id stringlengths 4 36 | question stringlengths 7 4.67k | options dict | answer stringclasses 4
values |
|---|---|---|---|
0200 | An unconscious 55-year-old man is brought to the Emergency Department by ambulance. He had recently lost his job and his house was about to begin foreclosure. His adult children were concerned for his well being and called the police requesting a welfare check. He was found unresponsive in his gurague. There were sever... | {
"A": "Calcium oxalate crystals",
"B": "Hyaline casts",
"C": "Urine ketones",
"D": "Urate crystals"
} | A |
0201 | A 17-year-old girl comes to the physician because of an 8-month history of severe acne vulgaris over her face, upper back, arms, and buttocks. Treatment with oral antibiotics and topical combination therapy with benzoyl peroxide and retinoid has not completely resolved her symptoms. Examination shows oily skin with num... | {
"A": "Hypertension",
"B": "Ovarian cancer",
"C": "Cervical cancer",
"D": "Breast cancer"
} | B |
0202 | A 48-year-old female presents for a follow-up appointment to discuss her ultrasound results. She presented with a lump in her neck 2 weeks ago. On examination, a thyroid nodule was present; the nodule was fixed, immobile, and non-tender. Ultrasound showed a hypoechoic nodule with a size of 2 cm. Histological examinatio... | {
"A": "Trachea",
"B": "Cervical lymph nodes",
"C": "Inferior thyroid arteries",
"D": "Thyrohyoid muscle"
} | C |
0203 | A 39-year-old man presents to his primary care physician because he has been having severe headaches and fever for the last 2 days. He also says his right eyelid has been painlessly swelling and is starting to block his vision from that eye. He recently returned from a tour of the world where he visited Thailand, Ethio... | {
"A": "Benznidazole",
"B": "Ivermectin",
"C": "Mebendazol",
"D": "Sodium stibogluconate"
} | A |
0204 | A 10-year-old Caucasian female with Turner's syndrome underwent an abdominal imaging study and was discovered that the poles of her kidneys were fused inferiorly. Normal ascension of kidney during embryological development would be prevented by which of the following anatomical structures? | {
"A": "Superior mesenteric artery",
"B": "Inferior mesenteric artery",
"C": "Celiac artery",
"D": "Splenic artery"
} | B |
0205 | A 34-year-old woman is assaulted and suffers a number of stab wounds to her abdomen. Bystanders call paramedics and she is subsequently taken to the nearest hospital. On arrival to the emergency department, her vitals are T: 36 deg C, HR: 110 bpm, BP: 100/60, RR: 12, SaO2: 99%. A FAST and abdominal CT are promptly obta... | {
"A": "I, II",
"B": "I, III, IV",
"C": "I, V",
"D": "III, IV"
} | B |
0206 | Researchers are studying the inheritance pattern of mutations in the cystic fibrosis transmembrane regulator (CFTR) gene, the gene responsible for cystic fibrosis. It is believed that, in addition to the commonly found ΔF508 mutation, a novel mutation in this gene is found in a particular population under study. Which ... | {
"A": "LOD Score < 1",
"B": "LOD Score < 2",
"C": "LOD Score > 3",
"D": "LOD Score = 0"
} | C |
0207 | A 28-year-old woman returns to the clinic to follow up on a recent abnormal cervical biopsy that demonstrated cervical intraepithelial neoplasia (CIN) I. The patient is quite anxious about the implications of this diagnosis. Her physical examination is within normal limits. Her vital signs do not show any abnormalities... | {
"A": "Close observation, pap smear screening at 6 and 12 months, and HPV DNA testing at 12 months",
"B": "Cryotherapy ablation",
"C": "Loop electrosurgical excision (LEEP)",
"D": "Hysterectomy"
} | A |
0208 | A clinical researcher is interested in creating a new drug for HIV patients. Darunavir has been particularly efficacious in recent patients; however, some have experienced an increased incidence of hyperglycemia. A new drug called DN501 is developed with the same mechanism of action as darunavir but fewer side effects.... | {
"A": "Prevents viral transcription",
"B": "Inhibits viral assembly",
"C": "Inhibits viral entry",
"D": "Prevents T-cell binding"
} | B |
0209 | A 58-year-old white man with hypertension and type 2 diabetes mellitus comes to the physician because of a 3-month history of a painless lesion on his lower lip. He has smoked one pack of cigarettes daily for 20 years. He has worked as a fruit picker for the past 25 years. His current medications include captopril and ... | {
"A": "Squamous cell carcinoma",
"B": "Aphthous stomatitis",
"C": "Actinic keratosis",
"D": "Traumatic ulcer"
} | A |
0210 | An investigator is studying the effect of drug X on the retinoblastoma (Rb) gene on chromosome 13 in endometrial cells. Endometrial cells obtained from study participants are plated on growth media and the distribution of cell cycle phase is measured with flow cytometry. Drug X, which is known to activate cyclin-depend... | {
"A": "G1 phase arrest",
"B": "Prophase I arrest",
"C": "Initiation of S phase",
"D": "Completion of G2 phase"
} | C |
0211 | A 65-year-old man presents with painless swelling of the neck over the past week. He also says he has been having intermittent fevers and severe night sweats which require a change of bed sheets the next day. His past medical history is significant for human immunodeficiency virus (HIV) diagnosed 10 years ago with whic... | {
"A": "Antinuclear antibody",
"B": "Hepatitis C virus antibodies",
"C": "JAK-2 mutation",
"D": "Tartrate-resistant acid phosphatase (TRAP) test"
} | B |
0212 | In order to assess the feasibility and evaluate the outcomes of cerclage wiring as a supportive approach to osteosynthesis in femur fractures, a group of orthopedic surgeons studied 14 patients with primary and periprosthetic fractures of the thigh bone. Parameters such as patient demographic, type of implant, number o... | {
"A": "No prevalence assessment",
"B": "Low number of patients",
"C": "Ascertainment bias",
"D": "Lack of risk calculation"
} | D |
0213 | A 67-year-old woman presents from home hospice with a change in her mental status. She has seemed more confused lately and is unable to verbalize her symptoms. Her temperature is 102°F (38.9°C), blood pressure is 117/65 mmHg, pulse is 110/min, respirations are 19/min, and oxygen saturation is 95% on room air. Physical ... | {
"A": "Acalculous cholecystitis",
"B": "Calculous cholescystitis",
"C": "Choledocholithiasis",
"D": "Emphysematous cholecystitis"
} | A |
0214 | A 35-year-old female is brought to the emergency department after being found unconscious. The patient is found to have a blood glucose level of 35 mg/dL. Hgb A1c was found to be 5.1%. C-peptide level was found to be decreased. The patient returned to her baseline after glucose replacement. She states that she has neve... | {
"A": "Insulinoma",
"B": "Factitious disorder",
"C": "Hypothyroidism",
"D": "Somatization disorder"
} | B |
0215 | A 45-year-old man presents to the physician with complaints of increased urinary frequency and decreasing volumes for the past 2 months. He does not complain of any pain during urination. He is frustrated that he has to wake up 2 or 3 times per night to urinate even though he tried reducing the amount of water he consu... | {
"A": "Urinalysis and serum creatinine",
"B": "Reassurance",
"C": "Digital rectal examination",
"D": "Prostate-specific antigen"
} | C |
0216 | A 48-year-old woman with chronic tension headaches comes to the physician because of several episodes of bilateral flank pain and reddish urine within the past month. Current medications include aspirin, which she takes almost daily for headaches. Her temperature is 37.4°C (99.3°F) and her blood pressure is 150/90 mm H... | {
"A": "Tubular lumen obstruction by protein casts",
"B": "Necrotizing inflammation of the renal glomeruli",
"C": "Bacterial infection of the renal parenchyma",
"D": "Vasoconstriction of the medullary vessels"
} | D |
0217 | A 37-year-old primigravid woman at 12 weeks' gestation comes to the emergency department because of vaginal bleeding and dull suprapubic pain for 3 hours. She has had spotting during the last 3 days. Her medications include folic acid and a multivitamin. She has smoked one pack of cigarettes daily for 15 years. Her tem... | {
"A": "Misoprostol therapy",
"B": "Methotrexate therapy",
"C": "Dilation and curettage",
"D": "Complete bed rest"
} | C |
0218 | A 17-year-old female accidentally eats a granola bar manufactured on equipment that processes peanuts. She develops type I hypersensitivity-mediated histamine release, resulting in pruritic wheals on the skin. Which of the following layers of this patient's skin would demonstrate histologic changes on biopsy of her les... | {
"A": "Stratum corneum",
"B": "Stratum granulosum",
"C": "Stratum basale",
"D": "Dermis"
} | D |
0219 | A 4-year-old girl is brought to the emergency department with a persistent cough, fever, and vomiting. The past year the child has been admitted to the hospital 3 times with pneumonia. For the past 1 week, the child has been experiencing thick purulent cough and says that her chest feels ‘heavy’. Her stools have been l... | {
"A": "Dysfunction in a transmembrane regulator",
"B": "Inefficient breakdown of leucine, isoleucine, and valine",
"C": "Dysfunction in the motility of respiratory cilia",
"D": "Deficiency in lymphocytic activity"
} | A |
0220 | A 48-year-old man seeks evaluation at a clinic with a complaint of breathlessness for the past couple of weeks. He says that he finds it difficult to walk a few blocks and has to rest. He also complains of a cough for the past 3 months, which is dry and hacking in nature. The medical history is relevant for an idiopath... | {
"A": "Decreased FEV1 and normal FVC",
"B": "Decreased FEV1 and FVC with decreased FEV1/FVC ratio",
"C": "Decreased FEV1 and FVC with normal FEV1/FVC ratio",
"D": "Increased FEV1 and FVC"
} | C |
0221 | A 2,300 g (5 lb) male newborn is delivered to a 29-year-old primigravid woman. The mother has HIV and received triple antiretroviral therapy during pregnancy. Her HIV viral load was 678 copies/mL 1 week prior to delivery. Labor was uncomplicated. Apgar scores were 7 and 8 at 1 and 5 minutes respectively. Physical exami... | {
"A": "Administer zidovudine",
"B": "HIV DNA testing",
"C": "HIV RNA testing",
"D": "Reassurance and follow-up"
} | A |
0222 | A 60-year-old woman presents to a physician for worsening shortness of breath and increasing abdominal distention over the last 3 months. She says that the shortness of breath is worse on exertion and improves with rest. While she could previously walk to the nearby store for her groceries, she now has to drive because... | {
"A": "Binding to the alpha subunit of the insulin receptor",
"B": "Closure of ATP-sensitive K-channels in the pancreatic beta-cell",
"C": "Increased gene expression of GLUT-4",
"D": "Glucagon-like peptide-1 receptor agonist"
} | C |
0223 | A 15-year-old girl comes to the physician because of episodic pelvic pain radiating to her back and thighs for 4 months. The pain occurs a few hours before her menstrual period and lasts for 2 days. She has been taking ibuprofen, which has provided some relief. Menses have occurred at regular 28-day intervals since men... | {
"A": "Endometrial sloughing and uterine contractions mediated by prostaglandin",
"B": "Ascending infection of the uterus, fallopian tubes, ovaries, or surrounding tissue",
"C": "Fluid-filled sac within the ovary",
"D": "Hormone-sensitive smooth muscle tumor of the myometrium"
} | A |
0224 | A 25-year-old male is hospitalized for acute agitation, photophobia, and dysphagia. His parents report that he has been experiencing flu-like symptoms for one week prior to hospital admission. Five weeks ago, the patient was in Mexico, where he went on several spelunking expeditions with friends. The patient ultimately... | {
"A": "Hematogenous dissemination to the meninges",
"B": "Retrograde migration up peripheral nerve axons",
"C": "Reactivation of virus previously latent in dorsal root ganglia",
"D": "Infection of oligodendrocytes and astrocytes"
} | B |
0225 | A 19-year-old Caucasian male presents to your office with hypopigmented skin. He undergoes a skin biopsy and is found to have an absence of melanocytes in the epidermis. Which of the following is the most likely diagnosis? | {
"A": "Tinea versicolor",
"B": "Albinism",
"C": "Vitiligo",
"D": "Melanoma"
} | C |
0226 | A 51-year-old man presents for a routine check-up. He has no complaints. At his last annual visit, his physical and laboratory tests were unremarkable. His past medical history is significant for hypercholesterolemia, well managed with rosuvastatin, and hypertension, well managed with hydrochlorothiazide. His current m... | {
"A": "Bleomycinrn",
"B": "Imatinib",
"C": "Fludarabinern",
"D": "Vincristinern"
} | C |
0227 | A 62-year-old woman is evaluated because of a 3-day history of headache, nausea, and decreased urination. Laboratory studies show:
Serum
Na+ 136 mEq/L
K+ 3.2 mEq/L
Cl- 115 mEq/L
Mg2+ 1.4 mEq/L
Urine
pH 7.0
Arterial blood gas analysis on room air shows a pH of 7.28 and a HCO3- concentration of 14 mEq/L. Prolonged treatm... | {
"A": "Trimethoprim-sulfamethoxazole",
"B": "Eplerenone",
"C": "Amphotericin B",
"D": "Heparin"
} | C |
0228 | A 21-year-old male presents to his primary care provider for fatigue. He reports that he graduated from college last month and returned 3 days ago from a 2 week vacation to Vietnam and Cambodia. For the past 2 days, he has developed a worsening headache, malaise, and pain in his hands and wrists. The patient has a past... | {
"A": "Chikungunya",
"B": "Dengue fever",
"C": "Epstein-Barr virus",
"D": "Hepatitis A"
} | A |
0229 | Three days after admission to the intensive care unit for septic shock and bacteremia from a urinary tract infection, a 34-year-old woman has persistent hypotension. Her blood cultures are positive for Escherichia coli, for which she has been receiving appropriate antibiotics since admission. She has no history of any ... | {
"A": "Bromocriptine",
"B": "Levothyroxine",
"C": "Removing toxic drugs",
"D": "Treating the underlying illness"
} | D |
0230 | An 11-year-old child complains of pain in the leg while playing. Blood pressure in the upper limb is 140/90 mm Hg and lower limbs are 110/70 mm Hg. There is a brachiofemoral delay in the pulse. Auscultation shows a loud S1, loud S2, and S4. There is a presence of an ejection systolic murmur in the interscapular area. C... | {
"A": "Pulmonic stenosis",
"B": "Coarctation of the aorta",
"C": "Aortic stenosis",
"D": "Transposition of great vessels"
} | B |
0231 | A 59-year-old man comes to the emergency department because of excruciating left knee pain for 4 days. He underwent a total knee arthroplasty of his left knee joint 4 months ago. He has hypertension and osteoarthritis. Current medications include glucosamine, amlodipine, and meloxicam. His temperature is 38.1°C (100.6°... | {
"A": "Staphylococcus epidermidis",
"B": "Escherichia coli",
"C": "Staphylococcus aureus",
"D": "Pseudomonas aeruginosa"
} | A |
0232 | A 47-year-old man presents to the emergency department with fever, fatigue, and loss of appetite for 1 week, followed by right shoulder pain, generalized abdominal pain, and paroxysmal cough. He has had diabetes mellitus for 15 years, for which he takes metformin and gliclazide. His vital signs include a temperature of... | {
"A": "Metronidazole and paromomycin",
"B": "Cholecystectomy",
"C": "Antibiotics and drainage",
"D": "Endoscopic retrograde cholangiopancreatography (ERCP)"
} | C |
0233 | A 36-year-old recent immigrant from India presents with a face similar to that seen in the image A. Examination of his face reveals skin that is thick and contains many lesions. The patient complains that he has experienced a loss of sensation in his toes and fingertips, which has caused him to injure himself often. Bi... | {
"A": "Acid-fast",
"B": "Catalase-negative",
"C": "Thermophiles",
"D": "Tennis-racket shaped"
} | A |
0234 | A 55-year-old man comes to the physician because of a 3-month history of a progressively growing mass in his axilla. During this period, he has had recurrent episodes of low-grade fever lasting for 7 to 10 days, and an 8-kg (18-lb) weight loss. His only medication is a multivitamin. Physical examination shows nontender... | {
"A": "Excessive intake of dietary ergocalciferol",
"B": "Induction of focal osteolysis by tumor cells",
"C": "Secretion of γ-interferon by activated T-lymphocytes",
"D": "Production of PTH-related peptide by malignant cells"
} | C |
0235 | A 32-year-old man comes to the physician for a pre-employment examination. He recently traveled to Guatemala. He feels well but has not seen a physician in several years, and his immunization records are unavailable. Physical examination shows no abnormalities. Serum studies show:
Anti-HAV IgM Positive
Anti-HAV IgG Neg... | {
"A": "Active hepatitis A infection",
"B": "Previous hepatitis A infection",
"C": "Chronic hepatitis B infection",
"D": "Chronic hepatitis C infection"
} | A |
0236 | A 7-month-old male infant is brought to the pediatrician by his mother. She reports that the child develops severe sunburns every time the infant is exposed to sunlight. She has applied copious amounts of sunscreen to the infant but this has not helped the problem. On examination, there are multiple areas of reddened s... | {
"A": "Nucleotide excision repair",
"B": "Non-homologous end joining",
"C": "Homologous recombination",
"D": "Mismatch repair"
} | A |
0237 | A 65-year-old man presents to his primary care physician with a neck mass. He first noticed a firm mass on the anterior aspect of his neck approximately 4 months ago. The mass is painless and has not increased in size since then. He has also noticed occasional fatigue and has gained 10 pounds in the past 4 months despi... | {
"A": "Diffuse infiltrate of lymphoid cells destroying thyroid follicles",
"B": "Dense fibroinflammatory infiltrate",
"C": "Pleomorphic undifferentiated infiltrative cells with necrosis",
"D": "Stromal amyloid deposition"
} | B |
0238 | A group of researchers decided to explore whether the estimates of incidence and prevalence rates of systemic lupus erythematosus (SLE) were influenced by the number of years it took to examine administrative data. These estimates were not only based on hospital discharges, but also on physician billing codes. For stud... | {
"A": "Incidence rates will be higher during shorter time periods than longer periods.",
"B": "The prevalence of SLE during consecutively shorter time windows will be overestimated.",
"C": "The inclusion of attack rates would increase incidence estimates in longer time periods.",
"D": "The inclusion of attack ... | A |
0239 | A 48-year-old Caucasian female presents to her primary care physician for evaluation of progressive weakness and shortness of breath. She has had progressive shortness of breath over the last year with an intermittent non-productive cough. In addition, she complains of difficulty raising her arms to brush her hair. Her... | {
"A": "Muscle biopsy",
"B": "CT scan",
"C": "Serum ANA titer",
"D": "Skin biopsy"
} | A |
0240 | A 46-year-old man presents to the physician with a complaint of a cough for 6 months. He has been taking over-the-counter cough medications, but they have not helped much. He adds that he expectorated bloody sputum the previous night. He denies breathlessness but mentions that he frequently experiences fatigue after li... | {
"A": "Bence-Jones protein",
"B": "Calcitonin",
"C": "CA 15-3",
"D": "Neuron-specific enolase"
} | D |
0241 | A 41-year-old man presents to his primary care provider with abdominal pain. He says that the pain “comes and goes” throughout the day and usually lasts 20-30 minutes per episode. He can point to the spot 1-2 inches above the umbilicus where he feels the pain. He denies any feeling of regurgitation or nighttime cough b... | {
"A": "Mucosal defect in the stomach",
"B": "Urease-producing organism in the small intestine",
"C": "PAS-positive material in the small intestine",
"D": "Crypt abscesses in the large intestine"
} | B |
0242 | A 5-year-old female presents to the pediatrician for a routine office visit. The patient is in kindergarten and doing well in school. She is learning to read and is able to write her first name. Her teacher has no concerns. The patient’s mother is concerned that the patient is a picky eater and often returns home from ... | {
"A": "Absent Barr bodies on buccal smear",
"B": "Elevated serum alkaline phosphatase level",
"C": "Elevated serum TSH level",
"D": "Mass in the sella turcica"
} | A |
0243 | A 61-year-old man was started on rosuvastatin 40 mg 8 weeks ago and presents today for a follow-up. He complains of pain in his legs and general weakness. On physical exam, he has full range of motion of his extremities but complains of pain. His blood pressure is 126/84 mm Hg and heart rate is 74/min. The decision is... | {
"A": "Restart rosuvastatin at a lower dose",
"B": "Initiate fenofibrate",
"C": "Initiate a different statin",
"D": "Initiate fish oils"
} | A |
0244 | An unidentified surgical specimen is received for histopathologic analysis. A portion of the specimen is cut and stained with hematoxylin and eosin. The remainder is analyzed and is found to contains type II collagen and chondroitin sulfate. Which of the following structures is most likely the origin of this surgical s... | {
"A": "Blood vessel",
"B": "Pinna",
"C": "Lens",
"D": "Larynx"
} | D |
0245 | A 70-year-old woman is brought to the emergency department for the evaluation of abdominal pain, nausea, and vomiting for 1 day. Computed tomography shows a small bowel perforation. The patient is prepared for emergent exploratory laparotomy. She is sedated with midazolam, induced with propofol, intubated, and maintain... | {
"A": "Increase the FiO2",
"B": "Increase the tidal volume",
"C": "Increase PEEP",
"D": "Increase the respiratory rate"
} | C |
0246 | A 43-year-old man with a history of hepatitis C and current intravenous drug use presents with 5 days of fever, chills, headache, and severe back pain. On physical exam, temperature is 100.6 deg F (38.1 deg C), blood pressure is 109/56 mmHg, pulse is 94/min, and respirations are 18/min. He is thin and diaphoretic with ... | {
"A": "Repeat blood cultures now",
"B": "Repeat blood cultures 24 hours after initial cultures were drawn",
"C": "Repeat blood cultures 48 hours after initial cultures were drawn",
"D": "Do not repeat blood cultures"
} | A |
0247 | A 42-year-old man with AIDS comes to the physician for intermittent fever, nonproductive cough, malaise, decreased appetite, abdominal pain, and a 3.6-kg (8-lb) weight loss over the past month. He has not seen a doctor since he became uninsured 2 years ago. His temperature is 38.3°C (100.9°F). Abdominal examination sho... | {
"A": "Voriconazole",
"B": "Amphotericin B and itraconazole",
"C": "Erythromycin",
"D": "Azithromycin and ethambutol"
} | D |
0248 | A 49-year-old woman comes to the physician for a scheduled colposcopy. Two weeks ago, she had a routine Pap smear that showed atypical squamous cells. Colposcopy shows an area of white discoloration of the cervix with application of acetic acid solution. Biopsy of this area shows carcinoma-in-situ. Activation of which ... | {
"A": "JAK2 tyrosine kinase",
"B": "E2F transcription factors",
"C": "Phosphoprotein p53",
"D": "Cyclin-dependent kinase inhibitors"
} | B |
0249 | A research group has developed a low-cost diagnostic retinal imaging device for cytomegalovirus retinitis in a population of HIV-infected patients. In a pilot study of 50 patients, the imaging test detected the presence of CMV retinitis in 50% of the patients. An ophthalmologist slit lamp examination, which was perform... | {
"A": "PPV decreases, NPV decreases",
"B": "PPV decreases, NPV increases",
"C": "PPV increases, NPV decreases",
"D": "PPV unchanged, NPV unchanged"
} | B |
0250 | A 35-year-old woman is brought into the clinic by a concerned neighbor who says that the patient is often seen setting up bear traps all around her property because of an impending ‘invasion of the mole people.’ The patient has come to the clinic wearing a garlic necklace. She vaguely explains that the necklace is to m... | {
"A": "Cognitive behavioral therapy (CBT)",
"B": "The patient does not require any intervention",
"C": "Electroconvulsive therapy (ECT)",
"D": "Refer to outpatient group therapy"
} | A |
0251 | A 71-year-old man complains of urinary hesitancy and nocturia of increasing frequency over the past several months. Digital rectal exam was positive for a slightly enlarged prostate but did not detect any additional abnormalities of the prostate or rectum. The patient’s serum PSA was measured to be 6 ng/mL. Image A sho... | {
"A": "Clonidine",
"B": "Finasteride",
"C": "Dihydrotestosterone",
"D": "Furosemide"
} | B |
0252 | A 30-year-old man presents to his primary care provider complaining of drowsiness at work for the past several months. He finds his work as a computer programmer rewarding and looks forward to coming into the office every day. However, he often falls asleep during meetings even though he usually gets a good night sleep... | {
"A": "Methylphenidate",
"B": "Sodium oxybate",
"C": "Imipramine",
"D": "Increase daytime naps"
} | A |
0253 | A 40-year-old man comes to the physician for the evaluation of a painless right-sided scrotal swelling. The patient reports that he first noticed the swelling several weeks ago, but it is not always present. He has hypertension treated with enalapril. His father was diagnosed with a seminoma at the age of 25 years. The... | {
"A": "Patent processus vaginalis",
"B": "Dilation of the pampiniform plexus",
"C": "Twisting of the spermatic cord",
"D": "Imbalance of fluid secretion and resorption by the tunica vaginalis"
} | D |
0254 | A 62-year-old man presents to the physician because of incomplete healing of a chest wound. He recently had a triple coronary artery bypass graft 3 weeks ago. His past medical history is significant for type 2 diabetes mellitus and hypertension for the past 25 years. Clinical examination shows the presence of wound deh... | {
"A": "Surgical debridement",
"B": "Negative pressure wound management",
"C": "Sternal wiring",
"D": "Sternal fixation"
} | A |
0255 | The Kozak sequence for the Beta-globin gene has a known mutation which decreases, though does not abolish, translation of the Beta-globin mRNA, leading to a phenotype of thalassemia intermedia. What would the blood smear be expected to show in a patient positive for this mutation? | {
"A": "Macrocytic red blood cells",
"B": "Hyperchromic red blood cells",
"C": "Microcytic red blood cells",
"D": "Bite cells"
} | C |
0256 | A 68-year-old man from California presents for a routine checkup. He does not have any complaints. He says that he has tried to keep himself healthy and active by jogging and gardening since his retirement at age 50. He adds that he spends his mornings in the park and his afternoons in his garden. He has no significant... | {
"A": "Psoriasis",
"B": "Seborrheic keratosis",
"C": "Actinic keratosis",
"D": "Squamous cell carcinoma"
} | C |
0257 | A routine newborn screening test for phenylketonuria in a male neonate shows a serum phenylalanine concentration of 44 mg/dL (N < 20). He is started on a special diet and the hyperphenylalaninemia resolves. At a routine well-child examination 4 months later, the physician notices that he has persistent head lag. On exa... | {
"A": "Tyrosine",
"B": "Pyridoxine",
"C": "Thiamine",
"D": "Tetrahydrobiopterin"
} | D |
0258 | A 36-year-old nursing home worker presents to the clinic with the complaints of breathlessness, cough, and night sweats for the past 2 months. She further expresses her concerns about the possibility of contracting tuberculosis as one of the patients under her care is being treated for tuberculosis. A PPD skin test is ... | {
"A": "Inhibition of ferrochelatase",
"B": "Increased homocysteine degradation",
"C": "Increased GABA production",
"D": "Decreased ALA synthesis"
} | D |
0259 | A 23-year-old woman is referred to a genetic counselor. She is feeling well but is concerned because her brother was recently diagnosed with hereditary hemochromatosis. All first-degree relatives were encouraged to undergo genetic screening for any mutations associated with the disease. Today, she denies fever, chills,... | {
"A": "BCR-ABL gene",
"B": "BRCA gene",
"C": "FA gene",
"D": "HFE gene"
} | D |
0260 | A 16-year-old girl is brought to the emergency department with constant abdominal pain over the past 8 hours. The pain is in her right lower quadrant (RLQ), which is also where it began. She has had no nausea or vomiting despite eating a snack 2 hours ago. She had a similar episode last month which resolved on its own.... | {
"A": "Methotrexate",
"B": "Nitrofurantoin",
"C": "Reassurance",
"D": "Referral for surgery"
} | C |
0261 | A 30-year-old male presents to the emergency department with a complaint of abdominal pain. The patient states he was at a barbecue around noon. Lunch was arranged as a buffet without refrigeration. Within 2 to 3 hours, he had abdominal pain with 3 episodes of watery diarrhea. On exam, vital signs are T 99.1, HR 103, B... | {
"A": "Salmonella enteritidis",
"B": "Listeria monocytogenes",
"C": "Staphylococcus aureus",
"D": "Vibrio cholerae"
} | C |
0262 | A 70-year-old man is brought to the emergency department by staff of the group home where he resides because of worsening confusion for the past week. He has a history of major depressive disorder and had an ischemic stroke 4 months ago. Current medications are aspirin and sertraline. He is lethargic and disoriented. H... | {
"A": "↓ ↓ ↓",
"B": "↑ ↓ normal",
"C": "↓ ↑ ↑",
"D": "↓ ↑ ↓"
} | D |
0263 | A 35-year-old woman presents with severe fear reactions to seeing dogs after moving into a new suburban neighborhood. She states that she has always had an irrational and excessive fear of dogs but has been able to avoid it for most of her life while living in the city. When she sees her neighbors walking their dogs ou... | {
"A": "Selective serotonin reuptake inhibitors (SSRIs)",
"B": "Short-acting benzodiazepines",
"C": "Systematic desensitization",
"D": "Cognitive behavioral therapy"
} | C |
0264 | A 45-year-old man arrives by ambulance to the emergency room after being involved in a very severe construction accident. The patient was found unconscious with a large metal spike protruding from his abdomen by a coworker who was unable to estimate the amount of time the patient went without medical aid. Upon arrival ... | {
"A": "Diffuse alveolar damage",
"B": "Ventricular septal defect",
"C": "Myocardial free wall rupture",
"D": "Myocardial reinfarction"
} | A |
0265 | A 76-year-old man with chronic obstructive pulmonary disease (COPD) presents complaining of 3 weeks of cough and progressive dyspnea on exertion in the setting of a 20 pound weight loss. He is a 60 pack-year smoker, worked as a shipbuilder 30 years ago, and recently traveled to Ohio to visit family. Chest radiograph sh... | {
"A": "Nodular mass spreading along pleural surfaces",
"B": "Honeycombing",
"C": "Air bronchogram",
"D": "Lower lobe cavitary mass"
} | D |
0266 | A 60-year-old man presents with a 2-day history of increasing difficulty in breathing with a productive cough. He reports having shortness of breath over the last 6 months, but he has felt worse since he contracted a cold that has been traveling around his office. Today, he reports body aches, headache, and fever along... | {
"A": "Primary respiratory acidosis",
"B": "Primary respiratory alkalosis",
"C": "Compensatory respiratory acidosis",
"D": "Anion gap metabolic acidosis with respiratory alkalosis"
} | A |
0267 | A 34-year-old male suffers from inherited hemophilia A. He and his wife have three unaffected daughters. What is the probability that the second daughter is a carrier of the disease? | {
"A": "0%",
"B": "25%",
"C": "50%",
"D": "100%"
} | D |
0268 | A 76-year-old man is brought to his physician's office by his wife due to progressively worsening hearing loss. The patient reports that he noticed a decrease in his hearing approximately 10 years ago. His wife says that he watches television at an elevated volume and appears to have trouble understanding what is being... | {
"A": "Tympanic membrane",
"B": "Malleus",
"C": "Incus",
"D": "Cochlea"
} | D |
0269 | A 13-year-old boy is brought to the emergency department by his mother because of a 6-hour history of severe eye pain and blurry vision. He wears soft contact lenses and has not removed them for 2 days. Ophthalmologic examination shows a deep corneal ulcer, severe conjunctival injection, and purulent discharge on the r... | {
"A": "Gram-negative, non-maltose fermenting diplococci",
"B": "Gram-negative, lactose-fermenting bacilli",
"C": "Gram-negative, oxidase-positive bacilli",
"D": "Gram-positive, optochin-sensitive diplococci\n\""
} | C |
0270 | A 31-year-old female patient complains of numbness and tingling in her left hand, weakness, difficulty with walking, dizziness, and bladder dysfunction. She said that about a year ago, she had trouble with her vision, and that it eventually recovered in a few days. On physical exam, bilateral internuclear ophthalmopleg... | {
"A": "Presence of 14-3-3 protein",
"B": "Decreased glucose with neutrophilic predominance",
"C": "Oligoclonal IgG bands on electrophoresis",
"D": "Decreased IgG CSF concentration"
} | C |
0271 | A 22-year-old primigravida presents for a regular prenatal visit at 16 weeks gestation. She is concerned about the results of a dipstick test she performed at home, which showed 1+ glucose. She does not know if her liquid consumption has increased, but she urinates more frequently than before. The course of her pregna... | {
"A": "HbA1c measurement",
"B": "No tests required",
"C": "Urinalysis",
"D": "Oral glucose tolerance test"
} | B |
0272 | A 9-month-old boy is brought to the physician by his mother because of intermittent watery diarrhea for several months. Pregnancy and delivery were uncomplicated. He was diagnosed with eczematous dermatitis at 3 months old. His height and weight are below the 5th percentile. Immunologic evaluation shows a defect in act... | {
"A": "Hemorrhagic diathesis",
"B": "Ocular telangiectasias",
"C": "Autoimmune endocrinopathy",
"D": "Retained primary teeth"
} | C |
0273 | A 57-year-old man comes to the physician because of a 3-week history of abdominal bloating and increased frequency of stools. He describes the stools as bulky, foul-smelling, and difficult to flush. He also has a 4-month history of recurrent dull upper abdominal pain that usually lasts for a few days, worsens after mea... | {
"A": "Abdominal CT scan",
"B": "Endoscopic ultrasonography",
"C": "Abdominal ultrasound",
"D": "Upper gastrointestinal endoscopy"
} | A |
0274 | A 67-year-old white man presents to his primary care provider for an annual examination. He notes a pink bump that has rapidly developed on his forehead over the last month. In the past, he has had significant sun exposure including multiple blistering sunburns. The physical examination reveals a 2 cm dome-shaped plaqu... | {
"A": "Keratoacanthoma",
"B": "Basal cell carcinoma",
"C": "Seborrheic keratosis",
"D": "Kaposi's sarcoma"
} | A |
0275 | A 56-year-old man presents to his primary care doctor with intermittent chest pain. He reports a 2-month history of exertional chest pain that commonly arises after walking 5 or more blocks. He describes the pain as dull, burning, non-radiating substernal pain. His past medical history is notable for hypercholesterolem... | {
"A": "Adenosine",
"B": "Inorganic phosphate",
"C": "Prostaglandin E2",
"D": "Transforming growth factor beta"
} | A |
0276 | A 69-year-old male with a history of metastatic small cell lung carcinoma on chemotherapy presents to his oncologist for a follow-up visit. He has responded well to etoposide and cisplatin with plans to undergo radiation therapy. However, he reports that he recently developed multiple “spots” all over his body. He deni... | {
"A": "Interleukin 2",
"B": "Interleukin 8",
"C": "Interleukin 11",
"D": "Granulocyte colony stimulating factor"
} | C |
0277 | A 60-year-old man with a history of osteoarthritis has been awaiting hip replacement surgery for 3 years. During his annual physical, he reports that he has been taking over the counter pain medications, but that no amount of analgesics can relieve his constant pain. Laboratory results reveal that his renal function ha... | {
"A": "Focal segmental glomerulosclerosis",
"B": "Ischemic acute tubular necrosis",
"C": "Nephrotoxic acute tubular necrosis",
"D": "Toxic tubulointerstitial nephritis"
} | D |
0278 | A 62-year-old man presents to the emergency department with shortness of breath. The patient says he feels as if he is unable to take a deep breath. The patient has a past medical history of COPD and a 44-pack-year smoking history. The patient has been admitted before for a similar presentation. His temperature is 98.7... | {
"A": "BiPAP",
"B": "Chest tube placement",
"C": "Intubation",
"D": "Needle decompression"
} | A |
0279 | A 76-year-old man is brought to the physician by his wife because of low back pain and weakness for the past 4 weeks. He says that the pain is sharp, radiates to his left side, and has a burning quality. He has had a cough occasionally productive of blood-streaked sputum for the past 2 months. He has had 3.2-kg (7.0-lb... | {
"A": "Radiation therapy",
"B": "Intravenous dexamethasone therapy",
"C": "Intravenous acyclovir therapy",
"D": "Intravenous ceftriaxone and azithromycin therapy"
} | B |
0280 | A 32-year-old man arrives to his primary care physician to discuss his fear of flying. The patient reports that he has had a fear of flying since being a teenager. He went on a family vacation 15 years ago, and during the flight there was turbulence and a “rough landing”. Since then he has avoided flying. He did not go... | {
"A": "Alprazolam",
"B": "Cognitive behavioral therapy",
"C": "Fluoxetine",
"D": "Psychodynamic psychotherapy"
} | B |
0281 | A 75-year-old man presents to a medical clinic for evaluation of a large, tense, pruritic bulla on his inner thighs, abdomen, and lower abdomen. A skin biopsy is performed, which shows an epidermal basement membrane with immunoglobulin G (IgG) antibodies and linear immunofluorescence. Which of the following is the most... | {
"A": "Desmosomes",
"B": "Gap junctions",
"C": "Hemidesmosomes",
"D": "Tight junctions"
} | C |
0282 | A 16-year-old girl is brought to the physician by her father because of concerns about her behavior during the past 2 years. She does not have friends and spends most of the time reading by herself. Her father says that she comes up with excuses to avoid family dinners and other social events. She states that she likes... | {
"A": "Schizoid personality disorder",
"B": "Antisocial personality disorder",
"C": "Schizophreniform disorder",
"D": "Autism spectrum disorder"
} | A |
0283 | Twelve hours after admission to the hospital because of a high-grade fever for 3 days, a 15-year-old boy has shortness of breath. During this period, he has had generalized malaise and a cough productive of moderate amounts of green sputum. For the past 10 days, he has had fever, a sore throat, and generalized aches; t... | {
"A": "Streptococcus pneumoniae",
"B": "Mycoplasma pneumoniae",
"C": "Chlamydophila pneumoniae",
"D": "Haemophilus influenzae"
} | A |
0284 | An elderly man presents to his physician with complaints of difficulty breathing, easy fatigability, and bilateral leg swelling which began 2 months ago. His breathlessness worsens while walking, climbing the stairs, and lying flat on his back. He also finds it difficult to sleep well at night, as he often wakes up to ... | {
"A": "Decrease in transmembrane sodium gradient",
"B": "Preferential dilatation of capacitance vessels",
"C": "Inhibition of aldosterone-mediated sodium reabsorption",
"D": "Reduction in myocardial contractility"
} | A |
0285 | A 30-year-old man presents to his primary care physician with complaints of excessive fatigue and weakness for the last several weeks. He also complains of abdominal pain and constipation for the same duration. On further questioning, he reports that he has lost 8 pounds in the last 2 weeks. Past medical history and fa... | {
"A": "Administer intravenous fludrocortisone",
"B": "Start him on androgen replacement treatment",
"C": "Start him on both hydrocortisone and fludrocortisone therapy",
"D": "Order an ACTH stimulation test"
} | C |
0286 | A 27-year-old HIV positive female gave birth to a 7lb 2oz (3.2 kg) baby girl. The obstetrician is worried that the child may have been infected due to the mother's haphazard use of her anti-retroviral medications. Which of the following assays would a hospital use detect the genetic material of HIV if the child had bee... | {
"A": "Enzyme-linked immunosorbent assay (ELISA)",
"B": "Rapid HIV antibody test",
"C": "Polymerase chain reaction",
"D": "Southern blot"
} | C |
0287 | A 53-year-old man presents to his physician’s office with a persistent cough which he has had over the last few months. He was diagnosed with chronic obstructive pulmonary disease (COPD) the previous year and since then has been on a short-acting β-agonist to help alleviate his symptoms. Since his diagnosis, he has qui... | {
"A": "Doxycycline",
"B": "Ciprofloxacin",
"C": "Erythromycin",
"D": "Antibiotics would not be appropriate at this time"
} | A |
0288 | An 8-year-old boy is brought to the physician because of headaches for the past 2 weeks. His headaches tend to occur in the morning and are associated with nausea and vomiting. One month ago, the patient was admitted to the hospital because of fever, irritability, and neck rigidity, and he was successfully treated with... | {
"A": "Increased CSF production by the choroid plexus",
"B": "Impaired CSF flow through the arachnoid granulations",
"C": "Impaired CSF drainage into the subarachnoid space",
"D": "Impaired CSF drainage into the fourth ventricle"
} | B |
0289 | A previously healthy 2-year-old boy is brought to the physician because of a 10-day history of unsteady gait, frequent falls, and twitching of the extremities. Physical examination shows bilateral saccadic eye movement in all directions and brief, involuntary muscle contractions of the trunk and limbs. There is an ill-... | {
"A": "Numerous immature lymphocytes in a starry sky pattern",
"B": "Abortive glomeruli and tubules in a spindle cell stroma",
"C": "Small blue cells arranged in rosettes around a central neuropil",
"D": "Hepatocytes in fetal and embryonic stages of differentiation"
} | C |
0290 | In a study, 2 groups are placed on different statin medications, statin A and statin B. Baseline LDL levels are drawn for each group and are subsequently measured every 3 months for 1 year. Average baseline LDL levels for each group were identical. The group receiving statin A exhibited an 11 mg/dL greater reduction in... | {
"A": "If 100 similar experiments were conducted, 5.2 of them would show similar results",
"B": "There is a 5.2% chance that A is more effective than B is due to chance",
"C": "There is a 94.8% chance that the difference observed reflects a real difference",
"D": "This is a statistically significant result"
} | B |
0291 | A 32-year-old woman presents to the emergency department because she has a cord-like rash on her left calf that is red and painful to touch. She says that she has had multiple such lesions previously. Other medical history reveals that she has had 3 past spontaneous abortions at < 10 weeks of gestational age but has ne... | {
"A": "Anti-cardiolipin",
"B": "Anti-centromere",
"C": "Anti-histone",
"D": "Anti-ribonucleoprotein"
} | A |
0292 | A 28-year-old female visits her physician for workup of a new onset diastolic murmur found on physical examination. Past medical history is insignificant. Her temperature is 37.0 degrees C, blood pressure is 115/75 mm Hg, pulse is 76/min, and respiratory rate is 16/min. The patient denies dyspnea, fatigue, and syncope.... | {
"A": "Abrupt hypotension",
"B": "Sudden cardiac death",
"C": "Acute arterial occlusion",
"D": "Septic embolism"
} | C |
0293 | An 8-year-old girl presents to the emergency department with respiratory distress, facial edema, and a skin rash after eating a buffet dinner with her family. She was born at 39 weeks via spontaneous vaginal delivery, has met all developmental milestones and is fully vaccinated. Past medical history is significant for ... | {
"A": "IM epinephrine",
"B": "oral diphenhydramine",
"C": "extra-strength topical diphenhydramine",
"D": "inhaled sodium cromolyn - mast cell stabilizer"
} | A |
0294 | An investigator is studying the cell morphologies of the respiratory tract. He obtains a biopsy from the mainstem bronchus of a patient. On microscopic examination, the biopsy sample shows uniform squamous cells in layers. Which of the following best describes the histologic finding seen in this patient? | {
"A": "Metaplasia",
"B": "Normal epithelium",
"C": "Dysplasia",
"D": "Anaplasia\n\""
} | A |
0295 | A 32-year-old female complains to her gynecologist that she has had irregular periods for several years. She has severe facial acne and dense black hairs on her upper lip, beneath her hairline anterior to her ears, and the back of her neck. Ultrasound reveals bilateral enlarged ovaries with multiple cysts. Which of the... | {
"A": "Endometrial carcinoma",
"B": "Addison disease",
"C": "Wegener granulomatosus",
"D": "Eclampsia"
} | A |
0296 | A 52-year-old fisherman presents to the clinic for an evaluation of a pigmented lesion on his neck. He states that he first noticed the lesion last year, but he believes that it has been slowly growing in size. Dermatopathology determines that the lesion contains neoplastic cells of melanocytic origin. Which of the fol... | {
"A": "Brown-black color in one area of the lesion to red-white in a different area",
"B": "Macule that is 5mm in diameter",
"C": "Well-circumscribed papule with smooth borders",
"D": "Itching and pain to palpation"
} | A |
0297 | Two days after being admitted to the hospital following a fall, a 77-year-old woman complains of fatigue and headaches. During the fall she sustained a right-sided subdural hematoma. She has hypertension and hyperlipidemia. Her medications prior to admission were hydrochlorothiazide and atorvastatin. Vital signs are wi... | {
"A": "Head elevation",
"B": "Tolvaptan",
"C": "Desmopressin",
"D": "Fluid restriction"
} | D |
0298 | An 18-month-old girl is brought to the pediatrician by her mother for vaginal bleeding. The mother states that she noticed the bleeding today, which appeared as brown discharge with clots in the patient’s diaper. The mother denies frequent nosebleeds or easy bruising. She also denies any known trauma. She does mention ... | {
"A": "Bitemporal hemianopsia",
"B": "Hypertension",
"C": "Pheochromocytoma",
"D": "Polyostotic fibrous dysplasia"
} | D |
0299 | A 72-year-old woman is admitted to the hospital for treatment of unstable angina. Cardiac catheterization shows occlusion that has caused a 50% reduction in the diameter of the left circumflex artery. Resistance to blood flow in this vessel has increased by what factor relative to a vessel with no occlusion? | {
"A": "64",
"B": "16",
"C": "8",
"D": "4"
} | B |
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