Property:Prompt
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A 2-year-old boy is brought by his mother to the emergency department (ED) for new-onset nonbilious vomiting, severe colicky abdominal pain, and blood per rectum with stools. The mother reports that her child's stools have an unusual color and resemble currant jelly. The patient's past medical history is remarkable only for a recent upper respiratory tract infection and bilateral conjunctivitis. He was born by a normal vaginal delivery with an uneventful neonatal course. Physical examination in the ED is remarkable for an abdominal mass upon deep palpation of the right lower quadrant. Which of the following best describes the patient's condition? +
A 58 year-old man with a past medical history of uncontrolled diabetes mellitus, hypertension, and dyslipidemia, presents to the physician's office with complaints of excessive fatigue, weight loss, and new-onset abdominal pain. The patient explains that his pain has progressively worsened over the past 3 weeks. He states that his pain is located in right upper abdominal quadrant and radiates to the right shoulder. Following extensive work-up, the patient is diagnosed with a malignant hepatic tumor of endothelial origin. Chronic exposure to which of the following is most likely associated with this patient's condition? +
A researcher is studying the role of omeprazole in gastric acid secretion. He conducts an experiment involving 10 volunteers, half of which are administered daily doses of omeprazole, and the other half administered similar daily doses of placebo. Six months later, accurate measurements of gastric acid are performed using esophageal pH testing. Although omeprazole is truly associated with suppression of gastric acid in the study, the researcher fails to demonstrate such significant association at a 95% confidence interval during his statistical analysis. Which of the following is true regarding the researcher's trial? +
A 78-year-old man is brought by his daughter to the physician's office for visual hallucinations. She tells the physician that her father has not been able to recognize his relatives and has recently been unable to distinguish place and time. Upon further questioning, the patient's daughter also explains that the patient has lately developed a new resting tremor and has recently had frequent falls. She also explains that his symptoms are progressing at a relatively rapid rate. The physician initially suspects a psychiatric illness and prescribes haloperidol. Several days later, the patient is brought back, and the physician is told that the patient's symptoms have in fact worsened. What is the hallmark feature of this patient's condition on histopathological examination? +
A 62-year-old man, with a significant history of aortic valvulopathy, undergoes a planned prosthetic aortic valve replacement. Following the procedure in the coronary care unit (CCU), the patient begins to seize and is not spontaneously recovering from his state. The physician explains that the patient suffers from an ischemic stroke caused by calcific cerebral embolization during the surgery and promptly prescribes pharmacologic therapy to stop his seizures. The prescribed medication is also indicated in which other condition? +
A 74-year-old man presents to the physician's office for a clouded dim vision that has been progressively worsening over the past 6 months. The patient further explains that he has difficulty seeing objects at night and sees normal lights too bright. His past medical history is significant for uncontrolled type 2 diabetes mellitus on daily insulin injections, hypertension on metoprolol and lisinopril, and dyslipidemia on atorvastatin. When asked, the physician explains to the patient the etiology of the patient's symptoms. Which of the following is true regarding the pathophysiology of the patient's condition? +
A 45-year-old man presents to the physician's office for his annual check-up and has no complaints. The patient's past medical history is significant for hypertension and hyperlipidemia. On physical examination, the physician uses a 128 Hz tuning fork and places it on the patient's knee. When asked, the patient confirms the sensation of vibration of the tuning fork. The physician then explains that peripheral sensation travels to the central nervous system with the help of neurons and synpases. Which of the following structures is able to detect the sensation of vibration from the skin? +
A lab technician is assessing a novel method to quantify serum vitamin B12 levels. First, he uses the new method to measure the levels of vitamin B12 in sera of 50 patients previously known to have identical vitamin B12 levels. Then, the technician compares the obtained vitamin B12 levels among each other, and also compares their levels to the reference standard. The technician finally concludes that a large random error is present despite the absence of a systematic error. Which of the following statements is entirely true regarding the technician's novel method? +
A 58-year-old woman recently diagnosed type 2 diabetes mellitus presents to the clinic for follow-up of her blood glucose concentration. Her fasting glycemia is 81 mg/dL (4.5 mmol/L) and she is doing well on diet and exercise alone. The patient asks about her need for insulin therapy and how insulin is involved in metabolism. Which of the following cells requires insulin for glucose uptake? +
A 45-year-old Caucasian female, non-smoker, single woman with a past medical history of amenorrhea and depression came to the clinic for a routine hospital visit. She had been a runway model for the past 29 years. This is the first time she is coming to the hospital. Her physical examination showed marked malnutrition and paleness. Her body mass index was 16.42 (height: 1.58 m; weight: 41 kg). On further questioning, she admitted to severely restricting her diet due to thoughts about actually being fat even whenever she sees herself in the mirror. She also confessed to occasional binge eating and abuse of laxatives.
Which of the following is the diagnosis in this woman? +
A young boy is brought by his mother to the physician's office for a scheduled vaccination. The boy has no complaints, and physical examination is unremarkable. Prior to the administration of the vaccine, the mother asks the physician if the vaccine is associated with any serious adverse reactions. The physician explains that the vaccine the child is about to receive is generally safe, but there is a very rare risk of inducing an actual disease. Which of the following vaccines is the child most likely receiving during his check-up? +
A 4-year-old boy with mild mental retardation is brought to the pediatrician's office for chronic constipation. The patient does not report any symptoms, and his mother states that he has a regular and balanced diet. On physical examination, the child has abnormal facies and exhibits cheerful and friendly demeanor. He has a bulge forehead, a low nasal bridge, and an abnormally wide mouth. His blood pressure is 152/88 mmHg, heart rate is 82/min, and temperature is 36.8 °C (98.2 °F). Cardiac auscultation is remarkable for a grade II/VI, mid-systolic ejection murmur at the right upper sternal border. Echocardiography with Doppler flow studies demonstrates supravalvular aortic stenosis. Lab work-up is remarkable for serum calcium concentration of 11.2 mg/dL. Which of the following supplements is contraindicated in this patient? +
A researcher, investigating the regulatory neurotransmitters in the basal ganglia, sends high frequency electrical impulses into specific areas of a rat brain. He then measures changes in the local concentration of neurotransmitters. Upon stimulation of the caudate, the researcher observes increased release of a neurotransmitter known to inhibit the globus pallidus internus. Which of the following amino acids is this neurotransmitter derived from? +
A 62-year-old man presents with complaints of a tremor in both hands. The tremor initially started in his right hand and has recently progressed over the past 4 weeks to involve his lips and his left hand. The patient also reports the tremor intensity decreases when he intentionally moves his hands, and it disappears when he sleeps. Physical examination is remarkable for a resting tremor, bradykinesia, rigidity, and shuffling gait. Which of the following is the most likely pathological mechanism responsible for this patient’s condition? +
A 23-year-old woman presents to the outpatient clinic with complaints of excessive worrying and inability to sleep. She is constantly anxious about issues related to work and family and has difficulty concentrating at work. The patient reports always being concerned about her son's safety at school, and cannot ignore the thoughts that her husband is in danger at his job. She is unable to sleep through the night despite improving her sleep hygiene. Which of the following neurotransmitter imbalances is most likely present in this patient? +
A 7-year-old girl is brought to the outpatient neurology clinic by her parents for the evaluation of a learning disability. The parents report that the child has been healthy and developing normally. She attended primary school with no problems. At the age 5, her teachers started noting some learning difficulties when the child was compared to her classmates. The parents also noticed that their daughter started having repetitive motor tics particularly jerking of the shoulder and hands and repetitive squinting. They also noticed episodes where the child would shout out her name repetitively and would not respond to their demands to stop. These symptoms were initially mild but have been worsening as the girl develops. What features are not likely to be found in this patient? +
A 52 year old man presents to the physician's office for his annual check-up. During history-taking, the patient denies any symptoms and reports he is feeling healthy. Vital signs and full physical examination are only remarkable for an elevated blood pressure. The physician notes that this is not the first time the patient's blood pressure is high in the clinic. Nonetheless, the patient assures the physician that his blood pressure is periodically measured using a calibrated sphygmomanometer by an experienced nurse practitioner at home and is always within normal limits when not in the clinic. A 24-hour Holter monitor is installed and results show that the patient's blood pressures at home are indeed within normal limits. Which of the following is the most likely diagnosis? +
A 43 year old male, comes to the office with complaints of fatigue and lethargy over the past several years. His wife says he has loss of libido and erectile dysfunction for the past few years. Previously they had a normal sexual life. On further review of history, he says he had intermittent abdominal pain and joint pains for several years for which he never consulted a doctor. His past history is otherwise insignificant and his family history is unremarkable. He says he takes calcium and multivitamin tablets to keep him healthy. He does not smoke and drink. On examination, his temperature is 36.7 C, blood pressure is 130/70 mmHg, pulse is 72/min and reparations are 16/min. Abdominal examination reveals mild hepatomegaly. His skin has golden blue hue. With respect to the disease, which of the following the patient has to avoid? +
A 43 year old male, comes to the office with his wife complainting of severe fatigue and lethargy over the past 1 month. On further review of history, he says he had intermittent fatigue, lethargy, nausea, abdominal pain and joint pains for several years for which he never consulted a doctor. His wife says he has loss of libido and erectile dysfunction for the past few years. Previous they had normal sexual life. His past history is otherwise insignificant and his family history is unremarkable. He is a vegetarian and does not smoke and drink. On examinations, his temperature is 36.7 C, blood pressure is 130/70 mmHg, pulse is 72/min and respiration's are 16/min. Abdominal examination reveals mild abdominal pain on the right upper quadrant and profound hepatomegaly. His skin has golden blue hue. The patient is admitted and treated suppourtively. His serum biochemistry results shows Na:135 mEq/L, K: 3.5 mEq/L, Cl:104mEq/L, Bi: 24 mEq/L, BUN: 30 mg/dl, glucose:226 mg/dl, Mg:1mg/dl and Ca: 8mg/dl. His tranferrin saturation is 72%, serum ferritn is 500 ng/ml and serum iron levels are 300 µg/dl. Liver function tests shows very highly elevated bilirubin, AST and ALT levels. Liver biopsy done shows cirrhosis and his renal function tests are highly abnormal which warrants an immediate dialysis. You explain the patients disease to his wife and discuss about his prognosis. Which of the following may pose an increased risk of infection in this patient? +
A 40 year old female, comes to the office with complaints of fatigue, lethargy, malaise and pruritis for the past few weeks. She recently noticed hyperpigmentation of skin in her upper limbs. Her past history is insignificant and her family history is unremarkable. She has no recent travel exposure outside the country. She denies smoking, alcohol and drugs. Her menstrual cycles are irregular with increased duration of cycles. Her temperature is 36.7 C, blood pressure is 130/70 mmHg, pulse is 102/min and respiartions are 16/min. On examination there is no jaundice, but xanthelasmas and excoriations from scratches with hyperpigmentation are present on skin examination. Abdomen is soft and non-tender with no organomegaly. Other system examinations are normal . Her lab results shows Hb:7 g/dl, hematocrit : 33, Na:135 mEq/L, K: 3 mEq/L, Cl:104mEq/L, Bi: 24 mEq/L, BUN: 30 mg/dl, glucose:176 mg/dl, Mg:1mg/dl and Ca: 8mg/dl. The liver fuction test results are as follows:
Alanine aminotransferase : 100 U/L
Aspartate aminotransferase : 90 U/L
Alkaline phosphatase : 480 U/L
Total bilirubin : 1 mg/dl
Direct bilirubin : 0.6 mg/dl
Hepatits A IgM : negative
HbsAg : negative
HBc Antibody : negative
HCV Antibody : negative
Which is the best diagnostic step to confirm the diagnosis in this patient ? +