Property:Prompt
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A 65-year-old man presents to his primary care physician for blood in his stools. He reports no pain with passing stool, but he states he has lost 10 pounds over the past 2 months. Physical exam and diagnostic sigmoidoscopy reveal a single mass in the distal anal canal. The mass is biopsied and shows tumor invasion of the basement membrane. Which of the following sites would be the most likely next site of spread of the tumor? +
A 70-year-old man presents to his primary care physician for a bulge in his right groin that becomes more prominent when coughing and standing up. Ultrasound of the region reveals a hernia that protrudes medial to the inferior epigastric vessels and lateral to the rectus abdominus. The inferior border of this hernia is bounded by a tissue formed from the aponeurosis of which of the following? +
A 33-year-old woman presents to the emergency department for a very painful headache for the past 5 hours. She recalls that prior to the onset of the headache, she experienced a bilateral loss of peripheral visual fields. She describes the pain as throbbing and localized to the frontotemporal areas. She also explains that she has to keep her eyes covered because the light worsens her pain. What is the mechanism of action of the most appropriate pharmacotherapy for this patient? +
A 72-year-old man with end-stage chronic lymphocytic leukemia is administered an investigational treatment with tumor-targeting T-cells. Approximately two weeks after receiving the injection, the patient develops a fever of 40 °C (104 °F) with chills and generalized erythema. Laboratory studies reveal a thousand-fold increase in IL-6 along with the results shown below. Which of the following is the most appropriate pharmacotherapy in this patient?<br>
'''Sodium''': 140 mEq/L <br>
'''Potassium''': 5.5 mm/L<br>
'''Phosphate''': 5.0 mg/dL<br>
'''Calcium''': 8.0 mg/dL<br>
'''Uric acid''': 16.0 mg/dL (Normal 2.0 - 8.0)<br>
'''Lactic Acid''': 5.0 mEq/L (Normal 0.7 - 2.1)<br> +
A sexually active 22-year-old woman presents to her primary care physician with complaints of burning sensation on urination for the past 2 days. Urine culture demonstrates colonies of catalase-positive, coagulase-negative, gram-positive cocci with novobiocin resistance. Which of the following pathogen's is most likely responsible for this patient's condition? +
A 36-year-old man presents to his primary care physician for anxiety, palpitations, and insomnia over the past week. The patient also reports dysphagia and unintentional weight loss. Physical examination is remarkable for a heart rate of 110/min and a tender neck mass. Radionuclide thyroid scan is abnormal and reveals a deceased uptake. Which of the following is the most appropriate therapy to manage this patient's condition? +
A 62-year-old woman undergoes total body irradiation followed by autologous bone marrow transplant for Chronic Lymphocytic Leukemia (CLL). Approximately one month following her transplant, she develops bloody stools, diarrhea, fever, abdominal pain, and dysphagia. Colonoscopy reveals several ulcers, and pp65 antigen assay is positive. Which of the following treatments is most appropriate to treat this patient's condition? +
A 22-year-old woman is brought to the emergency department (ED) after several members of her family witnessed her suffering a seizure. On the way to the hospital, she admitted to swallowing 50 aspirin pills in a suicide attempt. She is unconscious but responds to painful stimuli. In the ED, results from arterial blood gas on room air demonstrate the following: pH=7.32, pCO2=18 mmHg, pO2=111 mmHg, Bicarbonate=15 mEq/L. Blood samples are withdrawn, and electrolytes are as follows: Sodium=140 mEq/L, Chloride=100 mEq/L. Which of the following would have a similar effect on the oxygen-hemoglobin dissociation curve as this patient’s condition? +
A 25 year old male, comes to the office with complaints of severe fatigue and lethargy for the past 1 year. On further review of history, he says he has intermittent mild abdominal pain over the past few months. Of late he is having difficulty in writing his thesis and really worried about not finishing his project on time. He says he does not talk with friends anymore and spends most of his time at home. His past history is otherwise insignificant and his family history is unremarkable. He does not smoke and drink. His vitals are temperature: 36.7 C, blood pressure: 130/70 mmHg, pulse: 72/min and respirations: 16/min. Abdominal examination reveals mild abdominal pain on the right upper quadrant and mild hepatomegaly. Cardiovascular and respiratory system examinations are normal. Neurological examinations shows mild rigidity in the upper limbs. His eyes shows a brownish discoloration of iris and skin are normal. You admit the patient and send blood sample for CBC, peripheral smear, LFT’s and electrolytes. What is the most likely peripheral smear picture you see in this patient? +
A 21 year old male, comes to the office with complaints of severe fatigue and lethargy over the past 1 year. On further review of history, he says he has intermittent mild abdominal pain over the past few months. Of late he is feeling low and does not talk with friends anymore, spending most of his time at home. His past history is otherwise insignificant and his family history is unremarkable. He does not smoke and drink. His vitals are temperature: 36.7 C, blood pressure: 130/70 mmHg, pulse: 72/min and respiration's: 16/min. Abdominal examination reveals mild abdominal pain on the right upper quadrant and mild hepatomegaly. Cardiovascular and respiratory system examinations are normal. Neurological examinations shows mild rigidity in the upper limbs and there is gray green ring around his iris. After confirming with appropriate blood tests, you start the patient on medications. The patient on follow-up in a month says he is experiencing hand tremors on doing work, which he dint have earlier. What is the most appropriate treatment for this patient at this point? +
A 43 year old male, comes to the office with complaints of severe fatigue and lethargy over the past 1 month. On further review of history, he says he had intermittent fatigue, lethargy, nausea, abdominal pain and joint pains for several years to which he never consulted a doctor. He also says he has loss of libido and erectile dysfunction for the past few years. His family history is unremarkable. He does not smoke and drink. His temperature is 36.7 C, blood pressure is 130/70 mmHg, pulse is 72/min and respiration's are 16/min. Abdominal examination reveals profound hepatomegaly. His skin has golden blue hue. The patient is admitted and treated suppourtively. His serum biochemistry results shows Na:135 mEq/L, K: 3.5 mEq/L, Cl:104mEq/L, Bi: 24 mEq/L, BUN: 30 mg/dl, glucose:226 mg/dl, Mg:1mg/dl and Ca: 8mg/dl. His tranferrin saturation is 72%, serum ferritn is 500 ng/ml and serum iron levels are 300 µg/dl. Liver function tests are bilirubin: 1.5 mg/dl, AST : 100 IU/L , ALT : 122 IU/L, serum albumin 3.5 g/dl and prothrombin time : 11 sec. What is the best appropriate treatment for this patient? +
A 26 year old female presents to the office with a 6 month history of fatigue. On further review of history, she says she has been experiencing occasional palpitations for the past 1 year for which she never consulted a doctor. Her menstrual cycles are regular and she is sexually active. Her past history is otherwise insignificant and her family history is unremarkable. She does not smoke and drink. Her vitals are temperature: 36.7 C, blood pressure: 120/80 mmHg, pulse: 102/min and respiration's: 16/min. All system examinations are normal except pallor. Her laboratory values are :
Hb : 7 g/dl
RBC’s : 2 million/cmm
WBC’s : 6000/cmm
Segmented neutrophils : 60 %
Bands : 2 %
Eosinophils : 2 %
Lymphocytes : 32 %
Monocytes : 6 %
MCHC : 34 %
MCV : 85 fl
Her peripheral smear is shown below : +
A 65 year old female comes to the office with complaints of back pain and fatigue. On further review of history, she says she had a hip fracture 6 months back and unable to do day to day activities. She denies any weakness of her extremities. She attained menopause at the age of 48 and not on any estrogen pills. Her past history is otherwise insignificant and her family history is unremarkable. Her vitals are temperature: 36.7 C, blood pressure: 140/80 mmHg, pulse: 80/min and respiration's: 15/min. All system examinations are normal except pallor. Her laboratory values are :
Hb : 10 g/dl
RBC’s : 2.5 million/cmm
WBC’s : 6000/cmm
Neutrophils : 60 %
Eosinophils : 2 %
Lymphocytes : 32 %
Monocytes : 6 %
MCHC : 34 %
MCV : 85 fl
ESR : 15mm/hr
Serum creatinine : 2.3 mg/dl
Serum calcium : 11.7 g/dl
Bone marrow biopsy done reveals 20% plasma cells. What is the most appropriate investigation to find potential skeletal lesions in this patient? +
A 50 year old woman comes to the emergency department with complaints of shortness of breath and chest pain. She has these symptoms for the past one day. On further review of history she reveals a recent history of travel outside the United States 3 days back. Her past history is otherwise insignificant and her family history is unremarkable. She has smoked one pack of cigarette for the past 10 years. She attained menopause at the age of 48 and not on any medications. Her vitals are temperature: 36.7 C, blood pressure: 140/80 mmHg, pulse: 80/min and respiration: 15/min. The patients pulse oximetry shows 95 % on 4-litres of oxygen. All system examinations are normal. V/Q scan shows high probablity for pulmonary embolism. Her laboratory values comes as :
Hb : 13 g/dl
Hct : 38%
RBC’s : 2.5 million/cmm
WBC’s : 6000/cmm
Platelet’s : 300,000/cmm
PT : 13 sec (N 11-15 sec)
INR : 1.03
You start the patient on unfractionated heparin and warfarin. Her symptoms resolve the next day and a repeat CBC on the second day reveals a platelet count of 160,000/cumm. What is the most likely cause of her thrombocytopenia? +
A 62 year old woman comes to the emergency department with complaints of shortness of breath and chest pain. She was in her usual state this morning but suddenly developed these symptoms. Her past history is otherwise insignificant and her family history is unremarkable. She is a chronic smoker and smoked two packs of cigarette for the past 25 years. She occasionally consumes alcohol. She attained menopause at the age of 50 and not on any medications. Her vitals are temperature: 36.7 C, blood pressure: 140/80 mmHg, pulse: 80/min and respiration: 15/min. The patients pulse oximetry shows 92 % on 4-litres of oxygen. All system examinations are normal. V/Q scan of the chest shows high probablity for pulmonary embolism. Her intial laboratory values are :
Hb : 11 g/dl
Hct : 37%
RBC’s : 3 million/cmm
WBC’s : 8000/cmm
Platelet’s : 300,000/cmm
PT : 13 sec (N 11-15 sec)
APTT : 30 sec (N 25-40 sec)
BT : 7 min (N 2-7 min)
INR : 1.06
You start the patient on unfractionated heparin and warfarin. Her symptoms gradually resolve over the next five days. On the 7th day, she complaints of pain and pallor in the right arm. Examination of the right extremity reveals pale, tender arm with diminished peripheral pulses. A repeat CBC reveals
Hb : 12 g/dl
Hct : 37.5%
RBC’s : 2.8 million/cmm
WBC’s : 10000/cmm
Platelet’s : 60,000/cmm
PT : 19 sec (N 11-15 sec)
APTT : 60 sec (N 25-40 sec)
BT : 11 min (N 2-7 min)
INR : 2
What is the most likely cause of her symptoms ? +
A 54 year old woman comes to the emergency department with complaints of shortness of breath. She was in her usual state this morning but suddenly developed these symptoms. Her past history is otherwise insignificant and her family history is unremarkable. She is a chronic smoker and smoked two packs of cigarette for the past 25 years. She attained menopause at the age of 50 and is taking estrogen supplements. Her vitals are temperature: 36.7 C, blood pressure: 130/80 mmHg, pulse: 90/min and respiration: 15/min. The patients pulse oximetry shows 92 % on 4-litres of oxygen. All system examinations are normal. V/Q scan of the chest shows high probablity for pulmonary embolism. Her initial laboratory values are :
Hb : 11 g/dl
Hct : 37%
RBC’s : 3 million/cmm
WBC’s : 8000/cmm
Platelet’s : 300,000/cmm
PT : 13 sec (N 11-15 sec)
INR : 1.06
You start the patient on unfractionated heparin and warfarin. Her symptoms gradually resolve over the next three days. A repeat CBC on the 5th day reveals a platelet count of 60,000/cumm. Which of the following is the most appropriate step in the management of this patient? +
A 50 year old woman comes to the emergency department with complaints of shortness of breath and chest pain. She has these symptoms for the past one day. On further review of history she reveals a recent history of travel outside the United States 3 days back. Her past history is otherwise insignificant and her family history is unremarkable. She has smoked one pack of cigarette for the past 10 years. She attained menopause at the age of 48 and not on any medications. Her vitals are temperature: 36.7 C, blood pressure: 140/80 mmHg, pulse: 80/min and respiration: 15/min. The patients pulse oximetry shows 95 % on 4-litres of oxygen. All system examinations are normal. V/Q scan shows high probability for pulmonary embolism. Her laboratory values comes as :
Hb : 13 g/dl
Hct : 38%
RBC’s : 2.5 million/cmm
WBC’s : 6000/cmm
Platelet’s : 300,000/cmm
PT : 13 sec (N 11-15 sec)
INR : 1.03
You start the patient on unfractionated heparin and warfarin. Her symptoms resolve the next day and a repeat CBC on the second day reveals
Hb : 12 g/dl
Hct : 37.5%
RBC’s : 2.8 million/cmm
WBC’s : 8000/cmm
Platelet’s : 190,000/cmm
PT : 19 sec (N 11-15 sec)
APTT : 60 sec (N 25-40 sec)
BT : 11 min (N 2-7 min)
INR : 2
What is the best next step in the management of this patient ? +
A 65 year old female comes to the emergency department with sudden onset on confusion, blurry vision and mucosal bleeding by her family members. She was in her usual state this morning but suddenly developed these symptoms. On further review of history, her family members say that she had a hip fracture 6 months back and unable to do day to day activities. She attained menopause at the age of 48 and not on any estrogen pills. Her past history is otherwise insignificant and her family history is unremarkable. Her vitals are temperature: 36.7 C, blood pressure: 140/80 mmHg, pulse: 80/min and respiration: 15/min. All system examinations are normal. The patient is treated symptomatically with I.V fluids and her laboratory values comes as :
Blood glucose : 112 g/dl
Hb : 10 g/dl
RBC’s : 2.5 million/cmm
WBC’s : 6000/cmm
Neutrophils : 60 %
Eosinophils : 2 %
Lymphocytes : 32 %
Monocytes : 6 %
MCHC : 34 %
MCV : 85 fl
ESR : 15mm/hr
Serum creatinine : 2.3 mg/dl
Serum calcium : 11.7 g/dl
Bone marrow biopsy done to evaluate her anemia reveals 20% plasma cells. What is the most likely cause of the patient’s condition ? +
A 44 year old female comes to the emergency department with an episode of bloody vomiting. She was in her usual state this morning but suddenly developed these symptoms. On further review of history, she says she had intermittent passage of black stools over the past 2 weeks. She is a known hypertensive for past 10 years and on thiazide medications. Her past history is otherwise insignificant and her family history is unremarkable. Her menstrual cycles are normal. She sexually active with her husband and does not use contraceptives. Her vitals are temperature: 36.7 C, blood pressure: 140/80 mmHg, pulse: 80/min and respiration: 15/min. Skin is normal and all system examinations are normal. The patient is treated symptomatically and her laboratory values are as follows :
Hb : 10 g/dl
RBC’s : 2.5 million/cmm
WBC’s : 6000/cmm
Platelets : 300,000/cmm
Neutrophils : 60 %
Eosinophils : 2 %
Lymphocytes : 32 %
Monocytes : 6 %
MCHC : 34 %
MCV : 85 fl
ESR : 15mm/hr
PT : 13 sec (N 11-15 sec)
APTT : 30 sec (N 25-40 sec)
BT : 18 min (N 2-7 min)
Serum creatinine : 3 mg/dl
Serum calcium : 9 g/dl
Whats is the most likely cause of her symptoms ? +
A 30 year old female comes to the emergency department with an episode of bloody vomiting. She was in her usual state this morning but suddenly developed these symptoms. She had similar episodes thrice over the past one year, but never consulted a doctor. She is a known hypertensive on regular medications. Her past history is otherwise insignificant and her family history is positive for similar episodes in her brother. Her menstrual cycles are normal. She sexually active and uses contraceptives. Her vitals are temperature: 36.7 C, blood pressure: 140/80 mmHg, pulse: 80/min and respiration: 15/min. All system examinations are normal. The patient is treated symptomatically and you plan to do a upper GI endoscopy. Her laboratory values are as follows :
Hb : 13 g/dl
RBC’s : 2.5 million/cmm
WBC’s : 6000/cmm
Platelets : 250,000/cmm
Neutrophils : 60 %
Lymphocytes : 32 %
MCV : 85 fl
ESR : 15mm/hr
PT : 13 sec (N 11-15 sec)
APTT : 45 sec (N 25-40 sec)
BT : 18 min (N 2-7 min)
Serum creatinine : 1.2 mg/dl
Serum calcium : 9 g/dl
Which of the following is the best next step in the management of the patient? +