Property:Prompt
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A 28-year-old pregnant woman, G2P1A0, at 25 weeks gestation, presents to the emergency department complaining of vaginal bleeding and painful continuous contractions. Following appropriate work-up, the physician explains to the patient that her condition is caused by a premature detachment of the placenta from the site of implantation. Which of the following is a significant risk factor for this patient's condition? +
A 38-year-old woman presents to the physician's office with complaints of abdominal distention for the past 5 weeks. The patient also reports lower extremity swelling that has worsened significantly in the past 2 months. On physical examination, the patient appears weak, pale, and cachectic with marked edema and bluish discoloration of the mons pubis, lower abdomen, and back. Following appropriate work-up, the patient is found to have large bilateral ovarian tumors with moderate ascites. Cytologic analysis of the ascitic fluid reveals several signet ring cells. Which of the following is the most appropriate next step in management? +
A 38-year-old woman, G3P2A0, presents to the emergency department at 34 weeks gestation with complaints of severe nausea and dull right upper abdominal pain. Her past medical history is significant for preeclampsia in her previous pregnancy warranting premature delivery. On arrival, her heart rate is 94/min, blood pressure is 182/98, and temperature is 36.9 °C (98.4 °F). Initial work-up reveals thrombocytopenia, elevated ALT and AST, elevated LDH, low haptoglobin, and 4+ protein on urine dipstick. The physician informs the patient that immediate delivery is recommended. What is the most likely cause of mortality in this patient's condition? +
A 52-year-old man, recently diagnosed with gastric cancer, is scheduled to undergo total gastrectomy. During his surgery, the surgeon resects the ligament that connects the greater curvature of the stomach and the spleen. Which of the following arteries is most likely contained in the resected ligament? +
A 28-year-old woman presents to the physician's office with complaints of excessive fatigue and pallor. Following appropriate work-up, you diagnose her with megaloblastic anemia, with low vitamin B12 levels. As part of her work-up, the patient is instructed to drink a preparation containing radio-labeled vitamin B12. One hour later, she receives a second dose of vitamin B12 as an intramuscular injection. Over the next 24 hours, the patient collects her urine for analysis which shows more 35% radioactive vitamin B12 by radiotelegraph. What is the most likely diagnosis in this patient? +
A 2-year-old boy is brought to the pediatrics clinic by his mother for 2 months of noticeable fatigue. The mother reports that her child appears tired throughout the day, and that his most recent behavior has compelled her to seek help. She explains that she has, on several occasions, found her son chewing on small rocks in the backyard. On physical examination, you note a pale child with significant conjunctival pallor, and mild upward curving of the fingernails. Following complete work-up, you diagnose the child with iron deficiency anemia, and you prescribe oral iron supplementation. At which level of the GI tract would iron be absorbed? +
A 45-year-old man presents to the physician's office with complaints of diarrhea and stools that have been difficult to flush for the past 6 weeks. Upon further questioning, the patient reports abdominal cramps and weight loss despite a normal appetite. He explains that he recently returned from Peru after a three month long business trip. The patient undergoes an extensive work-up and is diagnosed with tropical sprue. Which of the following endoscopic findings is most likely observed in this patient? +
A 53-year-old man presents to the physician's office with complaints of persistent vague abdominal pain and nausea. He states that his pain is not associated with food intake or defecation. The patient's past medical history is only remarkable for hypercholesterolemia. He currently receives daily atorvastatin for the past 10 years and reports no known drug or food allergy. The patient then undergoes upper GI endoscopy and is told he has significant hypertrophy of the gastric folds with an alkaline gastric pH. At initial presentation, which physical examination finding is most likely consistent with this patient's condition? +
A 23 year old female comes to your office with 6 month H/O cold intolerance. She says that when the weather is cold, her fingers get numb and turn blue. She wears gloves to keep her hand warm, but it does not always work. She does not smoke or consume alcohol or use any illicit drugs. She is sexually active and use condoms as contraception. She is an accountant and says that her work is very stressful. Physical examinations are well within normal limits. What is the best next step in her line of management? +
A 24 year old female comes to your office with 3 month H/O amenorrhea. She is sexually active and says she and her husband has been planning pregnancy. She does not smoke or consume alcohol or use any illicit drugs. An urine pregnancy test done at the office turns positive. She reveals her past history about cold intolerance for 1 year and has been taking nifedipine for that. Physical examinations are well within normal limits. What is the best step in the line of management of her past medical condition during her pregnancy period? +
A 30 year old female a known case of Raynaud’s phenomenon returns to your office and says that treatment is not helping her symptoms and she is experiencing joint pains. She says that she has been compliant with medications and also have avoided exposure to cold. She does not smoke or consume alcohol now and even her husband has given up smoking. Physical examinations are well within normal limits. Which of the following is the best next step in her line of management? +
A 60 year old male comes to office with complaints of muscle weakness and cramps while climbing stairs for the past 3 months. He denies any rash, arthralgia and difficulty in swallowing. His symptoms are progressively getting worse. He has no other medical problems. He is a non-smoker and non-alcoholic. His vitals are BP:120/80 mmHg, pulse:72/min, temperature:98F and respirations 14/min. On physical examinations there is proximal weakness in both upper and lower limbs. There is no muscle tenderness. Skin examination is normal. Cardiovascular and respiratory examinations are normal. CPK levels are grossly elevated. Which of the following findings would be seen in this patient? +
A 72 year old female comes to office with complaints of diffuse aches and pain. These are more pronounced around her shoulder and pelvic girdle muscles. She denies any headache, fever, rash, arthralgia, visual symptoms and difficulty in swallowing. She has hypertension, osteoporosis and hypercholestrolemia. Her medications include simvstatin, enalapril, hydrochlorthiazide and alendronate. She is a non-smoker and non-alcoholic. Her vitals are BP: 120/80 mmHg, pulse: 72/min, temperature: 98F and respirations 14/min. On physical examinations there is tenderness in the pelvic girdle muscles. Rest of the examination is normal. Routine labs are normal except for elevated CPK levels. What is the best next step in her line of management? +
An 7-year-old boy is brought by his parents to the emergency department for severe left leg pain that started 2 days prior to presentation. His mother reports that the child has been very tired for the past few weeks. She also explains that her son has lost a lot of weight, and has been running out of breath with minimal activity recently. Upon further questioning, the child denies any trauma to his leg. On physical exam, you notice an ill appearing child with abdominal swelling and petechiae on the upper and lower extremities. A CBC is drawn and shows a hemoglobin of 8.5 g/dL, hematocrit of 25, and a WBC count of 75,000/uL. Which of the following findings is considered a good prognostic marker in this patient? +
A 40-year-old woman presents to the physician’s office for several weeks of cough and intermittent fever. Initial work-up reveals a heterogeneous right lower lobe mass, hilar lymphadenopathy, and a left-sided pleural effusion on chest x-ray. Bronchoscopy with transbronchial biopsy reveals necrotic lung tissue with spherules containing hundreds of uninucleated endospores. Which of the following is the most likely causative organism? +
A 42-year-old man with history significant for poorly controlled diabetes mellitus presents to the emergency department with a 2-day history of fever, headache, and facial swelling. Following an extensive work-up, a nasal biopsy frozen section reveals necrotic tissue with irregularly wide, non-septate hyphae branching at right angles. What is the most likely causative agent of this patient’s condition? +
A female neonate with severe bradycardia is rushed to the operating room for pacemaker placement. She is born to a 25-year-old African-American mother who has a medical history significant for an autoimmune disease with chronic joint pains, malar rash, and photosensitivity. Upon further investigation, the mother admits she has not received any prenatal care. Physical examination of the neonate is remarkable for severe bradycardia and presence of erythematous annular lesions with central clearing and raised red borders on the face and the scalp. An ECG prior to the procedure reveals a complete dissociation between the P waves and the QRS complexes. Screening for which auto-antibodies in the mother could have prevented this patient's condition? +
A 14-year-old girl is brought to the physician's office with complaints of frequent falls, stumbling gait, and slurred speech. Her mother explains that the patient's symptoms have been progressing for the past few years. On physical examination, the patient has moderate scoliosis and pes cavus. Neurological examination is remarkable for dysarthria, staggering gait , weakness of the distal lower extremities, loss of vibratory and proprioceptive sensation, absent deep tendon reflexes, and positive Babinski sign. Heart auscultation reveals an S4 gallop. Which of the following endocrine abnormalities is associated with this patient's condition? +
A 72-year-old male patient presents with progressive dyspnea on exertion, orthopnea and increasing lower extremities pitting edema for several days. On chest exam, he’s found to have bilateral rales. Heart exam is positive for an S3 gallop. Jugular venous distention is evident on inspection of the neck. Chest xray shows cardiomegaly and bilateral pleural effusions. Diagnosis of CHF is made and decision was made by the ER physician to start IV furosemide, IV nitroglycerin and IV digitalis. Use of IV digitalis in this patient has been proven to do which of the following: +
35 year-old pregnant female, 18 weeks gestation comes for a routine prenatal followup. She has no complaints except for mild pitting edema of her ankles. You order a set of labs which include renal functions, CBC and a thyroid profile. Which of the following will most likely appear on her lab work: +