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Answer the following medical question with one of the provided options:
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Q:A 3-year-old is brought in to the pediatrician's office for a routine checkup. Her parents report that they noticed some regression in their daughter’s behavior. She seemed to be progressing well during the first 18 months of her life. She had started saying words such as ‘I’, ‘you’ and ‘mama’ and she was linking words together. She also learned to follow simple instructions. However, over the past few months, they have noticed that she has been forgetting some of the things that she had previously learned and difficulty walking. On examination, the physician observes an apparently healthy girl who refuses to make eye contact and only slowly responds to her name. She is observed to wring her hands repeatedly in her lap. Which of the following genetic patterns of inheritance is responsible for this behavioral regression?? {'A': 'X-linked dominant', 'B': 'X-linked recessive', 'C': 'Autosomal dominant', 'D': 'Autosomal recessive', 'E': 'Chromosomal trisomy'},
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A: X-linked dominant
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Answer the following medical question with one of the provided options:
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Q:A 6-year-old boy presents with bleeding gums. His past medical history reveals a recent supracondylar fracture of the right humerus as the result of a fall while playing. On physical examination, petechiae are seen all over the patient’s body. The patient’s tongue is shown in the image. Which of the following is the most likely cause of this patient’s condition?? {'A': 'Child abuse', 'B': 'Osteogenesis imperfecta', 'C': 'Menkes disease', 'D': 'Vitamin C deficiency', 'E': 'Ehlers-Danlos syndrome'},
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D: Vitamin C deficiency
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Answer the following medical question with one of the provided options:
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Q:A 26-year-old man from India visits the clinic with complaints of feeling tired all the time and experiencing lack of energy for the past couple of weeks. He also complains of weakness and numbness of his lower limbs. He has been strictly vegan since the age of 18, including not consuming eggs and milk. He does not take any vitamin or dietary supplements. Physical examination reveals a smooth, red beefy tongue along with lower extremity sensory and motor deficits. What other finding is most likely to accompany this patient’s condition?? {'A': 'Ataxia', 'B': 'Upper limb weakness', 'C': 'Psychiatric symptoms', 'D': 'Decreased visual acuity', 'E': 'Microcytic anemia'},
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A: Ataxia
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Answer the following medical question with one of the provided options:
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Q:A 66-year-old man is brought to the emergency department with complaints of progressively worsening hemoptysis. The patient states that he has had a chronic cough on account of his COPD, but he noticed that he had been coughing more consistently and frequently for the past 3 weeks. Initially, the blood in his sputum was minimal, but he now is seeing a substantial amount of blood and is concerned. He denies any other changes in his sputum over the past 3 weeks, except for the increased amount of blood. He denies shortness of breath, fatigue, fever, or lightheadedness. He notes that he has unintentionally lost about 5 kg (11 lb) over the past month and has had some mild muscle cramping in his legs. Aside from COPD, the patient also has hypertension and was recently diagnosed with gout. He quit smoking 3 years ago, and he had a 25-pack-year history prior to cessation. His current medications include colchicine, lisinopril, and baby aspirin. The vital signs include: blood pressure 92/58mm Hg, pulse 105/min, respiratory rate 12/min, temperature 37.0°C (98.6°F), and oxygen saturation 95% on room air. There are crackles in the right lung base on auscultation. A chest radiograph reveals a poorly-circumscribed 2 cm nodule in the right lower lobe. Which of the following is the best next step in this patient’s management?? {'A': 'Consult a radiologist to perform a bronchial artery embolization', 'B': 'Consult a pulmonologist to perform a fiberoptic bronchoscopy', 'C': 'Secure airway and maintain adequate oxygen saturation', 'D': 'Obtain a chest CT to determine site of bleeding', 'E': 'Insert a nasogastric tube to determine site of bleeding'},
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C: Secure airway and maintain adequate oxygen saturation
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Answer the following medical question with one of the provided options:
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Q:A 24-year-old man is brought to the emergency department after he is found sluggish, drowsy, feverish, and complaining about a headache. His past medical history is unremarkable. His vital signs include: blood pressure 120/60 mm Hg, heart rate 70/min, respiratory rate 17/min, and body temperature 39.0°C (102.2°F). On physical examination, the patient is dysphasic and incapable of following commands. Gait ataxia is present. No meningeal signs or photophobia are present. A noncontrast CT of the head is unremarkable. A T2 MRI is performed and is shown in the image. A lumbar puncture (LP) is subsequently performed. Which of the following CSF findings would you most likely expect to find in this patient?? {'A': 'Opening pressure: 18 cm H2O, color: clear, protein: 40 mg/dL, cell count: 2 cells/µL, mostly polymorphonuclear (PMNs), ratio CSF:blood glucose: 0.7', 'B': 'Opening pressure: 28 cm H2O, color: cloudy, protein: 68 mg/dL, cell count: 150 cells/µL, mostly PMNs, ratio CSF:blood glucose: 0.3', 'C': 'Opening pressure: 40 cm H2O, color: cloudy, protein: 80 mg/dL, cell count: 135 cells/µL, mostly lymphocytes with some PMNs, ratio CSF:blood glucose: 0.2', 'D': 'Opening pressure: 15 cm H2O, color: clear, protein: 50 mg/dL, cell count: 40 cells/µL, mostly lymphocytes, ratio CSF:blood glucose: 0.65', 'E': 'Opening pressure: 38 cm H2O, color: cloudy, protein: 75 mg/dL, cell count: 80 cells/µL, mostly lymphocytes, ratio CSF:blood glucose: 0.25'},
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D: Opening pressure: 15 cm H2O, color: clear, protein: 50 mg/dL, cell count: 40 cells/µL, mostly lymphocytes, ratio CSF:blood glucose: 0.65
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Answer the following medical question with one of the provided options:
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Q:A 40-year-old male presents to the clinic. The patient has begun taking large doses of vitamin E in order to slow down the aging process and increase his sexual output. He has placed himself on this regimen following reading a website that encouraged this, without consulting a healthcare professional. He is interested in knowing if it is alright to continue his supplementation. Which of the following side-effects should he be concerned about should he continue his regimen?? {'A': 'Night blindness', 'B': 'Deep venous thrombosis', 'C': 'Peripheral neuropathy', 'D': 'Hemorrhage', 'E': 'Retinopathy'},
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D: Hemorrhage
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Answer the following medical question with one of the provided options:
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Q:A 60-year-old man with a history of hypertension, diabetes, and hyperlipidemia was successfully managed for acute myocardial infarction involving the left anterior descending artery. Eight months after his discharge home, an echocardiogram reveals the presence of a ventricular aneurysm. The patient subsequently dies after a stroke. Which of the following best explains the sequence of events leading to this outcome?? {'A': 'Stroke occurring as result of a mural thrombus', 'B': 'Stroke occurring because of a paradoxical embolus', 'C': 'Stroke occurring because of a deep venous thrombosis', 'D': 'Rupture of an aneurysm leading to hemorrhagic stroke', 'E': 'Ventricular free wall rupture leading global hypotension'},
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A: Stroke occurring as result of a mural thrombus
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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 with weakness and fatigue for 1 week. There is no significant past medical history. He mentions that he is very health conscious and has heard about the health benefits of juices. He is following a juice-only diet for the last 2 weeks. His physical examination is completely normal, except for depressed deep tendon reflexes. The only abnormality in a complete laboratory evaluation is a serum potassium level of 6.0 mEq/L (6.0 mmol/L). There are significantly peaked T-waves on ECG. Which of the following pathophysiologic mechanisms best explains the patient’s symptoms?? {'A': 'Dysfunction of Na+ channels', 'B': 'Decreased resting membrane potential of skeletal muscle cells', 'C': 'Dysfunction of dystrophin-glycoprotein complex', 'D': 'Hyperpolarization of skeletal muscle cells', 'E': 'Prolonged release of Ca2+ ions after stimulation of Ryanodine receptors'},
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B: Decreased resting membrane potential of skeletal muscle cells
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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 is brought to the physician for a well-child examination. He started walking at 20 months of age. He can use a cup to drink but cannot use silverware. He speaks in 2-word sentences and can build a tower of 4 blocks. He can scribble but cannot draw a circle. He is above the 99th percentile for height and at the 15th percentile for weight. Vital signs are within normal limits. Examination shows bilateral inferior lens dislocation. His fingers are long and slender. He has a high-arched palate. The thumb and 5th finger overlap when he grips a wrist with the opposite hand. The skin over the neck can be extended and stretched easily. Which of the following is the most likely cause of these findings?? {'A': 'Hypoxanthine-guanine-phosphoribosyl transferase deficiency', 'B': 'Fibrillin 1 deficiency', 'C': 'Type V collagen deficiency', 'D': 'Cystathionine synthase deficiency', 'E': 'Galactokinase deficiency'},
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D: Cystathionine synthase deficiency
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Answer the following medical question with one of the provided options:
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Q:A 78-year-old man suffers a fall in a nursing home and is brought to the emergency room. A right hip fracture is diagnosed, and he is treated with a closed reduction with internal fixation under spinal anesthesia. On the second postoperative day, the patient complains of pain in the lower abdomen and states that he has not urinated since the surgery. An ultrasound shows increased bladder size and volume. Which of the following is the mechanism of action of the drug which is most commonly used to treat this patient’s condition?? {'A': 'Parasympathetic agonist', 'B': 'Sympathetic agonist', 'C': 'Parasympathetic antagonist', 'D': 'Alpha-blocker', 'E': 'Beta-blocker'},
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A: Parasympathetic agonist
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Answer the following medical question with one of the provided options:
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Q:A 33-year-old woman with a history of multiple sclerosis is brought to the physician because of dizziness, urinary incontinence, loss of vision in her right eye, and numbness and weakness of the left leg. She has had recurrent episodes of neurological symptoms despite several changes in her medication regimen. An MRI of the brain shows several new enhancing lesions in the periventricular white matter and the brainstem. Treatment with a drug that binds to CD52 is initiated. Which of the following agents was most likely prescribed?? {'A': 'Eculizumab', 'B': 'Bevacizumab', 'C': 'Alemtuzumab', 'D': 'Rituximab', 'E': 'Abciximab'},
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C: Alemtuzumab
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Answer the following medical question with one of the provided options:
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Q:An 85-year-old man with terminal stage colon cancer formally designates his best friend as his medical durable power of attorney. After several courses of chemotherapy and surgical intervention, the patient’s condition does not improve, and he soon develops respiratory failure. He is then placed on a ventilator in a comatose condition. His friend with the medical power of attorney tells the care provider that the patient would not want to be on life support. The patient’s daughter disputes this and says that her father needs to keep receiving care, in case there should be any possibility of recovery. Additionally, there is a copy of the patient’s living will in the medical record which states that, if necessary, he should be placed on life support until full recovery. Which of the following is the most appropriate course of action?? {'A': 'The durable medical power of attorney’s decision should be followed.', 'B': 'Follow the daughter’s decision for the patient', 'C': 'Contact other family members to get their input for the patient', 'D': 'Act according to the patient’s living will', 'E': 'Withdraw the life support since the patient’s chances of recovery are very low'},
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D: Act according to the patient’s living will
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Answer the following medical question with one of the provided options:
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Q:A 8-month-old boy is brought to the physician for the evaluation of shortening of his arms and legs. The parents report that they have also noticed that their son's head is progressively enlarging. The patient was born at term via vaginal delivery. There is no personal or family history of serious illness. His immunizations are up-to-date. He is at the 3rd percentile for height, 25th percentile for weight, and 95th percentile for head circumference. Examination shows macrocephaly and prominent brow bones. The extremities are short and plump. Muscle strength is 3/5 in all muscle groups. Deep tendon reflexes are 4+ bilaterally. An x-ray of the lateral skull shows midfacial hypoplasia and frontal prominence. X-rays of the spine shows abnormally narrow interpedicular distance. Which of the following is the most appropriate next step in management?? {'A': 'Reassurance', 'B': 'Growth hormone therapy', 'C': 'Levothyroxine therapy', 'D': 'CT scan of the head', 'E': 'Bisphosphonate therapy\n"'},
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D: CT scan of the head
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Answer the following medical question with one of the provided options:
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Q:A 21-year-old primigravida presents to her physician for a prenatal visit. She has a positive pregnancy test 1 week ago. The estimated gestational age is 16 weeks. She has no complaints. She has a history of type 1 diabetes mellitus and takes insulin for glucose control. The urine dipstick test shows 3+ glucose and negative for protein. The blood tests ordered at the last visit 1 week ago are as follows: Fasting glucose 110 mg/dL HbA1c 8.3% Which of the following tests should be highly recommended for this patient?? {'A': 'Oral glucose tolerance test', 'B': 'C-peptide assessment', 'C': 'Triple test', 'D': 'Serum creatinine', 'E': 'Chorionic villus sampling'},
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C: Triple test
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Answer the following medical question with one of the provided options:
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Q:A 16-year-old boy comes to the physician for a routine health maintenance examination. He feels well. He has no history of serious illness. He is at the 60th percentile for height and weight. Vital signs are within normal limits. The lungs are clear to auscultation. A grade 3/6 ejection systolic murmur is heard along the lower left sternal border. The murmur decreases in intensity on rapid squatting and increases in intensity when he performs the Valsalva maneuver. This patient is at increased risk for which of the following complications?? {'A': 'Angiodysplasia', 'B': 'Infective endocarditis', 'C': 'Sudden cardiac death', 'D': 'Pulmonary apoplexy', 'E': 'Cerebral aneurysm\n"'},
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C: Sudden cardiac death
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Answer the following medical question with one of the provided options:
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Q:A 27-year-old man comes to the physician with throbbing right scrotal pain for 1 day. He has also had a burning sensation on urination during the last 4 days. He is sexually active with multiple female partners and does not use condoms. Physical examination shows a tender, palpable swelling on the upper pole of the right testicle; lifting the testicle relieves the pain. A Gram stain of urethral secretions shows numerous polymorphonuclear leukocytes but no organisms. Which of the following is the most likely causal pathogen of this patient's symptoms?? {'A': 'Pseudomonas aeruginosa', 'B': 'Mycobacterium tuberculosis', 'C': 'Mumps virus', 'D': 'Chlamydia trachomatis', 'E': 'Staphylococcus aureus'},
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D: Chlamydia trachomatis
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Answer the following medical question with one of the provided options:
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Q:A 76-year-old male presents to his primary care physician because he is concerned about changes in urination. Over the last few months, he has noticed increased urinary frequency as well as difficulty with initiating and stopping urination. He denies having pain with urination. Physical exam reveals a uniformly enlarged and non-tender prostate. Lab tests showed that the prostate specific antigen (PSA) was within normal limits. The patient did not tolerate an alpha blocker due to episodes of syncope so another medication is prescribed that affects testosterone metabolism. Which of the following disorders can also be treated with the medication most likely prescribed in this case?? {'A': 'Erectile dysfunction', 'B': 'Hypogonadism', 'C': 'Male pattern baldness', 'D': 'Polycystic ovarian syndrome (PCOS)', 'E': 'Prostate adenocarcinoma'},
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C: Male pattern baldness
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Answer the following medical question with one of the provided options:
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Q:A 19-year-old woman presents with an irregular menstrual cycle. She says that her menstrual cycles have been light with irregular breakthrough bleeding for the past three months. She also complains of hair loss and increased the growth of facial and body hair. She had menarche at 11. Vital signs are within normal limits. Her weight is 97.0 kg (213.8 lb) and height is 157 cm (5 ft 2 in). Physical examination shows excessive hair growth on the patient’s face, back, linea alba region, and on the hips. There is also a gray-brown skin discoloration on the posterior neck. An abdominal ultrasound shows multiple peripheral cysts in both ovaries. Which of the following cells played a direct role in the development of this patient’s excessive hair growth?? {'A': 'Ovarian follicular cells', 'B': 'Adipocytes', 'C': 'Pituitary gonadotropic cells', 'D': 'Ovarian theca cells', 'E': 'Pituitary lactotrophs'},
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D: Ovarian theca cells
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Answer the following medical question with one of the provided options:
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Q:A 23-year-old man presents to the emergency department with a severe headache. The patient states he gets sudden, severe pain over his face whenever anything touches it, including shaving or putting lotion on his skin. He describes the pain as electric and states it is only exacerbated by touch. He is currently pain free. His temperature is 98.1°F (36.7°C), blood pressure is 127/81 mmHg, pulse is 87/min, respirations are 15/min, and oxygen saturation is 98% on room air. Neurological exam is within normal limits, except severe pain is elicited with light palpation of the patient’s face. The patient is requesting morphine for his pain. Which of the following is the most likely diagnosis?? {'A': 'Cluster headache', 'B': 'Malingering', 'C': 'Migraine headache', 'D': 'Tension headache', 'E': 'Trigeminal neuralgia'},
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E: Trigeminal neuralgia
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Answer the following medical question with one of the provided options:
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Q:A 6-year-old girl is brought to the emergency department because of right elbow swelling and pain 30 minutes after falling onto her outstretched right arm. She has been unable to move her right elbow since the fall. Physical examination shows bruising, swelling, and tenderness of the right elbow; range of motion is limited by pain. An x-ray of the right arm shows a supracondylar fracture of the humerus with anterior displacement of the proximal fragment. Further evaluation is most likely to show which of the following findings?? {'A': 'Absent distal radial pulse', 'B': 'Radial deviation of the wrist', 'C': 'Atrophy of the thenar eminence', 'D': 'Inability to abduct shoulder', 'E': 'Inability to flex the elbow'},
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A: Absent distal radial pulse
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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 feeling weak for the past week. He states that he has felt much more tired than usual and has had a subjective fever during this time. The patient has a past medical history of IV drug use, hepatitis C, atrial fibrillation, cirrhosis, alcohol dependence, obesity, and depression. His temperature is 102°F (38.9°C), blood pressure is 157/98 mmHg, pulse is 110/min, respirations are 17/min, and oxygen saturation is 98% on room air. On physical exam, you note a fatigued man with diffuse yellowing of his skin. Cardiopulmonary exam is notable for bibasilar crackles on auscultation. Abdominal exam is notable for abdominal distension, dullness to percussion, and a fluid wave. The patient complains of generalized tenderness on palpation of his abdomen. The patient is started on piperacillin-tazobactam and is admitted to the medical floor. On day 4 of his stay in the hospital the patient is afebrile and his pulse is 92/min. His abdominal tenderness is reduced but is still present. Diffuse yellowing of the patient's skin and sclera is still notable. The nurses notice bleeding from the patient's 2 peripheral IV sites that she has to control with pressure. A few new bruises are seen on the patient's arms and legs. Which of the following is the best explanation for this patient's condition?? {'A': 'Bacterial destruction', 'B': 'Decreased metabolism of an anticoagulant', 'C': 'Decreased renal excretion of an anticoagulant', 'D': 'Diffuse activation of the coagulation cascade', 'E': 'Worsening infection'},
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A: Bacterial destruction
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Answer the following medical question with one of the provided options:
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Q:A 71-year-old woman comes to the physician with a 2-month history of fatigue, anorexia, abdominal swelling, shortness of breath, and a 5-kg (11-lb) weight loss. She appears chronically ill. Examination shows jaundice, bilateral temporalis muscle wasting, hepatosplenomegaly, and tense ascites. Ultrasonography of the abdomen shows multiple hepatic masses and enlargement of the portal vein. Which of the following is the most likely cause of these masses?? {'A': 'Metastatic spread of malignant cells from the colon', 'B': 'Malignant transformation of hepatocytes', 'C': 'Proliferation of hepatic capillaries', 'D': 'Hyperplasia of atypical bile duct tissue', 'E': 'Lymphoproliferative disorder of hepatic sinusoids'},
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A: Metastatic spread of malignant cells from the colon
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Answer the following medical question with one of the provided options:
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Q:A 68-year-old man comes to the physician in July for a routine health maintenance examination. He is a retired teacher and lives in a retirement community. He has hypercholesterolemia, hypertension, and osteoarthritis of the left knee. Last year, he was diagnosed with chronic lymphocytic leukemia. A colonoscopy 8 years ago was normal. The patient had a normal digital examination and a normal prostate specific antigen level 8 months ago. The patient has never smoked and does not drink alcohol. Current medications include aspirin, lisinopril, simvastatin, chlorambucil, rituximab, and a multivitamin. His last immunizations were at a health maintenance examination 7 years ago. His temperature is 37°C (98.6°F), pulse is 82/min, respirations are 14/min, and blood pressure is 133/85 mm Hg. Examination shows a grade 2/6 systolic ejection murmur along the upper right sternal border and painless cervical lymphadenopathy. Which of the following health maintenance recommendations is most appropriate at this visit?? {'A': 'Pneumococcal conjugate vaccine 13', 'B': 'Abdominal ultrasound', 'C': 'Meningococcal conjugate vaccine', 'D': 'Varicella vaccine', 'E': 'Influenza vaccine'},
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A: Pneumococcal conjugate vaccine 13
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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 after suffering a motor vehicle accident as the passenger. He had no obvious injuries, but he complains of excruciating right hip pain. His right leg is externally rotated, abducted, and extended at the hip and the femoral head can be palpated anterior to the pelvis. Plain radiographs of the pelvis reveal a right anterior right hip dislocation and femoral head fracture. Which sensory and motor deficits are most likely in this patient’s right lower extremity?? {'A': 'Loss of sensation laterally below the knee, weak thigh extension and knee flexion', 'B': 'Paresis and numbness of the medial thigh and medial side of the calf, weak hip flexion and knee extension', 'C': 'Numbness of the medial side of the thigh and inability to adduct the thigh', 'D': 'Numbness of the ipsilateral scrotum and upper medial thigh', 'E': 'Sensory loss to the dorsal surface of the foot and part of the anterior lower and lateral leg and foot drop'},
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B: Paresis and numbness of the medial thigh and medial side of the calf, weak hip flexion and knee extension
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Answer the following medical question with one of the provided options:
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Q:A 49-year-old man comes to the physician because of increasing difficulty achieving an erection for 6 months. During this period, he has had to reduce his hours as a construction worker because of pain in his lower back and thighs and a progressive lower limb weakness when walking for longer distances. His pain resolves after resting for a few minutes, but it recurs when he returns to work. He also reports that his pain is improved by standing still. He is sexually active with 4 female partners and uses condoms irregularly. His father has coronary artery disease and his mother died of a ruptured intracranial aneurysm at the age of 53 years. He has smoked one pack of cigarettes daily for 35 years. He has recently taken sildenafil, given to him by a friend, with no improvement in his symptoms. His only other medication is ibuprofen as needed for back pain. His last visit to a physician was 25 years ago. He is 172.5 cm (5 ft 8 in) tall and weighs 102 kg (225 lb); BMI is 34.2 kg/m2. His temperature is 36.9°C (98.4°F), pulse is 76/min, and blood pressure is 169/98 mm Hg. A complete blood count and serum concentrations of electrolytes, urea nitrogen, and creatinine are within the reference ranges. His hemoglobin A1c is 6.2%. Which of the following is the most likely finding on physical examination?? {'A': 'Decreased bilateral femoral pulses', 'B': 'Internuclear ophthalmoplegia', 'C': 'Papular rash over the palms and soles', 'D': 'Jugular venous distention', 'E': 'Decreased anal tone'},
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A: Decreased bilateral femoral pulses
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Answer the following medical question with one of the provided options:
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Q:A 38-year-old woman presents to the primary care physician with a complaint of painless hematuria over the last 5 days. History reveals that she has a 20 pack-year smoking history, and her last menses was 10 days ago. Her blood pressure is 130/80 mm Hg, heart rate is 86/min, respiratory rate is 19/min, and temperature is 36.6°C (98.0°F). Physical examination is within normal limits. Laboratory studies show: Creatinine 0.9 mg/dL Blood urea nitrogen 15 mg/dL Prothrombin time 12.0 sec Partial thromboplastin time 28.1 sec Platelet count 250,000/mm3 Urine microscopy reveals 15 RBC/HPF and no leukocytes, casts, or bacteria. Which of the following is the best next step for this patient?? {'A': 'Digital rectal examination', 'B': 'Check urine for NMP22 and BTA', 'C': 'Cystoscopy', 'D': 'Renal biopsy', 'E': 'Reassurance'},
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C: Cystoscopy
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Answer the following medical question with one of the provided options:
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Q:In an experiment, a certain gene product is known to stimulate the production of a particular hormone synthesized in the liver. This hormone, when present in increased amounts, downregulates the expression of a divalent cation transmembrane transporter located on the basolateral membranes of enterocytes. Mutations in the gene product have been linked to certain abnormalities in affected patients. Such individuals may present with darkening of the skin, cold intolerance, excessive urination, and weight loss. Patients may also present with symptoms of a cardiovascular disease as a result of this disease. Which of the following would be the first cardiac finding in affected patients?? {'A': 'Preload: increased, cardiac contractility: decreased, afterload: increased', 'B': 'Preload: decreased, cardiac contractility: decreased, afterload: decreased', 'C': 'Preload: increased, cardiac contractility: increased, afterload: increased', 'D': 'Preload: decreased, cardiac contractility: unchanged, afterload: increased', 'E': 'Preload: increased, cardiac contractility: increased, afterload: decreased'},
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D: Preload: decreased, cardiac contractility: unchanged, afterload: increased
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Answer the following medical question with one of the provided options:
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Q:A 48-year-old homeless man presents to a free clinic complaining of several weeks of bleeding gums. He states that he has not seen dental or medical care for several years and that the bleeding has been painless. He normally sleeps on the street or occasionally stays at a shelter and typically eats 1-2 fast food meals per day. On exam, his temperature is 98.4°F (36.9°C), blood pressure is 122/76 mmHg, pulse is 64/min, and respirations are 12/min. He has poor dentition and significant periodontal disease with notable areas of bleeding gingiva. The patient is found to have coarse hair and on further questioning, the patient endorses the recent loss of 2 of his teeth and several weeks of fatigue. Which of the following processes is most immediately affected by his condition?? {'A': 'Cross-linking', 'B': 'Glycosylation', 'C': 'Hydroxylation', 'D': 'Proteolytic cleavage', 'E': 'Translation'},
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C: Hydroxylation
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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 his pediatrician for severe developmental delay. On exam he is noted to have macroorchidism, hypertelorism, large protruding ears, a large jaw, and a long thin face. Suspicious of what the diagnosis may be, the pediatrician orders a PCR and DNA sequencing. The results reveal an expansion of 250 repeats of CGG. What is the diagnosis of the boy?? {'A': "Huntington's disease", 'B': 'Fragile X syndrome', 'C': 'Freidrich ataxia', 'D': 'Myotonic dystrophy type 1', 'E': 'Spinal and bulbar muscular atrophy'},
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B: Fragile X syndrome
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Answer the following medical question with one of the provided options:
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Q:A 13-year-old African-American boy is brought to the physician because of a 4-week history of left groin and buttock pain. The pain is worse with activity but also present at rest. He has had many episodes of abdominal, back, and chest pain that required hospitalization in the past. He is at the 20th percentile for height and 25th percentile for weight. His temperature is 36.7°C (98°F), blood pressure is 115/82 mm Hg, and pulse is 84/min. Examination shows tenderness over the lateral aspect of the left hip with no swelling, warmth, or erythema. There is pain with passive abduction and internal rotation of the left hip. Leukocyte count is 8,600/mm3. Which of the following is the most likely cause of this patient's symptoms?? {'A': 'Septic arthritis', 'B': 'Proximal femoral osteosarcoma', 'C': 'Avascular necrosis', 'D': 'Transient synovitis', 'E': 'Impaired skeletal growth\n"'},
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C: Avascular necrosis
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Answer the following medical question with one of the provided options:
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Q:A 54-year-old woman comes to the physician because of a 6-month history of dull, persistent pain and swelling of her right leg. The pain is worse at the end of the day and is relieved by walking or elevating her feet. Two years ago, she developed acute deep vein thrombosis in her right calf after a long flight, which was treated with anticoagulants for 6 months. Physical examination shows 2+ pitting edema of her right leg. The skin around the right ankle shows a reddish-brown discoloration and multiple telangiectasias. She has dilated varicose veins in the right leg. Which of the following is most likely to establish the diagnosis?? {'A': 'Computerized tomography scan with contrast', 'B': 'Nerve conduction studies', 'C': 'D-dimer assay', 'D': 'Ankle-brachial pressure index', 'E': 'Duplex ultrasonography'},
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E: Duplex ultrasonography
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Answer the following medical question with one of the provided options:
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Q:A 36-year-old woman comes to the physician because of an 8-month history of occasional tremor. The tremor is accompanied by sudden restlessness and nausea, which disrupts her daily work as a professional violinist. The symptoms worsen shortly before upcoming concerts but also appear when she goes for a walk in the city. She is concerned that she might have a neurological illness and have to give up her career. The patient experiences difficulty falling asleep because she cannot stop worrying that a burglar might break into her house. Her appetite is good. She drinks one glass of wine before performances ""to calm her nerves"" and otherwise drinks 2–3 glasses of wine per week. The patient takes daily multivitamins as prescribed. She appears nervous. Her temperature is 36.8°C (98.2°F), pulse is 92/min, and blood pressure is 135/80 mm Hg. Mental status examination shows a full range of affect. On examination, a fine tremor on both hands is noted. She exhibits muscle tension. The remainder of the neurological exam shows no abnormalities. Which of the following is the most likely explanation for this patient's symptoms?"? {'A': 'Generalized anxiety disorder', 'B': 'Essential tremor', 'C': 'Adjustment disorder', 'D': 'Panic disorder', 'E': 'Atypical depressive disorder'},
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A: Generalized anxiety disorder
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Answer the following medical question with one of the provided options:
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Q:A 67-year-old man with a past medical history of sleep apnea presents to the emergency room in severe respiratory distress. On exam, his blood pressure is 135/75 mmHg, heart rate is 110/min, respiratory rate is 34/min, and SpO2 is 73% on room air. He is intubated, admitted to the intensive care unit, and eventually requires a tracheostomy tube. After surgery, he continues to have episodes of apnea while sleeping. What is the most likely underlying cause of his apnea?? {'A': 'Incorrect ventilator settings', 'B': 'Central sleep apnea', 'C': 'Obstructive sleep apnea', 'D': 'Angioedema', 'E': 'Heart failure'},
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B: Central sleep apnea
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Answer the following medical question with one of the provided options:
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Q:A 40-year-old man is brought to the emergency department 20 minutes after his wife found him unconscious on the bathroom floor. On arrival, he is conscious and alert. He remembers having palpitations and feeling lightheaded and short of breath before losing consciousness. He takes captopril for hypertension and glyburide for type 2 diabetes mellitus. His vitals are within normal limits. Physical examination shows no abnormalities. Random serum glucose concentration is 85 mg/dL. An ECG shows a short PR interval and a wide QRS complex with initial slurring. Transthoracic echocardiography reveals normal echocardiographic findings with normal left ventricular systolic function. Which of the following is the most likely underlying cause of this patient's findings?? {'A': 'A dysfunctional AV node', 'B': 'Ectopic foci within the ventricles', 'C': 'Low serum glucose levels', 'D': 'Accessory atrioventricular pathway', 'E': 'Ischemic myocardial necrosis'},
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D: Accessory atrioventricular pathway
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Q:A 33-year-old woman, gravida 2, para 1, at 24 weeks' gestation is brought to the emergency department by her husband for lethargy, nausea, and vomiting for 4 days. She returned from a trip to South Asia 2 weeks ago. Her immunizations are up-to-date and she has never received blood products. Her temperature is 38.9°C (102°F). She is not oriented to person, place, and time. Examination shows jaundice and mild asterixis. Her prothrombin time is 18 sec (INR=2.0), serum alanine aminotransferase is 3911 U/L, and serum aspartate aminotransferase is 3724 U/L. This patient's current condition is most likely associated with increased titers of which of the following serum studies?? {'A': 'Anti-HBc IgM', 'B': 'HBsAg', 'C': 'Anti-HEV IgM', 'D': 'Anti-HCV IgG', 'E': 'Anti-HAV IgM'},
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C: Anti-HEV IgM
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Q:A 9-year-old boy, otherwise healthy, presents with persistent bleeding following tooth extraction. The patient’s mother states that yesterday, the patient had a tooth extracted that was complicated intraoperatively by persistent bleeding that continued postoperatively. She also says he has had no bleeding issues in the past. The past medical history is unremarkable. The patient is fully immunized and has been meeting all developmental milestones. The vital signs include: temperature 37.0°C (98.6°F), blood pressure 101/65 mm Hg, pulse 101/min, respirations 22/min, and oxygen saturation 98% on room air. The physical examination is significant for a wound consistent with the extraction of the second upper right molar, which is slowly oozing blood with no sign of a stable clot. There are no signs of infection. The laboratory findings are significant for the following: Sodium 141 mEq/L Potassium 4.1 mEq/L Chloride 101 mEq/L Bicarbonate 25 mEq/L BUN 12 mg/dL Creatinine 1.0 mg/dL Glucose (fasting) 80 mg/dL Bilirubin, conjugated 0.2 mg/dL Bilirubin, total 1.0 mg/dL AST (SGOT) 11 U/L ALT (SGPT) 12 U/L Alkaline Phosphatase 45 U/L Prothrombin Time (PT) 14 s Partial Thromboplastin Time (PTT) 35 s WBC 8,500/mm3 RBC 4.00 x 106/mm3 Hematocrit 37.5% Hemoglobin 13.1 g/dL Platelet Count 225,000/mm3 This patient’s condition would most likely also present with which of the following symptoms?? {'A': 'Epistaxis', 'B': 'Hemarthrosis', 'C': 'Purpura fulminans', 'D': 'Muscular hematoma', 'E': 'Intracranial hemorrhage'},
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A: Epistaxis
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Q:A 63-year-old man comes to the physician with a 4-week history of fatigue, crampy abdominal pain, watery diarrhea, and pain in his mouth and gums. He returned from a 2-week trip to the Dominican Republic 2 months ago. He has smoked one pack of cigarettes daily for 45 years. Examination shows three 1.5-cm, painful ulcers in the mouth. Abdominal examination shows mild tenderness to palpation in the right lower quadrant without guarding or rebound. His hemoglobin concentration is 11.2 g/dL, mean corpuscular volume is 75 fL, and leukocyte count is 11,900 mm3. Colonoscopy shows a cobblestone mucosa. A photomicrograph of a biopsy specimen is shown. Which of the following is the most likely diagnosis?? {'A': 'Tropical sprue', 'B': 'Behcet disease', 'C': 'Crohn disease', 'D': 'Whipple disease', 'E': 'Ulcerative colitis'},
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C: Crohn disease
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Q:A 13-year-old girl is admitted to the hospital due to muscle weakness, pain, and arthralgia in her wrist joints. The patient says, "I am having trouble walking home after school, especially climbing steep hills." She also complains of malaise. On physical examination, a heliotrope rash is observed around her eyes, and multiple hyperkeratotic, flat, red papules with central atrophy are present on the back of the metacarpophalangeal and interphalangeal joints. Deposits of calcium are also noted on the pads of her fingers. Her serum creatine kinase levels are elevated. Which of the following antibodies is most likely to be found in this patient?? {'A': 'Anti-Sm', 'B': 'Anti-Jo-1', 'C': 'Anti-centromere', 'D': 'Anti-Scl-70', 'E': 'Anti-histone'},
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B: Anti-Jo-1
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Q:You are a resident in the surgical ICU. One of the patients you are covering is a 35-year-old pregnant G1P0 in her first trimester admitted for complicated appendicitis and awaiting appendectomy. Your attending surgeon would like you to start the patient on moxifloxacin IV preoperatively. You remember from your obstetrics clerkship, however, that moxifloxacin is Pregnancy Category C, and animal studies have shown that immature animals exposed to flouroquinolones like moxifloxicin may experience cartilage damage. You know that there are potentially safer antibiotics, such as piperacillin/tazobactam, which is in Pregnancy Category B. What should you do?? {'A': 'Administer piperacillin/tazobactam instead of moxifloxacin without discussing with the attending since your obligation is to "first, do no harm" and both are acceptable antibiotics for complicated appendicitis.', 'B': 'Administer moxifloxacin since it is only Pregnancy Category C and, although studies may have revealed adverse effects in animals, there is no definite evidence that it causes risk in humans.', 'C': 'Administer moxifloxacin since the attending is the executive decision maker and had to know the patient was pregnant when deciding on an antibiotic.', 'D': 'Discuss the adverse effects of each antibiotic with the patient, and then let the patient decide which antibiotic she would prefer.', 'E': 'Wait to administer any antibiotics until you discuss your safety concerns with your attending.'},
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E: Wait to administer any antibiotics until you discuss your safety concerns with your attending.
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Q:Six hours after delivery, a 3100-g (6-lb 13-oz) male newborn has an episode of bilious projectile vomiting. He was born at term to a 21-year-old woman. The pregnancy was complicated by polyhydramnios. The mother smoked a pack of cigarettes daily during the pregnancy. Physical examination shows a distended upper abdomen. An x-ray of the abdomen shows 3 distinct, localized gas collections in the upper abdomen and a gasless distal abdomen. Which of the following is the most likely diagnosis?? {'A': 'Necrotizing enterocolitis', 'B': 'Duodenal atresia', 'C': 'Meconium ileus', 'D': 'Jejunal atresia', 'E': 'Hirschsprung disease'},
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D: Jejunal atresia
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Q:A 47-year-old woman presents to the physician with complaints of fatigue accompanied by symmetric pain, swelling, and stiffness in her wrists, fingers, knees, and other joints. She describes the stiffness as being particularly severe upon awakening, but gradually improves as she moves throughout her day. Her physician initially suggests that she take NSAIDs. However, after a few months of minimal symptomatic improvement, she is prescribed an immunosuppressive drug that has a mechanism of preventing IL-2 transcription. What is the main toxicity that the patient must be aware of with this particular class of drugs?? {'A': 'Hepatotoxicity', 'B': 'Hyperglycemia', 'C': 'Nephrotoxicity', 'D': 'Osteoporosis', 'E': 'Pancytopenia'},
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C: Nephrotoxicity
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Q:A P2G1 diabetic woman is at risk of delivering at 29 weeks gestation. Her obstetrician counsels her that there is a risk the baby could have significant pulmonary distress after it is born. However, she states she will give the mother corticosteroids, which will help prevent this from occurring. Additionally, the obstetrician states she will perform a test on the amniotic fluid which will indicate the likelihood of the infant being affected by this syndrome. Which of the following ratios would be most predictive of the infant having pulmonary distress?? {'A': 'lecithin:sphingomyelin > 1.5', 'B': 'lecithin:phosphatidylserine > 3.0', 'C': 'lecithin:sphingomyelin > 3.0', 'D': 'lecithin:sphingomyelin < 1.5', 'E': 'lecithin:phosphatidylserine < 1.5'},
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D: lecithin:sphingomyelin < 1.5
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Q:A 30-year-old man presents with progressive muscle weakness for the past 6 hours. He says he had significant bilateral ankle pain which onset shortly after completing a triathlon earlier in the day. Then, he says he awoke this morning with bilateral upper and lower extremity weakness, which has progressively worsened. He has no significant past medical history and takes no current medication. The vital signs include: temperature 37.0℃ (98.6℉), pulse 66/min, respiratory rate 21/min, and blood pressure 132/83 mm Hg. On physical examination, the patient has diffuse moderate to severe muscle pain on palpation. His strength is 5 out of 5, and deep tendon reflexes are 2+ in the upper and lower extremities bilaterally. Laboratory findings are significant for the following: Laboratory test Sodium 141 mEq/L Potassium 6.3 mEq/L Chloride 103 mEq/L Bicarbonate 25 mEq/L Blood urea nitrogen (BUN) 31 mg/dL Creatinine 6.1 mg/dL BUN/Creatinine 5.0 Glucose (fasting) 80 mg/dL Calcium 6.3 mg/dL Serum creatine kinase (CK) 90 mcg/L (ref: 10–120 mcg/L) Which of the following is the next best step in the management of this patient?? {'A': 'Hemodialysis', 'B': 'ECG', 'C': 'Kayexalate', 'D': 'IV calcium chloride', 'E': 'Blood transfusion'},
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B: ECG
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Q:A 70-year-old man with a history of Alzheimer dementia presents to the emergency department with a change in his behavior. The patient has been more confused recently and had a fever. Upon presentation, he is too confused to answer questions. His temperature is 103°F (39.4°C), blood pressure is 102/68 mmHg, pulse is 157/min, respirations are 22/min, and oxygen saturation is 99% on room air. The patient is given 3 liters of IV fluids and acetaminophen and his vitals improve. He is also less confused. The patient is asking where he is and becomes combative and strikes a nurse when he finds out he has to be admitted to the hospital. He is given sedation and put in soft restraints. His mental status subsequently worsens and he becomes much more aggressive, spitting at nurses and attempting to bite his restraints. He also complains of abdominal pain. A post void residual volume is notable for a urine volume of 750 mL. Which of the following is the etiology of this patient’s recent mental status change?? {'A': 'Acute infection', 'B': 'Diphenhydramine', 'C': 'Haloperidol', 'D': 'Lorazepam', 'E': 'Olanzapine'},
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B: Diphenhydramine
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Q:A 67-year-old woman comes to the physician because of a 3-week history of fatigue and worsening back and abdominal pain. During this period, she has also had excessive night sweats and a 4.6-kg (10-lb) weight loss. She has had swelling of the neck for 3 days. She does not smoke or drink alcohol. Vital signs are within normal limits. Physical examination shows a 4-cm, supraclavicular, nontender, enlarged and fixed lymph node. The spleen is palpated 2 cm below the left costal margin. Laboratory studies show: Hemoglobin 10.4 g/dL Mean corpuscular volume 87 μm3 Leukocyte count 5,200/mm3 Platelet count 190,000/mm3 Serum Lactate dehydrogenase 310 U/L A CT scan of the thorax and abdomen shows massively enlarged paraaortic, axillary, mediastinal, and cervical lymph nodes. Histopathologic examination of an excised cervical lymph node shows lymphocytes with a high proliferative index that stain positive for CD20. Which of the following is the most likely diagnosis?"? {'A': 'Marginal zone lymphoma', 'B': 'Diffuse large B-cell lymphoma', 'C': 'Adult T-cell lymphoma', 'D': 'Hairy cell leukemia', 'E': 'Follicular lymphoma'},
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B: Diffuse large B-cell lymphoma
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Answer the following medical question with one of the provided options:
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Q:A 55-year-old woman presents with pain in both hands and wrists for several years. It is associated with morning stiffness that lasts for almost an hour. She has a blood pressure of 124/76 mm Hg, heart rate of 71/min, and respiratory rate of 14/min. Physical examination reveals tenderness and swelling in both hands and wrists. Laboratory investigations reveal the presence of anti-cyclic citrullinated peptide. Which of the following immune-mediated processes is responsible for this patient’s condition?? {'A': 'Type III hypersensitivity', 'B': 'Type IV hypersensitivity ', 'C': 'IgE-mediated immune responses only', 'D': 'Self-tolerance', 'E': 'Both type II and III hypersensitivities'},
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A: Type III hypersensitivity
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Q:A 41-year-old man is brought to the emergency room after a blunt-force injury to the abdomen. His pulse is 130/min and blood pressure is 70/40 mm Hg. Ultrasound of the abdomen shows a large amount of blood in the hepatorenal recess and the pelvis. Which of the following responses by the kidney is most likely?? {'A': 'Decreased proton excretion', 'B': 'Decreased potassium excretion', 'C': 'Increased sodium reabsorption', 'D': 'Increased sodium filtration', 'E': 'Increased creatinine absorption'},
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C: Increased sodium reabsorption
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Q:A 45-year-old woman comes to the emergency department with severe menorrhagia for 3 days. She also reports dizziness. She has hypertension, for which she takes lisinopril. She appears pale. Her temperature is 37.5˚C (99.5˚F), pulse is 110/min, and blood pressure is 100/60 mmHg. Pulse oximetry shows an oxygen saturation of 98% on room air. Pelvic examination shows vaginal vault with dark maroon blood and clots but no active source of bleeding. Her hemoglobin concentration is 5.9 g/dL. Crystalloid fluids are administered and she is transfused with 4 units of crossmatched packed red blood cells. Two hours later, she has shortness of breath and dull chest pressure. Her temperature is 37.6°C (99.7°F), pulse is 105/min, and blood pressure is 170/90 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 92% on room air. Cardiac examination shows an S3 gallop. Diffuse crackles are heard over the lower lung fields on auscultation. An x-ray of the chest shows bilateral hazy opacities. An ECG shows no abnormalities. Which of the following is the most likely explanation of this patient's symptoms?? {'A': 'Type 1 hypersensitivity reaction', 'B': 'Acute pulmonary embolism', 'C': 'Acute kidney injury', 'D': 'Transfusion-associated circulatory overload', 'E': 'Acute myocardial infarction'},
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D: Transfusion-associated circulatory overload
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Answer the following medical question with one of the provided options:
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Q:A 4670-g (10-lb 5-oz) male newborn is delivered at term to a 26-year-old woman after prolonged labor. Apgar scores are 9 and 9 at 1 and 5 minutes. Examination in the delivery room shows swelling, tenderness, and crepitus over the left clavicle. There is decreased movement of the left upper extremity. Movement of the hands and wrists are normal. A grasping reflex is normal in both hands. An asymmetric Moro reflex is present. The remainder of the examination shows no abnormalities and an anteroposterior x-ray confirms the diagnosis. Which of the following is the most appropriate next step in management?? {'A': 'Nerve conduction study', 'B': 'Physical therapy', 'C': 'Pin sleeve to the shirt', 'D': 'Splinting of the arm', 'E': 'MRI of the clavicle'},
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C: Pin sleeve to the shirt
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Answer the following medical question with one of the provided options:
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Q:A 33-year-old woman who was recently involved in a motor vehicle accident presents to a medical clinic for a follow-up visit. She was in the front passenger seat when the vehicle swerved off the road and struck 2 pedestrians. She was restrained by her seatbelt and did not suffer any significant physical injury. Since then she has had 1 outpatient visit and is recovering well. She is here today upon the request of her family members who insist that she has not come to terms with the incident. They have noted that she has significant distress while riding in her car; however, she does not seem particularly worried and she cannot remember many of the details of the accident. On a mini-mental examination, she scores 27/30. Which of the following best describes this patient’s condition?? {'A': 'The condition is the least common form of dissociative disorder.', 'B': 'Patients are unable to recall obscure details in this condition.', 'C': 'Pharmacotherapy is the mainstay of treatment.', 'D': 'Patients are more likely to also have bipolar disorder.', 'E': 'Memory loss is usually self-limiting.'},
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E: Memory loss is usually self-limiting.
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Q:A 9-year-old boy is brought to the physician because of short stature. He has always had short stature around the 35th percentile on the growth curve. Over the past year, he has dropped further on the curve, despite maintaining the same diet. He has a history of low birth weight. The vital signs include: respiration rate 18/min, pulse 85/min, and blood pressure 110/65 mm Hg. His conjunctiva and nail beds are pale. Several hyperpigmented and hypopigmented patches are seen on the back. Chest inspection reveals pectus carinatum and prominent knobs of bone at most costochondral junctions. The thumbs are short, and he has bow legs. There are also petechiae on the lower limbs. The remainder of the physical exam shows no abnormalities. The laboratory results are as follows: Hemoglobin 8.2 g/dL Mean corpuscular volume 105 μm3 Platelet count 35,000/mm3 Serum Na+ 131 mEq/L K+ 2.8 mEq/L Cl- 105 mEq/L Phosphorus (inorganic) 2.5 mg/dL (3.0–4.5 mg/dL) Arterial blood gas analysis on room air: pH 7.30 PCO2+ 33 mm Hg HCO3− 17 mEq/L Urine pH 5.0 Glucose 2+ Ketones Negative Which of the following is the most likely diagnosis?? {'A': 'Diamond-Blackfan anemia', 'B': 'Fanconi anemia', 'C': 'Neurofibromatosis type 1', 'D': 'Renal tubular acidosis type 1', 'E': 'Rickets'},
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B: Fanconi anemia
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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 for a pre-employment medical check-up. He has a history of persistent asthma and regularly uses inhaled fluticasone for prophylaxis. For the last week, he has been experiencing increasing symptoms, such as night time cough and wheezing on exertion. Because his albuterol metered-dose inhaler ran out, he has been taking oral albuterol 3 times a day for the last 3 days, which has improved his symptoms. The physician performs a complete physical examination and orders laboratory tests. Which of the following findings is most likely to be present on his physical examination or laboratory studies?? {'A': 'Pulse rate is 116/min', 'B': 'Upbeat nystagmus', 'C': 'Myoclonus', 'D': 'Serum potassium is 5.5 mEq/L (5.5 mmol/L)', 'E': 'Serum magnesium is 2.4 mEq/L (1.2 mmol/L)'},
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A: Pulse rate is 116/min
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Answer the following medical question with one of the provided options:
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Q:A 28-year-old male comes to the physician for worsening back pain. The pain began 10 months ago, is worse in the morning, and improves with activity. He has also had bilateral hip pain and difficulty bending forward during exercise for the past 3 months. He has celiac disease and eats a gluten-free diet. Examination shows a limited range of spinal flexion. Flexion, abduction, and external rotation of both hips produces pain. Further evaluation of this patient is most likely to show which of the following laboratory findings?? {'A': 'Presence of anti-dsDNA antibodies', 'B': 'Presence of anti-Ro and anti-La antibodies', 'C': 'High levels of rheumatoid factor', 'D': 'HLA-B27 positive genotype', 'E': 'HLA-DR3-positive genotype'},
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D: HLA-B27 positive genotype
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Answer the following medical question with one of the provided options:
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Q:A previously healthy 30-year-old woman comes to the physician because of nervousness and difficulty sleeping over the past 4 weeks. She has difficulty falling asleep at night because she cannot stop worrying about her relationship and her future. Three months ago, her new boyfriend moved in with her. Before this relationship, she had been single for 13 years. She reports that her boyfriend does not keep things in order in the way she was used to. Sometimes, he puts his dirty dishes in the kitchen sink instead of putting them in the dishwasher directly. He refuses to add any groceries to the shopping list when they are used up. He has also suggested several times that they have dinner at a restaurant instead of eating at home, which enrages her because she likes to plan each dinner of the week and buy the required groceries beforehand. The patient says that she really loves her boyfriend but that she will never be able to tolerate his “flaws.” Vital signs are within normal limits. Physical examination shows no abnormalities. On mental status examination, she is cooperative but appears distressed. Her affect has little intensity or range. Which of the following is the most likely diagnosis?? {'A': 'Major depressive disorder', 'B': 'Generalized anxiety disorder', 'C': 'Obsessive-compulsive disorder', 'D': 'Obsessive-compulsive personality disorder', 'E': 'Schizoid personality disorder'},
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D: Obsessive-compulsive personality disorder
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Answer the following medical question with one of the provided options:
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Q:A population is studied for risk factors associated with testicular cancer. Alcohol exposure, smoking, dietary factors, social support, and environmental exposure are all assessed. The researchers are interested in the incidence and prevalence of the disease in addition to other outcomes. Which pair of studies would best assess the 1. incidence and 2. prevalence?? {'A': '1. Case-control study 2. Prospective cohort study', 'B': '1. Clinical trial 2. Cross sectional study', 'C': '1. Cross sectional study 2. Retrospective cohort study', 'D': '1. Prospective cohort study 2. Cross sectional study', 'E': '1. Prospective cohort study 2. Retrospective cohort study'},
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D: 1. Prospective cohort study 2. Cross sectional study
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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 with a history of long-standing hypertension is brought to the emergency department because of headache, dyspnea, and blurry vision for 2 hours. He says that he forgot to fill his prescription for his antihypertensive medications last week. His blood pressure is 230/130 mm Hg. Intravenous infusion of sodium nitroprusside is begun and the patient's symptoms slowly resolve. The next day, the patient develops confusion, abdominal pain, and flushing of the skin. Laboratory studies show metabolic acidosis and an elevated serum lactic acid concentration. Treatment is started with a drug that directly binds the toxin responsible for the patient's new symptoms. The patient was most likely given which of the following drugs?? {'A': 'Penicillamine', 'B': 'Dimercaprol', 'C': 'Amyl nitrite', 'D': 'Hydroxycobalamin', 'E': 'Sodium thiosulfate'},
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D: Hydroxycobalamin
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Answer the following medical question with one of the provided options:
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Q:A 26-year-old male is brought into the emergency room because he collapsed after working out. The patient is a jockey, and he states that he feels dehydrated and has an upcoming meet for which he needs to lose some weight. On exam, the patient has dry mucosa with cracked lips. His temperature is 98.9 deg F (37.2 deg C), blood pressure is 115/70 mmHg, pulse is 105/min, and respirations are 18/min. The patient's blood pressure upon standing up is 94/65 mmHg. His serum Na+ is 125 mEq/L and K+ is 3.0 mEq/L. His urinalysis reveals Na+ of 35 mEq/L and K+ of 32 mEq/L. The abuse of which of the following is most likely responsible for the patient's presentation?? {'A': 'Furosemide', 'B': 'Metoprolol', 'C': 'Polyethylene glycol', 'D': 'Spironolactone', 'E': 'Amiloride'},
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A: Furosemide
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Answer the following medical question with one of the provided options:
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Q:A 61-year-old man decides to undergo surgery for a hip replacement after seeing no improvement in his pain with non-operative treatment. At some point during the surgery, he is administered an agent that results in fasciculations in the patient's extremities. This was the expected response to the administered agent so no intervention was needed. After a while, the fasciculations stop and remain stopped for the remainder of the surgery. Consider the period of time during which the patient had fasciculations and subsequently the period of time after the fasciculations stopped. If the effects of the administered agent needed to be reversed during each of these two time periods respectively, which of the following agents should be administered during each time period?? {'A': 'Atracurium, atracurium', 'B': 'Neostigmine, no reversal', 'C': 'Neostigmine, neostigmine', 'D': 'No reversal, atracurium', 'E': 'No reversal, neostigmine'},
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E: No reversal, neostigmine
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Answer the following medical question with one of the provided options:
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Q:A 60-year-old man is brought to the emergency department by his wife with a sudden onset of right-sided weakness 2 hours ago. He can speak clearly without difficulty and denies any similar symptoms in the past. Past medical history is significant for hypertension and diabetes, both poorly managed due to medication non-compliance. Family history is significant for heart disease and diabetes in multiple paternal and maternal relatives. His vital signs include: blood pressure 150/88 mm Hg, pulse 86/min, and respiratory rate 15/min. On physical examination, strength is 3/5 on the right and 5/5 on the left upper and lower extremities. The sensation is intact, and no impairments in balance or ataxias are present. An initial noncontrast CT scan of the head is unremarkable, but a repeat noncontrast CT scan of the head performed a month later reveals the 2 lesions circled in the image. Which of the following is the most likely diagnosis in this patient?? {'A': 'Arteriovenous malformations', 'B': 'Carotid artery atherosclerosis', 'C': 'Charcot-Bouchard aneurysm', 'D': 'Hyaline arteriosclerosis', 'E': 'Hypertensive encephalopathy'},
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D: Hyaline arteriosclerosis
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Answer the following medical question with one of the provided options:
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Q:An inpatient psychiatrist recently had two patients who developed serious gastrointestinal infections while taking clozapine. He was concerned that his patients had developed agranulocytosis, a relatively rare but dangerous adverse event associated with clozapine. When the psychiatrist checked the absolute neutrophil count (ANC) of both patients, one was 450/mm3, while the other was 700/mm3 (N=1,500/mm3). According to the clozapine REMS (Risk Evaluation and Mitigation Strategy) program, severe neutropenia in clozapine recipients has often been defined as an absolute neutrophil count (ANC) less than 500/mm3. Changing the cutoff value to 750/mm3 would affect the test performance of ANC with regard to agranulocytosis in which of the following ways?? {'A': 'Increased positive predictive value', 'B': 'Decreased true positives', 'C': 'Unchanged specificity', 'D': 'Increased false positives', 'E': 'Decreased sensitivity\n"'},
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D: Increased false positives
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Answer the following medical question with one of the provided options:
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Q:A 63-year-old man with inoperable esophageal carcinoma undergoes palliative chemoradiotherapy. Four hours after his first infusion of carboplatin and paclitaxel, he develops nausea and 3 episodes of vomiting and dry heaving. This adverse reaction is caused by stimulation of a brain region on the floor of the fourth ventricle. Chemotherapeutic drugs are able to stimulate this region because of the absence of a cell junction that is composed of which of the following proteins?? {'A': 'Integrins', 'B': 'Claudins and occludins', 'C': 'Cadherins and catenins', 'D': 'Connexins', 'E': 'Desmogleins and desmocollins'},
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B: Claudins and occludins
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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 of a 4-month history of anxiety and weight loss. She also reports an inability to tolerate heat and intermittent heart racing for 2 months. She appears anxious. Her pulse is 108/min and blood pressure is 145/87 mm Hg. Examination shows a fine tremor of her outstretched hands. After confirmation of the diagnosis, the patient is scheduled for radioactive iodine ablation. At a follow-up visit 2 months after the procedure, she reports improved symptoms but new-onset double vision. Examination shows conjunctival injections, proptosis, and a lid lag. Slit-lamp examination shows mild corneal ulcerations. The patient is given an additional medication that improves her diplopia and proptosis. Which of the following mechanisms is most likely responsible for the improvement in this patient's ocular symptoms?? {'A': 'Inhibition of iodide oxidation', 'B': 'Elimination of excess fluid', 'C': 'Decreased uptake of iodine', 'D': 'Replacement of thyroid hormones', 'E': 'Decreased production of proinflammatory cytokines'},
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E: Decreased production of proinflammatory cytokines
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Answer the following medical question with one of the provided options:
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Q:A 60-year-old obese man comes to the emergency department with tightness in his chest and lower extremity edema. He has a history of heart failure that has gotten worse over the last several years. He takes finasteride, lisinopril, and albuterol. He does not use oxygen at home. He has mildly elevated blood pressure, and he is tachycardic and tachypneic. Physical examination shows an overweight man having difficulty speaking with 2+ pitting edema on his lower extremities up to his thighs. The attending asks you to chart out the patient's theoretical cardiac function curve from where it was 5 years ago when he was healthy to where it is right now. What changes occurred in the last several years without compensation?? {'A': 'Cardiac output went up, and right atrial pressure went down', 'B': 'Cardiac output went down, and right atrial pressure went up', 'C': 'Cardiac output went down, and right atrial pressure went down', 'D': 'Cardiac output went up, and right atrial pressure went up', 'E': 'Both cardiac output and right atrial pressures are unchanged'},
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B: Cardiac output went down, and right atrial pressure went up
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Q:A 3-year-old girl is brought to the emergency department because of an inability to walk for a few days. The patient’s mother says that the child was lying on the bed and must have fallen onto the carpeted floor. She lives at home with her mother and her 3-month-old brother. When the patient is directly asked what happened, she looks down at the floor and does not answer. Past medical history is noncontributory. Physical examination shows that the patient seems nervous and has noticeable pain upon palpation of the right thigh. A green-colored bruise is also noted on the child’s left arm. Radiographs of the right lower extremity show a femur fracture. Which of the following is the next best step in management?? {'A': 'Check vitamin D levels.', 'B': 'Check copper levels.', 'C': 'Collagen biochemical testing', 'D': 'Obtain a complete skeletal survey to detect other bony injuries and report child abuse case.', 'E': 'Run a serum venereal disease research laboratory (VDRL) test.'},
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D: Obtain a complete skeletal survey to detect other bony injuries and report child abuse case.
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Q:A 52-year-old male presents with recent weight loss, fever, and joint pain. He reports frequent bouts of diarrhea. An intestinal biopsy demonstrates PAS-positive, non-acid fast macrophage inclusions in the lamina propria. Which of the following organisms is likely responsible for this patient’s illness:? {'A': 'Ascaris lumbricoides', 'B': 'Giardia lambria', 'C': 'Mycobacterium avium-intracellulare complex', 'D': 'Campylobacter jejuni', 'E': 'Tropheryma whippelii'},
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E: Tropheryma whippelii
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Q:A 5-year-old boy is brought to the physician by his parents for evaluation of easy bruising. He has met all developmental milestones. Vital signs are within normal limits. He is at the 50th percentile for height and weight. Physical examination shows velvety, fragile skin that can be stretched further than normal and multiple ecchymoses. Joint range of motion is increased. A defect in which of the following is the most likely cause of this patient's condition?? {'A': 'α-collagen triple helix formation', 'B': 'α1-antitrypsin production', 'C': 'Fibrillin-1 glycoprotein production', 'D': 'Proline and lysine hydroxylation', 'E': 'Lysine-hydroxylysine cross-linking'},
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E: Lysine-hydroxylysine cross-linking
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Q:A 3-year-old boy is seen in clinic. He was born at home without perinatal care. He was apparently normal at birth, but later developed failure to thrive and developmental delay. He also has a history of cataracts. His older brother had a myocardial infarction at the age of 18 and is rather lanky and tall in appearance. Laboratory testing of his urine showed an increase in the level of an amino acid. What is the most likely mechanism responsible for this boy's pathology?? {'A': 'Hereditary defect of renal amino acid transporter', 'B': 'Cystathionine synthase deficiency', 'C': 'Decreased in phenylalanine hydroxylase', 'D': 'Deficiency of homogentisic acid oxidase', 'E': 'Inability to degrade branched chain amino acids'},
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B: Cystathionine synthase deficiency
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Q:A 33-year-old man presents to the emergency department with dizziness. He states he has experienced a sustained sense of disequilibrium for the past 2 days. He feels that the floor is unstable/moving. The patient is otherwise healthy and does not have any other medical diagnoses. The patient is currently taking vitamin C as multiple family members are currently ill and he does not want to get sick. His temperature is 98.1°F (36.7°C), blood pressure is 120/83 mmHg, pulse is 73/min, respirations are 16/min, and oxygen saturation is 98% on room air. Physical exam is notable for a horizontal nystagmus. The Dix-Hallpike maneuver does not provoke symptoms and examination of the patient’s cranial nerves is unremarkable. Which of the following is the most likely diagnosis?? {'A': 'Benign paroxysmal positional vertigo', 'B': 'Labyrinthitis', 'C': 'Meniere disease', 'D': 'Vertebrobasilar stroke', 'E': 'Vestibular neuritis'},
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E: Vestibular neuritis
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Q:After 1 week of intubation and sedation in the ICU for severe pneumonia, a 62-year-old man develops severe pain in his penis. He has a history of chronic obstructive pulmonary disease. He is an ex-smoker. He is currently on broad-spectrum IV antibiotics. In the ICU, his temperature is 36.7°C (98.1°F), blood pressure is 115/70 mm/Hg, and pulse is 84/min. He is on 2 L of oxygen via nasal cannula and with a respiratory rate of 18/min. On examination, he is uncircumcised with a urinary catheter in place. The foreskin is retracted revealing a severely edematous and erythematous glans. The area is markedly tender to touch. There are no ulcers on the penis or discharge from the urethral meatus. Examination of the scrotum and perineum shows no abnormalities. Which of the following is the most appropriate next step in management?? {'A': 'Emergency circumcision', 'B': 'Manual reduction', 'C': 'Referral to a urologist after discharge', 'D': 'Surgical incision', 'E': 'Topical betamethasone'},
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B: Manual reduction
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Q:A 35-year-old woman comes to the physician because of fatigue and a 9-kg (20-lb) weight gain over the past 12 months. She also has irregular menstrual cycles and difficulty sleeping. Menses occur at irregular 35- to 50-day intervals and last 3–7 days. Menarche was at age of 13 years and her last menstrual period was 4 weeks ago. She has 1-year history of hypertension treated with hydrochlorothiazide. She drinks a glass of wine daily. She is 163 cm (5 ft 4 in) tall and weighs 85 kg (187 lb); BMI is 32 kg/m2. Her temperature is 37°C (98.6°F), pulse is 82/min, respirations are 16/min, and blood pressure is 125/86 mm Hg. Examination shows acne on the face and hair on the chin and around the umbilicus. The face has a rounded shape and is reddened. There are several smaller bruises on both forearms. This patient is most likely to have which of the following findings?? {'A': 'Decreased serum sodium', 'B': 'Increased serum erythropoietin', 'C': 'Decreased bone mineral density', 'D': 'Discoloration of the corneal margin', 'E': 'Enlarged ovaries with multiple follicles\n"'},
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C: Decreased bone mineral density
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Q:A 50-year-old woman comes to the office complaining of fatigue over the last several months. She feels ‘drained out’ most of the time and she drinks coffee and takes other stimulants to make it through the day. She also complains of severe itching all over her body for about 3 months which worsens at night. Her past medical history is significant for celiac disease. Additionally, she uses eye drops for a foreign body sensation in her eyes with little relief. Her mother has some neck problem for which she takes medicine, but she could not provide with any further information. Vitals include temperature 37.0°C (98.6°F), blood pressure 120/85 mm Hg, pulse 87/min, and respiration 18/min. BMI 26 kg/m2. On physical examination, there are skin excoriations and scleral icterus. Her gums are also yellow. Laboratory values: Total bilirubin 2.8 mg/dL Direct bilirubin 2.0 mg/dL Albumin 4.5 g/dL AST 35 U/L ALT 40 U/L ALP 240 U/L Ultrasonogram of the right upper quadrant shows no abnormality. What is the next best step to do?? {'A': 'ERCP', 'B': 'Anti mitochondrial antibody (AMA)', 'C': 'Anti smooth muscle antibody', 'D': 'MRCP', 'E': ' Percutaneous Transhepatic Cholangiography'},
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B: Anti mitochondrial antibody (AMA)
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Q:A 32-year-old Caucasian female required a kidney transplant 3 years ago. She presents with elevated creatinine levels (2.6 mg/dl) and an elevated blood pressure (160/90 mmHg). A biopsy is taken of the transplanted kidney. Following histological findings, a diagnosis of chronic graft rejection is made. Which of the following is NOT a likely finding?? {'A': 'Interstitial fibrosis', 'B': 'Glomerular destruction', 'C': 'Tubular atrophy', 'D': 'Graft arteriosclerosis', 'E': 'Glomerular crescents'},
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E: Glomerular crescents
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Q:A 6-month-old infant girl is brought by her parents to the emergency room due to abnormal jerky movements of the upper and lower limbs for the past month. When questioned about her birth history, the parents mention that a prenatal scan of the fetal heart revealed that the patient had a mass in the left ventricle, which led to the diagnosis of a neurocutaneous disorder in the child. Which of the following findings is a characteristic cutaneous finding associated with this young patient’s disorder?? {'A': 'Ash-leaf spots', 'B': 'Cafe-au-lait spots', 'C': 'Cavernous hemangioma of the skin', 'D': 'Cutaneous neurofibromas', 'E': 'Port-wine stain'},
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A: Ash-leaf spots
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Q:A medical student is conducting an experiment related to body fluids. Part of his research requires a relatively precise estimation of extracellular body fluid in each volunteer. He knows that extracellular body fluid accounts for approximately 33% of the volume of total body water. Which of the following substances is most likely to be helpful to measure the volume of the extracellular body fluid?? {'A': 'Evans blue', 'B': 'Heavy water', 'C': 'Mannitol', 'D': 'Radio-iodine labeled serum albumin', 'E': 'Tritiated water'},
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C: Mannitol
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Q:A 35-year-old woman presents to the ER with shortness of breath, cough, and severe lower limb enlargement. The dyspnea was of sudden onset, started a week ago, and increased with exercise but did not disappear with rest. Her cough was dry, persistent, and non-productive. She has a family history of maternal hypertension. Her vital signs include heart rate 106/min, respiratory rate 28/min, and blood pressure 140/90 mm Hg. On physical examination, thoracic expansion was diminished on the right side with rhonchi and crackles on the lower two-thirds of both sides, with left predominance. A systolic murmur was heard on the tricuspid foci, which increased in intensity with inspiration. There was jugular engorgement when the bed was placed at 50°. Palpation of the abdomen was painful on the right hypochondrium, with hepatomegaly 4 cm below the lower coastal edge. Hepatojugular reflux was present. Soft, painless, pitting edema was present in both lower limbs up until the middle third of both legs. Lung computed tomography (CT) and transthoracic echocardiogram were performed and detected right heart failure and severe pulmonary fibrosis. What is the most likely diagnosis?? {'A': 'Left-sided heart failure', 'B': 'Coronary artery disease', 'C': 'Liver disease', 'D': 'Budd-chiari syndrome', 'E': 'Cor pulmonale'},
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E: Cor pulmonale
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Q:A 68-year-old woman with osteoarthritis comes to the physician because of a swollen and painful right knee for the past 2 days. Temperature is 37°C (98.6°F). Examination shows erythema and swelling of the right knee with a normal range of motion. An x-ray of the right knee shows punctate radiodensities in both menisci and in the joint capsule. Arthrocentesis of the right knee joint yields 5 mL of cloudy fluid with a leukocyte count of 27,000/mm3. Which of the following is the most likely underlying mechanism of this patient's knee pain?? {'A': 'Calcium pyrophosphate dihydrate crystal deposition', 'B': 'Immune complex deposition', 'C': 'Noncaseating granuloma formation', 'D': 'Gram-negative diplococci infection', 'E': 'Monosodium urate crystal precipitation'},
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A: Calcium pyrophosphate dihydrate crystal deposition
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Q:A 33-year-old comes to her dermatologist complaining of a rash that recently started appearing on her face. She states that over the past three months, she has noticed that her cheeks have been getting darker, which has been causing her psychological distress. She has attempted using skin lighteners on her cheeks, but recently noticed more dark spots on her forehead. Aside from a first-trimester miscarriage 5 years ago and a 15-year history of migraines, she has no other past medical history. She is currently taking ibuprofen and rizatriptan for her migraines, and is also on oral contraceptives. Her mother has a history of thyroid disease and migraines but was otherwise healthy. On exam, the patient’s temperature is 99.1°F (37.3°C), blood pressure is 130/88 mmHg, pulse is 76/min, and respirations are 12/min. The patient has Fitzpatrick phototype III skin and marked confluent hyperpigmented patches over her cheeks without scarring. Her forehead is also notable for hyperpigmented macules that have not yet become confluent. There are no oral ulcers nor any other visible skin lesion. The patient has a negative pregnancy test, and her ANA is negative. Which of the following is the most likely cause of this patient’s disease?? {'A': 'Autoantibodies', 'B': 'Enzyme inhibition', 'C': 'Hypersensitivity reaction', 'D': 'Medication', 'E': 'Post-inflammatory changes'},
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D: Medication
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Q:A 6-year-old boy is brought to the physician because of worsening headaches and a rash for 2 weeks. His mother reports that the rash started on his abdomen and diffusely spread to other areas. Over the past 2 months, he has had recurrent episodes of otitis media. Examination shows a diffuse, erythematous, papular rash involving the groin, abdomen, chest, and back. His cervical lymph nodes are palpable bilaterally. An x-ray of the skull shows well-defined lytic lesions of the left occipital bone and the mastoid bone. Electron microscopy of a biopsy of the patient's posterior cervical lymph nodes shows polygonal cells with organelles shaped like tennis rackets. The cells stain positive for S-100. Clonal proliferation of which of the following types of cells is most likely seen on microscopy?? {'A': 'Natural killer cells', 'B': 'B cells', 'C': 'Langerhans cells', 'D': 'Eosinophils', 'E': 'Plasma cells'},
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C: Langerhans cells
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Q:Please refer to the summary above to answer this question In the study, all participants who were enrolled and randomly assigned to treatment with pulmharkimab were analyzed in the pulmharkimab group regardless of medication nonadherence or refusal of allocated treatment. A medical student reading the abstract is confused about why some participants assigned to pulmharkimab who did not adhere to the regimen were still analyzed as part of the pulmharkimab group. Which of the following best reflects the purpose of such an analysis strategy?" "Impact of pulmharkimab on asthma control and cardiovascular disease progression in patients with coronary artery disease and comorbid asthma Introduction: Active asthma has been found to be associated with a more than two-fold increase in the risk of myocardial infarction, even after adjusting for cardiovascular risk factors. It has been suggested that the inflammatory mediators and accelerated atherosclerosis characterizing systemic inflammation may increase the risk of both asthma and cardiovascular disease. This study evaluated the efficacy of the novel IL-1 inhibitor pulmharkimab in improving asthma and cardiovascular disease progression. Methods: In this double-blind, randomized controlled trial, patients (N=1200) with a history of coronary artery disease, myocardial infarction in the past 2 years, and a diagnosis of comorbid adult-onset asthma were recruited from cardiology clinics at a large academic medical center in Philadelphia, PA. Patients who were immunocompromised or had a history of recurrent infections were excluded. Patients were subsequently randomly assigned a 12-month course of pulmharkimab 75 mg/day, pulmharkimab 150 mg/day, or a placebo, with each group containing 400 participants. All participants were included in analysis and analyzed in the groups to which they were randomized regardless of medication adherence. Variables measured included plaque volume, serum LDL-C levels, FEV1/FVC ratio, and Asthma Control Questionnaire (ACQ) scores, which quantified the severity of asthma symptoms. Plaque volume was determined by ultrasound. Analyses were performed from baseline to month 12. Results: At baseline, participants in the two groups did not differ by age, gender, race, plaque volume, serum LDL-C levels, FEV1/FVC ratio, and ACQ scores (p > 0.05 for all). A total of 215 participants (18%) were lost to follow-up. At 12-month follow-up, the groups contained the following numbers of participants: Pulmharkimab 75 mg/d: 388 participants Pulmharkimab 150 mg/d: 202 participants Placebo: 395 participants Table 1: Association between pulmharkimab and both pulmonary and cardiovascular outcomes. Models were adjusted for sociodemographic variables and medical comorbidities. All outcome variables were approximately normally distributed. Pulmharkimab 75 mg/d, (Mean +/- 2 SE) Pulmharkimab 150 mg/d, (Mean +/- 2 SE) Placebo, (Mean +/- 2 SE) P-value Plaque volume (mm3), change from baseline 6.6 ± 2.8 1.2 ± 4.7 15.8 ± 2.9 < 0.01 LDL-C levels, change from baseline -9.4 ± 3.6 -11.2 ± 14.3 -8.4 ± 3.9 0.28 FEV1/FVC ratio, change from baseline 0.29 ± 2.21 0.34 ± 5.54 -0.22 ± 3.21 0.27 ACQ scores, change from baseline 0.31 ± 1.22 0.46 ± 3.25 0.12 ± 1.33 0.43 Conclusion: Pulmharkimab may be effective in reducing plaque volume but does not lead to improved asthma control in patients with a history of myocardial infarction and comorbid asthma. Source of funding: Southeast Institute for Advanced Lung and Cardiovascular Studies, American Center for Advancement of Cardiovascular Health"? {'A': 'To increase internal validity of study', 'B': 'To increase sample size', 'C': 'To assess treatment efficacy more accurately', 'D': 'To reduce selection bias', 'E': 'To minimize type 2 errors'},
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D: To reduce selection bias
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Q:A 24-year-old G1P1 presents to her physician to discuss the results of her Pap smear. Her previous 2 Pap smears were normal. Her family history is significant for breast cancer in her grandmother and cervical carcinoma in situ in her older sister. The results of her current Pap smear are as follows: Specimen adequacy: satisfactory for evaluation Interpretation: atypical squamous cells of undetermined significance Which of the following options is the best next step in the management of this patient?? {'A': 'Repeat Pap smear in 3 years', 'B': 'Perform colposcopy', 'C': 'Obtain a vaginal smear', 'D': 'Test for HPV', 'E': 'Resume routine screening schedule'},
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D: Test for HPV
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Q:A 23-year-old woman comes to the physician because of a 2-month history of diarrhea, flatulence, and fatigue. She reports having 3–5 episodes of loose stools daily that have an oily appearance. The symptoms are worse after eating. She also complains of an itchy rash on her elbows and knees. A photograph of the rash is shown. Further evaluation of this patient is most likely to show which of the following findings?? {'A': 'Macrocytic, hypochromic red blood cells', 'B': 'PAS-positive intestinal macrophages', 'C': 'HLA-DQ2 serotype', 'D': 'Elevated exhaled hydrogen concentration', 'E': 'Elevated urine tryptophan levels'},
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C: HLA-DQ2 serotype
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Q:A 2-year-old boy is brought to the physician by his father for a well-child examination. He recently emigrated from Mexico with his family and has not seen a physician since birth. Vital signs are within normal limits. Cardiac examination shows a harsh, grade 3/6 holosystolic murmur heard best at the left lower sternal border. During deep inspiration, the second heart sound is split. If left untreated, irreversible changes would most likely be seen in which of the following structures?? {'A': 'Right atrium', 'B': 'Ascending aorta', 'C': 'Superior vena cava', 'D': 'Pulmonary artery', 'E': 'Mitral valve'},
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D: Pulmonary artery
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Q:A 48-year-old man who emigrated from Sri Lanka 2 years ago comes to the physician because of a 1-month history of fever, cough, and a 6-kg (13-lb) weight loss. He appears ill. An x-ray of the chest shows patchy infiltrates in the upper lung fields with a cavernous lesion at the right apex. A CT-guided biopsy of the lesion is obtained. A photomicrograph of the biopsy specimen is shown. Which of the following surface antigens is most likely to be found on the cells indicated by the arrow?? {'A': 'CD8', 'B': 'CD40L', 'C': 'CD56', 'D': 'CD14', 'E': 'CD34'},
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D: CD14
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Q:A 30-year-old man with Down syndrome is brought to the physician by his mother for the evaluation of fatigue. Physical examination shows bluish-colored lips and digital clubbing that were not present at his most recent examination. Right heart catheterization shows a right atrial pressure of 32 mmHg. Which of the following is most likely involved in the pathogenesis of this patient's current condition?? {'A': 'Aortic valve regurgitation', 'B': 'Reversible pulmonary hypertension', 'C': 'Intrapulmonary shunting', 'D': 'Right ventricular hypertrophy', 'E': 'Asymmetric septal hypertrophy'},
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D: Right ventricular hypertrophy
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Q:A data analyst is putting systolic blood pressure values into a spreadsheet for a research study on hypertension during pregnancy. The majority of systolic blood pressure values fall between 130 and 145. For one of the study participants, she accidentally types “1400” instead of “140”. Which of the following statements is most likely to be correct?? {'A': 'This is a systematic error', 'B': 'The standard deviation of the data set is decreased', 'C': 'The mode is now greater than the mean', 'D': 'The range of the data set is unaffected', 'E': 'The median is now smaller than the mean'},
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E: The median is now smaller than the mean
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Q:A 4-year-old girl is brought to her pediatrician for a routine check-up. She was diagnosed with sickle cell disease last year after an episode of dactylitis. She was started on hydroxyurea, with no painful crises or acute chest episodes since starting the medication. Which of the following is an appropriate preventive measure for this patient?? {'A': 'Splenectomy', 'B': 'Parenteral penicillin G', 'C': 'Pneumococcal vaccine', 'D': 'Intranasal influenza vaccine', 'E': 'Human papillomavirus vaccine'},
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C: Pneumococcal vaccine
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Q:A 37-year-old man presents to a clinic with complaints of breathlessness and fever for the past few days. He says that the breathlessness is the same throughout the day and is not related to exertion. He recorded his body temperature at home as 38.1°C (100.5°F). Past medical history is insignificant. He denies visiting any sick person recently. He admits that he uses marijuana frequently and illicit intravenous drugs intermittently. His vital signs include: blood pressure 120/60 mm Hg, temperature 38.3°C (101.0°F), respiratory rate 16/min, and pulse rate 65/min (regular). Physical examination reveals track marks on the arms and a lesion on the patient’s left ring finger as shown in the picture below. On cardiac auscultation, an early diastolic murmur over the right second intercostal space is heard; S3 and S4 are also present. Echocardiography shows vegetation on the aortic valve and mild valve insufficiency. Serial blood cultures are performed, and results are pending. Which of the following causative agents is most likely responsible for this patient’s condition?? {'A': 'Viridans group streptococci', 'B': 'Kingella kingae', 'C': 'Streptococcus gallolyticus', 'D': 'Noninfectious immune complex mediated', 'E': 'Staphylococcus aureus'},
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E: Staphylococcus aureus
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Q:A 31 year-old African-American female presents with a painful shin nodules, uveitis, and calcified hilar lymph nodes. A transbronchial biopsy of the lung would most likely show which of the following histologies?? {'A': 'Inflammation, fibrosis and cyst formation that is most prominent in subpleural regions', 'B': 'Silica particles (birefringent) surrounded by collagen', 'C': 'Golden-brown fusiform rods', 'D': 'Patchy interstitial lymphoid infiltrate into walls of alveolar units', 'E': 'Non-caseating granulomas'},
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E: Non-caseating granulomas
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Q:A 57-year-old man is admitted to the ER due to an abrupt onset of abdominal pain that radiates to the back, nausea, and multiple vomiting episodes for the past 10 hours. He does not have any significant past medical history. He admits to drinking alcohol every night. During admission, he is found to have a body temperature of 37.5°C (99.5°F), a respiratory rate of 20/min, a pulse of 120/min, and a blood pressure of 120/76 mm Hg. He looks pale with sunken eyes and has significant epigastric tenderness and flank discoloration. An initial laboratory panel shows the following: Total count (WBC) 10,000/mm3 Platelet count 140,000/mm3 Serum glucose 160 mg/dL Serum LDH 500 IU/L Aspartate aminotransferase 400 IU/dL Serum Amylase 500 IU/L Serum Lipase 300 IU/L Which of the following combinations would best predict severity in this case?? {'A': 'Glucose, LDH, AST', 'B': 'Age, LDH, AST', 'C': 'WBC, platelet count, AST', 'D': 'Age, glucose, amylase', 'E': 'AST, amylase, lipase'},
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B: Age, LDH, AST
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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 his primary care provider because of chest pain for the past 3 weeks. The chest pain occurs after climbing more than 2 flights of stairs or walking for more than 10 minutes. His symptoms remain for an average of 30 minutes despite rest, but they eventually remit. He is obese, has a history of type 2 diabetes mellitus, and has smoked 15–20 cigarettes a day for the past 25 years. His father died from a myocardial infarction at 52 years of age. His vital signs reveal a temperature of 36.7°C (98.0°F), blood pressure of 145/93 mm Hg, and a heart rate of 85/min. The physical examination is unremarkable. Which of the following is consistent with unstable angina?? {'A': 'Dyspnea on exertion', 'B': 'ST segment depression on ECG', 'C': 'Symptoms present for 30 minutes despite rest', 'D': 'Rales on auscultation', 'E': 'S3 on auscultation'},
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C: Symptoms present for 30 minutes despite rest
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Answer the following medical question with one of the provided options:
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Q:A 56-year-old man is brought to the emergency department for the evaluation of a 3-day history of left lower abdominal pain. During this period, the patient has also had a low-grade fever and has not had a bowel movement. He has a history of constipation. He underwent a cholecystectomy at the age of 53 years. He has smoked one pack of cigarettes daily for the last 30 years. His temperature is 38.8°C (101.8°F), pulse is 80/min, respirations are 18/min, and blood pressure is 130/84 mm Hg. Cardiopulmonary examination shows no abnormalities. Abdominal examination shows left lower quadrant tenderness with no guarding or rebound. There is no edema of his lower extremities. CT of the abdomen with contrast shows segmental wall thickening of the descending colon with multiple diverticula, surrounding fat stranding, and a 5.5-cm, low-attenuating pelvic fluid collection. Intravenous fluids and bowel rest are started. Treatment with intravenous morphine, ciprofloxacin, and metronidazole is begun. Which of the following is the most appropriate next step in the management of this patient?? {'A': 'Observation and serial CT scans', 'B': 'Left laparoscopic hemicolectomy', 'C': 'Colonoscopy', 'D': 'CT-guided percutaneous abscess drainage', 'E': 'Segmental colonic resection\n"'},
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D: CT-guided percutaneous abscess drainage
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Answer the following medical question with one of the provided options:
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Q:A 36-year-old man comes to the emergency department 4 hours after a bike accident for severe pain and swelling in his right leg. He has not had a headache, nausea, vomiting, abdominal pain, or blood in his urine. He has a history of gastroesophageal reflux disease and allergic rhinitis. He has smoked one pack of cigarettes daily for 17 years and drinks an average of one alcoholic beverage daily. His medications include levocetirizine and pantoprazole. He is in moderate distress. His temperature is 37°C (98.6°F), pulse is 112/min, and blood pressure is 140/80 mm Hg. Examination shows multiple bruises over both lower extremities and the face. There is swelling surrounding a 2 cm laceration 13 cm below the right knee. The lower two-thirds of the tibia is tender to palpation and the skin is pale and cool to the touch. The anterior tibial, posterior tibial, and dorsalis pedis pulses are weak. Capillary refill time of the right big toe is 4 seconds. Dorsiflexion of his right foot causes severe pain in his calf. Cardiopulmonary examination is normal. An x-ray is ordered, which is shown below. Which of the following is the most appropriate next step in management?? {'A': 'Low molecular weight heparin', 'B': 'Open reduction and internal fixation', 'C': 'Above knee cast', 'D': 'Fasciotomy', 'E': 'IVC filter placement'},
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D: Fasciotomy
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Q:A previously healthy 27-year-old man comes to the physician because of a 3-week history of anxiety, diarrhea, and a 4.1-kg (9-lb) weight loss. On questioning, he also reports that he noticed a painless mass on his left testicle 2 weeks ago. His pulse is 110/min and irregular and blood pressure is 150/70 mm Hg. Examination shows diaphoresis and a fine tremor of the outstretched fingers. Testicular examination shows a 3-cm, firm, nontender mass on the left scrotum that does not transilluminate. This patient's underlying condition is most likely to be associated with which of the following findings?? {'A': 'Proptosis on exophthalmometry', 'B': 'Elevated serum AFP', 'C': 'Elevated serum TSH', 'D': 'Positive urine metanephrines', 'E': 'Positive urine hCG'},
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E: Positive urine hCG
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Q:An 85-year-old man who recently immigrated to the US from Spain presents to your office complaining of hoarseness and dysphagia for the past 2 months. He says his symptoms have been getting progressively worse, and he expresses concerns about the difficulty swallowing as he cannot eat well and has even lost 9 kg (20 lb) since his last visit 3 months ago. He denies any shortness of breath, coughing of blood, and chest pain. His bowel and bladder habit are normal. Past medical history is unremarkable. He has a 60-pack-year history of smoking tobacco and drinks alcohol occasionally. Which of the following is the most likely cause of his symptoms?? {'A': 'Malignant proliferation of squamous cells', 'B': 'Transformation leading to metaplasia in the lower esophagus', 'C': 'Malignant proliferation of glandular tissue in the esophagus', 'D': 'Reduced lower esophageal pressure', 'E': 'Chronic autoimmune gastritis'},
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A: Malignant proliferation of squamous cells
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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 presents with difficulty sleeping and ‘feeling low’ for the past 6 months. Although he denies any suicidal thoughts, he admits to having an occasional feeling of hopelessness and loss of concentration at work. For the last 2 months, he has made excuses to avoid meeting his friends. He got married 1 year ago. The couple plans to try to have a child. He was started on sertraline 3 months ago and says it has not helped his depressive symptoms. He says he has also developed erectile dysfunction since starting the medication, which has been an issue since he and his wife would like to have a child. Past medical history is insignificant. The patient is afebrile and vital signs are within normal limits. Physical examination is unremarkable. Laboratory studies, including thyroid-stimulating hormone (TSH), are within normal limits. When switching drugs, which of the following would be most appropriate for this patient?? {'A': 'Nortriptyline', 'B': 'Bupropion', 'C': 'Buspirone', 'D': 'Phenelzine', 'E': 'Fluoxetine'},
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B: Bupropion
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Answer the following medical question with one of the provided options:
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Q:A 55-year-old patient is brought to the emergency department because he has had sharp chest pain for the past 3 hours. He reports that he can only take shallow breaths because deep inspiration worsens the pain. He also reports that the pain increases with coughing. Two weeks ago, he underwent cardiac catheterization for an acute myocardial infarction. Current medications include aspirin, ticagrelor, atorvastatin, metoprolol, and lisinopril. His temperature is 38.54°C (101.1°F), pulse is 55/min, respirations are 23/min, and blood pressure is 125/75 mm Hg. Cardiac examination shows a high-pitched scratching sound best heard when the patient is sitting upright and during expiration. An ECG shows diffuse ST elevations and ST depression in aVR and V1. An echocardiography shows no abnormalities. Which of the following is the most appropriate treatment in this patient?? {'A': 'Start heparin infusion', 'B': 'Administer nitroglycerin', 'C': 'Increase aspirin dose', 'D': 'Perform pericardiocentesis', 'E': 'Perform CT angiography'},
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C: Increase aspirin dose
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Answer the following medical question with one of the provided options:
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Q:A 25-year-old G2P1 woman at 28 weeks estimated gestational age presents with questions on getting epidural anesthesia for her upcoming delivery. She has not received any prenatal care until now. Her previous pregnancy was delivered safely at home by an unlicensed midwife, but she would like to receive an epidural for this upcoming delivery. Upon inquiry, she admits that she desires a ''fully natural experience'' and has taken no supplements or shots during or after her 1st pregnancy. Her 1st child also did not receive any post-delivery injections or vaccinations but is currently healthy. The patient has an A (-) negative blood group, while her husband has an O (+) positive blood group. Which of the following should be administered immediately in this patient to prevent a potentially serious complication during delivery?? {'A': 'Iron supplements', 'B': 'Folic acid', 'C': 'Vitamin K', 'D': 'Anti-RhO(D) immunoglobulin', 'E': 'Vitamin D'},
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D: Anti-RhO(D) immunoglobulin
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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 comes to the physician because of worsening fatigue and recurrent bleeding from his gums for 2 weeks. Physical examination shows marked pallor. There are scattered red, nonblanching pinpoints spots on his trunk and extremities. Laboratory studies show a hemoglobin of 8.0 g/dL, a leukocyte count of 80,000/mm3, and a platelet count of 104,000/mm3. Genetic analysis of a bone marrow aspirate shows leukemic cells with a balanced translocation between the long arms of chromosome 15 and 17. These cells are most likely to stain positive for which of the following?? {'A': 'Myeloperoxidase', 'B': 'Tartrate resistant acid phosphatase', 'C': 'Periodic acid-Schiff', 'D': 'Cluster of differentiation 1a', 'E': 'Terminal deoxynucleotidyl transferase'},
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A: Myeloperoxidase
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Answer the following medical question with one of the provided options:
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Q:A 69-year-old woman presents to her physician’s office with cough, increasing fatigue, and reports an alarming loss of 15 kg (33 lb) weight over the last 4 months. She says that she has observed this fatigue and cough to be present over the past year, but pushed it aside citing her age as a reason. The cough has been progressing and the weight loss is really worrying her. She also observed blood-tinged sputum twice over the last week. Past medical history is noncontributory. She does not smoke and does not use recreational drugs. She is relatively active and follows a healthy diet. Today, her vitals are normal. On examination, she appears frail and pale. At auscultation, her lung has a slight expiratory wheeze. A chest X-ray shows a coin-shaped lesion in the periphery of the middle lobe of the right lung. The nodule is biopsied by interventional radiology (see image). Which of the following types of cancer is most likely associated with this patient’s symptoms?? {'A': 'Mesothelioma', 'B': 'Large cell carcinoma', 'C': 'Small cell carcinoma', 'D': 'Squamous cell carcinoma', 'E': 'Adenocarcinoma'},
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E: Adenocarcinoma
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Answer the following medical question with one of the provided options:
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Q:A 5-month-old male presents to the pediatrician with his mother for a well visit. The patient was born at 35 weeks gestation to a 30-year-old gravida 2 via vaginal delivery. The pregnancy and labor were uncomplicated. The patient required no resuscitation after delivery and was discharged from the hospital on day two of life. His mother now reports that the patient has been exclusively breastfed since birth, and she says that feedings have been going well, and that the patient appears satisfied afterwards. The patient feeds for 30 minutes every two hours and urinates 8-10 times per day. The patient’s mother reports that she eats a varied diet that includes animal products, but she worries that the patient is not meeting his nutritional needs with breastmilk alone. The patient’s height and weight at birth were in the 15th and 20th percentile, respectively. His height and weight are now in the 20th and 25th percentile, respectively. His temperature is 98.1°F (36.7°C), blood pressure is 58/46 mmHg, pulse is 128/min, and respirations are 34/min. On physical exam, the patient appears well-developed and well-nourished. He has mild conjunctival pallor. Which of the following is the most appropriate guidance regarding this patient’s nutritional needs?? {'A': 'No changes are necessary to his diet', 'B': "Add cow's milk to his diet", 'C': 'Add pureed foods to his diet', 'D': 'Supplement his diet with formula', 'E': 'Supplement his diet with iron and vitamin D'},
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E: Supplement his diet with iron and vitamin D
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