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Answer the following medical question with the correct letter choice:
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<<Question:>> A 58-year-old woman is brought to the emergency department by her husband because of increasing confusion and generalized fatigue over the past week. During this period, she has had muscle cramps, headaches, nausea, and vomiting. Six days ago, she underwent resection of a parasagittal meningioma. She tolerated the procedure well without complications and was discharged two days ago. She has hypercholesterolemia and hypertension. Current medications include oxycodone, acetaminophen, atorvastatin, and hydrochlorothiazide. She is oriented only to person and place. Her temperature is 37°C (98.6°F), pulse is 89/min, respiratory rate is 14/min, and blood pressure is 142/88 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 97%. The remainder of the examination shows no abnormalities. Serum studies show: Serum Na+ 126 mEq/L K+ 3.6 mEq/L Cl- 107 mEq/L Urea nitrogen 16 mg/dL Glucose 87 mg/dL Creatinine 0.9 mg/dL Osmolality 255 mOsmol/kg H2O Urine Osmolality 523 mOsmol/kg H2O Sodium 44 mEq/L Which of the following is the most likely cause of this patient's symptoms?" ---- <<Choices:>> A) Cerebral salt wasting syndrome B) Syndrome of inappropriate antidiuretic hormone C) Primary polydipsia D) Mineralocorticoid deficiency ---- <<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 55-year-old man comes to the emergency department because of left arm pain after falling from a ladder. Physical examination shows tenderness along the proximal left humerus. An x-ray of the left arm and shoulder shows a nondisplaced proximal humerus fracture. Which of the following cytokines is most likely to be involved in normal bone healing in this patient? ---- <<Choices:>> A) Interleukin-4 B) Interferon-α C) Granulocyte colony-stimulating factor D) Macrophage colony-stimulating factor ---- <<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 62-year-old African American man is admitted to the emergency department with a 24-hour history of intense epigastric pain that radiates to the back with nausea and vomiting. His medical history is relevant for hypertension, heart failure (HF), chronic obstructive pulmonary disease (COPD), and radicular pain, all under control with amlodipine, furosemide, ipratropium, and gabapentin. He drinks occasionally at family gatherings and has never smoked cigarettes. His vital signs are recorded as follows: blood pressure of 130/80 mm Hg, a heart rate of 78/min, a respiratory rate of 18/min, and a body temperature of 36.6°C (97.9°F). Abdominal examination shows edema and bruising of periumbilical subcutaneous tissue and intense pain to touch but no signs of peritoneal irritation. Which of the following is the most likely responsible for this patient’s condition? ---- <<Choices:>> A) Furosemide B) Ipratropium C) Gabapentin D) Alcohol consumption ---- <<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 62-year-old woman presents to the emergency department complaining of intense pain in her right knee that started 12 hours ago. Her past medical history is significant for hemochromatosis, managed with biweekly phlebotomy. Her vitals include: blood pressure of 130/70 mm Hg, pulse of 82/min, respiratory rate of 18/min, and temperature of 36.5°C (97.7°F). Physical examination reveals an erythematous, warm, and severely tender right knee with a restricted range of motion. An arthrocentesis is performed, and synovial fluid analysis is significant for a neutrophil count of 3,200 cells/μL, a negative Gram stain, and the following result under polarized light microscopy (see image). Which of the following additional findings would you also expect to observe in this patient? ---- <<Choices:>> A) Chondrocalcinosis B) Urate tophi C) Heberden's nodes D) Rheumatoid nodules ---- <<Answer:>>
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A
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 52-year-old man with a history of mild chronic obstructive pulmonary disease (COPD) has been using albuterol as needed to manage his COPD without any other maintenance medications. Recently, he has been experiencing a greater degree of shortness of breath, wheezing, and a productive cough. He denies any recent changes to his activities of daily living, exercise, or recent upper respiratory illnesses. The vital signs include: temperature 36.7°C (98.0°F), blood pressure 126/74 mm Hg, heart rate 74/min, and respiratory rate 14/min. His physical examination shows decreased breath sounds bilateral, and expiratory wheezes, a barrel-shaped chest, and a holosystolic murmur heard best at the 2nd intercostal space on the left. Pulmonary function tests demonstrate a forced expiratory volume-1 (FEV-1) which is 60% of the predicted value. What is the next best step for the management of his COPD? ---- <<Choices:>> A) Add rofilumast to treatment regimen B) Add tiotropium to treatment regimen C) Add tiotropium plus fluticasone to treatment regimen D) Add carbocysteine to treatment regimen ---- <<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 24 year-old male presented to his physician with a homogenous, painless testicular swelling that he noticed for the past two weeks. After ultrasound and blood tests, he subsequently underwent a radical inguinal orchiectomy and pathology was consistent with seminoma. Which of the following would you expect to see in a tissue sample from the patient’s orchiectomy? ---- <<Choices:>> A) Lobules of large cells with prominent nuclei and watery cytoplasm B) Schiller-Duval bodies C) Tubular papillary architecture with necrosis D) Mature derivatives of endoderm, mesoderm, and ectoderm ---- <<Answer:>>
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A
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 31-year-old man comes to the physician because of diarrhea, bloating, nausea, and vomiting for the past week. He describes his stool as greasy, frothy, and soft; it is not red or darkened. The patient went on a hiking trip in Brazil 3 weeks ago. He has no history of serious illness and takes no medications. The patient appears dehydrated. His vital signs are normal. Examination shows dry mucous membranes and diffuse abdominal tenderness. Microscopy of the stool reveals egg-shaped cysts with prominent two-layered cell wall and multiple nuclei. Which of the following is the most appropriate treatment? ---- <<Choices:>> A) Supportive treatment only B) Trimethoprim-sulfamethoxazole therapy C) Metronidazole therapy D) Octreotide therapy ---- <<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 48-year-old man presents to the clinic feeling depressed after a string of failed business projects. His team noticed that he seems less engaged than he once used to be and this is reflecting in his work. He has no previous psychiatric history and symptoms of depressed mood have been ongoing for the past 6 months. A patient health questionnaire 9 (PHQ-9) was administered and the patient scored 10. The patient is started on venlafaxine. The alteration in the normal functioning of which of the following is the mechanism of action for this therapy? ---- <<Choices:>> A) Serotonin, norepinephrine, and dopamine B) Norepinephrine and dopamine C) Serotonin receptor antagonism D) Alpha-2 receptor antagonism ---- <<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 researcher is performing an experiment where she is using bacteria to clone copies of a mutated gene that she plans on introducing to cells. In order to perform this, she has created a small, circular segment of double-stranded DNA that includes the gene of interest as well as a gene for antibiotic resistance. After introducing this segment of DNA to competent bacteria, she plates the bacteria on media containing the antibiotic. Which of the following processes was necessary in order for the bacteria to survive on the plate and contain copies of the gene of interest? ---- <<Choices:>> A) Conjugation B) Transduction C) Transfection D) Transformation ---- <<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 27-year-old woman presents to the emergency department with altered mental status. Her parents found her in her room surrounded by pill bottles, alcohol, and illicit drugs 10 minutes ago and promptly brought her in. She was unconscious with lacerations on her wrists. The patient has a past medical history of depression, fibromyalgia, and multiple suicide attempts. Physical exam is notable for a somnolent young woman who responds to questions but is non-compliant in describing the history. She is currently vomiting and her gait seems ataxic. Initial laboratory values are unremarkable. An arterial blood gas analysis reveals the following findings. Arterial blood gas pH: 7.50 pO2: 105 mmHg pCO2: 20 mmHg Bicarbonate: 24 mEq/L Which of the following is the most likely intoxication in this patient? ---- <<Choices:>> A) Acetaminophen B) Amitriptyline C) Aspirin D) Ethylene glycol ---- <<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 33-year-old Asian American man presents to his primary care provider in February with pain in his fingers. His symptoms started 2 years ago and have gradually progressed. He initially attributed his symptoms to stress at work as a social worker. He has tried using ibuprofen, acetaminophen, and naproxen, but these medications did not improve his pain. He also reports that there have been at least 3 instances in the past 2 months in which his fingers became extremely painful and turned white before turning pale blue. These instances occurred when the patient was walking outside. His past medical history is notable for gastroesophageal reflux disease and gout. He takes omeprazole and allopurinol. His temperature is 99°F (37.2°C), blood pressure is 120/78 mmHg, pulse is 90/min, and respirations are 18/min. Physical examination reveals loss of skin fold wrinkles and indurated skin on the palmar side of the digits. Finger range of motion is limited. Which of the following medications is most appropriate to address this patient's concerns? ---- <<Choices:>> A) Ambrisentan B) Amlodipine C) Cilostazol D) Lisinopril ---- <<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 3-year-old boy is brought to the physician because of a 1-day history of abdominal pain and frequent urination. His mother reports that the patient has wet his bed overnight and that his urine smelled odd this morning. He has been toilet trained for 4 months and has had very few accidents since then. His last bowel movement was 3 days ago. He was born at term after a normal gestation and has reached all developmental milestones. His parents divorced 4 months ago and the patient's father has moved away. The patient began preschool 6 weeks ago. During this period, he has had two upper respiratory infections that resolved without treatment. His 12-year-old brother has type 1 diabetes mellitus. Vital signs are within normal limits. Physical examination of the abdomen shows mild suprapubic tenderness. Urine dipstick is positive for leukocyte esterase, nitrite, and blood; urinalysis shows white blood cells and gram-negative rods. Which of the following is the most likely predisposing factor for this patient's condition? ---- <<Choices:>> A) Social stressors B) Constipation C) Posterior urethral valves D) Respiratory tract infection ---- <<Answer:>>
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B
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 37-year-old male presents with difficulty eating solids and drinking water; which has been progressively worse over the past year. He has noticed that he is regurgitating food that appears undigested and has also been having difficulty belching. He said that lifting his neck seems to help him keep his food down. He is currently on omeprazole for his acid reflux; however, his heartburn still persists. An esophagogastroduodenoscopy (EGD) is performed that shows no evidence of mechanical obstruction or esophageal inflammation. If esophageal manometry is performed, which of the following will most likely be present in this patient? ---- <<Choices:>> A) Aperistalsis in the distal two-thirds of the esophagus with incomplete lower esophageal relaxation B) Normal amplitude, uncoordiated, simultaneous esophageal contractions C) Excessive amplitude or duration of coordinated esophageal contractions D) Hypotensive peristaltic contractions ---- <<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 man comes to the emergency department for chest pain that started 1 hour ago. He has a history of hypertension, hyperlipidemia, and type 2 diabetes mellitus. He appears diaphoretic and distressed. An ECG shows P waves independent of QRS complexes. The QRS interval is 0.11 seconds with normal morphology. Which of the following is the most likely trigger of this patient's ventricular contractions? ---- <<Choices:>> A) Sinoatrial node B) Bachmann bundle C) Bundle of His D) Purkinje fibers ---- <<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 29-year-old pregnant woman is brought to the emergency department complaining of the sudden onset of severe, sharp pelvic pain. She is at 6 weeks’ gestation. The patient is bleeding heavily from the vagina and feels very dizzy. Substantial pain is noted in the lower right quadrant, which intensified towards the end of the physical exam. On examination, there is evidence of abdominal and cervical motion tenderness. Her blood pressure is 71/37 mm Hg, respiratory rate is 21/min, pulse is 117/min, and temperature is 38.4°C (101.1°F). Which of the following is the most appropriate definitive step in the management of this patient? ---- <<Choices:>> A) Surgery B) Methotrexate C) Transvaginal ultrasound D) Serial hCG ---- <<Answer:>>
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A
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<<Question:>> A 24-year-old man presents to his primary care physician with heel pain that has been persistent for 3 weeks now. He is bothered by the feeling of significant pressure and swelling in his ankle. He is also having difficulty walking due to pain in his hip. Upon physical examination, there is evidence of swelling and warmth over his Achilles tendon. Imaging of his sacroiliac joint reveals soft tissue involvement and narrowing of the joint spaces. This patient also appears to have a low to moderate kyphosis of his spine. He has no family history of any bone or rheumatological diseases. This patient most likely presents with clinical features of which disease? ---- <<Choices:>> A) Ankylosing spondylitis B) Reactive arthritis C) Osteoma D) Fibromyalgia ---- <<Answer:>>
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A
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<<Question:>> A 51-year-old man comes to his physician with chronic sinusitis and rhinorrhea for which he uses mometasone nasal spray. He is seeking a refill on this prescription, noting that, although it has not fully relieved his nasal symptoms over the past 2 years, it has helped minimize the severity of those symptoms. On auscultation, there are faint crackles in the bilateral lung fields and an indentation at the nasal bridge. The patient also notes occasional hemoptysis and hematuria. He has no significant medical history and takes no other medications. Family history is significant for rheumatoid arthritis. The physician is suspicious for granulomatosis with polyangiitis and a nasal mucosal biopsy is obtained which confirms the diagnosis. The patient is started immediately on prednisone and cyclophosphamide. Which of the following should also be added to this patient’s therapeutic regimen? ---- <<Choices:>> A) Azithromycin B) Ganciclovir C) Doxycycline D) Trimethoprim/sulfamethoxazole ---- <<Answer:>>
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D
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 28-year-old man presents to a clinic for a health check-up. He says that he feels great and has not seen a physician for approximately 10 years. He is concerned about his health because his 3 older brothers have recently developed cardiac problems. His medical history is significant for an appendectomy 16 years ago. He works out twice a week and eats a low-salt, well-balanced diet. He drinks alcohol socially on the weekend, but does not use tobacco or drugs. The pulse is 80/min, respirations are 14/min, and the blood pressure is 129/80 mm Hg. The physical examination is unremarkable. Laboratory testing shows the following: Serum Glucose (fasting) 100 mg/dL Sodium 142 mEq/L Potassium 3.9 mEq/L Chloride 101 mEq/L Serum Creatinine 0.8 mg/dL Blood Urea Nitrogen 10 mg/dL Cholesterol, total 250 mg/dL HDL-cholesterol 34 mg/dL LDL-cholesterol 210 mg/dL Triglycerides 160 mg/dL The patient is most likely started on a medication which acts by which of the following mechanism? ---- <<Choices:>> A) Blockage of beta-adrenergic receptors B) Blockage of the angiotensin receptors C) Increase loss of bile acids in the feces D) Inhibition of HMG-CoA reductase ---- <<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 17-year-old boy presents for a psychotherapy session after finding out that his girlfriend has been carrying on another relationship with someone else. He expresses rage and complains of difficulty focusing on his upcoming high school comedy club routines and upcoming track meet. His therapist, while explaining the concept of defense mechanisms, describes some hypothetical examples related to the situation. Which of the following potential actions by this patient would be an example of sublimation? ---- <<Choices:>> A) Channeling his anger about the situation into training for his track meet B) Instigating a physical fight with his girlfriend’s other partner C) Making jokes about the situation and incorporating them into his comedy routine D) Not thinking about the upsetting situation until after his track meet, then confronting and processing his feelings about it ---- <<Answer:>>
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A
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<<Question:>> A 39-year-old woman is brought to the emergency room by her fiancé for severe abdominal pain for the past 5 hours. She was watching TV after dinner when she felt a sudden, sharp, 10/10 pain at the epigastric region that did not go away. Ibuprofen also did not help. She reports recurrent abdominal pain that would self-resolve in the past but states that “this one is way worse.” Her past medical history is significant for diabetes and an appendectomy 2 years ago. The patient endorses nausea and 1 episode of emesis, but denies fevers, chills, chest pain, shortness of breath, diarrhea, constipation, urinary symptoms, paresthesia, or weakness. She used to smoke marijuana in college and drinks about 2 beers a week. A physical examination demonstrates an overweight woman in acute distress with diffuse abdominal tenderness. Her vitals are within normal limits. Laboratory values are shown below: Hemoglobin: 12 g/dL Hematocrit: 34% Leukocyte count: 4,900/mm^3 with normal differential Platelet count: 160,000/mm^3 Serum: Na+: 138 mEq/L Cl-: 98 mEq/L K+: 4.8 mEq/L HCO3-: 25 mEq/L Glucose: 123 mg/dL Ca2+: 6.9 mg/dL AST: 387 U/L ALT: 297 U/L ALP: 168 U/L Lipase: 650 U/L (Normal 0 – 160 U/L) What is the best next step in the workup of this patient? ---- <<Choices:>> A) Abdominal computed tomography without IV contrast B) Abdominal magnetic resonance imaging C) Abdominal ultrasound D) Upright chest and abdominal radiograph ---- <<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 50-year-old man is evaluated for a 2-year history of intermittent, nonproductive, chronic cough, as well as mild dyspnea with exertion. He has a 20-pack-year history of smoking and is a current smoker. His medical history is significant for hypertension and type 2 diabetes mellitus, which he has controlled with diet and exercise. He also takes lisinopril. On physical examination, blood pressure is 125/76 mm Hg, pulse rate is 78/min, respiratory rate is 15/min, oxygen saturation is 98% (breathing room air), and his BMI is 25 kg/m2. There is no jugular venous distention. Heart sounds are normal, and there is no murmur. Auscultation of the lungs reveals faint, bilateral wheezing. No peripheral edema is noted. The remainder of the examination is normal. Which of the following is most likely to confirm the diagnosis for this patient? ---- <<Choices:>> A) Chest CT scan B) Measurement of protease inhibitor C) Spirometry D) Cardiac catheterization ---- <<Answer:>>
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C
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<<Question:>> A 51-year-old woman presents with bilateral hand tremors. She has had these tremors for several years, and her symptoms have gradually worsened over time. The tremors are restricted to her hands and are most prominent when she is holding a cup of tea or a pen. The tremors get worse when she is under stress or exhausted, and they are starting to disrupt her work routine. She denies walking difficulties, speech problems, and weakness. Her past medical history is significant for a recent hospitalization for an asthma exacerbation. Current medications include salmeterol, medium-dose fluticasone, and a daily multivitamin. The patient denies smoking but drinks alcohol socially. The patient is afebrile and her vital signs are within normal limits. On physical examination, her hands have a noticeable tremor when in use and remain still while resting in her lap. Which of the following is the best course of treatment for this patient? ---- <<Choices:>> A) Baclofen B) Primidone C) Propranolol D) Sodium valproate ---- <<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 39-year-old female was involved in a head-on collision motor vehicle accident. If she was found to have a traumatic rupture of the aorta, where along the path of the aorta is the most common site of injury? ---- <<Choices:>> A) Ascending aorta B) Site of attachment of ligamentum arteriosum C) Aortic isthmus D) Descending aorta - Thoracic aorta ---- <<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 previously healthy 2-month-old boy is brought to the physician because of a 10-day history of poor feeding. He used to feed for 20 minutes but now needs 40 minutes. He struggles to breathe and sweats while feeding. He was born at 38 weeks' gestation. He is at the 20th percentile for length and 10th percentile for weight. His vital signs are within normal limits. Pulse oximetry on room air shows an oxygen saturation of 98%. A grade 3/6 holosystolic murmur is heard at the left lower sternal border. An ECG shows left-axis deviation. An x-ray of the chest shows an enlarged left atrium and ventricle and increased pulmonary vascular markings. Doppler echocardiography confirms the presence of an intracardiac shunt. Which of the following is the most likely explanation for the direction of flow of blood across this shunt? ---- <<Choices:>> A) Communication between the right and left atria B) Right ventricular outflow tract obstruction C) Increase in pulmonary vascular resistance D) Decrease in pulmonary vascular resistance ---- <<Answer:>>
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D
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<<Question:>> A 14-year-old boy is brought to the physician for a follow-up examination. He has allergic rhinitis and his only medication is cetirizine. He is at the 60th percentile for height and above the 95th percentile for weight and BMI. Vital signs are within the normal limits. Examination shows a slightly tender, firm, 1-cm subareolar mass in the left breast. There are no changes in the skin or nipple. The right breast is unremarkable. There is no palpable axillary lymphadenopathy. Axillary and pubic hair is present. Examination of the penis and testis shows no abnormalities. Neurologic examination shows no focal findings. Which of the following is the most likely cause of this patient's findings? ---- <<Choices:>> A) Adverse drug reaction B) Leydig cell tumor C) Ductal ectasia D) Physiological development ---- <<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 54-year-old woman presents to her primary care physician complaining of a lump in her right breast. She first noticed it 1 month ago. Now she is worried that it may have grown. She claims that the lump is not painful or itchy, and she denies any abnormal nipple bleeding or discharge. She has a family history of breast cancer, including both her mother and older sister. Physical examination reveals a firm, immobile lump in the upper right breast. A mammogram is performed, which identifies an irregular mass with a fibrotically stranded border. A biopsy is performed that is positive for invasive ductal carcinoma. The patient is started on radiation induction therapy and scheduled for a modified radical mastectomy. Following tumor gene testing, the patient is found to be positive or the HER-2/neu oncogene. Which of the following should be started post-mastectomy to improve the patient’s prognosis? ---- <<Choices:>> A) Anastrozole B) Corticosteroids C) Leuprolide D) Trastuzumab ---- <<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 48-year-old man presents to his primary care physician concerned about his weight. He states he has been gaining weight though does not feel he has changed his diet. The patient also states he has felt fatigued lately and not himself. He denies taking any medications or using any illicit substances at baseline. His temperature is 99.2°F (37.3°C), blood pressure is 177/108 mmHg, pulse is 100/min, respirations are 18/min, and oxygen saturation is 98% on room air. Physical exam is notable for an obese man with striae on his abdomen. A 24-hour urine free cortisol is collected and demonstrates an elevated cortisol level; however, a high dose of dexamethasone when administered results in no attenuation of cortisol release. A CT scan of the abdomen is within normal limits. Which of the following is associated with the most likely diagnosis? ---- <<Choices:>> A) Adrenal adenoma B) Decreased ACTH level C) Enlargement of the facial bones D) History of smoking ---- <<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:>> Advances in molecular biology have identified important factors and sequences required for transcription and translation of mRNA as well as multiple diseases associated with mutations. The Kozak sequence is one such finding from this research. What is the Kozak consensus sequence? ---- <<Choices:>> A) A sequence box that binds to NF-1 B) An untranslated region downstream of the the stop codon C) An initiator of translation proximal to the start codon D) A site to which the 50S ribosome binds ---- <<Answer:>>
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C
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<<Question:>> A 3-week-old male infant is brought to the physician by his parents because they noticed that his head has been tilted to the left since birth. Physical examination shows the head turned toward the left side and the chin rotated toward the right. He cries during an attempt to rotate the head to the right. There is a firm, well-circumscribed mass on the left lower side of the neck. Which of the following is the strongest predisposing factor for this patient's condition? ---- <<Choices:>> A) Fetal macrosomia B) Cesarean delivery C) Intrauterine exposure to haloperidol D) Preterm birth ---- <<Answer:>>
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A
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<<Question:>> A 13-month-old boy was brought to the clinic due to failure-to-thrive and mental impairment. Retinal findings are shown in the picture. The parents are healthy, but they previously had a child who died at 14 months of age. What is the most likely cause for the underlying abnormalities? ---- <<Choices:>> A) Structural protein mutation B) Genomic imprinting C) Lysosomal enzyme mutation D) Mitochondrial gene mutation ---- <<Answer:>>
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C
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<<Question:>> A 24-year-old woman who is 16 weeks pregnant comes to your office requesting a referral for an abortion. Upon questioning she states that she is scared that her baby will be "deformed" because on routine screening she was found to have an elevated level of alpha-fetoprotein. What is the most likely cause of this lab abnormality in this patient? ---- <<Choices:>> A) Trisomy 13 B) Trisomy 18 C) Trisomy 21 D) Inaccurate gestational age ---- <<Answer:>>
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D
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<<Question:>> A previously healthy 45-year-old man is brought to the emergency department after being found by a search and rescue team in the mountains. He has been without food or water for 30 hours. His temperature is 37°C (98.6°F), pulse is 123/min, respirations are 20/min, and blood pressure is 90/55 mm Hg. Physical examination shows decreased skin turgor and dry mucous membranes. Evaluation of this patient's urine before treatment is initiated is most likely to show which of the following? ---- <<Choices:>> A) Low urine sodium and low urine osmolality B) Low urine sodium with hyaline casts C) High urine protein with fatty casts D) Low urine osmolality with RBC casts ---- <<Answer:>>
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B
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<<Question:>> A 14-year-old Caucasian male presents with painful erythematous and honey-colored crusted lesions around his mouth. Culture of the lesions reveals gram-positive cocci in clusters. Further analysis reveals bacteria that are beta-hemolytic, coagulase positive, catalase positive, and appear golden on the blood agar plate. Which of the following helps the bacterium in this infection bind to immunoglobulin and prevent phagocytosis when invading its host? ---- <<Choices:>> A) Protein A B) Staphylokinase C) Exfoliatin A D) Neurotoxin ---- <<Answer:>>
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A
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<<Question:>> A 70-year-old man comes to the physician for the evaluation of abdominal pain over the past month. The patient describes epigastric pain that radiates to the back. He also reports a 10-kg (22-lb) weight loss over the past 6 months. He has a history of untreated type 2 diabetes mellitus. He has not seen a doctor in 15 years. He is retired and spends most of his time at home watching TV. He rarely cooks and mainly eats fast food. He has smoked one pack of cigarettes daily for the past 50 years. He drinks 2–3 cans of beer per day. He appears pale. His temperature is 37°C (98.6°F), pulse is 80/min, and blood pressure is 150/90 mm Hg. Physical examination shows jaundice of the conjunctivae and the skin. The abdomen is soft, with no rebound or guarding. Laboratory studies show a serum glucose concentration of 260 mg/dL. Abdominal sonography shows enlargement of the gallbladder. Which of the following is most likely to have contributed to this patient's condition? ---- <<Choices:>> A) Smoking history B) Poor dietary habits C) History of alcohol use D) Diabetes mellitus ---- <<Answer:>>
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A
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<<Question:>> A 63-year-old African American man with a history of hypertension and dyslipidemia presents to the emergency department with facial swelling and difficulty breathing. Symptoms began suddenly that morning and continued to worsen. He started taking lisinopril several weeks ago. His blood pressure is 110/74 mm Hg, heart rate is 94/min, and respiratory rate is 20/min. Physical examination is notable for swelling of his lips and inspiratory stridor. Clinical lab results suggest a normal C1 esterase inhibitor level. Of the following options, which is the most likely diagnosis? ---- <<Choices:>> A) Erysipelas B) Facial lymphedema C) Drug-induced angioedema D) Contact dermatitis ---- <<Answer:>>
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C
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<<Question:>> A 21-year-old female college student comes to the physician because of a two-week history of vaginal itching and burning. She also noticed white vaginal discharge despite cleaning her genital area daily using a ""soap-free, natural"" vaginal douche. She is worried that she might have contracted a sexually transmitted disease after meeting her new boyfriend around one month ago. She has type 1 diabetes mellitus. The patient swims for the college swimming team. She had an intrauterine device implanted 3 months ago and does not use barrier protection. She smokes one pack of cigarettes per day and does not drink alcohol. Speculum examination shows an erythematous vagina covered in copious white discharge. Her vaginal pH is 4.4 and the microscopic image of a KOH preparation shows multiple pseudohyphae. Which of the following is the greatest predisposing factor for this patient's condition?" ---- <<Choices:>> A) Frequent vaginal douching B) Unprotected sexual intercourse C) Intrauterine device D) Diabetes mellitus ---- <<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 72-year-old female recently fractured her hip in a fall. She suffers from regular joint pain in her fingers, and hip X-rays reveal low bone mineral density. She has a history of diabetes mellitus and was diagnosed 2 years ago with end-stage renal disease. Serum phosphate levels are markedly elevated. Which of the following likely contributes to her orthopedic problems? ---- <<Choices:>> A) Decreased serum aldosterone B) Increased serum parathyroid hormone C) Increased serum glucose D) Chronic hypertension ---- <<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 52-year-old man presents to his primary care physician for his annual check-up. He says that he has no health concerns; however, his wife is concerned that he has become increasingly forgetful. For example, he has become forgetful during his daily activities and recently has been getting lost during errands like shopping. She says that these symptoms have been occurring for about a year. She says that she became alarmed when he started forgetting the names of their children. Finally, over the last month he has become more irritable, which has led to several confrontations at work. Based on the age of onset for his disease, the patient is referred for genetic testing. Which of the following chromosomes contain genes that may be mutated in this patient's disease? ---- <<Choices:>> A) 1 B) 4 C) 18 D) 20 ---- <<Answer:>>
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A
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<<Question:>> A 23-year-old woman, gravida 2, para 1, at 13 weeks gestation, comes to the physician because of a 2-day history of burning pain during urination. She has been sexually active with different male partners during the pregnancy and did not use condoms. She has not had any fever, chills, or pelvic pain. Physical examination shows thick, purulent discharge from the urethra. Urine dipstick shows leukocyte esterase, urinalysis shows 10 WBCs/hpf, and Gram stain of the urethral swab shows polymorphonuclear leukocytes with intracellular gram-negative diplococci. Pelvic ultrasound shows a viable intrauterine pregnancy. Which of the following is the most appropriate treatment? ---- <<Choices:>> A) Oral levofloxacin B) Intramuscular ceftriaxone C) Oral erythromycin D) Intramuscular ceftriaxone and oral azithromycin " ---- <<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 20-year-old college student is brought to his primary care physician by his parents over the New Years holiday because they are concerned about his behavior since right after high school graduation in May the spring before. Prior to this year, he was generally an outgoing and social young man, who now reportedly has been spending the majority of his time alone in his dorm room and room at home, where his mother and father have overheard him talking to other people when he has no guests. When asked if anything was bothering him at school, he reports that at night the voice of the school's mascot encourages him to save the school from the large oak grove that will soon takeover the student union building by setting the trees on fire for all to see. On exam, his appears to be otherwise healthy and his urine toxicology screen is negative. What is the most likely diagnosis? ---- <<Choices:>> A) Schizoaffective disorder B) Major depression C) Schizophrenia D) Schizophreniform 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 58-year-old man comes to the physician for evaluation of an increasing left-sided cheek swelling and recurrent oral ulcers for 1 year. He has smoked a pack of cigarettes daily for 25 years. Examination shows a mild, nontender swelling above the angle of the left jaw. An ultrasound-guided biopsy of the mass confirms the diagnosis of parotid adenoid cystic carcinoma. A left-sided total parotidectomy is performed. This patient is at greatest risk for which of the following complications? ---- <<Choices:>> A) Hyperesthesia of the left ear lobe B) Impaired taste of the posterior 1/3 of the tongue C) Flushing of the right cheek while eating D) Inability to wrinkle the left side of the forehead ---- <<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 man comes to the physician for a routine health maintenance examination required for his occupation as a school bus driver. He feels well and healthy. Upon questioning, he reports that he has smoked 2 joints of marijuana every night after work for the past year for recreational purposes. He typically smokes 5 joints or more on weekends. Which of the following responses by the physician is the most appropriate? ---- <<Choices:>> A) """Let me know when you are ready to stop smoking marijuana. We can talk about specific strategies to help you quit at that time.""" B) """Have you ever experienced a situation in which you wished you smoked less marijuana?""" C) """We have a great program to help patients with substance use disorder issues. Let me give you more information about specific details.""" D) """You should stop smoking marijuana because it is not good for your health.""" ---- <<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 6-year-old girl of Moroccan descent is brought to the pediatrician by her father who is concerned about the child developing a body odor. He reports that she has started to smell “like a teenage boy” especially after physical activity. The child has had limited medical follow-up since being born in Morocco and immigrating to the United States at 3 years of age. Her temperature is 99°F (37.2°C), blood pressure is 150/90 mmHg, pulse is 85/min, and respirations are 18/min. On exam, she has hair in her axillary and pubic regions. Genital examination demonstrates clitoral enlargement and labioscrotal fusion. Which of the following metabolites is most likely elevated in this patient? ---- <<Choices:>> A) Aldosterone B) Cortisol C) 11-deoxycorticosterone D) Leutenizing hormone ---- <<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 25-year-old woman presents to the clinic for burning with urination. She is a newlywed and reports 3 similar episodes within the past 4 months. She claims that since yesterday she has noticed a burning sensation whenever she urinates, an increase in urinary frequency, and some clear vaginal discharge. She denies fever, chills, back pain, or chest pain. Her past medical history is significant for chlamydia that was adequately treated 3 years ago. She is currently sexually active with her husband and has an IUD. She is subsequently prescribed a course of nitrofurantoin for her symptoms. While getting up to leave, the patient asks “why is it that I always get these symptoms but my husband is fine?” What is the most appropriate answer to this patient’s question? ---- <<Choices:>> A) Her partner is an asymptomatic carrier B) Inadequate treatment of her prior episodes C) The female urethra is shorter D) The patient is experiencing recurrence of her past chlamydial infection ---- <<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 17-year-old boy comes to the physician 1 week after noticing a lesion on his penis. There is no history of itching or pain associated with the lesion. He is sexually active with two female partners and uses condoms inconsistently. Five weeks ago, he returned from a trip to the Caribbean with some of his football teammates. He takes no medications. He has recently started an intense exercise program. His vital signs are within normal limits. Physical examination shows multiple enlarged, nontender lymph nodes in the inguinal area bilaterally. A photograph of the lesion is shown. Which of the following is the most likely pathogen? ---- <<Choices:>> A) Mycoplasma genitalium B) Human papillomavirus C) Treponema pallidum D) Herpes simplex virus type 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 36-year-old man presents to a physician for a post-transplant medical evaluation. He has been taking prednisone and azathioprine for the last 6 months after receiving a cadaveric renal transplant. He complains of fever, cough, and anorexia for the last 6-7 days. His cough is productive of thick sputum. His temperature is 38.5°C (101.5°F). The physical examination is significant for diminished breath sounds over the left lower lung with dullness on percussion and increased vocal resonance. A left lower lobe nodule, 5 cm (2 in) in diameter with eccentric central cavitation, is visible on the chest X-ray. A sputum analysis reveals branched, irregular, gram-positive filamentous rods. Which of the following constitutes the first-line therapy in this patient? ---- <<Choices:>> A) Erythromycin B) Ceftazidime C) Penicillin D) Sulfisoxazole ---- <<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 54-year-old woman presents to her gynecologist complaining of incontinence. She reports leakage of a small amount of urine when she coughs or laughs as well as occasionally when she is exercising. She denies any pain with urination. She underwent menopause 2 years ago and noted that this problem has increased in frequency since that time. Her history is significant only for three uncomplicated pregnancies with vaginal births. Urinalysis, post-void residual, and cystometrogram are conducted and all show normal results. The patient's vital signs are as follows: T 37.5 C, HR 80, BP 128/67, RR 12, and SpO2 99%. Physical examination is significant for pelvic organ prolapse on pelvic exam. Which of the following is a reasonable first step in the management of this patient's condition? ---- <<Choices:>> A) Kegel exercises B) Bethanechol C) Urethropexy D) Tension-free vaginal tape ---- <<Answer:>>
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A
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<<Question:>> Researchers from a public health institute located in the United States conducted a multicenter cohort study on a large number of elderly individuals in order to evaluate the protective effect of the new vaccine for herpes zoster (commonly known as shingles) reactivation. After a long follow-up period, the data shows that shingles developed in 15% of study participants who received the new vaccine compared to 20% of diseased study participants in the control group that did not receive the vaccine. If the new vaccine showed identical efficacy in groups with higher and lower risks of herpes zoster reactivation (e.g., 40% and 10% risk), the calculated protective proportion of 25% would be maintained, regardless of the different baseline risk for shingles development. What is this metric also known as? ---- <<Choices:>> A) Event rate B) Risk difference C) Relative risk reduction D) Absolute risk reduction ---- <<Answer:>>
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C
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<<Question:>> A 55-year-old gentleman has been working in a sand blasting factory for over 25 years. He presents to his primary care physician with what he describes as increasing shortness of breath. PFTs are performed describing a restrictive lung process. Which of the following has most likely been the long-term mechanism of his disease development? ---- <<Choices:>> A) Eosinophilic reaction B) Phagocytosis of silica C) Tuberculosis D) Defective mucociliary transport ---- <<Answer:>>
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B
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<<Question:>> A 37-year-old man presents to the emergency department with acute loss of vision, slurred speech, and agitation. Past medical history is significant for HIV and hepatitis C, diagnosed 10 years ago for which he is non-compliant with medication. A T1 MRI of the brain shows asymmetric, hypointense white matter lesions. Which of the following pathogens is most likely responsible for this patient’s opportunistic infection? ---- <<Choices:>> A) Herpes virus 8 B) Candida albicans C) JC virus D) Pneumocystis jirovecii ---- <<Answer:>>
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C
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<<Question:>> A 4-year-old girl is brought to the physician for evaluation of a rash that her mother noticed 5 months ago. The rash is not painful or itchy but she notices that her daughter sometimes picks at the “spots.” The girl's 2-year-old brother has also started developing similar skin lesions over the past month. The patient has no history of serious illness and takes no medications. She is in the 75th percentile for height and 50th percentile for weight. A photograph of the patient's rash is shown. Which of the following infectious agents is the most likely cause of this patient's skin condition? ---- <<Choices:>> A) Human herpesvirus 8 B) Human papillomavirus C) Poxvirus D) Varicella-zoster virus ---- <<Answer:>>
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C
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<<Question:>> A 51-year-old police officer is brought to the emergency room after being shot in the abdomen. His wound was packed and bandaged by emergency medical services before he was transported to the hospital. His past medical history is notable for hypertension and diabetes. He takes metformin and lisinopril. He has a 20-pack-year smoking history and does not drink alcohol. His temperature is 98.6°F (37°C), blood pressure is 142/86 mmHg, pulse is 120/min, and respirations are 24/min. On exam, he appears uncomfortable but is able to answer questions appropriately. He has a 1 cm x 1 cm wound in the left upper quadrant. There is an exit wound in the left lower back. After undergoing the appropriate laboratory and imaging tests, he undergoes a diagnostic laparotomy. No involvement of the colon or small intestine is noted intraoperatively. He is placed on the appropriate antibiotic and pain control regimens. Three days later, he experiences several episodes of non-bloody diarrhea. His temperature is 101°F (38.3°C). Sigmoidoscopy reveals multiple pseudomembranous plaques in the sigmoid and descending colon. This patient's symptoms are most likely due to taking an antibiotic that inhibits which of the following enzymes? ---- <<Choices:>> A) 30S ribosomal subunit B) 50S ribosomal subunit C) Dihydropteroate synthetase D) DNA-dependent RNA polymerase ---- <<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 3-year-old girl is brought to the physician by her parents for the evaluation of vaginal discharge for one month. The discharge is foul-smelling and contains some blood. The patient sometimes has pain with urination. She has not had increased urinary frequency or abdominal pain. Topical vaginal cream application did not improve the patient's symptoms. There is no personal or family history of serious illness. She lives with her parents and attends a local daycare center. Vital signs are within normal limits. Examination of the vulva and vaginal entrance shows an intact hymen, vaginal erythema with blood-tinged, foul-smelling discharge, and the tip of a white object. The remainder of the examination shows no abnormalities. Which of the following is the most appropriate next step in the management of this patient? ---- <<Choices:>> A) Vaginal irrigation with warm saline B) Vacuum suction C) Alert Child Protective Services D) Administration of oral metronidazole ---- <<Answer:>>
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A
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 60-year-old man comes to the physician because of a 3-month history of a slowly enlarging painless ulcer on his lower lip. One year ago he had a painful rash near his upper lip that resolved completely with acyclovir therapy. He has a 10-year history of type 2 diabetes mellitus treated with metformin. He has worked in construction for the past 33 years. He has smoked one pack of cigarettes daily for 35 years. Examination shows a 0.5 x 0.5 cm nontender ulcer with everted edges on the midline of his lower lip. The erythematous ulcer bleeds upon palpation. He has numerous moles of varying sizes all over his body. There are no palpable cervical lymph nodes. Which of the following is the most likely diagnosis? ---- <<Choices:>> A) Squamous cell carcinoma B) Aphthous stomatitis C) Psoriasis D) Seborrheic keratosis ---- <<Answer:>>
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A
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<<Question:>> A 3-year-old girl is brought to the pediatrician by her father for fever and cough. The patient’s father states that she had a sore throat and runny nose 2 weeks ago. Then last night she developed a productive cough and a fever. The father is worried that this is pneumonia again, and reports that she has been hospitalized 5 times already with pneumonia. Her medical history is also significant for chronic diarrhea. The father reports that the patient has 2 older brothers who are both healthy. The patient’s temperature is 102°F (38.9°C), blood pressure is 102/60 mmHg, pulse is 110/min, and respirations are 28/min with an oxygen saturation of 94% on room air. On physical examination, decreased breath sounds are appreciated on the right. A chest radiography shows consolidation in the right upper lobe, consistent with pneumonia. An antibody panel and flow cytometry are obtained in the setting of the patient’s recurrent infections. The results show a normal lymphocyte count with low levels of IgA, IgG, and IgE and elevated levels of IgM. Which of the following is the patient most at risk for developing? ---- <<Choices:>> A) Ataxia B) Atopic dermatitis C) Blurry vision D) Scant tonsils ---- <<Answer:>>
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C
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 72-year-old man presents with urinary frequency resulting in frequent awakening to urinate at night. He is a retired elite runner and does not have a history of any chronic medical conditions. The patient denies weight loss, bone pain, or pain with urination. The patient is not in distress. Vitals show: temperature 36.8°C (98.2°F), heart rate 98/min, respiratory rate 15/min, and blood pressure 100/75 mm Hg. Physical exam is significant for a smooth, non-tender, uniformly enlarged prostate on digital rectal exam. There is no CVA tenderness. CBC, CMP, urinalysis, and abdominal ultrasound are ordered. Significant findings include: bilateral hydronephrosis on ultrasound, BUN/creatinine > 20:1, specific gravity > 1,020, FENa < 1%, urine Na < 20, and urine osmolality > 450 mOsm/kg. Furthermore, post-void residual volume is > 100 mL. Which type of patient would least likely have these same diagnostic findings? ---- <<Choices:>> A) A 55-year-old Egyptian man with painless hematuria, 18.1 kg (40 lb) incidental weight loss and confirmed Schistosoma hematobium infection B) A 27-year-old woman with waxing and waning internuclear ophthalmoplegia, scanning speech, and optic neuritis C) An ICU patient with a kinked Foley catheter D) A 35-year-old woman with severe colicky pain radiating to the left flank ---- <<Answer:>>
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D
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<<Question:>> An 82-year-old man with Alzheimer disease is brought to the physician by his daughter because of extensive bruising on his arms. He lives in an assisted living facility. Physical examination shows large ecchymoses across both forearms and upper arms in varied stages of healing. His hemoglobin concentration is 11.7 g/dL, mean corpuscular volume is 78 μm3, and platelet count is 180,000/mm3. Coagulation studies are within normal limits. Which of the following is the most likely etiology of his bruises? ---- <<Choices:>> A) Platelet aggregation inhibition B) Intravascular coagulation with fibrinolysis C) Nonaccidental trauma D) Vitamin K 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 23-year-old woman presents to her gynecologist for a routine visit. She is nulliparous, does not report any gynecologic or systemic diseases, and has no complaints. She is sexually active with one partner and uses oral contraceptive pills. Her vital signs are as follows: blood pressure 125/70 mm Hg, heart rate 81/min, respiratory rate 12/min, and temperature 36.6℃ (97.9℉). The physical examination is within normal limits. The breast examination is normal. No pathology is noted in the external genitalia and a speculum examination reveals a normal cervix with a closed external os and no discharge. A specimen is obtained from the cervical portion for a Pap smear. On bimanual examination, the uterus is normal size, non-tender, and mobile adnexa is non-palpable. The pap smear result is as follows: The pap smear result is as follows: Specimen adequacy: satisfactory for evaluation Interpretation: negative for intraepithelial lesion or malignancy Notes: absent transformation zone component How should we proceed with the management of this patient? ---- <<Choices:>> A) Repeat Pap test in 3 years as a usual screening schedule suggests B) Repeat Pap test within 2 weeks and ensure proper sampling from the transformation zone C) Perform a screening test for high-risk human papillomavirus (HPV) D) Perform a HPV testing and Pap smear in one year ---- <<Answer:>>
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A
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<<Question:>> A 57-year-old woman presents to the emergency department with acute pain in the left lower abdomen associated with nausea and vomiting for the past 24 hours. Prior to this episode, the patient did not have any significant gastrointestinal (GI) problems except for occasional constipation and indigestion after heavy meals. She has had hypertension and hypercholesterolemia for the past 7 years. Her family history is negative for GI disorders. Vital signs include a temperature of 38.0°C (100.4°F), blood pressure of 120/80 mm Hg, and pulse of 85/min. On physical examination, there is tenderness in the left lower abdominal quadrant. Abdominal CT scan shows thickening of the bowel wall and streaky mesenteric fat. Which of the following best describe the primary disorder in this patient? ---- <<Choices:>> A) Obstruction of the lumen of the appendix B) Inflammation of the renal parenchyma, calyces and pelvis C) Herniation of mucosa and submucosa through the muscular layer of the colon D) Inflammation of the upper genital tract ---- <<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 35-year-old woman comes to the emergency department because of a 3-day history of pain in the left cheek. The pain occurs every few hours, lasts 30–60 seconds, and is aggravated by chewing and brushing. She has a history of pain with a vesicular rash in the right axillary area one year ago. She had an upper respiratory infection 2 weeks ago. Physical examination shows no abnormalities. Which of the following is the most likely diagnosis? ---- <<Choices:>> A) Cluster headache B) Trigeminal neuralgia C) Postherpetic neuralgia D) Temporal arteritis ---- <<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 45 year old male presents to clinic complaining of a ringing in his ears. The patient's vitals are: BP 120/65, RR 16, 100% on room air, HR 78 bpm and he appears to be in no acute distress. Upon obtaining a history you learn that this patient also complains that at times the "room feels like it's spinning." You also notice throughout the interview that you have to speak loudly as the patient has difficulty hearing. The patient is then lost to follow up for his current condition. The patient returns several years later with worsening symptoms and as part of this patient's workup a MRI is obtained (Image A). Which of the following chromosomes is most likely mutated in association with this patient's condition? ---- <<Choices:>> A) Chromosome 13 B) Chromosome 17 C) Chromosome 22 D) The X chromosome ---- <<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 35-year-old is brought into the emergency room after a bicycle vs motored vehicle accident. He was unconscious after hitting the side of his head on the road, but recovered consciousness after a few minutes. He started to ride his bicycle again, but then developed a severe headache with nausea and vomiting, at which time he called EMS. While in the hospital, the patient is confused and cannot provide a history. He quickly loses consciousness and his CT scan is displayed in Figure 1. What is the most likely diagnosis? ---- <<Choices:>> A) Subdural hematoma B) Epidural hematoma C) Subgaleal hematoma D) Caput succedaneum ---- <<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 39-year-old man comes to the physician because of a 2-month history of shortness of breath with exertion. He immigrated to the United States from Ghana 20 years ago. His pulse is 88/min, respirations are 18/min, and blood pressure is 120/80 mm Hg. Echocardiography shows thickened mitral valve leaflets with reduced motion and a narrowed mitral valve orifice diameter. Which of the following auscultation findings is most likely to correlate with the severity of this patient's valvular disease? ---- <<Choices:>> A) Decreased time between S2 and opening snap B) Radiation of murmur to the axilla C) Increased intensity of the murmur D) Absence of A2 heart sound ---- <<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 6-year-old boy is brought to the physician because of worsening fatigue for the past 4 weeks. Examination of the head and neck shows conjunctival pallor, grayish-brown spots on the irises, prominent epicanthal folds, and a broad nasal bridge. He has a single transverse palmar crease, and there are scattered petechiae over the chest. An ultrasound of the abdomen shows enlargement of the liver and spleen. Analysis of the bone marrow aspirate of this patient is most likely to show which of the following findings? ---- <<Choices:>> A) Translocation t(15;17) B) Ringed sideroblasts C) CD10 positive cells D) Hypocellular bone marrow ---- <<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 42-year-old female presents to the emergency department with two days of severe abdominal pain and fever. The patient has a history of gallstones, for which she was scheduled to have a cholecystectomy in two weeks. On physical exam, her abdomen is tender to palpation over the epigastrium, without rebound or guarding. The patient is noticeably jaundiced. Laboratory evaluation is notable for a leukocytosis and a total bilirubin of 6.4 mg/dL. What is the diagnosis in this patient? ---- <<Choices:>> A) Acute pancreatitis B) Chronic pancreatitis C) Acute cholangitis D) Primary sclerosing cholangitis ---- <<Answer:>>
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C
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<<Question:>> A 52-year-old woman presents to her primary care physician because she has been feeling pain in her right leg. Specifically, she says that an area on her right thigh has been feeling tender and swollen over the past few weeks. Her past medical history is significant for obesity, poorly controlled diabetes, and hypertension. She also has been taking estrogen replacement therapy and drinking alcohol to cope with her symptoms of menopause. Her family history is significant for cardiomyopathy. On physical exam, there is erythema and edema along a cord-like lesion in her thigh. This lesion feels thick and hardened on palpation and is tender to the touch. She is started on compression therapy as well as NSAIDs for pain management. Which of the following characteristics of this patient most likely increased her risk for this disorder? ---- <<Choices:>> A) Alcohol use B) Diabetes C) Estrogen therapy D) Hypertension ---- <<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 presents to the clinic complaining of constipation and dry mouth. She had uncontrollable diarrhea for 1 day and took some medications afterwards. Patient denies any recent hospitalizations or antibiotic use. She also denies melena, hematochezia, nausea, or vomiting. Vitals are within normal limits. What medication did the patient take? ---- <<Choices:>> A) Loperamide B) Oral vancomycin C) Sulfasalazine D) Setraline ---- <<Answer:>>
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A
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<<Question:>> A 25-year-old arrives at a gynecology clinic for a consult as she and her husband plan to conceive a baby soon. She is currently taking no medications, doesn’t smoke, and drinks alcohol socially. Her father passed away at the age of 51 due to heart failure. Her vital signs include blood pressure 150/100 mm Hg, heart rate 67/min, respiratory rate 16/min, and temperature 36.7°C (98.0°F). Physical examination is unremarkable. When asked about her high blood pressure, the patient says that her primary care physician once told her that her blood pressure was elevated on most of her visits; the physician emphasized that she should exercise and control her diet, but she never followed up with him as she always felt good. A number of tests are run to find out the etiology of her elevated blood pressure. Everything is within the normal range except for a renal angiogram shown in the picture. What is the most likely cause of this patient’s high blood pressure? ---- <<Choices:>> A) Atherosclerosis B) Adult polycystic kidney disease C) Fibromuscular hyperplasia D) Pheochromocytoma ---- <<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 73-year-old man is found to have an early stage hepatocellular carcinoma in the left lobe of his liver. He decides to undergo surgery to remove the tumor through partial liver resection. During the procedure, a ligament is found that attaches the liver to the anterior abdominal wall. Since part of this ligament lies over the part of the liver that needs to be resected, the ligament is incised to allow for removal of the tumor. The free edge of the ligament is found to have a thickening with small remnant blood vessels. Which of the following embryonic structures most likely gave rise to the thickening described here? ---- <<Choices:>> A) Ductus venosus B) Left umbilical vein C) Right umbilical artery D) Ductus arteriosus ---- <<Answer:>>
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B
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<<Question:>> A researcher is conducting an experiment on the physiology of body fluids. He documents specific observations and plots some of them as a Darrow-Yannet diagram. In his study, some diagrams are normal, while most are abnormal. The abnormalities in the diagram are mostly in the form of changes in the x-axis, changes in the y-axis or changes in both axes of the diagram. Which of the following parameters are most likely to affect the x-axis in the diagram? ---- <<Choices:>> A) Fluid osmolality B) Fluid surface tension C) Fluid viscosity D) Fluid volume ---- <<Answer:>>
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D
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Answer the following medical question with the correct letter choice:
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<<Question:>> An 11-year-old girl is brought to a pediatrician by her parents with recurrent wheezing for the last 3 years. After a detailed history, complete physical examination, and thorough diagnostic evaluation, the pediatrician informs the parents that the girl has mild persistent asthma, which will be most effectively treated with inhaled corticosteroids (ICS). However, her parents firmly object to the use of corticosteroids in any form, despite being told that the side effects associated with ICS are negligible. Therefore, the pediatrician suggests the regular use of a drug that does not contain a corticosteroid. The pediatrician mentions that the drug is used as prophylaxis only and will not be useful to treat acute bronchospasm. Which of the following drugs is most likely suggested by the pediatrician? ---- <<Choices:>> A) Subcutaneous terbutaline B) Inhaled ipratropium bromide C) Inhaled cromolyn sodium D) Oral roflumilast ---- <<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 team of scientists is researching the synthesis of a drug that would potentially reduce blood pressure in hypertensive patients by a novel mechanism of action. The drug A is an inactive prodrug and enters hepatocytes, reacts with reactant B, a native material in the cell, and creates products C and D. D has a blood pressure lowering effects. The reaction requires the presence of enzyme E. The researcher observes that, for the above chemical reaction, Gibbs free energy change (ΔG) is less than zero in normal hepatocytes whereas, in hepatocytes of patients with fatty liver, ΔG is more than 0 due to some unknown reason. Based on this knowledge, provided the concentration and actions of reactant B and enzyme E are same in both normal hepatocytes and hepatocytes of fatty liver patients, which of the following is the most likely possibility if drug A is administered to hypertensive patients with fatty liver? ---- <<Choices:>> A) Drug A will decrease blood pressure only if reactant B is also supplemented in necessary dose B) Drug A will decrease blood pressure only if enzyme E is also supplemented in necessary dose C) Drug A will not decrease blood pressure, regardless of its dose or supplementation of B or E D) Drug A will decrease blood pressure in same dose as required for patients with a healthy liver ---- <<Answer:>>
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C
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 70-year-old man comes to the physician because of a 4-month history of progressively worsening lower back pain. He describes the pain as a constant, dull ache that interferes with his sleep and is only partially relieved with ibuprofen. Two years ago, he was diagnosed with advanced prostate cancer, for which he underwent radiation therapy of the prostate and bilateral orchiectomy. One year postoperatively, serum prostate-specific antigen (PSA) was undetectable. He missed his previous follow-up visit. Current medications include over-the-counter ibuprofen. Vital signs are within normal limits. Physical examination shows tenderness of the spinous process of the third lumbar vertebra. Digital rectal examination shows a hard, nontender prostate. The remainder of the examination shows no abnormalities. The serum PSA concentration is 16 ng/mL (N<4). A technetium-99m bone scan shows increased uptake at the second and third lumbar vertebral bodies. In addition to analgesia, which of the following is the most appropriate next step in management? ---- <<Choices:>> A) External beam radiotherapy to the lumbar vertebrae B) Leuprolide therapy C) Finasteride therapy D) Observation with no further treatment ---- <<Answer:>>
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A
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<<Question:>> A 24-year-old woman presents complaining of a new onset vaginal odor. She reports that she is sexually active in a monogamous relationship with the same partner for two years. You perform a KOH prep, and notice an abnormal smell. On microscopy in your office, you observe the findings in figure A. What is the most likely causative organism? ---- <<Choices:>> A) Trichomonas vaginalis B) Candida albicans C) Escherichia coli D) Gardnerella vaginalis ---- <<Answer:>>
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D
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<<Question:>> A 22-year-old woman is brought to the emergency department 4 hours after the ingestion of 25 tablets of an unknown drug in an attempt to commit suicide. Her temperature is 36.7°C (98°F), pulse is 41/min, respirations are 14/min, and blood pressure is 88/55 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 93%. She is confused and oriented only to person. The pupils are equal and reactive to light. Examination shows cold, clammy extremities. Scattered expiratory wheezing and rhonchi are heard throughout both lung fields. The abdomen is soft. Fingerstick blood glucose concentration is 65 mg/dL. ECG shows prolonged PR intervals and narrow QRS complexes. Two large bore cannulas are inserted and intravenous normal saline, dextrose, and atropine are administered. Five minutes later, pulse is 51/min and blood pressure is 95/61 mm Hg. In addition to securing the airway, which of the following is the most appropriate next step in management? ---- <<Choices:>> A) Glucagon B) Activated charcoal C) Sodium bicarbonate D) Hemodialysis ---- <<Answer:>>
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A
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<<Question:>> A 56-year-old patient reports a history of recurrent dental caries. The bacteria causing this patient's dental problems most likely exhibits which of the following properties? ---- <<Choices:>> A) Inhibition of growth on optochin sensitivity test B) Production of dextrans from glucose C) Presence of catalase enzyme D) Soluble in bile ---- <<Answer:>>
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B
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<<Question:>> A 40-year-old woman comes to the physician for a follow-up examination. She says she has felt fatigued for about 3 months. She does not have enough energy for her job as a physician's assistant and often has to lie down and rest during shifts. She no longer adheres to her usual exercise routine because of exhaustion. During this time, she has noticed that her stools are sometimes pale and foul smelling. She also has generalized itching. The patient does not have abdominal pain, fever, or weight loss. She takes levothyroxine for hypothyroidism. She has smoked one pack of cigarettes weekly for 20 years. Physical examination shows no abnormalities. Laboratory studies show: Hemoglobin 14.1 g/dL Leukocyte count 7,200/mm3 Erythrocyte sedimentation rate 26 mm/h Serum Thyroid-stimulating hormone 4.2 μU/ml Bilirubin Total 1.7 mg/dL Direct 1.0 mg/dL Alkaline phosphatase 370 U/L Aspartate aminotransferase 80 U/L Alanine aminotransferase 46 U/L Cholesterol 320 mg/dL Gamma-glutamyl transferase 98 U/L (N = 5–50) Magnetic resonance cholangiopancreatography shows no gallstones and no evidence of extrahepatic biliary obstruction. Liver biopsy shows nonsuppurative destructive cholangitis with lymphocytic infiltration of portal areas and periductal granulomas. Which of the following autoantibodies is most likely to be present in this patient?" ---- <<Choices:>> A) Anti-liver-kidney microsomal-1 antibodies B) Anti-mitochondrial antibodies C) Anti-smooth muscle antibodies D) Perinuclear anti-neutrophil cytoplasmic antibodies ---- <<Answer:>>
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B
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<<Question:>> A 73-year-old man seeks evaluation for difficulty developing and maintaining erections. He has recently made lifestyle modifications, such as losing 4.5 kg (10 lb) but his erectile symptoms have not improved. He was prescribed a drug by his physician. Inhibition of which of the following best describes this drug’s mechanism of action? ---- <<Choices:>> A) 5-alpha reductase B) cGMP phosphodiesterase C) Estrogen receptors D) Testosterone receptors ---- <<Answer:>>
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B
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<<Question:>> A 65-year-old woman with hypertension comes to the emergency department because of sudden onset of a severe headache 2 hours ago. Her temperature is 35°C (95°F) and blood pressure is 189/115 mm Hg. A CT scan of the head shows a subarachnoid hemorrhage and she is started on appropriate pharmacotherapy. Which of the following regions of the brain is most likely affected? ---- <<Choices:>> A) Ventral lateral thalamic nucleus B) Pineal gland C) Preoptic nucleus D) Caudate nucleus ---- <<Answer:>>
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C
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<<Question:>> A 35-year-old woman with a one-year history of auditory hallucinations and periods of anhedonia and amotivation is being seen by her psychiatrist. She was started on haloperidol at her last visit, but she was told to stop taking the medication since she developed muscle stiffness and spasms soon after taking the drug. Today, her temperature is 97.7°F (36.5°C), blood pressure is 132/76 mmHg, pulse is 98/min, and respirations are 12/min. The patient is now started on a new medication that will seek to avoid the same side effects as her previous one; however, she will need to come in for weekly testing. Which of the following should be tested weekly? ---- <<Choices:>> A) Electrocardiogram B) Electrolytes C) Gonadotropin releasing hormone D) White blood cell count ---- <<Answer:>>
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D
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<<Question:>> A 9-year-old boy is brought to the emergency room by his concerned mother after he "urinated blood." The boy reports that, starting this morning, he experienced significant pain with urination and his urine appeared a bright red color. These symptoms were not present before today; however, he reports a cough, runny nose, and sore throat that started approximately 3 days ago. Vital signs are as follows: T 38.4 deg C, HR 101, BP 110/65, RR 14, SpO2 99%. Physical examination is significant for bilateral conjunctivitis, tenderness to suprapubic palpation, and a small amount of clotted blood is noted surrounding the urethral meatus. A urine sample is obtained, and urinalysis shows 3+ blood, and urine microscopy demonstrates gross blood with too many cells to count per high powered field. Which of the following is the most common viral cause of this child's condition? ---- <<Choices:>> A) Parvovirus B19 B) Coronavirus C) Adenovirus D) Coxsackie A virus ---- <<Answer:>>
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C
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<<Question:>> A young researcher wants to develop a method of increasing oxygen delivery to the peripheral tissues. He brainstorms several ideas but is informed by his mentor that only one of his ideas will most likely help him achieve the desired result. Of the following proposed mechanisms, which one would best serve the researcher's purpose? ---- <<Choices:>> A) Decrease lactic acid production by skeletal muscle B) Increase fetal hemoglobin concentration in circulation C) Increase relaxed form hemoglobin in muscle capillaries D) Increase taut form hemoglobin in muscle capillaries ---- <<Answer:>>
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D
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<<Question:>> A 29-year-old man comes to the physician for a follow-up examination. He has had numbness and tingling of his legs for the past 10 days. Three months ago, he was diagnosed with pulmonary tuberculosis and started on antituberculosis therapy. Examination shows dry scaly lips and cracks at the corner of the mouth. Sensation to pinprick and light touch is decreased over the lower extremities. His hemoglobin concentration is 10.4 g/dL and mean corpuscular volume is 76 μm3. Administration of which of the following is most likely to have prevented this patient's current symptoms? ---- <<Choices:>> A) Iron B) Vitamin E C) Folic acid D) Pyridoxine ---- <<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 36-year-old woman presents with a 2-month history of urinary incontinence, accompanied by urgency, nocturia, and occasional hematuria. Her symptoms are present day and night and have no known triggers. She was diagnosed with grade 2 pelvic organ prolapse (cystocele) 1 year ago, which is managed with pelvic floor training exercises and a vaginal pessary. She is otherwise healthy and does not take any medications. The blood pressure is 120/80 mm Hg, the heart rate is 67/min, the respiratory rate is 14/min, and the temperature is 36.8℃ (98.2℉). The physical examination is significant for suprapubic tenderness. No costovertebral angle tenderness is present. There are no signs of vulvar inflammation, and no urethral or vaginal discharge. The vaginal mucosa is normal and there is no cervical discharge. A vaginal pessary is placed. The cervix is non-tender and mobile, the uterus is not enlarged, and the adnexa have no masses. The urinalysis shows the following findings: Color: Pale yellow Clarity: Clear pH: 6.2 Specific gravity: 1.023 Glucose: Negative Ketones: Negative Nitrites: Positive Leukocyte esterase: Positive Bilirubin: Negative Urinary bilirubin: Negative Protein: Negative RBCs: 47 RBCs/hpf WBCs: 21 WBCs/hpf Epithelial cells: 27 squamous epithelial cells/hpf Casts: 5 hyaline casts/lpf Crystals: Occasional urates Bacteria: None noted Yeast: None noted The urinary culture is negative. Which investigation should be performed next in this patient? ---- <<Choices:>> A) Cystoscopy B) Ultrasound examination C) Cystometry D) Pelvic CT scan ---- <<Answer:>>
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B
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<<Question:>> The incidence of red-green color blindness in males in a certain population is 1/100. Which of the following is closest to the probability of a female and a male with normal vision having a daughter with red-green color blindness? ---- <<Choices:>> A) 1/100 B) 1/50 C) 98/100 D) 0 ---- <<Answer:>>
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D
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<<Question:>> A 31-year-old man comes to the physician for evaluation of chronic cough, sinus pain, and nasal discharge. He has a history of frequent upper respiratory infections and recurrent sinusitis since childhood. He is also concerned about fertility, as he and his wife have been trying to conceive for 5 years unsuccessfully. Pulmonary examination shows crackles and wheezing throughout both lung fields. A CT scan of the chest is shown. The most likely cause of this patient's condition is a defect in which of the following molecular structures? ---- <<Choices:>> A) IL-2R gamma chain B) NADPH oxidase C) CFTR protein D) Dynein arm ---- <<Answer:>>
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D
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 3-year-old boy is brought to the emergency department because of abdominal pain and watery diarrhea for the past 3 days. This morning he also had nausea and his stool had a red tint. Four days ago, he and his parents returned home from a vacation, during which they visited a petting zoo and consumed many new foods. He lives with his family and they have cats and dogs at home. The patient attends daycare. His immunizations are up-to-date. His temperature is 38°C (100.4°F), pulse is 140/min, and blood pressure is 80/45 mm Hg. Examination shows dry mucus membranes. The abdomen is soft, and there is tenderness to palpation of the right lower quadrant with rebound. Stool culture grows Yersinia enterocolitica. Which of the following is most likely to have prevented this patient's condition? ---- <<Choices:>> A) Hand-washing at daycare B) Avoiding the consumption of undercooked pork C) Avoiding the consumption of deli meats D) Avoiding the consumption of unwashed vegetables ---- <<Answer:>>
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B
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<<Question:>> A 61-year-old woman dies unexpectedly. She had not seen a physician in 10 years. Examination of the heart during autopsy shows hypertrophy of the left ventricular wall and enlargement of the left ventricular chamber. Microscopic examination shows lengthening of individual muscle fibers due to duplication of sarcomeres in series. Which of the following is the most likely underlying cause of these findings? ---- <<Choices:>> A) Increased pulmonary arterial pressure B) Decreased left ventricular contractility C) Decreased left ventricular compliance D) Increased left ventricular end diastolic volume ---- <<Answer:>>
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D
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<<Question:>> A 57-year-old man with a history of hypertension, hyperlipidemia, type 2 diabetes mellitus, and obstructive sleep apnea presents to your office for routine screening. He reports compliance with his medications but admits to difficulty maintaining the diet and exercise routines discussed during his last visit. He does not have any other complaints. He drinks 3-4 beers on the weekends and does not smoke cigarettes. His current medications include metformin, atorvastatin, and hydrochlorothiazide. On physical examination, his temperature is 99°F (37.2°C), blood pressure is 130/85 mmHg, pulse is 85/min, and respirations are 18/min. Laboratory results are shown below: Serum: Na+: 138 mEq/L Cl-: 100 mEq/L K+: 3.9 mEq/L HCO3-: 23 mEq/L BUN: 13 mg/dL Glucose: 160 mg/dL You decide to start the patient on a medication that triggers insulin release. What is the mechanism of action of this drug? ---- <<Choices:>> A) Close potassium channels B) Increase insulin sensitivity C) Delay gastric emptying D) Increase ATP generation ---- <<Answer:>>
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A
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<<Question:>> A 28-year-old woman presents to the emergency department with fever and abdominal pain for the past several days. She says she feels like she has a slight fever. She denies nausea or vomiting. Physical examination shows pain in the right upper quadrant to deep palpation with rebound tenderness and guarding. A laparoscopy is performed which shows string-like, fibrous scar tissue in the perihepatic recesses. Which of the following is the most likely organism responsible for the patient's condition? ---- <<Choices:>> A) Giardia lamblia B) Gardnerella vaginalis C) Trichomonas vaginalis D) Neisseria gonorrhoeae ---- <<Answer:>>
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D
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<<Question:>> A 30-year-old woman comes to the emergency department because of a 1-day history of sharp chest pain radiating to the left shoulder. The pain worsens when she coughs, breathes deeply, or lies down. She has had a mild fever and a cough for the past 2 days. She takes ibuprofen for hip and knee pain, which started 4 months ago. Examination shows a symmetric, erythematous rash on her nose and cheeks, and erythematous patches with scaling and plugged follicles over her hands. Cardiovascular evaluation of this patient is most likely to show which of the following findings? ---- <<Choices:>> A) Increased distension of jugular veins during inspiration B) 18 mm Hg decrease in systolic blood pressure during inspiration C) Triphasic scratchy heart sound of varying intensity D) Holosystolic blowing murmur heard best at the apex ---- <<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 man comes to the physician because he has been increasingly worried and stressed in recent weeks. He started a marketing job three months ago, which involves traveling between Washington and California several times a year. Two months ago, he was supposed to fly to Seattle, but he experienced nausea, palpitations, sweating, and shortness of breath and was unable to board the plane, causing him great embarrassment. He had never been on a plane before; his parents died in a plane crash when he was younger. A week ago, he called in sick when he was supposed to go on a business trip. He worries that he will lose his job. He is otherwise well and has no history of serious illness. He takes no medications. His temperature is 37.2°C (99°F), pulse is 85/min, respirations are 12/min, and blood pressure is 130/80 mm Hg. Physical examination shows no abnormalities. On mental status examination, he is alert and cooperative. His speech is normal and his thought process is organized. His memory, attention, and concentration are intact. Which of the following is the most appropriate next step in management of this patient's symptoms? ---- <<Choices:>> A) Oral paroxetine B) Oral alprazolam C) Observation D) Cognitive behavioral 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 52-year-old man presents to the office complaining of a 2-week history of fatigue, progressively worsening shortness of breath, and swelling of his lower legs and feet. His past medical history is only significant for slightly elevated blood pressure. The patient denies tobacco use although he does admit to drinking 8-10 beers, daily, for the past 10 years. He takes a low dose of aspirin daily, ever since he had an anterior myocardial infarction 2 years ago. The patient works as a financial consultant and frequently travels for work. The current temperature is 36.8°C (98.3°F), the pulse rate is 68/min, the blood pressure is 152/84 mm Hg, and the respiratory rate is 16/min. His weight is 102 kg (224 lb) and height 180 cm (5 ft 9 in). Echocardiography demonstrates an ejection fraction of 35% and a thin left ventricular wall. What is the appropriate medication for this patient’s condition? ---- <<Choices:>> A) Nifedipine B) Procainamide C) Ibuprofen D) Spironolactone ---- <<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 70-year-old man comes to the physician for a follow-up evaluation. Eight months ago, he presented with a 6-month history of increased urinary frequency, difficulty to initiate urination, and straining to maintain the urinary stream. Digital rectal examination showed symmetrically enlarged, nontender prostate with rubbery texture. Laboratory studies showed a prostate-specific antigen (PSA) level of 2 ng/mL. Abdominal ultrasound showed a post-void residual urine volume of 250 ml and bladder wall thickening. The patient received appropriate treatment. His vital signs are within normal limits. Laboratory studies now show a PSA level of 1 ng/mL. Which of the following medications was most likely used to treat this patient's symptoms? ---- <<Choices:>> A) Oxybutynin B) Dutasteride C) Terazosin D) Tadalafil ---- <<Answer:>>
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B
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<<Question:>> A 53-year-old man presents to the office complaining of persistent abdominal pain. He states that he has gained 4.5 kg (10.0 lb) because the pain is only relieved by eating. The patient also admits that he has had numerous loose, foul-smelling stools over the last few weeks with associated nausea. He has taken some over the counter antacids without relief or change in symptoms. His blood pressure is 132/76 mm Hg, respiratory rate is 14/min, and heart rate is 75/min. Physical examination reveals mild tenderness to palpation of the upper abdomen. Which of the following is the most likely diagnosis? ---- <<Choices:>> A) H. pylori infection B) Intestinal type gastric adenocarcinoma C) NSAID induced peptic ulcer disease D) Zollinger-Ellison syndrome ---- <<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 68-year-old man with advanced dementia is brought to the preoperative unit prior to an elective cholecystectomy for biliary colic. He says he does not want the surgery anymore. He begins yelling at unit staff and requests to leave. His designated medical power of attorney, who had previously signed the surgery consent forms, is present. Which of the following is the most appropriate next step in management? ---- <<Choices:>> A) Cancel the surgery and allow the patient to leave B) Ask the patient about his concerns and try to address them C) Call family members and schedule a family meeting D) Perform cognitive screening evaluation ---- <<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 67-year-old man presents to his physician’s office with a progressive cough. It has been increasing in intensity over the past week. He has also been noticing an increase in the amount of sputum he usually produces, which is thick and yellow. He also complains of increased difficulty in breathing, more so than he previously experienced. He was diagnosed with chronic obstructive lung disease (COPD) about 3 years ago and has been on treatment for it since then. He doesn’t report any fever, chills, or night sweats. He has observed a foul smell to his sputum. His blood pressure is 100/65 mm Hg, the respirations are 23/min and the pulse is about 110/min. Currently, his FEV1 is around 48% of the normal predicted value. He is currently receiving a yearly influenza shot and has taken the pneumococcal vaccination at the time of his diagnosis. In spite of this, he has had acute exacerbations of his symptoms 4 times over the last year. His last episode was 2 months ago, for which he was treated with a short course of antibiotics. He is also currently receiving treatment for diabetes. Which of the following pathogens should be considered before initiating treatment for the current episode? ---- <<Choices:>> A) S. pneumonia B) H. influenzae C) P. aeruginosa D) Syncytial virus ---- <<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 who was involved in a motor vehicle collision is brought into the emergency room with a fractured skull. The paramedics report that the patient was conscious and lucid on the way to the hospital but now is unresponsive. His vitals are a blood pressure of 122/78 mm Hg, temperature of 37.0°C (98.6°F), pulse rate of 88/min, and respiratory rate of 14/min. A noncontrast CT scan of the head shows an epidural hematoma. Which of the following structures is involved in the development of an epidural hematoma? ---- <<Choices:>> A) Middle meningeal artery B) Bridging cortical veins C) Arteriovenous malformation D) Lenticulostriate vessels ---- <<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 54-year-old woman presents to the emergency department due to recent onset of a high fever, accompanied by severe headache and neck stiffness. Her past medical history is significant for rapidly progressive glomerulonephritis. She is currently on immunosuppressants after a kidney transplant performed 6 months ago. On presentation, her temperature is 102.2°F (39°C), blood pressure is 112/71 mmHg, pulse is 107/min, and respirations are 22/min. Physical exam reveals severe pain with neck flexion and reciprocal knee flexion. Laboratory tests reveal a gram-positive organism with endotoxin. Which of the following characteristics is true of the most likely cause of this patient's disorder? ---- <<Choices:>> A) Anaerobic spore forming rods B) Catalase-negative C) Coagulase-positive D) Tumbling motility in broth ---- <<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 2-year-old boy is brought to see the pediatrician by his mother due to a “bad” cough. The mother reports that he has been coughing so hard that he threw up on several occasions. He is adopted and the mother does not know his vaccination history. He has no known allergies. His temperature is 38.5°C (100.5°F), pulse is 120/min, respirations are 33/min, blood pressure is 101/54 mm Hg, and oxygen saturation is 96% on room air. The boy looks unwell with mild difficulty breathing and a nonproductive cough multiple times followed by a “whoop” sound during the inhalation. He has scattered petechiae on his face. A nasopharyngeal swab is sent for culture and PCR. Which of the following antibiotics is recommended for this patient? ---- <<Choices:>> A) Ceftriaxone B) Cefotaxime C) Erythromycin D) Ampicillin ---- <<Answer:>>
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C
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