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| # | Code | QID |
Subspecialty
|
Topic
|
Complexity
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Importance
|
|
|---|---|---|---|---|---|---|---|
| 1 | M1.PY.17.4698 | 108207 | A 33-year-old man comes into the ED after getting into a fight at a bar. He tells the physician that he was punched in the face for no reason. In the ED, he declares multiple times that he is incredibly angry and upset that he was beaten up. The patient's mood rapidly shifts between anger and sadness. He is wearing a multi-colored top with bright yellow pants, and he makes broad gestures while speaking. Before the paramedics left, they told the doctor that multiple bystanders at the bar reported the patient was flirting with numerous women. He began to touch one of them inappropriately, and she shoved him away. Upset, he demanded to be taken to the ED. The doctor begins to suspect the patient has a personality disorder. Which one is most likely? | Personality Disorders |
M 3
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A
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|
| 2 | M1.OMB.20.4673 | 214219 | A 65-year-old man goes to the hospital to follow-up with his nephrologist. The patient has concerns about his new-onset fatigue and lack of appetite. Past medical history is significant for 20 years of type II diabetes and hypertension. Physical examination reveals bilateral 3+ pitting edema of the lower extremity. On urinalysis, output is below normal, and serum creatinine is 4.3 mg/dL. Furthermore, the patient’s glomerular filtration rate (GFR) is 14 mL/minute/1.73 m^2, and albumin excretion rate (AER) is 320 mg/day. One year ago, serum creatinine was 3.0 mg/dL, GFR was 32 mL/minute/1.73 m^2, and AER was 100 mg/day. Renal ultrasound now demonstrates the presence of shrunken kidneys. Given the disease progression, the nephrologist decides to start dialysis and discusses kidney transplant with the patient. What other lab findings would be expected in this patient? | Chronic Kidney Disease (CKD) |
M 2
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A
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|
| 3 | M1.BC.17.4695 | 107982 | A 45-year-old female presents to her primary care physician with a chief complaint of easy bruising and bleeding over the last 6 months. She has also noticed that she has been having fatty, foul smelling stools. Past history is significant for cholecystectomy a year ago to treat a long history of symptomatic gallstones. Based on clinical suspicion a coagulation panel was obtained showing a prothrombin time (PT) of 18 seconds (normal range 9-11 seconds), a partial thromboplastin time (PTT) of 45 seconds (normal 20-35 seconds), with a normal ristocetin cofactor assay (modern equivalent of bleeding time). Which of the following is the most likely cause of this patient's bleeding? | Fat Soluble Vitamins |
M 1
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A
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|
| 4 | M1.OMB.4874 | 214529 | A 15-year-old child with hepatosplenomegaly, fever, and fatigue is referred to oncology. The physician highly suspects acute lymphoblastic leukemia after confirming the accumulation of CD19 and CD79a positive lymphoblasts in the bone marrow. The physician informs the parents about the diagnosis, and they approve of the treatment plan. Later, when the physician is alone with the patient, the patient directly asks what will happen to him. How should the physician respond? | Ethical Principles |
M 1
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A
|
|
| 5 | M1.OMB.1 | 214605 | A 42-year-old man presents to a primary care physician to establish care after moving with his family across the country. His past medical history is significant for alcohol and opioid use disorder though he is not currently on any maintenance medications. He admits during the interview that he recently started using cocaine but has been hiding it from his family because he does not want them to be upset. After the visit, the physician receives a phone call from the patient's wife who says that she is extremely worried about her husband who she thinks had an appointment earlier in the day. She says that he has been disappearing randomly in the middle of the night and is passed out on the couch every morning. She is worried that he will have a negative impact on their pre-teen son and daughter. She requests a meeting with the physician to discuss a strategy for modifying his destructive behavior. Which of the following is the most appropriate response for the physician to give at this point? | Ethical Principles |
M 1
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A
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| 6 | M1.OMB.1 | 214355 | An 82-year-old man with metastatic squamous cell carcinoma of the lung tells his hospice nurse that he needs opioid pain medications for severe suprapubic pain associated with dysuria and increased urinary frequency as well as back pain. His past medical history is significant for chronic bronchitis as well as squamous cell lung cancer and his wife has durable power of attorney for making his healthcare decisions. At baseline, he requires between 1-3 liters of oxygen by nasal cannula and his oxygen saturation is currently 87% on 5L of oxygen. He is found to have cloudy urine that is positive for leukocytes, nitrates, and bacteria. Which of the following is the most appropriate course of action to take? | Ethical Principles |
M 3
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A
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|
| 7 | M1.OMB.20.1 | 213740 | A 16-year-old Hasidic Jewish woman presents to a gynecologist accompanied by her mother, requesting a "check-up." As the physician escorts the mother out of the examination room, the mother asks the physician to ensure that the patient does not become sexually active before marriage, as this is strictly forbidden in their religion. When interviewed alone, the patient shares that she has been dating someone and had unprotected sexual intercourse 2 days ago for the first time. She denies any interest in marrying or having children in the future and hopes to attend college instead. She requests treatment for emergency contraception as well as to prevent pregnancy in the future and requests that you do not tell anyone about it. After testing for sexually transmitted infections, which of the following is the most appropriate action at this time? | Ethical Principles |
M 3
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A
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|
| 8 | M1.OMB.4873 | 215002 | An 18-year-old girl presents to clinic for her first well-woman visit. She has no complaints currently. Menarche was at age 13, and her last menses was 2 weeks ago. Her temperature is 99.5°F (37.5°C), blood pressure is 110/60 mmHg, pulse is 84/min, and respirations are 15/min. Her physical exam, including pelvic exam, is normal. She currently takes no medications and has no allergies. She denies illicit drug use and acknowledges that she is sexually active. Which of the following is the most appropriate way to begin obtaining a sexual history? | Ethical Principles |
M 1
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A
|
|
| 9 | M1.OMB.1 | 214770 | A 71-year-old woman is brought to the emergency department by ambulance after she was found down on the sidewalk in front of her home. On presentation, she is found to be somnolent with sunken eyes and dry mucous membranes. A fingerstick test shows 781 mg/dL of serum glucose so she is admitted and treated appropriately. Chart review reveals that she has presented like this 5 times in the past year. During the hospitalization, she says that she often gets confused about her treatment plan and forgets to take her medications because "it's hard to remember now that I'm getting old." Which of the following is the most effective intervention for this patient? | Ethical Principles |
M 1
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A
|
|
| 10 | M1.OMB.4875 | 214775 | A 13-year-old boy is brought in to the emergency department by ambulance after sustaining a generalized tonic-clonic seizure while attending a summer camp. The seizure was witnessed in the cafeteria and lasted approximately 15 seconds. The camp nurse was present at the time and reported that all 4 of the patient's extremities were shaking, and he was confused after the seizure for approximately 10 minutes. After the parents arrive, they confirm that the patient has a history of epilepsy that had been controlled for nearly 2 years on his current medication regimen without any issues. The patient had brought his medication with him to camp but reports that he had missed several doses over the last 3 weeks. He states that he knows his medications are needed to prevent his seizures. Which of the following is the most likely cause of medication non-adherence in this child? | Ethical Principles |
M 1
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A
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| 11 | M1.OMB.1 | 214645 | A 22-year-old woman with a history of depression presents to her primary care physician with her husband for an annual exam. On presentation, she avoids eye contact and lets her husband answer all the questions asked by the physician. Her husband is then asked to step outside for the physical exam portion, and she is found to have significant bruising on her arms and legs. When asked about these findings, she first avoids the question and then says that her husband sometimes gets angry after drinking too much. She thinks that he is improving over time though and says she absolutely is not considering leaving at this time. She lives alone with her husband and says that nobody is aware of this issue other than the physician. Which of the following is the most appropriate course of action for the physician in this case? | Legal Principles |
M 1
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A
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|
| 12 | M1.OMB.4771 | 214774 | A 56-year-old man with a history of alcohol use disorder, hepatitis C infection, and hepatocellular carcinoma status post orthotopic liver transplant is brought in by ambulance to the emergency department with several days of nausea, vomiting, and fevers reaching 104.0°F (40.0°C). The patient had been found with altered mental status at his assisted living facility. On exam, his temperature is 104.9°F (40.5°C), blood pressure is 60/35 mmHg, pulse is 130/min, and respirations are 18/min. The patient appears to be in acute distress and is diaphoretic. The patient is intermittently responsive but is not alert or oriented. He is pan-cultured and started on vasopressors and broad-spectrum antibiotics. He is admitted to the intensive care unit. The patient had already been admitted twice in the past 6 months due to septic shock. Which of the following should be obtained on admission for this patient? | Legal Principles |
M 1
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A
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|
| 13 | M1.OMB.20.4770 | 214203 | A 65-year-old man with amyotrophic lateral sclerosis is brought to the hospital with breathing difficulties by his family. As his long-term provider, the treating physician understands the patient’s advanced level of disease can only be stabilized with invasive ventilation, which the family urges the physician to use. However, in the past, when the physician carefully explained the patient’s condition and the risks and benefits of various treatments (including no treatment) for emergencies, the patient has only ever consented to the use of non-invasive measures. Each time, the patient demonstrates comprehension of his illness and the consequences of his decision and is always vehemently against anything invasive. Soon, the patient becomes unresponsive. What is the most appropriate immediate course of action for the physician? | Legal Principles |
M 1
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A
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|
| 14 | M1.OMB.4731 | 214561 | A research team developed a study to assess the impact of tobacco smoking on cardiovascular disease in their local rural community. They decided to analyze a population of 50,000 men aged 50-75 years. In this group, approximately 20,000 are current tobacco smokers with at least a 20 pack-year history. Of these smokers, 17,000 have diagnoses of cardiovascular disease. Of the 30,000 in this population who are nonsmokers, 15,000 have diagnoses of cardiovascular disease. There are no significant differences in rates of obesity, diabetes, or other chronic conditions between the smokers and the nonsmokers. Which of the following is the attributable risk of smoking on cardiovascular disease in this study population? | Testing and Screening |
M 1
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A
|
|
| 15 | M1.OMB.1 | 214602 | An epidemiologist is studying the relationship between consumption of spicy foods and the development of gastric ulcers. In order to do this, she conducts a prospective cohort study where she enrolls 700 healthy individuals and follows them longitudinally for several years. At baseline, she finds that 200 of the subjects routinely eat spicy food whereas the rest of them do not. At the end of the study, she finds that 50 of the patients who regularly consume spicy food developed gastric ulcers, whereas 100 of the patients who do not consume spicy food developed gastric ulcers. Which of the following is the relative risk of developing gastric ulcers in patients who consume spicy foods? | Testing and Screening |
M 1
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A
|
|
| 16 | M1.OMB.20.4730 | 213799 | A phase 3 clinical trial is testing the efficacy of a novel checkpoint inhibitor as immunotherapy for metastatic melanoma with central nervous system involvement. The study enrolled 350 patients, 150 of whom were randomized to receive the novel checkpoint inhibitor. The primary endpoint of the study was mortality at 1 year. For the experimental group, the median survival was 13.6 months, and the number of subjects surviving at 1 year was 90. For the control group receiving standard treatment, the median survival was 11.9 months, and the number of subjects surviving at 1 year was 80. Which of the following represents the absolute risk reduction of this experimental drug? | Testing and Screening |
A
|
||
| 17 | M1.OMB.4732 | 214850 | A 23-year-old man is brought to the emergency department for a 50% total body surface area burn. He must be cleared of SARS-CoV-2 coronavirus infection prior to admission to the burn unit; otherwise, he will be redirected to another intensive care unit. A novel rapid test is performed in the emergency department, and the test is found to be negative. This new test has a clinical sensitivity of approximately 85.00% and a specificity of 75.00%. The rates of SARS-CoV-2 infection in this community are unknown, but it is believed that approximately 500 individuals out of every 10,000 are infected. The patient is admitted to the burn unit while the gold standard test results are pending. Which of the following is the probability that the patient truly is not infected? | Testing and Screening |
M 1
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A
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|
| 18 | M1.OMB.20.1 | 214196 | A 73-year-old man is brought to the emergency department by his daughter after he felt lightheaded during dinner at home. She says that he was standing up to get more food when he started complaining of dizziness. She had him sit back down and his symptoms appeared to resolve; however, she was concerned that he may have accidentally mixed up his medications so she decided to bring him in for further evaluation. His past medical history is significant for benign prostatic hyperplasia, diabetes, and depression. He takes tamsulosin, metformin, glipizide, and fluoxetine. Blood and urine tests are performed with the following results: Blood urea nitrogen: 71 mg/dL Serum creatinine: 2.7 mg/dL Urine sodium: 16 mEq/L Urine osmolality: 628 mOsm/kg Which of the following etiologies most likely explains this patient's symptoms and findings? | Acute Kidney Injury |
M 2
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A
|
|
| 19 | M1.CV.15.75 | 106831 | A 69-year-old male with a history of well-controlled hypertension, diabetes, and depression presents to his primary care physician for a routine visit. He has no present complaints at this time and states that he has been compliant on all his medications. On exam, the physician appreciates a IV/VI crescendo-decrescendo systolic ejection murmur that is immediately preceded by a click and radiates into the carotids. Which of the following pressure-volume loops corresponds to this patient's condition? | Cardiac Cycle |
M 1
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A
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|
| 20 | M1.OMB.1 | 214959 | A 72-year-old man presents to his primary care physician for his annual physical exam. He says that he has been feeling well without any symptoms to report. His past medical history is significant for a left-sided hip replacement surgery that was performed 7 years ago. He has never smoked and drinks 1 glass of wine at dinner. A review of his blood work results demonstrate dyslipidemia so his physician prescribes the most effective medication for raising high-density lipoprotein levels. Which of the following drugs should also be prescribed at this time? | Lipid Lowering Drugs |
M 3
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A
|
|
| 21 | M1.OMB.4886 | 214347 | A 37-year-old man presents to a primary care physician to establish care. He feels overall healthy, but has noticed increasing fatigue with exercise. He has no past medical history, is currently taking no medications, and has no allergies. His family history is significant for 2 uncles that died in their 40's from myocardial infarctions and he has a brother with diagnosed coronary artery disease. Lab analysis is as follows: Serum: Na+: 139 mEq/L K+: 4.1 mEq/L Cl-: 101 mEq/L Ca2+: 8.5 mg/dL Total cholesterol: 195 mg/dL (Normal: < 200 mg/dL) Triglycerides: 1012 mg/dL (Normal: < 150 mg/dL) A drug with which of the following mechanisms of action would be the most appropriate therapy? | Lipid Lowering Drugs |
M 3
|
A
|
|
| 22 | M1.OMB.1 | 214372 | A 55-year-old man presents to the emergency department for slurred speech and weakness affecting his left upper and lower extremities. His symptoms began approximately 2 hours ago and have not improved. A CT scan of the head is negative for an intracranial hemorrhage or space-occupying lesion, and he is started on alteplase. He is admitted to the hospital for further monitoring. In addition to aspirin, he is started on a second agent for secondary stroke prevention. Which of the following is the mechanism of action of this second agent? | Lipid Lowering Drugs |
M 3
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A
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|
| 23 | M1.OMB.1 | 214611 | A 71-year-old man presents to his primary care physician for follow-up 2-weeks after he was started on a new lipid-lowering medication. He says that he has had mild gastrointestinal upset but is otherwise tolerating PO. He discontinued taking cholestyramine due to intolerable side effects about 1 month before starting this new medication. His other medications include several longstanding medications for hypertension and hypercholesterolemia. During the visit, his physician states that they will need to do blood work to make sure that his liver enzyme levels are normal. The medication that was most likely started in this patient has which of the following mechanisms of action? | Lipid Lowering Drugs |
M 3
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A
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|
| 24 | M1.OMB.4885 | 214681 | A primary care physician decides to switch his hypertensive, diabetic patients to a blood pressure medication, X, after reading a study suggesting that medication X is associated with better outcomes compared to the typical anti-hypertensive he usually prescribes to this group of patients. Which type of study design would have provided the strongest evidence to make such a change? | Observational Studies |
M 1
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A
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| 25 | M1.OMB.1 | 214777 | An orthopedic surgeon is dissatisfied with the relatively high infection rate in patients with open traumatic fractures at her hospital. She decides to research best practices from other hospitals in order to determine which interventions may be effective in decreasing infectious complications. Upon review of medical journals, she is able to locate hundreds of articles reporting outcomes from open fractures. Which of the following types of references would be most valuable for the guiding change in her clinical practice? | Observational Studies |
M 1
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A
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| 26 | M1.OMB.4886 | 214746 | A 48-year-old woman presents to a wound center to follow up regarding a surgical site wound that she has on her abdomen. The patient underwent an open abdominal procedure 3 months prior, and a superficial dehiscence of the inferior aspect of the incision was noticed at her first postoperative visit. The provider evaluating this patient is deciding whether to start the patient on negative pressure wound therapy, which he has not previously used on any patients. He is considering changing his standard of practice for chronic wounds. Which of the following types of evidence in favor of negative pressure wound therapy for chronic wounds would best support this change in practice? | Observational Studies |
M 1
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A
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| 27 | M1.OMB.1 | 214713 | A researcher is investigating a potential association between adolescent dairy consumption and breast cancer. She interviews 100 patients with breast cancer and 200 patients without breast cancer to assess how many average servings of dairy they had per week in adolescence. She groups the dairy consumption levels as high versus low. She then calculates the odds ratio of high dairy consumption of patients with breast cancer compared to patients without breast cancer. What kind of study design did this researcher use? | Observational Studies |
M 1
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A
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| 28 | M1.OMB.4887 | 214806 | A research team wants to determine whether there are any prenatal factors associated with cleft lip in families that have no previous history of cleft lip. The research team decides to focus on all newly-diagnosed children with cleft lip at their children’s hospital in the last 2 years. They will then compare this group to a matched group of children without cleft lip. All subjects with a family history of cleft or other craniofacial syndromes will be excluded from the study. All subjects’ families will be sent a survey assessing for prenatal factors that may have been associated with cleft disease. What type of study is this, and what kind of outcome measure will it determine? | Observational Studies |
M 1
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A
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| 29 | M1.OMB.20.1 | 213781 | A 75-year-old white man presents to his cardiologist with a 2 week history of increasing dyspnea. He has been experiencing increasing shortness of breath while doing activities of daily living and has occasionally had shortness of breath even at rest. Physical exam reveals rales and coarse crackles at the bases of the lungs bilaterally. Based on worsening symptoms, his medications are changed to lisinopril, metoprolol, chlorthalidone, spironolactone, and digoxin as needed for symptoms. Which of these medications have been shown to improve survival in this patient? | Congestive Heart Failure |
M 3
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A
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| 30 | M1.OMB.4876 | 215179 | A 70-year-old man presents to the emergency department with worsening shortness of breath. He used to walk 2-3 miles every morning but over the past few months, his exercise tolerance has diminished. Now, he cannot take more than 10 steps without sitting to catch his breath. He has a history of diabetes, hypertension, and triple coronary bypass surgery. He has a 50 pack-year smoking history and drinks 6-7 beers per week. He has no recent travel history. The patient’s temperature is 98.2°F (36.8°C), blood pressure is 154/92 mmHg, pulse is 78/min, and respirations are 16/min. Physical exam is notable for 2+ pitting edema bilaterally, jugular venous pulsations 6 cm above the sternal notch, and an S3 murmur. An echocardiogram shows a left ventricular ejection fraction of 40%. What are the expected changes in total peripheral resistance, renin, angiotensin II, aldosterone, and bicarbonate (HCO3-) in this patient (Figure A)? | Congestive Heart Failure |
M 2
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A
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| 31 | M1.OMB.20.4875 | 214229 | A 56-year-old man with a history of hyperlipidemia, hypertension, and diabetes presents to the clinic with shortness of breath. He reports progressively worsening dyspnea beginning 1 week ago. At baseline, the patient walks 10 minutes with his dog but is now only able to take 20 steps before he feels winded. He denies any fevers, lightheadedness, or chills but endorses an upper respiratory tract infection (URI) 1 week ago with some residual cough. The patient works as a long-distance truck driver. He has a 40 pack-year smoking history and drinks occasionally. Medications include lisinopril, aspirin, atorvastatin, and metformin, but the patient reports non-compliance due to his busy schedule. A physical examination demonstrates a well-appearing gentleman with a pulsating bulge at the right neck. What additional physical examination finding is the most likely in this patient? | Congestive Heart Failure |
M 2
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A
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| 32 | M1.OMB.1 | 215108 | A 62-year-old man presents to the emergency department with a 1-day history of severe dyspnea. He says that he began to feel short of breath after eating Thanksgiving dinner and that he can only sleep while sitting straight up. He came to be evaluated today because he felt lightheaded while standing up and had palpitations of his heart. On presentation, his temperature is 97°F (36.1°C), blood pressure is 74/61 mmHg, pulse is 115/min, and respirations are 21/min. A physical exam reveals cool extremities with delayed capillary refill. He begins to feel extremely lightheaded and is started emergently on a medication. His blood pressure stabilizes but he develops headaches, tremors, bronchospasms, and hypokalemia. What is the mechanism of action for the most likely medication that was administered in this case? | Congestive Heart Failure |
M 3
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A
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| 33 | M1.OMB.20.4875 | 213879 | A 3-year-old boy is brought to the pediatrician’s office by his parents due to concerns for leg pain at night. The mother states that for the past several months, the boy has complained of intermittent pain in his legs, which tends to occur at night. The family has had to go to their local urgent care for pain control on 2 occasions. Otherwise, the boy has been feeding normally; however, the mother believes that he has not been gaining weight appropriately. On exam, the patient’s temperature is 98.4°F (36.9°C), blood pressure is 102/70 mmHg, pulse is 84/min, and respirations are 14/min. The boy is interacting appropriately for his age and can speak in short sentences. On his last visit 6 months prior, he was at the 30th percentile for weight and is now at the 15th percentile. The patient has a palpable spleen 2 cm below the costal margin, without tenderness to palpation. A mutational analysis is performed, and a cell analysis demonstrates glycolipid accumulation in macrophages. The patient is started on the appropriate enzyme replacement therapy. Neither parent is affected by the disease, and they are concerned about their chances of having another child with this disease. Which of the following is the most likely estimate of this probability? | Modes of Inheritance |
M 1
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A
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| 34 | M1.OMB.4876 | 214474 | A 3-month-old boy is brought in by his mother due to concerns about his head shape. The mother has a history of Crouzon syndrome, and states that her father is also affected. Her father was adopted, and she does not know any further family history from his side. The patient’s mother has 2 sisters, neither of whom are affected. The patient’s father is not affected. The mother believes that her son also has Crouzon syndrome, and would like to pursue surgical management. On exam, his temperature is 98.3°F (36.8°C), blood pressure is 104/68 mmHg, pulse is 84/min, and respirations are 14/min. The patient is brachycephalic with wide-set, proptotic eyes and a deficient midface. The mother is concerned about the chances of her son passing it down to his children. Given that Crouzon syndrome results from a mutation leading to overactive signaling of the FGFR2 protein, which of the following is the best answer for the mother? | Modes of Inheritance |
M 1
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A
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| 35 | M1.OMB.1 | 214915 | A husband and wife of northern European descent decide to undergo preconception counseling because they are worried that they will have a child with a genetic disease. Neither of them has any significant past medical history but each has a younger sibling with a genetic disorder involving dysfunctional chloride channels. Otherwise, family history is significant for hypertension on the paternal side and diabetes on the maternal side. Nobody else in the family has been diagnosed with a genetic disorder. Based on this history, which of the following represents the chance that a child of this couple will be a carrier for the genetic disorder affecting this family? | Modes of Inheritance |
M 1
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A
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| 36 | M1.OMB.1 | 214427 | A 26-year-old woman presents to a geneticist for preconception counseling because she is concerned that her children may inherit a disease that runs in the family. As part of the evaluation, the geneticist creates a pedigree of the family that indicates which members have been affected. This resulting chart is shown in Figure A. The geneticist says that the pattern seen is very classic for the disorder and gives appropriate advice about her risk of transmitting the disease. This patient's family is most likely affected with which of the following diseases? | Modes of Inheritance |
M 2
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A
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| 37 | M1.OMB.20.1 | 213780 | A 2-month old boy presents to the pediatrician for initial evaluation. He was born at home and has not previously come for evaluation because his parents were in the process of moving. On presentation, he is found to have poor weight gain and physical exam reveals hepatosplenomegaly. Further questioning reveals that the child has not been feeding well and that he often appears fatigued. A bone marrow biopsy is obtained and a slide preparation is shown in Figure A. Which of the following substances will most likely accumulate in this patient? | Lysosome |
M 2
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A
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| 38 | M1.OMB.20.1 | 214271 | A 6-month-old boy is referred to a geneticist because of failure to thrive and developmental delays. He was born at home and had late establishment of care around 3 months of age. At that time, he was found to have restricted joint motion as well as a weight in the bottom 10th percentile. Since then, he has continued to have decreased growth and was found on physical exam to have hepatosplenomegaly. Laboratory tests reveal high levels of hydrolases in the blood. The enzyme that is most likely defective in this patient is in which of the following classes? | Lysosome |
M 2
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A
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| 39 | M1.OMB.1 | 214601 | A 3-month-old boy is brought to the pediatrician by his parents with a 2-week history of increasing lethargy. They say that he has been sleeping more recently and does not seem as energetic as usual. He lives at home with his parents, and they deny any recent infectious symptoms. Physical exam reveals pallor and a prominent liver edge. Fundoscopic exam is conducted, and the results are shown in Figure A. A deficiency in which of the following proteins is the most likely cause of this patient's disorder? | Lysosome |
M 2
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A
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| 40 | M1.OMB.1 | 214914 | An 87-year-old man develops sudden onset shortness of breath and dizziness while recovering in the hospital after a myocardial infarction. He says that he was lying in bed when he started feeling like his "heart was beating crazy." His past medical history is significant for hypertension, hyperlipidemia, and a recent coronary artery stenting. Physical exam reveals a pale, diaphoretic man with an irregular pulse. Ten minutes after hospital staff are called to the patient's room, pulses are lost, and the patient passes away despite advanced cardiac life support measures. Which of the following would most likely be seen during pathologic examination of this patient's previously infarcted cardiac muscle? | Myocardial Infarction |
M 1
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A
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| 41 | M1.OMB.4800 | 214991 | A 63-year-old woman presents to her primary care provider with new-onset cough, night sweats, and hemoptysis since last week. The patient grew up in Bangladesh and immigrated to the United States when she was 35 years old. Her only medical condition is polycystic kidney disease, for which she received a kidney transplant 8 months ago. Her temperature is 98°F (36.7°C), blood pressure is 122/75 mmHg, pulse is 85/min, and respirations are 16/min. On lung auscultation, inspiratory crackles are present. A chest radiograph is ordered and a new cavitary lesion is noted in the apical-posterior segment of her left upper lobe. Which of the following is the most appropriate explanation for the apical location of this patient's radiography findings? | Mycobacterium Tuberculosis |
M 1
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A
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| 42 | M1.OMB.4799 | 214711 | A 65-year-old man presents to his family physician with complaints of a bloody cough and night sweats over the past month. When asked about his past medical history, the patient says that he was healthy growing up as a child in Bangladesh and has had no other symptoms prior. The patient’s chest radiograph is shown in Figure A. Upon viewing these results, the physician’s suspicions are confirmed. Which of the following cell types is directly responsible for the patient’s current presentation? | Mycobacterium Tuberculosis |
M 1
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A
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| 43 | M1.OMB.1 | 214365 | A 61-year-old veteran is being treated in the hospital after a myocardial infarction when he develops sudden onset shortness of breath. His past medical history is significant for emphysema and congestive heart failure but he says that he had not been experiencing any symptoms earlier in the day. On physical exam, a new holosystolic murmur is heard at the cardiac apex that radiates to the left axilla. He is also found to have coarse crackles bilaterally in the lung bases. Which of the following would most likely be seen on light microscopy of this patient's heart at the time of this complication? | Myocardial Infarction |
M 1
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A
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| 44 | M1.OMB.4875 | 214454 | A 57-year-old man is brought to the emergency department for chest pain. The patient reports sudden onset chest pain at the left sternal area that began 3 hours ago when he was shoveling snow. The pain is described as a dull pain that is 9/10 in severity with associated diaphoresis and shortness of breath. The patient received 324mg of aspirin and a dose of sublingual nitroglycerin during transport, which provided some relief. An electrocardiogram (ECG) was completed and is shown in Figure A. Which artery is most likely occluded in this patient? | Myocardial Infarction |
M 2
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A
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| 45 | M1.OMB.1 | 214613 | A 28-year-old man presents to a primary care physician to establish care after immigrating from Cambodia 2 weeks ago. He says that his only symptoms are occasional coughing with blood-tinged sputum. His past medical history is significant for 2 episodes of pneumonia, most recently 3 years ago. He has been taking a single medication as well as a vitamin for the last 2 months for a lung infection and says that he was told to take the medication for another 4 months. He drinks on average 5 beers per day and has smoked 2 packs per day for the last 10 years. Physical exam reveals coarse breath sounds over the right superior lung fields. A chest radiograph is obtained, and the result is shown in Figure A. What is the most likely outcome if the treatment regimen is continued as currently written? | Mycobacterium Tuberculosis |
M 4
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A
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| 46 | M1.OMB.4888 | 214925 | A pharmaceutical company is testing the efficacy of a novel lipid-lowering therapy called drug ABC101. Drug ABC101 was administered to a sample of 2,000 volunteers with moderate hyperlipidemia and the reduction in low-density lipoprotein (LDL) cholesterol was measured. The reduction in LDL cholesterol in this sample followed a normal distribution with a mean of 5.5 mg/dL and a standard deviation of 1.5 mg/dL. The pharmaceutical company is targeting a reduction in LDL cholesterol of at least 8.5 mg/dL and needs to provide an estimate of the efficacy of drug ABC101 for regulatory review. Approximately how many patients in this sample achieved the company’s target for LDL cholesterol reduction? | Statistical Distribution |
M 1
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| 47 | M1.ST.12.4887 | 214373 | A group of investigators is conducting a study to assess the age of diagnosis for disease X with 1,000 subjects who developed disease X. The mean age of development of disease X is 40 years. The standard deviation for age at the development of the disease is 10 years. How many subjects who contract disease X will contract it between ages 30 and 50? | Statistical Distribution |
M 1
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| 48 | M1.OMB.1 | 214633 | A researcher is studying how the blood levels of an industrial pollutant differ in children who grow up in urban versus rural environments. She decides that she will test only 6-year-old children during their annual exam in order to get as homogenous a study population as possible. She tests blood samples from 1000 children in urban environments and 1000 children in rural environments. She finds that the blood level of pollutant follows a normal distribution, and the following are the summary statistics from the study: Urban environment: Mean: 100 parts per million Interquartile range: 50 parts per million Standard deviation: 25 parts per million Rural environment: Mean: 50 parts per million Interquartile range: 28 parts per million Standard deviation: 41 parts per million Which of the following best represents the percentage of children from urban environments who have a higher blood pollutant level than the average child from a rural environment? | Statistical Distribution |
M 1
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| 49 | M1.OMB.4889 | 215031 | Researchers are conducting a study to evaluate the impact of sodium-glucose cotransporter-2 (SGLT-2) inhibitors as first-line agents in patients with newly diagnosed diabetes mellitus. Investigators prospectively collect a hemoglobin A1c (HbA1c) measurement in each study participant (if the initial diagnosis was made using HbA1c, then that value was used). Patients are then prescribed empagliflozin monotherapy. HbA1c measurements are obtained every 3 months, and additional glycemic agents are added at the treating physician’s discretion. Major endpoints are mortality, major cardiac events, and stroke at 1-year follow-up. The HbA1c measurements at study entry for the first 10 participants are shown in Figure A. The next 2 participants have HbA1c measurements of 10.4% and 12.6%. Which of the following measures of central tendency (with respect to these HbA1c measurements) is most likely to remain the same after the addition of these 2 participants? | Statistical Distribution |
M 1
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| 50 | M1.OMB.111 | 215065 | A 1-year-old Caucasian boy is brought to urgent care by his mother for fever and a worsening cough productive of green sputum for 3 days. He has also had bulky, foul-smelling stools that leave oily streaks on his diapers for the past month. He has had 5 prior episodes of bacterial pneumonia. The patient and his mother recently immigrated to the United States from Mexico. His mother did not receive any prenatal care. The patient’s temperature is 102.3°F (39.1°C), blood pressure is 98/62 mmHg, pulse is 140/min, and respirations are 30/min. Oxygen saturation is 90% on room air. Physical exam reveals a fussy toddler with reduced breath sounds and crackles over the left lower lung field. Which of the following best describes the normal function of the defective protein with respect to ion transport in this patient (Figure A)? | Cystic Fibrosis |
M 1
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| 51 | M1.OMB.20.1 | 214276 | A 71-year-old man is brought to the emergency department by his daughter after she found that he was having difficulty speaking when she returned home from work. On presentation, he is found to be dysarthric and also has some difficulty swallowing. His past medical history is significant for atrial fibrillation for which he is taking warfarin; however, his INR on presentation is found to be 1.3. Physical exam reveals deviation of the uvula to the left side and abnormal palate elevation on the right side. The cranial nerve most likely responsible for this patient's deficits travels through which of the following spaces? | Cranial Nerves |
M 2
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| 52 | M1.OMB.20.4767 | 213839 | During clinic, a 45-year-old man presents with new onset episodic hypertension. The patient states that he will start sweating and feel dizzy during episodes. He reports no significant past medical or surgical history, except for carotid endarterectomy 3 months prior. Following an extensive work-up, he is diagnosed with baroreceptor reflex failure. If this patient was healthy, which of the following baroreceptor reflex pathway sequences could be expected? | Baroreceptors and Chemoreceptors |
M 1
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A
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| 53 | M1.OMB.1 | 215174 | A 32-year-old man is brought to the emergency department for evaluation after he fainted at work. He says that he was reaching up for a box stored on a high shelf when he felt lightheaded and fell to the floor. He says that this only occurs at work when he is looking up or turning around, and he thinks that it is due to him feeling claustrophobic in a dress shirt and tie. He has no significant past medical history and his only medication is occasional calcium carbonate for gastrointestinal upset. On presentation, his temperature is 98.6°F (37°C), blood pressure is 117/71 mmHg, pulse is 85/min, and respirations are 11/min. He says that he has no residual symptoms and is able to respond appropriately to all questions. Which of the following mechanisms is most likely responsible for this patient's presentation? | Baroreceptors and Chemoreceptors |
M 1
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| 54 | M1.OMB.20.1 | 214193 | A group of hospitals is conducting a clinical trial to determine whether 2 new surgical techniques will improve outcomes for total hip arthroplasty patients. They organize a trial where patients are randomized to either the current standard technique or 1 of the 2 new techniques. They then ask patients to rate the outcomes as either excellent, good, fair, or poor. A researcher is given this data and asked to determine whether the surgical techniques had an effect on patient outcomes. Which of the following statistical measures would be most appropriate for analyzing this data? | Statistical Measures |
M 1
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| 55 | M1.OMB.4873 | 215014 | A 21-year-old man is brought into the emergency department after being involved in a physical fight. He cannot recall specific details but remembers being punched in the face and pushed to the ground. The patient is otherwise healthy and takes no medications. His temperature is 98.5°F (36.9°C), blood pressure is 128/84 mmHg, pulse is 78/min, and respirations are 12/min. Physical exam shows multiple facial abrasions, left periorbital edema and ecchymosis, and a 2-cm laceration on his forehead. Palpation of the nose does not reveal any step offs or crepitus. A CT of the head shows a small, non-displaced skull base fracture that extends through the cribiform plate. Which of the following symptoms is this patient most likely to experience as a result of this fracture? | Cranial Nerves |
M 4
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| 56 | M1.OMB.20.4767 | 214302 | A neurosurgeon is running a clinical trial on deep brain stimulation (DBS) of the nucleus accumbens for the treatment of binge-eating disorder. One of her hypotheses is that DBS is more effective at suppressing binge-eating in non-obese individuals compared to obese individuals. Following their operations, subjects are asked to track daily caloric intake for 6 months in a food diary. Which statistical test would be most appropriate for tackling this question? | Statistical Measures |
M 1
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| 57 | M1.OMB.20.1 | 214199 | A 28-year-old man is brought to the emergency department from his construction job after he was hit in the head by a falling brick. He has no past medical history and is otherwise healthy. On presentation, he is found to be confused and somnolent with a notable bump over the posterior parietal region of the skull. Trauma survey reveals no other injuries, and he does not appear to be actively bleeding at the time of presentation. A CT scan of the brain is obtained showing hyperdense material in the subarachnoid space and edematous brain tissue. Which of the following sets of blood pressure, heart rate, and respiratory rate may occur in response to the acute change in this patient's brain pathology? | Baroreceptors and Chemoreceptors |
M 1
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A
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| 58 | M1.OMB.4769 | 215036 | A 50-year-old man presents to the emergency department after a fainting episode. He was getting dressed for work this morning when he abruptly fainted. He regained consciousness within 10 seconds and was not confused afterwards. He denies any prodromal symptoms. His wife witnessed the entire event and did not observe any abnormal limb movements. The patient has a history of hypertension and takes chlorthalidone. There is no family history of sudden cardiac death. The patient’s temperature is 98.6°F (37.0°C), blood pressure is 116/74 mmHg while sitting and 112/72 mmHg while standing, pulse is 72/min, and respirations are 16/min. Physical exam reveals an anxious-appearing man with neck plethora dressed in business attire. There are no visible tongue lesions or heart murmurs. Cranial nerve, motor, sensory, and cerebellar exams are normal. What is the underlying pathophysiology of the most likely diagnosis? | Baroreceptors and Chemoreceptors |
M 2
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A
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| 59 | M1.OMB.4874 | 215091 | A 24-year-old man is brought in by ambulance after being hit by a car. The primary survey is unremarkable, and the patient has a Glasgow Coma Scale of 15. On the secondary survey, blood is noted behind both tympanic membranes. There is also blood draining from both nares. When asked to look downward, the patient is unable to move his right eye. However, both pupils constrict when a flashlight is shined into them. His temperature is 97°F (36.1°C), blood pressure is 145/85 mmHg, pulse is 100/min, and respirations are 15/min. The patient’s nose is packed, stopping the epistaxis. After 3 hours in the emergency department, the patient soon reports a salty taste in his throat. This new finding is most concerning for the development of which sequelae? | Cranial Nerves |
M 4
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A
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| 60 | M1.OMB.4768 | 215112 | A pharmaceutical company is investigating the efficacy of a new drug called ABC42 for lowering low density lipoprotein (LDL) cholesterol. The company recently completed a study that enrolled 9 cohorts of patients, each of which was administered a different dose of ABC42. The absolute reduction in LDL cholesterol was measured for each cohort and used to calculate the average absolute reduction in LDL cholesterol for each drug dose. The relationship between the average absolute reduction in LDL cholesterol and the drug dose administered to each cohort is shown in Figure A. Using this data, the company calculates a Pearson correlation coefficient of 0.996. What is the most accurate interpretation of this Pearson correlation coefficient? | Statistical Measures |
M 1
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A
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| 61 | M1.OMB.4768 | 214930 | A 36-year-old man presents to the trauma bay after a fall from the roof of his home 2 hours prior. Emergency medical responders at the scene found him agitated and vomiting. Upon arrival, his temperature is 98.8°F (37.1°C), blood pressure is 154/92 mmHg, pulse is 95/min, and respirations are 12/min. The physical exam is significant for a confused man with occipital bruising and abrasions on his posterior left arm and back. His Glasgow coma scale is 11 (eyes: 4, verbal: 3, and motor 4). Airway suctioning shows presence of food content and blood in his respiratory secretions. The decision was made to intubate for airway protection and to safely proceed for further assessment. Head CT shows mild cerebral edema with no evidence of intracranial hemorrhage. MRI confirms diffuse axonal injury. Once stabilized, the patient is admitted to the ICU for further monitoring. Later that day, his intraventricular pressure monitor documents pressures between 25-30 mmHg (normal: < 20mmHg) for the past 15 minutes. Which of the following is the most appropriate next step in management? | Baroreceptors and Chemoreceptors |
M 3
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A
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| 62 | M1.OMB.4802 | 214981 | A 48-year-old man presents to the primary care clinic for an annual check-up. He has no complaints other than urinating more often over the past 3 months. His past medical history includes type 2 diabetes, hypertension, hyperlipidemia, coronary artery disease, and congestive heart failure. His medications include metformin, atorvastatin, metoprolol, lisinopril, spironolactone, and aspirin. The patient’s temperature is 98.2°F (36.8°C), blood pressure is 128/78 mmHg, pulse is 68/min, and respirations are 16/min. Cardiac exam reveals a laterally displaced point of maximal impulse and an S3 heart sound. The rest of the exam is unremarkable. A recent echocardiogram showed a left ventricular ejection fraction (LVEF) of 40%. His laboratory results are as follows: Serum: Na+: 142 mEq/L Cl-: 102 mEq/L K+: 5.0 mEq/L HCO3-: 26 mEq/L BUN: 28 mg/dL Glucose: 162 mg/dL Creatinine: 1.5 mg/dL Hemoglobin A1c (HbA1c): 8.2% The patient is prescribed a glycemic agent that activates a nuclear receptor to stimulate adipogenesis. Which of the following side effects is most associated with this medication? | Diabetes Drugs |
M 1
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A
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| 63 | M1.OMB.1 | 214773 | A 61-year-old man presents to his primary care physician for follow-up after laboratory testing revealed that his hemoglobin A1c level was 7.6%. He had previously tried starting a diet and exercise program, but his blood glucose control has become steadily worse over time. After discussing his options, the patient agrees to start the first-line medication for this disease in addition to maintaining his diet and exercise program. Which of the following comorbidities would increase the risk of toxicity with this drug? | Diabetes Drugs |
M 3
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A
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| 64 | M1.OMB.4803 | 215200 | A 45-year-old woman presents to clinic for frequent urination. She has been waking up multiple times a night to urinate. She denies urgency, dysuria, or hematuria. She has a history of heart failure with reduced ejection fraction and diabetes. Her medications include lisinopril, metoprolol, spironolactone, and metformin. She is a non-smoker and does not drink alcohol. The patient’s temperature is 98.2°F (36.8°C), blood pressure is 134/82 mmHg, pulse is 82/min, and respirations are 16/min. There is no suprapubic pain or costovertebral angle tenderness. Urine dipstick shows 3+ glucose and serum studies demonstrate a glycated hemoglobin of 9.2%. The decision is made to start her on a medication that is known to carry an increased risk of urinary tract infections. What is the mechanism of action of the most likely medication she was started on? | Diabetes Drugs |
M 3
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A
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| 65 | M1.OMB.139 | 215012 | A 55-year-old man presents to the primary care clinic complaining of progressive fatigue with exertion. He used to walk 1.5 miles every morning, but over the past year, his activity tolerance has progressively worsened and now he cannot take more than 10 steps without sitting to catch his breath. He denies orthopnea. The patient has a history of heart failure and is on lisinopril, metoprolol, and spironolactone. He currently smokes 1 pack of cigarettes per day and has done so for 40 years. The patient’s temperature is 98.6°F (37.0°C), blood pressure is 118/78 mmHg, pulse is 92/min, respirations are 12/min, and oxygen saturation is 88% on room air. Physical exam reveals a thin-appearing man with reduced bilateral breath sounds and muffled heart sounds without peripheral edema. Figure A shows spirometry results. Figure B shows a diagram of lung volumes and capacities. Which of the following changes in lung volumes/capacities are most consistent with the patient’s underlying pathology? | Emphysema |
M 2
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A
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| 66 | M1.OMB.4875 | 215061 | A 65-year-old man presents to the clinic for 2 months of numbness in his feet. He has also had a depressed mood for the past 6 months. His current medical conditions include cirrhosis with a history of multiple prior hospitalizations for acute hepatitis. He takes no medications. He drinks a 6 pack of beers every night, which he has done for 45 years. He frequently skips meals to drink alcohol. The patient’s temperature is 96.0°F (35.6°C), blood pressure is 110/68 mmHg, pulse is 72/min, and respirations are 16/min. There is diminished sensation to light touch bilaterally over his toes and feet. The ankle jerk reflex is absent bilaterally. Laboratory studies reveal a deficiency of the coenzyme necessary for the reaction shown in Figure A. Which vitamin B provides the necessary coenzyme for this reaction? | Water Soluble Vitamins |
M 1
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A
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| 67 | M1.OMB.1 | 214598 | An 82-year-old man is brought to the emergency department by ambulance with a 2-hour history of increased difficulty breathing at home. His wife says that over the last day he started having more phlegm production and shortness of breath. He started gasping for air this morning at which point his family became concerned and called 911. Chart review reveals a previous myocardial infarction 4 years ago and social history reveals a 30 pack-year history of smoking as well as a 40-year history of working at a shipyard. Physical exam reveals decreased breath sounds with faint bilateral wheezing and non-distended neck veins at 45 degrees upper body elevation. Despite treatment, the patient passes away. Which of the following would most likely be seen in post-mortem examination of this patient's lungs? | Emphysema |
M 1
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A
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| 68 | M1.OMB.1 | 215130 | A 25-year-old man is transported to the emergency department after he caused a disturbance inside a car dealership. When asked about what happened, he says that he went to the dealership because he has a rare car that he wanted to sell and is secretly friends with the dealership owner. Past medical and social history is significant for multiple substance use disorder and homelessness. He is not currently taking any medications. On physical exam, he has horizontal nystagmus and is unable to complete finger-to-nose coordination or rapidly alternating movements. Administration of the most appropriate treatment for this patient's symptoms can be measured by increased activity of a protein located in which of the following cell areas? | Water Soluble Vitamins |
M 1
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A
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| 69 | M1.OMB.1 | 214982 | A 22-year-old man presents to his primary care physician with a 3-year history of increasing low back and knee pain. He says that he first noticed the pain in college but that it has worsened since he started a desk job after graduation. He denies fever, chills, or rashes but endorses dark urine, which he says has been present since birth. Physical exam reveals that the sclera of his eyes, and pinna of his ears have a bluish tinge. Which of the following mechanisms is most likely associated with the cause of this patient's symptoms? | Amino Acid Catabolism |
M 2
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A
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| 70 | M1.OMB.20.1 | 213854 | A 36-year-old African American woman presents to the emergency department with a 1-month history of increasing shortness of breath. She says that she started noticing that she became short of breath while walking up the stairs to work and that over the last month this has progressed to where she is no longer able to take the stairs at all. She has also developed a dry cough as well as diffuse joint pain. On physical exam, her liver is palpable 4 cm below the right costal margin, and she has a palpably enlarged spleen. A radiograph is obtained with the findings shown in Figure A. Which of the following would most likely also be seen in this patient? | Cardiomyopathies |
M 2
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| 71 | M1.OMB.1 | 214889 | A scientist is studying the effects of structural proteins on heart development and function. Specifically, she is studying the protein titin as it was identified in a genetic study of families with cardiac diseases. She uses CRISPR to generate the causative mutation in this protein and then introduces it into a rat model. At around 30 weeks after birth, she performs a cardiac ultrasound of the mutant rat line and compares the results with those obtained from wild type rats. Which of the following changes would most likely be observed in this experiment? | Cardiomyopathies |
M 2
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| 72 | M1.OMB.4868 | 214483 | An ophthalmologist is conducting a clinical study to examine the impact of utilizing optical coherence tomography (OCT) in screening for diabetic retinopathy in a population. Patients at a network of clinics are recruited to the study and randomized to either the intervention or control group. Patients in the intervention group undergo screening at regular intervals with OCT in addition to the gold standard of slit-lamp microscopy, while patients in the control group undergo screening with slit-lamp microscopy only. Clinical records of retinal examination findings are taken at each visit, and measurement of time elapsed between signs of mild diabetic retinopathy to the development of severe diabetic retinopathy is assessed. The researcher finds that time elapsed before progression to severe diabetic retinopathy is about 6 months longer in patients in the OCT screening group compared to patients in the control screening group. Which of the following types of bias is present in this study? | Bias |
M 1
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| 73 | M1.OMB.20.1 | 213887 | A 2-day-old boy is brought to the emergency department by his parents after he started vomiting numerous times within 1 hour. His parents say that he was born at home and appeared to be healthy at birth; however, he has become increasingly lethargic over the course of the past 24 hours. They became extremely concerned after he started vomiting copiously both with and without feeding. Physical exam reveals a distressed appearing infant who is hyperventilating, and laboratory tests demonstrate orotic acid in the urine. Which of the following metabolites is a substrate of the enzyme that is most likely defective in this patient? | Amino Acid Catabolism |
M 1
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A
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| 74 | M1.OMB.1 | 215073 | A 12-year-old boy is brought to the emergency department after collapsing on the field during a soccer game. He says that he felt his heart beating strangely before he lost consciousness but does not recall any injury or trauma prior to falling. His past medical history is significant for a neonatal cardiac defect that was surgically repaired during infancy. Otherwise, he has been healthy and does not currently take any medications. Physical exam reveals a pre-systolic gallop and a systolic murmur that decreases with hand grip. An echocardiogram is obtained in this patient at rest. Which of the parameters seen Figure A would most likely be found in this patient at rest? | Cardiomyopathies |
M 2
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A
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| 75 | M1.OMB.4803 | 214950 | A 17-year-old girl is brought to the primary care clinic by her parents for increasing fatigue over the past week. The patient says that she just feels tired because she has been working out more lately. She denies limiting her food intake, saying that she overeats if anything. She denies sensitivity to temperature changes and has regular menstrual cycles. She has no past medical history and does not take any medications. She is a competitive gymnast. Her temperature is 98.6°F (37.0°C), blood pressure is 108/74 mmHg, pulse is 48/min, respirations are 16/min, and her body mass index (BMI) is 17.0 kg/m2. Physical exam reveals a thin girl with a flat affect, several dental cavities, dorsal calluses on her knuckles, and soft, downy hair on her arms. What is the most likely diagnosis? | Other Eating Disorders |
M 2
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A
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| 76 | M1.OMB.1 | 214640 | A medical student is reviewing the chest radiograph of a newborn during her pediatrics rotation as seen in Figure A. The patient had a low-grade fever this morning prompting a workup for infection. The medical student suggests treating the patient for a right upper lobe pneumonia; however, the attending states the structure here is a normal finding. Which of the following is the most likely embryologic origin of the structure shown? | Germ Layer Derivatives |
M 1
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| 77 | M1.OMB.4698 | 214215 | A 14-year-old boy presents to his primary care physician for shortness of breath. He has never experienced this before. He noticed that his symptoms started when he joined a ski club and that they are worse with skiing. The patient is otherwise healthy and takes no medications. His temperature is 97.6°F (36.4°C), blood pressure is 110/74 mmHg, pulse is 88/min, respirations are 22/min, and oxygen saturation is 94% on room air. Pulmonary exam is notable for bilateral wheezes with good overall air movement. Which of the following is the most appropriate treatment for this patient? | Asthma |
M 3
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A
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| 78 | M1.OMB.20.4801 | 213892 | A 17-year-old boy is brought to the hospital after fainting while warming up for his high school wrestling match. He admits to restricting his food intake to 300 calories per day recently and drinking little water in order to lose weight. His current weight is 105 lbs (47.7 kg), height is 67 in (170.1 cm), and body mass index (BMI) is 16 kg/m^2. He is admitted for dehydration/malnutrition and given IV thiamine and IV fluids. He is provided with meals and observed to ensure he is eating them. Calorie counts, vital signs, and weight are monitored each day. By day 3, he is eating 2-3 meals per day and exceeding the calorie goals set for him. Which of the following is this patient at greatest risk for at this time? | Other Eating Disorders |
M 4
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| 79 | M1.OMB.20.4802 | 214288 | A 70-year-old Hispanic woman is brought by her daughter to the emergency department with complaints of diffuse abdominal pain for the past 3 months. The patient reports that she has a history of gallstones in the distant past and that this pain does not seem very different from that. On further questioning, the patient reports that her pants have felt looser recently. On exam, the patient has a temperature of 98.6°F (37.0°C), blood pressure is 110/76 mmHg, pulse is 80/min, and respirations are 12/min. Her sclerae are anicteric. She has diffuse abdominal pain but no tenderness to palpation. Her abdomen is generally soft with a palpable firm mass in the right upper quadrant. A radiograph is taken and shown in Figure A. The patient is then admitted for further management. Which of the following structures derives from the same embryonic germ layer as the affected tissue in this patient? | Germ Layer Derivatives |
M 2
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A
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| 80 | M1.OMB.4698 | 214697 | A 10-year-old boy is brought to his pediatrician due to complaints of pain in his hands and feet during swimming practice. While the patient’s parents have not had comparable symptoms in the past, the pediatrician learns that the patient’s maternal grandmother also had similar pain events in her youth. On physical examination, the pediatrician notices that the patient has an enlarged upper jaw and prominent frontal bossing. His blood smear is shown in Figure A. What is the pathophysiology for this patient’s condition? | Sickle Cell Anemia |
M 1
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| 81 | M1.OMB.4802 | 214797 | A 24-year-old G2P1 woman at 7 weeks' gestation presents for her prenatal checkup. The patient mentions that in addition to mild bouts of nausea and vomiting, she has recently started to have intense cravings for ice for the past month. Inquiring further, the physician learns that she consumes large amounts of ice and only drinks cold beverages. Physical examination is remarkable for the absence of papillae on the surface of the patient’s tongue. Which of the following is most likely responsible for the patient’s symptoms? | Other Eating Disorders |
M 2
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A
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| 82 | M1.OMB.1 | 214517 | A 34-year-old African American man is brought to the emergency department with a 1-hour history of increasing shortness of breath. He says that he was smoking outside during a break at work when he started having difficulty breathing. He has smoked 2 packs of cigarettes per day since he was 14 years old and has a childhood history of asthma. He works as a contractor and primarily replaces walls in old houses. His family history is significant for autoimmune diseases as well as lung cancer. Histology reveals the findings shown in Figure A. Which of the following is the most likely cause of this patient's symptoms? | Asthma |
M 2
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A
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| 83 | M1.OMB.1 | 213853 | A 78-year-old woman presents to the emergency department with sudden onset neurologic symptoms. She states that she suddenly felt "strange", thus prompting her presentation. She endorses an ongoing headache. The patient has a past medical history of hypertension, diabetes, and atherosclerosis. Her temperature is 97.6°F (36.4°C), blood pressure is 177/91 mmHg, pulse is 90/min, respirations are 15/min, and oxygen saturation is 98% on room air. Physical exam is notable for numbness on the patient's left lower face. The patient's headache improves with the administration of acetaminophen. She has decreased pain and temperature sensation on the right side of her body. She demonstrates an ataxic gait when walking to the bathroom. Her gag reflex is not present as well. Which of the following is the most likely diagnosis? | Ischemic Stroke |
M 2
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| 84 | M1.OMB.4755 | 214939 | A 43-year-old man presents to his primary care physician concerned about an episode of syncope that occurred 1 week prior while on his daily jog. The patient states that he was halfway through running his usual route when he started feeling a little dizzy and suddenly woke up on the ground. According to witnesses, he lost consciousness for about 10 seconds. Upon further questioning, he has noticed that lately he cannot run as far as he usually does without having to take a break. Family history is significant for multiple heart attacks in several relatives on his father’s side and diabetes on his mother’s side. The patient is otherwise healthy and does not take any medications other than his multivitamins. His current temperature is 98.5°F (36.9°C), blood pressure is 128/78 mmHg, pulse is 65/min, and respirations are 12/min. His physical exam is notable for a grade IV/VI crescendo-decrescendo systolic murmur that radiates to the carotids. The patient is then scheduled for an echocardiogram. What is the most likely etiology of his symptoms? | Valvular Disease |
M 2
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A
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| 85 | M1.OMB.20.1 | 214275 | A 42-year-old man presents to his primary care physician for an annual physical exam. His past medical history is significant for alcohol use disorder complicated by periods of homelessness. Otherwise, he has been well with no major complaints during this visit. On physical exam, a new cardiac murmur is heard between the S1 and S2 heart sounds. The murmur does not appear to vary much in intensity, and it is best heard along the left sternal border in the 4th intercostal space. Physical exam also reveals 1+ edema of the lower extremities bilaterally as well as increased jugular venous pressure. Which of the following is most likely associated with the cause of this patient's murmur? | Valvular Disease |
M 2
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A
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| 86 | M1.OMB.4819 | 215050 | A 65-year-old man presents to the emergency department with 3 hours of weakness. He was cleaning his living room when he experienced sudden onset left-sided arm and leg weakness and numbness. His wife says that he seemed confused and was not able to get words out. An ambulance was called, but all of the symptoms had resolved by the time the patient arrived at the emergency department. He has a past medical history of coronary artery disease and hypertension (on lisinopril and hydrochlorothiazide). He smokes 2 packs of cigarettes per day and drinks socially on the weekends. On exam, temperature is 99°F (37.2°C), blood pressure is 177/92 mmHg, pulse is 88/min and regular, and respirations are 12/min. Neurologic exam is within normal limits. Noncontrast computerized tomography (CT) scan shows no acute intracranial abnormality. What is the most appropriate next step in management? | Ischemic Stroke |
M 3
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A
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| 87 | M1.OMB.1 | 214362 | A 45-year-old man is brought to the emergency department by ambulance after he was found passed out on a park bench. On presentation, he is covered in vomit and urine, and he refuses to cooperate with staff. Chart review reveals that he is a frequent visitor to the emergency department and that he has been homeless for several years. During the first few minutes after presentation, he begins to shout that he can't see anything. He has no past medical history of visual problems. Electrolytes from a basic metabolic panel reveal the following: Serum: Na+: 142 mEq/L K+: 3.6 mEq/L Cl-: 100 mEq/L HCO3-: 11 mEq/L The treatment for this patient's condition prevents the formation of which of the following substances? | Poisons and Treatments |
M 2
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A
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| 88 | M1.OMB.142 | 214524 | A 53-year-old man presents to his primary care provider due to a chronic cough lasting for the last 3 years. The patient has not had any medical care for the last 5 years. He has a history of hypertension controlled by hydrochlorothiazide, hypercholesterolemia, and a tobacco smoking history of 35 years. The patient previously smoked 1 pack per day but cut down to half a pack per day 1 year ago. He reports that he coughs for nearly half of the year and constantly feels the need to clear his throat. His coughs are frequently productive of sputum. He denies any shortness of breath. On exam, his temperature is 98.8°F (37.1°C), blood pressure is 132/88 mmHg, pulse is 80/min, and respirations are 14/min. Oxygen saturation on pulse oximetry is 93% at rest. Lung exam demonstrates diffuse wheezing and crackles bilaterally. Pulmonary function testing is performed, which demonstrates normal total lung capacity (TLC) as well as normal diffusing capacity for carbon monoxide (DLCO). Which of the following histologic findings would be seen if a lung biopsy were to be performed? | Chronic Bronchitis |
M 2
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| 89 | M1.OMB.143 | 215003 | A 65-year-old man presents for evaluation of chronic cough. He reports worsening exertional dyspnea over the last 3 years and a persistent cough, which is productive of thick mucus and lasts for at least 4 months at a time. He has smoked 1 pack of cigarettes per day for the last 40 years. His temperature is 98.8°F (37.1°C), blood pressure is 140/85 mmHg, pulse is 78/min, and respirations are 18/min. Physical exam is notable for an increased anteroposterior chest diameter and bi-phasic wheezing. Which of the following histologic epithelial findings would you expect in this patient’s conducting airways? | Chronic Bronchitis |
M 1
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A
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| 90 | M1.OMB.4818 | 214460 | A 47-year-old woman presents to the clinic with complaints of nausea for the past month. She reports feelings of nausea often following meals. Due to this, she has had decreased appetite for the past 3 weeks and reports a 5-lb. weight loss. The symptoms began shortly after a cruise trip to the Bahamas where she enjoyed the beach and local food. Her past medical history includes diabetes mellitus for which she is on insulin and an episode of urinary tract infection for which she is currently being treated with trimethoprim and sulfamethoxazole. She is sexually active with her husband and does not use any birth control. She endorses some breast tenderness, episodic epigastric pain, and some numbness and tingling of her bilateral toes. What is the most likely explanation for this patient’s symptoms? | Diabetes Mellitus |
M 2
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A
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| 91 | M1.OMB.4800 | 214810 | A 50-year-old man presents to his primary care physician with complaints of chest pain, fever, and blood-tinged cough for the past month. While interviewing the patient, the physician learns that the man is a farmer in California who immigrated from India when he was a child. She also learns that the patient has had AIDS for the past 15 years. On computed tomography, multiple modules are detected in the superior lobe of the right lung. Figure A displays the results of the patient’s sputum sample. Which of the following is associated with the patient’s condition? | Opportunistic Mycoses |
M 2
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A
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| 92 | M1.OMB.1 | 214441 | A 72-year-old man presents to his primary care physician with a 3-month history of increasing cough and shortness of breath. He says that he first noticed these symptoms when he started a new morning walk routine, but they have worsened over time so that he is no longer able to perform activities of daily living without getting winded. Otherwise, he has felt constipated over the last 2 months and has been urinating more frequently than before. He thinks that this may be why he has lost about 18 pounds over the last 6 months despite no changes to his diet or exercise. He drinks 2 alcoholic beverages per day and smoked 1 pack per day for 30 years before quitting 4 years ago. He worked in a shipyard for 30 years before retiring 7 years ago. Physical exam reveals bony tenderness and costovertebral angle tenderness. Which of the following is the most likely cause of this patient's symptoms? | Lung Cancer |
M 2
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A
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| 93 | M1.OMB.4759 | 214653 | A 24-year-old woman presents to her gynecologist with painful urination. For 3 days, she has experienced pain with initiation and maintenance of micturition and has been going more frequently. She tried drinking cranberry juice with no relief in symptoms. She is currently sexually active with multiple partners and uses condoms sparingly. Her last menses occurred 5 weeks ago. Her temperature is 99.3°F (37.4°C), blood pressure is 115/70 mmHg, pulse is 64/min, and respirations are 14/min. On exam, she has suprapubic discomfort to light palpation with no costovertebral angle tenderness. Her introitus is non-inflamed with scant clear discharge. Which of the following is the most appropriate treatment for this patient? | Urinary Tract Infection |
M 3
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A
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| 94 | M1.OMB.1 | 214323 | A 25-year-old man presents to the emergency department after being found down in a park. The patient briefly awakens to voice or noxious stimuli but returns to sleep. His blood pressure is 110/75 mmHg, pulse is 90/min, and respirations are 8/min. On physical examination, his right and left pupils are miotic without the use of a penlight. He was subsequently appropriately treated. Shortly thereafter, the patient is awake and appropriately answering questions; however, he appears agitated. His blood pressure is 155/95 mmHg and pulse is 105/min. Which of the following would most likely be found in this patient? | Opiates |
M 2
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A
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| 95 | M1.OMB.20.1 | 214278 | A 41-year-old woman presents to the emergency department with a 1-day history of double vision. She says that she noticed the double vision as soon as she woke up and that when it did not go away for 1 hour she decided to come to the emergency department for evaluation. She has also been getting increasingly severe headaches over the last 3 months; however, she thought that these were simply due to the stress of her job. She also reports intermittent ringing in her ears that occurs once every few weeks. Imaging reveals a mass in the brain, and biopsy shows the findings seen in Figure A. The tumor seen in this patient most likely arose from which of the following cells? | Primary Brain Tumors |
M 2
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A
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| 96 | M1.OMB.4873 | 214330 | A 47-year-old woman with a history of left breast HER2+ ductal carcinoma presents to the emergency department with 2 weeks of worsening shortness of breath. She becomes short of breath while climbing stairs and exercising. She denies fever, weight loss, cough, and chest pain. She had bilateral mastectomies performed 6 months prior and is currently receiving adjuvant targeted biological therapy. She has no other past medical history and has no allergies. She has 2 children at home that currently attend daycare. She does not drink alcohol and has smoked 1 pack per day for 20 years. Her temperature is 99.0°F (37.2°C), blood pressure is 145/80 mmHg, pulse is 85/min, respirations are 20/min, and O2 saturation is 98% on room air. On exam, she has no conjunctival pallor and her mucous membranes are moist. Her heart rate and rhythm are regular with a third heart sound following S2. Crackles are heard in the bilateral lower lobes. The mastectomy scars are healed with no erythema. Her abdomen is soft and nontender and the remainder of the exam is unremarkable. Chest radiograph is shown in Figure A. Which of the following is the most likely cause of this patient's presentation? | Drug Reactions and Side Effects |
M 2
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A
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| 97 | M1.OMB.20.1 | 213768 | A 42-year-old woman presents to her primary care physician for an annual check-up. Her main concern during this visit is that she has been feeling increasingly anxious, and this anxiety is giving her palpitations. She believes that the anxiety may be due to the fact that her son is not doing well in school. Otherwise, she says that she is proud of losing 5 pounds but denies increased exercise or dietary changes. Family history is significant for diabetes mellitus and myocardial infarction on both sides of her family. On physical exam she is found to be diaphoretic with edema of the anterior tibia. Which of the following human leukocyte antigen variants would most likely be seen in this patient? | Graves Disease |
M 2
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A
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| 98 | M1.OMB.20.1 | 213779 | A forensic scientist receives a substance for evaluation that was found on an unconscious patient. She discovers that the substance binds to and activates opioid receptors in the central and peripheral nervous system. She discovers that this activation occupies all available receptors at maximal response. Kinetically, she discovers that the substance has an onset of action of about 30 minutes and that it decays with a half life of about 24 hours. Which of the following substances was most likely found on this patient? | Opiates |
M 3
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A
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| 99 | M1.OMB.20.4758 | 214220 | A 23-year-old woman presents to her primary care physician with complaints of painful urination. She describes the pain as burning and is unable to void completely secondary to the pain. She denies fevers, abdominal or back pain, and bleeding. She did note a clear, odorless discharge for 2 days prior to her last menstrual period 1 week ago. She is currently sexually active with multiple partners and uses protection occasionally. She has a history of social anxiety disorder, and her current medications include sertraline and oral contraceptives. Her temperature is 99.0°F (37.2°C), blood pressure is 100/65 mmHg, pulse is 60/min, and respirations are 17/min. On exam, her abdomen is soft and nontender, and there is no costovertebral angle tenderness. There are no introital lesions, and the cervix is pink with minimal clear discharge. There is no adnexal or cervical motion tenderness. The rest of the exam is unremarkable. Urinalysis results are shown below: Urine: Protein: Negative Glucose: Negative White blood cell (WBC) count: 30/hpf Bacteria: Many Leukocyte esterase: Positive Nitrites: Positive A drug with which of the following mechanisms of action would be the most appropriate treatment? | Urinary Tract Infection |
M 3
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A
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| 100 | M1.OMB.20.1 | 213883 | A medicinal chemist performs research on the molecular structure of various opiate compounds in order to discover novel clinically useful members of this drug class. He creates a compound that appears to decrease the plasma conductance of calcium in cells. When administering this drug to rodents, he finds that the drug does not appear to affect the pain tolerance or level of sedation of these animals. He then combines this compound with morphine and administers the mixture to animals and finds that the animals are equally sedated with or without this new compound. Finally, he administers a radiolabeled compound and finds that the compound appears to be concentrated selectively in the medulla of the brainstem. Which of the following medication is most analogous to the activity of this new compound? | Opiates |
M 1
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A
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| 101 | M1.OMB.20.4874 | 213726 | A 7-year-old girl is brought to the clinic by her parents due to complaints of several weeks of headaches, vomiting, and general malaise. The patient describes her headaches as “all over her head” and most severe after she wakes up in the morning, with gradual relief accompanied by vomiting throughout the day. Her parents note that her headaches and fatigue have impaired her concentration in school. On physical examination, the patient has an inability to abduct the left eye upon leftward gaze as well as slight unsteadiness in her gait. Head CT imaging is obtained and reveals a mass with cystic and solid components in the cerebellum, highly suggestive of a primary brain tumor. Surgical biopsy is performed to classify the tumor, and histological findings are shown in Figure A. Which of the following is the most likely cause of the patient’s symptoms? | Primary Brain Tumors |
M 2
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A
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| 102 | M1.OMB.4800 | 214551 | A 29-year-old woman with a history of asthma presents to the emergency department with a 5-week history of progressively worsening dry cough and shortness of breath on exertion. Her albuterol inhaler is no longer providing relief of her respiratory symptoms. She has also noticed painful bumps appearing on her shins over the last 4 months. Additional medical history includes irritable bowel syndrome. She is an electrical engineer, drinks socially, and has smoked 2 packs per day since she was 19 years old. On exam, she has a regular heart rate and rhythm and her lungs are clear to auscultation bilaterally. She has erythematous nodules on her bilateral anterior legs. Chest radiograph reveals bilateral hilar lymphadenopathy and microscopic analysis reveals the findings in Figure A. Which of the following mediators is responsible for the findings in Figure A? | Sarcoidosis |
M 1
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A
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| 103 | M1.OMB.1 | 214610 | A 1-day-old infant boy is brought to the emergency department by his parents after their midwife advised them to seek care immediately after birth. The parents have no past medical history and did not seek pre-natal care. On presentation, he is found to have small eyes, a cleft palate, a small head, and extra digits on both fingers. Imaging reveals cystic kidneys and no longitudinal separation between cerebral hemispheres. An abnormality in which of the following chromosomes is most likely responsible for this patient's disorder? | Chromosomal Diseases |
M 2
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A
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| 104 | M1.OMB.4874 | 214926 | A 45-year-old woman presents to the primary care clinic with 1 week of debilitating facial pain. The pain is episodic, stabbing in quality, and shoots across her right cheek. This morning, her pain was so severe while she was eating her breakfast that she had to stop. She denies prior facial trauma or headache. The patient has a history of diabetes for which she takes metformin. Her temperature is 98.8°F (37.1°C), blood pressure is 134/86 mmHg, pulse is 92/min, and respirations are 16/min. On physical exam, there is no palpable clicking of the jaw or crepitus during mouth opening and closing. There is no facial rash. Which of the following side effects is most associated with the first-line treatment for her condition? | Drug Reactions and Side Effects |
M 3
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A
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| 105 | M1.OMB.1 | 215173 | A 38-year-old man presents to his primary care physician for an annual physical exam. He reports no changes to his health over the last year and generally feels well. His past medical history is significant for childhood asthma, but he does not currently require any medications. He takes a multivitamin daily and drinks 1-2 beers per night. He has never smoked and is not sexually active. His lab results were significant for elevated serum glucose over the last few years, so a hemoglobin A1c test is obtained showing 7.9% modification. He is prescribed metformin and presents to the emergency department several hours after his first dose with bilateral deep venous thromboses. Which of the following best describes this patient's drug reaction? | Drug Reactions and Side Effects |
M 4
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A
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| 106 | M1.OMB.4755 | 214612 | An 84-year-old man with a history of diabetes, hypertension, and hypercholesterolemia is brought to the emergency department after falling at his grandson's outdoor soccer game. He recalls waking up shortly after falling and was alert and oriented according to his wife. She says that he fell suddenly without warning, and she did not observe seizures, tongue biting, or incontinence. In the past, he occasionally gets dizzy upon standing up and has had 2 episodes of syncope. He is currently taking lisinopril and atorvastatin. His temperature is 99.1°F (37.3°C), blood pressure is 105/60 mmHg, pulse is 58/min, and respirations are 14/min. An EKG is performed with the results shown in Figure A. A CT head without contrast shows no ischemia. Which of the following is the most likely cause of syncope in this patient? | Atrioventricular (AV) Heart Block |
M 2
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A
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| 107 | M1.OMB.4771 | 214936 | A 23-year-old man presents to the emergency department after being involved in a motorbike accident 2 hours prior to presentation. He reports that he was not able to brake in time and collided with a parked car. He now complains of left eye pain along with a laceration to his left forehead. On exam, his temperature is 98.8°F (37.1°C), blood pressure is 124/72 mmHg, pulse is 66/min, and respirations are 12/min. The patient is comfortable and there is no active bleeding from the forehead laceration, which is down to muscle. The patient demonstrates periorbital bruising on the left side and the left eye appears slightly sunken compared to the right. The patient demonstrates no changes in visual acuity using a Snellen chart. However, ocular motility examination is abnormal. Which of the following is likely seen on exam? | Eye Movement |
M 2
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A
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| 108 | M1.OMB.1 | 214735 | A 1-day-old boy is evaluated in the newborn nursery for difficulty feeding. He was born at term to a G1P1 mother who had limited prenatal care. He had APGAR scores of 8 at 1 minute and 9 at 5 minutes. Shortly after birth, he started vomiting after feeding and has had 2 episodes of forceful vomiting since then. A nasogastric tube is placed, and barium visualization of the gastrointestinal tract is shown in Figure A. Which of the following is the most likely mechanism that caused this patient's findings? | GI Embryology |
M 2
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A
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| 109 | M1.OMB.4770 | 214721 | A 31-year-old man is brought to the emergency department following a motor vehicle accident. He was a restrained driver in a car driving at 60 mph that was T-boned. He reports hitting his face on the steering wheel but denies loss of consciousness. He is currently complaining of left lower abdominal pain, bilateral eye pain, and double vision that is worse with upward gaze. The patient is hemodynamically stable upon arrival, and a bedside focused assessment with sonography for trauma (FAST) does not reveal any pericardial or intraabdominal fluid. He denies any vision changes but endorses pain with eye movement. A physical examination after cleaning his face reveals significant ecchymosis of the left orbit, a limited upward gaze of the left eye, and findings shown in Figure A. What is the most likely explanation for this patient’s symptoms? | Eye Movement |
M 2
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A
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| 110 | M1.OMB.4772 | 215060 | A 34-year-old woman presents to the emergency department with double vision and dizziness. She awoke with these symptoms, which are worse during lateral gaze. She denies any headache or eye pain. She had an episode of transient left arm weakness 1 month ago that has completely resolved. Her past medical history includes depression and vitamin D deficiency. She takes fluoxetine and a multivitamin. On presentation, the patient’s temperature is 98.8°F (37.1°C), blood pressure is 116/74 mmHg, pulse is 72/min, and respirations are 16/min. When asked to look to either side, the patient has normal abduction of the ipsilateral eye but the contralateral eye fails to adduct. There is also horizontal nystagmus of the abducting eye. A retinal exam is unremarkable and there is no ptosis. What is the most likely cause of her visual symptoms? | Eye Movement |
M 2
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A
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| 111 | M1.OMB.20.1 | 213882 | A 63-year-old man is brought to the emergency department after he had an episode of syncope at work. He says that he has been having episodes of lightheadedness over the last few weeks but had not collapsed before today. His past medical history is significant for diabetes. On presentation, his temperature is 98.6°F (37°C), blood pressure is 108/72 mmHg, pulse is 42/min, respirations are 18/min, and oxygen saturation is 98% on room air. An electrocardiogram is obtained, and the results are shown in Figure A. Which of the following represents a possible cause and treatment of this patient's symptoms? | Atrioventricular (AV) Heart Block |
M 2
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A
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| 112 | M1.OMB.20.4868 | 213891 | A 3-year-old boy is brought to the emergency department after having 4 days of a runny nose, low-grade fever, and general malaise. This morning, he started to experience shortness of breath with coughing and purulent sputum. The mother states that she is particularly concerned since the patient has already had 3 episodes of bacterial pneumonia during his lifetime, along with 2 episodes of viral gastroenteritis requiring hospitalization and intravenous fluids. On exam, the patient’s temperature is 101.0°F (38.3°C), blood pressure is 88/58 mmHg, pulse is 100/min, and respirations are 18/min. The patient is actively coughing, with crackles heard in the right lower chest. There are no palpable lymph nodes, but the exam is also notable for an absence of tonsils. After the patient is stabilized, blood testing and flow cytometry demonstrate the following: IgA: Undetectable IgE: Low IgG: Low IgM: Low CD3 positive cells: Normal CD19 positive cells: Low Which of the following characterizes this child’s condition? | Bruton Agammaglobulinemia |
M 2
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A
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| 113 | M1.OMB.1 | 215165 | A 54-year-old man presents to his primary care physician with a 10-month history of intermittent chest pain. He states that the pain occurs when he is walking in the mall and improves with rest. He reports that the pain feels like someone is pushing on his chest, but it does not radiate anywhere. His past medical history is significant for hypertension but he is not currently taking any medications, though he occasionally uses sildenafil for erectile dysfunction. Based on these findings, his physician prescribes several medications but states that one of them must only be used if he stops taking sildenafil. Which of the following is an important drug interaction for the medication described in this case? | Antianginal Therapy |
M 3
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A
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| 114 | M1.OMB.1 | 214747 | A 22-year-old woman presents to the emergency department with a 2-week history of back pain. She says that she began experiencing spasms of pain in her lower back during a vacation where she tried out many new types of foods. Since then, the pain occurs episodically and feels squeezing in nature. On presentation, she is found to have costovertebral angle tenderness. A urinalysis and urine microscopy are performed with the results shown in Figure A. Which of the following is the most likely pathophysiological process causing this patient's symptoms? | Nephrolithiasis |
M 2
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A
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| 115 | M1.OMB.4726 | 214893 | A 65-year-old woman presents to the office with a 1-week history of back pain. She states that the pain began after helping her daughter move into her apartment a week ago and is worsened with any kind of activity. The pain does not improve with rest. Her medical history is significant for diverticulosis. Her surgical history is notable for a hysterectomy she had 25 years ago for severe uterine prolapse after her fifth child. On physical exam, she complains of tenderness to palpation at the seventh thoracic vertebrae. She has 2+ knee and ankle jerk reflexes, and the remainder of her physical exam is normal. Which of the following is the most likely diagnosis? | Osteoporosis |
M 2
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A
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| 116 | M1.OMB.20.4754 | 214200 | A 60-year-old man presents to his primary care provider with throbbing headaches and facial flushing. The patient also has longstanding exercise intolerance. He quickly becomes fatigued and short of breath just walking across his driveway. On examination, bilateral pitting of the lower extremities is observed. After reviewing the patient’s medications, his physician recognizes that there was a recent dosage error. What is the mechanism of the incorrectly dosed medication? | Antianginal Therapy |
M 3
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A
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| 117 | M1.OMB.20.1 | 214273 | A 51-year-old woman presents to her primary care physician with a 1-month history of muscle weakness. She started noticing that she was dropping things more frequently over the last 3 months, but she became concerned when she started feeling weaker over the last month. Her past medical history is significant for a gastric bypass surgery complicated by necrosis of a segment of bowel. She says that since the surgery she has been having fatty, foul-smelling stools. Physical exam reveals ataxia, decreased deep tendon reflexes, diffuse myalgias, and conjunctival pallor. No rashes are noted, and she denies pain anywhere else. Histology shows a normocytic anemia with no abnormalities in other cell lines. The substance that is most likely deficient in this patient has which of the following functions? | Fat Soluble Vitamins |
M 2
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A
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| 118 | M1.OMB.4885 | 213793 | A 42-year-old African-American man presents to the physician with cough, shortness of breath, and fatigue for the past year, though he says that his symptoms have worsened in the past few months. He has smoked a half-pack of cigarettes a day since he was a teenager. His family history is significant for coronary artery disease in his father and hypertension in his mother. He has worked for the past 10 years in a stone countertop fabrication factory. Pulmonary function testing reveals decreased residual volume and a normal FEV1/FVC ratio. A chest radiograph is obtained and is shown in Figure A. Which of the following is the most likely cause of this patient’s pulmonary disease? | Pneumoconioses |
M 2
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A
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| 119 | M1.OMB.20.4886 | 214299 | A 65-year-old man presents to a pulmonologist with new-onset dyspnea. During the interview, the patient states he is recently retired but had been a plumber for the past 45 years. On physical examination, bibasilar fine crackles are auscultated at the end of expiration. His chest radiograph reveals the presence of bilateral pleural plaques with pleural thickening. Lab are unremarkable. Which of the following figures is characteristic of the patient’s condition? Pulmonary function tests (PFT): Vital capacity: Low Total lung capacity: Low Diffusion capacity for carbon monoxide: Low | Pneumoconioses |
M 2
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A
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| 120 | M1.OMB.4725 | 214480 | A 68-year-old woman presents to her physician complaining of sharp, stabbing pain in her lower back after attempting to lift a television set off the ground. Her pain is exacerbated by walking and bending forwards or backwards. On physical examination, the woman experiences tenderness upon palpation of her lower spine. A radiograph is obtained and is shown in Figure A. Which of the following are the laboratory findings from the table in Figure B that would be seen in this patient’s underlying condition? | Osteoporosis |
M 2
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A
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| 121 | M1.OMB.20.4870 | 213798 | A 35-year-old woman presents to her primary care provider reporting intermittent pain in her left side that is worse with urination. She states that she has also been urinating more frequently and is waking up at night to urinate. She was previously healthy, although she has had two episodes of urinary tract infections that resolved with antibiotics. Her temperature is 98.4°F (36.9°C), blood pressure is 110/78 mmHg, pulse is 65/min, and respirations are 12/min. The patient does not have any tenderness on exam, and genitourinary exam is grossly normal. A urinalysis is performed, demonstrating a urine pH of 8.0, negative leukocyte esterase, and negative bacteria. Large quantities of crystals are seen, as shown in Figure A. Which of the following is the likely composition of these crystals? | Nephrolithiasis |
M 2
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A
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| 122 | M1.OMB.1 | 214972 | A 26-year-old woman is evaluated for hepatitis serologies as part of a comprehensive medical evaluation in preparation for becoming a paramedic. She has no significant past medical history, drinks socially, and is sexually active with a long-term partner. Her serological results are as follows: Hepatitis B surface antigen: Negative Anti-hepatitis B surface antibody: Positive Anti-hepatitis B core antibody: IgG Positive Which of the following is the most likely status of this patient? | Hepatitis B Virus |
M 2
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A
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| 123 | M1.OMB.20.4801 | 214223 | A 25-year-old man presents to his primary care provider for HIV testing. He just learned that his sexual partner from 12 days ago recently tested positive for HIV. The patient has no significant past medical history, and previous STD testing has always been negative. He reports no symptoms, and physical examination is unremarkable. The patient is tested for HIV. Within 2 weeks, the patient becomes febrile and develops symptoms of pharyngitis, lymphadenopathy, and myalgias. Labs return back negative on the heterophile test. From the initial visit, what results were most likely seen on the patient’s HIV testing? | HIV |
M 2
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| 124 | M1.OMB.1 | 214908 | A 5-year-old girl presents to her pediatrician with a 1-day history of a pruritic rash on her left thigh. Her parents says they first noticed the rash when she woke up the day before but it has gotten worse since that time. She recently started kindergarten and plays outside in the backyard in her free time. Her past medical history is significant for seasonal allergies, and her family history is significant for systemic lupus erythematosus. On physical exam, the rash shown in Figure A is seen, with a negative Nikolsky sign. Which of the following diseases shares the same underlying pathophysiological process as this patient's rash? | Hypersensitivity |
M 1
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A
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| 125 | M1.OMB.6002 | 214990 | A 38-year-old man is brought to the emergency room due to severe substernal pressure for the past 45 minutes. He states that the chest pain is accompanied by palpitations, although he is not having any shortness of breath. He has no history of hypertension or diabetes. He has a history of intravenous drug use and started a methadone program last month. He presented to the emergency room 6 weeks ago with agitation and pressured speech but left without being evaluated. His mother died of a myocardial infarction at age 58, and his father died of pancreatic cancer at age 72. The patient is agitated and sweating profusely during the examination, frequently yelling at staff and to himself. His temperature is 99.5°F (37.5°C), blood pressure is 165/90 mmHg, pulse is 115/min, and respirations are 20/min. The remainder of his exam is notable for dilated, reactive pupils. EKG reveals sinus tachycardia with ST elevations in leads II, III, and aVF. What is the most likely explanation for the patient’s symptoms? | Sympathomimetics |
M 2
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A
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| 126 | M1.OMB.4873 | 215019 | A 21-year-old college student is brought to the emergency department by ambulance after he crashed his car into a tree. He explains that he was trying to escape from federal agents who were attempting to frame him for murder. The patient was at a house party when the police showed up due to a noise complaint. Empty bottles of fluoxetine and clonazepam were found on the passenger seat along with multiple empty bags of potato chips. Despite having several facial lacerations, the patient states, “I feel great!” He denies hallucinations or suicidal ideation. His past medical history includes depression and anxiety. The patient’s temperature is 98.2°F (36.8°C), blood pressure is 132/88 mmHg, pulse is 80/min, and respirations are 16/min. Physical exam reveals a pleasant, non-agitated young man. A neurologic exam shows normal muscle tone without involuntary muscle movements. The patient’s oral mucosa appears dry, and his eyes are shown in Figure A. What is the most likely diagnosis? | Signs and Symptoms of Drug Abuse (by Drug) |
M 2
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A
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| 127 | M1.OMB.1 | 214582 | A 31-year-old G1P0 woman presents to the emergency department at 28 weeks of gestation with a 2-day history of abdominal pain and fever. She says that she started feeling pain under her right rib cage but thought it might be related to the pregnancy; however, she became concerned when she noticed that her eyes were starting to turn yellow. Her past medical history is significant for intravenous drug abuse, and she refuses to say whether or not she recently used drugs. Her last episode of prenatal care was an anatomy ultrasound at 14 weeks of gestation that revealed normal fetal anatomy. Molecular testing reveals the presence of a circular deoxyribonucleic acid-containing virus. Which of the following is the most likely outcome of this patient's infection? | Hepatitis B Virus |
M 4
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A
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| 128 | M1.OMB.4722 | 215000 | A 45-year-old woman presents to the primary care clinic for 1 month of nausea and malaise. She also has had a 5-pound weight loss over the past 2 months. Her past medical history includes hypertension, for which she is on chlorthalidone. She also completed a recent course of antibiotics for chlamydia. She returned from a trip to Vietnam 1 month ago. Her body mass index (BMI) is 26.4 kg/m^2. The patient’s temperature is 99.2°F (37.3°C), blood pressure is 118/68 mmHg, pulse is 88/min, and respirations are 16/min. Physical exam reveals yellow-tinged sclera and discomfort upon palpation of the right upper quadrant of her abdomen. A pregnancy test is negative. Which of the following findings (See Figure A) are most likely on this patient’s liver function tests (alanine aminotransferase [ALT], aspartate aminotransferase [AST], alkaline phosphatase [AlkPhos], and total bilirubin [Tbili])? | Hepatitis B Virus |
M 2
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A
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| 129 | M1.OMB.1 | 215164 | A 6-day old infant boy is brought to a pediatrician for his first-week visit. He was born at 36 weeks' gestation to a 33-year-old G1P1 mother. His APGAR scores were 8 at 1 minute and 9 at 5 minutes, and initial evaluation was significant only for some dermal melanosis. His family history is significant for an uncle with immunodeficiency and a cousin who needed extensive facial reconstruction surgeries. A physical exam reveals a continuous polyphasic murmur but his parents say that no murmur was heard at birth. The most likely cause of this finding is derived from which of the following branchial arches? | Branchial Apparatus |
M 1
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A
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| 130 | M1.OMB.1 | 214970 | A researcher is studying the activity of a key protein that is discovered in a novel bacteria. She begins by performing immunofluorescence experiments and finds that the protein localizes near the prokaryotic nucleoid. She then performs co-immunoprecipitation experiments and finds that the protein is able to bind to both deoxyribonucleic acid (DNA) as well as ribonucleic acid (RNA). Finally, she synthesizes a segment of DNA where one strand is exclusively DNA and the other has a mixture of DNA and RNA fragments. After adding the protein and all appropriate cofactors, she finds that the RNA is slowly removed and replaced from the 5' direction to the 3' direction. Which of the following processes is most likely the core function of this protein? | DNA Repair |
M 1
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A
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| 131 | M1.OMB.4771 | 215159 | A 75-year-old man presents to his cardiologist for intermittent chest pain that is occurring at rest over the past week. In the past, the patient only had chest pain after physical activity. His past medical history includes hypertension and hyperlipidemia. His temperature is 97.0°F (36.1°C), blood pressure is 150/110 mmHg, pulse is 88/min, and respirations are 15/min. To evaluate the extent of coronary disease, stress myocardial perfusion imaging is performed. Assuming this patient now has >70% coronary occlusion, ischemia of which of the following regions is most occuring likely during systole? | Atherosclerosis |
M 2
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| 132 | M1.OMB.4871 | 214929 | A 6-month-old boy is brought to clinic for shortness of breath. For the past 2 days, his parents have noticed increasing irritability and work of breathing. They report an uncomplicated pregnancy and delivery, but since the patient’s birth, he has had multiple episodes of thrush and was hospitalized 2 months prior with a viral pneumonia. His temperature is 101.2°F (38.4°C), blood pressure is 90/52 mmHg, pulse is 140/min, and respirations are 50/min. Physical exam is notable for low-set ears, a hypoplastic jaw, bilateral crackles, and a grade III/VI systolic murmur heard best at the left sternal border. The abnormal development of which of the following is associated with this patient’s condition? | Branchial Apparatus |
M 2
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| 133 | M1.OMB.1 | 215151 | A 15-year-old boy presents to the emergency department with a 2-month history of malaise, weight loss, melena, and constipation and is found to have colon cancer after extensive workup. He has no significant past medical history but family history is significant for multiple relatives with early-onset colon cancer. The tumor is removed and biochemical analysis reveals dramatically increased levels of deaminated cytosines in the DNA content of the cells. Multiple other rare base-pair oxidations and modifications are found that are not present in normal DNA. Which of the following is most likely defective in this patient? | DNA Repair |
M 1
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A
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| 134 | M1.OMB.4819 | 215154 | A 42-year-old woman with a history of orthotopic liver transplant presents to her surgeon with 2 days of fever to 101.0°F (38.3°C) at home and feelings of nausea and fatigue. The patient underwent liver transplantation from a deceased donor 2 months prior, as a result of fulminant liver failure secondary to acetaminophen overdose. She had been recovering well since surgery until these symptoms began. On exam, her temperature is 100.6°F (38.1°C), blood pressure is 108/76 mmHg, pulse is 84/min, and respirations are 14/min. The patient has mild scleral icterus. There is mild abdominal tenderness to palpation, which has been present since surgery. The following labs are drawn: Hemoglobin: 13.0 g/dL Leukocyte count: 13,000/mm^3 Aspartate aminotransferase (AST, GOT): 50 U/L (normal: 5-40 U/L) Alanine aminotransferase (ALT, GPT): 150 U/L (normal: 5-40 U/L) Alkaline phosphatase (ALP): 280 U/L (normal: 35-130 U/L) A liver biopsy is performed, showing dense lymphocytic infiltrates. Which of the following is the most likely predominant mechanism for this patient’s rejection? | Transplant |
M 1
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| 135 | M1.OMB.1 | 214706 | A 48-year-old man presents to the emergency department with 2 weeks of progressive dyspnea and pain on inspiration in his left chest. He was treated for pneumonia by his primary care physician 1 week prior. The patient states he took the full course of antibiotics. He has diabetes that is well-controlled with diet. His surgical history is significant for a kidney transplant 3 years prior. He takes tacrolimus daily. He has no known allergies. He smokes half a pack of cigarettes per day. His temperature is 102.4°F (39.1°C), blood pressure is 116/78 mmHg, pulse is 108/min, and respirations are 22/min. On physical exam, the patient is alert and oriented. Cardiac examination demonstrates normal S1 and S2 with no murmurs, rubs, or gallops. Pulmonary examination demonstrates dullness to percussion in the lower left lung field. There is no evidence of edema in the bilateral lower extremities. A chest CT scan demonstrates a large, loculated pleural fluid collection on the left side. Laboratory results are as follows: Serum: Leukocyte count: 18,000/mm^3 Total serum protein: 7 g/dL Serum LDH: 100 U/L Pleural Fluid Analysis: pH: 7.0 Glucose: 38 mg/dL Leukocyte count: 80,000/mm^3 Protein: 5 g/dL LDH: 70 U/L Gram stain: Positive Which factor is the etiology of the patient's condition? | Innate Immune Response |
M 1
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| 136 | M1.OMB.4770 | 215015 | A 74-year-old man presents to the clinic with 1 month of intermittent chest discomfort. He describes a pressure-like sensation across his chest that only occurs during his morning walks. His symptoms resolve within 5 minutes after he sits down. He denies any symptoms at rest. He has a history of hypertension, hyperlipidemia, diabetes, and peripheral arterial disease. He takes lisinopril, hydrochlorothiazide, rosuvastatin, and metformin. He is a former smoker with a 50 pack-year smoking history. His temperature is 98.2°F (36.8°C), blood pressure is 154/88 mmHg, pulse is 78/min and regular, and respirations are 16/min. Physical exam reveals a well-appearing man with 1+ radial and pedal pulses. Cardiac exam is unremarkable. A resting electrocardiogram (ECG) is shown in Figure A. Which of the following changes is most likely to occur in this patient’s heart during systole? | Atherosclerosis |
M 4
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| 137 | M1.OMB.1 | 214351 | A scientist is studying serum protein profiles of patients with a new disease. Specifically, she is examining which proteins change in concentration between patients with the disease and patients without the disease. During her studies, she finds that the levels of ferritin, C-reactive protein, and hepcidin are elevated in affected patients compared with unaffected patients. The factor that was most likely responsible for these changes also has which of the following effects? | Innate Immune Response |
M 1
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A
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| 138 | M1.OMB.4800 | 214328 | A 61-year-old man with hypertension, human immunodeficiency virus infection (CD4+ count: 120 cells/µL), and alcohol abuse disorder presents to the emergency department after a fall at home. He denies head trauma and loss of consciousness. For the past 6 months, he has had multiple falls due to "losing my balance." He has consumed 3 beers per day for 25 years and denies any smoking or illicit drug history. He has been sexually active with multiple women since his early 20s and rarely uses condoms. His temperature is 99.0°F (37.2°C), blood pressure is 170/90 mmHg, pulse is 60/min, and respirations are 15/min. On physical exam, his pupils accommodate but do not constrict to direct or indirect light. His lungs are clear to auscultation bilaterally, and an early diastolic decrescendo murmur is best appreciated with the patient leaning forward. On neurologic exam, he is alert and oriented to person, place and time. He has 5/5 strength in all 4 extremities with a lack of vibratory sensation in his bilateral lower extremities. He has a wide-based gait and a positive Romberg sign. The patient is sent for MRI of the brain and spine. Which of the following is the most likely location of pathology? | Treponema pallidum / Syphilis |
M 2
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| 139 | M1.OMB.20.4662 | 213860 | A 38-year-old Caucasian man calls you for advice after a home genetic test reveals that he is a carrier of the F508del mutation in the CFTR gene on chromosome 7. He and his wife are trying to have a baby, but he is now worried that their future child could be at risk for cystic fibrosis. He tells you that his wife is healthy and has Ashkenazi Jewish ancestry. Given that 1 in 2300 Ashkenazi Jews are affected with cystic fibrosis, what is the chance that their child will have CF? | Population Genetics |
M 1
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A
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| 140 | M1.OMB.4728 | 214332 | A 65-year-old man presents to the clinic with complaints of back pain. His past medical history is significant for diabetes, hypertension, benign prostatic hyperplasia, and anxiety. He was recently hospitalized for streptococcal bacteremia from pneumonia but has recovered from that illness. The patient reports progressively worsening back pain that began 5 weeks ago shortly after he lifted some heavy groceries. The pain is concentrated at the lower back and is described as crampy and dull in quality. It waxes and wanes but is especially worse at night. He denies any urinary incontinence, fevers, sensory changes, or weakness. A physical examination is significant for tenderness at the lumbar spine. A straight leg test is negative, and the patient has no sensory or motor deficits. Laboratory studies are shown below. A radiograph of the lumbar spine is obtained and shown in Figure A. Hemoglobin: 11.2 g/dL Hematocrit: 32% Leukocyte count: 7,600/mm^3 with normal differential Platelet count: 136,000/mm^3 Serum: Na+: 137 mEq/L Cl-: 98 mEq/L K+: 3.8 mEq/L HCO3-: 24 mEq/L Ca2+: 12.8 mg/dL BUN: 24 mg/dL Glucose: 101 mg/dL Creatinine: 1.0 mg/dL Alkaline phosphatase: 124 U/L Aspartate aminotransferase (AST, GOT): 17 U/L Alanine aminotransferase (ALT, GPT): 12 U/L What is the most likely explanation for this patient’s symptoms? | Malignant Bone Tumors |
M 2
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A
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| 141 | M1.OMB.4801 | 214481 | A 32-year-old man presents to his primary care provider with concerns of a diffuse rash. This patient mentions that he had a painless sore on the head of his penis 6 weeks ago that has since healed. He states that he is sexually active with both men and women, and rarely uses condoms. On physical examination, the patient has no sores on his genitals or elsewhere on his body. His rash is maculopapular and covers his palms and soles. Which of the following should the physician use to confirm the diagnosis for this patient? | Treponema pallidum / Syphilis |
M 2
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A
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| 142 | M1.OMB.4802 | 214999 | A 60-year-old man presents with difficulty walking for the last year. He has experienced progressive difficulty gauging where to place his feet when he walks, and notes that the apartment tenant below his unit has complained regarding excessively loud footsteps. The patient has not been to the doctor since he was a young man. He is not currently taking any medications. His temperature is 98.5°F (36.9°C), blood pressure is 136/85 mmHg, pulse is 75/min, and respirations are 19/min. Physical exam is notable for pupils that constrict to accommodation but not to light, decreased light touch sensation and proprioception in the bilateral lower extremities, and a broad-based gait. Which of the following skin lesions might you also expect to find in this patient? | Treponema pallidum / Syphilis |
M 2
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A
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| 143 | M1.ST.12.3 | 214375 | A group of investigators has designed a phase II clinical trial to test the efficacy of medicine Y, a new weight loss medication. One hundred volunteers are randomized to the experimental group and receive drug Y for 3 months, and 100 volunteers are randomized to the control group and receive a placebo for the same duration. Paired t-tests were performed to assess the weight change in each of the 2 groups after 3 months. The mean weight change, t statistic, and p-value for both groups are shown in Figure A. If the significance level is set at 0.05, what is the correct interpretation of this data? | Statistical Hypotheses and Error |
M 1
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A
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| 144 | M1.OMB.20.1 | 214180 | A 52-year-old woman presents to the emergency department with a 1-day history of a rash on her left buttock. She says that she felt some pins and needles in the location of the rash over the last 3 days but became worried after she started noticing swelling and red dots in the area. Since then, the rash has become progressively worse. Her past medical history is significant for a recent right hip replacement that was complicated by the development of a right deep venous thrombosis in the femoral vein. She was discharged from the hospital 7 days ago on a number of medications, but she does not remember their names. Physical exam reveals the lesion shown in Figure A. Which of the following describes the mechanism of action of the drug that is responsible for this patient's symptoms? | Anticoagulants |
M 3
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A
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| 145 | M1.OMB.4709 | 214374 | A 3-year-old girl is brought by her parents to the pediatrician. The family recently immigrated from the Dominican Republic, and the child has never received pediatric care in the past. The parents report that the child often complains of discomfort in her legs after walking for a short distance and seems to have shortness of breath with exertion. They note that the child fed poorly as an infant and has had persistently swollen hands and feet since birth. The child is at the 5th percentile for both height and weight. On physical exam, the child is noted to have nonpitting edema of the hands and feet bilaterally as well as cold lower extremities with faint femoral pulses. She also has excess folds of skin along the sides of her neck, low-set ears, and a lower posterior hairline. Which of the following mechanisms is most likely responsible for the patient's leg discomfort with walking? | Coarctation of the Aorta |
M 2
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A
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| 146 | M1.OMB.4889 | 214335 | A 64-year-old woman presents to her primary care physician with severe joint pain in her bilateral hands and wrists. She was initiated on therapy 6 months ago by her previous doctor for which she has been compliant. While the patient initially had improvement in her symptoms, she now has worsening joint pain that is most severe in the morning. Her pain improves throughout the day and with movement. On physical exam, lungs are clear to auscultation and heart sounds are regular. Her hands and wrists are shown in Figure A. Laboratory results are the following: Leukocyte count: 12,000/mm^3 with normal differential Creatinine: 0.8 mg/dL Alkaline phosphatase: 45 U/L Aspartate aminotransferase (AST): 110 U/L Alanine aminotransferase (ALT): 120 U/L Sedimentation rate: 62 mm/hr C-reactive protein: 3.2 mg/L Which of the following is most likely to reduce the progression of this patient's condition? | Rheumatoid Arthritis |
M 3
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A
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| 147 | M1.OMB.4875 | 214556 | A 42-year-old man presents to the his primary care physician for blood pressure management. He was first diagnosed with hypertension 3 years ago and is currently on triple therapy. His medications include amlodipine, hydrochlorothiazide, and losartan. At this visit, his blood pressure is 172/90 mmHg. Subsequent workup for secondary causes of hypertension includes an abdominal MRA as shown in Figure A. Which of the following is most likely to occur in this patient's left kidney? | Renal Artery Stenosis |
M 2
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A
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| 148 | M1.OMB.4873 | 213875 | A 38-year-old primigravid woman at 32 weeks gestation with a history of type 2 diabetes goes into labor and develops umbilical cord prolapse, requiring an emergency cesarean section. Within minutes of delivery, the baby becomes tachypneic and cyanotic with excessive work of breathing. A portable chest radiograph is performed as seen in Figure A. The oxygen saturation is 70% on room air, so the baby is placed on 100% O2. 20 minutes later an arterial blood sample is drawn. Which of the arterial blood gases (ABGs) in Figure B is most consistent with this presentation? | Neonatal Respiratory Distress Syndrome |
M 2
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A
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| 149 | M1.OMB.96 | 214702 | A 36-year-old man presents to the emergency department with complaints of right upper quadrant (RUQ) and epigastric pain. He endorses a 6/10, sharp, intermittent pain that is associated with some nausea over the past 3 hours. The pain began after he ate lunch, and he reports similar episodes in the past that resolved on their own. He took some over the counter pain medication without any relief. He denies any fever, chills, headache, chest pain, shortness of breath, or urinary symptoms. The patient is currently on methotrexate and folic acid for the treatment of Crohn disease. He reports drinking 6-8 beers a night and admits to “drinking a little more than usual” the night before. He denies any smoking or drug use. A physical examination reveals tenderness at the RUQ and epigastric areas with a positive Murphy sign. Laboratory studies are shown below: Serum: Na+: 136 mEq/L Cl-: 96 mEq/L K+: 4.1 mEq/L HCO3-: 23 mEq/L Urea nitrogen: 10 mg/dL Glucose: 115 mg/dL Creatinine: 1.1 mg/dL Alkaline phosphatase (ALP): 145 U/L Aspartate aminotransferase (AST, GOT): 65 U/L Alanine aminotransferase (ALT, GPT):43 U/L Bilirubin, total: 2.5 mg/dL Bilirubin, direct: 2.1 mg/dL Lipase: 149 U/L Urine: Epithelial cells: 1/hpf Glucose: Negative WBC: 0/hpf RBC: 0/hpf Bacterial: None What is the most likely explanation for this patient’s symptoms? | Crohn Disease |
M 2
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A
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| 150 | M1.OMB.4890 | 214455 | A 42-year-old woman presents to the emergency department with complaints of fever and cough. She reports symptom onset about 2 days ago, and the cough has been progressively getting worse. The patient endorses rust-colored sputum, dyspnea, and overall malaise. Her past medical history is significant for rheumatoid arthritis for which she is taking infliximab and methotrexate, 2 episodes of bacterial pneumonia within the past 6 months, and multiple episodes of cellulitis. Her family history is significant for rheumatoid arthritis in her mother. A physical examination demonstrates decreased breath sounds at the left lower lobe and a palpable left upper quadrant (LUQ) abdominal mass. There is also notable ulnar deviation of the 3rd and 4th digits of the hand bilaterally. Laboratory studies are shown below. Hemoglobin: 13.6g/dL Hematocrit: 38% Leukocyte count and differential: Leukocyte count: 3,102/mm^3 Segmented neutrophils: 41% Bands: 5% Eosinophils: 3% Basophils: 0.7% Lymphocytes: 42% Monocytes: 8% Platelet count: 230,000/mm^3 What is the most likely explanation for this patient’s symptoms? | Rheumatoid Arthritis |
M 2
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A
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