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Answer the following medical question with the correct letter choice:
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<<Question:>> A 24-year-old man is brought to the emergency department for bowling at a local bowling alley while inappropriately dressed. The patient refused to speak with police and was seen conversing with inanimate objects in the back of the police car. The patient states that his clothes were contaminated by assassins who have been tracking him for years. The patient refuses to answer any further questions, and continues to whisper toward someone else. The patient has a past medical history of homelessness, alcohol abuse, marijuana use, and cocaine abuse. Physical exam is notable for a healthy young man who seems mistrustful of all hospital personnel. The patient is started on a medication and is transferred to the psychiatric inpatient unit. The patient’s condition improves, but he still often speaks of a contamination that is on his clothes and skin that is coming from external parties. The patient is started on a new medication. He is then sent to group therapy, followed by physical activity in the yard. The physician is called over when the patient is found down in the recreation yard while he was exercising. The patient is not responsive, and his limbs seem to resist passive force. His temperature is 104°F (40°C), pulse is 112/min, blood pressure is 140/90 mmHg, respirations are 18/min, and oxygen saturation is 95% on room air. Which of the following best describes the most likely diagnosis? ---- <<Choices:>> A) Dehydration B) Dopamine blockade C) Inadequate evaporative cooling D) Infection ---- <<Answer:>>
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B
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 23-year-old male presents to the emergency department after he was found naked wandering his neighborhood. The patient is disheveled and has not bathed in months. The patient has a past medical history of alcohol abuse and schizophrenia that is well controlled with haloperidol. The patient is started on haloperidol and most of his symptoms improve dramatically; however, he continues to refuse to eat food from the hospital as he believes it to be contaminated. The patient stays on the inpatient psychiatric unit and lab values are drawn and return as follows: Serum: Na+: 135 mEq/L K+: 3.0 mEq/L Cl-: 92 mEq/L HCO3-: 22 mEq/L BUN: 7 mg/dL Ca2+: 8.4 mg/dL Creatinine: 0.6 mg/dL Glucose: 70 mg/dL That patient is started on an intravenous solution containing potassium chloride and is closely monitored. His oral intake also seems to be improving. Lab values are ordered again the following day and return as follows: Serum: Na+: 137 mEq/L K+: 2.9 mEq/L Cl-: 95 mEq/L HCO3-: 22 mEq/L BUN: 8 mg/dL Ca2+: 9.0 mg/dL Creatinine: 1.0 mg/dL Glucose: 77 mg/dL The patient is continued on IV fluids and his clinical symptoms seem to further improve. Repeat labs the following three days remains largely unchanged. The patient's symptoms improve and he is determined to be at his baseline in terms of functioning. Which of the following is the best next step in management? ---- <<Choices:>> A) Discharge the patient on IM haloperidol B) IV fluids containing potassium C) IV fluids containing magnesium D) Increase oral intake ---- <<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 girl is brought to the physician because of high-grade fever and crying while passing urine. Four months ago, she was treated for a febrile urinary tract infection with cefixime. There is no family history of serious illness. Her temperature is 39.2°C (102.6°F) and pulse is 123/min. Physical examination shows no abnormalities. Urine dipstick shows leukocyte esterase; urinalysis shows WBCs. Urine culture shows Escherichia coli sensitive to cefixime. A voiding cystourethrogram is shown. Without treatment, which of the following is this patient most likely to develop? ---- <<Choices:>> A) Renal cell carcinoma B) Hypotension C) Renal scarring D) Nephrotic syndrome ---- <<Answer:>>
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C
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 37-year-old man presents to his primary care physician with a chief complaint of diarrhea. The patient states that his symptoms have worsened recently. He works as a farmer and is dressed in tattered and old denim. He lives alone, and this is the first time he has come to town in years. The patient’s diet is mostly dairy products and some meat products. He denies any systemic symptoms and states that diarrhea tends to occur right after a meal. He also claims that at times he struggles to fall asleep, and sometimes he feels he lacks energy. The patient is instructed to avoid consuming dairy products for a week and to return with a report of his symptoms. As you set up the return appointment with this patient you notice that he is rather emotionless. He also states that he lacks anybody that he can list as an emergency contact so he leaves that section of his medical forms blank. What is the most likely diagnosis? ---- <<Choices:>> A) Avoidant personality disorder B) Major depressive disorder C) Schizoid personality disorder D) Schizotypal personality disorder ---- <<Answer:>>
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C
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 77-year-old man presents to the emergency department with a change in his mental status. The patient’s daughter states that he can cook and clean up after himself and only needs help paying bills. Yesterday the patient seemed fine; however, this morning she noticed that he struggled to perform simple tasks and was forgetful while cooking, leaving the stove on. They recently returned from a trip to Mexico and admit to drinking unfiltered water and eating local cuisines while abroad. The patient has a past medical history of hypertension and diabetes. His temperature is 97.5°F (36.4°C), blood pressure is 187/118 mmHg, pulse is 90/min, respirations are 16/min, and oxygen saturation is 100% on room air. Which of the following is the most likely diagnosis? ---- <<Choices:>> A) Alzheimer dementia B) Lewy body dementia C) Normal pressure hydrocephalus D) Vascular dementia ---- <<Answer:>>
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D
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 65-year-old male with a past medical history of left ventricular hypertrophy presents to the emergency room because of a history of progressive shortness of breath and a cough productive of frothy pink sputum. Physical examination reveals crackles at the lung bases bilaterally. The patient denies fever, chills, or any recent infection. A radiograph of the chest shows septal lines and areas of opacification in both lung fields (see image). Which of the following most likely accounts for this patient’s dyspnea? ---- <<Choices:>> A) Destruction of interalveolar septa B) Excess mucous production in bronchiolar epithelium C) A collection of air in the pleural space D) Alveolar and interstitial fluid accumulation ---- <<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 42-year-old man is brought to the emergency department because of several episodes of black, tarlike stool and lightheadedness over the past couple of days. He underwent an appendectomy at the age of 16. He has hypertension and tension headaches. He drinks 4 beers daily. Current medications include amlodipine and naproxen. His temperature is 36.7°C (98°F), pulse is 100/min, and his blood pressure is 100/70 mm Hg. The lungs are clear to auscultation bilaterally. The abdomen is soft, nondistended, and nontender. The liver is palpated 3 cm below the right costal margin. His hemoglobin concentration is 10 g/dL. Intravenous fluid resuscitation is begun. An esophagogastroduodenoscopy is performed, which does not show bleeding. Which of the following is the most appropriate next step in management? ---- <<Choices:>> A) Double-balloon enteroscopy B) Colonoscopy C) Laparotomy D) Angiography " ---- <<Answer:>>
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B
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 68-year-old man comes to the physician because of constipation and decreased appetite during the past several months. In the past 2 weeks, he has also noticed an increasing frequency of urination. He has not had any dysuria or flank pain. He has a history of hypertension, calcium pyrophosphate crystal arthritis, and alcoholic cirrhosis. Current medications include hydrochlorothiazide, rifaximin, lactulose, and naproxen as needed for the joint pain. He quit drinking 5 years ago. He does not smoke cigarettes. His vital signs are within normal limits. Physical examination shows decreased bowel sounds but is otherwise unremarkable. Serum studies show: Creatinine 1.1 mg/dL Calcium 11.8 mg/dL Phosphorus 2.1 mg/dL Magnesium 1.6 mg/dL Total protein 6 g/dL Albumin 3.1 g/dL AST 53 U/L ALT 43 U/L Which of the following is the most appropriate next step in diagnosis?" ---- <<Choices:>> A) Serum parathyroid-related protein level B) Urine and serum protein electrophoresis C) Serum parathyroid hormone level D) X-ray of the chest ---- <<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 African American male presents to his primary care provider complaining of progressively worsening back pain. The pain is localized to the lower back and sometimes wakes him up from sleep. He has a history of hypertension and admits to a 50 pack-year smoking history. Further questioning reveals that he has also experienced fatigue and an unintentional weight loss of 18 pounds over the past year. Laboratory analysis is notable for an elevated alkaline phosphatase. A radiograph of the patient’s spine demonstrates multiple sclerotic lesions in the lumbar vertebral bodies. Which of the following tests would most likely confirm the diagnosis in this patient? ---- <<Choices:>> A) Renal biopsy B) Fine needle aspiration of the thyroid C) Transrectal ultrasound-guided prostate biopsy D) Chest radiograph ---- <<Answer:>>
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C
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 75-year-old man presents to his primary care physician because he has been experiencing increasing muscle and joint pain over the last 3 months. He says that he also feels increasingly fatigued and weak despite no change to his daily routine. His past medical history is significant for an infection when he was 12 years of age that led to 2 months of paralysis and mechanical ventilation through a tracheostomy tube. At the time, he developed the paralysis after 3 days of fever and sore throat. He recalls that he was still able to feel everything and was embarrassed that his daily activities had to be performed for him by caregivers. The most likely cause of this patient's symptoms is associated with which of the following structures? ---- <<Choices:>> A) DNA virus B) Enveloped (-) stranded RNA virus C) Naked (+) stranded RNA virus D) Naked (-) stranded RNA virus ---- <<Answer:>>
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C
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 2-year-old boy was rushed to the emergency department in the early morning by his mother because he was unresponsive to deep pain stimuli. The patient’s mother said that he has been suffering from a fever, cough and runny nose for the last 10 days. 2 days ago, they visited a free clinic and received medication. When she gave him the medication yesterday, the patient had 3 episodes of vomiting and his condition rapidly worsened. This morning, the patient did not wake up, even after multiple attempts. On physical examination, the patient is febrile, hypotensive, and tachycardic. Peripheral pulses are 1+, and his extremities are pale and cool to touch. Pupils are equal and slowly reactive to light. Significant hepatomegaly is noted. Which of the following is the most likely etiology of this patient’s symptoms? ---- <<Choices:>> A) Decrease in beta-oxidation B) Increase in gluconeogenesis C) Increase in beta-oxidation D) Increase in glycolysis ---- <<Answer:>>
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A
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 24-year-old patient presents to your gastroenterology practice on a referral from her primary care provider. The patient has been experiencing postprandial bloating and abdominal pain for one year. Symptoms occur following the ingestion of milk products. Which of the following drugs has a mechanism of action that is similar to the pathophysiology of this patient's disease? ---- <<Choices:>> A) Omeprazole B) Bismuth C) Octreotide D) Magnesium hydroxide ---- <<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:>> In which location is dimeric IgA most likely to be found in highest concentrations? ---- <<Choices:>> A) Colostrum B) Blood from the fetus C) Blood from the mother D) Fetal bone marrow ---- <<Answer:>>
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A
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 25-year-old man presents to the ER after a street fight. His girlfriend reports that he was struck with a bat in the head. After the initial hit, she reported that he briefly lost consciousness but then was normal for several hours. Since then, he has been rapidly decompensating. He is grabbing his head in pain and his mental status is altered. Vital signs are stable. Neurological exam reveals that his right pupil is dilated and his right lid is drooping. If this patient's symptoms are allowed to progress without intervention, which of the following would be expected to occur? ---- <<Choices:>> A) Right sided hemiparesis B) Down and in gaze of the right pupil C) Right sided homonymous hemianopsia. D) Right eye with an inability to abduct ---- <<Answer:>>
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A
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<<Question:>> A 7-year-old girl is brought to the emergency department because of diffuse abdominal pain and multiple episodes of vomiting for 2 hours. She started developing fever, headache, and neck pain 3 days ago. On arrival, she is unresponsive. Her temperature is 40.3°C (104.5°F) and palpable blood pressure is 45 mm Hg. Physical examination shows diffuse purpuric skin lesions. In spite of all appropriate therapy, she dies shortly thereafter. Autopsy shows massive parenchymal hemorrhage of the adrenal glands. Which of the following was the portal of entry for the most likely causal organism? ---- <<Choices:>> A) Nasopharynx B) Genital mucosa C) Choroid plexus D) Gastrointestinal tract ---- <<Answer:>>
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A
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<<Question:>> A 50-year-old female comes to the emergency department with sudden onset left-sided calf pain starting 20 minutes ago. Her past medical history is notable for diabetes, hypertension, and chronic atrial fibrillation controlled on an anti-arrhythmic. Upon arrival to the emergency department, her blood pressure is 150/91 mmHg, pulse is 100/min, and respirations of 22/min. Examination of the leg reveals a pale left calf with diminished dorsalis pedis and posterior tibial pulses. Prompt intervention relieves the patient’s symptoms. Which of the following, if seen microscopically, would indicate that her calf myocytes are more likely to recover without permanent damage? ---- <<Choices:>> A) Cellular swelling B) Mitochondrial vacuolization C) Nuclear pyknosis D) Fragmented cells and debris ---- <<Answer:>>
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A
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 56-year-old man comes to the physician because of progressive worsening of vision in both his eyes over the past 6 months. He reports that he first noticed some blurring of his vision and glare in the evenings, which have both gotten worse in this period. He works as a tower crane operator and spends most of his day outdoors. Ophthalmologic examination shows visual acuity of 20/100 in both eyes. A photograph of the eye is shown. Damage to which of the following structures is most likely responsible for this patient's current symptoms? ---- <<Choices:>> A) Aqueous humor B) Vitreous body C) Lens D) Retina ---- <<Answer:>>
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C
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 25-year-old man presents to the clinic with the complaint of yellow discoloration of his skin. He reports that the discoloration appeared gradually over the past 5 days. He does not have any other complaints. He never had similar symptoms before. Past medical history is only significant for a recent flu infection that was so bad that he missed work for a week. Physical exam is significant for yellow sclera and slight yellowish discoloration of the skin over the face and neck. Liver function tests reveal: Total bilirubin level 5 mg/dL Direct bilirubin level 0.4 mg/dL Aspartate aminotransferase (AST) 25 U/L Alanine aminotransferase (ALT) 15 U/L What is the most likely pathology giving rise to this patient’s condition? ---- <<Choices:>> A) Decreased conjugation of bilirubin by uridine-diphosphate glucuronyltransferase B) Bile duct obstruction C) Hemolysis D) Decreased transport of bile into the bile canaliculi ---- <<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 girl is brought to the physician by her father because of concerns about her behavior. She worries excessively about her weight and body image, and has frequent diarrhea. She is 170 cm (5 ft 7 in) tall and weighs 63.5 kg (140 lb); BMI is 22 kg/m2. She appears anxious but well. Vital signs are within normal limits. Physical examination shows calluses on the knuckles of her right hand. Further evaluation of this patient is most likely to show which of the following findings? ---- <<Choices:>> A) Parotid gland swelling B) Elevated blood pressure C) Right upper quadrant tenderness D) Jugular venous distention ---- <<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 comes to the emergency department because of left wrist pain and swelling that started immediately after a fall. She was walking her dog when the dog abruptly pulled away, causing her to fall forward onto both hands. Physical examination shows left wrist pain with pinching and grasping, moderate swelling, and mild tenderness. Her left thumb is placed in a thumb immobilization splint. An x-ray of the wrist 2 days later is shown. The most likely cause of these findings is a fracture of which of the following bones? ---- <<Choices:>> A) Scaphoid B) Ulna C) Lunate D) Hamate ---- <<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 2200-g (4-lb 14-oz) newborn is delivered at term to a 37-year-old primigravid woman. Apgar scores are 6 and 8 at 1 and 5 minutes, respectively. Examination in the delivery room shows that he is at the 2nd percentile for head circumference and at the 10th percentile for length. He has a small jaw, small eyes, and low-set ears. There is a keyhole-shaped defect in the iris of the left eye. He has seven fingers on each hand. There is an opening in the roof of the mouth extending into the soft and hard palate bilaterally. Cleft lip and cleft palate are present. A 3/6 holosystolic murmur is heard at the left lower sternal border. The heels are prominent, with convex-shaped deformity of the plantar surface of the feet. Which of the following is the most likely cause of these findings? ---- <<Choices:>> A) Fragile X syndrome B) Trisomy 18 C) Fetal alcohol syndrome D) Trisomy 13 ---- <<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 woman is rushed to the emergency department after being found lying unconscious in a burning house by a firefighter. No history can be obtained. Her vital signs include pulse 130/min and respirations 16/min. Physical examination reveals soot all over her face. Scattered wheezes can be heard on auscultation of the chest. A thorough survey of the body shows no evidence of any burn injuries. Which of the following changes in the oxygen-hemoglobin curve would most likely be expected in this patient? ---- <<Choices:>> A) The curve would be shifted left due to an increased oxygen binding affinity by hemoglobin. B) The curve would be shifted left due to metabolic acidosis in peripheral tissues. C) The curve would be unchanged because the partial pressure of oxygen is unchanged. D) The curve would be shifted right due to decreased hemoglobin affinity for oxygen. ---- <<Answer:>>
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A
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<<Question:>> A 73-year-old man with a past medical history significant for high blood pressure, hypothyroidism, and diabetes presents to the outpatient clinic. He complains of joint pain, muscle pain, and fatigue that has been present for the last several weeks. On examination, you notice a butterfly-shaped rash across the bridge of his nose and cheeks. He has a blood pressure of 124/72 mm Hg and heart rate of 64/min. Of the following, which medication is most likely responsible for his presentation? ---- <<Choices:>> A) Verapamil B) Clonidine C) Hydralazine D) Terazosin ---- <<Answer:>>
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C
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<<Question:>> A 65-year-old woman with a 6-month history of acute promyelocytic leukemia managed with all-trans-retinoic acid presents with severe abdominal pain, nausea, vomiting, and bloody urine. The patient states her symptoms onset acutely a few hours ago and has not improved. She describes the pain as severe, sharp and stabbing in character, and diffusely localized to the umbilical region, accompanied by nausea and vomiting. The patient also states that she noticed blood in her urine last time she urinated. No additional significant past medical history. Her vitals signs include: temperature 37.0°C (98.6°F), blood pressure 95/75 mm Hg, pulse 115/min, respiratory rate 23/min, and oxygen saturation 99% on room air. On physical examination, the patient is ill-appearing and in severe distress. The cardiac exam is normal. Lungs are clear to auscultation. The abdomen is severely tender and out of proportion with physical exam findings. There are diffuse petechiae present over the entire body. Laboratory results are pending. A peripheral blood smear is shown in the exhibit. A contrast CT of the abdomen shows findings consistent with acute mesenteric ischemia. Which of the following set of laboratory findings would most likely be seen in this patient? ---- <<Choices:>> A) PT: ↑ | PTT ↑ | Bleeding time: ↑ | Fibrin split products: ↑ | D-dimer: ↑| Fibrinogen: ↑ | Platelet count: ↓ B) PT: ↓ | PTT ↓ | Bleeding time: ↑ | Fibrin split products: ↑ | D-dimer: ↑| Fibrinogen: ↓ | Platelet count: ↓ C) PT: ↑ | PTT ↑ | Bleeding time: ↑ | Fibrin split products: ↑ | D-dimer: ↑| Fibrinogen: ↓ | Platelet count: ↓ D) PT: ↓ | PTT ↓ | Bleeding time: ↓ | Fibrin split products: ↓ | D-dimer: ↓| Fibrinogen: ↓ | Platelet count: ↓ ---- <<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 woman comes to the physician because of a throbbing left-sided headache that started 3 hours ago. Two hours ago, she took ibuprofen with no relief. She has been vomiting every 20 minutes since the start of the headache. She reports that she could not see very well for a few minutes this morning. A similar episode occurred last week. She is otherwise healthy and has recently started taking an oral contraceptive. Her vital signs are within normal limits. Physical examination shows no abnormalities except mild sensitivity to light. Visual acuity is 20/20. Which of the following is the most appropriate initial pharmacotherapy in this patient? ---- <<Choices:>> A) Intranasal dihydroergotamine and subcutaneous sumatriptan B) Oral tramadol C) Intravenous prochlorperazine D) Oral ketorolac and oral ergotamine " ---- <<Answer:>>
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C
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<<Question:>> A 66-year-old man presents with palpitation, syncope, and difficulty breathing. He has a past medical history of stroke and his current medications include warfarin. Physical examination is unremarkable. An ECG is performed and shows ventricular tachycardia. The patient is treated successfully with amiodarone. At the time of discharge, his medications include warfarin and amiodarone, and he is cautioned that his PT might be prolonged. Which of the following mechanisms best explains the effect of amiodarone on the coagulation profile of this patient? ---- <<Choices:>> A) Amiodarone induces CYP3A4 leading to a decreased effectiveness of warfarin B) Amiodarone inhibits CYP2C9 leading to an increased risk of bleeding C) Amiodarone causes hepatotoxicity which requires monitoring of the prothrombin time D) Inorganic iodine from amiodarone decreases the effectiveness of warfarin ---- <<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 presents to the emergency department with recent onset confusion and photophobia. Upon questioning her husband, you discover the patient has been sick over the past week with fevers and productive sputum. Her vital signs are Temperature 102.6 Pulse 80 Respirations 18 Blood Pressure 110/70. The physical exam is significant for lethargy and nuchal rigidity. A lumbar puncture is performed and demonstrates cloudy fluid with an opening pressure of 35 cm H20, cell count of 1500 cells/uL (neutrophil predominant), protein level of 50 mg/dL and glucose of 30 mg/dL. Computed tomography scan demonstrates no space-occupying lesions. What is the most appropriate initial treatment for this patient? ---- <<Choices:>> A) Acyclovir B) Ceftriaxone and dexamethasone C) Vancomycin, ceftriaxone, ampicillin and dexamethasone D) Vancomycin, ceftriaxone and ampicillin ---- <<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 male presents to his primary care physician complaining of a painless bump on his penis. He first noticed the lesion 1 year ago but was too embarrassed to mention the issue at his last annual physical exam. The lesion has since grown in size and has recently become more erythematous. He has hypertension treated with lisinopril. At age 45, he was successfully treated for phimosis with a steroid cream. He first engaged in sexual intercourse at age 14 and has had “too many sexual partners to count” in his lifetime. He smoked one pack of cigarettes daily for 30 years but quit 10 years ago. He drinks one alcoholic beverage daily. Physical examination shows a nontender 5 mm x 5 mm ulcerated lesion with an erythematous base on the dorsum of the glans. There is no inguinal lymphadenopathy. Excisional biopsy of the lesion is performed. Which of the following pathological findings is most likely to be seen on the biopsy specimen? ---- <<Choices:>> A) Atypical squamous cells with varying degrees of mitotic activity B) Spirochetes on dark-field microscopy C) Nonspecific inflammatory features with C. trachomatis amplification on PCR D) Safety pin-shaped intracellular inclusions that appear purple on Giemsa stain ---- <<Answer:>>
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A
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<<Question:>> A 54-year-old man comes to the physician for a follow-up appointment. Three weeks ago he underwent emergent cardiac catheterization because of a myocardial infarction and had to stay at the hospital longer than expected because of decreased kidney function. He says his symptoms have since improved greatly and he now produces even more urine than before the procedure. His serum creatinine concentration is 1.6 mg/dL and blood urea nitrogen concentration is 20 mg/dL.This patient is at increased risk for which of the following complications? ---- <<Choices:>> A) Hypermagnesemia B) Metabolic alkalosis C) Hypernatremia D) Hypokalemia ---- <<Answer:>>
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D
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<<Question:>> A 35-year-old woman visits her primary care provider with complaints of easy fatigability, breathlessness on exertion, and altered sensations in her lower limbs. Past medical history is positive for hypertension. She takes hydrochlorothiazide and lisinopril, ethinyl estradiol-progestin, and a multivitamin every day. Family history is noncontributory. She drinks alcohol almost every day and smokes cigarettes when she drinks. Today her heart rate is 95/min, respiratory rate is 17/min, blood pressure is 130/92 mm Hg, and temperature of 37.0°C (98.6°F). Overall, she has marked pallor with slight bluing of her lips and distal fingertips. Her heart has a regular rate and rhythm and her lungs are clear to auscultation bilaterally. Additionally, she has loss of touch, and vibration sense in both of her lower limbs. Her CBC is as follows: Hemoglobin 8.0 g/dL MCV 112 fL WBC 2,500/mm3 Platelets 95,000/mm3 What is the most likely diagnosis? ---- <<Choices:>> A) Vitamin B12 deficiency B) Folic acid deficiency C) Vitamin C deficiency D) Vitamin A deficiency ---- <<Answer:>>
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A
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<<Question:>> A 40-year-old man is brought by his wife with nausea and vomiting. He had been working for four hours on repairing his car with the garage shutter closed and the car running but did not lose consciousness. The patient’s blood pressure is 120/70 mmHg, respirations are 28/min, pulse is 120/min, and SaO2 is 98% on room air. The patient has no medical history and is not taking any medications. The patient has 1 alcoholic drink/week and does not use any other illicit drugs. Ophthalmologic exam reveals bilateral retinal hemorrhages. The compound responsible for this patient’s clinical presentation has what mechanism of action? ---- <<Choices:>> A) Inhibits the electron transport chain B) Inhibits acetylcholine esterase C) Prevents acetylcholine release D) DNA alkylation ---- <<Answer:>>
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A
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<<Question:>> A 54-year-old man is hospitalized after a left hemicolectomy for colon cancer. On postoperative day 1, his hemoglobin is noted on routine labs to have dropped overnight from 7.1 g/dL to 5.3 g/dL. The patient does not report feeling any differently. On exam, his temperature is 100.4°F (38.0°C), blood pressure is 102/80 mmHg, pulse is 95/min, and respirations are 14/min. The patient’s urine output in his Foley bag has been 1.0 cc/kg/hr for the last 8 hours. Prior to the operation, the patient had a temperature of 98.8°F (37.1°C), blood pressure of 122/70 mmHg, and a pulse of 65/min. Which of these findings is most concerning regarding the severity of his hypovolemia? ---- <<Choices:>> A) Decreased pulse pressure B) Decreased systolic blood pressure C) Increased heart rate D) Increased temperature ---- <<Answer:>>
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B
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<<Question:>> An obese 45-year-old female presents to the emergency room complaining of abdominal pain. She reports a 4-hour history of severe right upper quadrant pain following a fatty meal. She has a history of multiple similar episodes over the past year. An ultrasound of the right upper quadrant reveals gallstones. Due to the recurrent nature of her disease, she undergoes an elective laparoscopic cholecystectomy. While in the operating room, the surgeons use the laparoscope to visualize a structure connecting the liver to the anterior wall of the abdominal wall. Which of the following embryologic structures eventually ends up within the visualized structure? ---- <<Choices:>> A) Ductus venosus B) Umbilical artery C) Umbilical vein D) Vitelline duct ---- <<Answer:>>
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C
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<<Question:>> A 28-year-old woman presents with a recent history of severe headaches. The patient states that the headaches came on gradually about 1 week ago and have steadily worsened. She describes the headaches as severe, diffuse, and frequently causing nausea and vomiting, especially in the mornings. Past medical history is significant for bacterial meningitis, approx. one month ago, that was successfully treated. Current medications are combined oral contraceptives and fluoxetine. A review of systems is significant for fatigue and daytime sleepiness. Family history is significant for her mother and aunt who suffer from migraines with aura. Her temperature is 37.0°C (98.6°F), the blood pressure is 110/70 mm Hg, the pulse is 70/min, the respiratory rate is 16/min, and the oxygen saturation is 99% on room air. The cardiac exam is normal. Lungs are clear to auscultation. The neurological exam is normal. The ophthalmic exam reveals the indistinct margins of the optic disc, bilaterally. Which of the following is the most likely cause of the headaches in this patient? ---- <<Choices:>> A) Genetics B) Hydrocephalus C) Intracranial mass D) Infection ---- <<Answer:>>
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B
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<<Question:>> A 72-year-old presents to the Emergency Room with hemoptysis. He has smoked 1 pack of cigarettes a day for the past 30 years. Physical examination of the face is shown in Image A and is accompanied by left upper extremity edema. Of the following, which is the most likely cause of the patient’s symptoms: ---- <<Choices:>> A) Pleural effusion B) Superior sulcus tumor C) Pulmonary embolus D) Mass in the thoracic region of the spinal cord ---- <<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 59-year-old man who was recently diagnosed with renal cell carcinoma comes to the physician for a follow-up evaluation. The physician recommends starting treatment with a chemotherapeutic agent that is also used to treat neovascular age-related macular degeneration. A recent history of which of the following conditions would discourage the use of this drug? ---- <<Choices:>> A) Interstitial lung disease B) Chronic kidney disease C) Platinum allergy D) Gastrointestinal bleeding ---- <<Answer:>>
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D
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 36-year-old woman presents with a persistent cough productive of blood-streaked sputum, night sweats, and weight loss. No significant past medical history. She denies any history of smoking, alcohol consumption, or recreational drug use. She works as a nurse at a local hospital and lives in an apartment with her extended family. Her vital signs are a blood pressure of 100/80 mm Hg, heart rate of 94/min, respiratory rate of 17/min, and temperature of 35.9℃ (96.6℉). Physical examination reveals dullness to percussion and diminished breath sounds over the upper lobe of the left lung. During the discussion regarding the required workup, the patient tells the physician about recent contact with a patient with tuberculosis. She asks the physician not to report her case because she is concerned she will lose her job. Which of the following statements is correct? ---- <<Choices:>> A) If this patient is diagnosed with active pulmonary tuberculosis, it should be reported even without the patient’s consent, and the patient should receive isolation and treatment. B) The patient has a right to privacy, so, without her consent, the physician can not report her case even if she is diagnosed with active pulmonary tuberculosis. C) If this patient turns out to have active pulmonary tuberculosis, her case can stay unreported only if she agrees to stay home from work and remain isolated at home for her entire treatment period. D) Only active pulmonary tuberculosis is a reportable disease. ---- <<Answer:>>
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A
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<<Question:>> A 33-year-old woman gravida 2, para 1, at 35 weeks gestation is admitted to the hospital with fever and active labor. She reports a 2-day history of fluid leakage from the vagina without pain or vaginal bleeding. Her pregnancy has otherwise been uncomplicated. She has attended many prenatal appointments and followed the physician's advice about screening for diseases, laboratory testing, diet, and exercise. Her previous pregnancy was complicated by a preterm delivery at 34 weeks gestation. The patient reports a 10-pack-year history of smoking before pregnancy and smoked 4 cigarettes daily during pregnancy. At the hospital, her temperature is 39.6°C (103.3°F), blood pressure is 108/60 mm Hg, and pulse is 125/min. Her BMI is 18.2 kg/m2. Uterine palpation reveals tenderness. Cervical examination indicates 100% effacement and 10 cm dilation. Her lungs are clear to auscultation. The baseline fetal heart rate is 180/min. Which of the following is the most appropriate next step in management? ---- <<Choices:>> A) Amnioinfusion B) Ampicillin and gentamicin C) Intravenous betamethasone D) Ritodrine hydrochloride ---- <<Answer:>>
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B
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<<Question:>> A 49-year-old man, with a history of alcohol abuse over the last 2 decades, presents with a complaint of epigastric pain for about a year. He previously had one episode of acute pancreatitis for which he was hospitalized. He continued to drink 4–5 beers/day after he was discharged. His appetite is good, but he has a history of weight loss. He also complains of oily and bulky stools. He takes aluminum hydroxide gel and ranitidine for partial pain relief. Vital signs are stable. Routine physical exam and blood work are normal except for mild hypocalcemia. Abdominal CT scan is shown below. Which of the following tests is comparatively less useful in assessing the function of the organ involved in this condition? ---- <<Choices:>> A) Secretin stimulation test B) Serum amylase and lipase levels C) Fecal elastase level D) Magnetic resonance cholangiopancreatography (MRCP) ---- <<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 34-year-old woman presents to the office due to a pulmonary embolism confirmed by computed tomography (CT) chest angiogram, which she was recently hospitalized for. She does not have any recent surgical trauma or travel history. She complains of having episodes where her fingers become white and then blue, and they are usually accompanied by pain in the same region. These episodes tend to happen more frequently during winter and have been ongoing for about 2 years now. She also had a spontaneous abortion at 12 weeks of gestation last year. She does not have a family history of venous thromboembolic disease. The vital signs include heart rate 76/min, respiratory rate 18/min, temperature 37.2°C (99.0°F), and blood pressure 120/80 mm Hg. Physical examination is non-contributory. The complete blood count (CBC) results are as follows: Hemoglobin 14.2 g/dL Hematocrit 39% Leukocyte count 4,950/mm3 Neutrophils 59% Bands 3% Eosinophils 1% Basophils 0% Lymphocytes 31% Monocytes 4% Platelet count 120,000/mm3 The coagulation test results are as follows: Partial thromboplastin time (activated) 56 seconds Prothrombin time 15 seconds Reticulocyte count 1.0% Thrombin time < 2 seconds deviation from control Which of the following diagnostic tests would be the most appropriate? ---- <<Choices:>> A) Protein C B) Factor-V-Leiden C) Lupus anticoagulant D) Protein S ---- <<Answer:>>
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C
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 36-year-old woman, gravida 3, para 2, at 34 weeks' gestation is brought to the emergency department for the evaluation of continuous, dark, vaginal bleeding that started one hour ago. She also reports severe lower abdominal pain. Her current pregnancy was complicated by preeclampsia. Her first two children were delivered vaginally. Current medications include methyldopa and a multivitamin. Her pulse is 100/min, respirations are 16/min, and blood pressure is 90/60 mm Hg. The abdomen is tender, and hypertonic contractions are felt. There is blood on the vulva and on the medial aspect of both thighs bilaterally. The fetus is in a cephalic presentation. The fetal heart rate is 170/min with several decelerations. Which of the following is the most appropriate next step in the management of this patient? ---- <<Choices:>> A) Emergency cesarean delivery B) Elective cesarean delivery C) Administration of terbutaline D) Administration of oxytocin and normal vaginal birth ---- <<Answer:>>
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A
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<<Question:>> A 16-year-old boy is brought to the emergency department because of severe left flank pain and nausea for 3 hours. The pain is colicky and radiates towards his groin. He drinks multiple glasses of iced tea every day. He has had similar episodes of abdominal pain in the past. His maternal uncle has a similar history of abdominal pain. His temperature is 37.1°C (98.8°F), pulse is 103/min, and blood pressure is 108/72 mm Hg. Examination shows a soft and nontender abdomen. Left costovertebral angle tenderness is present. An x-ray of the abdomen shows no abnormalities. A urinary cyanide nitroprusside test is positive. Further evaluation of this patient is most likely to show which of the following? ---- <<Choices:>> A) Rhomboid crystals on urinalysis B) Urinary pH of 7.8 C) Serum anti-Saccharomyces cerevisiae antibodies D) Hexagon-shaped crystals on urinalysis ---- <<Answer:>>
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D
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 57-year-old woman comes to the emergency department because of severe dyspnea, cough, and pleuritic chest pain for 20 minutes. Three weeks ago, she underwent surgery for a total right knee replacement. The patient appears distressed. Her pulse is 112/min, respirations are 24/min, and blood pressure is 88/55 mm Hg. Examination shows jugular venous distention. There is a mildly tender surgical scar on her right knee. A CT scan of the chest is shown. Which of the following is the most appropriate treatment for this patient's condition? ---- <<Choices:>> A) Endovascular stent-grafting B) Alteplase C) Coronary angioplasty D) Pericardiocentesis ---- <<Answer:>>
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B
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<<Question:>> A group of multidisciplinary researchers from a tertiary hospital decides to investigate whether there is an association between splenectomy and pulmonary tuberculosis. From the hospital database, they identify 19,000 patients over the age of 20 with newly diagnosed pulmonary tuberculosis, as well as 72,000 patients without pulmonary tuberculosis for comparison purposes. Both of these groups are matched for age, gender, and an index year when the condition was initially diagnosed. The odds of pulmonary tuberculosis development associated with splenectomy and other comorbidities is estimated. After controlling for all relevant confounders, the results show that splenectomy is associated with a two-fold higher incidence of pulmonary tuberculosis development. There is also a synergistic effect between splenectomy and other comorbid conditions in the development of pulmonary tuberculosis. What type of study has been used by the researchers in this example? ---- <<Choices:>> A) Cohort study B) Case-control study C) Ecological study D) Intervention study ---- <<Answer:>>
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B
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<<Question:>> A 53-year-old woman presents to the clinic with complaints of fatigue. She reports that over the past several months she has been lethargic and tired. She has gained 10 pounds over the past month but attributes it to her menopause. Her last menstrual period (LMP) was 1 year ago. Past medical history is significant for asthma and seasonal allergies, and medications include a rescue inhaler and cetirizine as need. Review of systems is negative except for cold intolerance and constipation. What is the best next step in evaluating this patient? ---- <<Choices:>> A) Beta-hCG levels B) FSH levels C) Thyroid peroxidase antibody titer D) TSH levels ---- <<Answer:>>
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D
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<<Question:>> A 33-year-old man presents to his primary care physician for fatigue, weight loss, and diffuse pruritus. The patient has a past medical history of multiple admissions for severe abdominal pain and bloody diarrhea as well as several episodes of ascending cholangitis which were successfully treated. He is currently a member of Alcoholics Anonymous. His temperature is 98.2°F (36.8°C), blood pressure is 124/75 mmHg, pulse is 100/min, respirations are 13/min, and oxygen saturation is 99% on room air. Urinalysis is notable only for a dark urine sample with no red blood cells present. A rectal exam reveals pale stool and grossly visible blood. Physical exam is otherwise notable for pruritis, jaundice, and scleral icterus. Which of the following is the most likely underlying diagnosis? ---- <<Choices:>> A) Ascending cholangitis B) Cholangiocarcinoma C) Cirrhosis D) Colon cancer ---- <<Answer:>>
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B
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<<Question:>> A 43-year-old female presents with several years of pain and stiffness in her wrists and hands. Her symptoms have been getting progressively worse. She reports that her hands feel stiff for an hour or more after awaking in the morning. She undergoes subsequent testing, and is found to have anti-citrullinated protein antibodies. Her physician is concerned for rheumatoid arthritis, and discusses treatment with a biologic disease-modifying anti-rheumatic agent. Which of the following must be done before beginning treatment with a TNF inhibitor? ---- <<Choices:>> A) Confirm diagnosis with a test for rheumatoid factor B) Confirm diagnosis with elevated ESR and CRP C) Test for latent mycobacterial infection D) Obtain a radiograph demonstrating osteophytes ---- <<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 65-year-old man is brought to the emergency department with a complaint of right-sided numbness for 5 hours. The numbness started in the right-side of the face and has progressed to the same side arm and leg within 30 minutes. He denies limb weakness, walking difficulty, vision problem, or vertigo. He had similar symptoms 5 months ago that were resolved within 10 minutes. The past medical history includes type 2 diabetes mellitus, hypertension, dyslipidemia, and hyperuricemia. The medication list includes allopurinol, amlodipine, aspirin, glimepiride, lisinopril, and rosuvastatin. The blood pressure is 165/102 mm Hg, and the rest of the vital signs are within normal limits. On examination, there are no facial droop and slurring of the speech noted. The muscle strength is normal in all 4 limbs with a normal tone and deep tendon reflexes. There is a decreased pinprick sensation and proprioception on the right arm and leg. The gait is normal. The blood sugar is 221 mg/dL. The CT scan of the head is normal. The MRI of the head with diffusion-weighted imaging reveals a 15 mm diffusion restriction in the left thalamus. Which of the following is the most crucial in the development of this patient’s condition? ---- <<Choices:>> A) Emboli from deep leg veins with a patent foramen ovale B) Leakage of blood from intracranial vessel due to uncontrolled hypertension C) Lipohyalinosis of small penetrating arteries due to chronic hypertension D) Significant stenosis of the left carotid artery ---- <<Answer:>>
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C
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<<Question:>> A 23-year-old man presents to a psychiatrist for evaluation of situational anxiety. He reports that he recently started a new job that involves regular public speaking and is very stressed before every public speaking event. He describes developing a rapid heart rate and diaphoresis that interferes with his ability to speak well. He has no past medical history and takes no medications. He does not smoke or drink alcohol. His temperature is 98.6°F (37°C), blood pressure is 110/65 mmHg, pulse is 85/min, and respirations are 17/min. On exam, he is well-appearing and appropriately conversational. He is alert and fully oriented. The patient is prescribed propranolol to take before major public speaking events. Which of the following physiologic changes will occur when the patient takes this medication? ---- <<Choices:>> A) Decreased cardiac output and decreased peripheral resistance B) Decreased cardiac output and increased peripheral resistance C) Increased cardiac output and decreased peripheral resistance D) Increased cardiac output and increased peripheral resistance ---- <<Answer:>>
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B
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<<Question:>> A 69-year-old woman is brought into the emergency room by family members after they noted that she had become increasingly lethargic over the past 3 days. Her temperature is 39.5°C (103.1°F), the blood pressure is 75/40 mm Hg, the heart rate 130/min, the respiratory rate 24/min, and the oxygen saturation is 89% on room air. On examination, she is severely ill, drowsy, and unable to speak. Her skin is warm to the touch. White blood cell count is 15,000/mm3 and her urinalysis is positive for nitrites and leukocyte esterase. Which of the following is the best initial step in the management of this patient's condition? ---- <<Choices:>> A) Intramuscular adrenaline B) Intravenous hydrocortisone C) Assessment of airway, breathing, and circulation D) Intravenous noradrenaline ---- <<Answer:>>
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C
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<<Question:>> A 28-year-old G2P1 woman at 29 weeks gestation presents to the obstetrician after noticing red spots on her undergarments over the past week. Her vaginal bleeding has not been painful; however, she is concerned that it has persisted. Her previous child was born by cesarean section and she is currently taking folate and a multivitamin. She endorses feeling fetal movements. Her temperature is 98.9°F (37.2°C), blood pressure is 120/84 mmHg, pulse is 88/min, respirations are 17/min, and oxygen saturation is 99% on room air. Physical exam is notable for a gravid uterus and non-tender abdomen. Speculum exam reveals a closed cervical os and a small amount of blood. Which of the following is the most likely diagnosis? ---- <<Choices:>> A) Placenta percreta B) Placenta previa C) Placental abruption D) Uterine rupture ---- <<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 57-year-old woman comes to the emergency department 1 hour after experiencing a distressing 10-minute episode of stuttering during a business meeting. She has hypertension. She has smoked 2 packs of cigarettes daily for 30 years. Current medications include fosinopril and hydrochlorothiazide. Her temperature is 37°C (98.6°F), pulse is 90/min, respirations are 16/min, and blood pressure is 134/88 mm Hg. She is oriented to person, place, and time. Her speech is clear. When she is asked to hold both arms fully extended at shoulder level with palms upwards and eyes closed, her right palm turns inwards and downwards. Which of the following is the most likely cause of this patient's physical findings? ---- <<Choices:>> A) Cerebellar lesion B) Inferior frontal gyrus lesion C) Upper motor neuron lesion D) Thalamus lesion ---- <<Answer:>>
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C
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 40-year-old man comes to the physician because of a 5-kg (11-lb) weight loss over the past month and easy bruising. He has not changed his diet significantly. He also noticed that his arms now bruise more easily. He appears pale. His pulse is 70/min, his blood pressure is 125/75 mm Hg, and his temperature is 38°C (100.4°F). Examination shows a palm-sized hematoma on his right arm. His spleen is palpable 5 cm below the costal margin. His liver is enlarged. Laboratory results show: Leukocytes 10,500/mm3 Hemoglobin 10.2 g/dL Platelets 52,000/mm3 Fibrinogen 110 mg/dL (Reference: 150-400 mg/dL) Cytogenetic analysis shows leukocytes with a reciprocal translocation of chromosomes 15 and 17. Which of the following is the most appropriate treatment for this patient at this time?" ---- <<Choices:>> A) Cyclophosphamide B) All-trans retinoic acid C) Cryoprecipitate transfusion D) Imatinib ---- <<Answer:>>
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B
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<<Question:>> At a routine exam, a 68-year-old female patient is discovered to have a serum calcium level of 11.5 mg/dL. Follow-up laboratory tests show a high parathyroid hormone with low phosphorus and mildly elevated alkaline phosphatase. 24-hour urine calcium level is elevated. Review of symptoms includes complaints of fatigue, constipation, and diffuse bone pain for which she takes vitamin D. Past medical history is significant for type 2 diabetes mellitus for 25 years and essential hypertension for 15 years. The patient has a history of kidney stones. Family history is irrelevant. Which of the following is the most likely etiology of this patient's condition? ---- <<Choices:>> A) Vitamin D intoxication B) Familial hypocalciuric hypercalcaemia C) Solitary parathyroid adenoma D) Thyrotoxicosis ---- <<Answer:>>
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C
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<<Question:>> A 27-year-old man and his wife present to an infertility clinic for evaluation after they tried unsuccessfully to conceive for 2 years. He has no prior medical history and does not currently take any medications. On evaluation, he is found to have long extremities and gynecomastia. In addition, he has testicular atrophy and very little body hair, which is distributed primarily in the pubic region. Further analysis reveals azoospermia, and appropriate tests confirming the diagnosis are performed. The couple is told about the cause of their inability to conceive and given further options to pursue. Which of the following is associated with the pathophysiology underlying this patient's disorder? ---- <<Choices:>> A) Abnormal signaling through androgen receptors B) Abnormal conversion of testosterone C) Increased aromatase activity D) Increased production of prolactin ---- <<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 GP2 presents to an outpatient clinic for a routine gynecologic examination. The patient appears well, although she mentions that during the past 6 months she has noticed small amounts of vaginal bleeding in the middle of her menstrual cycles. Her last pregnancy was 3 years ago. Her subsequent menstrual cycles have been regular, lasting about 2–3 days. She mentions that she is up to date with her Pap smear; all of her Pap smears have been normal. She denies any recent travel or history of trauma. The patient is sexually active with her husband and they use condoms consistently. She does not smoke, drinks alcohol occasionally, and has never used illicit drugs. The physical examination is essentially normal. An ultrasound reveals a fleshy mass with a pedunculated stalk deep in the cervical canal. The uterine lining measures 5 mm in thickness and is homogeneous. Multiple small leiomyomas are also observed. The patient is otherwise asymptomatic and has no other complaints. The rest of the physical examination is unremarkable. Which of the following is the next best step in management? ---- <<Choices:>> A) No further intervention with follow-up in 6 months B) Electrocautery and cryofreezing C) Cervical brush biopsy D) Removal of the lesion with a ring forceps ---- <<Answer:>>
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D
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<<Question:>> An 11-year-old girl presents to her pediatrician with complaints of headache and rapid leg fatigue with exercise. Her vital signs are: HR 77, BP in left arm 155/100, RR 14, SpO2 100%, T 37.0 C. On palpation, her left dorsalis pedis pulse is delayed as compared to her left radial pulse. Her lower extremities feel slightly cool. Blood pressure obtained on the left lower extremity is 120/80. Which of the following is the most likely underlying pathology? ---- <<Choices:>> A) Peripheral arterial disease B) Vasospasm C) Coarctation of the aorta D) Tetralogy of Fallot ---- <<Answer:>>
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C
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 34-year-old woman comes to the gynecologist complaining of vaginal swelling and discomfort. She states that over the past 2 weeks she has noticed swelling of her right labia. The swelling continued to grow in size and now causes her discomfort when walking. She denies abnormal discharge or bleeding from the swelling or from the vulva. She normally shaves the area, but with the recent pain, she has been unable to. She denies any history of known trauma. The patient is relatively healthy and takes only a multivitamin. She never received the vaccine for human papillomavirus (HPV). On physical exam, there is a fluctuant, swelling of the right labia, most prominently at the posterior vestibule. Which of the following is the most likely diagnosis? ---- <<Choices:>> A) Bartholin gland cyst B) Folliculitis C) Granuloma inguinale D) Vulvar cancer ---- <<Answer:>>
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A
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 4-month-old boy is brought to the physician because of noisy breathing for 2 months that has progressively become louder. The noisy breathing improves when he is in the prone position. It is worse when he is agitated, feeding, or lying on his back. He was born at term and has been healthy since. His temperature is 37.1°C (98.8°F), pulse is 120/min, and respirations are 50/min. Pulse oximetry on room air shows an oxygen saturation of 98%. Examination shows inspiratory stridor. Which of the following is the most appropriate treatment? ---- <<Choices:>> A) Observation B) Surgical division C) Ceftriaxone therapy D) Supraglottoplasty ---- <<Answer:>>
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A
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<<Question:>> A 16-year-old girl comes to the physician with a 4-day history of painful vulvar lesions, generalized fatigue, and malaise. During this period, she has also had dysuria. She is sexually active with 2 male partners and uses condoms inconsistently. Her immunizations are up-to-date; she completed the vaccination course for human papilloma virus 2 months ago. Her temperature is 38.1°C (100.6°F), pulse is 100/min, respirations are 12/min, and blood pressure is 110/70 mm Hg. Pelvic examination shows several shallow ulcers on an erythematous base over the labia majora and minora. There is bilateral, tender inguinal lymphadenopathy. Which of the following is the most appropriate treatment for this patient's condition? ---- <<Choices:>> A) Acyclovir therapy B) Azithromycin therapy C) Doxycycline therapy D) Penicillin therapy ---- <<Answer:>>
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A
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 57-year-old man comes to the physician because of progressively worsening epigastric pain and 6.8-kg (15-lb) weight loss for the past 2 months. Two weeks ago, he noticed painful, red blotches on the medial aspect of his right calf. He has smoked one pack of cigarettes daily for the last 35 years. He appears thin. Physical examination shows tender erythematous nodules on the right ankle and left antecubital fossa. Endoscopy shows a large mass in the antrum of the stomach. A biopsy specimen of the gastric mass shows disorganized mucin-secreting cells with surrounding fibrosis. These cells most likely originated from which of the following structures? ---- <<Choices:>> A) Lymphoid tissue in the terminal ileum B) Mature hepatocytes in the liver C) Exocrine ducts in the body of the pancreas D) Squamous epithelium in the proximal esophagus ---- <<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 62-year-old woman comes to the emergency department because of painful and difficult swallowing. Her voice has also become muffled. She has been well until last night and reports having intermittent fevers at home. The patient has smoked a pack of cigarettes a day since age 19 but is otherwise healthy. Her temperature is 39°C (102.2°F), blood pressure is 142/93 Hg/mm, heart rate is 109/min, and respiratory rate is 18/min. On examination, the patient's head is extended and she appears anxious. Her voice is muffled and there is inspiratory stridor. There is tender bilateral cervical lymphadenopathy and pain upon palpation of the hyoid. The remainder of the examination shows no abnormalities. Laboratory studies show a leukocyte count of 18,000/mm3 with 83% neutrophils. Which of the following is the most likely cause of this patient's presentation? ---- <<Choices:>> A) Pseudomonas aeruginosa B) Corynebacterium diphtheriae C) Parainfluenza virus D) Haemophilus influenzae type b ---- <<Answer:>>
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D
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<<Question:>> A 56-year-old woman is brought to the emergency department by her husband 30 minutes after a generalized tonic-clonic seizure. Over the past 3 months, she has had recurrent headaches and worsening early-morning vomiting. She has no personal or family history of a seizure disorder. An MRI of the brain shows a central mass; surgical resection is planned. One day before the surgery, the patient has another generalized seizure and, despite resuscitative efforts, she dies. Gross examination of the brain at autopsy is shown. Which of the following was the most likely cause of this patient's symptoms? ---- <<Choices:>> A) Oligodendroglioma B) Glioblastoma C) Schwannoma D) Meningioma ---- <<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 29-year-old woman (gravida 2, para 1) presents at 32 weeks gestation for routine follow-up care. Her previous pregnancy was complicated with preeclampsia, and she delivered at 35 weeks via cesarean delivery. Four years ago, she was diagnosed with arterial hypertension. Prior to pregnancy, she took amlodipine and hydrochlorothiazide; after she found out she was pregnant, she switched to methyldopa. The course of her current pregnancy has been unremarkable with normal laboratory values at each checkup. According to her blood pressure diary, her systolic blood pressure varies between 120 and 130 mm Hg, and her diastolic blood pressure is usually normal. At presentation, the blood pressure is 140/80 mm Hg, heart rate is 76/min, respiratory rate is 15/min, and temperature is 36.9°C (98.4°F). The fetal heart rate is 143/min. Examination shows a 1+ pitting lower leg edema. Dipstick test shows 2+ protein. 24-hour urine assessment demonstrates urinary protein excretion of 1 g/L. Which of the following laboratory values should be assessed next in this patient? ---- <<Choices:>> A) Coagulogram B) Liver transaminases C) Total bilirubin D) Urinalysis ---- <<Answer:>>
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B
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<<Question:>> Following a colonoscopy performed on a 63-year-old man, the gastroenterologist identifies a firm tumor approx. 80 cm (31.4 in) from the entry site. He also performs an endoscopic polypectomy and tattooing at 50 cm (19.6 in) from the entry site. A pathologic report shows a benign polyp. One week later, the surgeon in the operating room is erroneously preparing to perform partial colectomy of the tattooed site. After confirming the patient’s name and before surgery, the surgical team reviews the patient’s history and medical documents orally based on institutional protocols. The surgery resident points out that the resected polyp is benign and the tumor lies 30 cm (11.8 in) distal to the tattooed area. The attending surgeon performs a partial colectomy on the correct site. Which of the following best describes this approach to the prevention of medical errors? ---- <<Choices:>> A) Closed-loop communication B) Preoperative time-out C) Primordial prevention D) Sentinel event ---- <<Answer:>>
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B
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 28-year-old G2P1001 presents for a routine obstetric visit in her 36th week of pregnancy. She has a history of type I diabetes controlled by insulin and delivered 1 child by normal spontaneous vaginal delivery 2 years ago. Earlier in this pregnancy, she had 2 episodes of burning with urination and frequent urination. Urinalysis each time confirmed a urinary tract infection, and both urine cultures isolated organisms sensitive to nitrofurantoin. Her symptoms resolved with 10-day courses of nitrofurantoin. She has no complaints today. Urinalysis is positive for leukocyte esterase and nitrites. Which of the following is the best next step in management? ---- <<Choices:>> A) Admit to the hospital and treat with intravenous ceftriaxone B) Treat with oral trimethroprim-sulfamethoxazole for 10 days then continue for prophylaxis until delivery C) Treat with oral nitrofurantion for 10 days D) Treat with oral nitrofurantion for 10 days then continue for prophylaxis until delivery ---- <<Answer:>>
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D
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<<Question:>> A 3-year-old boy is brought to the physician by his parents because of clumsiness and multiple falls over the past 4 months. He started walking at the age of 18 months and could walk up steps by the time he was 27 months old but now struggles to walk at all without assistance. When standing up from a lying position, he crawls onto his knees and slowly walks himself up with his hands. There is bilateral calf enlargement. Analysis of a left calf biopsy specimen from this patient is most likely to show which of the following? ---- <<Choices:>> A) Proliferation of mitochondria within muscle fibers B) Degeneration of muscle fibers with fibrofatty replacement C) Atrophic muscle fibers interspersed among hypertrophic muscle fibers D) Necrotic muscle fibers with lymphocytic infiltrate ---- <<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 60-year-old man presented to the hospital with right upper quadrant abdominal pain. He has a history of hepatitis B. He underwent a CT of his abdomen which revealed a large mass (11.3 cm x 7.2 cm in diameter) with a metastatic retroperitoneal lymph node. He was diagnosed with hepatocellular carcinoma and initially received radiotherapy while on the transplant list to prevent local expansion of his malignancy. 3 months after radiotherapy, the patient experienced hematemesis and melena. He was admitted to the emergency department for evaluation. His vitals were: blood pressure 84/56 mmHg, heart rate 92/min, and respiratory rate 20/min. Laboratory evaluation revealed severe anemia with a hemoglobin level of 5.7 g/dL, INR 1.8 and platelets of 68,000 cells/mm3. He received a blood transfusion. An endoscopic examination demonstrated diffuse edematous hyperemic mucosa and multiple hemorrhagic patches with active oozing in the antrum. What is the most likely diagnosis for the lesions seen in endoscopy? ---- <<Choices:>> A) Intrinsic apoptotic pathway B) Coagulative necrosis C) Overexpression of BcL-2 gene D) Cytotoxic CD8 T cells pathway ---- <<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 49-year-old Caucasian woman presents to your office for elevated blood pressure. She is a nurse and checks her blood pressure regularly while working in the wards. She presents with readings ranging between 163/101 and 156/94 mm Hg. After some research she conducted on her own, she has been exercising and following a low-fat, low-salt diet for the past 3 months. Her past medical history includes laparoscopic cholecystectomy for acute cholecystitis 2 years previously. Her mother and father have hypertension and her father had myocardial infarction at the age of 68 years. She takes no medications and denies smoking. She drinks 3 glasses of wine a week. Her blood pressure in the office after more than 10 minutes of rest was 153/89 mm Hg in her left arm and 145/90 mm Hg in her right arm. A review of her medical record reveals that her blood pressure was 142/92 mm Hg at her visit 1 year ago. Which of the following is the best next step in management? ---- <<Choices:>> A) Liver function tests B) Urine microalbumin C) Hemoglobin A1C D) Blood glucose ---- <<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 for back pain. The patient states that his back pain is worse in the morning and improves with certain activities. He does not experience pain when cycling but notices the pain when standing or walking. 2 months prior to presentation he was lifting heavy boxes and furniture into his daughter's new home. He is requesting pain medication and a doctor's note to take off work for the week as his symptoms are disrupting his life. Which of the following is most likely to be seen in this patient? ---- <<Choices:>> A) Bamboo appearance of the spine on radiography B) Muscular tenderness with perispinal palpation C) Multiple doctors visits for other unrelated problems D) Narrowing of the lumbar spinal canal on MRI ---- <<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 75-year-old man presents to the emergency department from his doctor’s office with a 2-day history of urinary hesitancy, fever, and chills. He additionally notes that he has been getting up frequently during the night to urinate. For the last 2 years, it has taken him longer than usual to initiate urination and his stream has gotten weaker. He has a history of hypertension for which he takes losartan. His blood pressure is 128/84 mm Hg, heart rate is 84/min, respiratory rate is 14/min, and temperature is 38.2°C (100.8°F). No costovertebral angle tenderness is present on physical examination. The patient declines rectal examination. Significant laboratory results are as follows: WBC 15.2 x 10°/L Hemoglobin 13.4 g/dL Platelets 185 x 109/L Prostate-specific antigen (PSA) 10 ng/mL What is the most likely cause of the patient’s symptoms? ---- <<Choices:>> A) Prostate cancer B) Pyelonephritis C) Nephrolithiasis D) Prostatitis ---- <<Answer:>>
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D
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 6-year-old boy is brought to the physician for evaluation of bilateral erythematous skin lesions on the flexures of the elbows and knees. He has been scratching the areas frequently. He has had similar lesions intermittently for the last 2 years. A photograph of the lesions on the back of the knees is shown. This patient's skin lesions are most likely associated with which of the following? ---- <<Choices:>> A) Reversible decrease in FEV1/FVC ratio B) IgA anti-tissue transglutaminase antibodies C) Hepatocyte infection with hepatitis C virus D) Pencil-in-cup deformity of the fingers ---- <<Answer:>>
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A
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Answer the following medical question with the correct letter choice:
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<<Question:>> An important step in the formation of thyroid hormones is the formation of I2 via oxidation of I-. Which of the following molecules is responsible for this reaction? ---- <<Choices:>> A) Thyroid deiodinase B) Thyroid peroxidase C) Perchlorate D) Propylthiouracil ---- <<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 29-year-old woman presents to her primary care provider for a normal check-up at the prompting of her mother. When asked how she is doing, she replies that she feels depressed. Upon further questioning, she states that she feels “worthless” now that her ex-boyfriend left her 2 days ago. She has been sitting in his bed all day trying to call him but he is not answering her calls. She says that she will never find another man like him and feels like she should just “disappear” rather than continue living without him. She also reports that she can hear his voice when he’s not around, especially at night before she goes to bed. She denies having any other friends and has some social anxiety, particularly in large groups of people. A review of her medical record indicates that she has endured several episodes of verbal and physical abuse from her prior relationships which she suggested “were all her fault.” She has had 4 prior serious relationships and reports that she has not been single for more than a few days in the last 10 years. On exam, she is unkempt with poor self-care. This patient’s history is most consistent with which of the following conditions? ---- <<Choices:>> A) Avoidant personality disorder B) Dependent personality disorder C) Histrionic personality disorder D) Paranoid personality disorder ---- <<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 man presents to the emergency department with confusion and chest pain. He states his symptoms started after he landed on a return flight from Brazil. Since then, the patient states that he feels anxious, short of breath, and has pleuritic chest pain. The patient has a past medical history of diabetes and chronic kidney disease. His medications include insulin, lisinopril, aspirin, and atorvastatin. His temperature is 101°F (38.3°C), blood pressure is 154/94 mmHg, pulse is 90/min, respirations are 17/min, and oxygen saturation is 96% on room air. Physical exam is notable for a confused man. The patient’s laboratory studies are ordered as seen below. Serum: Na+: 140 mEq/L Cl-: 103 mEq/L K+: 5.3 mEq/L HCO3-: 25 mEq/L BUN: 33 mg/dL Glucose: 168 mg/dL Creatinine: 1.8 mg/dL Ca2+: 10.0 mg/dL Troponin: < 0.05 mcg/L A chest CT angiogram, an echocardiogram (ECG), and a second troponin are ordered and are all unremarkable. The patient’s chest pain resolves with diazepam. A lumbar puncture is performed and based on the results the patient is subsequently started on acyclovir. Which of the following is the best next step in management? ---- <<Choices:>> A) Bolus of IV fluids B) Calcium gluconate C) Hemodialysis D) No further interventions needed ---- <<Answer:>>
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A
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 52-year-old homosexual man presents to the emergency department because of sudden right loin pain accompanied by nausea and vomiting. He has essential hypertension for 3 years for which he takes bisoprolol. He has a remote history of intravenous drug use. His temperature is 36.9°C (98.4°F), the blood pressure is 137/92 mm Hg, and the pulse is 95/min. Physical examination reveals right flank tenderness and 2+ edema of both legs up to the knees. Doppler ultrasonography shows an enlarged, echogenic right kidney with the absent venous signal. Laboratory results are shown: Serum creatinine 2.2 mg/dL Urine dipstick 4+ protein Urine analysis 20–25 red cells/high power field Which of the following is the most likely underlying etiology of this patient's condition? ---- <<Choices:>> A) Acute pyelonephritis B) Hypertensive kidney disease C) Membranous nephropathy D) Penile cancer ---- <<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 53-year-old woman is brought to the emergency department for a 2-hour history of balance problems. She was gardening when she suddenly felt very dizzy and she quickly called for her husband. When he arrived, she was sitting on the ground, swaying back and forth but overall leaning to the right. When she tried to stand up they found she was very unsteady and unbalanced, so her husband carried her to the car. In the emergency department, while lying in bed, she complains of a room-spinning sensation; when she sits up, she sways to the right. She is unable to walk more than 3 steps without falling. Finger-nose-finger and heel-knee-shin testing are abnormal. She has a past medical history of hypertension, polycystic ovarian syndrome, and type 2 diabetes mellitus. All of her vital signs are all within normal limits. Angiography would most likely show a dissection in which of the following vessels? ---- <<Choices:>> A) Anterior cerebral artery B) Middle cerebral artery C) Vertebral artery D) Anterior spinal 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 65-year-old man with squamous cell carcinoma of the lung presents with a sodium of 118 and an altered mental status. He is started on 3% normal saline over the next several hours. The patient’s mental status improves and and a repeat sodium six hours later is 129. Three days after treatment he demonstrates quadriparesis and dysarthria. Which of the following best describes this cause of the patients symptoms after treatment? ---- <<Choices:>> A) Lateral medullary syndrome B) Medial medullary syndrome C) Osmotic demyelination syndrome D) Hypercalcemia ---- <<Answer:>>
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C
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 27-year-old woman presents to the emergency department with severe wheezing, which started an hour ago. She informs the doctor that she has had mild persistent asthma for the last 2 years and is on inhaled corticosteroids, and uses them regularly. She has not experienced asthma symptoms for the last 2 months and there is no history of non-compliance. She mentions that her present symptoms came on about 20 minutes after her last meal. When the doctor makes specific inquiries, she recollects items in her lunch, which included canned milk product, commercially available roasted peanuts, homemade celery salad, and wine. She also mentions that she took a tablet of acetaminophen immediately after the meal because her legs were aching since morning, which she attributes to her morning walk at 6 am the same day. She has never developed respiratory symptoms in response to milk protein, peanuts, or acetaminophen until now. Skin prick testing for food allergens, performed a month back, was negative for all the common food allergens, including milk and peanuts. Which of the following is the most likely trigger for her current episode? ---- <<Choices:>> A) Ara-h-1 protein B) Food additive C) Acetaminophen D) Exercise ---- <<Answer:>>
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B
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<<Question:>> A 30-year old African-American woman comes into your office for pregnancy counseling with her husband. She states that both she and her husband have family histories of sickle cell disease. Based on previous genetic testing, they both also have a copy of the sickle cell gene from their parents, but neither of them has ever manifested symptoms associated with the disease. They want to conceive and are concerned about the chances that their child might have the disease. What is the chance the offspring will be a child WITHOUT sickle cell anemia? ---- <<Choices:>> A) 1/2 B) 3/4 C) 1/4 D) 2/3 ---- <<Answer:>>
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B
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 52-year-old man presents to the clinic complaining of blood in his urine. He had a mild respiratory illness 3 weeks ago. Urinalysis reveals a high red blood cell count and casts in the urine. A diagnosis of post-streptococcal glomerulonephritis is made. The physician explains that the treatment is supportive and that the patient needs to follow up with him every two weeks. Six weeks later, the patient returns to the clinic because he does not feel well; he has been experiencing malaise and fatigue. On examination, his pulse is 98/min, blood pressure is 135/85 mm Hg, temperature is 36.6°C (98.0°F), and respiratory rate is 16/min. He has a mildly distended abdomen. Blood tests reveal that the patient’s creatinine level has increased from 1.2 mg/dL to 3.0 mg/dL over the last month. He is referred to a nephrologist who diagnoses him with rapidly progressive glomerulonephritis (RPGN) and starts him on hemodialysis, as his potassium level has risen to 7 mEq/dL. The patient is advised to undergo renal transplantation. His human leukocyte antigen (HLA) genotype is A7/A5, B2/B9, C8/C3. The first allele in each locus is the maternal form; the second is paternal. Several potential donors are available for the renal graft. Which of the following would be the closest match? ---- <<Choices:>> A) Donor B: tA5/A12, tB22/9, ttC4/C3 B) Donor A: tA7/A5, ttB8/B2, ttC3/C8 C) Donor E: tA7/A8, ttB9/B27, tC3/C4 D) Donor D: tA4/A7, ttB1/B8, ttC8/C3 ---- <<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 determinants of childhood obesity by observing a cohort of pregnant women with obesity. After delivery, he regularly records the height and weight of the cohort's children. The results of the correlation analysis between mean childhood BMI at 4 years of age and mean maternal BMI before pregnancy are shown. Based on these findings, which of the following is the most likely correlation coefficient? ---- <<Choices:>> A) -0.45 B) 0.45 C) 0 D) -1.80 ---- <<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 25-year-old woman comes to the physician for a routine examination. She is a recreational runner and for the past 3 months she has been training for a marathon. Yesterday she ran 17 km (10.5 mile). Menses occur at regular 28-day intervals and last 6 days. She drinks three to five beers when going out with friends. She follows a vegan diet. She appears well. Her temperature is 36.6°C (98.0°F), blood pressure is 110/72 mm Hg, pulse is 70/min, and respirations are 14/min. Physical examination shows no abnormalities. Laboratory studies show: Hemoglobin 9.8 g/dL Mean corpuscular volume 91 fL Lactate dehydrogenase 400 U/L Platelet count 250,000/mm3 Reticulocyte count 3% Haptoglobin 23 mg/dL (N=41–165 mg/dL) Serum Iron 90 μg/dL Ferritin 170 ng/mL Total iron binding capacity (TIBC) 220 μg/dL (N=251–406 μg/dL) Urinalysis shows trace blood but no RBCs. Which of the following is the most likely cause of this patient's anemia?" ---- <<Choices:>> A) Extravascular hemolysis B) Vitamin B12 deficiency C) Intravascular hemolysis D) Impaired heme 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 45-year-old man comes into the ED after a car accident. After waiting an hour in the waiting room, he begins to berate the receptionist and demands to be seen by a doctor. During the exam, the patient brags that he recently had to quit his job because they did not appreciate his talent and drive. After a medical student declines his invitation for a date, he becomes very angry and throws supplies across the room. The physician manages the patient's physical injuries and begins to suspect the patient has a personality disorder. Which personality disorder is most likely? ---- <<Choices:>> A) Narcissistic personality disorder B) Avoidant personality disorder C) Histrionic personality disorder D) Obsessive-compulsive personality disorder ---- <<Answer:>>
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A
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 61-year-old man comes to the physician because of weight loss and a non-productive cough for 4 months. He has smoked 2 packs of cigarettes daily for 42 years. A CT scan of the chest shows an irregular mass at the right hilum and axillary lymphadenopathy. A biopsy of the mass obtained on bronchoscopy confirms the diagnosis of metastatic non-small cell lung cancer. Results of a molecular diagnostic test show a microdeletion on the short arm of chromosome 7. The physician recommends chemotherapy with erlotinib. The beneficial effect of this drug is most likely due to arrest in which of the following phases of the cell cycle? ---- <<Choices:>> A) G2 phase B) G1 phase C) G0 phase D) S phase ---- <<Answer:>>
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B
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 52-year-old woman comes to the physician because of a 4-day history of painful swallowing and retrosternal pain. She was diagnosed with HIV infection 2 months ago; her medications include tenofovir, emtricitabine, and raltegravir. Vital signs are within normal limits. Physical examination of the oral cavity shows no abnormalities. The patient's CD4+ T-lymphocyte count is 70/mm3 (N ≥ 500). Empiric treatment is started. Two weeks later, she reports no improvement in symptoms. Esophagogastroduodenoscopy is performed and shows multiple round superficial ulcers in the distal esophagus. Which of the following is the most likely underlying cause of this patient's symptoms? ---- <<Choices:>> A) Adverse effect of medication B) Degeneration of ganglion cells within the myenteric plexuses C) Infection with herpes simplex virus D) Infection with Candida species ---- <<Answer:>>
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C
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Answer the following medical question with the correct letter choice:
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<<Question:>> An 18-year-old girl comes to the emergency room with abdominal pain. She states that the pain started 6 hours ago, is 8/10, and localizes to the right lower abdomen. She recalls a similar episode last month. Her older brother was hospitalized 2 years ago for perforated appendicitis. Her mother has diverticulitis. The patient got her first menstrual period at age 14. Her periods occur regularly every 28 days. Her last menstrual period was 2 weeks ago. She is sexually active with multiple partners and uses condoms inconsistently. The patient’s temperature is 99°F (37.2°C), blood pressure is 110/74 mmHg, pulse is 89/min, and respirations are 14/min with an oxygen saturation of 98% on room air. On physical exam, the patient is in moderate distress. There is lower abdominal tenderness with guarding. A pelvic examination reveals clear mucous in the vaginal introitus, a mobile uterus, and tenderness of the right adnexa. Labs are obtained, as shown below: Leukocyte count: 10,000/mm^3 with normal differential Hemoglobin: 13.5 g/dL Platelet count: 200,000/mm^3 Beta-human chorionic gonadotropin: Pending A pelvic ultrasound demonstrates a small fluid collection in the cul-de-sac posterior to the uterus. Which of the following is the most likely diagnosis? ---- <<Choices:>> A) Appendicitis B) Endometriosis C) Midcycle pain D) Ruptured ectopic pregnancy ---- <<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:>> In a suburban town in Virginia, epidemiologists are alarmed by the increasing number of squamous cell lung cancer cases. Further investigation reveals that most people in the area work in a glass factory, the region’s main source of employment. A researcher is interested in studying the role of immunosurveillance in the pathogenesis of this lung cancer. He postulates that tumor infiltration by natural killer (NK) cells has a better prognosis since they play a major role in immunosurveillance. NK cells also kill tumor cells by the perforin-mediated destruction of cancerous cells. The researcher is interested in studying tumor infiltration by NK cells in the resected specimen from patients within the cohort who have been diagnosed with stage 1 lung cancer. Which of the following cluster of differentiation markers will he need to use to identify these cells in the resected specimens? ---- <<Choices:>> A) CD20 B) CD3 C) CD34 D) CD56 ---- <<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 26-year-old man presents to the office complaining of persistent back pain for the past 3 months. You saw the patient previously and prescribed NSAIDs and rest, but he has not improved. The patient states that his maternal grandfather had ‘back problems his whole life’, and he worries that he might have the same issues. An X-ray is performed and shows squaring of the vertebrae with longitudinal fibrous bands. What is the most likely diagnosis? ---- <<Choices:>> A) Ehlers-Danlos syndrome B) Osteosarcoma C) Ankylosing spondylitis D) Osteopetrosis ---- <<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 regional hospital system has decided to institute a new task group for quality improvement and patient safety. The task group would like to begin by decreasing the number of days given for narcotic pain medication prescriptions in the emergency department to at most 7 days instead of the hospital average of 21 days per prescription. Which of the following interventions would be most successful at achieving the task group’s mission? ---- <<Choices:>> A) Educating patients about appropriate narcotics dosing B) Printing out and posting handouts detailing the dangers of narcotics C) Sending an email to all providers notifying them of narcotics prescribing best practices D) Changing the electronic medical record to only allow a maximum of 7 days per prescription ---- <<Answer:>>
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D
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 57-year-old man comes to the clinic complaining of nausea and 1 episode of vomiting during the past day. He denies any precipitating event except for a headache for which he took some acetaminophen yesterday. The headache is described as bilateral, dull, and 8/10 in severity. He has never had such symptoms before. His past medical history is significant for hypertension, biliary colic, and a past hospitalization for delirium tremens when he “tried to quit alcohol cold turkey.” When asked about his current alcohol intake, the patient looks away and mutters “just a couple of drinks here and there.” The patient reports mild abdominal pain that began this morning but denies vision changes, bowel changes, fever, or weight loss. Physical examination demonstrates tenderness at the right upper quadrant (RUQ) that does not worsens with inhalation. What is the most likely explanation for this patient’s symptoms? ---- <<Choices:>> A) Accumulation of N-acetyl-p-benzoquinone imine in the liver B) Impaction of a gallstone in the ileus C) Malignant overgrowth of glial cells in the brain D) Obstruction of the cystic duct by gallstone ---- <<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 patient comes to the physician because of a 4-day history fever, headaches, loss of appetite, and myalgia. Two weeks ago, the patient went on a camping trip to Wisconsin. His temperature is 39.5°C (103.1°F). Physical examination shows no rash or joint swelling. Laboratory studies show: Hemoglobin 14.1 g/dL Leukocyte count 3,800/mm3 Platelet count 85,000/mm3 Serum AST 48 U/L ALT 52 U/L Treatment with doxycycline is begun and the patient recovers. A paired acute and convalescent indirect fluorescent antibody test confirms that the patient had anaplasmosis. The patient's condition was most likely transmitted by which of the following vectors?" ---- <<Choices:>> A) Lone star tick B) Ixodes tick C) Dog tick D) Flea ---- <<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 42-year-old woman comes to the clinic complaining of upper abdominal pain. Her symptoms started 1 month ago with vague abdominal discomfort following a meal at a steakhouse. Since then the pain has progressed to the point that she has more than 5 episodes a week. The pain is worse with eating but has not affected her appetite. She also reports a burning sensation in her chest when she lies down at night after dinner. She denies weight loss or dysphagia. She takes no medications except daily calcium supplements. She drinks 2 glasses of wine per week and denies tobacco use. Her blood pressure is 110/78, pulse is 72/min, and respirations are 13/min. On physical examination, the patient’s abdomen is soft and non-distended. Normal bowel sounds are appreciation. There is mild epigastric tenderness but no guarding and no rebound. Fecal occult blood is negative. Which of the following is the next best step in management? ---- <<Choices:>> A) Start antibiotic therapy B) Start omeprazole C) Surgical fundiplication D) Upper gastrointestinal endoscopy ---- <<Answer:>>
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B
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 3-year-old boy presents to the pediatrician crying with ear pain and his temperature has been 101°F (38.3°C) for several days. His mother states that other children at his daycare center have been having similar symptoms. She further describes that he was fed formula and was not breastfed. The mother admits that she smokes cigarettes daily. On exam, the boy is irritable and crying, and frequently tugs on his left ear. Both tympanic membranes appear erythematous, and the left appears opaque and bulging with decreased mobility on pneumatic otoscopy. Which of the following is the best next step in management? ---- <<Choices:>> A) Amoxicillin B) TMP-SMX C) Tympanocentesis D) Supportive therapy ---- <<Answer:>>
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A
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 47-year-old G3P2 woman presents to her endocrinologist for a follow-up appointment. Her last menstrual period was at the age of 35 years. She now feels fatigued and cannot concentrate on her work or type properly on the keyboard because of an onset of tremor in her hands. Her symptoms are taking a toll on her quality of life. The patient’s blood pressure is 124/83 mm Hg, pulse is 91/min, respirations are 17/min, and temperature is 36.7°C (98.1°F). On physical examination, there is a mild enlargement of the thyroid; the gland is minimally firm in texture and is nontender. Which of the following pathologic findings is she most likely to have? ---- <<Choices:>> A) Follicular thyroid neoplasia B) Silent thyroiditis C) Chronic lymphocytic thyroiditis D) Fibrous thyroiditis ---- <<Answer:>>
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B
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 44-year-old woman is brought to the emergency department after she was found lying in the park mumbling to herself. She is lethargic and disoriented. She has a 2-week history of increasing weakness, nausea, and vomiting. She denies any recent alcohol or drug use. She has a history of systemic lupus erythematosus but stopped taking methotrexate many years ago. Her temperature is 37.3°C (99.1°F), pulse is 89/min, and blood pressure is 154/91 mm Hg. On mental status examination, she is confused and only oriented to person, but not to place or time. She is unable to name the days of the week backwards. She exhibits moderate generalized weakness. Physical exam shows jugular venous distention and pitting edema in the lower extremities. Laboratory studies show: Serum Na+ 137 mEq/L K+ 5.5 mEq/L Cl- 120 mEq/L Bicarbonate 15 mEq/L Urea nitrogen 94 mg/dL Creatinine 5.5 mg/dL Glucose 92 mg/dL Which of the following is the most appropriate next step in management?" ---- <<Choices:>> A) Administer lactulose B) Hemodialysis C) Restart methotrexate D) Fluid restriction ---- <<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 secretion of gastrointestinal hormones before and after food intake. She isolates a hormone that accelerates the emptying of gastric contents into the duodenal bulb. The isolated hormone is most likely which of the following? ---- <<Choices:>> A) Glucagon-like peptide B) Gastrin C) Cholecystokinin D) Vasoactive intestinal peptide ---- <<Answer:>>
|
B
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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 the office with a chief complaint of a cough that has persisted for a month and a half. She also has night fevers and has lost 5 kg (11 lb) in the last 2 months. She recently returned from a 6-month trip to Peru. Her vitals include: heart rate 82/min, respiratory rate 17/min, temperature 38.0°C (100.4°F), and blood pressure 107/80 mm Hg. On auscultation, she has diminished respiratory sounds at the base of the right lung. Chest radiography shows an opacity in the right apex. What is the most likely cause of her presentation? ---- <<Choices:>> A) Echinococcosis B) Tuberculosis C) Pulmonary thromboembolism D) Heart failure ---- <<Answer:>>
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B
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 52-year-old homeless man is brought to the urgent care clinic with altered mental status and disorientation for the last day. Past medical records are unavailable. His temperature is 37°C (98.6°F), the respiratory rate is 15/min, the pulse is 107/min, and the blood pressure is 92/67 mm Hg. He has a flapping tremor of the wrists during attempted extension. He is started on intravenous D5 1/2NS and blood is drawn for further testing. His condition deteriorates overnight. On re-examination the next morning, he has developed visual disturbances with a new horizontal nystagmus and a staggering gait. His blood tests show: Serum Albumin 3.2 gm/dL Alkaline phosphatase 150 U/L Alanine aminotransferase 76 U/L Aspartate aminotransferase 155 U/L Gamma-glutamyl transpeptidase 202 U/L What is the most likely diagnosis? ---- <<Choices:>> A) Alcohol-related dementia B) Hepatic encephalopathy C) Delirium D) Wernicke's encephalopathy ---- <<Answer:>>
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D
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 27-year-old woman comes to the emergency department at 14 weeks gestation with abdominal pain. She states she has passed a large amount of blood from her vagina in the past 2 hours. Her vitals are within normal limits and she describes her abdominal pain as a 4/10. Physical exam is notable for a dilated cervix. The patient states she does not want any invasive procedures in her workup but is accepting to necessary medical interventions. Which of the following is the best next step in management? ---- <<Choices:>> A) Admission and external fetal monitoring B) Dilation and curettage C) Expectant management D) Transvaginal ultrasound ---- <<Answer:>>
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C
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