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Answer the following medical question with one of the provided options:
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Q:A 37-year-old man comes to the physician because of increasing swelling and pain of his right knee for the past month. He has not had any trauma to the knee or previous problems with his joints. He has hypertension. His only medication is hydrochlorothiazide. He works as a carpet installer. He drinks two to three beers daily. He is 170 cm (5 ft 7 in) tall and weighs 97 kg (214 lb); BMI is 33.6 kg/m2. His temperature is 37°C (98.6°F), pulse is 88/min, and blood pressure is 122/82 mm Hg. Examination of the right knee shows swelling and erythema; there is fluctuant edema over the lower part of the patella. The range of flexion is limited because of the pain. The skin over the site of his pain is not warm. There is tenderness on palpation of the patella; there is no joint line tenderness. The remainder of the examination shows no abnormalities. Which of the following is the most likely diagnosis?? {'A': 'Gout', 'B': 'Septic arthritis', 'C': 'Prepatellar bursitis', 'D': 'Osteoarthritis', 'E': 'Osgood-Schlatter disease\n"'},
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C: Prepatellar bursitis
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Answer the following medical question with one of the provided options:
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Q:A 25-year-old woman is brought to the physician by her husband because she has appeared increasingly agitated over the last week. She feels restless, has not been able to sleep well, and has been pacing around her house continuously in an attempt to relieve her symptoms. Two weeks ago, she was diagnosed with schizophrenia and treatment with fluphenazine was initiated. Today, physical examination is interrupted multiple times because she is unable to sit or stand still for more than a couple minutes. Which of the following is the most likely diagnosis?? {'A': 'Restless legs syndrome', 'B': 'Parkinsonism', 'C': 'Akathisia', 'D': 'Inadequately treated schizophrenia', 'E': 'Drug-induced mania'},
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C: Akathisia
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Answer the following medical question with one of the provided options:
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Q:A 33-year-old female with bipolar disorder, well controlled with lithium, presents to your clinic. She would like to discuss pregnancy and her medication. She is in a committed monogamous relationship and because her symptoms are well-controlled, would like to become pregnant. She is worried that her folate levels might be low despite taking multivitamins every day. She would like to know if she needs to wait before becoming pregnant. What is the single most appropriate recommendation at this stage?? {'A': 'Discontinue the lithium', 'B': 'Switch to lamotrigine for the 1st trimester', 'C': 'The fetus will be at risk for neural tube defects', 'D': 'She can be maintained on valproate instead', 'E': 'Electroconvulsive therapy is unsafe during pregnancy'},
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A: Discontinue the lithium
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Answer the following medical question with one of the provided options:
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Q:A 60-year-old patient presents to the urgent care clinic with complaints of pain and abdominal distention for the past several weeks. The pain began with a change in bowel habits 3 months ago, and he gradually defecated less until he became completely constipated, which led to increasing pain and distention. He also mentions that he has lost weight during this period, even though he has not changed his diet. When asked about his family history, the patient reveals that his brother was diagnosed with colorectal cancer at 65 years of age. An abdominal radiograph and CT scan were done which confirmed the diagnosis of obstruction. Which of the following locations in the digestive tract are most likely involved in this patient’s disease process?? {'A': 'Small bowel', 'B': 'Ascending colon', 'C': 'Rectum', 'D': 'Cecum', 'E': 'Sigmoid colon'},
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E: Sigmoid colon
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Answer the following medical question with one of the provided options:
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Q:A 45-year-old man comes to the clinic concerned about his recent exposure to radon. He heard from his co-worker that radon exposure can cause lung cancer. He brings in a study concerning the risks of radon exposure. In the study, there were 300 patients exposed to radon, and 18 developed lung cancer over a 10-year period. To compare, there were 500 patients without radon exposure and 11 developed lung cancer over the same 10-year period. If we know that 0.05% of the population has been exposed to radon, what is the attributable risk percent for developing lung cancer over a 10 year period after radon exposure?? {'A': '0.31%', 'B': '2.2%', 'C': '3.8%', 'D': '6.0%', 'E': '63.3%'},
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E: 63.3%
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Answer the following medical question with one of the provided options:
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Q:A 79-year-old woman with type 2 diabetes mellitus and hypertension undergoes 99mTc cardiac scintigraphy for the evaluation of a 3-month history of retrosternal chest tightness on exertion. The patient's symptoms are reproduced following the administration of dipyridamole. A repeat ECG shows new ST depression and T wave inversion in leads V5 and V6. Which of the following is the most likely underlying mechanism of this patient's signs and symptoms during the procedure?? {'A': 'Transient atrioventricular nodal blockade', 'B': 'Reduced left ventricular preload', 'C': 'Dilation of coronary vasculature', 'D': 'Ruptured cholesterol plaque within a coronary vessel', 'E': 'Increased myocardial oxygen demand'},
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C: Dilation of coronary vasculature
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Answer the following medical question with one of the provided options:
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Q:A 9-year-old healthy female presents to her pediatrician for a healthy child visit. She is doing well in school and has good relationships with her teachers, friends, and family. Her temperature is 98.6°F (37°C), blood pressure is 110/70 mmHg, pulse is 85/min, and respirations are 16/min. On examination, a minimal amount of pubic hair is noted. Her breasts and papillae are slightly elevated with enlargement of the areolas. Which of the following is the most likely Tanner stage of development in this patient?? {'A': 'Tanner stage 1', 'B': 'Tanner stage 2', 'C': 'Tanner stage 3', 'D': 'Tanner stage 4', 'E': 'Tanner stage 5'},
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B: Tanner stage 2
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Answer the following medical question with one of the provided options:
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Q:A 10-year-old boy is brought to his pediatrician over concern for a 2-month history of headaches. Recently, the patient has been experiencing nausea and vomiting, along with some difficulty with coordination during soccer practice last week. On exam, the patient's temperature is 98.2°F (36.8°C), blood pressure is 110/80 mmHg, pulse is 72/min, and respirations are 14/min. On further evaluation, the patient is found to have a well-encapsulated posterior fossa mass. The patient undergoes surgical resection, and the mass is found to be positive for GFAP. Which of the following is derived from the same embryologic germ layer as the cells that comprise this tumor?? {'A': 'Ependymal cells', 'B': 'Melanocytes', 'C': 'Microglia', 'D': 'Nucleus pulposus', 'E': 'Schwann cells'},
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A: Ependymal cells
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Answer the following medical question with one of the provided options:
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Q:A 42-year-old woman with hypertension comes to the physician because of a 2-month history of persistent reddening of her face, daytime fatigue, and difficulty concentrating. She has fallen asleep multiple times during important meetings. Her only medication is lisinopril. She is 170 cm (5 ft 7 in) tall and weighs 88 kg (194 lb); BMI is 30 kg/m2. Her blood pressure is 145/85 mm Hg. Physical examination shows erythema of the face that is especially pronounced around the cheeks, nose, and ears. Serum glucose concentration is 120 mg/dL. Which of the following is the most likely cause of this patient's facial discoloration?? {'A': 'Antibody-mediated vasculopathy', 'B': 'Increased cortisol levels', 'C': 'Increased bradykinin production', 'D': 'Increased erythropoietin production', 'E': 'Increased serotonin levels'},
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D: Increased erythropoietin production
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Answer the following medical question with one of the provided options:
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Q:Two-hours into recovery from general anesthesia for an orthopedic fracture, a 34-year-old woman develops fever and masseter muscle rigidity with lockjaw. She has no history of a similar episode. She has no history of serious illness and takes no medications. She appears confused. In the recovery room, her blood pressure is 78/50 mm Hg, the pulse is 128/min, the respirations are 42/min, and the temperature is 40.3°C (104.5°F). Cardiopulmonary examination shows no abnormalities. Laboratory studies show: Serum Na+ 145 mEq/L K+ 6.5 mEq/L Arterial blood gas on room air pH 7.01 PCO2 78 mm Hg HCO3− 14 mEq/L PO2 55 mm Hg The patient is reintubated. Which of the following is the most appropriate next step in pharmacotherapy?? {'A': 'Cyproheptadine', 'B': 'Dantrolene', 'C': 'Diphenhydramine', 'D': 'Labetalol', 'E': 'Lorazepam'},
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B: Dantrolene
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Answer the following medical question with one of the provided options:
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Q:A 62-year-old female with a history of uncontrolled hypertension undergoes kidney transplantation. One month following surgery she has elevated serum blood urea nitrogen and creatinine and the patient complains of fever and arthralgia. Her medications include tacrolimus and prednisone. If the patient were experiencing acute, cell-mediated rejection, which of the following would you most expect to see upon biopsy of the transplanted kidney?? {'A': 'Sloughing of proximal tubular epithelial cells', 'B': 'Lymphocytic infiltrate of the tubules and interstitium', 'C': 'Drug precipitation in the renal tubules', 'D': 'Granular immunofluorescence around the glomerular basement membrane', 'E': 'Crescent formation in Bowman’s space'},
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B: Lymphocytic infiltrate of the tubules and interstitium
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Answer the following medical question with one of the provided options:
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Q:A 28-year-old graduate student visits the university health clinic for 3-weeks of epigastric pain that worsens with meals, associated with retrosternal pain, early satiety, and bloating. She denies vomiting blood or blood in her stool. She has been consuming large volumes of caffeinated-drinks and fast-food for a month, as she has been studying for her tests. Her family and personal history are unremarkable with no history of gastrointestinal cancer. Her vital signs are within normal limits. Physical examination is only positive for a mild epigastric tenderness. Which of the following is the most appropriate approach in this case?? {'A': 'Upper endoscopy', 'B': 'Barium swallow radiograph', 'C': 'Fecal antigen testing for Helicobacter pylori', 'D': 'Treatment with omeprazole', 'E': 'Treatment with metoclopramide'},
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C: Fecal antigen testing for Helicobacter pylori
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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 comes to the physician because of dysphagia and hoarseness of voice for the past 3 months. Initially, he had difficulty swallowing solid food but now has difficulty swallowing porridge and liquids as well. He has recently been choking on his oral secretions. During this period, he has had an 8.2-kg (18-lb) weight loss. He has noticed increasing weakness of both arms over the past year. He appears ill. His temperature is 36.8°C (98.2°F), pulse is 74/min, respirations are 14/min, and blood pressure is 114/74 mmHg. Examination shows tongue atrophy and pooled oral secretions. There is diffuse muscle atrophy with occasional twitching. He is unable to lift his arms above the chest level. Deep tendon reflexes are 3+ in all extremities. Sensation to pinprick, light touch, and vibration is intact. Laboratory studies show: Hemoglobin 16.1 g/dL Leukocyte count 10,900/mm3 Erythrocyte sedimentation rate 20 mm/h Serum Na+ 133 mEq/L K+ 4.2 mEq/L Cl- 101 mEq/L Urea nitrogen 12 mg/dL Creatinine 1.1 mg/dL Creatine kinase 320 U/L Albumin 4.3 mg/dL Lactate dehydrogenase 307 U/L An esophagogastroduodenoscopy shows no abnormalities. Which of the following is the most likely cause of this patient's symptoms?"? {'A': 'Destruction of upper and lower motor neurons', 'B': 'Dilation of the central spinal canal', 'C': 'Demyelination of peripheral nerves', 'D': 'Autoimmune destruction of acetylcholine receptors', 'E': 'Multiple cerebral infarctions'},
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A: Destruction of upper and lower motor neurons
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Answer the following medical question with one of the provided options:
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Q:A 63-year-old man with non-Hodgkin lymphoma is brought to the emergency department because of fever and confusion that have progressively worsened over the past 3 days. He also has a 3-day history of loose stools. He returned from France 2 weeks ago where he stayed in the countryside and ate typical French cuisine, including frog, snail, and various homemade cheeses. His last chemotherapy cycle was 3 weeks ago. He is oriented to person but not to place or time. His temperature is 39.5°C (103.1°F), pulse is 110/min, and blood pressure is 100/60 mm Hg. Examination shows cervical and axillary lymphadenopathy. The lungs are clear to auscultation. There is involuntary flexion of the bilateral hips and knees with passive flexion of the neck. Neurologic examination shows no focal findings. Laboratory studies show: Hemoglobin 9.3 g/dL Leukocyte count 3600/mm3 Platelet count 151,000/mm3 Serum Na+ 134 mEq/L Cl- 103 mEq/L K+ 3.7 mEq/L Glucose 102 mg/dL Creatinine 1.3 mg/dL A lumbar puncture is performed. Cerebrospinal fluid analysis shows a leukocyte count of 1200/mm3 (76% segmented neutrophils, 24% lymphocytes), a protein concentration of 113 mg/dL, and a glucose concentration of 21 mg/dL. The results of blood cultures are pending. Which of the following is the most appropriate initial pharmacotherapy?"? {'A': 'Ampicillin and cefotaxime', 'B': 'Ampicillin, gentamicin, and dexamethasone', 'C': 'Acyclovir and dexamethasone', 'D': 'Acyclovir', 'E': 'Vancomycin, ampicillin, and cefepime'},
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E: Vancomycin, ampicillin, and cefepime
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Answer the following medical question with one of the provided options:
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Q:A 28-year-old woman presents with a 12-month history of headache, tinnitus, retrobulbar pain, and photopsias. She says the headaches are mild to moderate, intermittent, diffusely localized, and refractory to nonsteroidal anti-inflammatory drugs (NSAIDs). In addition, this past week, she began to have associated dizziness and photopsia with the headaches. Physical examination reveals a body temperature of 36.5°C (97.7°F), blood pressure of 140/80 mm Hg, and a respiratory rate of 13/min and regular. BMI is 29 kg/m2. Neurological examination is significant for peripheral visual field loss in the inferior nasal quadrant, diplopia, bilateral abducens nerve palsy, and papilledema. A T1/T2 MRI of the brain did not identify extra-axial or intra-axial masses or interstitial edema, and a lumbar puncture showed an opening pressure of 27 cm H2O, with a cerebrospinal fluid analysis within the normal range. Which of the following best describes the pathogenic mechanism underlying these findings?? {'A': 'Arachnoid granulation adhesions', 'B': 'Elevated intracranial venous pressure', 'C': 'Aqueductal stenosis', 'D': 'Increased cerebrospinal production', 'E': 'Systemic hypertension'},
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B: Elevated intracranial venous pressure
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Answer the following medical question with one of the provided options:
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Q:A 1-month-old girl is brought to the physician for a follow-up examination. The mother has noticed that the girl's neck is always tilted to the right. She was delivered at term, and childbirth was complicated by a breech position. There is no family history of serious illness. She appears healthy. She is at 60th percentile for length and weight. Her temperature is 37.1°C (98.8°F), pulse is 102/min, and respirations are 42/min. Examination shows the head tilted toward the right, and the chin rotated towards the left. Range of motion of the neck is limited. There is a palpable, firm, well-circumscribed mass in the right lower side of the neck. The remainder of the examination shows no abnormalities. Which of the following is the most appropriate next best step in management?? {'A': 'CT scan of the neck', 'B': 'Botulinum toxin injection', 'C': 'Stretching program', 'D': 'X-ray of the cervical spine', 'E': 'Myotomy'},
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C: Stretching program
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Answer the following medical question with one of the provided options:
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Q:A 45-year-old Caucasian male with a history of chronic myeloid leukemia for which he is receiving chemotherapy presents to the emergency room with oliguria and colicky left flank pain. His serum creatinine is 3.0 mg/dL and is urine pH is 5.0. You diagnose nephrolithiasis. His kidney stones, however, are not visible on abdominal x-ray. His stone is most likely composed of which of the following?? {'A': 'Calcium oxalate', 'B': 'Calcium phosphate', 'C': 'Magnesium ammonium phosphate', 'D': 'Uric acid', 'E': 'Cystine'},
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D: Uric acid
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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 because of a skin lesion on his nose and in his mouth. The lesions have been gradually increasing in size and are not painful or pruritic. Two months ago, he was treated for esophageal candidiasis. Physical examination shows one pinkish-brown papule on the right wing of the nose and two similar nodular lesions on the hard palate and buccal mucosa. A biopsy of one of the lesions shows spindle-shaped endothelial cells and infiltration of lymphocytes, plasma cells, and macrophages. Which of the following is the most likely causal organism of this patient's condition?? {'A': 'Polyomavirus', 'B': 'Poxvirus', 'C': 'Epstein-Barr virus', 'D': 'Human herpes virus 8', 'E': 'Mycobacterium avium complex'},
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D: Human herpes virus 8
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Answer the following medical question with one of the provided options:
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Q:A 3580-g (7-lb 14-oz) male newborn is delivered at 36 weeks' gestation to a 26-year-old woman, gravida 2, para 1 after an uncomplicated pregnancy. His temperature is 36.7°C (98.1°F), heart rate is 96/min, and respirations are 55/min and irregular. Pulse oximetry on room air shows an oxygen saturation of 65% measured in the right hand. He sneezes and grimaces during suction of secretions from his mouth. There is some flexion movement. The trunk is pink and the extremities are blue. The cord is clamped and the newborn is dried and wrapped in a prewarmed towel. Which of the following is the most appropriate next best step in management?? {'A': 'Administer erythromycin ophthalmic ointment', 'B': 'Administer positive pressure ventilation', 'C': 'Perform endotracheal intubation', 'D': 'Administer intravenous epinephrine', 'E': 'Perform chest compressions\n"'},
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B: Administer positive pressure ventilation
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Answer the following medical question with one of the provided options:
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Q:A 29-year-old man comes to the physician with his wife because she has noticed a change in his behavior over the past 2 weeks. His wife reports that he is very distracted and irritable. His colleagues have voiced concerns that he has not been turning up for work regularly and behaves erratically when he does. Previously, her husband had been a reliable and reasonable person. The patient says that he feels “fantastic”; he only needs 4 hours of sleep each night and wakes up cheerful and full of energy each morning. He thinks that his wife is overreacting. The patient has been healthy except for a major depressive episode 5 years ago that was treated with paroxetine. He currently takes no medications. His pulse is 98/min, respirations are 12/min, and blood pressure is 128/62 mm Hg. Mental status examination shows frenzied speech and a flight of ideas. Which of the following is the strongest predisposing factor for this patient's condition?? {'A': 'Maternal obstetric complications', 'B': 'Higher socioeconomic class', 'C': 'Advanced paternal age', 'D': 'Genetic predisposition', 'E': 'Being married'},
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D: Genetic predisposition
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Answer the following medical question with one of the provided options:
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Q:A 65-year-old man with decompensated cirrhosis secondary to hepatitis C is brought to the emergency department with 2 episodes of massive hematemesis that started 2 hours ago. He is a liver transplant candidate. The blood pressure is 110/85 mm Hg in the supine position and 90/70 mm Hg after sitting for 3 minutes. The pulse is 110/min, the respirations are 22/min, and the temperature is 36.1°C (97.0°F). The physical examination shows spider angiomata, palmar erythema, and symmetric abdominal distension with positive shifting dullness. The lung and heart examination shows no abnormalities. Two large-bore intravenous lines are obtained. Saline (0.9%) is initiated. Laboratory tests are pending. The most important next step is to administer which of the following intravenous therapies?? {'A': 'Fresh frozen plasma', 'B': 'Octreotide', 'C': 'Packed red blood cells (RBCs)', 'D': 'Pantoprazole', 'E': 'Propranolol'},
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B: Octreotide
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Answer the following medical question with one of the provided options:
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Q:A 55-year-old man presents to the emergency department with fatigue and a change in his memory. The patient and his wife state that over the past several weeks the patient has been more confused and irritable and has had trouble focusing. He has had generalized and non-specific pain in his muscles and joints and is constipated. His temperature is 99.3°F (37.4°C), blood pressure is 172/99 mmHg, pulse is 79/min, respirations are 14/min, and oxygen saturation is 99% on room air. Physical exam is unremarkable. Laboratory studies are ordered as seen below. Hemoglobin: 9.0 g/dL Hematocrit: 30% Leukocyte count: 6,500/mm^3 with normal differential Platelet count: 166,000/mm^3 MCV: 78 fL Serum: Na+: 141 mEq/L Cl-: 103 mEq/L K+: 4.6 mEq/L HCO3-: 25 mEq/L BUN: 20 mg/dL Glucose: 99 mg/dL Creatinine: 0.9 mg/dL Ca2+: 10.2 mg/dL Which of the following is the most likely diagnosis?? {'A': 'Guillain-Barre syndrome', 'B': 'Heavy metal exposure', 'C': 'Iron deficiency', 'D': 'Systemic lupus erythematosus', 'E': 'Vitamin B12 deficiency'},
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B: Heavy metal exposure
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Answer the following medical question with one of the provided options:
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Q:A previously healthy 25-year-old male comes to his primary care physician with a painless solitary lesion on his penis that developed 4 days ago. He has not experienced anything like this before. He is currently sexually active with multiple partners and uses condoms inconsistently. His temperature is 37.0°C (98.7°F), pulse is 67/min, respirations are 17/min, and blood pressure is 110/70 mm Hg. Genitourinary examination shows a shallow, nontender, firm ulcer with a smooth base along the shaft of the penis. There is nontender inguinal adenopathy bilaterally. Which of the following is the most appropriate next step to confirm the diagnosis?? {'A': 'Swab culture', 'B': 'Urine polymerase chain reaction', 'C': 'Rapid plasma reagin', 'D': 'Fluorescent treponemal antibody absorption test', 'E': 'Dark-field microscopy\n"'},
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E: Dark-field microscopy "
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Answer the following medical question with one of the provided options:
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Q:A 4-month-old is noted to have a grade 3/6, harsh, systolic ejection murmur heard at the left upper sternal border. The mother reports that the child's lips occasionally turn blue during feeding. A cardiologist recommends surgery. Later, the physician remarks that the infant's congenital abnormality was related to a failure of neural crest cell migration. Prior to surgery, which of the following was a likely finding?? {'A': 'Atrial septal defect', 'B': 'Pulmonic stenosis', 'C': 'Triscuspid atresia', 'D': 'Coarctation of the aorta', 'E': 'Transposition of the great vessels'},
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B: Pulmonic stenosis
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Answer the following medical question with one of the provided options:
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Q:A 45-year-old man presents to the physician with complaints of burning pain in both feet and lower legs for 3 months. He reports that the pain is especially severe at night. He has a history of diabetes mellitus for the past 5 years, and he frequently skips his oral antidiabetic medications. His temperature is 36.9°C (98.4°F), heart rate is 80/min, respiratory rate is 15/min, and blood pressure is 120/80 mm Hg. His weight is 70 kg (154.3 lb) and height is 165 cm (approx. 5 ft 5 in). The neurologic examination reveals loss of sensations of pain and temperature over the dorsal and ventral sides of the feet and over the distal one-third of both legs. Proprioception is normal; knee jerks and ankle reflexes are also normal. The tone and strength in all muscles are normal. The hemoglobin A1C is 7.8%. Involvement of what type of nerve fibers is the most likely cause of the patient’s symptoms?? {'A': 'Aα & Aβ fibers', 'B': 'Aβ & Aγ fibers', 'C': 'Aγ & B fibers', 'D': 'Aδ & C fibers', 'E': 'Aγ & C fibers'},
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D: Aδ & C fibers
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Answer the following medical question with one of the provided options:
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Q:A 31-year-old man presents with jaundice, scleral icterus, dark urine, and pruritus. He also says that he has been experiencing abdominal pain shortly after eating. He says that symptoms started a week ago and have not improved. The patient denies any associated fever or recent weight-loss. He is afebrile and vital signs are within normal limits. On physical examination, the patient’s skin appears yellowish. Scleral icterus is present. Remainder of physical examination is unremarkable. Laboratory findings are significant for: Conjugated bilirubin 5.1 mg/dL Total bilirubin 6.0 mg/dL AST 24 U/L ALT 22 U/L Alkaline phosphatase 662 U/L A contrast CT of the abdomen is unremarkable. An ultrasound of the right upper quadrant reveals a normal gallbladder, but the common bile duct is not visible. Which of the following is the next best step in the management of this patient?? {'A': 'Antibiotics and admit to observation', 'B': 'HIDA scan', 'C': 'Endoscopic retrograde cholangiopancreatography (ERCP)', 'D': 'Serologies for antimitochondrial antibodies', 'E': 'Hepatitis serologies'},
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C: Endoscopic retrograde cholangiopancreatography (ERCP)
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Answer the following medical question with one of the provided options:
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Q:A 5-year-old African-American boy is brought to the physician because of fatigue and night sweats for the past month. During this time, he has also lost 3 kg (6.6 lbs). Before the onset of symptoms, he had been healthy except for a febrile seizure as an infant. His brother had chickenpox 2 months ago. He is at the 75th percentile for height and 50th percentile for weight. He appears markedly fatigued. His temperature is 38°C (100.4°F), pulse is 95/min, respirations are 19/min, and blood pressure is 100/60 mm Hg. Lung and cardiac examination is normal. There are enlarged, nontender lymph nodes bilaterally in the neck. The abdomen is soft and nontender. A complete blood count shows: Leukocyte count 8,000/mm3 Hemoglobin 9.1 g/dL Hematocrit 26.9% Platelet count 34,000/mm3 Serum Na+ 135 mEq/L K+ 4.5 mEq/L Cl- 101 mEq/L HCO3- 27 mEq/L Urea nitrogen 9 g/dL Creatinine 0.7 g/dL Ca2+ 8.8 mg/dL PCR testing demonstrates a 9:22 chromosomal translocation. Which of the following is the most appropriate pharmacotherapy?"? {'A': 'Hydroxyurea', 'B': 'All-trans retinoic acid', 'C': 'Transfuse platelets', 'D': 'Cladribine', 'E': 'Imatinib'},
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E: Imatinib
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Answer the following medical question with one of the provided options:
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Q:A newborn infant with karyotype 46, XY has male internal and external reproductive structures. The lack of a uterus in this infant can be attributed to the actions of which of the following cell types?? {'A': 'Leydig', 'B': 'Sertoli', 'C': 'Theca', 'D': 'Granulosa', 'E': 'Reticularis'},
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B: Sertoli
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Answer the following medical question with one of the provided options:
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Q:A 32-year-old woman comes to the physician because of increasing muscle weakness in her shoulders and legs for 6 weeks. She is unable to climb stairs or comb her hair. She has also had difficulty swallowing food for the past week. Her symptoms do not improve with rest. Physical examination shows normal muscle tone. There is bilateral weakness of the iliopsoas, hamstring, deltoid, and biceps muscles. Deep tendon reflexes are 2+ bilaterally. Sensation to pinprick, temperature, and vibration is intact. The remainder of the examination shows no abnormalities. Laboratory studies show: Hemoglobin 10.7 g/dL Leukocyte count 10.800/mm3 Erythrocyte sedimentation rate 100 mm/h Serum Glucose 60 mg/dL Creatine kinase 7047 U/L Lactate dehydrogenase 2785 U/L Thyroid-stimulating hormone 4.0 μU/mL Which of the following is the most appropriate next step in management?"? {'A': 'Lumbar puncture', 'B': 'Electromyography', 'C': 'Tensilon test', 'D': 'Temporal artery biopsy', 'E': 'Skin biopsy'},
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B: Electromyography
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Answer the following medical question with one of the provided options:
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Q:A 5-year-old boy is brought by his mother to the emergency department with fever, sore throat, runny nose, and rash. The patient’s mother says that symptoms started 3 days ago and that the rash first appeared on his face before spreading. His past medical history is unremarkable. The patient’s family recently moved from Japan to the USA so that the patient's father could work in a famous sushi restaurant in New York. The boy’s vaccination history is not up to date according to US guidelines. His temperature is 38.3°C (101.0°F). On physical examination, there is a maculopapular rash present on the trunk and extremities. There is also significant bilateral cervical lymphadenopathy and small petechial spots on the soft palate. Symptomatic treatment is provided and the patient recovers in 3 days. Which of the following best describes the most likely causative agent responsible for this patient’s condition?? {'A': 'Double-stranded DNA virus', 'B': 'Single-stranded positive-sense RNA virus', 'C': 'Cocci in chains', 'D': 'Double-stranded RNA virus', 'E': 'Single-stranded RNA retrovirus'},
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B: Single-stranded positive-sense RNA virus
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Answer the following medical question with one of the provided options:
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Q:A 4-year-old girl is brought to the doctor by her mother with the complaint of hearing loss, which her mother noticed a few days ago when the girl stopped responding to her name. The mother is anxious and says, “I want my child to get better even if it requires admission to the hospital.” Her family moved to a 70-year-old family home in Flint, Michigan, in 2012. The girl has a known history of beta-thalassemia trait. She has never been treated for hookworm, as her mother states that they maintain “good hygiene standards” at home. On examination, the girl currently uses only 2-syllable words. She is in the 70th percentile for height and 50th for weight. A Rinne test reveals that the girl’s air conduction is greater than her bone conduction in both ears. She does not respond when the doctor calls her name, except when he is within her line of sight. Her lab parameters are: Hemoglobin 9.9 gm% Mean corpuscular volume 80 fl Red blood cell distribution width (RDW) 15.9% Serum ferritin 150 ng/ml Total iron binding capacity 320 µg/dL A peripheral smear shows a microcytic hypochromic anemia with basophilic stippling and a few target cells. Which of the following is the next best step in the management of this patient?? {'A': 'Blood transfusion', 'B': 'Multivitamins with iron supplementation', 'C': 'Chelation therapy if the blood lead level is more than 25 µg/dL', 'D': 'Remove and prevent the child from exposure to the source of lead', 'E': 'Treatment for hookworm'},
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D: Remove and prevent the child from exposure to the source of lead
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Q:A 58-year-old woman presents to her primary care physician with complaints of an aching pain and stiffness in her neck, shoulders, and hips for the past several months. She reports difficulty in rising from a seated position as well as in raising her arms above her head. The patient also states that she has had fatigue and chronic fevers for the past month. Close and careful physical examination reveals normal muscle strength (despite some pain with testing and palpation), but limited range of motion of the neck, shoulders, and hips. There is no evidence in the history or physical examination of giant cell (temporal) arteritis. An initial work-up reveals a hemoglobin of 9 g/dL on a complete blood count. Further laboratory results are still pending. Which of the following results would be expected in the work-up of this patient's presenting condition?? {'A': 'Normal erythrocyte sedimentation rate and normal serum creatinine kinase', 'B': 'Normal erythrocyte sedimentation rate and elevated serum creatinine kinase', 'C': 'Elevated erythrocyte sedimentation rate and normal serum creatinine kinase', 'D': 'Elevated erythrocyte sedimentation rate and elevated serum creatinine kinase', 'E': 'Elevated serum C-reactive protein and normal erythrocyte sedimentation rate'},
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C: Elevated erythrocyte sedimentation rate and normal serum creatinine kinase
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Q:A 70-year-old man with loose stools over the last 24 hours, accompanied by abdominal pain, cramps, nausea, and anorexia, was hospitalized. Previously, the man was diagnosed with a lung abscess and was treated with clindamycin for 5 days. Past medical history was significant for non-erosive antral gastritis and hypertension. He takes esomeprazole and losartan. Despite the respiratory improvement, fevers and leukocytosis persisted. Which of the following pathogenic mechanisms would you expect to find in this patient?? {'A': 'Glucosylation of Rho family GTPases', 'B': 'Inactivation of elongation factor EF-2', 'C': 'Inactivation of the 60S ribosome subunit', 'D': 'ADP-ribosylation of Gs-alpha subunit of G-protein coupled receptors', 'E': 'Cell membrane degradation by lecithinase'},
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A: Glucosylation of Rho family GTPases
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Q:A 23-year-old man is admitted to the intensive care unit with acute respiratory distress syndrome (ARDS) due to influenza A. He has no history of serious illness and does not smoke. An x-ray of the chest shows diffuse bilateral infiltrates. Two weeks later, his symptoms have improved. Pulmonary examination on discharge shows inspiratory crackles at both lung bases. This patient is most likely to develop which of the following long-term complication?? {'A': 'Pulmonary embolism', 'B': 'Interstitial lung disease', 'C': 'Spontaneous pneumothorax', 'D': 'Panacinar emphysema', 'E': 'Asthma'},
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B: Interstitial lung disease
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Q:A 49-year-old African American female with a history of chronic myeloid leukemia for which she is receiving chemotherapy presents to the emergency room with oliguria and colicky left flank pain. Her serum creatinine is 3.3 mg/dL. What is the preferred preventative therapy that could have been administered to this patient to prevent her complication of chemotherapy?? {'A': 'Diuresis', 'B': 'Acidification of the urine', 'C': 'Colchicine', 'D': 'Steroids', 'E': 'Dialysis'},
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A: Diuresis
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Q:A research consortium is studying a new vaccine for respiratory syncytial virus (RSV) in premature infants compared to the current standard of care. 1000 infants were randomized to either the new vaccine group or the standard of care group. In total, 520 receive the new vaccine and 480 receive the standard of care. Of those who receive the new vaccine, 13 contract RSV. Of those who received the standard of care, 30 contract RSV. Which of the following is the absolute risk reduction of this new vaccine?? {'A': '1.7%', 'B': '2.5%', 'C': '3.75%', 'D': '4.3%', 'E': '6.25%'},
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C: 3.75%
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Q:A 71-year-old woman comes to her doctor because she is having trouble staying awake in the evening. Over the past year, she has noticed that she gets tired unusually early in the evenings and has trouble staying awake through dinner. She also experiences increased daytime sleepiness, fatigue, and difficulty concentrating. She typically goes to bed around 9 PM and gets out of bed between 2 and 3 AM. She does not have any trouble falling asleep. She takes 30-minute to 1-hour daytime naps approximately 3 times per week. She has no history of severe illness and does not take any medication. Which of the following is the most likely diagnosis?? {'A': 'Advanced sleep phase disorder', 'B': 'Depressive disorder', 'C': 'Insomnia disorder', 'D': 'Delayed sleep phase disorder', 'E': 'Non-REM sleep arousal disorder'},
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A: Advanced sleep phase disorder
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Q:A 63-year-old woman presents to the emergency department after being found unresponsive by her family. Upon presentation she is confused and does not answer questions that are addressed to her. An EKG is obtained and the result is provided here. Which of the following processes would be consistent with the findings seen on this patient's EKG?? {'A': 'Acute kidney failure', 'B': 'Bundle branch conduction changes', 'C': 'Excessive use of thiazides', 'D': 'Failure of atrioventricular node conduction', 'E': 'Interruption of pulmonary perfusion'},
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A: Acute kidney failure
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Q:A 24-year-old woman, gravida 1, at 35 weeks gestation is admitted to the hospital with regular contractions and pelvic pressure for the last 5 hours. Her pregnancy has been uncomplicated and she has attended many prenatal appointments and followed the physician's advice about screening for diseases, laboratory testing, diet, and exercise. She has had no history of fluid leakage or bleeding. At the hospital, her temperature is 37.2°C (99.0°F), blood pressure is 108/60 mm Hg, pulse is 88/min, and respirations are 16/min. Cervical examination shows 60% effacement and 5 cm dilation with intact membranes. Cardiotocography shows a contraction amplitude of 220 MVU in 10 minutes. Which of the following is the most appropriate pharmacotherapy at this time?? {'A': 'Dexamethasone', 'B': 'Magnesium sulfate', 'C': 'Oxytocin', 'D': 'Terbutaline', 'E': 'No pharmacotherapy at this time'},
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E: No pharmacotherapy at this time
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Q:Researchers are studying a farming community with a high incidence of acute myelogenous leukemia (AML). A retrospective cohort study is performed looking at the relationship between exposure to a certain pesticide chemical and the risk of developing AML. In 84 patients who developed AML, 17 had exposure to the pesticide chemical. In the control group of 116 patients, 2 had exposure to the chemical. What is the relative risk of developing AML upon exposure to the pesticide in this study group?? {'A': 'Prevalence of cases (84/200) divided by prevalence of controls (116/200)', 'B': 'Odds of exposure in the cases (17/67) divided by odds of exposure in the controls (2/114)', 'C': 'Number of exposed with AML (17) divided by the total number of AML cases (84)', 'D': 'Probability of AML among exposed (17/19) divided by probability of AML among unexposed (67/181)', 'E': 'Total number of cases (84) divided by the total number of study participants (200)'},
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D: Probability of AML among exposed (17/19) divided by probability of AML among unexposed (67/181)
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Q:A 66-year-old man presents to his family physician complaining of a sandpaper-like sensation when he touches the lesion on his forehead. His medical history is relevant for hypertension and hypercholesterolemia, for which he is taking losartan and atorvastatin. He used to work as a gardener, but he retired 3 years ago. His vital signs are within normal limits. Physical examination of his forehead reveals male-pattern baldness and thin, adherent, yellow-colored skin lesions that feel rough to the touch (see image). His family physician refers to him to a dermatologist for further management and treatment. Which of the following conditions would the patient most likely develop if this skin condition is left untreated?? {'A': 'Basal cell carcinoma', 'B': 'Squamous cell carcinoma', 'C': 'Mycosis fungoides', 'D': 'Seborrheic keratosis', 'E': 'Actinic cheilitis'},
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B: Squamous cell carcinoma
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Q:A 19-year-old woman comes to the physician because of episodic, bilateral finger pain and discoloration that occurs with cold weather. Her fingers first turn white, then blue, before eventually returning to a normal skin color. The symptoms have been occurring daily and limit her ability to work. She has no history of serious illness and takes no medication. She does not smoke. Physician examination shows normal capillary refill of the nail beds. The radial pulse is palpable bilaterally. The remainder of the examination shows no abnormalities. Which of the following is the most appropriate pharmacotherapy for this patient?? {'A': 'Phenylephrine', 'B': 'Isosorbide dinitrate', 'C': 'Nifedipine', 'D': 'Ergotamine', 'E': 'Prednisone'},
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C: Nifedipine
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Q:A 65-year-old man presents to the emergency department with a complaint of intense pain in his right foot for the past month, along with fever and chills. He denies any traumatic injury to his foot in recent memory. He has a medical history of poorly-controlled type II diabetes and is a former smoker with extensive peripheral vascular disease. On physical exam, the area of his right foot around the hallux is swollen, erythematous, tender to light palpation, and reveals exposed bone. Labs are notable for elevated C-reactive protein and erythrocyte sedimentation rate. The physician obtains a biopsy for culture. What is the most likely causative organism for this patient’s condition?? {'A': 'Mycobacterium tuberculosis', 'B': 'Neisseria gonorrhoeae', 'C': 'Pasteurella multocida', 'D': 'Pseudomonas aeruginosa', 'E': 'Staphylococcus aureus'},
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E: Staphylococcus aureus
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Q:A 14-year-old girl with a history of severe persistent asthma presents to her pediatrician after a recent hospital discharge for asthma exacerbation. Her mother is concerned that her daughter continues to wheeze and cough multiple nights per week. She is also concerned that her daughter frequently uses the bathroom to urinate despite no recent change in her diet. She has allergies to pollen and shellfish, but her mother denies any recent exposure. The patient's medications include albuterol, salmeterol, and both inhaled and oral prednisone. What alternative drug can the pediatrician recommend for this patient?? {'A': 'Natalizumab', 'B': 'Omalizumab', 'C': 'Imatinib', 'D': 'Nivolumab', 'E': 'Trastuzumab'},
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B: Omalizumab
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Q:A medical student is studying human physiology. She learns that there is a membrane potential across cell membranes in excitable cells. The differential distribution of anions and cations both inside and outside the cells significantly contributes to the genesis of the membrane potential. Which of the following distributions of anions and cations best explains the above phenomenon?? {'A': 'High concentration of Na+ outside the cell and high concentration of K+ inside the cell', 'B': 'High concentration of K+ outside the cell and low concentration of K+ inside the cell', 'C': 'High concentration of Ca2+ outside the cell and high concentration of Cl- inside the cell', 'D': 'Low concentration of Cl- outside the cell and high concentration of Cl- inside the cell', 'E': 'Low concentration of K+ outside the cell and high concentration of Ca2+ inside the cell'},
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A: High concentration of Na+ outside the cell and high concentration of K+ inside the cell
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Q:A 3-year-old African-American female presents to the emergency department with fatigue. Her parents endorse malaise and weakness on behalf of the patient for two weeks. Her temperature is 98.9°F (37.2°C), blood pressure is 94/70 mmHg, pulse is 102/min, and respirations are 22/min. On physical exam, she is tired-appearing with conjunctival pallor. Her parents report that they immigrated from Liberia before the patient was born. They deny any family history of medical disorders, and the patient has no sick contacts at home. Laboratory tests are performed and reveal the following: Leukocyte count: 10,700/mm^3 Hemoglobin: 8.6 g/dL Hematocrit: 24% Mean corpuscular volume: 84 µm^3 Platelet count: 488,000/mm^3 Reticulocyte index: 3.8% The patient should receive which of the following nutritional supplements?? {'A': 'Vitamin B6', 'B': 'Vitamin B9', 'C': 'Vitamin B12', 'D': 'Vitamin D', 'E': 'Iron'},
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B: Vitamin B9
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Q:A 1-month-old male infant is brought to the physician because of inconsolable crying for the past 3 hours. For the past 3 weeks, he has had multiple episodes of high-pitched unprovoked crying every day that last up to 4 hours and resolve spontaneously. He was born at term and weighed 2966 g (6 lb 9 oz); he now weighs 3800 g (8 lb 6 oz). He is exclusively breast fed. His temperature is 36.9°C (98.4°F) and pulse is 140/min. Examination shows a soft and nontender abdomen. The remainder of the examination shows no abnormalities. Which of the following is the most appropriate next step in management?? {'A': 'Perform lumbar puncture', 'B': 'Administer simethicone', 'C': 'Administer pantoprazole', 'D': 'Reassurance', 'E': 'Recommend the use of Gripe water'},
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D: Reassurance
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Q:A 40-year-old man comes to the physician because of a 1-month history of a painless lump on his neck. Two years ago, he underwent surgery for treatment-resistant hypertension, episodic headaches, and palpitations. Physical examination shows a firm, irregular swelling on the right side of the neck. Ultrasonography of the thyroid gland shows a 2-cm nodule with irregular margins and microcalcifications in the right thyroid lobe. Further evaluation of this patient is most likely to show increased serum concentration of which of the following substances?? {'A': 'Calcitonin', 'B': 'Gastrin', 'C': 'Metanephrines', 'D': 'Thyroid-stimulating hormone', 'E': 'Parathyroid hormone'},
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A: Calcitonin
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Q:A 16-year-old girl is brought to the physician because she has not yet had her 1st period. She was born at 39 weeks gestation via spontaneous vaginal delivery. She is up to date on all vaccines and meeting all developmental milestones. She has no history of a serious illness and takes no medications. Physical examination shows underdeveloped breasts with scant pubic and axillary hair. Speculum examination shows a short vagina and no cervix. The remainder of the physical examination shows no abnormalities. Pelvic ultrasound shows no uterus. Which of the following is the most likely karyotype in this patient?? {'A': '45,X', 'B': '46,XX', 'C': '46,XX/46,XY', 'D': '46,XY', 'E': '47,XXY'},
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D: 46,XY
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Q:A 64-year-old woman with osteoarthritis is brought to the emergency room because of a 2-day history of nausea and vomiting. Over the past few weeks, she has been taking acetaminophen frequently for worsening knee pain. Examination shows scleral icterus and tender hepatomegaly. She appears confused. Serum alanine aminotransferase (ALT) level is 845 U/L, aspartate aminotransferase (AST) is 798 U/L, and alkaline phosphatase is 152 U/L. Which of the following is the most likely underlying mechanism of this patient's liver failure?? {'A': 'Glucuronide-conjugate formation', 'B': 'Salicylic acid formation', 'C': 'N-acetyl-p-benzoquinoneimine formation', 'D': 'N-acetylcysteine formation', 'E': 'Sulfate-conjugate formation'},
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C: N-acetyl-p-benzoquinoneimine formation
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Q:A 7-year-old girl presents with a lump in her neck which she noticed a few days ago. The patient’s mother states that her daughter’s left eyelid seems to be drooping, making her left eye look small. There is no significant past medical history. On neurological examination, the patient has normal bilateral pupillary reflexes but a miotic left pupil. A lateral radiograph of the chest reveals a mass in the posterior mediastinum with no evidence of bone erosion. An MRI is performed and the results are shown in the image. An imaging-guided biopsy of the mass reveals spindle-shaped cells arranged chaotically, with moderate cytoplasm and small nuclei. Scattered mature ganglion cells with abundant cytoplasm and round to oval nuclei are also present. The biopsy tissue is analyzed with immunohistochemistry and found to be positive for S-100, synaptophysin, chromogranin, and leukocyte common antigen (LCA). Which of the following factors is associated with poor prognosis for this patient’s most likely diagnosis?? {'A': 'Detectable levels of homovanillic acid (HVA) and/or vanillylmandelic acid (VMA) in urine', 'B': 'Age younger than 18 months', 'C': 'Absence of nodular pattern', 'D': 'Deletion of short arm of chromosome 1', 'E': 'Absence of MYCN gene amplification'},
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D: Deletion of short arm of chromosome 1
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Q:A 45-year-old man presents for a follow-up visit as part of his immigration requirements into the United States. Earlier this week, he was administered the Mantoux tuberculin skin test (TST). Today’s reading, 3 days after being administered the test, he shows an induration of 10 mm. Given his recent immigration from a country with a high prevalence of tuberculosis, he is requested to obtain a radiograph of the chest, which is shown in the image. Which of the following is true regarding this patient’s chest radiograph (CXR)?? {'A': 'If the spinous process is not in-between the two clavicular heads, the image is repeated.', 'B': 'The film is taken in a supine position.', 'C': 'The right lower boundary of the mediastinal silhouette belongs to the right ventricle.', 'D': 'Posterior ribs 9 and 10 are visible only in an expiratory film.', 'E': 'The view is anteroposterior (AP).'},
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A: If the spinous process is not in-between the two clavicular heads, the image is repeated.
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Q:A 21-year-old man undergoes orthopedic surgery for a leg fracture that he has sustained in a motorbike accident. After induction of anesthesia with desflurane, the patient's respiratory minute ventilation decreases notably. Which of the following additional effects is most likely to occur in response to this drug?? {'A': 'Increased glomerular filtration rate', 'B': 'Increased cerebral metabolic rate', 'C': 'Decreased seizure threshold', 'D': 'Increased intracranial pressure', 'E': 'Increased skeletal muscle tonus'},
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D: Increased intracranial pressure
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Q:A 64-year-old woman otherwise healthy presents with acute onset severe rectal bleeding. The patient says that 2 hours ago bleeding began suddenly after a difficult bowel movement. She says the blood is bright red, and, initially, bleeding was brisk but now has stopped. The patient denies having any similar symptoms in the past. She has noticed that she bled more easily while having her regular manicure/pedicure for the past 3 months but thought it was nothing serious. No significant past medical history and the patient does not take any current medications. Family history is unremarkable. Review of systems is positive for mild dyspnea on exertion the past 2-3 months. Her vital signs include: temperature 37.0°C (98.6°F), blood pressure 100/65 mm Hg, pulse 95/min, respiratory rate 15/min, and oxygen saturation 97% on room air. A cardiac examination is significant for a 2/6 systolic murmur loudest at the right upper sternal border. Rectal exam shows no evidence of external hemorrhoids, fissures, or lesions. No active bleeding is noted. The stool is guaiac positive. Deficiency of which of the following is most likely the cause of this patient’s condition?? {'A': 'Vitamin K', 'B': 'Antithrombin III', 'C': 'von Willebrand factor', 'D': 'Factor VIII', 'E': 'ADAMST13 gene mutation'},
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C: von Willebrand factor
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Answer the following medical question with one of the provided options:
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Q:A 6-month-old girl is brought to the physician because of drooling and excessive crying for 3 days. She calms down when cuddled or with a pacifier in her mouth. She feeds well and has no vomiting or diarrhea. She was breastfed exclusively for 5 months. She is given no medications and was born at 39 weeks gestation via spontaneous vaginal delivery. She is up to date on all vaccines and is meeting all developmental milestones. At the clinic, her weight is 7.3 kg (16 lb 1 oz) and her height is 65.8 cm (25.9 in) in length. She appears irritable. Her pulse is 124/min, the respirations are 32/min, the blood pressure is 92/63 mm Hg, and the temperature is 36.8°C (98.2°F). On physical examination, she has no conjunctivitis, cervical lymphadenopathy, or pharyngeal erythema. Which element of the physical examination is most likely to be present in this patient?? {'A': 'Closure of the anterior fontanel', 'B': 'Crying on frontal sinus palpation', 'C': 'Eruption of mandibular incisors', 'D': 'Erythema and fluctuance of the submandibular area', 'E': 'The rooting reflex'},
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C: Eruption of mandibular incisors
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Answer the following medical question with one of the provided options:
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Q:A 23-year-old woman gravida 2, para 1 at 12 weeks' gestation comes to the physician for her initial prenatal visit. She feels well. She was treated for genital herpes one year ago and gonorrhea 3 months ago. Medications include folic acid and a multivitamin. Vital signs are within normal limits. Pelvic examination shows a uterus consistent in size with a 12-week gestation. Urine dipstick is positive for leukocyte esterase and nitrite. Urine culture shows E. coli (> 100,000 colony forming units/mL). Which of the following is the most appropriate next step in management?? {'A': 'Administer gentamicin', 'B': 'Administer trimethoprim/sulfamethoxazole (TMP/SMX)', 'C': 'Perform renal ultrasound', 'D': 'Perform cystoscopy', 'E': 'Administer amoxicillin/clavulanate'},
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E: Administer amoxicillin/clavulanate
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Q:A 60-year-old man comes to the physician because of progressive fatigue and shortness of breath for 2 months. The dyspnea occurs on moderate exertion and during the night; he sometimes wakes up coughing and “gasping for air.” He has also had several episodes of heart pounding and palpitations. Two weeks ago, he had a runny nose and a productive cough. He has type 2 diabetes mellitus and peripheral arterial disease. He has never smoked. He drinks one to two beers occasionally. He has a history of intravenous illicit drugs use but has not used in over 25 years. Current medications include aspirin, atorvastatin, and metformin. Vital signs are within normal limits. Examination shows bilateral basilar rales. Cardiac auscultation is shown. Which of the following is the most likely diagnosis?? {'A': 'Mitral valve regurgitation', 'B': 'Tricuspid valve regurgitation', 'C': 'Aortic valve regurgitation', 'D': 'Mitral valve stenosis', 'E': 'Aortic valve stenosis'},
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A: Mitral valve regurgitation
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Answer the following medical question with one of the provided options:
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Q:A 20-year-old woman college volleyball player presents with left shoulder pain and difficulty elevating her left arm. The patient began to experience dull pain in her left shoulder 5 days ago after a volleyball game. The pain is worse when she sleeps with her arm under the pillow or elevates or abducts her left arm. Her temperature is 37.0℃ (98.6℉), the blood pressure is 110/75 mm Hg, the pulse is 66/min, the respiratory rate is 13/min, and the oxygen saturation is 99% on room air. On physical examination, she is alert and cooperative. The left shoulder is normal on the inspection with no swelling or bony deformities. There is point tenderness to palpation of the anterolateral aspect of the left shoulder. Active range of motion of abduction of the left arm is restricted to 70°. Passive range of motion of abduction of the left arm is normal but elicits pain. Strength in the left shoulder is 4/5 and strength in the right shoulder is 5/5. Deep tendon reflexes are 2+ bilaterally. The sensation is intact. Which of the following is the most likely cause of this patient’s condition?? {'A': 'IV disk protrusion at the C4-5 level', 'B': 'Tear of the supraspinatus muscle', 'C': 'Intra-articular humeral fracture', 'D': 'Entrapment of the axillary nerve', 'E': 'Shoulder joint dislocation'},
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B: Tear of the supraspinatus muscle
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Answer the following medical question with one of the provided options:
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Q:An investigator is studying the mechanism regulating pigment production in the skin. She has isolated a hormone produced by the anterior and intermediate lobe of the pituitary gland that stimulates neural crest-derived cells to produce pigments through the oxidation and polymerization of the amino acid tyrosine. This hormone is most likely cosecreted with a substance that acts on which of the following receptors?? {'A': 'Glucocorticoid receptor', 'B': 'Vasopressin receptor', 'C': 'TSH receptor', 'D': 'Mu receptor', 'E': 'Dopamine receptor\n"'},
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D: Mu receptor
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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 with type 2 diabetes mellitus comes to the physician with a 3-day history of fever, right calf pain, and swelling. Her temperature is 38.7°C (101.7°F). Physical examination shows a 5 x 6-cm erythematous, warm, raised skin lesion with well-defined margins over the right upper posterior calf. The organism isolated from the lesion forms large mucoid colonies on blood agar. Further evaluation shows that the organism has a thick hyaluronic acid capsule. The causal organism of this patient's condition is most likely to have which of the following additional characteristics?? {'A': 'Solubility in bile', 'B': 'Susceptibility to bacitracin', 'C': 'Negative pyrrolidonyl arylamidase test', 'D': 'Positive coagulase test', 'E': 'Resistance to optochin\n"'},
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B: Susceptibility to bacitracin
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Q:A 67-year-old man is seen on the surgical floor after a transplant procedure. The previous day, the patient had a renal transplant from a matched donor. He is currently recovering and doing well. The patient has a past medical history of IV drug use, diabetes mellitus, oral cold sores, hypertension, renal failure, and dyslipidemia. The patient's current medications include lisinopril, atorvastain, insulin, and aspirin. Prior to the procedure, he was also on dialysis. The patient is started on cyclosporine. The patient successfully recovers over the next few days. Which of the following medications should be started in this patient?? {'A': 'Acyclovir', 'B': 'Azithromycin', 'C': 'Low dose acyclovir', 'D': 'Penicillin', 'E': 'TMP-SMX'},
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E: TMP-SMX
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Answer the following medical question with one of the provided options:
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Q:A 50-year-old woman presents with an acute worsening of a chronic rash on her arms and hands for the past week. She says she first noticed the rash 1 year ago which started as little red spots and gradually increased in size. 7 days ago, she noticed the rash suddenly got much worse and spread to her inguinal area, scalp, and knees, which has steadily worsened. She describes the rash as itchy but generally not painful. She says she feels it is very noticeable now and is causing her significant anxiety and depression in addition to the discomfort. The patient denies any fever, chills, sick contacts, or recent travel, and has no significant past medical history. She denies any alcohol use, smoking history, or recreational drug use. Her family history is significant for Crohn disease in her mother and maternal grandmother. She mentions that she has been excessively stressed the past few weeks as she is starting a new job. Review of systems is significant for early morning swelling of the distal joints in her hands and feet for the past 3 months. The patient is afebrile and her vital signs are within normal limits. On physical examination, there are multiple silvery scaly plaques on the extensor surfaces of her upper extremities bilaterally as shown in the exhibit (see image). Similar lesions are present on both knees, inguinal area, and scalp, involving > 10% of her total body surface area. Laboratory tests are unremarkable. Which of the following is the next best step in the management of this patient?? {'A': 'Skin biopsy', 'B': 'Phototherapy', 'C': 'Methotrexate', 'D': 'Infliximab', 'E': 'Cyclosporine'},
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C: Methotrexate
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Answer the following medical question with one of the provided options:
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Q:A 1-day-old infant born at full term by uncomplicated spontaneous vaginal delivery is noted to have cyanosis of the oral mucosa. The baby otherwise appears comfortable. On examination, his respiratory rate is 40/min and pulse oximetry is 80%. His left thumb is displaced and hypoplastic. A right ventricular lift is palpated, S1 is normal, S2 is single, and a harsh 3/6 systolic ejection murmur is heard at the left upper sternal border. Chest X-ray is shown. Which of the following is the most likely diagnosis?? {'A': 'Transposition of great vessels', 'B': 'Tetralogy of Fallot', 'C': 'Ventricular septal defect', 'D': 'Transient tachypnoea of the newborn', 'E': 'Pneumothorax'},
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B: Tetralogy of Fallot
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Answer the following medical question with one of the provided options:
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Q:A 35-year-old man is pulled out of a burning building. He is unconscious and severely injured. He is transported to the nearest emergency department. Upon arrival, he is stabilized and evaluated for burns and trauma. Approximately 40% of his body is covered in burns. The burned areas appear blackened and charred but the skin is mostly intact. It is noted that the patient has loss of pain sensation in the burnt areas with minimal blanching on palpation. The affected area is soft to when palpated. What category of burn did the patient most likely to suffer from?? {'A': 'Superficial (1st degree)', 'B': 'Deep-partial thickness (3rd degree)', 'C': 'Full-thickness (4th degree)', 'D': 'Superficial-partial thickness (2nd degree)', 'E': 'Electric burn'},
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B: Deep-partial thickness (3rd degree)
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Q:An otherwise healthy 43-year-old woman comes to the physician because of several episodes of involuntary movements of her head over the past few months. They are sometimes associated with neck pain and last minutes to hours. Neurologic examination shows no abnormalities. During examination of the neck, the patient's head turns horizontally to the left. She states this movement is involuntary, and that she is unable to unturn her head. After 5 minutes, her head re-straightens. Which of the following best describes this patient's disorder?? {'A': 'Akathisia', 'B': 'Hemiballismus', 'C': 'Dystonia', 'D': 'Chorea', 'E': 'Athetosis'},
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C: Dystonia
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Q:A 35-year-old woman presents to her family physician with a complaint of painful joints for the past 2 weeks. She reports symmetric bilateral joint pain in her hands, knees, and ankles. She has never had this before, and her past medical history is notable only for asthma. She states the pain is worse in the morning and improves throughout the day. Review of systems is notable for a recent low-grade fever with malaise. She works as a school teacher and is sexually active with men and women. Her temperature is 97.9°F (36.6°C), blood pressure is 120/84 mmHg, pulse is 70/min, respirations are 14/min, and oxygen saturation is 97% on room air. The patient is instructed to take ibuprofen and acetaminophen for her joint pain. She returns 1 month later stating that she has not needed to take the medications as her pain has been absent for the past 3 days. Which of the following is the most likely diagnosis?? {'A': 'Osteoarthritis', 'B': 'Parvovirus', 'C': 'Reactive arthritis', 'D': 'Rheumatoid arthritis', 'E': 'Transient synovitis'},
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B: Parvovirus
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Q:A 65-year-old man presents to the emergency department with abdominal pain and a pulsatile abdominal mass. Further examination of the mass shows that it is an abdominal aortic aneurysm. A computed tomography scan with contrast reveals an incidental finding of a horseshoe kidney, and the surgeon is informed of this finding prior to operating on the aneurysm. Which of the following may complicate the surgical approach in this patient?? {'A': 'Abnormal relationship between the kidney and the superior mesenteric artery', 'B': 'Anomalous origins of multiple renal arteries', 'C': 'Low glomerular filtration rate due to unilateral renal agenesis', 'D': 'Proximity of the fused kidney to the celiac artery', 'E': 'There are no additional complications'},
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B: Anomalous origins of multiple renal arteries
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Q:Thirty minutes after vaginal delivery of a 2780-g (6-lb 2-oz) newborn at term, a 25-year-old woman, gravida 1, para 1, has heavy vaginal bleeding. Her pregnancy was complicated by pre-eclampsia. Her pulse is 111/min and blood pressure is 95/65 mm Hg. Physical examination shows a fundal height 2 inches below the xiphoid process of the sternum. A drug with which of the following mechanisms of action is most appropriate for this patient?? {'A': 'Inhibition of norepinephrine reuptake', 'B': 'Activation of phospholipase C', 'C': 'Depolarization of the motor end plate', 'D': 'Increased synthesis of cyclic AMP', 'E': 'Binding to prostaglandin I2 receptors'},
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B: Activation of phospholipase C
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Q:A 30-year-old African American woman develops a facial rash in a "butterfly" pattern over her face and complains of feeling tired and achy in her joints. In the course of a full rheumatologic workup you note that she has anti-snRNP antibodies. Which of the following do snRNPs affect?? {'A': "Addition of the 5' 7-methylguanosine cap of mRNA", 'B': "Polyadenylation of the 3' end of mRNA", 'C': 'Protection of mRNA from degradation', 'D': 'Intron removal from the mRNA', 'E': 'Transcription of mRNA'},
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D: Intron removal from the mRNA
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Q:A previously healthy 61-year-old man comes to the physician because of a 6-month history of morning headaches. He also has fatigue and trouble concentrating on his daily tasks at work. He sleeps for 8 hours every night; his wife reports that he sometimes stops breathing for a few seconds while sleeping. His pulse is 71/min and blood pressure is 158/96 mm Hg. He is 178 cm (5 ft 10 in) tall and weighs 100 kg (220 lb); BMI is 31.6 kg/m2 . Which of the following is the most likely cause of this patient's hypertension?? {'A': 'Nocturnal upper airway obstruction', 'B': 'Hypophyseal neoplasm', 'C': 'Hypersecretion of aldosterone', 'D': 'Overproduction of cortisol', 'E': 'Proliferation of adrenal chromaffin cells'},
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A: Nocturnal upper airway obstruction
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Q:A 3-year-old girl is brought to the physician by her parents due to observations of rapid, random, horizontal and vertical eye movements along with occasional jerking movements of her limbs and head. CT scan reveals an abdominal mass that crosses the midline. Further work-up reveals elevated 24-hour urinary homovanillic acid and vanillylmandelic acid. Which of the following diseases pathologically originates from the type of cells as this patient’s most likely diagnosis?? {'A': 'Craniopharyngioma', 'B': 'Hirschsprung disease', 'C': 'Medulloblastoma', 'D': 'Parinaud syndrome', 'E': 'Pilocytic astrocytoma'},
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B: Hirschsprung disease
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Q:A 41-year-old man comes to the physician because of a 3-week history of fatigue, cough, and a 4.5-kg (10-lb) weight loss. He does not smoke or drink alcohol. He appears emaciated. A chest x-ray shows a calcified nodule in the left lower lobe and left hilar lymphadenopathy. The physician initiates therapy for the condition and informs him that he will have to return for monthly ophthalmologic examination for the next 2 months. These examinations are most likely to evaluate the patient for an adverse effect of a drug with which of the following mechanisms of action?? {'A': 'Impaired protein synthesis due to binding to 30S ribosomes', 'B': 'Impaired synthesis of cell wall polysaccharides', 'C': 'Impaired synthesis of mycolic acids', 'D': 'Impaired protein synthesis due to binding to 50S ribosomes', 'E': 'Impaired production of hemozoin from heme'},
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B: Impaired synthesis of cell wall polysaccharides
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Q:A 12-year-old boy is brought in by his mother with a 2-day history of fever and generalized weakness. She says that her son was involved in a school fight with some other kids 4 days ago and sustained minor injuries to the face. He was otherwise well, until this morning, when he complained of pain in his right eye. Physical examination reveals periorbital erythema and edema of the right eye, along with ophthalmoplegia and proptosis. Which of the following findings will most likely be present in this patient on the affected side as a sequela of his current condition?? {'A': 'Anesthesia along the CN V3 distribution', 'B': 'Decreased vision with sparing of the optic disc', 'C': 'Monocular diplopia', 'D': 'Intact sympathetic innervation to the pupil, but not parasympathetic innervation', 'E': 'Absent blink reflex'},
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E: Absent blink reflex
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Q:A 68-year-old man presents with shortness of breath, particularly when walking up stairs and when lying down to go to sleep at night. He also complains of a chronic cough and states that he now uses 2 extra pillows at night. The patient has a history of type 2 diabetes that is well-managed with metformin. He also takes Prozac for a long-standing history of depression. The patient has a 60-pack-year smoking history. He also has a history significant for alcohol abuse, but he quit cold turkey 15 years ago when his brother was killed in a drunk driving accident. Both he and his brother were adopted, and he does not know other members of his biological family. Despite repeated efforts of patient counseling, the patient is not interested in quitting smoking. The physical exam is significant for an obese male using accessory muscles of aspiration. The vital signs include: temperature 36.8°C (98.2°F), heart rate 95/min, respiratory rate 16/min, and blood pressure 130/85 mm Hg. The oxygen saturation is 90% on room air. Additional physical exam findings include cyanotic lips, peripheral edema, hepatomegaly, and ascites. The cardiovascular exam is significant for an S3 heart sound and elevated JVP. The pulmonary exam is significant for expiratory wheezing, diffuse rhonchi, and hyperresonance on percussion. The laboratory test results are as follows: BUN 15 mg/dL pCO2 60 mm Hg Bicarbonate (HCO3) 32 mmol/L Creatinine 0.8 mg/dL Glucose 95 mg/dL Serum chloride 103 mmol/L Serum potassium 3.9 mEq/L Serum sodium 140 mEq/L Total calcium 2.3 mmol/L Hemoglobin 26 g/dL Bilirubin total 0.9 mg/dL Bilirubin indirect 0.4 mg/dL Iron 100 Ferritin 70 TIBC 300 The l posterior-anterior chest X-ray is shown in the image. Which of the following interventions is indicated for decreasing the mortality of this patient?? {'A': 'Flu vaccine', 'B': 'Smoking cessation alone', 'C': 'ACE inhibitors', 'D': 'Inhaled anticholinergics', 'E': 'Both smoking cessation and oxygen administration'},
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B: Smoking cessation alone
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Q:A 56-year-old woman comes to the physician because of increasing muscle weakness in her shoulders and legs for 1 month. She has difficulties standing up and combing her hair. She also has had a skin rash on her face and hands for the past week. She has hypercholesterolemia treated with simvastatin. She has chronic eczema of her feet that is well-controlled with skin moisturizer and corticosteroid cream. Her mother and sister have thyroid disease. Vital signs are within normal limits. Examination shows facial erythema. A photograph of her hands is shown. Muscle strength is 3/5 in the iliopsoas, hamstring, deltoid, and biceps muscles. Sensation to pinprick, temperature, and vibration is intact. Further evaluation of this patient is most likely to show which of the following?? {'A': 'Anti-dsDNA antibodies', 'B': 'Symptom resolution on statin withdrawal', 'C': 'Pathological edrophonium test', 'D': 'Intramuscular inclusion bodies', 'E': 'Elevated serum CA-125'},
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E: Elevated serum CA-125
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Q:A 27-year-old pregnant woman presents to an obstetrician at 35 weeks gestation reporting that she noted the presence of a mucus plug in her vaginal discharge this morning. The obstetrician performs an examination and confirms that she is in labor. She was diagnosed with HIV infection 1 year ago. Her current antiretroviral therapy includes abacavir, lamivudine, and nevirapine. Her last HIV RNA level was 2,000 copies/mL 3 weeks ago. Which of the following anti-retroviral drugs should be administered intravenously to the woman during labor?? {'A': 'Abacavir', 'B': 'Enfuvirtide', 'C': 'Nevirapine', 'D': 'Rilpivirine', 'E': 'Zidovudine'},
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E: Zidovudine
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Q:A 67-year-old female is brought to the emergency room by her son for unusual behavior. She moved into her son’s house three years ago after her husband passed away. The son reports that when he returned home from work earlier in the day, he found his mother minimally responsive. She regained consciousness soon after his arrival and did not recall the event. The son also reports that for the past two years, his mother has had trouble remembering names and addresses. She still goes shopping on her own and cooks regularly. Her past medical history is notable for major depressive disorder, diabetes mellitus, and hypertension. She takes clomipramine, glyburide, lisinopril, and hydrochlorothiazide. She recently saw her primary care provider who adjusted some of her medication dosages. Her temperature is 99°F (37.2°C), blood pressure is 135/75 mmHg, pulse is 80/min, and respirations are 18/min. On examination, she is easily distractible with disorganized speech. She does not recognize her son and thinks that her intravenous line is a rope. She says she feels fine and would like to go home. Brain imaging would likely reveal which of the following?? {'A': 'Normal cerebrum', 'B': 'Focal atrophy of the frontal and temporal cortices', 'C': 'Mesial temporal lobe atrophy', 'D': 'Caudate nucleus atrophy', 'E': 'Multiple ischemic sites and microhemorrhages'},
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A: Normal cerebrum
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Q:A 59-year-old man is brought to the emergency department by a coworker for right arm weakness and numbness. The symptoms started suddenly 2 hours ago. His coworker also noticed his face appears to droop on the right side and his speech is slurred. He has a history of hypertension, hyperlipidemia, type 2 diabetes, and peripheral arterial disease. He works as a partner at a law firm and has been under more stress than usual lately. His father died of a stroke at age 70. The patient has smoked a pack of cigarettes daily for the last 40 years. He drinks two pints (750 mL) of whiskey each week. He takes aspirin, atorvastatin, lisinopril, and metformin daily. He is 167.6 cm (5 ft 6 in) tall and weighs 104.3 kg (230 lb); BMI is 37 kg/m2. His temperature is 37.1°C (98.8°F), pulse is 92/min, respirations are 15/min, and blood pressure is 143/92 mm Hg. He is fully alert and oriented. Neurological examination shows asymmetry of the face with droop of the lips on the right. There is 3/5 strength in right wrist flexion and extension, and right finger abduction. Sensation to light touch and pinprick is reduced throughout the right arm. Which of the following is the strongest predisposing factor for this patient's condition?? {'A': 'Hypertension', 'B': 'Excessive alcohol intake', 'C': 'Increased stress', 'D': 'Obesity', 'E': 'Hyperlipidemia'},
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A: Hypertension
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Q:A 3-year-old boy is brought to the physician because he is easily fatigued and has not gained weight. He eats 3 meals and has 3 to 4 bowel movements daily with bulky stools that float. He had recurrent episodes of sinusitis in infancy. He is at the 15th percentile for height and 5th percentile for weight. Examination shows pale conjunctivae. A few scattered expiratory crackles are heard in the thorax. There is abdominal distention. Which of the following is the most likely underlying cause of this patient's failure to thrive?? {'A': 'Small intestine bacterial overgrowth', 'B': 'Exocrine pancreatic insufficiency', 'C': 'Impaired intestinal amino acid transport', 'D': 'Mucosal damage from excessive gastric acid', 'E': 'Intestinal inflammatory reaction to gluten'},
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B: Exocrine pancreatic insufficiency
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Q:A 54-year-old man is brought to the emergency department 30 minutes after being hit by a car while crossing the street. He had a left-sided tonic-clonic seizure and one episode of vomiting while being transported to the hospital. On arrival, he is not oriented to person, place, or time. Physical examination shows flaccid paralysis of all extremities. A CT scan of the head is shown. This patient's symptoms are most likely the result of a hemorrhage in which of the following structures?? {'A': 'Into the ventricular system', 'B': 'Between the dura mater and the arachnoid mater', 'C': 'Between the skull and the dura mater', 'D': 'Into the cerebral parenchyma', 'E': 'Between the arachnoid mater and the pia mater'},
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E: Between the arachnoid mater and the pia mater
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Q:A 15-month-old girl is brought to the physician because of the sudden appearance of a rash on her trunk that started 6 hours ago and subsequently spread to her extremities. Four days ago, she was taken to the emergency department because of a high fever and vomiting. She was treated with acetaminophen and discharged the next day. The fever persisted for several days and abated just prior to appearance of the rash. Physical examination shows a rose-colored, blanching, maculopapular rash, and postauricular lymphadenopathy. Which of the following is the most likely diagnosis?? {'A': 'Nonbullous impetigo', 'B': 'Roseola infantum', 'C': 'Drug allergy', 'D': 'Rubella', 'E': 'Erythema infectiosum'},
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B: Roseola infantum
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Q:A 17-year-old boy presents to his primary care physician for eye pain. The patient states that it has been going on for the past 3 days and has been steadily worsening. He recently suffered a superior orbital fracture secondary to playing football without a helmet that required no treatment other than to refrain from contact sports. That patient's past medical history is non-contributory, and his vitals are within normal limits. Physical exam demonstrates pain and swelling inferior to the patient's eye near the lacrimal duct. When pressure is applied to the area expressible pus is noted. Cranial nerves II-XII are grossly intact. Which of the following is the most likely diagnosis?? {'A': 'Abscess', 'B': 'Dacrocystitis', 'C': 'Hordeolum', 'D': 'Orbital cellulitis', 'E': 'Periorbital cellulitis'},
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B: Dacrocystitis
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Q:A 68-year-old man is being evaluated in your radiation oncology clinic for treatment of a solid tumor. Your hospital has just purchased a new proton beam purported to deliver targeted radiation with fewer side effects than traditional radiation therapy. The patient expresses strong interest in receiving proton beam therapy, and you feel that he may have a better outcome with this new treatment modality. Later that day, an executive from the patient's insurance company calls to tell you that proton beam therapy will cost the company (but not the patient) a much larger amount of money than traditional therapy. They are willing to pay for proton beam therapy, but request that you convince the patient to undergo traditional therapy instead. You have a longstanding relationship with this insurance company as well as this particular executive. How should you proceed?? {'A': 'Discuss the issue of cost to the insurer with your patient, pointing out that keeping his insurance company happy may make them more likely to cover additional treatments in the future', 'B': "Proceed with proton beam therapy as discussed at your patient's appointment", 'C': 'Tell the patient that proton beam therapy will not be covered by his insurance company, so you will need to proceed with traditional radiation therapy', 'D': "Discuss the issue of cost to the insurer with your patient, relaying the company's request to him without making further commentary or recommendation", 'E': "Call your hospital's ethics committee for a formal consultation"},
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B: Proceed with proton beam therapy as discussed at your patient's appointment
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Q:A 2-month-old boy is presented to the clinic for a well-child visit by his parents. They are concerned with his weak cry and difficulty with feeding. Birth history reveals that the boy was born at the 37th week of gestation by cesarean section due to poor fetal movement and fetal distress. His Apgar scores were 3 and 5 at 1st and 5th minute respectively and his birth weight was 2.5 kg (6 lb). His vital signs include heart rate 120/min, respiratory rate 40/min, blood pressure 90/50 mm Hg, and temperature 37.0°C (98.6°F). Physical examination reveals a malnourished boy with a small narrow forehead and a small jaw. His mouth is small and he has comparatively small genitals. He has a poor muscle tone. After repeated follow-up, he gains weight rapidly but his height fails to increase. Developmental milestones are delayed at the age of 3 years. Genetic testing reveals Prader-Willi syndrome. Which of the following is the most common mechanism for the development of this patient’s condition?? {'A': 'Heteroplasmy', 'B': 'Paternal uniparental disomy', 'C': 'Silencing in imprinting region', 'D': 'Anticipation', 'E': 'Incomplete penetrance'},
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C: Silencing in imprinting region
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Answer the following medical question with one of the provided options:
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Q:A 25-year-old male presents to his primary care physician for pain in his knee. The patient was in a wrestling match when his legs were grabbed from behind and he was taken to the floor. The patient states that the moment this impact happened, he felt a snapping and sudden pain in his knee. When the match ended and he stood back up, his knee felt unstable. Minutes later, his knee was swollen and painful. Since then, the patient claims that he has felt unstable bearing weight on the leg. The patient has no significant past medical history, and is currently taking a multivitamin and protein supplements. On physical exam you note a tender right knee, with erythema and an effusion. Which of the following is the most likely physical exam finding in this patient?? {'A': 'Laxity to valgus stress', 'B': 'Laxity to varus stress', 'C': 'Clicking and locking of the joint with motion', 'D': 'Anterior translation of the tibia relative to the femur', 'E': 'Posterior translation of the tibia relative to the femur'},
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D: Anterior translation of the tibia relative to the femur
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Q:A 55-year-old man presents to the physician for the evaluation of excessive daytime sleepiness over the past six months. Despite sleeping 8–9 hours a night and taking a nap during the day, he feels drowsy and is afraid to drive. His wife complains of loud snoring and gasping during the night. His blood pressure is 155/95 mm Hg. BMI is 37 kg/m2. Oropharyngeal examination shows a small orifice and an enlarged tongue and uvula. The soft palate is low-lying. The examination of the nasal cavity shows no septal deviation or polyps. Examination of the lungs and heart shows no abnormalities. Polysomnography shows an apnea-hypopnea index of 8 episodes/h. The patient is educated about weight loss, exercise, and regular sleep hours and duration. Which of the following is the most appropriate next step in management?? {'A': 'Continuous positive airway pressure', 'B': 'Oral appliances', 'C': 'Supplemental oxygen', 'D': 'Upper airway neurostimulation', 'E': 'Upper airway surgery'},
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A: Continuous positive airway pressure
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Q:A 60-year-old man comes to the emergency department because of a 3-day history of fever and shortness of breath. He has a history of COPD treated with inhaled albuterol. His temperature is 39.0°C (102.2°F), pulse is 95/min, respirations are 20/min, and blood pressure is 130/80 mm Hg. Cardiopulmonary examination shows decreased breath sounds and poor air movement over the left lung. A lateral decubitus x-ray of the chest shows a pleural effusion height of 2 cm. Thoracentesis is performed and pleural fluid analysis shows a protein concentration of 4.0 g/dL and LDH of 80 U/L. Which of the following is the most likely underlying cause of this patient's effusion?? {'A': 'Impaired lymphatic flow', 'B': 'Increased pulmonary capillary permeability', 'C': 'Increased pulmonary capillary pressure', 'D': 'Decreased intrapleural pressure', 'E': 'Decreased plasma oncotic pressure'},
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B: Increased pulmonary capillary permeability
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Q:A 30-year-old man comes to the physician for follow-up evaluation for hypertension. He reports a 1-month history of episodic throbbing headaches, palpitations, and paroxysmal sweating. Blood pressure is 160/90 mm Hg. He appears pale but physical examination is otherwise unremarkable. Laboratory studies show elevated urine and plasma metanephrines. A CT scan of the abdomen shows a mass in the left adrenal gland. Which of the following is the most appropriate initial pharmacotherapy for this patient?? {'A': 'Phenoxybenzamine', 'B': 'Octreotide', 'C': 'Propranolol', 'D': 'Clonidine', 'E': 'Hydrochlorothiazide'},
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A: Phenoxybenzamine
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Q:A 2-year-old boy is brought to the physician for the evaluation of fever, breathing difficulty, and cough during the past week. In the past year, the patient was diagnosed with four sinus infections, 3 upper respiratory tract infections, and an episode of severe bronchiolitis requiring hospitalization. Since birth, he has had multiple episodes of oral thrush treated with nystatin, as well as chronic diarrhea and failure to thrive. His temperature is 38.0°C (100.4°F), pulse is 130/min, respirations are 38/min, and blood pressure is 106/63 mm Hg. Pulse oximetry at room air shows an oxygen saturation of 88%. Pulmonary auscultation shows bilateral crackles and wheezing. Physical examination indicates a prominent nasal bridge, hypoplastic nasal wing, a shortened chin, and dysplastic ears. An X-ray of the chest shows hyperinflation of the lungs, interstitial infiltrates, and atelectasis. The patient tests positive for respiratory syncytial virus (RSV) in the nasopharyngeal aspirate. This patient most likely has a deficiency of which of the following?? {'A': 'B cells', 'B': 'B and T cells', 'C': 'Immunoglobulin A', 'D': 'Interleukin-12 receptor', 'E': 'T cells'},
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E: T cells
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Q:In recent years, psoriasis has been identified as a risk factor for cardiovascular disease. A researcher conducted a study in which he identified 200 patients with psoriasis and 200 patients without psoriasis. The patients were followed for 10 years. At the end of this period, participants' charts were reviewed for myocardial infarction during this time interval. Myocardial infarction No myocardial infarction Total Psoriasis 12 188 200 No psoriasis 4 196 200 Total 16 384 400 What is the 10-year risk of myocardial infarction in participants with psoriasis?"? {'A': '0.5', 'B': '0.75', 'C': '0.06', 'D': '0.04', 'E': '0.02'},
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C: 0.06
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Answer the following medical question with one of the provided options:
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Q:A 36-year-old woman, gravida 3, para 2, at 37 weeks' gestation comes to the emergency department because of sparse vaginal bleeding for 3 hours. She also noticed the bleeding 3 days ago. She has had no prenatal care. Both of her previous children were delivered by lower segment transverse cesarean section. Her temperature is 37.1°C (98.8°F), pulse is 90/min, respirations are 16/min, and blood pressure is 110/80 mm Hg. The abdomen is nontender, and no contractions are felt. Examination shows that the fetus is in a vertex presentation. The fetal heart rate is 160/min and shows no abnormalities. Which of the following is the most appropriate next step in management?? {'A': 'Perform pelvic examination', 'B': 'Perform transvaginal sonography', 'C': 'Perform cesarean delivery', 'D': 'Perform Kleihauer-Betke test', 'E': 'Conduct contraction stress test'},
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B: Perform transvaginal sonography
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Answer the following medical question with one of the provided options:
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Q:A 51-year-old woman schedules an appointment with her physician with complaints of upper abdominal pain, nausea, and early satiety for the last 6 months. She has type 1 diabetes for the past 10 years and is on subcutaneous insulin with metformin. She complains of occasional heartburn and lost 4.5 kg (10 lb) in the past 6 months without any changes in her diet. The medical history is significant for long QT syndrome. The vital signs include: pulse 74/min, respirations 18/min, temperature 37.7°C (99.9°F), and blood pressure 140/84 mm Hg. Abdominal examination is negative for organomegaly or a palpable mass, but there is a presence of succussion splash. She has slightly decreased vision in both her eyes and fundoscopy reveals diabetic changes in the retina. Esophagogastroduodenoscopy is performed, which is negative for obstruction, but a small ulcer is noted near the cardiac end of the stomach with some food particles. Which of the following drugs would be inappropriate in the management of this patient’s condition?? {'A': 'Bethanechol', 'B': 'Cisapride', 'C': 'Erythromycin', 'D': 'Promethazine', 'E': 'Domperidone'},
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B: Cisapride
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Answer the following medical question with one of the provided options:
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Q:A 3-year-old girl is brought to the physician by her parents for complaints of breast development and pubic hair growth for the past 6 months. She has no significant birth or medical history. The temperature is 37.0°C (98.6°F), the pulse is 88/min, and the respirations are 20/min. Physical examination shows enlarged breasts at Tanner stage 3 and pubic hair at stage 2. Height and weight are in the normal range. On GnRH stimulation testing, a luteinizing hormone (LH) response of < 5 IU/L is detected. What is the most appropriate next step in diagnosis?? {'A': 'Repeat the GnRH stimulation test to see the LH response', 'B': 'Use a GnRH test to see the LH:FSH ratio', 'C': 'Use a leuprolide test to see the estradiol levels', 'D': 'Use a leuprolide test to see the testosterone levels', 'E': 'Use a GnRH test to see the FSH levels'},
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C: Use a leuprolide test to see the estradiol levels
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Answer the following medical question with one of the provided options:
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Q:A 19-year-old woman presents to the physician for a routine health maintenance examination. She has a past medical history of gastroesophageal reflux disease. She recently moved to a new city to begin her undergraduate studies. Her father was diagnosed with colon cancer at age 46. Her father's brother died because of small bowel cancer. Her paternal grandfather died because of stomach cancer. She takes a vitamin supplement. Current medications include esomeprazole and a multivitamin. She smoked 1 pack of cigarettes daily for 3 years but quit 2 years ago. She drinks 1–2 alcoholic beverages on the weekends. She appears healthy. Vital signs are within normal limits. Physical examination shows no abnormalities. Colonoscopy is unremarkable. Germline testing via DNA sequencing in this patient shows mutations in DNA repair genes MLH1 and MSH2. Which of the following will this patient most likely require at some point in her life?? {'A': 'Annual colonoscopy beginning at 20–25 years of age', 'B': 'Celecoxib or sulindac therapy', 'C': 'Measurement of carcinoembryonic antigen and CA 19-9 yearly', 'D': 'Prophylactic proctocolectomy with ileoanal anastomosis', 'E': 'Surgical removal of a desmoid tumor'},
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A: Annual colonoscopy beginning at 20–25 years of age
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Answer the following medical question with one of the provided options:
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Q:A 61-year-old man presents to the emergency department for the evaluation of polyuria, polydipsia, and confusion. He has a history of the psychiatric disease but is unable to provide additional details. He is admitted to the hospital and his home medications are continued. Routine testing is unrevealing for the etiology of his symptoms. Desmopressin acetate (DDAVP) is given, but no effect is seen on urine output or urine osmolarity. Which of the following medications could have induced this syndrome?? {'A': 'Ranitidine', 'B': 'Omeprazole', 'C': 'Nitrofurantoin', 'D': 'Nafcillin', 'E': 'Lithium'},
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E: Lithium
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Answer the following medical question with one of the provided options:
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Q:A 32-year-old woman presents to your office with abdominal pain and bloating over the last month. She also complains of intermittent, copious, non-bloody diarrhea over the same time. Last month, she had a cough that has since improved but has not completely resolved. She has no sick contacts and has not left the country recently. She denies any myalgias, itching, or rashes. Physical and laboratory evaluations are unremarkable. Examination of her stool reveals the causative organism. This organism is most likely transmitted to the human host through which of the following routes?? {'A': 'Inhalation', 'B': 'Penetration of skin', 'C': 'Animal bite', 'D': 'Insect bite', 'E': 'Sexual contact'},
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B: Penetration of skin
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Answer the following medical question with one of the provided options:
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Q:A 78-year-old man presented to his primary physician with a 3-month history of weight loss, fever, fatigue, night sweats, and cough. He is a former smoker. A recent HIV test was negative. A CT scan of the chest reveals a 3 cm lesion in the lower lobe of the left lung and calcification around the left lung hilus. A sputum smear was positive for acid fast organisms. These findings are most consistent with which of the following:? {'A': 'Primary tuberculosis', 'B': 'Adenocarcinoma', 'C': 'Miliary tuberculosis', 'D': 'Coccidioidomycosis infection', 'E': 'Secondary tuberculosis'},
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A: Primary tuberculosis
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Answer the following medical question with one of the provided options:
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Q:A 45-year-old woman comes to see you for a second opinion regarding an upcoming surgery for pancreatic insulinoma. While taking a surgical history, she tells you she previously had a pituitary tumor resected. For which additional neoplasms might you consider testing her?? {'A': 'Medullary thyroid carcinoma', 'B': 'Pheochromocytoma', 'C': 'Parathyroid adenoma', 'D': 'Mucosal neuroma', 'E': 'Multiple myeloma'},
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C: Parathyroid adenoma
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Answer the following medical question with one of the provided options:
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Q:A 12-year-old girl comes to the clinic with a grossly enlarged abdomen. She has a history of frequent episodes of weakness, sweating, and pallor that are eliminated by eating. Her development has been slow. She started to walk unassisted at 2 years and was not performing well at school. Physical examination reveals a blood pressure of 100/60 mm Hg, heart rate of 80/min, and temperature of 36.9°C (98.4℉). On physical examination, the liver is enlarged, firm, and palpable up to the pelvis. The spleen and kidney are not palpable. Laboratory investigation reveals low blood glucose and pH with high lactate, triglycerides, ketones, and free fatty acids. The liver biopsy revealed high glycogen content. Hepatic glycogen structure was normal. The enzyme assay performed on the biopsy tissue revealed very low glucose-6-phosphatase levels. What is the most likely diagnosis?? {'A': 'Hereditary hemochromatosis', 'B': "Cori's disease", 'C': "Pompe's disease", 'D': "Von-Gierke's disease", 'E': 'McArdle disease'},
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D: Von-Gierke's disease
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Answer the following medical question with one of the provided options:
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Q:A 25-year-old man is brought to the emergency department after his girlfriend discovered him at home in a minimally responsive state. He has a history of drinking alcohol excessively and using illicit drugs. On arrival, he does not respond to commands but withdraws all extremities to pain. His pulse is 90/min, respirations are 8/min, and blood pressure is 130/90 mm Hg. Pulse oximetry while receiving bag-valve-mask ventilation shows an oxygen saturation of 95%. Examination shows cool, dry skin, with scattered track marks on his arms and legs. The pupils are pinpoint and react sluggishly to light. His serum blood glucose level is 80 mg/dL. The most appropriate next step in management is intravenous administration of which of the following?? {'A': 'Naloxone', 'B': 'Phentolamine', 'C': 'Methadone', 'D': 'Naltrexone', 'E': 'Fomepizole'},
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A: Naloxone
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