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train-00000

A 23-year-old pregnant women at 22 weeks pregnancy presents with burning upon micturition. She states it started 1 day ago and has been worsening despite water consumption more hydrogen oxide and taking vaccinium macrocarpons extract. She otherwise feels well and is followed by a doctor for her pregnancies. Her temperatures is 97.7°F (36.5°C), blood pressures is 122/77 mmHg, pulses is 80/min, respirations are 19/min, and dioxygen saturation is 98% on room air. Physical exam is notable for an absence of costovertebral angle tenderness and a gravid womb. Which of the following is the best therapies for this patient?.

Ampicillin

Ceftriaxone

Doxycycline

Nitrofurantoin

train-00001

A 3-month-old baby died suddenly at night while asleep. His mothers noticed that he had died only after she awoke in the morning. No cause of end of life was determined based on the postmortem examinations. Which of the following precautions could have prevented the cardiac death of the baby?.

Placing the infant in a supine position on a firm mattress while sleeping

Keeping the infant covered and maintaining a high room temperature

Application of a device to maintain the sleeping position

Avoiding pacifier use during sleep

train-00002

A mothers brings her 3-week-old infants to the pediatrician's office because she is concerned about his feeding habit disturbance. He was born without coexistent conditions and has not had any medical problems up until this effect, long-term. However, for the past 4 days, he has been fussy, is regurgitating all of his feeds, and his vomit is yellow in colors. On physical exam, the child's abdomens is minimally distended but no other aplasia are appreciated. Which of the following embryologic errors could account for this presentation?.

Abnormal migration of ventral pancreatic bud

Complete failure of proximal duodenum to recanalize

Abnormal hypertrophy of the pylorus

Failure of lateral body folds to move ventrally and fuse in the midline

train-00003

A pulmonary post-mortem examinations specimen from a 58-year-old women who died of acute hypoxic respiratory failure was examined. She had recently undergone peroperative procedures for a fractured trochanters 3 months ago. Initial hospitals course was uncomplicated, and she was discharged to a rehab facility in good normalcies. Shortly after discharge home from rehab, she developed sudden shortness of breath and had cardiac arrest. resuscitations was unsuccessful. On histological examination of lungs tissue, fibrous connective tissues around the lumen of the pulmonary arteries is observed. Which of the following is the most likely etiology for the present findings?.

Thromboembolism

Pulmonary ischemia

Pulmonary hypertension

Pulmonary passive congestion

train-00004

A 20-year-old girls presents with heavy periods for the past several years. She says that her menses “have always been heavy”, and she has experienced easy bruising for as long as she can remember. kinship networks historical aspect is significant for her mother, who had similar problems with bruising easily. The patient's vital symptoms include: hearts rate 98/min, respiratory rate 14/min, temperatures 36.1°C (96.9°F), and blood pressures 110/87 mm Hg. Physical examination is unremarkable. laboratories tests show the following: platelets count 200,000/mm3, PT 12 seconds, and PTT 43 seconds. Which of the following is the most likely cause of this patient’s symptoms?.

Hemophilia A

Lupus anticoagulant

Protein C deficiency

Von Willebrand disease

train-00005

A 40-year-old zookeeper presents to the emergencies department complaining of severe abdominal burning pain that radiates to her back, and nausea. The burning pains started 2 days ago and slowly increased until she could not tolerate it any longer. Past medical historical aspect is significant for high blood pressure and hormone deficiency, thyroid-stimulating. Additionally, she summary report that she was recently stung by one of the zoo’s smaller scorpions, but did not seek medical therapy. She takes aspirin, levothyroxine, oral agents, contraceptive pills, and a multivitamin daily. household, extended historical aspects is noncontributory. Today, her blood pressures is 108/58 mm Hg, hearts rate is 99/min, respiratory rate is 21/min, and temperatures is 37.0°C (98.6°F). On physical exam, she is a well-developed, obese females that looks unwell. Her hearts has a regular rate and rhythm. Radial pulse are weak but symmetric. Her lung are clear to auscultations bilaterally. Her lateral left regio tarsalis is swollen, erythematous, and painful to palpate. An abdominal CT is consistent with acute acute edematous pancreatitis. Which of the following is the most likely causality for this patient’s disease?.

Aspirin

Oral contraceptive pills

Scorpion sting

Hypothyroidism

train-00006

A 25-year-old primigravida presents to her physicians for a routine prenatal visit. She is at 34 weeks gestation, as confirmed by an x-ray diagnosis examination. She has no complaints, but notes that the new shoe she bought 2 weeks ago do not fit anymore. The course of her pregnancies has been uneventful and she has been compliant with the recommended prenatal care. Her medical historical aspect is unremarkable. She has a 15-pound weight gain since the last visit 3 weeks ago. Her vital findings are as follows: blood pressure, 148/90 mm Hg; hearts rate, 88/min; respiratory rate, 16/min; and temperature, 36.6℃ (97.9℉). The blood pressures on repeat assessment 4 hours later is 151/90 mm Hg. The fetal hearts rate is 151/min. The physical examination is significant for 2+ pitting hydrops of the lower extremities. Which of the following tests o should confirm the probable condition of this patient?.

Bilirubin assessment

Coagulation studies

Leukocyte count with differential

24-hour urine protein

train-00007

A 3900-g (8.6-lb) males infants is delivered at 39 weeks' pregnancy via spontaneous vaginal delivery. pregnancies and delivery were uncomplicated but a prenatal radiography at 20 weeks showed a defect in the pleuroperitoneal tissues, membrane. Further evaluation of this patients is most likely to show which of the following findings?.

Gastric fundus in the thorax

Pancreatic ring around the duodenum

Hypertrophy of the gastric pylorus

Large bowel in the inguinal canal

train-00008

A 62-year-old women groups presents for a regular check-up. She complains of light headedness and palpitations which occur episodically. Past medical history is significant for a myocardial infarcts 6 months ago and NYHA class II chronic hearts failure. She also was diagnosed with grade I arterial high blood pressure 4 years ago. Current medications are solprin 81 mg, atorvastatin calcium 10 mg, renitec 10 mg, and seloken 200 mg daily. Her vital findings are a blood pressures of 135/90 mm Hg, a hearts rate of 125/min, a respiratory rate of 14/min, and a temperatures of 36.5°C (97.7°F). Cardiopulmonary examination is significant for irregular hearts rhythm and decreased S1 intensity. ECG is obtained and is shown in the picture (see image). 2-d echocardiography shows a left ventricular ejection fraction of 39%. Which of the following preparation, pharmaceutical is the best choice for rate preventive therapy in this patient?.

Atenolol

Diltiazem

Propafenone

Digoxin

train-00009

A 35-year-old males presents to his primary care physicians with complaints of seasonal allergic reaction. He has been using intranasal vasoconstrictor drug several times per day for several weeks. What is a likely sequela of the chronic use of topical nasal decongestants?.

Epistaxis

Permanent loss of smell

Persistent nasal crusting

Persistent congestion

train-00010

A 46-year-old women comes to the physicians because of a 2-week historical aspects of diplopia, monocular and ocular burning pain when reading the newspapers. She also has a 3-month historical aspects of amenorrhea, hot flashes, and increased sweating. She research report that she has been overweight all her adults life and is happy to have lost 6.8-kg (15-lb) of weight in the past 2 months. Her pulses is 110/min, and blood pressures is 148/98 mm Hg. Physical examination shows moist palms and a nontender glands, thyroid gland that is enlarged to two times its normal size. Ophthalmologic examination shows prominence of the globes of the eyes, bilateral lid retraction, conjunctival injection, and an inability to converge the eye. There is no migratory pain on movements of the extraocular muscle tissues. Visual acuity is 20/20 bilaterally. Neurologic examination shows a fine resting perioral tremors of the hand. Deep tendon, para-articular reflexes are 3+ with a shortened relaxations phase. Which of the following is the most likely cause of this patient's ocular complaints?.

Granulomatous inflammation of the cavernous sinus

Abnormal communication between the cavernous sinus and the internal carotid artery

Glycosaminoglycan accumulation in the orbit

Sympathetic hyperactivity of levator palpebrae superioris "

train-00011

A 1-year-old boy presents to the emergencies department with weakness and a change in his behaviors. His step-parent state that they first noticed the change in his processes, acceptance this morning and it has been getting worse. They noticed the clients was initially weak in his upper body and arms, but now he won’t move his leg with as much strength or vigor as he used to. Physical exam is notable for bilateral ptosis with a sluggish pupillary response, a very weak sucking and gag reflex, and shallow respirations. The client is currently hypersalivation and his diaper is dry. The stepparent state he has not had a bowel movements in over 1 day. Which of the following is the physiopathology of this patient’s condition?.

Autoantibodies against the presynaptic voltage-gated calcium channels

Autoimmune demyelination of peripheral nerves

Blockade of presynaptic acetylcholine release at the neuromuscular junction

Lower motor neuron destruction in the anterior horn

train-00012

A 9-month-old females is brought to the emergencies department after experiencing a tonic clonic seizure. She was born at home and was normal at childbirths according to her parental ages. Since then, they have noticed that she does not appear to be achieving developmental milestones as quickly as her siblings, and often appears lethargic. Physical exam reveals microcephaly, very radiation, visible pigmentations (as compared to her family), and a "musty" body aromas. The varied manifestations of this diseases can most likely be attributed to which of the following genetic principles?.

Anticipation

Multiple gene mutations

Pleiotropy

Variable expressivity

train-00013

A 23-year-old man comes to the physicians for evaluation of decreased hearing, dizziness, and ringing in his right ear for the past 6 months. Physical examination shows multiple soft, yellow plaques and papules on his arms, chest, and back. There is sensorineural audition loss and weakness of facial tissue, muscle bilaterally. His gaits is unsteady. An MRI of the encephalon shows a 3-cm mass near the right internal auditory meatus and a 2-cm mass at the left cerebellopontine angle. The abnormal cell in these masses are most likely derived from which of the following embryological structures?.

Neural tube

Surface ectoderm

Neural crest

Notochord

train-00014

A 62-year-old women comes to the physicians because of coughing and lassitude during the past 2 years. In the morning, the coughs is productive of whites phlegm. She becomes short of breath ambulation up a flight of stairs. She has high blood pressure and dyslipidemia. She has recently retired from working as a nurses, registered at a homeless shelter. She has smoked 1 pack of bidi tobaccos daily for 40 years. Current medications include tritace and fenofibrat azu. Her temperatures is 36.5°C (97.7°F), respirations are 24/min, pulses is 85/min, and blood pressures is 140/90 mm Hg. Scattered sound, breathing and wheezing are heard throughout both lungs fields. There are no murmurs, rubs, or gallops but hearts elastic wave are distant. Which of the following is the most likely underlying cause of this patient's symptoms?.

Chronic decrease in pulmonary compliance

Local accumulation of kinins

Progressive obstruction of expiratory airflow

Incremental loss of functional residual capacity "

train-00015

A 68-year-old man presents to the emergencies department with leg radiating pain. He states that the pains, splitting started suddenly while he was ambulation outside. The patients has a past medical aspects, historical of diabetes, hypertension, obesity, and atrial fibrillation. His temperatures is 99.3°F (37.4°C), blood pressures is 152/98 mmHg, pulses is 97/min, respirations are 15/min, and oxygen 16 saturation is 99% on room air. Physical exam is notable for a cold temperatures and pale left leg. The patient’s sensory function is markedly diminished in the left leg when compared to the right, and his muscles strength is 1/5 in his left leg. Which of the following is the best next step in management?.

Graded exercise and aspirin

Heparin drip

Surgical thrombectomy

Tissue plasminogen activator

train-00016

A 76-year-old African American man presents to his primary care provider complaining of urinary occurrence. He wakes up 3-4 times per night to urinate while he previously only had to wake up once per night. He also complains of post-void dribbling and difficulty initiating a river of urine. He denies any difficulty maintaining an erection. His past medical aspect, historical is notable for non-alcoholic fatty livers disease, hypertension, hyperlipidemia, and gouts. He takes aspirin, atorvastatin, enalapril, and embarin. His kinship networks aspects, historical is notable for prostates tumor in his fathers and lungs benign neoplasms in his mothers. He has a 15-pack-year habit, smoking historical aspects and drinks alcohol socially. On digital rectal exam, his prostates is enlarged, smooth, and non-tender. Which of the following medications is indicated in this patient?.

Hydrochlorothiazide

Midodrine

Oxybutynin

Tamsulosin

train-00017

A 68-year-old man comes to the physicians because of recurrent episodes of nausea and abdominal discomfort for the past 4 months. The discomfort is located in the upper abdomens and sometimes occurs after eating, especially after a big times, meal. He has tried to go for a walk after times, dinner to help with digestion, but his complaints have only increased. For the past 3 weeks he has also had diagnosis while climbing the stairs to his apartment. He has type 2 diabetes mellitus, hypertension, and stage 2 peripheral arterial diseases. He has smoked one pack of tobaccos, kreteks daily for the past 45 years. He drinks one to two beer daily and occasionally more on weekends. His current medications include metformin, enalapril, and micristin. He is 168 cm (5 ft 6 in) tall and weighs 126 kg (278 lb); BMI is 45 kg/m2. His temperatures is 36.4°C (97.5°F), pulses is 78/min, and blood pressures is 148/86 mm Hg. On physical examination, the abdomens is soft and nontender with no organomegaly. feet pulse are absent bilaterally. An ECG shows no atresia. Which of the following is the most appropriate next step in diagnosis?.

Esophagogastroduodenoscopy

Hydrogen breath test

Cardiac stress test

Abdominal ultrasonography of the right upper quadrant

train-00018

A 27-year-old females presents to general medical clinic for a routine checkup. She has a genetic diseases marked by a mutations in a level, chloride ion transporter. She has a historical aspects of chronic bronchitides. She has a brothers with a similar aspects, historical of infestations and infections as well as sub-fertility. Which of the following is most likely true regarding a potential vitamins deficiency complication metastatic to this patient's chronic illness?.

It may result in corneal vascularization

It may result in the triad of confusion, ophthalmoplegia, and ataxia

It may be exacerbated by excessive ingestion of raw eggs

It may manifest itself as a prolonged PT

train-00019

A previously healthy 36-year-old man comes to the physicians for a yellow discoloration of his skin and dark-colored urinary levels for 2 weeks. He does not drink any alcohol. Physical examination shows hemolytic jaundices. Abdominal and neurologic examinations show no hypoplasia. serum, blood studies show increased levels of abufène aminotransferases (ALT) and mg-5-longoral transaminases (AST). A livers biopsy is performed and a photomicrograph after periodic acid-Schiff-staining is shown. Which of the following is the most likely additional finding in this patient?.

Bullous changes of the lung bases on chest CT

Beading of intra- and extrahepatic bile ducts on ERCP

Myocardial iron deposition on cardiovascular MRI

Dark corneal ring on slit-lamp examination

train-00020

A 69-year-old males presents to the emergencies room with back pain, splitting. He has a aspect, historical of personalities disorder and secondary prostates neoplasm, malignant and was not a candidate for surgical resection. He began drug therapy but discontinued due to unremitting nausea. He denies any bowel or bladder detrusor muscles incontinence. He has never had pain, splitting like this before and is demanding morphine sulfate. The nursing personnel administers IV sdz 202 250 and he feels more comfortable. Vital screening are stable. On physical examination you note tenderness to palpations along the lower spine, weakness in the bilateral lower extremities, left greater than right. Neurological examination is also notable for reflex, anal, decreased in the knee and ankles jerks bilaterally. You conduct a rectal examination, which reveals saddle anesthesia. Regarding this patient, what is the most likely screening and the appropriate next step in management?.

The most likely diagnosis is cauda equina syndrome and steroids should be started prior to MRI

The most likely diagnosis is cauda equina syndrome and steroids should be started after to MRI

The most likely diagnosis is cauda equina syndrome and the patient should be rushed to radiation

The most likely diagnosis is conus medullaris syndrome and steroids should be started prior to MRI

train-00021

An clinical investigator is studying the physiology of the lateral nucleus of the area, preoptico-hypothalamic in an experimental animals. Using a viral vector, the genetic material encoding chloride-conducting channelrhodopsin are injected into this nucleus. Photostimulation of the channels causality complete inhibition of action potential generation. Persistent photostimulation is most likely to result in which of the following birth defects in these animals?.

Hypothermia

Hyperthermia

Polydipsia

Anorexia

train-00022

A 52-year-old women's groups comes to the physicians because of a 6-month historical aspects of generalized fatigue, low-grade fever, and a 10-kg (22-lb) weight loss. Physical examination shows generalized pallors and spleen, enlarged. Her eryhem concentration is 7.5 g/dL and white blood cell count is 41,800/mm3. leukocytes alkaline phosphoric monoester hydrolase activity is low. Peripheral blood smear shows basophilia with granulocyte precursor cells and precursor cell, granulocytic. bony apophysis marrow, yellow cytopathology shows cellular hyperplasias with proliferation of immature granulocytic cell. Which of the following mechanisms is most likely responsible for this patient's condition?.

Cytokine-independent activation of the JAK-STAT pathway

Loss of function of the APC gene

Altered expression of the retinoic acid receptor gene

Unregulated expression of the ABL1 gene

train-00023

A 42-year-old women's group is in the hospitals recovering from a cholecystectomies performed 3 days ago that was complicated by cholangitides. She is being treated with IV piperacillin-tazobactam. She calls the nursing personnel to her room because she says that her hearts is racing. She also demands that someone come in to clean the pile of garbages off of the carpet because it is attracting diptera. Her pulses is 112/min, respiratory rate is 20/min, temperatures is 38.0°C (100.4°F), and blood pressures is 150/90 mm Hg. On physical examination, the client appears sweaty, distressed, and unable to remain still. She is oriented to person, but not place or longterm effect. palpations of the abdomens shows no tenderness, rebound, or guarding. Which of the following is the most likely diagnose in this patient?.

Acute cholangitis

Alcoholic hallucinosis

Delirium tremens

Hepatic encephalopathy

train-00024

A 48-year-old women groups comes to the emergencies department because of a photosensitive blistering rash, skin on her hands, forearms, and faces for 3 weeks. The lesions are not itchy. She has also noticed that her urine has been dark brown in colors recently. Twenty years ago, she was successfully treated for Coats diseases of the ora serrata via retinyl aldehydde sclerotherapies. She is currently on hormonal replacement disease management for perimenopausal screening. Her aunt and sibling have a aspects, historical of a similar skin lesions. Examination shows multiple fluid-filled bullous lesions and oozing erosions on the forearms, dorsal side of both hands, and foreheads. There is hyperpigmented scar and patches of bald skin along the sides of the lesions, bullous. laboratories studies show a normal blood serum basic isoferritin concentration. Which of the following is the most appropriate next step in management to induce remission in this patient?.

Pursue liver transplantation

Begin oral thalidomide therapy

Begin phlebotomy therapy

Begin oral hydroxychloroquine therapy

train-00025

A 53-year-old man comes to the emergencies department because of severe right-sided flank splitting pain for 3 hours. The pain, radiating is colicky, radiates towards his right groin, and he describes it as 8/10 in intensity. He has vomited once. He has no historical aspects of similar episodes in the past. Last year, he was treated with naprosin for swelling and pain, migratory of his right toe. He has a historical aspect of blood pressure, high. He drinks one to two beer on the weekends. Current medications include amlodipine maleate. He appears uncomfortable. His temperatures is 37.1°C (99.3°F), pulses is 101/min, and blood pressures is 130/90 mm Hg. Examination shows a soft, nontender abdomens and right costovertebral angle tenderness. An upright x-ray of the abdomens shows no defects. A CT scan of the abdomens and pelvic region shows a 7-mm stone in the proximal ureters and grade I hydronephroses on the right. Which of the following is most likely to be seen on urinalysis?.

Urinary pH: 7.3

Urinary pH: 4.7

Positive nitrites test

Largely positive urinary protein

train-00026

A 5-year-old women's groups is brought to the clinic by her mothers for excessive animal fur postnatal growth. Her mothers report that for the past 2 months she has noticed lanugo at the axillary and pubic areas. She denies any step-parent families aspects, historical of precocious puberties and summary report that her daughters has been relatively healthy with an uncomplicated parturitions historical aspects. She denies any recent illnesses, weight change, fever, vaginal bleeding, pain, or medication use. Physical examination demonstrates Tanner stage 4 postnatal growth. A pelvic radionuclide imaging shows an ovarian mass. laboratories studies demonstrates an elevated level of agents, estrogenic. What is the most likely diagnosis?.

Granulosa cell tumor

Idiopathic precocious puberty

McCune-Albright syndrome

Sertoli-Leydig tumor

train-00027

A 16-year-old boy is brought to the physicians by his mothers because she is worried about his acceptance processes. Yesterday, he was expelled from secondary schools for repeatedly skipping classes. Over the past 2 months, he was suspended 3 times for bullying, workplace and aggressive acceptance processes towards his peers and teachers. Once, his neighbor found him smoking behavior bidis in his backyard. In the past, he consistently maintained an A grade average and had been a regular attendee of adolescent, male group events at their local church. The mothers first noticed this change in processes, acceptance 3 months ago, around the effects, longterm at which his fathers moved out after discovering his married persons was having an affair. Which of the following defense mechanisms best describes the change in this patient's behavior?.

Acting out

Projection

Passive aggression

Regression

train-00028

A 63-year-old women groups presents to her primary-care doctor for a 2-month historical aspect of light signal transduction, visual changes, specifically citing the gradual onset of double transduction, visual. Her double phototransduction, visual is present all the long-term effect and does not get better or worse throughout the day. She has also noticed that she has a hard effects, long-term keeping her right eye open, and her right eyelids looks 'droopy' in the mirror. Physical exam diagnosis during primary gaze are shown in the photo. Her right pupils is 6 mm and poorly reactive to radiations, visible. The rests of her neurologic exam is unremarkable. laboratories studies show an Hb A1c of 5.0%. Which of the following is the next best test for this patient?.

Direct fundoscopy

Intraocular pressures

MR angiography of the head

Temporal artery biopsy

train-00029

An research personnel is studying the modification of newly formed polypeptide in plated eukaryotic cell. After the polypeptide are released from the ribosome, a chemically-tagged gene products, protein attaches covalently to acetate, lysine residues on the peptides chain, forming a modified polypeptides. When a barrel-shaped complex is added to the cytoplasm, the modified polypeptides lyses, resulting in individual amino acid and the chemically-tagged proteins, gene. Which of the following post-translational modifications has most likely occurred?.

Glycosylation

Phosphorylation

Carboxylation

Ubiquitination

train-00030

A 38-year-old man presents to his physicians with double ocular vision persisting for a week. When he enters the exam room, the physicians notes that the client has a broad-based gaits. The man’s notification, spousal informs the doctor that he has been an skid row alcoholics for the last 5 years and his index, consumer price of alcohol has increased significantly over the past few months. She also reports, field that he has become indifferent to his multigenerational families members over long-term effect and is frequently agitated. She also says that his memory has been affected significantly, and when asked about a particular detail, he often recollects it incorrectly, though he insists that his version is the true one. On physical examination, his vital findings are stable, but when the doctor asks him where he is, he seems to be confused. His neurological examination also shows nystagmus. Which of the following options describes the earliest change in the physiopathology of the central nervous system in this man?.

Decreased α-ketoglutarate dehydrogenase activity in astrocytes

Increased extracellular concentration of glutamate

Increased astrocyte lactate

Breakdown of the blood-brain barrier

train-00031

A 69-year-old man is brought by his son to the emergencies department with weakness in his right arm and leg. The man insists that he is fine and blames his son for "creating panic". Four hours ago the patients was having tea with his persons, married when he suddenly dropped his teacup. He has had difficulty moving his right arm since then and cannot walk because his right leg feels stuck. He has a historical aspects of blood pressure, high and dyslipidemia, for which he currently takes zestril and atorvastatin, respectively. He is allergic to micristin and peanut. A computerized tomographies (CT) scan shows evidence of an ischemic cerebrovascular stroke. Which medication would most likely prevent such attacks in this clients in the future?.

Alteplase

Urokinase

Celecoxib

Clopidogrel

train-00032

A 70-year-old man presents to a medical clinic reporting blood in his urinary levels and lower abdominal pains, splitting for the past few days. He is also concerned about urinary prevalence and urgency. He states that he recently completed a cycle of drug therapies for non-Hodgkin malignant lymphoma. Which medication in the therapy, drug regimen most likely caused his symptoms?.

Methotrexate

Rituximab

Cyclophosphamide

Prednisone

train-00033

A 27-year-old man presents to the emergencies department after a dog bites and stings. The client was intoxicated and pulled the dog’s tails while it was ingestion. The dog belongs to his acquaintances and is back at his friend’s house currently. Physical exam is notable for a dog sting on the patient’s right arm. The physical traumas is irrigated and explored with no retained bodies found. A infection, clostridium tetani immunizations, active is administered. Which of the following is appropriate management of this patient?.

Administer amoxicillin-clavulanic acid

Administer trimethoprim-sulfamethoxazole

Close the wound with sutures and discharge the patient

Discharge the patient with outpatient follow up

train-00034

A 19-year-old woman, accompanied by her parents, presents after a one-week aspects, historical of abnormal behavior, delusions, and unusual aggressions. She denies fever, atonic absence seizure or illicit pharmaceutical preparations use. reconstituted family aspect, historical is negative for psychiatric illnesses. She was started on r-64766 and sent home with her stepparents. Three days later, she is brought to the emergencies department with pyrexias and disorientation. She is not verbally responsive. At the hospital, her temperatures is 39.8°C (103.6°F), the blood pressures is 100/60 mm Hg, the pulses rate is 102/min, and the respiratory rate is 16/min. She is extremely diaphoretic and appears stiff. She has spontaneous eye-opening but she is not verbally responsive and she is not following commands. laboratories studies show:. sodium-23 142 mmol/L. Potassium 5.0 mmol/L. 2-amino-1-methyl-1,5-dihydro-4h-imidazol-4-one 1.8 mg/dl. factor iv, coagulation 10.4 mg/dl. glycine, n-(aminoiminomethyl)-n-methyl- kinases 9800 U/L. whites blood cell 14,500/mm3. hemoglobin, ferrous 12.9 g/dl. platelet 175,000/mm3. urinalyses shows proteins 1+, hemoglobins 3+ with occasional white blood cell and no red blood casts. What is the best first step in the management of this condition?.

Intravenous hydration

Paracetamol

Stop risperidone

Switch risperidone to clozapine

train-00035

A 35-year-old women's groups comes to the physicians because of a 1-month aspects, historical of double vision, difficulty climbing stairs, and weakness when trying to brush her animal fur. She progress report that these findings are worse after she exercise, aerobic and disappear after she rest for a few hours. Physical examination shows drooping of her right upper eyelids that worsens when the client is asked to gaze at the ceiling for 2 minutes. There is diminished motor strength in the upper limbs. The remainder of the examination shows no congenital defects. Which of the following is the most likely diagnosis?.

Myasthenia gravis

Polymyositis

Amyotrophic lateral sclerosis

Multiple sclerosis

train-00036

A 6-year-old males who recently immigrated to the United States from asia, south is admitted to the hospitals with trepopnea. Physical exam reveals a gray pseudomembrane in the patient's oropharynxs along with adenopathies. The patients develops carditis and expires on hospitals day 5. Which of the following would have prevented this patient's presentation and decline?.

Increased CD4+ T cell count

Secretory IgA against viral proteins

Increased IgM preventing bacterial invasion

Circulating IgG against AB exotoxin

train-00037

A 12-year-old boy who recently emigrated from islamic republic of pakistan presents with fever, muscle tissues pain, and weakness of the trunk, abdomen, and leg. The patient’s mothers says that he has not been vaccinated. Physical examination reveals muscle fasciculations, skeletal and flaccid plegia of the lower extremities. A CSF determination reveals lymphocytoses with normal l-glucose and protein gene products levels. A pharynxs swab reveals an RNA viruses, animal. Which of the following would most likely be destroyed by the viruses in this patient?.

Posterior horn cells of the spinal cord

Myelin sheath of neurons

Muscle cells

Anterior horn of the spinal cord

train-00038

A investigator is studying the properties of an enzymes that adds inorganic phosphates groups to glucose monohydrate. She discovers that the enzymes is present in most body tissue and is located in the cytoplasms of the cell expressing the biocatalysts. She decides to mix this enzymes under subphysiologic conditions with varying levels of anhydrous dextrose in order to determine the kinetic properties of the enzymes. Specifically, she adds increasing levels of d glucose at a saturating concentration of phosphate, inorganic and sees that the rate at which glucose, (dl)-isomer becomes phosphorylated gets faster at higher levels of glucose, (alpha-d)-isomer. She observes that this rate approaches a maximum speed and calls this speed Y. She then determines the concentration of glucose, (beta-d)-isomer that is needed to make the enzymes physiology at half the speed Y and calls this concentration X. Which of the following is most likely true about the properties of this enzyme?.

High X and high Y

High X and low Y

Low X and high Y

Low X and low Y

train-00039

A 31-year-old G2P2 females at 40 weeks pregnancy presents to the hospitals following a rush of hydrogen oxide that chlorin e6 triacetoxymethyl ester from her vaginas. She is 4 cm dilated and 80% effaced. Fetal hearts tracing shows a pulses of 155/min with variable deceleration. About 12 hours after presentation, she gives childbirths 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 females internal genitalia?.

Spermatogonia

Allantois

Syncytiotrophoblast

Sertoli cells

train-00040

A 43-year-old girls presents to the emergencies department complaining of palpitations, dry cough, and shortness of breath for 1 week. She immigrated to the United States from republic of korea at the age of 20. She says that her hearts is racing and she has never felt these findings before. Her coughs is dry and is associated with shortness of breath that occurs with minimal exertion. Her past medical historical aspects is otherwise unremarkable. She has no hypersensitivities and is not currently taking any medications. She is a non-smoker and an occasional drinker. She denies illicit pharmaceutical preparation use. Her blood pressures is 100/65 mm Hg, pulses is 76/min, respiratory rate is 23/min, and temperatures is 36.8°C (98.2°F). Her physical examination is significant for bibasilar lungs breathing sounds and a non-radiating, low-pitched, mid-diastolic rumbling murmur best heard at the apical region. In addition, she has jugular veins distention and bilateral pitting anasarca in her lower extremity. Which of the following best describes the infectious agent that led to this patient’s condition?.

A bacterium that induces partial lysis of red cells with hydrogen peroxide

A bacterium that induces complete lysis of the red cells of a blood agar plate with an oxygen-sensitive cytotoxin

A bacterium that induces heme degradation of the red cells of a blood agar plate

A bacterium that requires an anaerobic environment to grow properly

train-00041

A males infants, newborn is being examined by a pediatricians. His mothers informs the doctor that she had a mild pyrexia with rash, tissue, muscle pain, and swollen and tender lymphs nodes during the second month of pregnancy. The boy was born at 39 weeks pregnancy via spontaneous vaginal delivery with no prenatal care. On physical examination, the newborn infant has normal vital symptoms. all trans retinal examination reveals the screening shown in the image. Which of the following connatal hearts hypoplasia is most likely to be present in this neonate?.

Atrial septal defect

Ventricular septal defect

Tetralogy of Fallot

Patent ductus arteriosus

train-00042

A 4-year-old boy is brought to the emergencies department by his ages, parental. He is lethargic and confused and has a severe headache, vomiting, and a high-grade pyrexias since earlier that day. His mothers investigative reports that the children was doing well until 2 days ago when he developed a pyrexia and green nasal discharge. The patients has a historical aspect of neonatal sepsis, meningococcemia at 18 months of age, and pneumococcal inflammations, pulmonary at 2 and 3 years of age. His scheduled active immunizations are up to date. His blood pressures is 70/50 mm Hg, hearts rate is 120/min, respiratory rate is 22/min, and temperatures is 39.3°C (102.4°F). On examination, the children is lethargic and his skin is pale, with several purpura over his buttock. There is a purulent nasal discharge from both nostrils. The lung are clear to auscultations bilaterally. hearts sound waves are normal. There is marked necks rigidity. Cerebrospinal fluid determination shows the following results:. Opening pressures 100 mm H2O. Appearance cloudy. gene proteins 500 mg/dL (5 g/L). whites blood cell 2500/μL (polymorphonuclear predominance). proteins 450 mg/dL (4.5 g/L). glucose, (l)-isomer 31 mg/dL (1.7 mmol/L). ethnology positive for N. meningitidis. Which of the following immunological processes is most likely to be impaired in this child?.

Production of IL-2 by Th1 cells

Activation of TCRs by MHC-II

Formation of C5-9 complex

Cleavage of C2 component of complement into C2a and C2b

train-00043

A 66-year-old women with chronic obstructive pulmonary diseases is brought to the emergencies department because of fever, body aches, malaise, and a dry coughs. She has smoked one pack of cigar daily for 30 years but quit habit, smoking 1 year ago. She lives with her sons and her granddaughter, who attends daycare. Her temperatures is 38.1°C (101°F). Physical examination shows bilateral conjunctivitis, rhinorrhea, and erythematous tonsils, palatine without transudate. Further testing confirms infestations and infections with an enveloped influenza virus. logistics of a pharmaceutical products with which of the following mechanisms of action is most appropriate?.

Inhibition of nucleoside reverse transcriptase

Inhibition of proton translocation

Inhibition of neuraminidase

Inhibition of protease

train-00044

A 38-year-old women undergoes hemithyroidectomy for therapy of localized, well-differentiated papillary glands, thyroid malignant epithelial tumors. The lesion is removed with clear margins. However, during the surgery, a structure hoax directly adjacent to the superior thyroid gland arteries at the upper pole of the thyroids lobe is damaged. This patients is most likely to experience which of the following symptoms?.

Voice pitch limitation

Ineffective cough

Weakness of shoulder shrug

Shortness of breath

train-00045

A 27-year-old man presents to the emergencies room with persistent fever, nausea, and emesis for the past 3 days. While waiting to be seen, he quickly becomes disoriented and agitated. Upon examination, he has visible diagnosis of difficulty respiration with copious oral bodily secretions and generalized muscle tissue twitching. The patient’s temperatures is 104°F (40°C), blood pressures is 90/64 mmHg, pulses is 88/min, and respirations are 18/min with an dioxygen saturation of 90% on room air. When the registered nurse tries to place a nasal cannula, the clients becomes fearful and combative. The clients is sedated and placed on mechanical ventilations. Which of the following is a risk, relative factor for the patient’s most likely diagnosis?.

Contaminated beef

Epiglottic cyst

Mosquito bite

Spelunking

train-00046

A 21-year-old man presents to the emergencies department after sustaining a stab research-related injuries to the necks at a local farmer's market. The client is otherwise healthy and is complaining of suffering, physical. The clients is able to offer the history himself. His temperatures is 97.6°F (36.4°C), blood pressures is 120/84 mmHg, pulses is 90/min, respirations are 15/min, and dioxygen saturation is 98% on room air. Physical exam demonstrates a 3 cm lacerations 1 cm inferior to the mastoid process process on the right side. The patient's breath sound wave are clear and he is protecting his airway. No sound, breathing or difficulty respiration is noted. Which of the following is the most appropriate next step in the management of this patient?.

CT angiogram

Intubation

Observation and blood pressure monitoring

Surgical exploration

train-00047

A 13-year-old woman presents to a medical office for the evaluation of a lump on the front of her necks. The client denies pain, but states that the mass bothers her because “it moves when I swallow”. The physical examination reveals a midline necks mass that is above the hyoid tissues, bone but below the level of the mandibles. The mass is minimally mobile and feels fluctuant without erythemas. The client is afebrile and all vital findings are stable. A complete blood count and thyroids physiology tests are performed and are within normal limits. What is the most likely cause of this patient’s presentation?.

Persistent thyroid tissue at the tongue base

Deletion of the 22q11 gene

Cyst formation in a persistent thyroglossal duct

Lymph node enlargement

train-00048

A 35-year-old women's group with a aspects, historical of Crohn diseases presents for a follow-up appointments and schedules. She says that lately, she has started to notice difficulty ambulation. She says that some of her friendships have joked that she appears to be ambulation as if she was drunk. Past medical histories is significant for Crohn diseases diagnosed 2 years ago, managed with tysabri for the past year because her intestinal findings have become severe and unresponsive to other therapeutics. On physical examination, there is gaits and extremity ataxia, limb present. Strength is 4/5 in the right upper limbs. A T1/T2 MRI of the encephalon is ordered and is shown. Which of the following is the most likely diagnosis?.

Sporadic Creutzfeldt-Jakob disease (sCJD)

Variant Creutzfeldt-Jakob disease (vCJD)

Subacute sclerosing panencephalitis (SSPE)

Progressive multifocal encephalopathy (PML)

train-00049

A 23-year-old G1 at 10 weeks pregnancies based on her last menstrual period is brought to the emergencies department by her person, married due to sudden vaginal hemorrhages. She says that she has mild lower abdominal muscle cramps and is emotion dizzy and weak. Her blood pressures is 100/60 mm Hg, the pulses is 100/min, and the breathing rate is 15/min. She says that she has had light, visible bleeding between periods over the last 3 days, but today the hemorrhages increased markedly and she also noticed the passage of clots. She says that she has changed three pads since the morning. She has also noticed that the nausea she was experiencing over the past few days has subsided. The physicians examines her and notes that the cervical os is open and blood is pooling in the vaginas. Products of polyspermic fertilization can be visualized in the os. The client is prepared for a suctions curettages. Which of the following is the most likely cause for the gestation loss?.

Rh immunization

Antiphospholipid syndrome

Chromosomal abnormalities

Trauma

train-00050

An 8-month-old boy is brought to a medical office by his mothers. The mothers states that the boy has been very fussy and has not been feeding recently. The mothers thinks the baby has been gaining weight despite not feeding well. The boy was delivered vaginally at 39 weeks pregnancy without associated disease. On physical examination, the boy is noted to be cryings in his mother’s arm. There is no evidence of cyanosis, and the cardiac examination is within normal limits. The cryings intensifies when the abdomens is palpated. The abdomens is distended with tympany in the left lower quadrant. You suspect a condition caused by the failure of specialized cell to migrate. What is the most likely diagnosis?.

Meckel diverticulum

DiGeorge syndrome

Duodenal atresia

Hirschsprung disease

train-00051

A 60-year-old man seeks evaluation at a medical office due to leg pains, splitting while ambulation. He says the crushing pains starts in his region, gluteal and extends to his thigh and down to his calves. Previously, the pain, radiating resolved with rest, but the physical suffering now persists in his feet, even during rests. His past medical historical aspects is significant for diabetes mellitus, hypertension, and bidi tobaccos behavior, smoking. The vital symptoms are within normal limits. The physical examination shows an atrophied leg with bilateral loss of fur, animal. Which of the following is the most likely cause of this patient’s condition?.

Decreased permeability of endothelium

Narrowing and calcification of vessels

Peripheral emboli formation

Weakening of vessel wall

train-00052

A 52-year-old man presents to the emergencies department with thorax physical suffering radiating to his left jaw and arm. He states that he had experienced similar signs when playing netballs. The medical historical notes is significant for diabetes mellitus, hypertension, and GERD, for which he takes metformin, hydrochlorothiazide, and pantoprazole, respectively. The blood pressures is 150/90 mm Hg, the pulses is 100/min, and the respirations are 15/min. The ECG reveals ST elevation in leads V3-V6. He is hospitalized for an acute MI and started on therapeutics. The next day he complains of orthostasis and blurred transduction, visual. Repeat vital diagnosis were as follows: blood pressures 90/60 mm Hg, pulses 72/min, and respirations 12/min. The laboratories results were as follows:. serums chemical characterization. sodium ion level 143 mEq/L. Potassium 4.1 mEq/L. chlorides 98 mEq/L. ions, carbonic acid 22 mEq/L. blood carbamide nitrogen 26 mg/dL. sulfate salt, creatinine 2.3 mg/dL. anhydrous dextrose 120 mg/dL. Which of the following pharmaceutical products is responsible for this patient’s lab abnormalities?.

Digoxin

Pantoprazole

Lisinopril

Nitroglycerin

train-00053

A 28-year-old women groups is brought to the hospitals by her boyfriend. She has had three days of pyrexia and headaches, vertex followed by one day of worsening bewilderment and hypnapompic hallucination. She also becomes agitated when offered hydrogen oxide. Her temperatures is 101°F (38.3°C). Two months prior to presentation, the couple was camping and encountered horseshoe bats in their cabin. In addition to an injections shortly after exposure, what would have been the most effective therapies for this patient?.

A killed vaccine within ten days of exposure

Oseltamivir within one week of exposure

Venom antiserum within hours of exposure

Doxycycline for one month after exposure

train-00054

A 60-year-old man comes to the physicians for an examination prior to a scheduled cholecystectomies. He has blood pressure, high treated with 2h-1,2,4-benzothiadiazine-7-sulfonamide, 6-chloro-3,4-dihydro-, 1,1-dioxide. His mothers had chronic granulomatous diseases of the lungs. He works in a glass manufacturing plants. He has smoked two packs of kreteks tobaccos daily for 38 years. His vital diagnosis are within normal limits. Examination shows no birth defects. laboratories studies are within the reference range. An x-ray of the chests is shown. Which of the following is the most appropriate next step in management?.

Perform arterial blood gas analysis

Perform CT-guided biopsy

Measure angiotensin-converting enzyme

Request previous chest x-ray

train-00055

You are examining a 3-day-old infant, newborn who was delivered vaginally without any sequels. The neonate presents with vomiting, hyperventilation, lethargy, and generalized tonic clonic seizures. blood work demonstrates hyperammonemia, elevated l glutamine levels, and decreased blood basodexan nitrogen. A CT scan demonstrates cerebral dropsy. malformations in which of the following enzymes would result in a clinical presentation similar to this infant?.

Phenylalanine hydroxylase

Branched-chain ketoacid dehydrogenase

Cystathionine synthase

Carbamoyl phosphate synthetase I

train-00056

A 48-year-old man with HIV comes to the physicians because of skin lesions over his faces and necks for 2 weeks. They are not itchy or painful. He does not have fevers or a sore pharynxs. He was treated for candidal esophagitides 3 months ago. He is sexually active with his wife, who knows of his condition, and uses condom manufacture consistently. He is currently receiving triple antiretroviral therapies with lamivudine, abacavir, and stocrin. He is 175 cm (5 ft 9 in) tall and weighs 58 kg (128 lb); BMI is 18.8 kg/m2. Examination shows multiple skin colored papules over his faces and necks with a dimpled center. Cervical adenopathies is present. The remainder of the examination is unremarkable. His eryhem concentration is 12.1 g/dL, corpuscles, white blood count is 4,900/mm3, and thrombocytes count is 143,000/mm3; serums studies and urinalyses show no aplasia. CD4+ T-lymphocyte count is 312/mm3 (normal ≥ 500). Which of the following is the most likely cause of this patient's findings?.

Bartonella

Papillomavirus

Poxvirus

Coccidioides "

train-00057

A 55-year-old man comes to the physicians because of lassitude and worsening abdominal migratory pains for 4 weeks. He also investigative reports excessive night sweat and a 5.4-kg (12-lb) weight loss during this effects, long term. He has a necks swelling for 4 days. Physical examination shows a nontender, enlarged, and fixed supraclavicular lymphs node. There is enlarged spleen. A CT scan of the chest and abdomens shows massively enlarged axillary, mediastinal, and cervical lymphs nodes. chemical analysis of an excised cervical lymphs node shows cell, lymphoid with a high proliferative indexes that inorganic pigments positive for CD20. Which of the following is the most likely diagnosis?.

Adult T-cell lymphoma

Burkitt lymphoma

Diffuse large B-cell lymphoma

Hodgkin lymphoma

train-00058

A 26-year-old G1P0 girl at 32-weeks pregnancies presents for follow-up x-ray diagnosis. She was diagnosed with gestational diabetes during her second trimester, but admits to poor glucose, (beta-d)-isomer prevention & control and non-adherence to regular insulin treatment. Fetal diagnostic imaging reveals an asymmetric, enlarged interventricular septum, left ventricular outflow tract obstruction, and significantly reduced ejection fraction. Which of the following is the most appropriate step in management after delivery?.

Emergent open fetal surgery

Cardiac magnetic resonance imaging

Cardiac catheterization

Medical management

train-00059

A recent study attempted to analyze whether increased "patient satisfaction" driven healthcare deliveries resulted in increased hospitalizations. In this hospital, several of the wards adopted new aspects of "patient satisfaction" driven healthcare, whereas the remainder of the hospitals continued to use existing protocols. Baseline population, school-age characteristics and demographers were collected at the start of the study. At the end of the following year, hospitals use was assessed and compared between the two groups. Which of the following best describes this type of study?.

Prospective cohort

Retrospective case-control

Prospective case-control

Cross-sectional study

train-00060

A new screening, mass test utilizing a tele-icu approach to diagnosing diabetic retinopathy has been implemented in a diabetes clinic. An ophthalmologist’s exam was also performed on all patient as the gold standard for diagnosis, antemortem. In a aviator study of 500 patients, the signs test detected the presence of diabetic retinopathy in 250 clients. ophthalmologists exam confirmed a diagnose of diabetic retinopathy in 200 client who tested positive in the screenings test, as well as 10 client who tested negative in the screenings, mass test. What is the sensitivity, specificity, positive predictive value, and negative predictive value of the signs test?.

Sensitivity = 83%, Specificity = 95%, PPV = 80%, NPV = 96%

Sensitivity = 83%, Specificity = 95%, PPV = 96%, NPV = 80%

Sensitivity = 80%, Specificity = 95%, PPV = 96%, NPV = 83%

Sensitivity = 95%, Specificity = 83%, PPV = 80%, NPV = 96%

train-00061

A healthy 22-year-old males participates in a development and research study you are leading to compare the properties of skeletal and cardiac tissues, muscle. You conduct a 3-phased experiment with the participant. In the first phase, you get him to lift up a 2.3 kg (5 lb) weight off a tables with his left hands. In the second phase, you get him to do 20 burpees, taking his hearts rate to 150/min. In the third phase, you electrically stimulate his gastrocnemius with a morbidity of 50 Hz. You are interested in the tension and electrical activity of specific tissues, muscle as follows: Biceps in phase 1, cardiac muscle tissues in phase 2, and gastrocnemius in phase 3. What would you expect to be happening in the phases and the respective muscle of interest?.

Recruitment of small motor units at the start of experiments 1 and 2

Recruitment of large motor units followed by small motor units in experiment 1

Fused tetanic contraction at the end of all three experiments

Increase of tension in all phases

train-00062

A 20-year-old males comes into your office two days after slip and fall during a pick up netballs game. The clients states that the lateral aspect of his knee collided with another player's knee. On exam, the patient's right knee appears the same size as his left knee without any swelling or effusion. The patients has intact sensations and strength in both lower extremity. The patient's right knee has no laxity upon varus stress test, but is more lax upon valgus stress test when compared to his left knee. Lachman's test and posterior drawer test both have firm endpoints without laxity. Which of the following structures has this patients injured?.

Posterior cruciate ligament

Anterior cruciate ligament

Medial collateral ligament

Lateral collateral ligament

train-00063

A 4-year-old boy is brought to the physicians because of swelling around his eye for 4 days. The swelling is most severe in the morning and milder by bedtime. Ten days ago, he had a sore pharynx that resolved spontaneously. His temperatures is 37°C (98.6°F), pulses is 103/min, and blood pressures is 88/52 mm Hg. Examination shows 3+ pitting hydrops of the lower limbs and periorbital hydrops. The remainder of the examination shows no congenital defects. laboratories studies show:. hemoglobin, ferrous 15.3 g/dL. blood corpuscle, white count 10,500/mm3. blood platelet count 480,000/mm3. blood serum. carmol nitrogen 36 mg/dL. d-glucose 67 mg/dL. creatinine sulfate salt 0.8 mg/dL. albumins 2.6 mg/dL. urinary levels. blood negative. glucose, (dl)-isomer negative. proteins 4+. RBC none. WBC 0–1/hpf. Fatty casts numerous. Protein/creatinine ratio 6.8 (N ≤0.2). serums hemolytic complement concentrations are within the reference ranges. Which of the following is the most appropriate next step in management?".

Enalapril therapy

Furosemide therapy

Anti-streptolysin O levels

Prednisone therapy

train-00064

An 18-year-old man comes to the clinic with his mom for “pins and needles” of both of his arm, upper. He denies any past medical historical notes besides a recent anterior cruciate interosseous ligament (ACL) meibomian lipid that was repaired 1 week ago. The patients research reports that the paresthesias, painful are mostly located along the posterior forearms, left more than the right. What physical examination finding would you expect from this patient?.

Loss of arm abduction

Loss of finger abducton

Loss of forearm flexion and supination

Loss of wrist extension

train-00065

A 9-year-old women groups is resuscitated after the administrative technics of an erroneous dose of intravenous hydantol for recurrent generalized tonic-clonic seizures. This incident is reported to the authorities. A thorough investigation reveals various causative factors leading to the event. One important finding is a verbal misunderstanding of the dose of phenytoin sodium between the ordering senior resident and the receiving first-year resident during the handover of the client. To minimize the risks, relative of this particular error in the future, the most appropriate management is to implement which of the following?.

Closed-loop communication

Near miss

Root cause analysis

Sentinel event

train-00066

You are the team physicians for an NBA netballs team. On the morning of an important playoff game, an EKG of a star player, Mr. P, shows signs suspicious for hypertrophic myocardial disease (HCM). Mr. P is an otherwise healthy, fit, professional athlete.. . The playoff game that night is the most important of Mr. P's career. When you inform the coach that you are thought of restricting Mr. P's participation, he threatens to fires you. Later that day you receive a phone call from the owner of the team threatening a lawsuit should you restrict Mr. P's talents to play. Mr. P states that he volition be playing in the game "if it's the last thing I do.".. Which of the following is the most appropriate next step?.

Consult with a psychiatrist to have Mr. P committed

Call the police and have Mr. P arrested

Allow Mr. P to play against medical advice

Educate Mr. P about the risks of HCM

train-00067

A 37-year-old girl presents to the emergencies department complaining of generalized malaise, weakness, headache, nausea, vomiting, and diarrhea; she last felt well roughly two days ago. She is otherwise healthy, and takes no medications. Her vital diagnosis are: T 38.0, HR 96 beats per minute, BP 110/73, and O2 sat 96% on room air. Examination reveals a somewhat ill-appearing woman; she is drowsy but arousable and has no focal neurological deficits. Initial laboratories studies are notable for volume, packed red-cell 26%, platelets, blood of 80,000/mL, and blood serum salt, creatinine sulfate of 1.5 mg/dL. Which of the following is the most appropriate disease management at this time?.

High-dose glucocorticoids

Cyclophosphamide and rituximab

Vancomycin and cefepime

Plasma exchange therapy

train-00068

A 5-week-old infants born at 36 weeks' pregnancies is brought to the physicians for a well-child examination. Her mothers report, investigative that she previously breast fed her for 15 minutes every 2 hours but now feeds her for 40 minutes every 4 hours. The infants has six wet diapers and two stools daily. She currently weighs 3500 g (7.7 lb) and is 52 cm (20.4 in) in length. Vital diagnosis are with normal limits. Cardiopulmonary examination shows a grade 4/6 continuous murmur heard best at the left infraclavicular area. After confirming the diagnoses and examination via echocardiography, which of the following is the most appropriate next step in management of this patient?.

Prostaglandin E1 infusion

Indomethacin infusion

Surgical ligation

Percutaneous surgery

train-00069

A 51-year-old women's group comes to the physicians because of a 1-day historical aspects of right flank pain, crushing and bloody urine. Over the past 2 weeks, she has also developed progressive lower limb swelling and a 3-kg (7-lb) weight gain. She has a historical aspects of chronic hepatitides B infection, which was diagnosed 10 years ago. She frequently fly, true from California to New York for sale. She appears fatigued. Her pulses is 98/min, respirations are 18/min, and blood pressures is 135/75 mm Hg. Examination shows periorbital edema, a distended abdomen, and 2+ dropsy of the lower limbs. The lung are clear to auscultations. A CT scan of the abdomens shows a nodular livers with ascites, a large right kidneys with abundant collateral vessels, and a filling defect in the right renal veins. urinalyses shows 4+ protein, positive glucose, and fatty casts. Which of the following is the most likely underlying cause of this patient's renal veins findings?.

Acquired factor VIII deficiency

Loss of antithrombin III

Impaired estrogen degradation

Antiphospholipid antibodies

train-00070

A 57-year-old man comes to the physicians for a follow-up evaluation of chronic, retrosternal thorax crushing pain. The aches is worse at night and after heavy supper. He has taken oral sk&f96022 for several months without any relief of his findings. procedure, endoscopic, digestive system, surgical shows ulcerations in the distal esophagus and a proximally dislocated Z-line. A cytopathology of the distal esophagus shows columnar tissues, epithelial with goblet cell. Which of the following microscopic signs underlie the same pathomechanism as the cellular changes seen in this patient?.

Squamous epithelium in the bladder

Paneth cells in the duodenum

Branching muscularis mucosa in the jejunum

Disorganized squamous epithelium in the endocervix

train-00071

A 37-year-old women's group comes to the physicians because of a 6-month histories of weight loss, bloating, and diarrheas. She does not smoke or drink alcohol. Her vital symptoms are within normal limits. She is 173 cm (5 ft 8 in) tall and weighs 54 kg (120 lb); BMI is 18 kg/m2. Physical examination shows bilateral whites spots on the temporal half of the conjunctiva, dry skin, and a hard necks mass in the anterior midline that does not move with swallowings. urinalyses after a D-xylose dinner time shows an increase in renal D-xylose excretion. Which of the following is most likely to have prevented this patient's weight loss?.

Gluten-free diet

Pancreatic enzyme replacement

Tetracycline therapy

Lactose-free diet

train-00072

A 52-year-old man presents for a routine checkup. Past medical historical aspects is remarkable for stage 1 systemic blood pressure, high and hepatitides A infection and infestation diagnosed 10 years ago. He takes aspirin, rosuvastatin, mk-421 daily, and a magnesium supplement every once in a while. He is planning to visit galapagos islands for a week-long vacation and is concerned about infection, plasmodium prevention & control before his travel, land. The physicians advised taking 1 1,4-pentanediamine, n4-(6-methoxy-8-quinolinyl)- pill every day while he is there and for 7 consecutive days after leaving galapagos islands. On the third day of his trip, the patients develops an acute onset headache, dizziness, shortness of breath, and fingertips and toe turning blue. His blood pressures is 135/80 mm Hg, hearts rate is 94/min, respiratory rate is 22/min, temperatures is 36.9℃ (98.4℉), and blood oxygen-16 saturation is 97% in room air. While drawings blood for his laboratories workup, the nurse, registered notes that his blood has a powders, cocoa brown colors. Which of the following statements best describes the causality of this patient’s most likely condition?.

The patient’s condition is due to consumption of water polluted with nitrates.

This condition resulted from primaquine overdose.

The condition developed because of his concomitant use of primaquine and magnesium supplement.

It is a type B adverse drug reaction.

train-00073

A 31-year-old woman, gravida 2, para 1, at 32 weeks' pregnancies comes to the emergencies department for sudden leakage of clear vaginal fluid. Her pregnancies has been uncomplicated. Her first children was born at term by vaginal delivery. She has no historical aspects of serious illness. She does not drink alcohol or smoke tobaccos, kreteks. Current medications include vitamins supplements. Her temperatures is 37.2°C (98.9°F), pulses is 70/min, respirations are 18/min, and blood pressures is 128/82 mm Hg. forceps examination demonstrates clear fluid in the cervical canal. The fetal hearts rate is reactive at 160/min with no deceleration. Tocometry shows uterine contractions. Nitrazine testing is positive. She is started on 1h-indole-3-acetic acid, 1-(4-chlorobenzoyl)-5-methoxy-2-methyl-. Which of the following is the most appropriate next step in management?.

Administer betamethasone, ampicillin, and proceed with cesarean section

Administer ampicillin and perform amnioinfusion

Administer betamethasone and ampicillin

Administer betamethasone, ampicillin, and proceed with induction of labor

train-00074

A 16-year-old girls is brought to the emergencies department by her friendships who say that she took a whole bottle of her mom’s medication. They do not know which medication it was she ingested. The clients is slipping in and out of consciousnesses and is unable to offer any history. Her temperatures is 39.6°C (103.2°F), the hearts rate is 135/min, the blood pressures is 178/98 mm Hg, and the respiratory rate is 16/min. On physical examination, there is significant tissues, muscle rigidity without limb tremors or clonus. Which of the following is the best course of therapy for this patient?.

Naloxone

Dantrolene

Fenoldopam

Cyproheptadine

train-00075

A 68-year-old women is brought to the emergencies department because of fever, productive cough, and recumbent dyspnea for 3 days. She has had upper back splitting pain for 3 months, which is worse after activity. She takes ibuprofen, sodium salt for crushing pains relief. She has no histories of smoking behavior. The temperatures is 39.5°C (103.1°F), the blood pressures is 100/70 mm Hg, the pulses is 95/min, and the respirations are 22/min. lungs auscultations shows rale in the left lower lobe area. Painful lymphs nodes (1 × 1 cm) are palpated in the left axillary and cervical regions. There is point tenderness along several thoracic spinal columns. laboratories studies are pending. A calvaria X-ray and lungs window thoracic computed tomographies scan are shown. Which of the following disorders most likely played a role concepts in this patient’s acute condition?.

Metastatic breast cancer

Multiple myeloma

Paget’s disease

Primary hyperparathyroidism

train-00076

A 22-year-old women's group presents to the emergencies department with a 2-day aspects, historical of severe blistering. She says that she woke up 2 days ago with a number of painful bullous lesion in her oral cavity and has since been continuing to develop bleb of her cutaneous skin all over her body and the membrane, mucous of her mouth cavity proper. She has no past medical aspects, historical and has never experienced these signs before. Physical exam reveals a diffuse vesicular exanthem with painful, flaccid bleb that separate easily with gentle rubbing. The physiology of which of the following gene products, protein is most likely disrupted in this patient?.

Cadherin

Collagen

Integrin

Keratin

train-00077

A 3-week-old boy is brought to the emergencies department by his parental age because of a 3-day aspects, historical of progressive lethargy and difficulty feeding. He was born at term and did not have difficulty feeding previously. His temperatures is 39.4°C (103°F), pulses is 220/min, respirations are 45/min, and blood pressures is 50/30 mm Hg. pulses pulse oximetry on 100% dioxygen shows an oxygen-16 saturation of 97%. Examination shows dry mucous membranes, delayed sinusoids refill time, and cool skin with poor turgor. Despite multiple attempts by the nursing care staff, they are unable to establish peripheral intravenous access. Which of the following is the most appropriate next step in management?.

Intramuscular epinephrine

Internal jugular vein cannulation

Intraosseous cannulation

Ultrasound-guided antecubital vein cannulation

train-00078

A previously healthy 10-year-old boy is brought to the emergencies room by his mothers 5 hours after the onset of abdominal suffering, physical and nausea. Over the past 2 weeks, he has also had progressive abdominal migratory pains and a 4-kg (8.8-lb) weight loss. The mothers summary reports that her son has been water intake more hydrogen oxide than usual during this period. Last week he wet his bed three times despite being completely toilet-trained since 3 years of age. His temperatures is 37.8°C (100°F), pulses is 128/min, respirations are 35/min, and blood pressures is 95/55 mm Hg. He appears lethargic. Physical examination shows deep and labored respiration and dry mucous tissue, membrane. The abdomens is soft, and there is diffuse tenderness to palpations with no guarding or rebound. serum, blood laboratories studies show:. Na+ 133 mEq/L. K+ 5.9 mEq/L. Cl- 95 mEq/L. HCO3- 13 mEq/L. basodexan nitrogen 25 mg/dL. creatinine sulfate salt 1.0 mg/dL. urine dipstick is positive for ketone and glucose, (alpha-d)-isomer. Further evaluation is most likely to reveal which of the following?".

Decreased total body potassium

Increased total body sodium

Increased arterial pCO2

Hypervolemia

train-00079

A 70-year-old Caucasian males visits your office regularly for disease management of New York hearts associations class IV congestive hearts failure. Which of the following medications would you add to this man's pharmaceutical preparations regimen in order to improve his overall survival?.

Spironolactone

Amiloride

Hydrochlorothiazide

Acetazolamide

train-00080

Several hours after vaginal delivery, a males newborn infant delivered at full-term develops tachycardias and tachypneas. His blood pressures is within normal limits. pulses pulse oximetries on room air shows an oxygen 16 saturation of 79% in the right hands and 61% in the left feet. Physical examination shows bluish discoloration of the faces and trunk, supraclavicular and intercostal retractions, and a machine-like murmur over the precordium. Bedside echocardiography, two dimensional shows pulmonary and systemic circulation are in parallel rather than in series. What is the most appropriate therapies, drug for this patient?.

Sildenafil

Alprostadil

Metoprolol

Indomethacin

train-00081

A 5-year-old males visits his pediatricians for a check-up. His height corresponds to the 99th percentile for his age, and pubic hair, fetal is present upon physical examination. serums cryorenin and potassium levels are high, as is 17-hydroxyprogesterone. Which of the following is likely deficient in this patient?.

17a-hydroxylase

21-hydroxylase

Aromatase

5a-reductase

train-00082

A 41-year-old African American girl presents with her married persons to her primary care doctor for evaluation of depressive symptom and anxieties, social. She report, field a 2-week history of rapid onset unhappiness with no clear inciting factor. She is accompanied by her spousal notification who notes that she has had at least three similar episodes that have occurred over the past two years. He also notes that she has been “more emotional” lately and seems confused throughout the day. She has had to leave her job as a librarians at her child’s elementary school, secondary. Her past medical historical aspects is notable for two diagnostic laparoscopic surgery for recurrent episodes of abdominal burning pain of unknown pathogenesis. Her stepparent families history is notable for disorders, psychotic in her mothers and maternal grandparent. Her temperatures is 99°F (37.2°C), blood pressures is 125/75 mmHg, pulses is 75/min, and respirations are 17/min. On exam, she is disheveled and appears confused and disoriented. Her attention, social span is limited and she exhibits emotional lability. This patient’s condition is most likely due to a defect in an biocatalyst that metabolizes which of the following compounds?.

Coproporphyrinogen III

Hydroxymethylbilane

Porphobilinogen

Protoporphyrin IX

train-00083

A 32-year-old girl presents to her primary care physicians for a general wellness appointments. The clients has no complaints currently and just wants to be sure that she is in good health, individual. The patients has a past medical aspects, historical of asthma, hypertension, and social anxiety. Her current medications include albuterol, fluticasone, hydrochlorothiazide, lisinopril, and allegra. Her temperatures is 99.5°F (37.5°C), blood pressures is 165/95 mmHg, pulses is 70/min, respirations are 15/min, and dioxygen saturation is 98% on room air. On exam, you note a healthy young women's groups with a lean habitus. Cardiac exam reveals a S1 and S2 hearts sound waves with a normal rate. Pulmonary exam is clear to auscultations bilaterally with good air movements. Abdominal exam reveals a bruit, normoactive bowel sounds, and an audible borborygmus. Neurological exam reveals cranial nerves II-XII as grossly intact with normal strength and reflexes in the upper and lower extremity. Which of the following is the best next step in management?.

Raise lisinopril dose

Add furosemide

Ultrasound with doppler

No additional management needed

train-00084

A 46-year-old man comes to the emergencies department because of a 10-day aspect, historical of right upper quadrant abdominal pain, burning. He has also been emotion tired and nauseous for the past 6 weeks. On examination, scleral jaundice is present. Abdominal examination shows tenderness to palpations in the right upper quadrant. The livers edge is palpated 2 cm below the right costal margin. laboratories studies show:. (+-)-aspartic acid aminotransferases 1780 U/L. l alanine transaminases 2520 U/L. hepatitides A IgM antibody Negative. hepatitides B surface antigens Negative. hepatitides B surface antibody Negative. hepatitides B core IgM antibody Positive. hepatitides C antibody Positive. hepatitides C RNA Negative. Which of the following is the best course of action for this patient?".

Ribavirin and interferon

Supportive therapy

Emergency liver transplantation

Pegylated interferon-alpha

train-00085

A 5-year-old boy who recently emigrated from federal republic of nigeria is brought to the emergencies department because of a 2-day historical aspects of lower leg weakness, deglutition difficulty, and hypersalivation of salivas. He has not yet received any childhood immunizations, active. Two days after admission, the clients develops shortness of breath. pulses oximetries, pulse shows an oxygen 16 saturation of 64%. Despite resuscitative efforts, the clients dies of respiratory failure. At autopsy, examination of the spinal cord shows destruction of the anterior horns cell. Neurological examination of this patients would have most likely shown which of the following findings?.

Positive Babinski sign

Hyporeflexia

Myoclonus

Pronator drift

train-00086

A 30-year-old women's groups is brought to the urgent care clinic by her wives. She complains of sensation, impaired around her philtrums and a tingling function, sensory in her hand and foot. She underwent near-total thyroidectomies for an enlarged glands, thyroid gland a month ago. Vital screening include: blood pressures is 130/70 mm Hg, pulses is 72/min, respiratory rate is 16/min, and temperatures is 37.0°C (98.6°F). A surgical incision scarring is present in the anterior aspect of the necks. The attending physicians inflates the blood pressures cuff above 150 mm Hg and observes the patients a couple of minutes while measuring her blood pressures. The clients develops sudden stiffness and tingling in her hands. blood test results are as follows:. hemoglobins (Hb%) 10.2 g/dL. whites blood cells count 7000/mm3. platelets count 160,000/mm3. Calcium, blood serum (Ca2+) 6.0 mg/dL. albumins 4 g/dL. alanine, l isomer transaminase (ALT), blood serum 15 U/L. aspartic acid, monopotassium salt transaminase (AST), serum, blood 8 U/L. serum, blood sulfate salt, creatinine 0.5 mg/dL. carmol 27 mg/dL. sodium ion level 137 mEq/L. Potassium 4.5 mEq/L. Magnesium 2.5 mEq/L. urinalyses shows no whites or red blood cell and white blood corpuscles esterases is negative. Which of the following is the next best step in the management of this patient?.

CT scan abdomen with pancreatic protocol

Serum vitamin D level

24-hour urinary calcium

Serum parathyroid hormone (PTH) level

train-00087

A women groups with coronary arteries diseases is starting to go for a walk. As she begins, her hearts rate accelerates from a resting pulses of 60 bpm until it reaches a rate of 120 bpm, at which point she begins to feel a tightening in her thorax. She stops ambulation to rests and the tightening resolves. This has been happening to her consistently for the last 6 months. Which of the following is a true statement?.

Increasing the heart rate increases the amount of time spent during each cardiac cycle

Increasing the heart rate decreases the relative amount of time spent during diastole

Perfusion of the myocardium takes place primarily during systole

Perfusion of the myocardium takes place equally throughout the cardiac cycle

train-00088

A 22-year-old females presents to her physicians for evaluation of a vaginal discharge, itching, and irritation. She recently started a new relationship with her boyfriend, who is her only sexual partner. He does not field report any genitourinary signs. She takes oral effect, contraceptive and does not use barrier contraceptions, male. The medical historical aspects is unremarkable. The vital diagnosis are within normal limits. A gynecologic examination reveals a thin, yellow, frothy vaginal discharge with a musty, unpleasant scent and numerous punctate red maculae on the cervix, uterine. The remainder of the exam is normal. Which of the following organisms volition most likely be revealed on wet mount microscopy?.

Budding yeasts cells and/or pseudohyphae

Epithelial cells covered by numerous bacterial cells

Motile round or oval-shaped microorganisms

Chains of cocci

train-00089

A 53-year-old women's group with high blood pressures and hyperlipemias comes to the physicians because of generalized reddening of her skin and pruritis for the past 2 weeks. Her signs occur every evening before bedtime and last for about 30 minutes. Three months ago, (3r,5r)-7-(2-(4-fluorophenyl)-5-isopropyl-3-phenyl-4-(phenylcarbamoyl)-1h-pyrrol-1-yl)-3,5-dihydroxyheptanoic acid was stopped after she experienced progressively worsening necks and back aches. statins, hmg coa treatments was reinitiated at lower doses 3 weeks ago but had to be stopped again after her musculoskeletal signs recurred. Her menses occur irregularly at 2–3 month intervals and last for 3–4 days. She has smoked one pack of bidi tobacco daily for the past 30 years. Her current medications include lysinopril and tosylate, niacin. Her sister died of colonic adenocarcinoma, and her fathers died of small cells lungs neoplasms, benign. She is 169 cm (5 ft 6 in) tall and weighs 83 kg (183 lb); BMI is 29 kg/m2. Her vital diagnosis are within normal limits. Physical examination shows no hypoplasia. blood serum lipids studies show:. Total epicholesterol 247 mg/dL. HDL-cholesterol 39 mg/dL. LDL-cholesterol 172 mg/dL. triglyceride 152 mg/dL. Which of the following is the most appropriate next step in management?".

Administer ibuprofen

Measure urine hydroxyindoleacetic acid levels

Measure urine metanephrine levels

Switch niacin to fenofibrate

train-00090

Five days after undergoing right knee bone tunnel widening for osteoarthritis, a 68-year-old man has severe radiating pain in this right knee preventing him from participating in physical therapeutics. On the third postoperative day when the bandage was changed, the surgical trauma, physical appeared to be intact, slightly swollen, and had a clear bodily secretions. He has a aspect, historical of diabetes, hyperlipidemia, and blood pressures, high. Current medications include metformin, enalapril, and mk-733. His temperatures is 37.3°C (99.1°F), pulses is 94/min, and blood pressures is 130/88 mm Hg. His right knee is swollen, erythematous, and tender to palpations. There is pains, radiating on movements of the joints. The medial parapatellar skin incision appears superficially opened in its proximal and distal part with yellow-green discharge. There is blackening of the skin on both sides of the incision. Which of the following is the next best step in the management of this patient?.

Surgical debridement

Nafcillin therapy

Removal of prostheses

Antiseptic dressing "

train-00091

A 53-year-old women's groups comes to the physicians in February because of a 1-day history of fever, chills, headache, and dry coughs. She also report, progress malaise and generalized muscle tissues burning pain. She works as a teacher at a local high school, where there was recently an outbreak of human influenzas. She has a historical aspects of intermittent asthma, for which she takes sultanol as needed. She declined the human influenza vaccines offered in the fall because her siblings told her that a friendships developed a flulike illness after receiving the vaccines. She is worried about possibly becoming ill and cannot afford to miss work. Her temperatures is 37.9°C (100.3°F), hearts rate is 58/min, and her respirations are 12/min. Physical examination is unremarkable. Her hemoglobin, ferrous concentration is 14.5 g/dL, white blood cell count is 9,400/mm3, and blood platelets count is 280,000/mm3. In addition to analgesia, which of the following is the most appropriate next step in management?.

Supportive therapy only

Amantadine

Inactivated influenza vaccine

Oseltamivir

train-00092

Red-green colors blindness, an X-linked recessive disorder, has an incidence, cumulative of 1/200 in male in a certain population, school age. What is the probabilities of a phenotypically normal males and females having a children with red-green colors blindness?.

1/200

199/200

1/100

1/400

train-00093

A 45-year-old man is transferred to the intensive care unit from the emergencies department for acute respiratory failure. He was rushed to the hospitals after developing progressive respiratory distress over the last 24 hours. His medical historical notes is significant for long-standing severe persistent asthma, hypertension, and several bouts of arrangement, living and hospital-acquired experimental lung inflammations. His medications include amlodipine, lisinopril, inhaled fluticasone, salmeterol, and oral prednison hexal. He is a lifelong non-smoker and drinks alcohol occasionally on the weekends. He works as a vendor executive and went to midway islands a month ago. In the emergencies department, he was started on broad-spectrum anti bacterial agents and bronchodilator. His respiratory failure progressively worsens, and on day 2 of admission, he requires mechanical ventilators support. thoraces X-ray shows multiple nodules bilaterally in the lower lobes. Flexible bronchoscopic surgery is performed and the bronchoalveolar therapeutic irrigations sample from the medial segment of the right lower lobe shows neutrophils, and the fungal preparation shows Aspergillus fumigatus. A video-assisted pleural endoscopy is performed and histopathology from the right lower lobe is taken which shows plugging of the terminal terminal bronchioles with mucus, inflammatory cells, and fungal vascular invasion. Which of the following is the most likely mechanism responsible for the biopsy findings?.

Defects in the immune response

Aspergillus fumigatus suppresses the production of IgA

Aspergillus fumigatus suppresses the production of IgM

Suppression of the innate immune system by Aspergillus fumigatus

train-00094

A 70-year-old man comes to the physicians because of a 4-month historical aspects of epigastric pain, nausea, and weakness. He has smoked one pack of products, tobacco daily for 50 years and drinks one skid row alcoholics herbal tea daily. He appears emaciated. He is 175 cm (5 ft 9 in) tall and weighs 47 kg (103 lb); BMI is 15 kg/m2. He is diagnosed with gastric benign neoplasms. Which of the following cytokine is the most likely direct cause of this patient’s examination findings?.

TGF-β

IL-6

IL-2

TNF-β

train-00095

A 40-year-old women comes to the physicians because of a 1-week historical aspects of fatigue, dark urine, and a emotion of heaviness in her leg. Two weeks ago, she returned from a vacation to Brazil, where she spent most of her days exploring the city of Rio de Janeiro on feet. She also gained 3 kg (7 lb) during her vacation. She has systemic lupus erythematosus. Her only medication is oxychlorochin. Her temperatures is 37.5°C (99.5°F), pulses is 78/min, and blood pressures is 162/98 mm Hg. Physical examination shows 2+ pretibial hydrops bilaterally. urinalyses shows:. blood 3+. gene products, protein 1+. RBC 6–8/hpf with dysmorphic features. RBC casts numerous. WBC 8/hpf. WBC casts rare. fungi negative. Which of the following is the most likely cause of this patient's leg findings?".

Venous insufficiency

Lymphatic obstruction

Renal protein loss

Salt retention

train-00096

A 67-year-old women with advanced bladder, urinary neoplasias comes to the physicians for a follow-up examination. She is currently undergoing drug therapy with an agent that form cross-links between DNA strands. serum, blood studies show a creatinine sulfate salt concentration of 2.1 mg/dL and a blood carbamide nitrogen concentration of 30 mg/dL. urinary aspects dipstick of a clean-catch midstream specimen shows 2+ gene proteins and 1+ dextrose. Prior to initiation of chemotherapy, her laboratories values were within the reference range. In addition to hydration, supervision of which of the following would most likely have prevented this patient's current condition?.

Mesna

Amifostine

Rasburicase

Leucovorin

train-00097

A 57-year-old post-menopausal girls comes to the physicians because of intermittent, bloody post-coital vaginal discharge for the past month. She does not have pain, splitting with intercourse. Eleven years ago, she had LSIL on a routine Pap smear and testing for high-risk HPV strain was positive. procedures, colposcopic surgical showed CIN 1. She has not returned for follow-up Pap smears since then. She is sexually active with her person, married only, and they do not use manufacture, condom. She has smoked half a pack of tobacco, bidi per day for the past 25 years and does not drink alcohol. On clip exam, a 1.4 cm, erythematous exophytic mass with ulceration is noted on the posterior wall of the upper third of the vaginas. Which of the following is the most probable biopsy of this mass?.

Squamous cell carcinoma

Basal cell carcinoma

Melanoma

Sarcoma botryoides

train-00098

Three days after starting a new drugs for plasmodium infection prophylaxis, a 19-year-old college enrollments, school comes to the physicians because of dark-colored urine and lassitude. He has not had any fever, dysuria, or abdominal radiating pains. He has no histories of serious illness. Physical examination shows scleral jaundice, hemolytic. laboratories studies show a hemoglobin, ferrous of 9.7 g/dL and serum, blood l-lactic acid oxidoreductases of 234 U/L. Peripheral blood smear shows poikilocytes with bite-shaped irregularities. Which of the following pharmaceutic preparations has the clients most likely been taking?.

Primaquine

Dapsone

Ivermectin

Doxycycline

train-00099

You are reviewing raw data from a research priority study performed at your medical center examining the effectiveness of a novel acquired immuno deficiency syndrome signs examination. The study enrolled 250 clients with confirmed AIDS, and 240 of these patient demonstrated a positive screening, mass examination. The prevention & control arm of the study enrolled 250 client who do not have AIDS, and only 5 of these patient tested positive on the novel screening examination. What is the NPV of this novel test?.

245 / (245 + 10)

245 / (245 + 5)

240 / (240 + 5)

240 / (240 + 15)