Property:Prompt
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A 62-year-old man is transferred by EMS for severe chest pain and dyspnea at rest for the past 30 minutes. The patient has a medical history significant for hyperlipidemia, uncontrolled diabetes mellitus, and hypertension. He smokes 2 packs of cigarettes each day for the past 40 years. Prior to arrival to the hospital, ECG in the EMS shows ST-segment-elevation more than 2 consecutive leads. The patient is diagnosed with ST-segment-elevation myocardial infarction (STEMI). Despite appropriate and timely management, the patient dies prior to hospitalization. Which of the following is this patient's most likely cause of death? +
A 62-year-old man presents to the physician’s office with complaints of abnormal vision. The patient explains that he has been seeing yellow-green halos ever since he was administered a new drug whose name he cannot recall. The patient’s past medical history is significant for latent tuberculosis, advanced cardiac disease, and erectile dysfunction. Which of the following medications most likely induced this patient’s symptoms? +
A 15-year-old girl is brought to the physician’s office with low-grade fever and rash for the past 2 days. Upon further questioning, the patient informs the physician that she went camping in southeast USA one week ago and was bitten by ticks. Prior to the onset of fever and rash, she was complaining of nausea, anorexia, and myalgias. On physical examination, the physician notes several blanching maculopapular spots of 1-5 mm on her palms and soles. The physician then prescribes a course of antibiotics to treat the patient's condition. What is the mechanism of action of the most likely prescribed antibiotic agent? +
A 32-year-old woman from southwestern USA presents to the emergency department (ED) with a 2-day history of fever and a painful swelling in her left axilla. She denies any pulmonary symptoms. In the ED, the patient is appropriately isolated and blood cultures are withdrawn. The next day, the diagnosis of plague is made. When the physician explains to the patient about her disease, he informs her that the plague is caused by an organism that cycles between flea, wild rodents, squirrels, prairie dogs, and cats. Which of the following agents is responsible for the patient's diagnosis? +
A 35-year-old woman presents to the physician's office for an episode of double vision. The patient had a similar episode 4 weeks prior to presentation that self-resolved. Physical examination and neurological exam appear to be normal, but a cranial MRI demonstrates several periventricular plaques. Which disease share the same HLA subtype association as the patient's condition? +
A 6-year-old European boy is brought to the physician's office with complaints of abdominal pain, bloating, and explosive diarrhea following milk ingestion. The patient's mother explains that he used to drink milk during infancy, and his symptoms are relatively new. Breath hydrogen levels are elevated, and jejunal biopsies demonstrate normal gastrointestinal (GI) mucosa. Which of the following most likely characterizes the type of diarrhea in this patient? +
A 5-year-old boy is brought by his mother to the physician's office because she is concerned that he is unable to ingest dairy products anymore. She explains that every time he attempts to drink milk, he experiences abdominal pain and explosive diarrhea. Following appropriate work-up, the boy is diagnosed with lactase deficiency. Which cause of diarrhea is most likely characterized by the same type of diarrhea associated with lactase deficiency? +
An 6-month-old boy is brought by his mother to the pediatrician's office for failure to thrive, persistent diarrhea, and steatorrhea. Peripheral blood smear reveals acanthocytosis with undetectable plasma cholesterol and triglyceride. Which of the following disorders is the primary defect in this patient's condition? +
A 6-year-old boy is brought to the physician's office for concerns that he has a coarse face and an abnormal appearance. The mother explains that the patient has a long history of hospitalizations for lung infections. On physical examination, the physician notes the presence of multiple abscesses, simultaneous presence of primary and secondary teeth, and a facial eczema. Which of the following findings is most consistent with the patient's presentation? +
A 12-year-old African-American boy with a history of beta-thalassemia major is brought to the physician's office for bone marrow transplantation (BMT) work-up. The patient Liver biopsy is performed to calculate Pesaro class risk for the patient prior to BMT. Which of the following findings is most likely observed on liver biopsy? +
A 3-week-old girl is brought to the physician's office for asymmetric movement of her upper extremities. The mother reports that the girl is a first-born child. The girl weighed 4600 g at birth and is a product of a difficult assisted vaginal delivery with forceps. The pregnancy was complicated by gestational diabetes for which the mother was administered insulin before meals. On physical examination, the girl now has an adducted, medially rotated, and pronated left arm with flexion of the wrist and fingers, while the right arm is normal. Damage to which of the following nerves most likely caused this patient’s condition? +
A 67-year-old woman presents to the emergency department for unremitting high-grade fever and left leg pain. The patient explains that she had a left total knee replacement 5 months ago. The patient is admitted and blood cultures are withdrawn. The next day, blood cultures grow a non-motile organism. Which of the following pathogens is most likely responsible for the patient's condition? +
A 74-year-old European man presents to the physician's office for bone pain and hearing loss. Following appropriate work-up, the physician explains to the patient that his condition is caused by bone remodeling due to a simultaneous increase in osteoclastic and osteoblastic activities. Which of the following is most likely associated with the patient's condition? +
A 50-year-old woman presents to her dermatologist with complaints of multiple skin lesions. Physical examination is remarkable for flaccid skin blisters. The upper epidermal layer is easily removed with manual stroking or gentle pressure. Immunofluorescence demonstrates antibodies surrounding the cells in a net-like pattern. Which of the following processes best characterizes the patient's disease? +
A 24-year-old man is admitted to the hospital for auditory hallucinations and delusions. His older brother reports that the patient is diagnosed with treatment-resistant schizophrenia and has been administered several medications for the past 4 years without improvement. The physician then decides to start the patient on clozapine therapy. Which of the following lab tests should be routinely performed to monitor for clozapine-induced adverse events? +
A 72-year-old diabetic woman presents to the dermatology clinic with complaints of a nail lesion. Following history-taking and physical examination, the patient is diagnosed with onychomycosis. She is then prescribed an oral antimicrobial medication and is instructed to follow-up routinely. One month later, the patient reports she is experiencing an unusual taste disturbance; and she is found to have markedly elevated liver function tests. Which of the following best describes the mechanism of action of the prescribed antimicrobial agent? +
A 5-month-old boy is brought to the physician's office for recurrent infections. Following appropriate work-up, the patient is diagnosed with an inherited X-linked disease that results in a defective interleukin (IL)-2 receptor and is referred to bone marrow transplantation (BMT). Which of the following findings on physical examination is most likely associated with the patient's condition? +
A 66 year-old woman was admitted following an acute ST segment elevation myocardial infarction. She subsequently had percutaneous coronary intervention done where a thrombus was found causing an 80% occlusion of the proximal one-third of the left anterior descending artery (LAD). The interventional cardiologist was very happy to have achieved a 100% reperfusion in the epicardial artery (TIMI grade 0), but the patient continued to experience a sharp chest pain and the ST-segment elevation on the EKG failed to resolve in the absence of a mechanical occlusion. It was later postulated that the symptoms failed to resolve due to non-perfusion of the myocardium.
Which of the following best describes the pathophysiology of the most likely cause of the patient’s persistent chest pain? +
In a quest to find the ultimate low density liproprotein cholesterol (LDL-C) lowering drug for the treatment of heterozygous familial hypercholesterolemia, researchers have discovered an endogenous substance, Proprotein convertase subtilisin/kexin type 9 (PCSK9), which acts by binding to the epidermal growth factor-like repeat A (EGF-A) domain of the low-density lipoprotein receptor (LDLR). It was also postulated that developing monoclonal antibodies against this compound will have a tremendous effect in lowering the level of LDL-cholesterol in this group of patients.
Which of the following mechanisms of action best describes this experimental drug? +
A 48-year-old woman is admitted to the hospital for breast augmentation surgery. She is in good health and has never been admitted to the hospital or had previous operations. Her only medication is an oral contraceptive pill. Shortly after the administration of general anesthesia she develops muscular rigidity, temperature increases to 41°C, pulse increases to 140/min and blood pressure decreases from 130/70 mm Hg to 80/50 mm Hg. Laboratory investigation revealed:
Na+ 145 mmol/L
K+ - 6.2
PO2 - 60 mm Hg
PCO2 - 40 mm Hg
pH - 7.13
Total CO2 - 17 mm Hg
O2 saturation - 88%
Which of the following medication is contraindicated in the acute management of this condition? +