instruction
stringclasses 5
values | input
stringlengths 10
4.2k
| output
stringlengths 1
7.16k
|
|---|---|---|
Answer the following medical question with one of the provided options:
|
Q:A 60-year-old man visits his primary care doctor after being discharged from the hospital 3 weeks ago. He presented to the hospital with chest pain and was found to have ST elevations in leads I, aVL, and V6. He underwent cardiac catheterization with balloon angioplasty and was discharged on appropriate medications. At this visit, he complains of feeling deconditioned over the past week. He states that he is not able to jog his usual 3 miles and feels exhausted after walking up stairs. He denies chest pain. His temperature is 98.6°F (37°C), blood pressure is 101/62 mmHg, pulse is 59/min, and respirations are 18/min. His cardiac exam is notable for a 2/6 early systolic murmur at the left upper sternal border. He describes mild discomfort with palpation of his epigastrium. The remainder of his exam is unremarkable. His laboratory workup is shown below: Hemoglobin: 8 g/dL Hematocrit: 25 % Leukocyte count: 11,000/mm^3 with normal differential Platelet count: 400,000/mm^3 Serum: Na+: 136 mEq/L Cl-: 103 mEq/L K+: 3.8 mEq/L HCO3-: 25 mEq/L BUN: 45 mg/dL Glucose: 89 mg/dL Creatinine: 1.1 mg/dL Which medication is most likely contributing to this patient's current presentation?? {'A': 'Aspirin', 'B': 'Atorvastatin', 'C': 'Carvedilol', 'D': 'Furosemide', 'E': 'Lisinopril'},
|
A: Aspirin
|
Answer the following medical question with one of the provided options:
|
Q:An 18-year-old woman presents for a routine check-up. She is a college student with no complaints. She has a 2 pack-year history of smoking and consumes alcohol occasionally. Her sexual debut was at 15 years of age and has had 2 sexual partners. She takes oral contraceptives and uses barrier contraception. Her family history is significant for cervical cancer in her aunt. Which of the following statements regarding cervical cancer screening in this patient is correct?? {'A': 'The patient requires annual Pap testing due to her family history of cervical cancer.', 'B': 'The patient does not require Pap testing as long as she uses barrier contraception.', 'C': 'The patient should undergo screening every 3 years after she turns 21 years of age.', 'D': 'HPV testing is more preferable than Pap testing in sexually active women under 21 years of age.', 'E': 'It is reasonable to start Pap-test screening at the current visit and repeat it every 3 years.'},
|
C: The patient should undergo screening every 3 years after she turns 21 years of age.
|
Answer the following medical question with one of the provided options:
|
Q:A 53-year-old man comes to the emergency department for severe left knee pain for the past 8 hours. He describes it as an unbearable, burning pain that woke him up from his sleep. He has been unable to walk since. He has not had any trauma to the knee. Ten months ago, he had an episode of acute pain and swelling of the right great toe that subsided after treatment with indomethacin. He has hypertension, type 2 diabetes mellitus, psoriasis, and hyperlipidemia. Current medications include topical betamethasone, metformin, glipizide, losartan, and simvastatin. Two weeks ago, hydrochlorothiazide was added to his medication regimen to improve blood pressure control. He drinks 1–2 beers daily. He is 170 cm (5 ft 7 in) tall and weighs 110 kg (242 lb); BMI is 38.1 kg/m2. His temperature is 38.4°C (101.1°F). Examination shows multiple scaly plaques over his palms and soles. The left knee is erythematous, swollen, and tender; range of motion is limited by pain. Which of the following is the most appropriate next step in management?? {'A': 'Serum uric acid level', 'B': 'Arthrocentesis', 'C': 'Oral colchicine', 'D': 'Intra-articular triamcinolone', 'E': 'Oral methotrexate'},
|
B: Arthrocentesis
|
Answer the following medical question with one of the provided options:
|
Q:A 23-year-old man presents to his primary care physician for a runny nose, sneezing, and coughing that has persisted for a few months. He denies feeling weak or tired, but states that his symptoms have disrupted his every day life. The patient has no significant past medical history. He drinks alcohol occasionally on the weekends. His temperature is 98.6°F (37.0°C), blood pressure is 124/88 mmHg, pulse is 80/min, respirations are 13/min, and oxygen saturation is 98% on room air. Physical exam reveals a healthy young man who is repetitively blowing his nose. Percussion of his sinuses elicits no symptoms. Inspection of the patient's oropharynx is unremarkable. Which of the following is the best next step in management?? {'A': 'Amoxicillin', 'B': 'Diphenhydramine', 'C': 'Intranasal saline', 'D': 'Intranasal steroid', 'E': 'Loratadine'},
|
D: Intranasal steroid
|
Answer the following medical question with one of the provided options:
|
Q:A 47-year-old man presents to his primary care physician complaining of pain and stiffness in his right index finger and left knee. The past medical history is remarkable for severe dandruff and an episode of apparent gout in the left 1st toe 6 months ago, which never resolved. The physical examination confirms dactylitis of the right index finger and several toes, as well as synovitis of the left knee. He is also noted to have pitting of his fingernails. Plain X-rays of his hand reveal erosions in the distal interphalangeal (DIP) joint and periarticular new bone formation. Which of the following is most consistent with these findings?? {'A': 'Rheumatoid arthritis', 'B': 'Psoriatic arthritis', 'C': 'Osteoarthritis', 'D': 'Reactive arthritis', 'E': 'Pseudogout'},
|
B: Psoriatic arthritis
|
Answer the following medical question with one of the provided options:
|
Q:A 28-year-old man presents with visual disturbances. He says that he is having double vision since he woke up this morning. His past medical history is insignificant except for occasional mild headaches. The patient is afebrile and his vitals are within normal limits. On physical examination of his eyes, there is paralysis of left lateral gaze. Also, at rest, there is esotropia of the left eye. A noncontrast CT scan of the head reveals a tumor impinging on one of his cranial nerves. Which of the following nerves is most likely affected?? {'A': 'Optic nerve', 'B': 'Trochlear nerve', 'C': 'Trigeminal nerve', 'D': 'Oculomotor nerve', 'E': 'Abducens nerve'},
|
E: Abducens nerve
|
Answer the following medical question with one of the provided options:
|
Q:A 6-month-old male presents with a painless, enlarged left scrotum. After examining the patient, you suspect this enlargement is secondary to serous fluid entering and accumulating in the scrotum through a patent processus vaginalis. Which of the following would be the most useful next step in confirming the diagnosis of this patient’s condition?? {'A': 'Measurement of AFP and hCG levels', 'B': 'Transillumination test followed by scrotal ultrasound', 'C': 'Evaluation of cremasteric reflex on physical exam', 'D': 'Measurement of serum testosterone levels', 'E': 'Standard urinalysis'},
|
B: Transillumination test followed by scrotal ultrasound
|
Answer the following medical question with one of the provided options:
|
Q:A 46-year-old woman presents to your medical office complaining of ‘feeling tired’. The patient states that she has been having some trouble eating because her ‘tongue hurts’, but she has no other complaints. On examination, the patient has pale conjunctiva and skin and also appears tired. She has a smooth, red tongue that is tender to touch with a tongue depressor. The patient’s hands and feet feel cold. Fluoroscopic evaluation of the swallowing mechanism and esophagus is normal. Which of the following diagnoses is most likely?? {'A': 'Herpes simplex virus-1 infection', 'B': 'Pernicious anemia', 'C': 'Plummer-Vinson syndrome', 'D': 'Oral candidiasis infection', 'E': 'Kawasaki disease'},
|
B: Pernicious anemia
|
Answer the following medical question with one of the provided options:
|
Q:A 52-year-old man presents to the emergency department with severe pain of the left first metatarsophalangeal joint. He says that the pain started 3 hours ago and describes it as sharp in character. The pain has been so severe that he has not been able to tolerate any movement of the joint. His past medical history is significant for hypertension for which he takes a thiazide diuretic. His diet consists primarily of red meat, and he drinks 5 bottles of beer per night. On physical exam, his left first metatarsophalangeal joint is swollen, erythematous, and warm to the touch. Which of the following characteristics would be seen with the most likely cause of this patient's symptoms?? {'A': 'Fractures with bony consolidations', 'B': 'Inflammatory pannus formation', 'C': 'Negatively birefringent crystals in the joint', 'D': 'Positively birefringent crystals in the joint', 'E': 'Subchondral sclerosis and osteophyte formation'},
|
C: Negatively birefringent crystals in the joint
|
Answer the following medical question with one of the provided options:
|
Q:A 29-year-old woman comes to the office with the complaints of severe bleeding after a dental extraction which required local hemostatic therapy. She has a long-term excessive menstrual bleeding and iron-deficiency anemia that required treatment with iron supplement since the age of 17. In addition, she states that her mother also has a history of frequent nosebleeds. The vital signs include: pulse rate 107/min, respiratory rate 17/min, temperature 37.2°C (99.0°F), and blood pressure 90/60 mm Hg. Her physical exam shows generalized pallor. The complete blood count results are as follows: Hemoglobin 10.7 g/dL Hematocrit 41% Leukocyte count 8,000/mm3 Neutrophils 54% Bands 3% Eosinophils 1% Basophils 0% Lymphocytes 32% Monocytes 2% Mean corpuscular hemoglobin 25.4 pg/cell Mean corpuscular hemoglobin concentration 31% Hb/cell Mean corpuscular volume 76 μm3 Platelet count 380,000/mm³ The coagulation test results are as follows: Partial thromboplastin time (activated) 48.0 s Prothrombin time 14.0 s International normalized ratio 0.9 What is the most likely diagnosis?? {'A': 'Hemophilia A', 'B': 'Systemic lupus erythematosus', 'C': 'Sideroblastic anemia', 'D': 'Congenital thrombocytopenia', 'E': 'Von Willebrand disease'},
|
E: Von Willebrand disease
|
Answer the following medical question with one of the provided options:
|
Q:A 23-year-old woman presents with flatulence and abdominal cramping after meals. For the last year, she has been feeling uneasy after meals and sometimes has severe pain after eating breakfast in the morning. She also experiences flatulence and, on rare occasions, diarrhea. She says she has either cereal or oats in the morning which she usually consumes with a glass of milk. The patient is afebrile and vital signs are within normal limits. Physical examination is unremarkable. Which of the following drugs should be avoided in this patient?? {'A': 'Cimetidine', 'B': 'Magnesium hydroxide', 'C': 'Pantoprazole', 'D': 'Sucralfate', 'E': 'Loperamide'},
|
B: Magnesium hydroxide
|
Answer the following medical question with one of the provided options:
|
Q:A 21-year-old man is brought to the office by his parents due to concerns about his behavior. They describe their son as aloof and a loner who earns average to below average grades in school. Today, his heart rate is 90/min, respiratory rate is 17/min, blood pressure is 110/65 mm Hg, and temperature is 36.8°C (98.2°F). On physical examination, he appears gaunt and anxious. His heart has a regular rhythm, and his lungs are clear to auscultation bilaterally. CMP, CBC, and TSH are normal. A urine toxicology test is negative. During the examination, he avoids eye contact and appears detached. When asked about his social life, he claims that he does not care about making friends and prefers to be alone. He says he enjoys going to the movies, but he enjoys doing this alone. He has not had a romantic partner before and takes little pleasure in intimacy. He denies experiencing hallucinations or delusions. Which of the following is the most likely diagnosis?? {'A': 'Avoidant personality disorder', 'B': 'Schizoid personality disorder', 'C': 'Schizotypal personality disorder', 'D': 'Major depressive disorder', 'E': 'Autism spectrum disorder'},
|
B: Schizoid personality disorder
|
Answer the following medical question with one of the provided options:
|
Q:A 38-year-old woman is brought to the emergency department because of left lower leg pain after tripping on the stairs in her house. She reports that she has become a vegetarian and has been avoiding sunlight exposure for the last 2 years after watching a TV program on how to reduce the risk of malignancies. Physical examination shows tenderness over the left proximal shin. An x-ray of the left lower extremity shows a fracture of the tibia and decreased bone density with thinning of the cortex. Impairment of which of the following processes is the most likely cause of this patient's x-ray findings?? {'A': '1-alpha-hydroxylation of 25-hydroxycholecalciferol', 'B': '25-hydroxylation of cholecalciferol', 'C': 'Synthesis of 7-dehydrocholesterol', 'D': 'Synthesis of cholecalciferol', 'E': 'Synthesis of ergocalciferol'},
|
D: Synthesis of cholecalciferol
|
Answer the following medical question with one of the provided options:
|
Q:A 37-year-old man is brought to the emergency department by ambulance after a motor vehicle accident. He suffered multiple deep lacerations and experienced significant blood loss during transport. In the emergency department, his temperature is 98.6°F (37°C), blood pressure is 102/68 mmHg, pulse is 112/min, and respirations are 22/min. His lacerations are sutured and he is given 2 liters of saline by large bore intravenous lines. Which of the following changes will occur in this patient's cardiac physiology due to this intervention?? {'A': 'Decreased cardiac output and decreased right atrial pressure', 'B': 'Decreased cardiac output and increased right atrial pressure', 'C': 'Increased cardiac output and decreased right atrial pressure', 'D': 'Increased cardiac output and increased right atrial pressure', 'E': 'Increased cardiac output and unchanged right atrial pressure'},
|
D: Increased cardiac output and increased right atrial pressure
|
Answer the following medical question with one of the provided options:
|
Q:A 5-day-old male is brought to your office by his mother. The infant is experiencing bilious vomiting, abdominal distension, and overall failure to thrive. A contrast enema shows a transition point at the transverse colon between dilated ascending colon and non-distended distal portion of the colon. Which of the following is the most likely etiology of this patient's disease?? {'A': 'Muscle hypertrophy', 'B': 'Mechanical bowel obstruction', 'C': 'CFTR gene mutation', 'D': 'Meiotic nondisjunction', 'E': 'Failure of neural crest cell migration'},
|
E: Failure of neural crest cell migration
|
Answer the following medical question with one of the provided options:
|
Q:A 62-year-old woman presents to her physician because she has been feeling increasingly fatigued over the last several months. In addition, she says that she has woken up at night several times and found herself completely covered in sweat. Finally, she says that she has lost 20 pounds despite no changes in her daily routine. On presentation, her temperature is 101.0°F (38.3°C), blood pressure is 134/83 mmHg, pulse is 71/min, and respirations are 19/min. Physical exam reveals a number of enlarged lymph nodes. Based on these findings, she is given a lab test revealing an abnormally high concentration of a protein arranged in a pentameric complex on serum electrophoresis. Which of the following is most strongly associated with the cause of this patient's symptoms?? {'A': 'Bone marrow fibrosis', 'B': 'Calcitriol secretion', 'C': 'Jaw lesion', 'D': 'Retinal hemorrhage', 'E': 'Sjogren syndrome'},
|
D: Retinal hemorrhage
|
Answer the following medical question with one of the provided options:
|
Q:A 70-year-old man presents to an urgent care clinic with bilateral flank pain for the past 2 days. During the last week, he has been experiencing some difficulty with urination, which prevented him from leaving his home. Now, he has to go to the bathroom 4–5 times per hour and he wakes up multiple times during the night to urinate. He also complains of straining and difficulty initiating urination with a poor urinary stream. The temperature is 37.5°C (99.5°F), the blood pressure is 125/90 mm Hg, the pulse is 90/min, and the respiratory rate is 18/min. The physical examination showed bilateral flank tenderness and palpable kidneys bilaterally. A digital rectal exam revealed a smooth, severely enlarged prostate without nodules. A CT scan is obtained. He is prescribed a drug that will alleviate his symptoms by reducing the size of the prostate. Which of the following best describes the mechanism of action of this drug?? {'A': 'Alpha-1-adrenergic antagonists', 'B': 'Anticholinergic', 'C': '5-alpha reductase inhibitor', 'D': 'Phosphodiesterase-5 inhibitors', 'E': 'Cholinergic agonist'},
|
C: 5-alpha reductase inhibitor
|
Answer the following medical question with one of the provided options:
|
Q:A 13-month-old female infant is brought to the pediatrician by her stepfather for irritability. He states that his daughter was crying through the night last night, but she didn’t want to eat and was inconsolable. This morning, she felt warm. The father also notes that she had dark, strong smelling urine on the last diaper change. The patient’s temperature is 101°F (38.3°C), blood pressure is 100/72 mmHg, pulse is 128/min, and respirations are 31/min with an oxygen saturation of 98% on room air. A urinalysis is obtained by catheterization, with results shown below: Urine: Protein: Negative Glucose: Negative White blood cell (WBC) count: 25/hpf Bacteria: Many Leukocyte esterase: Positive Nitrites: Positive In addition to antibiotics, which of the following should be part of the management of this patient’s condition?? {'A': 'Hospitalization', 'B': 'Prophylactic antibiotics', 'C': 'Renal ultrasound', 'D': 'Repeat urine culture in 3 weeks', 'E': 'Voiding cystourethrogram'},
|
C: Renal ultrasound
|
Answer the following medical question with one of the provided options:
|
Q:A 4-year-old girl is brought to the emergency department by her father for the evaluation of abdominal pain for 1 hour after drinking a bottle of rust remover. The father reports that she vomited once on the way to the hospital and that her vomit was not bloody. The patient has pain with swallowing. She appears uncomfortable. Oral examination shows mild erythema of the epiglottis and heavy salivation. Which of the following is the most likely long-term complication in this patient?? {'A': 'Esophageal webs', 'B': 'Esophageal strictures', 'C': 'Thyroglossal fistula', 'D': 'Mallory-Weiss tears', 'E': 'Oral cavity cancer'},
|
B: Esophageal strictures
|
Answer the following medical question with one of the provided options:
|
Q:A clinical trial investigating a new biomedical device used to correct congenital talipes equinovarus (club foot) in infants has recently been published. The study was a preliminary investigation of a new device and as such the sample size is only 20 participants. The results indicate that the new biomedical device is less efficacious than the current standard of care of serial casting (p < 0.001), but the authors mention in the conclusion that it may be due to a single outlier--a patient whose foot remained uncorrected by the conclusion of the study. Which of the following descriptive statistics is the least sensitive to outliers?? {'A': 'Mean', 'B': 'Median', 'C': 'Mode', 'D': 'Standard deviation', 'E': 'Variance'},
|
C: Mode
|
Answer the following medical question with one of the provided options:
|
Q:A 38-year-old man comes to the physician because of a 2-week history of severe pain while passing stools. The stools are covered with bright red blood. He has been avoiding defecation because of the pain. Last year, he was hospitalized for pilonidal sinus surgery. He has had chronic lower back pain ever since he had an accident at his workplace 10 years ago. The patient's father was diagnosed with colon cancer at the age of 62. Current medications include oxycodone and gabapentin. He is 163 cm (5 ft 4 in) tall and weighs 100 kg (220 lb); BMI is 37.6 kg/m2. Vital signs are within normal limits. The abdomen is soft and nontender. Digital rectal examination was not performed because of severe pain. His hemoglobin is 16.3 mg/dL and his leukocyte count is 8300/mm3. Which of the following is the most appropriate next step in management?? {'A': 'Botulinum toxin injection', 'B': 'Tract curettage', 'C': 'Sitz baths and topical nifedipine', 'D': 'Colonoscopy', 'E': 'Anal sphincterotomy\n"'},
|
C: Sitz baths and topical nifedipine
|
Answer the following medical question with one of the provided options:
|
Q:A 4-month-old girl with Down syndrome is brought into the pediatrician’s office by her father for her first well-child visit. The father states she was a home birth at 39 weeks gestation after an uneventful pregnancy without prenatal care. The child has not received any routine immunizations. The father states that sometimes when she is crying or nursing she "gets a little blue", but otherwise the patient is healthy. The patient is within the normal range of weight and height. Her blood pressure is 110/45 mm Hg, the pulse is 185/min, the respiratory rate is 25/min, and the temperature is 37.1°C (98.7°F). The physician notes an elevated heart rate, widened pulse pressure, and some difficulty breathing. On exam, the patient is playful and in no apparent distress. On lung exam, some faint crackles are heard at the lung bases without wheezing. Cardiac exam is significant for a harsh, machine-like murmur. An echocardiogram verifies the diagnosis. What is the next step in treatment of this patient?? {'A': 'Antibiotics', 'B': 'Indomethacin', 'C': 'PGE2', 'D': 'Emergent open heart surgery', 'E': 'Heart transplant'},
|
B: Indomethacin
|
Answer the following medical question with one of the provided options:
|
Q:A 45-year-old woman comes to the emergency department because of severe pain in both of her wrist joints and her fingers for the past 24 hours. She has a 6-month history of similar episodes, which are often associated with stiffness for about 90 minutes when she wakes up in the morning. She has hyperlipidemia and hypertension. Two years ago she was diagnosed with peptic ulcer disease, for which she underwent treatment. Current medications include fenofibrate and amlodipine. Vital signs are within normal limits. She is 175 cm (5 ft 9 in) tall and weighs 102 kg (225 lb); BMI is 33 kg/m2. Examination shows swelling and tenderness of the wrists and metacarpophalangeal joints bilaterally. Range of motion is decreased due to pain. There are subcutaneous, nontender, firm, mobile nodules on the extensor surface of the forearm, with the overlying skin appearing normal. Which of the following is the most appropriate treatment for this patient's current symptoms?? {'A': 'Indomethacin', 'B': 'Methotrexate', 'C': 'Prednisolone', 'D': 'Vitamin D and calcium supplements', 'E': 'Sulfasalazine'},
|
C: Prednisolone
|
Answer the following medical question with one of the provided options:
|
Q:A 35-year old Caucasian woman visits a community clinic and is presenting with a long history of early satiety, diarrhea, fatigue, hair loss, and brittle nails. Her family history is insignificant. Her personal history is relevant for iron deficiency anemia and vitamin B12 deficiency, as seen in her lab reports a few months back. Her physical examination is unremarkable except for pale skin and mucous surfaces, and glossitis. She brings with herself an upper endoscopy report describing antral atrophic gastritis. Which of the following tests would you expect to be positive in this patient?? {'A': 'Anti-Helicobacter pylori antibodies', 'B': 'Anti-Saccharomyces cerevisiae antibodies (ASCAs)', 'C': 'Anti-parietal cell antibodies', 'D': 'Anti-neutrophil cytoplasmic antibodies (ANCAs)', 'E': 'Anti-IgA antibodies'},
|
C: Anti-parietal cell antibodies
|
Answer the following medical question with one of the provided options:
|
Q:A 14-year-old boy presents with abdominal pain and diarrhea after returning from an East Asian vacation. Stool sample reveals the presence of red and white blood cells. Stool culture shows growth of immobile, non-lactose fermenting gram-negative rods. The attending physician explains to the medical students that the bacteria function by invading intestinal M-cells. The bacterium responsible for this patient's infection is:? {'A': 'Vibrio cholera', 'B': 'Escherichia coli', 'C': 'Salmonella enteritidis', 'D': 'Shigella dysenteriae', 'E': 'Helicobacter pylori'},
|
D: Shigella dysenteriae
|
Answer the following medical question with one of the provided options:
|
Q:A previously healthy 37-year-old woman, gravida 3, para 2, at 29 weeks' gestation comes to the physician because of colicky postprandial abdominal pain. Her vital signs are within normal limits. Physical examination shows a uterus consistent in size with a 29-week gestation. Ultrasonography of the abdomen shows multiple 5-mm hyperechoic masses within the gallbladder lumen. Which of the following processes is most likely involved in the pathogenesis of this patient's condition?? {'A': 'Accelerated gallbladder emptying', 'B': 'Decreased caliber of bile duct', 'C': 'Increased secretion of bile acids', 'D': 'Overproduction of bilirubin', 'E': 'Increased secretion of cholesterol\n"'},
|
E: Increased secretion of cholesterol "
|
Answer the following medical question with one of the provided options:
|
Q:A 4-year-old boy is brought to a pediatrician with a history of repeated episodes of right-ear symptoms, including irritability, fever, ear pain, and pulling at the ear, for the last 2 years. Each episode has been treated with an appropriate antibiotic for the recommended duration of time as prescribed by the pediatrician. The boy had experienced 3 episodes during his 3rd year of life and 5 episodes during the last year; the last episode occurred 2 months ago. There is no history of recurrent rhinosinusitis or nasal obstruction. On physical examination, vital signs are stable. Otoscopic examination of the right ear reveals a white tympanic membrane with decreased mobility. There is no erythema or bulging of the tympanic membrane. Which of the following interventions is most likely to be considered for further management of this child?? {'A': 'Antibiotic prophylaxis with subtherapeutic dose of sulfonamide', 'B': 'Oral corticosteroids for 2 weeks', 'C': 'Adenoidectomy', 'D': 'Myringotomy without insertion of a tympanostomy tube', 'E': 'Myringotomy with insertion of a tympanostomy tube'},
|
E: Myringotomy with insertion of a tympanostomy tube
|
Answer the following medical question with one of the provided options:
|
Q:A 47-year-old man is brought to the emergency room by his wife. She states that they were having dinner at a restaurant when the patient suddenly became out of breath. His past medical history is irrelevant but has a 20-year pack smoking history. On evaluation, the patient is alert and verbally responsive but in moderate respiratory distress. His temperature is 37°C (98.6°F), blood pressure is 85/56 mm Hg, pulse is 102/min, and respirations are 20/min. His oxygen saturation is 88% on 2L nasal cannula. An oropharyngeal examination is unremarkable. The trachea is deviated to the left. Cardiopulmonary examination reveals decreased breath sounds on the right lower lung field with nondistended neck veins. Which of the following is the next best step in the management of this patient?? {'A': 'Heimlich maneuver', 'B': 'Chest X-ray', 'C': 'Urgent needle decompression', 'D': 'D-dimer levels', 'E': 'Nebulization with albuterol'},
|
C: Urgent needle decompression
|
Answer the following medical question with one of the provided options:
|
Q:A 56-year-old man comes to the emergency department complaining of substernal chest pain that radiates to the left shoulder. Electrocardiogram (EKG) demonstrates ST-elevations in leads II, III, and aVF. The patient subsequently underwent catheterization with drug-eluting stent placement with stabilization of his condition. On post-operative day 3, the patient experiences stabbing chest pain that is worse with inspiration, diaphoresis, and general distress. His temperature is 98.7°F (37.1°C), blood pressure is 145/97mmHg, pulse is 110/min, and respirations are 23/min. EKG demonstrates diffuse ST-elevations. What is the best treatment for this patient?? {'A': 'Aspirin', 'B': 'Atorvastatin', 'C': 'Lisinopril', 'D': 'Needle thoracotomy', 'E': 'Surgery'},
|
A: Aspirin
|
Answer the following medical question with one of the provided options:
|
Q:A 2-year-old boy presents for a routine checkup. The patient’s mother says that he has been ‘under the weather’ for the past few days. She did not measure his temperature at home but states that he has felt warm. She denies any episodes of diarrhea or vomiting. No significant past medical history or current medications. The patient attends daycare. He is due for a hepatitis A vaccine. The patient was born at term with no prenatal or perinatal complications. The vital signs include: temperature 37.8°C (100.1°F), blood pressure 112/62 mm Hg, pulse 80/min, respiratory rate 18/min, and oxygen saturation 99% on room air. The patient is alert and responsive. The physical exam is unremarkable. Which of the following is the most appropriate next step in the management of this patient?? {'A': 'Delay the hepatitis A immunization until next visit', 'B': 'Administer the hepatitis A vaccine', 'C': 'Strep rapid antigen detection test', 'D': 'Order a complete blood count', 'E': 'Order liver function tests'},
|
B: Administer the hepatitis A vaccine
|
Answer the following medical question with one of the provided options:
|
Q:A 10-year-old boy is brought to the emergency department by his mother due to frequent vomiting, abdominal pain, and weakness. Over the last 5 days, has been noted to have polydipsia and polyuria. Family history is irrelevant. His temperature is 37.1°C (98.7°F), blood pressure is 100/70 mm Hg, and pulse is 110/min. Physical examination reveals no response to verbal commands, sunken eyes, poor skin turgor, and rapid deep respirations. Laboratory results are shown: Random plasma glucose 420 mg/dL Serum beta-hydroxybutyrate elevated Fasting C-peptide undetectable Antiglutamic acid decarboxylase (GAD) antibodies positive This patient's condition occurs as a result of which of the following?? {'A': 'Insulin resistance', 'B': 'Immune-mediated destruction of pancreatic beta cells', 'C': 'Starvation', 'D': 'Salicylate poisoning', 'E': 'Defective synthesis or release of arginine vasopressin'},
|
B: Immune-mediated destruction of pancreatic beta cells
|
Answer the following medical question with one of the provided options:
|
Q:A 29-year-old woman came to the emergency department due to severe symptoms of intoxication and unexplained convulsions. She is accompanied by her husband who reports that she takes disulfiram. There is no prior personal and family history of epilepsy. She shows signs of confusion, hyperirritability, and disorientation. On further evaluation, the patient is noted to have stomatitis, glossitis, and cheilosis. A chest X-ray is unremarkable. The deficiency of which of the vitamins below is likely to be the major cause of this patient’s symptoms?? {'A': 'B9', 'B': 'B12', 'C': 'B2', 'D': 'B3', 'E': 'B6'},
|
E: B6
|
Answer the following medical question with one of the provided options:
|
Q:A 58-year-old woman presents to her primary care provider complaining fatigue and a vague muscle pain in her limbs. She always seems tired and has difficulty getting through her workday and doing chores around the house. This has been going on for several months and her symptoms seem to be getting worse. She also admits to long bouts of constipation. Past medical history is significant for cirrhosis and kidney stones. She was taking acetaminophen for the pain, but that no longer provides relief, and polyethylene glycol to treat her constipation. Today, her temperature is 37.0°C (98.6°F), blood pressure is 110/80 mm Hg, heart rate is 85/min, and oxygen saturation is 99% on room air. On physical exam, she has a regular rhythm, and her lungs are clear to auscultation bilaterally. Her laboratory results are as follows: Alkaline aminotransferase (ALT) 62 U/L Aspartate aminotransferase (AST) 50 U/L Total bilirubin 1.10 mg/dL Serum albumin 2.0 g/dL Calcium 10.6 mg/dL What is the cause of this patient’s symptoms?? {'A': 'Hepatic encephalopathy', 'B': 'Hyperparathyroidism', 'C': 'Thyroid storm', 'D': 'Septic shock secondary to pyelonephritis', 'E': 'Urinary tract infection (UTI)'},
|
B: Hyperparathyroidism
|
Answer the following medical question with one of the provided options:
|
Q:A 31-year-old man is brought to the emergency department because of fever and increasing confusion for the past day. He has bipolar disorder with psychotic features and hypothyroidism. Current medications are lithium, haloperidol, and levothyroxine. He drinks one beer with dinner every night. His speech is confused and he is oriented to person only. His temperature is 40°C (104°F), pulse is 124/min, and blood pressure is 160/110 mm Hg. He appears acutely ill. Examination shows diaphoresis and muscle rigidity. Deep tendon reflexes are 1+ bilaterally. There is minor rigidity of the neck with full range of motion. His lungs are clear to auscultation. The abdomen is soft and nontender. His leukocyte count is 15,100/mm3 and serum creatine kinase activity is 1100 U/L. Which of the following is the most likely diagnosis?? {'A': 'Delirium tremens', 'B': 'Herpes simplex encephalitis', 'C': 'Bacterial meningitis', 'D': 'Lithium toxicity', 'E': 'Neuroleptic malignant syndrome'},
|
E: Neuroleptic malignant syndrome
|
Answer the following medical question with one of the provided options:
|
Q:A 56-year-old woman comes to the physician because she palpated a mass in her right breast during self-examination a week ago. Menarche was at the age of 14, and her last menstrual period was at the age of 51. Vital signs are within normal limits. Examination shows a nontender, firm and hard mass in the upper outer quadrant of the right breast. Mammography shows large, dense breasts, with a 1.7-cm mass in the right upper outer quadrant. The patient undergoes right upper outer quadrant lumpectomy with subsequent sentinel node biopsy, which reveals moderately differentiated invasive ductal carcinoma and micrometastasis to one axillary lymph node. There is no evidence of extranodal metastasis. The tumor tests positive for both estrogen and progesterone receptors and does not show human epidermal growth factor receptor 2 (HER2) over-expression. Flow-cytometry reveals aneuploid tumor cells. Which of the following factors has the greatest effect on this patient's prognosis?? {'A': 'Age', 'B': 'Tumor size', 'C': 'Nodal status', 'D': 'HER2 receptor status', 'E': 'Hormone receptor status'},
|
C: Nodal status
|
Answer the following medical question with one of the provided options:
|
Q:A 14-year-old boy comes to the physician for a follow-up after a blood test showed a serum triglyceride level of 821 mg/dL. Several of his family members have familial hypertriglyceridemia. The patient is prescribed a drug that increases his risk of gallstone disease. The expected beneficial effect of this drug is most likely due to which of the following actions?? {'A': 'Increased lipoprotein lipase activity', 'B': 'Decreased lipolysis in adipose tissue', 'C': 'Increased PPAR-gamma activity', 'D': 'Decreased HMG-CoA reductase activity', 'E': 'Increased bile acid sequestration'},
|
A: Increased lipoprotein lipase activity
|
Answer the following medical question with one of the provided options:
|
Q:A 9-year-old boy is brought to the psychiatrist due to unusual behavior over the past several months. His mother reports that he has started to blink more frequently than usual. His parents initially attributed this behavior to attention-seeking but he has not stopped despite multiple disciplinary efforts and behavioral therapy from a clinical psychologist. He previously performed well in school but has recently become more disruptive and inattentive in class. He has not been sick recently and denies any drug use. His parents report multiple episodes in the past in which the child seemed overly elated and hyperactive for several days followed by periods in which he felt sad and withdrawn. On examination, he is a well-appearing boy in no acute distress. He is alert and oriented with a normal affect but gets distracted easily throughout the exam. He blinks both eyes several times throughout the examination. Strength, sensation, and gait are all normal. Which of the following medications is most appropriate for this patient?? {'A': 'Amitriptyline', 'B': 'Guanfacine', 'C': 'Lithium', 'D': 'Fluoxetine', 'E': 'Venlafaxine'},
|
B: Guanfacine
|
Answer the following medical question with one of the provided options:
|
Q:A newborn infant is resuscitated and transferred to the neonatal intensive care unit. The infant has notable limb deformities as well as low-set ears and a flattened nose. He was born at 34 weeks gestation to a healthy mother who received regular obstetric follow-up. Resuscitation was notable for difficulty maintaining oxygenation in the newborn. Despite appropriate interventions, the infant is still struggling to maintain adequate oxygenation. Which of the following is most likely the cause of this patient's symptoms?? {'A': 'Chromosomal abnormality', 'B': 'Cystic dilation of the collecting ducts in the kidney', 'C': 'Failure to administer betamethasone', 'D': 'Maternal diabetes', 'E': 'PKD1 gene mutation'},
|
B: Cystic dilation of the collecting ducts in the kidney
|
Answer the following medical question with one of the provided options:
|
Q:A researcher is studying the effects of various substances on mature B-cells. She observes that while most substances are only able to promote the production of antibodies when the B-cells are co-cultured with T-cells, a small subset of substances are able to trigger antibody production even in the absence of T-cells. She decides to test these substances that stimulate B-cells alone by injecting them into model organisms. She then analyzes the characteristics of the response that is triggered by these substances. Which of the following correctly describes how the immune response triggered by the B-cell-alone-substances compares with that triggered by substances that also require T-cells?? {'A': 'Leads to class switching', 'B': 'Produces memory', 'C': 'Results in affinity maturation', 'D': 'Requires mitogens', 'E': 'Requires a peptide antigen'},
|
D: Requires mitogens
|
Answer the following medical question with one of the provided options:
|
Q:An 81-year-old man is brought to the physician by his daughter after he was found wandering on the street. For the last 3 months, he often has a blank stare for several minutes. He also claims to have seen strangers in the house on several occasions who were not present. He has hypertension and hyperlipidemia, and was diagnosed with Parkinson disease 8 months ago. His current medications include carbidopa-levodopa, hydrochlorothiazide, and atorvastatin. His blood pressure is 150/85 mm Hg. He has short-term memory deficits and appears confused and disheveled. Examination shows bilateral muscle rigidity and resting tremor in his upper extremities. He has a slow gait with short steps. Microscopic examination of the cortex of a patient with the same condition is shown. Which of the following is the most likely diagnosis?? {'A': 'Lewy body dementia', 'B': 'Creutzfeldt-Jakob disease', 'C': 'Vascular dementia', 'D': 'Normal pressure hydrocephalus', 'E': 'Frontotemporal dementia'},
|
A: Lewy body dementia
|
Answer the following medical question with one of the provided options:
|
Q:A 75-year-old female presents to your office with her daughter. The patient states that she feels perfectly well and that she does not know why she is present. The daughter states that over the last several years, the patient has become forgetful and recently forgot her grandchild's name, along with the groceries she was supposed to buy. She was also found lost 10 miles away from her house last week. The daughter also states that the patient has had urinary incontinence over the last few months and has been seeing little children in the morning that are not present. The patient denies any recent falls. Her vitals are normal and her physical exam does not reveal any focal neurological deficits. Her mini-mental status exam is scored 22/30. What is the most accurate test for this patient?? {'A': 'MRI scan of head', 'B': 'CT scan of head', 'C': 'Lumbar puncture', 'D': 'PET scan of head', 'E': 'CT angiography of head'},
|
A: MRI scan of head
|
Answer the following medical question with one of the provided options:
|
Q:A 26-year-old female medical student presents to occupational health after sustaining a needlestick injury. She reports that she was drawing blood from an HIV-positive patient when she stuck herself percutaneously while capping the needle. She immediately washed the puncture wound with betadine. The medical student has a negative HIV serology from the beginning of medical school two years ago. She is monogamous with one male partner and denies any intravenous drug use. The source patient was recently diagnosed with HIV, and has a CD4 count of 550 cells/µL. His most recent viral load is 1,800,000 copies/mL, and he was started on HAART three days ago. Which of the following is the best next step to manage the female medical student’s exposure?? {'A': 'Immediately initiate three-drug antiretroviral therapy', 'B': 'Perform genotype testing on source patient and initiate antiretroviral therapy tailored to results', 'C': 'Draw her repeat HIV serology and initiate three-drug antiretroviral therapy if negative', 'D': 'Draw her repeat HIV serology and initiate three-drug antiretroviral therapy if positive', 'E': 'Draw her repeat HIV serology and immediately initiate three-drug antiretroviral therapy'},
|
E: Draw her repeat HIV serology and immediately initiate three-drug antiretroviral therapy
|
Answer the following medical question with one of the provided options:
|
Q:A 50-year-old man presents to the office for a routine health check-up. Managing his weight has been his focus to improve his overall health. The doctor discusses his weight loss goals and overall health benefits from weight loss, including better blood pressure management and decreased insulin resistance. The national average weight for males aged 50-59 years old is 90 kg (200 lb) with a standard deviation of 27 kg (60 lb). What would be the most likely expected value if his weight was 2 standard deviations above the mean?? {'A': '36 kg (80 lb)', 'B': '63 kg (140 lb)', 'C': '145 kg (320 lb)', 'D': '118 kg (260 lb)', 'E': '172 kg (380 lb)'},
|
C: 145 kg (320 lb)
|
Answer the following medical question with one of the provided options:
|
Q:An 18-month-old boy is brought to the physician for a well-child examination. His mother is concerned because he is unable to walk on his own. He has been increasingly irritable over the past month, has been feeding poorly, and has had multiple episodes of vomiting. His immunizations are up-to-date. He is at the 50th percentile for height, 40th percentile for weight, and 98th percentile for head circumference. He appears lethargic. His vital signs are within normal limits. Examination shows a bulging anterior fontanelle. The child is unable to stand without support and falls if he attempts to walk. Muscle tone is increased and deep tendon reflexes are 4+ in the lower extremities. Examination of the back is unremarkable. An MRI of the brain shows symmetrical enlargement of all four ventricles. Which of the following is the most appropriate treatment in this patient?? {'A': 'Cerebral aqueductoplasty', 'B': 'Ventriculoperitoneal shunt', 'C': 'Furosemide therapy', 'D': 'Acetazolamide therapy', 'E': 'Serial lumbar punctures'},
|
B: Ventriculoperitoneal shunt
|
Answer the following medical question with one of the provided options:
|
Q:An investigator for a nationally representative health survey is evaluating the heights and weights of men and women aged 18–74 years in the United States. The investigator finds that for each sex, the distribution of heights is well-fitted by a normal distribution. The distribution of weight is not normally distributed. Results are shown: Mean Standard deviation Height (inches), men 69 0.1 Height (inches), women 64 0.1 Weight (pounds), men 182 1.0 Weight (pounds), women 154 1.0 Based on these results, which of the following statements is most likely to be correct?"? {'A': '68% of weights in women are likely to fall between 153 and 155 pounds.', 'B': '99.7% of heights in women are likely to fall between 63.7 and 64.3 inches.', 'C': '86% of heights in women are likely to fall between 63.9 and 64.1 inches.', 'D': '99.7% of heights in men are likely to fall between 68.8 and 69.2 inches.', 'E': '95% of heights in men are likely to fall between 68.85 and 69.15 inches.'},
|
B: 99.7% of heights in women are likely to fall between 63.7 and 64.3 inches.
|
Answer the following medical question with one of the provided options:
|
Q:A 23-year-old female college senior comes to the physician with a 1-year history of recurrent palpitations accompanied by sweating, facial blushing, and sometimes nausea. The symptoms are worse during class when she is occasionally called out to speak, which causes her to feel embarrassed. She has been skipping class on discussion days because she is concerned that her classmates may notice her symptoms. The patient does not enjoy jogging in the park anymore and has gained 2 kg (4 lbs 7 oz) over the past 2 months. Her appetite is unchanged. She has no history of serious illness. She does not smoke or drink alcohol. She has experimented with marijuana but does not use it currently. She appears nervous and does not make eye contact with the physician. Her vitals show a pulse of 85/min, her blood pressure is 125/70 mmHg, and her temperature is 36.8°C. Mental status examination reveals full range of affect. Neurological exam shows no abnormalities. Which of the following is the most likely diagnosis for this patient's symptoms?? {'A': 'Schizotypal personality disorder', 'B': 'Normal shyness', 'C': 'Avoidant personality disorder', 'D': 'Generalized anxiety disorder', 'E': 'Social anxiety disorder\n"'},
|
E: Social anxiety disorder "
|
Answer the following medical question with one of the provided options:
|
Q:A 37-year-old man presents to the clinic because of painful, severe blistering over his buttocks for the past week. About a year ago, he noticed a similar outbreak on his inner thighs, but it receded within a few days on its own. Physical examination shows the blisters are tense, and rubbing the affected skin does not result in ‘popping’ of the blisters. A biopsy shows the entire epidermis lifting away from the basal lamina with extensive inflammatory infiltrates abundant with eosinophils. Immunofluorescence shows a linear pattern of immune complex deposits. Which of the following cellular structures, if defective, is most likely involved in the formation of these blisters?? {'A': 'Gap junctions', 'B': 'Hemidesmosomes', 'C': 'Lamellar bodies', 'D': 'Macula adherens', 'E': 'Zonula occludens'},
|
B: Hemidesmosomes
|
Answer the following medical question with one of the provided options:
|
Q:A 32-year-old man comes to the emergency department because of nausea and vomiting for the past 2 hours. The patient has neither had diarrhea nor fever. Four hours ago he ate some leftover Indian rice dish he had ordered the night before. There is no history of serious illness. He immigrated from India 8 years ago with his family and now works as a butcher. He appears ill. His temperature is 36.7°C (98°F), pulse is 85/min, and blood pressure is 115/70 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 98%. Which of the following is the most likely causal organism?? {'A': 'Vibrio parahaemolyticus', 'B': 'Bacillus cereus', 'C': 'Staphylococcus aureus', 'D': 'Shigella dysenteriae', 'E': 'Enterohemorrhagic Escherichia coli'},
|
B: Bacillus cereus
|
Answer the following medical question with one of the provided options:
|
Q:A 40-year-old man presents with multiple episodes of sudden-onset severe pain in his right side of the face lasting for only a few seconds. He describes the pain as lancinating, giving the sensation of an electrical shock. He says the episodes are precipitated by chewing or touching the face. Which of the following side effects is characteristic of the drug recommended for treatment of this patient’s most likely condition?? {'A': 'Alopecia', 'B': 'Pinpoint pupils', 'C': 'Gingival hyperplasia', 'D': 'Syndrome of inappropriate ADH', 'E': 'Hirsutism'},
|
D: Syndrome of inappropriate ADH
|
Answer the following medical question with one of the provided options:
|
Q:A 66-year-old man comes to the emergency department because of shortness of breath. His temperature is 37.2°C (99°F) and pulse is 105/min. When the blood pressure cuff is inflated to 140 mm Hg, the patient's pulse is audible and regular. However, upon inspiration, the pulse disappears and does not reappear until expiration. Only when the blood pressure cuff is inflated to 125 mm Hg is the pulse audible throughout the entire respiratory cycle. Which of the following underlying conditions is most likely responsible for this patient's physical examination findings?? {'A': 'Mitral regurgitation', 'B': 'Lobar pneumonia', 'C': 'Hypertrophic cardiomyopathy', 'D': 'Congestive heart failure', 'E': 'Asthma'},
|
E: Asthma
|
Answer the following medical question with one of the provided options:
|
Q:A 20-year-old woman presents with nausea, fatigue, and breast tenderness. She is sexually active with two partners and occasionally uses condoms during intercourse. A β-hCG urinary test is positive. A transvaginal ultrasound reveals an 8-week fetus in the uterine cavity. The patient is distressed by this news and requests an immediate abortion. Which of the following is the most appropriate step in management?? {'A': 'Conduct a psychiatric evaluation for mental competence.', 'B': 'Ask the patient to reconsider and refer her to a social worker.', 'C': 'Ask the patient to obtain consent from legal guardians.', 'D': 'Explain the risk and potential harmful effects of the procedure.', 'E': 'Ask the patient to obtain consent from the baby’s father.'},
|
D: Explain the risk and potential harmful effects of the procedure.
|
Answer the following medical question with one of the provided options:
|
Q:A previously healthy 5-year-old boy is brought to the emergency department 15 minutes after sustaining an injury to his right hand. His mother says that she was cleaning the bathroom when he accidentally knocked over the drain cleaner bottle and spilled the liquid onto his hand. On arrival, he is crying and holding his right hand in a flexed position. His temperature is 37.7°C (99.8°F), pulse is 105/min, respirations are 25/min, and blood pressure is 105/65 mm Hg. Examination of the right hand shows a 4 x 4 cm area of reddened, blistered skin. The area is very tender to light touch. His ability to flex and extend the right hand are diminished. Radial pulses are palpable. Capillary refill time is less than 3 seconds. Which of the following is the most appropriate next step in management?? {'A': 'Perform escharotomy', 'B': 'Apply mineral oil', 'C': 'Apply silver sulfadiazine', 'D': 'Apply split-thickness skin graft', 'E': 'Irrigate with water'},
|
E: Irrigate with water
|
Answer the following medical question with one of the provided options:
|
Q:A 67-year-old man with hypertension comes to the emergency department because of progressively worsening abdominal pain that started 1 week ago. The pain is localized to the right upper quadrant. He has also noticed yellowing of his eyes and skin during this time period. Physical examination shows jaundice, a distended abdomen, and tender hepatomegaly. There is no jugular venous distention. Laboratory studies show a hemoglobin concentration of 19.2 g/dL, aspartate aminotransferase of 420 U/L, alanine aminotransferase of 318 U/L, and total bilirubin of 2.2 mg/dL. Which of the following is the most likely cause of this patient's symptoms?? {'A': 'Hepatotropic viral infection', 'B': 'Hepatic vein obstruction', 'C': 'Thickened pericaridium', 'D': 'Increased iron absorption', 'E': 'Hepatic steatosis'},
|
B: Hepatic vein obstruction
|
Answer the following medical question with one of the provided options:
|
Q:A 15-year-old boy comes to the physician because of skin changes on his face, chest, and back over the past year. Treatment with over-the-counter benzoyl peroxide has been ineffective. Physical examination shows numerous open comedones, inflammatory papules, and pustules on his face, chest, and back. Which of the following is the most likely underlying mechanism of this patient’s skin condition?? {'A': 'Hyperplasia of pilosebaceous glands', 'B': 'Formation of superficial epidermal inclusion cyst', 'C': 'Hyperkeratinization of hair follicles', 'D': 'Excess androgen production', 'E': 'Type IV hypersensitivity reaction'},
|
D: Excess androgen production
|
Answer the following medical question with one of the provided options:
|
Q:A 22-year-old woman comes to the physician for a follow-up examination. She had a spontaneous abortion 3 months ago. Her last menstrual period was 3 weeks ago. She reports feeling sad occasionally but has continued working and attending social events. She does not have any suicidal ideation or tendencies. She does not smoke. Vital signs are within normal limits. Physical examination including pelvic examination show no abnormalities. A urine pregnancy test is negative. She wants to avoid becoming pregnant for the foreseeable future and is started on combined oral contraceptive pills. Which of the following is the patient at risk of developing?? {'A': 'Functional ovarian cysts', 'B': 'Acne', 'C': 'Endometriosis', 'D': 'Premenstrual syndrome', 'E': 'Hypertension'},
|
E: Hypertension
|
Answer the following medical question with one of the provided options:
|
Q:A 28-year-old man comes to the physician because of progressively worsening fatigue, nausea, and right upper quadrant pain. He has a history of intravenous heroin use. Both serum Anti-HBe and Anti-HBc are positive. Further analysis of the Anti-HBc immunoglobulin is most likely to show which of the following properties?? {'A': 'Activates eosinophils', 'B': 'Forms a pentamer when secreted', 'C': 'Protects against gastrointestinal infections', 'D': 'Crosses the placenta', 'E': 'Crosses epithelial cells'},
|
B: Forms a pentamer when secreted
|
Answer the following medical question with one of the provided options:
|
Q:A 27-year-old young man presents to his primary care physician for weakness and tingling in his hand. The patient is an avid bodybuilder and has noticed that his grip strength has gradually worsened in both hands with symptoms worse at the end of a long workout. The patient has a past medical history of anabolic steroid use in high school. His current medications include a multivitamin, fish oil, and whey protein supplements. On physical exam, you note a muscular young man with male pattern hair loss. The patient has a loss of sensation bilaterally over the volar surface of the 4th and 5th digits and over the medial aspect of the volar forearm. The patient has 3/5 grip strength of his left hand and 2/5 grip strength of his right hand. There is also notable weakness of finger adduction and abduction. The rest of the patient's physical exam is within normal limits. Which of the following is the most likely diagnosis?? {'A': 'Brachial plexopathy', 'B': 'Cubital tunnel compression', 'C': "Guyon's canal compression", 'D': 'Carpal tunnel syndrome', 'E': 'Posterior interosseous nerve compression'},
|
B: Cubital tunnel compression
|
Answer the following medical question with one of the provided options:
|
Q:A 69-year-old woman is brought to the physician by her daughter because of increasing forgetfulness and generalized fatigue over the past 4 months. She is unable to remember recent events and can no longer recognize familiar people. She lives independently, but her daughter has hired a helper in the past month since the patient has found it difficult to shop or drive by herself. She has stopped attending family functions and refuses to visit the neighborhood clubhouse, where she used to conduct game nights for the residents. She has had a 7-kg (15-lb) weight gain over this period. She is alert and oriented to time, place, and person. Her temperature is 36°C (97.6°F), pulse is 54/min, and blood pressure is 122/80 mm Hg. Mental status examination shows impaired attention and concentration; she has difficulty repeating seven digits forward and five in reverse sequence. She cannot recall any of the 3 objects shown to her after 10 minutes. She has no delusions or hallucinations. Further evaluation is most likely to show which of the following?? {'A': 'Decreased serum vitamin B12', 'B': 'Diffuse cortical atrophy on brain MRI', 'C': 'Ventriculomegaly on CT scan of the head', 'D': 'Elevated serum WBC count', 'E': 'Elevated serum TSH'},
|
E: Elevated serum TSH
|
Answer the following medical question with one of the provided options:
|
Q:A stool sample was taken from a 19-year-old male who presented with profuse watery diarrhea. He recently returned from a trip to Central America. A microbiologist identified the causative agent as a gram-negative, oxidase-positive, comma-shaped bacteria that is able to grow well in a pH > 8. Which of the following is a mechanism of action of the toxin produced by this bacteria?? {'A': 'Degradation of cell membranes by hydrolysis of the phosphilpids', 'B': 'Overactivation of adenylate cyclase by activation of Gs subunit by ADP-ribosylation', 'C': 'Overactivation of adenylate cyclase by inhibition of Gi subunit by ADP-ribosylation', 'D': 'Inactivation of the 60S ribosomal subunit by cleaving an adenine from the 28S rRNA', 'E': 'Overactivation of guanylate cyclase'},
|
B: Overactivation of adenylate cyclase by activation of Gs subunit by ADP-ribosylation
|
Answer the following medical question with one of the provided options:
|
Q:An investigator is attempting to assess the glomerular filtration rate (GFR) of a healthy adult volunteer. The volunteer's inulin clearance is evaluated under continuous inulin infusion and urine collection and compared to the creatinine clearance. It is found that the estimated GFR based on the volunteer's creatinine clearance is 129 mL/min and the estimated GFR calculated using the inulin clearance is 122 mL/min. Which of the following is the best explanation for the difference in these measurements?? {'A': 'Creatinine is not freely filtered', 'B': 'Inulin is actively secreted', 'C': 'Inulin is not freely filtered', 'D': 'Creatinine is passively reabsorbed', 'E': 'Creatinine is actively secreted'},
|
E: Creatinine is actively secreted
|
Answer the following medical question with one of the provided options:
|
Q:A 30-year-old man is brought into the emergency room for complaints of acute onset chest pain and shortness of breath. He has a history of mental retardation and lives at home with his adoptive parents. His parents inform you that he has not seen a doctor since he was adopted as child and that he currently takes no medications. The patient’s temperature is 99.1°F (37.3°C),pulse is 108/min, blood pressure is 125/70 mmHg, respirations are 25/min, and oxygen saturation is 92% on 2L nasal canula. Physical exam is notable for a tall, thin individual with high-arched feet and mild pectus excavatum. There is mild asymmetry in the lower extremities with discomfort to dorsiflexion of the larger leg. Lung auscultation reveals no abnormalities. What is the next step in the diagnosis of this patient’s underlying disorder?? {'A': 'Genetic testing', 'B': 'Chest radiograph', 'C': 'Angiogram', 'D': 'Electrocardiogram', 'E': 'Serum blood test'},
|
E: Serum blood test
|
Answer the following medical question with one of the provided options:
|
Q:A 34-year-old gravida 5, para 4 presents to the physician for prenatal care at 32 weeks of pregnancy. She comes from a rural region of Ethiopia and did not have appropriate prenatal care during previous pregnancies. She has no complaints of swelling, contractions, loss of fluid, or bleeding from the vagina. During her current pregnancy, she has received proper care and has completed the required laboratory and instrumental tests, which did not show any pathology. Her blood pressure is 130/70 mm Hg, heart rate is 77/min, respiratory rate is 15/min, and temperature is 36.6°C (97.8°F). Her examination is consistent with a normal 32-weeks’ gestation. The patient tells the physician that she is going to deliver her child at home, without any medical aid. The physician inquires about her tetanus vaccination status. The patient reports that she had tetanus 1 year after her first delivery at the age of 16, and it was managed appropriately. She had no tetanus vaccinations since then. Which of the following statements is true?? {'A': 'The patient does not need vaccination because she has developed natural immunity against tetanus and will pass it to her baby.', 'B': 'The patient is protected against tetanus due to her past medical history, so only the child is at risk of developing tetanus after an out-of-hospital delivery.', 'C': 'The patient should receive at least 2 doses of tetanus toxoid within the 4-week interval to ensure that she and her baby will both have immunity against tetanus.', 'D': 'The antibodies from tetanus immune globulin vaccine, if given to a pregnant woman, would not cross the placental barrier.', 'E': 'Even if the patient receives appropriate tetanus vaccination, it will be necessary to administer toxoid to the newborn.'},
|
C: The patient should receive at least 2 doses of tetanus toxoid within the 4-week interval to ensure that she and her baby will both have immunity against tetanus.
|
Answer the following medical question with one of the provided options:
|
Q:A 62-year-old man presents with multiple episodes of hemoptysis for a week. It is associated with generalized weakness, decreased appetite, and a 5.4 kg (12 lb) weight loss in 2 months. He has a smoking history of a pack a day for the last 47 years. Physical examination reveals pallor, while the rest of the results are within normal limits. Laboratory studies reveal decreased hemoglobin and a serum sodium value of 130 mEq/L. Chest X-ray shows a 3 cm rounded opaque shadow. Which of the following conditions is the patient most likely suffering from?? {'A': 'Tuberculoma', 'B': 'Small cell carcinoma of the lung', 'C': 'Squamous cell carcinoma of the lung', 'D': 'Lung abscess', 'E': 'Adenocarcinoma of the lung'},
|
B: Small cell carcinoma of the lung
|
Answer the following medical question with one of the provided options:
|
Q:An 84-year-old man is brought to the physician by the staff of a group home where he resides because of worsening confusion and decreased urinary output. His nurse reports that the patient has not been drinking much for the last 3 days. Examination shows a decreased skin turgor and dry oral mucosa. His pulse is 105/min and blood pressure is 100/65 mm Hg. His serum creatinine is 3.1 mg/dL and a urea nitrogen is 42 mg/dL. Urine studies show multiple brownish granular casts. Which of the following processes is most likely involved in the pathogenesis of this patient's condition?? {'A': 'Leukocytic infiltration of renal interstitium', 'B': 'Disruption of glomerular podocytes', 'C': 'Necrosis of renal papillae', 'D': 'Denudation of tubular basement membrane', 'E': 'Immune complex deposition in mesangium'},
|
D: Denudation of tubular basement membrane
|
Answer the following medical question with one of the provided options:
|
Q:A 47-year-old Caucasian woman presents with a 2-month history of general fatigue, slight jaundice, and mild itching. She has also noticed that her urine has been darker and stools have been lighter in color recently. She denies any fevers, chills, or alcohol use. She has no significant past medical or surgical history and is not taking any medications. She recalls that her mother saw a doctor for eye and mouth dryness but cannot remember the name of her diagnosis. She denies any illicit drug use, recent change in diet, or recent travel. On physical exam, her abdomen is soft and non-distended. There is right upper quadrant tenderness to deep palpation but a negative Murphy’s sign. Her laboratory findings were significant for increased liver enzymes, direct bilirubin, and alkaline phosphatase with normal levels of iron and ceruloplasmin. Ultrasound revealed no stones in the gallbladder or common bile duct and endoscopic retrograde cholangiopancreatography (ERCP) revealed normal extrahepatic biliary ducts. Which of the following findings is most likely to also be found in this patient?? {'A': 'Anti-neutrophilic cytoplasmic antibodies (ANCA)', 'B': 'Rheumatoid factor', 'C': 'Anti-gliadin antibody', 'D': 'Anti-centromere antibody', 'E': 'Anti-mitochondrial antibody'},
|
E: Anti-mitochondrial antibody
|
Answer the following medical question with one of the provided options:
|
Q:A 44-year-old man, with a history of intravenous (IV) drug use, presented to the emergency department due to worsening non-productive cough, exertional dyspnea, and night sweats. His cough started 3 weeks ago and progressively worsened. He is homeless and well-known by the hospital staff. He was previously admitted to the hospital after an overdose of opioids. He takes no medication. At the hospital, the vital signs included: blood pressure 101/68 mm Hg, heart rate 99/min, respiratory rate 20/min, oxygen saturation of 91% on room air, and oral temperature of 37.4°C (99.3°F). His chest X-ray showed left perihilar shadowing. The laboratory results included: WBC count 8,800/mm3 Arterial pH 7.39 Rapid HIV testing positive with an elevated viral load PaCO2 41 mm Hg PaO2 76 mm Hg He was admitted for the treatment of presumed sepsis and pneumonia, and he was immediately started on IV ceftriaxone. An induced sputum specimen shows multiple kidney bean-shaped cysts that are approximately 5 um. These cysts stain positive with methenamine silver. What is the preferred antibiotic therapeutic regimen for this condition?? {'A': 'Isoniazid, rifabutin, pyrazinamide and ethambutol', 'B': 'Intravenous liposomal amphotericin B with flucytosine', 'C': 'Fluconazole with flucytosine', 'D': 'Trimethoprim-sulfamethoxazole', 'E': 'Clindamycin and primaquine, with adjunctive prednisone'},
|
D: Trimethoprim-sulfamethoxazole
|
Answer the following medical question with one of the provided options:
|
Q:A 33-year-old woman comes to the physician because of vision impairment in her right eye for the past 2 weeks. During this period, she was unable to distinguish colors with her right eye. She also reports pain with eye movement. She has no double vision. She occasionally has headaches that are relieved by ibuprofen. One year ago, she had a similar episode that affected her left eye and resolved spontaneously. She has no history of serious illness. She works at a library and enjoys reading, even in poor lighting conditions. Her vital signs are within normal limits. The pupils are equal, round, and reactive to light and accommodation. Without correction, visual acuity is 20/50 in the left eye, and 20/100 in the right eye. With spectacles, the visual acuity is 20/20 in the left eye and 20/100 in the right eye. Slit lamp examination shows no abnormalities. A CT scan of the head shows no abnormalities. Which of the following is the most likely diagnosis?? {'A': 'Retinal detachment', 'B': 'Retinitis pigmentosa', 'C': 'Narrow-angle glaucoma', 'D': 'Macular degeneration', 'E': 'Optic neuritis\n"'},
|
E: Optic neuritis "
|
Answer the following medical question with one of the provided options:
|
Q:A 23-year-old man is brought to the emergency department by his girlfriend because of acute agitation and bizarre behavior. The girlfriend reports that, over the past 3 months, the patient has become withdrawn and stopped pursuing hobbies that he used to enjoy. One month ago, he lost his job because he stopped going to work. During this time, he has barely left his apartment because he believes that the FBI is spying on him and controlling his mind. He used to smoke marijuana occasionally in high school but quit 5 years ago. Physical and neurologic examinations show no abnormalities. On mental status examination, he is confused and suspicious with marked psychomotor agitation. His speech is disorganized and his affect is labile. Which of the following is the most likely diagnosis?? {'A': 'Schizoaffective disorder', 'B': 'Brief psychotic disorder', 'C': 'Schizoid personality disorder', 'D': 'Schizophreniform disorder', 'E': 'Delusional disorder'},
|
D: Schizophreniform disorder
|
Answer the following medical question with one of the provided options:
|
Q:A 27-year-old G1P0 female presents for her first prenatal visit. She is in a monogamous relationship with her husband, and has had two lifetime sexual partners. She has never had a blood transfusion and has never used injection drugs. Screening for which of the following infections is most appropriate to recommend this patient?? {'A': 'Syphilis and HIV', 'B': 'Syphilis, HIV, and HBV', 'C': 'Syphilis, HIV, HBV, and chlamydia', 'D': 'Syphilis, HIV, and chlamydia', 'E': 'No routine screening is recommended for this patient'},
|
B: Syphilis, HIV, and HBV
|
Answer the following medical question with one of the provided options:
|
Q:A 3-year-old boy presents to the emergency department with a fever and a rash. This morning the patient was irritable and had a fever which gradually worsened throughout the day. He also developed a rash prior to presentation. He was previously healthy and is not currently taking any medications. His temperature is 102.0°F (38.9°C), blood pressure is 90/50 mmHg, pulse is 160/min, respirations are 17/min, and oxygen saturation is 98% on room air. Physical exam is notable for a scarlatiniform rash with flaccid blisters that rupture easily, covering more than 60% of the patient’s body surface. The lesions surround the mouth but do not affect the mucosa, and palpation of the rash is painful. Which of the following is the most likely diagnosis?? {'A': 'Staphylococcal scalded skin syndrome', 'B': 'Stevens Johnson syndrome', 'C': 'Toxic epidermal necrolysis', 'D': 'Toxic shock syndrome', 'E': 'Urticaria'},
|
A: Staphylococcal scalded skin syndrome
|
Answer the following medical question with one of the provided options:
|
Q:A previously healthy 48-year-old man comes to the physician because of a 3-week history of progressively worsening jaundice, generalized itching, and epigastric discomfort. He also complains of nausea and loss of appetite. His stools have looked like clay for the past week. He has returned from a vacation in Thailand one week ago, where he got a new tattoo. He is sexually active with multiple partners and does not use protection. His vital signs are within normal limits. Examination shows jaundice and scleral icterus. Superficial excoriations are seen on all limbs. Abdominal examination shows no abnormalities. Serum studies show a fasting glucose level of 198 mg/dL, total bilirubin concentration of 10.6 mg/dL, direct bilirubin concentration of 9.8 mg/dl, and alkaline phosphatase activity of 450 U/L. Abdominal ultrasonography shows dilation of the biliary and pancreatic ducts and a 3-cm hypoechoic solid mass with irregular margins in the head of the pancreas. An elevation of which of the following serum findings is most specific for this patient's condition?? {'A': 'Anti-HBc immunoglobulin M', 'B': 'Elevated anti-neutrophil cytoplasmic antibodies', 'C': 'Cancer antigen 19-9', 'D': 'Glucagon', 'E': 'Alpha-fetoprotein'},
|
C: Cancer antigen 19-9
|
Answer the following medical question with one of the provided options:
|
Q:A 24-year-old man is brought to the doctor’s office by his mother because the patient believes aliens have begun to read his mind and will soon have him performing missions for them. The patient’s mother says that the delusions have been intermittently present for periods of at least 1-month over the past year. When he is not having delusions, she says he still lacks expression and has no interest in socializing with his friends or going out. He has no past medical history and takes no prescription medications. The patient has smoked 1 pack of cigarettes daily for the past 10 years. Since the disturbance, he has not been able to maintain employment and lives at home with his mother. His vitals include: blood pressure 124/82 mm Hg, pulse 68/min, respiratory rate 14/min, temperature 37.3°C (99.1°F). On physical examination, the patient exhibits poor eye contact with a flat affect. His speech is circumferential, land he is currently experiencing bizarre delusions. The results from a urine drug screen are shown below: Amphetamine negative Benzodiazepine negative Cocaine negative GHB negative Ketamine negative LSD negative Marijuana negative Opioids negative PCP negative Which of the following is the correct diagnosis?? {'A': 'Schizotypal personality disorder', 'B': 'Schizophreniform disorder', 'C': 'Schizophrenia', 'D': 'Schizoaffective disorder', 'E': 'Schizoid personality disorder'},
|
C: Schizophrenia
|
Answer the following medical question with one of the provided options:
|
Q:A 22-year-old female with no past medical history presents to her primary care physician with a 3-day history of knee pain. She denies any recent injury or trauma. On physical examination her knee is warm, erythematous, and has diminished range of movement. The patient reports to having multiple sexual partners over the last year and does not use protection regularly. Her blood pressure is 124/85 mmHg, heart rate is 76/min, and temperature is 38.3℃ (101.0℉). A joint aspiration is performed and a growth of gram-negative diplococci is noted on bacterial culture. What is the treatment of choice for this patient’s condition?? {'A': 'Nafcillin monotherapy and joint aspiration', 'B': 'Oxacillin and ceftriaxone', 'C': 'Vancomycin monotherapy', 'D': 'Ceftriaxone monotherapy and joint aspiration', 'E': 'Fluoroquinolones'},
|
D: Ceftriaxone monotherapy and joint aspiration
|
Answer the following medical question with one of the provided options:
|
Q:A 43-year-old woman comes to the physician because of a 3-week history of progressive weakness. She has had increased difficulty combing her hair and climbing stairs. She has hypertension. She has smoked a pack of cigarettes daily for 25 years. She does not drink alcohol. Her mother had coronary artery disease and systemic lupus erythematosus. Her current medications include chlorthalidone and vitamin supplements. Her temperature is 37.8°C (100.0°F), pulse is 71/min, and blood pressure is 132/84 mm Hg. Cardiopulmonary examination is unremarkable. A rash is shown that involves both her orbits. Skin examination shows diffuse erythema of the upper back, posterior neck, and shoulders. Which of the following antibodies are most likely to be present in this patient?? {'A': 'Anti-centromere antibodies', 'B': 'Anti-Ro antibodies', 'C': 'Anti-histone antibodies', 'D': 'Voltage-gated calcium channel antibodies', 'E': 'Anti-Jo-1 antibodies'},
|
E: Anti-Jo-1 antibodies
|
Answer the following medical question with one of the provided options:
|
Q:A 55-year-old man presents to the emergency department with nausea and vomiting. The patient states that he has felt nauseous for the past week and began vomiting last night. He thought his symptoms would resolve but decided to come in when his symptoms worsened. He feels that his symptoms are exacerbated with large fatty meals and when he drinks alcohol. His wife recently returned from a cruise with symptoms of vomiting and diarrhea. The patient has a past medical history of poorly managed diabetes, constipation, anxiety, dyslipidemia, and hypertension. His temperature is 99.5°F (37.5°C), blood pressure is 197/128 mmHg, pulse is 100/min, respirations are 17/min, and oxygen saturation is 95% on room air. Physical exam reveals a systolic murmur heard loudest along the left upper sternal border. Abdominal exam reveals an obese, tympanitic and distended abdomen with a 3 cm scar in the right lower quadrant. Vascular exam reveals weak pulses in the lower extremities. Which of the following is the most likely diagnosis?? {'A': 'Adhesions', 'B': 'Enteric nervous system damage', 'C': 'Impacted stool', 'D': 'Norovirus', 'E': 'Twisting of the bowel'},
|
A: Adhesions
|
Answer the following medical question with one of the provided options:
|
Q:A 55-year-old postmenopausal woman comes to the physician for a screening Pap smear. She has no history of serious illness. Her last Pap smear was 10 years ago and showed no abnormalities. She has smoked one-half pack of cigarettes daily for 20 years and drinks 3 bottles of wine per week. She is sexually active with multiple male partners and uses condoms inconsistently. Her paternal grandmother had ovarian cancer and her maternal aunt had breast cancer. Pelvic examination shows multiple red, fleshy polypoid masses on the anterior vaginal wall. A biopsy is obtained and histology shows large cells with abundant clear cytoplasm. Which of the following is the most significant risk factor for this diagnosis?? {'A': 'Alcohol consumption', 'B': 'Cigarette smoking', 'C': 'Family history of breast and ovarian cancer', 'D': 'Human papillomavirus infection', 'E': 'Diethylstilbestrol exposure in utero'},
|
E: Diethylstilbestrol exposure in utero
|
Answer the following medical question with one of the provided options:
|
Q:A 53-year-old woman presents with a severe headache, nausea, and vomiting for the past 48 hours. Vitals show a blood pressure of 220/134 mm Hg and a pulse of 88/min. Urinalysis shows a 2+ proteinuria and RBC casts. Which of the following renal lesions is most likely to be seen in this patient?? {'A': 'Fibrinoid necrosis', 'B': 'Acute pyelonephritis', 'C': 'Acute tubular necrosis (ATN)', 'D': 'Acute interstitial nephritis (AIN)', 'E': 'Papillary necrosis'},
|
A: Fibrinoid necrosis
|
Answer the following medical question with one of the provided options:
|
Q:A 28-year-old woman presents with weakness, fatigability, headache, and faintness. She began to develop these symptoms 4 months ago, and their intensity has been increasing since then. Her medical history is significant for epilepsy diagnosed 4 years ago. She was prescribed valproic acid, which, even at a maximum dose, did not control her seizures. She was prescribed phenytoin 6 months ago. Currently, she takes 300 mg of phenytoin sodium daily and is seizure-free. She also takes 40 mg of omeprazole daily for gastroesophageal disease, which was diagnosed 4 months ago. She became a vegan 2 months ago. She does not smoke and consumes alcohol occasionally. Her blood pressure is 105/80 mm Hg, heart rate is 98/min, respiratory rate is 14/min, and temperature is 36.8℃ (98.2℉). Her physical examination is significant only for paleness. Blood test shows the following findings: Erythrocytes 2.5 x 109/mm3 Hb 9.7 g/dL Hct 35% Mean corpuscular hemoglobin 49.9 pg/cell (3.1 fmol/cell) Mean corpuscular volume 136 µm3 (136 fL) Reticulocyte count 0.1% Total leukocyte count 3110/mm3 Neutrophils 52% Lymphocytes 37% Eosinophils 3% Monocytes 8% Basophils 0% Platelet count 203,000/mm3 Which of the following factors most likely caused this patient’s condition?? {'A': 'Omeprazole intake', 'B': 'Phenytoin intake', 'C': 'Epilepsy', 'D': 'Alcohol intake', 'E': 'Vegan diet'},
|
B: Phenytoin intake
|
Answer the following medical question with one of the provided options:
|
Q:A 17-year-old male presents to your office with right knee pain. He is the quarterback of his high school football team and developed the knee pain after being tackled in last night's game. He states he was running with the ball and was hit on the lateral aspect of his right knee while his right foot was planted. Now, he is tender to palpation over the medial knee and unable to bear full weight on the right lower extremity. A joint effusion is present and arthrocentesis yields 50 cc's of clear fluid. Which of the following exam maneuvers is most likely to demonstrate ligamentous laxity?? {'A': 'Anterior drawer test', 'B': "Lachman's test", 'C': 'Pivot shift test', 'D': 'Valgus stress test', 'E': 'Varus stress test'},
|
D: Valgus stress test
|
Answer the following medical question with one of the provided options:
|
Q:A 12-year-old boy admitted to the intensive care unit 1 day ago for severe pneumonia suddenly develops hypotension. He was started on empiric antibiotics and his blood culture reports are pending. According to the nurse, the patient was doing fine until his blood pressure suddenly dropped. Vital signs include: blood pressure is 88/58 mm Hg, temperature is 39.4°C (103.0°F), pulse is 120/min, and respiratory rate is 24/min. His limbs feel warm. The resident physician decides to start him on intravenous vasopressors, as the blood pressure is not responding to intravenous fluids. The on-call intensivist suspects shock due to a bacterial toxin. What is the mechanism of action of the toxin most likely involved in the pathogenesis of this patient’s condition?? {'A': 'Degradation of lecithin in cell membranes', 'B': 'Inhibition of acetylcholine release', 'C': 'Inactivation of elongation factor (EF) 2', 'D': 'Inhibition of GABA and glycine', 'E': 'Release of tumor necrosis factor (TNF)'},
|
E: Release of tumor necrosis factor (TNF)
|
Answer the following medical question with one of the provided options:
|
Q:A 27-year-old man comes to the physician because of severe fatigue that started 1 week ago. Ten days ago, he finished a course of oral cephalexin for cellulitis. He does not take any medications. He appears tired. His temperature is 37.5°C (99.5°F), pulse is 95/min, and blood pressure is 120/75 mm Hg. Examination shows scleral icterus and pallor of the skin and oral mucosa. The spleen tip is palpated 1 cm below the left costal margin. The remainder of the examination shows no abnormalities. Laboratory studies show: Hemoglobin 10.5 g/dL Hematocrit 32% Reticulocyte count 5% Serum Lactate dehydrogenase 750 IU/L Haptoglobin undetectable Direct antiglobulin test positive for IgG A peripheral blood smear shows spherocytes. Which of the following is the most appropriate next step in treatment?"? {'A': 'Splenectomy', 'B': 'Oral prednisone', 'C': 'Plasmapheresis', 'D': 'Intravenous immune globulin', 'E': 'Red blood cell transfusion\n"'},
|
B: Oral prednisone
|
Answer the following medical question with one of the provided options:
|
Q:A 47-year-old man presents to you with gradual loss of voice and difficulty swallowing for the past couple of months. The difficulty of swallowing is for both solid and liquid foods. His past medical history is insignificant except for occasional mild headaches. Physical exam also reveals loss of taste sensation on the posterior third of his tongue and palate, weakness in shrugging his shoulders, an absent gag reflex, and deviation of the uvula away from the midline. MRI scanning was suggested which revealed a meningioma that was compressing some cranial nerves leaving the skull. Which of the following openings in the skull transmit the affected cranial nerves?? {'A': 'Foramen spinosum', 'B': 'Foramen lacerum', 'C': 'Jugular foramen', 'D': 'Foramen ovale', 'E': 'Foramen rotundum'},
|
C: Jugular foramen
|
Answer the following medical question with one of the provided options:
|
Q:A newborn whose mother had uncontrolled diabetes mellitus during pregnancy is likely to have which of the following findings?? {'A': 'Atrophy of pancreatic islets cells', 'B': 'Hypoglycemia', 'C': 'Hyperglycemia', 'D': 'Amyloid deposits in pancreatic islets', 'E': 'Ketoacidosis'},
|
B: Hypoglycemia
|
Answer the following medical question with one of the provided options:
|
Q:A 25-year-old man comes to the physician because of right wrist pain after a fall from a ladder. Physical examination shows decreased grip strength and tenderness between the tendons of extensor pollicis longus and extensor pollicis brevis. X-ray of the right wrist shows no abnormalities. This patient is at increased risk for which of the following complications?? {'A': 'Paralysis of the abductor pollicis brevis muscle', 'B': 'Osteoarthritis of the radiocarpal joint', 'C': 'Avascular necrosis of the lunate bone', 'D': 'Hypesthesia of the hypothenar eminence', 'E': 'Contracture of the palmar aponeurosis\n"'},
|
B: Osteoarthritis of the radiocarpal joint
|
Answer the following medical question with one of the provided options:
|
Q:A 28-year-old woman comes to the physician because of a 4-day history of lower abdominal pain and pain with urination. Five months ago, she was treated for gonococcal urethritis. She recently moved in with her newlywed husband. She is sexually active with her husband and they do not use condoms. Her only medication is an oral contraceptive. Her temperature is 37.5°C (99.7°F) and blood pressure is 120/74 mm Hg. There is tenderness to palpation over the pelvic region. Pelvic examination shows a normal-appearing vulva and vagina. Laboratory studies show: Leukocyte count 8,400/mm3 Urine pH 6.7 Protein trace WBC 60/hpf Nitrites positive Bacteria positive Which of the following is the most likely causal organism?"? {'A': 'Neisseria gonorrhoeae', 'B': 'Staphylococcus saprophyticus', 'C': 'Klebsiella pneumoniae', 'D': 'Enterococcus faecalis', 'E': 'Escherichia coli'},
|
E: Escherichia coli
|
Answer the following medical question with one of the provided options:
|
Q:A 1-month-old girl presents to her pediatrician with her mother. The patient was born at 38 weeks gestation via Caesarian section for cervical incompetence. The patient’s mother has no complaints, although she notes that the child had a runny nose and cough for a few days last week. The patient’s mother endorses decreased appetite during the aforementioned illness which has now returned to baseline. The patient’s family history is significant for an older brother with glucose-6-phosphate dehydrogenase (G6PD) deficiency and a maternal uncle with cirrhosis secondary to chronic hepatitis B. On physical exam, the patient has scleral icterus and dark urine staining her diaper. Laboratory testing reveals the following: Serum: Na+: 137 mEq/L Cl-: 102 mEq/L K+: 4.2 mEq/L HCO3-: 24 mEq/L Urea nitrogen: 12 mg/dL Glucose: 96 mg/dL Creatinine: 0.36 mg/dL Alkaline phosphatase: 146 U/L Aspartate aminotransferase (AST): 86 U/L Alanine aminotransferase (ALT): 76 U/L Total bilirubin: 4.6 mg/dL Direct bilirubin: 3.8 mg/dL Which of the following is the most likely diagnosis?? {'A': 'Decreased metabolism of bilirubin', 'B': 'Increased enterohepatic circulation of bilirubin', 'C': 'Increased production of bilirubin', 'D': 'Obstruction of the extrahepatic biliary tree', 'E': 'Obstruction of the intrahepatic biliary tree'},
|
D: Obstruction of the extrahepatic biliary tree
|
Answer the following medical question with one of the provided options:
|
Q:A 36-year-old man comes to the clinic for follow-up of his general anxiety disorder. He was diagnosed a year ago for excessive worry and irritability and was subsequently started on paroxetine. He demonstrated great response to therapy but is now complaining of decreased libido, which is affecting his marriage and quality of life. He wishes to switch to a different medication at this time. Following a scheduled tapering of paroxetine, the patient is started on a different medication that is a partial agonist of the 5-HT1A receptor. Which of the following is the most likely drug that was prescribed?? {'A': 'Amitriptyline', 'B': 'Buspirone', 'C': 'Diazepam', 'D': 'Duloxetine', 'E': 'Phenelzine'},
|
B: Buspirone
|
Answer the following medical question with one of the provided options:
|
Q:A 35-year-old man presents with large tense blisters on the flexor surfaces of the upper extremities and trunk. The histologic findings show subepidermal blisters with an eosinophil-rich infiltrate. What is the most likely underlying pathology?? {'A': 'Autoantibodies to desmoglein 1', 'B': 'Autoantibodies to desmoglein 3', 'C': 'Granular deposits of immunoglobulin A (IgA) in the dermal papilla', 'D': 'Linear band of immunoglobulin G (IgG) in the epidermal basement membrane', 'E': 'Linear band of IgA in the basement membrane'},
|
D: Linear band of immunoglobulin G (IgG) in the epidermal basement membrane
|
Answer the following medical question with one of the provided options:
|
Q:A public health campaign increases vaccination rates against human papillomaviruses 16 and 18. Increased vaccination rates would have which of the following effects on the Papanicolaou test?? {'A': 'Increased true negative rate', 'B': 'Decreased true positive rate', 'C': 'Decreased positive predictive value', 'D': 'Increased positive likelihood ratio', 'E': 'Decreased negative predictive value'},
|
C: Decreased positive predictive value
|
Answer the following medical question with one of the provided options:
|
Q:A 39-year-old man presents to the emergency department with the complaint of ‘cola-colored’ urine that he noticed this morning. Additionally, he complains of malaise and reports that he has not been able to be productive at work since last week. Lab results revealed a hemoglobin of 6.7 g/dL, leukocyte total count of 1,000 cells/mm3, and a reticulocyte count of 6%. Coomb test is negative and flow cytometry shows CD55/CD59-negative red blood cells. Concerned about the results of his complete blood count, his physician explains the diagnosis to the patient. Which of the following sets of events best describes the mechanism underlying the development of neutropenia?? {'A': '↑ activation of neutrophil adhesion molecules, ↓ release of neutrophils in the bone marrow, and ↑ destruction of neutrophils', 'B': '↑ activation of neutrophil adhesion molecules, ↓ destruction of neutrophils, and ↓ production of neutrophils in the bone marrow', 'C': '↓ activation of neutrophil adhesion molecules and ↓ production of neutrophils in the bone marrow', 'D': '↑ release of neutrophils in the bone marrow, ↑ destruction of neutrophils, and ↑ activation of neutrophil adhesion molecules', 'E': '↓ production of neutrophils in the bone marrow, ↑ destruction of neutrophils, and ↑ activation of neutrophil adhesion molecules'},
|
A: ↑ activation of neutrophil adhesion molecules, ↓ release of neutrophils in the bone marrow, and ↑ destruction of neutrophils
|
Answer the following medical question with one of the provided options:
|
Q:A 31-year-old woman presents to her primary care physician with a 2-week history of diarrhea. She says that she has also noticed that she is losing weight, which makes her feel anxious since she has relatives who have suffered from anorexia. Finally, she says that she is worried she has a fever because she feels warm and has been sweating profusely. On physical examination she is found to have proptosis, fine tremor of her hands, and symmetrical, non-tender thyroid enlargement. Which of the following types of enzymes is targeted by a treatment for this disease?? {'A': 'Catalase', 'B': 'Cyclooxygenase', 'C': 'Kinase', 'D': 'Peroxidase', 'E': 'Phosphatase'},
|
D: Peroxidase
|
Answer the following medical question with one of the provided options:
|
Q:A 45-year-old woman, gravida 3, para 2, at 18 weeks' gestation comes to the physician for a prenatal visit. Ultrasonography at a previous visit when she was at 12 weeks' gestation showed a hypoplastic nasal bone. Pelvic examination shows a uterus consistent in size with an 18-week gestation. Maternal serum studies show low α-fetoprotein and free estriol concentrations, and increased inhibin A and β-hCG concentrations. Physical examination of the infant after delivery is most likely to show which of the following findings?? {'A': 'Ambiguous external genitalia', 'B': 'Microphthalmia', 'C': 'Extremity lymphedema', 'D': 'Meningomyelocele', 'E': 'Single transverse palmar crease'},
|
E: Single transverse palmar crease
|
Answer the following medical question with one of the provided options:
|
Q:A 21-year-old man presents to his physician for a routine checkup. His doctor asks him if he has had any particular concerns since his last visit and if he has taken any new medications. He says that he has not been ill over the past year, except for one episode of the flu. He has been training excessively for his intercollege football tournament, which is supposed to be a huge event. His blood pressure is 110/70 mm Hg, pulse is 69/min, and respirations are 17/min. He has a heart sound coinciding with the rapid filling of the ventricles and no murmurs. He does not have any other significant physical findings. Which of the following best describes the heart sound heard in this patient?? {'A': 'Opening snap', 'B': 'Fourth heart sound (S4)', 'C': 'Mid-systolic click', 'D': 'Second heart sound (S2)', 'E': 'Third heart sound (S3)'},
|
E: Third heart sound (S3)
|
Answer the following medical question with one of the provided options:
|
Q:A 25-year-old man presents to the emergency department with sudden-onset severe pain in the right shoulder that occurred when he threw a bowling ball 2 hours ago. He has a history of dislocations in both shoulders and subluxation of the right knee and left wrist. There is no history of fractures. On physical examination, the right arm is slightly abducted and externally rotated. An anterior bulge is seen near the shoulder joint. The neurovascular examination of the right arm shows no abnormalities. The skin examination shows multiple widened atrophic scars around the knees, elbows, and ankles. The skin of the neck and around the elbow can easily be extended up to 4 cm. The sclera is white. The remainder of the physical examination shows no abnormalities. A defect in which of the following proteins is the most likely cause of the findings in this patient?? {'A': 'Collagen', 'B': 'Elastin', 'C': 'Fibrillin-1', 'D': 'Keratin', 'E': 'Tau'},
|
A: Collagen
|
Answer the following medical question with one of the provided options:
|
Q:A 65-year-old woman presents with a complaint of a chronic, dry cough of insidious onset since working with her new primary care physician. She has a longstanding history of diabetes mellitus type 2, hypertension, and hyperlipidemia. She has a 10 pack-year smoking history, but does not currently smoke. What is the best next step?? {'A': 'Order chest radiograph', 'B': 'Review medication list', 'C': 'Monitor esophageal pH', 'D': 'Trial of decongestant and first-generation histamine H1 receptor antagonist', 'E': 'Spirometry'},
|
B: Review medication list
|
Answer the following medical question with one of the provided options:
|
Q:An 8-year-old boy is brought to the emergency department by his parents because of vomiting, abdominal pain, and blurry vision for the past hour. The parents report that the boy developed these symptoms after he accidentally ingested 2 tablets of his grandfather’s heart failure medication. On physical examination, the child is drowsy, and his pulse is 120/min and irregular. Digoxin toxicity is suspected. A blood sample is immediately sent for analysis and shows a serum digoxin level of 4 ng/mL (therapeutic range: 0.8–2 ng/mL). Which of the following electrolyte abnormalities is most likely to be present in the boy?? {'A': 'Hypermagnesemia', 'B': 'Hyperkalemia', 'C': 'Hypokalemia', 'D': 'Hypercalcemia', 'E': 'Hypocalcemia'},
|
B: Hyperkalemia
|
Answer the following medical question with one of the provided options:
|
Q:A 44-year-old man comes to the physician for a follow-up examination. Eight months ago, he was diagnosed with HIV infection and combined antiretroviral treatment was begun. He feels well. He does not smoke or drink alcohol. Current medications include lamivudine, zidovudine, atazanavir, and trimethoprim-sulfamethoxazole. Laboratory studies show: Hemoglobin 11.2 g/dL Mean corpuscular volume 102 μm3 Leukocyte count 2,600/mm3 Segmented neutrophils 38% Lymphocytes 54% Platelet count 150,000/mm3 Serum Folate normal Lactate 6.0 mEq/L (N = 0.5–2.2) Arterial blood gas analysis on room air shows: pH 7.34 pCO2 55 mm Hg pO2 99 mmHg HCO3- 14 mEq/L The drug most likely responsible for this patient's current laboratory findings belongs to which of the following classes of drugs?"? {'A': 'Entry inhibitor', 'B': 'Integrase inhibitor', 'C': 'Nucleoside reverse transcriptase inhibitor', 'D': 'Protease inhibitor', 'E': 'Dihyrofolate reductase inhibitor'},
|
C: Nucleoside reverse transcriptase inhibitor
|
Answer the following medical question with one of the provided options:
|
Q:A 52-year-old man comes to the physician because of a 3-week history of a cough and hoarseness. He reports that the cough is worse when he lies down after lunch. His temperature is 37.5°C (99.5°F); the remainder of his vital signs are within normal limits. Because the physician has recently been seeing several patients with the common cold, the diagnosis of a viral upper respiratory tract infection readily comes to mind. The physician fails to consider the diagnosis of gastroesophageal reflux disease, which the patient is later found to have. Which of the following most accurately describes the cognitive bias that the physician had?? {'A': 'Confirmation', 'B': 'Anchoring', 'C': 'Visceral', 'D': 'Framing', 'E': 'Availability'},
|
E: Availability
|
Answer the following medical question with one of the provided options:
|
Q:A researcher is studying the effects of 2 drugs, drug X, and drug Y. He is trying to measure the potential of each drug to achieve a certain response. The graphs in the images show some of his observations. He observes that when drug X acts on its own, it produces a much higher response compared to drug Y. When drug Y is added to the reaction, the maximum efficacy (Emax) is lower than expected. Then he decides to add more drug X to increase the Emax, but the efficacy continues to remain low. Which of the following best describes drug Y?? {'A': 'Antagonist', 'B': 'Agonist', 'C': 'Inverse agonist', 'D': 'Competitive antagonist', 'E': 'Partial agonist'},
|
E: Partial agonist
|
Answer the following medical question with one of the provided options:
|
Q:A 54-year-old man comes to the emergency department for nausea and vomiting for the past 2 days. The patient reports that he felt tired and weak for the past week without any obvious precipitating factors. Past medical history is significant for hypertension controlled with hydrochlorothiazide. He denies diarrhea, changes in diet, recent surgery, vision changes, or skin pigmentation but endorses a 10-lb weight loss, headaches, fatigue, and a chronic cough for 2 years. He smokes 2 packs per day for the past 20 years but denies alcohol use. Physical examination demonstrates generalized weakness with no peripheral edema. Laboratory tests are shown below: Serum: Na+: 120 mEq/L Cl-: 97 mEq/L K+: 3.4 mEq/L HCO3-: 24 mEq/L Ca2+: 10 mg/dL Osmolality: 260 mOsm/L Urine: Na+: 25 mEq/L Osmolality: 285 mOsm/L Specific gravity: 1.007 What is the most likely finding in this patient?? {'A': 'Antibodies against presynaptic calcium channels', 'B': 'Chromogranin positive mass in the lung', 'C': 'Orphan Annie eyes and psammoma bodies in the thyroid', 'D': 'Pituitary hypertrophy', 'E': 'Venous congestion at the liver'},
|
B: Chromogranin positive mass in the lung
|
Subsets and Splits
No community queries yet
The top public SQL queries from the community will appear here once available.