Property:Prompt
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A married couple seek marital counseling before applying for a divorce. The woman explains that her husband suddenly snapped and requested divorce for no obvious reason or trigger. She states that he woke up one night and said "I noticed you don’t love me”. Following multiple counseling sessions, the counselor then notices that the man is probably unaware to the fact that he hates his wife and believes she hates him too. The man is demonstrating which of the following defense mechanisms? +
A 76-year-old man presents to the emergency department (ED) with complaints of headache, difficulty maintaining balance, and progressive memory loss. Ten days prior to presentation, he was involved in a motor vehicle accident. On physical examination in the ED, the man appears alert and oriented to persons, but not to either place or time. A CT scan of the head with no contrast demonstrates a crescent-shaped isodense lesion that crosses the suture lines but not the dural attachments. A rupture in which of the following structures is most likely responsible for this patient's symptoms? +
A 10-year-old girl is brought to the emergency department for complaints of fever, recurrent watery diarrhea, and abdominal pain. Her family emigrated from Romania 1 year ago, and the child has not received any medical care since. The mother reports that her child has had a history of recurrent sinusitis and multiple hospitalizations for pneumonia since the age of 4. On physical examination, you notice a sick looking girl with a fair complexion, sparse light blonde hair, and blue eyes. You also note mild hepatosplenomegaly, diffuse petechiae, and decreased pin-prick sensation in both lower extremities. Which of the following defects is most likely to be responsible for this patient's condition? +
A 4-year-old boy is brought to the emergency department (ED) with fever, sore throat, and malaise. His mother states that the patient has no significant past medical history but has not received any childhood vaccinations. She denies any known allergies to medications or drugs. The family immigrated to the United States from Africa only 2 days ago. In the ED, his temperature is 38.5 °C (101.3 °F), blood pressure is 136/86 mmHg, and heart rate is 106/min. The patient is leaning forward on the hands and drooling saliva. Physical examination is remarkable for cervical lymphadenopathy, pharyngeal erythema, and presence of a grey-white exudative membrane that bleeds when scraped in the pharynx. The patient is immediately isolated and is managed promptly. Two days later, a club-shaped, gram-positive rod that contains red and blue granules grows on Loffler's media. What is the mechanism of virulence that characterizes the organism responsible for this patient's condition? +
A 4-month old boy is brought to the physician's office for psychomotor delay. The mother explains that the patient cannot sit or support his head. She states that his symptoms began when she noticed orange crystals in his diapers 5 weeks ago and have been progressively worsening. The boy has no significant past medical history and had a normal neonatal course. Laboratory findings demonstrate megaloblastic anemia, normal concentrations of vitamin B12 and folate, and increased concentrations of uric acid in blood and in urine. What type of inheritance pattern is associated with this patient's condition? +
A 42-year-old man presents to the emergency department (ED) with fever and facial redness, pain, and edema for the past day. The patient recalls that his symptoms started 2 days after he accidentally cut his face while shaving. In the ED, his temperature is 38.4 °C (101.1 °F), blood pressure is 130/84 mmHg, and heart rate is 100/min. Physical examination is remarkable for a tender, edematous, and erythematous skin lesion on the left side of the face that has clearly demarcated margins. Which of the following statements is true about the pathogenesis of erythema in this patient's condition? +
A 32-year-old man presents to the physician’s office with complaints of progressive numbness of the arms, weakness, and hiccups. His past medical history is unremarkable, and the patient denies intake of any medications. Physical examination is remarkable for bilateral loss of pain and temperature sensations over the shoulders and the upper extremities in a cape-like distribution. The physician also notes decreased sensation and a motor strength of 3/5 in the upper extremities. MRI of the brain and the neck is performed and demonstrates a dilated fluid-filled cavity in the spinal cord. Which of the following diseases is most commonly associated with this patient's condition? +
A 40-year-old man presents to the emergency department (ED) with complaints of headache, fever, vomiting, and a rash. He explains that he first had vomiting and headaches 5 days ago, but then developed a high-grade fever and rash. He also states that the rash started over his wrists and ankles, but then proceeded towards his trunk. Upon further questioning, the patient informs the physician that he has recently traveled to North Carolina to visit his relatives and went camping there for several days. In the ED, his temperature is 38.9 °C (102 °F), blood pressure is 132/86 mmHg, and heart rate is 102/min. Physical examination is remarkable for multiple, non-blanching petechiae over the trunk and extremities with involvement of the palms and soles. Which of the following organisms is responsible for this patient's symptoms? +
A 12-year-old girl with a medical history of type 1 diabetes mellitus presents to the emergency department (ED) with a painful and swollen left index finger for the past 3 days. Her mother explains that the patient habitually bites her fingernails and fingertips, and she often causes the fingertips to bleed. In the ED, the patient's temperature is 36.8 °C (98.24 °F), blood pressure is 122/78 mmHg, and heart rate is 78/min. On physical examination, the left index finger is edematous and tender to touch; it has an ulcerated lesion with a foul-smelling pus discharge under the nail bed. Lab tests are remarkable for an HbA1c of 8.6%, elevated ESR, and a WBC count within normal range. Two days later, cultures of the fingertip pus grow gram-negative rods that have a bleach-like odor and appear to corrode the surface of the agar medium. Which of the following organisms is responsible for this patient's infection? +
A 30-year-old woman presents to the emergency department for a burn lesion in her left hand. Upon further questioning, the patient reports that she has burned her fingers on many occasions recently because she is unable to feel the burning sensation. On physical examination, the patient has bilateral loss of pain and temperature in her upper extremities with preserved sensations of touch and vibration. Neurological examination of her lower extremities does not reveal any abnormalities. What is the most likely cause of this patient's symptoms? +
After isolating and purifying several bacterial toxins using thiol-disulfide exchange affinity chromatography, a researcher studying the properties of bacterial toxins exposes the purified product to a number of harsh conditions. In one experiment, he heats the product to 70 °C (158 °F) and then injects a sample into anesthetized rats. Which of the following bacterial toxins is likely to elicit symptoms following injection? +
A 4-month-old girl is brought to the emergency department following a seizure. Her mother had an uncomplicated pregnancy and had regular follow-ups with her obstetrician. The patient was delivered abroad and had a normal neonatal course. The family immigrated to USA only 3 weeks ago. Ever since the family moved, her mother has noticed that the girl has not been the same anymore. She does not seem to develop like her 2 sisters did before her; she appears lethargic all the time and feeds poorly. Upon further questioning, the mother adds that the patient's urine has an unusual musty odor. On physical examination, the patient has a pale skin with blonde hair and blue eyes. Her skin appears dry with eczematous lesions. Administration of which amino acid is required to relieve this patient's symptoms? +
A 26-year-old man presents to his primary care physician with complaints of muscle weakness. The patient used to partake in vigorous exercise, but over the past year has noted a gradual decline in his strength. He explains that he can no longer hold his body weight on the pull-up bar at the gym. Upon further questioning, the patient also reports he is sometimes unable to release his grip from a doorknob. On physical examination, the physician notes the patient has dysarthric speech and is unable to reverse the contraction of his thumb following percussion of the thenar eminence. What is the mode of inheritance of this patient's condition? +
A 40 year old is brought to the ER by his family member’s with weakness of left upper and lower limbs. On examination, the patient appears confused, temperature is normal, his vitals are stable and other system examination is also normal. His past history is insignificant. A CT scan performed shows a small focal well defined lesion in the right hemisphere. A lumbar puncture is performed, but CSF findings and cytology is inconclusive. HIV ELISA turns positive and his CD4 count is 45/µL. You start the patient on steroids, radiation therapy and HAART therapy. Which of the following is the best prognostic sign for this patient’s condition? +
A 28 year old male with AIDS is hospitalised for pneumocystosis carinii pneumonia infection. He was diagnosed with AIDS 1 year back and is on zidovudine, lamivudine and indinavir. The patient is non-compliant with his medications. His vitals are stable and temperature is 101.5 F. He is started on trimethoprim and sulphamethoxazole therapy. On the 3rd day in hospital, he complaints of weakness of the right upper and lower extremities. He also complaints of decreased vision in the right side. An MRI shows a ring enhancing lesion in the left parieto occipital area. What is the most likely cause of this patient’s condition? +
A 40 year old male come to clinic following his recent exposure to HIV. While he was on a business trip 4 weeks ago, he had unprotected anal intercourse with a man who confided he was HIV few days ago. Immediately he purchased an over the counter HIV ELISA with the western blot test which turned out to be positive. He has no symptoms at this time. His vitals are pulse 80/min, BP: 120/80 mmHg, temperature 100 F, RR: 15/min. Examination of other systems is normal. You order another set of HIV testing kit including CD4 count, viral load, CXR, sputum testing, urine culture. After 1 week, the HIV test turns out to be positive, CD4 count is 700 cells/µL, viral RNA 30,000 copies/ml but other routine tests are normal. On further inquiry, the patient says he already had an HIV test done a year back which was positive and CD4 count done 8 months back was 800 cells/µL. What is the best next step in the management of this patient? +
A 40 year old male come to clinic for a follow up visit regarding his HIV status. He was diagnosed with HIV 1 year back and has been taking zidovudine, lamivudine and indinavir since then. He currently has no symptoms and has been compliant with his medications. At the first visit his CD4 count was 50, and you started him on trimethoprim-suphamethoxazole, ganciclovir, fluconazole and azithromycin. His CD4 counts taken every four months were 75 and 100 respectively. His vitals are pulse 80/min, BP: 120/80 mmHg, temperature 100 F, RR: 15/min. Chest auscultation was unremarkable and heart sounds are normal. His abdomen is soft and non tender. No generalized lymphadenopathy. CD4 count taken 1 week back is 25O, seronegative for CMV and his CBC, serum biochemistry, urine analysis and LFT’s are all within normal limits. What is the most appropriate line of management in this patient? +
A 36 year old male with AIDS is hospitalised for weakness of left upper and lower extremities. He was diagnosed with AIDS 1 year back and is on zidovudine, lamivudine and indinavir. The patient is non-compliant with his medications. His vitals are pulse 80/min, BP: 120/80 mmHg, temperature 101.5 F, RR: 15/min. Chest auscultation reveals crackles and heart sounds are normal. His abdomen is soft and non tender are stable. Examination shows weakness of left upper and lower limb. CXR shows bilateral opacities. He is started on trimethoprim and sulphamethoxazole therapy. An MRI shows an irregular weak enhancing lesion in the right parieto occipital area. What is the most likely diagnosis? +
A 41-year-old woman presents to her primary care physician with complaints of distal weakness in her upper and lower extremities. Her past medical history is significant for cholecystecomy and chronic constipation. Upon further questioning, she reports some difficulty swallowing solids and liquids. On physical examination, the physician notes that the patient is unable to release her grip following contraction. When the thenar eminence was tapped using a tendon hammer, a prolonged muscle contraction is observed. Using a sample of this patient's DNA, which of the following techniques confirm the diagnosis? +
A 40-year-old man with Down syndrome is brought to his primary care physician by an employee of his assisted care facility for memory loss. The employee explains that the patient has always had baseline intellectual disability, but his condition has significantly worsened over the past year. He has increasingly forgotten where his room is and is unable to recognize staff he used to know well. Which of the following proteins is most likely responsible for predisposing the patient to his symptoms? +