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Answer the following medical question with one of the provided options:
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Q:A 25-year-old man presents with pain and a limited range of motion in his right shoulder. He is a collegiate baseball player and says he has not been playing for approx. 1 week because his shoulder hurts when he throws. He also noticed trouble raising his arm over his head. He describes the pain as moderate, dull, and aching in character and worse when he moves his arm above his shoulder or when he lays in bed on his side. He denies any recent acute trauma to the shoulder or other joint pain. The medical history is significant for asthma, which is managed medically. The current medications include albuterol inhaled and fluticasone. He reports a 5-year history of chewing tobacco but denies smoking, alcohol, or drug use. The temperature is 37.0°C (98.6°F); blood pressure is 110/85 mm Hg; pulse is 97/min; respiratory rate is 15/min, and oxygen saturation is 99% on room air. The physical examination is significant for tenderness to palpation on the anterolateral aspect of the right shoulder. The active range of motion on abduction of the right shoulder is decreased. The passive range of motion is intact. No swelling, warmth, or erythema is noted. The sensation is intact. The deep tendon reflexes are 2+ bilaterally. The peripheral pulses are 2+. The laboratory results are all within normal limits. A plain radiograph of the right shoulder shows no evidence of fracture or bone deformities. An MRI of the right shoulder shows increased T1 and T2 signals in the rotator cuff tendon. Which of the following is the best initial course of treatment for this patient?? {'A': 'No further treatment is needed', 'B': 'Conservative measures (rest and ice)', 'C': 'NSAIDs and conservative measures', 'D': 'Intra-articular corticosteroid injection', 'E': 'Acromioplasty'},
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C: NSAIDs and conservative measures
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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 the emergency department with testicular pain. His symptoms started 15 minutes ago and have not improved on the ride to the hospital. The patient’s past medical history is non-contributory, and he is not currently taking any medications. His temperature is 98.5°F (36.9°C), blood pressure is 123/62 mmHg, pulse is 124/min, respirations are 18/min, and oxygen saturation is 98% on room air. Physical exam is notable for a non-tender abdomen. The patient’s right testicle appears higher than his left and is held in a horizontal position. Stroking of the patient’s medial thigh elicits no response. Which of the following is the best treatment for this patient?? {'A': 'Bilateral surgical procedure', 'B': 'Ceftriaxone', 'C': 'Ciprofloxacin', 'D': 'Manual detorsion', 'E': 'Surgical debridement'},
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A: Bilateral surgical procedure
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Answer the following medical question with one of the provided options:
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Q:A 61-year-old woman visits the clinic with a complaint of new-onset episodic abnormal body movements. She says her husband noticed it twice in the past week. There were jerky movements for roughly 15 seconds during her last episode. She denies any recent trauma or fever. Her vital signs include: blood pressure 114/74 mm Hg, pulse 81/min, temperature 36.7°C (98.1°F) and respiratory rate 10/min. On physical examination, there is no evidence of focal neurological deficits. A basic metabolic panel is ordered which shows: Sodium 141 mEq/L Potassium 5.1 mEq/L Chloride 101 mEq/L Bicarbonate 24 mEq/L Albumin 4.3 mg/dL Urea nitrogen 11 mg/dL Creatinine 1.0 mg/dL Uric Acid 6.8 mg/dL Calcium 8.9 mg/dL Glucose 111 mg/dL A contrast magnetic resonance imaging (MRI) of the head is shown in the provided image. Which of the following cells is the origin of the lesion seen in this patient’s MRI?? {'A': 'Meningothelial cells', 'B': 'Ependymal cells', 'C': 'Astrocytes', 'D': 'Neurons', 'E': 'Oligodendroglia'},
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C: Astrocytes
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Answer the following medical question with one of the provided options:
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Q:A researcher is investigating the blood supply of the adrenal gland. While performing an autopsy on a patient who died from unrelated causes, he identifies a vessel that supplies oxygenated blood to the inferior aspect of the right adrenal gland. Which of the following vessels most likely gave rise to the vessel in question?? {'A': 'Renal artery', 'B': 'Abdominal aorta', 'C': 'Inferior phrenic artery', 'D': 'Superior mesenteric artery', 'E': 'Common iliac artery'},
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A: Renal artery
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Answer the following medical question with one of the provided options:
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Q:A 74-year-old female with a history of lung adenocarcinoma status post lobectomy, chronic obstructive pulmonary disease, congestive heart failure, and diabetic nephropathy presents to clinic complaining of hearing loss. Over the last week, she has noticed that she has had difficulty hearing the telephone or the television. When sitting in a quiet room, she also has noticed a high-pitched ringing in her ears. She denies any vertigo or disequilibrium. Further review reveals ongoing dyspnea on exertion and worsening cough productive of whitish sputum for the last month. The patient was recently discharged from the hospital for a congestive heart failure exacerbation. She lives alone and keeps track of all her medications, but admits that sometimes she gets confused. She has a 20 pack-year tobacco history. Her home medications include aspirin, lisinopril, furosemide, short-acting insulin, and a long-acting ß-agonist inhaler. Two weeks ago she completed a course of salvage chemotherapy with docetaxel and cisplastin. Her tympanic membranes are clear and intact with no signs of trauma or impaction. Auditory testing reveals bilateral hearing impairment to a whispered voice. The Weber test is non-lateralizing. Rinne test is unrevealing. Hemoglobin: 11.8 g/dL Leukocyte count: 9,400/mm^3 Platelet count: 450,000/mm^3 Serum (Present visit): Na+: 134 mEq/L K+: 3.8 mEq/L Cl-: 95 mEq/L HCO3-: 30 mEq/L BUN: 45 mg/dL Creatinine: 2.1 mg/dL Serum (1 month ago): Na+: 135 mEq/L K+: 4.6 mEq/L Cl-: 102 mEq/L HCO3-: 24 mEq/L BUN: 22 mg/dL Creatinine: 1.2 mg/dL On follow up visit two weeks later, the patient's hearing has significantly improved. Which of the following is the most likely cause of her initial hearing loss?? {'A': 'Lisinopril', 'B': 'Cisplatin', 'C': 'Aspirin', 'D': 'Docetaxel', 'E': 'Furosemide'},
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E: Furosemide
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Answer the following medical question with one of the provided options:
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Q:A 60-year-old man is brought to your medical office by his daughter, who noticed that he has had a progressive increase in breast size over the past 6 months. The patient does not complain of anything else except easy fatigability and weakness. His daughter adds that he does not have a good appetite as in the past. He has occasional discomfort and nipple sensitivity when he puts on a tight shirt. The medical history is significant for benign prostatic hyperplasia for which he takes tamsulosin. The patient also admits that he used to take anti-hypertensive medications, but stopped because his blood pressure had normalized. On physical examination, the pulse is regular at 78/min, the respirations are regular, the blood pressure is 100/68 mm Hg, and the temperature is 37.0°C (98.6°F). Examination of the chest reveals multiple vascular lesions consisting of central pinpoint red spots with red streaks radiating from a central lesion and bilaterally enlarged breast tissue. You also notice a lack of hair on the chest and axillae. There is no hepatosplenomegaly on abdominal palpation. What is the most likely cause of gynecomastia in this patient?? {'A': 'Cirrhosis', 'B': 'Chronic kidney disease', 'C': 'Drug induced', 'D': 'Hyperthyroidism', 'E': 'Physiologic'},
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A: Cirrhosis
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Answer the following medical question with one of the provided options:
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Q:A 40-year-old G1P0010 presents to the clinic with nausea and vomiting 8 weeks after a spontaneous abortion at 10 weeks gestation. She admits to heavy drinking (7–8 glasses of wine per day) for the last 20 years; however, after the pregnancy loss, she increased her drinking to 8–9 glasses per day. Hepatomegaly, right upper quadrant pain, and jaundice are noted on abdominal examination. The lungs are clear to auscultation with no abnormalities on chest X-ray. Liver function tests are obtained and a biopsy is performed. Which of the following findings is most likely to be true in her condition?? {'A': '↑ NADH/NAD+; AST:ALT ≥ 2:1; ß-oxidation ↓; ß-hydroxybutyrate ↑; lactic acid ↑', 'B': '↑ NAD+/NADH; ALT:AST ≥ 2:1; ß-oxidation ↑; ß-hydroxybutyrate, no change; lactic acid ↓', 'C': '↑ NADH/NAD+; ALT:AST ≥ 2:1; ß-oxidation ↓; ß-hydroxybutyrate ↓; lactic acid ↓', 'D': '↑ NAD+/NADH; AST:ALT ≥ 2:1; ß-oxidation ↑; ß-hydroxybutyrate ↓; lactic acid ↓', 'E': '↑ NADH/NAD+; ALT:AST ≥ 2:1; ß-oxidation ↓; ß-hydroxybutyrate ↓; lactic acid ↑'},
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A: ↑ NADH/NAD+; AST:ALT ≥ 2:1; ß-oxidation ↓; ß-hydroxybutyrate ↑; lactic acid ↑
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Answer the following medical question with one of the provided options:
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Q:A 63-year-old woman presents to the primary care physician’s clinic complaining of fatigue, diarrhea, headaches, and a loss of appetite. She denies any personal history of blood clots in her past, but she says that her mother has also had to be treated for pulmonary embolism in the recent past. Her past medical history is significant for preeclampsia, hypertension, polycystic ovarian syndrome, and hypercholesterolemia. She currently smokes 1 pack of cigarettes per day, drinks a glass of wine per day, and she currently denies any illicit drug use, although she has a remote past of injection drug use with heroin. The vital signs include: temperature 36.7°C (98.0°F), blood pressure 126/74 mm Hg, heart rate 111/min and irregular, and respiratory rate 17/min. On physical examination, her pulses are bounding and complexion is pale, but breath sounds remain clear. Oxygen saturation was initially 91% on room air and electrocardiogram (ECG) showed atrial fibrillation. Upon further discussion with the patient, her physician discovers that she is having some cognitive difficulty. The laboratory results reveal: mean corpuscular volume (MCV) 111 fL; hemoglobin (Hgb) 9.3 g/dL; methylmalonic acid (MMA) and homocysteine are both elevated. Schilling test is positive. What is the next best step in the management of this patient?? {'A': 'Lifelong folic acid supplementation', 'B': 'Lifelong Vitamin B12 supplementation', 'C': 'Iron supplementation for 4–6 months', 'D': 'Obtain a Coomb’s test', 'E': 'Give corticosteroids and iron supplementation'},
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B: Lifelong Vitamin B12 supplementation
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Answer the following medical question with one of the provided options:
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Q:A 33-year-old man presents with his recent laboratory results. He has no symptoms currently, but he underwent a medical evaluation as a requirement for taking up a new job. His medical history is not significant. His laboratory reports are as follows: Blood hemoglobin 13.7 g/dL Leukocyte count 8,000/mm3 Platelet count 350,000/mm3 Serum creatinine 0.8 mg/dL Serum alanine aminotransferase 16 U/L Serum aspartate aminotransferase 14 U/L Serum cholesterol 450 mg/dL Serum triglyceride 790 mg/dL Serum LDL cholesterol 150 mg/dL Serum HDL cholesterol 55 mg/dL Which of the following findings is most likely to be present on physical examination of this patient?? {'A': 'Eruptive xanthomas over back', 'B': 'Achilles tendon xanthoma', 'C': 'Palmar xanthomas in flexor creases', 'D': 'Metacarpophalangeal extensor tendon xanthoma', 'E': 'Xanthelasma'},
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C: Palmar xanthomas in flexor creases
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Answer the following medical question with one of the provided options:
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Q:A 30-year-old man with history of intravenous drug use and methamphetamine-associated chronic thromboembolic pulmonary hypertension (CTEPH) is brought to the emergency department by his girlfriend for worsening abdominal pain and fevers. The patient said the pain was initially around his umbilicus, but he is now experiencing intense tenderness near his groin. He was initially prescribed rivaroxaban, but due to insurance issues, he was switched to warfarin for management of CTEPH two weeks ago. His temperature is 102°F (38.9°C), blood pressure is 95/60 mmHg, pulse is 95/min, respirations are 22/min. He states that his blood pressure usually runs low. His physical exam is notable for an unremarkable cardiac exam, bibasilar crackles, and RLQ tenderness with rebound tenderness when the LLQ is palpated. Laboratory results are shown below: Hemoglobin: 11 g/dL Hematocrit: 35 % Leukocyte count: 16,000/mm^3 with normal differential Platelet count: 190,000/mm^3 Serum: Na+: 137 mEq/L Cl-: 100 mEq/L K+: 3.7 mEq/L HCO3-: 23 mEq/L BUN: 40 mg/dL Glucose: 110 mg/dL Creatinine: 0.8 mg/dL Ca2+: 9.1 mg/dL AST: 34 U/L ALT: 45 U/L International normalized ratio (INR): 6.2 Prothrombin time (PT): 40 seconds Partial thromboplastin time: 70 seconds Blood type: O Rhesus: Positive Antibody screen: Negative A clinical diagnosis is made and supported by the surgical consult team in lieu of imaging. The next operating room for an add-on procedure will not be available for another 5 hours. Appropriate medical therapy is initiated. What is the best next step for surgical optimization?? {'A': 'Do nothing', 'B': 'Fresh frozen plasma', 'C': 'Phytonadione', 'D': 'Protamine', 'E': 'Prothrombin complex concentrate'},
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B: Fresh frozen plasma
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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, who is known to have recurrent thromboembolic strokes, presents to his physician for a routine follow-up visit. While assessing drug compliance, the physician realizes that the patient inadvertently doubled his dose of warfarin 1 month ago. When he is asked about any new complaints, the patient denies any symptoms, including bleeding. The physical examination does not show any signs of bleeding. Based on the patient’s lifestyle, the physician does not consider him to be at increased risk for bleeding. He then orders an international normalized ratio (INR) for this patient, which is 13.5. In addition to temporarily holding warfarin, which of the following drugs is indicated for this patient?? {'A': 'Fresh frozen plasma', 'B': 'Phytonadione', 'C': 'Recombinant factor VIIa', 'D': 'Menaquinone', 'E': 'Protamine sulfate'},
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B: Phytonadione
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Answer the following medical question with one of the provided options:
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Q:A 15-year-old girl is brought to the physician for her annual physical examination. Breast and pubic hair development began at the age of 12 years, but menses have not yet occurred. She is 160 cm (5 ft 3 in) tall and weighs 54 kg (120 lb); BMI is 21 kg/m2. Physical examination shows normal external genitalia. Breast and pubic hair development are Tanner stage 5. A pelvic ultrasound shows normal ovaries but an absent uterus. These findings are most likely due to a defect in which of the following embryologic structures?? {'A': 'Mesonephric duct', 'B': 'Genital tubercle', 'C': 'Gubernaculum', 'D': 'Urogenital sinus', 'E': 'Paramesonephric duct'},
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E: Paramesonephric duct
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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 worsening fatigue and a 1-week history of gingival bleeding. He has also had decreased appetite and a 5-kg (11-lb) weight loss over the past month. He has tried over-the-counter vitamin supplements with no relief of his symptoms. He appears pale. His temperature 37.8° C (100.0°F), pulse is 72/min and blood pressure is 120/70 mm Hg. Physical examination shows numerous petechial lesions over the upper and lower extremities. A bone marrow smear is shown. Which of the following additional findings is most likely in this patient?? {'A': 'Translocation t(9;22)', 'B': 'Positive heterophile antibody test', 'C': 'Peroxidase-positive granules', 'D': 'Cold agglutinin antibodies', 'E': 'Follicular hyperkeratosis\n"'},
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C: Peroxidase-positive granules
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Answer the following medical question with one of the provided options:
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Q:A 74-year-old retired female teacher is referred to the endocrinology clinic. She is very concerned about a large mass in her neck that has progressively enlarged over the past 2 weeks. She also reports a 15 pound weight loss over the last 3 months. She now has hoarseness and difficulty swallowing her food, giving her a sensation that food gets stuck in her windpipe when she swallows. There is no pain associated with swallowing. Her speech is monotonous. No other gait or language articulation problems are noted. Testing for cranial nerve lesions is unremarkable. On palpation, a large, fixed and non-tender mass in the thyroid is noted. Cervical lymph nodes are palpable bilaterally. The patient is urgently scheduled for an ultrasound-guided fine needle aspiration to guide management. Which of the following is the most likely gene mutation to be found in this mass?? {'A': 'MEN2 gene mutation', 'B': 'RET gene mutation', 'C': 'Calcitonin receptor mutation', 'D': 'Inactivating mutation of the p53 tumor suppressor gene', 'E': 'Down expression of the Ras protooncogene'},
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D: Inactivating mutation of the p53 tumor suppressor gene
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Answer the following medical question with one of the provided options:
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Q:An institutionalized 65-year-old man is brought to the emergency department because of abdominal pain and distension for 12 hours. The pain was acute in onset and is a cramping-type pain associated with nausea, vomiting, and constipation. He has a history of chronic constipation and has used laxatives for years. There is no history of inflammatory bowel disease in his family. He has not been hospitalized recently. There is no recent history of weight loss or change in bowel habits. On physical examination, the patient appears ill. The abdomen is distended with tenderness mainly in the left lower quadrant and is tympanic on percussion. The blood pressure is 110/79 mm Hg, heart rate is 100/min, the respiratory rate is 20/min, and the temperature is 37.2°C (99.0°F). The CBC shows an elevated white blood cell count. The plain abdominal X-ray is shown in the accompanying image. What is the most likely cause of his condition?? {'A': 'Acute diverticulitis', 'B': 'Toxic megacolon', 'C': 'Sigmoid volvulus', 'D': 'Intussusception', 'E': 'Colon cancer'},
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C: Sigmoid volvulus
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Answer the following medical question with one of the provided options:
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Q:A 59-year-old male with a history of aortic stenosis secondary to a bicuspid aortic valve treated with aortic valve replacement (AVR) presents with fever and shortness of breath. Patient states a gradual onset of symptoms approximately five days ago that have been getting steadily worse. He reports that he has trouble getting up and walking across a room before becoming short of breath. Past medical history is significant for a mechanical AVR three years ago for severe aortic stenosis, removal of a benign polyp last year following a colonoscopy, and a tooth extraction 2 weeks ago. Current medications are warfarin 5 mg orally daily, rosuvastatin 20 mg orally daily, and enalapril 10 mg orally twice daily. Vital signs are: temperature 39°C (102.2°F), blood pressure 100/65 mm Hg, pulse 96/min, respiration rate 18/min, and oxygen saturation 96% on room air. On physical exam, patient is alert but dyspneic. Cardiac exam is significant for a systolic ejection murmur that is loudest at the upper right sternal border and radiates to the carotids. Lungs are clear to auscultation. Abdomen is soft and nontender. Splenomegaly is present. Extremities are pale and cool to the touch. Laboratory tests are significant for: Sodium 136 mEq/L Potassium 4.1 mEqL Chloride 107 mEq/L Bicarbonate 21 mEq/L BUN 13 mg/dL Creatinine 1.0 mg/dL Glucose (fasting) 75 mg/dL Bilirubin, conjugated 0.3 mg/dL Bilirubin, total 1.1 mg/dL AST (SGOT) 34 U/L ALT (SGPT) 40 U/L Alkaline phosphatase 39 U/L WBC 12,500/mm3 RBC 5.15 x 106/mm3 Hematocrit 32.1% Hemoglobin 13.0 g/dL Platelet count 215,000/mm3 Troponin I (cTnI) < 0.02 ng/mL INR 2.4 Chest X-ray shows no evidence of dehiscence or damage to the mechanical valve. ECG shows the following in the picture. Transesophageal echocardiography shows a possible large vegetation on one of the mechanical aortic valve leaflets. Left ventricular ejection fraction is 45% due to outflow tract obstruction. High flow supplemental oxygen and fluid resuscitation are started. Blood cultures x 2 are drawn. What is the next best step in management?? {'A': 'Stop warfarin immediately', 'B': 'Administer vancomycin 1 g IV every 12 hours, gentamicin 70 mg IV every 8 hours, and rifampin 300 mg IV every 8 hours', 'C': 'Emergency replacement of the mechanical aortic valve', 'D': 'Administer dobutamine', 'E': 'Intra-aortic balloon counterpulsation'},
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B: Administer vancomycin 1 g IV every 12 hours, gentamicin 70 mg IV every 8 hours, and rifampin 300 mg IV every 8 hours
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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 admitted to the hospital for the evaluation of progressive breathlessness. She has no history of major medical illness. Her temperature is 37°C (98.6°F), pulse is 110/min, and respirations are 22/min. Pulse oximetry on room air shows an oxygen saturation of 99%. Cardiac examination shows a loud S1 and S2. There is a grade 2/6 early systolic murmur best heard in the 2nd right intercostal space. Cardiac catheterization shows a mixed venous oxygen saturation of 55% (N= 65–70%). Which of the following is the most likely cause of this patient's breathlessness?? {'A': 'Increased carbon dioxide retention', 'B': 'Decreased left ventricular ejection fraction', 'C': 'Increased peripheral shunting', 'D': 'Increased pulmonary vascular resistance', 'E': 'Decreased hemoglobin concentration'},
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E: Decreased hemoglobin concentration
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Answer the following medical question with one of the provided options:
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Q:A 64-year-old female with a history of end-stage renal disease presents to her primary care physician complaining of weakness. She reports a six-month history of progressive weakness accompanied by occasional dull aching pain in her arms, legs, and lower back. She has also started to increase her fiber intake because of occasional strained bowel movements. Her past medical history is notable for poorly controlled diabetes, major depressive disorder, and obesity. She takes insulin and sertraline. She has a twenty pack-year smoking history and drinks alcohol socially. Her temperature is 98.5°F (36.9°C), blood pressure is 130/85 mmHg, pulse is 80/min, and respirations are 16/min. Laboratory findings are shown below: Serum: Na+: 138 mEq/L Cl-: 99 mEq/L K+: 3.9 mEq/L HCO3-: 26 mEq/L BUN: 20 mg/dL Glucose: 140 mg/dL Creatinine: 2.0 mg/dL Parathyroid hormone: 720 µU/mL Ca2+: 11.1 mg/dL Phosphorus (inorganic): 4.8 mg/dl A medication with which of the following mechanisms of action is most likely indicated to address this patient’s symptoms?? {'A': 'Sodium chloride cotransporter antagonist', 'B': 'Calcimimetic agent', 'C': 'Osteoprotegerin analog', 'D': 'Aldosterone receptor antagonist', 'E': 'Carbonic anhydrase inhibitor'},
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B: Calcimimetic agent
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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 comes to the clinic for generalized fatigue. He says that he is more tired than before and has difficulty catching his breath while walking upstairs. He feels tired quickly doing his usual activity such as gardening and shopping. He does not have any symptoms of fever, change in bowel habits, abdominal pain, rectal bleeding, or weight loss. His appetite is normal. His last colonoscopy was done 10 years ago and it was normal. His blood pressure is 116/74 and heart rate is 87/min. On physical examination, his conjunctivae are pale. A routine blood test shows iron deficiency anemia with hemoglobin of 10 gm/dL. His stool is positive for occult blood. He is then sent for a colonoscopy (image is shown). What is the most likely diagnosis for the above condition?? {'A': 'Diverticulitis', 'B': 'Hereditary hemorrhagic telangiectasia', 'C': 'Angiodysplasia', 'D': 'Intestinal obstruction', 'E': 'Colon cancer'},
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C: Angiodysplasia
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Answer the following medical question with one of the provided options:
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Q:A 27-year-old man presents to the emergency department with unrelenting muscle spasms for the past several hours. The patient’s girlfriend states that he started having jaw spasms and soreness last night but now his neck, back, and arms are spasming. She also states that he stepped on a nail about 1 week ago. Past medical history is noncontributory. The patient's vaccination status is unknown at this time. Today, the vital signs include temperature 39.1°C (102.4°F), heart rate 115/min, blood pressure 145/110 mm Hg, and respiratory rate 10/min. On exam, the patient is in obvious discomfort, with a clenched jaw and extended neck. Labs are drawn and a basic metabolic panel comes back normal and the white blood cell (WBC) count is moderately elevated. Which of the following is the most likely etiology of this patient’s symptoms?? {'A': 'A heat-labile toxin that inhibits ACh release at the NMJ', 'B': 'A toxin that disables the G-protein coupled receptor', 'C': 'An exotoxin that cleaves SNARE proteins', 'D': 'An edema factor that functions as adenylate cyclase', 'E': 'An exotoxin that causes ADP-ribosylation of EF-2'},
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C: An exotoxin that cleaves SNARE proteins
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Answer the following medical question with one of the provided options:
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Q:A 72-year-old woman presents to the emergency department complaining of left gluteal pain for the last 3 months. The onset of the pain was gradual and she does not recall any trauma to the region. She describes the pain as sharp and progressive, with radiation down the posterior left thigh to the level of the knee. She is a non-smoker without a history of anticoagulant therapy. Her past medical history is significant for peripheral vascular disease, hypertension, and hyperlipidemia. The physical examination focusing on the left gluteal region reveals atrophy and muscle weakness. The blood cell count and blood chemistry profile are within normal limits. The suspected embolus was confirmed with a pelvic computed tomography scan demonstrating a heterogeneously-enhanced blockage in the deep branch of the superior gluteal artery. The patient underwent an uneventful super-selective embolization and recovered well. Complete occlusion of this artery may cause muscle ischemia and atrophy that would compromise the ability to perform which of the following actions?? {'A': 'Rise from a sitting position', 'B': 'Walking', 'C': 'Climbing stairs', 'D': 'Standing', 'E': 'Running'},
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B: Walking
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Answer the following medical question with one of the provided options:
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Q:A 27-year-old woman presents to her primary care physician because of headaches that she has had over the last three weeks. She has not had any significant past medical history though she does recall that various types of cancer run in her family. She has also noticed that she has been gaining some weight, and her feet no longer fit into her favorite shoes. On presentation, her temperature is 98.6°F (37°C), blood pressure is 159/92 mmHg, pulse is 75/min, and respirations are 16/min. Physical exam reveals 1+ edema in her lower extremities bilaterally. She is placed on captopril and presents to the emergency department two weeks later after a minor motor vehicle accident. She is cleared of any serious injuries, and as part of her workup, labs are drawn with the following results: BUN: 47 mg/dL Creatinine: 1.4 mg/dL Which of the following findings would most likely also be seen in this patient?? {'A': 'Atherosclerotic plaques blocking blood flow', 'B': 'Mass present in adrenal cortex', 'C': 'Mass present in adrenal medulla', 'D': 'No lesions present', 'E': 'String-of-beads appearance on angiography'},
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E: String-of-beads appearance on angiography
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Answer the following medical question with one of the provided options:
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Q:A 76-year-old woman seeks evaluation at a medical office for chest pain and shortness of breath on exertion of 3 months' duration. Physical examination shows bilateral pitting edema on the legs. On auscultation, diffuse crackles are heard over the lower lung fields. Cardiac examination shows jugular venous distention and an S3 gallop. Troponin is undetectable. A chest film shows cardiomegaly and pulmonary edema. Which of the following medications would be effective in lowering her risk of mortality?? {'A': 'Digoxin', 'B': 'Furosemide', 'C': 'Lisinopril', 'D': 'Propranolol', 'E': 'Verapamil'},
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C: Lisinopril
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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 emergency room with cough, dyspnea, and fever over the past 2 days. He also has substernal chest pain that worsens with inspiration. He recently recovered from a mild upper respiratory infection. His past medical history is notable for gout, hypertension, major depressive disorder, obesity, diabetes mellitus, and non-alcoholic fatty liver disease. He takes allopurinol, lisinopril, buproprion, and metformin. He works as a policeman and has a 25-pack-year smoking history. His temperature is 100.8°F (38.2°C), blood pressure is 150/75 mmHg, pulse is 108/min, and respirations are 22/min. On examination, he appears to be in mild distress but is cooperative and appropriately interactive. When the patient leans forward, a friction rub can be heard at the left lower sternal border. A basic metabolic panel is within normal limits. This patient’s condition is most likely caused by which of the following types of pathogens?? {'A': 'Coronavirus', 'B': 'Flavivirus', 'C': 'Paramyxovirus', 'D': 'Picornavirus', 'E': 'Togavirus'},
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D: Picornavirus
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Answer the following medical question with one of the provided options:
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Q:A 38-year-old woman is referred to a cardiologist for evaluation of syncope. Over the past year she has experienced 2 syncopal events. The first event occurred while she was standing, and the second when she laid down on her side. She denies bowel or bladder incontinence during the episodes or palpitations. However, she reports the presence of a low-grade fever over the past 3 months and a recent visit to the emergency department for a transient ischemic attack. She has a history of intravenous drug use but reports not having used in over 5 years. Temperature is 100.0°F (37.8°C), pressure is 115/72 mmHg, pulse is 90/min, and respirations are 20/min and regular. A detailed neurologic examination reveals no focal deficits. Cardiac auscultation demonstrates a diastolic "plop" at the cardiac apex. Which of the following findings will most likely be demonstrated on transthoracic echocardiography?? {'A': 'Decreased left ventricular ejection fraction', 'B': 'Flail mitral valve leaflet', 'C': 'Left atrial pedunculated mass', 'D': 'Left ventricular mass', 'E': 'Patent foramen ovale'},
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C: Left atrial pedunculated mass
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Answer the following medical question with one of the provided options:
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Q:A 55-year-old man presents to his primary care physician for a wellness checkup. He states that he generally feels well and has no complaints at this time. The patient consumes alcohol frequently, eats a high sodium diet, and is sedentary. His temperature is 97.5°F (36.4°C), blood pressure is 167/108 mmHg, pulse is 90/min, respirations are 15/min, and oxygen saturation is 99% on room air. The patient’s blood pressure at his last 2 appointments were 159/100 mmHg and 162/99 mmHg, respectively. His physician wants to intervene to manage his blood pressure. Which of the following is the most effective treatment for this patient’s hypertension?? {'A': 'DASH diet', 'B': 'Exercise', 'C': 'Reduce alcohol consumption', 'D': 'Sodium restriction', 'E': 'Weight loss'},
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E: Weight loss
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Answer the following medical question with one of the provided options:
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Q:A 72-year-old man comes to the emergency department because of severe, acute, right leg pain for 2 hours. The patient's symptoms started suddenly while he was doing household chores. He has no history of leg pain at rest or with exertion. Yesterday, he returned home after a 6-hour bus ride from his grandson's home. He has hypertension treated with ramipril. He appears uncomfortable. His temperature is 37.4°C (99.3°F), pulse is 105/min and irregular, and blood pressure is 146/92 mm Hg. The right lower extremity is cool and tender to touch. A photograph of the limb is shown. Femoral pulses are palpable bilaterally; popliteal and pedal pulses are decreased on the right side. Sensation to pinprick and light touch and muscle strength are decreased in the right lower extremity. Which of the following is most likely to confirm the underlying source of this patient's condition?? {'A': 'Echocardiography', 'B': 'Doppler ultrasonography of the legs', 'C': 'Biopsy of a superficial vein', 'D': 'Digital subtraction angiography', 'E': 'Manometry'},
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A: Echocardiography
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Q:A 42-year-old man presents to his dermatologist with a rash on the extensor surfaces of his elbows and knees which has occurred episodically ever since he was a teenager. The patient was recently diagnosed with essential hypertension and was prescribed lisinopril by his primary care physician. The vital signs include: temperature 36.7°C (98.0°F), blood pressure 128/91 mm Hg, and heart rate 82/min. The physical examination reveals sharply demarcated, erythematous plaques with silvery-white scales on the back of his elbows and front of his knees. He has less than 3% of the total body surface area affected. Which of the following is the best initial therapy for this patient’s condition?? {'A': 'Topical clobetasol and/or topical calcipotriol', 'B': 'Phototherapy', 'C': 'Methotrexate', 'D': 'Cyclosporine', 'E': 'Oral prednisolone'},
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A: Topical clobetasol and/or topical calcipotriol
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Q:A 32-year-old woman presents to her family physician with a long history of depression, irritability, and, more recently, personality changes. As her partner comments, she has stopped engaging in activities she used to enjoy like dancing, drumming lessons, and yoga. The patient denies changes in skin pigmentation and assures she keeps a balanced diet low in fat and carbohydrates. During the physical examination, jaundice and dark rings encircling the iris of the eye are noted, as well as hepatomegaly and gait disturbances. For a follow-up visit, the patient brings a battery of laboratory tests that includes a complete blood count showing normocytic normochromic anemia, a negative Coombs, normal iron levels, normal fasting glucose levels, elevated aminotransferases from the liver biochemical tests, bilirubin, and decreased serum ceruloplasmin levels. Antinuclear antibodies are negative. What is the most likely diagnosis?? {'A': 'Wilson disease', 'B': 'Hemochromatosis', 'C': 'Autoimmune hepatitis', 'D': 'Nonalcoholic fatty liver disease', 'E': 'Primary sclerosing cholangitis'},
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A: Wilson disease
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Q:A 55-year-old man presents to the internal medicine clinic with complaints of numbness and tingling in his fingers that he first noticed 6 months ago. It has been progressively worsening and has reached the point where it is affecting his normal daily activities, such as brushing his teeth. His past medical history is significant for sinusitis and allergic rhinitis since the age of 18, as well as episodic wheezing and shortness of breath since he was 30. He was diagnosed with asthma when he was 22 years old, and subsequently with gastroesophageal reflux disease (GERD) when he was 40. His current medications include albuterol, loratadine, mometasone, and omeprazole. His blood pressure is 128/86 mm Hg, heart rate is 78/min, and respiratory rate is 16/min. On physical exam, the patient’s skin is mottled and appears to have a diffuse, lace-like, erythematous discoloration of the arms, legs, and trunk. There is also a small papular rash on his right forearm. Bilateral wheezes are heard on auscultation. Which of the following is the most likely diagnosis?? {'A': 'Eosinophilic granulomatosis with polyangiitis', 'B': 'Granulomatosis with polyangiitis', 'C': 'CREST syndrome', 'D': 'Microscopic vasculitis', 'E': 'Polyarteritis nodosa'},
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A: Eosinophilic granulomatosis with polyangiitis
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Q:A 20-year-old man comes to the clinic complaining of shoulder pain for the past week. He is a pitcher for the baseball team at his university and reports that the pain started shortly after a game. The pain is described as achy and dull, intermittent, 7/10, and is concentrated around the right shoulder area. He denies any significant medical history, trauma, fever, recent illness, or sensory changes but endorses some difficulty lifting his right arm. A physical examination demonstrates mild tenderness of the right shoulder. When the patient is instructed to resist arm depression when holding his arms parallel to the floor with the thumbs pointing down, he reports significant pain of the right shoulder. Strength is 4/5 on the right and 5/5 on the left with abduction of the upper extremities. What nerve innervates the injured muscle in this patient?? {'A': 'Accessory nerve', 'B': 'Axillary nerve', 'C': 'Long thoracic nerve', 'D': 'Subscapular nerve', 'E': 'Suprascapular nerve'},
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E: Suprascapular nerve
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Q:A 6-year-old boy and his parents present to the emergency department with high-grade fever, headache, and projectile vomiting. The boy was born at 39 weeks gestation via spontaneous vaginal delivery. He is up to date on all vaccines and is meeting all developmental milestones. Past medical history is noncontributory. He has had no sick contacts at school or at home. The family has not traveled out of the area recently. He likes school and playing videogames with his younger brother. Today, his blood pressure is 115/76 mm Hg, heart rate is 110/min, respiratory rate is 22/min, and temperature is 38.4°C (101.2°F). On physical exam, the child is disoriented. Kernig’s sign is positive. A head CT was performed followed by a lumbar puncture. Several aliquots of CSF were distributed throughout the lab. Cytology showed high counts of polymorphs, biochemistry showed low glucose and elevated protein levels, and a gram smear shows gram-positive lanceolate-shaped cocci alone and in pairs. A smear is prepared on blood agar in an aerobic environment and grows mucoid colonies with clearly defined edges and alpha hemolysis. On later evaluation they develop a ‘draughtsman’ appearance. Which one of the following is the most likely pathogen?? {'A': 'Streptococcus pneumoniae', 'B': 'Streptococcus agalactiae', 'C': 'Staphylococcus epidermidis', 'D': 'Staphylococcus aureus', 'E': 'Neisseria meningitidis'},
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A: Streptococcus pneumoniae
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Q:A forty-five-year-old farmer with past medical history of diabetes, hypertension, and glaucoma comes into your emergency room confused, diaphoretic, salivating, vomiting and shedding tears. He has pinpoint pupils. You conclude that he is showing effects of acute organophosphate poisoning. While administering the antidote, you should carefully monitor for which of the following side effects?? {'A': 'Tinnitus', 'B': 'Bronchospasm', 'C': 'Acute closed-angle glaucoma', 'D': 'Barotrauma to middle ear', 'E': 'Hyperkalemia'},
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C: Acute closed-angle glaucoma
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Q:A 54-year-old man is brought to the emergency department after having been hit by a car while riding his bicycle. He was not wearing a helmet. Despite appropriate life-saving measures, he dies 2 hours later because of a severe intracranial hemorrhage. Autopsy of the heart shows general thickening of the left ventricular wall with narrowing of the ventricular chamber. Which of the following conditions is the most likely underlying cause of the described cardiac changes?? {'A': 'Aortic regurgitation', 'B': 'Chronic heavy drinking', 'C': 'Chronic hypertension', 'D': 'Hemochromatosis', 'E': 'Sarcoidosis'},
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C: Chronic hypertension
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Q:A 25-year-old woman presents her physician with a complaint of feeling tired and low on energy for the past 6 months. She also has noticed she has been having trouble performing daily tasks and at times experiencing near-fainting spells. She has no recollection of similar instances in the past. Her past medical history is insignificant, except for the fact that she has been a strict vegan for the last 5 years. Her vital signs are stable. On physical examination, she is visibly pale and has decreased position and vibratory sensation in her both lower extremities. There is decreased lower limb reflexes with sensation intact. A complete blood count - done last week, - shows hemoglobin of 9.7 g/dL with an MCV of 110 fL. The serum levels of which of the following will most likely aid in the physician’s treatment plan?? {'A': 'Succinyl CoA', 'B': 'Homocysteine', 'C': 'Ferritin', 'D': 'Folate', 'E': 'Methylmalonic acid'},
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E: Methylmalonic acid
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Q:A 30-year old G2P1 woman, currently at 38 weeks estimated gestational age, presents with contractions. She says that she did not have any prenatal care, because she does not have health insurance. Upon delivery, the infant appears jaundiced and has marked hepatosplenomegaly. Serum hemoglobin is 11.6 g/dL and serum bilirubin is 8 mg/dL. The direct and indirect Coombs tests are both positive. The mother has never had a blood transfusion. Her previous child was born healthy with no complications. Which of the following is most consistent with this neonate’s most likely condition?? {'A': 'The neonate developed IgM autoantibodies to its own red blood cells', 'B': 'The mother generated IgG antibodies against fetal red blood cells', 'C': 'The mother generated IgM antibodies against fetal red blood cells', 'D': 'This condition could have been prevented with the administration of glucocorticoids', 'E': 'Vitamin K deficiency has led to hemolytic anemia'},
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B: The mother generated IgG antibodies against fetal red blood cells
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Q:A 39-year-old female with poorly controlled systemic lupus erythematosus (SLE) presents to the emergency room with a cough and pleuritic chest pain. She states that she developed these symptoms 2 days prior. The pain appears to improve when the patient leans forward. She currently takes hydroxychloroquine for her systemic lupus erythematosus but has missed several doses recently. Her temperature is 99°F (37.2°C), blood pressure is 135/80 mmHg, pulse is 115/min, and respirations are 22/min. Physical examination reveals a rise in jugular venous pressure during inspiration. In addition to tachycardia, which of the following EKG patterns is most likely to be seen in this patient?? {'A': 'Prolonged PR interval with normal QRS complexes', 'B': 'Peaked T waves with flattened P waves', 'C': 'Irregularly irregular QRS complexes with no P waves', 'D': 'ST segment depressions in leads II, III, and aVF', 'E': 'PR depressions and diffuse ST elevations'},
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E: PR depressions and diffuse ST elevations
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Q:A 32-year-old male patient presents to the emergency department after being found down on a sidewalk. He is able to be aroused but seems confused and confabulates extensively during history taking. Physical exam of the eye reveals nystagmus and the patient is unable to complete finger-to-nose or heel-to-shin testing. Chart review shows that the patient is well known for a long history of alcohol abuse. Which of the following substances should be administered prior to giving IV glucose to this patient?? {'A': 'Vitamin B1', 'B': 'Vitamin B12', 'C': 'Vitamin C', 'D': 'Folate', 'E': 'Fomepizole'},
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A: Vitamin B1
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Q:A 6-month-old boy is referred to a geneticist after he is found to have persistent hypotonia and failure to thrive. He has also had episodes of what appears to be respiratory distress and has an enlarged heart on physical exam. There is a family history of childhood onset hypertrophic cardiomyopathy, so a biopsy is performed showing electron dense granules within the lysosomes. Genetic testing is performed showing a defect in glycogen processing. A deficiency in which of the following enzymes is most likely to be responsible for this patient's symptoms?? {'A': 'Glucose-6-phosphatase', 'B': 'Lysosomal alpha 1,4-glucosidase', 'C': 'Debranching enzyme', 'D': 'Branching enzyme', 'E': 'Muscle phosphorylase'},
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B: Lysosomal alpha 1,4-glucosidase
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Q:A 68-year-old man is brought to the physician by his wife because she is concerned about his speech being irregular. Specifically, she says that over the last 8 months, her husband has been saying increasingly nonsensical statements at home. In addition, he is no longer able to perform basic verbal tasks such as ordering from a menu or giving directions even though he was an English teacher prior to retirement. She also reports that he has recently started attempting to kiss strangers and urinate in public. Finally, she has also noticed that he has been frequently binge eating sweets even though he was previously very conscientious about his health. When asked about these activities, the patient does not have insight into his symptoms. Which of the following would most likely be seen in this patient?? {'A': 'Alpha-synuclein', 'B': 'Intracellular hyperphosphorylated tau proteins', 'C': 'Hyperphosphorylated tau inclusion bodies', 'D': 'Large intracellular vacuoles', 'E': 'Perivascular inflammation'},
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C: Hyperphosphorylated tau inclusion bodies
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Q:A 3-year-old boy is brought to your pediatrics office by his parents for a well-child checkup. The parents are Amish and this is the first time their child has seen a doctor. His medical history is unknown, and he was born at 39 weeks gestation. His temperature is 98.3°F (36.8°C), blood pressure is 97/58 mmHg, pulse is 90/min, respirations are 23/min, and oxygen saturation is 99% on room air. The child is in the corner stacking blocks. He does not look the physician in the eye nor answer your questions. He continually tries to return to the blocks and becomes very upset when you move the blocks back to their storage space. The parents state that the child has not begun to speak and often exhibits similar behaviors with toy blocks he has at home. On occasion, they have observed him biting his elbows. Which of the following is the best next step in management?? {'A': 'Educating the parents about autism spectrum disorder', 'B': 'Fluoxetine', 'C': 'Hearing exam', 'D': 'Restructuring of the home environment', 'E': 'Risperidone'},
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C: Hearing exam
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Q:A 26-year-old primigravid woman at 39 weeks' gestation is admitted to the hospital in active labor. Pregnancy was complicated by mild oligohydramnios detected a week ago, which was managed with hydration. Her pulse is 92/min, respirations are 18/min, and blood pressure is 134/76 mm Hg. Pelvic examination shows 100% cervical effacement and 10 cm cervical dilation; the vertex is at 0 station. Cardiotocography is shown. Which of the following is the most appropriate next step in management?? {'A': 'Emergent cesarean section', 'B': 'Reassurance', 'C': 'Maternal repositioning and oxygen administration', 'D': 'Elevation of the fetal head', 'E': 'Rapid amnioinfusion'},
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C: Maternal repositioning and oxygen administration
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Q:A 22-year-old sexually active female presents to the emergency department in severe pain. She states that she has significant abdominal pain that seems to worsen whenever she urinates. This seems to have progressed over the past day and is accompanied by increased urge and frequency. The emergency room physician obtains a urinalysis which demonstrates the following: SG: 1.010, Leukocyte esterase: Positive, Protein: Trace, pH: 7.5, RBC: Negative. Nitrite: Negative. A urease test is performed which is positive. What is most likely cause of UTI in this patient?? {'A': 'Klebsiella pneumoniae', 'B': 'Staphylococcus saprophyticus', 'C': 'Proteus mirabilis', 'D': 'Escherichia coli', 'E': 'Serratia marcescens'},
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B: Staphylococcus saprophyticus
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Answer the following medical question with one of the provided options:
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Q:A 10-year-old boy is brought to the emergency department due to vomiting and weakness. He is attending a summer camp and was on a hike with the other kids and a camp counselor. His friends say that the boy skipped breakfast, and the counselor says he forgot to pack snacks for the kids during the hike. The child’s parents are contacted and report that the child has been completely healthy since birth. They also say there is an uncle who would have to eat regularly or he would have similar symptoms. At the hospital, his heart rate is 90/min, respiratory rate is 17/min, blood pressure is 110/65 mm Hg, and temperature is 37.0°C (98.6°F). Physical examination reveals a visibly lethargic child with slight disorientation to time and place. Mild hepatosplenomegaly is observed but no signs of dehydration are noted. A blood sample is drawn, and fluids are started via an intravenous line. Lab report Serum glucose 44 mg/dL Serum ketones absent Serum creatinine 1.0 mg/dL Blood urea nitrogen 32 mg/dL Alanine aminotransferase (ALT) 425 U/L Aspartate aminotransferase (AST) 372 U/L Hemoglobin (Hb%) 12.5 g/dL Mean corpuscular volume (MCV) 80 fl Reticulocyte count 1% Erythrocyte count 5.1 million/mm3 Which of the following is most likely deficient in this patient?? {'A': 'α-glucosidase', 'B': 'Acetyl-CoA carboxylase', 'C': 'Acyl-CoA dehydrogenase', 'D': 'Glucose-6-phosphatase', 'E': 'Nicotinic acid'},
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C: Acyl-CoA dehydrogenase
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Q:A middle aged man is brought in by emergency medical services after being found unconscious, lying on the street next to an empty bottle of vodka. His past medical history is unknown. Upon evaluation, he opens his eyes spontaneously and is able to obey commands. After peripheral access is obtained, IV normal saline and glucose are administered. Suddenly, the patient becomes confused and agitated. Horizontal nystagmus is noted on exam. This acute presentation was likely caused by a deficiency in which of the following?? {'A': 'Vitamin A', 'B': 'Vitamin B12', 'C': 'Vitamin B9', 'D': 'Vitamin B6', 'E': 'Vitamin B1'},
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E: Vitamin B1
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Q:A 22-year-old woman is brought to the physician by her husband because of a gradual 20-kg (45-lb) weight loss and recurrent episodes of vomiting without diarrhea over the past 2 years. Her last menstrual period was 6 months ago. On physical examination, she appears fatigued and emaciated, and there is bilateral swelling of the retromandibular fossa. Laboratory studies show hypokalemia and a hemoglobin concentration of 8 g/dL. Which of the following additional findings is most likely in this patient?? {'A': 'Decreased growth hormone', 'B': 'Increased testosterone', 'C': 'Decreased triiodothyronine', 'D': 'Increased beta-hCG', 'E': 'Increased leptin'},
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C: Decreased triiodothyronine
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Q:A 32-year-old man presents to the physician with a history of fever, malaise, and arthralgia in the large joints for the last 2 months. He also mentions that his appetite has been significantly decreased during this period, and he has lost considerable weight. He also informs the physician that he often experiences tingling and numbness in his right upper limb, and his urine is also dark in color. The past medical records show that he was diagnosed with an infection 7 months before and recovered well. On physical examination, the temperature is 37.7°C (99.8°F), the pulse rate is 86/min, the respiratory rate is 14/min, and the blood pressure is 130/94 mm Hg. Which of the following infections has most likely caused the condition the patient is suffering from?? {'A': 'Hepatitis B virus', 'B': 'Epstein-Barr virus infection', 'C': 'Mycoplasma pneumoniae', 'D': 'Chlamydophila pneumoniae', 'E': 'Yersinia enterocolitica'},
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A: Hepatitis B virus
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Q:A 20-year-old man presents to his physician with diarrhea, vomiting, and fever for the past 2 days. After laboratory evaluation, he is diagnosed with bacterial gastroenteritis. The man is a microbiology major and knows that the human gastrointestinal tract, respiratory tract, and skin are lined by epithelia which act as a barrier against several infective microorganisms. He also knows that there are specific T cells in these epithelia that play a part in innate immunity and in recognition of microbial lipids. Which of the following types of T cells is the man thinking of?? {'A': 'Naïve T cells', 'B': 'Natural killer T cells', 'C': 'Αβ T cells', 'D': 'γδ T cells', 'E': 'Regulatory T cells'},
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D: γδ T cells
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Q:A 28-year-old man presents with a yellow coloration of his skin. He says he feels well and denies any recent history of nausea, fatigue or fever, or discoloration of his urine or stool. The patient reports episodes with similar symptoms in the past. Family history is significant for similar symptoms in his father. The patient is afebrile and vital signs are within normal limits. On physical examination, he is jaundiced. Scleral icterus is present. Laboratory findings are significant only for an unconjugated hyperbilirubinemia. Liver enzymes are normal, and there is no bilirubin present in the urine. Which of the following is the most appropriate treatment for this patient’s most likely diagnosis?? {'A': 'Inhibitors of heme oxygenase', 'B': 'Phenobarbital', 'C': 'Phototherapy', 'D': 'No therapy indicated', 'E': 'Plasma exchange transfusion'},
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D: No therapy indicated
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Q:A 5-month-old boy is brought to the physician by his mother because of poor weight gain and chronic diarrhea. He has had 3 episodes of otitis media since birth. Pregnancy and delivery were uncomplicated but his mother received no prenatal care. His immunizations are up-to-date. He is at the 10th percentile for height and 5th percentile for weight. Physical examination shows thick white plaques on the surface of his tongue that can be easily scraped off with a tongue blade. Administration of which of the following is most likely to have prevented this patient's condition?? {'A': 'Fluconazole', 'B': 'Pencillin G', 'C': 'Zidovudine', 'D': 'Rifampin', 'E': 'Ganciclovir'},
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C: Zidovudine
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Answer the following medical question with one of the provided options:
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Q:In the coronary steal phenomenon, vessel dilation is paradoxically harmful because blood is diverted from ischemic areas of the myocardium. Which of the following is responsible for the coronary steal phenomenon?? {'A': 'Venodilation', 'B': 'Microvessel dilation', 'C': 'Dilation of the large coronary arteries', 'D': 'Arterial dilation', 'E': 'Volume loss of fluid in the periphery'},
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B: Microvessel dilation
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Q:A 15-year-old boy is brought to the emergency department one hour after sustaining an injury during football practice. He collided head-on into another player while wearing a mouthguard and helmet. Immediately after the collision he was confused but able to use appropriate words. He opened his eyes spontaneously and followed commands. There was no loss of consciousness. He also had a headache with dizziness and nausea. He is no longer confused upon arrival. He feels well. Vital signs are within normal limits. He is fully alert and oriented. His speech is organized and he is able to perform tasks demonstrating full attention, memory, and balance. Neurological examination shows no abnormalities. There is mild tenderness to palpation over the crown of his head but no signs of skin break or fracture. Which of the following is the most appropriate next step?? {'A': 'Discharge without activity restrictions', 'B': 'Administer prophylactic levetiracetam and observe for 24 hours', 'C': 'Administer prophylactic phenytoin and observe for 24 hours', 'D': 'Discharge and refrain from all physical activity for one week', 'E': 'Observe for 6 hours in the ED and refrain from contact sports for one week'},
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E: Observe for 6 hours in the ED and refrain from contact sports for one week
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Q:A 26-year-old woman comes to the emergency department 30 minutes after she was bitten by her neighbor's cat. She has no history of serious illness and takes no medications. She received all recommended immunizations during childhood but has not received any since then. Vital signs are within normal limits. Physical examination shows four puncture wounds on the thenar eminence of the right hand. There is mild swelling but no erythema. There is normal range of motion of her right thumb and wrist. The wound is cleaned with povidone iodine and irrigated with saline. Which of the following is the most appropriate next step in management?? {'A': 'Obtain a wound culture', 'B': 'Administer oral amoxicillin-clavulanate', 'C': 'Close the wound surgically', 'D': 'Close the wound with cyanoacrylate tissue adhesive', 'E': 'Administer tetanus toxoid and tetanus IV immunoglobulin'},
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B: Administer oral amoxicillin-clavulanate
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Answer the following medical question with one of the provided options:
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Q:An 11-month-old boy is brought to the pediatrician by his mother due to fever and tugging at his right ear. The mother says that he is currently irritable with a mild fever. About 1 week ago, he had a mild cough, mild fever, body aches, and a runny nose. He was treated with children’s Tylenol and the symptoms resolved after a few days. The child lives in an apartment with his mother, grandmother, and father. His grandmother watches him during the day. There have been no sick contacts at home. His father smokes cigarettes on the balcony. There is no pertinent family history. He was born full term by spontaneous vaginal delivery. He is progressing through his developmental milestones and is up to date on his vaccines. His temperature is 39.3°C (102.7°F), pulse is 122/min, and respirations are 24 /min. The child appears cranky and requires consoling during the physical exam. His heart and lung exam are normal. He has a red and mildly swollen right ear. Otoscopic evaluation of the right ear reveals the finding shown in the image below. Which of the following most likely contributed to this patient’s condition?? {'A': 'Day care exposure', 'B': 'Cystic Fibrosis', 'C': 'Trisomy 21', 'D': 'Immunodeficiency', 'E': 'Second hand smoke'},
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E: Second hand smoke
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Q:A 43-year-old male is transferred from an outside hospital to the neurologic intensive care unit for management of a traumatic brain injury after suffering a 30-foot fall from a roof-top. He now lacks decision-making capacity but does not fulfill the criteria for brain-death. The patient does not have a living will and did not name a specific surrogate decision-maker or durable power of attorney. Which of the following would be the most appropriate person to name as a surrogate decision maker for this patient?? {'A': "The patient's 67-year-old mother", 'B': "The patient's girlfriend of 12 years", 'C': "The patient's 22-year-old daughter", 'D': "The patient's older brother", 'E': "The patient's younger sister"},
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C: The patient's 22-year-old daughter
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Answer the following medical question with one of the provided options:
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Q:A previously healthy 33-year-old woman comes to the emergency department because she could feel her heart racing intermittently for the last 2 hours. Each episode lasts about 10 minutes. She does not have any chest pain. Her mother died of a heart attack and her father had an angioplasty 3 years ago. She has smoked a half pack of cigarettes daily for 14 years. She drinks one to two beers daily. She appears anxious. Her temperature is 37.6°C (98.1°F), pulse is 160/min, and blood pressure is 104/76 mm Hg. The lungs are clear to auscultation. Cardiac examination shows no murmurs, rubs, or gallops. An ECG is shown. Which of the following is the most appropriate initial step in management?? {'A': 'Intravenous procainamide', 'B': 'Vagal maneuvers', 'C': 'Coronary angioplasty', 'D': 'Intravenous adenosine', 'E': 'Aspirin'},
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B: Vagal maneuvers
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Answer the following medical question with one of the provided options:
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Q:A 19-year-old female presents with a malodorous vaginal discharge. She notes that the odor is more prominent after sexual intercourse. She is sexually active with one partner and uses barrier contraception. Her past medical history is significant only for community-acquired pneumonia treated with antibiotics 2 months ago. The vital signs were as follows: blood pressure, 110/70 mm Hg; heart rate, 68/min; respiratory rate, 12/min; and temperature, 36.6℃ (97.9℉). The physical examination was normal. On gynecologic examination, the vaginal walls and cervix appeared normal. There was a gray, thin, homogeneous discharge with bubbles. The pH of the discharge was approximately 6.0. Which of the following findings would be expected on further investigation of this patient?? {'A': 'Gram-positive diplococci on Gram stain', 'B': 'Negative whiff test', 'C': 'Bacteria-coated epithelial cells on wet mount microscopy', 'D': 'Motile protozoa on wet mount microscopy', 'E': 'Numerous gram-positive rod-shaped bacteria on Gram stain'},
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C: Bacteria-coated epithelial cells on wet mount microscopy
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Q:A 42-year-old man presents to the clinic for a several-month history of fatigue, and it is starting to affect his work. He often needs to sneak away in the middle of the day to take naps or else he cannot focus and is at risk of falling asleep at his desk. He has been feeling like this for approximately 1 year. Otherwise, he feels healthy and takes no medications. On further questioning, he also had constipation and thinks he has gained some weight. He denies shortness of breath, chest pain, lightheadedness, or blood in his stool. The vital signs include: pulse 56/min, blood pressure 124/78 mm Hg, and oxygen saturation 99% on room air. The physical exam is notable only for slightly dry skin. The complete blood count (CBC) is within normal limits, and the thyroid-stimulating hormone (TSH) is 8.0 μU/mL. Which of the following is the next best treatment for this patient?? {'A': 'Erythropoietin', 'B': 'Inhaled fluticasone plus salmeterol', 'C': 'Levothyroxine', 'D': 'Packed red blood cell (RBC) transfusion', 'E': 'Prednisone'},
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C: Levothyroxine
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Q:A 22-year-old primigravid woman at 41 weeks' gestation is admitted to the hospital in active labor. Pregnancy has been uncomplicated. She has asthma treated with theophylline and inhaled corticosteroids. She has had 2 surgeries in the past to repair multiple lower limb and pelvis fractures that were the result of a car accident. She is otherwise healthy. Her temperature is 37.2°C (99°F) and blood pressure is 108/70 mm Hg. Examination shows the cervix is 100% effaced and 10 cm dilated; the vertex is at -4 station, with the occiput in the anterior position. Uterine activity is measured at 275 MVUs. Maternal pushing occurs during the contractions. Fetal heart tracing is 166/min and reactive with no decelerations. Epidural anesthesia is initiated for pain relief. After 4 hours of pushing, the vertex is found to be at -4 station, with increasing strength and rate of uterine contractions; fetal heart tracing shows late decelerations. Which of the following is the most likely cause of this patient's prolonged labor?? {'A': 'Inefficient maternal pushing', 'B': 'Epidural anesthesia', 'C': 'Insufficient uterine contraction', 'D': 'Cephalopelvic disproportion', 'E': 'Deep transverse arrest'},
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D: Cephalopelvic disproportion
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Answer the following medical question with one of the provided options:
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Q:A senior medicine resident receives negative feedback on a grand rounds presentation from his attending. He is told sternly that he must improve his performance on the next project. Later that day, he yells at his medical student for not showing enough initiative, though he had voiced only satisfaction with the student's performance up until this point. Which of the following psychological defense mechanisms is he demonstrating?? {'A': 'Transference', 'B': 'Countertransference', 'C': 'Externalization', 'D': 'Displacement', 'E': 'Projection\n"'},
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D: Displacement
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Answer the following medical question with one of the provided options:
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Q:A 33-year-old man visits his psychiatrist with feelings of sadness on most days of the week for the past 4 weeks. He says that he is unable to participate in his daily activities and finds it hard to get out of bed on most days. If he has nothing scheduled for the day, he sometimes sleeps for 10–12 hours at a stretch. He has also noticed that on certain days, his legs feel heavy and he finds it difficult to walk, as though there are bricks tied to his feet. However, he is still able to attend social events and also enjoys playing with his children when he comes home from work. Other than these simple pleasures, he has lost interest in most of the activities he previously enjoyed. Another troubling fact is that he had gained weight over the past month, mainly because he eats so much when overcome by these feelings of depression. His is prescribed a medication to treat his symptoms. Which of the following is the mechanism of action of the drug he was most likely prescribed?? {'A': 'Inhibit the uptake of serotonin and norepinephrine at the presynaptic cleft', 'B': 'Non-selectively inhibits monoamine oxidase A and B', 'C': 'Stimulates the release of norepinephrine and dopamine in the presynaptic cleft', 'D': 'Works as an antagonist at the dopamine and serotonin receptors', 'E': 'Activates the Ƴ-aminobutyric acid receptors'},
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B: Non-selectively inhibits monoamine oxidase A and B
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Answer the following medical question with one of the provided options:
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Q:A 27-year-old man presents to the emergency department for altered mental status. The patient was found napping in a local market and brought to the hospital. The patient has a past medical history of polysubstance abuse and is homeless. His temperature is 104°F (40.0°C), blood pressure is 100/52 mmHg, pulse is 133/min, respirations are 25/min, and oxygen saturation is 99% on room air. Physical exam is notable for an altered man. Cardiopulmonary exam reveals a murmur over the left lower sternal border. A bedside ultrasound reveals a vegetation on the tricuspid valve. The patient is ultimately started on IV fluids, norepinephrine, vasopressin, vancomycin, and piperacillin-tazobactam. A central line is immediately placed in the internal jugular vein and the femoral vein secondary to poor IV access. Cardiothoracic surgery subsequently intervenes to remove the vegetation. While recovering in the ICU, days 3-5 are notable for an improvement in the patient’s symptoms. Two additional peripheral IVs are placed while in the ICU on day 5, and the femoral line is removed. On day 6, the patient's fever and hemodynamic status worsen. Though he is currently responding and not complaining of any symptoms including headache, photophobia, neck stiffness, or pain, he states he is feeling weak. Jolt accentuation of headache is negative and his abdominal exam is benign. A chest radiograph, urinalysis, and echocardiogram are unremarkable though the patient’s blood cultures are positive when drawn. Which of the following is the best next step in management?? {'A': 'Add cefepime to the patient’s antibiotics', 'B': 'Add micafungin to the patient’s antibiotics', 'C': 'Remove all peripheral IV’s and send for cultures', 'D': 'Remove the central line and send for cultures', 'E': 'Perform a lumbar puncture'},
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D: Remove the central line and send for cultures
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Q:A 25-year-old man is brought to the emergency department by his girlfriend for a nosebleed. Pinching the nose for the past hour has not stopped the bleeding. For the past several months, he has had recurring nosebleeds that resolved with pressure. He has no history of hypertension or trauma. He has asthma that is well controlled with an albuterol inhaler. He has intermittent tension headaches for which he takes aspirin. His temperature is 37.9°C (100.2°F), pulse is 114/min, and blood pressure is 160/102 mm Hg. Physical examination shows active bleeding from both nostrils. Pupil size is 6 mm bilaterally in bright light. The lungs are clear to auscultation. The hemoglobin concentration is 13.5 g/dL, prothrombin time is 12 seconds, partial thromboplastin time is 35 seconds, and platelet count is 345,000/mm3. Which of the following is the most likely explanation for this patient's symptoms?? {'A': 'Hypertension', 'B': 'Hereditary hemorrhagic telangiectasia', 'C': 'Adverse effect of medication', 'D': 'Cocaine use', 'E': 'Nasopharyngeal angiofibroma\n"'},
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D: Cocaine use
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Q:A 36-year-old man presents with increasing shortness of breath for a month, which is aggravated while walking and climbing up the stairs. He also complains of pain and stiffness in both wrists, and the distal interphalangeal and metacarpophalangeal joints of both hands. He was diagnosed with rheumatoid arthritis 6 months ago and was started on methotrexate with some improvement. He is a lifetime non-smoker and has no history of drug abuse. The family history is insignificant for any chronic disease. The blood pressure is 135/85 mm Hg, pulse rate is 90/min, temperature is 36.9°C (98.5°F), and the respiratory rate is 22/min. Physical examination reveals short rapid breathing with fine end-inspiratory rales. An echocardiogram is normal with an ejection fraction of 55%. A chest X-ray shows diffuse bilateral reticular markings with multiple pulmonary nodules. Which of the following is the most likely cause of this patient’s lung condition?? {'A': 'Granulomatous lung disease', 'B': 'Drug-induced pulmonary disease', 'C': 'Cardiogenic pulmonary edema', 'D': 'Idiopathic pulmonary fibrosis', 'E': 'Radiation-induced pulmonary disease'},
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B: Drug-induced pulmonary disease
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Q:A 27-year-old man presents to the emergency department after being stabbed. The patient was robbed at a local pizza parlor and was stabbed over 10 times with a large kitchen knife with an estimated 7 inch blade in the ventral abdomen. His temperature is 97.6°F (36.4°C), blood pressure is 74/54 mmHg, pulse is 180/min, respirations are 19/min, and oxygen saturation is 98% on room air. The patient is intubated and given blood products and vasopressors. Physical exam is notable for multiple stab wounds over the patient's abdomen inferior to the nipple line. Which of the following is the best next step in management?? {'A': 'CT scan of the abdomen and pelvis', 'B': 'Diagnostic peritoneal lavage', 'C': 'Exploratory laparoscopy', 'D': 'Exploratory laparotomy', 'E': 'FAST exam'},
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D: Exploratory laparotomy
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Answer the following medical question with one of the provided options:
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Q:A 37-year-old woman comes to the physician because of irregular menses and generalized fatigue for the past 4 months. Menses previously occurred at regular 25- to 29-day intervals and lasted for 5 days but now occur at 45- to 60-day intervals. She has no history of serious illness and takes no medications. She is 155 cm (5 ft 1 in) tall and weighs 89 kg (196 lb); BMI is 37 kg/m2. Her temperature is 37°C (98.6°F), pulse is 90/min, and blood pressure is 146/100 mm Hg. Examination shows facial hair as well as comedones on the face and back. There are multiple ecchymotic patches on the trunk. Neurological examination shows weakness of the iliopsoas and biceps muscles bilaterally. Laboratory studies show: Hemoglobin 13.1 g/dL Leukocyte count 13,500/mm3 Platelet count 510,000/mm3 Serum Na+ 145 mEq/L K+ 3.3 mEq/L Cl- 100 mEq/L Glucose 188 mg/dL Which of the following is the most likely diagnosis?"? {'A': 'Cushing syndrome', 'B': 'Primary hyperaldosteronism', 'C': 'Pheochromocytoma', 'D': 'Polycystic ovarian syndrome', 'E': 'Hypothyroidism'},
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A: Cushing syndrome
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Q:A 18-year-old male presents to his primary care provider with his parents for a sports physical. He was last seen in clinic several months ago, when he was diagnosed with attention deficit hyperactivity disorder (ADHD). He was started on methylphenidate at that time, and the patient now reports improvement in his ability to concentrate in school and at home. He hopes to play baseball in college and has begun lifting weights daily in preparation for baseball season. The patient reports that he eats a healthy diet to fuel his exercise regimen. His parents have no concerns and are pleased with the recent improvement in his grades. On physical exam, the patient has tall stature with average muscle mass for his age. He has no dysmorphic features. His chest has a normal appearance other than mild gynecomastia. The patient has sparse facial hair and a moderate amount of coarse pubic hair that extends across the pubis and spares the medial thighs. His testes are small and firm. Due to the latter, laboratory testing is performed and reveals the following: Follicle-stimulating hormone (FSH): 42 mIU/mL (Reference range: 4-25 mIU/mL) Luteinizing hormone (LH): 38 mIU/mL (Reference range: 6-23 mIU/mL) Which of the following is the most likely etiology of this patient’s presentation?? {'A': 'Anabolic steroid use', 'B': 'CGG trinucleotide repeat disorder', 'C': 'CTG trinucleotide repeat disorder', 'D': 'Failure of neuronal migration', 'E': 'Meiotic nondisjunction'},
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E: Meiotic nondisjunction
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Answer the following medical question with one of the provided options:
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Q:Following passage of a calcium oxalate stone, a 55-year-old male visits his physician to learn about nephrolithiasis prevention. Which of the following changes affecting urine composition within the bladder are most likely to protect against crystal precipitation?? {'A': 'Increased calcium, increased citrate, increased oxalate, increased free water clearance', 'B': 'Decreased calcium, increased citrate, increased oxalate, increased free water clearance', 'C': 'Decreased calcium, decreased citrate, increased oxalate, increased free water clearance', 'D': 'Decreased calcium, increased citrate, decreased oxalate, increased free water clearance', 'E': 'Decreased calcium, increased citrate, increased oxalate, decreased free water clearance'},
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D: Decreased calcium, increased citrate, decreased oxalate, increased free water clearance
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Q:A 67-year-old woman is brought to the emergency department for the evaluation of fever, chest pain, and a cough productive of a moderate amount of greenish-yellow sputum for 2 days. During this period, she has had severe malaise, chills, and difficulty breathing. She has hypertension, hypercholesterolemia, and type 2 diabetes mellitus. She smoked one pack of cigarettes daily for 20 years, but quit 5 years ago. Current medications include simvastatin, captopril, and metformin. Temperature is 39°C (102.2°F), pulse is 110/min, respirations are 33/min, and blood pressure is 143/88 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 94%. Crackles are heard on auscultation of the right upper lobe. Laboratory studies show a leukocyte count of 12,300/mm3, an erythrocyte sedimentation rate of 60 mm/h, and a urea nitrogen of 15 mg/dL. A chest x-ray is shown. Which of the following is the most appropriate next step in the management of this patient?? {'A': 'Inpatient treatment with cefepime, azithromycin, and gentamicin', 'B': 'Outpatient treatment with azithromycin and amoxicillin-clavulanate', 'C': 'Inpatient treatment with azithromycin and cefotaxime', 'D': 'ICU admission and administration of ampicillin-sulbactam and levofloxacin', 'E': 'Inpatient treatment with ceftriaxone'},
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C: Inpatient treatment with azithromycin and cefotaxime
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Answer the following medical question with one of the provided options:
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Q:A study is conducted to investigate the relationship between the development of type 2 diabetes mellitus and the use of atypical antipsychotic medications in patients with schizophrenia. 300 patients who received the atypical antipsychotic clozapine and 300 patients who received the typical antipsychotic haloperidol in long-acting injectable form were followed for 2 years. At the end of the observation period, the incidence of type 2 diabetes mellitus was compared between the two groups. Receipt of clozapine was found to be associated with an increased risk of diabetes mellitus relative to haloperidol (RR = 1.43, 95% p<0.01). Developed type 2 diabetes mellitus Did not develop type 2 diabetes mellitus Clozapine 30 270 Haloperidol 21 279 Based on these results, what proportion of patients receiving clozapine would not have been diagnosed with type 2 diabetes mellitus if they had been taking a typical antipsychotic?"? {'A': '33.3', 'B': '0.3', 'C': '0.03', 'D': '1.48', 'E': '0.43'},
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C: 0.03
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Q:A 44-year-old woman presents to her primary care physician for worsening dysuria, hematuria, and lower abdominal pain. Her symptoms began approximately 2 days ago and have progressively worsened. She denies headache, nausea, vomiting, or diarrhea. She endorses feeling "feverish" and notes to having foul smelling urine. She has a past medical history of Romano-Ward syndrome and is not on any treatment. She experiences profuse diarrhea and nausea when taking carbapenems and develops a severe rash with cephalosporins. Her temperature is 100.4°F (38C), blood pressure is 138/93 mmHg, pulse is 100/min, and respirations are 18/min. On physical exam, the patient appears uncomfortable and there is tenderness to palpation around the bilateral flanks and costovertebral angle. A urinalysis and urine culture is obtained and appropriate antibiotics are administered. On her next clinical visit urine studies and a basic metabolic panel is obtained, which is shown below: Serum: Na+: 140 mEq/L Cl-: 101 mEq/L K+: 4.2 mEq/L HCO3-: 22 mEq/L BUN: 20 mg/dL Glucose: 94 mg/dL Creatinine: 2.4 mg/dL Urinalysis Color: Yellow Appearance: Clear Blood: Negative pH: 7 (Normal 5-8) Protein: Negative Nitrite: Negative Leukocyte esterase: Negative Cast: Epithelial casts FeNa: 3% Urine culture Preliminary report: 10,000 CFU/mL E. coli Which of the following antibiotics was most likely given to this patient?? {'A': 'Aztreonam', 'B': 'Clindamycin', 'C': 'Levofloxacin', 'D': 'Tobramycin', 'E': 'Vancomycin'},
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D: Tobramycin
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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 presents to the physician due to difficulty initiating and sustaining erections for the past year. According to the patient, he has a loving wife and he is still attracted to her sexually. While he still gets an occasional erection, he has not been able to maintain an erection throughout intercourse. He no longer gets morning erections. He is happy at work and generally feels well. His past medical history is significant for angina and he takes isosorbide dinitrate as needed for exacerbations. His pulse is 80/min, respirations are 14/min, and blood pressure is 130/90 mm Hg. The physical examination is unremarkable. Nocturnal penile tumescence testing reveals the absence of erections during the night. The patient expresses a desire to resume sexual intimacy with his spouse. Which of the following is the best next step to treat this patient?? {'A': 'Check prolactin levels', 'B': 'Refer to a psychiatrist', 'C': 'Start captopril', 'D': 'Start sildenafil', 'E': 'Stop isosorbide dinitrate'},
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A: Check prolactin levels
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Q:A 3-year-old girl is brought to the physician because of a cough for 2 days. The cough occurs as paroxysmal spells, with vomiting sometimes occurring afterwards. She takes a deep breath after these spells that makes a whooping sound. She has been unable to sleep well because of the cough. She had a runny nose and low-grade fever 1 week ago. She was admitted at the age of 9 months for bronchiolitis. Her immunizations are incomplete, as her parents are afraid of vaccine-related complications. She attends a daycare center but there have been no other children who have similar symptoms. She appears well. Cardiopulmonary examination shows no abnormalities. Her hemoglobin concentration is 13.3 g/dL, leukocyte count is 41,000/mm3, platelet count is 230,000/mm3 and erythrocyte sedimentation rate is 31 mm/hr. An x-ray of the chest is unremarkable. The patient is at increased risk for which of the following complications?? {'A': 'Asthma', 'B': 'Hemolytic anemia', 'C': 'Hemoptysis', 'D': 'Pericarditis', 'E': 'Pneumothorax'},
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E: Pneumothorax
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Answer the following medical question with one of the provided options:
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Q:A 34-year-old man is brought to the emergency room by emergency medical technicians after being found unconscious near a park bench. He appears disheveled with a strong odor of alcohol. There is no known past medical history other than treatment for alcohol withdrawal in the past at this institution.The patient is laying on the stretcher with altered mental status, occasionally muttering a few words that are incomprehensible to the examiner. Physical examination reveals a heart rate of 94/min, blood pressure of 110/62 mm Hg, respiratory rate of 14/min, and temperature is 37.0°C (98.6°F). The patient’s physical exam is otherwise unremarkable with lungs clear to auscultation, a soft abdomen, and no skin rashes. Initial laboratory findings reveal: Blood glucose 56 mg/dL Blood alcohol level 215 mg/dL Hemoglobin 10.9 g/dL WBC 10,000/mm3 Platelets 145,000/mm3 Lactate level 2.2 mmol/L Which of the following describes the most likely physiological factor underlying the patient’s hypoglycemia?? {'A': 'Increase in insulin secretion', 'B': 'A decrease in the ratio of reduced form of nicotinamide adenine dinucleotide to nicotinamide adenine dinucleotide (NADH/NAD+ ratio)', 'C': 'Alcohol dehydrogenase-induced diuresis', 'D': 'Overactive pyruvate dehydrogenase', 'E': 'Glycogen depletion'},
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E: Glycogen depletion
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Answer the following medical question with one of the provided options:
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Q:A 68-year-old man is admitted to the emergency department after 2 days of difficulty breathing and fever. His past medical history is significant for hypertension and benign prostate hypertrophy. He takes hydrochlorothiazide and tamsulosin. He also admits to drinking alcohol on the weekends and a half pack a day smoking habit. Upon admission, he is found to have blood pressure of 125/83 mm Hg, pulse of 88/min, a respiratory rate of 28/min, and a temperature of 38.9°C (102°F). On physical exam breath sounds are decreased at the left pulmonary base. A chest x-ray reveals consolidation in the left lower lobe. Additional laboratory tests demonstrate leukocytosis, elevated C-reactive protein, a serum creatinine (Cr) of 8.0 mg/dL, and a blood urea nitrogen (BUN) of 32 mg/dL. The patient is admitted to the hospital and started on cefepime and clarithromycin. His dyspnea slowly improves after 48 hours, however, his body temperature remains at 39°C (102.2°F). Recent laboratory tests show reduced C-reactive protein levels, a Cr of 1.8 mg/dL and a BUN of 35 mg/dL. A urinalysis is ordered. Which of the following would you expect to find in this patient’s urine?? {'A': 'White blood cell casts', 'B': 'Acanthocytes', 'C': 'Urate crystals', 'D': 'Hyaline casts', 'E': 'Calcium oxalate crystals'},
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A: White blood cell casts
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Q:A 29-year-old man comes to the emergency department because of progressively worsening fatigue and shortness of breath for the past 2 weeks. His only medication is insulin. Examination shows elevated jugular venous distention and coarse crackles in both lungs. Despite appropriate life-saving measures, he dies. Gross examination of the heart at autopsy shows concentrically thickened myocardium and microscopic examination shows large cardiomyocytes with intracellular iron granules. Examination of the spinal cord shows atrophy of the lateral corticospinal tracts, spinocerebellar tracts, and dorsal columns. Which of the following is the most likely underlying cause of this patient's condition?? {'A': 'SOD1 gene mutation on chromosome 21', 'B': 'CTG trinucleotide repeat expansion on chromosome 19', 'C': 'Dystrophin gene mutation on the X chromosome', 'D': 'GAA trinucleotide repeat expansion on chromosome 9', 'E': 'SMN1 gene mutation on chromosome 5'},
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D: GAA trinucleotide repeat expansion on chromosome 9
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Q:A 51-year-old woman comes to the physician because of a 3-month history of fatigue, increased urinary frequency, and low back pain. She reports frequent passing of hard stools, despite using stool softeners. During this time, she has not been as involved with her weekly book club. Her family is concerned that she is depressed. She has no history of serious illness. She has smoked 1 pack of cigarettes daily for the past 20 years. Her pulse is 71/min and blood pressure is 150/90 mm Hg. Abdominal examination shows right costovertebral angle tenderness. The patient's symptoms are most likely caused by hyperplasia of which of the following?? {'A': 'Chief cells in the parathyroid gland', 'B': 'Chromaffin cells in the adrenal gland', 'C': 'Parafollicular cells in the thyroid gland', 'D': 'Spindle cells in the kidney', 'E': 'Kulchitsky cells in the lung'},
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A: Chief cells in the parathyroid gland
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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 comes to the physician because of a 3-month history of increased flow and duration of her menses. Menses previously occurred at regular 28-day intervals and lasted 5 days with normal flow. They now last 8–9 days and the flow is heavy with the passage of clots. During this period, she has also had lower abdominal pain that begins 2–3 days prior to onset of her menses and lasts for 2 days after the end of her menses. She has three children. Her mother died of endometrial cancer at the age of 61 years. Her temperature is 37°C (98.6°F), pulse is 86/min, and blood pressure is 110/70 mm Hg. Pelvic examination shows a uniformly enlarged, boggy uterus consistent in size with an 8-week gestation that is tender on palpation. A urine pregnancy test is negative. Which of the following is the most likely cause of this patient's findings?? {'A': 'Benign tumor of the myometrium', 'B': 'Pedunculated endometrial mass', 'C': 'Endometrial tissue within the uterine wall', 'D': 'Abnormal thickening of endometrial tissue', 'E': 'Inflammation of the endometrium'},
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C: Endometrial tissue within the uterine wall
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Answer the following medical question with one of the provided options:
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Q:A 54-year-old man comes to the emergency department because of abdominal distension for the past 3 weeks. He also complains of generalized abdominal discomfort associated with nausea and decreased appetite. He was discharged from the hospital 3 months ago after an inguinal hernia repair with no reported complications. He has a history of type 2 diabetes mellitus, congestive heart failure, and untreated hepatitis C. His current medications include aspirin, atorvastatin, metoprolol, lisinopril, and metformin. His father has a history of alcoholic liver disease. He has smoked one pack of cigarettes daily for 30 years but quit 5 years ago. He drinks 3–4 beers daily. He appears cachectic. His vital signs are within normal limits. Examination shows a distended abdomen and shifting dullness. There is no abdominal tenderness or palpable masses. There is a well-healed surgical scar in the right lower quadrant. Examination of the heart and lung shows no abnormalities. He has 1+ bilateral lower extremity nonpitting edema. Diagnostic paracentesis is performed. Laboratory studies show: Hemoglobin 10 g/dL Leukocyte count 14,000/mm3 Platelet count 152,000/mm3 Serum Total protein 5.8 g/dL Albumin 3.5 g/dL AST 18 U/L ALT 19 U/L Total bilirubin 0.8 mg/dL HbA1c 8.1% Peritoneal fluid analysis Color Cloudy Cell count 550/mm3 with lymphocytic predominance Total protein 3.5 g/dL Albumin 2.6 g/dL Glucose 60 mg/dL Triglycerides 360 mg/dL Peritoneal fluid Gram stain is negative. Culture and cytology results are pending. Which of the following is the most likely cause of this patient's symptoms?"? {'A': 'Recent surgery', 'B': 'Lymphoma', 'C': 'Infection with gram-positive bacteria', 'D': 'Nephrotic syndrome', 'E': 'Acute decompensated heart failure'},
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B: Lymphoma
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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 presents with a skin rash that has spread on her arm over the last few days. She also complains of fever, headache, joint pain, and stiffness of the neck associated with the onset of the rash. On physical examination, there is an annular, red rash with a clear area in the center similar to a bull’s-eye (see image). The patient says she went on a camping trip to Connecticut last month but does not remember being bitten by an insect. Which of the following could result if this condition remains untreated in this patient?? {'A': 'Necrotizing fasciitis', 'B': 'Bell’s palsy', 'C': 'Pseudomembranous colitis', 'D': 'Subacute sclerosing panencephalitis', 'E': 'Mitral valve prolapse'},
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B: Bell’s palsy
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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 office with complaints of facial puffiness and mild swelling in his lower back. He denies chest pain, blood in the urine, or fever. He was recently diagnosed with colon cancer. The vital signs include a blood pressure of 122/78 mm Hg, a pulse of 76/min, a temperature of 36.9°C (98.4°F), and a respiratory rate of 10/min. On physical examination, there is mild facial puffiness that is pitting in nature and presacral edema. His other systemic findings are within normal limits. Urinalysis shows: pH 6.2 Color light yellow RBC none WBC 3–4/HPF Protein 4+ Cast oval fat bodies Glucose absent Crystal none Ketone absent Nitrite absent 24 hours urine protein excretion 4.8 g A renal biopsy is ordered and diffuse capillary and basement membrane thickening is noted. Which of the following findings is expected to be present if an electron microscopy of the biopsy sample is performed?? {'A': 'Basket-weave appearance of GBM', 'B': 'Effacement of foot process', 'C': 'Subepithelial humps', 'D': 'Spike and dome appearance', 'E': 'Massive amyloid deposition and spicular aggregates'},
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D: Spike and dome appearance
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Answer the following medical question with one of the provided options:
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Q:A 16-year-old female presents to her pediatrician’s office because she has not yet started menstruating. On review of systems, she states that she has been increasingly tired, constipated, and cold over the last 6 months. She also endorses a long history of migraines with aura that have increased in frequency over the last year. She complains that these symptoms have affected her performance on the track team. She states that she is not sexually active. Her mother and sister both underwent menarche at age 15. The patient is 5 feet, 4 inches tall and weighs 100 pounds (BMI 17.2 kg/m^2). Temperature is 98.4°F (36.9°C), blood pressure is 98/59 mmHg, pulse is 98/min, and respirations are 14/min. On exam, the patient appears pale and has thinning hair. She has Tanner stage IV breasts and Tanner stage III pubic hair. Which of the following would be most useful in determining this patient’s diagnosis?? {'A': 'Pelvic exam', 'B': 'Prolactin level', 'C': 'TSH level', 'D': 'GnRH level', 'E': 'FSH and estrogen levels'},
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E: FSH and estrogen levels
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Answer the following medical question with one of the provided options:
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Q:An investigator is working with a mutant strain of mice that lack a consistent density of sarcolemmal transverse tubules in the skeletal muscle cells. Which of the following is the most likely associated finding as a result of this abnormality?? {'A': 'Increased activation of myosin-light-chain phosphatase', 'B': 'Decreased entry of calcium at the presynaptic membrane', 'C': 'Decreased expression of sarcolemmal Na+/K+ ATPase', 'D': 'Impaired synchronization of cross-bridge formation', 'E': 'Impaired binding of acetylcholine to nicotinic acetylcholine receptors\n"'},
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D: Impaired synchronization of cross-bridge formation
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Answer the following medical question with one of the provided options:
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Q:A 4-year-old male is accompanied by his mother to the pediatrician. His mother reports that over the past two weeks, the child has had intermittent low grade fevers and has been more lethargic than usual. The child’s past medical history is notable for myelomeningocele complicated by lower extremity weakness as well as bowel and bladder dysfunction. He has been hospitalized multiple times at an outside facility for recurrent urinary tract infections. The child is in the 15th percentile for both height and weight. His temperature is 100.7°F (38.2°C), blood pressure is 115/70 mmHg, pulse is 115/min, and respirations are 20/min. Physical examination is notable for costovertebral angle tenderness that is worse on the right. Which of the following would most likely be found on biopsy of this patient’s kidney?? {'A': 'Mononuclear and eosinophilic infiltrate', 'B': 'Replacement of renal parenchyma with foamy histiocytes', 'C': 'Destruction of the proximal tubule and medullary thick ascending limb', 'D': 'Diffusely necrotic papillae with dystrophic calcification', 'E': 'Tubular colloid casts with diffuse lymphoplasmacytic infiltrate'},
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E: Tubular colloid casts with diffuse lymphoplasmacytic infiltrate
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Answer the following medical question with one of the provided options:
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Q:A 5-month-old girl is brought to the physician with a red lesion on her scalp that was first noticed 2 months ago. The lesion has been increasing in size slowly. It is not associated with pain or pruritus. She was born at 37 weeks of gestation after an uncomplicated pregnancy and delivery. The patient’s older sister is currently undergoing treatment for fungal infection of her feet. Examination reveals a solitary, soft lesion on the vertex of the scalp that blanches with pressure. A photograph of the lesion is shown. Which of the following is the most appropriate next step in management?? {'A': 'Intralesional bevacizumab', 'B': 'Laser ablation', 'C': 'Oral propranolol', 'D': 'Reassurance and follow-up', 'E': 'Topical clobetasol'},
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D: Reassurance and follow-up
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Q:A 65-year-old man is admitted to the hospital because of a 1-month history of fatigue, intermittent fever, and weakness. Results from a peripheral blood smear taken during his evaluation are indicative of possible acute myeloid leukemia. Bone marrow aspiration and subsequent cytogenetic studies confirm the diagnosis. The physician sets aside an appointed time-slot and arranges a meeting in a quiet office to inform him about the diagnosis and discuss his options. He has been encouraged to bring someone along to the appointment if he wanted. He comes to your office at the appointed time with his daughter. He appears relaxed, with a full range of affect. Which of the following is the most appropriate opening statement in this situation?? {'A': '"""I may need to refer you to a blood cancer specialist because of your diagnosis. You may need chemotherapy or radiotherapy, which we are not equipped for.”"', 'B': '"""Your lab reports show that you have a acute myeloid leukemia"""', 'C': '"""What is your understanding of the reasons we did bone marrow aspiration and cytogenetic studies?"""', 'D': '"""Would you like to know all the details of your diagnosis, or would you prefer I just explain to you what our options are?"""', 'E': '"""You must be curious and maybe even anxious about the results of your tests."""'},
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C: """What is your understanding of the reasons we did bone marrow aspiration and cytogenetic studies?"""
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Answer the following medical question with one of the provided options:
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Q:A 53-year-old homeless woman is brought to the emergency department by the police after she was found in the park lying unconscious on the ground. Both of her pupils are normal in size and reactive to light. There are no signs of head trauma. Finger prick test shows a blood glucose level of 20 mg/dL. She has been brought to the emergency department for acute alcohol intoxication several times before. Her vitals signs include: blood pressure 100/70 mm Hg, heart rate 90/min, respiratory rate 22/min, and temperature 35.0℃ (95.0℉). On general examination, she looks pale, but there is no sign of icterus noted. On physical examination, the abdomen is soft and non-tender and no hepatosplenomegaly noted. She spontaneously opens her eyes after the administration of a bolus of intravenous dextrose, thiamine, and naloxone. Blood and urine samples are drawn for toxicology screening. Finally, the blood alcohol level turns out to be 300 mg/dL. What will be the most likely laboratory findings in this patient?? {'A': 'ALT > AST, increase gamma glutamyl transferase', 'B': 'AST > ALT, increased gamma-glutamyl transferase', 'C': 'Decreased ALP', 'D': 'AST > ALT, normal gamma glutamyl transferase', 'E': 'Decreased MCV'},
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B: AST > ALT, increased gamma-glutamyl transferase
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Q:A 37-year-old woman comes to the physician because of difficulty swallowing for the past 1 year. She was diagnosed with gastroesophageal reflux 3 years ago and takes pantoprazole. She has smoked a pack of cigarettes daily for 14 years. Examination shows hardening of the skin of the fingers and several white papules on the fingertips. There are small dilated blood vessels on the face. Which of the following is the most likely cause of this patient's difficulty swallowing?? {'A': 'Esophageal smooth muscle fibrosis', 'B': 'Degeneration of neurons within esophageal wall', 'C': 'Outpouching of the lower pharyngeal mucosa', 'D': 'Demyelination of brain and spinal cord axons', 'E': 'Tissue membrane obstructing esophageal lumen'},
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A: Esophageal smooth muscle fibrosis
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Q:A 68-year-old man presents for his first hemodialysis treatment. He was diagnosed with progressive chronic kidney disease 6 years ago that has now resulted in end-stage renal disease (ESRD). He currently is on a waiting list for a kidney transplant. His past medical history is significant for hypertension and peptic ulcer disease, managed with amlodipine and esomeprazole, respectively. He has diligently followed a severely restricted diet. The patient is afebrile and his vital signs are normal. His latest serum creatinine gives him an estimated glomerular filtration rate (eGFR) of 12 mL/min/1.73 m2. Which of the following should be increased as part of the management of this patient?? {'A': 'Sodium intake', 'B': 'Potassium intake', 'C': 'Protein intake', 'D': 'Fiber intake', 'E': 'Calcium intake'},
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C: Protein intake
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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 presents to the outpatient department with a recent onset of generalized weakness and weight gain. On physical examination, there is diffuse nontender enlargement of the thyroid gland. Fine-needle aspiration and cytology show lymphocytic infiltration with germinal centers and epithelial Hürthle cells. Which of the following autoantibodies is most likely to be found in this patient?? {'A': 'Anti-TSH receptor antibody', 'B': 'Antimicrosomal antibody', 'C': 'Antihistone antibody', 'D': 'Antimitochondrial antibody', 'E': 'Anti-parietal cell antibody'},
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B: Antimicrosomal antibody
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Answer the following medical question with one of the provided options:
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Q:A 27-year-old woman is brought to the office at the insistence of her fiancé to be evaluated for auditory hallucinations for the past 8 months. The patient’s fiancé tells the physician that the patient often mentions that she can hear her own thoughts speaking aloud to her. The hallucinations have occurred intermittently for at least 1-month periods. Past medical history is significant for hypertension. Her medications include lisinopril and a daily multivitamin both of which she frequently neglects. She lost her security job 7 months ago after failing to report to work on time. The patient’s vital signs include: blood pressure 132/82 mm Hg; pulse 72/min; respiratory rate 18/min, and temperature 36.7°C (98.1°F). On physical examination, the patient has a flat affect and her focus fluctuates from the window to the door. She is disheveled with a foul smell. She has difficulty focusing on the discussion and does not quite understand what is happening around her. A urine toxicology screen is negative. Which of the following is the correct diagnosis for this patient?? {'A': 'Schizophrenia', 'B': 'Schizophreniform disorder', 'C': 'Schizotypal personality disorder', 'D': 'Schizoid personality disorder', 'E': 'Schizoaffective disorder'},
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A: Schizophrenia
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Answer the following medical question with one of the provided options:
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Q:You are seeing an otherwise healthy 66-year-old male in clinic who is complaining of localized back pain and a new rash. On physical exam, his vital signs are within normal limits. You note a vesicular rash restricted to the upper left side of his back. In order to confirm your suspected diagnosis, you perform a diagnostic test. What would you expect to find on the diagnostic test that was performed?? {'A': 'Gram positive cocci', 'B': 'Gram negative bacilli', 'C': 'Pear shaped motile cells', 'D': 'Branching pseudohyphae', 'E': 'Multinucleated giant cells'},
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E: Multinucleated giant cells
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Answer the following medical question with one of the provided options:
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Q:A 54-year-old man comes to the physician for a follow-up examination after presenting with elevated blood pressures on both arms at a routine visit 1 month ago. He feels well and takes no medications. He is 178 cm (5 ft 10 in) tall and weighs 99 kg (218 lb); BMI is 31 kg/m2. His pulse is 76/min, and blood pressure is 148/85 mm Hg on the right arm and 152/87 mm Hg on the left arm. Physical examination and laboratory studies show no abnormalities. The physician recommends lifestyle modifications in combination with treatment with hydrochlorothiazide. From which of the following embryological tissues does the site of action of this drug arise?? {'A': 'Ureteric bud', 'B': 'Metanephric blastema', 'C': 'Mesonephric duct', 'D': 'Pronephros', 'E': 'Mesonephros'},
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B: Metanephric blastema
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Answer the following medical question with one of the provided options:
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Q:An 18-year-old boy is brought to the emergency department by his parents because he suddenly collapsed while playing football. His parents mention that he had complained of dizziness while playing before, but never fainted in the middle of a game. On physical examination, the blood pressure is 130/90 mm Hg, the respirations are 15/min, and the pulse is 110/min. The chest is clear, but a systolic ejection murmur is present. The remainder of the examination revealed no significant findings. An electrocardiogram is ordered, along with an echocardiogram. He is diagnosed with hypertrophic cardiomyopathy and the physician lists all the precautions he must follow. Which of the following drugs will be on the list of contraindicated substances?? {'A': 'Βeta-blockers', 'B': 'Dobutamine', 'C': 'Potassium channel blockers', 'D': 'Nitrates', 'E': 'Calcium channel blockers'},
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D: Nitrates
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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 crossbridge cycle of muscle contraction. Tissue from the biceps brachii muscle is obtained at the autopsy of an 87-year-old man. Investigation of the muscle tissue shows myosin heads attached to actin filaments. Binding of myosin heads to which of the following elements would most likely cause detachment of myosin from actin filaments?? {'A': 'cGMP', 'B': 'Troponin C', 'C': 'ATP', 'D': 'Tropomyosin', 'E': 'ADP'},
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C: ATP
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Answer the following medical question with one of the provided options:
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Q:A 52-year-old man awakens in the middle of the night with excruciating pain in his right great toe. He reports that even the touch of the bed sheet was unbearably painful. His right foot is shown in figure A. He is treated with colchicine. Which of the following describes the mechanism of colchicine?? {'A': 'Inhibition of xanthine oxidase', 'B': 'Inhibition of reabsorption of uric acid in proximal convoluted tubule', 'C': 'Nonselective inhibition of cyclooxygenase (COX) 1 and 2', 'D': 'Binds to glucocorticoid receptor', 'E': 'Decreases microtubule polymerization'},
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E: Decreases microtubule polymerization
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Answer the following medical question with one of the provided options:
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Q:A 15-year-old boy and his mother were referred to a pulmonology clinic. She is concerned that her son is having some breathing difficulty for the past few months, which is aggravated with exercise. The family is especially concerned because the patient’s older brother has cystic fibrosis. The past medical history is noncontributory. Today, the vital signs include: blood pressure 119/80 mm Hg, heart rate 90/min, respiratory rate 17/min, and temperature 37.0°C (98.6°F). On physical exam, he appears well-developed and well-nourished. The heart has a regular rate and rhythm, and the lungs are clear to auscultation bilaterally. During the exam, he is brought into a special room to test his breathing. A clamp is placed on his nose and he is asked to take in as much air as he can, and then forcefully expire all the air into a spirometer. The volume of expired air represents which of the following?? {'A': 'Expiratory reserve volume', 'B': 'Functional residual capacity', 'C': 'Tidal volume', 'D': 'Total lung capacity', 'E': 'Vital capacity'},
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E: Vital capacity
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Answer the following medical question with one of the provided options:
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Q:A 39-year-old woman is brought to the emergency department 30 minutes after her husband found her unconscious on the living room floor. She does not report having experienced light-headedness, nausea, sweating, or visual disturbance before losing consciousness. Three weeks ago, she was diagnosed with open-angle glaucoma and began treatment with an antiglaucoma drug in the form of eye drops. She last used the eye drops 1 hour ago. Examination shows pupils of normal size that are reactive to light. An ECG shows sinus bradycardia. This patient is most likely undergoing treatment with which of the following drugs?? {'A': 'Latanoprost', 'B': 'Timolol', 'C': 'Dorzolamide', 'D': 'Tropicamide', 'E': 'Pilocarpine'},
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B: Timolol
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Answer the following medical question with one of the provided options:
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Q:A 30-year-old forest landscape specialist is brought to the emergency department with hematemesis and confusion. One week ago she was diagnosed with influenza when she had fevers, severe headaches, myalgias, hip and shoulder pain, and a maculopapular rash. After a day of relative remission, she developed abdominal pain, vomiting, and diarrhea. A single episode of hematemesis occurred prior to admission. Two weeks ago she visited rainforests and caves in western Africa where she had direct contact with animals, including apes. She has no history of serious illnesses or use of medications. She is restless. Her temperature is 38.0℃ (100.4℉); the pulse is 95/min, the respiratory rate is 20/min; and supine and upright blood pressure is 130/70 mm Hg and 100/65 mm Hg, respectively. Conjunctival suffusion is noted. Ecchymoses are observed on the lower extremities. She is bleeding from one of her intravenous lines. The peripheral blood smear is negative for organisms. Filovirus genomes were detected during a reverse transcription-polymerase chain reaction. The laboratory studies show the following: Laboratory test Hemoglobin 10 g/dL Leukocyte count 1,000/mm3 Segmented neutrophils 65% Lymphocytes 20% Platelet count 50,000/mm3 Partial thromboplastin time (activated) 60 seconds Prothrombin time 25 seconds Fibrin split products positive Serum Alanine aminotransferase (ALT) 85 U/L Aspartate aminotransferase (AST) 120 U/L γ-Glutamyltransferase (GGT) 83 U/L Creatinine 2 mg/dL Which of the following is the most appropriate immediate step in management?? {'A': 'Esophagogastroduodenoscopy', 'B': 'Intravenous fluids and electrolytes', 'C': 'Parenteral artesunate plus sulfadoxine/pyrimethamine', 'D': 'Postexposure vaccination of close contacts', 'E': 'Use of N95 masks'},
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B: Intravenous fluids and electrolytes
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Answer the following medical question with one of the provided options:
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Q:You have isolated cells from a patient with an unknown disorder and would like to locate the defect in this patient. When radiolabeled propionate is added to the mitochondria, no radiolabeled carbon dioxide is detected. However, when radiolabeled methylmalonic acid is added, radiolabeled carbon dioxide is detected from these cells. Which of the following amino acids can be fully metabolized by this patient?? {'A': 'Methionine', 'B': 'Valine', 'C': 'Threonine', 'D': 'Isoleucine', 'E': 'Phenylalanine'},
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E: Phenylalanine
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