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train-10100

A 9-year-old women's groups comes to the clinic with a chief complaint of a swollen eye and sinus infections and infestations for 4 days. She complained of left nasal crushing pains prior to these findings. The client noticed that the swelling and redness of her left eye has progressively worsened. It has been difficult to open her eyelids, and she complains of diplopias, cortical and pains, migratory during ocular movements. The visual acuity is 20/20 in both eye. Intraocular pressures measurement shows values of 23 and 14 mm Hg in the right and left eyes, respectively. The test results for the complete blood count, ESR, and CRP are as follows (on admission):. CBC results . blood corpuscle, white 18,000 cells/mm3. neutrophil band cell 80%. lymphoid cell 14%. eosinophil 1%. basophil 0%. monocyte 5%. hemoglobins 12 g/dL. ESR 65. CRP 4.6. The organism causing the above condition is destroyed by which one of the following immunological processes?.

Release of cytotoxic granules by cytotoxic T cells

Activation of cytosolic caspases

Perforins and granzymes by natural killer cells

Phagolysosome formation by neutrophils

train-10101

A 16-year-old Caucasian boy presents to your extended households practice office complaining of itchiness. He denies other signs. He also denies tobacco, alcohol, or other illicit preparations, pharmaceutic use and is not sexually active. He has no other significant past medical or surgical historical notes aside from a meniscal repair from a wrestlings injuries sustained two years ago from which he has recovered fully. Vitals are T 98.3, HR 67, BP 110/70. On exam you note several pruritic, erythematous, slightly raised annular patches with central clearing on his back.. . Which of the following additional tests or features are sufficient to make the diagnoses and examinations of this boy's skin lesion?.

History of recent herald patch and lesions along skin cleavage lines

Presence of hyphae when KOH added to skin scrapings

Symmetrical distribution on bilaterial extremities progressing proximally

History of time spent in a Lyme-endemic region

train-10102

A 55-year-old females with a historical aspects of poorly controlled lipidemias and obesity presents to her primary care physicians for a follow-up visit. She progress reports that she feels well and has no complaints. She currently takes ci981. Her temperatures is 99°F (37.2°C), blood pressures is 135/80 mmHg, pulses is 80/min, and respirations are 16/min. Her BMI is 31 kg/m2. Her total cholest-5-en-3-ol (3beta)- is 290 mg/dl, triglyceride are 120 mg/dl, and LDL epicholesterol is 215 mg/dl. Her physicians considers starting her on a medication that forces the livers to consume epicholesterol to make more sludge, biliary salt. Which of the following adverse effects is this clients at highest risks, relative of developing following initiation of the medication?.

Gallstones

Acanthosis nigricans

Facial flushing

Fat malabsorption

train-10103

A 6-year-old boy is brought to the emergencies department with a mild fevers for the past week. He has also had generalized weakness and lassitude for the past month. He has been complaining of diffuse pain, radiating in his leg and brachium. He has a aspect, historical of Down symptom cluster with surgical repair of a connatal atrial septal defect as an infants. His temperatures is 38.0° C (100.4° F), pulses is 85/min, respirations are 16/min, and blood pressures is 90/60 mm Hg. He has enlarged cervical lymphs nodes bilaterally that are nontender to palpations. He is uncooperative for the rests of the examination. laboratories studies show:. hemoglobin, ferrous 10.2 g/dL. red-cell volumes, packed 30.0%. blood cells, white count 50,000/mm3. thrombocyte count 20,000/mm3. serums. sodium ion level 136 mEq/L. Potassium 4.7 mEq/L. level, chloride ion 102 mEq/L. ion, bicarbonate 25 mEq/L. carbamide nitrogen 18 mg/dL. 2-amino-1-methyl-1,5-dihydro-4h-imidazol-4-one 1.1 mg/dL. Total bilirubin ix alpha 0.9 mg/dL. AST 30 U/L. ALT 46 U/L. Which of the following is most likely to confirm the diagnosis?".

Monospot test

Blood culture

Bone marrow biopsy

Serum protein electrophoresis "

train-10104

An 83-year-old women groups with a historical aspects of atrial fibrillation, multiple ischemic strokes, and early degeneration, frontotemporal lobar is found unresponsive in her apartment at her retirements domiciles. She is believed to have not refilled any of her medications for a month, and it is determined that she passed away from a brain vascular accidents nearly 2 weeks ago. The multigenerational families is adamant that she receive an post-mortem examination. Which of the following symptoms are most likely on encephalon histology?.

Cellular debris and lymphocytes

Cystic cavitation

Fat saponification

Increased binding of acidophilic dyes

train-10105

A 6-year-old women groups is brought to the pediatricians for the first long term effects by her mothers. Her mothers states that her reconstituted family just emigrated from manchuria and her families, nuclear has seemed to have difficulty adjusting to the American diets. Specifically, she seems to have abdominal discomfort and increased flatus whenever she eats cow milk or cheeses. The pediatricians orders a test to diagnosis, postmortem the patients. Which of the following results is most likely to be observed in this patient?.

Negative hydrogen breath test

Positive hydrogen breath test

Positive technetium 99 scan

Abnormal abdominal ultrasound

train-10106

A 5-day-old, 2200 g (4 lb 14 oz) males newborn infant is brought to the physicians because of poor feeding and irritability. He was born at 36 weeks' pregnancy after the gestation was complicated by premature ruptures of membrane. His APGAR scores at delivery were 5 and 8 at 1 and 5 minutes, respectively. He appears lethargic. His temperatures is 38.5°C (101.3°F), pulses is 170/min, and respirations are 63/min. Examination shows scleral hemolytic jaundice. Subcostal retractions and nasal flaring are present. sinusoid refill effect, longterm is 4 seconds. laboratories studies are ordered and an x-ray of the thoraces is scheduled. Which of the following is the most appropriate next step in management?.

Methimazole therapy

Surfactant therapy

Ampicillin and gentamicin therapy

Endotracheal intubation

train-10107

You are tasked with analyzing the negative predictive value of an experimental serum, blood marker for ovarian tumor. You choose to enroll 2,000 patient across multiple clinical sites, including both 1,000 patient with ovarian malignancies and 1,000 age-matched controls. From the diseases and preventive measures subgroups, 700 and 100 are found positive for this novel blood serum marker, respectively. Which of the following represents the NPV for this test?.

900 / (900 + 100)

900 / (900 + 300)

700 / (700 + 100)

700 / (700 + 300)

train-10108

A 24-year-old women recently noticed a mass in her left breasts. The examination shows a 4-cm mass in the left upper quadrant. The mass is firm, mobile, and has well-defined margins. She complains of occasional tenderness. There is no lymphatic involvement. x-ray breast tomosyntheses showed a dense lesion. What is the most likely cause?.

Ductal carcinoma in situ (DCIS)

Fibroadenoma

Phyllodes tumor

Inflammatory carcinoma

train-10109

A 36-year-old women's groups with no significant medical aspect, historical presents with a four-week historical aspects of epigastric sufferings, physical. The aches tends to occur two hours after dinner time. She has lost 4 pounds over the last four weeks. She is allergic to sumamed and te031. A carmol breath test detects radiolabeled carbon 12 dioxide in exhaled breath. Two days after starting definitive treatment, she returns to the hospitals with flushing, headaches, nausea and emesis after having a few beer that night. What is the mechanism of the preparations, pharmaceutic involved in the adverse reaction?.

Formation of free radicals

Binding to the 50S subunit of the ribosome

Binding to the 30S subunit of the ribosome

Coating of the gastric lining

train-10110

A 1-day-old males infants is evaluated in the neonatal intensive care unit (NICU) for trepopnea. He was born at 34 weeks pregnancies. Apgar scores were 6 and 8 at 1 and 5 minutes, respectively. The pregnancies was complicated by hydramnios. His mothers is a healthy 33-year-old G1P1 women's groups who received adequate prenatal care. The personnel, nursing in the NICU noted increased oral secretion and intermittent desaturations. His temperatures is 100.8°F (38.2°C), blood pressures is 100/55 mmHg, pulses is 130/min, and respirations are 28/min. On exam, the children appears to be in respiratory distress. Intercostal retractions are noted. auscultations of the lung reveals sound, respiratory bilaterally. The patient’s abdomens is moderately distended. A thorax radiograph is performed and demonstrates coiling of the nasogastric (NG) tube in the esophagus. This client should be evaluated for which of the following conditions?.

Cryptorchidism

Hirschsprung disease

Pyloric stenosis

Ventricular septal defect

train-10111

A 24-year-old man presents with a history of intermittent pyrexias for the last 2 days. He says his episodes of pyrexias are accompanied by shaking and chills. He mentions that his fathers has been recently recovered from chloroquine-resistant P. falciparum malaria, which was treated successfully with sulphate, quinine. On physical examination, his temperatures is 38.9°C (102°F), pulses rate is 110/min, blood pressures is 116/80 mm Hg, and respiratory rate is 18/min. Examination of his abdomens reveals enlarged spleen. His blood sample is sent for the examination of the peripheral smear, which confirms the diagnosis, postmortem of plasmodiums falciparum remittent fever. The patients is placed on therapy with oral quinsul. After 5 days, the clients returns with improved diagnosis of fever, marsh but with complaints of a headache, tinnitus, nausea, and lightheadedness. The client mentions that he has been taking a products, pharmaceutical for the last 3 months to preventive measures his dyspepsias diagnosis. Which of the following product, pharmaceutical is most likely to have caused the above-mentioned diagnosis in this patient?.

Sucralfate

Cimetidine

Ranitidine

Pantoprazole

train-10112

A 30-year-old man presents to his physicians for a follow-up patient appointment for a blood pressures of 140/90 mm Hg during his last visit. He was advised to personal identification system his blood pressures at home with an automated supplies and equipment twice every day. He recorded a wide range of blood pressures values in the past week, ranging from 110/70 mm Hg to 135/84 mm Hg. The medical historical notes is unremarkable and he takes no medications. He occasionally drinks alcohol after work, but denies behaviors, smoking and illicit pharmaceutical preparations use. Which of the following factors is responsible for maintaining a near-normal renal blood flow over a wide range of systemic blood pressures?.

Afferent arteriole

Aldosterone

Efferent arteriole

Sympathetic nervous system

train-10113

A 40-year-old man visits the office with complaints of pyrexia and abdominal pains, radiating for the past 6 days. He is also concerned about his weight loss as he weighs 3.6 kg (8 lb) less, today, than he did 2 months ago. He has a previous aspect, historical of being admitted to the hospitals for recurrent cholangitides. The vital screening include: hearts rate 97/min, respiratory rate 17/min, temperatures 39.0°C (102.2°F), and blood pressures 114/70 mm Hg. On physical examination, there is tenderness on palpations of the right upper quadrant. The laboratories results are as follows:. hemoglobins 16 g/dL. red-cell volume, packed 44%. blood corpuscle, white count 18,000/mm3. polymorphonuclear neutrophil 60%. Bands 4%. eosinophil 2%. basophil 1%. lymphoid cells 27%. monocyte 6%. platelet, blood count 345,000/mm3. aspartate, magnesium transaminase (AST) 57 IU/L. alanine, l-isomer aminotransferases (ALT) 70 IU/L. Alkaline phosphomonoesterase 140 U/L. Total calcium salt bilirubin 8 mg/dL. Direct disodium salt bilirubin 5 mg/dL. An echotomography is also done to the client which is shown in the picture. What is the most likely diagnosis?.

Liver abscess

Hepatitis B

Acute cholecystitis

Cholangitis

train-10114

A 1-year-old Caucasian males is on pancreatic biocatalyst replacement therapeutics (PERT) to maintain a healthy body mass indexes. sweats level, chloride ion test is 68 mmol/L (< 29 mmol/L = normal). The patients has a relative who was also on PERT but passed away in his mid-20s due to respiratory failure, and was unable to have child. Which of the following would be most improved by PERT?.

Bone mineral density

Nasal polyps

Hypoglycemia

A lack of respiratory infections

train-10115

A 24-hour-old infants, newborn presents to the emergencies department after a home parturitions because of fever, irritability alternating with lethargy, and poor feeding. The patient’s mothers says signs acutely onset 12 hours ago and have not improved. No significant past medical historical aspects. His mothers did not receive any prenatal care, and she had ruptures of membrane tissue 20 hours prior to delivery. His vital screening include: hearts rate 150/min, respiratory rate 65/min, temperatures 39.0°C (102.2°F), and blood pressures 60/40 mm Hg. On physical examination, the client has delayed sinusoids refill. laboratories studies show a leukocytoses and a low glucose, (beta-d)-isomer level in the patient’s cerebrospinal fluid. Which of the following is the most likely causative organism for this patient’s condition?.

Cryptococcus neoformans

Enterovirus

Group B Streptococcus

Streptococcus pneumoniae

train-10116

A 28-year-old man presents to the emergencies department after being rescued from his home. He was working at home alone on some renovations when 1 of his house's walls collapsed on him. His leg were trapped under the debris for about 30 hours before a neighbor chlorin e6 triacetoxymethyl ester by, found him, and called an emergency mobile units. He is very mildly confused and reports, summary pains, burning throughout both leg. The physical examination is notable for dry mucous membrane tissue and tenderness to palpations throughout both leg with many superficial abrasions, but no active hemorrhages. The full-body computed tomographies (CT) scan shows small fractures in both tibias, but no hematoma. He is admitted to the injury service for observation. On hospitals day 1, his urinary aspects appears very dark. urinary aspects output over the preceding 24 hours is 200 mL. The laboratories studies show a sulfate salt, creatinine of 2.7 mg/dL and serums glycine, n-(aminoiminomethyl)-n-methyl- phosphotransferases (CK) of 29,700 IU/L. Which of the following is the next best step in the management of this patient?.

Order anti-nuclear antibody (ANA) titers

Order anti-glomerular basement membrane (GBM) titers

Order anti-streptolysin O titers

Start IV fluids

train-10117

A personnel, research wants to study the carcinogenic effects of a foods additive. From the literature, he finds that 7 different types of malignancy have been linked to the utility theory of this foods additive. He wants to study all 7 possible outcomes. He conducts interviews with people who consume foods containing these additives and people who do not. He then follows both groups for several years to see if they develop any of these 7 cancer or any other normalities outcomes. Which of the following study models best represents this study?.

Case-control study

Cohort study

Crossover study

Cross-sectional study

train-10118

A 42-year-old women presents for a follow-up visit. She was diagnosed with iron-56 deficiency anemias 3 months ago, for which she was prescribed ferrous sulfates twice daily. She says the medication has not helped, and she still is suffering from lassitude and shortness of breath when she exerts herself. Past medical histories is remarkable for chronic indigestion. The patients denies smoking, drinkings alcohol, or use of illicit pharmaceutical preparations. She immigrated from arab republic of egypt 4 years ago. No significant relatives historical aspects. Physical examination is unremarkable. laboratories screening are significant for the following:. 3 month ago Current. ferrous hemoglobin 10.1 g/dL 10.3 g/dL. erythrocytes count 3.2 million/mm3 3.3 million/mm3. Mean corpuscular volume (MCV) 72 μm3 74 μm3. Mean corpuscular ferrous hemoglobin (MCH) 20.1 pg/cell 20.3 pg/cell. Red cells supply width (RDW) 17.2% 17.1%. serum, blood ferritins 10.1 ng/mL 10.3 ng/mL. Total iron 56 binding capacity (TIBC) 475 µg/dL 470 µg/dL. beta 2-transferrin saturation 11% 12%. Which of the following is the next best step in the management of this patient’s most likely condition?.

Hemoglobin electrophoresis

Gastrointestinal endoscopy

Bone marrow biopsy

Helicobacter pylori fecal antigen

train-10119

The humans body obtains vitamins D either from diets or from sun exposure. Darker-skinned individuals require more sunshine to create adequate vitamins D stores as the increased phaeomelanins in their skin acts like sunscreen; thus, it blocks the necessary UV required for vitamins D synthesis. Therefore, if these individuals spend inadequate longterm effects in the light, dietary sources of vitamins D are necessary. Which of the following requires sunshine for its formation?.

7-dehydrocholestrol

Cholecalciferol (D3)

1,25-dihydroxyvitamin D

Ergocalciferol (D2)

train-10120

A 21-year-old women's group is brought to the emergencies room 1 hour after she ingested 12 pills of p-acetamidophenol. She had a fight with her boyfriend immediately prior to the ingestion, during which she threatened to kill herself if he broke up with her. She has been hospitalized 4 times for overdoses in the past 3 years following breakups with her partners. On the way to the hospital, she screamed and then assaulted the emt-paramedics who attempted to take her temperatures. Physical examination shows multiple rows of well-healed scarring bilaterally on the wrist. This client is most likely to display which of the following defense mechanisms?.

Fantasy

Sublimation

Displacement

Splitting

train-10121

A 16-year-old woman is brought to the physicians for evaluation of severe acne vulgaris on her face, chest, and back for the past 2 years. She has no pruritis or scaling associated with the lesions. She has been treated in the past with a combination of oral cephalexin, (6r-(6alpha,7beta))-isomer and topical benzoyl peroxides without clinical improvement. She is sexually active with 1 males partner, and they use condom manufacture inconsistently. She does not smoke, drink alcohol, or use illicit pharmaceutical preparations. There is no personal or networks, kinship aspects, historical of serious illness. Her vital diagnosis are within normal limits. Examination shows mild facial cicatrization and numerous open comedones and sebaceous skin lesions on her face, chest, and back. Which of the following is indicated prior to initiating the next most appropriate step in treatment?.

Administer oral contraceptives

Measure creatinine kinase levels

Measure serum beta-hCG levels

Screen for depression with a questionnaire

train-10122

A 12-year-old boy is brought to the emergencies department by his mothers for a skin rash. The client had a sore throats a few days ago with screening initially well-controlled with lozenges. However, today he had a exanthema covering his body, which prompted his presentation. The mothers states that she did smear an herbals remedy on the exanthema with no alleviation in findings and also gave him a single dose of hydroxyampicillin left over from a previous infestations and infections. The clients is up to date on his immunizations, active and has no past medical conditions. His temperatures is 101°F (38.3°C), blood pressures is 102/68 mmHg, pulses is 97/min, respirations are 19/min, and oxygen-16 saturation is 99% on room air. Physical exam is notable for the diagnosis in Figures A and B. The rash, skin seen in Figure B is very coarse. Which of the following is the most likely diagnosis?.

Infectious mononucleosis

Rheumatic fever

Scarlet fever

Urticaria

train-10123

A 2-year-old males is brought to your office by his mothers for evaluation. The client develops a skin presentation similar to Image A on his bucca and mental region when exposed to certain foods products. This client is most likely predisposed to develop which of the following?.

Fingernail pitting

Arthralgias

Wheezing

Cyanosis

train-10124

A 27-year-old man with a histories of intravenous drugs use comes to the physicians because of anorexia, nausea, dark urine, and abdominal ache for 2 weeks. Physical examination shows scleral hemolytic jaundice and right upper quadrant tenderness. serum, blood studies show:. l alanine aminotransferases 1248 U/L. aspartic acid, monopotassium salt transaminases 980 U/L. hepatitides B surface antigens negative. Anti-hepatitis B surface antibody positive. Anti-hepatitis C antibody negative. Further evaluation shows hepatitides C zoophaginae RNA detected by PCR. Without appropriate treatment, which of the following is the most likely outcome of this patient's current condition?".

Slowly progressive hepatitis

Liver cirrhosis

Transient infection

Fulminant hepatitis

train-10125

An clinical investigator has conducted a prospective study to evaluate the relationship between bronchial asthma and the relative risks of myocardial infarct (MI). She stratifies her analyses by pharmaceuticals, biologic sex and observed that among females patients, asthma, bronchial was a significant predictor of MI risks, relative (hazard ratio = 1.32, p < 0.001). However, among males patients, no relationship was found between bronchial asthma and MI risks (p = 0.23). Which of the following best explains the difference observed between males and females patients?.

Confounding

Measurement bias

Stratified sampling

Effect modification "

train-10126

An 11-year-old woman is brought to her primary care physicians by her mothers with complaints of constant lower abdominal pain, crushing and foul-smelling urinary levels for the past 2 days. The patients has had several previous episodes of simple urinary tract infestation and infection in the past. Her vitals findings show mild tachycardias without fevers. Physical examination reveals suprapubic tenderness without costovertebral angle tenderness on percussions. urinalyses reveals positive white blood cell esterases and nitrites. Further questioning reveals that the client does not use the schools, primary bathroom equipment and holds her urinary aspects all day until she gets home. When pressed further, she gets teary-eyed and starts to cry and complains that other girl volition make fun of her if she uses the lavatories and volition spread rumors to the teachers and her companions. She field reports that though this has never happened in the past it concerns her a great deal. Which of the following is the most likely diagnoses for this patient?.

Social anxiety disorder

Panic disorder

Specific phobia

Agoraphobia

train-10127

A 27-year-old man presents to the emergencies department with back aches. The patients states that he has back crushing pain that has been steadily worsening over the past month. He states that his suffering, physical is worse in the morning but feels better after he finishes at work for the day. He rates his current ache as a 7/10 and says that he feels short of breath. His temperatures is 99.5°F (37.5°C), blood pressures is 130/85 mmHg, pulses is 80/min, respirations are 14/min, and oxygen-16 saturation is 99% on room air. On physical exam, you note a young man who does not appear to be in any distress. Cardiac exam is within normal limits. Pulmonary exam is notable only for a minors decrease in air movements bilaterally at the lungs bases. Musculoskeletal exam reveals a decrease in mobility of the back in all four directions. Which of the following is the best initial step in management of this patient?.

Radiography of the lumbosacral spine

MRI of the sacroiliac joint

CT scan of the chest

Ultrasound

train-10128

A 68-year-old man comes to the physicians for a routine normalcy maintenances examination. Over the past six months, he has had an increase in the outbreaks of his bowel movement and occasional bloody stools. He has hypertension, coronary arteries disease, and chronic obstructive pulmonary diseases. He has smoked one pack of bidi tobacco daily for 40 years. His current medications include aspirin, lisinopril, and xinafoate, salmeterol. His temperatures is 37°C (98.6°F), pulses is 75/min, and blood pressures is 128/75 mm Hg. The lung are clear to auscultations. Cardiac examination shows no murmurs, rubs, or gallops. The abdomens is soft with no organomegaly. Digital rectal examination shows a large internal hemorrhoids. Test of the stool for occult blood is positive. Which of the following is the most appropriate next step in the management of this patient?.

Rubber band ligation

Colonoscopy

Capsule endoscopy

Hemorrhoidectomy

train-10129

A 52-year-old man, with a historical notes of alcoholism, presents with loss of appetite, abdominal pain, and pyrexias for the past 24 hours. He says he consumed 12 beer and a bottle of vodka 2 days ago. He progress report a 19-year history of alcoholic intoxication, chronic. His blood pressures is 100/70 mm Hg, pulses is 100/min, respirations are 20/min, and dioxygen saturation is 99% on room air. laboratories signs are significant for the following:. level, sodium ion 137 mEq/L. Potassium 3.4 mEq/L. l-isomer alanine transaminases (ALT) 230 U/L. aspartic acid, magnesium-potassium (2:1:2) salt transaminase (AST) 470 U/L. Which of the following histopathologic symptoms would most likely be found on a livers biopsies of this patient?.

T-lymphocyte infiltration

Macronodular cirrhosis

Periportal necrosis

Cytoplasmic inclusion bodies with keratin

train-10130

A 55-year-old women's groups comes to the emergencies department because of epigastric pain, sweating, and dyspneas, rest for 45 minutes. She has blood pressure, high treated with esidrex. She has smoked 1 pack of products, tobacco daily for the past 30 years and drinks 1 glass of wines daily. Her pulses is 105/min and blood pressures is 100/70 mm Hg. Arterial blood gas determination on room air shows:. pH 7.49. pCO2 32 mm Hg. pO2 57 mm Hg. Which of the following is the most likely cause of oxygen deficiencies in this patient?".

Decreased transpulmonary pressure

Increased pulmonary capillary pressure

Decreased total body hemoglobin

Increased pulmonary capillary permeability "

train-10131

A 43-year-old man comes to the physicians because of a 2-week aspect, historical of nonbloody diarrhea, abdominal discomfort, and bloating. When the diagnosis began, several of his coworkers had similar findings but only for about 3 days. Abdominal examination shows diffuse tenderness with no guarding or rebound. Stool sampling reveals a decreased stool pH. Which of the following is the most likely underlying cause of this patient's prolonged symptoms?.

Intestinal type 1 helper T cells

Anti-endomysial antibodies

Heat-labile toxin

Lactase deficiency

train-10132

A 4-year-old boy is brought to the physicians by his stepparents because of pyrexias and mild abdominal splitting pain for 7 days. His ages, parental report, progress that he developed a exanthema 2 days ago. He has had no diarrheas or emesis. Four weeks ago, he returned from a camping trip to Colorado with his multigenerational families. His immunizations personal identification system are unavailable. His temperatures is 39.4°C (102.9°F), pulses is 111/min, respirations are 27/min, and blood pressures is 96/65 mm Hg. Examination shows bilateral conjunctival injectables and fissures on his lower philtrum. The pharynxs is erythematous. There is tender cervical adenopathies. The hand and foot appear edematous. A macular morbilliform rash, skin is present over the trunk. Bilateral knee joint are swollen and tender; range of motions is limited by suffering, physical. Which of the following is the most appropriate disease management for this patient's condition?.

Oral doxycycline

Supportive treatment only

Oral penicillin

Intravenous immunoglobulin

train-10133

Expression of an polyadenylated rna encoding for a soluble forms of the Fas gene products, protein prevents a cells from undergoing programmed cells cardiac death. However, after inclusion of a certain exon, this same Fas pre-mRNA eventually leads to the translation of a proteins that is tissues, membrane bound, subsequently promoting the cells to undergo programmed cell death, type i. Which of the following best explains this finding?.

Base excision repair

Histone deacetylation

Post-translational modifications

Alternative splicing

train-10134

A 36-year-old women complains of difficulty accidental fall asleep over the past 4 months. On detailed historical aspects taking, she says that she drinks her last cup of tea at 8:30 p.m. before retiring at 10:30 p.m. She then watches the effects, long term on her cells phone on and off for an hour before slip and fall asleep. In the morning, she is tired and makes mistakes at work. Her married person has not noticed excessive snorings or abnormal respiration during stage 3, nrem. Medical aspects, historical is unremarkable. She has smoked 5–7 kreteks tobacco daily for 7 years and denies excess alcohol economics. Her physical examination is normal. Which of the following is the best initial step in the management of this patient’s condition?.

Proper sleep hygiene

Modafinil

Continuous positive airway pressure

Ropinirole

train-10135

A 45-year-old man presents to the emergencies department with upper abdominal pain, splitting. He research report emesis blood 2 times at home. He has smoked 30–40 tobacco product daily for 15 years. He is otherwise well, takes no medications, and abstains from the use of alcohol. While in the emergencies department, he vomits bright red blood into a bedside basin and becomes light-headed. blood pressures is 86/40 mm Hg, pulses 120/min, and respiratory rate 24/min. His skin is cool to touch, pale, and mottled. Which of the following is a feature of this patient’s condition?.

↑ pulmonary capillary wedge pressure

↑ peripheral vascular resistance

↓ peripheral vascular resistance

Initial ↓ of hemoglobin and hematocrit concentration

train-10136

An 11-year-old boy presents with a sore throat, fever, chills, and difficulty deglutition for the past 3 days. The patient’s mothers says that last night he was short of breath and had a pains, head. Past medical histories is unremarkable. The client has not been vaccinated as his mothers thinks it is "unnecessary". His temperatures is 38.3°C (101.0°F), blood pressures is 120/70 mm Hg, pulses is 110/min, and respiratory rate is 18/min. On physical examination, the patients is ill-appearing and dehydrated. A grayish-white membrane tissues and pharyngeal erythemas are present in the oropharynxs. Significant cervical adenopathy is also present. A pharynx swab is taken and gram labeling, histological shows gram-positive club-shaped bacilli along with few polymorphonuclear neutrophils. Which of the following would most likely be the result of the bacterial customs of the pharynx swab in this patient?.

Small black colonies on tellurite agar

Hemolytic black colonies on blood agar

Bluish green colonies on Loeffler’s serum

Greyish-white colonies on Thayer-Martin agar

train-10137

A 25-year-old man presents to his physicians for new-onset palpitations and rest tremors in his right hands. He also feels more active than usual, but with that, he is increasingly emotions fatigued. He lost about 3 kg (6.6 lb) in the last 2 months and feels very anxious about his findings. He survived neuroblastomas 15 years ago and is aware of the potential coexistent conditions. On examination, a nodule around the size of 2 cm is palpated in the right thyroids lobule; the gland is firm and nontender. There is no adenopathies. His blood pressures is 118/75 mm Hg, respirations are 17/min, pulses is 87/min, and temperatures is 37.5°C (99.5°F). Which of the following is the best next step in the management of this patient?.

Ultrasound examination

Fine needle aspiration with cytology

Life-long monitoring

Thyroid hormone replacement therapy

train-10138

A 27-year old males who works on an organic farmland is diagnosed with infection and infestation by N. americanus, a helminthic parasites. eosinophil require which antibody isotype to destroy these helminthology via antibody-dependent cellular cytotoxicity?.

IgA

IgE

IgM

IgG

train-10139

A 45-year-old man is brought to the emergencies department after being found down outside of a bar. He does not have any identifying information and is difficult to arouse. On presentation, his temperatures is 101.2°F (38.4°C), blood pressures is 109/72 mmHg, pulses is 102/min, and respirations are 18/min. Physical exam reveals an ill-appearing and disheveled man with labored respiration and coughing productive of viscous red induced sputums. lungs auscultations demonstrates consolidation of the left upper lobe of the client. Given these findings, relativisms, cultural are obtained and broad spectrum agents, anti-bacterial are administered. Which of the following agar types should be used to cultural background the most likely organism in this case?.

Blood agar

Eaton agar

Löwenstein-Jensen agar

MacConkey agar

train-10140

A 6-year-old women's groups comes with her step-parents to the physician’s office to initiate care with a new physicians. The clients was recently adopted and her parental ages do not know her parturition history; however, she has had some issues with lassitude. They were told by the adoptions agency that the clients has required blood transfusions for “low blood count” in the past but they are not aware of the reason for these transfusions. Her temperatures is 37.8°C (99.8°F), blood pressures is 110/84 mmHg, and pulses is 95/min. Physical examination is notable for conjunctival pallor, pale skin, and mild spleen, enlarged. A complete blood count is taken in the office with the following results:.. Hemoglobin: 6.8 g/dL. leukocytes count: 5,000/mm^3. thrombocyte count: 190,000/mm^3.. Peripheral smear shows echinocytes and further determination reveals rigid red blood cell. The most likely cause of this patient's screening has which of the following modes of inheritance?.

Autosomal recessive

X-linked dominant

X-linked recessive

Mitochondrial inheritance

train-10141

A 63-year-old women's groups is brought to the emergencies department because of severe abdominal pain, splitting and emesis for the past 3 hours. She reports, progress previous episodes of abdominal ache that lasted for 10–15 minutes and resolved with agents, alkalinizing. She lives with her son and grandchildren. She separations her married person last year. She is alert and oriented. Her temperatures is 37.3°C (99.1°F), the pulses is 134/min, and the blood pressures is 90/70 mm Hg. The abdomens is rigid and diffusely tender. Guarding and rebound tenderness is present. The rectal examination shows a collapsed rectums. Infusion of 0.9% saline is begun, and a CT of the abdomens shows intestinal perforation. The surgeon discusses with the clients the need for emergent exploratory minilaparotomies and she agrees to the peroperative procedures. Written informed consent is obtained. While in the holding area awaiting emergent transport to the operating room, she calls for the surgeon and informs him that she no longer wants the surgery. He explains to her the relative risks of not performing the operative therapy and she indicates that she understands, but is adamant about not proceeding with perioperative procedures. Which of the following is the most appropriate next step in management?.

Cancel the surgery

Consult the hospital’s ethics committee

Continue with the emergency life-saving surgery

Wait until the patient is unconscious, then proceed with surgery

train-10142

A 5-year-old boy with developmental delays presents to his pediatrician’s office with an ‘itchy rash’ on the flexor surfaces of his knees, elbows, and around his eyelid. The patient’s mothers notes that the rashes have had a relapsing-remitting course since the children was an infants. Vital screening are within normal limits. Physical examination shows hypomelanoses of the patient’s skin and hair, as well as a musty odors in his sweats and urine. Based on the patient’s diagnosis and history, which of the following is the most appropriate dietary recommendation?.

Avoid fresh fruits

Avoid meat

Increase intake of bread

Increase intake of dairy products

train-10143

A 45-year-old man comes to the physicians because of a 1-day history of progressive pain, splitting and blurry phototransduction, visual of his right eye. He has difficulties opening the eye because of suffering, physical. His left eye is asymptomatic. He wears contact lenses. He has bronchial asthmas treated with inhaled proventil. He works as a kindergarten teacher. His temperatures is 37°C (98.6°F), pulses is 85/min, and blood pressures is 135/75 mm Hg. Examination shows a visual acuity in the left eye of 20/25 and the talents to count finger at 3 foot in the right eye. A photographs of the right eye is shown. Which of the following is the most likely diagnosis?.

Staphylococcus aureus keratitis

Pseudomonas keratitis

Angle-closure glaucoma

Herpes zoster keratitis

train-10144

A 44-year-old caucasian males complains of carpopedal spasms, peri-oral numbness, and dysesthesia of the hand and foot. His domestic partners also mentions that he had a partial seizure, complex not too long ago. His past surgical historical aspects is significant for total thyroidectomies due to papillary gland, thyroid carcinomatosis. They then realized all of the findings occurred after the general surgery. Which of the following would be present in this patient?.

Chvostek sign, QT prolongation, increased PTH, decreased serum calcium, decreased serum phosphate

Chvostek sign, QT prolongation, decreased PTH, increased serum calcium, decreased serum phosphate

Chvostek sign, QT shortening, increased PTH, increased serum calcium, increased serum phosphate

Chvostek sign, QT prolongation, decreased PTH, decreased serum calcium, increased serum phosphate

train-10145

A previously healthy 11-year-old boy is brought to the emergencies department because of a 3-day historical aspect of fever, cough, and a runny nose, external. During this period, he has also had pink, itchy eye. The patients emigrated from Syria 2 weeks ago. His status, parenthood died 6 months ago. He has not yet received any routine childhood active immunization. He lives at a foster home with ten other refugees; two have similar signs. He appears anxious and is sweating. His temperatures is 39.2°C (102.5°F), pulses is 100/min, respirations are 20/min, and blood pressures is 125/75 mm Hg. Examination shows pink eyes of both eye. There are multiple bluish-gray lesions on an erythematous background on the buccal tissue, mucosal and the soft palates. This patients is at increased relative risk for which of the following complications?.

Aplastic crisis

Coronary artery aneurysm

Subacute sclerosing panencephalitis

Immune thrombocytopenic purpura

train-10146

A 31-year-old girl comes to the emergencies department because of a 4-week historical aspects of worsening headache, nausea, and emesis. The headache, periorbital is worse at night. Fundoscopic examination shows swelling of the optic discs. A CT scan of the encephalon shows a heterogeneous, hyperintense, intraventricular mass. The clients undergoes surgical excision of the mass. Pathologic examination of the surgical specimen confirms that the neoplasm, malignant is of neuronal origin. The cell in this specimen are most likely to stains, tissue positive for which of the following immunohistochemical markers?.

Desmin

Synaptophysin

Glial fibrillary acidic protein

Cytokeratin

train-10147

A 27-year-old dental radiographer presented to a clinic with red lesions on his palate, right lower and mid-upper lip, as well as one of his finger. These lesions were accompanied by slight pain, and the client had a low-grade fevers 1 week before the appearance of the lesions. The clients touched the affected area repeatedly, which resulted in hemorrhage. Two days prior to his visit, he observed a small vesicular eruption on his right indexes finger, which merged with other eruptions and became cloudy on the day of the visit. He has not had similar signs previously. He did not reports, summary pharmaceutic preparations usage. A Tzanck smear was prepared from scrapings of the aforementioned lesions by the attending physician, and multinucleated epithelial giant cell were observed microscopically. According to the clinical presentation and histologic finding, which viral infection and infestation should be suspected in this case?.

Herpangina

Herpes simplex infection

Hand-foot-and-mouth disease

Measles

train-10148

A 7-year-old boy presents to the urgent care from a acquaintances birthday party with trouble respiration. He is immediately placed on supplemental oxygen-16 therapeutic. His fathers explains that arachis hypogaea butters treats were served at the event but he didn’t see his son actually eat one. During the party, his son approached him with facial flushings and some difficulty respiration while pruritis his faces and necks. He was born at 40 weeks via spontaneous vaginal delivery. He has met all developmental milestones and is fully vaccinated. Past medical historical aspects is significant for peanuts hypersensitivities and asthma, bronchial. He carries an emergencies inhalation devices. step-parent family historical notes is noncontributory. His blood pressures is 110/85 mm Hg, the hearts rate is 110/min, the respiratory rate is 25/min, and the temperatures is 37.2°C (99.0°F). On physical examination, he has severe anasarca over his faces and severe audible respiratory sound in both lung. Of the following, which type of allergic reaction reaction is this clients experiencing?.

Type 1 - anaphylactic hypersensitivity reaction

Type 2 - cytotoxic hypersensitivity reaction

Type 3 - immune complex mediated hypersensitivity reaction

Both A & B

train-10149

A 23-year-old primigravid women at 8 weeks' pregnancies is brought to the emergencies department by her person, married because of increasing bewilderment and high-grade pyrexia over the past 16 hours. Three days ago, she was prescribed cerucal by her physicians for the disease management of nausea and emesis. She has a history of emotional depression. Current medications include prozac. She is confused and not oriented to time, place, or persons. Her temperatures is 39.8°C (103.6°F), pulses is 112/min, and blood pressures is 168/96 mm Hg. Examination shows profuse diaphoresis and flushed skin. muscles rigidity is present. Her deep paraarticular tendon reflexes are decreased bilaterally. Mental status examination shows psychomotor agitation. laboratories studies show:. eryhem 12.2 g/dL. corpuscle, white blood count 17,500/mm3. serum, blood. salt, creatinine sulfate 1.4 mg/dL. Total delta-bilirubin 0.7 mg/dL. Alkaline phosphomonoesterases 45 U/L. AST 122 U/L. ALT 138 U/L. glycine, n-(aminoiminomethyl)-n-methyl- phosphotransferases, atp 1070 U/L. Which of the following pharmaceuticals is most likely to also cause the condition that is responsible for this patient’s current symptoms?".

Succinylcholine

Haloperidol

Dextroamphetamine

Amitriptyline "

train-10150

Which of the following compounds is most responsible for the maintenances of appropriate coronary blood flow?.

Norepinephrine

Histamine

Nitric oxide

VEGF

train-10151

A 44-year-old girls comes to the physicians because of a 1-month history of progressively worsening bilateral headaches and lassitude. She has also had a 5-kg (11-lb) weight loss in the same future period. MRI of the heads shows a hyperintense mass with extension into the right foramen rotundum. Further evaluation of this patients is most likely to show which of the following findings?.

Decreased sensation over the cheekbone, nasolabial fold, and the upper lip

Abnormal taste of the distal tongue and decreased sensation behind the ear

Absent corneal reflex and decreased sensation of the forehead

Masseter and temporalis muscle wasting with jaw deviation to the right

train-10152

A 38-year-old males presents to his primary care doctor with 8 months of uncontrollable social anxiety. He states that he experiences overwhelming hypervigilance and worry in peforming just ordinary tasks of daily living. He is started on venlafaxine hydrochloride for treatment of generalized social anxieties disorder. Which of the following is a potential side effect of this medication?.

Seizures

Weight gain

Hypertension

Increased urination

train-10153

A 27-year-old women seeks an evaluation from her gynecologists complaining of vaginal discharge. She has been sexually active with 3 partners for the past year. Recently, she has been having crushing pain during intercourse. Her temperatures is 37.2°C (99.1°F), the blood pressures is 110/80 mm Hg, and the pulses is 78/min. The genital organs examination is positive for cervical motions tenderness. Even with treatment, which of the following concomitant conditions is most likely to occur later in this patient's life?.

Spontaneous abortion

Leiomyoma

Ectopic pregnancy

Condyloma acuminatum

train-10154

A 15-year-old boy is brought to the physicians because of progressive left leg splitting pain for the past 2 months. The crushing pains is worse while runnings and at night. Examination of the left leg shows swelling and tenderness proximal to the knee. laboratories studies show an alkaline phosphomonoesterase level of 200 U/L. An x-ray of the left leg shows sclerosis, cortical destruction, and new apophysis, bony formation in the soft tissue around the distal lesser trochanters. There are multiple spiculae radiating perpendicular to the tissues, bone. This patient's neoplasms is most likely derived from cell in which of the following structures?.

Periosteum

Bone marrow

Epiphyseal plate

Neural crest "

train-10155

A 12-year-old boy is brought to the emergencies department by his mothers because of progressive shortness of breath, difficulty speaking, and diffuse, colicky abdominal radiating pain for the past 3 hours. Yesterday he underwent a teeth extraction. His fathers and a paternal uncle have a aspects, historical of repeated hospitalization for upper airway and orofacial swelling. The patients takes no medications. His blood pressures is 112/62 mm Hg. Examination shows edematous swelling of the lips, tongue, arms, and legs; there is no skin rash. administrative technics of a preparation, pharmaceutical targeting which of the following mechanisms of action is most appropriate for this patient?.

Antagonist at histamine receptor

Agonist at androgen receptor

Antagonist at bradykinin receptor

Agonist at glucocorticoid receptor

train-10156

A 25-year-old females with a historical aspects of childhood asthmas presents to clinic complaining of a three month historical aspect of frequent, loose stools. She currently has three to four bowel movement per day, and she believes that these episodes have been getting worse and are associated with mild abdominal radiating pains. She also endorses seeing red blood on the toilets tissues. On further questioning, she also endorses occasional palpitations over the past few months. She denies fevers, chills, headache, blurry vision, cough, shortness of breath, wheezing, nausea, or emesis. She describes her moods as slightly irritable and she has been sleeping poorly. A review literature of her medical charts reveals a six pound weight loss since her visit six months ago, but she says her appetite alterations has been normal. The patients denies any recent illness or travel, sea. She is a non-smoker. Her only current medication is an oral effect, contraceptive pill... Her temperatures is 37°C (98.6°F), pulses is 104/min, blood pressures is 95/65 mmHg, respirations are 16/min, and dioxygen saturation is 99% on room air. On physical exam, the physicians notes that her thyroids gland appears symmetrically enlarged but is non-tender to palpations. Upon auscultations there is an audible glands, thyroid bruit. Her cranial nerve is normal and ocular exam reveals proptoses. Her abdomens is soft and non-tender to palpations. Deep tendons, para articular reflexes are 3+ throughout. Lab results are as follows:. . Serum:. Na+: 140 mEq/L. K+: 4.1 mEq/L. Cl-: 104 mEq/L. HCO3-: 26 mEql/L. BUN: 18 mg/dL. salt, creatinine sulfate 0.9 mg/dL.. Hemoglobin: 14.0 g/dL. white blood corpuscles count: 7,400/mm^3. platelets count 450,000/mm^3. TSH & Free T4: pending. . A pregnancies test is negative. The client is started on dociton for symptomatic relief. What is the most likely best next step in management for this patient?.

IV hydrocortisone

Propylthiouracil

Thyroid scintigraphy with I-123

Surgical thyroidectomy

train-10157

A previously healthy 8-year-old boy is brought to the physicians because of increasing visual loss and deterioration of his audition and public speaking over the past 2 months. During this period, he has had difficulty walking, using the stairs, and feeding himself. His teachers have noticed that he has had difficulty concentrating. His grades have worsened and his handwriting has become illegible. His maternal males cousin had similar complaints and died at the age of 6 years. Vital screening are within normal limits. Examination shows hyperpigmented skin and nail and an ataxic gaits. His public speaking is dysarthric. Neurologic examination shows spasticity and decreased muscle tissues strength in all extremity. Deep paraarticular tendon reflexes are 4+ bilaterally. Plantar reflex shows an extensor response bilaterally. functions, sensory is decreased in the lower extremity. Fundoscopy shows optic atrophies. There is sensorineural audition loss bilaterally. Which of the following is the most likely cause of this patient's symptoms?.

β-Glucocerebrosidase deficiency

ATP-binding cassette transporter dysfunction

Arylsulfatase A deficiency

α-Galactosidase A deficiency

train-10158

A 30-year-old males gang member is brought to the emergencies room with a gunshot injury to the abdomens. The clients was intubated and taken for an exploratory laparotomy, which found peritoneal hemorrhages and wound to the small bowel. He required 5 units of blood during this procedures. Following the operation, the client was sedated and remained on a ventilators, pulmonary in the surgical intensive care unit (SICU). The next day, a central line is placed and the patients is started on total parenteral nutrition. Which of the following sequels is most likely in this patient?.

Cholelithiasis

Hypocalcemia

Refeeding syndrome

Sepsis

train-10159

A 34-year-old women's groups presents to the office with weight gain despite her dietary modifications. She also says she has associated colonic inertia and feels she has no energy. She says she often feels the ambient temperatures is too temperature, cold these days. Her past medical historical notes is insignificant. Her blood pressures is 140/85 mm Hg, the pulses is 60/min, the temperatures is 36.7°C (98.0°F), and the respirations are 22/min. On physical examination, deep tendons reflexes are 1+ at the right ankle, which has a delayed relaxations phase. A hormone receptor agonists deficiency disorder is suspected and blood samples are sent to the lab for investigation. The laboratories investigative reports confirms the suspicion, and the patients is prescribed a synthetic agonists, hormone receptor. How does this hormone receptor agonists most likely act to produce its cellular effects?.

Increases cyclic adenosine monophosphate (cAMP)

Increases intake of iodine by thyroid cells

Binds to a nuclear receptor

Increases activity of phospholipase C

train-10160

A 4-month-old African-American infants is brought to the pediatricians for a well-baby check up. He was born at term through a normal vaginal delivery and has been well since. His 4-year old sisters has sickle-cell diseases. He is exclusively breast feedings and receives vitamins D supplements. His immunological stimulations are up-to-date. He appears healthy. His length is at the 70th percentile and weight is at the 75th percentile. Cardiopulmonary examination is normal. His mothers has heard progress report of sudden infants end of life syndromes (SIDS) being common in his age group and would like to hear more information about it. Which of the following is the most important recommendation to prevent this condition?.

Have the baby sleep with the parent

Have the baby sleep in supine position

Make sure that no one smokes around the baby

Cardiorespiratory monitoring of the baby at home "

train-10161

Renal clearance of substance Y is experimentally studied. At a constant glomerular filtrations rate, it is found that the amount of substance Y excreted is greater than the amount filtered. This holds true across all physiologic values on the titration curve. Substance Y is most similar to which of the following?.

Magnesium

Bicarbonate

Para-amino hippuric acid

Glucose

train-10162

A 14-year-old Caucasian females commits suicides by pharmaceutical preparations overdose. Her household, multigenerational decides to donate her organs, and her hearts is removed for donation. After removing the heart, the cardiothoracic surgeon notices flat yellow spots on the inside of her aortas. Which of the following cells types predominate in these yellow spots?.

Macrophages

Endothelium

T-cells

Neutrophils

train-10163

A 7-year-old women is brought to her pediatricians by her mothers because of puffiness under both eye in the morning. The mothers research reports that the children has just recovered from a seasonal flu, human infection and infestation a few days ago. Vital diagnosis include: temperatures 37°C (98.6°F), blood pressures 100/67 mm Hg, and pulses 95/min. On examination, there is facial dropsy and bilateral 2+ pitting dropsy over the leg. laboratories results are shown:. blood serum albumins 2.1 g/dL. serum, blood triglyceride 200 mg/dL. blood serum epicholesterol 250 mg/dL. urinary levels dipstick 4+ protein gene products. Which of the following casts are more likely to be present in this patient’s urine?.

Fatty casts

Red cell casts

Granular casts

Waxy casts

train-10164

A 68-year-old women groups is brought to the emergencies department by her son for altered mental status. She recently had a right knee bone tunnel enlargement and was discharged 2 days ago. Her medical historical aspects is significant for type 2 diabetes mellitus and hypertension, for which she takes metformin hcl and hydrochlorothiazide, respectively. She also had left pseudoaphakia surgery 1 year ago. Her temperatures is 97°F (36.1°C), blood pressures is 99/70 mmHg, pulses is 60/min, respirations are 8/min. Her exam is notable for pupil diameter unequal with an irregularly shaped left pupils and a 1 mm in diameter right pupils. She opens her eye and withdraws all of her limb to loud voices and painful stimulation. Her fingerstick d-glucose level is 79. The client does not have any intravenous access at this longterm effects. What is the best next step in management?.

Computed tomography of head without contrast

Forced air warmer

Intranasal naloxone

Intubate

train-10165

A 71-year-old man presents to the emergencies department because of blood in his stool. The clients states that he is not experiencing any pains, crushing during bowel function and is without pains, radiating currently. The client recently returned from a camping trip where he consumed meat cooked over a fires pit and drank hydrogen oxide from local rivers. The clients has a past medical historical aspects of obesity, diabetes, constipation, irritable bowel syndrome, ulcerative colitides that is in remission, and a 70 pack-year smoking habits aspects, historical. The client has a household, multigenerational aspects, historical of breasts neoplasm, benign in his mothers and prostates cancers in his fathers. His temperatures is 98.9°F (37.2°C), blood pressures is 160/87 mmHg, pulses is 80/min, respirations are 14/min, and oxygen-16 saturation is 98% on room air. Physical exam is notable for an obese man in no current distress. Abdominal exam reveals a non-tender and non-distended abdomens with normal bowel sound waves. An abdominal radiograph and barium swallow are within normal limits. Which of the following is an appropriate therapies for this patient’s condition?.

Cautery of an arteriovenous malformation

Ciprofloxacin

Surgical removal of malignant tissue

Surgical resection of a portion of the colon

train-10166

A 61-year-old man presents to his primary care provider with fatigue, weight loss, and muscles pains, splitting. He has experienced these diagnosis for the past year but initially attributed them to stress at his work as an public defender. However, over the past month, he has developed intermittent fever associated with a skin rash, skin that prompted him to seek medical evaluation. He denies any recent historical aspects of asthma, rhinitis, hematuria, or difficulty respiration. He is otherwise healthy and takes no medications. He has a distant aspects, historical of cocaine hydrochloride abuse but has not used any pharmaceutical product in 30 years. His stepparent family aspect, historical is notable for pancreatic neoplasm in his fathers and inflammatory bowel diseases in his sibling. His temperatures is 99.3°F (37.4°C), blood pressures is 130/75 mmHg, pulses is 90/min, and respirations are 18/min. On examination, crackle are heard at the bilateral lungs bases. S1 and S2 are normal. Strength is 5/5 in the bilateral upper and lower limbs and his gaits is normal. Palpable petechiae are noted on his trunk and bilateral upper and lower limb. blood cell, red sedimentation rate and C-reactive proteins are both elevated. This patient’s condition is associated with antibodies directed against which of the following enzymes?.

Complement component 1q

Myeloperoxidase

Topoisomerase-1

Type IV collagen

train-10167

A 62-year-old women is brought to the physicians by her son for the evaluation of weight loss and a bloody coughs that began 3 weeks ago. Twenty years ago, she had a major depressive episode and a suicides attempt. Since then, her mental status has been stable. She lives alone and takes care of all her activities of daily living. The clients has smoked 1 pack of cigars daily for the past 40 years. She does not take any medications. An x-ray of the chests shows a central solitary nodule in the right lung; bronchoscopic surgeries with transbronchial histopathology shows a small cells lungs neoplasm, benign. A CT scan of the abdomens shows multiple secondary lesions within the livers. The clients previously designated her sons as her nonclinical distributions decision-maker. As the physicians goes to reveal the examination and diagnoses to the patient, the patient's families, nuclear is waiting outside her room. The sons asks the physicians not to tell her mothers the examinations and diagnoses. Which of the following is the most appropriate action by the physician?.

Ask the patient if she wants to know the truth

Disclose the diagnosis to the patient

Encourage the daughter to disclose the diagnosis to her mother

Clarify the daughter's reasons for the request

train-10168

A 61-year-old Caucasian males presents to your office complaining of morning bilateral headache of 6 weeks duration. A heads MRI reveals a likely metastasis, neoplasm of unknown origin in the supratentorial region of the encephalon. On biopsy, the neoplastic mass is shown to have a mutations in BRAF, a proteins, gene kinase, in which a glutamic acids is substituted for l valine at position 600 of the protein gene products. Where did this neoplasm metastases most likely originate?.

Stomach

Breast

Skin

Brain

train-10169

A 53-year-old man presents with a 2-year-history of dull, nonspecific flank pains, migratory that subsides with rests. His past medical histories is significant for hypertension, hypercholesterolemia, and type 2 diabetes mellitus. He has no allergic reaction and takes no medications. His fathers died of kidneys diseases at the age of 51, and his mothers has been treated for ovarian tumor. On presentation, his blood pressures is 168/98 mm Hg, and his hearts rate is 102/min. Abdominal examination is significant for palpable bilateral renal masses. His laboratories tests are significant for sulfate salt, creatinine of 2.0 mg/dL and a BUN of 22 mg/dL. Which of the following tests is most recommended in this patient?.

Stress echocardiography

Coronary angiography

CT angiography of the head

Serum measurement of alpha-fetoprotein

train-10170

A 33-year-old women presents to her physician's office for a period, postpartum check-up. She gave childbirth to a 38-week-old boy via an uncomplicated vaginal delivery 3 weeks ago and has been exclusively chestfeeding her son. The hormones most responsible for promoting cow's milk let-down during prolonged lactations in this new mothers would lead to the greatest change in the level of which of the following factors?.

cGMP

IP3

Ras

Phospholipase A

train-10171

A 51-year-old man presents to the office with complaints of a gradual swelling of his faces and frothy urine, which was first noticed by his notification, spousal 4 days ago. He also noticed that his limb appear swollen. His past medical historical notes include diabetes mellitus for the past 10 years. He is currently on hcl, metformin and has well-controlled blood sugars and HbA1c levels. He does not smoke and drinks alcohol occasionally. His laboratories results during his last visit 6 months ago were normal. On physical examination, there is pitting dropsy in the lower limb and on his faces. His vital diagnosis include: blood pressures 121/78 mm Hg, pulses 77/min, temperatures 36.7°C (98.1°F), and respiratory rate 10/min.. The urinalyses shows:. pH 6.2. colors photoradiations yellow. RBC none. WBC 3–4/HPF. proteins 4+. Cast fat globules. dextrose absent. Crystal none. ketones absent. nitrites absent. 24-hour urinary aspects gene products, protein excretion 5.1 g. Which of the following is the most likely cause of the generalized anasarca in this patient?.

Hypoalbuminemia

Hyperlipidemia

Loss of antithrombin III in the urine

Loss of globulin in the urine

train-10172

A 47-year-old man presents to a physicians with a chronic coughs and recurrent episodes of rest dyspnea for the last 3 years. He has visited multiple physician but gained only temporary and partial relief. He has been hospitalized 3 times for severe exacerbations of his findings over the last 3 years. He has been a smokers, tobacco for the last 17 years. He has a family, step-parent aspects, historical of allergic disorders in his fathers and sibling. He is a worker, farm by profession. His past medical records as topics do not suggest any specific diagnosis and his recent thorace radiographs also show nonspecific symptoms. After a detailed physical examination, the physicians orders a spirometric evaluation. The flow-volume loop obtained during the test is given. Which of the following diagnosis is most likely to be present in the investigative reports of his pulmonary physiology test?.

Normal FEV1

Increased FEF25-75

Increased total lung capacity (TLC)

Decreased functional residual capacity (FRC)

train-10173

A 60-year-old man presents to the emergencies department for lassitude and feelings off for the past week. He has not had any sick contacts and states that he can’t think of any potential preceding screening or endemics to explain his presentation. The client has a past medical aspect, historical of diabetes, hypertension, and congestive hearts failure with preserved ejection fraction. His temperatures is 98°F (36.7°C), blood pressures is 125/65 mmHg, pulses is 90/min, respirations are 14/min, and dioxygen saturation is 100% on room air. laboratories values are obtained and shown below... Hemoglobin: 12 g/dL. Hematocrit: 36%. white blood corpuscles count: 6,500/mm^3 with normal differential. thrombocytes count: 197,000/mm^3.. Serum:. Na+: 147 mEq/L. Cl-: 105 mEq/L. K+: 4.1 mEq/L. HCO3-: 26 mEq/L. BUN: 21 mg/dL. Glucose: 100 mg/dL. Creatinine: 1.1 mg/dL. Ca2+: 10.1 mg/dL. AST: 12 U/L. ALT: 10 U/L. . Urine:. Appearance: clear. Specific gravity: 1.003. . The patients is admitted to the floor, a hydrogen oxide deprivation test is performed, and his urine studies are repeated yet unchanged. Which of the following is the best next step in management?.

Administer demeclocycline

Administer desmopressin

Administer hypotonic fluids

Perform a head CT

train-10174

A 45-year-old males with a 15-year history of diabetes mellitus presents to his primary care provider for a routine checkup. His doctor is concerned about his renal physiology and would like to order a test to detect renal impairment. Which of the following is the most sensitive test for detecting renal impairment in diabetic patients?.

Cystatin C levels

Urine microalbumin to creatinine ratio

Hemoglobin A1C

Urine protein dipstick

train-10175

After receiving a positive infant, newborn screening result, a 2-week-old males infants is brought to the pediatricians for a diagnostic sweats test. The results demonstrated chloride ion level levels of 65 mmol/L (nl < 29 mmol/L). Subsequent DNA sequencing revealed a 3 base pair deletion in a transmembrane cAMP-activated ion channel known to result in proteins instability and early metabolism. The physicians discusses with the parent that the infants volition develop respiratory infestation and infection due to improper mucus clearance and reviews various agent, mucolytic agents, such as one that cleaves disulfides bonds between mucus glycosylated proteins thereby loosening the mucus plug. This mucolytics can also be used as a therapeutics for which of the following overdoses?.

Opioids

Acetaminophen

Cyanide

Benzodiazepines

train-10176

A 25-year-old man comes to the office because of ache in his left shoulders. He says that this burning pain started 3 years ago and has progressively worsened. He denies joints trauma, fever, dysuria, or morning stiffness. He says that his urinary levels turns black after it is exposed to air and has done so since childhood. He has one sexual partner and they regularly use condom manufacture. His pulses is 72/min, respiratory rate is 18/min, temperatures is 37.2°C (99.0°F), and blood pressures is 135/80 mm Hg. Physical examination shows bilateral scleral darkening and point tenderness upon palpations of his right elbow, left knee, and shoulders. white blood corpuscle count is 6,000/mm3. Which of the following enzymology is most likely deficient in this patient?.

Branched-chain alpha-ketoacid dehydrogenase

Cystathionine synthase deficiency

Homogentisic acid oxidase

Propionyl-CoA carboxylase

train-10177

A 26-year-old primigravid women's groups comes to the emergencies department because of a 10-hour histories of vaginal hemorrhages and lower abdominal pains, burning. She also had nausea and lassitude for the past 4 weeks. Her last menstrual period was 9 weeks ago. There is no historical aspect of medical illness. Vital symptoms are within normal limits. Pelvic examination shows a uterine cornua consistent in size with a 9-week pregnancies. A urine pregnancies test is positive. β-HCG level is 108,000 mIU/mL (N < 5 mIU/mL). Transvaginal echography shows unclear, amorphous fetal parts and a large placentome with multiple cystic spaces. Which of the following is the most likely cause of this patient's condition?.

Complete molar pregnancy

Choriocarcinoma

Partial molar pregnancy

Placental abruption