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Answer the following medical question with one of the provided options:
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Q:A 26-year-old primigravid woman at 25 weeks' gestation comes to the physician for a prenatal visit. She has no history of serious illness and her only medication is a daily prenatal vitamin. A 1-hour 50-g glucose challenge shows a glucose concentration of 167 mg/dL (N < 135). A 100-g oral glucose tolerance test shows glucose concentrations of 213 mg/dL (N < 180) and 165 mg/dL (N < 140) at 1 and 3 hours, respectively. If she does not receive adequate treatment for her condition, which of the following complications is her infant at greatest risk of developing?? {'A': 'Elevated calcium levels', 'B': 'Islet cell hyperplasia', 'C': 'Decreased amniotic fluid production', 'D': 'Omphalocele', 'E': 'Decreased hematocrit'},
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B: Islet cell hyperplasia
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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 with type 1 diabetes mellitus is brought to the emergency department by her husband because of polyuria, nausea, vomiting, and altered mental status for 4 hours. On arrival, she is unconscious. Treatment with a drug is begun that increases glucose transport to skeletal muscle and adipose tissue. Which of the following cellular events is most likely to also occur in response to this drug?? {'A': 'Dephosphorylation of fructose-1,6-bisphosphatase', 'B': 'Upregulation of glucose transporter type 3 expression', 'C': 'Cleavage of UDP from UDP-glucose', 'D': 'Increased activity of acyl-CoA dehydrogenases', 'E': 'Phosphorylation of glycogen phosphorylase kinase'},
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A: Dephosphorylation of fructose-1,6-bisphosphatase
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Answer the following medical question with one of the provided options:
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Q:A 71-year-old male is brought to the emergency room by his caretaker and presents with difficulty breathing, muscle rigidity in the face, neck, back and upper extremities, and profuse sweating. The intern notes a large wound on his head near the back of his right ear which his caretaker had bandaged up. The caretaker explains that the wound was the result of a fall while walking in his backyard. The intern performs a quick physical exam and observes increased reflexes. The patient was intubated to assist in his breathing and was given diazepam, metronidazole, and an immunoglobulin after the blood work came back. Which of the following neurotransmitters is affected in this patient?? {'A': 'Glycine', 'B': 'Acetylcholine', 'C': 'Dopamine', 'D': 'Epinephrine', 'E': 'Serotonin'},
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A: Glycine
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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 physician because of a 6-month history of chest discomfort and progressive dyspnea. He cannot do daily chores without feeling out of breath. He has a history of an X-linked recessive disorder that causes progressive proximal muscle weakness and gait abnormalities. Physical examination shows a waddling gait and weak patellar reflexes. Cardiovascular examination shows a holosystolic murmur, displaced point of maximal impulse, and bilateral pitting edema of the ankle. Laboratory studies show elevated levels of brain natriuretic peptide. Which of the following is the most likely underlying cause of this patient's muscle weakness?? {'A': 'Impaired connection of cytoskeletal actin filaments to membrane-bound dystroglycan', 'B': 'Defective lysine-hydroxylysine crosslinking of tropocollagen', 'C': 'Interruption of microtubule depolymerization through stabilization of GDP-tubulin', 'D': 'Cell–mediated cytotoxicity against skeletal muscle antigens in the endomysium', 'E': 'Increased number of CTG repeats in the DMPK gene'},
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A: Impaired connection of cytoskeletal actin filaments to membrane-bound dystroglycan
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Answer the following medical question with one of the provided options:
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Q:A 24-year-old gravida 2 para 0 presents to her physician at 15 weeks gestation to discuss the results of recent screening tests. She has no complaints and the current pregnancy has been uncomplicated. Her previous pregnancy terminated with spontaneous abortion in the first trimester. Her immunizations are up to date. Her vital signs are as follows: blood pressure 110/60 mm Hg, heart rate 78/min, respiratory rate 14/min, and temperature 36.8℃ (98.2℉). The physical examination is within normal limits. The laboratory screening tests show the following results: HBsAg negative HBcAg negative Anti-HBsAg positive HIV 1/2 AB negative VDRL positive What is the proper next step in the management of this patient?? {'A': 'PCR for HBV DNA', 'B': 'T. pallidum hemagglutination assay', 'C': 'Prescription of benzylpenicillin', 'D': 'HBV vaccination', 'E': 'Full serum panel for HBV'},
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B: T. pallidum hemagglutination assay
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Answer the following medical question with one of the provided options:
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Q:A 52-year-old man comes to the physician because of a 4-day history of a productive cough, shortness of breath, and low-grade fever. He works as a farmer in southern Arizona. Physical examination shows multiple skin lesions with a dark blue center, pale intermediate zone, and red peripheral rim on the upper and lower extremities. There are diffuse crackles on the left side of the chest. An x-ray of the chest shows left basilar consolidation and left hilar lymphadenopathy. A photomicrograph of tissue obtained from a biopsy of the lung is shown. Which of the following is the most likely causal pathogen?? {'A': 'Coccidioides immitis', 'B': 'Aspergillus fumigatus', 'C': 'Paracoccidioides brasiliensis', 'D': 'Blastomyces dermatitidis', 'E': 'Candida albicans'},
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A: Coccidioides immitis
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Answer the following medical question with one of the provided options:
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Q:A 19-year-old woman presents to the family medicine clinic after noticing swelling of her right index finger a few hours ago. She has no past medical history and takes no prescription medications. She takes ibuprofen occasionally, as needed. She says that she has smoked a few cigarettes a day for the last year. On further questioning, the patient says that she has a dog and a cat at home. Her blood pressure is 108/67 mm Hg, heart rate is 94/min, respiratory rate is 12/min, and temperature is 37.8°C (100.1°F). On physical examination, the physician notices 2 clean puncture wounds with localized erythema and induration on the dorsum of the right second digit. Capillary refill is 2 seconds. Sensory and motor function are intact bilaterally. Which of the following is the most appropriate treatment choice for this patient?? {'A': 'Amoxicillin', 'B': 'Amoxicillin–clavulanate', 'C': 'Clindamycin', 'D': 'Doxycycline', 'E': 'Azithromycin'},
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B: Amoxicillin–clavulanate
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Answer the following medical question with one of the provided options:
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Q:A 55-year-old woman has a total thyroidectomy for papillary thyroid carcinoma. She complains of tingling around the mouth 11 hours after the operation. Her condition rapidly deteriorates with difficulty breathing and chest tightness. Which of the following best represent the signaling pathway of the deficient hormone responsible for this patient’s symptoms?? {'A': 'Cyclic guanosine monophosphate (cGMP)', 'B': 'Cyclic adenosine monophosphate (cAMP)', 'C': 'Inositol trisphosphate (IP3)', 'D': 'Receptor tyrosine kinase', 'E': 'Intracellular receptors'},
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B: Cyclic adenosine monophosphate (cAMP)
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Answer the following medical question with one of the provided options:
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Q:A 35-year-old woman comes to the physician for the evaluation of fatigue over the past 6 months. During this period, she has also had fever, joint pain, and a recurrent skin rash on her face. She has smoked one pack of cigarettes daily for the past 15 years. Her temperature is 38.5°C (101.3°F), pulse is 90/min, and blood pressure is 130/80 mm Hg. Physical examination shows a facial rash that spares the nasolabial folds and several oral ulcers. Joints of the upper and lower extremities are tender with no reddening or swelling. Laboratory studies show anti-dsDNA antibodies. The patient is diagnosed with systemic lupus erythematosus and treatment of choice is initiated. Eight months later, the patient has weakness in her shoulders and hips. Examination shows slight weakness of the proximal muscles. Deep tendon reflexes are 2+ bilaterally. Laboratory studies show normal erythrocyte sedimentation rate and creatine kinase. Which of the following is the most likely underlying cause of this patient's symptoms?? {'A': 'Autoantibodies against postsynaptic acetylcholine receptors', 'B': 'Dystrophin gene mutation', 'C': 'Autoantibodies against myelin', 'D': 'Upper and lower motor neuron degeneration', 'E': 'Adverse effect of medication'},
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E: Adverse effect of medication
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Answer the following medical question with one of the provided options:
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Q:A 7-year-old boy is brought to the emergency room because of severe, acute diarrhea. He is drowsy with a dull, lethargic appearance. He has sunken eyes, poor skin turgor, and dry oral mucous membranes and tongue. He has a rapid, thready pulse with a systolic blood pressure of 60 mm Hg and his respirations are 33/min. His capillary refill time is 6 sec. He has had no urine output for the past 24 hours. Which of the following is the most appropriate next step in treatment?? {'A': 'Give initial IV bolus of 2 L of Ringer’s lactate, followed by packed red cells, fresh frozen plasma, and platelets in a ratio of 1:1:1', 'B': 'Give antidiarrheal drugs', 'C': 'Start IV fluid resuscitation with normal saline or Ringer’s lactate, along with monitoring of vitals and urine output', 'D': 'Start IV fluid resuscitation by administering colloid solutions', 'E': 'Provide oral rehydration therapy to correct dehydration'},
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C: Start IV fluid resuscitation with normal saline or Ringer’s lactate, along with monitoring of vitals and urine output
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Answer the following medical question with one of the provided options:
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Q:A 16-year-old boy is brought to the physician by his mother because of a 4-day history of painful lesions in his mouth. During the past year, he has twice had similar lesions that resolved without treatment after approximately 10 days. He has never had any genital or anal lesions. His mother reports that he has been very stressed over the past month because he is approaching his senior year at high school. He is otherwise healthy and takes no medications. He appears thin. His temperature is 37.6°C (99.7°F). A photograph of his oral cavity is shown. The remainder of the examination shows no abnormalities. Which of the following is the most likely diagnosis?? {'A': 'Pemphigus vulgaris', 'B': 'Oral thrush', 'C': 'Herpangina', 'D': 'Aphthous stomatitis', 'E': 'Oral leukoplakia'},
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D: Aphthous stomatitis
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Answer the following medical question with one of the provided options:
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Q:A 65-year-old man with hypertension and paroxysmal atrial fibrillation presents to his cardiologist for follow-up after recently starting metoprolol for rate control. His EKG shows an atrial rate of 260/min with ventricular rate of 50/min on an irregular baseline. An echocardiogram from his previous visit revealed no evidence of hypokinesis or hypertrophy with functionally intact valves. The patient does not drink alcohol and had no evidence of liver dysfunction in prior studies. What is the best medication for rhythm control in this patient?? {'A': 'Verapamil', 'B': 'Flecainide', 'C': 'Procainamide', 'D': 'Mexiletine', 'E': 'Amiodarone'},
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B: Flecainide
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Answer the following medical question with one of the provided options:
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Q:A 36-year-old male is brought to the emergency department for severe chest pain and vomiting. He reports sudden onset 10/10 pain concentrated along his lower chest/epigastric region that radiates to his back for the past 3 hours. He denies any precipitating event, alcohol use, exertion, biliary colic, or family history of coronary artery disease. Medical history is significant for hypertension for which he recently started taking a “water pill.” Electrocardiogram (ECG) demonstrates normal sinus rhythm, and troponins are negative. Additional laboratory findings are shown below: Serum: Na+: 138 mEq/L K+: 3.9 mEq/L Cl-: 101 mEq/L Ca2+: 8.5 mg/dL Total cholesterol: 210 mg/dL (Normal: < 200 mg/dL) Triglycerides: 1,528 mg/dL (Normal: < 150 mg/dL) CRP: 28 mg/dL (Normal: < 3 mg/dL) Amylase: 582 U/L (Normal: 23-85 U/L) Lipase: 1,415 U/L (Normal: 0-160 U/L) What is the best medication for this patient in the long-term following initial stabilization?? {'A': 'Aspirin', 'B': 'Atorvastatin', 'C': 'Cholestyramine', 'D': 'Gemfibrozil', 'E': 'Niacin'},
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D: Gemfibrozil
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Answer the following medical question with one of the provided options:
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Q:A 70-year-old caucasian woman presents to her primary care provider complaining of a heavy cough with blood-tinged sputum. Her cough has bothered her for the last 2 weeks. Over the counter medications are no longer alleviating her symptoms. She also reports that she has unintentionally lost 6.8 kg (15 lb) in the last 5 months. Her past medical history is significant for peptic ulcer disease that was positive for H. pylori on biopsy and was treated with triple-drug therapy. She is a lifetime non-smoker and worked as a teacher before retiring at the age of 60. Today, her temperature is 36.9°C (98.4°F), blood pressure is 128/82 mm Hg, pulse is 87/min, and pulse oximetry is 90% on room air. On physical exam, her heart has a regular rate and rhythm. Auscultation of the lungs revealed scattered crackles and wheezes. A CT scan of the lungs shows an irregular mass in the peripheral region of the inferior lobe of the right lung and a CT guided biopsy is positive for malignant tissue architecture and gland formation with a significant amount of mucus. Which of the following risk factors most likely predisposed this patient to her condition?? {'A': 'Medication', 'B': 'Occupational history', 'C': 'Past medical history', 'D': 'Race', 'E': 'Gender'},
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E: Gender
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Answer the following medical question with one of the provided options:
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Q:A 64-year-old man presents to the emergency department because he has been experiencing increased shortness of breath for the last 2 weeks. Specifically, he says that he can barely walk up the stairs to his apartment before he feels winded. In addition, he has been waking up at night gasping for breath and has only been able to sleep propped up on 2 more pillows than usual. Physical exam reveals jugular venous distention as well as pitting lower extremity edema. Which of the following abnormal sounds will most likely be heard in this patient?? {'A': 'Extra heart sound in early diastole', 'B': 'Extra heart sound in late diastole', 'C': 'Fixed splitting', 'D': 'Opening snap', 'E': 'Parasternal holosystolic murmur'},
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A: Extra heart sound in early diastole
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Answer the following medical question with one of the provided options:
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Q:A 65-year-old obese man presents to his primary care clinic feeling weak. He was in the military and stationed in Vietnam in his youth. His current weakness gradually worsened to the point that he had to call his son to help him stand to get on the ambulance. He smokes a pack of cigarettes every day and drinks a bottle of vodka a week. He has been admitted for alcohol withdrawal multiple times and has been occasionally taking thiamine, folic acid, and naltrexone. He denies taking steroids. His temperature is 98°F (36.7°C), blood pressure is 170/90 mmHg, pulse is 75/min, and respirations are 20/min. He is obese with a significant pannus. Hepatomegaly is not appreciable. Abdominal striae are present. His workup is notable for the following: Serum: Na+: 142 mEq/L Cl-: 102 mEq/L K+: 3.9 mEq/L HCO3-: 25 mEq/L BUN: 24 mg/dL Glucose: 292 mg/dL Creatinine: 1.5 mg/dL Ca2+: 10.1 mg/dL AST: 7 U/L ALT: 14 U/L 24-hour urinary cortisol: 400 µg (reference range < 300 µg) Serum cortisol: 45 pg/mL (reference range < 15 pg/mL) A 48-hour high dose dexamethasone suppression trial shows that his serum cortisol levels partially decrease to 25 pg/mL and his adrenocorticotropin-releasing hormone (ACTH) level decreases from 10 to 6 pg/mL (reference range > 5 pg/mL). What is the best next step in management?? {'A': 'CT of the chest', 'B': 'MRI of the adrenal glands', 'C': 'MRI of the pituitary gland', 'D': 'Low-dose dexamethasone therapy for 3 months', 'E': 'High-dose dexamethasone therapy for 3 months'},
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C: MRI of the pituitary gland
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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 visits your office complaining about discharge from her left nipple for the past 3 months. The discharge looks like gray greenish and its amount is progressively increasing. She appears to be anxious and extremely uncomfortable with this situation as it is embarrassing for her when it occurs outdoors. Past medical history is insignificant. Her family history is negative for breast and ovarian disorders. She tries to stay active by running for 30 minutes every day on a treadmill, staying away from smoking, and by eating a balanced diet. She drinks alcohol occasionally. During physical examination you find a firm, stable mass under an inverted nipple in her left breast; while on the right breast, dilated subareolar ducts can be noted. There is no lymphadenopathy and remaining of the physical exam is normal. A mammogram is performed which reveals tubular calcifications. Which of the following is the most likely diagnosis?? {'A': 'Periareolar fistula', 'B': 'Phyllodes tumor', 'C': 'Duct ectasia', 'D': 'Periductal mastitis', 'E': 'Intraductal papilloma'},
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C: Duct ectasia
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Answer the following medical question with one of the provided options:
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Q:Two days after delivery, a 3470-g (7-lb 10-oz) newborn has an episode of bilious vomiting. He has not yet passed meconium. He was born at term to a 26-year-old woman; pregnancy and delivery were uncomplicated. His vital signs are within normal limits. Examination shows a distended abdomen. There is tympany to percussion. Digital rectal examination shows elevated sphincter tone; when the finger is removed, there is an explosive release of stool and air. An x-ray of the abdomen shows a massively dilated colon proximal to a narrowed segment of colon. Which of the following is the underlying cause of these findings?? {'A': 'Ischemic necrosis of the intestinal mucosa', 'B': 'Jejunal vascular accident in utero', 'C': 'Incomplete coiling of the intestine', 'D': 'Impaired migration of neural crest cells', 'E': 'Mutation in the CFTR gene'},
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D: Impaired migration of neural crest cells
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Answer the following medical question with one of the provided options:
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Q:Health officials are considering a change be made to the interpretation of the tuberculin skin test that will change the cut-off for a positive purified protein derivative (PPD) from 10 mm to 5 mm for healthcare workers. Which of the following is a true statement regarding this potential change?? {'A': 'This change will decrease the positive predictive value of the test', 'B': 'This change will decrease the negative predictive value of the test', 'C': 'This change will not change the negative predictive value of the test', 'D': 'This change will not change the sensitivity of the test', 'E': 'This change will increase the specificity of the test'},
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A: This change will decrease the positive predictive value of the test
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Answer the following medical question with one of the provided options:
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Q:A 39-year-old female presents with confusion. Her husband reports that she doesn't know where she is and cannot remember the date. She was recently diagnosed with small cell lung cancer. Vital signs are T 37C, HR 80, BP 120/80 mmHg, RR 14, and O2 sat 99% on room air. She is not orthostatic. Physical examination reveals moist mucous membranes and normal capillary refill. A basic metabolic profile reveals that serum sodium is 129. Regarding this patient's illness, which of the following is true?? {'A': 'Urinary osmolarity will be > 100, and this illness will not correct with saline infusion', 'B': 'Urinary osmolarity will be < 100, and another potential cause of this disorder is excessive water drinking', 'C': 'Urinary sodium will be > 20 and fractional excretion of sodium will be >1%', 'D': 'Urinary sodium will be < 10, and fractional excretion of sodium will be <1%', 'E': 'Urinary sodium will be > 20 and another potential cause of this disorder is renal failure'},
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A: Urinary osmolarity will be > 100, and this illness will not correct with saline infusion
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Answer the following medical question with one of the provided options:
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Q:A 25-year-old woman presents to the physician with a complaint of several episodes of headaches in the past 4 weeks that are affecting her school performance. These episodes are getting progressively worse, and over-the-counter medications do not seem to help. She also mentions having to raise her head each time to look at the board while taking notes; she cannot simply glance up with just her eyes. She has no significant past medical or family history and was otherwise well prior to this visit. Physical examination shows an upward gaze palsy and convergence-retraction nystagmus. What structure is most likely to be affected in this patient?? {'A': 'Tegmentum', 'B': 'Corpora quadrigemina', 'C': 'Inferior colliculi', 'D': 'Aqueduct of Sylvius', 'E': '3rd ventricle'},
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D: Aqueduct of Sylvius
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Answer the following medical question with one of the provided options:
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Q:A 67-year-old man presents to the emergency department for squeezing and substernal chest pain. He states that he was at home eating dinner when his symptoms began. The patient has a past medical history of diabetes, hypertension, and dyslipidemia. He is currently taking atorvastatin, lisinopril, insulin, metformin, metoprolol, and aspirin. Six days ago he underwent percutaneous coronary intervention. His temperature is 99.5°F (37.5°C), blood pressure is 197/118 mmHg, pulse is 120/min, respirations are 17/min, and oxygen saturation is 98% on room air. Physical exam reveals an uncomfortable elderly man who is sweating. An ECG is ordered. Which of the following is the best next step in management for this patient?? {'A': 'Angiography', 'B': 'Cardiac troponins', 'C': 'Creatine kinase-muscle/brain', 'D': 'Myoglobin', 'E': 'Stress testing'},
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C: Creatine kinase-muscle/brain
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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 comes to the physician because of severe epigastric pain for a week. The pain is constant and he describes it as 6 out of 10 in intensity. The pain radiates to his back and is worse after meals. He has had several episodes of nausea and vomiting during this period. He has taken ibuprofen for multiple similar episodes of pain during the past 6 months. He also has had a 5.4-kg (12-lb) weight loss over the past 4 months. He has a 12-year history of drinking 3 to 4 pints of rum daily. He has been hospitalized three times for severe abdominal pain in the past 3 years. He appears ill. His temperature is 37°C (98.6°F), pulse is 87/min, and blood pressure is 110/70 mm Hg. There is severe epigastric tenderness to palpation. Bowel sounds are normal. Cardiopulmonary examination shows no abnormalities. Laboratory studies show: Hemoglobin 13.6 g/dL Leukocyte count 7,800/mm3 Serum Glucose 106 mg/dL Creatinine 1.1 mg/dL Amylase 150 U/L A CT of the abdomen is shown. Which of the following is the most appropriate long-term management for this patient?"? {'A': 'Gluten-free diet', 'B': 'Whipple procedure', 'C': 'Endoscopic stent placement', 'D': 'Pancreatic enzyme therapy', 'E': 'Celiac ganglion block\n"'},
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D: Pancreatic enzyme therapy
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Answer the following medical question with one of the provided options:
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Q:A 40-year-old woman who works as a secretary presents to your office complaining of new pain and numbness in both of her hands. For the past few weeks, the sensation has occurred after long days of typing, but it now occasionally wakes her up from sleep. You do not note any deformities of her wrists or hands, but you are able to reproduce pain and numbness in the first three and a half digits by tapping the wrist. What is the best initial treatment for this patient's complaint?? {'A': 'A trial of gabapentin', 'B': 'Short-acting benzodiazepines', 'C': 'Local steroid injections', 'D': 'Carpal tunnel release surgery', 'E': 'Splinting'},
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E: Splinting
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Answer the following medical question with one of the provided options:
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Q:A 71-year-old woman comes to the physician because of sudden loss of vision in her right eye for 15 minutes that morning, which subsided spontaneously. Over the past 4 months, she has had fatigue, a 4-kg (8.8-lb) weight loss, and has woken up on several occasions at night covered in sweat. She has had frequent headaches and pain in her jaw while chewing for the past 2 months. She does not smoke or drink alcohol. Her temperature is 37.5°C (99.5°F), pulse is 88/min, and blood pressure is 118/78 mm Hg. Examination shows a visual acuity of 20/25 in the left eye and 20/30 in the right eye. The pupils are equal and reactive. There is no swelling of the optic discs. Her hemoglobin concentration is 10.5 g/dL, platelet count is 420,000/mm3, and erythrocyte sedimentation rate is 69 mm/h. The patient's condition puts her at the greatest risk of developing which of the following complications?? {'A': 'Myocardial infarction', 'B': 'Thoracic aortic aneurysm', 'C': 'Rapidly progressive glomerulonephritis', 'D': 'Internal carotid artery stenosis', 'E': 'Pulmonary artery hypertension'},
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B: Thoracic aortic aneurysm
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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 visits her psychiatrist a week after she delivered a baby. She is holding her baby and crying as she waits for her appointment. She tells her physician that a day or so after her delivery, she has been finding it difficult to contain her feelings. She is often sad and unable to contain her tears. She is embarrassed and often starts crying without any reason in front of people. She is also anxious that she will not be a good mother and will make mistakes. She hasn’t slept much since the delivery and is often stressed about her baby getting hurt. She makes excessive attempts to keep the baby safe and avoid any mishaps. She does not report any loss of interest in her activities and denies any suicidal tendencies. Which of the following is best course of management for this patient?? {'A': 'Give her child to child protective services', 'B': 'Start on a small dose of fluoxetine daily', 'C': 'Get admitted immediately', 'D': 'Come back for a follow-up in 2 weeks', 'E': 'Schedule an appointment for electroconvulsive therapy'},
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D: Come back for a follow-up in 2 weeks
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Answer the following medical question with one of the provided options:
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Q:A 53-year-old patient presents to his primary care provider with a 1-week history of abdominal pain at night and between meals. He has attempted taking antacids, which help briefly, but then the pain returns. The patient has not noticed any changes to the color of his stool but states that he has been having some loose bowel movements. The patient reports that he has had duodenal ulcers in the past and is concerned that this is a recurrence. On exam, his temperature is 98.4°F (36.9°C), blood pressure is 130/84 mmHg, pulse is 64/min, and respirations are 12/min. The abdomen is soft, nontender, and nondistended in clinic today. A fecal occult blood test is positive for blood in the stool. During outpatient workup, H. pylori stool antigen is negative, endoscopy demonstrates duodenal ulcers, and gastrin levels are elevated after a secretin stimulation test. Which of the following should also be examined in this patient?? {'A': 'Calcitonin', 'B': 'Parathyroid hormone', 'C': 'Plasma metanephrines', 'D': 'Thyroid stimulating hormone', 'E': 'Vasoactive intestinal peptide'},
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B: Parathyroid hormone
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Answer the following medical question with one of the provided options:
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Q:A 13-month-old boy is brought to the emergency department by his parents 30 minutes after having a 1-minute seizure. He has had a 1-day history of severe diarrhea and fever and 1 episode of vomiting. He has no history of serious illness. His immunization records are not available. He appears restless and cries when picked up from his mother's lap. His temperature is 38.9°C (102°F), pulse is is 150/min, respirations are 30/min, and blood pressure is 90/50 mm Hg. Examination shows a distended abdomen. The extremities are cool to the touch, and his capillary refill time is 2–3 seconds. Further evaluation is most likely to show which of the following?? {'A': 'Increased serum bicarbonate levels', 'B': 'Retinal hemorrhages', 'C': 'Hyperkalemia', 'D': 'Sunken anterior fontanelle', 'E': 'Kussmaul breathing'},
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D: Sunken anterior fontanelle
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Answer the following medical question with one of the provided options:
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Q:A 57-year-old woman comes to the physician for a routine examination. She takes no medications. She swims 3 times weekly and jogs several miles with her dog on most mornings. Her diet consists primarily of vegetables, fish, and whole grains; she avoids processed foods and carbohydrates. She drinks one glass of red wine with dinner on most evenings. There is no family history of serious medical illness or cardiovascular disease. Physical examination shows no abnormalities. This patient is most likely to have an increase in which of the following laboratory markers?? {'A': 'Very low density lipoprotein', 'B': 'High density lipoprotein', 'C': 'Apolipoprotein B-100', 'D': 'Triglyceride', 'E': 'Low density lipoprotein'},
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B: High density lipoprotein
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Answer the following medical question with one of the provided options:
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Q:A 52-year-old man is brought to the emergency department by ambulance after a motor vehicle accident. He was an unrestrained passenger who was ejected from the vehicle. On presentation, he is found to be actively bleeding from numerous wounds. His blood pressure is 76/42 mmHg and pulse is 152/min. Attempts at resuscitation fail, and he dies 25 minutes later. Autopsy shows blood in the peritoneal cavity, and histology of the kidney reveals swelling of the proximal convoluted tubule epithelial cells. Which of the following is most likely the mechanism underlying the renal cell findings?? {'A': 'Decreased activity of caspase 7', 'B': 'Decreased function of the Na+/K+-ATPase', 'C': 'Increased activity of caspase 8', 'D': 'Increased activity of caspase 9', 'E': 'Increased function of the Na+/K+-ATPase'},
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B: Decreased function of the Na+/K+-ATPase
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Answer the following medical question with one of the provided options:
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Q:A 59-year-old male presents to the emergency room with shortness of breath. Ten days ago, he was in the cardiac critical care unit after receiving a balloon angioplasty and a bare metal stent for an ST-elevation myocardial infarction (STEMI). On physical examination, a holosystolic murmur is heard at the cardiac apex radiating to the axilla. You also detect an S3 and bilateral crackles in the lung bases. What is the most likely etiology of this patient's acute decompensated heart failure?? {'A': 'Rupture of the anterior papillary muscle on the right ventricle', 'B': 'Rupture of the posterior papillary muscle on the right ventricle', 'C': 'Rupture of the septal papillary muscle on the right ventricle', 'D': 'Rupture of the anterolateral papillary muscle of the left ventricle', 'E': 'Rupture of the posteromedial papillary muscle of the left ventricle'},
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E: Rupture of the posteromedial papillary muscle of the left ventricle
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Answer the following medical question with one of the provided options:
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Q:A 52-year-old man with a history of type I diabetes mellitus presents to the emergency room with increasing fatigue. Two days ago, he ran out of insulin and has not had time to obtain a new prescription. He denies fevers or chills. His temperature is 37.2 degrees Celsius, blood pressure 84/56 mmHg, heart rate 100/min, respiratory rate 20/min, and SpO2 97% on room air. His physical exam is otherwise within normal limits. An arterial blood gas analysis shows the following: pH 7.25, PCO2 29, PO2 95, HCO3- 15. Which of the following acid-base disorders is present?? {'A': 'Metabolic acidosis with appropriate respiratory compensation', 'B': 'Respiratory acidosis with appropriate metabolic compensation', 'C': 'Mixed metabolic and respiratory acidosis', 'D': 'Metabolic alkalosis with appropriate respiratory compensation', 'E': 'Respiratory alkalosis with appropriate metabolic compensation'},
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A: Metabolic acidosis with appropriate respiratory compensation
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Q:A 32-year-old woman presents to her primary care provider complaining of a psoriatic flare that has worsened over the past 2 days. The patient states that her psoriasis is normally well-controlled. She also complains of some fatigue and states that she has recently developed pain and tenderness in the joints of her hands with the right hand being more tender than the left. Her hands are stiff in the morning, and sometimes her fingers swell up. She attributes these changes to her new job where she constantly uses her hands to manufacture cabinets. Physical exam reveals plaques with silvery scale on her elbows and knees. The distal joints of her right hand are mildly swollen and the nails on both hands appear pitted. What is the most likely pathogenesis of her joint pain?? {'A': 'Local invasive infection of the joint space', 'B': 'Repetitive injury', 'C': 'Autoantibodies to the Fc portion of IgG', 'D': 'Deposition of crystals in the joint space', 'E': 'Release of TNF and activation of RANKL pathway'},
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E: Release of TNF and activation of RANKL pathway
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Q:A 65-year-old female with a past medical history of hypertension presents to her primary care doctor with a 3 month history of spasmodic facial pain. The pain is located in her right cheek and seems to be triggered when she smiles, chews, or brushes her teeth. The pain is sharp and excruciating, lasts for a few seconds, and occurs up to twenty times per day. She denies headaches, blurry vision, facial weakness, or changes in her memory. She feels rather debilitated and has modified much of her daily activities to avoid triggering the spasms. In the clinic, her physical exam is within normal limits. Her primary care doctor prescribes carbamazepine and asks her to follow up in a few weeks. Which cranial nerve is most likely involved in the patient's disease process?? {'A': 'CN III', 'B': 'CN IV', 'C': 'CN V', 'D': 'CN VI', 'E': 'CN VII'},
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C: CN V
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Q:A 22-year-old man presents to his primary care provider because of fever, diarrhea, and abdominal cramps. He has returned from Dhaka, Bangladesh recently where he was visiting his relatives. He is diagnosed with Shigella infection, and ciprofloxacin is started. He develops severe nausea and weakness 2 days later and complains of passing dark urine. The lab test results reveal a hemoglobin level of 7.9 g/dL, increased unconjugated bilirubin, increased reticulocyte count, increased lactate dehydrogenase, and increased blood urea. Which of the following is the best next step for the diagnosis of this patient’s condition?? {'A': 'Hemoglobin electrophoresis', 'B': 'Direct antiglobulin (Coombs) test', 'C': 'Eosin-5-maleimide (EMA) binding test', 'D': 'ADAMTS-13 activity assay', 'E': 'Glucose-6-phosphate spectrophotometry'},
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E: Glucose-6-phosphate spectrophotometry
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Q:A 67-year-old woman with chronic kidney disease, hypertension, and diabetes mellitus presented with congestive heart failure and underwent uneventful 3-vessel coronary artery bypass surgery. Within 20 hours, she was extubated and all infusions except nitroprusside were stopped. On the 4th postoperative day, she deteriorated, exhibiting restlessness, tachypnea, tachycardia, and hypotension. Inotropes, vasopressors and bicarbonate infusions were started. Continuous hemodialysis was initiated, yet lactate levels continued to rise. Her chart clarified that she had received 319 mg of nitroprusside over 72 hours. What is the most likely cause of her condition?? {'A': 'Cyanide toxicity', 'B': 'Carbon monoxide poisoning', 'C': 'Sulfmethemoglobinemia', 'D': 'Methemoglobinemia', 'E': 'Anemia'},
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A: Cyanide toxicity
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Q:The height of American adults is expected to follow a normal distribution, with a typical male adult having an average height of 69 inches with a standard deviation of 0.1 inches. An investigator has been informed about a community in the American Midwest with a history of heavy air and water pollution in which a lower mean height has been reported. The investigator plans to sample 30 male residents to test the claim that heights in this town differ significantly from the national average based on heights assumed be normally distributed. The significance level is set at 10% and the probability of a type 2 error is assumed to be 15%. Based on this information, which of the following is the power of the proposed study?? {'A': '0.85', 'B': '0.15', 'C': '0.10', 'D': '0.90', 'E': '0.05\n"'},
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A: 0.85
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Q:A 52-year-old G0P0 presents to her gynecologist for an annual exam. The patient notes that she recently felt a lump in her right breast, and it has persisted for several months. She has not noticed any abnormal breast discharge or skin changes, and the lump is not particularly tender. The patient also reports feeling especially sweaty in the last three months and occasionally having sudden heat waves. As a result, she has been increasing her use of antiperspirant in the axilla. The patient has no medical problems, has a BMI of 18.4 kg/m^2, and takes no medications. She underwent menarche at age 16 and had a levonorgestrel intrauterine device inserted three years ago due to heavy menstrual bleeding. The patient has now been amenorrheic for two years. She has a family history of breast cancer in her cousin at age 61 and hypertension in her father, who is 91. At this office visit, a 3x3 cm lump is palpated in the upper outer quadrant of the right breast. It is firm and not freely mobile. Ultrasound and mammogram are shown in Figures A and B. Which of the following is a risk factor for this patient’s condition?? {'A': 'Late age at menarche', 'B': 'Nulliparity', 'C': 'Low body weight', 'D': 'Use of levonorgestrel intrauterine device', 'E': 'Fatty breast tissue'},
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B: Nulliparity
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Q:A 17-year-old boy presents to the emergency department for the evaluation of severe chest pain that started one hour ago. The pain suddenly began after he lifted a heavy object and the pain is constant. He has no history of a serious illness and takes no medications. His blood pressure is 125/85 mm Hg, the pulse is 89/min, the respiratory rate is 15/min, and the temperature is 36.7°C (98.1°F). Examination of the supraclavicular notch shows mild swelling of the skin with crepitation on palpation. Auscultation of the precordium in the left lateral decubitus position reveals a clicking sound with every heartbeat. The remainder of the physical examination shows no abnormalities. A chest X-ray is shown. Which of the following is the most appropriate next step in management?? {'A': 'Chest tube', 'B': 'Needle aspiration', 'C': 'Supplemental oxygen', 'D': 'Surgical exploration', 'E': 'Video-assisted thoracoscopic surgery'},
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C: Supplemental oxygen
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Q:A 27-year-old new patient presents to the physician’s office with complaints of burning, upper abdominal pain for the past 6 months. The pain does not radiate and is only partially relieved by eating small meals, over the counter antacids, and PPI. He previously underwent upper endoscopy that revealed small ulcers in the stomach and duodenum. He had to relocate across the country before he could receive proper treatment or further workup. He also complains of constipation and urinary frequency. His mother has a history of peptic ulcer disease and recurrent kidney stones. Vital signs are normal. On physical examination, the patient is alert and not under distress. Abdominal examination reveals epigastric tenderness with no rebounding. Cardiopulmonary examination is unremarkable. A fecal occult blood test is positive. Laboratory results are as follows: Sodium 142 mEq/L Potassium 4.1 mEq/L Chloride 108 mEq/L Bicarbonate 22 mEq/L Calcium 11.2 mg/dL Phosphorus 2.0 mg/dL Blood urea nitrogen 19 mg/dL Creatinine 1.1 mg/dL Additional evaluation is most likely to reveal which of the following?? {'A': 'Marfanoid body habitus', 'B': 'Pheochromocytoma', 'C': 'Medullary thyroid cancer', 'D': 'Papillary thyroid cancer', 'E': 'Pituitary adenoma'},
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E: Pituitary adenoma
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Q:A 15-year-old boy presents to the clinic complaining of an uncomfortable skin condition that started 2 years ago. The patient states that his skin feels ‘oily’ and that he is embarrassed by his appearance. On examination, he is a healthy-looking teenager who has reached the expected Tanner stage for his age. The skin on his face and back is erythematous and shows signs of inflammation. What is the microbiologic agent most associated with this presentation?? {'A': 'HHV-8', 'B': 'Streptococcus pyogenes', 'C': 'Cutibacterium acnes', 'D': 'Human papillomavirus (HPV) strains 2 and 4', 'E': 'Bartonella henselae'},
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C: Cutibacterium acnes
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Q:A 64-year-old woman presents to an endocrinologist after her second time having a kidney stone in the last year. The patient reports no other symptoms except overall fatigue. On evaluation, the patient’s temperature is 98.4°F (36.9°C), blood pressure is 120/76 mmHg, pulse is 72/min, and respirations are 12/min. The patient has no neck masses and no tenderness to palpation in the abdomen. On laboratory workup, the endocrinologist finds that the patient has elevated parathyroid hormone levels and serum calcium. For surgical planning, the patient undergoes a sestamibi scan, which localizes disease to an area near the superior aspect of the thyroid in the right neck. Which of the following is the embryologic origin of this tissue?? {'A': 'Dorsal wings of the third branchial pouch', 'B': 'Fourth branchial arch', 'C': 'Fourth branchial pouch', 'D': 'Third branchial arch', 'E': 'Ventral wings of the third branchial pouch'},
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C: Fourth branchial pouch
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Q:A 42-year-old man is brought to the emergency department 20 minutes after the sudden onset of severe chest pain, diaphoresis, shortness of breath, and palpitations. His symptoms occurred while he was at a party with friends. He has smoked one pack of cigarettes daily for 24 years. He uses cocaine occasionally. The last use was three hours ago. He appears pale. His pulse is 110/min, blood pressure is 178/106 mm Hg, and respirations are 24/min. His pupils are dilated and react sluggishly to light. The lungs are clear to auscultation. An ECG shows tachycardia and ST segment elevation in leads II, III, and aVF. While recording the ECG, the patient loses consciousness. A photo of the ECG at that point is shown. Which of the following is the most appropriate next step in management?? {'A': 'Administer lidocaine', 'B': 'Unsynchronized cardioversion', 'C': 'Coronary angiography', 'D': 'Administer epinephrine', 'E': 'Synchronized cardioversion'},
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B: Unsynchronized cardioversion
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Q:A 73-year-old man is brought to the emergency department by ambulance after being found to be non-communicative by his family during dinner. On presentation he appears to be alert, though he is confused and cannot follow instructions. When he tries to speak, he vocalizes a string of fluent but unintelligible syllables. Given this presentation, his physician decides to administer tissue plasminogen activator to this patient. This intervention best represents which of the following principles?? {'A': 'Primary prevention', 'B': 'Seconday prevention', 'C': 'Tertiary prevention', 'D': 'Quartenary prevention', 'E': 'This does not represent prevention'},
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C: Tertiary prevention
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Q:A 19-year-old primigravid woman at 32 weeks' gestation comes to the physician because of a 2-day history of headache and blurred vision. She has had no prenatal care. She is diagnosed with pre-eclampsia. Amniocentesis shows a lecithin-sphingomyelin ratio of 0.7. If delivery is induced at this time, the newborn is most likely to show which of the following findings?? {'A': 'Decreased right ventricular afterload', 'B': 'Increased diffusion capacity for carbon monoxide', 'C': 'Decreased functional residual capacity', 'D': 'Increased lung compliance', 'E': 'Increased anatomical dead space'},
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C: Decreased functional residual capacity
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Q:A 52-year-old male presents to clinic with complaints of anxiety and fatigue for 4 months. He has also been experiencing palpitations, muscle weakness, increased sweating, and an increase in the frequency of defecation. Past medical history is insignificant. He neither consumes alcohol nor smokes cigarettes. His pulse is 104/min and irregular, blood pressure is 140/80 mm Hg. On examination, you notice that he has bilateral exophthalmos. There are fine tremors in both hands. Which of the following results would you expect to see on a thyroid panel?? {'A': 'Low TSH; High T4; High T3', 'B': 'Normal TSH; Low T4; Low T3', 'C': 'High TSH; Low T4; Low T3', 'D': 'Normal TSH; Low total T4; Normal Free T4 and T3', 'E': 'High TSH; High T4; High T3'},
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A: Low TSH; High T4; High T3
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Q:A 75-year-old man presents with a tremor in his legs and arms. He says he has had the tremor for ‘many years’, but it has worsened in the last year. The tremor is more prominent at rest and nearly disappears on movement. He also says his family has mentioned that his movements have been slower, and he does feel like he has problem initiating movements. There is no significant past medical history. He says he often drinks wine, but this does not affect his tremors. The patient is afebrile and vital signs are within normal limits. On physical examination, the patient is hunched over and his face is expressionless throughout the examination. There is a ‘pill-rolling’ resting tremor that is accentuated when the patient is asked to clench the contralateral hand and alleviated by finger-nose testing. The patient is unable to play an imaginary piano with his fingers. There is the increased tone in the arm muscles bilaterally and resistance to passive movement at the elbow, knee, and hip joints is noted. When asked to walk across the room, the patient has difficulty taking the first step, has a stooped posture, and takes short rapid shuffling steps. Which of the following drugs would be the most effective treatment for this patient’s condition?? {'A': 'Levodopa/carbidopa', 'B': 'Bromocriptine', 'C': 'Benztropine', 'D': 'Entacapone', 'E': 'Selegiline'},
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A: Levodopa/carbidopa
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Q:A 34-year-old G5P5 woman gave birth to a healthy infant 30 minutes ago by vacuum-assisted vaginal delivery and is now experiencing vaginal bleeding. The placenta was delivered spontaneously and was intact upon examination. The infant weighed 5.2 kg and had Apgar scores of 8 and 9. No perineal tear or intentional episiotomy occurred. The patient has type 1 diabetes. She had good glycemic control throughout her pregnancy. She took a prenatal vitamin daily. Blood pressure is 135/72 mmHg, pulse is 102/min, and respirations are 18/min. Upon physical examination, the uterine fundus is soft and palpated 4 cm above the umbilicus. There are 3-cm blood clots on the patient’s bed pad. Which of the following is the next best step in management for the patient’s bleeding?? {'A': 'Administer misoprostol', 'B': 'Manually remove retained placental fragments', 'C': 'Perform hysterectomy', 'D': 'Perform uterine artery embolization', 'E': 'Perform uterine massage and administer oxytocin'},
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E: Perform uterine massage and administer oxytocin
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Q:A 31-year-old woman comes to the physician because of headaches and nausea for 2 weeks. The headaches are worse on awakening and she describes them as 7 out of 10 in intensity. During this period, she has noticed brief episodes of visual loss in both eyes lasting several seconds, especially when she suddenly stands up or bends over. She is 165 cm (5 ft 5 in) tall and weighs 98 kg (216 lb); BMI is 36 kg/m2. Vital signs are within normal limits. Examination shows a visual acuity of 20/20 in both eyes with mild peripheral vision loss. Fundoscopic examination shows bilateral optic disc swelling. An MRI of the brain shows no abnormalities. A lumbar puncture is performed; opening pressure is 310 mm H2O. Cerebrospinal fluid analysis shows a leukocyte count of 4/mm3 (75% lymphocytes), a protein concentration of 35 mg/dL, and a glucose concentration of 45 mg/dL. Which of the following is the most appropriate next step in management?? {'A': 'Acetazolamide therapy', 'B': 'Prednisone therapy', 'C': 'Optic nerve sheath fenestration', 'D': 'Ventricular shunting', 'E': 'Furosemide therapy'},
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A: Acetazolamide therapy
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Q:A 22-year-old female college student presents to the clinic with complaints of intense vaginal itching and a painful sensation when urinating. She also notes that she has felt more lethargic and has additionally been experiencing recent fevers and headaches. She says that she is sexually active and occasionally uses condoms. On physical exam, she is found to have red, vesicular ulcers on her labia that are painful to palpation and tender inguinal lymphadenopathy. What is the most likely pathogen causing her presentation?? {'A': 'Chlamydia trachomatis', 'B': 'Herpes simplex virus type 1', 'C': 'Herpes simplex virus type 2', 'D': 'Klebsiella granulomatis', 'E': 'Treponema pallidum'},
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C: Herpes simplex virus type 2
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Q:A 36-year-old G1P0 Caucasian woman in her 12th week of pregnancy presents to her obstetrician with vaginal bleeding. She also reports 3 episodes of non-bloody, non-bilious emesis. She failed to show up for her last 2 pre-natal visits due to work. Her past medical history is notable for obesity and type I diabetes mellitus. Her family history is notable for ovarian cancer in her mother and endometrial cancer in her maternal grandmother. On examination, her uterus is at 16 weeks in size and she has mild tenderness to palpation on her right suprapubic region. A transvaginal ultrasound in this patient would most likely reveal which of the following?? {'A': 'Fetal parts', 'B': 'Intrauterine cystic mass', 'C': 'Large intramural masses', 'D': 'Non-viable fetus', 'E': 'Unilateral ovarian cyst'},
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B: Intrauterine cystic mass
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Q:A 68-year-old woman is brought to the emergency department with intense abdominal pain for the past 2 hours. She has had 1 episode of bloody diarrhea recently. She has an 18-year history of diabetes mellitus. She was diagnosed with hypertension and ischemic heart disease 6 years ago. She is fully alert and oriented. Her temperature is 37.5°C (99.5°F), blood pressure is 145/90 mm Hg, pulse is 78/min, and respirations are 14/min. Abdominal examination shows mild generalized abdominal tenderness without guarding or rebound tenderness. An abdominal plain X-ray shows no abnormalities. Abdominal CT reveals colonic wall thickening and pericolonic fat stranding in the splenic curvature. Bowel rest, intravenous hydration, and IV antibiotics are initiated. Which of the following is the most important diagnostic evaluation at this time?? {'A': 'Angiography', 'B': 'Gastrografin-enhanced X-ray', 'C': 'Inpatient observation', 'D': 'Laparotomy', 'E': 'Sigmoidoscopy'},
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C: Inpatient observation
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Q:A 47-year-old woman presents to her primary care provider because of numbness and tingling on the palmar aspects of both hands. She denies any symptoms at the base of her thumbs. The symptoms are worse on the right (dominant hand) and are increased with activities such as driving or brushing her hair. She frequently wakes up with pain and has to shake her hand for pain relief. She has had rheumatoid arthritis for 9 years, for which she takes methotrexate. Her blood pressure is 124/76 mm Hg, the heart rate is 75/min, and the respiratory rate is 15/min. Lightly tapping over the middle of the anterior aspect of the right wrist leads to a tingling sensation in the palm. In this patient, electromyography (EMG) will most likely show which of the following results?? {'A': 'Denervation in C7 innervated paraspinal, arms, and shoulder muscles', 'B': 'Widespread symmetrical neuropathic changes without focal abnormalities', 'C': 'Widespread denervation in proximal muscles with normal sensory nerves', 'D': 'Focal slowing of conduction velocity in the median nerve in the carpal tunnel', 'E': 'Neuropathic changes in the palmar branch of the median nerve'},
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D: Focal slowing of conduction velocity in the median nerve in the carpal tunnel
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Q:A 15-year-old girl is brought to the physician because of a 2-week history of vaginal discharge. She has type 1 diabetes mellitus and her only medication is insulin. Menses occur at 28- to 29-day intervals, and her last menstrual period was 3 weeks ago. She does not want to share information regarding sexual activity. She is at the 60th percentile for height and weight. Vital signs are within normal limits. Examination shows Tanner stage II breast development. Pelvic examination shows white, thin, odorless vaginal discharge. A wet mount of the discharge shows no abnormalities. Which of the following is the most likely diagnosis?? {'A': 'Bacterial vaginosis', 'B': 'Vaginal foreign body', 'C': 'Trichomoniasis', 'D': 'Physiologic leukorrhea', 'E': 'Vaginal candidiasis'},
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D: Physiologic leukorrhea
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Q:A 24-year-old woman presents to her primary care physician for unilateral breast pain. The patient states that she has been breastfeeding her son but has been experiencing worsening pain recently. Her pain is severe enough that she is now struggling to breastfeed her son with her left breast. The patient's past medical history is notable for gestational diabetes which was controlled with diet and exercise. Her temperature is 101°F (38.3°C), blood pressure is 137/69 mmHg, pulse is 100/min, respirations are 13/min, and oxygen saturation is 97% on room air. Physical exam reveals an erythematous breast with a 3-cm tender and fluctuant mass of the left breast. Which of the following is the best next step in management?? {'A': 'Ice packs and breast pumping', 'B': 'Incision and drainage', 'C': 'No intervention necessary', 'D': 'Ultrasound and fine needle aspiration', 'E': 'Vancomycin and discharge home'},
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B: Incision and drainage
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Q:A 68-year-old man presents to his primary care provider after noticing that his urine has been pink for the last week. He does not have any pain with urination, nor has he had any associated fevers or infections. On his review of systems, the patient notes that he thinks he has lost some weight since his belt is looser, and he has also had occasional dull pressure in his back for the past two months. His temperature is 98.8°F (37.1°C), blood pressure is 132/90 mmHg, pulse is 64/min, and respirations are 12/min. The patient weighs 210 lbs (95.3 kg, BMI 31.9 kg/m^2), compared to his weight of 228 lbs (103.4 kg, BMI 34.7 kg/m^2) at his last visit 2 years prior. On exam, the patient does not have any back or costovertebral angle tenderness. On abdominal palpation, a firm mass can be appreciated deep in the left abdomen. The clinical workup should also assess for which of the following conditions?? {'A': 'Carcinoid syndrome', 'B': 'Cushing syndrome', 'C': 'Lambert-Eaton myasthenic syndrome', 'D': 'Myelitis', 'E': 'Syndrome of inappropriate antidiuretic hormone secretion (SIADH)'},
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B: Cushing syndrome
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Q:A 40-year-old woman comes to the physician for right lower abdominal pain for 6 months. She has multiple non-bloody, watery bowel movements daily and experiences abdominal cramping. Sometimes, she feels sudden palpitations, is short of breath, and her face becomes red. She has lost 7 kg over the past 3 months. She went on a 3-week hiking trip to Cambodia 6 months ago. She has smoked a pack of cigarettes daily for 15 years. Her temperature is 37˚C (98.6°F), her pulse is 72/min and her blood pressure is 125/70 mm Hg. On physical examination, tiny blood vessels are noted on her face and arms. Lung auscultation shows bilateral wheezing. The abdomen is soft and nondistended. There is localized tenderness to the right lower quadrant, but no rebound tenderness or guarding. Laboratory studies show: Leukocyte count 4,600 /mm3 Segmented neutrophils 61 % Eosinophils 2 % Platelet count 254,000 /mm3 Hemoglobin 13.1 g/dL Serum Aspartate aminotransferase (AST) 110 IU/L Alanine aminotransferase (ALT) 128 IU/L C-reactive protein 8 mg/dL (N = 0–10) Which of the following is the most likely diagnosis?"? {'A': 'Chronic appendicitis', 'B': 'Ascaris lumbricoides infection', 'C': 'Pheochromocytoma', 'D': 'Inflammatory bowel disease', 'E': 'Carcinoid tumor'},
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E: Carcinoid tumor
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Q:Two days after vaginal delivery of a healthy newborn at term, a 32-year-old woman, gravida 2, para 2, is unable to breastfeed. Her labor was complicated by antepartum hemorrhage and she received two units of packed red blood cells. Her pulse is 99/min and blood pressure is 90/55 mm Hg. Further evaluation of this patient is most likely to show which of the following sets of serum findings? $$$ ACTH %%% Aldosterone %%% Cortisol $$$? {'A': '↑ ↓ ↓', 'B': '↓ normal ↑', 'C': '↑ normal ↑', 'D': '↓ ↑ ↓', 'E': '↓ normal ↓'},
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D: ↓ ↑ ↓
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Q:A 23-year-old woman presents to her primary care provider complaining of diarrhea. She reports a 2 month history of 3-4 bloody stools per day as well as 10 pounds of unexpected weight loss. She has also developed intermittent mild gnawing lower abdominal pain. Her past medical history is unremarkable. She takes no medications and denies any drug allergies. Her family history is notable for colon cancer in her maternal aunt, rheumatoid arthritis in her paternal aunt, and Sjogren syndrome in her paternal grandmother. Her temperature is 99.1°F (37.3°C), blood pressure is 120/85 mmHg, pulse is 85/min, and respirations are 18/min. On exam, she has mild hypogastric tenderness to palpation. A stool guaiac test is positive. Flexible sigmoidoscopy demonstrates hyperemic and friable rectal mucosa. She is started on a medication to address her condition but presents to her physician one week later with a severe sunburn and skin itchiness following limited exposure to sunlight. Which of the following is the mechanism of action of the medication she received?? {'A': 'Calcineurin inhibitor', 'B': 'COX inhibitor', 'C': 'Dihydrofolate reductase inhibitor', 'D': 'DNA gyrase inhibitor', 'E': 'NF-kB inhibitor'},
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B: COX inhibitor
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Q:A 32-year-old man comes to the office complaining of right-sided upper abdominal pain for about 2 weeks. He is also complaining of subjective fever and malaise for the same duration. He has never been out of the United States. Additionally, he describes several episodes of bloody diarrhea and crampy abdominal pain that resolved on their own a few months ago. Travel history is noncontributory. He has been sexually active with 3 male partners in the last year and uses a condom inconsistently. He was diagnosed with syphilis 4 months ago and was treated with a single shot of penicillin. He has smoked 1 pack of cigarettes per day for the last 10 years and drinks 1–2 beers a day. Temperature is 38.7°C (101.6°F), blood pressure is 137/78 mm Hg, pulse is 98/min, respirations are 14/min, and BMI is 22 kg/m2. On physical examination, his liver is tender and palpable 2 cm below the right costal margin. Laboratory test Hemoglobin 15 g/dL Leucocyte and differential Leucocyte count 12,500/mm3 Neutrophil 60% Lymphocyte 31% Eosinophil 1% Liver function test ALT 100 U/L AST 95 U/L ALP 220 U/L CT scan of the abdomen shows a single cystic lesion on the right lobe of the liver. What is the diagnosis?? {'A': 'Amoebic liver abscess', 'B': 'Pyogenic liver abscess', 'C': 'Gonorrhea', 'D': 'Secondary syphilis', 'E': 'Alcoholic steatohepatitis'},
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A: Amoebic liver abscess
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Q:A 4-day-old girl presents with jaundice for the last 2 days. Although the patient’s parents were initially told that it was neonatal jaundice and would resolve quickly, they think that the yellow color of the patient’s skin appears to be more obvious today. The patient’s mother reports that the girl eats well, has normal stool and urine color. It’s her first child from the first healthy pregnancy. The patient was born at term via a spontaneous transvaginal delivery without any complications. Family history is significant for a paternal aunt who had 2 babies who died as infants from unknown causes and for a maternal uncle who has unexplained jaundice. On physical examination, the patient is awake, calm, and appears healthy except for the yellow tone of the skin and scleral icterus. Laboratory findings are significant for an elevated level of unconjugated bilirubin. A complete blood count and other routine biochemical blood tests are within expected parameters. The patient is treated with phototherapy, but her hyperbilirubinemia becomes more severe. Which of the following is the most appropriate course of treatment in this patient?? {'A': 'Continuation of phototherapy', 'B': 'Phenobarbital', 'C': 'Plasma exchange transfusion', 'D': 'No further treatment needed', 'E': 'Furosemide'},
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C: Plasma exchange transfusion
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Q:A 55-year-old man is brought to the emergency room by his roommate due to an abdominal pain that started 2 hours ago. His pain is dull, aching, and radiates to the back. He admits to binge drinking alcohol for the past 2 days. Past medical history is significant for multiple admissions to the hospital for similar abdominal pain events, hypertension, and hyperlipidemia. He takes chlorthalidone and atorvastatin. He admits to heavy alcohol consumption over the past 10 years. He has smoked a pack of cigarettes a day for the last 20 years. In the emergency department, his temperature is 38.9℃ (102.0℉), pulse rate is 100/min, and respiratory rate is 28/min. On physical examination, he looks generally unwell and diaphoretic. Auscultation of his heart and lungs reveals an elevated heart rate with a regular rhythm. His lungs are clear to auscultation bilaterally. His abdomen is tympanitic with generalized tenderness. Evaluation of lab values reveals a leukocyte count of 28,000/mm3 with 89% of neutrophils. His amylase level is 255 U/L. A CT scan of the abdomen shows the diffuse enlargement of the pancreas. Which pathological process is most likely occurring in this patient’s peripancreatic tissue?? {'A': 'Coagulative necrosis', 'B': 'Caseous necrosis', 'C': 'Liquefactive necrosis', 'D': 'Fibrinoid necrosis', 'E': 'Fat necrosis'},
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E: Fat necrosis
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Q:A 62-year-old man presents to his physician complaining of difficulty maintaining an erection over the past month. Otherwise he feels well. He has a history of hypertension and congestive heart failure. His current medications include metoprolol, amlodipine, furosemide, losartan, and aspirin. Three months ago, lisinopril was switched to losartan due to periodic cough. Two months ago, metoprolol and furosemide were added for better control of hypertension and edema, and the dose of amlodipine was reduced. He does not smoke. At the clinic, his blood pressure is 125/70 mm Hg, pulse is 58/min, and respirations are 14/min. Physical examination reveals clear lung sounds, a previously diagnosed systolic murmur, and mild pitting edema on the dorsum of both feet. Which of the following is the most appropriate modification in this patient’s medication?? {'A': 'Adding indapamide', 'B': 'Discontinuing furosemide', 'C': 'Increasing the amlodipine dose', 'D': 'Reducing the metoprolol dose', 'E': 'Switching losartan to lisinopril'},
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D: Reducing the metoprolol dose
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Q:A 59-year-old man with alcohol use disorder is brought to the emergency department by a friend because of progressively worsening forgetfulness and frequent falls. He appears disheveled. On mental status examination, he is confused and oriented only to person. Neurologic examination shows horizontal nystagmus on lateral gaze. He walks with wide-based, small steps and his gait is unsteady. An MRI of the brain is shown. Supplementation of which of the following is most likely to have prevented this patient's current condition?? {'A': 'Vitamin B12', 'B': 'Vitamin B1', 'C': 'Vitamin B6', 'D': 'Vitamin B3', 'E': 'Vitamin B9'},
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B: Vitamin B1
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Q:A newborn boy develops projectile vomiting 48 hours after delivery. He is found to be lethargic, with poor muscle tone, and is hyperventilating. Within hours, he suffers important neurological deterioration, leading to seizures, coma, and, ultimately, death. An autopsy is performed and the pathology team makes a diagnosis of a rare genetic disorder that leads to low levels of N-acetylglutamate. Which of the following enzymes would be secondarily affected by this process?? {'A': 'Carbamoyl phosphate synthetase I', 'B': 'Ornithine transcarbamylase', 'C': 'Arginase', 'D': 'Argininosuccinate lyase', 'E': 'Argininosuccinate synthetase'},
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A: Carbamoyl phosphate synthetase I
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Q:A 50-year-old female presents with a holosystolic murmur heard best over the apex, radiating to the axilla. She has no signs of pulmonary hypertension or edema. What best explains her lack of symptoms?? {'A': 'The right ventricle is compensating with decreased compliance', 'B': 'The left atrium is compensating with increased compliance', 'C': 'The aorta is compensating with increased compliance', 'D': 'As long as preload in the left ventricle is maintained there would be no symptoms', 'E': 'There is only a ballooning of the valve which would not result in any hemodynamic changes in the heart'},
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B: The left atrium is compensating with increased compliance
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Q:A 9-year-old girl is brought to her primary care physician because of a 4-month history of early morning headaches and worsening fatigue. The headaches are often accompanied by nausea and sometimes relieved by vomiting. She stopped going to her ballet lessons 2 weeks ago because she was embarrassed about falling frequently and having increasing difficulty performing the steps. Her temperature is 36.8°C (98.2°F), pulse is 98/min, and blood pressure is 105/65 mm Hg. She has a broad-based gait. While standing with both feet together and raising her arms, closing her eyes does not affect her balance. She is unable to perform rapid, alternating movements with her hands. An MRI of the brain is shown. Which of the following is the most likely diagnosis?? {'A': 'Acoustic schwannoma', 'B': 'Pilocytic astrocytoma', 'C': 'Oligodendroglioma', 'D': 'Diffuse brainstem glioma', 'E': 'Ependymoma'},
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B: Pilocytic astrocytoma
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Q:A 59-year-old male presents to his primary care physician complaining of a tremor. He developed a tremor in his left hand approximately three months ago. It appears to be worse at rest and diminishes if he points to something or uses the hand to hold an object. His past medical history is notable for emphysema and myasthenia gravis. He has a 40 pack-year smoking history. Physical examination reveals slowed movements. The patient takes several seconds to rise from his chair for a gait analysis which reveals a shuffling gait. The physician decides to start the patient on a medication that prevents the degradation of a neurotransmitter. This medication is also indicated for use in which of the following conditions?? {'A': 'Major depressive disorder', 'B': 'Influenza', 'C': 'Seasonal allergies', 'D': 'Hyperprolactinemia', 'E': 'Restless leg syndrome'},
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A: Major depressive disorder
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Q:A 61-year-old man is brought to the emergency room with slurred speech. According to the patient's wife, they were watching a movie together when he developed a minor headache. He soon developed difficulty speaking in complete sentences, at which point she decided to take him to the emergency room. His past medical history is notable for hypertension and hyperlipidemia. He takes aspirin, lisinopril, rosuvastatin. The patient is a retired lawyer. He has a 25-pack-year smoking history and drinks 4-5 beers per day. His father died of a myocardial infarction, and his mother died of breast cancer. His temperature is 98.6°F (37°C), blood pressure is 143/81 mmHg, pulse is 88/min, and respirations are 21/min. On exam, he can understand everything that is being said to him and is able to repeat statements without difficulty. However, when asked to speak freely, he hesitates with every word and takes 30 seconds to finish a short sentence. This patient most likely has an infarct in which of the following vascular distributions?? {'A': 'Anterior cerebral artery and middle cerebral artery watershed area', 'B': 'Inferior division of the middle cerebral artery', 'C': 'Middle cerebral artery and posterior cerebral artery watershed area', 'D': 'Proximal middle cerebral artery', 'E': 'Superior division of the middle cerebral artery'},
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A: Anterior cerebral artery and middle cerebral artery watershed area
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Q:A 45-year-old man comes to the emergency department because of hematuria and bilateral flank pain. He has passed urinary stones twice before and has a history of recurrent urinary tract infections. He reports no recent trauma. His father had a history of kidney failure and underwent a kidney transplant. His temperature is 38.0°C (100.4°F), pulse is 110/min, and blood pressure is 155/98 mm Hg. Abdominal examination shows palpable, bilateral flank masses. Results of a complete blood count are within the reference range. His serum creatinine concentration is 2.9 mg/dL. Which of the following findings is most likely to be associated with this patient's condition?? {'A': 'Colonic wall ulcerations', 'B': 'Vesicoureteral reflux', 'C': 'Portal hypertension', 'D': 'Osteolytic bone lesions', 'E': 'Cerebral saccular aneurysm'},
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E: Cerebral saccular aneurysm
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Q:A 12-year-old boy develops muscle weakness and pain, vomiting, seizures, and severe headache. Additionally, he presents with hemiparesis on one side of the body. A muscle biopsy shows 'ragged red fibers'. What is true about the mode of inheritance of the disease described?? {'A': 'Commonly more severe in males', 'B': 'Skips generations', 'C': 'Mothers transmit to 50% of daughters and son', 'D': 'It is transmitted only through the mother.', 'E': 'It can be transmitted through both parents.'},
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D: It is transmitted only through the mother.
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Q:A 35-year-old woman comes to the physician because of a 2-month history of progressive fatigue and intermittent abdominal pain. During this time, she has noticed that her urine is darker when she wakes up in the morning. Her stool is of normal color. Five months ago, she was diagnosed with type 2 diabetes mellitus, for which she takes metformin. Physical examination shows pallor and jaundice. There is no splenomegaly. Laboratory studies show: Hemoglobin 7.5 g/dL WBC count 3,500/mm3 Platelet count 100,000/mm3 Serum Creatinine 1.0 mg/dL Total bilirubin 6.0 mg/dL Direct bilirubin 0.2 mg/dl Lactate dehydrogenase 660 U/L Haptoglobin 18 mg/dL (N=41–165 mg/dL) Her urine is red, but urinalysis shows no RBCs. A Coombs test is negative. Peripheral blood smear shows no abnormalities. This patient is at greatest risk for which of the following complications?"? {'A': 'Cholesterol gallstones', 'B': 'Acrocyanosis', 'C': 'Hepatocellular carcinoma', 'D': 'Venous thrombosis', 'E': 'Chronic lymphocytic leukemia'},
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D: Venous thrombosis
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Q:A 52-year-old woman is brought to the emergency department by her husband because of weakness, abdominal pain, and a productive cough for 4 days. She also reports increased urination for the past 2 days. This morning, she had nausea and five episodes of vomiting. She has type 1 diabetes mellitus and hypertension. Current medications include insulin and lisinopril. She admits to have forgotten to take her medication in the last few days. Her temperature is 38.4°C (101.1°F), pulse is 134/min, respirations 31/min, and blood pressure is 95/61 mm Hg. Examination shows dry mucous membranes and decreased skin turgor. Abdominal examination shows diffuse tenderness with no guarding or rebound. Bowel sounds are normal. Laboratory studies show: Serum Na+ 139 mEq/L K+ 5.3 mEq/L Cl- 106 mEq/L Glucose 420 mg/dL Creatinine 1.0 mg/dL Urine Blood negative Glucose 4+ Ketones 3+ Arterial blood gas analysis on room air shows: pH 7.12 pCO2 17 mm Hg pO2 86 mm Hg HCO3- 12 mEq/L Which of the following is the most likely underlying cause of this patient's increased potassium?"? {'A': 'Increased renal potassium absorption', 'B': 'Intracellular potassium shift', 'C': 'Muscle cell breakdown', 'D': 'Extracellular potassium shift', 'E': 'Repeated vomiting'},
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D: Extracellular potassium shift
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Q:A 3-year-old girl with cystic fibrosis is brought to the physician for a follow-up examination. Her mother has noticed that the child has had multiple falls over the past 4 months while walking, especially in the evening. Her current medications include pancreatic enzyme supplements, an albuterol inhaler, and acetylcysteine. She is at the 10th percentile for height and the 5th percentile for weight. Examination shows dry skin, and cone shaped elevated papules on the trunk and extremities. There is an irregularly shaped foamy gray patch on the left conjunctiva. The remainder of the examination shows no abnormalities. Which of the following is the most appropriate next step in management?? {'A': 'Administer niacin', 'B': 'Administer zinc', 'C': 'Administer vitamin A', 'D': 'Administer riboflavin', 'E': 'Administer lutein'},
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C: Administer vitamin A
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Q:An otherwise healthy 55-year-old woman comes to the physician because of a 7-month history of insomnia. She has difficulty initiating sleep, and her sleep onset latency is normally about 1 hour. She takes melatonin most nights. The physician gives the following recommendations: leave the bedroom when unable to fall asleep within 20 minutes to read or listen to music; return only when sleepy; avoid daytime napping. These recommendations are best classified as which of the following?? {'A': 'Relaxation', 'B': 'Stimulus control therapy', 'C': 'Improved sleep hygiene', 'D': 'Cognitive behavioral therapy', 'E': 'Sleep restriction'},
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B: Stimulus control therapy
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Q:A 59-year-old man comes to the physician because of bilateral blurry vision and difficulty driving at night that has been worsening progressively over the past 5 months. He has hypertension, type 2 diabetes mellitus, and hyperlipidemia. His hemoglobin A1c concentration is 8.9 mg/dL. A slit-lamp shows cloudy opacities of the lenses bilaterally. The patient's eye condition is most likely due to increased activity of which of the following enzymes?? {'A': 'Galactokinase', 'B': 'Aldolase B', 'C': 'Glucokinase', 'D': 'Aldose reductase', 'E': 'Sorbitol dehydrogenase'},
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D: Aldose reductase
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Q:A 15-month-old infant is brought to the pediatrician with diarrhea. The infant’s history is positive for repeated episodes of diarrhea over the last 9 months. The mother reports that he was completely healthy until about 6 months of age. There is no history of lethargy, pedal edema, constipation, or vomiting. She mentions that because the symptoms were self-limiting, she did not consult a pediatrician. However, she has been regularly plotting his weight and length in a growth chart, shown below. The pediatrician observes his growth chart and suggests laboratory evaluation. Which of the following conditions is suggested by the growth curve plotted on the growth chart?? {'A': 'Constitutional growth delay', 'B': 'Mild wasting', 'C': 'Mild stunting', 'D': 'Failure to thrive', 'E': 'Kwashiorkor'},
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D: Failure to thrive
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Q:A 31-year-old G1P0 woman with a history of hypertension presents to the emergency department because she believes that she is in labor. She is in her 38th week of pregnancy and her course has thus far been uncomplicated. This morning, she began feeling painful contractions and noted vaginal bleeding after she fell off her bike while riding to work. She is experiencing lower abdominal and pelvic pain between contractions as well. Her temperature is 97.6°F (36.4°C), blood pressure is 177/99 mmHg, pulse is 100/min, respirations are 20/min, and oxygen saturation is 98% on room air. Physical exam is notable for a gravid and hypertonic uterus and moderate blood in the vaginal vault. Ultrasound reveals no abnormalities. Which of the following is the most likely diagnosis?? {'A': 'Abruptio placentae', 'B': 'Normal labor', 'C': 'Placenta previa', 'D': 'Uterine rupture', 'E': 'Vasa previa'},
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A: Abruptio placentae
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Q:A 79-year-old homeless man is brought to the emergency department by ambulance 30 minutes after being found unresponsive by the police. On arrival, he is apneic and there are no palpable pulses. Despite appropriate life-saving measures, he dies. Examination of the heart during autopsy shows normal ventricles with a sigmoid-shaped interventricular septum. A photomicrograph of a section of the heart obtained at autopsy is shown. Which of the following is the most likely underlying cause for the structure indicated by the arrow?? {'A': 'Accumulation of iron granules', 'B': 'Clumping of defective mitochondria', 'C': 'Oxidation of phospholipid molecules', 'D': 'Aggregation of alpha-synuclein', 'E': 'Deposition of wild-type transthyretin'},
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C: Oxidation of phospholipid molecules
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Q:A 19-year-old college student presents to student health with 1 day of fever and chills. He says that he has also been coughing for 2 days. His roommate was sick 3 days ago with similar symptoms and was diagnosed with Mycoplasma infection. He has otherwise been healthy and has had all the required vaccines as scheduled. He is currently taking introductory biology as part of his premedical studies and recently learned about antibodies. He therefore asks his physician about what his body is doing to fight off the infection. At this stage of his infection, which of the following forms are the antibodies circulating in his serum?? {'A': 'Dimers', 'B': 'Monomers', 'C': 'Pentamers', 'D': 'Tetramers', 'E': 'Trimers'},
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C: Pentamers
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Q:A 42-year-old woman is seen by her primary care physician for her annual checkup. She has no current concerns and says that she has been healthy over the last year except for a bout of the flu in December. She has no significant past medical history and is not currently taking any medications. She has smoked 1 pack per day since she was 21 and drinks socially with her friends. Her family history is significant for prostate cancer in her dad when he was 51 years of age and ovarian cancer in her paternal aunt when she was 41 years of age. Physical exam reveals a firm, immobile, painless lump in the upper outer quadrant of her left breast as well as 2 smaller nodules in the lower quadrants of her right breast. Biopsy of these lesions shows small, atypical, glandular, duct-like cells with stellate morphology. Which of the following pathways is most likely abnormal in this patient?? {'A': 'Base excision repair', 'B': 'Homologous recombination', 'C': 'Mismatch repair', 'D': 'Non-homologous end joining', 'E': 'Nucleotide excision repair'},
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B: Homologous recombination
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Q:A 56-year-old man presents to the emergency department with severe epigastric pain that began an hour prior to presentation. He describes the pain as sharp, 10/10 in severity, and radiating to the back. Swallowing worsens the pain and causes him to cough. Before the pain started, he had been vomiting multiple times per day for the past week. The emesis was yellow and he denied ever seeing blood. Medical history is significant for poorly controlled hypertension, type II diabetes, alcohol use disorder, and 2 prior hospitalizations for acute pancreatitis. He smokes 1 pack of cigarettes per day for the last 35 years, denies illicit drug use, and drinks 3 pints of vodka per day. On physical exam, there is mediastinal crackling in synchrony with cardiac contraction on cardiac auscultation in the left lateral decubitus position. Laboratory testing is significant for leukocytosis. Which of the following is most likely the cause of this patient’s symptoms?? {'A': 'Coronary artery occlusion', 'B': 'Dissection of the aorta', 'C': 'Inflammation of the pancreas', 'D': 'Ulcerative changes in the gastric mucosa', 'E': 'Transmural esophageal rupture'},
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E: Transmural esophageal rupture
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Q:A researcher is studying the interactions between foreign antigens and human immune cells. She has isolated a line of lymphocytes that is known to bind antigen-presenting cells. From this cell line, she has isolated a cell surface protein that binds the constant portion of the class I major histocompatibility complex molecule. The activation of this specific cell line requires co-activation via which of the following signaling molecules?? {'A': 'Interleukin 1', 'B': 'Interleukin 2', 'C': 'Interleukin 4', 'D': 'Interleukin 6', 'E': 'Interleukin 8'},
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B: Interleukin 2
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Q:A 76-year-old woman with a history of hypertension and type 2 diabetes mellitus is brought to the emergency department 60 minutes after the acute onset of left-sided abdominal pain and nausea with vomiting. Three weeks ago, she underwent emergency surgical revascularization for acute left lower extremity ischemia. Physical examination shows left upper quadrant tenderness without rebound or guarding. Serum studies show an elevated lactate dehydrogenase level. Laboratory studies, including a complete blood count, basic metabolic panel, and hepatic panel, are otherwise unremarkable. A transverse section of a CT scan of the abdomen is shown. Further evaluation is most likely to show which of the following?? {'A': 'Absent P waves on electrocardiogram', 'B': 'Non-compressible femoral vein on ultrasonography', 'C': 'Infrarenal aortic aneurysm on abdominal CT scan', 'D': 'Right atrial thrombus on transesophageal echocardiography', 'E': 'Schistocytes on peripheral blood smear'},
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A: Absent P waves on electrocardiogram
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Q:A 50-year-old woman comes to the physician for a follow-up examination. Two weeks ago she was seen for adjustment of her antihypertensive regimen and prescribed lisinopril because of persistently high blood pressure readings. A complete blood count and renal function checked at her last visit were within the normal limits. On questioning, she has had fatigue and frequent headaches over the last month. She has hypertension, type 2 diabetes mellitus, polycystic ovarian disease, and hyperlipidemia. Her mother has hyperthyroidism and hypertension. Current medications include amlodipine and hydrochlorothiazide at maximum doses, lisinopril, metformin, glimepiride, and atorvastatin. She has never smoked and drinks 1–2 glasses of wine with dinner every night. She is 167 cm (5 ft 5 inches) and weighs 81.6 kg (180 lbs); BMI is 30 kg/m2. Her blood pressure is 170/110 mm Hg in both arms, heart rate is 90/min, and respirations are 12/min. Examination shows an obese patient and no other abnormalities. Laboratory studies show: Hemoglobin 14 g/dL Leukocyte count 7,800/mm3 Serum Na+ 139 mEq/L K+ 3.4 mEq/L Cl- 100 mEq/L Creatinine 2.1 mg/dL Urea nitrogen 29 mg/dL TSH 3 μU/mL Urine Blood negative Protein negative Glucose 1+ Which of the following is the most likely diagnosis?"? {'A': 'Obstructive sleep apnea', 'B': 'Hyperthyroidism', 'C': 'Diabetic kidney disease', 'D': 'Polycystic kidney disease', 'E': 'Renal artery stenosis\n"'},
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E: Renal artery stenosis "
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Answer the following medical question with one of the provided options:
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Q:A 77-year-old man presents to the emergency department complaining of feeling like “his heart was racing” for the last 8 days. He denies any chest pain, dizziness, or fainting but complains of fatigue, difficulty breathing with exertion, and swelling of his legs bilaterally for the last 2 weeks. He has had hypertension for the last 25 years. He has a long history of heavy alcohol consumption but denies smoking. His blood pressure is 145/70 mm Hg and the pulse is irregular at the rate of 110/min. On examination of his lower limbs, mild pitting edema is noted of his ankles bilaterally. On cardiac auscultation, heart sounds are irregular. Bibasilar crackles are heard with auscultation of the lungs. An ECG is ordered and the result is shown in the image. Transesophageal echocardiography shows a reduced ejection fraction of 32% and dilatation of all chambers of the heart without any obvious intracardiac thrombus. Which of the following is the optimal therapy for this patient?? {'A': 'Observation', 'B': 'Immediate direct current (DC) cardioversion', 'C': 'Rivaroxaban for 3–4 weeks followed by cardioversion and continuation of rivaroxaban', 'D': 'Warfarin and diltiazem indefinitely', 'E': 'Catheter ablation for pulmonary vein isolation'},
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C: Rivaroxaban for 3–4 weeks followed by cardioversion and continuation of rivaroxaban
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Q:A 64-year-old woman is brought to the emergency department because of a 1-week history of progressive shortness of breath, lower extremity edema, and a 4-kg (9-lb) weight gain. She has ischemic cardiomyopathy and rheumatoid arthritis. Her respirations are 27/min. Examination shows pitting edema of the lower extremities and crackles over both lower lung fields. Therapy is initiated with intravenous furosemide. After 2 hours, urine output is minimal. Concomitant treatment with which of the following drugs is most likely to have contributed to treatment failure?? {'A': 'Sulfasalazine', 'B': 'Diclofenac', 'C': 'Prednisone', 'D': 'Infliximab', 'E': 'Digoxin\n"'},
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B: Diclofenac
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Q:A 7-year-old girl is brought to the physician because of scant painless bleeding from the vagina 6 hours ago. She has no history of serious illness or trauma. Her older sister had her first period at age 11. The patient is at the 80th percentile for height and 95th percentile for weight and BMI. Examination shows greasy facial skin and sparse axillary hair. Breast development is at Tanner stage 3 and pubic hair development is at Tanner stage 2. The external genitalia appear normal. Serum glucose is 189 mg/dL. Intravenous administration of leuprolide causes an increase in serum luteinizing hormone. Which of the following is the most likely underlying cause of this patient's findings?? {'A': 'Overproduction of adrenal cortisol', 'B': 'Ectopic hormone production', 'C': 'Compensatory hyperinsulinemia', 'D': 'Pulsatile GnRH release', 'E': 'Deficiency of thyroid hormones\n"'},
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D: Pulsatile GnRH release
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Q:A 9-year-old boy is brought to the physician by his mother because of a 3-day history of fever and bleeding after brushing his teeth. His mother also reports that her son has asked to be picked up early from soccer practice the past few days because of fatigue. He appears pale and ill. His temperature is 38.3°C (101.1°F), pulse is 115/min, and blood pressure is 100/60 mm Hg. The lungs are clear to auscultation. Examination shows a soft, nontender abdomen with no organomegaly. There are several spots of subcutaneous bleeding on the abdomen and shins. Laboratory studies show a hemoglobin concentration of 7 g/dL, a leukocyte count of 2,000/mm3, a platelet count of 40,000/mm3, and a reticulocyte count of 0.2%. Serum electrolyte concentrations are within normal limits. A bone marrow biopsy is most likely to show which of the following findings?? {'A': 'Sheets of abnormal plasma cells', 'B': 'Normocellular bone marrow', 'C': 'Hypocellular fat-filled marrow with RBCs of normal morphology', 'D': 'Hypercellular, dysplastic bone marrow with ringed sideroblasts', 'E': 'Infiltration of the marrow with collagen and fibrous tissue'},
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C: Hypocellular fat-filled marrow with RBCs of normal morphology
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Q:A 27-year-old woman comes to the physician because of a 1-year history of progressive shortness of breath. She is now unable to jog for more than 10 minutes without stopping to catch her breath. Cardiac examination shows a harsh systolic, crescendo-decrescendo murmur best heard at the lower left sternal border. The murmur increases in intensity when she moves from a squatting to a standing position and decreases when she clenches her fists. The lungs are clear to auscultation. Which of the following is the most likely cause of her condition?? {'A': 'Dystrophin defect', 'B': 'Fibrillin-1 defect', 'C': 'Myosin heavy chain defect', 'D': 'GAA trinucleotide repeats', 'E': 'CTG trinucleotide repeats'},
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C: Myosin heavy chain defect
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Q:A 27-year-old woman presented to the clinic with recurrent abdominal swelling and stunted growth relative to her siblings. She has a history of multiple blood transfusions in her childhood. She has a family history of jaundice in her father who was operated on for multiple gallbladder stones. The physical examination reveals a pale, icteric, small and short-statured young lady. On abdominal examination, the spleen was enlarged by 6 cm below the right costal margin, but the liver was not palpable. The ultrasound of the abdomen reveals multiple gallbladder stones. The laboratory test results are as follows: Hb 9 g/dL Hct 27% WBC 6,200/mm3 Platelets 200,000/mm3 MCV 75 um3 MCHC 37 gm/dL Reticulocytes 6.5% A peripheral blood smear is presented in the image. The direct Coombs test was negative. The osmotic fragility test was increased. What is the most likely cause of her condition?? {'A': 'Hereditary spherocytosis', 'B': 'Blood loss', 'C': 'Aplastic anemia', 'D': 'Vitamin B12 deficiency', 'E': 'Anemia of chronic disease'},
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A: Hereditary spherocytosis
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Q:A 43-year-old HIV positive male presents with signs and symptoms concerning for a fungal infection. He is currently not on antiretrovirals and his CD4 count is 98. Which of the following candidal infections could be seen in this patient but would be very rare in an immunocompetent host?? {'A': 'Oral thrush', 'B': 'Vaginitis', 'C': 'Intertrigo', 'D': 'Esophagitis', 'E': 'Endocarditis'},
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D: Esophagitis
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Q:A 55-year-old man is brought to the emergency department 3 hours after ingesting approximately 30 tablets of an unknown drug in an apparent suicide attempt. His temperature is 36.5°C (97.7°F), pulse is 40/min, respiratory rate is 19/min, and blood pressure is 85/50 mm Hg. Examination shows cold, clammy extremities. Scattered expiratory wheezing is heard throughout both lung fields. His fingerstick blood glucose concentration is 62 mg/dL. ECG shows prolonged PR intervals and narrow QRS complexes. Intravenous fluid resuscitation and atropine do not improve his symptoms. Administration of which of the following drugs is most appropriate next step in management of this patient?? {'A': 'Sodium bicarbonate', 'B': 'Pralidoxime', 'C': 'Glucagon', 'D': 'Activated charcoal', 'E': 'Naloxone'},
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C: Glucagon
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Q:A 33-year-old African-American female presents to her physician with complaints of a persistent, dry cough. She states that the cough has gone on for some time now. Three weeks ago, during her last general checkup, she was started on lisinopril and metformin for concerns regarding an elevated blood pressure and fasting blood glucose. Past medical history is notable for eczema, asthma, and seasonal allergies. At this visit the patient has other non-specific complaints such as fatigue and joint pain as well as a burning sensation in her sternum when she eats large meals. Her physical exam is only notable for painful bumps on her lower extremities (figure A) which the patient attributes to "bumping her shins," during exercise, and an obese habitus. Which of the following is most likely true for this patient's chief concern?? {'A': 'Serum levels of bradykinin will be elevated', 'B': 'Loratadine would best treat her chief complaint', 'C': 'Beta agonists would relieve this patients symptoms', 'D': 'Non-caseating granulomas are found on biopsy of mediastinal lymph nodes', 'E': 'Omeprazole is an appropriate next step in management'},
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D: Non-caseating granulomas are found on biopsy of mediastinal lymph nodes
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Q:Two hours after admission to the intensive care unit, a 56-year-old man with necrotizing pancreatitis develops profound hypotension. His blood pressure is 80/50 mm Hg and he is started on vasopressors. A central venous access line is placed. Which of the following is most likely to decrease the risk of complications from this procedure?? {'A': 'Initiation of anticoagulation after placement', 'B': 'Initiation of periprocedural systemic antibiotic prophylaxis', 'C': 'Replacement of the central venous line every 7-10 days', 'D': 'Preparation of the skin with chlorhexidine and alcohol', 'E': 'Placement of the central venous line in the femoral vein'},
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D: Preparation of the skin with chlorhexidine and alcohol
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Q:A 51-year-old woman comes to the physician because of swelling of her legs for 4 months. She first noticed the changes on the left leg, followed by the right leg. Sometimes her legs are itchy. She has a 1-month history of hoarseness. She returned from a trip to Mexico 8 months ago. She has a history of hypertension, constipation, and coronary artery disease. She works as a teacher at a primary school. Her mother had type-2 diabetes mellitus. She smoked one-half pack of cigarettes daily for 6 years but stopped smoking 11 years ago. She drinks one glass of wine daily and occasionally more on the weekend. Current medications include aspirin, bisoprolol, and atorvastatin. She is 165 cm (5 ft 5 in) tall and weighs 82 kg (181 lb); BMI is 30.1 kg/m2. Vital signs are within normal limits. Examination shows bilateral pretibial non-pitting edema. The skin is indurated, cool, and dry. Peripheral pulses are palpated bilaterally. The remainder of the examination shows no abnormalities. The patient is at increased risk for which of the following conditions?? {'A': 'Renal vein thrombosis', 'B': 'Esophageal variceal hemorrhage', 'C': 'Elephantiasis', 'D': 'Primary thyroid lymphoma', 'E': 'Venous ulcer'},
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D: Primary thyroid lymphoma
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Answer the following medical question with one of the provided options:
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Q:A 39-year-old male who recently presented with acetaminophen overdose was admitted to the MICU, where several attempts were made at obtaining intravenous access without success. The decision was made to place a right axillary arterial line, which became infected and was removed by the medical student while the patient was still intubated. It was later noticed that he had substantial swelling and bruising of the upper extremity. Given his sedation, a proper neuro exam was not performed at that time. Several days later, after the patient's liver function improved, he was successfully extubated. On exam, he complained of lack of sensation over the palmar and dorsal surface of the small finger and half of the ring finger, as well as weak digit abduction, weak thumb adduction, and weak thumb-index finger pinch of the affected extremity. What is the most likely cause and corresponding location of the injury?? {'A': 'Needle injury to ulnar nerve secondary to blind line placement', 'B': 'Needle injury to median nerve secondary to blind line placement', 'C': 'Compression of ulnar nerve secondary to coagulopathy', 'D': 'Compression of median nerve secondary to coagulopathy', 'E': 'Stretch injury to ulnar nerve secondary to frequent repositioning'},
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C: Compression of ulnar nerve secondary to coagulopathy
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Answer the following medical question with one of the provided options:
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Q:A mother brings her 6-year-old daughter in to the pediatrician’s clinic for a wellness visit. The mother has a history of von Willebrand’s disease (vWD) and is concerned that her daughter may be affected as well. The mother tells you that she has noticed that her daughter bruises very easily, and her bruises typically are visible for a longer period of time than those of her brother. She denies any personal history of blood clots in her past, but she says that her mother has had to be treated for pulmonary embolism in the recent past. Her birth history is significant for preeclampsia, preterm birth at 32 weeks, a NICU stay of two and a half weeks, and retinopathy of prematurity. She currently eats a diet full of green vegetables, fruits, and french fries. Her vital signs include: temperature, 36.7°C (98.0°F); blood pressure, 106/54 mm Hg; heart rate, 111/min; and respiratory, rate 23/min. On physical examination, her pulses are bounding, complexion is pale, scattered bruises throughout all extremities that are specifically scattered around the knees and elbows. After ordering a coagulation panel, which of the following would one expect to see in the lab panel of a patient with vWD?? {'A': 'Elevated platelet count', 'B': 'Prolonged PT', 'C': 'Prolonged PTT', 'D': 'Normal bleeding time', 'E': 'Decreased factor IX'},
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C: Prolonged PTT
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Answer the following medical question with one of the provided options:
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Q:A 35-year-old African American woman comes to the physician because of intermittent palpitations over the past 2 weeks. During this period she has also had constipation and has felt more tired than usual. She was diagnosed with hypertension 4 weeks ago and treatment with chlorthalidone was begun. Her temperature is 36.5°C (97.7°F), pulse is 75/min, and blood pressure is 158/97 mm Hg. Physical examination shows a soft and nontender abdomen. There is mild weakness of the upper and lower extremities. Deep tendon reflexes are 1+ bilaterally. Laboratory studies show: Hemoglobin 13.5 g/dL Leukocyte count 5,000/mm3 Serum Na+ 146 mEq/L Cl− 100 mEq/L K+ 2.8 mEq/L HCO3− 30 mEq/L Glucose 97 mg/dL Urea nitrogen 10 mg/dL Creatinine 0.8 mg/dL Test of the stool for occult blood is negative. An ECG shows premature atrial complexes. Chlorthalidone is discontinued and oral potassium chloride therapy is begun. One week later, the patient's plasma aldosterone concentration is 26 ng/dL (N=3.6 to 24.0 ng/dL) and plasma renin activity is 0.8 ng/mL/h (N=0.3 to 4.2 ng/mL/h). Which of the following is the most appropriate next step in management?"? {'A': 'Perform adrenalectomy', 'B': 'Perform CT scan of the abdomen', 'C': 'Measure urine pH and anion gap', 'D': 'Perform dexamethasone suppression test', 'E': 'Perform saline infusion test'},
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E: Perform saline infusion test
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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 is brought to the emergency department because of a 2-day history of a decreasing level of consciousness. He had blurred vision for several days. Two weeks ago, he had transient numbness in the right arm for 3 days. He was diagnosed with monoclonal gammopathy of undetermined significance 2 years ago. He is not fully alert. His temperature is 36.2°C (97.2°F), pulse is 75/min, respiratory rate is 13/min, and blood pressure is 125/70 mm Hg. He has gingival bleeding. Cervical lymphadenopathy is noted on palpation. Both the liver and spleen are palpated 6 cm below the costal margins. Serum protein electrophoresis with immunofixation is shown. Urine electrophoresis shows no abnormalities. A skeletal survey shows no abnormalities. Which of the following is the most appropriate next step in management?? {'A': 'Dexamethasone', 'B': 'Hemodialysis', 'C': 'Intravenous hydration with normal saline', 'D': 'Rituximab', 'E': 'Plasmapheresis'},
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E: Plasmapheresis
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