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A 52-year-old man, with a past medical history of myocardial infarction and heavy tobacco use, presents to the physician's office for his annual check-up. Upon further questioning, the physician notes that the patient still hasn't stopped smoking despite receiving multiple recommendations to do so. The patient explains that he is aware that smoking has been a problem for him, and he knows he needs help. However, he states that he does not feel like he is quite ready to stop smoking. Which of the following stages of change is the patient currently in? +
A couple has been trying to conceive a child for 5 years with no success. They decide to explore in-vitro fertilization (IVF) and ask their primary care physician for advice. The physician describes the process explaining that after fertilization the embyro is directly introduced into the uterus. Assuming fertilization occurs at day 0, at which day post-fertilization does an embryo undergoes implantation in the uterus? +
A 45-year-old man presents to his primary care physician for 2 weeks of recurrent occipital headaches. He reports several episodes of throbbing pain associated with mild blurring of his vision. He explains that his wife has recorded his blood pressure on several occasions an noticed that his systolic pressure always ranges between 160-190 mmHg. Physical exam is unremarkable except for a blood pressure of 168/92 mmHg. Concerned, the physician decides to start the patient on enalapril for blood pressure control. What is the most likely effect of this drug on the patient's renal dynamics? +
A 45-year-old female comes to the physician due to a 6-month history of difficulty swallowing. She is very worried because her condition is getting worse. At first, she thought it was a cold. Review of systems is significant for dyspnea and stridor. Upon examination her vitals are within normal limits, her neck is supple without JVD and her thyroid has a hard consistency and non-mobile. Her TSH and free T3 and T4 are within normal limits. A fine needle aspiration is performed on it shows dense collagenous replacement of the thyroid gland with chronic inflammation. Which of the following complications is this patient most likely to develop? +
A 62-year-old man with a past medical history significant for bioprosthetic mitral valve replacement presents to the physician’s office for tar-colored stools. The patient is maintained on metoprolol, ramipril, warfarin, and simvastatin. Upon further questioning, the patient explains that he recently recovered from a bacterial pneumonia and is currently continuing his antibiotics regimen. On physical examination, you notice several bruises on the forearms and shins. Work-up reveals an INR of 8 (therapeutic range: 2-3). Which of the following antibiotics is most likely responsible for this patient’s symptoms? +
A 55 year old man underwent an abdominoperineal resection for a stage 1 rectal cancer. During the surgery, he received 3 units of packed red blood cells. After successful resection, the patient was sent to the intensive care unit for close monitoring. Five hours later, in the intensive care unit, he started bleeding heavily from his perineal wound. Emergency coagulation studies were ordered and it revealed the following results<br>
Prothrombin time: 12 seconds<br>
Partial thromboplastin time: 64 seconds<br>
Bleeding time: 3 minutes<br>
Fibrin degradation products: 3 mg/L <br>
Serum fibrinogen: 160 mg/dL<br>
Platelet count: 80,000/μL<br>
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The most likely cause of bleeding in this patient is +
A wildlife worker presents to the emergency room after he was bitten on the hand by a raccoon while trying to capture the animal. On further history taking, he says that the animal appeared to be ill. He further states that he received a primary course of rabies vaccination before two years when he first started his job. The wound is immediately thoroughly cleaned by the emergency room staff. The wound appeared to be small because the patient was wearing gloves while trying to capture the animal. Which will be the most appropriate intervention for rabies prevention? +
A 35 year old man presents to a physicians office with a complaint of hoarseness in his voice for the 6 past months. He denies any other symptoms or complaints. He has no such past medical history, takes no medications. He has been smoking occasionally, one or two cigarettes every month for the past one year. He does not drink alcohol. He uses no illicit drugs. He has been working as a telephone operator for the past 8 months. Which of the following is the most likely diagnosis? +
A 40 yr old male comes to the emergency department with severe epigastric pain and vomiting. His past history is significant for similar episodes last year. He is a smoker and admits drinking heavily over the past 1 month. He denies any bloody vomit, dizziness and black stools. On examination pulse is 92/min and BP is 110/80 mmHg. Abdomen is tender with marked rigidity and decreased bowel sounds. Cardiovascular and respiratory examinations are normal. Initial lab investigations show hemoglobin and hematocrit of 12.3 g/dl and 36.5, respectively, Na:135 mEq/L, K : 3.6 mEq/L, Cl: 104mEq/L, Bi: 24 mEq/L, BUN: 40 mg/dl, glucose: 170 mg/dl and Ca: 10mg/dl and elevated amylase and lipase levels. The patient is treated with analgesics and IV fluids. After 48 hrs you assess the patient’s status. Which of the following lab values at this point would be ab indicator of severe prognosis in this patient? +
A 65 yr old male comes to the emergency department with severe upper abdominal pain. The pain started suddenly and is of 9/10 on pain grading scale. The pain is radiating to back and aggravated upon any movement. His past history is significant for peptic ulcer disease and is on H2 blockers and proton pump inhibitors. He is a known hypertensive on thiazide medications. He doesn’t smoke or consume alcohol. He denies any bloody vomit, constipation, diarrhea and black stools. On examination pulse is 110/min and BP is 110/60 mmHg. Abdomen is markedly tender and he does not allow further investigations. Cardiovascular and respiratory examinations are normal. Lab investigations show hemoglobin and hematocrit of 13 g/dl and 36, respectively, Na:142 mEq/L, K : 3 mEq/L, Cl: 105 mEq/L, Bi: 24 mEq/L, BUN: mg/dl, glucose: 110 mg/dl, Ca: 10mg/dl and elevated amylase levels. Which of the following is the diagnostic test of choice in this patient? +
A 40 yr old male comes to the emergency department with an episode coffee-ground colored vomiting. He denies any abdominal pain, dizziness and black stools. His past history is insignificant with no similar episodes. He occasionally smokes and consumes alcohol. On examination pulse is 92/min and BP is 110/80 mmHg. Abdomen is soft and non-tender. Cardiovascular and respiratory examinations are normal. The patient underwent an endoscopy and results shows a small tear at the gastroesophagel junction with no active bleeding. What is the most likely condition associated with the patient’s disease? +
A 71 yr old male comes to the emergency department with severe epigastric pain and vomiting. His past history is insignificant with no surgery and medications intake. He doesn’t smoke or consume alcohol. He denies any bloody vomit, constipation, diarrhea and black stools. On examination pulse is 92/min and BP is 110/80 mmHg. Abdomen is tender. Cardiovascular and respiratory examinations are normal. Lab investigations show hemoglobin and hematocrit of 13 g/dl and 36, respectively, Na: 142 mEq/L, K: 3 mEq/L, Cl: 105 mEq/L, Bicarbonate: 24 mEq/L, glucose: 170 mg/dl and Ca: 10mg/dl and elevated amylase and lipase levels. WBC count is 16,000/mm3, AST 200 IU/L and LDH 350 IU/L. Which of the following admission criteria is indicative of severe attack in this patient? +
A 60 yr old male is brought to the emergency department. He complains of vomiting and chest pain. He says his symptoms started 2 hours ago when he was in a party with his friends. He says he was drinking heavily and had a fight with his friend. He vomited twice before the onset of chest pain and is worsening over the 2 hour. The pain is radiating to the shoulders and is of 6/10 on severity scale. His chest pain is aggravated on deep inspiration. He denies any abdominal pain, bloody vomit, dizziness and black stools. His is a known coronary heart disease patient and on medications for that. Otherwise his past history is insignificant. His father died of myocardial infarction at the age of 60. He occasionally smokes and drinks heavily when he is with his friends. On examination pulse is 110/min, BP is 100/60 mmHg and SpO2 is 94%. Chest examination reveals S3, decreased breath sounds and dullness on percussion on left side. Abdomen is mildly distended and there is epigastric tenderness. What is the most likely diagnosis? +
To study the effects of a newly developed drug, a researcher uses polarized microscopy to monitor the changes in living Pectinaria oocytes exposed to intermittent doses of this agent. Although most oocytes are not directly affected, those in active replication seem to arrest at a certain point during mitosis with a significant reduction in the size of meiotic spindles, as measured by loss of birefringence under polarized light. The researcher also notices that shortly after the drug is washed, mitosis would resume and the spindles would regain birefringence. Which of the following drugs most likely has the same mechanism of action? +
A 74 year old male complaining of hip pain arrives at his physicians office. He also complaints of headache, hearing loss, and tinnitus. On physical exam the skull appears to be enlarged, with prominent superficial veins. There is marked kyphosis, and the bones of the leg appear to be deformed. Lab tests reveal an elevated plasma alkaline phosphatase level. A skull x-ray shows sharply demarcated lucencies in the frontal, parietal, and occipital bones. X-rays of the hip show thickening of the pelvic brim. Which one of the following is the most likely mechanism of the patient’s condition? +
A 57-year-old man, with a history of type II diabetes mellitus, hypertension, and hyperlipidemia, is brought to the emergency department in cardiac arrest. Following resuscitation and appropriate work-up, the patient is supported by venoatrial (VA) extracorporeal membrane oxygenation (ECMO) for salvage therapy. Several days later, the patient wakes up; and a neurological examination demonstrates early hypoxic brain injury. What are the most likely findings on neurological examination in this patient? +
A 72-year-old man presents to the emergency department with progressive shortness of breath at rest. On admission, his heart rate is 90/min, blood pressure is 142/80 mmHg, and respiratory rate is 32/min. Physical examination is remarkable for a low-pitched extra heart sound appreciated in early diastole, prominent jugular vein, and bilateral pitting edema in the lower extremities. Which of the following statements is true regarding the patient's extra heart sound? +
A 63-year-old man presents to the physician's office complaining of shortness of breath, rhythmic head nodding, and fatigue. On examination, his temperature is 37 °C (98.7 °F), heart rate is 88/min, and blood pressure is 160/60 mmHg. Cardiac auscultation is significant for a murmur. When the patient is asked to raise his hand above the level of his head, capillary pulsations of the nail beds are noted. Which of the following best describes the murmur present in this patient? +
A 10-year-old boy is brought to the pediatrician's office for declining school performance and poor concentration. The mother explains that her child is a day dreamer and is concerned about his recurrent blank stares. She is fearful that her son has attention deficit disorder (ADD). Following an extensive work-up, the patient is diagnosed with seizure disorder and treatment is initiated. Which of the following mechanisms of action corresponds to the medication prescribed to this patient? +
A researcher is studying the hemodynamic and respiratory effects of intravenous anesthetics. In one experiment, he injects a mouse with intravenous ketamine infusion. Several minutes later, he measures the mouse's heart rate (HR), blood pressure (BP), cerebral blood flow (CBF), and bronchial diameter (BDm) to assess the cardiovascular and respiratory roles of ketamine. Which of the following hemodynamic and respiratory changes are most likely to occur following ketamine infusion in this experiment? +