You are investigating the cause for a patient’s anemia. He is a 50-year-old man who was found to have a hematocrit of 25% on routine evaluation. His hematocrit was 47% 1 year ago. Mean corpuscular volume is 80, mean corpuscular hemoglobin concentration is 25, mean corpuscular hemoglobin is 25. Reticulocyte count is 5%. Review of the peripheral blood smear shows marked numbers of polychromatophilic macrocytes. Ferritin is 340 µg/L. What is the cause of this patient’s anemia?
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Question 2 of 49
2. Question
A patient presents to the clinic complaining of nausea, vomiting, crampy abdominal pain, and markedly increased flatus. The patient has not experienced any diarrhea or vomiting but notes that he has been belching more than usual and he describes a “sulfur-like” odor when he does so. He returned from a 3-week trip to Peru and Ecuador several days ago and notes that his symptoms began about a week ago. Giardiasis is considered in the differential. Which of the following is true regarding Giardia?
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Question 3 of 49
3. Question
Which of the following statements about diabetic retinopathy is true?
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Question 4 of 49
4. Question
Which of the following conditions is often the first sign of amyloidosis?
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Question 5 of 49
5. Question
A 73-year-old man is admitted to the hospital with 3 weeks of malaise and fevers. His past medical history is notable only for hypertension controlled with a thiazide diuretic. He smokes one pack of cigarettes per day and works as an attorney. His physical examination is notable only for a new systolic heart murmur heard best in the mitral region. His laboratory examination is notable for mild anemia, an elevated white blood cell count, and occasional red blood cells on clean catch urine. Blood cultures grow Streptococcus bovis and echocardiogram shows a <1-cm vegetation on the mitral valve. What additional evaluation is indicated for this patient?
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Question 6 of 49
6. Question
In a patient with bacterial endocarditis , which of the following echocardiographic lesions is most to lead to embolization ?
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Question 7 of 49
7. Question
Which of the following signs and symptoms are associated with Sjogren’s syndrome?
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Question 8 of 49
8. Question
A healthy 62-year-old woman returns to your clinic after undergoing routine colonoscopy. Findings included two 1.3-cm sessile (flat-based), villous adenomas in her ascending colon that were removed during the procedure. What is the next step in management?
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Question 9 of 49
9. Question
Several family members present to a local emergency room 2 days after a large family summer picnic where deli meats and salads were severed . They all complain of profuse diarrhea ,headaches ,fevers ,and myalgias .Their symptoms began ~24 h after the picnic . It appears that everyone who ate Aunt Emma’s bologna surprise was afflicted .Routine cultures of blood and stool are negative to date . Which of the following is true regarding Listeria gastroenteritis ?
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Question 10 of 49
10. Question
Which of the following laboratory results best support the diagnosis of subclinical hypothyroidism?
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Question 11 of 49
11. Question
Which of the following statements about cardiac toxicity from cancer treatments is true?
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Question 12 of 49
12. Question
A 19-year-old woman comes to your office after being bitten by a bat on the ear while camping in a primitive shelter. She is unable to produce a vaccination record. On physical examination, she is afebrile and appears well. There are two small puncture marks on the pinna of her left ear. What is an appropriate vaccination strategy in this context?
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Question 13 of 49
13. Question
A high urinary sodium concentration in the presence of a low plasma osmolality is most closely associated with:
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Question 14 of 49
14. Question
The triad of portal vein thrombosis, hemolysis, and pancytopenia suggests which of the following diagnoses?
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Question 15 of 49
15. Question
In a patient who has undergone a traumatic splenectomy, what test can be ordered to establish lack of splenic function?
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Question 16 of 49
16. Question
Side effects of 3-hydroxy-3-methylglutaryl coenzyme A (HMG CoA) reductase inhibitors include:
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Question 17 of 49
17. Question
Which of the following best describes the mechanism of action of clopidogrel?
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Question 18 of 49
18. Question
A person with liver disease caused by Schistosoma mansoni would be most likely to have what condition?
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Question 19 of 49
19. Question
A 24-year-old poorly controlled diabetic patient presents to your emergency room with ketoacidosis, fever, pain, and purulent drainage of the sinuses with black eschar formation affecting the nasal septum. The most likely diagnosis is:
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Question 20 of 49
20. Question
Which of the following symptoms is most suggestive of an esophageal mass?
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Question 21 of 49
21. Question
Which of the following represents an emergent (same day) indication for cardiac surgery in a patient with infective endocarditis?
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Question 22 of 49
22. Question
A 62-year-old business executive with a history of migraines is noted to have hypertension; otherwise, he is healthy. Which of the following is the best medication for the treatment of his mhypertension?
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Question 23 of 49
23. Question
Which of the following carries the best disease prognosis with appropriate treatment?
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Question 24 of 49
24. Question
A 30-year-old female is seen in the clinic before undergoing an esophageal dilation for a stricture. Her past medical history is notable for mitral valve prolapse with mild regurgitation. She takes no medications and is allergic to penicillin. Her physician should recommend which of the following?
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Question 25 of 49
25. Question
Which of the following is an effect of niacin use?
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Question 26 of 49
26. Question
A 48-year-old woman is admitted to the hospital with anemia and thrombocytopenia after complaining of profound fatigue. Her initial hemoglobin is 8.5 g/dL, hematocrit 25.7%, and platelet count 42,000/µL. Her leukocyte count is 9540/µL, but 8% blast forms are noted on peripheral smear. A chromosomal analysis shows a reciprocal translocation of the long arms of chromosomes 15 and 17, t(15;17), and a diagnosis of acute promyelocytic leukemia is made. The induction regimen of this patient should include which of the following drugs:
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Question 27 of 49
27. Question
A 78-years-old male presents to the clinic complaining that every time he shaves with a straight razor, he passes out. His symptoms have been occurring for the last 2 months. Occasionally, when he puts on a tight collar, he passes out as well. The loss of consciousness is brief, he has no associated prodrome, and he feels well afterward. His past medical history is notable for hypertension and hypercholesterolemia. His only medication is hydrochlorothiazide. On physical exam his vital signs are normal, and his cardiac exam is normal with the exception of a fourth heart sound. Which of the following is the most appropriate next diagnostic test?
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Question 28 of 49
28. Question
A 60-year-old alcoholic man, currently being treated for gastritis, presents to the office with painful breasts that appear enlarged. The most likely cause is:
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Question 29 of 49
29. Question
A 56-year-old patient inquires about screening for colon cancer. He has no risk factors for colon cancer, other than age. Which of the following statements is true regarding which screening test you recommend for this patient?
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Question 30 of 49
30. Question
A 37-years-old male with Wolff-Parkinson-White syndrome develops a broad-complex irregular tachycardia at a rate of 200 beats per minute. He appears comfortable and has little hemodynamic impairment. Useful treatment at his point might include:
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Question 31 of 49
31. Question
A 60-year-old man presents with pain, swelling, and redness of the first metatarsal phalangeal joint. His cardiologist recently prescribed hydrochlorothiazide for his hypertension. The most likely diagnosis is:
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Question 32 of 49
32. Question
A 46-year-old woman presents with new onset ascites and severe abdominal pain: a hepatic Doppler examination reveals hepatic vein thrombosis. She also reports tea colored urine on occasion, particularly in the morning, as well as recurrent worsening abdominal pain. On further evaluation, she is found to have an undetectable serum haptoglobin, elevated serum lactase dehydrogenase, hemoglobinuria and an elevated reticulocyte count. A peripheral smear shows no schistocytes. What is the most likely diagnosis?
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Question 33 of 49
33. Question
Which of the following patients meets criteria for the diagnosis of the metabolic syndrome?
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Question 34 of 49
34. Question
Which of the following values is acceptable for a 65-year-old man who had a previous coronary artery bypass graft?
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Question 35 of 49
35. Question
A 17-year-old woman presents to the clinic complaining of vaginal itchiness and malodorous discharge. She is sexually active with multiple partners, and she is interested in getting tested for sexually transmitted diseases. A wet-mount microscopic examination is performed, and trichomonal parasites are identified. Which of the following statements regarding trichomoniasis is true?
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Question 36 of 49
36. Question
When treating a patient with a non -ST-segment elevation myocardial infarction (NSTEMI), risk stratification and timely administration of anti-ischemic and antithrombotic therapies are paramount. For a patient with unstable angina with negative biomarkers. which medication regimen is most appropriate an initial treatment?
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Question 37 of 49
37. Question
A blood urea nitrogen (BUN): creatinine level greater than 20 is associated with:
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Question 38 of 49
38. Question
A 32-year-old man presents with jaundice and malaise. He is found to have acute hepatitis B with positive hepatitis B virus (HBV) DNA and E antigen. Which of the following antiviral agents are approved as part of a therapeutic regimen for mono-infection with hepatitis B?
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Question 39 of 49
39. Question
Which of the following associations correctly pairs clinical scenarios and community-acquired pneumonia (CAP) pathogens?
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Question 40 of 49
40. Question
Which of the following is the most appropriate medication for the treatment of hypertension in a diabetic patient?
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Question 41 of 49
41. Question
Which of the following is the most common cause of traveler’s diarrhea in Latin America?
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Question 42 of 49
42. Question
Which of the following forms of hepatitis does NOT have a chronic state?
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Question 43 of 49
43. Question
A 60-year-old woman presents with complaints of diffuse proximal muscle pain, low-grade fevers, and generalized fatigue. Laboratory findings include an elevated ESR and mild anemia. The most likely diagnosis is:
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Question 44 of 49
44. Question
In the inpatient setting, extended-spectrum β-lactamase (ESBL)-producing gram-negative infections are most likely to occur after frequent use of which of the following classes of antibiotics?
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Question 45 of 49
45. Question
Which of the following organisms is responsible for the development of pseudomembranous colitis?
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Question 46 of 49
46. Question
Which of the following is associated with pseudogout?
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Question 47 of 49
47. Question
Which of the following is true regarding influenza prophylaxis?
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Question 48 of 49
48. Question
Which of the following medications is used for the treatment of pseudomembranous colitis?
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Question 49 of 49
49. Question
A 65 year old man complains of gynecomastia and galactorhea with erectile dysfunction. the most likely diagnosis is: