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The following are multiple choice questions (with answers) about medical knowledge. Question: A 4-month-old boy is brought to the physician because of a lesion on his right thigh. Yesterday, he was administered all scheduled childhood immunizations. His vital signs are within normal limits. Physical examination shows a 2-cm sized ulcer with surrounding induration over the right anterolateral thigh. Which of the following is the most likely cause of his symptoms? (A) Dermal mast cell activation (B) Immune complex deposition (C) Intradermal acantholysis (D) Infective dermal inflammation	['(B) Immune complex deposition <> answer', 'The following are multiple choice questions (with answers) about medical knowledge. <> instruction', '(A) Dermal mast cell activation (B) Immune complex deposition (C) Intradermal acantholysis (D) Infective dermal inflammation <> possible answers', ' A 4-month-old boy is brought to the physician because of a lesion on his right thigh. Yesterday, he was administered all scheduled childhood immunizations. His vital signs are within normal limits. Physical examination shows a 2-cm sized ulcer with surrounding induration over the right anterolateral thigh. Which of the following is the most likely cause of his symptoms? <> context']
The following are multiple choice questions (with answers) about medical knowledge. Question: A 68-year-old male with congestive heart failure recently had his medication regiment adjusted to better control his hypertension. Three weeks later, laboratory analysis shows his serum calcium and magnesium levels have both decreased. The diuretic used in this patient acts predominantly on which nephron segment: (A) Proximal tubule (B) Descending loop of Henle (C) Thick ascending loop of Henle (D) Distal tubule	['(C) Thick ascending loop of Henle <> answer', 'The following are multiple choice questions (with answers) about medical knowledge. <> instruction', '(A) Proximal tubule (B) Descending loop of Henle (C) Thick ascending loop of Henle (D) Distal tubule <> possible answers', ' A 68-year-old male with congestive heart failure recently had his medication regiment adjusted to better control his hypertension. Three weeks later, laboratory analysis shows his serum calcium and magnesium levels have both decreased. The diuretic used in this patient acts predominantly on which nephron segment: <> context']
The following are multiple choice questions (with answers) about medical knowledge. Question: A 7-month-old girl is brought to the pediatrician by her parents with a mild, persistent fever for the past week. The patient’s mother also states she is feeding poorly and has become somewhat lethargic. The patient was born at term and the delivery was uncomplicated. The child’s birth weight was 3.5 kg (7.7 lb) and at 6 months was 7.0 kg (15.4 lb). She is fully immunized. The patient’s father recently returned from a business trip to India with a mild cough and was diagnosed with tuberculosis. The patient’s mother tests negative for tuberculosis The patient’s temperature is 38.1℃ (100.5℉). Today, she weighs 7.0 kg (15.4 lb). Cardiopulmonary auscultation reveals diminished breath sounds in the upper lobes. A chest radiograph demonstrates hilar lymphadenopathy and infiltrates in the upper lobes. Gastric aspirates are positive for acid-fast bacilli, however, cultures are still pending. Father and daughter are both started on standard antitubercular therapy. Which of the following is the appropriate management for the patient’s mother? (A) No medication is required (B) Isoniazid alone (C) Isoniazid and rifampicin (D) Isoniazid, rifampicin, and pyrazinamide	['(B) Isoniazid alone <> answer', 'The following are multiple choice questions (with answers) about medical knowledge. <> instruction', '(A) No medication is required (B) Isoniazid alone (C) Isoniazid and rifampicin (D) Isoniazid, rifampicin, and pyrazinamide <> possible answers', ' A 7-month-old girl is brought to the pediatrician by her parents with a mild, persistent fever for the past week. The patient’s mother also states she is feeding poorly and has become somewhat lethargic. The patient was born at term and the delivery was uncomplicated. The child’s birth weight was 3.5 kg (7.7 lb) and at 6 months was 7.0 kg (15.4 lb). She is fully immunized. The patient’s father recently returned from a business trip to India with a mild cough and was diagnosed with tuberculosis. The patient’s mother tests negative for tuberculosis The patient’s temperature is 38.1℃ (100.5℉). Today, she weighs 7.0 kg (15.4 lb). Cardiopulmonary auscultation reveals diminished breath sounds in the upper lobes. A chest radiograph demonstrates hilar lymphadenopathy and infiltrates in the upper lobes. Gastric aspirates are positive for acid-fast bacilli, however, cultures are still pending. Father and daughter are both started on standard antitubercular therapy. Which of the following is the appropriate management for the patient’s mother? <> context']
The following are multiple choice questions (with answers) about medical knowledge. Question: A 68-year-old man comes to the physician because of a 2-day history of a rash across his trunk and extremities. For the past 3 months, he has had persistent pruritus in these areas. He started hiking in the woods with his grandson last week to try to lose weight. His grandson, who often spends the weekends with him, recently had impetigo. He has hypertension, hyperlipidemia, and osteoarthritis of his thumbs. Five months ago, he was treated for a gout attack of his left hallux. Current medications include captopril, hydrochlorothiazide, simvastatin, allopurinol, and ibuprofen. Vital signs are within normal limits. There are diffuse vesicles and tense blisters involving the chest, flexures of the arms, and shoulders. Rubbing the skin on his chest does not produce blisters. Oral examination shows no abnormalities. This patient's condition is most likely associated with which of the following findings? (A) Growth of Gram-positive bacteria on blood culture (B) Antibodies to tissue transglutaminase on serologic testing (C) Linear deposits of IgG and C3 along the basement membrane on direct immunofluorescence studies (D) Spongiotic dermatitis on skin biopsy	['(C) Linear deposits of IgG and C3 along the basement membrane on direct immunofluorescence studies <> answer', 'The following are multiple choice questions (with answers) about medical knowledge. <> instruction', '(A) Growth of Gram-positive bacteria on blood culture (B) Antibodies to tissue transglutaminase on serologic testing (C) Linear deposits of IgG and C3 along the basement membrane on direct immunofluorescence studies (D) Spongiotic dermatitis on skin biopsy <> possible answers', " A 68-year-old man comes to the physician because of a 2-day history of a rash across his trunk and extremities. For the past 3 months, he has had persistent pruritus in these areas. He started hiking in the woods with his grandson last week to try to lose weight. His grandson, who often spends the weekends with him, recently had impetigo. He has hypertension, hyperlipidemia, and osteoarthritis of his thumbs. Five months ago, he was treated for a gout attack of his left hallux. Current medications include captopril, hydrochlorothiazide, simvastatin, allopurinol, and ibuprofen. Vital signs are within normal limits. There are diffuse vesicles and tense blisters involving the chest, flexures of the arms, and shoulders. Rubbing the skin on his chest does not produce blisters. Oral examination shows no abnormalities. This patient's condition is most likely associated with which of the following findings? <> context"]
The following are multiple choice questions (with answers) about medical knowledge. Question: A 23-year-old male is brought by police officers from a social gathering due combative behavior and altered mental status. The police say that phencyclidine was found on the premises. The patient is alone, and acquiring an accurate history proves difficult. However, you do learn that the patient is having visual hallucinations. Vital signs show a blood pressure of 155/95 mmHg, pulse is 103/min, respirations is 20/min, oxygen saturation of 99%. Airway, breathing, and circulation are intact. The patient appears violent, and is trying to remove his clothes. Multiple hospital staff are needed to restrain the patient in bed. A finger-stick glucose show 93 mg/dL. The team is unable to place an IV, and thus intramuscular midazolam is administered to achieve sedation; however, he is still agitated. What is the mechanism of action of the best alternative sedative drug for this patient? (A) Increases duration of chloride channel opening of GABA-A receptors (B) Competitive opioid receptor antagonist (C) Antagonist of D2 receptors (D) Mu-opioid receptor partial agonist	['(C) Antagonist of D2 receptors <> answer', 'The following are multiple choice questions (with answers) about medical knowledge. <> instruction', '(A) Increases duration of chloride channel opening of GABA-A receptors (B) Competitive opioid receptor antagonist (C) Antagonist of D2 receptors (D) Mu-opioid receptor partial agonist <> possible answers', ' A 23-year-old male is brought by police officers from a social gathering due combative behavior and altered mental status. The police say that phencyclidine was found on the premises. The patient is alone, and acquiring an accurate history proves difficult. However, you do learn that the patient is having visual hallucinations. Vital signs show a blood pressure of 155/95 mmHg, pulse is 103/min, respirations is 20/min, oxygen saturation of 99%. Airway, breathing, and circulation are intact. The patient appears violent, and is trying to remove his clothes. Multiple hospital staff are needed to restrain the patient in bed. A finger-stick glucose show 93 mg/dL. The team is unable to place an IV, and thus intramuscular midazolam is administered to achieve sedation; however, he is still agitated. What is the mechanism of action of the best alternative sedative drug for this patient? <> context']
The following are multiple choice questions (with answers) about medical knowledge. Question: A 17-year-old boy is brought to the physician because of swelling of his face and legs for 5 days. He immigrated to the United States from Korea with his family 10 years ago. He has been healthy except for an episode of sore throat 2 weeks ago. His younger sister has type 1 diabetes mellitus. His temperature is 37°C (98.6°F), pulse is 90/min, and blood pressure is 145/87 mm Hg. Examination shows periorbital edema and 3+ pitting edema of the lower extremities. Laboratory studies show: Hemoglobin 13.9 g/dL Leukocyte count 8,100/mm3 Serum Glucose 78 mg/dL Albumin 2.4 g/dL Hepatitis B surface antigen positive Hepatitis B surface antibody negative Complement C4 decreased Urine Blood negative Protein 4+ Glucose negative Protein/creatinine ratio 8.1 (N ≤ 0.2) Further evaluation is most likely to show which of the following additional findings?" (A) Subepithelial deposits on renal biopsy (B) Eosinophilic nodules on renal biopsy (C) Normal-appearing glomeruli on renal biopsy (D) Increased IgA levels in serum	['(A) Subepithelial deposits on renal biopsy <> answer', 'The following are multiple choice questions (with answers) about medical knowledge. <> instruction', '(A) Subepithelial deposits on renal biopsy (B) Eosinophilic nodules on renal biopsy (C) Normal-appearing glomeruli on renal biopsy (D) Increased IgA levels in serum <> possible answers', ' A 17-year-old boy is brought to the physician because of swelling of his face and legs for 5 days. He immigrated to the United States from Korea with his family 10 years ago. He has been healthy except for an episode of sore throat 2 weeks ago. His younger sister has type 1 diabetes mellitus. His temperature is 37°C (98.6°F), pulse is 90/min, and blood pressure is 145/87 mm Hg. Examination shows periorbital edema and 3+ pitting edema of the lower extremities. Laboratory studies show:\nHemoglobin 13.9 g/dL\nLeukocyte count 8,100/mm3\nSerum\nGlucose 78 mg/dL\nAlbumin 2.4 g/dL\nHepatitis B surface antigen positive\nHepatitis B surface antibody negative\nComplement C4 decreased\nUrine\nBlood negative\nProtein 4+\nGlucose negative\nProtein/creatinine ratio 8.1 (N ≤ 0.2)\nFurther evaluation is most likely to show which of the following additional findings?" <> context']
The following are multiple choice questions (with answers) about medical knowledge. Question: A 48-year-old man is brought to the emergency department 20 minutes after being rescued from a house fire. He reports headache, metallic taste, abdominal pain, and nausea. He appears confused and agitated. His pulse is 125/min, respirations are 33/min, and blood pressure is 100/65 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 98%. Physical examination shows a bright red color of the skin. His breath smells of bitter almonds. Hyperbaric oxygen therapy and appropriate pharmacotherapy are initiated. The expected beneficial effect of this drug is most likely due to which of the following mechanisms? (A) Synthesis of 2,3-bisphosphoglycerate (B) Formation of methemoglobin (C) Dissociation of carboxyhemoglobin (D) Inhibition of cytochrome c oxidase	['(B) Formation of methemoglobin <> answer', 'The following are multiple choice questions (with answers) about medical knowledge. <> instruction', '(A) Synthesis of 2,3-bisphosphoglycerate (B) Formation of methemoglobin (C) Dissociation of carboxyhemoglobin (D) Inhibition of cytochrome c oxidase <> possible answers', ' A 48-year-old man is brought to the emergency department 20 minutes after being rescued from a house fire. He reports headache, metallic taste, abdominal pain, and nausea. He appears confused and agitated. His pulse is 125/min, respirations are 33/min, and blood pressure is 100/65 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 98%. Physical examination shows a bright red color of the skin. His breath smells of bitter almonds. Hyperbaric oxygen therapy and appropriate pharmacotherapy are initiated. The expected beneficial effect of this drug is most likely due to which of the following mechanisms? <> context']
The following are multiple choice questions (with answers) about medical knowledge. Question: A 63-year-old man who recently immigrated to the United States from Indonesia comes to the physician because of worsening shortness of breath and swollen extremities for the past 3 months. He has had a 4-kg (8.8-lb) weight loss and intermittent fevers over the last 6 months. Examination shows pitting pedal edema and abdominal distension. Abdominal pressure over the right upper quadrant produces persistent distention of the jugular veins. An x-ray of the chest shows cavernous infiltrates in the left and right-upper lobes and a calcified cardiac silhouette. Cardiovascular examination is most likely to show which of the following? (A) Absent jugular venous pulse y descent (B) Pericardial knock (C) Pulsus parvus et tardus (D) Fixed split second heart sound	['(B) Pericardial knock <> answer', 'The following are multiple choice questions (with answers) about medical knowledge. <> instruction', '(A) Absent jugular venous pulse y descent (B) Pericardial knock (C) Pulsus parvus et tardus (D) Fixed split second heart sound <> possible answers', ' A 63-year-old man who recently immigrated to the United States from Indonesia comes to the physician because of worsening shortness of breath and swollen extremities for the past 3 months. He has had a 4-kg (8.8-lb) weight loss and intermittent fevers over the last 6 months. Examination shows pitting pedal edema and abdominal distension. Abdominal pressure over the right upper quadrant produces persistent distention of the jugular veins. An x-ray of the chest shows cavernous infiltrates in the left and right-upper lobes and a calcified cardiac silhouette. Cardiovascular examination is most likely to show which of the following? <> context']
The following are multiple choice questions (with answers) about medical knowledge. Question: A 32-year-old woman, gravida 2, para 2, comes to the physician for the evaluation of a palpable mass in her right breast that she first noticed 1 week ago. She has no associated pain. She has never had a mammogram previously. She has type II diabetes mellitus treated with metformin. She has no family history of breast cancer. She has smoked half a pack of cigarettes daily for 15 years. Her temperature is 37°C (98.6°F), pulse is 78/min, respirations are 14/min, and blood pressure is 125/75 mm Hg. Examination shows a firm, nonpainful, nonmobile mass in the right upper quadrant of the breast. There is no nipple discharge. Examination of the skin and lymph nodes shows no abnormalities. No masses are palpated in the left breast. Which of the following is the most appropriate next step in the management of this patient? (A) MRI scan of the breast (B) Mammography (C) BRCA gene testing (D) Monthly self-breast exams	['(B) Mammography <> answer', 'The following are multiple choice questions (with answers) about medical knowledge. <> instruction', '(A) MRI scan of the breast (B) Mammography (C) BRCA gene testing (D) Monthly self-breast exams <> possible answers', ' A 32-year-old woman, gravida 2, para 2, comes to the physician for the evaluation of a palpable mass in her right breast that she first noticed 1 week ago. She has no associated pain. She has never had a mammogram previously. She has type II diabetes mellitus treated with metformin. She has no family history of breast cancer. She has smoked half a pack of cigarettes daily for 15 years. Her temperature is 37°C (98.6°F), pulse is 78/min, respirations are 14/min, and blood pressure is 125/75 mm Hg. Examination shows a firm, nonpainful, nonmobile mass in the right upper quadrant of the breast. There is no nipple discharge. Examination of the skin and lymph nodes shows no abnormalities. No masses are palpated in the left breast. Which of the following is the most appropriate next step in the management of this patient? <> context']
The following are multiple choice questions (with answers) about medical knowledge. Question: A 14-year-old girl presents with pain in her right lower abdomen. She says the pain is sudden, severe, colicky, and associated with nausea and vomiting. Physical examination reveals tachycardia, point tenderness, and rebound tenderness in the right iliac region. Emergency laparotomy reveals an inflamed appendix. Her blood pressure is 128/84, heart rate is 92/min, and respiratory rate is 16/min. Her complete blood cell count shows an increase in the number of cells seen in the provided picture. What is the main function of these cells? (A) Phagocytosis (B) Allergic reaction (C) Blood clotting (D) Antigen presentation	['(A) Phagocytosis <> answer', 'The following are multiple choice questions (with answers) about medical knowledge. <> instruction', '(A) Phagocytosis (B) Allergic reaction (C) Blood clotting (D) Antigen presentation <> possible answers', ' A 14-year-old girl presents with pain in her right lower abdomen. She says the pain is sudden, severe, colicky, and associated with nausea and vomiting. Physical examination reveals tachycardia, point tenderness, and rebound tenderness in the right iliac region. Emergency laparotomy reveals an inflamed appendix. Her blood pressure is 128/84, heart rate is 92/min, and respiratory rate is 16/min. Her complete blood cell count shows an increase in the number of cells seen in the provided picture. What is the main function of these cells? <> context']
The following are multiple choice questions (with answers) about medical knowledge. Question: A 47-year-old man with bipolar I disorder and hypertension comes to the physician because of a 2-week history of increased thirst, urinary frequency, and sleep disturbance. He says that he now drinks up to 30 cups of water daily. He has smoked 2 packs of cigarettes daily for the past 20 years. Examination shows decreased skin turgor. Serum studies show a sodium concentration of 149 mEq/L, a potassium concentration of 4.1 mEq/L, and an elevated antidiuretic hormone concentration. His urine osmolality is 121 mOsm/kg H2O. Which of the following is the most likely explanation for these findings? (A) Adverse effect of a medication (B) Tumor of the pituitary gland (C) Paraneoplastic production of a hormone (D) Tumor in the adrenal cortex	['(A) Adverse effect of a medication <> answer', 'The following are multiple choice questions (with answers) about medical knowledge. <> instruction', '(A) Adverse effect of a medication (B) Tumor of the pituitary gland (C) Paraneoplastic production of a hormone (D) Tumor in the adrenal cortex <> possible answers', ' A 47-year-old man with bipolar I disorder and hypertension comes to the physician because of a 2-week history of increased thirst, urinary frequency, and sleep disturbance. He says that he now drinks up to 30 cups of water daily. He has smoked 2 packs of cigarettes daily for the past 20 years. Examination shows decreased skin turgor. Serum studies show a sodium concentration of 149 mEq/L, a potassium concentration of 4.1 mEq/L, and an elevated antidiuretic hormone concentration. His urine osmolality is 121 mOsm/kg H2O. Which of the following is the most likely explanation for these findings? <> context']
The following are multiple choice questions (with answers) about medical knowledge. Question: A 40-year-old man comes to the physician because of fatigue, increased sweating, and itching in his legs for the past 2 years. He has chronic bronchitis. He has smoked two packs of cigarettes daily for 24 years and drinks one to two beers every night. His only medication is a tiotropium bromide inhaler. His vital signs are within normal limits. He is 175 cm (5 ft 9 in) tall and weighs 116 kg (256 lb); BMI is 38 kg/m2. Physical examination shows facial flushing and bluish discoloration of the lips. Scattered expiratory wheezing and rhonchi are heard throughout both lung fields. Abdominal examination shows no abnormalities. Laboratory studies show: Erythrocyte count 6.9 million/mm3 Hemoglobin 20 g/dL Mean corpuscular volume 91 μm3 Leukocyte count 13,000/mm3 Platelet count 540,000/mm3 Serum Ferritin 8 ng/mL Iron 48 μg/dL Iron binding capacity 402 μg/dL (N: 251 - 406 μg/dL) Which of the following is the most appropriate next step in treatment?" (A) Weight loss (B) Hydroxyurea (C) Inhaled budesonide (D) Phlebotomy	['(D) Phlebotomy <> answer', 'The following are multiple choice questions (with answers) about medical knowledge. <> instruction', '(A) Weight loss (B) Hydroxyurea (C) Inhaled budesonide (D) Phlebotomy <> possible answers', ' A 40-year-old man comes to the physician because of fatigue, increased sweating, and itching in his legs for the past 2 years. He has chronic bronchitis. He has smoked two packs of cigarettes daily for 24 years and drinks one to two beers every night. His only medication is a tiotropium bromide inhaler. His vital signs are within normal limits. He is 175 cm (5 ft 9 in) tall and weighs 116 kg (256 lb); BMI is 38 kg/m2. Physical examination shows facial flushing and bluish discoloration of the lips. Scattered expiratory wheezing and rhonchi are heard throughout both lung fields. Abdominal examination shows no abnormalities. Laboratory studies show:\nErythrocyte count 6.9 million/mm3\nHemoglobin 20 g/dL\nMean corpuscular volume 91 μm3\nLeukocyte count 13,000/mm3\nPlatelet count 540,000/mm3\nSerum\nFerritin 8 ng/mL\nIron 48 μg/dL\nIron binding capacity 402 μg/dL (N: 251 - 406 μg/dL)\nWhich of the following is the most appropriate next step in treatment?" <> context']
The following are multiple choice questions (with answers) about medical knowledge. Question: A 52-year-old woman presents to the clinic with several days of vomiting and diarrhea. She also complains of headaches, muscle aches, and fever, but denies tenesmus, urgency, and bloody diarrhea. Past medical history is insignificant. When asked about any recent travel she says that she just came back from a cruise ship vacation. Her temperature is 37°C (98.6° F), respiratory rate is 15/min, pulse is 67/min, and blood pressure is 122/98 mm Hg. Physical examination is non-contributory. Microscopic examination of the stool is negative for ova or parasites. What is the most likely diagnosis? (A) Giardiasis (B) C. difficile colitis (C) Irritable bowel syndrome (D) Norovirus infection	['(D) Norovirus infection <> answer', 'The following are multiple choice questions (with answers) about medical knowledge. <> instruction', '(A) Giardiasis (B) C. difficile colitis (C) Irritable bowel syndrome (D) Norovirus infection <> possible answers', ' A 52-year-old woman presents to the clinic with several days of vomiting and diarrhea. She also complains of headaches, muscle aches, and fever, but denies tenesmus, urgency, and bloody diarrhea. Past medical history is insignificant. When asked about any recent travel she says that she just came back from a cruise ship vacation. Her temperature is 37°C (98.6° F), respiratory rate is 15/min, pulse is 67/min, and blood pressure is 122/98 mm Hg. Physical examination is non-contributory. Microscopic examination of the stool is negative for ova or parasites. What is the most likely diagnosis? <> context']
The following are multiple choice questions (with answers) about medical knowledge. Question: A 24-year-old woman presents to her primary care physician with a 3 day history of pain with urination. She says that this pain has been accompanied by abdominal pain as well as a feeling like she always needs to use the restroom. She has no past medical history and no family history that she can recall. She is currently sexually active with a new partner but has tested negative for sexually transmitted infections. Physical exam reveals suprapubic tenderness and urine culture reveals gram-positive cocci. Which of the following best describes the organism that is most likely causing this patient's symptoms? (A) Catalase negative and beta-hemolytic (B) Catalase positive and coagulase positive (C) Coagulase negative and novobiocin resistant (D) Coagulase negative and novobiocin sensitive	['(C) Coagulase negative and novobiocin resistant <> answer', 'The following are multiple choice questions (with answers) about medical knowledge. <> instruction', '(A) Catalase negative and beta-hemolytic (B) Catalase positive and coagulase positive (C) Coagulase negative and novobiocin resistant (D) Coagulase negative and novobiocin sensitive <> possible answers', " A 24-year-old woman presents to her primary care physician with a 3 day history of pain with urination. She says that this pain has been accompanied by abdominal pain as well as a feeling like she always needs to use the restroom. She has no past medical history and no family history that she can recall. She is currently sexually active with a new partner but has tested negative for sexually transmitted infections. Physical exam reveals suprapubic tenderness and urine culture reveals gram-positive cocci. Which of the following best describes the organism that is most likely causing this patient's symptoms? <> context"]
The following are multiple choice questions (with answers) about medical knowledge. Question: A 32-year-old man with a history of major depressive disorder is brought to the emergency department by his wife because of a sudden onset of restlessness and disorientation that developed 3 hours ago. The patient’s wife says that he suddenly started sweating, having tremors, and mumbling to himself. Yesterday, the patient visited his psychiatrist with worsening depression who added phenelzine to his current treatment regimen. No other significant past medical history. His temperature is 39.7°C (103.5°F), blood pressure is 145/90 mm Hg, and pulse is 115/min. On physical examination, the skin is flushed. Mucous membranes are dry, and pupils are dilated. There is pronounced clonus in the extremities bilaterally. Babinski sign is present bilaterally. All the patient’s medications are discontinued, and intravenous fluids are started. Which of the following drugs most likely interacted with phenelzine to cause this patient’s condition? (A) Mirtazapine (B) Bupropion (C) Sertraline (D) Lithium	['(C) Sertraline <> answer', 'The following are multiple choice questions (with answers) about medical knowledge. <> instruction', '(A) Mirtazapine (B) Bupropion (C) Sertraline (D) Lithium <> possible answers', ' A 32-year-old man with a history of major depressive disorder is brought to the emergency department by his wife because of a sudden onset of restlessness and disorientation that developed 3 hours ago. The patient’s wife says that he suddenly started sweating, having tremors, and mumbling to himself. Yesterday, the patient visited his psychiatrist with worsening depression who added phenelzine to his current treatment regimen. No other significant past medical history. His temperature is 39.7°C (103.5°F), blood pressure is 145/90 mm Hg, and pulse is 115/min. On physical examination, the skin is flushed. Mucous membranes are dry, and pupils are dilated. There is pronounced clonus in the extremities bilaterally. Babinski sign is present bilaterally. All the patient’s medications are discontinued, and intravenous fluids are started. Which of the following drugs most likely interacted with phenelzine to cause this patient’s condition? <> context']
The following are multiple choice questions (with answers) about medical knowledge. Question: A 72-year-old woman is brought to the emergency department because of severe pain in her left hip after a fall this morning. She has smoked one pack of cigarettes daily for 45 years. Her only medication is a vitamin D supplement. Physical examination shows that her left leg is externally rotated and appears shorter than her right leg. An x-ray of the pelvis shows a fracture of the neck of the left femur. Which of the following changes in bone architecture is the most likely underlying cause of this patient's symptoms? (A) Overgrowth of cortical bone and reduced marrow space (B) Loss of cortical bone mass and thinning of trabeculae (C) Formation of multiple sclerotic lesions in bony cortex (D) Deposition of lamellar bone interspersed with woven bone	['(B) Loss of cortical bone mass and thinning of trabeculae <> answer', 'The following are multiple choice questions (with answers) about medical knowledge. <> instruction', '(A) Overgrowth of cortical bone and reduced marrow space (B) Loss of cortical bone mass and thinning of trabeculae (C) Formation of multiple sclerotic lesions in bony cortex (D) Deposition of lamellar bone interspersed with woven bone <> possible answers', " A 72-year-old woman is brought to the emergency department because of severe pain in her left hip after a fall this morning. She has smoked one pack of cigarettes daily for 45 years. Her only medication is a vitamin D supplement. Physical examination shows that her left leg is externally rotated and appears shorter than her right leg. An x-ray of the pelvis shows a fracture of the neck of the left femur. Which of the following changes in bone architecture is the most likely underlying cause of this patient's symptoms? <> context"]
The following are multiple choice questions (with answers) about medical knowledge. Question: A 62-year-old man with a history of coronary artery disease comes to the emergency department with substernal chest pain for several hours. An ECG shows no abnormalities. Troponin T test results are negative. The patient is admitted to the hospital and treated with intravenous nitroglycerin, with an initial resolution of his symptoms. After 6 hours of continuous infusion of nitroglycerin, he reports increasing chest pain. The underlying cause of this patient's recurrent symptoms is most likely to also occur in treatment with which of the following drugs? (A) Levodopa (B) Alprazolam (C) Phenylephrine (D) Hydrocodone	['(C) Phenylephrine <> answer', 'The following are multiple choice questions (with answers) about medical knowledge. <> instruction', '(A) Levodopa (B) Alprazolam (C) Phenylephrine (D) Hydrocodone <> possible answers', " A 62-year-old man with a history of coronary artery disease comes to the emergency department with substernal chest pain for several hours. An ECG shows no abnormalities. Troponin T test results are negative. The patient is admitted to the hospital and treated with intravenous nitroglycerin, with an initial resolution of his symptoms. After 6 hours of continuous infusion of nitroglycerin, he reports increasing chest pain. The underlying cause of this patient's recurrent symptoms is most likely to also occur in treatment with which of the following drugs? <> context"]
The following are multiple choice questions (with answers) about medical knowledge. Question: A 70-year-old man comes to the physician for evaluation of worsening nocturia, fatigue, and shortness of breath on exertion. While he used to be able to walk for 15 minutes at a time, he now has to pause every 5 minutes. Recently, he has started using two pillows to avoid waking up short of breath at night. He has a history of hypertension treated with daily amlodipine and prazosin; he has difficulty adhering to his medication regimen. His pulse is 75/min, and blood pressure is 150/90 mm Hg. Physical examination shows a laterally displaced apical heartbeat and 2+ bilateral pitting edema of the lower legs. Auscultation shows an S4 gallop and fine bibasilar rales. Further evaluation is most likely to show which of the following pathophysiologic changes in this patient? (A) Constriction of efferent renal arterioles (B) Decrease in total peripheral vascular resistance (C) Reduction of alveolar surface tension (D) Retention of potassium	['(A) Constriction of efferent renal arterioles <> answer', 'The following are multiple choice questions (with answers) about medical knowledge. <> instruction', '(A) Constriction of efferent renal arterioles (B) Decrease in total peripheral vascular resistance (C) Reduction of alveolar surface tension (D) Retention of potassium <> possible answers', ' A 70-year-old man comes to the physician for evaluation of worsening nocturia, fatigue, and shortness of breath on exertion. While he used to be able to walk for 15 minutes at a time, he now has to pause every 5 minutes. Recently, he has started using two pillows to avoid waking up short of breath at night. He has a history of hypertension treated with daily amlodipine and prazosin; he has difficulty adhering to his medication regimen. His pulse is 75/min, and blood pressure is 150/90 mm Hg. Physical examination shows a laterally displaced apical heartbeat and 2+ bilateral pitting edema of the lower legs. Auscultation shows an S4 gallop and fine bibasilar rales. Further evaluation is most likely to show which of the following pathophysiologic changes in this patient? <> context']
The following are multiple choice questions (with answers) about medical knowledge. Question: Eight hours after undergoing an open right hemicolectomy and a colostomy for colon cancer, a 52-year-old man has wet and bloody surgical dressings. He has had episodes of blood in his stools during the past 6 months, which led to the detection of colon cancer. He has hypertension and ischemic heart disease. His younger brother died of a bleeding disorder at the age of 16. The patient has smoked one pack of cigarettes daily for 36 years and drinks three to four beers daily. Prior to admission, his medications included aspirin, metoprolol, enalapril, and simvastatin. Aspirin was stopped 7 days prior to the scheduled surgery. He appears uncomfortable. His temperature is 36°C (96.8°F), pulse is 98/min, respirations are 14/min, and blood pressure is 118/72 mm Hg. Examination shows a soft abdomen with a 14-cm midline incision that has severe oozing of blood from its margins. The colostomy bag has some blood collected within. Laboratory studies show: Hemoglobin 12.3 g/dL Leukocyte count 11,200/mm3 Platelet count 210,000/mm3 Bleeding time 4 minutes Prothrombin time 15 seconds (INR=1.1) Activated partial thromboplastin time 36 seconds Serum Urea nitrogen 30 mg/dL Glucose 96 mg/dL Creatinine 1.1 mg/dL AST 48 U/L ALT 34 U/L γ-Glutamyltransferase 70 U/L (N= 5–50 U/L) Which of the following is the most likely cause of this patient's bleeding?" (A) Liver dysfunction (B) Platelet dysfunction (C) Factor VIII deficiency (D) Insufficient mechanical hemostasis	['(D) Insufficient mechanical hemostasis <> answer', 'The following are multiple choice questions (with answers) about medical knowledge. <> instruction', '(A) Liver dysfunction (B) Platelet dysfunction (C) Factor VIII deficiency (D) Insufficient mechanical hemostasis <> possible answers', ' Eight hours after undergoing an open right hemicolectomy and a colostomy for colon cancer, a 52-year-old man has wet and bloody surgical dressings. He has had episodes of blood in his stools during the past 6 months, which led to the detection of colon cancer. He has hypertension and ischemic heart disease. His younger brother died of a bleeding disorder at the age of 16. The patient has smoked one pack of cigarettes daily for 36 years and drinks three to four beers daily. Prior to admission, his medications included aspirin, metoprolol, enalapril, and simvastatin. Aspirin was stopped 7 days prior to the scheduled surgery. He appears uncomfortable. His temperature is 36°C (96.8°F), pulse is 98/min, respirations are 14/min, and blood pressure is 118/72 mm Hg. Examination shows a soft abdomen with a 14-cm midline incision that has severe oozing of blood from its margins. The colostomy bag has some blood collected within. Laboratory studies show:\nHemoglobin 12.3 g/dL\nLeukocyte count 11,200/mm3\nPlatelet count 210,000/mm3\nBleeding time 4 minutes\nProthrombin time 15 seconds (INR=1.1)\nActivated partial thromboplastin time 36 seconds\nSerum\nUrea nitrogen 30 mg/dL\nGlucose 96 mg/dL\nCreatinine 1.1 mg/dL\nAST 48 U/L\nALT 34 U/L\nγ-Glutamyltransferase 70 U/L (N= 5–50 U/L)\nWhich of the following is the most likely cause of this patient\'s bleeding?" <> context']
The following are multiple choice questions (with answers) about medical knowledge. Question: A 49-year-old woman comes to the office complaining of 2 weeks of urinary incontinence. She says she first noticed some light, urinary dribbling that would increase with sneezing or coughing. This dribble soon worsened, soaking through a pad every 3 hours. She denies any fevers, chills, abdominal pain, hematuria, dysuria, abnormal vaginal discharge, or increased urinary frequency. The patient had a bilateral tubal ligation 3 weeks ago. Her last menstrual period was 2 weeks ago. Her menses are regular and last 5 days. She has had 3 pregnancies that each resulted in uncomplicated, term vaginal deliveries. Her last pregnancy was 2 years ago. The patient has hypothyroidism and takes daily levothyroxine. She denies tobacco, alcohol, or illicit drug use. She has no history of sexually transmitted diseases. She is sexually active with her husband of 25 years. Her BMI is 26 kg/m^2. On physical examination, the abdomen is soft, nondistended, and nontender without palpable masses or hepatosplenomegaly. Rectal tone is normal. The uterus is anteverted, mobile, and nontender. There are no adnexal masses. Urine is seen pooling in the vaginal vault. Urinalysis is unremarkable. Which of the following is next best step in diagnosis? (A) Cystoscopy (B) Methylene blue instillation into the bladder (C) Post-void residual volume (D) Transvaginal ultrasound	['(B) Methylene blue instillation into the bladder <> answer', 'The following are multiple choice questions (with answers) about medical knowledge. <> instruction', '(A) Cystoscopy (B) Methylene blue instillation into the bladder (C) Post-void residual volume (D) Transvaginal ultrasound <> possible answers', ' A 49-year-old woman comes to the office complaining of 2 weeks of urinary incontinence. She says she first noticed some light, urinary dribbling that would increase with sneezing or coughing. This dribble soon worsened, soaking through a pad every 3 hours. She denies any fevers, chills, abdominal pain, hematuria, dysuria, abnormal vaginal discharge, or increased urinary frequency. The patient had a bilateral tubal ligation 3 weeks ago. Her last menstrual period was 2 weeks ago. Her menses are regular and last 5 days. She has had 3 pregnancies that each resulted in uncomplicated, term vaginal deliveries. Her last pregnancy was 2 years ago. The patient has hypothyroidism and takes daily levothyroxine. She denies tobacco, alcohol, or illicit drug use. She has no history of sexually transmitted diseases. She is sexually active with her husband of 25 years. Her BMI is 26 kg/m^2. On physical examination, the abdomen is soft, nondistended, and nontender without palpable masses or hepatosplenomegaly. Rectal tone is normal. The uterus is anteverted, mobile, and nontender. There are no adnexal masses. Urine is seen pooling in the vaginal vault. Urinalysis is unremarkable. Which of the following is next best step in diagnosis? <> context']
The following are multiple choice questions (with answers) about medical knowledge. Question: A 35-year-old woman comes to the physician because of a 3-month history of worsening fatigue. She has difficulty concentrating at work despite sleeping well most nights. Three years ago, she was diagnosed with Crohn disease. She has about 7 non-bloody, mildly painful bowel movements daily. Her current medications include 5-aminosalicylic acid and topical budesonide. She does not smoke or drink alcohol. She appears pale. Her temperature is 37.9°C (100.2°F), pulse is 92/min, and blood pressure is 110/65 mmHg. The abdomen is diffusely tender to palpation, with no guarding. Laboratory results show: Hemoglobin 10.5 g/dL Mean corpuscular volume 83 μm3 Reticulocytes 0.2 % Platelets 189,000/mm3 Serum Iron 21 μg/dL Total iron binding capacity 176 μg/dL (N=240–450) A blood smear shows anisocytosis. Which of the following is the most appropriate next step in treatment?" (A) Oral prednisone therapy (B) Subcutaneous erythropoietin injection (C) Intravenous metronidazole therapy (D) Oral vitamin B12 supplementation	['(A) Oral prednisone therapy <> answer', 'The following are multiple choice questions (with answers) about medical knowledge. <> instruction', '(A) Oral prednisone therapy (B) Subcutaneous erythropoietin injection (C) Intravenous metronidazole therapy (D) Oral vitamin B12 supplementation <> possible answers', ' A 35-year-old woman comes to the physician because of a 3-month history of worsening fatigue. She has difficulty concentrating at work despite sleeping well most nights. Three years ago, she was diagnosed with Crohn disease. She has about 7 non-bloody, mildly painful bowel movements daily. Her current medications include 5-aminosalicylic acid and topical budesonide. She does not smoke or drink alcohol. She appears pale. Her temperature is 37.9°C (100.2°F), pulse is 92/min, and blood pressure is 110/65 mmHg. The abdomen is diffusely tender to palpation, with no guarding. Laboratory results show:\nHemoglobin 10.5 g/dL\nMean corpuscular volume 83 μm3\nReticulocytes 0.2 %\nPlatelets 189,000/mm3\nSerum\nIron 21 μg/dL\nTotal iron binding capacity 176 μg/dL (N=240–450)\nA blood smear shows anisocytosis. Which of the following is the most appropriate next step in treatment?" <> context']
The following are multiple choice questions (with answers) about medical knowledge. Question: A 5-year-old girl swallows a marble while playing and is rushed to the hospital by her mother. The patient’s mother says she suddenly started to cough violently and made "funny breathing" sounds for a few minutes which then resolved. Her pulse is 100/min and respirations are 28/min. Physical examination reveals a girl in no obvious distress and breathing comfortably. There are diminished breath sounds and mild expiratory wheezing over the lower right lung field. A chest X-ray is performed which shows a round foreign body about 1 cm ×1 cm in the lower portion of the right inferior lobe. Which of the following changes in blood flow through the affected part of the lung would most likely be present in this patient? (A) Blood flow would be increased due to arterial vasodilation. (B) Blood flow would be unchanged due to autoregulation. (C) Blood flow would be unchanged due to decreased surfactant. (D) Blood flow would be decreased due to arterial vasoconstriction.	['(D) Blood flow would be decreased due to arterial vasoconstriction. <> answer', 'The following are multiple choice questions (with answers) about medical knowledge. <> instruction', '(A) Blood flow would be increased due to arterial vasodilation. (B) Blood flow would be unchanged due to autoregulation. (C) Blood flow would be unchanged due to decreased surfactant. (D) Blood flow would be decreased due to arterial vasoconstriction. <> possible answers', ' A 5-year-old girl swallows a marble while playing and is rushed to the hospital by her mother. The patient’s mother says she suddenly started to cough violently and made "funny breathing" sounds for a few minutes which then resolved. Her pulse is 100/min and respirations are 28/min. Physical examination reveals a girl in no obvious distress and breathing comfortably. There are diminished breath sounds and mild expiratory wheezing over the lower right lung field. A chest X-ray is performed which shows a round foreign body about 1 cm ×1 cm in the lower portion of the right inferior lobe. Which of the following changes in blood flow through the affected part of the lung would most likely be present in this patient? <> context']
The following are multiple choice questions (with answers) about medical knowledge. Question: A 58-year old man comes to his physician because of a 1-month history of increased thirst and nocturia. He is drinking a lot of water to compensate for any dehydration. His brother has type 2 diabetes mellitus. Physical examination shows dry mucous membranes. Laboratory studies show a serum sodium of 151 mEq/L and glucose of 121 mg/dL. A water deprivation test shows: Serum osmolality (mOsmol/kg H2O) Urine osmolality (mOsmol/kg H2O) Initial presentation 295 285 After 3 hours without fluids 305 310 After administration of antidiuretic hormone (ADH) analog 280 355 Which of the following is the most likely diagnosis?" (A) Partial central diabetes inspidus (B) Complete central diabetes insipidus (C) Primary polydipsia (D) Osmotic diuresis	['(A) Partial central diabetes inspidus <> answer', 'The following are multiple choice questions (with answers) about medical knowledge. <> instruction', '(A) Partial central diabetes inspidus (B) Complete central diabetes insipidus (C) Primary polydipsia (D) Osmotic diuresis <> possible answers', ' A 58-year old man comes to his physician because of a 1-month history of increased thirst and nocturia. He is drinking a lot of water to compensate for any dehydration. His brother has type 2 diabetes mellitus. Physical examination shows dry mucous membranes. Laboratory studies show a serum sodium of 151 mEq/L and glucose of 121 mg/dL. A water deprivation test shows:\nSerum osmolality\n(mOsmol/kg H2O) Urine osmolality\n(mOsmol/kg H2O)\nInitial presentation 295 285\nAfter 3 hours without fluids 305 310\nAfter administration of antidiuretic hormone (ADH) analog 280 355\nWhich of the following is the most likely diagnosis?" <> context']
The following are multiple choice questions (with answers) about medical knowledge. Question: An 82-year-old woman is brought to the physician by her daughter because of a 3-day history of a runny nose, headache, and cough. The patient's grandson recently had similar symptoms. Her vital signs are within normal limits. Pulse oximetry on room air shows an oxygen saturation of 99%. Lungs are clear to auscultation. Testing of nasal secretions is performed to identify the viral strain. Electron microscopy shows a non-enveloped RNA virus with an icosahedral capsid. Binding to which of the following is responsible for the virulence of this virus? (A) P antigen (B) CD21 (C) ICAM-1 (D) Sialic acid residues	['(C) ICAM-1 <> answer', 'The following are multiple choice questions (with answers) about medical knowledge. <> instruction', '(A) P antigen (B) CD21 (C) ICAM-1 (D) Sialic acid residues <> possible answers', " An 82-year-old woman is brought to the physician by her daughter because of a 3-day history of a runny nose, headache, and cough. The patient's grandson recently had similar symptoms. Her vital signs are within normal limits. Pulse oximetry on room air shows an oxygen saturation of 99%. Lungs are clear to auscultation. Testing of nasal secretions is performed to identify the viral strain. Electron microscopy shows a non-enveloped RNA virus with an icosahedral capsid. Binding to which of the following is responsible for the virulence of this virus? <> context"]
The following are multiple choice questions (with answers) about medical knowledge. Question: A 65-year-old male presents to the physician after noticing gross blood with urination. He reports that this is not associated with pain. The patient smokes 1.5 packs per day for 45 years. Dipstick analysis is positive for blood, with 5 RBC per high-power field (HPF) on urinalysis. A cystoscopy is performed, which is significant for a lesion suspicious for malignancy. A biopsy was obtained, which is suggestive of muscle-invasive transitional cell carcinoma. Before radical cystectomy is performed, the patient is started on cisplatin-based chemotherapy. Which of the following is most likely associated with this chemotherapeutic drug? (A) Gentamicin enhances toxicity risk (B) Cardiotoxicity (C) Myelosuppression (D) Addition of mesna decreases drug toxicity	['(A) Gentamicin enhances toxicity risk <> answer', 'The following are multiple choice questions (with answers) about medical knowledge. <> instruction', '(A) Gentamicin enhances toxicity risk (B) Cardiotoxicity (C) Myelosuppression (D) Addition of mesna decreases drug toxicity <> possible answers', ' A 65-year-old male presents to the physician after noticing gross blood with urination. He reports that this is not associated with pain. The patient smokes 1.5 packs per day for 45 years. Dipstick analysis is positive for blood, with 5 RBC per high-power field (HPF) on urinalysis. A cystoscopy is performed, which is significant for a lesion suspicious for malignancy. A biopsy was obtained, which is suggestive of muscle-invasive transitional cell carcinoma. Before radical cystectomy is performed, the patient is started on cisplatin-based chemotherapy. Which of the following is most likely associated with this chemotherapeutic drug? <> context']
The following are multiple choice questions (with answers) about medical knowledge. Question: A 65-year-old male with a history of coronary artery disease and myocardial infarction status post coronary artery bypass graft (CABG) surgery presents to his cardiologist for a routine appointment. On physical exam, the cardiologist appreciates a holosystolic, high-pitched blowing murmur heard loudest at the apex and radiating towards the axilla. Which of the following is the best predictor of the severity of this patient's murmur? (A) Enhancement with expiration (B) Presence of audible S3 (C) Enhancement with inspiration (D) Presence of audible S4	['(B) Presence of audible S3 <> answer', 'The following are multiple choice questions (with answers) about medical knowledge. <> instruction', '(A) Enhancement with expiration (B) Presence of audible S3 (C) Enhancement with inspiration (D) Presence of audible S4 <> possible answers', " A 65-year-old male with a history of coronary artery disease and myocardial infarction status post coronary artery bypass graft (CABG) surgery presents to his cardiologist for a routine appointment. On physical exam, the cardiologist appreciates a holosystolic, high-pitched blowing murmur heard loudest at the apex and radiating towards the axilla. Which of the following is the best predictor of the severity of this patient's murmur? <> context"]
The following are multiple choice questions (with answers) about medical knowledge. Question: An obese 37-year-old woman is brought to the emergency department 2 hours after the onset of weakness in her left arm and leg. She fell from the stairs the day prior but did not have any loss of consciousness or nausea after the fall. She travels to Asia regularly on business; her last trip was 4 days ago. She has no history of serious illness. Her only medication is an oral contraceptive. Her temperature is 37.8°C (100°F), pulse is 113/min and regular, and blood pressure is 162/90 mm Hg. Examination shows decreased muscle strength on the left side. Deep tendon reflexes are 4+ on the left. Babinski sign is present on the left. The right lower leg is swollen, erythematous, and tender to palpation. Further evaluation is most likely to show which of the following? (A) Ventricular septal defect (B) Carotid artery dissection (C) Atrial fibrillation (D) Patent foramen ovale	['(D) Patent foramen ovale <> answer', 'The following are multiple choice questions (with answers) about medical knowledge. <> instruction', '(A) Ventricular septal defect (B) Carotid artery dissection (C) Atrial fibrillation (D) Patent foramen ovale <> possible answers', ' An obese 37-year-old woman is brought to the emergency department 2 hours after the onset of weakness in her left arm and leg. She fell from the stairs the day prior but did not have any loss of consciousness or nausea after the fall. She travels to Asia regularly on business; her last trip was 4 days ago. She has no history of serious illness. Her only medication is an oral contraceptive. Her temperature is 37.8°C (100°F), pulse is 113/min and regular, and blood pressure is 162/90 mm Hg. Examination shows decreased muscle strength on the left side. Deep tendon reflexes are 4+ on the left. Babinski sign is present on the left. The right lower leg is swollen, erythematous, and tender to palpation. Further evaluation is most likely to show which of the following? <> context']
The following are multiple choice questions (with answers) about medical knowledge. Question: A 47-year-old farmer presents to his primary care physician for the first time appointment. The patient has never seen a doctor and states that he is in good health. He has worked as a farmer for the past 30 years and has no complaints. His temperature is 98.9°F (37.2°C), blood pressure is 197/118 mmHg, pulse is 90/min, respirations are 14/min, and oxygen saturation is 98% on room air. Physical exam is notable for an obese man in no current distress. Laboratory values are seen below. Serum: Na+: 139 mEq/L Cl-: 101 mEq/L K+: 5.2 mEq/L HCO3-: 25 mEq/L BUN: 34 mg/dL Glucose: 179 mg/dL Creatinine: 2.1 mg/dL Ca2+: 10.2 mg/dL Which of the following is the best management of this patient's blood pressure? (A) Carvedilol (B) Lisinopril (C) Metoprolol (D) Nicardipine	['(B) Lisinopril <> answer', 'The following are multiple choice questions (with answers) about medical knowledge. <> instruction', '(A) Carvedilol (B) Lisinopril (C) Metoprolol (D) Nicardipine <> possible answers', " A 47-year-old farmer presents to his primary care physician for the first time appointment. The patient has never seen a doctor and states that he is in good health. He has worked as a farmer for the past 30 years and has no complaints. His temperature is 98.9°F (37.2°C), blood pressure is 197/118 mmHg, pulse is 90/min, respirations are 14/min, and oxygen saturation is 98% on room air. Physical exam is notable for an obese man in no current distress. Laboratory values are seen below.\n\nSerum:\nNa+: 139 mEq/L\nCl-: 101 mEq/L\nK+: 5.2 mEq/L\nHCO3-: 25 mEq/L\nBUN: 34 mg/dL\nGlucose: 179 mg/dL\nCreatinine: 2.1 mg/dL\nCa2+: 10.2 mg/dL\n\nWhich of the following is the best management of this patient's blood pressure? <> context"]
The following are multiple choice questions (with answers) about medical knowledge. Question: A 4-year-old girl is brought to the physician because of a nonpruritic, painless rash that has been on her face for 5 days. She was born at term and has been healthy throughout childhood. Her 62-year-old maternal grandmother has bullous pemphigoid. Her development is adequate for her age and immunizations are up-to-date. She appears healthy and well-nourished. Her temperature is 37.0°C (98.6°F) pulse is 90/min, and respiratory rate is 18/min. Examination shows a crusted rash on the right side of the patient's face. An image of the patient's lower face is shown. The remainder of the examination shows no abnormalities. Which of the following is the most appropriate next step in management? (A) Oral acyclovir therapy (B) Oral cephalexin therapy (C) Oral clindamycin therapy (D) Topical mupirocin therapy	['(D) Topical mupirocin therapy <> answer', 'The following are multiple choice questions (with answers) about medical knowledge. <> instruction', '(A) Oral acyclovir therapy (B) Oral cephalexin therapy (C) Oral clindamycin therapy (D) Topical mupirocin therapy <> possible answers', " A 4-year-old girl is brought to the physician because of a nonpruritic, painless rash that has been on her face for 5 days. She was born at term and has been healthy throughout childhood. Her 62-year-old maternal grandmother has bullous pemphigoid. Her development is adequate for her age and immunizations are up-to-date. She appears healthy and well-nourished. Her temperature is 37.0°C (98.6°F) pulse is 90/min, and respiratory rate is 18/min. Examination shows a crusted rash on the right side of the patient's face. An image of the patient's lower face is shown. The remainder of the examination shows no abnormalities. Which of the following is the most appropriate next step in management? <> context"]
The following are multiple choice questions (with answers) about medical knowledge. Question: A 35-year-old woman presents to the clinic for a several-month history of heat intolerance. She lives in a small apartment with her husband and reports that she always feels hot and sweaty, even when their air conditioning is on high. On further questioning, she's also had a 4.5 kg (10 lb) unintentional weight loss. The vital signs include: heart rate 102/min and blood pressure 150/80 mm Hg. The physical exam is notable for warm and slightly moist skin. She also exhibits a fine tremor in her hands when her arms are outstretched. Which of the following laboratory values is most likely low in this patient? (A) Calcitonin (B) Triiodothyronine (T3) (C) Thyroxine (T4) (D) Thyroid-stimulating hormone	['(D) Thyroid-stimulating hormone <> answer', 'The following are multiple choice questions (with answers) about medical knowledge. <> instruction', '(A) Calcitonin (B) Triiodothyronine (T3) (C) Thyroxine (T4) (D) Thyroid-stimulating hormone <> possible answers', " A 35-year-old woman presents to the clinic for a several-month history of heat intolerance. She lives in a small apartment with her husband and reports that she always feels hot and sweaty, even when their air conditioning is on high. On further questioning, she's also had a 4.5 kg (10 lb) unintentional weight loss. The vital signs include: heart rate 102/min and blood pressure 150/80 mm Hg. The physical exam is notable for warm and slightly moist skin. She also exhibits a fine tremor in her hands when her arms are outstretched. Which of the following laboratory values is most likely low in this patient? <> context"]
The following are multiple choice questions (with answers) about medical knowledge. Question: A 58-year-old woman comes to the physician for evaluation of vaginal dryness and pain during sexual intercourse with her husband. Four months ago, she was diagnosed with metastatic breast cancer and is currently undergoing chemotherapy. She has smoked one pack of cigarettes daily for 15 years but quit when she was diagnosed with breast cancer. Physical examination shows thinning of the vaginal mucosa. A dual-energy x-ray absorptiometry (DXA) study of her hip shows a T-score of -2.6. Six months ago, her T-score was -1.6. Which of the following drugs is most likely exacerbating this patient's symptoms? (A) Palbociclib (B) Paclitaxel (C) Tamoxifen (D) Exemestane	['(D) Exemestane <> answer', 'The following are multiple choice questions (with answers) about medical knowledge. <> instruction', '(A) Palbociclib (B) Paclitaxel (C) Tamoxifen (D) Exemestane <> possible answers', " A 58-year-old woman comes to the physician for evaluation of vaginal dryness and pain during sexual intercourse with her husband. Four months ago, she was diagnosed with metastatic breast cancer and is currently undergoing chemotherapy. She has smoked one pack of cigarettes daily for 15 years but quit when she was diagnosed with breast cancer. Physical examination shows thinning of the vaginal mucosa. A dual-energy x-ray absorptiometry (DXA) study of her hip shows a T-score of -2.6. Six months ago, her T-score was -1.6. Which of the following drugs is most likely exacerbating this patient's symptoms? <> context"]
The following are multiple choice questions (with answers) about medical knowledge. Question: A 33-year-old man comes to the emergency department because of a dry mouth and blurred vision for the past 30 minutes. Prior to this, he was on a road trip and started to feel nauseous, dizzy, and fatigued, so his friend gave him a drug that had helped in the past. Physical examination shows dry mucous membranes and dilated pupils. The remainder of the examination shows no abnormalities. Administration of which of the following drugs is most likely to cause a similar adverse reaction in this patient? (A) Oxycodone (B) Oxybutynin (C) Phenylephrine (D) Loratadine	['(B) Oxybutynin <> answer', 'The following are multiple choice questions (with answers) about medical knowledge. <> instruction', '(A) Oxycodone (B) Oxybutynin (C) Phenylephrine (D) Loratadine <> possible answers', ' A 33-year-old man comes to the emergency department because of a dry mouth and blurred vision for the past 30 minutes. Prior to this, he was on a road trip and started to feel nauseous, dizzy, and fatigued, so his friend gave him a drug that had helped in the past. Physical examination shows dry mucous membranes and dilated pupils. The remainder of the examination shows no abnormalities. Administration of which of the following drugs is most likely to cause a similar adverse reaction in this patient? <> context']
The following are multiple choice questions (with answers) about medical knowledge. Question: A father brings his 3-year-old son to the pediatrician because he is concerned about his health. He states that throughout his son's life he has had recurrent infections despite proper treatment and hygiene. Upon reviewing the patient's chart, the pediatrician notices that the child has been infected multiple times with S. aureus, Aspergillus, and E. coli. Which of the following would confirm the most likely cause of this patient's symptoms? (A) Negative nitroblue-tetrazolium test (B) Normal dihydrorhodamine (DHR) flow cytometry test (C) Increased IgM, Decreased IgG, IgA, and IgE (D) Increased IgE and IgA, Decreased IgM	['(A) Negative nitroblue-tetrazolium test <> answer', 'The following are multiple choice questions (with answers) about medical knowledge. <> instruction', '(A) Negative nitroblue-tetrazolium test (B) Normal dihydrorhodamine (DHR) flow cytometry test (C) Increased IgM, Decreased IgG, IgA, and IgE (D) Increased IgE and IgA, Decreased IgM <> possible answers', " A father brings his 3-year-old son to the pediatrician because he is concerned about his health. He states that throughout his son's life he has had recurrent infections despite proper treatment and hygiene. Upon reviewing the patient's chart, the pediatrician notices that the child has been infected multiple times with S. aureus, Aspergillus, and E. coli. Which of the following would confirm the most likely cause of this patient's symptoms? <> context"]
The following are multiple choice questions (with answers) about medical knowledge. Question: A 1-month-old male newborn is brought to the physician because of poor feeding, a hoarse cry, and lethargy for 1 week. The boy was born in Mozambique, from where he and his parents emigrated 2 weeks ago. He is at the 95th percentile for head circumference, 50th percentile for length, and 70th percentile for weight. Physical examination shows scleral icterus, an enlarged tongue, and generalized hypotonia. The abdomen is distended and there is a reducible, soft protruding mass at the umbilicus. Which of the following is the most likely cause of these findings? (A) Biliary atresia (B) Thyroid dysgenesis (C) Beckwith-Wiedemann syndrome (D) Congenital toxoplasmosis	['(B) Thyroid dysgenesis <> answer', 'The following are multiple choice questions (with answers) about medical knowledge. <> instruction', '(A) Biliary atresia (B) Thyroid dysgenesis (C) Beckwith-Wiedemann syndrome (D) Congenital toxoplasmosis <> possible answers', ' A 1-month-old male newborn is brought to the physician because of poor feeding, a hoarse cry, and lethargy for 1 week. The boy was born in Mozambique, from where he and his parents emigrated 2 weeks ago. He is at the 95th percentile for head circumference, 50th percentile for length, and 70th percentile for weight. Physical examination shows scleral icterus, an enlarged tongue, and generalized hypotonia. The abdomen is distended and there is a reducible, soft protruding mass at the umbilicus. Which of the following is the most likely cause of these findings? <> context']
The following are multiple choice questions (with answers) about medical knowledge. Question: A 45-year-old man is brought to the emergency department 30 minutes after falling off a staircase and hitting his head on the handrail. He was unconscious for 10 minutes and vomited twice. On arrival, he is drowsy. Examination shows a fixed, dilated left pupil and right-sided flaccid paralysis. A CT scan of the head shows a skull fracture in the region of the pterion and a biconvex hyperdensity overlying the left frontotemporal lobe. This patient's condition is most likely caused by damage to a vessel that enters the skull through which of the following foramina? (A) Foramen lacerum (B) Jugular foramen (C) Foramen magnum (D) Foramen spinosum	['(D) Foramen spinosum <> answer', 'The following are multiple choice questions (with answers) about medical knowledge. <> instruction', '(A) Foramen lacerum (B) Jugular foramen (C) Foramen magnum (D) Foramen spinosum <> possible answers', " A 45-year-old man is brought to the emergency department 30 minutes after falling off a staircase and hitting his head on the handrail. He was unconscious for 10 minutes and vomited twice. On arrival, he is drowsy. Examination shows a fixed, dilated left pupil and right-sided flaccid paralysis. A CT scan of the head shows a skull fracture in the region of the pterion and a biconvex hyperdensity overlying the left frontotemporal lobe. This patient's condition is most likely caused by damage to a vessel that enters the skull through which of the following foramina? <> context"]
The following are multiple choice questions (with answers) about medical knowledge. Question: A 49-year-old man comes to the physician because of a 6-month history of increasing fatigue and reduced libido. He also complains of joint pain in both of his hands. His vital signs are within normal limits. Physical examination shows tanned skin and small testes. The second and third metacarpophalangeal joints of both hands are tender to palpation and range of motion is limited. The liver is palpated 2 to 3 cm below the right costal margin. Histopathologic examination of a liver biopsy specimen shows intracellular material that stains with Prussian blue. This patient is at greatest risk for developing which of the following complications? (A) Colorectal carcinoma (B) Restrictive cardiomyopathy (C) Pancreatic adenocarcinoma (D) Non-Hodgkin lymphoma	['(B) Restrictive cardiomyopathy <> answer', 'The following are multiple choice questions (with answers) about medical knowledge. <> instruction', '(A) Colorectal carcinoma (B) Restrictive cardiomyopathy (C) Pancreatic adenocarcinoma (D) Non-Hodgkin lymphoma <> possible answers', ' A 49-year-old man comes to the physician because of a 6-month history of increasing fatigue and reduced libido. He also complains of joint pain in both of his hands. His vital signs are within normal limits. Physical examination shows tanned skin and small testes. The second and third metacarpophalangeal joints of both hands are tender to palpation and range of motion is limited. The liver is palpated 2 to 3 cm below the right costal margin. Histopathologic examination of a liver biopsy specimen shows intracellular material that stains with Prussian blue. This patient is at greatest risk for developing which of the following complications? <> context']
The following are multiple choice questions (with answers) about medical knowledge. Question: A 37-year-old woman with a history of systemic lupus erythematosus, on prednisone and methotrexate, presents to the dermatology clinic with three weeks of a diffuse, itchy rash. Physical exam is remarkable for small red papules in her bilateral axillae and groin and thin reddish-brown lines in her interdigital spaces. The following skin biopsy is obtained. Which of the following is the most appropriate treatment? (A) Hydrocortisone cream (B) Nystatin cream (C) Permethrin cream (D) Capsaicin cream	['(C) Permethrin cream <> answer', 'The following are multiple choice questions (with answers) about medical knowledge. <> instruction', '(A) Hydrocortisone cream (B) Nystatin cream (C) Permethrin cream (D) Capsaicin cream <> possible answers', ' A 37-year-old woman with a history of systemic lupus erythematosus, on prednisone and methotrexate, presents to the dermatology clinic with three weeks of a diffuse, itchy rash. Physical exam is remarkable for small red papules in her bilateral axillae and groin and thin reddish-brown lines in her interdigital spaces. The following skin biopsy is obtained. Which of the following is the most appropriate treatment? <> context']
The following are multiple choice questions (with answers) about medical knowledge. Question: A 45-year-old-man presents to the physician with complaints of intermittent episodes of severe headaches and palpitations. During these episodes, he notices that he sweats profusely and becomes pale in complexion. He describes the episodes as coming and going within the past 2 months. His temperature is 99.3°F (37.4°C), blood pressure is 165/118 mmHg, pulse is 126/min, respirations are 18/min, and oxygen saturation is 90% on room air. Which of the following would be the first medication given to treat this patient’s most likely diagnosis? (A) Phenoxybenzamine (B) Pilocarpine (C) Prazosin (D) Propanolol	['(A) Phenoxybenzamine <> answer', 'The following are multiple choice questions (with answers) about medical knowledge. <> instruction', '(A) Phenoxybenzamine (B) Pilocarpine (C) Prazosin (D) Propanolol <> possible answers', ' A 45-year-old-man presents to the physician with complaints of intermittent episodes of severe headaches and palpitations. During these episodes, he notices that he sweats profusely and becomes pale in complexion. He describes the episodes as coming and going within the past 2 months. His temperature is 99.3°F (37.4°C), blood pressure is 165/118 mmHg, pulse is 126/min, respirations are 18/min, and oxygen saturation is 90% on room air. Which of the following would be the first medication given to treat this patient’s most likely diagnosis? <> context']
The following are multiple choice questions (with answers) about medical knowledge. Question: A 35-year-old man presents to pulmonary function clinic for preoperative evaluation for a right pneumonectomy. His arterial blood gas at room air is as follows: pH: 7.34 PaCO2: 68 mmHg PaO2: 56 mmHg Base excess: +1 O2 saturation: 89% What underlying condition most likely explains these findings? (A) Acute respiratory distress syndrome (B) Chronic obstructive pulmonary disease (C) Cystic fibrosis (D) Obesity	['(B) Chronic obstructive pulmonary disease <> answer', 'The following are multiple choice questions (with answers) about medical knowledge. <> instruction', '(A) Acute respiratory distress syndrome (B) Chronic obstructive pulmonary disease (C) Cystic fibrosis (D) Obesity <> possible answers', ' A 35-year-old man presents to pulmonary function clinic for preoperative evaluation for a right pneumonectomy. His arterial blood gas at room air is as follows:\n\npH: 7.34\nPaCO2: 68 mmHg\nPaO2: 56 mmHg\nBase excess: +1\nO2 saturation: 89%\n\nWhat underlying condition most likely explains these findings? <> context']
The following are multiple choice questions (with answers) about medical knowledge. Question: A 14-year-old boy is brought to the emergency department because of a 4-hour history of vomiting, lethargy, and confusion. Three days ago, he was treated with an over-the-counter medication for fever and runny nose. He is oriented only to person. His blood pressure is 100/70 mm Hg. Examination shows bilateral optic disc swelling and hepatomegaly. His blood glucose concentration is 65 mg/dL. Toxicology screening for serum acetaminophen is negative. The over-the-counter medication that was most likely used by this patient has which of the following additional effects? (A) Decreased uric acid elimination (B) Reversible inhibition of cyclooxygenase-1 (C) Decreased expression of glycoprotein IIb/IIIa (D) Irreversible inhibition of ATP synthase	['(A) Decreased uric acid elimination <> answer', 'The following are multiple choice questions (with answers) about medical knowledge. <> instruction', '(A) Decreased uric acid elimination (B) Reversible inhibition of cyclooxygenase-1 (C) Decreased expression of glycoprotein IIb/IIIa (D) Irreversible inhibition of ATP synthase <> possible answers', ' A 14-year-old boy is brought to the emergency department because of a 4-hour history of vomiting, lethargy, and confusion. Three days ago, he was treated with an over-the-counter medication for fever and runny nose. He is oriented only to person. His blood pressure is 100/70 mm Hg. Examination shows bilateral optic disc swelling and hepatomegaly. His blood glucose concentration is 65 mg/dL. Toxicology screening for serum acetaminophen is negative. The over-the-counter medication that was most likely used by this patient has which of the following additional effects? <> context']