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Answer the following medical question with one of the provided options:
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Q:A 33-year-old male presents to his primary care physician with complaints of headaches and muscle weakness. His physical exam is entirely within normal limits except for a blood pressure of 150/95. Subsequent routine blood lab work showed a sodium level of 146 and potassium level of 3.0. What is the best pharmacological therapy for this patient?? {'A': 'Hydrochlorthiazide', 'B': 'Spironolactone', 'C': 'Propanolol', 'D': 'Lisinopril', 'E': 'Fludrocortisone'},
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B: Spironolactone
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Answer the following medical question with one of the provided options:
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Q:A 43-year-old woman is hospitalized for chemotherapy following a local recurrence of breast cancer. Because the tumor responded well to the previous chemotherapy regimen, the ordering physician copies and pastes previous recommendations from her electronic health record into the patient’s new orders. Subsequently, the patient develops drug-related toxicity that prolongs her hospital stay. An investigation into the cause shows that she has lost 8 kg (17.6 lb) since her last chemotherapy course, while her other information in recent notes is identical to the past. Which of the following is the most appropriate recommendation to reduce the recurrence of similar types of errors in the future?? {'A': 'Avoiding copy and paste in electronic health records', 'B': 'Limiting copy and paste to lengthy progress notes', 'C': 'Making copy and paste material readily identifiable', 'D': 'Preventing identification of authors', 'E': 'Using copy and paste only for patient demographics'},
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C: Making copy and paste material readily identifiable
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Answer the following medical question with one of the provided options:
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Q:A 3-year-old boy presents with his mother to the family medicine clinic for an itchy rash on the face that started 3 days ago. The mother states that her son had a fever with a runny nose a little more than a week ago. There has been no sore throat or cough according to the mother. No significant medical conditions are noted. No medications are on record. The boy is up-to-date on all immunizations. His heart rate is 102/min, respiratory rate is 24/min, temperature is 36.5°C (101.6°F), and blood pressure is 92/65 mm Hg. The boy appears well-nourished and alert. Auscultation of the heart is without murmurs. Lungs are clear to auscultation bilaterally. An erythematous malar rash extending from the left lateral nasal region to the left medial zygomatic region is present. There is no lymphadenopathy present. A full skin examination reveals an erythematous, reticulated rash on the lower extremities (see image). Which of the following etiologic agents is responsible for the patient’s signs and symptoms?? {'A': 'Parvovirus B19', 'B': 'Adenovirus', 'C': 'Streptococcus pyogenes', 'D': 'Human herpesvirus 6 (HHV-6)', 'E': 'Rubella virus'},
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A: Parvovirus B19
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Answer the following medical question with one of the provided options:
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Q:A 37-year-old G3P2 is referred to a gynecologist by her physician to follow-up on the results of some screening tests. She has a history of 1 medical abortion and 2 vaginal deliveries. The most recent labo, which occurred at 31 years of age, was induced at 41 weeks gestation with prostaglandin application to the cervix, and was complicated by a cervical laceration. A Pap smear obtained 1 year ago showed a low-grade intraepithelial lesion (LSIL), but HPV testing was negative. Currently, the patient reports no symptoms. Her husband is her only sexual partner. She uses oral contraception. She does not have any co-existing diseases. The HPV test performed at the patient’s last evaluation by her physician was positive. The Pap smear results were as follows: Specimen adequacy: satisfactory for evaluation Interpretation: high-grade squamous intraepithelial lesion (HSIL) A colposcopic examination is performed, but deemed inadequate due to cervical scarring with a partial obliteration of the external os. The lesion can be seen at the 7–8 o’clock position occupying 1/2 of the visible right lower quadrant of the cervix with a dense acetowhite epithelium and coarse punctuation. The cervical scar interferes with identification of the margins and extension of the lesion into the cervical canal. Which of the following would be the most appropriate next step in the management of this patient?? {'A': 'Cryoablation of the lesion', 'B': 'Genotyping for HPV type 16 and 18 and further management based on the results', 'C': 'Laser ablation of the lesion', 'D': 'Cold-knife conization', 'E': 'Punch biopsy and subsequent management based on the results'},
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D: Cold-knife conization
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Answer the following medical question with one of the provided options:
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Q:A 40-year-old man presents with a painless firm mass in the right breast. Examination shows retraction of the nipple and the skin is fixed to the underlying mass. The axillary nodes are palpable. Which of the following statements is true regarding the above condition?? {'A': 'Breast mass will regress after withdrawal of offending drugs', 'B': 'Lobular cancer is the most common breast cancer in males', 'C': 'These are positive for estrogen receptor', 'D': 'BRCA analysis is not recommended in his family members', 'E': 'Endocrine therapy has no role in the treatment'},
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C: These are positive for estrogen receptor
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Answer the following medical question with one of the provided options:
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Q:A 56-year-old man presents to the emergency department with severe chest pain and a burning sensation. He accidentally drank a cup of fluid at his construction site 2 hours ago. The liquid was later found to contain lye. On physical examination, his blood pressure is 100/57 mm Hg, respiratory rate is 21/min, pulse is 84/min, and temperature is 37.7°C (99.9°F). The patient is sent immediately to the radiology department. The CT scan shows air in the mediastinum, and a contrast swallow study confirms the likely diagnosis. Which of the following is the best next step in the management of this patient’s condition?? {'A': 'Oral antidote', 'B': 'Ceftriaxone', 'C': 'Surgical repair', 'D': 'Dexamethasone', 'E': 'Nasogastric lavage'},
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C: Surgical repair
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Answer the following medical question with one of the provided options:
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Q:A 36-year-old woman is brought to the emergency department 20 minutes after being involved in a high-speed motor vehicle collision. On arrival, she is unconscious. Her pulse is 140/min, respirations are 12/min and shallow, and blood pressure is 76/55 mm Hg. 0.9% saline infusion is begun. A focused assessment with sonography shows blood in the left upper quadrant of the abdomen. Her hemoglobin concentration is 7.6 g/dL and hematocrit is 22%. The surgeon decided to move the patient to the operating room for an emergent explorative laparotomy. Packed red blood cell transfusion is ordered prior to surgery. However, a friend of the patient asks for the transfusion to be held as the patient is a Jehovah's Witness. The patient has no advance directive and there is no documentation showing her refusal of blood transfusions. The patient's husband and children cannot be contacted. Which of the following is the most appropriate next best step in management?? {'A': 'Administer hydroxyethyl starch', 'B': 'Transfusion of packed red blood cells', 'C': 'Consult hospital ethics committee', 'D': 'Administer high-dose iron dextran', 'E': 'Proceed to surgery without transfusion'},
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B: Transfusion of packed red blood cells
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Answer the following medical question with one of the provided options:
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Q:A 26-year-old woman comes to the physician because of increasing pain and swelling in her right foot for the past 2 weeks. Initially, the pain was intermittent but it is now constant and she describes it as 8 out of 10 in intensity. She has not had any trauma to the foot or any previous problems with her joints. The pain has not allowed her to continue training for an upcoming marathon. Her only medication is an oral contraceptive. She is a model and has to regularly wear stilettos for fashion shows. She appears healthy. Vital signs are within normal limits. Examination shows swelling of the right forefoot. There is tenderness to palpation over the fifth metatarsal shaft. Pushing the fifth toe inwards produces pain. The remainder of the examination shows no abnormalities. Which of the following is the most likely diagnosis?? {'A': "Morton's neuroma", 'B': 'Acute osteomyelitis', 'C': 'Stress fracture', 'D': 'Plantar fasciitis', 'E': 'Freiberg disease'},
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C: Stress fracture
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Answer the following medical question with one of the provided options:
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Q:A 23-year-old man presents to student health for a cough. The patient states he has paroxysms of coughing followed by gasping for air. The patient is up to date on his vaccinations and is generally healthy. He states he has felt more stressed lately secondary to exams. His temperature is 101.0°F (38.3°C), blood pressure is 125/65 mmHg, pulse is 105/min, respirations are 14/min, and oxygen saturation is 98% on room air. Laboratory values are notable for the findings below. Hemoglobin: 12 g/dL Hematocrit: 36% Leukocyte count: 13,500/mm^3 with a lymphocytosis Platelet count: 197,000/mm^3 Physical exam is notable for clear breath sounds bilaterally. Which of the following is the best next step in management?? {'A': 'Azithromycin', 'B': 'Chest radiograph', 'C': 'Culture', 'D': 'PCR for Bordetella pertussis', 'E': 'Penicillin'},
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A: Azithromycin
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Answer the following medical question with one of the provided options:
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Q:A 4-year-old boy is brought to the physician because of frequent respiratory tract infections and chronic diarrhea. His stools are bulky and greasy, and he has around 8 bowel movements daily. He is at the 10th percentile for height and 25th percentile for weight. Chest examination shows intercostal retractions along with diffuse wheezing and expiratory rhonchi. Which of the following is the most likely cause of his condition?? {'A': 'Increased frequency of trinucleotide repeats', 'B': 'Defective ciliary protein function', 'C': 'Intracellular retention of misfolded proteins', 'D': 'Altered configuration of a protease inhibitor', 'E': 'Frameshift mutation of muscle-anchoring proteins\n"'},
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C: Intracellular retention of misfolded proteins
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Answer the following medical question with one of the provided options:
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Q:A 73-year-old man is admitted to the hospital for jaundice and weight loss. He is an immigrant from the Dominican Republic and speaks little English. A CT scan is performed showing a large mass at the head of the pancreas. When you enter the room to discuss these results with the patient, his daughter and son ask to speak with you outside of the patient's room. They express their desire to keep these results from their father. What is the appropriate response in this situation?? {'A': 'Consult the hospital ethics committee', 'B': 'Deliver the information in Spanish', 'C': "Explore the reasoning behind the children's request", 'D': "Respect the children's wishes to hold prognosis information", 'E': 'Tell the children that you are obligated to tell the father'},
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C: Explore the reasoning behind the children's request
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Answer the following medical question with one of the provided options:
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Q:A 2-year-old girl presents to the emergency department with a 3-minute episode of a tonic-clonic seizure. The parents deny any previous history of seizure involving the patient or the family. Physical examination reveals an afebrile, well-groomed, and playful appearance, with normal vital signs. The patient carries a pink birthmark on the right side of her face extending from the forehead to the zygomatic arch. Which of the following findings is most likely on a head CT of this patient?? {'A': 'A non-enhancing hemispheric lesion', 'B': 'Intraparenchymal hemorrhage', 'C': 'Prominent intraparenchymal white matter calcification', 'D': 'Subependymal giant cell astrocytoma', 'E': 'Subependymal nodule'},
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C: Prominent intraparenchymal white matter calcification
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Answer the following medical question with one of the provided options:
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Q:A 35-year-old woman comes to the physician accompanied by her husband after he started noticing strange behavior. He first noticed her talking to herself 8 months ago. For the past 6 months, she has refused to eat any packaged foods out of fear that the government is trying to poison her. She has no significant past medical history. She smoked marijuana in college but has not smoked any since. She appears restless. Mental status examination shows a flat affect. Her speech is clear, but her thought process is disorganized with many loose associations. The patient is diagnosed with schizophrenia and started on olanzapine. This patient is most likely to experience which of the following adverse effects?? {'A': 'Seizures', 'B': 'Diabetes insipidus', 'C': 'Dyslipidemia', 'D': 'Agranulocytosis', 'E': 'Myoglobinuria\n"'},
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C: Dyslipidemia
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Answer the following medical question with one of the provided options:
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Q:An investigator studying protein synthesis in human stem cells isolates tRNA molecules bound to mRNA molecules. The isolated tRNA molecules have inosine in the 5' position of the anticodon; of these, some are bound to adenine, some to cytosine, and some to uracil at the 3' position of the mRNA codon. Which of the following properties of the genetic code is best illustrated by this finding?? {'A': 'Specificity of the start codon', 'B': 'Specificity of stop codons', 'C': 'Degeneracy', 'D': 'Unambiguity', 'E': 'Non-overlapping'},
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C: Degeneracy
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Answer the following medical question with one of the provided options:
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Q:A 75-year-old man is evaluated in the emergency department for increasing shortness of breath for the last 8 months. He also complains of a dry cough for the last 6 months. Initially, his shortness of breath occurs with exertion, but now he feels it at rest as well. He has no other complaints. He has a sedentary lifestyle and had a hip replacement surgery recently. The past medical history is significant for hypertension for which he is taking lisinopril. The patient is a lifetime non-smoker. The blood pressure is 135/85 mm Hg, pulse rate is 85/min, and the temperature is 36.6°C (97.9°F). Physical examination reveals fine inspiratory crackles and digital clubbing. A chest X-ray reveals peripheral reticular opacities associated with traction bronchiectasis predominantly at the lung bases. The pulmonary function test results reveal a decreased FEV1, a decreased FVC, and a preserved FEV1/FVC ratio. High-resolution CT scan of the chest is shown. Which of the following is the most likely diagnosis?? {'A': 'Pulmonary embolism', 'B': 'Idiopathic pulmonary fibrosis', 'C': 'Chronic obstructive pulmonary disease', 'D': 'Drug-induced pulmonary fibrosis', 'E': 'Chlamydia pneumoniae'},
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B: Idiopathic pulmonary fibrosis
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Answer the following medical question with one of the provided options:
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Q:A previously healthy 39-year-old man comes to the physician because of a 1-month history of fatigue and red-colored urine. His vital signs are within normal limits. Physical examination shows pallor and jaundice. His platelet count is 90,000/mm3 and creatinine concentration is 1.0 mg/dL. A direct Coombs test is negative. Flow cytometry shows erythrocytes deficient in CD55 and CD59 surface antigens. This patient is at greatest risk for which of the following complications?? {'A': 'Radiolucent gallstones', 'B': 'Acrocyanosis', 'C': 'Venous thrombosis', 'D': 'Hepatocellular carcinoma', 'E': 'Chronic lymphocytic leukemia'},
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C: Venous thrombosis
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Answer the following medical question with one of the provided options:
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Q:A 58-year-old man is brought to the emergency department by his wife 30 minutes after the sudden onset of severe retrosternal chest pain radiating to his back. He has a history of hyperlipidemia, hypertension, and type 2 diabetes mellitus. He has smoked one-half pack of cigarettes daily for 20 years. Medications include aspirin, captopril, atorvastatin, and metformin. His pulse is 80/min and blood pressure is 160/60 mm Hg. A CT scan of the chest is shown. Which of the following is the strongest predisposing factor for this patient's current condition?? {'A': 'Diabetes mellitus', 'B': 'Age', 'C': 'Genetic collagen disorder', 'D': 'Hypertension', 'E': 'History of smoking'},
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D: Hypertension
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Answer the following medical question with one of the provided options:
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Q:A 5-year-old girl is brought to the emergency department after drinking a bottle of drain cleaner. It is unknown how much the child drank. She has a past medical history of Down syndrome and obesity. The patient's vitals are unremarkable. Physical exam is notable for a child in no acute distress. She is tolerating her oral secretions and interactive. Inspection of the oropharynx is unremarkable. Which of the following is appropriate management of this patient?? {'A': 'Dilute hydrochloric acid', 'B': 'Endoscopy', 'C': 'Intubation', 'D': 'Observation', 'E': 'Polyethylene glycol'},
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B: Endoscopy
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Answer the following medical question with one of the provided options:
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Q:A 38-year-old man presents to the emergency department with chest pain and difficulty breathing for the last 3 hours. He denies cough, nasal discharge or congestion, sneezing, and palpitations. There is no history of recent surgery or hospitalization but he mentions that he was diagnosed with a psychiatric disorder 6 months ago and has been on medication, as prescribed by the psychiatrist. His past medical history is negative for any cardiac or respiratory conditions. His temperature is 38.1°C (100.5°F), pulse is 112/min, blood pressure is 128/84 mm Hg, and respiratory rate is 24/min. Auscultation of the chest reveals crackles and a decreased intensity of breath sounds over the right infrascapular region. The heart sounds are normal and there are no murmurs. His plasma D-dimer level is elevated. A contrast-enhanced computed tomography (CT) of the chest shows a filling defect in 2 segmental pulmonary arteries on the right side. Which of the following medications is most likely to cause the condition found in this man?? {'A': 'Alprazolam', 'B': 'Chlorpromazine', 'C': 'Haloperidol', 'D': 'Lithium', 'E': 'Valproic acid'},
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B: Chlorpromazine
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Answer the following medical question with one of the provided options:
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Q:A 62-year-old man comes to the physician because of a 1-day history of dull pain and stiffness of the right knee. He takes chlorthalidone for hypertension. Physical examination of the right knee shows a large effusion and mild erythema; range of motion is limited by pain. Arthrocentesis of right knee yields a cloudy aspirate. Gram stain is negative. Analysis of the synovial fluid shows a leukocyte count of 15,000/mm3 and 55% neutrophils. Microscopic examination of the synovial fluid under polarized light shows positively birefringent rods and rhomboid crystals. Further evaluation of this patient is most likely to show which of the following findings?? {'A': 'Thickening of the synovia at the metacarpophalangeal joints', 'B': 'Calcification of the meniscal cartilage', 'C': 'Elevation of serum uric acid concentration', 'D': 'Expression of human leukocyte antigen-B27', 'E': 'Chalky nodules on the external ear'},
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B: Calcification of the meniscal cartilage
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Answer the following medical question with one of the provided options:
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Q:A 29-year-old man from India seeks evaluation at a clinic with complaints of sore muscles and lethargy of several days duration. After the physical examination and laboratory testing, the patient is asked to stay for treatment and monitoring. Despite the physician’s warning, the patient leaves the hospital against medical advice. He subsequently develops difficulty in breathing and anuria and is brought to the emergency department with loss of consciousness. The patient gets an immediate T2 weighted image of his head, which is shown in the exhibit. Laboratory findings confirm the presence of rings, which appear on the periphery of red blood cells (RBCs). What is the best treatment for his condition?? {'A': 'Atovaquone-proguanil', 'B': 'Primaquine', 'C': 'Chloroquine', 'D': 'Mefloquine', 'E': 'Chloramphenicol'},
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A: Atovaquone-proguanil
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Answer the following medical question with one of the provided options:
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Q:A 57-year-old male is found to have an elevated prostate specific antigen (PSA) level on screening labwork. PSA may be elevated in prostate cancer, benign prostatic hypertrophy (BPH), or prostatitis. Which of the following best describes the physiologic function of PSA?? {'A': 'Sperm production', 'B': 'Liquefaction of semen', 'C': 'Maintains corpus luteum', 'D': 'Response to peritoneal irritation', 'E': 'Regulation of transcription factors and phosphorylation of proteins'},
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B: Liquefaction of semen
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Answer the following medical question with one of the provided options:
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Q:An 18-year-old African-American woman comes to the physician for the evaluation of worsening fatigue that started 1 year ago. Physical examination shows mild jaundice and splenomegaly. Laboratory studies show: Hemoglobin 10.4 g/dL Mean corpuscular hemoglobin concentration 43% Hb/cell Platelet count 220,000/mm3 Reticulocyte count 7% A peripheral blood smear shows target cells and erythrocytes with hemoglobin crystals. Which of the following is the most likely underlying cause of this patient's findings?"? {'A': 'Replacement of glutamate by valine in beta-globin chain', 'B': 'Decreased conversion of oxidized glutathione into its reduced form', 'C': 'Replacement of glutamate by lysine in beta-globin chain', 'D': 'Reduced production of beta-globin due to a mutation in the HbB gene', 'E': 'Acquired mutation of membrane-bound glycosylphosphatidylinositol anchor'},
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C: Replacement of glutamate by lysine in beta-globin chain
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Answer the following medical question with one of the provided options:
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Q:A 3-month-old girl with an immunodeficiency syndrome has been hospitalized for 1 month due to a severe pulmonary infection. Her family came to visit her daily in the beginning of her hospital stay; however, since their car broke down they have been unable to visit for the last 2 weeks. While the infection has now been resolved with proper treatment and supportive care, the girl's nurse is concerned that the patient is becoming increasingly withdrawn. Specifically, the nurse has noticed that since the family has stopped visiting, the girl seems to shy away from contact and sometimes even becomes unresponsive to verbal or visual cues. Which of the following is most likely true about this infant's condition?? {'A': 'The condition can be diagnosed in adults if it lasts > 6 months', 'B': 'The condition is exclusively seen in girls', 'C': 'The condition is significantly more common in boys', 'D': 'The condition is reversible', 'E': 'The condition should be reported to state authorities'},
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D: The condition is reversible
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Answer the following medical question with one of the provided options:
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Q:A 6-year-old boy is brought to the emergency department because of colicky abdominal pain and vomiting for 1 day. He has a history of a sore throat 2 weeks ago. His temperature is 37°C (98.6°F), pulse is 100/min, blood pressure is 90/55, and respirations are 28/min. Examination of the lower extremities shows non-blanching raised erythematous papules. The abdomen is soft and nontender. Bowel sounds are high-pitched. Both ankles are swollen and tender; range of motion is limited by pain. Test of the stool for occult blood is positive. Laboratory studies show: Hemoglobin 13.1 g/dL Leukocyte count 9800/mm3 Platelet count 265,000/mm3 Serum Glucose 78 mg/dL Antinuclear antibodies negative Urine Glucose negative Protein negative Blood 2+ RBC 10-12/hpf with dysmorphic features WBC 0-1/hpf Ultrasonography of the abdomen shows a portion of the bowel with alternating echogenic and hypoechogenic bands in transverse view. Which of the following is the most likely cause of these findings?"? {'A': 'P-ANCA vasculitis of small vessels', 'B': 'Microthrombi occluding the vasculature', 'C': 'Gram-negative cocci infection', 'D': 'Deposition of IgA immune complexes', 'E': 'HLA-associated synovial inflammation'},
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D: Deposition of IgA immune complexes
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Answer the following medical question with one of the provided options:
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Q:During the course of investigation of a suspected abdominal aortic aneurysm in a 57-year-old woman, a solid 6 × 5 cm mass is detected in the right kidney. The abdominal aorta reveals no abnormalities. The patient is feeling well and has no history of any serious illness or medication usage. She is a 25-pack-year smoker. Her vital signs are within normal limits. Physical examination reveals no abnormalities. Biopsy of the mass shows renal cell carcinoma. Contrast-enhanced CT scan indicates no abnormalities involving contralateral kidney, lymph nodes, lungs, liver, bone, or brain. Which of the following treatment options is the most appropriate next step in the management of this patient?? {'A': 'Interferon-ɑ (IFN-ɑ)', 'B': 'Interleukin 2 (IL-2)', 'C': 'Nephrectomy', 'D': 'Radiation', 'E': 'Sunitinib'},
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C: Nephrectomy
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Answer the following medical question with one of the provided options:
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Q:A 57-year-old man comes to the physician because of a 3-month history of fatigue, difficulty swallowing, and weight loss. He has smoked 1 pack of cigarettes daily for 30 years. He is 173 cm (5 ft 8 in) tall, and weighs 54 kg (120 lb); BMI is 18 kg/m2. Upper gastrointestinal endoscopy shows an exophytic tumor at the gastroesophageal junction. The patient is diagnosed with advanced esophageal adenocarcinoma. Palliative treatment is begun. Two months later, he complains of difficulty sleeping. His husband says that the patient does not get out of bed most days and has lost interest in seeing his friends. Mental status examination shows a blunted affect, slowed speech, and poor concentration. This patient is at increased risk of developing which of the following findings on polysomnography?? {'A': 'Decreased REM sleep duration', 'B': 'Increased spike-and-wave discharge', 'C': 'Increased slow-wave sleep-cycle duration', 'D': 'Increased periodic sharp-wave discharge', 'E': 'Decreased REM sleep latency'},
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E: Decreased REM sleep latency
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Answer the following medical question with one of the provided options:
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Q:A 42-year-old woman, gravida 5, para 5, comes to the physician because of a 6-month history of occasional involuntary urine loss that is exacerbated by coughing, sneezing, and laughing. She has no urgency or dysuria. Physical examination shows normal appearing external genitalia, vagina, and cervix. There is a loss of urine with the Valsalva maneuver. The physician recommends doing Kegel exercises. Which of the following muscles is strengthened by these exercises?? {'A': 'Compressor urethrae', 'B': 'Internal urethral sphincter', 'C': 'Sphincter urethrae', 'D': 'Levator ani', 'E': 'Deep transverse perineal muscles'},
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D: Levator ani
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Answer the following medical question with one of the provided options:
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Q:A 3-year-old boy presents with progressive lethargy and confusion over the last 5 days. He lives with his parents in a home that was built in the early 1900s. His parents report that "his tummy has been hurting" for the last 3 weeks and that he is constipated. He eats and drinks normally, but occasionally tries things that are not food. Abdominal exam shows no focal tenderness. Hemoglobin is 8 g/dL and hematocrit is 24%. Venous lead level is 55 ug/dL. Which therapy is most appropriate for this boy's condition?? {'A': 'Deferoxamine', 'B': 'Folic acid', 'C': 'Docusate', 'D': 'Succimer', 'E': 'Psyllium'},
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D: Succimer
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Answer the following medical question with one of the provided options:
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Q:A 2-year-old boy is brought to the pediatrician with complaints of fever and a skin rash for the past 2 days. The boy was born by normal vaginal delivery at full term, and his neonatal period was uneventful. He has a history of severe pain in his legs and difficulty eating. His temperature is 38.6°C (101.4°F), pulse is 102/min, and respiratory rate is 22/min. Physical examination shows multiple papules on the hands, feet, and trunk. His neurologic examination shows decreased muscle strength in the lower limbs. On intraoral examination, multiple reddish 2 mm macules are present on the hard palate. Which of the following is the most likely causal organism?? {'A': 'Varicella-zoster virus', 'B': 'Coxsackievirus', 'C': 'Herpes simplex virus', 'D': 'Cytomegalovirus', 'E': 'Parvovirus B19'},
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B: Coxsackievirus
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Answer the following medical question with one of the provided options:
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Q:A 65-year-old man is brought into the emergency department by his wife for slurred speech and right-sided weakness. The patient has a significant past medical history of hypertension and hyperlipidemia. The wife reports her husband went to bed last night normally but woke up this morning with the symptoms mentioned. Physical examination shows right-sided hemiparesis along with the loss of vibration and proprioception. Cranial nerve examination shows a deviated tongue to the left. What is the most likely diagnosis?? {'A': 'Medial pontine syndrome', 'B': 'Lateral pontine syndrome', 'C': 'Dejerine syndrome', 'D': 'Wallenberg syndrome', 'E': 'Weber syndrome'},
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C: Dejerine syndrome
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Answer the following medical question with one of the provided options:
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Q:A 29-year-old woman is brought to the emergency room for seizure-like activity. Her husband reports that they were in bed sleeping when his wife began complaining of “hot flashes.” Several minutes later, her right arm began to twitch, and she did not respond to his calls. The whole episode lasted for about 5 minutes. She denies any prior similar episodes, tongue biting, loss of bowel or urinary control, new medications, or recent illness. She reports a family history of epilepsy and is concerned that she might have the same condition. Urine pregnancy test is positive. If this patient is prescribed phenytoin, during which of the following weeks is the fetus most sensitive to its side effects?? {'A': 'Weeks 1-2', 'B': 'Weeks 3-8', 'C': 'Weeks 10-12', 'D': 'Week 14', 'E': 'Week 18'},
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B: Weeks 3-8
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Answer the following medical question with one of the provided options:
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Q:A 59-year-old man comes to the physician because of a 1-year history of progressive shortness of breath and nonproductive cough. Pulmonary examination shows bibasilar inspiratory crackles. An x-ray of the chest shows multiple nodular opacities in the upper lobes and calcified hilar nodules. Pulmonary functions tests show an FEV1:FVC ratio of 80% and a severely decreased diffusing capacity for carbon monoxide. A biopsy specimen of a lung nodule shows weakly birefringent needles surrounded by concentric layers of hyalinized collagen. The patient has most likely been exposed to which of the following?? {'A': 'Beryllium', 'B': 'Crystalline silica', 'C': 'Moldy hay', 'D': 'Carbon dust', 'E': 'Asbestos fibers'},
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B: Crystalline silica
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Answer the following medical question with one of the provided options:
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Q:A 22-year-old man is brought to the emergency department after he was impaled by a metal rod during a work accident. The rod went into his back around the level of T9 but was removed before arrival. He has no past medical history and does not take any medications. On physical examination, he has significant muscle weakness in his entire left lower body. He also exhibits impaired vibration and proprioception in his left leg as well as loss of pain and temperature sensation in his right leg. Which of the following sections of the spinal cord was most likely damaged in this patient?? {'A': 'Anterior cord', 'B': 'Central cord', 'C': 'Left hemicord', 'D': 'Posterior cord', 'E': 'Right hemicord'},
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C: Left hemicord
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Answer the following medical question with one of the provided options:
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Q:A 62-year-old woman comes to the physician for evaluation of a mole on her forearm that has increased in size over the last several months. Physical examination shows a 9-mm skin lesion on the right forearm with irregular borders. An excisional biopsy is performed, and genetic analysis shows a mutation in the gene that encodes B-Raf. Which of the following cellular events most likely predisposed this patient to developing this skin lesion?? {'A': 'Double-strand breaks in DNA molecules', 'B': 'Insufficient phosphorylation of p53', 'C': 'Relocation of a chromosomal segment onto a nonhomologous chromosome', 'D': 'Formation of covalent bonds between adjacent pyrimidine bases', 'E': 'Deamination of cytosine, guanine, and adenine nucleotides'},
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D: Formation of covalent bonds between adjacent pyrimidine bases
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Answer the following medical question with one of the provided options:
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Q:A 13-year-old girl presents with a 4-week history of unrelenting cough, night sweats, and fever. No known past medical history and no current medications. The patient recently immigrated to the country from a rural town in northern India. Vaccination status is unknown. Her temperature is 38.5°C (101.3°F), pulse is 115/min, blood pressure is 95/65 mm Hg, and respiratory rate is 22/min. Physical examination is significant for decreased breath sounds in the right upper lobe and multiple right cervical lymphadenopathies. A chest radiograph reveals multiple cavitations in the right upper lobe and right hilar lymphadenopathy. A sputum culture shows acid-fast bacilli. Which of the following compounds must be included in addition to the recommended antimicrobial therapy in this patient?? {'A': 'Thiamine', 'B': 'Riboflavin', 'C': 'Pyridoxine', 'D': 'Niacin', 'E': 'Folic acid'},
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C: Pyridoxine
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Q:A 59-year-old man presents to the emergency department with diffuse abdominal pain, nausea, and vomiting. Laboratory evaluation of admission is significant for serum glucose of 2410 mg/dL, AST of 321 IU/dL, and leukocytes of 21,200 /mL. Within 3 days of admission with supportive care in the intensive care unit, the patient’s clinical condition begins to improve. Based on Ranson’s criteria, what is this patient’s overall risk of mortality, assuming all other relevant factors are negative.? {'A': '< 10%', 'B': '15%', 'C': '40%', 'D': '80%', 'E': '100%'},
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B: 15%
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Q:A 3-year-old boy is brought to the physician because of recurrent nosebleeds and fatigue for the past 2 months. He also frequently complains his head hurts. The patient has met all motoric milestones for his age but does not like to run because his legs start to hurt if he does. He is at the 40th percentile for both height and weight. His temperature is 37.0°C (98.6°F), pulse is 125/min, respirations are 32/min, and blood pressure in the right arm is 130/85 mm Hg. A grade 2/6 systolic murmur is heard in the left paravertebral region. Further evaluation of this patient is most likely to show which of the following findings?? {'A': 'Inferior rib notching', 'B': 'Interarm difference in tissue oxygenation', 'C': 'Pulmonary valve stenosis', 'D': 'Left-axis deviation on ECG', 'E': 'Delayed pulse in lower extremities'},
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E: Delayed pulse in lower extremities
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Q:A gastroenterology fellow is interested in the relationship between smoking and incidence of Barrett esophagus. At a departmental grand rounds she recently attended, one of the presenters claimed that smokers are only at increased risk for Barrett esophagus in the presence of acid reflux. She decides to design a retrospective cohort study to investigate the association between smoking and Barrett esophagus. After comparing 400 smokers to 400 non-smokers identified via chart review, she finds that smokers were at increased risk of Barrett esophagus at the end of a 10-year follow-up period (RR = 1.82, p < 0.001). Among patients with a history of acid reflux, there was no relationship between smoking and Barrett esophagus (p = 0.52). Likewise, no relationship was found between smoking and Barrett esophagus among patients without a history of acid reflux (p = 0.48). The results of this study are best explained by which of the following?? {'A': 'Random error', 'B': 'Effect modification', 'C': 'Confounding', 'D': 'Stratification', 'E': 'Matching'},
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C: Confounding
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Q:An investigator is studying the interaction between a new drug B and an existing drug A. The results are recorded and plotted on the graph shown. Which of the following properties of drug B best explain the observed effect on the dose-response curve of drug A?? {'A': 'Non-competitive antagonist', 'B': 'Competitive antagonist', 'C': 'Inverse agonist', 'D': 'Functional antagonist', 'E': 'Full agonist'},
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B: Competitive antagonist
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Q:A 30-year-old woman, gravida 2, para 1, at 38 weeks' gestation comes to the hospital for regular, painful contractions that have been increasing in frequency. Her pregnancy has been complicated by gestational diabetes treated with insulin. Pelvic examination shows the cervix is 50% effaced and 4 cm dilated; the vertex is at -1 station. Ultrasonography shows no abnormalities. A tocometer and Doppler fetal heart monitor are placed on the patient's abdomen. The fetal heart rate monitoring strip shows a baseline heart rate of 145/min with a variability of ≥ 15/min. Within a 20-minute recording, there are 7 uterine contractions, 4 accelerations, and 3 decelerations that have a nadir occurring within half a minute. The decelerations occur at differing intervals relative to the contractions. Which of the following is the most appropriate next step in the management of this patient?? {'A': 'Routine monitoring', 'B': 'Vibroacoustic stimulation', 'C': 'Placement of fetal scalp electrode', 'D': 'Emergent cesarean delivery', 'E': 'Administer tocolytics'},
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A: Routine monitoring
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Q:A 6-week-old boy is brought for routine examination at his pediatrician’s office. The patient was born at 39 weeks to a 26-year-old G1P1 mother by normal vaginal delivery. External cephalic version was performed successfully at 37 weeks for breech presentation. Pregnancy was complicated by gestational diabetes that was well-controlled with insulin. The patient’s maternal grandmother has early onset osteoporosis. On physical examination, the left hip dislocates posteriorly with adduction and depression of a flexed femur. An ultrasound is obtained that reveals left acetabular dysplasia and a dislocated left femur. Which of the following is the next best step in management?? {'A': 'Closed reduction and spica casting', 'B': 'Observation', 'C': 'Open reduction and femoral osteotomy', 'D': 'Pavlik harness', 'E': 'Physiotherapy'},
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D: Pavlik harness
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Q:A 25-year-old woman presents to the emergency department for the evaluation of a severe abdominal pain of 5 hours duration. The pain is colicky but is not localized. She also complains of nausea and an episode of vomiting. For the past 2 days, she has been constipated. She has had similar episodes of varying intensity in the past that resolved over a few hours. Several laboratory tests and imaging studies have been conducted in the past which were all within normal limits. The medical history is otherwise unremarkable. She denies smoking cigarettes or drinking alcohol. The vital signs are as follows: pulse 100/min, respiratory rate 16/min, and blood pressure 138/84 mm Hg. The physical examination reveals a young woman in obvious distress. There is no tenderness on abdominal examination. Laboratory tests are ordered, analgesics are administered, and the patient was admitted overnight for observation. In the morning, a urine sample was shown to have darkened overnight. Abnormal levels of which of the following most likely led to this patient’s condition?? {'A': 'Aminolevulinic acid dehydratase', 'B': 'Coproporphyrinogen oxidase', 'C': 'Porphobilinogen deaminase', 'D': 'Uroporphyrinogen III synthase', 'E': 'Uroporphyrinogen decarboxylase'},
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C: Porphobilinogen deaminase
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Q:A 59-year-old woman comes to the physician for a routine health maintenance examination. She feels well. She has systemic lupus erythematosus and hypertension. She does not drink alcohol. Her current medications include lisinopril and hydroxychloroquine. She appears malnourished. Her vital signs are within normal limits. Examination shows a soft, nontender abdomen. There is no ascites or hepatosplenomegaly. Serum studies show: Total bilirubin 1.2 mg/dL Alkaline phosphatase 60 U/L Alanine aminotransferase 456 U/L Aspartate aminotransferase 145 U/L Hepatitis A IgM antibody negative Hepatitis A IgG antibody positive Hepatitis B surface antigen positive Hepatitis B surface antibody negative Hepatitis B envelope antigen positive Hepatitis B envelope antibody negative Hepatitis B core antigen IgM antibody negative Hepatitis B core antigen IgG antibody positive Hepatitis C antibody negative Which of the following is the most appropriate treatment for this patient?"? {'A': 'Pegylated interferon alpha therapy', 'B': 'Lamivudine therapy', 'C': 'Tenofovir therapy', 'D': 'Referral to a liver transplantation center', 'E': 'Reassurance and follow-up'},
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C: Tenofovir therapy
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Q:A 71-year-old man is brought in by his daughter for forgetfulness. The daughter finds herself repeating things she has already told him. She also reports that the patient recently missed a lunch date they had scheduled. She is worried that he may have Alzheimer's disease because her mother had it, and this is how it started. The patient states that he sometimes forgets where he puts his glasses, but this is not new. He also admits to missing appointments if he doesn't write them in his planner, but he states “I always remember birthdays.” Since his wife passed, the patient has been responsible for all the finances, and the daughter confirms that he pays the bills on time. He cooks for himself, though sometimes he is “lazy” and will order fast food. The patient’s medical history is significant for hypertension, atherosclerosis, and rheumatoid arthritis. His medications include aspirin, lisinopril, atorvastatin, and methotrexate. He was also treated for depression for the first year following his wife's death, which was 3 years ago. He currently denies feelings of depression or suicidal ideation, but admits that he has been thinking more about death since some of his weekly golfing buddies have passed away. He drinks a beer every night with dinner and smokes cigars socially. A physical examination reveals ulnar deviation of the fingers, decreased grip strength, and a slow, steady gait. The patient is able to spell a 5-letter word backwards and remembers 3/3 items after 5 minutes. Which of the following diagnoses most likely explains the patient’s symptoms?? {'A': 'Alzheimer disease', 'B': 'Frontotemporal dementia', 'C': 'Major depressive disorder', 'D': 'Normal aging', 'E': 'Vascular dementia'},
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D: Normal aging
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Q:A 4700-g (10.3-lb) male newborn is delivered at 37 weeks' gestation to a 30-year-old woman, gravida 2, para 1. Apgar scores are 7 and 8 at 1 and 5 minutes, respectively. The newborn appears pale. Temperature is 37°C (98.6°F), pulse is 180/min, and blood pressure is 90/60 mm Hg. Examination in the delivery room shows midfacial hypoplasia, infraorbital creases, and a large tongue. The right side of the body is larger than the left. Abdominal examination shows that the abdominal viscera protrudes through the abdominal wall at the umbilicus; the viscera are covered by the amniotic membrane and the peritoneum. The liver is palpated 2–3 cm below the right costal margin. Fingerstick blood glucose concentration is 60 mg/dL. Ultrasonography of the abdomen shows enlarged kidneys bilaterally. In addition to surgical closure of the abdominal wall, which of the following is the most appropriate next step in management?? {'A': 'Serum IGF-1 measurement', 'B': 'Serum TSH measurement', 'C': 'Serum 17-hydroxyprogesterone measurement', 'D': 'Cranial MRI', 'E': 'Serial abdominal ultrasonography'},
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E: Serial abdominal ultrasonography
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Q:A 7-year-old girl presents for a follow-up visit after recent discharge from the hospital. She was admitted about 4 months ago for symptoms of seizures, altered mental status, and fever. She was diagnosed during that admission with herpes encephalitis and recovered well after being treated with acyclovir. However, at this visit, her parents complain of some “strange behaviors” that have developed over the past several weeks. For example, she seems to be snacking uncontrollably and eats significantly more than she did before. Her teacher has also sent home notes stating that she has been chewing on art supplies such as crayons and glue and that she has been sent to the principal twice for rubbing her genitals inappropriately during class. The pediatric neurologist decides to get a follow-up MRI. Which of the following parts of the brain is most likely to have abnormal findings?? {'A': 'Substantia nigra', 'B': 'Hippocampus', 'C': 'Lateral geniculate nucleus', 'D': 'Amygdala', 'E': 'Brainstem'},
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D: Amygdala
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Q:A 32-year-old woman with a recurrent vesicular genital rash comes to the physician because of a 3-day history of a painful, pruritic rash that began on the extremities and has spread to her trunk. Her only medication is acyclovir. Her temperature is 38.1°C (100.6°F). Examination of the skin shows several reddish-purple papules and macules, some of which have a dusky center with a lighter ring around them. Which of the following is the most likely diagnosis?? {'A': 'Eczema herpeticum', 'B': 'Erythema multiforme', 'C': 'Urticaria', 'D': 'Stevens-Johnson syndrome', 'E': 'Dermatitis herpetiformis'},
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B: Erythema multiforme
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Q:A 13-year-old male is admitted to the hospital for treatment of acute lymphoblastic leukemia. During his hospital course, he develops a fever of 39.0 degrees Celsius. A CBC demonstrates a leukocyte count of <500 /mm^3. Which of the following is the most appropriate initial management of this patient?? {'A': 'Granulocyte colony-stimulating factor (G-CSF)', 'B': 'IV ceftazidime', 'C': 'Oral doxycycline', 'D': 'Oral ciprofloxacin and amoxicillin/clavulanic acid', 'E': 'Strict quarantine and hand-washing'},
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B: IV ceftazidime
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Q:A 25-year-old woman presents with a history of recurrent attacks of unprovoked fear, palpitations, and fainting. The attacks are usually triggered by entering a crowded place or public transport, so the patient tries to avoid being in public places alone. Besides this, she complains of difficulties in falling asleep, uncontrolled worry about her job and health, fear to lose the trust of her friends, and poor appetite. She enjoys dancing and has not lost a passion for her hobby, but recently when she participated in a local competition, she had an attack which made her stop her performance until she calmed down and her condition improved. She feels upset due to her condition. She works as a sales manager and describes her work as demanding with multiple deadlines to be met. She recently broke up with her boyfriend. She does not report any chronic medical problems, but she sometimes takes doxylamine to fall asleep. She has a 4-pack-year history of smoking and drinks alcohol occasionally. On presentation, her blood pressure is 110/60 mm Hg, heart rate is 71/min, respiratory rate is 13/min, and temperature is 36.5°C (97.7°F). Her physical examination is unremarkable. Which of the following medications can be used for the acute management of the patient’s attacks?? {'A': 'Bupropion', 'B': 'Metoprolol', 'C': 'Clonazepam', 'D': 'Imipramine', 'E': 'Nifedipine'},
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C: Clonazepam
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Q:Two weeks after undergoing low anterior resection for rectal cancer, a 52-year-old man comes to the physician because of swelling in both feet. He has not had any fever, chills, or shortness of breath. His temperature is 36°C (96.8°F) and pulse is 88/min. Physical examination shows a normal thyroid and no jugular venous distention. Examination of the lower extremities shows bilateral non-pitting edema that extends from the feet to the lower thigh, with deep flexion creases. His skin is warm and dry, and there is no erythema or rash. Microscopic examination of the interstitial space in this patient's lower extremities would be most likely to show the presence of which of the following?? {'A': 'Acellular, protein-poor fluid', 'B': 'Lymphocytic, hemosiderin-rich fluid', 'C': 'Lipid-rich, protein-rich fluid', 'D': 'Protein-rich, glycosaminoglycan-rich fluid', 'E': 'Neutrophilic, protein-rich fluid'},
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C: Lipid-rich, protein-rich fluid
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Q:A 6-year-old girl presents to the clinic for a general checkup before her last scheduled DTaP vaccination. Her mother is concerned about mild swelling and redness at the site of injection after her daughter’s previous DTaP administration. The patient has mild spastic cerebral palsy. She was diagnosed with epilepsy at the age of 5, and it is well-controlled with levetiracetam. She is allergic to penicillin. Currently, she complains of malaise and mild breathlessness. The mother noted that her daughter has been sluggish for the last 3 days. Her vital signs are as follows: the blood pressure is 100/60 mm Hg, the heart rate is 90/min, the respiratory rate is 22/min, and the temperature is 38.8°C (101.8°F). On physical examination, the patient has slightly enlarged submandibular lymph nodes bilaterally and oropharyngeal erythema. On auscultation, there are diminished vesicular breath sounds with a few respiratory crackles over the lower lobe of the left lung. Which of the following factors requires delaying the patient’s vaccination?? {'A': 'Cerebral palsy', 'B': 'Epilepsy', 'C': 'Mild swelling and redness at the site of injection after the previous vaccine administration', 'D': 'Signs of pneumonia', 'E': 'Penicillin allergy'},
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D: Signs of pneumonia
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Q:A 25-year-old woman whose menses are 2 weeks late, presents to her physician for evaluation. She also complains of fatigue, morning nausea, and mood changes. She is a nulliparous with previously normal menstrual cycles and no known medical conditions. She had an intrauterine device (IUD) placed 6 months ago. The patient’s vital signs are as follows: blood pressure 120/80 mm Hg, heart rate 72/min, respiratory rate 12/min, and temperature 36.5℃ (97.7℉). The physical examination is unremarkable. The gynecologic exam revealed cervical cyanosis and softening, uterine enlargement, and non-palpable adnexa. A transvaginal ultrasound examination is performed to check the IUD position. Ultrasonography revealed 2 uterine cavities; one cavity had a gestational sac and the intrauterine device was in the other uterine cavity. The cavities are fully separated but there is one cervix. What is the most likely etiology of this patient’s condition?? {'A': 'Failure of the Wolffian duct regression', 'B': 'Incomplete Mullerian ducts fusion', 'C': 'Mullerian ducts duplication', 'D': 'Cloacal membrane duplication', 'E': 'Failure of fusion of the sex cords'},
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B: Incomplete Mullerian ducts fusion
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Q:A 28-year-old woman comes to the physician because of a two-month history of fatigue and low-grade fevers. Over the past 4 weeks, she has had increasing shortness of breath, a productive cough, and a 5.4-kg (11.9-lb) weight loss. Three months ago, the patient returned from a two-month trip to China. The patient appears thin. Her temperature is 37.9°C (100.2°F), pulse is 75/min, and blood pressure is 125/70 mm Hg. Examination shows lymphadenopathy of the anterior and posterior cervical chain. Rales are heard at the left lower lobe of the lung on auscultation. Laboratory studies show a leukocyte count of 11,300/mm3 and an erythrocyte sedimentation rate of 90 mm/h. An x-ray of the chest shows a patchy infiltrate in the left lower lobe and ipsilateral hilar enlargement. Microscopic examination of the sputum reveals acid-fast bacilli; polymerase chain reaction is positive. Sputum cultures are pending. After placing the patient in an airborne infection isolation room, which of the following is the most appropriate next step in management?? {'A': 'Await culture results before initiating treatment', 'B': 'Perform interferon-γ release assay', 'C': 'Obtain CT scan of the chest', 'D': 'Administer only isoniazid for 9 months', 'E': 'Administer isoniazid, rifampin, pyrazinamide, and ethambutol for 2 months, followed by isoniazid and rifampin for 4 months'},
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E: Administer isoniazid, rifampin, pyrazinamide, and ethambutol for 2 months, followed by isoniazid and rifampin for 4 months
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Q:A 7-year-old child is brought to the emergency room by his parents in severe pain. They state that he fell on his outstretched right arm while playing with his friends. He is unable to move his right arm which is being supported by his left. On exam, his vitals are normal. His right extremity reveals normal pulses without swelling in any compartments, but there is crepitus above the elbow upon movement. The child is able to flex and extend his wrist, but this is limited by pain. The child has decreased sensation along his thumb and is unable to make the "OK" sign with his thumb and index finger. What is the most likely diagnosis?? {'A': 'Midhumerus fracture', 'B': 'Scaphoid fracture', 'C': 'Distal radius fracture', 'D': 'Distal ulnar fracture', 'E': 'Supracondular humerus fracture'},
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E: Supracondular humerus fracture
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Q:A 14-month-old Caucasian boy is admitted to the pediatric clinic with an 8-month history of diarrhea, abdominal tenderness and concomitant failure to thrive. One of the possibilities that may cause these symptoms is Crohn’s disease, and on the basis of the attending pediatrician’s experience, the pre-test probability of this diagnosis was estimated at 40%. According to Fagan’s diagram (picture), if the likelihood ratio of a negative test result (LR-) is 0.04, what is the chance that this is the right diagnosis?? {'A': '2.5%', 'B': '25%', 'C': '40%', 'D': '75%', 'E': '97.5%'},
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A: 2.5%
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Q:A 5-week-old male infant is brought to the physician by his mother because of a 4-day history of recurrent nonbilious vomiting after feeding. He was born at 36 weeks' gestation via spontaneous vaginal delivery. Vital signs are within normal limits. Physical examination shows a 2-cm epigastric mass. Further diagnostic evaluation of this patient is most likely to show which of the following?? {'A': 'High serum 17-hydroxyprogesterone concentration', 'B': 'Dilated colon segment on abdominal x-ray', 'C': 'Double bubble sign on abdominal x-ray', 'D': 'Elongated and thickened pylorus on abdominal ultrasound', 'E': 'Corkscrew sign on upper gastrointestinal contrast series\n"'},
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D: Elongated and thickened pylorus on abdominal ultrasound
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Q:A 42-year-old woman presents to the emergency department with pain in her abdomen. She was eating dinner when her symptoms began. Upon presentation, her symptoms have resolved. She has a past medical history of type II diabetes mellitus, hypertension, heavy menses, morbid obesity, and constipation. Her current medications include atorvastatin, lisinopril, insulin, metformin, aspirin, ibuprofen, and oral contraceptive pills. She has presented to the ED for similar complaints in the past. Her temperature is 98.1°F (36.7°C), blood pressure is 160/97 mmHg, pulse is 84/min, respirations are 15/min, and oxygen saturation is 98% on room air. Physical exam and abdominal exam are unremarkable. The patient is notably obese and weighs 315 pounds. Cardiac and pulmonary exams are within normal limits. Which of the following is the best prophylactic measure for this patient?? {'A': 'Antibiotics, IV fluids, and NPO', 'B': 'Gastric bypass surgery', 'C': 'Ibuprofen', 'D': 'Strict diet and rapid weight loss in the next month', 'E': 'Ursodeoxycholic acid'},
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E: Ursodeoxycholic acid
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Q:A 21-year-old man is admitted to the intensive care unit for respiratory failure requiring mechanical ventilation. His minute ventilation is calculated to be 7.0 L/min, and his alveolar ventilation is calculated to be 5.1 L/min. Which of the following is most likely to decrease the difference between minute ventilation and alveolar ventilation?? {'A': 'Increasing the respiratory rate', 'B': 'Increasing the partial pressure of inhaled oxygen', 'C': 'Decreasing the physiologic dead space', 'D': 'Decreasing the affinity of hemoglobin for oxygen', 'E': 'Increasing the respiratory depth'},
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C: Decreasing the physiologic dead space
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Answer the following medical question with one of the provided options:
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Q:A 70-year-old man presents to a physician with a cough and difficulty breathing during the last 7 years. He has smoked since his teenage years and regularly inhales tiotropium, formoterol, and budesonide and takes oral theophylline. The number of exacerbations has been increasing over the last 6 months. His temperature is 37.2°C (99°F), the heart rate is 92/min, the blood pressure is 134/88 mm Hg and the respiratory rate is 26/min. On chest auscultation breath sounds are diffusely decreased and bilateral rhonchi are present. Pulse oximetry shows his resting oxygen saturation to be 88%. Chest radiogram shows a flattened diaphragm, hyperlucency of the lungs, and a long, narrow heart shadow. The physician explains this condition to the patient and emphasizes the importance of smoking cessation. In addition to this, which of the following is most likely to reduce the risk of mortality from the condition?? {'A': 'Low-dose oral prednisone', 'B': 'Prophylactic azithromycin', 'C': 'Roflumilast', 'D': 'Pulmonary rehabilitation', 'E': 'Supplemental oxygen'},
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E: Supplemental oxygen
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Q:A 12-year-old boy presents to the emergency department with a recent history of easy bleeding. He experienced multiple episodes of epistaxis and bleeding gums over the past two days. He also had flu-like symptoms a week ago which resolved over the past few days. His past medical history is notable for well-controlled asthma. His temperature is 98.9°F (37°C). Physical examination is notable for a petechial rash. No splenomegaly is noted. A coagulation panel reveals an elevation in bleeding time with normal PT and PTT. The blood component that is most likely deficient in this patient contains granules of which of the following?? {'A': 'von Willebrand factor', 'B': 'Myeloperoxidase', 'C': 'Heparin', 'D': 'Major basic protein', 'E': 'Tryptase'},
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A: von Willebrand factor
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Q:An 8-year-old boy is brought to the emergency department because of a 4-day history of severe, left-sided ear pain and purulent discharge from his left ear. One week ago, he returned with his family from their annual summer vacation at a lakeside cabin, where he spent most of the time outdoors hiking and swimming. Examination shows tragal tenderness and a markedly edematous and erythematous external auditory canal. Audiometry shows conductive hearing loss of the left ear. Which of the following is the most likely cause of this patient's symptoms?? {'A': 'Abnormal epithelial growth on tympanic membrane', 'B': 'Infection with Aspergillus species', 'C': 'Infection with varicella zoster virus', 'D': 'Pleomorphic replacement of normal bone', 'E': 'Infection with Pseudomonas aeruginosa\n"'},
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E: Infection with Pseudomonas aeruginosa "
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Q:A 49-year-old man with a past medical history of hypertension on amlodipine presents to your office to discuss ways to lessen his risk of complications from heart disease. After a long discussion, he decides to significantly decrease his intake of trans fats in an attempt to lower his risk of coronary artery disease. Which type of prevention is this patient initiating?? {'A': 'Primary prevention', 'B': 'Secondary prevention', 'C': 'Tertiary prevention', 'D': 'Quaternary prevention', 'E': 'Delayed prevention'},
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A: Primary prevention
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Answer the following medical question with one of the provided options:
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Q:A 45-year-old man presents to the surgery clinic with an ulcer on his left heel, which he first noticed a week ago. He was surprised by the large size of the ulcer since because he had never noticed it before, and it was asymptomatic. The man also noticed fluid oozing out of the ulcer, which he has been wiping off with a clean cloth. He has had diabetes mellitus for the past 10 years and hypertension for the past 8 years. His medications include metformin and enalapril, although he tends to not take them as directed. His vital signs are normal. Examination of his left foot reveals a 3 cm x 3 cm ulcer with an irregular border and clear fluid over the base with erythema in the surrounding skin. An image of the lesion is taken and shown below. Laboratory investigations reveal the following: Capillary blood glucose (CBG) 340 mg/dL Hemoglobin (Hb%) 9.8 mg/dL White blood cell count (WBC) 16,000/mm3 Erythrocyte sedimentation rate (ESR) 34 mm in the 1st hour The physician recommends wound debridement and prescribes an antibiotic for 1 week. The patient is also told to control his blood sugar by taking his medications regularly and paying better attention to his diet. He is also advised to change his dressing daily for the next 7 days. After 1 week, the patient’s ulcer begins to heal. Which of the following best describes the healing process of this patient’s lesion?? {'A': 'A greater volume of granulation tissue is formed during healing by secondary intention, which results in a larger scar followed by wound contraction.', 'B': 'During the process of healing, large tissue defects have a greater volume of necrotic debris, exudate, and fibrin that aids with healing.', 'C': 'During healing by secondary intention, a small scar is formed, with minimal wound contraction.', 'D': 'In this type of healing, the inflammatory reaction is not intense, and healing is completed within 2 weeks.', 'E': 'During healing by secondary intention, the narrow space is first filled with fibrin-clotted blood; granulation tissue is formed later and covered by new epithelium.'},
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A: A greater volume of granulation tissue is formed during healing by secondary intention, which results in a larger scar followed by wound contraction.
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Q:An otherwise healthy 57-year-old man presents to the emergency department because of progressive shortness of breath and exercise intolerance for the past 5 days. He denies recent travel or illicit habits. His temperature is 36.7°C (98.1°F), the blood pressure is 88/57 mm Hg, and the pulse is 102/min. The radial pulse becomes so weak with inspiration. Physical examination reveals bilateral 1+ pedal edema. There is jugular venous distention at 13 cm and muffled heart sounds. Transthoracic echocardiogram shows reciprocal respiratory ventricular inflow and ventricular diastolic collapse. Which of the following is the best next step in the management of this patient condition?? {'A': 'Cardiac catheterization', 'B': 'Pericardiectomy', 'C': 'Pericardial drainage', 'D': 'Chest X-ray', 'E': 'Cardiac MRI'},
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C: Pericardial drainage
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Q:A 29-year-old woman presents with a 2-hour history of sudden onset of severe mid-epigastric pain. The pain radiates to the back, and is not relieved by over-the-counter antacids. The patient also complains of profuse vomiting. The patient’s medical history is negative for similar symptoms. She consumes 3–4 alcoholic drinks daily. The blood pressure is 80/40 mm Hg and the heart rate is 105/min. Examination of the lungs reveals bibasilar crackles. Abdominal examination reveals diffuse tenderness involving the entire abdomen, marked guarding, rigidity, and reduced bowel sounds. The chest X-ray is normal. However, the abdominal CT scan reveals peritoneal fluid collection and diffuse pancreatic enlargement. The laboratory findings include: Aspartate aminotransferase 63 IU/L Alkaline phosphatase 204 IU/L Alanine aminotransferase 32 IU/L Serum amylase 500 IU/L (Normal: 25-125 IU/L) Serum lipase 1,140 IU/L (Normal: 0-160 IU/L) Serum calcium 2 mmol/L Which of the following cellular changes are most likely, based on the clinical and laboratory findings?? {'A': 'Coagulative necrosis', 'B': 'Fat necrosis', 'C': 'Caseous necrosis', 'D': 'Dry gangrene', 'E': 'Colliquative necrosis'},
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B: Fat necrosis
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Q:A 75-year-old woman comes to the physician because of a 6-month history of fatigue. During this period, she has had fever, pain in both shoulders and her hips, and a 5-kg (11-lb) weight loss. She also reports feeling stiff for about an hour after waking up. She has a history of hypertension and hypercholesterolemia. There is no family history of serious illness. She has smoked a pack of cigarettes daily for the past 50 years. Her medications include hydrochlorothiazide and atorvastatin. She appears pale. Her temperature is 38°C (100.4°F), pulse is 90/min, and blood pressure is 135/85 mm Hg. Range of motion of the shoulders and hips is reduced due to pain. Examination shows full muscle strength. The remainder of the examination shows no abnormalities. Laboratory studies show an erythrocyte sedimentation rate of 50 mm/h and a C-reactive protein concentration of 25 mg/dL (N=0–10 mg/dL). Which of the following is the most appropriate next step in management?? {'A': 'Muscle biopsy', 'B': 'Low-dose of oral prednisone', 'C': 'Electromyography', 'D': 'Chest x-ray', 'E': 'Antibody screening'},
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B: Low-dose of oral prednisone
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Q:A 61-year-old man with a history of type 1 diabetes mellitus and depression is brought to the emergency department because of increasing confusion and fever over the past 14 hours. Four days ago, he was prescribed metoclopramide by his physician for the treatment of diabetic gastroparesis. His other medications include insulin and paroxetine. His temperature is 39.9°C (103.8°F), pulse is 118/min, and blood pressure is 165/95 mm Hg. Physical examination shows profuse diaphoresis and flushed skin. There is generalized muscle rigidity and decreased deep tendon reflexes. His serum creatine kinase is 1250 U/L. Which of the following drugs is most likely to also cause this patient's current condition?? {'A': 'Nortriptyline', 'B': 'Desflurane', 'C': 'Fluphenazine', 'D': 'Methamphetamine', 'E': 'Tranylcypromine'},
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C: Fluphenazine
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Q:A 38-year-old woman presents to her primary care physician for complaints of insomnia. She states that for the last 8 months, she has had difficultly falling asleep. Additionally, she awakens in the middle of the night or early morning and cannot fall back to sleep. When further questioned, she reports decreased appetite with a 12-lb. weight loss in the last 6 months. She was recently demoted at her work as a baker due to trouble focusing and coordinating orders and excess fatigue. She feels she is to blame for her families current financial status given her demotion. She is given a prescription for fluoxetine at this visit with follow-up 2 weeks later. At the follow-up visit, she reports no improvement in her symptoms despite taking her medication consistently. What is the most appropriate next step in management?? {'A': 'Add lithium', 'B': 'Continue current medication', 'C': 'Increase dose of current medication', 'D': 'Switch to bupropion', 'E': 'Switch to paroxetine'},
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B: Continue current medication
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Q:The lac operon allows E. coli to effectively utilize lactose when it is available, and not to produce unnecessary proteins. Which of the following genes is constitutively expressed and results in the repression of the lac operon?? {'A': 'LacI', 'B': 'LacZ', 'C': 'LacY', 'D': 'LacA', 'E': 'CAP'},
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A: LacI
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Q:A 64-year-old female presents to her primary care physician for an annual checkup. She states that her health is adequate, but she has not been doing well since her husband died last year. She is able to get by but admits to having trouble caring for herself, cooking, cleaning, and paying her bills. The patient complains of diffuse muscle aches and pains. She has a past medical history of anxiety and seasonal affective disorder. She is not currently taking any medications. On physical exam, you note a gaunt woman with a depressed affect. You note that her body mass index (BMI) and height have both decreased since her last annual visit. On physical exam, her cardiac, pulmonary, and abdominal exams are within normal limits. Lab work is drawn and is as follows: Serum: Na+: 135 mEq/L K+: 3.7 mEq/L Cl-: 100 mEq/L HCO3-: 23 mEq/L Urea nitrogen: 7 mg/dL Glucose: 70 mg/dL Creatinine: 0.8 mg/dL Ca2+: 8.0 mg/dL Mg2+: 1.5 mEq/L Parathyroid hormone: 855 pg/mL Alkaline phosphatase: 135 U/L Phosphorus: 2.6 mg/dL Hemoglobin: 14 g/dL Hematocrit: 36% Platelet count: 187,000/mm^3 Leukocyte count: 4,700/mm^3 What is the most likely diagnosis?? {'A': 'Osteopenia', 'B': 'Osteoporosis', 'C': 'Osteomalacia', 'D': 'Hyperparathyroidism', 'E': 'Clinical malnutrition'},
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C: Osteomalacia
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Q:A 14-year-old girl is referred to a gynecologist for amenorrhea. Her mother is also concerned that she hasn't grown any hair "in her private parts." The patient states that she is getting used to high school and wants to join the volleyball team but complains that her weakness and headaches limit her physical activity. She does not share her mother's concerns about her menses. She reveals that her parents are maternal cousins. Her temperature is 98°F (37°C), blood pressure is 160/90 mmHg, pulse is 70/min, and respirations are 24/min. Her cardiac exam is unremarkable, and her abdominal exam reveals no bruits. After obtaining permission for a pelvic exam, the exam reveals a normal appearing vagina without any hair. No cervical os can be palpated. Initial labs reveal the following: Serum: Na+: 143 mEq/L Cl-: 110 mEq/L K+: 2.9 mEq/L HCO3-: 26 mEq/L BUN: 40 mg/dL Glucose: 104 mg/dL Creatinine: 1.3 mg/dL What is the most likely diagnosis?? {'A': '3-beta-hydroxysteroid dehydrogenase deficiency', 'B': '5-alpha reductase deficiency', 'C': '11-beta-hydroxylase deficiency', 'D': '17-alpha-hydroxylase deficiency', 'E': '21-alpha-hydroxylase deficiency'},
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D: 17-alpha-hydroxylase deficiency
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Q:A 60-year-old man who is a chronic smoker comes to the hospital with the chief complaint of shortness of breath which has worsened over the past 2 days. He also has a productive cough with yellowish sputum. There is no history of hemoptysis, chest pain, fever, palpitations, or leg swelling. He had a viral illness one week ago. He has been using an inhaler for 10 years for his respiratory disease. He sleeps with 2 pillows every night. He received 100 mg of hydrocortisone and antibiotics in the emergency department, and his symptoms have subsided. His FEV1/FVC ratio is < 0.70, and FEV1 is 40% of predicted. What is the most likely finding that can be discovered from the histology of his bronchioles?? {'A': 'Curschmann spirals', 'B': 'Charcot-Leyden crystals', 'C': 'Increase Reid index', 'D': 'Ferruginous bodies', 'E': 'Non-caseating granuloma'},
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C: Increase Reid index
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Q:A 65-year-old man comes to the physician because of a 6-month history of progressive fatigue and abdominal pain. Physical examination shows pale mucous membranes and splenomegaly. Hemoglobin concentration is 9.1 g/dL and leukocyte count is 3,400/mm3. Peripheral blood smear shows nucleated red blood cells and teardrop poikilocytosis. A Janus kinase 2 gene mutation is present. Which of the following is the most likely underlying mechanism of this patient's condition?? {'A': 'Viral replication in lymphoid cells', 'B': 'Lymphocytic infiltration of reticuloendothelial system', 'C': 'Fibrosis in the bone marrow', 'D': 'Translocation between chromosome 9 and 22', 'E': 'Elevated levels of circulating hepcidin'},
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C: Fibrosis in the bone marrow
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Q:A 72-year-old man is admitted to the hospital with a productive cough and fever. A chest radiograph is obtained and shows a lobar consolidation. The patient is diagnosed with pneumonia. He has a history of a penicillin and cephalosporin allergy. The attending physician orders IV levofloxacin as empiric therapy. On morning rounds the next day, the team discovers that the patient was administered ceftriaxone instead of levofloxacin. The patient has already received a full dose of ceftriaxone and had developed hives overnight which were treated with diphenhydramine. He is currently feeling better. Which of the following is the most appropriate next step in management?? {'A': 'Continue with ceftriaxone and use diphenhydramine as needed', 'B': 'Desensitize the patient to ceftriaxone and continue treatment', 'C': 'Discuss the error that occurred with the patient', 'D': 'Inform the patient that nursing gave the wrong medication and it has been corrected', 'E': 'Switch the medication to levofloxacin'},
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C: Discuss the error that occurred with the patient
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Q:A 3-year-old girl is brought to her pediatrician with 2 days of fever and abdominal pain. She has also been crying and complaining of pain while urinating. She was born at term without incident and was previously healthy at regular checkups. On presentation, her temperature is 102.2°F (39°C), blood pressure is 137/85 mmHg, pulse is 122/min, and respirations are 24/min. Physical exam reveals a palpable, painless, abdominal mass that does not cross the midline. Which of the following additional findings would be associated with this patient's disorder?? {'A': '11;22 chromosome translocation', 'B': 'Aniridia', 'C': 'Ash leaf spots', 'D': 'Epstein-Barr virus', 'E': 'Opsoclonus myoclonus'},
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B: Aniridia
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Q:A 47-year-old woman presents with abnormal vaginal bleeding. She reports that she has had heavy, irregular periods for the past 6 months. Her periods, which normally occur every 28 days, are sometimes now only 2-3 weeks apart, last 7-10 days, and has spotting in between menses. Additionally, her breasts feel enlarged and tender. She denies abdominal pain, dysuria, dyspareunia, constipation, or abnormal vaginal discharge. The patient has a history of depression and hyperlipidemia. She takes fluoxetine and atorvastatin. She is a widow and has 2 healthy children. She works as an accountant. The patient says she drinks a half bottle of wine every night to help her calm down after work and to help her sleep. She denies tobacco or illicit drug use. She is not currently sexually active. Physical examination reveals spider angiomata and mild ascites. The left ovary is palpable but non-tender. A thickened endometrial stripe and a left ovarian mass are noted on ultrasound. A mammogram, chest radiograph, and CT abdomen/pelvis are pending. Which of the following tumor markers is associated with the patient’s most likely diagnosis?? {'A': 'Alpha-fetoprotein', 'B': 'Cancer antigen-125', 'C': 'Carcinoembryonic antigen', 'D': 'Estrogen', 'E': 'Testosterone'},
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D: Estrogen
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Q:A 52-year-old man is admitted directly from the clinic for a serum glucose of 980 mg/dL. He has had type 2 diabetes for 16 years, for which he was prescribed metformin and glimepiride; however, he reports not having followed his prescription due to its high cost. For the past 12 days, he has had excess urination, and has lost 6 kg in weight. He has also noted a progressively worsening cough productive of greenish-brown sputum for approximately 20 days. His temperature is 38.9°C (102.02°F), blood pressure is 97/62 mm Hg, pulse is 97/minute and respiratory rate is 26/minute. On physical examination, he is somnolent, his eyes are sunken, and there are crackles at the left lung base. Lab results are shown: Arterial pH: 7.33 Serum sodium: 130 mEq/L Serum potassium: 3 mEq/L Serum osmolality: 325 mOsm/kg Serum beta-hydroxybutyrate: negative Urinalysis: trace ketones Intravenous normal saline infusion is started. Which of the following is the best next step in this patient?? {'A': 'Starting regular insulin infusion', 'B': 'Adding potassium to the intravenous fluids', 'C': 'Adding dopamine infusion', 'D': 'Adding sodium bicarbonate infusion', 'E': 'Starting basal-bolus insulin'},
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B: Adding potassium to the intravenous fluids
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Q:A 45-year-old man is brought to the hospital by his daughter with complaints of wide-based gait. His daughter reveals that he was sitting silently in the examination chair with a blank face. In addition, he was frequently talking to the empty chairs and told that his friends are sitting there. He has been forgetting many small things recently. On physical examination, fine movements are seen at resting condition that disappears when he is asked to drink water. A stepwise slowness in movement is also seen in his upper limb. Which of the following is most likely to be observed in the histological specimen of this patient?? {'A': 'Tau protein aggregates in cortex', 'B': 'Lewy bodies in affected neurons', 'C': 'Spongiform changes in cortex', 'D': 'Cortical lewy bodies', 'E': 'Neuritic plaques in cortex'},
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D: Cortical lewy bodies
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Q:A 23-year-old Caucasian male presents to the emergency department with a persistent penile erection for the last 6 hours. He recently began outpatient treatment for depression with associated insomnia. He traveled to Mexico 5 months ago. His medical history is otherwise unremarkable. Which of the following is the most likely precipitating factor for priapism in this patient?? {'A': 'Depression treatment with bupropion', 'B': 'Depression treatment with venlafaxine', 'C': 'Depression treatment with trazodone', 'D': 'Sickle cell disease', 'E': 'Infection acquired in Mexico'},
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C: Depression treatment with trazodone
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Q:A 6-year-old boy is brought to the physician because of right hip pain that started that afternoon. His mother reports that he has also been limping since the pain developed. He says that the pain worsens when he moves or walks. He participated in a dance recital yesterday, but his mother believes that he was not injured at the time. He was born at term and has been healthy except for an episode of nasal congestion and mild cough 10 days ago. His mother has rheumatoid arthritis and his grandmother has osteoporosis. He is at the 50th percentile for height and 50th percentile for weight. His temperature is 37.5°C (99.6°F), pulse is 105/min, respirations are 16/min, and blood pressure is 90/78 mm Hg. His right hip is slightly abducted and externally rotated. Examination shows no tenderness, warmth, or erythema. He is able to bear weight. The remainder of the examination shows no abnormalities. Laboratory studies show a hemoglobin concentration of 12.3 g/dL, a leukocyte count of 8,500/mm3, and an erythrocyte sedimentation rate of 12 mm/h. Ultrasound of the right hip shows increased fluid within the joint. X-ray of the hips shows no abnormalities. Which of the following is the most likely diagnosis?? {'A': 'Slipped capital femoral epiphysis', 'B': 'Transient synovitis', 'C': 'Legg-Calve-Perthes disease', 'D': 'Developmental dysplasia of the hip', 'E': 'Osteomyelitis'},
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B: Transient synovitis
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Answer the following medical question with one of the provided options:
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Q:A 26-year-old gravida 1 at 36 weeks gestation is brought to the emergency department by her husband complaining of contractions lasting up to 2 minutes. The contractions are mostly in the front of her abdomen and do not radiate. The frequency and intensity of contractions have not changed since the onset. The patient worries that she is in labor. The blood pressure is 125/80 mm Hg, the heart rate is 96/min, the respiratory rate is 15/min, and the temperature 36.8°C (98.2℉). The physical examination is unremarkable. The estimated fetal weight is 3200 g (6.6 lb). The fetal heart rate is 146/min. The cervix is not dilated. The vertex is at the -4 station. Which of the following would be proper short-term management of this woman?? {'A': 'Admit to the Obstetrics Department in preparation for labor induction', 'B': 'Perform an ultrasound examination', 'C': 'Reassurance, hydration, and ambulation', 'D': 'Manage with terbutaline', 'E': 'Admit to the Obstetrics Department for observation'},
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C: Reassurance, hydration, and ambulation
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Q:A 12-year-old boy presents to the emergency department after falling from his bike. He is holding his right arm tenderly and complains of pain in his right wrist. When asked, he says that he fell after his front tire hit a rock and landed hard on his right hand. Upon physical examination he is found to have tenderness on the dorsal aspect of his wrist in between the extensor pollicis longus and the extensor pollicis brevis. Given this presentation, which of the following is the most likely bone to have been fractured?? {'A': 'Scaphoid', 'B': 'Lunate', 'C': 'Pisiform', 'D': 'Capitate', 'E': 'Trapezoid'},
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A: Scaphoid
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Q:A previously healthy 3-year-old boy is brought to the physician by his mother because of a headache, fever, and facial pain that started 10 days ago. The symptoms initially improved but have gotten significantly worse over the past 2 days. Immunizations are up-to-date. His temperature is 39.1°C (102.3°F). Physical examination shows tenderness to palpation over both cheeks. Gram stain of a nasal swab shows small, gram-negative coccobacilli. Which of the following most likely accounts for this patient's infection with the causal pathogen?? {'A': 'Causal pathogen produces phospholipase C', 'B': 'Host has hyperviscous secretions', 'C': 'Causal pathogen is unencapsulated', 'D': 'Causal pathogen expresses protein A', 'E': 'Host has impaired splenic opsonization\n"'},
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C: Causal pathogen is unencapsulated
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Q:A 58-year-old man is diagnosed with right lower lobe pneumonia and has been admitted to a tertiary care hospital. His laboratory investigations suggest that he acquired an infection from the hospital where he underwent an elective abdominal surgery 3 weeks ago. His past medical records reveal a history of deep vein thrombosis and pulmonary embolism one year prior. After a steady clinical improvement over 5 days of inpatient treatment, he develops a cough, breathlessness, and hemoptysis on the 6th day. His temperature is 38.6°C (101.5°F), the pulse is 112/min, the blood pressure is 130/84 mm Hg, and the respiratory rate is 28/min. A general examination shows the presence of edema over the right leg and tenderness over the right calf region. Auscultation of the chest reveals localized crackles over the left mammary region and right infrascapular region. However, his heart sounds are normal, except for the presence of tachycardia, and there are no murmurs. Which of the following is the investigation of choice as the immediate next step in this patient’s management?? {'A': 'Plasma D-dimer', 'B': 'Serum brain natriuretic peptide', 'C': 'Echocardiography', 'D': 'Contrast-enhanced computed tomography (CECT) of chest', 'E': 'Ventilation-perfusion scanning'},
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D: Contrast-enhanced computed tomography (CECT) of chest
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Q:A 43-year-old man with HIV infection comes to the physician because of a 2-week history of progressive diarrhea and a 3-kg (6.6-lb) weight loss. During this period, he has had 3–4 episodes of watery stools daily, with multiple instances of blood in the stool. He is currently receiving antiretroviral therapy with zidovudine, lamivudine, and dolutegravir. Physical examination shows pallor and dry mucous membranes. A colonoscopy shows multiple linear ulcers. Polymerase chain reaction of a stool sample is positive for cytomegalovirus. Treatment with valganciclovir is begun. Adding this drug to his current medication regimen puts this patient at greatest risk for which of the following adverse effects?? {'A': 'Hyperglycemia', 'B': 'Abnormal dreams', 'C': 'Hepatic steatosis', 'D': 'Pancytopenia', 'E': 'Orthostatic dysregulation'},
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D: Pancytopenia
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Q:A 58-year-old patient comes to the physician because of progressive pain and swelling of his left calf for the past 2 days. He has no personal or family history of serious illness. He does not smoke or drink alcohol. His last digital rectal examination and colonoscopy at the age of 50 years were normal. His vital signs are within normal limits. He is 183 cm (6 ft) tall and weighs 80 kg (176 lb); BMI is 24 kg/m2. Physical examination shows redness, warmth, and tenderness of the left calf. The circumference of the left lower leg is 4 cm greater than the right. Dorsiflexion of the left foot elicits pain in the ipsilateral calf. Laboratory studies show: Hemoglobin 15 g/dL Leukocyte count 9000/mm3 Platelet count 190,000/mm3 Erythrocyte sedimentation rate 12 mm/h Serum Urea nitrogen 18 mg/dL Creatinine 1.0 mg/dL Alkaline phosphatase 24 U/L Aspartate aminotransferase (AST, GOT) 12 U/L Alanine aminotransferase (ALT, GPT) 10 U/L Urine Protein negative RBC 1/hpf WBC none Compression ultrasonography with Doppler shows a non-compressible left popliteal vein with a visible 0.5-cm hyperechoic mass and reduced flow. In addition to initiating anticoagulation, which of the following is the most appropriate next step in management?"? {'A': 'Colonoscopy', 'B': 'Inferior vena cava filter', 'C': 'X-ray of the chest', 'D': 'Abdominal ultrasound', 'E': 'Streptokinase therapy'},
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C: X-ray of the chest
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Answer the following medical question with one of the provided options:
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Q:Three hours after delivery, a 1800-g (3-lb 15-oz) male newborn develops respiratory distress. He was born at 31 weeks' gestation to a 27-year-old primigravid woman. His temperature is 36.9°C (98.4F), pulse is 140/min, respirations are 69/min, and blood pressure is 60/30 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 92%. Examination shows nasal flaring and expiratory grunting. An x-ray of the chest is shown. Which of the following is the most likely cause of these findings?? {'A': 'Surfactant deficiency', 'B': 'Hypertension in pulmonary vasculature', 'C': 'Impaired ciliary function', 'D': 'Delayed resorption of lung fluid', 'E': 'Aspiration of meconium'},
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A: Surfactant deficiency
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Answer the following medical question with one of the provided options:
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Q:A 69-year-old diabetic woman comes to the emergency department due to right flank pain for 10 days. Her right flank pain is radiating towards her groin and is associated with fever and chills. The pain is exacerbated with hip extension. She feels fatigued and is lying on her left side with her right hip flexed. The CT guided percutaneous drainage reveals 900 ml of greenish pus. The vital signs include blood pressure 145/75 mm Hg, pulse rate 96/min, temperature 36.9°C (98.4°F), respiratory rate 16/min, and the oxygen saturation is 95%. The complete blood count shows the following results upon admission: CBC results Leukocytes 16,600/mm3 Neutrophils 80% Lymphocytes 16% Eosinophils 1% Basophils 1% Monocyte 2% Hemoglobin 7.6 g/dL Creatinine 0.8 mg/dL BUN 15 mg/dL Which of the following processes most likely could have occurred?? {'A': 'Downregulation of regulation of cellular adhesion molecules in the endothelium', 'B': 'Diapedesis of neutrophils and chemotactic agents', 'C': 'Activation of cytosolic caspases', 'D': 'Decreased expression of selectin in the endothelium', 'E': 'Vasoconstriction'},
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B: Diapedesis of neutrophils and chemotactic agents
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Q:A 57-year-old woman comes to the physician because of a 2-week history of worsening epigastric pain that improves with meals. She has had similar pain of lesser intensity for the past 4 years. Physical examination shows no abnormalities. Upper endoscopy shows a 0.5-cm mucosal breach in the anterior duodenal bulb that extends into the submucosa. A biopsy specimen of the lesion shows hypertrophy of the Brunner glands. This patient is at the greatest risk for which of the following complications?? {'A': 'Perforation', 'B': 'Hematemesis', 'C': 'Gastric outlet obstruction', 'D': 'Adenocarcinoma', 'E': 'Pernicious anemia'},
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A: Perforation
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Q:A 3-month-old infant is brought to the E.R. by his parents. They state that the child has not had a bowel movement in several days and they are having trouble feeding the child. The physician examines the child and notices that the child appears less active and slightly hypotonic. Which of the following is most likely to be discovered during the patient history?? {'A': 'Recent pharyngitis', 'B': 'Recent consumption of honey', 'C': 'Recent episodes of diarrhea', 'D': 'Recent episodes of tetany', 'E': 'Recent episode of whooping cough'},
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B: Recent consumption of honey
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Q:A 58-year-old man presents with lower back pain that started a couple of weeks ago and is gradually increasing in severity. At present, he rates the intensity of the pain as 6/10. There is no radiation or associated paresthesias. There is no history of trauma. Past medical history is significant for aggressive squamous cell carcinoma of the right lung status post surgical resection followed by adjunct chemotherapy and radiation therapy that was completed 6 months ago. A technetium bone scan reveals metastatic lesions in the lumbar vertebrae at levels L2–L4. The physician explains to the patient that these are likely metastatic lesions from his primary lung cancer. Which of the following best describes the mechanism that most likely led to the development of these metastatic lesions?? {'A': 'PTH (parathormone)-related protein production by tumor cells', 'B': 'Collagenase produced by cancer cells dissolves the basement membrane and aids in cellular invasion', 'C': 'Hematogenous spread', 'D': 'Transcoelomic', 'E': 'Lymphatic spread'},
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C: Hematogenous spread
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Q:A group of researchers is trying to create a new drug that more effectively decreases systolic blood pressure levels, and it has entered the clinical trial period of their drug's development. If, during their trial, the scientists wanted to examine a mutual or linear relationship between 2 continuous variables, which of the following statistical models would be most appropriate for them to use?? {'A': 'Analysis of variance', 'B': 'Correlation', 'C': 'Chi-square exam', 'D': 'Paired t-exam', 'E': 'Independent t-exam'},
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B: Correlation
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Q:A 33-year-old immigrant from Bangladesh is evaluated by a primary care physician as a new patient. He immigrated from Bangladesh to the United States 1 month ago and lives with his extended family. He worked in a clothing factory in Bangladesh and has not been seen by a doctor in over 10 years. He reports that he has had a chronic cough for the past year that he attributes to smoking. He says that he feels well and has no complaints. He denies any past medical history and takes no medications. He smokes 2 packs of cigarettes per day. His temperature is 98.6°F (37°C), blood pressure is 120/75 mmHg, pulse is 105/min, and respirations are 20/min. On examination, he appears mildly cachectic with cervical lymphadenopathy. A purified protein derivative test leads to 12 mm of induration. A chest radiograph demonstrates an apical cavitary lesion. The patient is started on the standard medication regimen for his condition, including a medication that inhibits mycobacterial cell wall carbohydrate polymerization. Resistance to this medication is most likely to stem from which of the following processes?? {'A': 'Decreased cellular permeability', 'B': 'Enzymatic drug inactivation', 'C': 'Increased active drug efflux', 'D': 'Increased production of mycobacterial enzymes', 'E': 'Metabolic pathway alteration'},
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D: Increased production of mycobacterial enzymes
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Answer the following medical question with one of the provided options:
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Q:An investigator is studying the electrophysical properties of gastrointestinal smooth muscle cells using microelectrodes. He measures the resting membrane potential of a cell to be -70 mV. The equilibrium potentials of different ions involved in generating the membrane potential are shown. ENa+ +65 mV EK -85 mV ECa2+ +120 mV EMg2+ +10 mV ECl- -85 mV Which of the following is the most important contributor to the difference between the resting membrane potential and the equilibrium potential of potassium?"? {'A': 'Influx of Ca2+ ions', 'B': 'Influx of Mg2+ ions', 'C': 'Influx of Cl- ions', 'D': 'Electrogenic effect of Na+/K+-ATPase', 'E': 'Influx of Na+ ions'},
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E: Influx of Na+ ions
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Answer the following medical question with one of the provided options:
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Q:A 52-year-old woman presents with fatigue, difficulty swallowing solid foods, and frequent choking spells. She says her symptoms gradually onset 3 months ago and have progressively worsened. Past medical history is unremarkable. She reports drinking alcohol occasionally but denies smoking or illicit drug use. Her vital signs include: temperature 36.6°C (97.8°F), blood pressure 115/72 mm Hg, pulse 82/min. Physical examination shows conjunctival pallor but is otherwise unremarkable. Laboratory results are significant for the following: Hemoglobin 9.8 g/dL Red cell count 2.5 million/mm3 Mean corpuscular volume 73 μm3 Serum ferritin 9.7 ng/mL A barium swallow study is performed, which shows a proximal esophageal web. Which of the following is the most likely diagnosis in this patient?? {'A': 'Idiopathic achalasia', 'B': 'Esophageal carcinoma', 'C': 'Zenker diverticulum', 'D': 'Plummer-Vinson syndrome', 'E': 'Diffuse esophageal spasm'},
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D: Plummer-Vinson syndrome
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Answer the following medical question with one of the provided options:
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Q:A 75-year-old man is referred for thyroidectomy for treatment of thyroid nodules. A portion of the thyroid gland is resected, and the neck is closed with sutures. After awakening from anesthesia, the patient complains of ‘hoarseness’. His vital signs are normal and his incisional pain is minimal. The surgeon realizes he most likely damaged the recurrent laryngeal nerve. Which of the following should the surgeon tell the patient?? {'A': '"A mistake occurred because this hospital has poor operating room protocols."', 'B': '"A mistake occurred during the operation, but there was no harm to you."', 'C': '"The case took longer than we thought it would, but everything went well."', 'D': '"The operation was successful and no complications occurred."', 'E': '"We made a mistake during the operation that may have harmed you."'},
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E: "We made a mistake during the operation that may have harmed you."
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Q:A 70-year-old man presents with right-sided weakness. The patient says that symptoms acutely onset an hour ago while watching television at home. Past medical history is significant for poorly controlled hypertension and 2 myocardial infarctions in the last 2 years. His blood pressure is 140/100 mm Hg, the respiratory rate is 18/min, and the heart rate is 58/min. On physical examination, strength is 1/5 in the right upper and lower extremities. A noncontrast CT of the head is shown in the image. The physician explains that this patient’s condition is most likely caused by his poorly controlled hypertension. Which of the following conditions can also cause a similar kind of lesion?? {'A': 'Cerebral atrophy', 'B': 'Saccular aneurysm', 'C': 'Alcoholism', 'D': 'Amyloid angiopathy', 'E': 'Pterion fracture'},
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D: Amyloid angiopathy
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Answer the following medical question with one of the provided options:
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Q:A 57-year-old woman comes to the physician for evaluation of a lump in the right breast that she first noticed a week ago. Biopsy of the mass confirms a diagnosis of a pleomorphic lobular carcinoma-in-situ that is estrogen receptor-positive. The patient undergoes lumpectomy, and treatment with tamoxifen is initiated. Which of the following conditions is most likely to occur as a result of tamoxifen therapy?? {'A': 'Endometrial cancer', 'B': 'Osteoporosis', 'C': 'Myelosuppression', 'D': 'Ovarian cancer', 'E': 'Cardiotoxicity'},
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A: Endometrial cancer
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Answer the following medical question with one of the provided options:
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Q:A healthy 20-year-old male college student attempts to climb Mount Everest and travels to the Tibetan plateau by plane. Upon landing, he feels increasingly dizzy and fatigued. He notices that he is breathing faster than usual. What is the initial stimulus for the most likely acid-base disorder?? {'A': 'Hypoxic pulmonary vasodilation', 'B': 'Decreased partial pressure of alveolar oxygen', 'C': 'Increasing arterial partial pressure of carbon dioxide', 'D': 'Worsened diffusion limitation of oxygen', 'E': 'Undiagnosed atrial septal defect'},
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B: Decreased partial pressure of alveolar oxygen
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