Property:Prompt
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A 57-year-old man is brought to the emergency department with acute-onset substernal chest pain for the past 2 hours. He explains that his pain radiates to his left shoulder and is associated with nausea and diaphoresis. Following appropriate work-up, he is diagnosed with ST-segment elevation myocardial infarction (STEMI). He undergoes coronary revascularization and is discharged from the hospital the next day. A histopathological analysis of this patient's myocardium will show which of the following findings on light microscopy 12 days following his STEMI? +
A 32-year-old man with no past medical history sustains a motor vehicle collision and is brought to the emergency department (ED). In the ED, he complains of severe left abdominal pain that radiates to his left shoulder. Following appropriate work-up, the diagnosis of splenic rupture is made and a splenectomy is performed. Several months later, peripheral smear of the patient will most likely reveal which of the following findings? +
A 57-year-old Japanese man presents to the physician's office for abdominal fullness, weight loss, and excessive belching. Following appropriate work-up, he is diagnosed with advanced gastric cancer. The patient undergoes treatment with 5-fluorouracil and leucovorin rescue, but his tumor failed to show an objective response and therapy is discontinued. Several months later, he returns to the office appearing pale and asthenic. He suffers from dyspnea and weakness on minimal exertion. On physical examination, he has marked skeletal muscle atrophy and fat loss. Which of the following proteins most likely mediates the patient's condition? +
A 48-year-old woman with no past medical history presents to the physician's office with complaints of difficulty swallowing solid food for the past year. She explains that her condition has recently got worse, but denies difficulty swallowing liquids or odynophagia. Review of systems reveals significant fatigue and an unintentional weight loss of 4kg (9 lbs) in the past few months. Her blood pressure is 132/68 mm Hg, heart rate is 103/min, and temperature is 36.7 ᵒC (98 ᵒF). Physical examination is remarkable for skin pallor, fissuring of both corners of the mouth, and an inflammed and depapillated anterior tongue. The physician decides to perform an upper endoscopy for further evaluation. What is the most likely finding on endoscopy associated with this patient's condition? +
A 33-year-old-man presents to the emergency department for sudden onset right-sided facial paralysis. He reports that he woke up today and noticed he had lost all control of the right-side of his face and looked like he had just suffered a stroke. The patient denies any similar previous episodes. He explains that that he does not smoke or drink and lives a very healthy lifestyle. Physical exam is notable for right-sided facial paralysis involving most of the forehead. CT scan of the brain is unremarkable. During your examination, the patient remembers that a few weeks ago he noticed a rash on his left flank that looked much like a bull’s eye that self-resolved and was wondering if this was related to his current problem. What would you expect to find on pathology had the rash been biopsied? +
A 21-year-old woman presents to the dermatology clinic for a lesion on her right arm. The patient explains that the lesion has been expanding slowly. She describes it as scaly but neither itchy nor painful. She notices that the lesion bleeds when she scratches it or tries to lift off the overlying scale. The patient reports she has never had any similar lesions, but her grandma used to complain of similar scales on her arms and legs. On physical exam, you notice a well demarcated erythematous plaque covered by a fine, and loosely adherent, silvery-white scale. If you were to biopsy the lesion, what would you most likely find on microscopic examination? +
A 37-year-old woman presents to her primary care physician for painful fingers with associated purplish discoloration of the tips. The patient started to notice the symptoms early in the winter especially after her central heating system broke down. The physician decides to work the patient up and withdraws blood in a heparin tube to send for testing. Several minutes after withdrawal the physician notices that the patient’s blood had started to clump. Which of the following is a possible explanation for the patient’s condition? +
A 21-year-old man presents to the emergency department for 1 week of severe sore throat with associated odynophagia. The patient also reports significant fatigue that has been keeping him in bed most of the day. The physician does a bed-side rapid strep test that returns negative. He then asks the patient to visit the lab for a simple blood test. The technologist mixes a drop of the patient’s serum with a 15% suspension of sheep red blood cells in a 5% sodium citrate solution on a glass slide. The mixture is left undisturbed for one minute after which the technologist notices that the sheep red blood cells have agglutinated. Which of the following recptors would bind the organism responsible for this patient’s disease? +
A 33-year-old woman presents to the gynecology clinic for 2 weeks of vaginal itching and burning. She reports first noticing a greenish vaginal discharge 1 week ago associated with a very foul smell that did not seem to resolve completely after showers. The patient denies any previous episodes. She admits to having several sexual partners and to using barrier protection infrequently. What is the most likely finding on wet mount of a vaginal swab in this patient? +
A 6-month-old girl admitted to the pediatrics ward for fever was found to have coarse facial features, corneal clouding, bilateral dislocated hips, and significant developmental delay. An assay of alpha-mannosidase and beta-galactosidase, both of which are lysosomal enzymes, demonstrated deficient intracellular concentrations, but excessive plasma concentrations up to 50-fold the upper limit of normal. Which of the following processes is likely to be defective in this child? +
A 33-year-old man complains of excessive worry that often interferes with his daily functioning. He finds himself anticipating disasters, and worrying about everything from health issues, to money, death, and relationship troubles. He is diagnosed with generalized anxiety disorder and his psychiatrist decides to initiate treatment. The patient seems reluctant because he hates medications and would like an agent that would not cause him to become sleepy throughout the day, and would not be addictive on the long run. Which of the following medications could be used offered to this patient? +
A 37-year-old woman is seeking her gynecologist’s advice for contraception. She already has 3 children and does not wish to have any more. She explains that her husband doesn’t always agree to wear a condom and she was considering either tubal ligation or oral contraception as possible alternatives. Which of the following characteristics would make oral contraception contraindicated in this patient? +
A 52-year-old man previously diagnosed with AIDS with a recent CD4 count of 28 presents to the HIV clinic for 2 weeks of slowly decreasing visual acuity. Concerned about the possibility of infection, the infectious disease fellow admits him for treatment. One week into the treatment the patient starts experiencing anxiety, muscle twitching, and tremulousness. Blood tests reveal significant hypomagnesemia, hypocalcemia, and hypophosphatemia. Which of the following agents was the patient started on? +
A 47-year-old man with HIV presents to the emergency department for 3 hours of excruciating left flank pain and hematuria. The emergency physician suspects a renal colic and orders a non-contrast abdominopelvic CT scan that reveals left ureter dilation and edema without any visible obstruction. Further work-up is unremarkable. Given the patient's worsening status, the urologist decides to prepare the patient for interventional ureteroscopy. During the procedure, the surgeon recuperates 2 separate stones measuring around 1.5 cm each. Assuming the patient's condition had been caused by a medication, which of the following would be a likely culprit? +
A 55-year-old African-American man presents to the physician's office complaining of pruritus, unintentional weight loss, and depression. The patient's history is significant for heavy smoking for the past 30 years. Physical examination reveals marked jaundice and icterus. Abdominal CT scan demonstrates a large pancreatic head mass abutting the superior mesenteric artery. Which of the following findings may be present in this patient? +
A 52-year-old man presents to the physician's office complaining of headache and blurry vision. His past medical history is insignificant. The physician suspects the patient's blood pressure is elevated. In the clinic, the patient's blood pressure measures 150/70 mmHg in the right arm in sitting position. His other vital signs are as follows: Temperature 36.8 degrees C (98.2 degrees F), heart rate is 80 bpm, and respiratory rate is 14/min. What is the patient's approximate mean blood pressure? +
A 25-year-old obese woman presents to the physician's office with complains of weight gain. A complete work-up is unremarkable. The physician decides to attempt lifestyle modification as a first step to help the patient lose weight. The patient explains that she eats 250 grams of proteins, 700 grams of carbohydrates, and 200 grams of fat every day. What is the patient's total caloric intake (in kcal) per day? +
A 68-year-old man comes to the clinic complaining of an ulcer on his face. He has been a sailor for his entire life. He states that he does not feel any pain. The patient states that it has been growing slowly over the past 9 months. On physical exam it is clean looking, has 2 cm in diameter and is located on the lower lip. There are no lymphadenopathies in the head or neck. What is the most likely diagnosis? +
A 55-year-old man with darker skin is admitted to the hospital due to abdominal pain. The ER doctor orders lab tests and a CT scan, which shows multiple liver metastasis. On physical examination he does not have a toe; he says it was removed at the age of 20 for a tumor on the nail bed. The patient is admitted to the hospital. The internal medicine and oncology team tries to identify the primary tumor ordering a CXR and other diagnostic studies without any success. Which of the following is the most likely primary tumor? +
A 68-year-old man presents to the dermatology clinic complaining of a growing facial ulcer. He explains that the ulcer first developed 3 months ago and has not healed ever since. Physical examination is remarkable for a dark red-colored, asymmetric, ulcerating lesion at the lower lip that measures approximately 1 cm in diameter. Cervical lymphadenopathy cannot be appreciated on physical examination. Skin lesion biopsy demonstrates concentric epithelialized cells with foci of central keratinization. Which of the following is a risk factor for the development of this patient's condition? +