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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 58-year-old woman presents to a physician with a painless swelling behind her right ear, which she noticed 1 month ago. She has no other complaint nor does she have any specific medical condition. On physical examination, her vital signs are stable. An examination of the right post-auricular area shows enlarged lymph nodes, which are non-tender and rubbery in consistency, with normal overlying skin. A detailed general examination reveals the presence of one enlarged axillary lymph node on the left side with similar features. Complete blood counts are within normal limits but atypical lymphocytes are present on the peripheral blood smear. The patient’s serum lactate dehydrogenase level is slightly elevated. Excisional biopsy of the lymph node is performed and histopathological examination of the tissue yields a diagnosis of follicular lymphoma. Further cytogenetic studies reveal that the condition is associated with overexpression of the BCL-2 gene. Which of the following cytogenetic abnormalities is most likely to be present? (A) t(3;3)(q27;27) (B) t(9;14)(p13;q32) (C) t(11;18)(q21;q21) (D) t(14;18)(q32;q21)
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['(D) t(14;18)(q32;q21) <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A healthy 34-year-old woman comes to the physician for advice on UV protection. She works as an archaeologist and is required to work outside for extended periods of time. She is concerned about premature skin aging. The physician recommends sun-protective clothing and sunscreen. In order to protect effectively against photoaging, the sunscreen should contain which of the following active ingredients? (A) Trolamine salicylate (B) Trimethoprim/sulfamethoxazole (C) Vitamin E (D) Zinc oxide
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['(D) Zinc oxide <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 30-year-old woman, gravida 1, para 0, at 30 weeks' gestation is brought to the emergency department because of progressive upper abdominal pain for the past hour. The patient vomited once on her way to the hospital. She said she initially had dull, generalized stomach pain about 6 hours prior, but now the pain is located in the upper abdomen and is more severe. There is no personal or family history of any serious illnesses. She is sexually active with her husband. She does not smoke or drink alcohol. Medications include folic acid and a multivitamin. Her temperature is 38.5°C (101.3°F), pulse is 100/min, and blood pressure is 130/80 mm Hg. Physical examination shows right upper quadrant tenderness. The remainder of the examination shows no abnormalities. Laboratory studies show a leukocyte count of 12,000/mm3. Urinalysis shows mild pyuria. Which of the following is the most appropriate definitive treatment in the management of this patient? (A) Appendectomy (B) Cefoxitin and azithromycin (C) Biliary drainage (D) Intramuscular ceftriaxone followed by cephalexin
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['(A) Appendectomy <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 45-year-old man presents to his primary care physician for a wellness checkup. He states that he feels fatigued at times but feels near his baseline. The patient smokes 1 pack of cigarettes per day, drinks alcohol occasionally, and has a past medical history of poorly controlled diabetes. His temperature is 98.6°F (37.0°C), blood pressure is 167/108 mmHg, pulse is 80/min, respirations are 10/min, and oxygen saturation is 98% on room air. Physical exam reveals an overweight man with a ruddy complexion. Bilateral gynecomastia is noted for which the patient inquires about cosmetic surgery as a treatment. Laboratory values are ordered as seen below. Hemoglobin: 14 g/dL Hematocrit: 42% Leukocyte count: 6,500/mm^3 with normal differential Platelet count: 185,000/mm^3 Serum: Na+: 142 mEq/L Cl-: 102 mEq/L K+: 3.2 mEq/L HCO3-: 31 mEq/L BUN: 27 mg/dL Glucose: 173 mg/dL Creatinine: 1.5 mg/dL Ca2+: 9.8 mg/dL A CT scan demonstrates bilateral abnormal abdominal masses. Which of the following is the best next step in management? (A) Eplerenone (B) Hydrochlorothiazide (C) Spironolactone (D) Surgical excision
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['(A) Eplerenone <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A healthy mother gives birth to a child at 40 weeks of gestation. On examination, the child has ambiguous genitalia. A karyotype analysis reveals the presence of a Y chromosome. Additional workup reveals the presence of testes and a normal level of serum luteinizing hormone (LH) and testosterone. Which of the following is the most likely cause of this patient’s condition? (A) Androgen receptor deficiency (B) Failed migration of neurons producing gonadotropin releasing hormone (GnRH) (C) Presence of two X chromosomes (D) 5-alpha reductase deficiency
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['(D) 5-alpha reductase deficiency <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 28-year-old woman presents with weight gain and a milky-white discharge from her breasts. Patient says she noticed herself gaining weight and a milky white discharge from her breasts. Past medical history is significant for schizophrenia, recently diagnosed and treated with risperidone. No history of headache, nausea, and vomiting. No other current medications. Her last menstrual period was 2 months ago. Review of systems is significant for decreased libido. Patient is afebrile and vital signs are within normal limits. On physical examination, patient had a weight gain of 3 kg (6.6 lb) over the past month. There is bilateral breast tenderness present. A urine pregnancy test is negative. Which of the following is the most likely etiology of this patient’s symptoms? (A) Decrease in dopamine activity in mesolimbic pathway (B) Increase in dopamine activity in mesolimbic pathway (C) Decrease in dopamine activity in tuberoinfundibular pathway (D) Increase in dopamine activity in tuberoinfundibular pathway
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['(C) Decrease in dopamine activity in tuberoinfundibular pathway <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 54-year-old man presents to his primary care physician for back pain. His back pain worsens with standing for a prolonged period of time or climbing down the stairs and improves with sitting. Medical history is significant for hypertension, type II diabetes mellitus, and hypercholesterolemia. Neurologic exam demonstrates normal tone, 5/5 strength, and a normal sensory exam throughout the bilateral lower extremity. Skin exam is unremarkable and dorsalis pedis and posterior tibialis pulses are 3+. Which of the following is the best next step in management? (A) Ankle-brachial index (B) MRI of the lumbosacral spine (C) Naproxen (D) Radiography of the lumbosacral spine
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['(B) MRI of the lumbosacral spine <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 54-year-old woman comes to the physician for a follow-up examination after presenting with elevated blood pressure readings during her last two visits. After her last visit 2 months ago, she tried controlling her hypertension with weight loss before starting medical therapy, but she has since been unable to lose any weight. Her pulse is 76/min, and blood pressure is 154/90 mm Hg on the right arm and 155/93 mm Hg on the left arm. She agrees to start treatment with a thiazide diuretic. In response to this treatment, which of the following is most likely to decrease? (A) Serum uric acid levels (B) Urinary calcium excretion (C) Serum glucose levels (D) Urinary potassium excretion
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['(B) Urinary calcium excretion <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** An 18-year-old woman presents for a routine check-up. She is a college student with no complaints. She has a 2 pack-year history of smoking and consumes alcohol occasionally. Her sexual debut was at 15 years of age and has had 2 sexual partners. She takes oral contraceptives and uses barrier contraception. Her family history is significant for cervical cancer in her aunt. Which of the following statements regarding cervical cancer screening in this patient is correct? (A) The patient requires annual Pap testing due to her family history of cervical cancer. (B) The patient does not require Pap testing as long as she uses barrier contraception. (C) The patient should undergo screening every 3 years after she turns 21 years of age. (D) HPV testing is more preferable than Pap testing in sexually active women under 21 years of age.
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['(C) The patient should undergo screening every 3 years after she turns 21 years of age. <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 32-year-old previously healthy female presents to her primary care physician with double vision. She first noted the double vision yesterday and saw no improvement this morning. She does not think it is worsening. She has not had any changes in her normal routine though she recalls one episode of right arm weakness 2 months ago. She did not seek treatment and the weakness subsided after several days. She does not have a history of head trauma. She denies headache, fever, chills, nausea, vomiting, paresthesias, extremity pain, or weakness. On exam she has right adduction palsy on leftward gaze. She has no focal weakness. Which of the following additional physical exam findings is associated with the lesion responsible for her ocular findings? (A) Horizontal nystagmus in the left eye on leftward gaze (B) Ptosis on the right (C) Left abduction palsy on leftward gaze (D) Afferent pupillary defect in the left eye
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['(A) Horizontal nystagmus in the left eye on leftward gaze <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 17-year-old girl is brought to her pediatrician by her mother for a wellness checkup. The patient states she is doing well in school and has no concerns. She has a past medical history of anxiety and is currently taking clonazepam as needed. Her family history is remarkable for hypertension in her mother and father and renal disease in her grandparents and aunt. Her temperature is 98.6°F (37.0°C), blood pressure is 97/68 mmHg, pulse is 90/min, respirations are 9/min, and oxygen saturation is 99% on room air. The patient's BMI is 23 kg/m^2. Cardiac, pulmonary, and neurological exams are within normal limits. Laboratory values are ordered as seen below. Hemoglobin: 10 g/dL Hematocrit: 29% Leukocyte count: 6,500/mm^3 with normal differential Platelet count: 190,000/mm^3 Serum: Na+: 137 mEq/L Cl-: 97 mEq/L K+: 3.5 mEq/L HCO3-: 29 mEq/L BUN: 20 mg/dL Glucose: 67 mg/dL Creatinine: 1.1 mg/dL Ca2+: 10.2 mg/dL Urine: pH: 4.5 Color: yellow Glucose: none Chloride: 4 mEq/L Sodium: 11 mEq/L Which of the following is the most likely diagnosis? (A) Anorexia nervosa (B) Bulimia nervosa (C) Diuretic abuse (D) Gitelman syndrome
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['(B) Bulimia nervosa <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 59-year-old man presents to his primary care provider with the complaint of daytime fatigue. He often has a headache that is worse in the morning and feels tired when he awakes. He perpetually feels fatigued even when he sleeps in. The patient lives alone, drinks 2-3 beers daily, drinks coffee regularly, and has a 10 pack-year smoking history. His temperature is 99.0°F (37.2°C), blood pressure is 180/110 mm Hg, pulse is 80/min, respirations are 13/min, and oxygen saturation is 98% on room air. Physical exam is notable for a BMI of 39 kg/m^2. The rest of the patient's pulmonary and neurological exams are unremarkable. Which of the following is the best next step in management? (A) Alcohol avoidance in the evening (B) Caffeine avoidance (C) Screening for depression (D) Weight loss
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['(D) Weight loss <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 69-year-old woman comes to the physician because of lower back pain and right-sided chest pain for the past month. The pain is aggravated by movement. Over the past 2 months, she has had increasing fatigue. Her mother died of breast cancer. She has hypertension and reflux disease. Current medications include metoprolol and omeprazole. Vital signs are within normal limits. Examination shows full muscle strength. There is tenderness to palpation over the lower spine and the right lateral chest. The remainder of the examination shows no abnormalities. Laboratory studies show: Hemoglobin 9.5 g/dL Leukocyte count 7,300/mm3 Platelet count 230,000/mm3 Serum Na+ 137 mEq/L K+ 3.5 mEq/L Creatinine 1.3 mg/dL An ECG shows no evidence of ischemia. An x-ray of the chest shows lytic lesions in 2 ribs. Blood smear shows aggregations of erythrocytes. Protein electrophoresis of the serum with immunofixation shows an M-protein spike. This patient's condition is most likely associated with which of the following findings?" (A) Urinary tract infection (B) Leukemic hiatus (C) Splenomegaly (D) Richter's transformation
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['(A) Urinary tract infection <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 20-year-old female arrives at the urgent care clinic at her university’s health plan asking for an HIV test. She is an undergraduate at the university and just started having sexual intercourse with her new boyfriend. They use protection only occasionally so she wants to get tested to make sure everything is okay. She has never been tested for STDs before. She reports no symptoms and has not seen a physician regularly for any medical conditions in the past. Her family history is uncertain because she was adopted. Her HIV immunoassay and HIV-1/HIV-2 differentiation immunoassay both come back positive. She asks on the phone, “Doctor, tell it to me straight. Do I have AIDS?” Which of the following is the most accurate response? (A) We have to get a confirmatory PCR test to see if you have AIDS. (B) You do not have AIDS because you just started having sex recently. (C) You have AIDS but this disease is now a manageable condition. (D) We need additional bloodwork to see if you have AIDS.
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['(D) We need additional bloodwork to see if you have AIDS. <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** 2 hours after being admitted to the hospital because of a fracture of the right ankle, a 75-year-old man continues to complain of pain despite treatment with acetaminophen and ibuprofen. He has a history of dementia and cannot recall his medical history. The presence of which of the following features would most likely be a reason to avoid treatment with morphine in this patient? (A) Watery diarrhea (B) Biliary tract dysfunction (C) Persistent cough (D) Tachypnea
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['(B) Biliary tract dysfunction <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 40-year-old man presents with a painless firm mass in the right breast. Examination shows retraction of the nipple and the skin is fixed to the underlying mass. The axillary nodes are palpable. Which of the following statements is true regarding the above condition? (A) Lobular cancer is the most common breast cancer in males (B) These are positive for estrogen receptor (C) BRCA analysis is not recommended in his family members (D) Endocrine therapy has no role in the treatment
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['(B) These are positive for estrogen receptor <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 3-year-old boy is brought to the physician because of a 3-day history of a pruritic skin rash on his chest. His mother says that he has no history of dermatological problems. He was born at term and has been healthy except for recurrent episodes of otitis media. His immunizations are up-to-date. He appears pale. His temperature is 37°C (98.6°F), pulse is 110/min, respirations are 26/min, and blood pressure is 102/62 mm Hg. Examination shows vesicles and flaccid bullae with thin brown crusts on the chest. Lateral traction of the surrounding skin leads to sloughing. Examination of the oral mucosa shows no abnormalities. Complete blood count is within the reference range. Which of the following is the most likely diagnosis? (A) Bullous impetigo (B) Dermatitis herpetiformis (C) Stevens-Johnson syndrome (D) Pemphigus vulgaris
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['(A) Bullous impetigo <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 47-year-old woman presents to the emergency department with abdominal pain. The patient states that she felt this pain come on during dinner last night. Since then, she has felt bloated, constipated, and has been vomiting. Her current medications include metformin, insulin, levothyroxine, and ibuprofen. Her temperature is 99.0°F (37.2°C), blood pressure is 139/79 mmHg, pulse is 95/min, respirations are 12/min, and oxygen saturation is 98% on room air. On physical exam, the patient appears uncomfortable. Abdominal exam is notable for hypoactive bowel sounds, abdominal distension, and diffuse tenderness in all four quadrants. Cardiac and pulmonary exams are within normal limits. Which of the following is the best next step in management? (A) Emergency surgery (B) IV antibiotics and steroids (C) Nasogastric tube, NPO, and IV fluids (D) Stool guaiac
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['(C) Nasogastric tube, NPO, and IV fluids <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 3-year-old boy presents to the clinic for evaluation of leg pain. This has been persistent for the past 3 days and accompanied by difficulty walking. He has also had some erythema and ecchymoses in the periorbital region over the same time period. The vital signs are unremarkable. The physical exam notes the above findings, as well as some swelling of the upper part of the abdomen. The laboratory results are as follows: Erythrocyte count 3.3 million/mm3 Leukocyte count 3,000/mm3 Neutrophils 54% Eosinophils 1% Basophils 55% Lymphocytes 30% Monocytes 3% Platelet count 80,000/mm3 A magnetic resonance image (MRI) scan of the abdomen shows a mass of adrenal origin. Which of the following is the most likely cause of this patient’s symptoms? (A) Retinoblastoma (B) Wilms tumor (C) Neuroblastoma (D) Hepatoblastoma
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['(C) Neuroblastoma <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 45-year-old male presents to the hospital complaining of frequent headaches and a decreased libido. During the physical exam, the patient also states that he has recently been experiencing vision problems. The patient is suffering from what type of adenoma? (A) Lactotroph (B) Corticotroph (C) Thyrotroph (D) Gonadotroph
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['(A) Lactotroph <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 31-year-old African American woman presents to her primary care provider complaining of stiff, painful fingers. She reports that her symptoms started 2 years ago and have gradually worsened. Her pain is not relieved by ibuprofen or acetaminophen. She is most concerned about having occasional episodes in which her fingers become extremely painful and turn white then pale blue. Her past medical history is notable for hypertension but she has previously refused to take any medication. She works as a postal worker and spends most of her time outside. Physical examination reveals induration of her digits with loss of skin fold wrinkles. She has limited finger range of motion. She would like to know if she can do anything to address her intermittent finger pain as it is affecting her ability to work outside in the cold. Which of the following medications is most appropriate to address this patient’s concerns? (A) Ambrisentan (B) Enalapril (C) Methotrexate (D) Nifedipine
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['(D) Nifedipine <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 21-year-old woman has frequent sexual fantasies about female coworkers. When she is with her friends in public, she never misses an opportunity to make derogatory comments about same-sex couples she sees. Which of the following psychological defense mechanisms is she demonstrating? (A) Reaction formation (B) Acting out (C) Sexualization (D) Intellectualization "
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['(A) Reaction formation <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 63-year-old man presents to the physician with fever for 5 days. He has had increasing fatigue and dyspnea for the past 2 months. During this time, he has lost 3 kg (6.6 lb). He received outpatient treatment for pneumonia last month. He had urinary tract infection 2 weeks ago. He takes no other medications other than daily low dose aspirin and recent oral antibiotics. He does not smoke or drink alcohol. The vital signs include: temperature 38.5°C (101.3°F), pulse 93/min, respiration rate 18/min, and blood pressure 110/65 mm Hg. On physical examination, he has petechiae distally on the lower extremities and several purpura on the trunk and extremities. Several enlarged lymph nodes are detected in the axillary and cervical regions on both sides. The examination of the lungs, heart, and abdomen shows no abnormalities. The laboratory test results are as follows: Hemoglobin 10 g/dL Mean corpuscular volume 90 μm3 Leukocyte count 18,000/mm3 Platelet count 40,000/mm3 A Giemsa-stained peripheral blood smear is shown by the image. Which of the following is the most likely diagnosis? (A) Acute myeloblastic leukemia (B) Burkitt lymphoma (C) Hairy cell leukemia (D) MALT lymphoma
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['(A) Acute myeloblastic leukemia <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 52-year-old man presents to the Emergency Department because of bilateral leg swelling and puffiness of both eyes in the morning. His symptoms started about 2 weeks ago. He denies smoking or alcohol use and his family history is noncontributory. Today, his vital signs include a temperature of 36.8°C (98.2°F), blood pressure of 162/87 mm Hg, and a pulse of 85/min. On physical examination, he is jaundiced and there is hepatosplenomegaly and 2+ lower extremity edema up to the mid-thigh. Laboratory results are shown: Anti-HCV reactive Serum albumin 3 g/dL Urine dipstick 3+ protein Urinalysis 10–15 red blood cells/high power field and red cell casts Which of the following is a feature of this patient’s condition? (A) Subendothelial immune complex deposits (B) Phospholipase A2 receptor antibodies (C) Normal complement level (D) Few immune complex deposits
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['(A) Subendothelial immune complex deposits <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 29-year-old woman, gravida 1, para 1, comes to the physician for the evaluation of a painful mass in her left breast for several days. She has no fevers or chills. She has not noticed any changes in the right breast. She has no history of serious illness. Her last menstrual period was 3 weeks ago. She appears anxious. Her temperature is 37°C (98.6°F), pulse is 80/min, respirations are 13/min, and blood pressure is 130/75 mm Hg. Examination shows a palpable, mobile, tender mass in the left upper quadrant of the breast. Ultrasound shows a 1.75-cm, well-circumscribed anechoic mass with posterior acoustic enhancement. The patient says that she is very concerned that she may have breast cancer and wishes further diagnostic testing. Which of the following is the most appropriate next step in the management of this patient? (A) Fine needle aspiration (B) Mammogram (C) MRI scan of the left breast (D) Core needle biopsy
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['(A) Fine needle aspiration <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 30-year-old woman presents to her family doctor requesting sleeping pills. She is a graduate student and confesses that she is a “worry-a-holic,” which has been getting worse for the last 6 months as the due date for her final paper is approaching. During this time, she feels more on edge, irritable, and is having difficulty sleeping. She has already tried employing good sleep hygiene practices, including a switch to non-caffeinated coffee. Her past medical history is significant for depression in the past that was managed medically. No current medications. The patient’s family history is significant for her mother who has a panic disorder. Her vital signs are within normal limits. Physical examination reveals a mildly anxious patient but is otherwise normal. Which of the following is the most effective treatment for this patient’s condition? (A) Buspirone (B) Bupropion (C) Desensitization therapy (D) Relaxation training
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['(A) Buspirone <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A mother brings her newborn baby to the pediatrician after noting that his skin looks yellow. The patient's lactate dehydrogenase is elevated and haptoglobin is decreased. A smear of the child's blood is shown below. The patient is ultimately found to have decreased ability to process phosphoenolpyruvate to pyruvate. Which of the following metabolic changes is most likely to occur in this patient? (A) Left shift of the oxyhemoglobin curve (B) Right shift of the oxyhemoglobin curve (C) Broadening of the oxyhemoglobin curve (D) Narrowing of the oxyhemoglobin curve
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['(B) Right shift of the oxyhemoglobin curve <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 13-year-old boy is brought to the physician because of a 5-day history of a rash on his chest and back. His mother initially noticed only a few lesions on his back, but since then the rash has spread to his chest. His family returned from a trip to the Caribbean 2 weeks ago. His mother started using a new laundry detergent 8 days ago. He has type 1 diabetes mellitus controlled with insulin. His mother has Hashimoto thyroiditis and his brother has severe facial acne. His temperature is 37.2°C (99°F), pulse is 81/min, and blood pressure is 115/74 mm Hg. Examination of the skin shows multiple, nontender, round, white macules on the chest and trunk. There is fine scaling when the lesions are scraped with a spatula. There are no excoriation marks. The remainder of the examination shows no abnormalities. Which of the following is the most likely underlying mechanism of this patient's symptoms? (A) Autoimmune destruction of melanocytes (B) Increased sebum production (C) Increased growth of Malassezia globosa (D) Exposure to human herpes virus 7
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['(C) Increased growth of Malassezia globosa <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 73-year-old female presents to you for an office visit with complaints of getting lost. The patient states that over the last several years, the patient has started getting lost in places that she is familiar with, like in her neighborhood while driving to her church. She has also has difficulty remembering to pay her bills. She denies any other complaints. Her vitals are normal, and her physical exam does not reveal any focal neurological deficits. Her mini-mental status exam is scored 19/30. Work up for secondary causes of cognitive decline is negative. Which of the following should be included in the patient's medication regimen to slow the progression of disease? (A) Ropinirole (B) Memantine (C) Pramipexole (D) Pergolide
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['(B) Memantine <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 61-year-old woman presents to the emergency department with bloody vomiting for the last hour. She had been vomiting for several hours. Additionally, she states she felt a sudden onset of chest and epigastric pain when she noted blood in her vomit. In the emergency room, she endorses feeling lightheaded and denies difficulty breathing or coughing, and the pain is not worse with swallowing. On review of systems, she notes that she has been bruising more easily than usual over the last 3 months. The patient has a long history of alcoholism with recent progression of liver disease to cirrhosis. She has known esophageal varices and is on propranolol for prophylaxis. In the emergency room, the patient’s temperature is 98.2°F (36.8°C), blood pressure is 94/60 mmHg, pulse is 103/min, and respirations are 16/min. On exam, she is in moderate distress, and there is frank blood in her emesis basin. Cardiovascular and lung exams are unremarkable, and there is pain on palpation of her epigastrium and chest without crepitus. Initial labs are shown below: Hemoglobin: 13.1 g/dL Leukocyte count: 6,200/mm^3 Platelet count: 220,000/mm^3 Creatinine: 0.9 mg/dL The patient is started on IV isotonic saline, pantoprazole, ceftriaxone, and octreotide. Which of the following is the best next step in management? (A) Administer fresh frozen plasma (FFP) (B) Perform transjugular intrahepatic portosystemic shunt (TIPS) (C) Administer a non-selective ß-blocker (D) Perform endoscopy
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['(D) Perform endoscopy <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 55-year-old man with a past medical history of obesity and hyperlipidemia suddenly develops left-sided chest pain and shortness of breath while at work. He relays to coworkers that the pain is intense and has spread to his upper left arm over the past 10 minutes. He reports it feels a lot like the “heart attack” he had a year ago. He suddenly collapses and is unresponsive. Coworkers perform cardiopulmonary resuscitation for 18 minutes until emergency medical services arrives. Paramedics pronounce him dead at the scene. Which of the following is the most likely cause of death in this man? (A) Atrial fibrillation (B) Free wall rupture (C) Pericarditis (D) Ventricular tachycardia
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['(D) Ventricular tachycardia <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 17-year-old female presents to your office expressing concern that despite experiencing monthly pelvic pain for the past few years, she has not yet started her menstrual cycle. She is not taking oral contraceptive therapy and has never been sexually active. On physical exam the patient is of normal stature with appropriate breast development and growth of pubic and underarm hair. The patient declined a vaginal exam. Karyotype analysis reveals she has 46 XX. Pregnancy test is negative, thyroid stimulating hormone, prolactin, luteinizing hormone (LH) and follicle-stimulating hormone (FSH) levels are normal. The uterus is normal on ultrasound. What is the likely cause of this patient's primary amenorrhea? (A) Failure in development of Mullerian duct (B) Failed canalization of external vaginal membrane (C) Androgen insensitivity (D) Pituitary infarct
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['(B) Failed canalization of external vaginal membrane <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 23-year-old man presents to the emergency department brought in by police. He was found shouting at strangers in the middle of the street. The patient has no significant past medical history, and his only medications include a short course of prednisone recently prescribed for poison ivy exposure. His temperature is 77°F (25°C), blood pressure is 90/50 mmHg, pulse is 90/min, respirations are 17/min, and oxygen saturation is 98% on room air. The patient is only wearing underwear, and he is occasionally mumbling angrily about the government. He appears to be responding to internal stimuli, and it is difficult to obtain a history from him. Which of the following is the next best step in management? (A) Haloperidol IM (B) Lorazepam and discontinue steroids (C) Warm air recirculator (D) Warmed IV normal saline and warm blankets
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['(D) Warmed IV normal saline and warm blankets <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 16-year-old girl is brought to the physician because of generalized fatigue and an inability to concentrate in school for the past 4 months. During this period, she has had excessive daytime sleepiness. While going to sleep, she sees cartoon characters playing in her room. She wakes up once or twice every night. While awakening, she feels stiff and cannot move for a couple of minutes. She goes to sleep by 9 pm every night and wakes up at 7 am. She takes two to three 15-minute naps during the day and wakes up feeling refreshed. During the past week while listening to a friend tell a joke, she had an episode in which her head tilted and jaw dropped for a few seconds; it resolved spontaneously. Her father has schizoaffective disorder and her parents are divorced. Vital signs are within normal limits. Physical examination is unremarkable. Which of the following is the most appropriate initial pharmacotherapy? (A) Modafinil (B) Citalopram (C) Risperidone (D) Venlafaxine
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['(A) Modafinil <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 20-year-old man comes to the clinic complaining of fever and a sore throat for 5 days. He receives oral penicillin from his primary doctor. After a day of antibiotic treatment, he developed gross hematuria. As a child, he recalls having multiple episodes of hematuria. The vital signs are within normal limits. On physical examination, pharyngeal edema and cervical lymphadenopathy are present. His laboratory examination reveals the following: WBC 11,000/mm3 Neutrophils 76% Lymphocytes 23% Eosinophils 1% Platelets 150,000/mm3 Hemoglobin 14 g/dL Hct 41.2% BUN 16 mg/dL Creatinine 0.9 mg/dL ASO titer 100 Urinalysis shows hematuria but no proteinuria. Immunofluorescence shows granular IgA immune complex deposits in the mesangium. Hepatitis B, hepatitis C, and HIV serology are negative. ASO titers and C3 levels are within normal limits. What is the most likely diagnosis? (A) Berger’s disease (B) Post-streptococcal glomerulonephritis (C) Hemolytic uremic syndrome (D) Celiac disease
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['(A) Berger’s disease <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 66-year-old man comes to the physician for a 3-month history of fatigue. He has hypertension and hyperlipidemia. He had a transient ischemic attack 3 years ago. He drinks 3 beers a day, and sometimes a couple more on social occasions. He currently takes aspirin, simvastatin, hydrochlorothiazide, and metoprolol. His temperature is 37.1°C (98.8°F), pulse is 78, respirations are 19/min, and oxygen saturation on room air is 97%. He is in no distress but shows marked pallor and has multiple pinpoint, red, nonblanching spots on his extremities. On palpation, his spleen is significantly enlarged. Laboratory studies show a hemoglobin of 8.0 g/dL, a leukocyte count of 80,000/mm3, and a platelet count of 34,000/mm3. A blood smear shows immature cells with large, prominent nucleoli and pink, elongated, needle-shaped cytoplasmic inclusions. Which of the following is the most likely diagnosis? (A) Acute lymphoblastic leukemia (B) Myelodysplastic syndrome (C) Chronic lymphocytic leukemia (D) Acute myelogenous leukemia
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['(D) Acute myelogenous leukemia <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 28-year-old woman comes to the physician for genetic counseling prior to conception. For the past year, she has had intermittent episodes of headache, nausea, abdominal pain, and tingling of her fingers. She also complains of dark urine during the episodes. Her mother and maternal uncle have similar symptoms and her father is healthy. Her husband is healthy and there is no history of serious illness in his family. Serum studies show elevated concentrations of porphobilinogen and δ-aminolevulinic acid. What is the probability of this patient having a child with the same disease as her? (A) 67% (B) 50% (C) 25% (D) 100%
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['(B) 50% <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 32-year-old man comes to the physician because of low-grade fever, dry cough, and shortness of breath. His symptoms began 6 days ago while he was on vacation in Thailand where he went to an urgent care clinic and was started on cefuroxime. His temperature is 38.2°C (100.8°F). Physical examination shows decreased breath sounds at bilateral lung bases. An x-ray of the chest shows diffuse patchy infiltrates. Sputum analysis shows numerous neutrophils but no organisms. Giemsa stain shows epithelial cells with cytoplasmic inclusion bodies. This patient's condition did not improve after the initial treatment because of which of the following properties of the most likely causal pathogen? (A) Lack of peptidoglycan in cell wall (B) Enclosure by polysaccharide capsule (C) Formation of biofilms (D) Rapid alteration of drug binding sites
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['(A) Lack of peptidoglycan in cell wall <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** You have been asked to quantify the relative risk of developing bacterial meningitis following exposure to a patient with active disease. You analyze 200 patients in total, half of which are controls. In the trial arm, 30% of exposed patients ultimately contracted bacterial meningitis. In the unexposed group, only 1% contracted the disease. Which of the following is the relative risk due to disease exposure? (A) [30 / (30 + 70)] / [1 / (1 + 99)] (B) (30 * 99) / (70 * 1) (C) (70 * 1) / (39 * 99) (D) [1 / (1 + 99)] / 30 / (30 + 70)]
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['(A) [30 / (30 + 70)] / [1 / (1 + 99)] <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 58-year-old man presents to the emergency department with a chief complaint of ringing in his ears that started several hours previously that has progressed to confusion. The patient denies any history of medical problems except for bilateral knee arthritis. He was recently seen by an orthopedic surgeon to evaluate his bilateral knee arthritis but has opted to not undergo knee replacement and prefers medical management. His wife noted that prior to them going on a hike today, he seemed confused and not himself. They decided to stay home, and roughly 14 hours later, he was no longer making any sense. Physical exam is notable for a confused man. The patient's vitals are being performed and his labs are being drawn. Which of the following is most likely to be seen on blood gas analysis? (A) pH: 7.30, PaCO2: 15 mmHg, HCO3-: 16 mEq/L (B) pH: 7.31, PaCO2: 31 mmHg, HCO3-: 15 mEq/L (C) pH: 7.41, PaCO2: 65 mmHg, HCO3-: 34 mEq/L (D) pH: 7.47, PaCO2: 11 mmHg, HCO3-: 24 mEq/L
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['(A) pH: 7.30, PaCO2: 15 mmHg, HCO3-: 16 mEq/L <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 63-year-old man is brought to the emergency department by the police after he was found in the streets lying unconscious on the ground. Both of his pupils are normal in size and reactive to light. There are no obvious signs of head trauma. The finger prick test shows a blood glucose level of 20 mg/dL. He has been brought to the emergency department due to acute alcohol intoxication several times. The vital signs include: blood pressure 100/70 mm Hg, heart rate 110/min, respiratory rate 22/min, and temperature 35℃ (95℉). On general examination, he is pale looking and disheveled with an odor of EtOH. On physical examination, the abdomen is soft and non-tender with no hepatosplenomegaly. After giving a bolus of intravenous dextrose, thiamine, and naloxone, he spontaneously opens his eyes. Blood and urine samples are drawn for toxicology screening. The blood alcohol level comes out to be 300 mg/dL. What will be the most likely laboratory findings in this patient? (A) Hypersegmented neutrophils (B) Sickle cells (C) Macrocytosis MCV > 100fL (D) Howell-Jolly bodies
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['(C) Macrocytosis MCV > 100fL <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 2-day-old female infant undergoes a newborn examination by her pediatrician. The physician adducts both of the patient's hips and exerts a posterior force on her knees; this results in an abnormally increased amount of translation of the left lower extremity in comparison to the contralateral side. The physician then abducts both hips and exerts an anterior force on the greater trochanters; this maneuver results in an audible 'clunk' heard and felt over the left hip. Ultrasound reveals decreased concavity of the left acetabulum and confirms the dislocation of the left hip when the above maneuvers are repeated under real-time ultrasound evaluation. Which of the following best characterizes this patient's condition? (A) Malformation (B) Deformation (C) Sequence (D) Mutation
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['(B) Deformation <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 46-year-old woman comes to the physician for a routine health examination. She was last seen by a physician 3 years ago. She has been healthy aside from occasional mild flank pain. Her only medication is a multivitamin. Her blood pressure is 154/90 mm Hg. Physical examination shows no abnormalities. Serum studies show: Sodium 141 mEq/L Potassium 3.7 mEq/L Calcium 11.3 mg/dL Phosphorus 2.3 mg/dL Urea nitrogen 15 mg/dL Creatinine 0.9 mg/dL Albumin 3.6 g/dL Subsequent serum studies show a repeat calcium of 11.2 mg/dL, parathyroid hormone concentration of 890 pg/mL, and 25-hydroxyvitamin D of 48 ng/mL (N = 25–80). Her 24-hour urine calcium excretion is elevated. An abdominal ultrasound shows several small calculi in bilateral kidneys. Further testing shows normal bone mineral density. Which of the following is the most appropriate next step in management?" (A) Refer to surgery for parathyroidectomy (B) Begin cinacalcet therapy (C) Begin hydrochlorothiazide therapy (D) Perform percutaneous nephrolithotomy
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['(A) Refer to surgery for parathyroidectomy <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 31-year-old female undergoing treatment for leukemia is found to have a frontal lobe abscess accompanied by paranasal swelling. She additionally complains of headache, facial pain, and nasal discharge. Biopsy of the infected tissue would most likely reveal which of the following? (A) Budding yeast with a narrow base (B) Septate hyphae (C) Irregular non-septate hyphae (D) Spherules containing endospores
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['(C) Irregular non-septate hyphae <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 35-year-old man comes to the physician because of a rash on the thigh for 10 days. He reports that the rash has been enlarging and is intensely itchy. Two weeks ago, he adopted a stray dog from an animal shelter. Vital signs are within normal limits. A photograph of the examination findings is shown. Which of the following is the most likely cause of this patient's symptoms? (A) Psoriasis (B) Erythrasma (C) Pityriasis rosea (D) Dermatophyte infection
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['(D) Dermatophyte infection <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 47-year-old man presents to his primary care physician for fatigue. Over the past 3 months, his tiredness has impacted his ability to work as a corporate lawyer. He denies any changes to his diet, exercise regimen, bowel movements, or urinary frequency. His past medical history is notable for obesity, type II diabetes mellitus, and hypertension. He takes metformin and enalapril. His family history is notable for colorectal cancer in his father and paternal grandfather and endometrial cancer in his paternal aunt. He has a 20-pack-year smoking history and drinks one 6-pack of beer a week. His temperature is 98.8°F (37.1°C), blood pressure is 129/71 mmHg, pulse is 82/min, and respirations are 17/min. On exam, he has conjunctival pallor. A stool sample is positive for occult blood. A colonoscopy reveals a small hemorrhagic mass at the junction of the ascending and transverse colon. Which of the following processes is likely impaired in this patient? (A) Homologous recombination (B) Mismatch repair (C) Non-homologous end joining (D) Nucleotide excision repair
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['(B) Mismatch repair <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 60-year-old man comes to the physician because of recurrent nose bleeds that occur with light trauma or at random times during the day. Over the past 6 months, the patient has felt weak and fatigued and has had a 10-kg (22-lb) weight loss. He has poor appetite and describes abdominal discomfort. He does not have night sweats. His pulse is 72/min, blood pressure is 130/70 mm Hg, and his temperature is 37.5°C (99.5°F). The spleen is palpated 10 cm below the left costal margin. Multiple bruises are noted on both upper extremities. Laboratory studies show. Hemoglobin 9.8 g/dL Hematocrit 29.9% Leukocyte count 4,500/mm3 Neutrophils 30% Platelet count 74,000/mm3 Serum Lactate dehydrogenase 410 IU/L A peripheral blood smear detects tartrate-resistant acid phosphatase activity. Which of the following is the most appropriate initial treatment for this patient?" (A) Transfusion of packed red blood cells (B) Transfusion of platelets (C) Melphalan (D) Cladribine
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['(D) Cladribine <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A previously healthy 18-year-old woman comes to the physician because of a 2-day history of swelling and itchiness of her mouth and lips. It decreases when she eats cold foods such as frozen fruit. Four days ago, she underwent orthodontic wire-placement on her upper and lower teeth. Since then, she has been taking ibuprofen twice daily for the pain. For the past 6 months, she has been on a strict vegan diet. She is sexually active with one partner and uses condoms consistently. She had chickenpox that resolved spontaneously when she was 6 years old. Her vitals are within normal limits. Examination shows diffuse erythema and edema of the buccal mucosa with multiple serous vesicles and shallow ulcers. Stroking the skin with pressure does not cause blistering of the skin. The remainder of the examination shows no abnormalities. Which of the following is the most likely cause of these symptoms? (A) Dermatitis herpetiformis (B) Herpes labialis (C) Allergic contact dermatitis (D) Reactivation of varicella zoster virus
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['(C) Allergic contact dermatitis <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 55-year-old man comes to the physician for evaluation prior to parathyroidectomy. A Tc99m-sestamibi scan shows two spots of increased uptake in the superior mediastinum. These spots represent structures that are most likely derived from which of the following embryological precursors? (A) 4th branchial pouch (B) 3rd branchial pouch (C) 2nd branchial arch (D) 3rd branchial arch
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['(B) 3rd branchial pouch <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 42-year-old man who recently immigrated from Mexico presents to the clinic with fever, a productive cough streaked with blood, back pain, and night sweats. He was found to be HIV-positive 3 years ago but does not know his most recent CD4+ count. With further questioning, the patient notes that he had previously experienced these symptoms when he was in Mexico, but he has no recollection of taking any treatment. Which of the following characteristics would best describe the histology of a lung biopsy specimen obtained from this patient? (A) Cellular debris and macrophages followed by cystic spaces and cavitation (B) Epithelioid cells surrounded by multinucleated giant cells and lymphocytes (C) Macrophage filled with fungal microorganisms (D) Noncaseating granuloma
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['(B) Epithelioid cells surrounded by multinucleated giant cells and lymphocytes <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 75-year-old man is brought to the emergency department for a 5-day-history of worsening dyspnea, orthopnea, and lower leg swelling. He has a history of hypertension, hyperlipidemia, non-alcoholic fatty liver disease, and myocardial infarction 10 years ago. Current medications include metoprolol, lisinopril, ethacrynic acid, eplerenone, and aspirin. He drinks 1 beer daily. He has a 30-pack-year smoking history. He is allergic to sulfonamides. His temperature is 37.0°C (98.6°F), his pulse is 120/min, and his blood pressure is 120/80 mm Hg. Physical examination reveals jugular venous distention and 3+ pitting edema in his lower legs. Crackles are heard at both lung bases. The point of maximal impulse is 2 cm to the left of the midclavicular line in the 6th intercostal space. Which of the following additional findings would be most strongly associated with increased mortality? (A) Decreased BNP levels (B) Decreased serum Na+ (C) Increased VO2 (D) Increased heart rate variability
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['(B) Decreased serum Na+ <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 53-year old man presents for a well physical examination. He reports his diet is suboptimal, but otherwise reports a healthy lifestyle. He has no past medical history and only takes a multivitamin. He has a blood pressure of 116/74 mm Hg and a pulse of 76/min. On physical examination, he is in no acute distress, has no cardiac murmurs, and his lung sounds are clear to auscultation bilaterally. You order a lipid panel that returns as follows: LDL 203, HDL 37, TG 292. Of the following, which medication should be initiated? (A) Simvastatin 10 mg daily (B) Ezetimibe 10 mg daily (C) Fenofibrate 145 mg daily (D) Atorvastatin 40 mg
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['(D) Atorvastatin 40 mg <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 73-year-old man with a 50-year history of type 2 diabetes and stage 3 chronic kidney disease presents to his primary care doctor for a scheduled follow-up and routine labs. He states that he has had no real change in his health except that he feels like he has had bouts of lightheadedness and almost passing out, which resolve with sitting down. The patient does not have a history of syncope or arrhythmia. On his labs, he is found to have a hemoglobin of 11.0 g/dL. His estimated glomerular filtration rate is determined to be 45 ml/min/1.73m^2. Testing of his stool is negative for blood. Additionally, a peripheral blood smear demonstrates normochromic cells. As a result, the patient is started on erythropoietin. Which of the following likely describes the anemia? (A) Macrocytic anemia with megaloblasts (B) Macrocytic anemia without megaloblasts (C) Microcytic anemia (D) Normocytic anemia with decreased reticulocyte count
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['(D) Normocytic anemia with decreased reticulocyte count <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 28-year-old man presents to his physician with a complaint of a 4-week history of headaches that is affecting his academic performance. Over-the-counter medications do not seem to help. He also mentions that he has to raise his head each time to look at the board when taking notes. His blood pressure is 125/75 mm Hg, pulse 86/min, respiratory rate 13/min, temperature 36.8°C (98.2°F). Ophthalmic examination shows an upward gaze palsy, convergence-retraction nystagmus, and papilledema. CT scan of the head reveals a 1.5 x 1.2 cm heterogeneous mass in the epithalamus with dilated lateral and 3rd ventricles. What other finding is most likely to be associated with this patient’s condition? (A) Sensorineural hearing loss (B) Pseudo-Argyll Robertson pupils (C) Eyes down and out (D) Conducting hearing loss
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['(B) Pseudo-Argyll Robertson pupils <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 24-year-old woman complains of intermittent fever and joint pain. She says that these symptoms have been present for the past month. Before that, she had no signs or symptoms and was completely healthy. She has also lost her appetite and some weight. A complete blood count (CBC) showed severe pancytopenia. What is the next best step in evaluating this patient? (A) Bone marrow examination (B) Repeated CBCs for several weeks and reassess (C) Treatment with corticosteroids (D) Treatment for acute leukemia
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['(A) Bone marrow examination <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 35-year-old woman is started on a new experimental intravenous drug X. In order to make sure that she is able to take this drug safely, the physician in charge of her care calculates the appropriate doses to give to this patient. Data on the properties of drug X from a subject with a similar body composition to the patient is provided below: Weight: 100 kg Dose provided: 1500 mg Serum concentration 15 mg/dL Bioavailability: 1 If the patient has a weight of 60 kg and the target serum concentration is 10 mg/dL, which of the following best represents the loading dose of drug X that should be given to this patient? (A) 150 mg (B) 300mg (C) 450 mg (D) 600 mg
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['(D) 600 mg <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 61-year-old woman comes to the physician because of a constant, dull headache and generalized body pains for the past 8 months. She has also had difficulty hearing from her left side, which started a month after the onset of the headaches. Five months ago, she had surgery to correct a fracture of the right femur that occurred without a fall or any significant trauma. Five years ago, she underwent a total thyroidectomy for localized thyroid carcinoma. She takes levothyroxine and calcium supplements, which she started after menopause. Physical examination reveals a prominent forehead and irregular, tender skull surface. Bony tenderness is present over bilateral hip and knee joints, with decreased range of motion of the right hip joint and increased anterior curvature of both tibias. Laboratory studies show a highly elevated level of alkaline phosphatase, with vitamin D, calcium and PTH levels within normal limits. A plain x-ray of the head is most likely to show which of the following findings? (A) Lytic lesions with no sclerotic margin (B) Mixed lytic and sclerotic lesions (C) Periosteal trabeculations with radiolucent marrow hyperplasia (D) Generalized dense, sclerotic bone
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['(B) Mixed lytic and sclerotic lesions <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 23-year-old woman presents to her primary care physician for poor sleep. Her symptoms began approximately 1 week ago, when she started waking up multiple times throughout the night to urinate. She also reports an increase in her water intake for the past few days prior to presentation, as well as larger urine volumes than normal. Medical history is significant for asthma. Family history is significant for type 2 diabetes mellitus. She denies alcohol, illicit drug, or cigarette use. Her temperature is 98.6°F (37°C), blood pressure is 108/65 mmHg, pulse is 103/min, and respirations are 18/min. On physical exam, she has mildly dry mucous membranes and has no focal neurological deficits. Laboratory testing demonstrates the following: Serum: Na+: 145 mEq/L Cl-: 102 mEq/L K+: 4.2 mEq/L HCO3-: 28 mEq/L BUN: 15 mg/dL Glucose: 98 mg/dL Creatinine: 0.92 mg/dL Urine: Urine osmolality: 250 mOsm/kg The patient undergoes a water deprivation test, and her labs demonstrate the following: Na+: 147 mEq/L Cl-: 103 mEq/L K+: 4.4 mEq/L HCO3-: 22 mEq/L BUN: 16 mg/dL Glucose: 101 mg/dL Creatinine: 0.94 mg/dL Urine osmolality: 252 mOsm/kg Which of the following is the best next step in management? (A) Counsel to decrease excess water intake (B) Desmopressin (C) Intravenous fluids (D) Metformin
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['(B) Desmopressin <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 53-year-old man seeks evaluation from his physician with concerns about his blood pressure. He was recently told at a local health fair that he has high blood pressure. He has not seen a physician since leaving college because he never felt the need for medical attention. Although he feels fine, he is concerned because his father had hypertension and died due to a heart attack at 61 years of age. He does not smoke cigarettes but drinks alcohol occasionally. The blood pressure is 150/90 mm Hg today. The physical examination is unremarkable. Labs are ordered and he is asked to monitor his blood pressure at home before the follow-up visit. Two weeks later, the blood pressure is 140/90 mm Hg. The blood pressure measurements at home ranged from 130/90 to 155/95 mm Hg. An electrocardiogram (ECG) is normal. Lab tests show the following: Serum glucose (fasting) 88 mg/dL Serum electrolytes: Sodium 142 mEq/L Potassium 3.9 mEq/L Chloride 101 mEq/L Serum creatinine 0.8 mg/dL Blood urea nitrogen 10 mg/dL Cholesterol, total 250 mEq/L HDL-cholesterol 35 mEq/L LDL-cholesterol 186 mg/dL Triglycerides 250 mg/dL Urinalysis: Glucose negative Ketones negative Leucocytes negative Nitrite negative RBC negative Casts negative Regular exercise and a 'heart healthy diet' are advised. He is started on lisinopril for hypertension. Which of the following medications should be added to this patient? (A) Atorvastatin (B) Niacin (C) Gemfibrozil (D) Orlistat
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['(A) Atorvastatin <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 68-year-old man comes to the physician for a wellness visit. Physical examination shows an enlarged and nodular prostate. Laboratory studies show elevated levels of prostate-specific antigen. A prostate biopsy confirms the diagnosis of prostate cancer and a radical prostatectomy is planned. This patient should be counseled on the increased risk of injury to which of the following structures? (A) Cavernous nerve (B) Superior vesical artery (C) External anal sphincter (D) Hypogastric nerve
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['(A) Cavernous nerve <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 52-year-old man presents to the his primary care physician complaining of an ongoing cough. He reports that the cough started 1 year ago after a “bad cold” and then never resolved. He feels the cough is getting worse, sometimes the cough is dry, but often the cough will bring up a clear to white mucus, especially in the morning. The patient has hypertension and peripheral artery disease. He takes aspirin and lisinopril. He started smoking at age 16, and now smokes 2 packs of cigarettes a day. He has 1-2 beers a couple nights of the week with dinner. He denies illicit drug use. Which of the following cell types within the lung is most likely to undergo metaplasia caused by smoking? (A) Pseudostratified columnar (B) Simple cuboidal (C) Stratified squamous (D) Transitional
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['(A) Pseudostratified columnar <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 26-year-old G1P0 woman at 32-weeks gestation presents for follow-up ultrasound. She was diagnosed with gestational diabetes during her second trimester, but admits to poor glucose control and non-adherence to insulin therapy. Fetal ultrasound reveals an asymmetric, enlarged interventricular septum, left ventricular outflow tract obstruction, and significantly reduced ejection fraction. Which of the following is the most appropriate step in management after delivery? (A) Emergent open fetal surgery (B) Cardiac magnetic resonance imaging (C) Cardiac catheterization (D) Medical management
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['(D) Medical management <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 72-year-old woman comes to the emergency department 4 hours after the sudden onset of a diffuse, dull, throbbing headache. During this time, she also reports blurred vision, nausea, and one episode of vomiting. She has a history of hypertension and type 2 diabetes mellitus. Her medications include hydrochlorothiazide, lisinopril, atorvastatin, and metformin. She has smoked 1 pack of cigarettes daily for the past 30 years and drinks 1–2 glasses of wine per day. Her temperature is 36.6 °C (97.9 °F), pulse is 90/min, respirations are 14/min, and blood pressure is 185/110 mm Hg. Fundoscopic examination shows bilateral blurring of the optic disc margins. Physical and neurologic examinations show no other abnormalities. A complete blood count and serum concentrations of electrolytes, urea nitrogen, and creatinine are within the reference range. Urinalysis shows 2+ protein but no WBCs or RBCs. Which of the following is the most likely diagnosis? (A) Ischemic stroke (B) Subarachnoid hemorrhage (C) Idiopathic intracranial hypertension (D) Hypertensive emergency
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['(D) Hypertensive emergency <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 3-month-old boy presents to his pediatrician with persistent diarrhea, oral candidiasis, and signs and symptoms of respiratory syncytial virus (RSV) pneumonia. He is very lean with weight in the 10th percentile. His blood pressure is 105/64 mm Hg and heart rate is 84/min. He is being evaluated for an immunodeficiency. Laboratory results for HIV are negative by polymerase chain reaction (PCR). Which of the following is the most likely cause of this child’s presentation? (A) An X-linked inheritance of HLA genes (B) Defective T cell function (C) Selective IgA deficiency (D) Grossly reduced levels of B cells
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['(B) Defective T cell function <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 58-year-old woman presents to the physician for a routine gynecological visit. She denies any acute issues and remarks that she has not been sexually active for the past year. Her last Pap test was negative for any abnormal cytology. A pelvic examination and Pap test is performed at the current visit with no remarkable findings. Which of the following approaches to cervical cancer screening is most appropriate for this patient? (A) Colposcopy at the current visit to verify Pap test results (B) Colposcopy in 3 years (C) Pap test and HPV test in 5 years (D) Pap test only in 5 years
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['(C) Pap test and HPV test in 5 years <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 24-year-old man who is postoperative day 1 after an emergency appendectomy is evaluated by the team managing his care. He complains that he still has not been able to urinate after removal of the urinary catheter that was inserted during surgery. Given this issue, he is started on a medication that acts on a post-synaptic receptor and is resistant to a synaptic esterase. Which of the following is most likely another use of the medication that was administered in this case? (A) Diagnosis of myasthenia gravis (B) Glaucoma management (C) Neurogenic ileus (D) Pupillary contraction
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['(C) Neurogenic ileus <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 9-month-old girl is brought to the emergency department because of a 3-day history of fever, irritability, and discharge from her right ear. She had an episode of ear pain and fever three weeks ago. Her parents did not seek medical advice and the symptoms improved with symptomatic treatment. There is no family history of frequent infections. She appears ill. Her temperature is 39.3°C (102.7°F). Physical examination shows erythema and tenderness in the right postauricular region, and lateral and inferior displacement of the auricle. Otoscopy shows a bulging and cloudy tympanic membrane, with pus oozing out. The remainder of the examination shows no abnormalities. Laboratory studies show: Hemoglobin 11.5 g/dL Leukocyte count 15,800/mm3 Segmented neutrophils 80% Eosinophils 1% Lymphocytes 17% Monocytes 2% Platelet count 258,000/mm3 Which of the following is the most appropriate next step in management?" (A) Phenylephrine nasal drops therapy (B) CT scan of the temporal bone (C) Oral amoxicillin therapy (D) Oral aspirin therapy
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['(B) CT scan of the temporal bone <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 2-day old male newborn delivered vaginally at 36 weeks to a 29-year-old woman, gravida 3, para 2, has generalized convulsions lasting 2 minutes. Previous to the event, he had difficulty feeding and was lethargic. Pregnancy and delivery were uncomplicated. Apgar scores were 7 and 8 at 1 and 5 minutes, respectively. Pregnancy and delivery of the mother's first 2 children were also uncomplicated. Medications of the mother include folic acid and a multivitamin. The mother's immunizations are up-to-date. The infant appears icteric. His vital signs are within normal limits. The infant's weight and length are at the 5th percentile, and his head circumference at the 99th percentile for gestational age. There are several purpura of the skin. Ocular examination shows posterior uveitis. The patient does not pass his auditory screening tests. Cranial ultrasonography shows ventricular dilatation, as well as hyperechoic foci within the cortex, basal ganglia, and periventricular region. Which of the following is the most likely diagnosis? (A) Congenital toxoplasmosis (B) Congenital rubella infection (C) Congenital syphilis infection (D) Congenital varicella infection "
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['(A) Congenital toxoplasmosis <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 5-year-old boy is brought to the emergency room by his parents after slipping on a rug at home and experiencing exquisite pain and swelling of his arms. Radiographs reveal a new supracondylar fracture of the humerus, as well as indications of multiple, old fractures that have healed. His parents note that an inherited disorder is present in their family history. A comprehensive physical exam also reveals blue-tinted sclera and yellow-brown, discolored teeth. What is the etiology of the patient’s disorder? (A) Defect in the glycoprotein that forms a sheath around elastin (B) Defect in the hydroxylation step of collagen synthesis (C) Deficiency of type 1 collagen (D) Deficiency of type 5 collagen
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['(C) Deficiency of type 1 collagen <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 68-year-old man is brought to the emergency department 30 minutes after collapsing on the street. On arrival, he is obtunded. His pulse is 110/min and blood pressure is 250/120 mm Hg. A CT scan of the head shows an intracerebral hemorrhage involving bilateral thalamic nuclei and the third ventricle. Cortical detection of which of the following types of stimuli is most likely to remain unaffected in this patient? (A) Gustatory (B) Visual (C) Olfactory (D) Proprioception
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['(C) Olfactory <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 5-year-old boy with Down syndrome presents with his mother. The patient’s mother says that he isn’t playing or eating as much as he used to and seems lethargic. Expected developmental delays are present and stable. Physical examination reveals dry mucous membranes and abdominal distention with no tenderness to palpation. An abdominal radiograph is shown in the image below. Which of the following is the most likely diagnosis in this patient? (A) Pyloric stenosis (B) Ulcerative colitis (C) Incarcerated hernia (D) Hirschsprung's disease
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["(D) Hirschsprung's disease <> answer"]
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A scientist is working on creating synthetic hemoglobin that can be used to replace blood loss in humans. She therefore starts to study the behavior of this artificial hemoglobin in terms of its ability to bind oxygen. She begins by measuring the affinity between this synthetic hemoglobin and oxygen in a purified system before introducing modifications to this system. Specifically, she reduces the level of carbon dioxide in the system to mimic conditions within the lungs and plots an affinity curve. Which of the following should be observed in this artificial hemoglobin if it mimics the behavior of normal hemoglobin? (A) Left-shifted curve and decreased oxygen binding (B) Left-shifted curve and increased oxygen binding (C) No shift in the curve and increased oxygen binding (D) Right-shifted curve and decreased oxygen binding
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['(B) Left-shifted curve and increased oxygen binding <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** An 18-month-old boy is presented to the emergency department by his parents due to swelling in his right knee after playing in the park. His parents say there was no obvious injury. After questioning, the mother says that an uncle of hers had similar problems. The vital signs include heart rate 146/min, respiratory rate 26/min, temperature 37.1°C (98.8°F) and blood pressure 90/52 mm Hg. On physical examination, the swelling of the right knee is evident. The rest of the physical findings are unremarkable. The ultrasound is compatible with the hemarthrosis of the right knee. The complete blood count (CBC) results are as follows: Hemoglobin 12.2 g/dL Hematocrit 36% Leukocyte count 7,300/mm3 Neutrophils 45% Bands 3% Eosinophils 1% Basophils 0% Lymphocytes 44% Monocytes 2% Platelet count 200,000/mm³ The coagulation test results are as follows: Partial thromboplastin time (activated) 52.0 s Prothrombin time 14.0 s Reticulocyte count 1.2% Thrombin time < 2 seconds deviation from control What is the most likely diagnosis? (A) Marfan syndrome (B) Von Willebrand disease (C) Hemophilia A (D) Bernard-Soulier disease
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['(C) Hemophilia A <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** An autopsy of a 75-year-old man reveals obliterating endarteritis of the vasa vasorum of the aorta. Which of the following investigations will most likely be positive in this patient? (A) Increased double-stranded (ds) DNA titer (B) Increased ketonuria (C) Increased serum creatinine (D) Rapid plasma reagin (RPR)
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['(D) Rapid plasma reagin (RPR) <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A previously healthy 57-year-old man is brought to the emergency department because of a 3-day history of fever and headache. He also has nausea and vomited twice in the past 24 hours. His temperature is 39.1°C (102.4°F). He is lethargic but oriented to person, place, and time. Examination shows severe neck rigidity with limited active and passive range of motion. A lumbar puncture is performed; cerebrospinal fluid analysis shows a neutrophilic pleocytosis and a decreased glucose concentration. A Gram stain of the patient's cerebrospinal fluid is most likely to show which of the following? (A) Non-encapsulated, gram-negative cocci in pairs (B) Gram-positive cocci in clusters (C) Encapsulated, gram-positive cocci in pairs (D) Gram-positive bacilli
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['(C) Encapsulated, gram-positive cocci in pairs <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 67-year-old female is brought to the emergency room by her son for unusual behavior. She moved into her son’s house three years ago after her husband passed away. The son reports that when he returned home from work earlier in the day, he found his mother minimally responsive. She regained consciousness soon after his arrival and did not recall the event. The son also reports that for the past two years, his mother has had trouble remembering names and addresses. She still goes shopping on her own and cooks regularly. Her past medical history is notable for major depressive disorder, diabetes mellitus, and hypertension. She takes clomipramine, glyburide, lisinopril, and hydrochlorothiazide. She recently saw her primary care provider who adjusted some of her medication dosages. Her temperature is 99°F (37.2°C), blood pressure is 135/75 mmHg, pulse is 80/min, and respirations are 18/min. On examination, she is easily distractible with disorganized speech. She does not recognize her son and thinks that her intravenous line is a rope. She says she feels fine and would like to go home. Brain imaging would likely reveal which of the following? (A) Normal cerebrum (B) Focal atrophy of the frontal and temporal cortices (C) Mesial temporal lobe atrophy (D) Caudate nucleus atrophy
|
['(A) Normal cerebrum <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 5-year-old girl is brought to the hospital by her parents with a persistent fever of 41°C (105.8°F), which is not relieved by tylenol. Her birth history is unremarkable. On general examination, the child is agitated and looks ill. Her heart rate is 120/min and the respiratory rate is 22/min. The parents told the physician that she developed a rash, which started on her trunk and now is present everywhere, including the palms and soles. Her feet and hands are swollen. The pharynx is hyperemic, as shown in the picture. Generalized edema with non-palpable cervical lymphadenopathy is noted. The muscle tone is normal. The chest and heart examinations are also normal. No hepatosplenomegaly was noted. Laboratory test results are as follows: Hb, 9 gm/dL; RBC, 3.3/mm3; neutrophilic leukocytosis 28,000/mm3, normal platelet count of 200,000/mm3, increased ɣ-GT, hyperbilirubinemia, 2.98 mg/dL; hypoalbuminemia; AST and ALT are normal; markedly increased CRP; ANA, p-ANCA, and c-ANCA, negative; and rheumatoid factor, negative. Which of the following tests should be obtained due to its mortality benefit? (A) Rapid direct fluorescent antigen testing (B) Tzanck smear (C) Coronary angiography (D) Echocardiography
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['(D) Echocardiography <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A researcher is studying how arachidonic acid metabolites mediate the inflammatory response in rats. She has developed multiple enzyme inhibitors that specifically target individual proteins in the arachidonic acid pathway. She injects these inhibitors in rats who have been exposed to common bacterial pathogens and analyzes their downstream effects. In one of her experiments, she injects a leukotriene B4 inhibitor into a rat and observes an abnormal cell response. Which of the following interleukins would most closely restore the function of one of the missing products? (A) Interleukin 1 (B) Interleukin 4 (C) Interleukin 5 (D) Interleukin 8
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['(D) Interleukin 8 <> answer']
|
The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 38-year-old woman with a history of Crohn’s disease presents with a 3-week history of weight gain. The patient also presents with a 1-month history of abdominal pain, cramping, and bloody diarrhea consistent with worsening of her inflammatory bowel disease. Past medical history is significant for Crohn’s disease diagnosed 2 years ago for which she currently takes an oral medication daily and intermittently receives intravenous medication she cannot recall the name of. Her temperature is 37.0°C (98.6°F), blood pressure is 120/90 mm Hg, pulse is 68/min, respiratory rate is 14/min, and oxygen saturation is 99% on room air. Physical examination reveals significant truncal weight gain. The patient has excessive facial hair in addition to purplish striae on her abdomen. Which of the following laboratory findings would most likely be found in this patient? (A) Hyperkalemia (B) Normal random blood glucose levels (C) Metabolic acidosis (D) Hypokalemia
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['(D) Hypokalemia <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 67-year-old woman comes to the physician because of a 9-month history of progressive fatigue. Examination shows pallor. Her hemoglobin concentration is 8.9 g/dL, mean corpuscular volume is 75 μm3, and serum ferritin is 9 ng/mL. Test of the stool for occult blood is positive. Colonoscopy shows an irregular, bleeding 3-cm exophytic ulcer in the right colon. Which of the following lesions is the greatest risk factor for this patient's condition? (A) Submucosal lipomatous polyp (B) Serrated hyperplastic polyp (C) Villous adenomatous polyp (D) Tubular adenomatous polyp
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['(C) Villous adenomatous polyp <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 71-year-old man arrives to the emergency room appearing cyanotic and having weak, shallow respirations. He is brought in by his home care nurse, who reports that the patient has a history of myasthenia gravis and frequent urinary tract infections. The patient was in his normal state of health until 5 days ago when he developed a urinary tract infection. He was prescribed gentamicin with improvement of his urinary symptoms. This morning, while trying to eat breakfast, he began complaining of poor grip strength and progressive difficulty breathing. The patient’s medications include pyridostigmine and aspirin, both of which his nurse reports he takes every day as prescribed. The patient’s temperature is 99°F (37.2°C), blood pressure is 128/78 mmHg, pulse is 92/min, and respirations are 28/min with an oxygen saturation of 86% O2 on room air. Upon physical exam, the patient is noted to have gray-blue skin, hypophonia, weak upper extremities, and normal leg strength. An arterial blood gas is drawn with results as shown below: PO2: 55 mmHg PCO2: 60 mmHg pH: 7.30 The patient is intubated. Which of the following is the next best step in management? (A) Atropine (B) Edrophonium (C) Plasmapheresis (D) Thymectomy
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['(C) Plasmapheresis <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 53-year-old woman presents for a follow-up. She took some blood tests recently for her yearly physical, and her random blood sugar level was found to be 251 mg/dL. She was asked to repeat her blood sugar and come back with the new reports. At that time, her fasting blood sugar level was 130 mg/dL and the postprandial glucose level was 245 mg/dL. Her HbA1c is 8.9%. She has had occasions where she felt light-headed and felt better only after she had something to eat. Her physician starts her on a drug to help her control her sugar levels. He also advised that she should get her liver enzymes checked with a repeat HbA1c in 3 months. Which of the following is the mechanism of action of the drug that she was most likely prescribed? (A) Stimulates the release of insulin from the pancreas. (B) Increases the uptake of glucose and reduces peripheral insulin resistance. (C) Acts as an agonist at the peroxisome proliferator-activated receptor-Ƴ. (D) Inhibit alpha-glucosidase in the intestines.
|
['(C) Acts as an agonist at the peroxisome proliferator-activated receptor-Ƴ. <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 35-year-old male presents to his primary care physician with complaints of seasonal allergies. He has been using intranasal vasoconstrictors several times per day for several weeks. What is a likely sequela of the chronic use of topical nasal decongestants? (A) Epistaxis (B) Permanent loss of smell (C) Persistent nasal crusting (D) Persistent congestion
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['(D) Persistent congestion <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 30-year-old woman, gravida 2, para 1, at 12 weeks' gestation comes to the physician for a prenatal visit. She feels well. Pregnancy and vaginal delivery of her first child were uncomplicated. Five years ago, she was diagnosed with hypertension but reports that she has been noncompliant with her hypertension regimen. The patient does not smoke or drink alcohol. She does not use illicit drugs. Medications include methyldopa, folic acid, and a multivitamin. Her temperature is 37°C (98.6°F), pulse is 80/min, and blood pressure is 145/90 mm Hg. Physical examination shows no abnormalities. Laboratory studies, including serum glucose level, and thyroid-stimulating hormone concentration, are within normal limits. The patient is at increased risk of developing which of the following complications? (A) Spontaneous abortion (B) Polyhydramnios (C) Abruptio placentae (D) Placenta previa
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['(C) Abruptio placentae <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 57-year-old female presents to her primary care physician with a chief complaint of feeling tired all the time. She states her symptoms began several months ago, around the time that her husband committed suicide. Since then she has had thoughts of joining her husband. She complains of feeling excessively weak and states that she no longer has enough energy to go to the gym which she attributes to her 15 pound weight gain over the last month. The patient's medical history includes joint pain, a skin rash that recently resolved, obstructive sleep apnea, and metabolic syndrome. The patient takes ibuprofen and omeprazole as needed but otherwise cannot remember any other medications that she takes. On physical exam you note an overweight woman who has an overall depressed affect. The patient's cardiac exam reveals a normal rate and rhythm. The pulmonary exam reveals bilateral clear lung fields with good air movement. The patient's skin is very dry and tight appearing and her hair is coarse. Overall the patient appears somewhat unkempt. Laboratory work is performed and reveals the following: Hemoglobin: 13.0 g/dL Hematocrit: 37% Leukocyte count: 4,500 cells/mm^3 with normal differential Platelets: 250,000/mm^3 Serum: Na+: 140 mEq/L K+: 4.4 mEq/L Cl-: 102 mEq/L BUN: 15 mg/dL Glucose: 122 mg/dL Creatinine: 1.0 mg/dL Thyroid-stimulating hormone: 5.3 µU/mL Ca2+: 10.2 mg/dL AST: 11 U/L ALT: 13 U/L Which of the following laboratory findings is most likely to be abnormal in this patient? (A) Anti-DNA topoisomerase antibodies (B) Anti-nuclear antibodies (C) Anti-histidyl-tRNA synthetase antibodies (D) Anti-thyroid peroxidase antibodies
|
['(D) Anti-thyroid peroxidase antibodies <> answer']
|
The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 55-year-old man presents to the emergency department with a 3-week history of shortness of breath. It started as exertional only, but progressed and is now present at rest. He says it's worse when he lies down; he has had a couple of episodes of waking up because of this shortness of breath with a choking sensation. He has not had any fever, cough, wheezing, or chest pain, but has noticed new swelling in his legs that has never happened before. He has also noticed that his hands and feet feel ‘weird’. Past medical history is unremarkable and social history is notable for drinking 4 vodka beverages per night for "as long as I can remember." On physical exam, his lungs have crackles up to the mid-lung fields. His bilateral lower extremities have 2+ pitting edema up to the mid-calf and he has jugular venous distension up to the angle of mandible. His bilateral hands and feet have sensory loss to pinprick and light touch with 4/5 strength on handgrip, wrist flexion and extension, ankle plantar flexion, and ankle dorsiflexion. This patient's presentation is most likely related to which of the following micronutrients? (A) Vitamin B1 (B) Vitamin B2 (C) Vitamin B3 (D) Vitamin B12
|
['(A) Vitamin B1 <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** After receiving a positive newborn screening result, a 2-week-old male infant is brought to the pediatrician for a diagnostic sweat test. The results demonstrated chloride levels of 65 mmol/L (nl < 29 mmol/L). Subsequent DNA sequencing revealed a 3 base pair deletion in a transmembrane cAMP-activated ion channel known to result in protein instability and early degradation. The physician discusses with the parents that the infant will develop respiratory infections due to improper mucus clearance and reviews various mucolytic agents, such as one that cleaves disulfide bonds between mucus glycoproteins thereby loosening the mucus plug. This mucolytic can also be used as a treatment for which of the following overdoses? (A) Opioids (B) Acetaminophen (C) Cyanide (D) Benzodiazepines
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['(B) Acetaminophen <> answer']
|
The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 6-year-old boy is brought to the physician by his mother who is concerned about his early sexual development. He has no history of serious illness and takes no medications. He is at the 99th percentile for height and 70th percentile for weight. His blood pressure is 115/78 mm Hg. Examination shows greasy facial skin and cystic acne on his forehead and back. There is coarse axillary and pubic hair. Serum studies show: Cortisol (0800 h) 4 μg/dL Deoxycorticosterone 2.5 ng/dL (N = 3.5–11.5) Dehydroepiandrosterone sulfate 468 mcg/dL (N = 29–412) Which of the following is the most likely underlying cause of this patient's symptoms?" (A) Deficiency of 21β-hydroxylase (B) Idiopathic overproduction of GnRH (C) Deficiency of 17α-hydroxylase (D) Deficiency of 11β-hydroxylase
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['(A) Deficiency of 21β-hydroxylase <> answer']
|
The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 29-year-old male is brought to the emergency department 20 minutes after sustaining a stab wound to the right chest. First-responders found the patient sitting on the curb smoking a cigarette, complaining of pain where he had been stabbed. On arrival, he is alert. His temperature is 36.8°C (98.2°F), pulse is 110/min, respirations are 16/min, and blood pressure is 112/70 mmHg. Pulse oximetry on room air shows an oxygen saturation of 97%. Examination shows several 1–2 cm lacerations and ecchymoses over the face and trunk. There is no neck crepitus. There is a pocket knife in the right fourth intercostal space at the anterior axillary line and blood oozing out of the wound. There is no bubbling of the blood at the wound. The lungs are clear to auscultation with equal breath sounds. The remainder of the examination shows no abnormalities. A chest x-ray shows the knife in situ extending into the right thorax. Which of the following is the most appropriate next step in management? (A) Right needle thoracostomy (B) Endotracheal intubation (C) Cricothyroiditomy (D) CT scan of the chest
|
['(B) Endotracheal intubation <> answer']
|
The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 45-year-old man comes to the physician because of fatigue and joint pain for 8 months. He has pain in both knees, both elbows, and diffuse muscle pain. He does not have dyspnea. He also had several episodes of a nonpruritic rash on his lower extremities. Eight years ago, the patient was diagnosed with hepatitis C. His temperature is 37.9°C (100.2°F), pulse is 90/min, and blood pressure is 140/90 mm Hg. Examination of the lower extremities shows raised purple papules that do not blanch when pressure is applied. Cardiopulmonary examination shows no abnormalities. Laboratory studies show: Hemoglobin 13.9 g/dL Leukocyte count 8,500/mm3 Platelets 160,000/mm3 Serum Creatinine 1.1 mg/dL ALT 123 U/L AST 113 U/L Further evaluation of this patient is most likely to show which of the following findings?" (A) Elevated perinuclear anti-neutrophil cytoplasmic antibodies (B) Elevated IgA in serum (C) Positive pathergy test (D) Hypocomplementemia
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['(D) Hypocomplementemia <> answer']
|
The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 56-year-old man presents with constipation and trouble urinating for the past day. He says that he tried drinking a lot of water but that did not help. He also says that he has been tired all the time recently. Past medical history is significant for schizophrenia, diagnosed 3 months ago, and being managed on antipsychotic medication. Current medications also include sildenafil. The vital signs include blood pressure 80/45 mm Hg, respiratory rate 23/min, heart rate 86/min and temperature 38.7°C (101.7°F). On physical examination, the patient appears agitated and confused. Which of the following medications is the most likely cause of this patient’s presentation? (A) Haloperidol (B) Ziprasidone (C) Aripiprazole (D) Chlorpromazine
|
['(D) Chlorpromazine <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 27-year-old man presents to the emergency department with painless yellowing of his skin. The patient states he is generally healthy and has no past medical history. He smokes 2 packs of cigarettes per day and was recently treated for a urinary tract infection with a single dose of ceftriaxone followed by a 7 day course of ciprofloxacin. He recently returned from a 3 day hiking trip and is an avid vegan. His only other medical history is a mild cough for the past few days. His temperature is 97.5°F (36.4°C), blood pressure is 122/82 mmHg, pulse is 85/min, respirations are 15/min, and oxygen saturation is 98% on room air. Physical exam reveals an abdomen which is non-tender. Mild scleral icterus and sublingual jaundice is noted. Which of the following is the most likely etiology of this patient’s symptoms? (A) Ceftriaxone administration (B) Crigler-Najjar syndrome (C) Gilbert syndrome (D) Pancreatic cancer
|
['(C) Gilbert syndrome <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 58-year old man comes to the emergency department because of progressively worsening shortness of breath and fatigue for 3 days. During the last month, he has also noticed dark colored urine. One month ago, he underwent mechanical aortic valve replacement for high-grade aortic stenosis. A photomicrograph of a peripheral blood smear from the patient is shown. Which of the following findings is most likely to be seen in this patient? (A) Low unconjugated bilirubin (B) Elevated lactate dehydrogenase (C) Low platelets (D) Elevated haptoglobin
|
['(B) Elevated lactate dehydrogenase <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 27-year-old female presents to her primary care physician because she is concerned about lighter colored patches on her skin. She recently went sunbathing and noticed that these areas also did not tan. Her doctor explains that she has a fungal infection of the skin that damages melanocytes by producing acids. She is prescribed selenium sulfide and told to follow-up in one month. Which of the following describes the appearance of the most likely infectious organism under microscopy? (A) Branching septate hyphae (B) Broad based budding yeast (C) Germ tube forming fungus (D) "Spaghetti and meatballs" fungus
|
['(D) "Spaghetti and meatballs" fungus <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 35-year-old man presents to the primary care office with a recent history of frequent falls. He had been able to walk normally until about a year ago when he started noticing that both of his legs felt weak. He's also had some trouble with feeling in his feet. These 2 problems have caused multiple falls over the last year. On physical exam, he has notable leg and foot muscular atrophy and 4/5 strength throughout his bilateral lower extremities. Sensation to light touch and pinprick is absent up to the mid-calf. Ankle jerk reflex is absent bilaterally. A photo of the patient's foot is shown. Which of the following best describes the etiology of this patient's condition? (A) Autoimmune (B) Genetic (C) Infectious (D) Metabolic
|
['(B) Genetic <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 43-year-old woman comes to the physician because of a 3-month history of increased flow and duration of her menses. Menses previously occurred at regular 28-day intervals and lasted 5 days with normal flow. They now last 8–9 days and the flow is heavy with the passage of clots. During this period, she has also had lower abdominal pain that begins 2–3 days prior to onset of her menses and lasts for 2 days after the end of her menses. She has three children. Her mother died of endometrial cancer at the age of 61 years. Her temperature is 37°C (98.6°F), pulse is 86/min, and blood pressure is 110/70 mm Hg. Pelvic examination shows a uniformly enlarged, boggy uterus consistent in size with an 8-week gestation that is tender on palpation. A urine pregnancy test is negative. Which of the following is the most likely cause of this patient's findings? (A) Benign tumor of the myometrium (B) Endometrial tissue within the uterine wall (C) Abnormal thickening of endometrial tissue (D) Inflammation of the endometrium
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['(B) Endometrial tissue within the uterine wall <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 54-year-old woman comes to the physician because she has not had her menstrual period for the last 5 months. Menarche occurred at the age of 11 years, and menses occurred at regular 28-day intervals until they became irregular at 30- to 45-day intervals with light flow 2 years ago. She does not have vaginal dryness or decreased libido. She had four successful pregnancies and breastfed all her children until the age of 2 years. There is no personal or family history of serious illness. Except when she was pregnant, she has smoked one pack of cigarettes daily for 30 years. She does not drink alcohol. She is 167 cm (5 ft 5 in) tall and weighs 92 kg (203 lb); BMI is 33 kg/m2. Her vital signs are within normal limits. Physical examination shows no abnormalities. Which of the following best explains this patient's lack of symptoms other than amenorrhea? (A) Breastfeeding (B) Obesity (C) Smoking (D) Multiparity
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['(B) Obesity <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 60-year-old man comes to the physician for a routine health maintenance examination. He feels well. Five years ago, he underwent a colonoscopy, which was unremarkable. He has no history of serious illness except for an episode of poststreptococcal glomerulonephritis at the age of 10 years. His father died of bladder carcinoma at the age of 55 years. The patient works at a rubber factory. He has smoked one pack of cigarettes daily for the past 25 years. He drinks 1–2 cans of beer per day. He takes no medications. He has never received any pneumococcal vaccination. His temperature is 37°C (98.6°F), pulse is 70/min, and blood pressure is 120/80 mm Hg. Digital rectal examination shows mild symmetrical enlargement of the prostate with no masses. Which of the following is the most appropriate next step in management? (A) Discuss PSA assessment with patient (B) Administer pneumococcal conjugate vaccination (C) Obtain CT urography (D) Obtain renal ultrasound
|
['(A) Discuss PSA assessment with patient <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 62-year-old man comes to the physician because of a swollen and painful right knee for the last 3 days. He has no history of joint disease. His vital signs are within normal limits. Examination shows erythema and swelling of the right knee, with limited range of motion due to pain. Arthrocentesis of the right knee joint yields 7 mL of cloudy fluid with a leukocyte count of 29,000/mm3 (97% segmented neutrophils). Compensated polarized light microscopy of the aspirate is shown. Which of the following is the most likely underlying mechanism of this patient's knee pain? (A) Calcium pyrophosphate deposition (B) Mechanical stress and trauma (C) Immune complex-mediated cartilage destruction (D) Monosodium urate deposition
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['(A) Calcium pyrophosphate deposition <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 55-year-old woman sees her family doctor for a follow-up appointment to discuss her imaging studies. She previously presented with chest pain and shortness of breath for the past 2 months. Her CT scan shows a 3.5 cm mass in the lower lobe of her right lung. The mass has irregular borders. Saddle/hilar lymph nodes are enlarged. No distant metastases are identified with PET imaging. The patient has been a smoker for over 35 years (1.5 packs per day), but she has recently quit. This patient is referred to the Pulmonary Diseases Center. What is the most effective step in appropriately managing her case? (A) Tissue biopsy (B) Sputum cytology (C) CT scan in 3 months (D) Paclitaxel
|
['(A) Tissue biopsy <> answer']
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