Property:Prompt
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A 24 year old man presents to the emergency room after his car rear-ended another at approximately 15 mph. He was driving back after pitching at his baseball game when the crash occurred, but he cannot remember the crash itself. Physical exam reveals an internally rotated shoulder, with positive Jerk test, consistent with posterior shoulder dislocation. What is the most likely cause of this patient's shoulder injury? +
A 35-year-old man presents to his primary care physician for muscular pain, sweating, and fever over the past five days. He reports that his fever tends to worsen throughout the day and breaks at night. The patient denies any recent travel to foreign countries or new sexual partners. He works as a goat farmer and hunts deer on the weekends. Physical exam is remarkable for cervical lymphadenopathy and a body odor that resembles wet hay. If left untreated, development of which of the following complications is most likely? +
A 58 year old woman presents to the hospital for bilateral lower extremity leg cramps, paresthesias, and lower extremity weakness (right greater than left). She reports the symptoms occurred gradually over the course of two days. On admission, she is found to have urinary retention and a foley catheter is inserted. On physical exam she is afebrile, and her mental status is normal. She has symmetric 2+ reflexes in the lower extremities. Proprioception and sensation to vibration are diminished bilaterally in the lower extremities. The patient reports a general feeling of numbness below the umbilicus. She is unable to stand or ambulate on her own. The results of T2 spinal MRI are shown below. A lumbar puncture is performed, which demonstrates total protein of 141 mg/dL, glucose of 80 mg/dL and 13 WBC/mL.
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<img src="https://upload.wikimedia.org/wikipedia/commons/thumb/d/de/Transverse_myelitis_MRI.jpg/550px-Transverse_myelitis_MRI.jpg">
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What is the most likely diagnosis? +
A 25 year old left-handed transgender female-to-male presents with right upper extremity weakness. Complete sensation loss of the RUE. +
A 50 year old man with a history of end-stage renal failure presents to the hospital for head injury following a motor vehicle accident. The patient is unresponsive on admission. CT scan shows diffuse intraparenchymal hemorrhage. He is admitted to the neuro intensive care unit for further management. His blood pressure is 95/ . An epidural sensor is placed and the intracranial pressure is found to be 29 (Normal 5 - 15 mmHg). The patient is intubated and sedated with the head of the bed elevated. A central line and ventricular drain is placed, but the patient's ICP remains high at 28 mm Hg. What is the best next step to decrease this patient's intracranial pressure? +
A Quality improvement initiative team is investigating several cases of bedsores at a local nursing home. You’re the physician in charge of rounding on those patients. They are asking for your input in the project. What are the most common sites of bedsores in those patients? +
A 21-year-old man presents to the urgent care clinic for dark colored urine. Upon further questioning, the patient reports he has recently recovered from a flu-like illness 4 days prior to presentation. Patient denies dysuria, frequency, or urgency. Patient’s vital signs reveal a temperature of 36.7 degree C (98 degree F), heart rate of 68 beats per minute, and blood pressure measuring 110/85 mmHg. Patient’s physical examination is unremarkable. After appropriate work-up, renal biopsy reveals mesangial proliferation. Which finding is most consistent with the pathogenesis of the patient’s condition? +
A 24 year old Caucasian male patient presents to the emergency department with back pain that radiates to the inguinal region. The pain started on the day of presentation. On further questioning, the patient reveals he has had recurrent kidney stones since the age of 11. The patient’s urine smells like rotten eggs. Appropriate work-up done prior to presentation has shown elevated levels of urinary arginine, ornithine, and lysine. Which of the following treatment modalities is the best option for this patient’s renal colic? +
A lab researcher develops a novel pharmacologic agent that preferentially targets smooth muscle cells in the coronary vessels. During her experiment, she accidentally sticks herself with a needle loaded with the novel agent, and she begins to have repeated attacks of profound substernal discomfort that prompt urgent evaluation in the emergency department (ED). In the ED, her vital signs are within normal range, and her physical examination is unremarkable. A 12-lead ECG demonstrates modest ST-segment elevation. Which of the following molecular events is most likely to be induced by the novel pharmacologic agent? +
A 35-year-old man with no past medical history presents to the clinic with acute-onset, recurrent headaches for the past 3 weeks. The patient states that his symptoms are strongest at the beginning of each business week and usually improve by Fridays and the weekends. The patient denies any allergies or intake of any medications. Upon further questioning, the patient also reports occasional fatigue and light-headedness. In the clinic, the patient's vital signs are within normal limits, and his physical examination is unremarkable. Following history-taking and physical examination, the physician suspects that the patient's symptoms are caused by an occupational exposure. Which of the following industries does the patient most likely work in? +
A 58-year-old hypertensive woman presents to her physician's office for a routine check-up. Upon review of systems, the women states that she is asymptomatic and has no complaints. She reports that she was prescribed an antihypertensive drug by another primary care physician 6 months ago and has been taking one tablet each day. In the clinic, she is afebrile with a blood pressure of 118/80 mmHg, heart rate of 58/min, and respiratory rate of 14/min. Physical examination is unremarkable. Laboratory work-up demonstrates a total cholesterol concentration of 220 mg/dl, LDL-C of 100 mg/dl, HDL-C of 50 mg/dl, triglyceride concentration of 350 mg/dl. The patient is surprised and states that she never had abnormal lipid profiles in the past. The physician suspects the patient's abnormal findings are related to an adverse effect of the drug she has been prescribed. Which of the following antihypertensive drugs is the patient most likely receiving? +
A 24-year-old woman presents to her primary care physician with complains of finger discoloration and tingling sensations of her digits. She states that her fingers turn blue upon brief exposure to cold water, and 10 minutes later, the fingers appear pale and eventually become red and swollen. When her fingers are warmed up, their color returns to normal and the swelling disappears. She recalls that during winter time last year, she had similar complaints, and she had an ulcer on her left index finger that eventually healed. Upon further questioning, the patient denies fevers, recent weight changes, fatigue, skin changes, dysphagia, or joint pains or deformities. Which of the following pharmacologic agents is effective to manage this patient's condition? +
A 48-year-old woman with no past medical history presents to her physician's office with complaints of chronic watery diarrhea and occasional shortness of breath. She also complains of frequent abdominal pains that occasionally wake her up at night and intermittent facial flushing episodes which fail to respond to aspirin. Upon further questioning, she reports a 5 kg weight loss over the past 3 months and chronic fatigue. In the clinic, her blood pressure is 142/88 mmHg, heart rate is 90/min, and respiratory rate is 22/min. Cardiothoracic examination is remarkable for wheezing and a holosystolic murmur at the lower left sternal border that is intensified by applying pressure on her liver. Abdominal exam is remarkable for abdominal tenderness in the right lower quadrant, hyperactive bowel sounds, and mild hepatomegaly. Which of the following urinary findings are diagnostic of this patient's condition? +
A 5-year-old boy is brought to the physician's office for routine evaluation. The patient was diagnosed with a congenital disease immediately after birth and has been followed up by his physician ever since. The patient's genetic analysis reveals a homozygous deletion of three nucleotides coding for phenylalanine at amino acid position 508. Which of the following pathophysiological changes in this patient does not result in clinical manifestations at his present age? +
A novel chemotherapeutic pharmacologic agent of unclear mechanism is under investigation. Following intravenous administration of the investigational agent, hamster ovary cells are found to be arrested at metaphase. Further studies demonstrate that both the investigational agent and paclitaxel bind to beta-tubulins and promote stabilization of microtubules. Which of the following pharmacologic agents has the same mechanism of action? +
A newborn male is evaluated for vomiting and failure to pass his first stool within 48 hours of birth. The vomit is approximately two teaspoons in volume, green-brownish in color, without bloody contents. On physical examination, the patient's abdomen is distended, and digital rectal examination elicits massive passage of gas and stools. Diagnosis is made by rectal biopsy that demonstrates lack of migration of ganglions due to mutation of a proto-oncogene. Genetic mutation of the proto-oncogene involved in this patient's condition is also responsible for the development of which of the following clinical manifestations? +
A 32-year-old man with a history of intravenous drug use is admitted with a worsening respiratory distress accompanied by fever and nonproductive cough. Arterial blood gas values are pH=7.52, PaCO2=28 mm Hg, HCO3=22 mEq/L, and PaO2=70 mm Hg when breathing room air. The patient's CD4+ count is 145 cells per microliter. Chest X-ray demonstrates bilateral perihilar interstitial infiltrates suggive of an infectious etiology. The causative organism is detected in bronchoalveolar lavage with silver stain. Two days following pharmacologic therapy, the patient returns to the emergency department with chest pain, dizziness, headache, cold extremities, and pale skin. Peripheral blood smear is remarkable for irregularly fragmented erythrocytes. Supravital stain of the smear demonstrates immature red blood cells with dark blue dots and curved linear structures in the cytoplasm. Which of the following drugs is most likely to be responsible for this patient's readmission? +
A 33-year-old woman presents to her physician's office with complaints of headache and shortness of breath. She denies any chest pain, weakness of the extremities, cough, runny nose, or abdominal symptoms. In the clinic, her temperature is 36.7 °C (98.2 °F), her blood pressure is 182/122 mmHg, her heart rate is 20/min, and her respiratory rate is 22/min. Physical examination is remarkable for an abdominal bruit upon auscultation in the left periumbilical region. Work-up demonstrates normal values for thyroid-stimulating hormone (TSH), cortisol, and 24-hour urinary excretion of catecholamines. Abdominal angiogram demonstrates a string-of-bead appearance of the left renal artery. Which of the following pathologic findings is most likely to be found on lesional biopsy from her left renal artery? +
A 75-year-old woman presents to the emergency department (ED) with an acute-onset substernal chest pain for the past 30 minutes. She explains she was asymptomatic earlier today, but she felt a sudden, unusual chest pressure sensation while she was walking her dog in the afternoon. She recalls she has recently had a history of intermittent chest pains that are worsened by physical activity and relieved by rest, but her current chest pain has been constant and is markedly more severe than her usual symptoms. Upon further questioning, she reports her chest pain is associated with cold sweating, shortness of breath, and left upper extremity numbness. Her past medical history includes diabetes mellitus, hypertension, and dyslipidemia. In the ED, her temperature is 37.5 °C (99.5 °F), blood pressure is 90/65 mmHg, and heart rate is 115/min. Electrocardiogram demonstrates ST-segment elevation in leads I, aVL and V5-V6. Which of the following events is most likely to underlie her clinical presentation? +