id stringlengths 4 36 | question stringlengths 7 4.67k | options dict | answer stringclasses 4
values |
|---|---|---|---|
professional_medicine-209 | A 31-year-old woman, gravida 3, para 2, who is at 32 weeks' gestation, is admitted to the hospital because of a 1-week history of progressive dyspnea and wheezing. She says her heart is "racing" and she is coughing up a small amount of bloodstreaked sputum. Medical history is significant for hypothyroidism, for which s... | {
"A": "Chronic mitral regurgitation secondary to rheumatic heart disease",
"B": "Coarctation of the aorta",
"C": "Congenital aortic stenosis",
"D": "Mitral stenosis complicated by atrial fibrillation"
} | D |
professional_medicine-210 | A 47-year-old man comes to the physician 12 hours after the sudden onset of a severe occipital headache and stiff neck. He has not had any other symptoms and has no history of severe headache. He has hypertension and gastroesophageal reflux disease. Current medications include hydrochlorothiazide and ranitidine. He is ... | {
"A": "Cluster headache",
"B": "Meningitis",
"C": "Migraine",
"D": "Subarachnoid hemorrhage"
} | D |
professional_medicine-211 | A 10-year-old girl is brought to the office by her mother because her school nurse thinks that she may have Marfan syndrome. She is at the 95th percentile for height and 25th percentile for weight. Physical examination shows a narrow palate with dental crowding, long slender extremities, and joint laxity. Molecular tes... | {
"A": "It is a disease-causing mutation in the patient and her mother",
"B": "It is a polymorphism",
"C": "It is a sequence variant of unknown significance",
"D": "It will change the folding of the protein"
} | B |
professional_medicine-212 | A 50-year-old woman comes to the office for the first time because of recurrent abdominal pain. Review of her extensive medical chart, which she has brought with her, discloses that she has a long history of varying physical symptoms. Definitive causes for these symptoms have not been found despite extensive diagnostic... | {
"A": "Conversion disorder",
"B": "Histrionic personality disorder",
"C": "Occult medical disorder",
"D": "Somatic symptom disorder"
} | D |
professional_medicine-213 | A 5-year-old boy returns to the office with his 19-year-old mother to discuss results of studies done to evaluate his behavior of eating dirt. The patient sits quietly while his mother answers questions about his health. She says her son seems healthy, although he does not seem to be as active as other children his age... | {
"A": "Prescribe fluoxetine",
"B": "Prescribe methylphenidate",
"C": "Prescribe risperidone",
"D": "Refer the patient to a child psychiatrist"
} | D |
professional_medicine-214 | A 32-year-old man and his 29-year-old wife come to the office for evaluation for infertility. The wife's gynecologist has reported that her anatomic and physiologic evaluation disclosed no abnormalities and that assessment of potential male factors is needed. The husband is 188 cm (6 ft 3 in) tall with fair skin and li... | {
"A": "Karyotype from peripheral leukocytes",
"B": "Serum estrogen and testosterone concentrations",
"C": "Serum follicle-stimulating hormone and luteinizing hormone concentrations",
"D": "Serum prolactin concentration"
} | A |
professional_medicine-215 | A 28-year-old man comes to the office because he would like to quit smoking cigarettes. He says, "I cannot go more than a day without cigarettes because I get so anxious and irritable. I even wake up at night to smoke." The patient began smoking cigarettes at age 12 years; he was smoking two packs of cigarettes daily b... | {
"A": "Hypertension",
"B": "Polyuria",
"C": "Renal insufficiency",
"D": "The patient is at no increased risk"
} | D |
professional_medicine-216 | A 40-year-old male presents to the office with symptoms of odynophagia and gastroesophageal reflux. He also says that he experienced hematemesis once last week. Past medical history reveals AIDS, and his most recent CD4 count was 30 cells/mcL. The patient's tilt test result and hemoglobin level are normal. Rectal exami... | {
"A": "prescription for a proton pump inhibitor and a prokinetic agent",
"B": "prescription for an H2-blocker trial for 6 weeks",
"C": "prescription for clotrimazole troches",
"D": "referral for an upper endoscopy with biopsy"
} | D |
professional_medicine-217 | A 55-year-old man comes to the physician for a routine physical examination. He is currently taking no medications. His pulse is 80/min, and blood pressure is 165/95 mm Hg. Physical examination shows no other abnormalities. The presence of which of the following mechanisms is most likely to increase this patient's bloo... | {
"A": "Decreased cardiac output",
"B": "Decreased pulse",
"C": "Decreased stroke volume",
"D": "Increased peripheral vascular resistance"
} | D |
professional_medicine-218 | A 54-year-old man comes to the physician for a follow-up examination 10 days after undergoing a stereotactic brain operation to remove a small tumor. The operation was successful. During the procedure, he was under conscious sedation. The patient recalls that at one point during the operation he experienced a sudden, i... | {
"A": "Amygdala",
"B": "Hippocampus",
"C": "Mammillary body",
"D": "Prefrontal cortex"
} | A |
professional_medicine-219 | A 5-year-old boy is brought to the physician because of a 2-day history of fever and painful swelling of the left ankle. He has had recurrent cervical lymphadenitis and pneumonia since infancy. Two years ago, a culture from an abscess in the cervical region grew Staphylococcus aureus. His temperature is 38°C (100.4°F).... | {
"A": "Developmental arrest of maturation of B lymphocytes",
"B": "Dysmorphogenesis of the third and fourth pharyngeal pouches",
"C": "Impaired chemotaxis",
"D": "Impaired phagocytic oxidative metabolism"
} | D |
professional_medicine-220 | A placebo-controlled clinical trial is conducted to assess whether a new antihypertensive drug is more effective than standard therapy. A total of 5000 patients with essential hypertension are enrolled and randomly assigned to one of two groups: 2500 patients receive the new drug and 2500 patients receive placebo. If t... | {
"A": "Significant findings can be reported with greater confidence",
"B": "The study will have more power",
"C": "There is a decreased likelihood of a Type II error",
"D": "There is an increased likelihood of statistically significant findings"
} | A |
professional_medicine-221 | A 25-year-old man is brought to the emergency department because of a 6-day history of fever, severe muscle pain, and diffuse, painful swelling of his neck, underarms, and groin area. The symptoms began after returning from a camping trip in New Mexico. He appears ill and lethargic and can barely answer questions. His ... | {
"A": "DNA helicase",
"B": "Glucuronosyltransferase",
"C": "Proteasomal degradation",
"D": "Ribosomal assembly"
} | D |
professional_medicine-222 | A 26-year-old woman with HIV infection comes to the office because of a 4-day history of pain and redness of her left lower leg. She says the symptoms began after she tripped over a tree branch in her yard and scraped her left leg. Current medications include antiretroviral therapy and ibuprofen as needed. Vital signs ... | {
"A": "Amoxicillin",
"B": "Ciprofloxacin",
"C": "Clarithromycin",
"D": "Clindamycin"
} | D |
professional_medicine-223 | A 35-year-old woman comes to the physician because of two 12-hour episodes of dizziness over the past 3 months. During episodes, she experiences the acute onset of rotatory vertigo and imbalance, decreased hearing, tinnitus, a sense of fullness of the right ear, and vomiting. Examination shows a mild hearing loss of th... | {
"A": "Acoustic neuroma",
"B": "Benign positional vertigo",
"C": "Brain stem transient ischemic attacks",
"D": "Meniere's disease"
} | D |
professional_medicine-224 | A 22-year-old woman comes to the emergency department because of a 5-day history of sore throat and fever. During the past 3 days, she also has noticed a change in her voice and has had increased pain with swallowing. She has been taking acetaminophen since her symptoms began. Medical history is unremarkable and she ta... | {
"A": "Incision and drainage",
"B": "Intravenous methylprednisolone therapy",
"C": "Oral nystatin therapy",
"D": "Salt water gargle"
} | A |
professional_medicine-225 | A 45-year-old female presents to the office for evaluation of unexplained elevations of her blood pressure. Paroxysmal episodes of headache, sweating, anxiety, nausea, and vomiting occur frequently. A CT scan reveals a left adrenal mass. Which of the following urinary assays will be most helpful in establishing this pa... | {
"A": "cortisol",
"B": "glucose",
"C": "sodium",
"D": "vanillylmandelic acid"
} | D |
professional_medicine-226 | A 24-year-old man is brought to the emergency department 40 minutes after he was involved in a motor vehicle collision. He was the unrestrained driver. He is conscious. Physical examination shows numerous lacerations and ecchymoses over the face. His vision is normal. Ocular, facial, and lingual movements are intact. T... | {
"A": "Foramen lacerum",
"B": "Foramen ovale",
"C": "Foramen rotundum",
"D": "Foramen spinosum"
} | B |
professional_medicine-227 | A 3-week-old male infant is brought to the office by his mother because of a 2-day history of white lesions in the mouth. The infant was born at term via uncomplicated spontaneous vaginal delivery; he has been breast-feeding well and is urinating and having bowel movements normally. At birth, he weighed 3289 g (7 lb 4 ... | {
"A": "Acyclovir",
"B": "Fluconazole",
"C": "Nystatin",
"D": "Valacyclovir"
} | C |
professional_medicine-228 | A 45-year-old man comes to the physician because of right shoulder pain that began after he chopped wood 2 days ago. Examination of the right upper extremity shows no obvious bone deformities or point tenderness. The pain is reproduced when the patient is asked to externally rotate the shoulder against resistance; ther... | {
"A": "Infraspinatus",
"B": "Pectoralis",
"C": "Subscapularis",
"D": "Supraspinatus"
} | A |
professional_medicine-229 | A 67-year-old woman comes to the physician because of easy bruising for 4 months. She has a history of lung cancer treated with radiation therapy 6 months ago. She has a 2-year history of hypertension treated with a thiazide diuretic and an angiotensin-converting enzyme (ACE) inhibitor. Examination, including neurologi... | {
"A": "CT scan of the abdomen",
"B": "CT scan of the chest",
"C": "Bronchoscopy",
"D": "Bone marrow aspiration"
} | D |
professional_medicine-230 | A 16-year-old girl is brought to the office by her mother because she is concerned that she may have contracted meningitis from her soccer teammate, who was diagnosed with meningococcal meningitis and admitted to the hospital yesterday. The patient's soccer team traveled to a neighboring state to participate in a tourn... | {
"A": "Administer the meningococcal vaccine",
"B": "Prescribe doxycycline",
"C": "Prescribe penicillin",
"D": "Prescribe rifampin"
} | D |
professional_medicine-231 | A 19-year-old woman comes to the emergency department because, she says, "I'm burning up." Medical history is significant for intravenous drug use. Physical examination discloses a systolic heart murmur over the precordium. An expected physical finding will be which of the following? | {
"A": "Decreased intensity of S1",
"B": "Increased intensity of the murmur with deep inspiration",
"C": "Increased intensity of the murmur with forced expiration",
"D": "Positive Kussmaul sign (rise in jugular venous pulse with inspiration)"
} | B |
professional_medicine-232 | A 26-year-old male police officer comes to the office for an annual health maintenance examination. He is physically active and feels well, but he notes that his asthma has been more active during the past month. He says that he has had to use his albuterol inhaler one to two times daily for wheezing and chest tightnes... | {
"A": "Chest x-ray",
"B": "Fexofenadine therapy",
"C": "Increased use of the albuterol inhaler",
"D": "Initiation of a daily corticosteroid inhaler"
} | D |
professional_medicine-233 | A previously healthy 15-year-old boy is brought to the emergency department in August 1 hour after the onset of headache, dizziness, nausea, and one episode of vomiting. His symptoms began during the first hour of full-contact football practice in full uniform. He reported feeling weak and faint but did not lose consci... | {
"A": "Obtain a CT scan of the head",
"B": "Administer sodium chloride tablets",
"C": "Administer intravenous fluids",
"D": "Immerse the patient in an ice water bath"
} | C |
professional_medicine-234 | A new severe respiratory illness caused by a newly identified virus is discovered. Which of the following properties of a killed vaccine relative to a live vaccine is the most appropriate rationale for developing a killed vaccine for this illness? | {
"A": "Avoids the concern for reversion to virulence",
"B": "Develops more rapid protective immunity",
"C": "Is less likely to require subsequent boosters for lifelong immunity",
"D": "Is most likely to generate mucosal immunity"
} | A |
professional_medicine-235 | A 43-year-old man with a history of self-mutilation comes to the emergency department because of pain in his right thigh and shaking chills during the past 3 days. He says he intentionally burned his right thigh several times with a cigarette lighter 6 days ago. This morning he soaked his thigh in a tub of hot water an... | {
"A": "Incision and drainage",
"B": "Psychiatric consultation",
"C": "Topical silver sulfadiazine",
"D": "Transfer to a burn center"
} | A |
professional_medicine-236 | A 32-year-old man comes to the physician because he has had difficulty focusing on tasks at work and at home during the past 2 months. He works as an automobile mechanic. He has had a lot of energy for work but often is distracted to the point that he does not complete assigned tasks. He frequently stops working on his... | {
"A": "Antisocial personality disorder",
"B": "Attention-deficit/hyperactivity disorder",
"C": "Bipolar disorder",
"D": "Borderline personality disorder"
} | C |
professional_medicine-237 | A 72-year-old woman comes to the physician because of a 2-month history of painless swelling of both ankles. She also reports shortness of breath with exertion and when lying down. She has been awakened from sleep by shortness of breath. She has not had chest pain. Her pulse is 96/min and regular, respirations are 24/m... | {
"A": "Measurement of serum troponin I concentration",
"B": "ECG",
"C": "Exercise stress test",
"D": "Echocardiography"
} | D |
professional_medicine-238 | A 32-year-old man who is a jackhammer operator comes to the physician because of pain and swelling of his right arm for 3 days. The symptoms are moderately exacerbated by exertion. Examination of the right upper extremity shows erythema and moderate edema. Capillary refill time is less than 3 seconds. Which of the foll... | {
"A": "Axillary-subclavian venous thrombosis",
"B": "Deep venous valvular insufficiency",
"C": "Superficial thrombophlebitis of the basilic vein",
"D": "Superior vena cava syndrome"
} | A |
professional_medicine-239 | A 63-year-old woman is in the hospital recovery room 4 hours after elective left hemicolectomy for colon carcinoma at the splenic flexure. She has a preoperative written directive for no blood products through transfusion for religious reasons. Medical history is significant for hypertension and coronary artery disease... | {
"A": "Epigastric artery",
"B": "Liver",
"C": "Middle colic artery",
"D": "Spleen"
} | D |
professional_medicine-240 | A 30-year-old woman comes to the physician because of a 2-day history of abdominal pain. She has a history of recurrent upper respiratory tract infections, sinusitis, and pancreatitis. She has thick nasal secretions. She says that her sweat is salty and crystallizes on her skin. Her vital signs are within normal limits... | {
"A": "Only one G551D allele is needed in CFTR",
"B": "The patient is a CFTR obligate carrier",
"C": "The patient's CFTR mutation is unrelated to her clinical phenotype",
"D": "The second CFTR mutation was not detected by the testing obtained"
} | D |
professional_medicine-241 | A 27-year-old man is brought to the emergency department by his sister because of increasing confusion for 10 hours. He is unable to answer questions. His sister states that he recently saw a psychiatrist for the first time because of hearing voices; he was prescribed a medication, but she is not sure what it is. She s... | {
"A": "Amphetamine intoxication",
"B": "Bacterial meningitis",
"C": "Delirium tremens",
"D": "Neuroleptic malignant syndrome"
} | D |
professional_medicine-242 | A 16-year-old boy is admitted to the emergency department because of a knife wound to the left side of his chest. An x-ray of the chest shows an air-fluid level in the left side of the chest, partial collapse of the left lung, and elevation of the stomach bubble. The mediastinum is in the midline. Which of the followin... | {
"A": "Hemopneumothorax, not under tension",
"B": "Hemothorax, not under tension",
"C": "Pneumothorax, not under tension",
"D": "Tension hemopneumothorax"
} | A |
professional_medicine-243 | A 72-year-old man is admitted to the intensive care unit for pain management and observation of ventricular ectopy 4 hours after undergoing uncomplicated left total knee replacement. He is receiving fentanyl via systemic patient-controlled analgesic pump for pain management. Medical history is remarkable for coronary a... | {
"A": "Continuous application of bilateral lower extremity pneumatic compression devices",
"B": "Continuous intravenous infusion of heparin titrated to a PTT of 1.5 to 2.0 times the control value",
"C": "Oral warfarin",
"D": "Subcutaneous enoxaparin"
} | D |
professional_medicine-244 | A 67-year-old woman has had fatigue, dry skin, brittle hair, swelling of the ankles, and cold intolerance for 1 year; she has gained 9 kg (20 lb) during this period. Her pulse is 55/min, and blood pressure is 150/90 mm Hg. She appears lethargic. Examination shows dry skin and a nontender thyroid gland that is enlarged ... | {
"A": "Chronic lymphocytic thyroiditis (Hashimoto disease)",
"B": "Defect in thyroxine (T4) biosynthesis",
"C": "Graves disease",
"D": "Multinodular goiter"
} | A |
professional_medicine-245 | A 2-year-old boy is brought to the office by his mother for follow-up of a chromosome analysis done 1 month ago. The child has minor dysmorphic features, and growth and developmental delay. Chromosome analysis showed a small unbalanced chromosome translocation, with extra chromosomal material at the tip of chromosome 3... | {
"A": "Attempt to identify the father's physician and work with that physician to obtain chromosome studies on the father",
"B": "Contact the father by telephone and arrange for him to give a blood sample at a local hospital",
"C": "Document your attempts to work with the mother but proceed no further, since you... | D |
professional_medicine-246 | A 3-year-old girl is brought to the physician because of fever and left ear pain for 3 days. She has been treated with amoxicillin for the past 5 days for left otitis media. Her temperature is 38.5°C (101.3°F), pulse is 100/min, respirations are 20/min, and blood pressure is 80/60 mm Hg. Examination shows the left ear ... | {
"A": "Acoustic neuroma",
"B": "Labyrinthitis",
"C": "Lateral sinus thrombosis",
"D": "Mastoiditis"
} | D |
professional_medicine-247 | A 62-year-old woman comes to the physician because of low back pain for 1 week. Menopause occurred 10 years ago. Physical examination shows localized tenderness over the lumbar spine after movement. X-rays of the spine show a compression fracture of L1-2. A DEXA scan shows decreased bone mineral density. Serum calcium ... | {
"A": "Decreased insulin-like growth factor-1 concentration",
"B": "Decreased osteoclast activity",
"C": "Decreased osteoprotegerin production",
"D": "Increased 1,25-dihydroxycholecalciferol concentration"
} | B |
professional_medicine-248 | A 72-year-old woman who has smoked 20 cigarettes daily for the past 38 years begins using eyedrops for glaucoma. Three days later, she has a marked increase in shortness of breath while walking up a flight of stairs. Which of the following drugs is the most likely cause of the development of shortness of breath in this... | {
"A": "Apraclonidine",
"B": "Epinephrine",
"C": "Latanoprost",
"D": "Timolol"
} | D |
professional_medicine-249 | A 38-year-old man with Down syndrome and severe mental retardation is brought to the emergency department by ambulance because of increasing lethargy for the past several hours. The patient is noncommunicative and you are unable to obtain an initial history of his present illness or a past medical history. You do not k... | {
"A": "Administer intravenous antibiotics",
"B": "Await contact with the caregiver before proceeding with management",
"C": "Obtain CT scan of the head",
"D": "Obtain echocardiography"
} | A |
professional_medicine-250 | After being severely beaten and sustaining a gunshot wound to the abdomen, a 42-year-old woman undergoes resection of a perforated small bowel. During the operation, plastic reconstruction of facial fractures, and open reduction and internal fixation of the left femur are also done. Thirty-six hours postoperatively, sh... | {
"A": "Reassure the patient that her chance of becoming addicted to narcotics is minuscule",
"B": "Maintain the morphine, but periodically administer intravenous naloxone",
"C": "Switch the patient to oral acetaminophen as soon as she can take medication orally",
"D": "Switch the patient to intramuscular loraz... | A |
professional_medicine-251 | A 57-year-old man comes to the emergency department because of cramping in his hands and feet and numbness and tingling around his lips and in his fingers; these symptoms occurred intermittently for 6 months but have been progressively severe during the past 2 weeks. He also has had a 13-kg (30-lb) weight loss and bulk... | {
"A": "Hypomagnesemia",
"B": "Hypoparathyroidism",
"C": "Osteomalacia",
"D": "Vitamin D deficiency"
} | D |
professional_medicine-252 | A 78-year-old woman is admitted to the hospital for replacement of her left knee joint due to degenerative joint disease. She has type 2 diabetes mellitus, a long history of hypertension, and chronic renal failure presumed secondary to diabetes mellitus and hypertension. Reversible causes of renal failure have been exc... | {
"A": "Her eligibility to receive Medicare",
"B": "Her history of an abdominal operation",
"C": "Her history of arthritis",
"D": "Her suitability for home dialysis"
} | D |
professional_medicine-253 | A 75-year-old female presents to the office for a health maintenance examination. She says that she is more fatigued than she was at 65, but she still gardens and drives to the grocery store. Routine laboratory studies reveal a leukocyte count of 25.0 × 103/mcL (reference range 4.5-11.0 × 103/mcL) and 97% mature-appear... | {
"A": "acute lymphocytic leukemia",
"B": "acute myelogenous leukemia",
"C": "chronic lymphocytic leukemia",
"D": "chronic myelogenous leukemia"
} | C |
professional_medicine-254 | A previously healthy 27-year-old nulligravid woman comes to the emergency department because of a 2-day history of moderate-to-severe pain and swelling of the left labia. She is sexually active and uses condoms inconsistently. Her temperature is 37.2°C (99°F), pulse is 92/min, respirations are 18/min, and blood pressur... | {
"A": "Administration of intravenous metronidazole",
"B": "Administration of intravenous penicillin G",
"C": "Ultrasound-guided needle aspiration of the mass",
"D": "Incision and drainage"
} | D |
professional_medicine-255 | A previously healthy 24-year-old woman who is a college student comes to the office because of a 6-month history of abdominal bloating, upper abdominal discomfort, and constipation. The symptoms are more severe when she is preparing for examinations but improve after bowel movements. She takes no medications. She does ... | {
"A": "Azathioprine",
"B": "Infliximab",
"C": "Lubiprostone",
"D": "Mesalamine"
} | C |
professional_medicine-256 | A 22-year-old woman comes to the office because of urticaria. This is her first episode of urticaria and it has occurred and then resolved several times in the past week. The history and physical examination disclose no abnormalities. Which of the following is the most appropriate course of action? | {
"A": "Determine the serum IgE concentration",
"B": "Determine the total eosinophil count",
"C": "Refer her to an allergist",
"D": "Treat the symptoms"
} | D |
professional_medicine-257 | A 72-year-old man comes to the physician because of a 7-month history of leg weakness and dry eyes and mouth. He also has had a 10.4-kg (23-lb) weight loss over the past 4 months despite no change in appetite. He has smoked one and a half packs of cigarettes daily for 50 years. He drinks 4 oz of alcohol daily. He has p... | {
"A": "Muscle membrane",
"B": "Parasympathetic nervous system",
"C": "Peripheral nerve",
"D": "Presynaptic neuromuscular junction"
} | D |
professional_medicine-258 | A 4-year-old boy is brought for a follow-up examination. He has a history of chronic recurrent otitis media and recently completed a 10-day course of antibiotics. His vital signs are within normal limits. Examination shows clear ear canals and intact tympanic membranes; a brown, irregular mass is visualized behind the ... | {
"A": "Epithelial tissue proliferation",
"B": "Lingual papillae loss",
"C": "Middle ear effusion",
"D": "Midface hypoplasia"
} | A |
professional_medicine-259 | A 35-year-old male presents to the office for the result of an HIV test, and he is informed that the result is positive. The patient resists disclosure to his wife because he has not told her about his extramarital sexual partners. The physician informs the patient that his wife's right to know is paramount because she... | {
"A": "autonomy overrides beneficence",
"B": "autonomy overrides justice",
"C": "beneficence overrides autonomy",
"D": "nonmaleficence overrides autonomy"
} | D |
professional_medicine-260 | A 10-year-old boy is brought for a follow-up examination 2 days after he was seen in the emergency department because of hives, hoarseness, and light-headedness. His symptoms began 15 minutes after he was stung by a bee and lasted approximately 60 minutes; they resolved before he was treated. He has been stung by bees ... | {
"A": "Avoid areas known to have bees",
"B": "Avoid wearing colorful clothing outside",
"C": "Carrying diphenhydramine tablets",
"D": "Carrying self-injectable epinephrine"
} | D |
professional_medicine-261 | A 25-year-old man is brought to the emergency department after being discovered semiconscious and incoherent at home. On arrival, he is stuporous. His blood pressure is 105/70 mm Hg, pulse is 80/min, and respirations are 12/min. Examination shows cool, damp skin. The pupils are pinpoint and react sluggishly to light. W... | {
"A": "Alcohol",
"B": "Barbiturates",
"C": "Cocaine",
"D": "Heroin"
} | D |
professional_medicine-262 | A 52-year-old female presents to the office with the complaint of greenish discharge from her left nipple. There is no history of trauma or fever, and the patient is not currently using oral contraceptives nor is she on hormone replacement therapy. Her last pregnancy was approximately 20 years ago. Physical examination... | {
"A": "breast cancer",
"B": "fibrocystic disease",
"C": "mammary duct ectasia",
"D": "pituitary adenoma"
} | C |
professional_medicine-263 | A 15-year-old boy is brought to the office by his mother because he has been tired and irritable for the past 3 months. He is a high school freshman and a member of the track team. He reports that his symptoms began shortly after starting spring training. He practices sprints 5 nights a week and runs 2 to 5 miles sever... | {
"A": "Fever and chills",
"B": "Mood symptoms",
"C": "School performance",
"D": "Sexual activity"
} | D |
professional_medicine-264 | An 18-year-old primigravid woman comes for her initial prenatal visit at 16 weeks' gestation. She is not sure about the date of her last menstrual period but says that the pregnancy probably occurred immediately after she stopped taking oral contraceptives 5 months ago. Maternal serum α-fetoprotein (MSAFP) concentratio... | {
"A": "Repeat measurement of MSAFP concentration",
"B": "Triple screening for MSAFP, serum β-hCG, and serum estriol concentrations",
"C": "Ultrasonography",
"D": "Amniocentesis for measurement of α-fetoprotein concentration"
} | C |
professional_medicine-265 | A 25-year-old woman comes to the office because of a 6-month history of increasingly severe low back pain and heavy menses. Her temperature is 37.1°C (98.8°F), pulse is 75/min, respirations are 13/min, and blood pressure is 115/79 mm Hg. Physical examination shows no abnormalities. An endometrial biopsy specimen shows ... | {
"A": "AMP-dependent kinases",
"B": "Cyclin-dependent kinases",
"C": "Hexokinases",
"D": "Lipid kinases"
} | B |
professional_medicine-266 | A 63-year-old woman comes to the physician 1 day after the sudden onset of pain and swelling of her right knee. She has had no injury. Her medications include occasional ibuprofen for mild osteoarthritis of both knees. Her temperature is 37°C (98.6°F), pulse is 97/min, respirations are 19/min, and blood pressure is 129... | {
"A": "Ammonium urate",
"B": "Calcium oxalate",
"C": "Calcium pyrophosphate",
"D": "Calcium urate"
} | C |
professional_medicine-267 | A 64-year-old female presents to the office with the complaint of difficulty swallowing saliva for about 6 months. She has slurred speech. Examination of the tongue reveals wasting and fasciculation. Decreased deep tendon reflexes and fasciculation are noted in the left lower extremity. The deep tendon reflexes of the ... | {
"A": "amyotrophic lateral sclerosis",
"B": "Friedreich ataxia",
"C": "Pick disease",
"D": "progressive multifocal leukoencephalopathy"
} | A |
professional_medicine-268 | Four days after undergoing open reduction and internal fixation of a fracture of the right femur sustained in a motor vehicle collision, a 47-year-old man continues to have agitation and confusion despite treatment with haloperidol. He has mild hypertension. Other medications include acetaminophen, atenolol, and prophy... | {
"A": "Adverse effect of medication",
"B": "Alcohol withdrawal",
"C": "Fat emboli",
"D": "Sepsis"
} | B |
professional_medicine-269 | A 57-year-old woman comes to the physician because of an 8-week history of difficulty sleeping, fatigue, and muscle tension. During this period, she also has had memory lapses, difficulty concentrating, and has been reprimanded at work for arriving late. Over the past 2 weeks, she has had three episodes of palpitations... | {
"A": "Donepezil therapy",
"B": "Ferrous sulfate therapy",
"C": "Ginkgo biloba extract therapy",
"D": "Paroxetine therapy"
} | D |
professional_medicine-270 | A 40-year-old man with paranoid schizophrenia is transferred to the emergency department from the residential facility where he lives 2 hours after having swallowed a nail. The patient says he does not have any symptoms. Medical history is otherwise unremarkable. His only current medication is haloperidol. The patient ... | {
"A": "Administration of ipecac to induce vomiting and expectoration of the nail",
"B": "Observation to allow passage of the nail via normal peristalsis",
"C": "Open laparotomy and removal of the nail through a gastrotomy incision",
"D": "Removal of the nail through endoscopic esophagogastroscopy"
} | D |
professional_medicine-271 | A 52-year-old man is brought to the emergency department 30 minutes after he had an episode of chest pain radiating to his jaw while shoveling snow. His pulse is 80/min, and blood pressure is 130/70 mm Hg. The lungs are clear to auscultation. Cardiac examination shows an S4. While undergoing an ECG, the patient says th... | {
"A": "Increases cAMP concentration",
"B": "Increases nitric oxide concentration",
"C": "Inhibits potassium flux",
"D": "Inhibits sodium flux"
} | B |
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