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Answer the following medical question with one of the provided options:
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Q:A 3175-g (7-lb) female newborn is delivered at term. Initial examination shows a distended abdomen and a flat perineal region without an opening. A dark green discharge is coming out of the vulva. Which of the following is the most likely diagnosis?? {'A': 'Meconium ileus', 'B': 'Hirschsprung disease', 'C': 'Imperforate anus', 'D': 'Colonic atresia', 'E': 'Meconium plug syndrome\n"'},
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C: Imperforate anus
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Answer the following medical question with one of the provided options:
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Q:A 20-year-old woman visits the clinic for her annual physical examination. She does not have any complaints during this visit. The past medical history is insignificant. She follows a healthy lifestyle with a balanced diet and moderate exercise schedule. She does not smoke or drink alcohol. She does not take any medications currently. The family history is significant for her grandfather and uncle who had their parathyroid glands removed. The vital signs include: blood pressure:122/88 mm Hg, pulse 88/min, respirations 17/min, and temperature 36.7°C (98.0°F). The physical exam is within normal limits. The lab test results are as follows: Blood Urea Nitrogen 12 mg/dL Serum Creatinine 1.1 mg/dL Serum Glucose (Random) 88 mg/dL Serum chloride 107 mmol/L Serum potassium 4.5 mEq/L Serum sodium 140 mEq/L Serum calcium 14.5 mmol/L Serum albumin 4.4 gm/dL Parathyroid Hormone (PTH) 70 pg/mL (Normal: 10-65 pg/mL) 24-Hr urinary calcium 85 mg/day (Normal: 100–300 mg/day) Which of the following is the next best step in the management of this patient?? {'A': 'Parathyroidectomy', 'B': 'Start IV fluids to keep her hydrated', 'C': 'No treatment is necessary', 'D': 'Start her on pamidronate', 'E': 'Give glucocorticoids'},
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C: No treatment is necessary
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Answer the following medical question with one of the provided options:
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Q:A 9-month-old girl is brought to the physician by her parents for multiple episodes of unresponsiveness in which she stares blankly and her eyelids flutter. She has gradually lost control of her neck and ability to roll over during the past 2 months. She is startled by loud noises and does not maintain eye contact. Her parents are of Ashkenazi Jewish descent. Neurological examination shows generalized hypotonia. Deep tendon reflexes are 3+ bilaterally. Fundoscopy shows bright red macular spots bilaterally. Abdominal examination shows no abnormalities. Which of the following metabolites is most likely to accumulate due to this patient's disease?? {'A': 'Glucocerebroside', 'B': 'Galactocerebroside', 'C': 'Ceramide trihexoside', 'D': 'Sphingomyelin', 'E': 'GM2 ganglioside'},
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E: GM2 ganglioside
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Answer the following medical question with one of the provided options:
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Q:A 74-year-old man is brought to the physician by his wife for progressively worsening confusion and forgetfulness. Vital signs are within normal limits. Physical examination shows a flat affect and impaired short-term memory. An MRI of the brain is shown. Further evaluation of this patient is most likely to show which of the following findings?? {'A': 'Papilledema', 'B': 'Broad-based gait', 'C': 'Postural instability', 'D': 'Pill-rolling tremor', 'E': 'Choreiform movements'},
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B: Broad-based gait
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Answer the following medical question with one of the provided options:
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Q:A 62-year-old woman with type 2 diabetes mellitus is brought to the emergency department by her husband because of fever, chills, and purulent drainage from a foot ulcer for 2 days. Her hemoglobin A1c was 15.4% 16 weeks ago. Physical examination shows a 2-cm ulcer on the plantar surface of the left foot with foul-smelling, purulent drainage and surrounding erythema. Culture of the abscess fluid grows several bacteria species, including gram-negative, anaerobic, non-spore-forming bacilli that are resistant to bile and aminoglycoside antibiotics. Which of the following is the most likely source of this genus of bacteria?? {'A': 'Stomach', 'B': 'Skin', 'C': 'Vagina', 'D': 'Oropharynx', 'E': 'Colon'},
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E: Colon
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Answer the following medical question with one of the provided options:
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Q:A 1-year-old boy is brought to the emergency room by his parents because of inconsolable crying and diarrhea for the past 6 hours. As the physician is concerned about acute appendicitis, she consults the literature base. She finds a paper with a table that summarizes data regarding the diagnostic accuracy of multiple clinical findings for appendicitis: Clinical finding Sensitivity Specificity Abdominal guarding (in children of all ages) 0.70 0.85 Anorexia (in children of all ages) 0.75 0.50 Abdominal rebound (in children ≥ 5 years of age) 0.85 0.65 Vomiting (in children of all ages) 0.40 0.63 Fever (in children from 1 month to 2 years of age) 0.80 0.80 Based on the table, the absence of which clinical finding would most accurately rule out appendicitis in this patient?"? {'A': 'Guarding', 'B': 'Fever', 'C': 'Anorexia', 'D': 'Rebound', 'E': 'Vomiting'},
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B: Fever
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Answer the following medical question with one of the provided options:
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Q:An investigator is studying the effect of different cytokines on the growth and differentiation of B cells. The investigator isolates a population of B cells from the germinal center of a lymph node. After exposure to a particular cytokine, these B cells begin to produce an antibody that prevents attachment of pathogens to mucous membranes but does not fix complement. Which of the following cytokines is most likely responsible for the observed changes in B-cell function?? {'A': 'Interleukin-2', 'B': 'Interleukin-5', 'C': 'Interleukin-4', 'D': 'Interleukin-6', 'E': 'Interleukin-8'},
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B: Interleukin-5
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Answer the following medical question with one of the provided options:
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Q:A 20-year-old woman is brought to the emergency department 6 hours after the onset of colicky lower abdominal pain that has been progressively worsening. The pain is associated with nausea and vomiting. She has stable inflammatory bowel disease treated with 5-aminosalicylic acid. She is sexually active with her boyfriend and they use condoms inconsistently. She was diagnosed with chlamydia one year ago. Her temperature is 38.1°C (100.6°F), pulse is 94/min, respirations are 22/min, and blood pressure is 120/80 mm Hg. Examination shows right lower quadrant guarding and rebound tenderness. The remainder of the examination shows no abnormalities. Which of the following is the most appropriate next step in management?? {'A': 'Urine culture', 'B': 'Transvaginal ultrasound', 'C': 'CT scan of the abdomen', 'D': 'Serum β-hCG concentration', 'E': 'Erect abdominal x-ray'},
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D: Serum β-hCG concentration
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Answer the following medical question with one of the provided options:
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Q:A 27-year-old male arrives to your walk-in clinic complaining of neck pain. He reports that the discomfort began two hours ago, and now he feels like he can’t move his neck. He also thinks he is having hot flashes, but he denies dyspnea or trouble swallowing. The patient’s temperature is 99°F (37.2°C), blood pressure is 124/76 mmHg, pulse is 112/min, and respirations are 14/min with an oxygen saturation of 99% O2 on room air. You perform a physical exam of the patient's neck, and you note that his neck is rigid and flexed to the left. You are unable to passively flex or rotate the patient's neck to the right. There is no airway compromise. The patient's past medical history is significant for asthma, and he was also recently diagnosed with schizophrenia. The patient denies current auditory or visual hallucinations. He appears anxious, but his speech is organized and appropriate. Which of the following is the best initial step in management?? {'A': 'Change medication to clozapine', 'B': 'Dantrolene', 'C': 'Diphenhydramine', 'D': 'Lorazepam', 'E': 'Propranolol'},
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C: Diphenhydramine
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Answer the following medical question with one of the provided options:
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Q:An 18-year-old woman presents to the emergency department with a complaint of severe abdominal pain for the past 6 hours. She is anorexic and nauseous and has vomited twice since last night. She also states that her pain initially began in the epigastric region, then migrated to the right iliac fossa. Her vital signs include a respiratory rate of 14/min, blood pressure of 130/90 mm Hg, pulse of 110/min, and temperature of 38.5°C (101.3°F). On abdominal examination, there is superficial tenderness in her right iliac fossa, rebound tenderness, rigidity, and abdominal guarding. A complete blood count shows neutrophilic leukocytosis and a shift to the left. Laparoscopic surgery is performed and the inflamed appendix, which is partly covered by a yellow exudate, is excised. Microscopic examination of the appendix demonstrates a neutrophil infiltrate of the mucosal and muscular layers with extension into the lumen. Which of the following chemical mediators is responsible for pain in this patient?? {'A': 'Bradykinin and prostaglandin', 'B': 'Tumor necrosis factor and interleukin-1', 'C': 'IgG and complement C3b', 'D': 'Serotonin and histamine', 'E': '5- hydroperoxyeicosatetraenoic acid (5-HPETE) and leukotriene A4'},
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A: Bradykinin and prostaglandin
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Answer the following medical question with one of the provided options:
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Q:A 26-year-old woman is brought to the emergency department by her husband due to her disturbing behavior over the past 24 hours. Her husband says that he has noticed his wife talking to herself and staying in a corner of a room throughout the day without eating or drinking anything. She gave birth to their son 2 weeks ago but has not seen or even acknowledged her baby’s presence ever since he was born. He says that he didn’t think much of it because she seemed overwhelmed during her pregnancy and he considered that she was probably unable to cope with being a new mother; however, last night, he says, his wife told him that their child was the son of the devil and they ought to get rid of him as soon as possible. Which of the following describes this patient’s abnormal reaction to her child?? {'A': 'Major depressive disorder', 'B': 'Postpartum blues', 'C': 'Brief psychotic disorder', 'D': 'Schizoaffective disorder', 'E': 'Postpartum psychosis'},
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E: Postpartum psychosis
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Answer the following medical question with one of the provided options:
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Q:A 60-year-old man comes to the physician for the evaluation of nausea over the past week. During this period, he has also had several episodes of non-bloody vomiting. Last month, he was diagnosed with stage II Hodgkin lymphoma and was started on adriamycin, bleomycin, vinblastine, and dacarbazine. His temperature is 37°C (98.6°F), pulse is 95/min, and blood pressure is 105/70 mm Hg. Physical examination shows cervical lymphadenopathy. The liver is palpated 1 to 2 cm below the right costal margin, and the spleen is palpated 2 to 3 cm below the left costal margin. The remainder of the examination shows no abnormalities. The patient is started on an appropriate medication. Two weeks later, he develops headaches and states that his last bowel movement was 4 days ago. The patient was most likely treated with which of the following medications?? {'A': 'M2 antagonist', 'B': 'Cannabinoid receptor agonist', 'C': 'H1 antagonist', 'D': 'D2 antagonist', 'E': '5-HT3 antagonist'},
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E: 5-HT3 antagonist
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Answer the following medical question with one of the provided options:
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Q:A 24-year-old woman is brought to the emergency department by friends because of an episode of jerking movements of the whole body that lasted for one minute. She reports a 2-week history of fever, headache, and altered sensorium. Her fever ranges from 38.3°C (101.0°F) to 38.9°C (102.0°F). Her past medical history is significant for toothache and multiple dental caries. The patient denies any history of smoking or alcohol or drug use. She is not currently sexually active. Her vital signs include: blood pressure 110/74 mm Hg, pulse 124/min, respiratory rate 14/min, temperature 38.9°C (102.0°F). On physical examination, the patient is confused and disoriented. She is moving her right side more than her left. A noncontrast CT scan of the head reveals a ring-enhancing lesion in the left frontal lobe consistent with a cerebral abscess. The abscess is evacuated and sent for culture studies. Which of the following microorganisms did the culture most likely grow?? {'A': 'Actinomyces israelii', 'B': 'Escherichia coli', 'C': 'Pseudomonas aeruginosa', 'D': 'Staphylococcus aureus', 'E': 'Streptococcus viridans'},
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E: Streptococcus viridans
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Answer the following medical question with one of the provided options:
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Q:Four hours after undergoing an abdominal hysterectomy, a 43-year-old woman is evaluated in the post-anesthesia care unit because she has only had a urine output of 5 mL of blue-tinged urine since surgery. The operation went smoothly and ureter patency was checked via retrograde injection of methylene blue dye mixed with saline through the Foley catheter. She received 2.4 L of crystalloid fluids intraoperatively and urine output was 1.2 L. She had a history of fibroids with painful and heavy menses. She is otherwise healthy. She underwent 2 cesarean sections 8 and 5 years ago, respectively. Her temperature is 37.4°C (99.3°F), pulse is 75/min, respirations are 16/min, and blood pressure is 122/76 mm Hg. She appears comfortable. Cardiopulmonary examination shows no abnormalities. There is a midline surgical incision with clean and dry dressings. Her abdomen is soft and mildly distended in the lower quadrants. Her bladder is slightly palpable. Extremities are warm and well perfused, and capillary refill is brisk. Laboratory studies show: Leukocyte count 8,300/mm3 Hemoglobin 10.3 g/dL Hematocrit 31% Platelet count 250,000/mm3 Serum _Na+ 140 mEq/L _K+ 4.2 mEq/L _HCO3+ 26 mEq/L _Urea nitrogen 26 mg/dL _Creatinine 1.0 mg/dL Urine _Blood 1+ _WBC none _Protein negative _RBC none _RBC casts none A bladder scan shows 250 mL of retained urine. Which of the following is the next best step in the evaluation of this patient?"? {'A': 'Administer bolus 500 mL of Lactated Ringers', 'B': 'Check the Foley catheter', 'C': 'Perform ultrasound of the kidneys', 'D': 'Administer 20 mg of IV furosemide', 'E': 'Return to the operating room for emergency surgery'},
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B: Check the Foley catheter
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Answer the following medical question with one of the provided options:
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Q:A 3-month-old African American boy presents to his pediatrician’s office for his routine well visit. He was born full-term from an uncomplicated vaginal delivery. He is exclusively breastfeeding and not receiving any medications or supplements. Today, his parents report no issues or concerns with their child. He is lifting his head for brief periods and smiling. He has received only 2 hepatitis B vaccines. Which of the following is the correct advice for this patient’s parents?? {'A': 'He needs a 3rd hepatitis B vaccine.', 'B': 'He should start rice cereal.', 'C': 'He should start vitamin D supplementation.', 'D': 'He should have his serum lead level checked to screen for lead intoxication.', 'E': 'He should be sleeping more.'},
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C: He should start vitamin D supplementation.
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Answer the following medical question with one of the provided options:
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Q:A 53-year-old woman presents to the emergency room with severe chest pain radiating to the back. She was diagnosed with acute aortic dissection. A few hours into the resuscitation, she was having oliguria. Laboratory findings show a serum creatinine level of 5.3 mg/dL. Which of the following casts are most likely to been seen on urinalysis?? {'A': 'Muddy brown casts', 'B': 'Tamm-Horsfall casts', 'C': 'Waxy casts', 'D': 'RBC casts', 'E': 'Fatty casts'},
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A: Muddy brown casts
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Answer the following medical question with one of the provided options:
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Q:A 20-year-old man comes to the physician because of recurrent episodes of shortness of breath and a nonproductive cough for the past 4 months. He has two episodes per week, which resolve spontaneously with rest. Twice a month, he wakes up at night with shortness of breath. His pulse is 73/min, respirations are 13/min, and blood pressure is 122/70 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 98%. Physical examination shows no abnormalities. Spirometry shows an FVC of 95%, an FEV1:FVC ratio of 0.85, and an FEV1 of 81% of predicted. Which of the following is the most appropriate initial pharmacotherapy?? {'A': 'Budesonide and formoterol inhaler', 'B': 'Fluticasone inhaler', 'C': 'Oral montelukast sodium', 'D': 'Terbutaline inhaler', 'E': 'Mometasone inhaler and oral zafirlukast'},
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A: Budesonide and formoterol inhaler
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Answer the following medical question with one of the provided options:
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Q:A 72-year-old nursing home resident is complaining of pruritis. She is noted to have multiple, tense blisters on her trunk as well as the flexor surfaces of her extremities. The blisters have an erythematous base. You are unable to extend the blisters when you apply lateral traction. You suspect an autoimmune bullous dermatosis. Which of the following is the cause of the likely condition?? {'A': 'Antibodies to desmoglein', 'B': 'Antibodies to hemidesmosomes', 'C': 'Antibodies to desmosomes', 'D': 'Antibodies to epidural transglutaminase', 'E': 'Epidermal necrolysis'},
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B: Antibodies to hemidesmosomes
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Answer the following medical question with one of the provided options:
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Q:A 28-year-old man comes to the physician because of a 3-month history of a recurrent pruritic rash on his face and scalp. He reports that he has been using a new shaving cream once a week for the past 5 months. A year ago, he was diagnosed with HIV and is currently receiving triple antiretroviral therapy. He drinks several six-packs of beer weekly. Vital signs are within normal limits. A photograph of the rash is shown. A similar rash is seen near the hairline of the scalp and greasy yellow scales are seen at the margins of the eyelids. Which of the following is the most likely diagnosis?? {'A': 'Allergic contact dermatitis', 'B': 'Pellagra', 'C': 'Pityriasis versicolor', 'D': 'Seborrheic dermatitis', 'E': 'Dermatomyositis'},
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D: Seborrheic dermatitis
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Answer the following medical question with one of the provided options:
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Q:A 63-year-old African American man presents to the physician for a follow-up examination. He has a history of chronic hypertension and type 2 diabetes mellitus. He has no history of coronary artery disease. His medications include aspirin, hydrochlorothiazide, losartan, and metformin. He exercises every day and follows a healthy diet. He does not smoke. He consumes alcohol moderately. There is no history of chronic disease in the family. His blood pressure is 125/75 mm Hg, which is confirmed on a repeat measurement. His BMI is 23 kg/m2. The physical examination shows no abnormal findings. The laboratory test results show: Serum HbA1C 6.9% Total cholesterol 176 mg/dL Low-density lipoprotein (LDL-C) 105 mg/dL High-density lipoprotein (HDL-C) 35 mg/dL Triglycerides 175 mg/dL The patient's 10-year risk of cardiovascular disease (CVD) is 18.7%. Lifestyle modifications including diet and exercise have been instituted. Which of the following is the most appropriate next step in pharmacotherapy?? {'A': 'Atorvastatin', 'B': 'Fenofibrate', 'C': 'Liraglutide', 'D': 'Lisinopril', 'E': 'Metoprolol'},
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A: Atorvastatin
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Answer the following medical question with one of the provided options:
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Q:A 45-year-old man is brought to the emergency department because of a 1-day history of malaise and abdominal pain. Six weeks ago, he had vomiting and watery diarrhea for 2 days that resolved without treatment. Twelve weeks ago, he underwent orthotopic liver transplantation for alcoholic cirrhosis. At the time of discharge, his total serum bilirubin concentration was 1.0 mg/dL. He stopped drinking alcohol one year ago. His current medications include daily tacrolimus, prednisone, valganciclovir, and trimethoprim-sulfamethoxazole. His temperature is 37.7°C (99.9°F), pulse is 95/min, and blood pressure is 150/80 mm Hg. He appears uncomfortable and has mild jaundice. Examination shows scleral icterus. The abdomen is soft and tender to deep palpation over the right upper quadrant, where there is a well-healed surgical scar. His leukocyte count is 2500/mm3, serum bilirubin concentration is 2.6 mg/dL, and serum tacrolimus concentration is within therapeutic range. Which of the following is the next appropriate step in diagnosis?? {'A': 'CT scan of the abdomen with contrast', 'B': 'Viral loads', 'C': 'Liver biopsy', 'D': 'Esophagogastroduodenoscopy', 'E': 'Ultrasound of the liver'},
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E: Ultrasound of the liver
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Answer the following medical question with one of the provided options:
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Q:A 45-year-old woman presents to a physician with repeated episodes of vertigo for the last 6 months. The episodes usually last for 20–30 minutes, but 2 episodes persisted for more than an hour. The episodes are often associated with severe nausea and vomiting. She has experienced falls after losing her balance during these episodes on 3 occasions, but she has never lost consciousness. However, she reports that after an acute episode is over, she feels unsteady, tired, and nauseated for several hours. For the previous month, she has noted that the acute attacks of vertigo are preceded by a sense of fullness in the ear, hearing an ocean-like roaring sound, and hearing loss on the left side. In between episodes, she is completely normal. There is no history of a known medical disorder, substance use or regular use of medications. The vital signs are within normal limits. The neurologic examination shows normal tone and power in all muscle groups, normal deep tendon reflexes, absence of signs of cerebellar dysfunction, and normal gait. The Dix-Hallpike positional test is negative. The otoscopic exam of both ears does not reveal any significant abnormality. The physician orders an audiogram, which suggests mild low-frequency sensorineural hearing loss on the left side. In addition to lifestyle changes and symptomatic treatment of acute episodes, which of the following is the most appropriate initial treatment to prevent recurrent episodes?? {'A': 'Oral diazepam', 'B': 'Oral ephedrine', 'C': 'Oral hydrochlorothiazide', 'D': 'Oral prednisone', 'E': 'Intramuscular dexamethasone'},
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C: Oral hydrochlorothiazide
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Answer the following medical question with one of the provided options:
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Q:Please refer to the summary above to answer this question This patient is at greatest risk of damage to which of the following cardiovascular structures?" "Patient Information Age: 44 years Gender: M, self-identified Ethnicity: Caucasian Site of Care: office History Reason for Visit/Chief Concern: “I am thirsty all the time, and it's getting worse.” History of Present Illness: 6-month history of increased thirst has had to urinate more frequently for 4 months; urinates every 3–4 hours feels generally weaker and more tired than usual has also had a 1-year history of joint pain in the hands Past Medical History: gastroesophageal reflux disease tension headaches Social History: has smoked one-half pack of cigarettes daily for 15 years occasionally drinks two or three beers on weekends used to be sexually active with his husband but has been losing interest in sexual activity for the past 6 months Medications: pantoprazole, amitriptyline, multivitamin Allergies: no known drug allergies Physical Examination Temp Pulse Resp BP O2 Sat Ht Wt BMI 37.2°C (99.0°F) 78/min 16/min 127/77 mm Hg – 188 cm (6 ft 2 in) 85 kg (187 lb) 24 kg/m2 Appearance: no acute distress HEENT: sclerae anicteric; no oropharyngeal erythema or exudate Pulmonary: clear to auscultation Cardiac: regular rate and rhythm; normal S1 and S2; no murmurs, rubs, or gallops Abdominal: no tenderness, guarding, masses, or bruits; the liver span is 15 cm Pelvic: small, firm testes; no nodules or masses Extremities: tenderness to palpation and stiffness of the metacarpophalangeal joints of both hands Skin: diffusely hyperpigmented Neurologic: alert and oriented; cranial nerves grossly intact; no focal neurologic deficits"? {'A': 'Pulmonary valve', 'B': 'Cardiac septum', 'C': 'Coronary artery', 'D': 'Cardiac conduction system', 'E': 'Temporal artery'},
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A: Pulmonary valve
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Answer the following medical question with one of the provided options:
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Q:A 68-year-old woman comes to the physician for a follow-up examination. Three months ago, she underwent heart transplantation for restrictive cardiomyopathy and was started on transplant rejection prophylaxis. Her pulse is 76/min and blood pressure is 148/82 mm Hg. Physical examination shows enlargement of the gum tissue. There is a well-healed scar on her chest. Serum studies show hyperlipidemia. The physician recommends removing a drug that decreases T cell activation by inhibiting the transcription of interleukin-2 from the patient's treatment regimen and replacing it with a different medication. Which of the following drugs is the most likely cause of the adverse effects seen in this patient?? {'A': 'Prednisolone', 'B': 'Tacrolimus', 'C': 'Cyclosporine', 'D': 'Azathioprine', 'E': 'Mycophenolate mofetil'},
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C: Cyclosporine
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Answer the following medical question with one of the provided options:
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Q:A 27-year-old man presents to the family medicine clinic for a routine check-up. The patient recently accepted a new job at a childcare center and the employer is requesting his vaccination history. After checking the records from the patient’s childhood, the physician realizes that the patient never had the varicella vaccine. The patient is unsure if he had chickenpox as a child, and there is no record of him having had the disease in the medical record. There is no significant medical history, and the patient takes no current medications. The patient’s heart rate is 82/min, respiratory rate is 14/min, temperature is 37.5°C (99.5°F), and blood pressure is 120/72 mm Hg. The patient appears alert and oriented. Auscultation of the heart reveals no murmurs, rubs, or gallops. The lungs are clear to auscultation bilaterally. With regard to the varicella vaccine, which of the following is recommended for the patient at this time?? {'A': 'One dose of the vaccine', 'B': 'Serology then administer the vaccine (2 doses)', 'C': 'Serology then administer the vaccine (1 dose)', 'D': 'Two doses of vaccine', 'E': 'Wait until patient turns 50'},
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B: Serology then administer the vaccine (2 doses)
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Answer the following medical question with one of the provided options:
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Q:A 33-year-old Hispanic woman who recently immigrated to the United States with her newborn daughter is presenting to a free clinic for a wellness checkup for her baby. As part of screening for those immigrating or seeking refuge in the United States, she and her child are both evaluated for tuberculosis. The child’s purified protein derivative (PPD) test and chest radiograph are negative, and although the mother’s chest radiograph is also negative, her PPD is positive. She states that she is currently asymptomatic and has no known history of tuberculosis (TB). The mother’s vital signs include: blood pressure 124/76 mm Hg, heart rate 74/min, and respiratory rate 14/min. She is advised to begin treatment with isoniazid, supplemented with pyridoxine for the next 9 months. She asks about the potential for harm to the child if she begins this course of treatment since she is breastfeeding. Which of the following is the most appropriate response to this patient’s concerns?? {'A': '“You should not breastfeed your baby because she is at greater risk for infection with TB than for adverse side effects of your treatment regimen.”', 'B': '“You should not breastfeed your baby for the next 9 months because isoniazid in breast milk can damage your child’s liver.”', 'C': '“You should not breastfeed your baby for the next 9 months because pyridoxine in breast milk can damage your child’s liver.”', 'D': '“You may breastfeed your baby because pyridoxine will prevent isoniazid from causing peripheral neuropathy.”', 'E': '“You may breastfeed your baby because you are asymptomatic and because neither isoniazid nor pyridoxine will harm your child.”'},
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E: “You may breastfeed your baby because you are asymptomatic and because neither isoniazid nor pyridoxine will harm your child.”
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Answer the following medical question with one of the provided options:
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Q:Please refer to the summary above to answer this question Which of the following is the most likely diagnosis?" "Patient information Age: 61 years Gender: F, self-identified Ethnicity: unspecified Site of care: emergency department History Reason for Visit/Chief Concern: “My belly really hurts.” History of Present Illness: developed abdominal pain 12 hours ago pain constant; rated at 7/10 has nausea and has vomited twice has had two episodes of nonbloody diarrhea in the last 4 hours 12-month history of intermittent constipation reports no sick contacts or history of recent travel Past medical history: hypertension type 2 diabetes mellitus mild intermittent asthma allergic rhinitis Social history: diet consists mostly of high-fat foods does not smoke drinks 1–2 glasses of wine per week does not use illicit drugs Medications: lisinopril, metformin, albuterol inhaler, fexofenadine, psyllium husk fiber Allergies: no known drug allergies Physical Examination Temp Pulse Resp. BP O2 Sat Ht Wt BMI 38.4°C (101.1°F) 85/min 16/min 134/85 mm Hg – 163 cm (5 ft 4 in) 94 kg (207 lb) 35 kg/m2 Appearance: lying back in a hospital bed; appears uncomfortable Neck: no jugular venous distention Pulmonary: clear to auscultation; no wheezes, rales, or rhonchi Cardiac: regular rate and rhythm; normal S1 and S2; no murmurs, rubs, or gallops Abdominal: obese; soft; tender to palpation in the left lower quadrant; no guarding or rebound tenderness; normal bowel sounds Extremities: no edema; warm and well-perfused Skin: no rashes; dry Neurologic: alert and oriented; cranial nerves grossly intact; no focal neurologic deficits"? {'A': 'Crohn disease', 'B': 'Cholecystitis', 'C': 'Irritable bowel syndrome', 'D': 'Appendicitis', 'E': 'Diverticulitis'},
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E: Diverticulitis
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Answer the following medical question with one of the provided options:
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Q:A 34-year-old woman comes to the fertility clinic with her husband for infertility treatment. The couple has been having unprotected intercourse for the past 2 years without any pregnancies. This is their first time seeking fertility treatment. The patient’s past medical history includes asthma. She denies any menstrual irregularities, menstrual pain, abnormal bleeding or past sexually transmitted infections. The husband reports that “he would get sick easily and would always have some upper respiratory infections.” Physical examination of the wife demonstrates nasal polyps bilaterally; vaginal examination is unremarkable. Physical examination of the husband is unremarkable. Semen analysis results are shown below: Semen analysis: Volume: 1.9 mL (Normal > 1.5 mL) pH: 7.4 (Normal: > 7.2) Sperm concentration: 0 mil/mL (Normal: > 15 mil/mL) Total sperm count: 0 mil/mL (Normal: > 39 mil/mL) Total motility: N/A (Normal: > 40%) Morphology: N/A (Normal: > 4% normal forms) What is the most likely explanation for this couple’s infertility?? {'A': 'Deletion of Phe508 in husband', 'B': 'Deletion of Phe508 in wife', 'C': 'Undescended testes in husband', 'D': 'XO chromosome in wife', 'E': 'XXY chromosome in husband'},
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A: Deletion of Phe508 in husband
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Answer the following medical question with one of the provided options:
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Q:A 20-year-old male is brought by ambulance to the emergency room in extremis. He is minimally conscious, hypotensive, and tachypneic, and his breath gives off a "fruity" odor. An arterial blood gas and metabolic panel show anion gap metabolic acidosis. This patient is most likely deficient in which of the following metabolic actions?? {'A': 'Formation of ketone bodies', 'B': 'Glucose production', 'C': 'Cortisol secretion', 'D': 'Cellular uptake of glucose', 'E': 'Glucagon production'},
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D: Cellular uptake of glucose
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Answer the following medical question with one of the provided options:
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Q:A 38-year-old woman presents to a physician’s office for progressive weakness and pallor during the last few weeks. She also complains of shortness of breath during her yoga class. She denies fevers, cough, rhinorrhea, or changes in appetite or bowel and bladder habits. She is generally healthy except for an occasional migraine, which is relieved by acetaminophen. For the last month, she has been having more frequent migraine attacks and was started on prophylactic aspirin. The vital signs include: pulse 102/min, respirations 18/min, and blood pressure 130/84 mm Hg. Her blood pressure on previous visits has been 110/76 mm Hg, 120/78 mm Hg, and 114/80 mm Hg. The physical examination is otherwise unremarkable. Stool for occult blood is positive. In addition to a low hemoglobin concentration, which other laboratory finding is expected in this patient?? {'A': 'Decreased platelet count', 'B': 'Prolonged activated partial thromboplastin time (aPTT)', 'C': 'Elevated D-dimer', 'D': 'Prolonged prothrombin time (PT)', 'E': 'Prolonged bleeding time'},
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E: Prolonged bleeding time
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Q:A 35-year-old male has been arrested on suspicion of arson. He has a history of criminal activity, having been jailed several times for assault and robbery. When asked why he burned down his ex-girlfriend's apartment, he just smiled. Which of the following would the male most likely have exhibited during childhood?? {'A': 'Bed-wetting', 'B': 'Odd beliefs', 'C': 'Fear of abandonment', 'D': 'Need for admiration', 'E': 'Perfectionist'},
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A: Bed-wetting
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Q:A 54-year-old woman comes to the physician because she has not had her menstrual period for the last 5 months. Menarche occurred at the age of 11 years, and menses occurred at regular 28-day intervals until they became irregular at 30- to 45-day intervals with light flow 2 years ago. She does not have vaginal dryness or decreased libido. She had four successful pregnancies and breastfed all her children until the age of 2 years. There is no personal or family history of serious illness. Except when she was pregnant, she has smoked one pack of cigarettes daily for 30 years. She does not drink alcohol. She is 167 cm (5 ft 5 in) tall and weighs 92 kg (203 lb); BMI is 33 kg/m2. Her vital signs are within normal limits. Physical examination shows no abnormalities. Which of the following best explains this patient's lack of symptoms other than amenorrhea?? {'A': 'Breastfeeding', 'B': 'Early menarche', 'C': 'Obesity', 'D': 'Smoking', 'E': 'Multiparity'},
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C: Obesity
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Q:Three weeks after starting a new medication for hyperlipidemia, a 54-year-old man comes to the physician because of pain and swelling in his left great toe. Examination shows swelling and erythema over the metatarsophalangeal joint of the toe. Analysis of fluid from the affected joint shows needle-shaped, negatively-birefringent crystals. Which of the following best describes the mechanism of action of the drug he is taking?? {'A': 'Promotion of hepatic LDL secretion', 'B': 'Inhibition of hepatic HMG-CoA reductase', 'C': 'Inhibition of intestinal bile acid absorption', 'D': 'Inhibition of hepatic VLDL synthesis', 'E': 'Inhibition of intestinal cholesterol absorption'},
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D: Inhibition of hepatic VLDL synthesis
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Q:A researcher is studying the circulating factors that are released when immune cells are exposed to antigens. Specifically, she is studying a population of CD2+ cells that have been activated acutely. In order to determine which factors are secreted by these cells, she cultures the cells in media and collects the used media from these plates after several days. She then purifies a small factor from this media and uses it to stimulate various immune cell types. She finds that this factor primarily seems to increase the growth and prolong the survival of other CD2+ cells. Which of the following is most likely the factor that was purified by this researcher?? {'A': 'Interleukin-1', 'B': 'Interleukin-2', 'C': 'Interleukin-3', 'D': 'Interleukin-4', 'E': 'Interleukin-5'},
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B: Interleukin-2
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Q:A 63-year-old man comes to the physician because of shortness of breath and swollen extremities for 2 weeks. He has had excessive night sweats and a 4-kg (8.8-lb) weight loss over the last 8 weeks. He had an anterior myocardial infarction 3 years ago. He has type 2 diabetes mellitus and hypertension. He immigrated from Indonesia 4 months ago. He works in a shipyard. He has smoked one pack of cigarettes daily for 48 years. Current medications include insulin, aspirin, simvastatin, metoprolol, and ramipril. He is 160 cm (5 ft 3 in) tall and weighs 46.7 kg (103 lb); BMI is 18.2 kg/m2. His temperature is 38.0°C (100.4°F), pulse is 104/min, respirations are 20/min, and blood pressure is 135/95 mm Hg. Examination shows generalized pitting edema. There is jugular venous distention, hepatomegaly, and a paradoxical increase in jugular venous pressure on inspiration. Chest x-ray shows bilateral pleural effusion, patchy infiltrates in the right middle lobe, and pericardial thickening and calcifications. Laboratory studies show: Serum Urea nitrogen 25 mg/dL Creatinine 1.5 mg/dL Urine Blood negative Glucose negative Protein 1+ Which of the following is the most likely explanation for this patient's symptoms?"? {'A': 'Viral myocarditis', 'B': 'Tuberculosis', 'C': 'Amyloidosis', 'D': 'Asbestos', 'E': 'Postmyocardial infarction syndrome\n"'},
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B: Tuberculosis
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Q:A 42-year-old man with non-small cell lung cancer is enrolled in a clinical trial for a new chemotherapeutic drug. The drug prevents microtubule depolymerization by binding to the beta subunit of tubulin. The mechanism of action of this new drug is most similar to which of the following?? {'A': 'Vincristine', 'B': 'Cladribine', 'C': 'Paclitaxel', 'D': 'Irinotecan', 'E': 'Bleomycin'},
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C: Paclitaxel
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Q:A 29-year-old female presents to her gynecologist complaining of a painful rash around her genitals. She has multiple sexual partners and uses condoms intermittently. Her last STD screen one year ago was negative. On examination, she has bilateral erosive vesicles on her labia majora and painful inguinal lymphadenopathy. She is started on an oral medication that requires a specific thymidine kinase for activation. Which of the following adverse effects is associated with this drug?? {'A': 'Gingival hyperplasia', 'B': 'Pulmonary fibrosis', 'C': 'Deafness', 'D': 'Renal failure', 'E': 'Photosensitivity'},
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D: Renal failure
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Q:A 72-year-old man comes to the physician because of a 6-month history of intermittent dull abdominal pain that radiates to the back. He has smoked one pack of cigarettes daily for 50 years. His blood pressure is 145/80 mm Hg. Abdominal examination shows generalized tenderness and a pulsatile mass in the periumbilical region on deep palpation. Further evaluation of the affected blood vessel is most likely to show which of the following?? {'A': 'Accumulation of foam cells in the tunica intima', 'B': 'Obliterative inflammation of the vasa vasorum', 'C': 'Necrotizing inflammation of the entire vessel wall', 'D': 'Formation of giant cells in the tunica media', 'E': 'Fragmentation of elastic tissue in the tunica media'},
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A: Accumulation of foam cells in the tunica intima
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Q:A 31-year-old man with untreated HIV infection is admitted to the hospital because of a 3-day history of blurred vision and flashing lights in his left eye. Indirect ophthalmoscopy shows retinal hemorrhages of the left eye. Treatment with a drug that directly inhibits viral DNA polymerases by binding to pyrophosphate-binding sites is initiated. Two days later, the patient has a generalized tonic-clonic seizure. This patient's seizure was most likely caused by which of the following?? {'A': 'Demyelination', 'B': 'Encephalitis', 'C': 'Hypocalcemia', 'D': 'Hypoglycemia', 'E': 'Lactic acidosis'},
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C: Hypocalcemia
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Q:A 62-year-old man is brought to the emergency department with fatigue, dry cough, and shortness of breath for 3 days. He reports a slight fever and has also had 3 episodes of watery diarrhea earlier that morning. Last week, he attended a business meeting at a hotel and notes some of his coworkers have also become sick. He has a history of hypertension and hyperlipidemia. He takes atorvastatin, hydrochlorothiazide, and lisinopril. He appears in mild distress. His temperature is 102.1°F (38.9°C), pulse is 56/min, respirations are 16/min, and blood pressure is 150/85 mm Hg. Diffuse crackles are heard in the thorax. Examination shows a soft and nontender abdomen. Laboratory studies show: Hemoglobin 13.5 g/dL Leukocyte count 15,000/mm3 Platelet count 130,000/mm3 Serum Na+ 129 mEq/L Cl- 100 mEq/L K+ 4.6 mEq/L HCO3- 22 mEq/L Urea nitrogen 14 mg/dL Creatinine 1.3 mg/dL An x-ray of the chest shows infiltrates in both lungs. Which of the following is the most appropriate next step in diagnosis?"? {'A': 'Direct immunofluorescent antibody test', 'B': 'Stool culture', 'C': 'Polymerase chain reaction', 'D': 'CT Chest', 'E': 'Urine antigen assay'},
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E: Urine antigen assay
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Q:A 65-year-old African American man presents for follow-up examination with a 6-month history of urinary hesitancy, weak stream, and terminal dribbling, which is refractory to a combination therapy of finasteride and tamsulosin. The patient’s past medical history is otherwise unremarkable. His father and brother were diagnosed with prostate cancer at the age of 55 years. His vital signs are within normal limits. The patient has a normal anal sphincter tone and a bulbocavernosus muscle reflex. Digital rectal exam (DRE) reveals a prostate size equivalent to 2 finger pads with a hard nodule and without fluctuance or tenderness. Serum prostate-specific antigen (PSA) level is 5 ng/mL. Which of the following investigations is most likely to establish a definitive diagnosis?? {'A': '4Kscore test', 'B': 'Image-guided needle biopsy', 'C': 'Magnetic resonance imaging (MRI)', 'D': 'Prostate Health Index (PHI)', 'E': 'PSA in 3 months'},
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B: Image-guided needle biopsy
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Q:A 7-year-old boy presents with right hip pain for the past 2 days. He reports gradual onset of pain and states it hurts to walk. He had a recent cold last week but is otherwise healthy. His temperature is 98.2°F (36.8°C), blood pressure is 107/70 mm Hg, pulse is 90/min, respiratory rate is 19/min, and oxygen saturation is 98% on room air. Physical exam reveals no swelling or warmth surrounding the joint. The patient is sitting with the right hip flexed, abducted, and externally rotated. Passive range of motion of the hip causes discomfort. The patient is able to ambulate but states it hurts. An initial radiograph of the hip is unremarkable. The patient's CRP is 0.10 mg/L. Which of the following is the best next step in management of this patient?? {'A': 'Arthrocentesis', 'B': 'Ibuprofen', 'C': 'MRI', 'D': 'Prednisone', 'E': 'Vancomycin and piperacillin-tazobactam'},
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B: Ibuprofen
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Q:A 70-year-old man comes to the physician because of episodes of watery stools for the past 6 weeks. During this period, he has also had recurrent episodes of reddening of the face, neck, and chest that last up to 30 minutes, especially following alcohol consumption. He has hypertension. He smoked one pack of cigarettes daily for 20 years but quit 8 years ago. He drinks two glasses of wine daily. Current medications include enalapril. He appears pale. He is 185 cm (6 ft 1 in) tall and weighs 67 kg (147.7 lb); BMI is 19.6 kg/m2. His temperature is 36.7°C (98°F), pulse is 85/min, and blood pressure is 130/85 mm Hg. Scattered expiratory wheezing is heard throughout both lung fields. Cardiac examination shows no abnormalities. The abdomen is soft and mildly tender. The remainder of the physical examination shows no abnormalities. A complete blood count and serum concentrations of urea nitrogen and creatinine are within the reference range. Which of the following is the most likely diagnosis in this patient?? {'A': 'Idiopathic flushing', 'B': 'Irritable bowel syndrome', 'C': 'Celiac disease', 'D': 'Polycythemia vera', 'E': 'Carcinoid syndrome'},
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E: Carcinoid syndrome
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Q:A 4-year-old boy is brought to the physician for the evaluation of fatigue since he returned from visiting family in South Africa one week ago. The day after he returned, he had fever, chills, and diffuse joint pain for 3 days. His symptoms improved with acetaminophen. He was born at term and has been healthy. His immunizations are up-to-date. His temperature is 37.6°C (99.68°F), pulse is 100/min, and blood pressure is 100/60 mm Hg. Examination shows conjunctival pallor. The remainder of the examination shows no abnormalities. Laboratory studies show: Hemoglobin 10.8 g/dL Mean corpuscular volume 68 μm3 Red cell distribution width 14% (N = 13%–15%) Hemoglobin A2 6% (N < 3.5%) A peripheral smear shows microcytic, hypochromic erythrocytes, some of which have a darkly stained center and peripheral rim, separated by a pale ring. Which of the following is the most appropriate next step in the management of this patient?"? {'A': 'Folic acid therapy', 'B': 'Oral succimer', 'C': 'Reassurance', 'D': 'Oral pyridoxine', 'E': 'Iron supplementation'},
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C: Reassurance
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Q:A 15-year-old African American boy presents to a pediatrician with complaints of yellow discoloration of the sclerae for the last 3 days. His mother informs the pediatrician that the boy developed prolonged jaundice during the neonatal period. On physical examination, vital signs are stable and general examination shows mild icterus and pallor. Examination of the abdomen suggests mild splenomegaly. Laboratory results are as follows: Hemoglobin 9.9 g/dL Total leukocyte count 7,500/mm3 Platelet count 320,000/mm3 Reticulocyte count 5% Mean corpuscular hemoglobin 27.7 pg/cell Mean corpuscular hemoglobin concentration 32% g/dL Mean corpuscular volume 84 μm3 Serum total bilirubin 4.2 mg/dL Serum direct bilirubin 0.3 mg/dL Coombs test Negative Peripheral smear shows polychromasia, blister cells, and Heinz bodies. An abdominal ultrasonogram shows the presence of gallstones. Which of the following tests is most likely to be useful in diagnosing this patient?? {'A': 'Glycerol lysis test', 'B': 'Methemoglobin reduction test', 'C': 'Serum thyroxine, triiodothyronine, and thyroid-stimulating hormone', 'D': 'Serum lipoprotein-X level', 'E': 'Hepatoiminodiacetic acid scanning'},
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B: Methemoglobin reduction test
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Q:An 18-year-old girl is brought to the emergency department because of a 1-day history of severe headache with photophobia and diffuse myalgias. She is a college student and lives in a dormitory in a large urban area. She has not traveled recently. On arrival, she is lethargic. Her temperature is 39.3°C (102.7°F), pulse is 120/min, and blood pressure is 88/58 mm Hg. Examination shows scattered petechiae and ecchymoses on the trunk and lower extremities. There is decreased range of motion of the neck. Cerebrospinal fluid analysis shows a cell count of 1,600/μL (80% neutrophils) and a lactate concentration of 5.1 mmol/L. Which of the following is most likely to have prevented this patient's condition?? {'A': 'Doxycycline therapy', 'B': 'Intravenous vancomycin', 'C': 'Polysaccharide conjugate vaccine', 'D': 'Toxoid vaccine', 'E': 'Erythromycin therapy'},
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C: Polysaccharide conjugate vaccine
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Answer the following medical question with one of the provided options:
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Q:A 55-year-old man comes to the physician for a follow-up examination. For the past 6 months, he has had fatigue, headaches, and several episodes of dizziness. Three months ago, he was diagnosed with hypertension and started on medications. Since the diagnosis was made, his medications have been adjusted several times because of persistently high blood pressure readings. He also has hypercholesterolemia and peripheral arterial disease. He smoked one pack of cigarettes daily for 34 years but quit two months ago. His current medications include aspirin, atorvastatin, losartan, felodipine, and hydrochlorothiazide. He is 188 cm (6 ft 2 in) tall and weighs 109 kg (240 lb); BMI is 31 kg/m2. His pulse is 82/min and blood pressure is 158/98 mm Hg. Physical examination shows bilateral carotid bruits and normal heart sounds. Serum potassium concentration is 3.2 mEq/L, plasma renin activity is 4.5 ng/mL/h (N = 0.3–4.2 ng/mL/h), and serum creatinine concentration is 1.5 mg/dL. Further evaluation of this patient is most likely to show which of the following findings?? {'A': 'Unilateral kidney atrophy', 'B': 'Unilateral parathyroid mass', 'C': 'Bilateral kidney enlargement', 'D': 'Pituitary mass', 'E': 'Diffuse thyroid enlargement'},
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A: Unilateral kidney atrophy
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Q:Please refer to the summary above to answer this question The APPLE study investigators are currently preparing for a 30-year follow-up evaluation. They are curious about the number of participants who will partake in follow-up interviews. The investigators noted that of the 83 participants who participated in APPLE study's 20-year follow-up, 62 were in the treatment group and 21 were in the control group. This finding raises concerns for which of the following?"? {'A': 'Volunteer bias', 'B': 'Lead-time bias', 'C': 'Attrition bias', 'D': 'Inadequate sample size', 'E': 'Reporting bias\n"'},
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C: Attrition bias
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Q:A 72-year-old man comes to the physician because of several episodes of dark urine over the past 2 months. He has had a 6 kg (13.2-lb) weight loss over the past 3 months despite no changes in appetite. He has smoked a pack of cigarettes daily for 30 years. A CT scan shows a heterogeneous enhancing mass arising from the left renal pelvis. Pathologic examination of the lesion is most likely to show which of the following findings?? {'A': 'Ulcerating tumor comprised of glandular cells within mucinous material', 'B': 'Pedunculated tumor comprised of pleomorphic urothelial cells with severe nuclear atypia', 'C': 'Tumor with central scar comprised of large eosinophilic cells with central nuclei', 'D': 'Bright yellow tumor comprised of polygonal cells filled with lipids and glycogen', 'E': 'Grayish-tan tumor comprised of primitive blastemal cells forming abortive glomeruli'},
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B: Pedunculated tumor comprised of pleomorphic urothelial cells with severe nuclear atypia
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Q:A 54-year-old man comes to the physician because of diarrhea that has become progressively worse over the past 4 months. He currently has 4–6 episodes of foul-smelling stools per day. Over the past 3 months, he has had fatigue and a 5-kg (11-lb) weight loss. He returned from Bangladesh 6 months ago after a year-long business assignment. He has osteoarthritis and hypertension. Current medications include amlodipine and naproxen. He appears pale and malnourished. His temperature is 37.3°C (99.1°F), pulse is 76/min, and blood pressure is 140/86 mm Hg. Examination shows pale conjunctivae and dry mucous membranes. Angular stomatitis and glossitis are present. The abdomen is distended but soft and nontender. Rectal examination shows no abnormalities. Laboratory studies show: Hemoglobin 8.9 g/dL Leukocyte count 4100/mm3 Platelet count 160,000/mm3 Mean corpuscular volume 110 μm3 Serum Na+ 133 mEq/L Cl- 98 mEq/l K+ 3.3 mEq/L Creatinine 1.1 mg/dL IgA 250 mg/dL Anti-tissue transglutaminase, IgA negative Stool culture and studies for ova and parasites are negative. Test of the stool for occult blood is negative. Fecal fat content is 22 g/day (N < 7). Fecal lactoferrin is negative and elastase is within normal limits. Which of the following is the most appropriate next step in diagnosis?"? {'A': 'CT scan of the abdomen', 'B': 'Schilling test', 'C': 'IgG against deamidated gliadin peptide', 'D': 'Enteroscopy', 'E': 'PAS-stained biopsy of small bowel'},
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D: Enteroscopy
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Q:A 45-year-old male is presenting for routine health maintenance. He has no complaints. His pulse if 75/min, blood pressure is 155/90 mm Hg, and respiratory rate is 15/min. His body mass index is 25 kg/m2. The physical exam is within normal limits. He denies any shortness of breath, daytime sleepiness, headaches, sweating, or palpitations. He does not recall having an elevated blood pressure measurement before. Which of the following is the best next step?? {'A': 'Refer patient to cardiologist', 'B': 'Treat with thiazide diuretic', 'C': 'Repeat the blood pressure measurement', 'D': 'Obtained computed tomagraphy scan', 'E': 'Provide reassurance'},
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C: Repeat the blood pressure measurement
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Q:A 56-year-old man is brought to the clinic by his wife for complaints of progressive weakness for the past 3 months. He reports difficulty eating, especially when chewing foods like steak. The wife complains that he has been “out of it lately and has been forgetting my birthday." His past medical history is significant for celiac disease, for which he eats a gluten-free diet. He reports that he stepped on a nail last week, but the nail did not seem rusty so he just washed his feet afterward. His wife reports that he has been up to date on his tetanus vaccinations. Physical examination demonstrates weakness and fasciculations of the left upper extremity along with spastic clonus of the left ankle. The patient denies gait disturbances, vision or hearing changes, headaches, nausea/vomiting, gastrointestinal disturbances, or incontinence. What is best next step in terms of management for this patient?? {'A': 'Donepezil', 'B': 'Levodopa', 'C': 'Riluzole', 'D': 'Tetanus immunoglobulin and vaccine', 'E': 'Vitamin B12'},
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C: Riluzole
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Answer the following medical question with one of the provided options:
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Q:A 59-year-old man presents to his primary care physician complaining of leg pain with exertion for the last 6 months. He has cramping in his calves when walking. He states that the cramping is worse on the right than the left and that the cramping resolves when he stops walking. He has had type 2 diabetes mellitus for 15 years and is not compliant with his medications. He has smoked 20–30 cigarettes daily for the past 30 years. On examination, the femoral pulses are diminished on both sides. Which of the following is the most likely cause of this patient’s condition?? {'A': 'Joint degeneration', 'B': 'Narrowing of the spinal canal', 'C': 'Venous thrombosis', 'D': 'Atherosclerosis', 'E': 'Segmental arterial occlusions due to non-atherosclerotic vasculitis'},
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D: Atherosclerosis
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Q:A 27-year-old man comes to the emergency department because of abdominal pain, diarrhea, flushing, and generalized pruritus that began after playing soccer. He also has a 2-month history of fatigue. Physical examination shows pallor and dry mucous membranes. Bone marrow biopsy shows a dense infiltration of atypical leukocytes with basophilic granules; genetic analysis of these cells shows a mutation in the KIT gene. The patient is at greatest risk for which of the following complications?? {'A': 'Stress-induced cardiomyopathy', 'B': 'Laryngeal edema', 'C': 'Gastric ulceration', 'D': 'Mucosal neuromas', 'E': 'Tricuspid valve regurgitation'},
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C: Gastric ulceration
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Answer the following medical question with one of the provided options:
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Q:A 47-year-old female presents to her primary care physician complaining of diarrhea and fatigue. She reports an eight-month history of increasingly frequent diarrhea, fatigue, and muscle weakness. She currently has over 15 episodes of watery diarrhea per day despite fasting. Her past medical history is notable for diabetes that is well controlled with metformin. Her temperature is 98.6°F (37°C), blood pressure is 100/70 mmHg, pulse is 95/min, and respirations are 18/min. Physical examination is notable for mild diffuse abdominal pain and facial flushing. An upper endoscopy is performed and the stomach is found to be less acidic than normal. In addition to correcting this patient’s dehydration, which of the following medications is most appropriate in the management of this patient?? {'A': 'Octreotide', 'B': 'Secretin', 'C': 'Metoclopramide', 'D': 'Omeprazole', 'E': 'Metronidazole'},
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A: Octreotide
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Q:An 18-year-old male reports to his physician that he is having repeated episodes of a "racing heart beat". He believes these episodes are occurring completely at random. He is experiencing approximately 2 episodes each week, each lasting for only a few minutes. During the episodes he feels palpitations and shortness of breath, then nervous and uncomfortable, but these feelings resolve in a matter of minutes. He is otherwise well. Vital signs are as follows: T 98.8F, HR 60 bpm, BP 110/80 mmHg, RR 12. Included is a copy of his resting EKG. What is the likely diagnosis?? {'A': 'Paroxysmal atrial fibrillation', 'B': 'Panic attacks', 'C': 'Ventricular tachycardia', 'D': 'Atrioventricular reentrant tachycardia', 'E': 'Atrioventricular block, Mobitz Type II'},
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D: Atrioventricular reentrant tachycardia
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Q:A 39-year-old man comes to the emergency department because of fever, urinary frequency, and lower back pain for the last 3 days. During this period, he has also had pain with the 3 times he has defecated. He is sexually active with one female partner and does not use condoms. His father died of colon cancer at the age of 67 years. The patient has smoked one pack of cigarettes daily for 14 years and drinks alcohol occasionally. His temperature is 39.1°C (102.3°F), pulse is 114/min, and blood pressure is 140/90 mm Hg. Physical examination shows mild suprapubic pain on deep palpation and a swollen, tender prostate. The remainder of the examination shows no abnormalities. His hemoglobin concentration is 15.4 g/dL, leukocyte count is 18,400/mm3, and platelet count is 260,000/mm3. Which of the following is the most appropriate next step in the management of this patient's condition?? {'A': 'Perform transrectal ultrasonography', 'B': 'Measure serum prostate-specific antigen', 'C': 'Administer vancomycin', 'D': 'Urine culture', 'E': 'Administer tamsulosin'},
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D: Urine culture
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Q:A 27-year-old nulligravid woman comes to the physician for evaluation of fertility. She has been unable to conceive for one year despite regular intercourse with her husband 1–2 times per week. Recent analysis of her husband's semen showed a normal sperm count. Two years ago, she had an episode of a febrile illness with lower abdominal pain, which resolved without treatment. Menarche was at age 12 and menses occur at regular 28-day intervals and last 4 to 5 days. Before her marriage, she was sexually active with 4 male partners and used a combined oral contraceptive pill with estrogen and progesterone consistently, as well as barrier protection inconsistently. One year ago, she stopped using the oral contraceptive pill in order to be able to conceive. She is 165 cm (5 ft 5 in) tall and weighs 84 kg (185 lb); BMI is 30.8 kg/m2. Physical examination shows no abnormalities. Which of the following is the most likely cause of this patient's infertility?? {'A': 'Polycystic ovary syndrome', 'B': 'Long-term use of the oral contraceptive pill', 'C': 'Primary ovarian insufficiency', 'D': 'Tubal scarring', 'E': 'Cervical insufficiency'},
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D: Tubal scarring
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Q:A 4-year-old girl is being followed by the pediatric oncology team after her pediatrician found a palpable abdominal mass towards the right flank 2 weeks ago. Abdominal ultrasonography detected a solid mass in the right kidney without infiltration of the renal vein and inferior vena cava. The contrast-enhanced computed tomography (CT) confirmed the presence of a solitary mass in the right kidney surrounded by a pseudocapsule consisting of a rim of normal tissue, displacing it medially, and distorting the collecting system. No nodal involvement was detected. In which of the following chromosomes would you expect a genetic abnormality?? {'A': 'Chromosome 3', 'B': 'Chromosome 22', 'C': 'Chromosome 11', 'D': 'Chromosome 13', 'E': 'Chromosome 1'},
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C: Chromosome 11
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Q:Please refer to the summary above to answer this question Further evaluation of this patient is most likely to show which of the following findings?" "Patient Information Age: 28 years Gender: F, self-identified Ethnicity: unspecified Site of Care: office History Reason for Visit/Chief Concern: “I'm not making breast milk anymore.” History of Present Illness: 1-week history of failure to lactate; has previously been able to breastfeed her twins, who were born 12 months ago menses resumed 4 months ago but have been infrequent feels generally weak and tired has had a 6.8-kg (15-lb) weight gain over the past 2 months despite having a decreased appetite Past Medical History: vaginal delivery of twins 12 months ago, complicated by severe postpartum hemorrhage requiring multiple blood transfusions atopic dermatitis Social History: does not smoke, drink alcohol, or use illicit drugs is not sexually active Medications: topical triamcinolone, multivitamin Allergies: no known drug allergies Physical Examination Temp Pulse Resp BP O2 Sat Ht Wt BMI 37°C (98.6°F) 54/min 16/min 101/57 mm Hg – 160 cm (5 ft 3 in) 70 kg (154 lb) 27 kg/m2 Appearance: tired-appearing HEENT: soft, nontender thyroid gland without nodularity Pulmonary: clear to auscultation Cardiac: bradycardic but regular rhythm; normal S1 and S2; no murmurs, rubs, or gallops Breast: no nodules, masses, or tenderness; no nipple discharge Abdominal: overweight; no tenderness, guarding, masses, bruits, or hepatosplenomegaly; normal bowel sounds Extremities: mild edema of the ankles bilaterally Skin: diffusely dry Neurologic: alert and oriented; cranial nerves grossly intact; no focal neurologic deficits; prolonged relaxation phase of multiple deep tendon reflexes"? {'A': 'Increased serum sodium concentration', 'B': 'Decreased serum aldosterone concentration', 'C': 'Increased serum FSH concentration', 'D': 'Decreased serum oxytocin concentration', 'E': 'Decreased serum cortisol concentration'},
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E: Decreased serum cortisol concentration
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Q:A 37-year-old-man presents to the clinic for a 2-month follow-up. He is relatively healthy except for a 5-year history of hypertension. He is currently on lisinopril, amlodipine, and hydrochlorothiazide. The patient has no concerns and denies headaches, weight changes, fever, chest pain, palpitations, vision changes, or abdominal pain. His temperature is 98.9°F (37.2°C), blood pressure is 157/108 mmHg, pulse is 87/min, respirations are 15/min, and oxygen saturation is 98% on room air. Laboratory testing demonstrates elevated plasma aldosterone concentration and low renin concentration. What is the most likely explanation for this patient’s presentation?? {'A': 'Aldosterone-producing adenoma', 'B': 'Ectopic secretion of anti-diuretic hormone (ADH)', 'C': 'Increased activity of the epithelial sodium channel at the kidney', 'D': 'Mutation of the Na-K-2C- cotransporter at the thick ascending limb', 'E': 'Renin-secreting tumor'},
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A: Aldosterone-producing adenoma
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Q:A 62-year-old woman presents to her primary care provider with anal bleeding. She reports a 4-month history of intermittent anal bleeding that was initially mild but has increased in severity over the past 2 weeks. She also reports having intermittent mucoid discharge from her anus. She denies any pain with defecation but does experience occasional constipation that has been increasing in frequency over the past month. Her past medical history is notable for hypertension and breast cancer status-post-mastectomy and radiation therapy. She takes enalapril. She has a 15-pack-year smoking history and drinks 3-4 glasses of wine per week. Her temperature is 98.4°F (36.9°C), blood pressure is 135/85 mmHg, pulse is 85/min, and respirations are 18/min. On exam, she appears pale but is pleasant and conversational. Digital rectal examination reveals a small mass within the anal canal. Anoscopy demonstrates an erythematous irregular mass arising from the mucosa proximal to the dentate line. Which of the following histologic findings is most likely to be seen in this patient’s lesion?? {'A': 'Adenocarcinoma', 'B': 'Basal cell carcinoma', 'C': 'Basaloid carcinoma', 'D': 'Gastrointestinal stromal tumor', 'E': 'Squamous cell carcinoma'},
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C: Basaloid carcinoma
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Q:A 47-year old morbidly obese woman presents to the Emergency Department with complaints of profound nausea, diarrhea, and malaise. Her past surgical history is significant for undergoing a laparoscopic gastric bypass procedure seven weeks ago for weight reduction. She has lost 15 kg since the surgery and currently, her BMI is 41 kg/m2. Her only medications are vitamins. Blood pressure is 84/40 mm Hg and heart rate is 127/min. She is afebrile. Her abdomen is distended and tympanitic with some diffuse tenderness. An abdominal X-ray and without oral contrast demonstrates a diffusely dilated small-bowel without any obvious distal decompressed bowel nor any abdominal free air. What is this patient’s diagnosis likely related to?? {'A': 'Anastomotic dehiscence', 'B': 'Perforation', 'C': 'Bacterial overgrowth', 'D': 'Fistula', 'E': 'Stricture'},
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C: Bacterial overgrowth
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Q:A 66-year-old woman is brought to the emergency department because of fever, chills, night sweats, and progressive shortness of breath for 1 week. She also reports generalized fatigue and nausea. She has type 2 diabetes mellitus and hypothyroidism. Current medications include metformin, sitagliptin, and levothyroxine. She appears ill. Her temperature is 38.7° (101.7°F), pulse is 104/min, and blood pressure is 160/90 mm Hg. Examination shows pale conjunctivae and small nontender hemorrhagic macules over her palms and soles. Crackles are heard at both lung bases. A grade 2/6 mid-diastolic murmur is heard best at the third left intercostal space and is accentuated by leaning forward. The spleen is palpated 1–2 cm below the left costal margin. Laboratory studies show: Hemoglobin 10.6 g/dL Leukocyte count 18,300/mm3 Erythrocyte sedimentation rate 48 mm/h Urine Protein 1+ Blood 2+ RBCs 20-30/hpf WBCs 0-2/hpf An echocardiography shows multiple vegetations on the aortic valve. Blood cultures grow S. gallolyticus. She is treated with ampicillin and gentamicin for 2 weeks and her symptoms resolve. A repeat echocardiography at 3 weeks shows mild aortic regurgitation with no vegetations. Which of the following is the most appropriate next step in management?"? {'A': 'Warfarin therapy', 'B': 'Implantable defibrillator', 'C': 'Colonoscopy', 'D': 'CT scan of the abdomen and pelvis', 'E': 'Esophagogastroduodenoscopy'},
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C: Colonoscopy
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Q:A previously healthy 5-year-old girl is brought to the emergency department by her parents because of a severe headache, nausea, and vomiting for 6 hours. Last week she had fever, myalgias, and a sore throat for several days that resolved with over-the-counter medication. She is oriented only to person. Examination shows bilateral optic disc swelling. Serum studies show: Glucose 61 mg/dL Aspartate aminotransferase (AST) 198 U/L Alanine aminotransferase (ALT) 166 U/L Prothrombin time 18 sec Which of the following is the most likely cause of this patient's symptoms?"? {'A': 'Autoimmune destruction of beta cells', 'B': 'Acute viral hepatitis', 'C': 'Hepatic mitochondrial injury', 'D': 'Ruptured berry aneurysm', 'E': 'Ethylene glycol poisoning'},
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C: Hepatic mitochondrial injury
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Q:A 37-year-old woman with a history of systemic lupus erythematosus, on prednisone and methotrexate, presents to the dermatology clinic with three weeks of a diffuse, itchy rash. Physical exam is remarkable for small red papules in her bilateral axillae and groin and thin reddish-brown lines in her interdigital spaces. The following skin biopsy is obtained. Which of the following is the most appropriate treatment?? {'A': 'Hydrocortisone cream', 'B': 'Nystatin cream', 'C': 'Permethrin cream', 'D': 'Ketoconazole cream', 'E': 'Capsaicin cream'},
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C: Permethrin cream
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Q:A 23-year-old woman, gravida 1 para 0, at 16 weeks’ gestation presents to the physician because of swelling of her right breast for 1 month. She has no personal or family history of any serious illnesses. She has taken contraceptive pills over the past few years. Vital signs are within normal limits. Physical examination shows asymmetric breasts with the right breast being enlarged. The palpation of the breast shows a 4 x 5 cm (1.5 x 1.9 in) mass under the skin in the upper outer quadrant. It is nontender and mobile with a rubbery consistency and regular borders. A breast ultrasound shows a round and solid homogeneous mass with well-defined borders and low echogenicity, measuring 5 cm (1.9 in) in diameter. Which of the following is the most likely diagnosis?? {'A': 'Invasive ductal carcinoma', 'B': 'Fibroadenoma', 'C': 'Fibrocystic changes', 'D': 'Lobular carcinoma', 'E': 'Medullary carcinoma'},
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B: Fibroadenoma
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Q:A group of investigators is performing a phase I trial of a novel drug among patients with chronic right upper quadrant pain. Iminodiacetic acid labeled with technetium 99m is administered intravenously and subjects are subsequently imaged with a gamma camera. It is found that administration of the experimental drug increases the amount of iminodiacetic acid in the intestines. The effect of this novel drug is most similar to that of a substance secreted by which of the following cells?? {'A': 'Duodenal K cells', 'B': 'Pancreatic D cells', 'C': 'Antral G cells', 'D': 'Duodenal S cells', 'E': 'Jejunal I cells'},
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E: Jejunal I cells
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Q:A 2-month-old infant boy is brought into the clinic for a well-child check. Mom reports a healthy pregnancy with no complications. Though she said the ultrasound technician saw “some white deposits in his brain” during a prenatal check, mom was not concerned. The baby was delivered at 38 weeks of gestation during a home birth. When asked if there were any problems with the birthing process, mom denied any difficulties except that “he was small and had these blue dots all over.” Physical exam was unremarkable except for the absence of object tracking. What other finding would you expect?? {'A': 'Continuous machine-like murmur', 'B': 'Hutchinson teeth', 'C': 'Limb hypoplasia', 'D': 'Sensorineural hearing loss', 'E': 'Skin vesicles'},
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D: Sensorineural hearing loss
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Q:A 56-year-old man comes to the physician because of worsening double vision and drooping of the right eyelid for 2 days. He has also had frequent headaches over the past month. Physical examination shows right eye deviation laterally and inferiorly at rest. The right pupil is dilated and does not react to light or with accommodation. The patient's diplopia improves slightly on looking to the right. Which of the following is the most likely cause of this patient’s findings?? {'A': 'Thrombosis of the cavernous sinus', 'B': 'Aneurysm of the posterior communicating artery', 'C': 'Demyelination of the medial longitudinal fasciculus', 'D': 'Enlarging pituitary adenoma', 'E': 'Infarction of the midbrain'},
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B: Aneurysm of the posterior communicating artery
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Q:A 76-year-old female with a past medical history of obesity, coronary artery disease status post stent placement, hypertension, hyperlipidemia, and insulin dependent diabetes comes to your outpatient clinic for regular checkup. She has not been very adherent to her diabetes treatment regimen. She has not been checking her sugars regularly and frequently forgets to administer her mealtime insulin. Her Hemoglobin A1c three months ago was 14.1%. As a result of her diabetes, she has developed worsening diabetic retinopathy and neuropathy. Based on her clinical presentation, which of the following is the patient most at risk for developing?? {'A': 'Stress incontinence', 'B': 'Overflow incontinence', 'C': 'Uterine prolapse', 'D': 'Rectal prolapse', 'E': 'Hemorrhoids'},
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B: Overflow incontinence
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Q:A 35-year-old woman comes to the physician because of recurring episodes of headache for the past 5 months. During this period, she has had headaches for approximately 20 days per month. The episodes last for about 2 hours each. She describes the headaches as dull, pressing, and non-pulsating holocranial pain. The symptoms do not increase with exertion. She has no vomiting, nausea, phonophobia, or photophobia. She has two children and has had a great deal of stress lately due to frequent fights with her husband. She appears well. Vital signs are within normal limits. Physical examination shows no abnormalities. Which of the following is the most appropriate pharmacotherapy for this patient?? {'A': 'Amitriptyline therapy', 'B': 'Ergotamine therapy', 'C': 'Propranolol therapy', 'D': 'Aspirin therapy', 'E': 'Valproate therapy'},
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A: Amitriptyline therapy
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Q:A 7-year-old girl comes in to the emergency department with her mother for swelling of her left periorbital region. Yesterday morning she woke up with a painful, warm, soft lump on her left eyelid. Eye movement does not worsen the pain. Physical examination shows redness and swelling of the upper left eyelid, involving the hair follicles. Upon palpation, the swelling drains purulent fluid. Which of the following is the most likely diagnosis?? {'A': 'Hordeolum', 'B': 'Dacryocystitis', 'C': 'Blepharitis', 'D': 'Xanthelasma', 'E': 'Chalazion'},
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A: Hordeolum
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Q:A 57-year-old female presents to general gynecology clinic for evaluation of a pelvic mass. The mass was detected on a routine visit to her primary care doctor during abdominal palpation. In the office, she receives a transvaginal ultrasound, which reveals a mass measuring 11 cm in diameter. In the evaluation of this mass, elevation of which tumor marker would be suggestive of an ovarian cancer?? {'A': 'S-100', 'B': 'CA-125', 'C': 'Beta-hCG', 'D': 'Alpha fetoprotein', 'E': 'CA-19-9'},
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B: CA-125
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Q:A 23-year-old woman presents to her primary care physician for a wellness checkup. She has been treated for gonorrhea and chlamydia 3 times in the past 6 months but is otherwise healthy. She smokes cigarettes, drinks alcohol regularly, and wears a helmet while riding her bicycle. The patient is generally healthy and has no acute complaints. Her vitals and physical exam are unremarkable. She is requesting advice regarding contraception. The patient is currently taking oral contraceptive pills. Which of the following would be the most appropriate recommendation for this patient?? {'A': 'Condoms', 'B': 'Etonogestrel implant', 'C': 'Intrauterine device', 'D': 'Pull out method', 'E': 'Tubal ligation'},
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A: Condoms
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Q:A 57-year-old woman is brought to the emergency department by her husband with complaints of sudden-onset slurring for the past hour. She is also having difficulty holding things with her right hand. She denies fever, head trauma, diplopia, vertigo, walking difficulties, nausea, and vomiting. Past medical history is significant for type 2 diabetes mellitus, hypertension, and hypercholesterolemia for which she takes a baby aspirin, metformin, ramipril, and simvastatin. She has a 23-pack-year cigarette smoking history. Her blood pressure is 148/96 mm Hg, the heart rate is 84/min, and the temperature is 37.1°C (98.8°F). On physical examination, extraocular movements are intact. The patient is dysarthric, but her higher mental functions are intact. There is a right-sided facial weakness with preserved forehead wrinkling. Her gag reflex is weak. Muscle strength is mildly reduced in the right hand. She has difficulty performing skilled movements with her right hand, especially writing, and has difficulty touching far objects with her index finger. She is able to walk without difficulty. Pinprick and proprioception sensation is intact. A head CT scan is within normal limits. What is the most likely diagnosis?? {'A': 'Dysarthria-clumsy hand syndrome', 'B': 'Lateral medullary syndrome', 'C': 'Locked in syndrome', 'D': 'Parinaud’s syndrome', 'E': 'Pure motor syndrome'},
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A: Dysarthria-clumsy hand syndrome
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Q:An 80-year-old man is brought to the emergency department from a nursing home because of a 2-day history of an increasing cough, fever, and dyspnea. He has type 2 diabetes mellitus, hypertension, and dementia. Current medications include insulin, enalapril, and donepezil. On arrival, he has dyspnea and is disoriented to time, place, and person. His temperature is 38.1°C (100.6°F), pulse is 113/min, respirations are 35/min, and blood pressure is 78/60 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 77%. Auscultation shows diffuse crackles over the right lung field. Cardiac examination shows an S4. Intravenous fluid resuscitation is begun. He is intubated, mechanically ventilated, and moved to the intensive care unit. An x-ray of the chest shows right upper and middle lobe infiltrates and an enlarged cardiac silhouette. A norepinephrine infusion is begun. The patient is administered a dose of intravenous cefotaxime and levofloxacin. In spite of appropriate therapy, he dies the following day. Which of the following would most likely be found on Gram stain examination of this patient's sputum?? {'A': 'Gram-negative coccobacilli', 'B': 'No findings', 'C': 'Gram-positive cocci in clusters', 'D': 'Gram-positive diplococci', 'E': 'Gram-negative rods'},
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D: Gram-positive diplococci
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Q:A 60-year-old man comes to the physician because of a 2-month history of chest pain, dry cough, and shortness of breath. He describes two painless masses in his neck, which he says appeared 4 months ago and are progressively increasing in size. During this time, he has had week-long episodes of fever interspersed with 10-day periods of being afebrile. He reports that his clothes have become looser over the past few months. He drinks alcohol occasionally. His temperature is 38°C (100.4°F), pulse is 90/min, and blood pressure is 105/60 mm Hg. Physical examination shows two nontender, fixed cervical lymph nodes on either side of the neck, which are approximately 2.2 cm and 4.5 cm in size. The tip of the spleen is palpated 3 cm below the left costal margin. An x-ray of the chest shows discrete widening of the superior mediastinum. Which of the following is most appropriate to confirm the diagnosis?? {'A': 'Leukocyte count', 'B': 'Fine needle aspiration', 'C': 'Sputum polymerase chain reaction test', 'D': 'CT scan of the chest', 'E': 'Excisional biopsy'},
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E: Excisional biopsy
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Q:A 36-year-old man comes to the physician for a 4-week history of swollen legs. He has difficulty putting on socks because of the swelling. Two years ago, he was diagnosed with sleep apnea. He takes no medications. He emigrated from Guatemala with his family when he was a child. He is 171 cm (5 ft 6 in) tall and weighs 115 kg (253 lb); BMI is 39 kg/m2. His pulse is 91/min and blood pressure is 135/82 mm Hg. Examination shows periorbital and bilateral lower extremity edema. Serum Albumin 3.1 g/dL Total cholesterol 312 mg/dL Urine Blood negative Protein +4 RBC 1-2/hpf RBC cast negative Fatty casts numerous A renal biopsy is obtained. Which of the following is most likely to be seen under light microscopy of the patient's renal biopsy specimen?"? {'A': 'Segmental sclerosis of the glomeruli', 'B': 'Fibrin crescents within the glomerular space', 'C': 'Diffuse thickening of glomerular capillaries', 'D': 'Eosinophilic nodules within the glomeruli', 'E': 'Amyloid deposition in the mesangium'},
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A: Segmental sclerosis of the glomeruli
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Q:A 13-year-old girl is brought to the emergency department by her parents for 5 days of abdominal pain, fever, vomiting, and mild diarrhea. Her parents have been giving her acetaminophen in the past 3 days, which they stopped 24 hours ago when they noted blood in their daughter's urine. Upon admission, the patient has a fever of 39.6°C (103.3°F) and is hemodynamically stable. While waiting for the results of the laboratory tests, the patient develops intense left flank pain, and nausea and vomiting intensifies. Her condition rapidly deteriorates with an abnormally high blood pressure of 180/100 mm Hg, a heart rate of 120/min, and labored breathing leading to ventilatory failure. Under these conditions, the ER team immediately transfers the patient to the pediatric ICU, however, the patient dies shortly after. The pathologist shares with you some excerpts from her complete blood count and peripheral smear report: Hemoglobin 7 mg/dL Mean 14.0 g/dL (-2SD: 13.0 g/dL) MCV 85 fL; 80–96 fL Platelets 60,000; 150,000–450,000 Peripheral smear Schistocytes (+); Schistocytes (-) White blood cells 12,900; 4,500–11,000 What is the most likely diagnosis?? {'A': 'Antiphospholipid syndrome', 'B': 'Sickle cell disease', 'C': 'IgA nephropathy', 'D': 'Hemolytic uremic syndrome', 'E': 'Nonsteroidal anti-inflammatory drugs (NSAIDs) nephropathy'},
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D: Hemolytic uremic syndrome
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Q:A 63-year-old man is brought to the emergency department for the evaluation of severe abdominal pain that started suddenly 1 hour ago while he was having a barbecue with his family. The pain is located in the middle of his abdomen and he describes it as 9 out of 10 in intensity. The patient feels nauseated and has vomited twice. He has also had a loose bowel movement. He was diagnosed with hypertension 2 years ago and was started on hydrochlorothiazide. He stopped taking his pills 1 week ago because of several episodes of heart racing and dizziness that he attributes to his medication. The patient has smoked one pack of cigarettes daily for the last 40 years. He is in severe distress. His temperature is 37.6°C (99.7°F), pulse is 120/min, respirations are 16/min, and blood pressure is 130/90 mm Hg. Cardiac examination shows an irregularly irregular rhythm. Bowel sounds are normal. The abdomen is soft and nontender. The remainder of the physical examination shows no abnormalities. Laboratory studies show: Hemoglobin 16.8 g/dL Leukocyte count 13,000/mm3 Platelet count 340,000/mm3 Prothrombin time 13 seconds Partial thromboplastin time 38 seconds Lactate (venous) 2.4 mEq/L (N=0.5 - 2.2 mEq/L) Serum Urea Nitrogen 15 mg/dL Creatinine 1.2 mg/dL Lactate dehydrogenase 105 U/L CT angiography is performed and the diagnosis is confirmed. Which of the following is the most appropriate definitive management of this patient?"? {'A': 'Anticoagulation with heparin', 'B': 'Colonoscopy', 'C': 'MR angiography', 'D': 'Piperacillin/tazobactam administration', 'E': 'Balloon angioplasty and stenting'},
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E: Balloon angioplasty and stenting
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Q:A 68-year-old man presents to his primary care physician complaining of bulge in his scrotum that has enlarged over the past several months. He is found to have a right-sided inguinal hernia and proceeded with elective hernia repair. At his first follow-up visit, he complains of a tingling sensation on his scrotum. Which of the following nerve roots communicates with the injured tissues?? {'A': 'L1-L2', 'B': 'L2-L3', 'C': 'L4-L5', 'D': 'S1-S3', 'E': 'S2-S4'},
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A: L1-L2
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Q:A group of investigators is studying a drug to treat refractory angina pectoris. This drug works by selectively inhibiting the late influx of sodium ions into cardiac myocytes. At high doses, the drug also partially inhibits the degradation of fatty acids. Which of the following is the most likely effect of this drug?? {'A': 'Increased oxygen efficiency', 'B': 'Increased prolactin release', 'C': 'Decreased uric acid excretion', 'D': 'Decreased insulin release', 'E': 'Decreased serum pH'},
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A: Increased oxygen efficiency
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Q:A 31-year-old female presents to her gynecologist for a routine Pap smear. Her last Pap smear was three years ago and was normal. On the current Pap smear, she is found to have atypical squamous cells of unknown significance (ASCUS). Reflex HPV testing is positive. What is the best next step?? {'A': 'Repeat Pap smear and HPV testing in 5 years', 'B': 'Repeat Pap smear in 3 years', 'C': 'Repeat Pap smear in 1 year', 'D': 'Colposcopy', 'E': 'Loop electrosurgical excision procedure (LEEP)'},
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D: Colposcopy
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Q:A 42-year-old woman presents to the physician with symptoms of vague abdominal pain and bloating for several months. Test results indicate that she has ovarian cancer. Her physician attempts to reach her by phone but cannot. Next of kin numbers are in her chart. With whom can her doctor discuss this information?? {'A': "The patient's husband", 'B': "The patient's daughter", 'C': "The patient's brother", 'D': 'The patient', 'E': 'All of the above'},
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D: The patient
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Q:A 55-year old man living in Midwest USA comes in complaining of painless hematuria for the past week. He denies dysuria but complains of fatigue and lethargy at work. He has lost about 9.0 kg (20.0 lb) in the past 6 months. He drinks 1–2 beers on the weekends over the past 10 years but denies smoking. He has worked at a plastic chemical plant for the past 30 years and has never been out of the country. His father died of a heart attack at age 62 and his mother is still alive and well. There is a distant history of pancreatic cancer, but he can not remember the specifics. His vitals are stable and his physical exam is unremarkable. Urinary analysis is positive for RBCs. A cystoscopy is performed and finds a pedunculated mass projecting into the bladder lumen. A biopsy shows malignant cells. Which of the following is the most concerning risk factor for this patient’s condition?? {'A': 'Genetic predisposition', 'B': 'Schistosoma haematobium infection', 'C': 'Alcohol', 'D': 'Vinyl chloride exposure', 'E': 'Aromatic amine exposure'},
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E: Aromatic amine exposure
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Q:Collagen is a very critical structural protein in many of our connective tissues. Defects in collagen produce diseases such as Ehlers-Danlos syndrome, where there is a defective lysyl hydroxylase gene, or osteogenesis imperfecta, where there is a defect in the production of type I collagen. Which of the following represents the basic repeating tripeptide of collagen?? {'A': 'Ser-X-Y', 'B': 'Met-X-Y', 'C': 'Gly-X-Y', 'D': 'Glu-X-Y', 'E': 'Asp-X-Y'},
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C: Gly-X-Y
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Q:A 28-year-old woman presents with a malodorous vaginal discharge and itchiness that have lasted for 15 days. She reports that the smell of the discharge is worse after intercourse and is accompanied by a whitish-gray fluid. She has no significant past medical or gynecological history. She is in a stable monogamous relationship and has never been pregnant. She is diagnosed with bacterial vaginosis and prescribed an antimicrobial agent. Which of the following diagnostic features is consistent with this patient’s condition?? {'A': 'Vaginal fluid pH > 5.0, motile flagellated pyriform protozoa seen on the microscopic examination of the vaginal secretions', 'B': 'Vaginal fluid pH < 4.5, lactobacilli predominance on the microscopic examination of the vaginal secretions, which are scant and clear', 'C': 'Vaginal fluid pH > 4.5, clue cells present on a saline smear of the vaginal secretions, along with a fishy odor on addition of KOH', 'D': 'Vaginal fluid pH > 4.0, hyphae on the microscopic examination of the vaginal secretions after the addition of KOH', 'E': 'Vaginal fluid pH > 6.0, scant vaginal secretions, increased parabasal cells'},
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C: Vaginal fluid pH > 4.5, clue cells present on a saline smear of the vaginal secretions, along with a fishy odor on addition of KOH
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Q:A 45-year-old man with a history of recurrent gouty arthritis comes to the physician for a follow-up examination. Four weeks ago, he was diagnosed with hyperuricemia and treatment with allopurinol was begun. Since then, he has had another acute gout attack, which resolved after treatment with ibuprofen. His temperature is 37.1°C (98.8°F). Physical examination shows painless, chalky nodules on the metatarsophalangeal joint of his right foot. Laboratory studies show: Serum Creatinine 1.0 mg/dL Uric acid 11.6 mg/dL Cholesterol 278 mg/dL Urine Uric acid 245 mg/24 h (N = 240-755) Based on the urine findings, this patient would most likely benefit from treatment with which of the following drugs to prevent future gout attacks?"? {'A': 'Rasburicase', 'B': 'Probenecid', 'C': 'Indomethacin', 'D': 'Prednisolone', 'E': 'Colchicine'},
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B: Probenecid
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Q:A 61-year-old woman comes to the physician because of a 5-day history of fever, headache, coughing, and thick nasal discharge. She had a sore throat and nasal congestion the week before that had initially improved. Her temperature is 38.1°C (100.6°F). Physical exam shows purulent nasal drainage and tenderness to percussion over the frontal sinuses. The nasal turbinates are erythematous and mildly swollen. Which of the following describes the microbiological properties of the most likely causal organism?? {'A': 'Gram-negative, oxidase-positive, maltose-nonfermenting diplococci', 'B': 'Gram-positive, optochin-sensitive, lancet-shaped diplococci', 'C': 'Gram-negative, lactose-nonfermenting, blue-green pigment-producing bacilli', 'D': 'Gram-positive, coagulase-positive, clustered cocci', 'E': 'Gram-positive, anaerobic, non-acid fast branching filamentous bacilli'},
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B: Gram-positive, optochin-sensitive, lancet-shaped diplococci
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Q:A 57-year-old woman presents to her primary care physician with a concern for joint pain. She states that she often feels minor joint pain and morning stiffness in both of her hands every day, in particular in the joints of her fingers. Her symptoms tend to improve as the day goes on and she states they are not impacting the quality of her life. She lives alone as her partner recently died. She smokes 1 pack of cigarettes per day and drinks 2-3 alcoholic drinks per day. Her last menses was at the age of 45 and she works at a library. The patient has a history of diabetes and chronic kidney disease and her last GFR was 25 mL/min. Her temperature is 97.5°F (36.4°C), blood pressure is 117/58 mmHg, pulse is 90/min, respirations are 14/min, and oxygen saturation is 98% on room air. Physical exam is within normal limits. Which of the following interventions is appropriate management of future complications in this patient?? {'A': 'Alendronate', 'B': 'Ibuprofen', 'C': 'Infliximab', 'D': 'Methotrexate', 'E': 'Prednisone'},
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A: Alendronate
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Q:A 70-year-old woman presents to her primary care doctor complaining of left knee pain. She states that she has noticed this more during the past several months after a fall at home. Previously, she was without pain and has no history of trauma to her knees. The patient states that the majority of her pain starts in the afternoon after she has been active for some time, and that the pain resolves with rest and over-the-counter analgesics. Aside from the left knee, she has no other symptoms and no other joint findings. On exam, her temperature is 98.8°F (37.1°C), blood pressure is 124/76 mmHg, pulse is 70/min, and respirations are 12/min. The patient has no limitations in her range of motion and no changes in strength on motor testing. However, there is tenderness along the medial joint line. What finding is most likely seen in this patient?? {'A': 'Association with HLA-DR4', 'B': 'Heberden nodes', 'C': 'Increased synovial fluid', 'D': 'Joint pannus', 'E': 'Marginal sclerosis'},
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E: Marginal sclerosis
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Q:A 27-year-old homeless man presents to the emergency department with abdominal pain and vomiting. He has a known history of intravenous drug use and has been admitted to the hospital several times before. On physical examination his temperature is 99°F (37.2°C), blood pressure is 130/85 mmHg, pulse is 90/min, respirations are 19/min, and pulse oximetry is 99% on room air. The patient is in obvious discomfort. There is increased salivation and lacrimation. Pupils are reactive to light and 5 mm bilaterally. Cardiopulmonary exam is unremarkable. There is diffuse abdominal tenderness to palpation with no rebound or guarding. Which of the following interventions would have prevented this patient’s current condition?? {'A': 'Lorazepam', 'B': 'Buprenorphine', 'C': 'Naltrexone', 'D': 'Naloxone', 'E': 'Buproprion'},
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B: Buprenorphine
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Answer the following medical question with one of the provided options:
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Q:A 21-year-old gravida 1, para 0 woman presents to the family medicine clinic for her first prenatal appointment. She states that she has been taking folic acid supplements daily as directed by her mother. She smokes a few cigarettes a day and has done so for the last 5 years. Pediatric records indicate the patient is measles, mumps, and rubella non-immune. Her heart rate is 78/min, respiratory rate is 14/min, temperature is 36.5°C (97.7°F), and blood pressure is 112/70 mm Hg. Her calculated BMI is approximately 26 kg/m2. Her heart is without murmurs and lung sounds are clear bilaterally. Standard prenatal testing is ordered. Which of the following is the next best step for this patient’s prenatal care?? {'A': 'MMR vaccine postpartum', 'B': 'MMR vaccine during pregnancy', 'C': 'Serology, then vaccine postpartum', 'D': 'Serology, then vaccine during pregnancy', 'E': 'MMR vaccine and immune globulin postpartum'},
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A: MMR vaccine postpartum
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Answer the following medical question with one of the provided options:
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Q:A 76-year-old woman with hypertension and coronary artery disease is brought to the emergency department after the sudden onset of right-sided weakness. Her pulse is 83/min and blood pressure is 156/90 mm Hg. Neurological examination shows right-sided facial drooping and complete paralysis of the right upper and lower extremities. Tongue position is normal and she is able to swallow liquids without difficulty. Knee and ankle deep tendon reflexes are exaggerated on the right. Sensation to vibration, position, and light touch is normal bilaterally. She is oriented to person, place, and time, and is able to speak normally. Occlusion of which of the following vessels is the most likely cause of this patient's current symptoms?? {'A': 'Ipsilateral anterior cerebral artery', 'B': 'Anterior spinal artery', 'C': 'Contralateral middle cerebral artery', 'D': 'Ipsilateral posterior inferior cerebellar artery', 'E': 'Contralateral lenticulostriate artery'},
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E: Contralateral lenticulostriate artery
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Answer the following medical question with one of the provided options:
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Q:A patient with history of hypertension and bipolar disorder is seen in your clinic for new-onset tremor, as well as intense thirst and frequent desire to urinate. Although her bipolar disorder was previously well-managed by medication, she has recently added a new drug to her regimen. Which of the following medications did she likely start?? {'A': 'Furosemide', 'B': 'Fluoxetine', 'C': 'Acetaminophen', 'D': 'Hydrochlorothiazide', 'E': 'Valproate'},
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D: Hydrochlorothiazide
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Answer the following medical question with one of the provided options:
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Q:A 70-year-old man presents with severe abdominal pain over the last 24 hours. He describes the pain as severe and associated with diarrhea, nausea, and vomiting. He says he has had a history of postprandial abdominal pain over the last several months. The patient denies any fever, chills, recent antibiotic use. Past medical history is significant for peripheral arterial disease and type 2 diabetes mellitus. The patient reports a 20 pack-year smoking history. His vital signs include blood pressure 90/60 mm Hg, pulse 100/min, respiratory 22/min, temperature 38.0°C (100.5°F), and oxygen saturation of 98% on room air. On physical examination, the patient is ill-appearing. His abdomen is severely tender to palpation and distended with no rebound or guarding. Pain is disproportionate to the exam findings. Rectal examination demonstrates bright red-colored stool. Abdominal X-ray is unremarkable. Stool culture was negative for C. difficile. A contrast-enhanced CT scan reveals segmental colitis involving the distal transverse colon. Which of the following is the most likely cause of this patient’s symptoms?? {'A': 'Atherosclerosis', 'B': 'Aneurysm', 'C': 'Hypokalemia', 'D': 'Bacterial infection', 'E': 'Upper GI bleeding'},
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A: Atherosclerosis
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Answer the following medical question with one of the provided options:
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Q:An investigator studying DNA mutation mechanisms isolates single-stranded DNA from a recombinant bacteriophage and sequences it. The investigator then mixes it with a buffer solution and incubates the resulting mixture at 70°C for 16 hours. Subsequent DNA resequencing shows that 3.7 per 1,000 cytosine residues have mutated to uracil. Which of the following best describes the role of the enzyme that is responsible for the initial step in repairing these types of mutations in living cells?? {'A': "Cleavage of the phosphodiester bond 3' of damaged site", 'B': "Addition of free nucleotides to 3' end", 'C': 'Connecting the phosphodiester backbone', 'D': 'Release of the damaged nucleotide', 'E': 'Creation of empty sugar-phosphate site'},
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E: Creation of empty sugar-phosphate site
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Answer the following medical question with one of the provided options:
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Q:A 72-year-old woman comes to the emergency department because of severe pain in her right lower leg for 3 hours. She has also had worsening tingling that started 3 hours before. She has never had such pain in her leg in the past. Over the last couple months, she has occasionally had episodes of palpitations. She has hypertension and type 2 diabetes mellitus. Current medications include hydrochlorothiazide and lisinopril. Her pulse is 88/min and her blood pressure is 135/80 mm Hg. Physical examination shows a cool and pale right leg with delayed capillary filling. Muscle strength and tone in the right calf and foot are reduced. Femoral pulse is present bilaterally. Pedal pulses are absent on the right. Inhibition of which of the following would have most likely prevented this patient's condition?? {'A': 'Voltage-gated cardiac potassium channels', 'B': 'Receptors for platelet aggregation', 'C': 'Synthesis of vitamin K-dependent factors', 'D': 'Voltage-gated cardiac sodium channels', 'E': 'Receptors of sympathetic nervous system'},
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C: Synthesis of vitamin K-dependent factors
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Answer the following medical question with one of the provided options:
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Q:A healthy 20-year-old African American man presents to the clinic for pre-participation sports physical for college football. He has no health complaints at this time. He has no recent history of illness or injury. He denies chest pain and palpitations. He reports no prior syncopal episodes. He had surgery 2 years ago for appendicitis. His mother is healthy and has an insignificant family history. His father had a myocardial infarction at the age of 53, and his paternal uncle died suddenly at the age of 35 for unknown reasons. His temperature is 37.1°C (98.8°F), the heart rate is 78/min, the blood pressure is 110/66 mm Hg, and the respiratory rate is 16/min. He has a tall, proportional body. There are no chest wall abnormalities. Lungs are clear to auscultation. His pulse is 2+ and regular in bilateral upper and lower extremities. His PMI is nondisplaced. Auscultation of his heart in the 5th intercostal space at the left midclavicular line reveals the following sound. Which of the following is the most likely outcome of this patient’s cardiac findings?? {'A': 'Asymptomatic', 'B': 'Systolic heart failure', 'C': 'Infective endocarditis', 'D': 'Atrial fibrillation', 'E': 'Sudden cardiac death'},
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A: Asymptomatic
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