Property:Prompt
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A 24-year-old woman gradually develops throbbing headache, pulsatile tinnitus, and blurred vision that are worse in the morning and often accompanied by nausea and vomiting. She is awake, alert, afebrile and has no other focal neruologic deficit on exmaination. She has a past medical history significant for acne vulgaris, for which she takes daily oral isotretinoin. Neuroimaging is negative for space-occupying lesions. Cerebrospinal fluid pressure is elevated with a normal composition. Accumulation of the culprit substance is most likely to be found in which of the following cell types in the liver? +
A 37-year-old woman presents with malaise, proxmial muscle weakness, and swollen hand and knee joints. She also reports dry eyes and dry mouth. When exposed to cold temperatures, her fingers become pale and cyanotic and turn red and numb. Physical examination is remarkable for scaly erythematous eruptions overlying the knuckles and elbows. Laboratory findings demonstrate lymphopenia with mild anemia and thrombocytopenia. A diagnosis is then made following the detection of speckled anti-nuclear antibody as well as autoantibodies against extractable nuclear antigens. Which of the following structures is most likely to be the target of the antibodies? +
A 30-year-old woman presents with mild fever, malaise, and swollen hand and knee joints. Physical examination is remarkable for malar rash. Laboratory findings include lymphopenia with mild anemia and thrombocytopenia. A diagnosis is then made following the detection of a homogeneous pattern of anti-nuclear antibody as well as autoantibodies against RNA. Which of the following types of RNA is most likely to be the target of the antibodies? +
A 48-year-old woman visits the clinic for evaluation of her skin conditions. She has patches of hardened skin on her face, elbows, and knees. She feels that her fingers are tight especially in cold weathers, and become pale and cyanotic. She also complains of difficulty swallowing of both solids and liquids and often regurgigates her food. Laboratory findings are remarkable detection of nucleolar pattern of anti-nuclear antibodies as well as elevated anti-centromere antibodies. Which of the following conditions is most likely to be associated with this patient's condition? +
43 y/o female presents to her primary care physician for routine health examination. She denies any complaints and walks 2 miles 3 times a week. Initial evaluation reveals a Blood pressure is 127/77 mm Hg, Pulse is 82 /min, RR 14, oxygen saturation of 99% on room air. Physical examination is unremarkable except for a midsystolic click on cardiac auscultation. Which of the following mechanisms is likely responsible for this physical finding; +
89 y/o Caucasian male is admitted to the hospital due to altered mental status, lower back pain and development of a low-grade fever. His past medical history is remarkable for hypertension, hyperlipidemia, prior MI, prostate cancer and advanced dementia. Temperature is 99.6, Blood pressure is 109/67, Pulse is 95, Respiratory rate is 20. Physical exam is notable for absence of spontaneous movement of his lower extremities and loss of sensation from his waist downwards. He’s also unable to control neither his bladder nor his bowels. What is the most important next step in management? +
The patient is a 72-year-old man brought to the primary care clinic by his family over concerns that he has Alzheimer's disease. They have noticed a worsening of his memory over the past 6 months. He does not seem to want to get out of bed, and he appears to have difficulty providing for his basic needs such as cleaning, dressing, and cooking for himself. He is hesitant when talking, but it is unclear whether he is unable or unmotivated to speak. His family has also noticed that he appears depressed and is often seen crying. A MSE of the patient is performed to help determine whether he is suffering from a dementing illness or a depressive illness (pseudodementia).
Further history, cognitive examinations, physical examination, and laboratory/radiographic studies are obtained. The results are consistent with Alzheimer's dementia. While the family had been able to take care of him initially, they have since returned to the clinic stating that they can no longer keep him at home. They feel that he is becoming much more agitated. He is staying up at night. Lately he has been rearranging the furniture, claiming to look for "the little people who are teasing me." They have noticed that he has difficulty walking, often moving slowly and dropping items. The family has pursued nursing home placement, but they wish to have something prescribed in order to help him sleep and keep him calm.
Which of the following medications should be avoided in this patient? +
The police bring a 22-year-old male into the emergency room after a disruption at the local college campus. According to his medical chart, he has been treated for a depressive episode in the past. He describes his mood as "great" but claims to have been awake for 4 days due to working on several inventions. He admits to rapid thoughts and believes that God has chosen him to be the next Messiah. In fact, angels have commanded him to steal from the student union in order to begin a new church.
Urine toxicology performed in order to rule out a substance of abuse as a cause of his symptoms would most likely reveal which substance? +
A 12-month-old girl is brought to the physician’s office with complaints of fever, vomiting, and difficulty breathing. The mother is a chronic alcoholic and had consumed alcohol excessively throughout the child’s pregnancy. Physical examination is remarkable for microcephaly, facial abnormalities, a heart murmur, and developmental delay. Which one of the following errors most likely occurred during the embryonic period? +
A 4-year old boy is brought to the emergency department by his mother with complaints of fever, cough, runny nose, and a rash. The mother reports that the rash began on the forehead and progressively moved downwards. The patient's past medical history is unremarkable. Physical examination is remarkable for post-auricular lymphadenopathy. Which of the following is the most likely pathogen responsible for this patient's symptoms? +
The police bring a 22-year-old male into the emergency room after a disruption at the local college campus. According to his medical chart, he has been treated for a depressive episode in the past. He describes his mood as "great" but claims to have been awake for 4 days due to working on several inventions. He admits to rapid thoughts and believes that God has chosen him to be the next Messiah. In fact, angels have commanded him to steal from the student union in order to begin a new church.
Which of the following drugs should be given to treat symptoms of this patient? +
A 4-week-old female infant is brought to the emergency room for rapid breathing, diaphoresis, and difficulty feeding. The girl's past medical history is significant for preterm birth. Her mother mentions that ever since the girl was born, she has not been feeding well and there has been little weight gain. On physical examination, the infant has a hoarse cry with with evidence of bilateral basal crackles on pulmonary auscultation. Doppler echocardiogram demonstrates a significant left-to-right shunt. Which of the following statements is true about the infant’s underlying condition? +
A 42-year-old female presents to your office for elevated blood pressure (BP). She has been having headaches for the last 2 weeks. She checks her BP at pharmacy and she presents with readings ranging between 162/106 and 154/92. After some research she did on her own, she has been exercising and following the "DASH (Dietary Approaches to Stop Hypertension)" diet for the past 2 months. Her BP in the office after more than 10 minutes of resting was 152/88 in her left arm and 146/92 in her right. She tells you that both her mother and father have hypertension. She denies chest pain, shortness of breath, dizziness, or blurred vision. She denies tobacco use, drinks 3–4 beers on weekends, and uses no recreational drugs. Your physical examination should include documentation of which of these? +
A 3-year-old boy is brought to the physician’s office with a 3-day history of fever, cough, and runny nose. The mother states that the child is not growing like his siblings before him. Physical examination is remarkable for generalized hypotonia, restricted joint movements, and coarse facial features. Radiographic findings include bullet-shaped phalanges, wedging of the vertebrae, and widening and thickening of the ribs. Which of the following statements is true regarding the impaired cellular organelle involved in this patient's condition? +
A 6-year-old child is brought to office because of a sudden onset of irritability, weakness, and pallor. The father provides history that both of his children have been experiencing episodes of vomiting and diarrhea. His physical examination reveals a blood pressure of 116/82, dry mucus membranes, petechiae, and diffuse abdominal pain. The following laboratory work is obtained:
*Urinalysis: microscopic hematuria and proteinuria
*Blood urea nitrogen (BUN)/creatinine (Cr): 20/1.0 mg/dL
*Hemoglobin: 7 g/dL
*Peripheral blood smear: fragmented RBCs
*Prothrombin time (PT), partial thromboplastin time (PTT): normal
*Coombs' test: negative
What is the most likely diagnosis? +
Physician is called to see a newborn in the nursery because the nurse is concerned that the baby have single crease in the palm of the hand, small ears, small mouth, upward slanting eyes, wide space between the first and second toes, short hands with short fingers. Which of the following sign is most likely associated in this newborn? +
A 68-year-old male is seen in the office for recurrent chest pain. He reports that he is getting substernal chest pain, without radiation, when he goes for a walk. The pain resolves with 12–15 minutes of rest. He has never had pain at rest. He has no other cardiac complaints and his review of systems is otherwise negative. He has an unremarkable medical history and takes only a baby aspirin a day. On examination, his blood pressure is 130/68, pulse 86, and respiratory rate 14. His cardiac examination is notable for a harsh, 3/6 systolic ejection murmur along the sternal border that radiates to the carotid arteries. His carotid pulsation is noted to rise slowly and is small and sustained. His lungs are clear. The remainder of his examination is normal. Which of the following would be the most appropriate test to order? +
A 15-year-old girl presents to the emergency department after being bitten by a stray dog in her neighborhood. On physical examination, she has a 5 by 3 inch wound on her calf with evidence of deep punctures. The wound is cleaned and sutured and the patient is sent home. The next day, she returns to the emergency department with fever and a swollen and erythematous wound. Which of the following antimicrobial agents is most likely indicated in this case? +
An 8-year-old girl with a history of thalassaemia major presents to the emergency department with low-grade fever, leg pain, and malaise for the past week. Her blood pressure is 110/60 mm Hg, heart rate is 90/min, and temperature is 37.8 ᵒC (100 ᵒF). On physical examination, her anterior left shin is red, swollen, and tender to palpation. Following an extensive work-up, the diagnosis of tibial osteomyelitis is confirmed. Cultures from bone biopsies reveal gram-negative rods. Which of the following regimens is the most appropriate for the initial management of this patient? +
A 55-year-old man presents to the emergency department after being bitten by his brother during a domestic dispute. On physical examination, the physician notices a 3 by 3 inch wound on his arm lined by human teeth marks. What is the most appropriate agent to prevent infection of the wound in this case? +