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Answer the following medical question with one of the provided options:
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Q:A 49-year-old man presents to the clinic for evaluation of puncture wounds on the dorsal aspect of his right second and third metacarpals. He states that he was in a fight 3 nights ago and he struck another individual in the mouth. The patient’s medical history is significant for peripheral vascular disease and hypertension. He takes aspirin, sulfasalazine, and lisinopril. He is allergic to penicillin. He drinks socially on weekends and smokes one and one-half packs of cigarettes daily. Vitals of the patient are as follows: blood pressure is 142/88 mm Hg; heart rate is 88/min; respiratory rate is 14/min; temperature is 38.9°C (102.1°F). On physical examination, the patient appears alert and oriented. His BMI is 33 kg/ m². His eyes are without scleral icterus. His right orbital region reveals ecchymosis along the superior and inferior borders. His heart is regular in rhythm and rate without murmurs. Capillary refill is 4 seconds in fingers and toes. His right dorsal second and third metacarpal region reveals two 3 mm lacerations with edema. Which of the following is the most appropriate management strategy for this patient?? {'A': 'Azithromycin with irrigation and debridement', 'B': 'Amoxicillin-clavulanate with irrigation and debridement', 'C': 'Clindamycin plus doxycycline with irrigation and debridement', 'D': 'Doxycycline with irrigation and debridement', 'E': 'Irrigation and debridement'},
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C: Clindamycin plus doxycycline with irrigation and debridement
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Answer the following medical question with one of the provided options:
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Q:A 55-year-old man comes to the physician because of a 4-month history of episodic, pressure-like chest pain. The chest pain occurs when he is walking up stairs and improves with rest. He has hypertension and type 2 diabetes mellitus. His father died from a myocardial infarction at the age of 50 years. Current medications include hydrochlorothiazide and metformin. His pulse is 85/min, respirations are 12/min, and blood pressure is 140/90 mm Hg. Cardiac examination shows normal heart sounds without any murmurs, rubs, or gallops. An ECG shows high amplitude of the S wave in lead V3. An exercise stress test is performed but stopped after 4 minutes because the patient experiences chest pain. An ECG obtained during the stress test shows sinus tachycardia and ST-segment depressions in leads V1–V4. Which of the following is the most appropriate long-term pharmacotherapy to reduce the frequency of symptoms in this patient?? {'A': 'Isosorbide mononitrate', 'B': 'Nitroglycerin', 'C': 'Aspirin', 'D': 'Metoprolol', 'E': 'Clopidogrel'},
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D: Metoprolol
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Answer the following medical question with one of the provided options:
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Q:A 19-year-old man is brought to the emergency department by his mother because of increasing agitation and aggression at home. He has a history of bipolar disorder. During the last week, he has refused to take his lithium medication because it makes him “feel empty inside.” The mother thinks he has experimented with illicit drugs in the past. He appears acutely agitated, yells at multiple medical staff members, and demands to be discharged. His temperature is 37.7°C (99.8°F), pulse is 95/min, respirations are 18/min, and blood pressure is 140/75 mm Hg. Haloperidol is administered and the patient is admitted. The next morning, the patient reports worsening neck pain. He states that his neck is locked to the left and he cannot move it. Examination shows rigidity of his upper body and neck, with the neck fixed in flexion and rotated to the left. Administration of which of the following is the most appropriate next step in the management of this patient?? {'A': 'Physostigmine', 'B': 'Diazepam', 'C': 'Botulinum toxin', 'D': 'Benztropine', 'E': 'Bromocriptine'},
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D: Benztropine
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Answer the following medical question with one of the provided options:
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Q:A research group is investigating an allosteric modulator to improve exercise resistance and tolerance at low-oxygen conditions. The group has created cultures of myocytes derived from high-performance college athletes. The application of this compound to these cultures in a low-oxygen environment and during vigorous contraction leads to longer utilization of glucose before reaching a plateau and cell death; however, the culture medium is significantly acidified in this experiment. An activating effect on which of the following enzymes would explain these results?? {'A': 'Enolase', 'B': 'Pyruvate dehydrogenase', 'C': 'Bisphosphoglycerate mutase', 'D': 'Malate dehydrogenase', 'E': 'Lactate dehydrogenase'},
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E: Lactate dehydrogenase
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Answer the following medical question with one of the provided options:
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Q:A 67-year-old man with a history of diabetes mellitus, COPD, and a ST-elevation myocardial infarction currently on dialysis presents with shortness of breath for the past 2 hours. The patient missed his recent dialysis appointment and has been noncompliant with his other medications. The patient found out his best friend died this morning and has felt worse since this event. His temperature is 98.7°F (37.1°C), blood pressure is 87/48 mmHg, pulse is 130/min, respirations are 27/min, and oxygen saturation is 92% on room air. A bedside ultrasound demonstrates an anechoic rim surrounding the heart with poor cardiac squeeze, global hypokinesis, and right ventricular collapse with pleural sliding. Laboratory values are notable for 2 cardiac troponins that measure 0.72 ng/mL and 0.71 ng/mL. Which of the following is the most likely diagnosis?? {'A': 'Cardiac tamponade', 'B': 'Hyperkalemia', 'C': 'Myocardial infarction', 'D': 'Takotsubo cardiomyopathy', 'E': 'Tension pneumothorax'},
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A: Cardiac tamponade
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Answer the following medical question with one of the provided options:
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Q:A 36-year-old woman complains of recurrent headaches. The pain is located on the right side of the head, is accompanied by nausea, worsens when lifting heavy objects, and typically lasts 2 days. She describes the pain as pulsatile and says that they are usually triggered by eating chocolates. Her headache is not associated with an aura. She sits in a dark room due to her increased discomfort. The patient has tried multiple over-the-counter medications without relief. Which of the following will most likely be the next treatment of choice for acute episodes?? {'A': 'D2 receptor blocker', 'B': 'Beta-blocker', 'C': 'GABA transaminase inhibitor', 'D': '5-HT1B/D agonist', 'E': 'Cyclooygenase inhibitor'},
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D: 5-HT1B/D agonist
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Answer the following medical question with one of the provided options:
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Q:A 55-year-old man presents to the emergency department for severe pain in his knee. The patient states that the pain began yesterday and has steadily worsened. The patient has a history of osteoarthritis of the knee, which was previously responsive to ibuprofen. He reports taking 3 doses of hydrochlorothiazide today after not taking his medication for 3 days. He recently attended a barbecue, which entailed eating beef and drinking alcohol. The patient was also recently treated for cellulitis. The patient has a past medical history of obesity, diabetes, and osteoarthritis. His temperature is 101°F (38.3°C), blood pressure is 157/98 mmHg, pulse is 95/min, respirations are 17/min, and oxygen saturation is 98% on room air. Physical exam is notable for a warm and erythematous left knee. There is tenderness to palpation of the left knee with limited range of motion due to pain. Which of the following is the best next step in management?? {'A': 'Antibiotics', 'B': 'Arthrocentesis', 'C': 'CT scan', 'D': 'IV fluids', 'E': 'Naproxen'},
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B: Arthrocentesis
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Answer the following medical question with one of the provided options:
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Q:A 27-year-old woman visits your office with a 3-day complaint of fever, malaise, myalgias, and headaches associated with vulvar itching, vulvar soreness, dysuria, and urethral discharge. The pain when urinating is so severe that she has attempted to avoid the use of the toilet. She just returned from a spring break in the tropics and explains that she had multiple unprotected sexual encounters with men and women. Upon physical examination, the temperature was 38.7°C (101.6°F) and the heart rate was 90/min. The pelvic examination revealed vulvar ulcers, vulvar excoriations, erythema, vaginal mucosa edema, and ulcerative cervicitis. Which of the following will best aid you in the identification of the specific organism causing the above symptoms?? {'A': 'Serology', 'B': 'Direct fluorescence antigen', 'C': 'Culture in Thayer-Martin agar', 'D': 'Tzanck smear', 'E': 'Location of the lesions'},
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B: Direct fluorescence antigen
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Answer the following medical question with one of the provided options:
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Q:A 47-year-old man comes to the physician because of a 7-week history of cough, shortness of breath, and daily copious sputum production. He has had frequent respiratory tract infections over the past several years. Current medications include dextromethorphan and guaifenesin as needed. He does not smoke cigarettes. His temperature is 37.1°C (98.8°F), pulse is 88/min, respirations are 21/min, and blood pressure is 133/84 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 95%. Diffuse crackles and wheezing are heard on auscultation over bilateral lung fields. A CT scan of the chest is shown. The patient is at greatest risk for which of the following complications?? {'A': 'Damage to bronchial vessels', 'B': 'Infection with Rhizopus species', 'C': 'Rupture of pulmonary blebs', 'D': 'Neoplastic growth of pleural cells', 'E': 'Dysfunction of left ventricle'},
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A: Damage to bronchial vessels
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Answer the following medical question with one of the provided options:
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Q:An 11-year-old boy is brought to his pediatrician by his mother after he has complained of worsening left thumb pain for the last two weeks. The mother reports that the patient was previously healthy. Approximately 2 weeks ago, the family cat bit the patient’s thumb. The area around the bite wound then became red, hot, and slightly swollen and never healed. Earlier this week, the patient also started developing fevers that were recorded at home to be as high as 103.6°F. On exam, the patient's temperature is 102.2°F (39.0°C), blood pressure is 112/72 mmHg, pulse is 92/min, and respirations are 14/min. The patient’s left thumb is tender to touch over the proximal phalanx and the interphalangeal joint, but there is no obvious erythema or swelling. A radiograph performed in clinic is concerning for osteomyelitis at the proximal phalanx. Which of the following is the most likely cause of this patient’s condition?? {'A': 'Bartonella henselae', 'B': 'Eikenella corrodens', 'C': 'Pasteurella multocida', 'D': 'Pseudomonas aeruginosa', 'E': 'Salmonella spp.'},
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C: Pasteurella multocida
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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 comes to the emergency department because of a 3-hour history of severe nausea, vomiting, tremor, and anxiety. She recently started a new medication but does not remember its name. She has a history of major depressive disorder treated with fluoxetine. Her temperature is 38.9 C (102.1 F), pulse is 132/min, respirations are 22/min, and blood pressure is 152/94 mm Hg. She is confused. Physical examination shows diaphoresis and an ataxic gait. Patellar reflexes are 4+ bilaterally. This patient's condition is most likely due to which of the following medications?? {'A': 'Amiodarone', 'B': 'Sumatriptan', 'C': 'Scopolamine', 'D': 'Haloperidol', 'E': 'Succinylcholine'},
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B: Sumatriptan
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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 is brought to the emergency department because of a 1-day history of lower abdominal pain and vaginal bleeding. Her last menstrual period was 6 weeks ago. She is sexually active and uses condoms inconsistently with her boyfriend. She had pelvic inflammatory disease at the age of 22 years. Her temperature is 37.2°C (99°F), pulse is 90/min, respirations are 14/min, and blood pressure is 130/70 mm Hg. The abdomen is soft, and there is tenderness to palpation in the left lower quadrant with guarding but no rebound. There is scant blood in the introitus. Her serum β-human chorionic gonadotropin (hCG) level is 1,600 mIU/mL. Her blood type is O, RhD negative. She is asked to return 4 days later. Her serum β-hCG level is now 1,900 mIU/ml. A pelvic ultrasound shows a normal appearing uterus with an empty intrauterine cavity and a minimal amount of free pelvic fluid. Which of the following is the most appropriate next step in management?? {'A': 'Administration of anti-D immunoglobulin and intramuscular methotrexate', 'B': 'Administration of misoprostol', 'C': 'Administration of intramuscular methotrexate', 'D': 'Repeat serum β-hCG and pelvic ultrasound in 2 days', 'E': 'Administration of anti-D immunoglobulin and oral misoprostol'},
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A: Administration of anti-D immunoglobulin and intramuscular methotrexate
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Answer the following medical question with one of the provided options:
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Q:A 26-year-old woman presents to the women’s health clinic with a 9-week delay in menses. The patient has a history of grand mal seizures, and was recently diagnosed with acute sinusitis. She is prescribed lamotrigine and amoxicillin. The patient smokes one-half pack of cigarettes every day for 10 years, and drinks socially a few weekends every month. Her mother died of breast cancer when she was 61 years old. The vital signs are stable during the current office visit. Physical examination is grossly normal. The physician orders a urine beta-hCG that comes back positive. Abdominal ultrasound shows an embryo consistent in dates with the first day of last menstrual period. Given the history of the patient, which of the following would most likely decrease congenital malformations in the newborn?? {'A': 'Decrease alcohol consumption', 'B': 'Smoking cessation', 'C': 'Folic acid supplementation', 'D': 'Switching to another antiepileptic medication', 'E': 'Switching to cephalexin'},
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C: Folic acid supplementation
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Answer the following medical question with one of the provided options:
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Q:A 24-year-old woman presents to her primary care physician for bilateral nipple discharge. She states that this started recently and seems to be worsening. She denies any other current symptoms. The patient states that she is not currently sexually active, and her last menstrual period was over a month ago. Her medical history is notable for atopic dermatitis and a recent hospitalization for an episode of psychosis. Her temperature is 99.5°F (37.5°C), blood pressure is 110/65 mmHg, pulse is 70/min, respirations are 15/min, and oxygen saturation is 98% on room air. Cardiopulmonary and abdominal exam are within normal limits. Which of the following is the most likely cause of this patient's symptoms?? {'A': 'Alteration of the tuberoinfundibular pathway', 'B': 'Alteration of the nigrostriatal pathway', 'C': 'Alteration of the mesolimbic pathway', 'D': 'Prolactin-secreting mass', 'E': 'Normal pregnancy'},
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A: Alteration of the tuberoinfundibular pathway
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Answer the following medical question with one of the provided options:
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Q:A 60-year-old man comes to the clinic with the complaint of knee pain for the past few weeks. The pain is located in the left knee, associated with morning stiffness for about an hour, and improves with activities throughout the day. He also has a history of diabetes mellitus, hypertension, peptic ulcer disease, and ischemic heart disease. He underwent angioplasty last year for a STEMI. The patient takes metformin, aspirin, clopidogrel, atorvastatin, ramipril, omeprazole, and bisoprolol. He used to smoke one pack of cigarettes a day for the last 45 years but stopped smoking for the past one year following his heart attack. He drinks alcohol socially. His father has Alzheimer’s disease and is in adult home care, and his mother died of breast cancer when she was 55. His temperature is 37.6°C (99.8°F), blood pressure is 132/65 mm Hg, pulse is 90/min, respirations are 14/min, and BMI is 22 kg/m2. On examination, his left knee is swollen, warm, tender to touch, and has decreased range of movement due to pain. Cardiopulmonary and abdominal examinations are negative. Laboratory investigation is shown below: Complete blood count: Hemoglobin 11.5 g/dL Leukocytes 14,000/mm3 Platelets 155,000/mm3 ESR 40 mm/hr What is the best next step in the management of this patient?? {'A': 'X-ray left knee', 'B': 'Synovial fluid analysis', 'C': 'Ibuprofen', 'D': 'Flucloxacillin', 'E': 'Ceftriaxone and azithromycin'},
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B: Synovial fluid analysis
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Answer the following medical question with one of the provided options:
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Q:A 61-year-old man comes to the physician because of a 9-month history of progressive shortness of breath on exertion. Pulmonary examinations shows fine bibasilar end-inspiratory crackles. There is digital clubbing. Pulmonary functions tests show an FEV1:FVC ratio of 97% and a total lung capacity of 70%. An x-ray of the chest shows small bilateral reticular opacities, predominantly in the lower lobes. A photomicrograph of a specimen obtained on lung biopsy is shown. The patient most likely works in which of the following fields?? {'A': 'Shipbuilding', 'B': 'Aerospace manufacturing', 'C': 'Cattle farming', 'D': 'Sandblasting', 'E': 'Coal mining'},
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A: Shipbuilding
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Answer the following medical question with one of the provided options:
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Q:A 28-year-old man presents for a pre-placement health check-up. Auscultation reveals a mid-systolic click. An echocardiogram reveals a floppy mitral valve and a dilated aortic root. An ocular examination finds a subluxated lens superior and laterally. What is the most likely genetic defect?? {'A': 'NF1 protein', 'B': 'Cystathionine synthase deficiency', 'C': 'Fibrillin', 'D': 'Dystrophin', 'E': 'Spectrin'},
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C: Fibrillin
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Answer the following medical question with one of the provided options:
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Q:A 61-year-old man with longstanding diabetes and coronary artery disease presents to the ER with chest pain and dyspnea. The echocardiogram reveals moderate-to-severe mitral regurgitation and an ejection fraction of 27%. A chest X-ray shows bibasilar infiltrates. A new drug is added to his medication regimen, and the physician mentions urinary frequency, increased breast tissue development, and erectile dysfunction as possible side effects. What is the mechanism of action of this drug?? {'A': 'Inhibits beta-adrenergic receptors to decrease SA node conduction velocity', 'B': 'Inhibits epithelial Na-channels on the cortical collecting duct', 'C': 'Inhibits mineralocorticoid receptor on the cortical collecting duct', 'D': 'Inhibits Na-Cl symporter on the distal convoluted tubule', 'E': 'Inhibits Na-K-2Cl symporter on the ascending loop of Henle'},
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C: Inhibits mineralocorticoid receptor on the cortical collecting duct
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Answer the following medical question with one of the provided options:
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Q:A 28-year-old woman presents to the emergency department with a sudden onset of nausea, vomiting, and pain in the upper abdomen for the past 3 hours. She reports that the pain has increased in severity over these 3 hours and frequently radiates to the back. She was diagnosed as HIV positive 2 years ago. She was placed on raltegravir/tenofovir/emtricitabine 1 year ago, but because of treatment failure, her antiretroviral therapy was changed to abacavir/didanosine/dolutegravir/enfuvirtide/fosamprenavir 3 months ago. Her temperature is 37.8°C (100.0°F), heart rate is 110/min, respiratory rate is 18/min, and blood pressure is 124/80 mm Hg. Abdominal examination shows tenderness in the upper abdomen, but there is an absence of guarding or rigidity. Ultrasonography of the abdomen shows an edematous pancreas and an absence of gallstones. Laboratory studies show: Serum glucose 120 mg/dL Serum aspartate aminotransferase 74 U/L Serum alanine aminotransferase 88 U/L Serum amylase 800 U/L Serum triglyceride 125 mg/dL In addition to pain control, which of the following is an appropriate initial step in treatment?? {'A': 'Discontinue abacavir', 'B': 'Discontinue didanosine', 'C': 'Discontinue dolutegravir', 'D': 'Discontinue enfuvirtide', 'E': 'Discontinue fosamprenavir'},
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B: Discontinue didanosine
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Answer the following medical question with one of the provided options:
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Q:A previously healthy 4-year-old girl is brought to the physician for evaluation of a 3-week history of recurrent vomiting and difficulty walking. Examination shows a broad-based gait and bilateral optic disc swelling. An MRI shows an intracranial tumor. A ventriculoperitoneal shunt is placed, and surgical excision of the tumor is performed. A photomicrograph of a section of the tumor is shown. Which of the following is the most likely diagnosis?? {'A': 'Glioblastoma multiforme', 'B': 'Medulloblastoma', 'C': 'Oligodendroglioma', 'D': 'Pinealoma', 'E': 'Hemangioblastoma'},
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B: Medulloblastoma
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Answer the following medical question with one of the provided options:
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Q:A 77-year-old man is brought to the emergency department by his wife because of headache, nausea, and vomiting for 24 hours. His wife says that over the past 2 weeks, he has been more irritable and has had trouble remembering to do routine errands. Two weeks ago, he fell during a skiing accident but did not lose consciousness. He has coronary artery disease and hypertension. He has smoked one pack of cigarettes daily for 50 years. He has had 2 glasses of wine daily since his retirement 10 years ago. Current medications include atenolol, enalapril, furosemide, atorvastatin, and aspirin. He appears acutely ill. He is oriented to person but not to place or time. His temperature is 37°C (98.6°F), pulse is 99/min, respirations are 16/min, and blood pressure is 160/90 mm Hg. During the examination, he is uncooperative and unable to answer questions. Deep tendon reflexes are 4+ on the left and 2+ on the right. Babinski's sign is present on the left. There is mild weakness of the left iliopsoas and hamstring muscles. A CT scan of the head without contrast shows a high-density, 15-mm crescentic collection across the right hemispheric convexity. Which of the following is the most appropriate next step in the management of this patient?? {'A': 'Obtain an MRI of the head', 'B': 'Recombinant tissue plasminogen activator administration', 'C': 'Observation', 'D': 'Surgical evacuation', 'E': 'Obtain an Electroencephalography'},
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D: Surgical evacuation
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Answer the following medical question with one of the provided options:
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Q:A 17-year-old girl makes an appointment with her pediatrician because she is concerned that she may have gotten a sexually transmitted infection. Specifically, she had unprotected sex two weeks ago and has since been experiencing painful urination and abdominal pain. Laboratory tests confirm a diagnosis of Chlamydial infection. At this point, the girl says that she wants to personally give permission to be treated rather than seek consent from her parents because they do not know that she is in a relationship. She also asks that the diagnosis not be reported to anyone. What should the physician do with regards to these two patient requests?? {'A': "Choose based on the physician's interpretation of the patient's best interests", 'B': 'Contact her parents as well as report to public health agencies', 'C': 'Contact her parents but do not report to public health agencies', 'D': 'Do not contact her parents and do not report to public health agencies', 'E': 'Do not contact her parents but do report to public health agencies'},
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E: Do not contact her parents but do report to public health agencies
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Answer the following medical question with one of the provided options:
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Q:A 24-year-old woman presents to her primary care physician for a wellness exam. She currently has no acute concerns but has been feeling hopeless, has a poor appetite, difficulty with concentration, and trouble with sleep. She says that she has poor self-esteem and that her symptoms have been occurring for the past 3 years. She has had moments where she felt better, but it lasted a few weeks out of the year. She currently lives alone and does not pursue romantic relationships because she feels she is not attractive. She has a past medical history of asthma. Her mother is alive and healthy. Her father committed suicide and suffered from major depressive disorder. On physical exam, the patient has a gloomy demeanor and appears restless and anxious. Which of the following is the most likely diagnosis?? {'A': 'Cyclothymia', 'B': 'Disruptive mood dysregulation disorder', 'C': 'Major depressive disorder', 'D': 'Persistent depressive disorder', 'E': 'Seasonal affective disorder'},
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D: Persistent depressive disorder
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Answer the following medical question with one of the provided options:
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Q:A 17-year-old boy is brought to the pediatrician by his mother for an initial visit. He recently immigrated from Cambodia. Through an interpreter, the patient reports 6 months of mild exertional dyspnea. He denies chest pain or palpitations. His medical history is unremarkable and he has never had any surgeries. His family history is significant for hypertension and diabetes. His father died of tuberculosis. The patient’s vaccination history is unknown. His temperature is 98°F (36.7°C), blood pressure is 113/71 mmHg, and pulse is 82/min. His BMI is 24 kg/m^2. Physical examination shows a well-nourished, cooperative boy without any grossly dysmorphic features. Cardiac auscultation reveals a grade II systolic ejection murmur along the left upper sternal border and a mid-diastolic rumble along the left sternal border. S1 is normal and the splitting of S2 does not change with inspiration. Which of the following is the most likely diagnosis?? {'A': 'Atrial septal defect', 'B': 'Bicuspid aortic valve', 'C': 'Hypertrophic cardiomyopathy', 'D': 'Rheumatic heart disease', 'E': 'Ventricular septal defect'},
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A: Atrial septal defect
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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 comes to the physician because of dull abdominal pain on his right side for 4 months. He also reports episodic nausea and vomiting during this period. He does not have fever, altered bowel habits, or weight loss. He has had a pet dog for 8 years. He appears healthy. Vital signs are within normal limits. Abdominal examination shows a nontender mass 3 cm below the right costal margin that moves with respiration. Laboratory studies show: Hemoglobin 14.6 g/dL Leukocyte count 7200/mm3 Segmented neutrophils 58% Eosinophils 8% Lymphocytes 30% Monocytes 4% Ultrasound of the abdomen shows a focal hypoechoic cyst within the liver measuring 7 cm. An ELISA confirms the diagnosis. He is scheduled for CT-guided percutaneous drainage under general anesthesia with orotracheal intubation. Seven minutes into the procedure, the patient's oxygen saturation suddenly decreases from 95% to 64%. His heart rate is 136/min, and blood pressure is 86/58 mm Hg. Capnography cannot record an end tidal CO2 waveform. Breath sounds are absent bilaterally. Which of the following is most appropriate next step in management?"? {'A': 'Exploratory laparotomy', 'B': 'Epinephrine', 'C': 'Cricothyrotomy', 'D': 'Chest tube insertion', 'E': 'Norepinephrine\n"'},
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B: Epinephrine
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Answer the following medical question with one of the provided options:
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Q:An 85-year-old woman otherwise healthy presents with left-sided weakness. Her symptoms started 4 hours ago while she was on the phone with her niece. The patient recalls dropping the phone and not being able to pick it up with her left hand. No significant past medical history. No current medications. Physical examination reveals decreased sensation on the left side, worse in the left face and left upper extremity. There is significant weakness of the left upper extremity and weakness and drooping of the lower half of the left face. Ophthalmic examination reveals conjugate eye deviation to the right. A noncontrast CT of the head is unremarkable. The patient is started on aspirin. A repeat contrast CT of the head a few days later reveals an ischemic stroke involving the lateral convexity of right cerebral hemisphere. Which of the following additional findings would most likely be seen in this patient?? {'A': 'Amaurosis fugax', 'B': 'Profound lower limb weakness', 'C': "Horner's syndrome", 'D': 'Homonymous hemianopsia', 'E': 'Prosopagnosia'},
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D: Homonymous hemianopsia
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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 30 minutes after being involved in a motorcycle accident. He lost control at high speed and was thrown forward onto the handlebars. On arrival, he is alert and responsive. He has abdominal pain and superficial lacerations on his left arm. Vital signs are within normal limits. Examination shows a tender, erythematous area over his epigastrium. The abdomen is soft and non-distended. A CT scan of the abdomen shows no abnormalities. Treatment with analgesics is begun, the lacerations are cleaned and dressed, and the patient is discharged home after 2 hours of observation. Four days later, the patient returns to the emergency department with gradually worsening upper abdominal pain, fever, poor appetite, and vomiting. His pulse is 91/min and blood pressure is 135/82 mm Hg. Which of the following is the most likely diagnosis?? {'A': 'Pancreatic ductal injury', 'B': 'Aortic dissection', 'C': 'Abdominal compartment syndrome', 'D': 'Diaphragmatic rupture', 'E': 'Splenic rupture'},
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A: Pancreatic ductal injury
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Answer the following medical question with one of the provided options:
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Q:A 55-year-old man with a history of IV drug abuse presents to the emergency department with an altered mental status. He was found unconscious in the park by police. His temperature is 100.0°F (37.8°C), blood pressure is 87/48 mmHg, pulse is 150/min, respirations are 17/min, and oxygen saturation is 98% on room air. Physical exam is notable for multiple scars and abscesses in the antecubital fossa. His laboratory studies are ordered as seen below. Serum: Na+: 139 mEq/L Cl-: 105 mEq/L K+: 4.3 mEq/L HCO3-: 19 mEq/L BUN: 20 mg/dL Glucose: 95 mg/dL Creatinine: 1.5 mg/dL Ca2+: 10.2 mg/dL Which of the following is the most appropriate treatment for this patient’s blood pressure and acid-base status?? {'A': 'Dextrose 5% normal saline', 'B': 'Hypertonic saline', 'C': 'Normal saline', 'D': 'Ringer lactate', 'E': 'Sodium bicarbonate'},
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D: Ringer lactate
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Answer the following medical question with one of the provided options:
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Q:A 32-year-old G1P0 woman at 27 weeks estimated gestational age presents for her first prenatal care appointment. She recently immigrated to the United States and didn’t receive any prenatal care in her country. Her blood pressure is 130/70 mm Hg, pulse is 85/min, and respirations are 16/min. Her BMI is 38.3 kg/m2. Physical examination is unremarkable except for normal pregnancy changes. Fetal ultrasound is performed and reveals fetal macrosomia. Which one of the following diagnostic tests is most likely to reveal the cause of this fetal abnormality?? {'A': 'Serum insulin', 'B': 'C-peptide', 'C': 'Oral glucose tolerance test', 'D': 'Glycated hemoglobin', 'E': 'Leptin'},
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C: Oral glucose tolerance test
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Answer the following medical question with one of the provided options:
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Q:A 66-year-old man presents to the emergency department for shortness of breath for the last 2 hours. Despite his diagnosis of heart failure 2 years ago, he has refused to make any diet changes. He takes aspirin and carvedilol but is poorly compliant. His vitals signs are pulse of 135/min, respirations 30/min, and a blood pressure of 150/80 mm Hg. The patient is visibly distressed and unable to lie down. He is taking shallow breaths and auscultation reveals bilateral crackles in the chest. Jugular venous distension is seen. Pitting edema is present in the lower limbs. A chest X-ray shows prominent interstitial markings bilaterally with alveolar infiltrates. Which of the following is the mechanism of action of the drug that can relieve his ongoing symptoms?? {'A': 'Acting on the β-adrenergic receptors to increase cardiac contractility', 'B': 'By holding water within the tubule, leading to osmotic diuresis', 'C': 'Blocking the Na+-K+-2Cl- cotransporter in the thick ascending limb of the loop of Henle', 'D': 'Blocking the angiotensin II receptors, leading to vasodilation', 'E': 'Blocking the NaCl channels in the distal tubule of the nephron'},
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C: Blocking the Na+-K+-2Cl- cotransporter in the thick ascending limb of the loop of Henle
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Q:A 60-year-old woman is brought into the office by his son. His son states that the patient has been acting inappropriately over the last few years. She has been taking off her clothes in front of visitors and putting objects in her mouth. She has had no emotional response to the death of one of her close friends and was laughing at her funeral. She has almost no memory issues, but sometimes forgets how to use objects such as a telephone. She has no other medical issues and takes no medications. On exam, she has no focal neurological deficits and her mini-mental status exam is 25/30. What is the most likely diagnosis?? {'A': 'Normal aging', 'B': "Alzheimer's dementia", 'C': 'Lewy body dementia', 'D': "Pick's disease", 'E': 'Vascular dementia'},
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D: Pick's disease
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Answer the following medical question with one of the provided options:
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Q:A previously well 25-year-old woman was brought to the emergency department by her boyfriend because of progressive blurred vision. Examination of the eyes reveals loss of horizontal gaze, intact convergence, and nystagmus. A clinical diagnosis of multiple sclerosis is made and the patient is started on a course of corticosteroids. What is the most likely etiology for her eye examination findings?? {'A': 'Loss of reticular formations', 'B': 'Loss of frontal eye fields', 'C': 'Loss of bilateral medial longitudinal fasciculus', 'D': 'Loss of cranial nerve III', 'E': 'Loss of cranial nerve VI'},
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C: Loss of bilateral medial longitudinal fasciculus
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Q:A 58-year-old man comes to the physician because of a 6-month history of headaches and back pain. Examination shows mild sensorineural hearing loss. Serum concentration of alkaline phosphatase is increased. An x-ray of the skull is shown. The most appropriate pharmacotherapy for this patient is a drug that has which of the following mechanisms of action?? {'A': 'Inhibition of tubulin polymerization', 'B': 'Inhibition of nuclear factor-κB', 'C': 'Formation of DNA strand breaks', 'D': 'Inhibition of proteasomes', 'E': 'Apoptosis of osteoclasts'},
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E: Apoptosis of osteoclasts
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Q:A 9-month-old female infant is brought in by her mother to the pediatrician because she is concerned that her daughter is not growing normally. On physical exam, the head circumference is 95th percentile and the height is 5th percentile. The child has disproportionate growth such that both the upper and lower extremities show a rhizomelic pattern of shortening, but the axial skeleton appears to be normal. The child appears to have normal intelligence, but has delayed motor milestones; specifically, she is not able to roll or sit up by herself. Which of the following best describes the mode of inheritance for this disorder?? {'A': 'Autosomal recessive', 'B': 'Autosomal dominant', 'C': 'X-linked recessive', 'D': 'X-linked dominant', 'E': 'Mitochondrial pattern of inheritance'},
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B: Autosomal dominant
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Q:A 52-year-old woman presents to a local hospital complaining about a rash on her face and torso, as well as night sweats, low-grade fever, diarrhea, and unintentional weight loss. Her personal history is relevant for homelessness; she also has a history of risky behaviors such as the use and abuse of intravenous drugs, and unprotected intercourse with multiple sexual partners. Upon physical examination, well-demarcated violaceous plaques and papules distributed on her face and back are visible (see image below). Additional findings include fine reticular and interstitial changes on a chest radiograph, a CD4+ count of 50 cells/mm3, and a positive RPR for HIV. Which of the following is the most likely etiology of this patient’s dermatological condition?? {'A': 'Human alphaherpesvirus 3 (HHV-3) infection', 'B': 'HHV-1 infection', 'C': 'HHV-8 infection', 'D': 'HHV-5 infection', 'E': 'HHV-6 infection'},
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C: HHV-8 infection
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Q:A 21-year-old woman was brought to the emergency department after her roommate found her unconscious at their apartment. On arrival, her GCS was 3/15, with bilateral mydriasis, fever of 39.4℃ (103.0℉), and ventricular tachycardia which was converted to sinus rhythm. She had one episode of a generalized tonic-clonic seizure on the way to the hospital which was managed with intravenous diazepam. Her hypertension was managed with nitroglycerin. After nasogastric tube insertion, gastric lavage and activated charcoal were given. Biochemistry result showed elevated creatinine phosphatase of 268 U/L and low serum bicarbonate of 16.7 mmol/L. Her blood and urine samples will most likely show intoxication with which of the following drugs?? {'A': 'Cocaine', 'B': 'MPTP', 'C': 'PCP', 'D': 'Opioid', 'E': 'Marijuana'},
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A: Cocaine
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Q:A 4-year-old boy is brought to the emergency department with intense crying and pain in both hands after playing with ice cubes. His mother denies any preceding trauma. The temperature is 37.0°C (98.6°F), the blood pressure is 90/55 mm Hg, and the pulse is 100/min. The physical examination shows swollen dorsa of the hands and scleral icterus. The laboratory tests show hemoglobin of 10.1 g/dL and unconjugated hyperbilirubinemia. The cellulose acetate electrophoresis shows 60% HbS and absence of HbA. Which of the following can reduce the recurrence of the patient’s current condition?? {'A': 'Avoidance of sulfa drugs', 'B': 'Vaccinations', 'C': 'Hydroxyurea', 'D': 'Folic acid', 'E': 'Allopurinol'},
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C: Hydroxyurea
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Q:A 25-year-old woman is brought to the emergency department by her roommate with severe right lower quadrant pain for the last 8 hours. The pain is progressively getting worse and is associated with vomiting. When you ask the patient about her last menstrual period, she tells you that although she stopped keeping track of her cycle after undergoing surgical sterilization 1 year ago, she recalls bleeding yesterday. The physical examination reveals a hemodynamically stable patient with a pulse of 90/min, respiratory rate of 14/min, blood pressure of 125/70 mm Hg, and temperature of 37.0°C (98.6°F). The abdomen is tender to touch (more tender in the lower quadrants), and tenderness at McBurney's point is absent. Which of the following is the best next step in the management of this patient?? {'A': 'Urinary human chorionic gonadotropin (hCG)', 'B': 'Urinalysis', 'C': 'FAST ultrasound scan', 'D': 'Complete blood count', 'E': 'Appendectomy'},
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A: Urinary human chorionic gonadotropin (hCG)
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Q:A 65-year-old man presents to the emergency department for sudden weakness. He was doing mechanical work on his car where he acutely developed right-leg weakness and fell to the ground. He is accompanied by his wife, who said that this has never happened before. He was last seen neurologically normal approximately 2 hours prior to presentation. His past medical history is significant for hypertension and type II diabetes. His temperature is 98.8°F (37.1°C), blood pressure is 177/108 mmHg, pulse is 90/min, respirations are 15/min, and oxygen saturation is 99% on room air. Neurological exam reveals that he is having trouble speaking and has profound weakness of his right upper and lower extremity. Which of the following is the best next step in management?? {'A': 'Aspirin', 'B': 'CT angiogram', 'C': 'MRI of the head', 'D': 'Noncontrast head CT', 'E': 'Thrombolytics'},
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D: Noncontrast head CT
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Q:A 70-year-old man comes to the physician for the evaluation of pain, cramps, and tingling in his lower extremities over the past 6 months. The patient reports that the symptoms worsen with walking more than two blocks and are completely relieved by rest. Over the past 3 months, his symptoms have not improved despite his participating in supervised exercise therapy. He has type 2 diabetes mellitus. He had smoked one pack of cigarettes daily for the past 50 years, but quit 3 months ago. He does not drink alcohol. His current medications include metformin, atorvastatin, and aspirin. Examination shows loss of hair and decreased skin temperature in the lower legs. Femoral pulses are palpable; pedal pulses are absent. Which of the following is the most appropriate treatment for this patient?? {'A': 'Administration of cilostazol', 'B': 'Compression stockings', 'C': 'Endarterectomy', 'D': 'Percutaneous transluminal angioplasty', 'E': 'Bypass surgery'},
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A: Administration of cilostazol
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Q:A 44-year-old man comes to the physician because of a 5-month history of persistent cough productive of thick, yellow sputum and worsening shortness of breath. One year ago, he had similar symptoms that lasted 4 months. He has smoked two packs of cigarettes daily for the past 20 years. Physical examination shows scattered expiratory wheezing and rhonchi throughout both lung fields. Microscopic examination of a lung biopsy specimen is most likely to show which of the following findings?? {'A': 'Increased ciliated epithelial cells', 'B': 'Decreased alveolar macrophages', 'C': 'Increased club cells', 'D': 'Decreased smooth muscle cells', 'E': 'Increased goblet cells'},
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E: Increased goblet cells
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Q:One day after undergoing surgery for a traumatic right pelvic fracture, a 73-year-old man has pain over his buttocks and scrotum and urinary incontinence. Physical examination shows right-sided perineal hypesthesia and absence of anal sphincter contraction when the skin around the anus is touched. This patient is most likely to have which of the following additional neurological deficits?? {'A': 'Paralysis of hip adductors', 'B': 'Absent reflex erection', 'C': 'Impaired hip flexion', 'D': 'Impaired psychogenic erection', 'E': 'Absent cremasteric reflex'},
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B: Absent reflex erection
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Q:A 27-year-old man presents to his primary care physician for exposure to toxic materials. The patient states that when he left for work this morning he was certain that he had closed the door to his pantry. However, upon returning home, he saw that the door to his pantry was wide open. The patient is certain that his neighbors have been tampering with his food and potentially poisoned him. He further states that he has known, ever since they have moved in, that they have been trying to break into his house and steal his things. He has tried multiple times to get them evicted from the building to no avail. It is for this reason that he is certain that they are trying to get their revenge upon him. The physician performs a physical exam and tells the patient that he thinks there is nothing to be concerned about, but that he should call him or come into the office if he experiences any symptoms. The patient is outraged at this news and requests a competent doctor who is not colluding with his enemies. He storms out of the office angrily, stating that he deserves the best in medical care, not this. Which of the following is the most likely personality disorder that this patient is suffering from?? {'A': 'Narcissistic', 'B': 'Schizoid', 'C': 'Paranoid', 'D': 'Intermittent explosive disorder', 'E': 'Borderline'},
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C: Paranoid
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Q:A 43-year-old man presents with acute-onset left flank pain for the past 6 hours. He describes the pain as severe, intermittent, colicky, and “coming in waves”, and he points to the area of the left costovertebral angle (CVA). He says he recently has been restricting oral liquid intake to only 2 glasses of water per day based on the advice of his healer. He also reports nausea and vomiting. The patient has a history of hypertension, gout, and type 2 diabetes mellitus. He is afebrile, and his vital signs are within normal limits. On physical examination, he is writhing in pain and moaning. There is exquisite left CVA tenderness. A urinalysis shows gross hematuria. Which of the following is the next best step in the management of this patient?? {'A': 'Non-contrast CT of the abdomen', 'B': 'Contrast CT of the abdomen and pelvis', 'C': 'Renal ultrasound', 'D': 'Non-contrast CT of the abdomen and pelvis', 'E': 'Supine abdominal radiograph'},
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D: Non-contrast CT of the abdomen and pelvis
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Q:A 2-year-old boy presents to the pediatrician for evaluation of an elevated temperature, sore throat, runny nose, and lacrimation for the past week, and a rash which he developed yesterday. The rash began on the patient’s face and spread down to the trunk, hands, and feet. The patient’s mother gave him ibuprofen to control the fever. The child has not received mumps, measles, and rubella vaccinations because he was ill when the vaccine was scheduled and was later lost to follow-up. The vital signs include blood pressure 90/50 mm Hg, heart rate 110/min, respiratory rate 22/min, and temperature 37.8°C (100.0℉). On physical examination, the child was drowsy. His face, trunk, and extremities were covered with a maculopapular erythematous rash. Two irregularly-shaped red dots were also noted on the mucosa of the lower lip. The remainder of the physical examination was within normal limits. What is the probable causative agent for this child’s condition?? {'A': 'Rubulavirus', 'B': 'Morbillivirus', 'C': 'Herpesvirus', 'D': 'Influenzavirus', 'E': 'Group A Streptococcus'},
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B: Morbillivirus
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Q:A 6-year-old boy is brought to the physician by his mother for coughing, nasal congestion, and intermittent wheezing for the past 2 months. The child has a history of eczema. Since birth, he has had three upper respiratory tract infections that resolved without treatment, and one episode of acute otitis media treated with antibiotics. His family moved into affordable housing 3 months ago. His temperature is 37.2°C (98.9°F), pulse is 120/min, respirations are 28/min, and blood pressure is 90/60 mmHg. There are scattered wheezes on pulmonary examination. Which of the following is the most appropriate next step in management?? {'A': 'Flow cytometry for B cells', 'B': 'Spirometry', 'C': 'Skin prick testing', 'D': 'Throat culture', 'E': 'Dihydrorhodamine 123 test'},
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B: Spirometry
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Answer the following medical question with one of the provided options:
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Q:A 15-year-old boy is brought to the emergency department by ambulance after his mother found him having muscle spasms and stiffness in his room. His mother stated he scraped his foot on a rusty razor on the bathroom floor 2 days prior. On presentation, his temperature is 102.0°F (38.9°C), blood pressure is 108/73 mmHg, pulse is 122/min, and respirations are 18/min. On physical exam, he is found to have severe muscle spasms and rigid abdominal muscles. In addition, he has a dirty appearing wound on his right foot. The patient's mother does not recall any further vaccinations since age 12. Finally, he is found to have difficulty opening his mouth so he is intubated. Which of the following treatment(s) should be provided to this patient?? {'A': 'Antitoxin', 'B': 'Wound debridement', 'C': 'Wound debridement and antitoxin', 'D': 'Wound debridement and booster vaccine', 'E': 'Wound debridement, antitoxin, and booster vaccine'},
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C: Wound debridement and antitoxin
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Q:A 6-month-old boy is brought to the emergency department by his mother because of recurrent vomiting and yellowing of his eyes. The mother says that he has been eating poorly since she started weaning him off of breast milk 5 days ago. At this time, mashed vegetables and fruits were added to his diet. Examination shows scleral jaundice and dry mucous membranes. The tip of the liver is palpable 4 cm below the right costal margin. His serum glucose concentration is 47 mg/dL, serum alanine aminotransferase is 55 U/L, and serum aspartate aminotransferase is 66 U/L. Which of the following enzymes is most likely deficient?? {'A': 'Galactokinase', 'B': 'Galactose-1 phosphate uridyltransferase', 'C': 'Aldolase B', 'D': 'Fructokinase', 'E': 'Glucose-6-phosphatase'},
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C: Aldolase B
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Answer the following medical question with one of the provided options:
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Q:A 23-year-old pregnant woman (gravida 1, para 0) presents during her 16th week of pregnancy for a check-up. The course of her current pregnancy is unremarkable. She had normal results on the previous ultrasound examination. Her human chorionic gonadotropin (hCG) level measured at week 12 of pregnancy was 0.9 multiples of the normal median (MoM). She is human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV)-negative. She undergoes a quadruple test which shows the following results: Serum alpha-fetoprotein Low Unconjugated estriol Low Beta-hCG High Inhibin A High The risk of which condition indicates these results?? {'A': 'Trisomy 21', 'B': 'Trisomy 18', 'C': 'Neural tube defect', 'D': 'Congenital toxoplasmosis', 'E': 'Trophoblastic disease'},
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A: Trisomy 21
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Answer the following medical question with one of the provided options:
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Q:A 78-year old woman presents to the emergency department with severe abdominal pain. Past medical history is significant for congestive heart failure, hypertension, hyperlipidemia, and gout. Her medications include lisinopril, metoprolol, atorvastatin, and allopurinol. Her blood pressure is 125/90 mm Hg, heart rate 95/min and temperature is 37.3°C (99.2°F). Abdominal X-ray reveals a dilated bowel with bowel wall thickening and pneumatosis intestinalis isolated to the splenic flexure and descending colon. These findings are highly suspicious for ischemic colitis with a differential diagnosis of pseudomembranous colitis. Which vessel contributes the most to the delivery of blood to the affected area?? {'A': 'Sigmoid arteries', 'B': 'Internal pudendal artery', 'C': 'Right colic artery', 'D': 'Left colic artery', 'E': 'Superior rectal artery'},
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D: Left colic artery
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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 is scheduled to undergo a right hip total arthroplasty for severe hip osteoarthritis that has failed conservative management. She has never had surgery before. She has a history of major depressive disorder and takes sertraline daily and ibuprofen occasionally for pain. Her mother died of breast cancer and her father died from a myocardial infarction. She has a brother who had an adverse reaction following anesthesia, but she does not know details of the event. In the operating room, the anesthesiologist administers isoflurane and succinylcholine. Two minutes later, the patient develops hypercarbia and hypertonicity of his bilateral upper and lower extremities. Her temperature is 103.7°F (39.8°C), blood pressure is 155/95 mmHg, pulse is 115/min, and respirations are 20/min. A medication with which of the following mechanisms of action is most strongly indicated for this patient?? {'A': 'Antihistamine', 'B': 'Cholinesterase inhibitor', 'C': 'Dopamine receptor agonist', 'D': 'Muscarinic antagonist', 'E': 'Ryanodine receptor antagonist'},
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E: Ryanodine receptor antagonist
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Answer the following medical question with one of the provided options:
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Q:A 24-year-old woman comes to the emergency department because she has had dyspnea and palpitations occurring with mild exertion for the past 8 days. At first, the symptoms subsided immediately after cessation of activity, but they have become worse and now last up to 45 minutes. The patient returned from a summer camping trip in Vermont 6 weeks ago. Except for an episode of flu with fever and chills a month ago, she has no history of serious illness. Her father had a myocardial infarction at the age of 56. She drinks two to four beers on social occasions and occasionally smokes marijuana. Her temperature is 37°C (98.6°F), pulse is 47/min, respirations are 20/min, and blood pressure is 150/70 mm Hg. A resting ECG is shown. Two-step serological testing confirms the diagnosis. Which of the following is the most appropriate next step in management?? {'A': 'Intravenous ceftriaxone therapy', 'B': 'Oral amoxicillin therapy', 'C': 'Oral doxycycline therapy', 'D': 'Atropine therapy', 'E': 'Permanent pacemaker implantation'},
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A: Intravenous ceftriaxone therapy
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Answer the following medical question with one of the provided options:
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Q:A 19-year-old female college student is brought into the emergency department by her boyfriend. The boyfriend reports that the patient got caught stealing from the company she works for and subsequently got fired. The boyfriend received a text that evening saying “I’ll miss you.” When he arrived at her dorm room, the patient was slumped in the shower covered in blood. The patient agreed to be driven to the emergency room. When asked about what happened, the patient replies “I just want out of this life.” The patient has bipolar disorder, and takes lithium as prescribed. She has a psychiatrist she sees every week, which the boyfriend confirms. She has never had a prior suicide attempt nor has she ever been hospitalized for a psychiatric disorder. The patient’s vitals are stable. Upon physical examination, a 4 centimeter vertical incision is noted on the patient’s left forearm. During the patient’s laceration repair, she asks if she will be admitted. She states, “these ups and downs are common for me, but I feel better now.” She verbalizes that she understands that she overreacted. She asks to go home, and her boyfriend insists that he will stay with her. They both confirm that neither of them have guns or know any peers with access to guns. Which of the following is the most appropriate management for the patient?? {'A': 'Call the patient’s parents', 'B': 'Discontinue lithium and start valproate', 'C': 'Have the patient sign a suicide contract before discharge', 'D': 'Involuntarily admit the patient', 'E': 'Set up a next-day appointment with the patient’s psychiatrist'},
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D: Involuntarily admit the patient
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Q:An 8-year-old boy is brought to the physician because of a 1-day history of severe left hand pain. He has had similar painful episodes in the past that required hospitalization. Physical examination shows pale conjunctivae. There is tenderness on palpation of the wrist and the small joints of the left hand. Peripheral blood smear shows crescent-shaped erythrocytes. He is started on a pharmacologic agent that is known to cause macrocytosis. This drug causes an arrest in which of the following cell cycle phases?? {'A': 'G0 phase', 'B': 'M phase', 'C': 'S phase', 'D': 'G2 phase', 'E': 'G1 phase'},
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C: S phase
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Answer the following medical question with one of the provided options:
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Q:A 28-year-old man is brought to the emergency department after being struck by a car an hour ago as he was crossing the street. He did not lose consciousness. He is complaining of pain in his right arm, forehead, and pelvis. He also has the urge to urinate, but has been unable to do so since the accident. He takes no medications. His temperature is 37.1°C (98.9°F), pulse is 72/min, respirations are 18/min, and blood pressure is 118/82 mm Hg. There are abrasions over his scalp and face and a 1x3 cm area of ecchymosis above his right eye. Abdominal examination shows suprapubic tenderness. There is a scant amount of blood at the urethral meatus. There is no cervical spinal tenderness. Musculoskeletal examination shows tenderness and ecchymosis over his right distal forearm. An x-ray of the pelvis shows a fracture of the pelvic ramus. A CT scan of the head and neck show no abnormalities. Which of the following is the best next step in the management of this patient?? {'A': 'Retrograde urethrogram', 'B': 'IV pyelogram', 'C': 'Contrast-enhanced CT scan of the abdomen', 'D': 'Foley catheterization', 'E': 'Retroperitoneal ultrasound'},
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A: Retrograde urethrogram
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Answer the following medical question with one of the provided options:
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Q:A homeless 45-year-old man presents to the emergency room in December complaining of malaise, body aches, chills, and fever. He reports that his symptoms started 4 days ago. His myalgias and chills have begun to resolve, but now he is starting to develop a dry cough, dyspnea, and a sore throat. He does not have a primary care provider and has not had any vaccinations in over 2 decades. He receives medical care from the emergency room whenever he is feeling ill. His temperature is 103°F (39.4°C), blood pressure is 130/70 mmHg, pulse is 115/min, and respirations are 22/min. On exam, he appears fatigued with mildly increased work of breathing. A chest radiograph is negative. A nasopharyngeal viral culture is positive for an orthomyxovirus. Upon further review of the patient’s medical record, he was diagnosed with the same condition 1 year ago in November. Which of the following mechanisms is responsible for pandemics of this patient’s disease?? {'A': 'Complementation', 'B': 'Phenotypic mixing', 'C': 'Reassortment', 'D': 'Recombination', 'E': 'Transduction'},
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C: Reassortment
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Answer the following medical question with one of the provided options:
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Q:Three days after admission to the hospital with a clinical diagnosis of ischemic colitis, a 65-year-old man has recovered from his initial symptoms of bloody diarrhea and abdominal pain with tenderness. He feels well at this point and wishes to go home. He has a 15-year history of diabetes mellitus. Currently, he receives nothing by mouth, and he is on IV fluids, antibiotics, and insulin. His temperature is 36.7°C (98.1°F), pulse is 68/min, respiratory rate is 13/min, and blood pressure is 115/70 mm Hg. Physical examination of the abdomen shows no abnormalities. His most recent laboratory studies are all within normal limits, including glucose. Which of the following is the most appropriate next step in management?? {'A': 'Colonoscopy', 'B': 'Discharge home with follow-up in one month', 'C': 'Laparoscopy', 'D': 'Laparotomy', 'E': 'Total parenteral nutrition'},
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A: Colonoscopy
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Answer the following medical question with one of the provided options:
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Q:The surgical equipment used during a craniectomy is sterilized using pressurized steam at 121°C for 15 minutes. Reuse of these instruments can cause transmission of which of the following pathogens?? {'A': 'Non-enveloped viruses', 'B': 'Sporulating bacteria', 'C': 'Enveloped viruses', 'D': 'Yeasts', 'E': 'Prions'},
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E: Prions
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Answer the following medical question with one of the provided options:
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Q:A 68-year-old community-dwelling woman is transported to the emergency department with decreased consciousness, headache, and nausea. The symptoms began after the patient had a syncopal episode and fell at her home. She has a history of arterial hypertension and atrial fibrillation. Her current medications include hydrochlorothiazide, lisinopril, metoprolol, and warfarin. On admission, her blood pressure is 140/90 mm Hg, heart rate is 83/min and irregular, respiratory rate is 12/min, and temperature is 36.8°C (98.4°F). She is conscious and verbally responsive, albeit confused. She is able to follow motor commands. Her pupils are round, equal, and poorly reactive to light. She is unable to abduct both eyes on an eye movement examination. She has decreased strength and increased tone (Ashworth 1/4) and reflexes (3+) in her right upper and lower extremities. Her lungs are clear to auscultation. The cardiac examination shows the presence of S3 and a pulse deficit. A head CT scan is shown in the picture. Which of the following led to the patient’s condition?? {'A': 'Rupture of the middle meningeal artery', 'B': 'Rupture of a saccular aneurysm in the carotid circulation region', 'C': 'Laceration of the leptomeningeal blood vessels', 'D': 'Rupture of the cerebral bridging veins', 'E': 'Rupture of the vein of Galen'},
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D: Rupture of the cerebral bridging veins
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Answer the following medical question with one of the provided options:
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Q:A 34-year-old G3P2 presents at 33 weeks gestation with several episodes of bloody spotting and mild vaginal bleeding over the past 2 weeks. The bleeding has no specific triggers and resolves spontaneously. She does not report abdominal pain or uterine contractions. She has had two cesarean deliveries. At 20 weeks gestation, the ultrasound examination showed the placental edge to be 5 cm away from the internal cervical os. On examination at this visit, the vital signs are as follows: blood pressure, 110/70 mm Hg; heart rate, 89/min; respiratory rate, 15\min; and temperature, 36.6℃ (97.9℉). The uterus is tender with no palpable contractions and streaks of blood are noted on the perineum, but there is no active bleeding. An ultrasound evaluation shows the placental edge 1 cm from the internal cervical os. Which of the following options best describes the placental position at each ultrasound?? {'A': 'Normally lying placenta → marginal previa', 'B': 'Low-lying placenta → partial previa', 'C': 'Normally placed placenta → low-lying placenta', 'D': 'Marginal previa → partial previa', 'E': 'Low-lying placenta → marginal previa'},
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A: Normally lying placenta → marginal previa
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Answer the following medical question with one of the provided options:
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Q:A 40-year-old man with a past medical history of major depression presents to the clinic. He is interested in joining a research study on depression-related sleep disturbances. He had 2 episodes of major depression within the last 2 years, occurring once during the summer and then during the winter of the other year. He has been non-compliant with medication and has a strong desire to treat his condition with non-pharmacological methods. He would like to be enrolled in this study that utilizes polysomnography to record sleep-wave patterns. Which of the following findings is likely associated with this patient’s psychiatric condition?? {'A': 'Increased total REM sleep', 'B': 'Increased slow wave sleep', 'C': 'Late morning awakenings', 'D': 'Increased REM sleep latency', 'E': 'Associated with a seasonal pattern'},
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A: Increased total REM sleep
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Answer the following medical question with one of the provided options:
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Q:A 54-year-old woman with breast cancer comes to the physician because of redness and pain in the right breast. She has been undergoing ionizing radiation therapy daily for the past 2 weeks as adjuvant treatment for her breast cancer. Physical examination shows erythema, edema, and superficial desquamation of the skin along the right breast at the site of radiation. Sensation to light touch is intact. Which of the following is the primary mechanism of DNA repair responsible for preventing radiation-induced damage to neighboring neurons?? {'A': 'Base excision repair', 'B': 'DNA mismatch repair', 'C': 'Nucleotide excision repair', 'D': 'Nonhomologous end joining repair', 'E': 'Homology-directed repair'},
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D: Nonhomologous end joining repair
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Answer the following medical question with one of the provided options:
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Q:An 11-month-old male is brought to the emergency room by his mother. The mother reports that the child is in severe pain and has not moved his right leg since earlier this morning when he was crawling on the floor. The child did not fall or sustain any obvious injury. The child’s past medical history is notable for anemia and recurrent infections since birth. His temperature is 99.1°F (37.3°C), blood pressure is 100/65 mmHg, pulse is 120/min, and respirations are 22/min. Physical examination reveals mild macrocephaly and hepatosplenomegaly. Palpation of the right femur seems to exacerbate the child’s pain. A radiograph demonstrates a transverse mid-shaft femur fracture. Which of the following is the most likely cause of this patient’s condition?? {'A': 'Acidification deficiency', 'B': 'Endochondral ossification deficiency', 'C': 'Vitamin deficiency', 'D': 'Surreptitious child abuse', 'E': 'Collagen production deficiency'},
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A: Acidification deficiency
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Answer the following medical question with one of the provided options:
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Q:A 27-year-old African-American woman, gravida 1, para 0, at 11 weeks' gestation comes to her physician for a prenatal visit. She feels more fatigued than usual but has no other symptoms. She has no history of serious illness. She takes no medications. Her mother has systemic lupus erythematosus. Her temperature is 37.2°C (98.9°F), pulse is 80/min, respirations are 18/min, and blood pressure is 120/75 mm Hg. Examination shows no abnormalities. Laboratory studies show: Hemoglobin 9.2 g/dL Hematocrit 27.5% Leukocyte count 6,000/mm3 Platelet Count 180,000/mm3 MCV 74 μm3 MCH 24 pg/cell Serum Na+ 138 mEq/L K+ 4.5 mEq/L Cl- 100 mEq/L HCO3- 25 mEq/L Urea Nitrogen 15 mg/dL Creatinine 1.0 mg/dL Total Bilirubin 0.4 mg/dL Iron 67 U/L Ferritin 98 ng/mL Which of the following is the most appropriate next step in management?"? {'A': 'Measure anticardiolipin antibody titers', 'B': 'Measure LDH and haptoglobin', 'C': 'Amniocentesis', 'D': 'Perform direct Coombs test', 'E': 'Hemoglobin electrophoresis'},
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E: Hemoglobin electrophoresis
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Q:A 4-year-old boy is brought to the physician by his father because of a 3-day history of generalized rash. The rash is not pruritic. He has no cough. He has had a fever and a sore throat for 4 days. He was born at term and has been healthy except for an episode of tonsillitis 6 months ago treated with erythromycin. His immunizations are up-to-date. His temperature is 38.5°C (101.3°F). Examination shows cervical lymphadenopathy. The tongue is bright red. There is tonsillar erythema without any exudate. A photograph of the rash is shown. Which of the following is the most appropriate next step in management?? {'A': 'Monospot test', 'B': 'Elevated C-reactive protein', 'C': 'Detection of antistreptolysin titer', 'D': 'Echocardiography', 'E': 'Rapid streptococcal antigen test'},
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E: Rapid streptococcal antigen test
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Q:A 55-year-old man comes to the physician because of a 3-day history of decreased urine output, progressively worsening bilateral pedal edema, and fatigue. He has a 4-month history of persistent lower back pain. He has hypercholesterolemia and stable angina pectoris. Current medications include atorvastatin, aspirin, and ibuprofen. His pulse is 80/min, respirations are 16/min, and blood pressure is 150/100 mm Hg. Examination shows periorbital and pedal edema and pallor. There is tenderness of the lumbar spinal vertebrae. Straight leg raise test is negative. The remainder of the examination shows no abnormalities. Laboratory studies show: Hemoglobin 8.9 mg/dl Serum Urea nitrogen 20 mg/dl Creatinine 2.4 mg/dl Calcium 11.2 mg/dl Alkaline phosphatase 140 U/L X-ray of the spine shows diffuse osteopenia and multiple lytic lesions. Which of the following is most likely to confirm the diagnosis?"? {'A': 'Peripheral blood smear', 'B': 'Congo red stain of renal tissue', 'C': 'Parathyroid hormone levels', 'D': 'Bone marrow biopsy', 'E': 'Skeletal survey'},
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D: Bone marrow biopsy
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Q:A 7-year-old girl is brought to the physician by her mother because of a 4-week history of irritability, diarrhea, and a 2.2-kg (5-lb) weight loss that was preceded by a dry cough. The family returned from a vacation to Indonesia 2 months ago. Her vital signs are within normal limits. Abdominal examination shows mild tenderness with no guarding or rebound and increased bowel sounds. Her leukocyte count is 9,200/mm3 with 20% eosinophils. A photomicrograph of a wet stool mount is shown. Which of the following is the most appropriate pharmacotherapy?? {'A': 'Diethylcarbamazine', 'B': 'Metronidazole', 'C': 'Doxycycline', 'D': 'Albendazole', 'E': 'Praziquantel'},
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D: Albendazole
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Q:A 17-year-old previously healthy, athletic male suddenly falls unconscious while playing soccer. His athletic trainer comes to his aid and notes that he is pulseless. He begins performing CPR on the patient until the ambulance arrives but the teenager is pronounced dead when the paramedics arrived. Upon investigation of his primary care physician's office notes, it was found that the child had a recognized murmur that was ruled to be "benign." Which of the following conditions would have increased the intensity of the murmur?? {'A': 'Inspiration', 'B': 'Handgrip', 'C': 'Valsalva', 'D': 'Placing the patient in a squatting position', 'E': 'Passive leg raise'},
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C: Valsalva
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Q:A 45-year-old male presents to the emergency room complaining of severe nausea and vomiting. He returned from a business trip to Nigeria five days ago. Since then, he has developed progressively worsening fevers, headache, nausea, and vomiting. He has lost his appetite and cannot hold down food or water. He did not receive any vaccinations before traveling. His medical history is notable for alcohol abuse and peptic ulcer disease for which he takes omeprazole regularly. His temperature is 103.0°F (39.4°C), blood pressure is 100/70 mmHg, pulse is 128/min, and respirations are 22/min. Physical examination reveals scleral icterus, hepatomegaly, and tenderness to palpation in the right and left upper quadrants. While in the examination room, he vomits up dark vomitus. The patient is admitted and started on multiple anti-protozoal and anti-bacterial medications. Serology studies are pending; however, the patient dies soon after admission. The virus that likely gave rise to this patient’s condition is part of which of the following families?? {'A': 'Flavivirus', 'B': 'Togavirus', 'C': 'Calicivirus', 'D': 'Bunyavirus', 'E': 'Hepevirus'},
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A: Flavivirus
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Q:A 14-year-old girl is brought to the physician for evaluation of her short stature. She was born at term, and her birth length was normal. She has not yet attained menarche. Her mother is 162 cm (5 ft 4 in) tall and her father is 177 cm (5 ft 10 in) tall. She is at the 3rd percentile for height and 40th percentile for weight. Vital signs are within normal limits. Breast and pubic hair development are Tanner stage 2. The remainder of the examination shows no abnormalities. Which of the following is the most appropriate next step in diagnosis?? {'A': 'Measurement of serum insulin-like growth factor concentration', 'B': 'Genetic karyotyping', 'C': 'Measurement of serum thyroid-stimulating hormone concentration', 'D': 'X-ray of the hand and wrist', 'E': 'MRI of the brain\n"'},
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D: X-ray of the hand and wrist
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Q:A 59-year-old African-American man presents with dyspnea on exertion and bilateral lower leg edema. The patient had a myocardial infarction 2 years ago, in which he developed chronic heart failure. Also, he has type 2 diabetes mellitus. His medications include bisoprolol 20 mg, lisinopril 40 mg, and metformin 2000 mg daily. The vital signs at presentation include: blood pressure is 135/70 mm Hg, heart rate is 81/min, respiratory rate is 13/min, and temperature is 36.6℃ (97.9℉). The physical examination is significant for bilateral lower leg pitting edema. The cardiac auscultation demonstrated an S3 and a systolic murmur best heard at the apex. Which of the following adjustments should be made to the patient’s treatment plan?? {'A': 'Increase the dose of bisoprolol', 'B': 'Add amlodipine', 'C': 'Increase the dose of lisinopril', 'D': 'Add valsartan', 'E': 'Add hydralazine/isosorbide dinitrate'},
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E: Add hydralazine/isosorbide dinitrate
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Q:An investigator is studying the resting rate of oxygen consumption in the lower limbs of individuals with peripheral vascular disease. The rate of blood flow in a study subject's femoral vessels is measured using Doppler ultrasonography, and blood samples from the femoral vein and femoral artery are obtained. The blood samples are irradiated and centrifuged, after which the erythrocyte fractions from each sample are hemolyzed using 10% saline. Compared to the femoral vein, which of the following findings would be expected in the hemolysate from the femoral artery?? {'A': 'Lower chloride concentration', 'B': 'Lower NADP/NADPH ratio', 'C': 'Higher ADP/ATP ratio', 'D': 'Higher carbaminohemoglobin concentration', 'E': 'Lower potassium concentration'},
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A: Lower chloride concentration
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Q:A 5-year-old boy is brought to a pediatrician by his parents for evaluation of learning difficulties in school. He has short stature, a flat face, low-set ears, a large tongue, and a single line on the palm. He was born to his parents after 20 years of marriage. You ordered karyotyping which will likely reveal which of the following?? {'A': '47, XXX', 'B': '47, XXY', 'C': '47, XY, +21', 'D': '47, XY, +18', 'E': '45, XO'},
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C: 47, XY, +21
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Q:A 28-year-old woman presents for her annual physical examination. She describes a painless lump in her left breast detected during breast self-examination two weeks ago. She has no previous history of breast lumps and considers herself to be generally healthy. She takes no medication and does not smoke tobacco or drink alcohol. The patient has no personal or family history of breast cancer. Her vitals are normal. Physical examination reveals a firm, 1 to 2 cm mass in the lateral aspect of her left breast. However, no associated skin changes, nipple discharge, or retraction are found. No axillary adenopathy is present. What is the most appropriate next step in the workup of this patient?? {'A': 'Perform an ultrasound', 'B': 'Order a mammogram', 'C': 'Perform an ultrasound and order a mammogram', 'D': 'Order magnetic resonance imaging of the breast', 'E': 'Refer for an ultrasound-guided core biopsy'},
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A: Perform an ultrasound
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Q:A 10-year-old boy with trisomy 21 arrives for his annual check-up with his pediatrician. His parents explain that over the past week, he has been increasingly withdrawn and lethargic. On examination, lymph nodes appear enlarged around the left side of his neck; otherwise, there are no remarkable findings. The pediatrician orders some routine blood work. These are the results of his complete blood count: WBC 30.4 K/μL RBC 1.6 M/μL Hemoglobin 5.1 g/dL Hematocrit 15% MCV 71 fL MCH 19.5 pg MCHC 28 g/dL Platelets 270 K/μL Differential: Neutrophils 4% Lymphocytes 94% Monocytes 2% Peripheral smear demonstrates evidence of immature cells and the case is referred to hematopathology. On flow cytometry, the cells are found to be CALLA (CD10) negative. Which of the following diseases is most associated with these clinical and cytological findings?? {'A': 'Hairy cell leukemia', 'B': 'Precursor T-cell acute lymphoblastic leukemia/lymphoma', 'C': 'Classic Hodgkin’s lymphoma', 'D': 'Precursor B-cell acute lymphoblastic leukemia/lymphoma', 'E': 'Diffuse large B-cell lymphoma'},
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B: Precursor T-cell acute lymphoblastic leukemia/lymphoma
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Q:In large neurons the nucleus can be found a large distance away from the terminal end of its axon. The body has a complex system of intracellular transporters that are able to carry essential proteins from the nucleus to the distal edge of the cell and back. Which of the following proteins are essential for this function?? {'A': 'Kinesin, Troponin', 'B': 'Dynein, Kinesin', 'C': 'Actin, Dynein', 'D': 'Myosin, Kinesin', 'E': 'Glucose, Actin'},
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B: Dynein, Kinesin
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Q:A group of bariatric surgeons are investigating a novel surgically-placed tube that drains a portion of the stomach following each meal. They are interested in studying its efficacy in facilitating weight loss in obese adults with BMIs > 40 kg/m2 who have failed to lose weight through non-surgical options. After randomizing 150 patients to undergoing the surgical tube procedure and 150 patients to non-surgical weight loss options (e.g., diet, exercise), the surgeons found that, on average, participants in the surgical treatment group lost 15% of their total body weight in comparison to 4% in the non-surgical group. Which of the following statistical tests is an appropriate initial test to evaluate if this difference in weight loss between the two groups is statistically significant?? {'A': 'Paired two-sample t-test', 'B': 'Kaplan-Meier analysis', 'C': 'Multiple linear regression', 'D': 'Pearson correlation coefficient', 'E': 'Unpaired two-sample t-test'},
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E: Unpaired two-sample t-test
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Q:A 55-year-old Caucasian male presents for a routine colonoscopy. A polyp is found in the patient's transverse colon and is found to be cancerous on histological evaluation. Upon examination, it is found that these cancerous cells have decreased MHC class I expression on their surface. Which immune system cell is most capable of killing these tumor cells?? {'A': 'Natural killer cells', 'B': 'B-cells', 'C': 'Macrophages', 'D': 'Eosinophils', 'E': 'Cytotoxic T-cells'},
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A: Natural killer cells
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Q:A 68-year-old man comes to the physician because of headache, fatigue, and nonproductive cough for 1 week. He appears pale. Pulmonary examination shows no abnormalities. Laboratory studies show a hemoglobin concentration of 9.5 g/dL and an elevated serum lactate dehydrogenase concentration. A peripheral blood smear shows normal red blood cells that are clumped together. Results of cold agglutinin titer testing show a 4-fold elevation above normal. An x-ray of the chest shows diffuse, patchy infiltrates bilaterally. Treatment is begun with an antibiotic that is also used to promote gut motility. Which of the following is the primary mechanism of action of this drug?? {'A': 'Inhibition of transpeptidase cross-linking at the cell wall', 'B': 'Free radical creation within bacterial cells', 'C': 'Inhibition of peptide translocation at the 50S ribosomal subunit', 'D': 'Inhibition of folic acid synthesis', 'E': 'Inhibition of bacterial RNA polymerase'},
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C: Inhibition of peptide translocation at the 50S ribosomal subunit
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Q:A 48-year-old man comes to the emergency department because of a 1-hour history of heavy nasal bleeding. He drinks half a bottle of sherry daily. His pulse is 112/min, and blood pressure is 92/54 mm Hg. Physical examination shows scattered ecchymoses across the extremities and oozing from a venipuncture site. Laboratory studies show a prothrombin time of 28 seconds and a partial thromboplastin time of 36 seconds. Impaired function of which of the following proteins is the most likely cause of this patient's hemorrhage?? {'A': 'Protein S', 'B': 'Von Willebrand factor', 'C': 'Gamma-glutamyl carboxylase', 'D': 'Prolyl hydroxylase', 'E': 'Epoxide reductase'},
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C: Gamma-glutamyl carboxylase
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Q:A 68-year-old male smoker dies suddenly in a car accident. He had smoked 2 packs per day for 40 years. His past medical history is notable for a frequent, very productive cough, recurrent respiratory infections and occasional wheezing. He had no other medical problems. At autopsy, which of the following is most likely to be found in this patient?? {'A': 'Interstitial fibrosis of the lung', 'B': 'Pleural plaques', 'C': 'Increased number and activity of goblet cells', 'D': 'Ferruginous bodies', 'E': 'Mucous gland atrophy'},
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C: Increased number and activity of goblet cells
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Q:A 62-year-old man is found unconscious in the park on a bench, early in the morning in January. The temperature outside is -4.0°C (25°F). He is barefoot and is wearing nothing more than sweatpants, a tee-shirt, and a light coat. Upon arrival at the emergency department, his vitals include: heart rate 45/min, blood pressure 100/70 mm Hg, and respiratory rate 10/min. His core body temperature is 30.0°C (85.5°F). His feet and palms are covered with clear blisters, the skin is yellow with a waxy appearance, and the tissues are edematous. The patient is unresponsive to auditory stimuli. Which of the following cold-associated injuries does the patient have?? {'A': 'Frostnip', 'B': 'Pernio', 'C': 'Immersion foot', 'D': 'Frostbite', 'E': 'Trench foot'},
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D: Frostbite
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Q:A 16-year-old girl undergoes an emergent appendectomy after presenting to the emergency department with appendicitis. She is given a mixture of nitrous oxide and sevoflurane for induction of anesthesia and intubated for a secure airway during surgery. A few minutes after induction, she is found to have increased end-tidal carbon dioxide and tachycardia. Furthermore, the surgeon notices that her abdomen is extremely rigid before making his incision. Finally, she is found to have hyperkalemia despite having normal serum potassium during preoperative laboratory studies. Defective function of which of the following proteins is most likely responsible for this patient's findings?? {'A': 'Acetylcholine receptor', 'B': 'Dystrophin', 'C': 'L-type calcium channel', 'D': 'Myosin heavy chain', 'E': 'Ryanodine receptor'},
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E: Ryanodine receptor
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Q:An 18-year-old male in his first year of college presents to the emergency room with a fever and a severe headache. He reports having unprotected sex with several partners over the past few weeks. Upon examination, the male demonstrates nuchal rigidity and photophobia. His past medical history is notable for a lack of vaccinations beginning from infancy due to his parents' belief that vaccinations may cause autism. The bacteria causing these symptoms would most likely demonstrate which of the following?? {'A': 'Positive quellung reaction', 'B': 'Negative quellung reaction', 'C': 'Lactose fermentation', 'D': 'Urease positive', 'E': 'Negative catalase test'},
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A: Positive quellung reaction
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Q:A 9-year-old girl is brought to the pediatrician for a wellness checkup. The girl's past medical history is non-contributory, and she has met all her developmental milestones. Her parents were recently called into the office as the girl was found touching the genitals of one of her classmates. She was trying to insert a toy into her classmate's genitals. The girl is asked what has happened and what she thinks is going on but she is too shy to reply to the physician. The girl and her mother recently moved in with a family member. They live in low-income housing subsidized by the government and are currently on food stamps. The mother states that her daughter has been particularly argumentative lately and that they have gotten into arguments in which her daughter screamed at her and locked herself in the bathroom. Which of the following is the most likely diagnosis?? {'A': 'Adjustment disorder', 'B': 'Attention deficit hyperactivity disorder', 'C': 'Normal variant of development', 'D': 'Precocious puberty', 'E': 'Sexual abuse'},
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E: Sexual abuse
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Q:A previously healthy 59-year-old man comes to the physician with a 6-month history of worsening headaches, difficulty chewing, and progressive hearing loss. Examination shows a mildly tender, 1-cm, hard swelling over the left maxilla. The remainder of the examination shows no abnormalities. Serum studies show a calcium concentration of 8.5 mg/dL, alkaline phosphatase activity of 112 U/L, and parathyroid hormone concentration of 310 pg/mL. Audiometry shows bilateral mixed conductive and sensorineural hearing loss. Which of the following processes is the most likely cause of this patient's condition?? {'A': 'Increased activity of nuclear factor-κB', 'B': 'Decreased expression of menin protein', 'C': 'Defective synthesis of dynein', 'D': 'Defective synthesis of type I collagen', 'E': 'Decreased activity of carbonic anhydrase II\n"'},
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A: Increased activity of nuclear factor-κB
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Q:A 28-year-old woman, gravida 2, para 1, at 24 weeks gestation comes to the physician for a prenatal visit. She reports dull aching pain and paresthesia over her left hand during the last few weeks. The pain radiates to her shoulder and is worse at night. Her hand feels numb upon waking up in the morning. She has a sister who has multiple sclerosis. Her current medications include iron supplements and a multivitamin. Vital signs are within normal limits. When the wrist is passively held in full flexion, aggravation of paresthesia is perceived immediately. Which of the following is the most likely explanation for this patient's symptoms?? {'A': 'Ulnar nerve compression', 'B': 'Cervical radiculopathy', 'C': 'Demyelinating disease of peripheral nerves', 'D': 'Median nerve compression', 'E': 'Demyelinating disease of CNS'},
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D: Median nerve compression
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Q:A 62-year-old man comes to the physician because of gradual onset of bilateral ankle swelling over the past month. He also noticed reddish blotches of skin around his ankles. Five weeks ago, he came to the physician with difficulty walking and a resting tremor. He was diagnosed with Parkinson disease and started on medication. He has a history of hypertension and his antihypertensive medications were also adjusted. His temperature is 37.3°C (99.1°F), pulse is 64/min, respirations are 13/min, and blood pressure is 124/74 mm Hg. Physical examination shows bilateral 2+ edema in the ankles. There is purple-red discoloration on the lower legs in a reticular pattern. Neurologic examination shows resting tremor in both hands and bilateral cogwheel rigidity in the elbows. Which of the following pharmacotherapies is the most likely cause of this patient's edema?? {'A': 'Levodopa/carbidopa', 'B': 'Amantadine', 'C': 'Lisinopril', 'D': 'Hydrochlorothiazide', 'E': 'Benztropine'},
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B: Amantadine
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Q:A 60-year-old man is brought to the emergency department after a fall. He has been seen by the triage nurse but has not been evaluated by a physician. He is heard yelling down the hallway, requesting to speak to “whoever is in charge.” He refuses to talk to the emergency resident and insists on talking to the attending physician despite being informed that the attending is currently resuscitating a patient who was in a car accident. He says that he deserves better treatment because he has made numerous contributions to the field of medicine. When asked about his work, he mentions that he was a medical device salesman. He is accompanied by his wife, who appears embarrassed. She claims that her husband frequently makes a scene and apologizes for her husband's behavior. On mental status examination, the patient is oriented to person, place, and time. He appears agitated and speaks in short, pressured sentences. There is no disorder of thought process or content. Which of the following is the most likely diagnosis?? {'A': 'Acute stress disorder', 'B': 'Obsessive compulsive personality disorder', 'C': 'Histrionic personality disorder', 'D': 'Bipolar disorder', 'E': 'Narcissistic personality disorder'},
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E: Narcissistic personality disorder
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Q:A 56-year-old woman presents with fatigue and joint pain in her fingers and wrists for the last 6 months. She says the pain is present in both hands, and her wrists are also swollen. Furthermore, she describes morning stiffness in her joints lasting about 2 hours, which improves with use. She has been taking acetaminophen, which provided minimal relief, but the swelling has gotten progressively worse. She also feels increasingly tired. Her past medical history reveals she has been successfully treated for Helicobacter pylori (H. pylori) related ulcers last year but still takes omeprazole for her mild gastroesophageal reflux. The patient denies any smoking history and stopped drinking when her gastric symptoms started. Which of the following analgesic drugs is the best choice to use in this patient?? {'A': 'Indomethacin', 'B': 'Celecoxib', 'C': 'Diclofenac', 'D': 'Naproxen', 'E': 'Aspirin'},
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B: Celecoxib
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Q:A 15-year-old boy is brought to the physician by his parents for evaluation of his “weird” behavior. The parents report that their son tortured their cat to death two weeks ago. Over the past year, he has been accused of stealing a car and setting a fire at his school. He has no history of serious illness. He attends a local high school, and his performance at school is very poor compared to his classmates. He often loses his temper and argues with his teachers. He has smoked one pack of cigarettes daily for 2 years. He does not drink alcohol. His mother has a 10-year history of schizophrenia controlled with medication. On mental status examination, he is oriented to person, place, and time. The pupils are equal and reactive to light. His speech is normal in rate and rhythm, and his thought process is organized. Short- and long-term memory are intact. Attention and concentration are poor. Which of the following is the most likely diagnosis?? {'A': 'Autism spectrum disorder', 'B': 'Oppositional defiant disorder', 'C': 'Conduct disorder', 'D': 'Antisocial personality disorder', 'E': 'Disruptive mood dysregulation disorder\n"'},
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C: Conduct disorder
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Q:A 45-year-old homeless man comes to the emergency department because of a 1-week history of a red, itchy rash on his hands. He says the itching is worse at night and often wakes him from sleep. Physical examination shows the findings in the photograph. A topical drug with which of the following mechanisms of action is most likely to be effective?? {'A': 'Binding to sodium channels', 'B': 'Inhibition of nuclear factor-κB', 'C': 'Decrease in peptidoglycan synthesis', 'D': 'Inhibition of histamine-1 receptors', 'E': 'Increase in keratinocyte turnover'},
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A: Binding to sodium channels
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Q:A newborn presents with central cyanosis, nasal flaring, and subcostal retractions following a scheduled cesarean delivery. He was born to a healthy 29-year-old G-1-P-1 mother due to cervical incompetence at 34 weeks gestation; the pregnancy was otherwise uneventful. Appearance, Pulse, Grimace, Activity, and Respiration (APGAR) scores were 6 and 8 at 1 and 5 minutes, respectively and his birth weight was 3,200 g. The umbilical cord had 3 vessels and the placenta was tan-red with all cotyledons intact. Fetal membranes were tan-white and semi-translucent. Currently, the vital signs include: temperature 36.9°C (98.4°F), blood pressure 70/40 mm Hg, pulse 190/min, and respiratory rate 68/min. On auscultation, breath sounds are decreased. Diffuse ground-glass opacifications are identified on chest X-ray. Which of the factors listed below most likely contributed to this infant’s current condition?? {'A': 'Gestational diabetes', 'B': 'Alcohol abuse', 'C': 'Cytomegalovirus infection', 'D': 'Down syndrome', 'E': 'Lithium'},
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A: Gestational diabetes
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Q:A 23-year-old woman presents with a 4-week menstrual delay. She also complains of irritability, increased somnolence, and occasional nausea. She had her first menarche at the age of 13, and her menstrual cycle became regular at the age of 15. She has been sexually active since the age of 20 but has had the same sexual partner since then. They stopped using birth control protection approximately 6 months ago. She does not smoke and consumes alcohol occasionally. Her blood pressure is 120/80 mm Hg, heart rate is 71/min, respiratory rate is 14/min, and temperature is 36.6℃ (98.2℉). Physical examination is significant only for slight breast engorgement and nipple pigmentation. Gynecologic examination reveals cervical softening and cyanosis. Which of the following drugs would be recommended for this patient?? {'A': 'Progesterone', 'B': 'Biphasic oral contraceptive', 'C': 'Folic acid', 'D': 'Vitamin A', 'E': 'Combination of natural estrogen and progestin'},
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C: Folic acid
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Q:An 11-year-old girl presents to the pediatrician with her mother, who is concerned about her sexual development. She mentions that she herself experienced the onset of menses at the age of 10.5 years, while her daughter has still not had a menstrual period. However, she is otherwise a healthy girl with no significant medical problems since birth. On physical examination, her vital signs are stable. Evaluation of breast and pubic hair are Tanner stage 2. He reassures the mother that her daughter’s sexual development is within the normal range for girls and there is nothing to worry about at present. Which is a sign of Tanner stage 2?? {'A': 'Adrenarche', 'B': 'Pubarche', 'C': 'Coarse pubic hair', 'D': 'Menarche', 'E': 'Thelarche'},
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E: Thelarche
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Q:A 64-year-old man presents to his primary care physician for follow-up of a severe, unrelenting, productive cough of 2 years duration. The medical history includes type 2 diabetes mellitus, which is well-controlled with insulin. He has a 25-pack-year smoking history and is an active smoker. The blood pressure is 135/88 mm Hg, the pulse is 94/min, the temperature is 36.9°C (98.5°F), and the respiratory rate is 18/min. Bilateral wheezes and crackles are heard on auscultation. A chest X-ray reveals cardiomegaly, increased lung markings, and a flattened diaphragm. Which of the following is most likely in this patient?? {'A': 'Increased right ventricle compliance', 'B': 'Increased pulmonary arterial resistance', 'C': 'Increased cerebral vascular resistance', 'D': 'Decreased carbon dioxide content of the arterial blood', 'E': 'Increased pH of the arterial blood'},
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B: Increased pulmonary arterial resistance
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Q:A 62-year-old man comes to the physician because of a 2-month history of an itchy rash and a 7-kg (15-lb) weight loss. Physical examination shows multiple erythematous plaques on the arms, legs, and chest. There are palpable lymph nodes in the axillary and inguinal areas. A biopsy of a skin lesion shows aggregates of neoplastic cells within the epidermis. A peripheral blood smear is most likely to show which of the following findings in this patient?? {'A': 'Giant cells with bilobed nuclei', 'B': 'Erythrocytes with basophilic nuclear remnants', 'C': 'CD4+ cells with cerebriform nuclei', 'D': 'Myeloblasts with azurophilic granules', 'E': 'Plasma cells with intracytoplasmic inclusions'},
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C: CD4+ cells with cerebriform nuclei
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Q:A 35-year-old homeless man from New York City comes to the physician with a 2-month history of fever, night sweats, and a cough productive of white sputum. He uses intravenous heroin several times a week. His temperature is 38°C (100.4°F) and respirations are 22/min. Physical examination shows coarse crackles in the left upper posterior lung field. An x-ray of the chest shows a cavitary lesion in the left upper lobe. Which of the following is the most likely source of his pulmonary findings?? {'A': 'Aspiration of oral flora', 'B': 'Exposure to contaminated hot water tanks', 'C': 'Reactivation of a latent infection', 'D': 'Embolization of a bacterial vegetation', 'E': 'Close contact with pigeon droppings'},
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C: Reactivation of a latent infection
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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 with a history of bipolar disorder and an unknown cardiac arrhythmia presents with palpitations and chest pain. She admits to taking lithium and procainamide regularly, but she ran out of medication 2 weeks ago and has not been able to get refills. Her family history is significant for bipolar disorder in her mother and maternal aunt. Her vital signs include blood pressure 130/90 mm Hg, pulse 110/min, respiratory rate 18/min. Physical examination is significant for a widely split first heart sound with a holosystolic murmur loudest over the left sternal border. Visible cyanosis is noted in the lips and nailbeds. An electrocardiogram is performed which shows intermittent supraventricular tachyarrhythmia with a right bundle branch block. Her cardiac enzymes are normal. An echocardiogram is performed, which shows evidence of a dilated right atria with portions of the tricuspid valve displaced towards the apex. Which of the following medications was this patient most likely exposed to prenatally?? {'A': 'Mood stabilizer', 'B': 'Antidepressant', 'C': 'Isotretinoin', 'D': 'Insulin', 'E': 'Antihypertensive'},
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A: Mood stabilizer
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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 presents to the emergency department with severe nausea and diarrhea. One day prior to presentation, she went to a new seafood restaurant known for serving exotic fish. For the past day she experienced nausea, diarrhea, weakness, and a tingling sensation in her extremities. In the emergency department, her temperature is 100.3°F (37.9°C), blood pressure is 95/60 mmHg, pulse is 105/min, and respirations are 20/min. On physical examination, she appears fatigued and has 1+ Achilles and patellar reflexes. Which of the following is the mechanism of action of the compound most likely responsible for this patient's clinical presentation?? {'A': 'Promotes depolarization of Na+ channels', 'B': 'Prevents depolarization of Na+ channels', 'C': 'Increases synthesis of histamine', 'D': 'Superantigen that activates T-cells', 'E': 'Permanent Gs activation'},
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B: Prevents depolarization of Na+ channels
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