idx stringlengths 3 3 | question stringlengths 321 1.52k | options dict | answer stringclasses 4
values | explanation stringlengths 1.38k 5.51k | link stringlengths 22 48 |
|---|---|---|---|---|---|
001 | A 17-year-old girl presents to the emergency department with a headache. The patient has had headaches in the past but this is the worst headache of her life. Her symptoms started yesterday and have been getting progressively worse. The patient states that the pain is mostly on the left side of her head. There has been... | {
"A": "Subarachnoid hemorrhage",
"B": "Fat-soluble vitamin overuse",
"C": "Migraine headache",
"D": "Bacterial meningitis",
"E": ""
} | B | This patient is presenting with headache, bilateral papilledema, obesity, and increased opening pressure on lumbar puncture suggesting a diagnosis of Idiopathic intracranial hypertension (IIH or pseudotumor cerebri). This disease is associated with hypervitaminosis A (a fat-soluble vitamin).
Pseudotumor cerebri classi... | https://bit.ly/3AgFkva |
002 | An 18-year-old man presents to his primary care provider with his parents for a sports physical. He was last seen in the clinic several months ago when he was diagnosed with attention deficit hyperactivity disorder (ADHD). He was started on methylphenidate at that time and the patient now reports improvement in his abi... | {
"A": "CGG trinucleotide repeat disorder",
"B": "Anabolic steroid use",
"C": "Failure of neuronal migration",
"D": "Meiotic nondisjunction",
"E": ""
} | D | This patient presents with tall stature, gynecomastia, and small testes with elevated FSH and LH, which suggests a diagnosis of Klinefelter syndrome. Klinefelter syndrome is usually caused by meiotic nondisjunction that results in a 47,XXY genotype.
Klinefelter syndrome is the most common cause of primary hypogonadism... | https://bit.ly/3BSwAMD |
003 | A 62-year-old man presents to the emergency department with chest pain and shortness of breath that he experienced while barbecuing. The pain is over his chest and in his left arm. The patient has a medical history of obesity, type 2 diabetes mellitus, and hypertension. His current medications include insulin, metformi... | {
"A": "Prednisone",
"B": "Aspirin",
"C": "Stenting",
"D": "Ibuprofen",
"E": ""
} | B | This patient is presenting with chest pain several days after sustaining a myocardial infarction and has an ECG suggestive of pericarditis. This presentation is consistent with Dressler syndrome and the most appropriate initial step in management is aspirin.
Dressler syndrome is pericarditis that can occur after a myo... | https://bit.ly/3BV4U9Y |
004 | A 6-year-old boy presents to the emergency department after falling from his scooter. He has dull, aching pain along his left side where he hit the ground. He fell sideways off the scooter as he rounded a curve in the road. He has never had any serious injuries but that he always seems to bruise easily, especially afte... | {
"A": "Anti-platelet antibodies",
"B": "Von Willebrand factor deficiency",
"C": "GP1b deficiency",
"D": "Factor 8 deficiency",
"E": ""
} | D | This young patient presents with extensive bruising following an injury, a family history of blood disorder, and a prolonged partial thromboplastin time (PTT) with a normal prothrombin time (PT) and bleeding time. These findings suggest a diagnosis of hemophilia A caused by factor 8 deficiency.
Hemophilia is a deficie... | https://bit.ly/3BoKeXI |
005 | A 69-year-old man presents to his primary care physician for a general checkup. The patient works as a farmer and gardens in his spare time. He has a medical history of poorly managed type 2 diabetes mellitus and irritable bowel syndrome. His current medications include lisinopril, metformin, insulin, fiber supplements... | {
"A": "Basal cell carcinoma",
"B": "Squamous cell carcinoma",
"C": "Melanoma",
"D": "Poor wound healing secondary to diabetes",
"E": ""
} | B | This patient with a non-healing ulcer on the site of a previous actinic keratosis most likely has sustained progression of the lesion to squamous cell carcinoma.
Squamous cell carcinoma (SCC) is a common dermatological malignancy. Patients can present with actinic keratosis, which is a pre-malignant lesion in sun-expo... | https://bit.ly/3CB9Cdn |
006 | A 76-year-old woman is brought to a primary care physician by her daughter who is concerned about her mother's growing inability to take care of herself. Initially, she attributed her mother's forgetfulness and word-finding difficulties to normal aging, but over the past few years, her mother's memory has worsened, her... | {
"A": "Normal pressure hydrocephalus",
"B": "Frontotemporal dementia",
"C": "Alzheimer dementia",
"D": "Creutzfeldt-Jakob disease",
"E": ""
} | C | This elderly patient who presents with slowly progressive memory loss, language difficulties, and progression to inability to care for herself most likely has Alzheimer dementia.
Alzheimer dementia is a neurodegenerative disorder that is characterized by a gradual and progressive cognitive decline (memory loss, visuos... | https://bit.ly/3CrrhE1 |
007 | A 69-year-old man presents to his primary care physician for trouble sleeping. He recently retired from working the day shift at a cemetery. When the patient retired, his goal was to finally be able to go out with his wife; however, he finds that he is unable to stay awake past 6 pm in the evening. His wife is disappoi... | {
"A": "Normal aging",
"B": "Delayed sleep phase disorder",
"C": "Chronic insomnia",
"D": "Advanced sleep phase disorder",
"E": ""
} | D | This patient is presenting with difficulty staying awake in the early evening suggesting a diagnosis of advanced sleep phase disorder (also known as advanced sleep phase syndrome).
Advanced sleep phase disorder can present in patients of all ages. Patients will experience difficulty staying awake in the early evening ... | https://bit.ly/3CxfeFC |
008 | A 4-week-old boy is brought to the pediatrician by his parents for an initial evaluation. His parents are concerned that he is not feeding well and has lost weight over the last 2 weeks. He was born at home via spontaneous vaginal delivery at 37 weeks of gestation to a G1P1 mother. His mother did not receive prenatal c... | {
"A": "Vitamin B6 supplementation",
"B": "Changing to a soy based formula",
"C": "Providing imiglucerase enzyme replacement",
"D": "Removing phenylalanine from maternal diet during pregnancy",
"E": ""
} | B | This patient who presents with failure to thrive, hepatosplenomegaly, and bilateral cataracts most likely has classic galactosemia. Patients with this disorder should avoid lactose-containing products by changing to a soy-based formula.
Classic galactosemia is an autosomal recessive defect in galactose-1-phosphate uri... | https://bit.ly/3D10TBk |
009 | A 4-week-old boy presents with his parents to the pediatrician for a well-child visit. His mother reports he was eating well until 1 week ago when he began vomiting after breastfeeding. His mother has tried increasing the frequency of feeds and decreasing the amount of each feed, but the vomiting seems to be getting wo... | {
"A": "Abdominal ultrasound",
"B": "Trial of empiric proton pump inhibitor",
"C": "Abdominal radiograph",
"D": "Supplement breastfeeding with formula",
"E": ""
} | A | This patient presents with a history of nonbilious, forceful vomiting, poor weight gain, and signs of dehydration, which is consistent with pyloric stenosis. The most appropriate next step in management is abdominal ultrasound to confirm the diagnosis.
Pyloric stenosis presents in 4- to 6-week-old infants with nonbili... | https://bit.ly/3D2V2LR |
010 | A 27-year-old woman presents for her first prenatal visit at an estimated gestational age of 16 weeks and 4 days by last menstrual period. She is presenting late to prenatal care due to significant anxiety about her pregnancy, as she and her husband had struggled with infertility for several years prior to conceiving. ... | {
"A": "Pseudocyesis",
"B": "Couvade syndrome",
"C": "Feigned pregnancy",
"D": "Recent miscarriage",
"E": ""
} | A | This patient presents with signs and symptoms of pregnancy but a nongravid uterus on ultrasound and a negative pregnancy test. The most likely diagnosis is pseudocyesis.
Pseudocyesis, or false pregnancy, most commonly presents with abdominal distension, breast tenderness, nausea, and other typical symptoms of pregnanc... | https://bit.ly/3DDvy7X |
011 | A 2-year-old boy is brought to the emergency room by his mother, who states that her son has been coughing uncontrollably for 3 hours. The child has a medical history of obesity and atopic dermatitis and uses topical steroid cream. His birth history is unremarkable. His family history is notable for asthma in his older... | {
"A": "Observation",
"B": "Balloon catheter removal",
"C": "Surgical extraction",
"D": "Endoscopic removal",
"E": ""
} | D | This child presents with foreign body ingestion with a button battery seen in the esophagus on radiography. The most appropriate next step in management is urgent endoscopic removal of the battery.
Button batteries are commonly used in watches and small electronic devices. If these objects are ingested (usually by chi... | https://bit.ly/3DIAhW0 |
012 | A 54-year-old man presents to the clinic with 4 weeks of persistently worsening back pain. The pain is localized to 1 spot in his lower back and is worse with physical activity. His medical history is pertinent for intravenous drug use. He has no past surgical history. His temperature is 36.8°C (98.2°F), blood pressure... | {
"A": "Ankylosing spondylitis",
"B": "Osteomyelitis",
"C": "Degenerative spine disease",
"D": "Metastatic tumor",
"E": ""
} | B | This patient with a history of intravenous drug use who presents with worsening focal back pain and elevated erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) most likely has vertebral osteomyelitis.
Vertebral osteomyelitis typically occurs via three routes: hematogenous spread from a distant site (the... | https://bit.ly/3DkrY2C |
013 | A 27-year-old man presents to his primary care physician for a checkup. He has no health concerns and has not seen a physician in years. The patient has a medical history of depression treated with fluoxetine and lithium. His temperature is 99.5°F (37.5°C), blood pressure is 122/78 mmHg, pulse is 90/min, respirations a... | {
"A": "Alcohol consumption",
"B": "Antibiotic use",
"C": "Intravenous drug use",
"D": "Sexual intercourse",
"E": ""
} | A | This patient is presenting with adherent white plaques on the inside of the cheek consistent with oral leukoplakia. Alcohol consumption is a risk factor for this disease.
Oral leukoplakia presents with a white patch/plaque that occurs over the oral mucosa that is adherent and non-scrapable. Risk factors for this condi... | https://bit.ly/3FB3X8u |
014 | A 47-year-old man is brought in after a motor vehicle accident. He was driving under the influence of alcohol when he sustained a crash against a pole. His medical history is significant for hypertension but he does not take any medications. His temperature is 98.6°F (37.0°C), blood pressure is 110/80 mmHg, pulse is 60... | {
"A": "Conjugate eye movement to the left with rotation of the head to the right",
"B": "Grimacing after noxious stimulus to the arm",
"C": "Flexion of the thigh, leg, and foot upon noxious stimulation of the foot",
"D": "Spontaneous respiration 1 minute after disconnection from a ventilator",
"E": ""
} | C | This patient with a Glasgow coma score (GCS) of 3 and a known mechanism of injury due to motor vehicle accident trauma is normothermic, normotensive, not on sedatives, and without laboratory abnormalities so they are appropriate for examination of brain death. Cortical and brain stem function must be absent in brain de... | https://bit.ly/3FgV041 |
015 | A 67-year-old man presents to the emergency department 1 hour after sudden-onset weakness and double vision. His medical history is significant for hyperlipidemia and poorly controlled hypertension. His current medications include atorvastatin and amlodipine. His temperature is 98.6°F (37.0°C), blood pressure is 175/95... | {
"A": "Lateral medulla",
"B": "Lateral pons",
"C": "Posterior limb of internal capsule",
"D": "Midbrain",
"E": ""
} | D | This patient with a history of poorly controlled hypertension, acute onset of left-sided oculomotor nerve palsy (mydriasis, ptosis, and “down and out” pupil), right-sided paresis, and right-sided dysdiadochokinesia most likely has a lacunar stroke of the left midbrain.
Important structures in the midbrain often affect... | https://bit.ly/3FwRzGJ |
016 | A 9-year-old girl presents to the emergency department with a fever and a change in her behavior. She presented with similar symptoms 6 weeks ago and was treated for an Escherchia coli infection. She also was treated for a urinary tract infection 10 weeks ago. Her mother says that last night her daughter felt ill, and ... | {
"A": "Gastroenteritis",
"B": "Intentional contamination",
"C": "Meningitis",
"D": "Urinary tract infection",
"E": ""
} | B | This patient is presenting with repeat sepsis, which is uncommon in a pediatric patient with no significant medical history. This abnormal concentration of infections when the patient is with her mother suggests a diagnosis of intentional contamination.
Factitious disorder by proxy (formerly Munchausen syndrome) occur... | https://bit.ly/3GZtkBx |
017 | A 55-year-old man presents to urgent care for weakness and weight loss. For the past several months, he has felt progressively weaker and has lost 25 pounds with intermittent abdominal pain. The patient has not seen a physician in 30 years and recalls being current on most of his vaccinations. A few years ago, he went ... | {
"A": "CT scan of the abdomen and pelvis",
"B": "CT scan of the chest",
"C": "HIDA scan",
"D": "Smoking cessation advice and primary care follow up",
"E": ""
} | A | This patient with weight loss and painless liver dysfunction has symptoms that are suggestive of pancreatic cancer. The most appropriate next diagnostic test is a CT scan of the abdomen and pelvis.
Pancreatic cancer presents with weight loss, jaundice, epigastric pain, and fatigue/malaise typically in an older male sm... | https://bit.ly/3GigfDn |
018 | A 23-year-old woman presents to the emergency room for a self-inflicted laceration of her distal volar forearm. The patient states she knew her boyfriend was having sexual thoughts about the woman from the grocery store, prompting her decision to cut her own wrist. In the emergency department, the bleeding has stopped ... | {
"A": "Borderline",
"B": "Dependent",
"C": "Avoidant",
"D": "Antisocial",
"E": ""
} | A | This patient is presenting with a suicide attempt, unstable relationships, and emotional lability suggesting a diagnosis of borderline personality disorder.
Borderline personality disorder classically presents with emotional lability, and intense, unstable relationships. These patients fear abandonment and will often ... | https://bit.ly/3HvRZyr |
019 | A 34-year-old nulliparous woman presents to the clinic with 2 weeks of copper-colored discharge from her right nipple. Her breast has not been tender, and she has not noticed any changes to the skin. She is otherwise healthy and does not take any medications. Her temperature is 36.5°C (97.7°F), blood pressure is 110/82... | {
"A": "Ductal carcinoma in situ",
"B": "Mammary duct ectasia",
"C": "Invasive ductal carcinoma",
"D": "Intraductal papilloma",
"E": ""
} | D | This young patient who presents with non-painful unilateral bloody nipple discharge and no palpable mass on breast exam most likely has an intraductal papilloma.
Intraductal papilloma is a benign epithelial tumor that develops in the lactiferous ducts of the breast and is the most common cause of bloody nipple dischar... | https://bit.ly/3IgfxrD |
020 | A 45-year-old man presents to his primary care physician with a rash. He first noticed the rash 2 weeks prior and he endorses intermittent itchiness from the rash. His medical history is significant for chronic hepatitis C infection, hypertension, type 2 diabetes mellitus, and heart failure. The patient works as a butc... | {
"A": "Atopic dermatitis",
"B": "Lichen planus",
"C": "Scabies",
"D": "Psoriasis",
"E": ""
} | B | This patient presents with several purple, polygonal, pruritic papules and plaques. These findings are most consistent with a diagnosis of lichen planus.
Lichen planus is an inflammatory skin disorder most commonly characterized by an eruption of Purple, Polygonal, Planar, Pruritic, Papules and Plaques (the 6 P’s), of... | https://bit.ly/3JrjtWO |
021 | A 40-year-old south asian man presents to a primary care provider with a chronic cough that is worse at night. He has had the cough for several years but it has been getting worse over the last few months. He recently moved to the United States to work in construction. He has lost 10 pounds in the last 3 months along w... | {
"A": "Barium swallow",
"B": "Upper endoscopy",
"C": "Helicobacter pylori stool antigen test",
"D": "Trial of lansoprazole",
"E": ""
} | B | This patient presents with a chronic cough that is worse at night, which is consistent with gastroesophageal reflux disease (GERD). In light of this patient’s new weight loss and melena, the most appropriate next step in management would be upper endoscopy to rule out cancer.
GERD may present as a chronic or nighttime... | https://bit.ly/3KuUPFj |
022 | A 6-week-old boy is referred to a pediatric hematologist-oncologist for further evaluation following an abnormal newborn hemoglobinopathy screening. The father’s brother died of sickle cell anemia at an early age. Parental studies reveal that both mother and father are carriers of the sickle cell gene. The patient's te... | {
"A": "Stroke",
"B": "Hematuria",
"C": "Splenectomy",
"D": "Infection",
"E": ""
} | B | Based on the presence of both hemoglobin (Hb) A and S on gel electrophoresis, this patient has sickle cell trait. Episodes of painless hematuria are commonly seen in these patients.
Sickle cell trait is a condition that refers to carrying 1 normal and 1 abnormal beta-globin allele. On electrophoresis, this will presen... | https://bit.ly/3KxXaiO |
023 | A 4-day-old girl is brought in by her mother for bilateral purulent eye discharge. Pregnancy and delivery were uncomplicated. The newborn had been sleeping regularly and feeding well. Then 1 day ago, the patient developed eyelid edema and eye redness. This morning, the newborn developed a thick yellow-white eye dischar... | {
"A": "Topical erythromycin",
"B": "Topical bacitracin",
"C": "Artificial tears",
"D": "Oral erythromycin",
"E": ""
} | A | This patient is presenting with bilateral purulent eye discharge 4 days post-birth, suggesting the diagnosis of gonococcal conjunctivitis. Standard prophylaxis for this condition is topical erythromycin ointment.
Neonatal gonococcal conjunctivitis is caused by Neisseria gonorrhea and presents in newborns that are 0-5 ... | https://bit.ly/3LBleST |
024 | A 30-year-old man is evaluated in the post-anesthesia care unit for neck pain. He underwent a laparoscopic appendectomy and was treated for post-operative nausea and vomiting with metoclopramide. Approximately 20 minutes after receiving the medication, he developed pain and stiffness in his neck and eventually was unab... | {
"A": "Botulinum toxin injection",
"B": "Ondansetron",
"C": "Diphenhydramine",
"D": "Observation",
"E": ""
} | C | This patient is suffering from a metoclopramide-induced acute dystonic reaction. Treatment of this complication includes IV diphenhydramine or benztropine.
Dystonic reactions are reversible extrapyramidal symptoms that may include involuntary spasms or sustained contractions of the face, neck, torso, pelvis, extremiti... | https://bit.ly/3LH7lCu |
025 | A 69-year-old patient presents to the emergency department with shortness of breath and substernal pain. The patient has a medical history of obesity, anxiety, and constipation. He is currently not taking any medications and has not filled his prescriptions for over 1 year. An ECG is obtained and is seen in Figure A. T... | {
"A": "Add nifedipine",
"B": "Add lisinopril",
"C": "Add hydrochlorothiazide",
"D": "Continue current medications and schedule follow up",
"E": ""
} | B | This patient is presenting after a myocardial infarction for a follow-up appointment. The most appropriate next step in management is to start an angiotensin-converting enzyme (ACE) inhibitor such as lisinopril.
When a patient experiences a myocardial infarction, there are certain medications that the patient should b... | https://bit.ly/3LKCkh8 |
026 | A 65-year-old man presents to the emergency department with low back pain. The pain started 6 hours ago when he was gardening and carrying a heavy bag. The pain is rated as 10/10 in severity and radiates down the posterior aspect of the right thigh. He reports no fevers or chills. His only medical problem is hypertensi... | {
"A": "Acute inflammatory demyelinating polyneuropathy",
"B": "L5/S1 disc herniation",
"C": "Spinal stenosis",
"D": "Cauda equina syndrome",
"E": ""
} | D | This patient presenting with acute, severe, radiating low back pain with sensorimotor deficits (3/5 strength in hip extension, knee flexion/extension, plantar flexion, reduced sensation to pinprick) in multiple nerve root distributions (L3-S5), lower motor neuron signs, urinary incontinence (wet underwear), and acute u... | https://bit.ly/3LSMEDm |
027 | A 27-year-old man presents to the emergency department with altered mental status. He has become gradually more confused over the past several days. His wife also notes he has had diarrhea, nausea and vomiting, and abdominal pain for the past week. The patient has a history of depression and multiple suicide attempts. ... | {
"A": "Arsenic",
"B": "Cyanide",
"C": "Acetaminophen",
"D": "Iron",
"E": ""
} | A | This patient who works in the semiconductor industry and presents with confusion, hypotension, tachycardia, a garlic odor, and Mees lines (Figure A) most likely has arsenic poisoning.
Arsenic poisoning can occur due to exposure to contaminated drinking water, industrial jobs, insecticides, and certain preservatives. A... | https://bit.ly/3LX4YvI |
028 | A 14-year-old boy presents to his pediatrician with a 2-month history of intermittent arm and leg spasms. He says that the spasms usually occur after he wakes up as he is getting ready for school, and consist of disorganized jerking motions that stop after a few minutes. He has also noticed that they occur when he stay... | {
"A": "Alcohol intoxication",
"B": "Cannabinoid use",
"C": "Juvenile myoclonic epilepsy",
"D": "Absence seizures",
"E": ""
} | C | This patient who presents with intermittent jerking of his extremities that occur primarily after waking up or when sleep-deprived most likely has juvenile myoclonic epilepsy.
Juvenile myoclonic epilepsy (JME) is a poorly understood condition that presents with intermittent myoclonic jerks of the extremities. These my... | https://bit.ly/3LZVzD7 |
029 | A 25-year-old man presents to his primary care provider for a routine appointment. He feels well and has no complaints. His medical and surgical history is significant for the reconstruction of a torn anterior cruciate ligament in his right knee. His family history is significant for a mother with “thyroid problems” an... | {
"A": "Elevated serum prolactin level",
"B": "Elevated serum calcium level",
"C": "Elevated plasma metanephrines",
"D": "Fasting hypoglycemia",
"E": ""
} | C | This patient presents with tall stature, mucosal neuromas of the lips and tongue, an isolated thyroid nodule, and a family history of thyroid disease, which suggests a diagnosis of multiple endocrine neoplasia type 2 (MEN2B). MEN2B is also associated with pheochromocytomas, which cause elevated plasma metanephrines.
M... | https://bit.ly/3LbQCXB |
030 | A 54-year-old man is brought to the emergency department following a skiing accident. The patient lost control of his skis and collided with a tree. He lost consciousness for about 30 seconds. When he woke up, he was mildly confused but able to ski down the rest of the mountain. The patient initially denied medical tre... | {
"A": "Damage to the sphenoid bone",
"B": "Damage to the cerebral bridging veins",
"C": "Secondary hemorrhage into prior area of infarction",
"D": "Occlusion of cerebral small penetrating arteries",
"E": ""
} | A | This patient presents with a lucid interval followed by worsening somnolence and a biconvex lesion on head CT, which suggests a diagnosis of acute epidural hematoma. Acute epidural hematomas are most commonly caused by damage to the middle meningeal artery from trauma to the sphenoid bone.
Patients with an epidural he... | https://bit.ly/3LeIdlx |
031 | A 36-year-old man presents to the office for follow up after initiating antidepressant therapy. Two months ago, he was started on citalopram after several weeks of depressed mood, loss of interest in activities, depressed appetite, and inability to sleep. Today, he reports minimal improvement in his symptoms. He had so... | {
"A": "Switch to paroxetine",
"B": "Switch to phenelzine",
"C": "Electroconvulsive therapy",
"D": "Add mirtazapine",
"E": ""
} | D | This patient is being treated for depression without improvement in his symptoms after 6 weeks of medication use. In the setting of his reduced appetite and trouble sleeping, mirtazapine is an appropriate medication to add.
SSRIs (including paroxetine, citalopram, fluvoxamine, sertraline, and fluoxetine) are the first... | https://bit.ly/3Lm4zC8 |
032 | A 28-year-old woman presents to her primary care provider with a headache. Every few weeks she has an episode of a right-sided, throbbing headache. The episodes began several years ago and are accompanied by nausea and bright spots in her vision. The headache usually subsides if she lies still in a dark, quiet room for... | {
"A": "Topiramate",
"B": "Sumatriptan",
"C": "Acetazolamide",
"D": "High-flow oxygen",
"E": ""
} | B | This patient presents with episodic, unilateral throbbing headaches with photophobia, which suggests a diagnosis of migraine. The most appropriate treatment during these episodes is an abortive medication such as sumatriptan.
Migraines present with unilateral, "throbbing" pain and are associated with nausea and vomiti... | https://bit.ly/3LoaHJF |
033 | A 26-year-old medical student presents to occupational health after sustaining a needlestick injury. She was drawing blood from an HIV-positive patient when she stuck herself percutaneously while capping the needle. She immediately washed the puncture wound with saline. The medical student has had a negative HIV serolo... | {
"A": "Repeat HIV serology and initiate triple antiretroviral therapy if negative",
"B": "Immediately initiate triple antiretroviral therapy",
"C": "Repeat HIV serology and initiate triple antiretroviral therapy if positive",
"D": "Repeat HIV serology and initiate triple antiretroviral therapy immediately",
... | D | This medical student has sustained a hollow-bore needlestick injury. The most appropriate next step is to repeat HIV serology and immediately initiate triple antiretroviral therapy with tenofovir, emtricitabine, and raltegravir.
Healthcare exposures to HIV are divided into 2 categories based on the level of contact wi... | https://bit.ly/3M2S7YO |
034 | A 23-year-old woman presents to the emergency department complaining of a worsening headache. The headache started 1 month ago. It is constant and “all over” but gets worse when she is lying down or in the setting of bright lights. A review of systems is significant for a low-grade fever, night sweats, cough, malaise, ... | {
"A": "Fluconazole",
"B": "Dexamethasone",
"C": "Acyclovir",
"D": "Amphotericin B and 5-flucytosine",
"E": ""
} | D | The patient with a history of unprotected sex and intravenous drug use who presents with sub-acute fever, meningismus, photophobia, a low CD4+ count, and a positive India ink-stained lumbar puncture most likely has cryptococcal meningitis. Acute treatment for cryptococcal meningitis is intrathecal amphotericin B and 5-... | https://bit.ly/3MCzFqw |
035 | A 16-year-old boy presents to his primary care physician for a routine follow-up visit. He feels disappointed because his voice has not changed. He is concerned that he is not as tall as his classmates. He denies any headache, vision changes, nausea, or vomiting. He recently started playing for his high school basketba... | {
"A": "Testicular ultrasound",
"B": "Radiograph of the hand and wrist",
"C": "Karyotyping",
"D": "Reassurance with close follow-up",
"E": ""
} | B | This patient is greater than 14 years of age without the development of secondary sex characteristics (e.g., testicular volume < 4 mL), which is concerning for delayed puberty. The patient should have a radiograph of the hand and wrist to evaluate for discrepancies between bone age and chronological age.
Delayed puber... | https://bit.ly/3MdLLon |
036 | A 55-year-old man presents to the emergency department with nausea and vomiting for the past week. He decided to come in when his symptoms worsened. He feels that his symptoms are exacerbated with large fatty meals and when he drinks alcohol. His wife recently returned from a cruise with symptoms of vomiting and diarrh... | {
"A": "Adhesions",
"B": "Enteric nervous system damage",
"C": "Impacted stool",
"D": "Twisting of the bowel",
"E": ""
} | A | This patient is presenting with abdominal pain and a tympanitic abdomen, which are symptoms suggestive of a small bowel obstruction. In developed countries, these typically occur secondary to adhesions.
Small bowel obstructions (SBO) typically present with an absence of bowel sounds, bowel movements, and flatus, as we... | https://bit.ly/3MoRM2B |
037 | A 69-year-old man presents to the emergency department with shortness of breath. The patient has presented 3 times this month with similar complaints. He states his shortness of breath started when he was walking from his car to a local restaurant. He does not see a primary care physician and is not currently taking an... | {
"A": "D",
"B": "E",
"C": "A",
"D": "C",
"E": ""
} | D | This patient is presenting with symptoms of heart failure (CHF). The most likely laboratory abnormalities are elevated brain natriuretic peptide (BNP), high anti-diuretic hormone (ADH), low sodium, and low potassium.
Heart failure is characterized by the decreased performance of the cardiac ventricles resulting in ven... | https://bit.ly/3Mqa3f2 |
038 | A 72-year-old man presents to his primary care physician with weakness. He has felt very weak every morning with his symptoms persisting throughout the day. He notes minor improvement when he rides his bike but otherwise has not noticed any change in his symptoms with rest or ibuprofen use. The patient has lost 12 poun... | {
"A": "CT scan of the chest",
"B": "Electromyography",
"C": "Lung biopsy",
"D": "Muscle biopsy",
"E": ""
} | B | This patient who presents with weakness that improves with activity in the setting of a lung mass most likely has Lambert-Eaton syndrome. The most appropriate diagnostic test to confirm this syndrome is electromyography.
Small cell lung cancer presents with fatigue, weight loss, cough, and a coin lesion on chest radio... | https://bit.ly/3Mv3U1Q |
039 | A 59-year-old woman presents to her primary care physician for trouble sleeping. When she goes to bed at night, she has an urge to get up out of bed and walk around. The patient often wakes her husband when she does this which irritates him. There is a perpetual uneasiness and feeling of a need to move at night which i... | {
"A": "Alprazolam",
"B": "Iron studies",
"C": "Pramipexole",
"D": "Supportive therapy and an exercise routine",
"E": ""
} | B | This patient is presenting with the need to get up and walk around at night, which is suggestive of restless leg syndrome. The most appropriate initial step in management is collecting iron studies to assess for iron deficiency.
Restless leg syndrome presents with a sustained sense of restlessness and a feeling of a n... | https://bit.ly/3Mv8f5p |
040 | A 57-year-old man is brought to a neurologist by his wife for abnormal behavior. He was normal until around 3 months ago when he started forgetting important meetings and misplacing items around the house. One month ago, the patient was fired from his job as a software engineer after attempting to grope a coworker. The... | {
"A": "Alzheimer disease",
"B": "Creutzfeldt-Jacob disease",
"C": "Frontotemporal dementia",
"D": "Subcortical leukoencephalopathy",
"E": ""
} | B | This patient with rapidly progressive dementia over 3 months, declining executive function, impaired concentration, decreased memory, startle myoclonus (sudden jerking of extremities in response to unexpected stimulus), and elevated 14-3-3 protein levels on cerebrospinal fluid (CSF) analysis most likely has Creutzfeldt... | https://bit.ly/3My1xLG |
041 | A 39-year-old man presents to his doctor for a wellness checkup. He is concerned about a rash that does not seem to be improving. He was recently exposed to his grandfather who has vesicular lesions on his skin and is being treated. He has a family history of skin cancer, colon cancer, and ovarian cancer. The patient h... | {
"A": "Benign capillary proliferation",
"B": "Edema of the epidermis",
"C": "Healthy dermatologic development",
"D": "Viral infection",
"E": ""
} | A | This patient who presents with red raised papules is presenting with a cherry angioma. These lesions are composed of benign capillary proliferations.
Cherry angiomas present with cherry red macules/papules that occur secondary to benign capillary and venule proliferation. The lesions are entirely benign and are cosmet... | https://bit.ly/3N80FxZ |
042 | A 71-year-old man arrives to the emergency room appearing cyanotic and having weak, shallow respirations. He is brought in by his home care nurse, who reports that the patient has a history of myasthenia gravis and frequent urinary tract infections. The patient was in his normal state of health until 5 days ago when he... | {
"A": "Edrophonium",
"B": "Plasmapheresis",
"C": "Thymectomy",
"D": "Atropine",
"E": ""
} | B | This patient is presenting with a history of myasthenia gravis, recent exposure to an aminoglycoside, and respiratory failure, suggesting a diagnosis of myasthenic crisis. The most appropriate initial step in management is intubation and plasmapheresis.
Myasthenic crisis is an exacerbation of myasthenia gravis caused ... | https://bit.ly/3N81HdG |
043 | A 17-year-old high school student was in shop class when he accidentally sawed off a portion of his right index finger. The teacher applied dressings and pressure to the patient's injured digit and immediately transported the patient to the emergency department. He arrived within 20 minutes of the accident. The patient... | {
"A": "Rinse the finger in normal saline, wrap the finger in moist gauze, put in a plastic bag, and place the bag in ice water",
"B": "Wrap the finger in moist gauze and place in a plastic bag",
"C": "Submerge the finger in ice water",
"D": "Rinse the finger with hydrogen peroxide, wrap the finger in moist gau... | A | This patient is presenting with a fingertip amputation with loss of pulp, nail, and bone (with a possibility for surgical reattachment and repair, efforts should be made to recover the severed tissue). The correct way to transport an amputated digit is to rinse the finger in normal saline to remove gross contaminants, ... | https://bit.ly/3NOcdHz |
044 | A 4-year-old boy is brought in by his grandmother for worsening seizure activity. She reports that occasionally he “suddenly drops” when running around the house. She says that his first seizure occurred 1 year ago. Since then, he has been on valproic acid but the seizure activity remains unchanged. He was recently enr... | {
"A": "Implant a pacemaker",
"B": "Replete potassium and magnesium and start a beta-blocker",
"C": "Start ethosuximide",
"D": "Administer intravenous lorazepam",
"E": ""
} | B | The patient who presents with deafness and long QT syndrome that progressed to torsades de pointes most likely has Jervell and Lange-Nielsen syndrome. The most appropriate next step in management is to replete potassium and magnesium and then start a beta-blocker.
Jervell and Lange-Nielsen syndrome is an autosomal rec... | https://bit.ly/3O2B9LC |
045 | A 69-year-old man presents to clinic due to shortness of breath, worsening pain in his right shoulder, and episodes of hemoptysis. His symptoms began 3 months ago. He has also lost 18 pounds. He has a history of coronary artery disease and underwent an uncomplicated coronary angioplasty with stent placement 2 years ago... | {
"A": "Lung adenocarcinoma",
"B": "Mesothelioma",
"C": "Rotator cuff tendinopathy",
"D": "Tuberculosis",
"E": ""
} | A | This elderly patient with an extensive smoking history is presenting with hemoptysis, weight loss, and shortness of breath. Combined with neurological findings in the ulnar nerve distribution (paresthesias in fourth and fifth digits) and imaging evidence of a superior right lung mass, the most likely diagnosis is a Pan... | https://bit.ly/3OFDpHw |
046 | A 57-year-old man presents to the emergency department for weight loss and abdominal pain. The patient has felt steadily more fatigued over the past month and has lost 22 pounds without effort. Today, he fainted prompting his presentation. The patient has no significant medical history. He does have a 33-pack-year smok... | {
"A": "Intellectualization",
"B": "Pessimism",
"C": "Rationalization",
"D": "Optimism",
"E": ""
} | A | This patient is using facts and logic to emotionally distance himself from his stressful diagnosis. This ego defense method is suggestive of intellectualization.
Intellectualization typically occurs in patients who have received a very stressful diagnosis or bad news for a close loved one. They will often focus on the... | https://bit.ly/3OGVR2b |
047 | A 56-year-old woman presents to the emergency department with muscle weakness. Her symptoms have progressively worsened over the course of 2 weeks and are most significant in her lower extremities. She also notices increased urinary frequency. Approximately 1 month ago, she was diagnosed with calcium phosphate nephroli... | {
"A": "Administer intravenous sodium bicarbonate",
"B": "Begin potassium replacement therapy with dextrose",
"C": "Increase methotrexate dose",
"D": "Administer intravenous insulin",
"E": ""
} | A | This patient's non-anion gap metabolic acidosis, hypokalemia, alkaline urine, and history of a calcium phosphate kidney stone and rheumatoid arthritis are suggestive of type 1 (distal) renal tubular acidosis. The treatment of choice is alkali replacement (sodium bicarbonate).
Type 1 (distal) renal tubular acidosis res... | https://bit.ly/3OXaArd |
048 | A 26-year-old man presents to the emergency department with fatigue and dark urine over the past day. He was recently diagnosed with cellulitis of his left leg, for which he was prescribed trimethoprim-sulfamethoxazole. He denies having nausea, vomiting, or diarrhea. He has no significant medical history and does not c... | {
"A": "Schistocytes",
"B": "Codocytes",
"C": "Acanthocytes",
"D": "Degmacytes",
"E": ""
} | D | This patient presents with hemolytic anemia (low hemoglobin, elevated indirect bilirubin, and elevated lactate dehydrogenase) shortly after starting a sulfa medication (trimethoprim-sulfamethoxazole) in the setting of likely glucose-6-phosphate dehydrogenase deficiency. Degmacytes ("bite cells") will be seen on periphe... | https://bit.ly/3OhgJgC |
049 | A 41-year-old man presents to his primary care provider with a 2-month history of abdominal pain. He says that the pain “comes and goes” throughout the day and usually lasts 20-30 minutes per episode. The pain is above his umbilicus. He denies any feeling of regurgitation or nighttime cough but endorses nausea. He used... | {
"A": "Crypt abscesses in the large intestine",
"B": "Mucosal defect in the stomach",
"C": "Noncaseating granulomas in the small intestine",
"D": "Urease-producing organism in the small intestine",
"E": ""
} | D | This patient presents with episodic epigastric pain and nausea that improves with the consumption of food, which suggests a diagnosis of a duodenal ulcer. Duodenal ulcers are often caused by infection with Helicobacter pylori, a urease-producing organism.
Duodenal ulcers are erosions and defects in the mucosal lining ... | https://bit.ly/3OrGevt |
050 | A 23-year-old woman presents to the emergency department for evaluation of fever and chills over the last several days along with a progressive rash and diarrhea. She had nasal septoplasty performed 1 week prior and has had nasal packing in place since that time. Her rash has progressed and the skin on her hands is "pe... | {
"A": "Rhinovirus",
"B": "Borrelia burgdorferi",
"C": "Staphylococcus aureus",
"D": "Rickettsia rickettsii",
"E": ""
} | C | This patient with fever, diarrhea, and a diffuse, erythematous rash with prolonged nasal packing in place likely has developed toxic shock syndrome. Toxic shock syndrome occurs most commonly due to infection with Staphylococcus aureus.
Toxic shock syndrome (TSS) occurs due to infection with Staphylococcal or Streptoco... | https://bit.ly/3OvFRS0 |
051 | A 68-year-old woman presents to her primary care provider for dizziness. She often feels lightheaded and like she may “pass out” but never actually loses consciousness. She denies dyspnea on exertion or orthopnea. The patient had a myocardial infarction 6 months ago, and she now has multiple drug-eluting stents. Her EC... | {
"A": "Bundle branches",
"B": "Bundle of His",
"C": "Atrioventricular node",
"D": "Sinoatrial node",
"E": ""
} | C | This patient who presents with lightheadedness and is found to have progressive prolongation of the PR interval on ECG most likely has Mobitz type 1 (Wenckebach) 2nd-degree heart block. Mobitz type 1 heart block is usually caused by atrioventricular node dysfunction.
Second degree heart block can be divided into Mobit... | https://bit.ly/3P1O8fD |
052 | A 37-year-old woman presents to her physician for mood changes and recent falls over the course of 3 months. She feels more irritable with her husband and children and does not find pleasure in creating art anymore. Over the last 2 weeks, she has been sleeping approximately 5 hours a night and had a fall while walking ... | {
"A": "Subtherapeutic levothyroxine dose",
"B": "Reduced functional parietal cell count",
"C": "Reduced central nervous system dopamine and serotonin",
"D": "Poor iron absorption",
"E": ""
} | B | This patient's mood changes and findings concerning for subacute combined degeneration (fall in the dark, impaired proprioception, weakness, and brisk patellar reflexes), and history of Roux-en-Y gastric bypass surgery are concerning for vitamin B12 deficiency. Roux-en-y gastric bypass reduces parietal cell count, lead... | https://bit.ly/3P8eDBc |
053 | A 3-month-old boy presents to the pediatrician with his mother for a well-child visit. The patient drinks 4 ounces of cow’s milk formula every 3 hours. He usually stools 1 time per day and urinates up to 6 times per day. He regurgitates a moderate amount of formula through his nose and mouth after most feeds. He does n... | {
"A": "Provide reassurance",
"B": "Counsel on positioning and thickening feeds",
"C": "Obtain abdominal ultrasound",
"D": "Initiate proton pump inhibitor",
"E": ""
} | B | This patient presents with frequent regurgitation after feeding, worsening irritability, feeding aversion, and poor weight gain, which is concerning for gastroesophageal reflux disease (GERD). The most appropriate next step in management is counseling on proper positioning and thickening feeds.
Infants with GERD may p... | https://bit.ly/3PAOhbu |
054 | A 35-year-old man presents to the emergency department with altered mental status. He was found by his roommate to be disoriented this morning. He had complained of a right-sided headache for the past 5 days. He has a history of human immunodeficiency virus (HIV) infection being treated with bictegravir, emtricitabine,... | {
"A": "Bacterial meningitis",
"B": "Fungal meningitis",
"C": "Brain abscess",
"D": "Epilepsy",
"E": ""
} | C | This HIV-positive patient presents with fever, unilateral headache, altered mental status, focal neurological deficits (3/5 strength to right shoulder abduction, elbow flexion/extension, hip flexion/extension), and a generalized tonic-clonic seizure, suggestive of a brain abscess.
A brain abscess typically presents in... | https://bit.ly/3PAgPQX |
055 | A 4-week-old boy presents to the pediatrician for vomiting. The patient is breastfed and typically feeds for 20-30 minutes every 2 hours. One week ago, he began vomiting and regurgitating breastmilk through his nose after most feedings. His stools over the past week have also become blood-streaked. The patient does not... | {
"A": "Obtain abdominal ultrasound",
"B": "Initiate a proton pump inhibitor",
"C": "Switch to hydrolyzed formula",
"D": "Modify mother's diet",
"E": ""
} | D | This infant presents with vomiting, bloody stools, and poor weight gain, which suggests a diagnosis of milk-protein allergy. The most appropriate next step in management is the modification of the mother’s diet to eliminate cow’s milk and soy.
Infant food protein-induced proctocolitis is caused by distal colon inflamm... | https://bit.ly/3PCWiwF |
056 | A 26-year-old man presents to his primary care physician with a 6-month history of increasing lower back pain. He first felt the pain while lifting boxes at work but thought that he had just strained a muscle. The pain appears to be worse in the mornings and after rest. Exercise and physical activity appear to temporar... | {
"A": "Radiograph",
"B": "Bone scan",
"C": "Magnetic resonance imaging",
"D": "Ultrasound",
"E": ""
} | C | This young man presents with low back pain that is relieved by physical activity, decreased spinal mobility, enthesitis of his patellar tendons, and elevated ESR/CRP values most likely has ankylosing spondylitis (AS). The most accurate diagnostic test for early ankylosing spondylitis is MRI.
Multiple imaging tests can... | https://bit.ly/3PkQ1FJ |
057 | A 2-year-old girl presents to the pediatrician with her mother for a routine well-child visit. Her mother is concerned that the patient is a picky eater and refuses to eat vegetables. She drinks milk with meals and has juice sparingly. She goes to sleep easily at night and usually sleeps for 11-12 hours. The patient ha... | {
"A": "Fine motor skills",
"B": "Social and receptive language skills",
"C": "This child is developmentally normal",
"D": "Expressive language skills",
"E": ""
} | D | This child is meeting her milestones in every category but expressive language. By 2 years of age, a child should have a vocabulary of over 50 words and be using 2-word phrases.
Assessing whether a child is meeting developmental milestones is important for identifying delays and enabling early intervention. In the gro... | https://bit.ly/3Pmj3mJ |
058 | A 59-year-old man presents accompanied by his wife with nausea and dizziness. He is unsure when his symptoms started, but they have been affecting him for “a while.” It began as episodes of “unsteadiness” that progressed to a feeling of “spinning.” He cannot tell if his symptoms change with position but reports that if... | {
"A": "Low-salt diet",
"B": "Thiamine",
"C": "Epley maneuver",
"D": "Meclizine",
"E": ""
} | A | This patient is presenting with chronic vertigo, hearing loss, and horizontal nystagmus, which is suggestive of Meniere disease. The most appropriate initial step in the management of this disease is a low-salt diet.
Meniere disease is caused by an abnormal accumulation of endolymph within the inner ear. Symptoms will... | https://bit.ly/3PrMDbI |
059 | A 66-year-old woman presents to the emergency room after experiencing a tonic-clonic seizure. She has been having worsening headaches and intermittent nausea over the past 5 months. The headaches are constant and dull, and they typically worsen when she sneezes or laughs. Recently, she has become increasingly nauseous ... | {
"A": "Glioblastoma multiforme",
"B": "Cerebral toxoplasmosis",
"C": "Neurosarcoidosis",
"D": "Hemorrhagic stroke",
"E": ""
} | A | This patient is presenting with symptoms of increased intracranial pressure (i.e., positional headaches, nausea, vomiting, and papilledema). Combined with her CT finding of a space-occupying butterfly-shaped lesion, the most likely diagnosis is glioblastoma multiforme.
Glioblastoma multiforme is the most common malign... | https://bit.ly/3Pv88aE |
060 | A 51-year-old man presents for his annual wellness visit with his primary care physician. His wife has noticed a tremor while he is working on his car and knows that his father died of Parkinson disease. He says that the tremor is nothing to worry about and only occurs during a few activities such as pouring drinks, po... | {
"A": "Alcoholics anonymous",
"B": "Aripiprazole",
"C": "Phenobarbital",
"D": "Propranolol",
"E": ""
} | D | This patient who presents with a tremor that only occurs during terminal activity and is likely improved by alcohol (hence why he drinks prior to working on the car) has benign essential tremor. This is best treated with propranolol.
Benign essential tremor is a type of rhythmic oscillatory movement that occurs with p... | https://bit.ly/3Q3WlAi |
061 | A girl presents to her pediatrician for a well-child visit. Her mother reports that she is eating well at home and sleeping well throughout the night. She can jump and walk up and down stairs with both feet on each step. In the doctor’s office, the patient builds a 6-cube tower and imitates a circle. She seems to have ... | {
"A": "Cuts with scissors",
"B": "Turns pages in book",
"C": "Follows two-step commands",
"D": "Points to one body part",
"E": ""
} | C | This patient is able to walk up and down stairs, can build a 6 cube tower, has a 50+ word vocabulary, and uses 2-word phrases, which suggests she is 2 years of age. Another milestone at 2 years of age is following 2-step commands.
In the gross motor category, a child at 2 years of age should be able to jump and walk u... | https://bit.ly/3Q5BZZe |
062 | A 55-year-old woman is brought to the emergency department by her husband with a 1 hour history of an unremitting headache. The headache started suddenly while she was eating dinner and she says it feels like the “worst headache of my life.” An emergent CT scan of the head without contrast confirms the diagnosis, and a... | {
"A": "Cerebral salt wasting",
"B": "Diuretic overuse",
"C": "Primary polydipsia",
"D": "Syndrome of inappropriate anti-diuretic hormone",
"E": ""
} | A | This patient presents with a subarachnoid hemorrhage (“worst headache of my life”) which is treated and then subsequently develops nausea, vomiting, and altered mental status with reduced serum sodium concentration, indicative of symptomatic hyponatremia. In the setting of serum hypo-osmolality, urine hyper-osmolality,... | https://bit.ly/3QOJp1p |
063 | A 35-year-old man is brought into the emergency department by ambulance for a stab wound to the left leg near the inguinal ligament. The patient has no significant medical history, and takes no other medication. He was not stabbed or otherwise injured elsewhere. His temperature is 98.6°F (37.0°C), pulse is 130, blood p... | {
"A": "Emergent surgical intervention",
"B": "Wound closure",
"C": "Observation",
"D": "CT scan of the left lower extremity",
"E": ""
} | A | This patient with pulsatile bleeding from a wound to the left thigh and hemodynamic instability has hard signs of vascular injury. Patients with penetrating wounds and hard signs of vascular injury should be managed with emergent surgical intervention.
Vascular injury commonly occurs as a result of penetrating trauma,... | https://bit.ly/3QOZdTR |
064 | A 55-year-old woman presents to the emergency department for evaluation of headache. She had a headache that was present for a few hours before subsiding 2 days ago, and then today she developed a headache that was sudden in onset and at maximal intensity within minutes. She has never had a headache like this in the pa... | {
"A": "Dehydration and stress",
"B": "Hypersensitivity of the trigeminal nerve",
"C": "Muscular pain and strain",
"D": "Rupture of a berry aneurysm",
"E": ""
} | D | This patient with sudden-onset headache, neck pain, and a CT scan showing blood in the basal cisterns likely has a subarachnoid hemorrhage. The most common cause of non-traumatic subarachnoid hemorrhage (SAH) is rupture of a saccular (berry) aneurysm.
SAH typically presents with a sudden onset "thunderclap" headache t... | https://bit.ly/3QRYhxm |
065 | A 45-year-old man presents to a physician due to difficulty swallowing and slurred speech. For the past 3 months, the patient has been coughing when he drinks liquids. His speech also sounds different according to his wife. The patient has no significant medical history. His temperature is 98.6°F (37.0°C), blood pressu... | {
"A": "Dextromethorphan and quinidine",
"B": "Tizanidine",
"C": "Riluzole",
"D": "Edaravone",
"E": ""
} | C | This patient with dysphagia (difficulty swallowing water), dysarthria (altered and slurred speech), lower motor neuron deficits (tongue fasciculations and weakness), upper motor neuron deficits (exaggerated jaw jerk reflex), and preserved sensory function most likely has amyotrophic lateral sclerosis (ALS). Riluzole, a... | https://bit.ly/3QdXJSe |
066 | A 27-year-old woman presents to her primary care physician with pain in her hands, shoulders, and knees. The pain has lasted for several months but seems to have worsened recently. Any activity such as opening jars, walking, or brushing her teeth is painful. The patient has a medical history of a suicide attempt in col... | {
"A": "Anti-cyclic citrullinated peptide antibodies",
"B": "Degenerated cartilage in weight bearing joints",
"C": "Anti-dsDNA antibodies",
"D": "Anti-histone antibodies",
"E": ""
} | C | This patient is presenting with arthralgias, pancytopenia, possible malar rash, and a history of depression/abnormal behavior. Epidemiologically, the most likely diagnosis is systemic lupus erythematosus (SLE) which is associated with anti-dsDNA antibodies.
SLE is an autoimmune disorder that most commonly occurs in yo... | https://bit.ly/3Qj2QR9 |
067 | A 68-year-old man presents to the emergency department with right ear pain that he developed 4 days prior, and it has progressively worsened. The pain is worse at night. He has associated fever and chills. This morning, he awoke with purulent, foul-smelling discharge on his pillow. He has a history of type II diabetes ... | {
"A": "Ceftriaxone",
"B": "Ofloxacin ear drops",
"C": "Amoxicillin",
"D": "Vancomycin and piperacillin-tazobactam",
"E": ""
} | D | The patient in this vignette most likely has malignant otitis externa (also referred to as necrotizing otitis externa), which is a life-threatening infection requiring therapy with intravenous anti-pseudomonal and broad-spectrum antibiotics. Piperacillin-tazobactam and vancomycin is an appropriate initial regimen.
Mal... | https://bit.ly/3QjJGL8 |
068 | A 23-year-old man presents to the emergency department for altered mental status after a finishing a marathon. He has a medical history of obesity and anxiety and is not currently taking any medications. His temperature is 104°F (40°C), blood pressure is 147/88 mmHg, pulse is 200/min, respirations are 33/min, and oxyge... | {
"A": "Dextrose solution",
"B": "Hypotonic saline",
"C": "Lactated ringer",
"D": "Normal saline",
"E": ""
} | C | This patient is presenting with hypernatremia and heat stroke for which the most appropriate next step in management is the administration of lactated ringer solution.
Heat stroke presents with hot/flushed skin, fever, altered mental status, and hypernatremia secondary to loss of free water. Patients should immediatel... | https://bit.ly/3Qni72e |
069 | A newborn boy is assessed in the newborn nursery due to central cyanosis that does not respond to oxygen therapy. The patient was born to a G1P1 mother at 39 weeks gestation. The mother had diabetes that was managed with exercise and insulin during the pregnancy. The mother has never been vaccinated and did not follow ... | {
"A": "Truncus arteriosus",
"B": "Transposition of the great vessels",
"C": "Tricuspid valve atresia",
"D": "Total anomalous pulmonary venous return",
"E": ""
} | B | This patient is presenting with right axis deviation on ECG and an "egg on a string" heart on chest radiograph suggesting a diagnosis of transposition of the great vessels.
Transposition of the great vessels occurs when the spiral septum that divides the truncus arteriosus into the aorta and pulmonary artery fails to ... | https://bit.ly/3Qq9vcA |
070 | A 2-week-old boy is evaluated by his pediatrician for abnormal feet. The patient was born at 39 weeks via vaginal delivery to a G1P1 29-year-old woman. The patient has been breastfeeding and producing 5 stools/day. He is otherwise healthy. His temperature is 99.5°F (37.5°C), blood pressure is 60/38 mmHg, pulse is 150/m... | {
"A": "Botulinum toxin injections",
"B": "Reassurance and reassessment in 1 month",
"C": "Serial casting",
"D": "Surgical pinning",
"E": ""
} | C | This patient is presenting with talipes equinovarus (congenital clubfoot) for which the most appropriate initial step in management is serial casting using the Ponseti method.
Talipes equinovarus is described clinically as a foot that is cavus, adductus, varus, and equinus. Cavus occurs when the forefoot is pronated r... | https://bit.ly/3QrrmQ1 |
071 | A 70-year-old woman is brought to the emergency department by ambulance. She was found on the floor of her apartment after her neighbor called 911. She is confused and is unable to provide any history, but complains of generalized pain. Her temperature is 99.2°F (37.3°C), blood pressure is 129/64 mmHg, pulse is 63/min,... | {
"A": "Albuterol and IV fluid resuscitation",
"B": "Calcium gluconate",
"C": "IV fluid resuscitation",
"D": "Sodium polystyrene sulfonate",
"E": ""
} | B | This patient with confusion, dark urine, and peaked T waves on electrocardiogram in the setting of a prolonged time spent down likely has developed rhabdomyolysis with associated hyperkalemia. For patients with suspected hyperkalemia and electrocardiogram changes, the most appropriate next step in management is treatme... | https://bit.ly/3R0iH7u |
072 | A 51-year-old man presents to his primary care provider for intermittent shaking of his hands. For the last several years he has noticed this "shaking" when he brushes his teeth and prepares a cup of coffee in the morning. The shaking then gradually improves over the course of the day. His medical history is otherwise ... | {
"A": "Alprazolam",
"B": "Primidone",
"C": "Propranolol",
"D": "Topiramate",
"E": ""
} | C | This patient presents with a high frequency bilateral action tremor, which suggests a diagnosis of benign essential tremor. In light of his concomitant hypertension, the patient should be started on propranolol.
Benign essential tremor usually presents as a bilateral tremor of the hands that is observed during fine mo... | https://bit.ly/3RGVt6x |
073 | A 24-year-old man with epilepsy refractory to valproic acid, phenytoin, and levetiracetam undergoes magnetic resonance imaging of his brain while monitored by anesthetic care. He wakes up screaming in pain due to an electrocardiogram lead having caused a significant thermal burn circumferentially around his left leg. H... | {
"A": "Amputation",
"B": "Escharotomy",
"C": "Fasciotomy",
"D": "Intravenous fluid infusion based on Parkland formula",
"E": ""
} | B | This patient with a circumferential burn due to an ECG cable wrapped around his leg in an MRI machine now has clear evidence of compartment syndrome due to the eschar. The most appropriate next step in management is emergent escharotomy to restore blood flow.
Burns can be caused by chemical, thermal, electrical, and r... | https://bit.ly/3RSgtYc |
074 | A 2-year-old boy is brought to the pediatrician’s office for a well-child visit. The parents have no concerns at this time and note he is starting to run around and speak in 3-word sentences. He has no remarkable medical history and his mother had an uncomplicated full-term pregnancy and delivery. He is appropriately m... | {
"A": "Reevaluation at the next well-child visit",
"B": "Biopsy",
"C": "Genetic testing",
"D": "Ophthalmology referral",
"E": ""
} | D | This otherwise healthy patient presents with leukocoria, or a white pupillary reflex, and requires an urgent referral to ophthalmology for further evaluation given the concern for retinoblastoma.
The differential diagnosis for leukocoria includes retinoblastoma, cataract, vitreous hemorrhage, retinal detachment, and o... | https://bit.ly/3RhK2Tp |
075 | A 57-year-old woman presents to her primary care physician with weakness for the past 6 months with symptoms that have worsened recently. She feels fatigued, depressed, and has gained 10 pounds which she attributes to feeling too weak to go to the gym. She was recently treated for an ear infection with an antibiotic wh... | {
"A": "Dermatomyositis",
"B": "Hypothyroidism",
"C": "Inclusion body myositis",
"D": "Polymyositis",
"E": ""
} | C | This patient who presents with weakness and a rash has a biopsy suggestive of inclusion body myositis.
Inclusion body myositis presents with an insidious onset of weakness, a mildly elevated CRP and CK, and a rash. A muscle biopsy in this disease will demonstrate endomysial inflammation with basophilic-rimmed vacuoles... | https://bit.ly/3SyN6Lf |
076 | A 45-year-old man with history of IV drug use presents to the outpatient clinic with a history of fever for 5 days. He also endorses sweats, headache behind the eyes, sore throat, muscle and joint pain, and a new rash seen in Figure A. He reports that he traveled to Africa last year and returned from a vacation to Thai... | {
"A": "Blood smear",
"B": "Sputum with acid fast stain",
"C": "Serologic testing",
"D": "Stool culture",
"E": ""
} | C | This patient is presenting with fever, headache with retro-orbital pain, muscle aches, joint pain, rash, leukopenia and thrombocytopenia, which are classic findings for dengue fever. The diagnostic test of choice for dengue is serology.
Dengue is a viral infection endemic to South Asia, Central and South America, and ... | https://bit.ly/3UV1eNW |
077 | A 25-year-old woman presents to her primary care physician with joint and muscle pain. She has a general aching/pain in her joints that lasts all day. The pain is constant and is not relieved by rest or activity. She also has pain in her hands at times and occasionally notices trouble swallowing when she is eating. She... | {
"A": "Anti-nuclear antibody",
"B": "Anti-IgG Fc region",
"C": "Anti-ribonuleoprotein",
"D": "Anti-dsDNA",
"E": ""
} | C | This patient is presenting with diffuse muscle/joint pain, Raynaud phenomenon, and dysphagia suggesting a diagnosis of mixed connective tissue disease. Anti-ribonucleoprotein (U1) antibodies are found in this disease.
Mixed connective tissue disease can present with a vast array of symptoms. The most common symptoms a... | https://bit.ly/3WPL8WV |
078 | A 32-year-old G1P0 presents to the antenatal testing unit at 32 weeks of gestation for a non-stress test (NST). Yesterday she had several episodes of diarrhea and vomited once after attending a company picnic 2 days ago. She took loperamide with symptomatic relief. She is worried that she is dehydrated but otherwise fe... | {
"A": "Maternal medication use",
"B": "Normal results",
"C": "Fetal sleep cycle",
"D": "Maternal smoking",
"E": ""
} | C | This patient presents with a nonreactive NST on routine testing. The most common explanation for a nonreactive NST is the fetal sleep cycle.
Patients with gestational diabetes are at increased risk of fetal demise and other perinatal complications. They require closer monitoring during the 3rd trimester of pregnancy. ... | https://bit.ly/3Waen6G |
079 | A 27-year-old G1P0000 woman presents to her obstetrician’s office at 24 weeks gestation complaining of new hair growth on her upper lip. She now needs to shave her face every day or else thick hair appears. She also has worsening acne that started several weeks ago. Her pregnancy thus far has been complicated by gestat... | {
"A": "Spironolactone to treat hirsutism and acne",
"B": "Laparoscopy to remove a malignancy",
"C": "Reassurance",
"D": "Percutaneous umbilical blood sampling to determine prognosis",
"E": ""
} | C | This patient presents with hirsutism and acne, symptoms of hyperandrogenism, as well as a solid pelvic mass on ultrasound, most consistent with a luteoma. The most appropriate next step in management is reassurance as the mass tends to self-resolve after pregnancy.
Luteomas are ovarian tumors that arise during pregnan... | https://bit.ly/3YmWmmI |
080 | A 6-year-old boy is brought to the emergency department by his father for elbow pain. He was riding his bicycle when he fell onto his outstretched right hand. He immediately clutched his right elbow in pain and began crying. He refuses to move his elbow. He has no medical problems and takes no medications. His temperat... | {
"A": "Distal radius fracture",
"B": "Both bone forearm fracture",
"C": "Supracondylar humerus fracture",
"D": "Olecranon fracture",
"E": ""
} | C | This young patient presenting with elbow pain and associated signs of anterior interosseous nerve neurapraxia (inability to make pincer, weak pincer grasp) and vascular injury (diminished radial pulse) after a fall on an outstretched hand most likely has a supracondylar humerus fracture.
Supracondylar humerus fracture... | https://bit.ly/3ZAMN3W |
081 | A 25-year-old man presents to his gastroenterologist for trouble swallowing. Whenever he eats solids, he regurgitates them back up. Given this patient's suspected diagnosis, the gastroenterologist performs a diagnostic test. Several hours later, the patient presents to the emergency department with chest pain and short... | {
"A": "Barium swallow",
"B": "Urgent surgery",
"C": "Magnetic resonance imaging",
"D": "Gastrografin swallow",
"E": ""
} | D | This patient is presenting with chest pain and palpable crepitus after endoscopy suggesting a diagnosis of esophageal perforation. The most appropriate next step in management is a gastrografin swallow.
Esophageal perforation presents with severe chest pain and palpable crepitus typically occurring after endoscopy or ... | https://bit.ly/3ZLKJGM |
082 | A 4-day-old girl presents with her parents to the pediatrician for a routine visit. She was feeding well until this morning when she had several episodes of vomiting. The parents describe the vomitus as “bright green” and the patient has shown little interest in feeding since then. She was born at 36 weeks gestation to... | {
"A": "Hirschsprung disease",
"B": "Duodenal atresia",
"C": "Meconium ileus",
"D": "Intestinal malrotation",
"E": ""
} | D | This patient presents with bilious vomiting and an upper gastrointestinal series demonstrating the “corkscrew” appearance of the distal duodenum and proximal jejunum, which is consistent with a diagnosis of intestinal malrotation.
Intestinal malrotation most commonly presents in newborns with bilious emesis. This cond... | https://bit.ly/3ZgT30W |
083 | A 27-year-old woman presents to the emergency department with altered mental status. Her boyfriend found her at home next to a suicide note and brought her into the emergency department. According to her boyfriend, the patient has a medical history of bipolar disorder for which she takes lithium, as well as chronic low... | {
"A": "Miosis",
"B": "Diaphoresis",
"C": "Urinary retention",
"D": "Wheezing",
"E": ""
} | C | This patient is presenting after a suicide attempt with an unknown overdose and is confused, febrile, tachycardic, and has QRS widening on ECG. This combination of symptoms is highly concerning for a tricyclic antidepressant (TCA) overdose which can cause an anticholinergic toxidrome and urinary retention.
Tricyclic a... | https://bit.ly/3ZzPHpE |
084 | A 32-year-old man presents to his primary care provider for a headache. He reports that he has headaches at night several times a week. He first developed these headaches over 1 year ago, but they started up again 3 weeks ago. The episodes start suddenly and feel like a stabbing, electrical pain over his left eye. He a... | {
"A": "Verapamil",
"B": "Sumatriptan",
"C": "Carbamazepine",
"D": "High-flow oxygen",
"E": ""
} | A | This patient presents with an episodic, stabbing pain in the periorbital region that occurs at night, which is consistent with a diagnosis of cluster headaches. Verapamil is used as prophylaxis against cluster headaches.
Cluster headaches usually occur at night and may wake patients out of sleep. Cluster headaches may... | https://bit.ly/3n1kBse |
085 | A 67-year-old man presents to the emergency department with shortness of breath. His dyspnea began 1 hour ago while he was sitting in a chair watching television. He also endorses lightheadedness and fatigue but denies chest pain. Two weeks ago, he had a mitral valve repair for mitral insufficiency secondary to myxomat... | {
"A": "Cardioversion",
"B": "Atropine",
"C": "Procainamide",
"D": "Transvenous pacing",
"E": ""
} | D | This patient who presents with lightheadedness has an ECG consistent with a Mobitz type 2 2nd-degree heart block. Because the patient is symptomatic from his dysrhythmia and it did not respond to atropine, the most appropriate next step is transvenous pacing.
Mobitz type 2 2nd-degree heart block can be distinguished f... | https://bit.ly/3nG6FEE |
086 | A 46-year-old man presents with his wife to his primary care provider for depression and strange movements. His wife reports that her husband has not been himself for the last 2 months. Whereas he was previously outgoing and “the life of the party,” the patient is now irritable and withdrawn. He is a partner at an acco... | {
"A": "Dorsal striatum atrophy on head CT",
"B": "Neurofibrillary tangles on brain biopsy",
"C": "Alpha-synuclein aggregates on brain biopsy",
"D": "Frontotemporal atrophy on head CT",
"E": ""
} | A | This patient presents with recent mood changes, jerky movements of the upper extremities, and a history of early death in his father, which suggests a diagnosis of Huntington disease. Huntington disease is characterized by atrophy of the caudate nucleus, which is a structure of the dorsal striatum.
Huntington disease ... | https://bit.ly/3nctYpc |
087 | A 9-hour-old newborn girl is found in the newborn nursery with diffuse swelling of the scalp not present at birth. The child was born at 38 weeks of gestation to a 28-year-old G3P3 mother. The mother went into spontaneous labor but the delivery was complicated by a prolonged 2nd stage of labor. A vacuum-assisted vagina... | {
"A": "Between periosteum and galea aponeurosis",
"B": "Between periosteum and skull",
"C": "Between scalp and galea aponeurosis",
"D": "Into the lateral ventricles",
"E": ""
} | C | This patient presents following a vacuum-assisted vaginal delivery with an ecchymotic swelling of the scalp that crosses the midline, which suggests a diagnosis of caput succedaneum. Caput succedaneum is caused by bleeding between the skin and the galea aponeurosis.
Caput succedaneum is an uncommon extracranial injury... | https://bit.ly/3oZgxd5 |
088 | A 25-year-old woman is brought to the emergency department by her family. They found her somnolent next to her computer with an empty pill bottle around 3 hours ago. The family cannot recall the types of pill bottles that they found and did not bring them to the ED. The patient's medical history is notable for anxiety,... | {
"A": "Lactated ringer bolus",
"B": "N-acetylcysteine",
"C": "Charcoal",
"D": "Syrup of ipecac",
"E": ""
} | B | This patient is presenting with acute acetaminophen intoxication. The most appropriate next step in management is to administer the antidote N-acetyl cysteine (NAC).
In a toxicology case where the ingestion is unknown, the most appropriate initial step in management is to begin treatment empirically with IV fluids, ch... | https://bit.ly/3om7HFU |
089 | A 65-year-old man presents to the emergency department for evaluation of left arm and leg weakness. He was walking in the park about 45 minutes prior to arrival when the patient stumbled and fell. He had sudden weakness in his left leg and was unable to grasp a handrail with his left hand. He currently takes no medicat... | {
"A": "Aspirin",
"B": "Rivaroxaban",
"C": "Cardiac pacemaker",
"D": "Atorvastatin",
"E": ""
} | B | This patient presents with acute onset unilateral left-sided weakness secondary to an ischemic stroke in the right MCA in the setting of an irregularly irregular rhythm without P waves (suggesting that he had an embolic stroke secondary to atrial fibrillation). First-line primary and secondary stroke prevention in pati... | https://bit.ly/3pOkYrN |
090 | A 62-year-old man presents to the emergency department with skin lesions. He felt itchy recently, then noticed skin lesions that broke out prompting him to come to the emergency department. He recently went camping and hiking in the woods. The patient drinks 1-2 beers per day and smokes 1 pack of cigarettes per day. He... | {
"A": "IgG in a fish-net pattern",
"B": "Type IV hypersensitivity reaction",
"C": "Linear IgG along the basement membrane",
"D": "Multi-nucleated giant cells",
"E": ""
} | C | This patient is presenting with pruritic bullous skin lesions with a thick/tough covering suggesting a diagnosis of bullous pemphigoid. Linear IgG binding of anti-hemidesmosome antibodies along the basement membrane is the underlying cause of this disease.
Bullous pemphigoid presents with a urticarial prodrome in elde... | https://bit.ly/3qLbsG6 |
091 | A 57-year-old woman presents to the emergency department for a headache. She was at home when a sudden headache began with greater severity than she had experienced in the past. She presented within 30 minutes of symptom onset. The patient has a medical history of sinusitis, constipation, diabetes, and pelvic inflammat... | {
"A": "MRI of the head",
"B": "Piperacillin-tazobactam",
"C": "Dexamethasone",
"D": "Amoxicillin-clavulinic acid",
"E": ""
} | B | This patient is presenting with symptoms suggestive of septic cavernous sinus thrombosis (CST). The most appropriate initial step in management is urgent broad-spectrum antibiotics and surgical drainage.
Cavernous sinus thrombosis is an emergency that requires immediate intervention. It typically occurs in a patient w... | https://bit.ly/3qNCi0x |
092 | A 64-year-old woman presents to the emergency room with whole-body itching. She noticed her symptoms while in the bathtub at home. She has never had symptoms like this before. Over the previous several months she has had episodes of joint swelling and pain in her hands as well as redness, burning pain, and swelling of ... | {
"A": "Hydroxyurea",
"B": "Cyclophosphamide",
"C": "Prednisone",
"D": "Diphenhydramine",
"E": ""
} | A | This patient presents with polycythemia, leukocytosis, and thrombocytosis in the setting of pruritus after bathing, as well as episodes suggestive of acute gout flares. These findings are consistent with polycythemia vera, which can be treated with hydroxyurea.
Polycythemia vera is a malignancy of the bone marrow that... | https://bit.ly/3qUQrsf |
093 | A 27-year-old woman presents to her primary care physician with new hair growth on her face and lower abdomen over the last month. She has started to develop pimples on her face and back over the last several months. Her last menstrual period was over 3 months ago and her periods have been irregular over the last year.... | {
"A": "Polycystic ovary syndrome",
"B": "Adrenal tumor",
"C": "Ovarian tumor",
"D": "Ovarian hyperthecosis",
"E": ""
} | C | This young woman presents with rapid virilization, elevated testosterone, and a large left adnexal mass that is primarily solid on ultrasound. These findings are most consistent with an ovarian androgen-secreting tumor.
Sertoli-Leydig cell tumors are the most common androgen-secreting tumor of the ovaries and classica... | https://bit.ly/3qYGGdc |
094 | A 65-year-old woman presents to her family doctor to reestablish care since losing her insurance. She has not had time for regular check-ups. She exercises 3-4 times a week and consumes red meat sparingly. She drank and smoked cigarettes socially with coworkers but never at home or on vacation. She wakes up with achy w... | {
"A": "Chest radiograph",
"B": "Mammography",
"C": "Colonoscopy",
"D": "Vitamin D level",
"E": ""
} | B | This vignette describes an otherwise healthy elderly woman seeking to establish primary care. Among the answer choices, mammography is the most appropriate diagnostic test to recommend.
Mammography is a screening tool for breast cancer that becomes most effective in postmenopausal patients because of less glandular br... | https://bit.ly/3rJPzaL |
095 | A 6-month-old boy is brought to the physician by his mother for abnormal movements. Several times a day, he experiences paroxysmal episodes of crying, bending at the waist, and jerking of the arms and legs. These episodes last 1-2 seconds, but occur in clusters every 20-30 seconds for several minutes. His mother's preg... | {
"A": "Decreased gamma aminobutyric acid (GABA) levels",
"B": "Vitamin B6 deficiency",
"C": "Excess of corticotropin releasing hormone",
"D": "Anti-N-methyl-D-aspartate (NMDA) receptor antibodies",
"E": ""
} | C | This patient with infantile spasms (bending at the waist and jerking out the arms and legs), developmental regression (rolling over less frequently, worsening head control, loss of social smile), and hypsarrhythmia on video-EEG (slowing and multifocal epileptiform discharges) are characteristic of West syndrome. West s... | https://bit.ly/3rSAzaC |
096 | A 67-year-old man is seen on the surgical floor after a transplant procedure. The previous day, the patient had a renal transplant from a matched donor. He is currently recovering and doing well. The patient has a medical history of IV drug use, diabetes mellitus, oral cold sores, hypertension, renal failure, and dysli... | {
"A": "Valacyclovir",
"B": "Low dose acyclovir",
"C": "TMP-SMX",
"D": "Azithromycin",
"E": ""
} | C | This patient is presenting status post renal transplant and is currently on immunosuppressive therapy. This patient should be started on TMP-SMX as prophylaxis against Pneumocystis jiroveci pneumonia (PJP).
After a transplant procedure, patients are started on immunosuppressive therapy in order to avoid rejection of t... | https://bit.ly/3s3wiAZ |
097 | A 55-year-old male bodybuilder presents to the emergency department with weakness of his right arm. The patient states he has experienced these symptoms for a few weeks; however, today his hand felt so weak he dropped his cup of tea. The patient has a medical history of diabetes. He drinks 2-7 alcoholic drinks per day ... | {
"A": "Apical lung tumor",
"B": "Cerebral infarction",
"C": "Scalenus anticus syndrome",
"D": "Subclavian steal syndrome",
"E": ""
} | A | This patient is presenting with unilateral upper extremity paresthesia and weakness suggestive of compression of the neurovascular structures of the upper extremity secondary to an apical lung tumor.
An apical lung tumor can compress the neurovascular structures in its proximity and cause pain, numbness, and weakness ... | https://bit.ly/3sB1jwE |
098 | A 1-month-old girl presents to her pediatrician with her mother. The patient was born at 38 weeks gestation via Caesarean section for cervical incompetence. The patient’s mother has no complaints. The child had a runny nose and cough for a few days last week. The patient’s mother endorses decreased appetite during the ... | {
"A": "Decreased metabolism of bilirubin",
"B": "Increased enterohepatic circulation of bilirubin",
"C": "Obstruction of the extrahepatic biliary tree",
"D": "Obstruction of the intrahepatic biliary tree",
"E": ""
} | C | This 2-month-old patient presents with jaundice, dark urine, mild transaminitis, and conjugated hyperbilirubinemia, which suggests the diagnosis of biliary atresia. Biliary atresia is characterized by obstruction of the extrahepatic biliary tree.
Biliary atresia is a progressive, obliterative disease of the extrahepat... | https://bit.ly/3skGIMT |
099 | A 7-year-old boy is brought to the emergency department by his parents for worsening symptoms of previously diagnosed acute sinusitis. Initially, the pediatrician prescribed decongestants and sent the patient home. Since then, the patient has developed a nasal discharge with worsening pain. The patient has a medical hi... | {
"A": "Foreign body obstruction",
"B": "Nasopharyngeal carcinoma",
"C": "Bleeding and infected vessel of Kiesselbach plexus",
"D": "Septal perforation",
"E": ""
} | A | This patient presents with unilateral bloody/purulent discharge from the nose suggesting a diagnosis of a nasal foreign body.
The most common cause of unilateral nasal symptoms in a pediatric patient is a nasal foreign body. Nasal foreign bodies tend to be unilateral (though bilateral symptoms are plausible) and prese... | https://bit.ly/3sn97S5 |
100 | A 33-year-old man presents to the emergency department after slamming his finger in the car door 5 hours ago. He initially experienced pain which is currently well controlled with acetaminophen. The patient is otherwise healthy and does not take any medications. His temperature is 98.5°F (36.9°C), blood pressure is 123... | {
"A": "Fingernail removal",
"B": "Trephination",
"C": "Excision and histological examination",
"D": "Operative repair",
"E": ""
} | B | This patient is presenting after trauma to his finger with a subungual hematoma. Given that he has no other associated injuries, trephination is the only management indicated.
A subungual hematoma occurs after trauma to the finger leading to a collection of blood under the fingernail. Depending on the mechanism, this ... | https://bit.ly/3sorW7P |
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