Property:Prompt
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27 year old male presents to the office with several day history of multiple joint pains. He says he has been having pain for the past 4 months and it is progressively getting worse. His pains are more prominent on shoulders, elbows and lower back with no improvement on rest but feels better with exercise. His past medical history is significant for a motor vehicle accident, but did not have any serious complications except for abrasions at back. He is a chronic smoker and alcoholic. He is sexually active and does not use condoms. He has no recent travel outside the country and has no allergies. Physical examinations show mild swelling in the both shoulder and elbow joints. Mild shoulder and hip joint tenderness is present. Shoulder movements are restricted. Forward flexing movements of spine is restricted but lateral flexion is normal. No rash is present. Which of the following is the patient more prone to develop? +
27 year old male presents to the office with several day history of low back pain. He says he has been having such pain for the past 4 months. His pain is more severe early morning and improves during the day and feels better on taking NSAID's. His past medical history is insignificant. He is a chronic smoker and alcoholic. He is sexually active and does not use condoms. Physical examinations shows hip joint tenderness with restriction of spine. Examination of the other joints are normal. Initial lumbosacral X-ray shows mild disease involving the sacroiliac joints. What is most appropriate plan to monitor the disease activity? +
40 year old nurse presents to the office with one year H/O joint pains and stiffness. She says her symptoms are gradually progressing and not responding to over the counter NSAID’s. She experiences pain usually early morning that improves during the day. Since the start of this august she feels her symptoms are prolonged and her physical activities are restricted due to her symptoms. Her past medical history and family history are insignificant. She is a chronic smoker and alcoholic. Physical examination shows mild hyperemia and swelling of the proximal small hand joints, wrists and knees with restriction of movements. Examination of the other joints are normal. Initial knee X-ray shows periarticular joint erosions. RF and ESR are markedly elevated. What is most appropriate next step before starting her on her first DMARD? +
48 year old male presents to the office with 4 month history of fatigue, dry cough and dyspnea. He says his cough and breathing difficulty is getting worse. He denies any fever, weight loss, chest pain and joint pain. He works in a glass factory and his past medical history is significant for hypertension. He is a chronic smoker and alcoholic. On examination pulse is 80/min, BP:130/80 mmHg, temperature 37 degree Celsius and O2 saturation is 93%. Physical examinations are normal and no cervical lymph nodes are noted. Cardiovascular and respiratory system examinations are normal. Chest X-ray show B/L hilar lymphadenopathy and prominent nodules in the upper lobe. After treating with O2, bronchodialotrs the patient feels better. Which of the following would be the best appropriate management in this patient? +
A 16-year-old girl presents to the physician's office with fever and pelvic pain. Upon further questioning, she admits to a sexual history with multiple partners in the past 4 months. Following history-taking and physical examination, the patient is diagnosed with pelvic inflammatory disease (PID). The physician informs her that her condition is caused by her sexual activity and she requires antimicrobial therapy. She agrees to be treated, but she asks the physician that he does not tell her parents about her condition. Which of the following statements is the physician's most appropriate reply to this patient's request? +
A 56-year-old male smoker presents to the surgical ward for a left nephrectomy. The patient had recent complaints of gross hematuria and was then diagnosed with renal clear cell carcinoma. During his surgery, the surgeon notes the anatomy of the renal blood vessels and their neighboring structures. Which of the following statements is most accurate regarding the renal blood vessels and their surrounding structures? +
A 72-year-old man presents to the physician's office with complaints of dyspnea and bilateral pitting edema. His past medical history is significant for diabetes mellitus, gout, and osteoarthritis. Upon further questioning, the patient explains that he is allergic to several medications. Among the list of medications that he has tried in the past, he recalls he developed skin rash when he was administered sulfonylurea, probenicid, celecoxib, and sulfonamide antibiotics. Following appropriate work-up, the patient is diagnosed with congestive heart failure. The physician decides to prescribe diuretic therapy to relieve the patient's symptoms. Which of the following diuretics is the optimal therapeutic option to treat this patient's congestive heart failure? +
A 38-year-old woman is brought to the emergency department with complaints of chest pain and shortness of breath at rest. She describes her pain as a crushing sensation in the middle of her chest that radiates to her left arm and is associated with nausea and cold sweats. The patient receives daily atorvastatin for hypercholesterolemia. She reports that multiple members of her family died at a young age from cardiovascular disease. On physical examination, the physician notes xanthomas on the Achilles tendon and arcus senilis corneae on the outer margin of the iris. In the ED, her temperature is 37.0 °C (98.6 °F), heart rate is 112/min, and blood pressure is 148/84 mmHg. An electrocardiogram (ECG) reveals ST-segment elevation in the anterior leads. Her lab work-up is remarkable for elevation of troponin I and low-density lipoprotein-cholesterol (LDL-C) concentration of 680 mg/dL. The physician suspects that the patient's condition may be caused by an inherited disease. Which of the following explains the pathogenesis of this patient’s inherited disease? +
A 3-month-old boy is brought by his mother to the physician's office for hypotonia. The mother was recently told that her son's disease may be caused by an enzyme deficiency. Upon further work-up, the physician explains that the deficient enzyme is normally responsible to convert pyruvate to acetyl CoA, and the patient is required to be on a ketogenic diet. Which of the following cofactors is required for the normal functioning of the enzyme deficient in this patient? +
A 43 year-old obese man presents to the physician's office with recurrent occipital headaches and blurry vision. The patient explains that he has had multiple blood pressure measurements in the past, all of which were in the hypertensive range. Upon further questioning, the patient's wife states that her husband snores very loudly and wakes up unconsciously several times during his sleep. The physician recommends the patient undergoes polysomnography to evaluate for secondary causes of hypertension. While analyzing the polysomnogram, the physician notes the beginning of a sleep stage characterized by sleep spindles and K complexes. Which of the following clinical findings is mostly associated with this stage of sleep? +
A 1-year-old boy is brought to the physician’s office because his mother thinks that “he does not look like other children”. The mother explains that she did not follow up with her obstetrician and continued all her prescribed drugs during pregnancy. Physical examination is remarkable for fingernail hypoplasia. Upon further evaluation, the physician informs the mother that her child’s abnormal appearance is most likely a result of the teratogenic effect of a drug she received during pregnancy. Which of the following diseases has this patient's mother suffered from before or during pregnancy? +
A 43-year-old man presents to the physician’s office complaining that he is unable to differentiate between sweet and sour tastes at the tip of his tongue. Upon further questioning, the patient denies dysphagia, and reports he has normal somatosensation of his tongue. The physician suspects the patient's symptoms are caused by an injury to a specific cranial nerve. Which of the following additional findings will further confirm the physician’s diagnosis? +
A 25-year-old man with a history of hypertrophic cardiomyopathy (HCM) presents to the cardiologist’s office for an annual-check up. The patient has no complaints. He receives daily verapamil for his HCM and does not report any drug-related adverse effects. Physical examination is remarkable for a murmur on cardiac auscultation. Which of the following bedside maneuvers will most likely increase the intensity of this patient’s murmur? +
A 57-year-old man is brought to the emergency department with acute-onset, severe chest pain. The patient's wife reports he had a upper respiratory infection 6 days ago. In the ED, his temperature is 37.0 °C (98.6 °F), heart rate is 112/min, and blood pressure is 80/50 mmHg. Physical examination is remarkable for jugular venous distension (JVD) and weakness of the peripheral radial pulse upon inspiration. What is the most important determinant of severity of the clinical presentation of this patient’s condition? +
A 78-year-old woman presents to the physician’s office with complaints of right-sided headache, low-grade fever, and fatigue for the past 4 days. She states that she has a history of tension-type headaches, but her current headache is not the same and has not been relieved by either NSAIDs or acetaminophen. Her past medical history is remarkable for chronic, bilateral pain and stiffness in her proximal muscles. Upon further questioning, the patient explains that she has recently been experiencing pain in her jaw every time she chews her food. Her temperature is 38.2 °C (100.8 °F), heart rate is 104/min, and blood pressure is 122/86 mmHg. Physical examination is remarkable for scalp tenderness on the right side. Work-up is remarkable for Hb= 11.2 g/dL, MCV=88 fL, WBC=10,800 cells/mm3, and erythrocyte sedimentation rate (ESR)=122 mm/hr. The administration of high-dose steroids is most essential to prevent which of the following complications? +
A 78-year-old man presents to the physician’s office with complaints of back pain and fatigue for the past few weeks. The patient explains that unlike his previous pains, his current back pain awakens him at night and is not relieved by medications. Evaluation reveals normochromic normocytic anemia, elevated concentration of serum calcium, and renal insufficiency. Peripheral smear of the patient’s blood demonstrates rouleaux formation. Which of the following markers is most frequently used for the staging of the patient's condition? +
A 63-year-old man presents to the emergency department with severe chest pain and dyspnea. Following rapid work-up, the diagnosis of myocardial infarction (MI) is made. The patient undergoes appropriate management and is then discharged home. The patient returns 5 weeks later to the emergency department with complaints of a new-onset, low-grade fever associated with persistent chest pain that radiates to the back and relieved by leaning forward. Cardiac auscultation is remarkable for friction rub. Which of the following pathological processes is responsible for this patient’s rehospitalization? +
An 72-year-old man presents to the emergency department with a fractured hip following a fall. His daughter states that the patient has fallen twice in the past 3 days. The patient then explains that prior to his symptoms, he could not sleep for the past 8 days, and his neighbor has been giving him left-over benzodiazepine (BZD) pills each day to help him sleep. The patient states that ever since he started taking the new pill, he has been sleepy and dizzy throughout the day. Which of the following BZDs has this patient been receiving? +
A 28-year-old HIV-positive woman is brought to the emergency department (ED) with an episode of tonic-clonic seizure. The patient's family reports that the patient has recently lost weight and has been having complaints of high-grade fever and headaches for the past few days. The patient has been non-compliant with her anti-retroviral therapy for the past few weeks. Laboratory work-up in the ED is remarkable for CD4 count=80 cells/µL. Head computed tomography (CT) scan demonstrates multiple ring-enhancing lesions in the frontal lobes. The patient is administered empiric pharmacotherapy and is admitted to the hospital. What is the mechanism of action of the drug administered to this patient to treat her condition? +
A researcher conducts a cross-sectional study to identify factors that are associated with hemodialysis adequacy among 90 patients undergoing hemodialysis. Following data collection, statistical analysis reveals that the urea reduction rate (URR) is associated with hemodialysis adequacy with a p-value of 0.12 (significant p-value <0.05). Which of the following modifications will most likely increase the statistical power of the study? +