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A 2-week-old child is brought to the neonatal care clinic for irritability and poor feeding. The mother also reports that she has noticed her child's eyes are unusually yellow. On physical examination, you notice that the child is poorly responsive and is markedly icteric and jaundiced. Lab tests ordered show normal liver function tests. Serum bilirubin levels is detected to be 28 mg/dL with absent conjugated bilirubin from the serum. Which of the following mechanisms is most likely responsible for this patient's presentation? +
A 27 year old female pregnant patient in her 26th week of gestation presents to the physician with complaints of difficulty in breathing, difficulty in swallowing and cough . Vitals include pulse rate 95/min, blood pressure 100/70 mm Hg and respiratory rate 22/min. On cardiac auscultation, a diastolic murmur after an opening snap is heard. Past history is significant for a fever which was treated with penicillin but she does not remember the diagnosis. She is an immigrant from India, having immigrated to the United States 5 years ago.What is the most likely diagnosis? +
A 54 year old male hypertensive patient presents to his primary care physician’s office for difficulty breathing when walking 4-5 blocks for the last 2 months. Cardiac auscultation is significant for an apical murmur throughout systole that radiates to axilla. The murmur increases in intensity on hand grip. Mitral regurgitation is diagnosed on echocardiography. Ejection fraction, left ventricular end systolic diameter are measured. Operative criteria for mitral regurgitation includes which of the following? +
A 30 year old male patient presents to his primary care physician complaining shortness of breath and fatigue for the last 3 months. Physical examination is significant for a painless ulcer on the penis and painless lymphadenopathy in the inguinal region. Cardiac auscultation reveals a decrescendo diastolic murmur heard best at the left sternal border. He is sexually active with multiple partners both male and female. What is the most likely diagnosis of his heart murmur? +
A 35 year old male presents to his primary care physician for shortness of breathe on exertion. Past medical history is significant for ankylosing spondylitis. Physical examination shows high bounding pulse and head bobbing with each pulse. Cardiac auscultation reveals a diastolic decrescendo murmur at the lower left sternal border that increase in intensity on leg raising and squatting. Echocardiography finds a regurgitant aortic valve .Operative criteria for aortic regurgitation includes: +
A 32-year-old woman presents to the emergency department for 3 hours of severe right upper quadrant abdominal pain. The patient reports that her crisis started shortly after a lunch of chicken nuggets and french fries. On physical examination, you note marked tenderness to palpation, and a sudden interruption of her breathing when the liver is palpated. Abdominal ultrasound is unremarkable. Magnetic resonance cholangiogram reveals air in the biliary tree but no evidence of stone. What would you expect the patient to complain of other than her pain? +
A new vaccine is being developed for the prevention of Hepatitis E. In a phase 2 clinical trial, 100 individuals with negative Hepatitis E IgM and IgG anti-HEV antibodies are randomized to receive either the vaccine or placebo. Out of the 50 patients that received the vaccine, 1 went on to develop Hepatitis E in the 6 month follow-up after the vaccination. In the placebo group, 7 out of 50 patients developed Hepatitis E. What is the number needed to treat for this newly developed vaccine according to the results of this trial? +
A 45 year old male comes to the emergency room with light headedness, abdominal pain and several episodes of vomiting which began after binge drinking of alcohol at a party. Vomiting was non bloody in the beginning but was associated with blood after few episodes. His vital signs include blood pressure 85/50, pulse 125/min, respiratory rate 19/min. What is the next step in management? +
A 52-year-old woman presents to the physician's office complaining of excessive fatigue and pruritis. Her past medical history is significant for hypertension well-controlled on lisinopril, dyslipidemia on simvastatin, and Hashimoto's hypothyroidism on levothyroxine replacement therapy. She is a heavy smoker but does not consume alcohol. Her blood pressure is 110/60 mm Hg, heart rate is 110/min, and temperature is 36.7 ᵒC (98 ᵒF). Physical examination is remarkable for jaundice and skin excoriations, xanthelesmas, and mild hepatomegaly. Work-up reveals elevated antimitochondrial antibodies. Which of the following pathological findings best characterizes the patient's primary condition? +
A 42-year-old Korean woman, with no significant past medical history, presents to the physician's office with complaints of excessive fatigue and weight gain. Upon further questioning, the patient reports she has recent developed constipation, hair loss, and somnolence. Physical examination is remarkable for a palpable thyroid mass. Following appropriate work-up, the patient is found to have elevated TSH, low FT4, and elevated levels of anti-thyroid peroxidase antibodies (anti-TPO). Which of the following conditions is known to be associated with the patient's disease? +
A 52-year-old obese man, with a past medical history significant for hypertension, dyslipidemia, diverticulosis, and chronic kidney disease presents to the physician's office for his annual check-up. Routine work-up shows an HbA1c of 7.5%. The physician decides he wants to start the patient on oral antidiabetic therapy given this finding. Which of the following medications must be avoided in the patient? +
A 69-year-old woman with a past medical history significant for coronary artery disease, peripheral vascular disease, heart failure, and atrial fibrillation presents to the emergency department for severe abdominal pain that started several minutes before admission. Physical examination is grossly unremarkable. The abdomen is nontender and no masses or hepatosplenomegaly could be appreciated. The patient undergoes CT angiography and the diagnosis of occlusive acute mesenteric ischemia of the superior mesenteric artery (SMA) is made. Urgent laparotomy shows significant small bowel infarcts. Which of the following organs most likely has a similar gross pathological appearance when infarcted? +
An 82-year-old man is brought to the emergency department with severe shortness of breath, sweating, and altered state of consciousness. Past medical history is significant for prior myocardial infarction with ischemic heart failure. Physical examination is remarkable for cold extremities. After initial assessment, the patient is diagnosed with cardiogenic shock. Which of the following additional findings is consistent with the patient's condition? +
A 62-year-old man, with a past medical history of myocardial infarction and heart failure, is brought to the emergency department in severe shortness of breath. He is barely able to continue his sentences and is breathing heavily even at rest. Physical examination is remarkable for tachycardia, tachypnea, diffuse fine crackles on pulmonary auscultation, and lower extremity edema. Following appropriate work-up and imaging, the diagnosis of cardiogenic pulmonary edema is made. If the patient's pulmonary fluid and serum are to be analyzed, which of the following will most likely be present? +
A 60-year-old Egyptian man presents to the physician's office complaining of painless hematuria. Following appropriate work-up, the diagnosis of squamous cell carcinoma of the bladder is made. The physician explains to the patient that his condition is associated with an infectious agent. Which of the following is most likely the primary mechanism that led to the patient's cancer? +
An 8-year-old boy recently diagnosed with asthma is brought to the emergency department (ED) for seizures, severe abdominal pain, and vomiting. Upon further questioning, his parents explain that they traveled to USA only one day prior to admission, and the boy has been prescribed an anti-asthma drug by a physician abroad. The boy's vital signs are remarkable for tachycardia and tachypnea. Work-up demonstrates major electrolyte disturbances, including hypokalemia, hypophosphatemia, hypomagnesemia, and hypocalcemia. The ED physician explains to the parents that the patient must have been receiving very high doses of his anti-asthma drug. Which of the following pharmacologic agents is recommended to reverse this patient's condition? +
A 68-year-old man with no past medical history presents to the physician's office for swelling in his tongue, palate, and the submandibular region. His symptoms started acutely earlier the same day. The patient is unable to speak properly, but can still breathe normally. Upon further questioning, he denies the use of any drugs and denies any known tumors. He explains that he has had a similar condition recently that resolved within 2 days. Which of the following lab findings is most likely present in this patient? +
A 24-year-old man, with no significant past medical history, presents to the emergency department (ED) with complaints of abdominal pain and bloody diarrhea of several days duration. The patient is found to have amoebic cysts on stool analysis. Which of the following cytokines is most likely elevated in this patient? +
The anal canal is a unique anatomic region that is characterized by blood supply and lymphatic drainage from two different origins. While the lower rectum and the upper part of the anal canal above the pectinate line share the internal iliac as the primary lymph node drainage site, which of the following structures shares the same primary lymph node drainage site as that of the lower part of the anal canal below the pectinate line? +