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The dataset generation failed because of a cast error
Error code: DatasetGenerationCastError
Exception: DatasetGenerationCastError
Message: An error occurred while generating the dataset
All the data files must have the same columns, but at some point there are 1 missing columns ({'id'})
This happened while the json dataset builder was generating data using
hf://datasets/OpenDFM/SciEval/scieval-test-local.json (at revision 370117e4ee95dd8553f6a053ee00a4932429fe5f)
Please either edit the data files to have matching columns, or separate them into different configurations (see docs at https://hf.co/docs/hub/datasets-manual-configuration#multiple-configurations)
Traceback: Traceback (most recent call last):
File "/src/services/worker/.venv/lib/python3.9/site-packages/datasets/builder.py", line 2011, in _prepare_split_single
writer.write_table(table)
File "/src/services/worker/.venv/lib/python3.9/site-packages/datasets/arrow_writer.py", line 585, in write_table
pa_table = table_cast(pa_table, self._schema)
File "/src/services/worker/.venv/lib/python3.9/site-packages/datasets/table.py", line 2302, in table_cast
return cast_table_to_schema(table, schema)
File "/src/services/worker/.venv/lib/python3.9/site-packages/datasets/table.py", line 2256, in cast_table_to_schema
raise CastError(
datasets.table.CastError: Couldn't cast
category: string
cot_prompt: string
answer: list<item: string>
child 0, item: string
type: string
task_name: string
prompt: string
topic: string
question: string
ability: string
to
{'id': Value(dtype='string', id=None), 'category': Value(dtype='string', id=None), 'cot_prompt': Value(dtype='string', id=None), 'answer': Sequence(feature=Value(dtype='string', id=None), length=-1, id=None), 'type': Value(dtype='string', id=None), 'task_name': Value(dtype='string', id=None), 'prompt': Value(dtype='string', id=None), 'topic': Value(dtype='string', id=None), 'question': Value(dtype='string', id=None), 'ability': Value(dtype='string', id=None)}
because column names don't match
During handling of the above exception, another exception occurred:
Traceback (most recent call last):
File "/src/services/worker/src/worker/job_runners/config/parquet_and_info.py", line 1534, in compute_config_parquet_and_info_response
parquet_operations = convert_to_parquet(builder)
File "/src/services/worker/src/worker/job_runners/config/parquet_and_info.py", line 1155, in convert_to_parquet
builder.download_and_prepare(
File "/src/services/worker/.venv/lib/python3.9/site-packages/datasets/builder.py", line 1027, in download_and_prepare
self._download_and_prepare(
File "/src/services/worker/.venv/lib/python3.9/site-packages/datasets/builder.py", line 1122, in _download_and_prepare
self._prepare_split(split_generator, **prepare_split_kwargs)
File "/src/services/worker/.venv/lib/python3.9/site-packages/datasets/builder.py", line 1882, in _prepare_split
for job_id, done, content in self._prepare_split_single(
File "/src/services/worker/.venv/lib/python3.9/site-packages/datasets/builder.py", line 2013, in _prepare_split_single
raise DatasetGenerationCastError.from_cast_error(
datasets.exceptions.DatasetGenerationCastError: An error occurred while generating the dataset
All the data files must have the same columns, but at some point there are 1 missing columns ({'id'})
This happened while the json dataset builder was generating data using
hf://datasets/OpenDFM/SciEval/scieval-test-local.json (at revision 370117e4ee95dd8553f6a053ee00a4932429fe5f)
Please either edit the data files to have matching columns, or separate them into different configurations (see docs at https://hf.co/docs/hub/datasets-manual-configuration#multiple-configurations)Need help to make the dataset viewer work? Make sure to review how to configure the dataset viewer, and open a discussion for direct support.
question
string | category
string | type
string | task_name
string | ability
string | answer
sequence | prompt
string | id
string | cot_prompt
string | topic
null |
|---|---|---|---|---|---|---|---|---|---|
A 66-year-old man presents to the emergency department with abdominal pain, nausea, and vomiting. He endorses diffuse abdominal tenderness. His past medical history is notable for diabetic nephropathy, hypertension, dyslipidemia, depression, and morbid obesity. He also is currently being treated for an outbreak of genital herpes. His temperature is 99.0°F (37.2°C), blood pressure is 184/102 mmHg, pulse is 89/min, respirations are 18/min, and oxygen saturation is 98% on room air. Physical exam is notable for an obese man in no acute distress. A CT scan of the abdomen with contrast is performed and is unremarkable. The patient is admitted to the observation unit for monitoring of his pain. Notably, the patient's abdominal pain improves after an enema and multiple bowel movements. The patient's evening laboratory values are ordered and return as seen below.
Serum:
Na+: 141 mEq/L
Cl-: 99 mEq/L
K+: 4.8 mEq/L
HCO3-: 11 mEq/L
BUN: 20 mg/dL
Glucose: 177 mg/dL
Creatinine: 3.1 mg/dL
Which of the following is the most likely etiology of this patient's laboratory derangements?
A. Acyclovir
B. Atorvastatin
C. Metformin
D. Metoprolol
Answer: | biology | multiple-choice | MedQA | Knowledge Application | [
"C"
] | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". Please directly give the answer without any explanation. | 5534a4ef45aea8a6f1835750a54c01d0 | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". | null |
A 57-year-old man presents to the emergency department with confusion. His symptoms started a few days ago and have been gradually worsening. Initially, the patient had a fever and a cough which has progressed to abdominal pain, diarrhea, and confusion. His temperature is 102°F (38.9°C), blood pressure is 127/68 mmHg, pulse is 120/min, respirations are 17/min, and oxygen saturation is 94% on room air. Physical exam is notable for localized crackles and decreased breath sounds in the left lower lung field. The patient is confused and is answering questions inappropriately. Laboratory studies are ordered as seen below.
Hemoglobin: 12 g/dL
Hematocrit: 36%
Leukocyte count: 16,500/mm^3 with normal differential
Platelet count: 190,000/mm^3
Serum:
Na+: 130 mEq/L
Cl-: 100 mEq/L
K+: 4.3 mEq/L
HCO3-: 25 mEq/L
BUN: 20 mg/dL
Glucose: 99 mg/dL
Creatinine: 1.1 mg/dL
Ca2+: 10.2 mg/dL
Which of the following is the best diagnostic test to guide current therapy in this patient?
A. Chest radiography
B. Lung biopsy
C. Sputum culture
D. Urine antigen test
Answer: | biology | multiple-choice | MedQA | Knowledge Application | [
"D"
] | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". Please directly give the answer without any explanation. | dd8e589541d73a377bba717866c90663 | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". | null |
A 25-year-old man with a past medical history of constipation and fibromyalgia presents to the emergency department with generalized malaise and severe diarrhea. The patient states that he has not felt well for the past 24 hours and his symptoms are no longer tolerable. He denies taking any medications or illicit drugs and states he is generally healthy. His temperature is 99.3°F (37.4°C), blood pressure is 122/88 mmHg, pulse is 107/min, respirations are 19/min, and oxygen saturation is 99% on room air. Physical exam demonstrates an ill appearing young man. Physical exam is notable for rhinorrhea, lacrimation, and piloerection. The patient’s pupils are dilated and reactive to light. During placement of an ultrasound guided IV, multiple scars are noted in the antecubital fossa, and it is noted that it is very difficult to place an IV in this patient. During the exam, he begins actively vomiting. Which of the following could be an appropriate treatment for this patient’s symptoms?
A. Clonidine
B. Diazepam taper
C. Haloperidol and diphenhydramine
D. Oseltamivir
Answer: | biology | multiple-choice | MedQA | Knowledge Application | [
"A"
] | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". Please directly give the answer without any explanation. | 8311008699dd8a8270d6c2460eb273e2 | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". | null |
A pediatrician notices that 9 of her patients this year have developed paralysis after a flu-like illness. They range in age from 7 to 11, and most of them had no abnormal activities prior to developing the paralysis. These patients concern her because she has not seen this type of paralytic illness in over 20 years of practice. Based on this experience, she decides to write up the initial presentation and clinical course of these patients and publish them in a journal. Which of the following is most likely true about this study?
A. Different interventions with 2 or more variables can be studied
B. Hypothesis testing cannot be performed
C. It should be reported in terms of odds ratio
D. Participants act as their own controls
Answer: | biology | multiple-choice | MedQA | Knowledge Application | [
"B"
] | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". Please directly give the answer without any explanation. | e1afaa0a2270861b458abb792c3c3376 | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". | null |
A 21-year-old woman presents to the emergency room with right arm pain and limited range of motion. She does not recall trauma to the arm. She also complains of diarrhea and nausea. She is sexually active with one male partner and admits to having pain during intercourse. There is vague and diffuse tenderness to palpation in all four abdominal quadrants. No erythema or edema is noted on the right arm. The fecal occult test is negative. Past records show that this patient has been in the ER 7 times in the past year with similar symptoms. Which of the following is the most likely diagnosis?
A. Ulcerative colitis
B. Illness anxiety disorder
C. Somatization disorder
D. Somatoform pain disorder
Answer: | biology | multiple-choice | MedQA | Knowledge Application | [
"C"
] | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". Please directly give the answer without any explanation. | 35f91cbd3199a7e354006753ab457188 | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". | null |
A 25-year-old, G2P2L2 woman presents with a complaint of missed menstrual cycle for 4 weeks. Her previous menstrual cycles were regular, occurring every 28–35 days consistently. The patient does not have any other complaints currently. Her past medical history reveals two uncomplicated and normal vaginal deliveries at term. She has a 2-year-old boy and a 6-month-old girl. The patient and her partner use the withdrawal method for contraception. The urine pregnancy test result is positive. The patient returns to the clinic after 1 week expressing her desire to discontinue with the pregnancy and inquires about the possibility of an elective abortion. Which of the following procedures is the most appropriate for elective termination of pregnancy in this patient?
A. Dilatation and evacuation (D&E)
B. Oxytocin-induced labor
C. Manual uterine aspiration
D. Oral mifepristone + misoprostol
Answer: | biology | multiple-choice | MedQA | Knowledge Application | [
"D"
] | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". Please directly give the answer without any explanation. | 16ed5ae47712d1e0d5d11757ec2ef887 | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". | null |
A 21-year-old man comes to the emergency room with swelling and severe pain in his left lower leg that started 2 hours ago. He has no history of serious illness or trauma. His father has a history of pulmonary embolism. He has smoked one pack of cigarettes daily since he started college 3 years ago. He appears very distressed. He is 173 cm (5 ft 8 in) tall and weighs 92 kg (203 lb); BMI is 30.7 kg/m2. His temperature is 37°C (98.6°F), pulse is 94/min, respirations are 17/min, and blood pressure is 130/78 mm Hg. Physical examination shows a tender and mildly swollen left lower leg; dorsiflexion of the left foot causes severe pain in the calf. Laboratory studies show a platelet count of 184,000/mm3, a prothrombin time of 11 seconds, an activated partial thromboplastin time of 26 seconds, and positive fibrin split products. Ultrasonography of the left leg shows incompressibility of the popliteal vein with a hyperechoic mass and absent blood flow. The patient is administered a 5000 IU intravenous bolus of unfractionated heparin followed by a constant infusion. Six hours later, the activated partial thromboplastin time is 30 seconds. Which of the following is the most likely cause of this patient's symptoms?
A. Antithrombin III deficiency
B. Factor V Leiden
C. Protein C deficiency
D. Antiphospholipid syndrome
Answer: | biology | multiple-choice | MedQA | Knowledge Application | [
"A"
] | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". Please directly give the answer without any explanation. | 4e831a37450073ddc265d60ed49138b0 | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". | null |
A 5-year-old boy of African descent is presented to the emergency department by his parents. The child is clutching his abdomen and crying about pain in his belly. His mother reports intermittent episodes of jaundice with joint and bone pain since he was 5 months old. At presentation, the patient’s vital signs are within normal limits. Physical examination reveals slight jaundice and pale conjunctiva. The spleen is tender and easily palpable. After a complete blood count with differential and an abdominal ultrasound, the patient is found to have sickle-cell disease with splenic infarct. A partial splenectomy is performed. After the operation, the physician provides vaccines against Neisseria meningitidis, Haemophilus influenzae, and Streptococcus pneumoniae. The picture shows a slide obtained from the resected portion of the patient’s spleen. Dysfunction of the zone marked with which number predisposes the patient to the aforementioned infections?
A. 2 only
B. 1 only
C. 1 and 2
D. 1, 2, and 3
Answer: | biology | multiple-choice | MedQA | Knowledge Application | [
"C"
] | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". Please directly give the answer without any explanation. | 345ee843207e4040424f34ded5da2219 | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". | null |
A previously healthy 52-year-old woman is brought to the emergency department after sustaining burns over 45% of her body in a house fire. On arrival, she is in acute distress but is fully oriented. Aggressive intravenous fluid resuscitation is begun and the patient is transferred to the intensive care unit of a burn center. 20 hours later, she has several large, tarry black stools and develops hypotension and tachycardia. Despite appropriate lifesaving measures, she dies. Which of the following is the most likely underlying cause of the patient's tarry black stools?
A. Decreased prostaglandin synthesis
B. Erosion of tortuous submucosal arteriole
C. Bacterial colonization of the gastric antrum
D. Decreased gastric blood flow
Answer: | biology | multiple-choice | MedQA | Knowledge Application | [
"D"
] | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". Please directly give the answer without any explanation. | 138ae0431f9b20faf417b53867c55bb1 | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". | null |
A 48-year-old man is brought to the emergency department for sudden onset of difficulty breathing 6 hours ago. For the past several months, he has had shortness of breath on exertion and while lying down on the bed, frequent headaches, and swelling of his feet. He does not take any medications despite being diagnosed with hypertension 10 years ago. His pulse is 90/min, respirations are 20/min, blood pressure is 150/110 mm Hg, and temperature is 37.0°C (98.6°F). Physical examination shows an overweight male in acute distress with audible wheezes. Crackles are heard bilaterally and are loudest at the lung bases. Which of the following findings on cardiac auscultation will most likely be present in this patient?
A. Loud P2
B. S3 gallop
C. Absent S4
D. A loud S1
Answer: | biology | multiple-choice | MedQA | Knowledge Application | [
"B"
] | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". Please directly give the answer without any explanation. | 1143a6253c2fc906549b1d8160f040b1 | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". | null |
A 60-year-old man is referred to a dermatologist by his family physician for management of a rare case of dermatitis that has not responded to standard therapy with corticosteroids. The patient’s medical history is unremarkable, and he is currently working reduced hours at his job as an accountant. Physical examination reveals confluent scaly patches, plaques, and generalized erythroderma along the torso and lower extremities (see image). There is also a solid skin lesion with a diameter greater than 1 cm. The dermatologist suspects a malignancy and orders a biopsy. Which of the following is the most accurate description of this condition?
A. Vascular tumor containing spindle cells
B. Tumor arising from the folliculosebaceous–apocrine germ
C. Tumor arising from cutaneous T cells
D. Tumor arising from epidermal keratinocytes
Answer: | biology | multiple-choice | MedQA | Knowledge Application | [
"C"
] | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". Please directly give the answer without any explanation. | 700717b9a8a5295e03e4d86d9f48a4bc | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". | null |
A 70-year-old man is brought to the emergency department by his wife for incomprehensible speech. Upon first inspection you note the man is drooling and his eyes are tearing excessively. The patient's wife explains that the man was tilling the fields on the family beet farm when she found him collapsed on a pile of freshly picked beets. The patient seemed confused so the wife brought him in promptly, and states it has only been ten minutes since the patient was found down in the fields. Physical exam is deferred due to a confused and combative patient who is speaking clearly yet his sentences do not make any sense. The patients clothes are removed in the ED. Vital signs are currently being obtained. Which of the following is the best initial step in management?
A. Neostigmine
B. Physostigmine
C. 2-pralidoxime
D. Intubation
Answer: | biology | multiple-choice | MedQA | Knowledge Application | [
"C"
] | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". Please directly give the answer without any explanation. | 6e0a1f6f7ddbf888d13e4919c9ccbed4 | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". | null |
A 24-year-old woman comes to the physician’s office with concerns about a recent pregnancy. She and her boyfriend had intercourse for the first time a few weeks ago. Two weeks ago she missed her menstrual period. She took several over the counter pregnancy tests that confirmed her pregnancy. She is tearful about the pregnancy and is very concerned. After extensive conversations with her physician and counseling, she decides she wants to medically abort her 6-week pregnancy. Which of the following drugs should be administered to this patient for this purpose?
A. Tamoxifen
B. Terbutaline
C. Mifepristone
D. Copper intrauterine device
Answer: | biology | multiple-choice | MedQA | Knowledge Application | [
"C"
] | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". Please directly give the answer without any explanation. | dee8bc477274dcb0f594a5db3c5c51df | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". | null |
A 55-year-old woman with no significant past medical history presents to her primary care doctor with fever, fatigue, and bleeding gums for the past 3 days. She denies any sick contacts. Her temperature is 101°F (38.3°C), blood pressure is 110/70 mmHg, pulse is 96/min, and respirations are 15/min. Physical exam reveals several oral mucosal petechiae, bleeding gums, bilateral submandibular lymphadenopathy, and hepatosplenomegaly. Initial laboratory workup shows the following:
Leukocyte count and differential:
Leukocyte count: 6,600/mm^3
Segmented neutrophils: 60%
Bands: 20%
Eosinophils: 9%
Basophils: 1%
Lymphocytes: 0%
Monocytes: 10%
Platelet count: 99,000/mm^3
Hemoglobin: 8.1 g/dL
Hematocrit: 25%
Prothrombin time: 25 sec
Partial thromboplastin time: 50 sec
International normalized ratio: 1.6
D-dimer: 2,000 µg/mL
Fibrinogen: 99 mg/dL
A bone marrow biopsy demonstrates 34% myeloblasts with Auer rods that are myeloperoxidase positive. What is best treatment option?
A. Ascorbic acid
B. Fresh frozen plasma
C. Retinoic acid
D. Zoledronic acid
Answer: | biology | multiple-choice | MedQA | Knowledge Application | [
"C"
] | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". Please directly give the answer without any explanation. | 086c56e18c1e9bd5df1f2d8effa7bcef | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". | null |
A 31-year-old man comes to the physician because of a 4-week history of a painless lump near the left wrist and tingling pain over his left hand. Physical examination shows a transilluminating, rubbery, fixed, non-tender mass over the lateral volar aspect of the left wrist. There is decreased sensation to pinprick on the thumb, index finger, middle finger, and radial half of the ring finger of the left hand. The tingling pain is aggravated by tapping over the swelling. Which of the following adjacent structures is at risk of entrapment if this mass persists?
A. Ulnar artery
B. Flexor pollicis longus tendon
C. Flexor carpi radialis tendon
D. Ulnar nerve
Answer: | biology | multiple-choice | MedQA | Knowledge Application | [
"B"
] | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". Please directly give the answer without any explanation. | ef351055885bce2a20c0e11a85f0c661 | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". | null |
A 55-year-old woman is found to have an abnormal mass on routine mammography. The mass is biopsied and cytology results are diagnostic for invasive ductal adenocarcinoma that is estrogen receptor positive. The patient is started on chemotherapy and ultimately has the mass resected. She is taking tamoxifen and has regular outpatient follow up appointments to monitor for any recurrence of cancer. The patient has a past medical history of asthma, obesity, and a uterine leimyoma which was definitively treated last year. Her last menstrual period was at the age of 47. The patient's vital signs and exam are unremarkable. Which of the following is a potential complication that could occur in this patient?
A. Deep venous thrombosis
B. Eruption of seborrheic keratoses
C. Increased bleeding
D. Osteoporosis
Answer: | biology | multiple-choice | MedQA | Knowledge Application | [
"A"
] | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". Please directly give the answer without any explanation. | 3d9d9068768e592e9502ea98a787a4b4 | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". | null |
A 27-year-old man presents to the emergency room complaining of left shoulder pain for several weeks. He says that the pain often worsens when he tries to sleep on his left side. Although he tried several pain medications, none of the pain medications helped. He is an amateur tennis player who practices on weekends. He denies any trauma during his practice sessions. On examination of the shoulder joint, severe tenderness was present localized to the greater tuberosity of the left shoulder joint along with biceps tendon tenderness over the bicipital groove. The range of motion was limited to the left side. An X-ray of the joint showed narrowing of the acromiohumeral space with sclerosis and spurring of the acromion. Routine blood test results are normal except for the rheumatoid factor, which is positive. What is the most likely diagnosis?
A. Trauma
B. Rheumatoid arthritis
C. Osteoarthritis
D. Rotator cuff injury
Answer: | biology | multiple-choice | MedQA | Knowledge Application | [
"D"
] | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". Please directly give the answer without any explanation. | 098b2954d6334504614205262bc17823 | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". | null |
A 47-year-old man presents with hemoptysis, diffuse muscle pain, and shortness of breath. He has had these symptoms before but did not seek treatment. His past medical history is not known as he is not typically followed by a doctor and is homeless. His temperature is 99.0°F (37.2°C), blood pressure is 154/94 mmHg, pulse is 89/min, respirations are 22/min, and oxygen saturation is 90% on room air. Physical examination is notable for crackles noted in the bases of the lungs bilaterally. Labs values are ordered as seen below.
Serum:
Na+: 140 mEq/L
Cl-: 103 mEq/L
K+: 5.8 mEq/L
HCO3-: 21 mEq/L
BUN: 33 mg/dL
Glucose: 129 mg/dL
Creatinine: 2.6 mg/dL
Urine:
Color: Amber
Protein: Positive
Blood: Positive
Which of the following is the most appropriate treatment for this patient?
A. Methylprednisolone
B. Methylprednisolone and cyclophosphamide
C. Methylprednisolone, plasmapheresis, and cyclophosphamide
D. Plasmapheresis and cyclophosphamide
Answer: | biology | multiple-choice | MedQA | Knowledge Application | [
"C"
] | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". Please directly give the answer without any explanation. | 8c88bad4d64fbc8b7a5bf38a9aca140f | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". | null |
A four-day-old neonate is brought to the pediatrician with vaginal discharge for the last two days. Her mother is concerned about the blood-tinged discharge but states that her daughter has been feeding and voiding well. The neonate was delivered at 39 weeks gestation by an uncomplicated vaginal delivery, and she and her mother were discharged home after two days. The prenatal course was complicated by chlamydia in the mother during the first trimester, for which she and the partner were both treated with a negative test of cure. The neonate’s biological father is no longer involved the patient's care, but her mother’s boyfriend has been caring for the baby whenever the mother rests. At this visit, the neonate’s temperature is 98.5°F (36.9°C), pulse is 138/min, and respirations are 51/min. She appears comfortable, and cardiopulmonary and abdominal exams are unremarkable. There are no bruises or marks on her skin. Examination of the genitals reveals no vulvar irritation or skin changes, but there is scant pink mucoid discharge at the introitus. Which of the following is the best next step in management?
A. Vaginal exam under anesthesia
B. Vaginal culture
C. Warm water irrigation of the vagina
D. Reassurance
Answer: | biology | multiple-choice | MedQA | Knowledge Application | [
"D"
] | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". Please directly give the answer without any explanation. | a328b0671f1b365015eb8d5eea2c4273 | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". | null |
A 19-year-old man is brought to the emergency department because of severe right shoulder pain and inability to move the shoulder after a fall while climbing outdoors. Examination shows the right upper extremity is externally rotated and slightly abducted. There is loss of the the normal rounded appearance of the shoulder. The right humeral head is palpated below the coracoid process. Sensation to pinprick over which of the following skin areas is most likely to be reduced?
A. Medial aspect of the upper arm
B. Lateral aspect of the shoulder
C. Skin above the clavicle
D. Dorsal aspect of forearm and hand
Answer: | biology | multiple-choice | MedQA | Knowledge Application | [
"B"
] | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". Please directly give the answer without any explanation. | c14887100b5e31b7c87307e689959878 | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". | null |
A 45-year-old homeless man comes to the emergency department because of progressive neck pain for 3 days. He also reports headaches and numbness in both hands. Over the past 4 months, he has had intermittent lower back pain after waking up. The back pain improves with movement. He also has recurrent episodes of gout in the metatarsophalangeal joint of his right big toe. He has smoked one pack of cigarettes daily for 20 years and drinks four beers daily. The patient is a known user of intravenous heroin. He appears acutely ill. His temperature is 39°C (102.2°F), pulse is 110/min, and blood pressure is 140/85 mm Hg. There are several track marks on both forearms. Examination of the neck shows warmth, erythema, and limited range of motion. Gentle palpation over the midcervical spinal processes causes severe pain. Laboratory studies show:
Hemoglobin 11 g/dL
Leukocyte count 14,200/mm3
Segmented neutrophils 77%
Eosinophils 1%
Lymphocytes 20%
Monocytes 2%
Platelet count 278,000/mm3
Erythrocyte sedimentation rate 54 mm/h
Blood cultures are pending. An x-ray of the cervical spine shows no abnormalities. An MRI of the spine shows signs of inflammation. A bone biopsy confirms the diagnosis. Which of the following is the most appropriate next step in management?"
A. Lumbar puncture
B. Intravenous ciprofloxacin and vancomycin therapy
C. Oral indomethacin therapy
D. Bone scintigraphy
"
Answer: | biology | multiple-choice | MedQA | Knowledge Application | [
"B"
] | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". Please directly give the answer without any explanation. | 11610ed3747036994ac8a14247d93100 | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". | null |
A 27-year-old woman comes to the physician because of increasing shortness of breath and a non-productive cough for 2 months. She has been unable to perform her daily activities. She has had malaise and bilateral ankle pain during this period. She noticed her symptoms after returning from a vacation to Arizona. She is a research assistant at the university geology laboratory. She is originally from Nigeria and visits her family there twice a year; her last trip was 3 months ago. Her temperature is 37.8°C (100°F), pulse is 100/min, respirations are 24/min, and blood pressure is 112/72 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 94%. There is no palpable cervical or axillary lymphadenopathy. The lungs are clear to auscultation. Her left eye is notable for ciliary injection and photophobia. The remainder of the examination shows no abnormalities. A complete blood count is within the reference range. An x-ray of the chest is shown. Which of the following is the most likely diagnosis?
A. Sarcoidosis
B. Pulmonary tuberculosis
C. Hodgkin's lymphoma
D. Histoplasmosis
Answer: | biology | multiple-choice | MedQA | Knowledge Application | [
"A"
] | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". Please directly give the answer without any explanation. | 0d3ed15cb15917af2dd03cab01daa202 | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". | null |
A 3-year-old boy is brought to the emergency room by his mother after she found him somnolent at home next to multiple open pill bottles. The boy had seemingly opened several different pill bottles that were in a cabinet in his parent’s bathroom. The mother has brought the empty bottles to the emergency room, and they include aspirin, metoprolol, acetaminophen, levothyroxine, and lorazepam. The boy has no past medical history and takes no medications. His temperature is 98.6°F (37°C), blood pressure is 110/65 mmHg, pulse is 85/min, and respirations are 28/min. On exam, the boy is lethargic but responsive. He appears to be grasping at his ears and swaying from side-to-side when attempting to ambulate. He vomited once in the emergency room. Which of the following arterial blood gas readings is most likely to be found in this patient?
A. pH 7.29, PCO2 47 mmHg, and HCO3- 22 mEq/L
B. pH 7.35, PCO2 29 mmHg, and HCO3- 15 mEq/L
C. pH 7.36, PCO2 22 mmHg, and HCO3- 16 mEq/L
D. pH 7.47, PCO2 41 mmHg, and HCO3- 29 mEq/L
Answer: | biology | multiple-choice | MedQA | Knowledge Application | [
"C"
] | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". Please directly give the answer without any explanation. | 84efee95593c6c6c746fdd0c5eca1f60 | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". | null |
A 23-year-old college student presents to the clinic with a history of intermittent chest discomfort. He reports that, about once per month for the past 8 or 9 months, he's had episodes of "feeling like my chest is going to explode." During these episodes, he also feels shortness of breath, feels shakiness throughout his arms and legs, and sweats so heavily that he needs to change his shirt. He is unsure of any clear precipitating factors but thinks they may occur more often around important exams or when big school projects are due. He shares that, as these episodes continue to recur, he has had mounting anxiety about having one when he is in class or at a restaurant. As a result, he is leaving the house less and less. He has no past medical history; the physical exam is unremarkable. Which of the following is the best medication for the long-term management of this patient's condition?
A. Citalopram
B. Lithium
C. Propranolol
D. Quetiapine
Answer: | biology | multiple-choice | MedQA | Knowledge Application | [
"A"
] | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". Please directly give the answer without any explanation. | 31c80ddaa7f4842809003a76b7a7ec5d | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". | null |
A 72-year-old man in a nursing home was brought to the emergency department with right hand and leg weakness for 1 hour. There has been a gradual increase in the degree of weakness. The patient is disoriented. The medical history includes ischemic heart disease diagnosed 2 months ago, and long histories of diabetes and hypertension (30 and 25 years, respectively). On examination, the reflexes are hypertonic and the Babinski reflex is positive. The CT scan is shown. What is the most likely pathologic change?
A. Gangrenous necrosis
B. Liquefactive necrosis
C. Caseous necrosis
D. Fibrinoid necrosis
Answer: | biology | multiple-choice | MedQA | Knowledge Application | [
"B"
] | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". Please directly give the answer without any explanation. | f9c2d83f4f38e76a1de2f2bed02434bd | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". | null |
A 16-year-old boy is rushed to the emergency room with acute vomiting and abdominal pain that began earlier today. His parents say that the boy was doing well until two days ago when he told them that he was feeling unwell. He has diabetes and takes insulin but stopped taking it when he began to feel poorly two days ago. His temperature is 37°C (98.6°F), respirations are shallow and rapid with a rate of 33/min, pulse is 107/min, and blood pressure is 101/68 mm Hg. He appears severely dehydrated, showing signs of fatigue, and poor skin turgor. His breath has a fruity smell to it. His blood glucose level is 691 mg/dL. Blood is drawn for labs and the results are given below:
Serum:
pH: 7.21
pCO2: 32 mm HG
HCO 3-: 15.2 mEq/L
Sodium: 122 mEq/L
Potassium: 5.8 mEq/L
Urinalysis is positive for ketone bodies. What is the most appropriate immediate step in the management of this patient?
A. Administer IV fluids and insulin
B. Administer IV antibiotics
C. Administer IV fluids with oral antidiabetic medications
D. Administer potassium and magnesium
Answer: | biology | multiple-choice | MedQA | Knowledge Application | [
"A"
] | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". Please directly give the answer without any explanation. | 0a455c72412bb71099fa02c411fbf449 | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". | null |
A 45-year-old woman presents to the physician with a history of headache, palpitations, and episodic diaphoresis. She was diagnosed with hypertension in the past and is now regularly taking antihypertensive medication (amlodipine 10 mg once daily). She has had a diffuse thyroid swelling for the past 4 months. She complains of pain in the long bones of her arms and legs for the past 3 months. She is slightly built, appears thin, and is anxious and apprehensive. Her skin is moist and warm. Her weight is 45 kg (99.2 lb) and height is 146 cm (4 ft 7 in); BMI is 21.12 kg/m2. Her pulse is 116/min, the blood pressure is 196/102 mm Hg, the respiratory rate is 29/min, and the temperature is 37.2°C (99.0°F). Diffuse and firm thyromegaly is present. Her upper extremities exhibit fine tremors during an anxiety attack. The laboratory test results reveal elevated 24-hour urinary VMA and metanephrines. Serum epinephrine, calcitonin, and parathormone levels are also elevated. Hypercalcemia and hyperglycemia are also noted. Which of the following is the most likely diagnosis?
A. Von Hippel-Lindau syndrome
B. Multiple endocrine neoplasia (MEN) 2A
C. Multiple endocrine neoplasia (MEN) 2B
D. Neurofibromatosis
Answer: | biology | multiple-choice | MedQA | Knowledge Application | [
"B"
] | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". Please directly give the answer without any explanation. | 47112a9482adc897c56b21385f711ae4 | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". | null |
A 27-year-old woman was referred to a dermatology clinic due to a changing discoloration of her fingers from white to red to blue. Although she has not had any recent changes in her daily routines, she also complains of increasing fatigue, muscle weakness, and weight loss. She has a blood pressure of 126/77 mm Hg, respiratory rate of 14/min, and heart rate of 88/min. Physical examination reveals regular heart and lung sounds. Anti-U1 RNP antibodies and increased creatinine kinase were found in her serum. What is the most likely diagnosis in this patient?
A. Mixed connective tissue disease
B. Polymyositis
C. Systemic sclerosis
D. Rheumatoid arthritis
Answer: | biology | multiple-choice | MedQA | Knowledge Application | [
"A"
] | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". Please directly give the answer without any explanation. | f2f38f2056eca1cccaac3acb00bf3f8b | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". | null |
A 70-year-old man presents to the Emergency Department after 3 days of shortness of breath, orthopnea, and lower limb edema. His personal history is significant for a myocardial infarction 6 years ago that required revascularization and hypertension. His medication consists of simvastatin and lisinopril. In the ED, he has a blood pressure of 100/80 mm Hg, a pulse of 88/min, a respiratory rate of 28/min, and a temperature of 36.5°C (97.7°F). On physical examination, he has jugular vein distention, displaced point of maximal impulse (PMI), an S4-gallop, a holosystolic murmur, and 2+ pitting edema up to the mid calf. He is started on furosemide, carvedilol, and oxygen therapy. After 6-hours of continued therapy, his blood pressure remains low, and his serum creatinine is found to be 1.9 mg/dL. Which of the following test would be more useful to differentiate between prerenal and intrinsic kidney disease?
A. Sulfosalicylic acid test
B. Urine sodium content
C. Fractional excretion of urea (FEUrea)
D. Nitrates in urine
Answer: | biology | multiple-choice | MedQA | Knowledge Application | [
"C"
] | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". Please directly give the answer without any explanation. | b4ed2271a45dafb1d4612b6a4841c387 | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". | null |
An 11-year-old boy presents to your office with pitting edema and proteinuria exceeding 3.5g in 24 hours. You suspect that this patient has experienced a loss of polyanions in his glomerular basement membranes. Which of the following findings would confirm your diagnosis?
A. WBC casts in the urine
B. Selective albuminuria
C. Negatively birefringent crystals in the urine
D. Bence-Jones proteinuria
Answer: | biology | multiple-choice | MedQA | Knowledge Application | [
"B"
] | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". Please directly give the answer without any explanation. | 1ab6001b60e6941ccf4c6b9b430b8e95 | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". | null |
A 40-year-old woman presents to her family physician with a 3-week history of swollen neck. The small, round, and painless swelling, which was detected 3 weeks ago in the middle of her neck, has now increased in size. The swelling is associated with sweaty palms and soles, insomnia, irritability, nervousness, and fatigue; however, the patient does not complain of fever, cervical lymphadenopathy, weight loss, vision problems, or body swelling. The patient’s medical history is negative for similar symptoms or a thyroid disorder. The vital signs are within normal limits. Local examination reveals a 3 x 3 cm round, non-tender, non-fluctuant, and non-pulsatile swelling in the anterior triangle of her neck. The patient carries a total white blood cell count of 10,200/mm3, including 70% neutrophils, 30% lymphocytes, and zero eosinophils.The erythrocyte sedimentation rate is 20 mm/hr (normal, 0–29 mm/hr). What is the most likely diagnosis?
A. Graves' disease
B. De Quervain’s thyroiditis
C. Silent thyroiditis
D. Hashimoto’s thyroiditis
Answer: | biology | multiple-choice | MedQA | Knowledge Application | [
"C"
] | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". Please directly give the answer without any explanation. | f81be3a479133d5db9ccbda9a9df83c9 | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". | null |
A 3-month-old girl is brought to a pediatrician by her parents. She has central cyanosis without signs of respiratory distress or signs of heart failure. An echocardiogram reveals severe pulmonary outflow obstruction, right ventricular hypertrophy, a ventricular septal defect, and an overriding of the aorta. An elective primary surgical repair is planned at 4 months of age. Which of the following statements is true about this girl’s condition?
A. The tricuspid valve is the most common valve affected by bacterial endocarditis in uncorrected tetralogy of Fallot.
B. Normal hemoglobin in patients with tetralogy of Fallot does not rule out iron deficiency anemia.
C. Cerebral arterial thrombosis is more common than cerebral venous thrombosis.
D. Refractory heart failure is a common complication of tetralogy of Fallot.
Answer: | biology | multiple-choice | MedQA | Knowledge Application | [
"B"
] | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". Please directly give the answer without any explanation. | 0c185944046f8ea7f674a4fb9320bd87 | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". | null |
A 19-year-old man is brought to the physician by his mother because she is worried about his strange behavior. Over the past 3 years, he has been dressing all in black and wears a long black coat, even in the summer. The mother reports that her son has always had difficulties fitting in. He does not have any friends and spends most of his time in his room playing online games. He is anxious at college because he is uncomfortable around other people, and his academic performance is poor. Rather than doing his coursework, he spends most of his time reading up on paranormal phenomena, especially demons. He says that he has never seen any demons, but sometimes there are signs of their presence. For example, a breeze in an enclosed room is likely the “breath of a demon”. Mental status examination shows laborious speech. The patient avoids eye contact. Which of the following is the most likely diagnosis?
A. Social anxiety disorder
B. Avoidant personality disorder
C. Schizotypal personality disorder
D. Schizophrenia
Answer: | biology | multiple-choice | MedQA | Knowledge Application | [
"C"
] | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". Please directly give the answer without any explanation. | ee7ec15d42ef69b05cf7645651e4b297 | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". | null |
A 41-year-old man comes to the emergency department with nausea, abdominal discomfort, and diarrhea for the past 2 days. His abdominal discomfort is worse shortly after meals. He has also had progressive perioral numbness and upper-extremity muscle cramping for the past 24 hours. Six months ago, he underwent a Roux-en-Y gastric bypass to treat obesity. He underwent a total thyroidectomy to treat a Hurthle cell lesion 4 days ago. His mother died of lung cancer at age 68. He has smoked 1 pack of cigarettes daily for 22 years. His only current medication is a multivitamin supplement. He appears fatigued. His temperature is 36°C (96.8°F), pulse is 72/min, respirations are 20/min, and blood pressure is 130/70 mm Hg. While measuring the patient's blood pressure, the nurse observes spasm of the patient's hand. Physical examination shows a well-healing surgical wound on the neck. The abdomen is mildly tender to palpation with well-healed laparoscopic incisional sites. The remainder of the examination shows no abnormalities. Serum studies show:
Na+ 138 mEq/L
K+ 4.2 mEq/L
Cl- 102 mEq/L
HCO3- 25 mEq/L
Mg2+ 1.7 mEq/L
Phosphorus 4.3 mg/dL
25-hydroxyvitamin D 20 ng/mL (N: 20-100 ng/mL)
Parathyroid hormone 115 pg/mL
Total bilirubin, serum 0.7 mg/dL
Alanine aminotransferase, serum 14 U/L
Aspartate aminotransferase, serum 15 U/L
Alkaline phosphatase, serum 42 U/L
Which of the following is the most appropriate initial step in the management of this patient?"
A. Obtain abdominal CT
B. Begin rehydration therapy
C. Administer calcium gluconate
D. Supplementation with vitamin D
Answer: | biology | multiple-choice | MedQA | Knowledge Application | [
"C"
] | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". Please directly give the answer without any explanation. | ec65abb5d0e23296ae67ece155522d6b | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". | null |
A 43-year-old woman presents with complaints of retrosternal burning associated with eating. It has persisted for the past several years but has been getting worse. Her past medical history is unknown and this is her first time seeing a doctor. She states she is otherwise healthy and review of systems is notable for episodic hand pain that is worse in the winter as well as a chronic and severe cough with dyspnea which she attributes to her smoking. Her temperature is 97.7°F (36.5°C), blood pressure is 174/104 mmHg, pulse is 80/min, respirations are 22/min, and oxygen saturation is 92% on room air. Physical exam is notable for a young appearing woman with coarse breath sounds. Laboratory studies and urinalysis are ordered and currently pending. Which of the following is the pathophysiology of this patient's chief complaint?
A. Decreased lower esophageal tone
B. Esophageal fibrosis
C. Increased lower esophageal tone
D. Spastic cricopharyngeal muscle
Answer: | biology | multiple-choice | MedQA | Knowledge Application | [
"B"
] | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". Please directly give the answer without any explanation. | d7466a4845af99389a74cf17cdb308bc | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". | null |
A 75-year-old man presents to the emergency department with a racing heart and lightheadedness for 3 hours. He has had similar episodes in the past, but the symptoms never lasted this long. He denies chest pain, shortness of breath, headaches, and fevers. He had a myocardial infarction 4 years ago and currently takes captopril, metoprolol, and atorvastatin. His pulse is irregular and cardiac auscultation reveals an irregular heart rhythm. Laboratory reports show:
Serum glucose 88 mg/dL
Sodium 142 mEq/L
Potassium 3.9 mEq/L
Chloride 101 mEq/L
Serum creatinine 0.8 mg/dL
Blood urea nitrogen 10 mg/dL
Cholesterol, total 170 mg/dL
HDL-cholesterol 40 mg/dL
LDL-cholesterol 80 mg/dL
Triglycerides 170 mg/dL
Hematocrit 38%
Hemoglobin 13 g/dL
Leucocyte count 7,500/mm3
Platelet count 185,000 /mm3
Activated partial thromboplastin time (aPTT) 30 seconds
Prothrombin time (PT) 12 seconds
Cardiac enzymes Negative
An ECG shows the absence of P-waves with an irregular RR complex. A few hours later, his symptoms subside and he is discharged with an additional anticoagulation drug. Which of the following mechanisms explains how this new medication will exert its effects?
A. Activation of the antithrombin enzyme
B. Inhibition of the cyclooxygenase enzyme
C. Inhibition of vitamin K-dependent clotting factors
D. Blockage of glycoprotein IIb/IIIa receptors
Answer: | biology | multiple-choice | MedQA | Knowledge Application | [
"C"
] | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". Please directly give the answer without any explanation. | 888341e95e3c166d9339028408995ea3 | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". | null |
A 2-month-old infant is brought to the emergency department by her mother due to a fall. Tearfully, the patient’s mother describes witnessing her child fall from the changing table. The patient was born prematurely at 36 weeks estimated gestational age via vacuum-assisted vaginal delivery. The patient is afebrile. Her vital signs include: blood pressure of 94/60 mm Hg, pulse 200/min, and respiratory rate 70/min. Physical examination reveals a subconjunctival hemorrhage in the left eye and multiple bruises on the chest and back. Which of the following is the best initial step in management of this patient’s condition?
A. CT scan of the head
B. Involvement of social services
C. Family counseling
D. Rule out medical conditions
Answer: | biology | multiple-choice | MedQA | Knowledge Application | [
"A"
] | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". Please directly give the answer without any explanation. | 2887780a207ac64501eed1aa9d3d35dc | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". | null |
A 47-year-old woman is brought to the emergency department by paramedics. She was found unconscious on a park bench by a bystander. Her history is unobtainable. Vitals include a pulse of 64/min, a respiratory rate of 7/min, and a blood pressure of 110/70 mm Hg. On examination, the patient is unresponsive to voice and touch but shows a flexor response to pain. Her breathing is shallow. The pupils are constricted, and a response to light cannot be determined. An arterial blood gas sample reveals:
pH 7.26
Pco2 70 mm Hg
HCO3- 26 mEq/L
Which of the following could explain this patient's presentation?
A. Diabetic ketoacidosis
B. Diuretic overdose
C. Hyperventilation
D. Opioid overdose
Answer: | biology | multiple-choice | MedQA | Knowledge Application | [
"D"
] | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". Please directly give the answer without any explanation. | 3da6a015e82811a1f33b19a47c24be87 | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". | null |
A 77-year-old man comes to your office for a routine visit. He is doing well, and his only complaint is the recent appearance of several brown greasy appearing lesions on his forehead (figure A) that he can't seem to peel off. What is the most likely diagnosis?
A. Melanoma
B. Seborrheic keratosis
C. Acanthosis nigricans
D. Erythema nodosum
Answer: | biology | multiple-choice | MedQA | Knowledge Application | [
"B"
] | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". Please directly give the answer without any explanation. | b1d7e652eaa72c0c5bfba62a20cfdf61 | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". | null |
A 67-year old man presents to his primary care physician for his yearly checkup. He has not noticed any major changes in his health over the last year but says that unfortunately, he stopped exercising because he has been stressed by work. His past medical history is significant for obesity, hypertension, diabetes, hypercholesterolemia, and hyperlipidemia. He is taking a number of drugs but does not remember what they are. A panel of metabolic and lipid tests are ordered and show worsening of his metabolic parameters. Based on these findings, his physician prescribes a drug that leads to a large decrease in triglycerides with a much smaller increase in high-density lipoproteins and decrease in low-density lipoproteins. The drug that was most likely prescribed in this case is associated with which of the following side effects?
A. Cholelithiasis
B. Decreased vitamin D absorption
C. Hepatotoxicity
D. Teratogenicity
Answer: | biology | multiple-choice | MedQA | Knowledge Application | [
"A"
] | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". Please directly give the answer without any explanation. | 5ff43defd191dac9339b344afad0f4f2 | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". | null |
A 16-year-old girl comes to the emergency department because of left wrist pain and swelling for 5 hours. She fell on an outstretched hand while playing basketball. She ignored it initially as she thought it was just a bruise, but the pain and swelling worsened throughout the day. The analgesic spray she used did not provide adequate relief. There is no family history of serious illness. Her only medication is an oral contraceptive pill. Her immunizations are up-to-date. She appears anxious. Her temperature is 37.1°C (99°F), pulse is 88/min, and blood pressure is 118/72 mm Hg. Examination shows a swollen and tender left wrist; range of motion is limited. The anatomical snuffbox is tender to palpation. The grip strength of the left hand is decreased. The thumb can be opposed towards the other fingers. Finkelstein's test is negative. X-rays of the wrist shows no abnormalities. Which of the following is the most appropriate next best step in management?
A. Corticosteroid injections
B. Thumb spica cast and repeat x-rays in 2 weeks
C. Rest, ice, and repeat x-rays in 2 weeks
D. Percutaneous pinning
"
Answer: | biology | multiple-choice | MedQA | Knowledge Application | [
"B"
] | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". Please directly give the answer without any explanation. | 5ecc651dcbb0bc525e4f1b6119b179fe | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". | null |
A 31-year-old woman is brought to the emergency department with fever, right upper quadrant pain, and myalgia. Her boyfriend says she recently returned from a trip to Southeast Asia. She appears ill and is lethargic. Her temperature is 39°C (102.2°F). Physical examination shows jaundice and tender hepatomegaly. Laboratory studies show the presence of anti-hepatitis A IgM antibodies. A liver biopsy performed at this time would most likely show which of the following histopathological findings?
A. Hepatocytes with shrunken, eosinophilic cytoplasm and pyknotic nuclei
B. Cystic spaces with scattered areas of cellular debris
C. Basophilic adipocyte remnants, filled with calcifications
D. Engorged hepatocytes with red blood cell infiltration
"
Answer: | biology | multiple-choice | MedQA | Knowledge Application | [
"A"
] | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". Please directly give the answer without any explanation. | 1a8722db0c2c708efa6291472a87497b | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". | null |
The parents of a 14-year-old patient are concerned and have questions about the use of insulin for their son’s recently diagnosed type 1 diabetes. The patient has developed an upper respiratory infection while at school. He is coughing and has a runny nose. His temperature is 37.8° C (100.2° F) and vital signs are within normal limits. Physical examination is unremarkable. Which of the following modifications to his insulin regimen would you recommend to this patient and his parents?
A. Increase the frequency of blood glucose checks.
B. Reduce the insulin dose.
C. Continue same regimen.
D. Hold insulin until the patient gets better.
Answer: | biology | multiple-choice | MedQA | Knowledge Application | [
"A"
] | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". Please directly give the answer without any explanation. | cb640faea437caf01b46b286432c370a | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". | null |
A 32-year-old G1P1 patient presents to her obstetrician after having a positive pregnancy test at home. She reports that she and her husband had been trying to have a child for the past three months. She has no history of sexually transmitted disease, intravenous drug use, or blood transfusions, and she has never traveled outside of the United States. She was up-to-date on all immunizations before her pregnancy. Ultrasound is consistent with an 8-week gestational sac. The patient requests as few tests as possible, although she does not want to compromise the health of her fetus. Which of the following screening tests should be performed on all pregnant women?
A. HIV, syphilis, and hepatitis B
B. HIV, syphilis, and N. gonorrhea
C. HIV, hepatitis B, and hepatitis C
D. HIV, syphilis, hepatitis B, N. gonorrhea, and C. trachomatis
Answer: | biology | multiple-choice | MedQA | Knowledge Application | [
"A"
] | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". Please directly give the answer without any explanation. | 684e57e789657869f321bcb820a4e9c3 | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". | null |
A 4-week-old female newborn is brought to the physician because of increasing yellowing of her eyes and skin for 2 weeks. The mother has noticed that the girl's stools have become pale over the past week. She was breastfed since birth but her parents switched her to formula feeds recently after reading on the internet that breastfeeding could be the cause of her current symptoms. The patient was delivered vaginally at 38 weeks' gestation. Pregnancy and delivery were uncomplicated. She appears healthy. Vital signs are within normal limits. She is at the 50th percentile for length and at the 60th percentile for weight. Examination shows scleral icterus and jaundice. The liver is palpated 2 cm below the right costal margin. Cardiopulmonary examination shows no abnormalities. Neurologic examination shows no focal findings. Serum studies show:
Bilirubin
Total 15 mg/dL
Direct 12.3 mg/dL
Alkaline phosphatase 2007 U/L
AST 53 U/L
ALT 45 U/L
γ-glutamyl transferase 154 U/L
Blood group A positive
Which of the following is the most likely diagnosis?"
A. Galactosemia
B. Biliary atresia
C. Crigler–Najjar syndrome
D. Breast milk jaundice
Answer: | biology | multiple-choice | MedQA | Knowledge Application | [
"B"
] | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". Please directly give the answer without any explanation. | 2545e7271f74b1d18cbc7a23989361b1 | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". | null |
A 51-year-old Caucasian woman presents to the physician for a routine health maintenance examination. She had a Colles' fracture 2 years ago. The rest of her past medical history is unremarkable. She has a sedentary lifestyle. She has been smoking 1 pack of cigarettes daily for 30 years. She drinks alcohol moderately. Her mother had a fracture of the wrist when she was in her late 60s. The physical examination shows no abnormal findings. Dual-energy X-ray absorptiometry (DEXA scan) shows a T-score of -3.2 standard deviations (SDs) in the hip. The patient is educated regarding her risk of falls. Exercise regimen and smoking cessation assistance are provided. Appropriate diet is indicated, as well as supplements with calcium and vitamin D. Which of the following is the most appropriate next step in pharmacotherapy?
A. Alendronate
B. Calcitonin
C. Estrogen
D. Tamoxifen
Answer: | biology | multiple-choice | MedQA | Knowledge Application | [
"A"
] | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". Please directly give the answer without any explanation. | aa34a187a3013415714399336295b077 | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". | null |
A 24-year-old man, who recently migrated from a developing country, presents to a physician because of a 2-year history of cough, blood in his sputum, fever, and weight loss. His sputum smear and culture confirm the diagnosis of pulmonary tuberculosis due to Mycobacterium tuberculosis. His Mantoux test is 2 mm × 3 mm, and his chest radiograph is normal. High-sensitivity enzyme-linked immunosorbent assay for HIV-1 and Western blot assay for HIV-1 are positive. His CD4+ T cell count is 90/μL and HIV RNA is 30,000 copies/mL. He is started on a 4-drug regimen consisting of isoniazid, rifampin, pyrazinamide, and ethambutol in appropriate doses. He becomes sputum smear-negative after 4 weeks and reports significant improvement in symptoms. After another 4 weeks, the physician removes pyrazinamide from the antitubercular regimen and adds antiretroviral therapy (dolutegravir/tenofovir/emtricitabine). After 3 weeks, the patient presents with complaints of fever and significantly increased cough for 3 days. There is no respiratory distress but generalized lymphadenopathy is present. His chest radiograph shows pulmonary infiltrates and mediastinal lymphadenopathy, sputum smear is negative, Mantoux test is 12 mm × 14 mm, CD4+ T cell count is 370/μL, and HIV RNA is 2,900 copies/mL. What is the most appropriate initial step in treatment?
A. Stop antiretroviral therapy and continue antitubercular therapy
B. Change antitubercular therapy to isoniazid-rifampin-pyrazinamide-ethambutol-streptomycin
C. Change antitubercular therapy to isoniazid-rifampin-ethambutol-streptomycin
D. Continue antitubercular therapy and antiretroviral therapy without any change
Answer: | biology | multiple-choice | MedQA | Knowledge Application | [
"D"
] | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". Please directly give the answer without any explanation. | 5694429a756871d5ce67a38d2d6964d9 | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". | null |
A 24-year-old woman delivers a baby at term. The Apgar counts are 9 and 10 at 1 and 5 minutes, respectively. Thirty minutes after delivery, the mother’s blood pressure drops to 80/60 mm Hg and her pulse is 124/min. On physical examination, her distal extremities are clammy and cold, and the uterus is boggy. Aggressive fluid resuscitation is initiated. After administering 4 units of IV fluids and 4 units of whole blood, her vitals stabilize. The next morning, she says she is unable to lactate when she tries to breastfeed her child. Which of the following is the most likely cause of the failure of lactation in this patient?
A. Pituitary tumor
B. Remains of placenta in uterus
C. Pituitary infarction
D. Pituitary hemorrhage
Answer: | biology | multiple-choice | MedQA | Knowledge Application | [
"C"
] | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". Please directly give the answer without any explanation. | dd48f6e748075860adc1ed56d1240bec | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". | null |
A 64-year-old man with multiple sclerosis comes to the physician because of a 4-month history of urinary incontinence. The urge to urinate occurs suddenly, and he often is unable to make it to the bathroom before leaking urine. He has no incontinence with coughing or laughing. Digital rectal examination shows no abnormalities. Ultrasonography shows a normal post-void residual volume. Which of the following is the most appropriate pharmacotherapy for this patient's incontinence?
A. Midodrine
B. Rivastigmine
C. Mirtazapine
D. Tolterodine
Answer: | biology | multiple-choice | MedQA | Knowledge Application | [
"D"
] | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". Please directly give the answer without any explanation. | fee4e664388666da44f207554b6a8be1 | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". | null |
A 79-year-old woman presents to her physician complaining of a persistent non-productive cough and dyspnea after contracting a cold in the past month. She describes herself as being “generally healthy” before the cold started. Medical history includes hypertension and hyperlipidemia. The patient takes hydrochlorothiazide, lisinopril, and atorvastatin. Her parents are both deceased. She does not smoke and only drinks alcohol occasionally. During a review of symptoms, she described a month-long trip to St. Louis, Missouri, to visit family. At the physician’s office, her temperature is 37.0°C (98.6°F), pulse is 82/min, respirations are 20/min, and blood pressure is 130/82 mm Hg. A focused chest exam reveals mild crepitus on the right side. A chest X-ray shows a cavitary lesion in the right lung which is confirmed on chest computed tomography (CT). A lung biopsy is performed to rule out cancer and reveals necrotic granulomatous inflammation with oval yeast in macrophages. Which of the following is the most likely diagnosis?
A. Blastomycosis
B. Sporotrichosis
C. Histoplasmosis
D. Onychomycosis
Answer: | biology | multiple-choice | MedQA | Knowledge Application | [
"C"
] | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". Please directly give the answer without any explanation. | 7bec4612b778f9f3049f0f3276119731 | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". | null |
A 39-year-old woman presents with headaches, constipation, increased thirst, and increased urinary frequency. Her blood pressure is 160/100 mm Hg and pulse is 67/min. Blood tests reveal high blood glucose and low potassium level. Abdominal CT scan shows a well-circumscribed homogeneous mass in the left adrenal gland. The hormone excess responsible for her symptoms uses which of the following pathways to exert its action?
A. Intracellular receptors
B. cAMP pathway
C. cGMP pathway
D. JAK/STAT pathway
Answer: | biology | multiple-choice | MedQA | Knowledge Application | [
"A"
] | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". Please directly give the answer without any explanation. | 43903395471cc77be9f101a843dd23a5 | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". | null |
A 17-year-old football player with no significant past medical history, social history, or family history presents to his pediatrician with itching in his groin. He says this started during summer workouts leading up to this season. He denies having any rash anywhere else on his body. The blood pressure is 123/78 mm Hg, pulse is 67/min, respiratory rate is 15/min, and temperature is 38.1°C (98.7°F). Physical examination reveals an erythematous, well-demarcated patch with peripheral scale on the left thigh, pubic region, and perineum. There is no apparent scrotal involvement with the rash. How can you confirm the suspected diagnosis?
A. KOH examination of lesion scrapings
B. Nikolsky's sign on physical exam
C. Gram stain of skin scrapings
D. AFB stain of skin scrapings
Answer: | biology | multiple-choice | MedQA | Knowledge Application | [
"A"
] | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". Please directly give the answer without any explanation. | 66d8af5c1390c76c5bcb63f2e0f0024f | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". | null |
A 68-year-old man comes to the emergency department because of a cough, dyspnea, and fever for 1 day. The cough is productive of small amounts of green phlegm. He has metastatic colon cancer and has received three cycles of chemotherapy with 5-fluorouracil, leucovorin, and oxaliplatin; his last chemotherapy session was 2.5 months ago. He has chronic obstructive pulmonary disease and has been treated with antibiotics and prednisolone for acute exacerbations three times in the past year. His medications include a fluticasone-salmeterol inhaler and a tiotropium bromide inhaler. He has smoked one pack of cigarettes daily for 48 years. His temperature is 39.1°C (103.1°F), pulse is 112/min, respirations are 32/min, and blood pressure is 88/69 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 88%. Pulmonary examination shows diffuse crackles and rhonchi. An x-ray of the chest shows a left upper-lobe infiltrate of the lung. Two sets of blood cultures are obtained. Endotracheal aspirate Gram stain shows gram-negative rods. Two large bore cannulas are inserted and intravenous fluids are administered. Which of the following is the most appropriate pharmacotherapy?
A. Ceftriaxone and azithromycin
B. Ertapenem
C. Colistin
D. Cefepime and levofloxacin
Answer: | biology | multiple-choice | MedQA | Knowledge Application | [
"D"
] | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". Please directly give the answer without any explanation. | 605b126715ce7f1f6e86fde2d54204da | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". | null |
A 81-year-old man is brought to the emergency department after he fell asleep at the dinner table and was not able to be roused by his family. His past medical history is significant for Alzheimer disease though he is still relatively functional at baseline. He has also been taking warfarin over the last 3 months after he suffered a deep venous thrombosis. After he was transported to the ED, his family found that the pills his grandson takes for seizures were missing. On presentation, he is found to be somnolent and physical exam reveals ataxia and nystagmus. After determining the cause of this patient's symptoms, his physicians begin monitoring his international normalized ratio, because they are concerned that it will start trending down. Which of the following treatments would most improve the urinary excretion of the substance likely responsible for these symptoms?
A. Ammonium chloride
B. Mannitol
C. Sodium bicarbonate
D. Thiazide diuretics
Answer: | biology | multiple-choice | MedQA | Knowledge Application | [
"C"
] | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". Please directly give the answer without any explanation. | cd005264c47e5ee548a8c4ed6bc3c666 | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". | null |
A 5-year-old female suffers from recurrent infections by Aspergillus species, Pseudomonas species, and Staphylococcus aureus. The patient's neutrophils are examined in the laboratory and they fail to react during the nitroblue tetrazolium test. Which of the following is most likely dysfunctional in this patient?
A. Immunoglobulin class switching
B. Superoxide dismutase
C. Myeloperoxidase
D. Respiratory burst
Answer: | biology | multiple-choice | MedQA | Knowledge Application | [
"D"
] | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". Please directly give the answer without any explanation. | 90267948a5b1103282c0f806f0479715 | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". | null |
A 7-month-old boy is brought to the physician because of a 2-month history of fatigue, weakness, and difficulty feeding. He was delivered at term to a 32-year-old woman. He is not able to sit upright on his own. He is at the 75th percentile for height and 25th percentile for weight. His temperature is 37.7°C (99.8°F), blood pressure is 110/68 mm Hg, pulse is 150/min, and respirations are 50/min. His tongue protrudes beyond the teeth. Neck veins are distended. Crackles are heard at both lung bases. Cardiac examination shows an S3 gallop. The liver is palpated 2 cm below the right costal margin. Neurologic examination shows profound weakness in proximal and distal muscles of the upper and lower extremities. He has 2+ reflexes bilaterally. A chest x-ray shows cardiomegaly. Serum glucose is 105 mg/dL. Which of the following is the enzyme most likely to be defective in this patient?
A. Muscle glycogen phosphorylase
B. Very-long-chain acyl-CoA dehydrogenase
C. Lysosomal acid maltase
D. Glycogen debranching enzyme
Answer: | biology | multiple-choice | MedQA | Knowledge Application | [
"C"
] | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". Please directly give the answer without any explanation. | 18bb1f5df120094af06352afe618b485 | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". | null |
A 26-year-old woman is brought to the emergency department 20 minutes after being involved in a high-speed motor vehicle collision in which she was a restrained passenger. On arrival, she is lethargic and incoherent. She has severe facial lacerations and is in respiratory distress. Her pulse is 130/min, respirations are 29/min, and blood pressure is 90/58 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 70%. Examination shows multiple facial lacerations. There is dullness to percussion and decreased breath sounds over the left lung base. Abdominal examination shows diffuse tenderness with no guarding or rebound. Bowel sounds are normal. The remainder of the examination shows no abnormalities. Her hemoglobin concentration is 12.1 g/dL. An x-ray of the chest shows a fractured left second rib, depression of the left mainstem bronchus, deviation of the nasogastric tube to the right, and a widened mediastinum. Which of the following is the most likely diagnosis?
A. Diaphragmatic rupture
B. Traumatic bronchial rupture
C. Thoracic aortic rupture
D. Tension pneumothorax
Answer: | biology | multiple-choice | MedQA | Knowledge Application | [
"C"
] | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". Please directly give the answer without any explanation. | dbca9035244d2265ed988f7df0fb9251 | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". | null |
A 45-year-old man presents to the physician with complaints of increased urinary frequency and decreasing volumes for the past 2 months. He does not complain of any pain during urination. He is frustrated that he has to wake up 2 or 3 times per night to urinate even though he tried reducing the amount of water he consumes before bed and made some other dietary changes without any improvement. He has no family history of prostate disease. Physical examination is negative for any suprapubic mass or tenderness, and there is no costovertebral angle tenderness. Which of the following is the best next step in the management of this patient?
A. Urinalysis and serum creatinine
B. Reassurance
C. Digital rectal examination
D. Prostate-specific antigen
Answer: | biology | multiple-choice | MedQA | Knowledge Application | [
"C"
] | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". Please directly give the answer without any explanation. | c496ef9667757cbd0d1ebd80ab41698d | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". | null |
The ribosome is an essential organelle that plays an important role in the synthesis of new proteins. The location of the ribosome within the cell can vary and provides a clue to the function of the particular cell. What ribosome location is essential for protein-secreting cells?
A. Rough endoplasmic reticulum
B. Smooth endoplasmic reticulum
C. Cytosol
D. Nucleus
Answer: | biology | multiple-choice | MedQA | Knowledge Application | [
"A"
] | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". Please directly give the answer without any explanation. | 2960a75ca2a82455d1a03ee0512f9d69 | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". | null |
A 6-year-old Russian boy who recently immigrated to the United States presents to your office with fever and dyspnea. On examination of the oropharynx, you note a grayish-white pseudomembrane and uneven elevation of the soft palate. The patient displays marked enlargement of the cervical lymph nodes. Which of the following describes the organism responsible for this patient's disease?
A. Yeast with pseudohyphae
B. Gram-positive bacteria producing exotoxin that acts via ADP ribosylation
C. Gram-positive cocci with hyaluronic acid capsule
D. Gram-negative encapsulated bacteria producing IgA protease
Answer: | biology | multiple-choice | MedQA | Knowledge Application | [
"B"
] | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". Please directly give the answer without any explanation. | d28b260186ab07bc7cb9e449c0ec8de1 | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". | null |
A 30-year-old African American woman comes to the physician for the evaluation of a dry cough and chest discomfort for the past 3 days. During this period, the patient has had headaches, muscle aches, joint pain, fever, and chills. Ten days ago, she was hiking with her family in Mississippi. The patient has asthma that is treated with an albuterol inhaler. Her mother has a lung disease treated with methotrexate. The patient has smoked one pack of cigarettes daily for the past 10 years. Her temperature is 38°C (100.4°F). Physical examination shows slight wheezes throughout both lung fields. Laboratory studies and urinalysis are positive for polysaccharide antigen. Bronchoalveolar lavage using silver/PAS-staining shows macrophages filled with a dimorphic fungus with septate hyphae. Which of the following is the most likely cause of this patient's symptoms?
A. Legionella pneumophila infection
B. Pneumocystis pneumonia
C. Histoplasma capsulatum infection
D. Blastomyces dermatitidis infection
Answer: | biology | multiple-choice | MedQA | Knowledge Application | [
"C"
] | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". Please directly give the answer without any explanation. | ead4ae983b14b559505aa8e3a75bb99d | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". | null |
A 5-year-old Syrian immigrant and her family present for an immigration physical. Her mother describes photophobia, bilateral lacrimation, eye itching, and eyelid swelling for the last week. She is known to have an allergy to cephalosporins. She was born at 39 weeks gestation via spontaneous vaginal delivery. She has met all of her developmental milestones and most of her vaccines. Her vital signs are as follows: blood pressure 105/60 mm Hg, heart rate 98/min, respiratory rate 18/min, and temperature 37.0°C (98.6°F). The physical examination is mostly normal except for her eye exam as presented in the image below. Which of the following statements is true regarding treatment of this patient’s condition?
A. A third-generation cephalosporin would be the best treatment option in case the child did not have an actual allergy.
B. The child should be treated with topical bacitracin.
C. The best treatment option is oral tetracycline.
D. The child should be administered a single dose of oral azithromycin.
Answer: | biology | multiple-choice | MedQA | Knowledge Application | [
"D"
] | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". Please directly give the answer without any explanation. | 28dda5e189d0761cee930ffca0ce8318 | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". | null |
A 62-year-old Caucasian male presents to the emergency room with severe substernal chest pain, diaphoresis, and nausea. Imaging reveals transmural myocardial infarction in the posterior 1/3 of the ventricular septum. Which of this patient's coronary arteries is most likely occluded?
A. Left circumflex
B. Diagonal perforators
C. Septal perforators
D. Right main
Answer: | biology | multiple-choice | MedQA | Knowledge Application | [
"D"
] | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". Please directly give the answer without any explanation. | 4e0d940da067aa526a6ff83bc9873708 | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". | null |
A 42-year-old man comes to the physician after elevated liver function tests were found after a routine screening. He has had occasional headaches over the past year, but otherwise feels well. The patient reports that he was involved in a severe car accident 30 years ago. He does not smoke or drink alcohol. He has never used illicit intravenous drugs. He takes no medications and has no known allergies. His father had a history of alcoholism and died of liver cancer. The patient appears thin. His temperature is 37.8°C (100°F), pulse is 100/min, and blood pressure is 110/70 mm Hg. Physical examination shows no abnormalities. Laboratory studies show:
Hemoglobin 14 g/dL
Leukocyte count 10,000/mm3
Platelet count 146,000/mm3
Serum
Glucose 150 mg/dL
Albumin 3.2 g/dL
Total bilirubin 1.5 mg/dL
Alkaline phosphatase 75 U/L
AST 95 U/L
ALT 73 U/L
HIV negative
Hepatitis B surface antigen negative
Hepatitis C antibody positive
HCV RNA positive
HCV genotype 1
A liver biopsy is performed and shows mononuclear infiltrates that are limited to portal tracts and periportal hepatocyte necrosis. Which of the following is the most appropriate next step in management?"
A. Sofosbuvir and ledipasvir therapy
B. Tenofovir and velpatasvir therapy
C. Interferon and ribavirin therapy
D. Tenofovir and entecavir therapy
Answer: | biology | multiple-choice | MedQA | Knowledge Application | [
"A"
] | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". Please directly give the answer without any explanation. | 89764725dccbd8423dcdead1a145488f | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". | null |
A 37-year-old woman presents to the clinic with pain and swelling of her legs. She states that she first noticed the swelling 6 weeks ago. Initially, the swelling was minimal, but now she is finding it difficult to walk and she can’t fit into any of her shoes. Her medical history is significant for systemic lupus erythematosus. She takes ibuprofen and hydroxychloroquine. Her temperature is 99°F (37.2°C), blood pressure is 153/86 mmHg, and pulse is 88 beats/min. Pitting edema to bilateral knees is noted on physical examination. Urinalysis reveals proteinuria. The patient is started on an immunosuppressant. Two days later the patient returns to clinic complaining of blood in her urine. A urinalysis reveals moderate erythrocytes but is negative for leukocyte esterase, nitrites, or crystals. Diffuse oozing of the bladder mucosa with neovascularization is seen on cystoscopy. Which of the following could have prevented the patient’s condition?
A. Ifosfamide
B. Mesna
C. Methotrexate
D. Nitrofurantoin
Answer: | biology | multiple-choice | MedQA | Knowledge Application | [
"B"
] | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". Please directly give the answer without any explanation. | 4fd30da075de149f6b21f8feb134c0f2 | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". | null |
A previously healthy 46-year-old woman comes to the physician because of progressive shortness of breath, fatigue, and chest pain during exercise for the last 6 months. She does not smoke. Her maternal uncle had similar symptoms. Cardiac examination shows wide splitting of S2. The second component of S2 is loud and best heard at the 2nd left intercostal space. The lungs are clear to auscultation. Which of the following is the most likely cause of this patient's cardiac findings?
A. Increased right ventricular preload
B. Increased left ventricular preload
C. Increased right ventricular afterload
D. Increased left-to-right shunting
Answer: | biology | multiple-choice | MedQA | Knowledge Application | [
"C"
] | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". Please directly give the answer without any explanation. | 94a62946dc3e430d221b2d7d64148699 | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". | null |
A 39-year-old woman with poorly controlled systemic lupus erythematosus (SLE) presents to her rheumatologist for a follow-up visit. She has had intermittent myalgias, arthralgias, fatigue, and skin rashes over the past 10 years that have acutely worsened over the past year. She works as a school teacher but reports that she has had to miss several days of work due to her symptoms. She has been on hydroxychloroquine for several years but does not feel that it is adequately controlling her symptoms. She does not smoke or drink alcohol. Her temperature is 99.2°F (37.3°C), blood pressure is 130/75 mmHg, pulse is 80/min, and respirations are 18/min. On exam, she is well-appearing and in no acute distress. She has erythematous, raised plaques with keratotic scaling and follicular plugging on her hands. The physician decides to trial the patient on low-dose prednisone to better control her symptoms. At 2 months of follow-up, she reports that her flares have subsided and she has been able to return to work full-time. If this patient continues this medication regimen, she will be at an elevated risk for developing which of the following?
A. Femoral neck fracture
B. Femoral shaft fracture
C. Osgood-Schlatter disease
D. Proximal phalanx fracture
Answer: | biology | multiple-choice | MedQA | Knowledge Application | [
"A"
] | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". Please directly give the answer without any explanation. | d7f7b513f2e3c7514be7bd3550f30e6b | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". | null |
A 2-year-old boy is brought to the physician because of decreased appetite and abdominal pain for the last several weeks. Physical examination shows a well-appearing toddler with a palpable left-sided abdominal mass that does not cross the midline. A CT of the abdomen shows a large, necrotic tumor on the left kidney. Histological examination of the kidney mass shows primitive blastemal cells and immature tubules and glomeruli. This tissue is most likely derived from the same embryological structure as which of the following?
A. Adrenal medulla
B. Thyroid gland
C. Papillary muscles
D. Anterior pituitary
"
Answer: | biology | multiple-choice | MedQA | Knowledge Application | [
"C"
] | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". Please directly give the answer without any explanation. | 4ed4306a9e96ad6bae23fd2db3b45300 | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". | null |
A 60-year-old man comes to the physician for a routine physical examination. He lives in a group home and takes no medications. During the appointment, he frequently repeats the same information and needs to be reminded why he is at the doctor's office. He says that he is a famous poet and recently had a poem published in a national magazine. His vital signs are within normal limits. He has a constricted affect. Neurological examination shows no focal deficits. On mental status examination, he has no long-term memory deficits and is able to count in serial sevens without error. An MRI of the brain shows atrophy of the anterior thalami and small mamillary bodies. Which of the following is the most likely predisposing factor for this patient's condition?
A. Consumption of undercooked meat
B. Chronic hypertension
C. Alcohol use disorder
D. Spirochete infection
Answer: | biology | multiple-choice | MedQA | Knowledge Application | [
"C"
] | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". Please directly give the answer without any explanation. | 79889e29f76fe41d8b3946819015a66b | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". | null |
A 7-year-old boy is brought to his pediatrician’s office for a follow-up visit. He was diagnosed with asthma when he was 3 years old and has since been on treatment for the condition. He is currently on a β-agonist inhaler because of exacerbation of his symptoms. He has observed that his symptoms are more prominent in springtime, especially when the new flowers are blooming. His mother has a backyard garden and whenever he goes out to play there, he experiences chest tightness with associated shortness of breath. He has been advised to take more precaution during this seasonal change and to stay away from pollen. He is also being considered for an experimental therapy, which attenuates the activity of certain mediators which cause his asthmatic attack. The targeted mediator favors the class switching of antibodies. A reduction in this mechanism will eventually reduce the exaggerated response observed during his asthmatic attacks, even when exposed to an allergen. Which of the following mediators is described in this experimental study?
A. IL-2
B. IL-10
C. IL-13
D. IL-4
Answer: | biology | multiple-choice | MedQA | Knowledge Application | [
"D"
] | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". Please directly give the answer without any explanation. | f9a05eaa5b8b558a0020a5dd4350c073 | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". | null |
A 35-year-old woman comes to the physician for the evaluation of increasing weakness and numbness of the upper extremities for 5 days. During the past 2 days, she has had urinary incontinence not related to sneezing or laughing. Last summer, she had weakness and numbness of her right lower extremity that was worse when she was outside; she regained her strength 3 weeks later. She has no history of serious illness. She has had 10 male sexual partners in her lifetime and uses condoms inconsistently. Vital signs are within normal limits. Examination shows an impaired tandem gait. There is mild spasticity and muscle strength is decreased in both upper extremities. Deep tendon reflexes are 4+ bilaterally. The abdominal reflex is absent. Muscle strength in the right lower extremity is mildly decreased. Sensation to vibration and fine touch is decreased over the upper extremities. Which of the following is the most appropriate next step in diagnosis?
A. Muscle biopsy
B. Rapid plasma reagin test
C. MRI of the brain and spine
D. Lumbar puncture
Answer: | biology | multiple-choice | MedQA | Knowledge Application | [
"C"
] | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". Please directly give the answer without any explanation. | f631225af4a8fffa49d1979077e0e039 | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". | null |
A 3-year-old male is brought by his mother to the pediatrician's office. The mother and child are refugees from Somalia and arrived in the United States one week ago. They were recently placed in temporary housing. The mother reports that the child has been chronically tired and subdued since before their arrival in the United States. The child was born at 38 weeks gestation with the help of a local midwife. The child’s temperature is 98.2°F (36.8°C), blood pressure is 105/60 mmHg, pulse is 90/min, and respirations are 18/min. Physical examination reveals a listless child with a rotund abdomen and positive fluid wave. Notable lower extremity edema is present. This patient's condition is most likely caused by a deficiency in which of the following?
A. Total caloric intake
B. Relative protein intake
C. Relative carbohydrate intake
D. Relative fat intake
Answer: | biology | multiple-choice | MedQA | Knowledge Application | [
"B"
] | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". Please directly give the answer without any explanation. | 91d5885088e3909b2b7e1cc5514ba4ed | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". | null |
A 72-year-old woman comes to the physician because of a 1-month history of frequent headaches, double vision, fatigue, and myalgias. Physical examination shows pallor, tenderness to palpation over the temples, and inward deviation of the left eye. Laboratory studies show an erythrocyte sedimentation rate of 65 mm/h. Temporal artery biopsy shows transmural granulomatous inflammation and fragmentation of the internal elastic lamina. Treatment with high-dose intravenous corticosteroids is begun. The patient's condition puts her at greatest risk of developing which of the following complications?
A. Pulmonary hypertension
B. Lower extremity gangrene
C. Palpable purpura
D. Thoracic aortic aneurysm
Answer: | biology | multiple-choice | MedQA | Knowledge Application | [
"D"
] | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". Please directly give the answer without any explanation. | 4418b83322b6aee02e71dbc0cdf71a8c | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". | null |
A 55-year-old male presents to the emergency department with dyspnea and palpitations. He does not smoke cigarettes or consume alcohol, and past medical history is insignificant. Blood pressure is 115/75 mmHG and heart rate is 125/min. Heart rhythm is irregularly irregular. After initial treatment with IV digoxin the patient's heart rate drops to 85/min and remains irregular. Which of the following best explains the effect of digoxin in this patient?
A. Blockade of beta-adrenergic receptors
B. Calcium channel blockade
C. Vagal stimulation
D. Increased ventricular contractility
Answer: | biology | multiple-choice | MedQA | Knowledge Application | [
"C"
] | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". Please directly give the answer without any explanation. | d3024ff7a5e54b6381ecde5558650892 | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". | null |
The first 24 hours after delivery, a 2888 g (6.37 lb) male newborn is not feeding well, has a high-pitched cry, and is diaphoretic. He was born at 38 weeks' gestation to a 30-year-old woman, gravida 2, para 1, after an uncomplicated labor and delivery. Apgar scores were 8 and 9 at 1 and 5 minutes, respectively. The mother did not receive prenatal care. She takes codeine syrup frequently for dry cough. The infant's temperature is 37.8°C (100°F), pulse is 165/min, and blood pressure is 83/50 mm Hg. Examination shows hyperreflexia, tremors, and an excessive startle response. The baby is swaddled to prevent excoriations, and fluid resuscitation is initiated. Complete blood count and serum levels of glucose, bilirubin, and calcium are within normal limits. What is the most appropriate next step in treatment of this newborn?
A. Oral morphine therapy
B. Intravenous ampicillin and gentamicin combination therapy
C. Oral methimazole therapy
D. Dextrose infusion
Answer: | biology | multiple-choice | MedQA | Knowledge Application | [
"A"
] | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". Please directly give the answer without any explanation. | a4bf519ad49ea26dcfc498c2cf20406a | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". | null |
A 55-year-old woman is brought to the emergency department because of worsening upper abdominal pain for the past 8 hours. She reports that the pain radiates to her back and is associated with nausea. She has hypertension and hyperlipidemia, for which she takes enalapril, furosemide, and simvastatin. Her temperature is 37.5°C (99.5°F), blood pressure is 84/58 mm Hg, and pulse is 115/min. The lungs are clear to auscultation. Examination shows abdominal distention with epigastric tenderness and guarding. Bowel sounds are decreased. Extremities are warm. Laboratory studies show:
Hematocrit 48%
Leukocyte count 13,800/mm3
Platelet count 175,000/mm3
Serum
Calcium 8.0 mg/dL
Urea nitrogen 32 mg/dL
Amylase 250 U/L
An ECG shows sinus tachycardia. Which of the following is the most likely underlying cause of this patient's vital sign abnormalities?
A. Abnormal coagulation and fibrinolysis
B. Capillary leakage
C. Decreased cardiac output
D. Pseudocyst formation
Answer: | biology | multiple-choice | MedQA | Knowledge Application | [
"B"
] | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". Please directly give the answer without any explanation. | 01b240146f55dce43ade528a0ada6812 | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". | null |
A 35-year-old woman presents with an unsteady and broad-based gait, dysmetria, and intention tremor in the distal upper extremities. Her past medical history is relevant for depression, personality changes, and declining work performance, for which she has been put on leave from her current job as an elementary school teacher. On physical examination, patient has dysarthria, dystonia, and an ataxic gait. Ophthalmologic examination reveals multi-colored irises with concentric rings around the periphery (findings shown in the photo). Sensation and motor functions are preserved. Which of the following would you expect to be abnormally accumulated in this patient’s tissues?
A. Iron
B. Copper
C. Lead
D. Mercury
Answer: | biology | multiple-choice | MedQA | Knowledge Application | [
"B"
] | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". Please directly give the answer without any explanation. | 4be195af19a9a59df17610db20a655df | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". | null |
A 10-year-old Caucasian female with Turner's syndrome underwent an abdominal imaging study and was discovered that the poles of her kidneys were fused inferiorly. Normal ascension of kidney during embryological development would be prevented by which of the following anatomical structures?
A. Superior mesenteric artery
B. Inferior mesenteric artery
C. Celiac artery
D. Splenic artery
Answer: | biology | multiple-choice | MedQA | Knowledge Application | [
"B"
] | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". Please directly give the answer without any explanation. | 8cb0eeadf52ff25dba5c1bef41e21a9d | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". | null |
A 63-year-old man presents to his primary care physician for follow-up. He reports a slow and steady weight gain of 6 pounds over the past 6 months, despite attempts to control his diet and increase his level of exercise. His medications include pravastatin, lisinopril, and hydrochlorothiazide. On exam, his vital signs are stable. He is obese (BMI 32), and his waist circumference is 43 inches. His physician is concerned about an abnormal fasting blood glucose and dyslipidemia. On further work-up with oral glucose tolerance test, the patient is diagnosed with diabetes. Which of the following associations is consistent with this patient’s most likely form of diabetes?
A. Strong HLA class II gene makeup
B. Pancreatic islet cell amyloid deposition
C. Pancreatic islet cell leukocyte infiltration
D. Auto-antibodies against pancreatic islet cell antigens
Answer: | biology | multiple-choice | MedQA | Knowledge Application | [
"B"
] | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". Please directly give the answer without any explanation. | f5977eb66883659282b573fd2cb0a0a1 | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". | null |
A 27-year-old woman, gravida 1, para 0, at 38 weeks' gestation is admitted to the hospital for active labor. The pregnancy was complicated by gestational diabetes and fetal weight is estimated to be at the 90th percentile for gestational age. During delivery, there is an arrest in the second stage of labor, and a vacuum-assisted delivery is performed. Postpartum examination shows a third-degree laceration in the vagina extending into the perineum at the 6 o'clock position. This patient is most likely to experience which of the following complications?
A. Urge incontinence
B. Vesicovaginal fistula
C. Fecal incontinence
D. Stress incontinence
Answer: | biology | multiple-choice | MedQA | Knowledge Application | [
"C"
] | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". Please directly give the answer without any explanation. | d640c66f9df6c53311d80af6be6c852d | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". | null |
A 34-year-old man with acute lymphocytic leukemia presents for follow-up in the oncology clinic after his second cycle of chemotherapy. In addition to intermittent nausea, he has mild weakness, tingling, and numbness in his left hand. With his affected hand, he is able to grip, but occasionally drops small objects. His oncologist tells him that one of his chemotherapy agents likely caused his neuropathy given its strong association with neurotoxicity. He was recently treated with cyclophosphamide, vincristine, doxorubicin, dexamethasone, and dasatinib. The culprit medication works by which of the following mechanisms of action?
A. Covalently X-links DNA
B. Blocks microtubule formation
C. Intercalates between DNA
D. Modifies DNA transcription and protein synthesis
Answer: | biology | multiple-choice | MedQA | Knowledge Application | [
"B"
] | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". Please directly give the answer without any explanation. | 44c11b75445a2c76ae591587ef9cc509 | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". | null |
A 60-year-old woman is brought to the emergency department because of sudden, painless loss of vision in her right eye that occurred 30 minutes ago while watching TV. She has coronary artery disease, hypertension, and type 2 diabetes mellitus; she has had trouble adhering to her medication regimen. Her blood pressure is 160/85 mm Hg. Examination shows 20/50 vision in the left eye and no perception of light in the right eye. Direct pupillary reflex is present in the left eye, but absent in the right eye. Accommodation is intact bilaterally. Intraocular pressure is 16 mm Hg in the left eye and 18 mm Hg in the right eye. Fundoscopic examination of the right eye shows a pale, white retina with a bright red area within the macula. The optic disc appears normal. Which of the following is the most likely diagnosis?
A. Retinal detachment
B. Central retinal artery occlusion
C. Acute angle-closure glaucoma
D. Anterior ischemic optic neuropathy
Answer: | biology | multiple-choice | MedQA | Knowledge Application | [
"B"
] | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". Please directly give the answer without any explanation. | c4b5409965c6ee43269146f81ddc0473 | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". | null |
A 32-year-old woman, gravida 2, para 0, at 22 weeks' gestation comes to the emergency department for abdominal pain and heavy vaginal bleeding for 2 hours. She has had no prenatal care. Her temperature is 37.2°C (99.0°F), pulse is 102/min, respirations are 16/min, and blood pressure is 138/82 mm Hg. The abdomen is nontender, and regular contractions are felt every 2 minutes. The uterus is consistent in size with a 20-week gestation. There is blood on the vulva, introitus, and medial aspect of the thighs. Ultrasound shows complete detachment of the placenta from the uterus. Fetal heart tones are absent. An emergent cesarean delivery is performed. Following the procedure, the patient becomes tearful and distraught. Which of the following is the most appropriate initial response by the physician?
A. “I'm sorry for your loss. This must be a difficult situation for you.”
B. “Losing a baby is difficult, but I'm sure next time it'll work out.”
C. “Losing a baby is difficult; but I see this every day, and I know you'll get through it.”
D. “I'm sorry for your loss. I can write you a prescription to help with your anxiety and grief.”
Answer: | biology | multiple-choice | MedQA | Knowledge Application | [
"A"
] | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". Please directly give the answer without any explanation. | c4b1aab57acaa16b4113a95ff6f00079 | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". | null |
A 68-year-old female presents to her primary care physician with a 7-month history of fatigue and low back pain. Her pain is not improved by over the counter analgesics. Laboratory analysis is notable for a calcium level of 11.5 mg/dL, creatinine level of 2.0 mg/dL, and blood urea nitrogen level of 30 mg/dL. Large eosinophilic casts are seen on renal biopsy. Which of the following findings is most likely to be seen on peripheral blood smear?
A. Abundant reticulocytes
B. Linear aggregations of red blood cells
C. Schistocytes
D. Leukocytosis with abundant mature myeloid cells
Answer: | biology | multiple-choice | MedQA | Knowledge Application | [
"B"
] | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". Please directly give the answer without any explanation. | cfb1e66dbac3b164e5c239536153ce12 | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". | null |
A 67-year-old woman presents from home hospice with a change in her mental status. She has seemed more confused lately and is unable to verbalize her symptoms. Her temperature is 102°F (38.9°C), blood pressure is 117/65 mmHg, pulse is 110/min, respirations are 19/min, and oxygen saturation is 95% on room air. Physical exam is notable for a right upper quadrant mass that elicits discomfort when palpated. Ultrasound is notable for pericholecystic fluid and gallbladder wall thickening without any gallstones. Which of the following is the most likely diagnosis?
A. Acalculous cholecystitis
B. Calculous cholescystitis
C. Choledocholithiasis
D. Emphysematous cholecystitis
Answer: | biology | multiple-choice | MedQA | Knowledge Application | [
"A"
] | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". Please directly give the answer without any explanation. | 2f6972dd60500d80cfc27819246e0f1f | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". | null |
A 53-year-old man comes to the physician for a follow-up appointment three days after being prescribed a selective alpha-1 agonist. He reports improvement in his symptoms and has not experienced any adverse effects. This drug was most likely prescribed for which of the following conditions?
A. Bronchospasm due to bronchial asthma
B. Urinary hesitancy due to benign prostatic hyperplasia
C. Nasal congestion due to a viral infection
D. Blood pressure management prior to pheochromocytoma excision
Answer: | biology | multiple-choice | MedQA | Knowledge Application | [
"C"
] | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". Please directly give the answer without any explanation. | 322d37e7407ccff38fd25f3171d660d8 | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". | null |
A 58-year-old woman comes to the physician because of intermittent painful retrosternal dullness for 4 weeks. The pain is recurrent and occurs when she exerts herself or when she is outside during cold weather. She also experiences shortness of breath and palpitations during these episodes. The symptoms resolve spontaneously when she stops or sits down for a while. Over the past few days, the episodes have increased in frequency. She has hypertension, type 2 diabetes mellitus, and osteoarthritis. Her left leg was amputated below the knee after a motorcycle accident 25 years ago. She is currently waiting for a new prosthesis and walks with crutches. Current medications include captopril, glyburide, and ibuprofen. She does not smoke or drink alcohol. Her pulse is 88/min, respirations are 20/min, and blood pressure is 144/90 mm Hg. Cardiac examination shows no abnormalities. An x-ray of the chest shows no abnormalities. An ECG shows a normal sinus rhythm without any signs of ischemia. Serum cardiac markers are within the reference range. Which of the following is the most appropriate next step in diagnosis?
A. Myocardial perfusion scan under pharmacological stress
B. Upper endoscopy
C. Coronary angiography
D. Echocardiography at rest
Answer: | biology | multiple-choice | MedQA | Knowledge Application | [
"A"
] | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". Please directly give the answer without any explanation. | ba7ec36c0473d84836e13523230e1dd4 | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". | null |
A 61-year-old man comes to the emergency department because of a 2-day history of a productive cough and worsening shortness of breath. He has had frequent episodes of a productive cough over the past 3 years. He had smoked 2 packs of cigarettes daily for 30 years but quit 1 year ago. He appears distressed. Pulse oximetry on room air shows an oxygen saturation of 91%. Chest auscultation reveals diffuse wheezes and coarse crackles. A chest x-ray shows increased lung lucency bilaterally and flattening of the diaphragm. Which of the following is the most appropriate initial pharmacotherapy?
A. Prednisone and albuterol
B. Albuterol and montelukast
C. Prednisone and tiotropium
D. Albuterol and theophylline
Answer: | biology | multiple-choice | MedQA | Knowledge Application | [
"A"
] | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". Please directly give the answer without any explanation. | a2fca96d9c918b3f9f49762cd4f871c7 | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". | null |
A 74-year-old woman with a history of hypertension, hyperlipidemia, and type 2 diabetes mellitus is brought to her primary care doctor by her son who is concerned about the patient's ability to manage her activities of daily living. She has been living alone since her husband passed away 2 years ago. She has remained an active member of her retirement community's wine club; however, she stopped attending the meetings 3 weeks ago. She is generally able to her maintain her house, but her house appears more disorganized over the past 2 weeks. She generally drives short distances but avoids driving long distances as she occasionally gets lost when navigating new areas. She feels like her balance is getting worse, but she has not fallen. She has noticed increased urinary urgency over the past 8 months and has had 2 episodes of incontinence. Despite these changes, she reports feeling well. She drinks 4-6 glasses of wine per day. She was started on multiple medications for worsening anxiety by her psychiatrist 1 month ago. Her BMI is 31 kg/m^2. Her temperature is 99.8°F (37.7°C), blood pressure is 115/65 mmHg, pulse is 95/min, and respirations are 17/min. On examination, she is oriented to person and time but not place or situation. She does not seem to recognize her doctor despite knowing him for many years. She becomes somnolent intermittently throughout the interview. She can recall 0/3 words after 5 minutes. She has a low-frequency tremor in her right arm that increases in severity with deliberate movement. Which of the following is the most likely diagnosis in this patient?
A. Alzheimer dementia
B. Delirium
C. Lewy body dementia
D. Normal pressure hydrocephalus
Answer: | biology | multiple-choice | MedQA | Knowledge Application | [
"B"
] | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". Please directly give the answer without any explanation. | 385caa5f6bfaa103e82bad54306395df | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". | null |
A 31-year-old woman, gravida 2, para 1, at 32 weeks' gestation presents to the emergency department for clear vaginal discharge that started roughly 26 hours ago. Her pregnancy has been uncomplicated. Her first child was born at term by vaginal delivery. She has no history of any serious illnesses. She does not drink alcohol or smoke cigarettes. Current medications include vitamin supplements. Her temperature is 37.2°C (98.9°F), pulse is 70/min, respirations are 18/min, and blood pressure is 128/82 mm Hg. Speculum examination demonstrates clear fluid at the cervical os. The fetal heart rate is reactive at 160/min with no decelerations. Tocometry shows uterine contractions. Nitrazine testing is positive. She is started on indomethacin. Which of the following is the most appropriate next step in management?
A. Administer ampicillin and perform amnioinfusion
B. Administer ampicillin and progesterone
C. Administer betamethasone, ampicillin, and proceed with cesarean section
D. Administer betamethasone, ampicillin, and proceed with induction of labor
Answer: | biology | multiple-choice | MedQA | Knowledge Application | [
"C"
] | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". Please directly give the answer without any explanation. | 978807029e220ee8e20fb521c7850b83 | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". | null |
A 57-year-old woman is brought to the emergency department by ambulance for dysarthria and left-sided facial droop. She is accompanied by her son, who states that the patient had just returned home an hour ago from walking the dog when suddenly the patient stated she felt “strange.” When her son asked her what was wrong, her speech was slurred and her "face looked funny.” The son quickly called an ambulance. The paramedic upon arrival noted that the patient had left-sided facial droop. Her medical history includes asthma and sickle cell disease. She takes hydroxyurea, uses oxycodone as needed for pain, and an albuterol inhaler as needed for shortness of breath. The patient’s temperature is 97°F (36.1°C), blood pressure is 145/72 mmHg, pulse is 93/min, and respirations are 14/min with an oxygen saturation of 96% on room air. On physical examination, a left-sided facial droop is appreciated. She has trouble articulating her words, and her speech is garbled. She is put on 2 L of oxygen by nasal cannula. Labs are obtained and pending. Which of the following therapies is most likely indicated?
A. Alteplase
B. Exchange transfusion
C. Hydralazine
D. Warfarin
Answer: | biology | multiple-choice | MedQA | Knowledge Application | [
"B"
] | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". Please directly give the answer without any explanation. | a18af02057562ede63344f6cfd57213e | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". | null |
A 78-year-old man is brought to the emergency department because of a 1-day history of painful enlarging bruises and skin ulceration over his thighs and external genitalia. He has type 2 diabetes mellitus, mitral regurgitation, and atrial fibrillation. Three days ago, he was started on treatment with warfarin. His only other medications are metformin and lisinopril. His temperature is 37.8°C (100.0°F), pulse is 108/min and irregularly irregular, and blood pressure is 155/89 mm Hg. Examination of the skin shows large purpura, hemorrhagic bullae, and areas of skin necrosis over his anterior legs, gluteal region, and penis. This patient is most likely to benefit from treatment with which of the following?
A. Hyperbaric oxygen
B. Protein C concentrate
C. Argatroban
D. Tranexamic acid
Answer: | biology | multiple-choice | MedQA | Knowledge Application | [
"B"
] | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". Please directly give the answer without any explanation. | 3c0199001b040a306577fdae78ba8eaf | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". | null |
A 65-year-old woman is brought to the emergency department by her husband after he found her with nausea, headache, and agitation 1 hour ago. When he left their lakeside cabin 6 hours before to go ice fishing and get more firewood, she did not have any symptoms. She has chronic migraines, hypertension, and type 2 diabetes mellitus. Her medications include lisinopril and metformin, but she ran out of her anti-hypertensive medications over the weekend. Her temperature is 37.1°C (98.8°F), pulse is 110/min, respirations are 21/min, and blood pressure is 154/92 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 98%. She is confused and oriented only to person and place. She recalls only one of three objects after 5 minutes. Her gait is unsteady. Physical examination shows no abnormalities. Which of the following is the most effective intervention for this patient's current condition?
A. Intravenous nitroprusside
B. Hyperbaric oxygen therapy
C. 100% oxygen therapy
D. Heliox therapy
Answer: | biology | multiple-choice | MedQA | Knowledge Application | [
"B"
] | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". Please directly give the answer without any explanation. | 61c8291cefa77254eb14fe81338e677b | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". | null |
A 35-year-old woman presents with severe fear reactions to seeing dogs after moving into a new suburban neighborhood. She states that she has always had an irrational and excessive fear of dogs but has been able to avoid it for most of her life while living in the city. When she sees her neighbors walking their dogs outside, she is terrified and begins to feel short of breath. Recently, she has stopped picking up her children from the bus stop and no longer plays outside with her children in order to avoid seeing any dogs. Which of the following would be the best definitive treatment for this patient?
A. Selective serotonin reuptake inhibitors (SSRIs)
B. Short-acting benzodiazepines
C. Systematic desensitization
D. Cognitive behavioral therapy
Answer: | biology | multiple-choice | MedQA | Knowledge Application | [
"C"
] | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". Please directly give the answer without any explanation. | 5b7d7f10f78bba3b4cd78feeccf998fe | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". | null |
A 39-year-old man seeks an evaluation in the emergency room due to an episode of syncope at work. He says that he has felt increasing shortness of breath while exercising over the past 6 months. He is a well-built man in mild distress. The vital signs include heart rate 98/min, respiratory rate 18/min, temperature 36.5°C (97.7°F), and blood pressure 135/90 mm Hg. The cardiac examination is significant for a harsh systolic ejection murmur at the left lower sternal border which is accentuated by forceful expiration against a closed airway. Palpation of the carotid artery shows 2 closely spaced pulses which occur during systole. Which of the following is most consistent with these findings?
A. Aortic stenosis
B. Cardiac tamponade
C. Hypertrophic cardiomyopathy
D. Third-degree heart block
Answer: | biology | multiple-choice | MedQA | Knowledge Application | [
"C"
] | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". Please directly give the answer without any explanation. | 06f8fcf45b920ff2ffa00444f9052dd5 | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". | null |
A 15-year-old boy is brought to the physician for evaluation of a learning disability. His teachers have reported hyperactivity during class, difficulties with social interaction, and poor scores on reading and writing assessments. Molecular analysis shows an increased number of CGG trinucleotide repeats. Which of the following findings are most likely to be seen on physical examination of this patient?
A. Frontal balding and cataracts
B. Long face and large everted ears
C. Almond-shaped eyes and downturned mouth
D. Thin upper lip and receding chin
Answer: | biology | multiple-choice | MedQA | Knowledge Application | [
"B"
] | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". Please directly give the answer without any explanation. | 127038b6c487ef09749bc7e764b08600 | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". | null |
A 57-year-old man comes to the physician because of a 1-year history of increasing shortness of breath on exertion and a cough productive of a small amount of grayish-white phlegm. The cough had been initially nonproductive. He has not had fever or chest pain. He is originally from China and visits his family there once every year. He has worked as a car salesman for 15 years and worked in a shipyard before that for 22 years. He smoked half a pack of cigarettes daily for 13 years but stopped 25 years ago. His temperature is 37.1°C (98.8°F), pulse is 86/min, respirations are 16/min, and blood pressure is 130/80 mm Hg. Fine expiratory crackles are heard at both lung bases. An x-ray of the chest shows patchy infiltrates and supradiaphragmatic pleural thickening in both lungs. A photomicrograph from a sputum sample is shown. Further evaluation of this patient is most likely to show which of the following findings?
A. Increased alveolar-arterial gradient
B. Bloody pleural effusion
C. Concave flow-volume loop
D. Increased diffusing capacity (DLCO)
Answer: | biology | multiple-choice | MedQA | Knowledge Application | [
"A"
] | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". Please directly give the answer without any explanation. | e17ac36b15cbda90f17fc1f97f699242 | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". | null |
A group of researchers decided to explore whether the estimates of incidence and prevalence rates of systemic lupus erythematosus (SLE) were influenced by the number of years it took to examine administrative data. These estimates were not only based on hospital discharges, but also on physician billing codes. For study purposes, the researchers labeled incident cases at the initial occurrence of SLE diagnosis in the hospital database, while prevalent cases were those that were coded as harboring SLE at any time, with patients maintaining their diagnosis until death. Which statement is true regarding the relationship between incidence and prevalence rates during the time period that might be chosen for this specific study?
A. Incidence rates will be higher during shorter time periods than longer periods.
B. The prevalence of SLE during consecutively shorter time windows will be overestimated.
C. The inclusion of attack rates would increase incidence estimates in longer time periods.
D. The inclusion of attack rates would decrease incidence estimates in shorter time periods.
Answer: | biology | multiple-choice | MedQA | Knowledge Application | [
"A"
] | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". Please directly give the answer without any explanation. | 3f3fb3f51d731c5f01abc57ced2a38f5 | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". | null |
Eight weeks after starting a new weight-loss medication, a 43-year-old woman with obesity comes to the physician because of greasy diarrhea, excessive belching, and flatulence. She also complains of progressively worsening night-time vision. She has had no fever, chills, or vomiting. Physical examination shows dry, scaly skin on her extremities and face. Which of the following is the most likely mechanism of action of the drug she is taking?
A. Stimulation of monoamine neurotransmitter release
B. Inhibition of serotonin reuptake
C. Stimulation of norepinephrine release
D. Inhibition of lipase
Answer: | biology | multiple-choice | MedQA | Knowledge Application | [
"D"
] | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". Please directly give the answer without any explanation. | d0833d0accede2039c7ac1b01b6970b4 | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". | null |
A 21-year-old man is brought to the emergency department by his mother after being found lying unconscious next to a bottle of pills. The patient’s mother mentions that he has been diagnosed with major depressive disorder 3 years ago for which he was taking a medication that resulted in only a slight improvement in his symptoms. She says he still found it difficult to concentrate on his studies and did not participate in any social events in college. He didn’t have many friends and was often found sitting alone in his room. He has also threatened to take his life on several occasions, but she did not think he was serious. While recording his vital signs, the patient goes into a coma. His ECG shows a QT interval of 450 milliseconds. Which of the following medications did this patient most likely overdose on?
A. Bupropion
B. Sertraline
C. Venlafaxine
D. Clomipramine
Answer: | biology | multiple-choice | MedQA | Knowledge Application | [
"D"
] | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". Please directly give the answer without any explanation. | ef9d7a5ad58e9988c9dd0c82bd53aab7 | Given a question and four options, please select the right answer. Your answer should be "A", "B", "C" or "D". | null |
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