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usmle-11751 | A 35-year-old man presents to the clinic with a complaint of a “tingling sensation” in his legs and feet for the past 3 months, as well as occasional diarrhea and nausea. He has been feeling more fatigued than usual when carrying out his typical weekend hobbies of hiking and backpacking. He lives in Michigan, where he spends most of his free time swimming in the lakes and engaging in water sports. He reports no recent international travel. Physical examination is notable for decreased vibratory sensation in the lower extremities and conjunctival pallor. A peripheral blood smear is obtained and is shown in Figure A. Which of the following pathogens most likely contributed to this patient’s presentation? |
usmle-11752 | A 22-year-old woman presents to the emergency department with a 2-day history of severe blistering. She says that she woke up 2 days ago with a number of painful blisters in her mouth and has since been continuing to develop blisters of her cutaneous skin all over her body and the mucosa of her mouth. She has no past medical history and has never experienced these symptoms before. Physical exam reveals a diffuse vesicular rash with painful, flaccid blisters that separate easily with gentle rubbing. The function of which of the following proteins is most likely disrupted in this patient? |
usmle-11753 | A 4-year-old boy is brought to his pediatrician by his parents because he has been experiencing recurrent nosebleeds. He always seemed to bleed a lot with minor cuts and scrapes; however, since starting preschool 1 month ago he has had several prolonged nosebleeds. His teacher was concerned about the duration of these episodes and recommended he be medically evaluated. He has otherwise been healthy and there is no family history of bleeding disorders. Physical exam reveals scattered petechial rashes. Labs are obtained with the following results:
Bleeding time: 12 minutes (normal 2-7 minutes)
Partial thromboplastin time: 29 seconds (normal 25-40 seconds)
Prothrombin time: 14 seconds (normal 11-15 seconds)
A peripheral blood smear in shown in Figure A. The protein that is most likely defective in this patient most likely bind to which of the following? |
usmle-11754 | A 40-year-old male visits a urologist and reports that for the past 2 weeks, his penis has been gradually curving to the right with associated pain during intercourse. He is able to have a normal erection and he does not recollect of any trauma to his penis. Although he is married, he admits to having unprotected sexual relationship with several females in the past year. His vitals are normal and physical examination in unremarkable except for a lesionless curved penis. It is painless to touch. Test results for sexually transmitted disease is pending. Which of the following is the most likely cause? |
usmle-11755 | A 67-year-old man presents with a large, painful, skin lesion on his leg (Figure A). He has had a non-healing ulcer in the same location for several years after a burn, but he notes that it has never looked like this before. He has a past medical history of diabetes. He is a 30-pack-year smoker. Vital signs are stable. In addition to the skin lesion, his physical examination is notable for stocking glove neuropathy of the hands and feet. What is the most likely diagnosis? |
usmle-11756 | A six year-old female presents for evaluation of dry skin, fatigue, sensitivity to cold and constipation. The patient’s mother recalls that the patient had surgery to remove a “benign mass” at the base of her tongue 3 months ago because of trouble swallowing. What was the likely cause of the surgically removed mass? |
usmle-11757 | A 53-year-old man with recurrent pancreatic adenocarcinoma is enrolled in a clinical trial for a novel chemotherapeutic agent that his physician believes may be beneficial to his condition. The novel drug was previously tested in a small population and is now undergoing a larger phase 3 trial in preparation for FDA approval. A dose-response trial had the following results:
10 mg dose - 6/59 patients demonstrated improvement
20 mg dose - 19/49 patients demonstrated improvement
30 mg dose - 26/53 patients demonstrated improvement
40 mg dose - 46/51 patients demonstrated improvement
The same trial also had the following safety profile:
20 mg dose - 5/49 patients had a treatment related adverse event
40 mg dose - 11/51 patients had a treatment related adverse event
60 mg dose - 15/42 patients had a treatment related adverse event
80 mg dose - 23/47 patients had a treatment related adverse event
100 mg dose - 47/52 patients had a treatment related adverse event
Based on this study, which of the following represents the most likely therapeutic index for this novel chemotherapeutic agent? |
usmle-11758 | A 42-year-old woman is seen by her primary care physician for her annual checkup. She has no current concerns and says that she has been healthy over the last year except for a bout of the flu in December. She has no significant past medical history and is not currently taking any medications. She has smoked 1 pack per day since she was 21 and drinks socially with her friends. Her family history is significant for prostate cancer in her dad when he was 51 years of age and ovarian cancer in her paternal aunt when she was 41 years of age. Physical exam reveals a firm, immobile, painless lump in the upper outer quadrant of her left breast as well as 2 smaller nodules in the lower quadrants of her right breast. Biopsy of these lesions shows small, atypical, glandular, duct-like cells with stellate morphology. Which of the following pathways is most likely abnormal in this patient? |
usmle-11759 | A 51-year-old male presents to his primary care provider for a normal check-up. He reports that he “hasn’t felt like himself” recently. He describes feeling down for the past 8 months since his mother passed away. He has had trouble sleeping and has unintentionally lost 15 pounds. He feels guilty about his mother’s death but cannot articulate why. His performance at work has declined and he has stopped running, an activity he used to enjoy. He has not thought about hurting himself or others. Of note, he also complains of numbness in his feet and fingers and inability to maintain an erection. His past medical history is notable for diabetes. He is on metformin. His temperature is 98.6°F (37°C), blood pressure is 125/65 mmHg, pulse is 90/min, and respirations are 16/min. On exam, he is alert and oriented with intact memory and normal speech. He appears tired with a somewhat flattened affect. The best medication for this patient inhibits which of the following processes? |
usmle-11760 | A 12-year-old boy is brought to his primary care physician because he has been tripping and falling frequently over the past 2 months. He says that he feels like he loses his balance easily and finds it difficult to walk in tight spaces such as his school hallways. Furthermore, he says that he has been experiencing insomnia over the same time period. His past medical history is significant for some mild allergies, but otherwise he has been healthy. Physical exam reveals that his eyes are fixed downwards with nystagmus bilaterally. Which of the following structures is most likely affected by this patient's condition? |
usmle-11761 | A 22-year-old woman presents to her primary care physician because she has been having severe pruritus on her left leg. She says the symptoms started 1 week ago after she went on a hiking trip with her friends. She wore shorts during the hike and felt as if something brushed her skin on the front of her leg just below the knee. She has no past medical history and no family history of autoimmune diseases. On physical exam, she has red pruritic papules and vesicles on her left leg. Which of the following mechanisms was most likely involved in the development of this patient's symptoms? |
usmle-11762 | A 43-year-old man presents to the clinic for complaints of decreased sex drive for the past 2 weeks. He reports that it is hard for him to get an erection and maintain an erection with his partner. This has never happened before and he is concerned. He denies any fever, infections, trauma to the area, or sensory changes. His past medical history is significant for diabetes and depression diagnosed 1 year ago. He takes metformin and sertraline as prescribed. A physical examination demonstrates decreased peripheral vision bilaterally and chest findings shown in Figure A. Which of the following is the best treatment for this patient’s condition? |
usmle-11763 | A 35-year-old patient presents to the dermatologist with a new skin rash. The patient has noticed new bumps on her arm over the past 1 month. The bumps are about 0.5 cm in diameter and are filled with a clear fluid. They extend on both arms but are not in her mouth or torso. The lesions do not pop with pressure but remain tense. Her skin does not slough off with rubbing. The patient denies any other symptoms including joint pain or fever. The patient has no other medical history. The patient’s condition is most likely caused by antibodies against which of the following compounds? |
usmle-11764 | An 8-year-old boy is brought to the emergency department 15 minutes after he started experiencing difficulty breathing. He has experienced similar episodes in the last 2 months; however, those resolved within a few minutes. He has no past medical history and sees a pediatrician regularly. On presentation, his respirations are 28/min, and he has a productive cough. Pulmonary auscultation reveals diffuse wheezing bilaterally in all lung fields, and a sputum sample is shown in Figure A. Which of the following molecules is most likely related to the pathogenesis of this patient's disorder? |
usmle-11765 | A 52-year-old man presents to his primary care physician for an annual check-up. He says that he has no significant developments over the last year and that he has been feeling well in general. On presentation, his temperature is 98.6°F (37°C), blood pressure is 140/95 mmHg, pulse is 85/min, and respirations are 12/min. This is the third time that he has had elevated blood pressure so his physician suggests that he start taking a medication for hypertension. The patient is a biologist so he researches this medication after returning home. He finds that the medication can either decrease or increase the level of cyclic adenosine monophosphate depending on whether there is endogenous substrate around. Which of the following medications is mostly likely being described here? |
usmle-11766 | A 45-year-old female is brought by ambulance to your emergency room after complaining of shortness of breath along with profuse sweating at a company social function. Her vitals were notable for elevated blood pressure with a normal exam and a stable electrocardiogram. She has been seeing a psychiatrist recently for her depression and was prescribed phenelzine after failing treatment with a first-line antidepressant therapy. What must she have been exposed to at the party that led to such a dramatic side effect? |
usmle-11767 | While playing the catcher position in baseball, a 27-year-old male sustained a blow to his left testes which required surgical removal. Upon awakening from anesthesia, he jokes to his wife that he is now half the man that she once knew. Which of the following scenarios is a similar ego defense as the one above? |
usmle-11768 | A 4-year-old girl is brought by her mother to the pediatrician for neck drainage. The mother reports that the child has always had a small pinpoint opening on the front of her neck, though the opening has never been symptomatic. The child developed a minor cold approximately 10 days ago which resolved after a week. However, over the past 2 days, the mother has noticed clear thick drainage from the opening on the child’s neck. The child is otherwise healthy. She had an uncomplicated birth and is currently in the 45th and 40th percentiles for height and weight, respectively. On examination, there is a small opening along the skin at the anterior border of the right sternocleidomastoid at the junction of the middle and lower thirds of the neck. There is some slight clear thick discharge from the opening. Palpation around the opening elicits a cough from the child. This patient’s condition is caused by tissue that also forms which of the following? |
usmle-11769 | A 36-year-old man presents to the emergency department complaining of exquisite abdominal pain for the past 3 hours. He was watching TV when suddenly he felt an intense, 10/10, stabbing pain at his right abdomen. Since the onset of symptoms, he has taken 2 ibuprofen and 2 regular strength acetaminophen with no improvement. He denies any headache, fever, vision changes, chest pain, diarrhea, or sensory changes. However, he reports some nausea and reddish-colored urine this afternoon. His medical history is significant for Crohn disease that is well-controlled with azathioprine. A non-contrast computed tomography (CT) scan is obtained, and the results are shown in Figure A. What is the most likely explanation for this patient’s findings? |
usmle-11770 | A 72-year-old man sees his primary care physician because he has been experiencing severe flank pain for the past 2 weeks. He says that the pain has an intermittent squeezing quality and radiates to the groin. Furthermore, the pain is associated with nausea and vomiting; however, he denies any abdominal pain. Physical exam reveals severe costovertebral angle tenderness, and urine dipstick reveals microscopic hematuria. Urinalysis reveals the findings demonstrated in Figure A. To prevent recurrence of these symptoms, he is given a drug to decrease excretion of a substance. Which of the following kidney segments is targeted by the drug that was most likely administered? |
usmle-11771 | A 4-year-old boy presents to the emergency department with a fever and a rash. His parents state that his symptoms started last night and have been rapidly worsening. The patient is up to date on his vaccinations, and his past medical history is unremarkable. His temperature is 103°F (39.4°C), blood pressure is 97/48 mmHg, pulse is 160/min, respirations are 28/min, and oxygen saturation is 98% on room air. Physical exam is notable for the finding in Figure A without any lesions on mucosal surfaces. The patient's skin is warm and tender to the touch. Which of the following describes the most likely diagnosis? |
usmle-11772 | A 35-year-old woman presents to the emergency department after losing consciousness at work. On presentation, she is found to be somnolent though she is able to be woken by vocal stimuli. She says that over the last 12 hours, she has been experiencing muscle spasms, blurred vision, dry mouth, and hallucinations. She says that the symptoms started after she went on a hike in the woods and foraged from plants along the way. Physical exam reveals dry red skin and enlarged pupils. Her bladder is also found to be completely full though she says she is unable to urinate. Which of the following drugs would most likely be administered to this patient to treat her symptoms? |
usmle-11773 | A 16-year-old boy is brought to the clinic for a sore throat and fever. He began feeling a dull, 5/10 pain in his throat 2 days ago and had a documented fever today of 101.4°F (38.5°C). He also endorses fatigue and headache, but denies chills, cough, congestion, rhinorrhea, chest pain, ear pain, ulcerations, or gastrointestinal symptoms. He just returned from a hiking trip in the Rocky Mountains 1 week ago and reports taking some old antibiotics he had received for an ear infection when he began feeling sick. A physical examination demonstrates enlarged posterior cervical lymph nodes and a rash on the torso shown in Figure A. Which of the following findings would you expect in this patient? |
usmle-11774 | A 40-year-old man with a history of type I diabetes presents to the emergency room in respiratory distress. His respirations are labored and deep, and his breath odor is notably fruity. Which of the following laboratory results would you most expect to find in this patient? |
usmle-11775 | A 36-year-old woman presents to an infertility clinic because she has been unable to conceive with her new husband despite over a year of unprotected intercourse. Her husband has 2 children from a previous marriage and has been found to have no abnormalities. As part of the evaluation for infertility, she receives an injection of contrast into her cervix. This procedure is meant to visualize the reproductive tract to determine whether there are any structural abnormalities. On the radiographic test shown in Figure A, contrast material is also seen in the peritoneal cavity outside the reproductive tract. Which of the following represents the most likely explanation for this finding? |
usmle-11776 | A 7-year-old boy is brought to the pediatrician by his parents for a routine checkup. The parents note that the patient recently joined a baseball team and has had trouble keeping up with his teammates and gets short of breath with exertion. The patient has otherwise been healthy and has no known history of asthma or allergic reaction. Today, the patient’s temperature is 98.2°F (36.8°C), blood pressure is 112/72 mmHg, pulse is 70/min, and respirations are 12/min. The physical exam is notable for a heart murmur that decreases when the patient bears down. Additionally, the hand grip and rapid squatting maneuvers increase the severity of the murmur. Which of the following is likely heard on auscultation? |
usmle-11777 | A 67-year-old man presents to his primary care physician with a 2-month history of fatigue and intermittent fevers. He says that the fatigue has developed gradually over time, and he cannot think of any precipitating factors. In addition, he notes that he has experienced a few episodes of bleeding from his gums after the fatigue started. His past medical history is significant for diabetes and hypertension but he is not currently taking any medications. Physical exam reveals conjunctival pallor, hepatosplenomegaly, and numerous bruises on his body. A peripheral blood smear is obtained, and the results are shown in Figure A. Which of the following genetic translocations is most likely associated with this patient's disease? |
usmle-11778 | An 83-year-old woman with a history of atrial fibrillation, multiple ischemic strokes, and early dementia is found unresponsive in her apartment at her retirement community. She is believed to have not refilled any of her medications for a month, and it is determined that she passed away from a stroke nearly 2 weeks ago. The family is adamant that she receive an autopsy. Which of the following findings are most likely on brain histology? |
usmle-11779 | A 65-year-old man is hospitalized after undergoing operative fixation of a left distal radius fracture due to a fall. On postoperative day 1, he reports having several episodes of palpitations with associated lightheadedness. He denies any chest pain and states that these episodes last for a few seconds each before resolving. On exam, his temperature is 98.4°F (36.9°C), blood pressure is 124/76 mmHg, pulse is 94/min, and respirations are 12/min. The patient is currently asymptomatic without palpitations. The patient is immediately connected to a cardiac monitor which shows normal sinus rhythm. Over the course of the night, the monitor demonstrates 3 more episodes of the rhythm shown below in Figure A, with associated palpitations and lightheadedness. Blood pressure and oxygen saturation are stable during these episodes. The patient is given intravenous magnesium. The decision is made to also start medical therapy. Which of the following medications should be started? |
usmle-11780 | A 61-year-old man presents to his primary care provider complaining of abdominal pain and constipation. He reports a 4-day history of steady right lower quadrant pain. He has had one small bowel movement in 4 days. Normally he has a bowel movement once a day. His medical history is notable for poorly controlled hypertension and hyperlipidemia. He takes enalapril, hydrochlorothiazide, aspirin, and atorvastatin. He has a 40 pack-year smoking history and drinks 3-4 beers per day. His diet consists primarily of fast food. His temperature is 101.8°F (38.8°C), blood pressure is 160/95 mmHg, pulse is 90/min, and respirations are 16/min. A review of the patient’s medical record reveals colonoscopy results from 1 year ago. Relevant findings included multiple small, pedunculated polyps which were removed, multiple colonic mucosal outpouchings, and no other masses. This patient’s condition is most strongly associated with which of the following disorders? |
usmle-11781 | A 3-year-old male is brought by his mother to the pediatrician because she is concerned about a lump in his neck. She reports that the child was recently ill with a cough, nasal congestion, and rhinorrhea. She also noticed that a small red lump developed on the patient’s neck while he was sick. Although his cough and congestion subsided after a few days, the neck lump has persisted. The child has no notable past medical history. He was born at 39 weeks gestation and is in the 55th percentiles for both height and weight. His temperature is 98.6°F (37°C), blood pressure is 105/65 mmHg, pulse is 90/min, and respirations are 18/min. Physical examination reveals a small, soft, rounded mass at the midline of the neck inferior to the hyoid bone. The mass is warm and tender to palpation. It moves superiorly when the patient drinks water. Histologic examination of this lesion would most likely reveal which of the following? |
usmle-11782 | A 25-year-old G1P0 gives birth to a male infant at 33 weeks’ gestation. The mother immigrated from Sudan one month prior to giving birth. She had no prenatal care and took no prenatal vitamins. She does not speak English and is unable to provide a medical history. The child’s temperature is 101.0°F (38.3°C), blood pressure is 90/50 mmHg, pulse is 140/min, and respirations are 30/min. Physical examination reveals flexed upper and lower extremities, minimal response to stimulation, and slow and irregular respirations. A murmur is best heard over the left second intercostal space. The child’s lenses appear pearly white. Which of the following classes of pathogens is most likely responsible for this patient’s condition? |
usmle-11783 | A 46-year-old homeless male with cirrhosis presents to a free health clinic due to chronic fatigue and joint pain. He states he has not seen a physician in over 15 years. He admits to frequent IV drug use but denies any tobacco or alcohol use. He states apart from fatigue and joint pain, he has also noticed that his skin has seemed "puffier" than normal. The physician orders liver function tests which are only significant for a mildly elevated AST and ALT. A urinalysis is obtained which demonstrates significant proteinuria and fatty casts. A kidney biopsy is subsequently ordered. Which of the following figures most likely represents the findings of this patient's kidney biopsy? |
usmle-11784 | A 10-year-old boy presents to the emergency department with a swollen and painful elbow after accidentally bumping his arm into the kitchen table. His mom notes that he seems to bruise and bleed easily, but this is the first time he has had a swollen joint. She also remembers that her uncle had a bleeding disorder, but cannot remember the diagnosis. Physical exam reveals a warm and tender elbow joint, but is otherwise unremarkable. Based on clinical suspicion, a bleeding panel is ordered with the following findings:
Bleeding time: 3 minutes
Prothrombin time (PT): 13 seconds
Partial thromboplastin time (PTT): 54 seconds
Which of the following treatments would most likely be effective in preventing further bleeding episodes for this patient? |
usmle-11785 | A 77-year-old woman presents to a general medical clinic with progressive frontal headaches. Her symptoms began 2 months ago and have increased in intensity and frequency. She reports that her headaches are worse in the morning and often wake her from sleep. Her vital signs are stable. Neurologic examination reveals no focal deficits, but brain imaging reveals a mass lesion and biopsy is performed, with histology depicted in Figure A. Which of the following is true regarding this patient's illness? |
usmle-11786 | A 27-year-old woman comes to the clinic for blisters on both hands. The patient has a past medical history of asthma, eczema, and a car accident 2 years ago where she sustained a concussion. She also reports frequent transient episodes of blurred vision that clear with artificial tears. When asked about her blisters, the patient claims she was baking yesterday and forgot to take the pan out with oven gloves. Physical examination demonstrates weeping blisters bilaterally concentrated along the palmar surfaces of both hands and decreased pinprick sensation along the arms bilaterally. What is the most likely explanation of this patient’s symptoms? |
usmle-11787 | A 7-year-old healthy female with no past medical history is brought in by her mother for regular check up before starting school. She is up to date on all immunizations and is developmentally appropriate for her age. On physical exam, you notice that there is a nodule in her midline neck that is soft, mobile, and painless (Figure A). When the patient is licking a lollipop that you had provided during the examination to distract her, the nodule also moves up and down. Which the following is the most likely cause of the nodule? |
usmle-11788 | A 58-year-old obese male has noticed the gradual development of a soft bulge on his right groin that has been present over the past year and occasionally becomes very tender. He notices that it comes out when he coughs and strains during bowel movements. He is able to push the bulge back in without issue. After examination, you realize that he has an inguinal hernia and recommend open repair with mesh placement. After surgery, the patient returns to clinic and complains of numbness and tingling in the upper part of the scrotum and base of the penis. What nerve was most likely injured during the procedure? |
usmle-11789 | A 81-year-old man presents to his primary care physician with a 4-month history of shortness of breath. He says that he has slowly lost the ability to do things due to fatigue and now gets winded after walking around the house. He also says that his cough has been getting worse and seems to be producing more sputum. He has gained about 5 pounds over the last 6 months. His past medical history is significant for hypertension and diabetes. He has a 40 pack-year smoking history and drinks about 3 drinks per week. Physical exam reveals a cyanotic appearing man with 1+ edema in his legs bilaterally. He also has wheezing on lung auscultation with a prolonged expiratory phase. Which of the following would most likely be seen on a chest radiograph in this patient? |
usmle-11790 | A 40-year-old man with persistent moderate asthma presents for a pulmonary function test. His ratio of forced expiratory volume in one second (FEV1) to forced vital capacity (FVC) is 0.69, and his FEV1 is 65% of his predicted values. What other findings can be expected in the remainder of his pulmonary function test? |
usmle-11791 | A 15-year-old boy is undergoing the bodily changes associated with puberty. He is concerned that he easily develops a foul skin odor, even with mild exercise. Which of the following glandular structures is the causative agent for this foul skin odor? |
usmle-11792 | A 73-year-old man is found to have an early stage hepatocellular carcinoma in the left lobe of his liver. He decides to undergo surgery to remove the tumor through partial liver resection. During the procedure, a ligament is found that attaches the liver to the anterior abdominal wall. Since part of this ligament lies over the part of the liver that needs to be resected, the ligament is incised to allow for removal of the tumor. The free edge of the ligament is found to have a thickening with small remnant blood vessels. Which of the following embryonic structures most likely gave rise to the thickening described here? |
usmle-11793 | A 23-year-old woman presents to her primary care physician with 3 days of fatigue and back pain after she started a drug for malaria prophylaxis. She says that her urine has also been darker over the same time period. Her past medical history is significant for allergies as well as a broken elbow that was treated in a cast 10 years ago. She does not take any medications, does not smoke, and drinks socially. Peripheral blood smear reveals both red blood cells with dark intracellular inclusions as well as abnormally shaped red blood cells. The immune cells responsible for the shape of these red blood cells are located in which of the following places? |
usmle-11794 | A 76-year-old female is brought to the emergency department for altered mental status. She is accompanied by a nurse from her nursing home. The nurse says that usually the patient is interactive even though she is sometimes forgetful. In the last two days, the patient has been increasingly lethargic and doesn’t respond to the staff’s questions. She also has not been able to get up and use the restroom so the staff has had to change multiple soiled sheets. Her temperature is 102.1°F (38.9°C), blood pressure is 100/74 mmHg, pulse is 120/min, and respirations are 24/min. The patient is combative on arrival but can be subdued with reorientation by the care team. She is not oriented to person, place, or time. Urinalysis shows positive leukocyte esterase and nitrites. Urine culture grows >100,000 CFU of E. coli. The physician team would like to consent this patient for a Foley catheter. Which of the following is the best assessment of the patient’s capacity to make healthcare decisions? |
usmle-11795 | A 56-year-old Caucasian woman presents to the clinic for complaints of abdominal pain for the past 3 months. The pain is intermittent 7/10, dull in quality, and concentrated in the epigastric region. She endorses a 5-lb. weight loss over the past several months but denies fever, headaches, nausea, vomiting, hematochezia, diarrhea, or constipation. She is a long-time smoker with a 13 pack-year history. She is a vegetarian and takes the appropriate vitamins. Her past medical history is significant for GERD and hypertension. An upper endoscopy study is performed and its findings are shown in Figure A. Which of the following attributes increases this patient’s risk for developing her current condition? |
usmle-11796 | A 60-year-old woman is brought to the emergency department by paramedics after being found unresponsive. It is not possible to obtain a history. Her blood pressure is 75/30 mmHg and pulse is 108/min. Her extremities are cool and mottled. She admitted to the intensive care unit (ICU) for further supportive care, where she is started on a norepinephrine intravenous drip. After several hours on this infusion, which of the following changes in vitals would be expected? |
usmle-11797 | A 52-year-old woman presents to the clinic with complaints of intermittent chest pain for 3 days. The pain is retrosternal, 3/10, and positional (laying down seems to make it worse). She describes it as “squeezing and burning” in quality, is worse after food intake and emotional stress, and improves with antacids. The patient recently traveled for 4 hours in a car. Past medical history is significant for osteoarthritis, hypertension and type 2 diabetes mellitus, both of which are moderately controlled. Medications include ibuprofen, lisinopril, and hydrochlorothiazide. She denies palpitations, dyspnea, shortness of breath, weight loss, fever, melena, or hematochezia. What is the most likely explanation for this patient’s symptoms? |
usmle-11798 | A 56-year-old man with chronic kidney failure is brought to to the emergency department by ambulance after he passed out during dinner. On presentation, he is alert and complains of shortness of breath as well as chest palpitations. An EKG is obtained demonstrating an irregular rhythm consisting of QT amplitudes that vary in height over time. Other findings include uncontrolled contractions of his muscles. Tapping of his cheek does not elicit any response. Over-repletion of the serum abnormality in this case may lead to which of the following? |
usmle-11799 | A 37-year-old man presents to his gastroenterologist due to a transaminitis found by his primary care physician (PCP). He reports currently feeling well and has no acute concerns. Medical history is significant for ulcerative colitis treated with 5-aminosalicylate. He recently went on a trip to Mexico and experienced an episode of mild diarrhea. The patient is 5 ft 4 in and weighs 220 lbs (99.8 kg). His temperature is 98°F (36.7°C), blood pressure is 138/88 mmHg, pulse is 90/min, and respirations are 18/min. Physical examination is unremarkable. Laboratory testing demonstrates:
Leukocyte count: 7,200 /mm^3
Alkaline phosphatase: 205 U/L
Aspartate aminotransferase (AST): 120 U/L
Alanine aminotransferase (ALT): 115 U/L
Perinuclear antineutrophil cytoplasmic antibody (pANCA): Positive
Antimitochondrial antibody: Negative
Which of the following is most likely the diagnosis? |
usmle-11800 | A 73-year-old man is brought to the emergency department by ambulance after being found to be non-communicative by his family during dinner. On presentation he appears to be alert, though he is confused and cannot follow instructions. When he tries to speak, he vocalizes a string of fluent but unintelligible syllables. Given this presentation, his physician decides to administer tissue plasminogen activator to this patient. This intervention best represents which of the following principles? |
usmle-11801 | A 5-year-old boy is brought to the emergency department by his parents after a month of fatigue, difficulty concentrating, and diffuse abdominal pain. The pain has been mild, does not radiate, and was not associated with eating. He denies any nausea, vomiting, or diarrhea. His parents recently noticed that he began to drag his feet while walking. He has no significant past medical or surgical history and does not take any medication. His family recently began renovations on their home 3 months ago. On physical exam, his vital signs are within normal limits. Blood work shows the following findings:
Hematocrit: 30%
Total iron: 60 µg/dL
Ferritin: 215 ng/mL
Mean corpuscular volume: 65 µm^3
A peripheral blood smear shown in Figure A. Which of the following diseases involves the same metabolic pathway as the most likely diagnosis for this patient? |
usmle-11802 | A 16-year-old girl undergoes an emergent appendectomy after presenting to the emergency department with appendicitis. She is given a mixture of nitrous oxide and sevoflurane for induction of anesthesia and intubated for a secure airway during surgery. A few minutes after induction, she is found to have increased end-tidal carbon dioxide and tachycardia. Furthermore, the surgeon notices that her abdomen is extremely rigid before making his incision. Finally, she is found to have hyperkalemia despite having normal serum potassium during preoperative laboratory studies. Defective function of which of the following proteins is most likely responsible for this patient's findings? |
usmle-11803 | A 24-year-old man who is postoperative day 1 after an emergency appendectomy is evaluated by the team managing his care. He complains that he still has not been able to urinate after removal of the urinary catheter that was inserted during surgery. Given this issue, he is started on a medication that acts on a post-synaptic receptor and is resistant to a synaptic esterase. Which of the following is most likely another use of the medication that was administered in this case? |
usmle-11804 | The rapid response team is called for a 74-year-old woman on an inpatient surgical floor for supraventricular tachycardia. The patient had surgery earlier in the day for operative management of a femur fracture. The patient has a history of hypertension, atherosclerosis, type 2 diabetes, and uterine cancer status post total abdominal hysterectomy 20 years prior. With carotid massage, valsalva maneuvers, and metoprolol, the patient breaks out of her supraventricular tachycardia. Thirty minutes later, the nurse notices a decline in the patient’s status. On exam, the patient has a temperature of 98.4°F (36.9°C), blood pressure of 102/74 mmHg, pulse of 86/min, and respirations are 14/min. The patient is now dysarthric with noticeable right upper extremity weakness of 2/5 in elbow flexion and extension. All other extremities demonstrate normal strength and sensation. Which of the following most likely contributed to this decline? |
usmle-11805 | A 12-month-old boy is brought to the emergency department by his mother for several hours of crying and severe abdominal pain, followed by dark and bloody stools in the last hour. The mother reports that she did not note any vomiting or fevers leading up to this incident. She does report that the boy and his 7-year-old sister recently had “stomach bugs” but that both have been fine and that the sister has gone back to school. The boy was born by spontaneous vaginal delivery at 39 weeks and 5 days after a normal pregnancy. His temperature is 100.4°F (38.0°C), blood pressure is 96/72 mmHg, pulse is 90/min, respirations are 22/min. Which of the following was most likely to play a role in the pathogenesis of this patient’s disease? |
usmle-11806 | A 55-year-old African American female presents to her breast surgeon for a six-month follow-up visit after undergoing a modified radical mastectomy for invasive ductal carcinoma of the left breast. She reports that she feels well and her pain has been well controlled with ibuprofen. However, she is frustrated that her incisional scar is much larger than she expected. She denies any pain or pruritus associated with the scar. Her past medical history is notable for systemic lupus erythematosus and multiple dermatofibromas on her lower extremities. She has had no other surgeries. She currently takes hydroxychloroquine. On examination, a raised hyperpigmented rubbery scar is noted at the inferior border of the left breast. It appears to have extended beyond the boundaries of the initial incision. Left arm range of motion is limited due to pain at the incisional site. Abnormal deposition of which of the following molecules is most likely responsible for the appearance of this patient’s scar? |
usmle-11807 | A 1-year-old boy is brought to the clinic by his parents for a regular check-up. His weight, height, and head size were found to be in the lower percentile ranges on standard growth curves. His hair is tangled and has a dry, brittle texture. Genetic testing reveals that the patient has a connective tissue disorder caused by impaired copper absorption and transport. The patient’s disorder is caused by a mutation in which of the following genes? |
usmle-11808 | A 49-year-old man is referred to a cardiologist by his primary care provider (PCP) for a new heart murmur. He otherwise feels well and has no complaints. He had not seen a doctor in the last 15 years but finally went to his PCP for a check-up at the urging of his girlfriend. His past medical history is notable for gastroesophageal reflux disease, hypertension, and hepatitis B. He takes omeprazole and lisinopril. He has a prior history of intravenous drug abuse and a 50-pack-year smoking history. He has had many prior sexual partners and uses protection intermittently. He reports that he may have had a sore on his penis many years ago, but it went away without treatment. His temperature is 99°F (37.2°C), blood pressure is 141/91 mmHg, pulse is 89/min, and respirations are 18/min. On exam, S1 is normal and S2 has a tambour-like quality. There is a visible and palpable pulsation in the suprasternal notch and a diastolic decrescendo murmur over the right upper sternal border. A chest radiograph demonstrates calcification of the aortic root. Which of the following is the most likely cause of this patient's condition? |
usmle-11809 | A 45-year-old woman is in a high-speed motor vehicle accident and suffers multiple injuries to her extremities and abdomen. In the field, she was bleeding profusely bleeding and, upon arrival to the emergency department, she is lethargic and unable to speak. Her blood pressure on presentation is 70/40 mmHg. The trauma surgery team recommends emergency exploratory laparotomy. While the patient is in the trauma bay it is noted in the chart that the patient is a Jehovah's witness, and you are aware that her religion does not permit her to receive a blood transfusion. No advanced directives are available, but her ex-husband is contacted by phone and states that although they haven't spoken in a while, he thinks she would not want a transfusion. Which of the following is an appropriate next step? |
usmle-11810 | A 25-year-old patient comes to the physician with complaints of dysuria and white urethral discharge. He is sexually active with 4 partners and does not use condoms. The physician is concerned for a sexually transmitted infection and decides to analyze the nucleic acid sequences present in the discharge to aid in diagnosis via DNA amplification. Which of the following is responsible for the creation of the nucleic acid copies during the elongation phase of the technique most likely used in this case? |
usmle-11811 | An 18-year-old female presents to general medical clinic with the report of a rape on her college campus. The patient was visiting a local fraternity, and after having a few drinks, awakened to find another student having intercourse with her. Aside from the risk of unintended pregnancy and sexually transmitted infections, this patient is also at higher risk of developing which of the following? |
usmle-11812 | A 49-year-old woman presents to her pulmonologist for a follow-up visit. She reports a longstanding history of chronic dyspnea and fatigue. Her past medical history is notable for asthma. She has a known mutation in the BMPR2 gene. She was recently trialed on nifedipine but stopped due to severe lower extremity edema. She does not smoke and does not drink alcohol. Her temperature is 99.4°F (37.4°C), blood pressure is 135/80 mmHg, pulse is 80/min, and respirations are 20/min. Physical examination reveals an increased P2 on cardiac auscultation. Her physician recommends starting a medication to slow the patient’s clinical worsening that requires regular monitoring of liver function tests. This medication has which of the following mechanisms of action? |
usmle-11813 | A 26-year-old nulligravid woman presents to her gynecologist after noticing a lump in her right breast while showering. She states that she first noticed the lump approximately 2 weeks ago, when the mass was slightly tender to touch. Since then, the lump has gotten slightly smaller and is now non-tender. The patient is otherwise healthy. She does not take oral contraceptives. Her last menses was approximately 2 weeks ago. There is no family history of cancer. On exam, the patient's temperature is 98.3°F (36.8°C), blood pressure is 116/84 mmHg, pulse is 65/min, and respirations are 12/min. In her right breast, there is a small 1.5 cm mass that is mobile, well-circumscribed, and firm. Which of the following is most likely on histological examination of the mass? |
usmle-11814 | A 21-year-old G3P2 woman presents to her obstetrician at 6 weeks gestation for routine prenatal care. Her past medical history includes obesity and gestational diabetes. She has had two spontaneous vaginal deliveries at term. One infant was macrosomic with hypoglycemia, but otherwise, she has had no complications. Her physician informs her that she must start taking a multivitamin with folic acid daily. The defect that folic acid supplementation protects against arises in tissue that is derived from which germ cell layer? |
usmle-11815 | A 45-year-old man comes into the ED after a car accident. After waiting an hour in the waiting room, he begins to berate the receptionist and demands to be seen by a doctor. During the exam, the patient brags that he recently had to quit his job because they did not appreciate his talent and drive. After a medical student declines his invitation for a date, he becomes very angry and throws supplies across the room. The physician manages the patient's physical injuries and begins to suspect the patient has a personality disorder. Which personality disorder is most likely? |
usmle-11816 | A 41-year-old female presents to her primary care doctor with worsening muscle pain and weakness. Approximately two months ago, she reports the recent development of having difficulty climbing stairs and raising her arms above her head. Additionally, there was a dull aching pain in her shoulders over the same time period. Her family history is notable for systemic lupus erythematosus in her mother. Physical examination demonstrates symmetric muscle weakness in hip flexion, hip extension, and shoulder abduction. She has red scaly skin overlying the extensor joints of her fingers and has another dermatological finding seen in Figure A. Which of the following is associated with this patient’s most likely condition? |
usmle-11817 | A 46-year-old male presents to his dermatologist for routine follow-up of his psoriasis. He was last seen in the office six months prior, at which time he started undergoing ultraviolet light therapy. He reports that he initially noticed an improvement in his symptoms but the effects were transient. He has also started noticing pain and stiffness in his fingers. His past medical history is notable for obesity and diabetes mellitus. He takes metformin. His temperature is 99°F (37.2°C), blood pressure is 130/80 mmHg, pulse is 80/min, and respirations are 16/min. Multiple plaques with scaling are noted on the extensor surfaces of the upper and lower extremities. The patient’s physician suggests stopping the ultraviolet light therapy and starting an injectable medication that acts as a decoy receptor for a pro-inflammatory cytokine. Which of the following is an adverse effect associated with the use of this medication? |
usmle-11818 | A 47-year-old man comes into your general dermatology clinic with concerns about a skin lesion that has rapidly changed in size and color in the last several months (Figure A). Which mutation was most likely to have caused the lesion? |
usmle-11819 | A 12-year-old boy presents to the emergency department with a swollen and painful knee. He says that he was exploring with his friends when he tripped and hit his knee against the ground. He didn't feel like he hit it very hard but it started swelling and becoming very painful. His mom reports that he has always been prone to bleeding from very minor trauma and that others in the family have had similar problems. Based on clinical suspicion a coagulation panel was obtained showing a prothrombin time (PT) of 10 seconds (normal range 9-11 seconds), a partial thromboplastin time (PTT) of 45 seconds (normal 20-35 seconds), and a normal ristocetin cofactor assay (equivalent to bleeding time). Mixing tests with factor IX and XI do not show complementation, but mixing with factor VIII reverses the coagulation abnormality. Which of the following is the most likely diagnosis for this patient? |
usmle-11820 | A 56-year-old woman presents to the clinic complaining of fatigue and nausea. She was recently diagnosed with metastatic ovarian cancer and subsequently started treatment with an alkylating agent. The patient reports recent weight loss, malaise, and drowsiness, but denies fever, headaches, palpitations, shortness of breath, or genitourinary symptoms. Physical exam was unremarkable. Laboratory tests are shown below.
Serum:
Na+: 137 mEq/L
Cl-: 101 mEq/L
K+: 4.8 mEq/L
HCO3-: 25 mEq/L
BUN: 8.5 mg/dL
Glucose: 117 mg/dL
Creatinine: 2.1 mg/dL
Thyroid-stimulating hormone: 1.8 µU/mL
Ca2+: 9.6 mg/dL
AST: 8 U/L
ALT: 11 U/L
What findings on urinalysis are most specific to this patient’s diagnosis? |
usmle-11821 | A 31-year-old man presents to the clinic with complaints of sudden onset of fever, headache, chills, and a painful “bump” in his right groin. He recently spent three months working as a park ranger in New Mexico. His physical exam is notable for an enlarged lymph node in the inguinal region that is extremely tender to palpation. The patient is promptly treated with antibiotics, and his case is reported to the Centers for Disease Control and Prevention. Which of the following was the most likely vector that transmitted the disease to this for patient? |
usmle-11822 | A 52-year-old male presents with several months of fatigue, malaise, dry cough, and occasional episodes of painless hematuria. He recalls having had a sore throat several days prior to the onset of these symptoms that resolved without antibiotics. Physical exam is remarkable for diffusely coarse breath sounds bilaterally. Urinalysis reveals 2+ protein, 2+ blood, and numerous red blood cell casts are visible under light microscopy. Which is the most likely diagnosis? |
usmle-11823 | A 14-year-old boy is brought to a child psychiatry office by his father, who is concerned about his grades and teachers’ comments that he has “problems focusing.” He has a B- average. The boy's teachers in math, social studies, and English say that he often appears to not be listening in class, instead talking to classmates, making jokes, and blurting out incorrect answers. He typically turns in his homework late or not at all. During other classes (band and science, which he enjoys), none of these behaviors are observed. At home, he enjoys playing chess and reads comic and fiction books for hours without pause. His father describes him as calm and organized at home. Formal testing reveals an intelligence quotient (IQ) of 102. Which of the following is the most likely explanation for this patient’s grades? |
usmle-11824 | A 4-year-old boy presents to the emergency department with a 1 hour history of severe knee pain after he bumped his knee against a door. He has no past medical history though his parents say that he seems to bruise fairly easily. His parents say that they are afraid he may have accidentally taken his grandfather's warfarin medication. On presentation, he is found to have an erythematous, warm, swollen knee. Based on this presentation, a panel of laboratory tests are ordered with the following results:
Bleeding time: 3 minutes
Prothrombin time (PT): 12 seconds
Partial thromboplastin time (PTT): 56 seconds
Mixing studies show no change in the above lab values
Which of the following is most likely the cause of this patient's symptoms? |
usmle-11825 | A 14-year-old Caucasian girl presents to the pediatrician for poor balance. She reports a 7-month history of frequent falls that has progressively worsened. She has fallen 3 times in the past week and feels like she cannot walk normally. She was born full-term and spent 2 days in the neonatal intensive care unit for respiratory distress. She has had an otherwise normal childhood. Her family history is notable for multiple cardiac deaths before the age of 60. Her mother had a posterior spinal fusion for kyphoscoliosis as an adolescent. On exam, the patient has 4/5 strength in her bilateral upper and lower extremities. She walks with a staggering gait. Pes cavus is appreciated bilaterally. Skin examination is normal. This patient has a condition that is caused by a trinucleotide repeat of which of the following nucleotides? |
usmle-11826 | A 25-year-old male presents to his primary care doctor with left wrist pain. Two days ago he fell while running and landed on his outstretched hand. Since then, he has experienced a constant throbbing pain localized to the lateral wrist. On exam, he has focal tenderness on his dorsoradial wrist between the tendons of the extensor pollicis longus and extensor pollicis brevis. A radiograph of his left wrist is shown (Figure A). Without appropriate treatment, this patient will be at greatest risk for which of the following? |
usmle-11827 | A 62-year-old man presents to his primary care provider complaining of abdominal pain. He reports a 6-month history of gradually progressive epigastric pain and 10 pounds of unexpected weight loss. He has also noticed that his skin feels itchier than usual. His past medical history is notable for gout, hypertension, and diabetes mellitus. He takes allopurinol, enalapril, and glyburide. He has a 10-pack-year smoking history and a distant history of cocaine abuse. His temperature is 100.1°F (37.8°C), blood pressure is 135/85 mmHg, pulse is 100/min, and respirations are 20/min. On exam, he has notable hepatomegaly and a palpable gallbladder. A right upper quadrant ultrasound reveals an irregular extrahepatic mass originating from the gallbladder wall. Which of the following serum markers is most likely elevated in this patient? |
usmle-11828 | A 57-year-old woman presents to her primary care physician with a chief complaint of epigastric pain that has worsened over the past three weeks. She describes it as sudden “gnawing” sensations that last for up to half a minute before subsiding. She finds some relief after a glass of water, but does not associate relief or exacerbation around mealtimes. The patient denies any radiation of the pain, fever, weight loss, fatigue, or change in stool color and quality. She does not take any medications, and says her diet includes lots of spicy and smoked foods. The physician refers her for an upper endoscopy, which reveals evidence of duodenal ulcers and mild gastroesophageal reflux. The pathology report reveals focal intestinal metaplasia and gastric dysplasia in the stomach, but no Helicobacter pylori infection. How should the physician advise this patient? |
usmle-11829 | A 56-year-old man presents to his primary care provider with a 3-month history of violaceous papules and plaques around his nose and mouth, as seen in Figure A. He reports that the lesions have not bothered him too much, and there has not been any skin breakdown. The patient recalls getting all necessary immunizations throughout his life. On his social history, the patient reports that he lives alone and frequently engages in unprotected sexual activity with both men and women, with 2-3 different partners a month. On exam, his temperature is 97.5°F (36.4°C), blood pressure is 126/74 mmHg, pulse is 65/min, and respirations are 12/min. Which of the following describes the most likely cause for this patient’s findings? |
usmle-11830 | A 58-year-old male with a history of obesity, hypertension, and coronary artery disease is found to have the following EKG (Figure A) while visiting his cardiologist. He is asymptomatic and able to tolerate his regular routine. On physical exam, the patient's vitals are within normal limits and stable. Which of the following represents the pathophysiology of this rhythm? |
usmle-11831 | A 12-year-old boy presents to the emergency department with a recent history of easy bleeding. He experienced multiple episodes of epistaxis and bleeding gums over the past two days. He also had flu-like symptoms a week ago which resolved over the past few days. His past medical history is notable for well-controlled asthma. His temperature is 98.9°F (37°C). Physical examination is notable for a petechial rash. No splenomegaly is noted. A coagulation panel reveals an elevation in bleeding time with normal PT and PTT. The blood component that is most likely deficient in this patient contains granules of which of the following? |
usmle-11832 | A 54-year-old man tells his physician that he has had trouble swallowing for the past few months, and it has gotten much worse. He states it is difficult to swallow both liquids and solids. Sometimes at night he regurgitates bits of food. He has tried to overcome the difficulty by eating more slowly and has tried antacids with no relief. This problem has emerged recently, and he has no other complaints. A barium swallow is done for the patient (Figure A).
Which of the following is associated with this condition? |
usmle-11833 | A 60-year-old African-American male with no active medical problems presents to his primary care physician for a general check up. His blood pressure on the previous visit was 145/90, and his blood pressure at this visit is found to be 150/95. He is prescribed hydrochlorothiazide, a thiazide diuretic, to treat his hypertension. The serum level of which of the following is likely to decrease in response to his treatment? |
usmle-11834 | A 52-year-old female with a history of poorly-controlled diabetes presents to her primary care physician because of pain and tingling in her hands. These symptoms began several months ago and have been getting worse such that they interfere with her work as a secretary. She says that the pain is worse in the morning and she has been woken up at night by the pain. The tingling sensations have been located primarily in the thumb, index and middle fingers. On physical exam atrophy of the thenar eminence is observed and the pain is reproduced when the wrist is maximally flexed. The most likely cause of this patient's symptoms affects which of the nerves shown in the image provided? |
usmle-11835 | A 24-year-old medical student presents to urgent care with cough and rhinorrhea. He has been learning about HIV and immunosuppression in medical school, and he is worried that he is seriously ill. He has no significant medical history, and he is sexually active with his girlfriend. He consumes alcohol on weekends but does not use tobacco or other recreational drugs. He candidly reports that, in microbiology lab, he cultured his own sputum on Sabouraud agar, and Candida grew on the agar. Examination of the oropharynx does not show any abnormalities. You perform a nasal viral swab, which confirms that he has a rhinovirus infection. Which of the following is the most likely explanation for his positive Candida culture? |
usmle-11836 | A 34-year-old woman presents to the clinic complaining of constipation and dry mouth. She had uncontrollable diarrhea for 1 day and took some medications afterwards. Patient denies any recent hospitalizations or antibiotic use. She also denies melena, hematochezia, nausea, or vomiting. Vitals are within normal limits. What medication did the patient take? |
usmle-11837 | A 61-year-old female is referred to an oncologist for evaluation of a breast lump that she noticed two weeks ago while doing a breast self-examination. Her past medical history is notable for essential hypertension and major depressive disorder for which she takes lisinopril and escitalopram, respectively. Her temperature is 98.6°F (37°C), blood pressure is 120/65 mmHg, pulse is 82/min, and respirations are 18/min. Biopsy of the lesion confirms a diagnosis of invasive ductal carcinoma with metastatic disease in the ipsilateral axillary lymph nodes. The physician starts the patient on a multi-drug chemotherapeutic regimen. The patient successfully undergoes mastectomy and axillary dissection and completes the chemotherapeutic regimen. However, several months after completion of the regimen, the patient presents to the emergency department with dyspnea, chest pain, and palpitations. A chest radiograph demonstrates an enlarged cardiac silhouette. This patient’s current symptoms could have been prevented by administration of which of the following medications? |
usmle-11838 | A 62-year-old man presents to his primary care doctor with continued hypertension despite adherence to multiple anti-hypertensive medications. The physician suspects that the patient may have elevated aldosterone levels and wants to initiate a trial of an aldosterone receptor antagonist. The patient is very concerned about side effects, particularly impotence and gynecomastia, as he had a friend who took a similar medication and had these side-effects. Which of the following is the best medication to initiate, given his concerns and the physician's diagnosis? |
usmle-11839 | A 61-year-old man sustains an intracranial injury to a nerve that also passes through the parotid gland. Which of the following is a possible consequence of this injury? |
usmle-11840 | A 56-year old man presents to his primary care physician complaining of a dark spot on his left thigh. He says that he first noticed the spot about 3 years ago when he went to the beach with his family; however, at the time it was very small and he didn't think that it was worth mentioning. Since then, it has been growing slowly and he is now concerned about its size. He says that he does not have any other symptoms associated with the lesion. Physical exam reveals an asymmetric 2.5 centimeter plaque with irregular borders and a varying pattern of brown coloration. The lesion is studied and found to have a mutation in a gene that inhibits cyclin function. Which of the following is most likely true of this gene? |
usmle-11841 | A 26-year-old professional basketball player presents to his primary care provider for a health maintenance examination. He has no acute complaints, and no recent hospitalizations. Physical examination is unremarkable. An ECG was performed for teaching purposes, and is shown in Figure A. Which of the following is most consistent with this patient's ECG results? |
usmle-11842 | A 24-year-old woman presents to the emergency department with a 2-week history of a foot ulcer. She says that she punctured her foot with a rusty nail while she was playing tennis and that the puncture wound has since progressed to a non-healing ulcer. Over the last 2 days, she has also been experiencing a fever and drainage from the wound. On presentation, she is found to have a slightly fruity smelling red ulcer with purulent drainage. Probing the ulcer goes all the way down to bone. Which of the following characteristics is true of the most likely cause of this patient's symptoms? |
usmle-11843 | A 59-year-old man comes to the clinic for complaints of fatigue and diarrhea. He immigrated from Japan 2 months ago and has been feeling tired and lethargic since then. He denies lightheadedness, chest pain, shortness of breath, hematochezia, melena, or nausea/vomiting. However, he endorses intermittent loose stools and some numbness in his hands. A physical examination demonstrates conjunctival pallor. His laboratory studies are shown below. A stool ova and parasite study is done and its findings are demonstrated in Figure A.
Leukocyte count: 7,800/mm^3
Segmented neutrophils: 58%
Bands: 4%
Eosinophils: 2%
Basophils: 0%
Lymphocytes: 29%
Monocytes: 7%
Hemoglobin: 10 g/dL
Platelet count: 170,000/mm^3
Mean corpuscular hemoglobin concentration: 34% Hb/cell
Mean corpuscular volume: 103 µm^3
Homocysteine: 15 mmol/L (Normal = 4.0 – 10.0 mmol/L)
Methylmalonic acid: 0.6 umol/L (Normal = 0.00 – 0.40 umol/L)
What is the mechanism of action for the most appropriate medication that treats this patient’s condition? |
usmle-11844 | A 56-year-old man comes to the clinic complaining of sexual dysfunction. He reports normal sexual function until 4 months ago when his relationship with his wife became stressful due to a death in the family. When asked about the details of his dysfunction, he claims that he is “able to get it up, but just can’t finish the job.” He denies any decrease in libido or erections, endorses morning erections, but an inability to ejaculate. He is an avid cyclist and exercises regularly. His past medical history includes depression and diabetes, for which he takes citalopram and metformin, respectively. A physical examination is unremarkable. What is the most likely explanation for this patient’s symptoms? |
usmle-11845 | A 1-year-old Caucasian male is on pancreatic enzyme replacement therapy (PERT) to maintain a healthy body mass index. Sweat chloride test is 68 mmol/L (< 29 mmol/L = normal). The patient has a relative who was also on PERT but passed away in his mid-20s due to respiratory failure, and was unable to have children. Which of the following would be most improved by PERT? |
usmle-11846 | A 47-year-old Hispanic man presents with complaints of recent heat intolerance and rapid heart rate. The patient has also experienced recent unintentional weight loss of 15 pounds. Physical exam reveals tachycardia and skin that is warm to the touch. A radioactive iodine uptake scan of the thyroid reveals several focal nodules of increased iodine uptake. Prior to this study, the physician had also ordered a serum analysis that will most likely show which of the following? |
usmle-11847 | A 47-year-old man presents to his primary care physician for fatigue. Over the past 3 months, his tiredness has impacted his ability to work as a corporate lawyer. He denies any changes to his diet, exercise regimen, bowel movements, or urinary frequency. His past medical history is notable for obesity, type II diabetes mellitus, and hypertension. He takes metformin and enalapril. His family history is notable for colorectal cancer in his father and paternal grandfather and endometrial cancer in his paternal aunt. He has a 20-pack-year smoking history and drinks one 6-pack of beer a week. His temperature is 98.8°F (37.1°C), blood pressure is 129/71 mmHg, pulse is 82/min, and respirations are 17/min. On exam, he has conjunctival pallor. A stool sample is positive for occult blood. A colonoscopy reveals a small hemorrhagic mass at the junction of the ascending and transverse colon. Which of the following processes is likely impaired in this patient? |
usmle-11848 | A 55-year-old man presents to his primary care provider with increased urinary frequency. Over the past 3 months, he has been urinating 2-3 times more often than usual. He has started to feel dehydrated and has increased his water intake to compensate. He works as a bank teller. He has a 25-pack-year smoking history and drinks 8-10 beers per week. His temperature is 98°F (36.8°C), blood pressure is 114/68 mmHg, pulse is 100/min, and respirations are 18/min. Capillary refill is 3 seconds. His mucous membranes appear dry. The patient is instructed to hold all water intake. Urine specific gravity is 1.002 after 12 hours of water deprivation. The patient is given desmopressin but his urine specific gravity remains relatively unchanged. Which of the following is the most appropriate pharmacologic treatment for this patient's condition? |
usmle-11849 | A 42-year-old woman presents to the clinic with a rash on her left forearm for 1 day. The rash is erythematous, vesicular, and itchy (see Figure A). The patient denies any fever, joint pain, oral ulcers, or gastrointestinal symptoms. She reports an “allergy” to gluten for 2 years, but has tested negative for celiac disease in the past. Upon further questioning, she revealed that she was volunteering a couple of days ago and was weeding plants in a public yard. What is the most likely explanation of her findings? |
usmle-11850 | A 72-year-old man presents to his primary care physician because he feels like his vision has been changing over the last 6 months. In particular, he feels that he cannot see as well out of his right eye as previously. His past medical history is significant for myocardial infarction as well as Lyme disease. On presentation, he is found to have a droopy right eyelid as well as persistent constriction of his right pupil. Additionally, the skin on his right half of his face is found to be cracked and dry. Which of the following is most likely associated with this patient's symptoms? |