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 |
|---|---|---|---|---|---|
101 | A 37-year-old man presents to the emergency department for a persistent fever. The patient has felt unwell for the past week and has felt subjectively febrile. The patient has a medical history of a suicide attempt and alcohol abuse. He is not currently taking any medications. The patient admits to using heroin and coc... | {
"A": "Blood cultures",
"B": "CT scan",
"C": "Ultrasound",
"D": "Vancomycin and gentamicin",
"E": ""
} | A | This patient is presenting with fever and a systolic murmur suggestive of bacterial endocarditis. The most appropriate initial step in management is to draw blood cultures.
Bacterial endocarditis presents with fever, systemic symptoms (aches, myalgias, and fatigue), and a new murmur typically in a patient with intrave... | https://bit.ly/3tU2wPT |
102 | A 67-year-old man presents to the emergency room with difficulty speaking for the past 1 hour. He was having dinner at home with his wife when he suddenly noticed he had difficulty eating and speaking. He also noticed a new-onset weakness on his left side. His medical history is significant for type 2 diabetes mellitus... | {
"A": "Anterior spinal artery",
"B": "Lenticulostriate branches of the middle cerebral artery",
"C": "Pontine perforators of the basilar artery",
"D": "Posterior inferior cerebellar artery",
"E": ""
} | A | This patient with hypertension, diabetes, hyperlipidemia, deviation of the tongue to the right, left-sided hemiparesis, and decreased sensation to light touch and vibration on the left side of his body most likely has a stroke of the right medial medulla. The medial medulla is supplied by paramedian branches of the ver... | https://bit.ly/3u27ZnQ |
103 | A 6-month-old girl is brought to the pediatrician by her father for a scheduled check-up. She was in her usual state of health until 6 weeks ago when she was hospitalized for bacterial pneumonia. She received amoxicillin and had a resolution of her symptoms. Her father reports that she seems “back to normal.” She can r... | {
"A": "A",
"B": "B",
"C": "C",
"D": "D",
"E": ""
} | A | The thymus gland (labeled in A) is visible on a chest radiograph in infants and will change in response to illness due to its immunologic role.
The thymus gland is the site of T-cell maturation. The thymus is visible on a chest radiograph in infants and continues to grow throughout childhood. It is located in the ante... | https://bit.ly/3v12XZt |
104 | A 27-year-old man presents to his primary care physician for exposure to toxic materials. The patient states that when he left for work this morning he was certain that he had closed the door to his pantry. Upon returning home, he saw that the door to his pantry was wide open. The patient is certain that his neighbors ... | {
"A": "Paranoid personality disorder",
"B": "Borderline personality disorder",
"C": "Narcissistic personality disorder",
"D": "Schizoid personality disorder",
"E": ""
} | A | This patient is presenting with a history of mistrust and suspicion of others without frankly psychotic features suggesting a diagnosis of paranoid personality disorder.
Paranoid personality disorder is a cluster A personality disorder that is genetically associated with schizophrenia. These patients present with a pe... | https://bit.ly/40Awtzi |
105 | A 17-year-old boy presents to his primary care physician with a chief concern of "bad" skin that has not improved despite home remedies. The patient has had lesions on his face that have persisted since he was 13 years of age. He has a diet high in refined carbohydrates and has gained 20 pounds since starting high scho... | {
"A": "Continue current therapy for 1 more month",
"B": "Dietary intervention",
"C": "Isoretinoin",
"D": "Topical antibiotics",
"E": ""
} | D | This patient is presenting with persistent acne vulgaris that is refractory to topical benzoyl peroxide and retinoids. The next step in management is topical antibiotics.
Acne vulgaris is caused by blockage or outlet obstruction of the pilosebaceous unit. It presents with erythema, pustules, and comedones typically in... | https://bit.ly/40qTdn2 |
106 | A 10-year-old girl is admitted to the medical floor for a respiratory infection. The patient lives in a foster home and has been admitted many times. Since birth, the patient has had repeated episodes of pain/pressure over her frontal sinuses and a chronic cough that produces mucus. She was recently treated with amoxic... | {
"A": "Diastolic murmur best heard along the right lower sternal border",
"B": "Hypocalcemia",
"C": "Increased chloride in the patient's sweat",
"D": "Repeat sinus infections secondary to seasonal allergies",
"E": ""
} | A | This patient is presenting with recurrent sinus infections suggestive of Kartagener syndrome. Dextrocardia is a common feature in this pathology, which results in right-sided heart sounds or a diastolic murmur best heard along the right lower sternal border for this patient's tricuspid stenosis.
Kartagener syndrome (p... | https://bit.ly/40wICHc |
107 | A 38-year-old woman presents to the emergency department with difficulty eating. Over the past week, she has had increasing difficulty chewing her food and progressive pain in the left side of her jaw. This morning, she was unable to close her mouth for several minutes after taking a bite of her breakfast. Two months a... | {
"A": "Trimethoprim-sulfamethoxazole",
"B": "Penicillin",
"C": "Clindamycin",
"D": "Amphotericin B",
"E": ""
} | B | This patient presents with fever, trismus, and cutaneous drainage of sulfur granules in the setting of a recent dental procedure, which points to a diagnosis of cervicofacial actinomycosis. The most appropriate treatment for this disease is penicillin.
Actinomyces is a gram-positive, filamentous rod that causes a cerv... | https://bit.ly/41Hqt8O |
108 | A 16-year-old boy presents to an ophthalmologist with blurry vision. Over the past several months, he has had increasing difficulty seeing the board from the back of the classroom at school. The patient is otherwise doing well in school and enjoys playing basketball. His medical history is otherwise significant for sco... | {
"A": "Extra copy of sex chromosome",
"B": "Mutation of RET proto-oncogene",
"C": "Defective metabolism of methionine",
"D": "Mutation of chromosome 15",
"E": ""
} | D | This patient presents with tall stature, upward lens subluxation, and a family history of aortic valve disease, which suggests a diagnosis of Marfan syndrome. Marfan syndrome is caused by an autosomal dominant mutation in the fibrillin-1 gene on chromosome 15.
The fibrillin-1 gene codes for a glycoprotein in the extra... | https://bit.ly/42Cge5V |
109 | A 32-year-old woman presents to her primary care provider with pelvic pain. She reports that for the last several years, she has had chronic pain that is worse just before her menstrual period. Over the past 2 months, she has also had worsening pain during intercourse. She denies dysuria, vaginal discharge, or vaginal ... | {
"A": "Hysteroscopy",
"B": "Abdominal ultrasound",
"C": "Hysterosalpingogram",
"D": "Laparoscopy",
"E": ""
} | D | This patient presents with chronic pelvic pain that is worse before her menstrual period, vaginal tenderness on physical exam, and lateral displacement of the cervix, which is consistent with a diagnosis of endometriosis. Since this patient has failed therapy with oral contraceptive pills (OCPs), she should undergo lap... | https://bit.ly/42HsiTA |
110 | A 26-year-old woman presents to the emergency department with 1 day of vaginal bleeding and lower abdominal pain. The pain is most pronounced in the lower abdomen and has gotten worse over the past day. Her last menstrual period was 7 weeks ago. She denies any recent abdominal or vaginal trauma. She has no other past m... | {
"A": "Laparoscopy",
"B": "Transvaginal ultrasound",
"C": "Methotrexate therapy",
"D": "CT of the abdomen and pelvis",
"E": ""
} | A | This patient’s acute onset abdominal pain with uterine bleeding and tenderness, positive pregnancy test, anemia, and hemodynamic instability are concerning for a ruptured ectopic pregnancy. Emergency laparoscopy is the most appropriate next step in management.
An ectopic pregnancy, due to implantation of a fertilized ... | https://bit.ly/42mJcXw |
111 | A 41-year-old man presents to his primary care provider after seeing bright red blood in the toilet bowl after his last 2 bowel movements. He reports that he also noticed some blood mixed with his stool. The patient denies abdominal pain or any changes in his stool habits. He notes a weight loss of 8 pounds in the last... | {
"A": "Abdominal CT",
"B": "Colonoscopy",
"C": "Ultrasound of abdomen",
"D": "Barium enema",
"E": ""
} | B | This patient presents with hematochezia and weight loss, which raises concern for colorectal cancer. The most appropriate next step in management is performing a colonoscopy.
The differential diagnosis of hematochezia includes colorectal cancer, inflammatory bowel disease, diverticulosis, and hemorrhoids. The evaluati... | https://bit.ly/42tvFxa |
112 | A 19-year-old woman presents to her primary care physician with headaches, blurry vision, and tinnitus over the past month. She started treatment for a skin condition with a new oral medication 2 months prior. She has not noticed any changes in her complexion as of yet. Her temperature is 98.2°F (36.8°C), blood pressur... | {
"A": "Idiopathic intracranial hypertension",
"B": "Meniere disease",
"C": "Giant cell arteritis",
"D": "Cerebrovascular accident",
"E": ""
} | A | This young patient with severe nodulocytic acne who was started on a new oral medication (likely isotretinoin) is likely suffering from idiopathic intracranial hypertension, which can present with papilledema, headache, blurry vision, and diplopia.
Idiopathic intracranial hypertension is characterized by an increase i... | https://bit.ly/436MoX6 |
113 | A 14-day-old girl is brought to the emergency department for diarrhea. Her mother reports that the patient began having “explosive” diarrhea 6 hours ago. The patient has little interest in feeding since leaving the hospital after her birth and has not yet regained her birth weight. Her immediate postnatal period was ot... | {
"A": "Upper gastrointestinal series",
"B": "Rectal suction biopsy",
"C": "Contrast enema",
"D": "Intraoperative cholangiogram",
"E": ""
} | B | This neonatal patient presents with bilious vomiting, failure to thrive, colonic distension on an abdominal radiograph, and new fever and tachycardia, which suggests a diagnosis of Hirschsprung disease complicated by enterocolitis. A rectal suction biopsy is the most accurate test to diagnose Hirschsprung disease.
Hir... | https://bit.ly/4395jl7 |
114 | A 32-year-old G1P0 woman delivers a boy at 40 weeks and 3 days of gestation. The delivery is uncomplicated and the neonate has Apgar scores of 9 and 9 at 1 and 5 minutes respectively. After 15 minutes, he attempts to nurse for the 1st time. His mother notices that his face, chest, and extremities turn dusky blue during... | {
"A": "Digital clubbing",
"B": "Patent foramen ovale",
"C": "Inability to pass a nasogastric tube",
"D": "Areflexia in all extremities",
"E": ""
} | C | This neonate presents with central cyanosis upon feeding, resolution with crying, and midface hypoplasia on exam, most consistent with choanal atresia. A nasogastric (NG) tube would not pass through the nasal canal.
Choanal atresia is caused by failed recanalization of the nasal fossae during fetal development. This d... | https://bit.ly/43OL5NI |
115 | Figure A is the lateral radiograph of a 44-year-old male who sustained a fall on his outstretched hand while rollerblading. The patient reports pain localized to the posterior elbow and refuses to attempt elbow extension secondary to pain and swelling. Which of the following is the most likely diagnosis in this patient... | {
"A": "Exacerbation of elbow arthritis",
"B": "Olecranon bursitis",
"C": "Lateral collateral ligament tear",
"D": "Triceps rupture",
"E": ""
} | D | The flake sign, as seen in Figure A is pathognomonic of a triceps tendon rupture.
Tricep tendon ruptures are rare injuries to the elbow extensor mechanism that most commonly occur as a result of forceful elbow contraction. Diagnosis can be made clinically, as patients with complete ruptures are unable to extend the el... | https://bit.ly/43RQXWn |
116 | A 25-year-old G1P0 woman presents to her physician for a prenatal visit. She is at 12 weeks gestational age and has not received prior prenatal care. She has mild morning sickness but no other symptoms. She has no known medical problems and takes only a prenatal multivitamin. She has unprotected sexual intercourse with... | {
"A": "B",
"B": "A",
"C": "C",
"D": "E",
"E": ""
} | C | This pregnant patient presents with a positive HIV antibody test in the setting of unprotected sexual intercourse. An appropriate maternal HIV treatment regimen is abacavir, lamivudine, and raltegravir; prophylaxis in the infant consists of zidovudine alone if maternal HIV viral load is suppressed to < 50 copies/mL.
A... | https://bit.ly/43fo59y |
117 | A 25-year-old man presents to his primary care physician with a chief complaint of "failing health." He states that he typically can converse with animals via telepathy but is having trouble right now due to the weather. He has begun taking an assortment of Peruvian herbs to little avail. Otherwise, he is not currently... | {
"A": "Brief psychotic disorder",
"B": "Schizoid personality disorder",
"C": "Schizotypal personality disorder",
"D": "Schizophrenia",
"E": ""
} | C | This patient has several odd and eccentric beliefs without frankly psychotic features and he is able to function in society. This suggests a diagnosis of schizotypal personality disorder.
Schizotypal personality disorder presents with eccentric behavior, magical thinking, odd beliefs, and perceptual disturbances. Thes... | https://bit.ly/43nVOhs |
118 | A 46-year-old woman presents to her primary care doctor to request a referral to ophthalmology. Her vision has been steadily declining over the past 2 years and she thinks she needs a prescription for glasses. She further complains that her lips and feet feel numb. Her medical history is notable for medullary thyroid c... | {
"A": "Iatrogenic hypoparathyroidism",
"B": "Somatization",
"C": "Multiple endocrine neoplasia",
"D": "Hyperkalemia",
"E": ""
} | A | This patient who presents with cataracts and a prolonged QTc interval on ECG most likely has symptomatic hypocalcemia secondary to the surgical removal of all of her parathyroid glands (iatrogenic hypoparathyroidism).
Thyroid surgery may mandate the removal of parathyroid glands if there is evidence of malignant invas... | https://bit.ly/43oZtLT |
119 | A 2-day-old boy has an episode of vomiting in the hospital nursery. The vomitus was described as “bright green” without any traces of blood. The patient has urinated several times since he was born but has not passed any stool. He was born at 37 weeks of gestation to a 38-year-old G3P3 woman. The pregnancy was uncompli... | {
"A": "Pyloric stenosis",
"B": "Intestinal malrotation",
"C": "Hirschsprung disease",
"D": "Meconium ileus",
"E": ""
} | C | This pediatric patient presents with features of Down syndrome (trisomy 21), bilious vomiting, and colonic distention on an abdominal radiograph, which suggests a diagnosis of Hirschsprung disease.
Hirschsprung disease is associated with Down syndrome and presents with bilious vomiting, failure to pass meconium in the... | https://bit.ly/43wFOdc |
120 | A 25-year-old man presents to his primary care physician with anxiety and fatigue. During this past week, he has been unable to properly study and prepare for final exams because he is exhausted. He has been going to bed early but is unable to get a good night’s sleep. He admits to occasional cocaine and marijuana use.... | {
"A": "Polysomnography",
"B": "Sleep hygiene education",
"C": "Alprazolam",
"D": "Melatonin",
"E": ""
} | B | This patient is presenting with trouble sleeping without a known organic cause, for which the most appropriate initial step in management is to discuss sleep hygiene with the patient.
In any patient that presents with a chief complaint of fatigue, it is always best to assess how they are sleeping. After a physical exa... | https://bit.ly/448sWLu |
121 | A 53-year-old man presents to the clinic with a non-tender mass in his right anterior neck. The mass has been slowly enlarging over the past 1 year. He reports no dysphagia, difficulty breathing, or changes to his voice. He also denies heat intolerance, palpitations, tremors, or diarrhea. He has hypertension and hyperl... | {
"A": "Repeat ultrasound in 6 months",
"B": "Thyroidectomy followed by radioactive iodine",
"C": "Methimazole",
"D": "Radioactive iodine",
"E": ""
} | B | This patient who presents with a slowly enlarging neck mass has ultrasound (hypoechogenic nodule with microcalcifications) and histology findings (concentrically laminated calcifications called psammoma bodies) consistent with papillary thyroid carcinoma. The most appropriate next step in management would be thyroidect... | https://bit.ly/44GDl0l |
122 | A 29-year-old woman is recovering on the obstetrics floor after the vaginal delivery of 8-pound twin boys born at 42 weeks gestation. The patient is fatigued but states that she is doing well. Currently, she is complaining that her vagina hurts. The next morning, the patient experiences chills and a light red voluminou... | {
"A": "Supportive therapy only",
"B": "Vancomycin and clindamycin",
"C": "Cefoxitin and doxycycline",
"D": "Vancomycin and gentamicin",
"E": ""
} | A | This patient is presenting with a normal postpartum period which is managed with supportive therapy only.
A normal postpartum period is associated with breast tenderness, chills, edema, and abdominal cramps from a contracting uterus. Vaginal discharge (lochia) is normal in this phase and progresses from a red color (l... | https://bit.ly/44HVD16 |
123 | A 3-week-old boy presents to the emergency department with vomiting. His parents report that he suddenly started vomiting this morning and has shown no interest in feeding since then. They describe the vomitus as green and without any traces of blood. Prior to today, the patient was feeding, voiding, and stooling well.... | {
"A": "Upper gastrointestinal contrast series",
"B": "Contrast enema",
"C": "Abdominal CT",
"D": "Rectal suction biopsy",
"E": ""
} | A | This neonatal patient presents with sudden-onset bilious vomiting and an abdominal radiograph revealing a gasless abdomen, which is consistent with intestinal malrotation complicated by a midgut volvulus. The most appropriate next step in the diagnosis of intestinal malrotation is an upper gastrointestinal series.
Mal... | https://bit.ly/44Zo5vi |
124 | A 3-day-old boy is evaluated in the neonatal intensive care unit for failure to pass meconium. The patient is otherwise doing well and feeding every 2 hours. He is urinating 8-10 times per day. The patient has had 2 episodes of vomiting that were described as green in color. He was born at 39 weeks gestation to a 38-ye... | {
"A": "Sweat testing",
"B": "Contrast enema",
"C": "Upper gastrointestinal series",
"D": "Abdominal CT",
"E": ""
} | B | This patient presents with delayed passage of meconium, bilious emesis, unsuccessful disimpaction on digital rectal exam, and dilated loops of bowel on abdominal radiograph which suggests a diagnosis of meconium ileus. The most appropriate next step in management is an enema with water-soluble contrast which may be bot... | https://bit.ly/44eJlxH |
125 | A 25-year-old woman presents to her primary care physician complaining of recent hair growth along her jawline, now requiring her to shave every 2 days. She has not shaved in about a week. She has also gained about 10 pounds in the last several months, and her periods have become irregular over the last year. Her last ... | {
"A": "Endometrial carcinoma",
"B": "Ovarian cancer",
"C": "Type 1 diabetes mellitus",
"D": "Virilization",
"E": ""
} | A | This patient presents with hirsutism, oligomenorrhea, and multiple follicles on pelvic ultrasound, which is most consistent with polycystic ovarian syndrome (PCOS). PCOS is associated with an increased risk of endometrial carcinoma.
PCOS is an acquired endocrinopathy characterized by ovarian dysfunction and high rates... | https://bit.ly/44nTuaV |
126 | A 45-year-old morbidly obese woman with a history of asthma and type 2 diabetes mellitus presents to her primary care physician for advice on weight loss. She thinks that her husband is having sex with other women because they have not had sex over the past year. She feels that her co-workers also disrespect her for he... | {
"A": "Topical nystatin",
"B": "Topical clobetasol",
"C": "Prednisone",
"D": "Fluconazole",
"E": ""
} | A | This patient has a rash consistent with candidal intertrigo given the location and history of a damp, pruritic rash. The most appropriate next step in management is topical nystatin powder.
Intertrigo is caused by the Candida species and is characterized by pruritic, painful, and erythematous superficial patches surro... | https://bit.ly/44tTwi7 |
127 | A 4-day-old neonate is brought to the pediatrician with vaginal discharge for the last 2 days. Her daughter has been feeding and voiding well. The neonate was delivered at 39 weeks gestation via an uncomplicated vaginal delivery and was discharged home after 2 days. The prenatal course was complicated by chlamydia in t... | {
"A": "Reassurance",
"B": "Vaginal culture",
"C": "Warm water irrigation of the vagina",
"D": "Report to child protective services",
"E": ""
} | A | This neonate presents with bloody vaginal discharge soon after birth without vulvar irritation, which is most consistent with physiologic neonatal vaginal discharge. Reassurance is the most appropriate next step in management.
Vaginal discharge in a neonate that is bloody and/or mucoid is most commonly due to the rapi... | https://bit.ly/44zO6BC |
128 | A 29-year-old woman comes to the emergency department complaining of painful genital ulcers that have been present for 4 days as well as low-grade fever and malaise. She denies any recent travel, new sexual partners, or antibiotic use. Physical examination reveals multiple clustered vesicles and shallow ulcers in the v... | {
"A": "Acyclovir",
"B": "Amoxicillin",
"C": "Fluconazole",
"D": "Trimethoprim-sulfamethoxazole",
"E": ""
} | A | The patient's painful genital ulcers coupled with the presence of multinucleated giant cells on a Tzanck smear are indicative of a herpes simplex virus type 2 (HSV-2) infection. Acyclovir is the treatment of choice.
Herpes infections can present with painful genital ulcers and low-grade fever. The Tzanck smear showing... | https://bit.ly/45Rurxg |
129 | A 3-year-old boy presents with his parents to a pediatrician for a new patient visit. The child was recently adopted and little is known about his medical or family history. The child seems to be doing well, but the patient is much larger than any of the other 3-year-olds in his preschool class. He eats a varied diet a... | {
"A": "Thromboembolic stroke",
"B": "Wilms tumor",
"C": "Osteoarthritis",
"D": "Aortic dissection",
"E": ""
} | A | This patient presents with Marfanoid habitus, joint hypermobility, hyperelastic skin, developmental delay, and downward lens subluxation, which suggests a diagnosis of homocystinuria. Homocystinuria predisposes to thromboembolic events such as stroke.
Although homocystinuria shares many features with Marfan syndrome, ... | https://bit.ly/45Vk2SF |
130 | A 6-hour-old newborn boy is noted to have a “lump on his head” by his mother. She denies that the lump was present at birth and is concerned about an infection. The child was born at 39 weeks gestation to a 34-year-old G2P2 mother by vacuum-assisted vaginal delivery after prolonged labor. His birth weight was 3.8 kg (8... | {
"A": "Intensive phototherapy",
"B": "Incision and drainage",
"C": "Red blood cell transfusion",
"D": "Observation only",
"E": ""
} | D | This patient presents with a fluctuant swelling of the scalp that is limited by suture lines, which is the classic description of a cephalohematoma. The majority of cases of cephalohematoma self-resolve, thus the most appropriate next step in management is observation.
A cephalohematoma is a relatively common traumati... | https://bit.ly/45Y8H4f |
131 | A 5-year-old girl presents to the emergency room due to difficulty walking. She has been complaining of pain in her right leg for the last few days. Her neighbor’s cat bit her last week and her parents attributed the pain to her healing bite. At the time of the bite, they cleaned the wound and irrigated it with sterile... | {
"A": "Doxycycline",
"B": "Ampicillin and sulbactam",
"C": "Amoxicillin and clavulanate",
"D": "Flucanozole",
"E": ""
} | B | This young girl with a recent history of a cat bite and difficulty walking most likely has likely Pasteurella multocida osteomyelitis. Empiric IV antibiotic therapy with ampicillin-sulbactam is the most appropriate initial management.
Pasteurella multocida is a gram-negative rod that is associated with cat and dog bit... | https://bit.ly/45a5Zb7 |
132 | A 27-year-old man presents to the emergency department after he developed pain in his right leg after landing off a ski jump. The patient is otherwise healthy and does not take any medications. He states his pain is 10/10. He is requesting medications and is crying out in pain. His temperature is 98.7°F (37.1°C), blood... | {
"A": "Patellar fracture",
"B": "Apophysitis of the tibial tubercle",
"C": "Posterior dislocation of the knee",
"D": "Tibial plateau fracture",
"E": ""
} | D | This patient is presenting after an axial load on his lower extremity (landing off a ski jump) with severe pain, a fracture on radiography, and severe pain with passive range of motion. This suggests compartment syndrome in the setting of a tibial plateau fracture.
Tibial plateau fractures occur as a result of an axia... | https://bit.ly/45s1lW2 |
133 | A 35-year-old G0P0000 woman presents to her gynecologist with complaints of irregular menstruation. She has had only 2 periods in the last year. She feels flushed without provocation and is experiencing occasional dyspareunia with post-coital spotting. She has also had more frequent headaches than usual. The patient ha... | {
"A": "Combined oral contraceptive",
"B": "Increase levothyroxine dose",
"C": "Brain MRI",
"D": "Estradiol patch with oral medroxyprogesterone",
"E": ""
} | D | This patient presents with oligomenorrhea, hot flashes, and dyspareunia, and her labs are notable for a high FSH and low estradiol, most consistent with premature ovarian insufficiency/failure (POI). The most appropriate next step in management is an estradiol patch with oral medroxyprogesterone.
POI is defined by the... | https://bit.ly/45zXPbW |
134 | A 23-year-old woman presents with a 7-day history of abdominal pain, and now bloody diarrhea that brings her to her primary care physician. Review of systems is notable for a 12-pound unintentional weight loss and intermittent loose stools. She has a family history notable for a father with coronary artery disease and ... | {
"A": "Continuous lesion beginning in the rectum",
"B": "Fistulae and stricture formation",
"C": "Worse disease severity near the ileocecal valve",
"D": "Perianal disease",
"E": ""
} | A | This patient presents with features suggestive of inflammatory bowel disease (IBD), and her colonoscopic and serologic studies suggest ulcerative colitis (UC). UC typically begins in the rectum and progresses proximally towards the ileocecal valve in a continuous fashion.
The diagnosis of IBD should always prompt furt... | https://bit.ly/460v5JM |
135 | A 69-year-old man presents to his primary care physician for a general checkup. Overall he is doing well. Since he retired, he has been working on projects at home and taking time to exercise every day. He eats a balanced diet and has been spending time with his wife every evening. Despite this, the patient claims that... | {
"A": "Increased dopamine",
"B": "Decreased orexin",
"C": "Decreased melatonin",
"D": "Increased norepinephrine",
"E": ""
} | C | This elderly patient is presenting with sleep that is sufficient but less refreshing than sleep was for him in his past suggesting a diagnosis of normal aging. Melatonin levels naturally decrease as patients age.
Normal aging shortens most phases of sleep. It is normal for melatonin levels to decline during normal agi... | https://bit.ly/4634T1E |
136 | A 3-week-old girl presents with her parents to her pediatrician for a routine visit. The child is sleeping at regular 2-hour intervals and feeding and stooling well. The parents have noticed a “swelling of the belly button.” Cord separation occurred at 7 days of age. The swelling seems to come and go but is never large... | {
"A": "Elective surgical management",
"B": "Immediate surgical management",
"C": "Expectant management",
"D": "Histopathologic evaluation",
"E": ""
} | C | This infant presents with a soft, 1 cm bulge at the umbilicus that is easily reducible inside the umbilical ring, which suggests a diagnosis of an umbilical hernia. Most umbilical hernias in children resolve spontaneously and can be managed expectantly.
An umbilical hernia is a protrusion of bowel, omentum, or preperi... | https://bit.ly/468jb0I |
137 | A 22-year-old woman presents to the emergency department with shortness of breath. She was hiking when she suddenly felt unable to breathe and had to take slow deep breaths to improve her symptoms. The patient is a Swedish foreign exchange student and does not speak any English. Her medical history and current medicati... | {
"A": "Increased FVC",
"B": "Decreased airway tone",
"C": "Normal DLCO",
"D": "Increased FEV1/FVC",
"E": ""
} | C | This patient who presents with dyspnea and poor air movement bilaterally most likely has an acute asthma exacerbation. DLCO is the one parameter that is normal in these episodes.
Asthma is an obstructive lung disease that results in intermittent episodes of respiratory compromise. Asthma presents with shortness of bre... | https://bit.ly/46AmGNy |
138 | A 36-year-old G3P2002 woman presents to her obstetrician’s office for her 1st prenatal visit at 10 weeks and 2 days gestation. She has felt nauseous the last several mornings and has been tired for a few weeks. The patient has had 2 uncomplicated spontaneous vaginal deliveries at full term with her last child born 6 ye... | {
"A": "Anatomy ultrasound",
"B": "Genetic testing of patient’s sister",
"C": "Nuchal translucency test",
"D": "Chorionic villus sampling",
"E": ""
} | D | This patient is over 35 years of age and concerned about the risk of Down syndrome (trisomy 21) in her fetus at just over 10 weeks gestation. At this gestational age, the most definitive method for determining whether such an aneuploidy is present is chorionic villus sampling (CVS).
CVS, or sampling of the placental t... | https://bit.ly/46Ngn9O |
139 | An 8-year-old boy is brought to the emergency department by his parents for evaluation. He has had headache and fever for the last 2 days, and this morning he was confused and had difficulty answering questions. He also developed a rash this morning. He recently returned from summer camp. He has no significant medical ... | {
"A": "Lumbar puncture, ceftriaxone, vancomycin, and methylprednisolone",
"B": "MRI brain",
"C": "Vancomycin and ceftriaxone",
"D": "Vancomycin, ceftriaxone, and dexamethasone",
"E": ""
} | A | This patient with fever, headache, signs of meningeal irritation, and a purpuric rash likely has bacterial meningitis. The most appropriate initial step in management is a lumbar puncture as well as ceftriaxone, vancomycin, and methylprednisolone.
Meningitis classically presents with fever, neck stiffness or headache,... | https://bit.ly/46WSQly |
140 | A 59-year-old man presents to his primary care physician for fatigue. In general, he has been in good health; however, he recently has experienced weight loss, abdominal pain, and general fatigue. He has a medical history of anxiety, diabetes, a fracture of his foot sustained when he tripped, and a recent cold that cau... | {
"A": "Chronic lymphocytic leukemia",
"B": "Chronic myeloid leukemia",
"C": "Leukemoid reaction",
"D": "Multiple myeloma",
"E": ""
} | C | This patient is presenting with leukocytosis and an elevated leukocyte alkaline phosphatase suggestive of a leukemoid reaction.
A leukemoid reaction typically presents with a drastically elevated leukocyte count (typically > 50,000/mm^3) in the setting of an elevated leukocyte alkaline phosphatase score (LAP). This re... | https://bit.ly/46ZosaU |
141 | A 30-year-old man presents to the emergency room with a laceration over the 4th metacarpophalangeal (MCP) joint of his right hand. He reports that he is a mailman, and his closed fist was bitten by a dog while he was delivering mail yesterday. He reports pain but denies fevers, chills, drainage, or any other symptoms. ... | {
"A": "Clindamycin",
"B": "Amoxicillin-clavulanate",
"C": "Clindamycin plus doxycycline",
"D": "Wound closure and amoxicillin-clavulanate",
"E": ""
} | B | This patient has suffered a clenched fist injury which are generally managed with irrigation and amoxicillin-clavulanate.
Amoxicillin-clavulanate is the usual first-line antibiotic for patients with a human or dog bite. Lacerations sustained from animal or human bites should not be sutured due to the risk of infection... | https://bit.ly/46gXevP |
142 | A 60-year-old woman presents to the emergency department with back pain after gardening. Her pain is 7/10 in severity, non-radiating, and not relieved by rest. She has never experienced this pain in the past and denies fever, night sweats, unintentional weight loss, and bowel or bladder incontinence. She has hypertensi... | {
"A": "Spondylolisthesis",
"B": "Lumbosacral strain",
"C": "Herniated disc",
"D": "Multiple myeloma",
"E": ""
} | B | This patient presents with acute low back pain after physical exertion without radicular signs (e.g., motor or sensory changes in a nerve root distribution) and a negative straight leg raise, which are most consistent with lumbosacral strain.
The evaluation of acute low back pain is focused on eliciting clinical histo... | https://bit.ly/46vZtvp |
143 | A 42-year-old woman is enrolled in a randomized controlled trial to study cardiac function in the setting of several different drugs. She is started on verapamil and instructed to exercise at 50% of her VO2 max while several cardiac parameters are being measured. During this experiment, which of the following represent... | {
"A": "AV node > ventricles > atria > Purkinje fibers",
"B": "Purkinje fibers > ventricles > atria > AV node",
"C": "Purkinje fibers > atria > ventricles > AV node",
"D": "Purkinje fibers > AV node > ventricles > atria",
"E": ""
} | C | The conduction velocity of the structures of the heart are in the following order: Purkinje fibers > atria > ventricles > AV node. A calcium channel blocker such as verapamil would only slow conduction in the AV node.
The conduction velocity of cardiac tissue is determined by a wide variety of factors, including the n... | https://bit.ly/47KxMQs |
144 | A 1-year-old girl is brought to a neurologist due to increasing seizure frequency over the past 2 months. She recently underwent a neurology evaluation which revealed hypsarrhythmia on electroencephalography (EEG) with a mix of slow waves, multifocal spikes, and asynchrony. Her parents have noticed the patient occasion... | {
"A": "Cardiac rhabdomyoma",
"B": "Glaucoma",
"C": "Optic glioma",
"D": "Polyostotic fibrous dysplasia",
"E": ""
} | A | This patient with a seizure disorder, ash-leaf spots (innumerable hypopigmented macules), Shagreen patch (elevated irregular plaque on the lower back), and West syndrome (hypsarrhythmia on EEG and movements consistent with infantile spasms) likely has tuberous sclerosis. Tuberous sclerosis is associated with cardiac rh... | https://bit.ly/47NX9Au |
145 | A 55-year-old man presents to the emergency department with right knee pain. He woke last night with sudden-onset, sharp, 10/10 non-radiating pain in his right knee. He denies recent trauma and he has no known medical problems. He denies tobacco use and will often drink 6-8 beers or spirits on weekend nights. His tempe... | {
"A": "Gout",
"B": "Septic arthritis",
"C": "Lyme arthritis",
"D": "Pseudogout",
"E": ""
} | A | The patient’s sudden-onset knee pain with effusion and synovial fluid findings are characteristic of gout.
Gout is caused by monosodium urate crystal deposition in joint spaces, most commonly in the big toe, ankle, or knee. Crystal deposition in the joint space leads to an intense inflammatory reaction that causes sev... | https://bit.ly/47U1Ppp |
146 | A 15-year-old girl is brought to the clinic because her mother is worried the patient has not yet had her period. The patient’s older sister had her first period at age 14. The mother had her first period at age 13. The patient reports she is doing well in school and is on the varsity basketball team. Her medical histo... | {
"A": "CYP17 gene work-up",
"B": "Gonadotrophin-releasing hormone stimulation test",
"C": "Karotype",
"D": "Luteinizing hormone levels",
"E": ""
} | C | The patient is presenting with primary amenorrhea and an increased follicle-stimulating hormone (FSH) level, suggesting a gonadal abnormality and making karyotyping the most appropriate next step in management.
Primary amenorrhea can be diagnosed if a patient has normal secondary sex characteristics but no menarche by... | https://bit.ly/47X4aiT |
147 | A 31-year-old man presents to the emergency department for fever, malaise, and cough. For the last week, his cough has been progressively worsening, and he has been noticing blood in his sputum. He denies any recent travel or sick contacts and infrequently smokes cigarettes. Approximately 5 weeks ago, he presented with... | {
"A": "Continue current anti-retroviral treatment, antimicrobial, and anti-tuberculoid therapies",
"B": "Determine drug sensitivities against the patient’s pulmonary infection",
"C": "Obtain a D-dimer level",
"D": "Start high-dose glucocorticoid treatment and discontinue antiretroviral therapy",
"E": ""
} | A | This patient with recently diagnosed HIV and tuberculosis infection (upper lung lobe infiltrate) is presenting with worsening symptoms after being appropriately treated. Worsening of symptoms after initiation of these therapies is concerning for immune reconstitution inflammatory syndrome (IRIS), which is managed by co... | https://bit.ly/47Zw1Ph |
148 | An 84-year-old man presents to the physician with numbness and tingling in the right hand for the last 6 months. He reports these symptoms started intermittently in the middle finger after returning from a golfing trip but has progressed to being nearly constant. The thenar eminence, thumb, and other digits are spared.... | {
"A": "Amyotrophic lateral sclerosis",
"B": "Carpal tunnel syndrome",
"C": "Cervical spondylosis",
"D": "Syringomyelia",
"E": ""
} | C | This patient presents with chronic middle finger paresthesia, weakness in elbow extension and wrist flexion, and a diminished triceps reflex in the setting of a positive Spurling test (pain with axial loading during neck extension, rotation, and lateral bending towards the affected side), indicative of C7 cervical radi... | https://bit.ly/47eGzd4 |
149 | A 23-year-old woman presents to her psychiatrist concerned about her mood. She has felt tired and unwilling to engage in any activities lately. She states that her limbs feel heavy all the time and that completing any activity takes tremendous effort. She no longer finds any happiness in activities that she previously ... | {
"A": "Add lithium to treatment regimen",
"B": "Change treatment to duloxetine",
"C": "Change treatment to lithium",
"D": "Continue current therapy",
"E": ""
} | D | This patient is presenting with depression and should be treated with a selective serotonin reuptake inhibitor (SSRI) for at least 4 weeks. Patients who have tried the therapy for a shorter duration of time may not yet have experienced the benefit of the medication.
Depression presents with SIGE CAPS (Sleeplessness, I... | https://bit.ly/47eVBPi |
150 | A 72-year-old man presents to his primary care physician for a general checkup. The patient works as a farmer and has no concerns about his health. He has a medical history of hypertension and obesity. His current medications include lisinopril and metoprolol. His temperature is 99.5°F (37.5°C), blood pressure is 177/1... | {
"A": "Audible click heard at the cardiac apex",
"B": "Femoral artery murmur",
"C": "Murmur that radiates to the carotids during systole",
"D": "Wedge pressure lower than expected",
"E": ""
} | B | This patient is presenting with aortic regurgitation which could be associated with Duroziez sign (femoral artery murmur).
Aortic regurgitation occurs when the aortic valve closes improperly resulting in retrograde flow during diastole. This is auscultated as a diastolic murmur heard best over the left upper sternal b... | https://bit.ly/47rczKM |
151 | A 55-year-old man presents to the emergency department with chest pain and shortness of breath. He has a medical history of hypertension, diabetes, and obesity. His temperature is 98.6°F (37.0°C), blood pressure is 177/118 mmHg, pulse is 127/min, respirations are 11/min, and oxygen saturation is 98% on room air. An ECG... | {
"A": "Cholesterol embolism",
"B": "Medication side effect",
"C": "Pancreatitis",
"D": "Renal failure",
"E": ""
} | A | This patient is presenting with abdominal pain and livedo reticularis after a catheterization procedure. These symptoms are suggestive of a cholesterol embolism.
A cholesterol embolism typically presents after any vascular procedure due to a dislodged cholesterol emboli. Symptoms include livedo reticularis, gastrointe... | https://bit.ly/481p4x3 |
152 | A 37-year-old machinist presents to his primary care physician with eye problems. He has felt a mass in his eye that has persisted for the past month. The patient has a medical history of blepharitis treated with eye cleansing and squamous cell carcinoma of the skin treated with Mohs surgery. His temperature is 99.5°F ... | {
"A": "Chalazion",
"B": "Foreign body",
"C": "Hordeolum",
"D": "Ingrown eyelash follicle",
"E": ""
} | A | This patient presenting with a painless firm and rubbery nodule has symptoms that are suggestive of a chalazion.
Chalazion presents with a hard and painless eyelid nodule. This pathology occurs secondary to granulomatous inflammation of the Meibomian gland. The lesion can be treated with simple excision; however, recu... | https://bit.ly/483O4Um |
153 | A 55-year-old man presents with a 2-day history of mono-articular joint pain. He is otherwise healthy and denies fever, chills, or recent trauma. His medical history is notable for a kidney stone 6 months ago. He underwent a dental procedure to extract an infected wisdom tooth 3 weeks ago. The patient does not take any... | {
"A": "Tophi",
"B": "Heberden nodes",
"C": "Juxta-articular osteoporosis",
"D": "Chondrocalcinosis",
"E": ""
} | D | This patient is presenting with a joint aspiration positive for calcium pyrophosphate dehydrate crystals, suggesting a diagnosis of pseudogout, which may show chondrocalcinosis on radiography.
Pseudogout presents classically with mono- or oligo-articular arthritis that most often affects the knee and proximal joints o... | https://bit.ly/48MbdvT |
154 | A 27-year-old man presents for an appointment to establish care. He recently was released from prison. He has felt very fatigued and has had a cough. He has lost roughly 15 pounds over the past 3 weeks. He attributes this to intravenous drug use in prison. His temperature is 99.5°F (37.5°C), blood pressure is 127/68 mm... | {
"A": "Peripheral neuropathy",
"B": "Red body excretions",
"C": "Hyperuricemia",
"D": "Elevated liver enzymes",
"E": ""
} | D | This patient is presenting with weight loss and cough with a positive quantiFERON gold test suggestive of tuberculosis and has been started on treatment. The most likely indication to discontinue tuberculosis therapy is elevation of liver enzymes.
Tuberculosis typically presents with weight loss, cough, and night swea... | https://bit.ly/48TRMkR |
155 | A 35-year-old man presents to the emergency department for evaluation of chest pain. The pain starts in his chest and moves into his back, arms, and abdomen. He describes the pain as tearing. He has no known medical history and takes no medications. His temperature is 37.0°C (98.6°F), pulse is 130/min, blood pressure i... | {
"A": "Aspirin",
"B": "CT angiography of the chest, abdomen, and pelvis",
"C": "Echocardiography",
"D": "Lorazepam",
"E": ""
} | B | This patient with "tearing" chest pain, hypertension, and a chest radiograph demonstrating mediastinal widening likely has an aortic dissection. The most appropriate next step in management would be to obtain CT angiography of the chest, abdomen, and pelvis to confirm the diagnosis.
Aortic dissections develop due to a... | https://bit.ly/48elxeS |
156 | A 33-year-old woman presents to the emergency department with muscle spasms. She has noticed "twitching" in both her upper and lower extremities over the past 3 days that have interfered with her training for a marathon. She has felt more fatigued over the past month. She has no significant medical history. She takes n... | {
"A": "Hypocalcemia",
"B": "Hypothyroidism",
"C": "Hyponatremia",
"D": "Hypomagnesemia",
"E": ""
} | D | This patient is presenting with what appears to be anorexia nervosa (thin habitus, possible excessive exercise in the setting of marathon running, thinning hair, dry mucous membranes, decreased free T4 level, and multiple electrolyte derangements). The lack of improvement in either her muscle spasms with fluid repletio... | https://bit.ly/48uDHdl |
157 | A 27-year-old woman presents to her primary care physician for an abnormal vaginal discharge. The patient has engaged in unprotected intercourse with 12 different partners. She has a medical history of asthma, IV drug abuse, and depression. She has 1 to 2 alcoholic drinks per day. She feels ashamed of her behavior and ... | {
"A": "Photosensitivity",
"B": "Antigen exposure",
"C": "IV drug use",
"D": "Infection",
"E": ""
} | B | This patient is presenting with urticaria whenever she engages in sexual intercourse suggesting a latex allergy (found in condoms). These allergies are due to antigen exposure.
Anaphylaxis and urticaria are immunologically mediated responses to environmental antigens that are typically IgE-mediated. This results in cr... | https://bit.ly/4918Jtt |
158 | A 32-year-old man presents to the emergency department for evaluation of headache. His symptoms started last night and have persisted. He occasionally has migraine headaches, but he has not had a headache like this in the past. He reports associated nausea, vomiting, fevers, and neck pain. He has a medical history of a... | {
"A": "Acyclovir",
"B": "Ceftriaxone and vancomycin",
"C": "Ceftriaxone, vancomycin and steroids",
"D": "Supportive care and monitoring",
"E": ""
} | D | This patient with headache, fever, and neck stiffness has a presentation and CSF studies consistent with a diagnosis of viral or aseptic meningitis. Supportive care is the most appropriate management strategy for patients with viral meningitis.
Aseptic (viral) meningitis presents similarly to bacterial meningitis with... | https://bit.ly/49HJCwj |
159 | A 24-year-old man presents to the emergency department with abdominal pain, nausea, and vomiting. The symptoms began towards the end of running a marathon and persisted after finishing the race. The patient is otherwise healthy and has no other medical problems. His temperature is 98.0°F (36.7°C), blood pressure is 105... | {
"A": "Cecal volvulus",
"B": "Ileus",
"C": "Sigmoid volvulus",
"D": "Small bowel obstruction",
"E": ""
} | A | This young, healthy patient presents with abdominal pain, nausea, vomiting, and a distended, tender abdomen with a radiograph demonstrating the "coffee bean sign," likely has a cecal volvulus.
Cecal volvulus is the second most common cause of volvulus after sigmoid volvulus and presents with abdominal pain, constipati... | https://bit.ly/49ckvkP |
160 | A 28-year-old man is brought to the emergency department by helicopter after a high speed motorcycle crash. He was intubated and 2 large bore IVs were placed in the field with administration of 2 liters of lactated ringer's solution while en route. On arrival to the emergency department, his temperature is 98.6°F (37.0... | {
"A": "CT scan of the abdomen and pelvis with contrast",
"B": "FAST exam",
"C": "Norepinephrine infusion",
"D": "Diagnostic peritoneal lavage",
"E": ""
} | B | This patient with hemodynamic instability and abdominal bruising after a high speed motorcycle crash likely has shock secondary to blood loss. The first step in management of patients with blunt trauma and hemodynamic instability is a focused assessment with sonography for trauma (FAST exam)
For any patient with blunt... | https://step2.medbullets.com/testview?qid=103356 |
161 | A 26-year-old woman presents to the emergency department because she feels as though her heart is "beating out of her chest." She states that she feels well apart from the discomfort of that sensation. Her temperature is 97.9°F (36.6°C), blood pressure is 124/84 mmHg, pulse is 180/min, respirations are 22/min, and oxyg... | {
"A": "Tachycardia",
"B": "Photosensitivity",
"C": "Flushing",
"D": "Seizure",
"E": ""
} | C | This patient presents with a narrow complex tachycardia that is regular which is suggestive of supraventricular tachycardia (SVT) and was pharmacologically cardioverted with adenosine (as it has a very short half-life). Side effects of adenosine include flushing, hypotension, bronchospasm, and heart block.
SVT present... | https://step2.medbullets.com/testview?qid=106849 |
162 | A 23-year-old woman presents to the emergency department with severe abdominal pain. The pain has been dull and progressive, but became suddenly worse while she was exercising. Her medical history is notable for depression, anxiety, and gonococcal urethritis that was appropriately treated. She is sexually active and do... | {
"A": "Inflammation of the pancreas",
"B": "Obstruction of blood flow through the hepatic vein",
"C": "Obstruction of the common bile duct by radio-opaque stones",
"D": "Vascular ectasia within the liver",
"E": ""
} | D | This patient is presenting with constant right upper quadrant pain in the setting of oral contraceptives (OCP) and likely anabolic steroid use, suggesting a diagnosis of a ruptured hepatic adenoma (HA). The pathophysiology of HA is vascular ectasia from exposure to OCPs and androgens.
A hepatic adenoma typically occur... | https://step2.medbullets.com/testview?qid=108515 |
163 | A 44-year-old woman presents to the emergency department with fluctuating right upper quadrant abdominal pain. The pain was initially a 4/10 in severity but has increased recently to a 6/10 prompting her to come in. The patient has a medical history of type 2 diabetes mellitus, depression, anxiety, and irritable bowel ... | {
"A": "Laparoscopy",
"B": "ERCP with manometry",
"C": "Analgesics and await resolution of symptoms",
"D": "MRI of the abdomen",
"E": ""
} | B | This patient is presenting with classic symptoms of acute cholecystitis or choledocholithiasis such as right upper quadrant pain and direct hyperbilirubinemia with ultrasound findings demonstrating the absence of gallstones. In this setting, sphincter of Oddi dysfunction should be suspected, and ERCP with manometry sho... | https://step2.medbullets.com/testview?qid=108516 |
164 | A 21-year-old man presents to the emergency room with right lower quadrant pain that started this afternoon at his wrestling match. He also endorses loss of appetite and subjective fever. He has had vague, mild discomfort in the right upper quadrant since the start of this wrestling season. He endorses a history of unp... | {
"A": "Administer metronidazole",
"B": "Administer sofosbuvir",
"C": "Obtain follow-up CT of the abdomen in 3 months",
"D": "Perform liver mass resection",
"E": ""
} | D | This patient with a history of possible anabolic steroid use (wrestler with acne) who presents with right upper quadrant pain and an enhancing lesion in the liver most likely has a hepatic adenoma. The treatment of hepatic adenomas is surgical removal and discontinuation of precipitating agents.
Hepatic adenomas are b... | https://step2.medbullets.com/testview?qid=108583 |
165 | A 38-year-old man presents to the emergency department with nasal congestion, blurry vision, and diplopia. His nasal congestion started about 1 week ago and he noticed the blurry vision this morning when he struggled to read the words on his television screen. His medical history is significant for IV drug use, HIV (CD... | {
"A": "Empiric treatment with pyrimethamine-sulfadiazine",
"B": "Lumbar puncture",
"C": "Brain biopsy",
"D": "Empiric treatment with dexamethasone",
"E": ""
} | A | This patient with a past medical history of immunosuppression due to HIV (CD4 < 100/mm^3), new focal neurologic findings, and ring-enhancing lesions on head MRI should be treated empirically with pyrimethamine-sulfadiazine for 10-14 days.
The differential diagnosis for ring-enhancing lesions in patients with HIV is de... | https://step2.medbullets.com/testview?qid=108601 |
166 | A 24-year-old woman with no significant medical history presents to the emergency department for progressive shortness of breath. She endorses decreased exercise tolerance as well as intermittent palpitations. She returned from a recent missionary trip to South America 12 months prior where she endorsed eating a local ... | {
"A": "Benznidazole",
"B": "Ganciclovir",
"C": "Praziquantel",
"D": "Amphotericin B",
"E": ""
} | A | This patient presents with symptoms of heart failure, eosinophilia, trypanosomes on peripheral smear, and a history of recent travel to South America consistent with the diagnosis of Chagas disease. Treatment options for Chagas disease include benznidazole and nifurtimox.
Chagas disease is caused by the parasite Trypa... | https://step2.medbullets.com/testview?qid=108604 |
167 | A 66-year-old man presents to the clinic for evaluation of a skin lesion on his hand. The lesion has grown rapidly over the previous 2 weeks. He endorses trauma to the area when he accidentally scraped his hand against a window and notes that there was some bleeding. His medical history is significant for chronic renal... | {
"A": "Keratoacanthoma",
"B": "Verruca vulgaris",
"C": "Basal cell carcinoma",
"D": "Molluscum contagiosum",
"E": ""
} | A | This patient presents with a rapidly enlarging, well-circumscribed, volcano-like papule with a central keratotic core consistent with the diagnosis of keratoacanthoma.
Keratoacanthomas represent a well-differentiated variant of cutaneous squamous cell carcinoma. They present as a rapidly enlarging skin lesion with a c... | https://step2.medbullets.com/testview?qid=108605 |
168 | A 32-year-old G1P0 woman at 12 weeks gestation presents to her obstetrician for a follow-up appointment. She first presented 4 weeks ago with bilateral hand tremors. At that time, she was found to have a thyroid-stimulating hormone (TSH) concentration <0.01 mU/L and an elevated free T4. She was started on propranolol a... | {
"A": "Oral iodinated contrast",
"B": "Thyroidectomy in the 2nd trimester",
"C": "Methimazole",
"D": "Continue routine prenatal care only",
"E": ""
} | B | This patient who initially presented with tremors, a suppressed TSH, and elevated T4 has Graves disease which was appropriately treated with propranolol and propylthiouracil. However, she has persistent symptoms (diaphoresis, palpitations, tachycardia, nontender goiter) despite maximum doses of these medications, which... | https://step2.medbullets.com/testview?qid=108726 |
169 | A 34-year-old man is brought to a rural emergency department by ambulance after being involved in a motor vehicle accident. Paramedics report that the patient was driving the car and crashed into a tree at roughly 25 miles per hour. There were no passengers and he was awake but disoriented at the scene. His temperature... | {
"A": "Focused abdominal sonography for trauma exam",
"B": "Diagnostic peritoneal lavage",
"C": "Chest radiograph anterior-posterior and lateral",
"D": "Abdominal and chest CT",
"E": ""
} | D | This patient presents following a motor vehicle accident with a tender abdomen and stable vital signs. Given his stability, the most appropriate next step is an abdominal and chest CT.
In blunt abdominal trauma, the next step in management depends upon whether the patient is hemodynamically stable. With a normal blood... | https://step2.medbullets.com/testview?qid=108735 |
170 | A 31-year-old woman presents to her obstetrician for her first prenatal visit after having a positive home pregnancy test 1 week ago. Her last menstrual period was 8 weeks ago. The patient has a medical history of type 1 diabetes mellitus since childhood and her home medications include insulin. Her hemoglobin A1c 2 we... | {
"A": "Neonatal hyperglycemia",
"B": "Neural tube defect",
"C": "Oligohydramnios",
"D": "Post-term delivery",
"E": ""
} | B | This patient has type 1 diabetes mellitus and presents in early pregnancy with a markedly elevated hemoglobin A1c, suggesting poor glycemic control. Poor glycemic control increases the risk of a neural tube defect in the fetus.
Infants of diabetic mothers (IDM) are at increased risk of many congenital malformations as... | https://step2.medbullets.com/testview?qid=108737 |
171 | A 15-year-old boy is brought to his pediatrician for a follow-up visit. His parents report that he is doing well in school and has many friends. Their only concern is that he has a “difficult stomach.” Every few months, he complains of intermittent abdominal pain that takes several days to pass. He occasionally misses ... | {
"A": "Increased serum methylmalonic acid level",
"B": "Microcytes",
"C": "Decreased serum homocysteine level",
"D": "Prolonged partial thromboplastin time",
"E": ""
} | A | This patient with episodic abdominal pain, bloody stool, growth failure, and erythema nodosum most likely has Crohn disease. Disease involving the terminal ileum predisposes patients to vitamin B12 deficiency, which would cause anemia with an elevated serum methylmalonic acid level.
Crohn disease is an inflammatory bo... | https://step2.medbullets.com/testview?qid=108740 |
172 | An 83-year-old man is brought to the emergency department by his daughter due to confusion over the last 2 weeks. The patient initially became less talkative than usual before starting to confuse her with her sister. The patient also could not remember what day of the week it was and he was out of groceries and likely ... | {
"A": "Increased cerebrospinal fluid",
"B": "Aneurysmal rupture",
"C": "Cerebral atrophy",
"D": "Hypertension",
"E": ""
} | C | This patient is an elderly man with progressive confusion over weeks, a nonfocal neurologic exam, and a CT of the head showing a hypodense crescent, most consistent with chronic subdural hematoma (SDH). Cerebral atrophy plays the earliest role in this presentation, resulting in exposure of the bridging veins and subseq... | https://step2.medbullets.com/testview?qid=108758 |
173 | A 65-year-old man presents to his primary care physician for stiffness in his arm. He has been having trouble combing his hair and reaching objects that are high on the shelf. The patient has a medical history of type 2 diabetes mellitus, obesity, and hypertension. His current medications include metformin, insulin, li... | {
"A": "Glenohumeral osteoarthritis",
"B": "Adhesive capsulitis",
"C": "Subacromial bursitis",
"D": "Biceps tendinopathy",
"E": ""
} | B | This patient is presenting with stiffness and a decreased range of motion in his shoulders suggestive of a diagnosis of adhesive capsulitis.
Adhesive capsulitis classically presents in elderly, sedentary patients with a chief complaint of stiffness. On physical exam, the key findings are a loss of active, but more imp... | https://step2.medbullets.com/testview?qid=108971 |
174 | A 35-year-old man presents to his primary care physician with pain along the bottom of his foot. The patient is a long-time runner but states that the pain has been getting worse recently. When running and at rest he has a burning and aching pain along the bottom of his foot that sometimes turns to numbness. Taking tim... | {
"A": "Plantar fasciitis",
"B": "Vitamin B12 deficiency",
"C": "Tarsal tunnel syndrome",
"D": "Herniated disc",
"E": ""
} | C | This patient is presenting with pain, tingling, and numbness on the plantar surface of his foot that is not associated with exertion or rest suggesting a diagnosis of tarsal tunnel syndrome.
Tarsal tunnel syndrome occurs due to compression of the tibial nerve as it travels through the tarsal tunnel. Compression of the... | https://step2.medbullets.com/testview?qid=108977 |
175 | A 71-year-old woman arrives to clinic with sudden vision loss. She was in her usual state of health until waking up this morning unable to see out of her right eye. She denies pain, but reports her right eye “feels funny.” The patient’s medical history is significant for a previous myocardial infarction, hypertension, ... | {
"A": "Papilledema",
"B": "Retinal vein occlusion",
"C": "Retinal detachment",
"D": "Closed angle glaucoma",
"E": ""
} | B | This patient is presenting with sudden, painless, unilateral vision loss with a fundoscopic exam positive for venous dilation and retinal hemorrhage. These findings are consistent with the diagnosis of retinal vein occlusion.
Retinal vein occlusion can occur in either central or branch retinal veins and is often cause... | https://step2.medbullets.com/testview?qid=108987 |
176 | An 82-year-old man with a history of atrial fibrillation presents to the emergency room complaining of sudden-onset, painless vision loss in his right eye starting 2 days ago. When it started, he felt like a “curtain was pulled down” over his right eye but wasn't able to seek care immediately because it was snowing out... | {
"A": "Start retinal photocoagulation",
"B": "Continue aspirin and start statin therapy",
"C": "Administer tissue plasma activator",
"D": "Start timolol drops",
"E": ""
} | B | This patient with a history of atrial fibrillation is presenting with acute-onset, painless, monocular vision loss and a fundoscopic exam positive for retinal whitening. This suggests a diagnosis of central retinal artery occlusion and management should focus on control of underlying risk factors given that he is 2 day... | https://step2.medbullets.com/testview?qid=108988 |
177 | A 64-year-old man presents to the emergency room with a headache and nausea. He reports that he was rocking his grandson to sleep when the symptoms began. He states the pain is constant and is primarily located on his right side. When asked to indicate the area of pain, he says that it surrounds his eye and upper foreh... | {
"A": "Acetazolamide",
"B": "Clopidogrel",
"C": "Amitriptyline",
"D": "Epinephrine",
"E": ""
} | A | This patient is presenting with sudden-onset unilateral vision loss and an orbitofrontal headache with a dilated pupil and a hard ocular globe suggesting a diagnosis of acute angle-closure glaucoma. Long-term management of angle-closure glaucoma can include acetazolamide.
Examination of the eye in a patient with acute... | https://step2.medbullets.com/testview?qid=108992 |
178 | A 45-year-old African American woman presents to her primary care physician for not feeling well. She states she has had a cough for the past week. She also has abdominal pain and trouble focusing that has been worsening and has lost 5 pounds recently. Her gastroesophageal reflux disease (GERD) has been poorly controll... | {
"A": "Increased parathyroid hormone",
"B": "Malignancy",
"C": "Viral illness",
"D": "Antacid overuse",
"E": ""
} | A | This patient is presenting with hypercalcemia and low phosphate levels suggesting a diagnosis of hyperparathyroidism.
Hyperparathyroidism can cause hypercalcemia which typically presents with "bones, stones, moans, and groans," which corresponds to symptoms of bone pain (increased bone resorption), kidney stones, GI p... | https://step2.medbullets.com/testview?qid=108995 |
179 | A 57-year-old immigrant from Nigeria presents to the emergency department for sudden, severe pain and swelling in her lower extremity. She was at a rehabilitation hospital when her symptoms started. The patient has a medical history of obesity, diabetes, bipolar disorder, and tonic-clonic seizures. Her current medicati... | {
"A": "Nephrotic syndrome",
"B": "Factor V Leiden",
"C": "Liver failure",
"D": "Antithrombin III deficiency",
"E": ""
} | A | This patient who presents with a deep venous thrombosis (lower extremity swelling, ultrasound followed by treatment with heparin), anasarca, and asymptomatic hypocalcemia most likely has a diagnosis of nephrotic syndrome.
Nephrotic syndrome occurs when large amounts of protein are lost in the urine. This can lead to h... | https://step2.medbullets.com/testview?qid=108996 |
180 | A 16-year-old girl who recently immigrated to the United States from Bolivia presents to her primary care physician with a chief complaint of inattentiveness in school. The patient's teacher describes her as occasionally "daydreaming" for periods of time during where the patient does not respond or participate in schoo... | {
"A": "Ethosuximide",
"B": "Carbamazepine",
"C": "Cognitive behavioral therapy",
"D": "Valproic acid",
"E": ""
} | D | This patient is presenting with both absence seizures (periods of inattentiveness in school) and juvenile myoclonic epilepsy (abnormal, involuntary spasms of her upper extremity). The most appropriate treatment for these conditions is valproic acid.
Absence seizures classically present with cessation of motor activity... | https://step2.medbullets.com/testview?qid=108997 |
181 | A 23-year-old man presents to the emergency department. He was brought in by police for shouting on a subway. The patient claims that little people were trying to kill him and he was acting within his rights to defend himself. The patient has a medical history of marijuana and IV drug use as well as multiple suicide at... | {
"A": "Clozapine",
"B": "Thioridazine",
"C": "Chlorpromazine",
"D": "Fluphenazine",
"E": ""
} | A | This patient is presenting with symptoms of schizophrenia that are refractory to treatment with both typical and atypical antipsychotics. The most appropriate next step in management is treatment with clozapine.
Schizophrenia presents with auditory and/or visual hallucinations among many other findings. The most appro... | https://step2.medbullets.com/testview?qid=108999 |
182 | A 25-year-old man presents to his primary care physician for trouble with focus and concentration. He states that he lives at home with his parents his entire life and recently was able to get a job at a local factory. Ever since the patient started working, he has had trouble focusing on his job. He is unable to stay ... | {
"A": "Ethosuximide",
"B": "Zolpidem",
"C": "Bright light therapy and decreased light at night",
"D": "Modafinil",
"E": ""
} | C | This patient is presenting with fatigue and an inability to fall asleep until late in the morning suggesting a diagnosis of delayed sleep phase syndrome. The most appropriate initial therapy is light therapy, behavioral therapy, and sleep hygiene practices in addition to decreasing exposure to light at night.
Delayed ... | https://step2.medbullets.com/testview?qid=109002 |
183 | A 69-year-old man presents to his primary care physician with hip and back pain. He states this weekend he had a barbecue. When he was lifting a heavy object, he suddenly felt pain in his lower back. He describes the pain as in his buttocks but states that at times it travels down his leg. He states that it feels elect... | {
"A": "Palpating the paraspinal muscles",
"B": "Radiography",
"C": "Straight leg raise",
"D": "Flexion, abduction, and external rotation of the thigh",
"E": ""
} | C | This patient is presenting with lower back pain that is electrical and travels down his legs after lifting an object suggesting a diagnosis of a herniated disc. The straight leg test can help confirm the diagnosis.
A herniated disc classically presents in a middle-aged or older individual who was lifting a heavy objec... | https://step2.medbullets.com/testview?qid=109003 |
184 | A 47-year-old man presents to the emergency department with a headache. He suddenly developed a throbbing, bitemporal headache about 5 hours ago "out of nowhere." He has a history of migraine headaches, but he feels that this headache is significantly more painful than his typical migraines. The patient took his prescr... | {
"A": "Periosteum and galea aponeurosis",
"B": "Arachnoid mater and pia mater",
"C": "Dura mater and arachnoid mater",
"D": "Skull and dura mater",
"E": ""
} | B | This patient presents with a sudden, severe headache and a head CT showing bleeding in the subarachnoid space, which confirms a diagnosis of subarachnoid hemorrhage. The bleeding in a subarachnoid hemorrhage occurs between the arachnoid and pia mater.
Subarachnoid hemorrhages present with a sudden, severe headache ref... | https://step2.medbullets.com/testview?qid=109022 |
185 | A 36-year-old woman, G1P1001, presents to her gynecologist for an annual visit. She has a medical history of hypertension for which she takes hydrochlorothiazide. The patient’s mother had breast cancer at age 68, and her sister has endometriosis. She states that she feels well and has no complaints. Her temperature is ... | {
"A": "Endometrial cancer",
"B": "Iron deficiency anemia",
"C": "Uterine prolapse",
"D": "Uterine sarcoma",
"E": ""
} | B | This patient presents with an irregularly enlarged uterus on examination consistent with the intramural leiomyomas (fibroids) seen on ultrasound. Leiomyomas increase the risk of iron deficiency anemia due to heavy menstrual bleeding.
Leiomyoma are benign overgrowths of myometrial tissue. The most common presentation i... | https://step2.medbullets.com/testview?qid=109024 |
186 | A 13-day-old boy is brought by his mother for eye redness and ocular discharge. The mother reports that the patient has developed a cough and nasal discharge. Pregnancy and delivery were uncomplicated but the mother had limited prenatal care during the third trimester. Immediately after delivery, the baby was given sil... | {
"A": "Artificial tears",
"B": "Oral erythromycin",
"C": "Intravenous acyclovir",
"D": "Topical erythromycin",
"E": ""
} | B | This patient is presenting with mucoid ocular discharge around 2 weeks post-birth, suggesting the diagnosis of neonatal chlamydial conjunctivitis. The most appropriate treatment for this disease includes oral erythromycin.
Neonatal chlamydial conjunctivitis is caused by Chlamydia trachomatis. It presents in newborns t... | https://step2.medbullets.com/testview?qid=109042 |
187 | A 69-year-old man presents to his primary care provider for a general checkup. He has a medical history of type 2 diabetes mellitus, hypertension, depression, obesity, and a myocardial infarction 7 years ago. The patient's prescribed medications are metoprolol, aspirin, lisinopril, hydrochlorothiazide, fluoxetine, metf... | {
"A": "Heart sound after S2",
"B": "Holosystolic murmur at the apex",
"C": "Heart sound before S1",
"D": "Fixed splitting of S1 and S2",
"E": ""
} | C | This patient who presents with poorly managed hypertension over a long period of time most likely has compensatory hypertrophy of the heart. The most likely heart sound in this patient is an S4 gallop that occurs immediately before S1.
Chronic hypertension that is poorly controlled can lead to concentric hypertrophy o... | https://step2.medbullets.com/testview?qid=109092 |
188 | A 1-hour-old newborn boy is evaluated in the delivery room. He was born at 37 weeks gestation to a 39-year-old G3P3 mother. The mother initially labored at home with a midwife but was transferred to the hospital for failure to progress. The infant was eventually delivered via Caesarean section. The mother declined all ... | {
"A": "Ventricular septal defect",
"B": "Bicuspid aortic valve",
"C": "A normal cardiac exam",
"D": "Tetralogy of Fallot",
"E": ""
} | C | This patient presents with a full-thickness defect in the abdominal wall lateral to the umbilicus with evisceration of the bowel, which suggests a diagnosis of gastroschisis. Gastroschisis is not associated with any cardiac defects.
Gastroschisis and omphalocele are the most common abdominal wall defects found in infa... | https://step2.medbullets.com/testview?qid=109109 |
189 | A 6-month-old boy is brought to the pediatrician by his parents for a routine visit. His parents report that he is feeding and stooling well and they have just started experimenting with solid foods. His parents are concerned because a few weeks ago he started rolling from back to front in addition to front to back, bu... | {
"A": "Sphingomyelin",
"B": "Glucocerebroside",
"C": "GM2-ganglioside",
"D": "Galactocerebroside",
"E": ""
} | C | This 6-month-old boy who presents with developmental regression, a “cherry-red” macula, and hyperreflexia most likely has a diagnosis of Tay-Sachs disease. Tay-Sachs disease is caused by a deficiency of beta-hexosaminidase A that results in the accumulation of GM2-ganglioside.
Tay-Sachs disease is a genetic disorder c... | https://step2.medbullets.com/testview?qid=109134 |
190 | A 62-year-old man arrives at the emergency room complaining of chest pain and difficulty breathing. He reports that the dyspnea started 2 months ago after he had the flu. At first, the difficulty breathing occurred whenever he went up and down 1 flight of stairs, but the dyspnea progressively worsened since then. This ... | {
"A": "Restrictive cardiomyopathy",
"B": "Cirrhosis",
"C": "Constrictive pericarditis",
"D": "Cardiac tamponade",
"E": ""
} | C | This patient is presenting with peripheral edema, ascites, elevated jugular venous distension, and pericardial calcifications on chest radiograph, which are all consistent with a diagnosis of constrictive pericarditis.
Constrictive pericarditis is the result of scarring and loss of elasticity of the pericardial sac. C... | https://step2.medbullets.com/testview?qid=109135 |
191 | A 69-year-old woman presents with pain in her hip and groin. The pain is present in the morning but is nearly unbearable by the end of the day. Her medical history is notable for a treated episode of acute renal failure, diabetes mellitus, obesity, and hypertension. Her current medications include losartan, metformin, ... | {
"A": "Femoral neck fracture",
"B": "Posterior displacement of the femoral head",
"C": "Loss of joint space and osteophytes",
"D": "Hyperdense foci in the ureters",
"E": ""
} | C | This patient is presenting with pain worse on exertion, decreased range of motion, and crepitus in her hip, suggesting a diagnosis of osteoarthritis. A loss of joint space and osteophytes (reactive bone formation) would be seen on radiography.
Osteoarthritis occurs due to wear and tear of the joint typically from repe... | https://step2.medbullets.com/testview?qid=109238 |
192 | A 3-day-old boy is evaluated in the hospital nursery for the delayed passage of meconium. The patient is breastfed, has been feeding well every 2 hours, and is urinating over 8 times per day. He was born at 35 weeks gestation to a 27-year-old G4P4 mother. The patient is of Ashkenazi Jewish descent and the patient’s par... | {
"A": "Upper gastrointestinal series",
"B": "Sweat testing",
"C": "Abdominal radiograph",
"D": "Abdominal CT",
"E": ""
} | C | Delayed passage of meconium should be evaluated with an abdominal radiograph to rule out bowel perforation. Patients with a perforation require emergency surgery.
All neonates should pass meconium in the first 48 hours of life. Patients that fail do to so should be evaluated with an abdominal radiograph to exclude the... | https://step2.medbullets.com/testview?qid=109241 |
193 | A 7-week-old boy presents to the pediatrician for vomiting. Three weeks ago, the patient began vomiting after meals. The vomitus appears to be normal stomach contents without streaks of red or green. His parents have already tried repositioning him during mealtimes and switching his formula to eliminate cow’s milk and ... | {
"A": "Abdominal ultrasound",
"B": "Thickening feeds",
"C": "MRI of the head",
"D": "Intravenous hydration",
"E": ""
} | D | This patient presents with nonbilious, forceful vomiting, poor weight gain, signs of dehydration, and a history of exposure to azithromycin, which suggests a diagnosis of pyloric stenosis. The most appropriate next step in management is intravenous hydration.
Pyloric stenosis classically presents in a male infant betw... | https://step2.medbullets.com/testview?qid=109242 |
194 | A 6-week-old girl presents with her parents to the pediatrician for blood-streaked diapers. The patient is breastfed every 2-3 hours and voids 10-12 times daily. The patient previously had several soft stools per day that ranged in color from mustard yellow to dark green. Over the past 2 days, the patient’s stools have... | {
"A": "Congenital enzyme deficiency",
"B": "Passage of gastric contents into esophagus",
"C": "Non-IgE-mediated immunologic reaction",
"D": "Hypertrophy of sphincter muscle",
"E": ""
} | C | This patient presents with new regurgitation, blood-streaked stools, and eczema, which is consistent with proctocolitis secondary to milk-protein allergy. This type of delayed onset milk-protein allergy is a non-IgE mediated immunologic reaction.
Allergy to cow’s milk is the most common food allergy in children and en... | https://step2.medbullets.com/testview?qid=109255 |
195 | An 8-week-old boy presents with his mother to the pediatrician for a well visit. The patient has been breastfed since birth, and usually feeds for 30 minutes every 2-3 hours. The patient’s mother is concerned that her milk production is not keeping up with the patient’s nutritional requirements. She reports that about ... | {
"A": "Reassurance and counseling on positioning",
"B": "Switch to hydrolyzed formula",
"C": "Recommend modification of mother’s diet",
"D": "Initiate proton pump inhibitor",
"E": ""
} | A | This patient presents with regurgitation after feeding, appropriate appetite after episodes of regurgitation, and good weight gain, which suggests a diagnosis of uncomplicated gastroesophageal reflux. The most appropriate next step in management is reassurance and counseling on proper positioning.
Physiologic or uncom... | https://step2.medbullets.com/testview?qid=109261 |
196 | A 4-day-old boy presents to the pediatrician with his mother for his 1st well visit. The patient was born at 36 weeks gestation to a 26-year-old primigravid mother via cesarean section for cervical incompetence. The patient required no resuscitation at birth and both mother and child were discharged from the hospital a... | {
"A": "Order serum uric acid concentration",
"B": "Continue current breastfeeding regimen",
"C": "Order spot uric acid to creatinine ratio",
"D": "Administer intravenous hydration",
"E": ""
} | B | This patient presents at day 4 of life with weight loss of 5% of his birth weight, uric acid crystals in his diaper, desquamation of the palms and soles, and unconjugated hyperbilirubinemia, which are normal findings in a newborn. The most appropriate next step in management is continuing his current breastfeeding regi... | https://step2.medbullets.com/testview?qid=109282 |
197 | A newborn boy is evaluated 30 minutes after birth. He was born at 39 weeks gestation to a 27-year-old primigravid mother via cesarean section for cervical insufficiency. The pregnancy was complicated by gestational diabetes and the amniotic fluid was clear. Upon delivery, the patient had strong respiratory effort and a... | {
"A": "Meconium aspiration syndrome",
"B": "Persistent pulmonary hypertension",
"C": "Neonatal respiratory distress syndrome",
"D": "Transient tachypnea of the newborn",
"E": ""
} | D | This newborn is presenting with increased work of breathing and progressive tachypnea in the 1st hour of life, which is consistent with a diagnosis of transient tachypnea of the newborn.
Transient tachypnea of the newborn presents with respiratory distress and marked tachypnea within 2 hours of delivery. Transient tac... | https://step2.medbullets.com/testview?qid=109292 |
198 | A newborn boy is evaluated in the hospital nursery 2 hours after birth. The patient was born at 39 weeks of gestation to a 30-year-old primigravid via vaginal delivery. The patient’s mother received routine prenatal care and the pregnancy was uncomplicated. The patient’s anatomy ultrasound at 20 weeks of gestation was ... | {
"A": "4p",
"B": "5p",
"C": "7q",
"D": "15q",
"E": ""
} | B | This patient presents with a characteristic mew, microcephaly, hypertelorism, wide nasal bridge, and hypotonia, which suggests a diagnosis of cri-du-chat syndrome. Cri-du-chat syndrome is caused by a deletion on chromosome 5p.
Cri-du-chat syndrome is most commonly caused by a de novo partial deletion of chromosome 5p.... | https://step2.medbullets.com/testview?qid=109452 |
199 | A 57-year-old man presents to the emergency department for shortness of breath. He was riding the train home from a business conference when his symptoms began. The patient has a medical history of obesity, diabetes, diabetic nephropathy, hypertension, and a 40-pack-year smoking history. His current medications include... | {
"A": "Aspirin",
"B": "Cardiac troponins",
"C": "Heparin",
"D": "Ventilation perfusion scan",
"E": ""
} | C | This patient is presenting with a score of 7.5 on Wells criteria suggesting a diagnosis of pulmonary embolism. The most appropriate initial step in management is heparin administration.
Patients with suspected pulmonary embolism (PE) can be evaluated with Wells criteria which consists of: clinical signs and symptoms o... | https://step2.medbullets.com/testview?qid=109453 |
200 | A 25-year-old woman presents for a new patient physical exam. Aside from occasional shin splints, she has a relatively unremarkable medical history. She takes oral contraceptive pills and a multivitamin daily. All of her age appropriate immunizations are up to date. Her periods have been regular, occurring once every 2... | {
"A": "Mammogram now",
"B": "Colonoscopy in 5 years",
"C": "Colonoscopy in 10 years",
"D": "Pap smear in 5 years",
"E": ""
} | B | This patient is presenting for a health evaluation with a family history significant for her father's death due to colon cancer at age 45. She should thus get a colonoscopy when she reaches the age 10 years prior to her father's age of diagnosis or in 5 years (at age 30).
The age threshold for colon cancer screening v... | https://step2.medbullets.com/testview?qid=109573 |
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