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Answer the following medical question with one of the provided options:
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Q:An 18-month-old boy is brought in by his parents because of failure to gain weight. This patient’s pregnancy and spontaneous transvaginal delivery were uneventful. His vital signs include: temperature 37.0°C (98.6°F), blood pressure 102/57 mm Hg, pulse 97/min. His height is at the 30th percentile and weight is at the 25th percentile for his age and sex. Physical examination reveals generalized pallor, mild scleral icterus, and hepatosplenomegaly. Laboratory results are significant for the following: Hemoglobin 8.9 g/dL Mean corpuscular volume (MCV) 67 μm3 Red cell distribution width 12.7 % White blood cell count 11,300/mm3 Platelet count 420,000/mm3 A plain radiograph of the patient’s skull is shown in the exhibit (see image). Which of the following is the predominant type of hemoglobin in this patient?? {'A': 'Hemoglobin Bart', 'B': 'Hemoglobin F', 'C': 'Hemoglobin A', 'D': 'Hemoglobin A2', 'E': 'Hemoglobin S'},
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B: Hemoglobin F
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Answer the following medical question with one of the provided options:
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Q:A 3000-g (6-lb 10-oz) male newborn delivered at 38 weeks' gestation develops respiratory distress shortly after birth. Physical examination shows low-set ears, retrognathia, and club feet. Within a few hours, the newborn dies. Examination of the liver at autopsy shows periportal fibrosis. Which of the following is the most likely underlying cause of the neonate's presentation?? {'A': 'Bilateral hypoplasia of kidneys', 'B': 'Mutation on the short arm of chromosome 16', 'C': 'Valvular obstruction of urine outflow', 'D': 'Nondisjunction of chromosome 18', 'E': 'Cystic dilation of collecting duct'},
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E: Cystic dilation of collecting duct
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Answer the following medical question with one of the provided options:
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Q:A 45-year-old bank manager presents emergency department with abdominal pain for the last 2 weeks. The patient also vomited a few times, and in the last hour, he vomited blood as well. His pain was mild in the beginning but now he describes the pain as 8/10 in intensity, stabbing, and relentless. Ingestion of food makes it better as does the consumption of milk. He has a heart rate of 115/min. His blood pressure is 85/66 mm Hg standing, and 96/83 mm Hg lying down. He appears pale and feels dizzy. An intravenous line is started and a bolus of fluids is administered, which improved his vital signs. After stabilization, an esophagogastroduodenoscopy (EGD) is performed. There is a fair amount of blood in the stomach but after it is washed away, there are no abnormalities. A bleeding duodenal ulcer is seen located on the posteromedial wall of the duodenal bulb. Which artery is at risk from this ulcer?? {'A': 'Right gastroepiploic artery', 'B': 'Gastroduodenal artery', 'C': 'Dorsal pancreatic artery', 'D': 'Inferior pancreaticoduodenal artery', 'E': 'Superior pancreaticoduodenal artery'},
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B: Gastroduodenal artery
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Answer the following medical question with one of the provided options:
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Q:A 2-year-old girl is brought to the doctor by her mother with persistent scratching of her perianal region. The patient’s mother says that symptoms started 3 days ago and have progressively worsened until she is nearly continuously scratching even in public places. She says that the scratching is worse at night and disturbs her sleep. An anal swab and staining with lactophenol cotton blue reveal findings in the image (see image). Which of the following is the organism most likely responsible for this patient’s condition?? {'A': 'Enterobius vermicularis', 'B': 'Wuchereria bancrofti', 'C': 'Taenia saginata', 'D': 'Ancylostoma duodenale', 'E': 'Ascaris lumbricoides'},
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A: Enterobius vermicularis
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Answer the following medical question with one of the provided options:
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Q:A 29-year-old woman, gravida 2, para 1, at 17 weeks' gestation comes to the physician for a routine prenatal examination. A prenatal ultrasound at 10 weeks' gestation showed no abnormalities. Serum studies at 16 weeks' gestation showed an abnormally elevated α-fetoprotein level and normal beta human chorionic gonadotropin and estriol levels. After genetic counseling, the patient decides to continue with the pregnancy without any diagnostic testing. The remainder of her pregnancy is uncomplicated and she delivers a boy at 38 weeks' gestation. Analysis of the infant's leukocytes shows a 46, XY karyotype. Which of the following is the most likely cause for the abnormal second-trimester test results?? {'A': 'Robertsonian translocation', 'B': 'Underestimation of gestational age', 'C': 'Spina bifida occulta', 'D': 'Maternal hypothyroidism', 'E': 'Gestational trophoblastic disease'},
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B: Underestimation of gestational age
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Answer the following medical question with one of the provided options:
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Q:A 7-year-old boy is brought to the emergency department because of abdominal pain, nausea, and vomiting one day after he was a passenger in a low-velocity motor vehicle accident in which he was wearing an adult seatbelt. He has no personal or family history of serious illness. His temperature is 37.1°C (98.8°F), pulse is 107/min, respirations are 20/min, and blood pressure is 98/65 mm Hg. Physical examination shows dry mucous membranes. The upper abdomen is distended and tender to palpation. The remainder of the examination shows no abnormalities. A CT scan of the abdomen shows a large gastric bubble with mild gastric distention. Which of the following is the most appropriate next step in management?? {'A': 'Oral rehydration therapy and early refeeding', 'B': 'Esophagogastroduodenoscopy', 'C': 'Focused assessment with sonography for trauma', 'D': 'Emergent laparotomy', 'E': 'Nasogastric decompression and total parenteral nutrition'},
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E: Nasogastric decompression and total parenteral nutrition
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Answer the following medical question with one of the provided options:
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Q:A 21-year-old woman presents for a routine check-up with a new primary care physician. She is concerned about a needle-stick that occurred 2 days ago while volunteering to clean a public park. She notes that she had about 8 drinks last night while celebrating her best friend's engagement. Otherwise she has been healthy and has no past medical history. She does not smoke and drinks socially. On physical exam, she is found to have scleral icterus and mild jaundice. Lab results are shown below: Alanine aminotransferase (ALT): 9 U/L (normal range: 8-20 U/L) Aspartate aminotransferase (AST): 11 U/L (normal range: 8-20 U/L) Total bilirubin: 3.5 mg/dL (normal range: 0.1-1.0 mg/dL) Direct bilirubin: 0.2 mg/dL (normal range: 0.0-0.3 mg/dL) Hematocrit: 41% (normal range: 36%-46%) Which of the following processes is most likely responsible for this patient's jaundice?? {'A': 'Alcohol-induced damage to liver parenchyma', 'B': 'Defective conjugation of bilirubin with glucuronic acid', 'C': 'Defective secretion of bilirubin into the bile duct', 'D': 'Excessive extravascular hemolysis', 'E': 'Viral infection of hepatocytes'},
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B: Defective conjugation of bilirubin with glucuronic acid
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Answer the following medical question with one of the provided options:
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Q:A 49-year-old woman is brought to the emergency department for a severe, sudden-onset generalized headache that began while she was riding an exercise bike at home that morning. After quickly getting off the bike and lying down, she lost consciousness. She was unconscious for a period of one minute. When she regained consciousness, she had neck stiffness, nausea, and two episodes of vomiting. She has hypertension. She does not smoke or drink alcohol. Her current medications include chlorthalidone and a multivitamin. She is in severe distress. Her temperature is 37.3°C (99.1F°), pulse is 88/min, respirations are 18/min, and blood pressure is 169/102 mm Hg. A CT scan of the head without contrast shows hyperdense material between the arachnoid mater and the pia mater. The patient is taken to the operating room for surgical clipping and transferred to the intensive care unit. Five days later, she has new-onset focal weakness of her left lower extremity. Her temperature is 37.1°C (98.8°F), pulse is 70/min, respirations are 17/min, and blood pressure is 148/90 mm Hg. Strength is 3/5 in the left lower extremity and 5/5 in the right lower extremity. Which of the following would most likely have been able to prevent this patient's condition?? {'A': 'Intravenous labetalol', 'B': 'Intravenous fresh frozen plasma', 'C': 'Intravenous sodium nitroprusside', 'D': 'Oral nimodipine', 'E': 'Oral aspirin and clopidogrel'},
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D: Oral nimodipine
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Answer the following medical question with one of the provided options:
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Q:A 28-year-old woman comes to the doctor with a sudden onset of edematous and hyperemic circular skin lesions all over her body. The lesions are not painful but are pruritic. She also complains of severe genital pruritus. The patient also reports that she ate peanut butter 15–20 minutes before the onset of symptoms. Her blood pressure is 118/76 mm Hg, heart rate is 78 beats per minute, and respiratory rate is 15 breaths per minute. Physical examination reveals clear lung sounds bilaterally with no signs of respiratory distress. What should be the suggested treatment?? {'A': 'One of the beta-lactam antibiotics', 'B': 'No medications, just observation', 'C': 'Corticosteroids', 'D': 'H1 receptor antagonists', 'E': 'Acyclovir'},
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D: H1 receptor antagonists
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Answer the following medical question with one of the provided options:
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Q:A 5-year-old girl with no significant medical history is brought to her pediatrician because her mother is concerned about her axillary hair development. She first noticed the hair growth a day prior as she was assisting her daughter in getting dressed. The girl has no physical complaints, and her mother has not noticed a change in her behavior. On physical exam, the girl has scant bilateral axillary hair, no breast development, and no pubic hair. The exam is otherwise unremarkable. Activation of which of the following is responsible for this girl's presentation?? {'A': 'Hypothalamus', 'B': 'Pituitary', 'C': 'Adrenal glands', 'D': 'Neoplasm', 'E': 'Ovaries'},
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C: Adrenal glands
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Answer the following medical question with one of the provided options:
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Q:While at the emergency room, a 43-year-old woman starts experiencing progressive chest pain, shortness of breath, dizziness, palpitations, bilateral arm numbness, and a feeling that she is choking. She originally came to the hospital after receiving the news that her husband was injured in a car accident. The symptoms began 5 minutes ago. The patient has had two episodes involving similar symptoms in the past month. In both cases, symptoms resolved after approximately 10 minutes with no sequelae. She has no history of serious illness. Her father had a myocardial infarction at the age of 60 years. She is allergic to amoxicillin, cats, and pollen. She is 170 cm (5 ft 7 in) tall and weighs 52 kg (115 lb); BMI is 18 kg/m2. She appears distressed and is diaphoretic. Physical examination shows no other abnormalities. 12-lead ECG shows sinus tachycardia with a shortened QT interval and an isoelectric ST segment. Urine toxicology screening is negative. Which of the following is the most appropriate next step in management?? {'A': 'Order D-dimers', 'B': 'Order thyroid function tests', 'C': 'Order echocardiogram', 'D': 'Administer nebulized albuterol', 'E': 'Administer clonazepam'},
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E: Administer clonazepam
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Answer the following medical question with one of the provided options:
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Q:A 25-year-old previously healthy woman is admitted to the hospital with progressively worsening shortness of breath. She reports a mild fever. Her vital signs at the admission are as follows: blood pressure 100/70 mm Hg, heart rate 111/min, respiratory rate 20/min, and temperature 38.1℃ (100.6℉); blood saturation on room air is 90%. Examination reveals a bilateral decrease of vesicular breath sounds and rales in the lower lobes. Plain chest radiograph demonstrates bilateral opacification of the lower lobes. Despite appropriate treatment, her respiratory status worsens. The patient is transferred to the intensive care unit and put on mechanical ventilation. Adjustment of which of the following ventilator settings will only affect the patient’s oxygenation?? {'A': 'Tidal volume and respiratory rate', 'B': 'Tidal volume and FiO2', 'C': 'FiO2 and PEEP', 'D': 'Respiratory rate and PEEP', 'E': 'FiO2 and respiratory rate'},
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C: FiO2 and PEEP
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Answer the following medical question with one of the provided options:
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Q:A 23-year-old man comes to the emergency department because of a 2-day history of painful swelling of the right hand. There is no associated recent trauma. Physical examination shows a 3 × 3-cm area of induration that is fluctuant and warm to the touch, consistent with an abscess. The patient consents to incision and drainage of the abscess in the emergency department. Following evaluation of the patient's allergy status, a short-acting, local anesthetic drug is administered via subcutaneous infiltration. Which of the following local anesthetics would provide the shortest duration of analgesia?? {'A': 'Mepivacaine', 'B': 'Chloroprocaine', 'C': 'Lidocaine', 'D': 'Ropivacaine', 'E': 'Etidocaine'},
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B: Chloroprocaine
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Answer the following medical question with one of the provided options:
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Q:A 2-day-old boy, born at 38-weeks gestation, presents with jaundice and microcephaly. Social history reveals his mother is an animal caretaker. The vital signs include: temperature 37.0°C (98.6°F), blood pressure 75/40 mm Hg, pulse 150/min, respiratory rate 40/min, and oxygen saturation 99% on room air. Physical examination reveals hepatosplenomegaly. A CT and MRI of the head are significant for the following findings (see picture). Which of the following diseases contracted during pregnancy is the most likely cause of this patient’s condition? ? {'A': 'CMV', 'B': 'Rubella', 'C': 'Varicella', 'D': 'Toxoplasmosis', 'E': 'Syphilis'},
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A: CMV
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Answer the following medical question with one of the provided options:
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Q:A 72-year-old patient presents to the emergency department because of abdominal pain, diarrhea, and fever. He was started on levofloxacin for community-acquired pneumonia 2 weeks prior with resolution of his pulmonary symptoms. He has had hypertension for 20 years, for which he takes amlodipine. His temperature is 38.3°C (101.0°F), pulse is 90/min, and blood pressure is 110/70 mm Hg. On examination, mild abdominal distension with minimal tenderness was found. Laboratory tests reveal a peripheral white blood cell count of 12.000/mm3 and a stool guaiac mildly positive for occult blood. Which of the following best describe the mechanism of this patient illness?? {'A': 'Disruption of normal bowel flora and infection by spore-forming rods', 'B': 'Autoimmune inflammation of the rectum', 'C': 'Damage to the gastrointestinal tract by enteropathogenic viruses', 'D': 'Decreased blood flow to the gastrointestinal tract', 'E': 'Presence of osmotically active, poorly absorbed solutes in the bowel lumen'},
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A: Disruption of normal bowel flora and infection by spore-forming rods
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Answer the following medical question with one of the provided options:
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Q:A 31-year-old woman comes to the physician because of intermittent episodes of stabbing right lower jaw pain for 6 weeks. The pain is severe, sharp, and lasts for a few seconds. These episodes commonly occur when she washes her face, brushes her teeth, or eats a meal. She does not have visual disturbances, weakness of her facial muscles, or hearing loss. Five weeks ago, she had an episode of acute bacterial sinusitis, which was treated with antibiotics. Which of the following is the most appropriate initial treatment for this patient's condition?? {'A': 'Microvascular decompression', 'B': 'Amoxicillin', 'C': 'Carbamazepine', 'D': 'Valacyclovir', 'E': 'Doxepin'},
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C: Carbamazepine
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Answer the following medical question with one of the provided options:
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Q:A 2-year-old boy is brought to the physician because of fatigue and yellow discoloration of his skin for 2 days. One week ago, he had a 3-day course of low-grade fever and runny nose. As a newborn, he underwent a 5-day course of phototherapy for neonatal jaundice. His vital signs are within normal limits. Examination shows jaundice of the skin and conjunctivae. The spleen tip is palpated 3 cm below the left costal margin. His hemoglobin is 9.8 g/dl and mean corpuscular hemoglobin concentration is 38% Hb/cell. A Coombs test is negative. A peripheral blood smear is shown. This patient is at greatest risk for which of the following complications?? {'A': 'Malaria', 'B': 'Acute chest syndrome', 'C': 'Osteomyelitis', 'D': 'Acute myelogenous leukemia', 'E': 'Cholecystitis'},
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E: Cholecystitis
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Answer the following medical question with one of the provided options:
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Q:A 59-year-old woman presents to the emergency room with severe low back pain. She reports pain radiating down her left leg into her left foot. She also reports intermittent severe lower back spasms. The pain started after lifting multiple heavy boxes at her work as a grocery store clerk. She denies bowel or bladder dysfunction. Her past medical history is notable for osteoporosis and endometrial cancer. She underwent a hysterectomy 20 years earlier. She takes alendronate. Her temperature is 99°F (37.2°C), blood pressure is 135/85 mmHg, pulse is 85/min, and respirations are 22/min. Her BMI is 21 kg/m^2. On exam, she is unable to bend over due to pain. Her movements are slowed to prevent exacerbating her muscle spasms. A straight leg raise elicits severe radiating pain into her left lower extremity. The patient reports that the pain is worst along the posterior thigh and posterolateral leg into the fourth and fifth toes. Palpation along the lumbar vertebral spines demonstrates mild tenderness. Patellar reflexes are 2+ bilaterally. The Achilles reflex is decreased on the left. Which nerve root is most likely affected in this patient?? {'A': 'L3', 'B': 'L4', 'C': 'L5', 'D': 'S1', 'E': 'S2'},
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D: S1
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Answer the following medical question with one of the provided options:
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Q:A 57-year-old man is brought to the emergency department by his wife 20 minutes after having had a seizure. He has had recurrent headaches and dizziness for the past 2 weeks. An MRI of the brain shows multiple, round, well-demarcated lesions in the brain parenchyma at the junction between gray and white matter. This patient's brain lesions are most likely comprised of cells that originate from which of the following organs?? {'A': 'Thyroid', 'B': 'Prostate', 'C': 'Kidney', 'D': 'Lung', 'E': 'Skin'},
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D: Lung
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Answer the following medical question with one of the provided options:
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Q:Two weeks after undergoing an emergency cardiac catheterization for unstable angina pectoris, a 65-year-old man has decreased urinary output. He takes naproxen for osteoarthritis and was started on aspirin, clopidogrel, and metoprolol after the coronary intervention. His temperature is 38.1°C (100.5°F), pulse is 96/min, and blood pressure is 128/88 mm Hg. Examination shows mottled, reticulated purplish discoloration of the feet and ischemic changes on the right big toe. His leukocyte count is 16,500/mm3 with 56% segmented neutrophils, 12% eosinophils, 30% lymphocytes, and 2% monocytes. His serum creatinine concentration is 4.5 mg/dL. A photomicrograph of a kidney biopsy specimen is shown. Which of the following is the most likely cause of this patient's presentation?? {'A': 'Allergic interstitial nephritis', 'B': 'Cholesterol embolization', 'C': 'Contrast-induced nephropathy', 'D': 'Renal papillary necrosis', 'E': 'Eosinophilic granulomatosis with polyangiitis'},
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B: Cholesterol embolization
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Answer the following medical question with one of the provided options:
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Q:A 25-year-old woman presents to an urgent care center following a bee sting while at a picnic with her friends. She immediately developed a skin rash and swelling over her arm and face. She endorses diffuse itching over her torso. Past medical history is significant for a mild allergy to pet dander and ragweed. She occasionally takes oral contraceptive pills and diphenhydramine for her allergies. Family history is noncontributory. Her blood pressure is 119/81 mm Hg, heart rate is 101/min, respiratory rate is 21/min, and temperature is 37°C (98.6°F). On physical examination, the patient has severe edema over her face and severe stridor with inspiration at the base of both lungs. Of the following options, this patient is likely experiencing which of the following hypersensitivity reactions?? {'A': 'Type 1 - anaphylactic hypersensitivity reaction', 'B': 'Type 2 - cytotoxic hypersensitivity reaction', 'C': 'Type 3 - immune complex mediated hypersensitivity reaction ', 'D': 'Type 4 - cell mediated (delayed) hypersensitivity reaction', 'E': 'Both A & B'},
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A: Type 1 - anaphylactic hypersensitivity reaction
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Answer the following medical question with one of the provided options:
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Q:An investigator is studying the chemical structure of antibiotics and its effect on bacterial growth. He has synthesized a simple beta-lactam antibiotic and has added a bulky side chain to the molecule that inhibits the access of bacterial enzymes to the beta-lactam ring. The synthesized drug will most likely be appropriate for the treatment of which of the following conditions?? {'A': 'Nocardiosis', 'B': 'Folliculitis', 'C': 'Erythema migrans', 'D': 'Atypical pneumonia', 'E': 'Otitis media'},
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B: Folliculitis
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Answer the following medical question with one of the provided options:
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Q:A 31-year-old woman scrapes her finger on an exposed nail and sustains a minor laceration. Five minutes later, her finger is red, swollen, and painful. She has no past medical history and does not take any medications. She drinks socially with her friends and does not smoke. The inflammatory cell type most likely to be prominent in this patient's finger has which of the following characteristics?? {'A': 'Dark histamine containing granules', 'B': 'Dramatically expanded endoplasmic reticulum', 'C': 'Large cell with amoeboid movement', 'D': 'Multiple peripheral processes', 'E': 'Segmented nuclei'},
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E: Segmented nuclei
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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 her surgeon 1 year after a surgery for Crohn disease involving the removal of much of her small bowel. She had no major complications during the surgery and recovered as expected. Since then, she has noticed bone pain and weakness throughout her body. She has also had several fractures since the surgery. A panel of labs relevant to bone physiology was obtained and the results are shown below: Serum: Phosphate: Decreased Calcium: Decreased Alkaline phosphatase: Increased The factor that is most likely abnormal in this patient can also be synthesized from which of the following?? {'A': '7-dehydrocholesterol', 'B': 'Alpha-tocopherol', 'C': 'Beta-carotene', 'D': 'Calcium-sensing receptor', 'E': 'Glutamyl carboxylase'},
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A: 7-dehydrocholesterol
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Answer the following medical question with one of the provided options:
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Q:A 7-month-old girl is brought to the pediatrician by her parents with a mild, persistent fever for the past week. The patient’s mother also states she is feeding poorly and has become somewhat lethargic. The patient was born at term and the delivery was uncomplicated. The child’s birth weight was 3.5 kg (7.7 lb) and at 6 months was 7.0 kg (15.4 lb). She is fully immunized. The patient’s father recently returned from a business trip to India with a mild cough and was diagnosed with tuberculosis. The patient’s mother tests negative for tuberculosis The patient’s temperature is 38.1℃ (100.5℉). Today, she weighs 7.0 kg (15.4 lb). Cardiopulmonary auscultation reveals diminished breath sounds in the upper lobes. A chest radiograph demonstrates hilar lymphadenopathy and infiltrates in the upper lobes. Gastric aspirates are positive for acid-fast bacilli, however, cultures are still pending. Father and daughter are both started on standard antitubercular therapy. Which of the following is the appropriate management for the patient’s mother?? {'A': 'No medication is required', 'B': 'Isoniazid alone', 'C': 'Isoniazid and rifampicin', 'D': 'Isoniazid, rifampicin, and pyrazinamide', 'E': 'Isoniazid, rifampin, pyrazinamide, and ethambutol'},
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B: Isoniazid alone
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Answer the following medical question with one of the provided options:
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Q:A 63-year-old man comes to the physician because of a 2-month history of progressive fatigue. He also has shortness of breath and palpitations, which worsen on physical exertion and improve with rest. He has had intermittent constipation, low-grade fever, and generalized myalgia for the past 3 months. He has had a 10.4-kg (23-lb) weight loss over the past 4 months despite no change in appetite. His temperature is 37°C (98.6°F), pulse is 108/min, respirations are 16/min, and blood pressure is 130/78 mm Hg. Examination shows pale conjunctivae. His hemoglobin concentration is 9.1 g/dL, mean corpuscular volume is 70 μm3, and serum ferritin is 12 ng/mL. Test of the stool for occult blood is positive. Colonoscopy shows a 1.7-cm wide exophytic ulcer with irregular, bleeding edges in the ascending colon. Which of the following biopsy findings is the greatest predisposing factor for this patient's condition?? {'A': 'A submucosal lipomatous polyp', 'B': 'A villous adenomatous polyp', 'C': 'A pedunculated inflammatory polyp', 'D': 'A serrated hyperplastic polyp', 'E': 'A tubular adenomatous polyp'},
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B: A villous adenomatous polyp
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Answer the following medical question with one of the provided options:
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Q:A 51-year-old woman is brought into the emergency department following a motor vehicle accident. She is unconscious and was intubated in the field. Past medical history is unknown. Upon arrival, she is hypotensive and tachycardic. Her temperature is 37.2°C (99.1°F), the pulse is 110/min, the respiratory rate is 22/min, and the blood pressure is 85/60 mm Hg. There is no evidence of head trauma, she withdraws to pain and her pupils are 2mm and reactive to light. Her heart has a regular rhythm without any murmurs or rubs and her lungs are clear to auscultation. Her abdomen is firm and distended with decreased bowel sounds. Her extremities are cool and clammy with weak, thready pulses. There is no peripheral edema. Of the following, what is the likely cause of her presentation?? {'A': 'Neurogenic shock', 'B': 'Cardiogenic shock', 'C': 'Obstructive shock', 'D': 'Hypovolemic shock', 'E': 'Septic shock'},
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D: Hypovolemic shock
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Answer the following medical question with one of the provided options:
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Q:A 17-year-old girl comes to the emergency department because of a 6-day history of gradual onset abdominal pain, fever, vomiting, and decreased appetite. Her pain started as dull and diffuse over the abdomen but has progressed to a sharp pain on her right side. She has taken ibuprofen twice daily since the onset of symptoms, which has provided moderate pain relief. She has no history of serious illness. She is sexually active with one male partner and uses condoms consistently. She appears stable. Her temperature is 38.2°C (100.8°F), pulse is 88/min, respirations are 18/min, and blood pressure is 125/75 mm Hg. The abdomen is soft. There is tenderness to palpation of the right lower quadrant. Laboratory studies show: Leukocyte count 16,500/mm3 Serum Na+ 135 K+ 3.5 Cl- 94 HCO3- 24 Urea nitrogen 16 Creatinine 1.1 β-hCG negative Urine WBC 3/hpf RBC < 3/hpf Nitrite negative Leukocyte esterase negative CT scan of the abdomen shows a small (3-cm) fluid collection with an enhancing wall surrounded by bowel loops in the right pelvis. The patient is placed on bowel rest and started on IV fluids and antibiotics. Which of the following is the most appropriate next step in management?"? {'A': 'Correct electrolyte imbalances and proceed to the operating room for urgent open laparotomy', 'B': 'Ultrasound-guided percutaneous drainage of the fluid collection', 'C': 'Continue conservative management and schedule appendectomy in 6-8 weeks', 'D': 'Continue conservative management only', 'E': 'Correct electrolyte imbalances and proceed to the operating room for laparoscopic appendectomy'},
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C: Continue conservative management and schedule appendectomy in 6-8 weeks
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Answer the following medical question with one of the provided options:
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Q:A 61-year-old woman presents to the urgent care unit with a 2-week history of abdominal pain after meals. The patient reports vomiting over the past few days. The past medical history is significant for osteoarthritis and systemic lupus erythematosus. She regularly drinks alcohol. She does not smoke cigarettes. The patient currently presents with vital signs within normal limits. On physical examination, the patient appears to be in moderate distress, but she is alert and oriented. The palpation of the abdomen elicits tenderness in the epigastric region. The CT of the abdomen shows no signs of an acute process. The laboratory results are listed below. Which of the following is the most likely diagnosis? Na+ 139 mEq/L K+ 4.4 mEq/L Cl- 109 mmol/L HCO3- 20 mmol/L BUN 14 mg/dL Cr 1.0 mg/dL Glucose 101 mg/dL Total cholesterol 187 mg/dL LDL 110 mg/dL HDL 52 mg/dL TG 120 mg/dL AST 65 IU/L ALT 47 IU/L GGT 27 IU/L Amylase 512 U/L Lipase 1,262 U/L ? {'A': 'Acute liver failure', 'B': 'Acute cholecystitis', 'C': 'Acute pancreatitis', 'D': 'Acute mesenteric ischemia', 'E': 'Gastric ulcer'},
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C: Acute pancreatitis
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Answer the following medical question with one of the provided options:
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Q:A 65-year-old male engineer presents to the office with shortness of breath on exertion and a dry cough that he has had for about a year. He is a heavy smoker with a 25-pack-years history. His vitals include: heart rate 95/min, respiratory rate 26/min, and blood pressure 110/75 mm Hg. On examination, he presents with nail clubbing and bilateral and persistent crackling rales. The chest radiograph shows basal reticulonodular symmetric images, with decreased lung fields. The pulmonary function tests show the following: diffusing capacity of the lungs for carbon monoxide (DLCO) is 43% and reference SaO2 is 94% and 72%, at rest and with exercise, respectively. What is the most likely diagnosis?? {'A': 'Pleuropulmonary fibroelastosis', 'B': 'Pulmonary Langerhans cells histiocytosis', 'C': 'Chronic hypersensitivity pneumonitis', 'D': 'Asbestosis', 'E': 'Idiopathic pulmonary fibrosis'},
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E: Idiopathic pulmonary fibrosis
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Answer the following medical question with one of the provided options:
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Q:A 47-year-old patient returns to his primary care physician after starting aspirin two weeks ago for primary prevention of coronary artery disease. He complains that he wakes up short of breath in the middle of the night and has had coughing "attacks" three times. After discontinuing aspirin, what medication is most appropriate for prevention of similar symptoms in this patient?? {'A': 'Albuterol', 'B': 'Tiotropium', 'C': 'Prednisone', 'D': 'Montelukast', 'E': 'Fluticasone'},
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D: Montelukast
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Answer the following medical question with one of the provided options:
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Q:A 54-year-old man with hypertension and congenital blindness comes to the physician because he is unable to recognize objects by touch with his right hand. The symptoms started about 2 hours ago. When given a house key, he can feel the object in his right hand but is not able to identify what it is. This patient's condition is most likely caused by a lesion in which of the following locations?? {'A': 'Ipsilateral inferior frontal gyrus', 'B': 'Ipsilateral superior temporal gyrus', 'C': 'Contralateral superior parietal lobule', 'D': 'Contralateral precentral gyrus', 'E': 'Ipsilateral cingulate gyrus'},
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C: Contralateral superior parietal lobule
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Answer the following medical question with one of the provided options:
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Q:A 62-year-old man presents to his primary care physician because he is unhappy about his inability to tan this summer. He has been going to the beach with his family and friends, but he has remained pale. He has no other complaints except that he has been getting tired more easily, which he attributes to normal aging. Based on clinical suspicion a panel of tests are performed with the following results: Hemoglobin: 11 g/dL Leukocyte count: 5,370/mm^3 Platelet count: 168,000/mm^3 Mean corpuscular volume: 95 µm^3 Haptoglobin level: Decreased Reticulocytes: 3% Peripheral blood smear is also obtained and shown in the figure provided. Which of the following patient characteristics is consistent with the most likely cause of this patient's disease?? {'A': 'Aortic valve replacement', 'B': 'Consumption of fava beans', 'C': 'Infection of red blood cells', 'D': 'Inheritance of cytoskeletal defect', 'E': 'Red urine in the morning'},
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A: Aortic valve replacement
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Q:A 37-year-old primigravid woman comes to the physician at 13 weeks' gestation for a prenatal visit. She feels well. Her only medication is folic acid. Vital signs are within normal limits. Pelvic examination shows a uterus consistent in size with a 13-week gestation. Ultrasonography shows a nuchal translucency above the 99th percentile. Maternal serum pregnancy-associated plasma protein A is decreased and human chorionic gonadotropin concentrations are elevated to 2 times the median level. Which of the following is most likely to confirm the diagnosis?? {'A': 'Chorionic villus sampling', 'B': 'Quadruple marker test', 'C': 'Cell-free DNA testing', 'D': 'Triple screening test', 'E': 'Amniocentesis'},
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A: Chorionic villus sampling
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Q:A 10-month-old boy with a seizure disorder is brought to the physician by his mother because of a 2-day history of vomiting and lethargy. Laboratory studies show a decreased serum glucose concentration. Further testing confirms a deficiency in an enzyme involved in lipid metabolism that is found in the liver but not in adipose tissue. Which of the following enzymes is most likely deficient in this patient?? {'A': 'Acyl-CoA dehydrogenase', 'B': 'Glycerol-3-phosphate dehydrogenase', 'C': 'Glycerol kinase', 'D': 'Acetyl-CoA carboxylase', 'E': 'HMG-CoA reductase'},
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C: Glycerol kinase
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Q:A 38-year-old woman comes to the physician for the first time because of a 2-year history of lower back pain and fatigue. She also says that she occasionally feels out of breath. Her symptoms are not associated with physical activity. She has seen multiple physicians over the past year. Extensive workup including blood and urine tests, abdominal ultrasound, MRI of the back, and cardiac stress testing have shown no abnormalities. The patient asks for a medication to alleviate her symptoms. Which of the following is the most appropriate response by the physician?? {'A': '"""I would like to investigate your shortness of breath by performing coronary artery catheterization."""', 'B': '"""Your symptoms are suggestive of a condition called somatic symptom disorder."""', 'C': '"""I would like to assess your symptoms causing you the most distress and schedule monthly follow-up appointments."""', 'D': '"""I would like to refer you to a psychiatric specialist to start behavioral psychotherapy."""', 'E': '"""Your desire for pain medication is suggestive of a medication dependence disorder."""'},
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C: """I would like to assess your symptoms causing you the most distress and schedule monthly follow-up appointments."""
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Q:A 24-year-old woman arrives to an urgent care clinic for "eye discoloration." She states that for the past 3 days she has had the “stomach flu” and has not been eating much. Today, she reports she is feeling better, but when she woke up "the whites of [her] eyes were yellow." She denies fever, headache, palpitations, abdominal pain, nausea, vomiting, and diarrhea. She was recently diagnosed with polycystic ovary syndrome during a gynecology appointment 2 weeks ago for irregular menses. Since then, she has been taking a daily combined oral contraceptive. She takes no other medications. Her temperature is 98.6°F (37°C), blood pressure is 120/80 mmHg, and pulse is 76/min. Body mass index is 32 kg/m^2. On physical examination, there is scleral icterus and mild jaundice. Liver function tests are drawn, as shown below: Alanine aminotransferase (ALT): 19 U/L Aspartate aminotransferase (AST): 15 U/L Alkaline phosphatase: 85 U/L Albumin: 4.0 g/dL Total bilirubin: 12 mg/dL Direct bilirubin: 10 mg/dL Prothrombin time: 13 seconds If a liver biopsy were to be performed and it showed a normal pathology, which of the following would be the most likely diagnosis?? {'A': 'Cholelithiasis', 'B': 'Crigler-Najjar syndrome', 'C': 'Dubin-Johnson syndrome', 'D': 'Gilbert syndrome', 'E': 'Rotor syndrome'},
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E: Rotor syndrome
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Q:A 16-year-old male presents to an ophthalmologist as a new patient with a complaint of blurry vision. He reports that over the past several months he has had increasing difficulty seeing the board from the back of the classroom at school. The patient is otherwise doing well in school and enjoys playing basketball. His past medical history is otherwise significant for scoliosis which is managed by an orthopedic surgeon. His family history is significant for a mother with type II diabetes mellitus, and a father who underwent aortic valve replacement last year. On physical exam, the patient is tall for his age and has long arms. He has 20 degrees of thoracic scoliosis, which is stable from previous exams. On slit-lamp examination, the patient is found to have bilateral upward lens subluxation and is prescribed corrective lenses. Which of the following is the most likely etiology of this patient’s presentation?? {'A': 'Defective metabolism of methionine', 'B': 'Extra copy of sex chromosome', 'C': 'Mutation of gene on chromosome 15', 'D': 'Mutation of COL5A1 or COL5A2', 'E': 'Mutation of RET proto-oncogene'},
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C: Mutation of gene on chromosome 15
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Q:An 11-year-old boy is brought to the physician by his mother because of teacher complaints regarding his poor performance at school for the past 8 months. He has difficulty sustaining attention when assigned school-related tasks, does not follow the teachers' instructions, and makes careless mistakes in his homework. He often blurts out answers in class and has difficulty adhering to the rules during soccer practice. His mother reports that he is easily distracted when she speaks with him and that he often forgets his books at school. Physical examination shows no abnormalities. The patient is started on the appropriate first-line therapy. This boy is at increased risk for which of the following conditions?? {'A': 'Prolonged QT interval', 'B': 'Serotonin syndrome', 'C': 'Increased BMI', 'D': 'Decreased perspiration', 'E': 'Elevated blood pressure'},
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E: Elevated blood pressure
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Q:A 14-year-old boy is brought in to the clinic by his parents for weird behavior for the past 4 months. The father reports that since the passing of his son's pet rabbit about 5 months ago, his son has been counting during meals. It could take up to 2 hours for him to finish a meal as he would cut up all his food and arrange it in a certain way. After asking the parents to leave the room, you inquire about the reason for these behaviors. He believes that another family member is going to die a “terrible death” if he doesn’t eat his meals in multiples of 5. He understands that this is unreasonable but just can’t bring himself to stop. Which of the following abnormality is this patient's condition most likely associated with?? {'A': 'Atrophy of the frontotemporal lobes', 'B': 'Atrophy of the hippocampus', 'C': 'Decreased level of serotonin', 'D': 'Enlargement of the ventricles', 'E': 'Increased activity of the caudate'},
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E: Increased activity of the caudate
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Q:A 2720-g (6-lb) female newborn is delivered at term to a 39-year-old woman, gravida 3, para 2. Examination in the delivery room shows micrognathia, prominent occiput with flattened nasal bridge, and pointy low-set ears. The eyes are upward slanting with small palpebral fissures. The fists are clenched with fingers tightly flexed. The index finger overlaps the third finger and the fifth finger overlaps the fourth. A 3/6 holosystolic murmur is heard at the lower left sternal border. The nipples are widely spaced and the feet have prominent heels and convex, rounded soles. Which of the following is the most likely cause of these findings?? {'A': 'Trisomy 18', 'B': 'Fetal alcohol syndrome', 'C': 'Deletion of Chromosome 5p', 'D': 'Trisomy 13', 'E': 'Trisomy 21\n"'},
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A: Trisomy 18
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Q:You are a resident on an anesthesiology service and are considering using nitrous oxide to assist in placing a laryngeal mask airway (LMA) in your patient, who is about to undergo a minor surgical procedure. You remember that nitrous oxide has a very high minimal alveolar concentration (MAC) compared to other anesthetics. This means that nitrous oxide has:? {'A': 'decreased lipid solubility and decreased potency', 'B': 'increased lipid solubility and decreased potency', 'C': 'decreased lipid solubility and increased potency', 'D': 'increased lipid solubility and increased potency', 'E': 'no effect on lipid solubility or potency'},
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A: decreased lipid solubility and decreased potency
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Q:A 72-year-old man with congestive heart failure is brought to the emergency department because of chest pain, shortness of breath, dizziness, and palpitations for 30 minutes. An ECG shows a wide complex tachycardia with a P-wave rate of 105/min, an R-wave rate of 130/min, and no apparent relation between the two. Intravenous pharmacotherapy is initiated with a drug that prolongs the QRS and QT intervals. The patient was most likely treated with which of the following drugs?? {'A': 'Verapamil', 'B': 'Carvedilol', 'C': 'Flecainide', 'D': 'Sotalol', 'E': 'Quinidine\n"'},
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E: Quinidine "
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Q:An 18-year-old woman comes to the physician because of worsening headache and exertional dyspnea for 6 days. Two months ago, she had a spontaneous abortion. Since then, she has had intermittent bloody vaginal discharge. Pelvic examination shows blood at the cervical os and a tender, mildly enlarged uterus. A urine pregnancy test is positive. An x-ray of the chest shows multiple round opacities in both lungs. Dilation and curettage is performed. Histopathology of the curettage specimen is most likely to show which of the following findings?? {'A': 'Whorled pattern of smooth muscle fibers surrounded by a pseudocapsule', 'B': 'Poorly differentiated glandular cells with myometrial invasion', 'C': 'Cytotrophoblasts and syncytiotrophoblasts without chorionic villi', 'D': 'Glomeruli-like central blood vessels enveloped by germ cells', 'E': 'Trophoblast hyperplasia with mixture of edematous and normal villi'},
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C: Cytotrophoblasts and syncytiotrophoblasts without chorionic villi
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Q:A 22-year-old woman presents to the gynecologist for evaluation of amenorrhea and dyspareunia. The patient states that she recently got married and has been worried about getting pregnant. The patient states that she has never had a period and that sex has always been painful. On examination, the patient is Tanner stage 5 with no obvious developmental abnormalities. The vaginal exam is limited with no identified vaginal canal. What is the most likely cause of this patient’s symptoms?? {'A': 'Hyperprolactinemia', 'B': 'Exposure to DES in utero', 'C': 'Turner syndrome', 'D': 'PCOS', 'E': 'Mullerian agenesis'},
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E: Mullerian agenesis
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Q:A previously healthy 61-year-old man comes to the physician because of bilateral knee pain for the past year. The pain is worse with movement and is relieved with rest. Physical examination shows crepitus, pain, and decreased range of motion with complete flexion and extension of both knees. There is no warmth, redness, or swelling. X-rays of both knees show irregular joint space narrowing, osteophytes, and subchondral cysts. Which of the following is the most appropriate pharmacotherapy?? {'A': 'Prednisone', 'B': 'Naproxen', 'C': 'Allopurinol', 'D': 'Celecoxib', 'E': 'Infliximab'},
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B: Naproxen
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Q:A researcher is studying how electrical activity propagates across the heart. In order to do this, he decides to measure the rate at which an action potential moves within various groups of cardiac muscle tissue. In particular, he isolates fibers from areas of the heart with the following characteristics: A) Dysfunction leads to fixed PR intervals prior to a dropped beat B) Dysfunction leads to increasing PR intervals prior to a dropped beat C) Dysfunction leads to tachycardia with a dramatically widened QRS complex D) Dysfunction leads to tachycardia with a sawtooth pattern on electrocardiogram Which of the following is the proper order of these tissues from fastest action potential propagation to slowest action potential propagation.? {'A': 'A > C > D > B', 'B': 'A > D > C > B', 'C': 'B > C > D > A', 'D': 'B > D > C > A', 'E': 'D > C > A > B'},
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B: A > D > C > B
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Q:A 35-year-old nulligravid woman and her 33-year-old husband come to the physician for genetic counseling prior to conception. The husband has had severe psoriasis since adolescence that is now well-controlled under combination treatment with UV light therapy and etanercept. His father and two brothers also have this condition, and the couple wants to know how likely it is that their child will have psoriasis. The inheritance pattern of this patient's illness is most similar to which of the following conditions?? {'A': 'Schizophrenia', 'B': 'Alpha thalassemia minor', 'C': 'Alport syndrome', 'D': 'Oculocutaneous albinism', 'E': 'Familial hypercholesterolemia'},
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A: Schizophrenia
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Q:A 27-year old woman comes to the physician for a rash that began 5 days ago. The rash involves her abdomen, back, arms, and legs, including her hands and feet. Over the past month, she has also had mild fever, headache, and myalgias. She has no personal history of serious illness. She smokes 1 pack of cigarettes a day and binge drinks on the weekends. She uses occasional cocaine, but denies other illicit drug use. Vital signs are within normal limits. Physical examination shows a widespread, symmetric, reddish-brown papular rash involving the trunk, upper extremities, and palms. There is generalized, nontender lymphadenopathy. Skin examination further shows patchy areas of hair loss on her scalp and multiple flat, broad-based, wart-like papules around her genitalia and anus. Rapid plasma reagin and fluorescent treponemal antibody test are are both positive. In addition to starting treatment, which of the following is the most appropriate next step in management?? {'A': 'Lumbar puncture', 'B': 'Skin biopsy', 'C': 'Blood cultures', 'D': 'CT angiography of the chest', 'E': 'PCR for C. trachomatis and N. gonorrhea'},
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E: PCR for C. trachomatis and N. gonorrhea
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Q:A 35-year-old woman seeks evaluation at a clinic with a complaint of right upper abdominal pain for greater than 1 month. She says that the sensation is more of discomfort than pain. She denies any history of weight loss, changes in bowel habit, or nausea. Her medical history is unremarkable. She takes oral contraceptive pills and multivitamins every day. Her physical examination reveals a palpable liver mass that is 2 cm in diameter just below the right costal margin in the midclavicular line. An abdominal CT scan reveals 2 hypervascular lesions in the right hepatic lobe. The serum α-fetoprotein level is within normal limits. What is the next best step in the management of this patient’s condition?? {'A': 'Discontinue oral contraceptives', 'B': 'Radiofrequency ablation (RFA)', 'C': 'CT-guided biopsy', 'D': 'Referral for surgical excision', 'E': 'Observation'},
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A: Discontinue oral contraceptives
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Q:A 30-year-old woman presents to her physician for a routine check-up. She says she is planning to get pregnant. Past medical history is significant for arterial hypertension. Current medications are enalapril. The physician explains that this medication can be teratogenic. He changes her antihypertensive medication to methyldopa, which has no contraindications for pregnant women. A few days later, the patient is admitted to the emergency department with jaundice and dark urine. Her laboratory tests are as follows: Hemoglobin 0.9 g/dL Red blood cells 3.2 x 106/µL White blood cells 5,000/mm3 Platelets 180,000/mm3 Direct Coombs test Positive This patient is diagnosed with autoimmune hemolytic anemia (AIHA). Which of the following is correct about autoimmune hemolytic anemia in this patient?? {'A': 'The direct Coombs test is positive if there are antibodies in the serum.', 'B': 'Typical blood smear findings include spherocytes.', 'C': 'The indirect Coombs test is positive if red blood cells are coated with antibody or complement.', 'D': 'Parvovirus B19 can trigger AIHA.', 'E': 'Heinz bodies are common findings in blood smear.'},
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B: Typical blood smear findings include spherocytes.
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Q:A 30-year-old woman comes to the primary care physician because she has felt nauseous and fatigued for 3 weeks. Menses occur at irregular 24- to 33-day intervals and last for 4–6 days. Her last menstrual period was 7 weeks ago. Her temperature is 37°C (98.6°F), pulse is 95/min, and blood pressure is 100/70 mm Hg. Pelvic examination shows an enlarged uterus. Her serum β-hCG concentration is 96,000 mIU/mL (N < 5). An abdominal ultrasound is shown. Which of the following is the most likely diagnosis?? {'A': 'Bicornuate uterus pregnancy', 'B': 'Abdominal pregnancy', 'C': 'Dichorionic-diamniotic twins', 'D': 'Partial hydatidiform mole', 'E': 'Complete hydatid mole'},
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C: Dichorionic-diamniotic twins
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Q:A 38-year-old primigravid woman at 34 weeks' gestation comes to the emergency department because of progressive shortness of breath for 3 hours. At a prenatal visit 2 weeks earlier, she was diagnosed with gestational hypertension. Amniocentesis with chromosomal analysis was performed at 16 weeks' gestation and showed no abnormalities. The patient has been otherwise healthy, except for a deep venous thrombosis 2 years ago that was treated with low molecular weight heparin. Her current medications include methyldopa and a multivitamin. She appears anxious. Her pulse is 90/min, respirations are 24/min, and blood pressure is 170/100 mm Hg. Crackles are heard over both lung bases. Pelvic examination shows a uterus consistent in size with a 32-week gestation. Examination of the heart, abdomen, and extremities shows no abnormalities. Which of the following is the most likely cause of this patient's shortness of breath?? {'A': 'Pulmonary edema', 'B': 'Amniotic fluid embolism', 'C': 'Idiopathic pulmonary fibrosis', 'D': 'Pulmonary metastases', 'E': 'Pulmonary thromboembolism'},
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A: Pulmonary edema
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Q:A 12-year-old girl presents to a pediatrician because she fails to show signs of breast development. On physical examination, the pediatrician notes that her stature is shorter than expected for her age and sex. She has a webbed neck, a low posterior hairline, and a broad chest with widely spaced nipples. Non-pitting bilateral pedal edema is present. The pediatrician orders a karyotype analysis, the result of which is shown below. Which of the following findings is most likely to be present on auscultation of her chest?? {'A': 'A short systolic murmur along the left sternal border in the third and fourth intercostal spaces which radiates to the left infrascapular area', 'B': 'A systolic ejection murmur which is heard best over the pulmonic area, radiating to the lung fields bilaterally with an inaudible pulmonic component to the second heart sound', 'C': 'A continuous machine-like murmur over the second left intercostal space which radiates to the left clavicle', 'D': 'A high-pitched holosystolic murmur over the apical area which radiates to the left axilla', 'E': 'A loud and harsh holosystolic murmur which is heard best over the lower left sternal border'},
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A: A short systolic murmur along the left sternal border in the third and fourth intercostal spaces which radiates to the left infrascapular area
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Q:A 56-year-old woman is one week status post abdominal hysterectomy when she develops a fever of 101.4°F (38.6°C). Her past medical history is significant for type II diabetes mellitus and a prior history of alcohol abuse. The operative report and intraoperative cystoscopy indicate that the surgery was uncomplicated. The nurse reports that since the surgery, the patient has also complained of worsening lower abdominal pain. She has given the patient the appropriate pain medications with little improvement. The patient has tolerated an oral diet well and denies nausea, vomiting, or abdominal distension. Her blood pressure is 110/62 mmHg, pulse is 122/min, and respirations are 14/min. Since being given 1000 mL of intravenous fluids yesterday, the patient has excreted 800 mL of urine. On physical exam, she is uncomfortable, shivering, and sweating. The surgical site is intact, but the surrounding skin appears red. No drainage is appreciated. The abdominal examination reveals tenderness to palpation and hypoactive bowel sounds. Labs and a clean catch urine specimen are obtained as shown below: Leukocyte count and differential: Leukocyte count: 18,000/mm^3 Segmented neutrophils: 80% Bands: 10% Eosinophils: 1% Basophils: < 1% Lymphocytes: 5% Monocytes: 4% Platelet count: 300,000/mm^3 Hemoglobin: 12.5 g/dL Hematocrit: 42% Urine: Epithelial cells: 15/hpf Glucose: positive RBC: 1/hpf WBC: 2/hpf Bacteria: 50 cfu/mL Ketones: none Nitrites: negative Leukocyte esterase: negative Which of the following is most likely the cause of this patient’s symptoms?? {'A': 'Alcohol withdrawal', 'B': 'Surgical error', 'C': 'Post-operative ileus', 'D': 'Urinary tract infection', 'E': 'Wound infection'},
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E: Wound infection
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Answer the following medical question with one of the provided options:
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Q:A 34-year-old man is admitted to the emergency department after a motor vehicle accident in which he sustained blunt abdominal trauma. On admission, he is conscious, has a GCS score of 15, and has normal ventilation with no signs of airway obstruction. Vitals initially are blood pressure 95/65 mmHg, heart rate 87/min, respiratory rate 14/min, and oxygen saturation of 95% on room air. The physical exam is significant only for tenderness to palpation over the left flank. Noncontrast CT of the abdomen shows fractures of the 9th and 10th left ribs. Intravenous fluids are administered and the patient’s blood pressure increases to 110/80 mm Hg. Three days later after admission, the patient suddenly complains of weakness and left upper quadrant (LUQ) pain. VItals are blood pressure 80/50 mm Hg, heart rate 97/min, respiratory rate 18/min, temperature 36.2℃ (97.2℉) and oxygen saturation of 99% on room air. Prompt administration of 2L of IV fluids increases the blood pressure to 100/70 mm Hg. On physical exam, there is dullness to percussion and rebound tenderness with guarding in the LUQ. Bowel sounds are present. Raising the patient’s left leg results in pain in his left shoulder. Stat hemoglobin level is 9.8 mg/dL. Which of the following findings would be most likely seen if a CT scan were performed now?? {'A': 'Irregular linear areas of hypoattenuation in the liver parenchyma', 'B': 'Heterogeneous parenchymal enhancement of the pancreatic tail', 'C': 'Subdiaphragmatic air collection', 'D': 'Low-density areas within the splenic parenchyma', 'E': 'Herniation of the stomach into the thoracic cavity'},
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D: Low-density areas within the splenic parenchyma
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Q:A 23-year-old man comes to the physician because of a tremor in his right hand for the past 3 months. The tremor has increased in intensity and he is unable to perform his daily activities. When he wakes up in the morning, his pillow is soaked in saliva. During this period, he has been unable to concentrate in his college classes. He has had several falls over the past month. He has no past history of serious illness. He appears healthy. His vital signs are within normal limits. Examination shows a broad-based gait. There is a low frequency tremor that affects the patient's right hand to a greater extent than his left. When the patient holds his arms fully abducted with his elbows flexed, he has a bilateral low frequency arm tremor that increases in amplitude the longer he holds his arms up. Muscle strength is normal in all extremities. Sensation is intact. Deep tendon reflexes are 4+ bilaterally. Dysmetria is present. A photograph of the patient's eye is shown. Mental status examination shows a restricted affect. The rate and rhythm of his speech is normal. Which of the following is the most appropriate pharmacotherapy?? {'A': 'Penicillamine', 'B': 'Propranolol', 'C': 'Deferoxamine', 'D': 'Prednisone', 'E': 'Levodopa\n"'},
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A: Penicillamine
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Q:A 30-year-old man returns to the hospital 3 weeks after open reduction and internal fixation of left tibia and fibula fractures from a motor vehicle accident. The patient complains that his surgical site has been draining pus for a few days, and his visiting nurse told him to go to the emergency room after he had a fever this morning. On exam, his temperature is 103.0°F (39.4°C), blood pressure is 85/50 mmHg, pulse is 115/min, and respirations are 14/min. The ED physician further documents that the patient is also starting to develop a diffuse, macular rash. The patient is started on broad spectrum antibiotics, and Gram stain demonstrates purple cocci in clusters. Which of the following toxins is likely to be the cause of this patient's condition?? {'A': 'Alpha toxin', 'B': 'Endotoxin', 'C': 'Exfoliative toxin', 'D': 'Pyogenic exotoxin A', 'E': 'Toxic shock syndrome toxin 1'},
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E: Toxic shock syndrome toxin 1
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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 comes to the physician because of a sudden loss of vision in her right eye for 10 minutes that morning, which subsided spontaneously. Over the past 2 months, she has had multiple episodes of left-sided headaches and pain in her jaw while chewing. Examination shows conjunctival pallor. Range of motion of the shoulders and hips is slightly limited by pain. Her erythrocyte sedimentation rate is 69 mm/h. Treatment with the appropriate medication for this patient's condition is initiated. Which of the following sets of laboratory findings is most likely as a consequence of treatment? $$$ Lymphocytes %%% Neutrophils %%% Eosinophils %%% Fibroblasts $$$? {'A': '↓ ↓ ↓ ↓', 'B': '↑ ↑ ↓ ↑', 'C': '↓ ↓ ↑ ↓', 'D': '↓ ↑ ↓ ↓', 'E': '↑ ↓ ↓ ↓'},
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D: ↓ ↑ ↓ ↓
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Q:A 32-year-old man with hypertension and gout comes to the physician with left flank pain and bloody urine for two days. He does not smoke cigarettes but drinks two beers daily. Home medications include hydrochlorothiazide and ibuprofen as needed for pain. Physical examination shows left costovertebral angle tenderness. Urine dipstick is strongly positive for blood. Microscopic analysis of a stone found in the urine reveals a composition of magnesium ammonium phosphate. Which of the following is the strongest predisposing factor for this patient's condition?? {'A': 'Urinary tract infection', 'B': 'Use of vitamin C supplements', 'C': 'Uric acid precipitation', 'D': 'Ethylene glycol ingestion', 'E': 'Hereditary deficiency in amino acid reabsorption'},
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A: Urinary tract infection
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Q:A 25-year-old woman presents to the psychiatric emergency department in restraints. She was found trying to break into a deli at midnight. The patient claims that she has an idea that will revolutionize the shipping industry. The patient is not violent but seems highly agitated and is speaking very rapidly about her ideas. She is easily distractible and tells you about many of her other ideas. She has a past medical history of depression and hypertension refractory to treatment. Her current medications include captopril, iburprofen, and melatonin. A neurological exam is deferred due to the patient’s current status. Her pulmonary and cardiovascular exams are within normal limits and mild bilateral bruits are heard over her abdomen. The patient is given haloperidol and diphenhydramine and spends the night in the psychiatric inpatient unit. The patient is started on long-term therapy and is discharged 3 days later. At a follow up visit at her primary care physician, the patient is noted to have a blood pressure of 150/100 mmHg. She is started on chlorthalidone and instructed to return in 3 days. When the patient returns her blood pressure is 135/90 mmHg. She exhibits a fine tremor, and complains of increased urinary frequency. Her pulse is 47/minute, and she is afebrile. Which of the following is the best next step in management?? {'A': 'Change diuretics', 'B': 'Increase captopril dose', 'C': 'Increase chlorthalidone dose', 'D': 'Maintain current medication regimen', 'E': 'Ultrasound of the renal arteries'},
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A: Change diuretics
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Q:A 24-year-old man comes to the physician with his wife because of difficulty conceiving during the past year. He emigrated from rural Romania 2 years ago and has a history of recurrent respiratory infections since childhood for which he has not sought treatment. Physical examination shows mild hepatomegaly and clubbing of the nail beds. Serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels are increased. Microscopic analysis of centrifuged seminal fluid shows no sperm cells. This patient's condition is most likely caused by impaired function of a channel protein that normally opens in response to binding of which of the following?? {'A': 'Adenosine triphosphate', 'B': 'Dynein', 'C': 'γ-aminobutyric acid', 'D': 'N-methyl-D-aspartate', 'E': 'Cyclic guanosine monophosphate\n"'},
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A: Adenosine triphosphate
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Q:You examine an infant in your office. On exam you observe hypotonia, as well as the findings shown in Figures A and B. You order laboratory testing, which demonstrates the findings shown in Figure C. Which of the following is the most likely pathologic mechanism involved?? {'A': 'Accumulation of ceramide trihexoside', 'B': 'Accumulation of galactocerebroside', 'C': 'Accumulation of sphingomyelin', 'D': 'Accumulation of GM2 ganglioside', 'E': 'Accumulation of glucocerebroside'},
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C: Accumulation of sphingomyelin
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Q:A research study is comparing 2 novel tests for the diagnosis of Alzheimer’s disease (AD). The first is a serum blood test, and the second is a novel PET radiotracer that binds to beta-amyloid plaques. The researchers intend to have one group of patients with AD assessed via the novel blood test, and the other group assessed via the novel PET examination. In comparing these 2 trial subsets, the authors of the study may encounter which type of bias?? {'A': 'Selection bias', 'B': 'Measurement bias', 'C': 'Confounding bias', 'D': 'Recall bias', 'E': 'Lead-time bias'},
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B: Measurement bias
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Q:A 54-year-old man presents with fever, abdominal pain, nausea, and bloody diarrhea. He says that his symptoms started 36 hours ago and have not improved. Past medical history is significant for a left-leg abscess secondary to an injury he sustained from a fall 4 days ago while walking his dog. He has been taking clindamycin for this infection. In addition, he has long-standing gastroesophageal reflux disease, managed with omeprazole. His vital signs include: temperature 38.5°C (101.3°F), respiratory rate 19/min, heart rate 90/min, and blood pressure 110/70 mm Hg. Which of the following is the best course of treatment for this patient’s most likely diagnosis?? {'A': 'Ciprofloxacin', 'B': 'Tetracycline', 'C': 'Vancomycin', 'D': 'Erythromycin', 'E': 'Trimethoprim-sulfamethoxazole'},
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C: Vancomycin
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Answer the following medical question with one of the provided options:
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Q:A 36-year-old man with a history of a stab wound to the right upper thigh one year previously presents to the emergency department with complaints of difficulty breathing while lying flat. Physical examination reveals an S3 gallop, hepatomegaly, warm skin and a continuous bruit over the right upper thigh. Which of the following is most likely responsible for his symptoms?? {'A': 'Decreased sympathetic output', 'B': 'Increased peripheral resistance', 'C': 'Increased venous return', 'D': 'Decreased contractility', 'E': 'Increased pulmonary resistance'},
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C: Increased venous return
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Answer the following medical question with one of the provided options:
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Q:A 52-year-old man presents to the emergency department with sudden-onset dyspnea, tachycardia, tachypnea, and chest pain. He works as a long-haul truck driver, and he informs you that he recently returned to the west coast from a trip to Tennessee. His medical history is significant for gout, hypertension, hypercholesterolemia, diabetes mellitus type 2, and mild intellectual disability. He currently smokes 2 packs of cigarettes/day, drinks a 6-pack of beer/day, and he endorses a past history of injection drug use but currently denies any illicit drug use. The vital signs include: temperature 36.7°C (98.0°F), blood pressure 126/74 mm Hg, heart rate 87/min, and respiratory rate 23/min. His physical examination shows minimal bibasilar rales, but otherwise clear lungs on auscultation, grade 2/6 holosystolic murmur, and a benign abdominal physical examination. A computed tomography angiography (CTA) demonstrates a segmental pulmonary embolism (PE). Which of the following is the most appropriate treatment plan for this patient?? {'A': 'Initiate warfarin anticoagulation', 'B': 'Initiate heparin', 'C': 'Initiate heparin with a bridge to warfarin', 'D': 'Tissue plasminogen activator (tPA)', 'E': 'Consult interventional radiologist (IR) for IVC filter placement'},
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C: Initiate heparin with a bridge to warfarin
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Answer the following medical question with one of the provided options:
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Q:A 4-year-old boy is brought to the emergency department by his mother with an itchy rash on his trunk, malaise, and fever with spikes up to 38.5°C (101.3°F) for the past 2 weeks. The patient’s mother says she tried giving him Tylenol with little improvement. Past medical history includes a spontaneous vaginal delivery at full term. The patient’s vaccines are up-to-date and he has met all developmental milestones. On physical examination, his lips are cracking, and he has painful cervical lymphadenopathy. The rash is morbilliform and involves his trunk, palms, and the soles of his feet. There is fine desquamation of the skin of the perianal region. Which of the following anatomical structures is most important to screen for possible complications in this patient?? {'A': 'Gallbladder', 'B': 'Mitral valve', 'C': 'Coronary artery', 'D': 'Kidneys', 'E': 'Pylorus'},
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C: Coronary artery
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Q:A 45-year-old woman comes to the emergency department with recurrent episodes of shaking, sweating, and palpitations. The patient is confused and complains of hunger. One week ago, she had similar symptoms that improved after eating. She has hypertension and a history of biliary pancreatitis. She underwent cholecystectomy 1 year ago. She works as a nurse aide in a nursing care facility. She does not smoke or drink alcohol. She does not exercise. Her temperature is 36.7°C (98°F), pulse is 104/min, respirations are 20/min, and blood pressure is 135/88 mm Hg. Examination shows tremors and diaphoresis. Laboratory studies show: Blood glucose 50 mg/dL Thyroid-stimulating hormone 1 mU/L C-peptide 0.50 ng/mL (N=0.8–3.1) Abdominal ultrasound reveals a 1-cm anechoic lesion in the head of the pancreas. Which of the following is the most likely cause of this patient's symptoms?"? {'A': 'Pancreatic pseudocyst', 'B': 'Pancreatic neoplasm', 'C': "Grave's disease", 'D': 'Type 1 diabetes mellitus', 'E': 'Surreptitious insulin use'},
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E: Surreptitious insulin use
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Q:A randomized controlled trial is conducted to evaluate the relationship between the angiotensin receptor blocker losartan and cardiovascular death in patients with congestive heart failure (diagnosed as ejection fraction < 30%) who are already being treated with an angiotensin-converting enzyme (ACE) inhibitor and a beta blocker. Patients are randomized either to losartan (N = 1500) or placebo (N = 1400). The results of the study show: Cardiovascular death No cardiovascular death Losartan + ACE inhibitor + beta blocker 300 1200 Placebo + ACE inhibitor + beta blocker 350 1050 Based on this information, if 200 patients with congestive heart failure and an ejection fraction < 30% were treated with losartan in addition to an ACE inhibitor and a beta blocker, on average, how many cases of cardiovascular death would be prevented?"? {'A': '20', 'B': '10', 'C': '0.25', 'D': '50', 'E': '0.05'},
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B: 10
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Q:A 37-year-old man presents to an urgent care clinic with complaints of speech problems and yellowing of his eyes for a week. He admits to using illicit intravenous drugs. His vital signs include: blood pressure 110/60 mm Hg, pulse rate 78/min, and respiratory rate 22/min. On examination, the patient appears jaundiced, and his speech is slurred. His liver enzymes had viral markers as follows: Aspartate aminotransferase 6,700 IU/L Alanine aminotransferase 5,000 IU/L HbsAg Negative Anti-Hbs Negative Anti-HCV Ab Positive HCV RNA Positive He is at risk of developing a secondary dermatological condition. A biopsy would most likely show which of the findings?? {'A': 'Microabscesses with fibrin and neutrophils', 'B': 'Lymphocytic infiltrate at the dermalepidermal junction', 'C': 'Intraepithelial cleavage with acantholysis', 'D': 'Noncaseating granulomas', 'E': 'Crypt abscesses containing neutrophils'},
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B: Lymphocytic infiltrate at the dermalepidermal junction
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Q:A 4-year-old-female presents with a flattened, reddish 2 cm lump located at the base of the tongue. The patient's mother reports her having trouble swallowing, often leading to feeding difficulties. The mother also reports lethargy, constipation, dry skin, and hypothermia. Which of the following is the most appropriate management of this patient’s presentation?? {'A': 'Combination therapy of methimazole and Beta-blockers', 'B': 'Week-long course of penicillin', 'C': 'Radioactive iodine ablation', 'D': 'Surgical excision of mass followed by levothyroxine administration', 'E': 'No treatment is necessary, counsel mother on alternative feeding techniques'},
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D: Surgical excision of mass followed by levothyroxine administration
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Q:A 61-year-old man comes to the physician because of fatigue, diarrhea, and crampy abdominal pain for 3 weeks. The abdominal pain is worse after eating. During the past week, he has had up to 4 watery stools daily. He has also had pain in his mouth and gums for 6 days. He has not had nausea, vomiting, or fever. Four months ago, he went on a 1-week trip to the Dominican Republic. He has atrial fibrillation, hypertension, and hypothyroidism. Current medications include levothyroxine, metoprolol, and warfarin. He has smoked one pack of cigarettes daily for 40 years. His temperature is 37.9°C (100.2°F), pulse is 81/min, and blood pressure is 120/75 mm Hg. Examination shows two 1-cm, tender ulcerative lesions in the mouth. Abdominal examination shows mild tenderness to palpation in the right lower quadrant without guarding or rebound. Bowel sounds are normal. His hemoglobin concentration is 11.5 g/dL, mean corpuscular volume is 77 fL, leukocyte count is 11,800 mm3, and platelet count is 360,000 mm3. Colonoscopy with biopsy of the colonic mucosa is performed. Analysis of the specimen shows non-caseating granulomas and neutrophilic inflammation of the crypts. Which of the following is the most likely diagnosis?? {'A': 'Diverticulitis', 'B': 'Tropical sprue', 'C': 'Crohn disease', 'D': 'Celiac disease', 'E': 'Whipple disease'},
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C: Crohn disease
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Q:A 48-year-old man is brought to the emergency department by his wife because of a 3-day history of increasing confusion and lethargy. He complains of decreased urine output and abdominal pain for the past month. Two months ago, he was hospitalized for pyelonephritis and treated with ceftriaxone. He has a history of chronic hepatitis C. He does not take any medications. He appears pale and irritable. His temperature is 37°C (98.6°F), pulse is 90/min, and blood pressure is 98/60 mm Hg. On mental status examination, he is oriented to person but not to time or place. Physical examination shows scleral icterus and jaundice. There is 2+ pitting edema of the lower extremities. The abdomen is distended with a positive fluid wave. Laboratory studies show: Hemoglobin 10.1 g/dL Leukocyte count 4300/mm3 Platelet count 89,000/mm3 Prothrombin time 19 sec Serum Urea nitrogen 71 mg/dL Glucose 99 mg/dL Creatinine 3.5 mg/dL ALT 137 mg/dL AST 154 mg/dL Urinalysis shows no abnormalities. The FeNa is < 1%. Ultrasound of the kidneys is unremarkable. Intravenous fluids are administered for 36 hours but do not improve urine output. Which of the following is the most likely cause of the kidney dysfunction in this patient?"? {'A': 'Renal interstitial inflammation', 'B': 'Renal vein thrombosis', 'C': 'Decreased renal perfusion', 'D': 'Renal tubular injury', 'E': 'Renal microvascular thrombi\n"'},
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C: Decreased renal perfusion
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Answer the following medical question with one of the provided options:
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Q:An 8-year-old male presents to his pediatrician for a follow-up appointment for persistent fatigue. His mother reports that the patient’s teacher called her yesterday to tell her that her son has been sitting out of recess every day for the past week. The patient first developed symptoms of fatigue and weakness several years ago and has returned to the physician with similar episodes once or twice a year. These episodes seem to sometimes be triggered by viral illnesses, but others have no identifiable trigger. The patient has been on daily folate supplementation with some improvement and requires red blood cell transfusions several times a year. He has an allergy to sulfa drugs, and last month he was treated with amoxicillin for an ear infection. His paternal grandfather was recently diagnosed with multiple myeloma, but his parents deny any other family history of hematologic conditions. Her temperature is 99.0°F (37.2°C), blood pressure is 103/76 mmHg, pulse is 95/min, and respirations are 14/min. On physical exam, the patient is tired-appearing with conjunctival pallor. Laboratory tests performed during this visit reveal the following: Leukocyte count: 9,7000/mm^3 Hemoglobin: 8.4 g/dL Hematocrit: 27% Mean corpuscular volume: 97 µm^3 Mean corpuscular hemoglobin concentration (MCHC): 40% Hb/cell Platelet count: 338,000/mm^3 Reticulocyte index (RI): 4.2% What is the next step in management?? {'A': 'Hydroxyurea', 'B': 'Glucocorticoids', 'C': 'Stem cell transplant', 'D': 'Vaccinations followed by splenectomy', 'E': 'Vaccinations followed by splenectomy and penicillin for one year'},
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E: Vaccinations followed by splenectomy and penicillin for one year
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Q:A 34-year-old G3P3 woman with a history of migraines presents with several weeks of headaches. The headaches are unlike her usual migraines and are worse in the morning. This morning she had an episode of emesis prompting her to seek medical care. She also has some right sided weakness which she believes is related to a new exercise routine. Her mother is a breast cancer survivor. Her medications include oral contraceptives and ibuprofen as needed, which has not helped her current headaches. She drinks 2-3 alcoholic drinks on the weekends and does not smoke. Physical examination is remarkable for bilateral papilledema. Motor exam is notable for upper and lower extremity strength 4/5 on the right and 5/5 on the left. Magnetic resonance venography demonstrates absent flow in the left venous sinuses. Which of the following predisposed this patient to her current condition?? {'A': 'History of migraines', 'B': 'Alcohol use', 'C': 'Ibuprofen use', 'D': 'Oral contraceptive use', 'E': 'Family history'},
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D: Oral contraceptive use
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Q:A 37-year-old man presents with dull, continuous epigastric pain that radiates to the back in a circumscribing fashion. The history is significant for 3 episodes of acute pancreatitis that were managed conservatively. He reports no history of such episodes in his relatives and denies a family history of any cardiovascular or gastrointestinal disorders. The vital signs include: blood pressure 105/70 mm Hg, heart rate 101/min, respiratory rate 17/min, and temperature 37.4℃ (99.3℉). The physical examination reveals epigastric tenderness, slight muscle guarding, a positive Mayo-Robson’s sign, and abdominal distention. Laboratory studies show the following findings: Complete blood count Erythrocytes 4.5 x 106/mm3 Hgb 14.7 g/dL Hct 43% Leukocytes 12,700/mm3 Segmented neutrophils 65% Bands 4% Eosinophils 1% Basophils 0% Lymphocytes 27% Monocytes 3% Biochemistry Serum amylase 170 U/L ALT 21 U/L AST 19 U/L Total serum cholesterol 139 mg/dL (3.6 mmol/L) Serum triglycerides 127 mg/dL (1.4 mmol/L) The magnetic resonance cholangiopancreatography findings are shown in the exhibit. What embryogenic disruption could cause such anatomic findings?? {'A': 'Duplication of the embryonic pancreatic duct', 'B': 'Ectopy of the developing bile duct', 'C': 'Failure of fusion of dorsal and ventral pancreatic duct anlages', 'D': 'Duplication of the pancreatic bud of the midgut', 'E': 'Improper rotation of the anterior pancreatic bud'},
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C: Failure of fusion of dorsal and ventral pancreatic duct anlages
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Q:A 24-year-old woman, gravida 1, para 0, at 39 weeks' gestation, is admitted to the hospital in active labor. She currently has contractions occurring every 3–5 minutes. For the past 3 days, she has had burning pain in the vulvar area associated with intense itching. Her pregnancy has been uneventful. She has a history of genital herpes at the age of 16, which was treated with acyclovir. Her vital signs are within normal limits. Genital examination shows grouped vesicles on an erythematous base over the vulvar region. Pelvic examination shows rupture of membranes and that the cervix is 3 cm dilated. Which of the following is the most appropriate next step in management?? {'A': 'Tocolytic therapy until lesions are crusted', 'B': 'Topical acyclovir and cesarean delivery', 'C': 'Oral acyclovir therapy and vaginal delivery', 'D': 'Topical acyclovir and vaginal delivery', 'E': 'Oral acyclovir therapy and cesarean delivery'},
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E: Oral acyclovir therapy and cesarean delivery
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Q:A 27-year-old man is running on the treadmill at his gym. His blood pressure prior to beginning his workout was 110/72. Which of the following changes in his cardiovascular system may be seen in this man now that he is exercising?? {'A': 'Increased systemic vascular resistance', 'B': 'Decreased heart rate', 'C': 'Decreased stroke volume', 'D': 'Decreased systemic vascular resistance', 'E': 'Decreased blood pressure'},
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D: Decreased systemic vascular resistance
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Q:A 45-year-old bank manager is brought to the emergency department by ambulance after vomiting bright red blood while at work. He is also complaining of abdominal pain that is 10/10 in intensity, stabbing, and relentless. He had a similar yet less severe abdominal pain off and on for the last 2 weeks. Eating food and drinking milk seemed to make the pain a little more tolerable. When he arrives at the hospital his heart rate is 115/min, and blood pressure is 100/70 mm Hg. On physical exam, he appears pale. A nasogastric tube is placed and removes 30 ml of bright red fluid from his stomach. An intravenous line is started and a bolus of fluids is administered. After stabilizing the patient, an esophagogastroduodenoscopy (EGD) is performed. There is a fair amount of residual blood in the stomach but no other abnormalities are noted. However, a bleeding duodenal ulcer is found on the posteromedial wall of the second portion of the duodenum. Which vessels listed below is the most likely blood supply to this section of the duodenum?? {'A': 'Dorsal pancreatic artery', 'B': 'Inferior pancreaticoduodenal artery', 'C': 'Greater pancreatic artery', 'D': 'Left gastroepiploic artery', 'E': 'Gastroduodenal artery'},
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B: Inferior pancreaticoduodenal artery
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Q:A 39-year-old man comes to the physician for evaluation of hearing loss. He reports difficulty hearing sounds like the beeping of the microwave or birds chirping, but can easily hear the pipe organ at church. He works as an aircraft marshaller. A Rinne test shows air conduction greater than bone conduction bilaterally. A Weber test does not lateralize. Which of the following is the most likely underlying cause of this patient's condition?? {'A': 'Perforation of the tympanic membrane', 'B': 'Immobility of the stapes', 'C': 'Compression of the vestibulocochlear nerve', 'D': 'Destruction of the organ of Corti', 'E': 'Excess endolymphatic fluid pressure'},
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D: Destruction of the organ of Corti
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Q:A 36-year-old primigravida presents to her obstetrician for antenatal care. She is at 24 weeks of gestation and does not have any current complaint except for occasional leg cramps. She does not smoke or drink alcohol. Family history is irrelevant. Her temperature is 36.9°C (98.42°F), blood pressure is 100/60 mm Hg, and pulse of 95/minute. Her body mass index is 21 kg/m² (46 pounds/m²). Physical examination reveals a palpable uterus above the umbilicus with no other abnormalities. Which of the following screening tests is suitable for this patient?? {'A': 'HbA1C for gestational diabetes mellitus', 'B': 'Oral glucose tolerance test for gestational diabetes mellitus', 'C': 'Fasting and random glucose testing for gestational diabetes mellitus', 'D': 'Wet mount microscopy of vaginal secretions for bacterial vaginosis', 'E': 'Complete blood count for iron deficiency anemia'},
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B: Oral glucose tolerance test for gestational diabetes mellitus
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Q:A 25-year-old G1P0000 presents to her obstetrician’s office for her first prenatal visit. She had a positive pregnancy test 6 weeks ago, and her last period was about two months ago, though at baseline her periods are irregular. Aside from some slight nausea in the mornings, she feels well. Which of the following measurements would provide the most accurate dating of this patient’s pregnancy?? {'A': 'Biparietal diameter', 'B': 'Femur length', 'C': 'Abdominal circumference', 'D': 'Serum beta-hCG', 'E': 'Crown-rump length'},
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E: Crown-rump length
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Q:A 62-year-old man comes to the physician in May for a routine health maintenance examination. He feels well. He underwent a right inguinal hernia repair 6 months ago. He has hypertension and type 2 diabetes mellitus. There is no family history of serious illness. Current medications include metformin, sitagliptin, enalapril, and metoprolol. He received the zoster vaccine 1 year ago. He received the PPSV23 vaccine 4 years ago. His last colonoscopy was 7 years ago and was normal. He smoked a pack of cigarettes a day for 20 years but quit 17 years ago. He drinks two to three alcoholic beverages on weekends. He is allergic to amoxicillin. He is scheduled to visit Australia and New Zealand in 2 weeks to celebrate his 25th wedding anniversary. He appears healthy. Vital signs are within normal limits. An S4 is heard at the apex. The remainder of the examination shows no abnormalities. Which of the following is the most appropriate recommendation at this time?? {'A': 'Influenza vaccine', 'B': 'Pneumococcal conjugate vaccine 13', 'C': 'Abdominal ultrasound', 'D': 'Colonoscopy', 'E': 'Cardiac stress test'},
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A: Influenza vaccine
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Q:A 14-year-old boy presents with a 1-month history of gradual onset of pain immediately below his right kneecap. He has recently started playing basketball for the junior varsity team at his school, and he is very excited for the season to begin. Unfortunately, the pain in his knee is exacerbated by all the jumping activity during practice. The patient reports similar pain when climbing up and down the stairs. He denies any previous history of knee injury. Physical examination reveals full range of motion of his knee, but the pain is reproduced when the knee is extended against resistance. Which of the following is the most likely diagnosis?? {'A': 'Meniscal tear', 'B': 'Osgood-Schlatter disease', 'C': 'Patellofemoral syndrome', 'D': 'Prepatellar bursitis', 'E': 'Shearing injury of the anterior cruciate ligament (ACL)'},
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B: Osgood-Schlatter disease
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Q:A 62-year-old man is brought to the emergency department with a sudden onset of severe chest pain, that he describes as tearing. The pain started 90 minutes back and is now referring to the upper back. There is a history of essential hypertension for the past 17 years. The patient has smoked 20–30 cigarettes daily for the past 27 years. Vital signs reveal: temperature 36.8°C (98.2°F), heart rate 105/min, and blood pressure 192/91 mm Hg in the right arm and 159/81 mm Hg in the left arm. Pulses are absent in the right leg and diminished in the left. ECG shows sinus tachycardia, and chest X-ray shows a widened mediastinum. Transthoracic echocardiography shows an intimal flap arising from the ascending aorta and extended to the left subclavian artery. Intravenous morphine sulfate is started. Which of the following is the best next step in the management of this patient condition?? {'A': 'Intravenous metoprolol', 'B': 'Intravenous hydralazine', 'C': 'Oral aspirin', 'D': 'Chest magnetic resonance imaging', 'E': 'D-dimer'},
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A: Intravenous metoprolol
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Q:A 45-year-old man is brought to the physician by his wife because of difficulty sleeping and poor appetite for the past 4 weeks. During this period, he also has had persistent sadness and difficulty concentrating on tasks, because of which he has been reprimanded at work for poor performance. Over the past 3 years, he has often had such phases, with a maximum symptom-free gap of one month between each of them. His behavior is causing a strain in his relationships with his wife and children. His mother died 4 months ago from breast cancer. Physical examination shows no abnormalities. Mental status examination shows a depressed mood and constricted affect. What is the most likely diagnosis in this patient?? {'A': 'Persistent depressive disorder', 'B': 'Adjustment disorder with depressed mood', 'C': 'Bipolar affective disorder', 'D': 'Major depressive disorder', 'E': 'Persistent complex bereavement disorder'},
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A: Persistent depressive disorder
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Q:A 12-year-old boy is referred to a pediatric neurologist because of repetitive motions such as blinking or tilting his head. He is brought in by his mother who says that he also clears his throat and hums repeatedly. These actions have been happening for the past year and his mother is concerned. The boy was born at 39 weeks gestation via spontaneous vaginal delivery. He is up to date on all vaccinations and is meeting all developmental milestones. On physical exam, he shows no focal neurological deficits and is cognitively normal for his age. He occasionally sharply jerks his head to one side during the physical exam and utters obscene words. Which of the following is most associated with this condition?? {'A': '3 Hz spike-wave pattern on EEG', 'B': 'CAG repeat on the short arm of chromosome 4', 'C': 'Coprolalia', 'D': 'Severe atrophy of the caudate and putamen', 'E': 'X-linked MECP2 mutation with female predominance'},
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C: Coprolalia
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Q:A 27-year-old woman presents with painful swallowing for the past 2 days. She received a kidney transplant 3 months ago for lupus-induced end-stage renal disease. She takes tacrolimus, mycophenolate mofetil, prednisone, and calcium supplements. The blood pressure is 120/80 mm Hg, the pulse is 72/min, the respirations are 14/min, and the temperature is 38.0°C (100.4°F). Esophagoscopy shows serpiginous ulcers in the distal esophagus with normal surrounding mucosa. Biopsy shows large cytoplasmic inclusion bodies. Which of the following is the most appropriate pharmacotherapy at this time?? {'A': 'Budesonide', 'B': 'Fluconazole', 'C': 'Ganciclovir', 'D': 'Pantoprazole', 'E': 'No pharmacotherapy at this time'},
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C: Ganciclovir
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Answer the following medical question with one of the provided options:
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Q:A 67-year-old man comes to the emergency department because of retrosternal chest pressure and shortness of breath for 4 hours. The symptoms started while he was walking to work and have only minimally improved with rest. He has a history of type 2 diabetes mellitus. He has smoked one pack of cigarettes daily for 35 years. He appears uncomfortable. His pulse is 95/min. Serum studies show a normal troponin concentration. An ECG shows no abnormalities. Which of the following is the most likely underlying cause of this patient's symptoms?? {'A': 'Aortic valve thickening and calcification', 'B': 'Coronary artery occlusion due to transient increase in vascular tone', 'C': 'Stable atherosclerotic plaque with 85% coronary artery occlusion', 'D': 'Disruption of an atherosclerotic plaque with a non-occlusive coronary artery thrombus', 'E': 'Atherosclerotic plaque thrombus with complete coronary artery occlusion'},
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D: Disruption of an atherosclerotic plaque with a non-occlusive coronary artery thrombus
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Q:A 33-year-old nulliparous woman comes to the physician because of a 5-month history of increased flow and duration of her menses. Menses previously occurred at regular 32-day intervals and lasted 4 days with normal flow. They now last 10 days and the flow is heavy with the passage of clots. During this period, she has also had dyspareunia and cyclical lower abdominal pain. Her mother died of cervical cancer at the age of 58 years. Her BMI is 31 kg/m2. Her temperature is 37°C (98.6°F), pulse is 86/min, and blood pressure is 110/70 mm Hg. Pelvic examination shows an asymmetrically enlarged, nodular uterus consistent in size with a 12-week gestation. A urine pregnancy test is negative. Which of the following is the most likely cause of this patient's findings?? {'A': 'Endometrial tissue within the ovaries', 'B': 'Benign tumor of the myometrium', 'C': 'Malignant transformation of endometrial tissue', 'D': 'Abnormal thickening of endometrial tissue', 'E': 'Pedunculated endometrial mass'},
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B: Benign tumor of the myometrium
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Answer the following medical question with one of the provided options:
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Q:A group of investigators studying embryological defects in mice knock out a gene that is responsible for the development of the ventral wing of the third branchial pouch. A similar developmental anomaly in a human embryo is most likely to result in which of the following findings after birth?? {'A': 'White oral patches', 'B': 'Conductive hearing loss', 'C': 'Discharging neck sinus', 'D': 'Cleft palate', 'E': 'Carpopedal spasm'},
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A: White oral patches
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Q:A 17-year-old male, accompanied by his uncle, presents to his family physician with his arm in a sling. There is blood dripping down his shirt. He pleads with the physician to keep this injury "off the books", offering to pay in cash for his visit, as he is afraid of retaliation from his rival gang. The physician exams the wound, which appears to be a stabbing injury to his left anterior deltoid. How should the physician best handle this patient's request?? {'A': 'Maintain confidentiality, as retaliation may result in greater harm to the patient', 'B': 'Maintain confidentiality, as reporting stab wounds is not required', 'C': 'Maintain confidentiality and schedule a follow-up visit with the patient', 'D': 'Breach confidentiality and discuss the injury with the uncle', 'E': 'Breach confidentiality and report the stab wound to the police'},
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E: Breach confidentiality and report the stab wound to the police
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Answer the following medical question with one of the provided options:
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Q:An otherwise healthy 27-year-old man presents to his dermatologist because of a rash over his knees. The rash has been present for 5 weeks and is moderately itchy. Physical examination reveals erythematous plaques covered with silvery scales over the extensor surface of the knees as shown in the image. Which of the following is the best initial step in the management of this patient’s condition? ? {'A': 'Skin biopsy', 'B': 'Oral corticosteroids', 'C': 'Topical corticosteroids and/or topical vitamin D analog', 'D': 'Oral methotrexate', 'E': 'Oral cyclosporine'},
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C: Topical corticosteroids and/or topical vitamin D analog
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Q:A 34-year-old man with a 2-year history of rheumatoid arthritis is being evaluated on a follow-up visit. He is currently on methotrexate and celecoxib for pain management and has shown a good response until now. However, on this visit, he mentions that the morning stiffness has been getting progressively worse. On physical examination, both his wrists are erythematous and swollen, nodules on his elbows are also noted. Rheumatoid factor is 30 (normal reference values: < 15 IU/mL), ESR is 50 mm/h, anti-citrullinated protein antibodies is 55 (normal reference values: < 20). What is the next best step in the management of this patient?? {'A': 'Methotrexate and Corticosteroids', 'B': 'Sulfasalazine', 'C': 'Infliximab monotherapy', 'D': 'Adalimumab monotherapy', 'E': 'Methotrexate and Infliximab'},
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E: Methotrexate and Infliximab
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Q:A man appearing to be in his mid-50s is brought in by ambulance after he was seen walking on railroad tracks. On further questioning, the patient does not recall being on railroad tracks and is only able to provide his name. Later on, he states that he is a railroad worker, but this is known to be false. On exam, his temperature is 99.9°F (37.7°C), blood pressure is 128/86 mmHg, pulse is 82/min, and respirations are 14/min. He appears disheveled, and his clothes smell of alcohol. The patient is alert, is only oriented to person, and is found to have abnormal eye movements and imbalanced gait when attempting to walk. Which of the following structures in the brain likely has the greatest reduction in the number of neurons?? {'A': 'Basal ganglia', 'B': 'Cerebellar vermis', 'C': 'Frontal eye fields', 'D': 'Mammillary bodies', 'E': 'Parietal-temporal cortex'},
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D: Mammillary bodies
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Answer the following medical question with one of the provided options:
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Q:A 36-year-old primigravid woman at 22 weeks' gestation comes to the physician for a routine prenatal visit. Her previous prenatal visits showed no abnormalities. She has hyperthyroidism treated with methimazole. She previously smoked one pack of cigarettes daily for 15 years but quit 6 years ago. She reports gaining weight after quitting smoking, after which she developed her own weight loss program. She is 168 cm (5 ft 6 in) tall and weighs 51.2 kg (112.9 lb); BMI is 18.1 kg/m2. Her temperature is 37°C (98.5°F), pulse is 88/min, and blood pressure is 115/72 mm Hg. Pelvic examination shows no abnormalities. The fundus is palpated between the symphysis and the umbilicus. Ultrasound shows a fetal head at the 20th percentile and the abdomen at the 9th percentile. Fetal birth weight is estimated at the 9th percentile and a decreased amniotic fluid index is noted. The maternal quadruple screening test was normal. Thyroid-stimulating hormone is 0.4 mIU/mL, triiodothyronine (T3) is 180 ng/dL, and thyroxine (T4) is 10 μg/dL. Which of the following is the strongest predisposing factor for the ultrasound findings in this patient?? {'A': 'Maternal malnutrition', 'B': 'Advanced maternal age', 'C': 'Fetal aneuploidy', 'D': 'History of tobacco use', 'E': 'Maternal hyperthyroidism\n"'},
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A: Maternal malnutrition
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Answer the following medical question with one of the provided options:
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Q:A 22-year-old man comes to the emergency department because of several episodes of blood in his urine and decreased urine output for 5 days. His blood pressure is 158/94 mm Hg. Examination shows bilateral lower extremity edema. Urinalysis shows 3+ protein and red blood cell casts. Mass spectrometry analysis of the urinary protein detects albumin, transferrin, and IgG. Which of the following best describes this type of proteinuria?? {'A': 'Tubular', 'B': 'Overflow', 'C': 'Selective glomerular', 'D': 'Postrenal', 'E': 'Nonselective glomerular'},
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E: Nonselective glomerular
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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 1 hour after the sudden onset of a diffuse, dull, throbbing headache. She also reports blurred vision, nausea, and one episode of vomiting. She has a history of poorly controlled hypertension. A photograph of her fundoscopic examination is shown. Which of the following is the most likely underlying cause of this patient's symptoms?? {'A': 'Hemorrhagic lacunar stroke', 'B': 'Giant cell arteritis', 'C': 'Hypertensive emergency', 'D': 'Epidural hematoma', 'E': 'Transient ischemic attack'},
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C: Hypertensive emergency
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Answer the following medical question with one of the provided options:
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Q:A 28-year-old woman comes to the emergency department for a rash that began 3 days ago. She has low-grade fever and muscle aches. She has no history of serious illness and takes no medications. She has had 5 male sexual partners over the past year and uses condoms inconsistently. Her temperature is 38.1°C (100.6° F), pulse is 85/min, and blood pressure is 126/89 mm Hg. Examination shows a diffuse maculopapular rash that includes the palms and soles. The remainder of the examination shows no abnormalities. A venereal disease research laboratory (VDRL) test is positive. Which of the following is the next appropriate step in management?? {'A': 'Treponemal culture', 'B': 'Intravenous penicillin G', 'C': 'Dark field microscopy', 'D': 'Oral doxycycline', 'E': 'Fluorescent treponemal antibody absorption test\n"'},
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E: Fluorescent treponemal antibody absorption test "
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