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Answer the following medical question with the correct letter choice:
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<<Question:>> A 20-year-old African American woman comes to the clinic after missing her last two periods. Her cycles are usually regular, occurring at 28-32 day intervals with moderate bleeding and some abdominal discomfort. She also complains of occasional diffuse and generalized headaches. She is a college student and works part-time as a bartender. Past medical history is insignificant. Blood pressure is 110/70 mm Hg, pulse rate is 80 /min, respiratory rate is 14 /min, and temperature is 36.5°C (97.7°F). Physical examination is significant for mild breast tenderness and some secretions from the nipple area. Urine pregnancy test is negative. Which of the following is the best initial step in her management? ---- <<Choices:>> A) Serum prolactin levels B) LH/FSH ratio C) Ultrasound of abdomen and pelvis D) Dopamine agonists ---- <<Answer:>>
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A
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 25-year-old man comes to the physician because he and his wife have been unable to conceive a child despite having regular unprotected sexual intercourse. He is 187 cm (6 ft 1 in) tall and weighs 79 kg (174 lb). Examination shows long extremities, bilateral gynecomastia, and small, firm testes. A peripheral blood smear shows a dense, dark-staining spot at the periphery of the nucleus of a cell. Which of the following is the most likely explanation for the finding on this patient's peripheral blood smear? ---- <<Choices:>> A) Acetylation of histone lysine residues B) Methylation of cytosine nucleotides C) Aggregation of ribosomes D) Precipitation of oxidized hemoglobin ---- <<Answer:>>
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B
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 22-year-old woman college student presents with diarrhea and crampy abdominal pain that is relieved by defecation. She states that she has had a lot of ‘stomach issues’ in the past, especially during exam weeks. The past medical history is significant for major depressive disorder diagnosed 2 years ago that has been managed with Prozac. She does not have a family history of irritable bowel disease, autoimmune disease, or cancer. The symptoms do not seem to be worse with any particular food, though she admits to eating a lot of pizza and deli sandwiches with minimal fruits and vegetables. She denies recent travel and has not experienced fever, weight loss, nausea, or vomiting. She has not noticed blood in her stool. The physical exam and laboratory findings are unremarkable. Which of the following is a diagnostic criteria for the disorder that is most likely responsible for the patient’s presentation? ---- <<Choices:>> A) Symptoms present at least 6 months B) Symptoms not relieved with defecation C) Symptoms present at least 1 day per week for 3 consecutive months with symptom onset at least 6 months before diagnosis D) No change in stool consistency ---- <<Answer:>>
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C
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 69-year-old female presents to the emergency department with crampy abdominal pain. She has a past medical history of hypertension, dyslipidemia, and cholelithiasis status post cholecystectomy. The patient states she has not passed stool or gas for 48 hrs. On physical exam vitals are T 98.4 F HR 105 bpm BP 155/101 mmHg RR 16 SpO2 96%, abdominal exam is notable for distension, tympany to percussion, and tenderness to palpation without rebound or guarding. Which of the following findings are most likely on radiograph? ---- <<Choices:>> A) Apple core defect after lower GI series B) Multiple punctate mucosal outpouchings through the serosa on lower GI series C) Ladder-like series of distended bowel loops with air-fluid levels on abdominal radiograph D) Loss of haustral markings and "lead pipe" appearance to the descending colon on lower GI series ---- <<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 56-year-old man comes to the physician because of a 2-month history of worsening pain in his left buttock. The pain is described as a deep, dull ache that is worse at night. He does not report any recent trauma. He has hyperlipidemia. He has smoked one pack of cigarettes daily for the past 30 years and drinks one beer every night. He does not use illicit drugs. His only medication is simvastatin. Physical examination shows tenderness over the left gluteal region. Neurologic examination shows no focal findings. An x-ray of the pelvis shows a 4-cm, poorly defined, osteolytic lesion in the left ilium with a moth-eaten pattern of bone destruction, multiple well-defined sclerotic lesions, and an aggressive periosteal reaction. The remainder of the physical examination, including rectal examination, shows no abnormalities. Chest x-ray and abdominal ultrasonography show no abnormalities. Which of the following is the most likely diagnosis? ---- <<Choices:>> A) Giant cell tumor B) Fibrosarcoma C) Plasmacytoma D) Chondrosarcoma ---- <<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 otherwise healthy 49-year-old man comes to the physician because of a 1-month history of worsening headaches and increasing irritability. Examination shows bilateral papilledema. An MRI of the brain shows a mass in the right temporal lobe with heterogeneous peripheral rim enhancement that crosses the midline. He undergoes surgical resection of the mass. Gross examination shows a poorly-demarcated mass with areas of hemorrhage and necrosis. Microscopic examination of the mass will most likely show which of the following? ---- <<Choices:>> A) Closely-packed capillaries and foamy stromal cells B) Pleomorphic cells forming pseudopalisades C) Cells with clear cytoplasm and central round nuclei D) Areas of lamellated calcification ---- <<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 male newborn develops hyperammonemia, encephalopathy, and respiratory alkalosis 3 days after a normal delivery. He enters into a coma the next day and dies a week later. Family history is positive for parental consanguinity. Histopathologic examination of the liver shows diffuse microvesicular steatosis, distinct focal hepatocellular fibrosis, and Kupffer cell glycogenosis. Citrulline levels are low. What enzyme is most likely deficient in this patient’s case? ---- <<Choices:>> A) Carbamoyl phosphate synthetase I B) Homogentisic acid dioxygenase C) Ornithine transcarbamylase D) Propionyl-CoA carboxylase ---- <<Answer:>>
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A
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 48-year-old woman is brought to the emergency department immediately following a motor vehicle accident in an unconscious state. She is managed as per emergency treatment protocols with the airway, breathing, and circulation being appropriately managed by mechanical ventilation, intravenous fluids, and other supportive drugs. A complete diagnostic evaluation suggests a diagnosis of traumatic brain injury and rules out the presence of fractures and other visceral injuries. About 36 hours after the accident, pulse oximetry shows deteriorating oxygen saturation. Chest auscultation reveals widespread rales over bilateral lung fields. Her arterial blood gas analysis shows a PaO2 of 100 mm Hg at FiO2 of 60%. Her bedside echocardiogram is normal and suggests a pulmonary capillary wedge pressure of 11 mm Hg. Which of the following signs is most likely to be present in her chest radiogram? ---- <<Choices:>> A) Deep sulcus sign with radiolucency along the costophrenic sulcus B) Lung collapse at the hilum on one side and shift of the mediastinum to the opposite side C) Bilateral asymmetric pulmonary infiltrates with peripheral distribution D) Abrupt tapering of a pulmonary artery ---- <<Answer:>>
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C
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 58-year-old man with a history of heart failure is admitted to the hospital for a cardiac transplantation. Five years ago, the patient had a mitral valve replacement with a porcine valve, but since then his heart failure symptoms have not improved. He developed persistent New York Heart Association class IV symptoms and was placed on the transplant waiting list. The heart to be transplanted originated from a deceased donor and the family has given consent for the transplantation. The patient is subsequently started on cyclosporine, and the postoperative period is unremarkable. He is readmitted to the emergency department 10 months later due to chest pain and severe shortness of breath. What is true about the medication prescribed to this patient? ---- <<Choices:>> A) Inhibits IMP dehydrogenase B) Binds FK506 binding protein C) Inhibits calcineurin D) Is a precursor of 6-mercaptopurine ---- <<Answer:>>
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C
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Answer the following medical question with the correct letter choice:
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<<Question:>> An investigator studying renal physiology uses para-aminohippuric acid (PAH) to estimate the renal plasma flow in a human volunteer. An intravenous infusion of 400 mg of PAH solution is administered to the subject; effective renal plasma flow is calculated to be 600 ml/min. Next, an intravenous infusion of 1000 mg of PAH solution is administered to the subject; effective renal plasma flow is calculated to be 400 mL/min. Which of the following explains the measured decline in the calculated effective renal plasma flow? ---- <<Choices:>> A) Decreased serum protein binding B) Efferent arteriole dilation C) Afferent arteriole dilation D) Decreased PAH clearance ---- <<Answer:>>
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D
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 55-year-old man presents to his primary care physician with a 2-month history of fatigue. He says that he has been feeling tired, even after mild exertion, and decided to be evaluated because it has begun interfering with his job as a construction worker. He reports that he has been feeling numbness and tingling in his feet and has been tripping more frequently. His past medical history is significant for hypertension and type 2 diabetes well-controlled on metformin. His surgical history is significant for weight-loss surgery 2 years ago. Physical exam reveals bilateral vibration sensory deficits as well as conjunctival pallor. Selected lab results are presented as follows: Hemoglobin: 9.1 g/dL Hematocrit: 27% Platelet count: 265,000/mm^3 Mean corpuscular volume: 112 µm^3 Reticulocyte count: 0.19% Which of the following findings would most likely also be seen in this patient? ---- <<Choices:>> A) Elevated bilirubin levels B) High methylmalonic acid and high homocysteine levels C) High transferrin levels D) Low haptoglobin levels ---- <<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 27-year-old woman is brought to the emergency department by her coworker after having a generalized seizure at work. Her coworker reports that she is at 30 weeks' gestation and has mentioned headache and right upper quadrant pain earlier that day. Her temperature is 37°C (98.6°F), pulse is 91/min, and blood pressure is 170/102 mm Hg. Pulmonary examination shows bilateral rales. There is diffuse edema in the lower extremities. Deep tendon reflexes are increased bilaterally. She is not oriented to person, place, and time. Which of the following is the most appropriate initial pharmacotherapy? ---- <<Choices:>> A) Calcium gluconate B) Aspirin C) Phenytoin D) Magnesium sulfate ---- <<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 23-year-old woman presents to the emergency department because of nausea. She has been experiencing severe intermittent nausea and diarrhea for the last year and refuses to leave the emergency department until she is told what is causing her symptoms. She hates hospitals but has reluctantly undergone numerous workups and imaging studies in order to discern what is wrong. All of the studies have been normal. She says that these symptoms have been causing her severe distress and is impairing her ability to perform her job. She says that she feels as if the nausea is worse when she is trying to work but says that she will continue to work as an insurance agent despite the physical discomfort. She has started restricting her diet to only graham crackers because she thinks that helps her symptoms. She has also started avoiding eating lunch because of the nausea. Which of the following disorders is most consistent with this patient's presentation? ---- <<Choices:>> A) Conversion disorder B) Factitious disorder C) Malingering D) Somatic symptom disorder ---- <<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 37-year-old homeless man is brought in by ambulance to the emergency department after being found unresponsive. He was found in an area of IV drug use with drug paraphernalia including glassine envelopes with a white powder residue. There is no past medical history available. He is treated with intranasal naloxone and stabilized in the field. Upon arrival to the hospital, his blood pressure is 100/70 mm Hg, pulse rate is 90/min, respiratory rate is 18/min, and temperature is 38.9°C (102.0°F). On physical examination, the patient is jaundiced with white scrapable exudates on the oral mucosa. His arms are covered with stigmata of IV drug use. Heart auscultation reveals a holosystolic murmur that is loudest at the left sternal border. The lungs are clear to auscultation bilaterally. Laboratory work is performed which shows: Hemoglobin 10.9 g/dL Hematocrit 37.7% Leukocyte count 1,500/mm3 Neutrophils 65% Lymphocytes 30% Monocytes 5% Mean corpuscular volume 82.2 μm3 Platelet count 190,000/mm3 Erythrocyte sedimentation rate 35 mm/h Aspartate aminotransferase 2,400 U/L Alanine aminotransferase 3,200 U/L CD4 count 27 cells/mm3 HIV-1 antibody positive Hepatitis C virus antibody positive Quantiferon-gold test negative Which of the laboratory findings will be found in this patient? ---- <<Choices:>> A) Atypical lymphocytes on blood smear B) Positive blood culture C) Elevated levels of cardiac troponin I and T D) Positive sputum culture ---- <<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 35-year-old woman, gravida 6, para 5, at 35 weeks' gestation comes to the emergency department because of vaginal bleeding for 2 hours. This is her second episode in the past 2 days. She has had no prenatal care. Her children were delivered vaginally. Her pulse is 122/min, respirations are 20/min, and blood pressure is 88/59 mm Hg. The abdomen is nontender, and no contractions are felt. There is active bright red vaginal bleeding. The fetal heart rate is 110/min. Two large-bore peripheral intravenous cannulas are inserted and intravenous fluids are administered. Three units of blood are typed and cross-matched. Which of the following is the most appropriate step in management? ---- <<Choices:>> A) Perform cesarean delivery B) Hospitalization and observation C) Administer magnesium sulfate D) Perform cervical cerclage ---- <<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 2710-g (6-lb) male newborn is delivered at 38 weeks of gestation to a 26-year-old woman, gravida 2, para 2. The pregnancy, labor, and delivery were uncomplicated. Breastfeeding is initiated. Which of the following supplements is most important to prevent a potentially life-threatening condition in this newborn? ---- <<Choices:>> A) Vitamin B1 B) Vitamin K C) Folic acid D) Iron ---- <<Answer:>>
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B
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 4-month-old adopted infant is brought to the pediatrician because of feeding problems and recurrent fungal and bacterial infections. Her family has almost no background information about the infant. They report that she is a little fragile and looks different compared to other infants her age. Physical evaluation reveals a cleft lip with intact hard and soft palate and mild jaw malformation. An echocardiogram reveals an interrupted aortic arch. Further investigation reveals leukopenia and mild hypocalcemia. These findings support a diagnosis of which of the following? ---- <<Choices:>> A) Chediak-Higashi syndrome B) DiGeorge syndrome C) Severe combined immunodeficiency (SCID) D) Wiskott-Aidrich syndrome ---- <<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 48-year-old homeless man presents to clinic complaining of fatigue and fevers that "began recently." Cardiac exam reveals a holosystolic murmur, heard best over the left lower sternal border. The murmur increases on inspiration. He also has track marks on his arms bilaterally. This presentation is consistent with which defect? ---- <<Choices:>> A) Ventricular septal defect B) Tricuspid regurgitation C) Mitral regurgitation D) Pulmonary stenosis ---- <<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 65-year-old diabetic man presents to the emergency department with severe retrosternal chest pain, vomiting, and diaphoresis for the last half hour. He has a history of diabetic chronic kidney disease. He is on insulin therapy. Oral medications include aspirin, losartan, and metformin. The vital signs include: temperature 36.8°C (98.2°F), pulse 88/min, respiration rate 14/min, and blood pressure 120/65 mm Hg. The weight is 78 kg (172.0 lb). The lungs are clear to auscultation. Cardiac examination shows no abnormalities. The electrocardiogram (ECG) shows ST-segment elevation in the precordial leads V-1–V-4. Left ventricular ejection fraction is estimated at 55%. The laboratory test results are as follows: Laboratory test Hemoglobin 15 g/dL Leukocyte count 9,500/mm3 Serum Glucose 215 mg/dL Na+ 140 mEq/L Cl− 102 mEq/L K+ 4.1 mEq/L Urea nitrogen 22 mg/dL Creatinine 1.4 mg/dL Cardiac troponin I 0.8 ng/mL The patient is being considered for primary percutaneous coronary intervention. Which of the following management steps is most likely to decrease the risk for development of acute renal failure in this patient? ---- <<Choices:>> A) Intravenous normal saline B) Reduced intravenous contrast dose C) Preemptive hemodialysis D) Withholding losartan ---- <<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 7-year-old boy is brought in to your clinic by his mother, who is complaining of her son’s “dry scalp and hair loss.” She reports a scaling spot on his scalp developed around 2 months ago, soon after moving to a new school, which then became a larger bald spot. She denies that anyone in the household is exhibiting similar symptoms, but does recall a note that came home from school warning of a lice outbreak. Thus far, she has only tried daily baths with little improvement. The patient denies pain or itchiness, but the mother reports she does notice him scratching his scalp. The mother also reports that since her son has started at the new school, she has noticed an increase in his tics including excessive blinking and clearing of his throat. The patient's medical history is significant for asthma, allergic rhinitis, and attention deficient hyperactivity disorder. His current medications include fluticasone, salmeterol, loratadine, and methylphenidate. Family history includes obsessive compulsive disorder in his older sister. The mother also reports her father had a debilitating skin and joint disorder. On examination, you note swollen lymph glands at the back of the patient's ears and neck, and there are residual black dots within a patch of alopecia. Which of the following is the most likely diagnosis? ---- <<Choices:>> A) Nummular dermatitis B) Psoriasis C) Tinea capitis D) Trichotillomania ---- <<Answer:>>
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C
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 68-year-old man is brought to the emergency department because of a 1-day history of fever and cloudy urine. He lives in a group home and has a chronic indwelling urinary catheter for benign prostatic hyperplasia. He has depression, for which he takes vilazodone. His temperature is 38.3°C (100.9°F), pulse is 89/min, and blood pressure is 110/74 mm Hg. Urine cultures grow Enterococcus faecium resistant to vancomycin, and therapy with intravenous linezolid is initiated. Eight hours later, he becomes agitated and starts to sweat profusely. His temperature is 39.6°C (103.3°F), pulse is 120/min, and blood pressure is 184/105 mm Hg. Neurologic examination shows increased deep tendon reflexes and clonus of the arms and legs. In addition to discontinuation of his current medication, administration of which of the following drugs is most appropriate in this patient? ---- <<Choices:>> A) Flumazenil B) Dantrolene C) Octreotide D) Cyproheptadine ---- <<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 man is newly diagnosed with diabetes. As part of his clinical care, he undergoes testing to determine his kidney function. His glomerular filtration rate is found to be 80 mL/min. He is curious about how glomerular filtration occurs and which molecules are filtered the fastest and slowest. He is told that albumin is filtered less readily than sodium. Aside from size of the 2 molecules, which of the following features of the glomerular basement membrane accounts for this additional finding? ---- <<Choices:>> A) Thickness B) Positive charge C) Negative charge D) Presence of podocytes ---- <<Answer:>>
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C
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 2-year-old boy with recurrent ear infections is brought to the pediatrician for a follow-up examination. He can walk with support and his vocabulary consists of approximately 50 words. His maternal uncle died in childhood from an unknown disease. Physical examination shows coarse facial features with an enlarged tongue. The abdomen is distended and both the liver and spleen tip are palpable. Laboratory studies show elevated total urinary glycosaminoglycan levels and an absence of plasma iduronate-2-sulfatase. Which of the following additional findings is most likely in this patient? ---- <<Choices:>> A) Optic atrophy B) Cherry-red macula C) Corneal clouding D) Aggressive behavior ---- <<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 29-year-old woman presents to a physician at 16 weeks gestation with fevers and a cough for 2 days. The cough is productive and occurs more often in the morning. Her medical history is not significant. Physical and laboratory evaluations suggest a diagnosis of community-acquired pneumonia. The physician explains to her that she needs to be treated with antibiotic therapy. She asks the physician if she can take levofloxacin because she tolerates levofloxacin. The physician explains that levofloxacin should be avoided during pregnancy because fetal exposure may increase the risk of a specific medical condition. Which of the following medical conditions is the physician referring to? ---- <<Choices:>> A) Arthropathy B) Congenital heart defect C) Deafness D) Neural tube defect ---- <<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 large, multicenter study is conducted to assess the prevalence and mortality rate of pneumonia requiring hospitalization caused by various pathogens in 3 states over the past year. The study encompassed 250,000 adults between 45–79 years of age. The results for five different pathogens are shown: All cases Fatal cases Pathogen Number Percentage Number Percentage S. aureus 460 34.8 69 50.3 Influenza virus 288 21.8 12 8.8 P. aeruginosa 136 10.3 17 12.4 S. pneumoniae 338 25.5 27 19.7 Klebsiella spp. 101 7.6 12 8.8 Total 1323 100 137 100 A journalist would like to report the yearly case fatality rate of the pneumonia pathogen responsible for most hospitalizations in these states. Based on the study results, which of the following responses by the investigator is most accurate?" ---- <<Choices:>> A) 10.4% B) 34.8% C) 15.0% D) 12.5% ---- <<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 52-year-old woman is admitted to the surgical unit after a laparoscopic hysterectomy for uterine leiomyomas performed 2 days ago. The surgery was performed under general anesthesia, blood loss was minimal, and there were no intraoperative complications. The patient reports lower abdominal pain and discomfort. Medical history is significant for multiple sclerosis that is well-controlled with ocrelizumab. Her last multiple sclerosis flare was approximately 7 years ago and presented with paresthesias and weakness of the upper extremities. Her temperature is 99°F (37.2 °C), blood pressure is 125/85 mmHg, pulse is 99/min, and respirations are 19/min. On physical exam, the patient appears restless and uncomfortable. The surgical incision sites are mildly erythematous and without discharge. There is tenderness with deep suprapubic palpation. Neurologic exam is unremarkable. Laboratory studies show: Serum: Na+: 144 mEq/L Cl-: 100 mEq/L K+: 4.3 mEq/L HCO3-: 26 mEq/L Glucose: 105 mg/dL Creatinine: 3.1 mg/dL Which of the following is the best next step in management? ---- <<Choices:>> A) Bethanechol administration B) Bladder scan C) Intravenous fluids D) Urodynamic studies ---- <<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 38-year-old female visits your office complaining of several years of joint swelling and stiffness that is worse in the morning and improves throughout the day. Physical examination reveals bilateral deformities at her proximal interphalangeal and metacarpophalangeal joints. The presence of which of the following in this patient’s serum would most help 'rule in' a diagnosis of rheumatoid arthritis: ---- <<Choices:>> A) Anti-nuclear antibody B) Anti-citrullinated protein antibody C) Anti-centromere antibody D) Anti-smooth muscle antibody ---- <<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-week-old infant presents to the emergency department with thick white discharge from his eyes that has persisted for the past 24 hours. The patient's birth was not complicated, and he was born at home vaginally with a mid-wife supervising the birth. The patient has a documented allergy to penicillin which caused anaphylaxis after it was given secondary to a maternal syphilis infection. His temperature is 97.6°F (36.4°C), blood pressure is 75/40 mm Hg, pulse is 130/min, respiratory rate is 24/min, and oxygen saturation is 98% on room air. The patient is currently sleeping. Physical exam is notable for bilateral purulent drainage from the eyes. Which of the following is a complication associated with the best treatment for this patient? ---- <<Choices:>> A) Damage to the lacrimal ducts B) Non-bilious projectile vomiting C) Possible anaphylaxis and urticaria D) Sedation and increased sleepiness ---- <<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 10-year-old boy initially presented with a runny nose, fever, and watery eyes. His parents gave him aspirin. Over the next few days, the boy developed jaundice, became irritable, lethargic, and had seizures. The hepatic transaminases were significantly raised. The blood ammonia levels were also increased. A liver biopsy is performed. Which of the following histopathological findings will most likely be seen on the liver biopsy in this patient? ---- <<Choices:>> A) Hepatic granulomas B) Iron accumulation and proliferation of smooth endoplasmic reticulum C) Hepatocytes proliferation D) Cytoplasmic fatty vacuolization in hepatocytes and swollen mitochondria ---- <<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 18-year-old woman presents with a dry cough for the past 2 weeks. She also says that she is tired all the time and feels feverish and chilly at times. She is a college student and lives in a dormitory and says that her roommate has a similar cough. Past medical history is unremarkable. The patient denies any smoking history, alcohol or recreational drug use. Her vitals signs include: temperature 36.8°C (98.2°F), pulse 72/min, blood pressure 118/63 mm Hg, and respiratory rate 15/min. Physical examination is unremarkable. A chest radiograph reveals interstitial infiltrates that look worse than her symptoms. A nasopharyngeal swab is sent to the lab for a bacterial culture which shows colonies having fried-egg appearance on Eaton’s agar. Cold agglutinins are positive. Which of the following antibiotics would be best to administer to this patient? ---- <<Choices:>> A) Penicillin B) Ceftriaxone C) Erythromycin D) Aztreonam ---- <<Answer:>>
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C
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 9-year-old boy comes to the physician because of pain with swallowing and a burning sensation in his mouth for the past 10 days. Over the past 3 weeks, he has had increasing fatigue and runs out of breath easily. His father had gallstones, for which he underwent a cholecystectomy at the age of 30 years. The boy appears weak and lethargic. His temperature is 37.7°C (99.8°F), blood pressure is 110/68 mm Hg, pulse is 105/min, and respirations are 28/min. Examination shows pallor of the mucosal membranes, mild scleral icterus, and a swollen, red tongue. His spleen is enlarged and palpable 2–3 cm below the left costal margin. A complete blood cell count shows a hemoglobin concentration of 9.8 g/dL, mean corpuscular volume of 102 μm3, and a reticulocyte count of 0.4%. His peripheral blood smear shows erythrocytes without central pallor. Which of the following could have prevented this patient's chief complaints? ---- <<Choices:>> A) Folic acid supplementation B) Cholecystectomy C) Gluten-free diet D) Vitamin B12 injections ---- <<Answer:>>
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A
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<<Question:>> A 62-year-old man is brought to the hospital because of a 6-hour history of worsening upper abdominal pain, nausea, and vomiting. He is diagnosed with acute calculous cholecystitis and scheduled for cholecystectomy the next day. He has congestive heart failure, hyperlipidemia, and hypertension. Physical examination shows no abnormalities. Current medications include metoprolol and simvastatin. One month ago, spironolactone was added to his medication regimen. Preoperative serum studies show: Na+ 138 mEq/L K+ 6.1 mEq/L Cl- 100 mEq/L HCO3- 22 mEq/L Urea nitrogen 13 mg/dL Creatinine 1.0 mg/dL An ECG shows normal sinus rhythm. In addition to discontinuation of spironolactone, which of the following is the most appropriate next step in management of this patient's hyperkalemia?" ---- <<Choices:>> A) Administer intravenous saline with furosemide B) Administer intravenous sodium bicarbonate C) Order dietary modification D) Administer intravenous calcium gluconate ---- <<Answer:>>
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A
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<<Question:>> A 48-year-old woman comes to the physician for a follow-up examination. She has a history of type 2 diabetes mellitus and coronary artery disease. Current medications include metformin, aspirin, pravastatin, and losartan. Her body mass index is 30 kg/m2. Physical examination shows no abnormalities. Her hemoglobin A1c concentration is 8%. She does not want to start insulin injection therapy and is afraid that a new medication is going to cause weight gain. Empagliflozin is added to her diabetes regimen. This patient is at greatest risk for which of the following adverse effects of this new drug? ---- <<Choices:>> A) Localized lipodystrophy B) Vaginal candidiasis C) Hypoglycemia D) Lactic acidosis ---- <<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 62-year-old man with coronary artery disease and type 2 diabetes mellitus comes to the emergency department because of frequent episodes of palpitations for 4 days. His pulse is 165/min and blood pressure is 98/70 mm Hg. An ECG shows monomorphic ventricular tachycardia. Intravenous pharmacotherapy is begun with a highly lipophilic drug that prolongs the duration of the myocardial action potential and refractory period and inhibits adrenergic stimulation of the myocardium. The patient's ventricular tachycardia converts to normal sinus rhythm. He is discharged home with an oral formulation of the same drug. Which of the following adverse effects is most commonly associated with long-term use of this medication? ---- <<Choices:>> A) Priapism B) Angle-closure glaucoma C) Hyperthyroidism D) Hepatic adenoma ---- <<Answer:>>
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C
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 45-year-old woman presents to her primary care physician complaining of weight gain. She states that for the past few months she has gained 10 pounds, especially around her abdomen. She says that this is despite going to kickboxing classes 5 days a week. She reports mild fatigue and muscle soreness, which she attributes to her exercise classes. She also complains of dry skin and hair, but feels that this might be due to showering twice a day. Her medical history is significant for major depressive disorder. She takes citalopram and a multivitamin. She smokes a half pack of cigarettes a day. She drinks 1 glass of red wine every night after dinner, and 3-4 drinks mixed with hard liquor on the weekend with friends. Her temperature is 98°F (36.7°C), blood pressure is 122/75, and pulse is 65/min. Her physical examination is unremarkable, except for xerosis. Labs are obtained, as shown below: Serum: Na+: 130 mEq/L K+: 4.1 mEq/L Cl-: 101 mEq/L BUN: 16 mg/dL Glucose: 125 mg/dL Creatinine: 0.9 mg/dL Aspartate aminotransferase (AST): 56 U/L Alanine aminotransferase (ALT): 70 U/L Creatine kinase (CK): 223 U/L (normal 22 to 198 U/L) Hemoglobin A1c: 5.3 Total cholesterol: 264 mg/dL (normal < 200 mg/dL) Low-density lipoprotein (LDL) cholesterol: 117 mg/dL (normal < 100 mg/dL) High-density lipoprotein (HDL) cholesterol: 48 (normal > 50 mg/dL) Triglycerides: 163 mg/dL (normal < 150 mg/dL) Which of the following is the most appropriate next step in management? ---- <<Choices:>> A) Fludrocortisone B) Liver biopsy C) Muscle biopsy D) Thyroxine ---- <<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 31-year-old woman comes to the physician because of white lesions in her mouth that she first noticed 5 days ago. The lesions are not painful or itchy. She has asthma treated with theophylline, inhaled β-adrenergic agonists, and corticosteroids. She smokes half a pack of cigarettes daily. She appears healthy. Vital signs are within normal limits. Oral examination shows white plaques on the buccal mucosa and hard palate that are firmly adherent and cannot be scraped off. She has no cervical or axillary lymphadenopathy. Which of the following is the most appropriate next step in the management of this patient? ---- <<Choices:>> A) Topical nystatin B) Biopsy of the lesions C) Smoking cessation D) Culture of the lesions ---- <<Answer:>>
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B
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Answer the following medical question with the correct letter choice:
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<<Question:>> An 11-year-old male is brought to his pediatrician for continuing management of a chronic lung infection. He has had many lung infections throughout childhood, and current sputum samples show oxidase positive, non-lactose fermenting gram-negative rods that produce a blue-green pigment. Physical exam shows nasal polyps and nail clubbing. He has also recently been experiencing floating foul smelling diarrhea, so he is prescribed enzymes and vitamin supplementation tablets. Which of the following chromosomes most likely contains the gene mutation responsible for this patient's symptoms? ---- <<Choices:>> A) 7 B) 17 C) 22 D) X ---- <<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 16-year-old girl is brought to the physician for a routine health maintenance examination. Her last visit was over a year ago. Menarche was at the age of 12 years; her last menstrual period was 4 months ago. She is on the school's gymnastics team and is currently preparing for an important competition. She is 165 cm (5 ft 5 in) tall and weighs 45 kg (99 lbs); BMI is 16.5 kg/m2. Her temperature is 36.8°C (98.2°F), pulse is 53/min, and blood pressure is 98/64 mm Hg. Examination shows yellowish discoloration of the skin. There are bilateral soft symmetric masses below her mandible. The skin over the dorsal side of her right hand is thickened. The patient is most likely to develop which of the following complications? ---- <<Choices:>> A) Recurrent infections B) Ovarian cancer C) Fractures D) Hyperthyroidism ---- <<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 32-year-old female is seeing an endocrinologist for the first time after a recently-diagnosed illness by her primary care physician. Her temperature is 99.7 °F (37.6 °C), blood pressure is 110/65 mmHg, pulse is 89/min, and respirations are 11/min. Prior to starting medical management, the patient is cautioned to alert her providers if she becomes pregnant, as this medication crosses the placenta and is known to cause aplasia cutis. Which of the following activities is inhibited by this medication? ---- <<Choices:>> A) Coupling of iodine with tyrosine residues B) Production of TRH C) Response of peripheral tissues to thyroid hormone D) Sensitivity of anterior pituitary to TRH ---- <<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 her doctor complaining of painful tingling and burning in her feet for the past year. Careful physical exam demonstrates that she has poor position sense in her bilateral lower extremities. Lab results reveal elevated urine and plasma methylmalonic acid concentrations. What vitamin deficiency is this woman most likely suffering from? ---- <<Choices:>> A) Vitamin C B) Vitamin B1 C) Vitamin B12 D) Biotin ---- <<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 52-year-old man visits his psychiatrist saying he feels sad most of the time. 5 months ago, he lost his daughter in a motor vehicle accident and since then has been unable to cope with this loss. He spends most of his day thinking about her and this often distracts him from his daily activities. He also admits to hearing his daughter’s voice in his sleep and sometimes has dreams about her. During the day, he sometimes gets brief glimpses of her. He believes this is because he was not able to do anything to help her during the last moments of her life. Other than this, he is able to get along his daily life and has never contemplated suicide. But he often wishes he could be close to his daughter again. Which of the following best describes the symptoms this patient is expressing? ---- <<Choices:>> A) Brief psychotic disorder B) Major depressive disorder C) Normal grief reaction D) Post-traumatic stress 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 68-year-old woman with hypertension and congestive heart failure is brought to the emergency department because of a 2-day history of shortness of breath and confusion. Her pulse is 112/min, respirations are 22/min, and blood pressure is 73/45 mm Hg. Examination shows cool extremities, jugular venous distention, and diffuse crackles in the lungs. Treatment with intravenous dobutamine is begun. Which of the following is the primary mechanism of action of this drug? ---- <<Choices:>> A) α2-adrenergic agonism B) β2-adrenergic antagonism C) β1-adrenergic agonism D) α1-adrenergic antagonism ---- <<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 a follow-up examination dressed in a vampire costume. He is on his way to a Halloween party at an assisted-living facility, where he works as a patient care attendant. He feels well. He has a history of hypertension that is well controlled. He was also diagnosed with type 2 diabetes two months ago during a routine check up. His current medications include lisinopril and metformin. His father died of colon cancer at 52 years of age. His screening colonoscopy at age 55 was normal. He used to smoke half a pack of cigarettes daily for 10 years but quit 15 years ago. His temperature is 37°C (98.6°F), pulse is 90/min, respirations are 14/min, and blood pressure is 138/90 mm Hg. Physical examination shows no abnormalities. His hemoglobin A1c two months ago was 7.6%. Which of the following health maintenance recommendations is most appropriate at this time? ---- <<Choices:>> A) Hemoglobin A1c measurement B) Influenza vaccine C) Prostate-specific antigen measurement D) Colonoscopy ---- <<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 33-year-old homeless man presents to the emergency department with an altered mental status. The patient was found minimally responsive at a local mall and was brought in by police. The patient has a past medical history of polysubstance abuse, anxiety, depression, and panic disorder. His current medications include sertraline, clonazepam, and amitriptyline. His temperature is 98.7°F (37.1°C), blood pressure is 117/68 mmHg, pulse is 80/min, respirations are 10/min, and oxygen saturation is 98% on room air. Physical exam is notable for a somnolent man. Neurological exam reveals 4 mm pupils, which are equal and reactive to light, and a patient who responds incoherently to questions when stimulated. The patient has normoactive bowel sounds and is non-tender in all 4 quadrants. Laboratory values are ordered as seen below. Serum: Na+: 139 mEq/L Cl-: 100 mEq/L K+: 4.3 mEq/L HCO3-: 25 mEq/L BUN: 20 mg/dL Glucose: 99 mg/dL Creatinine: 1.1 mg/dL Ca2+: 10.2 mg/dL Ethanol: negative An initial ECG is unremarkable. Which of the following is the best treatment for this patient? ---- <<Choices:>> A) Flumazenil B) Fomepizole C) Observation D) Sodium bicarbonate ---- <<Answer:>>
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C
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 6-month-old boy is brought to her pediatrician for a checkup and vaccines. He was born at 39 weeks gestation via spontaneous vaginal delivery. He is meeting all the developmental milestones. His prenatal history was complicated with maternal diabetes. He is being breastfed exclusively and has 3–4 wet diapers a day. On physical exam, the vital signs include: temperature 37.0°C (98.6°F), blood pressure 85/45 mm Hg, pulse 140/min, and respiratory rate is 31/min. On physical examination, the patient is alert and responsive. Height, weight, and head circumference are above the 90th percentile. Which of the following vaccines should be administered for this patient at this visit? ---- <<Choices:>> A) RV, Tdap, PCV, Hib B) RV, DTaP, PCV, Hib, IPV C) Hep B, DTaP, Influenza D) RV, Hep B, Hep A ---- <<Answer:>>
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B
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<<Question:>> A 23-year-old woman is brought to the emergency department 20 minutes after being involved in a high-speed motor vehicle collision where she was the unrestrained driver. She was found thrown across the dashboard of the car. On arrival, she appears lethargic. She is unable to provide a history. Her pulse is 133/min, respirations are 23/min, and blood pressure is 90/60 mm Hg. Examination shows a 2-cm laceration over the right upper extremity. The pupils are equal and reactive to light. There are multiple bruises over the chest and abdomen. The lungs are clear to auscultation. Cardiac examination shows no abnormalities. The abdomen is soft and not distended. Neurologic examination shows no focal findings. 0.9% saline infusion is begun. Which of the following is the most appropriate next step in management? ---- <<Choices:>> A) Observation B) Exploratory laparotomy C) CT scan of the abdomen D) Ultrasonography ---- <<Answer:>>
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D
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<<Question:>> Three days after starting a new medication, a 66-year-old woman with resistant hypertension and hyperlipidemia comes to the doctor because of decreased urination. She denies dysuria, fevers, or chills. Blood pressure is 133/67 mm Hg. Physical examination shows no abnormalities. Compared to measurements from one week ago, the glomerular filtration rate is markedly decreased and plasma renin activity is elevated. A duplex ultrasound of the kidneys shows increased systolic flow velocity in both renal arteries when compared to the aorta. Which of the following drugs is the most likely cause of this patient's worsening renal function? ---- <<Choices:>> A) Furosemide B) Spironolactone C) Enalapril D) Atenolol ---- <<Answer:>>
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C
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Answer the following medical question with the correct letter choice:
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<<Question:>> An investigator is conducting an experiment to develop a new drug against HIV infection. HIV-infected and uninfected CD4 T-cell lines are mixed in-vitro with a chemically modified synthetic peptide triazole complex. The complex is found to have a high binding affinity to the gp120 protein, irreversibly inhibiting its function and reducing CD4 T cell infection. Inhibition of which of the following steps of HIV infection is the most likely therapeutic effect of this experimental drug? ---- <<Choices:>> A) Incorporation of viral genome into host cell DNA B) Transcription of the viral genome C) Fusion and entry into CD4 T-cells D) Attachment to host CD4 T-cells ---- <<Answer:>>
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D
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 35-year-old man presents to the physician for a medical evaluation necessary before joining the armed force services. He is a healthy man with no history of smoking or substance abuse. His past medical history is not significant. His vital signs are stable and his systemic examination is within normal limits. Examination of his respiratory system, including auscultation of his chest, does not reveal any abnormality. His laboratory investigations are within normal limits but his chest radiogram shows a solitary pulmonary nodule (SPN), size 9 mm (0.35 in) in diameter, in the middle zone of his right lung. The physician compares the radiogram with a radiogram obtained 3 years back for pre-employment medical evaluation. The physician notes that a similar SPN with the same size was present in the previous radiogram at the same location. Which of the following is the next best step in his evaluation? ---- <<Choices:>> A) No further workup B) Thin-section computed tomography (CT) scan C) Positron emission tomography (PET) scan D) Follow-up after 12 months; if unchanged, no further follow-up ---- <<Answer:>>
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A
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<<Question:>> A 32-year-old man presents to his primary care physician because he has been experiencing fatigue and back pain over the last 2 days. He suffered from malaria after going on vacation 5 years ago and recently started taking a medication to deal with a latent form of this infection. He started developing these symptoms 36 hours after taking the first dose and noticed his urine became progressively darker during that time. On physical exam he is found to have scleral icterus and skin jaundice. Labs are obtained with the following results: Hematocrit: 32% (Normal: 41%-53%) Hemoglobin: 10.6 g/dL (Normal: 13.5-17.5 g/dL) Leukocyte count: 8500/mm3 (Normal: 4500-11,000/mm3) Platelet count: 273,000/mm3 (Normal: 150,000-400,000/mm3) Which of the following would most likely be seen on a peripheral blood smear in this patient? ---- <<Choices:>> A) Helmet-shaped red blood cells B) Small round inclusions of denatured hemoglobin C) Small round inclusions of nuclear remnants D) Target-shaped red blood cells ---- <<Answer:>>
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B
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<<Question:>> A 30-year-old woman presents to the office for routine examination. She has no medical complaints except for mild burning sensation in her eyes and an occasional dry cough. She denies fever, headache, or any recent illnesses. Past medical history is unremarkable and she takes no medications. She does not smoke cigarettes or drinks alcohol. Her temperature is 37.0°C (98.6°F), the blood pressure is 110/70 mm Hg, the pulse is 78/min, and the respirations are 12/min. Physical examination is normal except for bilateral conjunctival injection. Laboratory results and chest X-ray is shown below: Serum chemistry Sodium 145 mEq/L Potassium 4.1 mEq/L Chloride 98 mEq/L Calcium 13 mEq/L Bicarbonate 20 mEq/L Blood urea nitrogen 8 mEq/L Creatinine 0.7 mEq/L Glucose 96 mEq/L Urine toxicology Negative Which of the following abnormalities would most likely be seen in this patient? ---- <<Choices:>> A) Increased ACE levels B) Increased ADH levels C) Presence of anti-dsDNA antibodies D) Caseating granulomas in lung tissue biopsy ---- <<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 presents to a physician with the complaint of a persistent cough for a year. He has visited multiple physicians to date, but there has been no conclusive diagnosis. He has been a smoker since the age of 30. There is no history of significant expectoration, blood in sputum, wheezing, or breathing difficulty, but he has lost approx. 6.35 kg (14 lb) of weight over the last 9 months. On physical examination, his vital signs are stable, and examination of the chest reveals decreased breath sounds over the left infrascapular region. His chest radiogram suggests atelectasis in the left lower lobe. A detailed evaluation confirms a diagnosis of non-small cell lung carcinoma involving the left main bronchus, which is 4 cm in size and is located 3.8 cm (1.5 in) from the carina. Ipsilateral hilar lymph nodes, ipsilateral subcarinal lymph nodes, and ipsilateral scalene lymph nodes are involved in metastasis with no distant metastasis. Investigations also suggest that the patient does not have any comorbidity that contraindicates any anti-cancer treatment modality and that his performance status is good. Which of the following is the initial treatment of choice for the patient? ---- <<Choices:>> A) Surgery followed by adjuvant chemotherapy B) Chemotherapy only C) Concurrent chemoradiotherapy D) Radiation therapy only ---- <<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 25-year-old woman comes to the physician because of a 3-week history of fever, recurrent headaches, and anorexia. One month ago, she returned from a camping trip in Chile. Her temperature is 39.3°C (102.8°F). Examination shows a swelling in the left periorbital region and axillary, cervical, and inguinal lymphadenopathy. A blood sample is obtained. Processing of the sample with which of the following methods is most likely to confirm the diagnosis? ---- <<Choices:>> A) Staining with India ink B) Staining with Giemsa dye C) Staining of glycogen D) Staining with silver ---- <<Answer:>>
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B
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<<Question:>> A 57-year-old man presents to the emergency department with chest and back pain. He states that his symptoms started suddenly 1 hour ago and have persisted. He has a past medical history of hypertension and diabetes. His temperature is 98.5°F (36.9°C), blood pressure is 168/111 mmHg, pulse is 95/min, respirations are 14/min, and oxygen saturation is 99% on room air. Physical exam is notable for an uncomfortable man but is otherwise within normal limits. An initial ECG is unremarkable. Laboratory values are ordered as seen below. Hemoglobin: 15 g/dL Hematocrit: 45% Leukocyte count: 6,300/mm^3 with normal differential Platelet count: 222,000/mm^3 Serum: Na+: 141 mEq/L Cl-: 103 mEq/L K+: 4.5 mEq/L HCO3-: 24 mEq/L BUN: 42 mg/dL Glucose: 129 mg/dL Creatinine: 1.9 mg/dL Ca2+: 10.2 mg/dL Which of the following is the best next step in management? ---- <<Choices:>> A) CT angiogram of the chest B) D-dimer C) Esmolol D) Transesophageal echocardiography ---- <<Answer:>>
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D
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<<Question:>> A 2-week-old infant is brought to the pediatrician for the first time by his parents. His mother received regular prenatal care and the child was born at home under the guidance of a midwife and a doula. The child appears well. The parents tell you they do not plan to have their child receive any vaccines. After a discussion regarding the risks and benefits of vaccines, the parents are still adamant in their wishes to forgo. Which of the following is the most appropriate course of action? ---- <<Choices:>> A) Call child protective services B) Refuse to continue to care for the child C) Give any scheduled vaccines during that visit against the will of the parents D) Document the visit, specifically the detailing of risks and benefits and the parents' refusal of treatment ---- <<Answer:>>
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D
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<<Question:>> A 15-year-old boy is brought in to his pediatrician's office by his step-mother for uncontrollable behavior. She reports he has an extensive history of detention for outbursts in class. He recently got expelled from school for fist fighting. At home, he punches his younger brother when he’s angry. The family had to give their cat away to a neighbor because the patient tried to set it on fire. The patient’s medical history is significant for bed-wetting until he was 11. His father has adult attention deficit disorder. The patient states that he thinks school is a “joke.” He denies having close friends and says “the kids in my town are stupid anyway.” He calmly describes how he would like to burn down all their houses. He admits to trying alcohol and cocaine but denies any other illicit drugs. Which of the following is the patient’s most likely diagnosis? ---- <<Choices:>> A) Antisocial personality disorder B) Attention deficient hyperactivity disorder C) Conduct disorder D) Substance abuse ---- <<Answer:>>
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C
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<<Question:>> A 30-year-old female complains of heat intolerance, excessive sweating, and recent unintentional weight loss. She denies alcohol, tobacco, and other drug use and does not take any medications. Laboratory analysis reveals elevated serum T4 and decreased serum TSH. You elect to manage the patient’s condition pharmacologically with methimazole. Methimazole interferes with the function of which of the following proteins? ---- <<Choices:>> A) Sex-hormone binding globulin B) Thyroid peroxidase C) 5’-deiodinase D) Sodium/iodide symporter ---- <<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 40-year-old woman presents to her primary care physician with complaints of worsening muscle aches and diffuse weakness over the past several months. She states that she now has difficulty climbing stairs and extending her neck. Ultimately, she became more concerned when she began having trouble swallowing and experienced shortness of breath last night which has resolved. Her temperature is 98.5°F (36.9°C), blood pressure is 120/84 mmHg, pulse is 70/min, respirations are 12/min, and oxygen saturation is 98% on room air. Physical exam is notable for 2/5 strength of the proximal muscles of the upper and lower extremities. Dermatologic, cardiac, and pulmonary exam are unremarkable. The patient is tolerating oral secretions and has no difficulty swallowing or protecting her airway currently. Laboratory studies are notable for an elevated CRP and aldolase. Which of the following is the most appropriate treatment for this patient? ---- <<Choices:>> A) Intravenous immunoglobulin B) Methotrexate C) Naproxen D) Prednisone ---- <<Answer:>>
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D
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<<Question:>> A 50-year-old woman visits her primary care practitioner with the complaints of generalized weakness, lightheadedness, and fatigability for the past month. She also claims to have epigastric pain, heartburn, and a sensation of a lump in her throat. Her family history is irrelevant, but her medical history is significant for a Pap smear that reported atypical squamous cells of undetermined significance (ASCUS), which was followed up with a cervical biopsy negative for malignancy. She occasionally takes over-the-counter medicines to cope with the heartburn, and recently her hemoglobin was found to be 11 g/dL, for which she received iron and vitamin B12 supplementation. Physical examination is unremarkable, except for pale skin, and a pulse of 120/min. Which of the following is the next best step in the management of this patient? ---- <<Choices:>> A) Proton pump inhibitor B) Anti-H2 agent C) Endoscopy D) Diet and lifestyle recommendations ---- <<Answer:>>
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C
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 67-year-old man presents to a primary care clinic to establish care after moving from another state. According to his prior medical records, he last saw a physician 4 years ago and had no significant medical problems at that time. Records also show a normal EKG and normal colonoscopy results at that time. The patient reports feeling well overall, but review of systems is positive for 1 year of mild cough productive of clear sputum and 2 years of increased urinary frequency. He denies fever, chills, dyspnea, dysuria or hematuria. He denies illicit drug use but has been drinking approximately 1-2 beers per night and smoking 1 pack of cigarettes per day since age 20. Physical exam is unremarkable. Which of the following tests is indicated at this time? ---- <<Choices:>> A) Abdominal ultrasound B) Bladder ultrasound C) Serum prostate specific antigen (PSA) testing D) Sputum culture ---- <<Answer:>>
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A
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<<Question:>> An 8-year-old boy is brought to the physician for evaluation of an excessive bleeding after undergoing a dental procedure. Laboratory studies show a platelet count of 195,000/mm3, a partial thromboplastin time of 44 sec, and a prothrombin time of 12 sec. A one-stage clotting assay shows a decreased factor VIII. Therapy with a drug that acts on endothelial cells is initiated. This drug is most likely to result in which of the following? ---- <<Choices:>> A) Decreased cAMP in renal tubular cells B) Increased tubular fluid osmolarity in the loop of Henle C) Increased permeability to urea in the collecting duct D) Increased bleeding time ---- <<Answer:>>
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C
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<<Question:>> A young girl is brought to the physician by her mother for a well-child examination. She is at the 55th percentile for height and at the 40th percentile for weight. Vital signs are within normal limits. Physical examination shows no abnormalities. She is able to follow simple commands, such as “close your eyes, then stick out your tongue,” but she is unable to follow 3-step commands. She knows approximately 75 words, and half of her speech is understandable. She can say 2-word phrases, and she is able to name many parts of the body. Assuming normal development, which of the following milestones would be expected in a patient this age? ---- <<Choices:>> A) Separates easily from parents B) Kicks a ball C) Pedals a tricycle D) Hops on one foot ---- <<Answer:>>
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B
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Answer the following medical question with the correct letter choice:
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<<Question:>> An investigator is studying the association between exclusive breastfeeding and body weight in infants. The body weights of 15 exclusively breastfed infants at the age of 6 months are measured. Results are shown: Patient Body weight (kg) 1 7.0 2 6.0 3 6.1 4 6.8 5 7.2 6 6.4 7 6.2 8 6.8 9 6.5 10 7.3 11 6.3 12 8.5 13 6.9 14 6.6 15 5.2 One of the computed measures of central tendency is 6.8 kg. Which of the following characteristics is generally true about this measurement?" ---- <<Choices:>> A) It is not applicable for qualitative data analysis. B) It is resistant to outliers. C) Its value only occurs once in a data set. D) It is useful to assess the extent of data variability. ---- <<Answer:>>
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B
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 32-year-old man presents to his primary care provider with right leg weakness and numbness. He reports a 2-day history of “clumsiness” in his right lower extremity after playing in his company’s annual weekend-long charity baseball tournament. He says a similar episode happened 1 year ago during the same tournament. He has a history of major depressive disorder and right distal radius fracture status post-closed reduction and casting after falling 2 years ago. He takes fluoxetine. He also reports that he several years ago he had an isolated episode of decreased vision and inability to move his right eye that resolved on its own. He has a 15-pack-year smoking history and drinks 3-4 beers per week. His temperature is 98.4°F (36.9°C), blood pressure is 115/65 mmHg, pulse is 85/min, and respirations are 18/min. On exam, hip flexion, knee extension, and ankle dorsiflexion are all 3/5 on his right and 5/5 on his left. Right Achilles and patellar reflexes are 1+ on the right and 2+ on the left. He has decreased sensation to light touch throughout the right leg especially below the knee. Additional questioning would most likely reveal which of the following additional features about this patient’s current symptoms? ---- <<Choices:>> A) Concomitant hyperreflexia B) Symptom improvement in the heat C) Symptom exacerbation in the heat D) Symptom exacerbation with repetitive muscle contractions ---- <<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 56-year-old man comes to the physician because of throat pain and increasing difficulty swallowing food for the past 5 months. He has also had episodic left ear pain for the past 3 months. He has hypertension. His only medication is amlodipine. His father died of laryngeal cancer at the age of 55 years. He has smoked one pack of cigarettes daily for 36 years. He drinks 2–3 beers daily. Vital signs are within normal limits. Examination shows left cervical lymphadenopathy. Oropharyngeal examination shows a 3-cm ulcerating left tonsillar mass. Examination of both auditory canals is unremarkable. Which of the following is the most appropriate initial step in management? ---- <<Choices:>> A) Nasopharyngoscopy B) Panendoscopy C) Barium swallow D) Laryngoscopy " ---- <<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 23-year-old woman presents to the emergency department with abdominal pain. The patient states that she has pain in her back that radiates to her abdomen. The pain started yesterday and is episodic. She describes the pain as a 10/10 when it occurs. The patient has a past medical history of asthma, anxiety, and chlamydia that was appropriately treated. Her current medications include fluoxetine. The patient's lab values are ordered as seen below. Hemoglobin: 14 g/dL Hematocrit: 40% Leukocyte count: 8,500 cells/mm^3 with normal differential Platelet count: 225,000/mm^3 Serum: Na+: 140 mEq/L Cl-: 100 mEq/L K+: 4.9 mEq/L HCO3-: 24 mEq/L BUN: 22 mg/dL Glucose: 89 mg/dL Creatinine: 1.2 mg/dL Ca2+: 10.0 mg/dL AST: 11 U/L ALT: 11 U/L Urine: Color: amber Nitrites: negative Na+: 12 mmol/24 hours Beta-hCG: positive Red blood cells: 11/hpf Which of the following is the best test for this patient's most likely diagnosis? ---- <<Choices:>> A) Abdominal CT B) Transvaginal ultrasound C) Abdominal ultrasound D) Renal ultrasound ---- <<Answer:>>
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D
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<<Question:>> A baby is delivered via cesarean section on the 31st gestational week. The child has tachypnea, nasal flaring, and subcostal, and intercostal retraction. Nasogastric tube was positioned without problems. Chest radiography shows bilateral, diffuse, ground-glass appearance, air bronchograms, and poor lung expansion. What is the best treatment plan in the present case? ---- <<Choices:>> A) No therapy right away, only observation B) Surfactant administration and oxygen therapy C) Antibiotics D) Emergency surgical repair of tracheoesophageal fistula ---- <<Answer:>>
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B
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Answer the following medical question with the correct letter choice:
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<<Question:>> A previously healthy 38-year-old man comes to the emergency department for evaluation of several hours of severe, right-sided, colicky flank pain that radiates to the groin. He drinks 2–3 energy drinks daily. An x-ray of the abdomen shows a 4-mm radiopaque mass in the right ureter. Microscopic examination of the urine shows biconcave, dumbbell-shaped crystals. Which of the following is most likely to prevent future episodes of flank pain? ---- <<Choices:>> A) Begin loop diuretic B) Maintain acidic urine C) Maintain adequate hydration D) Start high-dose vitamin C ---- <<Answer:>>
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C
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 45-year-old woman presents for evaluation of mild painless postcoital bleeding for the past 6 months. Recently, she started to note irregular intermenstrual bleeding. She has a regular menstrual cycle that lasts 30 days. She has no history of genital infections or any other major gynecologic diseases. She has 1 sexual partner and uses barrier contraception for birth control. The pelvic examination shows an erosive necrotizing lesion (6 cm in diameter) that involves the posterior lip of the cervix and extends to the cervical canal and posterior vaginal apex. Cervical mobility is decreased. The uterus is not enlarged and the ovaries are non-palpable. A colposcopy is performed and a biopsy is obtained. The histologic evaluation shows irregularly-shaped nests of squamous epithelium cells with large pleomorphic nuclei, inconspicuous nucleoli, a clear cytoplasm, and increased mitoses that infiltrate the stroma for greater than 10 mm. Which of the following investigations is the main method for staging the patient’s condition? ---- <<Choices:>> A) Pelvic MRI B) Clinical examination C) Pelvic CT D) PET-CT ---- <<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 69-year-old man presents for surgery due to chronic painful diverticula in the sigmoid colon. The patient is a Jehovah's witness and refuses a transfusion of blood products even in an emergency. Which artery should be briefly clamped to prevent bleeding during the partial sigmoidectomy? ---- <<Choices:>> A) Superior mesenteric artery B) Inferior mesenteric artery C) Celiac trunk D) Inferior rectal artery ---- <<Answer:>>
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B
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<<Question:>> A thymic sample from a fetus is examined. One cell type found was double-positive for the CD4 and CD8 receptors. What is the identity of these double-positive cells? ---- <<Choices:>> A) B-cells B) Immature T-cells of the thymic cortex C) Immature T-cells of the thymic medulla D) Macrophages ---- <<Answer:>>
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B
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<<Question:>> An investigator is studying the antimicrobial resistance profile of a bacterial pathogen using disk diffusion testing. The pathogen is isolated onto agar plates and antibiotic wafers are added to the plates. The inhibitory zone diameters are then recorded and used to define susceptibility thresholds. The results of the testing for the pathogen shown: Drug Susceptibility Penicillin G Resistant Cefazolin Resistant Doxycycline Susceptible Imipenem Resistant Azithromycin Susceptible Vancomycin Resistant Which of the following is most likely the organism being studied?" ---- <<Choices:>> A) Staphylococcus aureus B) Clostridioides difficile C) Borrelia burgdorferi D) Ureaplasma urealyticum ---- <<Answer:>>
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D
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<<Question:>> A 30-year-old man comes to the physician for evaluation of infertility. He does not smoke, drink, or take any medications. Physical examination shows no abnormalities. Serum analysis shows anti-sperm antibodies. What is the most likely cause of this patient's serum finding? ---- <<Choices:>> A) Increase in testicular temperature B) Dysgenesis of vas deferens C) Defect in Sertoli cell function D) Defect in GnRH production " ---- <<Answer:>>
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C
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<<Question:>> A mother calls the psychiatrist, saying that she is concerned about her 18-year-old son who has become quite emaciated over the past several months. She has noticed that his pupils are enlarged, he has frequent nose bleeds, and he wears long sleeve shirts even in warm weather. His personality has changed quite dramatically as well, as he repeatedly steals from her and sells anything valuable in the house. He also has become overconfident, aggressive, and paranoid. Which of the following is a risk of the drug that the son is most likely using? ---- <<Choices:>> A) Serotonin syndrome B) Sudden cardiac arrest C) CNS white matter lesions D) Increased risk of schizophrenia in predisposed patients ---- <<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 48-year-old man is brought to the physician by his wife because he has become increasingly restless and anxious. His wife says that he has seemed sad and irritable for the past 4 months. He lost his job as a store clerk because he often lied to avoid work, and spent most of his days on the phone placing bets on football games. He avoids all family-related events because he has borrowed money from most of his relatives. He is hopeful that his symptoms will improve once he is able to win some of his money back. He previously smoked 8–10 cigarettes daily but quit 1 month ago. He drinks beer on the weekends. On examination, he is uncooperative and dismissive. He is mildly tremulous. Neurologic examination is normal. He is oriented to person, place, and time. Which of the following is the most likely diagnosis? ---- <<Choices:>> A) Gambling disorder B) Alcohol withdrawal C) Bipolar II disorder D) Adjustment disorder ---- <<Answer:>>
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A
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<<Question:>> A 28-year-old man comes to the emergency department because of an excruciating headache that started 30 minutes ago. The pain is located around the right eye and it awoke him from sleep. Over the past two weeks, he has had similar headaches around the same time of the day, and he reports pacing around restlessly during these episodes. Physical examination shows conjunctival injection and tearing of the right eye. In addition to supplemental oxygen therapy, administration of which of the following drugs is most likely to provide acute relief in this patient? ---- <<Choices:>> A) Sumatriptan B) Amitriptyline C) Prednisone D) Oxycodone ---- <<Answer:>>
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A
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 27-year-old woman presents with loss of consciousness at work. The patient’s colleagues say that she had been complaining of a headache all day. Her past medical history is significant for diabetes mellitus type 1. Her blood pressure is 70/60 mm Hg, pulse is 105/min, temperature is 37.2°C (99.0°F), and her respiratory rate is 28/min and shallow. On physical examination, there is a black eschar formation on her nose and her breath has a fruity odor. Laboratory findings are significant for serum glucose of 750 mg/dL, potassium of 3.3 mmol/L, and blood pH of 7.1. Which of the following diabetic complications is most likely the cause of this patient’s presenting symptoms? ---- <<Choices:>> A) Diabetic ketoacidosis B) Hyperosmolar coma C) Lactic acidosis D) Hypoglycemic coma ---- <<Answer:>>
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A
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<<Question:>> A 61-year-old male presents to his primary care doctor with a six-month history of progressively worsening cough, shortness of breath, and 15-pound weight loss. Over the same time period, he has also started to notice occasional weakness in his legs that has made it difficult for him to stand up from his chair and climb stairs. The weakness appears to improve when he exercises at his local aerobics class. His past medical history is notable for hypertension and hyperlipidemia. He has smoked 2 packs of cigarettes per day for 35 years. Chest radiographs demonstrate a perihilar mass in his right lung. A biopsy of the lung lesion is shown. Which of the following is most likely true about this patient? ---- <<Choices:>> A) His weakness is due to a type III hypersensitivity reaction B) He is at high risk of developing extraocular weakness C) His weakness is due to antibodies directed against post-synaptic, voltage-gated ion channels D) His weakness improves when calcium builds up in the presynaptic nerve terminal ---- <<Answer:>>
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D
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<<Question:>> A 45-year-old man with a history of hypertension, IV drug use, and type 1 diabetes is brought to the emergency room due to nausea, vomiting, and altered consciousness. He was brought in by his sister who found him asleep on her couch. He is difficult to arouse and does not respond to questions. His sister does not know his medications; however, he has a known history of medication noncompliance. On physical exam his temperature is 99°F (37.2°C), blood pressure is 100/70 mmHg, pulse is 112/min, respirations are 26/min, and pulse oximetry is 99% on room air. He is arousable but is not cooperative with the exam. His breaths are deep and you notice a fruity-smell coming from his mouth. Exam is otherwise unremarkable. Which of the following findings would you also expect to see in this patient? ---- <<Choices:>> A) Decreased total body potassium B) Increased bicarbonate concentration C) Decreased hydrogen ion concentration D) Decreased free fatty acid concentration ---- <<Answer:>>
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A
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<<Question:>> A 31-year-old woman and her 32-year-old husband come to the physician because they have not been able to conceive since they married 1.5 years ago. They are sexually active and have not used any form of contraception during this period. She was diagnosed with cervicitis due to Chlamydia trachomatis infection 4 years ago, which was treated with oral azithromycin. The wife reports that she has regular menses and is otherwise healthy. Her last menstrual bleeding was 2 weeks ago. Neither partner shows abnormalities on physical examination. Which of the following is the most appropriate next step in management? ---- <<Choices:>> A) Chromosomal karyotyping B) Postcoital testing C) Post-ejaculatory urinalysis D) Semen analysis ---- <<Answer:>>
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D
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<<Question:>> A 66-year-old man comes to the physician with a 4-month history of recurrent crusty lesions on the dorsal surface of his hands. When he scrapes off the crusts, they reappear after a few days. The lesions are mildly pruritic and occasionally burn. He works as a landscaper. A photograph of his right hand is shown. Which of the following is the most likely diagnosis? ---- <<Choices:>> A) Sporotrichosis B) Basal cell carcinoma C) Actinic keratosis D) Seborrheic keratosis " ---- <<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 woman presents to the emergency department with severe abdominal pain and discomfort for several hours. She says that the pain started suddenly and rates it as an 8/10 pain. There are no exacerbating factors but the pain gets relieved by leaning forward. She also complains of nausea and vomiting. She has vomited 4 times in the last 2 hours. Her past medical history is significant for HIV, diabetes, asthma, depression, and acute angle glaucoma. She states that she is very diligent with her medications and has never missed a pill. She says that she does not smoke or drink alcohol. Her temperature is 37°C (98.6°F), respirations are 15/min, pulse is 97/min, and blood pressure is 102/98 mm Hg. On examination, she is pale, diaphoretic, and in extreme discomfort. She does not allow an abdominal exam. Laboratory results show a serum amylase of 456 U/L and a serum lipase of 562 U/L. Treatment of which of the following conditions most likely led to this patient's current condition? ---- <<Choices:>> A) Asthma B) Acquired immunodeficiency syndrome C) Depression D) Diabetes ---- <<Answer:>>
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B
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<<Question:>> A 66-year-old man is brought to the emergency department after 3 consecutive days of nausea and multiple episodes of vomiting every day. He has been receiving cisplatin as part of treatment for small cell lung carcinoma diagnosed about a year ago. Upon admission, he is found to be drowsy with muscle weakness. The patient’s vital signs are as follows: blood pressure is 98/60 mm Hg, heart rate is 120/min, respiratory rate is 14/min, and body temperature is 36.5°C (97.7°F). Physical examination reveals a mildly cachectic male with mild abdominal tenderness to palpation. The following tests are performed: Laboratory test Serum Na+ 136 mEq/L Serum Cl- 78 mEq/L Serum K+ 3.0 mEq/L Serum creatinine (SCr) 1.0 mg/dL Arterial blood gas pH 7.58 PO2 95 mm Hg PCO2 49 mm Hg SO2% 98% HCO3- 44.4 mEq/L Which of the following is the most likely cause of this patient’s acid-base abnormality? ---- <<Choices:>> A) Increased potassium secretion B) Excessive hydrogen ion loss C) Carbon dioxide retention D) Decreased bicarbonate excretion ---- <<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 30-year-old woman presents with a white patch on her tongue that she noticed a few weeks ago. She denies any changes in taste sensation or pain, weight loss, or night sweats. Past medical history is significant for a 10-year history of type 1 diabetes mellitus, managed currently on insulin therapy. Her last HbA1c a month ago was 9%. On physical examination, there are white patches present over the dorsum of her tongue (as seen in the image) that can easily be scraped off. Microscopic examination of KOH treated scrapings shows pseudohyphae. The patient is advised to have better blood glucose control and is prescribed a drug for these oral patches, which she is instructed to swish in her mouth for several minutes and then swallow. Which of the following best describes the mechanism of action of this drug? ---- <<Choices:>> A) Inhibition of synthesis of lanosterol B) Inhibit of synthesis of ergosterol C) Disruption of cell membrane integrity D) Inhibition of nucleic acid synthesis ---- <<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 African-American woman comes to the physician because of a 6-month history of fatigue, increasing shortness of breath on exertion, and a dry cough. She also has chronic constipation with bowel movements once every two to three days. She has not had fevers, night sweats, or weight loss. She has a history of hypertension and arthritis of both ankle joints. Current medications include hydrochlorothiazide and daily multivitamins. Her vital signs are within normal limits. Her serum sodium is 138 mEq/L, potassium is 3.9 mEq/L, and calcium is 11.5 mg/dL. An x-ray of the chest shows bilateral hilar lymphadenopathy and normal lung parenchyma. Which of the following is the most likely cause of this patient's hypercalcemia? ---- <<Choices:>> A) Elevated 1,25-dihydroxyvitamin D3 levels B) PTH-related protein production C) Thiazide-induced renal calcium reabsorption D) Chronic kidney disease ---- <<Answer:>>
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A
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<<Question:>> A 78-year-old man comes to the physician because of difficulty swallowing and regurgitation of undigested food for the past several months. The patient reports that his symptoms have gotten progressively worse. Physical examination shows severe halitosis and a gurgling sound after he swallows a small amount of water. Results of fluoroscopic barium esophagography are shown. The nerve responsible for motor innervation of the affected muscle is also responsible for which of the following functions? ---- <<Choices:>> A) Parasympathetic innervation of the AV node B) Sensory innervation of the posterior tongue C) Visceral sensory innervation of the carotid sinus D) Motor innervation of the ventral tongue ---- <<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 1-day-old boy is brought to the emergency department by ambulance after his parents found him to be increasingly lethargic. He was born at home with inconsistent prenatal care. Since then, his parents report that his head appears to be getting bigger over the past few hours. He also feeds poorly and has had a few episodes of vomiting. On presentation, he is found to have limb spasticity with adducted thumbs. His head circumference is bigger than expected and he appears to be unable to look up when following objects. Which of the following findings would most likely also be seen in this patient? ---- <<Choices:>> A) Abnormally large posterior fossa B) Downwardly displaced cerebellum C) Obstruction of the cerebral aqueduct D) Tuft of hair on the spine ---- <<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 woman presents to the emergency department with a 2-day history of chest pain. The patient’s symptoms started gradually after moving heavy objects during packing. The pain is constant and nagging but intensifies with lateral movement. The patient has no history of serious illness and takes no medications, currently. She does not smoke. Her vitals are as follows: blood pressure 125/75 mm Hg; pulse 75/min; respiratory rate 14/min; and temperature 36.9℃ (98.4℉). Examination of the anterior chest wall shows the absence of swelling, erythema, or warmth. The 3rd and 4th left rib bones are tender anteriorly near the sternum. An electrocardiogram is shown. The test for cardiac troponin I is negative. Which of the following is the most appropriate initial step in the management of this patient? ---- <<Choices:>> A) Ibuprofen B) Intercostal nerve block C) Serial ECG for 12 hours D) Sublingual nitroglycerin ---- <<Answer:>>
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A
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<<Question:>> A 28-year-old woman who recently immigrated from Kenya presents with fatigue, shortness of breath, and palpitations for a few weeks. Review of systems is significant for a painful swollen knee. The patient is afebrile, and her vital signs are within normal limits. On physical examination, her voice seems hoarse, although her pharynx does not show signs of an inflammatory process. Cardiopulmonary auscultation is significant for a loud first heart sound with a split second heart sound and a mid-diastolic rumbling murmur with an opening snap best heard over the cardiac apex. Transthoracic echocardiography shows a calcified mitral valve with an opening area of 1.5 cm2 (normal: 3.0–3.5 cm2). The patient is recommended to have her mitral valve replaced because of the risk for complications such as atrial fibrillation which may lead to the formation of a life-threatening blood clot that can travel to other parts of the body. Which of the following organs is most likely to be spared in this patient? ---- <<Choices:>> A) Lungs B) Spleen C) Brain D) Small bowel ---- <<Answer:>>
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A
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<<Question:>> A 14-year-old girl with a BMI of 17 complains of frequent urination, excessive thirst, and abdominal pain. Her parents have noticed that she appears to have lost some weight. Her past medical history is significant for celiac disease. A random plasma blood glucose is 267 mg/dL. Which of the following is a property of the hormone that is deficient in this patient? ---- <<Choices:>> A) Up-regulates glycogen phosphorylase activity B) Enhances potassium uptake C) Downregulates HMG-CoA reductase D) Crosses the placenta to affect the fetus ---- <<Answer:>>
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B
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<<Question:>> A 37-year-old woman presents to her primary care physician with a 6-month history of fatigue. She denies any recent history of fevers, chills or headaches. She does not smoke or drink alcohol. A CBC demonstrates a microcytic anemia. Iron studies are ordered and demonstrate the following: Serum iron: 40 µg/dL (normal 50–170 µg/dL); TIBC: 230 µg/dL (normal 250–370 µg/dL); Transferrin saturation: 10% (normal 15–50%); Serum ferritin: 180 µg/L (normal 15-150 µg/L); Which of the following is a likely cause of this patient's iron studies findings? ---- <<Choices:>> A) Lead poisoning B) Dysfunctional uterine bleeding C) Splenic sequestration of RBCs D) Rheumatoid arthritis ---- <<Answer:>>
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D
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<<Question:>> A 32-year-old man presents with epigastric gnawing pain occurring after meals. Occasionally, dull pain awakens him at night. He also complains of bloating and occasional constipation. He has been having these symptoms for almost 2 years and uses antacids and castor oil for relief. Recently, he began to note that these remedies provide less relief than in the past. He reports no significant weight loss, night sweats, or a change in stool color. He has no family history of peptic ulcer disease or gastrointestinal malignancies. The patient does not smoke cigarettes but drinks alcohol occasionally. He rarely uses NSAIDs for symptomatic treatment. His blood pressure is 120/80 mm Hg, heart rate is 85/min, respiratory rate is 14/min, and temperature is 36.6°C (97.9°F). A physical examination revealed epigastric tenderness on palpation and the abdomen was distended. A urea breath test was performed, which was positive. Which of the following statements regarding the test results in this patient is true? ---- <<Choices:>> A) The test detected products of increased cellular breakdown by the causative agent induced by urea ingestion. B) The causative agent possesses urease; thus, it is possible to detect urease by giving the patient urease with labeled N-14 orally and then measuring the ammonia content in the exhaled breath. C) The causative agent possesses urease; thus, it is possible to detect urease by giving the patient urea with labeled C-14 orally and then measuring the carbon dioxide content in the exhaled breath. D) The causative agent possesses urease; thus, it is possible to detect urease by giving the patient urease and then measuring the pH of the exhaled breath to determine whether or not there was an increased breakdown of ammonia. ---- <<Answer:>>
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C
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 45-year-old man is brought into the emergency department after he was found collapsed in a housing development stairwell. He was found in a pool of vomit, barely breathing. Used syringes and a tourniquet were found near the patient. His blood pressure is 100/70 mm Hg, pulse is 65/min, and respiratory rate is 6/min. Physical examination reveals a thin and disheveled man with track marks on both arms. The appropriate reversal agent is administered. Which of the following findings would be most likely seen in this patient as a result of administering this reversal agent? ---- <<Choices:>> A) Yawning B) Miosis C) Smooth skin D) Tremulousness ---- <<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 33-year-old woman comes to the physician because of a 1-year history of irregular menses and infertility. She has a history of an eating disorder and has received dietary and behavioral therapy over the past 6 months with minimal improvement in her symptoms. She is 170 cm (5 ft 7 in) tall and weighs 49 kg (104 lb); her BMI is 17 kg/m2. Physical examination is significant for pallor and thin, soft, depigmented hair on the arms and back. After an extensive workup, the physician recommends pulsatile GnRH therapy. One week after initiating therapy, a pelvic ultrasound shows a 24-mm hypoechogenic cavity in the right ovary. The patient subsequently receives a drug that results in the resumption of meiosis and the loss of gap junctions between the cumulus granulosa cells and the oocyte. This patient most likely received which of the following drugs? ---- <<Choices:>> A) Follicle-stimulating hormone B) Mifepristone C) Human chorionic gonadotropin D) Cyproterone citrate ---- <<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 52-year-old woman visits her primary care practitioner, who has been following her closely after she was diagnosed with peptic ulcer disease. She tested positive for H. pylori in a urea breath test, which was later confirmed by an endoscopic biopsy. Her family history is significant for colorectal carcinoma, as well as ovarian cancer. Her past medical history is relevant for cigarette smoking and peptic ulcer disease, which has been under treatment twice, initially with a clarithromycin-containing regime. This was followed by a bismuth-containing regime after a fecal antigen test was positive 4 weeks later. A recent endoscopy and fecal antigen test detected H. pylori in her stomach mucosa. In addition to a protein pump inhibitor (PPI), which of the following should be added to the treatment regime of this patient? ---- <<Choices:>> A) Bismuth subsalicylate, metronidazole, tetracycline B) Levofloxacin, amoxicillin C) Clarithromycin, amoxicillin D) Rifabutin, amoxicillin ---- <<Answer:>>
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B
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Answer the following medical question with the correct letter choice:
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<<Question:>> An 8-year-old boy is brought to the pediatrician’s office with his mother for a routine check-up. Although her son is doing well, the mother has some concerns with regards to his overall health. He was born at 39 weeks gestation via spontaneous vaginal birth. He is up to date on all vaccines and has met most of developmental milestones. She reports that he is shorter than his classmates and seems less developed physically than his older brother and sister when they were his age. Additionally, the boy’s teacher has some concerns regarding his learning capability not being at the level of his peers. His height and weight are at the 10th and 15th percentile respectively. He has a heart rate of 90/min, respiratory rate of 22/min, blood pressure of 110/65 mm Hg, and temperature of 37.0°C (98.6°F). At physical exam the child appears cheerful, well developed, and well nourished. He is small for his age. with upslanting palpebral fissures, flat occiput, low set ears, and a flat nose. Which of the following techniques would most likely identify the cause of this patient’s presentation? ---- <<Choices:>> A) Punnett square B) Karyotype C) Polymerase chain reaction D) Gene mapping ---- <<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 woman visits her primary care provider for concerns of frequent headaches. She complains of recurrent headaches and involuntary weight loss, which she attributes to a constant pain along the right side of her jaw that occasionally radiates to her right eye. Her past medical history includes diabetes mellitus type 2 and chronic glomerulonephritis resulting in stage II chronic kidney disease. Her mother passed away in her 70s and had been diagnosed with multiple sclerosis at the age of 50. Today, her blood pressure is 135/90 mm Hg, heart rate is 88/min, respiratory rate is 15/min, and temperature is 36.6°C (97.9°F). The right side of her face is painful to palpation from her jaw to the right side of her scalp. Which of the symptoms below is most commonly associated with the patient’s condition? ---- <<Choices:>> A) Limb muscle weakness B) Neck stiffness C) Diplopia D) Shock-like pain in face ---- <<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 66-year-old man presents to his primary care provider for a routine checkup. He says that he feels well overall but has experienced some intermittent back pain and vague epigastric pain over the past 6 months. He also has experienced cramping in both legs that is worse whenever he walks for long periods of time. He has a history of poorly controlled hypertension, diabetes mellitus, recurrent renal stones, and major depressive disorder. He takes lisinopril, nifedipine, metformin, glyburide, and fluoxetine. He has a 55-pack-year smoking history and drinks alcohol socially. His temperature is 98.4°F (36.9°C), blood pressure is 155/85 mmHg, pulse is 92/min, and respirations are 16/min. On exam, he is well-appearing and in no acute distress. A normal S1 and S2 are heard on auscultation. He has no abdominal tenderness to palpation. A light pulsatile mass is felt in the mid-epigastrium. Achilles and patellar reflexes are 2+ bilaterally. His gait is normal. Which of the following additional findings is most strongly associated with this patient’s condition? ---- <<Choices:>> A) Abdominal bruit B) Asymmetric upper extremity pulses C) Continuous machine-like murmur D) Costovertebral tenderness ---- <<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 17-year-old male collapses 25 minutes into a soccer game. He is unresponsive and pulseless. Despite adequate resuscitation by a bystander, the patient is pronounced dead when the ambulance arrives. The patient had no past medical history other than a heart murmur as a child and he took no medications. His family history is notable for an uncle who died suddenly of unknown causes at the age of 25. A mutation in which of the following proteins most likely contributed to this patient’s condition? ---- <<Choices:>> A) Myosin heavy chain B) Dystrophin C) Fibrilin D) Elastin ---- <<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 36-year-old woman, gravida 3, para 2, at 31 weeks' gestation comes to the emergency department because of painless, bright red vaginal bleeding for one day. She has not felt any contractions. Her other children were delivered by Cesarean section because of breech position. Fetal heart rate is reactive with no decelerations. Which of the following findings is most likely on ultrasound? ---- <<Choices:>> A) Retroplacental hematoma B) Adnexal bleeding C) Placenta over the cervical os D) Gestational sac in a dilated cervix ---- <<Answer:>>
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C
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