Property:Prompt
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A 42 year old male, comes to the office for routine physical examination. He has mild constipation for the past 2months and feels pain during his act of defecation. His past history is insignificant and his family history is unremarkable. He smokes a pack of cigarettes a day, but denies any illicit drug use. Recently he says his work is very stressful and started consuming alcohol daily. He is really concerned about his alcohol habit as one of his friends died of liver disease and he wants you to check for any initiation of liver damage in him. Which of the following would be the best initial test to assess alcoholic liver damage in this patient? +
A 34 year old Caucasian female, comes to the office with complaints of fatigue, lethargy, malaise, anorexia, nausea and abdominal pain for the past few weeks. She has been having fever on and off and an increase in the frequency of stools of 4-5 times a day over the past month with a single episode of blood in stools. Her past history is insignificant and her family history is unremarkable. She has no recent travel exposure outside the country. She denies smoking and drugs, but consumes alcohol occasionally. Her menstrual cycles are normal. Her temperature is 36.7 C, blood pressure is 130/70 mmHg, pulse is 102/min and respirations are 16/min. The physical examination is normal except for mild abdominal pain on the right upper quadrant and epigastric area. Serum biochemistry results shows Na:135 mEq/L, K: 3 mEq/L, Cl:104mEq/L, Bi: 24 mEq/L, BUN: 30 mg/dl, glucose:226 mg/dl, Mg:1mg/dl and Ca: 8mg/dl. The liver fuction test results are as follows:
Alanine aminotransferase : 110 U/L
Aspartate aminotransferase : 100 U/L
Alkaline phosphatase : 130 U/L
Total bilirubin : 1.3 mg/dl
Direct bilirubin : 1.3 mg/dl
Hepatits A IgM : negative
HbsAg : negative
HBc Antibody : negative
HCV Antibody : negative
What is the most likely diagnosis in this patient ? +
A 32 year old female, comes to your office for routine physical examination. Her past history is insignificant and his family history is unremarkable. She occasionally smokes cigarettes, but denies alcohol consumption or any illicit drug use. She is sexually active and is on oral contraceptive pills. Her general physical examination is normal. You run a battery of blood tests on her blood and the results are as follows.
Haemoglobin : 12.2 g/dl
Alanine aminotransferase : 45 U/L
Aspartate aminotransferase : 40 U/L
Alkaline phosphatase : 100 U/L
Total bilirubin : 0.8 mg/dl
Direct bilirubin : 0.4 mg/dl
Prothrombin time : 10 sec
Anti-HAV : negative
HbsAg : negative
Anti HBsAg : negative
HCV RNA : positive
Urine analysis shows bacteria, RBC’s, RBC cast without WBC’s. Liver biopsy done after these tests shows mild degree of hepatic inflammation. What is the best line of management at this time for the patient ? +
A 40 year old female, comes to the office with complaints of fatigue, lethargy, malaise and pruritus for the past few weeks. Her past history is insignificant and her family history is unremarkable. She has no recent travel exposure outside the country. She denies smoking, alcohol and drugs. Her menstrual cycles are irregular with increased duration of cycles. Her temperature is 36.7 C, blood pressure is 130/70 mmHg, pulse is 102/min and respirations are 16/min. On examination there is no jaundice, but xanthelasmas and excoriations from scratches are present on skin examination. Abdomen is soft and non-tender with no organomegaly. Other system examinations are normal . Her lab results shows Hb:7 g/dl, hematocrit : 33, Na:135 mEq/L, K: 3 mEq/L, Cl:104mEq/L, Bi: 24 mEq/L, BUN: 30 mg/dl, glucose:176 mg/dl, Mg:1mg/dl and Ca: 8mg/dl. The liver fuction test results are as follows:
Alanine aminotransferase : 100 U/L
Aspartate aminotransferase : 90 U/L
Alkaline phosphatase : 600 U/L
Total bilirubin : 1 mg/dl
Direct bilirubin : 0.6 mg/dl
Hepatits A IgM : negative
HbsAg : negative
HBc Antibody : negative
HCV Antibody : negative
This patient is at the risk of developing which of the following ? +
A 40 year old male, comes to the office with complaints of fatigue and malaise for the past few weeks. He is a known case of chronic hepatitis C who underwent allograft liver transplantation 6 months ago. He is currently on immunosuppressive agents with cyclosporine and tacrolimus. He denies any other complaints. He denies smoking and consuming alcohol. On examination his temperature is 37.7 C, blood pressure is 130/70 mmHg, pulse is 102/min and respiration's are 16/min. Abdomen is soft and non-tender with no organomegaly. Other system examinations are normal . His lab results are Hb:7 g/dl, hematocrit : 33, Na:135 mEq/L, K: 3.5 mEq/L, Cl:104mEq/L, Bi: 24 mEq/L, BUN: 30 mg/dl, glucose:98 mg/dl, Mg: 1mg/dl and Ca: 8mg/dl. The liver fuction test results are as follows:
Alanine aminotransferase : 200 U/L
Aspartate aminotransferase : 290 U/L
Alkaline phosphatase : 120 U/L
Total bilirubin : 1 mg/dl
Serum albumin : 3.6 g/dl
Prothrombin time : 12 sec
A liver biopsy is done and it reveals portal tract inflammation with piecemeal necrosis and scatterred lobular inflammation. What is the most likely diagnosis in this patient? +
64 year old Caucasian male, is brought to the emergency department by his family members because of an episode of bloody vomiting. He also complaints of fatigue, lethargy, malaise, anorexia, nausea and abdominal pain for the past few weeks. He is a chronic alcoholic for the past 25 years. He smokes 2 packs of cigarettes a day, but denies any illicit drug use. His past history is insignificant and his family history is unremarkable. His vitals are stable and there is no active bleeding. The physical examination shows spider angiomata, peripheral edema and mild heptomegaly. Other system examinations are normal. His serum biochemistry results are Na:135 mEq/L, K: 3 mEq/L, Cl:104mEq/L, Bi: 24 mEq/L, BUN: 30 mg/dl, glucose:126 mg/dl, Mg:1mg/dl and Ca: 8mg/dl. The liver fuction test results are as follows:
Alanine aminotransferase : 70 U/L
Aspartate aminotransferase : 50 U/L
Alkaline phosphatase : 130 U/L
Total bilirubin : 3.2 mg/dl
Prothrombin time : 16 sec
Serum albumin : 2.8 g/dl
Hepatits A IgM : negative
HbsAg : negative
HBc Antibody : negative
HCV Antibody : negative
An USG abdomen reveals mild ascitis and his liver biopsy reveals micronodular cirrhosis. Which of the following is the most appropraite treatment option? +
A study addresses the secondary prevention of acute coronary syndrome (ACS) using a novel cholesterol-lowering agent. After 5 years, follow-up of 4400 ACS patients reveals recurrence of at least 1 ACS event among 200 out of 2000 subjects who were administered the novel agent vs. 540 out of 2400 subjects who were administered standard therapy. Through 5 years, how many patients should be administered the novel agent to prevent at least 1 ACS event? +
A 58-year-old man presents to the outpatient clinic with compaints of episodic diarrhea, cutaneous flushing, and dyspnea. Cardiac auscultation is remarkable for a holosystolic, high-pitched blowing murmur heard best at the apex and radiates to the axillary region. Pulmonary auscultation is remarkable for diffuse, bilateral wheezing. Work-up reveals high concentration of urinary 5-hydroxyindoleacetic acid. Which of the following characterizes the appearance of the patient's disease under electron microscopy? +
A 2-year-old boy is brought by his mother to the emergency department (ED) for altered mental status. Upon further questioning, the mother reports that the child has been suffering from low grade fever and has had a diffuse skin rash for the past few days. She also explains that she has been giving him aspirin to relieve his symptoms. Rapid assessment in the ED is performed, and blood work-up demonstrates marked hyperammonemia, hypoglycemia, and lactic acidemia. Computed tomography (CT) scan of the brain shows diffuse edema. Which of the following molecular dysfunctions is most likely associated with this patient's condition? +
A 59-year-old woman, receiving chronic prednisone therapy for giant cell arteritis, is referred to an infectious disease specialist for 3 weeks of fatigue, sore throat, and generalized lymphadenopathy with recent onset blindness in her left eye. The patient is diagnosed with a protozoal illness and the physician decides to initiate therapy. He explains to the patient that the drug he intends to use works by a similar mechanism to a chemotherapeutic agent that causes bone marrow suppression. He reassures the patient that much like the chemotherapeutic agent, if this medication were to affect her, addition of folinic acid to her treatment would correct the bone marrow effects. Which of the following drugs is the physician prescribing to this patient? +
A 57 year old man with history of poorly controlled diabetes and hypertension presents to the emergency department for 2 days of high grade fever and chills. On admission, his heart rate is 122 bpm and blood pressure 100/78. He is admitted to the intensive care unit and stabilized with empiric antibiotic therapy initiated. Two days later, blood cultures drawn grow resistant gram negative rods. You decide to switch the patient to amikacin but consider the need for dual coverage. Which of the following add-on antibiotics would you try to avoid in this patient considering the organism is sensitive to all? +
A 68-year-old woman with history of chronic obstructive pulmonary disease (COPD) presents for 2 days of purulent productive cough with fever and chills noted in the last 3 hours. You obtain a chest x-ray that confirms your suspicion of pneumonia and admit the patient for intravenous antibiotics. Despite empiric therapy, the patient continues to worsen over the next few days. Sputum cultures obtained on admission grow gram-positive cocci in clusters that show resistance to oxacillin. Which of the following antibiotics is contraindicated in this patient? +
A new antibiotic agent is being studied for the treatment of multi-drug resistant gram-positive infection. The pharmaceutical company responsible for creating this drug explains that its mechanism of action involves 2 separate molecules that act synergistically at the same pathway. Which of the following combinations has a similar mechanism of action? +
A researcher is examining 2 plates of humanized epithelial cell cultures that his lab mate had prepared in an experiment. One of the cell cultures, labeled Plate A, received 2 hours of exposure to 250 Jm2 of ultraviolet B (UVB), while the other, Plate B, was kept in a dark incubator. While examining Plate A under the microscope, the researcher notices marked atypia at all levels of the epidermis with formation of keratin pearls and prominent intercellular bridges. If the researcher is to examine the retinoblastoma protein extracted from cells in Plate A, what will his observation be? +
A 48-year-old diabetic patient presents to the wound care clinic for a new 4 cm right foot ulcer he recently discovered while showering. The patient has a history of poorly controlled diabetes and 2 previous ulcers on his left foot one of which led to a toe amputation. While examining the patient, you note a large ulcer, approximately 1 cm deep, with a bright red base and a clean border. You also notice a smaller 2 cm ulcer that is almost completely healed. Compared to the larger ulcer which of the following is more abundant in the smaller ulcer? +
A 7-month-old boy is brought to the emergency room for bloody stools. The mother explains that she has been noticing blood tinged stools for the past week; but today, she noted frank blood in the diapers. On admission, the child appears well, his pulse is 123/min and his temperature is 36.8 ᵒC (98.2 ᵒF). Physical examination reveals multiple petechiae in the oral cavity. Skin inspection shows purpura most prominent on the legs and patchy eczema affecting the limbs, face, and trunk. Upon further questioning, the mother reports that the child has a history of multiple hospital admissions for recurrent respiratory tract infections. Which of the following best describes the pathophysiology of the disorder most likely present in this patient? +
A pharmaceutical company is manufacturing a novel antibiotic to overcome increasing resistance to macrolides. Its rationale is to create an agent that would be co-administered with azithromycin to counteract the mechanism by which bacteria become resistant to this antibiotic. Which of the following agents would be appropriate to investigate for this purpose? +
A 68-year-old woman with past history of Parkinson's disease presents to the emergency department for 12 hours of high grade fever and several episodes of chills. On admission the patient's pulse is 121/min, her blood pressure is 98/66 mm Hg, and temperature is 39.5 ᵒC (103 ᵒF). You draw 2 sets of blood cultures and initiate broad spectrum coverage with vancomycin and piperacillin/tazobactam. Two days later, the patient does not seem be improving and blood culture results reveal gram negative rods resistant to piperacillin/tazobactam. You decide to switch the patient to another antibiotic that covers gram-negative rods. After less than 24 hours on the new medication, the patient experiences a tonic-clonic seizure lasting 4 minutes and requiring sedation. What is the mechanism of action of the drug used in this patient? +
A 4-year-old girl presents to the emergency room for 2 episodes of blood in the stools. History is initially inconclusive, but further questioning reveals that the child was recently diagnosed with a rare disorder that causes her to have hyperelastic skin and hyperextensible joints. Considering this patient has a mutation in type 1 collagen, what co-factor is essential in the defective enzyme in this patient? +
A 34-year-old healthy man presents to the primary care clinic for a general check-up. The man has no complaints except minor fatigue during the day, but he relates this to his stressful life style. Physical exam is unremarkable except for mild scleral icterus. The primary care physician decides to order some tests to rule out any serious illness. Lab results return with a normal CBC, reticulocyte count, and blood smear. Transaminases, alkaline phosphatase, and GGT are also all within normal range. Indirect bilirubin is noted to be 2.6 mg/dL with direct bilirubin below the upper limit of normal. The patient remembers that he was noted to have an elevated indirect bilirubin several years earlier but his work-up back then also came back normal. Which of the following pathological mechanisms is involved in this patient's condition? +