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Answer the following medical question with one of the provided options:
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Q:A 24-year-old male is brought in by fire rescue after being the restrained driver in a motor vehicle accident. There was a prolonged extraction. At the scene, the patient was GCS 13. The patient was boarded and transported. In the trauma bay, vitals are T 97.2 F, HR 132 bpm, BP 145/90 mmHG, RR 22 rpm, and O2 Sat 100%. ABCs are intact with a GCS of 15, and on secondary survey you note the following (Figure F). FAST exam is positive at Morrison's pouch. Abdominal exam shows exquisite tenderness to palpation with rebound and guarding. Which of the following radiographs is most likely to be present in this patient?? {'A': 'Radiograph A', 'B': 'Radiograph B', 'C': 'Radiograph C', 'D': 'Radiograph D', 'E': 'Radiograph E'},
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C: Radiograph C
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Answer the following medical question with one of the provided options:
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Q:A 46-year-old premenopausal woman undergoes lumpectomy after a diagnosis of invasive ductal carcinoma of the breast is made. Pathologic examination of the surgical specimen shows that the breast cancer cells stain positive for estrogen receptor and progesterone receptor, and negative for human epidermal growth factor receptor 2. Which of the following characteristics applies to the most appropriate pharmacotherapy for this patient's condition?? {'A': 'Selective agonist at estrogen receptors in bone tissue', 'B': 'Selective agonist at progesterone receptors in mammary tissue', 'C': 'Monoclonal antibody against tyrosine kinase receptor', 'D': 'Monoclonal antibody against vascular endothelial growth factor', 'E': 'Selective antagonist at estrogen receptors in endometrium\n"'},
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A: Selective agonist at estrogen receptors in bone tissue
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Answer the following medical question with one of the provided options:
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Q:A 67-year-old woman comes to the physician with a 4-month history of chest pain that occurs on exertion. The pain is dull, and she experiences retrosternal pressure when she walks up the stairs to her apartment on the fifth floor. The pain disappears shortly after stopping for one minute. She has hypertension, for which she takes lisinopril and metoprolol daily. She does not smoke or drink alcohol. She is 158 cm (5 ft 2 in) tall and weighs 82 kg (180 lb); BMI is 33 kg/m2. Her pulse is 72/min and blood pressure is 140/85 mm Hg. Cardiac examination shows no murmurs, rubs, or gallops. Fasting lipid studies show: Total cholesterol 196 mg/dL LDL 110 mg/dL HDL 50 mg/dL A resting ECG shows no abnormalities. A week after uneventful initiation of aspirin, the patient is started on atorvastatin. This patient is most likely to develop which of the following?"? {'A': 'Bloating', 'B': 'Myositis', 'C': 'Elevated transaminases', 'D': 'Cholelithiasis', 'E': 'Flushing\n"'},
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C: Elevated transaminases
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Answer the following medical question with one of the provided options:
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Q:Antigen presentation of extracellular pathogens by antigen presenting cells requires endocytosis of the antigen, followed by the degradation in the acidic environment of the formed phagolysosome. Should the phagolysosome become unable to lower its pH, what is the most likely consequence?? {'A': 'Deficient NK cell activation', 'B': 'Deficient presentation of pathogens to CD4 T-cells', 'C': 'Deficient presentation of pathogens to CD8 T-cells', 'D': 'Deficient cell extravasation', 'E': 'Deficient expression of B7'},
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B: Deficient presentation of pathogens to CD4 T-cells
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Answer the following medical question with one of the provided options:
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Q:Five weeks after delivery, a 1350-g (3-lb 0-oz) male newborn has respiratory distress. He was born at 26 weeks' gestation. He required intubation and mechanical ventilation for a month following delivery and has been on noninvasive pressure ventilation for 5 days. His temperature is 36.8°C (98.2°F), pulse is 148/min, respirations are 63/min, and blood pressure is 60/32 mm Hg. Pulse oximetry on 40% oxygen shows an oxygen saturation of 91%. Examination shows moderate intercostal and subcostal retractions. Scattered crackles are heard in the thorax. An x-ray of the chest shows diffuse granular densities and basal atelectasis. Which of the following is the most likely diagnosis?? {'A': 'Tracheomalacia', 'B': 'Pneumonia', 'C': 'Bronchopulmonary dysplasia', 'D': 'Interstitial emphysema', 'E': 'Bronchiolitis obliterans\n"'},
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C: Bronchopulmonary dysplasia
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Answer the following medical question with one of the provided options:
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Q:A healthy 34-year-old woman comes to the physician for advice on UV protection. She works as an archaeologist and is required to work outside for extended periods of time. She is concerned about premature skin aging. The physician recommends sun-protective clothing and sunscreen. In order to protect effectively against photoaging, the sunscreen should contain which of the following active ingredients?? {'A': 'Trolamine salicylate', 'B': 'Trimethoprim/sulfamethoxazole', 'C': 'Vitamin E', 'D': 'Para-aminobenzoic acid', 'E': 'Zinc oxide'},
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E: Zinc oxide
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Answer the following medical question with one of the provided options:
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Q:A 68-year-old man comes to the physician because of a 6-week history of episodic tremors, headaches, and sweating. During this time, he has gained 2.5-kg (5 lb 8 oz). Two months ago, he was diagnosed with type 2 diabetes mellitus and treatment with an oral antidiabetic drug was initiated. The beneficial effect of the drug that was prescribed for this patient is most likely due to inhibition of which of the following?? {'A': 'ATP-sensitive potassium channels', 'B': 'Brush-border α-glucosidase', 'C': 'Sodium-glucose cotransporter-2', 'D': 'Glycerophosphate dehydrogenase', 'E': 'Dipeptidyl peptidase-4'},
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A: ATP-sensitive potassium channels
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Answer the following medical question with one of the provided options:
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Q:A 27-year-old woman presents to her primary care physician with a chief complaint of pain in her hands, shoulders, and knees. She states that the pain has lasted for several months but seems to have worsened recently. Any activity such as opening jars, walking, or brushing her teeth is painful. The patient has a past medical history of a suicide attempt in college, constipation, anxiety, depression, and a sunburn associated with surfing which was treated with aloe vera gel. Her temperature is 99.5°F (37.5°C), blood pressure is 137/78 mmHg, pulse is 92/min, respirations are 14/min, and oxygen saturation is 98% on room air. Laboratory values are obtained and shown below. Hemoglobin: 9 g/dL Hematocrit: 33% Leukocyte count: 2,500/mm^3 with normal differential Platelet count: 107,000/mm^3 Serum: Na+: 139 mEq/L Cl-: 102 mEq/L K+: 4.4 mEq/L HCO3-: 24 mEq/L BUN: 21 mg/dL Glucose: 90 mg/dL Creatinine: 1.0 mg/dL Ca2+: 10.2 mg/dL AST: 12 U/L ALT: 10 U/L Which of the following is the most likely to be found in this patient?? {'A': 'Anti-cyclic citrullinated peptide antibodies', 'B': 'Anti-dsDNA antibodies', 'C': 'Anti-histone antibodies', 'D': 'Degenerated cartilage in weight bearing joints', 'E': 'IgM against parvovirus B19'},
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B: Anti-dsDNA antibodies
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Answer the following medical question with one of the provided options:
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Q:A previously healthy 46-year-old man comes to the physician for an 8-month history of headache that is more severe in the mornings. His blood pressure is 151/92 mm Hg. Examination shows enlargement of the nose, forehead, and jaw as well as the hands, fingers, and feet. Ophthalmologic examination shows impaired vision in the outer peripheral fields of both eyes. Laboratory studies show a serum glucose concentration of 225 mg/dL. Which of the following findings is most likely to confirm the diagnosis?? {'A': 'Low serum growth hormone level', 'B': 'Elevated urine cortisol level', 'C': 'Low serum insulin level', 'D': 'Elevated serum prolactin level', 'E': 'Elevated serum insulin-like growth factor-1 level'},
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E: Elevated serum insulin-like growth factor-1 level
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Answer the following medical question with one of the provided options:
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Q:A 13-year-old boy is brought to the emergency department because of vomiting, diarrhea, abdominal pain, and dizziness for the past 3 hours with fever, chills, and muscle pain for the last day. He had presented 5 days ago for an episode of epistaxis caused by nasal picking and was treated with placement of anterior nasal packing. His parents report that the bleeding stopped, but they forgot to remove the nasal pack. His temperature is 40.0°C (104.0°F), pulse is 124/min, respirations are 28/min, and blood pressure is 96/68 mm Hg. He looks confused, and physical exam shows conjunctival and oropharyngeal hyperemia with a diffuse, erythematous, macular rash over the body that involves the palms and the soles. Removal of the anterior nasal pack shows hyperemia with purulent discharge from the underlying mucosa. Laboratory studies show: Total white blood cell count 30,000/mm3 (30 x 109/L) Differential count Neutrophils 90% Lymphocytes 8% Monocytes 1% Eosinophils 1% Basophils 0% Platelet count 95,000/mm3 (95 x 109/L) Serum creatine phosphokinase 400 IU/L What is the most likely diagnosis for this patient?? {'A': 'Disseminated gonococcal infection', 'B': 'Herpes simplex virus type 2 (HSV-2) meningitis', 'C': 'Toxic shock syndrome', 'D': 'Stevens-Johnson syndrome', 'E': 'Measles'},
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C: Toxic shock syndrome
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Answer the following medical question with one of the provided options:
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Q:A 56-year-old man presents with constipation and trouble urinating for the past day. He says that he tried drinking a lot of water but that did not help. He also says that he has been tired all the time recently. Past medical history is significant for schizophrenia, diagnosed 3 months ago, and being managed on antipsychotic medication. Current medications also include sildenafil. The vital signs include blood pressure 80/45 mm Hg, respiratory rate 23/min, heart rate 86/min and temperature 38.7°C (101.7°F). On physical examination, the patient appears agitated and confused. Which of the following medications is the most likely cause of this patient’s presentation?? {'A': 'Lithium', 'B': 'Haloperidol', 'C': 'Ziprasidone', 'D': 'Aripiprazole', 'E': 'Chlorpromazine'},
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E: Chlorpromazine
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Answer the following medical question with one of the provided options:
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Q:A 32-year-old woman comes to the physician because of a 3-month history of irregular menses, milky discharge from her nipples, fatigue, and weight gain. Menses occur at irregular 25–40-day intervals and last 1–2 days with minimal flow. 5 months ago, she was started on clozapine for treatment of schizophrenia. She has hypothyroidism but has not been taking levothyroxine over the past 6 months. Visual field examination show no abnormalities. Her serum thyroid-stimulating hormone is 17.0 μU/mL and serum prolactin is 85 ng/mL. Which of the following is the most likely explanation for the nipple discharge in this patient?? {'A': 'Hypothyroidism', 'B': 'Prolactinoma', 'C': 'Thyrotropic pituitary adenoma', 'D': 'Ectopic prolactin production', 'E': 'Adverse effect of medication'},
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A: Hypothyroidism
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Answer the following medical question with one of the provided options:
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Q:A 16-year-old Mexican female presents with symptoms of the common cold after the patient's respiratory epithelial cells were infected with Rhinovirus. Due to the presence of the virus, her respiratory epithelial cells begin producing interferon. Which is of the following is LEAST likely to be an outcome of the activation of the interferon response?? {'A': 'Decreased viral replication within the cell', 'B': 'A rhinovirus-specific, cell-mediated immune response', 'C': 'Upregulation of NK cell ligands on the infected cell', 'D': 'Activation of NK cells', 'E': 'Interferon binding to nearby uninfected epithelial cells'},
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B: A rhinovirus-specific, cell-mediated immune response
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Answer the following medical question with one of the provided options:
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Q:A 7-year-old boy is brought to the physician for evaluation of developmental delay and intellectual disability. He has been admitted to the hospital twice in the past 6 months because of a cerebral venous thrombosis and a pulmonary embolism, respectively. He is at 10th percentile for weight and 95th percentile for height. Physical examination shows bilateral downward and inward subluxation of the lenses. He has a high-arched palate and kyphosis. Laboratory studies show increased serum concentration of 5-methyltetrahydrofolate. Which of the following additional findings is most likely in this patient's serum?? {'A': 'Decreased cysteine concentration', 'B': 'Increased S-adenosylhomocysteine concentration', 'C': 'Decreased methionine concentration', 'D': 'Increased propionyl-CoA concentration', 'E': 'Decreased cystathionine concentration\n"'},
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C: Decreased methionine concentration
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Answer the following medical question with one of the provided options:
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Q:A 38-year-old man is brought to the emergency room because of diarrhea for 2 days. He has abdominal cramps and has also noticed a dark red tint to his stool. He returned from a trip to Mexico 3 weeks ago, where he completed a marathon. He has a history of mild anemia. He does not smoke and drinks 3–4 beers on weekends. He takes fish oil, a multivitamin, and iron supplements to improve his athletic performance. His temperature is 101.8°F (38.8°C), pulse is 65/min, and blood pressure is 120/75 mm Hg. Lungs are clear to auscultation. Cardiac examination shows no abnormalities. There is mild tenderness to palpation of the left lower quadrant without rebound or guarding. Laboratory studies show: Hematocrit 37.1% Leukocyte count 4,500/mm3 Platelet count 240,000/mm3 Serum Na+ 136 mEq/L K+ 4.5 mEq/L Cl- 102 mEq/L HCO3- 26 mEq/L Urea nitrogen 14 mg/dL Creatinine 1.2 mg/dL Stool culture demonstrates organisms with ingested erythrocytes. In addition to supportive therapy, which of the following is the most appropriate next step in management?"? {'A': 'Reassurance only', 'B': 'Praziquantel', 'C': 'Serological tests', 'D': 'Paromomycin', 'E': 'Metronidazole'},
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E: Metronidazole
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Answer the following medical question with one of the provided options:
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Q:A 46-year-old man presents to the clinic with a 2-week history of fever, fatigue, and coughing up blood. On questioning, he notes that he has also experienced some weight loss over the past 4 months and a change in the color of his urine, with intermittent passage of dark-colored urine during that time. The man does not have a prior history of cough or hemoptysis and has not been in contact with anyone with a chronic cough. The cough was originally productive of rust-colored sputum, but it has now progressed to the coughing up of blood and sputum at least twice daily. Sputum production is approximately 2 spoonfuls per coughing episode. Vital signs include: temperature 36.7°C (98.0°F), respiratory rate 42/min, and pulse 88/min. Physical examination reveals an anxious but tired-looking man with mild respiratory distress and mild pallor. Laboratory and antibody tests are ordered and the findings include the following: Laboratory test Hematocrit 34% Hepatitis antibody test negative Hepatitis C antibody test negative 24-hour urinary protein 2 g Urine microscopy more than 5 RBC under high power microscopy Antibody test C-ANCA negative Anti MPO/P-ANCA positive Serum urea 140 mg/dL Serum creatinine 2.8 mg/dL Renal biopsy shows glomerulonephritis with crescent formation. Which of the following is the most likely diagnosis in this patient?? {'A': 'Microscopic polyangiitis', 'B': 'Disseminated tuberculosis', 'C': 'Churg-Strauss syndrome', 'D': 'Granulomatosis with polyangiitis', 'E': 'Polyarteritis nodosa (PAN)'},
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A: Microscopic polyangiitis
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Answer the following medical question with one of the provided options:
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Q:A 47-year-old woman is brought to the emergency department by her husband with the complaints of severe abdominal pain and discomfort. The pain began 2 days earlier, she describes it as radiating to her back and is associated with nausea. Her past medical history is significant for similar episodes of pain after fatty meals that resolved on its own. She drinks socially and has a 15 pack-year smoking history. Her pulse is 121/min, blood pressure is 121/71 mm Hg, and her temperature is 103.1°F (39.5°C). She has tenderness in the right upper quadrant and epigastrium with guarding and rebound tenderness. Bowel sounds are hypoactive. Part of a CBC is given below. What is the next best step in the management of this patient? Hb%: 11 gm/dL Total count (WBC): 13,400/mm3 Differential count: Neutrophils: 80% Lymphocytes: 15% Monocytes: 5% ESR: 45 mm/hr C-reactive protein: 9.9 mg/dL (Normal < 3.0 mg/dL)? {'A': 'Ultrasound of the appendix', 'B': 'Erect abdominal X-ray', 'C': 'Ultrasound of the gallbladder', 'D': 'Upper GI endoscopy', 'E': 'Serum lipase levels'},
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C: Ultrasound of the gallbladder
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Answer the following medical question with one of the provided options:
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Q:A 62-year-old man is brought to the emergency department with a 2-day history of cough productive of yellowish sputum. He has had fever, chills, and worsening shortness of breath over this time. He has a 10-year history of hypertension and hyperlipidemia. He does not drink alcohol or smoke cigarettes. His current medications include atorvastatin, amlodipine, and metoprolol. His temperature is 38.9°C (102.0°F), pulse is 105/min, respirations are 27/min, and blood pressure is 110/70 mm Hg. He appears in mild distress. He has rales over the left lower lung field. The remainder of the examination shows no abnormalities. Leukocyte count is 15,000/mm3 (87% segmented neutrophils). Arterial blood gas analysis on room air shows: pH 7.44 pO2 68 mm Hg pCO2 28 mm Hg HCO3- 24 mEq/L O2 saturation 91% An x-ray of the chest shows a consolidation in the left lower lobe. Asking the patient to lie down in the left lateral decubitus position would most likely result in which of the following?"? {'A': 'Increased perfusion of right lung', 'B': 'Improve the hypoxemia', 'C': 'Worsen the hypocapnia', 'D': 'Decreased ventilation of the left lung', 'E': 'Increase in A-a gradient'},
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E: Increase in A-a gradient
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Answer the following medical question with one of the provided options:
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Q:A 41-year-old woman comes to the primary care physician’s office with a 7-day history of headaches, sore throat, diarrhea, fatigue, and low-grade fevers. The patient denies any significant past medical history, recent travel, or recent sick contacts. On review of systems, the patient endorses performing sex acts in exchange for money and recreational drugs over the last several months. You suspect primary HIV infection, but the patient refuses further evaluation. At a follow-up appointment 1 week later, she reports that she had been previously tested for HIV, and it was negative. Physical examination does not reveal any external abnormalities of her genitalia. Her heart and lung sounds are normal on auscultation. Her vital signs show a blood pressure of 123/82 mm Hg, heart rate of 82/min, and a respiratory rate of 16/min. Of the following options, which is the next best step in patient management?? {'A': 'Repeat rapid HIV at this office check-up', 'B': 'Retest with ELISA and Western blot in 1 year', 'C': 'Retest with ELISA and Western blot in 2.5–8.5 weeks and again in 6 months', 'D': 'Perform monospot test', 'E': 'Perform VDRL'},
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C: Retest with ELISA and Western blot in 2.5–8.5 weeks and again in 6 months
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Answer the following medical question with one of the provided options:
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Q:A 32-year-old woman comes to the physician because of flank pain, myalgia, and reddish discoloration of her urine for the past 2 days. One week ago, she had a fever and a sore throat and was prescribed antibiotics. She is otherwise healthy and has no history of serious illness. Her temperature is 37.9°C (100.2°F), pulse is 70/min, and blood pressure is 128/75 mm Hg. Physical examination shows a soft abdomen and no costovertebral angle tenderness. Examination of the mouth and pharynx shows no abnormalities. There is a faint maculopapular rash over the trunk and extremities. Serum creatinine is 2.4 mg/dL. Urinalysis shows: Protein 2+ Blood 2+ RBC 20–30/hpf WBC 12/hpf Bacteria none Which of the following is the most likely diagnosis?"? {'A': 'Allergic interstitial nephritis', 'B': 'Pyelonephritis', 'C': 'Crystal-induced acute kidney injury', 'D': 'Poststreptococcal glomerulonephritis', 'E': 'Thin basement membrane disease'},
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A: Allergic interstitial nephritis
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Answer the following medical question with one of the provided options:
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Q:An otherwise healthy 7-year-old boy is brought to the emergency department because of a 1-day history of involuntary muscle contractions and pain in his back and neck. Two weeks ago, he fell while playing in the sandbox and scraped both his knees. He has not received any vaccinations since birth. His temperature is 38.5°C (101.3°F). He is diaphoretic. Examination shows inability to open his mouth beyond 1 cm. There is hyperextension of the lumbar spine and resistance to neck flexion. Administration of which of the following would most likely have prevented this patient's current condition?? {'A': 'Capsular polysaccharides', 'B': 'Chemically-inactivated virus', 'C': 'Denaturated bacterial product', 'D': 'Human immunoglobulin against a viral protein', 'E': 'Viable but weakened microorganism'},
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C: Denaturated bacterial product
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Answer the following medical question with one of the provided options:
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Q:A 25-year-old construction worker presents to the office due to a yellowish discoloration of his skin and eyes for the past 2 weeks. He also complains of nausea and loss of appetite for the same duration. The past medical history is insignificant. He is a smoker, but recently has grown a distaste for smoking. The vital signs include: heart rate 83/min, respiratory rate 13/min, temperature 36.5°C (97.7°F), and blood pressure 111/74 mm Hg. On physical examination, there is mild hepatomegaly. The results of the hepatitis viral panel are as follows: Anti-HAV IgM positive HBsAg negative IgM anti-HBc negative Anti-HCV negative HCV-RNA negative Anti-HDV negative Anti-HEV negative What is the most common mode of transmission for this patient’s diagnosis?? {'A': 'Sexual contact', 'B': 'Fecal-oral', 'C': 'Blood transfusion', 'D': 'Perinatal', 'E': 'Breast milk'},
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B: Fecal-oral
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Answer the following medical question with one of the provided options:
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Q:A previously healthy 48-year-old man comes to the physician because of a 2-month history of weight loss and yellowing of the skin. He works as a farmer and cultivates soybean and corn. He does not smoke, drink alcohol, or use illicit drugs. His vital signs are within normal limits. Physical examination shows scleral icterus and tender hepatomegaly. Ultrasonography of the abdomen shows a 5-cm nodular lesion in the right lobe of the liver. Further evaluation of the lesion confirms hepatocellular carcinoma. The activity of which of the following enzymes most likely contributed to the pathogenesis of this patient's condition?? {'A': 'Peroxisomal catalases', 'B': 'Lysosomal serine proteases', 'C': 'Cytosolic cysteine proteases', 'D': 'Cytochrome P450 monooxygenases', 'E': 'Nuclear glycosylases'},
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D: Cytochrome P450 monooxygenases
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Answer the following medical question with one of the provided options:
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Q:A 66-year-old man presents to your office for a regular checkup. His only current complaint is periodic difficulty falling asleep at night. He takes captopril and hydrochlorothiazide for hypertension, atorvastatin for hyperlipidemia, and aspirin for cardiovascular disease prevention. His past medical history is significant for tympanoplasty performed 8 years ago for tympanic membrane rupture after an episode of purulent otitis media and intussusception that required surgical intervention 10 years ago. He also had a severe anaphylactic reaction after his 2nd Tdap administration 3 years ago. His blood pressure is 145/90 mm Hg, heart rate is 88/min, respiratory rate is 12/min, and temperature is 36.4°C (97.5°F). Physical examination only reveals a laterally displaced point of maximum impulse. Blood analysis shows the following findings: Sodium 139 mEq/L (139 mmol/L) Potassium 5.0 mEq/L (5.0 mmol/L) Chloride 100 mEq/L (100 mmol/L) Bicarbonate 22 mEq/L (22 mmol/L) Albumin 3.8 mg/dL (38 g/L) Urea nitrogen 8 mg/dL (2.86 mmol/L) Creatinine 2.1 mg/dL (0.185 mmol/l) Uric acid 5.8 mg/ dL (0.34 mmol/L) Calcium 8.9 mg/ dL (2.22 mmol/L) Glucose 106 mg/ dL (5.89 mmol/L) Total cholesterol 254 mg/dL (5.57 mmol/L) Low-density lipoprotein 58 mg/dL (1.5 mmol/L) High-density lipoprotein 77 mg/dL (2.0 mmol/L) Triglycerides 159 mg/dL (1.8 mmol/L) The patient is concerned about pneumococcal infection. He has never been vaccinated against pneumococcus, and he would like to get the appropriate vaccination. You advise him that he should not be vaccinated with PCV13 (pneumococcal conjugate vaccine) and should instead be administered PPSV23 (pneumococcal polysaccharide vaccine). Why is PCV13 contraindicated in this patient?? {'A': 'It is contraindicated in patients over the age of 65 years.', 'B': 'He has a history of intussusception.', 'C': 'He had an allergic reaction to the Tdap vaccination.', 'D': 'He takes aspirin.', 'E': 'He has hyperlipidemia.'},
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C: He had an allergic reaction to the Tdap vaccination.
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Answer the following medical question with one of the provided options:
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Q:A 29-year-old man comes to the physician because of a 3-day history of a swollen right knee. Over the past several weeks, he has had similar episodes affecting the right knee and sometimes also the left elbow, in which the swelling lasted an average of 5 days. He has a history of a rash that subsided 2 months ago. He lives in Connecticut with his wife and works as a landscaper. His temperature is 37.8°C (100°F), pulse is 90/min, respirations are 12/min, and blood pressure is 110/75 mm Hg. Physical examination shows a tender and warm right knee; range of motion is limited by pain. The remainder of the examination shows no abnormalities. His hematocrit is 44%, leukocyte count is 10,300/mm3, and platelet count is 145,000/mm3. Serum electrolyte concentrations are within normal limits. Arthrocentesis is performed and the synovial fluid is cloudy. Gram stain is negative. Analysis of the synovial fluid shows a leukocyte count of 70,000/mm3 and 80% neutrophils. Serologic testing confirms the diagnosis. Which of the following is the most likely cause?? {'A': 'Borrelia burgdorferi', 'B': 'Osteoarthritis', 'C': 'Rheumatoid arthritis', 'D': 'Neisseria gonorrhoeae', 'E': 'Campylobacter jejuni\n"'},
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A: Borrelia burgdorferi
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Answer the following medical question with one of the provided options:
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Q:A 25-year-old man comes to the physician for the evaluation of recurrent episodes of nosebleeds over the past 6 months. The nosebleeds occur spontaneously and stop after 10 minutes after pinching the nose at the nostrils. He has no history of serious illness except for prolonged bleeding following wisdom teeth extraction 2 years ago. He does not smoke or drink alcohol. He takes no medications. Vital signs are within normal limits. Examination of the nose shows no abnormalities. There are several bruises on the lower extremities. The remainder of the examination shows no abnormalities. Laboratory studies show: Hemoglobin 15 g/dL Leukocyte count 6,000/mm3 Platelet count 220,000/mm3 Bleeding time 9 minutes Prothrombin time 13 sec Partial thromboplastin time 55 sec Which of the following is the most likely diagnosis?"? {'A': 'Bernard-Soulier Syndrome', 'B': 'Wiskott-Aldrich syndrome', 'C': 'Hemophilia A', 'D': 'Factor X deficiency', 'E': 'Von Willebrand disease'},
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E: Von Willebrand disease
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Answer the following medical question with one of the provided options:
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Q:A 16-year-old girl is brought to the physician because of yellowish discoloration of her eyes and generalized fatigue since she returned from a 2-week class trip to Guatemala 2 days ago. During her time there, she had watery diarrhea, nausea, and lack of appetite for 3 days that resolved without treatment. She also took primaquine for malaria prophylaxis. Three weeks ago, she had a urinary tract infection that was treated with nitrofurantoin. Her immunizations are up-to-date. Her temperature is 37.1°C (98.8°F), pulse is 82/min and blood pressure is 110/74 mm Hg. Examination shows scleral icterus. There is no lymphadenopathy. The remainder of the examination shows no abnormalities. Laboratory studies show: Hemoglobin 12.1 g/dL Leukocyte count 6400/mm3 Platelet count 234,000/mm3 Reticulocyte count 1.1% Prothrombin time 12 sec (INR=1) Serum Bilirubin Total 2.8 mg/dL Direct 0.2 mg/dL Alkaline phosphatase 43 U/L AST 16 U/L ALT 17 U/L γ-Glutamyltransferase 38 U/L (N = 5–50) Anti-HAV IgG positive Anti-HBs positive A peripheral blood smear shows no abnormalities. Which of the following is the most likely diagnosis?"? {'A': "Gilbert's syndrome", 'B': 'Rotor syndrome', 'C': 'Dubin-Johnson syndrome', 'D': 'Hepatitis B infection', 'E': 'Crigler-Najjar syndrome\n"'},
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A: Gilbert's syndrome
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Answer the following medical question with one of the provided options:
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Q:A 48-year-old male chef presents to the dermatologist complaining of skin problems on his hands. They are itchy, red, and tender, making his work difficult. He has been using the same dish soap, hand soap, and industrial cleaner at work and at home for the past 5 years. There are no significant changes in his life, in his kitchen at work, or at home. He is otherwise healthy with no past medical or psychiatric history. He admits to enjoying his work and his family. He works at a fine dining restaurant with an immaculate kitchen with well-trained staff. He finds himself worrying about contamination. These thoughts are intrusive and upsetting. He admits to finding relief by washing his hands. He admits to washing his hands more than anyone else at the restaurant. Sometimes he takes 20 minutes to wash his hands. Sometimes he can’t get away from the sink to do his job because he is compelled to wash his hands over and over. Which of the following features is most correct regarding the patient’s psychiatric condition?? {'A': 'Patients generally have insight into their condition.', 'B': 'Disturbing thoughts are usually ego-syntonic.', 'C': 'There is no role for deep brain stimulation.', 'D': 'Behavioral treatment is not as effective as drug therapy.', 'E': 'Compulsions are logically related to the obsessions.'},
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A: Patients generally have insight into their condition.
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Answer the following medical question with one of the provided options:
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Q:A 27-year-old woman presents to her primary care physician for minor aches and pains in her bones and muscles. She states that these symptoms have persisted throughout her entire life but have worsened recently when she moved to attend college. The patient is physically active, and states that she eats a balanced diet. She is currently a full-time student and is sexually active with 1 partner. She states that she has been particularly stressed lately studying for final exams and occasionally experiences diarrhea. She has been taking acyclovir for a dermatologic herpes simplex virus infection with minimal improvement. On physical exam, the patient exhibits 4/5 strength in her upper and lower extremities, and diffuse tenderness over her limbs that is non-specific. Laboratory values are ordered as seen below: Serum: Na+: 144 mEq/L Cl-: 102 mEq/L K+: 4.7 mEq/L HCO3-: 24 mEq/L Ca2+: 5.0 Urea nitrogen: 15 mg/dL Glucose: 81 mg/dL Creatinine: 1.0 mg/dL Alkaline phosphatase: 225 U/L Aspartate aminotransferase (AST, GOT): 11 U/L Alanine aminotransferase (ALT, GPT): 15 U/L Which of the following is most likely associated with this patient’s presentation?? {'A': 'A history of anxiety/depression', 'B': 'Anaphylaxis when receiving a transfusion', 'C': 'Premature ovarian failure', 'D': 'Rash over the metacarpophalangeal joints', 'E': 'Sleep deprivation'},
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B: Anaphylaxis when receiving a transfusion
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Q:A 65-year-old man presents to his primary care physician for a yearly checkup. He states he feels he has been in good health other than minor fatigue, which he attributes to aging. The patient has a past medical history of hypertension and is currently taking chlorthalidone. He drinks 1 glass of red wine every night. He has lost 5 pounds since his last appointment 4 months ago. His temperature is 99.2°F (37.3°C), blood pressure is 147/98 mmHg, pulse is 80/min, respirations are 14/min, and oxygen saturation is 99% on room air. Physical exam reveals an obese man in no acute distress. Laboratory values are ordered as seen below. Hemoglobin: 9 g/dL Hematocrit: 27% Mean corpuscular volume: 72 µm^3 Leukocyte count: 6,500/mm^3 with normal differential Platelet count: 193,000/mm^3 Serum: Na+: 139 mEq/L Cl-: 101 mEq/L K+: 4.3 mEq/L HCO3-: 25 mEq/L BUN: 20 mg/dL Glucose: 99 mg/dL Creatinine: 1.1 mg/dL Ca2+: 9.0 mg/dL AST: 32 U/L ALT: 20 U/L 25-OH vitamin D: 15 ng/mL Which of the following is the best next step in management?? {'A': 'Colonoscopy', 'B': 'Counseling for alcohol cessation', 'C': 'Exercise regimen and weight loss', 'D': 'Iron supplementation', 'E': 'Vitamin D supplementation'},
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A: Colonoscopy
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Q:A 19-year-old man comes to the physician because of a 2 day history of blood-speckled stools and a protruding rectal mass. He has no abdominal pain, altered bowel habits, or fever. His mother has inflammatory bowel disease. His vital signs are within normal limits. Examination shows multiple, small, hyperpigmented maculae on the lips, buccal mucosa, palms, and soles. The abdomen is soft with no organomegaly. Rectal examination shows a 4-cm pedunculated polyp with superficial excoriations on the mucosa. A colonoscopy shows 14 polyps. A biopsy shows hamartomatous mucosal polyps. This patient's diagnosis is most likely associated with which of the following conditions?? {'A': 'Medulloblastoma', 'B': 'Enterovesicular fistula', 'C': 'Pancreatic carcinoma', 'D': 'Esophageal varices', 'E': 'Alopecia'},
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C: Pancreatic carcinoma
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Q:A 26-year-old woman with poor prenatal care and minimal antenatal screening presents to the emergency department in labor. Shortly thereafter, she delivers a baby girl who subsequently demonstrates symptoms of chorioretinitis on examination. A series of postpartum screening questions is significant only for the presence of multiple cats in the mother’s household. The clinical team orders an enhanced MRI examination of the infant’s brain which reveals hydrocephalus, multiple punctate intracranial calcifications, and 2 sub-cortical ring-enhancing lesions. Which is the most likely diagnosis?? {'A': 'Toxoplasmosis', 'B': 'CMV', 'C': 'Rubella', 'D': 'HSV', 'E': 'Syphilis'},
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A: Toxoplasmosis
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Q:A 35-year-old woman with no significant past medical, past surgical, family or social history presents to clinic with a recently identified area of flat, intact, pigmented skin. The patient believes that this is a large freckle, and she states that it becomes darker during the summer when she is outdoors. On physical examination, you measure the lesion to be 6 mm in diameter. Which of the following is the best descriptor of this patient’s skin finding?? {'A': 'Papule', 'B': 'Macule', 'C': 'Plaque', 'D': 'Wheal', 'E': 'Ulcer'},
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B: Macule
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Q:A 31-year-old female presents to her primary care physician with mild anxiety and complaints of mood swings lasting several months. The patient reports that the mood swings affect her work and personal relationships. In addition, she complains of increased irritability, breast tenderness, bloating, fatigue, binge-eating, and difficulty concentrating for 10 days prior to her menstrual period. The patient's symptoms increase in severity with the approach of menses but resolve rapidly on the first day of menses. She states that she is very sensitive to criticism of her work by others. She also snaps at her children and her husband. She has tried yoga to unwind, but with limited improvement. She is concerned that her behavior is affecting her marriage. The patient has no past medical history, and has regular periods every 24 days. She has had two normal vaginal deliveries. She uses condoms for contraception. Her mother has major depressive disorder. The physical exam is unremarkable. What is the most appropriate next step in the treatment of this patient?? {'A': 'Anxiolytic therapy', 'B': 'Selective serotonin reuptake inhibitors (SSRIs)', 'C': 'Oral contraceptive and nonsteroidal anti-inflammatory drugs (NSAIDs)', 'D': 'Gonadotropin-releasing hormone (GnRH) agonists', 'E': 'Nonserotonergic antidepressants'},
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C: Oral contraceptive and nonsteroidal anti-inflammatory drugs (NSAIDs)
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Q:A 43-year-old woman comes to the physician for an annual health maintenance examination. On questioning, she has had fatigue and headaches for the last month. A few weeks ago, she had to have her wedding ring resized because it had become too small for her finger. She has mild persistent asthma and anxiety disorder. She drinks 2–3 glasses of red wine per night and has smoked one pack of cigarettes daily for 16 years. She works a desk job in accounting and has recently been working long hours due to an upcoming company merger. Her father has a history of a pituitary adenoma. Current medications include alprazolam, a fluticasone inhaler, and an albuterol inhaler. She is 160 cm (5 ft 3 in) tall and weighs 81.6 kg (180 lb); her BMI is 32 kg/m2. Her temperature is 37.2°C (99°F), pulse is 92/min, and blood pressure is 132/80 mm Hg. Examination shows no abnormalities. Fasting laboratory studies show: Hemoglobin 13 g/dL Serum Na+ 135 mEq/L K+ 4.6 mEq/L Cl- 105 mEq/L HCO3- 22 mEq/L Urea nitrogen 17 mg/dL Glucose 160 mg/dL Creatinine 0.9 mg/dL Which of the following is the most likely underlying mechanism of this patient's hyperglycemia?"? {'A': 'Decreased insulin production', 'B': 'Adverse effect of medication', 'C': 'Stress', 'D': 'Hypersecretion of ACTH', 'E': 'Insulin resistance'},
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E: Insulin resistance
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Q:A 24-year-old professional athlete is advised to train in the mountains to enhance his performance. After 5 months of training at an altitude of 1.5 km (5,000 feet), he is able to increase his running pace while competing at sea-level venues. Which of the following changes would produce the same effect on the oxygen-hemoglobin dissociation curve as this athlete's training did?? {'A': 'Decreased pH', 'B': 'Decreased temperature', 'C': 'Decreased 2,3-bisphosphoglycerate', 'D': 'Increased carbon monoxide inhalation', 'E': 'Increased partial pressure of oxygen'},
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A: Decreased pH
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Q:A scientist in Chicago is studying a new blood test to detect Ab to the EBV virus with increased sensitivity and specificity. So far, her best attempt at creating such an exam reached 82% sensitivity and 88% specificity. She is hoping to increase these numbers by at least 2 percent for each value. After several years of work, she believes that she has actually managed to reach a sensitivity and specificity much greater than what she had originally hoped for. She travels to China to begin testing her newest blood test. She finds 2,000 patients who are willing to participate in her study. Of the 2,000 patients, 1,200 of them are known to be infected with the EBV virus. The scientist tests these 1,200 patients’ blood and finds that only 120 of them tested negative with her new exam. Of the patients who are known to be EBV-free, only 20 of them tested positive. Given these results, which of the following correlates with the exam’s specificity?? {'A': '82%', 'B': '84%', 'C': '86%', 'D': '90%', 'E': '98%'},
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E: 98%
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Q:A 49-year-old man comes to the emergency department because of recurrent abdominal pain for 1 week. The pain is worse after eating and he has vomited twice during this period. He was hospitalized twice for acute pancreatitis during the past year; the latest being 2 months ago. There is no family history of serious illness. His only medication is a vitamin supplement. He has a history of drinking five beers a day for several years but quit 1 month ago. His temperature is 37.1°C (98.8°F), pulse is 98/min and blood pressure 110/70 mm Hg. He appears uncomfortable. Examination shows epigastric tenderness to palpation; there is no guarding or rebound. A CT scan of the abdomen shows a 6-cm low attenuation oval collection with a well-defined wall contiguous with the body of the pancreas. Which of the following is the most appropriate next step in management?? {'A': 'Magnetic resonance cholangiopancreatography', 'B': 'CT-guided percutaneous drainage', 'C': 'Middle segment pancreatectomy', 'D': 'Distal pancreatectomy', 'E': 'Laparoscopic surgical drainage'},
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B: CT-guided percutaneous drainage
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Q:A 65-year-old non-smoking woman with no symptoms comes to your clinic to establish care with a primary care provider. She hasn’t seen a doctor in 12 years and states that she feels very healthy. You realize that guidelines by the national cancer organization suggest that she is due for some cancer screening tests, including a mammogram for breast cancer, a colonoscopy for colon cancer, and a pap smear for cervical cancer. These three screening tests are most likely to be considered which of the following?? {'A': 'Primary prevention', 'B': 'Secondary prevention', 'C': 'Tertiary prevention', 'D': 'Quaternary prevention', 'E': 'Cancer screening does not fit into these categories'},
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B: Secondary prevention
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Q:A 14-year-old boy comes to the physician because of multiple patches on his trunk and thighs that are lighter than the rest of his skin. He also has similar depigmented lesions on his hands and feet and around the mouth. The patches have gradually increased in size over the past 2 years and are not associated with itchiness, redness, numbness, or pain. His family emigrated from Indonesia 8 years ago. An image of the skin lesions is shown. What is the most likely cause of this patient's skin findings?? {'A': 'Malassezia globosa infection', 'B': 'Autoimmune melanocyte destruction', 'C': 'Increased mTOR signalling', 'D': 'Mycobacterum leprae infection', 'E': 'Postinflammatory depigmentation\n"'},
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B: Autoimmune melanocyte destruction
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Q:A physician at an internal medicine ward notices that several of his patients have hyponatremia without any associated symptoms. Severe hyponatremia, often defined as < 120 mEq/L, is associated with altered mental status, coma, and seizures, and warrants treatment with hypertonic saline. Because some patients are chronically hyponatremic, with serum levels < 120 mEq/L, but remain asymptomatic, the physician is considering decreasing the cutoff for severe hyponatremia to < 115 mEq/L. Changing the cutoff to < 115 mEq/L would affect the validity of serum sodium in predicting severe hyponatremia requiring hypertonic saline in which of the following ways?? {'A': 'Increased specificity and decreased negative predictive value', 'B': 'Decreased specificity and increased negative predictive value', 'C': 'Increased sensitivity and decreased positive predictive value', 'D': 'Decreased sensitivity and decreased positive predictive value', 'E': 'Increased specificity and decreased positive predictive value'},
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A: Increased specificity and decreased negative predictive value
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Q:A husband and wife consult a geneticist after an IUFD (intrauterine fetal demise). They both have achondroplasia. This would have been their 3rd child and 1st loss. Their 1st son also has achondroplasia while their daughter is phenotypically normal and is expected to grow to a normal height. The displayed pedigree is drawn and considers the severity of the proposed skeletal disorder. Both patients were adopted and do not know if their parents were affected (generation 1). Which of the following is the best interpretation of this pedigree?? {'A': 'All members of the 2nd generation are compound heterozygotes', 'B': 'One half of the children are unaffected', 'C': 'The penetrance of this disorder can be described as incomplete', 'D': 'The disorder is likely completely dominant', 'E': 'There is a 75% chance of having a viable offspring'},
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E: There is a 75% chance of having a viable offspring
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Q:For which of the following patients would you recommend prophylaxis against mycobacterium avium-intracellulare?? {'A': '22-year old HIV positive female with CD4 count of 750 cells/ microliter and a viral load of 500,000 copies/mL', 'B': '30-year old HIV positive male with CD4 count of 20 cells/ microliter and a viral load of < 50 copies/mL', 'C': '45-year old HIV positive female with CD4 count of 250 cells/ microliter and a viral load of 100,000 copies/mL', 'D': '50-year old HIV positive female with CD4 count of 150 cells/ microliter and a viral load of < 50 copies/mL', 'E': '36-year old HIV positive male with CD4 count of 75 cells/microliter and an undetectable viral load.'},
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B: 30-year old HIV positive male with CD4 count of 20 cells/ microliter and a viral load of < 50 copies/mL
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Q:A 10-year-old girl is brought to the emergency department because of a 2-day history of bloody diarrhea and abdominal pain. Four days ago, she visited a petting zoo with her family. Her temperature is 39.4°C (102.9°F). Abdominal examination shows tenderness to palpation of the right lower quadrant. Stool cultures at 42°C grow colonies that turn black after adding phenylenediamine. Which of the following best describes the most likely causal organism?? {'A': 'Gram-negative, non-flagellated bacteria that do not ferment lactose', 'B': 'Gram-positive, anaerobic, rod-shaped bacteria that form spores', 'C': 'Gram-negative, flagellated bacteria that do not ferment lactose', 'D': 'Gram-positive, aerobic, rod-shaped bacteria that produce catalase', 'E': 'Gram-positive, aerobic, rod-shaped bacteria that form spores\n"'},
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C: Gram-negative, flagellated bacteria that do not ferment lactose
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Q:A 6-week-old girl is brought to a pediatrician due to feeding difficulty for the last 4 days. Her mother mentions that the infant breathes rapidly and sweats profusely while nursing. She has been drinking very little breast milk and stops feeding as if she is tired, only to start sucking again after a few minutes. There is no history of cough, sneezing, nasal congestion, or fever. She was born at full term and her birth weight was 3.2 kg (7.0 lb). Her temperature is 37.0°C (98.6°F), pulse rate is 190/min, and respiratory rate is 64/min. On chest auscultation, bilateral wheezing is present. A precordial murmur starts immediately after the onset of the first heart sound (S1), reaching its maximal intensity at the end of systole, and waning during late diastole. The murmur is best heard over the second left intercostal space and radiates to the left clavicle. The first heart sound (S1) is normal, while the second heart sound (S2) is obscured by the murmur. Which of the following is the most likely diagnosis?? {'A': 'Aortopulmonary window', 'B': 'Congenital mitral insufficiency', 'C': 'Patent ductus arteriosus', 'D': 'Supracristal ventricular septal defect with aortic regurgitation', 'E': 'Ruptured congenital sinus of Valsalva aneurysm'},
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C: Patent ductus arteriosus
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Answer the following medical question with one of the provided options:
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Q:A research group designed a study to investigate the epidemiology of syphilis in the United States. After a review of medical records, the investigators identified patients who were active cocaine users, but did not have a history of syphilis. They subsequently examined the patient's medical charts to determine whether this same group of patients was more likely to develop syphilis over a 6-month period. The investigators ultimately found that the rate of syphilis was 30% higher in patients with active cocaine use compared to patients without cocaine use. This study is best described as which of the following?? {'A': 'Prospective cohort study', 'B': 'Case-control study', 'C': 'Meta-analysis', 'D': 'Cross-sectional study', 'E': 'Retrospective cohort study'},
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E: Retrospective cohort study
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Q:A 16-year-old college student presents to the emergency department with a 3-day history of fever, muscle rigidity, and confusion. He was started on a new medication for schizophrenia 2 months ago. There is no history of sore throat, burning micturition, or loose motions. At the hospital, his temperature is 38.6°C (101.5°F); the blood pressure is 108/62 mm Hg; the pulse is 120/min, and the respiratory rate is 16/min. His urine is cola-colored. On physical examination, he is sweating profusely. Treatment is started with antipyretics and intravenous hydration. Which of the following is most likely responsible for this patient's condition?? {'A': 'Amantadine', 'B': 'Chlorpromazine', 'C': 'Diazepam', 'D': 'Levodopa', 'E': 'Phenytoin'},
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B: Chlorpromazine
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Q:A 3-month-old infant who lives in an old house is brought to the emergency department because of lethargy and skin discoloration that started after he was fed some locally prepared baby food being sold in a farmer's market. On presentation, he appears to be irritable and responds slowly to stimuli. Physical exam reveals rapid, labored breaths and a blue tinge to the infant's skin. A blood sample drawn for electrolyte testing is found to be darker than normal. Treatment for which of the following intoxications could result in a similar presentation?? {'A': 'Carbon monoxide', 'B': 'Cyanide', 'C': 'Lead', 'D': 'Methanol', 'E': 'Salicylates'},
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B: Cyanide
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Q:A 27-year-old man comes to the physician because of pain and swelling in his right knee that began 3 days ago when he fell during football practice. He fell on his flexed right knee as he dove to complete a pass. He felt some mild knee pain but continued to practice. Over the next 2 days, the pain worsened and the knee began to swell. Today, the patient has an antalgic gait. Examination shows a swollen and tender right knee; flexion is limited by pain. The right knee is flexed and pressure is applied to proximal tibia; 8 mm of backward translation of the foreleg is observed. Which of the following is most likely injured?? {'A': 'Posterior cruciate ligament', 'B': 'Anterior cruciate ligament', 'C': 'Medial collateral ligament', 'D': 'Lateral collateral ligament', 'E': 'Lateral meniscus'},
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A: Posterior cruciate ligament
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Q:A 31-year-old G1P0000 presents to her obstetrician for her first prenatal visit after having a positive home pregnancy test one week ago. She states that her last menstrual period was 8 weeks ago. The patient has a past medical history of type I diabetes mellitus since childhood and is on insulin. Her hemoglobin A1c two weeks ago was 13.7%. At that time, she was also found to have microalbuminuria on routine urinalysis, and her primary care provider prescribed lisinopril but the patient has not yet started taking it. The patient’s brother is autistic, but family history is otherwise unremarkable. At this visit, her temperature is 98.6°F (37.0°C), blood pressure is 124/81 mmHg, pulse is 75/min, and respirations are 14/min. Exam is unremarkable. This fetus is at increased risk for which of the following?? {'A': 'Aneuploidy', 'B': 'Post-term delivery', 'C': 'Neural tube defect', 'D': 'Neonatal hyperglycemia', 'E': 'Oligohydramnios'},
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C: Neural tube defect
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Q:A 59-year-old woman comes to the physician because of left leg swelling that started after a transcontinental flight. A duplex ultrasound of the left leg shows a noncompressible popliteal vein. A drug is prescribed that inhibits the coagulation cascade. Two weeks later, laboratory studies show: Platelet count 210,000/mm3 Partial thromboplastin time 53 seconds Prothrombin time 20 seconds Thrombin time 15 seconds (control: 15 seconds) Which of the following drugs was most likely prescribed?"? {'A': 'Alteplase', 'B': 'Aspirin', 'C': 'Unfractionated heparin', 'D': 'Apixaban', 'E': 'Low molecular weight heparin'},
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D: Apixaban
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Answer the following medical question with one of the provided options:
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Q:A 28-year-old woman presents with depressed mood lasting for most days of the week for the past month. She also mentions that she has lost her appetite for the past 3 weeks. She adds that her job performance has significantly deteriorated because of these symptoms, and she feels like she will have to quit her job soon. Upon asking about her hobbies, she says that she used to enjoy dancing and music but does not have any desire to do them anymore. The patient’s husband says that she has had many sleepless nights last month. The patient denies any history of smoking, alcohol intake, or use of illicit substances. No significant past medical history. Physical examination is unremarkable. Routine laboratory tests are all within normal limits. Which of the following clinical features must be present, in addition to this patient’s current symptoms, to confirm the diagnosis of a major depressive episode?? {'A': 'Weight loss', 'B': 'Lack of concentration', 'C': 'Nightmares', 'D': 'Intense fear of losing control', 'E': 'Anterograde amnesia'},
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B: Lack of concentration
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Answer the following medical question with one of the provided options:
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Q:A randomized controlled trial is conducted investigating the effects of different diagnostic imaging modalities on breast cancer mortality. 8,000 women are randomized to receive either conventional mammography or conventional mammography with breast MRI. The primary outcome is survival from the time of breast cancer diagnosis. The conventional mammography group has a median survival after diagnosis of 17.0 years. The MRI plus conventional mammography group has a median survival of 19.5 years. If this difference is statistically significant, which form of bias may be affecting the results?? {'A': 'Selection bias', 'B': 'Misclassification bias', 'C': 'Lead-time bias', 'D': 'Recall bias', 'E': 'Because this study is a randomized controlled trial, it is free of bias'},
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C: Lead-time bias
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Q:A 40-year-old female visits the emergency department with right upper quadrant pain and fever of 2-hours duration. She denies alcohol, cigarette, and drug use and reports no other medical problems. Body mass index is 30 kg/m^2. Her temperature is 38.5 degrees Celsius (101.3 degrees Fahrenheit), blood pressure is 130/80 mm Hg, pulse is 90/min, and respirations are 18/min. Jaundice is present in the sclera and at the base of the tongue. The abdomen is tender in the right upper quadrant. Liver function test (LFTs) reveal elevated direct and total bilirubin and alkaline phosphatase of 500 U/L. IV Ampicillin-gentamicin is administered, fluid resuscitation is initiated, and over 24 hours the patient’s fever improves. Which of the following is the next step in the management of this patient:? {'A': 'Elective laparoscopic cholecystectomy', 'B': 'Urgent open cholecystectomy', 'C': 'Endoscopic retrograde cholangiopancreatography (ERCP)', 'D': 'Administer bile acids', 'E': 'Extracorporeal shock wave lithotripsy'},
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C: Endoscopic retrograde cholangiopancreatography (ERCP)
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Answer the following medical question with one of the provided options:
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Q:A 52-year-old woman is brought to the emergency department by fire and rescue after being involved in a motor vehicle accident. The paramedics report that the patient’s car slipped off the road during a rainstorm and rolled into a ditch. The patient was restrained and the airbags deployed during the crash. The patient has a past medical history of hypertension, hyperlipidemia, hypothyroidism, and gout. Her home medications include hydrochlorothiazide, simvastatin, levothyroxine, and allopurinol. The patient is alert on the examination table. Her temperature is 98.2°F (36.8°C), blood pressure is 83/62 mmHg, pulse is 131/min, respirations are 14/min, and SpO2 is 96%. She has equal breath sounds in all fields bilaterally. Her skin is cool with diffuse bruising over her abdomen and superficial lacerations, and her abdomen is diffusely tender to palpation. She is moving all four extremities equally. The patient’s FAST exam is equivocal. She is given several liters of intravenous fluid during her trauma evaluation but her blood pressure does not improve. Which of the following is the best next step?? {'A': 'Chest radiograph', 'B': 'Abdominal CT', 'C': 'Diagnostic peritoneal lavage', 'D': 'Diagnostic laparoscopy', 'E': 'Emergency laparotomy'},
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C: Diagnostic peritoneal lavage
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Answer the following medical question with one of the provided options:
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Q:A 24-year-old healthy male presents to the emergency room complaining of severe abdominal pain. He reports that he was playing rugby for his college team when he was tackled on his left side by a member of the opposing team. He is currently experiencing severe left upper abdominal pain and left shoulder pain. A review of his medical record reveals that he was seen by his primary care physician two weeks ago for mononucleosis. His temperature is 99°F (37.2°C), blood pressure is 90/50 mmHg, pulse is 130/min, and respirations are 26/min. He becomes increasingly lethargic over the course of the examination. He demonstrates exquisite tenderness to palpation over the left 8th, 9th, and 10th ribs as well as rebound tenderness in the abdomen. He is eventually stabilized and undergoes definitive operative management. After this patient recovers, which of the following is most likely to be found on a peripheral blood smear in this patient?? {'A': 'Basophilic nuclear remnants', 'B': 'Erythrocyte fragments', 'C': 'Erythrocytes lacking central pallor', 'D': 'Inclusions of denatured hemoglobin', 'E': 'Basophilic stippling'},
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A: Basophilic nuclear remnants
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Q:A 28-year-old man is brought to the emergency department after he was found half dressed and incoherent in the middle of the road. In the emergency department he states that he has not slept for 36 hours and that he has incredible ideas that will make him a billionaire within a few months. He also states that secret agents from Russia are pursuing him and that he heard one of them speaking through the hospital intercom. His past medical history is significant only for a broken arm at age 13. On presentation, his temperature is 102.2°F (39°C), blood pressure is 139/88 mmHg, pulse is 112/min, and respirations are 17/min. Physical exam reveals pupillary dilation and psychomotor agitation. Which of the following mechanisms is most likely responsible for this patient's symptoms?? {'A': '5-HT receptor agonist', 'B': 'Gamma-aminobutyric acid receptor agonist', 'C': 'Increased biogenic amine release', 'D': 'N-methyl-D-aspartate receptor antagonist', 'E': 'Opioid receptor agonist'},
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C: Increased biogenic amine release
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Answer the following medical question with one of the provided options:
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Q:Thirty minutes after normal vaginal delivery of twins, a 35-year-old woman, gravida 5, para 4, has heavy vaginal bleeding with clots. Physical examination shows a soft, enlarged, and boggy uterus. Despite bimanual uterine massage, administration of uterotonic drugs, and placement of an intrauterine balloon for tamponade, the bleeding continues. A hysterectomy is performed. Vessels running through which of the following structures must be ligated during the surgery to achieve hemostasis?? {'A': 'Suspensory ligament', 'B': 'Uterosacral ligament', 'C': 'Cardinal ligament', 'D': 'Round ligament', 'E': 'Ovarian ligament'},
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C: Cardinal ligament
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Answer the following medical question with one of the provided options:
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Q:A scientist is working on creating synthetic hemoglobin that can be used to replace blood loss in humans. She therefore starts to study the behavior of this artificial hemoglobin in terms of its ability to bind oxygen. She begins by measuring the affinity between this synthetic hemoglobin and oxygen in a purified system before introducing modifications to this system. Specifically, she reduces the level of carbon dioxide in the system to mimic conditions within the lungs and plots an affinity curve. Which of the following should be observed in this artificial hemoglobin if it mimics the behavior of normal hemoglobin?? {'A': 'Left-shifted curve and decreased oxygen binding', 'B': 'Left-shifted curve and increased oxygen binding', 'C': 'No shift in the curve and increased oxygen binding', 'D': 'Right-shifted curve and decreased oxygen binding', 'E': 'Right-shifted curve and increased oxygen binding'},
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B: Left-shifted curve and increased oxygen binding
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Q:A 32-year-old female comes to the physician because of recurrent episodes of abdominal pain, bloating, and loose stools lasting several days to a couple weeks. She has had these episodes since she was 24 years old but they have worsened over the last 6 weeks. The site of the abdominal pain and the intensity of pain vary. She has around 3–4 bowel movements per day during these episodes. Menses are regular at 31 day intervals with moderate flow; she has moderate pain in her lower abdomen during menstruation. She moved from a different city 2 months ago to start a new demanding job. Her mother has been suffering from depression for 10 years. She does not smoke or drink alcohol. Her own medications include multivitamins and occasionally naproxen for pain. Temperature is 37.4°C (99.3°F), pulse is 88/min, and blood pressure is 110/82 mm Hg. Abdominal examination shows no abnormalities. Laboratory studies show: Hemoglobin 14.1 g/dL Leukocyte count 8100/mm3 Erythrocyte sedimentation rate 15 mm/h Serum Glucose 96 mg/dL Creatinine 1.1 mg/dL IgA anti-tissue transglutaminase antibody negative Urinalysis shows no abnormalities. Further evaluation is most likely to show which of the following in this patient?"? {'A': 'Cutaneous flushing', 'B': 'Weight loss', 'C': 'Bright red blood in the stool', 'D': 'Relief of abdominal pain after defecation', 'E': 'Abdominal pain at night'},
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D: Relief of abdominal pain after defecation
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Answer the following medical question with one of the provided options:
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Q:A 59-year-old man comes to the physician because of a 1-year history of increased urinary frequency, weak urinary stream, and occasional straining to void urine. Rectal examination shows a large, nontender prostate without asymmetry or nodularity. His serum creatinine, prostate-specific antigen, and urinalysis are all within the reference range. A diagnosis of benign prostatic hyperplasia is made, and treatment with tamsulosin is begun. Which of the following changes in intracellular messaging is most likely to occur in response to this drug?? {'A': 'Decreased activity of protein kinase A', 'B': 'Increased production of diacylglycerol', 'C': 'Increased activity of protein kinase C', 'D': 'Decreased activity of phospholipase C', 'E': 'Increased activity of adenylyl cyclase\n"'},
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D: Decreased activity of phospholipase C
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Answer the following medical question with one of the provided options:
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Q:A 25-year-old woman presents to the emergency department with fatigue and weakness. She states over the past 24 hours she has not felt like herself and has felt like she has no strength. The patient has no significant past medical history other than a single episode of blood-tinged diarrhea 1 week ago which resolved on its own. Her temperature is 99.4°F (37.4°C), blood pressure is 124/62 mmHg, pulse is 95/min, respirations are 29/min, and oxygen saturation is 95% on room air. Physical exam is notable for 2/5 strength of the lower extremities and decreased sensation in the lower extremities and finger tips. Which of the following is the best initial step in management?? {'A': 'Dexamethasone', 'B': 'Intubation', 'C': 'IV immunoglobulin', 'D': 'Pyridostigmine', 'E': 'Spirometry'},
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E: Spirometry
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Answer the following medical question with one of the provided options:
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Q:A 47-year-old woman presents to the clinic complaining of bilateral eye pain for the past 2 days. The pain is described initially as “sand in the eye” but is now a sharp, stabbing pain. She denies any trauma, irritation, or new facial care products but endorses some joint pain in her fingers. Her past medical history includes diabetes diagnosed 5 years ago. A physical examination demonstrates some swelling of the cheeks bilaterally. A slit lamp examination with fluorescein stain shows a yellow-green lesion. What is the most specific antibody that characterizes this disease?? {'A': 'Antinuclear antibodies', 'B': 'Anti-Ro antibodies', 'C': 'Anti-Scl-70 antibodies', 'D': 'Anti-SRP antibodies', 'E': 'Anti-U1 RNP antibodies'},
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B: Anti-Ro antibodies
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Answer the following medical question with one of the provided options:
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Q:A 72-year-old man comes to the emergency department because of blurry vision for the past 3 days. He has also had 4 episodes of right-sided headaches over the past month. He has no significant past medical history. His father died of coronary artery disease at the age of 62 years. His temperature is 37.2°C (99°F), pulse is 94/min, and blood pressure is 232/128 mm Hg. Fundoscopy shows right-sided optic disc blurring and retinal hemorrhages. A medication is given immediately. Five minutes later, his pulse is 75/min and blood pressure is 190/105 mm Hg. Which of the following drugs was most likely administered?? {'A': 'Labetalol', 'B': 'Hydralazine', 'C': 'Fenoldopam', 'D': 'Nicardipine', 'E': 'Nitroprusside'},
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A: Labetalol
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Answer the following medical question with one of the provided options:
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Q:A 6-month-old girl presents to an outpatient office for a routine physical. She can sit momentarily propped on her hands, babbles with consonants, and transfers objects hand to hand. The pediatrician assures the parents that their daughter has reached appropriate developmental milestones. Which additional milestone would be expected at this stage in development?? {'A': 'Engaging in pretend play', 'B': 'Separation anxiety', 'C': 'Showing an object to her parents to share her interest in that object', 'D': 'Starts to share', 'E': 'Stranger anxiety'},
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E: Stranger anxiety
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Answer the following medical question with one of the provided options:
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Q:An 11-year-old boy who recently emigrated from Ukraine is brought to the physician for the evaluation of failure to thrive. Genetic analysis shows the deletion of the 508th codon in a gene on chromosome 7. The deletion results in defective post-translational folding of a protein and retention of the misfolded protein in the rough endoplasmic reticulum. The activity of which of the following channels is most likely to be increased as a result of the defect?? {'A': 'Bicarbonate channels of pancreatic ductal cells', 'B': 'Calcium channels of distal tubular cells', 'C': 'Sodium channels of respiratory epithelial cells', 'D': 'Chloride channels of epithelial cells in sweat glands', 'E': 'ATP-sensitive potassium channels of pancreatic beta cells\n"'},
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C: Sodium channels of respiratory epithelial cells
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Answer the following medical question with one of the provided options:
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Q:A newborn is evaluated by the on-call pediatrician. She was born at 33 weeks gestation via spontaneous vaginal delivery to a 34-year-old G1P1. The pregnancy was complicated by poorly controlled diabetes mellitus type 2. Her birth weight was 3,700 g and the appearance, pulse, grimace, activity, and respiration (APGAR) scores were 7 and 8 at 1 and 5 minutes, respectively. The umbilical cord had 3 vessels and the placenta was tan-red with all cotyledons intact. Fetal membranes were tan-white and semi-translucent. The normal-appearing placenta and cord were sent to pathology for further evaluation. On physical exam, the newborn’s vital signs include: temperature 36.8°C (98.2°F), blood pressure 60/44 mm Hg, pulse 185/min, and respiratory rate 74/min. She presents with nasal flaring, subcostal retractions, and mild cyanosis. Breath sounds are decreased at the bases of both lungs. Arterial blood gas results include a pH of 6.91, partial pressure of carbon dioxide (PaCO2) 97 mm Hg, partial pressure of oxygen (PaO2) 25 mm Hg, and base excess of 15.5 mmol/L (reference range: ± 3 mmol/L). What is the most likely diagnosis?? {'A': 'Transient tachypnea of the newborn', 'B': 'Infant respiratory distress syndrome', 'C': 'Meconium aspiration syndrome', 'D': 'Congenital pneumonia', 'E': 'Fetal alcohol syndrome'},
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B: Infant respiratory distress syndrome
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Answer the following medical question with one of the provided options:
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Q:A 68-year-old man comes to the emergency department because of a 1-week history of difficulty breathing. He has had recurrent palpitations over the past 2 years. During this time, he has also had several episodes of anxiety despite no change in his daily life. He has occasional sharp chest pain localized to the left upper sternal border. He has no abdominal pain or leg swelling. Two years ago, he had streptococcal pharyngitis, which was promptly treated with a 10-day course of penicillin. He has never traveled outside of the country. His temperature is 36.5°C (97.7°F), pulse is 82/min, and blood pressure is 140/85 mm Hg. Physical examination shows a 3/6 holosystolic murmur that is loudest at the apex and radiates to the axilla with a mid-systolic click. Bilateral fine crackles are heard on lung auscultation. Which of the following is the most likely cause of this patient's symptoms?? {'A': 'Ectopic production of serotonin', 'B': 'Myxomatous valve degeneration', 'C': 'Calcific valve degeneration', 'D': 'Inflammatory valve degeneration', 'E': 'Overproduction of catecholamines'},
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B: Myxomatous valve degeneration
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Answer the following medical question with one of the provided options:
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Q:A 50-year-old male with HIV presents to his primary care provider complaining of persistent fevers and night sweats over the past four months. He has also experienced a productive cough. He has been poorly adherent to his HAART regimen. His past medical history also includes gout, hypertension, and diabetes mellitus. He takes allopurinol, enalapril, and metformin. His temperature is 100.9°F (38.3°C), blood pressure is 125/75 mmHg, pulse is 95/min, and respirations are 20/min. His CD4 count is 85 cell/mm^3 and a PPD is negative. A chest radiograph reveals cavitations in the left upper lobe and left lower lobe. Bronchoalveolar lavage reveals the presence of partially acid-fast gram-positive branching rods. A head CT is negative for any intracranial process. A drug with which of the following mechanisms of action is most appropriate for the management of this patient?? {'A': 'Cell wall synthesis inhibitor', 'B': '30S ribosomal subunit inhibitor', 'C': '50S ribosomal subunit inhibitor', 'D': 'RNA synthesis inhibitor', 'E': 'Folate synthesis inhibitor'},
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E: Folate synthesis inhibitor
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Answer the following medical question with one of the provided options:
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Q:A 68-year-old man comes to the physician for a follow-up examination, accompanied by his daughter. Two years ago, he was diagnosed with localized prostate cancer, for which he underwent radiation therapy. He moved to the area 1 month ago to be closer to his daughter but continues to live independently. He was recently diagnosed with osteoblastic metastases to the spine and is scheduled to initiate therapy next week. In private, the patient’s daughter says that he has been losing weight and wetting the bed, and she tearfully asks the physician if his prostate cancer has returned. She says that her father has not spoken with her about his health recently. The patient has previously expressed to the physician that he does not want his family members to know about his condition because they “would worry too much.” Which of the following initial statements by the physician is most appropriate?? {'A': "“As your father's physician, I think that it's important that you know that his prostate cancer has returned. However, we are confident that he will respond well to treatment.”", 'B': '“It’s difficult to deal with parents aging, but I have experience helping families cope. We should sit down with your father and discuss this situation together.”', 'C': "“I'm sorry, I can't discuss any information with you without his permission. I recommend that you have an open discussion with your father.”", 'D': "“It concerns me that he's not speaking openly with you. I recommend that you seek medical power of attorney for your father. Then, we can legally discuss his diagnosis and treatment options together.”", 'E': '“Your father is very ill and may not want you to know the details. I can imagine it\'s frustrating for you, but you have to respect his discretion.”\n"'},
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C: “I'm sorry, I can't discuss any information with you without his permission. I recommend that you have an open discussion with your father.”
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Answer the following medical question with one of the provided options:
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Q:A 34-year-old G3P2103 with a past medical history of preeclampsia in her last pregnancy, HIV (CD4: 441/mm^3), and diabetes mellitus presents to her obstetrician for her first postpartum visit. She delivered her third child via C-section one week ago and reports that she is healing well from the surgery. She says that breastfeeding has been going well and that her baby has nearly regained his birth weight. The patient complains that she has been more tired than expected despite her efforts to sleep whenever her baby is napping. She relies on multiple iced coffees per day and likes to eat the ice after she finishes the drink. Her diet is otherwise unchanged, and she admits that she has not been getting outside to exercise as much as usual. Her home medications include metformin and her HAART regimen of dolutegravir, abacavir, and lamivudine. Her temperature is 98.9°F (37.2°C), blood pressure is 128/83 mmHg, pulse is 85/min, and respirations are 14/min. On physical exam, she is tired-appearing with conjunctival pallor. This patient is at risk of developing which of the following conditions?? {'A': 'Sideroblastic anemia', 'B': 'Hemolytic anemia', 'C': 'Megaloblastic anemia', 'D': 'Hyperparathyroidism', 'E': 'Restless legs syndrome'},
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E: Restless legs syndrome
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Answer the following medical question with one of the provided options:
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Q:A 22-year-old man presents to the physician due to a progressively worsening weakness and an increasingly large abdomen. He notes that he eats well and is fairly active; however, his abdomen has become increasingly protuberant. He also complains of easy bruisability. His medical history is not significant and he takes no medications. Physical examination reveals hepatomegaly and splenomegaly. Several bruises can be seen on the inside of his arms and legs. His skin has a yellowish tinge to it. Laboratory testing shows the following: Hematocrit 25% Erythrocyte count 2.5 x 106/mm3 Thrombocyte count 25,000/mm3 A bone marrow biopsy shows a crinkled-paper appearance to the macrophages. Which of the following enzymes is most likely deficient in this patient?? {'A': 'Arylsulfatase A', 'B': 'α-galactosidase', 'C': 'β-glucosidase', 'D': 'Hexosaminidase', 'E': 'Sphingomyelinase'},
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C: β-glucosidase
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Answer the following medical question with one of the provided options:
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Q:A 69-year-old woman is brought to the emergency department because of fatigue and lethargy for 5 days. She has also had weakness and nausea for the last 3 days. She has sarcoidosis, major depressive disorder, and hypertension. She had a stroke 5 years ago. Current medications include aspirin, nifedipine, prednisolone, fluoxetine, and rosuvastatin, but she has not taken any of her medications for 7 days due to international travel. Her temperature is 36.1°C (96.9°F), pulse is 95/min, and blood pressure is 85/65 mm Hg. She is lethargic but oriented. Examination shows no other abnormalities. Her hemoglobin concentration is 13.4 g/dL and leukocyte count is 9,600/mm3. Both serum cortisol and ACTH levels are decreased. This patient is most likely to have which of the following additional laboratory abnormalities?? {'A': 'Normal anion gap metabolic acidosis', 'B': 'Hyperkalemia', 'C': 'Hyperglycemia', 'D': 'Hypokalemia', 'E': 'Hyponatremia\n"'},
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E: Hyponatremia "
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Answer the following medical question with one of the provided options:
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Q:A 54-year-old woman comes to the physician with abdominal distention and mild diffuse abdominal discomfort. She has not had nausea, vomiting, fever, or chills. She was diagnosed with alcoholic liver cirrhosis 2 years ago. Examination shows a protruding, distended abdomen that is dull to percussion with a positive fluid wave. Ultrasonography shows mild to moderate ascites. Appropriate treatment of the patient's condition is started. Four days later, the patient experiences palpitations and chest pain at home. She is brought to the emergency department, where her temperature is 37.3°C (99.1°F), pulse is 182/min, respirations are 18/min, and blood pressure is 82/50 mm Hg. An ECG shows ventricular tachycardia. Initial laboratory studies show: Serum Na+ 131 mEq/L K+ 2.9 mEq/L Cl- 92 mEq/L Bicarbonate 34 mEq/L Urea nitrogen 42 mg/dL Creatinine 4.8 mg/dL Glucose 90 mg/dL Ca2+ 8.1 mg/dL Mg2+ 1.5 mg/dL Phosphate 4.7 mg/dL Arterial Blood Gas pH 7.52 pCO2 45 mm Hg pO2 90.2 mm Hg She is successfully cardioverted to normal sinus rhythm. Which of the following treatments is most likely responsible for this patient's presentation?"? {'A': 'Hydrochlorothiazide', 'B': 'Furosemide', 'C': 'Acetazolamide', 'D': 'Lisinopril', 'E': 'Mannitol'},
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B: Furosemide
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Answer the following medical question with one of the provided options:
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Q:A 33-year-old woman is brought to the emergency department 30 minutes after being rescued from a fire in her apartment. She reports nausea, headache, and dizziness. Physical examination shows black discoloration of her oral mucosa. Pulse oximetry shows an oxygen saturation of 99% on room air. The substance most likely causing symptoms in this patient primarily produces toxicity by which of the following mechanisms?? {'A': 'Competitive binding to heme', 'B': 'Rise in serum pH', 'C': 'Oxidation of Fe2+', 'D': 'Degradation of 2,3-bisphosphoglycerate', 'E': 'Inhibition of mitochondrial complex V'},
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A: Competitive binding to heme
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Answer the following medical question with one of the provided options:
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Q:A 35-year-old woman presents with increased anxiety and a reeling sensation. Her complaint started 30 minutes ago with increased sweating and palpitations and is gradually worsening. On examination, the blood pressure was found to be 194/114 mm Hg. She had normal blood pressure at the local pharmacy 5 days ago. She currently works as an event manager and her job involves a lot of stress. The family history is significant for thyroid carcinoma in her father. Which of the following is most likely in this person?? {'A': 'Increased urine metanephrines', 'B': 'Decreased hemoglobin', 'C': 'Decreased TSH levels', 'D': 'Decreased C-peptide', 'E': 'Increased serum serotonin'},
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A: Increased urine metanephrines
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Answer the following medical question with one of the provided options:
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Q:An 83-year-old man with advanced-stage prostate cancer comes to the physician because of a 1-week history of worsening lower back and hip pain. The patient's analgesic regimen includes oxycodone, ibuprofen, and alendronic acid. Physical examination shows localized tenderness over the lumbar spine and right hip. His current pain management requires opioid dose escalation. Which of the following opioid side effects is most likely to remain unaffected by the mechanism underlying this patient's need for a higher drug dose?? {'A': 'Constipation', 'B': 'Pruritus', 'C': 'Nausea', 'D': 'Mydriasis', 'E': 'Respiratory depression'},
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A: Constipation
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Answer the following medical question with one of the provided options:
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Q:A 1-month-old male newborn is brought to the physician because of poor feeding, a hoarse cry, and lethargy for 1 week. The boy was born in Mozambique, from where he and his parents emigrated 2 weeks ago. He is at the 95th percentile for head circumference, 50th percentile for length, and 70th percentile for weight. Physical examination shows scleral icterus, an enlarged tongue, and generalized hypotonia. The abdomen is distended and there is a reducible, soft protruding mass at the umbilicus. Which of the following is the most likely cause of these findings?? {'A': 'Biliary atresia', 'B': 'Thyroid dysgenesis', 'C': 'Acid maltase deficiency', 'D': 'Beckwith-Wiedemann syndrome', 'E': 'Congenital toxoplasmosis'},
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B: Thyroid dysgenesis
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Answer the following medical question with one of the provided options:
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Q:A 31-year-old obese Caucasian female presents to the Emergency Department late in the evening for left lower quadrant pain that has progressively worsened over the last several hours. She describes the pain as sharp and shooting, coming and going. Her last bowel movement was this morning. She has also had dysuria and urgency. Her surgical history is notable for gastric bypass surgery 2 years prior and an appendectomy at age 9. She is sexually active with her boyfriend and uses condoms. Her temperature is 99.5 deg F (37.5 deg C), blood pressure is 151/83 mmHg, pulse is 86/min, respirations are 14/minute, BMI 32. On physical exam, she has left lower quadrant tenderness to palpation with pain radiating to the left groin and left flank tenderness on palpation. Her urinalysis shows 324 red blood cells/high power field. Her pregnancy test is negative. What is the next best step in management?? {'A': 'A KUB (kidneys, ureters and bladder) plain film', 'B': 'Intravenous pyelogram', 'C': 'Transvaginal ultrasound', 'D': 'Noncontrast CT scan', 'E': 'Exploratory laparoscopy'},
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D: Noncontrast CT scan
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Answer the following medical question with one of the provided options:
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Q:A 66-year-old man is admitted to the medical floor after being diagnosed with community-acquired pneumonia. He has been in good health except for the use of steroids for the past 6 months for ulcerative colitis. The patient is started on the empiric therapy with ceftriaxone for the management of pneumonia. After 10 days of treatment in the hospital, he becomes tachypneic with a decreased level of consciousness. He develops generalized pustular eruptions all over his trunk. The temperature is 40.8°C (105.4°F), and the white blood cell count is 19,000/mm3. The gram stain of an aspirate shows many budding yeasts and neutrophils. A culture of the skin specimen is positive for Candida albicans. The nitroblue tetrazolium test is normal. What is the most likely condition related to his signs and symptoms?? {'A': 'Leukocyte adhesion deficiency-1', 'B': 'Chediak-Hegashi syndrome', 'C': 'Chronic granulomatous disease', 'D': 'Myeloperoxidase deficiency', 'E': 'X-linked agammaglobulinemia'},
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D: Myeloperoxidase deficiency
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Answer the following medical question with one of the provided options:
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Q:A 16-year-old male presents to the emergency department with a hematoma after falling during gym class. He claims that he has a history of prolonged nosebleeds and bruising/bleeding after minor injuries. Physical exam is unrevealing other than the hematoma. Labs are obtained showing an increased bleeding time and an abnormal ristocetin cofactor assay. Coagulation assays reveal an increased partial thromboplastin time (PTT) and but a normal prothrombin time (PT). The patient is given desmopressin and is asked to avoid aspirin. Which of the following findings is most likely directly involved in the etiology of this patient's presentation?? {'A': 'Decreased platelet count', 'B': 'Decreased levels of factor VIII', 'C': 'Decreased levels of factor IX', 'D': 'Decreased activity of ADAMTS13', 'E': 'Decreased plasma fibrinogen'},
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B: Decreased levels of factor VIII
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Answer the following medical question with one of the provided options:
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Q:A 40-year-old man presents to the physician for a scheduled checkup. He was diagnosed with type 2 diabetes mellitus 5 years ago and has been taking his prescribed metformin daily, as prescribed. He also started exercising and has improved his diet. He has no particular complaints at the time. The patient has no other medical concerns and takes no medications. There is no family history of cardiovascular disease or diabetes. He does not smoke tobacco, drink alcohol, or use illicit drugs. Vitals and normal. There are no physical findings. His laboratory tests show: Serum glucose (fasting) 149 mg/dL Hemoglobin A1c 7.7 % Serum electrolytes Sodium 142 mEq/L Potassium 3.9 mEq/L Chloride 101 mEq/L Serum creatinine 0.8 mg/dL Blood urea nitrogen 9 mg/dL Urinalysis Glucose Negative Ketones Negative Leucocytes Negative Nitrite Negative Red blood cells (RBC) Negative Casts Negative Which of the following lipid profile abnormalities is most likely to be seen?? {'A': 'Elevated triglycerides, low HDL', 'B': 'Elevated HDL, low LDL', 'C': 'Normal triglycerides, elevated LDL', 'D': 'Low HDL, elevated LDL', 'E': 'Normal lipid profile'},
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A: Elevated triglycerides, low HDL
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Answer the following medical question with one of the provided options:
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Q:A 25-year-old woman, gravida 2, para 1, is brought to the emergency department at 39 weeks' gestation in active labor. Her first child was delivered at 40 weeks' gestation by elective cesarean section due to limited range of motion in her hip. The patient has sickle cell disease. She has had multiple episodes of acute chest syndrome and has required several transfusions in the past. An uncomplicated repeat cesarean section is performed, and a 2.7-kg (6-lb) infant is delivered with approx. 550 mL blood loss. Perioperatively, she received one dose of intravenous cefazolin. Following the surgery, the patient continues to bleed, and she receives a transfusion of 1 unit of packed red blood cells. One hour later, the patient begins to have flank pain and appears to be in acute distress. Her temperature is 38.5°C (101.3°F), pulse is 111/min, respirations are 22/min, and blood pressure is 99/50 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 97%. Foley catheter shows dark brown urine. Further evaluation of this patient is most likely to show which of the following?? {'A': 'Serum antibodies against Class I HLA antigens', 'B': 'Low levels of serum IgA immunoglobulins', 'C': 'Positive blood cultures', 'D': 'Positive direct Coombs test', 'E': 'Bilateral pulmonary infiltrates on chest x-ray'},
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D: Positive direct Coombs test
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Answer the following medical question with one of the provided options:
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Q:An investigator is studying the replication of bacterial DNA with modified nucleotides. After unwinding, the double-stranded DNA strand forms a Y-shaped replication fork that separates into two strands. At each of these strands, daughter strands are synthesized. One strand is continuously extended from the template strands in a 5′ to 3′ direction. Which of the following is exclusively associated with the strand being synthesized away from the replication fork?? {'A': "Elongation in the 3'→5' direction", 'B': "5' → 3' exonuclease activity", 'C': 'Synthesis of short RNA sequences', 'D': 'Reverse transcriptase activity', 'E': 'Repeated activity of ligase'},
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E: Repeated activity of ligase
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Answer the following medical question with one of the provided options:
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Q:A clinical trial is being run with patients that have a genetic condition characterized by abnormal hemoglobin that can undergo polymerization when exposed to hypoxia, acidosis, or dehydration. This process of polymerization is responsible for the distortion of the red blood cell (RBC) that acquires a crescent shape and the hemolysis of RBCs. Researchers are studying the mechanisms of the complications commonly observed in these patients such as stroke, aplastic crisis, and auto-splenectomy. What kind of mutation leads to the development of the disease?? {'A': 'Missense mutation', 'B': 'Nonsense mutation', 'C': 'Splice site', 'D': 'Frameshift mutation', 'E': 'Silent mutation'},
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A: Missense mutation
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Answer the following medical question with one of the provided options:
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Q:An investigator isolates bacteria from a patient who presented with dysuria and urinary frequency. These bacteria grow rapidly in pink colonies on MacConkey agar. During replication of these bacteria, the DNA strands are unwound at the origin of replication, forming two Y-shaped replication forks that open in opposite directions. At each replication fork, daughter strands are synthesized from the template strands in a 5′ to 3′ direction. On one strand, the DNA is synthesized continuously; on the other strand, the DNA is synthesized in short segments. The investigator finds that three enzymes are directly involved in elongating the DNA of the lagging strand in these bacteria. One of these enzymes has an additional function that the others do not possess. Which of the following steps in DNA replication is unique to this enzyme?? {'A': "Elongation of lagging strand in 5'→3' direction", 'B': "Excision of nucleotides with 5'→3' exonuclease activity", 'C': 'Creation of ribonucleotide primers', 'D': 'Proofreading for mismatched nucleotides', 'E': 'Prevention of reannealing of the leading strand and the lagging strand'},
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B: Excision of nucleotides with 5'→3' exonuclease activity
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Answer the following medical question with one of the provided options:
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Q:A 35-year-old banker is brought to a medical clinic by his concerned wife. For the past 3 weeks, he has not been eating well and has had a 10 kg (22 lb) weight loss. He wakes up very early in the mornings and feels extremely despondent. He no longer goes out on the weekends to hang out with his close friends nor does he go on date nights with his wife. He feels guilty for letting his friends and family down recently. He additionally has a history of fibromyalgia and deals with daily pain. What would be the most appropriate treatment plan for this patient?? {'A': 'Amitriptyline', 'B': 'Fluoxetine', 'C': 'Venlafaxine', 'D': 'Phenelzine', 'E': 'Electroconvulsive therapy'},
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A: Amitriptyline
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Answer the following medical question with one of the provided options:
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Q:A 36-year-old man presents to his primary care physician with increasing fatigue. He says that the fatigue started after he returned from vacation in South America 4 weeks ago and thinks that it may be related to an infection he got while abroad. He does not know the name of the infection but says that he went to a local clinic for treatment and was given an antibiotic. Since then, he has noticed that he is no longer able to perform his job as a contractor who renovates old homes because he feels short of breath after just a few minutes of work. Furthermore, he says that he has been experiencing prolonged nosebleeds that never occurred prior to this episode. He denies any neurologic symptoms. His past medical history is significant for alcoholic hepatitis secondary to alcohol abuse 3 years prior. Physical exam reveals conjunctival pallor as well as petechiae. Which of the following findings is associated with the most likely cause of this patient's symptoms?? {'A': 'Dense lines in the metaphysis of long bones', 'B': 'Hypersegmented neutrophils', 'C': 'Hypocellular bone marrow with fatty infiltration', 'D': 'Low circulating levels of erythropoietin', 'E': 'Schistocytes on peripheral blood smear'},
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C: Hypocellular bone marrow with fatty infiltration
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Answer the following medical question with one of the provided options:
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Q:A randomized control double-blind study is conducted on the efficacy of 2 sulfonylureas. The study concluded that medication 1 was more efficacious in lowering fasting blood glucose than medication 2 (p ≤ 0.05; 95% CI: 14 [10-21]). Which of the following is true regarding a 95% confidence interval (CI)?? {'A': 'It represents the probability that chance would not produce the difference shown, 95% of the time.', 'B': 'When a 95% CI for the estimated difference between groups contains the value ‘0’, the results are significant.', 'C': 'The range of outcome values resulting from the trial has a 95% probability of encompassing the true value.', 'D': 'The study is adequately powered at the 95% confidence interval.', 'E': 'The 95% confidence interval is the probability chosen by the researcher to be the threshold of statistical significance.'},
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C: The range of outcome values resulting from the trial has a 95% probability of encompassing the true value.
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Answer the following medical question with one of the provided options:
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Q:A group of scientists is studying the mechanism of action of various pancreatic hormones in rats. The scientists studied hormone A, which is secreted by the β-cells of the pancreas, and found that hormone A binds to a complex dimeric receptor on the cell membrane and exerts its effects via dephosphorylation of different intracellular proteins. Now they are studying hormone B, which is secreted by the α-cells and antagonizes the actions of hormone A. Which 2nd messenger system would hormone B utilize to exert its cellular effects?? {'A': 'Direct nuclear receptor binding', 'B': 'Adenylyl cyclase-cyclic AMP', 'C': 'Direct cytoplasmic receptor binding', 'D': 'Phospholipase C', 'E': 'Tyrosine kinase'},
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B: Adenylyl cyclase-cyclic AMP
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Answer the following medical question with one of the provided options:
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Q:A 15-year-old boy presents with a sore throat and difficulty swallowing. The patient says he has had a sore throat over the last 3 weeks. Two days ago it became acutely more painful. There is no significant past medical history nor current medications. The vital signs include: temperature 38.2°C (100.8°F), blood pressure 100/70 mm Hg, pulse 101/min, respiratory rate 26/min, and oxygen saturation 99% on room air. Physical examination reveals an inability to fully open his mouth (trismus) and drooling. The patient’s voice has a muffled quality. CT of the head is significant for the findings seen in the picture. Which of the following is the best initial course of treatment for this patient? ? {'A': 'Inhaled epinephrine', 'B': 'Antitoxin', 'C': 'Prednisone', 'D': 'Incision and drainage', 'E': 'Piperacillin/tazobactam'},
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D: Incision and drainage
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Answer the following medical question with one of the provided options:
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Q:A 43-year-old man from Chile comes to the physician because of a 1-day history of upper back pain and difficulty swallowing. He has had pain in his shoulder and knee joints over the past 10 years. He is 190 cm (6 ft 3 in) tall and weighs 70.3 kg (155 lb); BMI is 19.4 kg/m2. His blood pressure is 142/86 mm Hg in the right arm and 130/70 mg Hg in the left arm. Physical examination shows a depression in the sternum and a grade 3/6 diastolic murmur at the right upper sternal border. A CT scan of the chest with contrast is shown. Which of the following is the most likely underlying cause of this patient's condition?? {'A': 'Protozoal infection', 'B': 'Autoimmune valve damage', 'C': 'Congenital aortic narrowing', 'D': 'Cystic medial degeneration', 'E': 'Atheroma formation\n"'},
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D: Cystic medial degeneration
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Answer the following medical question with one of the provided options:
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Q:A previously healthy 41-year-old woman comes to the physician for the evaluation of recurrent episodes of palpitations and sweating over the past month. Her symptoms typically start after swimming practice and improve after drinking ice tea and eating some candy. She has also had a 5-kg (11-lb) weight gain over the past 3 months. She works as a nurse. Physical examination shows no abnormalities. Fasting serum studies show: Glucose 38 mg/dL Insulin 260 μU/mL (N=11–240) Proinsulin 65 μU/mL (N <20% of total insulin) C-peptide 5.0 ng/mL (N=0.8–3.1) Insulin secretagogues absent Which of the following is the most likely cause of her symptoms?"? {'A': 'Exogenous administration of insulin', 'B': 'Binge eating disorder', 'C': 'Pancreatic β-cell tumor', 'D': 'Factitious use of sulfonylureas', 'E': 'Peripheral resistance to insulin'},
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C: Pancreatic β-cell tumor
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Answer the following medical question with one of the provided options:
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Q:An 8-year-old girl is brought to the clinic by her parents for fever and easy bruising. Her parents report that the child has been bruising easily ever since an upper respiratory infection 3 months ago. For example, a bump into the table resulted in a large bruise on the side of her hip for a week. Three days ago, her mother noticed that the child felt warm and subsequently measured a temperature of 101.8°F (38.8°C) that did not respond to acetaminophen. The patient denies any chills, cough, rhinorrhea, pharyngitis, sick contacts, headache, or urinary symptoms. A physical examination demonstrates a nontender, firm, and rubbery node along her left neck and splenomegaly. Laboratory findings are shown below: Leukocyte count and differential: Leukocyte count: 19,000/mm^3 Neutrophils: 39% Bands: 12% Eosinophils: 2% Basophils: 0.5% Lymphocytes: 40% Monocytes: 6.5% Hemoglobin: 9.7 g/dL Platelet count: 100,000/mm^3 Mean corpuscular hemoglobin concentration: 30% Mean corpuscular volume: 76 µm^3 Reticulocyte count: 0.7% What findings would you expect in this patient?? {'A': 'Low leukocyte alkaline phosphatase levels', 'B': 'Presence of Auer rods', 'C': 'Smudge cells on peripheral blood smear', 'D': 'Tartrate-resistant acid phosphatase positivity', 'E': 'Translocation of chromosomes 12 and 21'},
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E: Translocation of chromosomes 12 and 21
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Answer the following medical question with one of the provided options:
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Q:A 52-year-old woman presents to the urgent care center with several hours of worsening abdominal discomfort with radiation to the back. The patient also complains of malaise, chills, nausea, and vomiting. Social history is notable for alcoholism. On physical exam, she is febrile to 39.5°C (103.1°F), and she is diffusely tender to abdominal palpation. Complete blood count is notable for 13,500 white blood cells, bilirubin 2.1, lipase 842, and amylase 3,210. Given the following options, what is the most likely diagnosis?? {'A': 'Cholelithiasis', 'B': 'Acute cholecystitis', 'C': 'Gallstone pancreatitis', 'D': 'Choledocholithiasis', 'E': 'Ascending cholangitis'},
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C: Gallstone pancreatitis
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Answer the following medical question with one of the provided options:
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Q:A previously healthy 38-year-old woman is brought to the emergency department by her husband because of left-sided weakness. As she was getting dressed this morning, she was suddenly unable to button up her shirt. When she showed her husband, he noticed that she seemed confused. She has a 3-year history of diabetes mellitus, for which she takes metformin. She had a knee operation 2 days ago. Her temperature is 38.9°C (102°F), pulse is 98/min, respirations are 17/min, and blood pressure is 138/85 mm Hg. She is confused and oriented only to person. Neurologic examination shows diminished muscle strength on the left side. There are scattered petechiae over the chest, arms, and legs. Laboratory studies show: Hemoglobin 7.5 g/dL Leukocyte count 10,500/mm3 Platelet count 40,000/mm3 Prothrombin time 15 seconds Partial thromboplastin time 36 seconds Serum Bilirubin Total 3.5 mg/dL Direct 0.3 mg/dL Urea nitrogen 35 mg/dL Creatinine 2.5 mg/dL Lactate dehydrogenase 1074 U/L A peripheral smear shows numerous schistocytes. Further evaluation is most likely going to show which of the following findings?"? {'A': 'Decreased megakaryocytes on bone marrow biopsy', 'B': 'Enterohemorrhagic Escherichia coli on stool culture', 'C': 'RBC agglutination on direct Coombs test', 'D': 'Decreased ADAMTS13 activity in serum', 'E': 'Elevated fibrin degradation products in serum\n"'},
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D: Decreased ADAMTS13 activity in serum
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Answer the following medical question with one of the provided options:
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Q:A 62-year-old man is referred to neurology by his primary care physician. He is accompanied by his wife. The patient reports having a resting tremor in his left hand for over a year and some “stiffness” in his left arm. His wife notes that he has started to walk "funny" as well. He has a history of hypertension and hyperlipidemia. He takes aspirin, amlodipine, and rosuvastatin. On physical examination, you notice a repetitive circular movement of his left index finger and thumb that resolves with active movement of the hand. Passive motion of the left upper extremity is partially limited by rigidity. Gait is slow and shuffling. The patient is prescribed the most effective treatment for his disorder. Which of the following is the mechanism of a second drug given to prevent adverse effects of this therapy?? {'A': 'Activates dopamine receptors', 'B': 'Blocks muscarinic acetylcholine receptors', 'C': 'Inhibits catechol-O-methyltransferase', 'D': 'Inhibits aromatic L-amino acid decarboxylase', 'E': 'Inhibits monoamine oxidase-B'},
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D: Inhibits aromatic L-amino acid decarboxylase
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Answer the following medical question with one of the provided options:
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Q:A 34-year-old woman comes to the physician because of a 3-month history of fatigue and a 4.5-kg (10-lb) weight loss despite eating more than usual. Her pulse is 115/min and blood pressure is 140/60 mm Hg. Physical examination shows warm, moist skin, and a diffuse, non-tender swelling over the anterior neck. Ophthalmologic examination shows swelling of the eyelids and proptosis bilaterally. Which of the following is the most likely cause of this patient's symptoms?? {'A': 'Nongranulomatous thyroid inflammation', 'B': 'Thyrotropin receptor autoantibodies', 'C': 'Parafollicular cell hyperplasia', 'D': 'Thyroid peroxidase autoantibodies', 'E': 'Constitutively active TSH receptor'},
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B: Thyrotropin receptor autoantibodies
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Answer the following medical question with one of the provided options:
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Q:A 72-year-old man presents to his primary care physician for a general checkup. The patient works as a farmer and has no concerns about his health. He has a past medical history of hypertension and obesity. His current medications include lisinopril and metoprolol. His temperature is 99.5°F (37.5°C), blood pressure is 177/108 mmHg, pulse is 90/min, respirations are 17/min, and oxygen saturation is 98% on room air. Physical exam is notable for a murmur after S2 over the left sternal border. The patient demonstrates a stable gait and 5/5 strength in his upper and lower extremities. Which of the following is another possible finding in this patient?? {'A': 'Audible click heard at the cardiac apex', 'B': 'Femoral artery murmur', 'C': 'Murmur that radiates to the carotids', 'D': 'Rumbling heard at the cardiac apex', 'E': 'Wedge pressure lower than expected'},
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B: Femoral artery murmur
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Answer the following medical question with one of the provided options:
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Q:During a study on the immune system, an investigator isolates and labels T cells from the cortex of the thymus. The T cells that do not bind cortical epithelial cells expressing MHC molecules undergo apoptosis within 3–4 days. Which of the following best describes the T cells during this phase of differentiation?? {'A': 'CD4+ and CD8+', 'B': 'Th2', 'C': 'CD8+', 'D': 'T cell precursor', 'E': 'CD4+'},
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A: CD4+ and CD8+
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