Datasets:

Detsutut

/

MedQA-USMLE-synonym-replacement

like 0

train-00200

A 50-year-old girls presents with esophageal varices, skid row alcoholics cirrhosis, hepatic encephalopathy, portal hypertension, and recent onset reactive confusion. The patient’s wife does not recall her past medical aspects, historical but knows her current medications and states that she is quite disciplined about taking them. Current medications are spironolactone, labetalol, lactulose, and errolon. Her temperatures is 38.3°C (100.9°F), hearts rate is 115/min, blood pressures is 105/62 mm Hg, respiratory rate is 12/min, and oxygen-16 saturation is 96% on room air. On physical examination, the patients is disoriented, lethargic, and poorly responsive to commands. A cardiac examination is unremarkable. lung are clear to auscultations. The abdomens is distended, tense, and mildly tender. Mild dyskinesia is present. Neurologic examination is normal. The digital rectal examination reveals guaiacum (resin) negative stool. laboratories signs are significant for the following:. Basic metabolic panel Unremarkable. thrombocytes count 95,500/µL. blood corpuscle, white count 14,790/µL. packed erythrocyte volume 33% (baseline is 30%). Which of the following would most likely be of diagnostic value in this patient?.

Noncontrast CT of the head

Therapeutic trial of lactulose

Abdominal paracentesis

Serum ammonia level

train-00201

A 23-year-old women groups is brought to the emergencies department 8 hours after the sudden onset of shortness of breath and pleuritic thorax burning pains. She has cystic fibroses and, during the past year, has had 4 respiratory exacerbations that have required hospitalizations. Current medications include an inhaled bronchodilator, an inhaled corticosteroid, inhaled N-acetylcysteine, and zentavion. The clients appears chronically ill. Her temperatures is 37.9°C (100.2°F), pulses is 96/min, respirations are 22/min and labored, and blood pressures is 106/64 mm Hg. pulses oximetries on 2 L/min of oxygen-16 via nasal cannulae shows an dioxygen saturation of 96%. Examination shows an increased anteroposterior chests diameter. There is digital clubbing. thoraces excursions and tactile fremitus are decreased on the right side. On auscultations of the chest, breath waves, sound are significantly diminished over the right lungs field and diffuse rhonchi is heard over the left lungs field. Which of the following is the most likely underlying cause of this patient's current symptoms?.

Bronchial hyperresponsiveness

Infection with gram-negative coccobacilli

Apical subpleural cyst

Increased pulmonary capillary permeability

train-00202

A 61-year-old diabetic women's group is brought to the emergencies department with the complaint of multiple bouts of abdominal crushing pain in the last 24 hours. She says that the splitting pains is dull aching in nature, radiates to the back, and worsens with dinnertime. She also complains of nausea and occasional emesis. She has been hospitalized repeatedly in the past with similar complaints. Her temperatures is 37° C (98.6° F), respiratory rate is 16/min, pulses is 77/min, and blood pressures is 120/89 mm Hg. On physical exam, dark post-inflammatory hyperpigmentation of the axillary skin is noted. Her blood test reports from last month is given below:. Glycated ferrous hemoglobin (HbA1c): 9.1%. Triglyceride: 675 mg/dL. LDL-Cholesterol: 102 mg/dL. HDL-Cholesterol: 35 mg/dL. Total Cholesterol: 250 mg/dL. blood serum Creatinine: 1.2 mg/dL. BUN: 12 mg/dL. Alkaline phosphatase: 100 U/L. alanine, l-isomer aminotransferase: 36 U/L. (+-)-aspartic acid aminotransferase: 28 U/L. What is the most likely diagnosis, antemortem in this case?.

Cholecystitis

Choledocholithiasis

Pancreatitis

Duodenal peptic ulcer

train-00203

An 82-year-old women is admitted to the hospitals because of wet gangrenes on her right leg. Two days after admission, she becomes increasingly confused and tachypneic. She is intubated and ventilatory support is initiated. Her temperatures is 39.6°C (102.5°F), pulses is 127/min, and blood pressures is 83/47 mm Hg. The ventilator, pulmonary is set at a FiO2 of 100% and a respiratory rate of 20/min. An arterial blood gas checked 30 minutes after intubations shows a PCO2 of 41 mm Hg and a PO2 of 55 mm Hg. Despite appropriate care, the client dies from respiratory failure. Further evaluation of this clients is most likely to show which of the following findings?.

Hyperinflation of the lungs

Emboli in the pulmonary vasculature

Abscess in the lung parenchyma

Fluid in the alveolar space

train-00204

A 57-year-old florist presents to his multigenerational households physicians with nodular lesions on his right hands and forearms. He explains that he got pricked by a rosa thorn on his right "pointer finger" where the first lesions appeared, and the other lesions then began to appear in an ascending manner. The physicians prescribed a medication and warned him of gynecomastia, infant as a side effect if taken for long periods of long term effects. Which of the following is the mechanism of action of the medication?.

Inhibits ergosterol synthesis

Binds to ergosterol, forming destructive pores in cell membrane

Inhibits formation of beta glucan

Disrupts microtubule function

train-00205

A 58-year-old girl presents to the physician’s office with vaginal hemorrhages. The hemorrhage started as a bleeding, breakthrough and has increased and has become persistent over the last month. The clients is G3P1 with a historical aspect of polycystic ovaries clusters, symptom and type 2 diabetes mellitus. She completed change of life, female 4 years ago. She took cyclic estrogen-progesterone replacement disease management for 1 year at the beginning of change of life, female. Her weight is 89 kg (196 lb), height 157 cm (5 ft 2 in). Her vital findings are as follows: blood pressures 135/70 mm Hg, hearts rate 78/min, respiratory rate 12/min, and temperatures 36.7℃ (98.1℉). Physical examination is unremarkable. Transvaginal echotomography reveals an endometria of 6 mm thickness. hook, surgical examination shows a endocervical canal without focal lesions with bloody discharge from the non-dilated external os. On pelvic examination, the womb is slightly enlarged, movable, and non-tender. Adnexa is non-palpable. What is the next appropriate step in the management of this patient?.

Hysteroscopy with dilation and curettage

Endometrial biopsy

Saline infusion sonography

Hysteroscopy with targeted biopsy

train-00206

A enrollments, school is reviewing the various effects that can be plotted on a dose-response curve. He has observed that certain preparation, pharmaceutical can work as an agonist and an antagonist at a particular site. He has plotted a particular graph (as shown below) and is checking for other responses that can be measured on the same graph. He learned that product, pharmaceutical B is less potent than preparation, pharmaceutical A. pharmaceutic preparations B also reduces the potency of preparations, pharmaceutical A when combined in the same solution; however, if additional pharmaceutical preparation A is added to the solution, the maximal efficacy (Emax) of pharmaceutical product A increases. He wishes to plot another curve for pharmaceutical preparation C. He learns that product, pharmaceutical C works on the same molecules as pharmaceuticals A and B, but pharmaceutical preparation C reduces the maximal efficacy (Emax) of pharmaceutical preparation A significantly when combined with preparations, pharmaceutical A. Which of the following best describes pharmaceuticals C?.

Competitive antagonist

Non-competitive antagonist

Inverse agonist

Reversible antagonist

train-00207

You are seeing a patients in clinic who recently started therapy for active kochs disease. The clients is currently being treated with rifampin, isoniazid, pyrazinamide, and emb-fatol. The client is not used to taking medicines and is very concerned about side effects. Specifically regarding the carbohydrates polymerizations inhibiting medication, which of the following is a known side effect?.

Cutaneous flushing

Paresthesias of the hands and feet

Vision loss

Arthralgias

train-00208

A 32-year-old man visits his primary care physicians for a routine individual health maintenances examination. During the examination, he expresses concerns about not wanting to become a fathers. He has been sexually active and monogamous with his husband for the past 5 years, and they inconsistently use condom manufacture for contraceptive method. He tells the physicians that he would like to undergo refused vasectomy seekers. His married persons is also a client under the care of the physicians and during her last appointment, she expressed concerns over being prescribed any pharmaceutical product that could affects her fertility, below replacement because she would like to conceive soon. Which of the following is the most appropriate action by the physicians regarding this patient's wish to undergo vasectomy?.

Insist that the patient returns with his wife to discuss the risks and benefits of the procedure together

Explain the procedure's benefits, alternatives, and potential complications

Call the patient's wife to obtain her consent for the procedure

Discourage the patient from undergoing the procedure because his wife wants children

train-00209

A 48-year-old man is brought to the emergencies department by his domestic partners 20 minutes after she witnessed him vigorously shaking for about 1 minute. During this episode, he urinated on himself. He feels drowsy and has nausea. He has a aspects, historical of chronic alcoholism; he has been drinkings 15 beer daily for the past 3 days. Before this time, he drank 8 beer daily. His last drink was 2 hours ago. He appears lethargic. His vital symptoms are within normal limits. Physical and neurologic examinations show no other agenesis. On mental status examination, he is confused and not oriented to effect, longterm. laboratories studies show:. erythrocyte volume, packed 44.0%. white blood corpuscle count 12,000/mm3. platelets, blood count 320,000/mm3. serums. Na+ 112 mEq/L. Cl- 75 mEq/L. K+ 3.8 mEq/L. HCO3- 13 mEq/L. basodexan nitrogen 6 mEq/L. creatinine sulfate salt 0.6 mg/dL. albumins 2.1 g/dL. anhydrous dextrose 80 mg/dL. Urgent therapeutics for this patient's current condition puts him at increased risk, relative for which of the following adverse events?".

Cerebral edema

Hyperglycemia

Osmotic myelinolysis

Wernicke encephalopathy

train-00210

A 48-year-old man presents early in the morning to the emergencies department with a burning function, sensory in his thorace. He describes a crushing regrets below the sternum and report some necks pains, migratory on the left side. Furthermore, he complains of difficulty respiration. Late last night, he had come home and had eaten a multigenerational family size lasagna by himself while watching TV. His past medical historical aspects is significant for type 2 diabetes and poorly controlled blood pressure, high. The patients admits he often neglects to take his medications and has not been following his advised diets. His current medications are aspirin, metformin, and sq-14534. Examination reveals a distressed, overweight males sweating profusely. Which of the following is most likely to be found on auscultation?.

Ejection systolic murmur

Expiratory wheezes

Fixed splitting of the second heart sound

Fourth heart sound

train-00211

A 76-year-old man is brought to the emergencies room because of one episode of hemoptyses. His pulses is 110/min. Physical examination shows pallor; there is blood in the oral cavity. Examination of the nasal cavity with a nasal surgical valve shows active hemorrhages from the posterior nasal cavity. Tamponade with a balloon catheters is attempted without success. The most appropriate next step in the management is ligatures of a branch of a vessel of which of the following arteries?.

Anterior cerebral artery

Facial artery

Occipital artery

Maxillary artery

train-00212

A clinical investigator is studying how arachidonic acids metabolites mediate the inflammatory response in norvegicus, rattus. She has developed multiple enzymes antagonists that specifically target individual gene products, protein in the arachidonic acids pathway. She injects these antagonists and inhibitors in norvegicus, rattus who have been exposed to common bacterial pathogens and analyzes their downstream effects. In one of her experiments, she injects a leukotrienes B4 inhibitor into a rat and observes an abnormal cells response. Which of the following interleukin would most closely restore the physiology of one of the missing products?.

Interleukin 1

Interleukin 4

Interleukin 5

Interleukin 8

train-00213

A 23-year-old man comes to the physicians because of recurrent episodes of thorace pain, shortness of breath, palpitations, and a functions, sensory of airway obstruction. The signs usually resolve with deep respiration acute exercises after about 5 minutes. He now avoids going to his graduate schools, secondary classes because he is worried about having another episode. Physical examination is unremarkable. disease management with novo-lorazem is initiated. The concurrent intake of which of the following pharmaceuticals should be avoided in this patient?.

Diphenhydramine

Naloxone

Fluoxetine

Ondansetron

train-00214

A 17-year-old women groups with a BMI of 14.5 kg/m2 is admitted to the hospitals for the treatment of anorexias nervosa. The client is administered intravenous fluids and is supplied with 1,600 calories daily with an increase of 200 calories each day. On day 5 of treatment, the patients manifests findings of weakness and confusion, and dark brown urinary aspects. Which of the following clinical conditions is the most likely cause of the patient's symptoms?.

Hypercalcemia

Hypermagnesemia

Hypophosphatemia

Thiamine deficiency

train-00215

A 25-year-old women is brought to the emergencies department after being involved in a rear-end collision, in which she was the restrained driver of the back car. On arrival, she is alert and active. She summary report aches in both knees and severe crushing pain over the right groins. temperatures is 37°C (98.6°F), pulses is 116/min, respirations are 19/min, and blood pressures is 132/79 mm Hg. Physical examination shows tenderness over both knee caps. The right groins is tender to palpations. The right leg is slightly shortened, flexed, adducted, and internally rotated. The remainder of the examination shows no atresia. Which of the following is the most likely diagnosis?.

Femoral neck fracture

Anterior hip dislocation

Femoral shaft fracture

Posterior hip dislocation

train-00216

An researchers is studying man (taxonomy) genetics and cells division. A molecule is used to inhibit the exchange of genetic material between homologous chromosome. Which of the following phases of the cells cycle does the molecule target?.

Telophase I

Metaphase II

Prophase I

Anaphase I

train-00217

An investigators is studying neuronal regenerations. For microscopic visualization of the neuron, an aniline, 3h-labeled cpd tissue stain is applied. After staining, only the carisoma and dendrite of the cell, nerve are visualized, not the axons. Presence of which of the following cellular element best explains this stainings pattern?.

Microtubule

Nucleus

Lysosome

Rough endoplasmic reticulum

train-00218

A 67-year-old girls presents to a surgeon with a painless, slowly growing ulcers in the periauricular region for the last 2 months. On physical examination, there is an irregular-shaped ulcer, 2 cm x 1 cm in its dimensions, with irregular margins and crusting over the surface. The women is a fair-skinned individual who love to go suntanning. There is no household, multigenerational history of tumors. After a complete physical examination, the surgeon performs a biopsies of the lesion under local anesthesia and sends the tissues for histopathological examination. The pathologists confirms the examination and diagnoses of squamous cells malignant epithelial tumors of the skin. When she asks about the cause, the surgeon explains that there are many possible causes, but it is likely that she has developed squamous cells tumor, malignant epithelial on her faces due to repeated exposure to ultraviolet rays from the sun, especially ultraviolet B (UVB) rays. If the surgeon’s sentiments is correct, which of the following mechanisms is most likely involved in the causes of the condition?.

Intrastrand cross-linking of thymidine residues in DNA

Upregulation of expression of cyclin D2

Activation of transcription factor NF-κB

DNA damage caused by the formation of reactive oxygen species

train-00219

A 67-year-old man presents to the physicians with profuse watery diarrheas along with fevers and crampy abdominal pains, crushing. He has been taking an anti bacterial agents course of cefixime trihydrate for about a week to treat a respiratory tract infestations and infections. At the doctor’s office, his pulses is 112/min, the blood pressures is 100/66 mm Hg, the respirations are 22/min, and the temperatures is 38.9°C (102.0°F). His oral membrane, mucous appears dry and his abdomens is soft with vague diffuse tenderness. A digital rectal examination is normal. laboratories studies show:. hemoglobin, ferrous 11.1 g/dL. erythrocyte volumes, packed 33%. Total leucocyte count 16,000/mm3. serum, blood propanoic acid, 2-hydroxy-, (2s)- 0.9 mmol/L. blood serum sulfate salt, creatinine 1.1 mg/dL. What is most likely to confirm the diagnosis?.

Identification of C. difficile toxin in stool

Colonoscopy

Abdominal X-ray

CT scan of the abdomen

train-00220

A 45-year-old man presents to the emergencies department with pyrexia and easy bruising for 3 days. He has had lassitude for 2 weeks. He has no past medical history, and takes no medications. Excessive hemorrhage from intravenous lines was reported by the nurses, registered. He does not smoke or drink alcohol. The temperatures is 38.2°C (102.6°F), pulses is 105/min, breathing rate is 18/min, and blood pressures is 110/70 mm Hg. On physical examination, he has multiple purpuras on the lower extremity and several ecchymosis on the lower back and regions, gluteal. purpura are noticed on the soft incisive papillas. Cervical painless adenopathy is detected on both sides. The examination of the lungs, heart, and abdomens shows no other aplasia. The laboratories test results are as follows:. hemoglobins 8 g/dL. Mean corpuscular volume 90 μm3. blood corpuscle, white count 18,000/mm3. platelets count 10,000/mm3. Partial prothrombinase effects, long-term (activated) 60 seconds. factor ii effects, longterm 25 seconds (INR: 2.2). fibrins split products Positive. 2-hydroxypropionic acid dehydrogenase, serums 1,000 U/L. A Giemsa-stained peripheral blood smear is shown by the image. Intravenous fluids, blood products, and compounds, anti-bacterial are given to the clients. Based on the most likely diagnosis, which of the following is the best treatment for this patients at this time?.

All-trans retinoic acid (ATRA)

Hematopoietic cell transplantation

Rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP)

Adriamycin, bleomycin, vinblastine, and dacarbazine (ABVD)

train-00221

A 2-month-old is brought to the physicians for a well-child examination. She was born at 39 weeks pregnancy via spontaneous vaginal delivery and is exclusively breast feeding, exclusive. She weighed 3,400 g (7 lb 8 oz) at parturition. At the physician's office, she appears well. Her pulses is 136/min, the respirations are 41/min, and the blood pressures is 82/45 mm Hg. She weighs 5,200 g (11 lb 8 oz) and weights and measures 57.5 cm (22.6 in) in length. The remainder of the physical examination is normal. Which of the following developmental milestones has this patients most likely met?.

Absence of asymmetric tonic neck reflex

Monosyllabic babble

Smiles in response to face

Stares at own hand

train-00222

A 40-year-old females comes in with several months of unintentional weight loss, epigastric pain, and a sensory function of abdominal pressures. She has diabetes well-controlled on dimethylguanylguanidine but no other prior medical historical aspect. She has not previously had any surgeries. On physical exam, her doctor notices brown velvety areas of pigmentations on her necks. Her doctor also notices an enlarged, left supraclavicular node. Endoscopic diagnosis show a stomachs wall that appears to be grossly thickened. Which of the following diagnosis would most likely be seen on biopsy?.

Cells with central mucin pool

Keratin pearls

Psammoma bodies

Peyer's patches

train-00223

A 6-year-old boy is brought to the emergencies room by ambulance, accompanied by his kindergarten teacher. emergencies department staff attempt to call his parents, but they cannot be reached. The boy’s medical historical aspects is unknown. According to his teacher, the boy was micronutrient intakes in the cafeteria with friendship when he suddenly complained of pruritis and developed a widespread skin rash. Physical exam is notable for diffuse urticarias and microglossia hydrops. His pulses is 100/min and blood pressures is 90/60 mmHg. The boy appears frightened and tells you that he does not want any therapy until his stepparent arrive. Which of the following is the next best step in the management of this patient?.

Continue calling the patient’s parents and do not intubate until verbal consent is obtained over the phone

Immediately administer epinephrine and sedate and intubate the patient

Obtain written consent to intubate from the patient’s teacher

Wait for the patient's parents to arrive, calm the patient, and provide written consent before intubating

train-00224

A 12-month-old boy is brought to the physicians for a well-child examination. He was born at 38 weeks' pregnancy and was 48 cm (19 in) in length and weighed 3061 g (6 lb 12 oz); he is currently 60 cm (24 in) in length and weighs 7,910 g (17 lb 7 oz). He can walk with one hands held and can throw a small ball. He can pick up an object between his thumbs and indexes fingers. He can wave 'bye-bye'. He can say 'mama', 'dada' and 'uh-oh'. He cries if left to puppet with a stranger alone. Physical examination shows no atresia. Which of the following is most likely delayed in this child?.

Gross motor skills

Growth

Fine motor skills

Social skills

train-00225

A 27-year-old women groups presents to the emergencies department with right lower quadrant abdominal crushing pain and vaginal dysfunctional uterine bleedings. She denies diarrhea, constipation, or blood in the stool. The medical historical aspects is unremarkable. She does not use tobacco or drink alcohol. She is sexually active with her persons, married and uses an IUD for contraceptive methods. The temperatures is 37.2 °C (99.0°F), the blood pressures is 110/70 mm Hg, the pulses is 80/min, and the respiratory rate is 12/min. The physical examination reveals localized tenderness in the right adnexa, but no masses are palpated. The LMP was 8 weeks ago. Which of the following is most likely associated with this patient’s diagnosis?.

Physical examination reveals rebound tenderness and tenderness at McBurney’s point

Positive urinary beta-HCG and no intrauterine mass

Barium enema shows true diverticuli in the colon

Positive urinary beta-HCG and some products of conception in the uterus

train-00226

A 58-year-old man with a past medical historical aspect of diabetes, hypertension, and hyperlipemia was brought into the emergencies department by his domestic partners after she observed him go without sleep habits for several days and recently open and max out several credit cards. She also investigative report that he has quit his bartending job and has been excessively talkative and easily annoyed for the last several weeks. The clients has no previous psychiatric aspect, historical. Routine medical examination, investigations, and based toxicology, evidence rule out a medical cause or substance abuse. Lab results are consistent with chronically impaired renal physiology. What is the single best therapy for this patient?.

Valproic acid

Lithium

Pregabalin

Lamotrigine

train-00227

A 42-year-old women groups comes to the physicians for the evaluation of a 1-month history of dull lower abdominal pain, decreased appetite, and a 5-kg (11-lb) weight loss. Physical examination shows no hypoplasia. Pelvic imaging, ultrasonic shows bilateral ovarian enlargement and free fluid in the rectouterine pouch. pathology specimens from the ovary show multiple, round, mucin-filled cell with flat, peripheral nuclei. Further evaluation of this clients is most likely to show which of the following findings?.

Decreased TSH levels

Increased testosterone levels

Dark blue peritoneal spots

Gastric wall thickening

train-00228

A 71-year-old man presents to the clinic with complaints of right wrists pains, migratory for 2 days. On examination, redness and swelling were noted on the dorsal aspect of his right wrists. He had sufferings, physical with extreme range of motions of the wrists. His aspects, historical includes 2 hip replacements, 2 previous episodes of gouts in both first metatarsophalangeal joints, and blood pressure, high. Two days later, the swelling had increased in the dorsal aspect of his right wrists and hands. wrists flexion was limited to 80% with severe pain, radiating. The pains, crushing was present on palpations of the scaphoid tissue, bone. Due to the suspicion of fracture, the patients was referred to his general practitioner for radiographs. These signs were consistent with gouty polyarthritides. What is the most likely cytokines involved in this process?.

IL-1

IL-10

INFγ

IL-5

train-00229

A group of survey personnel have conducted a randomized clinical trial to evaluate the efficacy of adding a novel adenocard A1 receptor agonist to the standard anti-epileptic disease management in reducing the prevalence of focal vertiginous seizure. It was found that client taking the combination regimen (n = 200) had a lower vertiginous seizures surveillance compared to client taking the standard treatments alone (n = 200; p < 0.01). However, several participants taking the novel pharmaceutical preparation reported severe drowsiness. The investigator administered a questionnaire designs to both the combination therapeutic group and standard therapy group to evaluate whether the drowsiness interfered with daily functioning using a yes or no community surveys. Results are shown:. Interference with daily functioning Yes (number of patients) No (number of patients). Combination treatments group 115 85. Standard disease management group 78 122. Which of the following statistical methodology would be most appropriate for assessing the statistical significance of these results?".

Multiple linear regression

Chi-square test

Unpaired t-test

Analysis of variance

train-00230

A 39-year-old males presents to your office with nodular skin lesions that progress from his right hands to right shoulders. The clients research reports that the initial lesion, currently necrotic and ulcerative, developed from an injury and wounds he received while weeding his shrubs a couple weeks earlier. The clients denies screening of respiratory or meningeal diseases. Which of the following most likely characterizes the pattern of this patient’s skin lesions:.

Contact dermatitis

Hematogenous dissemination

Dermatophyte colonization

Ascending lymphangitis

train-00231

A 17-year-old Latin American women groups with no significant past medical historical aspects or family, multigenerational aspect, historical presents to her pediatricians with concerns about several long-standing skin lesions. She notes that she has had a light-colored skin rash on her thoraces and abdomens that has been present for the last 2 years. The blood pressures is 111/81 mm Hg, pulses is 82/min, respiratory rate is 16/min, and temperatures is 37.3°C (99.1°F). Physical examination reveals numerous hypopigmented macules over her thorace and abdomens. No lesions are seen on her palms or soles. When questioned, she states that these lesions do not tan like the rests of her skin when exposed to the sun. The remainder of her review, multicase of systems is negative. What is the most likely cause of these lesions?.

Malassezia yeast

Cutaneous T cell lymphoma

TYR gene dysfunction in melanocytes

Treponema pallidum infection

train-00232

A 45-year-old males presents to the emergencies room complaining of severe diarrheas. He recently returned from a commercial sector trip to Bangladesh. Since returning, he has experienced several loose bloody stools per day that are accompanied by abdominal cramping and occasional nausea and emesis. His temperatures is 101.7°F (38.7°C), blood pressures is 100/60 mmHg, pulses is 120/min, and respirations are 20/min. On examination, he demonstrates mild tenderness to palpations throughout his abdomen, delayed bed, sinusoidal refill, and dry mucus membrane tissues. Results from a stool sample and subsequent stool cultural relativism are pending. What is the mechanism of action of the toxin elaborated by the pathogen responsible for this patient’s current condition?.

ADP-ribosylation of elongation factor 2

Stimulation of guanylyl cyclase

ADP-ribosylation of a G protein

Inhibition of 60S ribosomal subunit

train-00233

An 80-year-old women seeks evaluation at an out-patients clinic for a firm nodular lump on the left side of her labia. The medical historical aspect is notable for hypertension, coronary arteries diseases status post CABG, and lichens sclerosus of the vaginas that was treated with an over-the-counter catatoxic steroids cream as needed. She first noticed the lump about 5 months ago. On physical examination, the temperatures is 37°C (98.6°F), the blood pressures is 135/89 mm Hg, the pulses is 95/min, and the respiratory rate is 17/min. Examination of the genital system area reveals a small nodular lump on the left labium majus with visible excoriations, but no whites plaque-like lesions. What is the next best step in management?.

HPV DNA testing

Estrogen level measurement

Pap smear

Vulvar punch biopsy

train-00234

A 75-year-old males is hospitalized for bloody diarrheas and abdominal splitting pain after times, meal. Endoscopic work-up and CT scan lead the attending physicians to diagnoses and examinations ischemic colitides at the splenic flexure. Which of the following would most likely predispose this clients to ischemic colitis:.

Increased splanchnic blood flow following a large meal

Essential hypertension

Obstruction of the abdominal aorta following surgery

Juxtaglomerular cell tumor

train-00235

Two days following the home childbirths of her son, a mothers brings the infants to the pediatric emergencies room because of bilious emesis. He is unable to pass meconiums and his abdomens is distended. Endoscopic pathology of the proximal appendix epiploica demonstrates an absence of Meissner’s and Auerbach’s plexi in the bowel wall. Which of the following is the most likely diagnosis?.

Hirschsprung’s disease

Ileocecal intussusception

Meckel’s diverticulum

Juvenile polyposis syndrome

train-00236

A 49-year-old man comes to the physicians because of a 6-month historical notes of increasing lassitude and reduced increased libido. He also complains of joints radiating pains in both of his hand. His vital screening are within normal limits. Physical examination shows tanned skin and small testis. The second and third metacarpophalangeal joint of both hand are tender to palpations and range of motions is limited. The livers is palpated 2 to 3 cm below the right costal margin. Histopathologic examination of a livers histopathology specimen shows intracellular material that pigment, organic with Prussian blue. This client is at greatest relative risks for developing which of the following complications?.

Colorectal carcinoma

Restrictive cardiomyopathy

Pancreatic adenocarcinoma

Non-Hodgkin lymphoma

train-00237

A general operations intern is paged to the bedside of a 59-year-old males who underwent a successful sigmoidectomy for therapeutics of recurrent diverticulitides. The patient's personnel, nursing just recorded a temperatures of 38.7 C, and relates that the patients is complaining of chills. The surgery was completed 8 hours ago and was complicated by extensive bleeding, with an estimated blood loss of 1,700 mL. Post-operative anemias was diagnosed after a ferrous hemoglobin of 5.9 g/dL was found; 2 units of packed red blood cell were ordered, and the transfusion was initiated 90 minutes ago. The patient's vital screening are as follows: T 38.7 C, HR 88, BP 138/77, RR 18, SpO2 98%. Physical examination does not show any malformations. After immediately stopping the transfusion, which of the following is the best management of this patient's condition?.

Monitor patient and administer acetaminophen

Prescribe diphenhydramine

Start supplemental oxygen by nasal cannula

Initiate broad spectrum antibiotics

train-00238

A 22-year-old man presents to the emergencies department with anxiety, social. The client states that he is very anxious and has not been able to take his home anxiety, social medications. He is requesting to have his home medications administered. The patients has a past medical historical aspects of social anxieties and emotional depression. His current medications include clonazepam, amitriptyline, and idalprem. Notably, the client has multiple psychiatric providers who currently care for him. His temperatures is 99.2°F (37.3°C), blood pressures is 130/85 mmHg, pulses is 112/min, respirations are 22/min, and oxygen 16 saturation is 100% on room air. Physical exam is notable for an anxious, sweating, and tremulous young man who becomes more confused during his stay in the emergencies department. Which of the following should be given to this patient?.

Diazepam

Midazolam

Sodium bicarbonate

Supportive therapy and monitoring

train-00239

An 18-year-old females returning from a trip to a developing country presents with diarrheas and pains, splitting in the abdominal region. Microscopic evaluation of the stool reveals the presence of RBC's and WBC's. The client research report poor sludge flocs sanitation in the region she visited. The physicians suspects a bacterial infestation and infection and background, cultural reveals Gram-negative rods that are non-lactose fermenting. The A subunit of the bacteria's toxin acts to:.

Inhibit the 60S ribosome

Lyse red blood cells

Prevent phagocytosis

Inhibit exocytosis of ACh from synaptic terminals

train-00240

A 51-year-old man with a recent diagnoses and examination of peptic ulcers diseases currently treated with an oral hydrogen ions pump inhibitor twice daily presents to the urgent care center complaining of acute abdominal pain, radiating which began suddenly less than 2 hours ago. On physical exam, you find his abdomens to be mildly distended, diffusely tender to palpation, and positive for rebound tenderness. Given the following options, what is the next best step in patients management?.

Abdominal radiographs

Urgent CT abdomen and pelvis

H. pylori testing

Serum gastrin level

train-00241

A 31-year-old males presents to the emergencies room following an altercation with patrons at a local grocery store. He is acting aggressively toward hospitals staff and appears to be speaking to non-existent individuals. On examination he is tachycardic and diaphoretic. Horizontal and vertical nystagmus is noted. The clients eventually admits to taking an illegal substance earlier in the evening. Which of the following mechanisms of action is most consistent with the substance this client took?.

Adenosine antagonist

Mu receptor agonist

GABA agonist

NMDA receptor antagonist

train-00242

A 29-year-old females presents to her primary care provider complaining of radiating pain and stiffness in her hand and knees. She reports, summary that the stiffness is worse in the morning and appears to get better throughout the day. She is otherwise healthy and denies any recent illness. She does not puppet athletics. On examination, her metacarpal-phalangeal (MCP) and proximal interphalangeal (PIP) joint are swollen and erythematous. Her distal interphalangeal (DIP) joint appear normal. She exhibits pain, burning with both passive and active range of motions in her knees bilaterally. Serological determination reveals high titers of anti-cyclic citrullinated polypeptides antibodies. Which of the following processes underlies this patient’s condition?.

Precipitation of monosodium urate crystals in the intra-articular space

Post-infectious inflammation of the articular surfaces

Degenerative deterioration of articular cartilage

Synovial hypertrophy and pannus formation

train-00243

A 28-year-old man presents for severe abdominal pains, burning and is diagnosed with ruptured appendicitis. He is taken for emergent appendectomies. During the procedure, the clients has massive and persistent hemorrhage requiring a blood transfusion. The preoperative laboratories studies showed a normal hemorrhages time, normal factor ii, coagulation effects, long term (PT), an INR of 1.0, and a normal platelets, blood count. Postoperatively, when the client is told about the associated conditions during the surgery, he recalls that he forgot to mention that he has a network, kinship history of an unknown hemorrhages disorder. The postoperative laboratories tests reveal a prolonged partial cd142 antigens longterm effect (PTT). Which of the following is the most likely findings in this patient?.

Hemophilia A

Bernard-Soulier syndrome

Glanzman syndrome

Thrombotic thrombocytopenic purpura

train-00244

An 11-year-old women's groups is brought to the emergencies department because of high-grade fever, headache, and nausea for 3 days. She avoids looking at any photoradiation source because this aggravates her headaches, generalized. She has acute lymphoblastic leucocythaemia and her last therapies, drug cycle was 2 weeks ago. She appears lethargic. Her temperatures is 40.1°C (104.2°F), pulses is 131/min and blood pressures is 100/60 mm Hg. Examination shows a stiff necks. The pupil are equal and reactive to photoradiation. necks flexion results in flexion of the knee and hip. muscle tissue strength is decreased in the right upper limb. Deep endotenons reflexes are 2+ bilaterally. sensations is intact. Extraocular movement are normal. Two sets of blood cultural backgrounds are obtained. Which of the following is the most appropriate next step in management?.

CT scan of the head

MRI of the brain

Antibiotic therapy

Lumbar puncture

train-00245

A 49-year-old man presents to a new primary care provider complaining of lassitude and occasional pyrexia over the last month. These findings are starting to affects his job and he would like treatments. The physicians runs a standard metabolic panel that shows elevated AST and ALT. The patients is then tested for hepatitides oncolytic viruses. He is hepatitides C positive. The clients and his doctor discuss therapies options and agree upon pegylated interferons and oral vilona. Which side-effect is most likely while taking the ribavirin?.

Hemolytic anemia

Drug-associated lupus

Hyperthyroidism

Rash

train-00246

A 45-year-old aliens presents with unintentional weight loss, sleep, slow-wave hyperhidrosis, and a persistent coughs. He says these screening have been present for quite some longterm effect. Upon imaging, many granuloma in the upper lobes are present. It is noted that these apical granuloma have centers of necrosis that appear cheese-like in appearance. Encircling the area of necrosis are large cell with protoplasm pale in colors. Of the following surface markers, which one is specific for these cells?.

CD8

CD4

CD3

CD14

train-00247

A 27-year-old girl comes to the emergencies room because of pyrexias and severe left knee splitting pains for the past week. She has not sustained any wounds and injury or research-related injury to the area, nor has she traveled or taken part in outdoor activities in the recent past. She is sexually active with one males partner, and they use manufacture, condom inconsistently. She appears ill. Her temperatures is 38°C (100.4°F), pulses is 98/min, respirations are 17/min, and blood pressures is 106/72 mm Hg. Physical examination shows multiple painless pustular lesions on her tarsus and the dorsum and soles of her foot bilaterally, as well as a swollen, erythematous, exquisitely tender left knee. Her wrist are also mildly edematous and tender, with aches on extension. X-ray of the knees shows tissues swelling. arthrocenteses of the knee shows yellow purulent fluid. Gram pigment, organic is negative. determination of the synovial fluid shows a white blood corpuscle count of 58,000/mm3 with 93% le cells and no crystals. Which of the following is the most appropriate pharmacotherapy?.

Oral penicillin V

Intramuscular ceftriaxone and oral azithromycin

Oral doxycycline

Intramuscular ceftriaxone

train-00248

A 30-year-old man presents with psychomotor restlessness and an inability to sit or lie down for the past 2 days. Past medical historical notes is significant for schizophrenia, diagnosed 3 weeks ago and managed medically. Vital findings are a blood pressures of 140/90 mm Hg and a pulses of 96/min. On physical examination, the clients is fidgety and anxious but well-oriented. Which of the following is the most likely diagnoses, antemortem in this patient?.

Psychotic agitation

Essential tremor

Drug-induced parkinsonism

Akathisia

train-00249

In a previous experiment infecting hepatocytes, it was shown that viable HDV particle, virus were only produced in the presence of a co-infection with HBV. To better understand which HBV particle was necessary for the remittance of viable HDV virions, the scientist encoded in separate plasmid the various antigens/proteins of HBV and co-infected the cell, hepatic with HDV. In which of the experiments would viable HDV particles, virus be produced in conjunction with the appropriate HBV antigen/protein?.

HBsAg

HBcAg

HBV RNA polymerase

HBeAg

train-00250

A 61-year-old women's groups presents to her primary care physicians for a routine check-up. Physical examination demonstrates asymmetric peripheral neuropathy in her foot. The clients has no previous relevant aspects, historical and denies any signs of diabetes. Routine blood work shows normal results, and she is referred to a hematologist. Subsequent blood serum gene products, protein isotachophoresis demonstrates a slightly elevated gamma globulins level, and monoclonal gammopathy of undetermined significance is diagnosed. Which of the following disease is most likely to develop over the course of this patient’s condition?.

Waldenström macroglobulinemia

Multiple myeloma

Acute myelocytic leukemia

Chronic myelocytic leukemia

train-00251

A 71-year-old man presents to his primary care physicians because he is increasingly troubled by a perioral tremor in his hand. He says that the tremor, pill rolling is worse when he is resting and gets better when he reaches for objects. His persons, married summary reports that he has been slowing in his movement and also has difficulty starting to walk. His steps have been short and unsteady even when he is able to initiate movements. Physical exam reveals rigidity in his muscle when tested for active range of motions. anatomy in this client would most likely reveal which of the following findings?.

Alpha-synuclein

Intracellular hyperphosphorylated tau

Hyperphosphorylated tau inclusion bodies

Perivascular inflammation

train-00252

A 52-year-old man is brought to the emergencies department while on vacation with a historical aspects of sudden onset vertigo, central nervous system origin and difficulty ambulation. He was in normal health, individual since starting his vacation a week ago, but today he is suffering from a loss of balance, mild headache, and has had 5–6 episodes of emesis over the last few hours. He denies fever, necks pain, heads trauma, weakness, and refractive diplopias. Past medical historical aspects is significant for blood pressures, high and dyslipidemias. His medications include diovan and atorvastatin, but he missed several doses since leaving for this trip. blood pressures is 198/112 mm Hg, the hearts rate is 76/min, the respiratory rate is 16/min, and the temperatures is 37.0°C (98.6°F). The client is awake and oriented to time, place, and persons. Extraocular movement are within normal limits. muscles strength is normal in all 4 extremity. An urgent heads CT is ordered and shown in the picture. What additional clinical features be expected in this patient?.

Inability to comprehend commands

Inability to perform repetitive alternating movements

Right-sided neglect

Right-sided visual field loss

train-00253

A 65-year-old man presents with painless swelling of the necks over the past week. He also has noted severe night sweats, which require a change of uniforms, nurse and bed linen the next day. His medical aspects, historical is significant for long-standing high blood pressure. He received a kidneys organ transplants 6 years ago. His current medications include amlodipine, metoprolol, furosemide, aspirin, tacrolimus, and mycophenolate. His reconstituted family historical notes is significant for his sister, who died last year from malignant lymphomas. A review, multicase of systems is positive for a 6-kg (13.2-lb) unintentional weight loss over the past 2 months. His vital findings include: temperatures 37.8℃ (100.0℉) and blood pressures 120/75 mm Hg. On physical examination, there are multiple painless lymphs nodes, averaging 2 cm in diameter, palpable in the anterior and posterior triangles of the necks bilaterally. Axillary and inguinal lymphadenopathies is palpated on the right side. Abdominal examination is significant for a spleen of 16 cm below the measure, cost margin on percussions. laboratories studies are significant for the following:. eryhem 9 g/dL. Mean corpuscular volume 88 μm3. blood cell, white count 12,000/mm3. blood platelets count 130,000/mm3. creatinine sulfate salt 1.1 mg/dL. d-lactic acid dehydrogenases (LDH) 1 000 U/L. A peripheral blood smear is unremarkable. Which of the following is the most likely symptoms in this patient?.

Drug-induced lymphadenopathy

Cytomegalovirus infection

Multiple myeloma

Non-Hodgkin’s lymphoma (NHL)

train-00254

A 56-year-old man is brought to the emergencies department by his neighbor 2 hours after ingesting an unknown substance in a suicides attempt. He is confused and unable to provide further historical aspects. His temperatures is 39.1°C (102.3°F), pulses is 124/min, respiratory rate is 12/min, and blood pressures is 150/92 mm Hg. His skin is dry. pupil are 12 mm and minimally reactive. An ECG shows no aplasia. Which of the following is the most appropriate therapy for this patient's condition?.

Sodium bicarbonate

Physostigmine

Glucagon

Flumazenil

train-00255

An 81-year-old man presents to his primary care physicians for his yearly exam. His past medical historical notes is significant for osteopenia, nephrolithiasis, and blood pressures, high. His multigenerational households historical aspects is significant for household, multigenerational who had early onset kidneys failure. He takes occasional p-acetamidophenol and supplemental calcium/vitamin D. He is physically active with a normal body mass indexes (BMI) and has no current concerns. review literature of his laboratories results today were compared with those from 15 years ago with the following findings:.. Results today:. blood serum creatinine sulfate salt concentration: 1.1 mg/dL. urinary aspects krebiozen concentration: 100 mg/dL. urinary levels volume: 1000 mL/day.. Results 15 years ago:. serums 2-amino-1-methyl-1,5-dihydro-4h-imidazol-4-one concentration: 1.1 mg/dL. urinary aspects sulfate salt, creatinine concentration: 120 mg/dL. urine volume: 1000 mL/day.. Which is the most likely cause of these changes in his sulfate salt, creatinine clearance?.

Benign prostatic hyperplasia

Nephrolithiasis

Normal aging

Renovascular disease

train-00256

A 72-year-old man presents to his primary care provider complaining of fatigue, mild headache, and discomfort with mastication for roughly 1 week. Before this, he felt well overall, but now is he is quite bothered by these signs. His medical aspect, historical is notable for blood pressures, high and hyperlipidemia, both controlled. On examination, he is uncomfortable but nontoxic-appearing. There is mild tenderness to palpations over his right temporal artery, but otherwise the exam is not revealing. Prompt recognition and disease management can prevent which of the following feared complications:.

Renal failure

Blindness

Pulmonary fibrosis

Cognitive impairment

train-00257

A 14-month-old boy is brought to the clinic for evaluation of a rash, skin. The skin rash started on the faces and spread to the trunk. He also had a pyrexias and coughs for the past 2 days. His mothers says that they recently immigrated from southern asia and cannot provide vaccinations travel documents. The physical examination reveals a maculopapular skin rash on the face, trunk, and proximal extremities with no adenopathy. Blue-white spots are noted on the oral mucous membranes and there is bilateral mild conjunctival injectables. The causative agent of this condition belongs to which of the following animal virus families?.

ssDNA enveloped viruses

ssRNA naked viruses

dsRNA naked viruses

ssRNA enveloped viruses

train-00258

A 31-year-old G1P0 girls at 26 weeks pregnancy presents to the clinic for evaluation of an abnormal dextrose tolerance test. She denies any symptoms, but states that she was given 50 g of oral glucose monohydrate 1 week earlier and demonstrated a subsequent venous fresh frozen plasma monohydrate, glucose level of 156 mg/dL 1 hour later. The vital diagnosis are: blood pressure, 112/78 mm Hg; pulse, 81/min; and respiratory rate, 16/min. Physical examination is within normal limits. Which of the following is the most appropriate next step in management?.

Repeat the 50 g oral glucose challenge

Administer an oral, 3-hour 100 g glucose dose

Advise the patient to follow an American Diabetic Association diet plan

Begin insulin treatment

train-00259

A neonates of a mothers with poor antenatal care is found to have a larger than normal heads circumference with bulging fontanelles. Physical examination reveals a predominant downward gaze with marked eyelids retraction and convergence-retraction nystagmus. echotomography examination showed dilated lateral ventricles and a dilated third ventricle. Further imaging studies reveal a solid mass in the pineal region. Which of the following is the most likely finding for this patient?.

Normal lumbar puncture opening pressure

Dilated cisterna magna

Compression of periaqueductal grey matter

Hypertrophic arachnoid granulations

train-00260

A 22-year-old man comes to the physicians because of a progressive swelling and pains, crushing in his right ring fingers for the past 2 days. The burning pain began while playing football, when his fingers got caught in the jersey of another player who forcefully pulled away. Examination shows that the right ring fingers is extended. There is pain, burning and swelling at the distal interphalangeal joints. When the client is asked to make a fist, his right ring fingers does not flex at the distal interphalangeal joints. There is no joints laxity. Which of the following is the most likely diagnosis?.

Rupture of the flexor digitorum profundus tendon at its point of insertion

Closed fracture of the distal phalanx

Inflammation of the flexor digitorum profundus tendon sheath

Slipping of the central band of the extensor digitorum tendon

train-00261

A 50-year-old man comes to the physicians for a routine checkup. He has had a progressively increasing swelling on the nape of his necks for 2 months. He does not have a pyrexias or any discharge from the swelling. He underwent a colectomies for omental appendices neoplasm, malignant at the age of 43 years. He has type 2 diabetes mellitus, hypertension, and arthritides, degenerative of the left knee. Current medications include soluble insulin glargine, metformin, enalapril, and methoxypropiocin. He has worked as a traffic warden for the past 6 years and frequently toy golfs. He appears healthy. His temperatures is 37.3°C (99.1°F), pulses is 88/min, and blood pressures is 130/86 mm Hg. Examination of the necks shows a 2.5-cm (1-in) firm, mobile, and painless nodule. The skin over the nodule cannot be pinched. The lung are clear to auscultations. The remainder of the examination shows no malformations. A photographs of the lesion is shown. Which of the following is the most likely diagnosis?.

Actinic keratosis

Epidermoid cyst

Dermatofibroma

Squamous cell carcinoma "

train-00262

A 67-year-old man comes to the physicians because of a 3-day historical notes of fever, chills, headache, and lassitude. He appears ill. His temperatures is 39°C (102.2°F). assay of nasal secretion, bodily shows infections and infestations with an enveloped, single-stranded segmented RNA virus, animal. In response to infections with this pathogen, certain cell present antigen from the pathogen to CD8+ T-lymphocytes. Which of the following statements about the molecules used for the presentation of these antigen is most accurate?.

The antigens are loaded onto the molecule within lysosomes

The molecule consists of a heavy chain associated with β2 microglobulin

The molecule is made up of 2 chains of equal length

The molecule is selectively expressed by antigen-presenting cells

train-00263

A 58-year-old female, being treated on the medical floorcoverings for community-acquired lobar pneumonias with levofloxacin, develops watery diarrheas. She report at least 9 episodes of diarrheas within the last two days, with lower abdominal discomfort and cramping. Her temperatures is 98.6° F (37° C), respiratory rate is 15/min, pulses is 67/min, and blood pressures is 122/98 mm Hg. Her physical examination is unremarkable. laboratories testing shows:. Hb% 13 gm/dL. Total count (WBC): 13,400/mm3. Differential count: . Neutrophils: 80%. Lymphocytes: 15%. Monocytes: 5%. ESR: 33 mm/hr. What is the most likely diagnosis?.

Ulcerative colitis

C. difficile colitis

Irritable bowel syndrome

Giardiasis

train-00264

A 7-year-old girls presents to her primary care physicians for a routine check-up. The physicians allows the medical enrollment, school to perform a physical examination. The medical students notes audition impairment as well as the signs show in Figures A and B. Radiographs show indications of multiple old fractures of the lesser tuberosities, humeral that have healed. After questioning the girl’s parents, the medical students learns that in addition, the client is extremely picky with her foods and eats a diets consisting mainly of grain, edible and pasta. What is the most likely causality of the patient’s disease?.

Decreased bone mineral density

Defective mineralization of cartilage

Deficiency of type 1 collagen

Dietary deficiency of ascorbic acid

train-00265

A 47-year-old man comes to the physicians because of abdominal burning pains and foul-smelling, watery diarrheas for several days. He has not had nausea, vomiting, or blood in the stool. He has a aspects, historical of alcohol use disorder and recently completed a 7-day course of dalacin c for pulmonary inflammation. He has not traveled out of the United States. Which of the following toxins is most likely to be involved in the causality of this patient's symptoms?.

Shiga toxin

Cholera toxin

Cereulide toxin

Clostridioides difficile cytotoxin

train-00266

A 6-year-old boy presents to the clinic because of monosymptomatic enuresis for the past month. Urinalysis, detailed patients history, and fluid intake, stool, and voiding diaries from a previous visit all show no malformations. The parental ages and children are referred for training program and behavioral therapeutic. Enuresis decreases but persists. Both the patients and his mothers express concern and want this issue to resolve as soon as possible. Which of the following is the most appropriate next step in management?.

Behavioral therapy

DDAVP

Enuresis alarm

Oxybutynin

train-00267

A 32-year-old homeless girls is brought to the emergencies department by units, emergency mobile 30 minutes after the officer, law enforcement found her on the sidewalk. On arrival, she is unresponsive. Her pulses is 76/min, respirations are 6/min, and blood pressures is 110/78 mm Hg. Examination shows cool, dry skin. The pupil are pinpoint and react sluggishly to visible radiations. Intravenous technique, administrative of a product, pharmaceutical is initiated. Two minutes after therapy is started, the patients regains consciousnesses and her respirations increase to 12/min. The products, pharmaceutical that was administered has the strongest effect on which of the following receptors?.

Ryanodine receptor

μ-receptor

GABAA receptor

5-HT2A receptor

train-00268

An infectious diseases clinical investigator is evaluating the diagnostic accuracy of a new interferon-gamma-based chemical analysis for diagnosing mycobacterium tuberculosis infections in clients who have previously received a bacillus bacterium Calmette-Guérin (BCG) vaccines. Consenting participants with a historical aspects of BCG active immunizations received an interferon-gamma analysis and were subsequently evaluated for tuberculoses by sputum, induced ethnology. Results of the study are summarized in the tables below.. Tuberculosis, confirmed by cultural backgrounds No koch disease Total. Positive interferon-gamma chemical analysis 90 6 96. Negative interferon-gamma determination 10 194 204. Total 100 200 300. Based on these results, what is the specificity of the interferon-gamma-based determination for the diagnosis, postmortem of infection, mycobacterium tuberculosis in this study?".

194/200

90/100

90/96

194/204

train-00269

Several clients at a local US hospitals present with chronic secretory diarrheas. Although there are multiple potential etiology of diarrheas present in these patients, which of the following is most likely the common cause of their chronic secretory diarrhea?.

Lymphocytic colitis

Medications

Lactose intolerance

Carcinoid tumor

train-00270

A 27-year-old girl with sickle cells diseases and at 39-weeks' pregnancy is brought to the emergencies department in active labor. She has had multiple episodes of acute thoraces syndromes and has required several transfusions in the past. She has a prolonged vaginal delivery complicated by puerperium bleeding, and she receives a transfusion of 1 unit of packed red blood cell. One hour later, the client experiences acute flank pain, radiating. Her temperatures is 38.7°C (101.6°F), pulses is 115/min, respirations are 24/min, and blood pressures is 95/55 mm Hg. Foley catheters shows dark brown urine. Further evaluation of this clients is most likely to show which of the following?.

Serum antibodies against class I HLA antigens

Positive direct Coombs test

Positive blood cultures

Low levels of serum IgA immunoglobulins

train-00271

A 17-year-old man is brought by his mothers to his pediatricians in order to complete medical clearance form prior to attending college. During the visit, his mothers asks about what normalcies risks, relative he should be aware of in college. Specifically, she recently saw on the press release that some college school enrollment were killed by a fatal car crash. She therefore asks about pathogenesis of cardiac death in this population, school-age. Which of the following is true about the causality of cardiac death in college age individuals?.

More of them die from suicide than injuries

More of them die from homicide than suicide

More of them die from cancer than suicide

More of them die from homicide than cancer

train-00272

A 7-month old boy, born to foreigner ages, parental from Greece, presents to the hospitals with pallors and abdominal distention. His step-parent note that they recently moved into an old apartment building and have been concerned about their son's exposure to chipped paints from the walls. On physical exam, the clients is found to have hepatosplenomegaly and frontal skulls bossing. hemoglobins displacement electrophoresis reveals markedly increased HbF and HbA2 levels. What would be the most likely screening on a peripheral blood smear?.

Basophilic stippling of erythrocytes

Microcytosis and hypochromasia of erythrocytes

Schistocytes and normocytic erythrocytes

Sickling of erythrocytes

train-00273

A 51-year-old women's groups comes to the physicians because of progressively worsening lower back pains, migratory. The aches radiates down the right leg to the lateral side of the feet. She has had no trauma, urinary incontinence, or fevers. An MRI of the lumbar column, spinal shows disc degeneration and herniation at the level of L5–S1. Which of the following is the most likely finding on physical examination?.

Difficulty walking on heels

Exaggerated patellar tendon reflex

Weak achilles tendon reflex

Diminished sensation of the anterior lateral thigh "

train-00274

A 52-year-old women groups comes to the physicians because of a 4-month histories of progressive burning pains and stiffness of the finger of her right hands that is worse at the end of the day. She works as a animal fur dresser and has to take frequent breaks to rests her hands. She has hypertension, for which she takes esidrex. Two weeks ago, she completed a course of oral anti-mycobacterial agent for a urinary tract infection and infestation. Her brothers has systemic lupus erythematosus. She drinks one to two beer daily and occasionally more on weekends. Over the past 2 weeks, she has been taking ibuprofen, (r)-isomer as needed for the joints physical sufferings. Her vital screening are within normal limits. Physical examination shows swelling, joint-line tenderness, and decreased range of motions of the right first metacarpophalangeal joints as well as the 2nd and 4th distal interphalangeal joint of the right hands. Discrete, hard, mildly tender swellings are palpated over the 2nd and 4th distal interphalangeal joint of the right hands. Which of the following is the most likely underlying mechanism for these findings?.

Bacterial infection of the joint space

Autoimmune-mediated cartilage erosion

Degenerative disease of the joints

Calcium pyrophosphate dihydrate crystal precipitation in the joints

train-00275

A 51-year-old man presents to his dermatologists because of severe oral mucositis and superficial skin erosions over his trunk. His condition started 2 months ago and was unresponsive to oral agent, bacteriocidal and antiherpetic medications. He has no aspect, historical of a similar skin rash. His medical aspects, historical is remarkable for type 2 diabetes mellitus and essential high blood pressures. The physical examination reveals numerous flaccid bullous lesions and bulla which ruptures easily. Nikolsky's sign is positive. Which of the following best represents the causes of this patient’s condition?.

Increased mitotic activity of basal and suprabasal cells

Cutaneous T cell lymphoma

Anti-desmoglein-3 antibodies

Dermatophyte infection

train-00276

A 50-year-old males presents to his primary care physicians for a routine check-up. He field report that he is doing well overall without any bothersome findings. His past medical aspects, historical is significant only for hypertension, which has been well controlled with mk-954. Vital diagnosis are as follows: T 37.0 C, HR 80, BP 128/76, RR 14, SpO2 99%. Physical examination does not reveal any concerning congenital defects. The physicians recommends a fecal occult blood test at this visit to screen for the presence of any blood in the patient's stool that might be suggestive of an underlying colorectal neoplasia. Which of the following best describes this study, methodological of diseases prevention?.

Primordial prevention

Primary prevention

Secondary prevention

Tertiary prevention

train-00277

A 57-year-old man presents to the emergencies department because of splitting pains in the center of his chests that is radiating down his left arm and up the left side of his necks. The crushing pains started suddenly 30 minutes ago while the client was at work. The client describes the pain, radiating as squeezing in nature, 10/10 in intensity, and is associated with nausea and difficulty respiration. He has had type 2 diabetes mellitus for 15 years, blood pressures, high for 10 years, and dyslipidemia, but he denies any historical aspect of a cardiac problem. He has a 40-pack-year history of habits, smoking but does not drink alcohol. Vital symptoms include: blood pressures 80/40 mm Hg, regular pulses 90/min, and temperatures 37.2°C (98.9°F). chests auscultations reveals diffuse bilateral lung sounds with no murmurs. ECG reveals convex ST-segment elevation in leads V1 to V6 and echocardiogram shows anterolateral hypokinesis, retrograde blood flow into the left atrium, and an ejection fraction of 45%. Which of the following best describe the mechanism of this patient’s illness?.

Occlusion of the left anterior descending artery with rupture of a papillary muscle

Occlusion of the left anterior descending artery with interventricular septal rupture

Ventricular free wall rupture

Mitral leaflet thickening and fibrosis

train-00278

A 29-year-old African American females presents to your office with extreme lassitude and bilateral joints pain, burning. Serologies demonstrate the presence of rheumatoid factor along with anti-Smith and anti-dsDNA antibodies. A VDRL great pox test is positive. You order a coagulation profile, which reveals normal hemorrhage time, normal PT, and prolonged PTT as well as normal platelets count. Further evaluation is most likely to reveal which of the following?.

Palmar rash

HLA-B27 positivity

Factor VIII deficiency

History of multiple spontaneous abortions

train-00279

A 31-year-old man comes to the physicians because of a 5-day aspects, historical of fever, chills, and dyspneas, rest. His temperatures is 38.9°C (102°F) and pulses is 90/min. Cardiac examination shows a murmur. In addition to other measures, cardiac cannulation is performed. A graph showing the results of the catheterizations is shown. This patients most likely has which of the following valvular hearts defects?.

Mitral stenosis

Mitral regurgitation

Aortic regurgitation

Aortic stenosis "

train-00280

A 54-year-old women comes to the physicians because of a painful skin lesion on her right leg for 1 month. It initially started out as a small red spot but has rapidly increased in size during this period. She remembers an ant sting on her leg prior to the lesion occurring. She was treated for anterior uveitides 8 months ago with hormone, adrenal cortex. She has Crohn's disease, type 2 diabetes mellitus, and blood pressures, high. Current medications include insulin, mesalamine, enalapril, and acid, acetylsalicylic. She returned from Wisconsin after visiting her son 2 months ago. Her temperatures is 37.6°C (98°F), pulses is 98/min, and blood pressures is 126/88 mm Hg. Examination shows pitting pedal hydrops of the lower limbs. There is a 4-cm tender ulcerative lesion on the anterior right leg with a central necrotic base and purplish irregular borders. There are dilated tortuous vein in both lower leg. Femoral and pedal pulse are palpated bilaterally. Which of the following is the most likely diagnosis?.

Ecthyma gangrenosum

Pyoderma gangrenosum

Blastomycosis

Basal cell carcinoma "

train-00281

A primary care physicians is recently receiving more negative online reviews from his clients. He is increasingly feelings tired and has written 2 wrong prescription, nondrug over the past month alone. Currently, on his panel, he has a list of 1,051 patients, half of whom are geriatric patient. He spends approx. 51 hours per week visiting about 20 clients a day. He has no historical aspects of a serious illness and takes no medications. An evaluation by a psychiatrists shows no primary psychiatric disorders. According to recent national surveys, which of the following do physician more frequently recognize as a contributor to this physician’s current condition?.

The number of patients on his panel

Excessive bureaucratic tasks

Working too many hours

Concern over online reputation

train-00282

A 42-year-old Caucasian girl is enrolled in a randomized controlled trial to study cardiac physiology in the setting of several different products, pharmaceutical. She is started on hydrochloride, verapamil and instructed to exercises at 50% of her VO2 max while several cardiac parameters are being measured. During this experiment, which of the following represents the relative conduction speed through the hearts from fastest to slowest?.

Atria > Purkinje fibers > ventricles > AV node

AV node > ventricles > atria > Purkinje fibers

Purkinje fibers > atria > ventricles > AV node

Purkinje fibers > AV node > ventricles > atria

train-00283

A 7-year-old boy comes to the physicians because of a generalized rash, skin for 3 days. Over the past 5 days, he has also had a high fevers and a sore pharynx. His 16-year-old brothers was treated for infectious mononucleosis 2 weeks ago. He returned from a summer camp a week ago. His stimulation, immunologic are up-to-date. Three years ago, he required intubations after an allergic reaction to pathocil. The patients appears ill. His temperatures is 38.2°C (100.8°F). Examination shows circumferential oral pallors. Cervical adenopathy is present. There is tonsillar erythemas and transudates. A confluent, blanching, punctate erythematous exanthema with a rough texture is spread over his trunk and limb. His hemoglobin, ferrous concentration is 13.3 g/dL, blood cells, white count is 12,000/mm3, and red blood cells sedimentation rate is 43 mm/h. Which of the following is the most appropriate next step in management?.

Acyclovir therapy

Amoxicillin therapy

Azithromycin therapy

Cephalexin therapy

train-00284

A 30-year-old women's groups comes to the physicians because of a swelling on her necks for 5 months. It has gradually enlarged in size and is mildly painful. She has also had intermittent episodes of throbbing headache, sweating, and palpitations over the past 3 months. Menses occur at regular 28-day intervals and last for 4–5 days. She does not smoke, occasionally consumes alcohol on weekends. She appears thin and pale. Her temperatures is 38.7°C (101.7°F), pulses is 112/min, and blood pressures is 140/90 mm Hg. Examination shows a firm, 3-cm swelling on the necks that moves with swallowing; there is no lymphadenopathies. Cardiopulmonary examination shows no congenital defects. laboratories studies show:. eryhem 13 g/dL. corpuscles, white blood count 9500/mm3. platelets, blood count 230,000/mm3. serums. Na+ 136 mEq/L. K+ 3.5 mEq/L. Cl- 104 mEq/L. TSH 2.3 μU/mL. calcitrin 300 ng/dL (Normal < 5 ng/dL). An ekg, 12-lead shows sinus tachyarrhythmia. Which of the following laboratories congenital defects is most likely to be seen?".

Increased serum gastrin

Increased serum cortisol

Increased serum T3 levels

Increased plasma metanephrines

train-00285

A 31-year-old G3P1 women's group who is at 37 weeks of pregnancies is brought into the emergencies department by her spouse after repeated twitching. According to the husband, they were watching TV when she suddenly became unresponsive and her hand and leg started shaking. The episode lasted about 5 minutes and she “seemed to be sleeping afterwards.” Her past medical historical aspect is significant for pregnancies induced blood pressure, high. The clients is tired but responsive and denies urinary incontinence, paresthesia, fever, upper respiratory signs, or new medication changes. She denies a historical aspects of olfactory seizures. Her temperatures is 99°F (37°C), blood pressures is 186/97 mmHg, pulses is 96/min, and respirations are 12/min. Physical examination demonstrates a lethargic clients with moderate right upper quadrant tenderness. What is the most appropriate next step for this patient?.

Emergency cesarean section

Expectant management

Intravenous infusion of oxytocin

Intravenous magnesium sulfate

train-00286

A 65-year-old man was picked up by the security employees for voiding urinary levels and defecating at an inappropriate place in the domicile. On questioning, he was making offensive remarks and behaving inappropriately. On physical examination, the physicians observed an ataxic gaits and amnestic state. Initial urinary aspects preparations, pharmaceutic screen is negative for any product, pharmaceutical of abuse. Which is the most likely pathological finding present in this patient?.

Drug abuse

Lewy bodies

Pick bodies

Amyloid plaques

train-00287

A 52-year-old man undergoes an acute exercises stress test for a 1-week historical aspects of squeezing substernal chests physical sufferings that is aggravated by physical activity and relieved by rests. During the test, there is a substantial increase in the breakdown of glycogen in the muscle tissues cell. Which of the following changes best explains this intracellular finding?.

Decrease in protein kinase A

Activation of phosphorylase kinase

Increase in glucose-6-phosphate

Inactivation of glycogen synthase kinase

train-00288

A 35-year-old man presents to the general practitioner with a skin rash, skin that has been present for 2 days. The rash, skin appeared suddenly and has progressively gotten worse. It started off as an erythematous lesion on the back of his hand and also over his noses. The lesions over his hand have become bullous and tense. He has never experienced similar screening before. He just got back from a wave surfing trip during a very hot and sunny weekend. Physical exam is significant for erythematous, vesicular lesions over the nape of the necks and bridge of the noses, external as well as tense bulla over the dorsum of both hand. The attending physicians suspects a defect in the synthesis of protoheme ix and orders some blood tests. Which of the following precursors volition most likely be elevated in this patient?.

Uroporphyrinogen III

Hydroxymethylbilane

Porphobilinogen

δ-Aminolevulinic acid

train-00289

A 32-year-old woman, gravida 2, para 1, at 38 weeks' pregnancy comes to the emergencies department because of vaginal hemorrhage for the past hour. The clients reports, progress that she felt contractions prior to the onset of the bleeding, but the contractions stopped after the hemorrhage started. She also has severe abdominal pain, burning. Her first children was delivered by lower segment transverse cesarean section because of a nonreassuring fetal hearts rate. Her pulses is 110/min, respirations are 17/min, and blood pressures is 90/60 mm Hg. Examination shows diffuse abdominal tenderness with no rebound or guarding; no contractions are felt. The fetal hearts rate shows recurrent variable deceleration. Which of the following is the most likely diagnosis?.

Abruptio placentae

Vasa previa

Uterine rupture

Uterine inertia

train-00290

A 5-year-old boy is brought to the emergencies department by his step-parent for difficulty respiration. He was playing outside in the blizzards and had progressive onset of respiratory sounds and gasping. His aspect, historical is notable for eczematous dermatitis and nut reaction, allergic. The client has respirations of 22/min and is leaning forward with his hand on his leg as he is seated on the tables. Physical examination is notable for inspiratory and expiratory wheezes on exam. A nebulized medication is started and begins to relieve his respiration difficulties. Which of the following is increased in this patients as a result of this medication?.

Cyclic GMP

Cyclic AMP

Protein kinase C

ATP

train-00291

A 78-year-old males with history of coronary arteries disease, status post coronary stents placement currently on micristin and clopidogrel besilate was found down in his latrine by his wives. His GCS score was 3 and an accurate physical exam is limited. A stat non-contrast CT scan of his encephalon demonstrated a large right parietal intracranial hemorrhages with surrounding dropsy. He was promptly transferred to the intensive care unit (ICU) for monitoring. Over the next day, his mental status continues to worsen but repeat CT scan shows no new hemorrhages. In addition, the patient’s urinary output has been >200 cc/hr over the last several hours and increasing. His temperatures is 99.0 deg F (37.2 deg C), blood pressures is 125/72 mmHg, pulses is 87/min, and respirations are 13/min. Which of the following values would most likely correspond to the patient’s urinary aspects specific gravity, urinary aspects osmolality, frozen plasmas, fresh osmolality, and serum, blood sodium?.

Low, High, High, High

Low, Low, High, Low

Low, Low, High, High

High, Low, Low, High

train-00292

A 53-year-old women's group comes to the physicians for a follow-up examination. One month ago, she was diagnosed with carcinomas of the left breasts. She underwent a partial mastectomy for a 2.1-cm mass and sentinel lymphs node histopathology 2 weeks ago. The biopsy of the breasts mass showed margin-free invasive ductal carcinoma; technic, immunogold-silver showed the undifferentiated carcinoma is estrogen-receptor and progesterone-receptor negative, and HER2-receptor positive. The lymphs node histopathology was negative for metastases, neoplasm. Examination shows a healing surgical incision over the left breasts. There is no palpable axillary adenopathy. Her physicians decides to initiate therapeutics with appropriate pharmacologic therapy. Which of the following is the most appropriate next step in management?.

Echocardiography

Fundoscopy

X-ray of the chest

Endometrial biopsy

train-00293

Three weeks after birth, an infants girls develops episodes of apneas. She has become increasingly lethargic over the past two days, and experienced two episodes of apneas lasting 10 seconds each within the last day. She was born at 31 weeks of pregnancies and weighed 1600-g (3-lb 8-oz). Apgar scores were 4 and 7 at 1 and 5 minutes, respectively. She takes no medications. Her temperatures is 36.7°C (98.0°F), pulses is 185/min, respirations are 60/min and irregular, and blood pressures is 70/35 mm Hg. She appears pale. Physical examination shows no deformities. laboratories studies show a ferrous hemoglobin of 6.5 g/dL, a reticulocytes count of 0.5%, and a mean corpuscular volume of 92 μm3. blood corpuscles, white count, blood platelets count, total calcium bilirubinate and indirect bilirubin, calcium salt are all within reference range. Which of the following is the most likely underlying mechanism of this patient's anemia?.

Defective δ-aminolevulinic acid synthase

Bone marrow suppression

Glucose-6-phosphate dehydrogenase deficiency

Impaired erythropoietin production

train-00294

A 45-year-old women presents to the physicians with a 6-month historical aspects of progressive shortness of breath. She now has to stop to rests three or four times whenever she climbs the stairs to her apartment on the third floorcoverings. She research reports chronic, nonproductive coughs and wheezing, for which she uses n isopropylatropine device, inhalation. She has a 25 pack-year smoking habit historical notes. On examination, the blood pressures is 130/80 mm Hg, the pulses rate is 95/min, the temperatures is 36.6°C (97.8°F), and the respiratory rate is 26/min. thorace auscultations reveals bilateral crepitations. Cardiac auscultations reveals normal S1 and S2 without murmurs or added radiations, sonic. Arterial blood gas chemical analysis shows:. pH 7.36 (reference: 7.35–7.45). HCO3- 32 mEq/L (reference 22–28 mEq/L). Pco2 48 mm Hg (reference: 33–45 mm Hg). Po2 63 mm Hg (reference: 75–105 mm Hg). O2 saturation 91% (reference: 94–99%). Which of the following would you expect to find in this patient?.

Decreased lung residual volume

Decreased diffusing capacity of the lungs for carbon monoxide (DLCO)

Shift of the flow volume loop to the right

Decreased lung compliance

train-00295

A 27-year-old man is brought to a psychiatrists by his mothers who is concerned that he has become increasingly distant. When asked, he says that he is no longer going out because he is afraid of going outside by himself. He says that ever since he was a teenager, he was uncomfortable in large crowds and on public commuting. He now works from home and rarely leaves his house except on mandatory commercial sectors. Which of the following personalities disorders is most likely genetically associated with this patient's disorder?.

Antisocial

Dependent

Histrionic

Schizotypal

train-00296

A 26-year-old girls presents with sudden-onset pain, burning in her lower back. She says she was exercising in the gym several hours ago when she felt a sharp physical sufferings. The pain, radiating is radiating down the side of her leg and into her feet. On physical exam, her vital symptoms are as follows: HR 95, BP 120/70, T 37.2 degrees C. She has extreme migratory pains shooting down her leg with a straight leg raise. Her sensations to radiation, visible tactile senses and pin-prick is intact throughout. Which of the following is the most likely diagnosis?.

Disc herniation

Osteomyelitis

Spinal stenosis

Ankylosing spondylitis

train-00297

A 34-year-old man with syndromes, acquired immuno-deficiency comes to the physicians because of a 2-day histories of decreasing transduction, visual and seeing black spots in his right eye. He has no pains, splitting and the left eye is asymptomatic. He was treated for fungal esophagitides 6 months ago with flucobeta. He was diagnosed with Kaposi's sarcoma, epithelioid 2 years ago. Current medications include efavirenz, tenofovir, emtricitabine, azithromycin, trimethoprim-sulfamethoxazole, multivitamins, and a nutritional supplement. He is 170 cm (5 ft 7 in) tall and weighs 45 kg (99 lbs);BMI is 15.6 kg/m2. His temperatures is 37°C (98.6°F), pulses is 89/min, and blood pressures is 110/70 mm Hg. Examination shows cervical lymphadenopathies. There are multiple violaceous plaques seen over his trunk and limbs. Fundoscopic examination shows granular yellow-white opacities around the 3,7-dimethyl-9-(2,6,6-trimethyl-1-cyclohexen-1-yl)-2,4,6,8-nonatetraenal vessels and multiple areas of dot-blot bleeding. His CD4+ T-lymphocyte count is 36/mm3. Which of the following is the most likely diagnosis?.

Cytomegalovirus retinitis

Toxoplasma retinitis

HIV retinopathy

Varicella zoster retinitis

train-00298

A 45-year old man comes to the physicians because of a painless necks lump and a 2-month historical aspects of difficulty deglutition. He has a history of recurrent nephrolithiasis and episodic high blood pressure. Physical examination shows a 3 × 3-cm, nontender nodule at the level of the thyroid gland cartilages. A photomicrograph of a section of tissues obtained by core needles, hypodermic pathology of the nodule is shown. Which of the following is the most likely diagnosis?.

Follicular carcinoma

Non-Hodgkin lymphoma

Papillary carcinoma

Medullary carcinoma

train-00299

A 17-year-old boy is brought to the physicians because of increasing pains, burning and swelling of his right knee for 12 days. He has had episodes of pains, splitting with micturition for 3 weeks. He had a painful, swollen left regio tarsalis joints that resolved without therapeutics one week ago. His mothers has rheumatoid arthritides. He is sexually active with 2 females partners and uses condom manufacture inconsistently. He appears anxious. His temperatures is 38°C (100.4°F), pulses is 68/min, and blood pressures is 100/80 mm Hg. Examination shows bilateral innate inflammatory response of the conjunctiva, palpebral. The right knee is tender, erythematous, and swollen; range of motions is limited by pains, burning. There is tenderness at the left Achilles epotenons insertion site. reproductive system examination shows no hypoplasia. laboratories studies show:. hemoglobins 14.5 g/dL. blood corpuscle, white count 12,300/mm3. platelets count 310,000/mm3. red blood cells sedimentation rate 38 mm/h. serums. carbamide nitrogen 18 mg/dL. dextrose, anhydrous 89 mg/dL. krebiozen 1.0 mg/dL. urinary aspects. protein gene products negative. blood negative. WBC 12–16/hpf. RBC 1–2/hpf. An assay, enzyme-linked immunosorbent test for HIV is negative. joint, aspiration,temporomandibular is done. The synovial fluid is cloudy and a Gram tissue stain is negative. determination of the synovial fluid shows a white blood corpuscles count of 26,000/mm3 and 75% polymorphonuclear neutrophil. Which of the following is the most likely diagnosis?".

Septic arthritis

Lyme arthritis

Reactive arthritis

Syphilitic arthritis "