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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 42-year-old woman is brought to the emergency department because of intermittent sharp right upper quadrant abdominal pain and nausea for the past 10 hours. She has vomited 3 times. There is no associated fever, chills, diarrhea, or urinary symptoms. She has 2 children who both attend high school. She appears uncomfortable. She is 165 cm (5 ft 5 in) tall and weighs 86 kg (190 lb). Her BMI is 32 kg/m2. Her temperature is 37.0°C (98.6°F), pulse is 100/min, and blood pressure is 140/90 mm Hg. She has mild scleral icterus. On physical examination, her abdomen is soft and nondistended, with tenderness to palpation of the right upper quadrant without guarding or rebound. Bowel sounds are normal. Laboratory studies show the following: Blood Hemoglobin count 14 g/dL Leukocyte count 9,000 mm3 Platelet count 160,000 mm3 Serum Alkaline phosphatase 238 U/L Aspartate aminotransferase 60 U/L Bilirubin Total 2.8 mg/dL Direct 2.1 mg/dL Which of the following is the most appropriate next step in diagnosis? (A) Endoscopic retrograde cholangiopancreatography (ERCP) (B) Hepatobiliary iminodiacetic acid (HIDA) scan of the biliary tract (C) Supine and erect X-rays of the abdomen (D) Transabdominal ultrasonography
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['(D) Transabdominal ultrasonography <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 32-year-old man comes to the emergency department for acute pain in the left eye. He reports having awoken in the morning with a foreign body sensation. He had forgotten to remove his contact lenses before sleeping. Following lens removal, he experienced immediate pain, discomfort, and tearing of the left eye. He reports that the foreign body sensation persists and that rinsing with water has not improved the pain. He has been wearing contact lenses for 4 years and occasionally forgets to remove them at night. He has no history of serious medical illness. On examination, the patient appears distressed with pain and photophobia in the left eye. Administration of a topical anesthetic relieves the pain. Visual acuity is 20/20 in both eyes. Ocular motility and pupillary response are normal. The corneal reflex is normal and symmetric in both eyes. Which of the following is most likely to establish the diagnosis in this patient? (A) Fluorescein examination (B) Ocular ultrasonography (C) Gonioscopy (D) CT scan of the orbit
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['(A) Fluorescein examination <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 25-year-old female comes to the clinic complaining of fatigue and palpitations. She has been undergoing immense stress from her thesis defense and has been extremely tired. The patient denies any weight loss, diarrhea, cold/heat intolerance. TSH was within normal limits. She reports a family history of "blood disease" and was later confirmed positive for B-thalassemia minor. It is believed that abnormal splicing of the beta globin gene results in B-thalassemia. What is removed during this process that allows RNA to be significantly shorter than DNA? (A) 3'-poly(A) tail (B) Exons (C) Introns (D) snRNPs
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['(C) Introns <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 50-year-old man comes to the physician because of gradually worsening rhythmic movements of his right hand for the past 5 months. His symptoms worsen when he is in a meeting and he is concerned that people are noticing it more frequently. There is no personal or family history of serious illness, but the patient recalls that his father developed bobbing of the head in older age. He takes no medications. Neurological examination shows a tremor of the right hand when the limbs are relaxed. When the patient is asked to move his arm the tremor decreases. He has reduced arm swing while walking. Which of the following is the most appropriate pharmacotherapy? (A) Donepezil (B) Trihexyphenidyl (C) Propranolol (D) Levodopa/carbidopa
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['(B) Trihexyphenidyl <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 68-year-old man presents to the physician with fever, cough, weakness, night sweats, and poor appetite for the past 6 months. Medical records suggest that he has lost 7.5 kg (16.5 lb) of weight during this period. There is no history of breathlessness, nasal discharge, nasal obstruction, palpitations, chest pain, or symptoms related to digestion. He was released from prison 9 months ago after serving a 2-year sentence. His temperature is 38.1°C (100.6°F), pulse is 84/min, respirations are 16/min, and blood pressure is 122/80 mm Hg. Physical examination shows hepatomegaly and generalized lymphadenopathy, and auscultation of the chest reveals diffuse crackles throughout the lung fields bilaterally. On direct ophthalmoscopy, three discrete, yellow-colored, 0.5 mm to 1.0 mm lesions with indistinct borders are seen in the posterior pole. A chest X-ray is shown in the image. Tuberculin skin test with purified protein derivative is negative. What is the most likely diagnosis? (A) Chronic histoplasmosis (B) Langerhans cell histiocytosis (C) Tuberculosis (D) Bronchoalveolar carcinoma
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['(C) Tuberculosis <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 56-year-old woman makes an appointment with her physician to discuss the results of her cervical cancer screening. She has been menopausal for 2 years and does not take hormone replacement therapy. Her previous Pap smear showed low-grade squamous intraepithelial lesion (LSIL); no HPV testing was performed. Her gynecologic examination is unremarkable. The results of her current Pap smear is as follows: Specimen adequacy satisfactory for evaluation Interpretation low-grade squamous intraepithelial lesion Notes atrophic pattern Which option is the next best step in the management of this patient? (A) Test for HPV 16 and 18 (B) Colposcopy (C) Immediate loop excision (D) Repeat HPV testing in 6 months
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['(B) Colposcopy <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 45-year-old man comes to the emergency department because of a 1-day history of black, tarry stools. He has also had upper abdominal pain that occurs immediately after eating and a 4.4-kg (9.7-lb) weight loss in the past 6 months. He has no history of major medical illness but drinks 3 beers daily. His only medication is acetaminophen. He is a financial consultant and travels often for work. Physical examination shows pallor and mild epigastric pain. Esophagogastroduodenoscopy shows a bleeding 15-mm ulcer in the antrum of the stomach. Which of the following is the strongest predisposing factor for this patient's condition? (A) Age above 40 years (B) Alcohol consumption (C) Work-related stress (D) Helicobacter pylori infection
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['(D) Helicobacter pylori infection <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 36-year-old woman, gravida 4, para 3, at 35 weeks' gestation is brought to the emergency department for the evaluation of a sudden, painless, bright red vaginal bleeding for the last hour. She has had no prenatal care. Her third child was delivered by lower segment transverse cesarean section because of a preterm breech presentation; her first two children were delivered vaginally. The patient's pulse is 100/min, respirations are 15/min, and blood pressure is 105/70 mm Hg. Examination shows a soft, nontender abdomen; no contractions are felt. There is blood on the vulva, the introitus, and on the medial aspect both thighs bilaterally. The fetus is in a cephalic presentation. The fetal heart rate is 140/min. One hour later, the bleeding stops. Which of the following is the most likely diagnosis? (A) Uterine atony (B) Abruptio placentae (C) Latent phase of labor (D) Placenta previa
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['(D) Placenta previa <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** An endocrinologist is working with a pharmaceutical research company on a new drug for diabetes mellitus type 2 (DM2). In their experimental studies, they isolated a component from Gila monster saliva, which was found to have > 50% homology with glucagon-like peptide-1 (GLP1). During the animal studies, the experimental drug was found to have no GLP1 agonist effect. Instead, it irreversibly binds DPP-IV with a higher affinity than GLP1. Which of the following drugs has a similar mechanism of action to this new experimental drug? (A) Pramlintide (B) Canagliflozin (C) Sitagliptin (D) Metformin
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['(C) Sitagliptin <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 60-year-old woman with a history of atrial arrhythmia arrives in the emergency department with complaints of tinnitus, headache, visual disturbances, and severe diarrhea. The patient is given oxygen by nasal cannula. ECG leads, pulse oximeter and an automated blood pressure cuff are applied. The patient suddenly faints. Her ECG indicates the presence of a multifocal ventricular tachycardia with continuous change in the QRS electrical axis. Which of the following drugs is most likely responsible for this patient's symptoms? (A) Digoxin (B) Quinidine (C) Amiodarone (D) Verapamil
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['(B) Quinidine <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A neurophysiology expert is teaching his students the physiology of the neuromuscular junction. While describing the sequence of events that takes place at the neuromuscular junction, he mentions that as the action potential travels down the motor neuron, it causes depolarization of the presynaptic membrane. This results in the opening of voltage-gated calcium channels, which leads to an influx of calcium into the synapse of the motor neuron. Consequently, the cytosolic concentration of Ca2+ ions increases. Which of the following occurs at the neuromuscular junction as a result of this increase in cytosolic Ca2+? (A) Release of Ca2+ ions into the synaptic cleft (B) Increased Na+ and K+ conductance of the motor end plate (C) Exocytosis of acetylcholine from the synaptic vesicles (D) Generation of an end plate potential
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['(C) Exocytosis of acetylcholine from the synaptic vesicles <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 41-year-old man is brought to the emergency room after a blunt-force injury to the abdomen. His pulse is 130/min and blood pressure is 70/40 mm Hg. Ultrasound of the abdomen shows a large amount of blood in the hepatorenal recess and the pelvis. Which of the following responses by the kidney is most likely? (A) Decreased proton excretion (B) Increased sodium reabsorption (C) Increased sodium filtration (D) Increased creatinine absorption
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['(B) Increased sodium reabsorption <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 25-year-old woman presents to the emergency department with palpitations, sweating, and blurry vision after playing volleyball on the beach. She denies chest pain and shortness of breath. She states that these episodes occur often, but resolve after eating a meal or drinking a sugary soda. Past medical history is unremarkable, and she takes no medications. Temperature is 37°C (98.6°F), blood pressure is 135/80 mm Hg, pulse is 102/min, and respirations are 18/min. Fingerstick blood glucose level is 42 g/dL. ECG reveals sinus tachycardia. Urinalysis and toxicology are noncontributory. Appropriate medical therapy is administered and she is discharged with an appointment for a fasting blood draw within the week. Laboratory results are as follows: Blood glucose 45 mg/dL Serum insulin 20 microU/L (N: < 6 microU/L) Serum proinsulin 10 microU/L (N: < 20% of total insulin) C-peptide level 0.8 nmol/L (N: < 0.2 nmol/L) Sulfonylurea Negative IGF-2 Negative What is the most likely cause of this patient’s hypoglycemia? (A) Heat stroke (B) Exogenous insulin (C) Beta cell tumor of the pancreas (D) Alpha cell tumor of the pancreas
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['(C) Beta cell tumor of the pancreas <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 6-year-old male presents to the pediatrician with seizures. His mother reports that the patient has had two seizures lasting about 30 seconds each over the last three days. She reports that the patient has previously had seizures a few times per year since he was 12 months of age. The patient’s past medical history is otherwise notable for intellectual disability. He rolled over at 14 months of age and walked at 24 months of age. The patient’s mother denies any family history of epilepsy or other neurologic diseases. The patient is in the 3rd percentile for height and the 15th percentile for weight. On physical exam, he has a happy demeanor with frequent smiling. The patient has strabismus and an ataxic gait accompanied by flapping of the hands. He responds intermittently to questions with one-word answers. This patient is most likely to have which of the following genetic abnormalities? (A) Chromosomal macrodeletion on chromosome 5 (B) Maternal uniparental disomy of chromosome 15 (C) Paternal uniparental disomy of chromosome 15 (D) Trinucleotide repeat disorder
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['(C) Paternal uniparental disomy of chromosome 15 <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 28-year-old woman has a follow-up visit with her physician. She was diagnosed with allergic rhinitis and bronchial asthma at 11 years of age. Her regular controller medications include daily high-dose inhaled corticosteroids and montelukast, but she still needs to use a rescue inhaler 3–4 times a week following exercise. She also becomes breathless with moderate exertion. After a thorough evaluation, the physician explains that her medication dosages need to be increased. She declines taking oral corticosteroids daily due to concerns about side effects. The physician prescribes omalizumab, which is administered subcutaneously every 3 weeks. Which of the following best explains the mechanism of action of the new medication that has been added to the controller medications? (A) Inhibition of synthesis of interleukin-4 (IL-4) (B) Prevention of binding of IgE antibodies to mast cell receptors (C) Selective binding to interleukin-3 (IL-3) and inhibition of its actions (D) Inhibition of synthesis of IgE antibodies
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['(B) Prevention of binding of IgE antibodies to mast cell receptors <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 37-year-old man presents to the emergency department with rapid onset epigastric pain that started 4 hours ago. He describes the pain as severe, localized to the epigastric region and radiating to the back, which is partially relieved by leaning forward. He admits to binge drinking this evening at a friend’s party. He is nauseated but denies vomiting. Vital signs include: blood pressure 90/60 mm Hg, pulse 110/min, temperature 37.2°C (99.0°F), and respiratory rate 16/min. Physical examination shows tenderness to palpation over the epigastric region with no rebound or guarding. The bowel sounds are decreased on auscultation. The laboratory findings are significant for the following: Laboratory test Leukocyte Count 18,000/mm³ Neutrophils 81% Serum amylase 416 U/L Serum lipase 520 U/L Which of the following would be the most helpful in determining the prognosis in this case? (A) Bedside Index of Severity in Acute Pancreatitis (BISAP) score (B) Modified Glasgow Score (C) C- reactive protein level (D) Ranson´s criteria
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['(A) Bedside Index of Severity in Acute Pancreatitis (BISAP) score <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 32-year-old nulliparous woman with polycystic ovary syndrome comes to the physician for a pelvic examination and Pap smear. Last year she had a progestin-releasing intrauterine device placed. Menarche occurred at the age of 10 years. She became sexually active at the age of 14 years. Her mother had breast cancer at the age of 51 years. She is 165 cm (5 ft 5 in) tall and weighs 79 kg (174 lb); BMI is 29 kg/m2. Examination shows mild facial acne. A Pap smear shows high-grade cervical intraepithelial neoplasia. Which of the following is this patient's strongest predisposing factor for developing this condition? (A) Early onset of sexual activity (B) Obesity (C) Family history of cancer (D) Polycystic ovary syndrome
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['(A) Early onset of sexual activity <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 47-year-old man was brought in by his wife for progressively worsening memory and bizarre behavior over the past 2 months. The wife reports that he has been sleeping 15 hours a day, but is still complaining of fatigue. He frequently forgets important events such as his son’s graduation and left the stove running 2 days ago. During the encounter, the patient reports that “it is no longer worth living.” Past medical history is significant for a corneal transplant 7 years ago. Physical examination reveals depressed mood, healed surgical scar on the left neck, and sustained jerking of the left foot. Which of the following could have prevented this patient’s condition? (A) Antidepressant therapy (B) Good social and familial support system (C) Specific autoclave sterilization (D) Statin therapy
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['(C) Specific autoclave sterilization <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 39-year-old man comes to the physician for preoperative evaluation. He is scheduled for a right inguinal hernia repair the following day. He has a history of polycystic kidney disease and hypertension. His medications include lisinopril and vitamin D3 supplements. His father had the same kidney condition and died of an intracerebral aneurysm when the patient was 2 years old. His temperature is 37°C (98.6 F), pulse is 87/min, and blood pressure is 108/68 mm Hg. He has bilateral pitting edema. There is a right inguinal hernia; cough impulse is present. The remainder of the examination shows no abnormalities. Laboratory studies show: Hemoglobin 9.0 g/dL Serum Na+ 132 mEq/L K+ 6.5 mEq/L Cl- 94 mEq/L HCO3- 21 mEq/L Glucose 86 mg/dL Creatinine 2.9 mg/dL Calcium 8.7 mg/dL Phosphorus 4.9 mg/dL An ECG shows tall T waves. Intravenous calcium gluconate is administered. Which of the following is the definitive treatment for this patient?" (A) Perform hemodialysis (B) Restrict salt and potassium intake (C) Administer sodium bicarbonate (D) Packed red blood cell transfusion
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['(A) Perform hemodialysis <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** An investigator is examining tissue samples from various muscle tissue throughout the body. She notices that biopsies collected from a specific site have a high concentration of sarcoplasmic reticulum, mitochondria, and myoglobin; they also stain poorly for ATPase. Additionally, the cell surface membranes of the myocytes in the specimen lack voltage-gated calcium channels. These myocytes are found in the greatest concentration at which of the following sites? (A) Ventricular myocardium (B) Semispinalis muscle (C) Glandular myoepithelium (D) Lateral rectus muscle
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['(B) Semispinalis muscle <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 1-month-old boy is brought to the emergency department by his parents for recent episodes of non-bilious projectile vomiting and refusal to eat. The boy had no problem with passing meconium or eating at birth; he only started having these episodes at 3 weeks old. Further history reveals that the patient is a first born male and that the boy’s mother was treated with erythromycin for an infection late in the third trimester. Physical exam reveals a palpable mass in the epigastrum. Which of the following mechanisms is likely responsible for this patient’s disorder? (A) Hypertrophy of smooth muscle (B) Intestinal vascular accident (C) Neural crest cell migration failure (D) Pancreatic fusion abnormality
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['(A) Hypertrophy of smooth muscle <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** An 11-month-old boy presents with a scaly erythematous rash on his back for the past 2 days. No significant past medical history. Family history is significant for the fact that the patient’s parents are first-degree cousins. In addition, his older sibling had similar symptoms and was diagnosed with a rare unknown skin disorder. On physical examination, whitish granulomatous plaques are present in the oral mucosa, which exhibit a tendency to ulcerate, as well as a scaly erythematous rash on his back. A complete blood count reveals that the patient is anemic. A plain radiograph of the skull shows lytic bone lesions. Which of the following immunohistochemical markers, if positive, would confirm the diagnosis in this patient? (A) CD21 (B) CD1a (C) CD15 (D) CD30
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['(B) CD1a <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 68-year-old woman is brought to the emergency department because of fever, productive cough, and dyspnea for 3 days. She has had upper back pain for 3 months, which is worse after activity. She takes ibuprofen for pain relief. She has no history of smoking. The temperature is 39.5°C (103.1°F), the blood pressure is 100/70 mm Hg, the pulse is 95/min, and the respirations are 22/min. Lung auscultation shows rales in the left lower lobe area. Painful lymph nodes (1 × 1 cm) are palpated in the left axillary and cervical regions. There is point tenderness along several thoracic vertebrae. Laboratory studies are pending. A skull X-ray and lung window thoracic computed tomography scan are shown. Which of the following disorders most likely played a role in this patient’s acute condition? (A) Metastatic breast cancer (B) Multiple myeloma (C) Paget’s disease (D) Primary hyperparathyroidism
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['(B) Multiple myeloma <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 70-year-old Caucasian women presents to the emergency department complaining of abdominal pain. She is oriented to person but is slow to answer questions and cannot name her location. She is afebrile on exam and endorses mild suprapubic tenderness. Her urine culture was positive for leukocyte esterase and nitrites. She was prescribed appropriate treatments. On follow-up, she complains of a new rash. In the past few days she has noticed that her skin becomes very red and more easily sunburns. Per the patient, her symptoms have resolved and her initial infection has cleared. Which of the following antibiotics was most likely prescribed to this patient? (A) Cephalexin (B) Azithromycin (C) Trimethoprim-sulfamethoxazole (D) Ceftriaxone
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['(C) Trimethoprim-sulfamethoxazole <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 64-year-old man is admitted with a history of altered mental status. He was in his usual state of health until a few days ago when he has started to become confused, lethargic, forgetful, and repeating the same questions. Over the last few days, he sometimes appears perfectly normal, and, at other times, he has difficulty recognizing his family members. Yesterday, he was screaming that the room was filled with snakes. Past medical history is significant for type 2 diabetes mellitus, managed medically, and chronic kidney disease, for which he undergoes regular hemodialysis on alternate days. There is no history of smoking, alcohol use, or illicit drug use. His vitals include: blood pressure 129/88 mm Hg, pulse 112/min, temperature 38.2°C (100.8°F), and respiratory rate 20/min. The patient is oriented only to person and place. His mini-mental state examination (MMSE) score is 18/30, where he had difficulty performing basic arithmetic calculations and recalled only 1 out of 3 objects. Nuchal rigidity is absent. Muscle strength is 5/5 bilaterally. Which of the following is the most likely diagnosis in this patient? (A) Delirium (B) Dementia (C) Transient global amnesia (D) Wernicke’s aphasia
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['(A) Delirium <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 34-year-old man presents to the office for evaluation of a lesion on his upper arm that appeared a few months ago and has not healed. A patient appears healthful but has a history of cardiovascular disease. He states that his friend at the industrial ammunition factory where he works told him he should “get it looked at.” The patient admits to some nausea, vomiting, and diarrhea over the past year, but he states that he “feels fine now.” On physical examination, the lesion is an erythematous, scaly, ulcerated plaque on the flexor surface of his upper arm. The rest of the exam is within normal limits. What is the most likely diagnosis? (A) Squamous cell carcinoma (SCC) (B) Actinic keratosis (C) Erysipelas (D) Contact dermatitis
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['(A) Squamous cell carcinoma (SCC) <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A previously healthy 20-year-old man is brought to the emergency department 15 minutes after collapsing while playing basketball. He has no history of serious illness. On arrival, there is no palpable pulse or respiratory effort observed. He is declared dead. The family agrees to an autopsy. Cardiac workup prior to this patient's death would most likely have shown which of the following findings? (A) Systolic anterior motion of the mitral valve (B) Narrowing of the left main coronary artery (C) Bicuspid aortic valve (D) Ventricular septum defect
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['(A) Systolic anterior motion of the mitral valve <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 17-year-old man presents to his primary care physician concerned about excessive sleepiness that has persisted his entire life. He notes that he has been having difficulty with his job as a waiter because he often falls asleep suddenly during the day. He also experiences a sensation of dreaming as he goes to sleep even though he still feels awake. He sleeps about 10 hours per day and still feels tired throughout the day. The patient has even reported driving into a tree once as he fell asleep while driving. The patient often stays up late at night working on the computer. Physical exam demonstrates an obese young man who appears tired. His oropharynx demonstrates high palatal ridges and good dental hygiene. Which of the following is the best next step in management? (A) Continuous positive airway pressure at night (B) Begin inhibitor of dopamine reuptake (C) Recommend scheduling regular naps and more time for sleep at night (D) Recommend to abstain from activities at night that expose the patient to blue light
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['(B) Begin inhibitor of dopamine reuptake <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 28-year-old gravida-2-para-1 at 12 weeks gestation presents for a prenatal visit. Over the past week, she has felt increasingly tired, even after waking up in the morning. She is vegan and avoids all animal products. She was diagnosed with Graves’ disease 6 months ago. Before conception, methimazole was switched to propylthiouracil (PTU). Other medications include folic acid and a multivitamin. The vital signs include: temperature 37.1℃ (98.8℉), pulse 72/min, respiratory rate 12/min, and blood pressure 110/75 mm Hg. The conjunctivae and nail beds are pale. Petechiae are present over the distal lower extremities. The pelvic examination reveals a uterus consistent in size with a 12-week gestation. Examination of the neck, lungs, heart, and abdomen shows no abnormalities. The laboratory studies show the following: Laboratory test Hemoglobin 9.0 g/dL Mean corpuscular volume 90 μm3 Leukocyte count 4,000/mm3 Segmented neutrophils 55% Lymphocytes 40% Platelet count 110,000/mm3 Serum Thyroid-stimulating hormone 0.1 μU/mL Thyroxine (T-4) 8 μg/dL Lactate dehydrogenase 60 U/L Total bilirubin 0.5 mg/dL Iron 100 μg/dL Ferritin 110 ng/mL Total iron-binding capacity 250 μg/dL Which of the following best explains these findings? (A) Autoimmune hemolysis (B) Drug-induced marrow failure (C) Hemodilution of pregnancy (D) Vitamin B12 deficiency
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['(B) Drug-induced marrow failure <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 34-year-old woman presents to the emergency department with moderate right wrist pain after falling on her outstretched hand. She has numbness in the 3 medial digits. The patient has no known previous medical conditions. Her family history is not pertinent, and she currently takes no medications. Physical examination shows her blood pressure is 134/82 mm Hg, the respirations are 14/min, the pulse is 87/min, and the temperature is 36.7°C (98.0°F). When asked to make a fist, the patient is able to flex only the lateral 2 digits. Tapping the anterior portion of her wrist elicits tingling in the medial 3 digits. The patient is taken to get an X-ray. Which of the following is the most likely diagnosis for this patient’s injury? (A) Lunate dislocation (B) Fracture of distal radius (C) Palmar aponeurosis tear (D) Interosseous ligament rupture
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['(A) Lunate dislocation <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 52-year-old man who was recently hospitalized with a pulmonary embolism is put on an unfractionated heparin drip as a bridge to chronic warfarin therapy. During morning rounds, he is found to have diffuse bruising despite minimal trauma, and his heparin infusion rate is found to be faster than prescribed. A coagulation panel is obtained, which shows a aPTT of 130 seconds (therapeutic 70-120 seconds), and the decision is made to reverse the effects of heparin. Which of the following would most likely be administered in order to do this? (A) Aminocaproic acid (B) Fresh frozen plasma (C) Platelets (D) Protamine sulfate
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['(D) Protamine sulfate <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A child with which of the following diseases would have the highest morbidity from being outside during a hot summer day? (A) Tay-Sachs disease (B) Cystic fibrosis (C) Cerebral palsy (D) Asthma
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['(B) Cystic fibrosis <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** An investigator studying protein synthesis in human stem cells isolates tRNA molecules bound to mRNA molecules. The isolated tRNA molecules have inosine in the 5' position of the anticodon; of these, some are bound to adenine, some to cytosine, and some to uracil at the 3' position of the mRNA codon. Which of the following properties of the genetic code is best illustrated by this finding? (A) Specificity of the start codon (B) Degeneracy (C) Unambiguity (D) Non-overlapping
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['(B) Degeneracy <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 24-year-old man presents with a history of intermittent fever for the last 2 days. He says his episodes of fever are accompanied by shaking and chills. He mentions that his father has been recently recovered from chloroquine-resistant P. falciparum malaria, which was treated successfully with quinine. On physical examination, his temperature is 38.9°C (102°F), pulse rate is 110/min, blood pressure is 116/80 mm Hg, and respiratory rate is 18/min. Examination of his abdomen reveals splenomegaly. His blood sample is sent for the examination of the peripheral smear, which confirms the diagnosis of Plasmodium falciparum malaria. The patient is placed on treatment with oral quinine. After 5 days, the patient returns with improved symptoms of malaria but with complaints of a headache, tinnitus, nausea, and dizziness. The patient mentions that he has been taking a drug for the last 3 months to control his dyspepsia symptoms. Which of the following drugs is most likely to have caused the above-mentioned symptoms in this patient? (A) Sucralfate (B) Cimetidine (C) Ranitidine (D) Pantoprazole
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['(B) Cimetidine <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** An endocrine surgeon wants to evaluate the risk of multiple endocrine neoplasia (MEN) type 2 syndromes in patients who experienced surgical hypertension during pheochromocytoma resection. She conducts a case-control study that identifies patients who experienced surgical hypertension and subsequently compares them to the control group with regard to the number of patients with underlying MEN type 2 syndromes. The odds ratio of MEN type 2 syndromes in patients with surgical hypertension during pheochromocytoma removal was 3.4 (p < 0.01). The surgeon concludes that the risk of surgical hypertension during pheochromocytoma removal is 3.4 times greater in patients with MEN type 2 syndromes than in patients without MEN syndromes. This conclusion is best supported by which of the following assumptions? (A) The 95% confidence interval for the odds ratio does not include 1.0 (B) Surgical hypertension associated with pheochromocytoma is rare (C) The case-control study used a large sample size (D) Pheochromocytoma is common in MEN type 2 syndromes
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['(B) Surgical hypertension associated with pheochromocytoma is rare <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** Following a motor vehicle accident, a 63-year-old man is scheduled for surgery. The emergency physician notes a posture abnormality in the distal left lower limb and a fracture-dislocation of the right hip and acetabulum based on the radiology report. The senior orthopedic resident mistakenly notes a fraction dislocation of the left hip and marks the left hip as the site of surgery. The examination by the surgeon in the operating room shows an externally rotated and shortened left lower limb. The surgeon inserts a pin in the left tibia but erroneously operates on the left hip. A review of postoperative imaging leads to a second surgery on the fracture-dislocation of the right hip. Rather than the surgeon alone, the surgical team and the hospital system are held accountable for not implementing the mandatory protocol of preincision ‘time-out’ and compliance monitoring. Which of the following best describes this approach to prevent medical errors? (A) Closed-loop communication (B) Root cause analysis (C) Swiss-cheese model (D) Sentinel event
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['(C) Swiss-cheese model <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 2-year-old girl presented to the emergency department after a generalized tonic-clonic seizure that lasted one minute, an hour ago. She has been in good health since birth and has no history of convulsions in the past. She has been sick with an upper respiratory tract infection for the last 2 days, and her parents have been medicating her at home for a subjective fever. Her blood pressure is 109/51 mm Hg, pulse rate is 180/min, temperature is 38.9°C (102.0°F), and oxygen saturation is 98% on room air. The child is sleepy and ill-appearing. The cardiovascular, respiratory, and abdominal examinations are unremarkable. Blood glucose level is 50 mg/dL. Three boluses of IV dextrose are given, but the patient remains drowsy. CXR is normal. After a few hours, her clinical condition deteriorates with associated respiratory failure that requires intubation and mechanical ventilation. Liver function tests reveal AST > 3,000 U/L, ALT > 2,200 U/L, and INR > 3.0. Further testing ruled out hepatitis A, B, and C, and CMV infection. CT scan of the brain was normal. What is the most likely cause of her condition? (A) Hemosiderin deposition (B) Ca2+ efflux (C) Glutathione saturation (D) Decrease in hypothalamic set point
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['(C) Glutathione saturation <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 22-year-old man comes to the emergency department because of several episodes of blood in his urine and decreased urine output for 5 days. His blood pressure is 158/94 mm Hg. Examination shows bilateral lower extremity edema. Urinalysis shows 3+ protein and red blood cell casts. Mass spectrometry analysis of the urinary protein detects albumin, transferrin, and IgG. Which of the following best describes this type of proteinuria? (A) Tubular (B) Overflow (C) Postrenal (D) Nonselective glomerular
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['(D) Nonselective glomerular <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 32-year-old Caucasian man presents to the physician because of the swelling and discomfort of the right testis for 3 weeks. There is no history of trauma, fever, or night sweats. He had surgery for an undescended right testis when he was 6 months old. There is no history of liver disease or hypogonadism. He has fathered 2 children. He takes no medications and denies any illicit drug use. The vital signs are within normal limits. Palpation of the scrotum reveals a firm nontender mass that cannot be separated from the right testis. Examination of the left testis shows no abnormalities. There is no supraclavicular or inguinal lymphadenopathy. Gynecomastia is present. The rest of the physical examination is unremarkable. Ultrasound shows an enlarged right testicle with a hypoechoic mass replacing a large portion of the normal architecture. The left testis is normal. The laboratory test results are as follows: HCG Elevated AFP Elevated LDH Normal Which of the following is the most likely diagnosis? (A) Embryonal carcinoma (B) Leydig cell tumor (C) Metastasis to testis (D) Seminomatous germ cell tumor
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['(A) Embryonal carcinoma <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 3-year-old girl presents with her mother for a well-child checkup. Recent laboratory data has demonstrated a persistent normocytic anemia. Her mother denies any previous history of blood clots in her past, but she says that her mother has also had to be treated for pulmonary embolism in the recent past, and her brother has had to deal with anemia his entire life. The patient’s past medical history is noncontributory other than frequent middle ear infections. The vital signs upon arrival include: temperature, 36.7°C (98.0°F); blood pressure, 106/74 mm Hg; heart rate, 111/min and regular; and respiratory rate, 17/min. On physical examination, her pulses are bounding and fingernails are pale, but breath sounds remain clear. Oxygen saturation was initially 91% on room air and electrocardiogram (ECG) shows sinus tachycardia. The patient’s primary care physician orders a peripheral blood smear to further evaluate this finding, and preliminary results show a hemolytic anemia. Which of the following pathophysiologic mechanisms best describes sickle cell disease? (A) Increased red blood cell sensitivity to complement activation, making patients prone to thrombotic events (B) A recessive beta-globin mutation causing morphological changes to the RBC (C) An X-linked recessive disease in which red blood cells are increasingly sensitive to oxidative stress (D) Secondarily caused by EBV, mycoplasma, CLL, or rheumatoid disease
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['(B) A recessive beta-globin mutation causing morphological changes to the RBC <> 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 doctor by his father because his father is worried about the boy's performance in school and his lack of a social life. His father is also worried about the ongoing bullying his son is experiencing due to swearing outbursts the boy has exhibited for several years. During these outbursts, the boy contorts his face, blinks repeatedly, and grunts. His father is worried that the bullying will worsen and would like to see if there is a medication that can help his son. Which of the following medications is most likely to be beneficial? (A) Valproic acid (B) Risperidone (C) Clonazepam (D) Lithium
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['(B) Risperidone <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 65-year-old woman is brought to the emergency department by her husband who found her lying unconscious at home. He says that the patient has been complaining of progressively worsening weakness and confusion for the past week. Her past medical history is significant for hypertension, systemic lupus erythematosus, and trigeminal neuralgia. Her medications include metoprolol, valsartan, prednisone, and carbamazepine. On admission, blood pressure is 130/70 mm Hg, pulse rate is 100 /min, respiratory rate is 17/min, and temperature is 36.5°C (97.7ºF). She regained consciousness while on the way to the hospital but is still drowsy and disoriented. Physical examination is normal. Finger-stick glucose level is 110 mg/dl. Other laboratory studies show: Na+ 120 mEq/L (136—145 mEq/L) K+ 3.5 mEq/L (3.5—5.0 mEq/L) CI- 107 mEq/L (95—105 mEq/L) Creatinine 0.8 mg/dL (0.6—1.2 mg/dL) Serum osmolality 250 mOsm/kg (275—295 mOsm/kg) Urine Na+ 70 mEq/L Urine osmolality 105 mOsm/kg She is admitted to the hospital for further management. Which of the following is the next best step in the management of this patient’s condition? (A) Fluid restriction (B) Rapid resuscitation with hypertonic saline (C) Desmopressin (D) Tolvaptan
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['(A) Fluid restriction <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** An 18-year-old girl comes to the clinic because she is concerned about her weight. She states that she is on her school’s cheerleading team and is upset because she feels she is the “fattest” girl on the team despite her healthy diet. She says that in the last 2 weeks since practice began, she has lost 2 lbs. The patient has bipolar disorder I. Her medications include lithium and a combined oral contraceptive that was recently started by her gynecologist, because “everyone is on it." Her mother has hypothyroidism and is treated with levothyroxine. The patient’s BMI is 23.2 kg/m2. Thyroid function labs are drawn and shown below: Thyroid-stimulating hormone (TSH): 4.0 mIU/L Serum thyroxine (T4): 18 ug/dL Free thyroxine (Free T4): 1.4 ng/dl (normal range: 0.7-1.9 ng/dL) Serum triiodothyronine (T3): 210 ng/dL Free triiodothyronine (T3): 6.0 pg/mL (normal range: 3.0-7.0 pg/mL) Which of the following is the most likely cause of the patient’s abnormal lab values? (A) Familial hyperthyroidism (B) Hypocholesterolemia (C) Lithium (D) Oral contraception-induced
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['(D) Oral contraception-induced <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 4-year-old girl is brought to the emergency department by her mother after a fall in the park. Her mother reports a history of spontaneous frequent falls and delayed development for which calcium and iron supplementations were prescribed by their family physician. She has been on antibiotic therapy for the last 2 days for an unremitting cough. Her vital signs include: blood pressure 110/60 mm Hg, pulse 98/min, temperature 38.0°C (100.4°F), and respiratory rate 18/min. On examination, there is tenderness over the femur which later turns out to be due to a fractured femoral neck. Moreover, systemic examination reveals red eyes with dilated, tortuous conjunctival blood vessels. Abnormal limb movements are also observed. Which of the following is expected to exceed the normal range in this patient? (A) Lymphocytes (B) Serum calcium (C) α- fetoprotein (D) Random blood glucose
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['(C) α- fetoprotein <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 66-year-old man is transferred to from another hospital after 3 days of progressively severe headache, vomiting, low-grade fever, and confusion. According to his partner, the patient has been dealing with some memory loss and complaining about headaches for the past 2 weeks. He has a history of interstitial pulmonary disease that required lung transplantation 2 years ago. Upon admission, he is found with a blood pressure of 160/100 mm Hg, a pulse of 58/min, a respiratory rate of 15/min, and a body temperature of 36°C (97°F). During the examination, he is found with oral thrush and symmetric and reactive pupils; there are no focal neurological signs or papilledema. A lumbar puncture is performed. Which of the following features would be expected to be found in this case? (A) Aspect: xanthochromic, opening pressure: normal, cell count: ↑ red blood cells, protein: normal, glucose: normal (B) Aspect: cloudy, opening pressure: ↑, cell count: ↑ neutrophils, protein: ↑, glucose: ↓ (C) Aspect: clear, opening pressure: normal, cell count: ↑ lymphocytes, protein: normal, glucose: normal (D) Aspect: cloudy, opening pressure: ↑, cell count: ↑ lymphocytes, protein: ↑, glucose: ↓
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['(D) Aspect: cloudy, opening pressure: ↑, cell count: ↑ lymphocytes, protein: ↑, glucose: ↓ <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A previously healthy 10-year-old boy is brought to the emergency room by his mother 5 hours after the onset of abdominal pain and nausea. Over the past 2 weeks, he has also had progressive abdominal pain and a 4-kg (8.8-lb) weight loss. The mother reports that her son has been drinking more water than usual during this period. Last week he wet his bed three times despite being completely toilet-trained since 3 years of age. His temperature is 37.8°C (100°F), pulse is 128/min, respirations are 35/min, and blood pressure is 95/55 mm Hg. He appears lethargic. Physical examination shows deep and labored breathing and dry mucous membranes. The abdomen is soft, and there is diffuse tenderness to palpation with no guarding or rebound. Serum laboratory studies show: Na+ 133 mEq/L K+ 5.9 mEq/L Cl- 95 mEq/L HCO3- 13 mEq/L Urea nitrogen 25 mg/dL Creatinine 1.0 mg/dL Urine dipstick is positive for ketones and glucose. Further evaluation is most likely to reveal which of the following?" (A) Decreased total body potassium (B) Increased total body sodium (C) Increased arterial pCO2 (D) Hypervolemia
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['(A) Decreased total body potassium <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 57-year-old woman with type 2 diabetes mellitus comes to the physician for a follow-up examination. She previously had been compliant with her diet and medication but has had a 5-kg (11-lb) weight gain since the last visit 6 months ago. She reports that she often misses doses of her metformin. Her hemoglobin A1c is 9.8%. Which of the following is the most appropriate course of action? (A) Refer the patient to a dietician (B) Schedule more frequent follow-up visits (C) Refer the patient to an endocrinologist (D) Add glyburide to the medication regimen
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['(B) Schedule more frequent follow-up visits <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 58-year-old man with a history of alcoholism is hospitalized with acute onset nausea and hematemesis. On admission, his vitals are as follows: blood pressure 110/70 mm Hg, heart rate 88/min, respiratory rate 16/min, and temperature 37.8℃ (100.0℉). Physical examination shows jaundice, palmar erythema, widespread spider angiomata, abdominal ascites, and visibly distended superficial epigastric veins. Abdominal ultrasound demonstrates portal vein obstruction caused by liver cirrhosis. Where in the liver would you find the earliest sign of fibrous deposition in this patient? (A) Portal field (B) Perisinusoidal space (C) Interlobular connective tissue (D) Lumen of bile ducts
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['(B) Perisinusoidal space <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 10-year-old boy is brought in by his parents with increasing breathlessness. He was diagnosed with asthma about 2 years ago and has been on treatment since then. He was initially observed to have breathlessness, cough and chest tightness 2 or 3 times a week. He would wake up once or twice a month in the nighttime with breathlessness. At that time, his pediatrician started him on a Ventolin inhaler to be used during these episodes. His symptoms were well controlled until a few months ago when he started to experience increased nighttime awakenings due to breathlessness. He is unable to play outside with his friends as much because he gets winded easily and has to use his inhaler almost daily to help him breathe easier. He is able to walk and perform other routine activities without difficulty, but playing or participating in sports causes significant struggles. Based on his symptoms, his pediatrician adds an inhaled formoterol and budesonide combination to his current regime. During spirometry, which of the following peak expiratory flow rates will most likely be observed in this patient? (A) 40% (B) 55% (C) 65% (D) 90%
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['(C) 65% <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 38-year-old woman seeks evaluation at the emergency room for sudden onset of pain and swelling of her left leg since last night. Her family history is significant for maternal breast cancer (diagnosed at 52 years of age) and a grandfather with bronchioloalveolar carcinoma of the lungs at 45 years of age. When the patient was 13 years old, she was diagnosed with osteosarcoma of the right distal femur that was successfully treated with surgery. The physical examination shows unilateral left leg edema and erythema that was tender to touch and warm. Homan's sign is positive. During the abdominal examination, you also notice a large mass in the left lower quadrant that is firm and fixed with irregular borders. Proximal leg ultrasonography reveals a non-compressible femoral vein and the presence of a thrombus after color flow Doppler evaluation. Concerned about the association between the palpable mass and a thrombotic event in this patient, you order an abdominal CT scan with contrast that reports a large left abdominopelvic cystic mass with thick septae consistent with ovarian cancer, multiple lymph node involvement, and ascites. Which of the following genes is most likely mutated in this patient? (A) TP53 (B) BRCA2 (C) MLH1 (D) STK11
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['(A) TP53 <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** An 11-year-old girl presents to her primary care physician because she has been having difficulty hearing her teachers at school. She says that the difficulty hearing started about a year ago, and it has slowly been getting worse. Her past medical history is significant for multiple fractures in both her upper and lower extremities. She also recently had a growth spurt and says that her friends say she is tall and lanky. A mutation in which of the following genes is most likely associated with this patient's condition? (A) Fibroblast growth factor receptor (B) Type 1 collagen (C) Type 3 collagen (D) Type 4 collagen
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['(B) Type 1 collagen <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 17-year-old boy comes to the emergency department because of a 3-day history of pain in his left wrist. That morning the pain increased and he started to have chills and malaise. Last week he had self-resolving left knee pain. He is otherwise healthy and has not had any trauma to the wrist. He recently returned from a camping trip to Minnesota. He is sexually active with one female partner, who uses a diaphragm for contraception. His temperature is 37.7°C (99.9°F). Examination shows several painless violaceous vesiculopustular lesions on the dorsum of both wrists and hands; two lesions are present on the left palm. There is swelling and erythema of the left wrist with severe tenderness to palpation and passive movement. Which of the following is the most likely diagnosis? (A) Lyme arthritis (B) Acute rheumatic fever (C) Disseminated gonococcal infection (D) Reactive arthritis "
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['(C) Disseminated gonococcal infection <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 61-year-old woman presents to her primary care provider with complaints of fatigue, weight gain of 5.5 kg (12.1 lb) and intermittent nausea over the past 4 months. She denies any changes to her diet. She has had type 2 diabetes mellitus for the past 27 years complicated by diabetic neuropathy. Vital signs include: temperature 37.0°C (98.6°F), blood pressure 167/98 mm Hg and pulse 80/min. Physical examination reveals bilateral pitting lower-extremity edema. Fundoscopic examination reveals bilateral micro-aneurysms and cotton wool patches. Her serum creatinine is 2.6 mg/dL. Which of the following is the best initial therapy for this patient? (A) Hydrochlorothiazide (B) Perindopril (C) Metoprolol (D) Diltiazem
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['(B) Perindopril <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 41-year-old female complains of frequent diarrhea and abdominal pain between meals. Endoscopy reveals a duodenal ulcer distal to the duodenal bulb. CT scan of the abdomen demonstrates a pancreatic mass, and subsequent tissue biopsy of the pancreas reveals a malignant islet cell tumor. Which of the following hormones is likely to be markedly elevated in this patient: (A) Gastrin (B) Secretin (C) Vasoactive intestinal peptide (D) Motilin
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['(A) Gastrin <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 42-year-old woman comes to the physician because of a 2-week history of joint pain and fatigue. She has a history of multiple unprovoked deep vein thromboses. Physical examination shows small bilateral knee effusions and erythematous raised patches with scaling and follicular plugging over the ears and scalp. Oral examination shows several small ulcers. Laboratory evaluation of this patient is most likely to show which of the following? (A) Positive rapid plasma reagin test (B) Positive anti-citrullinated peptide antibodies (C) Decreased activated partial thromboplastin time (D) Negative antinuclear antibodies
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['(A) Positive rapid plasma reagin test <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 25-year-old woman presents to you for a routine health checkup. She has no complaints. Family history is significant for 2 of her siblings who have died from Tay-Sachs disease, but she and her parents are phenotypically normal. Which of the following are the chances of this person being a heterozygous carrier of the mutation that causes Tay-Sachs disease? (A) 25% (B) 33% (C) 66% (D) 50%
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['(C) 66% <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 17-year-old boy is brought to the physician with complaints of an ataxic gait and hearing deficits for the past few days. His parents also reported a history of tonic gaze deviation on the right side and the spontaneous remission of a similar episode 6 months ago. His temperature is 37°C (98.6°F), pulse is 88/min, and respirations are 20/min. On physical examination, no abnormality is found, but evoked potential tests are abnormal. Magnetic resonance imaging of the head shows multiple lesions with high T2 signal intensity and one large white matter lesion showing contrast enhancement. His laboratory studies show: Hemoglobin 12.9 g/dL CSF leukocyte count 1000/μL CSF gamma globulin 15.4% (normal 7–14%) Erythrocyte sedimentation rate 16 mm/h Which of the following most likely explains the mechanism of this condition? (A) Type II hypersensitivity (B) Type III hypersensitivity (C) Type IV hypersensitivity (D) Type V hypersensitivity
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['(C) Type IV hypersensitivity <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 24-year-old female comes to the physician because of flu-like symptoms and a new rash for 2 days. She denies contacts with sick individuals or recent travel abroad, but recently went camping in Vermont. Vital signs are within normal limits. Examination of the lateral right thigh shows a circular red ring with central clearing. Which of the following is the natural reservoir of the pathogen responsible for this patient's symptoms? (A) Mouse (B) Rabbit (C) Tick (D) Flea
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['(A) Mouse <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A codon is an mRNA sequence consisting of 3 nucleotides that codes for an amino acid. Each position can be made up of any 4 nucleotides (A, U, G, C); therefore, there are a total of 64 (4 x 4 x 4) different codons that can be created but they only code for 20 amino acids. This is explained by the wobble phenomenon. One codon for leucine is CUU, which of the following can be another codon coding for leucine? (A) AUG (B) CCC (C) CCA (D) CUA
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['(D) CUA <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 14-year-old boy is brought to the clinic by his mother for temper tantrums for the past year. She is concerned as he gets abnormally irritated and angry towards the smallest things. After asking the mother to leave the room, the patient reports that he is simply annoyed by his mother’s constant nagging. He denies any violent tendencies, suicidal ideations, depressive symptoms, or intention to hurt others. The patient states he finds the physician irritating and that he reminds her of his mother in his mannerisms and demeanor. Without provocation, the patient shouts at the physician saying that he does not understand or really care about him and he never would. What is the likely explanation for this patient’s behavior toward the physician? (A) Displacement (B) Passive aggression (C) Projection (D) Transference
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['(D) Transference <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 17-year-old woman presents to an OBGYN clinic for evaluation of primary amenorrhea. She is a well-developed well-nourished woman who looks at her stated age. She has reached Tanner stage IV breast and pubic hair development. The external genitalia is normal in appearance. She has an older sister who underwent menarche at 12 years of age. A limited pelvic exam reveals a shortened vaginal canal with no cervix. No uterus is visualized during an ultrasound exam, but both ovaries are noted. What is the likely pathophysiology underlying this condition? (A) Failure of the mesonephric duct to degenerate (B) Failure of the ovaries to produce estrogen (C) Genotype 47 XXY (D) Failure of the paramesonephric duct to form
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['(D) Failure of the paramesonephric duct to form <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 54-year-old woman comes to the physician because of a 3-month history of upper midthoracic back pain. The pain is severe, dull in quality, and worse during the night. Ten months ago, she underwent a modified radical mastectomy for invasive ductal carcinoma of the right breast. Physical examination shows normal muscle strength. Deep tendon reflexes are 2+ in all extremities. Examination of the back shows tenderness over the thoracic spinous processes. An x-ray of the thoracic spine shows vertebral osteolytic lesions at the levels of T4 and T5. The patient's thoracic lesions are most likely a result of metastatic spread via which of the following structures? (A) Lateral axillary lymph nodes (B) Azygos vein (C) Thyrocervical trunk (D) Thoracic duct
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['(B) Azygos vein <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 23-year-old man is brought to the emergency department by ambulance. The patient was found unconscious in his bedroom after a suicide attempt. The patient had cut his wrists using a kitchen knife. The patient is unresponsive and pale. His temperature is 96°F (35.6°C), blood pressure is 70/35 mmHg, pulse is 190/min, respirations are 19/min, and oxygen saturation is 92% on room air. Pressure is applied to his bilateral wrist lacerations. His Glasgow Coma Scale (GCS) is 7. A full trauma assessment is performed and reveals no other injuries. IV fluids are started as well as a rapid transfusion sequence. Norepinephrine is administered. Repeat vitals demonstrate that his blood pressure is 100/65 mmHg and pulse is 100/min. The patient is responsive and seems mildly confused. Resuscitation is continued and the patient's GCS improves to 15. Thirty minutes later, the patient's GCS is 11. His temperature is 103°F (39.4°C), blood pressure is 90/60 mmHg, pulse is 122/min, respirations are 22/min, and oxygen saturation is 99% on room air. The patient complains of flank pain. Laboratory values are ordered and demonstrate the following: Hemoglobin: 9 g/dL Hematocrit: 27% Leukocyte count: 10,500 cells/mm^3 with normal differential Haptoglobin: 11 mg/dL Platelet count: 198,000/mm^3 Serum: Na+: 139 mEq/L Cl-: 101 mEq/L K+: 4.4 mEq/L HCO3-: 23 mEq/L BUN: 27 mg/dL Glucose: 99 mg/dL Creatinine: 1.5 mg/dL Ca2+: 10.0 mg/dL Bilirubin: 3.2 mg/dL AST: 22 U/L ALT: 15 U/L Which of the following describes the most likely diagnosis? (A) Non-cardiogenic acute lung injury (B) Decreased IgA levels (C) Major blood group incompatibility (D) Minor blood group incompatibility
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['(C) Major blood group incompatibility <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 65-year-old man presents to the emergency department with confusion and a change in his behavior. The patient was in his usual state of health 3 days ago. He became more confused and agitated this morning thus prompting his presentation. The patient has a past medical history of depression, hypertension, diabetes, and Parkinson disease and is currently taking fluoxetine, lisinopril, insulin, metformin, and selegiline (recently added to his medication regimen for worsening Parkinson symptoms). He also takes oxycodone and clonazepam for pain and anxiety; however, he ran out of these medications last night. His temperature is 101°F (38.3°C), blood pressure is 111/78 mmHg, pulse is 117/min, respirations are 22/min, and oxygen saturation is 99% on room air. Physical exam is notable for an irritable, sweaty, and confused elderly man. Neurological exam reveals hyperreflexia of the lower extremities and clonus. Which of the following is the most likely etiology of this patient’s symptoms? (A) Bacterial infection (B) Electrolyte abnormality (C) Medication complication (D) Viral infection
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['(C) Medication complication <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 32-year-old woman is admitted to the hospital with headache, photophobia, vomiting without nausea, and fever, which have evolved over the last 12 hours. She was diagnosed with systemic lupus erythematosus at 30 years of age and is on immunosuppressive therapy, which includes oral methylprednisolone. She has received vaccinations—meningococcal and pneumococcal vaccination, as well as BCG. Her vital signs are as follows: blood pressure 125/70 mm Hg, heart rate 82/min, respiratory rate 15/min, and temperature 38.7°C (101.7°F). On examination, her GCS score is 15. Pulmonary, cardiac, and abdominal examinations are within normal limits. A neurologic examination does not reveal focal symptoms. Moderate neck stiffness and a positive Brudzinski’s sign are noted. Which of the following would you expect to note in a CSF sample? (A) Lymphocytic pleocytosis (B) Haemophilus influenzae growth is the CSF culture (C) Decrease in CSF protein level (D) Listeria monocytogenes growth in the CSF culture
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['(D) Listeria monocytogenes growth in the CSF culture <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 12-year-old boy is brought to the emergency department because of acute onset abdominal pain. On arrival, he also complains of nausea and shortness of breath in addition to epigastric pain. He has previously been admitted to the hospital several times for respiratory infections with Pseudomonas species and uses a nebulizer and a chest wall oscillation vest at home. The patient's acute condition is found to be due to premature activation of an enzyme that normally interacts with the brush border. Which of the following describes the activity of this enzyme? (A) Activates phospholipase A2 (B) Breaks down elastin molecules (C) Digests triglycerides (D) Exclusively performs digestive proteolysis
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['(A) Activates phospholipase A2 <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 51-year-old man comes to the physician because of progressively worsening dyspnea on exertion and fatigue for the past 2 months. Cardiac examination shows no murmurs or bruits. Coarse crackles are heard at the lung bases bilaterally. An ECG shows an irregularly irregular rhythm with absent p waves. An x-ray of the chest shows globular enlargement of the cardiac shadow with prominent hila and bilateral fluffy infiltrates. Transthoracic echocardiography shows a dilated left ventricle with an ejection fraction of 40%. Which of the following is the most likely cause of this patient's condition? (A) Uncontrolled essential hypertension (B) Chronic supraventricular tachycardia (C) Inherited β-myosin heavy chain mutation (D) Acute psychological stress
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['(B) Chronic supraventricular tachycardia <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** An 8-month-old boy is brought to his pediatrician by his parents with a 12-hour history of fever and coughing. He has also been experiencing intermittent diarrhea and skin abscesses since birth. Otherwise, he has been meeting developmental milestones as expected. Analysis of this patient's sputum reveals acute angle branching fungi, and culture shows gram-positive cocci in clusters. A flow cytometry reduction test was obtained that confirmed the diagnosis. Which of the following processes is most likely defective in this patient? (A) Actin polymerization (B) Leukocyte migration (C) Transforming oxygen into superoxide radicals (D) Transforming superoxide radicals into hydrogen peroxide
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['(C) Transforming oxygen into superoxide radicals <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** You are conducting a systematic review on the effect of a new sulfonylurea for the treatment of type II diabetes. For your systematic review you would like to include 95% confidence intervals for the mean of blood glucose levels in the treatment groups. What further information is necessary to abstract from each of the original papers in order to calculate a 95% confidence interval for each study? (A) Power, mean, sample size (B) Power, standard deviation, sample size (C) Standard deviation, mean, sample size (D) Standard deviation, mean, sample size, power
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['(C) Standard deviation, mean, sample size <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 25-year-old man presents to the emergency department for a fever and abdominal pain. The patient states that his pain has been worsening over the past week in the setting of a fever. He has a past medical history of IV drug abuse and multiple admissions for septic shock. His temperature is 102°F (38.9°C), blood pressure is 94/54 mmHg, pulse is 133/min, respirations are 22/min, and oxygen saturation is 100% on room air. Physical exam is notable for a murmur over the left upper sternal border. Abdominal exam reveals left upper quadrant tenderness. Laboratory values are ordered as seen below. Hemoglobin: 15 g/dL Hematocrit: 44% Leukocyte count: 16,700/mm^3 Platelet count: 299,000/mm^3 Which of the following is the most likely diagnosis? (A) Diverticulitis (B) Hepatic abscess (C) Mesenteric ischemia (D) Splenic abscess
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['(D) Splenic abscess <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** During the exam of a 2-day-old female neonate you determine that she appears lethargic, cyanotic, and has a coarse tremor of her right arm. The patient's mother explains that she observed what she believed to be seizure-like activity just before you arrived in the room. The mother has a history of type two diabetes mellitus and during childbirth there was a delay in cord clamping. You decide to get electrolytes and a complete blood count to work up this patient. The labs are significant for mild hypoglycemia and a hematocrit of 72%. What is the most effective treatment for this patient's condition? (A) Partial exchange transfusion with hydration (B) Fluid resuscitation (C) Hydroxyurea (D) Interferon alpha
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['(A) Partial exchange transfusion with hydration <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 2300-g (5-lb 1-oz) male newborn is delivered to a 29-year-old primigravid woman. The mother has HIV and received triple antiretroviral therapy during pregnancy. Her HIV viral load was 678 copies/mL 1 week prior to delivery. Labor was uncomplicated. Apgar scores are 7 and 8 at 1 and 5 minutes respectively. Physical examination of the newborn shows no abnormalities. Which of the following is the most appropriate next step in management of this infant? (A) Administer zidovudine, lamivudine and nevirapine (B) Administer lamivudine and nevirapine (C) Administer nevirapine (D) Administer zidovudine
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['(D) Administer zidovudine <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 67-year-old woman presents to her primary care physician because she has been feeling increasingly fatigued over the last month. She has noticed that she gets winded halfway through her favorite walk in the park even though she was able to complete the entire walk without difficulty for years. She recently moved to an old house and started a new Mediterranean diet. Her past medical history is significant for hypertension and osteoarthritis for which she underwent a right hip replacement 2 years ago. Physical exam reveals conjunctival pallor as well as splenomegaly. Labs are obtained and the results are shown below: Hemoglobin: 9.7 g/dL (normal: 12-15.5 g/dL) Mean corpuscular volume: 91 µm^3 (normal: 80-100 µm^3) Direct Coombs test: positive Indirect Coombs test: positive Peripheral blood smear reveals spherical red blood cells. Red blood cells are also found to spontaneously aggregate at room temperature. The disorder that is most likely responsible for this patient's symptoms should be treated in which of the following ways? (A) Avoidance of fava beans (B) Chronic blood transfusions (C) Glucocorticoid administration (D) Vitamin supplementation
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['(C) Glucocorticoid administration <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 10-month-old infant is brought to the emergency by his parents after a seizure. The parents report no history of trauma, fever, or a family history of seizures. However, they both say that the patient fell while he was running. Neurologic examination was normal. A head CT scan was ordered and is shown in figure A. Which of the following is most likely found in this patient? (A) Slipped capital femoral epiphysis (B) Retinal hemorrhages (C) Microcephaly (D) Rupture of middle meningeal artery
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['(B) Retinal hemorrhages <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 22-year-old Caucasian G1 presents to her physician at 29 weeks gestation for a checkup. The medical history is unremarkable and the current pregnancy has been uncomplicated. Her weight is 81 kg (178.6 lb) and the height is 169 cm (5 ft 6 in). She has gained 13 kg (28.6 lb) during the pregnancy. She has no abnormalities on physical examination. Which of the following screening tests should be obtained ? (A) Non-fasting oral glucose tolerance test with 50 g of glucose (B) Fasting oral glucose test with 50 g of glucose (C) Non-fasting oral glucose load test with 75 g of glucose (D) Measurement of HbA1c
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['(A) Non-fasting oral glucose tolerance test with 50 g of glucose <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 22-year-old woman presents to an outpatient clinic complaining of an increasing vaginal discharge over the last week. The discharge is foul-smelling. The menstrual cycles are regular and last 4–5 days. The patient denies postcoital or intermenstrual bleeding. The last menstrual period was 2 weeks ago. She mentions that she has been sexually active with 2 new partners for the past 2 months, but they use condoms inconsistently. The patient has no chronic conditions, no previous surgeries, and does not take any medications. She is afebrile. The blood pressure is 125/82 mm Hg, the pulse is 102/min, and the respiratory rate is 19/min. The physical examination reveals a thin, yellow-green discharge accompanied by a pink and edematous vagina and a red-tan cervix. Which of the following is the most likely diagnosis? (A) Latex allergy (B) Physiologic leukorrhea (C) Candida vaginitis (D) Trichomonas vaginalis infection
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['(D) Trichomonas vaginalis infection <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 49-year-old man presents to the emergency department with acute onset of pain and redness of the skin of his lower leg for the past 3 days. He has had type 2 diabetes mellitus for the past 12 years, but he is not compliant with his medications. He has smoked 10–15 cigarettes per day for the past 20 years. His temperature is 38°C (100.4°F), pulse is 95/min, and blood pressure is 110/70 mm Hg. On physical examination, the pretibial area is erythematous, edematous, and tender. He is diagnosed with acute cellulitis, and intravenous ceftazidime sodium is started. On the 5th day of antibiotic therapy, the patient complains of severe watery diarrhea, fever, and abdominal tenderness without rigidity. Complete blood count is ordered for the patient and shows 14,000 white blood cells/mm3. Which of the following is the best initial therapy for this patient? (A) Intravenous vancomycin (B) Oral vancomycin (C) Oral metronidazole (D) Oral ciprofloxacin
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['(B) Oral vancomycin <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 29-year-old G1P0 female at 32 weeks gestation presents to the emergency department with vaginal bleeding. She has had minimal prenatal care to-date with only an initial visit with an obstetrician after a positive home pregnancy test. She describes minimal spotting that she noticed earlier today that has progressed to larger amounts of blood; she estimates 30 mL of blood loss. She denies any cramping, pain, or contractions, and she reports feeling continued movements of the baby. Ultrasound and fetal heart rate monitoring confirm the presence of a healthy fetus without any evidence of current or impending complications. The consulted obstetrician orders blood testing for Rh-status of both the mother as well as the father, who brought the patient to the hospital. Which of the following represents the best management strategy for this situation? (A) If mother is Rh-negative and father is Rh-positive then administer RhoGAM (B) If mother is Rh-positive and father is Rh-negative then administer RhoGAM (C) If mother is Rh-negative and father is Rh-positive, RhoGAM administration is not needed (D) After 28 weeks gestation, administration of RhoGAM will have no benefit
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['(A) If mother is Rh-negative and father is Rh-positive then administer RhoGAM <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 31-year-old G3P0 is admitted to the hospital with profuse vaginal bleeding and abdominal pain at 34 weeks gestation. She reports passing bright blood with clots and no water in the discharge. She denies recent trauma or medical illnesses. She had no prenatal care. Her previous pregnancies culminated in spontaneous abortions in the second trimester. She has a 6-year history of drug abuse and cocaine smoking 2 hours prior to the onset of her symptoms. Her blood pressure is 160/90 mm Hg, the heart rate is 93/min, the respiratory rate is 19/min, and the temperature is 36.9℃ (98.4℉). The fetal heart rate is 110/min. On examination, the patient is lethargic. Her pupils are constricted, but reactive to light bilaterally. There are no signs of trauma. Abdominal palpation identifies lower abdominal tenderness and strong uterine contractions. The fundus of the uterus is between the xiphoid process and umbilicus. The patient’s perineum is grossly bloody. On pelvic examination, the vaginal canal is without lesions. The cervix is almost completely effaced and 2 cm dilated. Which of the following options is the most likely cause of the patient’s pregnancy-related condition? (A) Thrombosis of the placental vessels (B) Abrupt constriction of maternal and placental vessels (C) Rupture of the placental vessels (D) Premature rupture of the membranes
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['(B) Abrupt constriction of maternal and placental vessels <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 28-year-old patient comes to the physician’s office with complaints of headaches and difficulty seeing out of the corner of her eye. She gave birth to her son 1 year ago. Further visual testing reveals the patient has bitemporal hemianopsia. The patient undergoes brain MRI which shows an anterior pituitary mass, likely adenoma. The patient has her blood tested to see if the adenoma is secreting extra hormone. The patient is found to have a slight excess of a hormone that uptakes a basophilic stain. Which of the following is most likely to be the hormone detected in her blood? (A) Prolactin (B) Oxytocin (C) Antidiuretic hormone (D) Thyroid stimulating hormone
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['(D) Thyroid stimulating hormone <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 7-year-old boy is brought to the physician for evaluation of developmental delay and intellectual disability. He has been admitted to the hospital twice in the past 6 months because of a cerebral venous thrombosis and a pulmonary embolism, respectively. He is at 10th percentile for weight and 95th percentile for height. Physical examination shows bilateral downward and inward subluxation of the lenses. He has a high-arched palate and kyphosis. Laboratory studies show increased serum concentration of 5-methyltetrahydrofolate. Which of the following additional findings is most likely in this patient's serum? (A) Increased S-adenosylhomocysteine concentration (B) Decreased methionine concentration (C) Increased propionyl-CoA concentration (D) Decreased cystathionine concentration "
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['(B) Decreased methionine concentration <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 20-year-old woman presents with menorrhagia for the past several years. She says that her menses “have always been heavy”, and she has experienced easy bruising for as long as she can remember. Family history is significant for her mother, who had similar problems with bruising easily. The patient's vital signs include: heart rate 98/min, respiratory rate 14/min, temperature 36.1°C (96.9°F), and blood pressure 110/87 mm Hg. Physical examination is unremarkable. Laboratory tests show the following: platelet count 200,000/mm3, PT 12 seconds, and PTT 43 seconds. Which of the following is the most likely cause of this patient’s symptoms? (A) Hemophilia A (B) Lupus anticoagulant (C) Protein C deficiency (D) Von Willebrand disease
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['(D) Von Willebrand disease <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 28-year-old female presents to her primary care provider for headache. The patient reports that every few weeks she has an episode of right-sided, throbbing headache. The episodes began several years ago and are accompanied by nausea and bright spots in her vision. The headache usually subsides if she lies still in a dark, quiet room for several hours. The patient denies any weakness, numbness, or tingling during these episodes. Her past medical history is significant for acne, hypothyroidism, obesity, and endometriosis. Her home medications include levothyroxine, oral contraceptive pills, and topical tretinoin. She has two glasses of wine with dinner several nights a week and has never smoked. She works as a receptionist at a marketing company. On physical exam, the patient has no focal neurologic deficits. A CT of the head is performed and shows no acute abnormalities. Which of the following is the most appropriate treatment for this patient during these episodes? (A) Acetazolamide (B) High-flow oxygen (C) Verapamil (D) Sumatriptan
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['(D) Sumatriptan <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 27-year-old man is brought into the emergency department by ambulance. The patient was at an appointment to receive welfare when he began acting abnormally. The patient was denied welfare. Shortly afterwards, he no longer responded to questions and stared blankly off into space, not responding to verbal stimuli. Other than odd lip-smacking behavior, he was motionless. Several minutes later, he became responsive but seemed confused. The patient has a past medical history of drug abuse and homelessness and is not currently taking any medications. His temperature is 98.9°F (37.2°C), blood pressure is 124/78 mmHg, pulse is 90/min, respirations are 14/min, and oxygen saturation is 99% on room air. Physical exam reveals cranial nerves II-XII as grossly intact with 5/5 strength in the upper and lower extremities and a stable gait. The patient seems confused when answering questions and has trouble remembering the episode. Which of the following is the most likely diagnosis? (A) Complex partial seizure (B) Generalized seizure (C) Malingering (D) Transient ischemic attack
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['(A) Complex partial seizure <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 75-year-old woman with a history of stroke 1 year ago was found unconscious on the floor of her home by her son. The patient was brought to the emergency department by ambulance but expired prior to arrival. An autopsy was performed and showed the cause of death to be a massive ischemic stroke. The coroner also examined sections taken from the area of her prior stroke. Which histologic finding would be prominent in the area of her stroke from one year prior? (A) Red neurons (B) Macrophages (C) Reactive gliosis and vascular proliferation (D) Cyst formed by astrocyte processes
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['(D) Cyst formed by astrocyte processes <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** An otherwise healthy 25-year-old primigravid woman at 31 weeks' gestation comes to the physician with a 2-day history of epigastric pain and nausea that is worse at night. Three years ago, she was diagnosed with a peptic ulcer and was treated with a proton pump inhibitor and antibiotics. Medications include folic acid and a multivitamin. Her pulse is 92/min and blood pressure is 139/90 mm Hg. Pelvic examination shows a uterus consistent in size with a 31-week gestation. Laboratory studies show: Hemoglobin 8.2 g/dL Platelet count 87,000/mm3 Serum Total bilirubin 1.4 mg/dL Aspartate aminotransferase 75 U/L Lactate dehydrogenase 720 U/L Urine pH 6.1 Protein 2+ WBC negative Bacteria occasional Nitrites negative Which of the following best explains this patient's symptoms?" (A) Bacterial invasion of the renal parenchyma (B) Acute inflammation of the pancreas (C) Inflammation of the gallbladder (D) Stretching of Glisson capsule
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['(D) Stretching of Glisson capsule <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 52-year-old man presents to his primary care physician for a yearly checkup complaining of recent weight gain. The patient states that he has noticed that, regardless of his diet, his midsection has gotten increasingly larger and his old clothes no longer fit. The patient has a 2-year history of left hip arthritis from a car accident for which he is on prednisone, as well as a history of migraine headaches. The patient has also noticed that in the last 2 months, he has developed acne and his face has become fuller in appearance. On exam, the patient has gained 26 pounds since his previous checkup 1 year prior, and he now has a BMI 28.2 kg/m^2 (up from 24.1 kg/m^2 previously). His temperature is 98.3°F (36.8°C), blood pressure is 134/94 mmHg, pulse is 72/min, and respirations are 12/min. His physical exam is notable for red striae on his shoulders and around his waist. On his labs, the patient’s serum ACTH is found to be decreased. Which of the following changes is most likely expected? (A) Bilateral adrenal atrophy (B) Bilateral adrenal hyperplasia (C) Unilateral adrenal atrophy (D) Unilateral adrenal hyperplasia
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['(A) Bilateral adrenal atrophy <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 39-year-old man is admitted to the hospital with profuse diarrhea. His wife says that it started yesterday and since then the patient has passed over 15 liters of watery stools which have become progressively clear and odorless. Over the past 2 days, the patient has only eaten homemade food. His wife and daughter do not have any symptoms. His wife says that he returned from a trip to rural India 2 days before the symptoms began. He has a history of gastroesophageal reflux disease. His vitals are as follows: blood pressure 95/70 mm Hg, heart rate 100/min, respiratory rate 21/min, and temperature 35.8°C (96.4°F). The patient appears fatigued and pale. His skin elasticity and turgor are decreased. Cardiac auscultation reveals a holosystolic murmur that changes characteristics with changes in the patient’s position. The chronic intake of which of the following drugs could predispose the patient to this condition? (A) Aspirin (B) Pantoprazole (C) Propranolol (D) Levocetirizine
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['(B) Pantoprazole <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 3-month-old girl is brought to the physician because of poor feeding, irritability and vomiting for 2 weeks. She was born at 36 weeks' gestation and pregnancy was uncomplicated. She is at 5th percentile for length and at 3rd percentile for weight. Her temperature is 36.8°C (98.2°F), pulse is 112/min and respirations are 49/min. Physical and neurologic examinations show no other abnormalities. Laboratory studies show: Serum Na+ 138 mEq/L K+ 3.1 mEq/L Cl- 115 mEq/L Ammonia 23 μmol/L (N <50 μmol/L) Urine pH 6.9 Blood negative Glucose negative Protein negative Arterial blood gas analysis on room air shows: pH 7.28 pO2 96 mm Hg HCO3- 12 mEq/L Which of the following is the most likely cause of these findings?" (A) Impaired metabolism of branched-chain amino acids (B) Impaired CFTR gene function (C) Inability of the distal tubule to secrete H+ (D) Deficiency of ornithine transcarbamylase
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['(C) Inability of the distal tubule to secrete H+ <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 45-year-old man presents to the physician with a complaint of recurrent chest pain for the last 2 weeks. He mentions that the pain is not present at rest, but when he walks for some distance, he feels pain like a pressure over the retrosternal region. The pain disappears within a few minutes of stopping the physical activity. He is an otherwise healthy man with no known medical disorder. He does not smoke or have any known dependence. There is no family history of ischemic heart disease or vascular disorder. On physical examination, his vital signs, including blood pressure, are normal. The diagnosis of coronary artery disease due to atherosclerosis is made. Which of the following is known to be an infection associated with this patient’s condition? (A) Chlamydophila pneumoniae (B) Legionella pneumophilia (C) Mycoplasma pneumoniae (D) Rickettsia rickettsii
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['(A) Chlamydophila pneumoniae <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 40-year-old woman who works as a secretary presents to your office complaining of new pain and numbness in both of her hands. For the past few weeks, the sensation has occurred after long days of typing, but it now occasionally wakes her up from sleep. You do not note any deformities of her wrists or hands, but you are able to reproduce pain and numbness in the first three and a half digits by tapping the wrist. What is the best initial treatment for this patient's complaint? (A) A trial of gabapentin (B) Local steroid injections (C) Carpal tunnel release surgery (D) Splinting
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['(D) Splinting <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 40-year-old male with a history of chronic alcoholism recently received a liver transplant. Two weeks following the transplant, the patient presents with a skin rash and frequent episodes of bloody diarrhea. A colonoscopy is performed and biopsy reveals apoptosis of colonic epithelial cells. What is most likely mediating these symptoms? (A) Donor T-cells (B) Recipient T-cells (C) Donor B-cells (D) Recipient B-cells
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['(A) Donor T-cells <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A rheumatologist is evaluating the long-term risk of venous thromboembolism in patients with newly diagnosed rheumatoid arthritis by comparing two retrospective cohort studies. In study A, the hazard ratio for venous thromboembolism was found to be 1.7 with a 95% confidence interval of 0.89–2.9. Study B identified a hazard ratio for venous thromboembolism of 1.6 with a 95% confidence interval of 1.1–2.5. Which of the following statements about the reported association in these studies is most accurate? (A) The HR of study B is less likely to be statistically significant than the HR of study A. (B) Study A likely had a larger sample size than study B. (C) The p-value of study A is likely larger than the p-value of study B. (D) The power of study B is likely smaller than the power of study A.
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['(C) The p-value of study A is likely larger than the p-value of study B. <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 39-year-old woman presents to your office with 4 days of fever, sore throat, generalized aching, arthralgias, and tender nodules on both of her shins that arose in the last 48 hours. Her medical history is negative for disease and she does not take oral contraceptives or any other medication regularly. The physical examination reveals the vital signs that include body temperature 38.5°C (101.3°F), heart rate 85/min, blood pressure 120/65 mm Hg, tender and enlarged submandibular lymph nodes, and an erythematous, edematous, and swollen pharynx with enlarged tonsils and a patchy white exudate on the surface. She is not pregnant. Examination of the lower limbs reveals erythematous, tender, immobile nodules on both shins. You do not identify ulcers or similar lesions on other areas of her body. What is the most likely diagnosis in this patient? (A) Erythema induratum (B) Cutaneous polyarteritis nodosa (C) Henoch-Schönlein purpura (D) Erythema nodosum
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['(D) Erythema nodosum <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 20-month-old boy is brought to the emergency department by his parents with fever and diarrhea that have persisted for the past 2 days. He has a history of repeated bouts of diarrhea, upper respiratory tract infections, and failure to thrive. His vital signs are as follows: blood pressure 80/40 mm Hg, pulse 130/min, temperature 39.0°C (102.2°F), and respiratory rate 30/min. Blood tests are suggestive of lymphopenia. The child is diagnosed with severe combined immune deficiency after additional testing. Which of the following is the most common association with this type of immunodeficiency? (A) X-linked severe combined immunodeficiency (B) Adenosine deaminase deficiency (C) Janus-associated kinase 3 (JAK3) deficiency (D) Bare lymphocyte syndrome
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['(A) X-linked severe combined immunodeficiency <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 27-year-old woman comes to the physician for a 1-week-history of painful urination and urinary frequency. She has no history of serious illness and takes no medications. She is sexually active with her boyfriend. Her temperature is 36.7°C (98.1°F). There is no costovertebral angle tenderness. Urine dipstick shows leukocyte esterase. A Gram stain does not show any organisms. Which of the following is the most likely causal pathogen? (A) Neisseria gonorrhoeae (B) Escherichia coli (C) Chlamydia trachomatis (D) Trichomonas vaginalis
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['(C) Chlamydia trachomatis <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 56-year-old man was brought to the emergency department by his wife when he passed out for 5 seconds after dinner at home. He says that he recalls feeling lightheaded moments prior to passing out and also had some palpitations. Otherwise, he has been feeling fatigued recently and has had some shortness of breath. His previous medical history is significant for diabetes that is well controlled on metformin. An EKG is obtained showing fast sawtooth waves at 200/min. He is administered a medication but soon develops ringing in his ears, headache, flushed skin, and a spinning sensation. The medication that was most likely administered in this case has which of the following properties? (A) Decreased rate of phase 0 depolarization and increased action potential duration (B) Normal rate of phase 0 depolarization and decreased action potential duration (C) Normal rate of phase 0 depolarization and increased action potential duration (D) Normal rate of phase 0 depolarization and normal action potential duration
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['(A) Decreased rate of phase 0 depolarization and increased action potential duration <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 50-year-old female radiologist who is interviewing for a night shift position states that she was fired from her past 3 previous positions because she had difficulty working with others. She states that she is perfect for this job however, as she likes to work on her own and be left alone. She emphasizes that she does not have any distractions or meaningful relationships, and therefore she is always punctual and never calls in sick. She is not an emotional individual. Which of the following personality disorders best fits this female? (A) Schizoid (B) Antisocial (C) Borderline (D) Obsessive-compulsive disorder
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['(A) Schizoid <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 48-year-old woman comes to the physician for the evaluation of 24-hour blood pressure monitoring results. Over the last 3 months, she has had intermittent nausea, decreased appetite, and increasing weakness and fatigue during the day. She has been treated twice for kidney stones within the past year. Her current medications include lisinopril, amlodipine, and furosemide. She is 178 cm (5 ft 10 in) tall and weighs 97 kg (214 lb); BMI is 31 kg/m2. Her blood pressure is 152/98 mm Hg. Physical examination shows no abnormalities. Serum studies show: Na+ 141 mEq/L Cl− 101 mEq/L K+ 4.5 mEq/L HCO3− 24 mEq/L Calcium 12.9 mg/dL Creatinine 1.0 mg/dL Twenty-four-hour blood pressure monitoring indicates elevated nocturnal blood pressure. Further evaluation is most likely to show which of the following findings?" (A) Increased serum aldosterone-to-renin ratio (B) Increased serum parathyroid hormone (C) Decreased renal blood flow (D) Decreased nocturnal oxygen saturation
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['(B) Increased serum parathyroid hormone <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 78-year-old woman with a history of cerebrovascular accident (CVA) presents to the emergency department with slurred speech, diplopia and dizziness that has persisted for eight hours. Upon further questioning you find that since her CVA one year ago, she has struggled with depression and poor nutrition. Her dose of paroxetine has been recently increased. Additionally, she is on anti-seizure prophylaxis due to sequelae from her CVA. CT scan reveals an old infarct with no acute pathology. Vital signs are within normal limits. On physical exam you find the patient appears frail. She is confused and has nystagmus and an ataxic gait. What would be an appropriate next step? (A) Administer tissue plasminogen activator (tPA) (B) Start trimethoprim-sulfamethoxazole (TMP-SMX) (C) Lower the dose of her anti-seizure medication (D) Start total parenteral nutrition (TPN)
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['(C) Lower the dose of her anti-seizure medication <> answer']
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