Property:Prompt
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A 27-year-old pregnant G1P0 presents to the emergency department at 19 weeks gestation with rupture of membranes. Upon questioning, she explains that she has not received any prenatal care and was not followed by an obstetrician. Following appropriate intervention, the patient’s fetus is evacuated but is not viable. Inspection of the fetus reveals clubbed feet and cranial anomalies. Which of the following additional findings is also expected to be most likely present on autopsy? +
A 68-year-old man with a significant history of alcoholism presents to the emergency department (ED) with an altered mental status. He is unable to provide further history. His daughter explains that the patient lives alone and has never visited his primary care physician in the 8 years. Physical examination in the ED is remarkable for fetor hepaticus, spider nevi, and gynecomastia. The patient's stomach is severely distended with shifting dullness. Following appropriate work-up, he is diagnosed with hepatic cirrhosis. At discharge, the patient is prescribed furosemide and spironolactone for his ascites. The patient should be monitored for which of the following electrocardiogram (ECG) changes following spironolactone administration? +
A 23-year-old Caucasian woman patient presents to the emergency department for confusion and altered level of consciousness. Appropriate history could not be taken due to the patient’s condition. Her temperature is 39.5 ᵒC (103.1 ᵒF), heart rate is 102/min and blood pressure is 90/50 mmHg. Physical examination reveals a petechial rash on predominantly on the lower extremities and significant nuchal rigidity. Blood cultures are withdrawn and broad spectrum antibiotic therapy is immediately initiated. The patient’s condition gradually improves over the next few days, but she remains anuric despite appropriate hydration. Blood cultures reveal 2 organisms: ''Neisseria meningitidis'' and ''Staphylococcus epidermidis''. What is the most likely finding on CT scan in this patient? +
42 y/o female presents to the emergency room with rapidly progressive shortness of breath and wheezing. She’s cyanotic and disoriented. Her son is with her and provides you with some of her medical history. Her past medical history is significant for hypertension, diabetes and dyslipidemia. She was started yesterday by her primary care physician on a blood pressure medication, but her son cannot recall the name of the pill. Her vital signs are bp 123/92, RR 28, P 123, Temperature 37.2 C, O2 saturations are 82% despite high flow oxygen. On exam, she has stridor of the airway with gasping or wheezy inspiratory breath sounds. Which of the following is the most appropriate next step in management: +
A novel diagnostic serum assay is developed to detect enzyme XY in sera of patients with ulcerative colitis. Researchers enroll young adults with complaints of chronic diarrhea and abdominal pain and withdraw blood for the detection of serum enzyme XY among these patients. The second day, all patients undergo endoscopic examination, and biopsies are taken to confirm or rule out the diagnosis of ulcerative colitis. Results from patients' serum enzyme XY are then compared with results from the biopsy. Which equation is used to calculate the proportion of patients that are known to have ulcerative colitis on biopsy and also have detectable serum enzyme XY? +
A 54-year-old man presents to the emergency department complaining of fever and diffuse pruritic rash. Further questioning reveals the patient was recently prescribed trimethoprim-sulfamethoxazole (TMP-SMX) for an uncomplicated urinary tract infection. On admission, his temperature is 38.5 ᵒC (101.3 ᵒF), heart rate is 98/min, and blood pressure is 118/80 mmHg. Physical examination is significant for costovertebral angle tenderness bilaterally and a maculopapular rash predominantly involving the trunk. Work-up reveals a creatinine of 2.6 mg/dL and eosinophiluria with eosinophil casts on urinalysis. Which of the following is the most important prognostic factor in this patient’s condition? +
A 38-year-old man presents to the emergency department with complaints of fever and back pain that radiates to the inguinal area. His temperature of 38.5 °C (101.3 °F), heart rate is 98/min, and blood pressure is 122/88 mmHg. Following appropriate work-up, the patient is diagnosed with struvite kidney stone. Urine cultures demonstrate a urea-splitting organism with swarming motility. Which of the following characteristics most likely correspond to the organism responsible for this patient's symptoms? +
An obese 40-year-old woman presents to the physician's office with complaints of recent headaches, nausea, and vomiting. The patient is found to have elevated opening pressure on lumbar puncture. She is advised to lose weight and is then prescribed a pharmacologic therapy to treat her condition. The patient's prescribed medication is also indicated for which other condition? +
A 12-year-old boy is brought by his mother to the physician’s office for red-colored urine. Upon further questioning, the mother explains that her son is deaf and has eye problems. The physician suspects a collagen disease. Genetic studies reveal a mutation of ''COL4A5'' the encodes collagen α chains. What is the most likely mode of inheritance of this patient’s condition? +
A researcher discovers developmental inhibitors of embryological components that help him study embryologic origins of various human tissues. In one experiment, the researcher decides to inhibit the development of the ureteric bud. As a result of his experiment, which of the following nephron structures will fail to develop? +
A 38-year-old man is brought to the emergency department in septic shock. His past medical history is insignificant. He does not smoke, drink alcohol, or take any medications. The patient is managed promptly and is admitted to the intensive care unit. The next day, the patient’s urine output is low and his serum creatinine is 2.2 mg/dL. Following appropriate work-up, the patient is consequently diagnosed with acute tubular necrosis (ATN). Which of the following statements provides the most accurate comparison between ATN and pre-renal azotemia? +
A 35-year-old HIV-positive man presents to the infectious disease clinic for a routine follow-up. His most recent CD4 count 3 months ago was 670 cells/mm3 and his viral load was low to undetectable. At the time, the physician did not initiate high active antiretroviral therapy (HAART). Over the past month, the patient had been admitted twice to the hospital for a community-acquired pneumonia and for a gastroenteritis. His current lab results are remarkable for a CD4 of 231 cells/mm3 and a viral load of 325,000 copies/ml. Given his current lab findings, the infectious disease physician decides to initiate HAART for this patient. Which of the following drug combinations is most suitable for this patient? +
During a minor abdominal surgery, a patient receives an injection of succinylcholine to facilitate access to the surgical site by paralyzing his abdominal muscles. Several minutes after the injection is administered, the patient's heart rate increases to 135/min and his blood pressure to 182/99 mmHg. The monitor shows an increase in minute ventilation and end-tidal carbon dioxide. His core temperature also begins to increase steadily, reaching 41.2 ᵒC (106.1 ᵒF). Alerted by the patient's status, the anesthesiologist administers an intravenous agent to counteract the effects of the muscle relaxant. The patient's vitals slowly begin to stabilize. Which of the following intravenous agents did the anesthesiologist most likely administer to the patient? +
A 32 year old Caucasian woman comes to the physicians office. She is 20 weeks pregnant and has been referred by her obstetrician following her complaint of increase in the size of her isolated right thyroid mass recently. She had this mass before her pregnancy. Thyroid scans and neck ultrasound then revealed a cold and solid mass respectively. Fine needle aspiration was consistent with papillary carcinoma. Further examination and scans did not reveal any lymph node metastasis. Physical examination now reveals a 2 cm mass that was previously 1.5 cm in size, without any palpable lymph nodes. Which of the following is the next best step in the management? +
A 31 year old woman who was 23 weeks pregnant presented with acute severe pain in her left buttock region radiating to the leg and increasing with ambulation. No underlying pathologies or drug abuse were present and no systemic symptoms were encountered. Backache was initially attributed to nerve compression. NSAID and rest were prescribed. After 4 days, the pain became worse. The patient appears to be warm and flushed. Physical examination further revealed a temperature of 39.2 C, pulse rate of 126 beats/minute, respiratory rate of 30 breaths/minute and blood pressure of 100/50mmHg. The laboratory test results were significant for leukocytes of 15400/mm3, hematocrit of 24%, D-Dimer of 946.8μg/L and platelet count of 85,000/mm3. Chest X-ray showed images of bilateral pulmonary condensation. A Swan-Ganz catheter is inserted and demonstrates increased cardiac output, decreased peripheral vascular resistance (vasodilation), and normal pulmonary capillary wedge pressure (PCWP). Which of the following is the most likely diagnosis? +
A deep-sea water diver is brought to the ER with complaints of lightheadedness, dizziness, ataxia, and nausea. He was on a diving expedition to explore sunken ships. He started experiencing these symptoms after reaching 110 ft of depth. Which of the following is the most likely diagnosis? +
A 3 year old boy is brought by his mother for the complaint of bowing of his legs to his physicians office. His birth history reveals an uncomplicated vaginal delivery without any birth defects. Mother denies any problem in her family and does not know about the family history of the child's father, whom she had divorced last year. The examination of the child reveals prominent knobs at the costochondral junctions and a horizontal groove along the lower border of the thorax. Lab values turn out as<br>
<br>
Serum calcium Normal<br>
Serum phosphate Decreased<br>
Serum alkaline phosphatase Normal<br>
Serum parathyroid hormone (PTH) Normal<br>
Plasma 25-OH vitamin D Normal<br>
Plasma 1,25 Dihydroxy vitamin D Normal<br>
<br>
What is the possible cause for this child's finding? +
The mechanism of action of a novel experimental drug is under investigation. The drug is intended to treat patients with atrial and ventricular arrhythmias who cannot tolerate other therapies. After initial rat testing, the core lab determines that the active molecule acts on the trans-membrane proteins that regulates the resting membrane potential of cardiomyocytes. ECG monitoring demonstrates significant, dose-dependent increase in the QT interval in treated rats. Which of the following drugs has a mechanism of action similar to the experimental drug being evaluated? +
A 32-year-old husband and wife attend marital counseling. During their first individual sessions, the wife states that her husband has been been abusing her ever since she had their first child. When approached by the counselor, the husband reluctantly confirms his wife's accusation. He attempts to validate his abusive behavior by claiming that she “deserves it". Upon further questioning, the psychologist learns that the husband was abused by his father when he was a child. Which of the following forms of defense is the husband exhibiting? +
A 67-year-old African-American woman with history of end-stage renal disease on hemodialysis presents to the physician with right wrist pain. The patient explains that she has tingling and burning sensation in the right hand along the thumb, index, and middle part of the fourth finger. The symptoms also seem to worsen at night, making it difficult for her to fall asleep. On physical examination, the patient has asymmetric weakness of thumb adduction with thenar atrophy. Tinel's sign and Phalen's maneuver are both positive. Accumulation of which product is most likely to be present in this patient’s condition? +