Property:Prompt
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A 24 year old male comes to your office for regular health check up as he is joining a new job. He has no symptoms and his past history is insignificant. His family history is positive for hypertension in both his parents. He is sexually active and uses contraception. His vitals are temperature: 36.7 C, blood pressure: 120/80 mmHg, pulse: 90/min and respirations: 15/min. All system examinations are normal. His laboratory values are as follows :
Blood glucose : 98 g/dl
Hb : 13 g/dl
RBC’s : 2.5 million/cmm
WBC’s : 6000/cmm
Platelets : 35,000/cmm
Neutrophils : 60 %
Lymphocytes : 32 %
MCV : 85 fl
ESR : 15mm/hr
PT : 13 sec (N 11-15 sec)
APTT : 30 sec (N 25-40 sec)
BT : 9 min (N 2-7 min)
Serum creatinine : 1.2 mg/dl
Serum calcium : 9 g/dl
Which of the following is the best next step in the management of this patient? +
A 66 year old female presents to the office with a 1 month history of fatigue and weakness. On further review of history, she says she has been feeling very weak even to do minor household work. She denies any change in appetite or weight. She attained menopause at the age of 54 and is not taking any estrogen pills. Her past history is significant for carcinoma breast and is on chemotherapy for the past 1 year. Her family history is unremarkable. She does not smoke and drink. Her vitals are temperature: 36.7 C, blood pressure: 120/80 mmHg, pulse: 102/min and respiration: 16/min. All system examinations are normal except pallor. Her laboratory values are :
Hb : 7 g/dl
RBC’s : 2 million/cmm
WBC’s : 6000/cmm
Platelets : 300,000/ cmm
Segmented neutrophils : 68 %
Bands : 2 %
Eosinophils : 2 %
Lymphocytes : 32 %
Monocytes : 6 %
MCHC : 34 %
MCV : 115 fl
Which of the following is the most appropriate treatment in this patient ? +
A 50 year old woman comes to the emergency department with complaints of shortness of breath. She has these symptoms for the past one day. Her past history is significant for chronic bronchitis and COPD. She has smoked one pack of cigarette for the past 10 years. She denies alcohol use and use of recreational drugs. She attained menopause at the age of 48 and not on any medications. Her vitals are temperature: 36.7 C, blood pressure: 140/80 mmHg, pulse: 80/min and respirations: 15/min. The patients pulse oximetry shows 96 % on 4-litres of oxygen. Respiratory examination reveals coarse wheeze all over the chest. All other system examinations are normal. Her laboratory values comes as :
Hb : 23 g/dl
RBC’s : 6.5 million/cmm
WBC’s : 6000/cmm
Platelet’s : 300,000/cmm
Neutrophils : 58%
Eosinophils : 2%
Lymphocytes : 33%
Monocytes : 7%
PT : 13 sec (N 11-15 sec)
INR : 1.03
What is the most likely diagnosis in this patient ? +
A 50 year old woman comes to the office for routine checkup. Her past history is otherwise insignificant and her family history is unremarkable. She is a chronic smoker and smoked two packs of cigarette for the past 25 years. She attained menopause at the age of 50 and is taking estrogen supplements. She denies alcohol use and use of recreational drugs. Her vitals are temperature: 36.7 C, blood pressure: 140/80 mmHg, pulse: 80/min and respirations: 15/min. All other system examinations are normal. Her laboratory values comes as :
Hb : 21 g/dl
RBC’s : 6 million/cmm
WBC’s : 6000/cmm
Platelet’s : 300,000/cmm
Neutrophils : 58%
Eosinophils : 2%
Lymphocytes : 33%
Monocytes : 7%
What is the next best step in the management of this patient ? +
A 62 year old woman comes to the emergency department with complaints of shortness of breath and chest pain. She was in her usual state this morning but suddenly developed these symptoms. Her past history is otherwise insignificant and her family history is unremarkable. She is a chronic smoker and smoked two packs of cigarette for the past 25 years. She occasionally consumes alcohol. She attained menopause at the age of 50 and not on any medications. Her vitals are temperature: 36.7 C, blood pressure: 140/80 mmHg, pulse: 80/min and respiration: 15/min. The patients pulse oximetry shows 92 % on 4-litres of oxygen. All system examinations are normal. V/Q scan of the chest shows high probability for pulmonary embolism. Her initial laboratory values are :
Hb : 11 g/dl
Hct : 37%
RBC’s : 3 million/cmm
WBC’s : 8000/cmm
Platelet’s : 300,000/cmm
PT : 13 sec (N 11-15 sec)
APTT : 30 sec (N 25-40 sec)
BT : 7 min (N 2-7 min)
INR : 1.06
You start the patient on unfractionated heparin and warfarin. On the 3rd day, she complaints of pain in the right arm and abdomen. Examination of the right extremity reveals pale, tender arm with erythema in the abdomen that progressed quickly to hemorrhage and necrosis. A repeat CBC reveals
Hb : 12 g/dl
Hct : 37.5%
RBC’s : 2.8 million/cmm
WBC’s : 10000/cmm
Platelet’s : 260,000/cmm
PT : 19 sec (N 11-15 sec)
APTT : 60 sec (N 25-40 sec)
BT : 11 min (N 2-7 min)
INR : 2
What is the most likely cause of her symptoms ? +
A 54 year old woman comes to the emergency department with complaints of shortness of breath. She was in her usual state this morning but suddenly developed these symptoms. Her past history is otherwise insignificant and her family history is unremarkable. She is a chronic smoker and smoked two packs of cigarette for the past 25 years. She attained menopause at the age of 50 and is taking estrogen supplements. Her vitals are temperature: 36.7 C, blood pressure: 130/80 mmHg, pulse: 90/min and respirations: 15/min. The patients pulse oximetry shows 92 % on 4-litres of oxygen. All system examinations are normal. V/Q scan of the chest shows high probability for pulmonary embolism. Her initial laboratory values are :
Hb : 11 g/dl
Hct : 37%
RBC’s : 3 million/cmm
WBC’s : 8000/cmm
Platelet’s : 300,000/cmm
PT : 13 sec (N 11-15 sec)
INR : 1.06
You start the patient on unfractionated heparin and warfarin. Her symptoms gradually resolve over the next three days. A repeat CBC on the 5th day reveals a platelet count of 60,000/cumm. Which would have been the most useful step that would have prevented the condition? +
A 30 year old woman comes to the office with complaints of burning micturition for the past 2 days. She also complaints increased urinary frequency and urgency which is causing extreme discomfort at the work place. She also complaints of mild supra-pubic pain. Her past history is otherwise insignificant and her family history is unremarkable. She is a nonsmoker, but occasionally consumes alcohol. Her menstrual history were regular 3 months back, but has missed her periods since then. She is sexually active with her husband and does not use contraception. Her vitals are temperature: 36.7 C, blood pressure: 140/80 mmHg, pulse: 80/min and respiration: 15/min. All system examinations were normal and there is no costovertebral tenderness. Urine analysis reveals pH: 6.6, WBC: 40+/HPF, RBC: 3/HPF, leukocyte esterase and nitrite positive. What is the most appropriate antibiotic in this patient? +
A 27 year old G2P1 in her 14th week of gestation comes to the office for regular check-up. She has no specific complaints and takes her iron and folic acid supplements regularly. Her past history is significant for hypertension and on beta-blockers. She is a non-smoker and does not consume alcohol. Her family history is unremarkable. Her first child is alive, healthy and Rh –ve. On examination, her vitals are temperature: 36.7 C, blood pressure: 100/70 mmHg, pulse: 80/min and respirations: 15/min. All system examinations are normal. Which of the following would be the best next step in the management of this patient’s chronic hypertension ? +
In an experiment, liver mitochondrial subfractions are purified from sample of bovine livers, and mitochondrial enzymes involved in the urea cycle are isolated. Fatty acylation assays are then carried out on the samples in order to study the regulatory role of fatty acylation in the kinetic activity of these enzymes. Which of the following enzymes is most likely present in the purified mitochondrial sample? +
A 6-months-old boy is brought by his mother to the emergency department (ED) for convulsions and vomiting. The mother states that her son has been healthy and has had an uneventual neonatal course. She also says he has been exclusively breastfed since birth. One day earlier, the pediatrician advised her to introduce soft foods in his diet, and the baby was fed small amounts of mashed bananas, apple juice, and carrot juice earlier today for the first time. The physician in the ED suspects this patient has an inborn error of metabolism caused by an enzyme deficiency. Which of the following compounds should be avoided in this patient's diet? +
A young couple are referred for genetic counseling. The couple are planning to conceive a child, and they are very concerned about the health of their child. The man's brother died at the age of 7 years due to coma that was caused by high serum concentration of ammonia. Following a thorough revision of the family records, the couple are informed that the man's brother suffered from the most common form of urea cycle disorder. What is the mode of inheritance of the disease the caused the death of this man's brother? +
A scientist studies the expression and enzymatic activities of aldose reductase and sorbitol dehydrogenase using western blotting and immunohistochemistry techniques. The study is conducted on samples of human cells obtained from multiple organs. In one sample, the expression of only aldose reductase is positive, whereas the expression of sorbitol dehydrogenase is completely absent. The sample is most likely obtained from which of the following organs/tissues? +
A 73-year-old woman presents with worsening pain in her left foot. Her past medical history is remarkable for a 20-year history of poorly type 2 controlled diabetes mellitus. Her temperature is 38.3 °C (100.9 °F), heart rate is 98/min, and blood pressure is 146/90 mmHg. On physical examination, the left foot is warm, erythematous, and tender, and an ulcer that involves the full thickness of the skin present. The right lower extremity appears normal. The patient is informed that her condition is a complication of her poorly controlled diabetes. Deficiency of which of the following enzymes in nerve cells is responsible for the organ damage associated with this patient's condition? +
A 10-year-old girl is brought to the emergency department (ED) for severe right flank pain that developed acutely over the past 2 hours. The patient explains that her pain radiates to her groin and is only associated with nausea and one episode of yellowish vomiting. When asked, she denies any association between her pain and food intake, change in bowel movement, or change in position. Physical examination is remarkable for costovertebral angle tenderness on the right side. Urinalysis in the ED is remarkable for numerous red blood cells in addition to the presence of hexagonal crystals. Chronic elevation in the urinary concentration of which compound is associated with the development of this patient's condition? +
A 27-year-old man presents to the emergency department with severe left flank pain for the past 3 hours. He states the pain is a sharp, stabbing sensation that radiates to his left groin. Upon further questioning, the patient recalls that he has had similar episodes in the past. Physical examination is remarkable for left costovertebral angle tenderness. Urinalysis demonstrates hematuria and hexagonal-shaped crystals. Following further investigation, the physician explains to the patient that his condition is caused by a genetic disorder characterized by a mutation in an amino acid transporters in the kidneys. If genetic testing reveals the patient's wife does not carry a similar mutation, what is the percentage that this couple's child will have the disease? +
A 4-day-old newborn is brought to the emergency department (ED) for convulsions. The mother states that her baby is a product of an uneventful vaginal delivery, and his neonatal course prior to presentation was normal. She delivered the baby in a rural village abroad and returned to the United States only one day ago. She received all her prenatal vitamins and had regular follow-ups with her obstetrician during pregnancy. In the ED, the patient's vital signs are normal, and on physical examination, he appears lethargic and exhibits a stereotyped bicycling movement. The physician notes a distinctive honey-like odor of his diapers. Deficiency of which of the following enzymes is responsible for this patient's condition? +
A 6-months-old boy is brought to the physician's office for irritability and hypotonia. The mother states that she received all her prenatal vitamins and had regular follow-ups with her obstetrician. The boy was delivered abroad, and the family returned to USA 1 week prior to presentation. Her boy was normal at birth, but has had impaired psychomotor development throughout his development, which remained undiagnosed. Laboratory testing is remarkable for lactic acidosis and elevated serum alanine concentration. The physician suspects an inborn error of metabolism, and genetic studies, which demonstrate a defect in the E1 alpha gene, confirm the diagnosis. The parents are advised to maintain a strict diet with high concentrations of leucine and lysine for their child. Which enzyme deficiency is responsible for this patient's condition? +
A 1-year-old boy is evaluated for mental retardation and developmental delay. The mother states that the family returned to USA only one day ago. Abroad, the boy had been diagnosed with a genetic disease, and the family has been advised to follow a special diet to manage the child's condition. The mother cannot recall the name of the supplements and she is concerned about her child's health. Metabolic studies demonstrate acidosis and elevated concentrations of urinary leucine, isoleucine, and valine. The physician explains that the patient needs strict dietary restriction along with vitamin supplementation to improve his clinical condition. Three months later, laboratory testing demonstrates significant reduction in the urinary concentration of leucine, isoleucine, and valine. Supplementation with which of the following vitamins most likely improved this patient's condition? +
A 10-month-old girl is brought to the physician's office for convulsions and generalized hypotonia. The mother states that her daughter's condition is associated with irritability and poor feeding. The girl's height and weight are below the lower threshold of growth on the height-weight chart. Laboratory work-up is remarkable for metabolic acidosis and elevated serum concentrations of LDH and ALT. A skeletal muscle biopsy demonstrates E1 subunit deficiency in the pyruvate dehydrogenase complex. The physician advises the family to adhere to a strict diet. Which of the following amino acids should be included in this girl's diet? +
A biology student collects 50 urine samples for pH measurement and microscopic analysis. The samples are obtained from 21-year-old healthy individuals and stored in sterile cups pending analysis. The student forgets to close one cup and leaves the cup open overnight. The next day, the student returns to his bench and notices that the urine color in the open cup turned bluish/black. The student inquires about his finding and eventually discovers that the sample was collected from a subject with a genetic disorder characterized by a deficiency of an enzyme involved in tyrosine breakdown. Which of the following is a long-term complication of this genetic disorder? +