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Answer the following medical question with one of the provided options:
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Q:A mother brings her son to the pediatrician because she is concerned about his health. She states that throughout her child's life he has demonstrated aggressive behavior. However, he has recently begun biting himself causing injury and bleeding. The patient has a past medical history of mental retardation and episodes of severe joint pain. His temperature is 99.5°F (37.5°C), blood pressure is 87/48 mmHg, pulse is 90/min, respirations are 17/min, and oxygen saturation is 98% on room air. Physical exam reveals a child attempting to bite his arms. Which of the following is the inheritance pattern of the disease with which this patient presents?? {'A': 'Autosomal dominant', 'B': 'Autosomal recessive', 'C': 'Maternal', 'D': 'X-linked dominant', 'E': 'X-linked recessive'},
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E: X-linked recessive
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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 is brought to the emergency department for confusion and lethargy for the past 2 hours. Per the husband, the patient was behaving weirdly and forgot how to get to the bathroom at her house. She was also difficult to wake up from her nap. The husband denies any fever, weight loss, headaches, dizziness, chest pain, or gastrointestinal changes. He reports that she had frequent diarrhea over the past 3 days but attributed it to food poisoning. In the emergency room, the patient had a 1-minute episode of seizure activity. Following initial resuscitation and stabilization, laboratory studies were performed and the results are shown below. Hemoglobin: 13 g/dL Hematocrit: 38% Leukocyte count: 7,600/mm^3 with normal differential Platelet count: 170,000/mm^3 Serum: Na+: 125 mEq/L Cl-: 90 mEq/L K+: 3.2 mEq/L HCO3-: 20 mEq/L BUN: 22 mg/dL Glucose: 101 mg/dL Creatinine: 1.0 mg/dL Thyroid-stimulating hormone: 3.2 µU/mL Ca2+: 9.3 mg/dL AST: 19 U/L ALT: 22 U/L What is the most appropriate treatment for this patient?? {'A': 'Increase the serum potassium with potassium solution', 'B': 'Increase the serum sodium slowly with hypertonic saline solution', 'C': 'Increase the serum sodium slowly with normal saline solution', 'D': 'Restrict fluids', 'E': 'Start patient on maintenance anti-epileptic medications'},
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B: Increase the serum sodium slowly with hypertonic saline solution
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Answer the following medical question with one of the provided options:
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Q:A 65-year-old woman is brought to the emergency department because of left wrist pain and swelling that began after she fell from a seated position. Menopause occurred 15 years ago. Her serum parathyroid hormone level is within normal limits. An x-ray of the left wrist shows a nondisplaced fracture of the distal radial metaphysis and decreased bone mineral density. The patient would likely benefit from an agent with a structure analogous to which of the following substances?? {'A': 'Inositol', 'B': 'Keratan sulfate', 'C': 'Hydroxyapatite', 'D': 'Nitric oxide', 'E': 'Pyrophosphate\n"'},
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E: Pyrophosphate "
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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 presents to his primary care physician for 4 weeks of recurrent fever, night sweats, malaise, and fatigue. Associated with shortness of breath and orthopnea. Family and personal history are unremarkable. Upon physical examination, he is found with a blood pressure of 100/68 mm Hg, a heart rate of 98/min, a respiratory rate of 20/min, and a body temperature of 38.5°C (101.3°F). Cardiopulmonary auscultation reveals a high-pitched holosystolic murmur over the lower end of the left sternal border and that radiates to the left axilla. Skin lesions are found on the patient’s palms seen in the picture below. Which of the following entities predisposed this patient’s condition?? {'A': 'Rheumatic heart disease', 'B': 'Systemic lupus erythematosus', 'C': 'Mitral valve prolapse', 'D': 'Bicuspid aortic valve', 'E': 'Pulmonary stenosis'},
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C: Mitral valve prolapse
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Answer the following medical question with one of the provided options:
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Q:A 69-year-old woman presents to the clinic with one week of suicidal ideation. She has a history of depression that began after her husband passed away from a motor vehicle accident seven years ago. At the time, she attempted to overdose on over-the-counter pills, but was able to recover completely. Her depression had been adequately controlled on sertraline until this past week. Aside from her depression, she has a history of hypertension, which is controlled with hydrochlorothiazide. The patient is retired and lives alone. She spends her time gardening and is involved with her local community center. On further questioning, the patient states that she does not have an organized plan, but reveals that she did purchase a gun two years ago. She denies tobacco, alcohol, or illicit substances. Which of the following is this patient’s most significant risk factor for completed suicide?? {'A': 'Female sex', 'B': 'Elderly age', 'C': 'No spouse', 'D': 'Firearm possession', 'E': 'Previous attempt'},
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E: Previous attempt
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Answer the following medical question with one of the provided options:
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Q:A 68-year-old woman presents to the emergency department for leg weakness. About 4 hours ago, she was out walking her dog when she had a sudden onset of left-leg weakness. She had no prior symptoms and noticed nothing else except that she was unable to move her left leg like she normally could. This weakness lasted for roughly 3 hours, but it resolved completely while she was in the car on her way to the emergency department, she can move her leg normally now. Her medical history is notable for a 20-year history of hypertension and hyperlipidemia. Her heart rate is 80/min, the blood pressure is 148/92 mm Hg, and the respiratory rate is 14/min. Physical exam, including a thorough neurological exam, is unremarkable; strength is 5/5 throughout her bilateral upper and lower extremities. A noncontrast CT scan of her head is shown. Which of the following is the most likely diagnosis in this patient?? {'A': 'Acute limb ischemia', 'B': 'Intracerebral hemorrhagic stroke', 'C': 'Ischemic stroke', 'D': 'Subarachnoid hemorrhage', 'E': 'Transient ischemic attack'},
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E: Transient ischemic attack
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Answer the following medical question with one of the provided options:
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Q:A 3-year-old boy is brought to the physician for the evaluation of recurrent skin lesions. The episodes of lesions started at the age of 3 months. He has also had several episodes of respiratory tract infections, enlarged lymph nodes, and recurrent fevers since birth. The boy attends daycare. The patient's immunizations are up-to-date. He is at the 5th percentile for length and 10th percentile for weight. He appears ill. Temperature is 38°C (100.4°F). Examination shows several raised, erythematous lesions of different sizes over the face, neck, groin, and extremities; some are purulent. Bilateral cervical and axillary lymphadenopathy are present. What is the most likely underlying mechanism of this patient's symptoms?? {'A': 'Defective neutrophil chemotaxis', 'B': 'NADPH oxidase deficiency', 'C': 'Impaired repair of double-strand DNA breaks', 'D': 'Defective cytoplasmic tyrosine kinase', 'E': 'Impaired signaling to actin cytoskeleton reorganization'},
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B: NADPH oxidase deficiency
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Answer the following medical question with one of the provided options:
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Q:A 16-year-old boy comes to the physician because of muscle weakness and cramps for 5 months. He becomes easily fatigued and has severe muscle pain and swelling after 15 minutes of playing basketball with his friends. The symptoms improve after a brief period of rest. After playing, he sometimes also has episodes of reddish-brown urine. There is no family history of serious illness. Serum creatine kinase concentration is 950 U/L. Urinalysis shows: Blood 2+ Protein negative Glucose negative RBC negative WBC 1–2/hpf Which of the following is the most likely underlying cause of this patient's symptoms?"? {'A': 'CTG repeat in the DMPK gene', 'B': 'Low levels of triiodothyronine and thyroxine', 'C': 'Acid maltase deficiency', 'D': 'Medium-chain acyl-CoA dehydrogenase deficiency', 'E': 'Myophosphorylase deficiency'},
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E: Myophosphorylase deficiency
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Answer the following medical question with one of the provided options:
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Q:A 43-year-old man hospitalized for acute pancreatitis develops a high-grade fever and productive cough with gelatinous sputum. A sample of his expectorated sputum is obtained and fixed to a microscope slide using heat. A crystal violet dye is applied to the slide, followed by an iodine solution, acetone solution, and lastly, safranin dye. A photomicrograph of the result is shown. Which of the following cell components is responsible for the pink color seen on this stain?? {'A': 'Peptidoglycan', 'B': 'Glycogen', 'C': 'Protein', 'D': 'Mycolic acid', 'E': 'Capsular polysaccharide'},
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A: Peptidoglycan
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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 male comes to the emergency department because of a high-grade fever and malaise for 3 days. He has severe generalized joint and body pains refractory to acetaminophen. He also has a severe stabbing pain behind his eyes. He returned from a trip to Taiwan 1 week ago. He is sexually active and uses condoms inconsistently. His temperature is 38.7°C (101.7°F), pulse is 102/min, and blood pressure is 100/70 mm Hg. Examination shows nontender inguinal lymphadenopathy. There is a maculopapular rash over the trunk and extremities with some sparing of the skin over his back and groin. Abdominal examination shows no abnormalities. Laboratory studies show: Hemoglobin 13.3 g/dL Leukocyte count 3,900/mm3 Platelet count 90,000/mm3 Serum Na+ 136 mEq/L Cl- 103 mEq/L K+ 4.2 mEq/L Urea nitrogen 15 mg/dL Creatinine 1.2 mg/dL Bilirubin Total 0.4 mg/dL Direct 0.1 mg/dL Alkaline phosphatase 40 U/L AST 130 U/L ALT 60 U/L Urinalysis is normal. An ELISA test for HIV is negative. Which of the following measures is most likely to have prevented this patient’s condition?"? {'A': 'Safe sexual practices', 'B': 'Mosquito repellent', 'C': 'Prophylaxis with doxycycline', 'D': 'Vaccination', 'E': 'Frequent hand washing'},
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B: Mosquito repellent
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Answer the following medical question with one of the provided options:
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Q:A 30-year-old woman presents to an urgent care center with progressively worsening cough and difficulty breathing. She has had similar prior episodes since childhood, one of which required intubation with mechanical ventilation. On physical exam, she appears anxious and diaphoretic, with diffuse wheezes and diminished breath sounds bilaterally. First-line treatment for this patient’s symptoms acts by which of the following mechanisms of action?? {'A': 'Beta-1 agonist', 'B': 'Beta-1 antagonist', 'C': 'Beta-2 agonist', 'D': 'Beta-2 antagonist', 'E': 'Beta-3 agonist'},
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C: Beta-2 agonist
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Answer the following medical question with one of the provided options:
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Q:A 2-month-old boy is brought to the pediatrician by his parents after they notice that he had a “floppy” appearance, poor suckling, vomiting, and spontaneous generalized movements a few weeks after birth. The boy was born at home, and routine newborn screening was normal. On physical examination, the infant is hypotonic, has poor suckling, cannot hold his head straight while prone, and does not follow objects. He has fair skin, red hair, blue eyes, eczema, and galactorrhea. At the second appointment, laboratory tests show high levels of phenylalanine and prolactin and low levels of homovanillic acid and serotonin. Which of the following enzymes is deficient in this patient?? {'A': 'Dopamine hydroxylase', 'B': 'Phenylethanolamine N-methyltransferase', 'C': 'Phenylalanine hydroxylase', 'D': 'Dopamine decarboxylase', 'E': 'Dihydropteridine reductase'},
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E: Dihydropteridine reductase
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Answer the following medical question with one of the provided options:
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Q:A 34-year-old G3P2 is admitted to the hospital at 32 weeks gestation with vaginal bleeding, which started 4 hours ago when she was taking a nap. She reports no pain or uterine contractions. The course of the current pregnancy has been uncomplicated. The two previous pregnancies resulted in cesarean sections. She did not undergo a scheduled ultrasound examination at 20 weeks gestation . Her vital signs are as follows: blood pressure, 110/60 mm Hg; heart rate, 77/min; respiratory rate, 14/min; and temperature, 36.6℃ (97.9℉). The fetal heart rate is 147/min. On examination, abdominal palpation is significant for normal uterine tone and no tenderness. The perineum is moderately bloody. The patient continues to pass a small amount of blood. Which of the following investigations would be most likely to confirm the diagnosis?? {'A': 'Transvaginal ultrasound', 'B': 'Digital cervical examination', 'C': 'Coagulation studies', 'D': 'Transabdominal ultrasound', 'E': 'Amniocentesis and fetal lung maturity testing'},
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A: Transvaginal ultrasound
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Answer the following medical question with one of the provided options:
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Q:A 44-year-old man comes to the physician for a routine health maintenance examination. He had not seen his primary care physician for 7 years. He has no complaints other than feeling easily fatigued. He has no significant medical history. He reports drinking half a pint of liquor a day. His temperature is 98.7°F (37.1°C), pulse is 65/min, respiratory rate is 15/min, and blood pressure is 120/70 mm Hg. Physical examination shows reddish color to both of his palms. His abdomen has no focal tenderness but is difficult to assess due to distention. Laboratory studies show: Hemoglobin 11.0 g/dL Hematocrit 33% Leukocyte count 5,000/mm3 Platelet count 60,000/mm3 Serum Na+ 135 mEq/L K+ 4.5 mEq/L Cl- 100 mEq/L HCO3- 24 mEq/L Urea nitrogen 15 mg/dL Creatinine 1.3 mg/dL Total bilirubin 3.0 mg/dL AST 112 U/L ALT 80 U/L Alkaline phosphatase 130 U/L Which of the following is the most likely explanation for this patient's thrombocytopenia?"? {'A': 'Bone marrow infiltration', 'B': 'Uremia', 'C': 'Decreased protein synthesis', 'D': 'Hypersplenism', 'E': 'Autoimmune antibodies'},
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D: Hypersplenism
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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 comes to the emergency room for worsening leg pain and a rash consistent with wet gangrene. He has no history of skin infections but has type 2 diabetes mellitus and has smoked 2 packs of cigarettes daily for 20 years. Three days after admission, he becomes increasingly hypoxic and tachypneic. He is emergently intubated and ventilatory support is initiated. He is 180 cm (5 ft 11 in) tall and weighs 90 kg (198 lb); BMI is 27.8 kg/m2. His pulse is 112/min and his blood pressure is 95/60 mmHg. The ventilator is set at an FIO2 of 100%, tidal volume of 540 mL, respiratory rate of 20/min, and positive end-expiratory pressure (PEEP) of 5 cm H2O. On pulmonary examination, there are diffuse crackles. Cardiac examination shows no abnormalities. Hemoglobin is 11.5 g/dL, serum lactate is 4.0 mmol/L, and serum creatinine is 2.5 mg/dL. An arterial blood gas checked 30 minutes after intubation shows a PaCO2 of 50 mm Hg and a PaO2 of 55 mm Hg. An x-ray of the chest shows new bilateral infiltrates. Which of the following is the most appropriate next step to improve tissue oxygen delivery in this patient?? {'A': 'Inhaled nitric oxide', 'B': 'Prone positioning of patient', 'C': 'Increase the tidal volume', 'D': 'Increase the positive end-expiratory pressure', 'E': 'Transfusion of red blood cells'},
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D: Increase the positive end-expiratory pressure
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Answer the following medical question with one of the provided options:
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Q:Ultrasonography of the scrotum shows a 2-cm hypoechoic, homogeneous testicular mass with sharp margins. A CT scan of the abdomen shows a single enlarged para-aortic lymph node. Which of the following is the most appropriate next step in management?? {'A': 'Radiation therapy', 'B': 'Systemic polychemotherapy', 'C': 'Scrotal orchiectomy', 'D': 'Radical inguinal orchiectomy', 'E': 'Open testicular biopsy'},
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D: Radical inguinal orchiectomy
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Answer the following medical question with one of the provided options:
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Q:A 27-year-old woman is brought to the emergency department after sustaining a fall from her bicycle 1 hour ago. The patient was on her way to work as she lost her balance, hitting her head on the sidewalk. She had an initial loss of consciousness for a couple of minutes following the accident. She currently has nausea and a headache. She has vomited twice during the last 30 minutes. She has no history of a serious illness. The patient does not smoke or drink alcohol. She has never used illicit drugs. She takes no medications. Her temperature is 37°C (98.6°F), pulse is 50/min, respirations are 10/min, and blood pressure is 160/90 mm Hg. She is oriented to person, place, and time. Her lungs are clear to auscultation. Cardiac examination shows bradycardia but no murmurs, rubs, or gallops. The abdomen is soft and nontender. There is a bruise on the right temporal side of the head. While performing the remainder of the physical examination the patient starts having a seizure. Intravenous lorazepam is administered and she is admitted to the intensive care unit. Which of the following is the most likely diagnosis in this patient?? {'A': 'Ischemic stroke', 'B': 'Intracerebral hemorrhage', 'C': 'Subarachnoidal hemorrhage', 'D': 'Idiopathic intracranial hypertension', 'E': 'Epidural hematoma'},
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E: Epidural hematoma
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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 with a history of depression presents to the emergency department after a suspected ingestion. She is confused, reporting blurry vision, and responding to visual hallucinations. Vital signs are as follows: Temperature: 98.9 degrees Farenheit (37.2 Celsius) Heart Rate: 105 bpm Blood Pressure: 90/65 mmHg Respiratory Rate: 21 respirations per minute O2 Saturation: 99% on room air Upon reviewing her ECG (shown in Image A), the emergency room physician orders sodium bicarbonate. What medication was the likely cause of this patient's cardiac abnormality?? {'A': 'Lithium', 'B': 'Amitriptyline', 'C': 'Paroxetine', 'D': 'Quetiapine', 'E': 'Sertraline'},
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B: Amitriptyline
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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 comes to the physician for a follow-up examination. During the last 6 months, he has had recurring pneumonia after undergoing a surgical operation. He reports that, when food has gone down his windpipe, he has not automatically coughed. Examination shows normal voluntary coughing, but an impaired cough reflex. The nerve responsible for this patient's symptoms is most likely damaged at which of the following anatomical sites?? {'A': 'Infratemporal fossa', 'B': 'Foramen magnum', 'C': 'Aortic arch', 'D': 'Piriform recess', 'E': 'Parotid gland'},
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D: Piriform recess
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Answer the following medical question with one of the provided options:
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Q:A 26-year-old G6P1050 presents for evaluation of infertility. She and her husband have been trying to have a child for the past three years. Over that time period, the patient suffered five miscarriages. Her past medical history is significant for anemia, bipolar disorder, and a blood clot in her right lower extremity that occurred during her first pregnancy. The patient reports she has been feeling fatigued and has gained at least 10 pounds within the last two months. She often cries when she thinks about the miscarriages and has trouble falling asleep at night. She admits that while she had quit smoking during the pregnancy of her first child, and one month after the birth she started smoking again. She currently smokes about a half a pack of cigarettes a day. A review of systems is also positive for diffuse joint discomfort. The patient's current medications include minocycline for acne, and prenatal vitamins. A physical exam is unremarkable. Her temperature is 99°F (37.2°C), pulse is 72/minute, blood pressure is 118/78 mmHg, and oxygen saturation is 98% O2 on room air. Routine labs are drawn, as shown below: Leukocyte count: 6,500/mm^3 Platelet count: 210,000/mm^3 Hemoglobin: 11.0 g/dL Prothrombin time: 12 seconds Activated partial thromboplastin time: 43 seconds International normalized ratio: 1.1 Which of the following is associated with this patient’s infertility?? {'A': 'Elevated TSH levels', 'B': 'Autosomal dominant mutation in factor V', 'C': 'Positive VDRL', 'D': 'Positive antihistone antibodies', 'E': 'Vasoconstriction with reduced placental blood flow'},
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C: Positive VDRL
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Answer the following medical question with one of the provided options:
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Q:A 22-year-old man with a history of schizophrenia presents to the emergency room escorted by police. The officers state that the patient was found at a local mall, threatening to harm people in the parking lot, screaming at them, and chasing them. The patient states that those people were agents of the government sent to kill him. The patient is agitated and seems to be responding to internal stimuli. He refuses treatment and states that he wants to leave or he will hurt the hospital staff and other patients. Which of the following is the most appropriate next step in management?? {'A': 'Determine patient competency.', 'B': 'Let the patient leave against medical advice.', 'C': 'Wait for a psychiatrist to determine patient capacity.', 'D': "Begin treatment due to patient's lack of decision making capacity.", 'E': 'Ask the police to escort the patient to jail.'},
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D: Begin treatment due to patient's lack of decision making capacity.
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Answer the following medical question with one of the provided options:
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Q:A 49-year-old man presents to his primary care physician complaining of heartburn and mild epigastric pain after eating for the past 6 months. He reports that his symptoms occur within an hour of eating a meal and persist for approximately an hour. He admits his symptoms have been progressively worsening. He recently began having these symptoms when he lies in the supine position. He has tried eating smaller meals and avoiding spicy food to no avail. He denies vomiting, difficulty swallowing, recent weight loss, or changes in stool color. He does admit to having a "sour" taste in his mouth when symptomatic. His temperature is 99.0°F (37.2°C), blood pressure is 149/82 mmHg, pulse is 86/min, respirations are 18/min, and BMI is 32 kg/m^2. His abdomen is soft, non-tender, and bowel sounds are auscultated in all quadrants. Laboratory results demonstrate the following: Serum: Hemoglobin: 13.5 g/dL Hematocrit: 41% Leukocyte count: 4,500/mm^3 with normal differential Platelet count: 257,000/mm^3 Fecal occult blood test (FOBT): Negative Which of the following is the next best step in management?? {'A': '24-hour pH monitoring', 'B': 'Endoscopy', 'C': 'Omeprazole', 'D': 'Metoclopramide', 'E': 'Ranitidine'},
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C: Omeprazole
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Answer the following medical question with one of the provided options:
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Q:A 6-year-old boy is brought to the physician by his mother because of a 3-month history of episodic chest pain and shortness of breath on exertion. He is at the 99th percentile for height and 40th percentile for weight. Examination shows a high-arched palate, long and slender upper extremities, and elbows and knees that can be hyperextended. Cardiac examination shows a grade 2/6 late systolic, crescendo murmur with a midsystolic click. Over which of the following labeled areas is the murmur most likely to be heard best?? {'A': 'Area A', 'B': 'Area C', 'C': 'Area E', 'D': 'Area F', 'E': 'Area G'},
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D: Area F
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Answer the following medical question with one of the provided options:
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Q:A 12-year-old boy is brought to the emergency department by his parents after he was bitten by a friend's cat while playing at their house. The patient reports moderate pain of the right hand and wrist but has full range of motion and strength. He is up to date on his vaccinations and is generally healthy. His vitals are unremarkable. Physical exam reveals a deep puncture wound that is actively bleeding. The wound is irrigated and a dressing is applied. Which of the following is appropriate management of this patient?? {'A': 'Ampicillin-sulbactam and surgical debridement', 'B': 'Ampicillin-sulbactam, surgical debridgment, and laceration closure', 'C': 'Amoxicillin-clavulanate', 'D': 'Amoxicillin-clavulanate and laceration closure', 'E': 'Laceration closure'},
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C: Amoxicillin-clavulanate
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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 comes to the physician for the evaluation of dyspnea and cough. He was diagnosed with esophageal cancer 10 months ago, for which he received radiochemotherapy. He has a history of atopic dermatitis and has smoked one pack of cigarettes daily for 30 years. Auscultation of the lungs shows decreased breath sounds bilaterally. Spirometry shows an FVC of 78% and an FEV1/FVC ratio of 95%. Which of the following is the most likely underlying condition?? {'A': 'Chronic bronchitis', 'B': 'Pulmonary emphysema', 'C': 'Allergic asthma', 'D': 'Pulmonary fibrosis', 'E': 'Pulmonary embolism'},
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D: Pulmonary fibrosis
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Answer the following medical question with one of the provided options:
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Q:A 72-year-old woman presents to her primary care provider complaining of fatigue for the last 6 months. She can barely complete her morning chores before having to take a long break in her chair. She rarely climbs the stairs to the second floor of her house anymore because it is too tiring. Past medical history is significant for Hashimoto's thyroiditis, hypertension, and hyperlipidemia. She takes levothyroxine, chlorthalidone, and atorvastatin. Her daughter developed systemic lupus erythematosus. She is retired and lives by herself in an old house build in 1945 and does not smoke and only occasionally drinks alcohol. She eats a well-balanced diet with oatmeal in the morning and some protein such as a hardboiled egg in the afternoon and at dinner. Today, her blood pressure is 135/92 mm Hg, heart rate is 110/min, respiratory rate is 22/min, and temperature is 37.0°C (98.6°F). On physical exam, she appears frail and her conjunctiva are pale. Her heart is tachycardic with a regular rhythm and her lungs are clear to auscultation bilaterally. A complete blood count (CBC) shows that she has macrocytic anemia. Peripheral blood smear shows a decreased red blood cell count, anisocytosis, and poikilocytosis with occasional hypersegmented neutrophils. An endoscopy and colonoscopy are performed to rule out an occult GI bleed. Her colonoscopy was normal. Endoscopy shows thin and smooth gastric mucosa without rugae. Which of the following is the most likely cause of this patient’s condition?? {'A': 'Lead poisoning', 'B': 'Pernicious anemia', 'C': 'Anemia due to chronic alcoholism', 'D': 'Helicobacter pylori gastritis', 'E': 'Glucose-6-phosphate dehydrogenase deficiency (G6PD deficiency)'},
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B: Pernicious anemia
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Answer the following medical question with one of the provided options:
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Q:A 9-year-old boy is admitted to the hospital for placement of halo gravitational traction in order to treat his previously observed kyphoscoliosis. Specifically, he has a previously diagnosed curve that has gotten worse over time and now threatens to compromise his thoracic cavity. His past medical history is significant for short stature, and he has consistently been below the 5th percentile for height since birth. On physical exam, he is found to have macrocephaly with frontal bossing, short arms and legs with disproportionate shortening of the proximal segments, and lumbar lordosis. Which of the following proteins are most likely mutated in this patient?? {'A': 'alpha-L iduronidase', 'B': 'COL1A1 strand', 'C': 'FGFR3 receptor', 'D': 'RUNX2 factor', 'E': 'SLC26A2 transporter'},
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C: FGFR3 receptor
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Answer the following medical question with one of the provided options:
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Q:While studying vesicular trafficking in mammalian epithelial cells, a scientist identified a specific protein that was responsible for contorting the plasma membrane to capture extracellular materials and forming endosomes. This protein also helps transport those endosomes from the trans-Golgi network to lysosomes. Which of the following is the protein that the scientists identified?? {'A': 'Kinesin', 'B': 'COPII', 'C': 'Sar1', 'D': 'COPI', 'E': 'Clathrin'},
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E: Clathrin
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Answer the following medical question with one of the provided options:
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Q:An 11-year-old boy is brought to the physician for the evaluation of frequent falling. His mother reports that the patient has had increased difficulty walking over the last few months and has refused to eat solid foods for the past 2 weeks. He has met all developmental milestones. The patient has had multiple ear infections since birth. His temperature is 37°C (98.6°F), pulse is 90/min, and blood pressure is 120/80 mm Hg. Examination shows foot inversion with hammertoes bilaterally. His gait is wide-based with irregular and uneven steps. Laboratory studies show a serum glucose concentration of 300 mg/dL. Further evaluation of this patient is most likely to show which of the following findings?? {'A': 'Mutation of type I collagen gene', 'B': 'Expansion of GAA trinucleotide repeats', 'C': 'Absence of dystrophin protein', 'D': 'Duplication of PMP22 gene', 'E': 'Defect of ATM protein\n"'},
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B: Expansion of GAA trinucleotide repeats
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Answer the following medical question with one of the provided options:
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Q:A 54-year-old man presents with 3 days of non-bloody and non-bilious emesis every time he eats or drinks. He has become progressively weaker and the emesis has not improved. He denies diarrhea, fever, or chills and thinks his symptoms may be related to a recent event that involved sampling many different foods. His temperature is 97.5°F (36.4°C), blood pressure is 133/82 mmHg, pulse is 105/min, respirations are 15/min, and oxygen saturation is 98% on room air. Physical exam is notable for a weak appearing man with dry mucous membranes. His abdomen is nontender. Which of the following laboratory changes would most likely be seen in this patient?? {'A': 'Anion gap metabolic acidosis and hypokalemia', 'B': 'Metabolic alkalosis and hyperkalemia', 'C': 'Metabolic alkalosis and hypokalemia', 'D': 'Non-anion gap metabolic acidosis and hypokalemia', 'E': 'Respiratory acidosis and hyperkalemia'},
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C: Metabolic alkalosis and hypokalemia
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Answer the following medical question with one of the provided options:
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Q:A 27-year-old man comes to the physician because of a 2-month history of palpitations and shortness of breath on exertion. He has no history of serious illness. He does not smoke or use illicit drugs. His pulse is 90/min, respirations are 18/min, and blood pressure is 140/40 mm Hg. Cardiac examination shows a murmur along the left sternal border. A phonocardiogram of the murmur is shown. Which of the following additional findings is most likely in this patient?? {'A': 'Increased left ventricular end-diastolic volume', 'B': 'Decreased left ventricular wall compliance', 'C': 'Decreased left ventricular wall stress', 'D': 'Decreased pulmonary capillary wedge pressure', 'E': 'Increased right ventricular oxygen saturation'},
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A: Increased left ventricular end-diastolic volume
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Answer the following medical question with one of the provided options:
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Q:A 26-year-old woman is found wandering in the street at 3 AM in the morning shouting about a new cure for cancer. When interviewed in the psychiatric triage unit, she speaks rapidly without pauses and continues to boast of her upcoming contribution to science. When the physician attempts to interrupt her, she becomes angry and begins to shout about all of her “accomplishments” in the last week. She states that because she anticipates a substantial sum of money from the Nobel Prize she will win, she bought a new car and diamond earrings. In addition, the patient divulges that she is 8 weeks pregnant with a fetus who is going to “change the course of history.” Her chart in the electronic medical record shows an admission 3 months ago for suicidality and depression. She was released on fluoxetine after being stabilized, but the patient now denies ever taking any medications that “could poison my brain.” Urine pregnancy test is positive. Which of the following is a potential adverse outcome of the drug shown to reduce suicide-related mortality in this patient?? {'A': 'Tardive dyskinesia', 'B': 'Atrialization of the right ventricle in the patient’s fetus', 'C': 'Weight loss', 'D': 'Stevens-Johnson syndrome', 'E': 'Hyperprolactinemia and galactorrhea'},
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B: Atrialization of the right ventricle in the patient’s fetus
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Q:A 54-year-old man comes to the physician because of persistent right knee pain and swelling for 2 weeks. Six months ago, he had a total knee replacement because of osteoarthritis. His temperature is 38.5°C (101.3°F), pulse is 100/min, and blood pressure is 139/84 mm Hg. Examination shows warmth and erythema of the right knee; range of motion is limited by pain. His leukocyte count is 14,500/mm3, and erythrocyte sedimentation rate is 50 mm/hr. Blood cultures grow gram-positive, catalase-positive cocci. These bacteria grow on mannitol salt agar without color change. Production of which of the following is most important for the organism's virulence?? {'A': 'Protein A', 'B': 'Vi capsule', 'C': 'Exotoxin A', 'D': 'Exopolysaccharides', 'E': 'Cord factor'},
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D: Exopolysaccharides
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Q:Two days after coronary artery stent placement for a posterior myocardial infarction, a 70-year-old woman complains of difficulty breathing and retrosternal chest pain. She has a history of atrial fibrillation, for which she takes verapamil. Following stent placement, the patient was started on aspirin and clopidogrel. She appears to be in acute distress and is disoriented. Respirations are 22/min. Pulse oximetry on room air shows an oxygen saturation of 80%. Diffuse crackles are heard on auscultation of the chest. The patient is intubated and mechanical ventilation is started. Shortly afterwards, she becomes unresponsive. Heart sounds are inaudible and her carotid pulses are not palpable. The cardiac monitor shows normal sinus rhythm with T-wave inversion. Which of the following is the most appropriate next step in management?? {'A': 'Unsynchronized cardioversion', 'B': 'Intravenous epinephrine therapy', 'C': 'Chest compressions', 'D': 'Coronary angiography', 'E': 'Synchronized cardioversion'},
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C: Chest compressions
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Q:Four weeks after starting hydrochlorothiazide, a 49-year-old man with hypertension comes to the physician because of muscle cramps and weakness. His home medications also include amlodipine. His blood pressure today is 176/87 mm Hg. Physical examination shows no abnormalities. The precordial leads of a 12-lead ECG are shown. The addition of which of the following is most likely to have prevented this patient's condition?? {'A': 'Torsemide', 'B': 'Nifedipine', 'C': 'Clonidine', 'D': 'Eplerenone', 'E': 'Hydralazine'},
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D: Eplerenone
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Q:A 47–year-old man presents to the emergency department with worsening weakness in the setting of persistent abdominal pain. The man arrived to the United States 6 months ago and has been working in a restaurant as a cook. His abdominal pain started 4 months ago, but he could not find time away from work to see a doctor. He reports nausea but denies any vomiting. His temperature is 98.6°F (37°C), blood pressure is 98/61 mmHg, pulse is 110/min, and respirations are 18/min. He has no cardiac murmurs but does have tenderness in his epigastric region. His heme-occult test is positive. His laboratory workup notes the following: Hemoglobin: 7.2 g/dL Hematocrit: 23% Leukocyte count: 11,000/mm^3 with normal differential Platelet count: 470,000/mm^3 Serum: Na+: 137 mEq/L Cl-: 109 mEq/L K+: 3.1 mEq/L HCO3-: 23 mEq/L BUN: 52 mg/dL Glucose: 89 mg/dL Creatinine: 0.9 mg/dL An esophagogastroduodenoscopy reveals the presence of a mass surrounded by bleeding ulcers. On initial shave biopsy, the preliminary diagnosis is mucosa-associated lymphatic tissue lymphoma (MALToma). What is the best next step in management?? {'A': 'Amoxicillin, clarithromycin, and pantoprazole', 'B': 'Cyclophosphamide, doxorubicin, vincristine, and prednisone', 'C': 'Full thickness biopsy', 'D': 'Hospice care', 'E': 'Partial gastrectomy'},
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A: Amoxicillin, clarithromycin, and pantoprazole
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Q:A hospital committee is established in order to respond to a national report on the dangers of wrong site surgery. The committee decides to conduct an investigation using a method that will hopefully prevent wrong site surgery from occurring prior to having any incidents. Therefore, the committee begins by analyzing systemic, design, process, and service issues. Which of the following components is a part of the analytical process being used by this committee?? {'A': 'Failure modes', 'B': 'Plan do study act cycles', 'C': 'Root causes', 'D': 'Safety culture', 'E': 'Simplification'},
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A: Failure modes
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Q:A 45-year-old man visits a psychiatrist with his wife asking for help with their ongoing family problem. The couple has been married for 20 years and the last 2 months the patient is fully convinced that his wife is cheating on him. He has hired numerous private investigators, who deny any such evidence for an extramarital affair. This persistent belief has begun to stress both sides of the family. The spouse has never in the past nor currently shown any evidence of infidelity. He is still able to hold a steady job and provide for his 2 children. Which of the following statements below is a diagnostic criterion for the above condition?? {'A': 'Daily functioning must be impaired', 'B': 'Delusions must be non-bizarre', 'C': 'Diagnosis meets criteria for another DSM-5 diagnosis', 'D': 'Must have active symptoms for 1 month followed by 6 months total duration', 'E': 'Must have 1 symptom from the core domain'},
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B: Delusions must be non-bizarre
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Q:A 3-year-old boy is brought to the emergency department because of pain and swelling of his right knee joint for 1 day. He has not had any trauma to the knee. He was born at term and has been healthy since. His maternal uncle has a history of a bleeding disorder. His temperature is 37.1°C (98.8°F) and pulse is 97/min. The right knee is erythematous, swollen, and tender; range of motion is limited. No other joints are affected. An x-ray of the knee shows an effusion but no structural abnormalities of the joint. Arthrocentesis is done. The synovial fluid is bloody. Further evaluation of this patient is most likely to show which of the following?? {'A': 'Synovial fluid leukocytosis', 'B': 'Decreased platelet count', 'C': 'Prolonged partial thromboplastin time', 'D': 'Elevated erythrocyte sedimentation rate', 'E': 'Elevated antinuclear antibody levels'},
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C: Prolonged partial thromboplastin time
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Q:A 32-year-old man recently visiting from Thailand presents with diarrhea and fatigue for the past 6 days, which began before leaving Thailand. The patient denies any recent history of laxatives, nausea, or vomiting. His vital signs include: blood pressure 80/50 mm Hg, heart rate 105/min, and temperature 37.7°C (99.8°F). On physical examination, the patient is pale with dry mucous membranes. A stool sample is obtained for culture, which is copious and appears watery. Which of the following is the correct categorization of this diarrheal disease?? {'A': 'Secretory diarrhea', 'B': 'Motility diarrhea', 'C': 'Invasive diarrhea', 'D': 'Osmotic diarrhea', 'E': 'Steatorrhea'},
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A: Secretory diarrhea
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Q:A 28-year-old woman with HIV comes to the physician because of an 8-day history of severe pain while swallowing. She has been hospitalized several times with opportunistic infections and has poor adherence to her antiretroviral drug regimen. Endoscopy shows extensive, white, plaque-like lesions in the proximal esophagus. Culture of a biopsy specimen grows Candida albicans. Treatment with intravenous anidulafungin is initiated. Which of the following is the primary mechanism of action of this drug?? {'A': 'Decreased DNA synthesis', 'B': 'Binding to ergosterol', 'C': 'Binding to tubulin', 'D': 'Decreased glucan synthesis', 'E': 'Inhibition of squalene epoxidase'},
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D: Decreased glucan synthesis
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Q:A study looking to examine the utility of colorectal cancer screening in patients younger than 50 is currently seeking subjects to enroll. A 49-year-old man with a family history of colorectal cancer is very interested in enrolling in the study, due to his own personal concerns about developing cancer. If enrolled in this study, which of the following types of biases will this represent?? {'A': 'Measurement bias', 'B': 'Recall bias', 'C': 'Lead-time bias', 'D': 'Selection bias', 'E': 'Length bias'},
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D: Selection bias
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Q:A 43-year-old Hispanic woman was admitted to the emergency room with intermittent sharp and dull pain in the right lower quadrant for the past 2 days. The patient denies nausea, vomiting, diarrhea, or fever. She states that she was ‘completely normal’ prior to this sudden episode of pain. The patient states that she is sure she is not currently pregnant and notes that she has no children. Physical exam revealed guarding on palpation of the lower quadrants. An abdominal ultrasound revealed free abdominal fluid, as well as fluid in the gallbladder fossa. After further evaluation, the patient is considered a candidate for laparoscopic cholecystectomy. The procedure and the risks of surgery are explained to her and she provides informed consent to undergo the cholecystectomy. During the procedure, the surgeon discovers a gastric mass suspicious for carcinoma. The surgeon considers taking a biopsy of the mass to determine whether or not she should resect the mass if it proves to be malignant. Which of the following is the most appropriate course of action to take with regards to taking a biopsy of the gastric mass?? {'A': 'The surgeon should biopsy the gastric mass', 'B': 'The surgeon should resect the gastric mass', 'C': 'The surgeon should obtain consent to biopsy the mass from the patient when she wakes up from cholecystectomy', 'D': 'The surgeon should contact an ethics committee to obtain consent to biopsy the mass', 'E': 'The surgeon should contact an attorney to obtain consent to biopsy the mass'},
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C: The surgeon should obtain consent to biopsy the mass from the patient when she wakes up from cholecystectomy
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Q:A previously healthy 35-year-old woman comes to the physician for a 3-week history of alternating constipation and diarrhea with blood in her stool. She has not had any fevers or weight loss. Her father died of gastric cancer at 50 years of age. Physical examination shows blue-gray macules on the lips and palms of both hands. Colonoscopy shows multiple polyps throughout the small bowel and colon with one ulcerated polyp at the level of the sigmoid colon. Multiple biopsy specimens are collected. These polyps are most likely to be characterized as which of the following histological subtypes?? {'A': 'Hyperplastic', 'B': 'Adenomatous', 'C': 'Mucosal', 'D': 'Serrated', 'E': 'Hamartomatous'},
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E: Hamartomatous
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Q:A 55-year-old woman is brought to the emergency department due to sudden onset retrosternal chest pain. An ECG shows ST-segment elevation. A diagnosis of myocardial infarction is made and later confirmed by elevated levels of troponin I. The patient is sent to the cardiac catheter laboratory where she undergoes percutaneous catheterization. She has 2 occluded vessels in the heart and undergoes a percutaneous coronary intervention to place 2 stents in her coronary arteries. Blood flow is successfully restored in the affected arteries. The patient complains of flank pain on post-procedure evaluation a few hours later. A significant drop in hematocrit is observed, as well as a drop in her blood pressure to 90/60 mm Hg. Physical examination reveals extensive ecchymoses in the flanks and loin as seen in the provided image. Which of the following conditions is this patient most likely experiencing?? {'A': 'Complication from femoral artery access', 'B': 'Fat embolism', 'C': 'Patent ductus arteriosus', 'D': 'Adrenal hemorrhage', 'E': 'Ventricular septal defect'},
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A: Complication from femoral artery access
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Q:A 21-year-old man comes to the physician because of a 6-month history of severe abdominal pain, bloating, and episodic diarrhea. He has also had a 5-kg (11-lb) weight loss during this time. Physical examination shows a mildly distended abdomen, hyperactive bowel sounds, and diffuse abdominal tenderness. A biopsy specimen of the colonic mucosa shows scattered areas of inflammation with fibrosis and noncaseating granulomas. Which of the following is most likely involved in the pathogenesis of this patient's condition?? {'A': 'Increased activity of type 1 T helper cells', 'B': 'Ectopic secretion of serotonin', 'C': 'Intestinal overgrowth of toxigenic bacteria', 'D': 'Accumulation of intracellular bacteria in macrophages', 'E': 'Viral infection with intranuclear inclusions'},
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A: Increased activity of type 1 T helper cells
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Q:A researcher needs to measure the volume of a specific body fluid compartment in subjects enrolled in his experiment. For such measurements, he injects an intravenous tracer into the subjects and then measures the concentration of the tracer in their blood samples. The volume of the specific body compartment will be calculated using the formula V = A/C, where V is the volume of the specific body fluid compartment, A is the amount of tracer injected, and C is the concentration of the tracer in the blood. For his experiment, he needs a tracer that is capillary membrane permeable but impermeable to cellular membranes. Which of the following tracers is most suitable for his experiment?? {'A': 'Albumin', 'B': 'Evans blue', 'C': 'Heavy water (D2O)', 'D': 'Inulin', 'E': 'Urea'},
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D: Inulin
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Q:A 35-year-old woman comes to the physician because of swelling of her right breast for the past 4 days. She also reports malaise and some pain with breastfeeding. Three weeks ago, she delivered a healthy 3500-g (7.7-lb) girl. She has no history of serious illness. Her mother died of breast cancer at the age of 55 years. Her only medication is a multivitamin. Her temperature is 38°C (100.4°F). Examination shows a tender, firm, swollen, erythematous right breast. Examination of the left breast shows no abnormalities. Which of the following is the most appropriate next step in management?? {'A': 'Dicloxacillin and continued breastfeeding', 'B': 'Trimethoprim-sulfamethoxazole and continued breastfeeding', 'C': 'Continued breastfeeding, cold compresses, and ibuprofen', 'D': 'Stop breastfeeding and perform mammography', 'E': 'Stop breastfeeding and perform breast biopsy'},
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A: Dicloxacillin and continued breastfeeding
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Q:A 19-year-old man presents to the office for a routine physical exam and a meningitis vaccination prior to attending college on a basketball scholarship. Also present at the appointment is his father who appears to be in his mid-sixties and is much shorter. The patient’s pulse is 70/min, respirations are 18/min, temperature is 37.0°C (98.6°F), and blood pressure is 120/80 mm Hg. He is 183 cm (6 ft 0 in) tall and weighs 79.4 kg (175 lb). His heart rate is regular with a mild diastolic murmur (II/VI) over the aortic valve and his lungs are clear to auscultation bilaterally. A scoliosis test shows mild deviation of his thoracic spine. A skin examination shows numerous red-to-white linear markings on the skin around his lower back. His fingers are long. Which of the following genes does this patient most likely have a mutation of?? {'A': 'COL3A1', 'B': 'COL5A1', 'C': 'ELN', 'D': 'FBN1', 'E': 'IT15'},
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D: FBN1
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Q:A 68-year-old man comes to the physician 3 months after noticing skin changes on his scalp. When he scrapes off the crust of the lesion, it reappears after a few days. Occasionally, his scalp itches or he notices a burning sensation. He had a mole removed on his right forearm 5 years ago. He is a retired winemaker. His vital signs are within normal limits. Examination shows multiple rough patches on his scalp. A photograph is shown. Which of the following is the most likely diagnosis?? {'A': 'Seborrheic keratosis', 'B': 'Keratoacanthoma', 'C': 'Actinic keratosis', 'D': 'Bowen disease', 'E': 'Amelanotic melanoma'},
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C: Actinic keratosis
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Q:A 20-year-old G1P0 woman at 12 weeks estimated gestational age presents to the obstetric clinic for the first prenatal visit She admits to being unsure of whether to keep or abort the pregnancy but now has finally decided to keep it. She says she is experiencing constant fatigue. Physical examination reveals conjunctival pallor. Her hemoglobin level is 10.1 g/dL. Which of the following additional features would likely be present in this patient?? {'A': 'Pica', 'B': 'Exercise tolerance', 'C': 'Onychorrhexis', 'D': 'Increased Transferrin Saturation', 'E': 'Decreased TIBC'},
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A: Pica
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Q:A 13-year-old male presents to his primary care provider with joint pain in his right knee. He has had multiple episodes of pain and effusion in both knees throughout his life as well as easy bruising. Most of these episodes followed minor trauma, including accidentally hitting his knee on a coffee table, but they occasionally occurred spontaneously. Both his uncle and grandfather have had similar problems. The patient denies any recent trauma and reports that his current pain is dull in nature. The patient is a long distance runner and jogs frequently. He is currently training for an upcoming track and field meet. On physical exam, the joint is warm and nonerythematous and with a large effusion. The patient endorses pain on both passive and active range of motion. Which of the following prophylactic treatments could have prevented this complication?? {'A': 'Desmopressin', 'B': 'Fresh frozen plasma', 'C': 'Cryoprecipitate', 'D': 'Factor concentrate', 'E': 'Additional rest between symptomatic episodes'},
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D: Factor concentrate
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Q:A 13-year-old boy presents to the pediatrician with yellow discoloration of the sclerae since yesterday, and dark-colored urine for 2 days. A detailed history is taken and reveals that he had a cough, cold, and fever the week before the onset of the current symptoms, and was treated with over-the-counter medications. He reports an improvement in his upper respiratory symptoms but has been experiencing fatigue, nausea, and poor appetite since then. There is no past history of recurrent nausea, vomiting, jaundice or abdominal pain, and he has not received any blood transfusion. In addition, he frequently eats at a roadside restaurant near his school. His growth and development are normal for his age and sex. The temperature is 37.9°C (100.2°F), pulse is 96/min, blood pressure is 110/70 mm Hg, and the respiratory rate is 22/min. The physical examination shows icterus. The examination of the abdomen reveals tender hepatomegaly with the liver having a firm, sharp, and smooth edge. The laboratory test results are as follows: Hemoglobin 14.2 g/dL WBC (white blood cell) 10,500/mm3 Differential leukocyte count Segmented neutrophils 56% Bands 4% Lymphocytes 35% Eosinophils 2% Basophils 0% Monocytes 3% Platelet count 270,000/mm3 Serum total bilirubin 8.4 mg/dL Serum direct bilirubin 7.8 mg/dL Serum alanine aminotransferase 350 U/L Serum alkaline phosphatase 95 U/L Prothrombin time 20 seconds Which of the following laboratory tests is most likely used to diagnose the condition of this patient?? {'A': 'Serum anti-HAV IgM antibody', 'B': 'Plasma tyrosine and methionine', 'C': 'Urine for reducing substances', 'D': 'Quantitative assay for glucose-6-phosphate dehydrogenase (G6PD) activity', 'E': 'Percutaneous liver biopsy'},
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A: Serum anti-HAV IgM antibody
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Q:A 4-year-old boy is brought to the emergency department because of fever, nausea, and headache for 1 day. His temperature is 39.7°C (103.5°F). Examination shows involuntary flexion of the knees and hips when the neck is flexed. A lumbar puncture is performed and cerebrospinal fluid (CSF) analysis shows numerous segmented neutrophils and a decreased glucose concentration. Gram stain of the CSF shows gram-negative diplococci. This patient is at increased risk for which of the following complications?? {'A': 'Temporal lobe inflammation', 'B': 'Acute pancreatitis', 'C': 'Adrenal insufficiency', 'D': 'Deep neck abscess', 'E': 'Vesicular skin rash'},
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C: Adrenal insufficiency
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Q:A 24-year-old woman presents with 3 days of diarrhea. She was recently on vacation in Peru and admits that on her last day of the trip she enjoyed a dinner of the local food and drink. Upon return to the United States the next day, she developed abdominal cramps and watery diarrhea, occurring about 3-5 times per day. She has not noticed any blood or mucous in her stool. Vital signs are stable. On physical examination, she is well appearing in no acute distress. Which of the following is commonly associated with the likely underlying illness?? {'A': 'Raw oysters', 'B': 'Soft cheese', 'C': 'Fried rice', 'D': 'Ground meat', 'E': 'Unwashed fruits and vegetables'},
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E: Unwashed fruits and vegetables
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Q:A 30-year-old woman, gravida 3, para 1, at 25 weeks' gestation comes to the physician because of mild itching of the vulva and anal region for 2 weeks. She has a history of 2 episodes of vulvovaginal candidiasis last year that both subsided following 1 week of treatment with butoconazole. Vital signs are within normal limits. Pelvic examination shows a uterus consistent in size with a 25-week gestation. There are no signs of vulvar or perianal erythema, edema, or fissures. Microscopy of an adhesive tape that was applied to the perianal region shows multiple ova. Which of the following is the most appropriate next step in management?? {'A': 'Praziquantel', 'B': 'Ivermectin', 'C': 'Albendazole', 'D': 'Pyrantel pamoate', 'E': 'Supportive therapy'},
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E: Supportive therapy
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Q:A 62-year-old healthy man is rushed into the emergency department after experiencing sharp chest pain that radiates down his left arm. Pre-hospital electrocardiography (ECG) shows ST-segment depression and the patient is administered supplemental oxygen, aspirin, and sublingual nitroglycerin. On arrival at the ER, the patient is stable; however, during the initial work-up the pO2 drops and the pulse is no longer detectable (see ECG). The patient is administered a drug which slows the phase 0 upswing and increases the duration of the action potential. Which of the following drugs is most likely to show the desired effects?? {'A': 'Flecainide', 'B': 'Mexiletine', 'C': 'Procainamide', 'D': 'Sotalol', 'E': 'Timolol'},
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C: Procainamide
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Q:A 44-year-old female is brought to the emergency room after losing consciousness at a shopping mall. Her husband states that they were shopping when the patient appeared sweaty and tremulous, became confused, then collapsed. She was unconscious for 5 minutes until a paramedic arrived. Fingerstick glucose at that time was 31 mg/dL and intramuscular glucagon was administered. The patient regained consciousness as she was being transported to the ambulance. On arrival in the emergency room, she is conscious but sleepy. She is able to report that her last meal prior to the mall was 5 hours ago. Her husband notes that over the last 3 months, she has complained of headaches and a milky discharge from both breasts, as well as nausea if she goes too long without eating. She works as an inpatient nurse and was exposed to tuberculosis 10 years ago but adequately treated. Because she was adopted as an infant, family history is unknown. Temperature is 98.4 deg F (36.9 deg C), blood pressure is 101/59 mmHg, pulse is 88/min, and respiration is 14/min. Preliminary lab values are shown below: Plasma glucose: 54 mg/dL Plasma insulin: 29 pmol/L (normal < 19 pmol/L) Plasma C-peptide: 272 pmol/L (normal < 200 pmol/L) Plasma proinsulin: 8 pmol/L (normal < 5 pmol/L) Plasma ß-hydroxybutyrate: 1.2 mmol/L (normal > 2.7 mmol/L after fasting) Which of the following is the most likely cause of this patient’s hypoglycemic episode?? {'A': 'Insulinoma', 'B': 'Exogenous insulin use', 'C': 'Sulfonylurea use', 'D': 'Noninsulinoma pancreatogenous hypoglycemia syndrome (NIPHS)', 'E': 'Primary adrenal insufficiency'},
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A: Insulinoma
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Q:A 55-year-old man with HIV on antiretroviral therapy comes to the physician for a follow-up examination. His HIV viral load is 559 copies/mL (N<49). His physician is concerned about the development of drug resistance. The result of HIV genotype testing shows reduced viral susceptibility to darunavir and ritonavir. Which of the following molecular processes is most likely affected by this mutation?? {'A': 'Integration of DNA into the host genome', 'B': 'Synthesis of DNA from an RNA template', 'C': 'Binding of aminoacyl-tRNA to ribosomes', 'D': 'Modification of translated proteins', 'E': 'Binding of glycoproteins to T-cell receptors'},
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D: Modification of translated proteins
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Q:A 38-year-old man comes to the physician because of fever, malaise, productive cough, and left-sided chest pain for 2 weeks. During this time, he has woken up to a wet pillow in the morning on multiple occasions and has not been as hungry as usual. He was diagnosed with HIV infection 1 year ago. He currently stays at a homeless shelter. He has smoked one pack of cigarettes daily for 22 years. He has a history of intravenous illicit drug use. He drinks 5–6 beers daily. He is receiving combined antiretroviral therapy but sometimes misses doses. His temperature is 38.6°C (101.5°F), pulse is 106/min, and blood pressure is 125/85 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 94%. Auscultation shows decreased breath sounds over the left base of the lung. There is dullness to percussion on the left lower part of the chest. Laboratory studies show: Hemoglobin 14 g/dL Leukocyte count 5,000/mm3 CD4+ T lymphocytes 240/mm3 (N > 500) Serum Creatinine 0.9 mg/dL γ-Glutamyltransferase (GGT) 65 U/L (N = 5–50) Aspartate aminotransferase (AST) 15 U/L Alanine aminotransferase (ALT) 19 U/L Alkaline phosphatase 40 U/L Lactate dehydrogenase (LDH) 50 U/L An x-ray of the chest shows a left-sided pleural effusion and hilar lymphadenopathy. Analysis of the pleural fluid shows an effusion with lymphocyte-predominant leukocytosis, high protein, an LDH of 500 U/L, and high adenosine deaminase. Which of the following is the most likely cause of this patient's condition?"? {'A': 'Cirrhosis', 'B': 'Rheumatoid arthritis', 'C': 'Pneumocystis jirovecii pneumonia', 'D': 'Lung cancer', 'E': 'Pulmonary tuberculosis\n"'},
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E: Pulmonary tuberculosis "
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Q:A 24-year-old female presents to her primary care physician with right knee pain for the last week. She states that she first noticed it after a long flight on her way back to the United States from Russia, where she had run a marathon along a mountain trail. The patient describes the pain as dull, aching, and localized to the front of her kneecap, and it worsens with sitting but improves with standing. Aspirin has not provided significant relief. The patient has a history of a torn anterior cruciate ligament (ACL) on the right side from a soccer injury three years ago. In addition, she was treated for gonorrhea last month after having intercourse with a new partner. At this visit, the patient’s temperature is 98.5°F (36.9°C), blood pressure is 112/63 mmHg, pulse is 75/min, and respirations are 14/min. Which of the following is most likely to establish the diagnosis?? {'A': 'Plain radiograph of the knee', 'B': 'MRI of the knee', 'C': 'Ballotable patella test', 'D': 'Patellar compression with extended knee', 'E': 'Anterior drawer test'},
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D: Patellar compression with extended knee
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Q:A 27-year-old woman presents to your office complaining of right arm numbness and weakness. Her past medical history is unremarkable. Her family history, however, is significant for the unexpected death of both her parents at age 59 in a motor vehicle accident last week. On physical exam, her bicep, brachioradialis, and patellar reflexes are 2+ bilaterally. CNS imaging shows no abnormalities. Which of the following is the most likely diagnosis?? {'A': 'Conversion disorder', 'B': 'Vitamin B12 deficiency', 'C': 'Amyotrophic lateral sclerosis', 'D': 'Arnold-Chiari malformation', 'E': 'Multiple sclerosis'},
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A: Conversion disorder
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Q:A 22-year-old woman presents to the physician due to lightheadedness. Earlier in the day, she had her first job interview since graduating from college 3 months ago. While waiting outside the interviewer’s office, she began to feel nervous and started breathing really fast. She then felt as if she was going to faint. She excused herself from the interview, and requested a friend to drive her to the clinic. Which of the following is responsible for her symptoms?? {'A': 'Decreased arterial pCO2', 'B': 'Increased arterial pO2', 'C': 'Decreased arterial pH', 'D': 'Increased plasma lactic acid', 'E': 'Vagus nerve stimulation'},
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A: Decreased arterial pCO2
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Q:Twelve hours after undergoing a right hip revision surgery for infected prosthesis, a 74-year-old man has numbness in his fingertips and around the lips. His surgery was complicated by severe blood loss. He underwent a total right hip replacement 2 years ago. He has hypertension and type 2 diabetes mellitus. His father had hypoparathyroidism. The patient has smoked one pack of cigarettes daily for 40 years. His current medications include metformin and captopril. He appears uncomfortable. His temperature is 37.3°C (99.1°F), pulse is 90/min, and blood pressure is 110/72 mm Hg. Examination shows an adducted thumb, flexed metacarpophalangeal joints and wrists, and extended fingers. Tapping the cheeks 2 cm ventral to the ear lobes leads to contraction of the facial muscles. The remainder of the examination shows no abnormalities. Which of the following is the most likely cause of this patient's symptoms?? {'A': 'Multiple blood transfusions', 'B': 'Hypoparathyroidism', 'C': 'Vitamin B12 deficiency', 'D': 'Peripheral nerve injury', 'E': 'Cerebrovascular event\n"'},
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A: Multiple blood transfusions
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Q:Two days after undergoing emergent laparotomy with splenectomy for a grade IV splenic laceration sustained in a motor vehicle collision, a 54-year-old man develops decreased urinary output. His urine output is < 350 mL/day despite aggressive fluid resuscitation. During the emergent laparotomy, he required three units of packed RBCs. He has type 2 diabetes mellitus and is on an insulin sliding scale. His vital signs are within normal limits. Physical examination shows a healing surgical incision in the upper abdomen and multiple large ecchymoses of the superior right and left abdominal wall. His hematocrit is 28%, platelet count is 400,000/mm3, serum creatinine is 3.9 mg/dL, and serum urea nitrogen concentration is 29 mg/dL. Urinalysis shows brown granular casts. Which of the following is the most likely underlying cause of these findings?? {'A': 'Acute tubular necrosis', 'B': 'Rapidly progressive glomerulonephritis', 'C': 'Focal segmental glomerulosclerosis', 'D': 'Myorenal syndrome', 'E': 'Acute renal infarction'},
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A: Acute tubular necrosis
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Q:A 34-year-old woman comes to the emergency department with midsternal chest pain, shortness of breath, and cough with bloody sputum for the past 3 hours. The pain started after moving furniture at home and worsens when taking deep breaths. The patient has a history of hypertension. She has smoked one pack of cigarettes daily for the past 20 years. She drinks 1–2 glasses of wine per day. Current medications include enalapril and an oral contraceptive. Her temperature is 38.2°C (100.8°F), pulse is 110/min, respirations are 20/min, and blood pressure is 110/70 mm Hg. Oxygen saturation is 92% on room air. Physical examination shows decreased breath sounds over the left lung base. There is calf pain on dorsal flexion of the right foot. Examination of the extremities shows warm skin and normal pulses. Further evaluation of this patient is most likely to show which of the following findings?? {'A': 'Thrombus in the left atrium on TEE', 'B': 'Wedge-shaped filling defect on chest CT', 'C': 'Diffuse fluffy bilateral lung infiltrates on CXR', 'D': 'Tracheal deviation on CXR', 'E': 'Elevated serum CK-MB'},
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B: Wedge-shaped filling defect on chest CT
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Q:A 15-year-old girl presents to her primary care physician with her parents. She is complaining of fever and a sore throat for the past 4 days. She was born at 39 weeks gestation via spontaneous vaginal delivery and is up to date on all vaccines and is meeting all developmental milestones. Her boyfriend at school has the same symptoms including fever and sore throat. Today, her heart rate is 90/min, respiratory rate is 17/min, blood pressure is 110/65 mm Hg, and temperature is 38.2°C (100.8°F). Examination revealed cervical lymphadenopathy and mild hepatosplenomegaly. Oral exam reveals focal tonsillar exudate. A monospot test is positive. This patient is most likely infected with which of the following viruses?? {'A': 'Epstein-Barr virus', 'B': 'Variola virus', 'C': 'Cytomegalovirus', 'D': 'Herpes simplex virus', 'E': 'Varicella virus'},
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A: Epstein-Barr virus
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Q:A 52-year-old woman presents with decreased exercise tolerance and difficulty breathing on exertion and while sleeping at night. She says that she requires 2 pillows to sleep at night to alleviate her shortness of breath. These symptoms started 6 months ago and are gradually increasing in severity. She does not have any chronic health problems. She has smoked 15 cigarettes per day for the past 20 years and drinks alcohol occasionally. Vital signs include: blood pressure 110/70 mm Hg, temperature 36.7°C (98.0°F), and regular pulse 90/min. On physical examination, the first heart sound is loud, and there is a low pitched rumbling murmur best heard at the cardiac apex. This patient is at high risk of developing which of the following complications?? {'A': 'Infective endocarditis', 'B': 'Myocarditis', 'C': 'Cardiac arrhythmia', 'D': 'High-output heart failure', 'E': 'Left atrial myxoma'},
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C: Cardiac arrhythmia
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Q:A 64-year-old man comes to the physician because of a 2-week history of intractable hiccups and shortness of breath on exertion. He also has a 1-month history of left shoulder pain. He has smoked one pack of cigarettes daily for 35 years. Physical examination shows decreased breath sounds at the left lung base. An x-ray of the chest shows a 3-cm perihilar mass and elevation of the left hemidiaphragm. This patient's symptoms are most likely caused by injury to a nerve that also innervates which of the following structures?? {'A': 'Fibrous pericardium', 'B': 'Serratus anterior muscle', 'C': 'Vocal cords', 'D': 'Ciliary muscle', 'E': 'Visceral pleura'},
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A: Fibrous pericardium
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Q:A 30-year-old woman, gravida 4, para 3, at 39 weeks' gestation comes to the hospital 20 minutes after the onset of vaginal bleeding. She has not received prenatal care. Her third child was delivered by lower segment transverse cesarean section because of a footling breech presentation. Her other two children were delivered vaginally. Her temperature is 37.1°C (98.8°F), pulse is 86/min, respirations are 18/min, and blood pressure is 132/74 mm Hg. The abdomen is nontender, and no contractions are felt. The fetus is in a vertex presentation. The fetal heart rate is 96/min. Per speculum examination reveals ruptured membranes and severe bleeding from the external os. Which of the following is the most likely diagnosis?? {'A': 'Placenta previa', 'B': 'Placenta accreta', 'C': 'Bloody show', 'D': 'Ruptured vasa previa', 'E': 'Threatened abortion'},
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D: Ruptured vasa previa
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Q:A male infant is born at 27 weeks following premature rupture of membranes and a precipitous labor to a G4P3 female. Given the speed of delivery steroids are not given. Shortly after delivery he develops respiratory distress and the decision is made to administer surfactant replacement therapy. While the components of the surfactant used in surfactant therapy may vary based on institution, what is the main component of pulmonary surfactant produced by type II pneumocytes?? {'A': 'Protein S', 'B': 'Zinc finger protein', 'C': 'Cholesterol', 'D': 'Surfactant-associated proteins', 'E': 'Phospholipids'},
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E: Phospholipids
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Q:A 66-year-old woman comes to the physician for a routine health maintenance examination. She has no history of serious medical illness and takes no medications. A screening DEXA scan shows a T-score of -1.5 at the femur. Which of the following is the strongest predisposing factor for osteopenia?? {'A': 'Hypoparathyroidism', 'B': 'NSAID use', 'C': 'Obesity', 'D': 'Smoking', 'E': 'Type 2 diabetes mellitus'},
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D: Smoking
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Q:A 68-year-old man presents to the emergency department with shortness of breath for the past 2 hours. He mentions that he had a cough, cold, and fever for the last 3 days and has taken an over-the-counter cold preparation. He is hypertensive and has had coronary artery disease for the last 7 years. His regular medications include aspirin and ramipril. On physical examination, temperature is 36.9°C (98.4°F), pulse is 120/min, blood pressure is 118/80 mm Hg, and respiratory rate is 24/min. Pulse oximetry shows an oxygen saturation of 99%. Pitting edema is present bilaterally over the ankles and pretibial regions, and the peripheral extremities are warm to touch. On auscultation of the lung fields, pulmonary crackles are heard over the lung bases bilaterally. Auscultation of the precordium reveals a third heart sound. On examination of the abdomen, mild tender hepatomegaly is present. The chest radiograph is not suggestive of consolidation. Which of the following medications is the drug of choice for initial management of this patient?? {'A': 'Dobutamine', 'B': 'Digoxin', 'C': 'Furosemide', 'D': 'Nitroglycerin', 'E': 'Milrinone'},
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C: Furosemide
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Q:A 34-year-old gravida 2, para 1 woman at 37+6 weeks of gestation presents for elective cesarean delivery. She says she has been having increased fatigue over the past few weeks. Past medical history includes gestational hypertension for which she has been taking an antihypertensive drug twice daily since week 24. Her vital signs include: temperature 36.7°C (98.0°F), blood pressure 120/75 mm Hg, pulse 127/min. Physical examination reveals generalized pallor. Her laboratory results reveal microcytic, hypochromic anemia with anisocytosis, hemoglobin of 9 g/dL, a differential with 14% lymphocytes, an ESR of 22 mm/hr, and a reticulocyte production index of 3.1. A direct antiglobulin test is positive. LFTs, creatinine, ferritin level, vitamin B12 level, coagulation studies, and urinalysis are normal. Which of the following is the most likely diagnosis in this patient?? {'A': 'Preeclampsia', 'B': 'Hereditary spherocytosis', 'C': 'HELLP syndrome', 'D': 'Drug-induced immune hemolytic reaction', 'E': 'Normal pregnancy'},
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D: Drug-induced immune hemolytic reaction
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Q:A 14-year-old boy is brought to the physician for evaluation of his tall stature. His father is 174 cm (5 ft 7 in) tall; his mother is 162 cm (5 ft 3 in) tall. He is at the 99th percentile for height and 88th percentile for BMI. Examination shows pronounced sweat stains below the armpits and broad hands and feet. There is frontal bossing and protrusion of the mandible. His fasting serum glucose is 138 mg/dL. An x-ray of the left hand and wrist shows a bone age of 16 years. Which of the following is most likely involved in the pathogenesis of this patient's condition?? {'A': 'Circulating TSH receptor autoantibodies', 'B': 'Increased serum insulin-like growth factor 1', 'C': 'Tumor of the posterior pituitary gland', 'D': 'Mosaic mutation in G-protein signaling', 'E': 'Mutated growth hormone receptor'},
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B: Increased serum insulin-like growth factor 1
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Q:Fifteen years ago, a physician was exposed to Mycobacterium tuberculosis during a medical mission trip to Haiti. A current CT scan of his chest reveals respiratory apical granulomas. The formation of this granuloma helped prevent the spread of the infection to other sites. Which pair of cells contributed to the walling-off of this infection?? {'A': 'TH1 cells and macrophages', 'B': 'TH2 cells and macrophages', 'C': 'TH1 cells and neutrophils', 'D': 'TH2 cells and neutrophils', 'E': 'CD8 T cells and NK cells'},
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A: TH1 cells and macrophages
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Q:A 63-year-old man comes to the physician because of a 3-week history of fatigue and shortness of breath. Physical examination shows diminished breath sounds at the right lung base. An x-ray of the chest shows blunting of the right costophrenic angle. Thoracentesis shows clear, yellow-colored fluid with a protein concentration of 1.9 g/dL. Which of the following is the most likely underlying cause of this patient's pleural effusion?? {'A': 'Pulmonary tuberculosis', 'B': 'Pulmonary sarcoidosis', 'C': 'Congestive heart failure', 'D': 'Thoracic duct injury', 'E': 'Bacterial pneumonia'},
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C: Congestive heart failure
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Q:A 4-year-old boy is brought to the physician because of a 1-day history of passing small quantities of dark urine. Two weeks ago, he had fever, abdominal pain, and bloody diarrhea for several days that were treated with oral antibiotics. Physical examination shows pale conjunctivae and scleral icterus. His hemoglobin concentration is 7.5 g/dL, platelet count is 95,000/mm3, and serum creatinine concentration is 1.9 mg/dL. A peripheral blood smear shows irregular red blood cell fragments. Avoiding consumption of which of the following foods would have most likely prevented this patient's condition?? {'A': 'Mushrooms', 'B': 'Shellfish', 'C': 'Raw pork', 'D': 'Undercooked beef', 'E': 'Canned carrots'},
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D: Undercooked beef
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Q:A 45-year-old gentleman comes to his primary care physician complaining of redness and foul-smelling discharge from his penis. The patient is not married and denies sexual activity. Upon further questioning, he denies trauma or any associated fevers or chills. After the initial work-up was found to be negative for sexually-transmitted diseases, a biopsy and imaging were ordered. The biopsy shows squamous cell carcinoma (SCC). Which of the following is associated with a reduced risk of developing penile SCC?? {'A': 'Having frequent intercourse', 'B': 'Testing positive for HPV 16 or 18', 'C': 'Smoking', 'D': 'Circumcision', 'E': 'UV light treatments for psoriasis'},
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D: Circumcision
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Q:A 21-year-old man seeks evaluation at an urgent care clinic because of nausea, vomiting, and abdominal pain that began 2 hours ago. He attended a picnic this afternoon, where he ate a cheese sandwich and potato salad. He says that a number of his friends who were at the picnic have similar symptoms, so he thinks the symptoms are associated with the food that was served. His medical history is significant for celiac disease, which is well-controlled with a gluten-free diet and an appendectomy was performed last year. His vital signs include a temperature of 37.0°C (98.6°F), respiratory rate of 15/min, pulse of 97/min, and blood pressure of 98/78 mmHg. He is started on intravenous fluids. Which of the following is the most probable cause of this patient’s condition?? {'A': 'A toxin produced by a gram-positive, catalase-positive bacteria', 'B': 'Antigliadin antibody', 'C': 'Gram-negative bacillus', 'D': 'Gram-positive, catalase-negative bacteria', 'E': 'Gram-positive, catalase-positive bacteria'},
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A: A toxin produced by a gram-positive, catalase-positive bacteria
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Q:A 34-year-old woman is brought into the emergency department by emergency medical services after an electrical fire in her apartment. She is coughing with an O2 saturation of 98%, on 2L of nasal cannula. The patient's physical exam is significant for a burn on her right forearm that appears to be dry, white, and leathery in texture. Her pulses and sensations are intact in all extremities. The patient's vitals are HR 110, BP 110/80, T 99.2, RR 20. She has no evidence of soot in her mouth and admits to leaving the room as soon as the fire started. Which is the following is the best treatment for this patient?? {'A': 'Bacitracin', 'B': 'Pain relievers', 'C': 'Mafenide acetate', 'D': 'Excision and grafting', 'E': 'Amputation'},
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D: Excision and grafting
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Q:A 44-year-old female presents to her primary care physician complaining of fatigue. She reports a four-month history of increasing fatigue accompanied by occasional constipation. She also reports a 15-pound weight gain over the same time period. She is otherwise healthy and takes no medications. She has never been pregnant. On physical examination, her skin is dry and cracked. Patellar reflexes are 1+ bilaterally. Laboratory analysis reveals an elevated serum TSH and decreased serum and free T4. Her blood is positive for the presence of specific antibodies. A biopsy of this patient’s thyroid gland would most likely reveal which of the following?? {'A': 'Large pleomorphic cells with vascular invasion and necrosis', 'B': 'Randomly oriented papillae with pleomorphic cells and dense fibrosis', 'C': 'Spindle cells with stromal amyloid deposition', 'D': 'Lymphocytic infiltrate with germinal center formation', 'E': 'Hyperplasia and hypertrophy of follicular cells'},
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D: Lymphocytic infiltrate with germinal center formation
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Q:A 18-year-old woman presents to her primary care physician reporting that she has not experienced her first menses. She is accompanied by her mother who states that she personally experienced menstruation at age 12 and that the patient's sister started menstruating at the age of 11 years. The patient is not sexually-active and denies taking any medications. On physical examination, the patient appears thin and has fine hair covering her arms. Her height is 62 inches (157.48 cm) and her weight is 85 pounds (38.5 kg). The patient does not make eye contact and only answers in one word responses. The mother is asked to step out of the room and the interview resumes. After establishing some trust, the patient admits that she does not have an appetite. She has had difficulty sleeping and some feels guilty for worrying her mother. She also admits to occasional cocaine use. She switches between binge-eating and vomiting. She is constantly fatigued but she also goes to the gym three times daily, often without her parents’ knowledge. Which of the following is the most likely diagnosis in this patient?? {'A': 'Anorexia nervosa', 'B': 'Bulimia nervosa', 'C': 'Binge-eating disorder', 'D': 'Illicit substance use', 'E': 'Major depressive disorder'},
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A: Anorexia nervosa
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Q:A 3-day-old infant presents because the patient’s parents noticed that his skin was becoming yellow. The mother said that the patient eats well, has normal stool and urine color. It’s her first child from first healthy pregnancy. The patient was born on time and delivered via spontaneous vaginal delivery with no complications. Family history is significant for a maternal aunt who died as an infant of unknown causes. The patient is afebrile and vital signs are within normal limits. On physical examination, he is awake, calm, and looks healthy, except for the yellow tone of the skin and scleral icterus. Laboratory findings are significant for elevated unconjugated bilirubin, with a normal complete blood count. Other routine laboratory blood tests are within normal limits. The patient is treated with phototherapy, but his jaundice worsens and his unconjugated hyperbilirubinemia persists well into the second week of life. Which of the following is the most likely diagnosis in this patient?? {'A': 'Crigler–Najjar syndrome type II', 'B': 'Crigler–Najjar syndrome type I', 'C': 'Hemolytic anemia', 'D': 'Gilbert syndrome', 'E': 'Neonatal jaundice'},
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B: Crigler–Najjar syndrome type I
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Q:A 29-year-old woman, gravida 1, para 0 at 11 weeks' gestation comes to the physician because of a 2-day history of left lower extremity pain and swelling. Her temperature is 37.9°C (100.2°F). Physical examination shows a tender, palpable cord on the lateral aspect of the left lower leg. The overlying skin is erythematous and indurated. Duplex ultrasound shows vascular wall thickening and subcutaneous edema. Which of the following is the most likely diagnosis?? {'A': 'Deep vein thrombosis', 'B': 'Erysipelas', 'C': 'Erythema nodosum', 'D': 'Varicose vein', 'E': 'Superficial thrombophlebitis'},
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E: Superficial thrombophlebitis
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Q:A 2-year-old, previously healthy female presents to the emergency department complaining of 7 hours of 10/10 intermittent abdominal pain, vomiting, and dark red stools. On exam, there is tenderness to palpation in the right lower quadrant and high-pitched bowel sounds. Technetium-99m pertechnetate scan was performed (Image A). Which of the following is true about this patient's condition?? {'A': 'It contains all the layers of the GI tract', 'B': 'It typically affects females more than males', 'C': 'It is typically found in the descending colon', 'D': 'It is a remnant of the allantois', 'E': 'It is typically symptomatic'},
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A: It contains all the layers of the GI tract
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Q:A 33-year-old woman comes to the physician because of constipation, abdominal pain, and decreased appetite for the past 2 months. She started a new diet and has been exercising 2 hours daily for several months in order to lose weight. She has a history of hypertension and hypothyroidism. She does not smoke or drink alcohol. Current medications include hydrochlorothiazide, a multivitamin, and levothyroxine. She recently started taking over-the-counter supplements with each meal. Her temperature is 36.2°C (97.2°F), pulse is 92/min, and blood pressure is 102/78 mm Hg. Examination shows dry mucous membranes. Cardiopulmonary examination shows no abnormalities. Her abdomen is soft; bowel sounds are decreased. Serum studies show: Calcium 12.8 mg/dL Phosphorus 4.6 mg/dL Bicarbonate 22 mEq/L Albumin 4 g/dL PTH 180 pg/mL TSH 9 μU/mL Free T4 5 μg/dL Which of the following is the most likely underlying cause of this patient's symptoms?"? {'A': 'Primary hypothyroidism', 'B': 'Primary hyperparathyroidism', 'C': 'Vitamin A toxicity', 'D': 'Excess calcium carbonate intake', 'E': 'Vitamin D toxicity'},
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E: Vitamin D toxicity
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Q:A 22-year-old man presents with a painful right arm. He says the pain started several hours ago after he fell on his right shoulder while playing college football. He says that he felt a stinging sensation running down his right arm when he fell. On physical examination, there is a reduced range of motion of the right arm. Plain radiographs of the right shoulder confirm the presence of a shoulder dislocation. A detailed examination yields no evidence of neurovascular problems, and a decision is made to reduce the shoulder using ketamine. Which of the following side effects will be most likely seen in this patient after administering ketamine?? {'A': 'Fever', 'B': 'Increased appetite', 'C': 'Diplopia', 'D': 'Renal failure', 'E': 'Cough'},
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C: Diplopia
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Q:An 8-year-old child is brought to the emergency department because of profuse diarrhea and vomiting that have lasted for 2 days. The boy was born at 39 weeks gestation via spontaneous vaginal delivery. He is up to date on all vaccines and is meeting all developmental milestones. Past medical history is noncontributory. The family recently made a trip to India to visit relatives. Today, his heart rate is 100/min, respiratory rate is 22/min, blood pressure is 105/65 mm Hg, and temperature is 37.2ºC (99.0°F). On physical examination, he appears unwell with poor skin turgor and dry oral mucosa. His heart has a regular rate and rhythm and his lungs are clear to auscultation bilaterally. His abdomen is sensitive to shallow and deep palpation. A gross examination of the stool reveals a ‘rice water’ appearance. Diagnostic microbiology results are pending. Which of the following is the best screening test to aid the diagnosis of this patient?? {'A': 'Mononuclear spot test', 'B': 'String test', 'C': 'Tzanck smear', 'D': 'Urea breath test', 'E': 'Catalase test'},
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B: String test
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Q:A 9-year-old boy is brought to the hospital by his mother with complaints of fever and right flank pain for the past 3 days. His mom mentions that he has had these symptoms recurrently for the past 4 years. He was treated with antibiotics in the past and got better, but eventually, these symptoms recurred. On physical examination, he is warm to touch and there is tenderness over his right costovertebral angle. The vital signs include a blood pressure of 100/64 mm Hg, a pulse of 100/min, a temperature of 38.0°C (100.4°F), and a respiratory rate of 14/min. Complete blood count results are as follows: Hemoglobin 12 g/dL Red blood cell 5.1 million cells/µL Hematocrit 45% Total leukocyte count 8,500 cells/µL Neutrophils 71% Lymphocyte 24% Monocytes 4% Eosinophil 1% Basophils 0% Platelets 240,000 cells/µL Urinalysis results: pH 6.2 Color turbid yellow RBC none WBC 8–10/HPF Protein trace Cast WBC casts Glucose absent Crystal none Ketone absent Nitrite positive A computed tomography scan shows renal scarring and multiple atrophy sites with compensatory hypertrophy of residual normal tissue. There is additional renal cortical thinning. Which of the following would be the most likely microscopic finding if a renal biopsy were to be done?? {'A': 'Segmental sclerosis and hyalinosis', 'B': 'Normal glomeruli with accumulated lipid in proximal convoluted tubular cells', 'C': 'Sloughed tubular cells within tubular lumen', 'D': 'Tubules containing eosinophilic casts', 'E': 'Polygonal clear cells with accumulated lipids and carbohydrates'},
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D: Tubules containing eosinophilic casts
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Answer the following medical question with one of the provided options:
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Q:A 41-year-old woman presents for evaluation of a mild bloody vaginal discharge for the past 4 months. Bleeding increases after sexual intercourse. For the past few weeks, the patient also began to note an unpleasant odor. The patient has a regular 28-day menstrual cycle. Her husband has been her only sexual partner for the past 15 years. She has a levonorgestrel-releasing intrauterine contraceptive device (IUD) that was inserted 4 years ago. She does not take oral contraceptives. She has not had a gynecologic evaluation since the IUD was placed. She is a machine operator. Her past medical history is significant for Graves’ disease with thyrotoxicosis that was treated with radioactive iodine ablation. The BMI is 22 kg/m2. The gynecologic examination shows no vulvar or vaginal lesions. The cervix is deformed and a 4-cm exophytic mass with necrotization is noted arising from the posterior lip of the cervix. The uterus is not enlarged. No masses are palpable in the adnexa. What is the most probable cause of the patient’s condition?? {'A': 'Hyperestrogenemia', 'B': 'Exposure to heavy metals', 'C': 'IUD complication', 'D': 'Human papillomavirus infection', 'E': 'Exposure to radioactive iodine'},
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D: Human papillomavirus infection
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Answer the following medical question with one of the provided options:
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Q:A 6-year-old female from a rural village in Afghanistan presents with her mother to a local health center complaining of leg weakness. Her mother also reports that the patient had a fever, fatigue, and headache a week prior that resolved. The patient has not received any immunizations since being born. Her temperature is 98.6°F (37°C), blood pressure is 110/70 mmHg, pulse is 90/min, and respirations are 18/min. Physical examination reveals 1/5 strength in right hip and knee actions and 0/5 strength in left hip and knee actions. Tone is notably decreased in both lower extremities. Sensation to touch, temperature, and vibration is intact. Patellar and Achilles reflexes are absent bilaterally. The most likely cause of this patient’s condition has which of the following characteristics?? {'A': 'Non-enveloped (+) ssRNA virus', 'B': 'Enveloped (+) ssRNA virus', 'C': 'Non-enveloped (-) ssRNA virus', 'D': 'Enveloped (-) ssRNA virus', 'E': 'dsRNA virus'},
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A: Non-enveloped (+) ssRNA virus
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Q:A 42-year-old man presents for evaluation of vitamin D deficiency with possible osteomalacia. The patient had a pathologic fracture 3 weeks ago and was found to have dangerously low levels of vitamin D with normal serum calcium levels. Bone density has been drastically affected, leading to the fracture this patient experienced. The lack of what compound is most responsible for the formation of this disease?? {'A': 'Calcifediol', 'B': 'Calcitriol', 'C': 'Vitamin D binding protein', 'D': 'PTH', 'E': '25-hydroxycholecalciferol'},
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B: Calcitriol
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Q:A 49-year-old woman comes to the physician because of a 4-month history of a dry cough and shortness of breath on exertion. She also reports recurrent episodes of pain, stiffness, and swelling in her wrist and her left knee over the past 6 months. She had two miscarriages at age 24 and 28. Physical examination shows pallor, ulcerations on the palate, and annular hyperpigmented plaques on the arms and neck. Fine inspiratory crackles are heard over bilateral lower lung fields on auscultation. Which of the following additional findings is most likely in this patient?? {'A': 'Decreased A-a gradient', 'B': 'Decreased right atrial pressure', 'C': 'Increased airway resistance', 'D': 'Decreased diffusing capacity', 'E': 'Increased lung compliance'},
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D: Decreased diffusing capacity
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Q:A 35-year-old man is found in the wilderness behind a ski resort where he was lost for 2 days, and deprived of food and water. He is rushed to the emergency department for medical care. Which of the following parameters best describes his physiologic state when found?? {'A': 'Urine volume: decreased; urine osmolarity: increased; free water clearance: increased; antidiuretic hormone (ADH): increased', 'B': 'Urine volume: decreased; urine osmolarity: increased; free water clearance: decreased; antidiuretic hormone (ADH): decreased', 'C': 'Urine volume: increased; urine osmolarity: increased; free water clearance: decreased; antidiuretic hormone (ADH): increased', 'D': 'Urine volume: decreased; urine osmolarity: decreased; free water clearance: decreased; antidiuretic hormone (ADH): increased', 'E': 'Urine volume: decreased; urine osmolarity: increased; free water clearance: decreased; antidiuretic hormone (ADH): increased'},
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E: Urine volume: decreased; urine osmolarity: increased; free water clearance: decreased; antidiuretic hormone (ADH): increased
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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 for a change in his behavior. The patient's wife called 911 and he was brought in by emergency medical services. She noticed that he seemed somnolent and not very responsive. The patient has a past medical history of type II diabetes, obesity, osteoarthritis, and migraine headaches. His current medications include naproxen, insulin, atorvastatin, metformin, ibuprofen, omeprazole, and fish oil. His temperature is 99.5°F (37.5°C), blood pressure is 170/115 mmHg, pulse is 80/min, respirations are 19/min, and oxygen saturation is 98% on room air. On physical exam, the patient is somnolent and has a Glasgow Coma Scale of 11. Cardiac and pulmonary exams are notable for bibasilar crackles and a systolic murmur that radiates to the carotids. Neurological exam is deferred due to the patient's condition. Laboratory values are shown below. Hemoglobin: 12 g/dL Hematocrit: 36% Leukocyte count: 9,500 cells/mm^3 with normal differential Platelet count: 199,000/mm^3 Serum: Na+: 144 mEq/L Cl-: 98 mEq/L K+: 4.0 mEq/L HCO3-: 16 mEq/L BUN: 44 mg/dL Glucose: 202 mg/dL Creatinine: 2.7 mg/dL Ca2+: 9.2 mg/dL AST: 12 U/L ALT: 22 U/L The patient is started on IV fluids. Which of the following represents the best next step in management?? {'A': 'Insulin', 'B': 'Potassium', 'C': 'Bicarbonate', 'D': 'Insulin and potassium', 'E': "Discontinue the patient's home medications"},
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E: Discontinue the patient's home medications
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Answer the following medical question with one of the provided options:
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Q:A 28-year-old man seeks evaluation at a medical office for facial swelling and blood in his urine during the last 3 days. He claims that he has had weakness, malaise, and low-grade fevers for the past 3 months. On physical examination, the blood pressure is 160/96 mm Hg and he has periorbital edema bilaterally. The lab testing is significant for leukocytosis, elevated blood urea nitrogen, and elevated serum creatinine. Urinalysis shows gross hematuria, proteinuria, and red blood cell casts. You suspect that this patient has Goodpasture’s disease and decide to order additional tests to confirm the diagnosis. Antibodies to which of the following would most likely be present in this patient if your suspicion is correct?? {'A': 'Collagen type III', 'B': 'Collagen type I', 'C': 'Collagen type V', 'D': 'Collagen type II', 'E': 'Collagen type IV'},
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E: Collagen type IV
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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 is admitted with a history of altered mental status. He was in his usual state of health until a few days ago when he has started to become confused, lethargic, forgetful, and repeating the same questions. Over the last few days, he sometimes appears perfectly normal, and, at other times, he has difficulty recognizing his family members. Yesterday, he was screaming that the room was filled with snakes. Past medical history is significant for type 2 diabetes mellitus, managed medically, and chronic kidney disease, for which he undergoes regular hemodialysis on alternate days. There is no history of smoking, alcohol use, or illicit drug use. His vitals include: blood pressure 129/88 mm Hg, pulse 112/min, temperature 38.2°C (100.8°F), and respiratory rate 20/min. The patient is oriented only to person and place. His mini-mental state examination (MMSE) score is 18/30, where he had difficulty performing basic arithmetic calculations and recalled only 1 out of 3 objects. Nuchal rigidity is absent. Muscle strength is 5/5 bilaterally. Which of the following is the most likely diagnosis in this patient?? {'A': 'Delirium', 'B': 'Dementia', 'C': 'Schizophrenia', 'D': 'Transient global amnesia', 'E': 'Wernicke’s aphasia'},
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A: Delirium
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Answer the following medical question with one of the provided options:
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Q:A 43-year-old man presents with a severe, throbbing, left-sided headache for the last 2 hours. He says that the pain has been progressively worsening and is aggravated by movement. The patient says he has had similar episodes in the past and would take acetaminophen and ‘sleep it off’. He also complains that the light in the room is intolerably bright, and he is starting to feel nauseous. No significant past medical history and no current medications. Vital signs include: pulse 110/min, respiratory rate 15/min, and blood pressure 136/86 mm Hg. Physical examination reveals mild conjunctival injection in the left eye. Intraocular pressure (IOP) is normal. The rest of the examination is unremarkable. The patient is given a medication which relieves his symptoms. During discharge, he wants more of this medication to prevent episodes in future but he is told that the medication is only effective in terminating acute attacks but not for prevention. Which of the following receptors does the drug given to this patient bind to?? {'A': 'β-adrenergic receptors', 'B': '5-hydroxytryptamine type 1 (5-HT1) receptors', 'C': 'Angiotensin II receptors', 'D': '5-hydroxytryptamine type 2 (5-HT2) receptors', 'E': 'Muscarinic receptors'},
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B: 5-hydroxytryptamine type 1 (5-HT1) receptors
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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 with a history of injection drug use has been feeling short of breath and fatigued for the past several weeks. He is having trouble climbing the stairs to his apartment and occasionally feels like his heart is racing out of control. His past medical history is most notable for a previous bout of infective endocarditis after which he was lost to follow-up. On exam, you note that his carotid pulse has rapid rise and fall. Which of the following would you also expect to find?? {'A': 'Mid-systolic click', 'B': 'Fixed, split S2', 'C': 'Venous hum', 'D': 'Widened pulse pressure', 'E': 'Systolic murmur that increases with valsalva'},
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D: Widened pulse pressure
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