Property:Prompt
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A 30 year old male presents with fatigue, decreased appetite, weight gain, constipation and cold intolerance. He recalls no event of stress. He does not take any medications. He is a non-smoker and a non alcoholic. His pulse is 48/min and blood pressure is 146/90 mmHg. Physical examination reveals cold extremities, pale skin, coarse hair and brittle nails. There is delayed relaxation of deep tendon reflexes. The thyroid gland is normal on palpitation. Laboratory studies reveal increased serum free T3 and T4 but normal serum TSH level. Which is the most likely diagnosis? +
A 58 year old male comes to the office and complains of nausea and early satiety for the past several months. He also complains of anorexia and abdominal bloating. He denies any epigastric pain. He is a known diabetic on insulin for the past 15 years. His home blood glucose readings have ranged between 40 to 400 mg/dL in past few months. The low blood glucose readings occurred after the meals. Which of the following is the most appropriate management of the patients symptoms? +
A 56 year old man complains of impotence. On physical examination, he looks obese with has an elevated jugular venous pressure, S3 gallop, hepatomegaly and a gray opaque ring in corneal margin of both the eyes. He also appears tanned, with pigmentation along joint folds. His left knee is swollen and tender. His blood pressure is 150/98 with a heart rate of 98/min. The liver enzymes are elevated and the plasma glucose is found to be 250 mg/dL. The next best investigation to establish the diagnosis will be +
A 54 year old male was admitted following complaints of epigastric abdominal pain and dysphagia. Upon admission he looked pale and underweight. He was then followed by an upper gastrointestinal endoscopy for a possible distal esophageal cancer. After the procedure, he complains of significant new substernal pain. Palpation reveals subcutaneous emphysema. His temperature is 38 C, blood pressure is 110/68 mm Hg, respiratory rate is 20/min and heart rate is 112/min. Perforation of the esophagus is suspected. An immediate chest film reveals air in the mediastinum. Which of the following management is most recommended? +
A 26 year old Caucasian male comes to his physicians office for his regular checkup. He is a known type 1 diabetes mellitus patient for the past four years who was on NPH insulin, 30 U each morning and 15 U every night. But following a persistent morning glycosuria that did not improve, the evening dose was increased to 20 U during his last visit. He strictly adheres to his diet schedule. His following lab tests reveal worsening of his morning glycosuria with moderate ketones in his urine. Several consecutive nights glucose monitoring did not reveal any hypoglycemia. The next step in management of this patient will be +
Following a large explosion at a construction site during excavation, its workers are brought to the ER. While examining them none appear to be injured. But some were diagnosed with hearing loss following the explosion. They were exposed to sound pressure levels of 190 dB. Which of the following is the most likely type of hearing loss +
A 36 year old man who sustained a gunshot wound to the left buttock is brought to the ER. No exit wound is found during examination. He is hemodynamically stable with a blood pressure of 110/70 mm Hg. His heart rate is 90/min and his respiratory rate is 16/min. An X ray of the abdomen shows the bullet to be located in his right lower quadrant. The most appropriate management of a suspected rectal injury in this patient will include +
An ill appearing 52 year old European female presents to the ED with nonspecific complaints like dizziness, nausea and fatigue. Laboratory tests show an anion gap of 13 mEq/L, lactate level of 15.0, pH 7.30 and a normal glucose level, HCO3 17. Detailed history reveals that she is taking oral metformin. Which of the following will apply to this patient’s lactic acidosis +
A 60 year old asymptomatic white female comes to the physicians office for a routine physical examination. Her routine lab test shows<br>
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Sodium: 138 mEq/L<br>
Potassium: 3.8 mEq/L<br>
Bicarbonate: 26 mEq/L<br>
Chloride: 101 mEq/L<br>
Calcium: 12 mg/dL<br>
Albumin: 4.0 g/dL<br>
Phosphorus: 2.2 mg/dL<br>
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PTH level is increased. Bone mineral density by dual energy X-ray absorptiometry (DEXA) shows T-2.5 bone mineral density 5 at lumbar spine and femoral neck. Neck examination reveals no mass. What is the most appropriate step in management of this patient? +
A 46 year old alcoholic male is being treated for tuberculosis, but he has not been compliant with his medications. He comes to his physicians office and complains of increasing weakness, fatigue and febrile episodes on and off over the past one week. He appears to have lost weight. His temperature is 99.6 F (35.6 C), pulse is 96/minute and blood pressure is 80/50 mmHg. There are some pigmentation over the elbows. Cardiac exam is normal. There is a possibility that he has developed a multi drug resistant strain of tuberculosis. The next best step in evaluation of the patients low blood pressure will be +
An experimental mouse model aims to assess the effect of a molecule found in excess in mice deprived of water. Following isolation of the molecule, it is administered by subcutaneous infusions to unrestrained, conscious mice that are provided with 5% dextrose solution to drink. Assessment after 30 minutes reveals significant retention of water and a decrease in serum sodium concentration. Which of the following is correct about this isolated molecule? +
A 53-year-old man presents to the clinic after noticing several bluish stretch marks on his abdomen. He has a history of autoimmune hepatitis treated with 20 mg daily prednisone for the past 8 months. He complains of weight gain and difficulty climbing stairs because his legs feel weak. His blood pressure is 150/72 mmHg, heart rate is 86/min, and temperature is 36.6 ᵒC (98 ᵒF). On exam, the physician notices thick bluish striae on the abdomen and round, full facies with extra fat around the neck and upper back. Which of the following is correct about the hormone causing this patient’s syndrome? +
A 56-year-old woman presents to the emergency department for 2 hours of continuous palpitations. The patient reports that for the past 6 months, she has noticed similar episodes that seemed to resolve spontaneously within a few minutes. She felt very anxious when her symptoms persisted and decided to seek care. The patient explains that she hasn't been herself lately; she has been constantly irritable and has been having trouble adapting to the hot weather. She has lost 4.5 kg (10 lbs) unintentionally and has noticed that her hair is becoming thinner. Which of the following is true about the hormone causing this patient’s syndrome? +
A 28-year-old man presents to the physician’s office for routine pre-employment check-up. During history-taking, the patient states that he grew up in Asia and immigrated to USA at the age of 20. The physician administers an intradermal injection of tuberculin skin test in the patient's left forearm, and the patient is instructed to follow-up in 2 days. When the patient returns, the site of his injection demonstrates a 16 mm erythematous, raised induration. Upon further questioning, the patient denies receiving a BCG vaccine in the past. When the patient asks why he did not develop any symptoms of his infection, the physician states that the majority of immunocompetent individuals are capable of containing the infection without developing any symptoms. Which of the following immunological changes occurs to contain this patient's infection? +
An 17-year-old man presents to the physician's office with complaints of bone pain and swelling over the right leg just above the knee. He has progressively lost weight over the past 2 months. His medical history indicates that he was treated for eye cancer as an infant. Which of the following genes is most likely responsible for this patient's condition? +
A 3-year-old boy is brought to the pediatrician's office by his mother for bloody urine and abdominal pain. His temperature is 37.2 °C (98.96 °F), blood pressure is 144/90 mmHg, and heart rate is 70/min. Physical examination is remarkable for a large abdominal mass. Abdominal ultrasonography confirms the presence of a renal mass. CT scan demonstrates a solid renal mass with normal renal parenchyma towards its rim (claw sign). Which one of the following genetic alterations is responsible for this patient's condition? +
A 72-year-old man with a history of type 2 diabetes presents to the physician’s office for progressive loss of vision. He explains that recently, he has been sensing that all lights are too bright and has been seeing halos around lights. His night vision has become much worse in the past few months, and he has been avoiding driving at night. His temperature is 36.6 °C (97.88 °F), his blood pressure is 136/80 mmHg, and his heart rate is 76/min. Laboratory findings are remarkable for a blood glucose level of 320 mg/dL and HbA1c of 9.9 mmol/mol. The accumulation of which substance is associated with the development of this patient’s progressive vision loss? +
A 60 year-old woman with a past medical history of primary biliary cirrhosis presents to the physician's office with complaints of increased pain in both wrists over the past two months. She usually experiences morning stiffness and pain in her wrists for at least 1 hour, but her symptoms gradually improve as she moves her wrists during the day. She reports that her pain is also temporarily relieved by ibuprofen. The patient receives daily ursodeoxycholic acid and reports no known drug or food allergies. Her blood pressure is 118/72 mmHg, her heart rate is 68/min, and her temperature is 36.5 °C (97.7 °F). Physical examination is remarkable for ulnar deviation in fingers of both upper extremities and boutonniere deformities of the PIP joints. A tender subcutaneous nodule is palpated over the left olecranon. Radiographs reveal erosions of her metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints with sparing of the distal interphalangeal (DIP) joints. Which of the following findings is mostly associated with this patient's condition? +
A 67-year-old woman presents to the physician's office with complaints of gradually progressing abdominal distension, fatigue, and a 7-kg weight loss over the past 3 months. Her past medical history is significant for well-controlled hypertension and dyslipidemia. On physical examination, the abdomen is markedly distended with a positive fluid wave. Mild abdominal tenderness is noted over the left lower quadrant on soft palpation along with a large firm lower abdominal mass most evident on deep palpation. Laboratory studies reveal elevated levels of carbohydrate antigen 125 (CA-125). Following a thorough work-up, the patient is diagnosed with stage IV ovarian cancer. After educating the patient about her condition and discussing her concerns, the physician offers her a course of palliative chemotherapy. The patient explains that she understands the risks but prefers to live out the remainder of her life without undergoing chemotherapy. The physician agrees to follow her wishes. Which principle of medical ethics does this interaction exemplify? +
A 5-year-old boy is brought to the emergency department (ED) by his mother. She reports that her boy has generalized swelling with decreased urine output, and she is concerned his condition is serious. She explains that 3 days ago, he had a mild swelling around the eyes, but soon his condition worsened and involved the rest of his body. The boy does not report any obvious exacerbating or alleviating factor. The patient has no past medical history and no family history for chronic diseases. Upon further questioning, the mother recalls that the patient was stung by a bee ten days ago. In the ED, the patient's temperature is 36.7 °C (98 °F), his blood pressure 110/72 mmHg, and his heart rate is 82/min. Physical examination is remarkable for generalized pitting edema and a bee sting mark in the left upper extremity. Chest x-ray is remarkable for pleural effusion. 24-hour urine collection demonstrates oval fat bodies and profound proteinuria. The physician suspects the patient's condition is caused by a renal disease. On renal biopsy, which of the following findings on light microscopy is consistent with this patient's diagnosis? +