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Answer the following medical question with the correct letter choice:
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<<Question:>> A 37-year-old 11-week primigravida will soon undergo a prenatal evaluation. The doctor wants to exclude chromosomal abnormalities with a test. He tells her that the test includes extracting a blood sample to determine the chances of having certain genetic conditions. This process involves analyzing fetal DNA in the mother’s blood. What conditions can the given test predict? ---- <<Choices:>> A) Trisomy 21, Ebstein anomaly B) Trisomy 21, trisomy 13, trisomy 18, fetal sex C) Trisomy 21, trisomy 13, spina bifida D) Trisomy 21, spina bifida ---- <<Answer:>>
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B
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 41-year-old man presents with progressive fatigue, pain in the front of the chest, and difficulty breathing with minimal exertion while trying to sleep. He reports having a flu-like illness consisting of fatigue, muscle pain, and cough 10 days ago that resolved spontaneously without seeking a medical help. He has no past medical history. He does not smoke cigarettes or drink alcohol. His vital signs include a blood pressure of 100/70 mm Hg, a temperature of 37.5°C (99.5°F), and a regular radial pulse of 105/min. On physical examination, the patient looks tired, the jugular venous pressure is elevated, pulmonary rales are present on both sides, and an S3 gallop is audible. His ECG shows nonspecific ST-segment and T-wave abnormalities. A 2-dimensional echocardiogram shows global left ventricular motion abnormalities and dilatation of the left ventricle. Troponin I and Creatine Kinase-MB are elevated. Which of the following is the most likely mechanism of the patient illness? ---- <<Choices:>> A) Rupture of an atherosclerotic plaque in the coronary artery B) Viral-mediated inflammation with local and systemic immunological activation C) Infection of the endocardial surface of the heart with microembolization and immune complex deposition D) Immune-mediated inflammation of the heart triggered by a preceding streptococcal infection ---- <<Answer:>>
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B
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Answer the following medical question with the correct letter choice:
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<<Question:>> A group of epidemiologists is studying the rates of cardiac surgeries performed in several Southeast Asian countries compared to the United States. Results show a significant increase in the number of mitral valve replacements performed in Vietnam in adults aged 30–50 years compared to the same age group in the United States. Which of the following public health interventions is most likely to decrease this number? ---- <<Choices:>> A) Prompt antibiotic treatment for bacterial pharyngitis B) Improved access to drug rehabilitation centers C) Genetic screening program for FBN1 gene mutation D) Screening echocardiography for prolapsed anterior mitral valve leaflets ---- <<Answer:>>
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A
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 31-year-old male presents to his primary care physician complaining of low back pain and fevers. He reports a four-day history of intermittent fevers, chills, and low back pain. He denies trauma or recent illness. His past medical history is notable for recurrent renal stones, diabetes mellitus, and alcohol abuse. He takes metformin but admits to missing several doses. He has had multiple sexual partners and uses condoms intermittently. His temperature is 100.6°F (38.1°C), blood pressure is 110/70 mmHg, pulse is 110/min, and respirations are 21/min. On examination, he demonstrates mild tenderness to palpation along his lower back. Sensation to touch is intact in the bilateral lower extremities. Strength in leg and hip flexion and extension is 5/5 bilaterally. The physician is unable to perform a digital rectal examination due to pain. A urinalysis demonstrates leukocytes. Which of the following treatment regimens is most appropriate in this patient? ---- <<Choices:>> A) Ampicillin and gentamicin B) Ciprofloxacin and trimethroprim-sulfamethoxazole C) Terazosin D) Ceftriaxone and doxycycline ---- <<Answer:>>
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D
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 12-year-old boy is brought to his pediatrician in order to be medically cleared for playing baseball. On presentation, the boy’s only complaint is that he has never been able to completely keep up with his classmates during gym or on the playground because he feels fatigued and short of breath. A review of his prior medical history reveals that he hit all his developmental milestones as expected and has otherwise been healthy. He lives with his parents and eats a diet consisting of mostly fast food and soda. Physical exam reveals a thin, pale boy with decreased color under his eyelids. A panel of hematologic tests are obtained with the following results: Hemoglobin: 11 g/dL Leukocyte count: 4,250/mm^3 Platelet count: 185,000/mm^3 Mean corpuscular volume: 116 µm^3 Blood smear: neutrophils with extra lobes Crystals are also found within this patient's urine. Which of the following treatments would be effective for this patient’s most likely condition? ---- <<Choices:>> A) Administration of uridine B) Administration of purine C) Cobalamin supplementation D) Folate supplementation ---- <<Answer:>>
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A
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 27-year-old woman presents to her primary care physician for a follow-up appointment. At her previous visit she had missed her previous two menses and also had a blood pressure of 147/100 mmHg. The patient has a past medical history of anxiety, depression, bulimia nervosa and irritable bowel syndrome. Her physician prescribed her an exercise program as well as started her on hydrochlorothiazide and ordered lab work. The results of the patient's lab work are below: Serum: Na+: 145 mEq/L K+: 2.9 mEq/L Cl-: 100 mEq/L HCO3-: 30 mEq/L BUN: 18 mg/dL Ca2+: 10.9 mg/dL Mg2+: 2.0 mEq/L Creatinine: 1.2 mg/dL Glucose: 110 mg/dL The patient's blood pressure at this visit is 145/100 mmHg and she has still not experienced her menses. Her cardiac, abdominal, and pulmonary exams are within normal limits. Inspection of the patient's oropharynx is unremarkable as is inspection of her extremities. The patient is started on furosemide and sent home. Which of the following is the most likely cause of this patient's presentation? ---- <<Choices:>> A) Increased mineralocorticoid production B) Vomiting C) Increased reabsorption at the collecting duct D) Decreased renal artery blood flow ---- <<Answer:>>
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A
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 59-year-old man is brought to the emergency room by his wife. Thirty minutes ago, he was carrying heavy moving boxes from his house to a truck when he felt short of breath and suddenly lost consciousness. His wife states that he fell to the ground and was unresponsive for 15 seconds before he regained consciousness. He was not confused after this episode. He does not have chest pain. On questioning, he recalls experiencing episodic shortness of breath and chest tightness while playing tennis over the past year. These symptoms resolved with rest. He has no personal history of serious illness and takes no medication. Vital signs are within normal limits. His temperature is 36.7°C (98°F), heart rate is 95/min and pulse is delayed but regular, respirations are 20/min, and blood pressure is 104/80 mm Hg. Which of the following is most likely to confirm the diagnosis? ---- <<Choices:>> A) CT angiography B) Echocardiogram C) Cardiac enzymes D) Electroencephalogram " ---- <<Answer:>>
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B
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Answer the following medical question with the correct letter choice:
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<<Question:>> A previously healthy 2-year-old girl is brought to the physician by her mother because of a dry, harsh cough for 2 days that worsens at night. She has also had mild rhinorrhea and fever. Her older brother has asthma and had a cold last week. Immunizations are up-to-date. She appears to be in mild distress. Her temperature is 38.1°C (100.5°F), pulse is 140/min, respirations are 35/min, and blood pressure is 99/56 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 96%. Examination shows clear rhinorrhea and a dry, hoarse cough. There is mild inspiratory stridor upon agitation that resolves with rest. The remainder of the examination shows no abnormalities. Which of the following is the most appropriate initial step in treatment? ---- <<Choices:>> A) Ceftriaxone B) Bronchoscopy C) Chest x-ray D) Cool mist and dexamethasone ---- <<Answer:>>
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D
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 78-year-old man comes to the physician for evaluation of progressive hearing loss in both ears over the past year. He has difficulties understanding conversations in crowded places and when more than one person talks at the same time. He has no dizziness, ear discharge, ringing noise, or ear pain. He has a history of hypertension, hypercholesterolemia, and type 2 diabetes mellitus. Medications include enalapril, metformin, and atorvastatin. Vital signs are within normal limits. Otoscopic examination shows pearly gray, translucent tympanic membranes with a normal light reflex. A vibrating 512 Hz tuning fork is placed on the left mastoid process. Once the patient no longer hears a tone, the fork is held over the ipsilateral ear and the patient reports to hear the tone again. The same test is repeated on the right side with similar results. There is no lateralization when a vibrating 512 Hz tuning fork is placed in the middle of the forehead. Which of the following is the most likely diagnosis? ---- <<Choices:>> A) Cerumen impaction B) Ototoxicity C) Vestibulocochlear nerve damage D) Presbycusis ---- <<Answer:>>
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D
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 35-year-old woman, gravida 3, para 2, at 37 weeks' gestation comes to the physician for a prenatal visit. She feels well. She states that she did not follow up with her gynecologist on a regular basis due to a busy work schedule. Pregnancy and delivery of her first two children were uncomplicated. Her blood pressure was 127/75 mm Hg at her initial obstetrics appointment. Her temperature is 37.2°C (99°F), pulse is 90/min, and blood pressure is 145/95 mm Hg. Pelvic examination shows a uterus consistent in size with a 37-week gestation. Physical examination shows 2+ edema in the lower extremities. Urinalysis shows: Blood negative Protein 3+ RBC 1–2/hpf RBC casts negative After four hours of observation, her vital signs are unchanged. Which of the following is the most appropriate next step in management?" ---- <<Choices:>> A) Induce labor B) Administration of methyldopa C) Reassurance D) Fetal monitoring with continuous cardiotocography ---- <<Answer:>>
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A
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 31-year-old presents with self-described complaints of being "fidgety and irritable" that is unlike his "calm personality a few years ago". What is concerning to him is that his father was diagnosed with a similar condition at the age of 38. His father began a progressive decline - losing interest in his life and family, becoming messy, experiencing involuntary movements, and worsening dementia as he grew older. Genetic tests were performed on the patient which confirmed that he has a larger number of repeats than his father. He is concerned that the disease may begin earlier for him or may have already started. Which of the following trinucleotide repeats is found in this disease? ---- <<Choices:>> A) CAG B) CTG C) GAA D) UGA ---- <<Answer:>>
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A
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 48-year-old woman comes to the physician because of a 3-month history of low-grade fever, unintentional weight loss, night sweats, and a right-sided neck mass. Examination shows pallor. There is a non-tender and immobile right-sided cervical mass and enlarged axillary and inguinal lymph nodes. The liver is palpated 4 cm below the right costal margin, and the spleen is palpated 3 cm below the left costal margin. Histopathologic examination of a cervical lymph node biopsy specimen shows a nodular proliferation of centrocytes and centroblasts that stain positive for CD20. Genetic analysis shows a reciprocal translocation of chromosomes 14 and 18. This patient's condition is most likely caused by mutation of an oncogene that encodes for a protein involved in which of the following cellular processes? ---- <<Choices:>> A) Hydrolysis of guanosine triphosphate B) Upregulation of cytokine receptor binding C) Transfer of phosphate from ATP to cellular protein D) Inhibition of programmed cell death ---- <<Answer:>>
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D
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 59-year-old man is brought to the emergency department for changes in mental status. His wife noticed that since lunch time today, he has been “zoning out” and forgetting simple things such as where the bathroom is. She decided to call the ambulance as he got uncharacteristically violent during dinner when he threw his plate to the floor. The patient denies fevers, weight loss, chills, chest pain, or shortness of breath, but reports mild abdominal discomfort and some dark stools that he attributes to iron supplements. A physical examination demonstrates a moderate fluid wave of the abdomen and shaking of the hands while the wrists are extended. What is the mechanism of action of the medication that can treat this patient’s condition? ---- <<Choices:>> A) Antagonist against 5-HT3 B) Long-acting somatostatin analog C) Mu-opioid receptor agonist D) Trapping of ammonia in the colon ---- <<Answer:>>
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D
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<<Question:>> An otherwise healthy 49-year-old man presents to his primary care doctor for routine screening. He does not have any symptoms and take no medications. He has smoked 15–20 cigarettes daily for the past 9 years. His father died of diabetes complications and his mother has been recently diagnosed with proliferative diabetic retinopathy. His blood pressure is 160/95 mm Hg, temperature is 36.9°C (98.4°F), pulse is 90/min, body mass index is 36 kg/m², fasting blood sugar 170 mg/dL, and A1c is 9%. Which of the following manifestations is more specific for this patient’s condition? ---- <<Choices:>> A) Kussmaul respiration B) Unintentional weight loss C) Acanthosis nigricans D) Polyurea ---- <<Answer:>>
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C
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 30-year-old woman is brought to the emergency department because of severe headache and vomiting that started after she was hiking in the mountains at high altitude. She normally lives in a city that is close to sea level. Therapy is initiated with a drug that alkalinizes the urine. Which of the following is the most likely site of action of this drug in the kidney? ---- <<Choices:>> A) Proximal convoluted tubule B) Ascending loop of Henle C) Glomerulus D) Early distal convoluted tubule ---- <<Answer:>>
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A
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 35-year-old woman comes to employee health services 30 minutes after a work-related incident. She works as a phlebotomist and reports that blood splashed into her right eye when she was drawing blood from a 30-year-old male patient. Immediately following the incident, she flushed her eye with water for several minutes. The patient from whom she drew blood was admitted for hemoptysis, weight loss, and night sweats. He is an intravenous drug user and is sexually active with several male and female partners. The phlebotomist has no history of serious illness and takes no medications. Her immunizations are up-to-date. Physical examination shows no abnormalities. In addition to drawing her blood for viral serologies, which of the following is the most appropriate next step? ---- <<Choices:>> A) Start raltegravir, tenofovir, and emtricitabine B) Start zidovudine C) Start tenofovir and emtricitabine D) Administer hepatitis B immune globulin and vaccine ---- <<Answer:>>
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A
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 65-year-old Asian woman comes to the physician for a routine health maintenance examination. On questioning, she has had occasional night sweats during the past 2 months. She has not had fevers or weight loss. Seven months ago, she had an acute myocardial infarction and was treated with percutaneous coronary intervention. She has hypertension, hyperlipidemia, and gastroesophageal reflux disease. She has smoked one pack of cigarettes daily for 37 years. Current medications include aspirin, atorvastatin, ramipril, metoprolol, and esomeprazole. She is 178 cm (5 ft 10 in) tall and weighs 89 kg (207 lbs); BMI is 29.7 kg/m2. Her temperature is 37.4°C (99.3°F), pulse is 84/min, respirations are 18/min, and blood pressure is 145/80 mm Hg. The lungs are clear to auscultation. Cardiac examination shows an S4. There is a nontender skin lesion near the right large toenail. A photograph of the lesion is shown. The remainder of the examination shows no abnormalities. Which of the following is the most likely diagnosis? ---- <<Choices:>> A) Traumatic subungual hemorrhage B) Malignant melanoma C) Onychomycosis D) Squamous cell carcinoma ---- <<Answer:>>
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B
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 12-year-old girl brought to the clinic by her mother has a 3-day history of fever and sore throat and hematuria since this morning. The patient’s mother says she had a fever up to 39.5℃ (103.1℉) for the last 3 days and a severe sore throat, which has improved slightly. The mother states that she noticed her daughter had red urine today. The patient’s temperature is 39.3℃ (102.8℉), pulse is 89/min, respiratory rate is 25/min, and blood pressure is 109/69 mm Hg. On physical examination, her pharynx is erythematous. There is significant swelling of the tonsils bilaterally, and there is a white exudate covering them. Ophthalmologic examination reveals evidence of conjunctivitis bilaterally. Otoscopic examination is significant for gray-white tympanic membranes bilaterally. The remainder of the exam is unremarkable. A urine dipstick is performed and shows the following results: Urine Dipstick Specific Gravity 1.019 Glucose None Ketones None Nitrites Negative Leukocyte Esterase Negative Protein None Blood 3+ Which of the following microorganisms is the most likely cause of this patient’s symptoms? ---- <<Choices:>> A) Streptococcus pyogenes B) Adenovirus C) Escherichia coli O157:H7 D) Proteus mirabilis ---- <<Answer:>>
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B
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 73-year-old woman with a past medical history of diabetes, hypertension, and hyperlipidemia presents to the emergency department with swelling in her left neck. The onset was a few months ago. She has lost 6.8 kg (15.0 lb) over the same duration. She denies any fever, night sweats or itching. Physical examination reveals a painless swelling in front of her left ear. There is painless lymphadenopathy below the ear. Biopsy of the lymph nodes reveals mucoepidermoid carcinoma of the parotid gland. Surgery is planned and the tumor is removed while trying to preserve a nerve that could be involved. What physical finding would suggest involvement of the nerve in its course through the parotid gland? ---- <<Choices:>> A) Loss of taste on the left anterior 2/3 of the tongue B) Hypersensitivity to sound in the left ear C) Inability to smile on the left side D) Numbness of the left cheek ---- <<Answer:>>
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C
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 43-year-old man is brought to the emergency department by his wife after a near-syncopal episode. He was doing yard work when he began feeling dizzy and had to lie down. Earlier in the day, he was started on lisinopril. On arrival, he is fully oriented. His pulse is 100/min and blood pressure is 92/60 mm Hg. Serum electrolytes are within normal limits. An ECG shows no evidence of ischemia. Concurrent treatment with which of the following agents most likely predisposed the patient to this episode? ---- <<Choices:>> A) Ibuprofen B) Hydrochlorothiazide C) Lithium D) Trimethoprim/sulfamethoxazole ---- <<Answer:>>
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B
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 4-year-old Caucasian girl previously diagnosed with asthma presents with recurrent sinusitis, otitis media, and clubbing of the nail bed. Family history is significant for a distant cousin with cystic fibrosis. A "sweat test" is performed and comes back normal. What additional diagnostic test would be helpful in establishing a diagnosis? ---- <<Choices:>> A) Nasal transepithelial potential difference B) Skeletal survey C) Complete blood cell count D) Urinalysis ---- <<Answer:>>
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A
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<<Question:>> A 35-year-old woman presents with a complaint of oral ulcers. It is the third recurrence of ulcers in the last 8 months. She is sexually active and complains of dyspareunia. Examination shows the presence of a uveitis. Which of the following would most likely be positive in this patient? ---- <<Choices:>> A) Anti-double stranded (Ds) DNA B) HLA-B51 C) ANCA D) HLA-B27 ---- <<Answer:>>
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B
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 22-year-old female software analyst presents to a medical clinic for evaluation of tingling and numbness in both hands for the past 2 months. Her symptoms are usually aggravated by the end of the work day and absent on most off days. She has been a type I diabetic for 2 years and is currently on insulin. She admits to being sexually active but has had irregular periods for the past 3 months. A urine pregnancy test is negative. What is the most likely cause of this patient’s symptoms? ---- <<Choices:>> A) Hypothyroidism B) Acute intermittent porphyria C) Amyotrophic lateral sclerosis D) Multiple sclerosis ---- <<Answer:>>
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A
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 60-year-old male presents to his primary care physician complaining of fatigue. He reports a six-month history of gradually worsening tiredness. More recently, he has experienced intermittent fevers and night sweats. His temperature is 99.5°F (37.5°C), blood pressure is 115/80 mmHg, pulse is 80/min, and respirations are 18/min. On examination, painless cervical lymphadenopathy is noted. A lymph node biopsy is performed and karyotypic analysis of the biopsy reveals an 11;14 translocation. What is the normal function of the protein that is overexpressed due to the translocation seen in this patient? ---- <<Choices:>> A) Promote cell growth B) Mediate cell cycle transition to mitosis C) Mediate cell cycle transition to G2 phase D) Mediate cell cycle transition to S phase ---- <<Answer:>>
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D
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Answer the following medical question with the correct letter choice:
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<<Question:>> An 8-year-old boy presents with abdominal pain and constipation. The patient’s mother says that the symptoms gradually onset 2 months ago. The patient describes the pain as moderate to severe, gnawing and diffusely localized. No significant past medical history and no current medications. The patient lives in a house built in the 1990s with his parents and has a sister who goes to daycare. His mother mentioned that he is a good student but has been irritable lately, and his homework has been full of careless mistakes. The vital signs include: temperature 37.0°C (98.6°F), blood pressure 100/65 mm Hg, pulse 82/min, respiratory rate 19/min, and oxygen saturation 99% on room air. On physical examination, the patient is alert and cooperative. The abdomen is diffusely tender to palpation with no rebound or guarding. There is a left wrist drop. A nontender, flat bluish line above the gums is noted. Laboratory results are significant for the following: Sodium 141 mEq/L Potassium 4.1 mEq/L Chloride 101 mEq/L Bicarbonate 25 mEq/L Blood urea nitrogen (BUN) 27 mg/dL Creatinine 1.7 mg/dL Glucose (fasting) 80 mg/dL White blood cell (WBC) count 8,700/mm3 Red blood cell (RBC) count 4.20 x 106/mm3 Hematocrit 41.5% Hemoglobin 10.3 g/dL Platelet count 190,000/mm3 Mean corpuscular volume (MCV) 65 mm3 Lead 72 mcg/dL Which of the following is the most appropriate next step in the management of this patient? ---- <<Choices:>> A) Chelation therapy with dimercaptosuccinic acid (succimer) B) Chelation therapy with dimercaprol C) Chelation therapy with dimercaprol and calcium disodium edetate (EDTA) D) Plain abdominal radiographs ---- <<Answer:>>
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C
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Answer the following medical question with the correct letter choice:
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<<Question:>> Two days after undergoing a left total hip replacement, a 68-year-old man has increasing shortness of breath and chest pain for 30 minutes. He has type 2 diabetes mellitus and bilateral osteoarthritis of the hips. Prior to admission to the hospital, his medications were metformin and naproxen. His temperature is 37.8°C (100°F), pulse is 110/min, respirations are 30/min, and blood pressure is 106/70 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 89%. The lungs are clear to auscultation. Cardiac examination shows no abnormalities. The right lower extremity is swollen. Right foot flexion in an upward direction causes pain in the right calf. Pedal pulses are palpable. Supplemental oxygen and intravenous fluid resuscitation are begun. His hematocrit is 30%. Arterial blood gas analysis on room air shows: pH 7.48 pCO2 27 mm Hg pO2 68 mm Hg HCO3- 23 mEq/L An electrocardiogram shows sinus tachycardia and right axis deviation. Which of the following is the most appropriate next step in management?" ---- <<Choices:>> A) Administer alteplase B) Obtain a spiral CT angiogram C) Obtain an x-ray of the chest D) Perfom an echocardiography ---- <<Answer:>>
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B
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Answer the following medical question with the correct letter choice:
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<<Question:>> An 11-month-old male presents to the emergency department with his father after “passing out” at home. His father reports that the patient started crying after his older brother took a toy away from him. The patient was difficult to soothe and then suddenly stopped breathing. His father reports that his lips turned slightly blue, and the patient’s entire body became limp. The episode lasted a few seconds, and the patient seemed to act normally afterwards. The patient’s father notes that the patient’s older brother had similar episodes as a child. He denies any family history of neurological disease. The patient’s temperature is 98.5°F (36.9°C), blood pressure is 86/64 mmHg, pulse is 98/min, and respirations are 26/min. On physical exam, the patient is in no acute distress playing on his father’s lap. The patient's neurological exam is unremarkable. Which of the following is the best next step in management? ---- <<Choices:>> A) Arterial blood gas B) Echocardiogram C) Electrocardiogram (ECG) D) Observation and reassurance ---- <<Answer:>>
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D
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<<Question:>> A 27-year-old woman presents to the emergency department for pain in multiple joints. She states that she has had symmetric joint pain that started yesterday and has been worsening. It is affecting her wrists, elbows, and shoulders. She also endorses a subjective fever and some fatigue but denies any other symptoms. The patient works as a schoolteacher and is generally healthy. She is currently sexually active with 2 male partners and uses condoms occasionally. Her temperature is 100°F (37.8°C), blood pressure is 122/85 mmHg, pulse is 88/min, respirations are 14/min, and oxygen saturation is 99% on room air. Her laboratory values are within normal limits. Physical exam is notable for joint stiffness and pain in particular of the metacarpophalangeal (MCP), proximal interphalangeal (PIP), and the wrist. The patient is discharged with ibuprofen. Four weeks later, the patient follows up at her primary doctor and notes that her symptoms have improved and she is no longer taking any medications for symptom control. Which of the following is the most likely diagnosis? ---- <<Choices:>> A) Gonococcal arthritis B) Parvovirus B19 C) Rheumatoid arthritis D) Transient synovitis ---- <<Answer:>>
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B
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<<Question:>> A 57-year-old man with HIV and GERD comes to the emergency department because of productive cough with malodorous phlegm and night sweats for the past week. He has smoked 1 pack of cigarettes daily for 30 years and he drinks 8–10 beers daily. His temperature is 38.9°C (102.0°F). Physical examination shows coarse crackles and dullness to percussion at the right lung base. Scattered expiratory wheezing is heard throughout both lung fields. The CD4+ T-lymphocyte count is 280/mm3 (N ≥ 500). An x-ray of the chest is shown. Which of the following is the most likely cause of this patient's symptoms? ---- <<Choices:>> A) Bronchiectasis B) Adenocarcinoma in situ C) Tuberculosis D) Aspiration pneumonia ---- <<Answer:>>
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D
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<<Question:>> A 20-year-old woman is brought to the emergency department by her boyfriend for right arm and leg weakness, numbness, and tingling that has been resolving gradually. The symptoms started 4 hours ago after she had an argument with her boyfriend during which she slapped and kicked him. She says she has been limping and cannot use her right arm anymore. She has never had similar symptoms in the past. She has a history of genital herpes and trichotillomania. She is alert and oriented. Physical examination shows upper and lower face symmetry and normal speech. She has 5/5 strength in all extremities and 5/5 right ankle plantar flexion when lying down. She has 4/5 strength in the right arm and leg when ambulating. She cannot stand on her toes when asked. Her deep tendon reflexes are 2+ bilaterally. She has normal proprioception, light touch sensation, and two-point discrimination in all extremities. She has a negative Spurling test. CT of the head without contrast shows no abnormalities. Which of the following is the most appropriate next step in management? ---- <<Choices:>> A) Administer alteplase B) Provide patient education C) Prescribe aspirin D) Start biofeedback therapy " ---- <<Answer:>>
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B
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<<Question:>> A 14-year-old female presents to her psychiatrist in hopes that she can find help in dealing with the sexual abuse that occurred in her childhood. While retelling her story of the numerous encounters the patient had with her abuser, the psychiatrist begins to feel protective and parental towards the client, wishing that he could have somehow helped the young girl. Which of the following best describes the feelings that the psychiatrist has for the patient? ---- <<Choices:>> A) Countertransference B) Identification C) Sublimation D) Projection ---- <<Answer:>>
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A
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<<Question:>> Which of the following trinucleotide DNA sequences would initiate protein translation when converted to mRNA? Note: sequences are written 3'-->5' ---- <<Choices:>> A) TAC B) ATC C) ATT D) AAA ---- <<Answer:>>
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A
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 47-year-old woman visits the emergency department due to painful, swollen fingers in both of her hands. She has worked as a bus driver for the county school system for the last 20 years. Her past medical history is significant for a transient ischemic attack 5 years ago. She reports that she has lost weight in the last 2 months although there have been no changes in her diet. She also says that she generally feels fatigued all day. On examination, nodules are seen over her Achilles tendon and both wrists are erythematous, swollen, and tender to touch. Laboratory tests are presented below: Hemoglobin: 11.0 g/dL Hematocrit: 40.5% Leukocyte count: 7400/mm3 Mean corpuscular volume: 80.1 μm3 Platelet count: 210,000/mm3 Erythrocyte sedimentation rate: 55 mm/h Anti-cyclic citrullinated peptide antibody: 45 (Normal reference values: < 20) Which side-effect is associated with the drug of choice for the treatment of this patient’s condition? ---- <<Choices:>> A) Retinopathy B) Arterial hypertension C) Pneumonitis D) Reactivation of latent tuberculosis ---- <<Answer:>>
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C
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 37-year-old man comes to the emergency room with fever, chills, and left lower leg pain for 2 days. He was recently discharged from the hospital after arthroscopic knee surgery. Physical examination shows an erythematous lesion with poorly defined margins over the left shin but no fluctuance. Treatment with an intravenous antibiotic is begun. Shortly after starting the infusion, the patient develops flushing, erythema, and pruritus of the upper body. The symptoms resolve after discontinuation of the infusion. Before the next dose with the same agent, the patient is given diphenhydramine and ranitidine and the antibiotic is subsequently given at a slower infusion rate without complications. The patient was most likely treated with an antibiotic that binds to which of the following? ---- <<Choices:>> A) Transpeptidase B) Topoisomerase II C) Dihydrofolate reductase D) D-alanyl-D-alanine ---- <<Answer:>>
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D
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 55-year-old man presents with worsening weakness of the left hand and progressive difficulty in walking for the last 2 months. He says he was previously healthy and active, hiking every weekend, but because of his increasing weakness and incoordination while walking, he stopped his weekly hiking excursion. His past medical history is unremarkable. Current medications are a daily multivitamin and occasional acetaminophen for headaches. He has no significant family history. The patient denies smoking, recreational drug use, or drinking. His vitals include: pulse 70/min, respirations 14/min, temperature 37.0°C (98.6°F), and blood pressure 130/80 mm Hg. Physical examination reveals fasciculations in the tongue and distal extremities. The left forearm shows significant atrophy, and mild lower limb muscle atrophy is also seen bilaterally. Hyporeflexia (1+) is present in the left arm, while hyperreflexia (3+) is seen in the legs bilaterally. Babinski’s sign is positive bilaterally. The patient's speech is notably slow but no evidence of productive or expressive aphasia is present. The cranial nerves are intact. Which of the following pathologies most likely underlies this patient’s condition? ---- <<Choices:>> A) Demyelination of neurons in various parts of the brain B) Degeneration of the dorsal columns of the spinal cord C) Infarction of the posterior limb of the internal capsule D) Loss of the pyramidal tract neurons and anterior horn cells of the spinal cord ---- <<Answer:>>
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D
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 14-year-old male who is a recent immigrant from India visits your office complaining of difficulty walking. Physical examination reveals weakness upon right leg extension and absent right patellar tendon reflex. PCR of a stool sample and a swab of the pharynx both yield viral RNA. Which of the following best describes the likely causal virus of this patient’s symptoms? ---- <<Choices:>> A) Non-enveloped, positive stranded, icosahedral virus B) Enveloped, positive stranded, icosahedral virus C) Enveloped, negative stranded, helical virus D) Non-enveloped, negative stranded, helical virus ---- <<Answer:>>
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A
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 21-year-old woman is brought to the emergency department because of the sudden onset of left-sided back pain with radiation to the groin that began 2 hours ago. She has had similar episodes in the past. Her pulse is 103/min. Examination shows a soft and non-tender abdomen. Left costovertebral angle tenderness is present. Leukocyte count is 11,000/mm3. Urine dipstick is positive for blood and a urinary cyanide nitroprusside test is positive. An x-ray of the abdomen shows no abnormalities. Further evaluation of this patient's urine is most likely to show which of the following? ---- <<Choices:>> A) pH of 7.8 B) Urease-producing bacteria C) High uric acid concentration D) Hexagon-shaped crystals ---- <<Answer:>>
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D
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 45-year-old man presents to the emergency department with sudden left lower back pain and bloody urine. The pain is dull and constant. He can not localize exactly where it is. Over the past 2 weeks, he has also gained 3 kg (7 lb) and his shoes feel tight. He denies a history of any chronic medical conditions, recent abdominal trauma or illness, and has never noticed blood in his urine before. In the hospital, his temperature is 36.8°C (98.2°F), the heart rate is 98/min, the respiratory rate is 15/min, and the blood pressure is 135/85 mm Hg. A review of medical records shows that his blood pressure was 115/75 mm Hg 6 months ago. On physical exam, he appears distressed. There are bruises on his left upper arm, chest, and right thigh. The patient does not remember when he got them. His heart has a regular rate and rhythm and his lungs are clear to auscultation bilaterally. He has 2+ pitting edema in both legs up to the knee and his hands appear edematous. A urine dipstick shows 3+ blood and 4+ protein. Additional specimens are sent to chemistry for analysis. What will be most helpful in diagnosing sequelae resulting from the patient’s underlying condition? ---- <<Choices:>> A) CT angiogram with contrast B) Non-contrast CT C) Cystoscopy D) Renal biopsy ---- <<Answer:>>
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A
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<<Question:>> A 21-year-old man visits his primary care provider complaining of visual disturbance in both eyes for a month and an episode of abnormal uncontrollable shaking that occurred twice last week. He was previously healthy and did not take any medication. His mother has intermittent muscle weakness and his maternal uncle developed hemiplegia at the age of 35. Neuroimaging shows bilateral occipital lobe infarcts and a skeletal muscle biopsy reveals atypical muscle fibers that stain positive for subsarcomelar structures. The physician suspects a maternally inherited genetic disorder. The difference in the level of severity of this disorder among family members in best explained by which of the following? ---- <<Choices:>> A) Heteroplasmy B) Mosaicism C) Anticipation D) Uniparental disomy ---- <<Answer:>>
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A
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Answer the following medical question with the correct letter choice:
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<<Question:>> Your hospital administrators want to provide you with a tool to analyze the usage of emergency department visits by patients in your high-risk practice. The following graph is displayed on the dashboard of your electronic medical record to show you how often your patients utilize the ED so that you can provide higher quality and more cost-effective care. The X-axis indicates the number of times a patient has been to the ED in the last year. The Y-axis indicates the number of patients who fit into that category. How would you describe the data shown below? ---- <<Choices:>> A) It is positively-skewed, with mean > median > mode. B) It is positively-skewed, with mode > median > mean. C) It is positively-skewed, with median > mode > mean. D) It is negatively-skewed, with mode > median > mean. ---- <<Answer:>>
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A
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 27-year-old G1P0000 at 17 weeks of gestation is interested in participating in a clinical trial for nausea management during pregnancy. The trial will be evaluating the effects of moderate ginger consumption on nausea symptoms. Prior to enrolling in the trial, the investigators explain to the patient that they will be doing a full exam and some special testing to make sure she is experiencing a healthy pregnancy. Which of the following findings would most likely be abnormal during pregnancy? ---- <<Choices:>> A) Hypertension B) Increased cardiac output C) Increase in factor VII D) Respiratory alkalosis ---- <<Answer:>>
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A
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 14-year-old Caucasian male of normal weight presents for a well-child checkup. During physical examination, his parents state that their son has been frequenting the bathroom more often than usual and his weight has decreased despite an increase in his caloric intake. Which of the following is most consistent with their son's symptoms? ---- <<Choices:>> A) Self-reactive T-cells B) Amyloid deposits in pancreatic islet cells C) Absence of leukocytic infiltrates in the pancreas D) Hypoglycemia ---- <<Answer:>>
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A
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<<Question:>> A 56-year-old woman with a history of stage IIA cervical cancer presents to your office after her 5th episode of a complicated urinary tract infection. She complains of easy fatigability, weakness, and has noted that her shoes no longer fit. The physical examination is unremarkable, except for a blood pressure of 165/90 mm Hg and mild pitting lower extremity edema. The rectovaginal exam revealed no masses. Given the patient’s medical history, the specialist makes a stage IIIB diagnosis; however, to confirm this, he orders abdominal and transvaginal ultrasounds and renal function tests. Which of the following findings would you most likely expect to be reported in the ultrasound? ---- <<Choices:>> A) Bladder or rectum mucosa invasion B) Distant metastasis C) Parametrial invasion by cancer D) Hydronephrosis ---- <<Answer:>>
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D
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 77-year-old man is brought to the physician because of a 2-day history of increasing shortness of breath and ankle swelling. He has type 2 diabetes mellitus, hypertension, coronary artery disease, and congestive heart failure. Current medications include lisinopril, metformin, and aspirin. He has smoked half a pack of cigarettes daily for 50 years. His temperature is 37.2°C (98.9°F), pulse is 100/min and regular, respirations are 20/min, and blood pressure is 100/65 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 91%. There are jugular venous pulsations 5 cm above the sternal angle. Crackles are heard at both lung bases. Cardiac examination shows an S3 gallop. There is edema from the mid-tibia to the ankle bilaterally. Laboratory studies show: Hemoglobin 14.1 g/dL Leukocyte count 7100/mm3 Serum Na+ 129 mEq/L Cl- 99 mEq/L K+ 4.8 mEq/L Urea nitrogen 48 mg/dL Glucose 196 mg/dL Creatinine 2.1 mg/dL Which of the following is the most appropriate next step in management?" ---- <<Choices:>> A) Discontinue metformin therapy B) Begin vancomycin therapy C) Begin nitroprusside therapy D) Begin hydrochlorothiazide therapy ---- <<Answer:>>
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A
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<<Question:>> A 32-year-old woman, gravida 2, para 1, at 40 weeks' gestation is admitted to the hospital 30 minutes after spontaneous rupture of membranes without labor pains. She delivered her first child vaginally at 38 weeks' gestation. Pregnancy was complicated by hypothyroidism. She has no other history of serious illness. Medications include levothyroxine and a multivitamin. Her pulse is 90/min, respirations are 16/min, and blood pressure is 134/76 mm Hg. Pelvic examination shows a uterus consistent in size with a 40 week gestation. A cardiotocography reading is shown. Which of the following is the most likely cause of the cardiotocography findings? ---- <<Choices:>> A) Umbilical cord compression B) Fetal head compression C) Uteroplacental insufficiency D) Fetal CNS depression ---- <<Answer:>>
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A
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<<Question:>> A 55-year-old man presents for a routine check-up. He currently has no complaints, and his last physical and laboratory studies were unremarkable. His past medical history is significant for hypercholesterolemia, well managed with rosuvastatin, and hypertension, well managed with hydrochlorothiazide. His current medications also include aspirin. The patient is afebrile and his vital signs are within normal limits. Physical examination reveals some generalized lymphadenopathy. Laboratory findings are significant for the following: WBC 38,000/mm3 RBC 4.20 x 106/mm3 Hematocrit 27.3% Hemoglobin 8.3 g/dL Platelet count 355,000/mm3 A peripheral blood smear and differential shows 92% small normocytic lymphocytes. Which of the following is the most likely diagnosis in this patient? ---- <<Choices:>> A) Acute myelogenous leukemia B) Chronic myelogenous leukemia C) Chronic lymphocytic leukemia D) Asymptomatic multiple myeloma ---- <<Answer:>>
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C
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 72-year-old man with a history of diabetes, dyslipidemia, and hypertension presents to the emergency department with sudden-onset right-sided facial paresthesia, word-finding difficulty, and lightheadedness. He was at a restaurant, in general good health, enjoying a dinner with friends when the 1st symptoms started. He takes atorvastatin, lisinopril, hydrochlorothiazide, and a multivitamin every day. A review of symptoms was negative. His symptoms spontaneously resolved after 5 minutes. In the emergency department, the vital signs included: blood pressure of 132/80 mm Hg, heart rate of 86/min, respiratory rate of 20/min, and oxygen saturation of 99% on room air. The laboratory results included: Hemoglobin 11.3 g/dL Hematocrit 33% WBC count 9,800/mm3 Platelet count 247,000/mm3 International normalized ratio (INR) 1.1 Prothrombin time (PT) 11.5 seconds Partial thromboplastin time (PTT) 32 seconds His electrocardiogram (ECG) and his head computed tomography (CT) scan were normal. A duplex ultrasound scan shows 70–89% stenosis in the left carotid artery and 50% in the right. In the course of evaluation, his aphasia recurred for 3 minutes. A brain magnetic resonance imaging (MRI) scan was negative for areas of ischemia or intracranial hemorrhage. His symptom recurrence prompted his hospital admission for inpatient care. What is the next step in management? ---- <<Choices:>> A) Enoxaparin B) Thrombolysis C) Carotid endarterectomy D) Carotid artery stenting ---- <<Answer:>>
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C
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 70-year-old woman visits her physician complaining of dry mouth and dry eyes. She states that she has recently been having difficulty wearing her dentures on account of her dry mouth. She also says that her tongue sticks to the roof of her mouth, making it difficult to speak and swallow food. Her eyes have also been burning, and she has had to use over the counter eye drops much more often. These symptoms have persisted for several months. On physical exam, mild bilateral enlargement of the parotid glands was noted, and an intraoral examination revealed a red, dry, and smooth mucosal surface on the dorsum of the tongue and buccal mucosa. The patient has a history of hypertension, for which she takes lisinopril. Which of the following is the best 1st step in this patient’s management? ---- <<Choices:>> A) Administer prednisone B) Obtain an electrocardiogram (ECG) C) Perform a Schirmer test and obtain anti-Ro/anti-La titers D) Perform a parotid gland biopsy ---- <<Answer:>>
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C
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<<Question:>> A 61-year old obese nulliparous female presents to your office with right lower quadrant abdominal pain. Her medical history is significant for breast cancer and past use of postmenopausal estrogen replacement therapy. This patient most likely has elevated levels of which of the following? ---- <<Choices:>> A) hCG B) AFP C) CA 19-9 D) CA 125 ---- <<Answer:>>
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D
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 28-year-old man comes to the physician because of a swollen, tender left knee for the past 4 days. During this period, the patient has had pain with urination. The patient has no history of serious illness and takes no medications. He is sexually active with two male partners and they use condoms inconsistently. His older sister has systemic lupus erythematosus. He is 180 cm (5 ft 11 in) tall and weighs 98 kg (216 lb); BMI is 30.1 kg/m2. His temperature is 37°C (98.6°F), pulse is 83/min, and blood pressure is 140/75 mm Hg. Examination shows conjunctivitis bilaterally. The left knee is warm, erythematous, and tender to touch; range of motion is limited. Laboratory studies show an erythrocyte sedimentation rate of 62 mm/h. Urinanalysis shows WBCs. Further evaluation of this patient is most likely to reveal which of the following? ---- <<Choices:>> A) HLA-B27 positive genotype B) Hiking trip two months ago C) Positive anti-dsDNA antibodies D) Intravenous drug use ---- <<Answer:>>
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A
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 21-year-old man comes to the physician because of nervousness and difficulty sleeping over the past 2 weeks. Three months ago, he started a new team project at his job. He says that he has trouble falling asleep at night because he thinks about the project. He insists on checking the work of his teammates and spends several hours each week making elaborate lists and schedules. He refuses to let others take on more tasks because he thinks that only he can complete them satisfactorily. The project deadline has already been postponed once. He says, “My teammates never understand how important it is to do things the right way.” Ever since high school, he has used the majority of his time to plan out assignments and does not have time to regularly participate in social activities. Which of the following is the most likely diagnosis? ---- <<Choices:>> A) Obsessive-compulsive personality disorder B) Obsessive-compulsive disorder C) Schizoid personality disorder D) Adjustment disorder with mixed anxiety and depressed mood " ---- <<Answer:>>
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A
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 52-years-old man presents with a history of recurrent episodes of unilateral headaches. He says the episodes are short-lived (usually lasting for a few seconds to 3-4 minutes), and he describes them as a severe throbbing orbital headache, accompanied by ipsilateral conjunctival injection and lacrimation. He says that often the episodes seem to be triggered by a cutaneous stimulus touching the face or while chewing food. Sometimes, he says he experiences countless attacks during a single day. The headaches do not respond to indomethacin and any other non-steroidal anti-inflammatory drug (NSAID). Which of the following drugs is most likely to be effective as a preventive therapy in this patient? ---- <<Choices:>> A) Ibuprofen B) Acetaminophen C) Lamotrigine D) Amitriptyline ---- <<Answer:>>
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C
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 55-year-old obese man presents to the emergency department with abdominal pain. His pain started 2 days ago and has been worsening steadily. His only current medication is allopurinol. His temperature is 101.0°F (38.3°C), blood pressure is 157/98 mmHg, pulse is 120/min, respirations are 17/min, and oxygen saturation is 98% on room air. Physical exam is notable for left lower quadrant abdominal tenderness and rectal exam is unremarkable. A CT scan is performed demonstrating inflamed outpouchings of the colonic mucosa with a 4-cm abscess. Which of the following is appropriate treatment of this patient? ---- <<Choices:>> A) Ciprofloxacin and gentamicin B) CT-guided percutaneous drainage C) Laparoscopy and drainage D) Piperacillin-tazobactam and vancomycin ---- <<Answer:>>
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B
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<<Question:>> A 32-year-old G2P2 woman gives birth to a boy at 39 weeks gestation. The mother recently immigrated from Somalia and had no prenatal care. She refused all intrapartum medications. The boy’s Apgar scores were 7 and 9 at 1 and 5 minutes, respectively. His height and weight were in the 20th and 15th percentiles, respectively. Mother and child were discharged the day after birth. However, 7 days later, the mother presents to the pediatrician because she noticed redness and discharge in her baby's eyes. His temperature is 98.8°F (37.1°C), blood pressure is 105/65 mmHg, pulse is 120/min, and respirations are 22/min. On exam, the boy has scant non-purulent mucoid bilateral eye discharge and conjunctival hyperemia. Which of the following is the most appropriate treatment for this patient? ---- <<Choices:>> A) Intravenous acyclovir B) Oral and topical erythromycin C) Sterile lubricant with artificial tear preparation D) Topical bacitracin ---- <<Answer:>>
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B
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<<Question:>> A 21-year-old woman presents to her physician for a regular follow-up visit. She was diagnosed with relapsing-remitting multiple sclerosis 2 months ago when she suffered a second episode of optic neuritis. She was successfully treated with methylprednisolone pulse therapy and discharged. Today, she only complains of slight fatigue with upper and lower extremity weakness. Her blood pressure is 120/80 mm Hg, her heart rate is 63/min, her respiratory rate is 14/min, and her temperature is 36.7°C (98.0°F). Neurological examination reveals brisk deep reflexes (3+ equal) and decreased strength (4/4) in the upper limbs. The rest of the examination is unremarkable. The patient is prescribed a drug that is an inhibitor of ɑ4-integrin (CD49d) for the prevention of relapses. She is concerned about the side effects of this drug, among which is increased susceptibility to the upper respiratory tract and urinary tract infections. Inhibition of which of the following processes is the best explanation for such adverse effects? ---- <<Choices:>> A) Tight adhesion of leukocytes to the endothelial cells B) Expression of selectins on the surface of endothelial cells C) Formation of tight bounds between leukocytes and endothelial selectins D) Inhibition of interaction between platelet endothelial cell adhesion molecules (PECAMs) on the surfaces of leukocytes and endothelial cells ---- <<Answer:>>
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A
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 64-year-old man presents to the clinic complaining of low back pain. He was diagnosed with benign prostatic hypertrophy several years ago, which worsened last year. A hard nodule was felt on a digital rectal exam, which led to a prostate biopsy that revealed high-grade adenocarcinoma. A bone scan at that time showed small, focal abnormalities in the lumbar spine. He subsequently underwent radiation therapy to his prostate and pelvic lymph nodes. He was then placed on leuprolide and an anti-androgen. He was doing well until 2 months ago when he developed low back pain, which has worsened since then. He reports that the pain is 8/10 and nearly constant. He states that the pain not only affects his ability to fall asleep but also wakes him up at night. The pain is mildly alleviated by ibuprofen. In addition to prostate cancer, his medical history is significant for hypertension, hyperlipidemia, recurrent nephrolithiasis, and gastroesophageal reflux disease. He takes aspirin, lisinopril, rosuvastatin, and pantoprazole. Upon physical examination, there is midline tenderness within the lumbar region. Magnetic resonance imaging of the spine is obtained, which shows bony metastasis to the L2 and L3 spine without evidence of fracture or spinal cord compression. His prostate-specific antigen is 17.5 ng/mL. Which of the following is the best next step in management? ---- <<Choices:>> A) Calcium and vitamin D supplementation B) External radiation therapy C) Flutamide D) Kyphoplasty ---- <<Answer:>>
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B
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Answer the following medical question with the correct letter choice:
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<<Question:>> Two days after undergoing internal fixation of a displaced right femoral fracture sustained during a motor vehicle accident, a 34-year-old woman develops sudden shortness of breath. On examination, she is oriented only to person. Her temperature is 38.3°C (100.9°F), pulse is 122/min, respiratory rate is 31/min, and blood pressure is 152/90 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 83%. There are several scattered petechiae on the anterior chest wall. Her hemoglobin concentration is 10.3 g/dL, leukocyte count is 9,500/mm3, and platelet count is 140,000/mm3. Which of the following is the most likely cause of her current condition? ---- <<Choices:>> A) Fat globules entering the circulation B) Rupture of a coronary plaque C) Damage to the alveolar capillary endothelium D) Bacterial invasion of the pulmonary parenchyma ---- <<Answer:>>
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A
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 15-year-old girl comes to the physician for the evaluation of a painless swelling under the left lower jaw for 5 months. Her 18-year-old sister has a history of acute lymphoblastic leukemia that has been in remission for 11 years. The patient's temperature is 37°C (98.6°F) Physical examination shows a 3 × 2 cm swelling on the left side, 4 cm below the base of the mandible and anterior to the sternocleidomastoid muscle. The swelling is soft and fluctuant. It does not move with swallowing, and forced exhalation against a closed glottis does not increase the size of the swelling. Ultrasound shows a round mass with uniform low echogenicity and no internal septations. Which of the following is the most likely diagnosis? ---- <<Choices:>> A) Lymphadenopathy B) Branchial cleft cyst C) Laryngocele D) Infantile hemangioma ---- <<Answer:>>
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B
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 70-year-old man is brought to the emergency department by staff of the group home where he resides because of fever, a productive cough, and blood-tinged sputum for 2 days. The staff report that he developed myalgia, headache, and rhinorrhea 7 days ago, which improved initially before worsening again. He has hypertension and Alzheimer disease. Current medications include enalapril and donepezil. On arrival, he is obtunded. His temperature is 39.8°C (103.6°F), pulse is 120/min, respirations are 22/min and shallow, and blood pressure is 100/60 mm Hg. Pulse oximetry on 10 L/min of oxygen via nasal cannula shows an oxygen saturation of 92%. Examination shows scattered crackles and rhonchi throughout both lung fields. An x-ray of the chest shows bilateral lung opacities and multiple small, thin-walled cystic spaces within the basal pulmonary parenchyma. Which of the following is the most likely cause of this patient’s current condition? ---- <<Choices:>> A) Infection with Staphylococcus aureus B) Infection with Aspergillus fumigatus C) Foreign body aspiration D) Granulomatosis with polyangiitis ---- <<Answer:>>
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A
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<<Question:>> A 55-year-old man presents to his primary care physician with ear pain. The patient states he has had worsening ear pain for the past 2 days. He describes his pain as 9/10. The patient has a past medical history of diabetes, obesity, and hypertension. His current medications include insulin, metformin, lisinopril, aspirin, and atorvastatin. His temperature is 100.5°F (38.1°C), blood pressure is 177/99 mmHg, pulse is 100/min, respirations are 19/min, and oxygen saturation is 98% on room air. Physical exam reveals a purulent drainage from the ear canal. Manipulation of the ear causes severe pain. Which of the following is the most likely infectious agent? ---- <<Choices:>> A) Haemophilus influenzae B) Moraxella catarrhalis C) Pseudomonas aeruginosa D) Staphylococcus aureus ---- <<Answer:>>
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C
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 19-year-old male college student with no significant medical history presents to the emergency department with altered mental status. His girlfriend said that he drank multiple shots of vodka and gin throughout the weekend and was found slumped on the couch with some vomit on his shirt. He is afebrile, with a blood pressure of 128/60 mmHg, pulse of 100/min, respirations at 25/min, and SpO2 of 95% on room air. His pupils are equal and reactive to light bilaterally. He exhibits no tremors or myoclonus. The remainder of the physical exam is unremarkable. His basic metabolic panel is displayed below: Serum: Na+: 138 mEq/L Cl-: 90 mEq/L K+: 4.0 mEq/L HCO3-: 20 mEq/L BUN: 30 mg/dL Glucose: 100 mg/dL Creatinine: 0.8 mg/dL An arterial blood gas reveals the following: pH: 7.32 pCO2: 34 mmHg pO2: 89 mmHg The girlfriend is concerned that the patient's breathing appears uncomfortable. How do you respond? ---- <<Choices:>> A) His breathing is concerning for hepatic encephalopathy B) His breathing suggests that he needs some fluids C) His breathing suggests that he has major depression disorder D) You are not his healthcare proxy and I cannot speak to you ---- <<Answer:>>
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B
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 56-year-old man presents to his primary care provider for a check-up. His past medical history is significant for type 2 diabetes mellitus for 20 years and insomnia. He takes metformin and insulin NPH. Both of his parents died in a car accident several years ago. He smokes a half of a pack of cigarettes every day and drinks 1-2 beers a day and more on the weekends. Today, his blood pressure is 130/80 mm Hg, pulse is 76/min, respiratory rate is 18/min, and temperature is 36.5°C (97.7°F). On physical exam, he appears obese. His heart has a regular rate and rhythm and his lungs are clear to auscultation bilaterally. A foot exam is performed and is unremarkable. A urinalysis reveals glucose (++), and protein (+++). Which of the following explains these findings? ---- <<Choices:>> A) Glomerular hyperfiltration B) Renal artery stenosis C) Subendothelial immune-complex deposits D) Interstitial atrophy ---- <<Answer:>>
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A
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<<Question:>> A 64-year-old man comes to the physician because of a 1-month history of progressively worsening back pain that wakes him up at night. He also reports symptoms of urinary urgency and a weak urine stream. He has no history of serious illness and takes no medications. Rectal examination shows an enlarged and hardened prostate with a nodular surface. After further evaluation and confirmation of the diagnosis, he is started on a new drug. Initially, there is an increase in serum testosterone and dihydrotestosterone levels, followed by a sustained decrease in both serum hormone levels. Treatment with which of the following drugs was most likely initiated in this patient? ---- <<Choices:>> A) Leuprolide B) Finasteride C) Ketoconazole D) Cyproterone acetate ---- <<Answer:>>
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A
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<<Question:>> A 46-year-old man presents to a physician three days after arriving in Morocco. He endorses acute onset of painless, profuse watery diarrhea that appears white and cloudy. The patient denies bloody stool, vomiting, or subjective fevers. Vital signs are T 98.6, HR 120, RR 17, and BP 85/50. On physical exam, the patient has dry mouth, decreased skin turgor, and cold clammy skin. His peripheral pulse is rapid and thready. The toxin responsible for this clinical presentation has a mechanism of action that is most similar to which other toxin? ---- <<Choices:>> A) Diphtheria toxin B) Exotoxin A C) Edema toxin D) Shiga-like toxin ---- <<Answer:>>
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C
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<<Question:>> A 25-year-old woman presents to the urgent care center with a one month history of intermittent chest pain that occurs about 2-3 times per week in the early mornings. She does not smoke and has never suffered from chest pain before. She has no family history of early MI. A 12 lead ECG does not show any abnormalities. Creatine kinase and troponin I enzymes are within normal limits. What test will most likely be positive? ---- <<Choices:>> A) Ergonovine B) Immediately repeat ECG C) Exercise stress test D) Kehr's sign ---- <<Answer:>>
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A
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<<Question:>> A 28-year-old man is scheduled for skin grafting of the right leg. Four weeks earlier, he underwent open reduction and internal fixation of an open right tibial fracture. The postoperative period at that time was complicated by necrosis of the overlying skin. In the operating room, he is placed on continuous hemodynamic monitoring and anesthetized with intrathecal bupivacaine injected into the L3–L4 spinal interspace. Thirty minutes later, he has severe shortness of breath and lightheadedness and loses consciousness. His temperature is 37.1°C (98.8°F), pulse is 38/min, respirations are 24/min, and palpable systolic blood pressure is 58 mmHg. The skin is diaphoretic and flushed. He withdraws the upper extremities to painful stimuli above the navel. The lungs are clear to auscultation. Heart sounds are not audible. Which of the following is the most likely underlying cause of this patient's symptoms? ---- <<Choices:>> A) Loss of sympathetic vascular tone B) Obstructive thrombus in the pulmonary artery C) Intravascular volume depletion D) Type I hypersensitivity reaction ---- <<Answer:>>
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A
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 42-year-old man with no significant medical history presents to the emergency department with complaints of headache, nausea, and dizziness. He states that he was at home working on his car when he started to feel dizzy and experienced a headache. This progressed to him feeling nauseous. The patient states he went inside and drank some water and felt better; however, when he started working on his car again his symptoms returned. Upon presentation, he states his symptoms have mostly improved except for a persistent headache. His temperature is 98.1°F (36.7°C), blood pressure is 125/84 mmHg, pulse is 87/min, respirations are 18/min, and oxygen saturation is 98% on room air. Neurologic exam is unremarkable. Which of the following is the best next step in management? ---- <<Choices:>> A) 100% oxygen B) CT C) Hydroxocobalamin D) Ibuprofen and acetaminophen ---- <<Answer:>>
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A
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 19-year-old woman comes to the physician because of severe headaches for the past 3 months. The headaches are pulsating in nature and she describes the pain as 8 out of 10 in intensity. She has visited the emergency department for headaches twice in the past month; during both visits, her blood pressure was elevated. She has polycystic ovarian disease. Her medications include metformin and an oral contraceptive pill. She is 162 cm (5 ft 4 in) tall and weighs 86 kg (190 lb); BMI is 32.8 kg/m2. Her temperature is 37°C (98.6°F), pulse is 99/min, and blood pressure is 168/98 mm Hg. Examination shows hirsutism. Cardiopulmonary examination shows no abnormalities. The abdomen is soft and nontender. An abdominal bruit is heard on the left side. Neurologic examination shows no focal findings. A complete blood count and serum concentrations of electrolytes, urea nitrogen, and creatinine are within the reference range. Plasma free metanephrines are within the reference range. An abdominal ultrasound shows an increased peak systolic velocity in the distal portion of the left renal artery. A contrast-enhanced CT scan of the abdomen shows alternating stenosis and dilation in an 8-mm distal segment of the left renal artery with approximately 75% reduction in the diameter of the vessel. A CT scan of the brain shows no abnormalities. Which of the following is the most appropriate next step in management? ---- <<Choices:>> A) Combination therapy with captopril and valsartan B) Percutaneous transluminal angioplasty without stent placement C) Ramipril and percutaneous transluminal angioplasty without stent placement D) Enalapril and aortorenal bypass with a vein graft ---- <<Answer:>>
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C
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 28-year-old male is found to have 93% HbA, 2% HbF, and 5% HbA2 on hemoglobin electrophoresis. Which of the following is the most likely diagnosis? ---- <<Choices:>> A) Alpha thalassemia major with Hb Bart's B) Beta-thalassemia minor C) Beta-thalassemia major D) Diabetes mellitus ---- <<Answer:>>
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B
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 76-year-old female is brought to the emergency department for altered mental status. She is accompanied by a nurse from her nursing home. The nurse says that usually the patient is interactive even though she is sometimes forgetful. In the last two days, the patient has been increasingly lethargic and doesn’t respond to the staff’s questions. She also has not been able to get up and use the restroom so the staff has had to change multiple soiled sheets. Her temperature is 102.1°F (38.9°C), blood pressure is 100/74 mmHg, pulse is 120/min, and respirations are 24/min. The patient is combative on arrival but can be subdued with reorientation by the care team. She is not oriented to person, place, or time. Urinalysis shows positive leukocyte esterase and nitrites. Urine culture grows >100,000 CFU of E. coli. The physician team would like to consent this patient for a Foley catheter. Which of the following is the best assessment of the patient’s capacity to make healthcare decisions? ---- <<Choices:>> A) The patient does not have capacity to make decisions B) The patient does have capacity to make decisions C) The hospital ethics board should be consulted D) Capacity cannot be determined at this time ---- <<Answer:>>
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D
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 19-year-old woman is brought to the emergency department by ambulance 1 hour after a motor vehicle accident. She has no history of serious illness. She is on mechanical ventilation without any sedation. Her vital signs are within a normal range. Her Glasgow Coma Scale (GCS) is 3. Examination by the attending trauma surgeon and neurologist shows brain death. Laboratory studies show no abnormalities. A search on the state donor registry shows that she has registered as an organ donor. Her father is shocked at the suggestion of organ donation and says that “life is still circulating in her body because it is warm, and she has a normal heartbeat!” While the physician empathizes with the family, which of the following is the most appropriate response? ---- <<Choices:>> A) “Only after your consent will her organs be removed.” B) “Brain death is considered legal death just as if her heart was not beating.” C) “She is very unlikely to recover.” D) “She will be dead once she is disconnected from advanced life-support.” ---- <<Answer:>>
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B
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<<Question:>> A 58-year-old male has had long-term involvement in the world of organized crime. He very recently retired from his post within this organization. This former mafia boss has now suddenly started making large contributions to several local charities. Which of the following ego defenses best characterizes this gentleman's behavior? ---- <<Choices:>> A) Altruism B) Displacement C) Sublimation D) Atonement ---- <<Answer:>>
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A
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<<Question:>> A 45-year-old man presents with a chronic productive cough that he has had for the past few years. He admits to having smoked 1 pack of cigarettes a day for the past 25 years. A chest radiograph reveals an enlarged heart. The patient's pulmonary function tests would be similar to that seen in a patient with: ---- <<Choices:>> A) Asymptomatic asthma B) Silicosis C) Emphysema D) Coal worker's pneumonitis ---- <<Answer:>>
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C
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 69-year-old gentleman presents to his primary care physician for a general checkup. He states that overall he is doing well. Ever since he retired, he has been working on projects at home, and taking time to exercise every day. He eats a balanced diet, and has been spending time with his wife every evening. Despite this, the patient claims that he feels less well rested when he awakes in the morning. The patient states that he used to sleep nine hours a night in his youth and felt excellent. Now he sleeps seven hours a night and doesn’t feel as well rested as he used to. The patient’s wife states that he seems to sleep peacefully. On physical exam the patient’s neurological exam is within normal limits. The patient is muscular and has a healthy weight and has a pleasant demeanor. He denies feeling fatigued or tired currently. Which of the following physiological changes is most likely in this patient? ---- <<Choices:>> A) Decreased orexin B) Decreased melatonin C) Increased dopamine D) Increased acetylcholine ---- <<Answer:>>
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B
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<<Question:>> A 7-year-old boy with sickle cell disease is brought into the clinic by his mother for knee and hip pain. The child has been admitted several times in the past for pain crises managed with fluids and hydromorphone. He started complaining of worsening hip pain over the last several days and now walks with a limp. His temperature is 97.9°F (36.6°C), blood pressure is 84/54 mmHg, pulse is 100/min, respirations are 19/min, and oxygen saturation is 99% on room air. On physical exam, the hip appears normal and is cool to the touch. There is decreased range of motion at the hip and pain with ambulation. Which of the following is the most appropriate next step in management? ---- <<Choices:>> A) CT B) Ibuprofen and acetaminophen C) MRI D) Radiograph ---- <<Answer:>>
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D
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 65-year-old asian man presents to his primary care physician because of abdominal distension, right upper quadrant (RUQ) abdominal pain, decreased appetite, and weight loss for several weeks. He denies smoking or excess alcohol intake. His temperature is 37.1°C (98.7°F), blood pressure is 120/80 mm Hg, and pulse is 85/min. Physical examination reveals a cachectic man with jaundice, palmar erythema, ascites, and a palpable mass in the RUQ. Abdominal ultrasound shows a 3 cm hypoechoic mass in the right lobe of the liver. Alpha fetoprotein (AFP) is 500 μg/L. Which of the following is a risk factor for this patient condition? ---- <<Choices:>> A) Exposure to nitrosamines B) Cyclophosphamide use C) Clonorchis sinensis infection D) Chronic hepatitis C infection ---- <<Answer:>>
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D
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 71-year-old man from Puerto Rico presents to the emergency department with a 2-week history of abdominal pain. He does not speak much English so his family explains that he has been complaining of intermittent pain that is not associated with any particular actions. Furthermore, his family is concerned because he has been having weight loss and blood in his stool for 3 months. The physician explains that there is a concern for colon cancer and that a colonoscopy is required to evaluate his condition further. The family is afraid that the news will upset the patient so they ask that they be allowed to make healthcare decisions on the patient's behalf. They explain that this is the way that their culture handles medical decisions. What should the physician do in this situation? ---- <<Choices:>> A) Ask the family to translate the plan for the patient and ask for questions B) Call for a Spanish-speaking interpreter to speak with the patient C) Respect the family's cultural wishes and not discuss the plan with the patient D) Speak directly with the patient in English to ascertain their wishes ---- <<Answer:>>
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B
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<<Question:>> A 45-year-old man presents to a physician with recurrent episodes of palpitations over the last 3 months. The episodes are self-limiting but cause significant distress and discomfort to the patient. After a detailed electrophysiological workup, the physician concludes that the symptoms occur mainly due to abnormal function of the cardiac ion channels, which primarily produce the plateau phase of the action potential in cardiac myocytes in healthy patients. Which of the following ion channels is dysfunctional in this patient? ---- <<Choices:>> A) Fast sodium channels B) L-type voltage-gated calcium channels C) T-type voltage-gated calcium channels D) Inward rectifier IK1 channels ---- <<Answer:>>
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B
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<<Question:>> A 23-year-old man comes to the physician because of severe daytime sleepiness and random episodes of falling asleep during the day for short periods of time. When he wakes up from these episodes, he feels refreshed. He sleeps 6–7 hours at night. He reports that sometimes he is unable to move for a few minutes when he first wakes up in the morning. Last week, he suddenly “lost control” of his legs and neck for about 30 seconds after his classmate had told him a joke. An analysis of this patient's cerebral spinal fluid is most likely to show which of the following findings? ---- <<Choices:>> A) Decreased orexin-A B) Increased neuron-specific enolase C) Increased 14-3-3 protein D) Anti-ganglioside antibodies ---- <<Answer:>>
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A
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 73-year-old man is brought to the emergency department 30 minutes after he lost consciousness for 5 minutes while watching a game of summer league football in a seat from the stands in the afternoon. On arrival, he is lethargic and oriented only to person. Three weeks ago, he was treated for hepatitis A. He has type 2 diabetes mellitus and hypothyroidism. Current medications include metformin and levothyroxine. His temperature is 41.5 °C (106.7 °F), pulse is 106/min, respirations are 26/min, and blood pressure is 128/70 mm Hg. Examination shows hot, dry skin. The pupils are equal and reactive to light. Neurologic examination shows no focal findings. Fundoscopy shows proliferative diabetic retinopathy. Cardiopulmonary examination shows no abnormalities. His abdomen is soft and nontender. There is no costovertebral angle tenderness. His serum glucose concentration is 160 mg/dL. An ECG shows a normal sinus rhythm. Which of the following is the most likely underlying cause of this patient's symptoms? ---- <<Choices:>> A) Inadequate hypothalamic response B) Metabolic acidosis with ketosis C) Elevation of serum thyroxine levels D) Central dopamine receptor blockade ---- <<Answer:>>
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A
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 3-year-old boy is brought to the physician for a well-child examination. He feels well. He was born at 38 weeks' gestation and weighed 2766 g (6 lb 2 oz). He now weighs 14 kg (31 lbs). There is no personal or family history of serious illness. His immunizations are up-to-date. He is at 60th percentile for height and 55th percentile for weight. Vital signs are within normal limits. The lungs are clear to auscultation. A grade 3/6 systolic ejection murmur is heard along the upper left sternal border. S2 is widely split and does not vary with respiration. There is a grade 2/6 mid-diastolic murmur along the lower left sternal border. The abdomen is soft and nontender; there is no organomegaly. Which of the following is the most likely diagnosis? ---- <<Choices:>> A) Patent ductus arteriosus B) Benign heart murmur C) Atrial septal defect D) Pulmonary valve stenosis ---- <<Answer:>>
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C
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 30-year-old man presents to the emergency department after being attacked by 2 men a few minutes ago. He was suddenly approached by 2 men holding knives while he was walking on the street nearby. While trying to escape, he was stabbed once in the neck. He is complaining of difficulty breathing and chest pain. He is in apparent distress. His temperature is 36.8°C (98.2°F), the blood pressure is 100/60 mm Hg, the pulse is 110/min, the respirations are 28/min, and the SaO2 is 85% on 4 L oxygen by nasal cannula. Examination of the neck reveals a deep penetrating injury on the right side and distended neck veins. The respiratory exam shows severe tenderness in the right chest, decreased inspiration in the right lung, and tracheal deviation to the left. What is the next best step in the management of this patient? ---- <<Choices:>> A) Pericardiocentesis B) Intravenous fluids C) Dobutamine D) Needle thoracostomy ---- <<Answer:>>
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D
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Answer the following medical question with the correct letter choice:
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<<Question:>> An 8-month-old male presents to your office with a 5-day history of blood in his stool. Abdominal pain is notably absent on history obtained from his parents. Past medical history and physical exam findings are not remarkable. Laboratory findings are significant for mild iron deficiency. Which of the following is characteristic of this patient’s diagnosis? ---- <<Choices:>> A) It may affect neonates but is more common in adolescents. B) It is rare, affecting less than 1% of the population. C) Both males and females are equally affected. D) Diagnostic studies localize ectopic gastric tissue. ---- <<Answer:>>
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D
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<<Question:>> A 19-year-old man is brought to a psychiatrist by his mother. The patient’s mother has become increasingly concerned about him since his high school graduation. Although she says that he had been an excellent student in high school, his grades have begun slipping in his second year in college, and he no longer socializes with friends. When she asked him why he no longer talks to his friends, she states that he told her, “They already know where I am. They can see me. They watch me from my bedroom window, so they already know what I’m doing. We don’t need to talk.” She found this to be bizarre, as nearly all of his friends live hours away. The patient states that he feels fine and doesn’t understand why everyone thinks he is crazy. The psychiatrist notices reduced spontaneous movements while the patient is speaking and that he speaks in a monotone with a voice that is soft in volume. He also appears suspicious and defensive, asking the psychiatrist “why are you asking me that?” after each evaluative question. His mood is generally flat with little reactivity or engagement during the course of his interview, but he denies any symptoms of depression or psychosis. No significant past medical history. Family history is not available as he was adopted. Which of the following is the most likely diagnosis in this patient? ---- <<Choices:>> A) Paranoid personality disorder B) Schizophrenia C) Drug abuse D) Brain tumor ---- <<Answer:>>
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B
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 26-year-old woman comes to the physician because of progressively worsening episodic pelvic pain for 2 years. The pain starts a few days before her menstrual period and lasts about 10 days. She has tried taking ibuprofen, but her symptoms do not improve. Menses have occurred at regular 29-day intervals since menarche at the age of 11 years and last for 5–7 days. The first day of her last menstrual period was 2 weeks ago. She is sexually active with her boyfriend and has noticed that intercourse is often painful; they use condoms inconsistently. Vital signs are within normal limits. Pelvic examination shows a normal vagina and cervix. Bimanual examination shows a normal-sized uterus and no palpable adnexal masses. Urine pregnancy test is negative. Which of the following is the most appropriate next step in management? ---- <<Choices:>> A) Perform MRI of the pelvis B) Prescribe gonadotropin-releasing hormone agonists C) Prescribe androgenic steroids D) Prescribe estrogen-progestin contraceptives ---- <<Answer:>>
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D
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<<Question:>> A research group has developed a new screening test for HIV that can detect infection 2 weeks earlier than the current gold standard. A rigorous clinical study of this new screening test involving n subjects yields a false-positive probability α, and a false-negative probability, β. Which of the following will most likely reduce the type II error of this screening test? ---- <<Choices:>> A) Decreasing n B) Increasing α C) Increasing the specificity of the test D) Decreasing the sensitivity of the test ---- <<Answer:>>
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B
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<<Question:>> A 70-year-old female underwent a right total knee arthroplasty without complication. She was discharged to a rehab facility on post-operative day 3. Two days after her discharge from the hospital, she began experiencing pain and swelling of the right leg. Doppler ultrasound imaging at this time revealed a deep venous thrombosis in the right popliteal and tibial veins. The patient was re-admitted and started on an unfractionated heparin infusion. Five days later, doppler ultrasonography of the lower extremities revealed extension of the clot in the right lower extremity to include the common femoral, superficial femoral, popliteal, tibial, and saphenous veins. In addition, a thrombus was noted in the left common femoral vein as well. CBC showed a decrease in platelet count from 195,000/uL on admission to 83,000/uL. Which of the following is the pathophysiology of this patient's presentation? ---- <<Choices:>> A) Excessive irreversible inactivation of the cyclo-oxygenase enzyme B) Formation of antibodies to heparin-platelet factor-4 complex C) Deposition of immune complex nuclear antigens in kidneys D) Inherited mutation in clotting factor V, which cannot be degraded by activated protein C ---- <<Answer:>>
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B
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<<Question:>> Three days after surgical repair of a distal right radius fracture, a 62-year-old man develops severe wound pain and fever. His temperature is 39.1°C (102.4°F). Physical examination shows erythema and edema of the right arm that extends up to the elbow. Yellow pus drains from the surgical wound. Cultures from the wound fluid grow gram-positive bacteria in grape-like clusters that are resistant to nafcillin. While treating the patient's condition, the hospital also wants to eradicate the causal pathogen in asymptomatic carriers. Which of the following measures would be most effective? ---- <<Choices:>> A) Permethrin hair wash B) Colistin nebulized aerosol C) Chlorhexidine hand disinfection D) Mupirocin nasal ointment ---- <<Answer:>>
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D
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<<Question:>> A research group from Europe is investigating a potential link between certain lifestyle risk factors and the development of potentially fatal renal disease. They designed a cohort study that included 68 individuals: 34 exposed and 34 unexposed to given risk factors, who were followed up for 4 years in total. During this time, the renal disease of interest was seen in 6 individuals among the exposed group and 6 individuals among the unexposed group; thus, the risk ratio (RR) of the disease development (exposed vs. unexposed) was 1. During the initial 2 years, there was 1 death in the exposed group, and another death in the unexposed group. A survey administered for the last 2 years of the study showed that the prevalence ratio of disease between exposed and unexposed individuals was in fact 0.5 (at 2 years of follow-up there was only 1 case of the disease in the 34 exposed individuals, with a resulting prevalence of 2.94%; and only 2 cases of the disease in the 34 unexposed individuals, with a resulting prevalence of 5.88%), a value that deviates from the true RR (i.e. 1). For this reason (and to accurately answer the research question), the risk of the disease should be estimated in terms of which of the following? ---- <<Choices:>> A) Incidence B) Prevalence C) Mortality D) Survival rates ---- <<Answer:>>
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A
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<<Question:>> A 55-year-old male with fever, fatigue, generalized weakness, and bleeding gums for the past 3 weeks presents to his family physician. On exam, he has bilateral submandibular lymphadenopathy and hepatosplenomegaly. CBC demonstrates decreased RBCs and mature WBCs. The patient is referred to an oncologist, and a bone marrow aspiration is performed, demonstrating >20% myeloblasts with Auer rods that are myeloperoxidase positive. What is the most likely chromosomal translocation that is responsible for this patient's clinical presentation and lab results? ---- <<Choices:>> A) 15;17 B) 14;18 C) 11;14 D) 8;14 ---- <<Answer:>>
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A
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 59-year-old man with Parkinson disease is brought to the emergency department 1 hour after he had a syncopal episode. Over the past two weeks, the patient has felt light-headed upon standing and has noticed that his legs have been swollen. He was started on a medication for early symptoms of Parkinson disease one month ago. Vital signs show blood pressure 114/70 mm Hg when supine and 92/38 mm Hg upon standing. Examination of the lower extremities shows a lacy, purple rash and 2+ pitting edema. Neurologic examination shows an ataxic gait. The physician decreases the dose of medication. The patient is most likely experiencing adverse effects caused by a drug that works through which of the following mechanisms of action? ---- <<Choices:>> A) Increased dopamine release from central neurons B) Inhibition of acetylcholine activity in the basal ganglia C) Selective inhibition of monoamine oxidase type B D) Inhibition of central methylation of dopamine ---- <<Answer:>>
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A
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 50-year-old woman presents to her primary care physician for muscle weakness. Her symptoms have progressively worsened over the course of several months, where she has experienced difficulty getting up from a chair, climbing the stairs, and placing her groceries on the top shelves of her kitchen. She also reports feeling tired lately and is unsure when this began. Physical examination is notable for muscle weakness in the deltoids and hip flexors with 2+ biceps, triceps, patellar, and ankle tendon reflexes. Laboratory testing demonstrates a creatine kinase level of 4,200 U/L (normal is 10-70 U/L), lactate dehydrogenase level of 150 U/L (normal is 45-90 U/L), and thyroid-stimulating hormone level of 1.5 µU/mL (normal is 0.5-5.0 µU/mL). Which of the following is the best initial treatment for this patient? ---- <<Choices:>> A) Azathioprine B) Intravenous immunoglobulin C) Prednisone D) Thyroxine ---- <<Answer:>>
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C
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 22-year-old woman comes to the physician because of a 5-kg (11-lb) weight gain and hair loss over the past 4 months. Menarche occurred at the age of 12 years and menses occurred at irregular intervals until she stopped having periods 2 months ago. She is 165 cm (5 ft 5 in) tall and weighs 82 kg (180 lb); BMI is 30 kg/m2. Physical examination shows a receding hairline and hair loss over the vertex of the head. Serum studies show: Thyroid-stimulating hormone 2 μU/mL Luteinizing hormone 32 mIU/mL Prolactin 11 ng/mL Urine pregnancy test is negative. Withdrawal bleeding occurs after a progestin challenge test. The most likely cause of amenorrhea in this patient is an increase in production of which of the following hormones?" ---- <<Choices:>> A) Progesterone in corpus luteum B) Estrogen in adipose tissue C) Follicle stimulating hormone in the adenohypophysis D) Dopamine in the hypothalamus ---- <<Answer:>>
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B
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 70-year-old man with chronic myopia comes to the physician because of a 4-month history of difficulty seeing distant objects, especially at night, despite wearing glasses. Examination shows bilateral narrowing of peripheral visual fields, cupping of the optic discs, and elevated intraocular pressure. Gonioscopy shows no abnormalities. He is prescribed a drug. At a follow-up examination several months later, intraocular pressure is normal, but darkening of the iris and an increase in the length of the eyelashes is observed. Which of the following drugs was most likely prescribed? ---- <<Choices:>> A) Timolol B) Acetazolamide C) Apraclonidine D) Latanoprost ---- <<Answer:>>
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D
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 3-week-old female presents with her parents to her pediatrician for a routine visit. The parents report that the child is sleeping in regular two-hour intervals and feeding and stooling well. They are concerned because they have on occasion noticed a “swelling of the belly button.” Cord separation occurred at seven days of age. The parents report that the swelling seems to come and go but is never larger than the size of a blueberry. They deny any drainage from the swelling. On physical exam, the child is in no acute distress and appears developmentally appropriate for her age. Her abdomen is soft and non-tender with a soft, 1 cm bulge at the umbilicus. The bulge increases in size when the child cries and can be easily reduced inside the umbilical ring without apparent pain. Which of the following is the best next step in management? ---- <<Choices:>> A) Expectant management B) Histopathologic evaluation C) Elective surgical management D) Immediate surgical management ---- <<Answer:>>
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A
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 25-year-old man presents to the emergency department after a motor vehicle collision. He is currently complaining of chest pain and shortness of breath and seems rather confused. His temperature is 97.7°F (36.5°C), blood pressure is 94/54 mmHg, pulse is 170/min, respirations are 12/min, and oxygen saturation is 90% on room air. A 14-gauge needle is placed in the 2nd intercostal space on the patient’s left, and his blood pressure increases to 104/74 mmHg and his pulse decreases to 100/min. Which of the following is the best next intervention for this patient? ---- <<Choices:>> A) Chest radiograph B) Pericardiocentesis C) Thoracotomy D) Tube thoracostomy ---- <<Answer:>>
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D
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 13-year-old girl presents with a rash on her left hand and forearm. She went hiking with friends the day before yesterday and awoke this morning to find her hand and forearm red and itchy. She denies any swelling of the face or throat, difficulty breathing, dizziness, or palpitations. She has no significant past medical history or known allergies. She is afebrile and her vital signs are within normal limits. On physical examination, there are multiple erythematous papules and fluid-filled vesicles in a linear pattern on her left hand and forearm as shown in the exhibit (see image). Which of the following is the best course of treatment for this patient? ---- <<Choices:>> A) Oral prednisone B) Topical clobetasol C) Phototherapy D) Azathioprine ---- <<Answer:>>
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B
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 12-year-old boy is brought to the physician for multiple bruises. He has fallen multiple times over the past 4 months and has difficulty walking without assistance. His speech is slow and difficult to understand. Neurological examination shows bilateral nystagmus, decreased muscle strength, 1+ reflexes bilaterally, and a wide-based gait with irregular and uneven steps. His proprioception and vibration senses are absent. The remainder of the examination shows kyphoscoliosis and foot inversion with hammer toes. This patient is most likely to die from which of the following complications? ---- <<Choices:>> A) Renal cell carcinoma B) Heart failure C) Posterior fossa tumors D) Aspiration pneumonia " ---- <<Answer:>>
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B
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 28-year-old nulligravid woman comes to the physician for a routine health maintenance examination. Upon questioning, she reports that she and her husband have been trying to conceive for more than 1 year; they have unprotected sexual intercourse 3–4 times per week. Recently, she has not been enjoying sexual intercourse with her husband because of painful penetration. She also reports episodic back and pelvic pain over the past 6 months that lasts for 2–3 days; she has missed several days of work each month because of the pain. Menarche was at the age of 13 years, and menses occur at 26–28 day intervals. Pelvic examination shows a normal-appearing vulva and vagina. There is rectovaginal tenderness. Ultrasonography of the pelvis shows a retroverted normal-sized uterus. Further evaluation is most likely to show which of the following findings? ---- <<Choices:>> A) Endometrial tisssue within the myometrium on biopsy B) Multiple bilateral ovarian cysts on ultrasonography C) Reddish-black peritoneal lesions on laparoscopy D) Concentric, solid myometrial tumors on MRI ---- <<Answer:>>
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C
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 2-year-old Caucasian male presents with recurrent diaper rash and oral thrush. He has also experienced recurrent episodes of otitis media from repeat Streptoccous pneumoniae. He notably has reduced T and B cell counts. What disease is the child suffering from? ---- <<Choices:>> A) X-linked agammaglobulinemia B) Isolated IgA deficiency C) Severe combined immunodeficiency D) DiGeorge syndrome ---- <<Answer:>>
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C
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