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Answer the following medical question with one of the provided options:
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Q:A 45-year-old male presents to his primary care physician complaining of joint pain and stiffness. He reports progressively worsening pain and stiffness in his wrists and fingers bilaterally over the past six months that appears to improve in the afternoon and evening. His past medical history is notable for obesity and diabetes mellitus. He takes metformin and glyburide. His family history is notable for osteoarthritis in his father and psoriasis in his mother. His temperature is 98.6°F (37°C), blood pressure is 130/80 mmHg, pulse is 90/min, and respirations are 16/min. On examination, his bilateral metacarpophalangeal joints and proximal interphalangeal joints are warm and mildly edematous. The presence of antibodies directed against which of the following is most specific for this patient’s condition?? {'A': 'Fc region of IgG molecule', 'B': 'Histidyl-tRNA synthetase', 'C': 'Citrullinated peptides', 'D': 'Topoisomerase I', 'E': 'Centromeres'},
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C: Citrullinated peptides
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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 comes to the clinic complaining of recurrent abdominal pain for the past 2 months. He reports a gnawing, dull pain at the epigastric region that improves with oral ingestion. He has been taking calcium carbonate for the past few weeks; he claims that “it used to help a lot but it’s losing its effects now.” Laboratory testing demonstrated increased gastrin levels after the administration of secretin. A push endoscopy visualized several ulcers at the duodenum and proximal jejunum. What characteristics distinguish the jejunum from the duodenum?? {'A': 'Crypts of Lieberkuhn', 'B': 'Lack of goblet cells', 'C': 'Lack of submucosal Brunner glands', 'D': 'Peyer patches', 'E': 'Pilcae circulares'},
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C: Lack of submucosal Brunner glands
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Answer the following medical question with one of the provided options:
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Q:An investigator is studying the activity of N-terminal peptidase in eukaryotes. Sulfur-containing amino acids are radiolabeled and isolated using 35S. During translation of a non-mitochondrial human genome, some of the radiolabeled amino acids bind to the aminoacyl, peptidyl, and exit sites of a eukaryotic ribosome but others bind only to the peptidyl and exit sites. Only the radiolabeled amino acids that do not bind to the ribosomal aminoacyl-site can be excised by the N-terminal peptidase. Which of the following best describes the anticodon sequence of the transfer RNA charged by the amino acid target of the N-terminal peptidase?? {'A': "5'-UCA-3'", 'B': "5'-CAU-3'", 'C': "5'-ACA-3'", 'D': "5'-ACU-3'", 'E': "5'-UAC-3'"},
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B: 5'-CAU-3'
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Answer the following medical question with one of the provided options:
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Q:A 3-day-old female newborn delivered vaginally at 36 weeks to a 27-year-old woman has generalized convulsions lasting 3 minutes. Prior to the event, she was lethargic and had difficulty feeding. The infant has two healthy older siblings and the mother's immunizations are up-to-date. The infant appears icteric. The infant's weight and length are at the 5th percentile, and her head circumference is at the 99th percentile for gestational age. There are several purpura of the skin. Ocular examination shows posterior uveitis. Cranial ultrasonography shows ventricular dilatation, as well as hyperechoic foci within the cortex, basal ganglia, and periventricular region. Which of the following is the most likely diagnosis?? {'A': 'Congenital Treponema pallidum infection', 'B': 'Congenital cytomegalovirus infection', 'C': 'Congenital rubella infection', 'D': 'Congenital parvovirus infection', 'E': 'Congenital Toxoplasma gondii infection'},
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E: Congenital Toxoplasma gondii infection
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Answer the following medical question with one of the provided options:
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Q:A 53-year-old man with a history of alcoholic liver cirrhosis was admitted to the hospital with ascites and general wasting. He has a history of 3-5 ounces of alcohol consumption per day for 20 years and 20-pack-year smoking history. Past medical history is significant for alcoholic cirrhosis of the liver, diagnosed 5 years ago. On physical examination, the abdomen is firm and distended. There is mild tenderness to palpation in the right upper quadrant with no rebound or guarding. Shifting dullness and a positive fluid wave is present. Prominent radiating umbilical varices are noted. Laboratory values are significant for the following: Total bilirubin 4.0 mg/dL Aspartate aminotransferase (AST) 40 U/L Alanine aminotransferase (ALT) 18 U/L Gamma-glutamyltransferase 735 U/L Platelet count 11,000/mm3 WBC 4,300/mm3 Serology for viral hepatitis B and C are negative. A Doppler ultrasound of the abdomen shows significant enlargement of the epigastric superficial veins and hepatofugal flow within the portal vein. There is a large volume of ascites present. Paracentesis is performed in which 10 liters of straw-colored fluid is removed. Which of the following sites of the portocaval anastomosis is most likely to rupture and bleed first in this patient?? {'A': 'Left branch of portal vein – inferior vena cava', 'B': 'Esophageal branch of left gastric vein – esophageal branches of azygos vein', 'C': 'Umbilical vein – superficial epigastric veins', 'D': 'Splenic vein – renal vein', 'E': 'Superior and middle rectal vein – inferior rectal veins'},
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B: Esophageal branch of left gastric vein – esophageal branches of azygos vein
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Answer the following medical question with one of the provided options:
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Q:A 21-year-old man presents to the emergency room complaining of pain upon urination and a watery discharge from his penis. It started a few days ago and has been getting progressively worse. His temperature is 98.0°F (36.7°C), blood pressure is 122/74 mmHg, pulse is 83/min, respirations are 14/min, and oxygen saturation is 98% on room air. Physical exam is notable for a tender urethra with a discharge. Gram stain of the discharge is negative for bacteria but shows many neutrophils. Which of the following is the most likely infectious etiology of this patient's symptoms?? {'A': 'Chlamydia trachomatis', 'B': 'Escherichia coli', 'C': 'Neisseria gonorrhoeae', 'D': 'Staphylococcus saprophyticus', 'E': 'Trichomonas vaginalis'},
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A: Chlamydia trachomatis
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Answer the following medical question with one of the provided options:
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Q:A 9-year-old girl is brought to the pediatrician by her mother who reports that the girl has been complaining of genital itching over the past few days. She states she has noticed her daughter scratching her buttocks and anus for the past week; however, now she is scratching her groin quite profusely as well. The mother notices that symptoms seem to be worse at night. The girl is otherwise healthy, is up to date on her vaccinations, and feels well. She was recently treated with amoxicillin for a middle ear infection. The child also had a recent bought of diarrhea that was profuse and watery that seems to be improving. Her temperature is 98.5°F (36.9°C), blood pressure is 111/70 mmHg, pulse is 83/min, respirations are 16/min, and oxygen saturation is 98% on room air. Physical exam is notable for excoriations over the girl's anus and near her vagina. Which of the following is the most likely infectious etiology?? {'A': 'Candida albicans', 'B': 'Enterobius vermicularis', 'C': 'Gardnerella vaginalis', 'D': 'Giardia lamblia', 'E': 'Herpes simplex virus'},
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B: Enterobius vermicularis
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Answer the following medical question with one of the provided options:
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Q:Replication in eukaryotic cells is a highly organized and accurate process. The process involves a number enzymes such as primase, DNA polymerase, topoisomerase II, and DNA ligase. In which of the following directions is DNA newly synthesized?? {'A': "3' --> 5'", 'B': "5' --> 3'", 'C': "3' --> 5' & 5' --> 3'", 'D': 'N terminus --> C terminus', 'E': 'C terminus --> N terminus'},
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B: 5' --> 3'
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Answer the following medical question with one of the provided options:
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Q:A researcher is designing an experiment to examine the toxicity of a new chemotherapeutic agent in mice. She splits the mice into 2 groups, one of which she exposes to daily injections of the drug for 1 week. The other group is not exposed to any intervention. Both groups are otherwise raised in the same conditions with the same diet. One month later, she sacrifices the mice to check for dilated cardiomyopathy. In total, 52 mice were exposed to the drug, and 50 were not exposed. Out of the exposed group, 13 were found to have dilated cardiomyopathy on necropsy. In the unexposed group, 1 mouse was found to have dilated cardiomyopathy. Which of the following is the relative risk of developing cardiomyopathy with this drug?? {'A': '12.5', 'B': '13.7', 'C': '16.3', 'D': '23.0', 'E': '25.0'},
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A: 12.5
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Answer the following medical question with one of the provided options:
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Q:A 24-year-old woman presents to the emergency department for evaluation of lower abdominal pain. She endorses 6 hours of progressively worsening pain. She denies any significant past medical history and her physical examination is positive for non-specific, diffuse pelvic discomfort. She denies the possibility of pregnancy given her consistent use of condoms with her partner. The vital signs are: blood pressure, 111/68 mm Hg; pulse, 71/min; and respiratory rate, 15/min. She is afebrile. Which of the following is the next best step in her management?? {'A': 'Obtain a pelvic ultrasound', 'B': 'Surgical consultation', 'C': 'Abdominal CT scan', 'D': 'Serum hCG', 'E': 'Admission and observation'},
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D: Serum hCG
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Answer the following medical question with one of the provided options:
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Q:A 32-year-old man presents to his primary care physician because he has been experiencing intermittent episodes of squeezing chest pain and tightness. He says that the pain is 8/10 in severity, radiates to his left arm, and does not appear to be associated with activity. The episodes started 3 months ago and have been occuring about twice per month. His past medical history is significant for migraines for which he takes sumatriptan. Physical exam reveals no abnormalities and an EKG demonstrates sinus tachycardia with no obvious changes. An angiogram is performed to evaluate coronary artery blood flow. During the angiogram, a norepinephrine challenge is administered and blood flow is observed to decrease initially; however, after 2 minutes blood flow is observed to be increased compared to baseline. Which of the following substances is most likely responsible for the increased blood flow observed at this later time point?? {'A': 'Adenosine', 'B': 'Angiotensin', 'C': 'Epinephrine', 'D': 'Histamine', 'E': 'Thromboxane A2'},
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A: Adenosine
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Answer the following medical question with one of the provided options:
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Q:A 63-year-old man who recently immigrated to the United States from Indonesia comes to the physician because of worsening shortness of breath and swollen extremities for the past 3 months. He has had a 4-kg (8.8-lb) weight loss and intermittent fevers over the last 6 months. Examination shows pitting pedal edema and abdominal distension. Abdominal pressure over the right upper quadrant produces persistent distention of the jugular veins. An x-ray of the chest shows cavernous infiltrates in the left and right-upper lobes and a calcified cardiac silhouette. Cardiovascular examination is most likely to show which of the following?? {'A': 'Absent jugular venous pulse y descent', 'B': 'Pericardial knock', 'C': 'Fourth heart sound', 'D': 'Pulsus parvus et tardus', 'E': 'Fixed split second heart sound'},
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B: Pericardial knock
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Answer the following medical question with one of the provided options:
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Q:A 30-year-old computer scientist receives negative feedback on a recent project from his senior associate. He is told sternly that he must improve his performance on the next project. Later that day, he yells at his intern, a college student, for not showing enough initiative, though he had voiced only satisfaction with his performance up until this point. Which of the following psychological defense mechanisms is he demonstrating?? {'A': 'Projection', 'B': 'Displacement', 'C': 'Countertransference', 'D': 'Acting out', 'E': 'Transference'},
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B: Displacement
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Answer the following medical question with one of the provided options:
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Q:A 27-year-old diabetic male rushes to the emergency department after finding his blood glucose level to be 492 mg/dL which is reconfirmed in the ED. He currently does not have any complaints except for a mild colicky abdominal pain. His temperature is 37°C (98.6°F), respirations are 15/min, pulse is 67/min, and blood pressure is 122/88 mm Hg. Blood is drawn for labs the result of which is given below: Serum: pH 7.0 pCO2 32 mm Hg HCO3- 15.2 mEq/L Sodium 122 mEq/L Potassium 4.8 mEq/L Urinalysis is positive for ketone bodies. He is admitted to the hospital and given intravenous bicarbonate and then started on an insulin drip and normal saline. 7 hours later, he is found to be confused and complaining of a severe headache. His temperature is 37°C (98.6°F), pulse is 50/min, respirations are 13/min and irregular, and blood pressure is 137/95 mm Hg. What other examination findings would be expected in this patient?? {'A': 'Pupillary constriction', 'B': 'Hypoglycemia', 'C': 'Pancreatitis', 'D': 'Papilledema', 'E': 'Peripheral edema'},
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D: Papilledema
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Answer the following medical question with one of the provided options:
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Q:A 70-year-old male presents to his primary care provider complaining of decreased sexual function. He reports that over the past several years, he has noted a gradual decline in his ability to sustain an erection. He used to wake up with erections but no longer does. His past medical history is notable for diabetes, hyperlipidemia, and a prior myocardial infarction. He takes metformin, glyburide, aspirin, and atorvastatin. He drinks 2-3 drinks per week and has a 25 pack-year smoking history. He has been happily married for 40 years. He retired from his job as a construction worker 5 years ago and has been enjoying retirement with his wife. His physician recommends starting a medication that is also used in the treatment of pulmonary hypertension. Which of the following is a downstream effect of this medication?? {'A': 'Decrease nitrous oxide production', 'B': 'Increase cAMP production', 'C': 'Increase cGMP production', 'D': 'Increase cGMP degradation', 'E': 'Decrease cGMP degradation'},
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E: Decrease cGMP degradation
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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 with Crohn disease is admitted to the hospital because of acute small bowel obstruction. Endoscopy shows a stricture in the terminal ileum. The ileum is surgically resected after endoscopic balloon dilatation fails to relieve the obstruction. Three years later, he returns for a follow-up examination. He takes no medications. This patient is most likely to have which of the following physical exam findings?? {'A': 'Weakness and ataxia', 'B': 'Hyperreflexia with tetany', 'C': 'Gingival swelling and bleeding', 'D': 'Pallor with koilonychia', 'E': 'Dry skin and keratomalacia'},
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A: Weakness and ataxia
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Answer the following medical question with one of the provided options:
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Q:A 52-year-old woman presents to the emergency department with breathlessness for the past 6 hours. She denies cough, nasal congestion or discharge, sneezing, blood in sputum, or palpitation. There is no past history of chronic respiratory or cardiovascular medical conditions, but she mentions that she has been experiencing frequent cramps in her left leg for the past 5 days. She is post-menopausal and has been on hormone replacement therapy for a year now. Her temperature is 38.3°C (100.9°F), the pulse is 116/min, the blood pressure is 136/84 mm Hg, and the respiratory rate is 24/min. Edema and tenderness are present in her left calf region. Auscultation of the chest reveals rales over the left infrascapular and scapular region. The heart sounds are normal and there are no murmurs. Which of the following mechanisms most likely contributed to the pathophysiology of this patient’s condition?? {'A': 'Decreased alveolar-arterial oxygen tension gradient', 'B': 'Decreased physiologic dead space', 'C': 'Secretion of vasodilating neurohumoral substances in pulmonary vascular bed', 'D': 'Alveolar hyperventilation', 'E': 'Increased right ventricular preload'},
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D: Alveolar hyperventilation
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Answer the following medical question with one of the provided options:
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Q:A 24-year-old woman comes to the physician because of progressively worsening episodes of severe, crampy abdominal pain and nonbloody diarrhea for the past 3 years. Examination of the abdomen shows mild distension and generalized tenderness. There is a fistula draining stool in the perianal region. Immunohistochemistry shows dysfunction of the nucleotide oligomerization binding domain 2 (NOD2) protein. This dysfunction most likely causes overactivity of which of the following immunological proteins in this patient?? {'A': 'β-catenin', 'B': 'Interferon-γ', 'C': 'NF-κB', 'D': 'IL-10', 'E': 'IL-1β'},
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C: NF-κB
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Answer the following medical question with one of the provided options:
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Q:A 35-year-old man presents with yellow discoloration of his eyes and skin for the past week. He also says he has pain in the right upper quadrant for the past few days. He is fatigued constantly and has recently developed acute onset itching all over his body. The patient denies any allergies. Past medical history is significant for ulcerative colitis diagnosed 2 years ago, managed medically. He is vaccinated against hepatitis A and B and denies any recent travel abroad. There is scleral icterus present, and mild hepatosplenomegaly is noted. The remainder of the physical examination is unremarkable. Laboratory findings are significant for: Total bilirubin 3.4 mg/dL Prothrombin time 12 s Aspartate transaminase (AST) 158 IU/L Alanine transaminase (ALT) 1161 IU/L Alkaline phosphatase 502 IU/L Serum albumin 3.1 g/dL Perinuclear antineutrophil cytoplasmic antibodies (p-ANCA) positive Which of the following is the most likely diagnosis in this patient?? {'A': 'Hepatitis E', 'B': 'Primary sclerosing cholangitis', 'C': 'Hepatitis A', 'D': 'Primary biliary cirrhosis', 'E': 'Hepatitis B'},
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B: Primary sclerosing cholangitis
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Answer the following medical question with one of the provided options:
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Q:A 42-year-old man presents to the physician with a painful ulcer in the mouth for 1 week. He has had similar episodes of ulcers over the past year. Every episode lasts about a week and heals without leaving a scar. He has also had similar ulcers on the scrotum, but the ulcers have left scars. He takes no medications. His temperature is 36.8°C (98.2°F), and the rest of the vital signs are stable. On physical examination, a 1-cm yellowish ulcer with a necrotic base is seen on the right buccal mucosa. Also, there are several tender nodules of different sizes on both shins. An image of one of the nodules is shown. Which of the following is the most likely complication of this patient’s current condition?? {'A': 'Uveitis', 'B': 'Cerebral brain thrombosis', 'C': 'Deforming arthritis', 'D': 'Gastrointestinal ulceration', 'E': 'Pulmonary embolism'},
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A: Uveitis
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Answer the following medical question with one of the provided options:
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Q:A 48-year-old man presents to the ER with a sudden-onset, severe headache. He is vomiting and appears confused. His wife, who accompanied him, says that he has not had any trauma, and that the patient has no relevant family history. He undergoes a non-contrast head CT that shows blood between the arachnoid and pia mater. What is the most likely complication from this condition?? {'A': 'Blindness', 'B': 'Arterial Vasospasm', 'C': 'Hemorrhagic shock', 'D': 'Bacterial Meningitis', 'E': 'Renal failure'},
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B: Arterial Vasospasm
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Answer the following medical question with one of the provided options:
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Q:A 25-year-old man presents to his primary care physician for recurrent headaches. The patient states that the headaches have been going on for the past week, and he is concerned that he may have cancer. Based on his symptoms, he strongly believes that he needs further diagnostic workup. The patient works as a nurse at the local hospital and is concerned that he is going to lose his job. The patient is also concerned about his sexual performance with his girlfriend, and as a result he has ceased to engage in sexual activities. Finally, the patient is concerned about his relationship with his family. He states that his concerns related to these issues has persisted for the past year. The patient has a past medical history of obesity, diabetes, hypertension, and irritable bowel syndrome. His current medications include metformin, insulin, lisinopril, and hydrochlorothiazide. The patient has a family history of colorectal cancer in his grandfather and father. The patient’s neurological exam is within normal limits. The patient denies having a headache currently. Which of the following is the best initial step in management?? {'A': 'Buspirone', 'B': 'Clonazepam', 'C': 'Fluoxetine', 'D': 'MRI head', 'E': 'Sumatriptan'},
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C: Fluoxetine
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Answer the following medical question with one of the provided options:
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Q:A 54-year-old woman is brought to the emergency department by a nurse 30 minutes after receiving scheduled radiation therapy for papillary thyroid cancer. After the radioisotope was ingested, the physician realized that a much larger fixed dose was given instead of the appropriate dose based on radiation dosimetry. Which of the following pharmacotherapies should be administered immediately to prevent complications from this exposure?? {'A': 'Propylthiouracil', 'B': 'Mercaptoethanesulfonate', 'C': 'Potassium iodide', 'D': 'Methimazole', 'E': 'Dexrazoxane'},
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C: Potassium iodide
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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 into the emergency department as he was wandering the streets naked with a sword. The patient had to be forcibly restrained by police and is currently combative. Upon calming the patient and obtaining further history, the patient states that he is being pursued and that he needs to kill them all. The patient is given intramuscular (IM) haloperidol and diphenhydramine, and is admitted into the psychiatric ward. The patient has a past medical history of schizophrenia, obesity, anxiety, recurrent pneumonia, and depression. The patient is started on his home medication and is discharged 5 days later with prescriptions for multiple psychiatric medications including mood stabilizers and antidepressants. One week later, the patient is found by police standing outside in freezing weather. He is brought to the emergency department with a rectal temperature of 93.2°F (34°C). Resuscitation is started in the emergency department. Which of the following medications most likely exacerbated this patient's current presentation?? {'A': 'Diphenhydramine', 'B': 'Lithium', 'C': 'Fluoxetine', 'D': 'Fluphenazine', 'E': 'Valproic acid'},
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D: Fluphenazine
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Answer the following medical question with one of the provided options:
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Q:A 15-year-old boy is referred to a child psychologist because of worsening behavior and constant disruption in class. He has received multiple reprimands in the past 6 months for not doing the homework his teacher assigned, and he refuses to listen to the classroom instructions. Additionally, his teachers say he is very argumentative and blames other children for not letting him do his work. He was previously well behaved and one of the top students in his class. He denies any recent major life events or changes at home. His past medical history is noncontributory. His vital signs are all within normal limits. Which of the following is the most likely diagnosis?? {'A': 'Antisocial personality disorder', 'B': 'Attention deficit hyperactivity disorder', 'C': 'Conduct disorder', 'D': 'Major depressive disorder', 'E': 'Oppositional defiant disorder'},
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E: Oppositional defiant disorder
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Answer the following medical question with one of the provided options:
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Q:A 33-year-old HIV-positive male is seen in clinic for follow-up care. When asked if he has been adhering to his HIV medications, the patient exclaims that he has been depressed, thus causing him to not take his medication for six months. His CD4+ count is now 33 cells/mm3. What medication(s) should he take in addition to his anti-retroviral therapy?? {'A': 'Fluconazole', 'B': 'Dapsone', 'C': 'Azithromycin and trimethoprim-sulfamethoxazole', 'D': 'Azithromycin and fluconazole', 'E': 'Azithromycin, dapsone, and fluconazole'},
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C: Azithromycin and trimethoprim-sulfamethoxazole
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Answer the following medical question with one of the provided options:
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Q:A 25-year-old G1P0 at 20 weeks of gestation woman arrives at a prenatal appointment complaining of pelvic pressure. She has had an uncomplicated pregnancy thus far. She takes prenatal vitamins and eats a well-balanced diet. Her medical history is significant for major depressive disorder that has been well-controlled on citalopram. Her mother had gestational diabetes with each of her 3 pregnancies. On physical exam, the cervix is soft and closed with minimal effacement. There is white vaginal discharge within the vagina and vaginal vault without malodor. Vaginal pH is 4.3. A transvaginal ultrasound measures the length of the cervix as 20 mm. Which of the following is most likely to prevent preterm birth in this patient?? {'A': 'Metformin', 'B': 'Metronidazole', 'C': 'Pessary', 'D': 'Prednisone', 'E': 'Vaginal progesterone'},
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E: Vaginal progesterone
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Answer the following medical question with one of the provided options:
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Q:A 31-year-old woman comes to the emergency department requesting an abortion. She hears voices telling her that she needs ""to undergo a cleanse."" She experiences daytime sleepiness because she repeatedly wakes up at night. She says that she is no longer interested in activities that she used to enjoy. About 2 months ago, her psychiatrist switched her medication from aripiprazole to risperidone because it was not effective even at maximum dose. Vital signs are within normal limits. Mental status examination shows accelerated speech, and the patient regularly switches the conversation to the natural habitat of bees. A urine pregnancy test is positive. Toxicology screening is negative. Pelvic ultrasonography shows a pregnancy at an estimated 15 weeks' gestation. Following admission to the hospital, which of the following is the most appropriate next step in management?"? {'A': 'Clozapine therapy', 'B': 'Quetiapine therapy', 'C': 'Electroconvulsive therapy', 'D': 'Clomipramine therapy', 'E': 'Lithium therapy'},
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A: Clozapine therapy
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Answer the following medical question with one of the provided options:
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Q:A 34-year-old man comes to the physician because of foul-smelling diarrhea, fatigue, and bloating for 6 months. During this time, he has had a 5-kg (11-lb) weight loss without a change in diet. He has type 1 diabetes mellitus that is well-controlled with insulin. Examination shows conjunctival pallor and inflammation of the corners of the mouth. The abdomen is soft, and there is diffuse tenderness to palpation with no guarding or rebound. His hemoglobin concentration is 10.4 g/dL. The patient undergoes upper endoscopy. A photomicrograph of tissue from an intestinal biopsy is shown. Which of the following is most likely to improve this patient's symptoms?? {'A': 'Treatment with ceftriaxone', 'B': 'Avoidance of certain types of cereal grains', 'C': 'Surgical resection of the colon', 'D': 'Reduced intake of milk proteins', 'E': 'Supplemention of pancreatic enzymes\n"'},
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B: Avoidance of certain types of cereal grains
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Answer the following medical question with one of the provided options:
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Q:A 55-year-old man presents to his primary care physician for trouble swallowing. The patient claims that he used to struggle when eating food if he did not chew it thoroughly, but now he occasionally struggles with liquids as well. He also complains of a retrosternal burning sensation whenever he eats. He also claims that he feels his throat burns when he lays down or goes to bed. Otherwise, the patient has no other complaints. The patient has a past medical history of obesity, diabetes, constipation, and anxiety. His current medications include insulin, metformin, and lisinopril. On review of systems, the patient endorses a 5 pound weight loss recently. The patient has a 22 pack-year smoking history and drinks alcohol with dinner. His temperature is 99.5°F (37.5°C), blood pressure is 177/98 mmHg, pulse is 90/min, respirations are 17/min, and oxygen saturation is 98% on room air. On physical exam, you note an overweight man in no current distress. Abdominal exam is within normal limits. Which of the following is the best next step in management?? {'A': 'Barium swallow', 'B': 'CT scan', 'C': 'Endoscopy', 'D': 'Manometry', 'E': 'Omeprazole trial'},
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C: Endoscopy
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Answer the following medical question with one of the provided options:
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Q:A 63-year-old man comes to the physician because of a 2-day history of fever and blood-tinged sputum. He has also had a productive cough for 1 year and has had 3 episodes of sinusitis during this time. Physical examination shows palpable erythematous skin lesions over his hands and feet that do not blanch on pressure. There are ulcerations of the nasopharyngeal mucosa and a perforation of the nasal septum. His serum creatinine is 2.6 mg/dL. Urinalysis shows acanthocytes, 70 RBCs/hpf, 2+ proteinuria, and RBC casts. An x-ray of the chest shows multiple, cavitating, nodular lesions bilaterally. Further evaluation of this patient is most likely to show which of the following findings?? {'A': 'Elevated anti-Smith titers', 'B': 'Elevated serum IgA titers', 'C': 'Elevated p-ANCA titers', 'D': 'Positive tuberculin test', 'E': 'Elevated c-ANCA titers'},
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E: Elevated c-ANCA titers
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Answer the following medical question with one of the provided options:
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Q:A 35-year-old man is brought into the emergency department by emergency medical services with his right hand wrapped in bloody bandages. The patient states that he is a carpenter and was cutting some wood for a home renovation project when he looked away and injured one of his digits with a circular table saw. He states that his index finger was sliced off and is being brought in by his wife. On exam, his vitals are within normal limits and stable, and he is missing part of his second digit on his right hand distal to the proximal interphalangeal joint. How should the digit be transported to the hospital for the best outcome?? {'A': 'Wrapped in a towel', 'B': 'In a sterile bag of tap water', 'C': 'In a sterile plastic bag wrapped in saline moistened gauze', 'D': 'In a sterile plastic bag wrapped in saline moistened gauze on ice', 'E': 'In the pocket of a coat or a jacket'},
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D: In a sterile plastic bag wrapped in saline moistened gauze on ice
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Answer the following medical question with one of the provided options:
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Q:A 22-year-old female presents to your office with gas, abdominal distention, and explosive diarrhea. She normally enjoys eating cheese but has been experiencing these symptoms after eating it for the past few months. She has otherwise been entirely well except for a few days of nausea, diarrhea, and vomiting earlier in the year from which she recovered without treatment. Which of the following laboratory findings would you expect to find during workup of this patient?? {'A': 'Decreased stool osmolar gap', 'B': 'Decreased stool pH', 'C': 'Positive fecal smear for leukocytes', 'D': 'Positive stool culture for Rotavirus', 'E': 'Positive stool culture for T. whippelii'},
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B: Decreased stool pH
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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 the emergency department with a hot, swollen, and painful knee. He was playing with his friends and accidentally bumped into one of them with his knee prior to presentation. His medical history is significant for an immunodeficiency syndrome, and he has been treated with long courses of antibiotics for multiple infections. His mother is concerned because he has also had significant bleeding that was hard to control following previous episodes of trauma. Laboratory tests are obtained with the following results: Prothrombin time: Prolonged Partial thromboplastin time: Prolonged Bleeding time: Normal The activity of which of the following circulating factors would most likely be affected by this patient's disorder?? {'A': 'Factor VIII', 'B': 'Factor XI', 'C': 'Platelet factor 4', 'D': 'Protein C', 'E': 'von Willebrand factor'},
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D: Protein C
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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 for an annual pelvic examination and Pap smear. Her last Pap smear was 3 years ago. She has been sexually active with multiple male partners and takes an oral contraceptive. She has smoked one pack of cigarettes daily for 10 years. Pelvic examination shows no abnormalities. A photomicrograph of cervical cells from the Pap smear specimen is shown. Cells similar to the one indicated by the arrow are most likely to be seen in which of the following conditions?? {'A': 'Genital herpes', 'B': 'Trichomoniasis', 'C': 'Condylomata acuminata', 'D': 'Syphilitic chancre', 'E': 'Bacterial vaginosis'},
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C: Condylomata acuminata
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Answer the following medical question with one of the provided options:
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Q:A 4-year-old boy is brought to the physician by his parents because of concerns about his behavior during the past year. His parents report that he often fails to answer when they call him and has regular unprovoked episodes of crying and screaming. At kindergarten, he can follow and participate in group activities, but does not follow his teacher's instructions when these are given to him directly. He is otherwise cheerful and maintains eye contact when spoken to but does not respond when engaged in play. He gets along well with friends and family. He started walking at the age of 11 months and can speak in two-to-three-word phrases. He often mispronounces words. Which of the following is the most likely diagnosis?? {'A': 'Selective mutism', 'B': 'Hearing impairment', 'C': 'Autistic spectrum disorder', 'D': 'Specific-learning disorder', 'E': 'Conduct disorder'},
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B: Hearing impairment
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Q:A 30-year-old woman presents to her primary care physician for evaluation of irregular and heavy periods. She also complains of recent fatigue, joint pain, and constipation. Physical exam is notable for thinning eyebrows and recent weight gain. Her temperature is 98.0°F (36.7°C), blood pressure is 140/90 mmHg, 51/min, and respirations are 19/min. Laboratory studies reveal the following: Serum: Na+: 141 mEq/L K+: 4.3 mEq/L Cl-: 102 mEq/L BUN: 15 mg/dL Glucose: 115 mg/dL Creatinine: 1.0 mg/dL Thyroid-stimulating hormone: 11.2 µU/mL Total T4: 2 ug/dL Thyroglobulin antibodies: Positive Anti-thyroid peroxidase antibodies: Positive Which of the following is this patient at increased risk of in the future?? {'A': 'Papillary carcinoma', 'B': 'Parathyroid adenoma', 'C': 'Subacute thyroiditis', 'D': 'Thyroid lymphoma', 'E': 'Thyroid storm'},
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D: Thyroid lymphoma
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Q:A 9-year-old African-American boy is brought to the physician by his mother because of an itchy rash on the right side of his scalp and progressive loss of hair for 1 month. He has no history of serious illness. His younger sibling was treated for pediculosis capitis 3 months ago. The boy attends elementary school, but has not been going for the last week because he was too embarrassed by the rash. He appears anxious. A photograph of his scalp is shown. Occipital lymphadenopathy is present. The remainder of the examination shows no abnormalities. Which of the following is the most appropriate next step in management?? {'A': 'Shampoo containing zinc-pyrithone', 'B': 'Topical mupirocin', 'C': 'Oral griseofulvin', 'D': 'Topical permethrin', 'E': 'Calcipotriene'},
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C: Oral griseofulvin
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Q:A 13-year-old boy is brought to the physician by his mother because she is concerned about her son's behavior. She reports that he has been wearing her dresses at home and asks to be called Lilly. He also stopped going to swim class because he “doesn't feel comfortable in swim trunks.” Since starting puberty about a year ago, he has not had any friends and the teachers report he is consistently being bullied at school. His academic performance has been poor for the last year even though he had maintained an A average the year before. The mother further reports that her son has had mainly female friends since preschool. She also mentions that as a child her son never enjoyed playing with typical boy toys like cars and instead preferred dressing up dolls. The patient was raised by his single mother from the age of 8 because his father left the family due to financial issues. He appears shy. Physical examination shows normal male external genitalia. There is scarce coarse, dark axillary and pubic hair. Upon questioning, the patient reports that he would rather be a girl. Which of the following is the most likely diagnosis?? {'A': 'Gender nonconformity', 'B': 'Sexual aversion', 'C': 'Body dysmorphic disorder', 'D': 'Gender dysphoria', 'E': 'Fetishistic disorder'},
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D: Gender dysphoria
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Q:A 42-year-old woman comes to her primary care physician with 2 days of fever and malaise. She also says that she has a painful red lesion on her left hand that she noticed after shucking oysters at a recent family reunion. Physical exam reveals a well-demarcated swollen, tender, warm, red lesion on her left hand. Pressing the lesion causes a small amount of purulent drainage. The material is cultured and the causative organism is identified. Which of the following characteristics describes the organism that is most associated with this patient's mechanism of infection?? {'A': 'Gram-negative aerobe', 'B': 'Gram-negative anaerobe', 'C': 'Gram-negative facultative anaerobe', 'D': 'Gram-positive chains', 'E': 'Gram-positive clusters'},
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C: Gram-negative facultative anaerobe
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Q:A 10-year-old boy is brought to the emergency room after a fall from a horse. He has severe pain in his right forearm. He has a history of asthma and atopic dermatitis. His current medications include an albuterol inhaler and hydrocortisone cream. Examination shows an open fracture of the right forearm and no other injuries. The patient is given a parenteral infusion of 1 L normal saline, cefazolin, morphine, and ondansetron. The right forearm is covered with a splint. Informed consent for surgery is obtained. Fifteen minutes later, the patient complains of shortness of breath. He has audible wheezing. His temperature is 37.0°C (98.6°F), heart rate is 130/min, respiratory rate is 33/min, and blood pressure is 80/54 mm Hg. Examination shows generalized urticaria and lip swelling. There is no conjunctival edema. Scattered wheezing is heard throughout both lung fields. Which of the following is the most appropriate next step in management?? {'A': 'Administer intravenous diphenhydramine', 'B': 'Administer vancomycin and piperacillin-tazobactam', 'C': 'Administer intravenous methylprednisolone', 'D': 'Administer intramuscular epinephrine', 'E': 'Endotracheal intubation'},
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D: Administer intramuscular epinephrine
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Q:A 25-year-old man presents to the emergency department after numerous episodes of vomiting. The patient states that he thinks he ‘ate something weird’ and has been vomiting for the past 48 hours. He says that he came to the hospital because the last few times he "threw up blood". He is hypotensive with a blood pressure of 90/55 mm Hg and a pulse of 120/min. After opening an intravenous line, a physical examination is performed which is normal except for mild epigastric tenderness. An immediate endoscopy is performed and a tear involving the mucosa and submucosa of the gastroesophageal junction is visualized. Which of the following is the most likely diagnosis?? {'A': 'Boerhaave syndrome', 'B': 'Gastric ulcer', 'C': 'Esophageal varices', 'D': 'Hiatal hernia', 'E': 'Mallory-Weiss tear'},
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E: Mallory-Weiss tear
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Q:A child is born by routine delivery and quickly develops respiratory distress. He is noted to have epicanthal folds, low-set ears that are pressed against his head, widely set eyes, a broad, flat nose, clubbed fleet, and a receding chin. The mother had one prenatal visit, at which time the routine ultrasound revealed an amniotic fluid index of 3 cm. What is the most likely underlying cause of this patient's condition?? {'A': 'An extra 18th chromosome', 'B': 'Bilateral renal agenesis', 'C': 'Autosomal recessive polycystic kidney disease (ARPKD)', 'D': 'Unilateral renal agenesis', 'E': 'A microdeletion in chromosome 22'},
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B: Bilateral renal agenesis
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Q:A 27-year-old primigravid woman at 32 weeks' gestation comes to the physician for a prenatal visit. She has had swollen legs, mild shortness of breath, and generalized fatigue for the past 2 weeks. Medications include iron supplements and a multivitamin. Her temperature is 37.2°C (99°F), pulse is 93/min, respirations are 20/min, and blood pressure is 108/60 mm Hg. There is 2+ pitting edema of the lower extremities, but no erythema or tenderness. The lungs are clear to auscultation. Cardiac examination shows an S3 gallop. Pelvic examination shows a uterus consistent in size with a 32-week gestation. Which of the following is the most appropriate next step in management for this patient's symptoms?? {'A': 'Echocardiography', 'B': 'Urinalysis', 'C': 'Lower extremity doppler', 'D': 'Ventilation-perfusion scan', 'E': 'Reassurance and monitoring\n"'},
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E: Reassurance and monitoring "
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Q:A 34-year-old primigravida was brought to an obstetric clinic with a chief complaint of painless vaginal bleeding. She was diagnosed with placenta praevia and transfused with 2 units of whole blood. Five hours after the transfusion, she developed a fever and chills. How could the current situation be prevented?? {'A': 'Performing Coombs test before transfusion', 'B': 'Administering prophylactic epinephrine', 'C': 'Administering prophylactic immunoglobulins', 'D': 'Transfusing leukocyte reduced blood products', 'E': 'ABO grouping and Rh typing before transfusion'},
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D: Transfusing leukocyte reduced blood products
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Q:A previously healthy 6-year-old boy is brought to the physician because of a 3-day history of progressive rash. The rash started on his face and now involves the entire body. For the past week, he has had a cough and a runny nose. He is visiting from the Philippines with his family. He is in first grade and spends his afternoons at an after-school child care program. Immunization records are not available. His temperature is 39.5°C (103°F), pulse is 115/min, and blood pressure is 105/66 mm Hg. Examination shows generalized lymphadenopathy. There is an erythematous maculopapular, blanching, and partially confluent exanthem on his entire body. The remainder of the examination shows no abnormalities. Which of the following is most likely to confirm the diagnosis?? {'A': 'Rapid plasma reagin', 'B': 'Tzanck smear', 'C': 'Measles-specific IgM antibodies', 'D': 'Rapid antigen detection testing', 'E': 'Monospot test'},
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C: Measles-specific IgM antibodies
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Q:An investigator is studying bacterial toxins in a nonpathogenic bacterial monoculture that has been inoculated with specific bacteriophages. These phages were previously cultured in a toxin-producing bacterial culture. After inoculation, a new toxin is isolated from the culture. Genetic sequencing shows that the bacteria have incorporated viral genetic information, including the gene for this toxin, into their genome. The described process is most likely responsible for acquired pathogenicity in which of the following bacteria?? {'A': 'Staphylococcus aureus', 'B': 'Corynebacterium diphtheriae', 'C': 'Haemophilus influenzae', 'D': 'Neisseria meningitidis', 'E': 'Streptococcus pneumoniae'},
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B: Corynebacterium diphtheriae
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Q:A 35-year-old patient is brought into the emergency department post motor vehicle crash. Stabilization of the patient in the trauma bay requires endotracheal intubation. The patient has a laceration on the femoral artery from shrapnel and seems to have lost large quantities of blood. The patient is transfused with 13 units of packed red blood cells. His vitals are T 96.5, HR 150, BP 90/40. Even with the direct pressure on the femoral artery, the patient continues to bleed. Results of labs drawn within the last hour are pending. Which of the following is most likely to stop the bleeding in this patient?? {'A': 'Fresh frozen plasma and platelets', 'B': 'Whole blood', 'C': 'Dextrose', 'D': 'Normal saline', 'E': 'Cryoprecipitate'},
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A: Fresh frozen plasma and platelets
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Q:A 42-year-old woman comes to the physician because of urinary leakage over the last year. She reports involuntarily losing small amounts of urine after experiencing a sudden need to void. She has difficulty making it to the bathroom in time, and only feels comfortable going out into public if she has documented the location of all nearby restrooms. She also has begun to wake up at night to urinate. These symptoms have persisted despite 6 months of bladder training and weight loss and reducing soda and coffee intake. Physical examination shows no abnormalities. The most appropriate pharmacotherapy for this patient is a drug that has which of the following mechanisms of action?? {'A': 'Antagonism of muscarinic M3 receptors', 'B': 'Antagonism of alpha-1 adrenergic receptors', 'C': 'Antagonism of beta-3 adrenergic receptors', 'D': 'Agonism of beta-2 adrenergic receptors', 'E': 'Agonism of muscarinic M2 receptors'},
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A: Antagonism of muscarinic M3 receptors
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Q:Prior to undergoing a total knee arthroplasty, a 62-year-old man with coronary artery disease undergoes diagnostic cardiac catheterization. The catheter is inserted via the femoral artery and then advanced to the ascending aorta. Pressure tracing of the catheter is shown. The peak marked by the arrow is most likely caused by which of the following?? {'A': 'Opening of the pulmonic valve', 'B': 'Right atrial relaxation', 'C': 'Closure of the aortic valve', 'D': 'Right ventricular contraction', 'E': 'Left atrial contraction'},
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C: Closure of the aortic valve
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Answer the following medical question with one of the provided options:
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Q:A 43-year-old woman comes to the physician because of a fever, nausea, and a nonproductive cough for 7 days. During this period, she has had headaches, generalized fatigue, and muscle and joint pain. She has also had increasing shortness of breath for 2 days. She has type 2 diabetes mellitus and osteoarthritis of her left knee. Current medications include insulin and ibuprofen. She had smoked two packs of cigarettes daily for 20 years but stopped 10 years ago. Her temperature is 38.1°C (100.6°F), pulse is 94/min, respirations are 18/min, and blood pressure is 132/86 mm Hg. The lungs are clear to auscultation. There are multiple skin lesions with a blue livid center, pale intermediate zone, and a dark red peripheral rim on the upper and lower extremities. Laboratory studies show: Hemoglobin 14.6 g/dL Leukocyte count 11,100/mm3 Serum Na+ 137 mEq/L K+ 4.1 mEq/L Cl- 99 mEq/L Urea nitrogen 17 mg/dL Glucose 123 mg/dL Creatinine 0.9 mg/dL An x-ray of the chest is shown. Which of the following is the most likely causal organism?"? {'A': 'Klebsiella pneumoniae', 'B': 'Haemophilus influenzae', 'C': 'Staphylococcus aureus', 'D': 'Mycoplasma pneumoniae', 'E': 'Legionella pneumophila'},
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D: Mycoplasma pneumoniae
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Q:A 4-year-old boy is brought by his mother to the emergency room after the child was bitten by a rattlesnake one hour prior to presentation. The child was reportedly playing in the backyard alone when his mother heard the child scream. She rushed out to her child and found a snake with a rattle on its tail slithering away from the child. On examination, the child has a bleeding bite mark and significant swelling over the dorsal aspect of his right hand. He is in visible distress and appears pale and diaphoretic. The child undergoes fluid resuscitation and is placed on supplemental oxygen. He is administered rattlesnake antivenom and is admitted for observation. He is subsequently discharged 24 hours later feeling better. However, 6 days after admission, he presents again to the emergency department with a temperature of 102°F (38.9°C), diffuse wheals, and knee and hip pain. This patient’s condition is caused by which of the following?? {'A': 'Antibodies directed against cell membrane antigens', 'B': 'Antibodies directed against cell surface receptors', 'C': 'Antibody-antigen complex deposition', 'D': 'Cell-mediated direct killing', 'E': 'IgE-mediated mast cell degranulation'},
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C: Antibody-antigen complex deposition
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Answer the following medical question with one of the provided options:
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Q:A 78-year-old woman is brought by her grandson to the urgent care clinic following a fall. He states that he was in the kitchen making lunch when he heard a thud in the living room. When he ran into the room, he found the patient conscious but lying on the floor. The patient says she remembers getting up to go to the bathroom, feeling lightheaded, and then “blacking out.” She says “it all happened at once,” so she does not remember if she hit her head. The son denies witnessing myoclonic jerks. The patient denies any urinary or bowel incontinence. The patient states that she has had similar episodes like this before but had never fallen or fainted. Her medical history is significant for rheumatoid arthritis and osteoporosis. She takes methotrexate and alendronate. She smokes 1/2 a pack of cigarettes per day. The patient’s temperature is 97°F (36.1°C), blood pressure is 110/62 mmHg, pulse is 68/min, and respirations are 13/min with an oxygen saturation of 98% on room air. She has a 3-cm area of ecchymosis on her right upper extremity that is tender to palpation. Laboratory data, radiography of the right upper extremity, and a computed tomography of the head are pending. Which of the following is most likely true in this patient?? {'A': 'Carotid sinus hypersensitivity', 'B': 'Decreased fractional excretion of sodium', 'C': 'Decreased hemoglobin', 'D': 'Increased fractional excretion of urea', 'E': 'New ST-elevation on electrocardiogram'},
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B: Decreased fractional excretion of sodium
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Answer the following medical question with one of the provided options:
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Q:A previously healthy 66-year-old woman comes to the physician because of a 3-day history of fever, cough, and right-sided chest pain. Her temperature is 38.8°C (101.8°F) and respirations are 24/min. Physical examination shows dullness to percussion, increased tactile fremitus, and egophony in the right lower lung field. The remainder of the examination shows no abnormalities. Which of the following is the most likely cause of these findings?? {'A': 'Collapse of a lung segment', 'B': 'Fluid in the pleural space', 'C': 'Fluid in the interstitial space', 'D': 'Consolidation of a lung segment', 'E': 'Air in the pleural space\n"'},
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D: Consolidation of a lung segment
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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 found on a routine auditory screening to have mild high frequency hearing impairment. On exam, he has no ear pain, no focal neurological deficits, and no cardiac murmurs. He has not had any recent illness. Laboratory studies show: Serum: Creatinine: 0.7 mg/dl Protein: 3.8 g/dl Antistreptolysin O titer: 60 Todd units (12-166 normal range) Urinalysis: Microscopic heme Protein: 4+ RBCs: 6/hpf A kidney biopsy is taken. Which of the following findings is most characteristic of this patient’s disease?? {'A': '“Basket-weave” pattern of basement membrane on electron microscopy', 'B': 'Crescent-moon shapes on light microscopy', 'C': 'Large eosinophilic nodular lesions on light microscopy', 'D': 'Thickened “tram-track” appearance of basement membrane on electron microscopy', 'E': '“Spike and dome” appearance on electron microscopy'},
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A: “Basket-weave” pattern of basement membrane on electron microscopy
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Q:A 61-year-old woman comes to the physician because of a 1-week history of dizziness, nausea, vomiting, and repeated falls. Neurologic examination shows past-pointing on a finger-nose test. She has a broad-based gait. Ophthalmologic exam shows rhythmic leftward movement of the globes. A serum antibody assay is positive for anti-Yo antibodies directed at proteins expressed by Purkinje cells. This patient's condition is most likely associated with which of the following tumors?? {'A': 'Ovarian teratoma', 'B': 'Neuroblastoma', 'C': 'Breast cancer', 'D': 'Thymoma', 'E': 'Small cell lung cancer'},
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C: Breast cancer
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Answer the following medical question with one of the provided options:
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Q:A 42-year-old man is brought to the emergency department by the police after he was involved in a physical altercation at a friend’s home. Upon physical examination, the patient is disheveled. He is very agitated and actively strikes out at nurses and other hospital staff. A decision is made to place him in restraints. Head, eyes, ears, nose, and throat exam reveals temporal wasting, marked tooth decay, and healing and new ulcers in his mouth and on his lips. His pupils are dilated and minimally reactive to light. His skin shows dramatic diaphoresis as well as excoriations over his arms. Vital signs show pulse of 120/min, respirations of 12/min, temperature of 39.0°C (102.2°F), and blood pressure of 150/100 mm Hg. Urine drug screen is positive for an amphetamine. Which of the following is a life-threatening complication of the toxicity seen in this patient?? {'A': 'Heat stroke', 'B': 'Malignant hyperthermia', 'C': 'Respiratory depression', 'D': 'Seizure', 'E': 'Sudden cardiac arrest'},
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E: Sudden cardiac arrest
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Answer the following medical question with one of the provided options:
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Q:A 32-year-old man is brought to the emergency department 15 minutes after falling 7 feet onto a flat-top wooden post. On arrival, he is in severe pain and breathing rapidly. His pulse is 135/min, respirations are 30/min, and blood pressure is 80/40 mm Hg. There is an impact wound in the left fourth intercostal space at the midaxillary line. Auscultation shows tracheal deviation to the right and absent breath sounds over the left lung. There is dullness to percussion over the left chest. Neck veins are flat. Cardiac examination shows no abnormalities. Two large-bore intravenous catheters are placed and intravenous fluid resuscitation is begun. Which of the following is the most likely diagnosis?? {'A': 'Cardiac tamponade', 'B': 'Bronchial rupture', 'C': 'Tension pneumothorax', 'D': 'Flail chest', 'E': 'Hemothorax'},
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E: Hemothorax
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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 is transferred to from another hospital after 3 days of progressively severe headache, vomiting, low-grade fever, and confusion. According to his partner, the patient has been dealing with some memory loss and complaining about headaches for the past 2 weeks. He has a history of interstitial pulmonary disease that required lung transplantation 2 years ago. Upon admission, he is found with a blood pressure of 160/100 mm Hg, a pulse of 58/min, a respiratory rate of 15/min, and a body temperature of 36°C (97°F). During the examination, he is found with oral thrush and symmetric and reactive pupils; there are no focal neurological signs or papilledema. A lumbar puncture is performed. Which of the following features would be expected to be found in this case?? {'A': 'Aspect: xanthochromic, opening pressure: normal, cell count: ↑ red blood cells, protein: normal, glucose: normal', 'B': 'Aspect: cloudy, opening pressure: ↑, cell count: ↑ neutrophils, protein: ↑, glucose: ↓', 'C': 'Aspect: clear, opening pressure: normal, cell count: ↑ lymphocytes, protein: normal, glucose: normal', 'D': 'Aspect: cloudy, opening pressure: ↑, cell count: ↑ lymphocytes, protein: ↑, glucose: ↓', 'E': 'Aspect: clear, opening pressure: normal, cell count: < 5 cells/µL, protein: normal, glucose: normal'},
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D: Aspect: cloudy, opening pressure: ↑, cell count: ↑ lymphocytes, protein: ↑, glucose: ↓
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Answer the following medical question with one of the provided options:
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Q:A 56-year-old woman comes to the emergency department because of worsening pain and swelling in her right knee for 3 days. She underwent a total knee arthroplasty of her right knee joint 5 months ago. The procedure and immediate aftermath were uneventful. She has hypertension and osteoarthritis. Current medications include glucosamine, amlodipine, and meloxicam. Her temperature is 37.9°C (100.2°F), pulse is 95/min, and blood pressure is 115/70 mm Hg. Examination shows a tender, swollen right knee joint; range of motion is limited by pain. The remainder of the examination shows no abnormalities. Arthrocentesis of the right knee is performed. Analysis of the synovial fluid shows: Appearance Cloudy Viscosity Absent WBC count 78,000/mm3 Segmented neutrophils 94% Lymphocytes 6% Synovial fluid is sent for culture and antibiotic sensitivity. Which of the following is the most likely causal pathogen?"? {'A': 'Pseudomonas aeruginosa', 'B': 'Staphylococcus epidermidis', 'C': 'Staphylococcus aureus', 'D': 'Escherichia coli', 'E': 'Streptococcus agalactiae'},
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B: Staphylococcus epidermidis
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Answer the following medical question with one of the provided options:
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Q:A 52-year-old woman presents to the urgent care center with several hours of worsening abdominal discomfort that radiates to the back. The patient also complains of malaise, chills, nausea, and vomiting. Social history is notable for alcoholism. On physical exam, she is febrile to 39.5°C (103.1℉), and she is diffusely tender on abdominal palpation. Other vital signs include a blood pressure of 126/74 mm Hg, heart rate of 74/min, and respiratory rate of 14/min. Complete blood count is notable for 13,500 white blood cells (WBCs), and her complete metabolic panel shows bilirubin of 2.1 and amylase of 3210. Given the following options, what is the most likely diagnosis?? {'A': 'Cholelithiasis', 'B': 'Acute cholecystitis', 'C': 'Gallstone pancreatitis', 'D': 'Choledocholithiasis', 'E': 'Ascending cholangitis'},
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C: Gallstone pancreatitis
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Answer the following medical question with one of the provided options:
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Q:A 32-year-old man and his wife are sent to a fertility specialist after trying to conceive for several years without success. They have had unprotected sex several times a week. He has no history of a serious illness and does not take any medications. There are no concerns about his libido or erections. His female partner is not on contraceptive medication and has a child from a previous marriage. At the clinic, his vitals are normal. Examination of the scrotum on the right side is normal, but on the left side there are many deep and superficial ducts or vessels that feels like a bag of worms on palpation. The lesion is more apparent when the patient bears down. Semen analysis shows a low sperm count with poor motility and an increased percentage of abnormal sperms. Which of the following is the most appropriate next step in management?? {'A': 'Intracytoplasmic sperm injection', 'B': 'Ligation of processus vaginalis', 'C': 'Microsurgical varicocelectomy', 'D': 'Pulsatile GNRH', 'E': 'No therapy at this time'},
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C: Microsurgical varicocelectomy
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Answer the following medical question with one of the provided options:
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Q:An 80-year-old man presents to the emergency department because of gnawing substernal chest pain that started an hour ago and radiates to his neck and left jaw. A 12-lead ECG is obtained and shows ST-segment elevation with newly developing Q waves. He is admitted for treatment. 4 days after hospitalization he suddenly develops altered mental status, and his blood pressure falls from 115/75 mm Hg to 80/40 mm Hg. Physical examination shows jugular venous distention, pulsus paradoxus, and distant heart sounds. What is the most likely cause of this patient's condition?? {'A': 'Acute pulmonary edema causing right heart failure', 'B': 'Arrhythmia caused by ventricular fibrillation', 'C': 'Compression of heart chambers by blood in the pericardial space', 'D': 'Pericardial inflammation', 'E': 'Rupture of papillary muscle'},
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C: Compression of heart chambers by blood in the pericardial space
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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 is admitted to the hospital with productive cough and fever. A chest radiograph is obtained and shows lobar consolidation. The patient is diagnosed with pneumonia. He has a history of penicillin allergy. The attending physician orders IV levofloxacin as empiric therapy. On morning rounds the next day, the team discovers that the patient was administered ceftriaxone instead of levofloxacin. The patient has already received a full dose of ceftriaxone and had no signs of allergic reaction, and his pneumonia appears to be improving clinically. What is the most appropriate next step?? {'A': 'Continue with ceftriaxone as empiric therapy', 'B': 'Continue with ceftriaxone and add azithromycin as inpatient empiric pneumonia therapy', 'C': 'Switch the patient to oral azithromycin in preparation for discharge and home therapy', 'D': 'Administer diphenhydramine as prophylaxis against allergic reaction', 'E': 'Switch the patient back to levofloxacin and discuss the error with the patient'},
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E: Switch the patient back to levofloxacin and discuss the error with the patient
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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 is diagnosed with hypertension. He has asthma. The creatinine and potassium levels are both slightly elevated. Which of the following anti-hypertensive drugs would be appropriate in his case?? {'A': 'Amlodipine', 'B': 'Propranolol', 'C': 'Enalapril', 'D': 'Hydrochlorothiazide (HCT)', 'E': 'Spironolactone'},
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A: Amlodipine
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Answer the following medical question with one of the provided options:
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Q:A 5-year-old girl is brought to the physician because of watery discharge from her right eye for 2 weeks. She and her parents, who are refugees from Sudan, arrived in Texas a month ago. Her immunization status is not known. She is at the 25th percentile for weight and the 50th percentile for height. Her temperature is 37.2°C (99°F), pulse is 90/min, and respirations are 18/min. Examination of the right eye shows matting of the eyelashes. Everting the right eyelid shows hyperemia, follicles, and papillae on the upper tarsal conjunctiva. Slit-lamp examination of the right eye shows follicles in the limbic region and the bulbar conjunctiva. There is corneal haziness with neovascularization at the 12 o'clock position. Examination of the left eye is unremarkable. Direct opthalmoscopy of both eyes shows no abnormalities. Right pre-auricular lymphadenopathy is present. Which of the following is the most likely diagnosis in this patient?? {'A': 'Angular conjunctivitis', 'B': 'Acute hemorrhagic conjuctivitis', 'C': 'Neisserial conjunctivitis', 'D': 'Acute herpetic conjunctivitis', 'E': 'Trachoma conjunctivitis'},
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E: Trachoma conjunctivitis
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Answer the following medical question with one of the provided options:
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Q:A 52-year-old Caucasian man with hypertension comes to the physician because of frequent urination and increased thirst. He drinks 4 oz of alcohol daily and has smoked 1 pack of cigarettes daily for the past 30 years. He is 180 cm (5 ft 10 in) tall and weighs 106 kg (233 lb); BMI is 33 kg/m2. His blood pressure is 130/80 mm Hg. Laboratory studies show a hemoglobin A1c of 8.5%. Which of the following is the most likely predisposing factor for this patient's condition?? {'A': 'Alcohol consumption', 'B': 'Caucasian ethnicity', 'C': 'High calorie diet', 'D': 'Smoking history', 'E': 'HLA-DR4 status'},
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C: High calorie diet
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Q:A 45-year-old man presents for his annual checkup. The patient has a past medical history of diabetes mellitus (DM) type 2 that is well-controlled with diet. In addition, he was admitted to this hospital 1-year ago for a myocardial infarction (MI). The patient reports a 40-pack-year smoking history. However, after his MI, his doctors informed him about how detrimental smoking was to his heart condition. Since then, he has made efforts to cut down and now, for the last six months, has stopped smoking. He says he used to use smoking as a means of dealing with his work and family stresses. He now attends wellness sessions at work and meditates early every morning before the family wakes up. Which of the following stages of the transtheoretical model is this patient most likely in?? {'A': 'Maintenance', 'B': 'Precontemplation', 'C': 'Contemplation', 'D': 'Preparation', 'E': 'Action'},
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A: Maintenance
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Q:One week after discharge from the neonatal intensive care unit to a regular pediatric ward, a 1450-g (3-lb 1-oz) male infant has respiratory distress and wheezing. After birth, the patient was intubated and mechanically ventilated for 3 weeks because of hypoxia. He required a 60% fraction of inspired oxygen to achieve adequate oxygen saturation. His temperature is 36.9°C (98.4°F), pulse is 144/min, respirations are 59/min, and blood pressure is 65/35 mm Hg. Physical examination shows labored breathing, intercostal retractions, and crackles at both lung bases. There is bluish discoloration around the lips. An x-ray of the chest shows interspersed areas of atelectasis, granular densities, and hyperinflation. Which of the following is the most likely diagnosis?? {'A': 'Bronchiolitis obliterans', 'B': 'Bronchopulmonary dysplasia', 'C': 'Meconium aspiration syndrome', 'D': 'Pulmonary hypoplasia', 'E': 'Neonatal pneumonia'},
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B: Bronchopulmonary dysplasia
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Q:A 19-year-old woman comes to the physician because of a 1-year history of severe abdominal pain, bloating, and episodic diarrhea. She has also has a 10-kg (22-lb) weight loss over the past 10 months. Physical examination shows a mildly distended abdomen, diffuse abdominal tenderness, and multiple erythematous, tender nodules on the anterior aspect of both legs. There is a small draining lesion in the perianal region. Further evaluation of this patient's gastrointestinal tract is most likely to show which of the following findings?? {'A': 'Villous atrophy', 'B': 'Crypt abscesses', 'C': 'No structural abnormalities', 'D': 'Melanosis coli', 'E': 'Transmural inflammation'},
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E: Transmural inflammation
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Q:A 21-year-old woman presents with palpitations and anxiety. She had a recent outpatient ECG that was suggestive of supraventricular tachycardia, but her previous physician failed to find any underlying disease. No other significant past medical history. Her vital signs include blood pressure 102/65 mm Hg, pulse 120/min, respiratory rate 17/min, and temperature 36.5℃ (97.7℉). Electrophysiological studies reveal an atrioventricular nodal reentrant tachycardia. The patient refuses an ablation procedure so it is decided to perform synchronized cardioversion with consequent ongoing management with verapamil. Which of the following ECG features should be monitored in this patient during treatment?? {'A': 'QRS complex amplitude', 'B': 'Length of QT interval', 'C': 'Length of PR interval', 'D': 'Length of QRS complex', 'E': 'Amplitude and direction of the T wave'},
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C: Length of PR interval
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Q:A 27-year-old is going through a pre-employment evaluation. The patient has no history of any medical conditions, but there is a strong family history of ischemic heart disease on his father’s side. The patient drinks alcohol occasionally but does not use any illicit drugs or smoke. On examination, the physician notices that the patient has a very flexible body and long fingers (seen in the image). Auscultation of the heart reveals a mid-systolic click over the apex. What is the most likely mechanism behind this finding?? {'A': 'Fibrillin defect', 'B': 'Calcification', 'C': 'Group A streptococcal pharyngitis', 'D': 'Root dilatation', 'E': 'Collagen defect'},
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A: Fibrillin defect
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Q:Three hours after undergoing left hip arthroplasty for chronic hip pain, a 62-year-old man complains of a prickling sensation in his left anteromedial thigh and lower leg. He has never had these symptoms before. He has hyperlipidemia and coronary artery disease. He has had recent right-sided gluteal and thigh pain with ambulation. Vital signs are within normal limits. Sensation to pinprick and light touch are decreased on the anteromedial left thigh as well as medial lower leg. Neurologic exam shows left leg strength 3/5 on hip flexion and 2/5 on knee extension. Patellar reflex is decreased on the left. The remainder of neurologic exam is normal. Dorsalis pedis, popliteal, and femoral pulses are 2+ bilaterally. The surgical incision is without erythema or drainage. Which of the following is the most likely underlying cause of this patient's symptoms?? {'A': 'Obturator nerve injury', 'B': 'Femoral nerve injury', 'C': 'Surgical site infection', 'D': 'Sural nerve injury', 'E': 'Femoral artery occlusion\n"'},
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B: Femoral nerve injury
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Q:A 46-year-old woman presents to your office with oral lesions as shown in Image A. On examination, you find that her back has flaccid bullae that spread when you apply lateral pressure with your fingertips. This patient most likely has autoantibodies directed against which of the following?? {'A': 'Desmosomes', 'B': 'Hemidesmosomes', 'C': 'Lamina densa', 'D': 'Lamina lucida', 'E': 'Type VII collagen'},
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A: Desmosomes
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Q:A 23-year-old G1P0 female presents to her OB/GYN for her routine 36-week visit. Her current complaints include increased fatigue at the end of the day, and edema in her ankles. The patient’s physical examination is unremarkable except for inguinal adenopathy. Upon pelvic examination for cervical changes, the OB/GYN notices a vaginal chancre. The patient states that it is not painful when touched. Which of the following is the most likely diagnosis?? {'A': 'Primary syphilis', 'B': 'Secondary syphilis', 'C': 'Gummatous syphilis', 'D': 'Neurosyphilis', 'E': 'Cardiovascular syphilis'},
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A: Primary syphilis
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Q:A 73-year-old man is brought to the emergency department because of fever, headaches, and confusion for the past 24 hours. Three years ago, he underwent heart transplantation because of congestive heart failure. His temperature is 38.1°C (100.5°F). He is oriented only to person. Physical examination shows nuchal rigidity. A cerebrospinal fluid culture on blood agar grows colonies of a gram-positive bacillus surrounded by a narrow transparent rim. Administration of which of the following antibiotics is most likely to be effective in the treatment of this patient's condition?? {'A': 'Chloramphenicol', 'B': 'Doxycycline', 'C': 'Erythromycin', 'D': 'Ampicillin', 'E': 'Vancomycin'},
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D: Ampicillin
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Q:A 23-year-old primigravid woman comes to the physician at 28 weeks' gestation for a prenatal visit. Over the past 2 months, she has developed a hoarse voice and facial hair. Her medications include iron and a multivitamin. The last fetal ultrasonography, performed at 21 weeks' gestation, was unremarkable. Vital signs are within normal limits. Examination shows facial acne and hirsutism. Pelvic examination shows clitoromegaly. The uterus is consistent in size with a 28-week gestation. There are bilateral adnexal masses present on palpation. Ultrasonography shows a single live intrauterine pregnancy consistent with a 28-week gestation and bilateral 6-cm solid, multinodular ovarian masses. Serum androgen levels are increased. Which of the following is the most appropriate next step in management?? {'A': 'Fine needle aspiration cytology', 'B': 'Diagnostic laparoscopy', 'C': 'Oophorectomy', 'D': 'Monitoring', 'E': 'Measurement of serum CEA'},
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D: Monitoring
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Q:A 4-year-old girl is brought to the physician for a painless lump on her neck. She has no history of serious illness and her vital signs are within normal limits. On examination, there is a firm, 2-cm swelling at the midline just below the level of the hyoid bone. The mass moves cranially when she is asked to protrude her tongue. Which of the following is the most likely diagnosis?? {'A': 'Thyroglossal cyst', 'B': 'Ranula', 'C': 'Laryngocele', 'D': 'Cystic hygroma', 'E': 'Dermoid cyst'},
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A: Thyroglossal cyst
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Answer the following medical question with one of the provided options:
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Q:A researcher is studying the effects of hormones on different cells within the ovarian follicle. She adds follicle stimulating hormone (FSH) to a culture of ovarian follicle cells. She then measures the activity levels of different enzymes within the cells. Which enzyme and ovarian cell type would be expected to be stimulated by the addition of FSH?? {'A': 'Desmolase; theca interna cell', 'B': 'Aromatase; theca externa cell', 'C': 'Aromatase; granulosa cell', 'D': 'Desmolase; granulosa cell', 'E': 'Aromatase; theca interna cell'},
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C: Aromatase; granulosa cell
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Answer the following medical question with one of the provided options:
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Q:To prepare for an endoscopy, a 27-year-old male was asked by the gastroenterologist to fast overnight for his 12 p.m. appointment the next day. Therefore, his last meal was dinner at 5 p.m. the day before the appointment. By 12 p.m. the day of the appointment, his primary source of glucose was being generated from gluconeogenesis, which occurs via the reversal of glycolysis with extra enzymes to bypass the irreversible steps in glycolysis. Which of the following irreversible steps of gluconeogenesis occurs in the mitochondria?? {'A': 'Glucose-6-phosphate to glucose', 'B': 'Fructose-1,6-biphosphate to fructose-6-phosphate', 'C': 'Pyruvate to oxaloacetate', 'D': 'Phosphoenolypyruvate to pyruvate', 'E': 'Glucose-6-phosphate to 6-phosphogluconolactone'},
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C: Pyruvate to oxaloacetate
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Q:A 29-year-old female visits her gynecologist because of an inability to conceive with her husband. Past medical history reveals that she has been amenorrheic for several months, and she complains of frequent white nipple discharge. Urine tests for beta-HCG are negative. A receptor agonist for which of the following neurotransmitters would be most likely to treat her condition:? {'A': 'Somatostatin', 'B': 'Dopamine', 'C': 'Vasopressin', 'D': 'Insulin', 'E': 'Serotonin'},
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B: Dopamine
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Answer the following medical question with one of the provided options:
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Q:A 21-year-old woman is brought by her mother to a psychiatrist due to concerns about her behavior. The patient’s mother tells the psychiatrist that she believes that a famous Hollywood celebrity actor loves her and will marry her. When the patient is asked about this, she says that she attended a function at which this actor was the guest of honor six months back, and he waved his hand at her by which she understood that he loves her. However, when she tries to contact him over the phone, he does not respond, which she says is probably because he is too busy with his career at present. When asked why the successful actor would marry her, she says, “Celebrities often prefer to marry ordinary people and that is why he expressed his interest in me that day”. The patient is otherwise healthy with no known medical condition. She denies any mood disturbances, hallucinations, or anxiety. She is currently working as an assistant manager at a private advertising firm and has a normal socio-occupational life. Which of the following is the most likely diagnosis in this patient?? {'A': 'Delusional disorder', 'B': 'Schizophrenia', 'C': 'Schizoid personality disorder', 'D': 'Schizotypal personality disorder', 'E': 'Schizophreniform disorder'},
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A: Delusional disorder
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Answer the following medical question with one of the provided options:
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Q:A 53-year-old woman visits her physician with complaints of shortness of breath and fatigue over the last few weeks. Her past medical history includes hypertension diagnosed 20 years ago. She takes hydrochlorothiazide and losartan daily. Her mother died at the age of 54 from a stroke, and both of her grandparents suffered from cardiovascular disease. She has a 13 pack-year history of smoking and drinks alcohol occasionally. Her blood pressure is 150/120 mm Hg, pulse is 95/min, respiratory rate is 22/min, and temperature is 36.7°C (98.1°F). On physical examination, she has bibasilar rales, distended jugular veins, and pitting edema in both lower extremities. Her pulse is irregularly irregular and her apical pulse is displaced laterally. Fundoscopy reveals ‘copper wiring’ and ‘cotton wool spots’. Which of the following echocardiographic findings will most likely be found in this patient?? {'A': 'Ejection fraction: 40% with increased left ventricular wall thickness', 'B': 'Ejection fraction: 60% with normal left ventricular wall thickness', 'C': 'Ejection fraction: 80% with regurgitant aortic valve', 'D': 'Ejection fraction: 55% with dilated chambers and thin walls', 'E': 'Ejection fraction: 65% with rapid early diastolic filling and slow late diastolic filling'},
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A: Ejection fraction: 40% with increased left ventricular wall thickness
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Answer the following medical question with one of the provided options:
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Q:A 28-year-old female comes to the emergency department complaining of heart palpitations. She has had multiple episodes of these in the past few months. She has found that if she wears tight clothing then sometimes these episodes will stop spontaneously. On presentation to the ED, she feels like her heart is pounding and reports feeling nauseous. She appears mildly diaphoretic. Her blood pressure is 125/75 mmHg, pulse is 180/min, and respirations are 22/min with an O2 saturation of 99% on room air. A neck maneuver is performed and her pulse returns to 90/min with improvement of her symptoms. Stimulation of afferent fibers from which nerve are most responsible for the resolution of her symptoms?? {'A': 'Hypoglossal', 'B': 'Vagus', 'C': 'Trigeminal', 'D': 'Glossopharyngeal', 'E': 'Facial'},
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D: Glossopharyngeal
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Answer the following medical question with one of the provided options:
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Q:A 45-year-old woman presents to the clinic with a variety of complaints on different areas of her body, including telangiectasias on both the upper and lower extremities, bluish discoloration of the fingertips when exposed to cold, and burning midsternal chest pain. She is a tobacco smoker and works as a school teacher. After evaluation, an anti-centromere antibody test is ordered, and returns with an elevated titer. Which of the following symptoms are least likely to be seen in this patient's condition?? {'A': 'Dysphagia', 'B': 'Erythematous periorbital rash', 'C': 'Spasm of blood vessels in response to cold or stress', 'D': 'Thickening and tightening of the skin on the fingers', 'E': 'Gastroesophageal reflux'},
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B: Erythematous periorbital rash
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Q:A 23-year-old active college student has a sudden loss of consciousness 40 minutes after he was playing basketball with his team. Cardiopulmonary resuscitation is administered by bystanders. On arrival of emergency medical professionals, he regains his consciousness. He has no past medical history. He does not smoke or drink alcohol. His family history is positive for a cousin who died suddenly in his youth. On physical examination, a systolic ejection murmur is audible on the left lower sternal border. ECG shows left ventricular hypertrophy and echocardiography shows asymmetric septal hypertrophy. Which of the following decreases the pressure gradient between the aorta and the left ventricle in this patient?? {'A': 'High-dose diuretics', 'B': 'Digoxin', 'C': 'Nitroglycerin', 'D': 'Metoprolol', 'E': 'Forceful attempted exhalation against a closed airway'},
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D: Metoprolol
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Answer the following medical question with one of the provided options:
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Q:A 33-year-old woman comes to the clinic for a follow-up visit after recently starting high dose corticosteroids for a newly diagnosed autoimmune condition. She was first evaluated a month ago due to fatigue, muscle weakness, and a scaly rash on both hands. On examination, muscle strength was rated 2 out of 5 in the upper extremities. Creatine kinase-MB was elevated, and anti-Jo-1 antibodies were observed. A muscle biopsy later showed perimysial inflammation and treatment was initiated. Today, the patient says that her symptoms have not improved despite treatment with corticosteroids. It is agreed upon to initiate methotrexate with the hopes of achieving better symptom control. Which of the following is most often associated with this patient’s condition?? {'A': 'Breast cancer', 'B': 'Acute myeloid leukemia', 'C': 'Uveitis', 'D': 'Cervical cancer', 'E': 'Hodgkin lymphoma'},
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A: Breast cancer
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Q:A 2-year-old boy is brought to a pediatrician because his parents have noticed that he seems to be getting tired very easily at home. Specifically, they have noticed that he is often panting for breath after walking around the house for a few minutes and that he needs to take naps fairly often throughout the day. He has otherwise been well, and his parents do not recall any recent infections. He was born at home, and his mom did not receive any prenatal care prior to birth. Physical exam reveals a high-pitched, harsh, holosystolic murmur that is best heard at the lower left sternal border. No cyanosis is observed. Which of the following oxygen tension profiles would most likely be seen in this patient? (LV = left ventricle, RV = right ventricle, and SC = systemic circulation).? {'A': 'LV: decreased, RV: increased, SC: decreased', 'B': 'LV: decreased, RV: normal, SC: decreased', 'C': 'LV: normal, RV: increased, SC: normal', 'D': 'LV: normal, RV: normal, SC: decreased', 'E': 'LV: normal, RV: normal, SC: normal'},
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C: LV: normal, RV: increased, SC: normal
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Answer the following medical question with one of the provided options:
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Q:A 21-year-old woman comes to the physician for an annual health maintenance examination. She has no particular health concerns. Laboratory studies show: Hemoglobin 11.2 g/dL Mean corpuscular volume 74 μm3 Mean corpuscular hemoglobin concentration 30% Hb/cell Red cell distribution width 14% (N=13–15) Genetic analysis shows a point mutation in intron 1 of a gene on the short arm of chromosome 11. A process involving which of the following components is most likely affected in this patient?"? {'A': 'Transfer RNA', 'B': 'MicroRNA', 'C': 'TATA-rich nucleotide sequence', 'D': 'Heat shock protein 60', 'E': 'Small nuclear ribonucleoprotein'},
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E: Small nuclear ribonucleoprotein
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Answer the following medical question with one of the provided options:
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Q:A 68-year-old male is brought to his primary care physician by his wife who is concerned that the patient seems more confused and irritable than usual. Three months ago, she started noticing that he appeared confused while doing simple tasks and seemed to be off balance. He has fallen several times over that time period. She has also noticed that if he is startled by one of their grandchildren, his arm starts to twitch uncontrollably. His past medical history is notable for transient ischemic attacks, hypertension, and hyperlipidemia. He takes aspirin, enalapril, hydrochlorothiazide, and rosuvastatin. He has a 30 pack-year smoking history. His family history is notable for Alzheimer’s disease in his mother and maternal uncle. His temperature is 98.6°F (37°C), blood pressure is 130/70 mmHg, pulse is 95/min, and respirations are 16/min. Physical examination reveals dysmetria and an ataxic gait. This patient’s condition is most strongly associated with which of the following findings on brain autopsy?? {'A': 'Accumulations of beta-pleated sheets', 'B': 'Multifocal ischemic changes', 'C': 'Intracellular aggregates of alpha-synuclein', 'D': 'Intracellular rounded hyperphosphorylated tau', 'E': 'Extracellular accumulation of amyloid beta'},
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A: Accumulations of beta-pleated sheets
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Q:A 14-year-old girl presents with pain in the right lower quadrant of her abdomen. She describes the pain as sudden, severe, colicky, and associated with nausea and vomiting. Physical exam reveals tachycardia and severe tenderness to palpation with rebound in the right iliac region. Emergency laparotomy is performed which reveals an inflamed appendix. A presurgical blood cell count shows an increase in the number of cells having a multilobed nucleus and multiple cytoplasmic granules as shown in the image below. Which of the following is the main function of these cells?? {'A': 'Antigen presentation', 'B': 'Blood clotting', 'C': 'Transplant rejection', 'D': 'Allergic reaction', 'E': 'Phagocytosis'},
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E: Phagocytosis
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Q:A 44-year-old female is admitted to the neurological service. You examine her chart and note that after admission she was started on nimodipine. Which of the following pathologies would benefit from this pharmacologic therapy?? {'A': 'Pseudotumor cerebri', 'B': 'Thromboembolic stroke', 'C': 'Epidural hematoma', 'D': 'Subdural hematoma', 'E': 'Subarachnoid hemorrhage'},
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E: Subarachnoid hemorrhage
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Answer the following medical question with one of the provided options:
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Q:A 47-year-old man presents to the emergency department with jaundice and extreme fatigue for the past 4 days. He also noticed that his stool is very pale and urine is dark. Past medical history is unremarkable. The review of systems is significant for a 23 kg (50 lb) weight loss over the last 3 months which he says is due to decreased appetite. He is afebrile and the vital signs are within normal limits. A contrast computed tomography (CT) scan of the abdomen reveals a mass in the pancreatic head. A blood test for carbohydrate antigen (CA19-9) is positive. The patient is admitted to the intensive care unit (ICU) and undergoes surgical decompression of the biliary tract. He is placed on total parenteral nutrition (TPN). On day 4 after admission, his intravenous access site is found to be erythematous and edematous. Which of the following microorganisms is most likely responsible for this patient’s intravenous (IV) site infection?? {'A': 'Hepatitis B virus', 'B': 'E. coli', 'C': 'Malassezia furfur', 'D': 'Candida parapsilosis', 'E': 'Pseudomonas aeruginosa'},
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D: Candida parapsilosis
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Answer the following medical question with one of the provided options:
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Q:A 6-year-old boy is brought to the physician because of headache, cough, runny nose, and a low-grade fever since waking up that morning. He has been healthy except for a urinary tract infection one week ago that has resolved with trimethoprim-sulfamethoxazole therapy. Both parents have a history of allergic rhinitis. His temperature is 37.8°C (100°F). Physical exam shows rhinorrhea and tenderness over the frontal and maxillary sinuses. There is cervical lymphadenopathy. Laboratory studies show: Hemoglobin 14.2 g/dL Leukocyte count 2,700/mm3 Segmented neutrophils 30% Bands 1% Eosinophils 4% Basophils 0% Lymphocytes 56% Monocytes 9% Platelet count 155,000/mm3 Which of the following is the most likely underlying cause of this patient's symptoms?"? {'A': 'Medication side effect', 'B': 'Acute lymphocytic leukemia', 'C': 'CMV infection', 'D': 'EBV infection', 'E': 'Acute myelogenous leukemia'},
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A: Medication side effect
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Answer the following medical question with one of the provided options:
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Q:A 16-year-old male is brought to the clinic by his mother for the complaints of fever, nonproductive cough, fatigue, lack of appetite, and sore throat for the past 2 months. Several other students at his high school have had similar symptoms. Physical exam shows a whitish membrane in his oropharynx, bilateral enlarged cervical lymphadenopathy, and mild splenomegaly. Which of the following tests is most likely to diagnose his condition.? {'A': 'Throat culture', 'B': 'Chest X-ray', 'C': 'Urine culture', 'D': 'Enzyme-linked immunosorbent assay', 'E': 'Monospot test'},
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E: Monospot test
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Answer the following medical question with one of the provided options:
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Q:Pancreatic islets were isolated from a healthy, non-diabetic donor to perform an experiment to look at insulin secretion inhibition. Compounds would be added to separate wells containing the islets bathed in a high glucose solution for one hour. After one hour, the supernatant would be collected, and the insulin content would be measured with an enzyme-linked immunosorbent assay (ELISA). Which of the following compounds would result in the least insulin secretion when added to the islets?? {'A': 'Dobutamine', 'B': 'Isoproterenol', 'C': 'Tolbutamide', 'D': 'Clonidine', 'E': 'Glyburide'},
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D: Clonidine
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Answer the following medical question with one of the provided options:
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Q:Five days after being admitted to the hospital for an open cholecystectomy, a 56-year-old woman develops difficulty breathing. She also has fevers, chills, and malaise. She has a cough productive of minimal amounts of yellowish-white sputum that started two days prior. She has type 2 diabetes mellitus, hypertension, and a history of gallstones. Her current medications include metformin, lisinopril, and atorvastatin. Her temperature is 39.5°C (103.1°F), pulse is 104/minute, blood pressure is 94/68 mm Hg, and respirations are 30/minute. Pulse oximetry on 2 L of oxygen via nasal cannula shows an oxygen saturation of 92%. Examination reveals decreased breath sounds over the right lung base. Abdominal examination shows a well-healing scar without erythema or discharge in the right upper quadrant. The skin is warm and well-perfused. Her hemoglobin concentration is 10.5 g/dL, leukocyte count is 16,000/mm3, platelet count is 345,000/mm3, and creatinine is 1.5 mg/dL. She is admitted to the ICU and started on IV fluids. Blood and urine for cultures are obtained. X-ray of the chest reveals a right sided pleural effusion. Which of the following is the next best step in management?? {'A': 'CT of the chest with contrast', 'B': 'External cooling and intravenous acetaminophen', 'C': 'Intravenous ceftriaxone and azithromycin', 'D': 'Intravenous vancomycin and cefepime', 'E': 'Intravenous dobutamine'},
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D: Intravenous vancomycin and cefepime
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Answer the following medical question with one of the provided options:
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Q:A 23-year-old man comes to the physician because of lightening of his skin on both hands, under his eyes, and on his neck for 2 years. During this period the lesions slowly grew in size. There is no itchiness or pain. He regularly visits his family in India. Vital signs are within normal limits. Examination shows sharply demarcated, depigmented skin patches on the dorsum of both hands, in the periocular region, and on the neck. Sensation of the skin is intact. The lesions fluorescence blue-white under Wood's lamp. Which of the following findings is most likely to be associated with this patient's diagnosis?? {'A': '“Spaghetti and meatballs” appearance on KOH scraping', 'B': 'Decreased pigment with normal melanocyte count', 'C': 'Elevated anti-TPO antibody levels', 'D': 'Poorly developed retinal pigment epithelium', 'E': 'Renal angiomyolipoma on abdominal MRI'},
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C: Elevated anti-TPO antibody levels
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Answer the following medical question with one of the provided options:
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Q:A 50-year-old man comes to the physician because of diffuse weakness for the past several months. There is an anterior mediastinal mass on a lateral x-ray of the chest that was performed as part of a pre-employment medical evaluation. He has gastroesophageal reflux disease. His only medication is rabeprazole. He is 178 cm (5 ft 10 in) tall and weighs 77 kg (170 lb); BMI is 24.3 kg/m2. Vital signs are within normal limits. There is no cervical or axillary lymphadenopathy. Cardiopulmonary examination shows no abnormalities. The abdomen is soft and nontender; there is no splenomegaly. Further evaluation of this patient is most likely to show which of the following?? {'A': 'Fever, night sweats, and weight loss', 'B': 'Elevated serum alpha-fetoprotein level', 'C': 'Acetylcholine receptor antibodies', 'D': 'Elevated TSH and a nodular anterior cervical mass', 'E': 'Increased urinary catecholamines'},
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C: Acetylcholine receptor antibodies
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Answer the following medical question with one of the provided options:
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Q:A 67-year-old woman presents with progressive shortness of breath, lower extremity swelling, and early satiety. These symptoms started 4 months ago and have been progressively worsening. She has had type 2 diabetes mellitus for 25 years and hypertension for 15 years; for these, she takes metformin and captopril. She had an anterolateral ST-segment elevation myocardial infarction 6 years ago. Her blood pressure is 110/60 mm Hg, the temperature is 36.3°C (97.3°F), and the pulse is 95/min and regular. On examination, she has a laterally displaced apical impulse with a loud 4/6 holosystolic murmur at the apex, which increases in intensity with breath-holding for 3–5 seconds. Jugular veins are distended to the angle of the jaw. Some basilar crackles are present on both sides. There is a history of increased abdominal girth, and the patient presents with shifting dullness on percussion. There is 2–3+ pitting edema in both lower extremities. Echocardiography shows a left ventricular ejection fraction of 40% and moderate mitral and tricuspid regurgitation. Which of the following is the mechanism that applies to this patient’s illness?? {'A': 'Progressive myxomatous degeneration of the mitral valve leaflets', 'B': 'Right-ventricular dilatation with subsequent functional tricuspid valve dysfunction', 'C': 'Streptococcal infection followed by mitral valve dysfunction', 'D': 'Release of serotonin and other vasoactive peptides into the systemic circulation', 'E': 'Thickening of the parietal pericardium with impaired filling of the heart'},
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B: Right-ventricular dilatation with subsequent functional tricuspid valve dysfunction
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