input
stringlengths 4
4.2k
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A 6-month-old baby boy presents to his pediatrician for the evaluation of recurrent bacterial infections. He is currently well but has already been hospitalized multiple times due to his bacterial infections. His blood pressure is 103/67 mm Hg and heart rate is 74/min. Physical examination reveals light-colored skin and silver hair. On examination of a peripheral blood smear, large cytoplasmic vacuoles containing microbes are found within the neutrophils. What diagnosis do these findings suggest?
Options:
{'A': 'Chediak-Higashi syndrome', 'B': 'Leukocyte adhesion deficiency-1', 'C': 'Congenital thymic aplasia', 'D': 'Common variable immunodeficiency', 'E': 'Acquired immunodeficiency syndrome'} | {'A': 'Chediak-Higashi syndrome', 'B': 'Leukocyte adhesion deficiency-1', 'C': 'Congenital thymic aplasia', 'D': 'Common variable immunodeficiency', 'E': 'Acquired immunodeficiency syndrome'} | Chediak-Higashi syndrome | <|start_header_id|>system<|end_header_id|>
The following are multiple choice questions about medical knowledge. Solve them in a step-by-step fashion, starting by summarizing the available information. Output a single option from the four options as the final answer.<|eot_id|>
<|start_header_id|>user<|end_header_id|>
A 6-month-old baby boy presents to his pediatrician for the evaluation of recurrent bacterial infections. He is currently well but has already been hospitalized multiple times due to his bacterial infections. His blood pressure is 103/67 mm Hg and heart rate is 74/min. Physical examination reveals light-colored skin and silver hair. On examination of a peripheral blood smear, large cytoplasmic vacuoles containing microbes are found within the neutrophils. What diagnosis do these findings suggest?
Options:
{'A': 'Chediak-Higashi syndrome', 'B': 'Leukocyte adhesion deficiency-1', 'C': 'Congenital thymic aplasia', 'D': 'Common variable immunodeficiency', 'E': 'Acquired immunodeficiency syndrome'}<|eot_id|>
<|start_header_id|>assistant<|end_header_id|>
Chediak-Higashi syndrome<|eot_id|> |
A 33-year-old man is brought to the emergency department 20 minutes after losing control over his bicycle and colliding with a parked car. The handlebar of the bicycle hit his lower abdomen. On arrival, he is alert and oriented. His pulse is 90/min, respirations are 17/min and blood pressure is 110/70 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 97%. The pupils are equal and reactive to light. There are multiple bruises over his chest and lower extremities. The lungs are clear to auscultation. Cardiac examination shows no abnormalities. The abdomen is soft and nontender. There is no pelvic instability. Rectal examination is unremarkable. A complete blood count, prothrombin time, and serum concentrations of glucose, creatinine, and electrolytes are within the reference range. Urine dipstick is mildly positive for blood. Microscopic examination of the urine shows 20 RBCs/hpf. Which of the following is the most appropriate next step in management?
Options:
{'A': 'Suprapubic catheterization', 'B': 'Intravenous pyelography', 'C': 'Laparotomy', 'D': 'Observation and follow-up', 'E': 'CT scan of the abdomen and pelvis'} | {'A': 'Suprapubic catheterization', 'B': 'Intravenous pyelography', 'C': 'Laparotomy', 'D': 'Observation and follow-up', 'E': 'CT scan of the abdomen and pelvis'} | Observation and follow-up | <|start_header_id|>system<|end_header_id|>
The following are multiple choice questions about medical knowledge. Solve them in a step-by-step fashion, starting by summarizing the available information. Output a single option from the four options as the final answer.<|eot_id|>
<|start_header_id|>user<|end_header_id|>
A 33-year-old man is brought to the emergency department 20 minutes after losing control over his bicycle and colliding with a parked car. The handlebar of the bicycle hit his lower abdomen. On arrival, he is alert and oriented. His pulse is 90/min, respirations are 17/min and blood pressure is 110/70 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 97%. The pupils are equal and reactive to light. There are multiple bruises over his chest and lower extremities. The lungs are clear to auscultation. Cardiac examination shows no abnormalities. The abdomen is soft and nontender. There is no pelvic instability. Rectal examination is unremarkable. A complete blood count, prothrombin time, and serum concentrations of glucose, creatinine, and electrolytes are within the reference range. Urine dipstick is mildly positive for blood. Microscopic examination of the urine shows 20 RBCs/hpf. Which of the following is the most appropriate next step in management?
Options:
{'A': 'Suprapubic catheterization', 'B': 'Intravenous pyelography', 'C': 'Laparotomy', 'D': 'Observation and follow-up', 'E': 'CT scan of the abdomen and pelvis'}<|eot_id|>
<|start_header_id|>assistant<|end_header_id|>
Observation and follow-up<|eot_id|> |
A 33-year-old man with a history of alcohol abuse and cirrhosis presents to the emergency department with profuse vomiting. The patient is aggressive, combative, emotionally labile, and has to be chemically restrained. The patient continues to vomit and blood is noted in the vomitus. His temperature is 99.2°F (37.3°C), blood pressure is 139/88 mmHg, pulse is 106/min, respirations are 17/min, and oxygen saturation is 100% on room air. The patient complains of sudden onset chest pain during his physical exam. A crunching and rasping sound is heard while auscultating the heart. Which of the following is the pathophysiology of the most likely diagnosis?
Options:
{'A': 'Dilated and tortuous veins', 'B': 'Inflammation of the pericardium', 'C': 'Mucosal tear', 'D': 'Pericardial fluid accumulation', 'E': 'Transmural tear'} | {'A': 'Dilated and tortuous veins', 'B': 'Inflammation of the pericardium', 'C': 'Mucosal tear', 'D': 'Pericardial fluid accumulation', 'E': 'Transmural tear'} | Transmural tear | <|start_header_id|>system<|end_header_id|>
The following are multiple choice questions about medical knowledge. Solve them in a step-by-step fashion, starting by summarizing the available information. Output a single option from the four options as the final answer.<|eot_id|>
<|start_header_id|>user<|end_header_id|>
A 33-year-old man with a history of alcohol abuse and cirrhosis presents to the emergency department with profuse vomiting. The patient is aggressive, combative, emotionally labile, and has to be chemically restrained. The patient continues to vomit and blood is noted in the vomitus. His temperature is 99.2°F (37.3°C), blood pressure is 139/88 mmHg, pulse is 106/min, respirations are 17/min, and oxygen saturation is 100% on room air. The patient complains of sudden onset chest pain during his physical exam. A crunching and rasping sound is heard while auscultating the heart. Which of the following is the pathophysiology of the most likely diagnosis?
Options:
{'A': 'Dilated and tortuous veins', 'B': 'Inflammation of the pericardium', 'C': 'Mucosal tear', 'D': 'Pericardial fluid accumulation', 'E': 'Transmural tear'}<|eot_id|>
<|start_header_id|>assistant<|end_header_id|>
Transmural tear<|eot_id|> |
A 55-year-old man presents to his primary care physician for leg pain. The patient works as a mailman but states he has had difficulty completing his deliveries for the past month. He complains of a burning and tingling pain in his legs when he walks that goes away when he sits down and takes a break. The patient has a past medical history of obesity, diabetes, stable angina, and constipation. His current medications include insulin and metformin. The patient has a 22-pack-year smoking history and he drinks 2-3 alcoholic beverages per day. Physical exam reveals a stout man with a ruddy complexion. His gait is stable and he demonstrates 5/5 strength in his upper and lower extremities. Which of the following is the best next step in management?
Options:
{'A': 'Ankle-brachial index', 'B': 'Arterial ultrasound', 'C': 'Arteriography', 'D': 'Aspirin', 'E': 'Atorvastatin'} | {'A': 'Ankle-brachial index', 'B': 'Arterial ultrasound', 'C': 'Arteriography', 'D': 'Aspirin', 'E': 'Atorvastatin'} | Ankle-brachial index | <|start_header_id|>system<|end_header_id|>
The following are multiple choice questions about medical knowledge. Solve them in a step-by-step fashion, starting by summarizing the available information. Output a single option from the four options as the final answer.<|eot_id|>
<|start_header_id|>user<|end_header_id|>
A 55-year-old man presents to his primary care physician for leg pain. The patient works as a mailman but states he has had difficulty completing his deliveries for the past month. He complains of a burning and tingling pain in his legs when he walks that goes away when he sits down and takes a break. The patient has a past medical history of obesity, diabetes, stable angina, and constipation. His current medications include insulin and metformin. The patient has a 22-pack-year smoking history and he drinks 2-3 alcoholic beverages per day. Physical exam reveals a stout man with a ruddy complexion. His gait is stable and he demonstrates 5/5 strength in his upper and lower extremities. Which of the following is the best next step in management?
Options:
{'A': 'Ankle-brachial index', 'B': 'Arterial ultrasound', 'C': 'Arteriography', 'D': 'Aspirin', 'E': 'Atorvastatin'}<|eot_id|>
<|start_header_id|>assistant<|end_header_id|>
Ankle-brachial index<|eot_id|> |
A 24-year-old woman at 6 weeks gestation seeks evaluation at a local walk-in clinic because she has noticed a clear, sticky discharge from her right nipple for the past 1 week. The discharge leaves a pink stain on her bra. She does not have pain in her breasts and denies changes in skin color or nipple shape. The past medical history is significant for a major depressive disorder, for which she takes fluoxetine. The family history is negative for breast, endometrial, and ovarian cancers. The physical examination is unremarkable. There are no palpable masses or tenderness on breast exam and no skin discoloration or ulcers. The breasts are symmetric. The nipple discharge on the right side is a pink secretion that is sticky. There are no secretions on the left. The axillary lymph nodes are normal. Which of the following is the most likely diagnosis?
Options:
{'A': 'Mastitis', 'B': 'Drug-induced', 'C': 'Papilloma', 'D': 'Breast cancer', 'E': 'Lactation'} | {'A': 'Mastitis', 'B': 'Drug-induced', 'C': 'Papilloma', 'D': 'Breast cancer', 'E': 'Lactation'} | Papilloma | <|start_header_id|>system<|end_header_id|>
The following are multiple choice questions about medical knowledge. Solve them in a step-by-step fashion, starting by summarizing the available information. Output a single option from the four options as the final answer.<|eot_id|>
<|start_header_id|>user<|end_header_id|>
A 24-year-old woman at 6 weeks gestation seeks evaluation at a local walk-in clinic because she has noticed a clear, sticky discharge from her right nipple for the past 1 week. The discharge leaves a pink stain on her bra. She does not have pain in her breasts and denies changes in skin color or nipple shape. The past medical history is significant for a major depressive disorder, for which she takes fluoxetine. The family history is negative for breast, endometrial, and ovarian cancers. The physical examination is unremarkable. There are no palpable masses or tenderness on breast exam and no skin discoloration or ulcers. The breasts are symmetric. The nipple discharge on the right side is a pink secretion that is sticky. There are no secretions on the left. The axillary lymph nodes are normal. Which of the following is the most likely diagnosis?
Options:
{'A': 'Mastitis', 'B': 'Drug-induced', 'C': 'Papilloma', 'D': 'Breast cancer', 'E': 'Lactation'}<|eot_id|>
<|start_header_id|>assistant<|end_header_id|>
Papilloma<|eot_id|> |
A 35-year-old woman is brought to the inpatient psychiatric unit by the police after she was found violating the conditions of her restraining order by parking on the side street of her "lover’s" home every night for the past week. Her "lover", a famous hometown celebrity, has adamantly denied any relationship with the patient over the past 6 months. The patient insists that ever since he signed a copy of his album at a local signing, she knew they were in love. Despite him having his own wife and children, the patient insists that he is in love with her and goes to his house to meet in secret. Physical examination of the patient is unremarkable. Urine toxicology is negative. Which of the following statements best describes this patient’s condition?
Options:
{'A': 'The patient will have concurrent psychotic disorders.', 'B': 'This disorder has a high prevalence rate.', 'C': 'Patients may have a contributing medical condition.', 'D': 'The disorder must meet 2 out of the 5 core criteria.', 'E': 'Symptoms must be present for at least 4 weeks.'} | {'A': 'The patient will have concurrent psychotic disorders.', 'B': 'This disorder has a high prevalence rate.', 'C': 'Patients may have a contributing medical condition.', 'D': 'The disorder must meet 2 out of the 5 core criteria.', 'E': 'Symptoms must be present for at least 4 weeks.'} | Symptoms must be present for at least 4 weeks. | <|start_header_id|>system<|end_header_id|>
The following are multiple choice questions about medical knowledge. Solve them in a step-by-step fashion, starting by summarizing the available information. Output a single option from the four options as the final answer.<|eot_id|>
<|start_header_id|>user<|end_header_id|>
A 35-year-old woman is brought to the inpatient psychiatric unit by the police after she was found violating the conditions of her restraining order by parking on the side street of her "lover’s" home every night for the past week. Her "lover", a famous hometown celebrity, has adamantly denied any relationship with the patient over the past 6 months. The patient insists that ever since he signed a copy of his album at a local signing, she knew they were in love. Despite him having his own wife and children, the patient insists that he is in love with her and goes to his house to meet in secret. Physical examination of the patient is unremarkable. Urine toxicology is negative. Which of the following statements best describes this patient’s condition?
Options:
{'A': 'The patient will have concurrent psychotic disorders.', 'B': 'This disorder has a high prevalence rate.', 'C': 'Patients may have a contributing medical condition.', 'D': 'The disorder must meet 2 out of the 5 core criteria.', 'E': 'Symptoms must be present for at least 4 weeks.'}<|eot_id|>
<|start_header_id|>assistant<|end_header_id|>
Symptoms must be present for at least 4 weeks.<|eot_id|> |
A 63-year-old female recovering from a total shoulder arthroplasty completed 6 days ago presents complaining of joint pain in her repaired shoulder. Temperature is 39 degrees Celsius. Physical examination demonstrates erythema and significant tenderness around the incision site. Wound cultures reveal Gram-positive cocci that are resistant to nafcillin. Which of the following organisms is the most likely cause of this patient's condition?
Options:
{'A': 'Streptococcus viridans', 'B': 'Escherichia coli', 'C': 'Staphylococcus epidermidis', 'D': 'Staphylococcus aureus', 'E': 'Streptococcus pyogenes'} | {'A': 'Streptococcus viridans', 'B': 'Escherichia coli', 'C': 'Staphylococcus epidermidis', 'D': 'Staphylococcus aureus', 'E': 'Streptococcus pyogenes'} | Staphylococcus aureus | <|start_header_id|>system<|end_header_id|>
The following are multiple choice questions about medical knowledge. Solve them in a step-by-step fashion, starting by summarizing the available information. Output a single option from the four options as the final answer.<|eot_id|>
<|start_header_id|>user<|end_header_id|>
A 63-year-old female recovering from a total shoulder arthroplasty completed 6 days ago presents complaining of joint pain in her repaired shoulder. Temperature is 39 degrees Celsius. Physical examination demonstrates erythema and significant tenderness around the incision site. Wound cultures reveal Gram-positive cocci that are resistant to nafcillin. Which of the following organisms is the most likely cause of this patient's condition?
Options:
{'A': 'Streptococcus viridans', 'B': 'Escherichia coli', 'C': 'Staphylococcus epidermidis', 'D': 'Staphylococcus aureus', 'E': 'Streptococcus pyogenes'}<|eot_id|>
<|start_header_id|>assistant<|end_header_id|>
Staphylococcus aureus<|eot_id|> |
A newborn of a mother with poor antenatal care is found to have a larger than normal head circumference with bulging fontanelles. Physical examination reveals a predominant downward gaze with marked eyelid retraction and convergence-retraction nystagmus. Ultrasound examination showed dilated lateral ventricles and a dilated third ventricle. Further imaging studies reveal a solid mass in the pineal region. Which of the following is the most likely finding for this patient?
Options:
{'A': 'Normal lumbar puncture opening pressure', 'B': 'Stenotic intraventricular foramina', 'C': 'Dilated cisterna magna', 'D': 'Compression of periaqueductal grey matter', 'E': 'Hypertrophic arachnoid granulations'} | {'A': 'Normal lumbar puncture opening pressure', 'B': 'Stenotic intraventricular foramina', 'C': 'Dilated cisterna magna', 'D': 'Compression of periaqueductal grey matter', 'E': 'Hypertrophic arachnoid granulations'} | Compression of periaqueductal grey matter | <|start_header_id|>system<|end_header_id|>
The following are multiple choice questions about medical knowledge. Solve them in a step-by-step fashion, starting by summarizing the available information. Output a single option from the four options as the final answer.<|eot_id|>
<|start_header_id|>user<|end_header_id|>
A newborn of a mother with poor antenatal care is found to have a larger than normal head circumference with bulging fontanelles. Physical examination reveals a predominant downward gaze with marked eyelid retraction and convergence-retraction nystagmus. Ultrasound examination showed dilated lateral ventricles and a dilated third ventricle. Further imaging studies reveal a solid mass in the pineal region. Which of the following is the most likely finding for this patient?
Options:
{'A': 'Normal lumbar puncture opening pressure', 'B': 'Stenotic intraventricular foramina', 'C': 'Dilated cisterna magna', 'D': 'Compression of periaqueductal grey matter', 'E': 'Hypertrophic arachnoid granulations'}<|eot_id|>
<|start_header_id|>assistant<|end_header_id|>
Compression of periaqueductal grey matter<|eot_id|> |
A 72-year-old and his caregiver present for a follow-up after a transthoracic needle biopsy of one of the large lesions in his chest was reported as non-small cell carcinoma of the lung. Previously, a chest CT revealed numerous nodules in the lungs bilaterally. The chest CT was ordered after the patient experienced a persistent cough with hemoptysis and a history of multiple episodes of pneumonia over the past year. The patient has a history of dementia and is a poor historian. The caregiver states that the patient has no history of smoking and that he was a lawyer before he retired, 10 years ago. The caregiver can only provide a limited medical history, but states that the patient sees another doctor “to monitor his prostate”. Which of the following is true regarding the pathogenesis of the nodules seen in this patient?
Options:
{'A': "Aspergillus infection leading to a formation of a 'fungus ball'", 'B': 'Malignant transformation of neuroendocrine cells', 'C': 'Infection of the lung parenchyma with a gram-negative bacteria grown on charcoal yeast agar', 'D': 'Proliferation of cells that contain glands that produce mucin', 'E': 'Tumors seeded via the pulmonary arteries'} | {'A': "Aspergillus infection leading to a formation of a 'fungus ball'", 'B': 'Malignant transformation of neuroendocrine cells', 'C': 'Infection of the lung parenchyma with a gram-negative bacteria grown on charcoal yeast agar', 'D': 'Proliferation of cells that contain glands that produce mucin', 'E': 'Tumors seeded via the pulmonary arteries'} | Tumors seeded via the pulmonary arteries | <|start_header_id|>system<|end_header_id|>
The following are multiple choice questions about medical knowledge. Solve them in a step-by-step fashion, starting by summarizing the available information. Output a single option from the four options as the final answer.<|eot_id|>
<|start_header_id|>user<|end_header_id|>
A 72-year-old and his caregiver present for a follow-up after a transthoracic needle biopsy of one of the large lesions in his chest was reported as non-small cell carcinoma of the lung. Previously, a chest CT revealed numerous nodules in the lungs bilaterally. The chest CT was ordered after the patient experienced a persistent cough with hemoptysis and a history of multiple episodes of pneumonia over the past year. The patient has a history of dementia and is a poor historian. The caregiver states that the patient has no history of smoking and that he was a lawyer before he retired, 10 years ago. The caregiver can only provide a limited medical history, but states that the patient sees another doctor “to monitor his prostate”. Which of the following is true regarding the pathogenesis of the nodules seen in this patient?
Options:
{'A': "Aspergillus infection leading to a formation of a 'fungus ball'", 'B': 'Malignant transformation of neuroendocrine cells', 'C': 'Infection of the lung parenchyma with a gram-negative bacteria grown on charcoal yeast agar', 'D': 'Proliferation of cells that contain glands that produce mucin', 'E': 'Tumors seeded via the pulmonary arteries'}<|eot_id|>
<|start_header_id|>assistant<|end_header_id|>
Tumors seeded via the pulmonary arteries<|eot_id|> |
A clinical study is studying new genetic gene-based therapies for children and adults with sickle cell disease. The patients were informed that they were divided into two age groups since younger patients suffer from different complications of the disease. The pediatric group is more likely to suffer from which of the complications?
I. Splenic sequestration
II. Avascular necrosis
III. Pulmonary hypertension
IV. Acute chest syndrome
V. Nephropathy
Options:
{'A': 'I, II', 'B': 'I, IV, V', 'C': 'I, II, IV', 'D': 'III, IV', 'E': 'I, IV'} | {'A': 'I, II', 'B': 'I, IV, V', 'C': 'I, II, IV', 'D': 'III, IV', 'E': 'I, IV'} | I, IV | <|start_header_id|>system<|end_header_id|>
The following are multiple choice questions about medical knowledge. Solve them in a step-by-step fashion, starting by summarizing the available information. Output a single option from the four options as the final answer.<|eot_id|>
<|start_header_id|>user<|end_header_id|>
A clinical study is studying new genetic gene-based therapies for children and adults with sickle cell disease. The patients were informed that they were divided into two age groups since younger patients suffer from different complications of the disease. The pediatric group is more likely to suffer from which of the complications?
I. Splenic sequestration
II. Avascular necrosis
III. Pulmonary hypertension
IV. Acute chest syndrome
V. Nephropathy
Options:
{'A': 'I, II', 'B': 'I, IV, V', 'C': 'I, II, IV', 'D': 'III, IV', 'E': 'I, IV'}<|eot_id|>
<|start_header_id|>assistant<|end_header_id|>
I, IV<|eot_id|> |
An 8-day-old male infant presents to the pediatrician with a high-grade fever and poor feeding pattern with regurgitation of milk after each feeding. On examination the infant showed abnormal movements, hypertonia, and exaggerated DTRs. The mother explains that during her pregnancy, she has tried to eat only unprocessed foods and unpasterized dairy so that her baby would not be exposed to any preservatives or unhealthy chemicals. Which of the following characteristics describes the causative agent that caused this illness in the infant?
Options:
{'A': 'Gram-positive, facultative intracellular, motile bacilli', 'B': 'Gram-positive, catalase-negative, beta hemolytic, bacitracin resistant cocci', 'C': 'Gram-negative, lactose-fermenting, facultative anaerobic bacilli', 'D': 'Gram-positive, catalase-negative, alpha hemolytic, optochin sensitive cocci', 'E': 'Gram-negative, maltose fermenting diplococci'} | {'A': 'Gram-positive, facultative intracellular, motile bacilli', 'B': 'Gram-positive, catalase-negative, beta hemolytic, bacitracin resistant cocci', 'C': 'Gram-negative, lactose-fermenting, facultative anaerobic bacilli', 'D': 'Gram-positive, catalase-negative, alpha hemolytic, optochin sensitive cocci', 'E': 'Gram-negative, maltose fermenting diplococci'} | Gram-positive, facultative intracellular, motile bacilli | <|start_header_id|>system<|end_header_id|>
The following are multiple choice questions about medical knowledge. Solve them in a step-by-step fashion, starting by summarizing the available information. Output a single option from the four options as the final answer.<|eot_id|>
<|start_header_id|>user<|end_header_id|>
An 8-day-old male infant presents to the pediatrician with a high-grade fever and poor feeding pattern with regurgitation of milk after each feeding. On examination the infant showed abnormal movements, hypertonia, and exaggerated DTRs. The mother explains that during her pregnancy, she has tried to eat only unprocessed foods and unpasterized dairy so that her baby would not be exposed to any preservatives or unhealthy chemicals. Which of the following characteristics describes the causative agent that caused this illness in the infant?
Options:
{'A': 'Gram-positive, facultative intracellular, motile bacilli', 'B': 'Gram-positive, catalase-negative, beta hemolytic, bacitracin resistant cocci', 'C': 'Gram-negative, lactose-fermenting, facultative anaerobic bacilli', 'D': 'Gram-positive, catalase-negative, alpha hemolytic, optochin sensitive cocci', 'E': 'Gram-negative, maltose fermenting diplococci'}<|eot_id|>
<|start_header_id|>assistant<|end_header_id|>
Gram-positive, facultative intracellular, motile bacilli<|eot_id|> |
A 12-year-old boy is referred to a pediatric neurologist because of repetitive motions such as blinking or tilting his head. He is brought in by his mother who says that he also clears his throat and hums repeatedly. These actions have been happening for the past year and his mother is concerned. The boy was born at 39 weeks gestation via spontaneous vaginal delivery. He is up to date on all vaccinations and is meeting all developmental milestones. On physical exam, he shows no focal neurological deficits and is cognitively normal for his age. He occasionally sharply jerks his head to one side during the physical exam and utters obscene words. Which of the following is most associated with this condition?
Options:
{'A': '3 Hz spike-wave pattern on EEG', 'B': 'CAG repeat on the short arm of chromosome 4', 'C': 'Coprolalia', 'D': 'Severe atrophy of the caudate and putamen', 'E': 'X-linked MECP2 mutation with female predominance'} | {'A': '3 Hz spike-wave pattern on EEG', 'B': 'CAG repeat on the short arm of chromosome 4', 'C': 'Coprolalia', 'D': 'Severe atrophy of the caudate and putamen', 'E': 'X-linked MECP2 mutation with female predominance'} | Coprolalia | <|start_header_id|>system<|end_header_id|>
The following are multiple choice questions about medical knowledge. Solve them in a step-by-step fashion, starting by summarizing the available information. Output a single option from the four options as the final answer.<|eot_id|>
<|start_header_id|>user<|end_header_id|>
A 12-year-old boy is referred to a pediatric neurologist because of repetitive motions such as blinking or tilting his head. He is brought in by his mother who says that he also clears his throat and hums repeatedly. These actions have been happening for the past year and his mother is concerned. The boy was born at 39 weeks gestation via spontaneous vaginal delivery. He is up to date on all vaccinations and is meeting all developmental milestones. On physical exam, he shows no focal neurological deficits and is cognitively normal for his age. He occasionally sharply jerks his head to one side during the physical exam and utters obscene words. Which of the following is most associated with this condition?
Options:
{'A': '3 Hz spike-wave pattern on EEG', 'B': 'CAG repeat on the short arm of chromosome 4', 'C': 'Coprolalia', 'D': 'Severe atrophy of the caudate and putamen', 'E': 'X-linked MECP2 mutation with female predominance'}<|eot_id|>
<|start_header_id|>assistant<|end_header_id|>
Coprolalia<|eot_id|> |
An 15-year-old boy is brought to the emergency department after he passed out in the hallway. On presentation, he is alert but confused about why he is in the hospital. He says that he remembers seeing flashes of light to his right while walking out of class but cannot recall what happened next. His next memory is being woken up by emergency responders who wheeled him into an ambulance. A friend who was with him at the time says that he seemed to be swallowing repeatedly and staring out into space. He has never had an episode like this before, and his past medical history is unremarkable. Which of the following characteristics is most likely true of the cause of this patient's symptoms?
Options:
{'A': 'Begins with 10-15 seconds of muscle contraction', 'B': 'Demonstrates quick and repetitive jerks of extremities', 'C': 'Episodes with 3-4 hertz spike and wave discharges', 'D': 'Isolated to the left occipital lobe', 'E': 'Starts in the left occipital lobe and then generalizes'} | {'A': 'Begins with 10-15 seconds of muscle contraction', 'B': 'Demonstrates quick and repetitive jerks of extremities', 'C': 'Episodes with 3-4 hertz spike and wave discharges', 'D': 'Isolated to the left occipital lobe', 'E': 'Starts in the left occipital lobe and then generalizes'} | Starts in the left occipital lobe and then generalizes | <|start_header_id|>system<|end_header_id|>
The following are multiple choice questions about medical knowledge. Solve them in a step-by-step fashion, starting by summarizing the available information. Output a single option from the four options as the final answer.<|eot_id|>
<|start_header_id|>user<|end_header_id|>
An 15-year-old boy is brought to the emergency department after he passed out in the hallway. On presentation, he is alert but confused about why he is in the hospital. He says that he remembers seeing flashes of light to his right while walking out of class but cannot recall what happened next. His next memory is being woken up by emergency responders who wheeled him into an ambulance. A friend who was with him at the time says that he seemed to be swallowing repeatedly and staring out into space. He has never had an episode like this before, and his past medical history is unremarkable. Which of the following characteristics is most likely true of the cause of this patient's symptoms?
Options:
{'A': 'Begins with 10-15 seconds of muscle contraction', 'B': 'Demonstrates quick and repetitive jerks of extremities', 'C': 'Episodes with 3-4 hertz spike and wave discharges', 'D': 'Isolated to the left occipital lobe', 'E': 'Starts in the left occipital lobe and then generalizes'}<|eot_id|>
<|start_header_id|>assistant<|end_header_id|>
Starts in the left occipital lobe and then generalizes<|eot_id|> |
A 27-year-old man presents to the emergency department after a dog bite. The patient was intoxicated and pulled the dog’s tail while it was eating. The dog belongs to his friend and is back at his friend’s house currently. Physical exam is notable for a dog bite on the patient’s right arm. The wound is irrigated and explored with no retained bodies found. A tetanus vaccination is administered. Which of the following is appropriate management of this patient?
Options:
{'A': 'Administer amoxicillin-clavulanic acid', 'B': 'Administer the rabies vaccine and rabies immunoglobulin', 'C': 'Administer trimethoprim-sulfamethoxazole', 'D': 'Close the wound with sutures and discharge the patient', 'E': 'Discharge the patient with outpatient follow up'} | {'A': 'Administer amoxicillin-clavulanic acid', 'B': 'Administer the rabies vaccine and rabies immunoglobulin', 'C': 'Administer trimethoprim-sulfamethoxazole', 'D': 'Close the wound with sutures and discharge the patient', 'E': 'Discharge the patient with outpatient follow up'} | Administer amoxicillin-clavulanic acid | <|start_header_id|>system<|end_header_id|>
The following are multiple choice questions about medical knowledge. Solve them in a step-by-step fashion, starting by summarizing the available information. Output a single option from the four options as the final answer.<|eot_id|>
<|start_header_id|>user<|end_header_id|>
A 27-year-old man presents to the emergency department after a dog bite. The patient was intoxicated and pulled the dog’s tail while it was eating. The dog belongs to his friend and is back at his friend’s house currently. Physical exam is notable for a dog bite on the patient’s right arm. The wound is irrigated and explored with no retained bodies found. A tetanus vaccination is administered. Which of the following is appropriate management of this patient?
Options:
{'A': 'Administer amoxicillin-clavulanic acid', 'B': 'Administer the rabies vaccine and rabies immunoglobulin', 'C': 'Administer trimethoprim-sulfamethoxazole', 'D': 'Close the wound with sutures and discharge the patient', 'E': 'Discharge the patient with outpatient follow up'}<|eot_id|>
<|start_header_id|>assistant<|end_header_id|>
Administer amoxicillin-clavulanic acid<|eot_id|> |
A 25-year-old woman comes to the emergency department one hour after the sudden onset of diffuse abdominal pain and nausea. She has no history of serious illness. Menses occur at regular 27-day intervals and last 4 to 6 days with moderate flow. Her last menstrual period was 6 weeks ago. She is sexually active with two sexual partners and uses oral contraceptive pills inconsistently. She appears pale and diaphoretic. Her temperature is 37.7°C (99.9°F), pulse is 120/min, respirations are 20/min, and blood pressure is 85/70 mm Hg. Abdominal examination shows diffuse abdominal tenderness. Pelvic examination shows a normal appearing vagina, cervix, and uterus, with right adnexal tenderness. Her hemoglobin concentration is 13 g/dL, leukocyte count is 10,000/mm3, and platelet count is 350,000/mm3. Results of a pregnancy test are pending. Which of the following is the most appropriate next step in management?
Options:
{'A': 'Perform exploratory laparoscopy', 'B': 'Administer intravenous normal saline fluids', 'C': 'Perform CT scan of the abdomen and pelvis with contrast', 'D': 'Transfuse O negative packed red blood cells', 'E': 'Perform pelvic ultrasound'} | {'A': 'Perform exploratory laparoscopy', 'B': 'Administer intravenous normal saline fluids', 'C': 'Perform CT scan of the abdomen and pelvis with contrast', 'D': 'Transfuse O negative packed red blood cells', 'E': 'Perform pelvic ultrasound'} | Administer intravenous normal saline fluids | <|start_header_id|>system<|end_header_id|>
The following are multiple choice questions about medical knowledge. Solve them in a step-by-step fashion, starting by summarizing the available information. Output a single option from the four options as the final answer.<|eot_id|>
<|start_header_id|>user<|end_header_id|>
A 25-year-old woman comes to the emergency department one hour after the sudden onset of diffuse abdominal pain and nausea. She has no history of serious illness. Menses occur at regular 27-day intervals and last 4 to 6 days with moderate flow. Her last menstrual period was 6 weeks ago. She is sexually active with two sexual partners and uses oral contraceptive pills inconsistently. She appears pale and diaphoretic. Her temperature is 37.7°C (99.9°F), pulse is 120/min, respirations are 20/min, and blood pressure is 85/70 mm Hg. Abdominal examination shows diffuse abdominal tenderness. Pelvic examination shows a normal appearing vagina, cervix, and uterus, with right adnexal tenderness. Her hemoglobin concentration is 13 g/dL, leukocyte count is 10,000/mm3, and platelet count is 350,000/mm3. Results of a pregnancy test are pending. Which of the following is the most appropriate next step in management?
Options:
{'A': 'Perform exploratory laparoscopy', 'B': 'Administer intravenous normal saline fluids', 'C': 'Perform CT scan of the abdomen and pelvis with contrast', 'D': 'Transfuse O negative packed red blood cells', 'E': 'Perform pelvic ultrasound'}<|eot_id|>
<|start_header_id|>assistant<|end_header_id|>
Administer intravenous normal saline fluids<|eot_id|> |
A 43-year-old man comes to the physician for a 1-week history of swelling around his eyes and decreased urination. His pulse is 87/min, and blood pressure is 152/95 mm Hg. Physical examination shows 1+ periorbital and pretibial edema. Serum studies show a urea nitrogen concentration of 21 mg/dL and a creatinine concentration of 1.4 mg/dL. Urinalysis shows 3+ blood and 1+ protein. Further evaluation of this patient is most likely to show which of the following?
Options:
{'A': 'Urinary rhomboid crystals', 'B': 'Hypoalbuminemia', 'C': 'Renal interstitial inflammation', 'D': 'Red blood cell casts', 'E': 'Detached renal tubular epithelial cells'} | {'A': 'Urinary rhomboid crystals', 'B': 'Hypoalbuminemia', 'C': 'Renal interstitial inflammation', 'D': 'Red blood cell casts', 'E': 'Detached renal tubular epithelial cells'} | Red blood cell casts | <|start_header_id|>system<|end_header_id|>
The following are multiple choice questions about medical knowledge. Solve them in a step-by-step fashion, starting by summarizing the available information. Output a single option from the four options as the final answer.<|eot_id|>
<|start_header_id|>user<|end_header_id|>
A 43-year-old man comes to the physician for a 1-week history of swelling around his eyes and decreased urination. His pulse is 87/min, and blood pressure is 152/95 mm Hg. Physical examination shows 1+ periorbital and pretibial edema. Serum studies show a urea nitrogen concentration of 21 mg/dL and a creatinine concentration of 1.4 mg/dL. Urinalysis shows 3+ blood and 1+ protein. Further evaluation of this patient is most likely to show which of the following?
Options:
{'A': 'Urinary rhomboid crystals', 'B': 'Hypoalbuminemia', 'C': 'Renal interstitial inflammation', 'D': 'Red blood cell casts', 'E': 'Detached renal tubular epithelial cells'}<|eot_id|>
<|start_header_id|>assistant<|end_header_id|>
Red blood cell casts<|eot_id|> |
An 8-year-old boy is brought to the physician because of a 7-day history of a progressively worsening cough. The cough occurs in spells and consists of around 5–10 coughs in succession. After each spell he takes a deep, noisy breath. He has vomited occasionally following a bout of coughing. He had a runny nose for a week before the cough started. His immunization records are unavailable. He lives in an apartment with his father, mother, and his 2-week-old sister. The mother was given a Tdap vaccination 11 years ago. The father's vaccination records are unavailable. His temperature is 37.8°C (100.0°F). Examination shows no abnormalities. His leukocyte count is 42,000/mm3. Throat swab culture and PCR results are pending. Which of the following are the most appropriate recommendations for this family?
Options:
{'A': 'Administer oral azithromycin to the baby and father and Tdap vaccination to the father', 'B': 'Administer oral azithromycin to all family members and Tdap vaccination to the father and mother', 'C': 'Administer oral erythromycin to all family members and Tdap vaccination to the father', 'D': 'Administer oral trimethoprim-sulfamethaxazole to the father and baby and Tdap vaccination to the father', 'E': 'Administer oral azithromycin to all family members and Tdap vaccination to the father'} | {'A': 'Administer oral azithromycin to the baby and father and Tdap vaccination to the father', 'B': 'Administer oral azithromycin to all family members and Tdap vaccination to the father and mother', 'C': 'Administer oral erythromycin to all family members and Tdap vaccination to the father', 'D': 'Administer oral trimethoprim-sulfamethaxazole to the father and baby and Tdap vaccination to the father', 'E': 'Administer oral azithromycin to all family members and Tdap vaccination to the father'} | Administer oral azithromycin to all family members and Tdap vaccination to the father and mother | <|start_header_id|>system<|end_header_id|>
The following are multiple choice questions about medical knowledge. Solve them in a step-by-step fashion, starting by summarizing the available information. Output a single option from the four options as the final answer.<|eot_id|>
<|start_header_id|>user<|end_header_id|>
An 8-year-old boy is brought to the physician because of a 7-day history of a progressively worsening cough. The cough occurs in spells and consists of around 5–10 coughs in succession. After each spell he takes a deep, noisy breath. He has vomited occasionally following a bout of coughing. He had a runny nose for a week before the cough started. His immunization records are unavailable. He lives in an apartment with his father, mother, and his 2-week-old sister. The mother was given a Tdap vaccination 11 years ago. The father's vaccination records are unavailable. His temperature is 37.8°C (100.0°F). Examination shows no abnormalities. His leukocyte count is 42,000/mm3. Throat swab culture and PCR results are pending. Which of the following are the most appropriate recommendations for this family?
Options:
{'A': 'Administer oral azithromycin to the baby and father and Tdap vaccination to the father', 'B': 'Administer oral azithromycin to all family members and Tdap vaccination to the father and mother', 'C': 'Administer oral erythromycin to all family members and Tdap vaccination to the father', 'D': 'Administer oral trimethoprim-sulfamethaxazole to the father and baby and Tdap vaccination to the father', 'E': 'Administer oral azithromycin to all family members and Tdap vaccination to the father'}<|eot_id|>
<|start_header_id|>assistant<|end_header_id|>
Administer oral azithromycin to all family members and Tdap vaccination to the father and mother<|eot_id|> |
Six days after undergoing a thoracic endovascular aortic repair following a high-speed motorcycle accident, a 29-year-old woman develops a fever, cough, and shortness of breath. Serum studies show a sodium concentration of 129 mEq/L. An x-ray of the chest shows a left-sided pleural effusion. Thoracentesis is performed and shows milky white fluid in the pleural space that remains uniform after centrifugation. A culture of the pleural fluid shows no organisms. Further analysis of the fluid would most likely show which of the following?
Options:
{'A': 'High triglycerides', 'B': 'Antinuclear antibodies', 'C': 'High adenosine deaminase', 'D': 'Cholesterol crystals', 'E': 'High LDH'} | {'A': 'High triglycerides', 'B': 'Antinuclear antibodies', 'C': 'High adenosine deaminase', 'D': 'Cholesterol crystals', 'E': 'High LDH'} | High triglycerides | <|start_header_id|>system<|end_header_id|>
The following are multiple choice questions about medical knowledge. Solve them in a step-by-step fashion, starting by summarizing the available information. Output a single option from the four options as the final answer.<|eot_id|>
<|start_header_id|>user<|end_header_id|>
Six days after undergoing a thoracic endovascular aortic repair following a high-speed motorcycle accident, a 29-year-old woman develops a fever, cough, and shortness of breath. Serum studies show a sodium concentration of 129 mEq/L. An x-ray of the chest shows a left-sided pleural effusion. Thoracentesis is performed and shows milky white fluid in the pleural space that remains uniform after centrifugation. A culture of the pleural fluid shows no organisms. Further analysis of the fluid would most likely show which of the following?
Options:
{'A': 'High triglycerides', 'B': 'Antinuclear antibodies', 'C': 'High adenosine deaminase', 'D': 'Cholesterol crystals', 'E': 'High LDH'}<|eot_id|>
<|start_header_id|>assistant<|end_header_id|>
High triglycerides<|eot_id|> |
A newborn male is evaluated in the hospital nursery 24 hours after birth for cyanosis. The patient was born at 38 weeks gestation to a 36-year-old gravida 3 via cesarean section for fetal distress. The patient’s mother received inconsistent prenatal care, and the delivery was uncomplicated. The patient’s Apgar evaluation was notable for acrocyanosis at both 1 and 5 minutes of life. The patient’s mother denies any family history of congenital heart disease. The patient’s father has a past medical history of hypertension, and one of the patient’s older siblings was recently diagnosed with autism spectrum disorder. The patient’s birth weight was 3180 g (7 lb 0 oz). In the hospital nursery, his temperature is 99.3°F (37.4°C), blood pressure is 66/37 mmHg, pulse is 179/min, and respirations are 42/min. On physical exam, the patient is in moderate distress. He has low-set ears, orbital hypertelorism, and a cleft palate. The patient is centrally cyanotic. A chest CT shows thymic hypoplasia. Echocardiography demonstrates a single vessel emanating from both the right and left ventricle.
This patient should be urgently evaluated for which of the following acute complications?
Options:
{'A': 'Cerebral edema', 'B': 'Hypoglycemia', 'C': 'Neuromuscular irritability', 'D': 'Rhabdomyolysis', 'E': 'Shortening of the QT interval'} | {'A': 'Cerebral edema', 'B': 'Hypoglycemia', 'C': 'Neuromuscular irritability', 'D': 'Rhabdomyolysis', 'E': 'Shortening of the QT interval'} | Neuromuscular irritability | <|start_header_id|>system<|end_header_id|>
The following are multiple choice questions about medical knowledge. Solve them in a step-by-step fashion, starting by summarizing the available information. Output a single option from the four options as the final answer.<|eot_id|>
<|start_header_id|>user<|end_header_id|>
A newborn male is evaluated in the hospital nursery 24 hours after birth for cyanosis. The patient was born at 38 weeks gestation to a 36-year-old gravida 3 via cesarean section for fetal distress. The patient’s mother received inconsistent prenatal care, and the delivery was uncomplicated. The patient’s Apgar evaluation was notable for acrocyanosis at both 1 and 5 minutes of life. The patient’s mother denies any family history of congenital heart disease. The patient’s father has a past medical history of hypertension, and one of the patient’s older siblings was recently diagnosed with autism spectrum disorder. The patient’s birth weight was 3180 g (7 lb 0 oz). In the hospital nursery, his temperature is 99.3°F (37.4°C), blood pressure is 66/37 mmHg, pulse is 179/min, and respirations are 42/min. On physical exam, the patient is in moderate distress. He has low-set ears, orbital hypertelorism, and a cleft palate. The patient is centrally cyanotic. A chest CT shows thymic hypoplasia. Echocardiography demonstrates a single vessel emanating from both the right and left ventricle.
This patient should be urgently evaluated for which of the following acute complications?
Options:
{'A': 'Cerebral edema', 'B': 'Hypoglycemia', 'C': 'Neuromuscular irritability', 'D': 'Rhabdomyolysis', 'E': 'Shortening of the QT interval'}<|eot_id|>
<|start_header_id|>assistant<|end_header_id|>
Neuromuscular irritability<|eot_id|> |
A 53-year-old man presents to a physician with repeated episodes of joint pain and fever for the last 3 months. The pain is present in the knee joints and small joints of the hands bilaterally. He recorded his temperature at home which never increased above 37.8°C (100.0°F). The medical history is significant for an acute myocardial infarction 1 year ago, with sustained ventricular tachycardia as a complication, for which he has been taking procainamide. The vital signs are as follows: pulse 88/min, blood pressure 134/88 mm Hg, respiratory rate 13/min, and temperature 37.2°C (99.0°F). On physical examination, he has mild joint swelling. A radiologic evaluation of the involved joints does not suggest osteoarthritis or rheumatoid arthritis. Based on the laboratory evaluation, the physician suspects that the joint pain and fever may be due to the use of procainamide. Which of the following serologic finding is most likely to be present in this patient?
Options:
{'A': 'Presence of anti-dsDNA antibodies', 'B': 'Decreased serum C4 level', 'C': 'Decreased serum C3 level', 'D': 'Presence of anti-histone antibodies', 'E': 'Presence of anti-Sm antibodies'} | {'A': 'Presence of anti-dsDNA antibodies', 'B': 'Decreased serum C4 level', 'C': 'Decreased serum C3 level', 'D': 'Presence of anti-histone antibodies', 'E': 'Presence of anti-Sm antibodies'} | Presence of anti-histone antibodies | <|start_header_id|>system<|end_header_id|>
The following are multiple choice questions about medical knowledge. Solve them in a step-by-step fashion, starting by summarizing the available information. Output a single option from the four options as the final answer.<|eot_id|>
<|start_header_id|>user<|end_header_id|>
A 53-year-old man presents to a physician with repeated episodes of joint pain and fever for the last 3 months. The pain is present in the knee joints and small joints of the hands bilaterally. He recorded his temperature at home which never increased above 37.8°C (100.0°F). The medical history is significant for an acute myocardial infarction 1 year ago, with sustained ventricular tachycardia as a complication, for which he has been taking procainamide. The vital signs are as follows: pulse 88/min, blood pressure 134/88 mm Hg, respiratory rate 13/min, and temperature 37.2°C (99.0°F). On physical examination, he has mild joint swelling. A radiologic evaluation of the involved joints does not suggest osteoarthritis or rheumatoid arthritis. Based on the laboratory evaluation, the physician suspects that the joint pain and fever may be due to the use of procainamide. Which of the following serologic finding is most likely to be present in this patient?
Options:
{'A': 'Presence of anti-dsDNA antibodies', 'B': 'Decreased serum C4 level', 'C': 'Decreased serum C3 level', 'D': 'Presence of anti-histone antibodies', 'E': 'Presence of anti-Sm antibodies'}<|eot_id|>
<|start_header_id|>assistant<|end_header_id|>
Presence of anti-histone antibodies<|eot_id|> |
Group of 100 medical students took an end of the year exam. The mean score on the exam was 70%, with a standard deviation of 25%. The professor states that a student's score must be within the 95% confidence interval of the mean to pass the exam. Which of the following is the minimum score a student can have to pass the exam?
Options:
{'A': '65%', 'B': '67.5%', 'C': '63.75%', 'D': '20%', 'E': '45%'} | {'A': '65%', 'B': '67.5%', 'C': '63.75%', 'D': '20%', 'E': '45%'} | 65% | <|start_header_id|>system<|end_header_id|>
The following are multiple choice questions about medical knowledge. Solve them in a step-by-step fashion, starting by summarizing the available information. Output a single option from the four options as the final answer.<|eot_id|>
<|start_header_id|>user<|end_header_id|>
Group of 100 medical students took an end of the year exam. The mean score on the exam was 70%, with a standard deviation of 25%. The professor states that a student's score must be within the 95% confidence interval of the mean to pass the exam. Which of the following is the minimum score a student can have to pass the exam?
Options:
{'A': '65%', 'B': '67.5%', 'C': '63.75%', 'D': '20%', 'E': '45%'}<|eot_id|>
<|start_header_id|>assistant<|end_header_id|>
65%<|eot_id|> |
A 44-year-old woman comes to the physician because of progressively worsening shortness of breath with exertion and intermittent palpitations over the last 2 months. She has had neither chest pain nor a cough. Her pulse is 124/min and irregular. Physical examination shows a grade 4/6 high-pitched holosystolic murmur that is best heard at the apex and radiates to the back. The murmur increases in intensity when she clenches her hands into fists. The lungs are clear to auscultation. Further evaluation of this patient is most likely to show which of the following findings?
Options:
{'A': 'Pulmonary artery thrombus on computed tomography scan', 'B': 'Diffuse ST elevations on electrocardiogram', 'C': 'Obstruction of the right marginal artery on coronary angiogram', 'D': 'Reversible area of myocardial ischemia on nuclear stress test', 'E': 'Dilation of left atrium on echocardiogram'} | {'A': 'Pulmonary artery thrombus on computed tomography scan', 'B': 'Diffuse ST elevations on electrocardiogram', 'C': 'Obstruction of the right marginal artery on coronary angiogram', 'D': 'Reversible area of myocardial ischemia on nuclear stress test', 'E': 'Dilation of left atrium on echocardiogram'} | Dilation of left atrium on echocardiogram | <|start_header_id|>system<|end_header_id|>
The following are multiple choice questions about medical knowledge. Solve them in a step-by-step fashion, starting by summarizing the available information. Output a single option from the four options as the final answer.<|eot_id|>
<|start_header_id|>user<|end_header_id|>
A 44-year-old woman comes to the physician because of progressively worsening shortness of breath with exertion and intermittent palpitations over the last 2 months. She has had neither chest pain nor a cough. Her pulse is 124/min and irregular. Physical examination shows a grade 4/6 high-pitched holosystolic murmur that is best heard at the apex and radiates to the back. The murmur increases in intensity when she clenches her hands into fists. The lungs are clear to auscultation. Further evaluation of this patient is most likely to show which of the following findings?
Options:
{'A': 'Pulmonary artery thrombus on computed tomography scan', 'B': 'Diffuse ST elevations on electrocardiogram', 'C': 'Obstruction of the right marginal artery on coronary angiogram', 'D': 'Reversible area of myocardial ischemia on nuclear stress test', 'E': 'Dilation of left atrium on echocardiogram'}<|eot_id|>
<|start_header_id|>assistant<|end_header_id|>
Dilation of left atrium on echocardiogram<|eot_id|> |
A 3-week old boy is brought to the physician for the evaluation of lethargy, recurrent vomiting, and poor weight gain since birth. Physical examination shows decreased skin turgor and a bulging frontal fontanelle. Serum studies show an ammonia concentration of 170 μmol/L (N < 30) and low serum citrulline levels. The oral intake of which of the following nutrients should be restricted in this patient?
Options:
{'A': 'Fructose', 'B': 'Protein', 'C': 'Vitamin A', 'D': 'Gluten', 'E': 'Lactose'} | {'A': 'Fructose', 'B': 'Protein', 'C': 'Vitamin A', 'D': 'Gluten', 'E': 'Lactose'} | Protein | <|start_header_id|>system<|end_header_id|>
The following are multiple choice questions about medical knowledge. Solve them in a step-by-step fashion, starting by summarizing the available information. Output a single option from the four options as the final answer.<|eot_id|>
<|start_header_id|>user<|end_header_id|>
A 3-week old boy is brought to the physician for the evaluation of lethargy, recurrent vomiting, and poor weight gain since birth. Physical examination shows decreased skin turgor and a bulging frontal fontanelle. Serum studies show an ammonia concentration of 170 μmol/L (N < 30) and low serum citrulline levels. The oral intake of which of the following nutrients should be restricted in this patient?
Options:
{'A': 'Fructose', 'B': 'Protein', 'C': 'Vitamin A', 'D': 'Gluten', 'E': 'Lactose'}<|eot_id|>
<|start_header_id|>assistant<|end_header_id|>
Protein<|eot_id|> |
A 66-year-old man with coronary artery disease and hypertension comes to the emergency department because of intermittent retrosternal chest pain, lightheadedness, and palpitations. He has smoked one pack of cigarettes daily for 39 years. His pulse is 140/min and irregularly irregular, respirations are 20/min, and blood pressure is 108/60 mm Hg. An ECG shows an irregular, narrow-complex tachycardia with absent P waves. A drug with which of the following mechanisms of action is most likely to be effective in the long-term prevention of embolic stroke in this patient?
Options:
{'A': 'Binding and activation of antithrombin III', 'B': 'Irreversible inhibition of cyclooxygenase', 'C': 'Interference with carboxylation of glutamate residues', 'D': 'Activation of the conversion of plasminogen to plasmin', 'E': 'Irreversible blockade of adenosine diphosphate receptors'} | {'A': 'Binding and activation of antithrombin III', 'B': 'Irreversible inhibition of cyclooxygenase', 'C': 'Interference with carboxylation of glutamate residues', 'D': 'Activation of the conversion of plasminogen to plasmin', 'E': 'Irreversible blockade of adenosine diphosphate receptors'} | Interference with carboxylation of glutamate residues | <|start_header_id|>system<|end_header_id|>
The following are multiple choice questions about medical knowledge. Solve them in a step-by-step fashion, starting by summarizing the available information. Output a single option from the four options as the final answer.<|eot_id|>
<|start_header_id|>user<|end_header_id|>
A 66-year-old man with coronary artery disease and hypertension comes to the emergency department because of intermittent retrosternal chest pain, lightheadedness, and palpitations. He has smoked one pack of cigarettes daily for 39 years. His pulse is 140/min and irregularly irregular, respirations are 20/min, and blood pressure is 108/60 mm Hg. An ECG shows an irregular, narrow-complex tachycardia with absent P waves. A drug with which of the following mechanisms of action is most likely to be effective in the long-term prevention of embolic stroke in this patient?
Options:
{'A': 'Binding and activation of antithrombin III', 'B': 'Irreversible inhibition of cyclooxygenase', 'C': 'Interference with carboxylation of glutamate residues', 'D': 'Activation of the conversion of plasminogen to plasmin', 'E': 'Irreversible blockade of adenosine diphosphate receptors'}<|eot_id|>
<|start_header_id|>assistant<|end_header_id|>
Interference with carboxylation of glutamate residues<|eot_id|> |
A 49-year-old woman comes to the physician because of difficulty walking and dizziness for the past 2 weeks. She has also had fatigue, heartburn, and diarrhea for 4 months. The stools are foul-smelling and do not flush easily. Over the past 4 months, she has had a 2.2-kg (5-lb) weight loss. Her only medication is an over-the-counter antacid. Her mother has autoimmune thyroid disease and Crohn disease. She is 150 cm (4 ft 11 in) tall and weighs 43 kg (95 lb); BMI is 19.1 kg/m2. Vital signs are within normal limits. Examination shows a wide-based gait. Muscle strength and tone are normal in all extremities. Rapid alternating movement of the hands is impaired. The abdomen is soft and there is mild tenderness to palpation in the epigastric area. Her hemoglobin concentration is 11.1 mg/dL, and levels of vitamin E and vitamin D are decreased. Upper endoscopy shows several ulcers in the gastric antrum and the descending duodenum. Which of the following is the most likely underlying mechanism of this patient's symptoms?
Options:
{'A': 'Autoantibodies against the intestinal mucosa', 'B': 'Inactivation of pancreatic enzymes', 'C': 'T. whipplei infiltration of intestinal villi', 'D': 'Intestinal inflammatory reaction to gluten', 'E': 'Small intestine bacterial overgrowth'} | {'A': 'Autoantibodies against the intestinal mucosa', 'B': 'Inactivation of pancreatic enzymes', 'C': 'T. whipplei infiltration of intestinal villi', 'D': 'Intestinal inflammatory reaction to gluten', 'E': 'Small intestine bacterial overgrowth'} | Inactivation of pancreatic enzymes | <|start_header_id|>system<|end_header_id|>
The following are multiple choice questions about medical knowledge. Solve them in a step-by-step fashion, starting by summarizing the available information. Output a single option from the four options as the final answer.<|eot_id|>
<|start_header_id|>user<|end_header_id|>
A 49-year-old woman comes to the physician because of difficulty walking and dizziness for the past 2 weeks. She has also had fatigue, heartburn, and diarrhea for 4 months. The stools are foul-smelling and do not flush easily. Over the past 4 months, she has had a 2.2-kg (5-lb) weight loss. Her only medication is an over-the-counter antacid. Her mother has autoimmune thyroid disease and Crohn disease. She is 150 cm (4 ft 11 in) tall and weighs 43 kg (95 lb); BMI is 19.1 kg/m2. Vital signs are within normal limits. Examination shows a wide-based gait. Muscle strength and tone are normal in all extremities. Rapid alternating movement of the hands is impaired. The abdomen is soft and there is mild tenderness to palpation in the epigastric area. Her hemoglobin concentration is 11.1 mg/dL, and levels of vitamin E and vitamin D are decreased. Upper endoscopy shows several ulcers in the gastric antrum and the descending duodenum. Which of the following is the most likely underlying mechanism of this patient's symptoms?
Options:
{'A': 'Autoantibodies against the intestinal mucosa', 'B': 'Inactivation of pancreatic enzymes', 'C': 'T. whipplei infiltration of intestinal villi', 'D': 'Intestinal inflammatory reaction to gluten', 'E': 'Small intestine bacterial overgrowth'}<|eot_id|>
<|start_header_id|>assistant<|end_header_id|>
Inactivation of pancreatic enzymes<|eot_id|> |
A 19-year-old nulligravid woman comes to the physician because of irregular heavy menstrual bleeding since menarche at age 16 years. Menses occur at irregular 15- to 45-day intervals and last 7 to 10 days. She has also noted increased hair growth on her face. She has not been sexually active since she started taking isotretinoin for acne vulgaris 4 months ago. Her 70-year-old grandmother has breast cancer. She is 163 cm (5 ft 4 in) tall and weighs 74 kg (163 lb); BMI is 28 kg/m2. Pelvic examination shows copious cervical mucus and slightly enlarged irregular ovaries. If left untreated, this patient is at an increased risk for which of the following complications?
Options:
{'A': 'Endometrial cancer', 'B': 'Thyroid lymphoma', 'C': 'Osteoporosis', 'D': 'Proximal myopathy', 'E': 'Breast cancer'} | {'A': 'Endometrial cancer', 'B': 'Thyroid lymphoma', 'C': 'Osteoporosis', 'D': 'Proximal myopathy', 'E': 'Breast cancer'} | Endometrial cancer | <|start_header_id|>system<|end_header_id|>
The following are multiple choice questions about medical knowledge. Solve them in a step-by-step fashion, starting by summarizing the available information. Output a single option from the four options as the final answer.<|eot_id|>
<|start_header_id|>user<|end_header_id|>
A 19-year-old nulligravid woman comes to the physician because of irregular heavy menstrual bleeding since menarche at age 16 years. Menses occur at irregular 15- to 45-day intervals and last 7 to 10 days. She has also noted increased hair growth on her face. She has not been sexually active since she started taking isotretinoin for acne vulgaris 4 months ago. Her 70-year-old grandmother has breast cancer. She is 163 cm (5 ft 4 in) tall and weighs 74 kg (163 lb); BMI is 28 kg/m2. Pelvic examination shows copious cervical mucus and slightly enlarged irregular ovaries. If left untreated, this patient is at an increased risk for which of the following complications?
Options:
{'A': 'Endometrial cancer', 'B': 'Thyroid lymphoma', 'C': 'Osteoporosis', 'D': 'Proximal myopathy', 'E': 'Breast cancer'}<|eot_id|>
<|start_header_id|>assistant<|end_header_id|>
Endometrial cancer<|eot_id|> |
Three days after undergoing coronary artery bypass surgery, a 72-year-old man has severe right upper quadrant pain, fever, nausea, and vomiting. He has type 2 diabetes mellitus, benign prostatic hyperplasia, peripheral vascular disease, and chronic mesenteric ischemia. He had smoked one pack of cigarettes daily for 30 years but quit 10 years ago. He drinks 8 cans of beer a week. His preoperative medications include metformin, aspirin, simvastatin, and finasteride. His temperature is 38.9°C (102°F), pulse is 102/min, respirations are 18/min, and blood pressure is 110/60 mmHg. Auscultation of the lungs shows bilateral inspiratory crackles. Cardiac examination shows no murmurs, rubs or gallops. Abdominal examination shows soft abdomen with tenderness and sudden inspiratory arrest upon palpation in the right upper quadrant. There is no rebound tenderness or guarding. Laboratory studies show the following:
Hemoglobin 13.1 g/dL
Hematocrit 42%
Leukocyte count 15,700/mm3
Segmented neutrophils 65%
Bands 10%
Lymphocytes 20%
Monocytes 3%
Eosinophils 1%
Basophils 0.5%
AST 40 U/L
ALT 100 U/L
Alkaline phosphatase 85 U/L
Total bilirubin 1.5 mg/dL
Direct 0.9 mg/dL
Amylase 90 U/L
Abdominal ultrasonography shows a distended gallbladder, thickened gallbladder wall with pericholecystic fluid, and no stones. Which of the following is the most appropriate next step in management?"
Options:
{'A': 'Intravenous heparin therapy followed by embolectomy', 'B': 'Careful observation with serial abdominal examinations', 'C': 'Immediate cholecystectomy', 'D': 'Intravenous piperacillin-tazobactam therapy and percutaneous cholecystostomy', 'E': 'Endoscopic retrograde cholangiopancreatography with papillotomy'} | {'A': 'Intravenous heparin therapy followed by embolectomy', 'B': 'Careful observation with serial abdominal examinations', 'C': 'Immediate cholecystectomy', 'D': 'Intravenous piperacillin-tazobactam therapy and percutaneous cholecystostomy', 'E': 'Endoscopic retrograde cholangiopancreatography with papillotomy'} | Intravenous piperacillin-tazobactam therapy and percutaneous cholecystostomy | <|start_header_id|>system<|end_header_id|>
The following are multiple choice questions about medical knowledge. Solve them in a step-by-step fashion, starting by summarizing the available information. Output a single option from the four options as the final answer.<|eot_id|>
<|start_header_id|>user<|end_header_id|>
Three days after undergoing coronary artery bypass surgery, a 72-year-old man has severe right upper quadrant pain, fever, nausea, and vomiting. He has type 2 diabetes mellitus, benign prostatic hyperplasia, peripheral vascular disease, and chronic mesenteric ischemia. He had smoked one pack of cigarettes daily for 30 years but quit 10 years ago. He drinks 8 cans of beer a week. His preoperative medications include metformin, aspirin, simvastatin, and finasteride. His temperature is 38.9°C (102°F), pulse is 102/min, respirations are 18/min, and blood pressure is 110/60 mmHg. Auscultation of the lungs shows bilateral inspiratory crackles. Cardiac examination shows no murmurs, rubs or gallops. Abdominal examination shows soft abdomen with tenderness and sudden inspiratory arrest upon palpation in the right upper quadrant. There is no rebound tenderness or guarding. Laboratory studies show the following:
Hemoglobin 13.1 g/dL
Hematocrit 42%
Leukocyte count 15,700/mm3
Segmented neutrophils 65%
Bands 10%
Lymphocytes 20%
Monocytes 3%
Eosinophils 1%
Basophils 0.5%
AST 40 U/L
ALT 100 U/L
Alkaline phosphatase 85 U/L
Total bilirubin 1.5 mg/dL
Direct 0.9 mg/dL
Amylase 90 U/L
Abdominal ultrasonography shows a distended gallbladder, thickened gallbladder wall with pericholecystic fluid, and no stones. Which of the following is the most appropriate next step in management?"
Options:
{'A': 'Intravenous heparin therapy followed by embolectomy', 'B': 'Careful observation with serial abdominal examinations', 'C': 'Immediate cholecystectomy', 'D': 'Intravenous piperacillin-tazobactam therapy and percutaneous cholecystostomy', 'E': 'Endoscopic retrograde cholangiopancreatography with papillotomy'}<|eot_id|>
<|start_header_id|>assistant<|end_header_id|>
Intravenous piperacillin-tazobactam therapy and percutaneous cholecystostomy<|eot_id|> |
A 4-year-old boy is brought to the physician because of a 3-day history of fever and left ear pain. Examination of the left ear shows a bulging tympanic membrane with green discharge. Gram stain of the discharge shows a gram-negative coccobacillus. The isolated organism grows on chocolate agar. The causal pathogen most likely produces a virulence factor that acts by which of the following mechanisms?
Options:
{'A': 'Binding of the Fc region of immunoglobulins', 'B': 'Inactivation of 60S ribosome', 'C': 'Overactivation of adenylate cyclase', 'D': 'Cleavage of secretory immunoglobulins', 'E': 'Inactivation of elongation factor'} | {'A': 'Binding of the Fc region of immunoglobulins', 'B': 'Inactivation of 60S ribosome', 'C': 'Overactivation of adenylate cyclase', 'D': 'Cleavage of secretory immunoglobulins', 'E': 'Inactivation of elongation factor'} | Cleavage of secretory immunoglobulins | <|start_header_id|>system<|end_header_id|>
The following are multiple choice questions about medical knowledge. Solve them in a step-by-step fashion, starting by summarizing the available information. Output a single option from the four options as the final answer.<|eot_id|>
<|start_header_id|>user<|end_header_id|>
A 4-year-old boy is brought to the physician because of a 3-day history of fever and left ear pain. Examination of the left ear shows a bulging tympanic membrane with green discharge. Gram stain of the discharge shows a gram-negative coccobacillus. The isolated organism grows on chocolate agar. The causal pathogen most likely produces a virulence factor that acts by which of the following mechanisms?
Options:
{'A': 'Binding of the Fc region of immunoglobulins', 'B': 'Inactivation of 60S ribosome', 'C': 'Overactivation of adenylate cyclase', 'D': 'Cleavage of secretory immunoglobulins', 'E': 'Inactivation of elongation factor'}<|eot_id|>
<|start_header_id|>assistant<|end_header_id|>
Cleavage of secretory immunoglobulins<|eot_id|> |
A 3-year-old boy is brought to the physician by his mother because of a 2-week history of generalized fatigue, intermittent fever, and occasional bleeding from his nose. His temperature is 38.3°C (100.9°F). He appears pale. Physical examination shows cervical lymphadenopathy and multiple petechiae on his trunk. The spleen is palpated 3 cm below the left costal margin. His hemoglobin concentration is 9.3 g/dL, leukocyte count is 63,000/mm3, and platelet count is 30,000/mm3. A bone marrow aspirate predominantly shows immature leukocytes that stain positive for CD10, CD19, and terminal deoxynucleotidyl transferase (TdT), and negative for myeloperoxidase. Which of the following is the most likely diagnosis?
Options:
{'A': 'Hairy cell leukemia', 'B': 'Acute myelomonocytic leukemia', 'C': 'Pre-B-cell acute lymphoblastic leukemia', 'D': 'Acute megakaryoblastic leukemia', 'E': 'T-cell chronic lymphocytic leukemia'} | {'A': 'Hairy cell leukemia', 'B': 'Acute myelomonocytic leukemia', 'C': 'Pre-B-cell acute lymphoblastic leukemia', 'D': 'Acute megakaryoblastic leukemia', 'E': 'T-cell chronic lymphocytic leukemia'} | Pre-B-cell acute lymphoblastic leukemia | <|start_header_id|>system<|end_header_id|>
The following are multiple choice questions about medical knowledge. Solve them in a step-by-step fashion, starting by summarizing the available information. Output a single option from the four options as the final answer.<|eot_id|>
<|start_header_id|>user<|end_header_id|>
A 3-year-old boy is brought to the physician by his mother because of a 2-week history of generalized fatigue, intermittent fever, and occasional bleeding from his nose. His temperature is 38.3°C (100.9°F). He appears pale. Physical examination shows cervical lymphadenopathy and multiple petechiae on his trunk. The spleen is palpated 3 cm below the left costal margin. His hemoglobin concentration is 9.3 g/dL, leukocyte count is 63,000/mm3, and platelet count is 30,000/mm3. A bone marrow aspirate predominantly shows immature leukocytes that stain positive for CD10, CD19, and terminal deoxynucleotidyl transferase (TdT), and negative for myeloperoxidase. Which of the following is the most likely diagnosis?
Options:
{'A': 'Hairy cell leukemia', 'B': 'Acute myelomonocytic leukemia', 'C': 'Pre-B-cell acute lymphoblastic leukemia', 'D': 'Acute megakaryoblastic leukemia', 'E': 'T-cell chronic lymphocytic leukemia'}<|eot_id|>
<|start_header_id|>assistant<|end_header_id|>
Pre-B-cell acute lymphoblastic leukemia<|eot_id|> |
A 21-year-old woman presents with right eye irritation, redness, and watery discharge. These symptoms started abruptly 4 days ago. She is on summer vacation and does not report any contacts with evidently ill patients. However, during the vacation, she frequently visited crowded places. The patient denies any other symptoms. At the presentation, the patient’s vital signs include: blood pressure 125/80 mm Hg, heart rate 75/min, respiratory rate 14/min, and temperature 36.7℃ (98℉). The physical examination shows conjunctival injection, watery discharge, and mild follicular transformation of the conjunctiva of the right eye. There are no corneal lesions. Ipsilateral preauricular lymph nodes are enlarged. Which of the following would be a proper medical therapy for this patient
Options:
{'A': 'Oral erythromycin', 'B': 'Acyclovir ointment', 'C': 'No medical treatment required', 'D': 'Levofloxacin drops', 'E': 'Tetracycline ointment'} | {'A': 'Oral erythromycin', 'B': 'Acyclovir ointment', 'C': 'No medical treatment required', 'D': 'Levofloxacin drops', 'E': 'Tetracycline ointment'} | No medical treatment required | <|start_header_id|>system<|end_header_id|>
The following are multiple choice questions about medical knowledge. Solve them in a step-by-step fashion, starting by summarizing the available information. Output a single option from the four options as the final answer.<|eot_id|>
<|start_header_id|>user<|end_header_id|>
A 21-year-old woman presents with right eye irritation, redness, and watery discharge. These symptoms started abruptly 4 days ago. She is on summer vacation and does not report any contacts with evidently ill patients. However, during the vacation, she frequently visited crowded places. The patient denies any other symptoms. At the presentation, the patient’s vital signs include: blood pressure 125/80 mm Hg, heart rate 75/min, respiratory rate 14/min, and temperature 36.7℃ (98℉). The physical examination shows conjunctival injection, watery discharge, and mild follicular transformation of the conjunctiva of the right eye. There are no corneal lesions. Ipsilateral preauricular lymph nodes are enlarged. Which of the following would be a proper medical therapy for this patient
Options:
{'A': 'Oral erythromycin', 'B': 'Acyclovir ointment', 'C': 'No medical treatment required', 'D': 'Levofloxacin drops', 'E': 'Tetracycline ointment'}<|eot_id|>
<|start_header_id|>assistant<|end_header_id|>
No medical treatment required<|eot_id|> |
A 6-week-old child is brought to his pediatrician for a physical exam and hepatitis B booster. The boy was born at 39 weeks gestation via spontaneous vaginal delivery to a 19-year-old G-1-P-1. He was previously up to date on all vaccines and is mildly delayed in some developmental milestones. His mother is especially concerned with colic, as the boy cries endlessly at night. During the conversation, the infant's mother breaks down and starts crying and complaining about how tired she is and how she has no support from her family. She admits to repeatedly striking the infant in an effort to stop his crying. On physical exam, the infant’s vitals are normal. The child appears cranky and begins to cry during the exam. The infant's backside is swollen, red, and tender to touch. Which of the following is the best response to this situation?
Options:
{'A': 'Confront the mother directly', 'B': 'Contact child protective services', 'C': 'Recommend treating the colic with a few drops of whiskey', 'D': 'Encourage the mother to take a class on parenting', 'E': 'Contact the hospital ethics committee'} | {'A': 'Confront the mother directly', 'B': 'Contact child protective services', 'C': 'Recommend treating the colic with a few drops of whiskey', 'D': 'Encourage the mother to take a class on parenting', 'E': 'Contact the hospital ethics committee'} | Contact child protective services | <|start_header_id|>system<|end_header_id|>
The following are multiple choice questions about medical knowledge. Solve them in a step-by-step fashion, starting by summarizing the available information. Output a single option from the four options as the final answer.<|eot_id|>
<|start_header_id|>user<|end_header_id|>
A 6-week-old child is brought to his pediatrician for a physical exam and hepatitis B booster. The boy was born at 39 weeks gestation via spontaneous vaginal delivery to a 19-year-old G-1-P-1. He was previously up to date on all vaccines and is mildly delayed in some developmental milestones. His mother is especially concerned with colic, as the boy cries endlessly at night. During the conversation, the infant's mother breaks down and starts crying and complaining about how tired she is and how she has no support from her family. She admits to repeatedly striking the infant in an effort to stop his crying. On physical exam, the infant’s vitals are normal. The child appears cranky and begins to cry during the exam. The infant's backside is swollen, red, and tender to touch. Which of the following is the best response to this situation?
Options:
{'A': 'Confront the mother directly', 'B': 'Contact child protective services', 'C': 'Recommend treating the colic with a few drops of whiskey', 'D': 'Encourage the mother to take a class on parenting', 'E': 'Contact the hospital ethics committee'}<|eot_id|>
<|start_header_id|>assistant<|end_header_id|>
Contact child protective services<|eot_id|> |
A 9-year-old boy is brought to his primary care physician after his mom noticed that he was limping. He says that he has been experiencing significant hip and knee pain over the last 2 months but thought he may have just strained a muscle. Radiographs show a collapse of the femoral head, and he is diagnosed with Legg-Calve-Perthes disease. He undergoes surgery and is placed in a Petrie cast from his hips to his toes bilaterally so that he is unable to move his knees or ankles. Eight weeks later, the cast is removed, and he is found to have significantly smaller calves than before the cast was placed. Which process in myocytes is most likely responsible for this finding?
Options:
{'A': 'Decreased formation of double membrane bound vesicles', 'B': 'Increased formation of double membrane bound vesicles', 'C': 'Inhibition of gene transcription', 'D': 'Monoubiquitination of proteins', 'E': 'Polyubiquitination of proteins'} | {'A': 'Decreased formation of double membrane bound vesicles', 'B': 'Increased formation of double membrane bound vesicles', 'C': 'Inhibition of gene transcription', 'D': 'Monoubiquitination of proteins', 'E': 'Polyubiquitination of proteins'} | Polyubiquitination of proteins | <|start_header_id|>system<|end_header_id|>
The following are multiple choice questions about medical knowledge. Solve them in a step-by-step fashion, starting by summarizing the available information. Output a single option from the four options as the final answer.<|eot_id|>
<|start_header_id|>user<|end_header_id|>
A 9-year-old boy is brought to his primary care physician after his mom noticed that he was limping. He says that he has been experiencing significant hip and knee pain over the last 2 months but thought he may have just strained a muscle. Radiographs show a collapse of the femoral head, and he is diagnosed with Legg-Calve-Perthes disease. He undergoes surgery and is placed in a Petrie cast from his hips to his toes bilaterally so that he is unable to move his knees or ankles. Eight weeks later, the cast is removed, and he is found to have significantly smaller calves than before the cast was placed. Which process in myocytes is most likely responsible for this finding?
Options:
{'A': 'Decreased formation of double membrane bound vesicles', 'B': 'Increased formation of double membrane bound vesicles', 'C': 'Inhibition of gene transcription', 'D': 'Monoubiquitination of proteins', 'E': 'Polyubiquitination of proteins'}<|eot_id|>
<|start_header_id|>assistant<|end_header_id|>
Polyubiquitination of proteins<|eot_id|> |
A 3-year-old male is brought to the ER with a sore throat and fever. Examination of the pharynx reveals a dark, inflammatory exudate. Cysteine-tellurite agar culture produces black, iridescent colonies. Microscopic features of the causal organism most likely include which of the following?
Options:
{'A': 'Serpentine growth patterns', 'B': 'Metachromic granules', 'C': 'Lancet-shape', 'D': 'Long, branching filaments', 'E': 'Kidney-bean shaped rod'} | {'A': 'Serpentine growth patterns', 'B': 'Metachromic granules', 'C': 'Lancet-shape', 'D': 'Long, branching filaments', 'E': 'Kidney-bean shaped rod'} | Metachromic granules | <|start_header_id|>system<|end_header_id|>
The following are multiple choice questions about medical knowledge. Solve them in a step-by-step fashion, starting by summarizing the available information. Output a single option from the four options as the final answer.<|eot_id|>
<|start_header_id|>user<|end_header_id|>
A 3-year-old male is brought to the ER with a sore throat and fever. Examination of the pharynx reveals a dark, inflammatory exudate. Cysteine-tellurite agar culture produces black, iridescent colonies. Microscopic features of the causal organism most likely include which of the following?
Options:
{'A': 'Serpentine growth patterns', 'B': 'Metachromic granules', 'C': 'Lancet-shape', 'D': 'Long, branching filaments', 'E': 'Kidney-bean shaped rod'}<|eot_id|>
<|start_header_id|>assistant<|end_header_id|>
Metachromic granules<|eot_id|> |
An otherwise healthy 16-year-old girl comes to the physician because she has not had a menstrual period. Examination shows normal breast development. There is coarse pubic and axillary hair. Pelvic examination shows a blind vaginal pouch. Ultrasonography shows normal ovaries and an atretic uterus. Which of the following is the most likely underlying cause of this patient's symptoms?
Options:
{'A': 'Deficiency of 5-alpha reductase', 'B': 'End-organ insensitivity to androgens', 'C': 'Monosomy of sex chromosomes', 'D': 'Agenesis of the paramesonephric duct', 'E': 'Deficiency of 17-alpha-hydroxylase'} | {'A': 'Deficiency of 5-alpha reductase', 'B': 'End-organ insensitivity to androgens', 'C': 'Monosomy of sex chromosomes', 'D': 'Agenesis of the paramesonephric duct', 'E': 'Deficiency of 17-alpha-hydroxylase'} | Agenesis of the paramesonephric duct | <|start_header_id|>system<|end_header_id|>
The following are multiple choice questions about medical knowledge. Solve them in a step-by-step fashion, starting by summarizing the available information. Output a single option from the four options as the final answer.<|eot_id|>
<|start_header_id|>user<|end_header_id|>
An otherwise healthy 16-year-old girl comes to the physician because she has not had a menstrual period. Examination shows normal breast development. There is coarse pubic and axillary hair. Pelvic examination shows a blind vaginal pouch. Ultrasonography shows normal ovaries and an atretic uterus. Which of the following is the most likely underlying cause of this patient's symptoms?
Options:
{'A': 'Deficiency of 5-alpha reductase', 'B': 'End-organ insensitivity to androgens', 'C': 'Monosomy of sex chromosomes', 'D': 'Agenesis of the paramesonephric duct', 'E': 'Deficiency of 17-alpha-hydroxylase'}<|eot_id|>
<|start_header_id|>assistant<|end_header_id|>
Agenesis of the paramesonephric duct<|eot_id|> |
A 22-year-old woman comes to the physician because of 1 week of progressive left anterior knee pain. The pain is worse after sitting for a prolonged period of time and while ascending stairs. She first noticed the pain the day after a basketball game. She has often taken painful blows to the side of the knees while playing basketball but does not recall this having happened in the last game. Four weeks ago, she was diagnosed with a chlamydial urinary tract infection and treated with azithromycin. She is sexually active with one male partner; they use condoms inconsistently. Her vital signs are within normal limits. She is 178 cm (5 ft 10 in) tall and weighs 62 kg (137 lb); BMI is 19.6 kg/m2. Physical examination shows tenderness over the left anterior knee that is exacerbated with anterior pressure to the patella when the knee is fully extended; there is no erythema or swelling. Which of the following is the most likely diagnosis?
Options:
{'A': 'Patellofemoral pain syndrome', 'B': 'Medial collateral ligament injury', 'C': 'Osgood-Schlatter disease', 'D': 'Anterior cruciate ligament injury', 'E': 'Patellar tendinitis\n"'} | {'A': 'Patellofemoral pain syndrome', 'B': 'Medial collateral ligament injury', 'C': 'Osgood-Schlatter disease', 'D': 'Anterior cruciate ligament injury', 'E': 'Patellar tendinitis\n"'} | Patellofemoral pain syndrome | <|start_header_id|>system<|end_header_id|>
The following are multiple choice questions about medical knowledge. Solve them in a step-by-step fashion, starting by summarizing the available information. Output a single option from the four options as the final answer.<|eot_id|>
<|start_header_id|>user<|end_header_id|>
A 22-year-old woman comes to the physician because of 1 week of progressive left anterior knee pain. The pain is worse after sitting for a prolonged period of time and while ascending stairs. She first noticed the pain the day after a basketball game. She has often taken painful blows to the side of the knees while playing basketball but does not recall this having happened in the last game. Four weeks ago, she was diagnosed with a chlamydial urinary tract infection and treated with azithromycin. She is sexually active with one male partner; they use condoms inconsistently. Her vital signs are within normal limits. She is 178 cm (5 ft 10 in) tall and weighs 62 kg (137 lb); BMI is 19.6 kg/m2. Physical examination shows tenderness over the left anterior knee that is exacerbated with anterior pressure to the patella when the knee is fully extended; there is no erythema or swelling. Which of the following is the most likely diagnosis?
Options:
{'A': 'Patellofemoral pain syndrome', 'B': 'Medial collateral ligament injury', 'C': 'Osgood-Schlatter disease', 'D': 'Anterior cruciate ligament injury', 'E': 'Patellar tendinitis\n"'}<|eot_id|>
<|start_header_id|>assistant<|end_header_id|>
Patellofemoral pain syndrome<|eot_id|> |
A 66-year-old man comes to the emergency department because of a 1-day history of chest pain, palpitations, and dyspnea on exertion. He had a similar episode 3 days ago and was diagnosed with an inferior wall myocardial infarction. He was admitted and a percutaneous transluminal coronary angioplasty was successfully done that day. A fractional flow reserve test during the procedure showed complete resolution of the stenosis. Laboratory tests including serum glucose, lipids, and blood count were within normal limits. He was discharged the day after the procedure on a drug regimen of aspirin, simvastatin, and isosorbide dinitrate. At the time of discharge, he had no chest pain or dyspnea. Presently, his vitals are normal and ECG at rest shows new T-wave inversion. Which of the following is the most reliable test for rapidly establishing the diagnosis in this patient?
Options:
{'A': 'Lactate dehydrogenase', 'B': 'Creatine kinase MB', 'C': 'Cardiac troponin T', 'D': 'Copeptin', 'E': 'Aspartate aminotransferase'} | {'A': 'Lactate dehydrogenase', 'B': 'Creatine kinase MB', 'C': 'Cardiac troponin T', 'D': 'Copeptin', 'E': 'Aspartate aminotransferase'} | Creatine kinase MB | <|start_header_id|>system<|end_header_id|>
The following are multiple choice questions about medical knowledge. Solve them in a step-by-step fashion, starting by summarizing the available information. Output a single option from the four options as the final answer.<|eot_id|>
<|start_header_id|>user<|end_header_id|>
A 66-year-old man comes to the emergency department because of a 1-day history of chest pain, palpitations, and dyspnea on exertion. He had a similar episode 3 days ago and was diagnosed with an inferior wall myocardial infarction. He was admitted and a percutaneous transluminal coronary angioplasty was successfully done that day. A fractional flow reserve test during the procedure showed complete resolution of the stenosis. Laboratory tests including serum glucose, lipids, and blood count were within normal limits. He was discharged the day after the procedure on a drug regimen of aspirin, simvastatin, and isosorbide dinitrate. At the time of discharge, he had no chest pain or dyspnea. Presently, his vitals are normal and ECG at rest shows new T-wave inversion. Which of the following is the most reliable test for rapidly establishing the diagnosis in this patient?
Options:
{'A': 'Lactate dehydrogenase', 'B': 'Creatine kinase MB', 'C': 'Cardiac troponin T', 'D': 'Copeptin', 'E': 'Aspartate aminotransferase'}<|eot_id|>
<|start_header_id|>assistant<|end_header_id|>
Creatine kinase MB<|eot_id|> |
A 49-year-old man is diagnosed with hypertension. He has asthma. The creatinine and potassium levels are both slightly elevated. Which of the following anti-hypertensive drugs would be appropriate in his case?
Options:
{'A': 'Amlodipine', 'B': 'Propranolol', 'C': 'Enalapril', 'D': 'Hydrochlorothiazide (HCT)', 'E': 'Spironolactone'} | {'A': 'Amlodipine', 'B': 'Propranolol', 'C': 'Enalapril', 'D': 'Hydrochlorothiazide (HCT)', 'E': 'Spironolactone'} | Amlodipine | <|start_header_id|>system<|end_header_id|>
The following are multiple choice questions about medical knowledge. Solve them in a step-by-step fashion, starting by summarizing the available information. Output a single option from the four options as the final answer.<|eot_id|>
<|start_header_id|>user<|end_header_id|>
A 49-year-old man is diagnosed with hypertension. He has asthma. The creatinine and potassium levels are both slightly elevated. Which of the following anti-hypertensive drugs would be appropriate in his case?
Options:
{'A': 'Amlodipine', 'B': 'Propranolol', 'C': 'Enalapril', 'D': 'Hydrochlorothiazide (HCT)', 'E': 'Spironolactone'}<|eot_id|>
<|start_header_id|>assistant<|end_header_id|>
Amlodipine<|eot_id|> |
A 33-year-old African American woman presents to the office complaining of blurry vision and headache for the past 2 weeks. She states that she has not been feeling herself lately and also fell down once after a dizzy episode. Her medical history is remarkable for hypertension and pulmonary sarcoidosis treated with hydralazine and prednisone respectively. She had a recent bout of acute optic neuritis, requiring high-dose IV methylprednisolone. Her temperature is 37°C (98.6°F), the blood pressure is 112/76 mm Hg, the pulse is 78/min, and the respirations are 14/min. On examination, the patient is mildly disoriented. Head and neck examination reveals a soft, supple neck and a right-sided facial droop. There is 5/5 muscle strength in all extremities. VDRL test is negative. A head MRI is pending. What is the most appropriate next step in the management of this patient?
Options:
{'A': 'Methotrexate', 'B': 'Methylprednisolone and methotrexate', 'C': 'Heparin', 'D': 'Plasmapheresis', 'E': 'Methotrexate and azathioprine'} | {'A': 'Methotrexate', 'B': 'Methylprednisolone and methotrexate', 'C': 'Heparin', 'D': 'Plasmapheresis', 'E': 'Methotrexate and azathioprine'} | Methylprednisolone and methotrexate | <|start_header_id|>system<|end_header_id|>
The following are multiple choice questions about medical knowledge. Solve them in a step-by-step fashion, starting by summarizing the available information. Output a single option from the four options as the final answer.<|eot_id|>
<|start_header_id|>user<|end_header_id|>
A 33-year-old African American woman presents to the office complaining of blurry vision and headache for the past 2 weeks. She states that she has not been feeling herself lately and also fell down once after a dizzy episode. Her medical history is remarkable for hypertension and pulmonary sarcoidosis treated with hydralazine and prednisone respectively. She had a recent bout of acute optic neuritis, requiring high-dose IV methylprednisolone. Her temperature is 37°C (98.6°F), the blood pressure is 112/76 mm Hg, the pulse is 78/min, and the respirations are 14/min. On examination, the patient is mildly disoriented. Head and neck examination reveals a soft, supple neck and a right-sided facial droop. There is 5/5 muscle strength in all extremities. VDRL test is negative. A head MRI is pending. What is the most appropriate next step in the management of this patient?
Options:
{'A': 'Methotrexate', 'B': 'Methylprednisolone and methotrexate', 'C': 'Heparin', 'D': 'Plasmapheresis', 'E': 'Methotrexate and azathioprine'}<|eot_id|>
<|start_header_id|>assistant<|end_header_id|>
Methylprednisolone and methotrexate<|eot_id|> |
A 31-year-old man comes to the physician because of several months of recurrent abdominal pain and diarrhea. Six months ago, he traveled to Lake Superior for a fishing trip with his friends, during which they often ate their day's catch for dinner. Physical examination shows pallor. Laboratory studies show macrocytic anemia with eosinophilia. A peripheral blood smear shows hypochromic red blood cells with megaloblasts and hypersegmented neutrophils. A cestode infection is suspected and a drug is prescribed that kills cestodes by inducing uncontrollable muscle spasm in the parasite. The drug prescribed for this patient most likely acts by which of the following mechanisms of action?
Options:
{'A': 'Blockade of myosin binding sites', 'B': 'Increased calcium influx into the sarcoplasm', 'C': 'Increased sodium efflux from the sarcoplasm', 'D': 'Increased potassium efflux from the sarcoplasm', 'E': 'Phosphorylation of adenosine diphosphate'} | {'A': 'Blockade of myosin binding sites', 'B': 'Increased calcium influx into the sarcoplasm', 'C': 'Increased sodium efflux from the sarcoplasm', 'D': 'Increased potassium efflux from the sarcoplasm', 'E': 'Phosphorylation of adenosine diphosphate'} | Increased calcium influx into the sarcoplasm | <|start_header_id|>system<|end_header_id|>
The following are multiple choice questions about medical knowledge. Solve them in a step-by-step fashion, starting by summarizing the available information. Output a single option from the four options as the final answer.<|eot_id|>
<|start_header_id|>user<|end_header_id|>
A 31-year-old man comes to the physician because of several months of recurrent abdominal pain and diarrhea. Six months ago, he traveled to Lake Superior for a fishing trip with his friends, during which they often ate their day's catch for dinner. Physical examination shows pallor. Laboratory studies show macrocytic anemia with eosinophilia. A peripheral blood smear shows hypochromic red blood cells with megaloblasts and hypersegmented neutrophils. A cestode infection is suspected and a drug is prescribed that kills cestodes by inducing uncontrollable muscle spasm in the parasite. The drug prescribed for this patient most likely acts by which of the following mechanisms of action?
Options:
{'A': 'Blockade of myosin binding sites', 'B': 'Increased calcium influx into the sarcoplasm', 'C': 'Increased sodium efflux from the sarcoplasm', 'D': 'Increased potassium efflux from the sarcoplasm', 'E': 'Phosphorylation of adenosine diphosphate'}<|eot_id|>
<|start_header_id|>assistant<|end_header_id|>
Increased calcium influx into the sarcoplasm<|eot_id|> |
A 37-year-old woman is being evaluated for difficulty with swallowing for the past few months. She explains that she experiences difficulty swallowing solid foods only. Her medical history is relevant for hypothyroidism and migraines. Her current medications include daily levothyroxine and acetaminophen as needed for pain. The vital signs include blood pressure 110/90 mm Hg, pulse rate 55/min, and respiratory rate 12/min. On physical examination, her abdomen is non-tender. Her voice is hoarse, but there is no pharyngeal hyperemia on oral examination. On cardiac auscultation, an opening snap followed by an early to mid-diastolic rumble is heard over the apex. A barium swallow X-ray is performed and is unremarkable. Echocardiography shows an enlarged left atrium and abnormal blood flow through 1 of the atrioventricular valves. What is the most likely valve abnormality seen in this patient?
Options:
{'A': 'Mitral valve stenosis', 'B': 'Mitral valve regurgitation', 'C': 'Aortic valve stenosis', 'D': 'Aortic valve regurgitation', 'E': 'Mitral valve prolapse'} | {'A': 'Mitral valve stenosis', 'B': 'Mitral valve regurgitation', 'C': 'Aortic valve stenosis', 'D': 'Aortic valve regurgitation', 'E': 'Mitral valve prolapse'} | Mitral valve stenosis | <|start_header_id|>system<|end_header_id|>
The following are multiple choice questions about medical knowledge. Solve them in a step-by-step fashion, starting by summarizing the available information. Output a single option from the four options as the final answer.<|eot_id|>
<|start_header_id|>user<|end_header_id|>
A 37-year-old woman is being evaluated for difficulty with swallowing for the past few months. She explains that she experiences difficulty swallowing solid foods only. Her medical history is relevant for hypothyroidism and migraines. Her current medications include daily levothyroxine and acetaminophen as needed for pain. The vital signs include blood pressure 110/90 mm Hg, pulse rate 55/min, and respiratory rate 12/min. On physical examination, her abdomen is non-tender. Her voice is hoarse, but there is no pharyngeal hyperemia on oral examination. On cardiac auscultation, an opening snap followed by an early to mid-diastolic rumble is heard over the apex. A barium swallow X-ray is performed and is unremarkable. Echocardiography shows an enlarged left atrium and abnormal blood flow through 1 of the atrioventricular valves. What is the most likely valve abnormality seen in this patient?
Options:
{'A': 'Mitral valve stenosis', 'B': 'Mitral valve regurgitation', 'C': 'Aortic valve stenosis', 'D': 'Aortic valve regurgitation', 'E': 'Mitral valve prolapse'}<|eot_id|>
<|start_header_id|>assistant<|end_header_id|>
Mitral valve stenosis<|eot_id|> |
A 31-year-old G2P2 female at 40 weeks gestation presents to the hospital following a rush of water that came from her vagina. She is 4 cm dilated and 80% effaced. Fetal heart tracing shows a pulse of 155/min with variable decelerations. About 12 hours after presentation, she gives birth to a 6 lb 15 oz baby boy with APGAR scores of 8 and 9 at 1 and 5 minutes, respectively. Which of the following structures is responsible for inhibition of female internal genitalia?
Options:
{'A': 'Spermatogonia', 'B': 'Allantois', 'C': 'Syncytiotrophoblast', 'D': 'Sertoli cells', 'E': 'Leydig cells'} | {'A': 'Spermatogonia', 'B': 'Allantois', 'C': 'Syncytiotrophoblast', 'D': 'Sertoli cells', 'E': 'Leydig cells'} | Sertoli cells | <|start_header_id|>system<|end_header_id|>
The following are multiple choice questions about medical knowledge. Solve them in a step-by-step fashion, starting by summarizing the available information. Output a single option from the four options as the final answer.<|eot_id|>
<|start_header_id|>user<|end_header_id|>
A 31-year-old G2P2 female at 40 weeks gestation presents to the hospital following a rush of water that came from her vagina. She is 4 cm dilated and 80% effaced. Fetal heart tracing shows a pulse of 155/min with variable decelerations. About 12 hours after presentation, she gives birth to a 6 lb 15 oz baby boy with APGAR scores of 8 and 9 at 1 and 5 minutes, respectively. Which of the following structures is responsible for inhibition of female internal genitalia?
Options:
{'A': 'Spermatogonia', 'B': 'Allantois', 'C': 'Syncytiotrophoblast', 'D': 'Sertoli cells', 'E': 'Leydig cells'}<|eot_id|>
<|start_header_id|>assistant<|end_header_id|>
Sertoli cells<|eot_id|> |
A 3-year-old boy is brought to the physician by his parents for a well-child examination. The boy was born at term via vaginal delivery and has been healthy except for impaired vision due to severe short-sightedness. He is at the 97th percentile for height and 25th percentile for weight. Oral examination shows a high-arched palate. He has abnormally long, slender fingers and toes, and his finger joints are hyperflexible. The patient is asked to place his thumbs in the palms of the same hand and then clench to form a fist. The thumbs are noted to protrude beyond the ulnar border of the hand. Slit lamp examination shows lens subluxation in the superotemporal direction bilaterally. Which of the following is the most likely underlying cause of this patient's condition?
Options:
{'A': 'Mutation in fibrillin-1 gene', 'B': 'Defective collagen cross-linking', 'C': 'Nondisjunction of sex chromosomes', 'D': 'Mutation of the FMR1 gene', 'E': 'Mutation in RET gene'} | {'A': 'Mutation in fibrillin-1 gene', 'B': 'Defective collagen cross-linking', 'C': 'Nondisjunction of sex chromosomes', 'D': 'Mutation of the FMR1 gene', 'E': 'Mutation in RET gene'} | Mutation in fibrillin-1 gene | <|start_header_id|>system<|end_header_id|>
The following are multiple choice questions about medical knowledge. Solve them in a step-by-step fashion, starting by summarizing the available information. Output a single option from the four options as the final answer.<|eot_id|>
<|start_header_id|>user<|end_header_id|>
A 3-year-old boy is brought to the physician by his parents for a well-child examination. The boy was born at term via vaginal delivery and has been healthy except for impaired vision due to severe short-sightedness. He is at the 97th percentile for height and 25th percentile for weight. Oral examination shows a high-arched palate. He has abnormally long, slender fingers and toes, and his finger joints are hyperflexible. The patient is asked to place his thumbs in the palms of the same hand and then clench to form a fist. The thumbs are noted to protrude beyond the ulnar border of the hand. Slit lamp examination shows lens subluxation in the superotemporal direction bilaterally. Which of the following is the most likely underlying cause of this patient's condition?
Options:
{'A': 'Mutation in fibrillin-1 gene', 'B': 'Defective collagen cross-linking', 'C': 'Nondisjunction of sex chromosomes', 'D': 'Mutation of the FMR1 gene', 'E': 'Mutation in RET gene'}<|eot_id|>
<|start_header_id|>assistant<|end_header_id|>
Mutation in fibrillin-1 gene<|eot_id|> |
A 52-year-old woman is accompanied by her husband to the emergency department with a severe occipital headache that started suddenly an hour ago. She is drowsy but able to answer the physician’s questions. She describes it as the worst headache she has ever had, 9/10 in intensity. The husband says it was initially localized to the occiput but has now spread all over her head and she also complained of a generalized heaviness. She took an ibuprofen without experiencing any relief. She also complains of blurry vision and nausea and had 1 episode of vomiting. She denies a recent history of fever, chills, numbness, or seizures. Her past medical history is significant for hypertension controlled with lisinopril and metoprolol. On examination, she is drowsy but oriented. Papilledema is seen on ophthalmoscopy. Neck flexion is difficult and painful. The rest of the exam is unremarkable. Her blood pressure is 160/100 mm Hg, heart rate is 100/min, and temperature is 37.0°C (98.6°F). The ECG, cardiac enzymes, and laboratory studies are normal. Lumbar puncture results are as follows:
Opening pressure 210 mm H2O
RBC 50/mm3, numbers steady over 4 test tubes
Cell count 5/mm3
Glucose 40 mg/dL
Proteins 100 mg/dL
The patient is admitted to the ICU for further management. Which of the following is the most likely pathophysiology based on her history and CSF findings?
Options:
{'A': 'Viral infection of the brain parenchyma', 'B': 'Intracerebral bleed', 'C': 'Bacterial infection of the meninges', 'D': 'Trauma during lumbar puncture', 'E': 'Rupture of the communicating branches of the cerebral arteries'} | {'A': 'Viral infection of the brain parenchyma', 'B': 'Intracerebral bleed', 'C': 'Bacterial infection of the meninges', 'D': 'Trauma during lumbar puncture', 'E': 'Rupture of the communicating branches of the cerebral arteries'} | Rupture of the communicating branches of the cerebral arteries | <|start_header_id|>system<|end_header_id|>
The following are multiple choice questions about medical knowledge. Solve them in a step-by-step fashion, starting by summarizing the available information. Output a single option from the four options as the final answer.<|eot_id|>
<|start_header_id|>user<|end_header_id|>
A 52-year-old woman is accompanied by her husband to the emergency department with a severe occipital headache that started suddenly an hour ago. She is drowsy but able to answer the physician’s questions. She describes it as the worst headache she has ever had, 9/10 in intensity. The husband says it was initially localized to the occiput but has now spread all over her head and she also complained of a generalized heaviness. She took an ibuprofen without experiencing any relief. She also complains of blurry vision and nausea and had 1 episode of vomiting. She denies a recent history of fever, chills, numbness, or seizures. Her past medical history is significant for hypertension controlled with lisinopril and metoprolol. On examination, she is drowsy but oriented. Papilledema is seen on ophthalmoscopy. Neck flexion is difficult and painful. The rest of the exam is unremarkable. Her blood pressure is 160/100 mm Hg, heart rate is 100/min, and temperature is 37.0°C (98.6°F). The ECG, cardiac enzymes, and laboratory studies are normal. Lumbar puncture results are as follows:
Opening pressure 210 mm H2O
RBC 50/mm3, numbers steady over 4 test tubes
Cell count 5/mm3
Glucose 40 mg/dL
Proteins 100 mg/dL
The patient is admitted to the ICU for further management. Which of the following is the most likely pathophysiology based on her history and CSF findings?
Options:
{'A': 'Viral infection of the brain parenchyma', 'B': 'Intracerebral bleed', 'C': 'Bacterial infection of the meninges', 'D': 'Trauma during lumbar puncture', 'E': 'Rupture of the communicating branches of the cerebral arteries'}<|eot_id|>
<|start_header_id|>assistant<|end_header_id|>
Rupture of the communicating branches of the cerebral arteries<|eot_id|> |
A 33-year-old man is brought to the emergency department 20 minutes after he fell from the roof of his house. On arrival, he is unresponsive to verbal and painful stimuli. His pulse is 72/min and blood pressure is 132/86 mm Hg. A CT scan of the head shows a fracture in the anterior cranial fossa and a 1-cm laceration in the left anterior orbital gyrus. If the patient survives, which of the following would ultimately be the most common cell type at the injured region of the frontal lobe?
Options:
{'A': 'Schwann cells', 'B': 'Neurons', 'C': 'Astrocytes', 'D': 'Microglia', 'E': 'Oligodendrocytes'} | {'A': 'Schwann cells', 'B': 'Neurons', 'C': 'Astrocytes', 'D': 'Microglia', 'E': 'Oligodendrocytes'} | Astrocytes | <|start_header_id|>system<|end_header_id|>
The following are multiple choice questions about medical knowledge. Solve them in a step-by-step fashion, starting by summarizing the available information. Output a single option from the four options as the final answer.<|eot_id|>
<|start_header_id|>user<|end_header_id|>
A 33-year-old man is brought to the emergency department 20 minutes after he fell from the roof of his house. On arrival, he is unresponsive to verbal and painful stimuli. His pulse is 72/min and blood pressure is 132/86 mm Hg. A CT scan of the head shows a fracture in the anterior cranial fossa and a 1-cm laceration in the left anterior orbital gyrus. If the patient survives, which of the following would ultimately be the most common cell type at the injured region of the frontal lobe?
Options:
{'A': 'Schwann cells', 'B': 'Neurons', 'C': 'Astrocytes', 'D': 'Microglia', 'E': 'Oligodendrocytes'}<|eot_id|>
<|start_header_id|>assistant<|end_header_id|>
Astrocytes<|eot_id|> |
A 71-year-old woman comes to her doctor because she is having trouble staying awake in the evening. Over the past year, she has noticed that she gets tired unusually early in the evenings and has trouble staying awake through dinner. She also experiences increased daytime sleepiness, fatigue, and difficulty concentrating. She typically goes to bed around 9 PM and gets out of bed between 2 and 3 AM. She does not have any trouble falling asleep. She takes 30-minute to 1-hour daytime naps approximately 3 times per week. She has no history of severe illness and does not take any medication. Which of the following is the most likely diagnosis?
Options:
{'A': 'Advanced sleep phase disorder', 'B': 'Depressive disorder', 'C': 'Insomnia disorder', 'D': 'Delayed sleep phase disorder', 'E': 'Non-REM sleep arousal disorder'} | {'A': 'Advanced sleep phase disorder', 'B': 'Depressive disorder', 'C': 'Insomnia disorder', 'D': 'Delayed sleep phase disorder', 'E': 'Non-REM sleep arousal disorder'} | Advanced sleep phase disorder | <|start_header_id|>system<|end_header_id|>
The following are multiple choice questions about medical knowledge. Solve them in a step-by-step fashion, starting by summarizing the available information. Output a single option from the four options as the final answer.<|eot_id|>
<|start_header_id|>user<|end_header_id|>
A 71-year-old woman comes to her doctor because she is having trouble staying awake in the evening. Over the past year, she has noticed that she gets tired unusually early in the evenings and has trouble staying awake through dinner. She also experiences increased daytime sleepiness, fatigue, and difficulty concentrating. She typically goes to bed around 9 PM and gets out of bed between 2 and 3 AM. She does not have any trouble falling asleep. She takes 30-minute to 1-hour daytime naps approximately 3 times per week. She has no history of severe illness and does not take any medication. Which of the following is the most likely diagnosis?
Options:
{'A': 'Advanced sleep phase disorder', 'B': 'Depressive disorder', 'C': 'Insomnia disorder', 'D': 'Delayed sleep phase disorder', 'E': 'Non-REM sleep arousal disorder'}<|eot_id|>
<|start_header_id|>assistant<|end_header_id|>
Advanced sleep phase disorder<|eot_id|> |
An investigator is studying gene expression in a mouse model. She inactivates the assembly of small nuclear ribonucleoproteins (snRNPs) in motor nerve cells. Which of the following processes is most likely to be affected as a result?
Options:
{'A': 'Folding of proteins', 'B': 'Aminoacylation of tRNA', 'C': 'Activity of 3′ to 5′ proofreading', 'D': 'Unwinding of DNA strands', 'E': 'Removal of introns'} | {'A': 'Folding of proteins', 'B': 'Aminoacylation of tRNA', 'C': 'Activity of 3′ to 5′ proofreading', 'D': 'Unwinding of DNA strands', 'E': 'Removal of introns'} | Removal of introns | <|start_header_id|>system<|end_header_id|>
The following are multiple choice questions about medical knowledge. Solve them in a step-by-step fashion, starting by summarizing the available information. Output a single option from the four options as the final answer.<|eot_id|>
<|start_header_id|>user<|end_header_id|>
An investigator is studying gene expression in a mouse model. She inactivates the assembly of small nuclear ribonucleoproteins (snRNPs) in motor nerve cells. Which of the following processes is most likely to be affected as a result?
Options:
{'A': 'Folding of proteins', 'B': 'Aminoacylation of tRNA', 'C': 'Activity of 3′ to 5′ proofreading', 'D': 'Unwinding of DNA strands', 'E': 'Removal of introns'}<|eot_id|>
<|start_header_id|>assistant<|end_header_id|>
Removal of introns<|eot_id|> |
A 27-year-old man is brought to a psychiatrist by his mother who is concerned that he has become increasingly distant. When asked, he says that he is no longer going out because he is afraid of going outside by himself. He says that ever since he was a teenager, he was uncomfortable in large crowds and on public transportation. He now works from home and rarely leaves his house except on mandatory business. Which of the following personality disorders is most likely genetically associated with this patient's disorder?
Options:
{'A': 'Antisocial', 'B': 'Dependent', 'C': 'Histrionic', 'D': 'Paranoid', 'E': 'Schizotypal'} | {'A': 'Antisocial', 'B': 'Dependent', 'C': 'Histrionic', 'D': 'Paranoid', 'E': 'Schizotypal'} | Dependent | <|start_header_id|>system<|end_header_id|>
The following are multiple choice questions about medical knowledge. Solve them in a step-by-step fashion, starting by summarizing the available information. Output a single option from the four options as the final answer.<|eot_id|>
<|start_header_id|>user<|end_header_id|>
A 27-year-old man is brought to a psychiatrist by his mother who is concerned that he has become increasingly distant. When asked, he says that he is no longer going out because he is afraid of going outside by himself. He says that ever since he was a teenager, he was uncomfortable in large crowds and on public transportation. He now works from home and rarely leaves his house except on mandatory business. Which of the following personality disorders is most likely genetically associated with this patient's disorder?
Options:
{'A': 'Antisocial', 'B': 'Dependent', 'C': 'Histrionic', 'D': 'Paranoid', 'E': 'Schizotypal'}<|eot_id|>
<|start_header_id|>assistant<|end_header_id|>
Dependent<|eot_id|> |
A 2-year-old boy is brought to the physician for the evaluation of fever, breathing difficulty, and cough during the past week. In the past year, the patient was diagnosed with four sinus infections, 3 upper respiratory tract infections, and an episode of severe bronchiolitis requiring hospitalization. Since birth, he has had multiple episodes of oral thrush treated with nystatin, as well as chronic diarrhea and failure to thrive. His temperature is 38.0°C (100.4°F), pulse is 130/min, respirations are 38/min, and blood pressure is 106/63 mm Hg. Pulse oximetry at room air shows an oxygen saturation of 88%. Pulmonary auscultation shows bilateral crackles and wheezing. Physical examination indicates a prominent nasal bridge, hypoplastic nasal wing, a shortened chin, and dysplastic ears. An X-ray of the chest shows hyperinflation of the lungs, interstitial infiltrates, and atelectasis. The patient tests positive for respiratory syncytial virus (RSV) in the nasopharyngeal aspirate. This patient most likely has a deficiency of which of the following?
Options:
{'A': 'B cells', 'B': 'B and T cells', 'C': 'Immunoglobulin A', 'D': 'Interleukin-12 receptor', 'E': 'T cells'} | {'A': 'B cells', 'B': 'B and T cells', 'C': 'Immunoglobulin A', 'D': 'Interleukin-12 receptor', 'E': 'T cells'} | T cells | <|start_header_id|>system<|end_header_id|>
The following are multiple choice questions about medical knowledge. Solve them in a step-by-step fashion, starting by summarizing the available information. Output a single option from the four options as the final answer.<|eot_id|>
<|start_header_id|>user<|end_header_id|>
A 2-year-old boy is brought to the physician for the evaluation of fever, breathing difficulty, and cough during the past week. In the past year, the patient was diagnosed with four sinus infections, 3 upper respiratory tract infections, and an episode of severe bronchiolitis requiring hospitalization. Since birth, he has had multiple episodes of oral thrush treated with nystatin, as well as chronic diarrhea and failure to thrive. His temperature is 38.0°C (100.4°F), pulse is 130/min, respirations are 38/min, and blood pressure is 106/63 mm Hg. Pulse oximetry at room air shows an oxygen saturation of 88%. Pulmonary auscultation shows bilateral crackles and wheezing. Physical examination indicates a prominent nasal bridge, hypoplastic nasal wing, a shortened chin, and dysplastic ears. An X-ray of the chest shows hyperinflation of the lungs, interstitial infiltrates, and atelectasis. The patient tests positive for respiratory syncytial virus (RSV) in the nasopharyngeal aspirate. This patient most likely has a deficiency of which of the following?
Options:
{'A': 'B cells', 'B': 'B and T cells', 'C': 'Immunoglobulin A', 'D': 'Interleukin-12 receptor', 'E': 'T cells'}<|eot_id|>
<|start_header_id|>assistant<|end_header_id|>
T cells<|eot_id|> |
A 58-year-old woman presents to the physician for a routine gynecological visit. She denies any acute issues and remarks that she has not been sexually active for the past year. Her last Pap test was negative for any abnormal cytology. A pelvic examination and Pap test is performed at the current visit with no remarkable findings. Which of the following approaches to cervical cancer screening is most appropriate for this patient?
Options:
{'A': 'Colposcopy at the current visit to verify Pap test results', 'B': 'Colposcopy in 3 years', 'C': 'Discontinue screening until the patient becomes sexually active', 'D': 'Pap test and HPV test in 5 years', 'E': 'Pap test only in 5 years'} | {'A': 'Colposcopy at the current visit to verify Pap test results', 'B': 'Colposcopy in 3 years', 'C': 'Discontinue screening until the patient becomes sexually active', 'D': 'Pap test and HPV test in 5 years', 'E': 'Pap test only in 5 years'} | Pap test and HPV test in 5 years | <|start_header_id|>system<|end_header_id|>
The following are multiple choice questions about medical knowledge. Solve them in a step-by-step fashion, starting by summarizing the available information. Output a single option from the four options as the final answer.<|eot_id|>
<|start_header_id|>user<|end_header_id|>
A 58-year-old woman presents to the physician for a routine gynecological visit. She denies any acute issues and remarks that she has not been sexually active for the past year. Her last Pap test was negative for any abnormal cytology. A pelvic examination and Pap test is performed at the current visit with no remarkable findings. Which of the following approaches to cervical cancer screening is most appropriate for this patient?
Options:
{'A': 'Colposcopy at the current visit to verify Pap test results', 'B': 'Colposcopy in 3 years', 'C': 'Discontinue screening until the patient becomes sexually active', 'D': 'Pap test and HPV test in 5 years', 'E': 'Pap test only in 5 years'}<|eot_id|>
<|start_header_id|>assistant<|end_header_id|>
Pap test and HPV test in 5 years<|eot_id|> |
A 65-year-old woman is brought to the emergency department by her husband who found her lying unconscious at home. He says that the patient has been complaining of progressively worsening weakness and confusion for the past week. Her past medical history is significant for hypertension, systemic lupus erythematosus, and trigeminal neuralgia. Her medications include metoprolol, valsartan, prednisone, and carbamazepine. On admission, blood pressure is 130/70 mm Hg, pulse rate is 100 /min, respiratory rate is 17/min, and temperature is 36.5°C (97.7ºF). She regained consciousness while on the way to the hospital but is still drowsy and disoriented. Physical examination is normal. Finger-stick glucose level is 110 mg/dl. Other laboratory studies show:
Na+ 120 mEq/L (136—145 mEq/L)
K+ 3.5 mEq/L (3.5—5.0 mEq/L)
CI- 107 mEq/L (95—105 mEq/L)
Creatinine 0.8 mg/dL (0.6—1.2 mg/dL)
Serum osmolality 250 mOsm/kg (275—295 mOsm/kg)
Urine Na+ 70 mEq/L
Urine osmolality 105 mOsm/kg
She is admitted to the hospital for further management. Which of the following is the next best step in the management of this patient’s condition?
Options:
{'A': 'Fluid restriction', 'B': 'Rapid resuscitation with hypertonic saline', 'C': 'Desmopressin', 'D': 'Lithium', 'E': 'Tolvaptan'} | {'A': 'Fluid restriction', 'B': 'Rapid resuscitation with hypertonic saline', 'C': 'Desmopressin', 'D': 'Lithium', 'E': 'Tolvaptan'} | Fluid restriction | <|start_header_id|>system<|end_header_id|>
The following are multiple choice questions about medical knowledge. Solve them in a step-by-step fashion, starting by summarizing the available information. Output a single option from the four options as the final answer.<|eot_id|>
<|start_header_id|>user<|end_header_id|>
A 65-year-old woman is brought to the emergency department by her husband who found her lying unconscious at home. He says that the patient has been complaining of progressively worsening weakness and confusion for the past week. Her past medical history is significant for hypertension, systemic lupus erythematosus, and trigeminal neuralgia. Her medications include metoprolol, valsartan, prednisone, and carbamazepine. On admission, blood pressure is 130/70 mm Hg, pulse rate is 100 /min, respiratory rate is 17/min, and temperature is 36.5°C (97.7ºF). She regained consciousness while on the way to the hospital but is still drowsy and disoriented. Physical examination is normal. Finger-stick glucose level is 110 mg/dl. Other laboratory studies show:
Na+ 120 mEq/L (136—145 mEq/L)
K+ 3.5 mEq/L (3.5—5.0 mEq/L)
CI- 107 mEq/L (95—105 mEq/L)
Creatinine 0.8 mg/dL (0.6—1.2 mg/dL)
Serum osmolality 250 mOsm/kg (275—295 mOsm/kg)
Urine Na+ 70 mEq/L
Urine osmolality 105 mOsm/kg
She is admitted to the hospital for further management. Which of the following is the next best step in the management of this patient’s condition?
Options:
{'A': 'Fluid restriction', 'B': 'Rapid resuscitation with hypertonic saline', 'C': 'Desmopressin', 'D': 'Lithium', 'E': 'Tolvaptan'}<|eot_id|>
<|start_header_id|>assistant<|end_header_id|>
Fluid restriction<|eot_id|> |
A 62-year-old woman with a history of subarachnoid hemorrhage is brought to the emergency department because of shortness of breath and sharp chest pain that worsens on inspiration. She underwent surgery for a hip fracture 3 weeks ago. Her pulse is 110/min, respirations are 20/min, and blood pressure is 112/74 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 92%. The lungs are clear to auscultation and there is no jugular venous distention. A ventilation and perfusion scan shows a small perfusion defect in the left lower lung. A drug with which of the following mechanisms of action is most appropriate for this patient?
Options:
{'A': 'Inhibition of vitamin K epoxide reductase', 'B': 'Inhibition of cyclooxygenase', 'C': 'Inhibition of adenosine diphosphate receptors', 'D': 'Activation of plasminogen', 'E': 'Activation of antithrombin III'} | {'A': 'Inhibition of vitamin K epoxide reductase', 'B': 'Inhibition of cyclooxygenase', 'C': 'Inhibition of adenosine diphosphate receptors', 'D': 'Activation of plasminogen', 'E': 'Activation of antithrombin III'} | Activation of antithrombin III | <|start_header_id|>system<|end_header_id|>
The following are multiple choice questions about medical knowledge. Solve them in a step-by-step fashion, starting by summarizing the available information. Output a single option from the four options as the final answer.<|eot_id|>
<|start_header_id|>user<|end_header_id|>
A 62-year-old woman with a history of subarachnoid hemorrhage is brought to the emergency department because of shortness of breath and sharp chest pain that worsens on inspiration. She underwent surgery for a hip fracture 3 weeks ago. Her pulse is 110/min, respirations are 20/min, and blood pressure is 112/74 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 92%. The lungs are clear to auscultation and there is no jugular venous distention. A ventilation and perfusion scan shows a small perfusion defect in the left lower lung. A drug with which of the following mechanisms of action is most appropriate for this patient?
Options:
{'A': 'Inhibition of vitamin K epoxide reductase', 'B': 'Inhibition of cyclooxygenase', 'C': 'Inhibition of adenosine diphosphate receptors', 'D': 'Activation of plasminogen', 'E': 'Activation of antithrombin III'}<|eot_id|>
<|start_header_id|>assistant<|end_header_id|>
Activation of antithrombin III<|eot_id|> |
A 57-year-old man presents with 2 days of severe, generalized, abdominal pain that is worse after meals. He is also nauseated and reports occasional diarrhea mixed with blood. Apart from essential hypertension, his medical history is unremarkable. His vital signs include a temperature of 36.9°C (98.4°F), blood pressure of 145/92 mm Hg, and an irregularly irregular pulse of 105/min. Physical examination is only notable for mild periumbilical tenderness. Which of the following is the most likely diagnosis?
Options:
{'A': 'Acute pancreatitis', 'B': "Crohn's disease", 'C': 'Acute mesenteric ischemia', 'D': 'Diverticular disease', 'E': 'Gastroenteritis'} | {'A': 'Acute pancreatitis', 'B': "Crohn's disease", 'C': 'Acute mesenteric ischemia', 'D': 'Diverticular disease', 'E': 'Gastroenteritis'} | Acute mesenteric ischemia | <|start_header_id|>system<|end_header_id|>
The following are multiple choice questions about medical knowledge. Solve them in a step-by-step fashion, starting by summarizing the available information. Output a single option from the four options as the final answer.<|eot_id|>
<|start_header_id|>user<|end_header_id|>
A 57-year-old man presents with 2 days of severe, generalized, abdominal pain that is worse after meals. He is also nauseated and reports occasional diarrhea mixed with blood. Apart from essential hypertension, his medical history is unremarkable. His vital signs include a temperature of 36.9°C (98.4°F), blood pressure of 145/92 mm Hg, and an irregularly irregular pulse of 105/min. Physical examination is only notable for mild periumbilical tenderness. Which of the following is the most likely diagnosis?
Options:
{'A': 'Acute pancreatitis', 'B': "Crohn's disease", 'C': 'Acute mesenteric ischemia', 'D': 'Diverticular disease', 'E': 'Gastroenteritis'}<|eot_id|>
<|start_header_id|>assistant<|end_header_id|>
Acute mesenteric ischemia<|eot_id|> |
A 55-year-old man, who was recently diagnosed with tuberculosis, presents to his primary care provider as part of his routine follow-up visit every month. He is currently in the initial phase of anti-tubercular therapy. His personal and medical histories are relevant for multiple trips to Southeast Asia as part of volunteer activities and diabetes of 5 years duration, respectively. A physical examination is unremarkable except for a visual abnormality on a color chart; he is unable to differentiate red from green. The physician suspects the visual irregularity as a sign of toxicity due to one of the drugs in the treatment regimen. Which of the following is the mechanism by which this medication acts in the treatment of Mycobacterium tuberculosis?
Options:
{'A': 'Inhibition of mycolic acid synthesis', 'B': 'Inhibition of DNA-dependent RNA polymerase', 'C': 'Induction of free radical metabolites', 'D': 'Inhibition of protein synthesis by binding to the 30S ribosomal subunit', 'E': 'Inhibition of arabinosyltransferase'} | {'A': 'Inhibition of mycolic acid synthesis', 'B': 'Inhibition of DNA-dependent RNA polymerase', 'C': 'Induction of free radical metabolites', 'D': 'Inhibition of protein synthesis by binding to the 30S ribosomal subunit', 'E': 'Inhibition of arabinosyltransferase'} | Inhibition of arabinosyltransferase | <|start_header_id|>system<|end_header_id|>
The following are multiple choice questions about medical knowledge. Solve them in a step-by-step fashion, starting by summarizing the available information. Output a single option from the four options as the final answer.<|eot_id|>
<|start_header_id|>user<|end_header_id|>
A 55-year-old man, who was recently diagnosed with tuberculosis, presents to his primary care provider as part of his routine follow-up visit every month. He is currently in the initial phase of anti-tubercular therapy. His personal and medical histories are relevant for multiple trips to Southeast Asia as part of volunteer activities and diabetes of 5 years duration, respectively. A physical examination is unremarkable except for a visual abnormality on a color chart; he is unable to differentiate red from green. The physician suspects the visual irregularity as a sign of toxicity due to one of the drugs in the treatment regimen. Which of the following is the mechanism by which this medication acts in the treatment of Mycobacterium tuberculosis?
Options:
{'A': 'Inhibition of mycolic acid synthesis', 'B': 'Inhibition of DNA-dependent RNA polymerase', 'C': 'Induction of free radical metabolites', 'D': 'Inhibition of protein synthesis by binding to the 30S ribosomal subunit', 'E': 'Inhibition of arabinosyltransferase'}<|eot_id|>
<|start_header_id|>assistant<|end_header_id|>
Inhibition of arabinosyltransferase<|eot_id|> |
A 67-year-old man comes to the emergency department because of retrosternal chest pressure and shortness of breath for 4 hours. The symptoms started while he was walking to work and have only minimally improved with rest. He has a history of type 2 diabetes mellitus. He has smoked one pack of cigarettes daily for 35 years. He appears uncomfortable. His pulse is 95/min. Serum studies show a normal troponin concentration. An ECG shows no abnormalities. Which of the following is the most likely underlying cause of this patient's symptoms?
Options:
{'A': 'Aortic valve thickening and calcification', 'B': 'Coronary artery occlusion due to transient increase in vascular tone', 'C': 'Stable atherosclerotic plaque with 85% coronary artery occlusion', 'D': 'Disruption of an atherosclerotic plaque with a non-occlusive coronary artery thrombus', 'E': 'Atherosclerotic plaque thrombus with complete coronary artery occlusion'} | {'A': 'Aortic valve thickening and calcification', 'B': 'Coronary artery occlusion due to transient increase in vascular tone', 'C': 'Stable atherosclerotic plaque with 85% coronary artery occlusion', 'D': 'Disruption of an atherosclerotic plaque with a non-occlusive coronary artery thrombus', 'E': 'Atherosclerotic plaque thrombus with complete coronary artery occlusion'} | Disruption of an atherosclerotic plaque with a non-occlusive coronary artery thrombus | <|start_header_id|>system<|end_header_id|>
The following are multiple choice questions about medical knowledge. Solve them in a step-by-step fashion, starting by summarizing the available information. Output a single option from the four options as the final answer.<|eot_id|>
<|start_header_id|>user<|end_header_id|>
A 67-year-old man comes to the emergency department because of retrosternal chest pressure and shortness of breath for 4 hours. The symptoms started while he was walking to work and have only minimally improved with rest. He has a history of type 2 diabetes mellitus. He has smoked one pack of cigarettes daily for 35 years. He appears uncomfortable. His pulse is 95/min. Serum studies show a normal troponin concentration. An ECG shows no abnormalities. Which of the following is the most likely underlying cause of this patient's symptoms?
Options:
{'A': 'Aortic valve thickening and calcification', 'B': 'Coronary artery occlusion due to transient increase in vascular tone', 'C': 'Stable atherosclerotic plaque with 85% coronary artery occlusion', 'D': 'Disruption of an atherosclerotic plaque with a non-occlusive coronary artery thrombus', 'E': 'Atherosclerotic plaque thrombus with complete coronary artery occlusion'}<|eot_id|>
<|start_header_id|>assistant<|end_header_id|>
Disruption of an atherosclerotic plaque with a non-occlusive coronary artery thrombus<|eot_id|> |
A 76-year-old man comes to the physician for a follow-up examination. One week ago, he was prescribed azithromycin for acute bacterial sinusitis. He has a history of atrial fibrillation treated with warfarin and metoprolol. Physical examination shows no abnormalities. Compared to one month ago, laboratory studies show a mild increase in INR. Which of the following best explains this patient's laboratory finding?
Options:
{'A': 'Depletion of intestinal flora', 'B': 'Inhibition of cytochrome p450', 'C': 'Increased non-protein bound warfarin fraction', 'D': 'Drug-induced hepatotoxicity', 'E': 'Increased gastrointestinal absorption of warfarin'} | {'A': 'Depletion of intestinal flora', 'B': 'Inhibition of cytochrome p450', 'C': 'Increased non-protein bound warfarin fraction', 'D': 'Drug-induced hepatotoxicity', 'E': 'Increased gastrointestinal absorption of warfarin'} | Depletion of intestinal flora | <|start_header_id|>system<|end_header_id|>
The following are multiple choice questions about medical knowledge. Solve them in a step-by-step fashion, starting by summarizing the available information. Output a single option from the four options as the final answer.<|eot_id|>
<|start_header_id|>user<|end_header_id|>
A 76-year-old man comes to the physician for a follow-up examination. One week ago, he was prescribed azithromycin for acute bacterial sinusitis. He has a history of atrial fibrillation treated with warfarin and metoprolol. Physical examination shows no abnormalities. Compared to one month ago, laboratory studies show a mild increase in INR. Which of the following best explains this patient's laboratory finding?
Options:
{'A': 'Depletion of intestinal flora', 'B': 'Inhibition of cytochrome p450', 'C': 'Increased non-protein bound warfarin fraction', 'D': 'Drug-induced hepatotoxicity', 'E': 'Increased gastrointestinal absorption of warfarin'}<|eot_id|>
<|start_header_id|>assistant<|end_header_id|>
Depletion of intestinal flora<|eot_id|> |
A 29-year-old primigravid woman at 24 weeks' gestation comes to the physician for a prenatal visit. She feels well. She has no personal history of serious illness. Medications include iron supplements and a multivitamin. Her temperature is 37.2°C (99°F) and blood pressure is 108/60 mm Hg. Pelvic examination shows a uterus consistent in size with a 24-week gestation. A 1-hour 50-g glucose challenge shows a glucose concentration of 155 mg/dL (N < 135 mg/dL). A 100-g oral glucose tolerance test shows glucose concentrations of 205 mg/dL (N < 180 mg/dL) and 154 mg/dL (N <140 mg/dL) at 1 and 3 hours, respectively. She refuses treatment with insulin. Which of the following complications is her infant at greatest risk of developing at birth?
Options:
{'A': 'Hypocalcemia', 'B': 'Omphalocele', 'C': 'Intrauterine growth restriction', 'D': 'Hypermagnesemia', 'E': 'Hyperglycemia'} | {'A': 'Hypocalcemia', 'B': 'Omphalocele', 'C': 'Intrauterine growth restriction', 'D': 'Hypermagnesemia', 'E': 'Hyperglycemia'} | Hypocalcemia | <|start_header_id|>system<|end_header_id|>
The following are multiple choice questions about medical knowledge. Solve them in a step-by-step fashion, starting by summarizing the available information. Output a single option from the four options as the final answer.<|eot_id|>
<|start_header_id|>user<|end_header_id|>
A 29-year-old primigravid woman at 24 weeks' gestation comes to the physician for a prenatal visit. She feels well. She has no personal history of serious illness. Medications include iron supplements and a multivitamin. Her temperature is 37.2°C (99°F) and blood pressure is 108/60 mm Hg. Pelvic examination shows a uterus consistent in size with a 24-week gestation. A 1-hour 50-g glucose challenge shows a glucose concentration of 155 mg/dL (N < 135 mg/dL). A 100-g oral glucose tolerance test shows glucose concentrations of 205 mg/dL (N < 180 mg/dL) and 154 mg/dL (N <140 mg/dL) at 1 and 3 hours, respectively. She refuses treatment with insulin. Which of the following complications is her infant at greatest risk of developing at birth?
Options:
{'A': 'Hypocalcemia', 'B': 'Omphalocele', 'C': 'Intrauterine growth restriction', 'D': 'Hypermagnesemia', 'E': 'Hyperglycemia'}<|eot_id|>
<|start_header_id|>assistant<|end_header_id|>
Hypocalcemia<|eot_id|> |
A 3-week-old boy is brought to the physician for the evaluation of poor feeding and recurrent episodes of vomiting. He was delivered at term after an uncomplicated pregnancy. He is at the 5th percentile for length and weight. Physical examination shows generalized hypotonia. Urinalysis shows increased propionic acid concentration. The finding on urinalysis is best explained by the breakdown of which of the following substances?
Options:
{'A': 'Even-chain fatty acids', 'B': 'Hexose monosaccharides', 'C': 'Branched-chain amino acids', 'D': 'Catechol-containing monoamines', 'E': 'Bicyclic nitrogenous bases'} | {'A': 'Even-chain fatty acids', 'B': 'Hexose monosaccharides', 'C': 'Branched-chain amino acids', 'D': 'Catechol-containing monoamines', 'E': 'Bicyclic nitrogenous bases'} | Branched-chain amino acids | <|start_header_id|>system<|end_header_id|>
The following are multiple choice questions about medical knowledge. Solve them in a step-by-step fashion, starting by summarizing the available information. Output a single option from the four options as the final answer.<|eot_id|>
<|start_header_id|>user<|end_header_id|>
A 3-week-old boy is brought to the physician for the evaluation of poor feeding and recurrent episodes of vomiting. He was delivered at term after an uncomplicated pregnancy. He is at the 5th percentile for length and weight. Physical examination shows generalized hypotonia. Urinalysis shows increased propionic acid concentration. The finding on urinalysis is best explained by the breakdown of which of the following substances?
Options:
{'A': 'Even-chain fatty acids', 'B': 'Hexose monosaccharides', 'C': 'Branched-chain amino acids', 'D': 'Catechol-containing monoamines', 'E': 'Bicyclic nitrogenous bases'}<|eot_id|>
<|start_header_id|>assistant<|end_header_id|>
Branched-chain amino acids<|eot_id|> |
A 30-year-old caucasian female comes to the physician because of chronic diarrhea and abdominal bloating that started 6 months ago. She also reports increasing fatigue and intermittent tingling in her hands and feet. She lost 5 kg (11 lb) of weight over the past 6 months without changing her diet or trying to lose weight. She and her husband have been trying to conceive for over a year without any success. Menses have been irregular at 28–45 day intervals and last for 1–2 days. She has generalized anxiety disorder for which she takes sertraline. Her height is 151 cm and weight is 50 kg; BMI is 22 kg/m2. Examination shows generalized pallor. Cardiopulmonary examination is normal. Test of the stool for occult blood is negative. Laboratory studies show:
Hemoglobin 9.5 g/dL
Leukocyte count 3900/mm3
Platelet count 130,000/mm3
Serum
Glucose 100 mg/dL
Creatinine 0.6 mg/dL
Thyroid-stimulating hormone 3.3 μU/mL
Vitamin B12 80 pg/mL (N > 200)
IgA anti-tissue transglutaminase antibody negative
Serum IgA decreased
Which of the following is the most appropriate next step in diagnosis?"
Options:
{'A': 'Plasma zinc concentration', 'B': 'Fecal fat test', 'C': 'IgG deamidated gliadin peptide test', 'D': 'IgA endomysial antibody', 'E': 'Skin prick test'} | {'A': 'Plasma zinc concentration', 'B': 'Fecal fat test', 'C': 'IgG deamidated gliadin peptide test', 'D': 'IgA endomysial antibody', 'E': 'Skin prick test'} | IgG deamidated gliadin peptide test | <|start_header_id|>system<|end_header_id|>
The following are multiple choice questions about medical knowledge. Solve them in a step-by-step fashion, starting by summarizing the available information. Output a single option from the four options as the final answer.<|eot_id|>
<|start_header_id|>user<|end_header_id|>
A 30-year-old caucasian female comes to the physician because of chronic diarrhea and abdominal bloating that started 6 months ago. She also reports increasing fatigue and intermittent tingling in her hands and feet. She lost 5 kg (11 lb) of weight over the past 6 months without changing her diet or trying to lose weight. She and her husband have been trying to conceive for over a year without any success. Menses have been irregular at 28–45 day intervals and last for 1–2 days. She has generalized anxiety disorder for which she takes sertraline. Her height is 151 cm and weight is 50 kg; BMI is 22 kg/m2. Examination shows generalized pallor. Cardiopulmonary examination is normal. Test of the stool for occult blood is negative. Laboratory studies show:
Hemoglobin 9.5 g/dL
Leukocyte count 3900/mm3
Platelet count 130,000/mm3
Serum
Glucose 100 mg/dL
Creatinine 0.6 mg/dL
Thyroid-stimulating hormone 3.3 μU/mL
Vitamin B12 80 pg/mL (N > 200)
IgA anti-tissue transglutaminase antibody negative
Serum IgA decreased
Which of the following is the most appropriate next step in diagnosis?"
Options:
{'A': 'Plasma zinc concentration', 'B': 'Fecal fat test', 'C': 'IgG deamidated gliadin peptide test', 'D': 'IgA endomysial antibody', 'E': 'Skin prick test'}<|eot_id|>
<|start_header_id|>assistant<|end_header_id|>
IgG deamidated gliadin peptide test<|eot_id|> |
A 41-year-old woman with subclinical hypothyroidism comes to the physician because of a 6-month history of progressively worsening headaches and irregular menses. Her menses had previously occurred at regular 30-day intervals with moderate flow, but her last menstrual period was 12 weeks ago. She also reports that her interest in sexual intercourse has recently decreased. Her serum prolactin level is elevated. Which of the following is the most appropriate pharmacotherapy for this patient?
Options:
{'A': 'Bromocriptine', 'B': 'Estrogen', 'C': 'Methyldopa', 'D': 'Metoclopromide', 'E': 'L-thyroxine'} | {'A': 'Bromocriptine', 'B': 'Estrogen', 'C': 'Methyldopa', 'D': 'Metoclopromide', 'E': 'L-thyroxine'} | Bromocriptine | <|start_header_id|>system<|end_header_id|>
The following are multiple choice questions about medical knowledge. Solve them in a step-by-step fashion, starting by summarizing the available information. Output a single option from the four options as the final answer.<|eot_id|>
<|start_header_id|>user<|end_header_id|>
A 41-year-old woman with subclinical hypothyroidism comes to the physician because of a 6-month history of progressively worsening headaches and irregular menses. Her menses had previously occurred at regular 30-day intervals with moderate flow, but her last menstrual period was 12 weeks ago. She also reports that her interest in sexual intercourse has recently decreased. Her serum prolactin level is elevated. Which of the following is the most appropriate pharmacotherapy for this patient?
Options:
{'A': 'Bromocriptine', 'B': 'Estrogen', 'C': 'Methyldopa', 'D': 'Metoclopromide', 'E': 'L-thyroxine'}<|eot_id|>
<|start_header_id|>assistant<|end_header_id|>
Bromocriptine<|eot_id|> |
A 42-year-old woman presents to her primary care physician with fatigue. She reports that over the past 2 months, she has felt increasingly tired despite no changes in her diet or exercise. Her past medical history is notable for obesity, seasonal allergies, and hypertension. She takes ranitidine as needed and hydrochlorothiazide daily. Her family history is notable for colorectal cancer in her mother and maternal uncle, endometrial cancer in her maternal aunt, and ovarian cancer in her maternal grandmother. Her temperature is 98.8°F (37.1°C), blood pressure is 132/71 mmHg, pulse is 89/min, and respirations are 17/min. On exam, she has conjunctival pallor. A stool sample is hemoccult positive. A colonoscopy reveals a fungating hemorrhagic mass in the ascending colon. Which of the following processes is likely impaired in this patient?
Options:
{'A': 'Base excision repair', 'B': 'Homologous recombination', 'C': 'Mismatch repair', 'D': 'Non-homologous end joining', 'E': 'Nucleotide excision repair'} | {'A': 'Base excision repair', 'B': 'Homologous recombination', 'C': 'Mismatch repair', 'D': 'Non-homologous end joining', 'E': 'Nucleotide excision repair'} | Mismatch repair | <|start_header_id|>system<|end_header_id|>
The following are multiple choice questions about medical knowledge. Solve them in a step-by-step fashion, starting by summarizing the available information. Output a single option from the four options as the final answer.<|eot_id|>
<|start_header_id|>user<|end_header_id|>
A 42-year-old woman presents to her primary care physician with fatigue. She reports that over the past 2 months, she has felt increasingly tired despite no changes in her diet or exercise. Her past medical history is notable for obesity, seasonal allergies, and hypertension. She takes ranitidine as needed and hydrochlorothiazide daily. Her family history is notable for colorectal cancer in her mother and maternal uncle, endometrial cancer in her maternal aunt, and ovarian cancer in her maternal grandmother. Her temperature is 98.8°F (37.1°C), blood pressure is 132/71 mmHg, pulse is 89/min, and respirations are 17/min. On exam, she has conjunctival pallor. A stool sample is hemoccult positive. A colonoscopy reveals a fungating hemorrhagic mass in the ascending colon. Which of the following processes is likely impaired in this patient?
Options:
{'A': 'Base excision repair', 'B': 'Homologous recombination', 'C': 'Mismatch repair', 'D': 'Non-homologous end joining', 'E': 'Nucleotide excision repair'}<|eot_id|>
<|start_header_id|>assistant<|end_header_id|>
Mismatch repair<|eot_id|> |
An 11-year-old male with light purple eyes presents with gradual loss of bilateral visual acuity. Over the past several years, vision has worsened from 20/20 to 20/100 in both eyes. He also has mild nystagmus when focusing on objects such as when he is trying to do his homework. He is diagnosed with a disease affecting melanin production in the iris. If both of his parents are unaffected, which of the following represents the most likely probabilities that another male or female child from this family would be affected by this disorder?
Options:
{'A': 'Same as general population', 'B': 'Male: 25% Female: 25%', 'C': 'Male: 50% Female: 50%', 'D': 'Male: 50% Female: 0%', 'E': 'Male: 100% Female: 0%'} | {'A': 'Same as general population', 'B': 'Male: 25% Female: 25%', 'C': 'Male: 50% Female: 50%', 'D': 'Male: 50% Female: 0%', 'E': 'Male: 100% Female: 0%'} | Male: 50% Female: 0% | <|start_header_id|>system<|end_header_id|>
The following are multiple choice questions about medical knowledge. Solve them in a step-by-step fashion, starting by summarizing the available information. Output a single option from the four options as the final answer.<|eot_id|>
<|start_header_id|>user<|end_header_id|>
An 11-year-old male with light purple eyes presents with gradual loss of bilateral visual acuity. Over the past several years, vision has worsened from 20/20 to 20/100 in both eyes. He also has mild nystagmus when focusing on objects such as when he is trying to do his homework. He is diagnosed with a disease affecting melanin production in the iris. If both of his parents are unaffected, which of the following represents the most likely probabilities that another male or female child from this family would be affected by this disorder?
Options:
{'A': 'Same as general population', 'B': 'Male: 25% Female: 25%', 'C': 'Male: 50% Female: 50%', 'D': 'Male: 50% Female: 0%', 'E': 'Male: 100% Female: 0%'}<|eot_id|>
<|start_header_id|>assistant<|end_header_id|>
Male: 50% Female: 0%<|eot_id|> |
A previously healthy 46-year-old man comes to the physician for an 8-month history of headache that is more severe in the mornings. His blood pressure is 151/92 mm Hg. Examination shows enlargement of the nose, forehead, and jaw as well as the hands, fingers, and feet. Ophthalmologic examination shows impaired vision in the outer peripheral fields of both eyes. Laboratory studies show a serum glucose concentration of 225 mg/dL. Which of the following findings is most likely to confirm the diagnosis?
Options:
{'A': 'Low serum growth hormone level', 'B': 'Elevated urine cortisol level', 'C': 'Low serum insulin level', 'D': 'Elevated serum prolactin level', 'E': 'Elevated serum insulin-like growth factor-1 level'} | {'A': 'Low serum growth hormone level', 'B': 'Elevated urine cortisol level', 'C': 'Low serum insulin level', 'D': 'Elevated serum prolactin level', 'E': 'Elevated serum insulin-like growth factor-1 level'} | Elevated serum insulin-like growth factor-1 level | <|start_header_id|>system<|end_header_id|>
The following are multiple choice questions about medical knowledge. Solve them in a step-by-step fashion, starting by summarizing the available information. Output a single option from the four options as the final answer.<|eot_id|>
<|start_header_id|>user<|end_header_id|>
A previously healthy 46-year-old man comes to the physician for an 8-month history of headache that is more severe in the mornings. His blood pressure is 151/92 mm Hg. Examination shows enlargement of the nose, forehead, and jaw as well as the hands, fingers, and feet. Ophthalmologic examination shows impaired vision in the outer peripheral fields of both eyes. Laboratory studies show a serum glucose concentration of 225 mg/dL. Which of the following findings is most likely to confirm the diagnosis?
Options:
{'A': 'Low serum growth hormone level', 'B': 'Elevated urine cortisol level', 'C': 'Low serum insulin level', 'D': 'Elevated serum prolactin level', 'E': 'Elevated serum insulin-like growth factor-1 level'}<|eot_id|>
<|start_header_id|>assistant<|end_header_id|>
Elevated serum insulin-like growth factor-1 level<|eot_id|> |
A 38-year-old woman comes to the physician because of a 10-month history of nonbloody diarrhea and recurrent episodes of flushing and wheezing. She does not take any medications. Physical examination shows a hyperpigmented rash around the base of her neck. Cardiac examination shows a grade 4/6, holosystolic murmur in the 5th intercostal space at the left midclavicular line. Echocardiography shows left-sided endocardial and valvular fibrosis with moderate mitral regurgitation; there are no septal defects or right-sided valvular defects. Urinalysis shows increased 5-hydroxyindoleacetic acid concentration. Further evaluation of this patient is most likely to show which of the following findings?
Options:
{'A': 'Tumor in the pancreas without metastasis', 'B': 'Tumor in the lung without metastasis', 'C': 'Tumor in the left atrium with hepatic metastasis', 'D': 'Tumor in the appendix without metastasis', 'E': 'Tumor in the descending colon with hepatic metastasis'} | {'A': 'Tumor in the pancreas without metastasis', 'B': 'Tumor in the lung without metastasis', 'C': 'Tumor in the left atrium with hepatic metastasis', 'D': 'Tumor in the appendix without metastasis', 'E': 'Tumor in the descending colon with hepatic metastasis'} | Tumor in the lung without metastasis | <|start_header_id|>system<|end_header_id|>
The following are multiple choice questions about medical knowledge. Solve them in a step-by-step fashion, starting by summarizing the available information. Output a single option from the four options as the final answer.<|eot_id|>
<|start_header_id|>user<|end_header_id|>
A 38-year-old woman comes to the physician because of a 10-month history of nonbloody diarrhea and recurrent episodes of flushing and wheezing. She does not take any medications. Physical examination shows a hyperpigmented rash around the base of her neck. Cardiac examination shows a grade 4/6, holosystolic murmur in the 5th intercostal space at the left midclavicular line. Echocardiography shows left-sided endocardial and valvular fibrosis with moderate mitral regurgitation; there are no septal defects or right-sided valvular defects. Urinalysis shows increased 5-hydroxyindoleacetic acid concentration. Further evaluation of this patient is most likely to show which of the following findings?
Options:
{'A': 'Tumor in the pancreas without metastasis', 'B': 'Tumor in the lung without metastasis', 'C': 'Tumor in the left atrium with hepatic metastasis', 'D': 'Tumor in the appendix without metastasis', 'E': 'Tumor in the descending colon with hepatic metastasis'}<|eot_id|>
<|start_header_id|>assistant<|end_header_id|>
Tumor in the lung without metastasis<|eot_id|> |
A 27-year-old man is brought to the emergency department by his girlfriend. The patient is a seasonal farm worker and was found laying down and minimally responsive under a tree. The patient was immediately brought to the emergency department. The patient has a past medical history of IV drug use, marijuana use, and alcohol use. His current medications include ibuprofen. His temperature is 98.2°F (36.8°C), blood pressure is 100/55 mmHg, pulse is 60/min, respirations are 15/min, and oxygen saturation is 98% on room air. On physical exam, the patient's extremities are twitching, and his clothes are soaked in urine and partially removed. The patient is also drooling and coughs regularly. Which of the following is the best next step in management?
Options:
{'A': 'Atropine', 'B': 'Electroencephalography', 'C': 'Lorazepam', 'D': 'Supportive therapy and monitoring', 'E': 'Urine toxicology'} | {'A': 'Atropine', 'B': 'Electroencephalography', 'C': 'Lorazepam', 'D': 'Supportive therapy and monitoring', 'E': 'Urine toxicology'} | Atropine | <|start_header_id|>system<|end_header_id|>
The following are multiple choice questions about medical knowledge. Solve them in a step-by-step fashion, starting by summarizing the available information. Output a single option from the four options as the final answer.<|eot_id|>
<|start_header_id|>user<|end_header_id|>
A 27-year-old man is brought to the emergency department by his girlfriend. The patient is a seasonal farm worker and was found laying down and minimally responsive under a tree. The patient was immediately brought to the emergency department. The patient has a past medical history of IV drug use, marijuana use, and alcohol use. His current medications include ibuprofen. His temperature is 98.2°F (36.8°C), blood pressure is 100/55 mmHg, pulse is 60/min, respirations are 15/min, and oxygen saturation is 98% on room air. On physical exam, the patient's extremities are twitching, and his clothes are soaked in urine and partially removed. The patient is also drooling and coughs regularly. Which of the following is the best next step in management?
Options:
{'A': 'Atropine', 'B': 'Electroencephalography', 'C': 'Lorazepam', 'D': 'Supportive therapy and monitoring', 'E': 'Urine toxicology'}<|eot_id|>
<|start_header_id|>assistant<|end_header_id|>
Atropine<|eot_id|> |
A 32-year-old woman presents with new left-arm pain. She was previously well but for 2 months has had episodes of low-grade fever, night sweats, and dizziness. She works as a stock assistant and has noticed left arm pain when she stocks shelves. She is taking a multivitamin but no other medications. On physical examination, her blood pressure is 126/72 in her right arm, but it cannot be measured in her left arm. The left radial pulse is not detectable. There is a bruit over the left subclavian area. Femoral and pedal pulses are normal and no abdominal bruits are heard. The left hand is cool but has no other evidence of ischemia. Which of the following is the most likely etiology of this patient’s condition?
Options:
{'A': 'Subclavian steal syndrome', 'B': 'Raynaud’s phenomenon', 'C': 'Fibromuscular dysplasia', 'D': 'Kawasaki disease', 'E': 'Aortic coarctation'} | {'A': 'Subclavian steal syndrome', 'B': 'Raynaud’s phenomenon', 'C': 'Fibromuscular dysplasia', 'D': 'Kawasaki disease', 'E': 'Aortic coarctation'} | Subclavian steal syndrome | <|start_header_id|>system<|end_header_id|>
The following are multiple choice questions about medical knowledge. Solve them in a step-by-step fashion, starting by summarizing the available information. Output a single option from the four options as the final answer.<|eot_id|>
<|start_header_id|>user<|end_header_id|>
A 32-year-old woman presents with new left-arm pain. She was previously well but for 2 months has had episodes of low-grade fever, night sweats, and dizziness. She works as a stock assistant and has noticed left arm pain when she stocks shelves. She is taking a multivitamin but no other medications. On physical examination, her blood pressure is 126/72 in her right arm, but it cannot be measured in her left arm. The left radial pulse is not detectable. There is a bruit over the left subclavian area. Femoral and pedal pulses are normal and no abdominal bruits are heard. The left hand is cool but has no other evidence of ischemia. Which of the following is the most likely etiology of this patient’s condition?
Options:
{'A': 'Subclavian steal syndrome', 'B': 'Raynaud’s phenomenon', 'C': 'Fibromuscular dysplasia', 'D': 'Kawasaki disease', 'E': 'Aortic coarctation'}<|eot_id|>
<|start_header_id|>assistant<|end_header_id|>
Subclavian steal syndrome<|eot_id|> |
A 52-year-old Caucasian male presents to your office with an 8 mm dark lesion on his back. The lesion, as seen below, has irregular borders and marked internal color variation. Upon excisional biopsy, the presence of which of the following would best estimate the risk of metastasis in this patient’s lesion:
Options:
{'A': 'Palisading nuclei', 'B': 'Keratin pearls', 'C': 'Vertical tumor growth', 'D': 'Cellular atypia', 'E': 'Increased production of melanosomes'} | {'A': 'Palisading nuclei', 'B': 'Keratin pearls', 'C': 'Vertical tumor growth', 'D': 'Cellular atypia', 'E': 'Increased production of melanosomes'} | Vertical tumor growth | <|start_header_id|>system<|end_header_id|>
The following are multiple choice questions about medical knowledge. Solve them in a step-by-step fashion, starting by summarizing the available information. Output a single option from the four options as the final answer.<|eot_id|>
<|start_header_id|>user<|end_header_id|>
A 52-year-old Caucasian male presents to your office with an 8 mm dark lesion on his back. The lesion, as seen below, has irregular borders and marked internal color variation. Upon excisional biopsy, the presence of which of the following would best estimate the risk of metastasis in this patient’s lesion:
Options:
{'A': 'Palisading nuclei', 'B': 'Keratin pearls', 'C': 'Vertical tumor growth', 'D': 'Cellular atypia', 'E': 'Increased production of melanosomes'}<|eot_id|>
<|start_header_id|>assistant<|end_header_id|>
Vertical tumor growth<|eot_id|> |
A 5-month-old boy is brought to the physician because of fever and a cough for 3 days. His mother reports that he has had multiple episodes of loose stools over the past 3 months. He has been treated for otitis media 4 times and bronchiolitis 3 times during the past 3 months. He was born at 37 weeks' gestation and the neonatal period was uncomplicated. He is at the 10th percentile for height and 3rd percentile for weight. His temperature is 38.3°C (100.9°F), pulse is 126/min, and respirations are 35/min. Examination shows an erythematous scaly rash over the trunk and extremities. There are white patches on the tongue and buccal mucosa that bleed when scraped. Inspiratory crackles are heard in the right lung base. An x-ray of the chest shows an infiltrate in the right lower lobe and an absent thymic shadow. Which of the following is the most likely diagnosis?
Options:
{'A': 'Wiskott-Aldrich syndrome', 'B': 'Severe combined immunodeficiency', 'C': 'Leukocyte adhesion deficiency', 'D': 'Chronic granulomatous disease', 'E': 'X-linked agammaglobulinemia'} | {'A': 'Wiskott-Aldrich syndrome', 'B': 'Severe combined immunodeficiency', 'C': 'Leukocyte adhesion deficiency', 'D': 'Chronic granulomatous disease', 'E': 'X-linked agammaglobulinemia'} | Severe combined immunodeficiency | <|start_header_id|>system<|end_header_id|>
The following are multiple choice questions about medical knowledge. Solve them in a step-by-step fashion, starting by summarizing the available information. Output a single option from the four options as the final answer.<|eot_id|>
<|start_header_id|>user<|end_header_id|>
A 5-month-old boy is brought to the physician because of fever and a cough for 3 days. His mother reports that he has had multiple episodes of loose stools over the past 3 months. He has been treated for otitis media 4 times and bronchiolitis 3 times during the past 3 months. He was born at 37 weeks' gestation and the neonatal period was uncomplicated. He is at the 10th percentile for height and 3rd percentile for weight. His temperature is 38.3°C (100.9°F), pulse is 126/min, and respirations are 35/min. Examination shows an erythematous scaly rash over the trunk and extremities. There are white patches on the tongue and buccal mucosa that bleed when scraped. Inspiratory crackles are heard in the right lung base. An x-ray of the chest shows an infiltrate in the right lower lobe and an absent thymic shadow. Which of the following is the most likely diagnosis?
Options:
{'A': 'Wiskott-Aldrich syndrome', 'B': 'Severe combined immunodeficiency', 'C': 'Leukocyte adhesion deficiency', 'D': 'Chronic granulomatous disease', 'E': 'X-linked agammaglobulinemia'}<|eot_id|>
<|start_header_id|>assistant<|end_header_id|>
Severe combined immunodeficiency<|eot_id|> |
A 4-month-old girl is brought to the physician by her father because he is concerned that she appears sickly and lethargic. She has always had a pale complexion, but it has been getting worse over the past month. She was delivered at home at 36 weeks to a 26-year-old woman following an uncomplicated pregnancy. She has not yet been examined by a physician. She is in the 2nd percentile for head circumference, 10th percentile for length, and 8th percentile for weight. Physical exam shows a pale infant with facial features of micrognathia, flat nasal bridge, and microopthalmos. The eyes are set widely apart and strabismus is present. She has a high arched palate and there is fusion of the cervical vertebrae with flaring of the skin around the neck. A 4/6 holosystolic murmur is heard best on the left chest. Laboratory studies show:
Hemoglobin 6.6 g/dL
Hematocrit 20%
Leukocytes 5400/mm3
Platelets 183,000/mm3
Mean corpuscular hemoglobin 41.3 pg/cell
Mean corpuscular hemoglobin concentration 33% Hb/cell
Mean corpuscular volume 125 μm3
This patient is most likely to have which of the following findings?"
Options:
{'A': 'Mild neutropenia', 'B': 'Spherocytes', 'C': 'Triphalangeal thumb', 'D': 'Target cells', 'E': 'Exocrine pancreatic dysfunction'} | {'A': 'Mild neutropenia', 'B': 'Spherocytes', 'C': 'Triphalangeal thumb', 'D': 'Target cells', 'E': 'Exocrine pancreatic dysfunction'} | Triphalangeal thumb | <|start_header_id|>system<|end_header_id|>
The following are multiple choice questions about medical knowledge. Solve them in a step-by-step fashion, starting by summarizing the available information. Output a single option from the four options as the final answer.<|eot_id|>
<|start_header_id|>user<|end_header_id|>
A 4-month-old girl is brought to the physician by her father because he is concerned that she appears sickly and lethargic. She has always had a pale complexion, but it has been getting worse over the past month. She was delivered at home at 36 weeks to a 26-year-old woman following an uncomplicated pregnancy. She has not yet been examined by a physician. She is in the 2nd percentile for head circumference, 10th percentile for length, and 8th percentile for weight. Physical exam shows a pale infant with facial features of micrognathia, flat nasal bridge, and microopthalmos. The eyes are set widely apart and strabismus is present. She has a high arched palate and there is fusion of the cervical vertebrae with flaring of the skin around the neck. A 4/6 holosystolic murmur is heard best on the left chest. Laboratory studies show:
Hemoglobin 6.6 g/dL
Hematocrit 20%
Leukocytes 5400/mm3
Platelets 183,000/mm3
Mean corpuscular hemoglobin 41.3 pg/cell
Mean corpuscular hemoglobin concentration 33% Hb/cell
Mean corpuscular volume 125 μm3
This patient is most likely to have which of the following findings?"
Options:
{'A': 'Mild neutropenia', 'B': 'Spherocytes', 'C': 'Triphalangeal thumb', 'D': 'Target cells', 'E': 'Exocrine pancreatic dysfunction'}<|eot_id|>
<|start_header_id|>assistant<|end_header_id|>
Triphalangeal thumb<|eot_id|> |
A 67-year-old woman with advanced bladder cancer comes to the physician for a follow-up examination. She is currently undergoing chemotherapy with an agent that forms cross-links between DNA strands. Serum studies show a creatinine concentration of 2.1 mg/dL and a blood urea nitrogen concentration of 30 mg/dL. Urine dipstick of a clean-catch midstream specimen shows 2+ protein and 1+ glucose. Prior to initiation of chemotherapy, her laboratory values were within the reference range. In addition to hydration, administration of which of the following would most likely have prevented this patient's current condition?
Options:
{'A': 'Mesna', 'B': 'Aprepitant', 'C': 'Amifostine', 'D': 'Rasburicase', 'E': 'Leucovorin'} | {'A': 'Mesna', 'B': 'Aprepitant', 'C': 'Amifostine', 'D': 'Rasburicase', 'E': 'Leucovorin'} | Amifostine | <|start_header_id|>system<|end_header_id|>
The following are multiple choice questions about medical knowledge. Solve them in a step-by-step fashion, starting by summarizing the available information. Output a single option from the four options as the final answer.<|eot_id|>
<|start_header_id|>user<|end_header_id|>
A 67-year-old woman with advanced bladder cancer comes to the physician for a follow-up examination. She is currently undergoing chemotherapy with an agent that forms cross-links between DNA strands. Serum studies show a creatinine concentration of 2.1 mg/dL and a blood urea nitrogen concentration of 30 mg/dL. Urine dipstick of a clean-catch midstream specimen shows 2+ protein and 1+ glucose. Prior to initiation of chemotherapy, her laboratory values were within the reference range. In addition to hydration, administration of which of the following would most likely have prevented this patient's current condition?
Options:
{'A': 'Mesna', 'B': 'Aprepitant', 'C': 'Amifostine', 'D': 'Rasburicase', 'E': 'Leucovorin'}<|eot_id|>
<|start_header_id|>assistant<|end_header_id|>
Amifostine<|eot_id|> |
A 48-hour-old newborn presents in respiratory distress. He is gasping for breath in the neonatal intensive care unit (NICU) and has had a fever for the past 2 days with a temperature ranging between 37.2°C (99.0°F) and 38.6°C (101.5°F). He also has not been feeding well and seems to be lethargic. The patient was delivered normally at 36 weeks of gestation. His mother had a premature rupture of membranes, which occurred with her last pregnancy, as well. No history of infection during pregnancy. On physical examination, a bulging anterior fontanelle is noticed, along with tensing of the extensor muscles. A lumbar puncture is performed, and CSF analysis is pending. Which of the following would be the best course of treatment in this patient?
Options:
{'A': 'Ampicillin and gentamicin', 'B': 'Ampicillin and cefotaxime', 'C': 'Ampicillin and acyclovir', 'D': 'Ampicillin and ticarcillin', 'E': 'Ampicillin and sulbactam'} | {'A': 'Ampicillin and gentamicin', 'B': 'Ampicillin and cefotaxime', 'C': 'Ampicillin and acyclovir', 'D': 'Ampicillin and ticarcillin', 'E': 'Ampicillin and sulbactam'} | Ampicillin and gentamicin | <|start_header_id|>system<|end_header_id|>
The following are multiple choice questions about medical knowledge. Solve them in a step-by-step fashion, starting by summarizing the available information. Output a single option from the four options as the final answer.<|eot_id|>
<|start_header_id|>user<|end_header_id|>
A 48-hour-old newborn presents in respiratory distress. He is gasping for breath in the neonatal intensive care unit (NICU) and has had a fever for the past 2 days with a temperature ranging between 37.2°C (99.0°F) and 38.6°C (101.5°F). He also has not been feeding well and seems to be lethargic. The patient was delivered normally at 36 weeks of gestation. His mother had a premature rupture of membranes, which occurred with her last pregnancy, as well. No history of infection during pregnancy. On physical examination, a bulging anterior fontanelle is noticed, along with tensing of the extensor muscles. A lumbar puncture is performed, and CSF analysis is pending. Which of the following would be the best course of treatment in this patient?
Options:
{'A': 'Ampicillin and gentamicin', 'B': 'Ampicillin and cefotaxime', 'C': 'Ampicillin and acyclovir', 'D': 'Ampicillin and ticarcillin', 'E': 'Ampicillin and sulbactam'}<|eot_id|>
<|start_header_id|>assistant<|end_header_id|>
Ampicillin and gentamicin<|eot_id|> |
A 52-year-old woman comes to the physician because of vaginal itchiness and urinary frequency for the past 1 year. She stopped having vaginal intercourse with her husband because it became painful and occasionally resulted in vaginal spotting. Her last menstrual cycle was 14 months ago. She has vitiligo. Her only medication is a topical tacrolimus ointment. Her temperature is 37.1°C (98.8°F), pulse is 85/min, and blood pressure is 135/82 mm Hg. Examination shows multiple white maculae on her forearms, abdomen, and feet. Pelvic examination shows scarce pubic hair, vulvar pallor, and narrowing of the vaginal introitus. Which of the following most likely contributes to this patient's current symptoms?
Options:
{'A': 'Thinning of the mucosa', 'B': 'Inflammation of the vestibular glands', 'C': 'Decrease of pH', 'D': 'Dysplasia of the epithelium', 'E': 'Sclerosis of the dermis'} | {'A': 'Thinning of the mucosa', 'B': 'Inflammation of the vestibular glands', 'C': 'Decrease of pH', 'D': 'Dysplasia of the epithelium', 'E': 'Sclerosis of the dermis'} | Thinning of the mucosa | <|start_header_id|>system<|end_header_id|>
The following are multiple choice questions about medical knowledge. Solve them in a step-by-step fashion, starting by summarizing the available information. Output a single option from the four options as the final answer.<|eot_id|>
<|start_header_id|>user<|end_header_id|>
A 52-year-old woman comes to the physician because of vaginal itchiness and urinary frequency for the past 1 year. She stopped having vaginal intercourse with her husband because it became painful and occasionally resulted in vaginal spotting. Her last menstrual cycle was 14 months ago. She has vitiligo. Her only medication is a topical tacrolimus ointment. Her temperature is 37.1°C (98.8°F), pulse is 85/min, and blood pressure is 135/82 mm Hg. Examination shows multiple white maculae on her forearms, abdomen, and feet. Pelvic examination shows scarce pubic hair, vulvar pallor, and narrowing of the vaginal introitus. Which of the following most likely contributes to this patient's current symptoms?
Options:
{'A': 'Thinning of the mucosa', 'B': 'Inflammation of the vestibular glands', 'C': 'Decrease of pH', 'D': 'Dysplasia of the epithelium', 'E': 'Sclerosis of the dermis'}<|eot_id|>
<|start_header_id|>assistant<|end_header_id|>
Thinning of the mucosa<|eot_id|> |
A 72-year-old woman is brought to the emergency department by her son after he noticed that she was slurring her speech. He also noticed that she appeared to have difficulty using her fork about halfway through dinner when the speech problems started. He brought her to the emergency department immediately and he estimates that only 1 hour has passed since the beginning of the symptoms. An immediate exam is conducted. A medication is administered to ameliorate the effects of this patient's condition that would not be available for use if the patient had presented significantly later. An hour later the patient's condition becomes significantly worse and new deficits are found. Which of the following agents should be used at this point?
Options:
{'A': 'Aminocaproic acid', 'B': 'Antivenin', 'C': 'Plasma transfusion', 'D': 'Protamine sulfate', 'E': 'Vitamin K'} | {'A': 'Aminocaproic acid', 'B': 'Antivenin', 'C': 'Plasma transfusion', 'D': 'Protamine sulfate', 'E': 'Vitamin K'} | Aminocaproic acid | <|start_header_id|>system<|end_header_id|>
The following are multiple choice questions about medical knowledge. Solve them in a step-by-step fashion, starting by summarizing the available information. Output a single option from the four options as the final answer.<|eot_id|>
<|start_header_id|>user<|end_header_id|>
A 72-year-old woman is brought to the emergency department by her son after he noticed that she was slurring her speech. He also noticed that she appeared to have difficulty using her fork about halfway through dinner when the speech problems started. He brought her to the emergency department immediately and he estimates that only 1 hour has passed since the beginning of the symptoms. An immediate exam is conducted. A medication is administered to ameliorate the effects of this patient's condition that would not be available for use if the patient had presented significantly later. An hour later the patient's condition becomes significantly worse and new deficits are found. Which of the following agents should be used at this point?
Options:
{'A': 'Aminocaproic acid', 'B': 'Antivenin', 'C': 'Plasma transfusion', 'D': 'Protamine sulfate', 'E': 'Vitamin K'}<|eot_id|>
<|start_header_id|>assistant<|end_header_id|>
Aminocaproic acid<|eot_id|> |
A 48-year-old woman presents to an urgent care clinic with the complaints of bloody diarrhea, mid-abdominal discomfort, and cramping for 3 days. She also has nausea, vomiting, and fever. She reports that she had eaten raw oysters at a local seafood restaurant almost 3 days ago, but she denies any other potentially infectious exposures. Her temperature is 37.5°C (99.6°F), respiratory rate is 15/min, pulse is 67/min, and blood pressure is 102/68 mm Hg. Physical examination is non-contributory. What is the most likely diagnosis?
Options:
{'A': 'Rotavirus infection', 'B': 'C. difficile colitis', 'C': 'Bacillus cereus infection', 'D': 'Norovirus infection', 'E': 'Vibrio parahaemolyticus infection'} | {'A': 'Rotavirus infection', 'B': 'C. difficile colitis', 'C': 'Bacillus cereus infection', 'D': 'Norovirus infection', 'E': 'Vibrio parahaemolyticus infection'} | Vibrio parahaemolyticus infection | <|start_header_id|>system<|end_header_id|>
The following are multiple choice questions about medical knowledge. Solve them in a step-by-step fashion, starting by summarizing the available information. Output a single option from the four options as the final answer.<|eot_id|>
<|start_header_id|>user<|end_header_id|>
A 48-year-old woman presents to an urgent care clinic with the complaints of bloody diarrhea, mid-abdominal discomfort, and cramping for 3 days. She also has nausea, vomiting, and fever. She reports that she had eaten raw oysters at a local seafood restaurant almost 3 days ago, but she denies any other potentially infectious exposures. Her temperature is 37.5°C (99.6°F), respiratory rate is 15/min, pulse is 67/min, and blood pressure is 102/68 mm Hg. Physical examination is non-contributory. What is the most likely diagnosis?
Options:
{'A': 'Rotavirus infection', 'B': 'C. difficile colitis', 'C': 'Bacillus cereus infection', 'D': 'Norovirus infection', 'E': 'Vibrio parahaemolyticus infection'}<|eot_id|>
<|start_header_id|>assistant<|end_header_id|>
Vibrio parahaemolyticus infection<|eot_id|> |
An 82-year-old woman is brought to the physician by her daughter because of a 3-day history of a runny nose, headache, and cough. The patient's grandson recently had similar symptoms. Her vital signs are within normal limits. Pulse oximetry on room air shows an oxygen saturation of 99%. Lungs are clear to auscultation. Testing of nasal secretions is performed to identify the viral strain. Electron microscopy shows a non-enveloped RNA virus with an icosahedral capsid. Binding to which of the following is responsible for the virulence of this virus?
Options:
{'A': 'P antigen', 'B': 'CD21', 'C': 'ICAM-1', 'D': 'Sialic acid residues', 'E': 'Integrin'} | {'A': 'P antigen', 'B': 'CD21', 'C': 'ICAM-1', 'D': 'Sialic acid residues', 'E': 'Integrin'} | ICAM-1 | <|start_header_id|>system<|end_header_id|>
The following are multiple choice questions about medical knowledge. Solve them in a step-by-step fashion, starting by summarizing the available information. Output a single option from the four options as the final answer.<|eot_id|>
<|start_header_id|>user<|end_header_id|>
An 82-year-old woman is brought to the physician by her daughter because of a 3-day history of a runny nose, headache, and cough. The patient's grandson recently had similar symptoms. Her vital signs are within normal limits. Pulse oximetry on room air shows an oxygen saturation of 99%. Lungs are clear to auscultation. Testing of nasal secretions is performed to identify the viral strain. Electron microscopy shows a non-enveloped RNA virus with an icosahedral capsid. Binding to which of the following is responsible for the virulence of this virus?
Options:
{'A': 'P antigen', 'B': 'CD21', 'C': 'ICAM-1', 'D': 'Sialic acid residues', 'E': 'Integrin'}<|eot_id|>
<|start_header_id|>assistant<|end_header_id|>
ICAM-1<|eot_id|> |
A 63-year-old woman is brought to the emergency department because of a 2-day history of severe epigastric pain and nausea. She has a 20-year history of alcohol use disorder. Nine hours after admission, she becomes increasingly dyspneic and tachypneic. Pulse oximetry on supplemental oxygen shows an oxygen saturation of 81%. Physical examination shows diffuse lung crackles, marked epigastric tenderness, and a periumbilical hematoma. Laboratory studies show normal brain natriuretic peptide. An x-ray of the chest shows bilateral opacities in the lower lung fields. Which of the following pathomechanisms best explains this patient's pulmonary findings?
Options:
{'A': 'Alveolocapillary membrane leakage', 'B': 'Increased production of surfactant', 'C': 'Embolic obstruction of pulmonary arteries', 'D': 'Inflammation of the bronchial mucosa', 'E': 'Increased pulmonary capillary pressure'} | {'A': 'Alveolocapillary membrane leakage', 'B': 'Increased production of surfactant', 'C': 'Embolic obstruction of pulmonary arteries', 'D': 'Inflammation of the bronchial mucosa', 'E': 'Increased pulmonary capillary pressure'} | Alveolocapillary membrane leakage | <|start_header_id|>system<|end_header_id|>
The following are multiple choice questions about medical knowledge. Solve them in a step-by-step fashion, starting by summarizing the available information. Output a single option from the four options as the final answer.<|eot_id|>
<|start_header_id|>user<|end_header_id|>
A 63-year-old woman is brought to the emergency department because of a 2-day history of severe epigastric pain and nausea. She has a 20-year history of alcohol use disorder. Nine hours after admission, she becomes increasingly dyspneic and tachypneic. Pulse oximetry on supplemental oxygen shows an oxygen saturation of 81%. Physical examination shows diffuse lung crackles, marked epigastric tenderness, and a periumbilical hematoma. Laboratory studies show normal brain natriuretic peptide. An x-ray of the chest shows bilateral opacities in the lower lung fields. Which of the following pathomechanisms best explains this patient's pulmonary findings?
Options:
{'A': 'Alveolocapillary membrane leakage', 'B': 'Increased production of surfactant', 'C': 'Embolic obstruction of pulmonary arteries', 'D': 'Inflammation of the bronchial mucosa', 'E': 'Increased pulmonary capillary pressure'}<|eot_id|>
<|start_header_id|>assistant<|end_header_id|>
Alveolocapillary membrane leakage<|eot_id|> |
A 66-year-old woman presents to her primary care physician with complaints of constipation and left lower abdominal discomfort. She says the pain usually gets worse after meals, which is felt as a dull pain. Her past medical history is positive for gastroesophageal reflux disease, for which she takes omeprazole. There is a positive history of chronic constipation but no episodes of bloody stools. On physical examination, she has a temperature of 38.5°C (101.3°F), blood pressure of 110/70 mm Hg, heart rate of 100/min, and respiratory rate of 19/min. Stool occult blood is negative. Which of the following is the most appropriate study to be performed at this stage?
Options:
{'A': 'Abdominal ultrasound', 'B': 'Abdominal CT', 'C': 'Colonoscopy', 'D': 'Barium study', 'E': 'MRI of the abdomen'} | {'A': 'Abdominal ultrasound', 'B': 'Abdominal CT', 'C': 'Colonoscopy', 'D': 'Barium study', 'E': 'MRI of the abdomen'} | Abdominal CT | <|start_header_id|>system<|end_header_id|>
The following are multiple choice questions about medical knowledge. Solve them in a step-by-step fashion, starting by summarizing the available information. Output a single option from the four options as the final answer.<|eot_id|>
<|start_header_id|>user<|end_header_id|>
A 66-year-old woman presents to her primary care physician with complaints of constipation and left lower abdominal discomfort. She says the pain usually gets worse after meals, which is felt as a dull pain. Her past medical history is positive for gastroesophageal reflux disease, for which she takes omeprazole. There is a positive history of chronic constipation but no episodes of bloody stools. On physical examination, she has a temperature of 38.5°C (101.3°F), blood pressure of 110/70 mm Hg, heart rate of 100/min, and respiratory rate of 19/min. Stool occult blood is negative. Which of the following is the most appropriate study to be performed at this stage?
Options:
{'A': 'Abdominal ultrasound', 'B': 'Abdominal CT', 'C': 'Colonoscopy', 'D': 'Barium study', 'E': 'MRI of the abdomen'}<|eot_id|>
<|start_header_id|>assistant<|end_header_id|>
Abdominal CT<|eot_id|> |
A 3-month-old girl is brought to the emergency department because of a 2-day history of progressive difficulty breathing and a dry cough. Five weeks ago, she was diagnosed with diffuse hemangiomas involving the intrathoracic cavity and started treatment with prednisolone. She appears uncomfortable and in moderate respiratory distress. Her temperature is 38°C (100.4°F), pulse is 150/min, respirations are 50/min, and blood pressure is 88/50 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 87%. Oral examination shows a white plaque covering the tongue that bleeds when scraped. Chest examination shows subcostal and intercostal retractions. Scattered fine crackles and rhonchi are heard throughout both lung fields. Laboratory studies show a leukocyte count of 21,000/mm3 and an increased serum beta-D-glucan concentration. An x-ray of the chest shows symmetrical, diffuse interstitial infiltrates. Which of the following is most likely to confirm the diagnosis?
Options:
{'A': 'Bronchoalveolar lavage', 'B': 'Urine antigen test', 'C': 'DNA test for CFTR mutation', 'D': 'CT scan of the chest', 'E': 'Tuberculin skin test'} | {'A': 'Bronchoalveolar lavage', 'B': 'Urine antigen test', 'C': 'DNA test for CFTR mutation', 'D': 'CT scan of the chest', 'E': 'Tuberculin skin test'} | Bronchoalveolar lavage | <|start_header_id|>system<|end_header_id|>
The following are multiple choice questions about medical knowledge. Solve them in a step-by-step fashion, starting by summarizing the available information. Output a single option from the four options as the final answer.<|eot_id|>
<|start_header_id|>user<|end_header_id|>
A 3-month-old girl is brought to the emergency department because of a 2-day history of progressive difficulty breathing and a dry cough. Five weeks ago, she was diagnosed with diffuse hemangiomas involving the intrathoracic cavity and started treatment with prednisolone. She appears uncomfortable and in moderate respiratory distress. Her temperature is 38°C (100.4°F), pulse is 150/min, respirations are 50/min, and blood pressure is 88/50 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 87%. Oral examination shows a white plaque covering the tongue that bleeds when scraped. Chest examination shows subcostal and intercostal retractions. Scattered fine crackles and rhonchi are heard throughout both lung fields. Laboratory studies show a leukocyte count of 21,000/mm3 and an increased serum beta-D-glucan concentration. An x-ray of the chest shows symmetrical, diffuse interstitial infiltrates. Which of the following is most likely to confirm the diagnosis?
Options:
{'A': 'Bronchoalveolar lavage', 'B': 'Urine antigen test', 'C': 'DNA test for CFTR mutation', 'D': 'CT scan of the chest', 'E': 'Tuberculin skin test'}<|eot_id|>
<|start_header_id|>assistant<|end_header_id|>
Bronchoalveolar lavage<|eot_id|> |
A 65-year-old African-American man presents to your office with dysphagia. He reports that he has found it progressively more difficult to swallow food over the past year. At the time of presentation, he is able to eat only soup. Social history is significant for asbestos exposure, multiple daily drinks of hard alcohol, and a 70 pack-year smoking history. What would you most expect to see on an esophageal biopsy of this patient?
Options:
{'A': 'Keratin nests and pearls', 'B': 'Ferruginous bodies', 'C': 'Glandular metaplasia', 'D': 'Mucosal abrasions', 'E': 'Esophageal varices'} | {'A': 'Keratin nests and pearls', 'B': 'Ferruginous bodies', 'C': 'Glandular metaplasia', 'D': 'Mucosal abrasions', 'E': 'Esophageal varices'} | Keratin nests and pearls | <|start_header_id|>system<|end_header_id|>
The following are multiple choice questions about medical knowledge. Solve them in a step-by-step fashion, starting by summarizing the available information. Output a single option from the four options as the final answer.<|eot_id|>
<|start_header_id|>user<|end_header_id|>
A 65-year-old African-American man presents to your office with dysphagia. He reports that he has found it progressively more difficult to swallow food over the past year. At the time of presentation, he is able to eat only soup. Social history is significant for asbestos exposure, multiple daily drinks of hard alcohol, and a 70 pack-year smoking history. What would you most expect to see on an esophageal biopsy of this patient?
Options:
{'A': 'Keratin nests and pearls', 'B': 'Ferruginous bodies', 'C': 'Glandular metaplasia', 'D': 'Mucosal abrasions', 'E': 'Esophageal varices'}<|eot_id|>
<|start_header_id|>assistant<|end_header_id|>
Keratin nests and pearls<|eot_id|> |
A 35-year-old man, with a history of neurofibromatosis type 2 (NF2) diagnosed 2 years ago, presents with hearing loss in the right ear and tinnitus. Patient says that symptoms have been gradually progressive. He has difficulty hearing speech as well as loud sounds. He also gives a history of occasional headaches and vertigo on and off for 1 month, which is unresponsive to paracetamol. His vitals include: blood pressure 110/78 mm Hg, temperature 36.5°C (97.8°F), pulse 78/min and respiratory rate 11/min. Tuning fork tests reveal the following:
Left Right
Rinne’s test Air conduction > bone conduction Air conduction > bone conduction
Weber test Lateralized to left ear
Other physical examination findings are within normal limits. An MRI of the head is ordered which is as shown in image 1. A biopsy is done which shows cells staining positive for S100 but negative for glial fibrillary acidic protein (GFAP). The histopathological slide is shown in image 2. What is the most likely diagnosis?
Options:
{'A': 'Glioblastoma multiforme', 'B': 'Hemangioblastoma', 'C': 'Schwannoma', 'D': 'Meningioma', 'E': 'Craniopharyngioma'} | {'A': 'Glioblastoma multiforme', 'B': 'Hemangioblastoma', 'C': 'Schwannoma', 'D': 'Meningioma', 'E': 'Craniopharyngioma'} | Schwannoma | <|start_header_id|>system<|end_header_id|>
The following are multiple choice questions about medical knowledge. Solve them in a step-by-step fashion, starting by summarizing the available information. Output a single option from the four options as the final answer.<|eot_id|>
<|start_header_id|>user<|end_header_id|>
A 35-year-old man, with a history of neurofibromatosis type 2 (NF2) diagnosed 2 years ago, presents with hearing loss in the right ear and tinnitus. Patient says that symptoms have been gradually progressive. He has difficulty hearing speech as well as loud sounds. He also gives a history of occasional headaches and vertigo on and off for 1 month, which is unresponsive to paracetamol. His vitals include: blood pressure 110/78 mm Hg, temperature 36.5°C (97.8°F), pulse 78/min and respiratory rate 11/min. Tuning fork tests reveal the following:
Left Right
Rinne’s test Air conduction > bone conduction Air conduction > bone conduction
Weber test Lateralized to left ear
Other physical examination findings are within normal limits. An MRI of the head is ordered which is as shown in image 1. A biopsy is done which shows cells staining positive for S100 but negative for glial fibrillary acidic protein (GFAP). The histopathological slide is shown in image 2. What is the most likely diagnosis?
Options:
{'A': 'Glioblastoma multiforme', 'B': 'Hemangioblastoma', 'C': 'Schwannoma', 'D': 'Meningioma', 'E': 'Craniopharyngioma'}<|eot_id|>
<|start_header_id|>assistant<|end_header_id|>
Schwannoma<|eot_id|> |
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