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Answer the following medical question with the correct letter choice:
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<<Question:>> A 57-year-old man presents to the emergency department with a change in his mental status. His wife noticed he was particularly somnolent this evening which prompted her to bring him in. The patient has a past medical history of congestive heart failure, diabetes, and hypertension. His temperature is 99.5°F (37.5°C), blood pressure is 97/58 mmHg, pulse is 40/min, respirations are 17/min, and oxygen saturation is 95% on room air. A fingerstick blood glucose is notable for a value of 47 mg/dL. Which of the following is the best treatment for this patient? ---- <<Choices:>> A) Calcium chloride B) Dextrose C) Glucagon D) Transcutaneous pacing ---- <<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 16-year-old boy comes to his primary care clinic for a sports physical. He states that he wants to try out for his high school’s football team this year. He's "trying to get in better shape.” The patient has no complaints except for occasional headaches when he is stressed about exams. The patient also mentions that he is embarrassed of his “small penis” and asks if there is something he can take for that. The patient’s temperature is 98°F (36.7°C), blood pressure is 118/76 mmHg, and pulse is 79/min. On physical examination, the patient is obese and has no visible facial hair. His testes are less than 20 mL in volume, and his phallus measures less than 8 cm. Initial labs show testosterone levels of 95 ng/dL and a low follicle stimulating hormone/luteinizing hormone ratio. Which of the following is the next best diagnostic step? ---- <<Choices:>> A) Adrenocorticotrophic hormone stimulation test B) Semen analysis C) Spectral karyotype D) Thyroid-stimulating hormone and prolactin levels ---- <<Answer:>>
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D
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 72-year-old man presents to the hospital with retrosternal chest pain and shortness of breath. The pain started 5 hours prior to arrival and has not changed after sublingual nitroglycerin intake. The patient has a history of long-standing persistent atrial fibrillation but had not been taking anticoagulants at the time of presentation. He had also been diagnosed with iron-deficiency anemia 3 months before admission and is taking 120 mg of elemental iron daily. He has no history of ischemic heart disease. Clinical investigation confirms inferior ST-elevation myocardial infarction with occlusion of the right coronary artery. The patient is managed with percutaneous coronary intervention (PCI). Six hours after the PCI, the patient develops cardiogenic shock; 8 hours after presentation, he dies, despite intensive care management. The autopsy reveals widespread inferior-posterior myocardial infarction and thrombotic occlusion of the left circumflex artery. The microscopic image depicts a macroscopically intact myocardium. Which of the following statements regarding this patient’s myocardial tissue is true? ---- <<Choices:>> A) This slide shows changes in the myocardial tissue that result from lipid peroxidation during the patient's lifetime. B) The changes shown on this slide are a result of iron overload. C) The slide shows cardiac steatosis. D) The microscopic image reveals cardiac tissue hypertrophy. ---- <<Answer:>>
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A
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 3-year-old boy is brought in by his parents for placement of a tracheostomy tube in order to allow for better ventilator support of his breathing. At birth, he was flaccid with a poor sucking reflex. Since then, his weakness has progressively worsened such that he is unable to sit, eat, or breathe independently. Family history reveals that his grandfather was affected by a degenerative disorder at age 50, and his father had the same degenerative disorder at age 30. Examination is significant for tongue fasciculations and absent deep tendon reflexes. Which of the following forms of inheritance is associated with the most likely cause of this patient's disorder? ---- <<Choices:>> A) Autosomal dominant on chromosome 19 B) Autosomal recessive on chromosome 5 C) Autosomal recessive on chromosome 9 D) X-linked dominant ---- <<Answer:>>
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B
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 73-year-old man is brought to the emergency department 30 minutes after the sudden onset of right-sided body weakness. His wife reports that he does not seem to understand simple questions. He has type 2 diabetes mellitus and has smoked 1 pack of cigarettes daily for 45 years. The patient speaks fluently, but he answers questions with nonsensical phrases and cannot repeat single words. Which of the following is the most likely diagnosis? ---- <<Choices:>> A) Conduction aphasia B) Global aphasia C) Wernicke aphasia D) Transcortical sensory aphasia ---- <<Answer:>>
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C
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 23-year-old woman comes to physician for an annual health maintenance examination. She feels well. She is 155 cm (5 ft 1 in) tall and weighs 79 kg (174 lb); BMI is 33 kg/m2. Examination shows a skin rash over both axillae. A photograph of her left axilla is shown. This patient's skin finding is most likely associated with which of the following conditions? ---- <<Choices:>> A) Niacin deficiency B) Primary adrenal insufficiency C) Polycystic ovarian syndrome D) Hashimoto thyroiditis ---- <<Answer:>>
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C
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 72-year-old female is brought in by ambulance after being found down in her home. Her daughter discovered her after returning from work and does not know how long she has been down. Physical exam reveals right sided paralysis with a positive babinski sign. She is also found to produce strained stuttering speech with no perceivable meaning. She is unable to follow any instructions and cannot repeat speech. An MRI is obtained showing a left MCA infarct. Damage to which of the following structures is most likely to be responsible for her language deficits? ---- <<Choices:>> A) Arcuate fasciculus B) Inferior frontal gyrus C) Inferior frontal gyrus + superior temporal gyrus D) Arcuate fasciculus + Inferior frontal gyrus + superior temporal gyrus ---- <<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 66-year-old male with a history of diabetes and knee osteoarthritis presents to his primary care provider in July complaining of headaches and blurry vision. He reports a 6-month history of occasional dull diffuse headaches and blurry vision. He notes that the episodes have increased in severity since the weather got warmer and that he occasionally feels extremely itchy when he spends time outdoors. The patient lives in southern Arizona. Moreover, he has felt chronically fatigued and has lost 10 pounds without dieting or changing his appetite. He currently takes metformin and his most recent hemoglobin A1c was 6.5%. Physical examination reveals multiple bruises on the bilateral upper and lower extremities and hepatosplenomegaly. Fundoscopic examination demonstrates enlarged retinal veins. Multiple laboratory tests are pending. At steady state, which of the following sets of findings is most likely in this patient? ---- <<Choices:>> A) Increased plasma volume, increased RBC mass, decreased EPO, normal SaO2 B) Normal plasma volume, increased RBC mass, increased EPO, normal SaO2 C) Decreased plasma volume, normal RBC mass, normal EPO, normal SaO2 D) Increased plasma volume, decreased RBC mass, decreased EPO, normal SaO2 ---- <<Answer:>>
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A
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 25-year-old woman is brought to the emergency department for the evaluation of severe abdominal pain for the last hour. Abdominal ultrasound shows a non-compressible and enlarged appendix. The patient is diagnosed with acute appendicitis. While obtaining informed consent from the patient for appendectomy, the patient reports that she does not want to undergo surgery because she does not trust doctors. She states that all doctors are “bad” and all they think about is money. She adds that she thinks that nurses are “angels” and that they should take care of her instead of the “arrogant” doctors. This patient's behavior is characteristic of a condition that is most typically associated with which of the following? ---- <<Choices:>> A) Repeated performance of certain routines B) Substance use disorder C) Fear of social situations D) Self-injurious behavior ---- <<Answer:>>
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D
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 20-year-old woman presents with persistent sadness for the last 2 months. She says that she is always feeling tired and nothing seems to cheer her up. Although previously a top student at her college, she did not register for classes this term, because she does not feel like going to school anymore. She says her friends complain that she does not want to ‘hang out’ with them anymore. She is sleeping more than usual and often does not want to leave the bed in the morning. The patient denies any suicidal ideation or preoccupation with death. Her past medical history is unremarkable. She currently takes a daily multivitamin. The vital signs include pulse 64/min, respiratory rate 12/min, blood pressure 110/70 mm Hg, and temperature 36.9°C (98.5°F). Her body mass index (BMI) is 17.5 kg/m2. On physical examination, the patient is pale. Mucous membranes and oral cavity are dry with poor dentition. Multiple calluses are present on the knuckles of her left hand. Which of the following medications is the best course of treatment in this patient? ---- <<Choices:>> A) Mirtazapine B) Lorazepam C) Bupropion D) Amitriptyline ---- <<Answer:>>
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A
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 31-year-old man presents to the clinic with complaints of sudden onset of fever, headache, chills, and a painful “bump” in his right groin. He recently spent three months working as a park ranger in New Mexico. His physical exam is notable for an enlarged lymph node in the inguinal region that is extremely tender to palpation. The patient is promptly treated with antibiotics, and his case is reported to the Centers for Disease Control and Prevention. Which of the following was the most likely vector that transmitted the disease to this for patient? ---- <<Choices:>> A) Armadillo B) Flea C) Rat D) Tick ---- <<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:>> As the only full-time inpatient endocrinologist at your hospital, you have been tasked with deciding which blood glucose measuring device to use on the wards. A medical device representative presents you with the data in Image A. All readings were performed on the same individual whose blood glucose was known to be 125 mg/dL at the time. Which of the devices has the best precision? ---- <<Choices:>> A) Device B B) Device C C) Device D D) Not enough information provided ---- <<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 21-year-old male comes to the physician’s office with complaints of fatigue. The patient is a college intramural athlete and has noticed that during hard workouts with his team, he gets severe muscle pain and weakness to the point where he has to stop and rest. Usually he is able to recover and the cramps subside after rest. After strenuous workouts he has also noticed that his urine is dark. On exam, the patient has no acute symptoms and appears to be sitting comfortably with a completely normal exam. The patient does not have any tenderness to palpation of his muscles. Which of the following enzymes is most likely defective in this patient? ---- <<Choices:>> A) Glucose-6-phosphatase B) Debranching enzyme C) Glycogen phosphorylase D) Acid maltase ---- <<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 78-year-old man comes to the physician because of a 3-week history of dyspnea, chest pain, dry cough, painful swallowing, and a feeling of fullness in his head. The symptoms were initially mild but have progressively worsened. He has a history of gastroesophageal reflux disease treated with esomeprazole. He does not smoke cigarettes. His pulse is 99/min and blood pressure is 95/66 mm Hg. Examination shows swelling and redness of the face and neck. There is distention of the superficial veins of his neck and upper thorax. Plain radiographs of the chest show a widened mediastinum and unremarkable lung fields. Which of the following is the most likely underlying cause of this patient's symptoms? ---- <<Choices:>> A) Pancoast tumor B) Constrictive pericarditis C) Descending aortic aneurysm D) Mediastinal lymphoma ---- <<Answer:>>
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D
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 52-year-old man is brought to the emergency department 30 minutes after his farmhand found him on the ground sweating profusely. On arrival, he is lethargic and unable to provide any history. His temperature is 37.5°C (99.5°F), pulse is 42/min, and blood pressure is 95/60 mm Hg. Physical examination shows diaphoresis and excessive salivation. The pupils are constricted. There is scattered expiratory wheezing throughout both lung fields. His clothes are soaked with vomit, urine, and feces. A drug with which of the following mechanisms of action is most appropriate for this patient? ---- <<Choices:>> A) Non-selective α adrenergic receptor antagonism B) β2 adrenergic receptor agonism C) Muscarinic acetylcholine receptor antagonism D) Nicotinic acetylcholine receptor agonism ---- <<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 woman is admitted to the hospital about four hours after her husband discovered that she ingested a bottle of acetaminophen in an attempted suicide. The patient denies any symptoms at this time. Vital signs include a blood pressure of 115/80 mmHg and pulse of 85/min. Physical exam is unremarkable. AST and ALT levels are approximately 2500 U/L. APAP level is 160 mcg/mL, and INR is 1.7. The patient refuses N-acetyl-cysteine (NAC) treatment. What is the best next step in management? ---- <<Choices:>> A) Administer NAC B) Cancel the NAC order C) Involve the patient's husband to guide medical care D) Force the patient to accept NAC ---- <<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 11-month-old baby boy is brought to the emergency room by his parents for vomiting. His mom reports that he has had a cold for the past week with a runny nose and low-grade fevers. However, his condition worsened today when he began coughing and struggling to breathe. During one of his coughing spells he threw up his milk as well. The parents deny any sick contacts, changes in diet, or bowel changes but endorse fatigue and decreased appetite. A physical examination demonstrates a healthy-looking baby with an intense cough and significant inspiratory stridor. What is the pathophysiology of this patient’s condition? ---- <<Choices:>> A) Generation of reactive oxygen species B) Production of IgA proteases C) Toxin that inactivates Gi protein D) Toxin that permanently activates Gs protein ---- <<Answer:>>
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C
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 56-year-old male undergoes a pancreaticoduodenectomy for resection of a tumor of the head of the pancreas. His medical history is otherwise insignificant except for a series of minor respiratory and gastrointestinal infections since childhood that were effectively treated with antibiotics. Before today, he has not had any prior surgeries or required a blood transfusion. In the post anesthesia care unit, his hemoglobin is measured and found to be 5.2 g/dL. A transfusion of 2 units of packed red blood cells is ordered. Minutes after the transfusion is initiated, the patient reports severe itching, nausea, and shortness of breath. His vital signs show a drop in blood pressure from 138/88 to 92/47 and an increase in heart rate from 94 to 118. The patient's nurse stops the transfusion immediately. Which of the following underlying conditions most likely predisposed this patient to develop this reaction? ---- <<Choices:>> A) Severe combined immunodeficiency disorder B) Bruton's agammaglobulilnemia C) Wiskott-Aldrich syndrome D) Selective IgA deficiency ---- <<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 5-year-old girl is brought to the emergency department after sustaining an atraumatic tibial fracture while playing with her friends. This patient has a history of fractures in her upper and lower extremities. Children's services have investigated the family several times in the past and found no abuse. She was born at 39 weeks gestation via spontaneous vaginal delivery which resulted in several mild fractures. She is up to date on all vaccines and is meeting all developmental milestones. The mother has a brother with a similar history that is still living. Her vital signs show a heart rate of 90/min, respiratory rate of 22/min, blood pressure of 110/65 mm Hg, and temperature of 37.0°C (98.6°F). Physical exam reveals a regular heart rate, and her lungs are clear to auscultation bilaterally. The sclera of both eyes are blue. Additionally, her teeth are brown and distorted. Her leg is swollen, erythematous, and tender to palpation. An X-ray reveals a tibia fracture, while multiple fractures at various stages of healing are also seen on her arms. The physician suspects this is a genetic condition. Which of the inheritance patterns can be attributed to the girl’s condition? ---- <<Choices:>> A) Pleiotropy B) Anticipation C) Locus heterogeneity D) De novo mutation ---- <<Answer:>>
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C
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 72-year-old woman presents to her primary care physician because she is coughing pink sputum and has difficulty breathing. She says that she was feeling pretty good until she traveled to her grandson's wedding last week. Since then she has had increasing difficulty sleeping and walking due to her shortness of breath. Physical exam reveals swollen ankles, basilar crackles bilaterally, and a murmur best heard in the left lateral decubitus position. She is already taking several medications for this condition; however, given the recent worsening of symptoms she is started on an additional medication. Which of the following is the most likely mechanism of action for the medication that was started in this patient? ---- <<Choices:>> A) Competitive inhibition of hormonal signaling B) Decrease in adenylyl cyclase activity C) Inhibition of Na-Cl symporter D) Inhibition of Na-K-Cl cotransporter ---- <<Answer:>>
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D
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 37-year-old woman is brought to the emergency department for acute abdominal pain for the past 2 hours. She reports that the pain is constant, 10/10, and is diffusely spread across her stomach. She reports nausea and 1 episode of vomiting 1 hour ago, painless bloody urine, and paresthesias in her hands bilaterally. The patient claims similar episodes in the past following the use of alcohol, though with milder pain. Her past medical history is significant for pelvic inflammatory disease that was adequately treated 5 years ago. She is currently sexually active with her husband without contraceptive use. Her temperature is 98.6°F (37°C), blood pressure is 148/98 mmHg, pulse is 103/min, respirations are 18/min, and oxygen saturation is 99% on room air. A physical examination demonstrates a patient in acute distress with diffuse abdominal tenderness and decreased sensation of the hands bilaterally. What is the most likely explanation for this patient’s symptoms? ---- <<Choices:>> A) Implantation of the embryo outside of the uterus B) Inflammation of the appendix C) Mutation of the porphobilinogen deaminase enzyme D) Obstruction of the cystic duct and subsequent inflammation of the gallbladder ---- <<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 medical research study is being conducted to evaluate the specificity of a novel blood test for rheumatoid arthritis. Of the 300 patients enrolled, half are diagnosed with RA. The remaining patients are age-matched controls. In the subgroup of patients with RA, 125 are found positive for the novel blood test. In the control group, 45 are found positive. Which of the following represents the overall specificity of this novel test? ---- <<Choices:>> A) 105 / (105 + 25) B) 125 / (125 + 105) C) 105 / (105 + 45) D) 125 / (125 + 25) ---- <<Answer:>>
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C
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 58-year-old man comes to the emergency department because of multiple episodes of coughing up blood over the past 2 hours. He says that he has coughed up approximately half a cup of bright-red blood each time. He has had progressively worsening shortness of breath on exertion and a productive cough with occasionally blood-tinged sputum for the past 6 months. He has a history of hypertension and chronic obstructive pulmonary disease. He has worked in a car manufacturing company for over 20 years. He drinks 2 to 3 beers every evening. He has smoked 1 pack of cigarettes daily for the past 30 years. His medications include amlodipine, tiotropium, and an albuterol inhaler as needed. His temperature is 37.2 °C (99.0 °F), blood pressure is 102/68 mm Hg, pulse is 108/min, and respirations are 22/min. Pulse oximetry on room air shows an oxygen saturation of 89%. He appears anxious and cachectic. Examination of the lung shows decreased breath sounds bilaterally. There is no cervical or axillary lymphadenopathy. His hemoglobin is 11.5 g/dL, leukocyte count is 8,800/mm3, and a platelet count is 160,000/mm3. His coagulation parameters are within normal limits. Serum studies and urine analysis show no abnormalities. He is intubated and mechanically ventilated, and infusion of 0.9% saline is begun. An x-ray of the chest shows hyperinflation of the lung fields and a 2-cm nodule in the right lower lobe. In addition to placing the patient in the right lateral decubitus position, which of the following is the most appropriate next step in management? ---- <<Choices:>> A) Radionuclide scan B) Upper endoscopy C) Arteriography D) Bronchoscopy ---- <<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 previously healthy 3-year-old girl is brought to the physician because she refuses to use her left arm after “tripping over a stone” that morning on the way to the supermarket while holding her mother's hand. She did not hit the ground. Development has been normal for her age. She appears anxious. Her vital signs are within normal limits. The left forearm is held close to her body in partial extension and pronation. There is no swelling or bruising of the elbow or the forearm. Palpation of the proximal radius produces pain. The child cries on attempting to passively supinate the forearm. Which of the following is the most appropriate next step for the physician? ---- <<Choices:>> A) Administer ibuprofen and ice packs B) Forced hyperpronation of the arm C) Notify child protective services D) Perform nerve conduction studies and electromyography " ---- <<Answer:>>
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B
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Answer the following medical question with the correct letter choice:
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<<Question:>> A previously healthy 29-year-old woman comes to the physician because of a 3-day history of low-grade fever, muscle aches, and a rash. She has had 4 male sexual partners over the past year and uses condoms inconsistently. Examination shows a diffuse maculopapular rash that includes the palms and soles. Testing for nonspecific anticardiolipin antibodies is positive. Which of the following is the most appropriate next step in management? ---- <<Choices:>> A) Assess for double-stranded DNA antibodies B) Administer penicillin G C) Analyze rash with darkfield microscopy D) Test for fluorescent treponemal antibody absorption ---- <<Answer:>>
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D
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 59-year-old man with New York Heart Association Class II heart failure presents to your outpatient clinic for routine follow-up. His blood pressure is 134/89 mm Hg and heart rate is 75/min. Physical examination reveals clear lung sounds bilaterally with normal S1 and S2 heart sounds. He currently takes captopril, bisoprolol, and furosemide. You would like to add on spironolactone. Of the following, which is true regarding aldosterone antagonists in patients with heart failure? ---- <<Choices:>> A) Aldosterone antagonists do not require renal dosing B) Aldosterone antagonists are indicated for patients in all stages of heart failure C) Aldosterone antagonists decrease morbidity and mortality in heart failure patients D) Aldosterone antagonists can cause visual disturbances ---- <<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 man comes to the physician because of a 1-week history of fever, nausea, headache, and confusion. Three weeks ago, he had an episode of a sore throat, diarrhea, and generalized lymphadenopathy. He is sexually active with a new partner that he met 2 months ago and they use condoms inconsistently. He appears ill. Physical examination shows nuchal rigidity. Further evaluation shows infection with a single-stranded, positive-sense RNA virus. The cells most likely affected in this patient’s current condition are analogous to which of the following cell types? ---- <<Choices:>> A) Osteoblasts B) Mast cells C) Schwann cells D) Langerhans cells ---- <<Answer:>>
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D
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 64-year-old man presents for a routine physical. He states that he has felt abnormally weak during this time and has had trouble focusing in the setting of losing 5 pounds. The patient states he has a decreased appetite and also has not had a bowel movement in the past 5 days and feels uncomfortable. On review of system, he endorses abdominal pain. His temperature is 97.5°F (36.4°C), blood pressure is 132/83 mmHg, pulse is 115/min, respirations are 15/min, and oxygen saturation is 98% on room air. Physical exam is notable only for the patient being able to recall 1 of 3 objects. His cranial nerve exam is unremarkable and his gait is stable. Urinalysis is initially notable for a clear and voluminous sample with a low specific gravity. Which of the following tests is most likely abnormal in this patient? ---- <<Choices:>> A) Calcium level B) Lead level C) Potassium level D) TSH level ---- <<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:>> Ten days after a motor vehicle collision, a 28-year-old man develops jaundiced skin. Upon initial presentation for his injuries, the patient was taken for an emergency laparotomy, which revealed significant internal hemorrhage from blunt abdominal trauma to the spleen. He required rapid transfusion with a total of 7 units of packed red blood cells. He has recovered well from the procedure until this morning, when he began to develop jaundiced skin and sclerae. He does not have pruritus. He has had no prior surgeries and takes no other medications. He is sexually active with one female partner. Prior to the accident, he drank 4 beers per day. His vital signs are within normal limits. Abdominal examination is limited due to pain. There are no palpable abdominal masses. There is a midline surgical scar with no erythema, purulence, or drainage. He has healing abrasions on the upper left side of his face and bruises over the anterior abdomen. CT scans show a resolving hematoma in the peritoneal cavity. Laboratory studies show: Hemoglobin 9.7 g/dL Hematocrit 30% Leukocyte count 7,000/mm3 Platelet count 135,000/mm3 Serum Total bilirubin 3.9 mg/dL Indirect bilirubin 3.7 mg/dL Direct bilirubin 0.2 mg/dL Aspartate aminotransferase (AST) 60 U/L Alanine aminotransferase (ALT) 92 U/L Which of the following is the most likely cause of this patient's jaundice?" ---- <<Choices:>> A) Biliary obstruction B) Hepatocellular injury C) Increased formation of bilirubin D) Decreased hepatic uptake of unconjugated bilirubin " ---- <<Answer:>>
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C
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<<Question:>> A 69-year-old man comes to the physician because of a cough for the past 3 months. The cough is mostly dry, but the patient recalls a recent episode in which he coughed up mucus with dark red streaks. He has felt tired for the past few months. Over the past month, he has had poor appetite and a 5-kg (11-lb) weight loss. He also has occasional back pain, which has worsened in recent weeks. He has no recent travel history. He has smoked a pack of cigarettes daily for 30 years. He does not drink alcohol. His vitals are within normal limits. Auscultation of the lungs reveals wheezing in the lower right lung field. There is no peripheral lymphadenopathy. The liver is of normal size, and the spleen is not palpable. Laboratory studies show a hemoglobin concentration of 13.5 g/dL, serum calcium concentration of 12.3 mg/dL, and a total serum protein of 7.0 g/dL. X-rays of the chest are shown. Which of the following is the most likely diagnosis? ---- <<Choices:>> A) Tuberculosis B) Lobar pneumonia C) Small cell lung carcinoma D) Squamous cell lung carcinoma " ---- <<Answer:>>
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D
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<<Question:>> A 37-year-old man comes to the physician because of a 3-month history of worsening painful swallowing, hoarseness, and bilateral otalgia. He has had a 10-kg (22-lb) weight loss during this period. He does not smoke or drink alcohol. Laryngoscopic examination shows an abnormal mass located on the right true vocal cord. Immunohistochemistry of the mass shows expression of HPV-16 DNA. This neoplasm most likely derived from which of the following types of epithelial tissue? ---- <<Choices:>> A) Stratified squamous epithelium with submucosal glands B) Simple columnar epithelium with cilia C) Pseudostratified columnar epithelium with cilia D) Pseudostratified columnar epithelium with cartilage ---- <<Answer:>>
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A
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<<Question:>> An investigator is studying patients with an autosomal dominant mutation in the long arm of chromosome 10. This mutation alters the structure of CD95 receptors and impairs the binding of a ligand to this receptor. These patients are at greatest risk for which of the following complications? ---- <<Choices:>> A) Partial albinism B) Autoimmune cytopenia C) Acute myeloid leukemia D) Diabetes mellitus ---- <<Answer:>>
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B
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<<Question:>> An investigator is studying cardiovascular changes during exercise. He is following a 25-year-old female volunteer who is training for a marathon. Her training consists of running on a treadmill for increasing amounts of time. During her training sessions, laboratory studies show increased concentrations of adenosine and lactate in the active muscles. Which of the following is most likely a direct effect of these metabolites? ---- <<Choices:>> A) Decreased capillary pressure B) Decreased systemic vascular resistance C) Increased venous return D) Increased mixed venous oxygen saturation ---- <<Answer:>>
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B
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<<Question:>> A previously healthy 16-year-old girl is brought to the physician by her parents because of behavior changes and involuntary limb movements over the past 2 days. She also has a 2-week history of fever, headache, and fatigue. Her temperature is 38°C (100.4°F), pulse is 110/min, respirations are 20/min, and blood pressure is 102/72 mm Hg. Mental status examination shows impaired speech and a disorganized thought process. Muscle strength is 5/5 in all extremities. Urine toxicology screening is negative. Cerebrospinal fluid analysis shows a leukocyte count of 70 cells/mm3 (90% lymphocytes) and a protein concentration of 51 mg/dL. Abdominal ultrasound shows a large right adnexal mass. The patient's symptoms are most likely caused by antibodies against which of the following? ---- <<Choices:>> A) Purkinje cell Yo antigens B) GM1 ganglioside C) Neuronal Hu antigens D) Glutamate receptors ---- <<Answer:>>
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D
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<<Question:>> A 7-year-old boy is brought to the physician by his mother because of low-grade fevers and a cough lasting for 2 weeks. He has vomited several times after fits of coughing. He has no history of serious illness and has not received any routine childhood vaccinations. His temperature is 38.3°C (101°F). Physical examination shows erythema of the nasal and oral mucosa. While in the exam room, he has a long series of consecutive coughs, during which he appears diaphoretic. The coughing is followed by a loud inspiratory gasp. Laboratory studies show a leukocyte count of 16,300/mm3 (67% lymphocytes). The pathogen most likely responsible for this patient's presentation contains a toxin that acts by which of the following mechanisms? ---- <<Choices:>> A) Increases intracellular cAMP B) Increases intracellular cGMP C) Inactivates host elongation factor D) Inactivates host 60S ribosome ---- <<Answer:>>
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A
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 21-year-old college student is rushed to the ER because of a high-grade fever that started this morning. She vomited several times last night. She is complaining of a severe, unremitting headache. Her temperature is 38.9°C (102.0°F), respiratory rate is 20/min, pulse is 112/min, and blood pressure is 105/78 mm Hg. She is highly sensitive to light. Her neck feels stiff on passive flexion, with positive Kernig’s and Brudzinski’s signs. There is a non-blanching maculopapular rash all over the body. Cerebrospinal fluid (CSF) samples are sent to the lab for analysis and she is started on intravenous fluids and antibiotics. The CSF analysis will most likely reveal which of the following? ---- <<Choices:>> A) Eosinophils B) Decreased protein concentration C) Lymphocytosis D) Polymorphonuclear leukocytosis ---- <<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 58-year-old man with chronic obstructive pulmonary disease and hypertension comes to the physician because of shortness of breath 3 days after starting propranolol. His temperature is 36.7°C (98.1°F), pulse is 64/min, respirations are 20/min, and blood pressure is 138/88 mm Hg. Auscultation of the lungs shows diffuse expiratory wheezes. In addition to discontinuing the propranolol, which of the following drugs should be administered? ---- <<Choices:>> A) Albuterol B) Prednisone C) Tiotropium bromide D) Theophylline ---- <<Answer:>>
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A
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 6-year-old boy is admitted with a one-week history of diarrhea, which was sometimes bloody and originally began after a birthday party. He has become lethargic and has not been eating or drinking. His vital signs are as follows: T 38.5 C, HR 135, BP 82/54. Physical examination is significant for petechiae on his legs and diffuse abdominal tenderness to palpation. Lab-work shows BUN 72 mg/dL, creatinine 8.1 mg/dL, and platelet count < 10,000. PT and PTT are within normal limits. Which of the following would be expected on a peripheral blood smear? ---- <<Choices:>> A) Rouleaux formation B) Fragmented red blood cells C) Spur cells D) Giant platelets ---- <<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 microbiology student is studying the different types of cell surface markers on immune cells. He is interested in the human major histocompatibility complex (MHC) and human leukocyte antigens (HLAs). While studying, he learns that both class I and class II MHC molecules are expressed on specific types of cells. Currently, he is studying the HLA-DP, HLA-DQ, HLA-DRα, and HLA-DRβ genes. Which of the following cells express molecules encoded by these genes? ---- <<Choices:>> A) Eosinophils B) Mesenchymal cells C) Platelets D) Thymic epithelial cells ---- <<Answer:>>
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D
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<<Question:>> A 10-year study of 1,000 residents in a small US town is conducted to determine the risk of developing lung cancer. The study assesses each subject with a comprehensive physical exam and chest X-ray at 3-time points: at baseline, at the 5-year point, and at the conclusion of the study. At each time point, the total number of cases of lung cancer in the population is recorded. The data gathered from the study are given in the table below: Time point Total cases of lung cancer t = 0 years 100 t = 5 years 500 t = 10 years 600 Which of the following is the incidence of lung cancer per 1,000 people per year? ---- <<Choices:>> A) 104 B) 0.6 C) 87 D) 125 ---- <<Answer:>>
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C
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<<Question:>> A 7-year-old boy suffers from generalized edema. Urine protein excretion is 5.2 g over 24 hours, and serum analysis reveals hyperlipidemia. The patient responds to treatment with prednisone, and, 8 weeks later, his urine does not contain measurable protein. If a kidney biopsy had been performed while the patient’s condition was pathologic, which of the following would you expect to find upon glomerular electron microscopy? ---- <<Choices:>> A) Effacement of podocyte foot processes B) Subepithelial ‘spike and dome’ deposits C) Subepithelial humps D) Subendothelial thickening ---- <<Answer:>>
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A
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<<Question:>> A previously healthy 3-month-old girl is brought to the emergency department because her lips turned blue while passing stools 20 minutes ago. She has not stopped crying since then. She was born at 38 weeks' gestation. She is at the 50th percentile for length and below the 30th percentile for weight. She is alert and agitated. Her temperature is 36.6°C (98°F), pulse is 180/min, respirations are 50/min, and blood pressure is 70/50 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 70%, which increases to 81% on administration of 100% oxygen. Physical examination shows perioral cyanosis and retractions of the lower ribs with respiration. Cardiac examination shows a harsh grade 2/6 systolic crescendo-decrescendo murmur at the left upper sternal border. Which of the following would most likely improve this patient's symptoms? ---- <<Choices:>> A) Knee-chest positioning B) Supine positioning C) Lower limb elevation D) Prone positioning ---- <<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 8-year-old girl of Asian descent is brought to the physician because of fatigue. She is not able to keep up with the rest of her classmates in gym class because she tires easily. Physical examination shows pale conjunctivae. Laboratory studies show: Hemoglobin 11.0 g/dL Mean corpuscular volume 74 μm3 Red cell distribution width 14 (N=13-15) Serum ferritin 77 ng/mL Peripheral blood smear shows small, pale red blood cells. Hemoglobin electrophoresis is normal. Which of the following best describes the pathogenesis of the disease process in this patient?" ---- <<Choices:>> A) Decreased production of β-globin proteins B) Amino acid substitution in the β-globin protein C) Cis deletion of α-globin genes D) Acquired inhibition of 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 52-year-old postmenopausal woman comes to the physician with a 6-month history of difficulty biting down and chewing that is becoming progressively worse. She has been taking acetaminophen for headaches and nonspecific pain in her hips and back. She also complains that her hearing has been deteriorating as she gets older. Vital signs are within normal limits. Examination shows a mildly tender, 1-cm, bony, immobile swelling in the left side of her forehead. Intraoral examination shows bilateral expansion of the maxillary alveolus and malocclusion. Audiometry shows bilateral mixed conductive and sensorineural hearing loss. Laboratory studies show: Hemoglobin 14.6 g/dL Leukocyte count 9,000/mm3 Platelet count 256,000/mm3 Serum Alkaline phosphatase 1100 U/L Vitamin D 40 ng/ml (N = 20–100 ng/mL) Calcium 9.5 mg/dL Parathyroid hormone 300 pg/mL A plain x-ray of the skull is shown. Which of the following is the most appropriate next step in management?" ---- <<Choices:>> A) Hematopoietic cell transplantation B) Transsphenoidal hypophysectomy C) Intravenous zoledronate D) Estrogen replacement therapy ---- <<Answer:>>
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C
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 66-year-old man is brought to the emergency department because of worsening shortness of breath and progressive swelling of his legs for 1 week. He has hypertension and hyperlipidemia. Current medications include amlodipine and pravastatin. His temperature is 37.5°C (99°F), pulse is 95/min, respirations are 12/min, and blood pressure is 113/70 mm Hg. Pulmonary examination shows bilateral coarse crackles. An S3 gallop is heard on auscultation. There is jugular venous distension and pitting edema of both ankles. He is admitted to the hospital and treatment with intravenous bumetanide is initiated. Serum studies obtained 5 days after admission show: Na+ 138 mEq/L Cl− 101 mEq/L Mg2+ 1.3 mEq/L Urea nitrogen 42 mg/dL Creatinine 1.8 mg/dL Arterial blood gas analysis on room air: pH 7.51 PCO2 52 mm Hg PO2 60 mm Hg HCO3- 33 mmol/L Further evaluation of this patient is most likely to show which of the following findings?" ---- <<Choices:>> A) Elevated serum aldosterone B) Decreased urine chloride C) Decreased serum renin D) Elevated serum potassium ---- <<Answer:>>
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A
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 16-year-old boy is brought to the emergency department by his parents after collapsing at home. He was resting at home after an uneventful dental procedure that involved the extraction of several teeth. He became drowsy and then unconscious and was unrousable. At the hospital, his temperature is 37.0° C (98.6° F), respiratory rate is 15/min, pulse rate is 67/min, and blood pressure is 122/98 mm Hg. Oxygen saturation is 85% on room air. The patient is deeply cyanosed despite a good respiratory effort and a clear airway. His lungs are clear to auscultation, bilaterally. Even though an endotracheal tube is introduced and assisted ventilation is induced, his condition does not improve. A review of dental records reveals the details of the procedure where the local anesthetic pilocarpine was administered. What is the most likely cause of this patient’s condition? ---- <<Choices:>> A) Cyanide poisoning B) Methemoglobinemia C) Sulfhemoglobinemia D) Carbon monoxide poisoning ---- <<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:>> Please refer to the summary above to answer this question Which of the following is the most likely underlying cause of this patient's upper extremity symptoms?" "Patient Information Age: 1 day Sex: F Ethnicity: Hispanic Site of Care: office History Reason for Visit/Chief Concern: brought in by her parents because “her arm looks funny” History of Present Illness: mother had no prenatal care labor was spontaneous with rupture of membranes yielding fluid with dark green streaks the infant was delivered vaginally 1 day ago at home at approximately 39 weeks' gestation the delivery was complicated by shoulder dystocia, which was managed with suprapubic pressure and the McRoberts maneuver father reports that the infant's right arm “just hangs by the side” and that she never bends her right elbow the infant is breastfeeding, stooling, and voiding without complication Past Medical History: none Family History: mother has type 2 diabetes mellitus Medications: none Immunizations: has not received any routine vaccinations Allergies: no known drug allergies Social History: the infant lives with her mother, father, and paternal grandmother no one in the residence smokes Physical Examination Temp Pulse Resp BP O2 Sat Ht Wt Head circumference 37.1°C (98.8°F) 154/min 45/min 87/49 mm Hg 99% 50 cm (20 in; 69th percentile) 4,400 g (9 lb 11 oz; 99th percentile) 35 cm (13.8 in; 82nd percentile) Appearance: well-appearing; crying during the examination HEENT: red reflex is seen bilaterally; there is a fluctuant area over the left parietal bone that crosses suture lines Pulmonary: clear to auscultation Cardiac: regular rate and rhythm; normal S1 and S2; no murmurs, rubs, or gallops Abdominal: no tenderness, masses, or hepatosplenomegaly; bowel sounds normal; umbilical stump is intact and clamped Extremities: hips are stable bilaterally Musculoskeletal: clavicles are intact bilaterally; the right upper extremity hangs limply from the shoulder in full extension, adduction, and fixed internal rotation; the hand is pronated, and the wrist and fingers are flexed Skin: dry, warm; no jaundice Neurologic: normal suck and grasp reflexes; the Moro reflex is normal in the left upper extremity and absent in the right upper extremity; deep tendon reflexes are 2+ bilaterally" ---- <<Choices:>> A) Injury to the median nerve B) Damage to the upper trunk of the brachial plexus C) Damage to the lower trunk of the brachial plexus D) Aspiration of meconium ---- <<Answer:>>
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B
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<<Question:>> A 34-year-old man presents with severe left inguinal pain and swelling since last night. He has just returned from a summer trip to the southwestern United States where he spent most of his time working with homeless and unemployed people in an area that straddles New Mexico and Utah. Upon further inquiry, he denies any contact with wild or domestic animals including pets, but he does remember occasionally seeing mice in his motel room and found their droppings on the floor. On physical exam his temperature is 38.5°C (101.3°F), pulse is 95/min, respiration rate is 18/min, and blood pressure is 130/85 mm Hg. The left inguinal area is swollen. There is no skin erythema and it is not warm to palpation. There are several enlarged and soft lymph nodes with a hard underlying core. The area is very tender and surrounded by edema. A localized rash is found in the ipsilateral inner thigh above the knee (see image). Examination of the heart, lungs, abdomen, and other limbs shows no abnormalities. Which of the following pathogens is the most likely cause of this patient’s condition? ---- <<Choices:>> A) Hantavirus B) Rhabdovirus C) Borrelia burgdorferi D) Yersinia pestis ---- <<Answer:>>
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D
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<<Question:>> A 10-year-old unvaccinated girl presents to her pediatrician with a rash. Her mother reports that she has had a fever, “red eyes,” sore throat, and rash on her face for the last day. On physical examination, the girl appears sick but not toxic, and has nonpurulent conjunctivitis and an erythematous posterior pharynx without exudate or tonsillar hypertrophy. She has lymphadenopathy bilaterally. Her heart has a regular rate without murmurs, her lungs are clear to auscultation bilaterally, and her abdomen is soft without hepatosplenomegaly. She has red cheeks with circumoral pallor and no other skin findings. Which of the following is the most appropriate advice for this patient’s mother? ---- <<Choices:>> A) This infection could have been prevented with a vaccine. B) Her symptoms were caused by human herpesvirus type 6 (HHV-6) or human herpesvirus type 7 (HHV-7). C) She will likely develop a maculopapular truncal rash in a few days that will fade to become a lacy rash. D) She should be started on oral valacyclovir. ---- <<Answer:>>
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C
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<<Question:>> A 42-year-old woman presents to the clinic for worsening fatigue and difficulty breathing for the last 6 months. Previously, she could routinely walk 3 miles after dinner, but now she can no longer walk more than 2 blocks without being short of breath. She also reports being tired soon after starting any type of physical activity. On further questioning, she recalls having on and off fevers, occasional night sweats, and losing 5 kg (11 lb) over the last 6 months. Her past medical history reveals 2 cesarean deliveries in her twenties and a hospitalization for acute appendicitis in her teens. She currently takes no medications and also denies smoking and recreational drug use. She drinks half a glass of wine with her evening meals. Her vitals include a respiratory rate of 14/min, a pulse rate of 87/min, a blood pressure of 110/89 mm Hg, and a temperature of 36.7°C (98.0°F). Physical examination is normal. A chest X-ray shows bilateral hilar lymphadenopathy. Which of the following changes in forced expiratory volume (FEV1) and forced vital capacity (FVC) are expected if she takes a pulmonary function test? ---- <<Choices:>> A) FEV1: decrease and FVC: decreased B) FEV1: decreased and FVC: no change C) FEV1: decreased and FVC: increased D) FEV1: no change and FVC: no change ---- <<Answer:>>
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A
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 42-year-old woman is brought to the emergency department because of a severe, throbbing, occipital headache for 2 hours. She also reports nausea, photophobia, and chest tightness. The symptoms developed shortly after she had a snack consisting of salami and some dried fruits at a wine tasting event. The patient has recurrent migraine headaches and depression, for which she takes medication daily. She is mildly distressed, diaphoretic, and her face is flushed. Her temperature is 37.2°C (98.9 F), pulse is 88/min, respirations are 19/min, and blood pressure is 190/128 mmHg. Deep-tendon reflexes are 2+ bilaterally. This patient's symptoms are most likely caused by a side effect of which of the following medications? ---- <<Choices:>> A) Tranylcypromine B) Almotriptan C) Topiramate D) Doxepin ---- <<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 70-year-old man is brought to the emergency department because of severe back pain that began when he was lifting a box 1 hour ago. He also has a 2-year history of increasingly severe right hip pain. Physical examination shows tenderness to palpation of the lower spine as well as erythema of the skin over the right hip. Neurologic examination shows decreased hearing in the left ear; the Weber test localizes to the left side. Serum studies show an alkaline phosphatase concentration of 410 U/L, calcium concentration of 9.5 mg/dL, and parathyroid hormone level of 322 pg/mL. An x-ray of the spine shows a fracture of the L4 vertebra. Which of the following is the most likely diagnosis? ---- <<Choices:>> A) Osteoporosis B) Osteomalacia C) Osteitis deformans D) Osteonecrosis ---- <<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 study investigating the use of adalimumab for the relief of peripheral arthropathy in patients with psoriatic arthritis was conducted. The study utilizes a crossover design in which half of the study participants are given adalimumab for a month while the other half takes placebo. After a 2 week washout period in which no one takes any adalimumab, the group that was originally on adalimumab is given placebo for a month while the group that was originally taking placebo is given adalimumab for a month. Pain in all affected joints is assessed clinically by follow-up visits every two weeks for the duration of the study. Which of the following is true about cross-over study designs? ---- <<Choices:>> A) Crossover studies avoid the ethical issue of not giving all participants access to a novel therapeutic agent B) Crossover studies minimize the effects of differences between participants C) The purpose of the washout period is to increase the length of the study to gather more data D) 1 and 2 ---- <<Answer:>>
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D
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 64-year-old woman presented to the community health clinic complaining of nausea, bloating, pain in both knees, and a burning sensation in her feet. She has recently immigrated to the United States and was previously diagnosed with diabetes mellitus, hypertension, and osteoarthritis but no medical records are currently available. She has stopped taking her medication since immigrating; however, she does recall being on insulin but cannot recall the dosage or the specific type. She has a blood pressure of 172/120 mm Hg, heart rate of 95/min, respiratory rate of 15/min, and temperature of 37.0°C (98.6°F). Her random serum glucose is 364 mg/dL. She is started on atorvastatin, amlodipine, ramipril, aspirin, duloxetine, metoclopramide, acetaminophen, and insulin detemir. Three weeks later, she presents with generalized weakness, walking difficulty, and hand tremors. Physical examination reveals bilateral hand tremors, cogwheel rigidity, and bradykinesia. She is walking with small narrow steps and reduced arm swing. Today her random serum glucose is 150 mg/dL. Her symptoms are presumed to be caused by a drug. Which medication is likely responsible for these symptoms? ---- <<Choices:>> A) Atorvastatin B) Metoclopramide C) Ramipril D) Acetaminophen ---- <<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 51-year-old man presents to the emergency room after being the victim of a robbery and assault. He was walking down an alley when he was approached by a stranger with a knife. Upon resisting, the stranger stabbed the patient’s right distal forearm before stealing his wallet and evading the scene. The patient was able to call an ambulance and has remained conscious despite mild bleeding from the injury site. He reports severe pain in his forearm and an inability to move his 2nd and 3rd fingers. He has no medical conditions and takes no medications. He is allergic to penicillin and ibuprofen. On exam, the patient is able to flex the proximal interphalangeal (PIP) joints of his 2nd through 5th fingers. When the PIP joints of his 2nd through 5th fingers are restrained by the examiner, flexion is noted at the DIP joints of the 4th and 5th fingers but not the 2nd and 3rd digits. Thumb flexion at the metacarpophalangeal (MCP) joint and interphalangeal (IP) joint is preserved. Sensation is intact over the palmar and dorsal aspects of the radial and ulnar hand. This patient most likely has an injury to which of the following muscle tendons? ---- <<Choices:>> A) Flexor digitorum longus B) Flexor digitorum profundus C) Flexor digitorum superficialis D) Flexor pollicis longus ---- <<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:>> Researchers develop a drug X that acts on the loop of Henle but discover that it does not reach its intended site of action within the nephron. It is freely filtered but rapidly disappears from the proximal tubule. They modify several of the chemical properties of drug X to produce drug Y, which cannot be reabsorbed from the proximal tubule. Which of the following natural substances are most similar to the concentration profiles of drug X and drug Y in the proximal tubule? ---- <<Choices:>> A) Drug X: creatinine; Drug Y: glucose B) Drug X: glucose; Drug Y: creatinine C) Drug X: glucose; Drug Y: potassium D) Drug X: potassium; Drug Y: creatinine ---- <<Answer:>>
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B
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 66-year-old woman comes to the emergency department because of fever and difficulty swallowing for 5 hours. She appears anxious. Her temperature is 39.1°C (102.4°F). Physical examination shows an extended neck and excessive drooling. Her voice is muffled and there is inspiratory stridor. There is tender bilateral cervical lymphadenopathy and pain upon palpation of the hyoid. Laboratory studies show a leukocyte count of 18,800/mm3 with 85% neutrophils. Which of the following is the most likely causal organism? ---- <<Choices:>> A) Haemophilus influenzae type b B) Streptococcus pyogenes C) Corynebacterium diphtheriae D) Parainfluenza virus " ---- <<Answer:>>
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A
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 65-year-old man with a history of coronary artery disease presents to your office complaining of ongoing chest pain with exertion. The patient has had a recent cardiac work-up that showed no areas of acute ischemia. At the last visit, the patient was prescribed sublingual nitroglycerin for symptom relief of stable angina. On further questioning, the patient states that he has been swallowing the tablet whole instead of allowing it to dissolve because he “does not like the taste”. What is the cause of the persistent symptoms? ---- <<Choices:>> A) Nitroglycerin tolerance B) Unstable angina C) First pass metabolism of nitroglycerin D) Concomitant use of sildenafil ---- <<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 5-year-old boy is brought to the physician by his mother because of a 3-day history of low-grade fever and sore throat. This morning, she noticed a rash on his buttocks, hands, and feet. He does not have pruritus. His temperature is 38.3°C (100.9°F), pulse is 99/min, and blood pressure is 123/78 mm Hg. Physical examination shows oral vesicles. A photograph of the rash on the feet is shown. Which of the following is the most likely pathogen? ---- <<Choices:>> A) Herpes simplex virus 1 B) Coxsackie A virus C) Parvovirus B19 D) Epstein-Barr virus ---- <<Answer:>>
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B
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Answer the following medical question with the correct letter choice:
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<<Question:>> An 8-year-old African-American male is found to have a holosystolic, harsh-sounding murmur upon physical examination. The murmur is best appreciated at the left sternal border, and is found to be louder when the patient squats. Which of the following is the most likely diagnosis? ---- <<Choices:>> A) Ventricular septal defect B) Patent ductus arteriosus C) Atrial septal defect D) Tricuspid atresia ---- <<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 29-year-old G1P0 woman at 32 weeks of gestation comes to the emergency department complaining of vaginal bleeding for the past hour. She noticed some blood on the toilet paper when she went to the bathroom an hour ago, but now she is bleeding through her underwear. She denies any trauma, pain, abnormal discharge or odor, fever, or recent infections. The patient mentioned that that during her last ultrasound, the doctor told her that, “there’s an abnormality but not to worry,” but she can’t remember the name of the condition. Her temperature is 100.1°F (37.8°C), blood pressure is 120/70 mmHg, pulse is 86/min, and respirations are 15/min . A fetal heart tracing is obtained and shows a fetal heart rate of 130-140, long-term variability, and appropriate accelerations. What is the most likely explanation for this patient’s presentation? ---- <<Choices:>> A) Abnormal placental spiral artery development B) Attachment of the placenta to the lower placental segment over the internal os C) Cystic swelling of chorionic villi and trophoblast proliferation D) Fetal vessels in close proximity to the cervical os ---- <<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 comes to the office complaining of a dry mouth for the past few months. She has to drink water more frequently, as she finds it difficult to chew and swallow solid foods. She has to wake up 3–5 times each night to drink due to intense thirst. She also complains of a foreign body sensation in both the eyes for the past month. She has had no joint pain, fever, weight loss, or urinary or bowel changes. She does not smoke cigarettes but drinks alcohol socially. Her mother has rheumatoid arthritis for which she takes methotrexate, and her father died of prostatic carcinoma 7 years ago. Her temperature is 36.7°C (98°F), blood pressure is 130/75 mm Hg, pulse is 80/min, respirations are 14/min, and BMI is 28 kg/m2. On examination, the eyes and oral cavity appear dry, and dental caries are present. No lymphadenopathy is noted. Cardiopulmonary and abdominal examinations are negative. Laboratory results are shown below: Complete blood count: Hemoglobin 10 g/dL Leukocytes 13,500/mm3 Platelets 170,000/mm3 ESR 65 mm/hr Antinuclear antibody Positive Rheumatoid factor Positive Anti dsDNA Negative Anti Ro Positive Anti-CCP Negative Anti Jo 1 Negative Which of the following is the most likely diagnosis? ---- <<Choices:>> A) Rheumatoid arthritis B) Systemic lupus erythematosus C) Primary Sjogren’s syndrome D) Polymyositis ---- <<Answer:>>
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C
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 42-year-old woman presents to the physician with chronic abdominal pain. She was initially diagnosed with an ulcer in the 2nd part of the duodenum and severe esophagitis 6 years ago. Despite confirmed H. pylori eradication and long-term therapy with pantoprazole, she has had frequent recurrences of duodenal and gastric ulcers. The medical history is otherwise unremarkable. She is a 10 pack-year smoker and consumes alcohol regularly. Her father had severe gastric ulcer disease. The vital signs are within normal limits. The body mass index is 19 kg/m2. Mild epigastric tenderness is noted on deep palpation of the epigastrium. The laboratory studies show the following: Laboratory test Hemoglobin 10 g/dL Mean corpuscular volume 75 μm3 Leukocyte count 7500/mm3 with a normal differential Serum Na+ 145 mEq/L K+ 4.5 mEq/L Ca+ 9.5 mg/dL Phosphorus 4 mg/dL Urea nitrogen 18 mg/dL Creatinine 1.0 mg/dL Which of the following is the most likely underlying cause of this patient’s condition? ---- <<Choices:>> A) Chronic alcohol consumption B) Gastrin-secreting tumor C) Primary hyperparathyroidism D) Tobacco use ---- <<Answer:>>
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B
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 33-year-old woman comes to the emergency department for severe abdominal pain for the past hour. The pain is 10/10, stabbing, and concentrated around the epigastric region with radiation to the back. She had 2 episodes of emesis and complains of nausea. She has had multiple similar episodes over the past 3 months which are not correlated with oral intake. She denies fever, weight changes, headaches, palpitations, bowel changes, or chest pain, but endorses nausea and stool that is hard to flush. Her medical history is significant for diabetes that is controlled with metformin. Her surgical history is significant for an elective cesarean section 5 years ago. She is currently sexually active with contraceptive use. What imaging finding would you expect in this patient? ---- <<Choices:>> A) Gallbladder thickening and presence of cholelithiasis on ultrasound B) Increase in appendicular diameter and fat stranding on computer tomography (CT) C) Lack of an intrauterine pregnancy on ultrasound D) Multiple pancreatic calcifications on CT ---- <<Answer:>>
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D
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 37-year-old female presents to her primary care provider for a normal follow-up visit. Her past medical history is notable for poorly controlled type II diabetes mellitus despite good treatment adherence to oral medications. She has been trialed on metformin and glyburide but stopped them due to rapid weight gain, respectively. She was started on a new oral diabetes medication three months ago. Since starting the new medication, she has noticed slowly progressive swelling in her lower extremities. Her temperature is 99.2°F (37.3°C), blood pressure is 120/75 mmHg, pulse is 105/min, and respirations are 22/min. She has gained 10 pounds since her last visit. Physical examination reveals 1+ pitting edema in the bilateral legs. A hemoglobin A1c lab test is drawn. This patient’s symptoms are most likely attributable to which of the following medications? ---- <<Choices:>> A) Glipizide B) Exenatide C) Pioglitazone D) Acarbose ---- <<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 21-year-old woman comes to the physician for a follow-up examination. Four months ago, she underwent posterior arthrodesis for thoracolumbar scoliosis. She has recovered well from the surgery but noticed difficulties combing her hair with her right hand. A photograph of the patient's back is shown. The nerve that was most likely injured in the surgery originates from which of the following spinal roots? ---- <<Choices:>> A) C6-C8 B) C1-C3 C) T2-T5 D) C5–C7 ---- <<Answer:>>
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D
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 45-year-old female is brought by ambulance to your emergency room after complaining of shortness of breath along with profuse sweating at a company social function. Her vitals were notable for elevated blood pressure with a normal exam and a stable electrocardiogram. She has been seeing a psychiatrist recently for her depression and was prescribed phenelzine after failing treatment with a first-line antidepressant therapy. What must she have been exposed to at the party that led to such a dramatic side effect? ---- <<Choices:>> A) Norepinephrine B) Tyramine C) Gluten D) Dopamine ---- <<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-day-old female infant is brought by her mother to the pediatrician’s office. The patient’s mother says she has been noticing bruising on her child’s arms and some blood in her diapers. The infant was born at home after the mother received normal prenatal care. The patient has been exclusively breastfed since birth and is gaining weight appropriately. On exam, multiple ecchymoses are noted throughout the patient’s torso and extremities. The patient is lethargic with a large, full anterior fontanelle. On examination of the diaper, some dried blood mixed with a small amount of stool is noted. Which of the following would most likely be expected for this patient's prothrombin time (PT), partial thromboplastin time (PTT), and bleeding time? ---- <<Choices:>> A) PT normal, aPTT normal, bleeding time normal B) PT increased, aPTT normal, bleeding time normal C) PT normal, aPTT normal, bleeding time increased D) PT normal, aPTT increased, bleeding time normal ---- <<Answer:>>
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B
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<<Question:>> A 53-year-old woman comes to see her primary care physician because she has had fever and malaise for two days. She was in her usual state of health until three days ago when she began to feel tired in the evening and decided to go to bed early. The next day she developed a fever, productive cough, chills, and malaise. She is otherwise healthy with no chronic conditions and lives by herself with two cats. She smokes one pack of cigarettes per day and drinks alcohol socially. On physical exam, she is found to have increased dullness to percussion at the lung bases and blood work is obtained showing elevated levels of C-reactive protein and hepcidin. The signal responsible for the elevated levels of these proteins was most likely secreted by which of the following cells? ---- <<Choices:>> A) Macrophages B) Neutrophils C) Regulatory T-cells D) Type 2 helper T-cells ---- <<Answer:>>
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A
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Answer the following medical question with the correct letter choice:
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<<Question:>> Three weeks after undergoing transurethral prostate resection for benign prostatic hyperplasia, a 70-year-old man has fever, malaise, and pain in his extremities. Physical examination shows subungal petechiae and tender red papules on his fingers and toes. A new holosystolic murmur is heard on chest auscultation. A photomicrograph of a Gram stain of an isolate from blood culture is shown. The organism does not cause hemolysis on blood agar. Addition of pyrrolidonyl-β-naphthylamide gives the bacterial colonies a cherry red color. Which of the following is the most likely causal organism? ---- <<Choices:>> A) Enterococcus faecalis B) Streptococcus gallolyticus C) Cardiobacterium hominis D) Staphylococcus epidermidis ---- <<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 85-year-old woman is brought to her primary care provider by her son for a checkup. She is feeling well with no major complaints. Her son is concerned that she has been bruising much more easily over the last week or two. Past medical history is significant for hypertension, hyperlipidemia, and a urinary tract infection that was successfully treated with an extended course of oral cephalexin 3 weeks ago. Family history is noncontributory. Today, her heart rate is 90/min, respiratory rate is 17/min, blood pressure is 125/85 mm Hg, and temperature is 36.7°C (98.1°F). On physical exam, her heart has a regular rate and rhythm and her lungs are clear to auscultation bilaterally. She has some poorly demarcated purple-yellow bruising and areas of dark purple bruising as well. Further analysis reveals a prolonged PT that corrects with mixing, normal liver function tests, and a stool test that is guaiac positive. The physician administers an injection that should improve her condition and recommends further testing and a follow-up exam. What is the mechanism of action of the medication received by the patient? ---- <<Choices:>> A) γ-carboxylation of pancreatic enzymes B) Protein C deficiency C) Activation of 7-dehydrocholesterol by UV light D) γ-carboxylation of liver enzymes ---- <<Answer:>>
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D
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 35-year-old man presents with loose stools and left lower quadrant abdominal pain. He says he passes 8–10 loose stools per day. The volume of each bowel movement is small and appears mucoid with occasional blood. The patient reports a 20-pack-year smoking history. He also says he recently traveled abroad about 3 weeks ago to Egypt. The vital signs include: blood pressure 120/76 mm Hg, pulse 74/min, and temperature 36.5°C (97.8°F). On physical examination, mild to moderate tenderness to palpation in the left lower quadrant with no rebound or guarding is present. Rectal examination shows the presence of perianal skin ulcers. Which of the following is the most likely diagnosis in this patient? ---- <<Choices:>> A) Amebiasis B) Crohn’s disease C) Salmonellosis D) Diverticulosis ---- <<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:>> Hepatocyte nuclear factor 4 alpha (HNF4a) is a transcription factor that is found in the liver, pancreas, kidney, and intestines. The gene is composed of 11 exons and depending on the tissue there are different isoforms of the protein being expressed. Which of the following is responsible for producing the different isoforms of HNF4a? ---- <<Choices:>> A) Addition of 7-methylguanosine cap B) Addition of polyadenylated (poly-A) tail C) Alternative splicing D) DNA methylation ---- <<Answer:>>
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C
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 50-year-old man presents for a routine examination. Past medical history is significant for cirrhosis secondary to hepatitis C virus (HCV) infection diagnosed 4 years ago and complicated by ascites. Current medications include furosemide 40 mg orally daily. Physical examination is unremarkable. Laboratory findings are significant for the following: Laboratory test Aspartate Aminotransferase (AST) 80 U/L Alanine Aminotransferase (ALT) 50 U/L Total bilirubin 2.5 mg/dL Direct bilirubin 1.8 mg/dL Alkaline phosphatase (ALP) 140 U/L International normalized ratido (INR) 1.9 Serum creatinine 1 mg/dL Urinalysis Sodium 200 mmol/24h Potassium 60 mmol/24h Protein Nil RBCs Nil RBC casts Nil WBCs Nil Urea 13 g/24h Creatinine 6 mmol/24h Abdominal and renal ultrasound reveals no interval change over the past 6 months. Moderate ascites is present. Upper GI endoscopy reveals esophageal varices with a hepatic venous pressure gradient measuring 14 mm Hg. Diagnostic paracentesis is performed and yields a clear liquid with an absolute polymorphonuclear neutrophil (PMN) count of 75 cells/mm3. Which of the following is the most likely etiology of this patient’s condition? ---- <<Choices:>> A) Hepatocellular carcinoma B) Portal hypertension C) Spontaneous bacterial peritonitis D) Hepatorenal syndrome ---- <<Answer:>>
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B
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 45-year-old man with HIV comes to the physician because of multiple lesions on his lower extremity. The lesions are increasing in size and are not painful or pruritic. He does not have lymphadenopathy. He works at a garden center. He lives in Mississippi. Medications include abacavir, dolutegravir, and lamivudine. His temperature is 37.7°C (98.8°F), pulse is 75/min, and blood pressure is 125/80 mm Hg. Examination shows multiple lesions on both heels; some are elevated. There are two similar lesions on the chest. An image of the patient's right heel is shown. His CD4+ T-lymphocyte count is 450/mm3 (normal ≥ 500/mm3). A skin biopsy shows multiple spindle-shaped cells and leukocyte infiltration. Which of the following is the most likely causal organism? ---- <<Choices:>> A) Mycobacterium avium complex B) Human herpesvirus 8 C) Coccidioides immitis D) Epstein-Barr virus ---- <<Answer:>>
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B
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 32-year-old woman presents to the office complaining of pain, numbness, and discoloration of her fingers over the past 6 months. She notices that cold temperatures worsen these symptoms, turning the tip of her fingers white and sometimes blue. Her vital signs show her temperature is 37.5°C (99.5°F), blood pressure is 124/86 mm Hg, pulse is 80/min, and respirations are 10/min. On physical examination, the patient has a pale malar rash spread across her face with tender cervical and axillary lymphadenopathy. Examination of her hands reveal tenderness and shiny sclerodactyly. Antinuclear and anti-U1 ribonucleoprotein antibodies are positive. A diagnosis of mixed connective tissue disease is confirmed. What is the next best step in management? ---- <<Choices:>> A) Echocardiogram B) Arthrocentesis C) Bone marrow transplant D) Upper GI series ---- <<Answer:>>
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A
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<<Question:>> A 58-year-old woman presents with difficulty moving her right shoulder. She underwent a right radical mastectomy with lymph node dissection 3 weeks ago. Her surgery went well with no complications. She has undergone some physical therapy which has not been effective. A few days ago, she started to notice brief periods of painful shoulder instability, especially while opening or closing doors. On physical examination, there is normal active and passive range of motion in the right shoulder. Strength is 5 out of 5 in all muscles of the right shoulder and upper extremity. Sensation is intact. When the patient is asked to push against the wall, her right shoulder blade moves backward (see image). Which of the following nerves is most likely injured in this patient? ---- <<Choices:>> A) Axillary nerve B) Suprascapular nerve C) Long thoracic nerve D) Ulnar nerve ---- <<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 he is concerned about the amount of breast tissue he has recently developed. His wife has noticed that he has been irritable for the past month. He was recently treated for tinea capitis. In preparation for an upcoming bodybuilding competition, he has been eating a lot of chicken breast. He drinks 2 beers everyday. He smokes marijuana 3–4 times a week but does not smoke cigarettes. He weighs 90 kg (198 lb) and is 175 cm (5 ft 8 in) tall; BMI is 30.1 kg/m2. Physical examination shows bilateral gynecomastia and small, firm testes. There is no hepatosplenomegaly or abdominal tenderness. Laboratory studies show: Hematocrit 60% Platelet count 400,000/mm3 Serum Na+ 135 mEq/L Cl- 97 mEq/L K+ 4.5 mEq/L HCO3- 25 mEq/L Glucose 100 mg/dL Which of the following is the most likely cause of his symptoms?" ---- <<Choices:>> A) Anabolic steroid use B) Normal aging C) Erythropoietin use D) Marijuana use ---- <<Answer:>>
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A
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<<Question:>> A 35-year-old woodsman from local forestry presents to a clinic for counseling regarding his contact with a wild fox that occurred 5 days ago. He says that the fox was not aggressive, allowed him to caress it, and even licked his forearm where he had an open wound. Two days ago, in the same forest, foresters shot a group of foxes who had attacked them, and the fox corpses were handed over to a local veterinary laboratory for testing. Two locals also reported they were attacked by foxes, so the patient became concerned about his exposure. At the time of presentation, the patient had no complaints. His vital signs are as follows: the blood pressure is 125/80 mmHg, the heart rate is 81/min, the respiratory rate is 14/min, and the temperature is 36.8°C (98.2°F). Physical examination reveals 2 healing lacerations, 2 × 3 cm, with a depth of 1 mm each, and multiple scratches on the flexor surface of his right arm. The patient is unaware of his immunization status. Which of the following statements is correct? ---- <<Choices:>> A) The patient does not need immunoglobulin to be administered since he was not bitten by the animal. B) Before initiating post-exposure prophylaxis, results of laboratory testing of the fox's corpses should be obtained. C) There is no need to treat the patient’s wounds before administering post-exposure prophylaxis because the wounds are already healing; thus, they do not pose a threat to the patient’s health. D) If rabies immunoglobulin is not available immediately, it can be administered within 7 days of the first vaccine dose. ---- <<Answer:>>
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D
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 14-year-old boy presents to his primary care physician for a general check up. The patient's parents refuse to allow the boy to join the school basketball team. The patient has attended two practices, and both times during conditioning, he has fainted. Otherwise, the child is performing well in school. The patient has a past medical history of obesity, elevated fasting blood glucose, and high blood pressure. He is not currently taking any medications. The patient's parents want the patient to be cleared medically before he goes back to playing basketball again. His temperature is 99.5°F (37.5°C), blood pressure is 130/87 mmHg, pulse is 81/min, and respirations are 11/min. Physical exam is notable for an obese child who is pleasant and conversational. Pulmonary exam reveals lungs that are clear to auscultation bilaterally. Cardiovascular exam reveals a murmur heard loudest along the left sternal border. Neurological exam reveals 5/5 strength in the upper and lower extremities with 2+ reflexes. Further diagnostic exams are ordered. Which of the following is appropriate management in this patient? ---- <<Choices:>> A) Metformin B) Metoprolol C) Suggest the patient exercise more before joining a competitive team D) Clear the patient to participate in sports ---- <<Answer:>>
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B
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<<Question:>> A 65-year-old man with chronic obstructive pulmonary disease is admitted to the hospital for the treatment of worsening shortness of breath and productive cough. Three days later, he complains of weakness in the lower limbs. His muscle strength is 4/5 at both hips but normal elsewhere. The drug that is most likely responsible for this patient's muscle weakness inhibits which of the following? ---- <<Choices:>> A) Adenosine receptor B) 5-lipoxygenase C) Myosin light-chain kinase D) Nuclear factor-κB ---- <<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 64-year-old woman is brought to the emergency department after a syncopal episode 2 hours ago while grocery shopping. She has been feeling fatigued and lightheaded for the past couple of days. She has hypertension. Current medications include carvedilol. She appears diaphoretic. She is oriented to person but not to place or time. Her blood pressure is 102/65 mm Hg. An ECG is shown. Which of the following is the most appropriate next step in management? ---- <<Choices:>> A) Observation B) Administration of dopamine C) Placement of transcutaneous pacemaker D) Administration of amiodarone " ---- <<Answer:>>
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C
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 42-year-old morbidly obese woman presents to the emergency room for evaluation of a rash that started 3 days ago. The rash appeared under the patient’s breasts as well as in the abdominal folds, and the patient describes it as being very itchy. The rash is bright red with scaling and a few scattered purulent areas of skin breakdown. The patient is afebrile and is in no apparent distress, besides being uncomfortable from the itching. What is the most likely causative agent of this rash? ---- <<Choices:>> A) A heavily encapsulated, urease-positive yeast B) A gram-negative rod that produces pyocyanin C) An acid-fast bacillus D) A commensal yeast that is catalase-positive ---- <<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 47-year-old man comes to the physician because of severe retrosternal chest pain and shortness of breath for 45 minutes. He has dyslipidemia, hypertension, and type 2 diabetes mellitus. Current medications include hydrochlorothiazide, lisinopril, metformin, and atorvastatin. He has smoked 1 pack of cigarettes daily for 20 years. He appears pale and diaphoretic. His temperature is 37°C (98.6°F), pulse is 115/min, and blood pressure is 140/70 mm Hg. Breath sounds are normal. The remainder of the examination shows no abnormalities. An ECG shows left ventricular hypertrophy with ST-segment elevation in leads I, aVL, and V1–V6. High-dose aspirin, clopidogrel, metoprolol, sublingual nitroglycerin, and unfractionated heparin are administered. As the patient awaits transport to the nearest emergency room, he collapses and becomes unresponsive. His pulse and blood pressure cannot be detected. Despite resuscitative efforts, the patient dies. Which of the following is the most likely cause of death in this patient? ---- <<Choices:>> A) Papillary muscle rupture B) Ventricular fibrillation C) Septal wall rupture D) Pulmonary embolism " ---- <<Answer:>>
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B
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 4-year-old boy presents to a clinic with intermittent fevers and a rash for 6 days. According to his mother, he is also complaining of pain all over his body. She adds that the rash 1st appeared on his face within 12 hours of the onset of fever, and later spread to his trunks and limbs. The patient denies any itchiness over the rash. There is no history of a sore throat or recent use of medication for symptom relief. The temperature is 37.2°C (99.9°F) and the pulse is 88/min. On examination, there is a maculopapular rash on the face and the trunk, including the limbs, but sparing the palms and soles. The pediatrician reassures the mother that this is most likely a viral infection and will resolve spontaneously. After 7–10 days, the boy is brought back to the clinic for a follow-up visit. The areas affected by the rash appear to have a central clearing giving a lacy or reticular appearance, especially on the cheeks and it looks like someone slapped him on the cheeks. Immunoglobulin M (IgM) antibody detection by the enzyme-linked immunoassay (ELISA) will most likely detect antibodies against which of the following pathogens? ---- <<Choices:>> A) Measles virus B) Human herpesvirus 6 C) Rubella virus D) Parvovirus B19 ---- <<Answer:>>
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D
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 25-year-old woman comes into your office with complaints of heavy bleeding. She states that her mother also has heavy bleeding during her menstrual cycle. She has had a heavy flow as long as she can remember and had her first menstrual cycle at age 12. She states during her cycle, she has to change pads every 2 hours for at least 3 days. She also states that she gets bruised easily just like her mother. She denies any past medical history other than her heavy menstrual flow and denies taking any medications. She also denies any medical history in her father and says he is "perfectly healthy." Her vitals are HR 85, T 98.8 F, RR 13, BP 125/75. Her CBC is significant for Hgb 10.5, WBC 5.8, Plts 250, Hct 33. On coagulation studies, her PT is 14 seconds and her PTT is 43 seconds. Her INR is 1.1. What is the most likely cause of this patient's menorrhagia? ---- <<Choices:>> A) Factor V Leiden B) Von Willebrand's disease C) Hemophilia B D) Antiphospholipid antibody syndrome ---- <<Answer:>>
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B
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<<Question:>> A 30-year-old woman comes to the physician because of numbness, fatigue, and blurry vision for 1 week. The symptoms are worse after a hot shower or bath. She had an episode of right arm weakness 2 years ago that resolved without intervention. She recently returned from a hiking trip in upstate New York. Her temperature is 37.1°C (100°F) and blood pressure is 100/66 mm Hg. Physical examination shows decreased sensation to light touch in the left hand, right thigh, and right flank. Strength is normal. There is left-sided photophobia and pupillary constriction in the left eye is decreased compared to the right eye. Which of the following best describes the pathogenesis of the disease process in this patient? ---- <<Choices:>> A) Spirochete protein cross-reactivity in the meninges B) Osmotically-mediated Schwann cell damage C) Th1 cell-mediated nerve sheath damage D) Lymphocytic infiltrate of the endoneurium ---- <<Answer:>>
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C
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 30-year-old man visits his physician with thoughts that he ‘is not real’ which occurred suddenly and have persisted for weeks. The patient states that, 3 weeks ago, he witnessed an armed robbery in which he saw a person get shot in the chest. The patient states that at the time the shot was fired, he felt as though he ‘wasn’t in the room’ and as if he was ‘floating above watching it all happen’ below him. Ever since the event, he has been having similar experiences without provocation. He states that now, seemingly out of nowhere, he will have a sudden feeling that he is ‘perceiving life as a dream’. He now seeks help to control these feelings of depersonalization. Which of the following would be the best course of treatment for this patient? ---- <<Choices:>> A) Amantadine B) Butorphanol C) Dextromethorphan D) Psychotherapy ---- <<Answer:>>
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D
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<<Question:>> A 9-year-old boy presents with recent onset worsening performance in school and facial lesions that look like acne. Past medical history is significant for developmental delays and infantile spasm. No current medications. On physical examination, there are facial papulonodular lesions (as shown in the image), pitting of dental enamel, and multiple hypomelanotic oval macules over the torso. Which of the following genes is most likely impaired in this patient? ---- <<Choices:>> A) VHL B) TSC C) NF1 D) GNAQ ---- <<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 14-year-old girl is brought to the emergency department because of occipital headache, nausea, and vomiting for the last 2 hours. She has a multi-year history of frequent left ear infections and discharge, with poor response to antimicrobial therapy. She has muffled hearing in the left ear. Her blood pressure is 134/78 mm Hg, the pulse is 83/min, the respiratory rate is 16/min, and the temperature is 36.5°C (97.7°F). She is alert and oriented. Physical examination of the left ear shows perforation of the tympanic membrane, granulation tissue, and white keratinaceous debris in the posterosuperior quadrant of the tympanic membrane. An MRI shows evidence of sigmoid sinus thrombosis on the left side and a hyperintense area in the middle ear on. Which of the following is the most likely underlying cause of this patient’s current condition? ---- <<Choices:>> A) Acoustic neuroma B) Cholesteatoma C) Chronic serous otitis media D) Chronic suppurative otitis media ---- <<Answer:>>
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B
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<<Question:>> An otherwise healthy 8-year-old boy is brought to the emergency department by his mother 2 hours after the sudden onset of scrotal pain. Physical examination shows nontender testes and a tender, 5-mm, bluish nodule at the superior pole of the left testis. The patient undergoes urgent surgical exploration of the scrotum. During the operation, the nodule on the superior pole of the testis is found to be necrotic. In the process of embryologic development, this nodule forms as a result of the activity of which of the following? ---- <<Choices:>> A) Leydig cells B) Estradiol C) Luteinizing hormone D) Sertoli cells ---- <<Answer:>>
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D
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 23-year-old woman comes to the physician for a 6-month history of dry cough, hoarseness, and chest pain. She does not smoke and has not lost weight. Laboratory studies show no abnormalities. An x-ray of the chest shows a mass that projects across the right hilum. A CT scan of the chest is shown. Which of the following is the most likely diagnosis? ---- <<Choices:>> A) Rhabdomyosarcoma B) Neurofibroma C) Sarcoma D) Aortic aneurysm ---- <<Answer:>>
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B
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 4-year-old is brought into the emeregency room by his mother. The mother states that the child had a slight cough one week ago that has since worsened. The mother states the child's cough sounds like someone barking and states that he has also had mild fevers along with rhinorrhea. The patient's vitals are significant for a fever of 100.8 F, and his physical exam reveals inspiratory stridor. What is the most likely organism responsible? ---- <<Choices:>> A) Parainfluenza virus B) Respiratory syncytial virus C) Adenovirus D) Ebstein barr virus ---- <<Answer:>>
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A
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Answer the following medical question with the correct letter choice:
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<<Question:>> A researcher interested in the relationship between vaccination and autism sends a survey to parents of children who are active patients at a large primary care practice. The survey asks several questions, including whether their children received their childhood vaccines on-time, and whether their children currently have a diagnosis of an autism spectrum disorder. Which of the following correctly identifies the study design used by the researcher? ---- <<Choices:>> A) Cross-sectional B) Cohort C) Randomized controlled trial D) Case-control ---- <<Answer:>>
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A
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 6-month-old boy is brought to the physician for a well-child examination. He was born at term, and pregnancy was complicated by prolonged labor. There is no family history of serious illness. He can sit upright without support and can roll over from the prone to the supine position. He cannot pull himself to stand. He can grasp his rattle and cannot transfer it from one hand to the other. He babbles. He cries if anyone apart from his parents holds him or plays with him. He touches his own reflection in the mirror. Vital signs are within normal limits. He is at 40th percentile for head circumference, 30th percentile for length and at 40th percentile for weight. Physical examination shows no abnormalities. Which of the following developmental milestones is delayed in this infant? ---- <<Choices:>> A) Fine motor B) Social C) Gross motor D) Cognitive ---- <<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 28-year-old woman is admitted to the hospital for treatment of a displaced fracture of the femoral neck following a high-speed motor vehicle collision. She is given pentazocine for pain relief. This drug binds to heptahelical transmembrane receptors. Which of the following is the most likely effect of this drug? ---- <<Choices:>> A) Release of presynaptic acetylcholine B) Release of presynaptic norepinephrine C) Opening of postsynaptic Na+ channels D) Opening of postsynaptic K+ channels ---- <<Answer:>>
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D
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 70-year-old man comes to the physician because of fatigue and intermittent epigastric pain. The symptoms began about one year ago. He describes the pain as diffuse and 3 out of 10 in intensity. Recently, he has had unusually large black stools. He appears pale. His pulse is 72/min and his blood pressure is 110/70 mm Hg. Physical examination shows epigastric tenderness. A urea breath test is positive. Upper gastrointestinal endoscopy reveals an ulcerating mass in the gastric antrum. Biopsies of the mass show diffuse infiltrates of small lymphoid cells that are positive for CD20 antigen. A CT scan of the chest and abdomen shows normal regional lymph nodes. Which of the following is the most appropriate therapy with curative intent at this time? ---- <<Choices:>> A) Rituximab, cyclophosphamide, adriamycin, and vincristine B) Imatinib C) External beam radiation therapy D) Amoxicillin, clarithromycin, and omeprazole ---- <<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 woman approaches your office complaining of a 1-year long persistent dysuria, increasing discomfort with bladder filling and voiding, and suprapubic pain. She further comments that she has been presenting with abdominal cramps, and alternating periods of diarrhea and constipation for the past 4 months. Her family medical history is negative for malignancies and hereditary disorders. Her personal history is relevant for various visits to the general practitioners for similar complaints that resulted in multiple antimicrobial treatments for urinary tract infection. At the moment, she is not taking any medication. Physical examination shows suprapubic tenderness as well as tender areas in the pelvic floor. The vital signs include: temperature 37.0°C (98.6°F), heart rate 68/min, blood pressure 120/58 mm Hg, and respiratory rate 13/min. Vaginal examination is normal. No adnexal masses are detected and no vaginal secretions are noticed. She brings a urinalysis and a urine culture from 1 week ago that show the following: Test Result Normal Range Urine culture Negative < 100,000 CFU/mL to no bacterial growth in asymptomatic patients Urinalysis Density: 1.030; Leukocyte esterase (-); Nitrites (-); pH: 6.0, Presence of 4 RBCs per high power field. Density: 1.030 - 1.060; Leukocyte esterase (-), Nitrites (-), pH: 4.5 - 8.0 What is the most appropriate step in this case? ---- <<Choices:>> A) Self-care and behavior modification B) Admission to the ER for intravenous antibiotic administration C) Urinary analgesia with phenazopyridine D) Conjugated estrogens ---- <<Answer:>>
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A
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 27-year-old man comes to the physician for a routine health maintenance examination. He says he feels well, but is worried because his 32-year-old brother recently had to start hemodialysis because of kidney disease. He reports that his grandfather had ""bad kidneys” as well. The patient does not have dysuria, hematuria, or flank pain. He has no history of serious illness. His vital signs are within normal limits. Physical examination shows no abnormalities. An ultrasound of his right kidney is shown. Which of the following is the most appropriate next step in management?" ---- <<Choices:>> A) Percutaneous aspiration B) Reassurance C) Abdominal CT scan D) Partial nephrectomy ---- <<Answer:>>
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B
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 45-year-old man is following up with his primary care doctor for follow up of his essential hypertension. This is his annual check-up, and he reports that he has been doing well since his appointment last year. He denies any negative side effects from his amlodipine or metformin. His physical examination is within normal limits, and his vital signs are all within normal limits, other than his blood pressure being 142/84 mm Hg. Which of the following best describes the mechanism of action for his blood pressure medication? ---- <<Choices:>> A) Dihydropyridine calcium channel blockers preferentially bind to a vascular smooth muscle B) Calcium channel blockers only bind to channels on cardiac muscles C) Non-dihydropyridine calcium channel blockers preferentially bind to a vascular smooth muscle D) Calcium channel blockers only bind to channels on the sarcoplasmic reticulum ---- <<Answer:>>
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A
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