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Answer the following medical question with one of the provided options:
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Q:A 67-year-old male presents to his primary care physician complaining of increased fatigue over the last year. He also says that his friends say he appears to be more pale. His past medical history is significant for 10 years of arthritis. Physical exam reveals spoon shaped nails as well as conjunctival pallor. Based on clinical suspicion RBC tests are ordered showing an mean corpuscular volume (MCV) of 75 fl (normal 80-100 fl) and a peripheral blood smear is obtained and found to be normal. Iron studies shows a serum iron of 30 micromolar (normal range 50-170) and a serum ferritin of 300 micrograms/liter (normal range 15-200). What is the most likely diagnosis in this patient?? {'A': 'Alpha-thalassemia', 'B': 'Anemia of chronic disease', 'C': 'Beta-thalassemia', 'D': 'Iron deficiency anemia', 'E': 'Lead poisoning anemia'},
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B: Anemia of chronic disease
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Answer the following medical question with one of the provided options:
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Q:A 25-year-old pregnant woman at 28 weeks gestation presents with a headache. Her pregnancy has been managed by a nurse practitioner. Her temperature is 99.0°F (37.2°C), blood pressure is 164/104 mmHg, pulse is 100/min, respirations are 22/min, and oxygen saturation is 98% on room air. Physical exam is notable for a comfortable appearing woman with a gravid uterus. Laboratory tests are ordered as seen below. Hemoglobin: 12 g/dL Hematocrit: 36% Leukocyte count: 6,700/mm^3 with normal differential Platelet count: 100,500/mm^3 Serum: Na+: 141 mEq/L Cl-: 101 mEq/L K+: 4.4 mEq/L HCO3-: 25 mEq/L BUN: 21 mg/dL Glucose: 99 mg/dL Creatinine: 1.0 mg/dL AST: 32 U/L ALT: 30 U/L Urine: Color: Amber Protein: Positive Blood: Negative Which of the following is the most likely diagnosis?? {'A': 'Acute fatty liver disease of pregnancy', 'B': 'Eclampsia', 'C': 'HELLP syndrome', 'D': 'Preeclampsia', 'E': 'Severe preeclampsia'},
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E: Severe preeclampsia
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Answer the following medical question with one of the provided options:
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Q:A 13-year-old boy is brought to the physician by his parents for the evaluation of multiple behavioral problems. The parents report that their son has been bullying several classmates at school over the past year. During this period, he has been accused twice of stealing items from a local store. He has also beaten up the neighbor's son for no obvious reason. The parents state that they had to give up their dog for adoption after finding out that their son was torturing him. There is no personal or family history of serious illness. He attends a local middle school and his performance at school is poor compared to his classmates. He often forgets to do his homework and argues with his teachers. He was also caught smoking cigarettes. Vital signs are within normal limits. Physical examination shows no abnormalities. He has poor attention and does not answer some of the questions. For questions he answers affirmatively about his actions, he sometimes replies, “So what?.” Which of the following conditions is this patient most likely to develop?? {'A': 'Major depressive disorder', 'B': 'Obsessive-compulsive disorder', 'C': 'Bipolar disorder', 'D': 'Antisocial personality disorder', 'E': 'Early-onset dementia'},
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D: Antisocial personality disorder
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Answer the following medical question with one of the provided options:
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Q:A 39-year-old woman with a history of migraine headaches is brought to the emergency room because of a severe, sudden-onset, throbbing headache and double vision for 1 hour. She says that she has been having frequent headaches and has not had her period in several months. Her blood pressure is 93/61 mm Hg. Visual field testing shows decreased visual acuity and loss of peripheral vision in both eyes. Which of the following is the most likely diagnosis?? {'A': 'Transient ischemic attack', 'B': 'Pituitary apoplexy', 'C': 'Sheehan syndrome', 'D': 'Migraine with aura', 'E': 'Cluster headache'},
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B: Pituitary apoplexy
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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 comes to the physician because of a 1-week history of palpitations and dizziness. His pulse is 65/min and regular. An ECG is shown. A drug is administered that inhibits non-dihydropyridine calcium channels in the heart and his symptoms improve. The drug administered to the patient most likely has which of the following effects on the cardiac conduction system?? {'A': 'Prolongation of Purkinje fiber refractory period', 'B': 'Decrease in bundle of His refractory period', 'C': 'Delay in ventricular myocardial repolarization', 'D': 'Decrease in ventricular myocardial action potential duration', 'E': 'Prolongation of AV node repolarization'},
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E: Prolongation of AV node repolarization
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Answer the following medical question with one of the provided options:
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Q:A 5-year-old girl is brought to the physician because of a 2-day history of redness and foreign body sensation in both eyes. She has not had vision loss. Her mother reports that she has also had violent coughing spells followed by a high-pitched inspiratory sound during this time. For the past week, she has had low-grade fevers and a runny nose. Her only vaccinations were received at birth. Her temperature is 37.7°C (99.9°F). Examination shows conjunctival hemorrhage and petechiae. Oropharyngeal examination shows no abnormalities. Which of the following is the most appropriate pharmacotherapy?? {'A': 'Topical azithromycin', 'B': 'Oral azithromycin', 'C': 'Artificial tears', 'D': 'Intramuscular ceftriaxone', 'E': 'Topical tobramycin'},
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B: Oral azithromycin
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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 with fatigue. He states that his symptoms started yesterday and have been worsening steadily. The patient endorses a recent weight loss of 7 pounds this past week and states that he feels diffusely itchy. The patient has a past medical history of alcohol abuse, obesity, asthma, and IV drug use. His current medications include metformin, atorvastatin, albuterol, and fluticasone. In addition, the patient admits to smoking and drinking more than usual lately due to the stress he has experienced. His temperature is 98.7°F (37.1°C), blood pressure is 130/75 mmHg, pulse is 90/min, respirations are 15/min, and oxygen saturation is 98% on room air. Physical exam is notable for an ill-appearing man. The patient's skin appears yellow. Abdominal exam is notable for right upper quadrant tenderness. Cardiac and pulmonary exams are within normal limits. Laboratory values are ordered as seen below: Hemoglobin: 14 g/dL Hematocrit: 42% Leukocyte count: 5,500 cells/mm^3 with normal differential Platelet count: 70,000/mm^3 Partial thromboplastin time: 92 seconds Prothrombin time: 42 seconds AST: 1110 U/L ALT: 990 U/L Which of the following is most likely to be found in this patient's history?? {'A': 'Appropriate acute management of a deep vein thrombosis', 'B': 'Decreased UDP-glucuronosyltransferase activity at birth', 'C': 'Prosthetic valve with appropriate post-operative care', 'D': 'Recent antibiotic treatment with gentamicin', 'E': 'Severe migraine headaches treated with acetaminophen'},
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E: Severe migraine headaches treated with acetaminophen
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Answer the following medical question with one of the provided options:
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Q:A 70-year-old man with hypertension and type 2 diabetes mellitus is admitted to the hospital 8 hours after the onset of impaired speech and right-sided weakness. Two days after admission, he becomes confused and is difficult to arouse. His pulse is 64/min and blood pressure is 166/96 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 95%. Fundoscopic examination shows bilateral optic disc swelling. He is intubated and mechanically ventilated. A CT scan of the brain shows hypoattenuation in the territory of the left middle cerebral artery with surrounding edema and a 1-cm midline shift to the right. Which of the following interventions is most likely to result in a decrease in this patient's intracranial pressure?? {'A': 'Decrease the blood pressure', 'B': 'Increase the respiratory rate', 'C': 'Increase the fraction of inhaled oxygen', 'D': 'Increase the positive end-expiratory pressure', 'E': 'Decrease the heart rate'},
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B: Increase the respiratory rate
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Answer the following medical question with one of the provided options:
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Q:A 59-year-old man presents to the emergency department with a 6 day history of persistent fevers. In addition, he has noticed that he feels weak and sometimes short of breath. His past medical history is significant for congenital heart disease though he doesn't remember the specific details. He has been unemployed for the last 3 years and has been occasionally homeless. Physical exam reveals nailbed splinter hemorrhages and painful nodes on his fingers and toes. Blood cultures taken 12 hours apart grow out Streptococcus gallolyticus. Which of the following is most likely associated with this patient's disease?? {'A': 'Dental procedures due to poor hygiene', 'B': 'Intravenous drug abuse', 'C': 'Genitourinary procedures', 'D': 'Left-sided colon cancer', 'E': 'Prosthetic heart valves'},
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D: Left-sided colon cancer
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Answer the following medical question with one of the provided options:
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Q:A 63-year-old African American man presents to the emergency department with edema over his face and difficulty breathing. Past medical history is significant for hypertension and dyslipidemia. He recently began lisinopril and atorvastatin several weeks ago. His father died at 80 years from complications of a stroke and his mother lives in a nursing home. His blood pressure is 135/92 mm Hg, the heart rate is 101/min, the respiratory rate is 21/min, the temperature is 32.0°C (98.6°F). Clinical pathology results suggest a normal C1 esterase inhibitor level. Of the following options, which is the most likely diagnosis?? {'A': 'Scleredema', 'B': 'Erysipelas', 'C': 'Facial lymphedema', 'D': 'Drug-induced angioedema', 'E': 'Contact dermatitis'},
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D: Drug-induced angioedema
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Answer the following medical question with one of the provided options:
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Q:A 45-year-old man presents to the office for evaluation of pruritic skin lesions, which he has had for 1 month on his elbows and knees. He has been using over-the-counter ointments, but they have not helped. He has not seen a healthcare provider for many years. He has no known allergies. His blood pressure is 140/80 mm Hg, his pulse is 82 beats per minute, his respirations are 18 breaths per minute, and his temperature is 37.2°C (98.9°F). On examination, clustered vesicular lesions are noted on both elbows and knees. Cardiovascular and pulmonary exams are unremarkable. Which of the following would most likely be associated with this patient’s condition?? {'A': 'Malabsorption', 'B': 'Transmural inflammation of the colon', 'C': 'Double bubble on X-ray', 'D': 'Erythema nodosum', 'E': 'Acanthosis nigricans'},
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A: Malabsorption
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Answer the following medical question with one of the provided options:
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Q:A 50-year-old man is brought to the emergency department with progressive retrosternal chest pain and shortness of breath that started the day before. The pain is severe, worsens with inspiration, and radiates to his neck. He has also had a sore throat and neck pain the last 4 days. He remained bed-bound during this time and had poor appetite. One week ago, he underwent an upper endoscopy for peptic ulcer disease. He has type 2 diabetes mellitus, peptic ulcer disease, hyperlipidemia, and hypertension. His only medication is omeprazole. He does not smoke or drink alcohol. He appears in significant distress. His temperature is 39.1°C (102.3°F), pulse is 108/min, respirations are 28/min, and blood pressure is 88/46 mm Hg. The lungs are clear to auscultation. Cardiac examinations shows tachycardia but is otherwise unremarkable. The abdomen is soft and nontender. Oropharyngeal examination is limited because the patient is unable to open his mouth due to pain. His hematocrit is 42%, leukocyte count is 13,800/mm3, and platelet count is 205,000/mm3. The patient is intubated in the emergency department and appropriate treatment is started. Chest x-ray shows a widened mediastinum. Which of the following is most likely to have prevented this patient's condition?? {'A': 'Pericardiocentesis', 'B': 'Intravenous methylprednisolone administration', 'C': 'Intravenous ampicillin-sulbactam administration', 'D': 'Blood pressure control', 'E': 'Intravenous levofloxacin administration\n"'},
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C: Intravenous ampicillin-sulbactam administration
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Answer the following medical question with one of the provided options:
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Q:Every time your neighbor in the adjacent apartment flushes the toilet, the water in your shower becomes very hot, causing you to jump out of the way of the water stream. After this has occurred for several months, you note that you reflexively jump back from the water directly after the sound of the flushing toilet but before the water temperature changes. Which of the following situations is the most similar to the conditioning process detailed above?? {'A': 'You consistently check the slots of pay telephones as you have previously found change left there', 'B': 'A young child elects to not throw a temper tantrum to avoid being grounded by his parents', 'C': 'A mouse repeatedly presses a red button to avoid receiving an electric shock', 'D': 'You now sleep through the noise of the train running past your apartment that kept you up 1 year ago', 'E': 'White coat syndrome (patient anxiety evoked at the sight of a white lab coat)'},
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E: White coat syndrome (patient anxiety evoked at the sight of a white lab coat)
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Answer the following medical question with one of the provided options:
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Q:A 28-year-old woman, gravida 3, para 2, at 12 weeks' gestation comes to the physician for a prenatal visit. She reports feeling fatigued, but she is otherwise feeling well. Pregnancy and delivery of her first 2 children were complicated by iron deficiency anemia. The patient does not smoke or drink alcohol. She does not use illicit drugs. She has a history of a seizure disorder controlled by lamotrigine; other medications include folic acid, iron supplements, and a multivitamin. Her temperature is 37°C (98.6°F), pulse is 80/min, and blood pressure is 144/96 mm Hg. She recalls that during blood pressure self-monitoring yesterday morning her blood pressure was 140/95 mm Hg. Physical examination shows no abnormalities. Laboratory studies, including serum glucose level and thyroid-stimulating hormone concentration, are within normal limits. This patient's child is most likely to develop which of the following?? {'A': 'Small for gestational age', 'B': 'Intellectual disability', 'C': 'Neonatal polycythemia', 'D': 'Caudal regression syndrome', 'E': 'Fetal hydantoin syndrome'},
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A: Small for gestational age
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Answer the following medical question with one of the provided options:
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Q:A 7-year-old girl is brought to the physician with complaints of recurrent episodes of dysuria for the past few months. Her parents reported 4 to 5 similar episodes in the last year. They also note that she has had several urinary tract infections throughout her childhood. She has no other medical problems and takes no medications. Her temperature is 38.6ºC (101.4°F), pulse is 88/min, and respiratory rate is 20/min. On physical examination, suprapubic tenderness is noted. On ultrasonography, hydronephrosis and scarring are present. Which of the following is the most appropriate next step?? {'A': 'Complete blood count', 'B': 'Ultrasonography of the abdomen and pelvis', 'C': 'Urine culture and sensitivity', 'D': 'Voiding cystourethrogram', 'E': 'Magnetic resonance imaging'},
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D: Voiding cystourethrogram
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Answer the following medical question with one of the provided options:
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Q:Two days after undergoing hemicolectomy for colon cancer, a 78-year-old man is found agitated and confused in his room. He says that a burglar broke in. The patient points at one corner of the room and says “There he is, doctor!” Closer inspection reveals that the patient is pointing to his bathrobe, which is hanging on the wall. The patient has type 2 diabetes mellitus and arterial hypertension. Current medications include insulin and hydrochlorothiazide. His temperature is 36.9°C (98.4°F), pulse is 89/min, respirations are 15/min, and blood pressure is 145/98 mm Hg. Physical examination shows a nontender, nonerythematous midline abdominal wound. On mental status examination, the patient is agitated and oriented only to person. Which of the following best describes this patient's perception?? {'A': 'External attribution', 'B': 'Illusion', 'C': 'Delusion', 'D': 'Loose association', 'E': 'Hallucination'},
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B: Illusion
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Answer the following medical question with one of the provided options:
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Q:Two days after an uncomplicated laparoscopic abdominal hernia repair, a 46-year-old man is evaluated for palpitations. He has a history of hypertension, type 2 diabetes mellitus, and a ventricular septal defect that closed spontaneously as a child. His father has coronary artery disease. Prior to admission, his only medications were hydrochlorothiazide and metformin. He currently also takes hydromorphone/acetaminophen for mild postoperative pain. He is 180 cm (5 ft 11 in) tall and weighs 100 kg (220 lb); BMI is 30.7 kg/m2. His temperature is 37.0°C (99°F), blood pressure is 139/85 mmHg, pulse is 75/min and irregular, and respirations are 14/min. Cardiopulmonary examination shows a normal S1 and S2 without murmurs and clear lung fields. The abdominal incisions are clean, dry, and intact. There is mild tenderness to palpation over the lower quadrants. An electrocardiogram is obtained and shown below. Which of the following is the most likely cause of this patient's ECG findings?? {'A': 'Hypokalemia', 'B': 'Accessory pathway in the heart', 'C': 'Hydromorphone administration', 'D': 'Acute myocardial ischemia', 'E': 'Atrial enlargement'},
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A: Hypokalemia
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Answer the following medical question with one of the provided options:
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Q:A 34-year-old man presents to the emergency department with a headache that has lasted for 2 hours. His headache is severe and he rates it as a 10/10 on the pain scale. It is generalized and associated with nausea and photophobia. He denies any history of head trauma or fever. He has a history of migraines, but he says this headache is worse than any he has had before. He has no other significant past medical history and takes no medications. His father has chronic kidney disease. Physical examination reveals: blood pressure 125/66 mm Hg, heart rate 80/min, and temperature 37.2°C (99.0°F). The patient is awake, alert, and oriented, but he is in severe distress due to the pain. On physical examination, his neck is stiff with flexion. Motor strength is 5/5 in all 4 limbs and sensation is intact. Fundoscopic examination results are within normal limits. What is the next best step in the management of this patient?? {'A': 'Acetazolamide', 'B': 'Antibiotics', 'C': 'Sumatriptan', 'D': 'Lumbar puncture', 'E': 'CT head '},
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E: CT head
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Answer the following medical question with one of the provided options:
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Q:An investigator is studying the structure and function of immunoglobulins that are transmitted across the placenta from mother to fetus. The structure indicated by the arrow is primarily responsible for which of the following immunological events?? {'A': 'Formation of dimer', 'B': 'Binding to mast cells', 'C': 'Fixing of complement', 'D': 'Attachment to antigen', 'E': 'Determination of idiotype\n"'},
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C: Fixing of complement
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Answer the following medical question with one of the provided options:
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Q:A 45-year-old man is brought to the emergency department after being found down in the middle of the street. Bystanders reported to the police that they had seen the man as he exited a local bar, and he was subsequently assaulted. He sustained severe facial trauma, including multiple lacerations and facial bone fractures. The man is taken to the operating room by the ENT team, who attempt to reconstruct his facial bones with multiple plates and screws. Several days later, he complains of the inability to open his mouth wide or to completely chew his food, both of which he seemed able to do prior to surgery. Which of the following is a characteristic of the injured nerve branch?? {'A': 'Sensory component only', 'B': 'Voluntary motor component only', 'C': 'Voluntary motor and sensory components', 'D': 'Parasympathetic component only', 'E': 'Sympathetic component only'},
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C: Voluntary motor and sensory components
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Answer the following medical question with one of the provided options:
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Q:A 75-year-old man with hypercholesterolemia, coronary artery disease, and history of a transient ischemic attack (TIA) comes to your office for evaluation of hypertension. Previously, his blood pressure was controlled with diet and an ACE inhibitor. Today, his blood pressure is 180/115 mm Hg, and his creatinine is increased from 0.54 to 1.2 mg/dL. The patient reports that he has been compliant with his diet and blood pressure medications. What is the most likely cause of his hypertension?? {'A': 'Progression of his essential hypertension', 'B': 'Renal artery stenosis', 'C': 'Coarctation of the aorta', 'D': 'Pheochromocytoma', 'E': 'Hypothyroidism'},
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B: Renal artery stenosis
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Answer the following medical question with one of the provided options:
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Q:A 69-year-old man presents to the urgent care clinic with a history of hypertension and a variety of systemic complaints including fatigue, occasional fever, abdominal pain, and diffuse palpable, pruritic eruptions over his lower extremities. He is currently unemployed. His medical history is significant for gout, hypertension, hypercholesterolemia, diabetes mellitus type II, HIV, and hepatitis C. He currently smokes 2 packs of cigarettes per day, drinks a 6-pack of beer per day, and endorses a history of injection drug use in the past with heroin but currently denies any drug use. His vital signs include: temperature 40.0°C (104.0°F), blood pressure 126/74 mm Hg, heart rate 111/min, and respiratory rate 23/min. On physical examination, the patient has motor weakness on dorsiflexion. Laboratory analysis shows an elevated erythrocyte sedimentation rate, elevated C-reactive protein, and proteinuria, increasing your suspicion of polyarteritis nodosa. Of the following options, which is the reaction mechanism that underlies polyarteritis nodosa?? {'A': 'Type I–anaphylactic hypersensitivity reaction', 'B': 'Type II–cytotoxic hypersensitivity reaction', 'C': 'Type III–immune complex-mediated hypersensitivity reaction', 'D': 'Type IV–cell-mediated (delayed) hypersensitivity reaction', 'E': 'Type I and IV–mixed anaphylactic and cell-mediated hypersensitivity reactions'},
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C: Type III–immune complex-mediated hypersensitivity reaction
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Answer the following medical question with one of the provided options:
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Q:A 12-year-old girl is brought to the physician for a follow-up examination. Two months ago, she was diagnosed with asthma and treatment was begun with an albuterol inhaler as needed. Since then, she has had episodic chest tightness and cough 2–3 times per week. The cough is intermittent and nonproductive; it is worse at night. She has been otherwise healthy and takes no other medications. Her vital signs are within normal limits. Pulmonary examination shows mild expiratory wheezing of all lung fields. Spirometry shows an FEV1:FVC ratio of 81% and an FEV1 of 80% of predicted; FEV1 rises to 93% of predicted after administration of a short-acting bronchodilator. Treatment with low-dose inhaled beclomethasone is begun. The patient is at greatest risk for which of the following adverse effects?? {'A': 'Oropharyngeal candidiasis', 'B': 'Bradycardia', 'C': 'High-pitched voice', 'D': 'Easy bruisability', 'E': 'Hypoglycemia'},
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A: Oropharyngeal candidiasis
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Answer the following medical question with one of the provided options:
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Q:A previously healthy 32-year-old woman comes to the emergency department with fatigue and bilateral leg swelling. Her pulse is 92/min, and respirations are 24/min. Physical examination shows jugular venous distention and pitting edema of the lower extremities. Her abdomen is distended with shifting dullness and tender hepatomegaly is present. Cardiovascular examination shows a holosystolic murmur heard best at the left lower sternal border that increases in intensity with inspiration. Which of the following is the most likely predisposing factor for this patient's condition?? {'A': '45,XO genotype', 'B': 'Intravenous drug use', 'C': 'Vitamin B1 deficiency', 'D': 'Fibrillin gene defect', 'E': 'Streptococcal pharyngitis'},
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B: Intravenous drug use
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Answer the following medical question with one of the provided options:
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Q:A 2-year-old boy is brought in by his parents to his pediatrician. The boy was born by spontaneous vaginal delivery at 39 weeks and 5 days after a normal pregnancy. The boy has received all age-appropriate vaccinations as of his last visit at 18 months of age. Of note, the boy has confirmed sickle cell disease and the only medication he takes is penicillin prophylaxis. The parents state that they plan on enrolling their son in a daycare, which requires documentation of up-to-date vaccinations. The pediatrician states that their son needs an additional vaccination at this visit, which is a polysaccharide vaccine that is not conjugated to protein. Which of the following matches this description?? {'A': 'Hib vaccine', 'B': 'Live attenuated influenza vaccine', 'C': 'Menactra', 'D': 'Prevnar', 'E': 'Pneumovax'},
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E: Pneumovax
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Answer the following medical question with one of the provided options:
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Q:Maturity Onset Diabetes of the Young (MODY) type 2 is a consequence of a defective pancreatic enzyme, which normally acts as a glucose sensor, resulting in a mild hyperglycemia. The hyperglycemia is especially exacerbated during pregnancy. Which of the following pathways is controlled by this enzyme?? {'A': 'Glucose --> glucose-6-phosphate', 'B': 'Glucose-6-phosphate --> fructose-6-phosphate', 'C': 'Fructose-6-phosphate --> fructose-1,6-biphosphate', 'D': 'Glyceraldehyde-3-phosphate --> 1,3-bisphosphoglycerate', 'E': 'Phosphoenolpyruvate --> pyruvate'},
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A: Glucose --> glucose-6-phosphate
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Answer the following medical question with one of the provided options:
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Q:A 75-year-old man presents to the clinic for chronic fatigue of 3 months duration. Past medical history is significant for type 2 diabetes and hypertension, both of which are controlled with medications, as well as constipation. He denies any fever, weight loss, pain, or focal neurologic deficits. A complete blood count reveals microcytic anemia, and a stool guaiac test is positive for blood. He is subsequently evaluated with a colonoscopy. The physician notes some “small pouches” in the colon despite poor visualization due to inadequate bowel prep. What is the blood vessel that supplies the area with the above findings?? {'A': 'Ileocolic artery', 'B': 'Inferior mesenteric artery', 'C': 'Middle colic artery', 'D': 'Right colic artery', 'E': 'Superior mesenteric artery'},
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B: Inferior mesenteric artery
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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 is brought to the emergency department by ambulance 30 minutes after the sudden onset of speech difficulties and right-sided arm and leg weakness. Examination shows paralysis and hypoesthesia on the right side, positive Babinski sign on the right, and slurred speech. A CT scan of the head shows a hyperdensity in the left middle cerebral artery and no evidence of intracranial bleeding. The patient's symptoms improve rapidly after pharmacotherapy is initiated and his weakness completely resolves. Which of the following drugs was most likely administered?? {'A': 'Rivaroxaban', 'B': 'Alteplase', 'C': 'Heparin', 'D': 'Prasugrel', 'E': 'Warfarin\n"'},
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B: Alteplase
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Answer the following medical question with one of the provided options:
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Q:A 25-year-old woman presents to her physician with a missed mense and occasional morning nausea. Her menstrual cycles have previously been normal and on time. She has hypothyroidism resulting from Hashimoto thyroiditis diagnosed 2 years ago. She receives levothyroxine (50 mcg daily) and is euthyroid. She does not take any other medications, including birth control pills. At the time of presentation, her vital signs are as follows: blood pressure 120/80 mm Hg, heart rate 68/min, respiratory rate 12/min, and temperature 36.5℃ (97.7℉). The physical examination shows slight breast engorgement and nipple hyperpigmentation. The gynecologic examination reveals cervical softening and increased mobility. The uterus is enlarged. There are no adnexal masses. The thyroid panel is as follows: Thyroid stimulating hormone (TSH) 3.41 mU/L Total T4 111 nmol/L Free T4 20 pmol/L Which of the following adjustments should be made to the patient’s therapy?? {'A': 'The patient is euthyroid, so no adjustments should be made', 'B': 'Decrease levothyroxine dosage by 30% ', 'C': 'Discontinue levothyroxine', 'D': 'Increase levothyroxine dosage by 20%–30%', 'E': 'Increase levothyroxine dosage by 5% each week up, to 50%'},
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D: Increase levothyroxine dosage by 20%–30%
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Answer the following medical question with one of the provided options:
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Q:To maintain blood glucose levels even after glycogen stores have been depleted, the body, mainly the liver, is able to synthesize glucose in a process called gluconeogenesis. Which of the following reactions of gluconeogenesis requires an enzyme different from glycolysis?? {'A': '2-phosphoglycerate --> 3-phosphoglycerate', 'B': 'Fructose 1,6-bisphosphate --> Fructose-6-phosphate', 'C': 'Phosphoenolpyruvate --> 2-phosphoglycerate', 'D': 'Dihydroxyacetone phosphate --> Glyceraldehyde 3-phosphate', 'E': '1,3-bisphosphoglycerate --> Glyceraldehyde 3-phosphate'},
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B: Fructose 1,6-bisphosphate --> Fructose-6-phosphate
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Answer the following medical question with one of the provided options:
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Q:A 46-year-old woman from Ecuador is admitted to the hospital because of tarry-black stools and epigastric pain for 2 weeks. The epigastric pain is relieved after meals, but worsens after 1–2 hours. She has no history of serious illness and takes no medications. Physical examination shows no abnormalities. Fecal occult blood test is positive. Esophagogastroduodenoscopy shows a bleeding duodenal ulcer. Microscopic examination of a duodenal biopsy specimen is most likely to show which of the following?? {'A': 'Curved, flagellated gram-negative rods', 'B': 'Irregularly drumstick-shaped gram-positive rods', 'C': 'Gram-positive lancet-shaped diplococci', 'D': 'Dimorphic budding yeasts with pseudohyphae', 'E': 'Teardrop-shaped multinucleated trophozoites\n"'},
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A: Curved, flagellated gram-negative rods
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Answer the following medical question with one of the provided options:
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Q:A 1-year-old, pale-looking boy presents with high-grade fever and ecchymosis, which he has been experiencing for the past 2 weeks. The boy has achieved all developmental milestones on time and has no history of medical illness in the past. Lab investigations reveal the following: Hemoglobin 5.5 g/dL WBC 112,000/mm3 Platelets 15,000/mm3 ESR 105/1st hour The boy is referred to a hematologist, who suspects that he may be suffering from the neoplastic proliferation of immature B cells. The physician decides to do a flow cytometry analysis. Detection of which of the following markers would help confirm the suspected diagnosis?? {'A': 'MHC II', 'B': 'CD 3, TCR', 'C': 'CD19, terminal deoxynucleotidyl transferase (Tdt)', 'D': 'CD56', 'E': 'CD16'},
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C: CD19, terminal deoxynucleotidyl transferase (Tdt)
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Answer the following medical question with one of the provided options:
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Q:A 35-year-old man who is a professional baseball player presents with stiffness in his hands. He says he is unable to bat as he would like and feels like he lacks power in his swings. He also has noticed that he sometimes seems to be dragging his feet while walking, and his voice seems to have changed. On physical examination, strength is 3 out of 5 in the extensor and flexor muscle groups in both upper and lower limbs bilaterally. Sensation is intact. Widespread muscle fasciculations are noted. Which of the following is the most likely diagnosis in this patient?? {'A': 'Lambert-Eaton Syndrome', 'B': 'Myasthenia gravis', 'C': 'Multiple sclerosis', 'D': 'Primary lateral sclerosis', 'E': 'Amyotrophic lateral sclerosis'},
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E: Amyotrophic lateral sclerosis
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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 presents to the emergency room with malaise, nausea, and vomiting. Four hours prior to presentation, he was spraying insecticide at his farm when he started feeling nauseous. He has had multiple episodes of diarrhea and has vomited non-bloody, non-bilious fluid twice. He also complains of muscle cramps and tremors. His past medical history is notable for hypertension, diabetes, hyperlipidemia, and a prior myocardial infarction. He takes aspirin, metoprolol, metformin, lisinopril, and atorvastatin. He has a 40-pack-year smoking history and drinks 3-4 shots of whiskey per day. His temperature is 98.6°F (37°C), blood pressure is 148/88 mmHg, pulse is 96/min, and respirations are 22/min. He is alert and oriented to person and place but not to time. He is diaphoretic and tremulous. His pupils are 2 mm bilaterally. The patient's clothing is removed, and he is placed in a medical gown. Which of the following is the most appropriate initial treatment for this patient?? {'A': 'Activated charcoal', 'B': 'Naloxone', 'C': 'Physostigmine', 'D': 'Pralidoxime', 'E': 'Sodium bicarbonate'},
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D: Pralidoxime
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Answer the following medical question with one of the provided options:
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Q:A 48-year-old man presents to his primary care physician with a complaint of lower back pain that has developed over the past week. He works in construction but cannot recall a specific injury or incident that could have led to this pain. He denies any pain, weakness, or change/loss of sensation in his legs. The patient also reports no episodes of incontinence and confirms that he has not noted any changes in his bowel movements or urination. His temperature is 97.6°F (36.4°C), blood pressure is 133/82 mmHg, pulse is 82/min, respirations are 15/min, and oxygen saturation is 98% on room air. Physical examination reveals no focal spine tenderness and demonstrates 5/5 strength and intact sensation to light touch throughout the lower extremities. Which of the following is the most appropriate next step in management?? {'A': 'CRP level', 'B': 'CT spine', 'C': 'Ibuprofen and bed rest', 'D': 'MRI spine', 'E': 'Naproxen and activity as tolerated'},
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E: Naproxen and activity as tolerated
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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 with vomiting and one day of lethargy after a one week history of flu-like symptoms and low-grade fevers. The vomiting is nonbilious and nonbloody. The patient has had no other symptoms aside from mild rhinorrhea and cough. He has no past medical history, and is on no medications except for over-the-counter medications for his fever. His temperature is 98.5°F (36.9°C), pulse is 96/min, respirations are 14/min, and blood pressure is 108/80 mmHg. The patient appears lethargic and is oriented only to person. Otherwise, the physical exam is benign and the patient has no other neurologic symptoms. What is the mechanism of the most likely cause of this patient’s presentation?? {'A': 'Bacterial infection', 'B': 'Deficient erythrocyte enzyme', 'C': 'Chemical ingestion', 'D': 'Reversible enzyme inhibition', 'E': 'Irreversible enzyme inhibition'},
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E: Irreversible enzyme inhibition
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Q:A 22-year-old woman comes to the office with complaints of dark urine and low-grade fever for 3 months. She also expresses her concerns about feeling fatigued most of the time. She says that she thought her dark urine was from dehydration and started to drink more water, but it showed minimal improvement. She reports a recent decrease in her appetite, and also states that her bowel movements are pale appearing. She denies smoking and alcohol consumption. The vital signs include: heart rate 99/min, respiratory rate 18/min, temperature 38.5°C (101.3°F) and blood pressure 100/60 mm Hg. On physical examination, telangiectasias on the anterior thorax are noted. The liver is palpable 4 cm below the costal border in the right midclavicular line and is tender on palpation. The spleen is palpable 2 cm below the costal border. Liver function results show: Aspartate aminotransferase (AST) 780 U/L Alanine Aminotransferase (ALT) 50 U/L Total bilirubin 10 mg/dL Direct bilirubin 6 mg/dL Alkaline phosphatase (ALP) 150 U/L Serum albumin 2.5 g/dL Serum globulins 6.5 g/dL Prothrombin time 14 s Agglutinations negative Serology for hepatitis C and D negative Anti-smooth muscle antibodies positive What is the most likely cause?? {'A': 'Primary biliary cholangitis', 'B': 'Secondary biliary cirrhosis', 'C': 'Autoimmune hepatitis', 'D': 'Primary sclerosing cholangitis', 'E': 'Alpha-1 antitrypsin deficiency'},
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C: Autoimmune hepatitis
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Q:A 7-month-old boy presents with fever, chills, cough, runny nose, and watery eyes. His elder brother is having similar symptoms. Past medical history is unremarkable. The patient is diagnosed with an influenza virus infection. Assuming that this is the child’s first exposure to the influenza virus, which of the following immune mechanisms will most likely function to combat this infection?? {'A': 'Natural killer cell-induced lysis of virus infected cells', 'B': 'Presentation of viral peptides on MHC- class I of CD4+ T cells', 'C': 'Binding of virus-specific immunoglobulins to free virus', 'D': 'Complement-mediated lysis of virus infected cells', 'E': 'Eosinophil-mediated lysis of virus infected cells'},
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A: Natural killer cell-induced lysis of virus infected cells
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Q:A 58-year-old man presents to the emergency department with worsening shortness of breath, cough, and fatigue. He reports that his shortness of breath was worst at night, requiring him to sit on a chair in order to get some sleep. Medical history is significant for hypertension, hypercholesterolemia, and coronary heart disease. His temperature is 98.8°F (37.1°C), blood pressure is 146/94 mmHg, pulse is 102/min, respirations are 20/min with an oxygen saturation of 89%. On physical examination, the patient's breathing is labored. Pulmonary auscultation reveals crackles and wheezes, and cardiac auscultation reveals an S3 heart sound. After appropriate imaging and labs, the patient receives a non-rebreather facemask, and two intravenous catheters. Drug therapy is initiated. Which of the following is the site of action of the prescribed drug used to relieve this patient's symptoms?? {'A': 'Proximal tubule', 'B': 'Descending loop of Henle', 'C': 'Ascending loop of Henle', 'D': 'Distal tubule', 'E': 'Collecting tubule'},
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C: Ascending loop of Henle
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Q:A 30-year-old woman, gravida 2, para 1, at 28 weeks' gestation comes to the physician for a prenatal visit. She feels well. Pregnancy and delivery of her first child were uncomplicated. She has a history of bipolar disorder and hypothyroidism. She uses cocaine once a month and has a history of drinking alcohol excessively, but has not consumed alcohol for the past 5 years. Medications include quetiapine, levothyroxine, folic acid, and a multivitamin. Her temperature is 37.1°C (98.8°F), pulse is 88/min, and blood pressure is 115/75 mm Hg. Pelvic examination shows a uterus consistent in size with a 28-week gestation. Serum studies show a hemoglobin concentration of 11.2 g/dL and thyroid-stimulating hormone level of 3.5 μU/mL. Her fetus is at greatest risk of developing which of the following complications?? {'A': 'Aplasia cutis congenita', 'B': 'Cretinism', 'C': 'Neural tube defect', 'D': 'Premature placental separation', 'E': 'Shoulder dystocia'},
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D: Premature placental separation
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Answer the following medical question with one of the provided options:
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Q:A 31-year-old woman presents to her gynecologist for cervical cancer screening. She has no complaints and is sexually active. There is no history of cervical cancer or other malignancy in her family. A complete physical examination, including an examination of the genitourinary system, is normal. A sampling of the cervix is performed at the transformation zone and is sent for a Papanicolaou (Pap) smear examination and high-risk human papillomavirus (HPV) DNA testing. After examination of the smear, the cytopathologist informs the gynecologist that it is negative for high-grade squamous intraepithelial lesions, but that atypical squamous cells are present in the sample and it is difficult to distinguish between reactive changes and low-grade squamous intraepithelial lesion. Atypical glandular cells are not present. The high-risk HPV DNA test is positive. Which of the following is the next best step in this patient’s management?? {'A': 'Follow-up after 1 year and repeat cytology by Pap smear and HPV testing', 'B': 'Follow-up after 3 years and repeat cytology by Pap smear', 'C': 'Colposcopy', 'D': 'Endometrial biopsy', 'E': 'Loop electrosurgical excision'},
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C: Colposcopy
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Q:A 23-year-old woman presents to her gynecologist for painful menses. Her menses are regular, occurring every 28 days and lasting approximately 4 days. Menarche was at age 12. Over the past 6 months, she has started to develop aching pelvic pain during the first 2 days of her menstrual period. Ibuprofen provides moderate relief of her symptoms. She denies nausea, vomiting, dyschezia, dyspareunia, irregular menses, or menses that are heavier than usual. Her past medical history is notable for chlamydia 4 years ago that was treated appropriately. She currently takes no medications. She works as a copywriter and does not smoke or drink. She has been in a monogamous relationship with her boyfriend for the past 3 years. They use condoms intermittently. Her temperature is 98.6°F (37°C), blood pressure is 111/69 mmHg, pulse is 92/min, and respirations are 18/min. Pelvic examination demonstrates a normal appearing vagina with no adnexal or cervical motion tenderness. The uterus is flexible and anteverted. Which of the following is the underlying cause of this patient's pain?? {'A': 'Endometrial gland invasion into the uterine myometrium', 'B': 'Extra-uterine endometrial gland formation', 'C': 'Intrauterine adhesions', 'D': 'Prostaglandin-induced myometrial contraction', 'E': 'Submucosal myometrial proliferation'},
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D: Prostaglandin-induced myometrial contraction
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Q:A 60-year-old woman comes to the physician because of intermittent abdominal pain for the past month. The patient reports that the pain is located in the right upper abdomen and that it does not change with food intake. She has had no nausea, vomiting, or change in weight. She has a history of hypertension and hyperlipidemia. She does not smoke. She drinks 1–2 glasses of wine per day. Current medications include captopril and atorvastatin. Physical examination shows a small, firm mass in the right upper quadrant. Laboratory studies are within the reference range. A CT scan of the abdomen is shown. This patient's condition puts her at increased risk of developing which of the following?? {'A': 'Bowel obstruction', 'B': 'Gallbladder adenocarcinoma', 'C': 'Pancreatic adenocarcinoma', 'D': 'Hepatocellular carcinoma', 'E': 'Acute pancreatitis'},
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B: Gallbladder adenocarcinoma
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Q:A 23-year-old woman goes to a walk-in clinic while on the fourth day of her honeymoon. She is very upset saying that her honeymoon is being ruined because she is in severe pain. She states that yesterday she began to experience severe pain with urination and seems to be urinating more frequently than normal. She does admit that she has been having increased sexual intercourse with her new husband while on their honeymoon. The physician diagnoses the patient and prescribes trimethoprim-sulfamethoxazole. Which of the following virulence factors is most likely responsible for this patient's infection?? {'A': 'LPS endotoxin', 'B': 'K capsule', 'C': 'P fimbriae', 'D': 'Flagella', 'E': 'Exotoxin'},
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C: P fimbriae
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Q:A 64-year-old man comes to the physician for a follow-up examination. Four months ago, he underwent a renal transplantation for end-stage renal disease. Current medications include sirolimus, tacrolimus, and prednisolone. Physical examination shows no abnormalities. Serum studies show a creatinine concentration of 2.7 mg/dL. A kidney allograft biopsy specimen shows tubular vacuolization without parenchymal changes. Which of the following is the most likely cause of this patient's renal injury?? {'A': 'Tacrolimus toxicity', 'B': 'Preformed antibody-mediated rejection', 'C': 'T cell-mediated rejection', 'D': 'Prednisolone toxicity', 'E': 'Sirolimus toxicity'},
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A: Tacrolimus toxicity
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Q:A 59-year-old man presents to the emergency department with a sudden onset of severe pain (10/10 in severity) between the shoulder blades. He describes the pain as tearing in nature. Medical history is positive for essential hypertension for 11 years. The patient has smoked 10–15 cigarettes daily for the past 30 years. His temperature is 36.6°C (97.8°F), the heart rate is 107/min, and the blood pressure is 179/86 mm Hg in the right arm and 157/72 mm Hg in the left arm. CT scan of the chest shows an intimal flap limited to the descending thoracic aorta. Which of the following best describes the most likely predisposing factor for this condition?? {'A': 'Abnormal elastic properties of the aorta', 'B': 'Coronary atherosclerosis', 'C': 'Aortic coarctation', 'D': 'Aortic atherosclerosis', 'E': 'Hypertensive urgency'},
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D: Aortic atherosclerosis
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Q:A 44-year-old male presents to the emergency department complaining of a headache. He reports that he developed a severe throbbing headache with blurred vision two hours ago. He has never experienced symptoms like these before. His past medical history is notable for hyperlipidemia and poorly controlled hypertension. He currently takes atorvastatin and lisinopril. His temperature is 98.6°F (37°C), blood pressure is 210/110 mmHg, pulse is 90/min, and respirations are 20/min. He is oriented to person, place, and time. No bruits or murmurs are noted. Strength is 2+ bilaterally in the upper and lower extremities. What is the next best step in the management of this patient?? {'A': 'Administer oral hydralazine', 'B': 'Administer IV labetalol', 'C': 'Funduscopic exam', 'D': 'Renal ultrasound', 'E': 'Head CT'},
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B: Administer IV labetalol
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Answer the following medical question with one of the provided options:
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Q:A 44-year-old woman comes to the emergency department because of a 10-hour history of severe nausea and abdominal pain that began 30 minutes after eating dinner. The pain primarily is in her right upper quadrant and occasionally radiates to her back. She has a history of type 2 diabetes mellitus and hypercholesterolemia. Current medications include metformin and atorvastatin. She is 163 cm (5 ft 4 in) tall and weighs 91 kg (200 lb); BMI is 34 kg/m2. Her temperature is 38.8°C (101.8°F), pulse is 100/min, respirations are 14/min, and blood pressure is 150/76 mm Hg. Abdominal examination shows right upper quadrant tenderness with guarding. A bedside ultrasound shows a gall bladder wall measuring 6 mm, pericholecystic fluid, sloughing of the intraluminal membrane, and a 2 x 2-cm stone at the neck of the gallbladder. The common bile duct appears unremarkable. Laboratory studies show leukocytosis and normal liver function tests. Intravenous fluids are started, and she is given ketorolac for pain control. Which of the following is the most appropriate next step in management?? {'A': 'CT scan of the abdomen with contrast', 'B': 'Endoscopic retrograde cholangiopancreatography', 'C': 'Antibiotic therapy', 'D': 'Emergent open cholecystectomy', 'E': 'Elective laparoscopic cholecystectomy in 6 weeks'},
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C: Antibiotic therapy
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Q:A 21-year-old man presents to his physician with a cough that has persisted for 4 weeks. His cough is usually nocturnal and awakens him from sleep. He denies having a fever, but was diagnosed with asthma when he was 15 years old and uses inhaled albuterol for relief of his symptoms. He usually needs to use a rescue inhaler once or twice a month. However, over the last 4 weeks, he has had to use inhaled albuterol almost daily. He does not have symptoms such as sneezing, running nose, nasal congestion, nasal discharge, headache, nausea, vomiting, regurgitation of food, or burning in the epigastrium. On physical examination, his temperature is 36.8°C (98.4°F), pulse rate is 96/min, blood pressure is 116/80 mm Hg, and respiratory rate is 16/min. On auscultation of the chest, end-expiratory wheezing is present bilaterally. The peak expiratory flow rate (PEFR) is 74% of that expected for his age, sex, and height. Which of the following is the best next step in the treatment of this patient?? {'A': 'Use inhaled albuterol 4 times daily and follow up after 4 weeks.', 'B': 'Add daily inhaled formoterol to the current regimen.', 'C': 'Add daily inhaled ipratropium bromide to the current regimen.', 'D': 'Add daily inhaled corticosteroids to the current regimen.', 'E': 'Add daily oral levocetirizine to the current regimen.'},
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D: Add daily inhaled corticosteroids to the current regimen.
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Q:A 22-year-old man presents with multiple, target-like skin lesions on his right and left upper and lower limbs. He says that the lesions appeared 4 days ago and that, over the last 24 hours, they have extended to his torso. Past medical history is significant for pruritus and pain on the left border of his lower lip 1 week ago, followed by the development of an oral ulcerative lesion. On physical examination, multiple round erythematous papules with a central blister, a pale ring of edema surrounding a dark red inflammatory zone, and an erythematous halo are noted. Mucosal surfaces are free of any ulcerative and exudative lesions. Which of the following statements best explains the pathogenesis underlying this patient’s condition?? {'A': 'Tumor necrosis factor (TNF) alpha production by CD4+ T cells in the skin', 'B': 'Circulating anti-desmoglein antibodies', 'C': 'Circulating anti-double-stranded DNA antibodies', 'D': 'IgA deposition in the papillary dermis', 'E': 'Interferon (IFN) gamma production by CD4+ T cells in the skin'},
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E: Interferon (IFN) gamma production by CD4+ T cells in the skin
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Answer the following medical question with one of the provided options:
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Q:A 72-year-old man presents to his primary care physician with the symptom of generalized malaise over the last month. He also has abdominal pain that has been persistent and not relieved by ibuprofen. He has unintentionaly lost 22 pounds recently. During this time, the patient has experienced intermittent diarrhea when he eats large meals. The patient has a past medical history of alcohol use, obesity, diabetes mellitus, hypertension, IV drug use, and asthma. His current medications include disulfiram, metformin, insulin, atorvastatin, lisinopril, albuterol, and an inhaled corticosteroid. The patient attends weekly Alcoholics Anonymous meetings and was recently given his two week chip for not drinking. His temperature is 99.5°F (37.5°C), blood pressure is 100/57 mmHg, pulse is 88/min, respirations are 11/min, and oxygen saturation is 98% on room air. The patient’s abdomen is tender to palpation, and the liver edge is palpable 2 cm inferior to the rib cage. Neurologic exam demonstrates gait that is not steady. Which of the following is the best initial diagnostic test for this patient?? {'A': 'CT scan of the abdomen', 'B': 'Ultrasound of the abdomen', 'C': 'Liver function tests including bilirubin levels', 'D': 'Stool guaiac test and culture', 'E': 'Sudan black stain of the stool'},
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A: CT scan of the abdomen
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Q:A 49-year-old man comes to the physician because of a 6-hour history of fever, an itchy rash, and generalized body aches. Ten days ago, he received treatment in the emergency department for a snake bite. His temperature is 38.5°C (101.3°F), pulse is 80/min, and blood pressure is 120/84 mm Hg. Physical examination shows multiple well-demarcated, raised, erythematous plaques over the trunk. There is tenderness to palpation and decreased range of motion of the metacarpophalangeal and wrist joints bilaterally. Urine dipstick shows 2+ protein. Further evaluation is most likely to show which of the following?? {'A': 'Keratinocyte necrosis on skin biopsy', 'B': 'Increased antistreptolysin O titers', 'C': 'Positive ELISA for anti-hemidesmosome antibodies', 'D': 'Increased serum tryptase concentration', 'E': 'Decreased serum complement concentration'},
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E: Decreased serum complement concentration
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Answer the following medical question with one of the provided options:
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Q:A 64-year-old man who is post-op day 4 following a radical nephrectomy is noted to have a temperature of 103.4F, pulse of 115, blood pressure of 86/44, and respiratory rate of 26. Arterial blood gas shows a pH of 7.29 and pCO2 of 28. Chemistry panel shows: Na+ 136, Cl- 100, HCO3- 14. CBC is significant for a significant leukocytosis with bandemia. The laboratory reports that blood cultures are growing gram positive cocci. Which of the following is true about this patient's biochemical state?? {'A': 'Increased activity of alcohol dehydrogenase', 'B': 'Decreased activity of pyruvate dehydrogenase', 'C': 'Decreased activity of lactate dehydrogenase', 'D': 'Increased activity of isocitrate dehydrogenase', 'E': 'Increased flux through the electron transport chain'},
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B: Decreased activity of pyruvate dehydrogenase
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Q:An 89-year-old woman is admitted to the neurology intensive care unit following a massive cerebral infarction. She has a history of hypertension, ovarian cancer, and lung cancer. Her medications include lisinopril and aspirin. She has smoked a few cigarettes each day for the last 60 years. She does not drink alcohol or use drugs. An arterial line and intraventricular pressure monitor are placed. You decide to acutely lower intracranial pressure by causing cerebral vasoconstriction. Which of the following methods could be used for this effect?? {'A': 'Mannitol infusion', 'B': 'Glucocorticoids', 'C': 'Mechanical hyperventilation', 'D': 'Mechanical hypoventilation', 'E': 'Elevating head position'},
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C: Mechanical hyperventilation
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Q:A 54-year-old male with a history of hypertension, coronary artery disease status post 3-vessel coronary artery bypass surgery 5 years prior, stage III chronic kidney disease and a long history of uncontrolled diabetes presents to your office. His diabetes is complicated by diabetic retinopathy, gastroparesis with associated nausea, and polyneuropathy. He returns to your clinic for a medication refill. He was last seen in your clinic 1 year ago and was living in Thailand since then and has recently moved back to the United States. He has been taking lisinopril, amlodipine, simvastatin, aspirin, metformin, glyburide, gabapentin, metoclopramide and multivitamins during his time abroad. You notice that he is constantly smacking his lips and moving his tongue in and out of his mouth in slow movements. His physical exam is notable for numbness and decreased proprioception of feet bilaterally. Which of the following medications most likely is causing his abnormal movements?? {'A': 'Aspirin', 'B': 'Amlodipine', 'C': 'Gabapentin', 'D': 'Glyburide', 'E': 'Metoclopramide'},
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E: Metoclopramide
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Answer the following medical question with one of the provided options:
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Q:A 52-year-old man presents to his primary care physician for an annual check-up. He says that he has no significant developments over the last year and that he has been feeling well in general. On presentation, his temperature is 98.6°F (37°C), blood pressure is 140/95 mmHg, pulse is 85/min, and respirations are 12/min. This is the third time that he has had elevated blood pressure so his physician suggests that he start taking a medication for hypertension. The patient is a biologist so he researches this medication after returning home. He finds that the medication can either decrease or increase the level of cyclic adenosine monophosphate depending on whether there is endogenous substrate around. Which of the following medications is mostly likely being described here?? {'A': 'Atenolol', 'B': 'Carvedilol', 'C': 'Esmolol', 'D': 'Pindolol', 'E': 'Propranolol'},
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D: Pindolol
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Answer the following medical question with one of the provided options:
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Q:A 32-year-old female presents to her primary care provider with pelvic pain. She reports that for the last several years, she has had chronic pain that is worst just before her menstrual period. Over the past two months, she has also had worsening pain during intercourse. She denies dysuria, vaginal discharge, or vaginal pruritus. The patient has never been pregnant and previously used a copper intrauterine device (IUD) for contraception, but she had the IUD removed a year ago because it worsened her menorrhagia. She has now been using combined oral contraceptive pills (OCPs) for nearly a year. The patient reports improvement in her menorrhagia on the OCPs but denies any improvement in her pain. Her past medical history is otherwise unremarkable. Her temperature is 98.0°F (36.7°C), blood pressure is 124/73 mmHg, pulse is 68/min, and respirations are 12/min. The patient has tenderness to palpation during vaginal exam with lateral displacement of the cervix. A pelvic ultrasound shows no abnormalities, and a urine pregnancy test is negative. Which of the following is the best next step in management to confirm the diagnosis?? {'A': 'Abdominal ultrasound', 'B': 'Pelvic MRI', 'C': 'Hysterosalpingogram', 'D': 'Hysteroscopy', 'E': 'Laparoscopy'},
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E: Laparoscopy
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Answer the following medical question with one of the provided options:
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Q:The study is performed to examine the association between type 2 diabetes mellitus (DM2) and Alzheimer's disease (AD). Group of 250 subjects diagnosed with DM2 and a matched group of 250 subjects without DM2 are enrolled. Each subject is monitored regularly over their lifetime for the development of symptoms of dementia or mild cognitive impairment. If symptoms are present, an autopsy is performed after the patient's death to confirm the diagnosis of AD. Which of the following is most correct regarding this study?? {'A': 'It is a retrospective observational study.', 'B': 'It can provide proof of causation between DM2 and AD.', 'C': 'Relative risk cannot be determined from this study.', 'D': 'It is a prospective observational study.', 'E': 'It is a case-control study.'},
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D: It is a prospective observational study.
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Answer the following medical question with one of the provided options:
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Q:A 72-year-old man presents to the emergency department with chest pain and shortness of breath. An EKG demonstrates an ST elevation myocardial infarction, and he is managed appropriately. The patient suffers from multiple comorbidities and was recently hospitalized for a myocardial infarction. The patient has a documented living will, which specifies that he does wish to receive resuscitative measures and blood products but refuses intubation in any circumstance. The patient is stabilized and transferred to the medical floor. On day 2, the patient presents with ventricular fibrillation and a resuscitative effort occurs. He is successfully resuscitated, but his pulmonary parameters warrant intervention and are acutely worsening. The patient's wife, son, and daughter are present and state that the patient should be intubated. The patient's prognosis even with intubation is very poor. Which of the following describes the best course of action?? {'A': 'Consult the hospital ethics committee', 'B': 'Do not intubate the patient as his prognosis is poor even with intubation', 'C': 'Do not intubate the patient given his living will', 'D': "Intubate the patient - a patient's next of kin take precedence over a living will", 'E': "Intubate the patient - the family is representing the patient's most recent and accurate wishes"},
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C: Do not intubate the patient given his living will
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Answer the following medical question with one of the provided options:
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Q:A 52-year-old woman presents to the clinic complaining of dry mouth for the past 2 months. The patient states that she drinks a lot of water but that her mouth is always dry. She says that she recently went to the dentist and had 3 cavities, which is more than she has ever had in her adult life. She has a history of type 2 diabetes and rheumatoid arthritis. Her vital signs are within normal limits. Her physical exam is unremarkable except that her sclera are dry and erythematous and she has a deformity in the joints of her hands, bilaterally. What is the etiology of this patient’s symptoms?? {'A': 'Uncontrolled blood glucose levels', 'B': 'Obstruction of salivary ducts', 'C': 'Autoimmune destruction of exocrine glands', 'D': 'Poor hygiene due to inability to care for self', 'E': 'Deposition of collagen in the salivary glands'},
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C: Autoimmune destruction of exocrine glands
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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 is voted off the board of her garden club for tardiness and incomplete work on the spring fair. When she arrives home, her husband attempts to console her and she yells at him for constantly criticizing her. Which defense mechanism is the woman using?? {'A': 'Intellectualization', 'B': 'Projection', 'C': 'Displacement', 'D': 'Reaction formation', 'E': 'Isolation of affect'},
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C: Displacement
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Q:A 13-year-old girl presents to her primary care physician due to concerns of not having her first menstrual period. She reports a mild headache but otherwise has no concerns. She does not take any medications. She states that she is sexually active and uses condoms inconsistently. Medical history is unremarkable. Menarche in the mother and sister began at age 11. The patient is 62 inches tall and weighs 110 pounds. Her temperature is 99°F (37.2 °C), blood pressure is 105/70, pulse is 71/min, and respirations are 14/min. On physical exam, she is Tanner stage 1 with a present uterus and normal vagina on pelvic exam. Urine human chorionic gonadotropin (hCG) is negative. Follicle-stimulating hormone (FSH) serum level is 0.5 mIU/mL (normal is 4-25 mIU/mL) and luteinizing hormone (LH) serum level is 1 mIU/mL (normal is 5-20 mIU/mL). Which of the following is the best next step in management?? {'A': 'Ask the patient to return to clinic in 6 months to see if she undergoes menarche', 'B': 'Begin estrogen replacement therapy', 'C': 'Obtain an HIV test', 'D': 'Obtain an MRI of the pituitary', 'E': 'Order a karyotype'},
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D: Obtain an MRI of the pituitary
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Answer the following medical question with one of the provided options:
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Q:A 66-year-old woman comes to the physician because of a 1-week history of pruritic blister formation. Physical examination shows multiple 1–3 cm bullae on the palms, soles, lower legs, and inguinal folds. Gentle rubbing of the skin does not result in sloughing of the epidermis. Immunofluorescence studies of a perilesional skin biopsy specimen are most likely to show deposition of antibodies in which of the following areas?? {'A': 'At the dermoepidermal junction', 'B': 'Between epidermal keratinocytes', 'C': 'No staining', 'D': 'In dermal papillae', 'E': 'In dermal vessel walls'},
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A: At the dermoepidermal junction
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Answer the following medical question with one of the provided options:
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Q:A 25-year-old woman presents to a medical clinic with complaints of right-sided chest pain, which is exacerbated during inspiration. She also reports intermittent fevers for the past 3 months associated with pain in both knee joints. She gives a history of an unintended 3 kg (6 lbs) weight loss in the past 2 months. The blood pressure is 110/84 mm Hg and the pulse is 86/min. On physical examination, a red rash is noted on her face overlying the nose and cheeks. The laboratory findings show that the hemoglobin is 9 g/dL and the total white cell count is 1500/mm3. Which of the following tests would be most specific to help diagnose this patient’s condition?? {'A': 'Antibody to histone protein', 'B': 'Antibody to microsomal cellular organelles', 'C': 'Antibody to double-stranded deoxyribonucleic acid', 'D': 'Antibody to phospholipid of cell membranes', 'E': 'Antibody to ribonucleoprotein'},
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C: Antibody to double-stranded deoxyribonucleic acid
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Answer the following medical question with one of the provided options:
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Q:An investigator is studying the regulation of adrenal hormone synthesis in rats. The investigator takes serum concentrations of different hormones before and after intravenous administration of metyrapone, which inhibits adrenal 11β-hydroxylase. The serum concentration of which of the following hormones is most likely to be decreased after administration of this agent?? {'A': 'Adrenocorticotropic hormone', 'B': 'Normetanephrine', 'C': 'Epinephrine', 'D': 'Dopamine', 'E': 'Dihydroxyphenylalanine\n"'},
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C: Epinephrine
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Answer the following medical question with one of the provided options:
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Q:Researchers are investigating a new mouse model of glycogen regulation. They add hepatocyte enzyme extracts to radiolabeled glucose to investigate glycogen synthesis, in particular two enzymes. They notice that the first enzyme adds a radiolabeled glucose to the end of a long strand of radiolabeled glucose. The second enzyme then appears to rearrange the glycogen structure such that there appears to be shorter strands that are linked. Which of the following pairs of enzymes in humans is most similar to the enzymes being investigated by the scientists?? {'A': 'Debranching enzyme and branching enzyme', 'B': 'Branching enzyme and debranching enzyme', 'C': 'Glycogen synthase and branching enzyme', 'D': 'Glycogen synthase and debranching enzyme', 'E': 'Glycogen phosphorylase and glycogen synthase'},
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C: Glycogen synthase and branching enzyme
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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 comes to the physician because of intense anal pain that began 2 hours ago. He has a history of chronic constipation and rectal itching. His past medical history is otherwise unremarkable. He takes no medications. His vital signs are within normal limits. Because of extreme pain, a rectal examination is performed in the office under local anesthesia and shows a palpable perianal mass. No skin tag or mucosal prolapse through the anal canal is noted. Which of the following is the most appropriate immediate management?? {'A': 'Elliptical excision', 'B': 'Incision and drainage', 'C': 'Infrared photocoagulation', 'D': 'Rubber band ligation', 'E': 'Sclerotherapy'},
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A: Elliptical excision
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Q:A 60-year-old African-American male with no active medical problems presents to his primary care physician for a general check up. His blood pressure on the previous visit was 145/90, and his blood pressure at this visit is found to be 150/95. He is prescribed hydrochlorothiazide, a thiazide diuretic, to treat his hypertension. The serum level of which of the following is likely to decrease in response to his treatment?? {'A': 'Cholesterol', 'B': 'Potassium', 'C': 'Glucose', 'D': 'Uric acid', 'E': 'Calcium'},
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B: Potassium
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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 with schizophrenia comes to the office for a follow-up appointment. She has been hospitalized 4 times in the past year, and she has failed to respond to multiple trials of antipsychotic medications. Six weeks ago, she was brought to the emergency department by her husband because of a bizarre behavior, paranoid delusions, and hearing voices that others did not hear. She was started on a new medication, and her symptoms have improved. Laboratory studies show: Hemoglobin 13.8 g/dL Leukocyte count 1,200/mm3 Segmented neutrophils 6% Eosinophils 0% Lymphocytes 92% Monocytes 2% Platelet count 245,000/mm3 This patient was most likely started on which of the following medications?"? {'A': 'Fluphenazine', 'B': 'Quetiapine', 'C': 'Promethazine', 'D': 'Lithium', 'E': 'Clozapine'},
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E: Clozapine
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Answer the following medical question with one of the provided options:
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Q:A 27-year-old male presents to his primary care physician with lower back pain. He notes that the pain started over a year ago but has become significantly worse over the past few months. The pain is most severe in the mornings. His past medical history is unremarkable except for a recent episode of right eye pain and blurry vision. Radiographs of the spine and pelvis show bilateral sacroiliitis. Which of the following is the most appropriate treatment for this patient?? {'A': 'Indomethacin', 'B': 'Methotrexate', 'C': 'Cyclophosphamide', 'D': 'Oral prednisone', 'E': 'Bed rest'},
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A: Indomethacin
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Answer the following medical question with one of the provided options:
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Q:A 25-year-old woman presents to an urgent care center following a presumed bee sting while at a picnic with her friends. She immediately developed a skin rash and swelling over her arms and face. She endorses diffuse itching over her torso. She denies any episodes similar to this and has no significant medical history. She does note that her father has an allergy to peanuts. Her blood pressure is 92/54 mm Hg, heart rate, 118/min, respiratory rate 18/min. On physical examination, the patient has severe edema over her face and inspiratory stridor. Of the following options, this patient is likely experiencing which of the following hypersensitivity reactions?? {'A': 'Type 1 hypersensitivity reaction', 'B': 'Type 2 hypersensitivity reaction', 'C': 'Type 3 hypersensitivity reaction', 'D': 'Type 4 hypersensitivity reaction', 'E': 'Mixed type 1 and type 3 hypersensitivity reactions'},
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A: Type 1 hypersensitivity reaction
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Answer the following medical question with one of the provided options:
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Q:A 25-year-old man is brought to the emergency department by his fiancée for altered mental status. She states that they got in a fight that morning. She later got a text from him at work that said he was going to kill himself. She rushed back home and found him unconscious on the living room floor surrounded by his prescription pill bottles. The patient is sedated but conscious and states that he thinks he swallowed “a bunch of pills” about 2 hours ago. He also complains of nausea. The patient’s medical history is significant for bipolar disorder and chronic back pain from a motor vehicle accident. He takes lithium and oxycodone. The patient’s temperature is 99°F (37.2°C), blood pressure is 130/78 mmHg, pulse is 102/min, and respirations are 17/min with an oxygen saturation of 97% on room air. On physical exam, the patient is drowsy, and his speech is slurred, but he is fully oriented. He has horizontal nystagmus, is diffusely hyperreflexic, and has a mild tremor. His initial electrocardiogram shows sinus tachycardia. Labs are obtained, as shown below: Serum: Na: 143 mEq/L K+: 4.3 mEq/L Cl-: 104 mEq/L HCO3-: 24 mEq/L BUN: 18 mg/dL Creatinine: 1.5 mg/dL Glucose: 75 mg/dL Lithium level: 6.8 mEq/L (normal 0.6 mEq/L – 1.2 mEq/L) An intravenous bolus of 1 liter normal saline is given. Which of the following is the next step in management?? {'A': 'Activated charcoal', 'B': 'Gastric lavage', 'C': 'Hemodialysis', 'D': 'Naloxone', 'E': 'Sodium bicarbonate'},
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C: Hemodialysis
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Answer the following medical question with one of the provided options:
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Q:A 42-year-old woman comes to the physician because of increasing pain in the right hip for 2 months. The pain is intermittent, presenting at the lateral side of the hip and radiating towards the thigh. It is aggravated while climbing stairs or lying on the right side. Two weeks ago, the patient was treated with a course of oral prednisone for exacerbation of asthma. Her current medications include formoterol-budesonide and albuterol inhalers. Vital signs are within normal limits. Examination shows tenderness to palpation over the upper lateral part of the right thigh. There is no swelling. The patient is placed in the left lateral decubitus position. Abducting the extended right leg against the physician's resistance reproduces the pain. The remainder of the examination shows no abnormalities. An x-ray of the pelvis shows no abnormalities. Which of the following is the most likely diagnosis?? {'A': 'Greater trochanteric pain syndrome', 'B': 'Iliotibial band syndrome', 'C': 'Osteoarthritis of the hip', 'D': 'Lumbosacral radiculopathy', 'E': 'Osteonecrosis of femoral head'},
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A: Greater trochanteric pain syndrome
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Q:A 7-year-old girl is brought to the physician by her mother because she has been increasingly reluctant to speak at school over the past 4 months. Her teachers complain that she does not answer their questions and it is affecting her academic performance. She was born at 35 weeks' gestation and pregnancy was complicated by preeclampsia. Previous well-child examinations have been normal. Her older brother was diagnosed with a learning disability 4 years ago. She is at 65th percentile for height and weight. Physical examination shows no abnormalities. She follows commands. She avoids answering questions directly and whispers her answers to her mother instead who then mediates between the doctor and her daughter. Which of the following is the most likely diagnosis?? {'A': 'Reactive attachment disorder', 'B': 'Autism spectrum disorder', 'C': 'Social anxiety disorder', 'D': 'Selective mutism', 'E': 'Rett syndrome'},
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D: Selective mutism
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Answer the following medical question with one of the provided options:
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Q:Two days after emergency treatment for acute decompensated heart failure in the coronary care unit (CCU), a 68-year-old man develops palpitations. He has a history of ischemic heart disease and congestive heart failure for the last 10 years. His current medications include intravenous furosemide and oral medications as follows: carvedilol, aspirin, lisinopril, nitroglycerin, and morphine. He has received no intravenous fluids. The vital signs include: blood pressure 90/70 mm Hg, pulse 98/min, respiratory rate 18/min, and temperature 36.8°C (98.2°F). On physical examination, he appears anxious. The lungs are clear to auscultation. Cardiac examination reveals no change compared to the initial exam, and his peripheral edema has become less significant. There is no edema in the back or sacral area. Urine output is 1.5 L/12h. Serial electrocardiogram (ECG) reveals no dynamic changes. The laboratory test results are as follows: Laboratory test Serum Urea nitrogen 46 mg/dL Creatinine 1.9 mg/dL Na+ 135 mEq/L K+ 3.1 mEq/L Arterial blood gas analysis on room air: pH 7.50 PCO2 44 mm Hg PO2 88 mm Hg HCO3− 30 mEq/L Which of the following is the most likely explanation for this patient’s current condition?? {'A': 'Exacerbation of heart failure', 'B': 'Excessive beta-adrenergic blockade', 'C': 'Hospital delirium', 'D': 'Iatrogenic dehydration', 'E': 'Oversedation'},
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D: Iatrogenic dehydration
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Q:A healthy 37-year-old gravida-3-para-1 (G-3-P-1) who underwent in vitro fertilization delivers a boy vaginally. On examination, he is found to have a ventral urethral meatus inferior to the glans. Which statement is correct?? {'A': 'Younger age of the mother is a major risk factor for this condition', 'B': 'It results from failure of the genital swellings to fuse', 'C': 'Hypospadias repair before the age of 3 years is associated with increased incidence of urethrocutaneous fistula', 'D': 'Such anatomy is formed before the 12th week of intrauterine development', 'E': 'It results from failure of the genital folds to fuse'},
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E: It results from failure of the genital folds to fuse
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Q:A 71-year-old man with type 2 diabetes mellitus comes to the physician because of a 9-month history of pain and stiffness in the right knee. He reports that the stiffness lasts approximately 10 minutes after waking up and that the pain is worse in the evening. There is no history of trauma. He is 175 cm (5 ft 9 in) tall and weighs 102 kg (225 lb); BMI is 33 kg/m2. Examination of the right knee shows tenderness in the anteromedial joint line and crepitus during knee movement. Laboratory studies show an erythrocyte sedimentation rate of 15 mm/h and a serum uric acid concentration of 6.9 mg/dL. Which of the following is the most likely finding on imaging of the right knee?? {'A': 'Osteophytes and narrowing of the joint-space', 'B': 'Marginal bony erosions and opacification of periarticular soft tissue', 'C': 'Periarticular osteopenia and pannus formation', 'D': 'Loculated epiphyseal cyst with thinning of the overlying cortex', 'E': 'Bony ankylosis and bone proliferation at the entheses'},
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A: Osteophytes and narrowing of the joint-space
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Q:A 5 year-old-boy with a history of severe allergies and recurrent sinusitis presents with foul-smelling, fatty diarrhea. He is at the 50th percentile for height and weight. The boy's mother reports that he has had several such episodes of diarrhea over the years. He does not have any known history of fungal infections or severe viral infections. Which of the following is the most likely underlying cause of this boy's presentation?? {'A': 'Thymic aplasia', 'B': 'Hyper IgE syndrome', 'C': 'Severe combined immune deficiency', 'D': 'Wiskott-Aldrich Syndrome', 'E': 'IgA deficiency'},
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E: IgA deficiency
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Answer the following medical question with one of the provided options:
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Q:A 65-year-old man is brought to the emergency department after loss of consciousness. He is accompanied by his wife. He is started on intravenous fluids, and his vital signs are assessed. His blood pressure is 85/50 mm Hg, pulse 50/min, and respiratory rate 10/min. He has been admitted in the past for a heart condition. His wife is unable to recall the name of the condition, but she does know that the doctor recommended some medications at that time in case his condition worsened. She has brought with her the test reports from previous medical visits over the last few months. She says that she has noticed that he often has difficulty breathing and requires three pillows to sleep at night to avoid being short of breath. He can only walk for a few kilometers before he has to stop and rest. His wife also reports that he has had occasional severe coughing spells with pinkish sputum production. She also mentions that he has been drinking alcohol for the past 30 years. Which of the following medications will improve the prognosis of this patient?? {'A': 'Furosemide', 'B': 'Enalapril', 'C': 'Digoxin', 'D': 'Amiodarone', 'E': 'Amlodipine'},
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B: Enalapril
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Q:A 47-year-old male with a medical history significant for hypertension, recurrent urinary tract infections, mitral valve prolapse, and diverticulosis experiences a sudden, severe headache while watching television on his couch. He calls 911 and reports to paramedics that he feels as if "someone shot me in the back of my head." He is rushed to the emergency room. On exam, he shows no focal neurological deficits but has significant nuchal rigidity and photophobia. Of the options below, what is the most likely etiology of this man's headache?? {'A': 'Migraine', 'B': 'Brain Tumor', 'C': 'Temporal Arteritis', 'D': 'Subarachnoid Hemorrhage', 'E': 'Carotid Dissection'},
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D: Subarachnoid Hemorrhage
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Answer the following medical question with one of the provided options:
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Q:A 28-year-old G0P0 woman presents to a gynecologist for evaluation of a breast mass. She has never seen a gynecologist before but says she noticed the mass herself while showering yesterday. She also reports a neck ache following a minor car accident last week in which she was a restrained driver. She otherwise feels well and has no personal or family history of major illness. Her last menstrual period was 3 weeks ago. Physical exam reveals a hard, round, nontender, 2-cm mass of the inferomedial quadrant of the left breast with trace bruising. Regional lymph nodes are not palpable. Which of the following is the next best step in management?? {'A': 'Breast ultrasound', 'B': 'Incision and drainage', 'C': 'Mammogram', 'D': 'Mastectomy', 'E': 'Reassurance'},
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A: Breast ultrasound
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Q:A 55-year-old construction worker falls off a 2-story scaffolding and injures his back. His coworkers bring him to the urgent care clinic within 30 minutes of the fall. He complains of left lower-limb weakness and loss of sensation in the right lower limb. He does not have any past medical history. His vital signs are stable. A neurologic examination reveals a total loss of motor function when testing left knee extension, along with the left-sided loss of light touch sensation from the mid-thigh and below. There is a right-sided loss of pin-prick sensation of the lateral leg and entire foot. At this time of acute injury, what other finding is most likely to be found in this patient?? {'A': 'Left-sided numbness at the level of the lesion', 'B': 'Intact voluntary anal contraction', 'C': 'Left-sided extensor plantar response', 'D': 'Right-sided loss of proprioception and vibration sensation', 'E': 'Left-sided spastic paralysis below the lesion'},
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A: Left-sided numbness at the level of the lesion
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Q:A 28-year-old woman comes to the physician because of a 4-day history of lower extremity numbness, weakness, and urinary incontinence. She has not had any trauma. Neurologic examination shows bilateral lower extremity weakness. Stroking the lateral side of the sole of the foot from the heel to the base of the small toe and medially to the base of the big toe elicits dorsiflexion of the big toe and fanning of the other toes. Further examination of this patient is most likely to show which of the following additional findings?? {'A': 'Spasticity', 'B': 'Palmar grasp reflex', 'C': 'Hyporeflexia', 'D': 'Fasciculation', 'E': 'Atrophy'},
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A: Spasticity
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Answer the following medical question with one of the provided options:
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Q:A 45-year-old woman gravida 1, para 1, comes to the physician because of a 2-month history of a right breast lump and a 4.5-kg (10-lb) weight loss. She has not had any breast pain or nipple discharge. She had right breast mastitis 10 years ago while breastfeeding but has no other history of serious illness. Palpation of the right breast shows a 3-cm firm mass with well-defined margins lateral to the right nipple . There is dimpling of the overlying skin but no rash. The left breast is normal. A mammogram shows a density with calcifications in a star-shaped formation in the same location of the mass. Histological examination of a biopsy specimen from the breast mass is most likely to show which of the following?? {'A': 'Dilated ducts lined with neoplastic cells and necrotic centers', 'B': 'Disorganized nests of glandular cells with surrounding fibrosis', 'C': 'Large, pink-staining cells in the epidermis', 'D': 'Orderly rows of monomorphic cells that do not stain with E-cadherin', 'E': 'Infiltration of ductal cells blocking the dermal lymphatics'},
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B: Disorganized nests of glandular cells with surrounding fibrosis
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Answer the following medical question with one of the provided options:
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Q:A 32-year-old woman presents to the clinic with complaints of insomnia, diarrhea, anxiety, thinning hair, and diffuse muscle weakness. She has a family history of type 1 diabetes mellitus and thyroid cancer. She drinks 1–2 glasses of wine weekly. Her vital signs are unremarkable. On examination, you notice that she also has bilateral exophthalmos. Which of the following results would you expect to see on a thyroid panel?? {'A': 'Low TSH, high T4, high T3', 'B': 'Low TSH, low T4, low T3', 'C': 'High TSH, low T4, low T3', 'D': 'High TSH, high T4, high T3', 'E': 'Low TSH, high T4, low T3'},
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A: Low TSH, high T4, high T3
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Answer the following medical question with one of the provided options:
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Q:A 20-year-old male military recruit comes to the office with complaints of a fever and a non-productive cough that started 5 days ago. He also states having pain during swallowing. He has a mild headache and pain in his left ear. He does not have any relevant past medical history. His vitals include the following: blood pressure of 120/78 mm Hg, pulse of 100/min, temperature 37.8°C (100°F), respiratory rate 14/min. Physical exam reveals a congested left tympanic membrane and rhonchi on auscultation of the right lung base. The blood test results are given below: Hemoglobin: 15 mg/dL Hematocrit: 50% Leukocyte count: 7,500/mm3 Neutrophils: 67% Bands: 5% Eosinophils: 1% Basophils: 0% Lymphocytes: 28% Monocytes: 5% Platelet count: 265,000/mm3 Low titers of cold agglutinins are detected. His chest radiograph shows poorly defined nodular opacities in the right lower lung zone. Which of the following is the most likely organism responsible for this patient’s condition?? {'A': 'Staphylococcus aureus', 'B': 'Mycoplasma pneumonia', 'C': 'Streptococcus pneumoniae', 'D': 'Haemophilus influenzae', 'E': 'Chlamydia psittaci'},
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B: Mycoplasma pneumonia
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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 is referred to the cardiology department with complaints of shortness of breath on exertion that has been progressive for the last 6 months. He has a history of diabetes mellitus type II which is controlled with diet alone. He has a temperature of 37.1℃ (98.8℉), the pulse is 76/min, and the blood pressure is 132/86 mm Hg. Physical examination is notable for a systolic murmur heard best at the right upper sternal border with radiation to the carotid arteries. ECG shows left ventricular hypertrophy and absent Q waves. Transthoracic echocardiogram shows an elevated aortic pressure gradient with severe leaflet calcification and left ventricular diastolic dysfunction. Which of the following has a survival benefit for this patient’s cardiac problem?? {'A': 'A combination of captopril and hydrochlorothiazide', 'B': 'Atorvastatin', 'C': 'Serial clinical and echocardiographic follow-up', 'D': 'Transcatheter aortic valve replacement', 'E': 'Sodium nitroprusside'},
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D: Transcatheter aortic valve replacement
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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 presents with urinary retention for the past week. He says his symptoms onset gradually almost immediately after being prescribed a new medication for his depression. He states that he has increased his fluid intake to try to help the issue, but this has been ineffective. He also mentions that he has been having problems with constipation and dry mouth. His past medical history is significant for major depressive disorder, diagnosed 6 months ago. The patient denies any history of smoking, alcohol consumption, or recreational drug use. He is afebrile, and his vital signs are within normal limits. A physical examination is unremarkable. A urinalysis is normal. Which of the following medications was this patient most likely prescribed for his depression?? {'A': 'Phenelzine', 'B': 'Mirtazapine', 'C': 'Citalopram', 'D': 'Amitriptyline', 'E': 'Venlafaxine'},
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D: Amitriptyline
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Answer the following medical question with one of the provided options:
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Q:You are trying to design a randomized controlled trial to evaluate the effectiveness of metoprolol in patients with heart failure. In preparing for the statistical analysis, you review some common types of statistical errors. Which of the following is true regarding a type 1 error in a clinical study?? {'A': 'A type 1 error means the study is not significantly powered to detect a true difference between study groups.', 'B': 'A type 1 error occurs when the null hypothesis is true but is rejected in error.', 'C': 'A type 1 error occurs when the null hypothesis is false, yet is accepted in error.', 'D': 'A type 1 error is a beta (β) error and is usually 0.1 or 0.2.', 'E': 'A type 1 error is dependent on the confidence interval of a study.'},
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B: A type 1 error occurs when the null hypothesis is true but is rejected in error.
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Answer the following medical question with one of the provided options:
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Q:A 65-year-old man is brought to the emergency department for a 1-week history of worsening shortness of breath. The symptoms occur when he climbs the stairs to his apartment on the 3rd floor and when he goes to bed. He gained 2.3 kg (5 lbs) in the past 5 days. He has a history of hypertension, hyperlipidemia, alcoholic steatosis, and osteoarthritis. He received surgical repair of a ventricular septal defect when he was 4 months old. He started taking ibuprofen for his osteoarthritis and simvastatin for his hyperlipidemia one week ago. He drinks 2–3 beers daily after work. His temperature is 37.0°C (98.6°F), his pulse is 114/min, and his blood pressure is 130/90 mmHg. Physical examination reveals jugular venous distention and 2+ pitting edema in his lower legs. On cardiac auscultation, an additional, late-diastolic heart sound is heard. Bilateral crackles are heard over the lung bases. Echocardiography shows concentric hypertrophy of the left ventricle. Which of the following is the most likely underlying cause of this patient's condition?? {'A': 'Alcoholic cardiomyopathy', 'B': 'Pericardial effusion', 'C': 'Recent use of simvastatin', 'D': 'Arterial hypertension', 'E': 'Flow reversal of ventricular shunt'},
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D: Arterial hypertension
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Answer the following medical question with one of the provided options:
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Q:An 8-day-old male infant presents to the pediatrician with a high-grade fever and poor feeding pattern with regurgitation of milk after each feeding. On examination the infant showed abnormal movements, hypertonia, and exaggerated DTRs. The mother explains that during her pregnancy, she has tried to eat only unprocessed foods and unpasterized dairy so that her baby would not be exposed to any preservatives or unhealthy chemicals. Which of the following characteristics describes the causative agent that caused this illness in the infant?? {'A': 'Gram-positive, facultative intracellular, motile bacilli', 'B': 'Gram-positive, catalase-negative, beta hemolytic, bacitracin resistant cocci', 'C': 'Gram-negative, lactose-fermenting, facultative anaerobic bacilli', 'D': 'Gram-positive, catalase-negative, alpha hemolytic, optochin sensitive cocci', 'E': 'Gram-negative, maltose fermenting diplococci'},
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A: Gram-positive, facultative intracellular, motile bacilli
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Q:A 35-year-old woman is brought to the emergency department by her husband after she lost consciousness 30 minutes ago. The patient’s husband says that she has been in a bad mood lately and getting upset over small things. He also says she has been crying a lot and staying up late at night. Her husband mentions that her mother died earlier this year, and she hasn’t been coping well with this loss. He says that he came home an hour ago and found her lying on the floor next to a bottle of pills. The patient’s husband knows that they were a bottle of her migraine pills but cannot remember the name of the medication. On examination, the patient’s blood pressure is 75/50 mm Hg, the pulse is 50/min, and the respiratory rate is 12/min. Which of the following is the best course of treatment for this patient? ? {'A': 'Insulin', 'B': 'Beta-agonist', 'C': 'Sodium bicarbonate', 'D': 'N-Acetylcysteine', 'E': 'Glucagon'},
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E: Glucagon
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Answer the following medical question with one of the provided options:
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Q:A 68-year-old man comes to the physician for evaluation of a lump in his left axilla that he first noticed 1 year ago. He reports that the size of the mass has varied over time and that there have been similar masses in his neck and groin. He has not had fever, weight loss, or night sweats. Physical examination shows a nontender, rubbery mass in the left axilla and a similar, smaller mass in the right groin. His spleen is palpable 3 cm below the left costal margin. Laboratory studies, including complete blood count, are within reference ranges. Genetic analysis obtained on resection of the axillary mass shows a t(14;18) translocation. Which of the following is the most likely diagnosis?? {'A': 'Hodgkin lymphoma', 'B': 'Follicular lymphoma', 'C': 'Diffuse large B-cell lymphoma', 'D': 'Burkitt lymphoma', 'E': 'Marginal zone lymphoma'},
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B: Follicular lymphoma
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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 comes to the physician because of a 4-week history of generalized weakness. He also reports increased urination and thirst. He has type 2 diabetes mellitus and chronic kidney disease. His only medication is metformin. Serum studies show: Na+ 134 mEq/L Cl- 110 mEq/L K+ 5.6 mEq/L HCO3- 19 mEq/L Glucose 135 mg/dL Creatinine 1.6 mg/dL Urine pH is 5.1. Which of the following is the most likely underlying cause of this patient's symptoms?"? {'A': 'Impaired HCO3- reabsorption in the proximal tubule', 'B': 'Decreased serum aldosterone levels', 'C': 'Impaired H+ secretion in the distal tubule', 'D': 'Increased serum lactate levels', 'E': 'Decreased serum cortisol levels'},
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B: Decreased serum aldosterone levels
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Answer the following medical question with one of the provided options:
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Q:A 55-year-old female presents to clinic with recurrent episodes of abdominal discomfort and pain for the past month. She reports that the pain occurs 2-3 hours after meals, usually at midnight, and rates it as moderate to severe in intensity when it occurs. She also complains of being fatigued all the time. Past medical history is insignificant. She is an office secretary and says that the job has been very stressful recently. Her temperature is 98.6°F (37.0°C), respiratory rate is 15/min, pulse is 67/min, and blood pressure is 122/98 mm Hg. Her BMI is 34. A physical examination reveals conjunctival pallor and mild tenderness over her epigastric region. Blood tests show: Hb%: 10 gm/dL Total count (WBC): 11,000 /mm3 Differential count: Neutrophils: 70% Lymphocytes: 25% Monocytes: 5% ESR: 10 mm/hr Which of the following is the most likely diagnosis?? {'A': 'Acute cholecystitis', 'B': 'Choledocholithiasis', 'C': 'Pancreatitis', 'D': 'Duodenal peptic ulcer', 'E': 'Gallbladder cancer'},
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D: Duodenal peptic ulcer
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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 comes to the physician because of a 3-week history of yellow discoloration of his skin, right upper abdominal pain, and fatigue. Two years ago, he underwent right-sided pleurodesis for recurrent spontaneous pneumothorax. Pulmonary examination shows mild bibasilar crackles and expiratory wheezing. Laboratory studies show an elevation of serum transaminases. Histopathological examination of a tissue specimen obtained on liver biopsy shows PAS-positive globules within periportal hepatocytes. Genetic analysis shows substitution of lysine for glutamic acid at position 342 of a gene located on chromosome 14 that encodes for a protease inhibitor (Pi). This patient most likely has which of the following Pi genotypes?? {'A': 'PiZZ', 'B': 'PiSS', 'C': 'PiMS', 'D': 'PiSZ', 'E': 'PiMZ'},
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A: PiZZ
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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 is brought to the emergency department by ambulance. The patient was found unconscious in his bedroom after a suicide attempt. The patient had cut his wrists using a kitchen knife. The patient is unresponsive and pale. His temperature is 96°F (35.6°C), blood pressure is 70/35 mmHg, pulse is 190/min, respirations are 19/min, and oxygen saturation is 92% on room air. Pressure is applied to his bilateral wrist lacerations. His Glasgow Coma Scale (GCS) is 7. A full trauma assessment is performed and reveals no other injuries. IV fluids are started as well as a rapid transfusion sequence. Norepinephrine is administered. Repeat vitals demonstrate that his blood pressure is 100/65 mmHg and pulse is 100/min. The patient is responsive and seems mildly confused. Resuscitation is continued and the patient's GCS improves to 15. Thirty minutes later, the patient's GCS is 11. His temperature is 103°F (39.4°C), blood pressure is 90/60 mmHg, pulse is 122/min, respirations are 22/min, and oxygen saturation is 99% on room air. The patient complains of flank pain. Laboratory values are ordered and demonstrate the following: Hemoglobin: 9 g/dL Hematocrit: 27% Leukocyte count: 10,500 cells/mm^3 with normal differential Haptoglobin: 11 mg/dL Platelet count: 198,000/mm^3 Serum: Na+: 139 mEq/L Cl-: 101 mEq/L K+: 4.4 mEq/L HCO3-: 23 mEq/L BUN: 27 mg/dL Glucose: 99 mg/dL Creatinine: 1.5 mg/dL Ca2+: 10.0 mg/dL Bilirubin: 3.2 mg/dL AST: 22 U/L ALT: 15 U/L Which of the following describes the most likely diagnosis?? {'A': 'Non-cardiogenic acute lung injury', 'B': 'Decreased IgA levels', 'C': 'Major blood group incompatibility', 'D': 'Minor blood group incompatibility', 'E': 'Recipient antibody reaction against foreign leukocytes'},
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C: Major blood group incompatibility
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Answer the following medical question with one of the provided options:
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Q:A 28-year-old primigravida presents to the office with complaints of heartburn while lying flat on the bed at night and mild constipation that started a couple of weeks ago. She is 10 weeks pregnant, as determined by her last menstrual period. Her first menstruation was at 13 years of age and she has always had regular 28-day cycles. Her past medical history is insignificant. She does not smoke cigarettes or drink alcohol and does not take any medications. Her father died of colon cancer at 70 years of age, while her mother has diabetes and hypertension. Her vital signs include: temperature 36.9℃ (98.4℉), blood pressure 98/52 mm Hg, pulse 113/minute, oxygen saturation 99%, and respiratory rate 12 /minute. The physical examination was unremarkable, except for a diastolic murmur heard over the apex. Which of the following is considered abnormal in this woman?? {'A': 'Decreased vascular resistance', 'B': 'Increased cardiac output', 'C': 'Diastolic murmur', 'D': 'Low blood pressure', 'E': 'Tachycardia'},
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C: Diastolic murmur
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Answer the following medical question with one of the provided options:
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Q:A 32-year-old male patient presents to a medical office requesting screening for colorectal cancer. He currently has no symptoms and his main concern is that his father was diagnosed with colorectal cancer at 55 years of age. What screening strategy would be the most appropriate?? {'A': 'Perform a colonoscopy now and repeat every 10 years', 'B': 'Perform a colonoscopy at the age of 40 and repeat every 5 years', 'C': 'Perform a colonoscopy at the age of 40 and repeat every 3 years', 'D': 'Perform a colonoscopy at the age of 50 and repeat every 5 years', 'E': 'Perform a colonoscopy at the age of 50 and repeat every 10 years'},
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B: Perform a colonoscopy at the age of 40 and repeat every 5 years
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Answer the following medical question with one of the provided options:
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Q:A 32-year-old woman presents to the emergency department due to severe, intractable headaches, and bilateral ocular pain. Her symptoms began approximately 2 weeks prior to presentation and have progressively worsened. She initially had right-sided headaches that were sharp, interfered with sleep, and were unresponsive to pain medications. The headache was around her right eye and cheek, and she noticed diplopia with right lateral gaze. Her symptoms were accompanied by fatigue, fever, and edema around the right eye. Approximately 2 days after these symptoms, she developed swelling around the left eye. Medical history is significant for a recent rhinosinusitis infection. Her temperature is 101°F (38.3°C), blood pressure is 133/72 mmHg, pulse is 90/min, and respirations are 18/min. On physical exam, there is ptosis, proptosis, chemosis, and periorbital swelling of both eyes. There is hyperesthesia in the bilateral ophthalmic and maxillary divisions of the trigeminal nerve. Fundoscopic exam demonstrates bilateral papilledema. There is mydriasis and eye muscle weakness in all directions. Which of the following is the most likely diagnosis?? {'A': 'Acute angle-closure glaucoma', 'B': 'Bacterial endophthalmitis', 'C': 'Cavernous sinus thrombosis', 'D': 'Orbital cellulitis', 'E': 'Preseptal cellulitis'},
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C: Cavernous sinus thrombosis
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