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Answer the following medical question with one of the provided options:
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Q:A 19-year-old man comes to the emergency department for right wrist pain and swelling 2 hours after falling on an outstretched hand while playing softball. The pain worsened when he attempted to pitch after the fall. He has eczema and type 1 diabetes mellitus. Current medications include insulin and topical clobetasol. He appears uncomfortable. Examination shows multiple lichenified lesions over his forearms. The right wrist is swollen and tender; range of motion is limited by pain. There is tenderness to palpation in the area between the tendons of the abductor pollicis longus, extensor pollicis brevis, and extensor pollicis longus muscle. The thumb can be opposed actively towards the other fingers. Muscle strength of the right hand is decreased. Which of the following is the most likely diagnosis?? {'A': "Colles' fracture", 'B': 'Transscaphoid perilunate dislocation', 'C': 'Scaphoid fracture', 'D': "De Quervain's tenosynovitis", 'E': 'Lunate dislocation'},
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C: Scaphoid fracture
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Answer the following medical question with one of the provided options:
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Q:A 81-year-old man presents to his cardiologist for ongoing management of mild heart failure. He has not had any changes in his cardiac function status and says that he is tolerating lisinopril without any major side effects. During the course of the visit, the patient says that he is unhappy with his urologist because he has been experiencing episodes of dizziness after starting prazosin for benign prostatic hyperplasia. He says that he feels these episodes were caused by malpractice on his urologist's behalf and is considering a lawsuit against his urologist. Which of the following is the most appropriate course of action for the cardiologist?? {'A': 'Call the urologist and warn him of an impending lawsuit', 'B': "Call the urologist to convey the patient's dissatisfaction", 'C': 'Contact his insurance agent to discuss possible risks', 'D': 'Encourage the patient to speak with his urologist directly', 'E': "Sympathize with the patient's desire for a lawsuit"},
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D: Encourage the patient to speak with his urologist directly
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Answer the following medical question with one of the provided options:
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Q:A 33-year-old man presents to the emergency department complaining of weakness and fatigue. He states that his symptoms have worsened over the past day. He has a past medical history of IV drug abuse and alcoholism and he currently smells of alcohol. His temperature is 102°F (38.9°C), blood pressure is 111/68 mmHg, pulse is 110/min, respirations are 17/min, and oxygen saturation is 98% on room air. Physical exam is notable for focal tenderness over the lumbar spine. Initial lab values and blood cultures are drawn and are notable for leukocytosis and an elevated C-reactive protein (CRP). Which of the following is the best treatment for this patient?? {'A': 'Ceftriaxone', 'B': 'Ibuprofen and warm compresses', 'C': 'Nafcillin', 'D': 'Piperacillin-tazobactam', 'E': 'Vancomycin'},
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E: Vancomycin
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Answer the following medical question with one of the provided options:
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Q:Two dizygotic twins present to the university clinic because they believe they are being poisoned through the school's cafeteria food. They have brought these concerns up in the past, but no other students or cafeteria staff support this belief. Both of them are average students with strong and weak subject areas as demonstrated by their course grade-books. They have no known medical conditions and are not known to abuse illicit substances. Which statement best describes the condition these patients have?? {'A': 'The disorder is its own disease entity in DSM-5.', 'B': 'A trial separation is likely to worsen symptoms.', 'C': 'Can affect two or more closely related individuals.', 'D': 'Treatment can be augmented with antipsychotics.', 'E': 'Cognitive behavioral therapy is a good first-line.'},
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C: Can affect two or more closely related individuals.
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Answer the following medical question with one of the provided options:
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Q:A 4-year-old boy presents to the emergency department with diarrhea. Several days ago, he experienced a fever which has progressed to vomiting and diarrhea. He has had multiple episodes of non-bloody diarrhea and states that he feels fatigued. He is not up to date on his vaccinations and takes many different herbal supplements from his parents. His temperature is 101°F (38.3°C), blood pressure is 100/55 mmHg, pulse is 111/min, respirations are 19/min, and oxygen saturation is 100% on room air. Physical exam is notable for dry mucous membranes and a fatigued appearing child. Which of the following is the most likely etiology of this patient’s symptoms?? {'A': 'Campylobacter jejuni', 'B': 'Coronavirus', 'C': 'Norovirus', 'D': 'Rotavirus', 'E': 'Vibrio cholerae'},
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D: Rotavirus
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Answer the following medical question with one of the provided options:
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Q:A 14-year-old boy is admitted to the emergency department with acute onset of confusion, malaise, diffuse abdominal pain, nausea, and a single episode of vomiting. He denies ingestion of any suspicious foods, fevers, respiratory symptoms, or any other symptoms preceding his current condition. However, he notes an increase in his liquid consumption and urinary frequency over the last 6 months. On physical examination, he is responsive but somnolent. His blood pressure is 90/50 mm Hg, heart rate is 101/min, respiratory rate is 21/min, temperature is 36.0°C (96.8°F), and SpO2 is 96% on room air. He has facial pallor and dry skin and mucous membranes. His lungs are clear to auscultation, and heart sounds are normal. His abdomen is soft with no rebound tenderness on palpation. Neurological examination is significant for 1+ deep tendon reflexes in all extremities. A dipstick test shows 3+ for ketones and glucose. The patient’s blood tests show the following findings: RBCs 4.1 million/mm3 Hb 13.7 mg/dL Hematocrit 56% Leukocyte count 7,800/mm3 Platelet count 321,000/mm3 Glucose 565 mg/dL Potassium 5.8 mEq/L Sodium 136 mEq/L ALT 15 U/L AST 17 U/L Amylase 88 U/L Bicarbonate 19 mEq/L BE −3 mEq/L pH 7.3 pCO2 37 mm Hg pO2 66 mm Hg Which of the medications listed below should be administered to the patient intravenously?? {'A': 'Isophane insulin', 'B': 'Insulin detemir', 'C': 'Cefazolin', 'D': 'Regular insulin', 'E': 'Potassium chloride'},
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D: Regular insulin
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Answer the following medical question with one of the provided options:
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Q:A 29-year-old primigravid woman at 18 weeks’ gestation comes to the physician for her first prenatal visit. She works as a paralegal and lives with her husband. Her current pregnancy was unexpected, and she did not take any prenatal medications or supplements. Physical examination shows a uterus 2 inches above the umbilicus. The concentration of α-fetoprotein in the maternal serum and concentrations of both α-fetoprotein and acetylcholinesterase in the amniotic fluid are elevated. Ultrasonography of the uterus shows an increased amniotic fluid volume. The fetus most likely has which of the following conditions?? {'A': 'Holoprosencephaly', 'B': 'Lissencephaly', 'C': 'Spina bifida occulta', 'D': 'Myelomeningocele', 'E': 'Anencephaly'},
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E: Anencephaly
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Answer the following medical question with one of the provided options:
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Q:An otherwise healthy 58-year-old man comes to the physician because of a 1-year history of episodic coughing whenever he cleans his left ear. There is no history of hearing loss, tinnitus, or vertigo. Stimulating his left ear canal with a cotton swab triggers a bout of coughing. The physician informs him that these symptoms are caused by hypersensitivity of a cranial nerve. A peripheral lesion of this nerve is most likely to manifest with which of the following findings on physical examination?? {'A': 'Inability to raise ipsilateral eyebrow', 'B': 'Ipsilateral deviation of the tongue', 'C': 'Decreased secretion from ipsilateral sublingual gland', 'D': 'Ipsilateral vocal cord palsy', 'E': 'Ipsilateral sensorineural hearing loss'},
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D: Ipsilateral vocal cord palsy
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Answer the following medical question with one of the provided options:
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Q:A 7-year-old girl is brought to the physician because of generalized fatigue and dark urine for 1 week. Four weeks ago, she was treated with topical mupirocin for a skin infection. Her 5-year-old brother has steroid-resistant nephrotic syndrome. Her temperature is 37°C (98.6°F), pulse is 90/min, respirations are 14/min, and blood pressure is 132/89 mm Hg. Examination shows periorbital and 1+ pretibial edema bilaterally. The remainder of the examination shows no abnormalities. Laboratory studies show: Hemoglobin 12.9 g/dL Leukocyte count 7,200/mm3 Platelet count 230,000/mm3 Serum Urea nitrogen 32 mg/dL Creatinine 1.8 mg/dL Urine Blood 2+ Protein 2+ Glucose negative RBC 12–14/hpf with dysmorphic features RBC casts numerous Which of the following is the most likely cause of these findings?"? {'A': 'Subepithelial immune complex deposition', 'B': 'Antibodies against type IV collagen', 'C': 'Defective circulating IgA antibodies', 'D': 'Antibodies against cell nucleus proteins', 'E': 'Inflammation of small-sized blood vessels'},
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A: Subepithelial immune complex deposition
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Answer the following medical question with one of the provided options:
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Q:A 9-year-old boy is getting fitted for leg braces because he has become too weak to walk without them. He developed normally until age 3 but then he began to get tired more easily and fell a lot. Over time he started having trouble walking and would stand up by using the Gower maneuver. Despite this weakness, his neurologic development is normal for his age. On exam his calves appeared enlarged and he was sent for genetic testing. Sequence data showed that he had a mutation leading to a string of incorrect amino acids. Which of the following types of mutations is most likely the cause of this patient's disorder?? {'A': 'Frameshift', 'B': 'Missense', 'C': 'Nonsense', 'D': 'Silent', 'E': 'Splice site'},
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A: Frameshift
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Answer the following medical question with one of the provided options:
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Q:A 64-year-old woman comes to the physician because of gradually worsening blurry vision in both eyes for 5 months. She has also had intermittent headaches for the past 2 months. She has type 2 diabetes mellitus, osteoarthritis, second-degree heart block, and presbyopia. Her current medications include metformin, lisinopril, and ibuprofen. Examination shows bilateral equal and reactive pupils. The best-corrected visual acuity in each eye is 20/40. There is narrowing of her visual fields bilaterally. Fundoscopic examination shows bilateral narrowing of the outer rim of the optic nerve head and cupping of the optic disk. Intraocular pressure by applanation tonometry is 27 mm Hg in the right eye and 26 mm Hg in the left eye (N=10–21 mm Hg). Gonioscopy shows no abnormalities. Which of the following is the most appropriate next step in management?? {'A': 'Surgical trabeculectomy', 'B': 'Topical pilocarpine therapy', 'C': 'Topical latanoprost therapy', 'D': 'Topical timolol', 'E': 'Laser iridotomy\n"'},
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C: Topical latanoprost therapy
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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 comes to the physician because she has noted darkening of the skin around her neck since wearing a chain she recently bought at a thrift shop. The darkening occurred gradually over the past 2 months and is accompanied by thickening of the affected skin. She has peptic ulcer disease. Menses occur at irregular 35- to 60-day intervals and last for 9 days with heavy flow. Menarche was at the age of 14 years and her last menstrual period was 3 weeks ago. She is sexually active with her husband and they do not use contraception. The patient's only medication is cimetidine. She is 163 cm (5 ft 4 in) tall and weighs 91 kg (200 lb); BMI is 34 kg/m2. Vital signs are within normal limits. Physical examination shows velvety, hyperpigmented plaques in the axillae, the inframammary fold, and around the neck. The remainder of the examination shows no abnormalities. Further evaluation of this patient is most likely to show which of the following findings?? {'A': 'Diffusely enlarged thyroid gland on ultrasonography of the neck', 'B': 'Elevated serum 17-hydroxyprogesterone levels', 'C': 'Atrophic adrenal glands on CT scan of the abdomen', 'D': 'Malignant glandular cells on gastric biopsy', 'E': 'Polycystic ovaries on ultrasonography of the pelvis'},
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E: Polycystic ovaries on ultrasonography of the pelvis
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Answer the following medical question with one of the provided options:
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Q:A 51-year-old woman comes to the physician because of a 1-year history of occasional discoloration and tingling in her fingers. She has no history of major medical illness and takes no medications. Examination of the hands and fingers shows thickened, waxy skin and several firm white nodules on the fingertips. Further evaluation of this patient is most likely to show which of the following findings?? {'A': 'Serositis', 'B': 'Upper eyelid rash', 'C': 'Telangiectasia', 'D': 'Endocardial immune complex deposition', 'E': 'Interstitial lung disease'},
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C: Telangiectasia
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Answer the following medical question with one of the provided options:
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Q:A 26-year-old African-American woman presents to the clinic for a routine check-up. Review of systems reveals that she often feels nervous and has recently developed a slight tremor. Of note, she has lost 15 pounds in the past 3 months, despite an increased appetite. The patient’s temperature is 99°F (37.2°C), blood pressure is 130/78 mmHg, pulse is 85/min, and respirations are 14/min with an oxygen saturation of 98% on room air. On physical exam, her skin is warm and she has mild exophthalmos. Which of the following is the direct mechanism causing the patient's ophthalmologic findings?? {'A': 'Anti-thyroid peroxidase antibodies', 'B': 'Anti-thyroglobulin antibodies', 'C': 'Decreased levels of T4/T3', 'D': 'Lymphocytic infiltration', 'E': 'Anti-myelin antibodies'},
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D: Lymphocytic infiltration
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Answer the following medical question with one of the provided options:
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Q:A 33-year-old man has a history of intermittent bloody diarrhea, tenesmus, fever, fatigue, and lower abdominal cramps for the past 2 weeks. On physical examination, he is lethargic and appears lean and pale. He has aphthous stomatitis, red congested conjunctiva, and tender swollen joints. At the doctor’s office, his pulse is 114/min, blood pressure is 102/76 mm Hg, respirations are 20/min, and his temperature is 39.4°C (102.9°F). There is vague lower abdominal tenderness and frank blood on rectal examination. Laboratory studies show: Hemoglobin 7.6 g/dL Hematocrit 33% Total leucocyte count 22,000/mm3 Stool assay for C.difficile is negative Abdominal X-ray shows no significant abnormality He is symptomatically managed and referred to a gastroenterologist, who suggests a colonoscopy and contrast (barium) study for the diagnosis. Which of the following is the most likely combination of findings in his colonoscopy and barium study?? {'A': 'Colonoscopy: Multiple vascular malformations that resemble telangiectasias on the colon wall, Barium study: Normal', 'B': 'Colonoscopy: Continuous ulcerated lesions involving the mucosa and submucosa granular mucosa, crypt abscess, and pseudopolyps, Barium study: Lead pipe colon appearance', 'C': 'Colonoscopy: Patches of mucosal erosions with pseudomembrane formation, Barium study: Lead pipe colon appearance', 'D': 'Colonoscopy: Discontinuous transmural ‘skip lesions’ with aphthoid linear ulcers and transverse fissures, non-caseating granulomas, and strictures, Barium study: Cobblestone appearance with strictures', 'E': 'Colonoscopy: Patches of mucosal erosions with pseudomembrane formation, Barium study: Cobblestone appearance with strictures'},
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B: Colonoscopy: Continuous ulcerated lesions involving the mucosa and submucosa granular mucosa, crypt abscess, and pseudopolyps, Barium study: Lead pipe colon appearance
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Answer the following medical question with one of the provided options:
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Q:A 72-year-old woman with metastatic ovarian cancer is brought to the physician by her son because she is in immense pain and cries all the time. On a 10-point scale, she rates the pain as an 8 to 9. One week ago, a decision to shift to palliative care was made after she failed to respond to 2 years of multiple chemotherapy regimens. She is now off chemotherapy drugs and has been in hospice care. Current medications include 2 mg morphine intravenously every 2 hours and 650 mg of acetaminophen every 4 to 6 hours. The son is concerned because he read online that increasing the dose of morphine would endanger her breathing. Which of the following is the most appropriate next step in management?? {'A': 'Increase dosage of morphine', 'B': 'Initiate palliative radiotherapy', 'C': 'Change morphine to a non-opioid analgesic', 'D': 'Initiate cognitive behavioral therapy', 'E': 'Counsel patient and continue same opioid dose'},
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A: Increase dosage of morphine
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Answer the following medical question with one of the provided options:
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Q:A 20-year-old man is brought to the emergency department because of fever and lethargy for the past 2 days. He reports that during this time he has had occasional palpitations and shortness of breath. He has asthma and sickle cell disease. Current medications include inhaled albuterol, hydroxyurea, and folic acid. He appears fatigued. His temperature is 38.4°C (101.1°F), pulse is 122/min, respirations are 25/min, and blood pressure is 110/72 mm Hg. Examination shows pale conjunctivae. Cardiac examination shows a midsystolic ejection murmur. Laboratory studies show: Hemoglobin 6.5 g/dl Leukocyte count 5,000/mm3 Platelet count 165,000/mm3 Mean corpuscular volume 82 μm3 Reticulocyte count 0.2% Which of the following is the most likely cause of these findings?"? {'A': 'Dysfunctional erythrocyte membrane proteins', 'B': 'Splenic sequestration crisis', 'C': 'Hyperhemolysis', 'D': 'Viral infection', 'E': 'Adverse effect of medication'},
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D: Viral infection
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Answer the following medical question with one of the provided options:
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Q:A well-dressed couple presents to the emergency department with sudden onset of headache, a sensation of floating, and weakness of arms and legs after eating a plate of shellfish 2 hours ago. They mention that they had experienced tingling of the lips and mouth within 15 minutes of ingesting the shellfish. They also complain of mild nausea and abdominal discomfort. On physical examination, their vital signs are within normal limits. Their neurological examination reveals decreased strength in all extremities bilaterally and hyporeflexia. After detailed laboratory evaluation, the physician confirms the diagnosis of paralysis due to the presence of a specific toxin in the shellfish they had consumed. Which of the following mechanisms best explains the action of the toxin these patients had consumed?? {'A': 'Inactivation of synaptobrevin', 'B': 'Inactivation of syntaxin', 'C': 'Blockade of voltage-gated fast sodium channels', 'D': 'Increased opening of presynaptic calcium channels', 'E': 'Inhibition of acetylcholinesterase'},
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C: Blockade of voltage-gated fast sodium channels
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Answer the following medical question with one of the provided options:
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Q:A 53-year-old woman presents to her primary care doctor due to discolored, itchy skin, joint pain, and a feeling of abdominal fullness for the past week. Her medical history includes anxiety and depression. She also experiences occasional headaches and dizziness. Of note, the patient recently returned from an expedition to Alaska, where her and her group ate polar bear liver. Physical examination shows dry skin with evidence of excoriation and mild hepatosplenomegaly. Lab investigations reveal an alkaline phosphatase level of 35 U/L and total bilirubin of 0.4 mg/dL. Which of the following tests is most likely to uncover the etiology of her condition?? {'A': 'Antimitochondrial antibodies', 'B': 'BRCA2 gene mutation', 'C': 'Elevated hepatic venous pressure gradient', 'D': 'Jejunal biopsy', 'E': 'Plasma retinol levels'},
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E: Plasma retinol levels
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Answer the following medical question with one of the provided options:
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Q:A 26-year-old African-American woman comes to the physician because of a 4-day history of a nonproductive cough and chest pain. The pain is sharp and worse when she breathes deeply. During this time, she has also had two episodes of hematuria. Over the past 6 months, she has had intermittent pain, stiffness, and swelling in her fingers and left knee. She had two miscarriages at age 22 and 24. Her only medication is minocycline for acne vulgaris. Her temperature is 38.1°C (100.6°F), pulse is 75/min, and blood pressure is 138/85 mm Hg. Physical examination shows an erythematous rash on her face. There is mild tenderness over the metacarpophalangeal joints bilaterally with no warmth or erythema. Further evaluation of this patient is most likely to show which of the following findings?? {'A': 'Anti-histone antibodies', 'B': 'Low serum levels of C3 and C4', 'C': 'Erosions of the metacarpophalangeal joints', 'D': 'Bilateral enlargement of the hilar lymph nodes', 'E': 'Cytotoxic glomerular antibodies'},
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B: Low serum levels of C3 and C4
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Answer the following medical question with one of the provided options:
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Q:One and a half hours after undergoing an elective cardiac catheterization, a 53-year-old woman has right flank and back pain. She has hypertension, hypercholesterolemia, and type 2 diabetes mellitus. She had an 80% stenosis in the left anterior descending artery and 2 stents were placed. Intravenous unfractionated heparin was used prior to the procedure. Prior to admission, her medications were enalapril, simvastatin, and metformin. Her temperature is 37.3°C (99.1°F), pulse is 102/min, and blood pressure is 109/75 mm Hg. Examination shows a tender lower abdomen; there is no guarding or rigidity. There is right suprainguinal fullness and tenderness. There is no bleeding or discharge from the femoral access site. Cardiac examination shows no murmurs, rubs, or gallops. Femoral and pedal pulses are palpable bilaterally. 0.9% saline infusion is begun. A complete blood count shows a hematocrit of 36%, leukocyte count of 8,400/mm3, and a platelet count of 230,000/mm3. Which of the following is the most appropriate next step in management?? {'A': 'X-ray of the abdomen', 'B': 'Administer protamine sulfate', 'C': 'CT scan of the abdomen and pelvis', 'D': 'Administer intravenous atropine', 'E': 'Obtain an ECG'},
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C: CT scan of the abdomen and pelvis
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Answer the following medical question with one of the provided options:
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Q:A 4-month-old girl is brought to the physician by her father because he is concerned that she appears sickly and lethargic. She has always had a pale complexion, but it has been getting worse over the past month. She was delivered at home at 36 weeks to a 26-year-old woman following an uncomplicated pregnancy. She has not yet been examined by a physician. She is in the 2nd percentile for head circumference, 10th percentile for length, and 8th percentile for weight. Physical exam shows a pale infant with facial features of micrognathia, flat nasal bridge, and microopthalmos. The eyes are set widely apart and strabismus is present. She has a high arched palate and there is fusion of the cervical vertebrae with flaring of the skin around the neck. A 4/6 holosystolic murmur is heard best on the left chest. Laboratory studies show: Hemoglobin 6.6 g/dL Hematocrit 20% Leukocytes 5400/mm3 Platelets 183,000/mm3 Mean corpuscular hemoglobin 41.3 pg/cell Mean corpuscular hemoglobin concentration 33% Hb/cell Mean corpuscular volume 125 μm3 This patient is most likely to have which of the following findings?"? {'A': 'Mild neutropenia', 'B': 'Spherocytes', 'C': 'Triphalangeal thumb', 'D': 'Target cells', 'E': 'Exocrine pancreatic dysfunction'},
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C: Triphalangeal thumb
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Answer the following medical question with one of the provided options:
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Q:A 55-year-old man presents to his physician complaining of pain. He states that in the morning he feels rather stiff and has general discomfort and pain in his muscles. The patient has a past medical history of diabetes and is not currently taking any medications. His temperature is 99.2°F (37.3°C), blood pressure is 147/98 mmHg, pulse is 80/min, respirations are 12/min, and oxygen saturation is 99% on room air. Physical exam demonstrates mild tenderness of the patient's musculature diffusely. The patient has 2+ reflexes and 5/5 strength in his upper and lower extremities. Laboratory values are notable for an elevated erythrocyte sedimentation rate. Which of the following is the best next step in management?? {'A': 'Aldolase levels', 'B': 'Glucocorticoids', 'C': 'Muscle biopsy', 'D': 'Temporal artery biopsy', 'E': 'Thyroxine'},
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B: Glucocorticoids
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Answer the following medical question with one of the provided options:
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Q:A 28-year-old man is brought in by ambulance to the ER, barely conscious, after feeling drowsy and falling to the floor during a presentation several hours ago. His colleague who accompanied him says he has had similar episodes 5 times in the past 3 months. No significant past medical history. His blood pressure is 110/80 mm Hg and pulse is 114/min. His capillary blood glucose is 15 mg/dL. Immediate IV dextrose with thiamine is started, and he rapidly regains consciousness. A contrast CT of the abdomen is performed which reveals a tumor in the pancreas. Which of the following relative laboratory findings would you most likely expect to find in this patient?? {'A': 'Glucose: ↓, Insulin: ↑, C-Peptide: ↓, Ketoacidosis: Absent', 'B': 'Glucose: Normal, Insulin: Normal, C-Peptide: Normal, Ketoacidosis: Absent', 'C': 'Glucose: ↓, Insulin: ↑, C-Peptide: ↑, Ketoacidosis: Absent', 'D': 'Glucose: ↑, Insulin: ↓, C-Peptide: ↓, Ketoacidosis: Present', 'E': 'Glucose: ↑, Insulin: ↑/Normal, C-Peptide: ↑/Normal, Ketoacidosis: Absent'},
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C: Glucose: ↓, Insulin: ↑, C-Peptide: ↑, Ketoacidosis: Absent
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Answer the following medical question with one of the provided options:
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Q:A 73-year-old man comes to the physician because of a 4-kg (9-lb) weight loss over the last month. During this time he has not been able to eat more than one bite without coughing immediately and sometimes he regurgitates food through his nose. His symptoms are worse with liquids. One month ago he had a stroke in the right middle cerebral artery. He has a history of hypertension, type 2 diabetes mellitus, and hyperlipidemia. Current medications include aspirin, amlodipine, metformin, and simvastatin. Examination of the oropharynx, chest, and abdomen shows no abnormalities. Neurological examination shows facial drooping on the left and decreased strength in the left upper and lower extremities. Which of the following is the most appropriate next step in management?? {'A': 'Videofluoroscopy', 'B': 'CT scan of the neck', 'C': 'Barium swallow', 'D': 'Esophageal manometry', 'E': 'Transnasal laryngoscopy'},
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A: Videofluoroscopy
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Answer the following medical question with one of the provided options:
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Q:A 21-year-old man presents to the emergency room with abdominal pain and nausea for the past 5 hours. The pain is diffusely spread and of moderate intensity. The patient also says he has not felt like eating since yesterday. He has no past medical history and is not on any medications. He regularly drinks 2–4 beers per day but does not smoke or use illicit substances. Vitals show a pulse of 120/min, a respiratory rate of 26/min, a blood pressure of 110/60 mm Hg, and a temperature of 37.8°C (100.0°F). Examination reveals a soft, diffusely tender abdomen with no guarding. Bowel sounds are present. His mucous membranes are slightly dry and there is a fruity smell to his breath. Laboratory tests show: Laboratory test pH 7.31 Serum glucose (random) 450 mg/dL Serum electrolytes Sodium 149 mEq/L Potassium 5 mEq/L Chloride 99 mEq/L Bicarbonate 16 mEq/L Serum creatinine 1.0 mg/dL Blood urea nitrogen 15 mg/dL Urinalysis Proteins Negative Glucose Positive Ketones Positive Leucocytes Negative Nitrites Negative Red blood cells (RBC) Negative Casts Negative Which of the following explains this patient's presentation?? {'A': 'Blunt trauma to the abdomen', 'B': 'Burn out of pancreatic beta cells', 'C': 'Effects of alcohol on mitochondrial metabolic activity', 'D': 'Fecalith in the caecum', 'E': 'Presence of gut contents in the abdominal cavity'},
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B: Burn out of pancreatic beta cells
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Answer the following medical question with one of the provided options:
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Q:A 51-year-old woman comes to the physician because of fatigue and progressive pain and stiffness in her hands for 3 months. She used to play tennis but stopped 1 month ago because of difficulties holding the racket and her skin becoming “very sensitive to sunlight.” Her last menstrual period was 1 year ago. She has diabetes mellitus controlled with insulin. She does not smoke or drink alcohol. Vital signs are within normal limits. The patient appears tanned. The second and third metacarpophalangeal joints of both hands are tender to palpation and range of motion is limited. Which of the following is the most appropriate next step in diagnosis?? {'A': 'Testing for anti-nuclear antibodies', 'B': 'Synovial fluid analysis', 'C': 'Testing for parvovirus B19 antibodies', 'D': 'Iron studies', 'E': 'Testing for rheumatoid factors'},
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D: Iron studies
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Q:A 7-year-old boy is brought to the physician because of repetitive, involuntary blinking, shrugging, and grunting for the past year. His mother states that his symptoms improve when he is physically active, while tiredness, boredom, and stress aggravate them. He has felt increasingly embarrassed by his symptoms in school, and his grades have been dropping from average levels. He has met all his developmental milestones. Vital signs are within normal limits. Mental status examination shows intact higher mental functioning and thought processes. Excessive blinking, grunting, and jerking of the shoulders and neck occur while at rest. The remainder of the examination shows no abnormalities. This patient's condition is most likely associated with which of the following findings?? {'A': 'Excessive impulsivity and inattention', 'B': 'Defiant and hostile behavior toward teachers and parents', 'C': 'Feelings of persistent sadness and loss of interest', 'D': 'Chorea and hyperreflexia', 'E': 'Recurrent episodes of intense fear'},
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A: Excessive impulsivity and inattention
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Q:An 18-month-old boy is brought to the physician by his parents for the evaluation of passing large amounts of dark red blood from his rectum for 2 days. His parents noticed that he has also had several episodes of dark stools over the past 3 weeks. The parents report that their child has been sleeping more and has been more pale than usual over the past 24 hours. The boy's appetite has been normal and he has not vomited. He is at the 50th percentile for height and 50th percentile for weight. His temperature is 37°C (98.6°F), pulse is 135/min, respirations are 38/min, and blood pressure is 90/50 mm Hg. Examination shows pale conjunctivae. The abdomen is soft and nontender. There is a small amount of dark red blood in the diaper. Laboratory studies show: Hemoglobin 9.5 g/dL Hematocrit 30% Mean corpuscular volume 68 μm3 Leukocyte count 7,200/mm3 Platelet count 300,000/mm3 Which of the following is most likely to confirm the diagnosis?"? {'A': 'Plain abdominal x-ray', 'B': 'Technetium-99m pertechnetate scan', 'C': 'Water-soluble contrast enema', 'D': 'Esophagogastroduodenoscopy', 'E': 'Colonoscopy'},
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B: Technetium-99m pertechnetate scan
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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 comes to the physician because of an ulcer on his penis for 12 days. The ulcer is painful and draining yellow purulent material. He returned from a study abroad trip to India 3 months ago. His immunizations are up-to-date. He is sexually active with one female partner and uses condoms inconsistently. He appears uncomfortable. His temperature is 37.2°C (99.0°F), pulse is 94/min, and blood pressure is 120/80 mm Hg. Examination shows tender inguinal lymphadenopathy. There is a 2-cm ulcer with a necrotic base proximal to the glans of the penis. Which of the following is the most likely causal organism?? {'A': 'Chlamydia trachomatis', 'B': 'Klebsiella granulomatis', 'C': 'Treponema pallidum', 'D': 'Herpes simplex virus 2', 'E': 'Haemophilus ducreyi'},
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E: Haemophilus ducreyi
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Q:A 49-year-old man comes to the physician because of tender, red nodules that appeared on his chest 3 days ago. Three weeks ago, he had similar symptoms in his right lower limb and another episode in his left foot; both episodes resolved spontaneously. He also has diarrhea and has had a poor appetite for 1 month. He has a history of dry cough and joint pain, for which he takes albuterol and aspirin as needed. He has smoked 2 packs of cigarettes daily for 15 years. He does not drink alcohol. Physical examination shows a linear, erythematous lesion on the right anterior chest wall, through which a cord-like structure can be palpated. The lungs are clear to auscultation. The abdomen is soft, nontender, and non-distended. Examination of the legs is normal. An ultrasound of the legs shows no abnormalities. Which of the following is the most appropriate next step in diagnosis of the underlying condition?? {'A': 'Serum angiotensin-converting enzyme level', 'B': 'CT scan of the abdomen', 'C': 'X-ray of the chest', 'D': 'Coagulation studies', 'E': 'Ankle brachial index'},
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B: CT scan of the abdomen
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Q:A 31-year-old woman presents to the emergency room with high-grade fever and abdominal pain for the past 2 days. She also complains of malaise and has vomited several times since last night. The past medical history is benign. The vital signs include: temperature 40.0°C (104.0°F), pulse 120/min, respiratory rate 28/min, and blood pressure 120/89 mm Hg. On physical examination, severe costovertebral angle tenderness is noted. She is admitted to the medical floor and blood is drawn. The laboratory testing reveals leukocytosis with predominant neutrophilia and increased C-reactive protein and ferritin levels. She is suspected to have a retroperitoneal organ infection. Which of the following best describes the involved organ?? {'A': 'It stores and concentrates bile.', 'B': 'It produces hydrochloric acid.', 'C': 'It is composed of tubules and parenchyma.', 'D': "It is the most common site of Meckel's diverticulum.", 'E': 'It is composed of white pulp and red pulp.'},
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C: It is composed of tubules and parenchyma.
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Q:A 43-year-old woman visits her primary care provider complaining of fatigue. Although she has had it for several months, her fatigue has been worsening over the past few weeks. She has no other symptoms. Past medical history is significant for hypertension. She takes chlorthalidone, an oral contraceptive pill, and a multivitamin every day. Family history is noncontributory. She drinks about 1 bottle of wine every day and started taking a shot or two of whisky or vodka every morning before work to “clear out the cobwebs”. She was recently fired from her job. Today, her heart rate is 90/min, respiratory rate is 17/min, blood pressure is 110/65 mm Hg, and temperature is 36.7°C (98.1°F). On physical exam, she appears malnourished and anxious. Her conjunctiva are pale, and glossitis is noted on oral exam. Her heart has a regular rate and rhythm and her lungs are clear to auscultation bilaterally. She has no gait or balance abnormalities. Lab results show a hemoglobin of 10 g/dL, with a mean corpuscular volume (MCV) of 108 fl. Elevated level of which of the following will most likely to be found in this patient?? {'A': 'Methylmalonic acid', 'B': 'Homocysteine', 'C': 'Methionine', 'D': 'Cysteine', 'E': 'Phenylalanine'},
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B: Homocysteine
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Q:A 22-year-old woman comes to the emergency department because of frontal throbbing headaches for 3 weeks. Yesterday, the patient had blurry vision in both eyes and a brief episode of double vision. She has been taking ibuprofen with only mild improvement of her symptoms. She has polycystic ovarian syndrome, type 2 diabetes mellitus, and facial acne. She has not had any trauma, weakness, or changes in sensation. Her current medications include metformin and vitamin A. She is 158 cm (5 ft 2 in) tall and weighs 89 kg (196 lbs); BMI is 36 kg/m2. Vital signs are within normal limits. Examination shows decreased peripheral vision. Fundoscopic examination of both eyes is shown. MRI of the brain shows an empty sella. Which of the following is the most appropriate next step in management?? {'A': 'Emergent craniotomy', 'B': 'Acetazolamide therapy', 'C': 'Cerebral shunt', 'D': 'Lumbar puncture', 'E': 'Alteplase therapy'},
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D: Lumbar puncture
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Q:A 14-year-old boy is brought to the emergency department because of abdominal swelling and vomiting over the past 24 hours. He has generalized abdominal pain. He has no history of any serious illnesses and takes no medications. His temperature is 36.7°C (98.1°F), blood pressure is 115/70 mm/Hg, pulse is 88/min, and respirations are 16/min. Abdominal examination shows diffuse swelling with active bowel sounds. Mild generalized tenderness without guarding or rebound is noted. His leukocyte count is 8,000/mm3. An X-ray of the abdomen is shown. Intravenous fluids have been initiated. Which of the following is the most appropriate next step in management?? {'A': 'Close observation', 'B': 'Colectomy', 'C': 'Endoscopy', 'D': 'IV antibiotics', 'E': 'Rectal tube'},
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C: Endoscopy
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Q:A 71-year-old man is admitted to the ICU with a history of severe pancreatitis and new onset difficulty breathing. His vital signs are a blood pressure of 100/60 mm Hg, heart rate of 100/min, respirations of 27/min, temperature of 36.7°C (98.1°F), and oxygen saturation of 85% on room air. Physical examination shows a cachectic male in severe respiratory distress. Rales are heard at the base of each lung. The patient is intubated and a Swan-Ganz catheter is inserted. Pulmonary capillary wedge pressure is 8 mm Hg. An arterial blood gas study reveals a PaO2: FiO2 ratio of 180. The patient is diagnosed with acute respiratory distress syndrome. In which of the following segments of the respiratory tract are the cells responsible for the symptoms observed in this patient found?? {'A': 'Respiratory bronchioles', 'B': 'Terminal bronchioles', 'C': 'Bronchioles', 'D': 'Alveolar sacs', 'E': 'Bronchi'},
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D: Alveolar sacs
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Q:A 40-year-old homeless man is brought to the emergency department after police found him in the park lying on the ground with a minor cut at the back of his head. He is confused with slurred speech and fails a breathalyzer test. Pupils are normal in size and reactive to light. A bolus of intravenous dextrose, thiamine, and naloxone is given in the emergency department. The cut on the head is sutured. Blood and urine are drawn for toxicology screening. The blood-alcohol level comes out to be 200 mg/dL. Liver function test showed an AST of 320 U/L, ALT of 150 U/L, gamma-glutamyl transferase of 100 U/L, and total and direct bilirubin level are within normal limits. What is the most likely presentation with a person of this history?? {'A': 'Ataxic gait', 'B': 'Pin point pupil', 'C': 'Vertical nystagmus', 'D': 'High blood pressure', 'E': 'Increased appetite'},
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A: Ataxic gait
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Q:A 59-year-old man is brought to the emergency department one hour after developing shortness of breath and “squeezing” chest pain that began while he was mowing the lawn. He has asthma, hypertension, and erectile dysfunction. Current medications include salmeterol, amlodipine, lisinopril, and vardenafil. His pulse is 110/min and blood pressure is 122/70 mm Hg. Physical examination shows diaphoresis. An ECG shows sinus tachycardia. Sublingual nitroglycerin is administered. Five minutes later, his pulse is 137/min and his blood pressure is 78/40 mm Hg. Which of the following is the most likely mechanism of this patient's hypotension?? {'A': 'Bradykinin accumulation', 'B': 'Calcium channel antagonism', 'C': 'Alpha-1 receptor antagonism', 'D': 'Cyclic GMP elevation', 'E': 'Decreased nitric oxide production'},
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D: Cyclic GMP elevation
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Q:A 49-year-old man presents to his primary care physician complaining of multiple symptoms. He states that over the past 8 months he has noticed voice changes and difficulty swallowing. The dysphagia started with just dry foods like crackers but has progressed to include smoothies and ice cream. He works as a newspaper editor and has also noticed trouble writing with his dominant hand. He is accompanied by his wife, who complains that he snores and drools in his sleep. His medical history is significant for hypertension and a bicuspid aortic valve. He takes hydrochlorothiazide. On physical examination, there is atrophy of the right hand. The patient’s speech is slow. A systolic murmur at the right upper sternal border is appreciated. Tapping of the left patellar tendon causes the patient’s left lower extremity to forcefully kick out. Stroking of the plantar aspect of the patient’s left foot causes his left toes to extend upward. Which of the following therapies is most likely to slow the progression of the patient’s symptoms?? {'A': 'Amantadine', 'B': 'Beta interferon', 'C': 'Donepezil', 'D': 'Reserpine', 'E': 'Riluzole'},
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E: Riluzole
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Answer the following medical question with one of the provided options:
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Q:A 72-year-old woman comes to the physician because of a 1-month history of progressive fatigue and shortness of breath. Physical examination shows generalized pallor. Laboratory studies show: Hemoglobin 5.8 g/dL Hematocrit 17% Mean corpuscular volume 86 μm3 Leukocyte count 6,200/mm3 with a normal differential Platelet count 240,000/mm3 A bone marrow aspirate shows an absence of erythroid precursor cells. This patient’s condition is most likely associated with which of the following?"? {'A': 'Cold agglutinins', 'B': 'Polyomavirus infection', 'C': 'HbF persistence', 'D': 'Thymic tumor', 'E': 'Lead poisoning'},
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D: Thymic tumor
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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 department 35 minutes after he sustained a gunshot wound to the right thigh. He has type 1 diabetes mellitus. On arrival, his pulse is 112/min, respirations are 20/min, and blood pressure is 115/69 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 98%. There is an entrance wound on the anteromedial surface of the right thigh 2 cm below the inguinal ligament. There is no bruit or thrill. There is no exit wound. The pedal pulse is diminished on the right side compared to the left. The abdomen is soft and nontender. The remainder of the examination shows no abnormalities. Laboratory studies show: Hematocrit 46% Serum Urea nitrogen 24 mg/dL Glucose 160 mg/dL Creatinine 3.1 mg/dL Which of the following is the most appropriate next step in management?"? {'A': 'Wound cleaning and tetanus toxoid', 'B': 'Fasciotomy', 'C': 'CT angiography', 'D': 'Digital subtraction angiography', 'E': 'Duplex ultrasonography'},
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E: Duplex ultrasonography
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Q:A 73-year-old male is brought in by ambulance after he was found to be lethargic and confused. He has not been routinely seeing a physician and is unable to recall how he came to be in the hospital. His temperature is 99°F (37°C), blood pressure is 150/95 mmHg, pulse is 75/min, and respirations are 18/min. His past medical history is significant for poorly controlled diabetes and longstanding hypertension, and he says that he has not been taking his medications recently. Labs are obtained and shown below: Serum: Na+: 142 mEq/L Cl-: 105 mEq/L K+: 5 mEq/L HCO3-: 16 mEq/L Urea nitrogen: 51 mg/dL Glucose: 224 mg/dL Creatinine: 2.6 mg/dL Which of the following changes would most likely improve the abnormal parameter that is responsible for this patient's symptoms?? {'A': 'Decreased filtration coefficient', 'B': 'Decreased glomerular capillary hydrostatic pressure', 'C': 'Increased glomerular capillary oncotic pressure', 'D': "Increased Bowman's space hydrostatic pressure", 'E': "Increased Bowman's space oncotic pressure"},
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E: Increased Bowman's space oncotic pressure
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Q:A previously healthy 25-year-old woman is brought to the emergency department because of a 1-hour history of sudden severe lower abdominal pain. The pain started shortly after having sexual intercourse. The pain is worse with movement and urination. The patient had several urinary tract infections as a child. She is sexually active with her boyfriend and uses condoms inconsistently. She cannot remember when her last menstrual period was. She appears uncomfortable and pale. Her temperature is 37.5°C (99.5°F), pulse is 110/min, and blood pressure is 90/60 mm Hg. Abdominal examination shows a palpable, tender right adnexal mass. Her hemoglobin concentration is 10 g/dL and her hematocrit is 30%. A urine pregnancy test is negative. Pelvic ultrasound shows a 5 x 3-cm right ovarian sac-like structure with surrounding echogenic fluid around the structure and the uterus. Which of the following is the most appropriate management for this patient's condition?? {'A': 'CT scan of the abdomen', 'B': 'Oral doxycycline and metronidazole administration', 'C': 'Uterine artery embolization', 'D': 'Intravenous methotrexate administration', 'E': 'Emergency exploratory laparotomy'},
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E: Emergency exploratory laparotomy
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Q:A 58-year-old man presents to the Emergency Department after 3 hours of intense suprapubic pain associated with inability to urinate for the past day or two. His medical history is relevant for benign prostatic hyperplasia (BPH) that has been under treatment with prazosin and tadalafil. Upon admission, he is found to have a blood pressure of 180/100 mm Hg, a pulse of 80/min, a respiratory rate of 23/min, and a temperature of 36.5°C (97.7°F). He weighs 84 kg (185.1 lb) and is 175 cm (5 ft 7 in) tall. Physical exam, he has suprapubic tenderness. A bladder scan reveals 700 ml of urine. A Foley catheter is inserted and the urine is drained. Initial laboratory tests and their follow up 8 hours after admission are shown below. Admission 8 hours after admission Serum potassium 4.2 mmol/L Serum potassium 4.0 mmol/L Serum sodium 140 mmol/L Serum sodium 142 mmol/L Serum chloride 102 mmol/L Serum chloride 110 mmol/L Serum creatinine 1.4 mg/dL Serum creatinine 1.6 mg/dL Serum blood urea nitrogen 64 mg/dL Serum blood urea nitrogen 62 mg/dL Urine output 250 mL Urine output 260 mL A senior attending suggests a consultation with Nephrology. Which of the following best justifies this suggestion? ? {'A': 'Serum potassium', 'B': 'Serum creatinine (SCr)', 'C': 'Serum blood urea nitrogen (BUN)', 'D': 'Urine output', 'E': 'Estimated glomerular filtration rate (eGFR)'},
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D: Urine output
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Q:Study X examined the relationship between coffee consumption and lung cancer. The authors of Study X retrospectively reviewed patients' reported coffee consumption and found that drinking greater than 6 cups of coffee per day was associated with an increased risk of developing lung cancer. However, Study X was criticized by the authors of Study Y. Study Y showed that increased coffee consumption was associated with smoking. What type of bias affected Study X, and what study design is geared to reduce the chance of that bias?? {'A': 'Observer bias; double blind analysis', 'B': 'Lead time bias; placebo', 'C': 'Selection bias; randomization', 'D': 'Measurement bias; blinding', 'E': 'Confounding; randomization or crossover study'},
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E: Confounding; randomization or crossover study
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Q:An 87-year-old woman is brought to the emergency department from her nursing home because of increasing confusion and lethargy for 12 hours. The nursing home aide says she did not want to get out of bed this morning and seemed less responsive than usual. She has Alzheimer's disease, hypertension, and a history of nephrolithiasis. She has chronic, intractable urinary incontinence, for which she has an indwelling urinary catheter. Current medications include galantamine, memantine, and ramipril. Her temperature is 38.5°C (101.3°F), pulse is 112/min, respiratory rate is 16/min, and blood pressure is 108/76 mm Hg. Physical examination shows mild tenderness to palpation of the lower abdomen. On mental status examination, she is oriented only to person. Laboratory studies show: Hemoglobin 12.4 g/dL Leukocyte count 9,000/mm3 Platelet count 355,000/mm3 Urine pH 8.2 Glucose 1+ Protein 2+ Ketones negative RBC 5/hpf WBC 35/hpf Bacteria moderate Nitrites positive Which of the following is the most likely causal organism?"? {'A': 'Escherichia coli', 'B': 'Proteus mirabilis', 'C': 'Enteroccocus faecalis', 'D': 'Staphylococcus saprophyticus', 'E': 'Klebsiella pneumoniae'},
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B: Proteus mirabilis
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Answer the following medical question with one of the provided options:
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Q:A 17-year-old girl is brought into the physician's office with complaints of nausea, vomiting, headache, and blurry vision. In preparation for final exams the patient's mother started her on an array of supplements and herbal preparations given the "viral illness" that is prevalent at her school. Despite these remedies, the girl has been feeling perpetually worse, and yesterday during cheerleading practice had to sit out after vomiting and feeling dizzy. The patient admits to falling during one of the exercises and hitting her head on another girl's shin due to her dizziness. When asked to clarify her dizziness, the patient states that she feels rather lightheaded at times. The patient's BMI is 19 kg/m^2. She endorses diarrhea of recent onset, and some non-specific, diffuse pruritus of her skin which she attributes to stress from her finals. The patient has a past medical history of anxiety, depression, and excessive exercise habits. On physical exam the patient is alert and oriented to place, person, and time, and answers questions appropriately. She denies any decreased ability to participate in school or to focus. Her skin is dry and peeling with a minor yellow discoloration. Her memory is intact at 1 minute and 5 minutes for 3 objects. The patient's pupils are equal and reactive to light and there are no abnormalities upon examination of cranial nerve III, IV or VI. Which of the following is the most likely cause of this patient's symptoms?? {'A': 'Head trauma', 'B': 'Supplement use', 'C': 'Idiopathic intracranial hypertension', 'D': 'Migraine headache with aura', 'E': 'Bulimia nervosa'},
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B: Supplement use
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Q:A 6-year-old boy is brought to the pediatrician by his mother complaining of abdominal pain and constipation. She reports that his appetite has been reduced and that he has not had a bowel movement in 2 days. Prior to this, he had a regular bowel movement once a day. She also reports that he has appeared to be more tired than usual. The family recently moved into a house built in the 1940s and have just begun renovations. The child was born via spontaneous vaginal delivery at 39 weeks gestation. He is up to date on all vaccinations and meeting all developmental milestones. Today, his blood pressure is 120/80 mm Hg, heart rate is 95/min, respiratory rate is 25/min, and temperature is 37.0°C (98.6°F). A physical exam is only significant for moderate conjunctival pallor. A peripheral blood smear shows red blood cells with basophilic stippling. What is the most likely mechanism causing this patient’s symptoms?? {'A': 'Activation of ALA dehydratase', 'B': 'Inhibition of ferrochelatase', 'C': 'Activation of glutathione', 'D': 'Inhibition of ALA synthase', 'E': 'Inactivation of uroporphyrinogen III cosynthase'},
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B: Inhibition of ferrochelatase
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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 is taken to the emergency room after losing consciousness. According to his wife, he suddenly complained of fluttering in his chest, lightheadedness, and profuse sweating while walking to the grocery store. He then turned gray, lost consciousness, and collapsed onto the ground. His medical history is significant for a prior anterior wall myocardial infarction 2 years ago that was complicated by severe left ventricular systolic dysfunction. His blood pressure is 80/50 mm Hg, the temperature is 36.7°C (98.0°F), and the carotid pulse is not palpable. An ECG was obtained and the results are shown in the picture. Cardiopulmonary resuscitation is initiated and the patient is cardioverted to sinus rhythm with an external defibrillator. The patient regains consciousness and states there was no antecedent chest discomfort. Cardiac enzymes are negative and serum electrolytes are normal. Which of the following is the best next step for this patient?? {'A': 'Intravenous metoprolol', 'B': 'Intravenous magnesium sulphate', 'C': 'Implantable cardioverter-defibrillator', 'D': 'Intravenous adenosine', 'E': 'Temporary or permanent cardiac pacing'},
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C: Implantable cardioverter-defibrillator
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Q:A 58-year-old woman presents with vision loss in her right eye. She noticed the visual changes the morning of presentation and has never experienced this visual disturbance before. Her medical history is significant for hypertension, hypercholesterolemia, and type II diabetes mellitus. She is currently on lisinopril, lovastatin, and metformin. She has smoked a pack of cigarettes daily for the last 25 years and also is a social drinker. On physical exam, her lids and lashes appear normal and there is no conjunctival injection. Both pupils are equal, round, and reactive to light; however, when the penlight is swung from the left eye to the right eye, there is bilateral pupillary dilation. The nerve that is most likely defective in this patient relays information to which of the following?? {'A': 'Medial geniculate nucleus', 'B': 'Lateral geniculate nucleus', 'C': 'Edinger-Westphal nucleus', 'D': 'Oculomotor nucleus', 'E': 'Ventral posteromedial nucleus'},
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B: Lateral geniculate nucleus
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Answer the following medical question with one of the provided options:
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Q:A 10-year-old boy is brought to the physician by his parents for a follow-up examination. He has had a short stature since birth and underwent diagnostic testing. Genetic analyses showed a gain of function mutation in the fibroblast growth factor receptor 3 (FGFR3) gene. He has met all developmental milestones. He is at the 10th percentile for height and 90th percentile for weight. Which of the following additional findings is most likely on physical examination?? {'A': 'Absent collar bones', 'B': 'Blue sclerae', 'C': 'Long extremities', 'D': 'Small genitalia', 'E': 'Frontal bossing'},
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E: Frontal bossing
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Q:A 19-year-old woman presents to her university health clinic for a regularly scheduled visit. She has a past medical history of depression, acne, attention-deficit/hyperactivity disorder, and dysmenorrhea. She is currently on paroxetine, dextroamphetamine, and naproxen during her menses. She is using nicotine replacement products to quit smoking. She is concerned about her acne, recent weight gain, and having a depressed mood this past month. She also states that her menses are irregular and painful. She is not sexually active and tries to exercise once a month. Her temperature is 97.6°F (36.4°C), blood pressure is 133/81 mmHg, pulse is 80/min, respirations are 14/min, and oxygen saturation is 98% on room air. Physical exam is notable for a morbidly obese woman with acne on her face. Her pelvic exam is unremarkable. The patient is given a prescription for isotretinoin. Which of the following is the most appropriate next step in management?? {'A': 'Administer bupropion', 'B': 'Check hCG', 'C': 'Check prolactin', 'D': 'Check TSH', 'E': 'Recheck blood pressure in 1 week'},
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B: Check hCG
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Q:A 2-year-old boy is brought to his pediatrician for evaluation of a tender red big toe. His mother also notes that she has seen him recently starting to bite his own fingers and also exhibits spasms of muscle tightness. She reports that his diapers often contain the substance shown in the photograph. On exam he is noted to be significantly developmentally delayed as he is neither walking nor talking. Which of the following would be the first-line pharmacologic treatment for this patient's disorder?? {'A': '6-mercaptopurine', 'B': 'Allopurinol', 'C': 'Hydroxyurea', 'D': 'Methionine', 'E': 'Probenecid'},
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B: Allopurinol
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Q:A 32-year-old man is brought to the Emergency Department after 3 consecutive days of diarrhea, fatigue and weakness. His stool has been soft and mucoid, with no blood stains. The patient just came back from a volunteer mission in Guatemala, where he remained asymptomatic. His personal medical history is unremarkable. Today his blood pressure is 98/60 mm Hg, pulse is 110/min, respiratory rate is 19/min, and his body temperature is 36.7°C (98.1°F). On physical exam, he has sunken eyes, dry mucosa, mild diffuse abdominal tenderness, and hyperactive bowel sounds. Initial laboratory tests are shown below: Serum creatinine (SCr) 1.8 mg/dL Blood urea nitrogen (BUN) 50 mg/dL Serum sodium 132 mEq/L Serum potassium 3.5 mEq/L Serum chloride 102 mEq/L Which of the following phenomena would you expect in this patient?? {'A': 'High urine osmolality, high fractional excretion of sodium (FeNa+), high urine Na+', 'B': 'High urine osmolality, low FeNa+, low urine Na+', 'C': 'Low urine osmolality, high FeNa+, high urine Na+', 'D': 'Low urine osmolality, low FeNa+, high urine Na+', 'E': 'Low urine osmolality, high FeNa+, low urine Na+'},
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B: High urine osmolality, low FeNa+, low urine Na+
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Q:A 32-year-old woman comes to the physician with fever and malaise. For the past 2 days, she has felt fatigued and weak and has had chills. Last night, had a temperature of 40.8°C (104.2°F). She has had a sore throat since this morning. The patient was recently diagnosed with Graves disease and started on methimazole. Laboratory studies show: Hemoglobin 13.3 g/dL Leukocyte count 3,200/mm3 Segmented neutrophils 8% Basophils < 1% Eosinophils < 1% Lymphocytes 80% Monocytes 11% Platelet count 220,000/mm3 Which of the following is the most appropriate next step in management?"? {'A': 'Switch to propylthiouracil', 'B': 'Bone marrow biopsy', 'C': 'Test for EBV, HIV, and CMV', 'D': 'Begin oral aminopenicillin', 'E': 'Discontinue methimazole'},
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E: Discontinue methimazole
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Answer the following medical question with one of the provided options:
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Q:A 62-year-old woman comes to the physician because of a 2-month history of exertional shortness of breath and fatigue. She sometimes wakes up at night coughing and gasping for air. Cardiac examination shows a grade 3/6 holosystolic murmur best heard at the apex. Which of the following physical exam findings would be consistent with an exacerbation of this patient's condition?? {'A': 'Early diastolic extra heart sound', 'B': 'Prominent V wave', 'C': 'Head bobbing', 'D': 'Absence of A2 heart sound', 'E': 'Radiation of the murmur to the axilla'},
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A: Early diastolic extra heart sound
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Q:A group of investigators who are studying individuals infected with Trypanosoma cruzi is evaluating the ELISA absorbance cutoff value of serum samples for diagnosis of infection. The previous cutoff point is found to be too high, and the researchers decide to lower the threshold by 15%. Which of the following outcomes is most likely to result from this decision?? {'A': 'Increased negative predictive value', 'B': 'Unchanged true positive results', 'C': 'Decreased sensitivity', 'D': 'Increased positive predictive value', 'E': 'Increased specificity'},
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A: Increased negative predictive value
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Q:A 33-year-old man comes to the physician because of a 2-month history of burning epigastric pain, dry cough, and occasional regurgitation. The pain is aggravated by eating and lying down. Physical examination shows a soft, non-tender abdomen. Upper endoscopy shows hyperemia in the distal third of the esophagus. Which of the following drugs is most likely to directly inhibit the common pathway of gastric acid secretion?? {'A': 'Pirenzepine', 'B': 'Ranitidine', 'C': 'Aluminum hydroxide', 'D': 'Lansoprazole', 'E': 'Octreotide'},
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D: Lansoprazole
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Answer the following medical question with one of the provided options:
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Q:A 24-year-old woman comes to the physician for a routine health maintenance examination. She feels well. Menses occur at regular 28-day intervals and last for 3–5 days, with normal flow. They are occasionally accompanied by pain. Three years ago, she was diagnosed with chlamydial cervicitis and treated with doxycycline. She has been sexually active with multiple partners since the age of 18 years. She regularly uses condoms for contraception. She drinks 2–3 beers on weekends and smokes half a pack of cigarettes daily. Vital signs are within normal limits. Physical examination including a complete pelvic exam shows no abnormalities. A Pap smear shows a low-grade squamous epithelial lesion (LSIL). Which of the following is the most appropriate next step in management?? {'A': 'Colposcopy with endocervical sampling', 'B': 'Colposcopy with endocervical and endometrial sampling', 'C': 'Repeat Pap smear in 12 months', 'D': 'Repeat Pap smear in 3 years', 'E': 'Loop electrosurgical excision procedure'},
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C: Repeat Pap smear in 12 months
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Q:A 43-year-old man presents to the office with complaints of mild abdominal pain, yellowish discoloration of eyes, and itching all over his body for a year. He recently lost 2.4 kg (5.3 lb) over a period of 1 month. He says that his urine is dark and stool appears clay-colored. He denies any history of hematemesis, melena, or fever, but mentions about his travel to Europe 6 months ago. The past history includes a coronary angiography for anginal chest pain 2 years ago, which showed 75% blockage in the left anterior descending (LAD) artery. He takes medications on a daily basis, but is unable to remember the names. On physical examination, there is a palpable, non-tender mass in the right upper abdomen. The lab results are as follows: Alkaline phosphatase 387 IU/L Total bilirubin 18 mg/dL Aspartate transaminase 191 IU/L Alanine transaminase 184 IU/L CA 19-9 positive The serology is negative for hepatotropic viruses. The abdominal CT scan with contrast shows multifocal short segmental stricture of the bile duct outside the liver and mild dilation along with hypertrophy of the caudate lobe and atrophy of the left lateral and right posterior segments. The biopsy of the bile duct reveals periductal fibrosis with atypical bile duct cells in a desmoplastic stroma. Which of the following predisposing factors is responsible for this patient’s condition?? {'A': 'Long term carcinogenic effect of the contrast agent', 'B': 'Chronic infection due to hepatitis virus', 'C': 'Idiopathic inflammatory scarring of the bile duct', 'D': 'Liver fluke induced inflammation leading to metaplastic change', 'E': 'Abnormal cystic dilation of the biliary tree'},
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C: Idiopathic inflammatory scarring of the bile duct
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Q:A 1-month-old girl is brought to the physician for evaluation of a rash on her face that first appeared 3 days ago. She was delivered at term after an uncomplicated pregnancy. She is at the 25th percentile for length and 40th percentile for weight. Examination shows small perioral vesicles surrounded by erythema and honey-colored crusts. Laboratory studies show: At birth Day 30 Hemoglobin 18.0 g/dL 15.1 g/dL Leukocyte count 7,600/mm3 6,830/mm3 Segmented neutrophils 2% 3% Eosinophils 13% 10% Lymphocytes 60% 63% Monocytes 25% 24% Platelet count 220,000/mm3 223,000/mm3 Which of the following is the most likely diagnosis?"? {'A': 'Severe congenital neutropenia', 'B': 'Parvovirus B19 infection', 'C': 'Acute lymphoblastic leukemia', 'D': 'Selective IgA deficiency', 'E': 'Diamond-Blackfan syndrome'},
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A: Severe congenital neutropenia
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Q:A 56-year-old man is brought to the emergency department 25 minutes after he was involved in a high-speed motor vehicle collision where he was the unrestrained passenger. He has severe lower abdominal and pelvic pain. On arrival, he is alert and oriented. His pulse is 95/min, respirations are 22/min, and blood pressure is 106/62 mm Hg. Examination shows severe tenderness to palpation over the lower abdomen and over the left anterior superior iliac spine. There is no limb length discrepancy. Application of downward pressure over the pelvis shows no springy resistance or instability. Rectal examination is unremarkable. A focused assessment with sonography shows no free fluid in the abdomen. There is no blood at the urethral meatus. Placement of a Foley catheter shows gross hematuria. An x-ray of the pelvis shows a fracture of the left pelvic edge. Which of the following is the most appropriate next step in management?? {'A': 'Intravenous pyelography', 'B': 'Cystoscopy', 'C': 'External fixation of the pelvis', 'D': 'Retrograde urethrography', 'E': 'Retrograde cystography'},
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E: Retrograde cystography
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Q:A 43-year-old woman comes to the physician because of worsening heartburn and abdominal pain for the past 4 months. During this period she has also had multiple episodes of greasy diarrhea. Six months ago, she had similar symptoms and was diagnosed with a duodenal ulcer. Her mother died of complications from uncontrolled hypoglycemia and had primary hyperparathyroidism. The patient does not drink alcohol or smoke cigarettes. Her only medications are pantoprazole and ranitidine. Her epigastric region is tender when palpated. An esophagogastroduodenoscopy shows a friable ulcer in the distal duodenum. Further evaluation is most likely to show which of the following?? {'A': 'Anti-intrinsic factor antibodies in the serum', 'B': 'Anti-tissue transglutaminase antibodies in the serum', 'C': 'Parietal cell hyperplasia in the stomach', 'D': 'Noncaseating granulomas in the jejunum', 'E': 'Dystrophic calcifications in the pancreas'},
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C: Parietal cell hyperplasia in the stomach
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Q:A 25-year-old man presents with a mass on his neck. He says that he first noticed the mass a few weeks ago while taking a shower. Since then, the mass has not increased in size. He denies any pain or difficulty in swallowing. Past medical history is unremarkable. Family history is significant for his father who had his thyroid removed when he was around his age but doesn’t know why. Review of systems is significant for occasional episodes of anxiety that include a pounding headache, racing heart, and sweating. His vital signs include: pulse 88/min, blood pressure 133/87 mm Hg, temperature 37.2°C (99.0°F), and respiratory rate 14/min. He is 183 cm (6 ft 2 in) tall with long extremities. On physical examination, the patient appears cachectic. There is a palpable 4 cm x 4 cm nodule present on the left lobe of the thyroid. Which of the following is the most likely thyroid pathology in this patient?? {'A': 'Giant cell thyroiditis', 'B': 'Anaplastic carcinoma', 'C': 'Papillary carcinoma', 'D': 'Follicular adenoma', 'E': 'Medullary carcinoma'},
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E: Medullary carcinoma
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Q:A 46-year-old man presents to the office complaining of dry, irritated eyes that have gotten worse over the last week. The patient states that he has also developed a red bumpy rash on his arms. On exam, his bilateral cornea and conjunctiva are dry and thickened. There are small ulcerations on the cornea. The skin of the bilateral arms has an erythematous rash characterized by small, white raised lesions. The patient has a history of alcoholism but has no other significant past medical history. What is most likely deficient in this patient?? {'A': 'Folic acid', 'B': 'Vitamin B12', 'C': 'Vitamin K', 'D': 'Thiamine', 'E': 'Vitamin A'},
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E: Vitamin A
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Q:A 3-year-old boy presents with fever, generalized fatigue, nausea, and progressive anemia. The patient’s mother says his condition was normal until one week ago when he started having flu-like symptoms such as fever, general fatigue, and abdominal discomfort. Past medical experience is significant for sickle cell disease, diagnosed 2 years ago. His vital signs include: blood pressure 98/50 mm Hg, pulse 120/min, temperature 39.0℃ (102.0℉). On physical examination, the patient is crying excessively and his skin and the conjunctivae look pale. Splenomegaly is noted. There is no skin rash nor lymphadenopathy. Laboratory findings are significant for the following: Total WBC count 22,000/mm3 Neutrophils 35% Lymphocytes 44% Atypical lymphocytes 9% Monocytes 12% RBC 1. 6 million/mm3 Hb 5.4 g/dL Hct 14.4% MCV 86 fL MCHC 37.5% Reticulocytes 0.1% A peripheral blood smear shows sickle cells. A direct and indirect Coombs test is negative. Which of the following is the most likely cause of this patient’s most recent symptoms?? {'A': 'Parvovirus infection', 'B': 'IgG-mediated hemolytic anemia', 'C': 'Sickle cell disease', 'D': 'Myelofibrosis', 'E': 'Fanconi’s anemia'},
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A: Parvovirus infection
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Q:A 35-year-old man presents to his primary care provider complaining of dull pain in his scrotum and lower back pain over the last 3 months. He is a computer engineer working in a private IT company. He had an uncomplicated appendectomy at the age of 22 years, but is otherwise without a significant past medical history. He smokes 2–3 cigarettes on weekends and drinks alcohol occasionally. He is sexually active with his wife. Today his heart rate is 90/min and blood pressure is 132/76 mm Hg. Scrotal examination reveals a firm, small and painless nodule on the left testicle. Scrotal ultrasound reveals a 0.9 x 0.5 cm irregular, non-cystic mass. He undergoes a left radical orchiectomy and histopathological examination reveals uniform tumor cells with abundant clear cytoplasm and distinct cell borders, consistent with a seminoma. Subsequent PET/CT scans show supraclavicular and para-aortic lymph node involvement. Which is the next and most appropriate step in the management of this patient?? {'A': 'Observation', 'B': 'Chemotherapy', 'C': 'Radiotherapy', 'D': 'Surgery', 'E': 'Immunotherapy'},
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B: Chemotherapy
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Q:A 32-year-old woman comes to the physician because of a 3-month history of recurrent headaches and nausea. The headaches occur a few times a month and alternately affect the right or left side. The headaches are exacerbated by loud sounds or bright light. She is in graduate school and has been under a lot of stress recently. She does not smoke or drink alcohol but does drink 2–3 cups of coffee daily. Her only medication is an oral contraceptive. Physical examination shows no abnormalities; visual acuity is 20/20. Which of the following is the most likely diagnosis?? {'A': 'Migraine headache', 'B': 'Tension headache', 'C': 'Trigeminal neuralgia', 'D': 'Cluster headache', 'E': 'Pseudotumor cerebri'},
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A: Migraine headache
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Q:A 12-year-old girl is brought to the emergency department 3 hours after the sudden onset of colicky abdominal pain and vomiting. She also has redness and swelling of the face and lips without pruritus. Her symptoms began following a tooth extraction earlier this morning. She had a similar episode of facial swelling after a bicycle accident 1 year ago which resolved within 48 hours without treatment. Vital signs are within normal limits. Examination shows a nontender facial edema, erythema of the oral mucosa, and an enlarged tongue. The abdomen is soft and there is tenderness to palpation over the lower quadrants. An abdominal ultrasound shows segmental thickening of the intestinal wall. Which of the following is the most likely cause of this patient's condition?? {'A': 'Drug-induced bradykinin excess', 'B': 'Complement inhibitor deficiency', 'C': 'Immune-complex deposition', 'D': 'Leukotriene overproduction', 'E': 'T-cell mediated immune reaction'},
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B: Complement inhibitor deficiency
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Q:A 23-year-old man comes to the physician because of a 1-year history of episodic shortness of breath. Physical examination shows no abnormalities. Laboratory studies show elevated serum IgE levels. Microscopic examination of the sputum shows eosinophilic, hexagonal, double-pointed crystals. A methacholine challenge test is positive. Exposure to which of the following is most likely responsible for this patient's condition?? {'A': 'Bird droppings', 'B': 'Aspirin', 'C': 'Cold air', 'D': 'Dust mites', 'E': 'Tobacco smoke'},
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D: Dust mites
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Q:A 58-year-old man comes to the emergency department for complaints of crushing chest pain for 4 hours. He was shoveling snow outside when the pain started. It is rated 7/10 and radiates to his left arm. An electrocardiogram (ECG) demonstrates ST-segment elevation in leads V2-4. He subsequently undergoes percutaneous coronary intervention (PCI) and is discharged with aspirin, clopidogrel, carvedilol, atorvastatin, and lisinopril. Five days later, the patient is brought to the emergency department by his wife with complaints of dizziness. He reports lightheadedness and palpitations for the past 2 hours but otherwise feels fine. His temperature is 99.7°F (37.6°C), blood pressure is 95/55 mmHg, pulse is 105/min, and respirations are 17/min. A pulmonary artery catheter is performed and demonstrates an increase in oxygen concentration at the pulmonary artery. What finding would you expect in this patient?? {'A': 'Drop of systolic blood pressure by 20 mmHg during inspiration', 'B': 'Harsh, loud, holosystolic murmur at the lower left sternal border', 'C': 'Normal findings', 'D': 'Pulseless electrical activity', 'E': 'Widespread ST-segment elevations'},
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B: Harsh, loud, holosystolic murmur at the lower left sternal border
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Q:A 73-year-old man presents to your clinic for a routine checkup. His medical history is notable for a previous myocardial infarction. He states that he has not seen a doctor in "many years". He has no complaints. When you auscultate over the cardiac apex with the bell of your stethoscope, you notice an additional sound immediately preceding S1. This extra heart sound is most likely indicative of which of the following processes?? {'A': 'Increased left ventricular compliance', 'B': 'Decreased left ventricular compliance', 'C': 'Increased left ventricular filling volume', 'D': 'Decreased left ventricular filling volume', 'E': 'Increased pulmonary compliance'},
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B: Decreased left ventricular compliance
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Q:A 4-year-old boy is brought to the physician because of a 3-day history of fever and left ear pain. Examination of the left ear shows a bulging tympanic membrane with green discharge. Gram stain of the discharge shows a gram-negative coccobacillus. The isolated organism grows on chocolate agar. The causal pathogen most likely produces a virulence factor that acts by which of the following mechanisms?? {'A': 'Binding of the Fc region of immunoglobulins', 'B': 'Inactivation of 60S ribosome', 'C': 'Overactivation of adenylate cyclase', 'D': 'Cleavage of secretory immunoglobulins', 'E': 'Inactivation of elongation factor'},
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D: Cleavage of secretory immunoglobulins
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Q:You have been asked to deliver a lecture to medical students about the effects of various body hormones and neurotransmitters on the metabolism of glucose. Which of the following statements best describes the effects of sympathetic stimulation on glucose metabolism?? {'A': 'Norepinephrine causes increased glucose absorption within the intestines.', 'B': 'Without epinephrine, insulin cannot act on the liver.', 'C': 'Sympathetic stimulation to alpha receptors of the pancreas increases insulin release.', 'D': 'Peripheral tissues require epinephrine to take up glucose.', 'E': 'Epinephrine increases liver glycogenolysis.'},
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E: Epinephrine increases liver glycogenolysis.
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Q:A 43-year-old man with a history of chronic alcoholism presents with a chronic cough and dyspnea. He says he traveled to Asia about 4 months ago and his symptoms started shortly after he returned. His temperature is 40.2°C (104.4°F) and pulse is 92/min. Physical examination reveals poor personal hygiene and a cough productive of foul blood-streaked sputum. Auscultation reveals decreased breath sounds on the right. A chest radiograph reveals an ill-defined circular lesion in the right middle lobe. Which of the following is true regarding this patient’s most likely diagnosis?? {'A': 'Stains of gastric washing and urine have a high diagnostic yield on microscopy.', 'B': 'Inoculation of a sputum sample into selective agar media needs to be incubated at 35–37°C (95.0–98.6°F) for up to 8 weeks.', 'C': 'Ziehl-Neelsen staining is more sensitive than fluorescence microscopy with auramine-rhodamine stain.', 'D': 'DNA polymerase chain reaction (PCR) has poor sensitivity when applied to smear positive specimens.', 'E': 'A positive tuberculin test would be diagnostic of active infection.'},
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B: Inoculation of a sputum sample into selective agar media needs to be incubated at 35–37°C (95.0–98.6°F) for up to 8 weeks.
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Q:A 47-year-old female with a history of mild asthma, type II diabetes, hypertension, and hyperlipidemia presents to clinic complaining of swelling in her lips (Image A). She has had no changes to her medications within the past two years. Vital signs are stable. Physical exam is notable for significant erythema around and swelling of the lips. The remainder of her exam is unremarkable. What is the mechanism of action of the drug that has caused her current symptoms?? {'A': 'Inhibition of angiotensin-converting enzyme', 'B': 'Inhibition of HMG-CoA reductase', 'C': 'Stimulation of the Beta 2 receptor', 'D': 'Inhibition of the Na/K/Cl triple transporter of the thick ascending limb', 'E': 'Inhibition of voltage-dependent L-type calcium channels'},
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A: Inhibition of angiotensin-converting enzyme
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Q:A 24-year-old man presents to the physician because of headache, malaise, fatigue, aching pain in the bones, and a non-itchy skin rash for the past week. He reports that he had developed a single, raised, red-colored eruption over the glans penis 2 months ago, which had healed spontaneously 1 month ago. Physical examination shows bilaterally symmetric, discrete, round, pale-red-colored, 5–10 mm-sized macules on his trunk and extremities, including over the palms and soles. His genital examination shows reddish-brown plaques on the penis. Venereal disease research laboratory test is positive and high-sensitivity enzyme-linked immunosorbent assay for HIV is negative. Fluorescent treponemal antibody-absorption test is positive. Eight hours after the administration of intramuscular benzathine penicillin, the patient presents to the emergency department with complaints of fever with chills, worsening headache, muscle pains, and worsening of his pre-existing skin lesions for the past 4 hours. There is no history of itching. His temperature is 38.5°C (101.3°F), heart rate is 108/min, respiratory rate is 24/min, and blood pressure is 104/76 mm Hg. There is no bronchospasm. His complete blood count shows leukocytosis with lymphopenia. What is the most appropriate next step in management?? {'A': 'Prescribe an antipyretic and an analgesic for symptom relief', 'B': 'Prescribe oral prednisone for 5 days', 'C': 'Administer intravenous diphenhydramine', 'D': 'Administer intramuscular epinephrine', 'E': 'Prescribe doxycycline for 28 days'},
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A: Prescribe an antipyretic and an analgesic for symptom relief
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Q:A 2-year-old boy is brought to the office by his mother due to the recent onset of fever and ear pain. He began tugging on his ear and complaining of pain 3 days ago. The mother reports a temperature of 37.8°C (100.0°F) this morning, with decreased appetite. The current temperature is 38.6ºC (101.4ºF). Ear, nose, and throat (ENT) examination shows erythema and decreased the mobility of the right tympanic membrane. Which is the most appropriate pharmacological agent for the management of this patient?? {'A': 'Amoxicillin', 'B': 'Azithromycin', 'C': 'Ceftriaxone', 'D': 'Ciprofloxacin', 'E': 'Piperacillin'},
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A: Amoxicillin
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Q:A 27-year-old man comes to the physician because of worsening abdominal pain over the last several months. He has also had recent feelings of sadness and a lack of motivation at work, where he is employed as a computer programmer. He denies suicidal thoughts. He has a history of multiple kidney stones. He has a family history of thyroid cancer in his father and uncle, who both underwent thyroidectomy before age 30. His temperature is 37°C (98°F), blood pressure is 138/86 mm Hg, and pulse is 87/min. Physical examination shows diffuse tenderness over the abdomen and obesity but is otherwise unremarkable. Serum studies show: Na+ 141 mEq/L K+ 3.6 mEq/L Glucose 144 mg/dL Ca2+ 12.1 mg/dL Albumin 4.1 g/dL PTH 226 pg/mL (normal range 12–88 pg/mL) Results of a RET gene test return abnormal. The physician refers him to an endocrine surgeon. Which of the following is the most appropriate next step in diagnosis?"? {'A': 'Thyroidectomy', 'B': 'Urine metanephrines', 'C': 'Urine 5-HIAA', 'D': 'Midnight salivary cortisol', 'E': 'Serum gastrin'},
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B: Urine metanephrines
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Q:An 82-year-old woman presents with 2 months of foul-smelling, greasy diarrhea. She says that she also has felt very tired recently and has had some associated bloating and flatus. She denies any recent abdominal pain, nausea, melena, hematochezia, or vomiting. She also denies any history of recent travel and states that her home has city water. Which of the following tests would be most appropriate to initially work up the most likely diagnosis in this patient?? {'A': 'Fecal fat test', 'B': 'CT of the abdomen with oral contrast', 'C': 'Stool O&P', 'D': 'Stool guaiac test', 'E': 'Tissue transglutaminase antibody test'},
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A: Fecal fat test
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Q:A 12-year-old boy is brought to the office by his mother with complaints of clear nasal discharge and cough for the past 2 weeks. The mother says that her son has pain during swallowing. Also, the boy often complains of headaches with a mild fever. Although his mother gave him some over-the-counter medication, there was only a slight improvement. Five days ago, his nasal discharge became purulent with an increase in the frequency of his cough. He has no relevant medical history. His vitals include: heart rate 95 bpm, respiratory rate 17/min, and temperature 37.9°C (100.2°F). On physical exploration, he has a hyperemic pharynx with purulent discharge on the posterior wall, halitosis, and nostrils with copious amounts of pus. Which of the following is the most likely cause?? {'A': 'Diphtheria', 'B': 'Acute sinusitis', 'C': 'Non-allergic vasomotor rhinitis', 'D': 'Streptococcal pharyngitis', 'E': 'Common cold'},
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B: Acute sinusitis
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Q:A 65-year-old male presents to the physician after noticing gross blood with urination. He reports that this is not associated with pain. The patient smokes 1.5 packs per day for 45 years. Dipstick analysis is positive for blood, with 5 RBC per high-power field (HPF) on urinalysis. A cystoscopy is performed, which is significant for a lesion suspicious for malignancy. A biopsy was obtained, which is suggestive of muscle-invasive transitional cell carcinoma. Before radical cystectomy is performed, the patient is started on cisplatin-based chemotherapy. Which of the following is most likely associated with this chemotherapeutic drug?? {'A': 'Gentamicin enhances toxicity risk', 'B': 'Cardiotoxicity', 'C': 'Hemorrhagic cystitis', 'D': 'Myelosuppression', 'E': 'Addition of mesna decreases drug toxicity'},
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A: Gentamicin enhances toxicity risk
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Q:Three hours after undergoing open proctocolectomy for ulcerative colitis, a 42-year-old male complains of abdominal pain. The pain is localized to the periumbilical and hypogastric regions. A total of 20 mL of urine has drained from his urinary catheter since the end of the procedure. Temperature is 37.2°C (98.9°F), pulse is 92/min, respirations are 12/min, and blood pressure is 110/72 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 99%. Physical examination shows a 20 cm vertical midline incision and an ileostomy in the right lower quadrant. There is no fluid drainage from the surgical wounds. The urinary catheter flushes easily and is without obstruction. Cardiopulmonary examination shows no abnormalities. Serum studies show a blood urea nitrogen of 30 mg/dL and a creatinine of 1.3 mg/dL. Which of the following is the most appropriate next step in management?? {'A': 'Administer intravenous furosemide', 'B': 'Start ciprofloxacin', 'C': 'Administer intravenous fluids', 'D': 'Obtain an abdominal CT', 'E': 'Administer tamsulosin'},
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C: Administer intravenous fluids
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Q:Three days after undergoing coronary artery bypass surgery, a 72-year-old man has severe right upper quadrant pain, fever, nausea, and vomiting. He has type 2 diabetes mellitus, benign prostatic hyperplasia, peripheral vascular disease, and chronic mesenteric ischemia. He had smoked one pack of cigarettes daily for 30 years but quit 10 years ago. He drinks 8 cans of beer a week. His preoperative medications include metformin, aspirin, simvastatin, and finasteride. His temperature is 38.9°C (102°F), pulse is 102/min, respirations are 18/min, and blood pressure is 110/60 mmHg. Auscultation of the lungs shows bilateral inspiratory crackles. Cardiac examination shows no murmurs, rubs or gallops. Abdominal examination shows soft abdomen with tenderness and sudden inspiratory arrest upon palpation in the right upper quadrant. There is no rebound tenderness or guarding. Laboratory studies show the following: Hemoglobin 13.1 g/dL Hematocrit 42% Leukocyte count 15,700/mm3 Segmented neutrophils 65% Bands 10% Lymphocytes 20% Monocytes 3% Eosinophils 1% Basophils 0.5% AST 40 U/L ALT 100 U/L Alkaline phosphatase 85 U/L Total bilirubin 1.5 mg/dL Direct 0.9 mg/dL Amylase 90 U/L Abdominal ultrasonography shows a distended gallbladder, thickened gallbladder wall with pericholecystic fluid, and no stones. Which of the following is the most appropriate next step in management?"? {'A': 'Intravenous heparin therapy followed by embolectomy', 'B': 'Careful observation with serial abdominal examinations', 'C': 'Immediate cholecystectomy', 'D': 'Intravenous piperacillin-tazobactam therapy and percutaneous cholecystostomy', 'E': 'Endoscopic retrograde cholangiopancreatography with papillotomy'},
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D: Intravenous piperacillin-tazobactam therapy and percutaneous cholecystostomy
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Answer the following medical question with one of the provided options:
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Q:A 57-year-old man presents to the emergency department for weight loss and abdominal pain. The patient states that he has felt steadily more fatigued over the past month and has lost 22 pounds without effort. Today, he fainted prompting his presentation. The patient has no significant past medical history. He does have a 33 pack-year smoking history and drinks 4 to 5 alcoholic drinks per day. His temperature is 99.5°F (37.5°C), blood pressure is 100/58 mmHg, pulse is 100/min, respirations are 17/min, and oxygen saturation is 98% on room air. On physical exam, you see a patient who is very thin and appears to be pale. Stool fecal occult blood testing is positive. A CT scan of the abdomen is performed demonstrating a mass in the colon with multiple metastatic lesions scattered throughout the abdomen. The patient is informed of his diagnosis of metastatic colon cancer. When the patient conveys the information to his family he focuses his efforts on discussing the current literature in the field and the novel therapies that have been invented. He demonstrates his likely mortality outcome which he calculated using the results of a large multi-center study. Which of the following is this patient most likely demonstrating?? {'A': 'Optimism', 'B': 'Pessimism', 'C': 'Intellectualization', 'D': 'Dissociation', 'E': 'Rationalization'},
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C: Intellectualization
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Q:A home drug screening test kit is currently being developed. The cut-off level is initially set at 4 mg/uL, which is associated with a sensitivity of 92% and a specificity of 97%. How might the sensitivity and specificity of the test change if the cut-off level is changed to 2 mg/uL?? {'A': 'Sensitivity = 90%, specificity = 99%', 'B': 'Sensitivity = 92%, specificity = 97%', 'C': 'Sensitivity = 95%, specificity = 98%', 'D': 'Sensitivity = 97%, specificity = 96%', 'E': 'Sensitivity = 100%, specificity = 97%'},
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D: Sensitivity = 97%, specificity = 96%
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Q:A 49-year-old woman presents to the office for a follow-up visit. She was diagnosed with cirrhosis of the liver 1 year ago and is currently receiving symptomatic treatment along with complete abstinence from alcohol. She does not have any complaints. She has a 4-year history of gout, which has been asymptomatic during treatment with medication. She is currently prescribed spironolactone and probenecid. She follows a diet rich in protein. The physical examination reveals mild ascites with no palpable abdominal organs. A complete blood count is within normal limits, while a basic metabolic panel with renal function shows the following: Sodium 141 mEq/L Potassium 5.1 mEq/L Chloride 101 mEq/L Bicarbonate 22 mEq/L Albumin 3.4 mg/dL Urea nitrogen 4 mg/dL Creatinine 1.2 mg/dL Uric Acid 6.8 mg/dL Calcium 8.9 mg/dL Glucose 111 mg/dL Which of the following explains the blood urea nitrogen result?? {'A': 'Use of probenecid', 'B': 'Liver disease', 'C': 'Spironolactone', 'D': 'Increase in dietary protein', 'E': 'The urea value is within normal limits'},
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B: Liver disease
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Q:A 65-year-old man comes to the physician because of abdominal pain and bloody, mucoid diarrhea for 3 days. He has been taking over-the-counter supplements for constipation over the past 6 months. He was diagnosed with type 2 diabetes mellitus 15 years ago. He has smoked one pack of cigarettes daily for 35 years. His current medications include metformin. His temperature is 38.4°C (101.1°F), pulse is 92/min, and blood pressure is 134/82 mm Hg. Examination of the abdomen shows no masses. Palpation of the left lower abdomen elicits tenderness. A CT scan of the abdomen is shown. Which of the following is the most likely underlying cause of the patient's condition?? {'A': 'Focal weakness of the colonic muscularis layer', 'B': 'Infiltrative growth in the descending colon', 'C': 'Transmural inflammation of the terminal ileum', 'D': 'Twisting of the sigmoid colon around its mesentery', 'E': 'Decreased perfusion to mesenteric blood vessel'},
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A: Focal weakness of the colonic muscularis layer
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Q:A 55-year-old woman comes to the physician with concerns about swelling and pain in her right breast. Physical examination shows erythema and prominent pitting of the hair follicles overlying the upper and lower outer quadrants of the right breast. There are no nipple changes or discharge. A core needle biopsy shows invasive carcinoma of the breast. Which of the following is the most likely explanation for this patient's skin findings?? {'A': 'Bacterial invasion of the subcutaneous tissue', 'B': 'Obstruction of the lymphatic channels', 'C': 'Involution of the breast parenchyma and ductal system', 'D': 'Infiltration of the lactiferous ducts', 'E': 'Tightening of the suspensory ligaments'},
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B: Obstruction of the lymphatic channels
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Q:A 59-year-old woman comes to the emergency department 25 minutes after the onset of severe left periorbital pain and blurred vision in the same eye. The pain began soon after she entered a theater to watch a movie. She has a headache and vomited twice on the way to the hospital. Two weeks ago, she had acute sinusitis that resolved spontaneously. She has atrial fibrillation and hypertension. Current medications include metoprolol and warfarin. Her temperature is 37.1°C (98.8°F), pulse is 101/min, and blood pressure is 140/80 mm Hg. Visual acuity is counting fingers at 3 feet in the left eye and 20/20 in the right eye. The left eye shows conjunctival injection and edematous cornea. The left pupil is mid-dilated and irregular; it is not reactive to light. Extraocular movements are normal. Fundoscopic examination is inconclusive because of severe corneal edema. Which of the following is the most likely diagnosis?? {'A': 'Central retinal artery occlusion', 'B': 'Open-angle glaucoma', 'C': 'Retrobulbar neuritis', 'D': 'Acute iridocyclitis', 'E': 'Angle-closure glaucoma'},
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E: Angle-closure glaucoma
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Answer the following medical question with one of the provided options:
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Q:A 70-year-old female with chronic kidney failure secondary to diabetes asks her nephrologist to educate her about the techniques used to evaluate the degree of kidney failure progression. She learns about the concept of glomerular filtration rate (GFR) and learns that it can be estimated by measuring the levels of some substances. The clearance of which of the following substances is the most accurate estimate for GFR?? {'A': 'Creatinine', 'B': 'Glucose', 'C': 'Inulin', 'D': 'Paraaminohippurate (PAH)', 'E': 'Sodium'},
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C: Inulin
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Answer the following medical question with one of the provided options:
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Q:A 32-year-old man is brought to the emergency department because he was found stumbling in the street heedless of oncoming traffic. On arrival, he is found to be sluggish and has slow and sometimes incoherent speech. He is also drowsy and falls asleep several times during questioning. Chart review shows that he has previously been admitted after getting a severe cut during a bar fight. Otherwise, he is known to be intermittently homeless and has poorly managed diabetes. Serum testing reveals the presence of a substance that increases the duration of opening for an important channel. Which of the following symptoms may be seen if the most likely substance in this patient is abruptly discontinued?? {'A': 'Cardiovascular collapse', 'B': 'Delayed delirium', 'C': 'Flashbacks', 'D': 'Insomnia', 'E': 'Piloerection'},
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A: Cardiovascular collapse
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Answer the following medical question with one of the provided options:
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Q:A 4-month-old boy is brought to the physician for a well-child examination. He was born at 39 weeks gestation via spontaneous vaginal delivery and is exclusively breastfed. He weighed 3,400 g (7 lb 8 oz) at birth. At the physician's office, he appears well. His pulse is 146/min, the respirations are 39/min, and the blood pressure is 78/44 mm Hg. He weighs 7.5 kg (16 lb 9 oz) and measures 65 cm (25.6 in) in length. The remainder of the physical examination is normal. Which of the following developmental milestones has this patient most likely met?? {'A': 'Bounces actively when held in standing position', 'B': 'Grasps small objects between thumb and finger', 'C': 'Intentionally rolls over', 'D': 'Sits with support of pelvis', 'E': 'Transfers objects from hand to hand'},
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C: Intentionally rolls over
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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 comes to the physician for a 1-month history of fever, malaise, and skin rash. He has had a 5-kg (11-lb) weight loss during this period. He does not smoke, drink alcohol, or use illicit drugs. He appears pale. His temperature is 39.1°C (102.3°F), pulse is 110/min, and blood pressure is 140/85 mm Hg. Physical examination shows nontender, erythematous macules on the palms and soles. A photograph of one of his fingernails is shown. Microscopic examination of the nail lesion is most likely to show which of the following?? {'A': 'IgE immune complexes', 'B': 'Aschoff granulomas', 'C': 'Arteriovenous malformations', 'D': 'Microemboli', 'E': 'Non-caseating granulomas'},
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D: Microemboli
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Q:A 23-year-old man is brought to the emergency department by the police for impaired cognition and agitation after being struck in the head at a local nightclub. The patient refuses to respond to questions and continues to be markedly agitated. An alcoholic smell is noted. His temperature is 36.9°C (98.4°F), pulse is 104/min, respirations are 24/min, and blood pressure is 148/95 mm Hg. He is confused and oriented only to person. Neurological examination shows miosis and nystagmus but is quickly aborted after the patient tries to attack several members of the care team. CT scan of the head shows no abnormalities. Ingestion of which of the following substances most likely explains this patient's symptoms?? {'A': 'Heroin', 'B': 'Alcohol', 'C': 'Lysergic acid diethylamide', 'D': 'Methamphetamine', 'E': 'Phencyclidine'},
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E: Phencyclidine
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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, gravida 1, para 0, at 18 weeks' gestation, comes to the physician for a prenatal visit. She recently read about a genetic disorder that manifests with gait ataxia, kyphoscoliosis, and arrhythmia and is concerned about the possibility of her child inheriting the disease. There is no personal or family history of this disorder. The frequency of unaffected carriers in the general population is 1/100. Assuming the population is in a steady state without selection, what is the probability that her child will develop this disease?? {'A': '1/10,000', 'B': '1/20,000', 'C': '1/40,000', 'D': '1/200', 'E': '1/400'},
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C: 1/40,000
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Answer the following medical question with one of the provided options:
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Q:A previously healthy 5-year-old girl is brought to the emergency department because of difficulty breathing and vomiting that began 1 hour after she took an amoxicillin tablet. She appears anxious. Her pulse is 140/min, respirations are 40/min, and blood pressure is 72/39 mmHg. She has several well-circumscribed, raised, erythematous plaques scattered diffusely over her trunk and extremities. Pulmonary examination shows diffuse, bilateral wheezing. Which of the following is the most appropriate initial pharmacotherapy?? {'A': 'Methylprednisolone', 'B': 'Norepinephrine', 'C': 'Diphenhydramine', 'D': 'Dobutamine', 'E': 'Epinephrine'},
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E: Epinephrine
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Answer the following medical question with one of the provided options:
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Q:An 8-year-old boy is brought in for initial evaluation by a pediatrician after he was adopted from an international orphanage. On presentation, he is found to have difficulty with walking as well as bone and joint pain. The adoption papers for the child state that he was the product of a normal birth with no medical issues noted at that time. Since then, he has not seen a doctor until this presentation. Physical exam reveals bowed legs, hard lumps on his ribs, and tenderness to palpation over his bones. He is found to be low in a substance that directly promotes intestinal absorption of a nutrient. Which of the following is a characteristic of the substance that is abnormally low in this patient?? {'A': 'It is a fat soluble vitamin', 'B': 'It is a water soluble vitamin', 'C': 'It is produced by chief cells of the parathyroid gland', 'D': 'It is produced by oxyphil cells of the parathyroid gland', 'E': 'It is produced by parafollicular cells of the thyroid gland'},
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A: It is a fat soluble vitamin
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Answer the following medical question with one of the provided options:
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Q:A 4-year-old boy presents to the emergency department after his parents found him drinking blue liquid out of an unlabeled bottle in the garage. They have no idea what was in the bottle and are concerned for his health. They have brought the bottle with them to the emergency department. The child's past medical history is not remarkable, and he is currently not taking any medications. The patient's vitals are within normal limits for his age. Physical exam reveals a crying child who is drooling. A radiograph is performed, and the child's vitals are closely monitored. It is determined that the blue liquid is a strong alkali. Which of the following is the best next step in management?? {'A': 'Administration of a diluent', 'B': 'Administration of a weak acid', 'C': 'Charcoal', 'D': 'Gastrografin swallow and endoscopy', 'E': 'Ipecac'},
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D: Gastrografin swallow and endoscopy
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Answer the following medical question with one of the provided options:
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Q:A newborn is brought to the pediatric clinic by his mother because she has noticed a swelling in the belly while dressing her baby. On physical examination, the newborn is found to have a non-tender upper abdominal mass. The clinician also noticed absent irises and undescended testes in this baby. A magnetic resonance image (MRI) scan of the abdomen shows a mass of intra-renal origin. Which 1 of the following genetic disorders is most probably the cause of this neonate’s symptoms and signs?? {'A': 'WT-1 missense mutation', 'B': 'Deletion 11-p-13', 'C': 'Deletion 11-p-15', 'D': 'Duplication of 11-p-15', 'E': 'Amplification of MYCN (N-myc) proto-oncogene'},
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B: Deletion 11-p-13
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