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Answer the following medical question with the correct letter choice:
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<<Question:>> A 50-year-old male visits his primary care physician with skin lesions on his knees and elbows. He reports joint pain, and physical examination reveals severe swelling of the fingers on both hands. Tests for serum rheumatoid factor are negative. Which of the following pairs of adjectives most likely characterize the patient’s skin lesions: ---- <<Choices:>> A) Honey-colored, crusting B) Irregular, depigmented C) Silver, scaly D) Non-blanching, hemorrhagic ---- <<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 comes to the physician because of a low-grade fever and generalized fatigue for a week. During this period, she has passed decreased amounts of urine. Two months ago, she underwent a renal allograft transplant because of reflux nephropathy. There is no family history of serious illness. Her current medications include prednisone, cyclosporine, and azathioprine. Her temperature is 37.8°C (100°F), pulse is 99/min, and blood pressure is 160/94 mm Hg. Examination shows several white patches within the oral cavity. There is a well-healed surgical incision over the right lower abdomen. The remainder of the examination shows no abnormalities. Laboratory studies show: Hemoglobin 12.1 g/dL Leukocyte count 6,000/mm3 Platelet count 156,000/mm3 Serum Urea nitrogen 89 mg/dL Glucose 76 mg/dL Creatinine 3.9 mg/dL Donor-specific antibodies negative A biopsy of the allograft shows mononuclear infiltrates with tubulitis and arteritis. C4d staining is negative. Oral fluconazole is administered. Which of the following is the most appropriate next step in the management of this patient?" ---- <<Choices:>> A) Intravenous immunoglobulin therapy B) Methylprednisolone therapy C) Removal of graft D) Plasmapheresis ---- <<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 is brought to your office for evaluation of 6 months of anal discomfort, vaginal pruritus, and soreness that worsened in the last several months. The past medical history is significant for hypertension and smoking. The family history is negative for malignancies. The physical examination is unremarkable, except for the presence of white, atrophic papules merging into an ulcerated plaque, with some of the white lesions extending and surrounding the anus (see image). You order biopsies of the lesions and a follow-up appointment. 2 weeks later, the histology evaluation reports hyperkeratosis, significant epidermal thinning, and plugging of infundibular follicles. Which of the following lesions is the patient at risk to develop? ---- <<Choices:>> A) Basal cell carcinoma (BCC) B) Vulvar low-grade squamous intraepithelial lesion (LSIL) C) Differentiated squamous cell carcinoma (SCC) D) Vulvar high-grade squamous intraepithelial lesion (HSIL) ---- <<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 male presents to his primary care physician with complaints of chronic headaches that have developed and increased in frequency and severity over the last several months. Additionally, the patient has noted he has been less coordinated over the last few weeks, stumbling and tripping often when he is walking. Physical examination is significant for notably reduced hand grip strength bilaterally as well as decreased pain and temperature sensation along the upper back and down both arms to the hands. A referral to the appropriate specialist is made, and an MRI of the brain and neck is obtained. Results of the MRI are show in Figures A and B. Which of the following is the most likely diagnosis in this patient? ---- <<Choices:>> A) Arnold-Chiari malformation type 1 B) Arnold-Chiari malformation type 2 C) Arnold-Chiari malformation type 3 D) Arnold-Chiari malformation type 4 ---- <<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:>> After hospitalization for urgent chemotherapy to treat Burkitt’s lymphoma, a 7-year-old boy develops paresthesias of the fingers, toes, and face. Blood pressure is 100/65 mm Hg, respirations are 28/min, pulse is 100/min, and temperature is 36.2°C (97.2°F). Inflating a blood pressure cuff on the boy’s arm produces carpal spasm. He has excreted 20 mL urine in the past 6 hours. Laboratory studies show the following: Hemoglobin 15 g/dL Leukocyte count 6,000/mm3 with a normal differential serum K+ 6.5 mEq/L Ca+ 6.6 mg/dL Phosphorus 5.4 mg/dL HCO3− 15 mEq/L Uric acid 12 mg/dL Urea nitrogen 54 mg/dL Creatinine 3.4 mg/dL Arterial blood gas analysis on room air: pH 7.30 PCO2 30 mm Hg O2 saturation 95% Febuxostat is initiated. Which of the following is the most appropriate next step in management? ---- <<Choices:>> A) Hemodialysis B) Intravenous 0.9% saline C) Sodium bicarbonate D) Orotracheal intubation ---- <<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 84-year-old woman with an indwelling urinary catheter and a history of recurrent nephrolithiasis is brought to the emergency department from her nursing home because of increasing confusion over the past day. On arrival, she is oriented only to person. Her temperature is 38.3°C (100.9°F). Examination shows dry mucous membranes. Urine studies show: pH 8.3 WBC 40/hpf Bacteria moderate Nitrites positive The urine has an ammonia odor. Which of the following is most likely to be present on this patient's urine culture?" ---- <<Choices:>> A) Gram-negative, oxidase-positive rods B) Gram-positive, novobiocin-resistant cocci C) Gram-positive, gamma-hemolytic cocci D) Gram-negative, oxidase-negative rods ---- <<Answer:>>
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D
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 28-year-old woman who was recently hired at a new company feels intense physical attraction towards her supervisor. She feels he is exceptionally kind to her and finds herself fantasizing about him during work. While talking to her co-workers, she ardently raises complaints about her supervisor and declares that she finds him to be extremely repulsive, rude, and arrogant. Which of the following ego defenses is this patient most closely exhibiting? ---- <<Choices:>> A) Denial B) Isolation of affect C) Reaction formation D) Repression ---- <<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-year-old boy presents to his pediatrician with his mother for a sore throat. His symptoms began approximately a few days ago after attending a birthday party with his friends. His symptoms are accompanied by nausea, vomiting, and a mild headache. He also has mild discomfort in his throat when eating food or drinking water. The patient denies rhinorrhea, conjunctivitis, cough, myalgias, or a rash. His mother said his temperature last night was 101°F (38.3°C). On physical exam, the patient has tender and enlarged anterior cervical lymph nodes. Upon oral inspection, there is pharyngeal inflammation and exudates with petechial lesions on the soft palate. Which of the following is the best next step in management? ---- <<Choices:>> A) Azithromycin B) Observation C) Penicillin V D) Rapid antigen detection test ---- <<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 male with follicular non-Hodgkin lymphoma undergoes chemotherapy. He develops suprapubic pain and hematuria. Which of the following compounds is most likely responsible for this patient's symptoms? ---- <<Choices:>> A) Cyclophosphamide B) Mesna C) Bleomycin D) Carmustine ---- <<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 68-year-old man comes to the physician because of a 1-week history of difficulty with urination. Two weeks ago, he was hospitalized for treatment of a cerebrovascular accident; his symptoms began after he was discharged. His vital signs are within normal limits. Neurologic examination shows mild dysarthria, right facial droop, and right hemiparesis. Rectal examination shows a normal prostate. The patient produces 70 mL of urine for a sample. Placement of a Foley catheter yields an additional 500 mL of urine. Which of the following is the most appropriate pharmacotherapy for this patient? ---- <<Choices:>> A) Muscarinic agonist B) Muscarinic antagonist C) Alpha-1 receptor agonist D) 5-alpha-reductase inhibitor ---- <<Answer:>>
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A
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 61-year-old woman presents with painless vaginal bleeding. Patient says the bleeding has been occurring occasionally for the past 3 years. Past medical history is significant for diabetes mellitus type 2 and hypertension, both managed medically. Current medications are atorvastatin, lisinopril, hydrochlorothiazide, and metformin. Patient has not been sexually active since the death of her husband 9 years ago. Menopause occurred 8 years ago, and she denies taking hormone replacement therapy or estrogen-containing oral contraceptives. Her last Pap smear 1 year ago was normal. Vital signs are temperature 37.0℃ (98.6℉), blood pressure 130/85 mm Hg, pulse 82/min, respiratory rate 13/min, and oxygen saturation 99% on room air. BMI is 33.8 kg/m2. On physical examination, patient is alert and cooperative. Cardiac exam is normal. Lungs are clear to auscultation. Abdomen is soft and non-tender with no masses or hepatosplenomegaly. Examination of the perineum shows pale, atrophic vaginal mucosa. Speculum examination shows no vaginal or cervical lesions. The cervix is movable and non-tender. There is trace blood in the vaginal vault and mild bleeding from the cervical os. The uterus is not enlarged but softened on palpation. Adnexa is non-palpable. Which of the following is the next best diagnostic step in this patient? ---- <<Choices:>> A) Hysteroscopy B) Pap test C) Endometrial biopsy D) Pelvic MRI ---- <<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 20-year-old African American woman presents to the clinic after missing her last 2 periods. Her cycles are usually regular, occurring at 28–32 day intervals with moderate bleeding and some abdominal discomfort. She also complains of occasional diffuse and generalized headaches. She is a college student and works part-time as a bartender. The past medical history is benign. The blood pressure is 110/70 mm Hg, the pulse is 80/min, the respiratory rate is 14/min, and the temperature is 36.5°C (97.7°F). The physical examination is significant for mild breast tenderness and secretions from the nipple area. A urine pregnancy test is negative. Which of the following is the best initial step in her management? ---- <<Choices:>> A) MRI of the brain B) Serum prolactin levels C) LH:FSH ratio D) Dopamine agonists ---- <<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 50-year-old man comes to the physician because of an 8-month history of intermittent watery diarrhea and abdominal pain. He has had a 12-kg (26-lb) weight loss during this period. He has also had episodic pain of the ankle, wrist, and knee joints during the past 5 years. An endoscopy with small bowel biopsy is performed. Histopathologic examination of a tissue specimen shows foamy macrophages in the lamina propria with periodic acid-Schiff (PAS)-positive inclusions. Further evaluation is most likely to show which of the following? ---- <<Choices:>> A) Anti-tissue transglutaminase antibodies B) Anti-cyclic citrullinated peptide antibody C) Intracellular, gram-positive bacilli D) Low serum TSH and high free T4 concentrations ---- <<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 49-year-old woman comes to the physician because of a growing lump in the right breast that she first noticed 1 month ago. Physical examination of the right breast shows a 3.5-cm firm, fixed mass in the right upper quadrant. There is dimpling of the overlying skin. A mammogram shows a mass with poorly-defined margins and microcalcifications. Immunohistochemical analysis of a biopsy specimen from the mass shows malignant cells that stain negative for estrogen and progesterone receptors and positive for human epidermal growth factor receptor 2. The drug that most specifically targets this patient's tumor is also used in the treatment of which of the following conditions? ---- <<Choices:>> A) Multiple sclerosis B) Gastric cancer C) Osteoporosis D) Rheumatoid arthritis ---- <<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 17-year-old girl is brought to the physician because her mother is concerned about her lack of appetite. She has had a 4-kg (8.8-lb) weight loss over the past 4 months. The patient states that she does not “feel like eating so much”. Over the last year her academic performance in school has decreased and she has had a lot of disputes with her parents concerning her future. Her mother says that she has also become more nervous and restless. Her grandmother had a problem with her thyroid. She is sexually active with two male partners and uses condoms inconsistently. She is at 60th percentile for height and at 15th percentile for weight. She appears thin. Her temperature is 37°C (98.6°F), pulse is 104/min, and blood pressure is 135/80 mm Hg. The pupils are 9 mm large, round and minimally reactive to light. Deep tendon reflexes are 2+ bilaterally. There is fine tremor of her hands. The remainder of the examination shows no abnormalities. Which of the following is the most appropriate next step in diagnosis? ---- <<Choices:>> A) Measure serum electrolytes B) Perform abdominal ultrasound C) Obtain toxicology screening D) Obtain HIV screening test ---- <<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-year-old male presents to the pediatrician to be evaluated for learning difficulties. His parents report that the patient’s grades have been falling since he started middle school this year. The patient previously attended a smaller elementary school that focused more on the arts and creative play. His parents report that at home the patient bathes and dresses himself independently but requires help with more difficult tasks, such as packing his backpack and making a schedule for homework. He enjoys reading comic books and playing video games. The patient’s parents report that he said his first word at 19 months and walked at 21 months. His mother notes that she herself struggled to pay attention in her classes and completed college in six years after taking a reduced course load. On physical exam, the patient has a long, narrow face with large ears. His testicles are larger than expected for his age. Which of the following additional findings is most likely to be found in this patient’s history? ---- <<Choices:>> A) Compulsive completion of rituals B) Cruelty to animals or fire-setting C) Difficulty seeing the board at school D) Poor reciprocal emotional 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 17-year-old girl comes to the primary care clinic with her father complaining of right knee pain. She reports that the pain started about a month ago, and since then it has gotten progressively worse. The knee pain is not constant but becomes most noticeable when going up or down the stairs. She also endorses that her knee becomes uncomfortable towards the end of class. Her father is worried because the pain is affecting her ability to play basketball, and she has college scouts coming to watch her play. The patient has no chronic medical conditions. She had a tonsillectomy as a child. She takes a multivitamin and uses ibuprofen as needed for the pain. On physical examination, there is tenderness at the inferior pole of the patella, without swelling or overlying skin changes. Which of the following is the most likely diagnosis? ---- <<Choices:>> A) Osgood-Schlatter disease B) Patellar stress fracture C) Patellar tendonitis D) Patellofemoral syndrome ---- <<Answer:>>
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C
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 60-year-old man presents to the physician for his 10-year colonoscopy screening. He has no complaints except for occasional diarrhea and dribbling of urine. He says that he is on a healthy diet and exercises 3 days a week. He quit smoking 5 years ago after smoking 1 pack of cigarettes per day for 20 years. He has hypertension and dyslipidemia. He has benign prostatic hyperplasia that was diagnosed last year. On physical examination, his abdomen is lax with no tenderness or rigidity. Rectal examination reveals no blood in the rectal vault. Colonoscopy reveals a 4 x 3 cm polyp in the sigmoid colon. Multiple biopsies are obtained and sent for pathologic examination. Genetic testing reveals a mutation in the KRAS gene. Which of the following pathological type of polyp does this patient most likely have that also puts him at higher risk of malignancy? ---- <<Choices:>> A) Hamartomatous polyps B) Villous adenomatous polyps C) Tubular adenomatous polyps D) Hyperplastic polyps ---- <<Answer:>>
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B
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 20-year-old healthy female volunteer is enrolled in a study involving renal perfusion. The medical history is unremarkable and she takes no medications. She denies smoking, drinking, and drug use. The family history is unremarkable. The physical examination reveals no abnormal findings. A drug which is known to selectively act on a segment of the renal vasculature is administered and the glomerular filtration rate (GFR) and filtration fraction (FF) both increase. Which of the following could be the mechanism of action of the administered drug? ---- <<Choices:>> A) Efferent arteriole constriction B) Renal artery constriction C) Increased peritubular capillary permeability D) Afferent arteriole constriction ---- <<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 male is brought to the emergency room by his mother for a rash and fever. The mother reports that the child first developed a cough and malaise three days ago. Over the last 24 hours, a rash developed and the patient had a temperature up to 101.4°F (38.6°C) the night prior to presentation. The child’s medical history is notable for a prior hospitalization at the age of 2 for fever, vomiting, and lethargy. During that hospitalization, a cerebrospinal fluid sample demonstrated gram-negative diplococci. His current temperature is 100.9°F (38.3°C), blood pressure is 130/85 mmHg, pulse is 115/min, and respirations are 22/min. Physical examination reveals a lethargic male child with a diffuse petechial skin rash that is most prominent on the trunk and legs. This patient most likely has a deficiency in which of the following factors? ---- <<Choices:>> A) C1q B) C3 C) C4 D) C5 ---- <<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 13-month-old boy is brought to the physician for the evaluation of rectal bleeding that occurred earlier that morning. The patient has also had several itchy and red skin lesions that started on his scalp and spread downwards. The parents report that their son has had six episodes of bilateral otitis media since birth. His immunizations are up-to-date. He is at the 3rd percentile for height and weight. His vital signs are within normal limits. Examination shows several eczematous lesions over the scalp, neck, and upper and lower extremities, as well as multiple red spots that do not blanch on pressure. The remainder of the physical examination shows no abnormalities. Laboratory studies show: Hemoglobin 9.4 g/dL Leukocyte count 11,500/mm3 Platelet count 30,000/mm3 Prothrombin time 14 sec Partial thromboplastin time 33 sec Which of the following is the most likely diagnosis?" ---- <<Choices:>> A) Chronic granulomatous disease B) DiGeorge syndrome C) Chediak-Higashi syndrome D) Wiskott-Aldrich syndrome ---- <<Answer:>>
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D
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 28-year-old woman, gravida 3, para 2, at 34 weeks' gestation comes to the physician because of a 1-day history of dyspnea, dry cough, and chest pain. Her pulse is 112/min, respirations are 24/min, and blood pressure is 108/78 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 90%. Examination shows jugular venous distention and bilateral pitting edema below the knees that is worse on the right side. There is dullness to percussion over the right lung base. Which of the following is the most likely diagnosis? ---- <<Choices:>> A) Pulmonary embolism B) Panic attack C) Bacterial pneumonia D) Acute pericarditis ---- <<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 55-year-old man comes to the physician for a follow-up examination. One month ago, he underwent a right-sided kidney transplantation due to severe polycystic kidney disease. Following the procedure, he was started on transplant rejection prophylaxis. He has had some chest and back pain as well as frequent coughing. He has also had 5–6 bowel movements per day of loose stool and occasional vomiting. He appears pale. Temperature is 37°C (98.6°F), pulse is 80/min, and blood pressure is 155/90 mm Hg. Physical examination shows lower extremity pitting edema. Laboratory studies show: Hemoglobin 10 g/dL Leukocyte count 2,500/mm3 Platelet count 80,000/mm3 Serum Urea nitrogen 30 mg/dL Glucose 150 mg/dL Which of the following is the most likely underlying cause of this patient's symptoms?" ---- <<Choices:>> A) Tacrolimus B) Daclizumab C) Mycophenolate mofetil D) Azathioprine ---- <<Answer:>>
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C
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 2-year-old boy with a history of multiple hospitalizations for fever and infection undergoes immunologic evaluation. Serum CH50 assay shows inappropriately low erythrocyte lysis and further workup confirms C8 deficiency. This patient is at increased risk for recurrent infections with which of the following pathogens? ---- <<Choices:>> A) Neisseria species B) Giardia species C) Pneumocystis species D) Mycobacterium species " ---- <<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 55-year-old man is brought to the emergency department because of cough and poor appetite for the past week. Since it began, he has been coughing up small amounts of malodorous phlegm. During the past two nights, he has also had night sweats. He was diagnosed with HIV infection 5 years ago. He has hypertension, type 2 diabetes mellitus, and severe heartburn. The patient is homeless and does not take any medication. He has smoked a pack of cigarettes daily for 30 years. He drinks 8–10 beers daily. His temperature is 38.9°C (102.0°F), pulse is 101/min, respirations are 25/min and blood pressure is 145/92 mm Hg. The patient appears intoxicated. Physical examination shows crackles and dullness to percussion at the right lung base. Scattered expiratory wheezing is heard throughout both lung fields. A grade 2/6 mid-systolic ejection murmur is heard along the upper right sternal border. His CD4+T-lymphocyte count is 280/mm3 (Normal ≥ 500). An x-ray of the chest shows a hazy infiltrate in the right lower lung field. Which of the following is the most likely cause of this patient's symptoms? ---- <<Choices:>> A) Pneumocystis pneumonia B) Aspiration pneumonia C) Mitral valve regurgitation D) Pharyngoesophageal diverticulum " ---- <<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 2-year-old boy is brought in to his pediatrician for his annual exam, flu vaccination, and to evaluate a diaper rash. The itchy pink rash has been bothering the boy for about 1 week and over the counter, remedies are not helping. He was born at 39 weeks gestation via spontaneous vaginal delivery. He is up to date on all vaccines and is meeting all developmental milestones. During the discussion, his parents are frustrated by his behavior and inability to follow directions. Today, his vital signs are stable and normal for his age. On physical examination, the boy appears uncomfortable. His heart has a regular rate and rhythm and his lungs are clear to auscultation bilaterally. There is a pink-red, raised rash in the anogenital region and medial thighs. Additionally, there are multiple bruises on the boy’s buttocks and the back of his thighs. Some are healing and some are fresh. When questioned about the bruising, the parents become evasive and end the discussion. Which of the following is the next best step in the management of the child? ---- <<Choices:>> A) To report to Child Protective Services B) To order patch testing for allergic contact dermatitis C) To obtain skin scrapings for examination by light microscopy D) Mupirocin cream ---- <<Answer:>>
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A
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 62-year-old woman comes to the physician for the evaluation of a palpable mass in the left breast that she noticed 3 weeks ago. During this period, she has also had some left-sided blood-tinged discharge. She has hypertension, type 2 diabetes mellitus, and hypercholesterolemia. She has no children. The patient's menopause occurred at 57 years of age. Her mother died of colon cancer at the age of 65 years. The patient had smoked one pack of cigarettes daily for 30 years but quit 15 years ago. She does not drink alcohol. Her current medications include enalapril, metformin, atorvastatin, and a multivitamin. She is 165 cm (5 ft 5 in) tall and weighs 84 kg (187 lb); BMI is 30.9 kg/m2. She appears well. Her temperature is 37°C (98.6°F), pulse is 78/min, and blood pressure is 135/80 mm Hg. Examination of the breasts shows a left-sided single, nontender, firm mass with poorly defined margins in the upper outer quadrant. Biopsy of the mass confirms the diagnosis of pleomorphic lobular carcinoma in situ (LCIS) that is estrogen-receptor (ER) positive. The patient undergoes lumpectomy of the left breast and treatment with tamoxifen is started. The patient's therapy increases her risk of which of the following conditions? ---- <<Choices:>> A) Myelosuppression B) Osteoporosis C) Endometrial cancer D) Ovarian cancer ---- <<Answer:>>
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C
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Answer the following medical question with the correct letter choice:
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<<Question:>> A confused and disoriented 32-year-old man is brought to the emergency department by his wife. He was in his usual state of health until yesterday, when he started complaining of fever and headache. This morning he was complaining of worsened headache and was acting odd, prompting his wife to bring him to the hospital. His past medical history is unremarkable. At the hospital, his temperature is 39.2°C (102.5°F), pulse is 116/min, and blood pressure is 96/64 mm Hg. Physical examination is notable for neck stiffness and a large scar across his abdomen that his wife says is from a splenectomy operation following a car accident a few years ago. He has not seen a doctor since that time. A lumbar puncture shows elevated protein, low glucose, and 1,200 WBCs with 95% polymorphonuclear cells; gram staining shows gram-positive diplococci. Which of the following is the most likely risk factor contributing to this patient's underlying diagnosis? ---- <<Choices:>> A) Congenital humoral immunodeficiency B) Dysfunction of a single organ C) Dysfunction of multiple organs D) Undiagnosed viral infection ---- <<Answer:>>
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B
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Answer the following medical question with the correct letter choice:
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<<Question:>> A group of scientists is verifying previous research on DNA replication. The diagram illustrates the theoretical DNA replication process in bacteria such as Escherichia coli. What does the letter ‘a’ represent in this process? ---- <<Choices:>> A) RNA Primers B) Okazaki fragments C) The leading strand D) Replication fork ---- <<Answer:>>
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B
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<<Question:>> A physician is involved in a research collaboration with a pharmaceutical company. The company invites her to give a lecture series for other physicians on new therapies in her field of expertise at a retreat center in the Caribbean. Which of the following is acceptable for the physician to accept?: A) Compensation for travel expenses B) An honorarium for speaking C) Assistance with preparing her presentations ---- <<Choices:>> A) A only B) B only C) C only D) A and B ---- <<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 15-year-old teenager is brought to a pediatrician by his parents. They are concerned about his performance at school and have received several letters from his school noting that the adolescent has difficulty with reading and writing compared to his classmates and often misbehaves during class. A physical exam reveals some atypical findings. A Wechsler Intelligence Scale for Children (WISC) shows that the boy has a mild intellectual disability with an IQ of 84. Complete blood count and serum TSH levels are normal. After a careful review of all findings the pediatrician suspects the teenager may have a numerical chromosomal disorder and orders karyotype (see image). Which of the following set of findings were most likely found during the physical exam? ---- <<Choices:>> A) Arachnodactyly, scoliosis and aortic root dilation B) Short stature, broad chest and thick skin folds in neck C) Short stature, hypotonia and obesity D) Tall Stature and gynecomastia ---- <<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:>> Ten days after delivery, a 1500-g (3.3-lb) male newborn is feeding poorly. He was born at 32 weeks' gestation. He has had frequent episodes of vomiting for the past 2 days. He has no fever, diarrhea, or hematemesis. He appears lethargic and is difficult to arouse. His temperature is 37°C (98.6°F), pulse is 145/min, respirations are 65/min, and blood pressure is 78/55 mm Hg. The lungs are clear to auscultation. The abdomen is hard with rebound tenderness. The patient is responsive only to painful stimuli. His hemoglobin concentration is 13.0 g/dL, leukocyte count is 10,900/mm3, and platelet count is 90,000/mm3. Arterial blood gas analysis on room air shows: pH 7.31 PCO2 30 mm Hg PO2 80 mm Hg O2 saturation 98% An x-ray of the abdomen is shown. Which of the following is the most appropriate treatment?" ---- <<Choices:>> A) Nasogastric tube gut decompression B) Exploratory laparotomy C) Administration of ampicillin, gentamicin, and metronidazole D) Barium enema " ---- <<Answer:>>
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B
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<<Question:>> A 45-year-old man who underwent liver transplantation 3 months ago for chronic liver failure presents to the physician because of a backache following a fall from sitting. He is currently on immunosuppressive therapy with glucocorticoids and cyclosporine. He has no comorbidities. On physical examination, his vitals are within normal limits. He has tenderness over his lumbar spine. An X-ray of the lumbar spine shows a wedge compression fracture of the L1 vertebra. His serum testosterone and serum creatinine levels are normal. Bone mineral densitometry shows a T-score of –3.0. What is the most likely diagnosis? ---- <<Choices:>> A) Renal osteodystrophy B) Osteopenia C) Osteomalacia D) Transplantation-related osteoporosis ---- <<Answer:>>
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D
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 56-year-old woman presents to the emergency department with acute onset of pain and redness of the skin of her right arm for the past 3 days. She has had type 2 diabetes mellitus for the past 22 years, but she is not compliant with her medications. Her temperature is 38.0°C (100.4°F), pulse is 105/min, and blood pressure is 116/74 mm Hg. On physical examination, her forearm is tender and erythematous. She is diagnosed with acute cellulitis, and intravenous clindamycin is started. On the 6th day of antibiotic therapy, the patient complains of severe watery diarrhea, fever, and abdominal tenderness without rigidity. Which of the following is the best initial diagnostic test for her current complaint? ---- <<Choices:>> A) Complete blood count with differential B) Sigmoidoscopy or colonoscopy C) Fecal occult blood test D) Polymerase chain reaction ---- <<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 group of researchers attempts to determine the mean fasting triglyceride levels in patients between the ages of 30 and 60 in a suburb of Tampa, FL. Over the course of several years, the team manages to obtain the blood levels of a random sample of 10,000 volunteers who fit their inclusion criteria. The blood levels are measured and demonstrate a standard deviation of 5. Which of the following correlates with the estimated standard error of the mean for this population? ---- <<Choices:>> A) 0.02 B) 0.05 C) 0.10 D) 0.15 ---- <<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 physician by her mother for evaluation of several bruises on her lower extremities. She has had these bruises for about 6 weeks, and the mother is concerned that she might be bullied at school. The patient has had increasing fatigue and paleness over the past several days. She has a history of recurrent generalized tonic-clonic seizures treated with carbamazepine. She appears pale and ill. Her temperature is 37.8°C (100.1°F), pulse is 115/min, and blood pressure is 100/60 mm Hg. The lungs are clear to auscultation. Examination shows a soft, nontender abdomen with no organomegaly. There are several subcutaneous purple spots on her legs bilaterally. Her hemoglobin concentration is 8.4 g/dL, leukocyte count is 2,600/mm3, platelet count is 18,000/mm3, and reticulocyte count is 0.3%. Serum electrolyte concentrations are within normal limits. Which of the following is the most likely underlying cause of this patient's symptoms? ---- <<Choices:>> A) Immune thrombocytopenic purpura B) Sickle cell disease C) Systemic lupus erythematosus D) Adverse effect of medication ---- <<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 51-year-old man comes to the emergency department because of a 3-day history of shortness of breath, fever, and chills. He has no history of serious illness. His temperature is 39.5°C (103.1°F). Physical examination shows a grade 4/6, holosystolic, blowing murmur over the apex that radiates to the axilla. Crackles are heard in both lower lung fields. Examination of the extremities shows several non-tender, non-blanching, erythematous macules on the palms and soles. Histopathologic examination of these macules is most likely to show which of the following? ---- <<Choices:>> A) Microabscesses with neutrophil infiltration of capillaries B) Epithelioid cells with surrounding multinucleated giant cells C) Cleft-like vacuoles within the arterioles D) Spiral-shaped bacteria with axial filaments in the epidermis ---- <<Answer:>>
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A
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Answer the following medical question with the correct letter choice:
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<<Question:>> An investigator is studying the maternal and fetal consequences of a recent spike in benzodiazepine addiction in Ireland. She is particularly interested in whether benzodiazepine use contributes to oral cleft deformities in newborns exposed to alprazolam, clonazepam, or lorazepam during the first trimester. The investigator uses statistical data from the local demographic institute to calculate the number of newly diagnosed cases of oral cleft deformities in Ireland over the past 5 years. Which of the following terms describes the investigator's statistical measure of interest? ---- <<Choices:>> A) Mortality rate B) Relative risk C) Cumulative incidence D) Attributable risk ---- <<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 55-year-old woman comes to the office for preventive health care. She has recently migrated to the United States from Hong Kong. Her past medical history is noncontributory. She denies smoking cigarettes or drinking alcohol. She last saw a doctor at the age of 14 when she was diagnosed with appendicitis and underwent an appendectomy. Her father died of a stroke at 59 years old and her mother died of a heart attack at 66 years old. She has 2 daughters who are in good health. Temperature is 37°C (98.7°F), blood pressure is 113/85 mm Hg, pulse is 69/min, respiratory rate is 14/min, and BMI is 24 kg/m2. Cardiopulmonary and abdominal examinations are negative. Laboratory test Complete blood count Hemoglobin 12.5 g/dL MCV 88 fl Leukocytes 5,500/mm3 Platelets 155,000/mm3 Basic metabolic panel Serum Na+ 135 mEq/L Serum K+ 3.7 mEq/L Serum Cl- 106 mEq/L Serum HCO3- 25 mEq/L BUN 10 mg/dL Serum creatinine 0.8 mg/dL Liver function test Serum bilirubin 0.8 mg/dL AST 30 U/L ALT 35 U/L ALP 130 U/L (20–70 U/L) What is the next best step in management of this patient? ---- <<Choices:>> A) Bone scan B) Ultrasonography of the abdomen C) Gamma glutamyl transferase D) Anti mitochondrial antibody ---- <<Answer:>>
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C
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 33-year-old man presents to his primary care practitioner, complaining about the presence of white spots in both of his hands. He states that the white spots have expanded in the last few months; they are not tender nor ulcerated. His past medical history is relevant for hypothyroidism. Upon physical examination, the patient shows hypopigmented macules on both hands and on the back and shoulders adjacent to a patch of skin, with signs of excoriation and scratching. Under the Wood’s lamp, the skin lesions on the hands, back, and shoulders show fluorescence. There are no signs of inflammation in any of the skin lesions. The vital signs of the patient are within normal limits. Which is the most likely diagnosis of this condition? ---- <<Choices:>> A) Vitiligo B) Tinea versicolor C) Pityriasis alba D) Halo nevus ---- <<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 to the emergency department by his mother. He started violently coughing, wheezing, and having difficulty breathing about 10 minutes ago. She had briefly left him lying on his back playing with toys and when she returned he was choking. She attempted the Heimlich maneuver with no improvement. He has a heart rate is 120/min, respiratory rate is difficult to evaluate, blood pressure of 110/65 mm Hg, and temperature of 37.0°C (98.6°F). A respiratory exam reveals wheezing and decreased breath sounds on the right side. A stat chest X-ray is ordered. Which of the following is the most likely site where the aspirated foreign body is lodged? ---- <<Choices:>> A) Basilar segment of the right upper lobe B) Posterior segment of the right upper lobe C) Basilar segment of the left lower lobe D) Basilar segment of the right lower lobe ---- <<Answer:>>
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B
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<<Question:>> A 38-year-old man presents with weakness, loss of appetite, headaches, and irritability. He developed these symptoms gradually over the past 4 months. He was diagnosed with Crohn’s disease, which was moderate at the time of diagnosis 6 months ago. He takes methotrexate 15 mg, which effectively controls his symptoms. The patient’s vital signs include: blood pressure 105/70 mm Hg, heart rate 102/min, respiratory rate 16/min, and temperature 36.4℃ (97.5℉). On physical examination, the patient is pale. His lungs are clear to auscultation. His heart sounds are rhythmic; a short early systolic murmur can be heard over the apex of the heart. The rest of the exam is unremarkable. The patient’s blood test shows the following findings: Erythrocytes 2.7 x 109/mm3 Hb 9.3 g/dL Hct 37% Mean corpuscular hemoglobin 45.2 pg/cell (2.8 fmol/cell) Mean corpuscular volume 122 µm3 (122 fL) Reticulocyte count 0.4% Total leukocyte count 3050/mm3 Neutrophils 62% Lymphocytes 32% Eosinophils 1% Monocytes 5% Basophils 0% Platelet count 199,000/mm3 Which of the following drugs should be prescribed to this patient? ---- <<Choices:>> A) Riboflavin B) Niacin C) Pyridoxine D) Folic acid ---- <<Answer:>>
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D
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 75-year-old man with coronary artery disease and mitral valve stenosis status-post coronary artery bypass graft and mitral bioprosthetic valve replacement is evaluated in the intensive care unit. His postsurgical course was complicated by ventilator-associated pneumonia and bilateral postoperative pleural effusions requiring chest tubes. He has been weaned from the ventilator and has had his chest tubes removed but has required frequent suctioning to minimize aspirations. He has been dependent on a percutaneous gastrostomy tube for enteral nutrition for the past four weeks. He is currently on aspirin, carvedilol, atorvastatin, ceftazidime, and pantoprazole. He has a history of prostate cancer status post radical prostatectomy. His temperature is 96°F (35.6°C), blood pressure is 95/55 mmHg, pulse is 50/min, and respirations are 20/min. On physical exam, he is not alert and oriented but responds with moans when stimulated. His laboratory data are listed below: Serum: Na+: 145 mEq/L Cl-: 110 mEq/L K+: 3.4 mEq/L HCO3-: 26 mEq/L BUN: 10 mg/dL Glucose: 112 mg/dL Creatinine: 1.4 mg/dL Thyroid-stimulating hormone: 10 µU/mL Ca2+: 11.1 mg/dL PO4-: 1.0 mg/dL AST: 6 U/L ALT: 10 U/L Albumin: 2.5 mg/dL Lactate dehydrogenase: 200 U/L (140-280 U/L) Haptoglobin: 150 mg/dL (30-200 mg/dL) 1,25-(OH)2 D3: 10 pg/mL (15-75 pg/mL) Parathyroid hormone: 9 pg/mL (10-60 pg/mL) Leukocyte count: 10,000 cells/mm^3 with normal differential Hemoglobin: 9 g/dL Hematocrit: 30 % Platelet count: 165,000 /mm^3 His electrocardiogram and chest radiograph are shown in Figures A and B. What is the most likely cause of his hypercalcemia? ---- <<Choices:>> A) Euthyroid sick syndrome B) Immobilization C) Malignancy D) Primary hyperparathyroidism ---- <<Answer:>>
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B
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<<Question:>> A 35-year-old woman presents for a follow-up. The patient was diagnosed with major depressive disorder 16 months ago and has tried multiple medications with no improvement, namely bupropion, fluoxetine, sertraline, and imipramine. Upon inquiry, she assures the psychiatrist that she has been fully compliant with her medications so far but stopped her current medications a few weeks back as they did not help either. Her husband suggested her to try a herbal preparation for improving her mood. She also noted that she felt temporarily better while attending her sister’s wedding last weekend, but she still remains depressed most of the times. Which of the following would be the next best step in the treatment of this patient’s depression? ---- <<Choices:>> A) St John’s Wort B) Selegiline C) Phenelzine D) Electroconvulsive 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 17-year-old boy is brought in by paramedics to the emergency department. He was found down at a family picnic. The boy's parents state that he tried many new foods at the picnic. Additionally, because it is springtime, many insects were out while he was playing football. His temperature is 99.5°F (37.5°C), blood pressure is 127/68 mmHg, pulse is 120/min, respirations are 33/min, and oxygen saturation is 84% on room air. Physical exam is notable for tachycardia and very minimal breath sounds bilaterally. No jugular venous distention is noted and an abdominal exam is within normal limits. Which of the following best describes an effect of the next best step in management? ---- <<Choices:>> A) Decreased serum potassium B) Equilibration of environmental and chest cavity pressure C) Hypoglycemia D) Increased systemic vascular resistance ---- <<Answer:>>
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A
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<<Question:>> A 45-year-old woman comes to the emergency department with her 17-year-old son because she believes she has been poisoned by her ex-husband. She reports that her coffee tasted “strange” this morning. After breakfast, she then saw a black car drive by the house, which she concludes must have been her ex-husband, who also drives a black car. She says that since the divorce 3 years ago, her ex-husband has been seeking revenge and thinks that he has installed cameras in her apartment to spy on her and their son. She has never seen any of these cameras but when she is alone in the apartment, she can sometimes hear them beeping and feel them recording her. The son also reports his mother's coffee mug smelled of bitter almonds, which he suspects was cyanide. He agrees with the mother's distrust towards his father and reports that he has also occasionally heard a camera beeping but has not been able to find any cameras yet. The mother's vital signs are within normal limits. Physical examination shows no abnormalities. Arterial blood gas analysis on room air shows a pH of 7.4. Toxicology screening is negative. Which of the following is the best initial step in management? ---- <<Choices:>> A) Ziprasidone therapy B) Repetitive transcranial magnetic stimulation C) Examine mother and son separately D) Report the case to the authorities ---- <<Answer:>>
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C
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 2-year-old boy is brought to the physician after his adoptive mother observed jerking movements of his arms and legs earlier that morning. He was adopted from an orphanage in Albania at 4 months of age. He has a history of intellectual disability. Examination shows pale skin and light blue eyes. There is a dry, eczematous, scaly rash on the extensor surfaces of the extremities. This patient is most likely deficient in which of the following enzymes? ---- <<Choices:>> A) Phenylalanine hydroxylase B) α-ketoacid dehydrogenase C) Cystathionine synthase D) Homogentisate oxidase ---- <<Answer:>>
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A
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<<Question:>> A 45-year-old man comes to the physician because of a 4-month history of increased frequency of urination. He wakes up several times a night to urinate and feels fatigued during the day. He also complains of increased thirst; he drinks multiple liters of water and soda daily and still feels thirsty. Vital signs are within normal limits. Physical examination shows patches of velvety hyperpigmentation in the axilla and on the posterior neck. Laboratory evaluation in this patient is most likely to show which of the following? ---- <<Choices:>> A) Elevated serum thyroxine concentration B) Elevated glycated hemoglobin concentration C) Positive urinary leukocyte esterase D) Low urine osmolality ---- <<Answer:>>
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B
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<<Question:>> A 69-year-old man comes to the physician with a 9-month history of worsening shortness of breath on exertion and need to urinate at night. He occasionally has palpitations but does not have chest pain. The patient had a transient ischemic attack 5 years ago for which he underwent right-sided carotid endarterectomy. He has hypertension and type 2 diabetes mellitus. Current medications include metformin, lisinopril, aspirin, and simvastatin. He appears fatigued. His pulse is 61/min, blood pressure is 120/75 mmHg, and respirations are 25/min. Pulse oximetry shows an oxygen saturation of 96%. Examination shows cold extremities. There are no murmurs or rubs on cardiac auscultation. Fine, bilateral crackles are heard at the lung bases. There is 2+ lower extremity edema. An ECG shows sinus rhythm and known T wave inversions in leads V1 to V4. Which of the following agents is most likely to improve the patient's long-term survival? ---- <<Choices:>> A) Eplerenone B) Ivabradine C) Verapamil D) Digoxin ---- <<Answer:>>
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A
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<<Question:>> A 22-year-old woman presents to her primary care provider complaining of a facial rash. She says the rash began 3 weeks ago after hiking in the White Mountains of New Hampshire this summer. Since that time she has also experienced pain in her hands and wrists that is worse in the morning and accompanied by subjective fevers. She denies chest pain, shortness of breath, nausea, or vomiting. Vital signs are 99.6°F (37.6°F), blood pressure is 134/82 mmHg, pulse is 88/min, and respirations are 18/min. Examination demonstrates a rash on the patient's face that spares the nasolabial folds along with oral ulcers. The metacarpophalangeal joints are tender to palpation, and range of motion is limited by pain. Complete blood count demonstrates normocytic anemia with thrombocytopenia. Which of the following is the next best step in diagnosis? ---- <<Choices:>> A) Anti-cardiolipin antibodies B) Anti-dsDNA antibodies C) Anti-nuclear antibodies D) Anti-Smith antibodies ---- <<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 54-year-old man presents with fever and a painful jaw mass with a yellowish discharge. He says that he first noticed the jaw mass 6 weeks ago and that the mass has been progressively increasing in size. He reports a history of chronic alcoholism and currently takes more than 6 drinks daily. His temperature is 37.9°C (100.2°F). On physical examination, there is a 7 × 7 cm mass at the tip of the jaw bone with significant surrounding edema and sclerosis The mass is severely tender on light palpation and has a yellowish malodorous discharge. The oral cavity shows signs of very poor dentition. Laboratory analysis of the discharge reveals gram-positive anaerobic filamentous bacteria. Which of the following organisms is the most likely cause of this patient’s condition? ---- <<Choices:>> A) Peptostreptococcus magnus B) Actinomyces israelii C) Nocardia asteroides D) Eikenella corrodens ---- <<Answer:>>
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B
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<<Question:>> A 57-year-old homosexual man presents to the emergency department with epigastric pain. He has presented multiple times for the same complaint in the past. The patient has a past medical history of alcoholism and is homeless. He states that his symptoms at this time are constant and occur at all times of the day and are near his baseline. He also endorses fatty and foul smelling diarrhea during this time frame. Which of the following is the best initial diagnostic test for this patient’s condition? ---- <<Choices:>> A) CT scan B) Lipase C) Secretin stimulation test D) Stool ova and parasite analysis ---- <<Answer:>>
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A
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<<Question:>> A 6-year-old boy is rushed to the emergency department after being involved in a motor vehicle accident. He has abrasions on his left knee and left elbow. His wounds are cleaned and a pressure bandage is applied. Typically, neutrophils and macrophages are attracted toward the site of injury by various chemical mediators. Which of the following cells is responsible for the initial cascade by the release of TGF-β and PDGF? ---- <<Choices:>> A) Mast cells B) Fibroblasts C) Platelets D) Basophils ---- <<Answer:>>
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C
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 70-year-old man comes to the emergency department after briefly losing consciousness and collapsing when rising from a chair. He did not sustain any injuries from his collapse. He has had a two-week history of dizziness upon standing. He has smoked one pack of cigarettes daily for 55 years. He drinks three beers and two glasses of whiskey daily. He currently takes dutasteride and tamsulosin for benign prostatic hyperplasia. His blood pressure is 120/80 mm Hg supine and 100/70 mm Hg one minute after standing with no change in pulse rate. Physical examination shows conjunctival pallor. On cardiac auscultation, there is a plopping sound followed by a low-pitched, rumbling mid-diastolic murmur heard best at the apex. Which of the following is the most likely cause of this patient's presentation? ---- <<Choices:>> A) Stokes-Adams attack B) Constricted aortic valve orifice C) Cardiac tumor D) Left ventricular dilation ---- <<Answer:>>
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C
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<<Question:>> A 6-month-old infant is brought to a pediatrician for his scheduled immunizations. The parents deny any specific current complaints, but his facial features differ from those of other children in the family. During the physical examination, the pediatrician notes that the infant’s vital signs are stable. His facial features include a medial epicanthic fold, a face that appears flat, and a flat occiput with low-set ears. The pediatrician also notes a single transverse palmar crease on both hands. An echocardiogram is performed which suggests that the infant has a congenital heart disease which is the most common form of congenital heart disease seen in children with this particular genetic disorder. Which of the following congenital heart diseases does this infant most likely present with? ---- <<Choices:>> A) Supravalvar aortic stenosis B) Tetralogy of Fallot C) Atrial septal defect D) Atrioventricular septal defect ---- <<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 32-year-old white woman comes to the physician because of fatigue, lethargy, and swelling of the lower legs for 2 months. She reports recurrent episodes of pain in both wrists, her right knee, and her right ankle in the past year. She has had skin problems that are aggravated by exposure to sunlight for the past 18 months. She has smoked one pack of cigarettes daily for 13 years and drinks one alcoholic beverage daily. Her temperature is 37°C (98.6°F), pulse is 92/min, and blood pressure is 115/75 mm Hg. Examination shows 2+ pretibial edema bilaterally and periorbital edema. There are erythematous patches with scaling on both cheeks. Laboratory studies show: Hemoglobin 11.2 g/dL Leukocyte count 8500/mm3 Platelet count 130,000/mm3 Serum Urea nitrogen 36 mg/dL Glucose 77 mg/dL Creatinine 0.9 mg/dL Albumin 2.6 mg/dL Total cholesterol 275 mg/dL Triglycerides 180 mg/dL Urine Blood negative Glucose negative Protein 4+ WBC 0–1/hpf Fatty casts numerous A renal biopsy specimen is most likely to show which of the following?" ---- <<Choices:>> A) Thickened capillary loops B) Segmental sclerosis C) Crescent formation D) Hypercellular glomeruli ---- <<Answer:>>
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A
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<<Question:>> A 60-year-old man presents to the clinic with his wife for “weird breathing” during the night. The patient’s wife says that his breathing pattern is irregular but he does not snore. The patient says he is not aware of these symptoms. Past medical history is remarkable for an NSTEMI when he was 50 years old. He spends a night at the sleep lab where his tidal volume is monitored overnight and a tracing is shown in the image below. Which of the following is most likely responsible for this patient’s breathing pattern? ---- <<Choices:>> A) Diabetic ketoacidosis B) Hypothyroidism C) Left ventricular heart failure D) Obesity ---- <<Answer:>>
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C
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 72-year-old man with a history of chronic kidney disease presents to his primary care physician complaining of recurrent chest pain with activity. The patient used to have chest pain when he mowed his lawn. Now he gets chest pain whenever he walks short distances such as to get his mail. The pain resolves on its own when the patient sits and rests. His temperature is 98.2°F (36.8°C), blood pressure is 157/98 mm Hg, pulse is 80/min, respirations are 15/min, and oxygen saturation is 98% on room air. Physical exam is notable for an obese man who is in no distress. An initial ECG is unchanged from a previous ECG. The patient's first troponin is 0.06 ng/mL which is unchanged from previous troponins. Which of the following is the most likely diagnosis? ---- <<Choices:>> A) NSTEMI B) Stable angina C) Unstable angina D) Variant angina ---- <<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 55-year-old woman presents to the surgical oncology clinic as a new patient for evaluation of recently diagnosed breast cancer. She has a medical history of hypertension for which she takes lisinopril. She denies any surgical history. Her family history is notable for breast cancer in her maternal grandmother. She is visibly anxious during the encounter, but physical examination is otherwise unremarkable. Her primary concern today is which surgical approach will be chosen to remove her breast cancer. Which of the following procedures involves the removal of an entire breast? ---- <<Choices:>> A) Vasectomy B) Mastectomy C) Lumpectomy D) Arthroplasty ---- <<Answer:>>
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B
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<<Question:>> A 14-year-old female is seeing her pulmonologist in clinic after a recent asthma exacerbation. She has been adherent to her original controller medication so the physician prescribes an additional new drug which prevents IgE binding to mast cells. Which of the following did the physician add? ---- <<Choices:>> A) Theophylline B) Albuterol C) Omalizumab D) Beclamethasone ---- <<Answer:>>
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C
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 24-year-old man is brought in to the emergency room after being retrieved by firefighters from a burning building. The patient is responding coherently to questions but reports pain secondary to a burn on his leg. He states he also has a headache and feels dizzy. His temperature is 98.5°F (36.9°C), blood pressure is 129/66 mmHg, pulse is 126/min, respirations are 14/min, and oxygen saturation is 99% on room air. Physical exam is notable for a confused young man with dry and flushed skin. Cardiopulmonary exam reveals a normal S1 and S2 as well as clear breath sounds bilaterally. The patient’s neurological exam is within normal limits. Towards the end of his exam, the patient begins vomiting. Dermatologic exam reveals a superficial burn covering 1% of the patient’s body over his right leg. Which of the following is the best next step in management for this patient? ---- <<Choices:>> A) 100% oxygen B) Hydroxocobalamin C) Normal saline D) Ondansetron ---- <<Answer:>>
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A
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<<Question:>> A 29-year-old female presents to her psychiatrist with concerns that she may be "OCD." She explains that she has become extremely obsessed with making sure that her fruits and vegetables are completely sanitized by first rinsing with water for exactly 60 seconds and then boiling for exactly 60 minutes. She refuses to eat any fruits or vegetables that did not undergo this process, which she began doing about 3 months ago. Which of the following vitamin deficiencies is she most likely to develop? ---- <<Choices:>> A) Vitamin A B) Vitamin K C) Vitamin C D) Vitamin E ---- <<Answer:>>
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C
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<<Question:>> A 73-year-old male is brought to his family practitioner by his daughter with the complaints of a spinning sensation for the past 4 weeks. He says that the room appears to be continuously spinning. This has progressively worsened over the last 4 weeks to the point that he has become bed bound and cannot walk without support. These spinning sensations are present throughout the day and do not change with position. They are associated with nausea and vomiting. He denies ear pain, ear discharge, ringing in the ear, hearing disturbances, ear fullness, head trauma, fever, or recent flu-like illness. He has a blood pressure of 133/80 mm Hg, heart rate of 80/min, respiratory rate of 12/min, and temperature of 36.7°C (98.2°F). His extraocular eye movements are normal in all directions, but a vertical nystagmus is present that does not disappear despite repetitive testing. Hearing tests are within normal limits. What is the most likely diagnosis? ---- <<Choices:>> A) Acute labyrinthitis B) Benign paroxysmal positional vertigo C) Cerebellar tumor D) Meniere's disease ---- <<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 79-year-old man presents to the emergency room after a syncopal event. The patient has a history of hyperlipidemia for which he is taking atorvastatin. On physical examination, his vital signs are stable, but on cardiac auscultation, you detect a crescendo-decrescendo systolic murmur loudest on the right upper sternal border radiating to the neck. On physical exam, one would also expect: ---- <<Choices:>> A) That the murmur would best be heard in the lateral left decubitus position B) The character of the murmur would be machine-like C) The murmur would also have a mid-systolic click loudest before S2 D) Palpation of the carotid pulse would be weak and late relative to the patient’s heart sounds ---- <<Answer:>>
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D
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<<Question:>> A researcher is designing a study to examine a possible correlation between exposure to a particular pesticide and chronic bronchitis. The researcher gathers all records of patients presenting with bronchitis for the past 10 years from the local hospital and contacts the qualifying subjects to ask them about exposure to the particular pesticide. Using the data he compiles, he is able to calculate an estimate for the relative and absolute risk for developing chronic bronchitis in people who have been exposed to that pesticide. Which of the following best describes this type of study design? ---- <<Choices:>> A) Case-control study B) Cross-sectional study C) Cohort study D) Double-blind, randomized, placebo-controlled clinical trial ---- <<Answer:>>
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B
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<<Question:>> A 49-year-old woman presents to her primary care physician due to fatigue and shortness of breath. She finds herself being short of breath when climbing the stairs or walking uphill. Approximately 1 year ago, she was able to partake in long-distance running and weightlifting. Two weeks ago she noticed blood-tinged sputum after severely coughing during sleep. She emigrated from Mexico to the United States 3 years ago. Her temperature is 98°F (36.7°C), blood pressure is 100/62 mmHg, pulse is 135/min and irregularly irregular, and respirations are 21/min. On physical exam her speech is hoarse. She has bilateral crackles heard in the lung bases. Which of the following will most likely be found on cardiac auscultation? ---- <<Choices:>> A) Crescendo-decrescendo systolic ejection murmur B) High-pitched, early diastolic decrescendo murmur C) Holosystolic, high-pitched murmur loudest at the left lower sternal border D) Opening snap with a mid-to-late diastolic murmur ---- <<Answer:>>
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D
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<<Question:>> A 60-year-old man presents to the physician for a follow-up examination. During the previous visit, splenomegaly was detected on the abdominal exam, which has been confirmed by abdominal ultrasound. He has no complaints other than fatigue for several months. He has no history of serious illness and takes no medications. The vital signs are within the normal range. On percussion, spleen size is 15 cm (5.9 in). Otherwise, the physical examination shows no abnormalities. The laboratory test results are as follows: Hemoglobin 10 g/dL Mean corpuscular volume 88 μm3 Leukocyte count 65,000/mm3 Platelet count 500,000/mm3 The peripheral blood smear shows a predominance of neutrophils and the presence of band cells, myelocytes, promyelocytes, and blasts (< 5%). The molecular studies document the BCR-ABL1 rearrangement. Which of the following is the most appropriate pharmacotherapy at this time? ---- <<Choices:>> A) All-trans retinoic acid B) Aspirin C) Imatinib D) Hydroxyurea ---- <<Answer:>>
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C
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<<Question:>> A 45-year-old man presents to the outpatient unit with a complaint of lower extremity edema for the past few weeks. He has also been observing puffiness of the face lately. The urinalysis shows 4+ proteinuria. The serum creatinine is 3.5 mg/dL, and antinuclear antibodies are absent. The biopsy findings are given in the picture. What is the most likely cause of the following findings? ---- <<Choices:>> A) Membranoproliferative glomerulonephritis B) Rapidly progressive glomerlonephritis C) Postinfectious glomerulonephritis D) Membranous glomerulonephritis ---- <<Answer:>>
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D
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<<Question:>> A 2-year-old male is brought to his pediatrician by his parents because of a lack of testes in his scrotum. Physical examination confirms that testes are absent from the scrotal sac and palpable masses are found bilaterally around the inguinal canal. If the child’s condition is left untreated, levels of which of the following hormones is most likely to be decreased most when the child reaches sexual maturity? ---- <<Choices:>> A) FSH B) LH C) Inhibin D) Prolactin ---- <<Answer:>>
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C
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 23-year-old man presents to the emergency department by ambulance after being rescued from a burning house. The patient was intubated in the field and is maintaining his oxygen saturation above 98%. Physical exam reveals partial or full-thickness burns across an estimated 30% of his total body surface area. His weight is 70 kg. Which of the following is the volume of isotonic fluid that should be given to this patient over the next 24 hours? ---- <<Choices:>> A) 1,100 mL B) 4,200 mL C) 8,400 mL D) 16,800 mL ---- <<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 28-year-old G1P0 primigravida woman at 28 weeks estimated gestational age presents for routine prenatal care. She has no complaints and says she can feel her baby move and respond to outside sounds. The patient has no significant past medical or family history. Currently, she is taking a prenatal multivitamin which contains iron and folic acid. Her blood type is A (-) negative, and her husband is A (+) positive. The patient says she stopped drinking alcohol 2 years ago and denies any history of smoking or recreational drug use. Her pulse is 90/min, blood pressure is 114/68 mm Hg, and respiratory rate is 18/min. She has gained 9.0 kg (19.8 lb) over the course of the pregnancy. Physical examination shows a gravid uterus, extending 28 cm above the pubic symphysis. Occasional movements are observed in the abdomen. There is no guarding or tenderness to palpation. Fetal heart sounds can be auscultated. The remainder of the examination is unremarkable. The patient is administered an injection of RhO(D) immunoglobulin (RhoGAM). Which of the following statements best describes the rationale for administering RhO(D) immunoglobulins (RhoGAM) in this patient? ---- <<Choices:>> A) RhO(D) immunoglobulin will prevent hemolytic disease in this pregnancy. B) The father requires RhO(D) immunoglobulin administration rather than the patient. C) RhO(D) immunoglobulins will prevent anti-D antibody formation in the mother. D) RhO(D) immunoglobulins will prevent anti-D antibody formation in the fetus. ---- <<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 51-year-old man comes to the physician for evaluation of inability to attain an erection during sexual activity for 6 months. He has had an active sexual life in the past. He reports that early morning erections are present every other day. He has a history of hypertension and diabetes mellitus. His wife recently filed for divorce. He has smoked one pack of cigarettes daily for 25 years. His only medications are enalapril and metformin. Physical examination shows no abnormalities. The underlying cause of this patient's condition is best classified as which of the following? ---- <<Choices:>> A) Hormonal B) Neurogenic C) Psychogenic D) Vascular ---- <<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 49-year-old G4P4 woman comes to the clinic complaining of repeated leakage of fluid from her vagina for the past 5 months. She noticed an increase in episodes following her cold last week when she was coughing and sneezing a lot. Her past medical history is significant for Crohn disease, which is well controlled with sulfasalazine. Her last menstrual period was 1 year ago. She is currently sexually active with multiple partners with inconsistent condom use. She denies any vaginal itching, abnormal discharge, pain, subpubic pressure, urinary urges, or odors. Physical examination is significant for a bulge at the anterior vaginal wall. What is the most likely explanation for this patient’s symptoms? ---- <<Choices:>> A) Prolapse of the bladder B) Detrusor muscle overactivity C) Genitourinary syndrome of menopause D) Rectovaginal fistula ---- <<Answer:>>
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A
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 24-year-old woman presents to a physician with recurrent episodes of palpitations, shortness of breath, and perspiration. The episodes are self-limited and are usually preceded by specific social circumstances that she does not enjoy. There is no significant past medical history. After a complete history and physical examination, the physician diagnoses an anxiety disorder. He explains that anxiety is associated with the stimulation of the sympathetic nervous system which produces several symptoms related to anxiety such as tachycardia. Which of the following cellular mechanisms best explains the effects of stimulation of sympathetic cardiac nerves on the pacemaker cells in the sinoatrial node? ---- <<Choices:>> A) Decreased intracellular cyclic adenosine monophosphate (cAMP) level in the sinoatrial node B) Inactivation of L-type voltage-gated calcium channels C) Facilitation of If currents through HCN channels D) Opening of G-protein activated potassium channels ---- <<Answer:>>
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C
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 14-year-old boy is brought to the office by his parents because he states that for the past 2 months he has been feeling constantly tired, and also noticed a dull pain in the pit of his stomach. The patient has no relevant family history. The vital signs include a heart rate of 105/min, a respiratory rate of 16/min, a temperature of 37.0°C (98.6°F), and a blood pressure of 111/66 mm Hg. On physical exam, the abdomen is distended with hepatomegaly 5 cm underneath the xiphoid process. The complete blood count results are as follows: Hemoglobin 17.6 g/dL Hematocrit 64% RBC 6.02 x 1012/L Leukocyte count 26,300/mm3 Neutrophils 55% Bands 2% Eosinophils 1% Basophils 0% Lymphocytes 29% Monocytes 2% Platelet count 480,000/mm³ Erythropoietin < 1.0 mU/mL The coagulation test results are as follows: Partial thromboplastin time (activated) 30.9 s Prothrombin time 14.0 s The abdominal Doppler ultrasound imaging is shown in the picture. What is the most likely etiology of this patient’s diagnosis? ---- <<Choices:>> A) Behçet's syndrome B) Protein C deficiency C) Factor V Leiden mutation D) Polycythemia vera ---- <<Answer:>>
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D
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 17-year-old girl is presented to the clinic by her mom for hair loss. Both the girl and her mom have noted random patches of hair loss across the girl's scalp, eyebrows, and eyelashes, 1st appearing several months ago. The girl has noticed no other symptoms, though the spots of hair loss are sometimes sore. On further questioning, the girl shares that she has been very stressed lately about getting good grades and applying to colleges. She knows she needs to do well on all of her homework in order to get into a good college, so she has sometimes had to stay up late into the night to rewrite her homework over and over again so that they are 'absolutely perfect'. The physical exam shows an anxious-appearing, somewhat quiet girl. There is diffuse hair loss and thinning across her scalp, with many different hair shafts of different lengths. There is no discernible pattern to the hair loss. Which of the following is the best treatment for this patient? ---- <<Choices:>> A) Cognitive-behavioral therapy B) Intralesional steroids C) Oral griseofulvin D) Systemic steroids ---- <<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:>> In a town with a hepatitis B prevalence of 4%, a new screening test is introduced as part of a study. The first round of the study detects cases of hepatitis B using the new test, which has a sensitivity of 99% and a specificity of 77%. In the second round of the study, the same test is used again in a different population with a hepatitis B prevalence of 29%. Which of the following best describes the findings obtained from the study? ---- <<Choices:>> A) The positive predictive value would increase in the second round. B) The sensitivity would decrease in the second round. C) The negative predictive value would increase in the second round. D) The positive likelihood ratio would increase in the second round. ---- <<Answer:>>
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A
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<<Question:>> A 5-year-old girl is brought to the physician for a well-child examination. Her mother says she has been having trouble sleeping for 3 weeks because of pruritus in her genital area. The girl has otherwise been feeling well. She is at the 45th percentile for height and 51st percentile for weight. Vital signs are within normal limits. Pelvic examination shows erythema of the vulva and perianal region. There is no vaginal discharge. Which of the following is the most appropriate next step in management? ---- <<Choices:>> A) Potassium hydroxide preparation B) Perianal cellophane-tape examination C) Cultures for chlamydia and gonorrhea D) Stool microscopy ---- <<Answer:>>
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B
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<<Question:>> A 25-year-old man comes to the emergency department because of left flank pain for 2 hours. The pain is colicky in nature and he describes it as 8 out of 10 in intensity. He has nausea and has vomited once. He had a similar episode 6 months ago for which he took naproxen. There is no personal or family history of serious illness. He is a second-year medical student and has been consuming more coffee and energy drinks than normal to stay awake and study for the past 2 days. He does not smoke or drink alcohol. He takes no medications. His temperature is 37.3°C (99.1°F), pulse is 98/min, and blood pressure is 124/78 mm Hg. The abdomen is soft and nontender. Examination of the back shows no costovertebral angle tenderness. The remainder of the examination shows no abnormalities. Urinalysis is unremarkable. Which of the following is the most likely underlying cause of this patient's symptoms? ---- <<Choices:>> A) Bilateral renal cysts B) Glomerular IgA deposits C) Ureteropelvic junction obstruction D) Ascending urinary tract infection " ---- <<Answer:>>
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C
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Answer the following medical question with the correct letter choice:
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<<Question:>> An otherwise healthy 6-year-old boy presents for a follow-up visit to his pediatrician's office for persistent nocturnal enuresis. He has never been dry at night and throughout the last year the pediatrician has seen him multiple times for this issue. He and his family have tried not drinking liquids 2 hours before bed, bed wetting alarms, and a reward sticker chart with limited success. His 2 older brothers had nocturnal enuresis that resolved on its own when they were 8 years of age, but the patient often sleeps over at a friend's house and is very bothered by this problem. He has 1 soft stool a day, denies abdominal pain, dysuria, or frequency, and has been continent during the day since 3 years of age. He has a completely normal physical exam, urinalysis, and basic metabolic panel. What is the next best step in management? ---- <<Choices:>> A) Cognitive behavioral therapy B) Desmopressin C) Imipramine D) Oxybutynin ---- <<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 41-year-old woman presents with acute right flank pain for the past 6 hours. She says the pain is severe, colicky, ‘comes in waves’, and is localized to the right flank. She also has associated nausea and vomiting. The patient is afebrile, and her vital signs are within normal limits. On physical examination, she is writhing in pain and moaning. There is severe right costovertebral angle tenderness. Gross hematuria is present on urinalysis. A noncontrast CT of the abdomen and pelvis reveals a 4-mm-diameter radiopaque stone obstructing the right ureteropelvic junction. Aggressive IV fluid hydration is started, and ondansetron is administered. Which of the following is the next best step in the management of this patient? ---- <<Choices:>> A) Renal ultrasound B) 24-hour urine chemistry C) Potassium citrate D) Hydrocodone/acetaminophen ---- <<Answer:>>
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D
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 36-year-old female presents with a 6-month history of stiffness in her joints. She reports bilateral knee pain that is worse in the morning prior to activity and stiffness of the fingers in both hands. Anti-CCP antibody tests are positive. Over several months, the patient's symptoms prove unresponsive to NSAIDs and methotrexate, and the decision is made to begin infliximab. Which of the following drugs has the most similar mechanism to inflixmab? ---- <<Choices:>> A) Imatinib B) Cyclophosphamide C) Trastuzumab D) Allopurinol ---- <<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 55-year-old man presents to the emergency department with chest pain that started 1 hour ago and has not been improving. He has a past medical history of diabetes, hypertension, and obesity. His temperature is 98.5°F (36.9°C), blood pressure is 147/68 mmHg, pulse is 130/min, respirations are 13/min, and oxygen saturation is 100% on room air. Physical exam is notable for jugular venous distension and bilateral lower extremity pitting edema. The patient is given nitroglycerin, and his chest pain improves. Which of the following is the best explanation for this patient’s improvement in symptoms? ---- <<Choices:>> A) Coronary artery vasodilation B) Decreased adrenergic tone C) Mu receptor agonism D) Preload reduction ---- <<Answer:>>
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D
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Answer the following medical question with the correct letter choice:
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<<Question:>> An investigator is studying energy metabolism in athletes. Baseline serum lactate levels at rest are recorded and repeat levels are obtained directly after a 1000-meter sprint. Compared to the baseline measurements, the serum lactate levels are significantly increased after the sprint. This increase in serum lactate is necessary to regenerate an essential cofactor for which of the following enzymes? ---- <<Choices:>> A) Glycogen phosphorylase B) Glyceraldehyde-3 phosphate dehydrogenase C) Phosphofructokinase-1 D) Pyruvate carboxylase ---- <<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 scientist is studying the development of CD8+ T cells. In his experiments, he uses a radioactive isotope to mark a population of T cells. Once injected into the thymus, these cells bind tightly to MHC I self-antigen complexes. Later in the experiment, the scientist cannot find any marked cells in the peripheral blood. Which of the following processes is responsible for the loss of these marked CD8+ cells? ---- <<Choices:>> A) Positive selection B) Negative selection C) APC antigen presentation D) IL-2 stimulation ---- <<Answer:>>
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B
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 65-year-old woman who has smoked 2 packs per day for forty years comes to your practice complaining of a chronic cough, dyspnea, hemoptysis, and difficulty rising from a chair. Based on CXR and biopsy slides shown, you feel that all of the following would be consistent with her diagnosis EXCEPT? ---- <<Choices:>> A) Decreasing muscle strength with repetitive stimulation B) Antibodies to presynaptic calcium channels C) Dry mouth D) Orthostatic hypotension ---- <<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-month-old boy is brought to the pediatrician after his parents noticed the appearance of a rash on his face, torso, and limbs. The boy has been ill for almost 2 weeks, initiating with fever, malaise, coryza, headache, nausea, diarrhea, and a rash on both of his cheeks. Physical examination is unremarkable except for an erythematous maculopapular rash on the face, trunk, and extremities with a reticular pattern (as shown in the photograph). What is the most likely diagnosis? ---- <<Choices:>> A) Measles B) Chickenpox C) Erythema infectiosum D) Roseola infantum ---- <<Answer:>>
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C
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 27-year-old woman presents to a neurologist complaining of facial pain. She reports that over the past 6 months, she has developed intermittent burning unilateral facial pain that happens over 10 seconds to 3 minutes. The pain is severe enough to completely stop her from her activities. She is worried whenever she goes out that another attack will happen and she is sad that this has limited her ability to work as a lawyer. Her past medical history is notable for irritable bowel syndrome and polycystic ovarian syndrome. She takes an oral contraceptive pill. Her temperature is 98.6°F (37°C), blood pressure is 130/75 mmHg, pulse is 75/min, and respirations are 18/min. On exam, she is a well-appearing woman who is alert, oriented, and appropriately interactive. Her pupils are 2 mm and reactive to light bilaterally. Fundoscopic examination is unremarkable. Her strength and range of motion are full and symmetric in her upper and lower extremities. This patient’s symptoms are likely due to irritation of a nerve that passes through which of the following foramina? ---- <<Choices:>> A) Foramen rotundum B) Inferior orbital fissure C) Jugular foramen D) Superior orbital fissure ---- <<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 26-year-old man comes to the physician because of high-grade fever, fatigue, nausea, and headache for 4 days. The headache is constant and feels like a tight band around his head. He also reports that his eyes hurt while looking at bright lights. He has been taking acetaminophen and using cold towels to help relieve his symptoms. He works as an assistant for a nature camp organization but has been unable to go to work for 3 days. His immunization records are unavailable. His temperature is 38.5°C (101.3°F), pulse is 92/min, and blood pressure is 108/74 mm Hg. He is oriented to time, place, and person. There is no rash or lymphadenopathy. Flexion of the neck results in flexion of the knee and hip. A lumbar puncture is done; cerebrospinal fluid analysis shows an opening pressure of 80 mm H2O, leukocyte count of 93/mm3 (78% lymphocytes), a glucose concentration of 64 mg/dL, and a protein concentration of 50 mg/dL. Which of the following is the most likely causal organism? ---- <<Choices:>> A) Borrelia burgdorferi B) Mycobacterium tuberculosis C) Herpes simplex virus 1 D) Coxsackievirus ---- <<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 4-year-old girl presents to the pediatrician’s office for a physical examination prior to starting preschool. She was born at 39 weeks gestation via spontaneous vaginal delivery. She is up to date on all vaccines and is meeting all developmental milestones. Past medical history is noncontributory. She takes no medications but does take a chewable vitamin daily. She lives with her parents and older brother in a house. Today, her blood pressure is 110/65 mm Hg, heart rate is 90/min, respiratory rate is 22/min, and temperature of 37.0°C (98.6°F). On physical exam, she appears well developed and pleasant. She sits listening to the conversation and follows directions. Palpation of the heart reveals a mild parasternal heave. Auscultation reveals a normal S1 but the S2 is split and remains split during inhalation and exhalation. Additionally, there is a medium pitched midsystolic murmur that is loudest between ribs 2 and 3 on the left side and a very soft diastolic rumble. Which of the following congenital defects is the most likely cause of these findings? ---- <<Choices:>> A) Atrial septal defect B) Coarctation of the aorta C) Patent ductus arteriosus D) Tetralogy of Fallot ---- <<Answer:>>
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A
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 24-year-old man is brought to the emergency department after his head was hit with a bat during a baseball game. His teammates state that he was unresponsive after the incident but regained consciousness after 15 minutes. The patient initially refused to go to the hospital and sat on the bench for the remainder of the game. He initially appeared fine but became increasingly confused. He appears lethargic but opens his eyes to loud verbal commands. He is oriented to person and place. His temperature is 37.1 (98.8°F), pulse is 78/min, respiratory rate is 16/min, and blood pressure is 148/87 mm Hg. Examination shows an area of soft-tissue swelling over the left temporal region. A complete blood count and serum concentrations of electrolytes, urea nitrogen, and creatinine are within the reference range. A CT scan of the head is shown. After returning from the CT scan, the patient only opens his eyes to painful stimuli and responds to questions with incomprehensible sounds. He withdraws from painful stimuli. On repeat examination, the left pupil is 6 mm in diameter and reacts minimally to light. The right pupil is 3 mm in diameter and reacts normally to light. His respiratory rate is 10/min and he is intubated in the emergency department. Which of the following is the most appropriate next step in management? ---- <<Choices:>> A) Adminster hypotonic saline B) Administer dexamethasone C) Perform craniotomy D) Perform brain MRI ---- <<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 woman comes to the physician for a routine follow-up examination. She has a history of type 2 diabetes mellitus, hypertension, and asthma. Last year, she received laser photocoagulation for proliferative retinopathy. Her current medications include metformin, lisinopril, and an albuterol inhaler. Her mother died of complications from diabetes. She drinks 1 glass of wine daily with dinner and does not smoke. Her temperature is 37.2°C (99°F), pulse is 92/min, respirations are 14/min, and blood pressure is 152/98 mm Hg. Cardiopulmonary examination is unremarkable. There is decreased sensation to monofilament testing of the plantar surfaces of both feet. Laboratory studies show: Today 6 months ago Hemoglobin A1c 6.2% 6.4% Serum Creatinine 1.3 mg/dL 1.1 mg/dL Urine Albumin:creatinine ratio (N < 30) 470 mg/g 260 mg/g The addition of which of the following medications is most likely to have prevented this patient's progressively worsening renal function?" ---- <<Choices:>> A) Losartan B) Aspirin C) Atorvastatin D) Amlodipine ---- <<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 4-year-old boy is brought to the physician by his mother because of a rash on his hands and feet for the past two weeks. It is intensely pruritic, especially at night. He has not had fever, headache, or diarrhea. His mother has a history of eczema. The child was due for an appointment later in the week to follow up on any potentially missing vaccinations. His temperature is 37.8°C (100.1°F). Examination shows a maculopapular rash with linear patterns affecting the interdigital spaces of the fingers and toes. The remainder of the examination shows no abnormalities. Which of the following is the most effective intervention for this patient's skin lesion? ---- <<Choices:>> A) Oral acyclovir B) Supportive care C) Topical permethrin D) Topical clotrimazole ---- <<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 with his wife to the primary care physician because she is concerned about his drinking behavior. Specifically, he drinks 7 drinks every day and has abandoned many social activities that he previously enjoyed. In addition, he starts drinking in the morning because he feels shaky when he does not have a drink. When asked about his behavior, the man says that he knows that he probably should drink less but feels that he is not motivated enough to change. He says that perhaps the topic should be addressed again next year. Which of the following stages does this patient's behavior most likely represent? ---- <<Choices:>> A) Contemplation B) Precontemplation C) Preparation D) Relapse ---- <<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 18-month-old boy is brought to the emergency department 25 minutes after an episode of loss of consciousness. The child began crying after his 4-year-old brother snatched a toy from him. The brief shrill cry was followed by a period of expiration; he then turned blue, became unconscious, and briefly lost his muscle tone, before he stiffened and had jerky movements of his arms and legs for 15 seconds. After this episode, he immediately regained consciousness. He had a similar episode 2 weeks ago when his father refused to give him a juice box. He has been healthy and has met all his developmental milestones. Vital signs are within normal limits. He is alert and active. Cardiopulmonary examination shows no abnormalities. Neurologic examination shows no focal findings. Which of the following is the most appropriate next step in management? ---- <<Choices:>> A) CT scan of the head B) Echocardiography C) Reassurance D) Tilt table test ---- <<Answer:>>
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C
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 67-year-old woman presents to the ophthalmologist with complaints of worsening visual loss. She states that her vision is blurry. Driving has become difficult, particularly at night, as she experiences substantial glare and sees halos around lights. On physical examination, there is absence of a red reflex. What is the most likely cause of this patient’s visual loss? ---- <<Choices:>> A) Age-related macular degeneration B) Cataracts C) Open-angle glaucoma D) Refractive error ---- <<Answer:>>
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B
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 30-year-old woman comes to the physician because of headaches and nausea for the past 3 weeks. The headaches are holocranial and last up to several hours. During this period, she has also had a swishing sound in both ears, which decreases when she turns her head to either side. She has had multiple episodes of blurring of vision and double vision for the past 2 weeks. She has vomited twice in the past week. She has nodular cystic acne and polycystic ovarian disease. Current medications include an oral contraceptive, metformin, and isotretinoin. She is 163 cm (5 ft 4 in) tall and weighs 89 kg (196 lb); BMI is 33.5 kg/m2. Her temperature is 37.3°C (99.1°F), pulse is 70/min, and blood pressure is 128/82 mm Hg. She is oriented to time, place, and person. Examination shows acne over her cheeks and back. Hirsutism is present. Visual acuity is 20/20 in both eyes. There is esotropia of the left eye. Further evaluation of this patient is most likely to show which of the following findings? ---- <<Choices:>> A) Hyperpigmentation of palmar creases B) Bilateral optic disc swelling C) Raised intra-ocular pressure D) Weakness of left upper and lower extremities ---- <<Answer:>>
|
B
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 64-year-old woman with knee osteoarthritis comes to the physician for a follow-up examination. She reports significantly improved pain control since starting celecoxib 1 month ago. A history involving which of the following conditions is most likely to explain the administration of this drug instead of another nonsteroidal anti-inflammatory drug? ---- <<Choices:>> A) Reye syndrome B) Sulfa drug allergy C) Glanzmann thrombasthenia D) Gout ---- <<Answer:>>
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C
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Answer the following medical question with the correct letter choice:
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<<Question:>> A 48-year-old woman is admitted to the hospital and requires anticoagulation. She is administered a drug that binds tightly to antithrombin III. Which of the following drugs was administered? ---- <<Choices:>> A) Aspirin B) Warfarin C) Dabigatran D) Enoxaparin ---- <<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 comes to the physician because of a 2-day history of low-grade fever and painful lesions on her left index finger. Two weeks ago, she had a painful rash on the right labia majora that resolved without treatment. Physical examination shows tender lymphadenopathy of the left epitrochlear and right inguinal region. A photograph of the left index finger is shown. Which of the following best describes the properties of the most likely virus involved? ---- <<Choices:>> A) Naked virus with a double-stranded, circular DNA structure B) Naked virus with a single-stranded, positive sense, linear RNA structure C) Enveloped virus with a double-stranded, linear DNA structure D) Enveloped virus with a partially double-stranded, circular DNA structure ---- <<Answer:>>
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C
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