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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A previously healthy 53-year-old man is brought to the emergency department 45 minutes after the onset of a severe headache. He returned from a vacation in the mountains 4 days ago, during which he went swimming in a freshwater lake. On arrival, he is confused. His temperature is 39°C (102.2°F) and blood pressure is 105/68 mm Hg. Neurologic examination shows diffuse hyperreflexia. An MRI of the brain shows asymmetrical, bitemporal hyperintensities. A lumbar puncture is performed. Cerebrospinal fluid analysis shows: Leukocyte count 120/mm3 Segmented neutrophils 10% Lymphocytes 90% Erythrocyte count 15/mm3 Glucose 45 mg/dL Opening pressure 130 mm Hg Protein 75 mg/dL Which of the following is the most likely causal pathogen?" (A) Herpes simplex virus (B) La Crosse virus (C) Enterovirus (D) Rabies virus
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['(A) Herpes simplex virus <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** An 18-year-old man presents to the emergency department with complaints of sudden severe groin pain and swelling of his left testicle. It started roughly 5 hours ago and has been progressively worsening. History reveals that he has had multiple sexual partners but uses condoms regularly. Vital signs include: blood pressure 120/80 mm Hg, heart rate 84/min, respiratory rate 18/min, and temperature 36.6°C (98.0°F). Physical examination reveals that he has an impaired gait and a tender, horizontal, high-riding left testicle and absent cremasteric reflex. Which of the following is the best next step for this patient? (A) Urinalysis (B) Antibiotics (C) Surgery (D) Ultrasound of the scrotum
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['(C) Surgery <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 35-year-old man presents to his primary care provider in Philadelphia with a skin rash on his right thigh. He reports that the rash appeared 3 days ago. He recently returned from a weeklong trip to his vacation home in central Pennsylvania. He denies pain, numbness, paresthesias, itchiness, or burning around the rash. He does not recall finding any ticks on his body. He otherwise feels well. His past medical history is notable for gout. He takes allopurinol. He is an avid hiker and spends 3 months out of the year hiking. He does not smoke and drinks alcohol socially. On exam, he has a bullseye-like circular erythematous rash on the anterolateral aspect of his right thigh. The doctor decides to perform a new serum test for Lyme disease that was trialed at the same hospital in Philadelphia, where it was shown to have a sensitivity of 91% and specificity of 94%. The prevalence of Lyme disease in the area is among the highest in the country. How would the sensitivity and specificity of this new test change if it were performed on a patient in Texas, an area with a very low prevalence of Lyme disease? (A) A (B) B (C) D (D) E
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['(A) A <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 34-year-old man was brought into the emergency room after he was found running in the streets. Upon arrival to the emergency room, he keeps screaming, “they are eating me alive," and swatting his hands. He reports that there are spiders crawling all over him. His girlfriend, who arrives shortly after, claims that he has been forgetful and would forget his keys from time to time. He denies weight loss, fever, shortness of breath, abdominal pain, or urinary changes but endorses chest pain. His temperature is 98.9°F (37.2°C), blood pressure is 160/110 mmHg, pulse is 112/min, respirations are 15/min, and oxygen saturation is 98%. He becomes increasingly agitated as he believes the healthcare providers are trying to sacrifice him to the “spider gods.” What is the most likely explanation for this patient’s symptoms? (A) Cocaine use (B) Narcolepsy (C) Pick disease (D) Schizophrenia
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['(A) Cocaine use <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 21-year-old man was involved in a motor vehicle accident and died. At autopsy, the patient demonstrated abnormally increased mobility at the neck. A section of cervical spinal cord at C6 was removed and processed into slides. Which of the following gross anatomic features is most likely true of this spinal cord level? (A) Prominent lateral horns (B) Least amount of white matter (C) Absence of gray matter enlargement (D) Cuneate and gracilis fasciculi are present
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['(D) Cuneate and gracilis fasciculi are present <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 23-year-old man presents with increasing neck pain for several months that does not improve with nonsteroidal anti-inflammatory drugs. The patient says he has had neck pain ever since he was involved in a motor vehicle accident 10 months ago. For the last 2 weeks, he says he has also noticed weakness and numbness in his hands and has difficulty gripping objects. Physical examination reveals a thermal injury that he says he got while holding a hot cup of coffee a week ago when he could not feel the warmth of the coffee mug. Strength is 4/5 bilaterally during elbow flexion and extension and wrist extension. He also has exaggerated deep tendon reflexes bilaterally and decreased sensation symmetrically on the dorsal and ventral surface of both forearms and hands. Which of the following additional findings would you expect to find in this patient? (A) Fusion of cervical vertebrae (B) Hypoplasia of the cerebellar vermis (C) A cavitation in the cervical spinal cord (D) Cervical spinal epidural abscess
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['(C) A cavitation in the cervical spinal cord <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 24-year-old man is referred to an endocrinologist for paroxysms of headaches associated with elevated blood pressure and palpitations. He is otherwise healthy, although he notes a family history of thyroid cancer. His physical examination is significant for the findings shown in Figures A, B, and C. His thyroid is normal in size, but there is a 2.5 cm nodule palpable in the right lobe. On further workup, it is found that he has elevated plasma-free metanephrines and a normal TSH. Fine-needle aspiration of the thyroid nodule stains positive for calcitonin. The endocrinologist suspects a genetic syndrome. What is the most likely inheritance pattern? (A) Autosomal dominant (B) Autosomal recessive (C) Mitochondrial (D) X-linked dominant
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['(A) Autosomal dominant <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 37-year-old man presents to his primary care provider complaining of bilateral arm numbness. He was involved in a motor vehicle accident 3 months ago. His past medical history is notable for obesity and psoriatic arthritis. He takes adalimumab. His temperature is 99.3°F (37.4°C), blood pressure is 130/85 mmHg, pulse is 90/min, and respirations are 18/min. On exam, superficial skin ulcerations are found on his fingers bilaterally. His strength is 5/5 bilaterally in shoulder abduction, arm flexion, arm extension, wrist extension, finger abduction, and thumb flexion. He demonstrates loss of light touch and pinprick response in the distal tips of his 2nd and 5th fingertips and over the first dorsal web space. Vibratory sense is intact in the bilateral upper and lower extremities. Which of the following nervous system structures is most likely affected in this patient? (A) Ventral white commissure (B) Cuneate fasciculus (C) Anterior corticospinal tract (D) Spinocerebellar tract
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['(A) Ventral white commissure <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 29-year-old woman at 38 weeks gestation comes to the emergency room with regular contractions and spontaneous rupture of membranes. She subsequently delivers a 3500g (7lbs 7oz) newborn with ambiguous genitalia by spontaneous vaginal delivery. Her pregnancy and labor was uncomplicated. Examination of the newborn demonstrated no palpable gonads at the inguinal canal or perineum. Karyotype analysis demonstrated 46,XX. What is the best explanation for this patient’s presentation? (A) Defective androgen receptors (B) Defective migration of gonadotropin-releasing hormone (GnRH) releasing neurons (C) Deficiency of 5-alpha-reductase (D) Exposure to excessive androgenic steroids during gestation
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['(D) Exposure to excessive androgenic steroids during gestation <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 33-year-old woman presents with lethargy and neck pain. She says that, for the past 6 months, she has been feeling tired all the time and has noticed a lot of muscle tension around the base of her neck. She also says she finds herself constantly worrying about everything, such as if her registered mail would reach family and friends in time for the holidays or if the children got their nightly bath while she was away or the weekend. She says that this worrying has prevented her from sleeping at night and has made her more irritable and edgy with her family and friends. Which of the following is the best course of treatment for this patient? (A) Buspirone (B) Diazepam (C) Family therapy (D) Support groups
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['(A) Buspirone <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 45-year-old woman comes to the emergency department because of severe pain in both of her wrist joints and her fingers for the past 24 hours. She has a 6-month history of similar episodes, which are often associated with stiffness for about 90 minutes when she wakes up in the morning. She has hyperlipidemia and hypertension. Two years ago she was diagnosed with peptic ulcer disease, for which she underwent treatment. Current medications include fenofibrate and amlodipine. Vital signs are within normal limits. She is 175 cm (5 ft 9 in) tall and weighs 102 kg (225 lb); BMI is 33 kg/m2. Examination shows swelling and tenderness of the wrists and metacarpophalangeal joints bilaterally. Range of motion is decreased due to pain. There are subcutaneous, nontender, firm, mobile nodules on the extensor surface of the forearm, with the overlying skin appearing normal. Which of the following is the most appropriate treatment for this patient's current symptoms? (A) Indomethacin (B) Prednisolone (C) Vitamin D and calcium supplements (D) Sulfasalazine
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['(B) Prednisolone <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 16-year-old boy comes to the physician with a 4-day history of sore throat and mild fever. He is on the varsity soccer team at his high school, but has been unable to go to practice for the last few days because he has been very tired and is easily exhausted. He has no history of serious illness and takes no medications. His mother has type 2 diabetes mellitus. He appears weak and lethargic. His temperature is 38.7°C (101.7°F), pulse is 84/min, and blood pressure is 116/78 mm Hg. Examination shows enlarged, erythematous, and exudative tonsils; posterior cervical lymphadenopathy is present. Abdominal examination shows no abnormalities. His hemoglobin concentration is 14.5 g/dL and leukocyte count is 11,200/mm3 with 48% lymphocytes. A heterophile antibody test is positive. In addition to supportive therapy, which of the following is the most appropriate next step in management? (A) Write a medical note that excuses from soccer events (B) Oral amoxicillin therapy (C) Oral corticosteroid therapy (D) Intravenous acyclovir therapy
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['(A) Write a medical note that excuses from soccer events <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 44-year-old man presents for a routine check-up. He has a past medical history of rheumatic fever. The patient is afebrile, and the vital signs are within normal limits. Cardiac examination reveals a late systolic crescendo murmur with a mid-systolic click, best heard over the apex and loudest just before S2. Which of the following physical examination maneuvers would most likely cause an earlier onset of the click/murmur? (A) Handgrip (B) Left lateral decubitus position (C) Rapid squatting (D) Standing
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['(D) Standing <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** An 18-year-old male was brought to the emergency room after he caused an accident by driving at a slow speed as he was entering the freeway. He appears to have sustained no major injuries just minor scratches and lacerations, but appears to be paranoid, anxious, and is complaining of thirst. He has conjunctival injection and has slowed reflexes. A police officer explained that he had confiscated contraband from the vehicle of the male. Which of the following substances was most likely used by the male? (A) Phencyclidine (PCP) (B) Cocaine (C) Alprazolam (D) Marijuana
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['(D) Marijuana <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 38-year-old man with a history of hypertension presents to his primary care physician for a headache and abdominal pain. His symptoms began approximately 1 week ago and have progressively worsened. He describes his headache as pressure-like and is mildly responsive to ibuprofen. His abdominal pain is located in the bilateral flank area. His hypertension is poorly managed with lifestyle modification and chlorthalidone. He had 1 urinary tract infection that was treated with ciprofloxacin approximately 6 months ago. He has a home blood pressure monitor, where his average readings are 155/95 mmHg. Family history is significant for his father expiring secondary to a myocardial infarction and his history was complicated by refractory hypertension and end-stage renal disease. His vital signs are significant for a blood pressure of 158/100 mmHg. Physical examination is notable for bilateral flank masses. Laboratory testing is significant for a creatinine of 3.1 mg/dL. Urinalysis is remarkable for hematuria and proteinuria. Which of the following will this patient most likely be at risk for developing? (A) Epilepsy (B) Lymphangioleiomyomatosis (C) Mitral valve prolapse (D) Neuroendocrine pancreatic tumor
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['(C) Mitral valve prolapse <> 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 physician because of progressive burning pain and intermittent “electrical shocks” in his right chest for 3 months. Over the last 2 weeks, the pain has increased to an extent that he can no longer tolerate clothing on the affected area. Three months ago, he had a rash around his right nipple and axilla that resolved a week later. The patient had a myocardial infarction 2 years ago. He has smoked one packs of cigarettes daily for 47 years. Current medications include aspirin, simvastatin, metoprolol, and ramipril. His temperature is 36.9°C (97.9°F), pulse is 92/min, and blood pressure is 150/95 mm Hg. Examination shows increased sensation to light touch over the right chest. The remainder of the physical examination shows no abnormalities. Which of the following is the most appropriate next step in management? (A) Sublingual nitrates (B) Oral tricyclic antidepressants (C) Oral famciclovir (D) Oral gabapentin
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['(D) Oral gabapentin <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 55-year-old man who recently immigrated to the United States from Azerbaijan comes to the physician because of a 6-week history of recurrent fever, progressive cough with bloody streaks, fatigue, and a 3.6-kg (8-lb) weight loss. He has poorly-controlled type 2 diabetes mellitus treated with insulin. An x-ray of the chest shows a cavitary lesion of the posterior apical segment of the right upper lobe with consolidation of the surrounding parenchyma. He is started on a treatment regimen with a combination of drugs. A culture of the sputum identifies a causal pathogen that is resistant to a drug that alters the metabolism of pyridoxine. Which of the following is the most likely mechanism of resistance to this drug? (A) Increased production of arabinosyl transferase (B) Impaired conversion to pyrazinoic acid (C) Mutation in genes encoding RNA polymerase (D) Decreased production of catalase-peroxidase
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['(D) Decreased production of catalase-peroxidase <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 69-year-old man presents to his dermatologist with an enlarging, scaly pink plaque on his face. It has been present for 5 weeks and is shown. Physical examination reveals a friable lesion that bleeds easily. Medical history is remarkable for type 1 diabetes mellitus complicated by end-stage kidney disease, which required kidney transplantation 5 years ago. The patient also reports a history of common viral warts but has not had any in several years. A skin biopsy of the lesion reveals full-thickness keratinocyte atypia with keratin pearls. Which of the following is a key risk factor for this patient's condition? (A) Atypical nevi (B) Immunosuppression (C) Hepatitis C virus (D) Human immunodeficiency virus
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['(B) Immunosuppression <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** You are seeing a 4-year-old boy in clinic who is presenting with concern for a primary immune deficiency. He has an unremarkable birth history, but since the age of 6 months he has had recurrent otitis media, bacterial pneumonia, as well as two episodes of sinusitis, and four episodes of conjunctivitis. He has a maternal uncle who died from sepsis secondary to H. influenza pneumonia. If you drew blood work for diagnostic testing, which of the following would you expect to find? (A) Abnormally low number of B cells (B) Abnormally high number of B cells (C) Abnormally high number of T cells (D) Elevated immunoglobulin levels
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['(A) Abnormally low number of B cells <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 44-year-old G5P3 presents with a 2-year history of leaking urine upon exerting herself, coughing, and laughing. Her symptoms are only present in the daytime. She denies urgency, nocturia, or painful urination. She has no menstrual cycle disturbances. Her husband is her only sexual partner. She has a 12 pack-year smoking history, a 3-year history of chronic bronchitis, and a 3-year history of arterial hypertension. She takes fosinopril (10 mg), metoprolol (50 mg), and atorvastatin (10 mg) daily. Her weight is 88 kg (194 lb) and the height is 160 cm (5.2 ft). On examination, the vital signs are as follows: blood pressure 130/80 mm Hg, heart rate 78/min, respiratory rate 14/min, and temperature 36.7℃ (98℉). Lung auscultation revealed bilateral lower lobe rales. No costovertebral angle or suprapubic tenderness are present. Which of the following findings is most likely to be revealed by the gynecologic examination? (A) Rectocele (B) Ovarian mass (C) Purulent cervical discharge (D) Cystocele
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['(D) Cystocele <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 32-year-old G2P0A1 woman presents at 36 weeks of gestation for the first time during her pregnancy. The patient has no complaints, currently. However, her past medical history reveals seizure disorder, which is under control with valproic acid and lithium. She has not seen her neurologist during the past 2 years, in the absence of any complaints. She also reports a previous history of elective abortion. The physical examination is insignificant. Her blood pressure is 130/75 mm Hg and pulse is 80/min. The patient is scheduled to undergo regular laboratory tests and abdominal ultrasound. Given her past medical history, which of the following conditions is her fetus most likely going to develop? (A) Trisomy 21 (B) Neural tube defects (NTDs) (C) Intrauterine growth restriction (D) Limb anomalies
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['(B) Neural tube defects (NTDs) <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 45-year-old man is transferred to the intensive care unit from the emergency department for acute respiratory failure. He was rushed to the hospital after developing progressive respiratory distress over the last 24 hours. His medical history is significant for long-standing severe persistent asthma, hypertension, and several bouts of community and hospital-acquired pneumonia. His medications include amlodipine, lisinopril, inhaled fluticasone, salmeterol, and oral prednisone. He is a lifelong non-smoker and drinks alcohol occasionally on the weekends. He works as a sales executive and went to Hawaii a month ago. In the emergency department, he was started on broad-spectrum antibiotics and bronchodilators. His respiratory failure progressively worsens, and on day 2 of admission, he requires mechanical ventilator support. Chest X-ray shows multiple nodules bilaterally in the lower lobes. Flexible bronchoscopy is performed and the bronchoalveolar lavage sample from the medial segment of the right lower lobe shows neutrophils, and the fungal preparation shows Aspergillus fumigatus. A video-assisted thoracoscopy is performed and biopsy from the right lower lobe is taken which shows plugging of the terminal bronchioles with mucus, inflammatory cells, and fungal vascular invasion. Which of the following is the most likely mechanism responsible for the biopsy findings? (A) Defects in the immune response (B) Aspergillus fumigatus suppresses the production of IgA (C) Aspergillus fumigatus suppresses the production of IgM (D) Suppression of the innate immune system by Aspergillus fumigatus
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['(A) Defects in the immune response <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 65-year-old man presents to the diabetes clinic for a check-up. He has been successfully managing his diabetes through diet alone, and has not experienced any complications related to retinopathy, neuropathy, or nephropathy. He recently started a new exercise regimen and is eager to see whether his weight has declined since his last visit. The nurse measures his height to be 170 cm and his weight to be 165 lb (75 kg). What range does this patient’s body mass index currently fall into? (A) < 18.5 (B) 25.0 - 29.9 (C) > 30.0 (D) > 40.0
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['(B) 25.0 - 29.9 <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A research group is investigating an allosteric modulator to improve exercise resistance and tolerance at low-oxygen conditions. The group has created cultures of myocytes derived from high-performance college athletes. The application of this compound to these cultures in a low-oxygen environment and during vigorous contraction leads to longer utilization of glucose before reaching a plateau and cell death; however, the culture medium is significantly acidified in this experiment. An activating effect on which of the following enzymes would explain these results? (A) Pyruvate dehydrogenase (B) Bisphosphoglycerate mutase (C) Malate dehydrogenase (D) Lactate dehydrogenase
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['(D) Lactate dehydrogenase <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 23-year-old college student presents with his parents for a follow-up appointment. He was recently diagnosed with schizophrenia and was started on risperidone approx. 2 months ago. He reports a significant improvement since the start of treatment. His parents report that their son’s symptoms of delusions, hallucinations, and paranoid behavior have been ameliorated. On physical examination, the patient seems uncomfortable. He frequently fidgets and repeatedly crosses and uncrosses his legs. When asked if something is troubling him, he gets up and starts pacing. He says, “It’s always like this. I cannot sit still. It is frustrating.” What is the most likely diagnosis? (A) Akathisia (B) Generalized anxiety disorder (C) Restless legs syndrome (D) Tardive dyskinesia
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['(A) Akathisia <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 25-year-old woman has dysuria, pyuria, increased frequency of urination, and fever of 1-day duration. She is sexually active. Urine cultures show gram-positive bacteria in clusters that are catalase-positive and coagulase-negative. The patient is started on trimethoprim-sulfamethoxazole. Which of the following characteristics is used to identify the offending organism? (A) Beta hemolysis (B) Sensitivity to novobiocin (C) Sensitivity to bacitracin (D) Resistance to novobiocin
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['(D) Resistance to novobiocin <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 72-year-old patient is referred to an ophthalmologist because he has noticed some mild discomfort in his eyes though his vision remains unchanged. He cannot recall when this feeling started. His past medical history is significant for diabetes mellitus and two myocardial infarctions that have led to significant cardiac dysfunction. Specifically, he has dyspnea and peripheral edema and occasionally decompensates into more severe pulmonary edema requiring hospitalization. Testing reveals increased intra-ocular pressure so the ophthalmologist prescribes several medications. The medication for this disorder that is most likely to be contraindicated in this patient has which of the following characteristics? (A) It decreases intracellular cyclic AMP levels (B) It increases intracellular calcium levels (C) It increases adenylyl cyclase activity (D) It is produced by cyclooxygenase
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['(A) It decreases intracellular cyclic AMP levels <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A previously healthy 49-year-old woman comes to the emergency department because of chest pain that radiates to her back. The pain started 45 minutes ago while she was having lunch. Over the past 3 months, she has frequently had the feeling of food, both liquid and solid, getting “stuck” in her chest while she is eating. The patient's vital signs are within normal limits. An ECG shows a normal sinus rhythm with no ST-segment abnormalities. An esophagogram is shown. Further evaluation is most likely to show which of the following? (A) Simultaneous multi-peak contractions on manometry (B) Elevated lower esophageal sphincter pressure on manometry (C) Gastroesophageal junction mass on endoscopy (D) Hypertensive contractions on manometry
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['(A) Simultaneous multi-peak contractions on manometry <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 2-year-old girl is brought to the physician by her parents because of clumsiness and difficulty walking. She began to walk at 12 months and continues to have difficulty standing still without support. She also appears to have difficulty grabbing objects in front of her. Over the past year, she has had 5 episodes of sinusitis requiring antibiotic treatment and was hospitalized twice for bacterial pneumonia. Physical examination shows an unstable, narrow-based gait and several hyperpigmented skin patches. Serum studies show decreased levels of IgA and IgG and an increased level of alpha-fetoprotein. Over the next 5 years, which of the following complications is this patient most likely to develop? (A) Chronic eczema (B) Conjunctival telangiectasias (C) Cardiac rhabdomyoma (D) Chronic lymphocytic leukemia
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['(B) Conjunctival telangiectasias <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 32-year-old woman comes to the physician because of pain and stiffness in both of her hands for the past 3 weeks. The pain is most severe early in the day and does not respond to ibuprofen. She has no history of serious illness and takes no medications. Vital signs are within normal limits. Examination shows swelling and tenderness of the wrists and metacarpophalangeal joints bilaterally. Range of motion is decreased due to pain. There are subcutaneous, nontender, firm, mobile nodules on the extensor surface of the forearm. Which of the following is the most appropriate pharmacotherapy for this patient's current symptoms? (A) Methotrexate (B) Colchicine (C) Sulfasalazine (D) Prednisone
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['(D) Prednisone <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 72-year-old woman is brought to the physician by her son for an evaluation of cognitive decline. Her son reports that she has had increased difficulty finding her way back home for the last several months, despite having lived in the same city for 40 years. He also reports that his mother has been unable to recall the names of her relatives and been increasingly forgetting important family gatherings such as her grandchildren's birthdays over the last few years. The patient has hypertension and type 2 diabetes mellitus. She does not smoke or drink alcohol. Her current medications include enalapril and metformin. Her temperature is 37°C (98.6°F), pulse is 70/min, and blood pressure is 140/80 mm Hg. She is confused and oriented only to person and place. She recalls 2 out of 3 words immediately and 1 out of 3 after 5 minutes. Her gait and muscle strength are normal. Deep tendon reflexes are 2+ bilaterally. The remainder of the examination shows no abnormalities. Further evaluation is most likely to reveal which of the following findings? (A) Hallucinations (B) Resting tremor (C) Generalized cerebral atrophy (D) Urinary incontinence
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['(C) Generalized cerebral atrophy <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** An American doctor is on an outreach trip to visit local communities in Ethiopia. In one clinic, he found many cases of children ages 2–5 years who have significantly low weight and height for their age. These children also had pale sclerae, distended abdomens, dermatoses, and marked edema in the lower extremities. Malnutrition in these patients is investigated and classified as (kwashiorkor) protein malnutrition. Appropriate nutrition supplementation was ordered and shipped in for the affected families. Which of the following amino acids must be included for these patients? (A) Alanine (B) Tyrosine (C) Arginine (D) Methionine
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['(D) Methionine <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 29-year-old man presents to his primary care provider complaining of not being able to get enough rest at night. He goes to bed early enough and has otherwise good sleep hygiene but feels drained the next day. He feels he is unable to perform optimally at work, but he is still a valued employee and able to complete his share of the work. About a month ago his wife of 5 years asked for a divorce and quickly moved out. He has cut out coffee after 12 pm and stopped drinking alcohol. He also exercises 3 days per week. Today, his blood pressure is 120/80 mm Hg, heart rate is 95/min, respiratory rate is 25/min, and temperature is 37.0°C (98.6°F ). On physical exam, his heart has a regular rate and rhythm and his lungs are clear to auscultation bilaterally. A CMP, CBC, and thyroid test are negative. Which of the following statements best describes this patient’s condition? (A) Symptoms will wax and wane but may persist for 6-12 months (B) Symptoms are persistent and must resolve within 6 months of the stressor terminating (C) Symptoms develop within 3 months of the stressor (D) Symptoms are usually self-limited and may persist for 2 years
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['(A) Symptoms will wax and wane but may persist for 6-12 months <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** Renal clearance of substance Y is experimentally studied. At a constant glomerular filtration rate, it is found that the amount of substance Y excreted is greater than the amount filtered. This holds true across all physiologic values on the titration curve. Substance Y is most similar to which of the following? (A) Magnesium (B) Bicarbonate (C) Para-amino hippuric acid (D) Glucose
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['(C) Para-amino hippuric acid <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 68-year-old man presents to the office with his wife complaining of difficulty in swallowing, which progressively worsened over the past month. He has difficulty in initiating swallowing and often has to drink water with solid foods. He has no problems swallowing liquids. His wife is concerned about her husband’s bad breath. Adding to his wife, the patient mentions a recent episode of vomiting where the vomit smelled ‘really bad’ and contained the food that he ate 2 days before. On examination, the patient’s blood pressure is 110/70 mm Hg, pulse rate is 72/min, with normal bowel sounds, and no abdominal tenderness to palpation. A barium swallow radiograph is taken which reveals a localized collection of contrast material in the cervical region suggestive of an outpouching. Which of the following statements best describes the lesion seen on the radiograph? (A) Persistence of an embryologic structure (B) Outpouching of all 3 layers of the esophageal mucosal tissue distal to the upper esophageal sphincter (C) Increased pressure above the upper esophageal sphincter resulting in a defect in the wall (D) Failure of neural crest migration into the Auerbach plexus
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['(C) Increased pressure above the upper esophageal sphincter resulting in a defect in the wall <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** Thirty minutes after delivery, a 1780-g (3-lb 15-oz) male newborn develops respiratory distress. He was born at 30 weeks' gestation via vaginal delivery. His temperature is 36.8C (98.2F), pulse is 140/min, respirations are 64/min, and blood pressure is 61/32 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 90%. Examination shows pale extremities. Grunting and moderate subcostal retractions are present. Pulmonary examination shows decreased breath sounds bilaterally. Supplemental oxygen is administered. Ten minutes later, his pulse is 148/min and respirations are 66/min. Pulse oximetry on 60% oxygen shows an oxygen saturation of 90%. Which of the following is the most likely diagnosis? (A) Respiratory distress syndrome (B) Tracheomalacia (C) Neonatal pneumonia (D) Tracheoesophageal fistula
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['(A) Respiratory distress syndrome <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 14-year-old Asian girl is brought to the physician because of a 6-week history of fatigue. During this period, she has had a 3-kg (6.6-lb) weight loss and intermittent low-grade fevers. She also reports recurrent episodes of pain in her left wrist and right knee. She has no personal history of serious illness. Her aunt has rheumatoid arthritis. The patient appears pale. Her temperature is 38°C (100.4°F). Examination shows diffuse lymphadenopathy. Oral examination shows several painless oral ulcers. The left wrist and the right knee are swollen and tender to touch. The remainder of the examination shows no abnormalities. Laboratory studies show a hemoglobin concentration of 10 g/dL, a leukocyte count of 3,000/mm3, and a platelet count of 80,000/mm3. Urinalysis shows excessive protein. Further evaluation of this patient is most likely to show which of the following findings? (A) Anti-citrullinated peptide antibodies (B) Positive monospot test (C) Anti-dsDNA antibodies (D) Elevated serum IgA levels
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['(C) Anti-dsDNA antibodies <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 13-month-old girl is brought to the physician because of a pruritic rash for 2 days. The girl's mother says she noticed a few isolated skin lesions on her trunk two days ago that appear to be itching. The girl received her routine immunizations 18 days ago. Her mother has been giving her ibuprofen for her symptoms. The patient has no known sick contacts. She is at the 71st percentile for height and the 64th percentile for weight. She is in no acute distress. Her temperature is 38.1°C (100.6°F), pulse is 120/min, and respirations are 26/min. Examination shows a few maculopapular and pustular lesions distributed over the face and trunk. There are some excoriation marks and crusted lesions as well. Which of the following is the most likely explanation for these findings? (A) Antigen contact with presensitized T-lymphocytes (B) Reactivation of virus dormant in dorsal root ganglion (C) Crosslinking of preformed IgE antibodies (D) Replication of the attenuated vaccine strain
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['(D) Replication of the attenuated vaccine strain <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 34-year-old man presents to his dermatologist with white scaly papules and plaques on his extensor arms, elbows, knees, and shins. Scaly and flaky eruptions are also present on his ears, eyebrows, and scalp. He describes the lesions as being itchy and irritating. When the scales are scraped away, pinpoint bleeding is noted. His vital signs are unremarkable, and physical examination is otherwise within normal limits. Which of the following is the best initial test for this patient’s condition? (A) Skin biopsy (B) Serum autoantibodies (C) No tests are necessary (D) Wood’s lamp
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['(C) No tests are necessary <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 23-year-old patient who has recently found out she was pregnant presents to her physician for her initial prenatal visit. The estimated gestational age is 10 weeks. Currently, the patient complains of recurrent palpitations. She is gravida 1 para 0 with no history of any major diseases. On examination, the blood pressure is 110/60 mm Hg heart rate, heart rate 94/min irregular, respiratory rate 12/min, and temperature 36.4°C (97.5°F). Her examination is significant for an opening snap before S2 and diastolic decrescendo 3/6 murmur best heard at the apex. No venous jugular distension or peripheral edema is noted. The patient’s electrocardiogram (ECG) is shown in the image. Cardiac ultrasound reveals the following parameters: left ventricular wall thickness 0.4 cm, septal thickness 1 cm, right ventricular wall thickness 0.5 cm, mitral valve area 2.2 cm2, and tricuspid valve area 4.1 cm2. Which of the following statements regarding this patient’s management is correct? (A) The patient requires balloon commissurotomy. (B) Warfarin should be used for thromboembolism prophylaxis. (C) It is reasonable to start antidiuretic therapy right at this moment. (D) Beta-blockers are the preferable drug class for rate control in this case.
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['(D) Beta-blockers are the preferable drug class for rate control in this case. <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 52-year-old woman presents with mild epigastric pain and persistent heartburn for the past 2 months. An endoscopy is performed and reveals inflammation of the stomach mucosa without evidence of ulceration. A biopsy is performed and reveals intestinal metaplasia with destruction of a large number of parietal cells. She is diagnosed with chronic atrophic gastritis. Which of the following is characteristic of this patient’s diagnosis? (A) It is the most common cause of folate deficiency in the US. (B) Caused by a gram-negative rod that is urease positive (C) MALT lymphoma is a common complication. (D) Destruction of the mucosa of the stomach is mediated by T cells.
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['(D) Destruction of the mucosa of the stomach is mediated by T cells. <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A physician at an internal medicine ward notices that several of his patients have hyponatremia without any associated symptoms. Severe hyponatremia, often defined as < 120 mEq/L, is associated with altered mental status, coma, and seizures, and warrants treatment with hypertonic saline. Because some patients are chronically hyponatremic, with serum levels < 120 mEq/L, but remain asymptomatic, the physician is considering decreasing the cutoff for severe hyponatremia to < 115 mEq/L. Changing the cutoff to < 115 mEq/L would affect the validity of serum sodium in predicting severe hyponatremia requiring hypertonic saline in which of the following ways? (A) Increased specificity and decreased negative predictive value (B) Decreased specificity and increased negative predictive value (C) Increased sensitivity and decreased positive predictive value (D) Increased specificity and decreased positive predictive value
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['(A) Increased specificity and decreased negative predictive value <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 43-year-old man with a history of untreated HIV presents with fever, shortness of breath, and a nonproductive cough for the past week. Past medical history is significant for HIV diagnosed 10 years ago and never treated. His most recent CD4+ T cell count was 105/µL. Physical examination reveals bilateral crepitus over all lobes. No lymphadenopathy is present. A chest radiograph reveals bilateral infiltrates. Which of the following is the best treatment for this patient? (A) Highly active antiretroviral therapy (HAART) (B) Trimethoprim-sulfamethoxazole (C) Ganciclovir (D) Azithromycin
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['(B) Trimethoprim-sulfamethoxazole <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 21-year-old man presents for a pre-employment medical check-up. He has a history of persistent asthma and regularly uses inhaled fluticasone for prophylaxis. For the last week, he has been experiencing increasing symptoms, such as night time cough and wheezing on exertion. Because his albuterol metered-dose inhaler ran out, he has been taking oral albuterol 3 times a day for the last 3 days, which has improved his symptoms. The physician performs a complete physical examination and orders laboratory tests. Which of the following findings is most likely to be present on his physical examination or laboratory studies? (A) Pulse rate is 116/min (B) Myoclonus (C) Serum potassium is 5.5 mEq/L (5.5 mmol/L) (D) Serum magnesium is 2.4 mEq/L (1.2 mmol/L)
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['(A) Pulse rate is 116/min <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 38-year-old man is admitted to the hospital because of fever, yellowing of the skin, and nausea for 1 day. He recently returned from a backpacking trip to Brazil and Paraguay, during which he had a 3-day episode of high fever that resolved spontaneously. Physical examination shows jaundice, epigastric tenderness, and petechiae over his trunk. Five hours after admission, he develops dark brown emesis and anuria. Despite appropriate lifesaving measures, he dies. Postmortem liver biopsy shows eosinophilic degeneration of hepatocytes with condensed nuclear chromatin. This patient’s hepatocytes were most likely undergoing which of the following processes? (A) Necrosis (B) Regeneration (C) Apoptosis (D) Proliferation
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['(C) Apoptosis <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 37-year-old G1P1001 presents for her 6-week postpartum visit after delivering a male infant by spontaneous vaginal delivery at 41 weeks and 5 days gestation. She notes that five days ago, her right breast began to hurt, and the skin near her nipple turned red. She also states that she has felt feverish and generally achy for 2 days but thought she was just sleep deprived. The patient’s son has been having difficulty latching for the last 2 weeks and has begun receiving formula in addition to breast milk, though the patient wishes to continue breastfeeding. She is generally healthy with no past medical history but has smoked half a pack per day for the last 15 years. Her mother died from breast cancer at the age of 62, and her father has hypertension and coronary artery disease. At this visit, her temperature is 100.6° F (38.1° C), blood pressure is 116/73 mmHg, pulse is 80/min, and respirations are 14/min. She appears tired and has a slightly flat affect. Examination reveals a 4x4 cm area of erythema on the lateral aspect near the nipple on the right breast. In the center of this area, there is a fluctuant, tender mass that measures 2x2 cm. The overlying skin is intact. The remainder of her exam is unremarkable. Which of the following is the best next step in management? (A) Mammogram (B) Incision and drainage (C) Needle aspiration and oral dicloxacillin (D) Cessation of smoking
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['(C) Needle aspiration and oral dicloxacillin <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 23-year-old man presents to the physician with nausea, vomiting, constipation, and abdominal pain for the past 24 hours. He has also developed difficulty in swallowing and blurring of vision. He also complains of significant dryness of his mouth and throat. When asked about his diet, he reports that he has been saving money by eating dented and old canned goods. On physical examination, his vital signs are stable. His neurologic examination reveals bilateral fixed dilated pupils, weakness of extraocular muscles, and weak gag reflex, while sensations and gait are normal. Laboratory evaluation of his stool isolates a toxin produced by gram-positive, anaerobic, spore-forming bacilli. Which of the following mechanisms best explains the action of the toxin? (A) Blockade of release of acetylcholine at neuromuscular junctions (B) Inactivation of acetylcholinesterase at neuromuscular junctions (C) Competitive antagonism of acetylcholine at postsynaptic receptors (D) Prolonged depolarization of NM receptors
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['(A) Blockade of release of acetylcholine at neuromuscular junctions <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 4-year-old girl presents to the emergency department after persistent vomiting and complaints that her abdomen hurts. Her parents came home to their daughter like this while she was at home being watched by the babysitter. The child is otherwise healthy. Family history is notable for depression, suicide, neuropathic pain, diabetes, hypertension, cancer, and angina. The child is now minimally responsive and confused. Her temperature is 100°F (37.8°C), blood pressure is 100/60 mmHg, pulse is 140/min, respirations are 22/min, and oxygen saturation is 100% on room air. Physical exam is notable for a confused girl who is vomiting bloody emesis into a basin. Laboratory studies are ordered as seen below. Serum: Na+: 140 mEq/L Cl-: 101 mEq/L K+: 3.9 mEq/L HCO3-: 11 mEq/L BUN: 20 mg/dL Glucose: 99 mg/dL Creatinine: 1.0 mg/dL Radiography is notable for a few radiopaque objects in the stomach. Urine and serum toxicology are pending. Which of the following is the most likely intoxication? (A) Acetaminophen (B) Aspirin (C) Iron (D) Nortriptyline
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['(C) Iron <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 55-year-old man is brought to the emergency room by his roommate due to an abdominal pain that started 2 hours ago. His pain is dull, aching, and radiates to the back. He admits to binge drinking alcohol for the past 2 days. Past medical history is significant for multiple admissions to the hospital for similar abdominal pain events, hypertension, and hyperlipidemia. He takes chlorthalidone and atorvastatin. He admits to heavy alcohol consumption over the past 10 years. He has smoked a pack of cigarettes a day for the last 20 years. In the emergency department, his temperature is 38.9℃ (102.0℉), pulse rate is 100/min, and respiratory rate is 28/min. On physical examination, he looks generally unwell and diaphoretic. Auscultation of his heart and lungs reveals an elevated heart rate with a regular rhythm. His lungs are clear to auscultation bilaterally. His abdomen is tympanitic with generalized tenderness. Evaluation of lab values reveals a leukocyte count of 28,000/mm3 with 89% of neutrophils. His amylase level is 255 U/L. A CT scan of the abdomen shows the diffuse enlargement of the pancreas. Which pathological process is most likely occurring in this patient’s peripancreatic tissue? (A) Coagulative necrosis (B) Caseous necrosis (C) Liquefactive necrosis (D) Fat necrosis
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['(D) Fat necrosis <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 54-year-old woman comes to the office complaining of increased urinary frequency and dysuria. She is accompanied by her husband. The patient reports that she goes to the bathroom 6-8 times a day. Additionally, she complains of pain at the end of her urinary stream. She denies fever, abdominal pain, vaginal discharge, or hematuria. Her husband adds, “we also don’t have sex as much as we used to.” The patient reports that even when she is “in the mood,” sex is “no longer pleasurable.” She admits feeling guilty about this. The patient’s last menstrual period was 15 months ago. Her medical history is significant for hyperlipidemia and coronary artery disease. She had a non-ST elevation myocardial infarction (NSTEMI) 3 months ago, and she has had multiple urinary tract infections (UTIs) in the past year. She smokes 1 pack of cigarettes a day and denies alcohol or illicit drug use. Body mass index is 32 kg/m^2. Pelvic examination reveals vaginal dryness and vulvar tissue thinning. A urinalysis is obtained as shown below: Urinalysis Glucose: Negative WBC: 25/hpf Bacterial: Many Leukocyte esterase: Positive Nitrites: Positive The patient is prescribed a 5-day course of nitrofurantoin. Which of the following is the most appropriate additional management for the patient’s symptoms? (A) Antibiotic prophylaxis (B) Topical clobetasol (C) Topical estrogen (D) Venlafaxine
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['(C) Topical estrogen <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 77-year-old woman, gravida 2, para 2, is brought to the physician by staff of the nursing home where she resides because of involuntary loss of urine and increased frequency of urination over the past 2 weeks. She reports that she has very little time to get to the bathroom after feeling the urge to urinate. “Accidents” have occurred 4–6 times a day during this period. She has never had urinary incontinence before. She has also been more tired than usual. She drinks 3 cups of coffee daily. Her last menstrual period was 15 years ago. She takes no medications. Vital signs are within normal limits. The abdomen is soft and nontender. Pelvic examination shows a normal-appearing vagina and cervix; uterus and adnexa are small. Which of the following is the most appropriate next step in management? (A) Vaginal estrogen cream (B) Urinalysis and culture (C) Pad test (D) MRI of the pelvis
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['(B) Urinalysis and culture <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A rapid diagnostic test has been developed amid a major avian influenza outbreak in Asia. The outbreak has reached epidemic levels with a very high attack rate. Epidemiologists are hoping to use the rapid diagnostic test to identify all exposed individuals and curb the rapid spread of disease by isolating patients with any evidence of exposure to the virus. The epidemiologists compared rapid diagnostic test results to seropositivity of viral antigen via PCR in 200 patients. The findings are represented in the following table: Test result PCR-confirmed avian influenza No avian influenza Positive rapid diagnostic test 95 2 Negative rapid diagnostic test 5 98 Which of the following characteristics of the rapid diagnostic test would be most useful for curbing the spread of the virus via containment?" (A) Sensitivity of 98/100 (B) Specificity of 95/100 (C) Specificity of 98/100 (D) Sensitivity of 95/100
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['(D) Sensitivity of 95/100 <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 35-year-old woman is brought to the emergency department by her coworkers after a sudden onset of vision loss. She is a lawyer and lost 3 cases in the past week. Yesterday, she experienced weakness and paralysis of her left wrist. Past medical history is significant for acid reflux. Physical examination reveals 2/4 in reflexes and 5/5 in muscular strength in all extremities. She appears indifferent to her current situation and presents with a flat affect. Slurring of words is absent. CT without contrast and MRI of the brain are unremarkable. Which of the following is the most likely diagnosis? (A) Factitious disorder (B) Transient ischemic attack (C) Major depressive disorder (D) Conversion disorder
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['(D) Conversion disorder <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 57-year-old woman with a history of diabetes and hypertension accidentally overdoses on antiarrhythmic medication. Upon arrival in the ER, she is administered a drug to counteract the effects of the overdose. Which of the following matches an antiarrhythmic with its correct treatment in overdose? (A) Quinidine and insulin (B) Encainide and epinephrine (C) Esmolol and glucagon (D) Sotalol and norepinephrine
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['(C) Esmolol and glucagon <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 63-year-old woman comes to the physician because of worsening shortness of breath, cough, and a 4-kg (8.8-lb) weight loss over the last year. She has no history of serious illness and takes no medications. She has smoked one pack of cigarettes daily for 35 years. Her temperature is 37°C (98.6°F), pulse is 92/min, respirations are 20/min, blood pressure is 124/78 mm Hg, and pulse oximetry on room air shows an oxygen saturation of 93%. Physical examination shows decreased breath sounds. A flow-volume loop obtained via pulmonary function testing is shown. Which of the following is the most likely cause of this patient's respiratory symptoms? (A) Chronic obstructive pulmonary disease (B) Idiopathic pulmonary fibrosis (C) Endotracheal neoplasm (D) Unilateral mainstem obstruction
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['(A) Chronic obstructive pulmonary disease <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** An investigator inoculates three different broths with one colony-forming unit of Escherichia coli. Broth A contains 100 μmol of lactose, broth B contains 100 μmol of glucose, and broth C contains both 100 μmol of lactose and 100 μmol of glucose. After 24 hours, the amounts of lactose, galactose, and glucose in the three broths are measured. The results of the experiment are shown: Lactose Galactose Glucose Broth A 43 μmol 11 μmol 9 μmol Broth B 0 μmol 0 μmol 39 μmol Broth C 94 μmol 1 μmol 66 μmol The observed results are most likely due to which of the following properties of broth A compared to broth C?" (A) Increased activity of glycosylases (B) Decreased activity of catabolite activator protein (C) Decreased production of α-galactosidase A (D) Increased activity of adenylate cyclase
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['(D) Increased activity of adenylate cyclase <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 71-year-old woman presents with high-grade fever and chills, difficulty breathing, and a productive cough with rust-colored sputum. She complains of a sharp left-sided chest pain. Physical examination reveals increased fremitus, dullness to percussion, and bronchial breath sounds on the lower left side. A chest X-ray shows left lower lobe consolidation. The offending organism that was cultured from the sputum was catalase-negative and had a positive Quellung reaction. The organism will show which gram stain results? (A) Cannot be seen with gram staining since the organism lacks a cell wall (B) Gram-negative rod (C) Gram-positive diplococci (D) Gram-negative diplococci
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['(C) Gram-positive diplococci <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 19-year-old woman comes to the physician because of a 2-day history of difficulty sleeping. She worries that the lack of sleep will ruin her career prospects as a model. She has been coming to the physician multiple times over the past year for minor problems. She is dressed very extravagantly and flirts with the receptionist. When she is asked to sit down in the waiting room, she begins to cry and says that no one listens to her. When she is called to the examination room, she moves close to the physician, repeatedly intends to touch his cheek, and makes inappropriate comments. She does not have a history of self-harm or suicidal ideation. Which of the following is the most likely diagnosis? (A) Dependent personality disorder (B) Histrionic personality disorder (C) Narcissistic personality disorder (D) Borderline personality disorder
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['(B) Histrionic personality disorder <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 24-year-old woman presents with blisters and erosions on her upper face, chest, and back. The blisters have erythema, scales, and crust formation. The lesions are aggravated, especially after sun exposure. Examination shows oromucosal involvement. Histopathologic evaluation reveals a tombstone arrangement at the base of the blister. What is the most likely cause for the patient’s condition? (A) Pemphigus vulgaris (B) Bullous pemphigoid (C) Pemphigus foliaceus (D) Linear immunoglobulin A (IgA) disease (LAD)
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['(A) Pemphigus vulgaris <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 55-year-old man presents to his primary care provider with increased urinary frequency. Over the past 3 months, he has been urinating 2-3 times more often than usual. He has started to feel dehydrated and has increased his water intake to compensate. He works as a bank teller. He has a 25-pack-year smoking history and drinks 8-10 beers per week. His temperature is 98°F (36.8°C), blood pressure is 114/68 mmHg, pulse is 100/min, and respirations are 18/min. Capillary refill is 3 seconds. His mucous membranes appear dry. The patient is instructed to hold all water intake. Urine specific gravity is 1.002 after 12 hours of water deprivation. The patient is given desmopressin but his urine specific gravity remains relatively unchanged. Which of the following is the most appropriate pharmacologic treatment for this patient's condition? (A) Desmopressin (B) Furosemide (C) Mannitol (D) Metolazone
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['(D) Metolazone <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 55-year-old man comes to the physician because of a 2-month history of gradually worsening pain and burning in his feet that is impairing his ability to sleep. He also has a non-healing, painless ulcer on the bottom of his right toe, which has been progressively increasing in size despite the application of bandages and antiseptic creams at home. He has a 7-year history of type II diabetes mellitus treated with oral metformin. He also has narrow-angle glaucoma treated with timolol eye drops and chronic back pain due to a motorcycle accident a few years ago, which is treated with tramadol. Vital signs are within normal limits. Physical examination shows a 3-cm, painless ulcer on the plantar surface of the right toe. The ulcer base is dry, with no associated erythema, edema, or purulent discharge. Neurological examination shows loss of touch, pinprick sensation, proprioception, and vibration sense of bilateral hands and feet. These sensations are preserved in the proximal portions of the limbs. Muscle strength is normal. Bilateral ankle reflexes are absent. A diabetic screening panel is done and shows a fasting blood sugar of 206 mg/dL. An ECG shows a left bundle branch block. Which of the following is the most appropriate next step in the management of this patient's pain? (A) Oxycodone (B) Ulcer debridement (C) Injectable insulin (D) Pregabalin
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['(D) Pregabalin <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 20-year-old man presents to his physician with diarrhea, vomiting, and fever for the past 2 days. After laboratory evaluation, he is diagnosed with bacterial gastroenteritis. The man is a microbiology major and knows that the human gastrointestinal tract, respiratory tract, and skin are lined by epithelia which act as a barrier against several infective microorganisms. He also knows that there are specific T cells in these epithelia that play a part in innate immunity and in recognition of microbial lipids. Which of the following types of T cells is the man thinking of? (A) Naïve T cells (B) Natural killer T cells (C) Αβ T cells (D) γδ T cells
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['(D) γδ T cells <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 65-year-old man presented to the hospital with a history of repeated falls, postural dizziness, progressive fatigue, generalized weakness, and a 13.6 kg (30 lb) weight loss over a duration of 6 months. He is a vegetarian. His family members complain of significant behavioral changes over the past year. The patient denies smoking, alcohol consumption, or illicit drug use. There is no significant family history of any illness. Initial examination reveals a pale, thin built man. He is irritable, paranoid, delusional, but denies any hallucinations. The blood pressure is 100/60 mm Hg, heart rate is 92/min, respiratory rate is 16/min, and the temperature is 36.1℃ (97℉). He has an unstable, wide-based ataxic gait. The anti-intrinsic factor antibodies test is positive. The laboratory test results are as follows: Hb 6.1gm/dL MCV 99 fL Platelets 900,000/mm3 Total WBC count 3,000/mm3 Reticulocyte 0.8% The peripheral blood smear is shown in the image below. What is the most likely cause of his condition? (A) Hypothyroidism (B) Folate deficiency (C) Pernicious anemia (D) Alcoholism
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['(C) Pernicious anemia <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 4-month-old male infant is brought to the physician by his father because of swelling of his left hemiscrotum. He has otherwise been healthy and is gaining weight appropriately. Physical examination shows a nontender left scrotal mass that transilluminates. The mass increases in size when the boy cries but is easily reducible. Which of the following is the most likely underlying cause of this patient's findings? (A) Lack of testicular fixation (B) Germ cell neoplasia (C) Sperm collection in epididymal duct (D) Patent processus vaginalis
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['(D) Patent processus vaginalis <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 25-year-old woman presents to her primary care physician complaining of several months of diarrhea. She has also had crampy abdominal pain. She has tried modifying her diet without improvement. She has many watery, non-bloody bowel movements per day. She also reports feeling fatigued. The patient has not recently traveled outside of the country. She has lost 10 pounds since her visit last year, and her BMI is now 20. On exam, she has skin tags and an anal fissure. Which of the following would most likely be seen on endoscopy and biopsy? (A) Diffuse, non-focal ulcerations with granuloma (B) Diffuse, non-focal ulcerations without granuloma (C) Focal ulcerations with granuloma (D) Friable mucosa with pinpoint hemorrhages
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['(C) Focal ulcerations with granuloma <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 6-day-old boy is brought to the emergency room with a fever. He was born to a G1P1 mother at 39 weeks gestation via vaginal delivery. The mother underwent all appropriate prenatal care and was discharged from the hospital 1 day after birth. The boy has notable skin erythema around the anus with some serosanguinous fluid. The umbilical stump is present. The patient is discharged from the emergency room with antibiotics. He returns to the emergency room at 32 days of age and his mother reports that he has been clutching his left ear. The left tympanic membrane appears inflamed and swollen. The umbilical stump is still attached and is indurated, erythematous, and swollen. The boy's temperature is 99°F (37.2°C), blood pressure is 100/60 mmHg, pulse is 130/min, and respirations are 20/min. A complete blood count is shown below: Hemoglobin: 14.0 g/dL Hematocrit: 42% Leukocyte count: 16,000/mm^3 with normal differential Platelet count: 190,000/mm^3 A deficiency in which of the following compounds is most likely the cause of this patient's condition? (A) IL-12 receptor (B) Immunoglobulin A (C) LFA-1 integrin (D) NADPH oxidase
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['(C) LFA-1 integrin <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 35-year-old woman presents with an inability to move her right arm or leg. She states that symptoms onset acutely 2 hours ago. Past medical history is significant for long-standing type 1 diabetes mellitus, well-managed with insulin. The patient reports a 15-pack-year smoking history. Family history is significant for breast cancer in her mother at age 66 and her father dying of a myocardial infarction at age 57. Review of systems is significant for excessive fatigue for the past week, and her last menstrual period that was heavier than normal. Her vitals signs include: temperature 38.8°C (101.8°F), blood pressure 105/75 mm Hg, pulse 98/min, respirations 15/min, and oxygen saturation 99% on room air. On physical examination, the patient appears pale and tired. The cardiac exam is normal. Lungs are clear to auscultation. The abdominal exam is significant for splenomegaly. There is a non-palpable purpura present on the lower extremities bilaterally. Conjunctiva and skin are pale. Laboratory results are pending. A peripheral blood smear is shown in the exhibit. Which of the following laboratory findings would least likely be seen in this patient? (A) Normal PTT and PT (B) Elevated creatinine (C) Elevated reticulocyte count (D) Elevated bilirubin
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['(B) Elevated creatinine <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 4-year-old boy with a history of cerebral palsy is brought to the neurology clinic by his mother with progressive tightness in the lower extremities. Although the patient has been intermittently undergoing physiotherapy for the past 2 years at a specialized center, the patient’s mother is concerned he cannot yet climb the stairs. The neurologist recommends a different treatment, which involves multiple intramuscular injections of a drug in the muscles of the lower extremities to relieve tightness. The neurologist says this treatment approach is also often used to relieve headaches and reduce facial wrinkles. Which of the following is most likely the mechanism of action of this drug? (A) Stimulates adenylate cyclase (B) Reduces neurotransmitter GABA (C) Blocks the release of acetylcholine (D) Interferes with the 60s ribosomal subunit
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['(C) Blocks the release of acetylcholine <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 18-year-old male presents to his primary care provider with his parents for a sports physical. He was last seen in clinic several months ago, when he was diagnosed with attention deficit hyperactivity disorder (ADHD). He was started on methylphenidate at that time, and the patient now reports improvement in his ability to concentrate in school and at home. He hopes to play baseball in college and has begun lifting weights daily in preparation for baseball season. The patient reports that he eats a healthy diet to fuel his exercise regimen. His parents have no concerns and are pleased with the recent improvement in his grades. On physical exam, the patient has tall stature with average muscle mass for his age. He has no dysmorphic features. His chest has a normal appearance other than mild gynecomastia. The patient has sparse facial hair and a moderate amount of coarse pubic hair that extends across the pubis and spares the medial thighs. His testes are small and firm. Due to the latter, laboratory testing is performed and reveals the following: Follicle-stimulating hormone (FSH): 42 mIU/mL (Reference range: 4-25 mIU/mL) Luteinizing hormone (LH): 38 mIU/mL (Reference range: 6-23 mIU/mL) Which of the following is the most likely etiology of this patient’s presentation? (A) Anabolic steroid use (B) CGG trinucleotide repeat disorder (C) Failure of neuronal migration (D) Meiotic nondisjunction
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['(D) Meiotic nondisjunction <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 43-year-old woman was admitted to the hospital for anticoagulation following a pulmonary embolism. She was found to have a deep venous thrombosis on further workup after a long plane ride coming back from visiting China. She denies any personal history of blood clots in her past, but she says that her mother has also had to be treated for pulmonary embolism in the recent past. Her past medical history is significant for preeclampsia, hypertension, polycystic ovarian syndrome, and hypercholesterolemia. She currently smokes 1 pack of cigarettes per day, drinks a glass of wine per day, and she currently denies any illicit drug use. The vital signs include: temperature 36.7°C (98.0°F), blood pressure 126/74 mm Hg, heart rate 111/min, and respiratory rate 23/min. On physical examination, her pulses are bounding and complexion is pale, but breath sounds remain clear. Oxygen saturation was initially 81% on room air, with a new oxygen requirement of 8 L by face mask. On day 6 of combined heparin and warfarin anticoagulation, her platelet count decreases from 182,000/mcL to 63,000/mcL. Her international normalized ratio (INR) is not yet therapeutic. What is the next best step in therapy? (A) Continue heparin and warfarin until INR is therapeutic for 24 hours (B) Discontinue heparin; continue warfarin (C) Discontinue heparin and warfarin (D) Continue heparin and warfarin, and administer vitamin K
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['(C) Discontinue heparin and warfarin <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 63-year-old man comes to the physician because of a 3-month history of fatigue and constipation. He reports having dull pain in the left portion of the midback for 2 weeks that has persisted despite taking ibuprofen. His father died of prostate cancer at 70 years of age. The patient has smoked one pack of cigarettes daily for 45 years. Vital signs are within normal limits. Physical examination shows a left-sided varicocele both in supine and in standing position. Rectal examination shows a symmetrically enlarged prostate with no masses. Laboratory studies show: Hemoglobin 11.2 g/dL Serum Creatinine 1.0 mg/dL Calcium 11.8 mg/dL Urine Protein 1+ Blood 2+ Which of the following is the most appropriate next step in management?" (A) CT scan of the abdomen (B) Urine cytology (C) Chest x-ray (D) Prostate biopsy
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['(A) CT scan of the abdomen <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 34-year-old woman is brought to the emergency department because of a 3-hour history of weakness, agitation, and slurred speech. She speaks slowly with frequent breaks and has difficulty keeping her eyes open. Over the past three days, she has had a sore throat, a runny nose, and a low-grade fever. She says her eyes and tongue have been “heavy” for the past year. She goes to bed early because she feels too tired to talk or watch TV after dinner. She appears pale and anxious. Her temperature is 38.0°C (100.4°F), pulse is 108/min, respirations are 26/min and shallow, and blood pressure is 118/65 mm Hg. On physical examination, there is bluish discoloration of her lips and around the mouth. Her nostrils dilate with every breath. The lungs are clear to auscultation. There is generalized weakness of the proximal muscles. Which of the following is the most appropriate next step in management? (A) Intravenous immunoglobulin therapy (B) Plasmapheresis (C) Endotracheal intubation (D) Administration of edrophonium "
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['(C) Endotracheal intubation <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 35-year-old man arrives at the emergency department within minutes after a head-on motor vehicle accident. He suffered from blunt abdominal trauma, several lacerations to his face as well as lacerations to his upper and lower extremities. The patient is afebrile, blood pressure is 45/25 mmHg and pulse is 160/minute. A CBC is obtained and is most likely to demonstrate which of the following? (A) Hb 5 g/dL, Hct 20% (B) Hb 15 g/dL, Hct 45% (C) Hb 20 g/dL, Hct 60% (D) Hb 17 g/dL, Hct 20%
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['(B) Hb 15 g/dL, Hct 45% <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 45-year-old African-American woman presents with dyspnea, cough, and non-radiating chest pain. Her chest pain is relieved by leaning forward and worsens upon leaning backwards. A scratchy rub is heard best with the patient leaning forward. Physical examination did not elucidate evidence of a positive Kussmaul's sign, pulsus paradoxus, or pericardial knock. The patient most likely is suffering from which of the following? (A) Constrictive pericarditis (B) Acute pericarditis (C) Libman-Sacks endocarditis (D) Acute myocardial infarction
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['(B) Acute pericarditis <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 65-year-old African-American man comes to the physician for a follow-up examination after presenting with elevated blood pressure readings during his last visit. He has no history of major medical illness and takes no medications. He is 180 cm (5 ft 9 in) tall and weighs 68 kg (150 lb); BMI is 22 kg/m2. His pulse is 80/min and blood pressure is 155/90 mm Hg. Laboratory studies show no abnormalities. Which of the following is the most appropriate initial pharmacotherapy for this patient? (A) Metoprolol (B) Chlorthalidone (C) Aliskiren (D) Captopril
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['(B) Chlorthalidone <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 29-year-old woman presents for an annual flu shot. She has no symptoms. Past medical history is significant for mild rheumatoid arthritis, diagnosed 3 years ago and managed with celecoxib and methotrexate. Current medications also include a daily folate-containing multivitamin. She also had 2 elective cesarean sections during her early 20s and an appendectomy in her teens. Her family history is insignificant. The patient does not consume alcohol, smoke cigarettes, or take recreational drugs. Her physical examination is unremarkable. Recent laboratory studies show: Hemoglobin (Hb) 14.2 g/dL Mean corpuscular volume (MCV) 103 fL Since she is asymptomatic, the patient asks if her medications can be discontinued. Which of the following diagnostic tests is the most useful for monitoring this patient’s condition and detecting the overall inflammatory state of the patient at this time? (A) C-reactive protein (CRP) (B) Anti-cyclic citrullinated peptide (anti-CCP) (C) Erythrocyte sedimentation rate (ESR) (D) Complete blood count
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['(A) C-reactive protein (CRP) <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 19-year-old woman presents with worsening pain in her neck for the past 5 days. She says she is not able to wear her tie for her evening job because is it too painful. She also reports associated anxiety, palpitations, and lethargy for the past 10 days. Past medical history is significant for a recent 3-day episode of flu-like symptoms about 20 days ago which resolved spontaneously. She is a non-smoker and occasionally drinks beer with friends on weekends. Her vital signs include: blood pressure 110/80 mm Hg, pulse 118/min. On physical examination, her distal extremities are warm and sweaty. There is severe bilateral tenderness to palpation of her thyroid gland, as well as mild symmetrical swelling noted. No nodules palpated. An ECG is normal. Laboratory findings are significant for low thyroid-stimulating hormone (TSH), elevated T4 and T3 levels, and an erythrocyte sedimentation rate (ESR) of 30 mm/hr. Which of the following is the most appropriate treatment for this patient’s most likely diagnosis? (A) Levothyroxine administration (B) Aspirin (C) Increase dietary intake of iodine (D) Reassurance
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['(B) Aspirin <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 17-year-old girl comes to your outpatient clinic. She is sexually active with multiple partners and requests a prescription for oral contraceptive pills. A urine pregnancy test in your office is negative. Which of the following is the most appropriate next step? (A) Contact the patient's parents to obtain consent (B) Recommend sexually-transmitted infection screening and provide the requested prescription (C) Perform urine drug screen (D) Advise against oral contraceptive medications and recommend condom use instead
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['(B) Recommend sexually-transmitted infection screening and provide the requested prescription <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 44-year-old female presents to her primary care physician complaining of fatigue. She reports a four-month history of increasing fatigue accompanied by occasional constipation. She also reports a 15-pound weight gain over the same time period. She is otherwise healthy and takes no medications. She has never been pregnant. On physical examination, her skin is dry and cracked. Patellar reflexes are 1+ bilaterally. Laboratory analysis reveals an elevated serum TSH and decreased serum and free T4. Her blood is positive for the presence of specific antibodies. A biopsy of this patient’s thyroid gland would most likely reveal which of the following? (A) Large pleomorphic cells with vascular invasion and necrosis (B) Randomly oriented papillae with pleomorphic cells and dense fibrosis (C) Lymphocytic infiltrate with germinal center formation (D) Hyperplasia and hypertrophy of follicular cells
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['(C) Lymphocytic infiltrate with germinal center formation <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 42-year-old man comes to the physician for 1 month of worsening right knee pain. He has not had any trauma other than stubbing his toe 3 days ago at the garage where he works as a mechanic. Examination of the right knee shows swelling and erythema with fluctuance over the inferior patella. There is tenderness on palpation of the patella but no joint line tenderness or warmth. The range of flexion is limited because of the pain. Which of the following is the most likely underlying cause of this patient's symptoms? (A) Noninflammatory degeneration of the joint (B) Infection of the joint (C) Deposition of crystals in the joint (D) Inflammation of periarticular fluid-filled sac
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['(D) Inflammation of periarticular fluid-filled sac <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 30-year-old man presents to clinic. He was born in southeast Asia and immigrated to the US three years ago. He has a history of chronic hepatitis C which he contracted from intravenous drug use. He reports that he has continued to take ribavirin, but unfortunately has started using heroin again. The patient was seen in the clinic last week and had blood work done. His results are as follows: HBsAg - negative; HBsAb - negative; HBcAb - negative. In addition to encouraging the patient to seek treatment for his heroin addiction, what else should be done at this health visit for general health maintenance? (A) Obtain a PSA (B) Write a prescription for a fecal ocult blood test (C) Write a prescription for a colonoscopy (D) Vaccinate the patient for Hepatitis B
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['(D) Vaccinate the patient for Hepatitis B <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 30-year-old woman, gravida 2, para 1, at 40 weeks' gestation is admitted to the hospital in active labor. Her first pregnancy and delivery were complicated by iron deficiency anemia and pregnancy-induced hypertension. She has had no routine prenatal care during this pregnancy but was diagnosed with oligohydramnios 4 weeks ago. The remainder of her medical history is not immediately available. A 2400-g (5.4-lb) female newborn is delivered vaginally. Examination of the newborn shows a short, mildly webbed neck and low-set ears. Ocular hypertelorism along with slanted palpebral fissures are noted. A cleft palate and hypoplasia of the nails and distal phalanges are present. There is increased coarse hair on the body and face. Which of the following best explains the clinical findings found in this newborn? (A) Maternal phenytoin therapy (B) Fetal posterior urethral valves (C) Maternal diabetes mellitus (D) Maternal alcohol intake
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['(A) Maternal phenytoin therapy <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 66-year-old man comes to the emergency department because of shortness of breath. His temperature is 37.2°C (99°F) and pulse is 105/min. When the blood pressure cuff is inflated to 140 mm Hg, the patient's pulse is audible and regular. However, upon inspiration, the pulse disappears and does not reappear until expiration. Only when the blood pressure cuff is inflated to 125 mm Hg is the pulse audible throughout the entire respiratory cycle. Which of the following underlying conditions is most likely responsible for this patient's physical examination findings? (A) Lobar pneumonia (B) Hypertrophic cardiomyopathy (C) Congestive heart failure (D) Asthma
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['(D) Asthma <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 20-year-old man presents to the family medicine clinic with left knee pain. He is the star running back for his college football team with a promising future in the sport. He states he injured his knee 2 days ago during the final game of the season while making a cutting move, where his foot was planted and rotated outward and his knee buckled inward. He admits to feeling a ‘pop’ and having immediate pain. He denies any locking, clicking, or giving way since the event. Physical examination reveals an antalgic gait with avoidance of active knee extension. His left knee demonstrates moderate, diffuse swelling and is very tender to palpation along the joint line. Which of the following structures is most likely damaged in this patient? (A) Anterior cruciate ligament (B) Lateral meniscus (C) Medial collateral ligament (D) Posterior cruciate ligament
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['(A) Anterior cruciate ligament <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 45-year-old woman is found to have multiple masses in her liver while performing abdominal ultrasonography for recurrent right upper quadrant abdominal pain. Biopsy of one of the masses discloses large plates of adenoma cells, which are larger than normal hepatocytes and contain glycogen and lipid. Regular septa, portal tracts, and bile ductules are absent. Which of the following is associated with this patient's condition? (A) Carbon tetrachloride (B) Aflatoxin (C) Oral contraceptive pills (D) Smoking
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['(C) Oral contraceptive pills <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 25-year-old woman presents to the emergency department with fatigue and weakness. She states over the past 24 hours she has not felt like herself and has felt like she has no strength. The patient has no significant past medical history other than a single episode of blood-tinged diarrhea 1 week ago which resolved on its own. Her temperature is 99.4°F (37.4°C), blood pressure is 124/62 mmHg, pulse is 95/min, respirations are 29/min, and oxygen saturation is 95% on room air. Physical exam is notable for 2/5 strength of the lower extremities and decreased sensation in the lower extremities and finger tips. Which of the following is the best initial step in management? (A) Dexamethasone (B) Intubation (C) Pyridostigmine (D) Spirometry
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['(D) Spirometry <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** An investigator is studying the function of the endoplasmic reticulum in genetically modified lymphocytes. A gene is removed that facilitates the binding of ribosomes to the endoplasmic reticulum. Which of the following processes is most likely to be impaired as a result of this genetic modification? (A) Production of secretory proteins (B) Synthesis of ketone bodies (C) α-Oxidation of fatty acids (D) Ubiquitination of proteins
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['(A) Production of secretory proteins <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 78-year-old man suffers a fall in a nursing home and is brought to the emergency room. A right hip fracture is diagnosed, and he is treated with a closed reduction with internal fixation under spinal anesthesia. On the second postoperative day, the patient complains of pain in the lower abdomen and states that he has not urinated since the surgery. An ultrasound shows increased bladder size and volume. Which of the following is the mechanism of action of the drug which is most commonly used to treat this patient’s condition? (A) Parasympathetic agonist (B) Sympathetic agonist (C) Alpha-blocker (D) Beta-blocker
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['(A) Parasympathetic agonist <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** In a routine medical examination, an otherwise healthy 12-year-old by is noted to have tall stature with a wide arm span and slight scoliosis. Chest auscultation reveals a heart murmur. Transthoracic echocardiography shows an enlarged aortic root and aortic valve insufficiency. Mutations in mutations in fibrillin-1 gene are positive. Plasma homocysteine levels are not elevated. This patient is at high risk for which of the following complications? (A) Aortic aneurysm (B) Thrombotic events (C) Infertility (D) Pheochromocytoma
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['(A) Aortic aneurysm <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 27-year-old man presents to the emergency room with persistent fever, nausea, and vomiting for the past 3 days. While waiting to be seen, he quickly becomes disoriented and agitated. Upon examination, he has visible signs of difficulty breathing with copious oral secretions and generalized muscle twitching. The patient’s temperature is 104°F (40°C), blood pressure is 90/64 mmHg, pulse is 88/min, and respirations are 18/min with an oxygen saturation of 90% on room air. When the nurse tries to place a nasal cannula, the patient becomes fearful and combative. The patient is sedated and placed on mechanical ventilation. Which of the following is a risk factor for the patient’s most likely diagnosis? (A) Contaminated beef (B) Epiglottic cyst (C) Mosquito bite (D) Spelunking
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['(D) Spelunking <> 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 physician because of a 3-day history of fever, chills, headache, and fatigue. He appears ill. His temperature is 39°C (102.2°F). Analysis of nasal secretions shows infection with an enveloped, single-stranded segmented RNA virus. In response to infection with this pathogen, certain cells present antigens from the pathogen to CD8+ T-lymphocytes. Which of the following statements about the molecules used for the presentation of these antigens is most accurate? (A) The antigens are loaded onto the molecule within lysosomes (B) The molecule consists of a heavy chain associated with β2 microglobulin (C) The molecule is made up of 2 chains of equal length (D) The molecule is selectively expressed by antigen-presenting cells
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['(B) The molecule consists of a heavy chain associated with β2 microglobulin <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 27-year-old man presents to the emergency department after being stabbed. The patient was robbed at a local pizza parlor and was stabbed over 10 times with a large kitchen knife with an estimated 7 inch blade in the ventral abdomen. His temperature is 97.6°F (36.4°C), blood pressure is 74/54 mmHg, pulse is 180/min, respirations are 19/min, and oxygen saturation is 98% on room air. The patient is intubated and given blood products and vasopressors. Physical exam is notable for multiple stab wounds over the patient's abdomen inferior to the nipple line. Which of the following is the best next step in management? (A) CT scan of the abdomen and pelvis (B) Diagnostic peritoneal lavage (C) Exploratory laparoscopy (D) Exploratory laparotomy
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['(D) Exploratory laparotomy <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 10-year-old boy is brought to a pediatrician by his mother for evaluation of fever, malaise, and rash with severe itching all over his body for the past 5 days. His immunization history is unavailable. His vital signs include: pulse 110/min, temperature 37.8°C (100.0°F), and respiratory rate 26/min. On examination of the skin, diffuse peeling vesicular lesions involving the arms and chest are observed. The pediatrician diagnosis the boy with chickenpox and reassures the mother. A few days later the boy returns to the clinic for a follow-up with his mother. The skin lesions have healed and there are scars. The formation of these scars is best described by which of the following statements? (A) The scars represent complete resolution of acute inflammation. (B) It is a part of the healing process of acute inflammation. (C) The scars are permanent and remain for life in all cases. (D) Neutrophils, plasma cells, and macrophages are the predominant cells in these lesions.
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['(B) It is a part of the healing process of acute inflammation. <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 24-year-old woman visits her psychiatrist a week after she delivered a baby. She is holding her baby and crying as she waits for her appointment. She tells her physician that a day or so after her delivery, she has been finding it difficult to contain her feelings. She is often sad and unable to contain her tears. She is embarrassed and often starts crying without any reason in front of people. She is also anxious that she will not be a good mother and will make mistakes. She hasn’t slept much since the delivery and is often stressed about her baby getting hurt. She makes excessive attempts to keep the baby safe and avoid any mishaps. She does not report any loss of interest in her activities and denies any suicidal tendencies. Which of the following is best course of management for this patient? (A) Start on a small dose of fluoxetine daily (B) Get admitted immediately (C) Come back for a follow-up in 2 weeks (D) Schedule an appointment for electroconvulsive therapy
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['(C) Come back for a follow-up in 2 weeks <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 26-year-old G1P0 woman presents for her first prenatal visit. Past medical history reveals the patient is blood type O negative, and the father is type A positive. The patient refuses Rho(D) immune globulin (RhoGAM), because it is derived from human plasma, and she says she doesn’t want to take the risk of contracting HIV. Which of the following is correct regarding the potential condition her baby may develop? (A) Rho(D) immune globulin is needed both before and immediately after delivery to protect this baby from developing the condition (B) She should receive Rho(D) immune globulin to prevent the development of Rh(D) alloimmunization (C) The Rho(D) immune globulin will also protect the baby against other Rh antigens aside from Rh(D) (D) The injection can be avoided because the risk of complications of this condition is minimal
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['(B) She should receive Rho(D) immune globulin to prevent the development of Rh(D) alloimmunization <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 55-year-old man with a history of congestive heart failure, hypertension, and hyperlipidemia presents to his primary care clinic. He admits he did not adhere to a low salt diet on a recent vacation. He now has progressive leg swelling and needs two pillows to sleep because he gets short of breath when lying flat. Current medications include aspirin, metoprolol, lisinopril, atorvastatin, and furosemide. His physician decides to increase the dosage and frequency of the patient’s furosemide. Which of the following electrolyte abnormalities is associated with loop diuretics? (A) Hypocalcemia (B) Hypouricemia (C) Hypoglycemia (D) Hypermagnesemia
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['(A) Hypocalcemia <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A previously healthy 25-year-old woman comes to the physician because of a one-week history of diffuse abdominal pain. Her temperature is 39.1°C (102.3°F). Physical examination shows numerous scars and excoriations along both arms, scleral icterus, and tender hepatomegaly. Serum studies show: Alanine aminotransferase 927 U/L Aspartate aminotransferase 796 U/L Hepatitis B surface antigen positive Hepatitis B surface antibody negative Anti-hepatitis B core antibody negative Hepatitis C antibody negative Which of the following is the most likely outcome of this patient's infection?" (A) Asymptomatic carrier state (B) Hepatocellular carcinoma (C) Transient infection (D) Fulminant hepatitis
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['(C) Transient infection <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 53-year-old man with a past medical history significant for hyperlipidemia, hypertension, and hyperhomocysteinemia presents to the emergency department complaining of 10/10 crushing, left-sided chest pain radiating down his left arm and up his neck into the left side of his jaw. His ECG shows ST-segment elevation in leads V2-V4. He is taken to the cardiac catheterization laboratory for successful balloon angioplasty and stenting of a complete blockage in his left anterior descending coronary artery. Echocardiogram the following day shows decreased left ventricular function and regional wall motion abnormalities. A follow-up echocardiogram 14 days later shows a normal ejection fraction and no regional wall motion abnormalities. This post-infarct course illustrates which of the following concepts? (A) Ventricular remodeling (B) Myocardial hibernation (C) Myocardial stunning (D) Coronary collateral circulation
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['(C) Myocardial stunning <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** An 18-year-old female college student is brought to the emergency department by ambulance for a headache and altered mental status. The patient lives with her boyfriend who is with her currently. He states she had not been feeling well for the past day and has vomited several times in the past 12 hours. Lumbar puncture is performed in the emergency room and demonstrates an increased cell count with a neutrophil predominance and gram-negative diplococci on Gram stain. The patient is started on vancomycin and ceftriaxone. Which of the following is the best next step in management? (A) Add ampicillin, dexamethasone, and rifampin to treatment regimen (B) Add ampicillin to treatment regimen (C) Treat boyfriend with ceftriaxone and vancomycin (D) Treat boyfriend with rifampin
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['(D) Treat boyfriend with rifampin <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 44-year-old man is brought to the emergency department by his daughter for a 1-week history of right leg weakness, unsteady gait, and multiple falls. During the past 6 months, he has become more forgetful and has sometimes lost his way along familiar routes. He has been having difficulties operating simple kitchen appliances such as the dishwasher and coffee maker. He has recently become increasingly paranoid, agitated, and restless. He has HIV, hypertension, and type 2 diabetes mellitus. His last visit to a physician was more than 2 years ago, and he has been noncompliant with his medications. His temperature is 37.2°C (99.0°F), blood pressure is 152/68 mm Hg, pulse is 98/min, and respiratory rate is 14/min. He is somnolent and slightly confused. He is oriented to person, but not place or time. There is mild lymphadenopathy in the cervical, axillary, and inguinal areas. Neurological examination shows right lower extremity weakness with normal tone and no other focal deficits. Laboratory studies show: Hemoglobin 9.2 g/dL Leukocyte count 3,600/mm3 Platelet count 140,000/mm3 CD4+ count 56/µL HIV viral load > 100,000 copies/mL Serum Cryptococcal antigen Negative Toxplasma gondii IgG Positive An MRI of the brain is shown below. Which of the following is the most likely diagnosis? (A) Cryptococcal meningoencephalitis (B) HIV encephalopathy (C) Primary CNS lymphoma (D) Progressive multifocal leukoencephalopathy
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['(D) Progressive multifocal leukoencephalopathy <> answer']
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