instruction
stringclasses 5
values | input
stringlengths 10
4.2k
| output
stringlengths 1
7.16k
|
|---|---|---|
Answer the following medical question with one of the provided options:
|
Q:An otherwise healthy 42-year-old man undergoes routine investigations prior to blood donation. His complete blood count is shown: Hemoglobin 9.3 g/dL Mean corpuscular volume (MCV) 71 μm3 Mean corpuscular hemoglobin (MCH) 21 pg/cell White blood cell count 8,200/mm3 Platelet count 317,000/mm3 Iron studies are shown: Serum iron 210 μg/dL Serum ferritin 310 ng/mL Total iron binding capacity (TIBC) 290 μg/dL Transferrin saturation 78% He occasionally drinks alcohol and denies smoking or use of illicit drugs. There is a family history of anemia including his brother and maternal uncle. Examination shows conjunctival pallor, but is otherwise unremarkable. Which of the following is the most likely diagnosis?? {'A': 'Anemia of chronic disease', 'B': 'Hemochromatosis', 'C': 'Acute myeloid leukemia', 'D': 'Myelodysplastic syndrome', 'E': 'Sideroblastic anemia'},
|
E: Sideroblastic anemia
|
Answer the following medical question with one of the provided options:
|
Q:A 7-year-old girl is brought by her parents to her pediatrician’s office for a persistent cough observed over the past month. She was diagnosed with cystic fibrosis 2 years ago and his been receiving chest physiotherapy regularly and the flu vaccine yearly. Her parents tell the pediatrician that their daughter has been coughing day and night for the past month, and produces thick, purulent, foul-smelling sputum. They are concerned because this is the first time such an episode has occurred. She has not had a fever, chills or any other flu-like symptoms. On examination, her blood pressure is 100/60 mm Hg, the pulse is 82/min, and the respiratory rate is 16/min. Breath sounds are reduced over the lower lung fields along with a presence of expiratory wheezing. Her sputum culture comes back positive for an aerobic, non-lactose fermenting, oxidase-positive, gram-negative bacillus. Which of the following prophylactic regimes should be considered after treating this patient for her current symptoms?? {'A': 'Oral amoxicillin/clavulanic acid', 'B': 'Inhaled levofloxacin', 'C': 'Inhaled tobramycin', 'D': 'Oral trimethoprim-sulfamethoxazole', 'E': 'Oral ciprofloxacin'},
|
C: Inhaled tobramycin
|
Answer the following medical question with one of the provided options:
|
Q:A 22-year-old man presents with lower limb weakness for the past 2 days. The patient says that the weakness started in both his feet, manifesting as difficulty walking, but it has progressed to where he cannot move his legs completely and has become bedbound. He also has experienced a recent history of numbness and tingling sensations in both his feet. He denies any recent history of fever, backache, urinary or bowel incontinence, trauma, shortness of breath, or diplopia. His past medical history is remarkable for a viral flu-like illness 2 weeks ago. The patient is afebrile, and his vital signs are within normal limits. On physical examination, muscle strength in both lower limbs is 1/5. The muscle strength in the upper limbs is ⅘ bilaterally. Sensation to pinprick is decreased in both lower limbs in a stocking distribution. The sensation is intact in the upper limbs bilaterally. Knee and ankle reflexes are absent bilaterally. The laboratory findings are significant for the following: Hemoglobin 14.2 g/dL White blood cell count 8,250/mm3 Platelet count 258,000/mm3 BUN 14 mg/dL Creatinine 0.9 mg/dL Serum sodium 144 mEq/L Serum potassium 3.9 mEq/L Which of the following tests would most likely confirm the diagnosis in this patient?? {'A': 'Acetylcholine receptor antibodies', 'B': 'Serum creatine kinase', 'C': 'MRI of the lumbosacral spine', 'D': 'Muscle biopsy', 'E': 'Nerve conduction studies'},
|
E: Nerve conduction studies
|
Answer the following medical question with one of the provided options:
|
Q:An 11-year-old girl presents to the emergency department with a 12-hour history of severe abdominal pain. She says that the pain started near the middle of her abdomen and moved to the right lower quadrant after about 10 hours. Several hours after the pain started she also started experiencing nausea and loss of appetite. On presentation, her temperature is 102.5°F (39.2°C), blood pressure is 115/74 mmHg, pulse is 102/min, and respirations are 21/min. Physical exam reveals rebound tenderness in the right lower quadrant. Raising the patient's right leg with the knee flexed significantly increases the pain. Which of the following is the most common cause of this patient's symptoms in children?? {'A': 'Fecalith obstruction', 'B': 'Ingestion of indigestible object', 'C': 'Lymphoid hyperplasia', 'D': 'Meckel diverticulum', 'E': 'Parasitic infection'},
|
C: Lymphoid hyperplasia
|
Answer the following medical question with one of the provided options:
|
Q:A 40-year-old female presents to her gynecologist with dysmenorrhea, menorrhagia, and pelvic pain. The patient is not taking any medication and has no evidence of fever. Transvaginal sonogram reveals an enlarged, soft, and tender uterus, and uterine biopsy shows normal-appearing endometrial glands within the myometrium. Which of the following is the most likely diagnosis in this patient:? {'A': 'Adenomyosis', 'B': 'Endometriosis', 'C': 'Endometritis', 'D': 'Leiomyoma', 'E': 'Endometrial carcinoma'},
|
A: Adenomyosis
|
Answer the following medical question with one of the provided options:
|
Q:A 10-month-old girl is brought to the physician because of a 4-day history of irritability and a rash. Her temperature is 37.7°C (99.9°F). Examination of the skin shows flaccid, transparent blisters and brown crusts on her chest and upper extremities. Application of a shear force to normal skin causes sloughing. Which of the following is the most likely underlying cause of this patient's condition?? {'A': 'Type IV hypersensitivity reaction', 'B': 'Exfoliative toxin A release', 'C': 'Streptococcus pyogenes infection', 'D': 'Uroporphyrin accumulation', 'E': 'Anti-hemidesmosome antibody formation'},
|
B: Exfoliative toxin A release
|
Answer the following medical question with one of the provided options:
|
Q:A 49-year-old man is referred to a cardiologist by his primary care provider (PCP) for a new heart murmur. He otherwise feels well and has no complaints. He had not seen a doctor in the last 15 years but finally went to his PCP for a check-up at the urging of his girlfriend. His past medical history is notable for gastroesophageal reflux disease, hypertension, and hepatitis B. He takes omeprazole and lisinopril. He has a prior history of intravenous drug abuse and a 50-pack-year smoking history. He has had many prior sexual partners and uses protection intermittently. He reports that he may have had a sore on his penis many years ago, but it went away without treatment. His temperature is 99°F (37.2°C), blood pressure is 141/91 mmHg, pulse is 89/min, and respirations are 18/min. On exam, S1 is normal and S2 has a tambour-like quality. There is a visible and palpable pulsation in the suprasternal notch and a diastolic decrescendo murmur over the right upper sternal border. A chest radiograph demonstrates calcification of the aortic root. Which of the following is the most likely cause of this patient's condition?? {'A': 'Fibrinous plaque formation in the arterial intima', 'B': 'Neoplastic growth in the cardiac atria', 'C': 'Pericardial inflammation', 'D': 'Tricuspid valve inflammation', 'E': 'Vasa vasorum destruction'},
|
E: Vasa vasorum destruction
|
Answer the following medical question with one of the provided options:
|
Q:A 22-year-old woman, gravida 2, para 1, at 41 weeks' gestation is admitted to the hospital in active labor. Pregnancy has been uncomplicated. At the beginning of the second stage of labor, the cervix is 100% effaced and 10 cm dilated; the vertex is at -1 station. The fetal heart rate is reactive with no decelerations. As she pushes, it is noted that the fetal heart rate decreases, as seen on cardiotocography (CTG). Which of the following is the most likely cause of this finding?? {'A': 'Maternal hypotension', 'B': 'Placental insufficiency', 'C': 'Umbilical cord compression', 'D': 'Fetal myocardial depression', 'E': 'Fetal head compression'},
|
E: Fetal head compression
|
Answer the following medical question with one of the provided options:
|
Q:A 3400-g (7-lb 8-oz) female newborn is delivered at term to a 28-year-old primigravid woman. Apgar scores are 7 and 8 at 1 and 5 minutes, respectively. Vital signs are within normal limits. Examination shows swelling of bilateral upper and lower extremities and low-set ears. The posterior hair line is low and the chest appears broad. There are skin folds running down the sides of the neck to the shoulders. A grade 2/6 systolic ejection murmur and systolic click is heard at the apex. Which of the following is the most likely cause of this patient's swelling?? {'A': 'Renal retention of sodium', 'B': 'Dysfunctional lymphatic system', 'C': 'Impaired protein synthesis', 'D': 'Urinary protein loss', 'E': 'Increased capillary permeability'},
|
B: Dysfunctional lymphatic system
|
Answer the following medical question with one of the provided options:
|
Q:A 7-year-old boy is brought to the physician with a 2-day history of fever, chills, malaise, and a sore throat. He has otherwise been healthy and development is normal for his age. He takes no medications. His immunizations are up-to-date. His temperature is 38.4°C (101.4°F), pulse is 84/min, respirations are 16/min, and blood pressure is 121/71 mm Hg. Pulse oximetry shows an oxygen saturation of 100% on room air. Examination shows discrete 1–2-mm papulovesicular lesions on the posterior oropharynx and general erythema of the tonsils bilaterally. Which of the following conditions is most likely associated with the cause of this patient's findings?? {'A': 'Rheumatic fever', 'B': 'Burkitt lymphoma', 'C': 'Infective endocarditis', 'D': 'Herpetic whitlow', 'E': 'Hand, foot, and mouth disease'},
|
E: Hand, foot, and mouth disease
|
Answer the following medical question with one of the provided options:
|
Q:A 45-year-old obese woman presents to the office complaining of intermittent chest pain for the past 3 days. She states that the pain worsens when she lays down and after she eats her meals. She thinks that she has experienced similar pain before but does not remember it lasting this long. She also complains of a bitter taste in her mouth but is otherwise in no apparent distress. She has a history of asthma, a partial hysterectomy 4 years ago, and hypothyroidism that was diagnosed 7 years ago. She admits to drinking 5–6 cans of beer on weekend nights. Her blood pressure is 130/90 mm Hg, and her heart rate is 105/min. An ECG is performed that shows no abnormal findings. Which of the following is the most likely cause of her pain?? {'A': 'Erosion of the mucosa of the antrum of the stomach', 'B': 'Autodigestion of pancreatic tissue', 'C': 'Blockage of the cystic duct leading to inflammation of the wall of the gallbladder', 'D': 'An atherosclerotic blockage of a coronary artery causing transient ischemia during times of increased cardiac demand', 'E': 'Decreased lower esophageal sphincter tone'},
|
E: Decreased lower esophageal sphincter tone
|
Answer the following medical question with one of the provided options:
|
Q:A 42-year-old man presents with palpitations, 2 episodes of vomiting, and difficulty breathing for the past hour. He says he consumed multiple shots of vodka at a party 3 hours ago but denies any recent drug use. The patient denies any similar symptoms in the past. Past medical history is significant for type 2 diabetes mellitus diagnosed 2 months ago, managed with a single drug that has precipitated some hypoglycemic episodes, and hypothyroidism diagnosed 2 years ago, well-controlled medically. The patient is a software engineer by profession. He reports a 25-pack-year smoking history and currently smokes 1 pack a day. He drinks alcohol occasionally but denies any drug use. His blood pressure is 100/60 mm Hg, pulse is 110/min, and respiratory rate is 25/min. On physical examination, the patient appears flushed and diaphoretic. An ECG shows sinus tachycardia. Which of the following medications is this patient most likely taking to explain his symptoms? ? {'A': 'Tolbutamide', 'B': 'Sitagliptin', 'C': 'Metformin', 'D': 'Levothyroxine', 'E': 'Pioglitazone'},
|
A: Tolbutamide
|
Answer the following medical question with one of the provided options:
|
Q:A 9-year-old girl is brought to the physician by her father because of multiple episodes of staring and facial grimacing that have occurred over the past 3 weeks. There are no precipitating factors for these episodes and they last for several minutes. She does not respond to her family members during these episodes. One week ago, her brother witnessed an episode in which she woke up while sleeping, stared, and made hand gestures. She does not remember any of these episodes but does recall having a vague muddy taste in her mouth prior to the onset of these symptoms. After the episode, she feels lethargic and is confused. Physical and neurologic examinations show no abnormalities. Which of the following is the most likely diagnosis?? {'A': 'Generalized tonic-clonic seizures', 'B': 'Atonic seizure', 'C': 'Complex partial seizure', 'D': 'Breath-holding spell', 'E': 'Myoclonic seizure'},
|
C: Complex partial seizure
|
Answer the following medical question with one of the provided options:
|
Q:A 26-year-old man with a history of alcoholism presents to the emergency department with nausea, vomiting, and right upper quadrant pain. Serum studies show AST and ALT levels >5000 U/L. A suicide note is found in the patient's pocket. The most appropriate initial treatment for this patient has which of the following mechanisms of action?? {'A': 'Glutathione substitute', 'B': 'Heavy metal chelator', 'C': 'Opioid receptor antagonist', 'D': 'GABA receptor competitive antagonist', 'E': 'Competitive inhibitor of alcohol dehydrogenase'},
|
A: Glutathione substitute
|
Answer the following medical question with one of the provided options:
|
Q:A 45-year-old African American male presents to his primary care physician complaining of difficulty swallowing that was initially limited to solids but has now progressed to liquids. Biopsy of the esophagus reveals dysplastic cells, but does not show evidence of glands or increased mucin. Which of the following patient behaviors most contributed to his condition?? {'A': 'Obesity', 'B': 'Smoking', 'C': 'Drinking extremely hot beverages', 'D': 'Gastroesophageal reflux disease', 'E': 'Radiation exposure in the past 6 months'},
|
B: Smoking
|
Answer the following medical question with one of the provided options:
|
Q:A 7-year-old boy is being evaluated in pediatric cardiology clinic. He appears grossly normal, but suddenly becomes tachypneic and cyanotic when his mom takes a toy away from him. These symptoms resolve somewhat when he drops into a squatting position. Transthoracic echocardiography reveals pulmonic stenosis, a ventricular septal defect, right ventricular hypertrophy, and an overriding aorta. Which of the following best predicts the degree of cyanosis and other hypoxemic symptoms in this patient?? {'A': 'Degree of pulmonic stenosis', 'B': 'Size of ventricular septal defect (VSD)', 'C': 'Degree of right ventricular hypertrophy (RVH)', 'D': 'Degree to which aorta overrides right ventricle', 'E': 'Presence of S3'},
|
A: Degree of pulmonic stenosis
|
Answer the following medical question with one of the provided options:
|
Q:A 72-year-old man presents to his primary care provider at an outpatient clinic for ongoing management of his chronic hypertension. His past medical history is significant for diabetes and osteoarthritis though neither are currently being treated with medication. At this visit, his blood pressure is found to be 154/113 mmHg so he is started on lisinopril. After leaving the physician's office, he visits his local pharmacy and fills the prescription for lisinopril before going home. If this patient is insured by medicare with a prescription drug benefit provided by a private company through medicare, which of the following components of medicare are being used during this visit?? {'A': 'Part A alone', 'B': 'Part B alone', 'C': 'Parts A and B', 'D': 'Parts B and D', 'E': 'Parts A, B, C and D'},
|
D: Parts B and D
|
Answer the following medical question with one of the provided options:
|
Q:A 16-year-old boy presents to the emergency room with severe right shoulder pain following a painful overhead swing during a competitive volleyball match. On physical examination, the patient has limited active range of motion of the right shoulder and significant pain with passive motion. Suspecting a rotator cuff injury, the physician obtains an MRI, which indicates a minor tear in the tendon of the rotator cuff muscle that is innervated by the axillary nerve. Which of the following muscles was affected?? {'A': 'Infraspinatus', 'B': 'Subscapularis', 'C': 'Supraspinatus', 'D': 'Teres major', 'E': 'Teres minor'},
|
E: Teres minor
|
Answer the following medical question with one of the provided options:
|
Q:A rheumatologist is interested in studying the association between osteoporosis and the risk of sustaining a distal radius fracture. To explore this association, she develops a retrospective study design in which she identifies patients in a large institutional database over the age of 55 with and without osteoporosis, then follows them over a 10-year period to identify cases of distal radius fracture. She matches patients on age, sex, and body mass index to control for known confounding. After completing the study, she finds that patients with osteoporosis were at an increased risk of developing distal radius fractures. Which of the following study designs did this investigator use in this case?? {'A': 'Case-control study', 'B': 'Case series', 'C': 'Cohort study', 'D': 'Cross-sectional study', 'E': 'Ecological study'},
|
C: Cohort study
|
Answer the following medical question with one of the provided options:
|
Q:A 25-year-old female with no significant past medical history presents to her primary care physician with several weeks of increased fatigue and decreased exercise tolerance. On physical exam, her skin and conjunctiva appear pale. The physician suspects some form of anemia and orders a complete blood panel, which is remarkable for hemoglobin 11.7 g/dl, MCV 79 fL, MCHC 38% (normal 31.1-34%), and reticulocyte index 3.6%. Peripheral blood smear shows red blood cells with a lack of central pallor. This patient would most likely develop which of the following conditions?? {'A': 'Retinopathy', 'B': 'Aplastic anemia with parvovirus B19 infection', 'C': 'Stroke', 'D': 'Gallstones', 'E': 'Avascular necrosis of the femoral head'},
|
D: Gallstones
|
Answer the following medical question with one of the provided options:
|
Q:A 62-year-old man comes to his primary care physician with a 3-month history of insomnia and severe work anxiety. He says that he is unable to retire because he has no financial resources; however, the stress level at his work has been causing him to have worsening performance and he is afraid of being fired. He thinks that he would be able to resume work normally if he was able to decrease his level of anxiety. His physician prescribes him a trial 1-month regimen of benzodiazepine therapy and schedules a follow-up appointment to see whether this treatment has been effective. Three weeks later, the patient's wife calls and says "My husband was fired from work and it's your fault for prescribing that medication! I know he must have been taking too much of that drug. Don't you know that he had a horrible problem with drug abuse in his 30s?" Which of the following is the most appropriate first action for the physician to take?? {'A': 'Contact the patient directly to discuss the situation', 'B': "Contact the physician's medical practice insurance company regarding a potential claim", 'C': 'Discharge the patient for inappropriate use of medication', 'D': "Inform the patient's wife that this information cannot be accepted because of HIPAA", 'E': 'Refer the patient to a substance abuse program'},
|
A: Contact the patient directly to discuss the situation
|
Answer the following medical question with one of the provided options:
|
Q:A 53-year-old woman presents to a physician for a regular check-up. She has no complaints, but notes that she has been anxious and easily irritable for no particular reason over the past year. Six months ago, she was diagnosed with grade I arterial hypertension and prescribed lifestyle modification and weight loss to control her blood pressure. She currently takes aspirin (81 mg) and rosuvastatin (10 mg) daily. The vital signs are as follows: blood pressure 145/80 mm Hg, heart rate 81/min, respiratory rate 14/min, and temperature 36.6℃ (97.9℉). She weighs 91 kg (213.8 lb), the height is 167 cm (5.5 ft), and the BMI is 32.6 kg/m2. The physical examination is unremarkable. Blood testing was performed, and the results are shown below. Plasma glucose 109.9 mg/dL (6.1 mmol/L) Plasma triglycerides 185.8 mg/dL (2.1 mmol/L) Na+ 141 mEq/L K+ 4.2 mEq/L The patient was prescribed atenolol. If the medication alone affects the patient’s measurements, which laboratory finding would you expect to note several weeks after the treatment is initiated?? {'A': 'Plasma glucose 54 mg/dL (3.0 mmol/L)', 'B': 'Na+ 137 mEq/L', 'C': 'K+ 2.6 mEq/L', 'D': 'Plasma triglycerides 150.4 mg/dL (1.7 mmol/L)', 'E': 'Na+ 148 mEq/L'},
|
B: Na+ 137 mEq/L
|
Answer the following medical question with one of the provided options:
|
Q:A 43-year-old woman presents to her primary care physician with complaints of mild shortness of breath and right-sided chest pain for three days. She reports that lately she has had a nagging nonproductive cough and low-grade fevers. On examination, her vital signs are: temperature 99.1 deg F (37.3 deg C), blood pressure is 115/70 mmHg, pulse is 91/min, respirations are 17/min, and oxygen saturation 97% on room air. She is well-appearing, with normal work of breathing, and no leg swelling. She is otherwise healthy, with no prior medical or surgical history, currently taking no medications. The attending has a low suspicion for the most concerning diagnosis and would like to exclude it with a very sensitive though non-specific test. Which of the following should this physician order?? {'A': 'Obtain spiral CT chest with IV contrast', 'B': 'Obtain ventilation-perfusion scan', 'C': 'Obtain chest radiograph', 'D': 'Order a lower extremity ultrasound', 'E': 'Order a D-dimer'},
|
E: Order a D-dimer
|
Answer the following medical question with one of the provided options:
|
Q:A 29-year-old GP10 woman at 24 weeks estimated gestational age presents for follow-up. Six weeks ago, a complete blood count showed a microcytic hypochromic anemia for which she was prescribed iron sulfate tablets. A repeat complete blood count today shows no improvement in her hemoglobin level. Past medical history is significant for her being Rh-positive with an Rh-negative partner. She emigrated to the United States with her husband 7 years ago and did not have regular medical care in her country. An abdominal ultrasound shows findings consistent with hydrops fetalis. Which of the following is the most likely etiology of the condition of her fetus?? {'A': 'Deletion of 4 alpha-globin genes', 'B': 'Impaired synthesis of beta-globin chains', 'C': 'Pyruvate kinase deficiency', 'D': 'Rh incompatibility', 'E': 'Parvovirus infection'},
|
A: Deletion of 4 alpha-globin genes
|
Answer the following medical question with one of the provided options:
|
Q:A 17-year-old boy is brought to the physician because of a sore throat, nonproductive cough, and bloody urine for 3 days. He has had 2 similar episodes involving a sore throat and bloody urine over the past year. His sister has systemic lupus erythematosus. His temperature is 38.1°C (100.6°F). Serum studies show a urea nitrogen concentration of 8 mg/dL and a creatinine concentration of 1.4 mg/dL. Urinalysis shows acanthocytes and red blood cell casts. Renal ultrasonography shows no abnormalities. A renal biopsy is most likely to show which of the following findings?? {'A': 'IgA mesangial deposition', 'B': 'Capillary wire looping', 'C': 'Splitting of the glomerular basement membrane', 'D': 'Granular deposits of IgG, IgM, and C3 complement', 'E': 'Effacement of the foot processes'},
|
A: IgA mesangial deposition
|
Answer the following medical question with one of the provided options:
|
Q:A 34-year-old woman comes to the emergency department because of decreased appetite, nausea, vomiting, and episodic abdominal pain for the past two months. The pain is sharp, colicky, and lasts about an hour after meals. Her stools are light in appearance and difficult to flush. Physical examination shows tenderness in the right upper quadrant. Without treatment, this patient is at greatest risk for developing which of the following?? {'A': 'Glossitis', 'B': 'Megaloblastic anemia', 'C': 'Low bone mineral density', 'D': 'Delayed wound healing', 'E': 'Steatohepatitis'},
|
C: Low bone mineral density
|
Answer the following medical question with one of the provided options:
|
Q:Laboratory studies, including serum vitamin B12 (cyanocobalamin), thyroxine (T4), and thyroid-stimulating hormone concentrations, are within normal limits. A lumbar puncture is performed. Cerebrospinal fluid (CSF) analysis is most likely to show which of the following?? {'A': 'Antiganglioside GM1 antibodies', 'B': 'Increased α-synuclein protein concentration', 'C': 'Increased 14-3-3 protein concentration', 'D': 'Oligoclonal bands', 'E': 'Anti-glutamic acid decarboxylase antibodies'},
|
C: Increased 14-3-3 protein concentration
|
Answer the following medical question with one of the provided options:
|
Q:A 31-year-old woman presents to her primary care provider to discuss the results from a previous urine analysis. She has no new complaints and feels well. Past medical history is significant for systemic lupus erythematosus. She was diagnosed 5 years ago and takes hydroxychloroquine every day and prednisone when her condition flares. Her previous urine analysis shows elevated protein levels (4+) and blood (3+). The urine sediment contained red blood cells (6 RBCs/high-power field). The treating physician would like to perform a renal biopsy to rule out lupus nephritis. What type of hypersensitivity is suggestive of lupus nephritis?? {'A': 'Type IV, mediated by CD4+ T cells', 'B': 'Type II, mediated by CD4+ T cells', 'C': 'Type I, mediated by IgE antibodies', 'D': 'Type III, mediated by IgG antibodies', 'E': 'Type IV, mediated by IgG and IgM antibodies'},
|
D: Type III, mediated by IgG antibodies
|
Answer the following medical question with one of the provided options:
|
Q:A 10-year-old boy is brought to a pediatric clinic by his parents with pain and weakness in the lower extremities for the past 3 weeks. The patient’s mother says that he has been active until the weakness and pain started during his soccer practice sessions. He says he also experiences muscle cramps, especially at night. His mother adds that, recently, the patient constantly wakes up in the night to urinate and is noticeably thirsty most of the time. The patient denies any recent history of trauma to his legs. His vaccinations are up to date and his family history is unremarkable. His vital signs are within normal limits. Physical examination is unremarkable. Laboratory findings are shown below: Laboratory test Serum potassium 3.3 mEq/L Serum magnesium 1.3 mEq/L Serum chloride 101 mEq/L pH 7.50 Pco2 38 mm Hg HCO3- 20 mEq/L Po2 88 mm Hg Which of the following is the most likely diagnosis in this patient?? {'A': 'Fanconi syndrome', 'B': 'Gitelman’s syndrome', 'C': 'Bartter syndrome', 'D': 'Liddle syndrome', 'E': 'Conn’s syndrome'},
|
B: Gitelman’s syndrome
|
Answer the following medical question with one of the provided options:
|
Q:A 55-year-old man with alcoholic cirrhosis is admitted to the hospital for routine evaluation before liver transplantation. The physician asks the patient to stop eating 10 hours before surgery. Which of the following structures contributes directly to preventing fasting hypoglycemia by producing glucose in this patient?? {'A': 'Red blood cells', 'B': 'Skeletal muscle', 'C': 'Skin', 'D': 'Intestine', 'E': 'Adrenal cortex'},
|
D: Intestine
|
Answer the following medical question with one of the provided options:
|
Q:A crying 4-year-old child is brought to the emergency department with a red, swollen knee. He was in his usual state of health until yesterday, when he sustained a fall in the sandbox at the local park. His mother saw it happen; she says he was walking through the sandbox, fell gently onto his right knee, did not cry or seem alarmed, and returned to playing without a problem. However, later that night, his knee became red and swollen. It is now painful and difficult to move. The child’s medical history is notable for frequent bruising and prolonged bleeding after circumcision. On physical exam, his knee is erythematous, tender, and swollen, with a limited range of motion. Arthrocentesis aspirates frank blood from the joint. Which of the following single tests is most likely to be abnormal in this patient?? {'A': 'Bleeding time', 'B': 'Complete blood count', 'C': 'Platelet aggregation studies', 'D': 'Prothrombin time (PT)', 'E': 'Partial thromboplastin time (PTT)'},
|
E: Partial thromboplastin time (PTT)
|
Answer the following medical question with one of the provided options:
|
Q:A 28-year-old male with a history of HIV infection is found to have a CD4+ T lymphocyte count of 68 cells per microliter. As a consequence of his HIV infection, this patient is at increased risk of malignancy due to which of the following?? {'A': 'Pneumocystis jiroveci', 'B': 'HHV-6', 'C': 'Actinomyces israelii', 'D': 'Helicobacter pylori', 'E': 'Epstein-Barr Virus (EBV)'},
|
E: Epstein-Barr Virus (EBV)
|
Answer the following medical question with one of the provided options:
|
Q:A 75-year-old woman presents with sudden loss of vision. She says that she was reading when suddenly she was not able to see the print on half of the page. Her symptoms started 4 hours ago and are accompanied by a severe posterior headache. Vital signs reveal the following: blood pressure 119/76 mm Hg, pulse 89/min, SpO2 98% on room air. The patient was unable to recognize her niece when she arrived to see her. A noncontrast CT of the head shows no evidence of hemorrhagic stroke. What is the most likely diagnosis in this patient?? {'A': 'Middle cerebral artery stroke', 'B': 'Vertebrobasilar stroke', 'C': 'Subarachnoid hemorrhage', 'D': 'Lacunar stroke', 'E': 'Posterior cerebral artery stroke'},
|
E: Posterior cerebral artery stroke
|
Answer the following medical question with one of the provided options:
|
Q:A 27-year-old man is brought to the emergency department 30 minutes after being shot in the abdomen during a violent altercation. His temperature is 36.5°C (97.7°F), pulse is 118/min and regular, and blood pressure is 88/65 mm Hg. Examination shows cool extremities. Abdominal examination shows a 2.5-cm entrance wound in the left upper quadrant at the midclavicular line, below the left costal margin. Focused ultrasound shows free fluid in the left upper quadrant. Which of the following sets of hemodynamic changes is most likely in this patient? $$$ Cardiac output (CO) %%% Pulmonary capillary wedge pressure (PCWP) %%% Systemic vascular resistance (SVR) %%% Central venous pressure (CVP) $$$? {'A': '↑ ↓ ↓ ↓', 'B': '↓ ↓ ↑ ↓', 'C': '↓ ↓ ↑ ↑', 'D': '↓ ↓ ↓ ↓', 'E': '↓ ↑ ↑ ↑'},
|
B: ↓ ↓ ↑ ↓
|
Answer the following medical question with one of the provided options:
|
Q:A 30-year-old patient presents to clinic for pulmonary function testing. With body plethysmography, the patient's functional residual capacity is 3 L, tidal volume is 650 mL, expiratory reserve volume is 1.5 L, total lung capacity is 8 L, and dead space is 150 mL. Respiratory rate is 15 breaths per minute. What is the alveolar ventilation?? {'A': '8.5 L/min', 'B': '8 L/min', 'C': '7.5 L/min', 'D': '7 L/min', 'E': '6.5 L/min'},
|
C: 7.5 L/min
|
Answer the following medical question with one of the provided options:
|
Q:A 56-year-old man comes to the physician because of intermittent retrosternal chest pain. Physical examination shows no abnormalities. Endoscopy shows salmon pink mucosa extending 5 cm proximal to the gastroesophageal junction. Biopsy specimens from the distal esophagus show nonciliated columnar epithelium with numerous goblet cells. Which of the following is the most likely cause of this patient's condition?? {'A': 'Neoplastic proliferation of esophageal epithelium', 'B': 'Esophageal exposure to gastric acid', 'C': 'Atopic inflammation of the esophagus', 'D': 'Hypermotile esophageal contractions', 'E': 'Fungal infection of the lower esophagus'},
|
B: Esophageal exposure to gastric acid
|
Answer the following medical question with one of the provided options:
|
Q:A 23-year-old woman comes to the physician because of vaginal discharge for 3 days. She has been sexually active with three male partners over the past year and uses condoms inconsistently. Her only medication is an oral contraceptive. Physical exam shows thin grayish-white vaginal discharge. There is no erythema of the vaginal mucosa. The pH of the discharge is 5.9. Adding potassium hydroxide (KOH) to a mount containing vaginal discharge produces a fishy odor. Further evaluation of this patient's vaginal discharge is most likely to show which of the following findings?? {'A': 'Pseudohyphae', 'B': 'Gram-variable rod', 'C': 'Spiral-shaped bacteria', 'D': 'Gram-negative diplococci', 'E': 'Flagellated protozoa'},
|
B: Gram-variable rod
|
Answer the following medical question with one of the provided options:
|
Q:A 39-year-old woman comes to the physician for a follow-up examination after a colonoscopy showed 42 hamartomatous polyps. The physical examination findings are shown in the photograph. Which of the following conditions is most likely to develop in this patient?? {'A': 'Mandibular osteoma', 'B': 'Medulloblastoma', 'C': 'Pancreatic carcinoma', 'D': 'Malignant melanoma', 'E': 'Hepatocellular carcinoma'},
|
C: Pancreatic carcinoma
|
Answer the following medical question with one of the provided options:
|
Q:A 60-year-old man who recently immigrated from South America schedules an appointment with a physician to complete his pre-employment health clearance form. According to company policy, a skin test for tuberculosis must be administered to all new employees. Thus, he received an intradermal injection of purified protein derivative (PPD) on his left forearm. After 48 hours, a 14-mm oval induration is noticed. The type of cells most likely present and responsible for the indurated area will have which of the following characteristic features?? {'A': 'They play an important part in allergic reactions.', 'B': 'They have multiple-lobed nucleus.', 'C': 'Their half-life is 24–48 hours.', 'D': 'They need thymus for their maturation.', 'E': 'They are rich in myeloperoxidase enzyme.'},
|
D: They need thymus for their maturation.
|
Answer the following medical question with one of the provided options:
|
Q:A 2-year-old girl is rushed to the emergency department by her parents following ingestion of unknown pills from an unmarked bottle she found at the park. The parents are not sure how many pills she ingested but say the child has been short of breath since then. Her respiratory rate is 50/min and pulse is 150/min. Examination shows the girl to be quite restless and agitated. No other findings are elicited. Laboratory testing shows: Serum electrolytes Sodium 142 mEq/L Potassium 4.0 mEq/L Chloride 105 mEq/L Bicarbonate 14 mEq/L Serum pH 7.23 The girl most likely ingested which of the following drugs?? {'A': 'Acetaminophen', 'B': 'Calcium carbonate', 'C': 'Codeine', 'D': 'Docusate sodium', 'E': 'Spironolactone'},
|
A: Acetaminophen
|
Answer the following medical question with one of the provided options:
|
Q:An investigator is studying the genotypes of wingless fruit flies using full exome sequencing. Compared to wild-type winged fruit flies, the wingless fruit flies are found to have a point mutation in the gene encoding wing bud formation during embryogenesis. The point mutation in the gene causes the mRNA transcript to have a 'UUG' segment instead of an 'AUG' segment. Which of the following processes is most likely affected by this mutation?? {'A': 'Binding of met-tRNA to 60S complex', 'B': 'Shift of peptidyl-tRNA from A to P site', 'C': 'Dissociation of mRNA from ribosome complex', 'D': 'Catalyzation of peptide bond formation', 'E': "Cleavage of 5' intron"},
|
A: Binding of met-tRNA to 60S complex
|
Answer the following medical question with one of the provided options:
|
Q:A 7-year-old girl is brought to the physician because of a 1-month history of worsening fatigue, loss of appetite, and decreased energy. More recently, she has also had intermittent abdominal pain and nausea. She is at the 50th percentile for height and 15th percentile for weight. Her pulse is 119/min and blood pressure is 85/46 mm Hg. Physical examination shows darkened skin and bluish-black gums. The abdomen is soft and nontender. Serum studies show: Sodium 133 mEq/L Potassium 5.3 mEq/L Bicarbonate 20 mEq/L Urea nitrogen 16 mg/dL Creatinine 0.8 mg/dL Glucose 72 mg/dL Which of the following is the most appropriate pharmacotherapy?"? {'A': 'Succimer', 'B': 'Deferoxamine', 'C': 'Isoniazid + rifampin + pyrazinamide + ethambutol', 'D': 'Glucocorticoids', 'E': 'Norepinephrine'},
|
D: Glucocorticoids
|
Answer the following medical question with one of the provided options:
|
Q:A 28-year-old woman comes to the physician because of an 8-hour history of painful leg cramping, a runny nose, and chills. She has also had diarrhea and abdominal pain. She appears irritable and yawns frequently. Her pulse is 115/min. Examination shows cool, damp skin with piloerection. The pupils are 7 mm in diameter and equal in size. Bowel sounds are hyperactive. Deep tendon reflexes are 3+ bilaterally. Withdrawal from which of the following substances is most likely the cause of this patient's symptoms?? {'A': 'Heroin', 'B': 'Gamma-hydroxybutyric acid', 'C': 'Barbiturate', 'D': 'Alcohol', 'E': 'Cocaine'},
|
A: Heroin
|
Answer the following medical question with one of the provided options:
|
Q:A previously healthy 17-year-old boy is brought to the emergency department because of fever, nausea, and myalgia for the past day. His temperature is 39.5°C (103.1°F), pulse is 112/min, and blood pressure is 77/55 mm Hg. Physical examination shows scattered petechiae over the anterior chest and abdomen. Blood culture grows an organism on Thayer-Martin agar. Which of the following virulence factors of the causal organism is most likely responsible for the high mortality rate associated with it?? {'A': 'Lipoteichoic acid', 'B': 'Lipooligosaccharide', 'C': 'Immunoglobulin A protease', 'D': 'Toxic shock syndrome toxin-1', 'E': 'Erythrogenic exotoxin A\n"'},
|
B: Lipooligosaccharide
|
Answer the following medical question with one of the provided options:
|
Q:A 47-year-old woman presents to the emergency department with ongoing dyspnea and confusion for 2 hours. She has a history of psychosis and alcohol abuse. She has smoked 1 pack per day for 25 years. She is agitated and confused. Her blood pressure is 165/95 mm Hg; pulse 110/min; respirations 35/min; and temperature, 36.7°C (98.1°F). The pulmonary examination shows tachypnea and mild generalized wheezing. Auscultation of the heart shows no abnormal sounds. The remainder of the physical examination shows no abnormalities. Laboratory studies show: Serum Na+ 138 mEq/L CI- 100 mEq/L Arterial blood gas analysis on room air pH 7.37 pCO2 21 mm Hg pO2 88 mm Hg HCO3- 12 mEq/L Which of the following best explains these findings?? {'A': 'Alcoholic ketoacidosis', 'B': 'Hyperventilation syndrome', 'C': 'Salicylate intoxication', 'D': 'Severe chronic obstructive pulmonary disease', 'E': 'Vomiting'},
|
C: Salicylate intoxication
|
Answer the following medical question with one of the provided options:
|
Q:An endocrine surgeon wants to evaluate the risk of multiple endocrine neoplasia (MEN) type 2 syndromes in patients who experienced surgical hypertension during pheochromocytoma resection. She conducts a case-control study that identifies patients who experienced surgical hypertension and subsequently compares them to the control group with regard to the number of patients with underlying MEN type 2 syndromes. The odds ratio of MEN type 2 syndromes in patients with surgical hypertension during pheochromocytoma removal was 3.4 (p < 0.01). The surgeon concludes that the risk of surgical hypertension during pheochromocytoma removal is 3.4 times greater in patients with MEN type 2 syndromes than in patients without MEN syndromes. This conclusion is best supported by which of the following assumptions?? {'A': 'The 95% confidence interval for the odds ratio does not include 1.0', 'B': 'Surgical hypertension associated with pheochromocytoma is rare', 'C': 'The case-control study used a large sample size', 'D': 'The relationship between MEN syndromes and surgical hypertension is not due to random error', 'E': 'Pheochromocytoma is common in MEN type 2 syndromes'},
|
B: Surgical hypertension associated with pheochromocytoma is rare
|
Answer the following medical question with one of the provided options:
|
Q:A 3-year-old boy presents to the pediatrics clinic for follow-up. He has a history of severe pyogenic infections since birth. Further workup revealed a condition caused by a defect in CD40 ligand expressed on helper T cells. This congenital immunodeficiency has resulted in an inability to class switch and a poor specific antibody response to immunizations. Which of the following best characterizes this patient's immunoglobulin profile?? {'A': 'Increased IgE', 'B': 'Decreased IgA', 'C': 'Decreased Interferon gamma', 'D': 'Increased IgE and IgA; and decreased IgM', 'E': 'Increased IgM; decreased IgG, IgA, and IgE'},
|
E: Increased IgM; decreased IgG, IgA, and IgE
|
Answer the following medical question with one of the provided options:
|
Q:A 25-year-old woman presents to her primary care clinic for a general checkup. She states she's been a bit more fatigued lately during finals season but is otherwise well. Her mother and sister have hypothyroidism. She denies fatigue, weight gain, cold intolerance, constipation, heavy or irregular menses, or changes in the quality of her hair, skin, or nails. Physical exam is unremarkable. Laboratory studies are ordered as seen below. Hemoglobin: 14 g/dL Hematocrit: 40% Leukocyte count: 5,500/mm^3 with normal differential Platelet count: 188,000/mm^3 Serum: Na+: 139 mEq/L Cl-: 102 mEq/L K+: 4.4 mEq/L HCO3-: 24 mEq/L BUN: 20 mg/dL Glucose: 99 mg/dL Creatinine: 0.8 mg/dL Ca2+: 10.2 mg/dL Antithyroid peroxidase Ab: Positive AST: 12 U/L ALT: 10 U/L Which of the following laboratory values is most likely in this patient?? {'A': 'Elevated TSH and elevated T4', 'B': 'Elevated TSH and low T4', 'C': 'Normal TSH and normal T4', 'D': 'Normal TSH and low T4', 'E': 'Low TSH and elevated T4'},
|
C: Normal TSH and normal T4
|
Answer the following medical question with one of the provided options:
|
Q:A 69-year-old man presents to his dermatologist with an enlarging, scaly pink plaque on his face. It has been present for 5 weeks and is shown. Physical examination reveals a friable lesion that bleeds easily. Medical history is remarkable for type 1 diabetes mellitus complicated by end-stage kidney disease, which required kidney transplantation 5 years ago. The patient also reports a history of common viral warts but has not had any in several years. A skin biopsy of the lesion reveals full-thickness keratinocyte atypia with keratin pearls. Which of the following is a key risk factor for this patient's condition?? {'A': 'Atypical nevi', 'B': 'Immunosuppression', 'C': 'Human papillomavirus', 'D': 'Hepatitis C virus', 'E': 'Human immunodeficiency virus'},
|
B: Immunosuppression
|
Answer the following medical question with one of the provided options:
|
Q:A 48-year-old man comes to the physician because of severe joint pain and swelling involving different joints for 3 months. He has also been having loose stools and episodes of epigastric pain for 6 months. He reports a 10-kg (22-lb) weight loss during this period. He has type 2 diabetes mellitus. He does not smoke or drink alcohol. His medications include insulin and metformin. His vital signs are within normal limits. Examination shows pale conjunctivae, angular cheilitis, and glossitis. Axillary and cervical lymphadenopathy is present. A grade 2/6 pansystolic murmur is heard best at the apex. The right knee is swollen and tender; range of motion is limited. The sacroiliac joints are tender. Test of the stool for occult blood is negative. Laboratory studies show: Hemoglobin 9.2 g/dL Mean corpuscular volume 90 μm3 Leukocyte count 4,800/mm3 Serum Na+ 134 mEq/L Cl- 96 mEq/L K+ 3.3 mEq/L Glucose 143 mg/dL Creatinine 1.2 mg/dL A small intestine biopsy shows periodic acid-Schiff-positive (PAS-positive) macrophages in the lamina propria. Which of the following is the most appropriate next step in management?"? {'A': 'Oral doxycycline', 'B': 'Gluten-free diet', 'C': 'Oral rifampin', 'D': 'Intravenous ceftriaxone', 'E': 'Oral trimethoprim-sulfamethoxazole'},
|
D: Intravenous ceftriaxone
|
Answer the following medical question with one of the provided options:
|
Q:A 6-year-old boy is brought to the pediatrician by his parents. He has been coughing extensively over the last 5 days, especially during the night. His mother is worried that he may have developed asthma, like his uncle, because he has been wheezing, too. The boy usually plays without supervision, and he likes to explore. He has choked a few times in the past. He was born at 38 weeks of gestation via a normal vaginal delivery. He has no known allergies. Considering the likely etiology, what is the best approach to manage the condition of this child?? {'A': 'Order a CT scan', 'B': 'Prescribe montelukast', 'C': 'Perform cricothyroidotomy', 'D': 'Perform bronchoscopy', 'E': 'Encourage the use of a salbutamol inhaler'},
|
D: Perform bronchoscopy
|
Answer the following medical question with one of the provided options:
|
Q:A 30-year-old man comes to the physician for a follow-up examination 1 month after sustaining a chemical burn over the dorsum of his right hand and forearm. Physical examination shows hyperextension of the hand at the wrist. The skin over the dorsum of the wrist is tense and there is a thick, epithelialized scar. Range of motion of the right wrist is restricted. This patient's contracture is most likely due to activity of which of the following cells?? {'A': 'Neutrophils', 'B': 'Macrophages', 'C': 'Fibroblasts', 'D': 'Endothelial cells', 'E': 'Myofibroblasts'},
|
E: Myofibroblasts
|
Answer the following medical question with one of the provided options:
|
Q:A 60-year-old man comes to the physician because of persistent fatigue over the past ten months. His previous annual health maintenance examination showed no abnormalities. He appears pale. Physical examination shows numerous petechial lesions over the abdomen and marked splenomegaly. His serum hemoglobin concentration is 9.4 g/dL, leukocyte count is 4,100/mm3, and thrombocyte count is 110,000/mm3. A peripheral blood smear shows large white blood cells with centrally placed nuclei and multiple fine, radial cytoplasmic projections that stain positively for tartrate-resistant acid phosphatase (TRAP). Which of the following is the most likely characteristic of the medication used as first-line treatment for this patient's condition?? {'A': 'Increases risk of thromboembolic events', 'B': 'Resistant to breakdown by adenosine deaminase', 'C': 'Requires bioactivation by the liver', 'D': 'Inhibits progression from G2 phase', 'E': 'Unable to cross the blood-brain barrier'},
|
B: Resistant to breakdown by adenosine deaminase
|
Answer the following medical question with one of the provided options:
|
Q:A 29-year-old G1P0 presents to her obstetrician for her first prenatal care visit at 12 weeks gestation by last menstrual period. She states that her breasts are very tender and swollen, and her exercise endurance has declined. She otherwise feels well. She is concerned about preterm birth, as she heard that certain cervical procedures increase the risk. The patient has a gynecologic history of loop electrosurgical excision procedure (LEEP) for cervical dysplasia several years ago and has had negative Pap smears since then. She also has mild intermittent asthma that is well controlled with occasional use of her albuterol inhaler. At this visit, this patient’s temperature is 98.6°F (37.0°C), pulse is 69/min, blood pressure is 119/61 mmHg, and respirations are 13/min. Cardiopulmonary exam is unremarkable, and the uterine fundus is just palpable at the pelvic brim. Pelvic exam reveals normal female external genitalia, a closed and slightly soft cervix, a 12-week-size uterus, and no adnexal masses. Which of the following is the best method for evaluating for possible cervical incompetence in this patient?? {'A': 'Transabdominal ultrasound in the first trimester', 'B': 'Transabdominal ultrasound at 18 weeks gestation', 'C': 'Transvaginal ultrasound in the first trimester', 'D': 'Transvaginal ultrasound at 18 weeks gestation', 'E': 'Serial transvaginal ultrasounds starting at 16 weeks gestation'},
|
D: Transvaginal ultrasound at 18 weeks gestation
|
Answer the following medical question with one of the provided options:
|
Q:A 55-year-old man presents to his primary care physician for knee pain. The patient has had left knee pain, which has been steadily worsening for the past year. He states that ice and rest has led to minor improvement in his symptoms. He recently bumped his knee; however, he says that it has not altered his baseline pain when ambulating. The patient is a butcher and lives with his wife. His current medications include insulin, metformin, hydrochlorothiazide, and lisinopril. He is attending Alcoholics Anonymous with little success. Physical exam reveals a left knee that is mildly erythematous with some bruising. There is no pain upon palpation of the join or with passive range of motion. The patient exhibits a mildly antalgic gait. Which of the following is the best initial step in management?? {'A': 'Aspirin', 'B': 'Colchicine', 'C': 'MRI', 'D': 'Rest for 1-2 weeks', 'E': 'Weight loss'},
|
E: Weight loss
|
Answer the following medical question with one of the provided options:
|
Q:A 66-year-old woman comes to the emergency department because of a 1-day history of severe abdominal pain, nausea, and vomiting. She has also had profuse watery diarrhea with streaks of blood for the past 5 days. She had a urinary tract infection 3 weeks ago and was treated with a 14-day course of ciprofloxacin. She appears in severe distress. Her temperature is 39.3°C (102.7°F), pulse is 110/min, and blood pressure is 100/60 mm Hg. Examination shows a distended abdomen, tenderness in the lower quadrants, and hypoactive bowel sounds; rebound tenderness and abdominal rigidity are absent. Cardiopulmonary examination shows no abnormalities. Test of the stool for occult blood is positive. Laboratory studies show: Hemoglobin 10.2 g/dL Leukocyte count 28,000/mm3 Serum Na+ 133 mEq/L K+ 3.3 mEq/L Cl- 97 mEq/L Glucose 98 mg/dL Creatinine 1.3 mg/dL Two wide bore needles are inserted and intravenous fluids are administered. An abdominal x-ray of the patient would be most likely to show which of the following?"? {'A': 'Dilation of the colon with loss of haustration', 'B': 'String-like appearance of a bowel loop', 'C': 'Dilated transverse colon and cut-off sign at splenic flexure', 'D': 'Large volume of gas under the right diaphragm', 'E': 'Dilated sigmoid colon resembling a coffee bean'},
|
A: Dilation of the colon with loss of haustration
|
Answer the following medical question with one of the provided options:
|
Q:A 49-year-old woman comes to the physician because of a 4-month history of fatigue and recurrent pain in both of her wrists and her fingers. During this time, she has also had stiffness of her joints for about 80 minutes after waking up in the morning. Examination shows swelling and tenderness of the wrists and metacarpophalangeal joints bilaterally. Her serum erythrocyte sedimentation rate is 42 mm/h and rheumatoid factor is positive. Treatment is begun with a drug that results in decreased synthesis of deoxythymidine monophosphate. This mechanism is most similar to the mechanism of action of which of the following drugs?? {'A': 'Sulfamethoxazole', 'B': 'Doxycycline', 'C': 'Trimethoprim', 'D': 'Gentamicin', 'E': 'Azithromycin\n"'},
|
C: Trimethoprim
|
Answer the following medical question with one of the provided options:
|
Q:A 73-year-old man presents to his primary care doctor with his son who reports that his father has been acting strangely. He has started staring into space throughout the day and has a limited attention span. He has been found talking to people who are not present and has gotten lost while driving twice. He has occasional urinary incontinence. His past medical history is notable for a stroke 5 years ago with residual right arm weakness, diabetes, hypertension, and hyperlipidemia. He takes aspirin, glyburide, metformin, lisinopril, hydrochlorothiazide, and atorvastatin. On examination, he is oriented to person and place but thinks the year is 1989. He is inattentive throughout the exam. He takes short steps while walking. His movements are grossly slowed. A brain biopsy in this patient would most likely reveal which of the following?? {'A': 'Eosinophilic intracytoplasmic inclusions', 'B': 'Intracellular round aggregates of hyperphosphorylated microtubule-associated protein', 'C': 'Intracellular tangles of hyperphosphorylated microtubule-associated protein', 'D': 'Large intracellular vacuoles within a spongiform cortex', 'E': 'Marked diffuse cortical atherosclerosis'},
|
A: Eosinophilic intracytoplasmic inclusions
|
Answer the following medical question with one of the provided options:
|
Q:A 69-year-old man with aggressive metastatic cholangiocarcinoma presents after the second round of chemotherapy. He has suffered a great deal of pain from the metastasis to his spine, and he is experiencing side effects from the cytotoxic chemotherapy drugs. Imaging shows no change in the tumor mass and reveals the presence of several new metastatic lesions. The patient is not willing to undergo any more chemotherapy unless he gets something for pain that will “knock him out”. High-dose opioids would be effective, in his case, but carry a risk of bradypnea and sudden respiratory failure. Which of the following is the most appropriate next step in management?? {'A': 'Give the high-dose opioids', 'B': 'Give a lower dose even though it has less efficacy', 'C': 'Continue another round of chemotherapy without opioids', 'D': 'Stop chemotherapy', 'E': 'Put him in a medically-induced coma during chemotherapy sessions'},
|
A: Give the high-dose opioids
|
Answer the following medical question with one of the provided options:
|
Q:A 34-year-old woman is brought to the emergency department by fire and rescue after an apparent suicide attempt. She reports ingesting several pills 6 hours prior to presentation but cannot recall what they were. No pills were found on the scene. She complains of severe malaise, ringing in her ears, and anxiety. Her past medical history is notable for bipolar disorder, generalized anxiety disorder, rheumatoid arthritis, obesity, and diabetes. She takes lithium, methotrexate, metformin, and glyburide. She has a reported history of benzodiazepine and prescription opioid abuse. Her temperature is 102.2°F (39°C), blood pressure is 135/85 mmHg, pulse is 110/min, and respirations are 26/min. On exam, she appears diaphoretic and pale. Results from an arterial blood gas are shown: pH: 7.48 PaCO2: 32 mmHg HCO3-: 23 mEq/L This patient should be treated with which of the following?? {'A': 'Ammonium chloride', 'B': 'Atropine', 'C': 'Flumazenil', 'D': 'Physostigmine', 'E': 'Sodium bicarbonate'},
|
E: Sodium bicarbonate
|
Answer the following medical question with one of the provided options:
|
Q:A 19-year-old woman is diagnosed with metastatic Ewing sarcoma. She has undergone multiple treatments without improvement. She decides to stop treatment and pursue only palliative care. She is of sound mind and has weighed the benefits and risks of this decision. The patient’s mother objects and insists that treatments be continued. What should be done?? {'A': 'Continue treatments until the patient has a psychiatric evaluation.', 'B': 'Follow the wishes of the patient’s mother as she has decision making power for the patient.', 'C': 'Halt treatments and begin palliative care.', 'D': 'Try to seek additional experimental treatments that are promising.', 'E': 'Continue treatment because otherwise, the patient will die.'},
|
C: Halt treatments and begin palliative care.
|
Answer the following medical question with one of the provided options:
|
Q:A 4-year-old girl is brought to the physician because of increasing swelling around her eyes and over both her feet for the past 4 days. During this period, she has had frothy light yellow urine. Her vital signs are within normal limits. Physical examination shows periorbital edema and 2+ pitting edema of the lower legs and ankles. A urinalysis of this patient is most likely to show which of the following findings?? {'A': 'Muddy brown casts', 'B': 'Epithelial casts', 'C': 'Fatty casts', 'D': 'Waxy casts', 'E': 'WBC casts'},
|
C: Fatty casts
|
Answer the following medical question with one of the provided options:
|
Q:A 74-year-old woman is brought to the physician by her daughter for worsening memory for the past 1 month. She can no longer manage her bills and frequently forgets the names of her children. Her daughter is also concerned that her mother has a urinary tract infection because she has had increased urinary urgency and several episodes of urinary incontinence. Vital signs are within normal limits. Physical examination shows poor short-term memory recall and a slow gait with wide, short steps. Which of the following is most likely to improve this patient's condition?? {'A': 'Cerebral shunt placement', 'B': 'Bromocriptine therapy', 'C': 'Donepezil therapy', 'D': 'Ciprofloxacin therapy', 'E': 'Vaginal pessary placement'},
|
A: Cerebral shunt placement
|
Answer the following medical question with one of the provided options:
|
Q:A 42-year-old woman is brought to the emergency department because of a 5-day history of epigastric pain, fever, nausea, and malaise. Five weeks ago she had acute biliary pancreatitis and was treated with endoscopic retrograde cholangiopancreatography and subsequent cholecystectomy. Her maternal grandfather died of pancreatic cancer. She does not smoke. She drinks 1–2 beers daily. Her temperature is 38.7°C (101.7°F), respirations are 18/min, pulse is 120/min, and blood pressure is 100/70 mm Hg. Abdominal examination shows epigastric tenderness and three well-healed laparoscopy scars. The remainder of the examination shows no abnormalities. Laboratory studies show: Hemoglobin 10 g/dL Leukocyte count 15,800/mm3 Serum Na+ 140 mEq/L Cl− 103 mEq/L K+ 4.5 mEq/L HCO3- 25 mEq/L Urea nitrogen 18 mg/dL Creatinine 1.0 mg/dL Alkaline phosphatase 70 U/L Aspartate aminotransferase (AST, GOT) 22 U/L Alanine aminotransferase (ALT, GPT) 19 U/L γ-Glutamyltransferase (GGT) 55 U/L (N = 5–50) Bilirubin 1 mg/dl Glucose 105 mg/dL Amylase 220 U/L Lipase 365 U/L (N = 14–280) Abdominal ultrasound shows a complex cystic fluid collection with irregular walls and septations in the pancreas. Which of the following is the most likely diagnosis?"? {'A': 'Pancreatic abscess', 'B': 'Pancreatic pseudocyst', 'C': 'Pancreatic cancer', 'D': 'Acute cholangitis', 'E': 'ERCP-induced pancreatitis'},
|
A: Pancreatic abscess
|
Answer the following medical question with one of the provided options:
|
Q:A 38-year-old man is brought to the emergency department 35 minutes after an episode of loss of consciousness. He was having dinner with a client when his left arm suddenly became weak and numb. A few minutes later he became tense and his arms and legs began jerking violently, following which he lost consciousness. He has no recollection of this event. He works as a business consultant. He has a history of asthma and major depressive disorder. Current medication include an albuterol inhaler and doxepin. He increased the dose of doxepin one week ago because he felt the medication was not helping. He drinks two to three beers on the weekend. He admits to using cocaine 4–5 times per week. On arrival, he is alert and oriented to person, place, and time. His speech is slurred. His temperature is 37°C (98.6F), pulse is 96/min, and blood pressure is 155/90 mm Hg. The pupils are equal and reactive to light. Neurologic exam shows left facial droop. There is 3/5 strength in the left arm. Which of the following is the most likely underlying mechanism of this patient's symptoms?? {'A': 'Antagonism on M3 receptor', 'B': 'Ruptured berry aneurysm', 'C': 'Tear in the carotid artery', 'D': 'Lowered seizure threshold', 'E': 'Vasospasm of cerebral vessels\n"'},
|
E: Vasospasm of cerebral vessels "
|
Answer the following medical question with one of the provided options:
|
Q:A 32-year-old man, otherwise healthy, presents with flank pain and severe nausea for the last 9 hours. He describes the pain as severe, intermittent, localized to the right flank, and radiates to the groin. His past medical history is significant for recurrent nephrolithiasis. The patient does not smoke and drinks alcohol socially. Today his temperature is 37.0°C (98.6°F), the pulse is 90/min, the respiratory rate is 25/min, and the oxygen saturation is 99% on room air. On physical examination, the patient is in pain and unable to lie still. The patient demonstrates severe costovertebral angle tenderness. The remainder of the exam is unremarkable. Non-contrast CT of the abdomen and pelvis reveals normal-sized kidneys with the presence of a single radiopaque stone lodged in the ureteropelvic junction and clusters of pyramidal medullary calcifications in both kidneys. Intravenous pyelography reveals multiple, small cysts measuring up to 0.3 cm in greatest dimension in medullary pyramids and papillae of both kidneys. Which of the following would you also most likely expect to see in this patient?? {'A': 'Renal cell carcinoma', 'B': 'Hematuria', 'C': 'Proteinuria', 'D': 'Malignant hypertension', 'E': 'Hyperparathyroidism'},
|
B: Hematuria
|
Answer the following medical question with one of the provided options:
|
Q:A 37-year-old African-American man presents to his primary care provider with a history of fatigue and nausea that started about 6 months ago. His symptoms have slowly gotten worse and now he has trouble climbing the stairs to his 3rd floor apartment without resting. Past medical history is significant for poorly controlled HIV and a remote history of heroin addiction. Today his temperature is 36.9°C (98.4°F), the blood pressure is 118/72 mm Hg, and the pulse is 75/min. Physical examination reveals morbid obesity and 1+ pitting edema of both lower extremities. Urine dipstick reveals 2+ proteinuria. Urinalysis shows no abnormal findings. Which of the following is the most likely etiology of this patient condition?? {'A': 'Amyloidosis', 'B': 'Minimal change disease', 'C': 'Membranous nephropathy', 'D': 'Focal segmental glomerulosclerosis', 'E': 'Membranoproliferative glomerulonephritis'},
|
D: Focal segmental glomerulosclerosis
|
Answer the following medical question with one of the provided options:
|
Q:A 24-year-old woman presents with episodic shortness of breath, chest tightness, and wheezing. She has noticed an increased frequency of such episodes in the spring season. She also has a history of urticaria. She has smoked a half pack of cigarettes per day over the last 5 years. Her mother also has similar symptoms. The physical exam is within normal limits. Which of the following findings is characteristic of her condition? ? {'A': 'Decreased forced vital capacity (FVC) on pulmonary tests', 'B': 'Increased oxygen saturation', 'C': 'Chest X-ray showing hyperinflation', 'D': 'Decrease in forced expiratory volume in 1 second (FEV1) after methacholine', 'E': 'Paroxysmal nocturnal dyspnea'},
|
D: Decrease in forced expiratory volume in 1 second (FEV1) after methacholine
|
Answer the following medical question with one of the provided options:
|
Q:A 28-year-old woman presents with increased facial hair growth. She says she noticed a marked growth and darkening of hair on her face and feels embarrassed. Past medical history is significant for asthma, well-controlled by medication, and epilepsy diagnosed 6 months ago, managed with phenytoin. Her other medications are albuterol, beclomethasone, a daily multivitamin, and a garlic supplement. The patient denies any smoking history, alcohol or recreational drug use. Family history is significant for asthma in her father. Review of systems is positive for occasional diplopia. Her pulse is 75/min, respiratory rate is 15 /min, and blood pressure is 110/76 mm Hg. Her body mass index (BMI) is 24 kg/m2. On physical examination, she appears healthy in no apparent distress. There are excessive facial hair growth and enlarged gums. The remainder of the examination is unremarkable. Which of the following medications is most likely responsible for this patient's symptoms?? {'A': 'Beclomethasone', 'B': 'Albuterol', 'C': 'Garlic supplement', 'D': 'Multivitamin', 'E': 'Phenytoin'},
|
E: Phenytoin
|
Answer the following medical question with one of the provided options:
|
Q:A 14-year-old boy is brought to the physician by his parents for the evaluation of a skin rash for one day. The patient reports intense itching. He was born at 39 weeks' gestation and has a history of atopic dermatitis. He attends junior high school and went on a camping trip with his school the day before yesterday. His older brother has celiac disease. Examination shows erythematous papules and vesicles that are arranged in a linear pattern on the right forearm. Laboratory studies are within normal limits. Which of the following is the most likely underlying cause of this patient's symptoms?? {'A': 'IgG antibodies against hemidesmosomes', 'B': 'Preformed IgE antibodies', 'C': 'IgG antibodies against desmoglein', 'D': 'Immune complex formation', 'E': 'Presensitized T cells'},
|
E: Presensitized T cells
|
Answer the following medical question with one of the provided options:
|
Q:A 23-year-old G1P0 primigravid woman at 28 weeks estimated gestational age presents for a prenatal checkup. She says she has been having occasional headaches but is otherwise fine. The patient says she feels regular fetal movements and mild abdominal pain at times. Her past medical history is unremarkable. Current medications are a prenatal multivitamin and the occasional acetaminophen. Her blood pressure is 148/110 mm Hg today. On her last visit at 24 weeks of gestation, her blood pressure was 146/96 mm Hg. On physical exam, the fundus measures 28 cm above the pubic symphysis. Laboratory findings are significant for the following: Serum Glucose (fasting) 88 mg/dL Sodium 142 mEq/L Potassium 3.9 mEq/L Chloride 101 mEq/L Serum Creatinine 0.9 mg/dL Blood Urea Nitrogen 10 mg/dL Alanine aminotransferase (ALT) 18 U/L Aspartate aminotransferase (AST) 16 U/L Mean Corpuscular Volume (MCV) 85 fL Leukocyte count 4,200/mm3 Reticulocyte count 1% Erythrocyte count 5.1 million/mm3 Platelet count 95,000mm3 Urinalysis show: Proteins 2+ Glucose negative Ketones negative Leucocytes negative Nitrites negative Red Blood Cells (RBCs) negative Casts negative Which of the following medications would be the next best step in the treatment of this patient?? {'A': 'Diazepam', 'B': 'Ethosuximide', 'C': 'Magnesium sulfate', 'D': 'Valproic acid', 'E': 'Phenobarbital'},
|
C: Magnesium sulfate
|
Answer the following medical question with one of the provided options:
|
Q:A 55-year-old man comes to the physician because of a 2-month history of gradually worsening pain and burning in his feet that is impairing his ability to sleep. He also has a non-healing, painless ulcer on the bottom of his right toe, which has been progressively increasing in size despite the application of bandages and antiseptic creams at home. He has a 7-year history of type II diabetes mellitus treated with oral metformin. He also has narrow-angle glaucoma treated with timolol eye drops and chronic back pain due to a motorcycle accident a few years ago, which is treated with tramadol. Vital signs are within normal limits. Physical examination shows a 3-cm, painless ulcer on the plantar surface of the right toe. The ulcer base is dry, with no associated erythema, edema, or purulent discharge. Neurological examination shows loss of touch, pinprick sensation, proprioception, and vibration sense of bilateral hands and feet. These sensations are preserved in the proximal portions of the limbs. Muscle strength is normal. Bilateral ankle reflexes are absent. A diabetic screening panel is done and shows a fasting blood sugar of 206 mg/dL. An ECG shows a left bundle branch block. Which of the following is the most appropriate next step in the management of this patient's pain?? {'A': 'Oxycodone', 'B': 'Amitriptyline', 'C': 'Ulcer debridement', 'D': 'Injectable insulin', 'E': 'Pregabalin'},
|
E: Pregabalin
|
Answer the following medical question with one of the provided options:
|
Q:A father brings his 3-year-old son to the pediatrician because he is concerned about his health. He states that throughout his son's life he has had recurrent infections despite proper treatment and hygiene. Upon reviewing the patient's chart, the pediatrician notices that the child has been infected multiple times with S. aureus, Aspergillus, and E. coli. Which of the following would confirm the most likely cause of this patient's symptoms?? {'A': 'Negative nitroblue-tetrazolium test', 'B': 'Normal dihydrorhodamine (DHR) flow cytometry test', 'C': 'Positive nitroblue-tetrazolium test', 'D': 'Increased IgM, Decreased IgG, IgA, and IgE', 'E': 'Increased IgE and IgA, Decreased IgM'},
|
A: Negative nitroblue-tetrazolium test
|
Answer the following medical question with one of the provided options:
|
Q:A researcher is currently working on developing new cholinergic receptor agonist drugs. He has formulated 2 new drugs: drug A, which is a selective muscarinic receptor agonist and has equal affinity for M1, M2, M3, M4, and M5 muscarinic receptors, and drug B, which is a selective nicotinic receptor agonist and has equal affinity for NN and NM receptors. The chemical structure and mechanisms of action of both drugs mimic acetylcholine. However, drug A does not have any nicotinic receptor activity and drug B does not have any muscarinic receptor activity. Which of the following statements is most likely correct regarding these new drugs?? {'A': 'Drug A acts by causing conformational changes in ligand-gated ion channels', 'B': 'Drug A acts on receptors located at the neuromuscular junctions of skeletal muscle', 'C': 'Drug B may produce some of its effects by activating the IP3-DAG (inositol triphosphate-diacylglycerol) cascade', 'D': 'Drug A acts by stimulating a receptor which is composed of 6 segments', 'E': 'Drug B acts by stimulating a receptor which is composed of 5 subunits'},
|
E: Drug B acts by stimulating a receptor which is composed of 5 subunits
|
Answer the following medical question with one of the provided options:
|
Q:A researcher is studying whether a new knee implant is better than existing alternatives in terms of pain after knee replacement. She designs the study so that it includes all the surgeries performed at a certain hospital. Interestingly, she notices that patients who underwent surgeries on Mondays and Thursdays reported much better pain outcomes on a survey compared with those who underwent the same surgeries from the same surgeons on Tuesdays and Fridays. Upon performing further analysis, she discovers that one of the staff members who works on Mondays and Thursdays is aware of the study and tells all the patients about how wonderful the new implant is. Which of the following forms of bias does this most likely represent?? {'A': 'Golem effect', 'B': 'Hawthorne effect', 'C': 'Berkson bias', 'D': 'Pygmalion effect', 'E': 'Attrition bias'},
|
D: Pygmalion effect
|
Answer the following medical question with one of the provided options:
|
Q:A 43-year-old woman presents to her physician’s office complaining of fatigue and light headedness for one month. She has regular periods but notes that they have become heavier in the last year. She endorses increased urination and feels that she has gained weight in her abdomen, but review of systems is otherwise negative. She is a daycare teacher and has a first cousin with von Willebrand disease. Temperature is 98.4°F (36.9°C), pulse is 92/min, blood pressure is 109/72 mmHg, and respirations are 14/min. A CBC demonstrates: Hemoglobin: 9.9 g/dL Leukocyte count: 6,300/mm^3 Platelet count: 180,000/mm^3 Which of the following is the best next step to evaluate the etiology of this patient’s findings?? {'A': 'Pelvic ultrasound', 'B': 'TSH', 'C': 'Hysteroscopy', 'D': 'Parvovirus B19 IgM and IgG', 'E': 'von Willebrand factor antigen'},
|
A: Pelvic ultrasound
|
Answer the following medical question with one of the provided options:
|
Q:A 48-year-old woman comes to the physician because of an increasingly painful swelling behind her right knee for the past 2 months. During this time, she has also had intermittent low-grade fever and she has been more fatigued than usual. She has not had any trauma to the knee. Over the past year, she has had occasional pain in her hands and wrists bilaterally. She has hypertension and type 2 diabetes mellitus. She drinks 1–2 glasses of wine daily and occasionally more on weekends. Current medications include enalapril, metformin, and glimepiride. Her mother and older brother have osteoarthritis. She is 165 cm (5 ft 5 in) tall and weighs 68 kg (150 lb); BMI is 25 kg/m2. Vital signs are within normal limits. Examination shows a 3-cm nontender mass in the right popliteal fossa that becomes prominent when the knee is extended. There is mild swelling and redness of her right knee joint. Which of the following is the most likely diagnosis?? {'A': 'Osteoarthritis', 'B': 'Psoriatic arthritis', 'C': 'Popliteal artery aneurysm', 'D': 'Rheumatoid arthritis', 'E': 'Systemic lupus erythematosus\n"'},
|
D: Rheumatoid arthritis
|
Answer the following medical question with one of the provided options:
|
Q:Although nucleotide addition during DNA replication in prokaryotes proceeds approximately 20-times faster than in eukaryotes, why can much larger amounts of DNA be replicated in eukaryotes in a time-effective manner?? {'A': 'Eukaryotes have less genetic material to transcribe', 'B': 'Eukaryotes have fewer polymerase types', 'C': 'Eukaryotes have helicase which can more easily unwind DNA strands', 'D': 'Eukaryotes have multiple origins of replication', 'E': 'Eukaryotes do not have exons'},
|
D: Eukaryotes have multiple origins of replication
|
Answer the following medical question with one of the provided options:
|
Q:A 33-year-old woman presents to her primary care physician complaining of right jaw pain for the last 3 weeks. She first noticed it while eating a steak dinner but generally feels that it is worse in the morning. She describes the pain as deep and dull, with occasional radiation to the ear and back of her neck. She denies any incidents of jaw locking. The patient also states that her husband has noticed her grinding her teeth in her sleep in the last several months. She has a past medical history of depression, for which she takes fluoxetine, and carpal tunnel syndrome, for which she uses a wrist brace. The patient works as a secretary. Her father passed away from coronary artery disease at the age of 54, and her mother has rheumatoid arthritis. At this visit, her temperature is 98.5°F (36.9°C), blood pressure is 135/81 mmHg, pulse is 70/min, and respirations are 14/min. On exam, there is no overlying skin change on the face, but there is mild tenderness to palpation at the angle of the mandible on the right. Opening and closing of the jaw results in a slight clicking sound. The remainder of the exam is unremarkable. Which of the following is the next best step in management?? {'A': 'Nighttime bite guard', 'B': 'Plain radiograph of the jaw', 'C': 'MRI of the brain', 'D': 'Surgical intervention', 'E': 'Electrocardiogram'},
|
A: Nighttime bite guard
|
Answer the following medical question with one of the provided options:
|
Q:An autopsy is being performed on an elderly man who died from a myocardial infarction. Biopsy of the heart is likely to reveal necrosis most similar to necrosis seen in which of the following scenarios?? {'A': 'The central nervous system following a stroke', 'B': 'The lung following a tuberculosis infection', 'C': 'Acute pancreatitis resulting from release of enzymatically active enzymes into the pancreas', 'D': 'A region of kidney where blood flow is obstructed', 'E': 'An abscess'},
|
D: A region of kidney where blood flow is obstructed
|
Answer the following medical question with one of the provided options:
|
Q:In a healthy patient with no renal abnormalities, several mechanisms are responsible for moving various filtered substances into and out of the tubules. Para-aminohippurate (PAH) is frequently used to estimate renal blood flow when maintained at low plasma concentrations. The following table illustrates the effect of changing plasma PAH concentrations on PAH excretion: Plasma PAH concentration (mg/dL) Urinary PAH concentration (mg/dL) 0 0 10 60 20 120 30 150 40 180 Which of the following mechanisms best explains the decrease in PAH excretion with the increase in plasma concentration greater than 20 mg/dL?? {'A': 'Saturation of PAH transport carriers', 'B': 'Increased diffusion rate of PAH', 'C': 'Decreased glomerular filtration of PAH', 'D': 'Increased flow rate of tubular contents', 'E': 'Increased rate of PAH reabsorption'},
|
A: Saturation of PAH transport carriers
|
Answer the following medical question with one of the provided options:
|
Q:A husband returns from a three-month long business trip from Thailand, where he also engaged in extramarital affairs. He arrives back at home to find that his wife is distant and not as affectionate as she used to be. He then proceeds to argue with his wife stating that she must be cheating on him since she is so distant. Which of the following best explains the ego defense of the husband?? {'A': 'Passive aggression', 'B': 'Rationalization', 'C': 'Projection', 'D': 'Reaction formation', 'E': 'Regression'},
|
C: Projection
|
Answer the following medical question with one of the provided options:
|
Q:A 36-year-old G4P1021 woman comes to the emergency room complaining of intense abdominal pain and vaginal bleeding. She is 9 weeks into her pregnancy and is very concerned as she experienced similar symptoms during her past pregnancy losses. Her pain is described as “stabbing, 10/10 pain that comes and goes.” When asked about her vaginal bleeding, she reports that “there were some clots initially, similar to my second day of menstruation.” She endorses joint pains that is worse in the morning, “allergic” rashes at her arms, and fatigue. She denies weight loss, chills, fever, nausea/vomiting, diarrhea, or constipation. Physical examination reveals an enlarged and irregularly shaped uterus with a partially open external os and a flesh-colored bulge. Her laboratory findings are shown below: Serum: Hemoglobin: 11.8 g/dL Hematocrit: 35% Leukocyte count:7,600 /mm^3 with normal differential Platelet count: 200,000/mm^3 Bleeding time: 4 minutes (Normal: 2-7 minutes) Prothrombin time: 13 seconds (Normal: 11-15 seconds) Partial thromboplastin time (activated): 30 seconds (Normal: 25-40 seconds) What is the most likely cause of this patient’s symptoms?? {'A': 'Adenomyosis', 'B': 'Anti-phospholipid syndrome', 'C': 'Chromosomal abnormality', 'D': 'Leiomyomata uteri', 'E': 'Polycystic ovarian syndrome'},
|
D: Leiomyomata uteri
|
Answer the following medical question with one of the provided options:
|
Q:A 67-year-old woman presents to the infectious disease clinic after her PPD was found to be positive. A subsequent chest radiography shows a cavity in the apex of the right upper lobe, along with significant hilar adenopathy. The patient is diagnosed with tuberculosis and is started on the standard four-drug treatment regimen. Four weeks later, she returns for her first follow-up appointment in panic because her eyes have taken on an orange/red hue. Which of the following describes the mechanism of action of the drug most likely responsible for this side effect?? {'A': 'Inhibition of RNA polymerase', 'B': 'Inhibition of arabinosyltransferase', 'C': 'Inhibition of mycolic acid synthesis', 'D': 'Inhibition of topoisomerase', 'E': 'Inhibition of squalene epoxidase'},
|
A: Inhibition of RNA polymerase
|
Answer the following medical question with one of the provided options:
|
Q:A 48-year-old woman presents with a sudden-onset severe headache that she describes as the worst in her life, followed by binocular horizontal diplopia and ptosis. Her past medical history is significant for hypertension. On admission, her vital signs include: blood pressure 130/70 mm Hg, heart rate 78/min, respiratory rate 18/min, and temperature 36.5°C (97.7°F). On neurological examination, the left eye deviates inferolaterally. There is also ptosis, mydriasis, and an absent pupillary light response on the left. A non-contrast CT of the head is performed and is shown below. Which of the following structures is most likely to be abnormal in this patient?? {'A': 'Cavernous segment of the internal carotid artery', 'B': 'Anterior communicating artery (ACom)', 'C': 'Posterior communicating artery (PCom)', 'D': 'Middle cerebral artery (MCA)', 'E': 'Pericallosal artery'},
|
C: Posterior communicating artery (PCom)
|
Answer the following medical question with one of the provided options:
|
Q:A 21-year-old Caucasian male presents to your office with wheezing and rhinitis. Laboratory results show peripheral eosinophilia and antibodies against neutrophil myeloperoxidase. What is the most likely diagnosis?? {'A': 'Allergic bronchopulmonary aspergellosis', 'B': 'Eosinophilic granulomatosis with polyangiitis (Churg-Strauss syndrome)', 'C': 'Cystic fibrosis', 'D': 'Paragoniums westermani infection', 'E': 'Pancoast tumor'},
|
B: Eosinophilic granulomatosis with polyangiitis (Churg-Strauss syndrome)
|
Answer the following medical question with one of the provided options:
|
Q:A 7-year-old Caucasian girl with asthma presents to her pediatrician with recurrent sinusitis. The patient’s mother states that her asthma seems to be getting worse and notes that ‘lung problems run in the family’. The patient has had 2 episodes of pneumonia in the last year and continues to frequently have a cough. Her mother says that 1 of her nieces was recently diagnosed with cystic fibrosis. On physical examination, the child has clubbing of the nail beds on both hands. A chloride sweat test is performed on the patient, and the child’s sweat chloride concentration is found to be within normal limits. The physician is still suspicious for cystic fibrosis and believes the prior asthma diagnosis is incorrect. Which of the following diagnostic tests would aid in confirming this physician’s suspicions?? {'A': 'A chest radiograph', 'B': 'A nasal transepithelial potential difference', 'C': 'A complete blood count', 'D': 'A chest CT scan', 'E': 'A urinalysis'},
|
B: A nasal transepithelial potential difference
|
Answer the following medical question with one of the provided options:
|
Q:A 9-year-old boy is brought to the emergency department by his parents with a 2-day history of weakness and joint pain. He was adopted 3 weeks ago from an international adoption agency and this is his first week in the United States. He says that he has been healthy and that he had an episode of sore throat shortly before his adoption. Physical exam reveals an ill-appearing boy with a fever, widespread flat red rash, and multiple subcutaneous nodules. The type of hypersensitivity seen in this patient's disease is also characteristic of which of the following diseases?? {'A': 'Asthma', 'B': 'Contact dermatitis', 'C': 'Goodpasture syndrome', 'D': 'Osteogenesis imperfecta', 'E': 'Serum sickness'},
|
C: Goodpasture syndrome
|
Answer the following medical question with one of the provided options:
|
Q:A 17-year-old female presents to your office expressing concern that despite experiencing monthly pelvic pain for the past few years, she has not yet started her menstrual cycle. She is not taking oral contraceptive therapy and has never been sexually active. On physical exam the patient is of normal stature with appropriate breast development and growth of pubic and underarm hair. The patient declined a vaginal exam. Karyotype analysis reveals she has 46 XX. Pregnancy test is negative, thyroid stimulating hormone, prolactin, luteinizing hormone (LH) and follicle-stimulating hormone (FSH) levels are normal. The uterus is normal on ultrasound. What is the likely cause of this patient's primary amenorrhea?? {'A': 'Failure in development of Mullerian duct', 'B': 'Premature ovarian failure', 'C': 'Failed canalization of external vaginal membrane', 'D': 'Androgen insensitivity', 'E': 'Pituitary infarct'},
|
C: Failed canalization of external vaginal membrane
|
Answer the following medical question with one of the provided options:
|
Q:An investigator is studying the normal process of shrinking of the thymus gland with increasing age in humans. Thymic size is found to gradually start decreasing during puberty. Which of the following enzymes is most likely involved in the process underlying the decline in thymus mass with aging?? {'A': 'Lipase', 'B': 'Metalloproteinase', 'C': 'Caspase', 'D': 'NADPH oxidase', 'E': 'Collagenase'},
|
C: Caspase
|
Answer the following medical question with one of the provided options:
|
Q:A 57-year-old man comes to the physician because of tiredness and dyspnea on exertion for several months. Recently, he has also noticed changes of his fingernails. A photograph of his nails is shown. Which of the following is the most likely underlying cause of these findings?? {'A': 'Iron deficiency anemia', 'B': 'Herpetic whitlow', 'C': 'Psoriasis', 'D': 'Dermatophyte infection', 'E': 'Infectious endocarditis'},
|
A: Iron deficiency anemia
|
Answer the following medical question with one of the provided options:
|
Q:A 22-year-old female with a history of bipolar disease presents to the emergency room following an attempted suicide. She reports that she swallowed a bottle of pain reliever pills she found in the medicine cabinet five hours ago. She currently reports malaise, nausea, and anorexia. She has vomited several times. Her history is also notable for alcohol abuse. Her temperature is 99.4°F (37.4°C), blood pressure is 140/90 mmHg, pulse is 90/min, and respirations are 20/min. Physical examination reveals a pale, diaphoretic female in distress with mild right upper quadrant tenderness to palpation. Liver function tests and coagulation studies are shown below: Serum: Alkaline phosphatase: 110 U/L Aspartate aminotransferase (AST, GOT): 612 U/L Alanine aminotransferase (ALT, GPT): 557 U/L Bilirubin, Total: 2.7 mg/dl Bilirubin, Direct: 1.5 mg/dl Prothrombin time: 21.7 seconds Partial thromboplastin time (activated): 31 seconds International normalized ratio: 2.0 Serum and urine drug levels are pending. Which of the following medications should be administered to this patient?? {'A': 'Flumazenil', 'B': 'Atropine', 'C': 'Fomepizole', 'D': 'Physostigmine', 'E': 'N-acetylcysteine'},
|
E: N-acetylcysteine
|
Answer the following medical question with one of the provided options:
|
Q:A 54-year-old woman presents with acute pain in her left toe. She says she hasn’t been able to wear closed shoes for 2 weeks. Past medical history is significant for gastroesophageal reflux disease, diagnosed 2 years ago. The patient is afebrile and vital signs are within normal limits. Her BMI is 31 kg/m2. On physical examination, the left toe is warm to touch, swollen, and erythematous. A joint fluid aspiration from the left toe is performed and shows needle-shaped negatively birefringent urate crystals. The patient is started on a xanthine oxidase inhibitor. On her follow-up visit 6 weeks later, she has an elevated homocysteine level, a decreased serum folic acid level, and a normal methylmalonic acid level. Which of the following drugs would most likely cause a similar side effect to that seen in this patient?? {'A': 'Penicillins', 'B': 'Cephalosporins', 'C': 'Azathioprine', 'D': 'α-Methyldopa', 'E': 'Cisplatin'},
|
C: Azathioprine
|
Answer the following medical question with one of the provided options:
|
Q:A 58-year-old man comes to the physician because of depressed mood for 6 months. He works as a store manager and cannot concentrate at work anymore. He experiences daytime sleepiness and fatigue because he repeatedly wakes up at night and has difficulties falling asleep again after 4 a.m. He reports no longer taking pleasure in activities he used to enjoy, such as going fishing with his son. He has decreased appetite and has had a weight-loss of 5 kg (11 lb) over the past 6 months. He does not have suicidal ideation. He has no history of serious illness and takes no medication. He is divorced and lives with his girlfriend. He drinks several alcoholic beverages on the weekends. He does not take any medications. He is diagnosed with major depressive disorder and a trial of sertraline is suggested. The patient is at greatest risk for which of the following adverse effects?? {'A': 'Postural hypotension', 'B': 'Delayed ejaculation', 'C': 'Urinary retention', 'D': 'Increased suicidality', 'E': 'Priapism'},
|
B: Delayed ejaculation
|
Answer the following medical question with one of the provided options:
|
Q:A 76-year-old woman is brought to the physician by her daughter for evaluation of progressive cognitive decline and a 1-year history of incontinence. She was diagnosed with dementia, Alzheimer type, 5 years ago. The daughter has noticed that in the past 2 years, her mother has had increasing word-finding difficulties and forgetfulness. She was previously independent but now lives with her daughter and requires assistance with all activities of daily living. Over the past year, she has had decreased appetite, poor oral intake, and sometimes regurgitates her food. During this time, she has had a 12-kg (26-lb) weight loss. She was treated twice for aspiration pneumonia and now her diet mainly consists of pureed food. She has no advance directives and her daughter says that when her mother was independent the patient mentioned that she would not want any resuscitation or life-sustaining measures if the need arose. The daughter wants to continue taking care of her mother but is concerned about her ability to do so. The patient has hypertension and hyperlipidemia. Current medications include amlodipine and atorvastatin. Vital signs are within normal limits. She appears malnourished but is well-groomed. The patient is oriented to self and recognizes her daughter by name, but she is unaware of the place or year. Mini-Mental State Examination score is 17/30. Physical and neurologic examinations show no other abnormalities. A complete blood count and serum concentrations of creatinine, urea nitrogen, TSH, and vitamin B12 levels are within the reference range. Her serum albumin is 3 g/dL. Urinalysis shows no abnormalities. Which of the following is the most appropriate next step in management?? {'A': 'Short-term rehabilitation', 'B': 'Prescribe oxycodone', 'C': 'Home hospice care', 'D': 'Evaluation for alternative methods of feeding', 'E': 'Inpatient palliative care'},
|
C: Home hospice care
|
Answer the following medical question with one of the provided options:
|
Q:A 5-year-old is brought into the emergency department for trouble breathing. He was at a family picnic playing when his symptoms began. The patient is currently struggling to breathe and has red, warm extremities. The patient has an unknown medical history and his only medications include herbs that his parents give him. His temperature is 99.5°F (37.5°C), pulse is 112/min, blood pressure is 70/40 mmHg, respirations are 18/min, and oxygen saturation is 82% on 100% O2. Which of the following is the best initial step in management?? {'A': 'Albuterol', 'B': 'Epinephrine', 'C': 'Intubation', 'D': 'Cricothyroidotomy', 'E': 'Albuterol, ipratropium, and magnesium'},
|
B: Epinephrine
|
Answer the following medical question with one of the provided options:
|
Q:A 19-year-old woman comes to the physician because of recent weight gain. She started a combined oral contraceptive for dysmenorrhea and acne six months ago. She has been taking the medication consistently and experiences withdrawal bleeding on the 4th week of each pill pack. Her acne and dysmenorrhea have improved significantly. The patient increased her daily exercise regimen to 60 minutes of running and weight training three months ago. She started college six months ago. She has not had any changes in her sleep or energy levels. Her height is 162 cm and she weighs 62 kg; six months ago she weighed 55 kg. Examination shows clear skin and no other abnormalities. A urine pregnancy test is negative. Which of the following is the most appropriate next step in management?? {'A': 'Reassure the patient', 'B': 'Measure serum TSH level', 'C': 'Measure serum testosterone concentration', 'D': 'Perform a low-dose dexamethasone suppression test', 'E': 'Switch contraceptive to a non-hormonal contraceptive method'},
|
A: Reassure the patient
|
Answer the following medical question with one of the provided options:
|
Q:A 25-year-old man presents to the emergency department for severe abdominal pain. The patient states that for the past week he has felt fatigued and had a fever. He states that he has had crampy lower abdominal pain and has experienced several bouts of diarrhea. The patient states that his pain is somewhat relieved by defecation. The patient returned from a camping trip 2 weeks ago in the Rocky Mountains. He is concerned that consuming undercooked meats on his trip may have caused this. He admits to consuming beef and chicken cooked over a fire pit. The patient is started on IV fluids and morphine. His temperature is 99.5°F (37.5°C), blood pressure is 130/77 mmHg, pulse is 90/min, respirations are 12/min, and oxygen saturation is 98% on room air. Laboratory studies are ordered and are seen below. Hemoglobin: 10 g/dL Hematocrit: 28% Leukocyte count: 11,500 cells/mm^3 with normal differential Platelet count: 445,000/mm^3 Serum: Na+: 140 mEq/L Cl-: 102 mEq/L K+: 4.1 mEq/L HCO3-: 24 mEq/L BUN: 24 mg/dL Glucose: 145 mg/dL Creatinine: 1.4 mg/dL Ca2+: 9.6 mg/dL Erythrocyte sedimentation rate (ESR): 75 mm/hour Physical exam is notable for a patient who appears to be uncomfortable. Gastrointestinal (GI) exam is notable for abdominal pain upon palpation. Ear, nose, and throad exam is notable for multiple painful shallow ulcers in the patient’s mouth. Inspection of the patient’s lower extremities reveals a pruritic ring-like lesion. Cardiac and pulmonary exams are within normal limits. Which of the following best describes this patient’s underlying condition?? {'A': 'Bowel wall spasticity', 'B': 'Gram-negative microaerophilic organism', 'C': 'p-ANCA positive autoimmune bowel disease', 'D': 'Rectal mucosa outpouching', 'E': 'Transmural granulomas in the bowel'},
|
E: Transmural granulomas in the bowel
|
Answer the following medical question with one of the provided options:
|
Q:A 72-year-old man presents to the emergency department with a 1 hour history of bruising and bleeding. He says that he fell and scraped his knee on the ground. Since then, he has been unable to stop the bleeding and has developed extensive bruising around the area. He has a history of gastroesophageal reflux disease, hypertension, and atrial fibrillation for which he is taking an oral medication. He says that he recently started taking omeprazole for reflux. Which of the following processes is most likely inhibited in this patient?? {'A': 'Acetylation', 'B': 'Filtration', 'C': 'Glucuronidation', 'D': 'Oxidation', 'E': 'Sulfation'},
|
D: Oxidation
|
Answer the following medical question with one of the provided options:
|
Q:A 27-year-old woman who recently emigrated from Brazil comes to the physician because of fever, fatigue, decreased appetite, and mild abdominal discomfort. She has not seen a physician in several years and her immunization status is unknown. She drinks 2 alcoholic beverages on the weekends and does not use illicit drugs. She is sexually active with several male partners and uses condoms inconsistently. Her temperature is 38°C (99.8°F). Physical examination shows right upper quadrant tenderness and scleral icterus. Serology confirms acute infection with a virus that has partially double-stranded, circular DNA. Which of the following is most likely involved in the replication cycle of this virus?? {'A': 'Bacterial translation of viral DNA', 'B': 'Cleavage of gp160 to form envelope glycoprotein', 'C': 'Transcription of viral DNA to RNA in the cytoplasm', 'D': 'Reverse transcription of viral RNA to DNA', 'E': 'Adhesion of virus to host ICAM-1 receptor'},
|
D: Reverse transcription of viral RNA to DNA
|
Subsets and Splits
No community queries yet
The top public SQL queries from the community will appear here once available.