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Answer the following medical question with one of the provided options:
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Q:A previously healthy 6-year-old boy is brought to the physician because he has increased facial and axillary hair. There is no family history of serious illness. He is at 95th percentile for height and weight. Examination shows coarse pubic and axillary hair. The penis and left testicle are enlarged. Serum concentrations of human chorionic gonadotropin and alpha-fetoprotein are within the reference range. Which of the following is the most likely cause of these findings?? {'A': 'Leydig cell tumor', 'B': 'Seminoma', 'C': 'Sertoli cell tumor', 'D': 'Choriocarcinoma', 'E': 'Lymphoma'},
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A: Leydig cell tumor
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Answer the following medical question with one of the provided options:
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Q:A newborn boy born vaginally to a healthy 37-year-old G3P1 from a pregnancy complicated by hydramnios fails to pass meconium after 24 hours of life. The vital signs are within normal limits for his age. The abdomen is distended, the anus is patent, and the rectal examination reveals pale mucous with non-pigmented meconium. Based on a barium enema, the boy is diagnosed with sigmoid colonic atresia. Disruption of which structure during fetal development could lead to this anomaly?? {'A': 'Celiac artery', 'B': 'Vitelline duct', 'C': 'Superior mesenteric artery', 'D': 'Inferior mesenteric artery', 'E': 'Cloaca'},
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D: Inferior mesenteric artery
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Answer the following medical question with one of the provided options:
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Q:A 20-year-old man visits the clinic for a regular follow-up appointment. Patient says he has been experiencing dry mouth and flushing of his skin for the past few days. He also feels tired and sleepy most of the time. Past medical history is significant for a skin rash a couple weeks ago after eating strawberries, for which he has prescribed a medication that he is still taking. Which of the following is the most likely etiology of this patient’s symptoms?? {'A': 'Activation of alpha-1 adrenergic receptors', 'B': 'Activation of parasympathetic receptors', 'C': 'Inhibition of alpha-1 adrenergic receptors', 'D': 'Inhibition of parasympathetic receptors', 'E': 'Inhibition of histamine receptors'},
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D: Inhibition of parasympathetic receptors
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Answer the following medical question with one of the provided options:
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Q:A 12-year-old boy is brought in by his mother for a routine checkup. The patient’s mother says he is frequently fatigued and looks pale. She also claims that he has recently become “much quieter” than normal and is no longer interested in playing baseball with his friends. The patient’s mother believes it may just be “growing pains.” The patient has no significant medical history. He is the 90th percentile for height and weight and has been meeting all developmental milestones. The patient is afebrile, and his vital signs are within normal limits. Physical examination reveals several small bruises on the patient’s right arm and on both thighs. Laboratory findings are significant for the following: Sodium 140 mEq/L Potassium 4.2 mEq/L Chloride 101 mEq/L Bicarbonate 27 mEq/L BUN 16 mg/dL Creatinine 1.2 mg/dL Glucose (fasting) 111 mg/dL WBC 3,400/mm3 RBC 4.20 x 106/mm3 Hematocrit 22% Hemoglobin 7.1 g/dL Platelet count 109,000/mm3 A peripheral blood smear reveals myeloblasts. Which of the following is the next best step in the management of this patient?? {'A': 'Referral to social services', 'B': 'Administration of oral ferrous sulfate', 'C': 'Packed red blood cell transfusion', 'D': 'Bone marrow biopsy', 'E': 'Chest radiograph'},
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D: Bone marrow biopsy
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Answer the following medical question with one of the provided options:
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Q:A 22-year-old man comes to the physician because of a fall associated with a 6-month history of increasing difficulty walking. Over the last year, his friends have also noticed his speech becoming slower. During this period, he also gave up his hobby of playing video games because he has become clumsy with his hands. His father died of esophageal varices at the age of 40 years. The patient does not smoke or drink alcohol. He takes no medications. He appears sad. His temperature is 37°C (98.6°F), pulse is 70/min, and blood pressure is 120/80 mm Hg. He is alert and oriented to person, place, and time. His speech is slurred and monotonous; his gait is unsteady. Examination shows scleral icterus and some drooling. The liver is palpated 2 to 3 cm below the right costal margin, and the spleen is palpated 1 to 2 cm below the left costal margin. Further evaluation of this patient is most likely to show which of the following findings?? {'A': 'Increased transferrin saturation', 'B': 'Increased number of CAG repeats', 'C': 'Oligoclonal bands on CSF analysis', 'D': 'Ventriculomegaly on CT scan of the brain', 'E': 'Low serum ceruloplasmin concentration'},
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E: Low serum ceruloplasmin concentration
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Answer the following medical question with one of the provided options:
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Q:A young infant is brought to an immunologist because of recurrent infections, which have not resolved despite appropriate medical treatment. On reviewing her medical history, the immunologist notes that the child has had frequent disseminated mycobacterial infections. He suspects a possible immunodeficiency. What is the most likely cause of this patient's immunodeficiency?? {'A': 'B-cell maturation defect', 'B': 'ATM gene defect', 'C': 'LFA-1 integrin defect', 'D': 'Interferon-gamma signaling defect', 'E': 'BTK gene defect'},
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D: Interferon-gamma signaling defect
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Answer the following medical question with one of the provided options:
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Q:You are counseling a pregnant woman who plans to breast-feed exclusively regarding her newborn's nutritional requirements. The child was born at home and the mother only plans for her newborn to receive vaccinations but no other routine medical care. Which vitamins should be given to the newborn?? {'A': 'Folic acid', 'B': 'Vitamin B6', 'C': 'Vitamin K', 'D': 'Vitamin D', 'E': 'Vitamin K and Vitamin D'},
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E: Vitamin K and Vitamin D
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Answer the following medical question with one of the provided options:
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Q:An otherwise healthy 62-year-old woman comes to the physician because of a 3-year history of hearing loss. To test her hearing, the physician performs two tests. First, a vibrating tuning fork is held against the mastoid bone of the patient and then near her ear, to which the patient responds she hears the sound better on both sides when the tuning fork is held near her ear. Next, the physician holds the tuning fork against the bridge of her forehead, to which the patient responds she hears the sound better on the right side than the left. The patient's examination findings are most consistent with which of the following conditions?? {'A': 'Cerumen impaction on the right', 'B': 'Otosclerosis on the left', 'C': 'Cochlear ischemia on the right', 'D': 'Acoustic neuroma on the left', 'E': 'Cholesteatoma on the right'},
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D: Acoustic neuroma on the left
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Answer the following medical question with one of the provided options:
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Q:A 50-year-old HIV-positive male presents to the ER with a two-day history of fever and hemoptysis. Chest radiograph shows a fibrocavitary lesion in the right middle lobe. Biopsy of the afflicted area demonstrates septate hyphae that branch at acute angles. Which of the following is the most likely causal organism?? {'A': 'Mycobacterium tuberculosis', 'B': 'Candida albicans', 'C': 'Pneumocystis jeroveci', 'D': 'Aspergillus fumigatus', 'E': 'Naegleria fowleri'},
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D: Aspergillus fumigatus
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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 is admitted to the hospital after being physically assaulted by her husband. She developed severe vaginal bleeding and abdominal pain. She is at 30 weeks gestation. Her previous pregnancies were uncomplicated, as has been the course of the current pregnancy. The vital signs are as follows: blood pressure, 80/50 mmHg; heart rate, 117/min and irregular; respiratory rate, 20/min; and temperature, 36.2℃ (97.1). The fetal heart rate is 103/min. On physical examination, the patient is pale and lethargic. Abdominal palpation reveals severe uterine tenderness and tetanic contractions. The perineum is grossly bloody. There are no vaginal or cervical lesions. There is active heavy bleeding with blood clots passing through the cervix. An ultrasound shows a retroplacental hematoma with a volume of approximately 400 ml. Laboratory workup shows the following findings: Red blood cells count: 3.0 millions/mL Hb%: 7.2 g/dL Platelet count: 61,000/mm3 Prothrombin time: 310 seconds (control 20 seconds) Partial prothrombin time: 420 seconds Serum fibrinogen: 16 mg/dL Elevated levels of which of the following laboratory markers is characteristic for this patient’s complication?? {'A': 'Procalcitonin', 'B': 'C-reactive protein', 'C': 'Creatinine', 'D': 'D-dimer', 'E': 'Pro-brain natriuretic peptide'},
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D: D-dimer
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Answer the following medical question with one of the provided options:
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Q:A 21-year-old male college student is very anxious about having thyroid cancer as he found a lump in his neck a few days ago. He has also had diarrhea and a feeling of warmth on his face for 3 days now. His father and uncle both have been diagnosed with thyroid cancer. The lump is about 1 cm in diameter and is fixed and nontender on palpation. Physical examination is otherwise unremarkable. Ultrasound shows a non-cystic cold nodule that requires fine needle aspiration for diagnosis. Thyroid functions tests are normal, and his calcitonin level is 346 ug/ml. Which of the following genetic mutations would warrant thyroidectomy in this patient?? {'A': 'MEN1 gene mutation', 'B': 'RET gene mutation', 'C': 'A loss of function of PPARɣ', 'D': 'Activating mutation of the BRAF receptor', 'E': 'Down expression of the Ras protooncogene'},
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B: RET gene mutation
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Answer the following medical question with one of the provided options:
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Q:A 78-year-old man presents to his primary care physician for persistent back pain. The patient states that he has had back pain for awhile; however, this past weekend he was helping his son move heavy furniture. Since the move, his symptoms have been more severe. The patient states that the pain is constant and occurs throughout the day. On review of systems, the patient endorses a recent 15 pound weight loss and constipation. His temperature is 99.5°F (37.5°C), blood pressure is 137/79 mmHg, pulse is 90/min, respirations are 15/min, and oxygen saturation is 98% on room air. Cardiovascular exam is notable for a murmur at the right sternal border that radiates to the carotids. Pulmonary exam reveals mild bibasilar crackles. Musculoskeletal exam is notable for mild midline tenderness of the lower thoracic spine and the upper segment of the lumbar spine. No bruising or signs of external trauma are observable on the back. Symptoms are not exacerbated when the patient is lying down and his straight leg is lifted. Strength is 5/5 in the lower and upper extremities. The patient's sensation is intact bilaterally in his lower and upper extremities. Laboratory values are ordered and return as seen below. Hemoglobin: 11 g/dL Hematocrit: 34% Leukocyte count: 10,500/mm^3 with normal differential Platelet count: 288,000/mm^3 Serum: Na+: 139 mEq/L Cl-: 100 mEq/L K+: 4.3 mEq/L HCO3-: 25 mEq/L BUN: 20 mg/dL Glucose: 99 mg/dL Creatinine: 1.6 mg/dL Ca2+: 11.8 mg/dL AST: 12 U/L ALT: 12 U/L Which of the following is the most likely diagnosis?? {'A': 'Muscle strain', 'B': 'Herniated nucleus pulposus', 'C': 'Sciatic nerve irritation', 'D': 'Piriformis muscle inflammation', 'E': 'Plasma cell dyscrasia'},
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E: Plasma cell dyscrasia
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Answer the following medical question with one of the provided options:
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Q:A 4-week-old neonate boy who was born at 27 weeks gestation to a 19-year-old G2P1 mother due to premature rupture of membranes has his hospital stay complicated by chorioamnionitis. He received 2 doses of surfactant and has been weaned from the ventilator to continuous positive airway pressure (CPAP). Over the last 6 hours he has developed abdominal distention and is no longer tolerating his tube feeds. You suspect necrotizing enterocolitis. Which of the following would be diagnostic?? {'A': 'Pyloric thickness greater than 3 mm on abdominal ultrasound', 'B': 'Positive blood culture for coagulase-negative Staphylococcus aureus', 'C': "A 'double-bubble' sign on an abdominal X-ray", 'D': 'Pneumatosis intestinalis on an abdominal X-ray', 'E': 'Suction biopsy showing absence of ganglion cells'},
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D: Pneumatosis intestinalis on an abdominal X-ray
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Answer the following medical question with one of the provided options:
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Q:A 48-year-old woman with a history of obesity presents with acute onset of diffuse epigastric pain that began a few hours ago and then localized to the right upper quadrant. Further questioning reveals that the pain has been exacerbated by eating but has otherwise been unchanged in nature. Physical exam reveals severe right upper quadrant pain that is accompanied by arrest of respiration with deep palpation of the right upper quadrant. Which of the following symptoms is associated with the most likely etiology of this patient's presentation?? {'A': 'Hematemesis', 'B': 'Pain with passive right leg raising', 'C': 'Crunching sound upon heart auscultation', 'D': 'Diffuse substernal pain', 'E': 'Pain radiating to the right shoulder'},
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E: Pain radiating to the right shoulder
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Answer the following medical question with one of the provided options:
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Q:A 25-year-old man was referred to a neurologist for right-hand weakness. He was involved in a motor vehicle accident 2 months ago in which his right hand was injured. On examination, his grip is weak, especially in fingers 2, 4, and 5 and he is unable to adduct these fingers. Which of the following groups of muscles is most likely affected?? {'A': 'Extensor digitorum', 'B': 'Palmar interossei muscles', 'C': 'Lumbrical muscles', 'D': 'Dorsal interossei muscles', 'E': 'Flexor digitorum profundus'},
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B: Palmar interossei muscles
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Answer the following medical question with one of the provided options:
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Q:A 14-year-old girl presents with fever, headache, and muscle aches that have lasted for 2 days. She also complains of malaise and pain in her joints. She says she just returned from a camping trip in Delaware. Her past medical history is not significant. The patient denies any recent sick contacts. Her temperature is 38.3°C (101.0°F), pulse is 87/min, respirations are 17/min, and blood pressure is 120/78 mm Hg. On physical examination, there is a 3-inch-diameter, red, erythematous, round rash with central clearing on the right leg (see image). Antibodies against Proteus vulgaris OX-19 are absent. Which of the following is the most likely cause of this patient’s symptoms?? {'A': 'Measles virus', 'B': 'Borrelia burgdorferi ', 'C': 'Rickettsia rickettsii', 'D': 'Chlamydia trachomatis', 'E': 'Dermatophytosis'},
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B: Borrelia burgdorferi
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Answer the following medical question with one of the provided options:
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Q:A 55-year-old woman visits the clinic after experiencing what she describes as an odd episode of tingling in her fingers and the sensation of smelling sour milk. She denies loss of consciousness, confusion, or incontinence. She also denies a history of head trauma or the ingestion of toxic substances. Past medical history is significant for type 2 diabetes mellitus, which is well controlled with metformin. Her temperature is 36.8°C (98.2°F), the heart rate is 98/min, the respiratory rate is 15/min, the blood pressure is 100/75 mm Hg, and the O2 saturation is 100% on room air. The physical exam, including a full neurologic and cardiac assessment, demonstrates no abnormal findings. Laboratory findings are shown. Brain MRI does not indicate any areas of infarction or hemorrhage. ECG is normal, and EEG is pending. BUN 15 mg/dL pCO2 40 mmHg Creatinine 0.8 mg/dL Glucose 95 mg/dL Serum chloride 103 mmol/L Serum potassium 3.9 mEq/L Serum sodium 140 mEq/L Total calcium 2.3 mmol/L Magnesium 1.7 mEq/L Phosphate 0.9 mmol/L Hemoglobin 14 g/dL Glycosylated hemoglobin 5.5% Total cholesterol 4 mmol/L Bicarbonate (HCO3) 19 mmol/L Urine toxicology screen is negative. What kind of seizure is most likely being described?? {'A': 'Simple partial', 'B': 'Complex partial', 'C': 'Absence', 'D': 'Tonic-clonic', 'E': 'Myoclonic'},
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A: Simple partial
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Answer the following medical question with one of the provided options:
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Q:A 29-year-old woman at 38 weeks gestation comes to the emergency room with regular contractions and spontaneous rupture of membranes. She subsequently delivers a 3500g (7lbs 7oz) newborn with ambiguous genitalia by spontaneous vaginal delivery. Her pregnancy and labor was uncomplicated. Examination of the newborn demonstrated no palpable gonads at the inguinal canal or perineum. Karyotype analysis demonstrated 46,XX. What is the best explanation for this patient’s presentation?? {'A': 'Defective androgen receptors', 'B': 'Defective migration of gonadotropin-releasing hormone (GnRH) releasing neurons', 'C': 'Deficiency of 5-alpha-reductase', 'D': 'Exposure to excessive androgenic steroids during gestation', 'E': 'Ovarian dysgenesis'},
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D: Exposure to excessive androgenic steroids during gestation
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Answer the following medical question with one of the provided options:
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Q:A 14-year-old teenager is brought to the physician by her mother who seems extremely concerned that her daughter is unable to sleep at night and has become increasingly irritated and aggressive. She has been noticing changes in her daughter’s behavior recently. She had no idea what was going on until she found pills hidden in her daughter’s room a week ago. Her daughter confessed that she tried these drugs once with her friends and started using them since then. Her mother threw away all the pills and prevented her daughter from seeing her friends. This is when she started to notice her tear often and sweat. She is seeking a quick and effective treatment for her daughter. Which drug was the teenager most likely using?? {'A': 'Atomoxetine', 'B': 'Oxycodone', 'C': 'Naloxone', 'D': 'Marijuana', 'E': 'Cocaine'},
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B: Oxycodone
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Answer the following medical question with one of the provided options:
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Q:A group of researchers is studying molecules and DNA segments that are critical for important cellular processes in eukaryotic cells. They have identified a region that is located about 28 bases upstream of the 5’ coding region. This region promotes the initiation of transcription by binding with transcription factors. Which of the following regions have these researchers most likely identified?? {'A': 'CAAT Box', 'B': 'RNA polymerase II', 'C': 'Small nuclear ribonucleoprotein (SnRNPs)', 'D': 'DNA methyltransferase', 'E': 'TATA Box'},
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E: TATA Box
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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 with HIV infection comes to the physician for a follow-up examination. She has been inconsistently taking combined antiretroviral therapy for the past 5 years. She did not receive any childhood vaccinations because her parents were against them. During the consultation, the patient says that she wants to catch up on the missed vaccinations. Laboratory studies show a CD4+ T lymphocyte cell count of 180/mm3. Administration of the vaccine against which of the following agents should be avoided in this patient?? {'A': 'Bordetella pertussis', 'B': 'Human papillomavirus', 'C': 'Haemophilus influenzae', 'D': 'Clostridium tetani', 'E': 'Varicella zoster virus'},
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E: Varicella zoster virus
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Answer the following medical question with one of the provided options:
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Q:A 77-year-old woman is brought to the emergency department from her nursing home because she was found down overnight. On presentation she was found to be delirious and was unable to answer questions. Chart review shows that she is allergic to cephalosporins. Her temperature is 102.2°F (39°C), blood pressure is 105/52 mmHg, pulse is 94/min, and respirations are 23/min. Physical exam reveals a productive cough. A metabolic panel is obtained with the following results: Serum: Na+: 135 mEq/L Cl-: 95 mEq/L K+: 4 mEq/L HCO3-: 19 mEq/L BUN: 40 mg/dL Creatinine: 2.5 mg/dL Glucose: 150 mg/dL Based on these findings two different drugs are started empirically. Gram stain on a blood sample is performed showing the presence of gram-positive organisms on all samples. One of the drugs is subsequently stopped. The drug that was most likely stopped has which of the following characteristics?? {'A': 'Accumulates inside bacteria via O2-dependent uptake', 'B': 'Associated with red man syndrome', 'C': 'Causes discolored teeth in children', 'D': 'Resistance conveyed through acetylation', 'E': 'Single-ringed ß-lactam structure'},
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E: Single-ringed ß-lactam structure
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Answer the following medical question with one of the provided options:
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Q:A 30-year-old man presents to the physician after he discovered a raised, red, string-shaped lesion beneath the skin on his right foot. The lesion seems to move from one location to another over the dorsum of his foot from day to day. He says that the the lesion is extremely itchy and has not responded to over the counter topical treatment. He and his wife recently returned from a honeymoon in southern Thailand, where they frequented the tropical beaches. The physician diagnoses him with a parasitic infection and prescribes albendazole for the patient. With which of the following organisms is the patient most likely infected?? {'A': 'Ancylostoma braziliense', 'B': 'Dracunculus medinensis', 'C': 'Necator americanus', 'D': 'Strongyloides stercoralis', 'E': 'Wucheria bancrofti'},
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A: Ancylostoma braziliense
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Answer the following medical question with one of the provided options:
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Q:A 56-year-old man comes to the emergency department because of progressive swelling and pain in his left calf for 1 day. He does not have shortness of breath or chest pain. He has hypertension and chronic kidney disease. Current medications include enalapril, aspirin, simvastatin, and vitamin D. His temperature is 100.4°F (38°C), pulse is 84/min, and blood pressure is 135/92 mm Hg. Physical examination shows tenderness and swelling of the left lower extremity. A venous Doppler ultrasonography shows a thrombus in the left popliteal vein. Treatment with unfractionated heparin is begun. Two days later, physical examination shows improvement of symptoms. Laboratory studies at admission and 2 days after admission show: Admission Two days after admission Hemoglobin 11.2 g/dL 11.1 g/dL Leukocyte count 5,500/mm3 6,100/mm3 Platelet count 230,000/mm3 170,000/mm3 Serum Prothrombin time 12 seconds 13 seconds Partial thromboplastin time 30 seconds 55 seconds Estimated glomerular filtration rate 29 mL/min/1.73 m2 28 mL/min/1.73 m2 Which of the following is the most appropriate next step in management?"? {'A': 'Switch to enoxaparin', 'B': 'Continue unfractionated heparin', 'C': 'Switch to warfarin', 'D': 'Discontinue anticoagulation', 'E': 'Obtain serum immunoassay'},
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B: Continue unfractionated heparin
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Answer the following medical question with one of the provided options:
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Q:An 84-year-old woman is brought to the physician by her son after he found her trying to hang herself from the ceiling because she felt that she was a burden to her family. Her family says that for the past 2 months she has had no energy to leave her room, has been sleeping most of the day, has lost 10 kg (22 lb), and cries every day. She was diagnosed with breast cancer that has metastasized to the liver 4 months ago. She moved in with her son and daughter-in-law shortly after the diagnosis. She initially underwent chemotherapy but discontinued the treatment when the metastases spread to the spine and brain. Her life expectancy is 1–2 weeks and she is currently receiving home-hospice care. Her only current medication is a fentanyl patch. She is 160 cm (5 ft 3 in) tall and weighs 46 kg (101.4 lb); BMI is 18 kg/m2. Her vital signs are within normal limits. Examination shows slow speech, a flat affect, and depressed mood. Which of the following treatments is initially most likely to provide the greatest benefit for this patient?? {'A': 'Methylphenidate', 'B': 'Electroconvulsive therapy', 'C': 'Megestrol', 'D': 'Fluoxetine', 'E': 'Bupropion'},
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A: Methylphenidate
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Answer the following medical question with one of the provided options:
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Q:A 29-year-old G1P0 woman at 24 weeks gestation presents to her physician with complaints of burning with urination, and she reports that she has been urinating much more frequently than usual over the past several days. She otherwise is doing well and has experienced no complications with her pregnancy or vaginal discharge. Her temperature is 97.5°F (36.4°C), blood pressure is 112/82 mmHg, pulse is 89/min, respirations are 19/min, and oxygen saturation is 98% on room air. Examination is significant for suprapubic discomfort upon palpation and a gravid uterus. There is no costovertebral angle tenderness. Urinalysis shows increased leukocyte esterase, elevated nitrites, 55 leukocytes/hpf, and bacteria. The physician prescribes a 7-day course of nitrofurantoin. Which of the following is the next best step in management?? {'A': 'Add ciprofloxacin to antibiotic regimen', 'B': 'Add penicillin to antibiotic regimen', 'C': 'Perform a renal ultrasound', 'D': 'Send a urine culture', 'E': 'Test for gonorrhea and chlamydia'},
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D: Send a urine culture
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Answer the following medical question with one of the provided options:
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Q:A steel welder presents to his family physician with a one-week history of intense abdominal cramping with nausea, vomiting, constipation, headaches, myalgias, and arthralgias. He claims that the symptoms started about two months after he began work on replacing the pipes in an early 20th century house. Blood was taken and he was found to have a microcytic, hypochromic anemia with basophilic stippling. Which of the following is the best treatment for his symptoms?? {'A': 'Deferoxamine', 'B': 'EDTA', 'C': 'Deferasirox', 'D': 'Prussian blue', 'E': 'N-acetylcysteine'},
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B: EDTA
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Answer the following medical question with one of the provided options:
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Q:A 38-year-old man arrives at the emergency department with severe periumbilical, colicky pain and abdominal distention for the past 2 days. He is nauseated and reports vomiting light-green emesis 8 times since yesterday morning. He has not had a bowel movement or passed any gas for the past 3 days. He has a past medical history of ventral hernia repair 5 years ago. His heart rate is 110/min, respiratory rate is 24/min, temperature is 38.0°C (100.4°F), and blood pressure is 120/90 mm Hg. The abdomen is distended and mildly tender to deep palpation. Bowel sounds are high-pitched and tinkling. Which of the following is the most likely cause?? {'A': 'Cholecystitis', 'B': "Crohn's disease", 'C': 'Diverticulitis', 'D': 'Small bowel obstruction', 'E': 'Viral gastroenteritis'},
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D: Small bowel obstruction
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Answer the following medical question with one of the provided options:
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Q:A 4-week-old Caucasian baby presents for a routine checkup. The patient was born to a 28-year-old G1P1 woman at 38 weeks estimated gestational age by cesarean section secondary to breech presentation. The pregnancy was complicated by gestational diabetes, which the mother controlled with diet and exercise. Prenatal ultrasounds showed normal fetal anatomy. Both parents are nonsmokers. The vital signs include: temperature 37.0°C (98.6°F), blood pressure 85/45 mm Hg, pulse 140/min, respiratory rate 42/min, and oxygen saturation 99% on room air. Height, weight, and head circumference are within the 90th percentile. Positive Moro and Babinski reflexes are present. The cardiopulmonary examination is normal. While in the supine position, the left leg is visibly shortened relative to the right. When the left hip is abducted with pressure applied to the greater trochanter of the femur, there is a non-tender clunking sound elicited. There is asymmetry of the labial skin folds. A blue macule is noted over the sacral region. Which of the following is the most appropriate next step in the management of this patient?? {'A': 'Observation with follow-up in 6 months', 'B': 'Magnetic resonance image (MRI) of the lumbosacral spine', 'C': 'Ultrasound of the hips', 'D': 'Ultrasound of the lumbosacral spine', 'E': 'X-ray of the hips'},
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C: Ultrasound of the hips
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Answer the following medical question with one of the provided options:
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Q:A 24-year-old man presents to the emergency department complaining of a prolonged course of diarrhea. He reports that he has had 3–4 large volume watery stools daily for the last several weeks. He has no pain with bowel movements, no abdominal pain, and no blood in his stools. He is homeless and uses recreational drugs. He also reports that he usually drinks a half-liter of whiskey, or whatever else he can find, every day and he has done this for several years. The physical exam is notable for a hyperpigmented rash across his face, neck, chest, and the backs of his hands and forearms. On mental status exam, he is oriented to person and place but not time; he scores a 23/30 on the Montreal Cognitive Assessment (MOCA). This patient's presentation is most likely related to which of the following micronutrients?? {'A': 'Vitamin B2', 'B': 'Vitamin B3', 'C': 'Vitamin B12', 'D': 'Vitamin C', 'E': 'Vitamin D'},
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B: Vitamin B3
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Q:The World Health Organization suggests the use of a new rapid diagnostic test for the diagnosis of malaria in resource-limited settings. The new test has a sensitivity of 70% and a specificity of 90% compared to the gold standard test (blood smear). The validity of the new test is evaluated at a satellite health center by testing 200 patients with a positive blood smear and 150 patients with a negative blood smear. How many of the tested individuals are expected to have a false negative result?? {'A': '155', 'B': '15', 'C': '195', 'D': '60', 'E': '135'},
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D: 60
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Q:A 21-year-old woman presents into the clinic worried that she might be pregnant. Her last menstrual period was 4 months ago and recalls that she did have unprotected sex with her boyfriend, despite not having sexual desire. They have since broken up, and she would like to do a pregnancy test. She appears very emaciated but is physically active. She says that she spends a few hours in the gym almost every day but would spend longer if she was to stray from her diet so that she does not gain any weight. Her calculated BMI is 17 kg/m2, and her urine pregnancy test is negative. Which of the following additional findings would most likely be present in this patient?? {'A': 'Orthostasis', 'B': 'Primary amenorrhea', 'C': 'Increased LH and FSH', 'D': 'Hypocholesterolemia', 'E': 'Hypokalemic alkalosis'},
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A: Orthostasis
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Q:An 18-year-old Caucasian female presents to your clinic because of a recent increase in thirst and hunger. Urinalysis demonstrates elevated glucose. The patient's BMI is 20. Which of the following is the most common cause of death in persons suffering from this patient's illness?? {'A': 'Renal failure', 'B': 'Myocardial infarction', 'C': 'Infection', 'D': 'Peripheral neuropathy', 'E': 'Coma'},
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B: Myocardial infarction
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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 presents to the clinic on her own, complaining of fatigue and feeling cold all the time. She is also very concerned about several minor medical conditions she has developed over the last year or so. Her past medical history is noncontributory. Menarche was at age 11 and her last menstrual period was 3 months ago. Her mother has hypothyroidism and she is concerned that she has it too. She proudly describes her “healthy” routine that consists of 2 grapefruits a day for breakfast and lunch and no dinner and that she runs 6 miles 4 times a week. She reports having good grades in school and that she tries very hard to fit in with the popular girls. She is also concerned that she has trouble losing weight and persistently asks for a prescription for weight loss medication. Her temperature is 36.9°C (98.5°F), blood pressure is 110/70 mm Hg, pulse is 60/min, and respirations are 13/min. Physical examination reveals a thin girl with pale mucosa and lanugo on her arms and back. Urine hCG is negative. Which of the following will most likely be detected in this patient?? {'A': 'Normal serum iron levels', 'B': 'Pressured speech', 'C': 'Moist, supple skin', 'D': 'BMI less than 17', 'E': 'Increased hemoglobin'},
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D: BMI less than 17
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Q:A 78-year-old man dies suddenly from complications of acute kidney failure. An autopsy is performed and microscopic evaluation of the kidneys shows pale, swollen cells in the proximal convoluted tubules. Microscopic evaluation of the liver shows similar findings. Which of the following is the most likely underlying mechanism of these findings?? {'A': 'Cytochrome C release', 'B': 'Impaired Na+/K+-ATPase pump activity', 'C': 'Cytoplasmic triglyceride accumulation', 'D': 'Double-stranded DNA breakage', 'E': 'Free radical formation'},
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B: Impaired Na+/K+-ATPase pump activity
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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 comes to the physician because of a 2-week history of increasing shortness of breath. He has also had chest pain that is exacerbated by deep inspiration. He has had recurrent episodes of pain in his fingers for the past 2 years. Two years ago, he was treated for a deep vein thrombosis. He has hypertension and anxiety. Current medications include enalapril, St John's wort, and ibuprofen. His temperature is 37°C (98.6°F), pulse is 110/min, respirations are 17/min, and blood pressure is 110/70 mm Hg. Examination shows pale conjunctiva. There is tenderness to palpation of the proximal interphalangeal and metacarpophalangeal joints of both hands. Heart sounds are distant. The lungs are clear to auscultation. Laboratory studies show: Hemoglobin 11.9 g/dL Leukocyte count 4200/mm3 Platelet count 330,000/mm3 Serum Na+ 136 mEq/L K+ 4.3 mEq/L Antinuclear antibodies 1: 320 Anti-SM-1 antibodies positive Anti-CCP antibodies negative An x-ray of the chest is shown. Which of the following is most likely to be seen on this patient's ECG?"? {'A': 'Pseudo right bundle branch block', 'B': 'Increased QT interval', 'C': 'Deep Q wave', 'D': 'Electric alternans', 'E': 'S1Q3T3 pattern'},
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D: Electric alternans
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Q:A 32-year-old male presents to his primary care provider for headache. He reports that he has headaches at night several times a week. He first developed these headaches over a year ago, but he had not had any for several months before they started up again three weeks ago. The episodes start suddenly and feel like a stabbing, electrical pain over his left eye. He also reports tearing of the left eye during these episodes. The headaches self-resolve over the course of 2-3 hours, but the patient complains that he is avoiding going to sleep for fear of waking up in pain. His past medical history includes type I diabetes mellitus and an episode of herpes zoster on his right flank one year ago. His only home medication is insulin. On physical exam, his extraocular muscles are intact and his eyes are not injected and without lacrimation. A CT of the head and sinuses shows no acute abnormalities. Which of the following is most likely to prevent future episodes of headache in this patient?? {'A': 'Carbamazepine', 'B': 'High-flow oxygen', 'C': 'Sumatriptan', 'D': 'Topiramate', 'E': 'Verapamil'},
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E: Verapamil
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Q:A 23-year-old woman presents to the emergency department with severe abdominal pain. The pain started suddenly several hours ago and has steadily worsened. The patient has a past medical history of anxiety and depression. Her current medications include sertraline, sodium docusate, a multivitamin, and fish oil. The patient is currently sexually active with her boyfriend and uses the "pull-out" method for contraception. A pelvic ultrasound in the emergency room reveals an ectopic pregnancy. The patient is scheduled for surgery and is promptly treated. She is recovering on the surgical floor. The procedure was complicated by a large amount of blood loss. The patient is recovering on IV fluids when her family comes to visit. When her parents find out the diagnosis, yelling ensues and they leave angrily. The patient is scheduled to go home today. Prior to discharge, the patient reports she is unable to use her left hand. Upon examination, she is teary-eyed and she claims that she has “the worst family in the world,” and she does not want to go home. Physical exam reveals no skin or bony abnormalities of the left arm. Strength is 0/5 in the left upper extremity. She does not recoil her left arm to pain. A MRI is obtained and is unremarkable. The rest of the patient’s neurological exam is within normal limits. Which of the following is the most likely diagnosis?? {'A': 'Borderline personality disorder', 'B': 'Conversion disorder', 'C': 'Factitious disorder', 'D': 'Ischemic stroke', 'E': 'Malingering'},
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B: Conversion disorder
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Q:A 27-year-old woman presents with acute abdominal pain in her right upper quadrant. The pain came on suddenly while she was eating dinner. After this pain she began feeling dizzy and came to the emergency department. In the ED, her blood pressure is 75/40 mmHg, pulse is 100/minute, and she is afebrile. On physical exam, she feels too light-headed to ambulate. She demonstrates normal bowel sounds with tenderness upon palpation in the right upper quadrant. The patient is deemed too unstable for imaging. An abdominal radiograph and CT are reviewed from a recent previous visit to the ED for mild abdominal pain, and are shown in Figures A and B, respectively. Which of the following specific additional findings in her history supports the most likely diagnosis?? {'A': 'A 15 pack/year history of smoking', 'B': 'Use of oral contraceptives (OCPs) for birth control', 'C': 'Symptoms that began after a fatty meal', 'D': 'A history of Epstein-Barr virus and participation in rugby', 'E': 'An extensive history of sexually transmitted diseases (STDs) and pelvic inflammatory disease (PID)'},
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B: Use of oral contraceptives (OCPs) for birth control
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Q:A 2-year-old boy is brought to the physician because of a productive cough for 5 days. He has a history of recurrent lower respiratory tract infections and sinusitis treated with oral antibiotics. He frequently has loose stools that do not flush easily. He was born at 37 weeks' gestation and the neonatal period was complicated by meconium ileus. His immunizations are up-to-date. He is at the 15th percentile for height and at the 5th percentile for weight. His temperature is 37.1°C (98.8°F), pulse is 98/min, and respirations are 38/min. Pulse oximetry on room air shows an oxygen saturation of 95%. Examination shows bilateral nasal polyps. There are scattered inspiratory crackles heard in the thorax. Further evaluation of this patient is most likely to show which of the following?? {'A': 'Decreased residual volume on spirometry', 'B': 'Elevated prothrombin time', 'C': 'Metabolic acidosis', 'D': 'Cytoplasmic anti-neutrophil cytoplasmic antibodies', 'E': 'Glutamic acid decarboxylase antibodies'},
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B: Elevated prothrombin time
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Answer the following medical question with one of the provided options:
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Q:A 37-year-old man is brought to the emergency department by his wife after having a seizure. He has a 1-week history of headaches, blurry vision in his right eye, and muscle pain in his arms and neck. He has no history of a seizure disorder, and his vision was normal until the onset of his symptoms 1 week ago. He has a history of migraine headaches that occur on a monthly basis and are relieved with ibuprofen. He immigrated from Ecuador 6 years ago and often returns to visit his family. He appears confused. His vital signs are within normal limits. Ophthalmologic examination shows subretinal cysts. An MRI of the brain shows multiple small, ring-enhancing lesions in the parenchyma. A lumbar puncture is done; cerebrospinal fluid analysis shows numerous eosinophils and a protein concentration of 53 mg/dL. Which of the following is the most likely direct cause of infection in this patient?? {'A': 'Ingestion of undercooked fish', 'B': 'Ingestion of eggs from cat feces', 'C': 'Ingestion of eggs from dog feces', 'D': 'Ingestion of eggs from human feces', 'E': 'Ingestion of eggs after scratching the anal region'},
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D: Ingestion of eggs from human feces
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Q:An 8-year-old boy is being seen in your neurology clinic for seizures of the type observed in video V. While speaking with the child, you notice that he frequently asks you to repeat yourself, and looks at you occasionally with a blank stare. Which of the following medications would be most appropriate for this patient?? {'A': 'Gabapentin', 'B': 'Valproic acid', 'C': 'Phenytoin', 'D': 'Ethosuximide', 'E': 'Lorazepam'},
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B: Valproic acid
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Answer the following medical question with one of the provided options:
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Q:A 72-year-old man presents to the clinic for the evaluation of a lesion on his nose that has been slowly getting larger for the past 2 months. The patient notes no history of trauma, pruritus, or pain, but states that the size of the lesion is making his nose feel uncomfortable. On exam, the nodule is pink with rolled borders. Telangiectasias are also present within the lesion, with central ulceration. What is the characteristic histologic appearance of this lesion?? {'A': 'Keratin pearls', 'B': 'Palisading nuclei', 'C': 'Sawtooth lymphocytic infiltrate', 'D': 'Atypical melanocytes', 'E': 'Epidermal hyperplasia with cutaneous darkening'},
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B: Palisading nuclei
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Q:A 4-year-old boy is brought to the emergency department with 2 days of fever and painful lumps in his legs bilaterally. In addition, he says that his arms and legs are extremely itchy. Since birth he has had recurrent skin and soft tissue infections. Physical exam reveals a pruritic erythematous scaling rash along both upper and lower extremities bilaterally. Palpation of the painful lesions reveal indurated tissue without any production of pus. Which of the following protein functions is most likely disrupted in this patient?? {'A': 'Actin polymerization', 'B': 'B-cell survival during selection', 'C': 'Phagolysosome formation and development', 'D': 'Reactive oxygen species production', 'E': 'Transcription factor activity'},
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E: Transcription factor activity
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Q:A 45-year-old woman presents to her primary care physician for an annual checkup. She states that she feels well and has no complaints. She lives alone and works as a banker. She smokes 1 cigarette per day and drinks 2 alcoholic beverages per night. She occasionally gets symmetrical pain in her hands where they change from red to white to blue then return to normal again. Her temperature is 98.7°F (37.1°C), blood pressure is 177/118 mmHg, pulse is 82/min, respirations are 15/min, and oxygen saturation is 99% on room air. The patient's hypertension is treated, and she returns 2 weeks later complaining of weight gain in her legs and arms. On exam, bilateral edema is noted in her extremities. Which of the following is the best next step in management?? {'A': 'Compression stockings', 'B': 'Furosemide', 'C': 'Increase current medication dose', 'D': 'Lisinopril', 'E': 'Metoprolol'},
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D: Lisinopril
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Q:А 55-уеаr-old mаn рrеѕеntѕ to hіѕ рrіmаrу саrе рhуѕісіаn wіth a сomрlаіnt of fatigue for a couple of months. He was feeling well during his last visit 6 months ago. He has a history of hypertension for the past 8 years, diabetes mellitus for the past 5 years, and chronic kidney disease (CKD) for a year. The vіtаl ѕіgnѕ include: blood рrеѕѕurе 138/84 mm Нg, рulѕе 81/mіn, tеmреrаturе 36.8°C (98.2°F), аnd rеѕріrаtorу rаtе 9/mіn. Оn physical ехаmіnаtіon, modеrаtе раllor іѕ noted on thе раlреbrаl сonјunсtіvа аnd nаіl bеd. Complete blood count results are as follows: Hemoglobin 8.5 g/dL RBC 4.2 million cells/µL Hematocrit 39% Total leukocyte count 6,500 cells/µL cells/µL Neutrophils 61% Lymphocyte 34% Monocytes 4% Eosinophil 1% Basophils 0% Platelets 240,000 cells/µL A basic metabolic panel shows: Sodium 133 mEq/L Potassium 5.8 mEq/L Chloride 101 mEq/L Bicarbonate 21 mEq/L Albumin 3.1 mg/dL Urea nitrogen 31 mg/dL Creatinine 2.8 mg/dL Uric Acid 6.4 mg/dL Calcium 8.1 mg/dL Glucose 111 mg/dL Which of the following explanation best explains the mechanism for his decreased hemoglobin?? {'A': 'Progressive metabolic acidosis', 'B': 'Failure of adequate erythropoietin production', 'C': 'Side effect of his medication', 'D': 'Increased retention of uremic products', 'E': 'Failure of 1-alpha-hydroxylation of 25-hydroxycholecalciferol'},
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B: Failure of adequate erythropoietin production
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Q:A 25-year-old woman, gravida 2, para 1, at 25 weeks' gestation comes to the emergency department because of a 1-day history of fever and right-sided flank pain. During this period, she also had chills, nausea, vomiting, and burning on urination. Her last prenatal visit was 10 weeks ago. Pregnancy and delivery of her first child were uncomplicated. Her temperature is 39°C (102.2°F), pulse is 110/min, respirations are 20/min, and blood pressure is 110/70 mm Hg. Physical examination shows costovertebral angle tenderness on the right. The abdomen is soft and nontender, and no contractions are felt. Pelvic examination shows a uterus consistent in size with a 25-week gestation. Fetal heart rate is 170/min. Laboratory studies show: Leukocyte count 15,000/mm3 Urine Nitrite 2+ Protein 1+ Blood 1+ RBC 5/hpf WBC 500/hpf Blood and urine samples are obtained for culture and drug sensitivity. Which of the following is the most appropriate next step in management?"? {'A': 'Perform a renal ultrasound', 'B': 'Outpatient treatment with oral ciprofloxacin', 'C': 'Admit the patient and request an emergent obstetrical consult', 'D': 'Inpatient treatment with intravenous ceftriaxone', 'E': 'Inpatient treatment with intravenous ampicillin and gentamicin\n"'},
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D: Inpatient treatment with intravenous ceftriaxone
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Q:A 34-year-old G2P2 undergoes colposcopy due to high-grade intraepithelial neoplasia detected on a Pap smear. Her 2 previous Pap smears showed low-grade intraepithelial neoplasia. She has had 2 sexual partners in her life, and her husband has been her only sexual partner for the last 10 years. She had her sexual debut at 16 years of age. She had her first pregnancy at 26 years of age. She uses oral contraceptives for birth control. Her medical history is significant for right ovary resection due to a large follicular cyst and cocaine abuse for which she completed a rehabilitation program. Colposcopy reveals an acetowhite lesion with distorted vascularity at 4 o’clock. A directed biopsy shows the following on histologic evaluation. Which of the following factors present in this patient is a risk factor for the detected condition?? {'A': 'Patient age', 'B': 'Age of sexual debut', 'C': 'Ovarian surgery', 'D': 'History of cocaine abuse', 'E': 'Age at first pregnancy'},
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B: Age of sexual debut
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Answer the following medical question with one of the provided options:
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Q:A 71-year-old man is brought in by his wife with acute onset aphasia and weakness in his right arm and leg for the past 2 hours. The patient’s wife says they were eating breakfast when he suddenly could not speak. His symptoms have not improved over the past 2 hours. The patient denies any similar symptoms in the past. His past medical history is significant for immune thrombocytopenic purpura, managed intermittently with oral prednisone, hypertension, managed with hydrochlorothiazide, and a previous myocardial infarction (MI) 6 months ago. The patient reports a 20-pack-year smoking history and moderate daily alcohol use. His family history is significant for his father who died of an MI at age 58 and his older brother who died of a stroke at age 59. The vital signs include: blood pressure 175/105 mm Hg, pulse 85/min, and respiratory rate 20/min. On physical examination, there is a noticeable weakness of the lower facial muscles on the right. The muscle strength in his upper and lower extremities is 4/5 on the right and 5/5 on the left. There is also a loss of sensation on the right. He has productive aphasia. The laboratory findings are significant for the following: WBC 7,500/mm3 RBC 4.40 x 106/mm3 Hematocrit 41.5% Hemoglobin 14.0 g/dL Platelet count 95,000/mm3 A noncontrast computed tomography (CT) scan of the head is unremarkable. Diffusion-weighted magnetic resonance imaging (MRI) and CT angiography (CTA) confirms a left middle cerebral artery (MCA) ischemic stroke. Which of the following aspects of this patient’s history is a contraindication to intravenous (IV) tissue plasminogen activator (tPA)?? {'A': 'Blood pressure 175/105 mm Hg', 'B': 'Age 71 years', 'C': 'Platelet count 95,000/mm3', 'D': 'Myocardial infarction 6 months ago', 'E': '20-pack-year smoking history'},
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C: Platelet count 95,000/mm3
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Answer the following medical question with one of the provided options:
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Q:A 62-year-old man is brought to the emergency department because of progressive shortness of breath, mild chest pain on exertion, and a cough for 2 days. One week ago, he had a low-grade fever and nasal congestion. He has hypertension but does not adhere to his medication regimen. He has smoked one pack of cigarettes daily for 30 years and drinks 3–4 beers daily. His temperature is 37.1°C (98.8°F), pulse is 125/min, respirations are 29/min, and blood pressure is 145/86 mm Hg. He is in moderate respiratory distress while sitting. Pulmonary examination shows reduced breath sounds bilaterally. There is scattered wheezing over all lung fields. There is inward displacement of his abdomen during inspiration. Arterial blood gas analysis shows: pH 7.29 PCO2 63 mm Hg PO2 71 mm Hg HCO3- 29 mEq/L O2 saturation 89% Which of the following is the most likely cause of this patient's symptoms?"? {'A': 'Acute asthma exacerbation', 'B': 'Acute pulmonary embolism', 'C': 'Acute exacerbation of chronic obstructive pulmonary disease', 'D': 'Acute decompensatation of congestive heart failure', 'E': 'Acute respiratory distress syndrome'},
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C: Acute exacerbation of chronic obstructive pulmonary disease
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Answer the following medical question with one of the provided options:
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Q:A research group designs a study to investigate the epidemiology of syphilis in the United States. After a review of medical records, the investigators identify patients who are active cocaine users but did not have a history of syphilis as of one year ago. Another group of similar patients with no history of cocaine use or syphilis infection is also identified. The investigators examine the medical charts to determine whether the group of patients who are actively using cocaine was more likely to have developed syphilis over a 6-month period. The investigators ultimately found that the rate of syphilis was 30% higher in patients with active cocaine use compared to patients without cocaine use. This study is best described as which of the following?? {'A': 'Prospective cohort study', 'B': 'Meta-analysis', 'C': 'Case series', 'D': 'Retrospective cohort study', 'E': 'Case-control study'},
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D: Retrospective cohort study
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Answer the following medical question with one of the provided options:
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Q:A 31-year-old man comes to the emergency department because of drooping of the left side of his face since awakening that morning. He had difficulty chewing his food at breakfast. He was treated the previous day at the hospital after sustaining a head injury from falling off a ladder while working on his roof. A plain CT of the brain at that visit showed no abnormalities. He is in no apparent distress. His vital signs are within normal limits. The pupils are equal and reactive to light. There is drooping of the left corner of the mouth. The left nasolabial fold is flattened. When asked to close both eyes, the left eye remains partially open. There are no wrinkles on the left side of the forehead when the eyebrows are raised. Which of the following is the most appropriate next step in management?? {'A': 'Reassurance', 'B': 'Steroid therapy', 'C': 'Surgical repair', 'D': 'Acyclovir therapy', 'E': 'Surgical decompression'},
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B: Steroid therapy
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Q:A 52-year-old woman is accompanied by her husband to the emergency department with a severe occipital headache that started suddenly an hour ago. She is drowsy but able to answer the physician’s questions. She describes it as the worst headache she has ever had, 9/10 in intensity. The husband says it was initially localized to the occiput but has now spread all over her head and she also complained of a generalized heaviness. She took an ibuprofen without experiencing any relief. She also complains of blurry vision and nausea and had 1 episode of vomiting. She denies a recent history of fever, chills, numbness, or seizures. Her past medical history is significant for hypertension controlled with lisinopril and metoprolol. On examination, she is drowsy but oriented. Papilledema is seen on ophthalmoscopy. Neck flexion is difficult and painful. The rest of the exam is unremarkable. Her blood pressure is 160/100 mm Hg, heart rate is 100/min, and temperature is 37.0°C (98.6°F). The ECG, cardiac enzymes, and laboratory studies are normal. Lumbar puncture results are as follows: Opening pressure 210 mm H2O RBC 50/mm3, numbers steady over 4 test tubes Cell count 5/mm3 Glucose 40 mg/dL Proteins 100 mg/dL The patient is admitted to the ICU for further management. Which of the following is the most likely pathophysiology based on her history and CSF findings?? {'A': 'Viral infection of the brain parenchyma', 'B': 'Intracerebral bleed', 'C': 'Bacterial infection of the meninges', 'D': 'Trauma during lumbar puncture', 'E': 'Rupture of the communicating branches of the cerebral arteries'},
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E: Rupture of the communicating branches of the cerebral arteries
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Answer the following medical question with one of the provided options:
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Q:A 40-year-old man presents to a clinic in Michigan in December complaining of painful blue fingers and toes. He also complains of numbness and tingling. The patient’s vital signs are within normal limits, and his symptoms typically disappear when he comes back into a warm room. The patient also notes that he recently moved to the area from Arizona and had recently recovered from a viral infection in which he had a low-grade fever and severe lymphadenopathy. Which of the following tests would most likely be positive in this patient?? {'A': 'Indirect Coomb’s test', 'B': 'Direct Coomb’s test with anti-IgG reagent', 'C': 'Direct Coomb’s test with anti-C3 reagent', 'D': 'Anti-centromere antibody', 'E': 'Anti-Ro antibody'},
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C: Direct Coomb’s test with anti-C3 reagent
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Q:A drug research team has synthesized a novel oral drug that acts as an agonist at multiple adrenergic receptors. When administered in animals, it has been shown to produce urinary retention at therapeutic doses with the absence of other manifestations of adrenergic stimulation. The researchers are interested in understanding signal transduction and molecular mechanisms behind the action of the novel drug. Which of the following receptors would most likely transduce signals across the plasma membrane following the administration of this novel drug?? {'A': 'GiPCRs (Gi protein-coupled receptors)', 'B': 'GsPCRs (Gs protein-coupled receptors)', 'C': 'GtPCRs (Gt protein-coupled receptors)', 'D': 'GoPCRs (Go protein-coupled receptors)', 'E': 'GqPCRs (Gq protein-coupled receptors)'},
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E: GqPCRs (Gq protein-coupled receptors)
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Q:A 31-year-old man comes to the physician because of a 2-day history of abdominal pain and diarrhea. He reports that his stools are streaked with blood and mucus. He returned from a vacation in the Philippines 3 weeks ago. His vital signs are within normal limits. Abdominal examination shows hyperactive bowel sounds. A photomicrograph of a trichrome-stained wet mount of a stool specimen is shown. Which of the following organisms is the most likely cause of this patient's symptoms?? {'A': 'Entamoeba histolytica', 'B': 'Giardia lamblia', 'C': 'Shigella dysenteriae', 'D': 'Campylobacter jejuni', 'E': 'Cryptosporidium parvum'},
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A: Entamoeba histolytica
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Answer the following medical question with one of the provided options:
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Q:A 25-year-old man is admitted to the emergency department because of an episode of acute psychosis with suicidal ideation. He has no history of serious illness and currently takes no medications. Despite appropriate safety precautions, he manages to leave the examination room unattended. Shortly afterward, he is found lying outside the emergency department. A visitor reports that she saw the patient climbing up the facade of the hospital building. He does not respond to questions but points to his head when asked about pain. His pulse is 131/min, respirations are 22/min, and blood pressure is 95/61 mm Hg. Physical examination shows a 1-cm head laceration and an open fracture of the right tibia. He opens his eyes spontaneously. Pupils are equal, round, and reactive to light. Breath sounds are decreased over the right lung field, and the upper right hemithorax is hyperresonant to percussion. Which of the following is the most appropriate next step in management?? {'A': 'Perform a needle thoracostomy', 'B': 'Perform an endotracheal intubation', 'C': 'Apply a cervical collar', 'D': 'Obtain a chest x-ray', 'E': 'Perform an open reduction of the tibia fracture\n"'},
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C: Apply a cervical collar
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Answer the following medical question with one of the provided options:
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Q:Given the pattern of inheritance shown in the pedigree, where might you find the disease gene in question?? {'A': 'On single-stranded DNA in the cytoplasm', 'B': 'On circular DNA in the mitochondrion', 'C': 'On double stranded DNA in the nucleus', 'D': 'On linear DNA in the mitochondrion', 'E': 'On helical RNA in the cytoplasm'},
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B: On circular DNA in the mitochondrion
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Q:A 24-year-old man presents to the emergency room with a stab wound to the left chest at the sternocostal junction at the 4th intercostal space. The patient is hemodynamically unstable, and the trauma attending is concerned that there is penetrating trauma to the heart as. Which cardiovascular structure is most likely to be injured first in this stab wound?? {'A': 'Left atrium', 'B': 'Left ventricle', 'C': 'Right atrium', 'D': 'Right ventricle', 'E': 'Aorta'},
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D: Right ventricle
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Answer the following medical question with one of the provided options:
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Q:A 24-year-old man comes to the physician with a wound on his forearm. He says that he injured himself by absentmindedly walking into a glass door. He does not have health insurance. He has had 5 jobs in the past 8 months. He quit each job after 3–4 weeks because he found the work beneath him. He was imprisoned 6 years ago for credit card fraud. He was released from prison on parole a year ago. He was expelled from school at the age of 13 years for stealing school property and threatening to assault a teacher. He has fathered 6 children with 4 women. He says that he does not provide child support because he needs the money for his own personal expenses. The patient's vital signs are within normal limits. Examination of the forearm shows a 6 cm long, 0.5 cm deep wound with neat edges on the dorsal surface of the left forearm. There are bruises on the left shoulder, back, and the proximal phalanges of the right hand. On mental status examination, the patient is alert and calm. His mood is described as cheerful. His thought process, thought content, and speech are normal. Which of the following is the most likely diagnosis?? {'A': 'Intermittent explosive disorder', 'B': 'Oppositional defiant disorder', 'C': 'Antisocial personality disorder', 'D': 'Conduct disorder', 'E': 'Narcissistic personality disorder\n"'},
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C: Antisocial personality disorder
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Answer the following medical question with one of the provided options:
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Q:While performing a Western blot, a graduate student spilled a small amount of the radiolabeled antibody on her left forearm. Although very little harm was done to the skin, the radiation did cause minor damage to the DNA of the exposed skin by severing covalent bonds between the nitrogenous bases and the core ribose leaving several apurinic/apyrimidinic sites. Damaged cells would most likely repair these sites by which of the following mechanisms?? {'A': 'Nucleotide excision repair', 'B': 'Base excision repair', 'C': 'Mismatch repair', 'D': 'Nonhomologous end joining repair', 'E': 'Homologous recombination'},
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B: Base excision repair
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Answer the following medical question with one of the provided options:
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Q:A 2-year-old girl presents to the pediatrician with an itchy rash. Her mother reports that she has had a crusty rash on the face and bilateral upper extremities intermittently for the past 2 months. The child's past medical history is notable for 3 similar episodes of severely itchy rashes since birth. She has also had 2 non-inflamed abscesses on her arms over the past year. Her temperature is 98.9°F (37.2°C), blood pressure is 108/68 mmHg, pulse is 94/min, and respirations are 18/min. On exam, she appears uncomfortable and is constantly itching her face and arms. There is an eczematous rash on the face and bilateral upper extremities. Her face has thickened skin with a wide-set nose. This patient's condition is most likely caused by a mutation in which of the following genes?? {'A': 'Adenosine deaminase', 'B': 'IL-12 receptor', 'C': 'LYST', 'D': 'STAT3', 'E': 'WAS'},
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D: STAT3
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Answer the following medical question with one of the provided options:
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Q:A 32-year-old farmer is brought to the emergency department by his wife. The patient was reportedly anxious, sweaty, and complaining of a headache and chest tightness before losing consciousness on route to the hospital. Which of the following is mechanistically responsible for this patient's symptoms?? {'A': 'Competitive inhibition of acetylcholine at post-junctional effector sites', 'B': 'Binding of acetylcholine agonists to post-junctional receptors', 'C': 'Inhibition of presynaptic exocytosis of acethylcholine vesicles', 'D': 'Irreversible inhibition of acetylcholinesterase', 'E': 'Reversible inhibition of acetylcholinesterase'},
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D: Irreversible inhibition of acetylcholinesterase
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Answer the following medical question with one of the provided options:
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Q:An 8-year-old boy is brought to the emergency department by his parents 30 minutes after losing consciousness. He was at a water park with his family when he fell to the ground and started to have jerking movements of the arms and legs. On arrival, he continues to have generalized, violent muscle contractions and is unresponsive to verbal and painful stimuli. The emergency department physician administers lorazepam. The expected beneficial effect of this drug is most likely caused by which of the following mechanisms?? {'A': 'Increased affinity of GABA receptors to GABAB', 'B': 'Allosteric activation of GABAA receptors', 'C': 'Increased duration of chloride channel opening', 'D': 'Inhibition of GABA transaminase', 'E': 'Noncompetitive NMDA receptor antagonism'},
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B: Allosteric activation of GABAA receptors
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Answer the following medical question with one of the provided options:
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Q:A 48-year-old multiparous woman visits the clinic for her annual physical check-up. During the interview, you find out that her father passed away 5 months ago after massive blood loss secondary to lower gastrointestinal bleeding, and both her younger siblings (45 and 42 years of age) were recently diagnosed with various colonic lesions compatible with colorectal cancer. The diet history reveals that the patient consumes large amounts of fried food and sugary drinks. She has smoked 1 pack of cigarettes every day for the last 10 years and frequently binges drinks to ‘calm her nerves’. The medical history is significant for estrogen-progestin therapy (to control menopausal vasomotor symptoms) and hypertension. The vital signs include a blood pressure of 139/66 mm Hg, a pulse of 72/min, a temperature of 37.2°C (99.0°F), and a respiratory rate of 16/min. Physical examination is unremarkable, except for a BMI of 38 kg/m² and a lesion in her axilla, as shown in the image. You explain that she needs to start taking care of herself by modifying her lifestyle to lower her increased risk for endometrial carcinoma. Which of the following is the most important risk factor for this patient?? {'A': 'Obesity', 'B': 'Smoking', 'C': 'Family history', 'D': 'Hormonal replacement therapy', 'E': 'Multiparity'},
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C: Family history
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Q:Three days after admission to the hospital following a motor vehicle accident, a 45-year-old woman develops a fever. A central venous catheter was placed on the day of admission for treatment of severe hypotension. Her temperature is 39.2°C (102.5°F). Examination shows erythema surrounding the catheter insertion site at the right internal jugular vein. Blood cultures show gram-positive, catalase-positive cocci that have a low minimum inhibitory concentration when exposed to novobiocin. Which of the following is the most appropriate pharmacotherapy?? {'A': 'Metronidazole', 'B': 'Vancomycin', 'C': 'Clarithromycin', 'D': 'Penicillin G', 'E': 'Polymyxin B'},
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B: Vancomycin
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Q:A 23-year-old woman presents to the emergency department with abnormal vaginal discharge and itchiness. She states it started a few days ago and has been worsening. The patient has a past medical history of a medical abortion completed 1 year ago. Her temperature is 98.6°F (37.0°C), blood pressure is 129/68 mmHg, pulse is 80/min, respirations are 14/min, and oxygen saturation is 99% on room air. Physical exam demonstrates an anxious woman. Pelvic exam reveals yellow cervical discharge. Nucleic acid amplification test is negative for Neisseria species. Which of the following is the best next step in management?? {'A': 'Azithromycin', 'B': 'Azithromycin and ceftriaxone', 'C': 'Ceftriaxone', 'D': 'Cervical cultures', 'E': 'Fluconazole'},
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A: Azithromycin
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Q:A 64-year-old man presents to the emergency department with sudden onset of pleuritic chest pain and dyspnea on exertion. He has a history of lung cancer and is currently being treated with outpatient chemotherapy. His temperature is 98.9°F (37.2°C), blood pressure is 111/64 mmHg, pulse is 130/min, respirations are 25/min, and oxygen saturation is 90% on room air. Initial laboratory values in the emergency department are seen below. Hemoglobin: 8.2 g/dL Hematocrit: 26% Leukocyte count: 7,700/mm^3 with normal differential Platelet count: 157,000/mm^3 A CT angiogram demonstrates a blood clot in the pulmonary vasculature. The patient is started on heparin and he is admitted to the ICU. Laboratory values 6 days later are shown below. Hemoglobin: 8.0 g/dL Hematocrit: 25% Leukocyte count: 7,500/mm^3 with normal differential Platelet count: 22,000/mm^3 Which of the following is the most appropriate next step in management?? {'A': 'Blood transfusion', 'B': 'No treatment changes needed', 'C': 'Platelet transfusion', 'D': 'Start warfarin', 'E': 'Stop heparin'},
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E: Stop heparin
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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 comes to the physician because of prolonged stiffness in the morning and progressive pain and swelling of her wrists and hands over the past 4 months. Examination shows bilateral swelling and mild tenderness of the wrists and the second, third, and fourth metacarpophalangeal joints. Her range of motion is limited by pain. Serum studies show elevated anti-cyclic citrullinated peptide antibodies. Treatment with methotrexate is begun. At a follow-up examination, her serum aspartate aminotransferase (AST) concentration is 75 U/L and her serum alanine aminotransferase (ALT) concentration is 81 U/L. Which of the following substances is essential for the function of these enzymes?? {'A': 'Niacin', 'B': 'Thiamine', 'C': 'Folic acid', 'D': 'Riboflavin', 'E': 'Pyridoxine'},
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E: Pyridoxine
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Q:An 82-year-old woman comes to the physician because of difficulty sleeping and increasing fatigue. Over the past 3 months she has been waking up early and having trouble falling asleep at night. During this period, she has had a decreased appetite and a 3.2-kg (7-lb) weight loss. Since the death of her husband one year ago, she has been living with her son and his wife. She is worried and feels guilty because she does not want to impose on them. She has stopped going to meetings at the senior center because she does not enjoy them anymore and also because she feels uncomfortable asking her son to give her a ride, especially since her son has had a great deal of stress lately. She is 155 cm (5 ft 1 in) tall and weighs 51 kg (110 lb); BMI is 21 kg/m2. Vital signs are within normal limits. Physical examination shows no abnormalities. On mental status examination, she is tired and has a flattened affect. Cognition is intact. Which of the following is the most appropriate initial step in management?? {'A': 'Notify adult protective services', 'B': 'Recommend relocation to a nursing home', 'C': 'Begin cognitive-behavioral therapy', 'D': 'Begin mirtazapine therapy', 'E': 'Assess for suicidal ideation\n"'},
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E: Assess for suicidal ideation "
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Q:A 14-year-old boy is brought to the physician by his parents for a well-child visit. The patient was born at 38 weeks' gestation via vaginal delivery and has been healthy. He attends a junior high school and is having difficulties keeping up with his classmates in many classes. He is at the 97th percentile for height and 50th percentile for weight. Vital signs are within normal limits. Cardiac examination shows a high-frequency midsystolic click that is best heard at the left fifth intercostal space. The patient has long extremities along with excess breast tissue bilaterally. He has no axillary hair. Genital examination shows reduced scrotal size and a normal sized penis. Which of the following tests is the most likely to diagnose the patient's underlying disorder?? {'A': 'Serum IGF-1 measurement', 'B': 'Urinalysis', 'C': 'Southern blot', 'D': 'Slit-lamp examination', 'E': 'Karyotyping'},
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E: Karyotyping
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Q:A 37-year-old man is brought to the emergency department following a motor vehicle collision. His temperature is 38.1°C (100.6°F), pulse is 39/min, respirations are 29/min, and blood pressure is 58/42 mm Hg. There is no improvement in his blood pressure despite adequate fluid resuscitation. A drug is administered that causes increased IP3 concentrations in arteriolar smooth muscle cells and increased cAMP concentrations in cardiac myocytes. This drug only has a negligible effect on cAMP concentration in bronchial smooth muscle cells. Which of the following sets of cardiovascular changes is most likely following administration of this drug? $$$ Cardiac output %%% Mean arterial pressure %%% Systemic vascular resistance $$$? {'A': 'No change ↑ ↑', 'B': '↑ ↑ ↓', 'C': '↓ ↓ ↑', 'D': '↑ ↓ ↓', 'E': '↑ no change no change'},
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A: No change ↑ ↑
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Q:A 57-year-old man is brought to the emergency department by his family because of several episodes of vomiting of blood in the past 24 hours. He has a history of alcoholic cirrhosis and is being treated for ascites with diuretics and for encephalopathy with lactulose. His vital signs include a temperature of 36.9°C (98.4°F), pulse of 85/min, and blood pressure of 80/52 mm Hg. On examination, he is confused and unable to give a complete history. He is noted to have jaundice, splenomegaly, and multiple spider angiomas over his chest. Which of the following is the best initial management of this patient?? {'A': 'Non-selective beta-blockers', 'B': 'Combined vasoactive and endoscopic therapy', 'C': 'Balloon tamponade', 'D': 'Transjugular intrahepatic portosystemic shunt (TIPS)', 'E': 'Endoscopic surveillance'},
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B: Combined vasoactive and endoscopic therapy
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Q:A 3-year-old boy is brought to his pediatrician by his mother when he developed redness, burning, itching, and exquisite pain all over his arms, lower legs, neck, and face. The mother states that she just recently began taking him to the local playground in the afternoons. She reports that she applied liberal amounts of sunscreen before and during the time outside. She states that they were at the playground for 30 minutes to 1 hour each day for the last 3 days. The patient has experienced prior episodes of redness and pain after being outdoors, but they were relatively minor and resolved within 12 hours. She says his current presentation is much more severe with more exquisite pain than in the past. The patient's vital signs are as follows: T 37.2 C, HR 98, BP 110/62, RR 16, and SpO2 99%. Physical examination reveals edema, erythema, and petechiae over the patient's face, neck, arms, and lower legs. No blistering or scarring of the skin is noted. Which of the following is the best treatment option for this patient's condition?? {'A': 'Recommend use of a high SPF topical sunscreen', 'B': 'Begin dexamethasone taper', 'C': 'Start therapeutic phlebotomy', 'D': 'Initiate oral beta carotene', 'E': 'Prescribe chloroquine'},
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D: Initiate oral beta carotene
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Answer the following medical question with one of the provided options:
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Q:An 8-month-old boy presents with poor feeding. The patient’s mother says that he has refused to eat since yesterday morning. She also noticed that he has had trouble keeping his head up and appears floppy. She had breastfed him exclusively and just recently introduced him to pureed foods. His last bowel movement was 3 days ago which was normal. Past medical history is significant for recent otitis media. No current medications except for herbal supplements administered by his parents. Patient is not immunized due to the parent’s religious beliefs. The vital signs include: temperature 37.0°C (98.6°F), blood pressure 85/45 mm Hg, pulse 140/min, respiratory rate 31/min, and oxygen saturation 99% on room air. On physical examination, the patient is lethargic and drooling. Flaccid muscle tone present in all extremities. There is bilateral ptosis with sluggish pupillary reflexes. Which of the following best describes the pathophysiology of this patient’s condition?? {'A': 'Post-viral ascending demyelinating polyneuropathy', 'B': 'Autoantibodies against acetylcholine receptors', 'C': 'Bacterial infection of the meninges', 'D': 'Ingestion of a preformed toxin', 'E': 'Haemophilus influenzae infection'},
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D: Ingestion of a preformed toxin
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Q:A 72-year-old man is brought into clinic by his daughter for increasing confusion. The daughter states that over the past 2 weeks, she has noticed that the patient “seems to stare off into space.” She reports he has multiple episodes a day during which he will walk into a room and forget why. She is also worried about his balance. She endorses that he has had several falls, the worst being 3 weeks ago when he tripped on the sidewalk getting the mail. The patient denies loss of consciousness, pre-syncope, chest pain, palpitations, urinary incontinence, or bowel incontinence. He complains of headache but denies dizziness. He reports nausea and a few episodes of non-bloody emesis but denies abdominal pain, constipation, or diarrhea. The patient’s medical history is significant for atrial fibrillation, diabetes, hypertension, hyperlipidemia, and osteoarthritis. He takes aspirin, warfarin, insulin, lisinopril, simvastatin, and ibuprofen. He drinks a half glass of whisky after dinner every night and smokes a cigar on the weekends. On physical examination, he is oriented to name and place but not to date. He is unable to spell "world" backward. When asked to remember 3 words, he recalls only 2. There are no motor or sensory deficits. Which of the following is the most likely diagnosis?? {'A': 'Alzheimer disease', 'B': 'Ischemic stroke', 'C': 'Normal pressure hydrocephalus', 'D': 'Subdural hematoma', 'E': 'Vitamin B12 deficiency'},
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D: Subdural hematoma
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Answer the following medical question with one of the provided options:
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Q:A 3-year-old girl is brought to the physician by her parents because of a barking cough, a raspy voice, and noisy breathing for the last 3 days. Five days ago, she had a low-grade fever and runny nose. She attends daycare. Her immunizations are up-to-date. Her temperature is 37.8°C (100°F) and respirations are 33/min. Physical examination shows supraclavicular retractions. There is a high-pitched sound present on inspiration. Examination of the throat shows erythema without exudates. Which of the following is the most likely location of the anatomic narrowing causing this patient's symptoms?? {'A': 'Distal trachea', 'B': 'Pharynx', 'C': 'Epiglottis', 'D': 'Subglottic larynx', 'E': 'Bronchioles'},
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D: Subglottic larynx
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Q:A student health coordinator plans on leading a campus-wide HIV screening program that will be free for the entire undergraduate student body. The goal is to capture as many correct HIV diagnoses as possible with the fewest false positives. The coordinator consults with the hospital to see which tests are available to use for this program. Test A has a sensitivity of 0.92 and a specificity of 0.99. Test B has a sensitivity of 0.95 and a specificity of 0.96. Test C has a sensitivity of 0.98 and a specificity of 0.93. Which of the following testing schemes should the coordinator pursue?? {'A': 'Test A on the entire student body followed by Test B on those who are positive', 'B': 'Test A on the entire student body followed by Test C on those who are positive', 'C': 'Test B on the entire student body followed by Test A on those who are positive', 'D': 'Test C on the entire student body followed by Test A on those who are positive', 'E': 'Test C on the entire student body followed by Test B on those who are positive'},
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D: Test C on the entire student body followed by Test A on those who are positive
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Q:A 40-year-old man is brought into the emergency department because he was involved in a bar fight and sustained an injury to the head. The next day, as requested by the patient, the psychiatry team is called to address some of the concerns he has regarding his drinking habits. He admits that he got irate last night at the bar because his driver’s license was recently taken away and his wife had taken his children to live with her parents because of his drinking problem. He drinks 4–6 beers on a weeknight and more on the weekends. He wants to know if there is anything that could help him at this point. Which stage of overcoming his addiction is this patient currently in?? {'A': 'Precontemplation', 'B': 'Contemplation', 'C': 'Preparation', 'D': 'Action', 'E': 'Maintenance'},
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C: Preparation
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Q:A 30-year-old woman presents with generalized fatigue, joint pain, and decreased appetite. She says that symptoms onset a year ago and have not improved. The patient’s husband says he has recently noticed that her eyes and skin are yellowish. The patient denies any history of smoking or alcohol use, but she admits to using different kinds of intravenous illicit drugs during her college years. The patient is afebrile and vital signs are within normal limits. Physical examination is unremarkable, except for moderate scleral icterus. A polymerase chain reaction (PCR) of a blood sample is positive for a viral infection that reveals a positive-sense RNA virus, that is small, enveloped, and single-stranded. The patient is started on a drug that resembles a purine RNA nucleotide. She agrees not to get pregnant before or during the use of this medication. Which of the following is the drug that was most likely given to this patient?? {'A': 'Simeprevir', 'B': 'Sofosbuvir', 'C': 'Ribavirin', 'D': 'Interferon-alpha', 'E': 'Cidofovir'},
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C: Ribavirin
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Q:A 10-year-old girl is brought to the physician because of a severe, throbbing headache for 1 hour. The headache is located in the right frontotemporal region. It is her fifth such headache in the past 2 months. Her mother says that all the previous episodes started after soccer practice, following which the child would lock herself in her room, close the curtains, and sleep for a few hours. After waking up, the headache is either diminished or has stopped entirely. One month ago, the child was diagnosed with myopic vision and has been wearing glasses since. Her 4-year-old brother had herpetic gingivostomatitis 2 months ago. Her vital signs are within normal limits. Funduscopic examination is inconclusive because the child is uncooperative. The remainder of the examination shows no abnormalities. Which of the following is the most appropriate next step in management?? {'A': 'Neuro-optometric assessment', 'B': 'Acetaminophen therapy', 'C': 'Dihydroergotamine therapy', 'D': 'MRI of the brain', 'E': 'Acyclovir therapy'},
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B: Acetaminophen therapy
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Answer the following medical question with one of the provided options:
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Q:A 60-year-old woman comes to the physician because of lower back pain, generalized weakness, and weight loss that has occurred over the past 6 weeks. She also says that her urine has appeared foamy recently. Physical examination shows focal midline tenderness of the lumbar spine and conjunctival pallor. Her temperature is 100.5°F (38°C). A photomicrograph of a bone marrow biopsy specimen is shown. Further evaluation of this patient is most likely to show which of the following findings?? {'A': 'Erythrocytes with cytoplasmic hemoglobin inclusions', 'B': 'B-lymphocytes with radial cytoplasmic projections', 'C': 'Neutrophils with hypersegmented nuclear lobes', 'D': 'Grouped erythrocytes with stacked-coin appearance', 'E': 'Myeloblasts with needle-shaped cytoplasmic inclusions'},
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D: Grouped erythrocytes with stacked-coin appearance
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Q:A 52-year-old woman presents with mild epigastric pain and persistent heartburn for the past 2 months. An endoscopy is performed and reveals inflammation of the stomach mucosa without evidence of ulceration. A biopsy is performed and reveals intestinal metaplasia with destruction of a large number of parietal cells. She is diagnosed with chronic atrophic gastritis. Which of the following is characteristic of this patient’s diagnosis?? {'A': 'It is the most common cause of folate deficiency in the US.', 'B': 'Caused by a gram-negative rod that is urease positive', 'C': 'MALT lymphoma is a common complication.', 'D': 'Destruction of the mucosa of the stomach is mediated by T cells.', 'E': 'Serum gastrin levels are decreased.'},
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D: Destruction of the mucosa of the stomach is mediated by T cells.
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Q:A 62-year-old man presents to the emergency department with sudden onset of severe left leg pain accompanied by numbness and weakness. His medical history is remarkable for hypertension and hyperlipidemia. His vital signs include a blood pressure of 155/92 mm Hg, a temperature of 37.1°C (98.7°F), and an irregular pulse of 92/min. Physical examination reveals absent left popliteal and posterior tibial pulses. His left leg is noticeably cold and pale. There is no significant tissue compromise, nerve damage, or sensory loss. Which of the following will most likely be required for this patient's condition?? {'A': 'Amputation', 'B': 'Thromboembolectomy', 'C': 'Fasciotomy', 'D': 'Warfarin', 'E': 'Antibiotics'},
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B: Thromboembolectomy
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Q:A 25-year-old male presents to his primary doctor with difficulty sleeping. On exam, he is noted to have impaired upgaze bilaterally, although the rest of his ocular movements are intact. On pupillary exam, both pupils accommodate, but do not react to light. What is the most likely cause of his symptoms?? {'A': 'Frontal lobe cavernoma', 'B': 'Craniopharyngioma', 'C': 'Pinealoma', 'D': 'Melanoma with temporal lobe metastasis', 'E': 'Spinal cord ependymoma'},
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C: Pinealoma
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Q:A 49-year-old man being treated for Helicobacter pylori infection presents to his primary care physician complaining of lower back pain. His physician determines that a non-steroidal anti-inflammatory drug (NSAID) would be the most appropriate initial treatment. Which of the following is the most appropriate NSAID for this patient?? {'A': 'Aspirin', 'B': 'Ibuprofen', 'C': 'Codeine', 'D': 'Bismuth', 'E': 'Celecoxib'},
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E: Celecoxib
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Q:Five sets of PCR primers were designed and sythesized, one for each of the viruses listed below. The viral genomic material from each virus was extracted and added to a PCR reaction containing a DNA-dependent Taq polymerase with the corresponding primers. However, of the five PCR reactions, only one yielded an amplified product as detected by gel agarose. From which of the following viruses did the PCR product arise?? {'A': 'Poliovirus', 'B': 'Rhinovirus', 'C': 'Adenovirus', 'D': 'Rubella virus', 'E': 'Yellow Fever virus'},
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C: Adenovirus
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Q:A 72-year-old man with type 2 diabetes mellitus, hypertension, and systolic heart failure comes to the physician because of a 5-day history of progressively worsening shortness of breath at rest. Physical examination shows jugular venous distention, diffuse crackles over the lower lung fields, and bilateral lower extremity edema. As a part of treatment, he is given a derivative of a hormone that acts by altering guanylate cyclase activity. This drug has been found to reduce pulmonary capillary wedge pressure and causes systemic hypotension as an adverse effect. The drug is most likely a derivative of which of the following hormones?? {'A': 'Angiotensin II', 'B': 'Aldosterone', 'C': 'Brain natriuretic peptide', 'D': 'Prostacyclin', 'E': 'Somatostatin'},
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C: Brain natriuretic peptide
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Answer the following medical question with one of the provided options:
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Q:A 14-year-old boy is brought to the physician because of blurry vision. He is at the 97th percentile for height and 25th percentile for weight. He has long, slender fingers and toes that are hyperflexible. Examination of the oropharynx shows a high-arched palate. Slit lamp examination shows bilateral lens subluxation in the superotemporal direction. The patient's older sister is also tall, has hyperflexible joints, and has hyperelastic skin. However, she does not have lens subluxation or an arched palate. Which of the following genetic principles accounts for the phenotypical differences seen in this pair of siblings?? {'A': 'Incomplete penetrance', 'B': 'Variable expressivity', 'C': 'Compound heterozygosity', 'D': 'Frameshift mutation', 'E': 'Chromosomal instability'},
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B: Variable expressivity
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Q:A 45-year-old male alcoholic presents with fever, productive cough, and foul-smelling sputum for the past two weeks. Vital signs are T 38.3 C, HR 106, BP 118/64 and RR 16. Oxygen saturation on room air is 90%. Given a diagnosis of aspiration pneumonia, initial chest radiograph findings would most likely include:? {'A': 'Left lung abscess due to increased ventilation-perfusion ratio of the left lung', 'B': 'Left lung abscess due to the left main bronchus being located superior to the right main bronchus', 'C': 'Right lung abscess due to increased anterior-posterior diameter of the right lung', 'D': 'Right lung abscess due to the right main bronchus being wider and more vertically oriented', 'E': 'Mediastinal abscess located between vertebral levels T1-T3'},
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D: Right lung abscess due to the right main bronchus being wider and more vertically oriented
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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 comes to the emergency department because of a 1-day history of chest pain, palpitations, and dyspnea on exertion. He had a similar episode 3 days ago and was diagnosed with an inferior wall myocardial infarction. He was admitted and a percutaneous transluminal coronary angioplasty was successfully done that day. A fractional flow reserve test during the procedure showed complete resolution of the stenosis. Laboratory tests including serum glucose, lipids, and blood count were within normal limits. He was discharged the day after the procedure on a drug regimen of aspirin, simvastatin, and isosorbide dinitrate. At the time of discharge, he had no chest pain or dyspnea. Presently, his vitals are normal and ECG at rest shows new T-wave inversion. Which of the following is the most reliable test for rapidly establishing the diagnosis in this patient?? {'A': 'Lactate dehydrogenase', 'B': 'Creatine kinase MB', 'C': 'Cardiac troponin T', 'D': 'Copeptin', 'E': 'Aspartate aminotransferase'},
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B: Creatine kinase MB
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Answer the following medical question with one of the provided options:
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Q:A research group wants to assess the safety and toxicity profile of a new drug. A clinical trial is conducted with 20 volunteers to estimate the maximum tolerated dose and monitor the apparent toxicity of the drug. The study design is best described as which of the following phases of a clinical trial?? {'A': 'Phase II', 'B': 'Phase III', 'C': 'Phase 0', 'D': 'Phase V', 'E': 'Phase I'},
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E: Phase I
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Q:A 32-year-old African American woman presents to the office with complaints of frothy urine and swelling of her body that started 4 days ago. She noticed the swelling 1st in the face then gradually involved in other parts of her body. The frequency of urination is the same with no noticeable change in its appearance. She is human immunodeficiency virus (HIV) positive and is currently under treatment with abacavir, dolutegravir, and lamivudine. The vital signs include blood pressure 122/89 mm Hg, pulse 55/min, temperature 36.7°C (98.0°F), and respiratory rate 14/min. On physical examination, there is generalized pitting edema. Urinalysis results are as follows: pH 6.6 Color light yellow Red blood cell (RBC) count none White blood cell (WBC) count 1–2/HPF Protein 4+ Cast fat globules Glucose absent Crystal none Ketone absent Nitrite absent 24 hours of urine protein excretion 5.2 g HPF: high-power field A renal biopsy is performed which shows the following (see image). What condition is this patient most likely suffering from?? {'A': 'Minimal change disease', 'B': 'Focal segmental glomerulosclerosis', 'C': 'Renal amyloidosis', 'D': 'Diffuse proliferative glomerulonephritis', 'E': 'Post-streptococcal glomerulonephritis'},
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B: Focal segmental glomerulosclerosis
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Answer the following medical question with one of the provided options:
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Q:A 5-year-old patient is brought to the emergency department by his parents for concerning behavior. His parents relate that over the past 3 weeks, he has had multiple episodes of staring into space, lip smacking, and clasping his hands together. The patient has his eyes open during these episode but does not respond to his parents’ voice or his name. These episodes last between 1-2 minutes after which the patient appears to return back to awareness. The patient is confused after these episodes and appears not to know where he is for about 15 minutes. These episodes occur once every few days and the most recent one happened about 10 minutes before the patient arrived to the emergency department. On arrival, the patient is mildly confused and does not know where he is or what recently happened. He is slow to respond to questions and appears tired. Which of the following is the most likely diagnosis in this patient?? {'A': 'Simple partial seizure', 'B': 'Complex partial seizure', 'C': 'Generalized tonic-clonic seizure', 'D': 'Absence seizure', 'E': 'Syncopal episodes'},
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B: Complex partial seizure
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Q:A 23-year-old man presents into his physician's office with increasing breathlessness over the past one month. He was diagnosed with asthma when he was a child and has been able to keep his symptoms under control with a Ventolin inhaler. However, over the past year or so he has found that he gets out of breath on several occasions during the week. He wakes up at least once a week with breathlessness. He finds that he feels out of breath during his weekly football matches, which never used to happen before. He has to sit down and take a couple of puffs of his inhaler to feel better. He has no other pertinent history at this moment, except that he started on a new job painting houses about 5 months ago. His physical examination does not show anything significant. His peak expiratory flow rate during spirometry averages about 85% of the normal value, after conducting the test 3 times. Which of the following would be the next best step in management?? {'A': 'Chest X-ray', 'B': 'Arterial blood gas', 'C': 'Patch test', 'D': 'Methacholine bronchoprovocation test', 'E': 'Follow up spirometry in 2 months'},
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D: Methacholine bronchoprovocation test
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Answer the following medical question with one of the provided options:
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Q:A 12-year-old boy is brought to his orthopedic surgeon for evaluation of leg pain and positioning. Specifically, over the past several months he has been complaining of thigh pain and has more difficulty sitting in his wheelchair. His medical history is significant for spastic quadriplegic cerebral palsy since birth and has undergone a number of surgeries for contractures in his extremities. At this visit his legs are found to be scissored such that they cross each other at the knees and are difficult to separate. Surgery is performed and the boy is placed into a cast that keeps his legs abducted to prevent scissoring. Overactivity of the muscles innervated by which of the following nerves is most consistent with this patient's deformity?? {'A': 'Femoral nerve', 'B': 'Nerve to the iliopsoas', 'C': 'Obturator', 'D': 'Sciatic nerve', 'E': 'Superior gluteal nerve'},
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C: Obturator
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Answer the following medical question with one of the provided options:
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Q:A 59-year-old man is brought to the emergency department with signs of spontaneous bruising of the lower legs. The patient has a history of alcohol use disorder and has been unemployed for the last 2 years. He reports a 1-year history of fatigue and joint pain. Physical examination of the patient’s legs reveals the findings illustrated in the image. Oral examination shows swollen gums, petechiae of the hard palate, and poor dentition. The most likely underlying cause of this patient's current findings involves which of the following metabolic deficiencies?? {'A': 'Conversion of pyruvate to acetyl-CoA', 'B': 'Gamma-carboxylation of glutamic acid residues', 'C': 'Hydroxylation of lysine residues', 'D': 'Intestinal absorption of Ca2+ and PO43-', 'E': 'Methylation of homocysteine'},
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C: Hydroxylation of lysine residues
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Answer the following medical question with one of the provided options:
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Q:A 22-year-old woman comes to the physician because of abdominal pain and diarrhea for 2 months. The pain is intermittent, colicky and localized to her right lower quadrant. She has anorexia and fears eating due to the pain. She has lost 4 kg (8.8 lb) during this time. She has no history of a serious illness and takes no medications. Her temperature is 37.8°C (100.0°F), blood pressure 125/65 mm Hg, pulse 75/min, and respirations 14/min. An abdominal examination shows mild tenderness of the right lower quadrant on deep palpation without guarding. Colonoscopy shows small aphthous-like ulcers in the right colon and terminal ileum. Biopsy from the terminal ileum shows noncaseating granulomas in all layers of the bowel wall. Which of the following is the most appropriate pharmacotherapy at this time?? {'A': 'Azathioprine', 'B': 'Budesonide', 'C': 'Ciprofloxacin', 'D': 'Metronidazole', 'E': 'Rectal mesalamine'},
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B: Budesonide
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Answer the following medical question with one of the provided options:
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Q:An 8-month-old boy is brought to the physician by his parents for gradually increasing loss of neck control and inability to roll over for the past 2 months. During this time, he has had multiple episodes of unresponsiveness with a blank stare and fluttering of the eyelids. His parents state that he sometimes does not turn when called but gets startled by loud noises. He does not maintain eye contact. He was able to roll over from front to back at 5 months of age and has not yet begun to sit or crawl. His parents are of Ashkenazi Jewish descent. Neurological examination shows generalized hypotonia. Deep tendon reflexes are 3+ bilaterally. Plantar reflex shows extensor response bilaterally. Fundoscopy shows bright red macular spots bilaterally. The remainder of the examination shows no abnormalities. Which of the following is the most likely cause of this patient's symptoms?? {'A': 'Sphingomyelinase deficiency', 'B': 'ATP-binding cassette transporter mutation', 'C': 'β-glucocerebrosidase deficiency', 'D': 'α-galactosidase A deficiency', 'E': 'β-hexosaminidase A deficiency\n"'},
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E: β-hexosaminidase A deficiency "
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Answer the following medical question with one of the provided options:
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Q:A 70-year-old woman presents with numbness and tingling that is worse in the soles of her feet. She says that symptoms started a few weeks ago and have progressively worsened. She also complains of mild nausea and white lines on her fingernails. Past medical history is significant for diabetes mellitus type 2, managed with metformin. Her last HbA1c was 5.8%. The patient denies any changes in her vision, chest pain, or palpitations. She says she lives near an industrial area that was in the newspaper for leaking waste into the groundwater but she can’t remember the details. She also says she spends a lot of her free time in her garden. On physical examination, there is decreased fine touch, temperature, and vibrational sensation in the extremities bilaterally Strength is reduced symmetrically 4 out of 5 in all limbs along with reduced (1+) deep tendon reflexes. Which of the following is the best treatment option for this patient?? {'A': 'Tight control of her diabetes mellitus by adding insulin', 'B': 'Calcium disodium edetate (EDTA)', 'C': 'Dimercaprol', 'D': 'Trientine', 'E': 'Penicillamine'},
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C: Dimercaprol
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