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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 69-year-old male presents to his primary care provider for a general checkup. The patient currently has no complaints. He has a past medical history of diabetes mellitus type II, hypertension, depression, obesity, and a myocardial infarction seven years ago. The patient's prescribed medications are metoprolol, aspirin, lisinopril, hydrochlorothiazide, fluoxetine, metformin, and insulin. The patient states that he has not been filling his prescriptions regularly and that he can not remember what medications he has been taking. His temperature is 99.5°F (37.5°C), pulse is 96/min, blood pressure is 180/120 mmHg, respirations are 18/min, and oxygen saturation is 97% on room air. Serum: Na+: 139 mEq/L K+: 4.3 mEq/L Cl-: 100 mEq/L HCO3-: 24 mEq/L BUN: 7 mg/dL Glucose: 170 mg/dL Creatinine: 1.2 mg/dL On physical exam which of the following cardiac findings would be expected? (A) Normal S1 and S2 (B) Heart sound prior to S1 (C) Heart sound after S2 (D) Holosystolic murmur at the apex
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['(B) Heart sound prior to S1 <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** Four days after admission to the hospital for acute pancreatitis, a 41-year-old man develops hypotension and fever. His temperature is 39.1°C (102.3°F), pulse is 115/min, and blood pressure is 80/60 mm Hg. Physical examination shows warm extremities, asymmetric calf size, and blood oozing around his IV sites. There are numerous small, red, non-blanching macules and patches covering the extremities, as well as several large ecchymoses. His hemoglobin concentration is 9.0 g/dL. A peripheral blood smear shows schistocytes and decreased platelets. Which of the following sets of serum findings are most likely in this patient? $$$ Prothrombin time %%% Partial thromboplastin time %%% Fibrinogen %%% D-dimer $$$ (A) ↑ ↑ ↓ normal (B) Normal normal normal normal (C) ↑ ↑ ↓ ↑ (D) Normal normal normal ↑
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['(C) ↑ ↑ ↓ ↑ <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** An investigator is studying muscle tissue in high-performance athletes. He obtains blood samples from athletes before and after a workout session consisting of short, fast sprints. Which of the following findings is most likely upon evaluation of blood obtained after the workout session? (A) Increased concentration of insulin (B) Increased concentration of H+ (C) Decreased concentration of lactate (D) Decreased concentration of NADH
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['(B) Increased concentration of H+ <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 27-year-old woman presents to the emergency department with right lower quadrant abdominal pain and vaginal spotting. She denies diarrhea, constipation, or blood in the stool. The medical history is unremarkable. She does not use tobacco or drink alcohol. She is sexually active with her husband and uses an IUD for contraception. The temperature is 37.2 °C (99.0°F), the blood pressure is 110/70 mm Hg, the pulse is 80/min, and the respiratory rate is 12/min. The physical examination reveals localized tenderness in the right adnexa, but no masses are palpated. The LMP was 8 weeks ago. Which of the following is most likely associated with this patient’s diagnosis? (A) Physical examination reveals rebound tenderness and tenderness at McBurney’s point (B) Positive urinary beta-HCG and no intrauterine mass (C) Barium enema shows true diverticuli in the colon (D) Positive urinary beta-HCG and some products of conception in the uterus
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['(B) Positive urinary beta-HCG and no intrauterine mass <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 36-year-old man comes to the clinic for follow-up of his general anxiety disorder. He was diagnosed a year ago for excessive worry and irritability and was subsequently started on paroxetine. He demonstrated great response to therapy but is now complaining of decreased libido, which is affecting his marriage and quality of life. He wishes to switch to a different medication at this time. Following a scheduled tapering of paroxetine, the patient is started on a different medication that is a partial agonist of the 5-HT1A receptor. Which of the following is the most likely drug that was prescribed? (A) Amitriptyline (B) Buspirone (C) Duloxetine (D) Phenelzine
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['(B) Buspirone <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** In order to study the association between coffee drinking and the subsequent development of lung cancer, a group of researchers decides to carry out a multicentric case-control study with a large number of participants–800 with a diagnosis of lung cancer, and 800 as age-adjusted controls. According to the results outlined in table 1 (below), 80% of those with lung cancer were regular coffee drinkers, resulting in an odds ratio of 23. Lung cancer present Lung cancer absent Coffee drinking 640 120 No coffee drinking 160 680 Table: Contingency table of coffee drinking in relation to the presence of lung cancer The researchers concluded from this that regular consumption of coffee is strongly linked to the development of lung cancer. Which of the following systematic errors did they not take into account? (A) Selection bias (B) Confounding bias (C) Attrition bias (D) Information bias
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['(B) Confounding bias <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 17-year-old girl is brought to the physician by her mother for the evaluation of irregular menstrual bleeding. Menses have occurred at 60- to 90-day intervals since menarche at the age of 12 years. Her last menstrual period was 4 weeks ago. She is sexually active with one male partner, and they use condoms consistently. She reports that she currently has no desire to have children. She is 165 cm (5 ft 5 in) tall and weighs 85 kg (187 lb); BMI is 31 kg/m2. Examination shows scattered pustules on the forehead and oily skin. There is coarse hair on the chin and upper lip. Fingerstick blood glucose concentration is 190 mg/dL. A urine pregnancy test is negative. Which of the following is the most appropriate pharmacotherapy? (A) Danazol (B) Leuprolide (C) Metformin (D) Combination oral contraceptives
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['(D) Combination oral contraceptives <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 1-year-old male presents to his pediatrician for a well-child visit. Through a history from the mother and physical examination, the pediatrician learns that the baby babbles non-specifically, takes several steps independently, and picks up his cereal using two fingers. His weight is currently 22 lbs (birth-weight 6 lbs, 9 oz), and his height is 30 inches (birth length 18 inches). Are there any aspects of this child's development that are delayed? (A) Inadequate growth (B) Language delay (C) Gross motor skill delay (D) There are no developmental concerns
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['(B) Language delay <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 62-year-old man presents to his primary care provider complaining of leg pain with exertion for the past 6 months. He notices that he has bilateral calf cramping with walking. He states that it is worse in his right calf than in his left, and it goes away when he stops walking. He has also noticed that his symptoms are progressing and that this pain is occurring sooner than before. His medical history is remarkable for type 2 diabetes mellitus and 30-pack-year smoking history. His ankle-brachial index (ABI) is found to be 0.80. Which of the following can be used as initial therapy for this patient's condition? (A) Endovascular revascularization (B) Duloxetine (C) Heparin (D) Cilostazol
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['(D) Cilostazol <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 30-year-old woman presents for pregnancy counseling. She says she has a 8 week history of chronic diarrhea. She is also found to be intolerant to heat and has been significantly losing her hair. She denies any recent changes to her diet. The patient is afebrile and her vital signs are within normal limits. Her weight today is 45.0 kg (99.2 lb) which is 4.5 kg (10 lb) less than her weight during her last visit 2 months back. On physical examination, the patient is anxious and has a non-intention tremor. Significant exophthalmos is present. Laboratory findings are significant for a low TSH, elevated free T4 and free T3, and a positive thyroid stimulating immunoglobulin assay. She still wants to conceive a baby and asks for an appropriate treatment that is safe in pregnancy. Which of the following best describes the therapy she will most likely receive during her pregnancy for her thyroid disorder? (A) Thyroidectomy and thyroid replacement (B) Beta-blockers (C) Thyroid peroxidase inhibitors (D) Plasmapheresis
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['(C) Thyroid peroxidase inhibitors <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 9-year-old boy is brought to the emergency department by ambulance due to difficulty breathing. On presentation he is found to be straining to breathe. Physical exam reveals bilateral prolonged expiratory wheezing, difficulty speaking, and belly breathing. Radiographs also reveal hyperinflation of the lungs. He is given oxygen as well as albuterol, which begins to reverse the flow limitation in the airway segments of this patient. The airway segment that is most susceptible to this type of flow limitation has which of the following characteristics? (A) Contains c-shaped hyaline cartilage rings (B) Contains mucous producing goblet cells (C) Distal most extent of smooth muscle (D) Lined by type I and type II pneumocytes
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['(C) Distal most extent of smooth muscle <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 33-year-old woman, gravida 1, para 0, at 26 weeks' gestation comes to the physician for a routine prenatal examination. Her pregnancy has been uneventful. Physical examination shows a uterus consistent in size with a 26-week gestation. She is given an oral 50-g glucose load; 1 hour later, her serum glucose concentration is 116 mg/dL. Which of the following most likely occurred immediately after the entrance of glucose into the patient's pancreatic beta-cells? (A) Closure of membranous potassium channels (B) Generation of adenosine triphosphate (C) Depolarization of beta-cell membrane (D) Exocytosis of insulin granules
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['(B) Generation of adenosine triphosphate <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** An 11-year-old boy is brought to the physician for a follow-up examination. He has been having difficulties with his schoolwork over the past 4 years. He has a seizure disorder treated with valproic acid. He was able to walk independently at the age of 3 years and was able to use a fork and spoon at the age of 4 years. He is at the 40th percentile for height and 60th percentile for weight. Vitals signs are within normal limits. Examination shows multiple freckles in the axillary and groin skin folds as well as scoliosis. There are 14 hyperpigmented macules over the back and chest. There are multiple soft, painless nodules over the extremities and the trunk. Ophthalmic examination shows hyperpigmented iris nodules bilaterally. This patient is at increased risk for which of the following conditions? (A) Optic glioma (B) Glaucoma (C) Renal cell carcinoma (D) Giant cell astrocytoma "
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['(A) Optic glioma <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** An otherwise healthy 42-year-old man undergoes routine investigations prior to blood donation. His complete blood count is shown: Hemoglobin 9.3 g/dL Mean corpuscular volume (MCV) 71 μm3 Mean corpuscular hemoglobin (MCH) 21 pg/cell White blood cell count 8,200/mm3 Platelet count 317,000/mm3 Iron studies are shown: Serum iron 210 μg/dL Serum ferritin 310 ng/mL Total iron binding capacity (TIBC) 290 μg/dL Transferrin saturation 78% He occasionally drinks alcohol and denies smoking or use of illicit drugs. There is a family history of anemia including his brother and maternal uncle. Examination shows conjunctival pallor, but is otherwise unremarkable. Which of the following is the most likely diagnosis? (A) Anemia of chronic disease (B) Hemochromatosis (C) Myelodysplastic syndrome (D) Sideroblastic anemia
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['(D) Sideroblastic anemia <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 23-year-old primipara with no co-morbidities presents at 34 weeks gestation with edema and a moderate headache. Her vital signs are as follows: blood pressure, 147/90 mm Hg; heart rate, 82/min; respiratory rate, 16/min; and temperature, 36.6℃ (97.9℉). The physical examination is significant for a 2+ pitting edema. The dipstick test shows 2+. proteinuria. Laboratory testing showed the following findings: Erythrocyte count 3.2 million/mm3 Hemoglobin 12.1 g/dL Hematocrit 0.58 Reticulocyte count 0.3% Leukocyte count 7,300/mm3 Thrombocyte count 190,000/mm3 Total bilirubin 3.3 mg/dL (56.4 µmol/L) Conjugated bilirubin 1.2 mg/dL (20.5 µmol/L) ALT 67 U/L AST 78 U/L Creatinine 0.91 mg/dL (80.4 µmol/L) Which of the following laboratory parameters satisfies the criteria for the patient’s condition? (A) Hemoglobin (B) Hematocrit (C) Liver transaminases (D) Creatinine
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['(C) Liver transaminases <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 32-year-old woman presents to the emergency department with unilateral vision loss. She states it started suddenly this evening and this has never happened to her before. The patient is not followed by a primary care physician and is not currently taking any medications. She has had a few episodes of weakness or numbness in the past but states her symptoms usually resolve on their own. Her temperature is 97.6°F (36.4°C), blood pressure is 120/74 mmHg, pulse is 88/min, respirations are 12/min, and oxygen saturation is 98% on room air. Physical exam is notable for decreased sensation over the patient's dorsal aspect of her left foot. Visual exam reveals a loss of vision in the patient's left eye and she endorses pain in the eye on exam. Which of the following findings is also likely to be found in this patient? (A) Electrical pain with neck flexion (B) Ipsilateral loss of proprioception and vibration sensation (C) Symmetric lower extremity reflex loss (D) Weakness with repeat exertion
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['(A) Electrical pain with neck flexion <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 38-year-old man presents to his physician with double vision persisting for a week. When he enters the exam room, the physician notes that the patient has a broad-based gait. The man’s wife informs the doctor that he has been an alcoholic for the last 5 years and his consumption of alcohol has increased significantly over the past few months. She also reports that he has become indifferent to his family members over time and is frequently agitated. She also says that his memory has been affected significantly, and when asked about a particular detail, he often recollects it incorrectly, though he insists that his version is the true one. On physical examination, his vital signs are stable, but when the doctor asks him where he is, he seems to be confused. His neurological examination also shows nystagmus. Which of the following options describes the earliest change in the pathophysiology of the central nervous system in this man? (A) Decreased α-ketoglutarate dehydrogenase activity in astrocytes (B) Increased extracellular concentration of glutamate (C) Increased astrocyte lactate (D) Breakdown of the blood-brain barrier
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['(A) Decreased α-ketoglutarate dehydrogenase activity in astrocytes <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 30-year-old man comes to the emergency department because of the sudden onset of back pain beginning 2 hours ago. Beginning yesterday, he noticed that his eyes started appearing yellowish and his urine was darker than normal. Two months ago, he returned from a trip to Greece, where he lived before immigrating to the US 10 years ago. Three days ago, he was diagnosed with latent tuberculosis and started on isoniazid. He has worked as a plumber the last 5 years. His temperature is 37.4°C (99.3°F), pulse is 80/min, and blood pressure is 110/70 mm Hg. Examination shows back tenderness and scleral icterus. Laboratory studies show: Hematocrit 29% Leukocyte count 8000/mm3 Platelet count 280,000/mm3 Serum Bilirubin Total 4 mg/dL Direct 0.7 mg/dL Haptoglobin 15 mg/dL (N=41–165 mg/dL) Lactate dehydrogenase 180 U/L Urine Blood 3+ Protein 1+ RBC 2–3/hpf WBC 2–3/hpf Which of the following is the most likely underlying cause of this patient's anemia?" (A) Crescent-shaped erythrocytes (B) Absence of reduced glutathione (C) Inhibition of aminolevulinate dehydratase (D) Defective ankyrin in the RBC membrane
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['(B) Absence of reduced glutathione <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 70-year-old man presents to his physician for evaluation of fullness and swelling of the left side of the abdomen over the last month. During this time, he has had night sweats and lost 2 kg (4.4 lb) unintentionally. He has no history of severe illness and takes no medications. The vital signs include: blood pressure 115/75 mm Hg, pulse 75/min, and temperature 36.8℃ (98.2℉). The abdomen has asymmetric distention. Percussion and palpation of the left upper quadrant reveal splenomegaly. No lymphadenopathy is detected. Heart and lung examination shows no abnormalities. The laboratory studies show the following: Hemoglobin 9.5 g/dL Mean corpuscular volume 95 μm3 Leukocyte count 8,000/mm3 Platelet count 240,000/mm3 Ultrasound shows a spleen size of 15 cm, mild hepatomegaly, and mild ascites. The peripheral blood smear shows teardrop-shaped and nucleated red blood cells (RBCs) and immature myeloid cells. Marrow is very difficult to aspirate but reveals hyperplasia of all 3 lineages. The tartrate-resistant acid phosphatase (TRAP) test is negative. The cytogenetic analysis is negative for translocation between chromosomes 9 and 22. Which of the following laboratory findings is most likely to be present in this patient? (A) Monoclonal elevation of IgG (B) Hair-like cell-membrane projections (C) JAK-2 mutation (D) Philadelphia chromosome
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['(C) JAK-2 mutation <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 30-year-old forest landscape specialist is brought to the emergency department with hematemesis and confusion. One week ago she was diagnosed with influenza when she had fevers, severe headaches, myalgias, hip and shoulder pain, and a maculopapular rash. After a day of relative remission, she developed abdominal pain, vomiting, and diarrhea. A single episode of hematemesis occurred prior to admission. Two weeks ago she visited rainforests and caves in western Africa where she had direct contact with animals, including apes. She has no history of serious illnesses or use of medications. She is restless. Her temperature is 38.0℃ (100.4℉); the pulse is 95/min, the respiratory rate is 20/min; and supine and upright blood pressure is 130/70 mm Hg and 100/65 mm Hg, respectively. Conjunctival suffusion is noted. Ecchymoses are observed on the lower extremities. She is bleeding from one of her intravenous lines. The peripheral blood smear is negative for organisms. Filovirus genomes were detected during a reverse transcription-polymerase chain reaction. The laboratory studies show the following: Laboratory test Hemoglobin 10 g/dL Leukocyte count 1,000/mm3 Segmented neutrophils 65% Lymphocytes 20% Platelet count 50,000/mm3 Partial thromboplastin time (activated) 60 seconds Prothrombin time 25 seconds Fibrin split products positive Serum Alanine aminotransferase (ALT) 85 U/L Aspartate aminotransferase (AST) 120 U/L γ-Glutamyltransferase (GGT) 83 U/L Creatinine 2 mg/dL Which of the following is the most appropriate immediate step in management? (A) Esophagogastroduodenoscopy (B) Intravenous fluids and electrolytes (C) Parenteral artesunate plus sulfadoxine/pyrimethamine (D) Use of N95 masks
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['(B) Intravenous fluids and electrolytes <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 23-year-old woman comes to the emergency department because of increasing abdominal pain with associated nausea and vomiting. The symptoms began suddenly after having intercourse with her partner six hours ago. There is no associated fever, diarrhea, vaginal bleeding, or discharge. Menarche was at the age of 13 years and her last menstrual period was 4 weeks ago. She uses combination contraceptive pills. She had an appendectomy at the age of 12. Her temperature is 37.5°C (99.5°F), pulse is 100/min, respirations are 22/min, and blood pressure is 110/70 mm Hg. Abdominal examination shows severe right lower quadrant tenderness with associated rebound and guarding. Pelvic examination shows scant, clear vaginal discharge and right adnexal tenderness. There is no cervical wall motion tenderness. Her hemoglobin concentration is 10.5 g/dL, leukocyte count is 9,000/mm3, and platelet count is 250,000/mm3. A urine pregnancy test is negative. Which of the following imaging findings is most likely? (A) Echogenic tubal ring (B) Decreased ovarian blood flow on doppler (C) Complex, echogenic intrauterine mass (D) Distended fallopian tube with incomplete septations
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['(B) Decreased ovarian blood flow on doppler <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 17-year-old girl is brought into the clinic by her mother who is concerned that she may be depressed. The mother states that her daughter feels unattractive and does not fit into any of the social groups at school. When talking to the patient, it is discovered that she mostly avoids the kids in school because of fear of rejection. She usually keeps to herself and says she hasn’t involved herself in any group activities since elementary school. The patient’s mother is worried that this kind of behavior might continue or worsen if it progresses into her college years. Which of the following is the most likely diagnosis in this patient? (A) Avoidant personality disorder (B) Schizoid personality disorder (C) Social phobia (D) Body dysmorphic disorder
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['(A) Avoidant personality disorder <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 82-year-old man who is currently being managed by the internal medicine service agrees to be examined by medical students as part of their training in physical examination. He is visited by a small group of medical students under the instruction of a preceptor and allows the students to make observations. They find that he has bibasilar crackles that are most prominent during inspiration as well as some wheezing. Furthermore, he coughs up some sputum during the exam, and this sputum is found to have a rust color. He does not report any pain and no skin findings are seen. Which of the following is most closely associated with the cause of this patient's physical exam findings? (A) Left heart failure (B) Long bone fractures (C) Protein C/S deficiency (D) Tall, thin males
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['(A) Left heart failure <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 2-year-old girl presents to the emergency department with a 3-minute episode of a tonic-clonic seizure. The parents deny any previous history of seizure involving the patient or the family. Physical examination reveals an afebrile, well-groomed, and playful appearance, with normal vital signs. The patient carries a pink birthmark on the right side of her face extending from the forehead to the zygomatic arch. Which of the following findings is most likely on a head CT of this patient? (A) A non-enhancing hemispheric lesion (B) Intraparenchymal hemorrhage (C) Prominent intraparenchymal white matter calcification (D) Subependymal nodule
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['(C) Prominent intraparenchymal white matter calcification <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** Thirty minutes after delivery, a 3400-g (7.5-lb) female newborn develops cyanosis of her lips and oral mucosa. She was born at 36 weeks of gestation to a 30-year-old woman, gravida 1, para 0. Apgar scores are 7 and 8 at 1 and 5 minutes, respectively. Pregnancy was complicated by polyhydramnios. The patient's temperature is 37°C (98.6°F), pulse is 144/min, respirations are 52/min, and blood pressure is 70/40 mm Hg. Examination shows foaming and drooling at the mouth. Bilateral crackles are heard at the lung bases. There is a harsh 3/6 systolic murmur along the left sternal border. The abdomen is soft and mildly distended. There is an anterior ectopic anus. Insertion of a nasogastric tube is attempted. An x-ray of the chest and abdomen is shown. Which of the following is the most likely diagnosis? (A) H‑type tracheoesophageal fistula without esophageal atresia (B) Esophageal atresia with tracheoesophageal fistula to the distal esophageal segment (C) Esophageal atresia with tracheoesophageal fistula to the proximal and distal esophageal segments (D) Esophageal atresia without tracheoesophageal fistula
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['(B) Esophageal atresia with tracheoesophageal fistula to the distal esophageal segment <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 62-year-old woman presents to her physician because she has been feeling increasingly fatigued over the last several months. In addition, she says that she has woken up at night several times and found herself completely covered in sweat. Finally, she says that she has lost 20 pounds despite no changes in her daily routine. On presentation, her temperature is 101.0°F (38.3°C), blood pressure is 134/83 mmHg, pulse is 71/min, and respirations are 19/min. Physical exam reveals a number of enlarged lymph nodes. Based on these findings, she is given a lab test revealing an abnormally high concentration of a protein arranged in a pentameric complex on serum electrophoresis. Which of the following is most strongly associated with the cause of this patient's symptoms? (A) Calcitriol secretion (B) Jaw lesion (C) Retinal hemorrhage (D) Sjogren syndrome
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['(C) Retinal hemorrhage <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 62-year-old woman is brought to the emergency department after briefly losing consciousness while walking her dog. She spontaneously regained consciousness 20 seconds later. She has a history of atrial fibrillation. Current medications include metoprolol. She reports that she forgot to take her medication the day before and took double the dose this morning instead. A decrease in which of the following most likely contributed to this patient's episode? (A) Phosphorylation of myosin light chains in vascular smooth muscle cells (B) Activity of protein kinase C in cardiomyocytes (C) Activity of adenylyl cyclase in cardiomyocytes (D) Diastolic efflux of calcium in cardiomyocytes
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['(C) Activity of adenylyl cyclase in cardiomyocytes <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 33-year-old man is brought to the emergency department 20 minutes after losing control over his bicycle and colliding with a parked car. The handlebar of the bicycle hit his lower abdomen. On arrival, he is alert and oriented. His pulse is 90/min, respirations are 17/min and blood pressure is 110/70 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 97%. The pupils are equal and reactive to light. There are multiple bruises over his chest and lower extremities. The lungs are clear to auscultation. Cardiac examination shows no abnormalities. The abdomen is soft and nontender. There is no pelvic instability. Rectal examination is unremarkable. A complete blood count, prothrombin time, and serum concentrations of glucose, creatinine, and electrolytes are within the reference range. Urine dipstick is mildly positive for blood. Microscopic examination of the urine shows 20 RBCs/hpf. Which of the following is the most appropriate next step in management? (A) Suprapubic catheterization (B) Intravenous pyelography (C) Laparotomy (D) Observation and follow-up
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['(D) Observation and follow-up <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 66-year-old man is brought to the emergency department because of fever, chills, and altered mental status for 3 days. According to his daughter, he has had a productive cough during this period. He has type 2 diabetes, hypertension, hypercholesterolemia, peripheral neuropathic pain, and a history of deep vein thromboses. Current medications include insulin, lisinopril, atorvastatin, warfarin, and carbamazepine. He is oriented only to self. His temperature is 39.3°C (102.7°F), pulse is 110/min, respirations are 26/min, and blood pressure is 86/50 mm Hg. Physical examination shows ecchymoses on both lower extremities. Crackles are heard at the right lung base. Laboratory studies show: Hemoglobin 11.1 g/dL Leukocyte count 18,000/mm3 Platelet count 45,000/mm3 Prothrombin time 45 sec Partial thromboplastin time 75 sec Serum Na+ 135 mEq/L K+ 5.4 mEq/L Cl- 98 mEq/L Urea nitrogen 46 mg/dL Glucose 222 mg/dL Creatinine 3.3 mg/dL Which of the following is the most likely cause of this patient's ecchymoses?" (A) Disseminated intravascular coagulation (B) Thrombotic thrombocytopenic purpura (C) Immune thrombocytopenic purpura (D) Adverse effect of warfarin "
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['(A) Disseminated intravascular coagulation <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 37-year-old man comes to the emergency department for severe eye pain. The patient reports that he is a construction worker and was drilling metal beams when he suddenly felt a sharp pain in his right eye. Since then, the vision in his right eye has seemed blurry and his eye “has not stopped tearing.” The patient’s medical history is significant for type II diabetes mellitus and hypertension. His medications include metformin, captopril, and lovastatin. He has a mother with glaucoma, and both his brother and father have coronary artery disease. Upon physical examination, there is conjunctival injection present in the right eye with no obvious lacerations to the eyelids or defects in extraocular eye movements. Pupils are equal and reactive to light. No afferent pupillary defect is appreciated. The unaffected eye has 20/20 visual acuity. The patient refuses to participate in the visual acuity exam of the right eye due to pain. Which of the following is the best initial step in management? (A) Fluorescein stain (B) Orbital magnetic resonance imaging (C) Tonometry (D) Topical corticosteroids
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['(A) Fluorescein stain <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 77-year-old female comes to a medical school's free clinic for follow-up examination after a urinary tract infection (UTI) and is seen by a fourth year medical student. The clinic serves largely uninsured low-income patients in a New York City neighborhood with a large African American and Latino population. Two weeks ago, the patient was treated in the local emergency department where she presented with altered mental state and dysuria. The medical student had recently read about a study that described a strong relationship between cognitive impairment and UTI hospitalization risk (RR = 1.34, p < 0.001). The attending physician at the medical student's free clinic is also familiar with this study and tells the medical student that the study was conducted in a sample of upper middle class Caucasian patients in the Netherlands. The attending states that the results of the study should be interpreted with caution. Which of the following concerns is most likely underlying the attending physician's remarks? (A) Low internal validity (B) Poor reliability (C) Low external validity (D) Selection bias
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['(C) Low external validity <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 33-year-old African American woman presents to the office complaining of blurry vision and headache for the past 2 weeks. She states that she has not been feeling herself lately and also fell down once after a dizzy episode. Her medical history is remarkable for hypertension and pulmonary sarcoidosis treated with hydralazine and prednisone respectively. She had a recent bout of acute optic neuritis, requiring high-dose IV methylprednisolone. Her temperature is 37°C (98.6°F), the blood pressure is 112/76 mm Hg, the pulse is 78/min, and the respirations are 14/min. On examination, the patient is mildly disoriented. Head and neck examination reveals a soft, supple neck and a right-sided facial droop. There is 5/5 muscle strength in all extremities. VDRL test is negative. A head MRI is pending. What is the most appropriate next step in the management of this patient? (A) Methotrexate (B) Methylprednisolone and methotrexate (C) Heparin (D) Plasmapheresis
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['(B) Methylprednisolone and methotrexate <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 25-year-old man presents with jaw discomfort and the inability to open his mouth fully for about 3 days. About a week ago, he says he cut himself while preparing a chicken dinner but did not seek medical assistance. Five days after the original injury, he started noticing jaw discomfort and an inability to open his mouth completely. He has no history of a serious illness or allergies and takes no medications. The patient says he had received his primary tetanus series in childhood, and that his last booster was more than 10 years ago. His blood pressure is 125/70 mm Hg and temperature is 36.9℃ (98.5°F). On physical examination, the patient is unable to open his jaw wider than 2.5 cm. Head and neck examinations are otherwise unremarkable. There is a 5 cm linear shallow laceration with some granulation tissue on the right index finger without necrosis, erythema, or pus. After wound care and initiation of metronidazole, which of the following is the next best step in the management of this patient? (A) Tdap (B) Td (C) Tetanus immunoglobulin (TIG) (D) DTaP
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['(C) Tetanus immunoglobulin (TIG) <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 10-month-old boy is admitted to the pediatric intensive care ward because of progressive dyspnea and fever. For the past 2 weeks, he was unsuccessfully treated for an upper respiratory tract infection with ampicillin. He has a history of neonatal sepsis, frequent respiratory tract infections since the age of 3 months, and recurrent otitis media. He was born full-term vaginally to a consanguineous couple from an uncomplicated pregnancy. He received routine immunizations until 6 months of age. The patient’s vital signs are as follows: blood pressure is 70/40 mm Hg, heart rate is 138/min, respiratory rate is 39/min, and temperature is 39.5℃ (103.1 ℉). Physical examination reveals cyanosis, nasal flare, intercostal retractions, and bilaterally decreased breath sounds with crackles heard over the lower lobes on auscultation. The chest X-ray confirms bilateral lower lobe pneumonia. The blood count shows the following findings: Erythrocytes 4.1 x 106/mm3 Hgb 13 g/dL Total leukocyte count 41,100/mm3 Neutrophils 74% Lymphocytes 14% Eosinophils 2% Monocytes 10% Basophils 0% Platelet count 210,000/mm3 The patient is diagnosed with bilateral community-acquired lower lobe pneumonia and prescribed antibiotics. An immunological workup is performed to assess the patient’s immunity: Measurement Result Normal range Antibodies Total serum IgG 22.0 mg/dL 231–1,411 mg/dL Serum IgA 59.3 mg/dL 0–83 mg/dL Serum IgM 111.9 mg/dL 0–145 mg/dL Lymphocyte flow cytometry CD3+ cells 2.2% 60–85% CD19+ cells 95.1% 8–20% CD16/CD56+ cells 0.1% 3–30% Which of the following procedures is the option of choice for the further management of this patient? (A) Periodical prophylactic antibiotic administration (B) Periodical intravenous immune globulin administration (C) Bone marrow transplantation (D) Chemotherapy
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['(C) Bone marrow transplantation <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 55-year-old woman comes to the physician because of involuntary rhythmic shaking of both hands for several months. More recently, she also noticed involuntary head nodding movements. The shaking seems to improve after having one or two glasses of wine. Her father had similar symptoms starting at the age of 60. Neurologic examination shows a symmetric hand tremor that worsens with voluntary movement of the respective extremity. The most appropriate pharmacotherapy for this patient's symptoms is also recommended for the treatment of which of the following conditions? (A) Motion sickness (B) Restless legs syndrome (C) Sleepwalking (D) Hyperthyroidism
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['(D) Hyperthyroidism <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A young woman from the Ohio River Valley in the United States currently on corticosteroid therapy for ulcerative colitis presented to a clinic complaining of fever, sweat, headache, nonproductive cough, malaise, and general weakness. A chest radiograph revealed patchy pneumonia in the lower lung fields, together with enlarged mediastinal and hilar lymph nodes. Skin changes suggestive of erythema nodosum (i.e. an acute erythematous eruption) were noted. Because the patient was from a region endemic for fungal infections associated with her symptoms and the patient was in close contact with a person presenting similar symptoms, the attending physician suspected that systemic fungal infection might be responsible for this woman’s illness. Which of the following laboratory tests can the physician use to ensure early detection of the disease, and also effectively monitor the treatment response? (A) Culture method (B) Antibody testing (C) Fungal staining (D) Antigen detection
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['(D) Antigen detection <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 27-year-old woman seeks evaluation by her general physician with complaints of an odorous yellow vaginal discharge and vaginal irritation for the past 3 days. She also complains of itching and soreness. The medical history is unremarkable. She is not diabetic. She has been sexually active with a single partner for the last 3 years. A vaginal swab is sent to the lab for microscopic evaluation, the results of which are shown in the exhibit, and the culture yields heavy growth of protozoa. A pregnancy test was negative. What is the most appropriate treatment for this patient? (A) Metronidazole (B) Nystatin (C) Ampicillin (D) Acyclovir
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['(A) Metronidazole <> 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 for a follow-up examination. He has had lower back pain for several months. The pain radiates down the right leg to the foot. He has no history of any serious illness and takes no medications. His pain increases after activity. The straight leg test is positive on the right. The results of the laboratory studies show: Laboratory test Hemoglobin 14 g/d Leukocyte count 5,500/mm3 with a normal differential Platelet count 350,000/mm3 Serum Calcium 9.0 mg/dL Albumin 3.8 g/dL Urea nitrogen 14 mg/dL Creatinine 0.9 mg/dL Serum immunoelectrophoresis shows an immunoglobulin G (IgG) type monoclonal component of 40 g/L. Bone marrow plasma cells return at 20%. Skeletal survey shows no bone lesions. Magnetic resonance imaging (MRI) shows a herniated disc at the L5. Which of the following is the most appropriate next step? (A) Dexamethasone (B) Physical therapy (C) Plasmapheresis (D) Thalidomide
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['(B) Physical therapy <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 4-year-old male is brought into your office because his mother states he has been fatigued. He has not been acting like himself and has been getting tired easily while running around and playing with other children. As of last week, he has also been complaining of being short of breath. His vitals are temperature 98.6 deg F (37.2 deg C), blood pressure 100/75 mmHg, pulse 98/min, and respirations 22/min. On exam, the patient is short of breath, and there is a holosystolic murmur with an appreciable thrill along the left sternal border. There are no other noticeable abnormalities, and the mother states that the child's prenatal course along with genetic testing was normal. What is the most likely diagnosis? (A) Tetrology of Fallot (B) Patent ductus arteriosus (PDA) (C) Ventricular septal defect (VSD) (D) Atrial septal defect (ASD)
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['(C) Ventricular septal defect (VSD) <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 32-year-old woman is brought to the emergency department by her husband because of an episode of hematemesis 2 hours ago. She has had dyspepsia for 2 years. Her medications include occasional ibuprofen for headaches. After initial stabilization, the risks and benefits of upper endoscopy and alternative treatments, including no therapy, are explained thoroughly. She shows a good understanding of her condition and an appreciation of endoscopic treatment and its complications. She decides that she wants to have an endoscopy to find the source of bleeding and appropriately manage the ulcer. Her medical records show advance directives that she signed 3 years ago; her sister, who is a nurse, has a durable power of attorney. Regarding obtaining informed consent, which of the following is the most accurate conclusion for providing endoscopic treatment for this patient? (A) Documentation of her decision prior to treatment is required (B) Endoscopic treatment may be performed without further action (C) Her decision to have an endoscopy is not voluntary (D) Her sister must sign the consent form
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['(A) Documentation of her decision prior to treatment is required <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 59-year-old man presents to the emergency department with a complaint of palpitations for the last 30 minutes. He denies chest pain, breathlessness, and loss of consciousness. The medical history is negative for hypertension or ischemic heart disease. On physical examination, the temperature is 36.9°C (98.4°F), the pulse rate is 146/min and irregular, the blood pressure is 118/80 mm Hg, and the respiratory rate is 15/min. A 12-lead electrocardiogram reveals an absence of normal P waves and the presence of saw tooth-appearing waves. The physician treats him with a single intravenous infusion of ibutilide under continuous electrographic monitoring, which successfully converts the abnormal rhythm to sinus rhythm. Which of the following mechanisms best explains the therapeutic action of this drug in this patient? (A) Prolongation of action potential duration by blocking the rapid outward sodium current (B) Prolongation of cardiac depolarization by blocking the potassium channels and activating the slow inward sodium current (C) Slowing the rapid upstroke during phase 0 by blocking the calcium channels (D) Suppression of phase 4 upstroke in the myocardial fibers by slowly dissociating from sodium channels
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['(B) Prolongation of cardiac depolarization by blocking the potassium channels and activating the slow inward sodium current <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** Twelve days after undergoing total pancreatectomy for chronic pancreatitis, a 62-year-old woman notices oozing from her abdominal wound. She first noticed fluid draining 8 hours ago. Her postoperative course has been complicated by persistent hypotension requiring intravenous fluids and decreased ability to tolerate food. She has type 1 diabetes mellitus and glaucoma. The patient smoked one pack of cigarettes daily for 30 years, but quit 2 years ago. She drank a pint of vodka every day starting at age 20 and quit when she was 35 years old. Her current medications include subcutaneous insulin and timolol eye drops. She appears comfortable. Her temperature is 37°C (98.6°F), pulse is 95/min, and blood pressure is 104/78 mm Hg. The abdomen is soft and mildly tender to palpation. There is a 12-cm vertical wound beginning in the epigastrium and extending caudally. 25 mL of a viscous, dark green substance is draining from the middle of the wound. There is a small amount of dried fluid on the patient's hospital gown. The wound edges are nonerythematous. There is no pus draining from the wound. Laboratory studies show: Hematocrit 38% Leukocyte count 8,000/mm3 Serum Na+ 135 mEq/L Cl- 100 mEq/L K+ 3.4 mEq/L HCO3- 23 mEq/L Urea nitrogen 13 mg/dL Creatinine 1.1 mg/dL Glucose 190 mg/dL Which of the following is the most appropriate next step in management?" (A) Surgical exploration of the abdomen (B) Oral food intake and intravenous fluid administration (C) Total parenteral nutrition and ostomy pouch (D) Wound debridement and irrigation "
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['(C) Total parenteral nutrition and ostomy pouch <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 3-month-old infant is brought to her pediatrician for a well-child visit. The infant was born to a 22-year-old mother via a spontaneous vaginal delivery at 38 weeks of gestation in her home. She moved to the United States approximately 3 weeks ago from a small village. She reports that her infant had 2 episodes of non-bloody and non-bilious vomiting. The infant's medical history includes eczema and 2 seizure episodes that resolved with benzodiazepines in the emergency department. Physical examination is notable for a musty body odor, eczema, and a fair skin complexion. Which of the following is the best next step in management? (A) Abdominal radiography (B) Dermatology consult (C) Dietary restriction (D) MRI of the brain
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['(C) Dietary restriction <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 13-year-old girl is brought to the physician by her father because of a worsening pruritic rash for 2 days. Five weeks ago, she was diagnosed with juvenile myoclonic epilepsy and treatment with lamotrigine was begun. Her immunizations are up-to-date. Her temperature is 38.8°C (101.8°F). Physical examination shows facial edema and a partially confluent morbilliform rash over the face, trunk, and extremities. There is swelling of the cervical and inguinal lymph nodes and hepatomegaly. Further evaluation is most likely to show which of the following? (A) Fragmented red blood cells (B) Increased absolute eosinophil count (C) Positive heterophile antibody test (D) Elevated antistreptolysin-O titer
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['(B) Increased absolute eosinophil count <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 52-year-old man presents to the emergency department with chest pain radiating to his left jaw and arm. He states that he had experienced similar symptoms when playing basketball. The medical history is significant for diabetes mellitus, hypertension, and GERD, for which he takes metformin, hydrochlorothiazide, and pantoprazole, respectively. The blood pressure is 150/90 mm Hg, the pulse is 100/min, and the respirations are 15/min. The ECG reveals ST elevation in leads V3-V6. He is hospitalized for an acute MI and started on treatment. The next day he complains of dizziness and blurred vision. Repeat vital signs were as follows: blood pressure 90/60 mm Hg, pulse 72/min, and respirations 12/min. The laboratory results were as follows: Serum chemistry Sodium 143 mEq/L Potassium 4.1 mEq/L Chloride 98 mEq/L Bicarbonate 22 mEq/L Blood urea nitrogen 26 mg/dL Creatinine 2.3 mg/dL Glucose 120 mg/dL Which of the following drugs is responsible for this patient’s lab abnormalities? (A) Digoxin (B) Pantoprazole (C) Lisinopril (D) Nitroglycerin
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['(C) Lisinopril <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 24-year-old male is brought into the emergency department complaining of chills, headaches, and malaise for several days. He also states that he experiences shortness of breath when climbing two flights of stairs in his home. He admits to occasionally using intravenous drugs during the previous year. On exam, his vital signs are temperature 39.2° C, heart rate 108/min, blood pressure 124/82 mm Hg, respiratory rate 20/min, and oxygen saturation 98% on room air. A holosystolic murmur is heard near the lower left sternal border. An echocardiogram confirms vegetations on the tricuspid valve. What is the most likely causative organism of this patient's condition? (A) Streptococcus bovis (B) Staphylococcus epidermidis (C) Streptococcus mutans (D) Staphylococcus aureus
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['(D) Staphylococcus aureus <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 41-year-old woman presents to urgent care with complaints of a new rash. On review of systems, she endorses ankle pain bilaterally. Otherwise, she has no additional localized complaints. Physical examination reveals numerous red subcutaneous nodules overlying her shins, bilaterally. Complete blood count shows leukocytes 7,300, Hct 46.2%, Hgb 18.1 g/dL, mean corpuscular volume (MCV) 88 fL, and platelets 209. Chest radiography demonstrates bilateral hilar adenopathy with clear lungs. Which of the following is the most likely diagnosis? (A) Coccidioidomycosis (B) Sarcoidosis (C) Chlamydophila pneumoniae (D) Histoplasmosis
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['(B) Sarcoidosis <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 5-year-old girl is brought to the physician by her mother because of a 1-month history of a painful ulcer on her face. She has developed painful sunburns in the past with minimal UV exposure. Examination of the skin shows a 2-cm ulcerated nodule on the left cheek. There are scaly, hyperpigmented papules and plaques over the skin of the entire body. Ophthalmologic examination shows decreased visual acuity, clouded corneas, and limbal injection. Examination of a biopsy specimen from the facial lesion shows poorly-differentiated squamous cell carcinoma. Impairment of which of the following proteins is the most likely cause of this patient's condition? (A) Excision endonuclease (B) Rb nuclear protein (C) Base-specific glycosylase (D) DNA helicase
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['(A) Excision endonuclease <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 24-year-old woman presents with fever, abdominal pain, and bloody bowel movements. She says her symptoms onset 2 days ago and have not improved. She describes the abdominal pain as moderate, cramping in character, and poorly localized. 1 week ago, she says she was on a camping trip with her friends and had barbecued chicken which she thought tasted strange. The patient denies any chills, hemoptysis, hematochezia, or similar symptoms in the past. The vital signs include: pulse 87/min and temperature 37.8°C (100.0°F). Physical examination is significant for moderate tenderness to palpation in the periumbilical region with no rebound or guarding. Stool is guaiac positive. Which of the following is a complication associated with this patient’s most likely diagnosis? (A) Typhoid (B) Appendicitis (C) Toxic megacolon (D) Guillain-Barré syndrome
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['(D) Guillain-Barré syndrome <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 33-year-old woman presents to a walk-in clinic for evaluation of some bumps around her eyes. The bumps are not itchy or painful. They have been getting larger since appearing last year. She has no other complaints. She has not sought out medical attention for the last 20 years due to lack of insurance coverage. Her medical history reveals no problems and she takes no medications. Her periods are regular. A review of systems reveals no other concerns. She does not drink, smoke, or use illicit drugs. Her vital signs show a heart rate of 86/min, respirations of 14/min, and blood pressure of 124/76 mm Hg. On examination, the rash is a series of small papules and plaques around her eyes. The rest of the examination is unremarkable. Which of the following initial blood tests are most appropriate at this time? (A) Fasting blood glucose and lipid profile (B) Fasting lipid profile alone (C) Thyroid stimulating hormone alone (D) Fasting blood glucose, lipid profile, and thyroid stimulating hormone
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['(B) Fasting lipid profile alone <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A section from the thymus of a patient with myasthenia gravis is examined (see image). The function of the portion of the thymus designated by the arrow plays what role in the pathophysiology of this disease? (A) Failure to bind MHC class II molecules (B) Premature involution of the thymus (C) Failure of afferent lymph vessels to form (D) Failure of apoptosis of negatively selected T cells
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['(D) Failure of apoptosis of negatively selected T cells <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 59-year-old man comes to the physician because of urinary frequency and perineal pain for the past 3 days. During this time, he has also had pain with defecation. He is sexually active with his wife only. His temperature is 39.1°C (102.3°F). His penis and scrotum appear normal. Digital rectal examination shows a swollen, exquisitely tender prostate. His leukocyte count is 13,400/mm3. A urine culture obtained prior to initiating treatment is most likely to show which of the following? (A) Gram-negative, lactose-fermenting rods in pink colonies (B) Gram-negative, oxidase-positive rods in green colonies (C) Gram-negative, encapsulated rods in mucoid colonies (D) Gram-negative, aerobic, intracellular diplococci
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['(A) Gram-negative, lactose-fermenting rods in pink colonies <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 17-year-old girl comes to the physician because of a 1-week history of severe itching in the area of her genitals. She reports that the itching is most severe at night. She has been sexually active with three partners over the past year; she uses condoms for contraception. Her current sexual partner is experiencing similar symptoms. Pelvic examination shows vulvar excoriations. A photomicrograph of an epilated pubic hair is shown. Which of the following is the most likely causal organism? (A) Phthirus pubis (B) Pediculus humanus (C) Enterobius vermicularis (D) Epidermophyton floccosum
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['(A) Phthirus pubis <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 21-year-old woman is admitted to the hospital for severe malnutrition with a BMI of 15 kg/m2. Past medical history is significant for chronic anorexia nervosa. During the course of her stay, she is treated with parenteral fluids and nutrition management. On the 4th day, her status changes. Her blood pressure is 110/75 mm Hg, heart rate is 120/min, respiratory rate is 25/min, and temperature is 37.0°C (98.6°F). On physical exam, her heart is tachycardic with a regular rhythm and her lungs are clear to auscultation bilaterally. She appears confused, disoriented, and agitated. Strength in her lower extremities is 4/5. What is the next step in management? (A) MRI of the brain (B) Arrange for outpatient counseling (C) Measure electrolytes (D) Administer insulin
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['(C) Measure electrolytes <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A researcher is studying the mammalian immune response with an unknown virus. A group of mice are inoculated with the virus, and blood is subsequently drawn from these animals at various intervals to check immunoglobulin levels. Which of the following is a critical step in the endogenous pathway of antigen presentation for the virus model presented above? (A) Degradation of the antigen by the proteases in the phagolysosome (B) Translocation of the antigen into the endoplasmic reticulum via TAP proteins (C) Binding of the peptide to MHC class II (D) Interaction of the MHC class II complex with its target CD4+ T cell
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['(B) Translocation of the antigen into the endoplasmic reticulum via TAP proteins <> 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 clinic for establishment of care. He recently retired and moved to Florida with his wife. His past medical history includes hypertension, diabetes, chronic back pain, and hyperlipidemia. According to the patient, he takes lisinopril, metformin, atorvastatin, acetaminophen, and methadone. His previous doctor prescribed methadone for breakthrough pain as he has been having more severe pain episodes due to the recent move. He is currently out of his methadone and asks for a refill on the prescription. A physical examination is unremarkable except for mild lower extremity edema bilaterally and diffuse lower back pain upon palpation. What is the best initial step in the management of this patient? (A) Assess the patient's pain medication history (B) Encourage the patient to switch to duloxetine (C) Prescribe a limited dose of methadone for breakthrough back pain (D) Refer the patient to a pain management clinic
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["(A) Assess the patient's pain medication history <> answer"]
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 62-year-old man comes to the physician in May for a routine health maintenance examination. He feels well. He underwent a right inguinal hernia repair 6 months ago. He has hypertension and type 2 diabetes mellitus. There is no family history of serious illness. Current medications include metformin, sitagliptin, enalapril, and metoprolol. He received the zoster vaccine 1 year ago. He received the PPSV23 vaccine 4 years ago. His last colonoscopy was 7 years ago and was normal. He smoked a pack of cigarettes a day for 20 years but quit 17 years ago. He drinks two to three alcoholic beverages on weekends. He is allergic to amoxicillin. He is scheduled to visit Australia and New Zealand in 2 weeks to celebrate his 25th wedding anniversary. He appears healthy. Vital signs are within normal limits. An S4 is heard at the apex. The remainder of the examination shows no abnormalities. Which of the following is the most appropriate recommendation at this time? (A) Influenza vaccine (B) Pneumococcal conjugate vaccine 13 (C) Abdominal ultrasound (D) Colonoscopy
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['(A) Influenza vaccine <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 46-year-old male presents in consultation for weight loss surgery. He is 6’0” and weighs 300 pounds. He has tried multiple dietary and exercise regimens but has been unsuccessful in losing weight. The surgeon suggests a sleeve gastrectomy, a procedure that reduces the size of the stomach removing a large portion of the stomach along the middle part of the greater curvature. The surgeon anticipates having to ligate a portion of the arterial supply to this part of the stomach in order to complete the resection. Which of the following vessels gives rise to the vessel that will need to be ligated in order to complete the resection? (A) Right gastric artery (B) Splenic artery (C) Right gastroepiploic artery (D) Gastroduodenal artery
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['(B) Splenic artery <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A previously well 25-year-old woman was brought to the emergency department by her boyfriend because of progressive blurred vision. Examination of the eyes reveals loss of horizontal gaze, intact convergence, and nystagmus. A clinical diagnosis of multiple sclerosis is made and the patient is started on a course of corticosteroids. What is the most likely etiology for her eye examination findings? (A) Loss of reticular formations (B) Loss of frontal eye fields (C) Loss of bilateral medial longitudinal fasciculus (D) Loss of cranial nerve VI
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['(C) Loss of bilateral medial longitudinal fasciculus <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 59-year-old man is brought to the emergency department with signs of spontaneous bruising of the lower legs. The patient has a history of alcohol use disorder and has been unemployed for the last 2 years. He reports a 1-year history of fatigue and joint pain. Physical examination of the patient’s legs reveals the findings illustrated in the image. Oral examination shows swollen gums, petechiae of the hard palate, and poor dentition. The most likely underlying cause of this patient's current findings involves which of the following metabolic deficiencies? (A) Conversion of pyruvate to acetyl-CoA (B) Gamma-carboxylation of glutamic acid residues (C) Hydroxylation of lysine residues (D) Intestinal absorption of Ca2+ and PO43-
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['(C) Hydroxylation of lysine residues <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 35-year-old G0P1 female presents to her OB/GYN after 17 weeks gestation. A quad screen is performed revealing the following results: elevated inhibin and beta HCG, decreased aFP and estriol. An ultrasound was performed demonstrating increased nuchal translucency. When the fetus is born, what may be some common characteristics of the newborn if amniocentesis confirms the quad test results? (A) Epicanthal folds, high-pitched crying/mewing, and microcephaly (B) Microphthalmia, microcephaly, cleft lip/palate, holoprosencephaly, and polydactyly (C) Epicanthal folds, macroglossia, flat profile, depressed nasal bridge, and simian palmar crease (D) Elfin facies, low nasal bridge, and extreme friendliness with strangers
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['(C) Epicanthal folds, macroglossia, flat profile, depressed nasal bridge, and simian palmar crease <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 58-year-old right-handed man is brought to the emergency department after he was found unconscious in his living room by his wife. She reports that he has never had a similar episode before. The patient has hypertension and consumes multiple alcoholic drinks per day. On arrival, he is confused and oriented only to person. He cannot recall what happened. He has difficulty speaking and his words are slurred. He reports a diffuse headache and muscle pain and appears fatigued. His temperature is 37°C (98.6°F), pulse is 85/min, respirations are 14/min, and blood pressure is 135/70 mm Hg. Examination shows a 2-cm bruise on his right shoulder. Strength is 5/5 throughout, except for 1/5 in the left arm. The remainder of the physical examination shows no abnormalities. An ECG shows left ventricular hypertrophy. A CT scan of the head without contrast shows no abnormalities. Which of the following is the most likely underlying cause of this patient's symptoms? (A) Transient ischemic attack (B) Migraine (C) Syncope (D) Seizure
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['(D) Seizure <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 56-year-old man presents to the family medicine office since he has been having difficulty keeping his blood pressure under control for the past month. He has a significant medical history of hypertension, coronary artery disease, and diabetes mellitus. He has a prescription for losartan, atenolol, and metformin. The blood pressure is 178/100 mm Hg, the heart rate is 92/min, and the respiratory rate is 16/min. The physical examination is positive for a grade II holosystolic murmur at the left sternal border. He also has diminished sensation in his toes. Which of the following statements is the most effective means of communication between the doctor and the patient? (A) “Have you been taking your medications as prescribed?” (B) “What is causing your blood pressure to be elevated?” (C) “You are taking your medications as prescribed, aren’t you?” (D) “Would you like us to consider trying a different medication for your blood pressure?”
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['(B) “What is causing your blood pressure to be elevated?” <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 53-year-old homeless woman is brought to the emergency department by the police after she was found in the park lying unconscious on the ground. Both of her pupils are normal in size and reactive to light. There are no signs of head trauma. Finger prick test shows a blood glucose level of 20 mg/dL. She has been brought to the emergency department for acute alcohol intoxication several times before. Her vitals signs include: blood pressure 100/70 mm Hg, heart rate 90/min, respiratory rate 22/min, and temperature 35.0℃ (95.0℉). On general examination, she looks pale, but there is no sign of icterus noted. On physical examination, the abdomen is soft and non-tender and no hepatosplenomegaly noted. She spontaneously opens her eyes after the administration of a bolus of intravenous dextrose, thiamine, and naloxone. Blood and urine samples are drawn for toxicology screening. Finally, the blood alcohol level turns out to be 300 mg/dL. What will be the most likely laboratory findings in this patient? (A) AST > ALT, increased gamma-glutamyl transferase (B) Decreased ALP (C) AST > ALT, normal gamma glutamyl transferase (D) Decreased MCV
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['(A) AST > ALT, increased gamma-glutamyl transferase <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 69-year-old woman is brought to the physician by her daughter because of increasing forgetfulness and generalized fatigue over the past 4 months. She is unable to remember recent events and can no longer recognize familiar people. She lives independently, but her daughter has hired a helper in the past month since the patient has found it difficult to shop or drive by herself. She has stopped attending family functions and refuses to visit the neighborhood clubhouse, where she used to conduct game nights for the residents. She has had a 7-kg (15-lb) weight gain over this period. She is alert and oriented to time, place, and person. Her temperature is 36°C (97.6°F), pulse is 54/min, and blood pressure is 122/80 mm Hg. Mental status examination shows impaired attention and concentration; she has difficulty repeating seven digits forward and five in reverse sequence. She cannot recall any of the 3 objects shown to her after 10 minutes. She has no delusions or hallucinations. Further evaluation is most likely to show which of the following? (A) Diffuse cortical atrophy on brain MRI (B) Ventriculomegaly on CT scan of the head (C) Elevated serum WBC count (D) Elevated serum TSH
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['(D) Elevated serum TSH <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 12-year-old male presents to the pediatrician after two days of tea-colored urine which appeared to coincide with the first day of junior high football. He explains that he refused to go back to practice because he was humiliated by the other players due to his quick and excessive fatigue after a set of drills accompanined by pain in his muscles. A blood test revealed elevated creatine kinase and myoglobulin levels. A muscle biopsy was performed revealing large glycogen deposits and an enzyme histochemistry showed a lack of myophosphorylase activity. Which of the following reactions is not occuring in this individuals? (A) Converting glucose-6-phosphate to glucose (B) Breaking down glycogen to glucose-1-phosphate (C) Cleaving alpha-1,6 glycosidic bonds from glycogen (D) Converting galactose to galactose-1-phosphate
|
['(B) Breaking down glycogen to glucose-1-phosphate <> answer']
|
The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 31-year-old female receives a kidney transplant for autosomal dominant polycystic kidney disease (ADPKD). Three weeks later, the patient experiences acute, T-cell mediated rejection of the allograft and is given sirolimus. Which of the following are side effects of this medication? (A) Pancreatitis (B) Hyperlipidemia, thrombocytopenia (C) Cytokine release syndrome, hypersensitivity reaction (D) Nephrotoxicity, gingival hyperplasia
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['(B) Hyperlipidemia, thrombocytopenia <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 76-year-old man is brought to the emergency department by his daughter because he has been feeling lightheaded and almost passed out during dinner. Furthermore, over the past few days he has been experiencing heart palpitations. His medical history is significant for well-controlled hypertension and diabetes. Given this presentation, an electrocardiogram is performed showing an irregularly irregular tachyarrhythmia with narrow QRS complexes. The patient is prescribed a drug that decreases the slope of phase 0 of the ventricular action potential but does not change the overall duration of the action potential. Which of the following drugs is consistent with this mechanism of action? (A) Mexiletine (B) Procainamide (C) Propafenone (D) Propanolol
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['(C) Propafenone <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 65-year-old man presents to his primary care physician for a yearly checkup. He states he feels he has been in good health other than minor fatigue, which he attributes to aging. The patient has a past medical history of hypertension and is currently taking chlorthalidone. He drinks 1 glass of red wine every night. He has lost 5 pounds since his last appointment 4 months ago. His temperature is 99.2°F (37.3°C), blood pressure is 147/98 mmHg, pulse is 80/min, respirations are 14/min, and oxygen saturation is 99% on room air. Physical exam reveals an obese man in no acute distress. Laboratory values are ordered as seen below. Hemoglobin: 9 g/dL Hematocrit: 27% Mean corpuscular volume: 72 µm^3 Leukocyte count: 6,500/mm^3 with normal differential Platelet count: 193,000/mm^3 Serum: Na+: 139 mEq/L Cl-: 101 mEq/L K+: 4.3 mEq/L HCO3-: 25 mEq/L BUN: 20 mg/dL Glucose: 99 mg/dL Creatinine: 1.1 mg/dL Ca2+: 9.0 mg/dL AST: 32 U/L ALT: 20 U/L 25-OH vitamin D: 15 ng/mL Which of the following is the best next step in management? (A) Colonoscopy (B) Counseling for alcohol cessation (C) Exercise regimen and weight loss (D) Iron supplementation
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['(A) Colonoscopy <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 45 year-old gentleman presents to his primary care physician complaining of wrist pain and is diagnosed with carpal tunnel syndrome. Upon further questioning, the patient admits that he has recently been outgrowing his gloves and shoes and has had to purchase a new hat as well due to increased head size. Upon exam, he is found to have new mild hypertension and on basic labs he is found to be hyperglycemic. Which of the following is the best blood test to diagnose his suspected disorder? (A) Hydroxyproline level (B) Alkaline Phosphatase level (C) Cortisol level (D) IGF-1 level
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['(D) IGF-1 level <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 5-year-old boy is brought to the physician by his parents because of 2 episodes of screaming in the night over the past week. The parents report that their son woke up suddenly screaming, crying, and aggressively kicking his legs around both times. The episodes lasted several minutes and were accompanied by sweating and fast breathing. The parents state that they were unable to stop the episodes and that their son simply went back to sleep when the episodes were over. The patient cannot recall any details of these incidents. He has a history of obstructive sleep apnea. He takes no medications. His vital signs are within normal limits. Physical examination shows no abnormalities. Which of the following is the most likely diagnosis? (A) Insomnia disorder (B) Sleep terror disorder (C) Nightmare disorder (D) Sleepwalking disorder
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['(B) Sleep terror disorder <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 58-year-old woman comes to the physician for evaluation of worsening fatigue for 1 week. She also has a 1-year history of hand pain and stiffness. Four months ago, she started a new medication for these symptoms. Medications used prior to that included ibuprofen, prednisone, and hydroxychloroquine. Examination shows a subcutaneous nodule on her left elbow and old joint destruction with Boutonniere deformity. Her hemoglobin concentration is 10.1 g/dL, leukocyte count is 3400/mm3, and platelet count is 101,000/mm3. Methylmalonic acid levels are normal. Which of the following could have prevented this patient's laboratory abnormalities? (A) Vitamin B6 (B) Vitamin B12 (C) Amifostine (D) Leucovorin
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['(D) Leucovorin <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 58-year-old Caucasian male is being treated for atrial fibrillation and angina complains of dyspnea on exertion. On exam, his heart rate 104-115/min and irregularly irregular at rest. He has no chest pain. You believe his rate control for atrial fibrillation is suboptimal and the likely cause of his dyspnea. You are considering adding verapamil to his current metoprolol for additional rate control of his atrial fibrillation. Which of the following side effects should you be most concerned about with this additional medication? (A) Diarrhea (B) Shortening of action potential length at the AV node (C) Hypotension (D) Torsades de pointes
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['(C) Hypotension <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 66-year-old woman presents to the emergency department after a fall 4 hours ago. She was on her way to the bathroom when she fell to the ground and lost consciousness. Although she regained consciousness within one minute, she experienced lightheadedness for almost half an hour. She has experienced on-and-off dizziness for the past 2 weeks whenever she tries to stand. She has a history of type 2 diabetes mellitus, hypertension, hypercholesterolemia, and chronic kidney disease secondary to polycystic kidneys. Her medications include aspirin, bisoprolol, doxazosin, erythropoietin, insulin, rosuvastatin, and calcium and vitamin D supplements. She has a blood pressure of 111/74 mm Hg while supine and 84/60 mm Hg on standing, the heart rate of 48/min, the respiratory rate of 14/min, and the temperature of 37.0°C (98.6°F). CT scan of the head is unremarkable. Electrocardiogram reveals a PR interval of 250 ms. What is the next best step in the management of this patient? (A) Electroencephalogram (B) Holter monitoring (C) Stop antihypertensive medicines (D) Tilt table testing
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['(C) Stop antihypertensive medicines <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 46-year-old female is brought to the emergency department by her husband 1 hour after the onset of chest palpitations. Her symptoms began suddenly while she was drinking coffee and have persisted since then. She has not had shortness of breath, chest pain, dizziness, or loss of consciousness. She has experienced these palpitations before, but they typically resolve spontaneously within a few minutes. She has no history of serious illness and takes no medications. Her temperature is 36.8°C (98.2°F), pulse is 155/min, respirations are 18/min, and blood pressure is 130/82 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 97%. Physical examination shows no abnormalities other than tachycardia. An ECG is shown. Repeated, forceful exhalation against a closed glottis while supine fails to relieve her symptoms. Which of the following is the most appropriate next step in management? (A) Administer adenosine intravenously (B) Administer verapamil intravenously (C) Electrical cardioversion (D) Administer diltiazem intravenously
|
['(A) Administer adenosine intravenously <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 67-year-old man is referred to a dermatologist after a reddish mole appears on his nose. The mole’s size has changed over the last 2 years, and occasional bleeding is noted. The man’s medical history is unremarkable, and he does not take any medications. He retired from his construction job 15 years ago. Physical examination of his nose reveals a 2-cm pink papule with a pearly appearance and overlying telangiectasia on the ala of the nose (see image). Which of the following would be the best treatment modality if surgery is not an option? (A) Photodynamic therapy (B) 5-fluorouracil (C) Radiation therapy (D) Interferon
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['(C) Radiation therapy <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 62-year-old woman is referred to a tertiary care hospital with a history of diplopia and fatigue for the past 3 months. She has also noticed difficulty in climbing the stairs and combing her hair. She confirms a history of 2.3 kg (5.0 lb) weight loss in the past 6 weeks and constipation. Past medical history is significant for type 2 diabetes mellitus. She has a 50-pack-year cigarette smoking history. Physical examination reveals a blood pressure of 135/78 mm Hg supine and 112/65 while standing, a heart rate of 82/min supine and 81/min while standing, and a temperature of 37.0°C (98.6°F). She is oriented to time and space. Her right upper eyelid is slightly drooped. She has difficulty in abducting the right eye. Pupils are bilaterally equal and reactive to light with accommodation. The corneal reflex is intact. Muscle strength is reduced in the proximal muscles of all 4 limbs, and the lower limbs are affected more when compared to the upper limbs. Deep tendon reflexes are bilaterally absent. After 10 minutes of cycling, the reflexes become positive. Sensory examination is normal. Diffuse wheezes are heard on chest auscultation. Which of the following findings is expected? (A) Antibodies against muscle-specific kinase (B) Incremental pattern on repetitive nerve conduction studies (C) Periventricular plaques on MRI of the brain (D) Thymoma on CT scan of the chest
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['(B) Incremental pattern on repetitive nerve conduction studies <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 49-year-old man with alcohol use disorder is brought to the emergency department immediately after two episodes of coffee-ground emesis. His pulse is 116/min and blood pressure is 92/54 mm Hg. Physical examination shows a distended abdomen with shifting dullness. Skin examination shows jaundice, erythematous palms, and dilated veins in the anterior abdominal wall. After fluid resuscitation, he is given a drug that decreases portal venous pressure. The drug works by inhibiting the secretion of splanchnic vasodilatory hormones as well as blocking glucagon and insulin release. This drug is a synthetic analog of a substance normally produced in which of the following cells? (A) G cells (B) K cells (C) D cells (D) I cells "
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['(C) D cells <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 25-year-old female with a history of childhood asthma presents to clinic complaining of a three month history of frequent, loose stools. She currently has three to four bowel movements per day, and she believes that these episodes have been getting worse and are associated with mild abdominal pain. She also endorses seeing red blood on the toilet tissue. On further questioning, she also endorses occasional palpitations over the past few months. She denies fevers, chills, headache, blurry vision, cough, shortness of breath, wheezing, nausea, or vomiting. She describes her mood as slightly irritable and she has been sleeping poorly. A review of her medical chart reveals a six pound weight loss since her visit six months ago, but she says her appetite has been normal. The patient denies any recent illness or travel. She is a non-smoker. Her only current medication is an oral contraceptive pill. Her temperature is 37°C (98.6°F), pulse is 104/min, blood pressure is 95/65 mmHg, respirations are 16/min, and oxygen saturation is 99% on room air. On physical exam, the physician notes that her thyroid gland appears symmetrically enlarged but is non-tender to palpation. Upon auscultation there is an audible thyroid bruit. Her cranial nerve is normal and ocular exam reveals exophthalmos. Her abdomen is soft and non-tender to palpation. Deep tendon reflexes are 3+ throughout. Lab results are as follows: Serum: Na+: 140 mEq/L K+: 4.1 mEq/L Cl-: 104 mEq/L HCO3-: 26 mEql/L BUN: 18 mg/dL Creatinine 0.9 mg/dL Hemoglobin: 14.0 g/dL Leukocyte count: 7,400/mm^3 Platelet count 450,000/mm^3 TSH & Free T4: pending A pregnancy test is negative. The patient is started on propranolol for symptomatic relief. What is the most likely best next step in management for this patient? (A) IV hydrocortisone (B) Propylthiouracil (C) Thyroid scintigraphy with I-123 (D) Surgical thyroidectomy
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['(B) Propylthiouracil <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 28-year-old woman with a past medical history of fibromyalgia presents to her primary care provider for her annual well visit. She reports that her pain has become more severe over the last several weeks and is no longer well-controlled by NSAIDs. She notes that the pain is beginning to interfere with her sleep and that she feels she no longer has energy to take care of her 2-year-old son. Upon questioning, the patient also endorses feeling more down than usual recently, little interest in seeing friends, and difficulty concentrating on her work. She admits to feeling that she would be “better off dead.” The patient feels strongly that the worsening pain is driving these changes in her mood and that she would feel better if her pain was better controlled. Which of the following is the best next step in management? (A) Add acetaminophen and gabapentin to the patient’s pain regimen (B) Ask the patient if she would voluntarily enter a psychiatric hospital (C) Ask the patient if she has an idea about how she might hurt herself (D) Initiate pharmacotherapy with duloxetine and refer for psychotherapy
|
['(C) Ask the patient if she has an idea about how she might hurt herself <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 56-year-old man of Nepalese origin presents to a clinic complaining of skin rashes that have been troubling him for years. On examination, there are numerous poorly demarcated skin lesions present on all parts of the body. There is also evidence of significant facial thickening, eyebrow loss, and symmetrical sensory neuropathy in a ‘glove and stocking’ distribution. An examination of the hands reveals bilateral weakness. A skin biopsy is taken from one of the lesions, and the culture is positive for acid-fast bacilli. Which of the following pharmacological therapies is involved in the treatment of this condition? (A) Dapsone (B) Flucloxacillin (C) Isoniazid (D) Prednisone
|
['(A) Dapsone <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 5-year-old African American female has experienced recurrent respiratory infections. To determine how well her cell-mediated immunity is performing, a Candida skin injection is administered. After 48 hours, there is no evidence of induration at the injection site. Of the following cell types, which one would have mediated the reaction? (A) Basophils (B) T-cells (C) Mast cells (D) Fibroblasts
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['(B) T-cells <> answer']
|
The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 45-year-old woman presents with a complaint of pain in the metacarpophalangeal joints and proximal interphalangeal joints bilaterally. Serology showed positive anti-CCP antibodies. She has been prescribed infliximab for control of her condition. Which of the following needs to be tested before starting treatment in this patient? (A) PPD skin test (B) Complete blood counts (C) G6PD levels (D) Ophthalmic examination
|
['(A) PPD skin test <> answer']
|
The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 49-year-old man is brought to the emergency department after being discovered unconscious in a field near the county fair. Several empty bottles of vodka were found near him. On arrival, he is mumbling incoherently. He appears malodorous and disheveled. Serum studies show: Na+ 150 mEq/L K+ 3.3 mEq/L Cl- 115 mEq/L HCO3- 13 mEq/L Urea nitrogen 30 mg/dL Glucose 75 mg/dL Creatinine 1.4 mg/dL Lactic acid 6 mmol/L (N < 2) Which of the following changes to enzyme activity best explains this patient's laboratory findings?" (A) Decreased activity of glucose-6-phosphate dehydrogenase (B) Increased activity of α-ketoglutarate dehydrogenase (C) Increased activity of phenylalanine hydroxylase (D) Decreased activity of pyruvate dehydrogenase
|
['(D) Decreased activity of pyruvate dehydrogenase <> answer']
|
The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 4700-g (10.3-lb) male newborn is delivered at 37 weeks' gestation to a 30-year-old woman, gravida 2, para 1. Apgar scores are 7 and 8 at 1 and 5 minutes, respectively. The newborn appears pale. Temperature is 37°C (98.6°F), pulse is 180/min, and blood pressure is 90/60 mm Hg. Examination in the delivery room shows midfacial hypoplasia, infraorbital creases, and a large tongue. The right side of the body is larger than the left. Abdominal examination shows that the abdominal viscera protrudes through the abdominal wall at the umbilicus; the viscera are covered by the amniotic membrane and the peritoneum. The liver is palpated 2–3 cm below the right costal margin. Fingerstick blood glucose concentration is 60 mg/dL. Ultrasonography of the abdomen shows enlarged kidneys bilaterally. In addition to surgical closure of the abdominal wall, which of the following is the most appropriate next step in management? (A) Serum IGF-1 measurement (B) Serum 17-hydroxyprogesterone measurement (C) Cranial MRI (D) Serial abdominal ultrasonography
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['(D) Serial abdominal ultrasonography <> answer']
|
The following are multiple choice questions (with answers) about medical knowledge. **Question:** An investigator is studying the effect of antihypertensive drugs on cardiac output and renal blood flow. For comparison, a healthy volunteer is given a placebo and a continuous infusion of para-aminohippuric acid (PAH) to achieve a plasma concentration of 0.02 mg/ml. His urinary flow rate is 1.5 ml/min and the urinary concentration of PAH is measured to be 8 mg/ml. His hematocrit is 50%. Which of the following values best estimates cardiac output in this volunteer? (A) 3 L/min (B) 6 L/min (C) 8 L/min (D) 1.2 L/min
|
['(B) 6 L/min <> answer']
|
The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 50-year-old man comes to the physician for the evaluation of recurrent episodes of chest pain, difficulty breathing, and rapid heart beating over the past two months. During this period, he has had a 4-kg (8.8-lb) weight loss, malaise, pain in both knees, and diffuse muscle pain. Five years ago, he was diagnosed with chronic hepatitis B infection and was started on tenofovir. His temperature is 38°C (100.4°F), pulse is 110/min, and blood pressure is 150/90 mm Hg. Cardiopulmonary examination shows no abnormalities except for tachycardia. There are several ulcerations around the ankle and calves bilaterally. Laboratory studies show: Hemoglobin 11 g/dL Leukocyte count 14,000/mm3 Erythrocyte sedimentation rate 80 mm/h Serum Perinuclear anti-neutrophil cytoplasmic antibodies negative Hepatitis B surface antigen positive Urine Protein +2 RBC 6-7/hpf Which of the following is the most likely diagnosis?" (A) Takayasu arteritis (B) Giant cell arteritis (C) Polyarteritis nodosa (D) Granulomatosis with polyangiitis
|
['(C) Polyarteritis nodosa <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 75-year-old man presents to the emergency department because of pain in his left thigh and left calf for the past 3 months. The pain occurs at rest, worsens with walking, and is slightly improved by hanging his foot off the bed. He has had hypertension for 25 years and type 2 diabetes mellitus for 30 years. He has smoked 30–40 cigarettes per day for the past 45 years. On examination, the femoral, popliteal, and dorsalis pedis pulses are diminished, but detectable on both sides. The patient’s foot is shown in the image. Which of the following is the most likely diagnosis? (A) Critical limb ischemia (B) Raynaud’s phenomenon (C) Pseudogout (D) Cellulitis
|
['(A) Critical limb ischemia <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** Please refer to the summary above to answer this question A 63-year-old HIV-positive man comes to the physician for a routine health maintenance examination. Four years ago, he was diagnosed with HIV and was started on cART therapy. He tells the physician that he has been having difficulty adhering to his medication regimen. He has been unemployed for the past couple of years and relies on unemployment benefits to cover the costs of daily living. His father died of lymphoma at the age of 60 years. He had recently heard about the results of the study featured in the abstract and wants more information about his risk of developing DLBCL. Based on the study, which of the following is the greatest risk factor for the development of DLBCL in HIV-positive patients?" (A) Positive family history of cancer (B) Male sex (C) Poor adherence to cART (D) Income below $30,000 per year
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['(C) Poor adherence to cART <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 20-year-old man is brought to the emergency room for evaluation of a back injury sustained while at work. A CT scan of the lumbar spine shows an incidental 2-cm mass adjacent to the inferior vena cava. Histologic examination of a biopsy specimen of the mass shows clusters of chromaffin cells. This mass is most likely to secrete which of the following substances? (A) Norepinephrine (B) Cortisol (C) Estrogen (D) Dehydroepiandrosterone
|
['(A) Norepinephrine <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 23-year-old woman visits her general practitioner with left ear pain and fever. She complains of multiple episodes of respiratory infection including bronchitis, laryngitis, and sinusitis. She was diagnosed with systemic lupus erythematosus with nephritis 8 months ago and was placed on oral prednisone. Currently, she takes prednisone daily. Her vital signs are as follows: blood pressure 130/85 mm Hg, heart rate 79/min, respiratory rate 16/min, and temperature 37.5°C (99.5°F). Her weight is 78 kg (172 lb) and height is 169 cm (5 ft 6 in). Physical examination reveals a swollen erythematous left eardrum, erythematous macular rash over sun-exposed skin, and slight calf edema. Inhibition of which of the following pathways causes diminished immune cell activation in this patient? (A) Wnt pathway (B) NF-kß pathways (C) PI3K/AKT/mTOR pathway (D) Notch pathway
|
['(B) NF-kß pathways <> answer']
|
The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 63-year-old African American man presents to the physician for a follow-up examination. He has a history of chronic hypertension and type 2 diabetes mellitus. He has no history of coronary artery disease. His medications include aspirin, hydrochlorothiazide, losartan, and metformin. He exercises every day and follows a healthy diet. He does not smoke. He consumes alcohol moderately. There is no history of chronic disease in the family. His blood pressure is 125/75 mm Hg, which is confirmed on a repeat measurement. His BMI is 23 kg/m2. The physical examination shows no abnormal findings. The laboratory test results show: Serum HbA1C 6.9% Total cholesterol 176 mg/dL Low-density lipoprotein (LDL-C) 105 mg/dL High-density lipoprotein (HDL-C) 35 mg/dL Triglycerides 175 mg/dL The patient's 10-year risk of cardiovascular disease (CVD) is 18.7%. Lifestyle modifications including diet and exercise have been instituted. Which of the following is the most appropriate next step in pharmacotherapy? (A) Atorvastatin (B) Fenofibrate (C) Liraglutide (D) Metoprolol
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['(A) Atorvastatin <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 40-year-old woman with HIV infection presents to the emergency department because of a 4-week history of progressively worsening fatigue and headache. On mental status examination, the patient is somnolent and oriented only to person. Her CD4+ lymphocyte count is 80/mm3 (N = 500). Analysis of this patient's cerebrospinal fluid (CSF) shows a leukocyte count of 30/mm3 (60% lymphocytes), a protein concentration of 52 mg/dL, and a glucose concentration of 37 mg/dL. An India ink stain of the CSF is shown. Which of the following characteristics would also point towards the most likely cause? (A) Chancre (B) Cranial neuropathy (C) Focal neurologic deficits (D) Pulmonary symptoms
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['(B) Cranial neuropathy <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** During an experiment, an investigator attempts to determine the rates of apoptosis in various tissue samples. Injecting cytotoxic T cells into the cell culture of one of the samples causes the tissue cells to undergo apoptosis. Apoptosis is most likely due to secretion of which of the following substances in this case? (A) Bcl-2 (B) TNF-α (C) Granzyme B (D) Caspases
|
['(C) Granzyme B <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 38-year-old woman presents to a physician’s office for progressive weakness and pallor during the last few weeks. She also complains of shortness of breath during her yoga class. She denies fevers, cough, rhinorrhea, or changes in appetite or bowel and bladder habits. She is generally healthy except for an occasional migraine, which is relieved by acetaminophen. For the last month, she has been having more frequent migraine attacks and was started on prophylactic aspirin. The vital signs include: pulse 102/min, respirations 18/min, and blood pressure 130/84 mm Hg. Her blood pressure on previous visits has been 110/76 mm Hg, 120/78 mm Hg, and 114/80 mm Hg. The physical examination is otherwise unremarkable. Stool for occult blood is positive. In addition to a low hemoglobin concentration, which other laboratory finding is expected in this patient? (A) Decreased platelet count (B) Elevated D-dimer (C) Prolonged prothrombin time (PT) (D) Prolonged bleeding time
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['(D) Prolonged bleeding time <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 5-week-old male infant is rushed to the emergency department due to severe vomiting and lethargy for the past 3 days. His mother describes the vomiting as forceful and projectile and contains undigested breast milk, but she did not notice any green fluids. He has not gained much weight in the past 3 weeks and looks very thin. He has a pulse of 144/min, temperature of 37.5°C (99.5°F), and respiratory rate of 18/min. Mucous membranes are dry and the boy is lethargic. Abdominal examination reveals a palpable mass in the epigastrium that becomes more prominent after vomiting with visible peristaltic movements over the epigastrium. Barium-contrast studies show a double channel appearance of the pylorus. What is the best immediate step in the management of this patient’s condition? (A) Reassurance and observation (B) Pyloromyotomy (C) Whipple procedure (D) Correct electrolyte imbalances
|
['(D) Correct electrolyte imbalances <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 40-year-old man presents with severe fatigue, dyspnea on exertion, and weight loss. He reports a weight loss of 15 kg (33.0 lb) over the past 3 months and feels full almost immediately after starting to eat, often feeling nauseous and occasionally vomiting. Past medical history is not significant. However, the patient reports a 10-pack-year smoking history. His temperature is 37.0°C (98.6°F), respiratory rate is 15/min, pulse is 67/min, and blood pressure is 122/98 mm Hg. Physical examination reveals paleness and conjunctival pallor. Abdominal examination reveals an ill-defined nontender mass in the epigastric region along with significant hepatomegaly. Routine laboratory studies show a hemoglobin level of 7.2 g/dL. A contrast CT scan of the abdomen is presented below. Which of the following structures is most helpful in the anatomical classification of gastrointestinal bleeding in this patient? (A) Ligament of Treitz (B) Hepatoduodenal ligament (C) Ampulla of Vater (D) Portal vein
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['(A) Ligament of Treitz <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 2-day-old boy born to a primigravida with no complications has an ear infection. He is treated with antibiotics and sent home. His parents bring him back 1 month later with an erythematous and swollen umbilical cord still attached to the umbilicus. A complete blood cell count shows the following: Hemoglobin 18.1 g/dL Hematocrit 43.7% Leukocyte count 13,000/mm3 Neutrophils 85% Lymphocytes 10% Monocytes 5% Platelet count 170,000/mm3 The immunoglobulin levels are normal. The absence or deficiency of which of the following most likely led to this patient’s condition? (A) CD18 (B) Histamine (C) Prostaglandin E2 (D) IL-1
|
['(A) CD18 <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 40-year-old woman comes to the physician with a 5-day history of mild shortness of breath with exertion. She has also had a cough for 5 days that became productive of whitish non-bloody sputum 3 days ago. Initially, she had a runny nose, mild headaches, and diffuse muscle aches. She has not had fevers or chills. Three weeks ago, her 9-year-old son had a febrile illness with a cough and an exanthematous rash that resolved without treatment 1 week later. The patient has occasional migraine headaches. Her sister was diagnosed with antiphospholipid syndrome 12 years ago. The patient does not smoke; she drinks 3–4 glasses of wine per week. Her current medications include zolmitriptan as needed. Her temperature is 37.1°C (99°F), pulse is 84/min, respirations are 17/min, and blood pressure is 135/82 mm Hg. Scattered wheezes are heard at both lung bases. There are no rales. Egophony is negative. Which of the following is the most appropriate next step in management? (A) Supportive treatment only (B) Perform Bordetella pertussis PCR (C) Conduct a high-resolution chest CT (D) Administer clarithromycin
|
['(A) Supportive treatment only <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 20-year-old female presents to the college health clinic concerned about a rash that has recently developed along her back and flank. Aside from a history of chronic diarrhea and flatulence, she reports being otherwise healthy. She is concerned that this rash could be either from bed bugs or possible be sexually transmitted, as she has engaged in unprotected sex multiple times over the past two years. The physician orders several lab tests and finds that the patient does indeed have chlamydia and elevated tissue transglutaminase (tTG) levels. What is the most likely cause of her rash? (A) Disseminiated chlamydial infection (B) Streptococcal meningitis infection (C) Immunologic response to gluten (D) Bed bug infestation
|
['(C) Immunologic response to gluten <> answer']
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