Property:Prompt
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A 16-year-old boy is brought by his mother to the physician's office for a painful lesion in his right thigh. The patient describes the pain started 8 months ago. It is an aching feeling that is worse at night. The pain is not relieved by any position or even at rest. However, the pain is dramatically relieved by aspirin. His blood pressure is 116/74 mmHg, his heart rate is 88/min, and his temperature is 37.2 °C (99 °F). Physical examination is remarkable for proximal right femoral tenderness with muscle atrophy, and muscle weakness in the same region. Imaging of the lower extremity reveals a radiopaque osteolytic zone of dense homogenous bony sclerosis surrounding a central nidus. What is the most likely diagnosis of the patient's condition? +
A 62-year-old woman presents to the physician's office with complaints of of muscle weakness for the past 3 weeks. She states that she has recently been unable to comb her hair or stand from a seated position. When asked, she says that she has no difficulty buttoning shirts. Review of systems is remarkable for arthralgia that involves the hand joints, wrists, and knees. Inspection of the patient's face shows periorbital violaceous erythema with edematous eyelids. Physical examination is remarkable for symmetric proximal muscle weakness. Further evaluation of her dorsal interphalangeal and metacarpophalangeal joints reveals violaceous flat-topped papules and plaques. Lab work-up is remarkable for elevated concentration of creatine kinase. What is the histopathological feature of this patient's condition? +
A 58-year-old man presents to the emergency department with complaints of excruciating right toe pain. Physical examination is remarkable for erythema, edema, and tenderness around the right metatarsophalangeal joint (MTPJ) of the great toe. In contrast, the left lower extremity appears normal. Lab work-up reveals elevated blood concentration of uric acid. Arthrocentesis of the joint is performed, and fluid analysis demonstrates needle-shaped yellow crystals under parallel light. Which of the following findings during history-taking is most consistent with this patient's diagnosis? +
A 27-year-old man with no past medical history presents to the physician's office for recurrent left knee pain. The patient explains that he has recently received antibiotics to treat a urethral infection 2 weeks ago. He reports his knee pain does not involve his right knee and is moderately relieved with administration of naproxen. Work-up is remarkable for elevated concentration of C-reactive protein (CRP) and a markedly elevated HLA-B27 surface antigen. Which of the following findings on physical examination is most associated with this patient's condition? +
A 55-year-old alcoholic man presents to the physician's office with complaints of excruciating pain in the left great toe. The patient explains that he has been recently having recurrent episodes of the same pain, each episode lasting for a few days. Physical examination is remarkable for erythema and tenderness of the first metatarsophalangeal joint. Work-up is remarkable for elevated blood concentrations of uric acid and C-reactive protein (CRP). The physician prescribes a drug that lacks a purine ring and directly inhibits the conversion of hypoxanthine to xanthine. Which drug has this patient been most likely prescribed? +
A 12-year-old boy is brought by his mother to the physician's office for occasional shortness of breath. The boy explains that whenever he is playing soccer with his friends, he becomes short of breath and can hear himself "whistling" during expiration. When asked, the patient denies any symptoms during normal, non-exertional activity. Following appropriate work-up, the physician prescribes inhaled albuterol and oral montelukast. What is the mechanism of action of montelukast? +
A 23-year-old man with no past medical history presents to the physician's office with complaints of difficulty breathing during exercise. The patient denies similar symptoms at rest. The physician suspects exercise-induced asthma and decides to perform a bronchoprovocation challenge test using a crystalline powder. Using a sterile technique, he dilutes the powder in saline containing 0.4% phenol using a sterile technique. For safety precautions, the physician prepares another drug and puts it on the table to manage any potential serious adverse event that may occur with the bronchoprovocation challenge test. Which drug is most likely put nearby on the table during the procedure? +
A 26-year-old woman with no past medical history presents to the physician's office with complaints of generalized weakness for the past 4 weeks. The patient explains that she has recently noticed her eyelids have drooped down, and she has been having difficulty chewing and swallowing her foods. She also complains she has been having a "flat" smile that she never noticed in the past. When asked, the patient denies any shortness of breath or chest pain. Physical examination is remarkable for progressive bilateral weakness of the upper extremities upon repetitive movement. Which of the following factors is not associated with the severity of symptoms in this patient's condition? +
A 45-year-old man with no past medical history presents to the physician's office for hair loss. Upon further questioning, the patient explains that he has a strong family history of alopecia. Physical examination is remarkable for male pattern baldness with no evidence of skin disease. The physician prescribes a topical medication to reduce the patient's hair loss. The patient then asks if he can use the same drug in an oral preparation instead, but the physician explains that oral administration of the drug is indicated for another disease. What is the indication for the oral form of the prescribed topical solution? +
A sick-looking 7-year-old girl is brought to the emergency department (ED) in respiratory distress. The physician quickly inquires about her condition. Her mother informs the physician that the entire family lived in India and only recently emigrated to USA. The girl has not received any childhood vaccinations. On physical examination, the girl is in acute distress; she is sitting in a tripod position. Her breathing is laborious, and she is drooling. The diagnosis of acute epiglottitis is promptly made, but the girl suddenly turns blue and collapses. The physician rapidly perform an urgent tracheostomy. The mother intervenes, saying that the family's religious beliefs prevent the girl from having any surgical procedure. What must the physician do in this case? +
A 62-year-old man presents to his physician's office complaining of dry cough. Following appropriate work-up, he is diagnosed with small cell lung carcinoma. During his first chemotherapy session in the hospital, his oncologist visits the patient to make sure he asymptomatic and has no complaints. Following the visit, the patient's 27-year-old daughter, who has been waiting outside the infusion room, asks the physician what will happen to her father. Which of the following is the most appropriate answer in this situation? +
A researcher is analyzing muscle biopsy sections from 10 volunteers. In his experiment, he biopsies 20 mg of muscles from different regions of the body using a special needle technique. Then, he types muscle fibers according to myofibrillar ATPase histochemistry and calculates the percentage of type I and type II fibers. Finally, vapor fixation and quantitative histochemical techniques are used and compared to blocks of myoglobin for calibration. The researcher concludes that myogbolin concentration varies significantly between different muscle samples. Biopsy of which of the following muscles has the most myoglobin concentration? +
Osteogenesis is a complex process that results in the development of bone. Intramembranous and endochondral ossification are 2 processes that result in osteogenesis. Both processes are similar in their conversion of a pre-existing tissue into bone. However, intramembranous and endochondral ossification differ greatly in the means to form bone. Which of the following statements is true regarding osteogenesis? +
A 17-year-old male achondroplastic dwarf is brought by his mother to the physician's office to inquire about his condition. The physician informs the patient that his condition is caused by an abnormal functioning of a growth factor receptor that affects his bone development. Which of the following abnormalities of osteogenesis have most likely occurred in this patient? +
A 14-year-old girl is brought by her mother to the physician's office for facial asymmetry and a limp on the right side. Her past medical history is significant for McCune-Albright syndrome. Physical examination is remarkable for facial asymmetry, breast enlargement, and multiple cafe-au-lait spots on her skin. X-ray of the right proximal femur demonstrates a "ground glass" appearance and findings consistent with a "shepherd's crook" deformity. The physician explains that the patient's condition is caused by a disease of the bone marrow stromal cells with abnormal production of fibro-osseous masses of tissue. Biopsy of the bone lesions will most likely show which of the following findings? +
A 58-year-old man with a recent diagnosis of small cell lung carcinoma (SCLC) presents to the physician's office with complaints of proximal muscle weakness and eyelid ptosis. He explains that his lower extremities were first affected, but then his upper extremities became involved. Physical examination is remarkable for tendinous areflexia. Electromyographic repetitive nerve stimulation using high-frequency stimulation demonstrates an increment in compound muscle action potential amplitude. What is the pathogenesis of the disease responsible for the patient's condition? +
A 58-year-old woman presents to the physician's office for a mandibular lesion. Her past medical history is significant for breast cancer. She is currently receiving zoledronic acid for osteoporosis. The physician suspects the patient is having zoledronic acid-related osteonecrosis of the jaw. Which risk factor is associated with the development of this patient's condition? +
A 27-year-old woman is brought to the emergency department (ED) with severe abdominal pain and nausea. Her temperature is 36.8 °C (98.24 °F), heart rate is 88/min, and blood pressure is 128/78 mmHg. Her husband arrives to the ED shortly and informs the physician that the patient attempted suicide and ingested more than 20 tables of acetaminophen 5 hours before admission. The physician promptly administers an antioxidant drug that regenerates glutathione and reduces the effect of acetaminophen toxicity. The administered drug is also indicated to manage which condition? +
A 14 year-old-boy is brought to the physician's office by his mother for multiple pruritic lesions on his legs. The mother informs the physician that the child had recently returned from a picnic and she fears he has been exposed to poison ivy. On physical examination, the physician notes vesicular bullous lesions with erythema on the lower extremities. The patient's condition is best characterized by a hypersensitivity disorder that resembles which other disease? +
A 48-year-old woman with no past medical history presents to the physician's office for a left breast lump that she recently noticed on self-exam. She explains that she incidentally palpated the lump during showering, but she does not complain of any pain or breast discharge. Following appropriate work-up, she is diagnosed with triple-negative breast cancer of ductal histological subtype. Genetic analysis demonstrates a germline c.185delAG frameshift mutation in the ''BRCA1'' gene. When asked, the physician explains the normal function of BRCA1 protein. Which of the following best describes the molecular classification of the ''BRCA1'' gene product? +