as an infant and has been placed on mechanical ventilation intermittently. Since then, he has had several bouts of pneumonia similar to his current presentation. In addition, he has been deaf since birth but is able to communicate through sign language. He attends school and performs above average for his grade. Physical exam reveals underdeveloped cheekbones, hypoplasia of the mandible, and malformed ears. Abnormal development of which of the following structures is most likely responsible for this patient's symptoms?? {'A': 'Branchial arch 1', 'B': 'Branchial arch 2', 'C': 'Branchial cleft 1', 'D': 'Branchial pouch 1', 'E': 'Branchial pouch 3'},
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A: Branchial arch 1
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Answer the following medical question with one of the provided options:
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Q:A 31-year-old man comes to the physician because of a 9-month history of increasing fatigue and recurrent nausea. During this period, he has had a 3.8 kg (8.3 lb) weight loss. He also reports feeling lightheaded when he stands up suddenly. He was diagnosed with alopecia areata 1 year ago and was treated with monthly intralesional triamcinolone injections for 3 months. He does not smoke or drink alcohol. His temperature is 37.4°C (99.3°F), pulse is 86/min, and blood pressure is 102/68 mm Hg. Examination of the scalp shows a few well-defined patches of hair loss without scarring. The creases of the palm are darkened. Serum studies show: Na+ 125 mEq/L Cl- 98 mEq/L K+ 5.6 mEq/L Glucose 72 mg/dL Creatinine 0.8 mg/dL Thyroid-stimulating hormone 4.1 μU/mL Cortisol (AM) 2.5 μg/dL Cortisol (30 min after 250 μg corticotropin) 2.6 μg/dL Which of the following is the most likely underlying mechanism of this patient's symptoms?"? {'A': 'Defective 21β-hydroxylase enzyme', 'B': 'Amyloid deposition within the adrenal gland', 'C': 'Granulomatous inflammation of the adrenal gland', 'D': 'Autoimmune destruction of the adrenal gland', 'E': 'Suppression of pituitary corticotrophic activity'},
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D: Autoimmune destruction of the adrenal gland
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Answer the following medical question with one of the provided options:
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Q:A 49-year-old woman presents to the clinic for a routine exam. She recently quit smoking after a 30 pack-year history and started exercising a little. Past medical history is noncontributory. She takes no medication. Her mother died at 65 from lung cancer. She rarely drinks alcohol and only uses nicotine gum as needed. She admits to having some cravings for a cigarette in the morning before work, and after work. Which of the following best describes this patient’s stage in overcoming her nicotine addiction?? {'A': 'Relapse', 'B': 'Maintenance', 'C': 'Precontemplation', 'D': 'Contemplation', 'E': 'Action'},
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B: Maintenance
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Answer the following medical question with one of the provided options:
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Q:A 43-year-old woman presents for a routine checkup. She says she has been uncontrollably grimacing and smacking her lips for the past 2 months, and these symptoms have been getting progressively worse. Past medical history is significant for schizophrenia, managed medically with clozapine. Which of the following is the most likely diagnosis in this patient?? {'A': 'Torticollis', 'B': 'Oculogyric crisis', 'C': 'Tourette’s syndrome', 'D': 'Tardive dyskinesia', 'E': 'Trismus'},
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D: Tardive dyskinesia
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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 with type 2 diabetes mellitus comes to the physician because of generalized pain and muscle weakness. She suffered a nondisplaced left ulnar fracture 3 months ago after lifting a heavy crate of books. She has had progressively worsening renal function over the past 2 years but has not yet started hemodialysis. An x-ray of the left wrist shows a healing fracture in the ulna with thinned cortices. There are multiple transverse radiolucent bands adjacent to the fracture, surrounded by a thin sclerotic margin. This patient's findings are most likely due to the impaired production of which of the following substances?? {'A': '25-hydroxycholecalciferol', 'B': '1,25-dihydroxycholecalciferol', 'C': 'Ergosterol', 'D': 'Cholecalciferol', 'E': '7-dehydrocholesterol'},
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B: 1,25-dihydroxycholecalciferol
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Answer the following medical question with one of the provided options:
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Q:A 46-year-old man presents to the emergency department with confusion, lacrimation, salivation, nausea, vomiting, abdominal pain, and diarrhea. He developed these symptoms 30 minutes after he finished treating his garden with the insecticide malathion. His vital signs are as follows: blood pressure is 85/50 mm Hg, heart rate is 49/min, respiratory rate is 12/min, and temperature is 36.5℃ (97.7℉). At presentation, the patient is lethargic. Physical examination reveals pallor, mydriasis, nystagmus, widespread bilateral loud wheezes on lung auscultation, decreased heart sounds on cardiac auscultation, abdominal tenderness, and bilaterally increased upper and lower extremities muscle tone. Which of the following statements is true?? {'A': 'The patient’s symptoms are caused by reversible enzyme inhibition.', 'B': 'Maximum reaction rate (Vmax) of the affected enzyme is not changed in this patient.', 'C': 'The patient’s symptoms result from the formation of covalent bonds between malathion and the affected enzyme.', 'D': 'The affected enzyme is inhibited by malathion via the formation of hydrogen bonds between its allosteric site and malathion phosphoric groups.', 'E': 'Malathion activates the enzyme responsible for acetylcholine breakdown by modifying its allosteric site.'},
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C: The patient’s symptoms result from the formation of covalent bonds between malathion and the affected enzyme.
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Answer the following medical question with one of the provided options:
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Q:An 8-year-old boy is brought to his pediatrician by his mother because she is worried about whether he is becoming ill. Specifically, he has been sent home from school six times in the past month because of headaches and abdominal pain. In fact, he has been in the nurse's office almost every day with various symptoms. These symptoms started when the family moved to an old house in another state about 2 months ago. Furthermore, whenever he is taken care of by a babysitter he also has these symptoms. Despite these occurrences, the boy never seems to have any problems at home with his parents. Which of the following treatments would likely be effective for this patient?? {'A': 'Clonidine', 'B': 'Methylphenidate', 'C': 'Play therapy', 'D': 'Succimer', 'E': 'Supportive only'},
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C: Play therapy
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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 comes to the physician for the evaluation of lower back pain and tingling and numbness in his legs for the past 6 months. The pain radiates bilaterally to his buttocks and legs gets worse while standing or walking downhill. Two weeks ago, he had an upper respiratory tract infection that resolved spontaneously. He has hypertension and hypercholesterolemia. His son has ankylosing spondylitis. The patient does not smoke. He drinks 2–3 beers on the weekends. Current medications include enalapril and atorvastatin. He is 180 cm (5 ft 11 in) tall and weighs 90 kg (198 lb); BMI is 27.8 kg/m2. His temperature is 37°C (98.6°F), pulse is 70/min, and blood pressure is 135/85 mm Hg. There is no tenderness to palpation over the lumbar spine. Sensation to pinprick and light touch is decreased over the lower extremities. The patient's gait is unsteady and wide based. Muscle strength is normal. Deep tendon reflexes are 1+ bilaterally. Babinski's sign is absent bilaterally. Further evaluation is most likely to reveal which of the following findings?? {'A': 'Positive HLA-B27', 'B': 'Increased hemoglobin A1c', 'C': 'Albuminocytologic dissociation on CSF analysis', 'D': 'Leaning forward relieves the pain', 'E': 'Decreased ankle-brachial index'},
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D: Leaning forward relieves the pain
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Answer the following medical question with one of the provided options:
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Q:A 62-year-old woman comes to the physician because of a 2-month history of a rash on her ankles with intermittent itching. After the rash developed, she started applying a new scented lotion to her legs daily. She works as a cashier at a grocery store. She has type 2 diabetes mellitus and hypertension. Current medications include metformin and enalapril. Examination shows enlarged superficial veins of the right lower extremity and red-brown discoloration with indistinct margins over the medial ankles. There is 1+ edema in the lower extremities. Which of the following is the most likely cause of this patient’s skin findings?? {'A': 'Bacterial spread through the superficial dermis', 'B': 'Contact of antigen with pre-sensitized T lymphocytes', 'C': 'Intracellular accumulation of sorbitol', 'D': 'Infection with dermatophyte', 'E': 'Dermal deposition of hemosiderin\n"'},
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E: Dermal deposition of hemosiderin "
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Answer the following medical question with one of the provided options:
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Q:A 65-year-old patient comes to the physician because of a 6-month history of persistent dry cough and shortness of breath with mild exertion. He reports feeling too weak to leave the house on most days. He has a history of hypertension and chronic atrial fibrillation. He has smoked a pack of cigarettes daily for 45 years. His medications include warfarin, enalapril, and amiodarone. His temperature is 36.1°C (97°F), pulse is 85/min and irregularly irregular, and blood pressure is 148/82 mm Hg. Physical examination shows enlargement of the fingertips with increased curving of the nail. Inspiratory crackles are heard over both lung bases. Spirometry shows decreased vital capacity. A CT scan of the chest shows clustered air spaces and reticular opacities in the basal parts of the lung. Which of the following is the most likely underlying mechanism of this patient's dyspnea?? {'A': 'Excess collagen deposition in the extracellular matrix of the lung', 'B': 'Chronic airway inflammation', 'C': 'Pleural scarring', 'D': 'Increased pressure in the pulmonary arteries', 'E': 'Peribronchiolar accumulation of Langerhans cells'},
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A: Excess collagen deposition in the extracellular matrix of the lung
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Answer the following medical question with one of the provided options:
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Q:A 40-year-old man presents with problems with his vision. He says he has been experiencing blurred vision and floaters in his left eye for the past few days. He denies any ocular pain, fever, or headaches. Past medical history is significant for HIV infection a few years ago, for which he is noncompliant with his antiretroviral medications and his most recent CD4 count was 100 cells/mm3. His temperature is 36.5°C (97.7°F), the blood pressure is 110/89 mm Hg, the pulse rate is 70/min, and the respiratory rate is 14/min. Ocular exam reveals a decreased vision in the left eye, and a funduscopic examination is shown in the image. The patient is admitted and immediately started on intravenous ganciclovir. A few days after admission he is still complaining of blurry vision and floaters, so he is switched to a different medication. Inhibition of which of the following processes best describes the mechanism of action of the newly added medication?? {'A': 'Viral penetration into host cells', 'B': 'Nucleic acid synthesis', 'C': 'Progeny virus release', 'D': 'Viral uncoating', 'E': 'Protein synthesis'},
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B: Nucleic acid synthesis
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Answer the following medical question with one of the provided options:
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Q:On a medical trip to Nicaragua, you observe a sweet odor in the cerumen of 12-hour female newborn. Within 48 hours, the newborn develops ketonuria, poor feeding, and a sweet odor is also noticed in the urine. By 96 hours, the newborn is extremely lethargic and opisthotonus is observed. In order to prevent a coma and subsequent death, which of the following amino acids should be withheld from this newborn's diet?? {'A': 'Phenylalanine', 'B': 'Valine', 'C': 'Tyrosine', 'D': 'Methionine', 'E': 'Threonine'},
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B: Valine
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Answer the following medical question with one of the provided options:
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Q:A 77-year-old man with refractory shock has been under treatment in an intensive care unit for last 7 days. Despite the best possible management by the team of physicians and intensivists, he fails to show improvement. After discussion with his relatives and obtaining informed consent from them, the team administers to him a novel drug, an adrenergic agonist that produces positive chronotropic effects and inotropic effects and stimulates the release of renin from the kidneys. The drug does not have any other adrenergic effects. Which of the following second messengers is most likely to be responsible for the actions of the novel drug?? {'A': 'Cyclic adenosine monophosphate (cAMP)', 'B': 'Diacylglycerol (DAG)', 'C': 'Calcium ion', 'D': 'Inositol 1,4,5-triphosphate (IP3)', 'E': 'Cyclic guanosine monophosphate (cGMP)'},
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A: Cyclic adenosine monophosphate (cAMP)
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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 pulmonary function clinic for preoperative evaluation for a right pneumonectomy. His arterial blood gas at room air is as follows: pH: 7.34 PaCO2: 68 mmHg PaO2: 56 mmHg Base excess: +1 O2 saturation: 89% What underlying condition most likely explains these findings?? {'A': 'Acute respiratory distress syndrome', 'B': 'Bronchiectasis', 'C': 'Chronic obstructive pulmonary disease', 'D': 'Cystic fibrosis', 'E': 'Obesity'},
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C: Chronic obstructive pulmonary disease
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Answer the following medical question with one of the provided options:
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Q:An 18-year-old girl comes to the clinic because she is concerned about her weight. She states that she is on her school’s cheerleading team and is upset because she feels she is the “fattest” girl on the team despite her healthy diet. She says that in the last 2 weeks since practice began, she has lost 2 lbs. The patient has bipolar disorder I. Her medications include lithium and a combined oral contraceptive that was recently started by her gynecologist, because “everyone is on it." Her mother has hypothyroidism and is treated with levothyroxine. The patient’s BMI is 23.2 kg/m2. Thyroid function labs are drawn and shown below: Thyroid-stimulating hormone (TSH): 4.0 mIU/L Serum thyroxine (T4): 18 ug/dL Free thyroxine (Free T4): 1.4 ng/dl (normal range: 0.7-1.9 ng/dL) Serum triiodothyronine (T3): 210 ng/dL Free triiodothyronine (T3): 6.0 pg/mL (normal range: 3.0-7.0 pg/mL) Which of the following is the most likely cause of the patient’s abnormal lab values?? {'A': 'Familial hyperthyroidism', 'B': 'Hypocholesterolemia', 'C': 'Lithium', 'D': 'Oral contraception-induced', 'E': 'Surreptitious use of levothyroxine'},
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D: Oral contraception-induced
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Answer the following medical question with one of the provided options:
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Q:A 35-year-old woman comes to the physician for evaluation of a 6-month history of persistent rhinorrhea and nasal congestion. She works in retail and notices her symptoms worsen anytime she is exposed to strong perfumes. Her symptoms have worsened since winter began 2 months ago. She has not had fever, nausea, wheezing, itching, or rash. She has no history of serious illness or allergies. She takes no medications. Her vital signs are within normal limits. Examination shows congested nasal mucosa, enlarged tonsils, and pharyngeal postnasal discharge. The remainder of the examination shows no abnormalities. Which of the following is the most appropriate next step in management?? {'A': 'Radioallergosorbent testing', 'B': 'Oral phenylephrine', 'C': 'Oral diphenhydramine', 'D': 'Intranasal azelastine', 'E': 'Percutaneous allergy testing'},
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D: Intranasal azelastine
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Answer the following medical question with one of the provided options:
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Q:A 32-year-old woman is hospitalized after developing an allergic reaction to the contrast medium used for a cerebral angiography. The study was initially ordered as part of the diagnostic approach of a suspected case of pseudotumor cerebri. Her medical history is unremarkable. On physical examination she has stable vital signs, a diffuse maculopapular rash over her neck and chest, and a mild fever. She is started on hydrocortisone and monitored for the next 8 hours. After the monitoring period, a laboratory test shows significant azotemia. The patient complains of generalized weakness and palpitations. Tall-peaked T waves are observed on ECG. Which of the following explains this clinical manifestation?? {'A': 'Hyperkalemia', 'B': 'Metabolic acidosis', 'C': 'Uremic pericarditis', 'D': 'Anemia', 'E': 'Platelet dysfunction'},
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A: Hyperkalemia
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Answer the following medical question with one of the provided options:
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Q:A 5-year-old patient presents to the pediatrician’s office with fatigue and swollen lymph nodes. Extensive work-up reveals a diagnosis of acute lymphoblastic leukemia. In an effort to better tailor the patient’s treatments, thousands of genes are arranged on a chip and a probe is made from the patient’s DNA. This probe is then hybridized to the chip in order to measure the gene expression of thousands of genes. The technology used to investigate this patient’s gene expression profile is the best for detecting which of the following types of genetic abnormalities?? {'A': 'Large scale chromosomal deletions', 'B': 'Frame-shift mutations', 'C': 'Single nucleotide polymorphisms', 'D': 'Trisomies', 'E': 'Chromosomal translocations'},
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C: Single nucleotide polymorphisms
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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 into the emergency department by ambulance. He was found stumbling in the street. He smells of alcohol and has difficulty answering any questions are giving any history about recent events. He is diagnosed with acute ethanol intoxication. After a night of IV fluid and sleep, he recovers and becomes talkative. He describes an outlandish personal history as a war hero, a movie star, and a famous professor. On physical examination, the patient is malnourished, thin, disheveled, and mildly agitated. He has temporal wasting and conjunctival pallor. Which of the following symptoms would not improve with aggressive therapy including thiamine in this patient?? {'A': 'Anterograde amnesia', 'B': 'Ataxia', 'C': 'Ophthalmoplegia', 'D': 'Confusion', 'E': 'Delirium tremens'},
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A: Anterograde amnesia
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Answer the following medical question with one of the provided options:
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Q:A 34-year-old man with worsening refractory epigastric pain secondary to long-standing gastroesophageal reflux disease presents for endoscopic evaluation. Past medical history is also significant for type 2 diabetes mellitus that was diagnosed 3 years ago, managed medically. Current medications are metformin, metoclopramide, and omeprazole. Which of the following best describes this patient’s most likely endoscopic findings?? {'A': 'Longitudinal lacerations of the esophageal mucosa', 'B': 'Esophageal smooth muscle atrophy', 'C': 'Hypertrophy of the esophageal mucosa protruding into the lumen of the lower esophagus', 'D': 'Metaplasia of the esophageal mucosa', 'E': 'A malignant proliferation of squamous cells'},
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D: Metaplasia of the esophageal mucosa
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Answer the following medical question with one of the provided options:
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Q:A clinical trial is conducted to determine the efficacy of ginkgo biloba in the treatment of Parkinson disease. A sample of patients with major depression is divided into two groups. Participants in the first group are treated with ginkgo biloba, and participants in the other group receive a placebo. A change in the Movement Disorder Society-Unified Parkinson Disease Rating Scale (MDS-UPDRS) score is used as the primary endpoint for the study. The investigators, participants, and data analysts were meant to be blinded throughout the trial. However, while the trial is being conducted, the patients' demographics and their allocated treatment groups are mistakenly disclosed to the investigators, but not to the participants or the data analysts, because of a technical flaw. The study concludes that there is a significant decrease in MDS-UPDRS scores in patients treated with gingko biloba. Which of the following is most likely to have affected the validity of this study?? {'A': 'Recall bias', 'B': 'Pygmalion effect', 'C': 'Hawthorne effect', 'D': 'Effect modification', 'E': 'Procedure bias'},
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B: Pygmalion effect
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Answer the following medical question with one of the provided options:
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Q:A 4-month-old boy is brought to the physician by his parents because of fever for the past 3 days. They also state that he has been less active and has been refusing to eat. The patient has had two episodes of bilateral otitis media since birth. He was born at term and had severe respiratory distress and sepsis shortly after birth that was treated with antibiotics. Umbilical cord separation occurred at the age of 33 days. The patient appears pale. Temperature is 38.5°C (101.3°F), pulse is 170/min, and blood pressure is 60/40 mm Hg. He is at the 25th percentile for height and 15th percentile for weight. Examination shows a capillary refill time of 4 seconds. Oral examination shows white mucosal patches that bleed when they are scraped off. There is bilateral mucoid, nonpurulent ear discharge. Several scaly erythematous skin lesions are seen on the chest. Laboratory studies show a leukocyte count of 38,700/mm3 with 90% neutrophils and a platelet count of 200,000/mm3. Which of the following is the most likely underlying cause of this patient's symptoms?? {'A': 'Defective IL-2R gamma chain', 'B': 'Defective beta-2 integrin', 'C': 'Defective NADPH oxidase', 'D': 'Defective lysosomal trafficking regulator gene', 'E': 'WAS gene mutation\n"'},
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B: Defective beta-2 integrin
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Answer the following medical question with one of the provided options:
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Q:A 10-year-old boy is brought to the clinic by his mother with complaints of cough productive of yellow sputum for the past couple of weeks. This is the 4th episode the boy has had this year. He has had recurrent episodes of cough since childhood, and previous episodes have subsided with antibiotics. There is no family history of respiratory disorders. His vaccinations are up to date. He has a heart rate of 98/min, respiratory rate of 13/min, temperature of 37.6°C (99.7°F), and blood pressure of 102/70 mm Hg. Auscultation of the chest reveals an apex beat on the right side of the chest. A chest X-ray reveals that the cardiac apex is on the right. A high-resolution CT scan is performed which is suggestive of bronchiectasis. Which of the following structures is most likely impaired in this patient?? {'A': 'Dynein', 'B': 'Kinesin', 'C': 'Microfilaments', 'D': 'Neurofilaments', 'E': 'Microvilli'},
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A: Dynein
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Answer the following medical question with one of the provided options:
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Q:A 49-year-old man presents to his primary care physician for leg pain. He states that when he goes for walks with his dog, he starts feeling calf pain. He either has to stop or sit down before the pain resolves. He used to be able to walk at least a mile, and now he starts feeling the pain after 8 blocks. His medical history includes hyperlipidemia and hypertension. He takes lisinopril, amlodipine, and atorvastatin, but he admits that he takes them inconsistently. His blood pressure is 161/82 mmHg, pulse is 87/min, and respirations are 16/min. On physical exam, his skin is cool to touch and distal pulses are faint. His bilateral calves are smooth and hairless. There are no open wounds or ulcers. Dorsi- and plantarflexion of bilateral ankles are 5/5 in strength. Ankle-brachial indices are obtained, which are 0.8 on the left and 0.6 on the right. In addition to lifestyle modifications, which of the following is the next best step in management?? {'A': 'Angioplasty', 'B': 'Arteriography', 'C': 'Bed rest', 'D': 'Clopidogrel', 'E': 'Electromyography'},
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D: Clopidogrel
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Answer the following medical question with one of the provided options:
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Q:A 67-year-old woman comes to the physician with a 6-month history of pain and swelling of both legs. The symptoms are worst at the end of the day and are associated with itching of the overlying skin. Physical examination shows bilateral pitting ankle edema. An image of one of the ankles is shown. This patient is at greatest risk for which of the following complications?? {'A': 'Thrombosis of a deep vein', 'B': 'Malignant transformation of lymphatic endothelium', 'C': 'Biliverdin accumulation in the epidermis', 'D': 'Osmotic injury to the peripheral nerves', 'E': 'Ulceration of the cutis'},
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E: Ulceration of the cutis
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Answer the following medical question with one of the provided options:
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Q:A 64-year-old woman presents to the physician with fever and sore throat for 2 days. She was diagnosed with rheumatoid arthritis 15 years ago. She has had several flares necessitating admission to the hospital in recent years. She has developed deformity in her joints despite aggressive therapy. She is a candidate for surgical correction. Her temperature is 38.2°C (100.9°F), and the rest of her vital signs are stable. Physical examination of the hands reveals multiple swan-neck, boutonniere, and Z-line deformities. Ulnar deviation is evident in both hands. She has flat feet. There are 3 firm, nontender nodules palpated around the right elbow and one on the left Achilles tendon. The spleen is palpated 5 cm below the costal margin with a percussion span of 15 cm. Lymphadenopathy is absent on exam. The laboratory test results show: Hemoglobin 11 g/dL Mean corpuscular volume 90 μm3 Leukocyte count 3,500/mm3 Segmented neutrophils 20% Lymphocytes 70% Platelet count 240,000/mm3 Erythrocyte sedimentation rate 65 mm/hour Rheumatoid factor 85 IU/mL (Normal: up to 14 IU/mL) Which of the following is the most likely cause of this patient’s current condition?? {'A': 'Diffuse large B cell lymphoma', 'B': 'Felty syndrome', 'C': 'Sarcoidosis', 'D': 'Secondary amyloidosis', 'E': 'T cell large granular lymphocytic leukemia'},
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B: Felty syndrome
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Q:A 48-year-old man comes to the physician for evaluation of an intensely pruritic skin rash on his arms and legs for 12 hours. Two days ago, he returned from an annual camping trip with his son. The patient takes no medications. A photograph of the skin lesions on his left hand is shown. Activation of which of the following cell types is the most likely cause of this patient's skin findings?? {'A': 'T cells', 'B': 'Neutrophils', 'C': 'B cells', 'D': 'Mast cells', 'E': 'Eosinophils\n"'},
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A: T cells
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Q:A 25-year-old man presents to the emergency department with the sudden onset of neck pain and a severe spinning sensation for the last 6 hours. The symptoms initially began while he was lifting weights in the gym. He feels the room is spinning continuously, and he is unable to open his eyes or maintain his balance. The dizziness and pain are associated with nausea and vomiting. Past medical history is unremarkable. His blood pressure is 124/88 mm Hg, the heart rate is 84/min, the temperature is 37.0°C (98.6°F), the respiratory rate is 12/min, and the BMI is 21.6 kg/m2. On physical examination, he is awake and oriented to person, place, and time. Higher mental functions are intact. There are several horizontal beats of involuntary oscillatory eye movements on the left lateral gaze. He has difficulty performing repetitive pronation and supination movements on the left side. Electrocardiogram reveals normal sinus rhythm. Which of the following additional clinical features would you expect to be present?? {'A': 'Bitemporal hemianopsia', 'B': 'Expressive aphasia', 'C': 'Hemiplegia', 'D': 'Past-pointing', 'E': 'Sensory aphasia'},
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D: Past-pointing
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Q:A 30-year-old man presents to clinic. He was born in southeast Asia and immigrated to the US three years ago. He has a history of chronic hepatitis C which he contracted from intravenous drug use. He reports that he has continued to take ribavirin, but unfortunately has started using heroin again. The patient was seen in the clinic last week and had blood work done. His results are as follows: HBsAg - negative; HBsAb - negative; HBcAb - negative. In addition to encouraging the patient to seek treatment for his heroin addiction, what else should be done at this health visit for general health maintenance?? {'A': 'Draw blood for an HIV western blot', 'B': 'Obtain a PSA', 'C': 'Write a prescription for a fecal ocult blood test', 'D': 'Write a prescription for a colonoscopy', 'E': 'Vaccinate the patient for Hepatitis B'},
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E: Vaccinate the patient for Hepatitis B
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Q:A 74-year-old man presents to the emergency department with shortness of breath that started about 30 mins ago. He is also experiencing chest pain on deep inspiration. He has several significant medical conditions including obstructive pulmonary disease, hypertension, and dyslipidemia. He used to smoke about 3 packs of cigarettes every day until last year when he quit. He was in the emergency room 2 weeks ago for a hemorrhagic stroke which was promptly treated. He currently weighs 97.5 kg (215 lb). His respirations are 20/min, the blood pressure is 110/ 80 mm Hg, and the pulse is 105/min. On physical examination, Homan’s sign is positive. An ECG and chest X-ray are performed. His current oxygen saturation is at 87% and D-dimer results are positive. He is wheeled in for a CT scan. Which of the following treatments would this patient be an ideal candidate for?? {'A': 'Surgical thrombectomy', 'B': 'Greenfield filter', 'C': 'Unfractionated heparin', 'D': 'Subcutaneous fondaparinux', 'E': 'Warfarin'},
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B: Greenfield filter
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Q:A 22-year-old man presents to the emergency department after being tackled in a game of football. The patient was hit from behind and fell to the ground. After the event, he complained of severe pain in his knee. The patient has a past medical history of anabolic steroid use. His current medications include whey protein supplements, multivitamins, and fish oil. His temperature is 99.5°F (37.5°C), blood pressure is 137/68 mmHg, pulse is 100/min, respirations are 17/min, and oxygen saturation is 98% on room air. On physical exam, you see a muscular young man clutching his knee in pain. The knee is inflamed and erythematous. When valgus stress is applied to the leg, there is some laxity when compared to the contralateral leg. The patient is requesting surgery for his injury. Arthrocentesis is performed and demonstrates no abnormalities of the synovial fluid. Which of the following physical exam findings is most likely to be seen in this patient?? {'A': 'A palpable click with passive motion of the knee', 'B': 'Anterior displacement of the femur relative to the tibia', 'C': 'Anterior displacement of the tibia relative to the femur', 'D': 'Laxity to varus stress', 'E': 'Severe pain with compression of the patella'},
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A: A palpable click with passive motion of the knee
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Q:A research group from a small outpatient clinic is investigating the health benefits of a supplement containing polyphenol-rich extract from pomegranate, as several studies have suggested that pomegranate juice may have antiatherogenic, antihypertensive, and anti-inflammatory effects. Two researchers involved in the study decide to measure blood glucose concentration and lipid profile postprandially (i.e. after a meal), as well as systolic and diastolic blood pressure. Their study group consists of 16 women over 50 years of age who live in the neighborhood in a small town where the clinic is located. The women are given the supplement in the form of a pill, which they take during a high-fat meal or 15 minutes prior to eating. Their results indicate that the supplement can reduce the postprandial glycemic and lipid response, as well as lower blood pressure. Based on their conclusions, the researchers decided to put the product on the market and to conduct a nation-wide marketing campaign. Which of the following is a systematic error present in the researchers’ study that hampers the generalization of their conclusions to the entire population?? {'A': 'Confounding bias', 'B': 'Expectancy bias', 'C': 'Design bias', 'D': 'Late-look bias', 'E': 'Proficiency bias'},
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C: Design bias
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Q:A 47-year-old woman with chronic epigastric pain comes to the physician because of a 1-month history of intermittent, loose, foul-smelling stools. She has also had a 6-kg (13-lb) weight loss. She has consumed 9–10 alcoholic beverages daily for the past 25 years. Seven years ago, she traveled to Mexico on vacation; she has not been outside the large metropolitan area in which she resides since then. She appears malnourished. The stool is pale and loose; fecal fat content is elevated. An immunoglobulin A serum anti-tissue transglutaminase antibody assay is negative. Further evaluation is most likely to show which of the following?? {'A': 'Inflammation of subcutaneous fat', 'B': 'Trophozoites on stool microscopy', 'C': 'Pancreatic calcifications', 'D': 'Villous atrophy of duodenal mucosa', 'E': 'Positive lactulose breath test'},
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C: Pancreatic calcifications
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Q:A 38-year-old, working, first-time mother brings her 9-month-old male infant to the pediatrician for "wounds that simply won't heal" and bleeding gums. She exclaims, "I have been extra careful with him making sure to not let him get dirty, I boil his baby formula for 15 minutes each morning before I leave for work to give to the caregiver, and he has gotten all of his vaccinations." This infant is deficient in a molecule that is also an essential co-factor for which of the following reactions?? {'A': 'Conversion of pyruvate to acetyl-CoA', 'B': 'Conversion of pyruvate to oxaloacetate', 'C': 'Conversion of homocysteine to methionine', 'D': 'Conversion of dopamine to norepinephrine', 'E': 'Conversion of alpha ketoglutarate to succinyl-CoA'},
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D: Conversion of dopamine to norepinephrine
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Q:A 20-year-old man comes to the physician because of a 3-day history of fever, myalgia, and swelling in his left groin after a recent camping trip in northern California. He appears acutely ill. Physical examination shows tender, left-sided inguinal lymphadenopathy and an enlarged, tender lymph node in the right axilla that is draining bloody necrotic material. Microscopic examination of a lymph node aspirate shows gram-negative coccobacilli with bipolar staining and a safety-pin appearance. This patient's condition is most likely caused by an organism with which of the following reservoirs?? {'A': 'Deer', 'B': 'Birds', 'C': 'Squirrels', 'D': 'Dogs', 'E': 'Bats'},
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C: Squirrels
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Q:An investigator is measuring the blood calcium level in a sample of female cross country runners and a control group of sedentary females. If she would like to compare the means of the two groups, which statistical test should she use?? {'A': 't-test', 'B': 'ANOVA (Analysis of Variance)', 'C': 'Linear regression', 'D': 'Chi-square test', 'E': 'F-test'},
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A: t-test
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Q:A 16-year-old boy presents with acute left-sided weakness. The patient is obtunded and can not provide any history other than his stomach hurts. The patient’s friend states that the patient has had episodes like this in the past and that “he has the same weird disease as his mom”. On physical examination, strength is 1 out of 5 in the left upper and lower extremities. A noncontrast CT scan of the head is normal. Laboratory tests reveal an anion gap metabolic acidosis. Which of the following is a normal function of the structure causing this patient’s condition?? {'A': 'Extrinsic pathway of apoptosis', 'B': 'Extracellular potassium homeostasis', 'C': 'Conversion of pyruvate to oxaloacetate', 'D': 'Synthesis of globin chains of hemoglobin', 'E': 'Creation of exogenous reactive oxygen species'},
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C: Conversion of pyruvate to oxaloacetate
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Q:A 54-year-old female presents to her primary care physician with recurrent episodes of flushing. At first she attributed these symptoms to hormonal changes. However, lately she has also been experiencing episodes of explosive, watery diarrhea. She has also noticed the onset of heart palpitations. Her vital signs are within normal limits. Her physical exam is notable for an elevated jugular venous pressure (JVP). Echocardiography shows tricuspid insufficiency. Urine 5-HIAA is elevated. Which of the following is the most appropriate next step in management?? {'A': 'Octreotide', 'B': 'Metoclopramide', 'C': 'Levothyroxine', 'D': 'Ondensatron', 'E': 'Promethazine'},
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A: Octreotide
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Q:A 7-year-old boy is brought to the physician by his mother because his teachers have noticed him staring blankly on multiple occasions over the past month. These episodes last for several seconds and occasionally his eyelids flutter. He was born at term and has no history of serious illness. He has met all his developmental milestones. He appears healthy. Neurologic examination shows no focal findings. Hyperventilation for 30 seconds precipitates an episode of unresponsiveness and eyelid fluttering that lasts for 7 seconds. He regains consciousness immediately afterward. An electroencephalogram shows 3-Hz spikes and waves. Which of the following is the most appropriate pharmacotherapy for this patient?? {'A': 'Clonazepam', 'B': 'Carbamazepine', 'C': 'Ethosuximide', 'D': 'Phenytoin', 'E': 'Levetiracetam'},
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C: Ethosuximide
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Q:A 64-year-old woman comes to the physician for a follow-up examination. She has had difficulty reading for the past 6 months. She tried using multiple over-the-counter glasses with different strengths, but they have not helped. She has hypertension and type 2 diabetes mellitus. Current medications include insulin and enalapril. Her temperature is 37.1°C (98.8°F), pulse is 80/min, and blood pressure is 126/84 mm Hg. The pupils are round and react sluggishly to light. Visual acuity in the left eye is 6/60 and in the right eye counting fingers at 6 feet. Fundoscopy shows pallor of the optic disc bilaterally. The cup-to-disk ratio is 0.7 in the left eye and 0.9 in the right eye (N = 0.3). Which of the following is the most likely diagnosis?? {'A': 'Hypertensive retinopathy', 'B': 'Age-related macular degeneration', 'C': 'Diabetic retinopathy', 'D': 'Open-angle glaucoma', 'E': 'Optic neuritis\n"'},
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D: Open-angle glaucoma
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Q:A 65-year-old male presented to his primary care physician with exertional dyspnea. The patient had a 30-year history of smoking one pack of cigarettes per day. Physical examination reveals a barrel-chested appearance, and it is noted that the patient breathes through pursed lips. Spirometry shows decreased FEV1, FVC, and FEV1/FVC. This patient’s upper lobes are most likely to demonstrate which of the following?? {'A': 'Panacinar emphysema', 'B': 'Centriacinar emphysema', 'C': 'Calcified nodule', 'D': 'Hypersensitivity pneumonitis', 'E': 'Uncalcified nodule'},
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B: Centriacinar emphysema
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Q:A 30-year-old woman presents to a medical clinic for a routine check-up. She gained about 5 kg (11 lb) since the last time she weighed herself 3 months ago. She also complains of constipation and sensitivity to cold. She also noticed her hair appears to be thinning. The patient started to use combined oral contraceptives a few months ago and she is compliant. On physical examination, the temperature is 37.0°C (98.6°F), the blood pressure is 110/70 mm Hg, the pulse is 65/min, and the respiratory rate is 14/min. The laboratory results are as follows: Thyroxine (T4), total 25 ug/dL Thyroxine (T4), free 0.8 ng/dL TSH 0.2 mU/L Which of the following is the main mechanism of action of the drug that caused her signs and symptoms?? {'A': 'Inhibition of an enzyme in the thyroid gland', 'B': 'Inhibition of hormones in the pituitary gland', 'C': 'Inhibition of hormones in hypothalamus', 'D': 'Increase the thickness of cervical mucus secretions', 'E': 'Inducing endometrial atrophy'},
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B: Inhibition of hormones in the pituitary gland
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Q:A 31-year-old woman is brought to the emergency department for a severe throbbing headache, nausea, and photophobia for the past 3 hours. She has severe occipital pain and chest tightness. Prior to the onset of her symptoms, she had attended a networking event where she had red wine and, shortly after, a snack consisting of salami and some dried fruits. The patient has recurrent migraine headaches and depression, for which she takes medication daily. She is mildly distressed, diaphoretic, and her face is flushed. Her temperature is 37.0°C (98.6°F), the pulse is 90/min, the respirations are 20/min, and the blood pressure is 195/130 mm Hg. She is alert and oriented. Deep tendon reflexes are 2+ bilaterally. This patient's symptoms are most likely caused by a side effect of which of the following medications?? {'A': 'Amitriptyline', 'B': 'Phenelzine', 'C': 'Sertraline', 'D': 'Sumatriptan', 'E': 'Topiramate'},
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B: Phenelzine
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Q:Shortly after delivery, a female newborn develops bluish discoloration of the lips, fingers, and toes. She was born at term to a 38-year-old primigravid woman. Pregnancy was complicated by maternal diabetes mellitus. Pulse oximetry on room air shows an oxygen saturation of 81%. Echocardiography shows immediate bifurcation of the vessel arising from the left ventricle; the vessel emerging from the right ventricle gives out coronary, head, and neck vessels. An abnormality in which of the following developmental processes most likely accounts for this patient's condition?? {'A': 'Separation of tricuspid valve tissue from myocardium', 'B': 'Fusion of endocardial cushion', 'C': 'Alignment of infundibular septum', 'D': 'Division of aorta and pulmonary artery', 'E': 'Spiraling of aorticopulmonary septum'},
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E: Spiraling of aorticopulmonary septum
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Q:A thymidine kinase-deficient varicella-zoster virus strain has been isolated at a retirement home. Many of the elderly had been infected with this strain and are experiencing shingles. Which of the following would be the best antiviral agent to treat this population?? {'A': 'Acyclovir', 'B': 'Famciclovir', 'C': 'Ganciclovir', 'D': 'Cidofovir', 'E': 'Amantadine'},
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D: Cidofovir
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Q:A worried mother brings her 12-day-old son to the emergency room concerned that his body is turning "yellow". The patient was born at 39 weeks via spontaneous vaginal delivery without complications. The mother received adequate prenatal care and has been breastfeeding her son. The patient has had adequate urine and stool output. Physical exam demonstrates a comfortable, well nourished neonate with a jaundiced face and chest. The patient's indirect bilirubin was 4 mg/dL at 48 hours of life. Today, indirect bilirubin is 10 mg/dL, and total bilirubin is 11 mg/dL. All other laboratory values are within normal limits. What is the next best treatment in this scenario?? {'A': 'Phenobarbitol', 'B': 'Phototherapy', 'C': 'Exchange transfusion', 'D': 'Reassure mother that jaundice will remit, advise her to continue breastfeeding', 'E': 'Stop breastfeeding and switch to formula'},
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D: Reassure mother that jaundice will remit, advise her to continue breastfeeding
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Q:A 27-year-old man interested in pre-exposure therapy for HIV (PrEP) is being evaluated to qualify for a PrEP study. In order to qualify, patients must be HIV- and hepatitis B- and C-negative. Any other sexually transmitted infections require treatment prior to initiation of PrEP. The medical history is positive for a prior syphilis infection and bipolar affective disorder, for which he takes lithium. On his next visit, the liver and renal enzymes are within normal ranges. HIV and hepatitis B and C tests are negative. Which of the following about the HIV test is true?? {'A': 'It is a quantitative test used for screening purposes.', 'B': 'It is a qualitative test used for screening purposes.', 'C': 'An unknown antigen binds to the known serum.', 'D': 'A known antigen binds to the patient’s serum.', 'E': 'A secondary reagent is needed to interpret the results.'},
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B: It is a qualitative test used for screening purposes.
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Q:A 59-year-old man comes to the physician for the evaluation of generalized fatigue, myalgia, and a pruritic skin rash for the past 5 months. As a child, he was involved in a motor vehicle accident and required several blood transfusions. Physical examination shows right upper abdominal tenderness, scleral icterus, and well-demarcated, purple, polygonal papules on the wrists bilaterally. Laboratory studies show an elevated replication rate of a hepatotropic virus. Further analysis shows high variability in the genetic sequence that encodes the glycosylated envelope proteins produced by this virus. Which of the following is the most likely explanation for the variability in the genetic sequence of these proteins?? {'A': 'Neutralizing host antibodies induce viral genome mutations', 'B': 'Viral RNA polymerase lacks proofreading ability', 'C': 'Incorporation of envelope proteins from a second virus', 'D': 'Integration of viral genes into host cell genome', 'E': 'Infection with multiple viral genotypes'},
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B: Viral RNA polymerase lacks proofreading ability
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Q:A 58-year-old man presents to the emergency department with severe right leg pain accompanied by tingling and weakness. His condition started suddenly 3 hours ago when he was watching a movie. His medical history is remarkable for type 2 diabetes mellitus and hypertension. He has been smoking 20–30 cigarettes per day for the past 35 years. His vital signs include a blood pressure of 149/85 mm Hg, a temperature of 36.9°C (98.4°F), and an irregular pulse of 96/min. On physical examination, his right popliteal and posterior tibial pulses are absent. His right leg is pale and cold. Which of the following is the most likely diagnosis? ? {'A': 'Leriche syndrome', 'B': "Buerger's disease", 'C': 'Acute limb ischemia', 'D': 'CREST syndrome', 'E': 'Deep vein thrombosis'},
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C: Acute limb ischemia
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Q:A 15-day-old girl presents to the pediatrician for a well visit. Her mother reports that she has been exclusively breastfeeding since birth. The patient feeds on demand every one to two hours for 10-15 minutes on each breast. The patient’s mother reports that once or twice a day, the patient sleeps for a longer stretch of three hours, and she wonders whether she should be waking the patient up to feed at those times. She also reports that she sometimes feels that her breasts are not completely empty after feeding. The patient voids 4-5 times per day and stools 2-3 times per day. Her mother occasionally saw red streaks in the patient’s diaper during the first week of life. The patient was born at 39 weeks gestation via a vaginal delivery, and her birth weight was 2787 g (6 lb 2 oz, 16th percentile). One week ago, the patient weighed 2588 g (5 lb 11 oz, 8th percentile), and today the patient weighs 2720 g (6 lb, 8th percentile). Her temperature is 98.7°F (37.1°C), blood pressure is 52/41 mmHg, pulse is 177/min, and respirations are 32/min. She has normal cardiac sounds, her abdomen is soft, non-tender, and non-distended. Which of the following is the best next step in management?? {'A': 'Continue current breastfeeding regimen', 'B': 'Observe the patient during a feeding', 'C': 'Recommend modification of mother’s diet', 'D': 'Recommend waking the patient to feed', 'E': 'Supplement breastfeeding with conventional formula'},
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B: Observe the patient during a feeding
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Answer the following medical question with one of the provided options:
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Q:A 36-year-old man presents to the physician with a cough accompanied by expectoration and recurrent wheezing, for the last 2 years. He says that his symptoms have progressed slowly in severity and frequency over this period. There is no history of rhinorrhea, nasal congestion, or high fever. He has been a smoker for the last 5 years. His environmental history does not suggest that he is at increased risk of developing any occupational lung disease but his house has mold growth in some areas. His temperature is 37°C (98.6°F), the heart rate is 80/min, the blood pressure is 124/80 mm Hg, and the respiratory rate is 22/min. Auscultation of his chest reveals bilateral wheezing in the infrascapular regions. A high-resolution computed tomography (HRCT) of his chest shows widespread abnormally hypoattenuating areas and simplification of lung architecture in both lower lobes. Pulmonary vessels are decreased in number and widely dispersed in both lower lobes. Which of the following tests is most likely to be helpful in the diagnosis of this patient?? {'A': 'Serum total IgE level', 'B': 'Skin prick test for aero-allergens', 'C': 'Serum α1-antitrypsin level', 'D': 'Sweat chloride levels', 'E': 'Serum Aspergillus precipitins'},
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C: Serum α1-antitrypsin level
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Q:A 30-year-old man who recently emigrated from Southeast Asia presents with heartburn and a bad taste in his mouth. He says the symptoms have been present for the last 6 months and are much worse at night. He describes the pain as moderate to severe, burning in character, and localized to the epigastric region. He mentions that 1 month ago, he was tested for Helicobacter pylori back in his country and completed a course of multiple antibiotics, but there has been no improvement in his symptoms. Which of the following is the most likely diagnosis in this patient?? {'A': 'Gastric MALT (mucosa-associated lymphoid tissue) lymphoma', 'B': 'Gastric adenocarcinoma', 'C': 'Duodenal ulcer disease', 'D': 'Peptic ulcer disease', 'E': 'Gastroesophageal reflux disease'},
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E: Gastroesophageal reflux disease
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Answer the following medical question with one of the provided options:
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Q:A 45-year-old man in respiratory distress presents to the emergency department. He sustained a stab to his left chest and was escorted to the nearest hospital. The patient appears pale and has moderate difficulty with breathing. His O2 saturation is 94%. The left lung is dull to percussion. CXRs are ordered and confirm the likely diagnosis. His blood pressure is 95/57 mm Hg, the respirations are 22/min, the pulse is 87/min, and the temperature is 36.7°C (98.0°F). His chest X-ray is shown. Which of the following is the next best step in management for this patient?? {'A': 'Needle aspiration', 'B': 'Chest tube insertion', 'C': 'ABG', 'D': 'Thoracotomy', 'E': 'CT scan '},
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B: Chest tube insertion
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Q:A 32-year-old woman complains of fatigue and pallor. She says symptoms that started several months ago and have been becoming more serious with time. She reports that she has been exercising regularly and has been adhering to a strict vegan diet. The patient has no significant past medical history and takes no current medications. She denies any smoking history, alcohol use, or recreational drug use. She is tachycardic, but otherwise, her physical examination is unremarkable. A complete blood count (CBC) shows anemia with a low MCV (mean corpuscular volume), and a peripheral blood smear shows small erythrocytes. Which of the following is the most likely diagnosis in this patient?? {'A': 'Hemolytic anemia', 'B': 'Glucose-6-phosphate dehydrogenase deficiency', 'C': 'Lead poisoning', 'D': 'Iron deficiency anemia', 'E': 'Pernicious anemia'},
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D: Iron deficiency anemia
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Q:A 12-year-old girl with an autosomal dominant mutation in myosin-binding protein C is being evaluated by a pediatric cardiologist. The family history reveals that the patient's father died suddenly at age 33 while running a half-marathon. What was the likely finding on histological evaluation of her father's heart at autopsy?? {'A': 'Myocyte disarray', 'B': 'Amyloid deposits', 'C': 'Eosinophilic infiltration', 'D': 'Wavy myocytes', 'E': 'Viral particles'},
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A: Myocyte disarray
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Q:A 25-year-old female comes to the clinic complaining of fatigue and palpitations. She has been undergoing immense stress from her thesis defense and has been extremely tired. The patient denies any weight loss, diarrhea, cold/heat intolerance. TSH was within normal limits. She reports a family history of "blood disease" and was later confirmed positive for B-thalassemia minor. It is believed that abnormal splicing of the beta globin gene results in B-thalassemia. What is removed during this process that allows RNA to be significantly shorter than DNA?? {'A': "3'-poly(A) tail", 'B': 'Exons', 'C': 'Introns', 'D': 'microRNAs', 'E': 'snRNPs'},
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C: Introns
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Q:A 35-year-old patient with a history of diabetes presents to the ED with a myriad of systemic complaints. An arterial blood gas shows serum pH = 7.3, HCO3- = 13 mEq/L, PCO2 = 27 mmHg. Which of the following would you LEAST expect to observe in this patient?? {'A': 'Increased anion gap', 'B': 'Increased serum ketones', 'C': 'Increased urine output', 'D': 'Decreased respiratory rate', 'E': 'Increased serum potassium'},
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D: Decreased respiratory rate
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Answer the following medical question with one of the provided options:
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Q:A 20-year-old woman is brought to the physician by her mother because she has been worried about her daughter's strange behavior for the past 2 years. She does not have any friends and spends most of her time alone in her room. She usually wears a long, black, hooded cloak. She is anxious at college because she is uncomfortable around other people, and her academic performance is poor. She collects rare crystals and says that they support her “sixth sense.” Mental status examination shows slow, hesitant speech, and she avoids eye contact. Which of the following is the most likely diagnosis?? {'A': 'Social anxiety disorder', 'B': 'Schizotypal personality disorder', 'C': 'Paranoid personality disorder', 'D': 'Schizoid personality disorder', 'E': 'Schizophrenia'},
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B: Schizotypal personality disorder
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Answer the following medical question with one of the provided options:
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Q:A 60-year-old African American woman presents to her family physician with shortness of breath on exertion. She also describes shortness of breath when she lies down to go to bed at night, as well as recent swelling in her ankles. Past medical history is significant for long-standing hypertension, for which she takes amlodipine and lisinopril. Her temperature is 36.8°C (98.2°F), the heart rate is 90/min, the respiratory rate is 15/min, and the blood pressure is 135/80 mm Hg. The physical exam is significant for JVD, lower extremity pitting edema, laterally displaced PMI, left ventricular heave, bilateral pulmonary crackles, and an S4 heart sound. Chest X-ray demonstrates pulmonary vascular congestion, Kerley B lines, and cardiomegaly. Echocardiogram demonstrates a preserved ejection fraction. Kidney biopsy would likely demonstrate which of the following?? {'A': 'Intimal thickening and medial hypertrophy', 'B': 'Thinning of the intima and media', 'C': 'Fibrinoid necrosis', 'D': 'Nodular sclerosis', 'E': 'Onion-skinning'},
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A: Intimal thickening and medial hypertrophy
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Q:A 6-year-old boy is brought to the physician by his mother who is concerned about his early sexual development. He has no history of serious illness and takes no medications. He is at the 99th percentile for height and 70th percentile for weight. His blood pressure is 115/78 mm Hg. Examination shows greasy facial skin and cystic acne on his forehead and back. There is coarse axillary and pubic hair. Serum studies show: Cortisol (0800 h) 4 μg/dL Deoxycorticosterone 2.5 ng/dL (N = 3.5–11.5) Dehydroepiandrosterone sulfate 468 mcg/dL (N = 29–412) Which of the following is the most likely underlying cause of this patient's symptoms?"? {'A': 'Deficiency of 21β-hydroxylase', 'B': 'Constitutive activation of adenylyl cyclase', 'C': 'Idiopathic overproduction of GnRH', 'D': 'Deficiency of 17α-hydroxylase', 'E': 'Deficiency of 11β-hydroxylase'},
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A: Deficiency of 21β-hydroxylase
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Q:A 52-year-old man comes to to the emergency department with fatigue and shortness of breath that has become progressively worse over the past week. He had an upper respiratory tract infection 2 weeks ago, for which he was given an antibiotic. He has hypertension, type 2 diabetes mellitus, and colonic polyps diagnosed on screening colonoscopy 2 years ago. His mother has systemic lupus erythematosus and his brother has a bicuspid aortic valve. He does not smoke cigarettes or drink alcohol. Current medications include lisinopril and metformin. His temperature is 37.3°C (99.1°F), pulse is 91/min, respirations are 18/min, and blood pressure is 145/84 mm Hg. His conjunctivae are pale. Cardiac examination shows a late systolic crescendo-decrescendo murmur at the right upper sternal border. Laboratory studies show: Leukocyte Count 9,500/mm3 Hematocrit 24% Platelet Count 178,000/mm3 LDH 215 U/L Haptoglobin 22 mg/dL (N=41–165 mg/dL) Serum Na+ 140 mEq/L K+ 4.6 mEq/L CL- 100 mEq/L HCO3- 25 mEq/L Urea nitrogen 21 mg/dL Creatinine 1.2 mg/dL Total bilirubin 1.9 mg/dL A peripheral blood smear is shown. Which of the following is the most likely cause of this patient's anemia?"? {'A': 'Autoimmune destruction of erythrocytes', 'B': 'Occult blood loss', 'C': 'Erythrocyte membrane fragility', 'D': 'Erythrocyte enzyme defect', 'E': 'Mechanical destruction of erythrocytes'},
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E: Mechanical destruction of erythrocytes
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Q:A 17-year-old girl comes in to her primary care physician's office for an athletic physical. She is on her school’s varsity swim team. She states she is doing “ok” in her classes. She is worried about her upcoming swim meet. She states, “I feel like I’m the slowest one on the team. Everyone is way more fit than I am.” The patient has polycystic ovarian syndrome and irregular menses, and her last menstrual period was 5 weeks ago. She takes loratadine, uses nasal spray for her seasonal allergies, and uses ibuprofen for muscle soreness occasionally. The patient’s body mass index (BMI) is 19 kg/m^2. On physical examination, the patient has dark circles under her eyes and calluses on the dorsum of her right hand. A beta-hCG is negative. Which of the following is associated with the patient’s most likely condition?? {'A': 'Dental cavities', 'B': 'Galactorrhea', 'C': 'Lanugo', 'D': 'Metatarsal stress fractures', 'E': 'Motor tics'},
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A: Dental cavities
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Q:After being warned by the locals not to consume the freshwater, a group of American backpackers set off on a week-long hike into a region of the Ecuadorean Amazon forest known for large gold mines. The group of hikers stopped near a small stream and used the water they filtered from the stream to make dinner. Within the next half hour, the hikers began to experience headaches, vertigo, visual disturbances, confusion, tachycardia, and altered levels of consciousness. Which of the following enzymes was most likely inhibited in this group of hikers?? {'A': 'NADH dehydrogenase', 'B': 'Succinate dehydrogenase', 'C': 'Cytochrome bc1 complex', 'D': 'Cytochrome c oxidase', 'E': 'ATP synthase'},
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D: Cytochrome c oxidase
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Q:A 50-year-old woman comes to the emergency department because of fever and productive cough with blood in the sputum for 1 day. She also reports a sharp pain under her ribs that is worsened on taking deep breaths. Over the past 2 years, she has had repeated episodes of sinusitis, for which she used over the counter medication. She has recently started a new job at a wire-mesh factory. Her temperature is 38.3°C (100.9 °F), pulse is 72/min, respirations are 16/min, and blood pressure is 120/80 mm Hg. Physical examination shows palpable nonblanching skin lesions over her hands and feet. Examination of the nasal cavity shows ulcerations of the nasopharyngeal mucosa and a small septal perforation. Pulmonary examination shows stridor on inspiration. Laboratory studies show: Hemoglobin 13.2 g/dL Leukocyte count 10,300/mm3 Platelet count 205,000/mm3 Serum Urea nitrogen 24 mg/dL Creatinine 2.4 mg/dL Urine Protein 2+ RBC 70/hpf RBC casts numerous WBC 1–2/hpf A chest x-ray shows multiple cavitating, nodular lesions bilaterally. Which of the following additional findings is most likely to be present in this patient?"? {'A': 'Increased c-ANCA titers', 'B': 'Decreased ADAMTS13 activity', 'C': 'Increased p-ANCA titers', 'D': 'Increased anti-GBM titers', 'E': 'Increased anti-Smith titers'},
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A: Increased c-ANCA titers
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Q:A 52-year-old man presents with a 5-week history of multiple cutaneous ulcers on his left forearm and neck, which he first noticed after returning from a 2-month stay in rural Peru. He does not recall any trauma or arthropod bites. The lesions began as non-pruritic erythematous papules that became enlarged, ulcerated, and crusted. There is no history of fever or abdominal pain. He has been sexually active with a single partner since their marriage at 24 years of age. The physical examination reveals erythematous, crusted plaques with central ulceration and a raised border. There is no fluctuance, drainage, or sporotrichoid spread. A punch biopsy was performed, which revealed an ulcerated lesion with a mixed inflammatory infiltrate. Amastigotes within dermal macrophages are seen on Giemsa staining. What is the most likely diagnosis?? {'A': 'Histoplasmosis', 'B': 'Cutaneous leishmaniasis', 'C': 'Ecthyma', 'D': 'Syphilis', 'E': 'Cutaneous tuberculosis'},
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B: Cutaneous leishmaniasis
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Q:A 2-year-old boy is brought in to the pediatrician by his mother because she is concerned that he is not gaining weight. She reports that the patient has a good appetite, eats a varied diet of solid foods, and drinks 2 cups of milk a day. The patient’s mother also reports that he has foul-smelling stools over 6 times a day. The patient has a history of recurrent bronchiectasis and chronic sinusitis. On physical examination, multiple nasal polyps are appreciated and scattered rhonchi are heard over both lung fields. The patient is below the 25th percentile in height and weight. Genetic testing is ordered to confirm the suspected diagnosis. Which of the following is most common complication associated with the patient’s most likely diagnosis?? {'A': 'Asthma', 'B': 'Inferior lens dislocation', 'C': 'Infertility', 'D': 'Lymphoma', 'E': 'Meconium ileus'},
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C: Infertility
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Q:A 42-year-old man comes to the physician because of a 2-month history of fatigue and increased urination. The patient reports that he has been drinking more than usual because he is constantly thirsty. He has avoided driving for the past 8 weeks because of intermittent episodes of blurred vision. He had elevated blood pressure at his previous visit but is otherwise healthy. Because of his busy work schedule, his diet consists primarily of fast food. He does not smoke or drink alcohol. He is 178 cm (5 ft 10 in) tall and weighs 109 kg (240 lb); BMI is 34 kg/m2. His pulse is 75/min and his blood pressure is 148/95 mm Hg. Cardiopulmonary examination shows no abnormalities. Laboratory studies show: Hemoglobin A1c 6.8% Serum Glucose 180 mg/dL Creatinine 1.0 mg/dL Total cholesterol 220 mg/dL HDL cholesterol 50 mg/dL Triglycerides 140 mg/dL Urine Blood negative Glucose 2+ Protein 1+ Ketones negative Which of the following is the most appropriate next step in management?"? {'A': 'Fibrates therapy', 'B': 'Insulin therapy', 'C': 'ACE inhibitor therapy', 'D': 'Aspirin therapy', 'E': 'Low-carbohydrate diet'},
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C: ACE inhibitor therapy
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Q:A 3-year-old girl with no significant past medical history presents to the clinic with a 4-day history of acute onset cough. Her parents have recently started to introduce several new foods into her diet. Her vital signs are all within normal limits. Physical exam is significant for decreased breath sounds on the right. What is the most appropriate definitive management in this patient?? {'A': 'Chest x-ray (CXR)', 'B': 'Rigid broncoscopy', 'C': 'Inhaled bronchodilators and oral corticosteroids', 'D': 'Flexible broncoscopy', 'E': 'Empiric antibiotic therapy'},
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B: Rigid broncoscopy
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Q:A 14-year-old boy presents with his mother complaining of a swollen, red, painful left knee. His physician aspirates the joint and discovers frank blood. The patient denies a recent history of trauma to the knee. Upon further discussion, the mother describes that her son has had multiple swollen painful joints before, often without evidence of trauma. She also mentions a history of frequent nosebleeds and gum bleeding following visits to the dentist. Which of the following is the most likely underlying diagnosis?? {'A': 'Hemophilia A', 'B': 'Hemophilia B', 'C': 'Hemophilia C', 'D': 'Factor VII deficiency', 'E': 'Child abuse'},
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A: Hemophilia A
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Q:A 25-year-old man comes to the emergency department with right knee pain. He was playing soccer when an opposing player tackled him from the side and they both fell down. He immediately heard a popping sound and felt severe pain in his right knee that prevented him from standing or walking. On physical examination, his right knee is swollen and there is local tenderness, mostly at the medial aspect. External rotation of the right knee elicits a significant sharp pain with a locking sensation. Which of the following structures is most likely injured?? {'A': 'Anterior cruciate ligament', 'B': 'Posterior cruciate ligament', 'C': 'Medial collateral ligament', 'D': 'Medial meniscus tear', 'E': 'Lateral meniscus tear'},
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D: Medial meniscus tear
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Q:A 46-year-old man comes to the emergency department because of sharp pain in his left flank that began suddenly 30 minutes ago. Physical examination shows costovertebral angle tenderness on the left side. A photomicrograph of the urine is shown. The patient is most likely to benefit from an increase of which of the following components in the urine?? {'A': 'Sodium', 'B': 'Citrate', 'C': 'Hydrogen', 'D': 'Oxalate', 'E': 'Phosphate'},
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B: Citrate
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Q:A 24-year-old man comes to the physician for a 1-week history of a painless swelling on the right side of his neck that he noticed while showering. He is 203 cm (6 ft 8 in) tall and weighs 85 kg (187 lb); BMI is 21 kg/m2. Physical examination shows long, thin fingers and an increased arm-length to body-height ratio. Examination of the neck shows a single 2-cm firm nodule. Ultrasonography of the neck shows a hypoechoic thyroid lesion with irregular margins. A core needle biopsy of the thyroid lesion shows sheets of polygonal cells surrounded by Congo red-stained amorphous tissue. Which of the following additional findings is most likely in this patient?? {'A': 'Gastric ulcers', 'B': 'Oral tumors', 'C': 'Recurrent hypoglycemia', 'D': 'Kidney stones', 'E': 'Breast enlargement'},
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B: Oral tumors
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Q:A 2-day-old newborn boy is brought to the emergency department because of apnea, cyanosis, and seizures. He is severely hypoglycemic and does not improve with glucagon administration. His blood pressure is 100/62 mm Hg and heart rate is 75/min. Blood tests show high lactate levels. Physical examination is notable for hepatomegaly. Which of the following enzymes is most likely to be deficient in this baby?? {'A': 'Glucose-6-phosphatase', 'B': 'Glucocerebrosidase', 'C': 'Phenylalanine hydroxylase', 'D': 'Sphingomyelinase', 'E': 'α-ketoacid dehydrogenase'},
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A: Glucose-6-phosphatase
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Q:An American pediatrician travels to Bangladesh on a medical mission. While working in the local hospital's emergency room, she sees a 2-week-old boy who was brought in by his mother with muscle spasms and difficulty sucking. The mother gave birth at home at 38 weeks gestation and was attended to by her older sister who has no training in midwifery. The mother had no prenatal care. She has no past medical history and takes no medications. The family lives on a small fishing vessel on a major river, which also serves as their fresh water supply. The boy's temperature is 99°F (37.2°C), blood pressure is 100/60 mmHg, pulse is 130/min, and respirations are 22/min. On exam, the boy's arms are flexed at the elbow, his knees are extended, and his neck and spine are hyperextended. Tone is increased in the bilateral upper and lower extremities. He demonstrates sustained facial muscle spasms throughout the examination. The umbilical stump is foul-smelling. Cultures are taken, and the appropriate treatment is started. This patient's condition is most likely caused by a toxin with which of the following functions?? {'A': 'Binding to MHC II and the T cell receptor simultaneously', 'B': 'Blocking release of acetylcholine', 'C': 'Blocking release of GABA and glycine', 'D': 'Blocking voltage-gated calcium channel opening', 'E': 'Blocking voltage-gated sodium channel opening'},
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C: Blocking release of GABA and glycine
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Q:A 12-year-old boy is brought to the physician because of increased frequency of micturition over the past month. He has also been waking up frequently during the night to urinate. Over the past 2 months, he has had a 3.2-kg (7-lb) weight loss. There is no personal or family history of serious illness. He is at 40th percentile for height and weight. Vital signs are within normal limits. Physical examination shows no abnormalities. Serum concentrations of electrolytes, creatinine, and osmolality are within the reference range. Urine studies show: Blood negative Protein negative Glucose 1+ Leukocyte esterase negative Osmolality 620 mOsmol/kg H2O Which of the following is the most likely cause of these findings?"? {'A': 'Insulin resistance', 'B': 'Elevated thyroxine levels', 'C': 'Infection of the urinary tract', 'D': 'Insulin deficiency', 'E': 'Inadequate ADH secretion'},
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D: Insulin deficiency
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Q:A 40-year-old man comes to his doctor because of 2 weeks of progressively worsening pain on the outer side of his right elbow. He does not recall any trauma to the area. The patient plays tennis recreationally and has recently gone from playing weekly to playing daily in preparation for a local tournament. He has had some pain relief with ibuprofen. On physical examination, there is tenderness over the lateral surface of the right distal humerus. The pain is reproduced by supinating the forearm against resistance. Which of the following is the most likely underlying cause of this patient's condition?? {'A': 'Nerve compression at the elbow', 'B': 'Bursal inflammation', 'C': 'Repeated wrist flexion', 'D': 'Excessive stress to bone', 'E': 'Repeated wrist extension'},
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E: Repeated wrist extension
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Q:A 3-week old boy is brought to the physician for the evaluation of lethargy, recurrent vomiting, and poor weight gain since birth. Physical examination shows decreased skin turgor and a bulging frontal fontanelle. Serum studies show an ammonia concentration of 170 μmol/L (N < 30) and low serum citrulline levels. The oral intake of which of the following nutrients should be restricted in this patient?? {'A': 'Fructose', 'B': 'Protein', 'C': 'Vitamin A', 'D': 'Gluten', 'E': 'Lactose'},
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B: Protein
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Q:A 57-year-old man presents for a regular check-up. He does not have any complaints at the time of presentation. He has a history of several episodes of acute non-necrotizing pancreatitis with the last episode being 2 years ago. Also, he was diagnosed with hypertension 5 years ago. Currently, he takes aspirin, atorvastatin, enalapril, and indapamide. He plays tennis twice a week, does low impact cardio workouts 3 times a week, and follows a low-fat diet. He smokes half a pack of cigarettes per day and refuses to quit smoking. The patient’s blood pressure is 140/85 mm Hg, heart rate is 88/min, respiratory rate is 14/min, and temperature is 36.6°C (97.9°F). His height is 181 cm (5 ft 11 in), weight is 99 kg (218 lb), and BMI is 30.8 kg/m2. Physical examination reveals multiple xanthomas on the patient’s trunk, elbows, and knees. Heart sounds are diminished with fixed splitting of S2 and an increased aortic component. The rest of the examination is unremarkable. The patient’s lipid profile shows the following results: Total serum cholesterol 235.9 mg/dL HDL 46.4 mg/dL LDL 166.3 mg/dL Triglycerides 600 mg/dL Glucose 99 mg/dL Which of the following modifications should be made to the patient’s therapy?? {'A': 'Add simvastatin', 'B': 'Add fenofibrate', 'C': 'Add metformin', 'D': 'Add aprotinin', 'E': 'Increase atorvastatin dosage'},
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B: Add fenofibrate
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Answer the following medical question with one of the provided options:
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Q:A 38-year-old woman comes to the physician because of a 4-day history of swelling and pain in her left knee. She has had similar episodes of swollen joints over the past 3 weeks. Two months ago, she had a rash on her upper back that subsided after a few days. She lives in Pennsylvania and works as a forest ranger. Her temperature is 37.8°C (100°F). Physical examination shows a tender and warm left knee. Arthrocentesis of the knee joint yields cloudy fluid with a leukocyte count of 65,000/mm3 and 80% neutrophils. A Gram stain of synovial fluid does not show any organisms. Which of the following is the most likely cause of this patient's condition?? {'A': 'Production of autoantibodies against Fc portion of IgG', 'B': 'Wearing down of articular cartilage', 'C': 'Infection with round bacteria in clusters', 'D': 'Postinfectious activation of innate lymphoid cells of the gut', 'E': 'Infection with spiral-shaped bacteria'},
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E: Infection with spiral-shaped bacteria
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Q:A 65-year-old man is brought to the emergency department from his home. He is unresponsive. His son requested a wellness check because he had not heard from his father in 2 weeks. He reports that his father was sounding depressed during a telephone. The paramedics found a suicide note and a half-empty bottle of antifreeze near the patient. The medical history includes hypertension and hyperlipidemia. The vital signs include: blood pressure 120/80 mm Hg, respiratory rate 25/min, heart rate 95/min, and temperature 37.0°C (98.5°F). He is admitted to the hospital. What do you expect the blood gas analysis to show?? {'A': 'Metabolic alkalosis', 'B': 'Anion gap metabolic acidosis', 'C': 'Mixed acid-base disorder', 'D': 'Respiratory acidosis', 'E': 'Non-anion gap metabolic acidosis'},
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B: Anion gap metabolic acidosis
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Answer the following medical question with one of the provided options:
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Q:A 24-year-old man presents to the postoperative unit after undergoing an appendectomy following 2 episodes of acute appendicitis. He complains of nausea and vomiting. On physical examination, his temperature is 36.9°C (98.4ºF), pulse rate is 96/minute, blood pressure is 122/80 mm Hg, and respiratory rate is 14/minute. His abdomen is soft on palpation, and bowel sounds are normoactive. Intravenous ondansetron is administered, and the patient reports relief from his symptoms. Which of the following best explains the mechanism of action of this drug?? {'A': 'Inhibition of gastroesophageal motility', 'B': 'Inhibition of dopamine receptors on chemoreceptor trigger zone (CTZ)', 'C': 'Stimulation of 5-HT3 receptors on the nucleus of the tractus solitarius', 'D': 'Stimulation of intestinal and colonic motility', 'E': 'Inhibition of serotonin receptors on the vagal and spinal afferent nerves from the intestines'},
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E: Inhibition of serotonin receptors on the vagal and spinal afferent nerves from the intestines
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Answer the following medical question with one of the provided options:
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Q:A pharmaceutical company is studying a new drug that inhibits the glucose transporter used by intestinal enterocytes to absorb glucose into the body. The drug was designed such that it would act upon the glucose transporter similarly to how cyanide acts upon cytochrome proteins. During pre-clinical studies, the behavior of this drug on the activity of the glucose transporter is examined. Specifically, enterocyte cells are treated with the drug and then glucose is added to the solution at a concentration that saturates the activity of the transporter. The transport velocity and affinity of the transporters under these conditions are then measured. Compared to the untreated state, which of the following changes would most likely be seen in these transporters after treatment?? {'A': 'Decreased Km and decreased Vmax', 'B': 'Increased Km and decreased Vmax', 'C': 'Increased Km and unchanged Vmax', 'D': 'Unchanged Km and decreased Vmax', 'E': 'Unchanged Km and unchanged Vmax'},
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D: Unchanged Km and decreased Vmax
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Q:A 28-year-old G1P1 woman is brought into the clinic by her concerned husband. The husband has noted that his wife is not behaving normally. She no longer enjoys his company or is not particularly happy around their newborn. The newborn was delivered 3 weeks ago via normal vaginal delivery with no complications. He also notes that his wife seems to be off in some other world with her thoughts. Overall, she appears to be drained, and her movements and speech seem slow. The patient complains that the newborn is sucking the lifeforce from her when she breastfeeds. She has thus stopped eating to save herself from this parasite. Which of the following statements is true regarding this patient’s most likely condition?? {'A': 'If symptoms present within a month after delivery and treatment occurs promptly, the prognosis is good', 'B': 'Risk for this patient’s condition increases with each pregnancy', 'C': 'This patient’s condition is self-limited', 'D': 'Ziprasidone is the first-line pharmacotherapy recommended for this patient’s condition', 'E': 'Electroconvulsive therapy is the first-line therapy for this patient’s condition'},
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A: If symptoms present within a month after delivery and treatment occurs promptly, the prognosis is good
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Q:A 31-year-old man comes to the physician because of worsening abdominal pain, an inability to concentrate at work, and a general lack of motivation over the past several months. He has a history of spontaneous passage of two kidney stones. His father and uncle underwent thyroidectomy before the age of 35 for thyroid cancer. Physical examination shows diffuse tenderness over the abdomen. Serum studies show: Na+ 142 mEq/L K+ 3.7 mEq/L Glucose 131 mg/dL Ca2+ 12.3 mg/dL Albumin 4.1 g/dL Parathyroid hormone 850 pg/mL Further evaluation is most likely to show elevated levels of which of the following?"? {'A': 'Serum prolactin', 'B': 'Serum aldosterone to renin ratio', 'C': 'Midnight salivary cortisol', 'D': 'Urine 5-hydroxyindoleacetic acid', 'E': 'Urine metanephrines'},
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E: Urine metanephrines
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Answer the following medical question with one of the provided options:
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Q:A 45-year-old HIV-positive male presents to his primary care physician complaining of decreased libido. He reports that he has been unable to maintain an erection for the past two weeks. He has never encountered this problem before. He was hospitalized four weeks ago for cryptococcal meningitis and has been on long-term antifungal therapy since then. His CD4 count is 400 cells/mm^3 and viral load is 5,000 copies/ml. He was previously non-compliant with HAART but since his recent infection, he has been more consistent with its use. His past medical history is also notable for hypertension, major depressive disorder, and alcohol abuse. He takes lisinopril and sertraline. His temperature is 98.6°F (37°C), blood pressure is 120/85 mmHg, pulse is 80/min, and respirations are 18/min. The physician advises the patient that side effects like decreased libido may manifest due to a drug with which of the following mechanisms of action?? {'A': 'Inhibition of pyrimidine synthesis', 'B': 'Inhibition of beta-glucan synthesis', 'C': 'Formation of pores in cell membrane', 'D': 'Disruption of microtubule formation', 'E': 'Inhibition of ergosterol synthesis'},
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E: Inhibition of ergosterol synthesis
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Answer the following medical question with one of the provided options:
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Q:A 78-year-old right-handed man with hypertension and hyperlipidemia is brought to the emergency department for sudden onset of nausea and vertigo one hour ago. Physical examination shows 5/5 strength in all extremities. Sensation to light touch and pinprick is decreased in the right arm and leg. A CT scan of the brain shows an acute infarction in the distribution of the left posterior cerebral artery. Further evaluation of this patient is most likely to show which of the following findings?? {'A': 'Left-sided hemineglect', 'B': 'Right-sided homonymous hemianopia', 'C': 'Left-sided gaze deviation', 'D': 'Prosopagnosia', 'E': 'Right-sided superior quadrantanopia'},
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B: Right-sided homonymous hemianopia
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Answer the following medical question with one of the provided options:
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Q:A 50-year-old man comes to the physician because of gradually worsening rhythmic movements of his right hand for the past 5 months. His symptoms worsen when he is in a meeting and he is concerned that people are noticing it more frequently. There is no personal or family history of serious illness, but the patient recalls that his father developed bobbing of the head in older age. He takes no medications. Neurological examination shows a tremor of the right hand when the limbs are relaxed. When the patient is asked to move his arm the tremor decreases. He has reduced arm swing while walking. Which of the following is the most appropriate pharmacotherapy?? {'A': 'Donepezil', 'B': 'Trihexyphenidyl', 'C': 'Clonazepam', 'D': 'Propranolol', 'E': 'Levodopa/carbidopa'},
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B: Trihexyphenidyl
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Answer the following medical question with one of the provided options:
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Q:A 71-year-old man comes to the physician for routine health maintenance examination. He feels well. He has hypertension and gastroesophageal reflux disease. Current medications include metoprolol and pantoprazole. He does not smoke or drink alcohol. Temperature is 37.3°C (99.1°F), pulse is 75/min, and blood pressure 135/87 mm Hg. Examination shows no abnormalities. Laboratory studies show: Hematocrit 43% Leukocyte count 32,000/mm3 Segmented neutrophils 22% Basophils 1% Eosinophils 2% Lymphocytes 74% Monocytes 1% Platelet count 190,000/mm3 Blood smear shows small, mature lymphocytes and several smudge cells. Immunophenotypic analysis with flow cytometry shows B-cells that express CD19, CD20 and CD23. Which of the following is the most appropriate next step in management?"? {'A': 'Stem cell transplantation', 'B': 'All-trans retinoic acid', 'C': 'Observation and follow-up', 'D': 'Fludarabine, cyclophosphamide, and rituximab', 'E': 'Imatinib'},
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C: Observation and follow-up
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Answer the following medical question with one of the provided options:
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Q:29-year-old G2P2002 presents with foul-smelling lochia and fever. She is post-partum day three status-post cesarean section due to eclampsia. Her temperature is 101 F, and heart rate is 103. She denies chills. On physical exam, lower abdominal and uterine tenderness is present. Leukocytosis with left shift is seen in labs. Which of the following is the next best step in management?? {'A': 'Endometrial culture', 'B': 'Blood culture', 'C': 'Intravenous clindamycin and gentamicin treatment', 'D': 'Intramuscular cefotetan treatment', 'E': 'Prophylactic intravenous cefazolin treatment'},
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C: Intravenous clindamycin and gentamicin treatment
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Q:A 23-year-old man presents with fatigue and increased daytime somnolence. He says his symptoms began gradually 6 months ago and have progressively worsened and have begun to interfere with his job as a computer programmer. He is also bothered by episodes of paralysis upon waking from naps and reports visual hallucinations when falling asleep at night. He has been under the care of another physician for the past several months, who prescribed him the standard pharmacotherapy for his most likely diagnosis. However, he has continued to experience an incomplete remission of symptoms and has been advised against increasing the dose of his current medication because of an increased risk of adverse effects. Which of the following side effects is most closely associated with the standard drug treatment for this patient’s most likely diagnosis?? {'A': 'Cardiac irregularities, nervousness, hallucinations', 'B': 'Loss of concentration, memory impairment', 'C': 'Parkinsonism and tardive dyskinesia', 'D': 'Nephrogenic diabetes insipidus', 'E': 'Weight gain and metabolic syndrome'},
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A: Cardiac irregularities, nervousness, hallucinations
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Answer the following medical question with one of the provided options:
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Q:Which of the following physiologic changes decreases pulmonary vascular resistance (PVR)?? {'A': 'Inhaling the inspiratory reserve volume (IRV)', 'B': 'Exhaling the expiratory reserve volume (ERV)', 'C': 'Inhaling the entire vital capacity (VC)', 'D': 'Exhaling the entire vital capacity (VC)', 'E': 'Breath holding maneuver at functional residual capacity (FRC)'},
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E: Breath holding maneuver at functional residual capacity (FRC)
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Q:A 37-year-old G2P1 woman presents to the clinic complaining of amenorrhea. She reports that she has not had a period for 2 months. A urine pregnancy test that she performed yesterday was negative. She is sexually active with her husband and uses regular contraception. Her past medical history is significant for diabetes and a dilation and curettage procedure 4 months ago for an unviable pregnancy. She denies any discharge, abnormal odor, abnormal bleeding, dysmenorrhea, or pain but endorses a 10-pound intentional weight loss over the past 3 months. A pelvic examination is unremarkable. What is the most likely explanation for this patient’s presentation?? {'A': 'Extreme weight loss', 'B': 'Intrauterine adhesions', 'C': 'Polycystic ovarian syndrome', 'D': 'Pregnancy', 'E': 'Premature menopause'},
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B: Intrauterine adhesions
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Q:A 3-month old male infant with HIV infection is brought to the physician for evaluation. The physician recommends monthly intramuscular injections of a monoclonal antibody to protect against a particular infection. The causal pathogen for this infection is most likely transmitted by which of the following routes?? {'A': 'Aerosol inhalation', 'B': 'Blood transfusion', 'C': 'Skin inoculation', 'D': 'Breast feeding', 'E': 'Fecal-oral route'},
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A: Aerosol inhalation
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Answer the following medical question with one of the provided options:
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Q:A 67-year-old man presents to the emergency department with a 1-hour history of nausea and upper abdominal and substernal chest pain radiating to his lower jaw. He vomited several times before arriving at the hospital. His last visit to the primary care physician was 6 months ago during which he complained of fatigue, ‘slowing down’ on his morning walks, and abdominal pain that exacerbated by eating spicy food. His current medications include atorvastatin, metformin, insulin, omeprazole, aspirin, enalapril, nitroglycerin, and metoprolol. Today, his blood pressure is 95/72 mm Hg in his right arm and 94/73 in his left arm, heart rate is 110/min, temperature is 37.6°C (99.6°F), and respiratory rate is 30/min. On physical examination, he is diaphoretic and his skin is cool and clammy. His cardiac enzymes were elevated. He is treated appropriately and is admitted to the hospital. On day 5 of his hospital stay, he suddenly develops breathlessness. His blood pressure drops to 80/42 mm Hg. On examination, bibasilar crackles are heard. Cardiac auscultatory reveals a high pitched holosystolic murmur over the apex. Which of the following most likely lead to the deterioration of this patient’s condition?? {'A': 'Scarring of mitral valve as a complication of childhood illness', 'B': 'Age-related fibrosis and calcification of the aortic valve', 'C': 'Aortic root dilation', 'D': 'Ballooning of mitral valve into the left atrium', 'E': 'Papillary muscle rupture leading to reflux of blood into left atrium'},
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E: Papillary muscle rupture leading to reflux of blood into left atrium
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