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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 33-year-old man presents to the emergency department with back pain. He is currently intoxicated but states that he is having severe back pain and is requesting morphine and lorazepam. The patient has a past medical history of alcohol abuse, drug seeking behavior, and IV drug abuse and does not routinely see a physician. His temperature is 102°F (38.9°C), blood pressure is 127/68 mmHg, pulse is 120/min, respirations are 17/min, and oxygen saturation is 98% on room air. Physical exam is notable for tenderness over the thoracic and lumbar spine. The pain is exacerbated with flexion of the spine. The patient’s laboratory values are notable for the findings below. Hemoglobin: 12 g/dL Hematocrit: 36% Leukocyte count: 16,500/mm^3 with normal differential Platelet count: 197,000/mm^3 Serum: Na+: 139 mEq/L Cl-: 100 mEq/L K+: 4.3 mEq/L HCO3-: 25 mEq/L BUN: 20 mg/dL Glucose: 99 mg/dL Creatinine: 1.1 mg/dL Ca2+: 10.2 mg/dL CRP: 5.2 mg/L Further imaging is currently pending. Which of the following is the most likely diagnosis? (A) Herniated nucleus pulposus (B) Malingering (C) Musculoskeletal strain (D) Spinal epidural abscess
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['(D) Spinal epidural abscess <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 74-year-old man comes to the physician for evaluation of a skin lesion on his right arm. The lesion first appeared 3 months ago and has since been slowly enlarging. Physical examination shows a 1.5-centimeter, faintly erythematous, raised lesion with irregular borders on the dorsum of the right forearm. A biopsy specimen is obtained. If present, which of the following histopathological features would be most consistent with carcinoma in situ? (A) Pleomorphism of cells in the stratum corneum (B) Irreversible nuclear changes in the stratum basale (C) Increased nuclear to cytoplasmic ratio in the stratum spinosum (D) Presence of epithelial cells in the dermis
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['(B) Irreversible nuclear changes in the stratum basale <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 70-year-old Caucasian male visits your office regularly for treatment of New York Heart association class IV congestive heart failure. Which of the following medications would you add to this man's drug regimen in order to improve his overall survival? (A) Spironolactone (B) Amiloride (C) Hydrochlorothiazide (D) Acetazolamide
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['(A) Spironolactone <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** An investigator is studying cardiomyocytes in both normal and genetically modified mice. Both the normal and genetically modified mice are observed after aerobic exercise and their heart rates are recorded and compared. After a 10-minute session on a treadmill, the average pulse measured in the normal mice is 680/min, whereas in the genetically modified mice it is only 160/min. Which of the following is most likely to account for the increased heart rate seen in the normal mice? (A) Greater cardiomyocyte size (B) Greater ratio of heart to body weight (C) Lower number of gap junctions (D) Greater T-tubule density
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['(D) Greater T-tubule density <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** Please refer to the summary above to answer this question Further evaluation of this patient is most likely to show which of the following findings?" "Patient Information Age: 28 years Gender: F, self-identified Ethnicity: unspecified Site of Care: office History Reason for Visit/Chief Concern: “I'm not making breast milk anymore.” History of Present Illness: 1-week history of failure to lactate; has previously been able to breastfeed her twins, who were born 12 months ago menses resumed 4 months ago but have been infrequent feels generally weak and tired has had a 6.8-kg (15-lb) weight gain over the past 2 months despite having a decreased appetite Past Medical History: vaginal delivery of twins 12 months ago, complicated by severe postpartum hemorrhage requiring multiple blood transfusions atopic dermatitis Social History: does not smoke, drink alcohol, or use illicit drugs is not sexually active Medications: topical triamcinolone, multivitamin Allergies: no known drug allergies Physical Examination Temp Pulse Resp BP O2 Sat Ht Wt BMI 37°C (98.6°F) 54/min 16/min 101/57 mm Hg – 160 cm (5 ft 3 in) 70 kg (154 lb) 27 kg/m2 Appearance: tired-appearing HEENT: soft, nontender thyroid gland without nodularity Pulmonary: clear to auscultation Cardiac: bradycardic but regular rhythm; normal S1 and S2; no murmurs, rubs, or gallops Breast: no nodules, masses, or tenderness; no nipple discharge Abdominal: overweight; no tenderness, guarding, masses, bruits, or hepatosplenomegaly; normal bowel sounds Extremities: mild edema of the ankles bilaterally Skin: diffusely dry Neurologic: alert and oriented; cranial nerves grossly intact; no focal neurologic deficits; prolonged relaxation phase of multiple deep tendon reflexes" (A) Increased serum sodium concentration (B) Increased serum TSH concentration (C) Decreased serum oxytocin concentration (D) Decreased serum cortisol concentration
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['(C) Decreased serum oxytocin concentration <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** Six days after undergoing a left hemicolectomy for colorectal carcinoma, a 59-year-old man collapses in the hospital hallway and is unconscious for 30 seconds. Afterwards, he complains of shortness of breath and chest pain with deep inhalation. He has hypertension and hyperlipidemia. He smoked one pack of cigarettes daily for 35 years but quit prior to admission to the hospital. He does not drink alcohol. He is in distress and appears ill. His temperature is 36.5°C (97.7°F), blood pressure is 80/50 mm Hg, and pulse is 135/min and weak. Oxygen saturation is 88% on room air. Physical examination shows elevated jugular venous distention. Cardiac examination shows a regular, rapid heart rate and a holosystolic murmur that increases during inspiration. His abdomen is soft and mildly tender to palpation around the surgical site. Examination of his extremities shows pitting edema of the left leg. His skin is cold and clammy. Further examination is most likely to reveal which of the following findings? (A) Rapid, aberrant contractions of the atria (B) Stenosis of the carotid arteries (C) Dilated right ventricular cavity (D) Reduced regional ventricular wall motion
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['(C) Dilated right ventricular cavity <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 25-year-old man with no significant past medical history is brought in by ambulance after a witnessed seizure at home. On physical exam, temperature is 102.3 deg F (39.1 deg C), blood pressure is 90/62 mmHg, pulse is 118/min, and respirations are 25/min. He is unable to touch his chin to his chest and spontaneously flexes his hips with passive neck flexion. Appropriate empiric treatment is begun. CT head is unremarkable, and a lumbar puncture sample is obtained. Gram stain of the cerebrospinal fluid (CSF) reveals gram-positive diplococci. Which of the following would you expect to see on CSF studies? (A) Elevated opening pressure, elevated protein, normal glucose (B) Elevated opening pressure, elevated protein, low glucose (C) Normal opening pressure, elevated protein, normal glucose (D) Normal opening pressure, normal protein, normal glucose
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['(B) Elevated opening pressure, elevated protein, low glucose <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 66-year-old farmer is being evaluated for abnormal lung findings on a low dose chest CT scan obtained as part of his lung cancer screening. He has a 50-pack-year smoking history and has been hesitant to quit. He has a non-productive cough but brushes it away saying he is not bothered by it. He denies ever coughing up blood, breathlessness, chest pain, fatigue, or weight loss. He has never sought any medical care and states that he has always been in good shape. He consumes alcohol moderately and uses marijuana occasionally. He lives with his wife and has not traveled recently. On physical examination, his temperature is 37.1°C (98.8°F), blood pressure is 148/70 mm Hg, and pulse rate is 95/min. His BMI is 32 kg/m2. A general physical examination is unremarkable. Coarse breath sounds are present bilaterally. The cardiac exam is normal. Laboratory studies show a normal complete blood count and comprehensive metabolic panel. A follow-up high-resolution CT scan is performed that shows small irregular subcentimeter pulmonary nodules, several of which are cavitated in both lungs, predominantly distributed in the upper and middle zones. There is no mediastinal or hilar lymphadenopathy. A transbronchial needle aspiration of the lesion is performed which shows a nodular pattern of abundant, granular, mildly eosinophilic cells with grooved nuclei with indented nuclear membranes and a chronic inflammation that consists primarily of eosinophils. Immunohistochemical staining reveals numerous cells that stain positive for S100 and CD1a. Which of the cells of the human immune system are responsible for this lesion? (A) T lymphocytes (B) Natural killer cells (C) Dendritic cells (D) Ciliary epithelium
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['(C) Dendritic cells <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 47-year-old woman presents to the emergency department with a fever and a headache. Her symptoms started yesterday and have rapidly progressed. Initially, she was experiencing just a fever and a headache which she was treating with acetaminophen. It rapidly progressed to blurry vision, chills, nausea, and vomiting. The patient has a past medical history of diabetes and hypertension and she is currently taking insulin, metformin, lisinopril, and oral contraceptive pills. Her temperature is 104°F (40.0°C), blood pressure is 157/93 mmHg, pulse is 120/min, respirations are 15/min, and oxygen saturation is 98% on room air. Upon further inspection, the patient also demonstrates exophthalmos in the affected eye. The patient's extraocular movements are notably decreased in the affected eye with reduced vertical and horizontal gaze. The patient also demonstrates decreased sensation near the affected eye in the distribution of V1 and V2. While the patient is in the department waiting for a CT scan, she becomes lethargic and acutely altered. Which of the following is the most likely diagnosis? (A) Acute closed angle glaucoma (B) Cavernous sinus thrombosis (C) Periorbital cellulitis (D) Intracranial hemorrhage
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['(B) Cavernous sinus thrombosis <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 33-year-old man comes into the urgent care clinic with an intensely itchy rash on the bilateral mid-lower extremities, with a fine linear demarcation approximately an inch above his socks. The rash is arranged in streaks of erythema with superimposed vesicular lesions. The patient states that he recently began hiking in the woods behind his house, but he denies any local chemical exposures to his lower extremities. His vital signs include: blood pressure of 127/76, heart rate of 82/min, and respiratory rate of 12/min. Of the following options, which is the mechanism of his reaction? (A) Type I–anaphylactic hypersensitivity reaction (B) Type II–cytotoxic hypersensitivity reaction (C) Type III–immune complex-mediated hypersensitivity reaction (D) Type IV–cell-mediated (delayed) hypersensitivity reaction
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['(D) Type IV–cell-mediated (delayed) hypersensitivity reaction <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 45-year-old woman comes to the physician’s office with complaints of clumsiness. She feels like she is tripping over her feet more often, and she recently fell and sprained her wrist. Her medical history is significant for well-controlled diabetes. She has been a strict vegan for over 20 years. She lives at home with her husband and two children. On exam, she appears well-nourished. She has diminished proprioception and vibration sense in both her feet. She has a positive Romberg sign. She has diminished Achilles reflexes bilaterally. Which of the following tracts are most likely damaged in this patient? (A) Fasciculus gracilis (B) Fasciculus cuneatus (C) Vestibulospinal (D) Anterior spinothalamic tract
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['(A) Fasciculus gracilis <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 79-year-old homeless man is brought to the emergency department by ambulance 30 minutes after being found unresponsive by the police. On arrival, he is apneic and there are no palpable pulses. Despite appropriate life-saving measures, he dies. Examination of the heart during autopsy shows normal ventricles with a sigmoid-shaped interventricular septum. A photomicrograph of a section of the heart obtained at autopsy is shown. Which of the following is the most likely underlying cause for the structure indicated by the arrow? (A) Accumulation of iron granules (B) Clumping of defective mitochondria (C) Oxidation of phospholipid molecules (D) Aggregation of alpha-synuclein
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['(C) Oxidation of phospholipid molecules <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 33-year-old man is brought to the emergency department after being involved in a bar fight. Physical examination shows tenderness to palpation over the left side of the back. An x-ray of the chest shows a fracture of the 12th rib on the left side. Further evaluation is most likely to show which of the following injuries? (A) Liver hematoma (B) Colon perforation (C) Kidney laceration (D) Pancreatic transection
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['(C) Kidney laceration <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 7-year-old girl is brought to the physician by her mother because of a 4-week history of irritability, diarrhea, and a 2.2-kg (5-lb) weight loss that was preceded by a dry cough. The family returned from a vacation to Indonesia 2 months ago. Her vital signs are within normal limits. Abdominal examination shows mild tenderness with no guarding or rebound and increased bowel sounds. Her leukocyte count is 9,200/mm3 with 20% eosinophils. A photomicrograph of a wet stool mount is shown. Which of the following is the most appropriate pharmacotherapy? (A) Diethylcarbamazine (B) Metronidazole (C) Albendazole (D) Praziquantel
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['(C) Albendazole <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 51-year-old woman with hyperlipidemia comes to the physician because of weakness for one month. At the end of the day, she feels too fatigued to cook dinner or carry a laundry basket up the stairs. She also complains of double vision after she reads for long periods of time. All of her symptoms improve with rest. Her only medication is pravastatin. Physical examination shows drooping of the upper eyelids. Strength is initially 5/5 in the upper and lower extremities but decreases to 4/5 after a few minutes of sustained resistance. Sensation to light touch is intact and deep tendon reflexes are normal. Which of the following best describes the pathogenesis of this patient's condition? (A) Type II hypersensitivity reaction (B) Impaired acetylcholine release (C) Adverse drug effect (D) Anterior horn cell destruction
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['(A) Type II hypersensitivity reaction <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 47-year-old woman presents with weakness, shortness of breath, and lightheadedness. She says her symptoms onset gradually 4 months ago and have progressively worsened. Past medical history is significant for a long history of menorrhagia secondary to uterine fibroids. Her vital signs include: temperature 36.9°C (98.4°F), blood pressure 135/82 mm Hg, and pulse 97/min. Physical examination is unremarkable. Laboratory test results are shown below: Hemoglobin 9.2 g/dL Mean corpuscular volume (MCV) 74 μm3 Mean corpuscular hemoglobin (MCH) 21 pg/cell Reticulocyte count 0.4 % Serum ferritin 10 ng/mL Which of the following is a specific feature of this patient's condition? (A) Loss of proprioception (B) Bone deformities (C) Leg ulcers (D) Restless leg syndrome
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['(D) Restless leg syndrome <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 67-year-old woman comes to the physician because of a 3-week history of fatigue and worsening back and abdominal pain. During this period, she has also had excessive night sweats and a 4.6-kg (10-lb) weight loss. She has had swelling of the neck for 3 days. She does not smoke or drink alcohol. Vital signs are within normal limits. Physical examination shows a 4-cm, supraclavicular, nontender, enlarged and fixed lymph node. The spleen is palpated 2 cm below the left costal margin. Laboratory studies show: Hemoglobin 10.4 g/dL Mean corpuscular volume 87 μm3 Leukocyte count 5,200/mm3 Platelet count 190,000/mm3 Serum Lactate dehydrogenase 310 U/L A CT scan of the thorax and abdomen shows massively enlarged paraaortic, axillary, mediastinal, and cervical lymph nodes. Histopathologic examination of an excised cervical lymph node shows lymphocytes with a high proliferative index that stain positive for CD20. Which of the following is the most likely diagnosis?" (A) Marginal zone lymphoma (B) Diffuse large B-cell lymphoma (C) Hairy cell leukemia (D) Follicular lymphoma
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['(B) Diffuse large B-cell lymphoma <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 29-year-old nulligravid woman comes to the physician because of a 10-day history of small quantities of intermittent, blood-tinged discharge from her left nipple. There is no personal or family history of serious illness. She has smoked 1 pack of cigarettes daily for 5 years. Her last menstrual period was 12 days ago. She is sexually active and uses condoms inconsistently. Physical examination shows scant serosanguinous fluid expressible from the left nipple. There is no palpable breast mass or axillary lymphadenopathy. Examination shows no other abnormalities. Which of the following is the most appropriate next step in management? (A) Subareolar ultrasound (B) Image-guided core biopsy of the affected duct (C) Nipple discharge cytology (D) Reassurance
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['(A) Subareolar ultrasound <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** An inconsolable mother brings her 2-year-old son to the emergency room after finding a large amount of bright red blood in his diaper, an hour ago. She states that for the past week her son has been having crying fits while curling his legs towards his chest in a fetal position. His crying resolves either after vomiting or passing fecal material. Currently, the child is in no apparent distress. Physical examination with palpation in the gastric region demonstrates no acute findings. X-ray of the abdominal area demonstrates no acute findings. His current temperature is 36.5°C (97.8°F), heart rate is 93/min, blood pressure is 100/64 mm Hg, and respiratory rate is 26/min. His weight is 10.8 kg (24.0 lb), and height is 88.9 cm (35.0 in). Laboratory tests show the following: RBC count 5 million/mm3 Hematocrit 36% Hemoglobin 12 g/dL WBC count 6,000/mm3 Mean corpuscular volume 78 fL What is the most likely cause of this condition? (A) Failure of the vitelline duct to open (B) Failure of the vitelline duct to close (C) Problem with bilirubin conjugation (D) Elevated anti-mitochondrial uptake
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['(B) Failure of the vitelline duct to close <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 9-year-old girl is brought to the emergency department for sudden-onset slurring of speech and weakness of her right arm and leg. She has a mild intellectual disability. She is at the 10th percentile for weight and at the 85th percentile for height. Physical examination shows bilateral inferonasal subluxation of the lens and a high-arched palate. Her fingers are long and slender. Neurological examination shows an extensor plantar response on the left. This patient is most likely to respond to treatment with which of the following? (A) Supplementation of methionine (B) Restriction of phenylalanine (C) Supplementation of vitamin B6 (D) Restriction of cysteine
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['(C) Supplementation of vitamin B6 <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** Fourteen days after a laparoscopic cholecystectomy for cholelithiasis, a 45-year-old woman comes to the emergency department because of persistent episodic epigastric pain for 3 days. The pain radiates to her back, occurs randomly throughout the day, and is associated with nausea and vomiting. Each episode lasts 30 minutes to one hour. Antacids do not improve her symptoms. She has hypertension and fibromyalgia. She has smoked 1–2 packs of cigarettes daily for the past 10 years and drinks 4 cans of beer every week. She takes lisinopril and pregabalin. She appears uncomfortable. Her temperature is 37°C (98.6° F), pulse is 84/min, respirations are 14/min, and blood pressure is 127/85 mm Hg. Abdominal examination shows tenderness to palpation in the upper quadrants without rebound or guarding. Bowel sounds are normal. The incisions are clean, dry, and intact. Serum studies show: AST 80 U/L ALT 95 U/L Alkaline phosphatase 213 U/L Bilirubin, total 1.3 mg/dL Direct 0.7 mg/dL Amylase 52 U/L Abdominal ultrasonography shows dilation of the common bile duct and no gallstones. Which of the following is the most appropriate next step in management?" (A) Counseling on alcohol cessation (B) Endoscopic retrograde cholangiopancreatography (C) Reassurance and follow-up in 4 weeks (D) CT scan of the abdomen
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['(B) Endoscopic retrograde cholangiopancreatography <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 34-year-old female presents to a counselor at the urging of her parents because they are concerned that she might be depressed. After recently breaking up with her long-term boyfriend, she moved back in with her parents because she could not handle making decisions alone. Soon after their breakup, she started going on 5–7 dates a week. She has been unemployed for 3 years, as her boyfriend took care of all the bills. In the past year, she thought of looking for a job but never felt confident enough to start the process. Her mom arranges her doctors appointments and handles her car maintenance. She describes feeling uneasy when she is alone. She has hypothyroidism treated with levothyroxine. She does not smoke or drink alcohol. Vital signs are normal. Mental status exam shows a neutral affect. Neurologic examination shows no focal findings. Which of the following is the most likely diagnosis? (A) Separation anxiety disorder (B) Dependent personality disorder (C) Histrionic personality disorder (D) Borderline personality disorder
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['(B) Dependent personality disorder <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 58-year-old woman comes to the physician because of headaches for 1 month. She describes them as 7 out of 10 in intensity. She has no nausea. Two years ago, she was treated for invasive lobular carcinoma of the left breast. She underwent a left mastectomy and multiple cycles of chemotherapy. She has been in good health since this treatment. Her temperature is 37°C (98.6°F), pulse is 90/min, and blood pressure is 118/72 mm Hg. There is a well-healed scar on the left side of the chest. There is no lymphadenopathy. The abdomen is soft and nontender; there is no organomegaly. Neurologic examination shows no focal findings. An MRI of the brain shows a 4-cm temporal hyperintense mass near the surface of the brain. Which of the following is the most appropriate next step in management? (A) Whole brain radiation therapy (B) Surgical resection (C) Chemotherapy (D) Antibiotic therapy
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['(B) Surgical resection <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 51-year-old woman is brought into the emergency department following a motor vehicle accident. She is unconscious and was intubated in the field. Past medical history is unknown. Upon arrival, she is hypotensive and tachycardic. Her temperature is 37.2°C (99.1°F), the pulse is 110/min, the respiratory rate is 22/min, and the blood pressure is 85/60 mm Hg. There is no evidence of head trauma, she withdraws to pain and her pupils are 2mm and reactive to light. Her heart has a regular rhythm without any murmurs or rubs and her lungs are clear to auscultation. Her abdomen is firm and distended with decreased bowel sounds. Her extremities are cool and clammy with weak, thready pulses. There is no peripheral edema. Of the following, what is the likely cause of her presentation? (A) Neurogenic shock (B) Cardiogenic shock (C) Obstructive shock (D) Hypovolemic shock
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['(D) Hypovolemic shock <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 45-year-old woman visits your office with concerns about recent changes in her menstrual cycle. She noticed that her menses last longer and are heavier, to the point of needing almost twice the number of sanitary pads than 6 months ago. She denies any abdominal or pelvic discomfort. She started menstruating at 9 years of age. She had a negative Pap smear and HPV test 5 years ago. The physical examination is unremarkable with no masses on abdominal palpation and the pelvic examination is negative for vaginal lesions or tenderness. The bimanual examination reveals a mobile, non-tender, retroverted uterus with no masses in the adnexa. A transvaginal ultrasound performed 4 days after her last menses revealed an endometrial thickness of 4 mm. Which of the following is the most likely cause of this patient’s condition? (A) Endometrial carcinoma (B) Uterine adenomyosis (C) Endometrial polyp (D) Endometrial hyperplasia
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['(D) Endometrial hyperplasia <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 52-year-old man presents to the emergency department with sudden-onset dyspnea, tachycardia, tachypnea, and chest pain. He works as a long-haul truck driver, and he informs you that he recently returned to the west coast from a trip to Tennessee. His medical history is significant for gout, hypertension, hypercholesterolemia, diabetes mellitus type 2, and mild intellectual disability. He currently smokes 2 packs of cigarettes/day, drinks a 6-pack of beer/day, and he endorses a past history of injection drug use but currently denies any illicit drug use. The vital signs include: temperature 36.7°C (98.0°F), blood pressure 126/74 mm Hg, heart rate 87/min, and respiratory rate 23/min. His physical examination shows minimal bibasilar rales, but otherwise clear lungs on auscultation, grade 2/6 holosystolic murmur, and a benign abdominal physical examination. A computed tomography angiography (CTA) demonstrates a segmental pulmonary embolism (PE). Which of the following is the most appropriate treatment plan for this patient? (A) Initiate warfarin anticoagulation (B) Initiate heparin with a bridge to warfarin (C) Tissue plasminogen activator (tPA) (D) Consult interventional radiologist (IR) for IVC filter placement
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['(B) Initiate heparin with a bridge to warfarin <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 36-year-old woman comes to the physician to discuss contraceptive options. She is currently sexually active with one male partner, and they have not been using any contraception. She has no significant past medical history and takes no medications. She has smoked one pack of cigarettes daily for 15 years. She is allergic to latex and copper. A urine pregnancy test is negative. Which of the following contraceptive methods is contraindicated in this patient? (A) Diaphragm with spermicide (B) Progestin-only pill (C) Intrauterine device (D) Combined oral contraceptive pill
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['(D) Combined oral contraceptive pill <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 45-year-old male presents to the emergency room following a seizure. The patient suffered from an upper respiratory infection complicated by sinusitis two weeks ago. The patient's past medical history is remarkable for hypertension for which he takes hydrochlorathiazide. Temperature is 39.5C, blood pressure is 120/60 mmHg, pulse is 85/min, and respiratory rate is 20/min. Upon interview, the patient appears confused and exhibits photophobia. CSF cultures are obtained. Which of the following is the most appropriate next step in the management of this patient? (A) Ceftriaxone (B) Ceftriaxone and vancomycin (C) Ceftriaxone, vancomycin and ampicillin (D) MRI of the head
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['(B) Ceftriaxone and vancomycin <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** Researchers are studying the relationship between heart disease and alcohol consumption. They review the electronic medical records of 500 patients at a local hospital during the study period and identify the presence or absence of acute coronary syndrome (ACS) and the number of alcoholic drinks consumed on the day of presentation. The researchers determine the prevalence of ACS and of alcoholic drink consumption. They correlate the relationship between these two variables and find that patients who reported no alcohol consumption or 1 drink only that day had a lower risk of acute coronary syndrome than patients who reported 2 or more drinks. Which of the following is the most accurate description of this study type? (A) Randomized controlled trial (B) Case-control study (C) Cross-sectional study (D) Retrospective study
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['(C) Cross-sectional study <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 58-year-old woman with type 2 diabetes mellitus comes to the physician because of generalized pain and muscle weakness. She suffered a nondisplaced left ulnar fracture 3 months ago after lifting a heavy crate of books. She has had progressively worsening renal function over the past 2 years but has not yet started hemodialysis. An x-ray of the left wrist shows a healing fracture in the ulna with thinned cortices. There are multiple transverse radiolucent bands adjacent to the fracture, surrounded by a thin sclerotic margin. This patient's findings are most likely due to the impaired production of which of the following substances? (A) 1,25-dihydroxycholecalciferol (B) Ergosterol (C) Cholecalciferol (D) 7-dehydrocholesterol
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['(A) 1,25-dihydroxycholecalciferol <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 10-year-old boy presents to his pediatrician for a well child appointment. The patient has been doing well in school. He plays on a club basketball team and is also a member of the chess club. He has many friends and is very happy. His parents currently have no concerns for him. His temperature is 99.5°F (37.5°C), blood pressure is 127/68 mmHg, pulse is 85/min, respirations are 17/min, and oxygen saturation is 98% on room air. On physical exam, you note a tall, muscular young boy. He is in the 99th percentile for weight and height. Cardiopulmonary exam is within normal limits. The patient's abdomen is obese, non-tender, and non-distended. Neurological exam is grossly non-focal. Testicular exam is notable for a right-sided testicular mass. Musculoskeletal exam reveals a normal range of motion and 5/5 strength in his upper and lower extremities. Dermatologic exam reveals acne and facial hair on the patient's face. Which of the following is the most likely underlying diagnosis in this patient? (A) Leydig cell tumor (B) Normal development in the setting of obesity (C) Pituitary adenoma (D) Precocious puberty
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['(A) Leydig cell tumor <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** An 8-year-old boy and his 26-year-old babysitter are brought into the emergency department with severe injuries caused by a motor vehicle accident. The child is wheeled to the pediatric intensive care unit with a severe injury to his right arm, as well as other external and internal injuries. He is hemorrhaging and found to be hemodynamically unstable. He subsequently requires transfusion and surgery, and he is currently unconscious. The pediatric trauma surgeon evaluates the child’s arm and realizes it will need to be amputated at the elbow. Which of the following is the most appropriate course of action to take with regards to the amputation? (A) Amputate the child’s arm at the elbow joint (B) Wait for the child to gain consciousness to obtain his consent to amputate his arm (C) Wait for the child’s babysitter to recover from her injuries to obtain her consent to amputate the child’s arm (D) Obtain an emergency court order from a judge to obtain consent to amputate the child’s arm
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['(A) Amputate the child’s arm at the elbow joint <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 67-year-old gentleman with severe COPD is found to have a respiratory quotient of 0.8. His physician would like to decrease the amount of CO2 produced by the patient's metabolism, thereby reducing the energy breathing expenditure required to eliminate the patient's CO2 respiratory burden. Which of the following dietary modifications would decrease this patient's respiratory quotient? (A) Increasing carbohydrate intake, decreasing protein intake (B) Decreasing carbohydrate intake, increasing fat intake (C) Decreasing carbohydrate intake, increasing protein intake (D) Decreasing fat intake, increasing protein intake
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['(B) Decreasing carbohydrate intake, increasing fat intake <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 46-year-old man comes to the emergency department because of a 10-day history of right upper quadrant abdominal pain. He has also been feeling tired and nauseous for the past 6 weeks. On examination, scleral icterus is present. Abdominal examination shows tenderness to palpation in the right upper quadrant. The liver edge is palpated 2 cm below the right costal margin. Laboratory studies show: Aspartate aminotransferase 1780 U/L Alanine aminotransferase 2520 U/L Hepatitis A IgM antibody Negative Hepatitis B surface antigen Negative Hepatitis B surface antibody Negative Hepatitis B core IgM antibody Positive Hepatitis C antibody Positive Hepatitis C RNA Negative Which of the following is the best course of action for this patient?" (A) Ribavirin and interferon (B) Supportive therapy (C) Emergency liver transplantation (D) Pegylated interferon-alpha
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['(B) Supportive therapy <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 16-year-old woman with no known past medical history and non-significant social and family histories presents to the outpatient clinic for an annual wellness checkup. She has no complaints, and her review of systems is negative. She is up to date on her childhood and adolescent vaccinations. The patient's blood pressure is 120/78 mm Hg, pulse is 82/min, respiratory rate is 16/min, and temperature is 37.0°C (98.6°F). On further questioning, she discloses that she has recently become sexual active and enquires about any necessary screening tests for cervical cancer. What is the appropriate recommendation regarding cervical cancer screening in this patient? (A) Begin 2-year interval cervical cancer screening via Pap smear today (B) Begin 3-year interval cervical cancer screening via Pap smear at age 21 (C) Begin 5-year interval cervical cancer screening via Pap smear at age 21 (D) Offer to administer the HPV vaccine so that Pap smears can be avoided
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['(B) Begin 3-year interval cervical cancer screening via Pap smear at age 21 <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 53-year-old man presents to the office for a routine examination. The medical history is significant for diabetes mellitus, for which he is taking metformin. The medical records show blood pressure readings from three separate visits to fall in the 130–160 mm Hg range for systolic and 90–100 mm Hg range for diastolic. Prazosin is prescribed. Which of the following are effects of this drug? (A) Vasoconstriction, bladder sphincter constriction, mydriasis (B) Vasodilation, bladder sphincter relaxation, miosis (C) Vasodilation, decreased heart rate, bronchial constriction (D) Vasodilation, increased peristalsis, bronchial dilation
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['(B) Vasodilation, bladder sphincter relaxation, miosis <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 30-year-old male visits you in the clinic complaining of chronic abdominal pain and diarrhea following milk intake. Gastrointestinal histology of this patient's condition is most similar to which of the following? (A) Celiac disease (B) Crohns disease (C) Tropical sprue (D) No GI disease
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['(D) No GI disease <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 25-year-old college student is diagnosed with acute myelogenous leukemia after presenting with a 3-week history of fever, malaise, and fatigue. He has a history of type 1 diabetes mellitus, multiple middle ear infections as a child, and infectious mononucleosis in high school. He currently smokes 1 pack of cigarettes per day, drinks a glass of wine per day, and denies any illicit drug use. The vital signs include: temperature 36.7°C (98.0°F), blood pressure 126/74 mm Hg, heart rate 87/min, and respiratory rate 17/min. On physical examination, his pulses are bounding; his complexion is pale, but breath sounds remain clear. A rapidly progressive form of leukemia is identified, and the patient is scheduled to start intravenous chemotherapy. Which of the following treatments should be given to this patient to prevent or decrease the likelihood of developing acute renal failure during treatment? (A) Sulfinpyrazone (B) Probenecid (C) Allopurinol (D) Colchicine
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['(C) Allopurinol <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 31-year-old woman has a follow-up visit with her psychiatrist. She was recently diagnosed with major depressive disorder and was started on citalopram 3 months ago. Her dosage was increased one time 6 weeks ago. She has come in to discuss her progress and notes that she feels “normal again” and “happier” and has not experienced her usual feelings of depression, crying spells, or insomnia. Her appetite has also improved and she is performing better at work, stating that she has more focus and motivation to complete her assignments. During the beginning of her treatment, she states that she had occasional headaches and diarrhea, but that she no longer has those side effects. Which of the following is the most appropriate next step in this patient’s management? (A) Lower the dose of citalopram (B) Maintain the current dose of citalopram for several months (C) Increase the dose of citalopram (D) Discontinue the citalopram and switch to amitriptyline
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['(B) Maintain the current dose of citalopram for several months <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 75-year-old male presents to the emergency room complaining of severe lower abdominal pain and an inability to urinate. He reports that he last urinated approximately nine hours ago. When asked to urinate, only a few drops dribble from the tip of his penis. Further questioning reveals that the patient has experienced progressively worsening difficulty with urinating over the past two years. He has lived alone for five years since his wife passed away. He has not seen a doctor in that time. His temperature is 98.8°F (37.1°C), blood pressure is 145/90 mmHg, pulse is 115/min, and respirations are 22/min. He appears to be in severe pain. Physical examination reveals a distended bladder and significant tenderness to palpation over the inferior aspect of his abdomen. Which of the following sets of lab values would most likely be found in a urinalysis of this patient? (A) Urine osmolality 400 mOsmol/kg H2O, Urine Na+ 25 mEq/L, FENa 1.5%, no casts (B) Urine osmolality 200 mOsmol/kg H2O, Urine Na+ 35 mEq/L, FENa 3%, muddy brown casts (C) Urine osmolality 550 mOsmol/kg H2O, Urine Na+ 15 mEq/L, FENa 0.9%, red blood cell casts (D) Urine osmolality 300 mOsmol/kg H2O, Urine Na+ 45 mEq/L, FENa 5%, no casts
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['(D) Urine osmolality 300 mOsmol/kg H2O, Urine Na+ 45 mEq/L, FENa 5%, no casts <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 57-year-old man presents to the office with complaints of perianal pain during defecation and perineal heaviness for 1 month. He also complains of discharge around his anus, and bright red bleeding during defecation. The patient provides a history of having a sexual relationship with other men without using any methods of protection. The physical examination demonstrates edematous verrucous anal folds that are of hard consistency and painful to the touch. A proctosigmoidoscopy reveals an anal canal ulcer with well defined, indurated borders on a white background. A biopsy is taken and the results are pending. What is the most likely diagnosis? (A) Anal fissure (B) Anal cancer (C) Proctitis (D) Polyps
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['(B) Anal cancer <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 53-year-old woman presents to her physician for evaluation of sudden onset respiratory distress for the past few hours. The past medical history includes a myocardial infarction 2 years ago. The vital signs include a blood pressure 70/40 mm Hg, pulse 92/min, respiratory rate 28/min, and SpO2 92% on room air. The physical examination reveals bilateral basal crepitations on auscultation. The echocardiogram reveals an ejection fraction of 34%. She is admitted to the medical floor and started on furosemide. The urine output in 24 hours is 400 mL. The blood urea nitrogen is 45 mg/dL and the serum creatinine is 1.85 mg/dL. The fractional excretion of sodium is 0.89 %. Urinalysis revealed muddy brown granular casts. Which of the following is the most likely cause of the abnormal urinalysis? (A) Acute glomerulonephritis (B) Chronic kidney disease (C) Acute pyelonephritis (D) Acute tubular necrosis
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['(D) Acute tubular necrosis <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A previously healthy 18-year-old woman comes to the emergency department for evaluation of intractable vomiting and uterine cramping. Her last menstrual period was 7 weeks ago. Serum β-human chorionic gonadotropin concentration is 170,000 mIU/mL. A transvaginal ultrasound shows a complex intrauterine mass with numerous anechoic spaces and multiple ovarian cysts. The patient undergoes dilation and curettage, which shows hydropic villi with diffuse, circumferential trophoblastic proliferation. Karyotype analysis of the specimen is most likely to show which of the following? (A) 46,XX of maternal origin only (B) 69,XXY of paternal origin only (C) 46,XX of paternal origin only (D) 69,XYY of both maternal and paternal origin
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['(C) 46,XX of paternal origin only <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** An newborn infant comes to the attention of the neonatal care unit because he started having heavy and rapid breathing. In addition, he was found to be very irritable with pale skin and profuse sweating. Finally, he was found to have cold feet with diminished lower extremity pulses. Cardiac auscultation reveals a harsh systolic murmur along the left sternal border. Notably, the patient is not observed to have cyanosis. Which of the following treatments would most likely be effective for this patient's condition? (A) Leukotriene E4 (B) Prostaglandin E1 (C) Prostaglandin E2 (D) Prostaglandin I2
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['(B) Prostaglandin E1 <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 61-year-old man is brought to the emergency room with slurred speech. According to the patient's wife, they were watching a movie together when he developed a minor headache. He soon developed difficulty speaking in complete sentences, at which point she decided to take him to the emergency room. His past medical history is notable for hypertension and hyperlipidemia. He takes aspirin, lisinopril, rosuvastatin. The patient is a retired lawyer. He has a 25-pack-year smoking history and drinks 4-5 beers per day. His father died of a myocardial infarction, and his mother died of breast cancer. His temperature is 98.6°F (37°C), blood pressure is 143/81 mmHg, pulse is 88/min, and respirations are 21/min. On exam, he can understand everything that is being said to him and is able to repeat statements without difficulty. However, when asked to speak freely, he hesitates with every word and takes 30 seconds to finish a short sentence. This patient most likely has an infarct in which of the following vascular distributions? (A) Anterior cerebral artery and middle cerebral artery watershed area (B) Inferior division of the middle cerebral artery (C) Middle cerebral artery and posterior cerebral artery watershed area (D) Proximal middle cerebral artery
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['(A) Anterior cerebral artery and middle cerebral artery watershed area <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** An investigator is studying the immune response and the spleen in a mouse model infected with Escherichia coli. Which of the following anatomical sites in the spleen is important for the initial maturation of B cells that will ultimately target Escherichia coli? (A) Red pulp (B) Marginal zone (C) Germinal center (D) Sinusoids
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['(C) Germinal center <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 2-month-old boy is brought to the pediatrician by his parents after they notice that he had a “floppy” appearance, poor suckling, vomiting, and spontaneous generalized movements a few weeks after birth. The boy was born at home, and routine newborn screening was normal. On physical examination, the infant is hypotonic, has poor suckling, cannot hold his head straight while prone, and does not follow objects. He has fair skin, red hair, blue eyes, eczema, and galactorrhea. At the second appointment, laboratory tests show high levels of phenylalanine and prolactin and low levels of homovanillic acid and serotonin. Which of the following enzymes is deficient in this patient? (A) Dopamine hydroxylase (B) Phenylethanolamine N-methyltransferase (C) Phenylalanine hydroxylase (D) Dihydropteridine reductase
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['(D) Dihydropteridine reductase <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 32-year-old woman comes to the emergency department because of a 5-day history of anxiety, irritability, insomnia, and abdominal pain that began after a weekend of partying. She also reports “bloody” urine as well as a tingling sensation in her hands and feet. She has never experienced similar symptoms. She does not smoke but says that she tends to drink too much (5 or more drinks) when partying with friends. Her temperature is 37°C (98.6°F), pulse is 123/min, and blood pressure is 124/70 mm Hg. Examination shows slightly decreased power in the shoulders (3/5) and thighs (4/5), along with hyporeflexia. Urine dipstick shows: Blood Negative Protein Negative WBC Negative Bilirubin Negative Urobilinogen 3+ This patient's condition is most likely caused by a defect in which of the following enzymes?" (A) Homogentisic acid dioxygenase (B) Aminolevulinic acid synthase (C) Ferrochelatase (D) Porphobilinogen deaminase
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['(D) Porphobilinogen deaminase <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 15-year-old female is brought to the emergency room with high fever and confusion. She complains of chills and myalgias, and physical examination reveals a petechial rash. Petechial biopsy reveals a Gram-negative diplococcus. The patient is at greatest risk for which of the following? (A) Bilateral adrenal destruction (B) Pelvic inflammatory disease (C) Septic arthritis (D) Acute endocarditis
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['(A) Bilateral adrenal destruction <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 63-year-old man presents to the clinic with fever accompanied by shortness of breath. The symptoms developed a week ago and have been progressively worsening over the last 2 days. He reports his cough is productive of thick, yellow sputum. He was diagnosed with chronic obstructive pulmonary disease 3 years ago and has been on treatment ever since. He quit smoking 10 years ago but occasionally experiences shortness of breath along with chest tightness that improves with the use of an inhaler. However, this time the symptoms seem to be more severe and unrelenting. His temperature is 38.6°C (101.4°F), the respirations are 21/min, the blood pressure is 100/60 mm Hg, and the pulse is 105/min. Auscultation reveals bilateral crackles and expiratory wheezes. His oxygen saturation is 95% on room air. According to this patient’s history, which of the following should be the next step in the management of this patient? (A) Chest X-ray (B) CT scan (C) Bronchoscopy (D) Bronchoprovocation test
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['(A) Chest X-ray <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 29-year-old G1P1 woman presents to her primary care physician with unilateral breast pain. She is currently breastfeeding her healthy 3-month-old baby boy. She has been breastfeeding since her child's birth without any problems. However, 3 days prior to presentation, she developed left breast pain, purulent nipple discharge, and malaise. Her past medical history is notable for obesity and generalized anxiety disorder. She takes sertraline. She does not smoke or drink alcohol. Her temperature is 100.8°F (38.2°C), blood pressure is 128/78 mmHg, pulse is 91/min, and respirations are 17/min. On exam, she appears lethargic but is able to answer questions appropriately. Her right breast appears normal. Her left breast is tender to palpation, warm to the touch, and swollen relative to the right breast. There is a visible fissure in the left nipple that expresses minimal purulent discharge. Which of the following pathogens is the most likely cause of this patient's condition? (A) Candida albicans (B) Staphylococcus aureus (C) Staphylococcus epidermidis (D) Streptococcus pyogenes
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['(B) Staphylococcus aureus <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** An otherwise healthy 45-year-old man comes to the physician because of a painful ulcer on his tongue for 3 days. Examination shows a shallow, tender 5-mm wide ulcer on the lateral aspect of the tongue, adjacent to his left first molar. There is no induration surrounding the ulcer or cervical lymphadenopathy. A lesion of the cranial nerve responsible for the transmission of pain from this ulcer would most likely result in which of the following? (A) Difficulty chewing (B) Loss of taste from the supraglottic region (C) Inability to wrinkle the forehead (D) Lateral deviation of the tongue
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['(A) Difficulty chewing <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 3-year-old boy presents with progressive lethargy and confusion over the last 5 days. He lives with his parents in a home that was built in the early 1900s. His parents report that "his tummy has been hurting" for the last 3 weeks and that he is constipated. He eats and drinks normally, but occasionally tries things that are not food. Abdominal exam shows no focal tenderness. Hemoglobin is 8 g/dL and hematocrit is 24%. Venous lead level is 55 ug/dL. Which therapy is most appropriate for this boy's condition? (A) Folic acid (B) Docusate (C) Succimer (D) Psyllium
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['(C) Succimer <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A previously healthy 25-year-old male comes to his primary care physician with a painless solitary lesion on his penis that developed 4 days ago. He has not experienced anything like this before. He is currently sexually active with multiple partners and uses condoms inconsistently. His temperature is 37.0°C (98.7°F), pulse is 67/min, respirations are 17/min, and blood pressure is 110/70 mm Hg. Genitourinary examination shows a shallow, nontender, firm ulcer with a smooth base along the shaft of the penis. There is nontender inguinal adenopathy bilaterally. Which of the following is the most appropriate next step to confirm the diagnosis? (A) Swab culture (B) Rapid plasma reagin (C) Fluorescent treponemal antibody absorption test (D) Dark-field microscopy "
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['(D) Dark-field microscopy <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 28-year-old man presents to his primary care provider because of shortness of breath, cough, and wheezing. He reports that in high school, he occasionally had shortness of breath and would wheeze after running. His symptoms have progressively worsened over the past 6 months and are now occurring daily. He also finds himself being woken up from sleep by his wheeze approximately 3 times a week. His medical history is unremarkable. He denies tobacco use or excessive alcohol consumption. His temperature is 37.1°C (98.8°F), blood pressure is 121/82 mm Hg, and heart rate is 82/min. Physical examination is remarkable for expiratory wheezing bilaterally. Spirometry shows an FEV1 of 73% of predicted, which improves by 19% with albuterol. In addition to a short-acting beta-agonist as needed, which of the following is the most appropriate therapy for this patient? (A) A long-acting beta-agonist alone (B) A low-dose inhaled corticosteroid and a long-acting beta-agonist (C) A medium-dose inhaled corticosteroid and a long-acting beta-agonist (D) A high-dose inhaled corticosteroid and a long-acting beta-agonist
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['(B) A low-dose inhaled corticosteroid and a long-acting beta-agonist <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 2-year-old girl is brought to the doctor by her mother with persistent scratching of her perianal region. The patient’s mother says that symptoms started 3 days ago and have progressively worsened until she is nearly continuously scratching even in public places. She says that the scratching is worse at night and disturbs her sleep. An anal swab and staining with lactophenol cotton blue reveal findings in the image (see image). Which of the following is the organism most likely responsible for this patient’s condition? (A) Enterobius vermicularis (B) Taenia saginata (C) Ancylostoma duodenale (D) Ascaris lumbricoides
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['(A) Enterobius vermicularis <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 30-year-old man is brought to the emergency department by his brother for the evaluation of progressive confusion over the past 6 hours. The patient is lethargic and unable to answer questions. His brother states that there is no personal or family history of serious illness. His temperature is 37°C (98.6°F), pulse is 110/min, and blood pressure 135/80 mm Hg. Physical examination shows warm, dry skin and dry mucous membranes. The pupils are dilated. The abdomen is distended and bowel sounds are hypoactive. Laboratory studies are within normal limits. An ECG shows no abnormalities. Intoxication with which of the following substances is the most likely cause of this patient's symptoms? (A) Cannabis (B) Amphetamine (C) Carbon monoxide (D) Antihistamine "
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['(D) Antihistamine <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 37-year-old woman presents to the emergency department with a chief complaint of severe pain in her face. She states that over the past week she has experienced episodic and intense pain in her face that comes on suddenly and resolves on its own. She states she feels the pain over her cheek and near her eye. The pain is so severe it causes her eyes to tear up, and she is very self conscious about the episodes. She fears going out in public as a result and sometimes feels her symptoms come on when she thinks about an episode occurring while in public. While she is waiting in the emergency room her symptoms resolve. The patient has a past medical history of diabetes, constipation, irritable bowel syndrome, and anxiety. She is well known to the emergency department for coming in with chief complaints that often do not have an organic etiology. Her temperature is 99.5°F (37.5°C), blood pressure is 177/108 mmHg, pulse is 90/min, respirations are 17/min, and oxygen saturation is 98% on room air. Cardiopulmonary and abdominal exams are within normal limits. Neurological exam reveals cranial nerves II-XII are grossly intact. The patient's pupils are equal and reactive to light. Pain is not elicited with palpation of the patient's face. Which of the following is the best initial step in management? (A) Alprazolam (B) Carbamazepine (C) High flow oxygen (D) Regular outpatient follow up
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['(B) Carbamazepine <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 30-year-old woman, gravida 2, para 1, at 42 weeks' gestation is admitted to the hospital in active labor. Pregnancy has been complicated by gestational diabetes, for which she has been receiving insulin injections. Her first child was delivered by lower segment transverse cesarean section because of a nonreassuring fetal heart rate. Her pulse is 90/min, respirations are 18/min, and blood pressure is 135/80 mm Hg. The fetal heart rate tracing shows a baseline heart rate of 145/min and moderate variation with frequent accelerations and occasional early decelerations. She undergoes an elective repeat lower segment transverse cesarean section with complete removal of the placenta. Shortly after the operation, she starts having heavy uterine bleeding with passage of clots. Examination shows a soft uterus on palpation. Her bleeding continues despite fundal massage and the use of packing, oxytocin, misoprostol, and carboprost. Her pulse rate is now 120/min, respirations are 20/min, and blood pressure is 90/70 mm Hg. Her hemoglobin is 8 g/dL, hematocrit is 24%, platelet count is 120,000 mm3, prothrombin time is 11 seconds, and partial thromboplastin time is 30 seconds. Mass transfusion protocol is activated and a B-Lynch uterine compression suture is placed to control her bleeding. Which of the following is the mostly likely cause of her postpartum complication? (A) Lack of uterine muscle contraction (B) Uterine inversion (C) Adherent placenta to myometrium (D) Uterine rupture
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['(A) Lack of uterine muscle contraction <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 20-year-old man presents to the emergency department. The patient was brought in by his coach after he fainted during a competition. This is the second time this has happened since the patient joined the track team. The patient has a past medical history of multiple episodes of streptococcal pharyngitis which were not treated in his youth. He is not currently on any medications. He is agreeable and not currently in any distress. His temperature is 99.5°F (37.5°C), blood pressure is 132/68 mmHg, pulse is 90/min, respirations are 12/min, and oxygen saturation is 98% on room air. On physical exam, you note a young man in no current distress. Neurological exam is within normal limits. Pulmonary exam reveals clear air movement bilaterally. Cardiac exam reveals a systolic murmur best heard at the lower left sternal border that radiates to the axilla. Abdominal exam reveals a soft abdomen that is non-tender in all 4 quadrants. The patient's cardiac exam is repeated while he squats. Which of the following is most likely true for this patient? (A) Decreased murmur in hypertrophic obstructive cardiomyopathy (B) Increased murmur in mitral stenosis (C) Decreased murmur in mitral stenosis (D) Increased murmur in aortic stenosis
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['(A) Decreased murmur in hypertrophic obstructive cardiomyopathy <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 36-year-old man undergoes ileocecal resection after a gunshot injury. The resected ileocecal segment is sent for histological evaluation. One of the slides derived from the specimen is shown in the image. Which of the following statements regarding the structure marked within the red circle is correct? (A) This structure can be only found in the colon. (B) This structure can become a site of entry of certain microorganisms including S. typhi. (C) Infants have the largest amount of these structures within their intestinal wall. (D) This structure only appears in case of bacterial infection.
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['(B) This structure can become a site of entry of certain microorganisms including S. typhi. <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 25-year-old female presents to the emergency room with a heart rate of 32 BPM and a blood pressure of 80/40. She was found by emergency medical services with an empty bottle of propanolol that was taken from her grandmother. Her vital signs do not improve despite IV fluids and oxygen. Which of the following is a first line treatment for overdose? (A) Glucagon (B) Atropine (C) Adenosine (D) Vagal maneuvers
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['(A) Glucagon <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** An otherwise healthy 8-year-old girl is brought to the physician by her parents because of concern for growth retardation. Although she has always been short for her age, her classmates have begun teasing her for her height. She is at the 5th percentile for height and 25th percentile for weight. Physical examination shows a low-set posterior hairline, increased skin folds along the side of the neck, and a high-arched palate. The nipples are widely spaced and the fourth metacarpal bones are shortened bilaterally. This patient is at increased risk of developing which of the following complications? (A) Intellectual disability (B) Aortic stenosis (C) Acute lymphoblastic leukemia (D) Lens dislocation
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['(B) Aortic stenosis <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 3-year-old girl is brought to the physician by her mother two days after the sudden onset of a rash. The mother says that the rash developed an hour after she bathed the child in lukewarm water. Two weeks ago, the patient was diagnosed with a skin infection and was treated with penicillin V. She has been otherwise healthy but has missed several well-child examinations. She lives with her single mother, who recently lost her job and is now dependent on social assistance. The patient's mother has major depressive disorder and her maternal aunt has systemic lupus erythematosus. The girl's temperature is 36.8°C (98.2°F), pulse is 112/min, and blood pressure is 108/62 mm Hg. She has poor eye contact. Physical examination shows sharply delineated erythema on the lower extremities up to the umbilicus with sparing of the knees and flexor surfaces. Further evaluation is most likely to reveal which of the following? (A) Multiple injuries in different stages of healing (B) Positive Nikolsky's sign (C) Malar rash with sparing of the nasolabial folds (D) Ulcers of the oral mucosa "
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['(A) Multiple injuries in different stages of healing <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 30-year-old woman was found lying down and unresponsive by her parents 2 hours ago. She has no significant medical history. Two years ago, the woman discovered that her husband of 8 years was having an extramarital affair; this revelation subsequently resulted in a drawn-out divorce. After the separation, she moved back in with her parents, who note that she stays in her room, sleeps a lot, and rarely eats. A physical exam shows obtundation. Her temperature is 37.1ºC (98.7ºF), pulse is 110/min, respirations are 24/min, and blood pressure is 126/78 mm Hg. The patient’s admission labs are as follows: TSH 3.2 µU/mL Morning cortisol 8 µg/dL Prolactin 15 ng/mL FSH 7 mIU/mL LH 6 mIU/mL Glucose 22 mg/dL C-peptide not detected Beta-hydroxybutyrate ≤ 2.7 mmol/L Which of the following is most true of the cell type that is likely involved in the production of the molecule causing this patient’s symptoms? (A) Gram-negative enteric bacillus; catalase-positive, oxidase-negative, turns pink on MacConkey agar (B) Located in the periphery of islets of Langerhans (C) Located in zona fasciculata of the adrenal cortex (D) Gram-negative enteric bacillus; urease-positive, oxidase-positive, can be identified by silver stain
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['(A) Gram-negative enteric bacillus; catalase-positive, oxidase-negative, turns pink on MacConkey agar <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** The VALIANT trial compared the effect of captopril and valsartan on mortality in patients with myocardial infarction complicated by heart failure. Subjects were randomly assigned to treatment with either captopril or valsartan and subsequently followed for 2 years. The primary endpoint was death from any cause. The study concluded that valsartan was as effective as captopril in patients who are at high risk for cardiac events after an MI. Which of the following describes this type of study? (A) Randomized controlled trial (B) Cohort study (C) Case-control study (D) Crossover study
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['(A) Randomized controlled trial <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 52-year-old man with chronic alcoholism presents to an ambulatory medical clinic, where the hepatologist elects to perform comprehensive hepatitis B screening, in addition to several other screening and preventative measures. Given the following choices, which serologic marker, if positive, would indicate the patient has immunity to the hepatitis B virus? (A) HBsAgrn (B) HBsAb (C) HBcAbrn (D) HBeAg
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['(B) HBsAb <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 6-month-old male presents with a painless, enlarged left scrotum. After examining the patient, you suspect this enlargement is secondary to serous fluid entering and accumulating in the scrotum through a patent processus vaginalis. Which of the following would be the most useful next step in confirming the diagnosis of this patient’s condition? (A) Measurement of AFP and hCG levels (B) Transillumination test followed by scrotal ultrasound (C) Evaluation of cremasteric reflex on physical exam (D) Standard urinalysis
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['(B) Transillumination test followed by scrotal ultrasound <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 33-year-old Hispanic woman who recently immigrated to the United States with her newborn daughter is presenting to a free clinic for a wellness checkup for her baby. As part of screening for those immigrating or seeking refuge in the United States, she and her child are both evaluated for tuberculosis. The child’s purified protein derivative (PPD) test and chest radiograph are negative, and although the mother’s chest radiograph is also negative, her PPD is positive. She states that she is currently asymptomatic and has no known history of tuberculosis (TB). The mother’s vital signs include: blood pressure 124/76 mm Hg, heart rate 74/min, and respiratory rate 14/min. She is advised to begin treatment with isoniazid, supplemented with pyridoxine for the next 9 months. She asks about the potential for harm to the child if she begins this course of treatment since she is breastfeeding. Which of the following is the most appropriate response to this patient’s concerns? (A) “You should not breastfeed your baby because she is at greater risk for infection with TB than for adverse side effects of your treatment regimen.” (B) “You should not breastfeed your baby for the next 9 months because pyridoxine in breast milk can damage your child’s liver.” (C) “You may breastfeed your baby because pyridoxine will prevent isoniazid from causing peripheral neuropathy.” (D) “You may breastfeed your baby because you are asymptomatic and because neither isoniazid nor pyridoxine will harm your child.”
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['(D) “You may breastfeed your baby because you are asymptomatic and because neither isoniazid nor pyridoxine will harm your child.” <> 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 after a motor vehicle collision. He was being carpooled to school by an intoxicated driver and was involved in a high velocity head-on collision. The patient is otherwise healthy and has no past medical history. His temperature is 99.2°F (37.3°C), blood pressure is 80/45 mmHg, pulse is 172/min, respirations are 36/min, and oxygen saturation is 100% on room air. A FAST exam demonstrates free fluid in Morrison pouch. The patient’s parents arrive and state that they are Jehovah’s witnesses. They state they will not accept blood products for their son but will allow him to go to the operating room to stop the bleeding. Due to poor understanding and a language barrier, the parents are also refusing IV fluids as they are concerned that this may violate their religion. The child is able to verbalize that he agrees with his parents and does not want any treatment. Which of the following is the best next treatment for this patient? (A) Blood products and emergency surgery (B) IV fluids alone as surgery is too dangerous without blood product stabilization (C) IV fluids and vasopressors followed by emergency surgery (D) Observation and monitoring and obtain a translator
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['(A) Blood products and emergency surgery <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A public health researcher is invited to participate in a government meeting on immunization policies. Other participants in the meeting include physicians, pediatricians, representatives of vaccine manufacturers, persons from the health ministry, etc. For a specific viral disease, there are 2 vaccines - one is a live attenuated vaccine (LAV) and the other is a subunit vaccine. Manufacturers of both the vaccines promote their own vaccines in the meeting. Non-medical people in the meeting ask the public health researcher to compare the 2 types of vaccines objectively. The public health researcher clearly explains the pros and cons of the 2 types of vaccines. Which of the following statements is most likely to have been made by the public health researcher in his presentation? (A) LAV has a less potential for immunization errors as compared to a subunit vaccine (B) LAV cannot cause symptomatic infection in a immunocompetent person and, therefore, is as safe as a subunit vaccine (C) LAV is equally safe as a subunit vaccine for administration to a pregnant woman (D) LAV requires stricter requirements for cold chain maintenance as compared to a subunit vaccine
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['(D) LAV requires stricter requirements for cold chain maintenance as compared to a subunit vaccine <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 36-year-old man comes to the physician because of a 2-week history of productive cough, weight loss, and intermittent fever. He recently returned from a 6-month medical deployment to Indonesia. He appears tired. Physical examination shows nontender, enlarged, palpable cervical lymph nodes. An x-ray of the chest shows right-sided hilar lymphadenopathy. A sputum smear shows acid-fast bacilli. A diagnosis of pulmonary tuberculosis is made from PCR testing of the sputum. The patient requests that the physician does not inform anyone of this diagnosis because he is worried about losing his job. Which of the following is the most appropriate initial action by the physician? (A) Inform the local public health department of the diagnosis (B) Request the patient's permission to discuss the diagnosis with an infectious disease specialist (C) Assure the patient that his diagnosis will remain confidential (D) Confirm the diagnosis with a sputum culture
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['(A) Inform the local public health department of the diagnosis <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 6-year-old refugee with delayed growth and weakness is brought to the physician. Her family has been displaced several times over the last few years, and nutrition and housing were frequently inadequate. Examination of the lower limbs shows bowing of the legs with reduced proximal muscle strength. The abdomen is protruded. Inspection of the chest shows subcostal grooving during inspiration. An image of the patient’s wrist is shown. Which of the following is the most likely cause of this patient’s condition? (A) Defective collagen synthesis (B) Insufficient protein consumption (C) Osteoclast hyperactivity (D) Vitamin D deficiency
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['(D) Vitamin D deficiency <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 3-year-old girl is brought to the pediatrician by her parents who are concerned that she is not developing normally. They say she does not talk and avoids eye contact. She prefers to sit and play with blocks by herself rather than engaging with other children. They also note that she will occasionally have violent outbursts in inappropriate situations. She is otherwise healthy. In the office, the patient sits quietly in the corner of the room stacking and unstacking blocks. Examination of the patient shows a well-developed female with no physical abnormalities. Which of the following is the most likely diagnosis in this patient? (A) Autism spectrum disorder (B) Cri-du-chat syndrome (C) Oppositional defiant disorder (D) Rett syndrome
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['(A) Autism spectrum disorder <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 56-year-old man presents to the emergency department with severe epigastric pain that began an hour prior to presentation. He describes the pain as sharp, 10/10 in severity, and radiating to the back. Swallowing worsens the pain and causes him to cough. Before the pain started, he had been vomiting multiple times per day for the past week. The emesis was yellow and he denied ever seeing blood. Medical history is significant for poorly controlled hypertension, type II diabetes, alcohol use disorder, and 2 prior hospitalizations for acute pancreatitis. He smokes 1 pack of cigarettes per day for the last 35 years, denies illicit drug use, and drinks 3 pints of vodka per day. On physical exam, there is mediastinal crackling in synchrony with cardiac contraction on cardiac auscultation in the left lateral decubitus position. Laboratory testing is significant for leukocytosis. Which of the following is most likely the cause of this patient’s symptoms? (A) Coronary artery occlusion (B) Dissection of the aorta (C) Ulcerative changes in the gastric mucosa (D) Transmural esophageal rupture
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['(D) Transmural esophageal rupture <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 60-year-old woman presents for an evaluation for snoring. According to her husband, her snoring has increased over the last year, and he can’t tolerate it anymore. He has also noticed that she wakes up at night regularly for a few seconds but then falls back asleep. During the day, the patient says she is sleepy most of the time and complains of headaches and poor concentration. Past medical history is significant for hypertension and hyperlipidemia. Her temperature is 36.6°C (97.9°F), blood pressure is 156/98 mm Hg, pulse is 90/min and respirations are 20/min. Her body mass index (BMI) is 38 kg/m2. A polysomnographic study is ordered, and the result is shown below. While counseling the patient about her condition and available treatment options, she is asked if she wants to try a new therapy in which a device stimulates one of her cranial nerves. Which of the following muscles would most likely be stimulated by this method? (A) Genioglossus muscle (B) Digastric muscle (C) Hyoglossus muscle (D) Palatoglossus muscle
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['(A) Genioglossus muscle <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 13-year-old boy is brought to the emergency department by his parents for severe right hip pain that suddenly started about 2 hours ago. The parents are extremely anxious and feel overwhelmed because the boy has been hospitalized several times in the past for similar episodes of pain. The boy was born at 39 weeks of gestation via spontaneous vaginal delivery. He is up to date on all vaccinations and is meeting all developmental milestones. His only medication is hydroxyurea, which he has been receiving for 3 years. His blood pressure is 125/84 mm Hg, the respirations are 23/min, the pulse is 87/min, and the temperature is 36.7°C (98.0°F). On physical examination, the patient is in distress and has severe pain (8/10) elicited by gentle palpation of the right femoral head. Which of the following conditions has the same pathophysiology as the likely diagnosis for the patient described in this case? (A) Iliotibial band syndrome (B) Osgood-Schlatter disease (C) Legg-Calve-Perthes disease (D) Developmental dysplasia of the hip
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['(C) Legg-Calve-Perthes disease <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 34-year-old, previously healthy woman is admitted to the hospital with abdominal pain and bloody diarrhea. She reports consuming undercooked beef a day before the onset of her symptoms. Her medical history is unremarkable. Vital signs include: blood pressure 100/70 mm Hg, pulse rate 70/min, respiratory rate 16/min, and temperature 36.6℃ (97.9℉). Physical examination shows paleness, face and leg edema, and abdominal tenderness in the lower right quadrant. Laboratory investigation shows the following findings: Erythrocytes 3 x 106/mm3 Hemoglobin 9.4 g/dL Hematocrit 0.45 (45%) Corrected reticulocyte count 5.5% Platelet count 18,000/mm3 Leukocytes 11,750/mm3 Total bilirubin 2.33 mg/dL (39.8 µmol/L) Direct bilirubin 0.2 mg/dL (3.4 µmol/L) Serum creatinine 4.5 mg/dL (397.8 µmol/L) Blood urea nitrogen 35.4 mg/dL (12.6 mmol/L) E. coli O157: H7 was identified in the patient’s stool. Which toxin is likely responsible for her symptoms? (A) Shiga toxin (B) Verotoxin (C) Enterotoxin type B (D) Erythrogenic toxin
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['(B) Verotoxin <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 34-year-old woman with a seizure disorder comes to the physician because of fever, fatigue, and a productive cough with foul-smelling sputum for 2 weeks. Her temperature is 38.3°C (100.9°F). Physical examination shows dullness to percussion over the right lung fields. An x-ray of the chest shows a cavitary infiltrate with an air-fluid level in the right lower lobe of the lung. Cultures of an aspirate of the infiltrate grow Peptostreptococcus and Prevotella species. Which of the following is the most likely predisposing factor for this patient's condition? (A) Recent hospitalization (B) Intravenous drug use (C) Crowded housing situation (D) Periodontal infection
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['(D) Periodontal infection <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 26-year-old primigravida presents to her physician’s office at 35 weeks gestation with new onset lower leg edema. The course of her pregnancy was uneventful up to the time of presentation and she has been compliant with the recommended prenatal care. She reports a 4 pack-year history of smoking prior to her pregnancy. She also used oral contraceptives for birth control before considering the pregnancy. Prior to pregnancy, she weighed 52 kg (114.6 lb). She gained 11 kg (24.3 lb) during the pregnancy thus far, and 2 kg (4.4 lb) during the last 2 weeks. Her height is 169 cm (5 ft 7 in). She has a family history of hypertension in her mother (diagnosed at 46 years of age) and aunt (diagnosed at 51 years of age). The blood pressure is 145/90 mm Hg, the heart rate is 91/min, the respiratory rate is 15/min, and the temperature is 36.6℃ (97.9℉). The blood pressure is unchanged 15 minutes and 4 hours after the initial measurement. The fetal heart rate is 144/min. The examination is remarkable for 2+ pitting lower leg edema. The neurologic examination shows no focality. A urine dipstick test shows 2+ proteinuria. Which of the following factors is a risk factor for her condition? (A) Smoking prior to pregnancy (B) Primigravida (C) BMI < 18.5 kg/m2 prior to pregnancy (D) Family history of hypertension
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['(B) Primigravida <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 49-year-old man being treated for Helicobacter pylori infection presents to his primary care physician complaining of lower back pain. His physician determines that a non-steroidal anti-inflammatory drug (NSAID) would be the most appropriate initial treatment. Which of the following is the most appropriate NSAID for this patient? (A) Ibuprofen (B) Codeine (C) Bismuth (D) Celecoxib
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['(D) Celecoxib <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 17-year-old girl comes to the urgent care center after testing negative for HIV. She recently had sexual intercourse for the first time and had used a condom with her long-term boyfriend. She has no personal history of serious illness and no history of sexually transmitted infections. However, the patient is still worried about the possibility she has HIV despite the negative HIV test. She states that the package insert of the HIV test shows that of 100 patients who are found to be HIV-positive on PCR, 91 tested positive via the HIV test. Later in the day, a 23-year-old woman with a history of genitourinary chlamydia infection also comes to the urgent care center after testing negative for HIV. She states that she recently had unprotected intercourse with “someone who might have HIV.” If the test is conducted a second time on the 23-year-old patient, how will its performance compare to a second test conducted on the 17-year-old patient? (A) Increased sensitivity (B) Increased validity (C) Increased specificity (D) Decreased negative predictive value
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['(D) Decreased negative predictive value <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 14-year-old male is brought to your psychiatric clinic after he was caught stealing his peers’ belongings multiple times by his teacher. He is a straight-A student with many friends and is an outstanding football player. He describes his family as very loving and gets along with his older siblings. He also states that he has no ill will towards anyone he stole from in class. Although never caught, he admits that he would often steal things in stores or locker rooms when no one was looking in order to satisfy an intense impulse. Which of the following is the best diagnosis for this patient? (A) Manic episode (B) Conduct disorder (C) Kleptomania (D) Schizophrenia
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['(C) Kleptomania <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 67-year-old man is brought to the emergency room after being involved in a traffic accident. He currently complains of bilateral hip pain. His vital signs are within the normal range, and he is hemodynamically stable. The pelvic compression test is positive. External genitalia appears normal, except there is blood at the urethral meatus and a contusion at the base of the scrotum. Digital rectal examination (DRE) shows a high-riding ballotable prostate. An X-ray reveals the presence of a pelvic fracture. Which of the following initial actions is the most appropriate for this patient? (A) Obtain a retrograde urethrogram (RUG), including a pre-injection kidney, ureter, and bladder (KUB) film (B) Insert a Foley catheter (C) Perform a suprapubic cystostomy (D) Take the patient emergently to the operating room and check for a urethral injury with IV indigo carmine
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['(A) Obtain a retrograde urethrogram (RUG), including a pre-injection kidney, ureter, and bladder (KUB) film <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 13-year-old female comes to your office complaining of dry, scaling skin (FIgure A). She is particularly concerned about the appearance of her skin around her peers. She indicates that she did not start having problems until she was 5 years of age, after which her skin has progressively become drier and scalier. She has tried all types of over-the-counter moisturizers with no resolution. What is the most likely diagnosis? (A) Ichthyosis vulgaris (B) Psoriasis (C) Miliaria (D) Suborrheic dermatitis
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['(A) Ichthyosis vulgaris <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 16-year-old boy presents with acute left-sided weakness. The patient is obtunded and can not provide any history other than his stomach hurts. The patient’s friend states that the patient has had episodes like this in the past and that “he has the same weird disease as his mom”. On physical examination, strength is 1 out of 5 in the left upper and lower extremities. A noncontrast CT scan of the head is normal. Laboratory tests reveal an anion gap metabolic acidosis. Which of the following is a normal function of the structure causing this patient’s condition? (A) Extracellular potassium homeostasis (B) Conversion of pyruvate to oxaloacetate (C) Synthesis of globin chains of hemoglobin (D) Creation of exogenous reactive oxygen species
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['(B) Conversion of pyruvate to oxaloacetate <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 44-year-old woman is brought to the emergency department because of confusion and agitation. She was brought by police after she was found walking along a highway. The patient's brother comes to join her soon after her arrival. He says she has peptic ulcer disease and hypertension. He thinks she drinks around half a bottle of vodka daily. Her current medications include omeprazole and hydrochlorothiazide, although the brother is unsure if she takes them regularly. Her temperature is 37.1°C (98.7°F), pulse is 90/min, respirations are 16/min, and blood pressure is 135/90 mm Hg. On mental status examination, she is confused and not oriented to person, place, or time. Neurologic examination shows horizontal nystagmus. Her gait is wide-based with small steps. Her hemoglobin concentration is 9 g/dL. Her serum homocysteine concentration is elevated and her methylmalonic acid concentration is within the reference range. A peripheral blood smear shows hypersegmented neutrophils. Which of the following is the most likely cause of this patient's anemia? (A) Folate deficiency (B) Vitamin E deficiency (C) Vitamin B1 deficiency (D) Vitamin B12 deficency
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['(A) Folate deficiency <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 65-year-old woman was referred to a specialist for dysphagia and weight loss. She has a history of difficulty swallowing solid foods, which has become worse over the past year. She has unintentionally lost 2.3 kg (5 lb). A previous gastroscopy showed mild gastritis with a positive culture for Helicobacter pylori. A course of triple antibiotic therapy and omeprazole was prescribed. Follow-up endoscopy appeared normal with no H. pylori noted on biopsy. Her heartburn improved but the dysphagia persisted. She had a myocardial infarction four years ago, complicated by acute mitral regurgitation. Physical examination revealed a thin woman with normal vital signs. Auscultation of the heart reveals a 3/6 blowing systolic murmur at the apex radiating to the axilla. Breath sounds are reduced at the base of the right lung. The abdomen is mildly distended but not tender. The liver and spleen are not enlarged. Electrocardiogram shows sinus rhythm with a non-specific intraventricular block. Chest X-ray shows an enlarged cardiac silhouette with mild pleural effusion. What is the most probable cause of dysphagia? (A) Thoracic aortic aneurysm (B) Achalasia (C) Left atrium enlargement (D) Diffuse esophageal spasm
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['(C) Left atrium enlargement <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 30-year-old man comes to the physician for follow-up evaluation for hypertension. He reports a 1-month history of episodic throbbing headaches, palpitations, and paroxysmal sweating. Blood pressure is 160/90 mm Hg. He appears pale but physical examination is otherwise unremarkable. Laboratory studies show elevated urine and plasma metanephrines. A CT scan of the abdomen shows a mass in the left adrenal gland. Which of the following is the most appropriate initial pharmacotherapy for this patient? (A) Phenoxybenzamine (B) Propranolol (C) Clonidine (D) Hydrochlorothiazide
|
['(A) Phenoxybenzamine <> 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 physician because of fever, malaise, and a painful, itchy rash on the right shoulder for 2 weeks. The patient's mother says the boy's condition has worsened over the past 4 days. He has a history of atopic dermatitis. He has lived with his mother at several public shelters since she separated from his physically abusive father 2 months ago. His immunizations are up-to-date. There is cervical lymphadenopathy. Laboratory studies show no abnormalities. A photograph of the rash is shown. Which of the following is the most likely diagnosis? (A) Bed bug bites (B) Nonbullous impetigo (C) Stevens-Johnson syndrome (D) Eczema herpeticum
|
['(D) Eczema herpeticum <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 48-year-old female presents to the emergency room with mental status changes. Laboratory analysis of the patient's serum shows: Na 122 mEq/L K 3.9 mEq/L HCO3 24 mEq/L BUN 21 mg/dL Cr 0.9 mg/dL Ca 8.5 mg/dL Glu 105 mg/dL Urinalysis shows: Osmolality 334 mOsm/kg Na 45 mEq/L Glu 0 mg/dL Which of the following is the most likely diagnosis? (A) Diarrhea (B) Diabetes insipidus (C) Primary polydipsia (D) Lung cancer
|
['(D) Lung cancer <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 39-year-old woman with a history of migraine headaches is brought to the emergency room because of a severe, sudden-onset, throbbing headache and double vision for 1 hour. She says that she has been having frequent headaches and has not had her period in several months. Her blood pressure is 93/61 mm Hg. Visual field testing shows decreased visual acuity and loss of peripheral vision in both eyes. Which of the following is the most likely diagnosis? (A) Transient ischemic attack (B) Pituitary apoplexy (C) Sheehan syndrome (D) Migraine with aura
|
['(B) Pituitary apoplexy <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 27-year-old G1P0 woman at 25 weeks estimated gestational age presents with a blood pressure of 188/99 mm Hg during a routine prenatal visit. She has no symptoms, except for a mild headache. The patient's heart rate is 78/min. An injectable antihypertensive along with a beta-blocker is administered, and her blood pressure returns to normal within a couple of hours. She is sent home with advice to continue the beta-blocker. The patient returns after a couple of weeks with joint pain in both of her knees and fatigue. A blood test for anti-histone antibodies is positive. Which of the following is the mechanism of action of the intravenous antihypertensive medication most likely used in this patient? (A) Calcium channel antagonism (B) Potassium channel activation (C) Release endogenous nitrous oxide (D) Interference with action of inositol trisphosphate (IP3) on intracellular calcium release
|
['(D) Interference with action of inositol trisphosphate (IP3) on intracellular calcium release <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 58-year-old man is admitted to the hospital for severe abdominal pain and confusion. He has a history of alcohol use disorder, with several previous admissions for intoxication. Twelve hours after admission, he has worsening shortness of breath. His temperature is 38.3°C (100.9°F), pulse is 120/min, respirations are 30/min, and blood pressure is 100/60 mm Hg. Pulse oximetry on mask ventilation shows an oxygen saturation of 85%. The patient is intubated and mechanically ventilated with an FiO2 of 40%. Physical examination shows diffuse lung crackles, marked epigastric tenderness, and a periumbilical hematoma. Cardiac examination is normal with no murmurs, rubs, or gallops. There is no jugular venous distension. Arterial blood gas analysis shows: pH 7.29 PO2 60 mm Hg PCO2 40 mm Hg HCO3- 15 mmol/L An x-ray of the chest shows bilateral opacities in the lower lung fields. Which of the following is the most likely cause of this patient's respiratory symptoms?" (A) Hospital-acquired pneumonia (B) Acute respiratory distress syndrome (C) Congestive heart failure (D) Hepatic hydrothorax
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['(B) Acute respiratory distress syndrome <> 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 emergency department by his mother 1 hour after falling off his bike and landing head-first on the pavement. His mother says that he did not lose consciousness but has been agitated and complaining about a headache since the event. He has no history of serious illness and takes no medications. His temperature is 37.1°C (98.7°F), pulse is 115/min, respirations are 20/min, and blood pressure is 100/65 mm Hg. There is a large bruise on the anterior scalp. Examination, including neurologic examination, shows no other abnormalities. A noncontrast CT scan of the head shows a non-depressed linear skull fracture with a 2-mm separation. Which of the following is the most appropriate next step in management? (A) Inpatient observation (B) Discharge home (C) MRI of the brain (D) CT angiography "
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['(A) Inpatient observation <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 27-year-old African American male presents to his family physician for “spots” on his foot. Yesterday, he noticed brown spots on his foot that have a whitish rim around them. The skin lesions are not painful, but he got particularly concerned when he found similar lesions on his penis that appear wet. He recalls having pain with urination for the last 4 weeks, but he did not seek medical attention until now. He also has joint pain in his right knee which started this week. He is sexually active with a new partner and uses condoms inconsistently. His physician prescribes a topical glucocorticoid to treat his lesions. Which of the following risk factors is most commonly implicated in the development of this condition? (A) Race (B) HLA B27 allele (C) Co-infection with HIV (D) Diagnosis with psoriasis
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['(B) HLA B27 allele <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A pharmaceutical company has created an experimental medication, Drug Z, for patients with relapsing-remitting multiple sclerosis. Drug Z has been deemed to be safe in rats and is nearly ready for human trials. Before initiating a Phase I clinical trial, the company would like to study the medication’s pharmacokinetic properties in humans. The drug was found to have a half-life of 2.5 hours and is eliminated by first-order kinetics. The volume of distribution of the drug is determined to be 0.5 L/kg. The drug is administered intravenously and sublingually and plasma drug concentration vs. time plots are obtained. Intravenous administration of 10 mg of Drug Z yields an area under the curve (AUC) of 15 mg hr/L. Sublingual administration of 25 mg of Drug Z yields an area under the curve of 20 mg hr/L. What is the absolute bioavailability of this medication? (A) 53% (B) 59% (C) 67% (D) 71%
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['(A) 53% <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 4-year-old boy is brought by his parents to his pediatrician’s office. His mother mentions that the child has been producing an increased number of foul stools recently. His mother says that over the past year, he has had 1 or 2 foul-smelling stools per month. Lately, however, the stools are looser, more frequent, and have a distinct odor. Over the past several years, he has been admitted 4 times with episodes of pneumonia. Genetic studies reveal a mutation on a specific chromosome that has led to a 3 base-pair deletion for the amino acid phenylalanine. Which of the following chromosomes is the defective gene responsible for this boy’s clinical condition? (A) Chromosome 15 (B) Chromosome 4 (C) Chromosome 22 (D) Chromosome 7
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['(D) Chromosome 7 <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 4-year-old boy is brought to the physician because of frequent falls, worsening muscle pain, and poor vision in low light conditions. His mother reports that he has been on a low-fat diet since infancy because of persistent diarrhea. He is at the 5th percentile for height and weight. Physical examination shows bilateral proximal muscle weakness and a wide ataxic gait. His serum cholesterol level is 21 mg/dL. Peripheral blood smear shows red blood cells with irregular spiny projections of varying size. Further evaluation of this patient is most likely to show which of the following findings? (A) GAA trinucleotide repeats on chromosome 9 (B) Post-prandial lipid-laden enterocytes (C) IgA anti-tissue transglutaminase antibodies (D) Fibrofatty replacement of muscle tissue
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['(B) Post-prandial lipid-laden enterocytes <> answer']
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The following are multiple choice questions (with answers) about medical knowledge. **Question:** A 72-year-old man is brought to your office by his daughter due to concern over recent behavioral changes. Over the last several months he has had increasing difficulty with remembering recent events. She mentions that he is embarrassed due to a new inability to control urination. His medical history is significant for hypertension and insomnia. His medications include alprazolam and hydrochlorothiazide. On physical exam, he is oriented to time and place and thinks his daughter is exaggerating; however, when asked to recall 3 items, the patient refuses to continue the mental status exam. He has 5/5 strength bilaterally. He walks in short strides by sliding his feet across the floor. Which of the following would you expect to see in his patient? (A) Distortion of corona radiata fibers (B) Atrophy of the caudate and putamen (C) Atrophy of the subthalamic nucleus (D) Depigmentation of the substantia nigra pars compacta
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['(A) Distortion of corona radiata fibers <> answer']
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