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Answer the following medical question with the correct letter choice:
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<<Question:>> A 42-year-old primigravida woman presents to her gynecologist for a routine prenatal visit at 11 weeks of gestation. Her pregnancy has been uneventful so far. She denies smoking, using alcohol, or any illicit drugs. Past medical history is significant for Hashimoto’s thyroiditis which is well-controlled with levothyroxine. Her blood pressure is 110/70 mm Hg, a heart rate of 95/min, a respiratory rate of 20/min, and a temperature of 36.4°C (97.5°F). Physical examination is unremarkable. A transvaginal ultrasound reveals increased nuchal translucency. Laboratory studies show decreased levels of PAPP-A and increased levels of β-hCG. If the pregnancy is continued to term, the child is at an increased risk of developing which of the following conditions? ---- <<Choices:>> A) Vaginal adenosis B) Huntington disease C) Alzheimer’s disease D) Ebstein anomaly ---- <<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:>> An 18-month-old boy is brought to the emergency department by his babysitter because of lethargy and fever for 3 hours. He has not fully recovered from a middle ear infection that started a few days ago. The parents cannot be reached for further information. His temperature is 39.1°C (102.3°F). Physical examination shows nuchal rigidity. A pathogen is isolated from the patient's cerebrospinal fluid that does not grow on regular blood agar plate but produces colonies when cocultured with Staphylococcus aureus. Vaccination against the causal pathogen of this patient's current disease is most likely to also prevent which of the following conditions? ---- <<Choices:>> A) Bacterial rhinosinusitis B) Epiglottitis C) Chancroid D) Impetigo ---- <<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 20-month-old boy is brought to the physician for the evaluation of intellectual and behavioral abnormalities and abnormal movements of his extremities. His mother reports that he often hits his head and limbs against furniture. He is unable to walk without support and speaks in unclear 2-word phrases. Examination shows multiple bruises on the forehead and several healing wounds over the fingers. There is increased muscle tone in all extremities. Laboratory studies show an increased serum uric acid concentration. The serum concentration of which of the following substances is most likely to also be increased in this patient? ---- <<Choices:>> A) Phenylalanine B) Deoxyadenosine trisphosphate C) Phosphoribosyl pyrophosphate D) Cytosine monophosphate ---- <<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 24-year-old man presents to the office for a physical exam and drug screening requested by his parole officer. He has a history of multiple run-ins with the law, including theft, destruction of property, and assault and battery. Patient confesses that he has always been the 'problem child' in his home and always got into trouble with authority figures. Past medical records reveal testimonies from his mother describing episodes of physically aggressive behavior in school starting at before 12. Although a single parent, his mother states there were no stressful changes or issues at home. Today's urine toxicology screens are negative. Which of the following is most likely this patient’s diagnosis? ---- <<Choices:>> A) Substance use-related aggression B) Conduct disorder C) Antisocial personality disorder D) Borderline personality disorder ---- <<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 47-year old woman is referred to a nephrologist due to hematuria over the last week and lower extremity edema. She first noticed her feet and legs would swell in the mornings about 2 weeks ago. Her past medical history is significant for systemic lupus erythematosus for the past 24 years. This causes her mild joint and muscle pain on most day and she manages her symptoms with ibuprofen and acetaminophen. Today, her heart rate is 90/min, the respiratory rate is 17/min, the blood pressure is 140/90 mm Hg, and the temperature is 37.1°C (98.8°F). Urine analysis shows 6-10 dysmorphic RBCs per high powered field and occasional cellular casts. Serum creatinine is 2.4 mg/dL and a 24 hour urine collection reveals 550mg of excreted protein. A kidney biopsy shows findings consistent with diffuse proliferative glomerulonephritis. Which of the following is the best initial therapy for this patient? ---- <<Choices:>> A) Methotrexate and folic acid B) Intravenous immunoglobulin C) Plasmapheresis D) Cyclophosphamide and prednisolone ---- <<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 6-year-old girl presents to your clinic two weeks after receiving a routine immunization in preparation for a trip overseas. Periorbital edema is present on exam, and 24 hour urine collection shows excretion of 4.3 grams of protein/day. Which pathological change would likely be seen on microscopy? ---- <<Choices:>> A) Linear IgG deposition on light microscopy B) IgA-immune complexes in the mesangium on electron microscopy C) Subepithelial deposits with “spike and dome” appearance on electron microscopy D) Podocyte effacement on electron microscopy ---- <<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 9-year-old girl is brought to the physician by her father for evaluation of intermittent muscle cramps for the past year and short stature. She has had recurrent upper respiratory tract infections since infancy. She is at the 5th percentile for weight and 10th percentile for height. Physical examination shows nasal polyps and dry skin. An x-ray of the right wrist shows osteopenia with epiphyseal widening. Which of the following sets of laboratory findings is most likely in this patient's serum? $$$ Calcium %%% Phosphorus %%% Parathyroid hormone %%% Calcitriol $$$ ---- <<Choices:>> A) ↓ ↓ ↑ ↓ B) ↓ ↑ ↑ ↓ C) ↑ ↓ ↑ ↑ D) Normal ↓ ↑ ↓ ---- <<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 24-year-old medical student presents to urgent care with cough and rhinorrhea. He has been learning about HIV and immunosuppression in medical school, and he is worried that he is seriously ill. He has no significant medical history, and he is sexually active with his girlfriend. He consumes alcohol on weekends but does not use tobacco or other recreational drugs. He candidly reports that, in microbiology lab, he cultured his own sputum on Sabouraud agar, and Candida grew on the agar. Examination of the oropharynx does not show any abnormalities. You perform a nasal viral swab, which confirms that he has a rhinovirus infection. Which of the following is the most likely explanation for his positive Candida culture? ---- <<Choices:>> A) HIV virus infection B) Xerostomia C) Surreptitious drug use D) Benign Candida colonization ---- <<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 57-year-old woman comes to her physician with a persistent cough. She has observed an increase in the frequency of her cough over the past few months and also the production of yellowish sputum on several occasions. She says that sputum production is greater in the morning compared to the rest of the day. She has been a chain smoker for about 35 years now, smoking close to 3 packs a day. She has never had the will to quit. Over the last 2 years, she has had this cough and doesn't recall being free of it for 3 months at a stretch. On examination, there is a slight expiratory wheeze in the lower lung fields. Her respiratory rate is 18/min, pulse is 85/min, and blood pressure is 110/70 mm Hg. Her forced expiratory volume in the first second is 83% at this time. Her FEV1/FVC post-bronchodilator ratio is 0.65. Based on these findings, her physician recommends that she quit smoking. She is also advised to take pneumococcal and influenza vaccinations over the next few months. Which of the following medications would be most appropriate to assist the patient with her symptoms at this time? ---- <<Choices:>> A) Albuterol B) Fluticasone C) Doxycycline D) Prednisone ---- <<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 56-year-old woman presents to her primary care physician for dizziness. She says that her symptoms began approximately 1 month prior to presentation and are associated with nausea and ringing of the ears. She describes her dizziness as a spinning sensation that has a start and end and lasts approximately 25 minutes. This dizziness is severe enough that she cannot walk or stand. Her symptoms are fluctuating, and she denies any tunnel vision or feelings of fainting. However, she has abruptly fallen to the ground in the past and denied losing consciousness. Medical history is significant for a migraine with aura treated with zolmitriptan, type 2 diabetes managed with metformin, and hypertension managed with lisinopril. Her blood pressure is 125/75 mmHg, pulse is 88/min, and respirations are 16/min. On physical exam, when words are whispered into her right ear, she is unable to repeat the whispered words aloud; however, this is normal in the left ear. Air conduction is greater than bone conduction with Rinne testing, and the sound of the tuning fork is loudest in the left ear on Weber testing. Which of the following is most likely the diagnosis? ---- <<Choices:>> A) Benign paroxysmal positional vertigo B) Meniere disease C) Migraine D) Transient ischemic attack ---- <<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 3086-g (6-lb) male newborn is delivered at 39 weeks' gestation to a 29-year-old woman. Initial examination shows micrognathia, a broad nasal bridge, short philtrum, and a cleft palate. Intermittent muscle spasms are seen predominantly in the hands and feet. A harsh systolic murmur is heard over the lower left sternal border. Which of the following is the most likely cause of this infant’s symptoms? ---- <<Choices:>> A) Deletion in chromosome 7 B) Deletion in chromosome 22 C) Nondisjunction of chromosome 21 D) Nondisjunction of chromosome 13 ---- <<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 37-year-old woman comes to the emergency department because her eyes have had a yellow discoloration and she has had dark urine for the past 3 days. She has also had fever, itching, and severe fatigue. She reports having symptoms of the stomach flu a week ago, which resolved with over-the-counter medication. She does not have diarrhea but says her stools are whitish in appearance. She has no personal history of serious illness. She does not smoke and drinks an average of 2 beers on weekends. She does not use illicit drugs. She has been sexually active with the same partner for 12 years and uses condoms consistently. She works as a flight attendant for an international airline. She appears ill. Her temperature is 39.3°C (102.7°F), pulse is 64/min, and blood pressure is 132/82 mm Hg. Examination shows scleral icterus, excoriation marks over her extremities, and parched lips. The liver is tender on palpation; there is no splenomegaly. Cardiopulmonary examination is normal. Laboratory studies show: Hemoglobin 11.6 g/dL Leukocyte count 10,300/mm3 Platelet count 256,000/mm3 ESR 19 mm/hr Prothrombin time 13 seconds Serum Urea nitrogen 28 mg/dL Glucose 89 mg/dL Creatinine 0.7 mg/dL Bilirubin Total 8 mg/dL Direct 4 mg/dL ALP 80 U/L AST 312 U/L ALT 569 U/L An ultrasound of the abdomen shows no abnormalities. Serum studies are most likely to show which of the following findings?" ---- <<Choices:>> A) Anti-mitochondrial antibodies B) Perinuclear anti-neutrophil cytoplasmic antibodies C) Anti-HAV IgM D) Anti-HEV IgG ---- <<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 27-year-old man presents with diarrhea, fatigue and weight loss. He says he has been having occasional loose stools and abdominal pain for the past month, but he did not seek any medical attention because of work deadlines. He says the diarrhea is associated with cramping lower abdominal pain and an urgency to defecate. His stool is loose, occasionally blood-tinged, and contains mucus. He also says he feels fatigued and has lost 11 kg (24 lb) over the last 2 months. The patient denies any fever, sick contacts, or a history of recent travel. No significant past medical history. Family history is significant for colon cancer in his father, who died at the age of 50. On physical examination, the patient has generalized pallor. Abdominal exam reveals mild tenderness to palpation in the left lower quadrant. Laboratory investigations reveal microcytic anemia with an elevated ESR. A colonoscopy with biopsy is performed, which shows inflammation of the sigmoid colon and rectum. Biopsy shows a predominantly lymphoid infiltration of the mucosa and submucosa with multiple crypt abscesses. No evidence of granulomatous disease. What is the mechanism of action of the drug which typically induces remission of this patient’s most likely condition? ---- <<Choices:>> A) Inhibition of prostaglandins and inflammatory cytokines B) Antibody against tumor necrosis factor C) Inhibition of cellular metabolism D) Suppression of polymorphonuclear cell migration ---- <<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 61-year-old woman presents to your office complaining of mild fatigue and weight loss over the past 6 months. She states she has felt generally unwell and has had decreased appetite during this time frame. Her temperature is 98.1°F (36.7°C), blood pressure is 122/80 mmHg, pulse is 88/min, respirations are 16/min, and oxygen saturation is 98% on room air. Physical exam reveals splenomegaly and a nontender abdomen. A complete blood count with differential shows the following: Hemoglobin: 10 g/dL Hematocrit: 30% Leukocyte count: 166,500/mm^3 Segmented neutrophils 92% Leukocyte alkaline phosphatase: Low Platelet count: 92,000/mm^3 A bone marrow biopsy is performed demonstrating infiltration with a large number of normal-appearing neutrophils. Which of the following translocations is likely to be seen in this patient? ---- <<Choices:>> A) t(8;14) B) t(9;22) C) t(12;21) D) t(15;17) ---- <<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 44-year-old homeless man is brought to the emergency department after he was arrested when found intoxicated in someone's garage. The patient is acutely altered and is covered in urine, stool, and vomit. His temperature is 97.6°F (36.4°C), blood pressure is 104/64 mmHg, pulse is 130/min, respirations are 19/min, and oxygen saturation is 98% on room air. The patient is aroused with pain and begins answering basic questions. He states his vision is blurry and he can't see anything. Laboratory values are ordered as seen below. Serum: Na+: 141 mEq/L Cl-: 102 mEq/L K+: 4.4 mEq/L HCO3-: 14 mEq/L BUN: 25 mg/dL Glucose: 99 mg/dL Creatinine: 1.4 mg/dL Ca2+: 10.2 mg/dL Which of the following is the most appropriate initial treatment of this patient? ---- <<Choices:>> A) Glutathione formation B) Inhibition of alcohol dehydrogenase C) Muscarinic antagonism D) Removal via dialysis ---- <<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 32-year-old construction worker is brought to the Emergency Department after a block of concrete crushed his right leg. His coworkers tried to remove the block, but it was not possible until firemen arrived on the scene 30 minutes after the incident. His personal medical history is unremarkable. Upon admission his vitals were stable. On physical examination the man is unconscious. His right leg is deformed with lacerations and hematomas. There are at least two fractures and several areas of the muscle appear pulpified. Distal right pulses are absent. An X-ray of the right leg reveals several displaced fractures of the tibia and fibula. Blood samples and a urine specimens are sent to the lab for analysis. Which of the following laboratory abnormalities would you expect to find in this patient? ---- <<Choices:>> A) Fractional excretion of sodium (FeNa+) > 2% B) Urine osmolality > 500 mOsmol/kg C) Red-tinted plasma D) Elevated haptoglobin ---- <<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 primigravida woman goes into labor at 37 weeks. After several hours of labor, a boy is born with multiple physical abnormalities including cleft palate, micrognathia, and low-set ears. Imaging reveals an absence of the thymic shadow. Which of the following is the most likely cause of the patient’s condition? ---- <<Choices:>> A) Microdeletion of the long arm of chromosome 22 B) Microdeletion of the long arm of chromosome 7 C) Microdeletion of the short arm of chromosome 5 D) Adenosine deaminase deficiency ---- <<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 20-year-old woman presents following a seizure 2 hours ago. The patient's roommate describes seeing the patient suddenly 'freeze', collapse, and start having jerky movements involving her entire body. The patient says she can not recall the episode but does remember 'seeing stars' before losing consciousness. She remembers being confused about where she was soon after the seizure and had urinated in her clothes when she regained consciousness. A persistent headache has troubled her since the seizure for which she took acetaminophen before coming to the hospital. Her past medical history is unremarkable. She denies alcohol and drug use. The physician starts her on an antiepileptic drug that acts in the motor cortex by blocking repeated activation of voltage-gated sodium channels and is also used in status epilepticus. When this drug is used long-term, which of the following complications can develop? ---- <<Choices:>> A) Drug dependence B) Drug-induced SLE C) Renal failure D) Liver failure ---- <<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 68-year-old man presents to his primary care physician for pain in his feet. The patient states that it is very painful for him to walk around, and he has significant pain in his right and left toes. The patient has a past medical history of obesity, type II diabetes mellitus, anxiety, depression, COPD, and a 30 pack-year smoking history. The patient’s current medications include lisinopril, hydrochlorothiazide, insulin, metformin, fluoxetine, clonazepam, albuterol, home oxygen, varenicline, and fish oil and he is compliant with all medications. On physical exam, the patient’s toes appear pale and dirty. When inspecting his toes, shallow wounds with a pale base devoid of granulation tissue can be appreciated. The patient has decreased pinprick sensation in his lower extremities bilaterally. Pulmonary exam is notable for a prolonged expiratory phase. Which of the following findings is most likely to be found in this patient? ---- <<Choices:>> A) Bipedal edema B) Increased reflexes of the lower extremities C) Loss of vibration sensation in the lower extremities D) Calf pain after walking moderate distance ---- <<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 16-year-old man is brought to the emergency department for left arm pain. Per the patient, he was playing at his high-school football game when a member of the opposing team tackled him from behind, which resulted in him landing on his left arm. He felt a “popping” sensation and immediate, sharp pain at his left shoulder. The patient is in mild distress and holds his arm against his abdomen. Physical examination demonstrates limited abduction secondary to pain and reduced muscle tone over the shoulder. What additional finding would you expect from this patient? ---- <<Choices:>> A) Loss of sensation over the dorsal hand B) Loss of sensation over the lateral 3 1/2 fingers C) Loss of sensation over the lateral arm D) Loss of sensation over the lateral forearm ---- <<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 68-year-old woman is brought to the emergency room because of pain in her right shoulder after falling down the stairs in her apartment. She has a history of postmenopausal osteoporosis. Her current medications are alendronate, vitamin D, and calcium supplementation. Physical examination shows shortening of the right arm as well as tenderness and swelling over the right shoulder. The range of motion of the right arm is limited by pain. An x-ray of the right shoulder shows a fracture of the surgical neck of the humerus. Which of the following movements is most likely to be impaired in this patient? ---- <<Choices:>> A) Wrist extension B) Elbow flexion C) Arm abduction D) Thumb adduction ---- <<Answer:>>
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C
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<<Question:>> A hematologist has found a historical hemocytometer used during the 1960s. Out of curiosity, he decides to obtain platelet counts from his brother, who has idiopathic thrombocytopenic purpura (ITP), with both the historical hemocytometer and a modern automated CBC analyzer. The platelet counts of repeated measurements are shown in ascending order: Historical hemocytometer 55,000 57,000 62,000 76,000 77,000 82,000 92,000 Mean: 72,000 Modern automated CBC analyzer 71,000 71,000 72,000 72,000 73,000 74,000 74,000 Mean: 72,000 If the measurements on a modern automated CBC analyzer are considered accurate, which of the following conclusions can be drawn about the historical hemocytometer?" ---- <<Choices:>> A) Test lacks accuracy B) Test lacks validity C) Test lacks specificity D) Test lacks precision ---- <<Answer:>>
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D
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<<Question:>> A 9-year-old female child whose family recently emigrated from Afghanistan presents to the county hospital with difficulty swallowing and generalized muscle rigidity. Her parents note that although she is in severe pain she always appears to be smiling. After getting a detailed history from the parents, the residents comes to the conclusion that the child's clinical presentation is due to a lack of immunizations and a deep wound on her knee resulting from a fall six days ago. Which of the following is the mechanism of action of the toxin causing this child's symptoms? ---- <<Choices:>> A) Inhibiting protein synthesis via ADP-ribosylation of elongation factor 2 B) Overactivating adenylate cyclase by ADP-ribosylation of the Gs alpha subunit C) Overactivating adenylate cyclase by disabling the Gi subunit D) Preventing release of GABA by cleaving of synaptobrevin 2 ---- <<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 49-year-old obese man presents to the emergency department with a fever and a cough productive of bloody sputum. He has also been waking up at night frequently, which he attributes to sweating while asleep. He is also proud of recently losing some weight but denies actively trying to do so. He says that he has had these symptoms intermittently for the last several years but has not consistently sought treatment because his housing has been transient with periods of homelessness. He is started on a course of therapy and leaves against medical advice before his physician is able to explain the medications. He returns two days later because he is concerned that his eyes are bleeding. The area of the lung most likely affected by this patient's condition has which of the following characteristics? ---- <<Choices:>> A) High perfusion, high ventilation, high V/Q ratio B) High perfusion, high ventilation, low V/Q ratio C) Low perfusion, low ventilation, high V/Q ratio D) Low perfusion, low ventilation, low V/Q ratio ---- <<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 66-year-old male presents to clinic for a blood glucose level of 169 mg/dL taken at a local pharmacy. He is a farmer in rural Alabama and has not seen a doctor for decades. He wants to be in excellent shape prior to his trip to visit his daughter at college. His past medical history and family history are unknown, and he does not take any medications. His diet consists of pork products and he does not smoke. His temperature is 99.5°F (37.5°C), pulse is 100/min, blood pressure is 169/90 mmHg, respirations are 18/min, and oxygen saturation is 97% on room air. The patient is started on metformin, lisinopril, and a guided exercise program. Lab results are below: Serum: Na+: 145 mEq/L Cl-: 100 mEq/L K+: 4.9 mEq/L HCO3-: 24 mEq/L BUN: 18 mg/dL Glucose: 211 mg/dL Creatinine: 1.0 mg/dL Ca2+: 10.0 mg/dL He returns from his trip, complaining of cough. He denies any other symptoms. His temperature is 99.5°F (37.5°C), pulse is 101/min, blood pressure is 160/85 mmHg, respirations are 18/min, and oxygen saturation is 98% on room air. Repeat lab results are below: Serum: Na+: 145 mEq/L Cl-: 100 mEq/L K+: 5.3 mEq/L HCO3-: 24 mEq/L BUN: 22 mg/dL Glucose: 169 mg/dL Creatinine: 1.2 mg/dL Ca2+: 10.1 mg/dL What is the next best step in management? ---- <<Choices:>> A) Switch blood pressure medication to losartan B) Switch blood pressure medication to hydrochlorothiazide C) Azithromycin D) Loratadine ---- <<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 woman presents to her primary care physician for her annual physical exam. Her prior medical history is significant for seasonal allergies and a broken arm at age 12 that was treated in a long arm cast. She has not had any major illnesses in the previous year and does not currently have any major complaints. On physical exam her blood pressure is found to be 152/95 mmHg. Laboratory findings reveal elevated levels of renin and aldosterone. Given her elevated blood pressure, she is prescribed captopril; however, 1 week later she presents to the emergency department with hypertensive urgency. At that point captopril is immediately stopped. Which of the following is the most likely cause of this patient's disorder? ---- <<Choices:>> A) Bilateral fibromuscular dysplasia B) Conn syndrome C) Renin secreting tumor D) Unilateral fibromuscular dysplasia ---- <<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:>> An investigator is analyzing the serum calcium and parathyroid hormone levels of 100 patients. A scatter plot of the findings is shown. Which of the following is a possible explanation for the group marked with the letter E? ---- <<Choices:>> A) Lymphoma B) End-stage kidney disease C) Thyroidectomy D) Multiple endocrine neoplasia ---- <<Answer:>>
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A
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<<Question:>> A 56-year-old male is admitted to the emergency department with sudden onset of pain, left-sided scrotal swelling, and nausea. The patient states that the symptoms started three hours ago after he lifted up a heavy pack. He says that the swelling had been intermittently present for several years already and was most prominent when physically straining or coughing, but it had never been painful. Past medical history is unremarkable. Patient reports a 26-pack-year history of smoking. Vital signs are as follows: blood pressure 150/90 mm Hg, heart rate 85/min, respiratory rate 14/min, and temperature 37.8℃ (100℉). BMI is 32.9 kg/m2. Patient’s respiratory and cardiovascular exams are within normal limits. The abdomen is moderately distended. There is a tender erythematous scrotal swelling on the left, which cannot be manually reduced. Which of the following tests should be performed to confirm the diagnosis in this patient? ---- <<Choices:>> A) Ultrasonography B) No further tests are needed C) Fine needle biopsy D) Laparoscopy ---- <<Answer:>>
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B
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<<Question:>> A 6-year-old boy presents to a pediatrician for initial evaluation. He was recently adopted from abroad and his parents want to establish care in the United States. His medical history is unclear and there are no records on any family history. On presentation, he is found to fall below the 5th percentile in height for his age with shortened 4th and 5th digits. Physical exam reveals wrist spasms when his blood pressure is taken. Radiographs reveal decreased bone mineral density and several healing fractures. Which of the following mechanisms is most likely associated with this patient's presentation? ---- <<Choices:>> A) Decreased production of parathyroid hormone B) Inadequate intake of vitamin D C) Malabsorption of nutrients D) Resistance to effects of parathyroid hormone ---- <<Answer:>>
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D
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<<Question:>> A 12-year-old boy is brought to the emergency department with a 2-month history of increasing difficulty with physical activity. Specifically, he says that he gets short of breath quickly with exertion even though he used to participate in all activities without a problem. When asked, he endorses sometimes coughing up flecks of blood. His past medical history is unclear because he was recently adopted from abroad and has not yet established care. Physical exam reveals blue discoloration of his lips and fingernails as well as a holosystolic murmur best heard at the lower left sternal border. Which of the following physiologic mechanisms is primarily responsible for this patient's current presentation? ---- <<Choices:>> A) Increasing size of ventricular septal defect B) Left ventricular outflow tract obstruction C) New atrial septal defect D) Pulmonary artery hypertension ---- <<Answer:>>
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D
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<<Question:>> A scientist isolates the rough endoplasmic reticulum from HeLa cells. He performs a northern blot to isolate nucleic acid sequences of interest. Which of the following molecules make up part of the structure that was separated? ---- <<Choices:>> A) RNA polymerase B) Transfer RNA C) Ribosomal RNA D) Mitochondrial RNA ---- <<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 14-month-old girl is brought to the pediatrician after her parents noticed her being increasingly irritable with frequent vomiting for the past 2 weeks. Parents deny any history of fever. They recently immigrated to the country and, unfortunately, the mother did not receive prenatal care during pregnancy due to a lack of health insurance. Physical examination is unremarkable except for a head circumference over 2 standard deviations larger than the mean for her age, and delay in meeting motor developmental milestones. A magnetic resonance imaging (MRI) of her brain shows an enlargement of the posterior fossa, cystic dilation of the 4th ventricle, and hypoplasia of the cerebellar vermis (see image). Which of the following is the most likely diagnosis in this patient? ---- <<Choices:>> A) Chiari II malformation B) Chiari III malformation C) Dandy-Walker malformation D) Klippel Feil syndrome ---- <<Answer:>>
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C
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<<Question:>> A 28-year-old woman presents with a 3-year history of recurrent headaches. She says the episodes are typically triggered by hunger, mental stress, physical exertion, and lack of sleep, although many times the trigger is not known. She describes her headaches as unilateral, severe, throbbing, and aggravated by movement. The patient says that each episode usually lasts for 6–24 hours and is often accompanied by nausea, vomiting, and intolerance to light. Which of the following brain regions, if lesioned, would most likely result in no change in this patient’s symptoms? ---- <<Choices:>> A) Red nucleus B) Locus coeruleus C) Nucleus raphe magnus D) Periaqueductal gray ---- <<Answer:>>
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A
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<<Question:>> A 68-year-old man comes to the physician for a routine health maintenance examination. He has had increasing shortness of breath and a productive cough for the past 1 year. He can walk up a flight of stairs without stopping. He has hypertension and his only medication is amlodipine. He has a history of asthma during childhood. He smoked 1 pack of cigarettes daily for 30 years but quit 16 years ago. He used to work at a shipyard and retired 5 years ago. His pulse is 98/min, respirations are 25/min and blood pressure is 134/88 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 93%. Scattered expiratory wheezing and rhonchi are heard throughout both lung fields. Cardiac examination shows no murmurs, rubs, or gallops. Spirometry shows an FEV1:FVC ratio of 63% and an FEV1 of 65% of predicted. His diffusing capacity for carbon monoxide (DLCO) is 40% of predicted. Which of the following is the most likely cause of this patient's findings? ---- <<Choices:>> A) Asthma B) Congestive heart failure C) Emphysema D) Asbestosis " ---- <<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 9-year-old boy presents to his orthopedic surgeon for ongoing evaluation of his lower extremity deformities. Specifically, his hips have been dislocating over the last year despite bracing in hip-knee-ankle-foot orthoses. He is paralyzed from below the L2 nerve root and has difficulty with both bladder and bowel incontinence. He has had these abnormalities since birth due to a lower back lesion that required surgical closure during infancy. Which of the following substances was most likely elevated in his mother's serum during her pregnancy? ---- <<Choices:>> A) Alpha-fetoprotein B) Beta-human chorionic growth hormone C) Estriol D) Sphingomyelin ---- <<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:>> Polymerase chain reaction (PCR) has revolutionized the molecular biology field. PCR allows for amplification of a single piece of genetic material to produce trillions of idential copies. Which of the following is NOT necessary for PCR? ---- <<Choices:>> A) Taq polymerase B) Reverse transcriptase C) Primers D) Target DNA strand ---- <<Answer:>>
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B
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<<Question:>> An investigator is studying the efficacy of antiviral drugs in infected human cells. Harvested human cells are inoculated onto four cell culture plates. Live varicella-zoster virus (VZV) is administered to cells on two of the culture plates. One healthy and one infected cell set are set aside as controls. In comparison with the control plates, the subsequent application of a guanosine analog to the experimental cell sets induces cell death in the virally infected cells but not in the healthy cells. Which of the following is the most likely mechanism for these findings? ---- <<Choices:>> A) Secretion of interferons by virally infected cells B) Mutation of viral DNA polymerase C) Phosphorylation by virally-encoded thymidine kinase D) Inhibition of RNA-dependent DNA polymerase ---- <<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 13-year-old boy is brought to the physician because of pain and redness on his back for 2 days. He returned yesterday from a vacation to East Africa with his parents, where he took multiple rides on hot air balloons. His vital signs are within normal limits. Examination shows a tender, nonpruritic, erythematous rash with edema covering the extensor surface of both forearms, the shoulders, and the upper back, with small patches of skin exfoliation. The rash becomes pale when pressed and then rapidly regains color. The remainder of the examination shows no abnormalities. Which of the following is the most appropriate next step in management? ---- <<Choices:>> A) Dress wound with wet gauze B) Administer 2 liters of intravenous fluids C) Apply topical mupirocin D) Apply aloe vera-based moisturizer " ---- <<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 comes to the emergency department because of headache, fever, chills, shortness of breath, and abdominal pain for 1 week. He also feels tired and nauseous. He returned from a trip to Botswana 2 weeks ago. He has type 2 diabetes mellitus. He has smoked one pack of cigarettes daily for the past 30 years and drinks a glass of beer daily. His only current medication is metformin. His temperature is 39.3°C (102.8°F), pulse is 122/min, respirations are 28/min, and blood pressure is 109/84 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 94%. Examination shows jaundice. A few scattered inspiratory crackles are heard in the thorax. The liver is palpated 2 cm below the right costal margin. Laboratory studies show: Hemoglobin 9.2 g/dL Leukocyte count 9,400/mm3 Platelet count 90,000/mm3 Serum Na+ 137 mEq/L Cl- 102 mEq/L K+ 5.2 mEq/L HCO3- 13 mEq/L Glucose 69 mg/dL Lactate dehydrogenase 360 U/L Creatinine 0.9 mg/dL Bilirubin _ Total 4.2 mg/dL _ Direct 0.8 mg/dL AST 79 U/L ALT 90 U/L Urine Blood 3+ Protein trace RBC 0–1/hpf WBC 1–2/hpf Arterial blood gas analysis on room air shows a pH of 7.31. Which of the following is the most appropriate next step in management?" ---- <<Choices:>> A) Coombs test B) Blood culture C) Blood smear D) Serology ---- <<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 population study was conducted to evaluate coronary artery disease in the general population. A cohort of 700 patients underwent coronary angiography to evaluate the geographic distribution of coronary arteries throughout the heart. Which of the following was the most common finding in this cohort? ---- <<Choices:>> A) The SA node is supplied by a branch of the right coronary artery. B) The AV node is supplied by a branch of the right coronary artery. C) Right coronary artery dominance D) A SA node is supplied by a branch of the left coronary artery. ---- <<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 24-year-old woman comes to the physician because of intermittent episodes of stabbing facial pain for 4 months. The pain occurs over her left cheek, is 9 out of 10 in intensity, radiates towards her mouth, and lasts around half a minute before subsiding. These episodes commonly occur when she washes her face, brushes her teeth, or eats a meal. She does not have visual disturbances, weakness of her facial muscles, or hearing loss. She had a tooth extracted about 2 months ago, but the facial pain has persisted. She has hypothyroidism and vitiligo. Her mother has major depressive disorder. Current medications include levothyroxine and a herbal cream. She appears anxious. Vital signs are within normal limits. Cardiopulmonary examination shows no abnormalities. Neurologic examination shows no focal findings. Which of the following is the most appropriate next step in management? ---- <<Choices:>> A) Microvascular decompression B) Botulinum toxin injection C) Radiofrequency rhizotomy D) Carbamazepine ---- <<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 67-year-old man is brought to the emergency department after the sudden onset of dizziness, blurry vision, and a raspy voice. He has type 2 diabetes mellitus, hypercholesterolemia, coronary artery disease, and hypertension. He has smoked two packs of cigarettes daily for 30 years. He drinks three to four beers daily. His current medications include metformin, atenolol, lisinopril, furosemide, and aspirin. His temperature is 36.6°C (98°F), pulse is 85/min, respirations are 18/min, and blood pressure is 142/90 mm Hg. He is alert and oriented to person, place, and time. The pupil on the left is pinpoint. There is ptosis of the left eye. Horizontal nystagmus is present. The gag reflex is diminished. When he stands without support, he falls towards his left side. There is loss of pain and temperature sensation over the left face and right trunk and limbs. Occlusion of which of the following arteries is the most likely cause of this patient's symptoms? ---- <<Choices:>> A) Right middle cerebral artery B) Left posterior inferior cerebellar artery C) Right internal carotid artery D) Left posterior cerebral artery ---- <<Answer:>>
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B
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<<Question:>> A 67-year-old woman with a recently found hepatic carcinoma has been an inpatient for more than a week. During morning rounds, she was abnormally disoriented to time and place along with a shortened attention span. The overnight resident reports that she was coming in and out of this state for the past couple nights. The patient was known to drink often, but reported that she has not consumed alcohol in weeks leading up to her admission. She is not jaundiced and has no metabolic imbalance upon laboratory tests. What is the most likely cause of her recent mental impairment? ---- <<Choices:>> A) Delirium B) Substance abuse C) Brain metastasis D) Delirium tremens ---- <<Answer:>>
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A
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<<Question:>> A 51-year-old man comes to the physician because of recurrent episodes of dizziness, tinnitus, and hearing loss on the left side for 6 weeks. These episodes last for hours at a time and are associated with the sensation that the room is spinning. He has no history of major medical illness and takes no medications. Examination shows horizontal nystagmus to the left. Weber test shows lateralization to the right ear. The Rinne test is positive bilaterally. Which of the following is the most likely cause of this patient's symptoms? ---- <<Choices:>> A) Dislodged otoliths B) Acoustic neuroma C) Endolymphatic hydrops D) Posterior inferior cerebellar artery infarction ---- <<Answer:>>
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C
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<<Question:>> A 37-year-old farmer presents to the emergency department with acute onset of complaints of diarrhea, excessive tearing, and increased saliva production. He is concerned that he is dehydrated, as he has also been urinating with increased frequency over the past several hours. His temperature is 97.6°F (36.4°C), blood pressure is 111/64 mmHg, pulse is 60/min, respirations are 10/min, and oxygen saturation is 98% on room air. Physical exam is significant for a moderately agitated and diaphoretic man who demonstrates pinpoint pupils. Which of the following is the most appropriate next step in management? ---- <<Choices:>> A) Atropine B) Diphenhydramine C) Naloxone D) Physostigmine ---- <<Answer:>>
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A
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<<Question:>> A 54-year-old woman comes to the emergency department because of sharp chest pain and shortness of breath for 1 day. She has been coughing intermittently, which worsens the pain. She has osteoporosis, for which she takes raloxifene. Arterial blood gas analysis on room air shows: pH 7.52 PCO2 25 mm Hg PO2 65 mm Hg O2 saturation 92% Physical examination is most likely to show which of the following findings?" ---- <<Choices:>> A) Unilateral swelling of the leg B) Increased anteroposterior diameter of the thorax C) Grouped vesicles on the right hemithorax D) Absent left radial pulse ---- <<Answer:>>
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A
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<<Question:>> A previously healthy 18-year-old woman comes to the emergency department because of diarrhea and abdominal cramps since the previous evening. She has had around 3–4 episodes of watery stools. She feels nauseous and has vomited twice. She recollects eating out 2 days ago. She has been on a vegan diet for 6 months. She takes no medications and has not traveled anywhere recently. Her temperature is 36.8°(98.2°F), pulse is 73/min, and blood pressure is 110/70 mm Hg. Examination shows dry mucous membranes. Abdominal examination is unremarkable. Which of the following is the most likely causal organism? ---- <<Choices:>> A) Rotavirus B) Norovirus C) Vibrio vulnificus D) Bacillus cereus ---- <<Answer:>>
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B
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<<Question:>> A 6-year-old boy is brought to the physician for a well-child examination. He has no history of major medical illness. His mother says, “Sometimes when my son forgets to flush, his urine leaves dark stains in the toilet.” She is unconcerned because her son already had dark-colored urine as a baby and he has never had any health issues. His vital signs are within normal limits. Physical examination shows no abnormalities. The patient’s condition is most likely associated with impaired formation of which of the following? ---- <<Choices:>> A) Cystathionine B) Methylmalonate C) Tyrosine D) Maleylacetoacetate ---- <<Answer:>>
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D
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<<Question:>> A 72-year-old man presents with a recent episode of slurred speech and numbness in his left arm and left leg 2 hours ago that resolved completely within 45 minutes. He says he was having breakfast when he noticed that he had difficulty talking and the left side of his body was numb. The patient denies any past similar symptoms. Past medical history is significant for type 2 diabetes mellitus, hypertension, and ischemic heart disease. He had a coronary artery bypass graft 12 years ago and a percutaneous intervention 3 years ago. Current medications are aspirin, metformin, nitrates, and rosuvastatin. His vital signs include: blood pressure 143/97 mm Hg, pulse 80/min, oxygen saturation 98% on room air. On physical examination, the patient is alert and oriented. Higher mental functions are intact. Muscle strength is 5 out of 5l in both upper and lower limbs bilaterally. The sensation is intact. Cerebellar signs are absent and his gait is normal. Which of the following is the next best step in the management of this patient? ---- <<Choices:>> A) Add clopidogrel and discharge the patient B) Admit the patient for observation and workup C) Discharge now and ask him to visit again when symptoms reoccur D) Start antiepileptic drugs ---- <<Answer:>>
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B
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<<Question:>> A 29-year-old man is brought to the emergency department after being found unresponsive at home. The patient's roommate says that the patient had previously been feeling well. The patient and his roommate had a celebration the night before, where they drank homemade liquor. His temperature is 37°C (98.6°F), pulse is 126/min, respirations are 30/min and shallow, and blood pressure is 84/44 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 96%. He is unresponsive to painful stimuli. The pupils are 3 mm, equal, round, and reactive to light. The lungs are clear to auscultation. Cardiac examination shows a grade 2/6 systolic murmur along the left parasternal border. Laboratory studies show: Serum Na+ 146 mmol/L K+ 7.7 mmol/L Cl- 111 mmol/L Urea nitrogen 5.8 mmol/L Glucose 83 mg/dL Lactate 11.2 mmol/L Serum osmolality 379 mosm/kg Arterial blood gas analysis shows: pH 6.69 pCO2 53 mm Hg pO2 84 mm Hg HCO3- 4.3 mmol/L The patient is intubated and fluid resuscitation is begun. Which of the following is the most appropriate pharmacotherapy?" ---- <<Choices:>> A) N-acetylcysteine B) Fomepizole C) Naloxone D) Flumazenil ---- <<Answer:>>
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B
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<<Question:>> A 22-year-old woman presents with an episodic history of swelling of the face, hands, and neck and a single episode of difficulty swallowing. She also has a history of frequent, severe abdominal pain. At the time of her visit, her blood pressure is 126/84 mm Hg, heart rate is 82/min, and respiratory rate is 15/min. Physical examination is unremarkable except for a swollen right hand as shown in the image below. Imaging studies are normal and do not reveal any cause of her pain. Her C1 inhibitor level is less than 6% of the reference value. Which of the following is the most likely diagnosis for this patient? ---- <<Choices:>> A) DiGeorge syndrome B) Hereditary angioedema C) Paroxysmal nocturnal hemoglobinuria D) Chediak-Higashi syndrome ---- <<Answer:>>
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B
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<<Question:>> A 60-year-old man calls his hospital and asks to speak to his physician about laboratory test reports ordered because of a 3-month history of abdominal fullness and generalized fatigue. The referral note shows that he was constipated for the previous week. His abdominal examination had shown distention, and a 7-cm, hard, irregular, nontender mass was palpable on rectal examination. His colonoscopy report reveals a low anterior circumferential rectal lesion. An MRI of the pelvis shows a rectal mass with involvement of the prostate and seminal vesicles. A brief review of the results shows that an endoscopic biopsy confirms the clinical diagnosis of advanced rectal adenocarcinoma. His serum carcinoembryonic antigen concentration is 21.0 ng/mL (N < 2.5). The physician is tasked with delivering the diagnosis to the patient. Which of the following is the most appropriate statement by the physician at this time? ---- <<Choices:>> A) """Your lab reports show that you have a locally advanced rectal adenocarcinoma""" B) """Would you like to know all the details of your diagnosis, or would you prefer I just explain to you what our options are?""" C) """I would like to meet later today at 4:00 PM so that we have enough time to discuss the lab results. If you'd like a friend or family member to accompany you, feel free to bring them along.""" D) """You must be be curious as to why all these tests were ordered, and you may even be anxious about the results.""" ---- <<Answer:>>
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C
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<<Question:>> A 50-year-old man has a kidney transplantation for end-stage renal disease in the setting of long-standing polycystic kidney disease. His postoperative course is uncomplicated. He had smoked one pack of cigarettes daily for 20 years but quit 5 years ago. He does not drink alcohol or use illicit drugs. Current medications include basiliximab, mycophenolate mofetil, and prednisone. His vital signs are within normal limits. On physical examination, the surgical incisions appear clean and intact. Prior to discharge, administration of which of the following is most appropriate in this patient? ---- <<Choices:>> A) Azithromycin B) Trimethoprim-sulfamethoxazole C) Acyclovir D) Varicella vaccine ---- <<Answer:>>
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B
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<<Question:>> A 28-year-old woman, gravida 1, para 0, at 32 weeks' gestation comes to the physician for a prenatal visit. She has had no prenatal care. She emigrated from China 5 years ago and cannot recall all of her vaccinations. She appears well. Physical examination shows a uterus consistent in size with a 32-week gestation. Serum studies show: Anti-hepatitis A IgM antibody negative Anti-hepatitis A IgG antibody positive Hepatitis B surface antigen negative Anti-hepatitis B surface antibody positive Hepatitis B core antigen negative Anti-hepatitis B core antibody negative Which of the following is the most appropriate next step in management?" ---- <<Choices:>> A) Plan normal vaginal delivery at term B) Determine hepatitis B e antigen serum level C) Administer hepatitis B vaccine to mother D) Perform liver biopsy of mother ---- <<Answer:>>
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A
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<<Question:>> A 58-year-old woman presents to her family physician for an annual checkup. During the visit, the patient asks her physician for help quitting smoking cigarettes. She has unsuccessfully tried quitting several times previously and has also failed prior attempts with meditation and exercise. The physician prescribes a partial agonist of the nicotinic receptor to aid the patient in cessation. Which of the following is a potential side effect of this medication? ---- <<Choices:>> A) Seizure B) Sexual dysfunction C) Suicidal ideation D) Tachycardia ---- <<Answer:>>
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C
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<<Question:>> A 57-year-old man with chronic obstructive pulmonary disease comes to the emergency department because of leg swelling for 2 weeks. He has smoked 2 packs of cigarettes daily for the past twenty years. His vital signs are within normal limits. Physical examination shows jugular venous distention, hepatomegaly, and pitting edema of both lower extremities. Cardiac examination shows a regular heart rate and normal heart sounds. Auscultation of the lungs shows scattered wheezing without crackles. Left ventricular ejection fraction is 60%. Which of the following is the most likely underlying cause of this patient's condition? ---- <<Choices:>> A) Left-sided systolic heart failure B) Ventricular septal defect C) Chronic occlusion of the pulmonary vessels D) Chronic hypoxic vasoconstriction ---- <<Answer:>>
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D
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<<Question:>> A young Mediterranean teen brings her 4-year-old little brother to the Emergency Room because of a high temperature. Their parents are on their way to the hospital, but, in the meantime, she provides some of the history. She explains that he has been running a fever and limping for the past week. This morning, she had trouble awakening him, and she noticed some swelling and redness around his right ankle. In terms of his past medical history, she knows he has something wrong with his blood. He had to receive extra vaccinations as an infant, and he takes an antibiotic everyday. On exam in the ED, his temperature is 102.4 deg F (39.1 deg C), blood pressure is 90/60 mmHg, pulse is 123/min, and respirations are 22/min. He is lethargic, and his exam is noteworthy for erythema and edema in an area surrounding his distal shin. What is the most likely diagnosis? ---- <<Choices:>> A) Dactylitis B) Avascular necrosis C) Osteomyelitis D) Thrombophlebitis ---- <<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 47-year-old man comes to the emergency department complaining of weight gain and abdominal discomfort. He states that over the past month he has gained 10 lbs. This week he began experiencing mild, diffuse abdominal discomfort. He denies nausea, vomiting, constipation, or diarrhea. The patient has not seen a physician in years and takes no medications. He is a truck driver. He states that he drinks a 6-pack of beer per night. On physical examination, there is jaundice, hepatomegaly, and a positive fluid wave. An abdominal ultrasound reveals cirrhosis, portal vein dilation, and moderate ascites. He undergoes a paracentesis that relieves his symptoms. Fluid analysis is shown below: Serum: Albumin: 4.0 g/dL Ascitic fluid: Color: Yellow Leukocyte count: 100/mm^3 with 50% neutrophils Protein: 2.3 g/dL Albumin: 1.9 g/dL A culture is pending. He is discharged and instructed to follow-up with a gastroenterologist for an upper endoscopy. Upper endoscopy reveals multiple, small non-bleeding esophageal varices. Which of the following is the next best step in management of the patient’s condition? ---- <<Choices:>> A) Atenolol B) Ceftriaxone C) Propranolol D) Transjugular intrahepatic portosystemic shunt ---- <<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:>> An 8-month-old boy is brought to the office by his mother for recurrent infections. Over the past 2 months, the boy had multiple visits to the urgent care clinic for respiratory, ear, and skin infections. His mother is concerned about the health of her child. Currently, the child had a runny nose for the last 2 days. There is no fever but the mother adds that the boy is not eating very well. His mother denies any history of infection during her pregnancy and was tested negative for HIV. The patient’s heart rate is 90/min, respiratory rate is 14/min, and temperature is 36.7°C (98.0°F). On physical exam, there are decreased lung sounds in the left lower lobe. A chest X-ray reveals an absent thymic shadow and fails to show any lung pathology. There is no history of similar symptoms in the families of either parent. What is the most likely cause of this patient’s condition? ---- <<Choices:>> A) Adenosine deaminase deficiency B) Hypoxanthine-guanine phosphoribosyl transferase (HGPRT) deficiency C) HIV infection D) Purine nucleoside phosphorylase deficiency ---- <<Answer:>>
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A
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<<Question:>> A 4-year-old girl is brought to the physician because of a nonpruritic, painless rash on her face for 5 days. She was born at term and has been healthy since. Her 62-year-old maternal grandmother has bullous pemphigoid. Her development is adequate for her age and immunizations are up-to-date. She appears healthy and well-nourished. Her temperature is 37°C (98.6°F) and pulse is 90/min. Examination shows a nontender rash on the right side of the patient's face. An image of the patient's lower face is shown. The remainder of the examination shows no abnormalities. Which of the following is the most appropriate next step in management? ---- <<Choices:>> A) Potassium hydroxide preparation B) Oral cephalexin therapy C) Skin biopsy D) Topical mupirocin therapy ---- <<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 56-year-old man comes to the physician for a routine health maintenance examination. He has had mild pain in his left groin for 2 weeks. He was admitted to the hospital 1 month ago for myocardial infarction. Cardiac catheterization and angiography showed occlusion of the left anterior descending artery and he underwent placement of 2 stents. He has hypertension and hypercholesterolemia. There is no family history of serious illness. He has smoked 2 packs of cigarettes daily for 30 years. Current medications include aspirin, clopidogrel, rosuvastatin, and enalapril. His temperature is 36.7°C (98°F), pulse is 88/min, and blood pressure is 130/84 mm Hg. Examination shows a 3-cm (1.2-in), tender, pulsatile mass in the left thigh, below the inguinal ligament. There is mild erythema of the overlying skin. A loud murmur is heard on auscultation of the mass. Cardiopulmonary examination shows no abnormalities. There is no edema in the lower limbs. Femoral and pedal pulses are palpable bilaterally. Neurologic examination shows no focal findings. Which of the following is the most likely diagnosis? ---- <<Choices:>> A) Femoral artery dissection B) Femoral artery pseudoaneurysm C) Femoral artery thrombosis D) Femoral abscess ---- <<Answer:>>
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B
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<<Question:>> A 1-year-old girl is brought to the physician because of fever and crying while passing urine for 2 days. She was born at term and has been healthy since. Three months ago, she was treated for a urinary tract infection with oral cefixime. Her temperature is 39°C (102.2°F), pulse is 144/min, and blood pressure is 85/40 mm Hg. Physical examination shows no abnormalities. Her leukocyte count is 14,000/mm3. Urine dipstick shows leukocyte esterase and nitrites; urinalysis shows WBCs and gram-negative rods. Urine culture results are pending. Renal ultrasonography shows hydronephrosis of the left kidney. Empirical antimicrobial therapy is initiated, following which the patient's symptoms improve. Which of the following is the most appropriate next step in diagnosis? ---- <<Choices:>> A) Intravenous pyelography B) Dynamic renal scintigraphy C) Urodynamic testing D) Voiding cystourethrography ---- <<Answer:>>
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D
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<<Question:>> A 69-year-old woman presents to her primary care physician complaining of a new-onset, left-sided, throbbing headache that has lasted for several days. She reports that the pain is worsened by eating. Which of the following is a complication of this condition if not treated promptly? ---- <<Choices:>> A) Skin nodules B) Intestinal ischemia C) Monocular blindness D) Ischemic stroke ---- <<Answer:>>
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C
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<<Question:>> A 32-year old woman presents to the office complaining of progressively worsening shortness of breath for 2 months. She was seen multiple times in the past for complications of systemic lupus erythematosus that include anemia, pericarditis, and chronic interstitial lung disease. As she does not have medical insurance, she does not regularly follow up with her physician and also is not compliant with her medications. She does not drink alcohol, smoke cigarettes, or take illicit drugs. Her family history is positive for colon cancer in her father. Her temperature is 36.5°C (97.8°F), the blood pressure is 106/70 mm Hg, the pulse is 84/min, and the respirations are 16/min. Severe clubbing of her fingernails is noted. Which of the following best describes the pathogenesis of this patient's nail findings? ---- <<Choices:>> A) Septic emboli B) Atherosclerotic emboli C) Entrapment of megakaryocytes in the nail bed D) Chronic hypoxemia ---- <<Answer:>>
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C
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<<Question:>> An otherwise healthy 27-year-old woman presents to the emergency department because of worsening headaches and nosebleeds. Her blood pressure is 185/115 mm Hg, pulse is 88/min and temperature is 36.9°C (98.4°F). She denies the use of nicotine, alcohol, or illicit drugs. Family history is irrelevant. Physical examination is only positive for abdominal bruits. She is given a calcium-channel blocker and a thiazide diuretic, but her blood pressure did not respond adequately. Aldosterone-to-renin ratio is < 20. Which of the following is the most likely cause of this patient’s condition? ---- <<Choices:>> A) Renal artery stenosis B) Essential hypertension C) Coarctation of the aorta D) Primary aldosteronism ---- <<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 farmer from Jamaica presents to his physician with a wart-like lesion on his left foot. He is a plantain farmer and often farms barefoot because of the pleasant climate. Physical examination reveals warty, cutaneous nodules that resemble the florets of cauliflower. On a KOH preparation, irregular, dark brown, yeast-like bodies with septae are noted. Culture on Sabouraud agar reveals sclerotic bodies. Which of the following is the most likely diagnosis? ---- <<Choices:>> A) Mycetoma B) Sporotrichosis C) Entomophthoromycoses D) Chromoblastomycosis ---- <<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 52-year-old man comes to the physician because of a 3.6-kg (8-lb) weight loss over the past 3 months and increasing fatigue. He was diagnosed with hepatitis C 6 years ago. His father died of colon cancer. He has smoked one pack of cigarettes daily for 35 years and drinks one beer daily. He used cocaine and heroin in the past but stopped 12 years ago. He is 176 cm (5 ft 8 in) tall and weighs 71 kg (156 lb); BMI is 22.9 kg/m2. His temperature is 37.0°C (98.6°F), pulse is 79/min, and blood pressure is 115/75 mm Hg. He appears weak and lethargic. Examination shows scleral icterus and scars on both cubital fossae. There is reddening of the palms bilaterally. There are several telangiectasias over the chest and back. The abdomen is soft and nontender. The liver is firm and of nodular consistency. Laboratory studies show: Hemoglobin 11.6 g/dL Mean corpuscular volume 88 μm3 Leukocyte count 9,600/mm3 Platelet count 223,000/mm3 Ultrasonography of the liver shows a solitary lesion. Which of the following findings is most likely in this patient?" ---- <<Choices:>> A) Positive blood cultures B) Elevated α-fetoprotein C) Elevated carcinoembryonic antigen D) Spiculated lesion on chest CT ---- <<Answer:>>
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B
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<<Question:>> A 63-year-old man comes to the physician for the evaluation of difficulty walking for the last 6 months. He reports weakness in his lower legs that improves with exercise and throughout the day. Three months ago, he started adding flax seeds to his breakfast because he is frequently constipated. He has hypertension and type 2 diabetes mellitus. He has smoked 2 packs of cigarettes daily for the last 45 years. His current medications include enalapril and metformin. Vital signs are within normal limits. Examination shows dry mucous membranes. Muscle strength in the lower extremities is decreased. Sensation to pinprick and light touch is normal. Deep tendon reflexes are 1+ bilaterally. Active muscle contraction or repeated muscle tapping increases reflex activity. Which of the following is most likely to confirm the diagnosis? ---- <<Choices:>> A) Demyelinating plaques on a brain MRI B) Autoantibodies against voltage-gated calcium channels C) Decremental response following repetitive nerve stimulation D) Fasciculations and positive sharp waves on EMG ---- <<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 5-year-old boy is brought to the emergency department by his mother because of abdominal pain. His mother says that he has not had any fever, vomiting, diarrhea, or dysuria. His last bowel movement was 3 days ago and appeared normal. The boy is restless and clutches his abdomen. His temperature is 37.2°C (99°F), blood pressure is 108/76 mm Hg, pulse is 110/min, respirations are 20/min. The abdomen appears mildly distended. On auscultation, he has hyperactive bowel sounds. The remainder of the examination shows no abnormalities. An ultrasound of the abdomen shows no abnormalities. Which of the following is the most appropriate next step in management? ---- <<Choices:>> A) Administer polyethyelene glycol B) Reassurance and observation C) Perform a barium enema D) Start empirical antibiotic therapy ---- <<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 30-year-old woman presents to the emergency department with chest pain. She states that she was making coffee this morning when she suddenly developed sharp, 8/10, mid-sternal chest pain. The pain does not radiate and is constant. She is worried because she has a marathon next week that she has been training for. Her medical history is significant for seasonal allergies. She takes no medications except a multivitamin. Her mother has asthma. She works as a lawyer. She denies sick contacts or recent travel. She has a glass of wine with dinner but denies tobacco or recreational drug use. The patient’s initial temperature is 98°F (36.7°C), blood pressure is 122/78 mmHg, pulse is 89/min, and respirations are 14/min with an oxygen saturation of 98% on room air. A physical examination is within normal limits. Labs are pending. Which of the following is the best initial step in management? ---- <<Choices:>> A) Aspirin, oxygen, nitroglycerin, and morphine B) Computerized tomography scan C) Electrocardiogram D) Heparin ---- <<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 34-year-old woman, gravida 2, para 1, at 34 weeks' gestation comes to the physician because of a 10-day history of generalized pruritus and a 2-day history of jaundice, dark urine, and pale stools. She had developed pruritus at the end of her previous pregnancy, which disappeared after delivery. She has had standard prenatal care. Medications include folic acid and a multivitamin. Her blood pressure is 108/60 mm Hg. Examination shows scleral icterus, jaundice, and scratch marks on her upper and lower limbs. Pelvic examination shows a uterus consistent in size with a 30-week gestation. Hemoglobin 11.5 g/dl Platelet 350,000/mm3 Prothrombin time 11 seconds (INR=1) Serum Total bilirubin 5 mg/dl Direct bilirubin 4.2 mg/dl Bile acid 25 μmol/l (N= 0.3 to 10 μmol/l) Aspartate aminotransferase 55 U/L Alanine aminotransferase 45 U/L There are no abnormalities on abdominopelvic ultrasonography. Which of the following is the most appropriate next step in management?" ---- <<Choices:>> A) 24-hour urine protein B) Emergency endoscopic retrograde cholangiopancreatography and sphincterotomy C) Immediate induction of labor D) Ursodeoxycholic acid ---- <<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 mother brings her 17-year-old daughter to your office because of a recent onset dull unilateral pelvic pain that started last week. In addition, the daughter also complains of constipation for which she increased her fiber intake, but the dietary changes are not helping her. She began menstruating at the age of 13, and her menstrual cycles are regular (about 28 days). On physical examination, the patient has a large, non-tender, mobile adnexal mass in the left lower quadrant. The pelvic examination is normal except for the presence of the adnexal mass. The patient is advised to have an outpatient ultrasound, and then return to the clinic next week. After 2 weeks, you learned that the patient visited the emergency department for a sudden onset of abdominal pain that required observation after an abdominal ultrasound was performed. The ultrasound showed a large simple cystic mass with increased internal echoes, having a diameter of 10 cm and hyperechogenic vascular walls on the left ovary with a small intraperitoneal collection in the pouch of Douglas. What was the most likely diagnosis of this patient? ---- <<Choices:>> A) Follicular cyst B) Endometrioma C) Corpus luteum cyst D) Dermoid cyst ---- <<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 clinic complaining of right anterior knee pain. She reports that the pain has been present for 3 months and has gradually worsened. She says the pain is exacerbated when climbing or descending the stairs. She also states the pain is sometimes worse with prolonged periods of sitting. She has tried over-the-counter aspirin and ibuprofen without relief. She is a soccer player and is worried that the pain is starting to affect her ability to play. She reports multiple minor lower extremity injuries due to soccer but denies significant trauma such as known fractures or torn ligaments. Her past medical history is unremarkable. She had a myringotomy in her left ear as a child. On examination, there is pain and crepitus on extension of the right knee with anterior patellar compression. Which of the following is the most appropriate management of the patient’s symptoms? ---- <<Choices:>> A) Aspiration B) Orthopedic surgery C) Ossicle resection D) Quadriceps exercises ---- <<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 25-year-old woman is brought to the emergency department by her husband for abdominal pain. The husband answers all questions posed to the patient by the physician. Throughout the interview, the patient makes very little eye contact with the physician. Her husband asks the physician to prescribe “something for her abdominal pain” so that they can return home. Examination of the patient shows mild bruising in the left infraorbital area and a right periorbital hematoma. When asked about her injuries, she quietly states that she fell while walking down the stairwell of her apartment complex. The husband reluctantly leaves the examination room when asked to by the physician. While alone with the physician, the patient admits that her husband is responsible for her injuries. Which of the following immediate responses by the physician is most appropriate? ---- <<Choices:>> A) """May I add some information about local domestic violence agencies to your discharge records?""" B) """Do you feel safe leaving the emergency department?""" C) """How often has your husband physically hurt you in the past?""" D) “May I ask your husband to join us so we can talk about this matter together?” ---- <<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 15-year-old girl comes to the physician because of a 2-month history of progressive fatigue and weakness. She also reports recurrent headaches for 2 years, which have increased in severity and frequency. Her blood pressure is 185/95 mm Hg. Serum studies show a morning renin activity of 130 ng/mL per hour (N=1–4), a morning aldosterone concentration of 60 ng/dL (N=5-30), and a potassium concentration of 2.9 mEq/L. Further evaluation is most likely to show which of the following? ---- <<Choices:>> A) ACTH-producing growth in the pituitary gland B) Increased 17-hydroxyprogesterone levels C) Pleomorphic modified smooth muscle cells in the renal cortex D) Involution of zona glomerulosa of the adrenal gland ---- <<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 15-year-old boy is brought to the emergency department by his mother because of severe left testicular pain for 1 hour. For the past week, he has also had mild testicular pain and pain on urination. He has not had nausea or vomiting. He is otherwise healthy. His temperature is 39.1°C (102.3°F), pulse is 114/min, and blood pressure is 120/76 mm Hg. Examination shows a high-riding, swollen, erythematous tender left testis; lifting the left testis relieves his pain. His hemoglobin concentration is 15.6 g/dL, leukocyte count is 14,600/mm3, and platelet count is 290,000/mm3. Testicular ultrasound shows increased blood flow to the left testicle when compared to the right and an enlarged left epididymis with decreased echogenicity. Further evaluation of this patient is most likely to show which of the following findings? ---- <<Choices:>> A) Reducible scrotal mass B) Gram-negative rods in urethral swab C) Positive nucleic acid amplification testing D) Absent cremasteric reflex ---- <<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 27-year-old female presents to the emergency department with complaints of acute-onset fatigue, blurred vision, and rash earlier today. Her husband rushed her to emergency department when he noted that she was exhibiting changes in her mental status and had trouble speaking. Her vital signs are as follows: T 38.4, HR 87, BP 110/85, RR 14, and SpO2 96%. Physical examination reveals petechiae, pallor, and left upper extremity weakness. Work-up reveals Hgb 8.5 g/dL, platelets 22,000 cells/uL, normal PT/INR and PTT, absent fibrin split products, elevated fibrinogen, a negative Coombs test, 3.7 mg/dL creatinine, 3.8 mg/dL indirect bilirubin, and LDH 1000 IU/L. Which of the following would be expected on a peripheral blood smear from this patient? ---- <<Choices:>> A) Spherocytes B) Atypical lymphocytes C) Schistocytes D) Rouleaux formation ---- <<Answer:>>
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C
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<<Question:>> A 67-year-old African American male presents to his primary care physician for routine follow-up. He has a history of poorly controlled hypertension, despite being on lisinopril, hydrochlorothiazide, amlodipine and metoprolol, which he takes regularly. His blood pressure during the visit is 170/80. He does not have kidney disease. His primary care physician decides to start him on methyldopa. What is the mechanism of action of methyldopa? ---- <<Choices:>> A) Direct vascular smooth muscle relaxation B) Dopamine receptor agonist C) Centrally acting alpha2 adrenergic receptor agonist D) Inhibition of alpha1 adrenergic receptors ---- <<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 2800-g (6-lb 3-oz), 3-day-old newborn is in the intensive care unit for fever, vomiting, tremors, cyanotic episodes, and seizures. She was born at 36 weeks to a 25-year-old primigravid woman. Spontaneous vaginal delivery was complicated by maternal fever and chorioamnionitis. Apgar scores were 6 at 1 minute and 7 at 5 minutes, respectively. Shortly after delivery, the child had seizures and high-grade fever with poor feeding and hypotonia. She was intubated for respiratory distress. Her temperature is 39°C (102.3°F), pulse is 180/min, and respirations are 60/min. Physical exam shows grunting breath sounds, an enlarged liver palpable 3 cm below the right costal margin, and lethargy. A CT scan of the chest, abdomen, and pelvis shows multiple pulmonary and hepatic granulomas. Which of the following would most likely have prevented this complication? ---- <<Choices:>> A) Avoiding unpasteurized milk products B) Measles, mumps, rubella vaccination before pregnancy C) Prophylactic penicillin D) Delivery via cesarean section ---- <<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 45-year-old woman presents to her primary care practitioner requesting a routine checkup for a job application. Her family history is negative for malignancies and inheritable diseases. She has been married for 15 years and has 2 healthy children. Her past medical history is negative for surgical procedures and cardiovascular disease; however, she used to work as a radiology technician. Her only complaints at the moment are neck pain and hoarseness. Physical examination is unremarkable except for a painless nodule in the right lobe of the thyroid gland with no inflammatory signs. In a follow-up appointment, the patient brings the results of her thyroid function tests, which are normal. She also brings the results of a fine-needle aspiration biopsy that report the pathology of the nodule as follicular neoplasia. After some discussion, the patient opts for surgical treatment. With a surgical pathology report that describes vascular invasion, which of the following additional features would you expect to find for this thyroid nodule? ---- <<Choices:>> A) Capsular invasion B) Cystic nature C) Psammoma bodies D) Pleomorphic cells without follicle development ---- <<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 man comes to the physician because of progressive shortness of breath and a worsening cough for the past month. He also reports occasional bloody sputum. He has lost about 7 kg (15.4 lb) of weight over the past 4 months despite having no change in appetite. He has smoked 2 packs of cigarettes daily for 15 years but stopped smoking at the age of 55. Physical examination shows reduced breath sounds throughout both lungs. An x-ray of the chest is shown. Which of the following is the most likely cause of the patient's symptoms? ---- <<Choices:>> A) Squamous cell lung carcinoma B) Small cell lung cancer C) Lung adenocarcinoma D) Pulmonary metastases ---- <<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 67-year-old man comes to the physician due to exertional dyspnea and lower extremity swelling for the last 4 weeks. The patient has been a smoker for the last 45 years and has been diagnosed with COPD. He has no history of diabetes mellitus or ischemic heart disease. He is non-compliant with his medications for COPD. The patient is a retired social worker and spends most of his time at home. His temperature is 37.2°C (98.9°F), blood pressure is 135/115 mm Hg, pulse is 90/min, and respirations are 22/min. Oxygen saturation on room air is 92%. Physical examination reveals a barrel-shaped chest, distension of neck veins, and 3+ bilateral pitting edema of his lower extremities. The liver is palpated 6 cm below the costal margin and is tender to palpation. Application of pressure on the upper abdomen causes persistent distension of jugular veins. Lungs are clear to auscultation. Chest X-ray shows enlarged main pulmonary arteries. ECG shows right bundle branch block and right ventricular hypertrophy. Which of the following is the gold standard test for diagnosing this patient’s condition? ---- <<Choices:>> A) Right heart catheterization B) Coronary angiography C) Abdominal paracentesis D) Ultrasound of liver ---- <<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 13-year-old African-American girl is brought to the physician for right shoulder pain that has worsened over the past month. She has had many episodes of joint and bone pain and recurrent painful swelling in her hands and feet. Physical examination shows tenderness of the right anterior humerus without swelling or skin changes. Active and passive range of motion of the right shoulder is decreased and there is pain with movement. The leukocyte count is 4600/mm3. An x-ray of the right shoulder shows subchondral lucency of the humeral head with sclerosis and joint space narrowing. Which of the following is the most likely underlying cause of this patient's shoulder pain? ---- <<Choices:>> A) Infection of the joint space B) Crystal deposition within the joint C) Infarction of the bone trabeculae D) Infection of the bone ---- <<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 4-month-old male presents to the emergency department with severe cough, wheezing, and cyanosis. You suspect bronchiolitis of viral etiology and you administer an anti-viral medication. This drug is often used to treat which one of these other infections? ---- <<Choices:>> A) Hepatitis B B) Hepatitis C C) Rhinovirus D) HSV ---- <<Answer:>>
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B
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<<Question:>> A 43-year-old woman presents to the clinic complaining of “spotting.” She states that over the past 5 months she has had intermenstrual bleeding. Additionally, her menses last more than a week with the first 4 days consisting of heavy bleeding. She denies abdominal pain but reports feeling an increasing “pressure-like" discomfort. She denies dysuria, dyspareunia, or dyschezia. Prior to 5 months ago, her menstrual periods were only 4 days long and consisted of moderate bleeding. Her periods normally occur every 28 days. She is frustrated because she feels like she needs to wear a pad all the time. The patient delivered 3 healthy children vaginally without complications, followed by a tubal ligation. Her last menstrual period was 1 week ago. She is sexually active with her husband and denies a history of sexually transmitted diseases. She has never had an abnormal pap smear. Her last pap smear and test for human papillomavirus was 4 years ago. The patient has hypothyroidism treated with levothyroxine. On physical examination, the thyroid is normal in size without masses or tenderness. Pelvic examination reveals a firm, mobile, enlarged, irregularly-shaped uterus without adnexal tenderness. Speculum exam is unremarkable. Which of the following is the most likely diagnosis? ---- <<Choices:>> A) Adenomyosis B) Cervical cancer C) Endometriosis D) Leiomyoma ---- <<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 comes to the physician because of a 1-week history of fatigue and yellow discoloration of her eyes. Four weeks ago, she had a sore throat and was diagnosed with a viral infection that self-resolved. She has no history of serious medical illness. Her only medication is an oral contraceptive. She appears tired. Her pulse is 94/min, and blood pressure is 125/75 mm Hg. Physical examination shows scleral icterus. The liver edge is palpable 2 cm below the right costal margin and the spleen tip is palpable 4 cm below the left costal margin. Skin examination shows no rashes. Her hemoglobin concentration is 9.5 g/dL, and the direct antiglobulin test is positive. Which of the following additional laboratory findings is most likely in this case? ---- <<Choices:>> A) Increased serum C3 complement concentration B) Increased direct bilirubin level C) Decreased haptoglobin level D) Decreased mean corpuscular volume ---- <<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 67-year-old female is admitted to the hospital with enterococcus endocarditis and is treated with penicillin and gentamicin. During her admission, she develops worsening pulmonary edema secondary to valvular insufficiency and requires therapy with IV furosemide. This patient is most likely to experience which of the following adverse reactions to her current pharmacological treatment: ---- <<Choices:>> A) Ringing in the ears and impaired hearing B) Hyperkalemia leading to possible cardiac arrhythmia C) Diffuse flushing and redness over body surface D) Pseudomembranous colitis and diarrhea ---- <<Answer:>>
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A
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<<Question:>> A 75-year-old male is brought to the emergency room by his daughter due to slurred speech and a drooping eyelid on the right side. This morning, he had difficulty eating his breakfast and immediately called his daughter for help. She says that his voice also seems different. His temperature is 99°F (37.2°C), blood pressure is 120/78 mmHg, pulse is 90/min, respirations are 21/min, and pulse oximetry is 98% on room air. On physical exam, he is oriented to time and place. There is right-sided nystagmus and he has difficulty with point-to-point movement. Where is the lesion responsible for his symptoms most likely located? ---- <<Choices:>> A) Posterior inferior cerebellar artery B) Anterior cerebral artery C) Anterior inferior cerebellar artery D) Basilar artery ---- <<Answer:>>
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A
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<<Question:>> You are conducting an experiment on a cell line in your laboratory. You introduce a molecule into the tissue culture dish containing the cell line that binds to a transmembrane protein. As a result, the affected cell initiates a process characterized by karyorrhexis, membrane blebbing, and pyknosis. What was the molecule that you introduced into the culture? ---- <<Choices:>> A) Perforin B) Granzyme B C) FAS-ligand D) BCL-2 ---- <<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 45-year-old woman comes to the physician because of a 6-month history of progressive irritability, palpitations, heat intolerance, frequent bowel movements, and a 6.8-kg (15-lb) weight loss. She also has a smooth, uniformly enlarged mass at the front of her neck and protuberant eyes with lid retraction. Laboratory investigations show undetectable levels of thyroid stimulating hormone, elevated levels of free T3 and T4, and a raised titer of TSH receptor autoantibodies (TRAbs). Therapy is initiated with radioactive iodine-131. This patient is at greatest risk for which of the following complications? ---- <<Choices:>> A) Worsening exophthalomos B) Agranulocytosis C) Vocal cord paralysis D) Thyroid carcinoma " ---- <<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 56-year-old woman comes to the emergency department because of severe abdominal pain associated with nausea and vomiting for 12 hours. The pain extends from the epigastrium to the right upper quadrant and radiates to the right scapula. The patient has gastroesophageal reflux disease. She underwent total thyroidectomy for papillary thyroid carcinoma 3 years ago. She has smoked one pack of cigarettes daily for 35 years. Current medications include levothyroxine, omeprazole, and a multivitamin. The patient appears uncomfortable. Her temperature is 38.1°C (100.6°F), pulse is 93/min, and blood pressure is 140/85 mm Hg. Abdominal examination shows tenderness to deep palpation in the right upper quadrant. The patient's leukocyte count is 10,300/mm3. Abdominal ultrasonography shows thickening of the gallbladder wall, without dilatation of the intra- and extrahepatic bile ducts. Laparoscopic cholecystectomy is performed. Pathological examination shows acute cholecystitis. There is an ulcerated 1 x 1.5-cm mass in the fundus of the gallbladder with invasion of the gallbladder wall and lymphatic vessels. Which of the following is the most likely underlying condition? ---- <<Choices:>> A) Adenocarcinoma of the sigmoid colon B) Cutaneous malignant melanoma C) Multiple endocrine neoplasia D) Squamous cell carcinoma of the esophagus " ---- <<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:>> You are on your first day of a pathology rotation and the attending pathologist gives you a biopsy specimen to examine. She says it is from the antrum of the stomach of a 32-year-old man who has been complaining of abdominal pain for the past 6 months. The patient states the pain gets worse when eating. On endoscopy, there was a single ulcerated lesion with a 'punched out' appearance. What are the most likely histologic findings in this biopsy specimen? ---- <<Choices:>> A) Signet ring cells B) An abundance of self reactive T cells C) A urease-positive organism D) Absence or evidence of destruction of parietal cells ---- <<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 40-year-old man is brought into the emergency department by his wife complaining of intense lower right abdominal pain. An abdominal CT scan was performed which noted a dilated appendix with a thickened wall and the accumulation of extraluminal fluid. A quick history is taken while the OR is prepped for surgery. Past medical history is noncontributory and the patient takes no medications. Social history reveals a sedentary lifestyle. The patient admits to regularly drinking several beers and several shots of vodka every night. He had to stop drinking 2 days ago due to the intense abdominal pain. The patient is brought into the OR and the inflamed and necrotic appendix is removed. He is admitted to the hospital for overnight monitoring. Later that night, the patient begins to hallucinate. Which type of hallucination is this patient likely to experience? ---- <<Choices:>> A) Proprioceptive hallucinations B) Olfactory hallucination C) Gustatory hallucination D) Tactile hallucination ---- <<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 34-year-old woman presents with sudden onset flank pain for the past day. She describes the pain as intermittent and radiating to her groin. She denies any similar symptoms in the past. No significant past medical history. The patient currently does not take any medications. Family history is significant for her mother who died of a pancreatic tumor at the age of 53. Laboratory analysis reveals: Serum calcium 12 mg/dL Serum phosphorus 2.2 mg/dL Serum parathyroid hormone 105 pg/mL Which of the following mutated gene products is most likely causing this patient’s symptoms? ---- <<Choices:>> A) Receptor tyrosine kinase B) Cytokine receptor C) Threonine kinase D) Menin ---- <<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:>> As a public health practitioner, you are charged with choosing which blood test to use for the screening of a new infectious disease. You want to ensure that as many cases of this disease as possible are picked up by this initial screening test. Which of the following is the highest priority characteristic of this new test? ---- <<Choices:>> A) Highly sensitive test B) Low false positive rate C) High true positive rate D) Low negative predictive value ---- <<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 is brought into the hospital by his family because they are concerned that he has post-traumatic stress disorder. The patient is a marine and was deployed to Afghanistan 2 years ago. He was able to successfully reintegrate with society upon his return; however, for the last 2 weeks, he has been having recurrent nightmares and avoiding news coverage on the war. He has become more and more detached from his family and friends and, on the few times he does interact with them, he has angry outbursts. The patient is afebrile, and his vital signs are within normal limits. Physical examination is unremarkable. Which of the following findings is most important in correctly diagnosing this patient’s condition? ---- <<Choices:>> A) Duration of symptoms B) State of hyperarousal C) Avoidance of triggers D) Negative 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 4-year-old girl is brought to the pediatrician because of throat pain for 2 days. She had frequent episodes of oral thrush as a baby and has been treated for vaginal yeast infection twice in the past year. Physical examination shows white patches on the tongue and palate. Scraping off the patches reveals erythematous oral mucosa with pinpoint bleeding. Leukocyte count is within normal range. Exposure to nitroblue tetrazolium turns the patient's neutrophils dark blue. A deficiency in which of the following enzymes is the most likely cause of this patient's recurrent infections? ---- <<Choices:>> A) Adenosine deaminase B) Pyruvate kinase C) Glucose-6-phosphate dehydrogenase D) Myeloperoxidase ---- <<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 male with chronic dyspnea is intubated and started on mechanical ventilation for respiratory failure. Pressure-volume scalars on the ventilator show decreased change in volume for each unit change in pressure as compared to normal values. Of the following options, which is the most likely cause of his respiratory failure? ---- <<Choices:>> A) Asthma B) Centriacinar emphysema C) Pulmonary fibrosis D) Alpha-1-antitrypsin deficiency ---- <<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 6-year-old African-American boy presents with severe pain and swelling of both his hands and wrists. His symptoms onset 2 days ago and have not improved. He also has had diarrhea for the last 2 days and looks dehydrated. This patient has had two similar episodes of severe pain in the past. Physical examination reveals pallor, jaundice, dry mucous membranes, and sunken eyes. Which of the following mutations is most consistent with this patient’s clinical condition? ---- <<Choices:>> A) Chromosomal deletion B) Nonsense C) Missense D) Frame shift ---- <<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 45-year-old woman presents to her primary care physician with complaints of weight loss and anxiety. She says that over the past 6 months she has lost 10 pounds even though she has had an increased appetite. In addition, she describes 3 episodes where it felt like her heart was "pounding out of her chest." Her temperature is 99.3°F (37.4°C), pulse is 106/min and regular, blood pressure is 141/80 mmHg, and respirations are 18/min. Physical exam is significant for mild bilateral proptosis and 3+ deep tendon reflexes bilaterally. Which of the following is the best initial therapy for the patient's condition? ---- <<Choices:>> A) Adenosine B) Potassium iodide C) Propranolol D) Thyroidectomy ---- <<Answer:>>
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C
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