Property:Prompt
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37 y/o woman was brought to the emergency room after a motor vehicle accident with altered mental status and several crush injuries. Her blood pressure is 80/40, Pulse 117, RR 32. She was noted to be in severe respiratory distress and was intubated by the emergency room physician. Follow-up chest X-ray revealed diffuse bilateral alveolar infiltrates. She was reported to be previously healthy with no smoking history and on no medications. Which of the following is likely present in this patient? +
33 y/o African American woman presents with malaise, constipation and intolerance to cold weather. Physical examination reveals an enlarged thyroid gland that’s soft, diffuse, nodular and mobile. Her TSH is elevated and her T3 and T4 are decreased. Anti thyroglobulin antibodies are positive. The patient was referred to an endocrinologist for a fine needle aspiration. Which of the following cells will be predominant on her biopsy results? +
A 22-year-old male student visits his primary care physician for the evaluation of chronic alcohol dependence. He praises the values of abstinence and engages in a prolonged discussion about how the government should have legislations to ban the sale and consumption of alcoholic beverages. This patient is displaying which defense mechanism? +
A 5-year-old boy is evaluated for his recurrent upper respiratory tract infections. His past history is notable for abdominal pain and vomiting due to failure to pass his first stool as a newborn. Genetic analysis reveals a homozygous deletion of three nucleotides coding for phenylalanine at amino acid position 508. At his present age, which of the following conditions is most likely to be associated with the gene defect? +
A new chemotherapeutic drug of unclear mechanism is under investigation. After treatment with the drug, hamster ovary cells are found to be arrested in metaphase. Further studies show that the drug and paclitaxel both bind to beta-tubulins and promote stabilization of microtubules. Which of the following drugs is most likely to have the same mode of action? +
A newborn male is evaluated for vomiting due to failure to pass his first stool within 48 hours of birth. The vomit is approximately two teaspoons in volume, green-brownish in color, and without bloody contents. His abdomen is distended and digital rectal examination elicits massive passage of gas and stools. Diagnosis is confirmed with rectal biopsy that demonstrates lack of migration of ganglion cells due to mutation of a proto-oncogene. Which of the following conditions is associated with mutation of this gene? +
A 32-year-old homosexual intravenous drug user is admitted with a worsening respiratory distress accompanied by fever and nonproductive cough. Arterial blood gas values on room air are pH 7.52, PaCO2=28 mmHg, HCO3=22 mEq/L, and PaO2=70 mmHg. His CD4+ count is 150 cells/μl. Chest X-ray reveals bilateral perihilar interstitial infiltrates suggesting an infectious etiology. The causative organism is detected in bronchoalveolar lavage (BAL) with silver stain. The next day, he starts to have back pain, dizziness, headache, coldness in hands and feet, pale skin, and chest pain. Peripheral blood smear shows irregularly fragmented erythrocytes. Supravital stain of the smear shows immature red cells with dark blue dots and curved linear structures in the cytoplasm. Which of the following medications is most likely to be the cause of his symptoms? +
During a routine checkup, a 33-year-old woman is noted to have an elevated blood pressure of 180/120 mmHg and mild headache. She denies the presence of chest pain, shortness of breath, or frothy urine. Her thyroid-stimulating hormone, cortisol, and 24-hour urinary excretion of catecholamines are all within normal range. However, there is a string-of-beads appearance on an angiogram of her left renal artery. Which of the following pathologic findings is most likely to be observed from the lesional biopsy? +
A 48-year-old man presents to the primary care clinic with a two-day history of eye pain, excessive watering of the eyes, and the sensation of foreign bodies in the eyes. He reports he has had multiple similar episodes in the past. On examination with Woods lamp and flourescein dye, multiple corneal erosions are noted. This condition results from failure of attachment between which of the following two structures? +
A 32-year-old woman presents to her fertility physician for pregnancy evaluation. She reports that the first day of her most recent menstrual period occurred exactly 5 weeks ago, and her period lasted for 7 days. Her test results reveal beta-hCG levels at 30 mIU/mL. If the patient currently follows a typical menstruation cycle following her most recent menstrual period, and fertilization occurs on the expected date of ovulation, which of the following stages of embryonic development is expected to have occurred at the time of her office visit? +
A 60 year-old female comes to your office complaining of fatigue, lethargy, intolerance of cold and dry skin. These symptoms started gradually over the last month. The patient has a past medical history of hypertension for 15 years which is controlled by metoprolol and hydrochlorothiazide, thyroiditis which was treated successfully with corticosteroids 3 years ago, and atrial fibrillation 1 year ago which is controlled by amiodarone and warfarin with controlled INR. On examination, all vital signs are normal, no pain or swelling in her neck. Serum TSH is elevated, with low levels of free T4. What is the most probable cause of hypothyroidism in this patient? +
A 5-year-old boy is brought to the emergency department (ED) by his parents for severe right knee pain and swelling that started a few hours ago. The parents explain that approximately 12 hours ago, the patient hit his knee on a table in his room when jumping off of his bed. Since then, his knee has swollen severely. On physical examination, the right knee is tender to palpation; and pain is elicited with both active and passive flexion of the right knee. Initial work-up shows the following lab results: <br>
PT:12 seconds (normal: 9.5-13.5) <br>
PTT: 65 seconds (normal: 25-40 seconds) <br>
Platelet count: 250,000/μl (normal: 150,000-400,000/μl) <br>
In the ED, the patient is infused with cryoprecipitate, after which his bleeding resolves. Which of the following proteins is most likely deficient in this patient? +
A 26 year old woman in her 16th week of pregnancy presents to the office for a routine pregnancy check-up. She gives a history of coming into contact with a 2 year old child who had German measles. At what time during her pregnancy is she at highest risk of transmitting the virus to the fetus to cause congenital rubella syndrome? +
A 26-year-old G1P0 pregnant woman with no prenatal care presents to her physician's office at 8 weeks gestation for low-grade fever and cough that started on the same day. She just returned from a trip to Africa where she was exposed 4 days ago to her sick niece who had similar symptoms, and a maculopapular rash that "looked like measles but lasted for only 3 days". Further history reveals the patient recently immigrated to the United States and did not receive her childhood vaccinations. She does not smoke or drink alcohol. She does not take any medications and has no known allergies. Her blood pressure is 110/72 mmHg, heart rate is 80/min, temperature is 38.3 °C (100.9 °F), and respiratory rate is 16/min. Physical examination is remarkable for a widespread maculopapular rash on her face and trunk, along with palpable posterior auricular and occipital lymphadenopathy. Which of the following congenital disorders is most commonly associated with the infectious agent responsible for this patient's condition? +
A 30 year old immigrant from Africa presents to the clinic with complaints of skin swelling. On physical examination, subcutaneous nodules are noted. A skin biopsy of a nodule is taken and incubated in normal saline at room temperature for 24 hours. The sample shows microfilariae of oncocerca volvulus. Treatment of choice for this patient is: +
A 28-year-old female immigrant presents to the emergency department (ED) for diffuse pruritus and a foreign body sensation in her right eye for the past 2 hours. The patient states that she returned from a rainforest trip in western Africa 8 months ago. The patient has no significant past medical history. She takes no medications and has no known allergies. Physical examination is remarkable for a mild eyelid swelling and non-tender localized angioedema in the right forearm. Dim slit-lamp examination of the the right eye shows a thread-like worm in the subconjunctival space. Initial laboratory work-up in the ED reveals eosinophilia. Peripheral smear and PCR confirm the diagnosis. Which of the following vectors is most likely associated with the infectious agent responsible for this patient's condition? +
A 26 year old mother was seen by an Infectious disease consult team on the 2 second day after delivery. She has positive test results for VDRL and FTA-ABS. Which test should be ordered by the team before starting treatment in the infant? +
A 38-year-old healthy man presents to the emergency department (ED) for fever, abdominal pain, vomiting, and watery diarrhea. He states that his symptoms have been present for the past 2 days and are progressively worsening. He recently returned from a trip to South America. He reports that during his travel, he ingested unpasteurized milk. Physical examination in the ED is unremarkable. Following appropriate management, the patient is prescribed antibiotics and is then discharged home. Two days later, his stool cultures reveal a gram-positive rod with tumbling motility. Which of the following organisms is most likely responsible for the patient's condition? +
A 40-year-old man is brought to his physician's office by his wife for aggressive behavior, involuntary rhythmic jerking movements of the hands, and memory loss. His symptoms have been progressively worsening for the past 6 months. The patient's father died of similar symptoms at the age of 55. The patient does not smoke cigarettes and only drinks alcohol occasionally. He denies use of medications or illicit drugs. The patient's condition is an example of which of the following genetic disorders? +
A 38-year-old man is brought to the emergency department by his wife with complaints of excessive thirst, fear of drinking water, and disorientation. She reports that he also had three episodes of seizures in the past few days. Three days after his admission, the patient experiences vivid visual hallucinations, lapses into a coma, and dies despite appropriate resuscitative measures. Which of the following cell surface molecules is most likely involved in this patient's condition? +