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Answer the following medical question with one of the provided options:
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Q:A 14-year-old girl presents to the pediatrician for behavior issues. The girl has been having difficulty in school as a result. Every time the girl enters her classroom, she feels the urge to touch every wall before heading to her seat. When asked why she does this, she responds, "I'm not really sure. I just can't stop thinking about it until I have touched each wall." The parents have noticed this behavior occasionally at home but were not concerned. The girl is otherwise healthy, has many friends, eats a balanced diet, does not smoke, and is not sexually active. Her temperature is 98.2°F (36.8°C), blood pressure is 117/74 mmHg, pulse is 80/min, respirations are 15/min, and oxygen saturation is 98% on room air. Physical exam is notable for a healthy young girl. Neurologic exam is unremarkable. There is no observed abnormalities in behavior while the girl is in the office. Which of the following is the most appropriate initial step in management for this patient?? {'A': 'Clomipramine', 'B': 'Cognitive behavioral therapy', 'C': 'Fluoxetine', 'D': 'Lorazepam', 'E': 'Risperidone'},
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B: Cognitive behavioral therapy
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Answer the following medical question with one of the provided options:
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Q:An orthopaedic surgeon at a local community hospital has noticed that turnover times in the operating room have been unnecessarily long. She believes that the long wait times may be due to inefficient communication between the surgical nursing staff, the staff in the pre-operative area, and the staff in the post-operative receiving area. She believes a secure communication mobile phone app would help to streamline communication between providers and improve efficiency in turnover times. Which of the following methods is most appropriate to evaluate the impact of this intervention in the clinical setting?? {'A': 'Failure modes and effects analysis', 'B': 'Forcing function', 'C': 'Plan-Do-Study-Act cycle', 'D': 'Root cause analysis', 'E': 'Standardization'},
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C: Plan-Do-Study-Act cycle
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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 with a history of alcoholic cirrhosis is brought to the physician by his wife for a 1-week history of progressive abdominal distension and yellowing of the eyes. For the past month, he has been irritable, had difficulty falling asleep, become clumsy, and fallen frequently. Two months ago he underwent banding for esophageal varices after an episode of vomiting blood. His vital signs are within normal limits. Physical examination shows jaundice, multiple bruises, pedal edema, gynecomastia, loss of pubic hair, and small, firm testes. There are multiple small vascular lesions on his chest and neck that blanch with pressure. His hands are erythematous and warm; there is a flexion contracture of his left 4th finger. A flapping tremor is seen on extending the forearms and wrist. Abdominal examination shows dilated veins over the anterior abdominal wall, the spleen tip is palpated 4 cm below the left costal margin, and there is shifting dullness on percussion. Which of the following physical examination findings are caused by the same underlying pathophysiology?? {'A': 'Jaundice and flapping tremor', 'B': 'Palmar erythema and gynecomastia', 'C': 'Caput medusae and spider angiomata', 'D': 'Testicular atrophy and abdominal distension', 'E': 'Multiple bruises and loss of pubic hair'},
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B: Palmar erythema and gynecomastia
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Answer the following medical question with one of the provided options:
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Q:A 42-year-old woman presents with complaints of a sharp, stabbing pain in her chest upon coughing and inhalation. She says that the pain started acutely 2 days ago and has progressively worsened. Her past medical history is significant for a rash on her face, joint pains, and fatigue for the past few weeks. The patient is afebrile and her vital signs are within normal limits. On physical examination, there is a malar macular rash that spares the nasolabial folds. There is a friction rub at the cardiac apex that does not vary with respiration. Which of the following additional physical examination signs would most likely be present in this patient?? {'A': 'Mid-systolic click', 'B': 'Pain improvement with inspiration', 'C': 'Displaced apical impulse', 'D': 'High-pitched diastolic murmur', 'E': 'Breakthrough pain that improves with leaning forward'},
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E: Breakthrough pain that improves with leaning forward
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Answer the following medical question with one of the provided options:
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Q:A 63-year-old man presents to his primary care provider complaining of changes in his vision. He says that he has been having transient episodes of "shimmering lights" and generalized blurring of his vision for the past 3 months. He is disturbed by this development as he worries it may interfere with his job as a bus driver. He additionally reports a 12-pound weight loss over this time unaccompanied by a change in appetite, and his gout flares have grown more frequent despite conforming to his recommended diet and allopurinol. His temperature is 98.0°F (36.7°C), blood pressure is 137/76 mmHg, pulse is 80/min, and respirations are 18/min. Hemoglobin and hematocrit obtained the previous day were 18.1 g/dL and 61%, respectively. Peripheral blood screening for JAK2 V617F mutation is positive. Which of the following findings is most likely expected in this patient?? {'A': 'Decreased erythrocyte sedimentation rate', 'B': 'Decreased oxygen saturation', 'C': 'Increased erythropoetin levels', 'D': 'Schistocytes on peripheral smear', 'E': 'Thrombocytopenia'},
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A: Decreased erythrocyte sedimentation rate
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Answer the following medical question with one of the provided options:
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Q:A 19-year-old woman is brought to the emergency department by ambulance 30 minutes after her neighbor found her unconscious on a running trail. Her neighbor reports that she has been training for a marathon since the beginning of the summer. She is alert and oriented but becomes irritable when realizing that she is at a hospital and refuses to answer questions. She appears tired. She is 174 cm (5 ft 7 in) tall and weighs 51 kg (112 lb). Her temperature is 35.5°C (96°F), pulse is 44/min, respirations are 20/min, and blood pressure is 84/48 mm Hg. Examination shows dry, scaly skin and dry mucous membranes. Cardiopulmonary examination shows a high-frequency, mid-to-late systolic murmur that is heard best at the apex. Her hemoglobin concentration is 11.9 g/dL. Which of the following is the most likely diagnosis?? {'A': 'Hypertrophic obstructive cardiomyopathy', 'B': 'Hypothyroidism', 'C': 'Heat exhaustion', 'D': 'Amphetamine use', 'E': 'Anorexia nervosa'},
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E: Anorexia nervosa
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Answer the following medical question with one of the provided options:
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Q:An 18-year-old G1P0 woman who is 10 weeks pregnant presents for her first prenatal visit. She reports nausea with occasional vomiting but denies bleeding, urinary symptoms, or abdominal pain. She just graduated high school and works at the local grocery store. She does not take any medications and has no known drug allergies. Physical examination is unremarkable. Initial laboratory studies reveal the following: Serum: Na+: 140 mEq/L Cl-: 100 mEq/L K+: 4.0 mEq/L HCO3-: 24 mEq/L BUN: 10 mg/dL Glucose: 100 mg/dL Creatinine: 1.0 mg/dL Thyroid-stimulating hormone: 2.5 µU/mL Ca2+: 9.5 mg/dL AST: 25 U/L ALT: 20 U/L Leukocyte count: 10,000 cells/mm^3 with normal differential Hemoglobin: 14 g/dL Hematocrit: 42% Platelet count: 200,000 /mm^3 Urine: Epithelial cells: few Glucose: negative WBC: 20/hpf Bacterial: > 100,000 cfu / E. coli pan-sensitive What is the best next step in management?? {'A': 'Observation and treatment if symptoms develop', 'B': 'Nitrofurantoin for seven days', 'C': 'Observation and repeat cultures in one week', 'D': 'Nitrofurantoin for duration of pregnancy', 'E': 'Levofloxacin for three days'},
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B: Nitrofurantoin for seven days
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Answer the following medical question with one of the provided options:
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Q:2 hours after being admitted to the hospital because of a fracture of the right ankle, a 75-year-old man continues to complain of pain despite treatment with acetaminophen and ibuprofen. He has a history of dementia and cannot recall his medical history. The presence of which of the following features would most likely be a reason to avoid treatment with morphine in this patient?? {'A': 'Watery diarrhea', 'B': 'Severe hypertension', 'C': 'Biliary tract dysfunction', 'D': 'Persistent cough', 'E': 'Tachypnea'},
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C: Biliary tract dysfunction
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Answer the following medical question with one of the provided options:
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Q:An immunology expert is explaining the functions of macrophages to biology students. He describes a hypothetical case scenario as follows: a potentially harmful gram-negative bacillus encounters a macrophage in the tissues. The Toll-like receptor (TLR) on the macrophage recognizes the bacterial lipopolysaccharide (LPS). The macrophage is activated by the binding of TLR with bacterial LPS and by interferon-γ (IFN-γ). Which of the following cytokines is most likely to be secreted by the activated macrophage?? {'A': 'Interleukin-1 receptor antagonist (IL-1RA)', 'B': 'Interleukin-2 (IL-2)', 'C': 'Interleukin-4 (IL-4)', 'D': 'Interleukin-10 (IL-10)', 'E': 'Interleukin-12 (IL-12)'},
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E: Interleukin-12 (IL-12)
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Answer the following medical question with one of the provided options:
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Q:A 59-year-old woman with a past medical history of atrial fibrillation currently on warfarin presents to the emergency department for acute onset dizziness. She was watching TV in the living room when she suddenly felt the room spin around her as she was getting up to go to the bathroom. She denies any fever, weight loss, chest pain, palpitations, shortness of breath, lightheadedness, or pain but reports difficulty walking and hiccups. A physical examination is significant for rotary nystagmus and decreased pin prick sensation throughout her left side. A magnetic resonance image (MRI) of the head is obtained and shows ischemic changes of the right lateral medulla. What other symptoms would you expect to find in this patient?? {'A': 'Decreased gag reflex', 'B': 'Language impairment', 'C': 'Left-sided tongue deviation', 'D': 'Paralysis of the right lower limb', 'E': 'Right-sided facial paralysis'},
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A: Decreased gag reflex
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Answer the following medical question with one of the provided options:
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Q:A 75-year-old man comes to the physician because of fatigue and decreased urine output for 1 week. He takes ibuprofen as needed for lower back pain and docusate for constipation. Physical examination shows tenderness to palpation over the lumbar spine. There is pedal edema. Laboratory studies show a hemoglobin concentration of 8.7 g/dL, a serum creatinine concentration of 2.3 mg/dL, and a serum calcium concentration of 12.6 mg/dL. Urine dipstick is negative for blood and protein. Which of the following is the most likely underlying cause of this patient's symptoms?? {'A': 'Antiglomerular basement membrane antibodies', 'B': 'Immunoglobulin light chains', 'C': 'Renal deposition of AL amyloid', 'D': 'Anti double-stranded DNA antibodies', 'E': 'Hypersensitivity reaction'},
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B: Immunoglobulin light chains
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Answer the following medical question with one of the provided options:
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Q:A 12-year-old Caucasian male presents with his mother to the pediatrician’s office complaining of right thigh pain. He reports that he has noticed slowly progressive pain and swelling over the distal aspect of his right thigh over the past two months. He denies any recent trauma to the area and his temperature is 100.9°F (38.3°C). On exam, there is swelling and tenderness overlying the distal right femoral diaphysis. Laboratory evaluation is notable for an elevated white blood cell (WBC) count and elevated erythrocyte sedimentation rate (ESR). A radiograph of the patient’s right leg is shown. Biopsy of the lesion demonstrates sheets of monotonous small round blue cells with minimal cytoplasm. Which of the following genetic mutations is most likely associated with this patient’s condition?? {'A': 't(8;14)', 'B': 't(11;22)', 'C': 'APC inactivation', 'D': 'TP53 inactivation', 'E': 'RB1 inactivation'},
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B: t(11;22)
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Answer the following medical question with one of the provided options:
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Q:A 42-year-old, G3P2012 woman comes to the clinic complaining of painful menstruation for the past 4 months. She is also using more tampons compared to prior periods. She is concerned as her close friend was just diagnosed with endometrial cancer. Prior to these symptoms, her menstrual cycle was regular (every 28 days) and without pain. She denies abnormal uterine bleeding, abnormal discharge, past sexually transmitted diseases, or spotting. A bimanual pelvic examination is unremarkable except for a mobile, diffusely enlarged, globular uterus. What is the most likely explanation for this patient’s symptoms?? {'A': 'Abnormal endometrial gland proliferation at the endometrium', 'B': 'Benign smooth muscle tumor within the uterine wall', 'C': 'Collection of endometrial tissue protruding into the uterine cavity', 'D': 'Invasion of endometrial glands into the myometrium', 'E': 'Non-neoplastic endometrial tissue outside of the endometrial cavity'},
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D: Invasion of endometrial glands into the myometrium
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Answer the following medical question with one of the provided options:
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Q:A researcher is studying a new antituberculosis drug. In the laboratory, the drug has been shown to be effective against mycobacteria located within phagolysosomes of macrophages, but it is also significantly less effective against extracellular tuberculoid bacteria. The characteristics of this drug are most similar to which of the following agents?? {'A': 'Isoniazid', 'B': 'Rifampin', 'C': 'Ethambutol', 'D': 'Pyrazinamide', 'E': 'Streptomycin'},
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D: Pyrazinamide
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Answer the following medical question with one of the provided options:
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Q:A cohort study was conducted to investigate the impact of post-traumatic stress disorder (PTSD) on asthma symptoms in a group of firefighters who worked at Ground Zero during the September 11, 2001 terrorist attacks in New York City and developed asthma in the attack's aftermath. The study compared patients who had PTSD with those who did not have PTSD in order to determine if PTSD is associated with worse asthma control. During a follow-up period of 12 months, the researchers found that patients with PTSD had a greater number of hospitalizations for asthma exacerbations (RR = 2.0, 95% confidence interval = 1.4–2.5) after adjusting for medical comorbidities, psychiatric comorbidities other than PTSD, and sociodemographic variables. Results are shown: ≥ 1 asthma exacerbation No asthma exacerbations PTSD 80 80 No PTSD 50 150 Based on these results, what proportion of asthma hospitalizations in patients with PTSD could be attributed to PTSD?"? {'A': '2.0', 'B': '0.25', 'C': '3.0', 'D': '0.50', 'E': '4.0'},
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D: 0.50
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Answer the following medical question with one of the provided options:
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Q:A previously healthy 25-year-old woman comes to the physician because of a 1-month history of palpitations that occur on minimal exertion and sometimes at rest. She has no chest discomfort or shortness of breath. She feels nervous and irritable most of the time and attributes these feelings to her boyfriend leaving her 2 months ago. Since then she has started exercising more frequently and taking an herbal weight-loss pill, since which she has lost 6.8 kg (15 lb) of weight. She finds it hard to fall asleep and awakens 1 hour before the alarm goes off each morning. She has been drinking 2 to 3 cups of coffee daily for the past 7 years and has smoked one pack of cigarettes daily for the past 3 years. Her temperature is 37.4°C (99.4°F), pulse is 110/min, respirations are 18/min, and blood pressure is 150/70 mm Hg. Examination shows moist palms. Neurologic examination shows a fine resting tremor of the hands. Deep tendon reflexes are 3+ with a shortened relaxation phase. Which of the following is the most likely cause of this patient's symptoms?? {'A': 'Coffee consumption', 'B': 'Pheochromocytoma', 'C': 'Hashimoto thyroiditis', 'D': 'Exogenous hyperthyroidism', 'E': 'Generalized anxiety disorder\n"'},
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D: Exogenous hyperthyroidism
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Answer the following medical question with one of the provided options:
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Q:A 23-year-old woman comes to the physician for evaluation of two masses on her right auricle for several months. The masses appeared a few weeks after she had her ear pierced and have increased in size since then. A photograph of her right ear is shown. Which of the following is the most likely cause of these findings?? {'A': 'Implantation of epidermis into the dermis', 'B': 'Increased production of hyalinized collagen', 'C': 'Infection with human papilloma virus', 'D': 'Malignant transformation of keratinocytes', 'E': 'Excess formation of organized extracellular matrix'},
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B: Increased production of hyalinized collagen
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Answer the following medical question with one of the provided options:
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Q:A 37-year-old man presents to the clinic for evaluation of a chronic cough that has increased in frequency and severity for the past 2 days. His cough began 2 weeks ago but was not as bothersome as now. He states that he can hardly get to sleep because he is coughing all the time. Upon further questioning, he says that he had a low-grade fever, runny nose, and fatigue. However, everything resolved except for his cough. He has a history of hyperlipidemia and takes simvastatin. His vital signs are within normal limits. On physical examination, the patient is in no apparent distress and is alert and oriented. His head is normocephalic with non-tender sinuses. Sclerae are not jaundiced and there are no signs of conjunctivitis. Nares are clear without erythema. Examination of the pharynx shows erythematous mucosa without exudate. Lungs are clear to auscultation bilaterally. Posteroanterior chest X-ray shows no regions of consolidation, hypervascularity or effusion. Which of the following is the next best step in the management of this patient?? {'A': 'Levofloxacin', 'B': 'Supportive treatment', 'C': 'Azithromycin', 'D': 'Azithromycin with amoxicillin-clavulanate', 'E': 'Amoxicillin'},
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C: Azithromycin
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Answer the following medical question with one of the provided options:
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Q:A previously healthy, 16-year-old boy is brought to the emergency department with persistent bleeding from his gums after an elective removal of an impacted tooth. Multiple gauze packs were applied with minimal effect. He has a history of easy bruising. His family history is unremarkable except for a maternal uncle who had a history of easy bruising and joint swelling. Laboratory studies show: Hematocrit 36% Platelet count 170,000/mm3 Prothrombin time 13 sec Partial thromboplastin time 65 sec Bleeding time 5 min Peripheral blood smear shows normal-sized platelets. Which of the following is the most likely diagnosis?"? {'A': 'Von Willebrand disease', 'B': 'Glanzmann thrombasthenia', 'C': 'Hemophilia', 'D': 'Disseminated intravascular coagulation', 'E': 'Bernard-Soulier syndrome'},
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C: Hemophilia
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Answer the following medical question with one of the provided options:
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Q:A 60-year-old woman presents with progressive difficulty swallowing solid foods for the past 2 months. She also says her voice has gradually changed, and she has had recent episodes of vertigo associated with nausea and vomiting and oscillating eye movements while reading. She denies any problems with the movement of her face or extremities. Past medical history is significant for hypertension, managed with enalapril, and dyslipidemia, which she is managing with dietary modifications. The patient reports a 40-pack-year smoking history. Vital signs are within normal limits. On physical examination, there is decreased pain and temperature sensation on the right side of her body, and she cannot touch her nose with her eyes closed. Which of the following is the most likely site of vascular occlusion in this patient?? {'A': 'Anterior spinal artery', 'B': 'Anterior cerebral artery', 'C': 'Middle cerebral artery', 'D': 'Anterior inferior cerebellar artery', 'E': 'Posterior inferior cerebellar artery'},
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E: Posterior inferior cerebellar artery
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Answer the following medical question with one of the provided options:
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Q:A 41-year-old woman presents to urgent care with complaints of a new rash. On review of systems, she endorses ankle pain bilaterally. Otherwise, she has no additional localized complaints. Physical examination reveals numerous red subcutaneous nodules overlying her shins, bilaterally. Complete blood count shows leukocytes 7,300, Hct 46.2%, Hgb 18.1 g/dL, mean corpuscular volume (MCV) 88 fL, and platelets 209. Chest radiography demonstrates bilateral hilar adenopathy with clear lungs. Which of the following is the most likely diagnosis?? {'A': 'Coccidioidomycosis', 'B': 'Sarcoidosis', 'C': 'Yersiniosis', 'D': 'Chlamydophila pneumoniae', 'E': 'Histoplasmosis'},
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B: Sarcoidosis
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Answer the following medical question with one of the provided options:
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Q:A 4-month-old boy is brought to the physician because of a seizure. He was delivered at term after an uncomplicated pregnancy. He is currently at the 10th percentile for height, 5th percentile for weight, and 15th percentile for head circumference. Examination shows muscle hypotonia. His serum lactic acid and alanine are elevated. A functional assay of pyruvate dehydrogenase complex in serum leukocytes shows decreased enzyme activity. Supplementation with which of the following substances should be avoided in this patient?? {'A': 'Arachidonic acid', 'B': 'Valine', 'C': 'Lysine', 'D': 'Thiamine', 'E': 'Riboflavin'},
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B: Valine
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Answer the following medical question with one of the provided options:
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Q:A 55-year-old woman presents with fatigue. She says her symptoms are present throughout the day and gradually started 4 months ago. Her past medical history is significant for rheumatoid arthritis–treated with methotrexate, and diabetes mellitus type 2–treated with metformin. The patient is afebrile, and her vital signs are within normal limits. A physical examination reveals pallor of the mucous membranes. Initial laboratory tests show hemoglobin of 7.9 g/dL, hematocrit of 22%, and mean corpuscular volume of 79 fL. Which of the following is the best next diagnostic step in this patient?? {'A': 'Serum ferritin level', 'B': 'Serum ferritin and serum iron levels', 'C': 'Serum ferritin level and total iron-binding capacity (TIBC)', 'D': 'Serum ferritin and soluble transferrin receptor levels', 'E': 'Serum iron level'},
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D: Serum ferritin and soluble transferrin receptor levels
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Answer the following medical question with one of the provided options:
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Q:A 31-year-old man presents to his primary care physician with shortness of breath. He states that he had a “cold” 2 weeks ago and since then has had a persistent cough and worsening shortness of breath. He denies fever, chills, chest pain, sore throat, or rhinorrhea. His medical history is significant for seasonal allergies. He uses fluticasone nasal spray. He had his tonsils removed when he was 8 years of age. His mother and maternal grandfather have cirrhosis, and his father has depression and hypertension. The patient endorses that he smokes tobacco socially on the weekends and uses marijuana daily. He drinks 1-2 beers after work with his co-workers most evenings. A chest radiograph shows hyperinflation of the lungs and hyperlucency. Routine labs are drawn, as shown below. Serum: Na+: 139 mEq/L Cl-: 105 mEq/L K+: 4.0 mEq/L HCO3-: 26 mEq/L Urea nitrogen: 15 mg/dL Glucose: 100 mg/dL Creatinine: 0.8 mg/dL Alkaline phosphatase: 98 U/L Aspartate aminotransferase (AST, GOT): 46 U/L Alanine aminotransferase (ALT, GPT): 49 U/L Pulmonary function tests are pending. Which of the following is most likely to confirm the patient’s diagnosis?? {'A': 'Abdominal ultrasound', 'B': 'Bronchoalveolar lavage', 'C': 'Enzyme-linked immunosorbent assay', 'D': 'Liver biopsy', 'E': 'Viral hepatitis serologies'},
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D: Liver biopsy
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Answer the following medical question with one of the provided options:
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Q:A 70-year-old woman is brought to the emergency department due to worsening lethargy. She lives with her husband who says she has had severe diarrhea for the past few days. Examination shows a blood pressure of 85/60 mm Hg, pulse of 100/min, and temperature of 37.8°C (100.0°F). The patient is stuporous, while her skin appears dry and lacks turgor. Laboratory tests reveal: Serum electrolytes Sodium 144 mEq/L Potassium 3.5 mEq/L Chloride 115 mEq/L Bicarbonate 19 mEq/L Serum pH 7.3 PaO2 80 mm Hg Pco2 38 mm Hg This patient has which of the following acid-base disturbances?? {'A': 'Anion gap metabolic acidosis', 'B': 'Anion gap metabolic acidosis with respiratory compensation', 'C': 'Non-anion gap metabolic acidosis', 'D': 'Non-anion gap metabolic acidosis with respiratory compensation', 'E': 'Chronic respiratory acidosis'},
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D: Non-anion gap metabolic acidosis with respiratory compensation
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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 comes to the physician because of fatigue over the past 6 months. He has been to the emergency room several times over the past 3 years for recurrent shoulder and patella dislocations. Physical examination shows abnormal joint hypermobility and skin hyperextensibility. A high-frequency mid-systolic click is heard on auscultation. Which of the following is most likely to result in an earlier onset of this patient’s auscultation finding?? {'A': 'Hand grip', 'B': 'Abrupt standing', 'C': 'Rapid squatting', 'D': 'Valsalva release phase', 'E': 'Leaning forward'},
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B: Abrupt standing
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Answer the following medical question with one of the provided options:
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Q:A 21-year-old female presents to her obstetrician because she has stopped getting her period, after being irregular for the last 3 months. Upon further questioning, the patient reveals that she has had a 17 lb. unintended weight loss, endorses chronic diarrhea, abdominal pain, and constipation that waxes and wanes. Family history is notable only for an older brother with Type 1 Diabetes. She is healthy, and is eager to gain back some weight. Her OBGYN refers her to a gastroenterologist, but first sends serology laboratory studies for IgA anti-tissue transglutaminase antibodies (IgA-tTG). These results come back positive at > 10x the upper limit of normal. Which of the following is the gastroenterologist likely to find on endoscopy and duodenal biopsy?? {'A': 'Foamy macrophages, which stain PAS positive', 'B': 'Cobblestoning with biopsy showing transmural inflammation and noncaseating granulomas', 'C': 'Friable mucosal pseudopolyps with biopsy notable for crypt abscesses', 'D': 'Normal appearing villi and biopsy', 'E': 'Villous atrophy with crypt lengthening and intraepithelial lymphocytes'},
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E: Villous atrophy with crypt lengthening and intraepithelial lymphocytes
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Answer the following medical question with one of the provided options:
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Q:A 56-year-old woman presents to the clinic complaining of fatigue and nausea. She was recently diagnosed with metastatic ovarian cancer and subsequently started treatment with an alkylating agent. The patient reports recent weight loss, malaise, and drowsiness, but denies fever, headaches, palpitations, shortness of breath, or genitourinary symptoms. Physical exam was unremarkable. Laboratory tests are shown below. Serum: Na+: 137 mEq/L Cl-: 101 mEq/L K+: 4.8 mEq/L HCO3-: 25 mEq/L BUN: 8.5 mg/dL Glucose: 117 mg/dL Creatinine: 2.1 mg/dL Thyroid-stimulating hormone: 1.8 µU/mL Ca2+: 9.6 mg/dL AST: 8 U/L ALT: 11 U/L What findings on urinalysis are most specific to this patient’s diagnosis?? {'A': 'Elevated protein', 'B': 'Granular casts', 'C': 'Normal findings', 'D': 'RBC casts', 'E': 'WBC casts'},
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B: Granular casts
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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 comes to the physician because of a 5-month history of undulating, dull pain in his right thigh. Physical examination shows a tender, round mass located above the right knee on the anterior aspect of the thigh. An x-ray of the right thigh shows sunburst pattern of osteolytic bone lesions in combination with sclerotic bone formation and invasion of the surrounding tissue. Despite limb-sparing attempts, the patient has to undergo amputation of the right leg. A photograph of a cross-section of the affected leg is shown. Which of the following is the strongest predisposing factor for this patient's condition?? {'A': 'Paget disease of bone', 'B': 'Gardner syndrome', 'C': 't(11;22) translocation', 'D': 'Hyperparathyroidism', 'E': 'FGF receptor mutation'},
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A: Paget disease of bone
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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 emergency department because of intermittent episodes of inconsolable crying for 4 hours. The parents report that the patient does not appear to be in discomfort between episodes, and moves and plays normally. The episodes have occurred at roughly 15-minute intervals and have each lasted a few minutes before subsiding. He has also vomited 3 times since these episodes began. The first vomitus appeared to contain food while the second and third appeared pale green in color. The patient was born at term and has been healthy. His immunizations are up-to-date. He has no history of recent travel. His older brother has Crohn's disease. The patient is at 50th percentile for height and 60th percentile for weight. He does not appear to be in acute distress. His temperature is 37.1°C (98.8°F), pulse is 125/min, respirations are 36/min, and blood pressure is 85/40 mm Hg. During the examination, the patient begins to cry and draws his knees up to his chest. Shortly thereafter, he passes stool with a mixture of blood and mucous; the patient's discomfort appears to resolve. Abdominal examination shows a sausage-shaped abdominal mass in the right upper quadrant. Which of the following is the most appropriate next step in the management of this patient?? {'A': 'Exploratory laparotomy', 'B': 'X-ray of the abdomen', 'C': 'Stool cultures', 'D': 'MRI of the abdomen', 'E': 'Air enema'},
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E: Air enema
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Answer the following medical question with one of the provided options:
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Q:A 61-year-old woman presents to the emergency room with right hand pain and numbness. She was jogging around her neighborhood when she tripped and fell on her outstretched hand 3 hours prior to presentation. She reports severe wrist pain and numbness along the medial aspect of her hand. Her past medical history is notable for osteoporosis and gastroesophageal reflux disease. She takes omeprazole. She has a 10-pack-year smoking history. She has severe tenderness to palpation diffusely around her right wrist. She has decreased sensation to light touch along the palmar medial 2 digits. Sensation to light touch is normal throughout the palm and in the lateral 3 digits. When she is asked to extend all of her fingers, her 4th and 5th fingers are hyperextended at the metacarpophalangeal (MCP) joints and flexed at the interphalangeal (IP) joints. Which of the following nerves is most likely affected in this patient?? {'A': 'Distal median nerve', 'B': 'Distal ulnar nerve', 'C': 'Posterior interosseous nerve', 'D': 'Proximal ulnar nerve', 'E': 'Recurrent branch of the median nerve'},
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B: Distal ulnar nerve
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Answer the following medical question with one of the provided options:
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Q:A 52-year-old African-American woman presents to the office complaining of difficulty swallowing for 1 week, and described it as "food getting stuck in her throat". Her discomfort is mainly for solid foods, and she does not have any problem with liquids. She further adds that she has frequent heartburn and lost 5 pounds in the last month because of this discomfort. She sometimes takes antacids to relieve her heartburn. Her past medical history is insignificant. She is an occasional drinker and smokes a half pack of cigarettes a day. On examination, her skin is shiny and taut especially around her lips and fingertips. A barium swallow study is ordered. Which of the following is the most likely diagnosis?? {'A': "Zenker's diverticulum", 'B': 'Achalasia', 'C': 'Scleroderma', 'D': 'Polyomyositis', 'E': 'Diffuse esophageal spasm'},
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C: Scleroderma
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Answer the following medical question with one of the provided options:
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Q:A 45-year-old woman comes to the physician because of a 1-week history of fatigue and bruises on her elbows. Examination shows a soft, nontender abdomen with no organomegaly. Laboratory studies show a hemoglobin concentration of 7 g/dL, a leukocyte count of 2,000/mm3, a platelet count of 40,000/mm3, and a reticulocyte count of 0.2%. Serum electrolyte concentrations are within normal limits. A bone marrow biopsy is most likely to show which of the following findings?? {'A': 'Sheets of abnormal plasma cells', 'B': 'Wrinkled cells with a fibrillary cytoplasm', 'C': 'Hyperplasia of adipocytes', 'D': 'Increased myeloblast count', 'E': 'Dysplastic bone with ringed sideroblasts'},
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C: Hyperplasia of adipocytes
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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 has a history of smoking 1 pack per day and drinking a six-pack of beer daily over the last ten years. He is admitted to the medical floor after undergoing a cholecystectomy. One day after the surgery, the patient states that he feels anxious and that his hands are shaking. While being checked for a clean surgical site, the patient starts shaking vigorously and loses consciousness. The patient groans and falls to the floor. His arms and legs begin to jerk rapidly and rhythmically. This episode lasts for almost five minutes, and the patient's airway, breathing, and circulation are stabilized per seizure protocol. What is the best next step for this patient?? {'A': 'Urinalysis', 'B': 'Lorazepam', 'C': 'Morphine', 'D': 'Antibiotics', 'E': 'Chest radiograph'},
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B: Lorazepam
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Q:A 63-year-old man comes to the physician for a routine health maintenance examination. He feels well. He has a history of hypertension, atrial fibrillation, bipolar disorder, and osteoarthritis of the knees. Current medications include lisinopril, amiodarone, lamotrigine, and acetaminophen. He started amiodarone 6 months ago and switched from lithium to lamotrigine 4 months ago. The patient does not smoke. He drinks 1–4 beers per week. He does not use illicit drugs. Vital signs are within normal limits. Examination shows no abnormalities. Laboratory studies show: Serum Na+ 137 mEq/L K+ 4.2 mEq/L Cl- 105 mEq/L HCO3- 24 mEq/L Urea nitrogen 14 mg/dL Creatinine 0.9 mg/dL Alkaline phosphatase 82 U/L Aspartate aminotransferase (AST) 110 U/L Alanine aminotransferase (ALT) 115 U/L Which of the following is the most appropriate next step in management?"? {'A': 'Discontinue amiodarone', 'B': 'Discontinue acetaminophen', 'C': 'Follow-up laboratory results in 6 months', 'D': 'Follow-up laboratory results in 3 months', 'E': 'Decrease alcohol consumption'},
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A: Discontinue amiodarone
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Q:A 23-year-old woman comes to the emergency department because of a 5-day history of nausea and vomiting. There is no associated fever, abdominal pain, constipation, diarrhea, or dysuria. She is sexually active and uses condoms inconsistently. Her last menstrual period was 10 weeks ago. Her temperature is 37°C (98.6°F), pulse is 90/min, respirations are 18/min, and blood pressure is 110/70 mm Hg. There is no rebound tenderness or guarding. A urine pregnancy test is positive. Ultrasonography shows an intrauterine pregnancy consistent in size with an 8-week gestation. The hormone that was measured in this patient's urine to detect the pregnancy is also directly responsible for which of the following processes?? {'A': 'Inhibition of ovulation', 'B': 'Maintenance of the corpus luteum', 'C': 'Hypertrophy of the uterine myometrium', 'D': 'Stimulation of uterine contractions at term', 'E': 'Fetal angiogenesis'},
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B: Maintenance of the corpus luteum
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Answer the following medical question with one of the provided options:
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Q:A 25-year-old male medical student presents to student health with a chief complaint of picking at his skin. He states that at times he has urges to pick his skin that he struggles to suppress. Typically, he will participate in the act during finals or when he has "too many assignments to do." The patient states that he knows that his behavior is not helping his situation and is causing him harm; however, he has trouble stopping. He will often ruminate over all his responsibilities which make his symptoms even worse. The patient has a past medical history of surgical repair of his ACL two years ago. His current medications include melatonin. On physical exam you note a healthy young man with scars on his arms and face. His neurological exam is within normal limits. Which of the following is the best initial step in management?? {'A': 'Clomipramine', 'B': 'Fluoxetine', 'C': 'Dialectical behavioral therapy', 'D': 'Supportive psychotherapy', 'E': 'Interpersonal psychotherapy'},
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B: Fluoxetine
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Q:A 31-year-old female presents to the clinic with excessive anxiety and palpitations for a month. She also mentions losing of 2.72 kg (6 lb) of her weight over the last month. Her past medical history is insignificant. She does not smoke nor does she drink alcohol. Her temperature is 37°C (98.6°F), pulse is 81/min, respiratory rate is 23/min, and blood pressure is 129/88 mm Hg. On examination, mild exophthalmos is noted. Heart and lung examination is normal including cardiac auscultation. What is the most likely cause of her symptoms?? {'A': 'Inadequate iodine in her diet', 'B': 'Thyroid stimulating antibodies', 'C': 'Medullary carcinoma of the thyroid', 'D': 'Lithium use', 'E': 'Use of propylthiouracil'},
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B: Thyroid stimulating antibodies
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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 to the emergency department with a history of a fever that "won't break." She has taken acetaminophen without relief. Upon obtaining a past medical history you learn that the patient is a prostitute who is homeless with a significant history of intravenous drug use and alcohol abuse. The patient uses barrier protection occasionally when engaging in intercourse. On physical exam you note a murmur heard along the left mid-sternal border. The pulmonary exam reveals minor bibasilar crackles. Examination of the digits is notable for linea melanonychia. The patient's upper limbs demonstrate many bruises and scars in the antecubital fossa. Her temperature is 103.5°F (39.5°C), blood pressure is 100/70 mmHg, pulse is 112/min, respirations are 18/min, and oxygen saturation is 93% on room air. The patient's BMI is 16 kg/m^2. The patient is started on vancomycin and gentamicin and sent for echocardiography. Based on the results of echocardiography the patient is scheduled for surgery the next day. Vegetations are removed from the tricuspid valve during the surgical procedure and vancomycin and gentamicin are continued over the next 5 days. On post-operative day five, the patient presents with bleeding from her gums, oozing from her surgical sites, and recurrent epitaxis. Lab value are obtained as seen below: Serum: Na+: 135 mEq/L Cl-: 90 mEq/L K+: 4.4 mEq/L HCO3-: 23 mEq/L BUN: 20 mg/dL Glucose: 110 mg/dL Creatinine: 1.0 mg/dL Ca2+: 10.1 mg/dL AST: 9 U/L ALT: 9 U/L Leukocyte count and differential: Leukocyte count: 6,000 cells/mm^3 Lymphocytes: 20% Monocytes: 1% Neutrophils: 78% Eosinophils: 1% Basophils: 0% PT: 27 seconds aPTT: 84 seconds D-dimer: < 50 µg/L Hemoglobin: 14 g/dL Hematocrit: 40% Platelet count: 150,000/mm^3 Mean corpuscular volume: 110 fL Mean corpuscular hemoglobin concentration: 34 g/dL RDW: 14% Which of the following is the most likely cause of this patient's current symptoms?? {'A': 'Antibiotic therapy', 'B': 'Coagulation cascade activation', 'C': 'Bacterial infection of the bloodstream', 'D': 'Defect in von Willebrand factor', 'E': 'Factor VIII deficiency'},
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A: Antibiotic therapy
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Q:A 2720-g (6-lb) female newborn is delivered at term to a 39-year-old woman, gravida 3, para 2. Apgar scores are 6 and 7 at 1 and 5 minutes, respectively. Examination in the delivery room shows micrognathia, prominent occiput with flattened nasal bridge, and pointy low-set ears. The eyes are upward slanting with small palpebral fissures. The fists are clenched with fingers tightly flexed. The index finger overlaps the third finger and the fifth finger overlaps the fourth. A 3/6 holosystolic murmur is heard at the lower left sternal border. The nipples are widely spaced and the feet have prominent heels and convex, rounded soles. Which of the following is the most likely cause of these findings?? {'A': 'Trisomy of chromosome 21', 'B': 'Maternal alcohol intake', 'C': 'Monosomy of chromosome X', 'D': 'FMR1 gene silencing', 'E': 'Trisomy of chromosome 18'},
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E: Trisomy of chromosome 18
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Q:A 38-year-old woman, gravida 4, para 3, at 20 weeks' gestation comes to the physician for a prenatal care visit. She used fertility enhancing treatment for her current pregnancy. Her other children were born before 37 weeks' gestation. She is 170 cm (5 ft 7 in) tall and weighs 82 kg (180 lb); BMI is 28.4 kg/m2. Her vital signs are within normal limits. The abdomen is nontender, and no contractions are felt. Ultrasonography shows a cervical length of 22 mm and a fetal heart rate of 140/min. Which of the following is the most likely diagnosis?? {'A': 'Cephalopelvic disproportion', 'B': 'Bicornuate uterus', 'C': 'Placental insufficiency', 'D': 'Diethylstilbestrol exposure', 'E': 'Cervical insufficiency'},
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E: Cervical insufficiency
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Q:An 11-year-old boy with a history of attention deficit disorder presents to a general medicine clinic with leg pain. He is accompanied by his mother. He reports dull, throbbing, diffuse pain in his bilateral lower extremities. He reports that the pain feels deep in his muscles. He has awakened several times at night with the pain, and his symptoms tend to be better during the daylight hours. He denies fatigue, fever, or pain in his joints. On physical examination, his vital signs are stable, and he is afebrile. Physical examination reveals full range of motion in the hip and knee joints without pain. He has no joint effusions, erythema, or warmth. What is the next best step in management?? {'A': 'Lower extremity venous ultrasound', 'B': 'MRI of the knees', 'C': 'Xray of the knees', 'D': 'Send ESR and CRP', 'E': 'Reassurance'},
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E: Reassurance
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Q:A 49-year-old woman presents to her primary care physician for a general check up. She has not seen a primary care physician for the past 20 years but states she has been healthy during this time frame. She had breast implants placed when she was 29 years old but otherwise has not had any surgeries. She is concerned about her risk for breast cancer given her friend was recently diagnosed. Her temperature is 97.0°F (36.1°C), blood pressure is 114/64 mmHg, pulse is 70/min, respirations are 12/min, and oxygen saturation is 98% on room air. Physical exam is unremarkable. Which of the following is the most appropriate workup for breast cancer for this patient?? {'A': 'BRCA genetic testing', 'B': 'Mammography', 'C': 'No intervention indicated at this time', 'D': 'Sentinel node biopsy', 'E': 'Ultrasound'},
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C: No intervention indicated at this time
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Q:A 29-year-old man with post-traumatic stress disorder is admitted to the hospital following an intentional opioid overdose. He is a soldier who returned from a deployment in Afghanistan 3 months ago. He is divorced and lives alone. His mother died by suicide when he was 8 years of age. He states that he intended to end his life as painlessly as possible and has also contemplated using his service firearm to end his life. He asks the physician if assisted suicide is legal in his state. He does not smoke or drink alcohol but uses medical marijuana daily. Mental status examination shows a depressed mood and constricted affect. Which of the following is the strongest risk factor for suicide in this patient?? {'A': 'Male sex', 'B': 'Family history of completed suicide', 'C': 'Attempted drug overdose', 'D': 'Use of medical marijuana', 'E': 'Lack of social support'},
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C: Attempted drug overdose
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Q:A 37-year-old man presents to his primary care physician because he has had constipation for the last several weeks. He has also been feeling lethargic and complains that this winter has been particularly cold. He also complains that he has been gaining weight despite no change in his normal activities. He reveals that two months prior to presentation he had what felt like the flu for which he took tylenol and did not seek medical attention. Several days after this he developed anterior neck pain. Which of the following findings would most likely be seen on biopsy of this patient's abnormality?? {'A': 'Fibrous tissue', 'B': 'Focal hyperplasia', 'C': 'Germinal follicles', 'D': 'Granulomatous inflammation', 'E': 'Scalloped clear areas'},
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D: Granulomatous inflammation
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Q:A 28-year-old woman presents to her primary care physician with recurring muscle cramps that have lasted for the last 2 weeks. She mentions that she commonly has these in her legs and back. She also has a constant tingling sensation around her mouth. On physical examination, her vital signs are stable. The Trousseau sign and Chvostek sign are present with exaggerated deep tendon reflexes. A comprehensive blood test reveals the following: Na+ 140 mEq/L K+ 4.5 mEq/L Chloride 100 mEq/L Bicarbonate 24 mEq/L Creatinine 0.9 mg/dL Ca2+ 7.0 mg/dL Which of the following electrophysiologic mechanisms best explain this woman’s clinical features?? {'A': 'Stimulation of GABA (γ-aminobutyric acid) receptors', 'B': 'Increased firing threshold for action potential', 'C': 'Reduction of afterhyperpolarization', 'D': 'Inhibition of Na+ and Ca2+ currents through cyclic nucleotide-gated (CNG) channels', 'E': 'Inhibition of sodium current through sodium leak channels (NALCN)'},
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C: Reduction of afterhyperpolarization
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Q:A 56-year-old man is brought to the emergency department with increasing crampy abdominal pain and swelling over the past 2 days. He has not passed stool or flatus for over 12 hours. He has vomited twice. He has noted a lower stool caliber over the past month. His past medical history is unremarkable except for an appendectomy 8 years ago. He takes no medications. His temperature is 37.5°C (99.5°F), pulse is 82/min, respirations are 19/min, and blood pressure is 110/70 mm Hg. Abdominal examination shows symmetric distension, active bowel sounds, and generalized tenderness without guarding or rebound tenderness. His leukocyte count is 10,000/mm3. An upright and supine X-ray of the abdomen are shown. Which of the following is the most likely underlying cause of this patient’s recent condition?? {'A': 'Acute mesenteric ischemia', 'B': 'Adhesions', 'C': 'Diverticulitis', 'D': 'Ogilvie’s syndrome', 'E': 'Sigmoid tumor'},
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E: Sigmoid tumor
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Q:A 6-year-old boy is brought to the physician because he has a limp for 3 weeks. He was born at term and has been healthy since. His immunization are up-to-date; he received his 5th DTaP vaccine one month ago. He is at 50th percentile for height and weight. His temperature is 37°C (98.6°F), pulse is 80/min and respirations are 28/min. When asked to stand only on his right leg, the left pelvis sags. The remainder of the examination shows no abnormalities. Which of the following is the most likely cause of these findings?? {'A': 'L5 radiculopathy', 'B': 'Damage to the left inferior gluteal nerve', 'C': 'Spinal abscess', 'D': 'Damage to the right common peroneal nerve', 'E': 'Damage to the right superior gluteal nerve'},
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E: Damage to the right superior gluteal nerve
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Q:A 47-year-old man with gastroesophageal reflux disease comes to the physician because of severe burning chest pain and belching after meals. He has limited his caffeine intake and has been avoiding food close to bedtime. Esophagogastroduodenoscopy shows erythema and erosions in the distal esophagus. Which of the following is the mechanism of action of the most appropriate drug for this patient?? {'A': 'Enhancement of the mucosal barrier', 'B': 'Inhibition of D2 receptors', 'C': 'Neutralization of gastric acid', 'D': 'Inhibition of H2 receptors', 'E': 'Inhibition of ATPase'},
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E: Inhibition of ATPase
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Q:An 87-year-old male nursing home resident is currently undergoing antibiotic therapy for the treatment of a decubitus ulcer. One week into the treatment course, he experiences several episodes of watery diarrhea. Subsequent sigmoidoscopy demonstrates the presence of diffuse yellow plaques on the mucosa of the sigmoid colon. Which of the following is the best choice of treatment for this patient?? {'A': 'Oral morphine', 'B': 'Intravenous gentamicin', 'C': 'Oral metronidazole', 'D': 'Oral trimethoprim/sulfamethoxazole', 'E': 'Intravenous vancomycin'},
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C: Oral metronidazole
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Q:A 38-year-old woman comes to the physician because of a 3-month history of moderate abdominal pain that is unresponsive to medication. She has a history of two spontaneous abortions at 11 and 12 weeks' gestation. Ultrasound examination of the abdomen shows normal liver parenchyma, a dilated portal vein, and splenic enlargement. Upper endoscopy shows dilated submucosal veins in the lower esophagus. Further evaluation of this patient is most likely to show which of the following findings?? {'A': 'Increased prothrombin time', 'B': 'Hepatic venous congestion', 'C': 'Increased serum bilirubin levels', 'D': 'Councilman bodies', 'E': 'Thrombocytopenia'},
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E: Thrombocytopenia
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Q:A 31-year-old man and his wife were referred to a genetic counselor. They are concerned about the chance that their children are likely to inherit certain conditions that run in their families. The wife’s father and grandfather are both healthy, but her grandfather can not see the color red. The husband is unaware if any member of his family has the same condition. The geneticist provides some details about genetic diseases and inheritance patterns, then orders lab tests to analyze the gene mutations carried by both partners. Which of the following are the correct terms regarding the genotype and phenotype of males affected by the condition described?? {'A': 'Heterozygotes; reduced or incomplete penetrance', 'B': 'Hemizygous; reduced or incomplete penetrance', 'C': 'Homozygote; reduced or incomplete penetrance', 'D': 'Heterozygotes; full penetrance', 'E': 'Hemizygous; full penetrance'},
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E: Hemizygous; full penetrance
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Q:A 56-year-old woman presents to the emergency department after falling in the shower 2 days ago. At that time, she was complaining of severe back pain that she treated with over the counter acetaminophen. Since the fall, she has had increasing stomach pain and difficulty walking. She has not urinated or had a bowel movement since the incident. She has no significant past medical history and takes a multivitamin regularly. No significant family history. Her vitals include: blood pressure 137/82 mm Hg, pulse 78/min, respiratory rate 16/min, temperature 37.0°C (98.6°F). On physical examination, she is alert and oriented but in great discomfort. There is focal, non-radiating midline pain with palpation of the L1 vertebrae. On pinprick sensory testing, she reveals decreased sensations below the level of the knees bilaterally. Muscle strength is 4/5 in both lower extremities. Which of the following additional findings would most likely be present in this patient?? {'A': 'Decreased muscle strength in upper extremities', 'B': 'Difficulty in swallowing', 'C': 'Decreased deep tendon reflexes', 'D': 'Increased deep tendon reflexes', 'E': 'Intentional tremors'},
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D: Increased deep tendon reflexes
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Answer the following medical question with one of the provided options:
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Q:A 5-year-old girl is brought to the emergency department because of abdominal pain, vomiting, and diarrhea for 6 days. Her mother says that over the last 24 hours she has developed a rash and has been urinating less frequently than usual. One month ago, she had a 3-day episode of high fever and sore throat that subsided without medical treatment. She appears weak. Her temperature is 37.7°C (99.8°F), pulse is 120/min, respirations are 28/min, and blood pressure is 114/72 mm Hg. Examination shows petechiae on the trunk and jaundice of the skin. The abdomen is diffusely tender with no peritoneal signs. Neurological examination shows no abnormalities. Laboratory studies show: Hemoglobin 8 g/dL Mean corpuscular volume 85 μm3 Leukocyte count 16,200/mm3 Platelet count 38,000/mm3 Serum Blood urea nitrogen 43 mg/dL Creatinine 2.9 mg/dL pH 7.0 Urine dipstick is positive for blood and protein. A blood smear shows schistocytes and normochromic, normocytic cells. In addition to supportive treatment, which of the following is the most appropriate next step in management of this patient?"? {'A': 'Diazepam therapy', 'B': 'Red blood cell transfusions', 'C': 'Platelet transfusion', 'D': 'Levofloxacin therapy', 'E': 'Hemodialysis'},
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E: Hemodialysis
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Q:A 25-year-old man is brought to the emergency department by police for aggressive behavior. The patient is combative and shouts sexually aggressive remarks at the nursing staff. While obtaining the patient’s vitals, it is noted that he has markedly dilated pupils. His temperature is 98.2°F (36.8°C), pulse is 112/min, blood pressure is 130/70 mmHg, respirations are 18/min, and oxygen saturation is 98% on room air. Urine toxicology is obtained and sent off. Physical exam is notable for an energetic patient with dilated pupils and increased sweating. The patient spends the night in the emergency department. In the morning the patient is withdrawn and has a notable depressed affect. He apologizes for his behavior the previous night and states that he is concerned about his problem and wants help. Which of the following is appropriate management of this patient?? {'A': 'Acamprosate', 'B': 'Disulfiram', 'C': 'Naltrexone', 'D': 'Psychotherapy', 'E': 'Varenicline'},
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D: Psychotherapy
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Q:A 23-year-old woman is brought to the emergency department by her boyfriend 10 minutes after ingesting at least 15 acetaminophen tablets. She has been admitted to the hospital several times in the past few months after attempted self-harm. She claims that her boyfriend is “extremely selfish” and “does not care for her.” She says she feels lonely and wants her boyfriend to pay attention to her. Her boyfriend says that they have broken up 10 times in the past year because she is prone to outbursts of physical aggression as well as mood swings. He says that these mood swings last a few hours and can vary from states of “exuberance and affection” to states of “depression.” On examination, the patient appears well-dressed and calm. She has normal speech, thought processes, and thought content. Which of the following is the most likely diagnosis?? {'A': 'Narcissistic personality disorder', 'B': 'Cyclothymic disorder', 'C': 'Bipolar II disorder', 'D': 'Borderline personality disorder', 'E': 'Dependent personality disorder'},
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D: Borderline personality disorder
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Answer the following medical question with one of the provided options:
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Q:A 28-year-old primigravid woman at 36 weeks' gestation comes to the emergency department because of worsening pelvic pain for 2 hours. Three days ago, she had a burning sensation with urination that resolved spontaneously. She has nausea and has vomited fluid twice on her way to the hospital. She appears ill. Her temperature is 39.7°C (103.5°F), pulse is 125/min, respirations are 33/min, and blood pressure is 130/70 mm Hg. Abdominal examination shows diffuse tenderness. No contractions are felt. Speculum examination shows pooling of nonbloody, malodorous fluid in the vaginal vault. The cervix is not effaced or dilated. Laboratory studies show a hemoglobin concentration of 14 g/dL, a leukocyte count of 16,000/mm3, and a platelet count of 250,000/mm3. Fetal heart rate is 148/min and reactive with no decelerations. Which of the following is the most appropriate next step in management?? {'A': 'Administer intravenous ampicillin and gentamicin and perform C-section', 'B': 'Expectant management', 'C': 'Administer oral azithromycin and induce labor', 'D': 'Administer intravenous ampicillin and gentamicin and induce labor', 'E': 'Perform C-section'},
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D: Administer intravenous ampicillin and gentamicin and induce labor
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Q:A 45-year-old woman with history of systemic sclerosis presents with new onset dyspnea, which is worsened with moderate exertion. She also complains of chest pain. An ECG was obtained, and showed right-axis deviation. Chest x-ray showed right ventricle hypertrophy. Given the patient's history and presentation, right heart catheterization was performed, which confirmed the suspected diagnosis of pulmonary artery hypertension. It is decided to start the patient on bosentan. Which of the following describes the method of action of bosentan?? {'A': 'Endothelin receptor antagonist', 'B': 'Endothelin receptor agonist', 'C': 'Phosphodiesterase type 5 inhibitor', 'D': 'Calcium channel blocker', 'E': 'Anticoagulant'},
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A: Endothelin receptor antagonist
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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 presents to his primary care provider for evaluation of nocturnal cough and dyspnea. He has been a smoker for the past 15 years with a 7.5-pack-year smoking history. He has no significant medical history and takes no medications. His blood pressure is 118/76 mm Hg, the heart rate is 84/min, the respiratory rate is 15/min, and the temperature is 37.0°C (98.6°F). A sputum sample shows Charcot-Leyden crystals and Curschmann spirals. What is the most likely diagnosis?? {'A': 'Chronic obstructive pulmonary disease', 'B': 'Atopic asthma', 'C': 'Panacinar emphysema', 'D': 'Pneumonia', 'E': 'Bronchiectasis'},
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B: Atopic asthma
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Answer the following medical question with one of the provided options:
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Q:A 35-year-old man, with a history of neurofibromatosis type 2 (NF2) diagnosed 2 years ago, presents with hearing loss in the right ear and tinnitus. Patient says that symptoms have been gradually progressive. He has difficulty hearing speech as well as loud sounds. He also gives a history of occasional headaches and vertigo on and off for 1 month, which is unresponsive to paracetamol. His vitals include: blood pressure 110/78 mm Hg, temperature 36.5°C (97.8°F), pulse 78/min and respiratory rate 11/min. Tuning fork tests reveal the following: Left Right Rinne’s test Air conduction > bone conduction Air conduction > bone conduction Weber test Lateralized to left ear Other physical examination findings are within normal limits. An MRI of the head is ordered which is as shown in image 1. A biopsy is done which shows cells staining positive for S100 but negative for glial fibrillary acidic protein (GFAP). The histopathological slide is shown in image 2. What is the most likely diagnosis?? {'A': 'Glioblastoma multiforme', 'B': 'Hemangioblastoma', 'C': 'Schwannoma', 'D': 'Meningioma', 'E': 'Craniopharyngioma'},
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C: Schwannoma
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Q:A 24-year old G1P0 mother with no prenatal screening arrives to the hospital in labor and has an uneventful delivery. The infant is full term and has no significant findings on physical exam. Shortly after birth, an ophthalmic ointment is applied to the newborn in order to provide prophylaxis against infection. Which of the following is the most common mechanism of resistance to the ointment applied to this newborn?? {'A': 'Penicillinase in bacteria cleaves the beta-lactam ring', 'B': 'Alteration of amino acid cell wall', 'C': 'Increased efflux out of bacterial cells with plasmid-encoded transport pumps', 'D': 'Mutation in DNA polymerase', 'E': 'Methylation of 23S rRNA-binding site'},
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E: Methylation of 23S rRNA-binding site
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Q:A 2-year-old boy is brought to the emergency department by his mother 30 minutes after having a generalized tonic-clonic seizure. He was born at home and has not attended any well-child visits. He is not yet able to walk and does not use recognizable words. His paternal uncle has a severe intellectual disability and has been living in an assisted-living facility all of his life. The boy's urine phenylacetate level is markedly elevated. Which of the following amino acids is most likely nutritionally essential for this patient because of his underlying condition?? {'A': 'Phenylalanine', 'B': 'Glutamate', 'C': 'Alanine', 'D': 'Tyrosine', 'E': 'Cysteine'},
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D: Tyrosine
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Q:A 30-year-old G3P0 woman who is 28 weeks pregnant presents for a prenatal care visit. She reports occasionally feeling her baby move but has not kept count over the past couple weeks. She denies any bleeding, loss of fluid, or contractions. Her previous pregnancies resulted in spontaneous abortions at 12 and 14 weeks. She works as a business executive, has been in excellent health, and has had no surgeries. She states that she hired a nutritionist and pregnancy coach to ensure good prospects for this pregnancy. On physical exam, fetal heart tones are not detected. Abdominal ultrasound shows a 24-week fetal demise. The patient requests an autopsy on the fetus and wishes for the fetus to pass "as naturally as possible." What is the best next step in management?? {'A': 'Caesarean delivery', 'B': 'Induction of labor at term', 'C': 'Dilation and curettage', 'D': 'Dilation and evacuation', 'E': 'Induction of labor now'},
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E: Induction of labor now
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Q:On the 3rd day post-anteroseptal myocardial infarction (MI), a 55-year-old man who was admitted to the intensive care unit is undergoing an examination by his physician. The patient complains of new-onset precordial pain which radiates to the trapezius ridge. The nurse informs the physician that his temperature was 37.7°C (99.9°F) 2 hours ago. On physical examination, the vital signs are stable, but the physician notes the presence of a triphasic pericardial friction rub on auscultation. A bedside electrocardiogram shows persistent positive T waves in leads V1–V3 and an ST segment: T wave ratio of 0.27 in lead V6. Which of the following is the drug of choice to treat the condition the patient has developed?? {'A': 'Aspirin', 'B': 'Colchicine', 'C': 'Clarithromycin', 'D': 'Furosemide', 'E': 'Prednisolone'},
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A: Aspirin
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Q:A 63-year-old man with alpha-1-antitrypsin deficiency is brought to the emergency department 1 hour after his daughter found him unresponsive. Despite appropriate care, the patient dies. At autopsy, examination of the lungs shows enlargement of the airspaces in the respiratory bronchioles and alveoli. Destruction of which of the following cells is the most likely cause of these findings?? {'A': 'Non-ciliated cuboidal cells', 'B': 'Type I pneumocytes', 'C': 'Type II pneumocytes', 'D': 'Ciliated cuboidal cells', 'E': 'Ciliated columnar cells'},
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B: Type I pneumocytes
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Answer the following medical question with one of the provided options:
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Q:A 32-year-old woman is supposed to undergo tooth extraction surgery. Physical examination is unremarkable, and she has a blood pressure of 126/84 mm Hg and regular pulse of 72/min. She takes no medications. Which of the following cardiac conditions would warrant antibiotic prophylaxis to prevent infective endocarditis in this patient?? {'A': 'Hypertrophic obstructive cardiomyopathy (HOCM)', 'B': 'Ventricular septal defect (VSD)', 'C': 'Implantable cardioverter defibrillator (ICD)', 'D': 'Past history of infective endocarditis', 'E': 'Mitral regurgitation'},
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D: Past history of infective endocarditis
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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 to the physician with 2 days of profuse, watery diarrhea. He denies seeing blood or mucus in the stools. On further questioning, he reveals that he eats a well-balanced diet and generally prepares his meals at home. He remembers having some shellfish from a street vendor 3 days ago. He takes no medications. His past medical history is unremarkable. Which of the following mechanisms most likely accounts for this patient’s illness?? {'A': 'ADP-ribosylation of Gs protein', 'B': 'Inflammation of the gastrointestinal wall', 'C': 'Osmotic effect of intestinal contents', 'D': 'Tyrosine kinase phosphorylation', 'E': 'Tyrosine kinase dephosphorylation'},
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A: ADP-ribosylation of Gs protein
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Answer the following medical question with one of the provided options:
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Q:A medical student is spending his research year studying the physiology of cholesterol transport within the body. Specifically, he wants to examine how high density lipoprotein (HDL) particles are able to give other lipoproteins the ability to hydrolyse triglycerides into free fatty acids. He labels all the proteins on HDL particles with a tracer dye and finds that some of them are transferred onto very low density lipoprotein (VLDL) particles after the 2 are incubated together. Furthermore, he finds that only VLDL particles with transferred proteins are able to catalyze triglyceride hydrolysis. Which of the following components were most likely transferred from HDL to VLDL particles to enable this reaction?? {'A': 'Apo-A1', 'B': 'ApoB-100', 'C': 'ApoC-II', 'D': 'ApoE', 'E': 'Lipoprotein lipase'},
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C: ApoC-II
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Answer the following medical question with one of the provided options:
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Q:A patient is hospitalized for pneumonia. Gram-positive cocci in clusters are seen on sputum gram stain. Which of the following clinical scenarios is most commonly associated with this form of pneumonia?? {'A': 'Elderly patient who has trouble swallowing and poor dentition', 'B': 'HIV positive adult with a CD4 count less than 150 and an impaired diffusion capacity', 'C': 'An otherwise healthy young adult with a week of mild fatigue, chills, and cough', 'D': 'Hospitalized adult with development of pneumonia symptoms 2 weeks following a viral illness', 'E': 'An alcoholic with evidence of empyema and "currant jelly sputum"'},
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D: Hospitalized adult with development of pneumonia symptoms 2 weeks following a viral illness
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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 is brought to the emergency department 30 minutes after he was involved in a motorcycle collision. He was not wearing a helmet. Physical examination shows left periorbital ecchymosis. A CT scan of the head shows a fracture of the greater wing of the left sphenoid bone with compression of the left superior orbital fissure. Physical examination of this patient is most likely to show which of the following findings?? {'A': 'Decreased sense of smell', 'B': 'Numbness of the left cheek', 'C': 'Preserved left lateral gaze', 'D': 'Absent left corneal reflex', 'E': 'Complete loss of vision of the left eye'},
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D: Absent left corneal reflex
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Answer the following medical question with one of the provided options:
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Q:A 47-year-old woman presents with difficulty in speaking and swallowing for the past 2 weeks. She has difficulty in swallowing solid food but not liquids. She also complains of blurry vision. No significant past medical history. The patient is afebrile and vital signs are within normal limits. Physical examination is significant for the fullness of the suprasternal notch and slurred speech. Routine laboratory tests are unremarkable. Chest radiography shows a widened mediastinum. A contrast CT of the chest reveals a mass in the anterior mediastinum with irregular borders and coarse calcifications. A CT-guided biopsy is performed. Which of the following cell surface markers would most likely be positive if immunotyping of the biopsy sample is performed?? {'A': 'Positive for thyroglobulin and thyroid transcription factor 1 (TTF-1)', 'B': 'Positive for c-kit', 'C': 'Positive for CD5, CD7 and TdT and negative for keratin', 'D': 'Double-positive for CD4 and CD8', 'E': 'Positive for CD15 and CD30 and negative for CD45, CD3, CD43 and keratin'},
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D: Double-positive for CD4 and CD8
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Answer the following medical question with one of the provided options:
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Q:A researcher wants to study how smoking electronic cigarettes affects the risk of developing lung cancer. She decides to perform a cohort study and consults a medical statistician in order to discuss how the study should be designed. After looking at the data she has available, she concludes that she will perform a retrospective study on existing patients within her database. She then discusses how to set up the experimental and control groups for comparison in her study. Which of the following would be the most appropriate set of experimental and control groups for her cohort study, respectively?? {'A': 'Subjects who smoke electronic cigarettes and subjects who do not smoke', 'B': 'Subjects who smoke electronic cigarettes and subjects who smoke normal cigarettes', 'C': 'Subjects with lung cancer and subjects without lung cancer', 'D': 'Subjects with lung cancer who smoke and subjects with lung cancer who did not smoke', 'E': 'Subjects with lung cancer who smoke and subjects without lung cancer who smoke'},
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A: Subjects who smoke electronic cigarettes and subjects who do not smoke
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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 comes to the physician because of a 6-month history of vaginal bleeding for 2 to 5 days every 2 to 3 weeks. The flow is heavy with passage of clots. Menarche occurred at the age of 10 years, and menses previously occurred at regular 28- to 32- day intervals and lasted for 5 days with normal flow. Her only medication is a multivitamin. She has no children. Her mother was diagnosed with ovarian cancer at age 60. She is 158 cm (5 ft 2 in) tall and weighs 86 kg (190 lb); BMI is 34 kg/m2. Her temperature is 36.6°C (97.8°F), pulse is 86/min and blood pressure is 110/70 mm Hg. Pelvic examination shows a normal sized uterus. Laboratory studies, including a complete blood count, thyroid function tests, and coagulation studies are within the reference ranges. A urine pregnancy test is negative. The remainder of the examination shows no abnormalities. Which of the following is the most appropriate next step in management?? {'A': 'Endometrial ablation', 'B': 'Endometrial biopsy', 'C': 'Abdominal ultrasonography', 'D': 'Combined oral contraceptives', 'E': 'Diagnostic laparoscopy'},
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B: Endometrial biopsy
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Answer the following medical question with one of the provided options:
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Q:A 24-year-old man is brought by ambulance to the emergency department after a motor vehicle accident. He was the front seat driver in a head on collision. He is currently unconscious. The patient’s past medical history is only notable for an allergy to amoxicillin as he developed a rash when it was given for a recent upper respiratory infection 1 week ago. Otherwise, he is a college student in good health. The patient is resuscitated. A FAST exam is notable for free fluid in Morrison’s pouch. An initial assessment demonstrates only minor bruises and scrapes on his body. After further resuscitation the patient becomes responsive and begins vomiting. Which of the following is the most likely diagnosis?? {'A': 'Duodenal hematoma', 'B': 'Laceration of the liver', 'C': 'Laceration of the spleen', 'D': 'No signs of internal trauma', 'E': 'Rupture of the inferior vena cava'},
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C: Laceration of the spleen
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Answer the following medical question with one of the provided options:
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Q:A 52-year-old male presents to the office for diabetes follow-up. He is currently controlling his diabetes through lifestyle modification only. He monitors his blood glucose at home with a glucometer. He gives the doctor a list of his most recent early morning fasting glucose readings from the past 8 days, which are 128 mg/dL, 130 mg/dL, 132 mg/dL, 125 mg/dL, 134 mg/dL, 127 mg/dL, 128 mg/dL, and 136 mg/dL. Which value most likely corresponds with the median of this data set?? {'A': '127 mg/dL', 'B': '128 mg/dL', 'C': '129 mg/dL', 'D': '130 mg/dL', 'E': '132 mg/dL'},
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C: 129 mg/dL
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Answer the following medical question with one of the provided options:
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Q:A 33-year-old woman presents to her local clinic in rural eastern India complaining of neck pain and fever. She reports a 4 day history of severe neck pain, neck stiffness, mild diarrhea, and fever. She has not taken her temperature. She works as a laborer and frequently carries heavy weights on her back. She is prescribed a medication and told to come back if her symptoms do not improve. Her symptoms resolve after a couple days. Six months later, she gives birth to a newborn male at 34 weeks gestation. His temperature is 97.8°F (36.6°C), blood pressure is 90/55 mmHg, pulse is 110/min, and respirations are 24/min. On examination, the baby is irritable with a weak cry. Ashen gray cyanosis is noted diffusely. What the is the mechanism of action of the drug responsible for this child’s presentation?? {'A': 'Dihydropteroate synthase inhibitor', 'B': 'DNA-dependent RNA polymerase inhibitor', 'C': 'DNA gyrase inhibitor', 'D': '30S ribosomal subunit inhibitor', 'E': '50S ribosomal subunit inhibitor'},
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E: 50S ribosomal subunit inhibitor
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Answer the following medical question with one of the provided options:
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Q:A 4-year-old girl is brought by her mother to the pediatrician for neck drainage. The mother reports that the child has always had a small pinpoint opening on the front of her neck, though the opening has never been symptomatic. The child developed a minor cold approximately 10 days ago which resolved after a week. However, over the past 2 days, the mother has noticed clear thick drainage from the opening on the child’s neck. The child is otherwise healthy. She had an uncomplicated birth and is currently in the 45th and 40th percentiles for height and weight, respectively. On examination, there is a small opening along the skin at the anterior border of the right sternocleidomastoid at the junction of the middle and lower thirds of the neck. There is some slight clear thick discharge from the opening. Palpation around the opening elicits a cough from the child. This patient’s condition is caused by tissue that also forms which of the following?? {'A': 'Epithelial lining of the Eustachian tube', 'B': 'Inferior parathyroid glands', 'C': 'Superior parathyroid glands', 'D': 'Thymus gland', 'E': 'Epithelial tonsillar lining'},
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E: Epithelial tonsillar lining
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Answer the following medical question with one of the provided options:
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Q:On physical examination and imaging, a 3-year-old male shows evidence of multiple healed fractures and bruising. On eye exam, the child's irises appear blue, and results of a fundoscopic exam are shown in Image A. What is the most appropriate next step in the care of this patient?? {'A': 'Intravenous vitamin C', 'B': 'Genetic testing for collagen synthesis disorder', 'C': 'Call child protective services', 'D': 'Hearing test', 'E': 'Bone marrow transplant'},
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C: Call child protective services
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Answer the following medical question with one of the provided options:
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Q:A 32-year-old woman presents with odorless vaginal discharge, irritation, and itching. She developed these symptoms about a week ago, which was 5 days after she had finished treatment with ceftriaxone for otitis media. She has a single sexual partner and uses oral contraceptives. She is allergic to macrolides, azoles, and nystatin. Her vital signs are as follows: blood pressure is 110/60 mm Hg, heart rate is 80/min, respiratory rate is 15/min, and temperature is 36.6℃ (97.9℉). Examination reveals a thick, curd-like, white odorless vaginal discharge and vulvar erythema. Considering the spectrum of agents she is allergic to, she is prescribed topical sulfonamide, a competitive inhibitor against an important bacterial enzyme. Which of the following Michaelis-Menten plots describes the kinetics of conversion of para-aminobenzoic acid to folate by dihydropteroate synthase under the influence of sulfanilamide?? {'A': '1', 'B': '2', 'C': '3', 'D': '4', 'E': '5'},
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B: 2
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Answer the following medical question with one of the provided options:
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Q:A 34-year-old woman comes to the physician for a routine health maintenance examination. She has gastroesophageal reflux disease. She recently moved to a new city. Her father was diagnosed with colon cancer at age 46. Her father's brother died because of small bowel cancer. Her paternal grandfather died because of stomach cancer. She takes a vitamin supplement. Current medications include esomeprazole and a multivitamin. She smoked one pack of cigarettes daily for 6 years but quit 2 years ago. She drinks one to two alcoholic beverages on weekends. She appears healthy. Vital signs are within normal limits. Physical examination shows no abnormalities. Colonoscopy is unremarkable. Germline testing via DNA sequencing in this patient shows mutations in DNA repair genes MLH1 and MSH2. Which of the following will this patient most likely require at some point in her life?? {'A': 'Hysterectomy and bilateral salpingo-oophorectomy', 'B': 'Surgical removal of a desmoid tumor', 'C': 'Celecoxib or sulindac therapy', 'D': 'Bilateral prophylactic mastectomy', 'E': 'Prophylactic proctocolectomy with ileoanal anastomosis'},
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A: Hysterectomy and bilateral salpingo-oophorectomy
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Answer the following medical question with one of the provided options:
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Q:A 35-year-old woman comes to the physician because of progressive left flank pain over the past 2 weeks. She has a history of type 1 diabetes mellitus. Her temperature is 38°C (100.4°F). There is tenderness to percussion along the left flank. Passive extension of the left hip is painful. Her leukocyte count is 16,000/mm3. An axial CT scan is shown. The underlying pathology is most likely located in which of the following anatomical structures?? {'A': 'Quadratus lumborum muscle', 'B': 'Iliacus muscle', 'C': 'Psoas major muscle', 'D': 'Left kidney', 'E': 'Abdominal aorta'},
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C: Psoas major muscle
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Answer the following medical question with one of the provided options:
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Q:A 45-year-old woman comes to the physician because of a 3-month history of worsening fatigue, loss of appetite, itching of the skin, and progressive leg swelling. Although she has been drinking 2–3 L of water daily, she has been passing only small amounts of urine. She has type 1 diabetes mellitus, chronic kidney disease, hypertension, and diabetic polyneuropathy. Her current medications include insulin, torasemide, lisinopril, and synthetic erythropoietin. Her temperature is 36.7°C (98°F), pulse is 87/min, and blood pressure is 138/89 mm Hg. She appears pale. There is 2+ pitting edema in the lower extremities. Sensation to pinprick and light touch is decreased over the feet and legs bilaterally. Laboratory studies show: Hemoglobin 11.4 g/dL Leukocyte count 6000/mm3 Platelet count 280,000/mm3 Serum Na+ 137 mEq/L K+ 5.3 mEq/L Cl− 100 mEq/L HCO3− 20 mEq/L Urea nitrogen 85 mg/dL Creatinine 8 mg/dL pH 7.25 Which of the following long-term treatments would best improve quality of life and maximize survival in this patient?"? {'A': 'Hemofiltration', 'B': 'Cadaveric kidney transplant', 'C': 'Fluid restriction', 'D': 'Living donor kidney transplant', 'E': 'Peritoneal dialysis'},
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D: Living donor kidney transplant
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Answer the following medical question with one of the provided options:
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Q:A research team is studying certain congenital anomalies of the respiratory tract. The method consists of marking a certain germinal layer with an isotope, following its development stages in chicken embryos, and finally analyzing the specimen. A given specimen of tissue is presented in the exhibit. Which of the following germinal structures most likely gave rise to the epithelial lining of this specimen?? {'A': 'Endoderm', 'B': 'Mesoderm', 'C': 'Ectoderm', 'D': 'Neural crest', 'E': 'Surface ectoderm'},
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A: Endoderm
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Answer the following medical question with one of the provided options:
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Q:A 59-year-old man presents to his primary care provider with the complaint of daytime fatigue. He often has a headache that is worse in the morning and feels tired when he awakes. He perpetually feels fatigued even when he sleeps in. The patient lives alone, drinks 2-3 beers daily, drinks coffee regularly, and has a 10 pack-year smoking history. His temperature is 99.0°F (37.2°C), blood pressure is 180/110 mm Hg, pulse is 80/min, respirations are 13/min, and oxygen saturation is 98% on room air. Physical exam is notable for a BMI of 39 kg/m^2. The rest of the patient's pulmonary and neurological exams are unremarkable. Which of the following is the best next step in management?? {'A': 'Alcohol avoidance in the evening', 'B': 'Caffeine avoidance', 'C': 'CT head', 'D': 'Screening for depression', '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 21-year-old man comes to the physician because of painful, firm, dark bumps on his neck and jawline. He has no history of serious illness and takes no medications. His brother had a similar rash that improved with topical erythromycin therapy. A photograph of the rash is shown. Which of the following is the most likely underlying mechanism of this patient's condition?? {'A': 'Trichophyton infection of the superficial hair follicle', 'B': 'Cutibacterium acnes colonization of the pilosebaceous unit', 'C': 'Follicular obstruction with subsequent duct rupture', 'D': 'Interfollicular penetration of the skin by distal end of hair', 'E': 'Bacterial infection of the superficial or deep hair follicle'},
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D: Interfollicular penetration of the skin by distal end of hair
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Answer the following medical question with one of the provided options:
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Q:A 25-year-old woman comes to the physician because of pain and weakness in her right forearm and hand for several months. Two years ago, she sustained a fracture of her ulnar shaft with dislocation of the radial head that was treated surgically. Physical examination shows mild tenderness a few centimeters distal to the lateral epicondyle. She has marked weakness when attempting to extend her right middle finger. There is radial deviation on extension of the wrist. Sensation is not impaired. Which of the following nerves is most likely affected in this patient?? {'A': 'Ulnar nerve', 'B': 'Anterior interosseous nerve', 'C': 'Superficial radial nerve', 'D': 'Posterior interosseous nerve', 'E': 'Musculocutaneous nerve'},
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D: Posterior interosseous nerve
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Answer the following medical question with one of the provided options:
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Q:A 74-year-old man is admitted to the medical ward after he developed a fungal infection. He has aplastic anemia. The most recent absolute neutrophil count was 450/µL. An anti-fungal agent is administered that inhibits the fungal enzyme, (1→3)-β-D-glucan synthase, and thereby disrupts the integrity of the fungal cell wall. He responds well to the treatment. Although amphotericin B is more efficacious for his condition, it was not used because of the side effect profile. What was the most likely infection?? {'A': 'Paracoccidioidomycosis', 'B': 'Candidemia', 'C': 'Invasive aspergillosis', 'D': 'Histoplasmosis', 'E': 'Mucormycosis'},
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B: Candidemia
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Answer the following medical question with one of the provided options:
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Q:A 31-year-old Asian woman presents with painless vaginal bleeding late in the first trimester of her pregnancy. She has had no prenatal care up to this point. Serum HCG levels are elevated much more than expected. You obtain an abdominal ultrasound, and observed the findings in figure A. Which of the following is the most likely karyotype associated with this pregnancy?? {'A': '45XO', 'B': '47XYY', 'C': '46XX', 'D': '69XXX', 'E': '69XYY'},
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C: 46XX
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Answer the following medical question with one of the provided options:
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Q:A 20-year-old man comes to the clinic complaining of fever and a sore throat for 5 days. He receives oral penicillin from his primary doctor. After a day of antibiotic treatment, he developed gross hematuria. As a child, he recalls having multiple episodes of hematuria. The vital signs are within normal limits. On physical examination, pharyngeal edema and cervical lymphadenopathy are present. His laboratory examination reveals the following: WBC 11,000/mm3 Neutrophils 76% Lymphocytes 23% Eosinophils 1% Platelets 150,000/mm3 Hemoglobin 14 g/dL Hct 41.2% BUN 16 mg/dL Creatinine 0.9 mg/dL ASO titer 100 Urinalysis shows hematuria but no proteinuria. Immunofluorescence shows granular IgA immune complex deposits in the mesangium. Hepatitis B, hepatitis C, and HIV serology are negative. ASO titers and C3 levels are within normal limits. What is the most likely diagnosis?? {'A': 'Penicillin-induced hypersensitivity reaction', 'B': 'Berger’s disease', 'C': 'Post-streptococcal glomerulonephritis', 'D': 'Hemolytic uremic syndrome', 'E': 'Celiac disease'},
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B: Berger’s disease
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Answer the following medical question with one of the provided options:
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Q:A 46-year-old woman presents with palpitations, tremors, and anxiety. She says these symptoms have been present ever since a recent change in her diabetic medication. The most recent time she felt these symptoms, her blood glucose level was 65 mg/dL, and she felt better after eating a cookie. Which of the following is the mechanism of action of the drug most likely to have caused this patient's symptoms?? {'A': 'Inhibitor of dipeptidyl peptidase (DPP-IV)', 'B': 'Block reabsorption of glucose in proximal convoluted tubule (PCT)', 'C': 'Inhibition of α-glucosidase', 'D': 'Blocking of the ATP-sensitive K+ channels', 'E': 'Decreased hepatic gluconeogenesis'},
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D: Blocking of the ATP-sensitive K+ channels
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Answer the following medical question with one of the provided options:
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Q:A 21-year-old male presents to the ED with a stab wound to the right neck. The patient is alert and responsive, and vital signs are stable. Which of the following neurologic findings would most likely support the diagnosis of right-sided spinal cord hemisection?? {'A': 'Right-sided tactile, vibration, and proprioception loss; left-sided pain and temperature sensation loss; right-sided paresis', 'B': 'Left-sided tactile, vibration, and proprioception loss; right-sided pain and temperature sensation loss; right-sided paresis', 'C': 'Left-sided tactile, vibration, and proprioception loss; right-sided pain and temperature sensation loss; left-sided paresis', 'D': 'Right-sided tactile, vibration, and proprioception loss; right-sided pain and temperature sensation loss; right-sided paresis', 'E': 'Right-sided tactile, vibration, and proprioception loss, left-sided pain and temperature sensation loss; left-sided paresis'},
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A: Right-sided tactile, vibration, and proprioception loss; left-sided pain and temperature sensation loss; right-sided paresis
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Answer the following medical question with one of the provided options:
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Q:A 9-year-old girl presents with a 3-week history of cough. Her mother reports that initially, she had a runny nose and was tired, with a slight cough, but as the runny nose resolved, the cough seemed to get worse. She further states that the cough is dry sounding and occurs during the day and night. She describes having coughing spasms that occasionally end in vomiting, but between episodes of coughing she is fine. She reports that during a coughing spasm, her daughter will gasp for air and sometimes make a “whooping” noise. A nasopharyngeal swab confirms a diagnosis of Bordetella pertussis. Which of the following statements apply to this patient?? {'A': 'Her 3-month-old brother should be treated with azithromycin as prophylaxis.', 'B': 'She should be started on azithromycin for more rapid resolution of cough.', 'C': 'Her classmates should be treated with clarithromycin as prophylaxis.', 'D': 'She will have lifelong natural immunity against Bordetella pertussis.', 'E': 'Her classmates should receive a TdaP booster regardless of their vaccination status.'},
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A: Her 3-month-old brother should be treated with azithromycin as prophylaxis.
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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 comes to the emergency room with a 4-day history of fever and worsening cough. She describes bringing up a purulent, yellow sputum when she coughs. The patient has a history of cystic fibrosis and works as an elementary school teacher. The patient’s temperature is 102.3°F (39.1°C), blood pressure is 113/73 mmHg, pulse is 98/min, respirations are 18/min, and oxygen saturation is 94% on room air. She is sitting up in bed and sweating. Physical exam reveals bilateral crackles and decreased breath sounds with a dullness to percussion in the right lung base. A chest radiograph is obtained and reveals a right lower lobe pneumonia. Which of the following is the most likely agent?? {'A': 'Haemophilus influenzae', 'B': 'Influenza virus', 'C': 'Pseudomonas aeruginosa', 'D': 'Staphylococcus aureus', 'E': 'Streptococcus pneumoniae'},
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C: Pseudomonas aeruginosa
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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 comes to the physician for evaluation of a recurrent rash. He has multiple skin lesions on his legs, buttocks, and around his mouth. The rash first appeared a year ago and tends to resolve spontaneously in one location before reappearing in another location a few days later. It begins with painless, reddish spots that gradually increase in size and then develop into painful and itchy blisters. The patient also reports having repeated bouts of diarrhea and has lost 10 kg (22 lb) over the past year. One year ago, the patient was diagnosed with major depressive syndrome and was started on fluoxetine. Vital signs are within normal limits. Physical examination shows multiple crusty patches with central areas of bronze-colored induration, as well as tender eruptive lesions with irregular borders and on his legs, buttocks, and around his lips. The Nikolsky sign is negative. His hemoglobin concentration is 10.2 g/dL, mean corpuscular volume is 88 μm3, and serum glucose is 210 mg/dL. A skin biopsy of the lesion shows epidermal necrosis. Which of the following additional findings is most likely to be found in this patient?? {'A': 'Antibodies against hemidesmosomes', 'B': 'Antibodies against glutamic acid decarboxylase', 'C': 'Increased fasting serum glucagon level', 'D': 'Increased serum vasoactive intestinal polypeptide level', 'E': 'Antibodies against desmoglein 1 and 3'},
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C: Increased fasting serum glucagon level
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Answer the following medical question with one of the provided options:
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Q:A 14-year-old male is brought to the Emergency Department by his mother. She is worried because his face has become puffy and his urine has turned a tea-color. Patient history reveals the child recently suffered from a sore throat. The physician suspects a bacterial infection. Which of the following describes the likely bacteria responsible?? {'A': 'Coagulase positive', 'B': 'Catalase positive', 'C': 'Beta-hemolytic', 'D': 'Bacitracin insensitive', 'E': 'Gram negative'},
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C: Beta-hemolytic
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Answer the following medical question with one of the provided options:
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Q:A 45-year-old woman presents with gradual abdominal distension that has progressively increased over the past 3 months. The physical examination showed shifting dullness. A paracentesis showed malignant cells. An ultrasound shows an adnexal mass. Which is the most likely cause of this condition?? {'A': 'Endometrioma', 'B': 'Mucinous cystadenocarcinoma', 'C': 'Granulosa cell tumor', 'D': 'Choriocarcinoma', 'E': 'Benign cystic teratoma'},
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B: Mucinous cystadenocarcinoma
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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 is brought to the emergency department after a motor vehicle accident. He was the unrestrained driver in a head on collision. The patient is responding incoherently and is complaining of being in pain. He has several large lacerations and has been impaled with a piece of metal. IV access is unable to be obtained and a FAST exam is performed. His temperature is 98.2°F (36.8°C), blood pressure is 90/48 mmHg, pulse is 150/min, respirations are 13/min, and oxygen saturation is 98% on room air. Which of the following is the best next step in management?? {'A': 'Administer oral fluids', 'B': 'Exploratory laparatomy', 'C': 'Obtain intraosseus access', 'D': 'Place a central line', 'E': 'Reattempt intravenous access'},
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C: Obtain intraosseus access
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Answer the following medical question with one of the provided options:
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Q:An 18-month-old girl is brought to the emergency department because of the stiffening of her body and unresponsiveness that occurred 1 hour ago. Her symptoms lasted < 10 minutes. She has had coryza for 24 hours without any fever. She had an episode of a febrile generalized tonic-clonic seizure 6 months ago. Her past medical history has otherwise been unremarkable. Her vaccination history is up to date. Her uncle has epilepsy. Her temperature is 38.9°C (102.0°F). Other than nasal congestion, physical examination shows no abnormal findings. Which of the following factors most strongly indicates the occurrence of subsequent epilepsy?? {'A': 'Family history of epilepsy', 'B': 'Focal seizure', 'C': 'History of prior febrile seizure', 'D': 'Recurrence of seizure within 24 hours', 'E': 'Seizure within 1 hour of fever onset'},
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B: Focal seizure
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Answer the following medical question with one of the provided options:
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Q:An 8-year-old girl is brought to the physician by her mother because of a 6-month history of an episodic dry cough, shortness of breath, and chest tightness. She has seasonal allergic rhinitis. Physical examination shows high-pitched expiratory wheezes throughout both lung fields. Pulmonary function testing shows an FEV1 of 70% (N ≥ 80%). Which of the following drugs would be most effective at reducing bronchial inflammation in this patient?? {'A': 'Salmeterol', 'B': 'Adenosine', 'C': 'Tiotropium', 'D': 'Montelukast', 'E': 'Budesonide'},
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E: Budesonide
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Answer the following medical question with one of the provided options:
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Q:A 31-year-old woman comes to the physician because of a 2-day history of low-grade intermittent fever, dyspnea, and chest pain that worsens on deep inspiration. Over the past 4 weeks, she has had pain in her wrists and the fingers of both hands. During this period, she has also had difficulties working on her computer due to limited range of motion in her fingers, which tends to be more severe in the morning. Her temperature is 37.7°C (99.8°F). Physical examination shows a high-pitched scratching sound over the left sternal border. Further evaluation of this patient is most likely to reveal which of the following findings?? {'A': 'Mutation of the HFE gene', 'B': 'Blood urea nitrogen level > 60 mg/dL', 'C': 'Decreased C3 complement levels', 'D': 'Increased titer of anti-citrullinated peptide antibodies', 'E': 'Coxsackie virus RNA'},
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D: Increased titer of anti-citrullinated peptide antibodies
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