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A 25-year-old man presents to the emergency department (ED) with acute chest pain radiating to the left arm. He states that his pain is associated with nausea and cold sweating. In the ED, ECG is remarkable for ST-segment elevation in the anterior leads, and the serum troponin concentration is elevated. The patient is transferred to the catheterization laboratory for urgent percutaneous coronary intervention (PCI). The next day, further investigations are remarkable for elevated concentrations of homocysteine and methionine in the blood and urine. Supplementation with which of the following vitamins could possibly improve this patient's condition? +
An attending in the cardiac intensive care unit at a major academic medical center is teaching a resident about the pulmonary vasculature. A patient with a history of hypertrophic cardiomyopathy is recovering from an anterior myocardial infarction and the following values below are measured. Which of the following corresponds to the pulmonary vascular resistance in this patient?
<br>
'''Pulmonary artery pressure (mean): 15 mmHg'''<br>
'''Pulmonary capillary wedge pressure (mean): 10 mmHg'''<br>
'''Aortic systolic pressure: 140 mmHg'''<br>
'''Aortic diastolic pressure: 90 mmHg'''<br>
'''Heart rate: 90/min'''<br>
'''Stroke volume: 40 mL'''<br> +
A 59 year- old male comes to ED complaining of chest pain. The pain started while he was watching TV 30 minutes ago, and radiating to the left shoulder. His pain is dull constant in nature, and it is accompanied by diaphoresis and nausea. EKG is normal, and his Troponin levels are elevated. The patient has been given oxygen, nitrates, morphine, and aspirin. Which of the following is the best next step in managing this patient? +
A 50 year- old male comes to ED complaining of a dull pain started 15 min ago all over his chest that radiates to the left shoulder and arm. EKG is normal. After the resolve of his attack, you ordered a stress test, which turn abnormal and show a reversible ischemia. The patient was indicated for angiography which shows >70% stenosis in the left main coronary artery, and the patient indicated for CABG. Which of the following is the main difference between saphenous vein grafts and internal mammary artery grafts? +
A 56 year-old female comes to ED complaining of sudden onset of dizziness and palpitation, and light headedness. These symptoms have been occurring frequently for the past 2 days, last for few minutes, and resolve spontaneously. She has a history of hypertension, and ischemic heart disease. Her current medications are daily aspirin, metoprolol, and hydrochlorothiazide. On examination, her heart rate is 110 bpm and shows irregular irregularity, blood pressure is 130/80 mmHg, temperature is 37 C (98.6 F), and respiratory rate is 18/min. Her EKG shows atrial fibrillation. What is the best next step in the management of this patient? +
A 56 year-old female comes to ED complaining of sudden onset of dizziness and palpitation, and light headedness. These symptoms have been occurring frequently for the past 2 days, last for few minutes, and resolve spontaneously. She has a history of hypertension, and ischemic heart disease. Her current medications are daily aspirin, Metoprolol, and hydrochlorothiazide. On examination, her heart rate is 110 bpm and shows irregular irregularity, blood pressure is 130/80 mmHg, temperature is 37 C (98.6 F), and respiratory rate is 18/min. Her EKG shows atrial fibrillation, and her ventricular rate was controlled by IV diltiazem drip. Which of the following should be used to keep her sinus rhythm? +
A 62 year-old man comes to ED complaining of acute shortness of breath, fatigue, and worsening exertional dyspnea. He hardly can talk, and mentioned waking up several times at night on sever cough with frothy sputum. He used to sleep on two pillows but now he is using three. The patient has past medical history of hypertension for 15 years, and diabetes mellitus for 20 years. On examination, his BP 90/70, pulse 120, respiratory rate 28, and temperature is 36.9 C (98.5F). Chest examination revealed decreased breath sounds and dullness at both bases with bibasilar rales. Cardiac examination revealed diffuse, laterally and inferiorly displaced apex, with distant heart sounds and S3 gallop. There is a jugular venous distention, with JVP of 12 cm, and oxygen saturation of 83%. Extremities are cool and show 2+ pitting edema in both legs up to the knees. Which of the following is the best next step in managing this patient? +
A 62 year-old man comes to ED complaining of acute shortness of breath, fatigue, and worsening exertional dyspnea. He hardly can talk, and mentioned waking up several times at night on sever cough with frothy sputum. He used to sleep on two pillows but now he is using three. The patient has past medical history of hypertension for 15 years, and diabetes mellitus for 20 years. On examination, his BP 90/70, pulse 120, respiratory rate 28, and temperature is 36.9 C (98.5F). Chest examination revealed decreased breath sounds and dullness at both bases with bibasilar rales. Cardiac examination revealed diffuse, laterally and inferiorly displaced apex, with distant heart sounds and S3 gallop. There is a jugular venous distention, with JVP of 12 cm, and oxygen saturation of 83%. Extremities are cool and show 2+ pitting edema in both legs up to the knees. Which test would be most sensitive for the diagnosis of this condition? +
A 62 year-old man comes to ED complaining of acute shortness of breath, fatigue, and worsening exertional dyspnea. He hardly can talk, and mentioned waking up several times at night on sever cough with frothy sputum. He used to sleep on two pillows but now he is using three. The patient has past medical history of hypertension for 15 years, and diabetes mellitus for 20 years. On examination, his BP 90/70, pulse 120, respiratory rate 28, and temperature is 36.9 C (98.5F). Chest examination revealed decreased breath sounds and dullness at both bases with bibasilar rales. Cardiac examination revealed diffuse, laterally and inferiorly displaced apex, with distant heart sounds and S3 gallop. There is a jugular venous distention, with JVP of 12 cm, and oxygen saturation of 83%. Extremities are cool and show 2+ pitting edema in both legs up to the knees. Which of the following has been shown to reduce mortality in patients with this condition? +
A 5-year-old child is brought to the pediatrics clinic by concerned parents. He is reported to have occasional episodes of “staring into space” which last about 1-2 mins during which the child is unarousable even with painful stimuli but does not seem disoriented after he regains consciousness. The parents deny any jerky movements or tonic muscle spasms. Overnight monitoring with electroencephalogram demonstrates 3 Hz spike-and-slow wave complexes during one of the episodes. What is the mechanism of action of drug most commonly used to treat this condition? +
A 35 year old female presents with a 2 week history of sensitivity to sunlight. Whenever she steps outside unprotected she develops blistering, scarring, pigmentation on the back of her hands and face. She has also noticed increased hair growth at unusual places during these past 2 weeks. She is sexually active and takes oral contraceptives regularly. The physician orders the following labs:
Complete blood count:
:* Hemoglobin 12.0 mg/dL
:* Hematocrit 45%
:* RBC's 4 million/cc
:* WBC's 8000 /cc
:* Platelets 3 lac/cc
LFT's <br>
:* AST 100 IU/L <br>
:* ALT 90 IU/L <br>
:* Prothrombin time 20 secs<br>
:* Bilirubin 2.0
Urinalysis: <br>
:* Color - pale<br>
:* pH – 5 <br>
:* Specific gravity – 1.010 <br>
:* Ketones – None <br>
:* Nitrates – Negative <br>
:* Leukocyte esterase – Negative <br>
:* WBCs - 3 WBCs/hpf <br>
:* Casts – 0-5 hyaline casts/lpf <br>
:* Crystals – none <br>
:* Uroporphyrin Elevated <br>
:* Porphobilinogen Normal
USG: Normal liver architecture
The patient is diagnosed with an enzymatic defect in heme metabolism, which of the following represents the enzyme deficiency and the best treatment strategy for the same? +
An 18 years old female is brought to her psychiatrist by her mother. Her mother reports to the doctor that her daughter is always troubled by the fact that she keeps moving from one relationship to another, she feels emotionally detached from them. After several visits, the daughter confides to psychiatrist that she was abused my her uncle when she was 8, and she hates to talk about it. Ever since, she has trouble confiding in people. What kind of a defense mechanism is she demonstrating? +
A 56 year-old female presents to ED complaining of sudden onset of dizziness, palpitation, and light headedness. These symptoms have been occurring frequently for the past week, it lasts for few minutes, and resolve spontaneously. She has a history of hypertension, and ischemic heart disease. Her current medications are daily aspirin, Metoprolol, and hydrochlorothiazide. On examination, her heart rate is 110 b/pm and shows irregular irregularity, blood pressure is 130/80 mmHg, temperature is 37 C (98.6 F), and respiratory rate is 18/min. Her EKG shows atrial fibrillation. After controlling the ventricular rate with IV diltiazem drip, she is prescribed amiodarone for the maintenance of sinus rhythm, and warfarin as an anticoagulant. After 7 weeks of follow up, the patient presents to ED complaining of red urine, which turns to be hematuria after urine analysis. Which of the following could prevent this from happening? +
A 56 year-old female presents to ED complaining of sudden onset of dizziness, palpitation, and light headedness. These symptoms have been occurring frequently for the past week, last for few minutes, and resolve spontaneously. She has a history of hypertension, and ischemic heart disease. Her current medications are daily aspirin, metoprolol, and hydrochlorothiazide. On examination, her heart rate is 110 beat per minute and shows irregular irregularity, blood pressure is 130/80 mmHg, temperature is 37 C (98.6 F), and respiratory rate is 18/min. Her EKG shows atrial fibrillation. After controlling the ventricular rate with IV diltiazem drip, she is prescribed amiodarone for the maintenance of sinus rhythm, and warfarin as an anticoagulant. Which of the following is the most important test to order after 7 weeks of follow up? +
Hemodynamic parameters are collected from the medical records of hospitalized patients with different medical conditions for a retrospective study. One of the patients has the following parameters:<br>
Systolic blood pressure: 160 mmHg<br>
Diastolic blood pressure: 60 mmHg<br>
Pulse: 102 beats per minute<br>
Which of the following diseases is associated with the patient's hemodynamic parameters? +
A 76-year-old woman presents with complaints of dyspnea and generalized fatigue. She states that she becomes short of breath when she when she either lies down or walks 2 flights of stairs. Laboratory work-up is remarkable for markedly elevated NT-proBNP. Echocardiography demonstrates abnormal filling dynamics of the left ventricle with preserved contractility and elevated left atrial filling pressures with left atrial enlargement. Which of the following most likely corresponds to this patient's left ventricular end-diastolic and end-systolic volumes, respectively? +
A 35-year-old woman develops hypertension and creatinuria approximately 6 months following drug therapy. Urinalysis is negative for proteinuria. Renal biopsy demonstrates tubulointerstitial damage and focal segmental glomerulosclerosis. Which of the following is the most likely causative agent? +
A 5-month-old boy was evaluated for poor feeding and growth, hypotonia, vomiting, lactic acidemia, and garlic breath. The ratio of pyruvate to lactate in the serum is elevated with decreased conversion of pyruvate to acetyl CoA in fibroblasts. Administration of the following compounds is recommended to manage this patient's condition? +
A 16-year-old boy is brought to the pediatrician's office for the evaluation of genital ulcers. Upon further questioning, the patient admits to a history of sexual intercourse with his girlfriend. The patient is then informed that work-up for sexually transmitted infections needs to be performed. Following appropriate work-up, the diagnosis of genital herpes is made. Which of the following courses of action should the physician take prior to the initiation of therapy? +
A 2-year-old boy is brought to the physician's office for muscle weakness. The mother explains that the boy walks differently than his siblings his age, and when he tries to stand up from a squatting position, he walks up his own body using both hands and feet. The physician suspects the patient has an X-linked recessive congenital disease. Both parents deny any family history of similar symptoms. Which of the following genetic mechanisms best explains the patient's underlying condition? +