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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 31-year-old woman, gravida 2, para 1, at 32 weeks' gestation comes to the emergency department for sudden leakage of clear vaginal fluid. Her pregnancy has been uncomplicated. Her first child was born at term by vaginal delivery. She has no history of serious illness. She does not drink alcohol or smoke cigarettes. Current medications include vitamin supplements. Her temperature is 37.2°C (98.9°F), pulse is 70/min, respirations are 18/min, and blood pressure is 128/82 mm Hg. Speculum examination demonstrates clear fluid in the cervical canal. The fetal heart rate is reactive at 160/min with no decelerations. Tocometry shows uterine contractions. Nitrazine testing is positive. She is started on indomethacin. Which of the following is the most appropriate next step in management? (A) Administer betamethasone, ampicillin, and proceed with cesarean section (B) Administer ampicillin and perform amnioinfusion (C) Administer betamethasone and ampicillin (D) Administer betamethasone, ampicillin, and proceed with induction of labor
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['(C) Administer betamethasone and ampicillin <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 67-year-old man presents to his family physician’s office for a routine visit and to discuss a growth on his toenail that has been gradually enlarging for a month. He has a history of diabetes mellitus, hyperlipidemia, and hypertension and is on metformin, atorvastatin, and lisinopril. He admits to smoking 2 packs of cigarettes daily for the past 45 years. His blood pressure reading today is 132/88 mm Hg, heart rate is 78/min, respiration rate is 12/min and his temperature is 37.1°C (98.8°F). On exam, the patient appears alert and in no apparent distress. Capillary refill is 3 seconds. Diminished dull and sharp sensations are present bilaterally in the lower extremities distal to the mid-tibial region. An image of the patient’s toenail is provided. A potassium hydroxide (KOH) preparation of a nail clipping sample confirms the presence of hyphae. Which of the following treatment options will be most effective for this condition? (A) Terbinafine (B) Betamethasone + vitamin D analog (C) Fluconazole (D) Griseofulvin
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['(A) Terbinafine <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 44-year-old woman comes to the emergency department after waking up with facial swelling and with difficulties speaking and swallowing. She states that she does not have allergies or recently had insect bites. She has a 4-year history of hypertension and type 2 diabetes mellitus controlled with medication. Her pulse is 110/min, respirations are 20/min, and blood pressure is 140/90 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 97%. On physical exam, she appears uncomfortable, with notable swelling of the lips and tongue. The remainder of the examination shows no abnormalities. Serum C4 levels are within normal limits. Which of the following is the most likely underlying mechanism of this patient's symptoms? (A) Type 2 hypersensitivity reaction (B) Anaphylactoid reaction (C) Immune-complex deposition (D) Impaired bradykinin metabolism
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['(D) Impaired bradykinin metabolism <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 45-year-old man comes to the physician because of intermittent lower back pain for 1 week. His symptoms began shortly after lifting heavy boxes at work. He has not had any fever, chills, or weight loss. He has a history of peptic ulcer disease. He does not smoke or drink alcohol. His vital signs are within normal limits. Examination shows mild paraspinal lumbar tenderness. Neurologic examination shows no focal findings. An x-ray of the spine shows no abnormalities. Which of the following is the most appropriate initial pharmacotherapy? (A) Acetaminophen (B) Oxycodone (C) Naproxen (D) Ibuprofen
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['(A) Acetaminophen <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 32-year-old primigravid woman with a history of seizures comes to the physician because she had a positive pregnancy test at home. Medications include valproic acid and a multivitamin. Physical examination shows no abnormalities. A urine pregnancy test is positive. Her baby is at increased risk for requiring which of the following interventions? (A) Lower spinal surgery (B) Kidney transplanation (C) Respiratory support (D) Arm surgery
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['(A) Lower spinal surgery <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 56-year-old woman is referred to a plastic surgeon for breast reconstruction approximately 18 months after undergoing right modified radical mastectomy for breast cancer. Physical exam demonstrates atrophy of the lower lateral pectoralis major muscle. Damage to which of the following nerves during mastectomy is the most likely cause of her atrophy? (A) Long thoracic (B) Intercostobrachial (C) Medial pectoral (D) Lateral pectoral
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['(C) Medial pectoral <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 22-year-old male college student volunteers for a research study involving renal function. He undergoes several laboratory tests, the results of which are below: Urine Serum Glucose 0 mg/dL 93 mg/dL Inulin 100 mg/dL 1.0 mg/dL Para-aminohippurate (PAH) 150 mg/dL 0.2 mg/dL Hematocrit 50% Urine flow rate 1 mL/min What is the estimated renal blood flow? (A) 200 mL/min (B) 1,500 mL/min (C) 750 ml/min (D) 3,000 mL/min
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['(B) 1,500 mL/min <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 35-year-old female presents to her PCP at the request of her husband after 3 weeks of erratic behavior. The patient has been staying up all night online shopping on eBay. Despite a lack of sleep, she is "full of energy" during the day at her teaching job, which she believes is "beneath [her], anyway." She has not sought psychiatric treatment in the past, but reports an episode of self-diagnosed depression 2 years ago. The patient denies thoughts of suicide. Pregnancy test is negative. Which of the following is the best initial treatment? (A) Valproate and venlafaxine (B) Valproate and olanzapine (C) Haloperidol (D) Electroconvulsive therapy
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['(B) Valproate and olanzapine <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 70-year-old male comes to the emergency department complaining of severe back pain. The pain started 20 minutes ago when he was sitting and watching TV. He describes the pain as intense, epigastric, and radiating to his back. His vitals on presentation to the emergency department are blood pressure is 150/75 mmHg, pulse is 110/min, and respirations are 24/min with an oxygen saturation of 98% on room air. His body mass index is 35 kg/m^2 and he appears pale and in visible pain. On abdominal exam, his abdomen is tender and a pulsatile mass is felt in the midline during deep palpation. His past medical history includes diabetes, hypertension well-controlled on medications, and a history of benign prostatic hyperplasia. His social history is notable for consuming 2-3 beers per night and a smoking history of ½ pack per day. Which of the following is considered the greastest risk factor for this patient’s condition? (A) Obesity (B) Smoking (C) Diabetes (D) Alcohol consumption
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['(B) Smoking <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 31-year-old man and his wife were referred to a genetic counselor. They are concerned about the chance that their children are likely to inherit certain conditions that run in their families. The wife’s father and grandfather are both healthy, but her grandfather can not see the color red. The husband is unaware if any member of his family has the same condition. The geneticist provides some details about genetic diseases and inheritance patterns, then orders lab tests to analyze the gene mutations carried by both partners. Which of the following are the correct terms regarding the genotype and phenotype of males affected by the condition described? (A) Heterozygotes; reduced or incomplete penetrance (B) Hemizygous; reduced or incomplete penetrance (C) Heterozygotes; full penetrance (D) Hemizygous; full penetrance
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['(D) Hemizygous; full penetrance <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 2-month-old boy is brought to the emergency room by his mother who reports he has appeared lethargic for the past 3 hours. She reports that she left the patient with a new nanny this morning, and he was behaving normally. When she got home in the afternoon, the patient seemed lethargic and would not breastfeed as usual. At birth, the child had an Apgar score of 8/9 and weighed 2.8 kg (6.1 lb). Growth has been in the 90th percentile, and the patient has been meeting all developmental milestones. There is no significant past medical history, and vaccinations are up-to-date. On physical examination, the patient does not seem arousable. Ophthalmologic examination shows retinal hemorrhages. Which of the following findings would most likely be expected on a noncontrast CT scan of the head? (A) Crescent-shaped hematoma (B) Lens-shaped hematoma (C) Blood in the basal cisterns (D) Multiple cortical and subcortical infarcts
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['(A) Crescent-shaped hematoma <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 10-month-old girl is brought to the physician because of a 4-day history of irritability and a rash. Her temperature is 37.7°C (99.9°F). Examination of the skin shows flaccid, transparent blisters and brown crusts on her chest and upper extremities. Application of a shear force to normal skin causes sloughing. Which of the following is the most likely underlying cause of this patient's condition? (A) Exfoliative toxin A release (B) Streptococcus pyogenes infection (C) Uroporphyrin accumulation (D) Anti-hemidesmosome antibody formation
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['(A) Exfoliative toxin A release <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 37-year-old man comes to the emergency department with his wife because of a 3-day history of severe pain in his right arm. He also reports that he cannot move his right arm. The symptoms began after the patient woke up one morning, having slept on his side. He is otherwise healthy. He works as a waiter and says that he feels exhausted from working several night shifts per week. He adds that he “can barely keep his eyes open” when looking after their daughter the next day. Since the onset of the pain, he has been unable to work and is fully dependent on his wife, who took an extra shift to make enough money to pay their monthly bills. The patient appears relaxed but only allows himself to be examined after his wife convinces him. His vital signs are within normal limits. Examination shows 1/5 muscle strength in the right arm. Reflexes are normal. He has no sensation to light touch over the entire right arm and forearm. When a pin prick test is conducted, the patient rapidly withdraws the right arm. Which of the following is the most likely diagnosis? (A) Brachial neuritis (B) Factitious disorder (C) Malingering (D) Radial nerve palsy
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['(C) Malingering <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 30-year-old man is brought into the emergency room for complaints of acute onset chest pain and shortness of breath. He has a history of mental retardation and lives at home with his adoptive parents. His parents inform you that he has not seen a doctor since he was adopted as child and that he currently takes no medications. The patient’s temperature is 99.1°F (37.3°C),pulse is 108/min, blood pressure is 125/70 mmHg, respirations are 25/min, and oxygen saturation is 92% on 2L nasal canula. Physical exam is notable for a tall, thin individual with high-arched feet and mild pectus excavatum. There is mild asymmetry in the lower extremities with discomfort to dorsiflexion of the larger leg. Lung auscultation reveals no abnormalities. What is the next step in the diagnosis of this patient’s underlying disorder? (A) Chest radiograph (B) Angiogram (C) Electrocardiogram (D) Serum blood test
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['(D) Serum blood test <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 24-year-old male presents to the emergency room with a cough and shortness of breath for the past 3 weeks. You diagnose Pneumocystis jiroveci pneumonia (PCP). An assay of the patient's serum reveals the presence of viral protein p24. Which of the following viral genes codes for this protein? (A) gag (B) env (C) tat (D) rev
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['(A) gag <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** An 82-year-old right-handed woman is brought in by ambulance after being found down in her home. On presentation, she is found to be awake but does not follow directions or respond to questions. She is able to speak and produces a fluent string of nonsensical words and sounds. She does not appear to be bothered by her deficits. Subsequent neurologic exam finds that the patient is unable to comprehend any instructions and is also unable to repeat phrases. CT scan reveals an acute stroke to her left hemisphere. Damage to which of the following structures would be most likely to result in this pattern of deficits? (A) Inferior frontal gyrus (B) Precentral gyrus (C) Superior temporal gyrus (D) Watershed zone
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['(C) Superior temporal gyrus <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** An 80-year-old man comes to the office for evaluation of anemia. His medical history is relevant for end-stage renal disease and aortic stenosis. When questioned about his bowel movements, the patient mentions that he has occasional episodes of loose, black, tarry stools. His heart rate is 78/min, respiratory rate is 17/min, temperature is 36.6°C (97.8°F), and blood pressure is 80/60 mm Hg. Physical examination shows pale skin and conjunctiva and orthostasis upon standing. A complete blood count shows his hemoglobin is 8.7 g/dL, hematocrit is 27%, and mean corpuscular volume is 76 μm3. A colonoscopy is obtained. Which of the following is the most likely cause of this patient’s current condition? (A) Angiodysplasia (B) Ischemic colitis (C) Portal hypertension (D) Colonic polyps
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['(A) Angiodysplasia <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** The success of a new treatment designed to deter people from smoking was evaluated by a team of researchers. However, the heaviest and most committed smokers in the study group were less interested in quitting and subsequently dropped out of the study. Nonetheless, the researchers continued with their research (disregarding those who dropped out), which resulted in a false conclusion that the treatment was more successful than the results would have shown under ideal study conditions. The smokers who were confirmed as quitters were actually the ones who were more interested in giving up smoking, which is why they remained in the study. Which of the following is the bias that invalidates the researchers’ conclusion in this example? (A) Ascertainment bias (B) Exclusion bias (C) Detection bias (D) Attrition bias
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['(D) Attrition bias <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 52-year-old man comes to the physician because of right shoulder pain that began after he repainted his house 1 week ago. Physical examination shows right subacromial tenderness. The pain is reproduced when the patient is asked to abduct the shoulder against resistance with the arm flexed forward by 30° and the thumb pointing downwards. The tendon of which of the following muscles is most likely to be injured in this patient? (A) Supraspinatus (B) Infraspinatus (C) Teres minor (D) Deltoid
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['(A) Supraspinatus <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 52-year-old man presents to his primary care physician for generalized pain. The patient states that he feels like his muscles and bones are in constant pain. This has persisted for the past several weeks, and his symptoms have not improved with use of ibuprofen or acetaminophen. The patient has a past medical history of alcohol abuse, repeat episodes of pancreatitis, constipation, and anxiety. He has a 22 pack-year smoking history. His temperature is 99.5°F (37.5°C), blood pressure is 140/95 mmHg, pulse is 70/min, respirations are 15/min, and oxygen saturation is 99% on room air. On physical exam, you note generalized tenderness/pain of the patient's extremities. Abdominal exam reveals normoactive bowel sounds and is non-tender. Dermatologic exam is unremarkable. Laboratory values are ordered as seen below. Hemoglobin: 12 g/dL Hematocrit: 36% Leukocyte count: 7,500/mm^3 with normal differential Platelet count: 147,000/mm^3 Serum: Na+: 138 mEq/L Cl-: 100 mEq/L K+: 4.2 mEq/L HCO3-: 24 mEq/L BUN: 20 mg/dL Glucose: 99 mg/dL Creatinine: 1.0 mg/dL Ca2+: 10.2 mg/dL Alkaline phosphatase: 252 U/L Lipase: 30 U/L AST: 12 U/L ALT: 10 U/L Which of the following is associated with this patient's condition? (A) Hearing loss (B) Bence Jones proteins (C) Hypercalcemia (D) Obstructive jaundice
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['(A) Hearing loss <> 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 after 2 days of severe diffuse abdominal pain, nausea, vomiting, and lack of bowel movements, which has led him to stop eating. He has a history of type-2 diabetes mellitus, hypertension, and chronic pulmonary obstructive disease. Upon admission, his vital signs are within normal limits and physical examination shows diffuse abdominal tenderness, distention, lack of bowel sounds, and an empty rectal ampulla. After initial fluid therapy and correction of moderate hypokalemia, the patient’s condition shows mild improvement. His abdominal plain film is taken and shown. Which of the following is the most appropriate concomitant approach? (A) Initiate pain management with morphine (B) Nasogastric decompression (C) Exploratory surgery (D) Gastrografin enema
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['(B) Nasogastric decompression <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 60-year-old Caucasian man is brought to the emergency department by his roommate after he reportedly ingested a bottle of Tylenol. He reports being suddenly sad and very lonely and impulsively overdosed on some pills that he had laying around. He then immediately induced vomiting and regurgitated most of the pills back up and rushed to his roommate for help. The patient has a past medical history significant for hypertension and diabetes. He takes chlorthalidone, methadone, and glimepiride regularly. He lives in a room alone with no family and mostly keeps to himself. The patient’s vital signs are normal. Physical examination is unremarkable. The patient says that he still enjoys his life and regrets trying to overdose on the pills. He says that he will probably be fine for the next few days but has another bottle of pills he can take if he starts to feel sad again. Which of the following is the best predictor of this patient attempting to commit suicide again in the future? (A) He has a previous attempt (B) He has a plan (C) His race (D) His lack of social support
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['(A) He has a previous attempt <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 56-year-old woman presents to the emergency department with an episode of nausea and severe unrelenting right upper abdominal pain. She had a cholecystectomy for gallstones a year earlier and has since experienced frequent recurrences of abdominal pain, most often after a meal. Her past medical history is otherwise unremarkable and she only takes medications for her pain when it becomes intolerable. Her physical exam is normal except for an intense abdominal pain upon deep palpation of her right upper quadrant. Her laboratory values are unremarkable with the exception of a mildly elevated alkaline phosphatase, amylase, and lipase. Her abdominal ultrasound shows a slightly enlarged common bile duct at 8 mm in diameter (N = up to 6 mm) and a normal pancreatic duct. The patient is referred to a gastroenterology service for an ERCP (endoscopic retrograde cholangiopancreatography) to stent her common bile duct. During the procedure the sphincter at the entrance to the duct is constricted. Which statement best describes the regulation of the function of the sphincter which is hampering the cannulation of the pancreatic duct in this patient? (A) A hormone released by the I cells of the duodenum in the presence of fatty acids is the most effective cause of relaxation. (B) The sphincter is contracted between meals. (C) Sphincter relaxation is enhanced via stimulation of opioid receptors. (D) A hormone released by the M cells of the duodenum is the most effective cause of relaxation.
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['(A) A hormone released by the I cells of the duodenum in the presence of fatty acids is the most effective cause of relaxation. <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 22-year-old man presents with lower limb weakness for the past 2 days. The patient says that the weakness started in both his feet, manifesting as difficulty walking, but it has progressed to where he cannot move his legs completely and has become bedbound. He also has experienced a recent history of numbness and tingling sensations in both his feet. He denies any recent history of fever, backache, urinary or bowel incontinence, trauma, shortness of breath, or diplopia. His past medical history is remarkable for a viral flu-like illness 2 weeks ago. The patient is afebrile, and his vital signs are within normal limits. On physical examination, muscle strength in both lower limbs is 1/5. The muscle strength in the upper limbs is ⅘ bilaterally. Sensation to pinprick is decreased in both lower limbs in a stocking distribution. The sensation is intact in the upper limbs bilaterally. Knee and ankle reflexes are absent bilaterally. The laboratory findings are significant for the following: Hemoglobin 14.2 g/dL White blood cell count 8,250/mm3 Platelet count 258,000/mm3 BUN 14 mg/dL Creatinine 0.9 mg/dL Serum sodium 144 mEq/L Serum potassium 3.9 mEq/L Which of the following tests would most likely confirm the diagnosis in this patient? (A) Serum creatine kinase (B) MRI of the lumbosacral spine (C) Muscle biopsy (D) Nerve conduction studies
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['(D) Nerve conduction studies <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 23-year-old woman presents to your office for a gynecological exam. She says that she has been in good health and has no complaints. She has been in a steady monogamous relationship for the past year. Physical examination was unremarkable. Screening tests are performed and return positive for gonorrhea. You treat her with an intramuscular injection of ceftriaxone and 7 day course of doxycycline. What else is recommended for this case? (A) Treatment with penicillin G for potential co-infection with syphilis (B) Treat her partner for gonorrhea and chlamydia (C) Inform her that her partner is likely cheating on her (D) Perform an abdominal ultrasonography in order to rule out pelvic inflammatory disease
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['(B) Treat her partner for gonorrhea and chlamydia <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 70-year-old male visits his primary care physician because of progressive weight loss. He has a 20-year history of smoking 2 packs of cigarettes a day and was diagnosed with diabetes mellitus 6 years ago. After physical examination, the physician tells the patient he suspects adenocarcinoma at the head of the pancreas. Which of the following physical examination findings would support the diagnosis: (A) Lymphadenopathy of the umbilicus (B) Acanthosis nigricans (C) Palpable gallbladder (D) Splenomegaly
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['(C) Palpable gallbladder <> 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 for evaluation of multiple red spots on his trunk. He first noticed these several months ago, and some appear to have increased in size. One day ago, he scratched one of these spots, and it bled for several minutes. Physical examination shows the findings in the photograph. Which of the following is the most likely diagnosis? (A) Cherry angioma (B) Amelanotic melanoma (C) Spider angioma (D) Seborrheic keratosis
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['(A) Cherry angioma <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 28-year-old man comes to the physician because of increasing shortness of breath, abdominal fullness, and pedal edema for 3 months. Four months ago, he was diagnosed with pulmonary tuberculosis and is currently receiving therapy with isoniazid, rifampin, pyrazinamide, and ethambutol. His temperature is 37°C (98.6°F), pulse is 100/min, respirations are 20/min and blood pressure is 96/70 mm Hg. Examination shows 2+ pretibial edema bilaterally. There is jugular venous distention. The jugular venous pressure rises with inspiration. Breath sounds are decreased at lung base bilaterally. Cardiac examination reveals an early diastolic sound over the left sternal border. The abdomen is distended and shifting dullness test is positive. An ECG shows low-amplitude QRS complexes. Chest x-ray shows small pleural effusions bilaterally and calcifications over the left cardiac silhouette. Echocardiography shows a 40% decrease in the velocity of peak diastolic blood flow across the mitral valve during inspiration. A cardiac catheterization shows elevated right ventricular diastolic pressure with characteristic dip-and-plateau waveform. Which of the following is the most appropriate next step in management? (A) Colchicine therapy (B) Pericardiectomy (C) Metoprolol therapy (D) Heart transplantation
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['(B) Pericardiectomy <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 6-day-old newborn girl is brought into the hospital by her mother because of excessive vomiting and poor feeding. The mother did not have antenatal care. Her temperature is 36.8°C (98.2°F), blood pressure is 50/30 mm Hg, and pulse is 150/min. On examination, the infant is dehydrated and demonstrates signs of shock. Her genitalia are ambiguous, with fused labia and an enlarged clitoris. Laboratory results are shown: Serum sodium (Na) 125 mEq/L Serum potassium (K) 6 mEq/L Serum 17-hydroxyprogesterone 100,000 ng/dL (normal level is 1,000–3,000 ng/dL) Which of the following is the most likely cause of this infant's condition? (A) Deficiency of 21-hydroxylase (B) Deficiency of 11-beta-hydroxylase (C) Deficiency of 17-alpha-hydroxylase (D) Deficiency of placental aromatase
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['(A) Deficiency of 21-hydroxylase <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 28-year-old pregnant female presents for a prenatal check-up at 20 weeks gestation, which includes routine screening ultrasound. Fetal ultrasound demonstrates bilateral multicystic dysplastic kidneys. Her pregnancy has been complicated by persistent oligohydramnios. The child requires significant pulmonary support upon delivery. Which of the following clinical findings is most likely present in this child as a result of these abnormalities? (A) Urachal fistula (B) Esophageal atresia (C) Spina bifida occulta (D) Clubbed feet
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['(D) Clubbed feet <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 67-year-old man comes to the emergency department complaining of severe abdominal pain for the last several hours. The pain is cramp-like in nature, constant, 8/10, and has worsened over time. It is associated with bilious vomiting. He gives a history of episodic right upper abdominal pain for the past few months, mostly after consuming fatty foods, radiating to the tip of the right scapula. He reports no change in bowel habits, bladder habits, or change in weight. His past medical history includes diabetes and hypertension, and he takes hydrochlorothiazide, metformin, ramipril, and atorvastatin. Temperature is 38.2°C (100.8°F), blood pressure is 110/70 mm Hg, pulse is 102/min, respiratory rate is 20/min, and BMI is 23 kg/m2. On physical examination, his abdomen is distended and diffusely tender. Laboratory test Complete blood count Hemoglobin 13 g/dL WBC 16,000/mm3 Platelets 150,000/mm3 Basic metabolic panel Serum Na+ 148 mEq/L Serum K+ 3.3 mEq/L Serum Cl- 89 mEq/L An abdominal CT scan is shown. What is the most likely underlying cause of this patient’s current presentation? (A) Cholelithiasis (B) Pancreatitis (C) Peptic ulcer disease (D) Intestinal adhesion
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['(A) Cholelithiasis <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 27-year-old woman presents to the emergency department for sudden, bilateral, painful loss of vision. She states that her symptoms started last night and have persisted until this morning. The patient has a past medical history of peripheral neuropathy which is currently treated with duloxetine and severe anxiety. Her temperature is 99.5°F (37.5°C), blood pressure is 100/60 mmHg, pulse is 100/min, respirations are 15/min, and oxygen saturation is 98% on room air. On physical exam, the patient demonstrates 4/5 strength in her upper and lower extremities with decreased sensation in her fingers bilaterally. Towards the end of the exam, the patient embarrassingly admits to having an episode of urinary incontinence the previous night. An MRI is obtained and is within normal limits. Which of the following is the best next step in management and most likely finding for this patient? (A) A repeat MRI 3 days later demonstrating periventricular lesions (B) A high resolution CT demonstrating hyperdense lesions (C) A lumbar puncture demonstrating oligoclonal bands (D) Urine toxicology panel demonstrating cocaine use
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['(C) A lumbar puncture demonstrating oligoclonal bands <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 3-year-old girl with cystic fibrosis is brought to the physician for a follow-up examination. Her mother has noticed that the child has had multiple falls over the past 4 months while walking, especially in the evening. Her current medications include pancreatic enzyme supplements, an albuterol inhaler, and acetylcysteine. She is at the 10th percentile for height and the 5th percentile for weight. Examination shows dry skin, and cone shaped elevated papules on the trunk and extremities. There is an irregularly shaped foamy gray patch on the left conjunctiva. The remainder of the examination shows no abnormalities. Which of the following is the most appropriate next step in management? (A) Administer zinc (B) Administer vitamin A (C) Administer riboflavin (D) Administer lutein
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['(B) Administer vitamin A <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 6-month-old infant male is brought to the emergency department with a 1-hour history of vomiting and convulsions. He was born at home and had sporadic prenatal care though his parents say that he appeared healthy at birth. He initially fed well; however, his parents have noticed that he has been feeding poorly and is very irritable since they moved on to baby foods. They have also noticed mild yellowing of his skin but assumed it would go away over time. On presentation, he is found to be very sleepy, and physical exam reveals an enlarged liver and spleen. The rest of the physical exam is normal. Which of the following enzymes is most likely functioning abnormally in this patient? (A) Aldolase B (B) Fructokinase (C) Gal-1-phosphate uridyl transferase (D) Lactase
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['(A) Aldolase B <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A neurology resident sees a stroke patient on the wards. This 57-year-old man presented to the emergency department after sudden paralysis of his right side. He was started on tissue plasminogen activator within 4 hours, as his wife noticed the symptoms and immediately called 911. When the resident asks the patient how he is doing, he replies by saying that his apartment is on Main St. He does not seem to appropriately answer the questions being asked, but rather speaks off topic. He is able to repeat the word “fan.” His consciousness is intact, and his muscle tone and reflexes are normal. Upon striking the lateral part of his sole, his big toe flexes and the other toes flare down. Which of the following is the area most likely affected in his condition? (A) Caudate nucleus (B) Cuneus gyrus (C) Broca’s area (D) Temporal lobe
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['(D) Temporal lobe <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 26-year-old nulligravid woman presents to her gynecologist after noticing a lump in her right breast while showering. She states that she first noticed the lump approximately 2 weeks ago, when the mass was slightly tender to touch. Since then, the lump has gotten slightly smaller and is now non-tender. The patient is otherwise healthy. She does not take oral contraceptives. Her last menses was approximately 2 weeks ago. There is no family history of cancer. On exam, the patient's temperature is 98.3°F (36.8°C), blood pressure is 116/84 mmHg, pulse is 65/min, and respirations are 12/min. In her right breast, there is a small 1.5 cm mass that is mobile, well-circumscribed, and firm. Which of the following is most likely on histological examination of the mass? (A) Dilated glands with 2 cell layers present (B) Hypercellular stroma with overgrowth of fibrous and glandular tissues (C) Large, pleomorphic cells with associated central necrosis and microcalcifications (D) Terminal duct lobular units surrounded by dense stroma
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['(B) Hypercellular stroma with overgrowth of fibrous and glandular tissues <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 24-year-old, gravida 1, para 1 woman develops lower abdominal pain and fevers 4 days after undergoing a cesarean delivery under general anesthesia for prolonged labor. Since delivery, she has had malodorous lochia and difficulty breastfeeding due to breast pain. She has not had any shortness of breath or chest pain. She received intravenous intrapartum penicillin for group B streptococcus prophylaxis, but does not take any other medications on a regular basis. She appears ill. Her temperature is 38.8°C (102°F), pulse is 120/min, respirations are 22/min, and blood pressure is 110/70 mm Hg. Examination shows a urinary catheter in place. Breasts are engorged and tender. Nipples are cracked with mild erythema. There is erythema surrounding a mildly tender, dry, low transverse, 12-cm incision in the lower abdomen. Pelvic examination shows dark-red, foul-smelling lochia and uterine tenderness. Her hemoglobin concentration is 9 g/dL, leukocyte count is 16,000/mm3, and platelet count is 300,000/mm3. Which of the following is the most likely cause of this patient's fever? (A) Endometritis (B) Pyelonephritis (C) Normal postpartum fever (D) Chorioamnionitis
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['(A) Endometritis <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 37-year-old African American man is brought to the emergency department by police. The patient refused to leave a petting zoo after closing. He states that he has unique ideas to revolutionize the petting zoo experience. The patient has a past medical history of multiple suicide attempts. His temperature is 99.5°F (37.5°C), blood pressure is 130/85 mmHg, pulse is 100/min, respirations are 16/min, and oxygen saturation is 99% on room air. The patient's cardiac and pulmonary exams are within normal limits. He denies any nausea, vomiting, shortness of breath, or systemic symptoms. The patient struggles to answer questions, as he is constantly changing the subject and speaking at a very rapid rate. The patient is kept in the emergency department overnight and is observed to not sleep and is very talkative with the nurses. Which of the following is the best long-term therapy for this patient? (A) Lithium (B) Risperidone (C) Haloperidol (D) Diphenhydramine
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['(A) Lithium <> 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 for hematemesis and progressive heartburn over the past 5 days. Ten days ago, he was started on a medication to treat a condition that causes hearing difficulties and pain of the lower legs. He has no other history of serious illness. He has smoked 1 pack of cigarettes daily for the past 20 years. Physical examination shows bowing of the tibias. Upper endoscopy shows inflammation of the mucosa and a 1-cm punched-out ulcer in the distal esophagus. Which of the following drugs is the most likely cause of the patient's current condition? (A) Calcium citrate (B) Denosumab (C) Risedronate (D) Acetaminophen
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['(C) Risedronate <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 22-year-old man comes to the physician because of a 2-week history of cough and decreased urination. The cough was initially nonproductive, but in the last few days he has coughed up small amounts of blood-tinged sputum with clots. He has not had any fevers, chills, or weight loss. He has smoked one pack of cigarettes daily for 5 years. Pulse is 115/min and blood pressure is 125/66 mm Hg. Physical examination shows dried blood around the lips. Serum studies show a creatinine of 2.9 mg/dL. Results of a serum antineutrophil cytoplasm antibody test are negative. A biopsy specimen of the kidney is most likely to show which of the following light microscopy findings? (A) Neutrophilic infiltration of the capillaries (B) Thinning of the basement membrane (C) Fibrin crescents in Bowman space (D) Enlarged and hypercellular glomeruli
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['(C) Fibrin crescents in Bowman space <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 23-year-old man comes to the physician because of recurrent episodes of chest pain, shortness of breath, palpitations, and a sensation of choking. The symptoms usually resolve with deep breathing exercises after about 5 minutes. He now avoids going to his graduate school classes because he is worried about having another episode. Physical examination is unremarkable. Treatment with lorazepam is initiated. The concurrent intake of which of the following drugs should be avoided in this patient? (A) Diphenhydramine (B) Naloxone (C) Fluoxetine (D) Ondansetron
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['(A) Diphenhydramine <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 51-year-old woman comes to the physician because of a 3-month history of fatigue, increased urinary frequency, and low back pain. She reports frequent passing of hard stools, despite using stool softeners. During this time, she has not been as involved with her weekly book club. Her family is concerned that she is depressed. She has no history of serious illness. She has smoked 1 pack of cigarettes daily for the past 20 years. Her pulse is 71/min and blood pressure is 150/90 mm Hg. Abdominal examination shows right costovertebral angle tenderness. The patient's symptoms are most likely caused by hyperplasia of which of the following? (A) Chief cells in the parathyroid gland (B) Parafollicular cells in the thyroid gland (C) Spindle cells in the kidney (D) Kulchitsky cells in the lung
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['(A) Chief cells in the parathyroid gland <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 32-year-old man is brought to the Emergency Department after 3 consecutive days of diarrhea, fatigue and weakness. His stool has been soft and mucoid, with no blood stains. The patient just came back from a volunteer mission in Guatemala, where he remained asymptomatic. His personal medical history is unremarkable. Today his blood pressure is 98/60 mm Hg, pulse is 110/min, respiratory rate is 19/min, and his body temperature is 36.7°C (98.1°F). On physical exam, he has sunken eyes, dry mucosa, mild diffuse abdominal tenderness, and hyperactive bowel sounds. Initial laboratory tests are shown below: Serum creatinine (SCr) 1.8 mg/dL Blood urea nitrogen (BUN) 50 mg/dL Serum sodium 132 mEq/L Serum potassium 3.5 mEq/L Serum chloride 102 mEq/L Which of the following phenomena would you expect in this patient? (A) High urine osmolality, high fractional excretion of sodium (FeNa+), high urine Na+ (B) High urine osmolality, low FeNa+, low urine Na+ (C) Low urine osmolality, high FeNa+, high urine Na+ (D) Low urine osmolality, high FeNa+, low urine Na+
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['(B) High urine osmolality, low FeNa+, low urine Na+ <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 2-year-old boy is brought to the physician for evaluation of delayed onset of speech. Over the past year, he has also had recurrent dizziness and three episodes of syncope. Examination of the ears shows clear auditory canals and intact tympanic membranes with normal light reflexes. Visual reinforcement audiometry shows bilateral sensorineural deafness. Genetic analysis reveals a mutation in the KCNQ1 gene causing a defect in slow voltage-gated potassium channels. An electrocardiogram of this patient is most likely to show which of the following? (A) Pseudo-right bundle branch block (B) Slurred upstroke of the QRS complex (C) Absence of P waves (D) Prolongation of the QT interval
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['(D) Prolongation of the QT interval <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 62-year-old woman presents to the clinic for postmenopausal bleeding for the past month. She reports that the bleeding often occurs after intercourse with her husband. The patient denies fever, weight loss, chills, chest pain, abdominal pain, or shortness of breath but endorses mild dyspareunia and vaginal discharge. Her past medical history is significant for human papilloma virus and cervical cancer that was treated with surgical resection and radiation 5 years ago. Physical examination is unremarkable except for an irregular mass protruding from the vaginal wall. What is the most likely explanation for this patient’s condition? (A) Atrophy of vaginal tissues secondary to old age (B) Metastasis of cervical cancer via direct extension (C) Metastasis of cervical cancer via hematogenous spread (D) Primary malignancy of vaginal squamous cells
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['(B) Metastasis of cervical cancer via direct extension <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 16-year-old male adolescent presents to his pediatrician with increasing fatigue and breathlessness with exercise. His parents inform the doctor that they have recently migrated from a developing country, where he was diagnosed as having a large ventricular septal defect (VSD). However, due to their poor economic condition and scarce medical facilities, surgical repair was not performed in that country. The pediatrician explains to the parents that patients with large VSDs are at increased risk for several complications, including Eisenmenger syndrome. If the patient has developed this complication, he is not a good candidate for surgical closure of the defect. Which of the following clinical signs, if present on physical examination, would suggest the presence of this complication? (A) A mid-diastolic low-pitched rumble at the apex (B) Right ventricular heave (C) Prominence of the left precordium (D) Lateral displacement of the apical impulse
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['(B) Right ventricular heave <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 59-year-old patient with COPD is admitted with difficulty breathing and increased sputum production. Approx. a week ago, he developed an upper respiratory tract infection. On admission, his blood pressure is 130/80 mm Hg, the heart rate 92/min, the respiratory rate 24/min, the temperature 37.6°C (99.7°F), and SaO2 on room air 87%. Chest radiograph shows consolidation in the lower lobe of the right lung. Arterial blood gases (ABG) are taken and antibiotics are started. A nasal cannula provides 2L of oxygen to the patient. When the ABG results arrive, the patient’s SaO2 is 93%. The results are as follows: pH 7.32 PaO2 63 mm Hg PaCO2 57 mm Hg HCO3- 24 mEq/L What is the most appropriate next step in the management of this patient? (A) Increase oxygen to SaO2 > 95% (B) Start non-invasive positive pressure ventilation (C) Intubate and start invasive ventilation (D) Administer oral corticosteroids
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['(B) Start non-invasive positive pressure ventilation <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 25-year-old female presents with recent muscle weakness, fatigue, and constipation. Physical examination reveals a bradycardic patient with cool, dry skin. Which of the following lab values would be most likely to be present with this patient's presentation? (A) Elevated serum calcitonin (B) Elevated serum CK (C) Low serum TSH (D) Activating TSH-receptor immunoglobulins
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['(B) Elevated serum CK <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 7-year-old boy is brought to the physician by his parents because of a 4.5-kg (10-lb) weight loss during the last 3 months. During this period, he has complained of abdominal pain and fullness, and his parents feel that he has been eating less. His parents also report that his urine has appeared pink for several weeks. He has been performing poorly in school lately, with reports from teachers that he has not been paying attention in class and has been distracting to other students. He was born at term and has been healthy except for a history of several infantile seizures. His vital signs are within normal limits. He is at the 60th percentile for height and 20th percentile for weight. Physical examination shows a palpable abdominal mass, abdominal tenderness in the left upper quadrant, and left costovertebral angle tenderness. There are several ellipsoid, hypopigmented macules on the back and legs and a 4-cm raised plaque of rough, dimpled skin on the right lower back that is the same color as the surrounding skin. Which of the following is the most likely diagnosis? (A) Neurofibromatosis type 1 (B) Sturge-Weber syndrome (C) Tuberous sclerosis (D) Neurofibromatosis type 2
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['(C) Tuberous sclerosis <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A biology graduate student is performing an experiment in the immunology laboratory. He is researching the recombination activation genes RAG1 and RAG2 in order to verify the function of these genes. He then decides to carry out the experiment on knock-out mice so that these genes will be turned off. Which of the following changes should he be expecting to see? (A) Defect of NADPH oxidase in phagocyte (B) Total lack of B and T cells (C) Absence of CD18 in leukocytes (D) The mice should be asymptomatic
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['(B) Total lack of B and T cells <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 39-year-old woman with multiple sclerosis comes to the physician for a follow-up examination. Over the past 3 years, she has been hospitalized 7 times for acute exacerbations of her illness. She has not responded to therapy with several disease-modifying agents and has required at least two pulse corticosteroid therapies every year. She has seen several specialists and sought out experimental therapies. During this time period, her disease course has been rapidly progressive. She currently requires a wheelchair and is incontinent. Today, she says, “I'm not going to allow myself to hope because I'll only be disappointed, like I have been over and over again. What's the point? No one in this system knows how to help me. Sometimes I don't even take my pills any more because they don't help.” Which of the following is the most appropriate initial response to this patient? (A) """While I completely understand your hopelessness about the lack of improvement, not taking your medication as instructed is only going to make things worse.""" (B) """I'm very sorry to hear that you feel this way about your situation. With all that you've been through, I can see why you would be so frustrated.""" (C) """I understand how your illness would make you angry. Apparently your previous doctors did not know how to help you handle your condition well, but I believe I can help you.""" (D) """I am concerned that this terrible illness may be affecting your capacity to make decisions for yourself and would like to refer you to a psychiatrist."""
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['(B) """I\'m very sorry to hear that you feel this way about your situation. With all that you\'ve been through, I can see why you would be so frustrated.""" <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 7-year-old girl is brought to the physician because of vaginal bleeding for 2 days. There is no personal or family history of serious illness. She is at the 95th percentile for height and at the 90th percentile for weight. Examination shows enlarged breasts, and the areola and papilla have formed a secondary mound. There is coarse pubic hair that does not extend to the inner thigh. The remainder of the examination show no abnormalities. An x-ray of the left hand and wrist shows a bone age of 11 years. Her serum luteinizing hormone concentration is 0.1 mIU/mL (N < 0.2 mIU/mL). Which of the following is the most appropriate next step in management? (A) MRI of the brain (B) Ultrasound of the pelvis (C) GnRH stimulation test (D) Serum dehydroepiandrosterone level
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['(C) GnRH stimulation test <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 38-year-old male presents to his primary care doctor with 8 months of uncontrollable anxiety. He states that he experiences overwhelming anxiety and worry in peforming just ordinary tasks of daily living. He is started on venlafaxine for treatment of generalized anxiety disorder. Which of the following is a potential side effect of this medication? (A) Seizures (B) Weight gain (C) Hypertension (D) Increased urination
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['(C) Hypertension <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 24-year-old man is taken to the emergency department by local law enforcement after they witnessed him physically assaulting a complete stranger. The officers report that they saw his eyes “moving back and forth quickly” and noted that he was very red-faced. The patient has no significant past medical or psychiatric history. His vital signs include: temperature 38.0°C (100.4°F), blood pressure 110/70 mm Hg, pulse 102/min, and respiratory rate 25/min. On physical examination, the patient is belligerent and refuses to cooperate during the examination. Rotary nystagmus is noted. Which of the following drugs would most likely be present in a urine toxicology screen from this patient? (A) Marijuana (B) Methamphetamine (C) Cocaine (D) Phencyclidine hydrochloride (PCP)
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['(D) Phencyclidine hydrochloride (PCP) <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 66-year-old woman comes to the physician because of a 1-week history of pruritic blister formation. Physical examination shows multiple 1–3 cm bullae on the palms, soles, lower legs, and inguinal folds. Gentle rubbing of the skin does not result in sloughing of the epidermis. Immunofluorescence studies of a perilesional skin biopsy specimen are most likely to show deposition of antibodies in which of the following areas? (A) At the dermoepidermal junction (B) Between epidermal keratinocytes (C) In dermal papillae (D) In dermal vessel walls
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['(A) At the dermoepidermal junction <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A medical student is spending his research year studying the physiology of cholesterol transport within the body. Specifically, he wants to examine how high density lipoprotein (HDL) particles are able to give other lipoproteins the ability to hydrolyse triglycerides into free fatty acids. He labels all the proteins on HDL particles with a tracer dye and finds that some of them are transferred onto very low density lipoprotein (VLDL) particles after the 2 are incubated together. Furthermore, he finds that only VLDL particles with transferred proteins are able to catalyze triglyceride hydrolysis. Which of the following components were most likely transferred from HDL to VLDL particles to enable this reaction? (A) Apo-A1 (B) ApoB-100 (C) ApoC-II (D) Lipoprotein lipase
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['(C) ApoC-II <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A medical student is performing research on the properties of viruses in order to determine the transmission patterns of various organisms. He accidentally drops a rack of tubes and spills various virus samples on the benchtop. Upon seeing this, the laboratory technician wipes down the workbench with alcohol in order to clean up the spill. Which of the following organisms would most likely still be alive after this cleaning? (A) Adenovirus and herpesvirus (B) Adenovirus and rhinovirus (C) Coronavirus and herpesvirus (D) Coronavirus and rhinovirus
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['(B) Adenovirus and rhinovirus <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 34-year-old patient with a history of anxiety, chronic constipation, chronic headaches, and chronic hypertension presents to the emergency room with severe right flank pain radiating to his scrotum. A urinalysis with stone analysis is performed and the results are shown in figure A. Prior to discharge, it is noted that the patients BP is still 170/110 mmHg. Furthermore, his calcium and PTH levels were both found to be increased. Which of the following representative histology slides of thyroid tissue represents a potential complication of the patients condition? (A) Medullary thyroid cancer (B) Papillary thyroid cancer (C) Lymphoma (D) Follicular thyroid cancer
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['(A) Medullary thyroid cancer <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 65-year-old man presents with hypercholesterolemia. Family history is significant for multiple cardiac deaths and other cardiovascular diseases. The patient reports a 40-pack-year smoking history. BMI is 28 kg/m2. Total cholesterol is 255 mg/dL and low-density lipoprotein (LDL) is more than 175 mg/dL. Lifestyle and dietary modifications are recommended, and the patient has prescribed a hypolipidemic drug. He returns for follow-up 4 weeks later complaining of muscle pains. Laboratory findings are significant for a significant increase in serum transaminases. Which of the following drugs is most likely responsible for this patient’s symptoms on follow-up? (A) Colestipol (B) Glyceryl trinitrate (C) Gemfibrozil (D) Atorvastatin
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['(D) Atorvastatin <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** An 8-year-old boy is brought to the emergency department by his parents because of vomiting, abdominal pain, and blurry vision for the past hour. The parents report that the boy developed these symptoms after he accidentally ingested 2 tablets of his grandfather’s heart failure medication. On physical examination, the child is drowsy, and his pulse is 120/min and irregular. Digoxin toxicity is suspected. A blood sample is immediately sent for analysis and shows a serum digoxin level of 4 ng/mL (therapeutic range: 0.8–2 ng/mL). Which of the following electrolyte abnormalities is most likely to be present in the boy? (A) Hypermagnesemia (B) Hyperkalemia (C) Hypokalemia (D) Hypercalcemia
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['(B) Hyperkalemia <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 55-year-old man presents to the emergency department complaining of mild vision changes, dizziness, and severe pain in the chest for the past hour. He has also been experiencing nausea since this morning and has already vomited twice. Past medical history includes poorly controlled type 2 diabetes and end-stage renal disease requiring dialysis. His blood pressure is 210/100 mm Hg, pulse is 110/min, and respirations are 18/min. Ophthalmic examination of his eyes show papilledema and flame-shaped hemorrhages and he is diagnosed with hypertensive emergency. Treatment involves rapidly lowering his blood pressure, and he is started on intravenous sodium nitroprusside while emergent dialysis is arranged. Which of the following cardiac pressure-volume loops closely represents the action of the drug he has been administered, where blue represents before administration and purple represent after administration? (A) Diagram A (B) Diagram B (C) Diagram C (D) Diagram E
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['(B) Diagram B <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** An 84-year-old man presents to the emergency department for a loss of consciousness. The patient states that he was using the bathroom when he lost consciousness and fell, hitting his head on the counter. The patient has a past medical history of diabetes, hypertension, obesity, factor V leiden, constipation, myocardial infarction, and vascular claudication. His current medications include lisinopril, atorvastatin, valproic acid, propranolol, insulin, metformin, and sodium docusate. The patient denies use of illicit substances. His temperature is 99.5°F (37.5°C), blood pressure is 167/98 mmHg, pulse is 90/min, respirations are 15/min, and oxygen saturation is 98% on room air. Physical exam reveals an elderly man sitting comfortably in his stretcher. Cardiac exam reveals a systolic murmur heard at the right upper sternal border that radiates to the carotids. Pulmonary exam reveals mild bibasilar crackles. Neurological exam reveals 5/5 strength in his upper and lower extremities with normal sensation. The patient's gait is mildly unstable. The patient is unable to give a urine sample in the emergency department and states that he almost fainted again when he tried to. Which of the following is the most likely diagnosis? (A) Postural hypotension (B) Seizure (C) Cardiac arrhythmia (D) Situational syncope
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['(D) Situational syncope <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 27-year-old man is brought to a psychiatrist by his mother who is concerned that he has become increasingly distant. When asked, he says that he is no longer going out because he is afraid of going outside by himself. He says that ever since he was a teenager, he was uncomfortable in large crowds and on public transportation. He now works from home and rarely leaves his house except on mandatory business. Which of the following personality disorders is most likely genetically associated with this patient's disorder? (A) Antisocial (B) Dependent (C) Histrionic (D) Schizotypal
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['(B) Dependent <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 75-year-old man with hypercholesterolemia, coronary artery disease, and history of a transient ischemic attack (TIA) comes to your office for evaluation of hypertension. Previously, his blood pressure was controlled with diet and an ACE inhibitor. Today, his blood pressure is 180/115 mm Hg, and his creatinine is increased from 0.54 to 1.2 mg/dL. The patient reports that he has been compliant with his diet and blood pressure medications. What is the most likely cause of his hypertension? (A) Renal artery stenosis (B) Coarctation of the aorta (C) Pheochromocytoma (D) Hypothyroidism
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['(A) Renal artery stenosis <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 55-year-old college professor with a long-standing history of neuropathic pain presents to a medical clinic with weight loss and early morning awakening for the past several months. She feels as if she has no energy to go about her work. She complains that she is not as focused at work or home as she used to be and finds both her life and work unfulfilling. She has had these symptoms for the past 2 months. She was started on antidepressants in the past, but the antidepressants did not provide any significant improvement. She eventually improved and has been in remission for almost 1 year now. She would really like a simple treatment option to address both her neuropathic pain and her depression, and she is started on a tricyclic antidepressant. What safety advice is most important for this patient’s treatment plan? (A) The medication can cause serotonin syndrome. (B) The medication can cause agranulocytosis. (C) The medication can lower the seizure threshold. (D) This medication is rarely lethal at high doses.
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['(A) The medication can cause serotonin syndrome. <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 62-year-old woman with type 2 diabetes mellitus comes to the physician because of a 3-month history of fatigue and weakness. Her hemoglobin A1c concentration was 13.5% 12 weeks ago. Her blood pressure is 152/92 mm Hg. Examination shows lower extremity edema. Serum studies show: K+ 5.1 mEq/L Phosphorus 5.0 mg/dL Ca2+ 7.8 mg/dL Urea nitrogen 60 mg/dL Creatinine 2.2 mg/dL Which of the following is the best parameter for early detection of this patient’s renal condition?" (A) Urinary red blood cell casts (B) Serum total protein (C) Urinary albumin (D) Serum creatinine
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['(C) Urinary albumin <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 40-year-old chronic smoker presents to the office complaining of a cough and pleuritic chest pain. He also has had pain in his right shoulder for the past 2 weeks. He denies fever, night sweats, but has noticed a 2.2 kg (5 lb) weight loss in the last month. He has no recent history of travel. Past medical history is unremarkable. On cardiopulmonary examination, bilateral velcro-like crackles are auscultated in the upper to middle lung fields, with normal heart sounds. There is a 3 x 3 cm swelling on the right shoulder with a normal range of motion and intact sensation. 5/5 muscular strength in all extremities is noted. Chest X-ray reveals bilateral nodular opacities in the upper lung lobes and a lytic lesion on the right humeral head. Electron microscopy of the lung biopsy shows the following. Which of the following is the most likely diagnosis? (A) Pancoast tumor (B) Small cell carcinoma of the lung (C) Histiocytosis X (D) Pulmonary tuberculosis
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['(C) Histiocytosis X <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 28-year-old man seeks evaluation at a medical office for facial swelling and blood in his urine during the last 3 days. He claims that he has had weakness, malaise, and low-grade fevers for the past 3 months. On physical examination, the blood pressure is 160/96 mm Hg and he has periorbital edema bilaterally. The lab testing is significant for leukocytosis, elevated blood urea nitrogen, and elevated serum creatinine. Urinalysis shows gross hematuria, proteinuria, and red blood cell casts. You suspect that this patient has Goodpasture’s disease and decide to order additional tests to confirm the diagnosis. Antibodies to which of the following would most likely be present in this patient if your suspicion is correct? (A) Collagen type I (B) Collagen type V (C) Collagen type II (D) Collagen type IV
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['(D) Collagen type IV <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 65-year-old woman presents with complaints of difficulty sleeping due to discomfort in her legs for the past 6 months. She is unable to describe the discomfort, but says it is an unpleasant, creeping and crawling feeling that is not painful. She feels an irresistible urge to move her legs to decrease the discomfort. The unpleasant sensation in her legs often occurs at night when she is lying in bed. She is recently divorced and lives alone. She denies any changes in appetite, weight loss, low mood, or suicidal thoughts. The physical examination is unremarkable except for signs of mild pallor. Laboratory test results show microcytic anemia with hemoglobin of 9.8 g/dL and decreased serum iron and ferritin levels. Apart from correcting her anemia, which additional drug would you prescribe for her symptoms? (A) Haloperidol (B) Lithium (C) Propranolol (D) Ropinirole
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['(D) Ropinirole <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 13-year-old girl is brought to the physician because of an itchy rash on her knee and elbow creases. She has had this rash since early childhood. Physical examination of the affected skin shows crusty erythematous papules with skin thickening. She is prescribed topical pimecrolimus. The beneficial effect of this drug is best explained by inhibition of which of the following processes? (A) Reduction of ribonucleotides (B) Oxidation of dihydroorotic acid (C) Synthesis of tetrahydrofolic acid (D) Dephosphorylation of serine
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['(D) Dephosphorylation of serine <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 22-year-old male varsity athlete visits the on-campus health services for shortness of breath, fatigue, and lower limb edema with onset 1 week after mild upper respiratory tract infection. Upon physical examination, his blood pressure is 100/68 mm Hg, heart rate is 120/min, respiratory rate is 23/min, and temperature is 36.4°C (97.5°F). He is referred to the nearest hospital, where his systolic pressure drops below 90 mm Hg with an S3 gallop, and he needs inotropic support in the critical care unit. A chest radiograph shows an enlarged heart, clear lungs, and effacement of the right costodiaphragmatic angle. A subsequent esophageal echocardiogram reveals severe dilation of all heart cavities, an ejection fraction of 23%, and mitral regurgitation. His family and personal history are unremarkable; therefore, an endomyocardial biopsy (EMB) is ordered. Which of the following microscopic findings would you expect in this specimen? (A) Infiltration with lymphocytes (B) Infiltration with eosinophils (C) Infiltration with neutrophils (D) Infiltration with granulomas
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['(A) Infiltration with lymphocytes <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 31-year-old woman presents to her primary care physician with a 2-week history of diarrhea. She says that she has also noticed that she is losing weight, which makes her feel anxious since she has relatives who have suffered from anorexia. Finally, she says that she is worried she has a fever because she feels warm and has been sweating profusely. On physical examination she is found to have proptosis, fine tremor of her hands, and symmetrical, non-tender thyroid enlargement. Which of the following types of enzymes is targeted by a treatment for this disease? (A) Cyclooxygenase (B) Kinase (C) Peroxidase (D) Phosphatase
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['(C) Peroxidase <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 8-month-old boy is brought to the emergency department by his mother and father due to decreasing activity and excessive sleepiness. The patient was born at full-term in the hospital with no complications. The patient's parents appear incredibly worried as their son has had no medical issues in the past. They show you videos of the child happily playing with his parents the day before. The patient’s mother states that the patient hit his head while crawling this morning and since then has been difficult to arouse. His mother is worried because she thinks he had a fever earlier in the day and he was clutching his head and neck in pain. Physical examination shows a barely arousable boy with a large, full anterior fontanelle. The boy grimaces on palpation of his chest, and a radiograph show posterior rib fractures. Retinal examination shows bilateral retinal hemorrhages. Which of the following is the most likely cause for this patient’s presentation? (A) Child abuse (B) Vitamin K deficiency (C) Osteogenesis imperfecta (D) Bacterial meningitis
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['(A) Child abuse <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 3-month-old boy is brought to the physician by his mother because of poor weight gain. She also reports a dusky blue discoloration to his skin during feedings and when crying. On examination, there is a harsh, systolic murmur heard over the left upper sternal border. An x-ray of the chest is shown below. Which of the following is the most likely cause of his symptoms? (A) Hypoplasia of the left ventricle (B) Narrowing of the distal aortic arch (C) Right ventricular outflow obstruction (D) Anatomic reversal of aorta and pulmonary artery
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['(C) Right ventricular outflow obstruction <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** Four weeks after starting hydrochlorothiazide, a 49-year-old man with hypertension comes to the physician because of muscle cramps and weakness. His home medications also include amlodipine. His blood pressure today is 176/87 mm Hg. Physical examination shows no abnormalities. The precordial leads of a 12-lead ECG are shown. The addition of which of the following is most likely to have prevented this patient's condition? (A) Torsemide (B) Nifedipine (C) Eplerenone (D) Hydralazine
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['(C) Eplerenone <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** While studying vesicular trafficking in mammalian epithelial cells, a scientist identified a specific protein that was responsible for contorting the plasma membrane to capture extracellular materials and forming endosomes. This protein also helps transport those endosomes from the trans-Golgi network to lysosomes. Which of the following is the protein that the scientists identified? (A) Kinesin (B) COPII (C) Sar1 (D) Clathrin
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['(D) Clathrin <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 34-year-old man comes to the physician because of fatigue and shortness of breath with moderate exertion for the past 2 months. Over the past 10 days, he has had low-grade fevers and night sweats. He has no history of serious illness except for a bicuspid aortic valve diagnosed 5 years ago. He has smoked one pack of cigarettes daily for 10 years and drinks 3–5 beers on social occasions. He does not use illicit drugs. The patient takes no medications. He appears weak. His temperature is 37.7°C (99.9°F), pulse is 70/min, and blood pressure is 128/64 mm Hg. The lungs are clear to auscultation. A grade 2/6 systolic murmur is heard best at the right sternal border and second intercostal space. There are several hemorrhages underneath his fingernails on both hands and multiple tender, red nodules on his fingers. Which of the following is the most likely causal organism? (A) Staphylococcus epidermidis (B) Streptococcus sanguinis (C) Streptococcus pneumoniae (D) Streptococcus pyogenes
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['(B) Streptococcus sanguinis <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 25-year-old sexually active male presents to an internal medicine physician for a routine health check up after having several unprotected sexual encounters. After appropriate testing the physician discusses with the patient that he is HIV+ and must be started on anti-retroviral treatment. Which of the following medications prescribed acts on the gp41 subunit of the HIV envelope glycoprotein? (A) Amantadine (B) Zidovudine (C) Saquinavir (D) Enfuvirtide
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['(D) Enfuvirtide <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 21-year-old man comes to the physician for a follow-up examination. Four days ago, he injured his right knee while playing soccer. Increased laxity of the right knee joint is noted when the knee is flexed to 30° and an abducting force is applied to the lower leg. The examination finding in this patient is most likely caused by damage to which of the following structures? (A) Posterior cruciate ligament (B) Lateral collateral ligament (C) Lateral meniscus (D) Medial collateral ligament
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['(D) Medial collateral ligament <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 3-year-old African-American female presents to the emergency department with fatigue. Her parents endorse malaise and weakness on behalf of the patient for two weeks. Her temperature is 98.9°F (37.2°C), blood pressure is 94/70 mmHg, pulse is 102/min, and respirations are 22/min. On physical exam, she is tired-appearing with conjunctival pallor. Her parents report that they immigrated from Liberia before the patient was born. They deny any family history of medical disorders, and the patient has no sick contacts at home. Laboratory tests are performed and reveal the following: Leukocyte count: 10,700/mm^3 Hemoglobin: 8.6 g/dL Hematocrit: 24% Mean corpuscular volume: 84 µm^3 Platelet count: 488,000/mm^3 Reticulocyte index: 3.8% The patient should receive which of the following nutritional supplements? (A) Vitamin B6 (B) Vitamin B9 (C) Vitamin D (D) Iron
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['(B) Vitamin B9 <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 35-year-old woman comes to the physician because of a 3-month history of headache, palpitations, diarrhea, and weight loss. She takes no medications. Her pulse is 110/min and blood pressure is 125/70 mm Hg. Examination shows warm, moist skin and diffuse hyperreflexia. An MRI of the brain shows a sellar mass. The underlying cause of this patient's condition is best explained by binding of a ligand to which of the following? (A) Intracytosolic nuclear receptor (B) G protein-coupled receptors (C) Membrane-bound guanylate cyclase (D) Nonreceptor tyrosine kinase
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['(B) G protein-coupled receptors <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 45-year-old man presents for a follow-up visit as part of his immigration requirements into the United States. Earlier this week, he was administered the Mantoux tuberculin skin test (TST). Today’s reading, 3 days after being administered the test, he shows an induration of 10 mm. Given his recent immigration from a country with a high prevalence of tuberculosis, he is requested to obtain a radiograph of the chest, which is shown in the image. Which of the following is true regarding this patient’s chest radiograph (CXR)? (A) If the spinous process is not in-between the two clavicular heads, the image is repeated. (B) The film is taken in a supine position. (C) Posterior ribs 9 and 10 are visible only in an expiratory film. (D) The view is anteroposterior (AP).
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['(A) If the spinous process is not in-between the two clavicular heads, the image is repeated. <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 16-year-old girl undergoes an emergent appendectomy after presenting to the emergency department with appendicitis. She is given a mixture of nitrous oxide and sevoflurane for induction of anesthesia and intubated for a secure airway during surgery. A few minutes after induction, she is found to have increased end-tidal carbon dioxide and tachycardia. Furthermore, the surgeon notices that her abdomen is extremely rigid before making his incision. Finally, she is found to have hyperkalemia despite having normal serum potassium during preoperative laboratory studies. Defective function of which of the following proteins is most likely responsible for this patient's findings? (A) Acetylcholine receptor (B) L-type calcium channel (C) Myosin heavy chain (D) Ryanodine receptor
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['(D) Ryanodine receptor <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** An investigator is studying collagen synthesis in human fibroblast cells. Using a fluorescent tag, α-collagen chains are identified and then monitored as they travel through the rough endoplasmic reticulum, the Golgi apparatus, and eventually into the extracellular space. Which of the following steps in collagen synthesis occurs extracellularly? (A) Glycosylation of pro-α chains (B) Cleavage of procollagen C- and N-terminals (C) Triple-helix formation (D) Translation of pro-α chains
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['(B) Cleavage of procollagen C- and N-terminals <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 64-year-old man presents to his primary care physician for a fall. The patient states that he has felt abnormally clumsy lately and has noticed himself tripping and bumping into things. He states he otherwise is healthy but admits to having unprotected sex with multiple people recently. His temperature is 99.5°F (37.5°C), blood pressure is 127/68 mm Hg, pulse is 100/min, respiratory rate is 24/min, and oxygen saturation is 98% on room air. Laboratory values are ordered as seen below. Hemoglobin: 9 g/dL Hematocrit: 30% Mean corpuscular volume: 110 fL Leukocyte count: 6,500/mm^3 with normal differential Platelet count: 197,000/mm^3 AST: 15 U/L ALT: 22 U/L GGT: 10 U/L Physical exam is notable for a broad-based and unstable gait. Which of the following conditions is the most likely etiology of this patient's presentation? (A) Chronic alcoholism (B) Chronic gastritis (C) Tertiary syphilis (D) Vegetarian diet
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['(B) Chronic gastritis <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 56-year-old woman presents to the emergency department after falling in the shower 2 days ago. At that time, she was complaining of severe back pain that she treated with over the counter acetaminophen. Since the fall, she has had increasing stomach pain and difficulty walking. She has not urinated or had a bowel movement since the incident. She has no significant past medical history and takes a multivitamin regularly. No significant family history. Her vitals include: blood pressure 137/82 mm Hg, pulse 78/min, respiratory rate 16/min, temperature 37.0°C (98.6°F). On physical examination, she is alert and oriented but in great discomfort. There is focal, non-radiating midline pain with palpation of the L1 vertebrae. On pinprick sensory testing, she reveals decreased sensations below the level of the knees bilaterally. Muscle strength is 4/5 in both lower extremities. Which of the following additional findings would most likely be present in this patient? (A) Decreased muscle strength in upper extremities (B) Difficulty in swallowing (C) Increased deep tendon reflexes (D) Intentional tremors
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['(C) Increased deep tendon reflexes <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 45-year-old man presents to the emergency department with crushing substernal chest pain. The patient has a past medical history of obesity, diabetes, and hypertension. He drinks 5 alcoholic drinks every night and has a 40 pack-year smoking history. The patient works as a truck driver and leads a sedentary lifestyle. His initial electrocardiogram (ECG) is notable for ST elevation in V2-V5 with reciprocal changes. The patient is sent for cardiac catheterization, and several stents are placed. The patient is being monitored after the procedure, when he suddenly becomes less responsive. His temperature is 98.5°F (36.9°C), blood pressure is 87/48 mmHg, pulse is 150/min, respirations are 18/min, and oxygen saturation is 97% on room air. Jugular venous distension is absent and pulmonary exam is notable for clear breath sounds bilaterally. The patient states that he is experiencing back and flank pain and is tender to palpation over his lumbar back and flanks. The patient is given 3 liters of Lactated Ringer solution and his blood pressure improves to 110/70 mmHg and his pulse is 95/min. Which of the following is the best next step in management? (A) CT scan (B) Emergency surgery (C) FAST exam (D) Repeat cardiac catheterization
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['(A) CT scan <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 33-year-old G2P2 woman presents with a history of fatigue and difficulty breathing upon exertion. She was not able to tolerate antenatal vitamin supplements due to nausea and constipation. Her vital signs include: temperature 37.0°C (98.6°F), blood pressure 112/64 mm Hg, and pulse 98/min. Physical examination reveals conjunctival pallor and spoon nails. Laboratory findings are significant for the following: Hemoglobin 9.1 g/dL Hematocrit 27.3% Mean corpuscular volume (MCV) 73 μm3 Mean corpuscular hemoglobin (MCH) 21 pg/cell Red cell distribution width (RDW) 17.5% (ref: 11.5–14.5%) Serum ferritin 9 ng/mL Which of the following would most likely be seen on a peripheral blood smear in this patient? (A) Teardrop cells (B) Degmacytes (C) Anisopoikilocytosis (D) Echinocytes
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['(C) Anisopoikilocytosis <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** Please refer to the summary above to answer this question Administration of which of the following is most likely to improve this patient's current symptoms?" "Patient information Age: 82 years Gender: M, self-identified Ethnicity: Caucasian Site of care: office History Reason for Visit/Chief Concern: “I have been getting these large bruises on my arms and legs.” History of Present Illness: his wife noticed 6 weeks ago that he had bruising on the bilateral lower extremities additional ecchymoses developed on the bilateral upper extremities 2 weeks ago feels increasingly fatigued has joint pain of the elbows, hips, and knees was unable to complete his final cycle of chemotherapy for non-small cell lung carcinoma because of the pain has not had trauma or prior episodes of significant bleeding Past Medical History: hypertension benign prostatic hyperplasia osteoarthritis non-small cell lung carcinoma: treated with resection, currently undergoing adjuvant chemotherapy Social History: lives with his wife has been eating sparingly has smoked 2 packs of cigarettes daily for 60 years Medications: amlodipine, lisinopril, tamsulosin, acetaminophen; currently undergoing cisplatin-based chemotherapy Allergies: no known drug allergies Physical Examination Temp Pulse Resp. BP O2 Sat Ht Wt BMI 36.6°C (97.8°F) 88/min 20/min 128/83 mm Hg 96% 175 cm (5 ft 9 in) 53 kg (117 lb) 17 kg/m2 Appearance: pale, tired-appearing, cachectic man, sitting in a wheelchair HEENT: mild mucosal bleeding Pulmonary: diminished breath sounds in the left lower lung field; moderate inspiratory wheezes bilaterally; no rales or rhonchi Cardiac: normal S1 and S2; no murmurs, rubs, or gallops Abdominal: soft; nontender; nondistended; normal bowel sounds Extremities: symmetrically cool; no edema Skin: coiled hairs with perifollicular hemorrhages; multiple ecchymoses of the bilateral upper and lower extremities Neurologic: symmetrically decreased sensation to pinprick, vibration, and fine touch in the distal lower extremities" (A) Vitamin C (B) Vitamin A (C) Vitamin B6 (D) Vitamin K "
|
['(A) Vitamin C <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 52-year-old man presents for a routine checkup. Past medical history is remarkable for stage 1 systemic hypertension and hepatitis A infection diagnosed 10 years ago. He takes aspirin, rosuvastatin, enalapril daily, and a magnesium supplement every once in a while. He is planning to visit Ecuador for a week-long vacation and is concerned about malaria prophylaxis before his travel. The physician advised taking 1 primaquine pill every day while he is there and for 7 consecutive days after leaving Ecuador. On the third day of his trip, the patient develops an acute onset headache, dizziness, shortness of breath, and fingertips and toes turning blue. His blood pressure is 135/80 mm Hg, heart rate is 94/min, respiratory rate is 22/min, temperature is 36.9℃ (98.4℉), and blood oxygen saturation is 97% in room air. While drawing blood for his laboratory workup, the nurse notes that his blood has a chocolate brown color. Which of the following statements best describes the etiology of this patient’s most likely condition? (A) The patient’s condition is due to consumption of water polluted with nitrates. (B) This condition resulted from primaquine overdose. (C) The condition developed because of his concomitant use of primaquine and magnesium supplement. (D) It is a type B adverse drug reaction.
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['(D) It is a type B adverse drug reaction. <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 28-year-old woman, gravida 2, para 1, at 30 weeks' gestation comes to the physician because of headache for the past 5 days. Her pregnancy has been uncomplicated to date. Pregnancy and vaginal delivery of her first child were uncomplicated. The patient does not smoke or drink alcohol. She does not use illicit drugs. Medications include folic acid and a multivitamin. Her temperature is 37°C (98.6°F), pulse is 82/min, and blood pressure is 150/92 mm Hg. Physical examination reveals 2+ pitting edema in the lower extremities. Laboratory studies show: Hemoglobin 11.8 g/dL Platelet count 290,000/mm3 Urine pH 6.3 Protein 2+ WBC negative Bacteria occasional Nitrites negative The patient is at increased risk of developing which of the following complications?" (A) Abruptio placentae (B) Spontaneous abortion (C) Uterine rupture (D) Polyhydramnios
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['(A) Abruptio placentae <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** An 80-year-old African American male presents complaining of worsening shortness of breath that occurs during his weekly round of golf. He also notes he has been waking up at night "choking and gasping for air", though he has been able to gain some relief by propping his head on a stack of pillows before he goes to bed. Upon auscultation, a low frequency, early diastolic gallop is heard over the apex while the patient rests in the left lateral decubitus position. This finding is most consistent with which of the following? (A) Right atrial hypertrophy (B) Left atrial hypertrophy (C) Left ventricular eccentric hypertrophy (D) Mitral stenosis
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['(C) Left ventricular eccentric hypertrophy <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 60-year-old man with a history of coronary artery disease and hyperlipidemia presents to his internist for a follow-up visit 3 weeks after visiting an urgent care center for symptoms of cough, fever, and difficulty breathing. He had been prescribed erythromycin in addition to his usual regimen of rosuvastatin and aspirin. With which potential side effect or interaction should the internist be most concerned? (A) Unstable angina due to decreased rosuvastatin metabolism in the presence of erythromycin (B) Myalgia due to decreased rosuvastatin metabolism in the presence of erythromycin (C) Metabolic acidosis due to decreased aspirin metabolism in the presence of erythromycin (D) Tinnitus due to decreased aspirin metabolism in the presence of erythromycin
|
['(B) Myalgia due to decreased rosuvastatin metabolism in the presence of erythromycin <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 33-year-old woman presents to the clinic complaining of a 9-month history of weight loss, fatigue, and a general sense of malaise. She additionally complains of an unusual sensation in her chest upon rapidly rising from a supine to a standing position. Current vitals include a temperature of 36.8°C (98.2°F), pulse of 72/min, blood pressure of 118/63 mm Hg, and a respiratory rate of 15/min. Her BMI is 21 kg/m2. Auscultation demonstrates an early-mid diastole low-pitched sound at the apex of the heart. A chest X-ray reveals a poorly demarcated abnormality in the heart and requires CT imaging for further analysis. What would most likely be seen on CT imaging? (A) Tumor within the right atria (B) Fistula between the right and left atria (C) Normal cardiac imaging (D) Tumor within the left atria
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['(D) Tumor within the left atria <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 30-year-old woman is brought to the emergency department because of a 30-minute history of palpitations, dizziness, and chest discomfort. She has also not urinated since she woke up. She has a history of fibromyalgia treated with clomipramine. There is no family history of serious illness. She does not smoke or drink alcohol. Her temperature is 37°C (98.6°F), pulse is 120/min, and blood pressure is 90/60 mm Hg. On mental status examination, she is confused. Examination shows dilated pupils and dry skin. The abdomen is distended, there is tenderness to deep palpation of the lower quadrants with no guarding or rebound and dullness on percussion in the suprapubic region. An ECG shows tachycardia and a QRS complex width of 110 ms. Activated carbon is administered. The patient is intubated. Intravenous fluids and oxygenation are begun. Which of the following is the most appropriate pharmacotherapy for this patient? (A) Glucagon (B) Cyproheptadine (C) Sodium bicarbonate (D) Lorazepam
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['(C) Sodium bicarbonate <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 32-year-old female comes to the physician because of recurrent episodes of abdominal pain, bloating, and loose stools lasting several days to a couple weeks. She has had these episodes since she was 24 years old but they have worsened over the last 6 weeks. The site of the abdominal pain and the intensity of pain vary. She has around 3–4 bowel movements per day during these episodes. Menses are regular at 31 day intervals with moderate flow; she has moderate pain in her lower abdomen during menstruation. She moved from a different city 2 months ago to start a new demanding job. Her mother has been suffering from depression for 10 years. She does not smoke or drink alcohol. Her own medications include multivitamins and occasionally naproxen for pain. Temperature is 37.4°C (99.3°F), pulse is 88/min, and blood pressure is 110/82 mm Hg. Abdominal examination shows no abnormalities. Laboratory studies show: Hemoglobin 14.1 g/dL Leukocyte count 8100/mm3 Erythrocyte sedimentation rate 15 mm/h Serum Glucose 96 mg/dL Creatinine 1.1 mg/dL IgA anti-tissue transglutaminase antibody negative Urinalysis shows no abnormalities. Further evaluation is most likely to show which of the following in this patient?" (A) Weight loss (B) Bright red blood in the stool (C) Relief of abdominal pain after defecation (D) Abdominal pain at night
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['(C) Relief of abdominal pain after defecation <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 55-year old man living in Midwest USA comes in complaining of painless hematuria for the past week. He denies dysuria but complains of fatigue and lethargy at work. He has lost about 9.0 kg (20.0 lb) in the past 6 months. He drinks 1–2 beers on the weekends over the past 10 years but denies smoking. He has worked at a plastic chemical plant for the past 30 years and has never been out of the country. His father died of a heart attack at age 62 and his mother is still alive and well. There is a distant history of pancreatic cancer, but he can not remember the specifics. His vitals are stable and his physical exam is unremarkable. Urinary analysis is positive for RBCs. A cystoscopy is performed and finds a pedunculated mass projecting into the bladder lumen. A biopsy shows malignant cells. Which of the following is the most concerning risk factor for this patient’s condition? (A) Genetic predisposition (B) Alcohol (C) Vinyl chloride exposure (D) Aromatic amine exposure
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['(D) Aromatic amine exposure <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 74-year-old woman is brought to the physician by her husband because of difficulty sleeping for several years. She says that she has been gradually sleeping less each night over the past 2 years. It takes her 20–25 minutes to fall asleep each night and she wakes up earlier in the morning than she used to. On average, she sleeps 5–6 hours each night. She says that she has also been waking up several times per night and needs about 20 minutes before she is able to fall back to sleep. She feels mildly tired in the afternoon but does not take any naps. Her husband reports that she does not snore. The patient drinks two cups of coffee each morning, but she does not smoke or drink alcohol. She takes a 45 minute walk with her husband and their dog every other day. She is 160 cm (5 ft 3 in) tall and weighs 55 kg (121 lb); BMI is 21 kg/m2. Vital signs are within normal limits. On mental status examination, she appears cooperative with a mildly anxious mood and a full range of affect. Which of the following is the most appropriate next step in management? (A) Sleep restriction (B) Flurazepam (C) Reassurance (D) Paradoxical intention
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['(C) Reassurance <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 58-year-old man with an unknown previous medical history is found on the floor at home by his daughter. During the initial assessment, the patient has right-sided arm weakness and incomprehensible speech. The patient is admitted to the hospital where he is diagnosed with an ischemic stroke where his magnetic resonance image (MRI) scan showed diffusion restriction in the right middle cerebral artery (MCA) territory. Further evaluation reveals the patient had been on the floor for about 2 days before he was found by his daughter. At presentation to the hospital, the blood pressure is 161/88 mm Hg and the heart rate is 104/min and regular. His laboratory values at the time of admission are shown: BUN 40 mg/dL Creatinine 1.9 mg/dL Potassium 5.3 mEq/dL Sodium 155 mEq/dL Chloride 100 mEq/dL HCO3 24 mmol/L Hemoglobin 13.8 g/dL Hematocrit 40% Leukocytes 11,000/mL Platelets 300,000/µL Serum creatine kinase 40,000 U/L Which of the following is most indicated in this patient? (A) Forced diuresis with intravenous (IV) fluids (B) Stress echocardiography (C) Transfusion of fresh frozen plasma (FFP) (D) Rhythm control with metoprolol
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['(A) Forced diuresis with intravenous (IV) fluids <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 60-year-old man is brought to the emergency department by police officers because he was acting strangely in public. The patient was found talking nonsensically to characters on cereal boxes in the store. Past medical history is significant for multiple hospitalizations for alcohol-related injuries and seizures. The patient’s vital signs are within normal limits. Physical examination shows a disheveled male who is oriented to person, but not time or place. Neurologic examination shows nystagmus and severe gait ataxia. A T1/T2 MRI is performed and demonstrates evidence of damage to the mammillary bodies. The patient is given the appropriate treatment for recovering most of his cognitive functions. However, significant short-term memory deficits persist. The patient remembers events from his past such as the school and college he attended, his current job, and the names of family members quite well. Which of the following is the most likely diagnosis in this patient? (A) Delirium tremens (B) Korsakoff's syndrome (C) Schizophrenia (D) Wernicke encephalopathy
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["(B) Korsakoff's syndrome <> answer"]
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