input
stringlengths 133
5.87k
| output
stringlengths 19
305
|
|---|---|
The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 40-year-old female visits the emergency department with right upper quadrant pain and fever of 2-hours duration. She denies alcohol, cigarette, and drug use and reports no other medical problems. Body mass index is 30 kg/m^2. Her temperature is 38.5 degrees Celsius (101.3 degrees Fahrenheit), blood pressure is 130/80 mm Hg, pulse is 90/min, and respirations are 18/min. Jaundice is present in the sclera and at the base of the tongue. The abdomen is tender in the right upper quadrant. Liver function test (LFTs) reveal elevated direct and total bilirubin and alkaline phosphatase of 500 U/L. IV Ampicillin-gentamicin is administered, fluid resuscitation is initiated, and over 24 hours the patient’s fever improves. Which of the following is the next step in the management of this patient: (A) Elective laparoscopic cholecystectomy (B) Urgent open cholecystectomy (C) Endoscopic retrograde cholangiopancreatography (ERCP) (D) Administer bile acids
|
['(C) Endoscopic retrograde cholangiopancreatography (ERCP) <> answer']
|
The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 32-year-old male patient presents to a medical office requesting screening for colorectal cancer. He currently has no symptoms and his main concern is that his father was diagnosed with colorectal cancer at 55 years of age. What screening strategy would be the most appropriate? (A) Perform a colonoscopy at the age of 40 and repeat every 5 years (B) Perform a colonoscopy at the age of 40 and repeat every 3 years (C) Perform a colonoscopy at the age of 50 and repeat every 5 years (D) Perform a colonoscopy at the age of 50 and repeat every 10 years
|
['(A) Perform a colonoscopy at the age of 40 and repeat every 5 years <> answer']
|
The following are multiple choice questions (with answers) about medical knowledge. **Question:** An 11-year-old boy is brought to the emergency department by his parents with a 2-day history of fever, malaise, and productive cough. On presentation, he is found to be very weak and is having difficulty breathing. His past medical history is significant for multiple prior infections requiring hospitalization including otitis media, upper respiratory infections, pneumonia, and sinusitis. His family history is also significant for a maternal uncle who died of an infection as a child. Lab findings include decreased levels of IgG, IgM, IgA, and plasma cells with normal levels of CD4 positive cells. The protein that is most likely defective in this patient has which of the following functions? (A) Actin polymerization (B) Autoimmune regulation (C) Lysosomal trafficking (D) Protein phosphorylation
|
['(D) Protein phosphorylation <> answer']
|
The following are multiple choice questions (with answers) about medical knowledge. **Question:** A primigravida at 10+5 weeks gestation registers in an obstetric clinic for prenatal care. She has noted a rash that is rough with red-brown spots on her palms. The rapid plasma reagin (RPR) test is positive. The diagnosis is confirmed by darkfield microscopy. What is the fetus at risk for secondary to the mother’s condition? (A) Vision loss (B) Saddle nose (C) Chorioretinitis (D) Muscle atrophy
|
['(B) Saddle nose <> answer']
|
The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 42-year-old woman comes to the physician because of episodic abdominal pain and fullness for 1 month. She works as an assistant at an animal shelter and helps to feed and bathe the animals. Physical examination shows hepatomegaly. Abdominal ultrasound shows a 4-cm calcified cyst with several daughter cysts in the liver. She undergoes CT-guided percutaneous aspiration under general anesthesia. Several minutes into the procedure, one liver cyst spills, and the patient's oxygen saturation decreases from 95% to 64%. Her pulse is 136/min, and blood pressure is 86/58 mm Hg. Which of the following is the most likely causal organism of this patient's condition? (A) Strongyloides stercoralis (B) Schistosoma mansoni (C) Clonorchis sinensis (D) Echinococcus granulosus
|
['(D) Echinococcus granulosus <> answer']
|
The following are multiple choice questions (with answers) about medical knowledge. **Question:** One week after delivery, a 3550-g (7-lb 13-oz) newborn has multiple episodes of bilious vomiting and abdominal distention. He passed urine 14 hours after delivery and had his first bowel movement 3 days after delivery. He was born at term to a 31-year-old woman. Pregnancy was uncomplicated and the mother received adequate prenatal care. His temperature is 37.1°C (98.8°F), pulse is 132/min, and respirations are 50/min. Examination shows a distended abdomen. Bowel sounds are hypoactive. Digital rectal examination shows a patent anus and an empty rectum. The remainder of the examination shows no abnormalities. An x-ray of the abdomen is shown. Which of the following is the underlying cause of these findings? (A) Defective migration of neural crest cells (B) Disruption of blood flow to the fetal jejunum (C) Mutation in the CFTR gene (D) Abnormal rotation of the intestine
|
['(A) Defective migration of neural crest cells <> answer']
|
The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 14-year-old girl is brought to the physician because of a 10-day history of vaginal bleeding. The flow is heavy with the passage of clots. Since menarche 1 year ago, menses have occurred at irregular 26- to 32-day intervals and last 3 to 6 days. Her last menstrual period was 4 weeks ago. She has no history of serious illness and takes no medications. Her temperature is 37.1°C (98.8°F), pulse is 98/min, and blood pressure is 106/70 mm Hg. Pelvic examination shows vaginal bleeding. The remainder of the examination shows no abnormalities. Her hemoglobin is 13.1 g/dL. A urine pregnancy test is negative. Which of the following is the most appropriate next step in management? (A) Tranexamic acid (B) Uterine artery embolization (C) Uterine curretage (D) Conjugated estrogen therapy
|
['(D) Conjugated estrogen therapy <> answer']
|
The following are multiple choice questions (with answers) about medical knowledge. **Question:** A previously healthy 4-year-old boy is brought to the physician by his parents because he has had a fever, diffuse joint pain, and a rash on his abdomen for the past week. Acetaminophen did not improve his symptoms. He emigrated from China with his family 2 years ago. He attends daycare. His immunization records are not available. His temperature is 38.5°C (101.3°F), pulse is 125/min, and blood pressure is 100/60 mm Hg. Examination shows polymorphous truncal rash. The eyes are pink with no exudate. The tongue is shiny and red, and the lips are cracked. The hands and feet are red and swollen. There is right-sided anterior cervical lymphadenopathy. Which of the following is the most appropriate next step in management? (A) Echocardiography (B) ANA measurement (C) Antistreptolysin O titer measurement (D) HHV-6 immunoglobulin M (IgM) detection
|
['(A) Echocardiography <> answer']
|
The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 30-year-old woman presents to an urgent care center with progressively worsening cough and difficulty breathing. She has had similar prior episodes since childhood, one of which required intubation with mechanical ventilation. On physical exam, she appears anxious and diaphoretic, with diffuse wheezes and diminished breath sounds bilaterally. First-line treatment for this patient’s symptoms acts by which of the following mechanisms of action? (A) Beta-1 agonist (B) Beta-1 antagonist (C) Beta-2 agonist (D) Beta-2 antagonist
|
['(C) Beta-2 agonist <> answer']
|
The following are multiple choice questions (with answers) about medical knowledge. **Question:** An 8-year-old girl is brought to the emergency department because of a 2-day history of an intermittent, diffuse abdominal pain. She has also had a nonpruritic rash on her legs and swelling of her ankles for 1 week. Two weeks ago, she had a sore throat, which was treated with oral amoxicillin. Examination of the lower extremities shows non-blanching, raised erythematous papules. The ankle joints are swollen and warm, and their range of motion is limited by pain. Laboratory studies show a platelet count of 450,000/mm3. Test of the stool for occult blood is positive. Which of the following is the most likely diagnosis? (A) Immune thrombocytopenic purpura (B) Acute rheumatic fever (C) Familial Mediterranean fever (D) Leukocytoclastic vasculitis
|
['(D) Leukocytoclastic vasculitis <> answer']
|
The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 23-year-old male presents to the emergency department. He was brought in by police for shouting on a subway. The patient claims that little people were trying to kill him, and he was acting within his rights to defend himself. The patient has a past medical history of marijuana and IV drug use as well as multiple suicide attempts. He is currently homeless. While in the ED, the patient is combative and refuses a physical exam. He is given IM haloperidol and diphenhydramine. The patient is transferred to the inpatient psychiatric unit and is continued on haloperidol throughout the next week. Though he is no longer aggressive, he is seen making "armor" out of paper plates and plastic silverware to defend himself. The patient is switched onto risperidone. The following week the patient is still seen gathering utensils, and muttering about people trying to harm him. The patient's risperidone is discontinued. Which of the following is the best next step in management? (A) Fluphenazine (B) Thioridazine (C) Olanzapine (D) Clozapine
|
['(D) Clozapine <> answer']
|
The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 73-year-old man is brought in by his wife with a history of progressive personality changes. The patient’s wife says that, over the past 3 years, he has become increasingly aggressive and easily agitated, which is extremely out of character for him. His wife also says that he has had several episodes of urinary incontinence in the past month. He has no significant past medical history. The patient denies any history of smoking, alcohol use, or recreational drug use. The patient is afebrile, and his vital signs are within normal limits. A physical examination is unremarkable. The patient takes the mini-mental status examination (MMSE) and scores 28/30. A T2 magnetic resonance image (MRI) of the head is performed and the results are shown in the exhibit (see image). Which of the following is the next best diagnostic step in the management of this patient? (A) Contrast MRI of the head (B) Lumbar puncture (C) Brain biopsy (D) Serum ceruloplasmin level
|
['(B) Lumbar puncture <> answer']
|
The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 48-year-old man presents to an urgent care center with epigastric discomfort following meals and an occasional dry cough worse in the morning, both of which have increased in frequency over the past several months. He is otherwise healthy and has no additional complaints. Past medical history is significant for major depressive disorder, anxiety, and hypothyroidism. Physical examination is unremarkable. His vital signs include temperature 36.7°C (98.0°F), blood pressure 126/74 mm Hg, heart rate 74/min, and respiratory rate 14/min. Given the following options, what is the most appropriate next step in patient management? (A) Electrocardiography (ECG) (B) Lifestyle modifications (C) Begin omeprazole therapy (D) Fluoroscopic barium swallow
|
['(B) Lifestyle modifications <> answer']
|
The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 59-year-old man presents to a clinic with exertional chest pain for the past several months. He says the pain is central in his chest and relieved with rest. The physical examination is unremarkable. An electrocardiogram is normal, but an exercise tolerance test revealed ST-segment depression in chest leads V1-V4. He is prescribed nitroglycerin to be taken in the first half of the day. Which of the following statements best describes the reason behind the timing of this medication? (A) To prevent collapse (B) To avoid nitrate headache (C) To prevent methemoglobinemia (D) To avoid nitrate tolerance
|
['(D) To avoid nitrate tolerance <> answer']
|
The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 63-year-old woman presents to her primary care doctor with increased urinary frequency. She has noticed that over the past 6 months, she has had to urinate more often than usual. Several times per day, she develops a rapid-onset need to urinate and has occasionally been unable to reach the restroom. These symptoms have caused her a lot of distress and impacted her work as a grocery store clerk. She has tried pelvic floor exercises, decreasing her caffeine consumption, and has intentionally lost 20 pounds in an effort to alleviate her symptoms. She denies urinary hesitancy or hematuria. Her past medical history is notable for rheumatoid arthritis for which she takes methotrexate. She does not smoke or drink alcohol. Her temperature is 98.8°F (37.1°C), blood pressure is 124/68 mmHg, pulse is 89/min, and respirations are 19/min. She is well-appearing and in no acute distress. Which of the following interventions would be most appropriate in this patient? (A) Oxybutynin (B) Pessary placement (C) Tamsulosin (D) Topical estrogen
|
['(A) Oxybutynin <> answer']
|
The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 12-year-old boy is brought to the emergency department by his parents after he was bitten by a friend's cat while playing at their house. The patient reports moderate pain of the right hand and wrist but has full range of motion and strength. He is up to date on his vaccinations and is generally healthy. His vitals are unremarkable. Physical exam reveals a deep puncture wound that is actively bleeding. The wound is irrigated and a dressing is applied. Which of the following is appropriate management of this patient? (A) Ampicillin-sulbactam, surgical debridgment, and laceration closure (B) Amoxicillin-clavulanate (C) Amoxicillin-clavulanate and laceration closure (D) Laceration closure
|
['(B) Amoxicillin-clavulanate <> answer']
|
The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 57-year-old woman with non-small cell lung cancer comes to the physician 4 weeks after her tumor was resected. She takes no medications. The physician starts her on a treatment regimen that includes vinblastine. This treatment puts the patient at highest risk for which of the following? (A) Pulmonary embolism (B) Progressive multifocal leukoencephalopathy (C) Pulmonary fibrosis (D) Invasive fungal infection
|
['(D) Invasive fungal infection <> answer']
|
The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 32-year-old African American woman presents to her family physician complaining of fevers, fatigue, weight loss, joint pains, night sweats and a rash on her face that extends over the bridge of her nose. She has also had multiple sores in her mouth over the past few weeks. She recently had a root canal procedure done without complications. She has no significant past medical history, but has recently had a urinary tract infection. She denies tobacco, alcohol, and illicit drug use. Laboratory evaluation reveals hemolytic anemia. If she were found to have a cardiac lesion, what would be the most likely pathogenetic cause? (A) Bacteremia secondary to a recent dental procedure (B) Bacteremia secondary to a urinary tract infection (C) Immune complex deposition and subsequent inflammation (D) Left atrial mass causing a ball valve-type outflow obstruction
|
['(C) Immune complex deposition and subsequent inflammation <> answer']
|
The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 68-year-old man comes to the physician because of a 3-month history of a painless skin lesion on his neck. The lesion has gradually become darker in color. Sometimes it is itchy. He also noticed one similar lesion on his lower back. He is a retired gardener. He has smoked half a pack of cigarettes daily for 40 years. His temperature is 36.7°C (98°F), pulse is 72/min, and blood pressure is 123/78 mm Hg. Physical examination shows a 0.8-cm hyperpigmented papule on his neck and a 0.6-cm hyperpigmented papule on his lower back, both of which have a greasy and wax-like appearance. A photograph of the neck is shown. Which of the following is the most likely diagnosis? (A) Lentigo maligna (B) Basal cell carcinoma (C) Seborrheic keratosis (D) Dermatofibroma "
|
['(C) Seborrheic keratosis <> answer']
|
The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 32-year-old female presents to her primary care provider with pelvic pain. She reports that for the last several years, she has had chronic pain that is worst just before her menstrual period. Over the past two months, she has also had worsening pain during intercourse. She denies dysuria, vaginal discharge, or vaginal pruritus. The patient has never been pregnant and previously used a copper intrauterine device (IUD) for contraception, but she had the IUD removed a year ago because it worsened her menorrhagia. She has now been using combined oral contraceptive pills (OCPs) for nearly a year. The patient reports improvement in her menorrhagia on the OCPs but denies any improvement in her pain. Her past medical history is otherwise unremarkable. Her temperature is 98.0°F (36.7°C), blood pressure is 124/73 mmHg, pulse is 68/min, and respirations are 12/min. The patient has tenderness to palpation during vaginal exam with lateral displacement of the cervix. A pelvic ultrasound shows no abnormalities, and a urine pregnancy test is negative. Which of the following is the best next step in management to confirm the diagnosis? (A) Abdominal ultrasound (B) Pelvic MRI (C) Hysteroscopy (D) Laparoscopy
|
['(D) Laparoscopy <> answer']
|
The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 31-year-old unresponsive man is admitted to the emergency department after a single-vehicle roll-over accident. On primary assessment by paramedics, he was unresponsive. On admission, he opened his eyes to painful stimuli, was not responsive to verbal commands, his arms were flexed and the legs were straight with no reaction to pain. The patient was intubated and examined. The blood pressure is 150/90 mm Hg; the heart rate, 56/min; the respiratory rate, 14/min; the temperature, 37.5℃ (99.5℉), and the SpO2, 94% on room air. The examination shows a depressed fracture of the left temporal bone and ecchymoses and scratches over his abdomen and extremities. His pupils are round, equal, and show a poor response to light. There is no disconjugate eye deviation. His lungs are clear to auscultation and the heart sounds are normal. Abdominal examination reveals normal bowel sounds and no fluid wave. There are no meningeal signs. Focused assessment with sonography for trauma is negative for blood in the abdominal cavity. Head CT scan is shown in the picture. Which procedure is required to guide further management? (A) Lumbar puncture (B) Placement of an intraventricular catheter (C) Diagnostic peritoneal lavage (D) Brain MRI
|
['(B) Placement of an intraventricular catheter <> answer']
|
The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 21-year-old primigravida woman visits the clinic in her 22nd week of gestation as part of her antenatal care. She has no complaints. Past medical history is unremarkable. Her only medication is a prenatal vitamin. Her temperature is 37.0°C (98.6°F), blood pressure is 110/70 mm Hg, pulse rate is 78/min, and respiration rate is 20/min. Physical examination is consistent with the gestational age of her pregnancy with no abnormalities noted. Urine dipstick is normal. Which of the following is the current primary location for fetal myelopoiesis at this stage of development? (A) Yolk sac (B) Liver (C) Aorta-gonad-mesonephros region (D) Spleen
|
['(B) Liver <> answer']
|
The following are multiple choice questions (with answers) about medical knowledge. **Question:** An investigator is studying the replication of a virus in denucleated embryonic fibroblasts. After the fibroblasts are infected with the virus, viral proteins are directly translated from the virion's genetic material using fibroblast ribosomes. The resultant large polypeptides are then cleaved into smaller peptides by viral proteases to generate mature viral proteins. Finally, the virion's genetic material is replicated using a protein translated from the virion's genetic material. Which of the following is the most likely virus being evaluated in this study? (A) Parvovirus (B) Molluscum contagiosum virus (C) Measles virus (D) Coxsackievirus
|
['(D) Coxsackievirus <> answer']
|
The following are multiple choice questions (with answers) about medical knowledge. **Question:** A new mother brings in her 4-week-old son who has no significant past medical history but she complains of a new, itchy rash on his body. The patient has an older sister who developed similar symptoms when she was around the same age. The patient's blood pressure is 121/78 mm Hg, pulse is 70/min, respiratory rate is 16/min, and temperature is 37.3°C (99.1°F). Physical examination reveals confluent, erythematous patches and plaques with tiny vesicles and scaling overlying his lower back and abdomen. When questioned about possible etiologies, the mother notes that she has been bathing the patient at least twice a day. Which of the following statements is most appropriate for this patient? (A) Hot baths that are too long, or too frequent, can dry out the skin. (B) This condition is caused by the herpes simplex virus. (C) You can expect blisters, fever and large areas of skin that peel or fall away. (D) This condition is usually seen on the scalp, face, ears, and neck.
|
['(A) Hot baths that are too long, or too frequent, can dry out the skin. <> answer']
|
The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 16-year-old Caucasian boy presents to your family practice office complaining of itchiness. He denies other symptoms. He also denies tobacco, alcohol, or other illicit drug use and is not sexually active. He has no other significant past medical or surgical history aside from a meniscal repair from a wrestling injury sustained two years ago from which he has recovered fully. Vitals are T 98.3, HR 67, BP 110/70. On exam you note several pruritic, erythematous, slightly raised annular patches with central clearing on his back. Which of the following additional tests or features are sufficient to make the diagnosis of this boy's skin lesion? (A) History of recent herald patch and lesions along skin cleavage lines (B) Presence of hyphae when KOH added to skin scrapings (C) Symmetrical distribution on bilaterial extremities progressing proximally (D) History of time spent in a Lyme-endemic region
|
['(B) Presence of hyphae when KOH added to skin scrapings <> answer']
|
The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 70-year-old man presents for a routine checkup. He says that he recently completely lost hearing in both ears and has been having occasional flare-ups of osteoarthritis in his hands and hips. Past medical history is significant for hypertension diagnosed 25 years ago that is well controlled. Family history is significant for his brother, who recently died from prostate cancer. The patient's blood pressure is 126/84 mm Hg. Laboratory findings are significant for an alkaline phosphatase level that is more than 3 times the upper limit. Right upper quadrant ultrasound and non-contrast computed tomography of the abdomen and pelvis reveal no significant abnormalities. Which of the following is the most likely complication of this patient’s condition? (A) Pulmonary metastasis (B) Cushing syndrome (C) Hypoparathyroidism (D) Osteosarcoma
|
['(D) Osteosarcoma <> answer']
|
The following are multiple choice questions (with answers) about medical knowledge. **Question:** A medical technician is trying to isolate a pathogen from the sputum sample of a patient. The sample is heat fixed to a slide then covered with carbol fuchsin stain and heated again. After washing off the stain with clean water, the slide is covered with sulfuric acid. The sample is rinsed again and stained with methylene blue. Microscopic examination shows numerous red organisms. Which of the following is the most likely isolated pathogen? (A) Rickettsia rickettsii (B) Nocardia asteroides (C) Cryptococcus neoformans (D) Staphylococcus aureus
|
['(B) Nocardia asteroides <> answer']
|
The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 10-year-old girl is brought to the neurologist for management of recently diagnosed seizures. Based on her clinical presentation, the neurologist decides to start a medication that works by blocking thalamic T-type calcium channels. Her parents are cautioned that the medication has a number of side effects including itching, headache, and GI distress. Specifically, they are warned to stop the medication immediately and seek medical attention if they notice skin bullae or sloughing. Which of the following conditions is most likely being treated in this patient? (A) Absence seizures (B) Complex seizures (C) Simple seizures (D) Status epilepticus
|
['(A) Absence seizures <> answer']
|
The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 58-year-old man presents to the emergency department for evaluation of intermittent chest pain over the past 6 months. His history reveals that he has had moderate exertional dyspnea and 2 episodes of syncope while working at his factory job. These episodes of syncope were witnessed by others and lasted roughly 30 seconds. The patient states that he did not have any seizure activity. His vital signs include: blood pressure 121/89 mm Hg, heart rate 89/min, temperature 37.0°C (98.6°F), and respiratory rate 16/min. Physical examination reveals a crescendo-decrescendo systolic murmur in the right second intercostal area. An electrocardiogram is performed, which shows left ventricular hypertrophy. Which of the following is the best next step for this patient? (A) Cardiac chamber catheterization (B) Chest radiograph (C) Computed tomography (CT) chest scan without contrast (D) Transthoracic echocardiography
|
['(D) Transthoracic echocardiography <> answer']
|
The following are multiple choice questions (with answers) about medical knowledge. **Question:** A researcher is studying the ability of breast cancer cells to metastasize. Neoplastic cells obtained from 30 patients with stage IV ductal carcinoma of the breast are tagged with a fluorescent antibody. The cells are then inserted into a medium resembling normal human tissue. After 2 weeks, all samples show in vitro hematogenous invasion and migration away from the original site of insertion. Which of the following properties is most likely responsible for the ability of these neoplastic cells to metastasize? (A) Loss of cellular polarity (B) Overexpression of HER2/neu (C) Presence of fibrous tissue capsule (D) Release of matrix metalloproteinase
|
['(D) Release of matrix metalloproteinase <> answer']
|
The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 29-year-old woman presents to her gynecologist for a routine check-up. She is sexually active with multiple partners and intermittently uses condoms for contraception. She denies vaginal discharge, burning, itching, or rashes in her inguinal region. Pelvic examination is normal. Results from a routine pap smear are shown. The cellular changes seen are attributable to which of the following factors? (A) Inhibition of p53 (B) Activation p53 (C) Activation of Rb (D) Activation of K-Ras
|
['(A) Inhibition of p53 <> answer']
|
The following are multiple choice questions (with answers) about medical knowledge. **Question:** An investigator is studying bone metabolism and compares the serum studies and bone biopsy findings of a cohort of women 25–35 years of age with those from a cohort of women 55–65 years of age. Which of the following processes is most likely to be increased in the cohort of older women? (A) Expression of RANK ligand (B) Demineralization of bone with normal osteoid matrix (C) Urinary excretion of cyclic AMP (D) Urinary excretion of osteocalcin
|
['(A) Expression of RANK ligand <> answer']
|
The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 54-year-old male presents to the emergency department after an episode of bloody vomiting. He is a chronic alcoholic with a history of cirrhosis, and this is the third time he is presenting with this complaint. His first two episodes of hematemesis required endoscopic management of bleeding esophageal varices. His hemoglobin on admission laboratory evaluation was 11.2 g/dL. The patient is stabilized, and upper endoscopy is performed with successful banding of bleeding varices. Follow-up lab-work shows hemoglobin levels of 10.9 g/dL and 11.1 g/dL on days 1 and 2 after admission. Which of the following is the best next step in the management of this patient? (A) Monitor stability and discharge with continuation of endoscopic surveillance at regular 3 month intervals (B) Discuss with the patient the option of a transjugular intrahepatic portosystemic stent (TIPS) (C) Begin long-term octreotide and a 4-week course of prophylactic antibiotics (D) Give 2 units packed RBCs
|
['(B) Discuss with the patient the option of a transjugular intrahepatic portosystemic stent (TIPS) <> answer']
|
The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 5-year-old boy is brought to the emergency department by his stepmother because of multiple injuries. She says that he sustained these injuries while playing. Radiographic findings show multiple fractures in various stages of healing. Physical examination shows the findings in the image below. What is the most likely diagnosis in this patient? (A) Marfan syndrome (B) Wilson disease (C) Osteogenesis imperfecta (D) Child abuse
|
['(C) Osteogenesis imperfecta <> answer']
|
The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 45-year-old woman comes to the physician because of a 4-month history of irritability and frequent bowel movements. During this time, she has had a 6.8-kg (15-lb) weight loss. She has not had a change in appetite or diet. She takes no medications. Her temperature is 37.4°C (99.4°F), pulse is 112/min, respirations are 16/min, and blood pressure is 126/74 mm Hg. Examination shows moist palms. The thyroid gland is diffusely enlarged; there are no palpable nodules. Serum studies show a thyroid-stimulating hormone (TSH) concentration of 0.2 μU/mL, thyroxine (T4) concentration of 22 μg/dL, and antibodies against the TSH receptor. Which of the following treatment modalities is associated with the lowest rate of recurrence for this patient's condition? (A) Subtotal thyroidectomy (B) Radioactive iodine ablation (C) Propranolol (D) Methimazole
|
['(B) Radioactive iodine ablation <> answer']
|
The following are multiple choice questions (with answers) about medical knowledge. **Question:** A newborn male, delivered by emergency Cesarean section during the 28th week of gestation, has a birth weight of 1.2 kg (2.5 lb). He develops rapid breathing 4 hours after birth. Examination of the respiratory system reveals a respiratory rate of 80/min, expiratory grunting, intercostal and subcostal retractions with nasal flaring. His chest radiograph shows bilateral diffuse reticulogranular opacities and poor lung expansion. His echocardiography suggests a diagnosis of patent ductus arteriosus with left-to-right shunt and signs of fluid overload. The pediatrician administers intravenous indomethacin to facilitate closure of the duct. Which of the following effects best explains the mechanism of action of this drug in the management of this neonate? (A) Inhibition of lipoxygenase (B) Increased synthesis of prostaglandin E2 (C) Decreased blood flow in the vasa vasorum of the ductus arteriosus (D) Increased synthesis of platelet-derived growth factor (PDGF)
|
['(C) Decreased blood flow in the vasa vasorum of the ductus arteriosus <> answer']
|
The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 28-year-old woman is brought to the hospital by her boyfriend. She has had three days of fever and headache followed by one day of worsening confusion and hallucinations. She also becomes agitated when offered water. Her temperature is 101°F (38.3°C). Two months prior to presentation, the couple was camping and encountered bats in their cabin. In addition to an injection shortly after exposure, what would have been the most effective treatment for this patient? (A) A killed vaccine within ten days of exposure (B) Oseltamivir within one week of exposure (C) Venom antiserum within hours of exposure (D) Doxycycline for one month after exposure
|
['(A) A killed vaccine within ten days of exposure <> answer']
|
The following are multiple choice questions (with answers) about medical knowledge. **Question:** A young researcher is studying the structure of class I and class II major histocompatibility complex (MHC) molecules. He understands that these molecules are proteins, but the structures of class I MHC molecules are different from those of class II. Although all these molecules consist of α and β chains, some of their domains are polymorphic, meaning they are different in different individuals. He calls them ‘P’ domains. The other domains are nonpolymorphic, which remain invariant in all individuals. He calls these domains ‘N’ domains. Which of the following are examples of ‘N’ domains? (A) α1 domain in class I molecules and α1 domain in class II molecules (B) α2 domain in class I molecules and β2 domain in class II molecules (C) α1-α2 domains in class I molecules and α1-β1 domains in class II molecules (D) α3 domain in class I molecules and β2 domain in class II molecules
|
['(D) α3 domain in class I molecules and β2 domain in class II molecules <> answer']
|
The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 42-year-old man presents to his primary care physician for a wellness checkup. The patient has a past medical history of obesity, constipation, and depression. His current medications include metformin, lactulose, and fluoxetine. His temperature is 99.5°F (37.5°C), blood pressure is 157/102 mmHg, pulse is 90/min, respirations are 17/min, and oxygen saturation is 98% on room air. Laboratory values are ordered as seen below. Hemoglobin: 12 g/dL Hematocrit: 36% Leukocyte count: 5,500/mm^3 with normal differential Platelet count: 190,000/mm^3 Serum: Na+: 139 mEq/L Cl-: 105 mEq/L K+: 3.5 mEq/L HCO3-: 21 mEq/L BUN: 20 mg/dL Glucose: 129 mg/dL Creatinine: 1.1 mg/dL AST: 12 U/L ALT: 10 U/L Urine: Appearance: Yellow Bacteria: Absent Red blood cells: 0/hpf pH: 2.7 Nitrite: Absent Which of the following is the next best step in management? (A) Administer bicarbonate and repeat lab studies (B) Administer high dose bicarbonate (C) Administer hydrochlorothiazide (D) Obtain urine sodium level
|
['(A) Administer bicarbonate and repeat lab studies <> answer']
|
The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 50-year-old man presents to a physician with recurrent episodes of coughing over the last 3 years. He mentions that his cough has been accompanied by expectoration during 5–6 consecutive months every year for the last 3 years and he experiences breathing difficulty on exertion. He has been a smoker for the last 10 years. There is no family history of allergy. He was prescribed inhaled corticosteroids and an inhaled bronchodilator 1 month previously, but there has been no improvement. There is no history of fever or breathing difficulty at present. On physical examination his temperature is 37.0°C (98.6°F), the pulse is 84/min, the blood pressure 126/84 mm Hg, and the respiratory rate is 20/min. Auscultation of his chest reveals coarse rhonchi and wheezing bilaterally. His sputum is mucoid and microscopic examination shows predominant macrophages. His chest radiogram (posteroanterior view) shows flattening of the diaphragm, increased bronchovascular markings, and mild cardiomegaly. If lung biopsy is carried out, which of the following microscopic findings is most likely to be present in this patient? (A) Destruction of the pulmonary capillary bed (B) Variable-sized cysts against a background of densely scarred lung tissue (C) Hyperplasia of the mucus glands in the airways (D) Eosinophilic infiltration of the airways
|
['(C) Hyperplasia of the mucus glands in the airways <> answer']
|
The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 70-year-old woman is brought to her physician by her daughter who reports that the patient has been increasingly confused and forgetful over the past year. The daughter reports that the patient has difficulty finding words, remembering names, and maintaining a conversation. She has gotten lost twice while driving. Her past medical history is known for obesity, diabetes, and atrial fibrillation. She takes metformin, glyburide, and warfarin. She drinks socially and has a 30 pack-year smoking history. Her family history is notable for Parkinson’s disease in her father and stroke in her mother. A head CT demonstrates sulcal widening and narrowing of the gyri. The physician decides to start the patient on a medication known to inhibit a cell surface glutamate receptor. Which of the following is a downstream effect of this medication? (A) Decreased intracellular calcium (B) Increased intracellular sodium (C) Increased intracellular acetylcholine (D) Decreased intracellular acetylcholine
|
['(A) Decreased intracellular calcium <> answer']
|
The following are multiple choice questions (with answers) about medical knowledge. **Question:** A newborn of a mother with poor antenatal care is found to have a larger than normal head circumference with bulging fontanelles. Physical examination reveals a predominant downward gaze with marked eyelid retraction and convergence-retraction nystagmus. Ultrasound examination showed dilated lateral ventricles and a dilated third ventricle. Further imaging studies reveal a solid mass in the pineal region. Which of the following is the most likely finding for this patient? (A) Normal lumbar puncture opening pressure (B) Dilated cisterna magna (C) Compression of periaqueductal grey matter (D) Hypertrophic arachnoid granulations
|
['(C) Compression of periaqueductal grey matter <> answer']
|
The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 68-year-old man of Mediterranean descent comes to the clinic with complaints of fatigue for the past month. He reports that it is increasingly difficult for him to complete his after-dinner walks as he would get breathless and tired around 10 minutes. He endorses dizziness and an upper respiratory infection last week for which he “took a lot of aspirin.” Past medical history is significant for malaria 10 years ago (for which he was adequately treated with anti-malarial medications) and aortic stenosis status post prosthetic valve replacement 5 months ago. When asked if he has had similar episodes before, he claims, “Never! I’ve been as healthy as a horse until my heart surgery.” Physical examination is significant for mild scleral icterus bilaterally and a faint systolic murmur. Which of the following images represents a potential peripheral smear in this patient? (A) A (B) B (C) C (D) E
|
['(A) A <> answer']
|
The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 43-year-old woman presents to the physician because of a persistent rash on her right nipple for 1 month. The rash has persisted despite topical medication. She has no personal or family history of any serious illnesses. Other medications include oral contraceptive pills. She is single and has never had any children. Vital signs are within normal limits. An image of the right breast and nipple is shown. Palpation of the right breast shows a 2 x 2 cm under the areola. Lymphadenopathy is palpated in the right axilla. The remainder of the physical examination shows no abnormalities. A mammogram shows subareolar microcalcifications. Which of the following types of breast cancer is most likely to be found in this patient? (A) Ductal carcinoma in situ (B) Invasive ductal carcinoma (C) Invasive lobular carcinoma (D) Medullary carcinoma
|
['(B) Invasive ductal carcinoma <> answer']
|
The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 26-day-old newborn is brought to the physician because of poor feeding and lethargy for 2 weeks. During this period, he has had a raspy cry. The child was delivered at term at home and has not yet been evaluated by a physician. He is at the 90th percentile for head circumference, 50th percentile for length, and 60th percentile for weight. Vital signs are within normal limits. Examination shows scleral icterus and an enlarged tongue. The abdomen is distended and there is a reducible, soft protruding mass at the umbilicus. Muscle tone is decreased in all extremities. Which of the following is the most likely cause of these findings? (A) Thyroid dysgenesis (B) Acid maltase deficiency (C) Trisomy 21 (D) Chromosome 11p alteration
|
['(A) Thyroid dysgenesis <> answer']
|
The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 6-year-old boy is brought to the pediatrician by his mother after he reported having red urine. He has never experienced this before and did not eat anything unusual before the episode. His past medical history is notable for sensorineural deafness requiring hearing aids. He is otherwise healthy and enjoys being in the 1st grade. His birth history was unremarkable. His temperature is 98.8°F (37.1°C), blood pressure is 145/85 mmHg, pulse is 86/min, and respirations are 18/min. On examination, he is a well-appearing boy in no acute distress. Cardiac, respiratory, and abdominal exams are normal. A urinalysis is notable for microscopic hematuria and mild proteinuria. This patient’s condition is most commonly caused by which of the following inheritance patterns? (A) Autosomal recessive (B) Mitochondrial inheritance (C) X-linked dominant (D) X-linked recessive
|
['(C) X-linked dominant <> answer']
|
The following are multiple choice questions (with answers) about medical knowledge. **Question:** A mother presents to the family physician with her 16-year-old son. She explains, "There's something wrong with him doc. His grades are getting worse, he's cutting class, he's gaining weight, and his eyes are often bloodshot." Upon interviewing the patient apart from his mother, he seems withdrawn and angry at times when probed about his social history. The patient denies abuse and sexual history. What initial test should be sent to rule out the most likely culprit of this patient's behavior? (A) Complete blood count (B) Blood culture (C) Sexually transmitted infection (STI) testing (D) Urine toxicology screen
|
['(D) Urine toxicology screen <> answer']
|
The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 44-year-old man presents for a checkup. The patient says he has to urinate quite frequently but denies any dysuria or pain on urination. Past medical history is significant for diabetes mellitus type 2 and hypertension, both managed medically, as well as a chronic mild cough for the past several years. Current medications are metformin, aspirin, rosuvastatin, captopril, and furosemide. His vital signs are an irregular pulse of 74/min, a respiratory rate of 14/min, a blood pressure of 130/80 mm Hg, and a temperature of 36.7°C (98.0°F). His BMI is 32 kg/m2. On physical examination, there are visible jugular pulsations present in the neck bilaterally. Laboratory findings are significant for the following: Glycated Hemoglobin (Hb A1c) 7.5% Fasting Blood Glucose 120 mg/dL Serum Electrolytes Sodium 138 mEq/L Potassium 3.9 mEq/L Chloride 101 mEq/L Serum Creatinine 1.3 mg/dL Blood Urea Nitrogen 18 mg/dL Which of the following is the next best step in the management of this patient? (A) Stop metformin. (B) Replace captopril with valsartan. (C) Start rosiglitazone. (D) Start exenatide.
|
['(D) Start exenatide. <> answer']
|
The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 22-year-old man presents to the emergency department after being tackled in a game of football. The patient was hit from behind and fell to the ground. After the event, he complained of severe pain in his knee. The patient has a past medical history of anabolic steroid use. His current medications include whey protein supplements, multivitamins, and fish oil. His temperature is 99.5°F (37.5°C), blood pressure is 137/68 mmHg, pulse is 100/min, respirations are 17/min, and oxygen saturation is 98% on room air. On physical exam, you see a muscular young man clutching his knee in pain. The knee is inflamed and erythematous. When valgus stress is applied to the leg, there is some laxity when compared to the contralateral leg. The patient is requesting surgery for his injury. Arthrocentesis is performed and demonstrates no abnormalities of the synovial fluid. Which of the following physical exam findings is most likely to be seen in this patient? (A) A palpable click with passive motion of the knee (B) Anterior displacement of the tibia relative to the femur (C) Laxity to varus stress (D) Severe pain with compression of the patella
|
['(A) A palpable click with passive motion of the knee <> answer']
|
The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 42-year-old woman comes to the physician because of a 12 month history of progressive fatigue and shortness of breath with exertion. Five years ago, she emigrated from Eastern Europe. She has smoked one pack of cigarettes daily for 20 years. She has a history of using methamphetamines and cocaine but quit 5 years ago. Vital signs are within normal limits. Physical examination shows jugular venous pulsations 9 cm above the sternal angle. The lungs are clear to auscultation. There is a normal S1 and a loud, split S2. An impulse can be felt with the fingers left of the sternum. The abdomen is soft and nontender. The fingertips are enlarged and the nails are curved. There is pitting edema around the ankles bilaterally. An x-ray of the chest shows pronounced central pulmonary arteries and a prominent right heart border. Which of the following is most likely to confirm the diagnosis? (A) CT angiography (B) Doppler echocardiography (C) High-resolution CT of the lung (D) Right-heart catheterization
|
['(D) Right-heart catheterization <> answer']
|
The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 14-year-old boy presents to his pediatrician with weakness and frequent episodes of dizziness. He had chronic mucocutaneous candidiasis when he was 4 years old and was diagnosed with autoimmune hypoparathyroidism at age 8. On physical examination, his blood pressure is 118/70 mm Hg in the supine position and 96/64 mm Hg in the upright position. Hyperpigmentation is present over many areas of his body, most prominently over the extensor surfaces, elbows, and knuckles. His laboratory evaluation suggests the presence of antibodies to 21-hydroxylase and a mutation in the AIRE (autoimmune regulator) gene. The pediatrician explains to his parents that his condition is due to the failure of immunological tolerance. Which of the following mechanisms is most likely to have failed in the child? (A) Positive selection (B) Negative selection (C) Inhibition of the inactivation of harmful lymphocytes by regulatory T cells (D) Deletion of mature lymphocytes
|
['(B) Negative selection <> answer']
|
The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 31-year-old woman visits her primary care physician with the complaint that over the past 6 months she has “felt out of breath and dizzy while walking, even after short distances.” She reports no other medical problems and denies taking any medications, vitamins, supplements, recreational drugs, alcohol or tobacco. Her BMI is 24kg/m2. On physical examination, the patient has a loud second heart sound over the left upper sternal border, increased jugular venous pressure, and a palpable right ventricular impulse. Which of the following is the patient most at risk of developing if her condition is allowed to persist for a prolonged period: (A) Abdominal aortic aneurysm (B) Right ventricular failure (C) Pulmonary abscess (D) Tension pneumothorax
|
['(B) Right ventricular failure <> answer']
|
The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 26-year-old man comes to the physician for a follow-up examination. He was diagnosed with HIV infection 2 weeks ago. His CD4+ T-lymphocyte count is 162/mm3 (N ≥ 500). An interferon-gamma release assay is negative. Prophylactic treatment against which of the following pathogens is most appropriate at this time? (A) Aspergillus fumigatus (B) Mycobacterium tuberculosis (C) Pneumocystis jirovecii (D) Cytomegalovirus
|
['(C) Pneumocystis jirovecii <> answer']
|
The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 74-year-old man returns to his physician to follow-up on laboratory studies obtained for anemia 2 weeks ago. He has no complaints. He has a 20-year history of hypertension and several years of knee osteoarthritis. He walks 2 miles a day. He does not smoke. He drinks alcohol moderately. He takes hydrochlorothiazide, losartan, and pain killers, including ibuprofen. The vital signs include: temperature 37.1°C (98.8°F), pulse 68/min, respiratory rate 12/min, and blood pressure 110/70 mm Hg. The physical examination shows no abnormalities. The laboratory studies show the following: Laboratory test Hemoglobin 10 g/dL Mean corpuscular volume 75 μm3 Leukocyte count 5,000/mm3 Platelet count 350,000/mm3 ESR 18 mm/hr Serum Ferritin 5 μg/L Iron 30 μg/L Total iron-binding capacity 500 μg/dL Calcium (Ca+) 9 mg/dL Albumin 4 g/dL Urea nitrogen 14 mg/dL Creatinine 0.9 mg/dL Monoclonal protein on serum electrophoresis is 12 g/L (non-IgM). Clonal bone marrow plasma cells comprise 4% of the total number of cells. Skeletal survey with magnetic resonance imaging reveals no pathologic findings. In addition to iron deficiency anemia, which of the following diagnosis is most appropriate to consider? (A) Monoclonal gammopathy of undetermined significance (B) Smoldering (asymptomatic) multiple myeloma (C) Symptomatic multiple myeloma (D) Waldenstrom’s macroglobulinemia
|
['(A) Monoclonal gammopathy of undetermined significance <> answer']
|
The following are multiple choice questions (with answers) about medical knowledge. **Question:** 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
|
['(D) Pancreatic enzyme therapy <> answer']
|
The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 28-year-old woman is brought to the emergency department after being found in a confused state on an interstate rest area in Florida. She is unable to recall her name, address, or any other information regarding her person. She denies being the woman on a Connecticut driver's license found in her wallet. A telephone call with the police department of her hometown reveals that she had been reported missing three days ago by her husband. When the husband arrives, he reports that his wife has had a great deal of stress at work lately and before she went missing, was anxious to tell her boss that she will not meet the deadline for her current project. She has had two major depressive episodes within the past 4 years that were treated with citalopram. She drinks one to two beers daily and sometimes more on weekends. She does not use illicit drugs. Her vital signs are within normal limits. Physical and neurological examinations show no abnormalities. On mental status exam, she is oriented only to time and place but not to person. Short-term memory is intact; she does not recognize her husband or recall important events of her life. Which of the following is the most likely diagnosis? (A) Depersonalization disorder (B) Korsakoff syndrome (C) Dissociative amnesia with dissociative fugue (D) Delirium
|
['(C) Dissociative amnesia with dissociative fugue <> answer']
|
The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 33-year-old woman is brought to the emergency department after she was involved in a high-speed motor vehicle collision. She reports severe pelvic pain. Her pulse is 124/min and blood pressure is 80/56 mm Hg. Physical examination shows instability of the pelvic ring. As part of the initial emergency treatment, she receives packed red blood cell transfusions. Suddenly, the patient starts bleeding from peripheral venous catheter insertion sites. Laboratory studies show decreased platelets, prolonged prothrombin time and partial thromboplastin time, and elevated D-dimer. A peripheral blood smear of this patient is most likely to show which of the following findings? (A) Erythrocytes with irregular, thorny projections (B) Crescent-shaped, fragmented erythrocytes (C) Grouped erythrocytes with a stacked-coin appearance (D) Erythrocytes with cytoplasmic hemoglobin inclusions
|
['(B) Crescent-shaped, fragmented erythrocytes <> answer']
|
The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 32-year-old woman presents to her primary care physician for recent onset headaches, weight loss, and restlessness. Her symptoms started yesterday, and since then she has felt sweaty and generally uncomfortable. The patient’s past medical history is unremarkable except for a recent viral respiratory infection which resolved on its own. The patient is not currently on any medications. Her temperature is 99.5°F (37.5°C), blood pressure is 127/68 mmHg, pulse is 110/min, respirations are 14/min, and oxygen saturation is 98% on room air. On physical exam, you see a sweaty and uncomfortable woman who has a rapid pulse. The patient demonstrates no abnormalities on HEENT exam. The patient’s laboratory values are ordered as seen below. Hemoglobin: 12 g/dL Hematocrit: 36% Leukocyte count: 8,500/mm^3 with normal differential Platelet count: 195,000/mm^3 Serum: Na+: 139 mEq/L Cl-: 102 mEq/L K+: 4.4 mEq/L HCO3-: 24 mEq/L BUN: 20 mg/dL Glucose: 99 mg/dL Creatinine: 1.0 mg/dL Ca2+: 10.2 mg/dL TSH: .03 mIU/L AST: 12 U/L ALT: 10 U/L The patient is prescribed propranolol and proplythiouracil. She returns 1 week later complaining of severe fatigue. Laboratory values are ordered as seen below. Hemoglobin: 12 g/dL Hematocrit: 36% Leukocyte count: 8,500/mm^3 with normal differential Platelet count: 195,000/mm^3 Serum: Na+: 139 mEq/L Cl-: 102 mEq/L K+: 4.4 mEq/L HCO3-: 24 mEq/L BUN: 20 mg/dL Glucose: 99 mg/dL Creatinine: 1.0 mg/dL Ca2+: 10.2 mg/dL TSH: 6.0 mIU/L AST: 12 U/L ALT: 10 U/L Which of the following is the best next step in management? (A) Decrease dose of current medications (B) Discontinue current medications and add ibuprofen (C) Discontinue medications and add T3 (D) Discontinue current medications
|
['(D) Discontinue current medications <> answer']
|
The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 43-year-old woman presents to her primary care physician with complaints of mild shortness of breath and right-sided chest pain for three days. She reports that lately she has had a nagging nonproductive cough and low-grade fevers. On examination, her vital signs are: temperature 99.1 deg F (37.3 deg C), blood pressure is 115/70 mmHg, pulse is 91/min, respirations are 17/min, and oxygen saturation 97% on room air. She is well-appearing, with normal work of breathing, and no leg swelling. She is otherwise healthy, with no prior medical or surgical history, currently taking no medications. The attending has a low suspicion for the most concerning diagnosis and would like to exclude it with a very sensitive though non-specific test. Which of the following should this physician order? (A) Obtain spiral CT chest with IV contrast (B) Obtain ventilation-perfusion scan (C) Obtain chest radiograph (D) Order a D-dimer
|
['(D) Order a D-dimer <> answer']
|
The following are multiple choice questions (with answers) about medical knowledge. **Question:** An investigator studying the immunologic profile of various cells notices that the blood of a test subject agglutinates upon addition of a serum containing antibodies against P blood group antigens. Infection with which of the following pathogens would most likely be prevented by these antibodies? (A) Parvovirus B19 (B) Babesia microti (C) Plasmodium vivax (D) Influenza virus
|
['(A) Parvovirus B19 <> answer']
|
The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 6-month-old boy is brought to the pediatrician for multiple swellings on his scalp. His mother reports that she first noticed 3 softened and swollen areas over the child's scalp 2 months ago that have grown in size. The child is also urinating more frequently than usual. He was born by cesarean section at 39 weeks gestation. The mother had appropriate prenatal care. She has a history of gastroesophageal reflux disease for which she takes omeprazole. Her family history is unknown as she was adopted at a young age. The boy's temperature is 99°F (37.2°C), blood pressure is 100/60 mmHg, pulse is 110/min, and respirations are 20/min. On exam, he has 3 areas of soft tissue swelling on his skull that are tender to palpation. Moderate asymmetric exophthalmos is noted. A water deprivation test is performed which demonstrates a urine specific gravity of 1.005. The urine specific gravity rises with desmopression administration. A head computerized tomography (CT) scan is performed which demonstrates multifocal lytic calvarial lesions. A biopsy of one of the lesions is performed. Analysis of the biopsy would most likely reveal which of the following findings? (A) Atypical lymphocytes with cerebriform nuclei (B) B cells with hair-like cytoplasmic projections (C) Proliferative monoclonal plasma cells (D) Rod-shaped granules with a latticed matrix
|
['(D) Rod-shaped granules with a latticed matrix <> answer']
|
The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 27-year-old man is witnessed falling off his bicycle. The patient rode his bicycle into a curb and hit his face against a rail. The patient did not lose consciousness and is ambulatory at the scene. There is blood in the patient's mouth and one of the patient's teeth is found on the sidewalk. The patient is transferred to the local emergency department. Which of the following is the best method to transport this patient's tooth? (A) Submerged in milk (B) Submerged in normal saline (C) Submerged in water (D) Wrapped in gauze soaked in normal saline
|
['(A) Submerged in milk <> answer']
|
The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 41-year-old man with a history of hypertension and hyperlipidemia is brought to the emergency department by his wife for difficulty breathing after choking on food at dinner. He is unconscious and pulseless on arrival. Despite appropriate life-saving measures, he dies. Examination of the heart shows a necrotic, pale yellow plaque in the left circumflex artery. Similar lesions are most likely to be found in which of the following locations? (A) Abdominal aorta (B) Thoracic aorta (C) Internal carotid artery (D) Pulmonary artery
|
['(A) Abdominal aorta <> answer']
|
The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 46-year-old Caucasian female presents with cold intolerance, weight gain, and constipation. She has also noticed that her nails have become thinner recently but denies any fever or neck pain. Which of the following is NOT an expected histological finding in the thyroid? (A) Multinucleate giant cells (B) Lymphocytic infiltration (C) Fibrosis (D) Hurthle cells
|
['(A) Multinucleate giant cells <> answer']
|
The following are multiple choice questions (with answers) about medical knowledge. **Question:** Eighteen hours after the vaginal delivery of a 2788-g (6-lb 2-oz) newborn, a 22-year-old woman has weakness and numbness of her right foot. She is unable to walk without dragging and shuffling the foot. The delivery was complicated by prolonged labor and had received epidural analgesia. There is no personal or family history of serious illness. Her temperature is 37.3°C (99.1°F), pulse is 98/min, and blood pressure is 118/70 mm Hg. Examination shows a high-stepping gait. There is weakness of right foot dorsiflexion and right ankle eversion. Sensation is decreased over the dorsum of the right foot and the anterolateral aspect of the right lower extremity below the knee. Deep tendon reflexes are 2+ bilaterally. The remainder of the examination shows no abnormalities. Which of the following is the most likely cause of this patient's symptoms? (A) Effect of epidural anesthesia (B) Postpartum angiopathy (C) Compression of the common peroneal nerve (D) Lateral femoral cutaneous nerve injury
|
['(C) Compression of the common peroneal nerve <> answer']
|
The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 59-year-old man with a history of major depressive disorder, asthma, and erectile dysfunction presents to his family physician complaining of depressed mood, amotivation, overeating, and anhedonia. He currently takes no medications. The patient has a 3 pack-year smoking history and would like to quit but has been unsuccessful in the past. His BMI is 29 kg/m^2. The physician suggests starting an antidepressant for the patient's mood symptoms. The patient is reluctant, as he used to take sertraline, but stopped it after his erectile dysfunction worsened. Which of the following antidepressants would be most appropriate for this patient? (A) Amitriptyline (B) Bupropion (C) Citalopram (D) Mirtazapine
|
['(B) Bupropion <> answer']
|
The following are multiple choice questions (with answers) about medical knowledge. **Question:** An otherwise healthy 15-month-old boy is brought to the emergency department by his mother 1 hour after having a single episode of generalized tonic-clonic seizure, which stopped spontaneously after 1 minute. He was sleepy initially but is now awake and alert. His mother reports that he has had a fever and runny nose for the past 3 days. His temperature is 40.1°C (104.2°F). Physical examination shows no abnormalities. Analysis of his cerebrospinal fluid shows 3 cells/mm3, a glucose concentration of 68 mg/dL, and a protein concentration of 35 mg/dL. Administration of a drug that acts through which of the following mechanisms of action is most appropriate in this patient? (A) Increasing duration of Cl− channel opening (B) Decreasing production of prostaglandin E2 (C) Inhibiting transpeptidase cross-linking (D) Blocking T-type Ca2+ channels
|
['(B) Decreasing production of prostaglandin E2 <> answer']
|
The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 16-year-old girl is brought to the emergency department by her friends who say that she took a whole bottle of her mom’s medication. They do not know which medication it was she ingested. The patient is slipping in and out of consciousness and is unable to offer any history. Her temperature is 39.6°C (103.2°F), the heart rate is 135/min, the blood pressure is 178/98 mm Hg, and the respiratory rate is 16/min. On physical examination, there is significant muscle rigidity without tremor or clonus. Which of the following is the best course of treatment for this patient? (A) Naloxone (B) Dantrolene (C) Fenoldopam (D) Cyproheptadine
|
['(B) Dantrolene <> answer']
|
The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 32-year-old female with Crohn's disease diagnosed in her early 20s comes to your office for a follow-up appointment. She is complaining of headaches and fatigue. Which of the following arterial blood findings might you expect? (A) Normal Pa02, normal 02 saturation (Sa02), normal 02 content (Ca02) (B) Low Pa02, low 02 saturation (Sa02), low 02 content (Ca02) (C) Low Pa02, normal 02 saturation (Sa02), normal 02 content (Ca02) (D) Normal Pa02, normal 02 saturation (Sa02), low 02 content (Ca02)
|
['(D) Normal Pa02, normal 02 saturation (Sa02), low 02 content (Ca02) <> answer']
|
The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 4-day-old boy is brought to the physician by his mother because of vomiting, irritability, and poor feeding. Pregnancy and delivery were uncomplicated. Physical examination shows increased muscle tone in all extremities. He appears lethargic. His diapers emit a caramel-like odor. Urine studies are positive for ketone bodies. Supplementation of which of the following is most likely to improve this patient's condition? (A) Thiamine (B) Leucine (C) Tyrosine (D) Tetrahydrobiopterin
|
['(A) Thiamine <> answer']
|
The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 35-year-old man is brought to the emergency department after experiencing a seizure. According to his girlfriend, he has had fatigue for the last 3 days and became confused this morning, after which he started having uncontrollable convulsions throughout his entire body. He was unconscious throughout the episode, which lasted about 4 minutes. He has not visited a physician for over 10 years. He has smoked one pack of cigarettes daily for 12 years. His girlfriend admits they occasionally use heroin together with their friends. His temperature is 38.8°C (101.8°F), pulse is 93/min, respirations are 20/min, and blood pressure is 110/70 mm Hg. The lungs are clear to auscultation and examination shows normal heart sounds and no carotid or femoral bruits. He appears emaciated and somnolent. There are multiple track marks on both his arms. He is unable to cooperate for a neurological exam. Laboratory studies show a leukocyte count of 3,000/mm3, a hematocrit of 34%, a platelet count of 354,000/mm3, and an erythrocyte sedimentation rate of 27 mm/h. His CD4+ T-lymphocyte count is 84/mm3 (normal ≥ 500). A CT scan of the head is shown. Which of the following is the most appropriate next step considering this patient's CT scan findings? (A) Pyrimethamine, sulfadiazine, and leucovorin (B) CT-guided stereotactic aspiration (C) Albendazole (D) Glucocorticoids
|
['(A) Pyrimethamine, sulfadiazine, and leucovorin <> answer']
|
The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 68-year-old Caucasian male complains of severe headache and pain while chewing. Upon examination, he is found to have a left visual field deficit. Laboratory results show elevated erythrocyte sedimentation rate. Which of the following drugs would be the best choice for treatment of this patient? (A) Propranolol (B) Prednisone (C) Pilocarpine (D) Clopidogrel
|
['(B) Prednisone <> answer']
|
The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 3-week-old male is brought to the emergency department because of increasing lethargy. He was born at home without prenatal care or neonatal screening and appeared to be normal at birth. Despite this, his parents noticed that he would vomit after breastfeeding. He then progressively became more lethargic and began to have a few episodes of diarrhea after feeding. His parents do not recall any significant family history and neither of his siblings have had similar symptoms. Upon presentation, the infant is found to be generally unresponsive with mild hepatomegaly. Physical exam further reveals signs of clouding in the lenses of his eyes bilaterally. The levels of which of the following metabolites will be most dramatically elevated in this patient? (A) Galactose (B) Galactose-1-phosphate (C) Fructose (D) Fructose-1-phosphate
|
['(B) Galactose-1-phosphate <> answer']
|
The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 55-year-old man presents to his primary care physician for a wellness checkup. He states that he generally feels well and has no complaints at this time. The patient consumes alcohol frequently, eats a high sodium diet, and is sedentary. His temperature is 97.5°F (36.4°C), blood pressure is 167/108 mmHg, pulse is 90/min, respirations are 15/min, and oxygen saturation is 99% on room air. The patient’s blood pressure at his last 2 appointments were 159/100 mmHg and 162/99 mmHg, respectively. His physician wants to intervene to manage his blood pressure. Which of the following is the most effective treatment for this patient’s hypertension? (A) DASH diet (B) Reduce alcohol consumption (C) Sodium restriction (D) Weight loss
|
['(D) Weight loss <> answer']
|
The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 72-year-old man with type 2 diabetes mellitus, hypertension, and systolic heart failure comes to the physician because of a 5-day history of progressively worsening shortness of breath at rest. Physical examination shows jugular venous distention, diffuse crackles over the lower lung fields, and bilateral lower extremity edema. As a part of treatment, he is given a derivative of a hormone that acts by altering guanylate cyclase activity. This drug has been found to reduce pulmonary capillary wedge pressure and causes systemic hypotension as an adverse effect. The drug is most likely a derivative of which of the following hormones? (A) Angiotensin II (B) Brain natriuretic peptide (C) Prostacyclin (D) Somatostatin
|
['(B) Brain natriuretic peptide <> answer']
|
The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 46-year-old man comes to the physician because of a 2-month history of hoarseness and drooling. Initially, he had difficulty swallowing solid food, but now he has difficulty swallowing foods like oatmeal as well. During this period, he also developed weakness in both arms and has had an 8.2 kg (18 lb) weight loss. He appears ill. His vital signs are within normal limits. Examination shows tongue atrophy and pooled oral secretions. There is diffuse muscle atrophy in all extremities. Deep tendon reflexes are 3+ in all extremities. Sensation to pinprick, light touch, and vibration is intact. An esophagogastroduodenoscopy shows no abnormalities. Which of the following is the most likely cause of this patient's symptoms? (A) Multiple cerebral infarctions (B) Autoimmune destruction of acetylcholine receptors (C) Demyelination of peripheral nerves (D) Destruction of upper and lower motor neurons
|
['(D) Destruction of upper and lower motor neurons <> answer']
|
The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 55-year-old IV drug user comes into the emergency department after four days of pain in his right ankle. The patient is lethargic and unable to answer any questions about his medical history. His vitals are HR 110, T 101.5, RR 20, BP 100/60. His physical exam is notable for track marks in his toes and his right ankle is erythematous and swollen. Moving any part of the right foot creates a 10/10 pain. A radiograph revels no evidence of fractures. A Gram stain of the joint fluid aspirate demonstrates purple cocci in clusters. The fluid is yellow, opaque, with more than 70,000 cells/mm^3 (80% neutrophils). What is the most likely diagnosis? (A) Salmonella infectious arthritis (B) Staphylococcus infectious arthritis (C) Borrelia infectious arthritis (D) Osteoarthritis
|
['(B) Staphylococcus infectious arthritis <> answer']
|
The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 55-year-old man presents to the emergency department with shortness of breath and weakness. Past medical history includes coronary artery disease, arterial hypertension, and chronic heart failure. He reports that the symptoms started around 2 weeks ago and have been gradually worsening. His temperature is 36.5°C (97.7°F), blood pressure is 135/90 mm Hg, heart rate is 95/min, respiratory rate is 24/min, and oxygen saturation is 94% on room air. On examination, mild jugular venous distention is noted. Auscultation reveals bilateral loud crackles. Pitting edema of the lower extremities is noted symmetrically. His plasma brain natriuretic peptide level on rapid bedside assay is 500 pg/mL (reference range < 125 pg/mL). A chest X-ray shows enlarged cardiac silhouette. He is diagnosed with acute on chronic left heart failure with pulmonary edema and receives immediate care with furosemide. The physician proposes a drug trial with a new BNP stabilizing agent. Which of the following changes below are expected to happen if the patient is enrolled in this trial? (A) Increased water reabsorption by the renal collecting ducts (B) Restricted aldosterone release (C) Increased potassium release from cardiomyocytes (D) Inhibition of funny sodium channels
|
['(B) Restricted aldosterone release <> answer']
|
The following are multiple choice questions (with answers) about medical knowledge. **Question:** An 11-year-old boy with HIV and esophageal candidiasis is being treated with caspofungin. What is the mechanism of action of this drug? (A) Pore formation in cell membranes (B) Inhibition of ergosterol synthesis (C) Inhibition of squalene epoxidase (D) Inhibition of 1,3-Beta-glucan synthase
|
['(D) Inhibition of 1,3-Beta-glucan synthase <> answer']
|
The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 64-year-old man presents to the emergency department with sudden onset of pleuritic chest pain and dyspnea on exertion. He has a history of lung cancer and is currently being treated with outpatient chemotherapy. His temperature is 98.9°F (37.2°C), blood pressure is 111/64 mmHg, pulse is 130/min, respirations are 25/min, and oxygen saturation is 90% on room air. Initial laboratory values in the emergency department are seen below. Hemoglobin: 8.2 g/dL Hematocrit: 26% Leukocyte count: 7,700/mm^3 with normal differential Platelet count: 157,000/mm^3 A CT angiogram demonstrates a blood clot in the pulmonary vasculature. The patient is started on heparin and he is admitted to the ICU. Laboratory values 6 days later are shown below. Hemoglobin: 8.0 g/dL Hematocrit: 25% Leukocyte count: 7,500/mm^3 with normal differential Platelet count: 22,000/mm^3 Which of the following is the most appropriate next step in management? (A) Blood transfusion (B) No treatment changes needed (C) Platelet transfusion (D) Stop heparin
|
['(D) Stop heparin <> answer']
|
The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 25-year-old woman presented to an urgent care center with a complaint of a cough for more than 3 weeks that was accompanied by night sweats, weight loss, and malaise. On physical examination, the patient had slightly pale palpebral conjunctivae bilateral posterior cervical lymphadenopathy, but with no adventitious breath sounds in the lung fields bilaterally. The remainder of the physical examination was routine. The patient was started on a drug regimen that was to be taken for 6 months. On follow-up after 2 months, the ALT and AST levels were elevated. Which of the following anti-tubercular drug could have contributed to this labor result? (A) Pyrazinamide (B) Isoniazid (C) Streptomycin (D) Ethambutol
|
['(A) Pyrazinamide <> answer']
|
The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 12-month-old boy is brought to the physician by his mother for a well-child examination. He was delivered at term after an uncomplicated pregnancy. His mother says he is breastfeeding well. He is at the 50th percentile for height and 65th percentile for weight. Physical examination shows no abnormalities. Urinalysis shows 3+ reducing substances. Compared to a healthy infant, giving this patient apple juice to drink will result in increased activity of which of the following enzymes? (A) Aldolase B (B) Galactokinase (C) α-1,6-glucosidase (D) Hexokinase
|
['(D) Hexokinase <> answer']
|
The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 50-year-old man presents to the emergency department with a complaint of crushing chest pain. The pain started suddenly 30 minutes ago while he was walking his dog. The patient also complains of difficulty breathing and palpitations. The pain is described as starting behind the sternum and moving towards the left jaw. Medical history includes recently diagnosed hypercholesterolemia and peptic ulcer disease. He currently takes atorvastatin and omeprazole. The patient has smoked a pack of cigarettes per day for 10 years and consumes 2–3 beers on the weekends. His blood pressure is 148/90 mm Hg, the pulse is 106/min, and the respiratory rate is 22/min. Examination shows him to be visibly distressed, diaphoretic, and slightly hunched over. Aspirin is administered and blood work is sent to the laboratory. His ECG is shown in the picture. What is the best next step for this patient? (A) Start heparin infusion and ICU admission (B) Perform an urgent bedside echocardiography (C) Urgent percutaneous coronary intervention (D) Monitor closely and wait for cardiac troponin levels
|
['(C) Urgent percutaneous coronary intervention <> answer']
|
The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 58-year-old man is brought to the emergency department because of confusion, weight loss, and anuria. He has chronic kidney disease, hypertension, and type 2 diabetes mellitus. He was diagnosed with acute lymphoblastic leukemia at the age of 8 years and was treated with an allogeneic stem cell transplantation. He is HIV-positive and has active hepatitis C virus infection. He drinks around 8 cans of beer every week. His current medications include tenofovir, emtricitabine, atazanavir, daclatasvir, sofosbuvir, insulin, amlodipine, and enalapril. He appears lethargic. His temperature is 36°C (96.8°F), pulse is 130/min, respirations are 26/min, and blood pressure is 145/90 mm Hg. Examination shows severe edema in his legs and generalized muscular weakness. Auscultation of the lung shows crepitant rales. Laboratory studies show positive HCV antibody and positive HCV RNA. His HIV viral load is undetectable and his CD4+ T-lymphocyte count is 589/μL. Six months ago, his CD4+ T-lymphocyte count was 618/μL. An ECG of the heart shows arrhythmia with frequent premature ventricular contractions. Arterial blood gas analysis on room air shows: pH 7.23 PCO2 31 mm Hg HCO3- 13 mEq/L Base excess -12 mEq/L The patient states he would like to donate organs or tissues in the case of his death. Which of the following is an absolute contraindication for organ donation in this patient?" (A) Childhood leukemia (B) Acute kidney injury (C) Alcoholism (D) No absolute contraindications
|
['(D) No absolute contraindications <> answer']
|
The following are multiple choice questions (with answers) about medical knowledge. **Question:** Three days after undergoing laparoscopic colectomy, a 67-year-old man reports swelling and pain in his right leg. He was diagnosed with colon cancer 1 month ago. His temperature is 38.5°C (101.3°F). Physical examination shows swelling of the right leg from the ankle to the thigh. There is no erythema or rash. Which of the following is likely to be most helpful in establishing the diagnosis? (A) Transthoracic echocardiography (B) CT pulmonary angiography (C) Blood cultures (D) Compression ultrasonography
|
['(D) Compression ultrasonography <> answer']
|
The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 30-year-old woman presents to her new doctor at 27 weeks' gestation with her second pregnancy. Her blood type is B- and the father of the child is B+. Her first child had an Apgar score of 7 at 1 minute and 9 at 5 minutes and has a B+ blood type. The fetus has a heart rate of 130/min and blood pressure of 100/58 mm Hg. There is a concern that the fetus may develop erythroblastosis fetalis (EF). Which of the following statements is true about erythroblastosis fetalis? (A) Can occur with an Rh-negative mother and Rh-positive father. (B) Rho(D) immune globulin should be administered during the first trimester. (C) The combination of an Rh-positive mother and an Rh-negative fetus will cause the condition. (D) In EF, IgM crosses the placenta and causes erythrocyte hemolysis in the fetus.
|
['(A) Can occur with an Rh-negative mother and Rh-positive father. <> answer']
|
The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 36-year-old man presents to a physician with the complaint of a dry cough for the last 2 months. He denies any nasal discharge, sneezing, nose congestion, blood in sputum, breathlessness, fever, or weight loss. He started smoking 2 years back. His temperature is 37.3°C (99.2°F), the heart rate is 88/min, the blood pressure is 118/78 mm Hg, and the respiratory rate is 18/min. Auscultation of the lungs reveals localized rhonchi over the left infrascapular region. His chest radiogram reveals a single, round-shaped nodule with scalloped margins in the lower zone of the left lung. The nodule is surrounded by normally aerated lung tissue, and its size is approx. 9 mm (0.35 in) in diameter. The physician explains to him that he requires further diagnostic evaluation, as the nodule could be malignant. On the radiogram, which of the following features of the nodule is associated with the increased possibility of a malignant lesion? (A) Lack of calcification (B) Dense central nidus of calcification (C) Multiple punctate foci of calcification throughout the nodule (D) Popcorn ball calcification
|
['(A) Lack of calcification <> answer']
|
The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 12-year-old boy is brought to the emergency department by his mother because of progressive shortness of breath, difficulty speaking, and diffuse, colicky abdominal pain for the past 3 hours. Yesterday he underwent a tooth extraction. His father and a paternal uncle have a history of repeated hospitalizations for upper airway and orofacial swelling. The patient takes no medications. His blood pressure is 112/62 mm Hg. Examination shows edematous swelling of the lips, tongue, arms, and legs; there is no rash. Administration of a drug targeting which of the following mechanisms of action is most appropriate for this patient? (A) Antagonist at histamine receptor (B) Agonist at androgen receptor (C) Antagonist at bradykinin receptor (D) Agonist at glucocorticoid receptor
|
['(C) Antagonist at bradykinin receptor <> answer']
|
The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 49-year-old woman comes to the physician because of a 4-month history of a dry cough and shortness of breath on exertion. She also reports recurrent episodes of pain, stiffness, and swelling in her wrist and her left knee over the past 6 months. She had two miscarriages at age 24 and 28. Physical examination shows pallor, ulcerations on the palate, and annular hyperpigmented plaques on the arms and neck. Fine inspiratory crackles are heard over bilateral lower lung fields on auscultation. Which of the following additional findings is most likely in this patient? (A) Decreased right atrial pressure (B) Increased airway resistance (C) Decreased diffusing capacity (D) Increased lung compliance
|
['(C) Decreased diffusing capacity <> answer']
|
The following are multiple choice questions (with answers) about medical knowledge. **Question:** A man appearing to be in his mid-50s is brought in by ambulance after he was seen walking on railroad tracks. On further questioning, the patient does not recall being on railroad tracks and is only able to provide his name. Later on, he states that he is a railroad worker, but this is known to be false. On exam, his temperature is 99.9°F (37.7°C), blood pressure is 128/86 mmHg, pulse is 82/min, and respirations are 14/min. He appears disheveled, and his clothes smell of alcohol. The patient is alert, is only oriented to person, and is found to have abnormal eye movements and imbalanced gait when attempting to walk. Which of the following structures in the brain likely has the greatest reduction in the number of neurons? (A) Cerebellar vermis (B) Frontal eye fields (C) Mammillary bodies (D) Parietal-temporal cortex
|
['(C) Mammillary bodies <> answer']
|
The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 25-year-old man presents to his primary care physician for recurrent headaches. The patient states that the headaches have been going on for the past week, and he is concerned that he may have cancer. Based on his symptoms, he strongly believes that he needs further diagnostic workup. The patient works as a nurse at the local hospital and is concerned that he is going to lose his job. The patient is also concerned about his sexual performance with his girlfriend, and as a result he has ceased to engage in sexual activities. Finally, the patient is concerned about his relationship with his family. He states that his concerns related to these issues has persisted for the past year. The patient has a past medical history of obesity, diabetes, hypertension, and irritable bowel syndrome. His current medications include metformin, insulin, lisinopril, and hydrochlorothiazide. The patient has a family history of colorectal cancer in his grandfather and father. The patient’s neurological exam is within normal limits. The patient denies having a headache currently. Which of the following is the best initial step in management? (A) Buspirone (B) Clonazepam (C) Fluoxetine (D) Sumatriptan
|
['(C) Fluoxetine <> answer']
|
The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 42-year-old man presents to his primary care physician complaining of subjective fever, cough, and night sweats. He states that over the past 2 months he has “not felt like myself.” He has lost 12 lbs over this time period. Two weeks ago, he started experiencing night sweats and cough. This morning he decided to take his temperature and reports it was “high.” He has a history of HIV and admits to inconsistently taking his anti-retrovirals. A chest radiograph reveals a cavitary lesion in the left upper lobe. An interferon-gamma release assay is positive, and the patient is started on appropriate antimicrobial therapy. A month later he is seen in clinic for follow-up. Lab work is obtained, as shown below: Leukocyte count: 11,000/mm^3 with normal differential Hemoglobin: 9.2 g/dL Platelet count: 400,000/mm^3 Mean corpuscular volume (MCV): 75 µm^3 Based on these results, a peripheral smear is sent and shows Pappenheimer bodies. Which of the following is the most accurate test for the patient’s diagnosis? (A) Genetic testing (B) Iron studies (C) Methylmalonic acid level (D) Prussian blue staining
|
['(D) Prussian blue staining <> answer']
|
The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 71-year-old man presents to the clinic with complaints of right wrist pain for 2 days. On examination, redness and swelling were noted on the dorsal aspect of his right wrist. He had pain with extreme range of motion of the wrist. His history includes 2 hip replacements, 2 previous episodes of gout in both first metatarsophalangeal joints, and hypertension. Two days later, the swelling had increased in the dorsal aspect of his right wrist and hand. Wrist flexion was limited to 80% with severe pain. The pain was present on palpation of the scaphoid bone. Due to the suspicion of fracture, the patient was referred to his general practitioner for radiographs. These findings were consistent with gouty arthritis. What is the most likely cytokine involved in this process? (A) IL-1 (B) IL-10 (C) INFγ (D) IL-5
|
['(A) IL-1 <> answer']
|
The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 75-year-old male arrives by ambulance to the emergency room severely confused. His vitals are T 40 C, HR 120 bpm, BP 80/55 mmHg, RR 25. His wife explains that he injured himself about a week ago while cooking, and several days later his finger became infected, oozing with pus. He ignored her warning to see a doctor and even refused after he developed fever, chills, and severe fatigue yesterday. After being seen by the emergency physician, he was given antibiotics and IV fluids. Following initial resuscitation with IV fluids, he remains hypotensive. The ED physicians place a central venous catheter and begin infusing norepinephrine. Which of the following receptors are activated by norepinephrine? (A) Alpha 1 (B) Alpha 2 (C) Alpha 1, Alpha 2, Beta 1 (D) Alpha 1, Beta 1, Dopamine 1
|
['(C) Alpha 1, Alpha 2, Beta 1 <> answer']
|
The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 54-year-old man presents to the emergency department with a severe diffuse abdominal pain, nausea, and vomiting. The patient states that the pain acute onset approximately 3 hours ago and has not improved. He denies any fever or chills. His last bowel movement was yesterday morning which was normal. The patient has a history of hypertension and infectious endocarditis 7 years ago. Current medications are hydrochlorothiazide and lisinopril. Patient denies any history of gastrointestinal disease although notes he frequently has abdominal discomfort after meals. Vital signs are as follows: blood pressure 150/90 mm Hg, heart rate 87/min, respiratory rate 22/min, and temperature of 37.4℃ (99.3℉). On physical examination, the patient is agitated and appears to be in significant pain. Lungs are clear to auscultation. The cardiac exam is significant for a 2/6 pansystolic grade murmur best heard at the apex and the presence of a pulse deficit. The abdomen is soft and nondistended, but there is tenderness to palpation in the periumbilical region. No rebound or guarding. Bowel sounds are present. Laboratory tests show the following results: RBC count 4.4 x 106/mm3 Hemoglobin 12.9 g/dL Hematocrit 35% Leukocyte count 12,400/mm3 Platelet count 312,000/mm3 Serum: Na+ 140 mEq/L Cl- 103 mEq/L K+ 4.4 mEq/L HCO3 20 mEq/L Base deficit -4 BUN 11 mg/dL Glucose 97 mg/dL Creatinine 1.1 mg/dL Ca2+ 10.7 mg/dL Lactate 7.6 mmol/L Amylase 240 U/L Stool guaiac negative EKG is significant for findings consistent with atrial fibrillation and left ventricular hypertrophy. Which of the following findings is most likely to be seen on this patient’s contrast CT of the abdomen? (A) Numerous round and tubular structures communicating with the small intestine wall (B) Inner and outer layer enhancement of the bowel wall with non-enhancing middle layer (C) Lack of enhancement of the branches of the superior mesenteric artery (D) Loss of normal haustral markings of the large bowel
|
['(C) Lack of enhancement of the branches of the superior mesenteric artery <> answer']
|
The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 45-year-old man presents with 2 weeks of low-grade fever, malaise, night sweats, orthopnea, and shortness of breath. Past medical history is unremarkable. He reports a long-standing history of intravenous drug use for which he has been hospitalized a couple of times in the psychiatry ward. His vital signs upon admission show a blood pressure of 100/80 mm Hg, pulse of 102/min, a respiratory rate of 20/min, and a body temperature of 38.4°C (101.0°F). On cardiac auscultation, there is an S3 gallop and a 3/6 holosystolic murmur heard best along the right sternal border. There are fine rattles present over the lung bases bilaterally. Which of the following tests would be of the greatest diagnostic value in this patient? (A) Procalcitonin (B) B-type natriuretic peptide (C) CPK-MB (D) Blood culture
|
['(D) Blood culture <> answer']
|
The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 42-year-old female presents to her primary care provider for an annual checkup. She reports feeling sad over the past few months for no apparent reason. She has lost interest in swimming, which she previously found enjoyable. Additionally, she has had trouble getting a full night’s sleep and has had trouble concentrating during the day. She has lost 15 pounds since her last visit one year prior. Which of the following sets of neurotransmitter levels is associated with this patient’s condition? (A) Decreased acetylcholine, normal serotonin, normal dopamine (B) Increased norepinephrine, decreased serotonin, decreased GABA (C) Decreased GABA, decreased acetylcholine, increased dopamine (D) Decreased norepinephrine, decreased serotonin, decreased dopamine
|
['(D) Decreased norepinephrine, decreased serotonin, decreased dopamine <> answer']
|
The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 28-year-old female suffering from a urinary tract infection is given trimethoprim-sulfamethoxazole (TMP-SMX) by her physician. Several days later, she begins to experience itchiness and joint pain. Laboratory and histologic analysis reveals vasculitis and antibody complexes deposited near the basement membrane of the glomerulus. What other serological finding is expected with this presentation? (A) Decreased levels of IgE (B) Increased levels of IgE (C) Increased serum levels of complement protein C3 (D) Lowered serum levels of complement protein C3
|
['(D) Lowered serum levels of complement protein C3 <> answer']
|
The following are multiple choice questions (with answers) about medical knowledge. **Question:** A genetic counselor sees a family for the first time for genetic assessment. The 24-year-old businessman and his 19-year-old sister are concerned about having a mutant allele and have decided to get tested. Their grandfather and great aunt both have Huntington’s disease which became apparent when they turned 52. Their father who is 47 years old appears healthy. The geneticist discusses both the benefits and risks of getting tested and orders some tests. Which of the following tests would best provide evidence for whether the siblings are carriers or not? (A) Polymerase chain reaction (B) Gel electrophoresis (C) Pyrosequencing (D) DNA isolation and purification
|
['(B) Gel electrophoresis <> answer']
|
The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 24-year-old female comes to the physician for evaluation of a delayed menstrual period and intermittent lower abdominal pain for 2 days. Menarche occurred at the age of 12 years, and menses have occurred at regular 28-day intervals. Her last menstrual period was 7 weeks ago. Two years ago, she was treated for chlamydia infection. Pelvic examination shows a soft, mildly enlarged uterus. Endometrial biopsy shows decidualization of the endometrium without chorionic villi. Further evaluation of this patient is most likely to show which of the following findings? (A) Benign proliferation of myometrial smooth muscle (B) Fertilized ovum outside the uterus (C) Endometrial infiltration by plasma cells (D) Empty ovum fertilized by two sperm
|
['(B) Fertilized ovum outside the uterus <> answer']
|
Subsets and Splits
No community queries yet
The top public SQL queries from the community will appear here once available.