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Repository: Gen-Verse/LatentMAS
Branch: main
Commit: b9b2095f4109
Files: 16
Total size: 21.3 MB

Directory structure:
gitextract_kqtlwho5/

├── LICENSE
├── README.md
├── __init__.py
├── data/
│ └── medqa.json
├── data.py
├── example_logs/
│ ├── qwen3_14b_humanevalplus_hierarchical.txt
│ └── qwen3_14b_mbppplus_sequential.txt
├── methods/
│ ├── __init__.py
│ ├── baseline.py
│ ├── latent_mas.py
│ └── text_mas.py
├── models.py
├── prompts.py
├── requirements.txt
├── run.py
└── utils.py

================================================
FILE CONTENTS
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FILE: LICENSE
================================================
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================================================
FILE: README.md
================================================
<a name="readme-top"></a>

<h3 align="center">
Latent Collaboration in Multi-Agent Systems
</h3>

---

## 💡 Introduction

**LatentMAS** is a multi-agent reasoning framework that **moves agent collaboration from token space into the model’s latent space**.
Instead of producing long textual reasoning traces, agents communicate by **passing latent thoughts** through their own **working memory**. LatentMAS has the following key features:

- **Efficient** multi-step reasoning with drastically fewer tokens
- **Training-free** latent-space alignment for stable generation
- **A general technique** compatible with **any HF model** and optionally **vLLM** backends.

Overall, LatentMAS achieves **superior performance**, **lower token usage**, and **major wall-clock speedups** of the multi-agent system.

## 🔔 News

- **[2026-02-26]** 🦞 Check out [**OpenClaw-RL**](https://github.com/Gen-Verse/OpenClaw-RL) from our Gen-Verse group! OpenClaw-RL is a fully asynchronous RL framework that trains personalized AI agents directly from natural conversation feedback — no manual labels, no API keys. It introduces two learning paradigms (Binary RL via GRPO and On-Policy Distillation) and runs the entire stack on your own infrastructure. A great complement to LatentMAS's efficient multi-agent reasoning!
- **[2025-12-20]** Check [**Science-LatentMAS**](https://github.com/Gen-Verse/LatentMAS/tree/Science-LatentMAS), an excellent extension of LatentMAS developed by Prof. Markus J. Buehler and the [LAMM Lab](https://github.com/lamm-mit) at MIT. Science-LatentMAS is specifically designed for the scientific discovery downstream applications! For more details and instructions, please check our README section "Science-LatentMAS" below and the new `Science-LatentMAS` branch.
- **[2025-12-15]** Check out these amazing community-driven extensions of LatentMAS!
- **[KNN-LatentMAS](https://github.com/Bookmaster9/kNN-latentMAS)** — Enables more efficient KV utilization for latent memory.
- **[Hybrid-LatentMAS](https://github.com/nhminle/LatentMAS-Hybrid)** — Extends LatentMAS to support hybrid, heterogeneous multi-agent systems.

- **[2025-11-25]** We have released our paper and code implementations for LatentMAS! Stay tuned for more model-backbone supports and advanced features!
- **[2025-11-25]** We are featured as 🤗 [**HuggingFace 1st Paper of the Day**](https://huggingface.co/papers/2511.20639)!

## 🌐 Awesome Works Built on Top of LatentMAS

Explore community-driven extensions that expand LatentMAS into new domains, architectures, and collaboration patterns:

### 🔬 1. **Science-LatentMAS**
**By Prof. Markus J. Buehler & MIT LAMM Group**
- **New Branch:** https://github.com/Gen-Verse/LatentMAS/tree/Science-LatentMAS
- **Original Code:** https://github.com/lamm-mit/LatentMAS/tree/flexible_agents
**New Features:** Extends LatentMAS for scientific modeling and material-system collaboration, enabling flexible agent types and specialized latent communication for science domains.

### 🧠 2. **KNN-LatentMAS**
**By Bookmaster9**
- **Blog (Overview):** https://bookmaster9.github.io/kNN-latentMAS/
- **Code:** https://github.com/Bookmaster9/kNN-latentMAS
- **New Features:** Introduce kNN-based latent retrieval to improve KV-cache usage, boosting memory efficiency and multi-step reasoning stability across agents.

### 🤖 3. **Hybrid-LatentMAS**
**By nhminle**
- **Code:** https://github.com/nhminle/LatentMAS-Hybrid
- **New Features:** Support heterogeneous/hybrid agent collaboration (LLM + non-LLM agents), enabling modular multi-agent pipelines that mix models, tools, and reasoning strategies.

### 🌍 4. **Awareness Network**
**By Everest-AN**
- **Website:** https://awareness.market/
- **Code:** https://github.com/everest-an/Awareness-Market
- **New Features:** A decentralized AI awareness market product built on LatentMAS research, enabling autonomous agent collaboration and memory sharing.

### 🧩 5. LatentMAS-SLoRA
**By Arifuzzaman Joy**
- **Demo:** https://www.youtube.com/watch?v=g7sxYjwgRRk
- **Code:** https://github.com/Arifuzzamanjoy/latent_mas_slora
- **New Features:** Augment LatentMAS with role-specialized, dynamically switchable LoRA adapters for better specialization and adaptability.

### 🛰️ 6. AVP (Agent Vector Protocol)
**By VectorArc**
- **Blog:** https://blog.avprotocol.ai/avp-binary-protocol-latent-agent-communication/
- **Code:** https://github.com/VectorArc/avp-python
- **New Features:** Enables agents to share KV-cache and hidden states instead of text, supporting zero-training latent handoff, cross-model transfer, and faster multi-agent collaboration.

**If your work extends LatentMAS, feel free to open a PR and we’ll feature it here! 🚀**

## 📊 Experiments Overview

### ⭐ Main Results
Three main tables from our paper spanning 9 tasks across math & science reasoning, commensonse reasoning, and code generation:

- **Table 1 — LatentMAS under the Sequantial MAS setting**
<img src="assets/main_table1.png" width="1000">

- **Table 2 — LatentMAS under the Hierarchical MAS setting**
<img src="assets/main_table2.png" width="1000">

- **Table 3 — Main Results on Reasoning Intensive Tasks**
<img src="assets/main_table3.png" width="1000">

### ⚡ Superior Efficiency on **Time and Tokens**

Overall, LatentMAS reduces:
- **~50–80% tokens**
- **~3×–7× wall-clock time**
compared to standard Text-MAS or chain-of-thought baselines.

## 🛠️ Getting Started

This repository provides all code for reproducing LatentMAS, TextMAS, and baseline single-agent experiments across GSM8K, AIME24/25, GPQA, ARC-Easy/Challenge, MBPP+, HumanEval+, and MedQA.

### ⚙️ Setup Environment Variables

We recommend setting your HF cache directory to avoid repeated downloads:

```bash
export HF_HOME=/path/to/huggingface
export TRANSFORMERS_CACHE=$HF_HOME
export HF_DATASETS_CACHE=$HF_HOME
````

Models and datasets will automatically be downloaded into `$HF_HOME`.

### 📦 Install Packages

```bash
conda create -n latentmas python=3.10 -y
conda activate latentmas

pip install -r requirements.txt
```

If you want **vLLM support**, also install:

```bash
pip install vllm
```

## 🚀 Quick Start

### 1. Clone the repo

```bash
git clone https://github.com/Gen-Verse/LatentMAS.git
cd LatentMAS
```

### 2. Repository Structure

```
LatentMAS/
│── run.py # Main entry for experiments
│── models.py # Wrapper for HF + vLLM + latent realignment
│── methods/
│ ├── baseline.py # Single-agent baseline
│ ├── text_mas.py # Token-space multi-agent method
│ └── latent_mas.py # Latent-space multi-agent (our method)
│── prompts.py # Prompt constructors
│── data.py # Dataset loaders
│── data/ # Provided data + figures (We give medqa.json as an example here)
│── utils.py # Answer parsing / timeout / helpers
│── example_logs/ # Example logs from LatentMAS
│── requirements.txt
```

## 🧪 Running Experiments (standard HF backend)

### 🔹 **Baseline (single model)**

```bash
python run.py --method baseline --model_name Qwen/Qwen3-14B --task gsm8k --max_samples -1 --max_new_tokens 2048
```

### 🔹 **TextMAS (text based multi-agent system)**

```bash
python run.py --method text_mas --model_name Qwen/Qwen3-14B --task gsm8k --prompt sequential --max_samples -1 --max_new_tokens 2048
```

### 🔹 **LatentMAS (our latent mas method)**

```bash
python run.py --method latent_mas --model_name Qwen/Qwen3-14B --task gsm8k --prompt sequential --max_samples -1 --max_new_tokens 2048
```

#### Notes:

* **`--latent_steps`** ∈ [0, 80]
Tune for best performance.
* **`--latent_space_realign`**
Enables latent→embedding alignment
We treat this as a **hyperparameter** — enable/disable depending on task/model:

```bash
python run.py --method latent_mas --model_name Qwen/Qwen3-14B --task gsm8k --prompt sequential --max_samples -1 --latent_space_realign --max_new_tokens 2048
```

## 📘 Example Logs

Two example LatentMAS logs are provided for reference purposes:

* `example_logs/qwen3_14b_mbppplus_sequential.txt`
* `example_logs/qwen3_14b_humanevalplus_hierarchical.txt`

Please refer to additional experiment logs [here](https://drive.google.com/drive/folders/1evGv5YAmLb4YM_D9Yu0ABa1nfqHC5N-l?usp=drive_link).
You can open them to view the full agent interaction traces and outputs.

## ⚡ vLLM Integration

LatentMAS supports vLLM for faster inference.

### 🔹 Baseline with vLLM

```bash
python run.py --method baseline --model_name Qwen/Qwen3-14B --task gsm8k --max_samples -1 --use_vllm --max_new_tokens 2048
```

### 🔹 TextMAS with vLLM

```bash
python run.py --method text_mas --model_name Qwen/Qwen3-14B --task gsm8k --prompt sequential --max_samples -1 --use_vllm --max_new_tokens 2048
```

### 🔹 LatentMAS with vLLM

LatentMAS supports a **hybrid HF + vLLM pipeline** for fast inference:
- vLLM handles **final text generation** (with prefix caching, tensor parallelism, etc.)
- A HuggingFace model handles **latent-space rollout** and hidden-state alignment

For this setup, we recommend using two GPUs:
- One GPU for vLLM (`--device`, e.g., `cuda:0`)
- One GPU for the auxiliary HF model (`--device2`, e.g., `cuda:1`)

```bash
CUDA_VISIBLE_DEVICES=0,1 python run.py --method latent_mas --model_name Qwen/Qwen3-14B --task gsm8k --prompt sequential --max_samples -1 --max_new_tokens 2048 \
--use_vllm \
--use_second_HF_model \
--enable_prefix_caching \
--device2 cuda:1
```

**📍Important Note:**

> vLLM does **not** officially support modifying KV-cache or prompting via latent embeddings.
> We modify the partial inner package inside vLLM backend for our method implementation.
> Note minor numeric differences may arise compared to offical HF backend due to different decoding (generation) strategies. Please Use the HF backend to reproduce the official published results.

## 📚 Citation

💫 If you find **LatentMAS** helpful, please kindly give us a star ⭐️ and cite below. Thanks!

```
@article{zou2025latentmas,
title={Latent Collaboration in Multi-Agent Systems},
author={Zou, Jiaru and Yang, Xiyuan and Qiu, Ruizhong and Li, Gaotang and Tieu, Katherine and Lu, Pan and Shen, Ke and Tong, Hanghang and Choi, Yejin and He, Jingrui and Zou, James and Wang, Mengdi and Yang, Ling},
journal={arXiv preprint arXiv:2511.20639},
year={2025}
}
```

## 🤝 Ackowledgement

This code is partially based on the amazing work of [vLLM](https://github.com/vllm-project/vllm).

================================================
FILE: __init__.py
================================================
__all__ = []

================================================
FILE: data/medqa.json
================================================
[
{
"idx": 0,
"question": "A 34-year-old man comes to the physician because of a 3-week history of colicky abdominal pain and diarrhea. He has bowel movements 10–12 times daily; the stool contains blood and mucus. He constantly has the urge to defecate. His vital signs are within normal limits. Examination of the abdomen shows diffuse tenderness to palpation. Serum concentration of C-reactive protein is 20 mg/L (N<10). Colonoscopy shows a bleeding, ulcerated rectal mucosa with several pseudopolyps. Which of the following is this patient at greatest risk of developing?\nA. Hemolytic uremic syndrome\nB. Oral ulcers\nC. Colorectal cancer\nD. Pancreatic cancer\n\nA. Hemolytic uremic syndrome\nB. Oral ulcers\nC. Colorectal cancer\nD. Pancreatic cancer",
"options": [
"A. Hemolytic uremic syndrome",
"B. Oral ulcers",
"C. Colorectal cancer",
"D. Pancreatic cancer"
],
"answer": "Colorectal cancer",
"gen_text_store": "",
"pid": "0",
"query": "A 34-year-old man comes to the physician because of a 3-week history of colicky abdominal pain and diarrhea. He has bowel movements 10–12 times daily; the stool contains blood and mucus. He constantly has the urge to defecate. His vital signs are within normal limits. Examination of the abdomen shows diffuse tenderness to palpation. Serum concentration of C-reactive protein is 20 mg/L (N<10). Colonoscopy shows a bleeding, ulcerated rectal mucosa with several pseudopolyps. Which of the following is this patient at greatest risk of developing?\nA. Hemolytic uremic syndrome\nB. Oral ulcers\nC. Colorectal cancer\nD. Pancreatic cancer\nChoose the correct option.",
"image": null
},
{
"idx": 1,
"question": "A 38-year-old woman presents to her primary care physician for her yearly exam. Her only complaint is difficulty losing weight. Her BMI is 34 kg/m^2. In addition to a standard physical exam, the physician orders a glucose tolerance test. The woman's fasting blood glucose level is 120 mg/dL and two-hour post 75g glucose load blood glucose level is 190 mg/dL. The physician informs the patient that she is \"pre-diabetic\" or at risk of developing diabetes and recommends lifestyle modification with follow-up in 6 months. Which of the following endogenous signaling molecules or receptors will increase insulin sensitivity in this patient?\nA. Catecholamines\nB. Glucagon\nC. Glucocorticoids\nD. Peroxisome proliferator-activated receptor gamma\n\nA. Catecholamines\nB. Glucagon\nC. Glucocorticoids\nD. Peroxisome proliferator-activated receptor gamma",
"options": [
"A. Catecholamines",
"B. Glucagon",
"C. Glucocorticoids",
"D. Peroxisome proliferator-activated receptor gamma"
],
"answer": "Peroxisome proliferator-activated receptor gamma",
"gen_text_store": "",
"pid": "1",
"query": "A 38-year-old woman presents to her primary care physician for her yearly exam. Her only complaint is difficulty losing weight. Her BMI is 34 kg/m^2. In addition to a standard physical exam, the physician orders a glucose tolerance test. The woman's fasting blood glucose level is 120 mg/dL and two-hour post 75g glucose load blood glucose level is 190 mg/dL. The physician informs the patient that she is \"pre-diabetic\" or at risk of developing diabetes and recommends lifestyle modification with follow-up in 6 months. Which of the following endogenous signaling molecules or receptors will increase insulin sensitivity in this patient?\nA. Catecholamines\nB. Glucagon\nC. Glucocorticoids\nD. Peroxisome proliferator-activated receptor gamma\nChoose the correct option.",
"image": null
},
{
"idx": 2,
"question": "A 33-year-old man presents to the emergency department after a motor vehicle collision. He was the front seat unrestrained driver in a head-on collision. The patient has a Glasgow Coma Scale of 5 and is subsequently intubated. Physical exam is notable for subcutaneous emphysema in the clavicular area. Needle decompression and chest tube placement are performed, and the patient is stabilized after receiving 2 units of blood and 2 liters of fluid. Chest radiography demonstrates proper tube location and resolution of the pneumothorax. The patient is transferred to the trauma intensive care unit. On the unit, a repeat chest radiograph is notable for a recurrent pneumothorax with the chest tube in place. Which of the following is the most likely diagnosis?\nA. Inappropriate chest tube placement\nB. Spontaneous pneumothorax\nC. Tension pneumothorax\nD. Tracheobronchial rupture\n\nA. Inappropriate chest tube placement\nB. Spontaneous pneumothorax\nC. Tension pneumothorax\nD. Tracheobronchial rupture",
"options": [
"A. Inappropriate chest tube placement",
"B. Spontaneous pneumothorax",
"C. Tension pneumothorax",
"D. Tracheobronchial rupture"
],
"answer": "Tracheobronchial rupture",
"gen_text_store": "",
"pid": "2",
"query": "A 33-year-old man presents to the emergency department after a motor vehicle collision. He was the front seat unrestrained driver in a head-on collision. The patient has a Glasgow Coma Scale of 5 and is subsequently intubated. Physical exam is notable for subcutaneous emphysema in the clavicular area. Needle decompression and chest tube placement are performed, and the patient is stabilized after receiving 2 units of blood and 2 liters of fluid. Chest radiography demonstrates proper tube location and resolution of the pneumothorax. The patient is transferred to the trauma intensive care unit. On the unit, a repeat chest radiograph is notable for a recurrent pneumothorax with the chest tube in place. Which of the following is the most likely diagnosis?\nA. Inappropriate chest tube placement\nB. Spontaneous pneumothorax\nC. Tension pneumothorax\nD. Tracheobronchial rupture\nChoose the correct option.",
"image": null
},
{
"idx": 3,
"question": "A 45-year-old mechanic presents to the emergency department complaining of acute-onset shortness of breath while repairing a plowing tractor for his neighbor. The patient denies having any history of asthma or respiratory symptoms, and does not smoke. His temperature is 99.8°F (37.7°C), pulse is 65/min, blood pressure is 126/86 mmHg, and respirations are 20/min. His oxygen saturation is 97%. On exam, he is pale and diaphoretic. His pupils are contracted. Diffuse wheezes are noted in all lung fields. What is the best treatment for his condition?\nA. Succinylcholine\nB. Inhaled ipratropium and oxygen\nC. Atropine and pralidoxime\nD. Inhaled albuterol and oxygen\n\nA. Succinylcholine\nB. Inhaled ipratropium and oxygen\nC. Atropine and pralidoxime\nD. Inhaled albuterol and oxygen",
"options": [
"A. Succinylcholine",
"B. Inhaled ipratropium and oxygen",
"C. Atropine and pralidoxime",
"D. Inhaled albuterol and oxygen"
],
"answer": "Atropine and pralidoxime",
"gen_text_store": "",
"pid": "3",
"query": "A 45-year-old mechanic presents to the emergency department complaining of acute-onset shortness of breath while repairing a plowing tractor for his neighbor. The patient denies having any history of asthma or respiratory symptoms, and does not smoke. His temperature is 99.8°F (37.7°C), pulse is 65/min, blood pressure is 126/86 mmHg, and respirations are 20/min. His oxygen saturation is 97%. On exam, he is pale and diaphoretic. His pupils are contracted. Diffuse wheezes are noted in all lung fields. What is the best treatment for his condition?\nA. Succinylcholine\nB. Inhaled ipratropium and oxygen\nC. Atropine and pralidoxime\nD. Inhaled albuterol and oxygen\nChoose the correct option.",
"image": null
},
{
"idx": 4,
"question": "A 64-year-old man comes to the physician with a 1-week history of sore mouth. He says that swallowing is not painful. He has had asthma for more than 20 years. His only medication is a high-dose combination salmeterol/fluticasone inhaler. His temperature is 37.1°C (98.8°F), pulse is 74/min, respirations are 14/min, and blood pressure is 125/65 mm Hg. A photograph of his oral mucosa is shown. Indirect mirror examination of the posterior oropharynx, larynx, and hypopharynx shows no abnormalities. Which of the following is the most appropriate next step in management?\nA. Fluconazole\nB. Isotretinoin\nC. Nystatin\nD. Penicillin V\n\nA. Fluconazole\nB. Isotretinoin\nC. Nystatin\nD. Penicillin V",
"options": [
"A. Fluconazole",
"B. Isotretinoin",
"C. Nystatin",
"D. Penicillin V"
],
"answer": "Nystatin",
"gen_text_store": "",
"pid": "4",
"query": "A 64-year-old man comes to the physician with a 1-week history of sore mouth. He says that swallowing is not painful. He has had asthma for more than 20 years. His only medication is a high-dose combination salmeterol/fluticasone inhaler. His temperature is 37.1°C (98.8°F), pulse is 74/min, respirations are 14/min, and blood pressure is 125/65 mm Hg. A photograph of his oral mucosa is shown. Indirect mirror examination of the posterior oropharynx, larynx, and hypopharynx shows no abnormalities. Which of the following is the most appropriate next step in management?\nA. Fluconazole\nB. Isotretinoin\nC. Nystatin\nD. Penicillin V\nChoose the correct option.",
"image": null
},
{
"idx": 5,
"question": "A 62-year-old man presents with episodes of palpitations for the past 3 weeks. He says that he has episodes where he feels his heart is ‘racing and pounding’, lasting 1–2 hours on average. Initially, he says the episodes would happen 1–2 times per week but now happen almost every day. This last episode has been constant for the past 2 days. He denies any seizure, loss of consciousness, dizziness, chest pain, or similar symptoms in the past. His past medical history is significant for an ischemic stroke of the right anterior cerebral artery 1 month ago, status post intravenous (IV) tissue plasminogen activator (tPA) with still some residual neurologic impairment, and long-standing gastroesophageal reflux secondary to a hiatal hernia, managed medically. The patient reports a 15-pack-year smoking history, but no alcohol or recreational drug use. The vital signs include: temperature 37.0°C (98.6°F), blood pressure 100/70 mm Hg, pulse 105/min, and respiratory rate 16/min. On physical examination, muscle strength in the lower extremities is 4/5 on the left and 5/5 on the right, along with sensory loss on the left, all of which is improved from his previous exam 3 weeks ago. There is a loss of the left half of the visual field bilaterally which is stable from the previous exam. Cardiac examination is significant for a new-onset irregular rate and rhythm. No rubs, thrills or murmurs. A noncontrast computed tomography (CT) scan shows evidence of an area of infarction in the vicinity of the right anterior cerebral artery showing normal interval change with no evidence of new hemorrhage or expansion of the area of infarction. An electrocardiogram (ECG) is performed, which is shown in the exhibit (see image below). Which of the following is the most appropriate intervention to best prevent future cerebrovascular accidents (CVAs) in this patient?\nA. Begin aspirin therapy\nB. Begin clopidogrel\nC. Carotid endarterectomy\nD. Begin warfarin and heparin\n\nA. Begin aspirin therapy\nB. Begin clopidogrel\nC. Carotid endarterectomy\nD. Begin warfarin and heparin",
"options": [
"A. Begin aspirin therapy",
"B. Begin clopidogrel",
"C. Carotid endarterectomy",
"D. Begin warfarin and heparin"
],
"answer": "Begin warfarin and heparin",
"gen_text_store": "",
"pid": "5",
"query": "A 62-year-old man presents with episodes of palpitations for the past 3 weeks. He says that he has episodes where he feels his heart is ‘racing and pounding’, lasting 1–2 hours on average. Initially, he says the episodes would happen 1–2 times per week but now happen almost every day. This last episode has been constant for the past 2 days. He denies any seizure, loss of consciousness, dizziness, chest pain, or similar symptoms in the past. His past medical history is significant for an ischemic stroke of the right anterior cerebral artery 1 month ago, status post intravenous (IV) tissue plasminogen activator (tPA) with still some residual neurologic impairment, and long-standing gastroesophageal reflux secondary to a hiatal hernia, managed medically. The patient reports a 15-pack-year smoking history, but no alcohol or recreational drug use. The vital signs include: temperature 37.0°C (98.6°F), blood pressure 100/70 mm Hg, pulse 105/min, and respiratory rate 16/min. On physical examination, muscle strength in the lower extremities is 4/5 on the left and 5/5 on the right, along with sensory loss on the left, all of which is improved from his previous exam 3 weeks ago. There is a loss of the left half of the visual field bilaterally which is stable from the previous exam. Cardiac examination is significant for a new-onset irregular rate and rhythm. No rubs, thrills or murmurs. A noncontrast computed tomography (CT) scan shows evidence of an area of infarction in the vicinity of the right anterior cerebral artery showing normal interval change with no evidence of new hemorrhage or expansion of the area of infarction. An electrocardiogram (ECG) is performed, which is shown in the exhibit (see image below). Which of the following is the most appropriate intervention to best prevent future cerebrovascular accidents (CVAs) in this patient?\nA. Begin aspirin therapy\nB. Begin clopidogrel\nC. Carotid endarterectomy\nD. Begin warfarin and heparin\nChoose the correct option.",
"image": null
},
{
"idx": 6,
"question": "An investigator is studying cellular regeneration of epithelial cells. She has obtained a tissue sample from a normal thyroid gland for histopathologic examination. It shows follicles lined by a single layer of cube-like cells with large central nuclei. Which of the following parts of the female reproductive tract is also lined by this type of epithelium?\nA. Ovaries\nB. Vagina\nC. Fallopian tubes\nD. Vulva\n\nA. Ovaries\nB. Vagina\nC. Fallopian tubes\nD. Vulva",
"options": [
"A. Ovaries",
"B. Vagina",
"C. Fallopian tubes",
"D. Vulva"
],
"answer": "Ovaries",
"gen_text_store": "",
"pid": "6",
"query": "An investigator is studying cellular regeneration of epithelial cells. She has obtained a tissue sample from a normal thyroid gland for histopathologic examination. It shows follicles lined by a single layer of cube-like cells with large central nuclei. Which of the following parts of the female reproductive tract is also lined by this type of epithelium?\nA. Ovaries\nB. Vagina\nC. Fallopian tubes\nD. Vulva\nChoose the correct option.",
"image": null
},
{
"idx": 7,
"question": "A 4-year-old girl is brought to the emergency department with a persistent cough, fever, and vomiting. The past year the child has been admitted to the hospital 3 times with pneumonia. For the past 1 week, the child has been experiencing thick purulent cough and says that her chest feels ‘heavy’. Her stools have been loose and foul-smelling over the past week. Her parents are also concerned that she has not gained much weight due to her frequent hospital visits. She was born at 39 weeks gestation via spontaneous vaginal delivery and is up to date on all vaccines and is meeting all developmental milestones. On physical exam, the temperature is 39.1°C (102.4°F). She appears lethargic and uncomfortable. Crackles are heard in the lower lung bases, with dullness to percussion. A small nasal polyp is also present on inspection. Which of the following is the most likely cause for the girl’s symptoms?\nA. Dysfunction in a transmembrane regulator\nB. Inefficient breakdown of leucine, isoleucine, and valine\nC. Dysfunction in the motility of respiratory cilia\nD. Deficiency in lymphocytic activity\n\nA. Dysfunction in a transmembrane regulator\nB. Inefficient breakdown of leucine, isoleucine, and valine\nC. Dysfunction in the motility of respiratory cilia\nD. Deficiency in lymphocytic activity",
"options": [
"A. Dysfunction in a transmembrane regulator",
"B. Inefficient breakdown of leucine, isoleucine, and valine",
"C. Dysfunction in the motility of respiratory cilia",
"D. Deficiency in lymphocytic activity"
],
"answer": "Dysfunction in a transmembrane regulator",
"gen_text_store": "",
"pid": "7",
"query": "A 4-year-old girl is brought to the emergency department with a persistent cough, fever, and vomiting. The past year the child has been admitted to the hospital 3 times with pneumonia. For the past 1 week, the child has been experiencing thick purulent cough and says that her chest feels ‘heavy’. Her stools have been loose and foul-smelling over the past week. Her parents are also concerned that she has not gained much weight due to her frequent hospital visits. She was born at 39 weeks gestation via spontaneous vaginal delivery and is up to date on all vaccines and is meeting all developmental milestones. On physical exam, the temperature is 39.1°C (102.4°F). She appears lethargic and uncomfortable. Crackles are heard in the lower lung bases, with dullness to percussion. A small nasal polyp is also present on inspection. Which of the following is the most likely cause for the girl’s symptoms?\nA. Dysfunction in a transmembrane regulator\nB. Inefficient breakdown of leucine, isoleucine, and valine\nC. Dysfunction in the motility of respiratory cilia\nD. Deficiency in lymphocytic activity\nChoose the correct option.",
"image": null
},
{
"idx": 8,
"question": "A 70-year-old woman is brought to the emergency department for the evaluation of abdominal pain, nausea, and vomiting for 1 day. Computed tomography shows a small bowel perforation. The patient is prepared for emergent exploratory laparotomy. She is sedated with midazolam, induced with propofol, intubated, and maintained on nitrous oxide and isoflurane for the duration of the surgery. A single perforation in the terminal ileum is diagnosed intraoperatively and successfully repaired. The patient is transferred to the intensive care unit. The ventilator is set at an FiO2 of 50%, tidal volume of 1000 mL, respiratory rate of 12/min, and positive end-expiratory pressure of 2.5 cm H2O. Her temperature is 37.3°C (99.1°F), pulse is 76/min, and blood pressure is 111/50 mm Hg. She is responsive to painful stimuli. Lung examination shows bilateral rales. Abdominal examination shows a distended abdomen and intact abdominal surgical incisions. The remainder of the physical examination shows no abnormalities. Arterial blood gas analysis shows:\npH 7.44\npO2 54 mm Hg\npCO2 31 mm Hg\nHCO3- 22 mm Hg\nWhich of the following is the best next step in the management of this patient?\"\nA. Increase the FiO2\nB. Increase the tidal volume\nC. Increase PEEP\nD. Increase the respiratory rate\n\nA. Increase the FiO2\nB. Increase the tidal volume\nC. Increase PEEP\nD. Increase the respiratory rate",
"options": [
"A. Increase the FiO2",
"B. Increase the tidal volume",
"C. Increase PEEP",
"D. Increase the respiratory rate"
],
"answer": "Increase PEEP",
"gen_text_store": "",
"pid": "8",
"query": "A 70-year-old woman is brought to the emergency department for the evaluation of abdominal pain, nausea, and vomiting for 1 day. Computed tomography shows a small bowel perforation. The patient is prepared for emergent exploratory laparotomy. She is sedated with midazolam, induced with propofol, intubated, and maintained on nitrous oxide and isoflurane for the duration of the surgery. A single perforation in the terminal ileum is diagnosed intraoperatively and successfully repaired. The patient is transferred to the intensive care unit. The ventilator is set at an FiO2 of 50%, tidal volume of 1000 mL, respiratory rate of 12/min, and positive end-expiratory pressure of 2.5 cm H2O. Her temperature is 37.3°C (99.1°F), pulse is 76/min, and blood pressure is 111/50 mm Hg. She is responsive to painful stimuli. Lung examination shows bilateral rales. Abdominal examination shows a distended abdomen and intact abdominal surgical incisions. The remainder of the physical examination shows no abnormalities. Arterial blood gas analysis shows:\npH 7.44\npO2 54 mm Hg\npCO2 31 mm Hg\nHCO3- 22 mm Hg\nWhich of the following is the best next step in the management of this patient?\"\nA. Increase the FiO2\nB. Increase the tidal volume\nC. Increase PEEP\nD. Increase the respiratory rate\nChoose the correct option.",
"image": null
},
{
"idx": 9,
"question": "A 47-year-old man with a history of HIV1 infection presents to his HIV clinic to discuss his antiretroviral medications. He is interested in including maraviroc in his maintenance regimen after seeing advertisements about the medication. On exam, his temperature is 98.8°F (37.1°C), blood pressure is 116/74 mmHg, pulse is 64/min, and respirations are 12/min. His viral load is undetectable on his current regimen, and his blood count, electrolytes, and liver function tests have all been within normal limits. In order to consider maraviroc for therapy, a tropism assay needs to be performed. Which of the following receptors is affected by the use of maraviroc?\nA. gp120\nB. gp160\nC. p24\nD. Reverse transcriptase\n\nA. gp120\nB. gp160\nC. p24\nD. Reverse transcriptase",
"options": [
"A. gp120",
"B. gp160",
"C. p24",
"D. Reverse transcriptase"
],
"answer": "gp120",
"gen_text_store": "",
"pid": "9",
"query": "A 47-year-old man with a history of HIV1 infection presents to his HIV clinic to discuss his antiretroviral medications. He is interested in including maraviroc in his maintenance regimen after seeing advertisements about the medication. On exam, his temperature is 98.8°F (37.1°C), blood pressure is 116/74 mmHg, pulse is 64/min, and respirations are 12/min. His viral load is undetectable on his current regimen, and his blood count, electrolytes, and liver function tests have all been within normal limits. In order to consider maraviroc for therapy, a tropism assay needs to be performed. Which of the following receptors is affected by the use of maraviroc?\nA. gp120\nB. gp160\nC. p24\nD. Reverse transcriptase\nChoose the correct option.",
"image": null
},
{
"idx": 10,
"question": "A 23-year-old woman comes to the physician because of a 2-month history of episodic headaches associated with dizziness, nausea, and vomiting. Over-the-counter pain medications have failed to reduce her symptoms. An MRI of the brain shows isolated dilation of the left lateral ventricle. This dilatation is most likely caused by blockade of which of the following structures?\nA. Arachnoid villi\nB. Interventricular foramen\nC. Median aperture\nD. Lateral apertures\n\nA. Arachnoid villi\nB. Interventricular foramen\nC. Median aperture\nD. Lateral apertures",
"options": [
"A. Arachnoid villi",
"B. Interventricular foramen",
"C. Median aperture",
"D. Lateral apertures"
],
"answer": "Interventricular foramen",
"gen_text_store": "",
"pid": "10",
"query": "A 23-year-old woman comes to the physician because of a 2-month history of episodic headaches associated with dizziness, nausea, and vomiting. Over-the-counter pain medications have failed to reduce her symptoms. An MRI of the brain shows isolated dilation of the left lateral ventricle. This dilatation is most likely caused by blockade of which of the following structures?\nA. Arachnoid villi\nB. Interventricular foramen\nC. Median aperture\nD. Lateral apertures\nChoose the correct option.",
"image": null
},
{
"idx": 11,
"question": "A 65-year-old man comes to the physician because of progressively worsening fatigue for 6 months. During this time, he has also had shortness of breath and palpitations on exertion. He has noticed blood in his stools on three separate occasions in the past 4 months. He has type 2 diabetes mellitus and end-stage renal disease. He drinks two to four beers daily. He does not smoke. His pulse is 95/min and blood pressure is 120/70 mm Hg. Examination shows pale conjunctivae. The abdomen is soft with no organomegaly. Rectal examination is unremarkable. His hemoglobin concentration is 7.2 g/dL, hematocrit is 32%, and mean corpuscular volume is 68 μm3. Which of the following is the most likely underlying cause of this patient's bleeding?\nA. Inflammation in an outpouching of the colonic wall\nB. Symptomatic enlargement of hemorrhoidal plexus\nC. Chronic mucosal and submucosal inflammation of the colon\nD. Arteriovenous malformation in the colonic wall\n\nA. Inflammation in an outpouching of the colonic wall\nB. Symptomatic enlargement of hemorrhoidal plexus\nC. Chronic mucosal and submucosal inflammation of the colon\nD. Arteriovenous malformation in the colonic wall",
"options": [
"A. Inflammation in an outpouching of the colonic wall",
"B. Symptomatic enlargement of hemorrhoidal plexus",
"C. Chronic mucosal and submucosal inflammation of the colon",
"D. Arteriovenous malformation in the colonic wall"
],
"answer": "Arteriovenous malformation in the colonic wall",
"gen_text_store": "",
"pid": "11",
"query": "A 65-year-old man comes to the physician because of progressively worsening fatigue for 6 months. During this time, he has also had shortness of breath and palpitations on exertion. He has noticed blood in his stools on three separate occasions in the past 4 months. He has type 2 diabetes mellitus and end-stage renal disease. He drinks two to four beers daily. He does not smoke. His pulse is 95/min and blood pressure is 120/70 mm Hg. Examination shows pale conjunctivae. The abdomen is soft with no organomegaly. Rectal examination is unremarkable. His hemoglobin concentration is 7.2 g/dL, hematocrit is 32%, and mean corpuscular volume is 68 μm3. Which of the following is the most likely underlying cause of this patient's bleeding?\nA. Inflammation in an outpouching of the colonic wall\nB. Symptomatic enlargement of hemorrhoidal plexus\nC. Chronic mucosal and submucosal inflammation of the colon\nD. Arteriovenous malformation in the colonic wall\nChoose the correct option.",
"image": null
},
{
"idx": 12,
"question": "An 11-month-old boy is brought to the physician for a well-child examination. He is growing along with the 75th percentile and meeting all milestones. Physical examination shows a poorly rugated scrotum. The palpation of the scrotum shows only 1 testicle. A 2nd testicle is palpated in the inguinal canal. The examination of the penis shows a normal urethral meatus. The remainder of the physical examination shows no abnormalities. Which of the following is the most appropriate next step in management?\nA. Chorionic gonadotropin therapy\nB. Exploratory laparoscopy\nC. Orchiectomy\nD. Orchiopexy\n\nA. Chorionic gonadotropin therapy\nB. Exploratory laparoscopy\nC. Orchiectomy\nD. Orchiopexy",
"options": [
"A. Chorionic gonadotropin therapy",
"B. Exploratory laparoscopy",
"C. Orchiectomy",
"D. Orchiopexy"
],
"answer": "Orchiopexy",
"gen_text_store": "",
"pid": "12",
"query": "An 11-month-old boy is brought to the physician for a well-child examination. He is growing along with the 75th percentile and meeting all milestones. Physical examination shows a poorly rugated scrotum. The palpation of the scrotum shows only 1 testicle. A 2nd testicle is palpated in the inguinal canal. The examination of the penis shows a normal urethral meatus. The remainder of the physical examination shows no abnormalities. Which of the following is the most appropriate next step in management?\nA. Chorionic gonadotropin therapy\nB. Exploratory laparoscopy\nC. Orchiectomy\nD. Orchiopexy\nChoose the correct option.",
"image": null
},
{
"idx": 13,
"question": "A 24-year-old woman presents to her primary care physician for a wellness visit. She says that she has been generally healthy but has noticed difficulty concentrating, becoming increasingly fatigued, and a 15-pound weight increase over the course of a few months. She also reports mild constipation and joint pain. Approximately 6-months ago, she experienced palpitations, increased stool frequency, and a hand tremor. Her past medical history is significant for asthma. Her father is not living and had Parkinson disease, and her mother has poorly controlled rheumatoid arthritis. She is currently sexually active in a monogamous relationship and uses contraception consistently. She denies cigarette smoking and occasionally drinks wine. She experimented once with lysergic acid diethylamide 6 years ago. Her temperature is 99°F (37.2°C), blood pressure is 127/98 mmHg, pulse is 55/min, and respirations are 13/min. On physical exam, the patient has slow speech and movement. She has tenderness to palpation of her wrist and ankle joints. She has delayed relaxation of deep tendon reflexes. Which of the following will most likely be found in this patient?\nA. Elevated TSH\nB. High Patient Health Questionnaire-9 (PHQ-9) score\nC. Positive anti-CCP antibodies\nD. Positive urine toxicology\n\nA. Elevated TSH\nB. High Patient Health Questionnaire-9 (PHQ-9) score\nC. Positive anti-CCP antibodies\nD. Positive urine toxicology",
"options": [
"A. Elevated TSH",
"B. High Patient Health Questionnaire-9 (PHQ-9) score",
"C. Positive anti-CCP antibodies",
"D. Positive urine toxicology"
],
"answer": "Elevated TSH",
"gen_text_store": "",
"pid": "13",
"query": "A 24-year-old woman presents to her primary care physician for a wellness visit. She says that she has been generally healthy but has noticed difficulty concentrating, becoming increasingly fatigued, and a 15-pound weight increase over the course of a few months. She also reports mild constipation and joint pain. Approximately 6-months ago, she experienced palpitations, increased stool frequency, and a hand tremor. Her past medical history is significant for asthma. Her father is not living and had Parkinson disease, and her mother has poorly controlled rheumatoid arthritis. She is currently sexually active in a monogamous relationship and uses contraception consistently. She denies cigarette smoking and occasionally drinks wine. She experimented once with lysergic acid diethylamide 6 years ago. Her temperature is 99°F (37.2°C), blood pressure is 127/98 mmHg, pulse is 55/min, and respirations are 13/min. On physical exam, the patient has slow speech and movement. She has tenderness to palpation of her wrist and ankle joints. She has delayed relaxation of deep tendon reflexes. Which of the following will most likely be found in this patient?\nA. Elevated TSH\nB. High Patient Health Questionnaire-9 (PHQ-9) score\nC. Positive anti-CCP antibodies\nD. Positive urine toxicology\nChoose the correct option.",
"image": null
},
{
"idx": 14,
"question": "A 16-year-old boy is rushed to the emergency room with acute vomiting and abdominal pain that began earlier today. His parents say that the boy was doing well until two days ago when he told them that he was feeling unwell. He has diabetes and takes insulin but stopped taking it when he began to feel poorly two days ago. His temperature is 37°C (98.6°F), respirations are shallow and rapid with a rate of 33/min, pulse is 107/min, and blood pressure is 101/68 mm Hg. He appears severely dehydrated, showing signs of fatigue, and poor skin turgor. His breath has a fruity smell to it. His blood glucose level is 691 mg/dL. Blood is drawn for labs and the results are given below:\nSerum: \n pH: 7.21\n pCO2: 32 mm HG\n HCO 3-: 15.2 mEq/L\nSodium: 122 mEq/L\nPotassium: 5.8 mEq/L\nUrinalysis is positive for ketone bodies. What is the most appropriate immediate step in the management of this patient?\nA. Administer IV fluids and insulin\nB. Administer IV antibiotics\nC. Administer IV fluids with oral antidiabetic medications\nD. Administer potassium and magnesium\n\nA. Administer IV fluids and insulin\nB. Administer IV antibiotics\nC. Administer IV fluids with oral antidiabetic medications\nD. Administer potassium and magnesium",
"options": [
"A. Administer IV fluids and insulin",
"B. Administer IV antibiotics",
"C. Administer IV fluids with oral antidiabetic medications",
"D. Administer potassium and magnesium"
],
"answer": "Administer IV fluids and insulin",
"gen_text_store": "",
"pid": "14",
"query": "A 16-year-old boy is rushed to the emergency room with acute vomiting and abdominal pain that began earlier today. His parents say that the boy was doing well until two days ago when he told them that he was feeling unwell. He has diabetes and takes insulin but stopped taking it when he began to feel poorly two days ago. His temperature is 37°C (98.6°F), respirations are shallow and rapid with a rate of 33/min, pulse is 107/min, and blood pressure is 101/68 mm Hg. He appears severely dehydrated, showing signs of fatigue, and poor skin turgor. His breath has a fruity smell to it. His blood glucose level is 691 mg/dL. Blood is drawn for labs and the results are given below:\nSerum: \n pH: 7.21\n pCO2: 32 mm HG\n HCO 3-: 15.2 mEq/L\nSodium: 122 mEq/L\nPotassium: 5.8 mEq/L\nUrinalysis is positive for ketone bodies. What is the most appropriate immediate step in the management of this patient?\nA. Administer IV fluids and insulin\nB. Administer IV antibiotics\nC. Administer IV fluids with oral antidiabetic medications\nD. Administer potassium and magnesium\nChoose the correct option.",
"image": null
},
{
"idx": 15,
"question": "A 22-year-old woman comes to the physician for the evaluation of irregular menstrual bleeding. Menses have occurred at 45- to 90-day intervals since menarche at the age of 15 years. Her last menstrual period was 5 weeks ago. The patient reports that she was too embarrassed to discuss this issue with anyone until now. Over the past two years, she was unable to become pregnant despite having unprotected sexual intercourse with her husband on a regular basis. There is no personal or family history of serious illness. She is 170 cm (5 ft 7 in) tall and weighs 85 kg (187 lb); BMI is 29.4 kg/m2. Her vital signs are within normal limits. Examination shows oily skin and severe facial acne. There is abnormal pigmented hair on the upper lip and around both nipples. The patient wishes to have children. In addition to recommending lifestyle modifications, which of the following is the most appropriate step in management?\nA. In vitro fertilization with patient's egg\nB. Progesterone therapy\nC. Clomiphene therapy\nD. Leuprolide therapy\n\nA. In vitro fertilization with patient's egg\nB. Progesterone therapy\nC. Clomiphene therapy\nD. Leuprolide therapy",
"options": [
"A. In vitro fertilization with patient's egg",
"B. Progesterone therapy",
"C. Clomiphene therapy",
"D. Leuprolide therapy"
],
"answer": "Clomiphene therapy",
"gen_text_store": "",
"pid": "15",
"query": "A 22-year-old woman comes to the physician for the evaluation of irregular menstrual bleeding. Menses have occurred at 45- to 90-day intervals since menarche at the age of 15 years. Her last menstrual period was 5 weeks ago. The patient reports that she was too embarrassed to discuss this issue with anyone until now. Over the past two years, she was unable to become pregnant despite having unprotected sexual intercourse with her husband on a regular basis. There is no personal or family history of serious illness. She is 170 cm (5 ft 7 in) tall and weighs 85 kg (187 lb); BMI is 29.4 kg/m2. Her vital signs are within normal limits. Examination shows oily skin and severe facial acne. There is abnormal pigmented hair on the upper lip and around both nipples. The patient wishes to have children. In addition to recommending lifestyle modifications, which of the following is the most appropriate step in management?\nA. In vitro fertilization with patient's egg\nB. Progesterone therapy\nC. Clomiphene therapy\nD. Leuprolide therapy\nChoose the correct option.",
"image": null
},
{
"idx": 16,
"question": "A 61-year-old man presents to the clinic with complaints of excessive thirst, frequent urination, and partial visual loss in both eyes for 1 day. His family history is significant for type 2 diabetes mellitus in his mother and cousin. His weight is 112 kg ( 246.9 lb), height 187 cm (6 ft 1 in), blood pressure: 150/90 mm Hg, heart rate: 89/min, respiratory rate: 14/min, and temperature: 36.7℃ (98.4℉). The physical examination is significant for dry skin, a pustular rash over the patient’s shoulders and back, an accentuated second heart sound (S2) best heard in the second intercostal space at the right sternal border, and distal loss of vibration sensitivity in both feet. A fundoscopic examination shows small red dots in the superficial retinal layers suggestive of microaneurysms. The HbA1c is 9% and the urinalysis shows the following:\nColor Pale yellow (light/pale-to-dark/deep amber)\nClarity Cloudy\npH 6.6\nSpecific gravity 1.010\nGlucose 199 mg/dl\nKetones None\nNitrites Negative\nLeukocyte esterase Negative\nBilirubin Negative\nUrinary bilirubin Traces\nRed blood cells 3 RBCs\nProtein 120 mg/d\nRBCs ≤ 2 RBCs/hpf\nWBCs 22 WBCs/hpf\nEpithelial cells 27 squamous epithelial cells/hpf\nCasts 5 hyaline casts/lpf\nCrystals Occasional\nBacteria None\nYeast Present\nWhich of the following statements best describes the cause of this patient’s glucosuria?\nA. There is a disruption of primary active transport of glucose in the proximal renal tubules\nB. Secondary active transporters fail to completely reabsorb glucose in the renal tubules\nC. There is a disruption of passive transport of the glucose in the proximal renal tubules\nD. Glucosuria results from increased glomerular filtration rate\n\nA. There is a disruption of primary active transport of glucose in the proximal renal tubules\nB. Secondary active transporters fail to completely reabsorb glucose in the renal tubules\nC. There is a disruption of passive transport of the glucose in the proximal renal tubules\nD. Glucosuria results from increased glomerular filtration rate",
"options": [
"A. There is a disruption of primary active transport of glucose in the proximal renal tubules",
"B. Secondary active transporters fail to completely reabsorb glucose in the renal tubules",
"C. There is a disruption of passive transport of the glucose in the proximal renal tubules",
"D. Glucosuria results from increased glomerular filtration rate"
],
"answer": "Secondary active transporters fail to completely reabsorb glucose in the renal tubules",
"gen_text_store": "",
"pid": "16",
"query": "A 61-year-old man presents to the clinic with complaints of excessive thirst, frequent urination, and partial visual loss in both eyes for 1 day. His family history is significant for type 2 diabetes mellitus in his mother and cousin. His weight is 112 kg ( 246.9 lb), height 187 cm (6 ft 1 in), blood pressure: 150/90 mm Hg, heart rate: 89/min, respiratory rate: 14/min, and temperature: 36.7℃ (98.4℉). The physical examination is significant for dry skin, a pustular rash over the patient’s shoulders and back, an accentuated second heart sound (S2) best heard in the second intercostal space at the right sternal border, and distal loss of vibration sensitivity in both feet. A fundoscopic examination shows small red dots in the superficial retinal layers suggestive of microaneurysms. The HbA1c is 9% and the urinalysis shows the following:\nColor Pale yellow (light/pale-to-dark/deep amber)\nClarity Cloudy\npH 6.6\nSpecific gravity 1.010\nGlucose 199 mg/dl\nKetones None\nNitrites Negative\nLeukocyte esterase Negative\nBilirubin Negative\nUrinary bilirubin Traces\nRed blood cells 3 RBCs\nProtein 120 mg/d\nRBCs ≤ 2 RBCs/hpf\nWBCs 22 WBCs/hpf\nEpithelial cells 27 squamous epithelial cells/hpf\nCasts 5 hyaline casts/lpf\nCrystals Occasional\nBacteria None\nYeast Present\nWhich of the following statements best describes the cause of this patient’s glucosuria?\nA. There is a disruption of primary active transport of glucose in the proximal renal tubules\nB. Secondary active transporters fail to completely reabsorb glucose in the renal tubules\nC. There is a disruption of passive transport of the glucose in the proximal renal tubules\nD. Glucosuria results from increased glomerular filtration rate\nChoose the correct option.",
"image": null
},
{
"idx": 17,
"question": "A 61-year-old woman presents to an outpatient clinic with fatigue and mild neck pain for a month. She adds that she is having difficulty swallowing. She denies trouble with her breathing but endorses 5–10 lb of unintentional weight loss over the past few months. On physical exam, the patient’s fingernails appear flat and mild conjunctival pallor is noted. An upper barium esophagram shows an upper esophageal web. A complete blood count reveals:\nHb% 10 gm/dL\nTotal count (WBC) 11,000 /mm3\nDifferential count:\nNeutrophile 70%\nLymphocytes 25%\nMonocytes 5%\nESR 10 mm/hr\nWhat is the most likely diagnosis?\nA. Plummer-Vinson syndrome\nB. Esophageal squamous cell carcinoma\nC. Zenker’s diverticulum\nD. Achalasia\n\nA. Plummer-Vinson syndrome\nB. Esophageal squamous cell carcinoma\nC. Zenker’s diverticulum\nD. Achalasia",
"options": [
"A. Plummer-Vinson syndrome",
"B. Esophageal squamous cell carcinoma",
"C. Zenker’s diverticulum",
"D. Achalasia"
],
"answer": "Plummer-Vinson syndrome",
"gen_text_store": "",
"pid": "17",
"query": "A 61-year-old woman presents to an outpatient clinic with fatigue and mild neck pain for a month. She adds that she is having difficulty swallowing. She denies trouble with her breathing but endorses 5–10 lb of unintentional weight loss over the past few months. On physical exam, the patient’s fingernails appear flat and mild conjunctival pallor is noted. An upper barium esophagram shows an upper esophageal web. A complete blood count reveals:\nHb% 10 gm/dL\nTotal count (WBC) 11,000 /mm3\nDifferential count:\nNeutrophile 70%\nLymphocytes 25%\nMonocytes 5%\nESR 10 mm/hr\nWhat is the most likely diagnosis?\nA. Plummer-Vinson syndrome\nB. Esophageal squamous cell carcinoma\nC. Zenker’s diverticulum\nD. Achalasia\nChoose the correct option.",
"image": null
},
{
"idx": 18,
"question": "A 28-year-old woman with no significant past medical history presents to her primary care physician with increased menstrual bleeding over the past three months. She also notes easy bruising and bleeding from her gums when brushing her teeth. She is sexually active with multiple partners and has no history of intravenous drug use. Physical exam is remarkable for petechiae and scattered ecchymoses on the patient's bilateral upper and lower extremities. Urine beta-HCG is negative. Laboratory results are as follows: Hgb 13.0 g/dL, WBCs 6,000/mL, platelets 95,000/mL, PT 13.2s, aPTT 30s. Peripheral blood smear shows normocytic, normochromic red blood cells and few platelets with no morphologic abnormalities. Which diagnostic study should be performed next?\nA. Serum factor VIII levels and von Willebrand factor activity\nB. Measurement of ADAMTS13 activity\nC. HIV and HCV testing\nD. Bone marrow aspiration\n\nA. Serum factor VIII levels and von Willebrand factor activity\nB. Measurement of ADAMTS13 activity\nC. HIV and HCV testing\nD. Bone marrow aspiration",
"options": [
"A. Serum factor VIII levels and von Willebrand factor activity",
"B. Measurement of ADAMTS13 activity",
"C. HIV and HCV testing",
"D. Bone marrow aspiration"
],
"answer": "HIV and HCV testing",
"gen_text_store": "",
"pid": "18",
"query": "A 28-year-old woman with no significant past medical history presents to her primary care physician with increased menstrual bleeding over the past three months. She also notes easy bruising and bleeding from her gums when brushing her teeth. She is sexually active with multiple partners and has no history of intravenous drug use. Physical exam is remarkable for petechiae and scattered ecchymoses on the patient's bilateral upper and lower extremities. Urine beta-HCG is negative. Laboratory results are as follows: Hgb 13.0 g/dL, WBCs 6,000/mL, platelets 95,000/mL, PT 13.2s, aPTT 30s. Peripheral blood smear shows normocytic, normochromic red blood cells and few platelets with no morphologic abnormalities. Which diagnostic study should be performed next?\nA. Serum factor VIII levels and von Willebrand factor activity\nB. Measurement of ADAMTS13 activity\nC. HIV and HCV testing\nD. Bone marrow aspiration\nChoose the correct option.",
"image": null
},
{
"idx": 19,
"question": "A 55-year-old man with a history of chronic glomerulonephritis due to IgA nephropathy presents to your office with bone pain. Which of the following laboratory findings would you most expect upon analysis of this patient's serum?\nA. Increased PTH, decreased calcium, increased phosphate, decreased calcitriol\nB. Decreased PTH, increased calcium, increased phosphate, increased calcitriol\nC. Decreased PTH, decreased calcium, increased phosphate, decreased calcitriol\nD. Normal PTH, normal calcium, normal phosphate, normal calcitriol\n\nA. Increased PTH, decreased calcium, increased phosphate, decreased calcitriol\nB. Decreased PTH, increased calcium, increased phosphate, increased calcitriol\nC. Decreased PTH, decreased calcium, increased phosphate, decreased calcitriol\nD. Normal PTH, normal calcium, normal phosphate, normal calcitriol",
"options": [
"A. Increased PTH, decreased calcium, increased phosphate, decreased calcitriol",
"B. Decreased PTH, increased calcium, increased phosphate, increased calcitriol",
"C. Decreased PTH, decreased calcium, increased phosphate, decreased calcitriol",
"D. Normal PTH, normal calcium, normal phosphate, normal calcitriol"
],
"answer": "Increased PTH, decreased calcium, increased phosphate, decreased calcitriol",
"gen_text_store": "",
"pid": "19",
"query": "A 55-year-old man with a history of chronic glomerulonephritis due to IgA nephropathy presents to your office with bone pain. Which of the following laboratory findings would you most expect upon analysis of this patient's serum?\nA. Increased PTH, decreased calcium, increased phosphate, decreased calcitriol\nB. Decreased PTH, increased calcium, increased phosphate, increased calcitriol\nC. Decreased PTH, decreased calcium, increased phosphate, decreased calcitriol\nD. Normal PTH, normal calcium, normal phosphate, normal calcitriol\nChoose the correct option.",
"image": null
},
{
"idx": 20,
"question": "A 50-year-old man presents to his primary care doctor following an inguinal hernia repair. The patient reports no pain in his lower abdomen or groin, no constipation, and states that he enjoys his usual diet. He denies any use of alcohol, tobacco, or illicit drugs. He has returned to work as a cruise ship attendant. Preoperative workup included chest radiography which demonstrated an opacification in his right middle lobe. The patient agrees to undergo computed tomography (CT) of his chest without contrast for further evaluation. The radiologist reports an 8 mm nodule in the patient's peripheral right middle lobe that has regular margins and appears calcified. One year later, the patient obtains another chest CT without contrast that reports the nodule size as 10 mm with similar characteristics. What is the most appropriate next step in management?\nA. CT chest without contrast in 24 months\nB. Positive emission tomography (PET) of chest now\nC. Right middle lobectomy now\nD. Bronchoscopy-guided biopsy now\n\nA. CT chest without contrast in 24 months\nB. Positive emission tomography (PET) of chest now\nC. Right middle lobectomy now\nD. Bronchoscopy-guided biopsy now",
"options": [
"A. CT chest without contrast in 24 months",
"B. Positive emission tomography (PET) of chest now",
"C. Right middle lobectomy now",
"D. Bronchoscopy-guided biopsy now"
],
"answer": "Positive emission tomography (PET) of chest now",
"gen_text_store": "",
"pid": "20",
"query": "A 50-year-old man presents to his primary care doctor following an inguinal hernia repair. The patient reports no pain in his lower abdomen or groin, no constipation, and states that he enjoys his usual diet. He denies any use of alcohol, tobacco, or illicit drugs. He has returned to work as a cruise ship attendant. Preoperative workup included chest radiography which demonstrated an opacification in his right middle lobe. The patient agrees to undergo computed tomography (CT) of his chest without contrast for further evaluation. The radiologist reports an 8 mm nodule in the patient's peripheral right middle lobe that has regular margins and appears calcified. One year later, the patient obtains another chest CT without contrast that reports the nodule size as 10 mm with similar characteristics. What is the most appropriate next step in management?\nA. CT chest without contrast in 24 months\nB. Positive emission tomography (PET) of chest now\nC. Right middle lobectomy now\nD. Bronchoscopy-guided biopsy now\nChoose the correct option.",
"image": null
},
{
"idx": 21,
"question": "An 8-year-old boy is brought to the physician by his parents for short stature. Neither his clothing nor his shoe size have changed over the past year. He also frequently bumps into obstacles such as furniture and has headaches at night. He is always thirsty for cold water and has been urinating more frequently. Three years ago, he had an asthma attack that was treated with albuterol and a one-week course of steroids. His mother has Hashimoto's thyroiditis and had precocious puberty. His mother's height is 147 cm (4 ft 10 in) and his father's height is 160 cm (5 ft 3 in). He is at the 5th percentile for height and 5th percentile for weight. His temperature is 37°C (98.6°F), pulse is 98/min, respirations are 16/min, and blood pressure is 100/64 mm Hg. Examination shows a soft and nontender abdomen. The genitals and pubic hair are both Tanner stage 1. Axillary hair is absent. Patellar reflexes are 1+ bilaterally. Laboratory studies show:\nNa+ 145 mEq/L\nK+ 4.1 mEq/L\nCl- 102 mEq/L\nHCO3- 25 mEq/L\nCa2+ 9.4 mg/dL\nGlucose 110 mg/dL\nThyroid-stimulating hormone 0.3 μU/mL\nThyroxine 3.9 μg/dL\nInsulin-like growth factor 1 24 ng/mL (N=61–356 ng/mL)\nInsulin-like growth factor binding protein 3 2.1 mcg/mL (N=1.6–6.5 μg/mL)\nWhich of the following is the most likely diagnosis?\"\nA. Rathke cleft cyst\nB. Craniopharyngioma\nC. Multiple endocrine neoplasia\nD. Pituitary adenoma\n\nA. Rathke cleft cyst\nB. Craniopharyngioma\nC. Multiple endocrine neoplasia\nD. Pituitary adenoma",
"options": [
"A. Rathke cleft cyst",
"B. Craniopharyngioma",
"C. Multiple endocrine neoplasia",
"D. Pituitary adenoma"
],
"answer": "Craniopharyngioma",
"gen_text_store": "",
"pid": "21",
"query": "An 8-year-old boy is brought to the physician by his parents for short stature. Neither his clothing nor his shoe size have changed over the past year. He also frequently bumps into obstacles such as furniture and has headaches at night. He is always thirsty for cold water and has been urinating more frequently. Three years ago, he had an asthma attack that was treated with albuterol and a one-week course of steroids. His mother has Hashimoto's thyroiditis and had precocious puberty. His mother's height is 147 cm (4 ft 10 in) and his father's height is 160 cm (5 ft 3 in). He is at the 5th percentile for height and 5th percentile for weight. His temperature is 37°C (98.6°F), pulse is 98/min, respirations are 16/min, and blood pressure is 100/64 mm Hg. Examination shows a soft and nontender abdomen. The genitals and pubic hair are both Tanner stage 1. Axillary hair is absent. Patellar reflexes are 1+ bilaterally. Laboratory studies show:\nNa+ 145 mEq/L\nK+ 4.1 mEq/L\nCl- 102 mEq/L\nHCO3- 25 mEq/L\nCa2+ 9.4 mg/dL\nGlucose 110 mg/dL\nThyroid-stimulating hormone 0.3 μU/mL\nThyroxine 3.9 μg/dL\nInsulin-like growth factor 1 24 ng/mL (N=61–356 ng/mL)\nInsulin-like growth factor binding protein 3 2.1 mcg/mL (N=1.6–6.5 μg/mL)\nWhich of the following is the most likely diagnosis?\"\nA. Rathke cleft cyst\nB. Craniopharyngioma\nC. Multiple endocrine neoplasia\nD. Pituitary adenoma\nChoose the correct option.",
"image": null
},
{
"idx": 22,
"question": "A 9-month-old boy is brought to his pediatrician by his mother for a routine health checkup. The boy was born at 39 weeks gestation via spontaneous vaginal delivery. He is up to date on all vaccines and is meeting all developmental milestones. He was breastfed for the first 3 months and then switched to cow’s milk and about two months ago she started giving him fruits and vegetables. Family history is noncontributory. Today, his heart rate is 120/min, respiratory rate is 40/min, blood pressure is 90/50 mm Hg, and temperature of 37.0°C (98.6°F). On examination, he has a heartbeat with a regular rate and rhythm and his lungs are clear to auscultation bilaterally. Generally, the boy looks pale. His weight and height fall within the expected range. A complete blood count (CBC) shows the following:\nHemoglobin (Hb): 9.1 g/dL\nMean corpuscular volume (MCV): 65 fL\nTotal iron binding capacity (TIBC): 550 μg/dL\nSerum iron: 45 µg/dL\nSerum lead: < 5 µg/dL\nWhat is the best treatment for this patient?\nA. Iron supplementation only\nB. Proper diet and iron supplementation\nC. Multivitamins\nD. Proper diet only\n\nA. Iron supplementation only\nB. Proper diet and iron supplementation\nC. Multivitamins\nD. Proper diet only",
"options": [
"A. Iron supplementation only",
"B. Proper diet and iron supplementation",
"C. Multivitamins",
"D. Proper diet only"
],
"answer": "Proper diet and iron supplementation",
"gen_text_store": "",
"pid": "22",
"query": "A 9-month-old boy is brought to his pediatrician by his mother for a routine health checkup. The boy was born at 39 weeks gestation via spontaneous vaginal delivery. He is up to date on all vaccines and is meeting all developmental milestones. He was breastfed for the first 3 months and then switched to cow’s milk and about two months ago she started giving him fruits and vegetables. Family history is noncontributory. Today, his heart rate is 120/min, respiratory rate is 40/min, blood pressure is 90/50 mm Hg, and temperature of 37.0°C (98.6°F). On examination, he has a heartbeat with a regular rate and rhythm and his lungs are clear to auscultation bilaterally. Generally, the boy looks pale. His weight and height fall within the expected range. A complete blood count (CBC) shows the following:\nHemoglobin (Hb): 9.1 g/dL\nMean corpuscular volume (MCV): 65 fL\nTotal iron binding capacity (TIBC): 550 μg/dL\nSerum iron: 45 µg/dL\nSerum lead: < 5 µg/dL\nWhat is the best treatment for this patient?\nA. Iron supplementation only\nB. Proper diet and iron supplementation\nC. Multivitamins\nD. Proper diet only\nChoose the correct option.",
"image": null
},
{
"idx": 23,
"question": "Three patients present to the pediatrician for routine well-child visits. The first child’s mother reports that he seems to be breastfeeding well and voids at least eight times per day. His stools are a yellow color, and he does not seem to be straining. In the office, he can lift his head and chest when in the prone position, and he can track an object with his eyes to the midline. His hands remain fisted 50% of the time.\n\nThe second child’s parents report that she is doing well at home and seems to enjoy playing with her older brother. In the office, she can roll from supine to prone and can transfer her rattle from hand to hand. She cannot yet say any words.\n\nThe third child’s father reports that he is starting to explore the world around him. He has begun taking independent steps at home. In the office, he seems to recognize the name of several objects, but he cannot follow the direction to “grab the ball.” All three children are assessed as developmentally normal.\n\nWhich of the following represents these patient's respective ages?\nA. Ages 1 month, 4 months, and 9 months\nB. Ages 2 months, 4 months, and 12 months\nC. Ages 2 months, 6 months, and 9 months\nD. Ages 2 months, 6 months, and 12 months\n\nA. Ages 1 month, 4 months, and 9 months\nB. Ages 2 months, 4 months, and 12 months\nC. Ages 2 months, 6 months, and 9 months\nD. Ages 2 months, 6 months, and 12 months",
"options": [
"A. Ages 1 month, 4 months, and 9 months",
"B. Ages 2 months, 4 months, and 12 months",
"C. Ages 2 months, 6 months, and 9 months",
"D. Ages 2 months, 6 months, and 12 months"
],
"answer": "Ages 2 months, 6 months, and 12 months",
"gen_text_store": "",
"pid": "23",
"query": "Three patients present to the pediatrician for routine well-child visits. The first child’s mother reports that he seems to be breastfeeding well and voids at least eight times per day. His stools are a yellow color, and he does not seem to be straining. In the office, he can lift his head and chest when in the prone position, and he can track an object with his eyes to the midline. His hands remain fisted 50% of the time.\n\nThe second child’s parents report that she is doing well at home and seems to enjoy playing with her older brother. In the office, she can roll from supine to prone and can transfer her rattle from hand to hand. She cannot yet say any words.\n\nThe third child’s father reports that he is starting to explore the world around him. He has begun taking independent steps at home. In the office, he seems to recognize the name of several objects, but he cannot follow the direction to “grab the ball.” All three children are assessed as developmentally normal.\n\nWhich of the following represents these patient's respective ages?\nA. Ages 1 month, 4 months, and 9 months\nB. Ages 2 months, 4 months, and 12 months\nC. Ages 2 months, 6 months, and 9 months\nD. Ages 2 months, 6 months, and 12 months\nChoose the correct option.",
"image": null
},
{
"idx": 24,
"question": "A 22-year-old primigravida presents for a regular prenatal visit at 16 weeks gestation. She is concerned about the results of a dipstick test she performed at home, which showed 1+ glucose. She does not know if her liquid consumption has increased, but she urinates more frequently than before. The course of her pregnancy has been unremarkable and she has no significant co-morbidities. The BMI is 25.6 kg/cm2 and she has gained 3 kg (6.72 lb) during the pregnancy. The blood pressure is 110/80 mm Hg, the heart rate is 82/min, the respiratory rate is 14/min, and the temperature is 36.6℃ (97.9℉). The lungs are clear to auscultation, the heart sounds are normal with no murmurs, and there is no abdominal or costovertebral angle tenderness. The laboratory tests show the following results:\nFasting glucose 97 mg/L\nALT 12 IU/L\nAST 14 IU/L\nTotal bilirubin 0.8 mg/dL(15 µmol/L)\nPlasma creatinine 0.7 mg/dL (61.9 µmol/L)\nWhich of the following tests are indicated to determine the cause of the abnormal dipstick test results?\nA. HbA1c measurement\nB. No tests required\nC. Urinalysis\nD. Oral glucose tolerance test\n\nA. HbA1c measurement\nB. No tests required\nC. Urinalysis\nD. Oral glucose tolerance test",
"options": [
"A. HbA1c measurement",
"B. No tests required",
"C. Urinalysis",
"D. Oral glucose tolerance test"
],
"answer": "No tests required",
"gen_text_store": "",
"pid": "24",
"query": "A 22-year-old primigravida presents for a regular prenatal visit at 16 weeks gestation. She is concerned about the results of a dipstick test she performed at home, which showed 1+ glucose. She does not know if her liquid consumption has increased, but she urinates more frequently than before. The course of her pregnancy has been unremarkable and she has no significant co-morbidities. The BMI is 25.6 kg/cm2 and she has gained 3 kg (6.72 lb) during the pregnancy. The blood pressure is 110/80 mm Hg, the heart rate is 82/min, the respiratory rate is 14/min, and the temperature is 36.6℃ (97.9℉). The lungs are clear to auscultation, the heart sounds are normal with no murmurs, and there is no abdominal or costovertebral angle tenderness. The laboratory tests show the following results:\nFasting glucose 97 mg/L\nALT 12 IU/L\nAST 14 IU/L\nTotal bilirubin 0.8 mg/dL(15 µmol/L)\nPlasma creatinine 0.7 mg/dL (61.9 µmol/L)\nWhich of the following tests are indicated to determine the cause of the abnormal dipstick test results?\nA. HbA1c measurement\nB. No tests required\nC. Urinalysis\nD. Oral glucose tolerance test\nChoose the correct option.",
"image": null
},
{
"idx": 25,
"question": "A four-day-old neonate is brought to the pediatrician with vaginal discharge for the last two days. Her mother is concerned about the blood-tinged discharge but states that her daughter has been feeding and voiding well. The neonate was delivered at 39 weeks gestation by an uncomplicated vaginal delivery, and she and her mother were discharged home after two days. The prenatal course was complicated by chlamydia in the mother during the first trimester, for which she and the partner were both treated with a negative test of cure. The neonate’s biological father is no longer involved the patient's care, but her mother’s boyfriend has been caring for the baby whenever the mother rests. At this visit, the neonate’s temperature is 98.5°F (36.9°C), pulse is 138/min, and respirations are 51/min. She appears comfortable, and cardiopulmonary and abdominal exams are unremarkable. There are no bruises or marks on her skin. Examination of the genitals reveals no vulvar irritation or skin changes, but there is scant pink mucoid discharge at the introitus. Which of the following is the best next step in management?\nA. Vaginal exam under anesthesia\nB. Vaginal culture\nC. Warm water irrigation of the vagina\nD. Reassurance\n\nA. Vaginal exam under anesthesia\nB. Vaginal culture\nC. Warm water irrigation of the vagina\nD. Reassurance",
"options": [
"A. Vaginal exam under anesthesia",
"B. Vaginal culture",
"C. Warm water irrigation of the vagina",
"D. Reassurance"
],
"answer": "Reassurance",
"gen_text_store": "",
"pid": "25",
"query": "A four-day-old neonate is brought to the pediatrician with vaginal discharge for the last two days. Her mother is concerned about the blood-tinged discharge but states that her daughter has been feeding and voiding well. The neonate was delivered at 39 weeks gestation by an uncomplicated vaginal delivery, and she and her mother were discharged home after two days. The prenatal course was complicated by chlamydia in the mother during the first trimester, for which she and the partner were both treated with a negative test of cure. The neonate’s biological father is no longer involved the patient's care, but her mother’s boyfriend has been caring for the baby whenever the mother rests. At this visit, the neonate’s temperature is 98.5°F (36.9°C), pulse is 138/min, and respirations are 51/min. She appears comfortable, and cardiopulmonary and abdominal exams are unremarkable. There are no bruises or marks on her skin. Examination of the genitals reveals no vulvar irritation or skin changes, but there is scant pink mucoid discharge at the introitus. Which of the following is the best next step in management?\nA. Vaginal exam under anesthesia\nB. Vaginal culture\nC. Warm water irrigation of the vagina\nD. Reassurance\nChoose the correct option.",
"image": null
},
{
"idx": 26,
"question": "A group of researchers decided to explore whether the estimates of incidence and prevalence rates of systemic lupus erythematosus (SLE) were influenced by the number of years it took to examine administrative data. These estimates were not only based on hospital discharges, but also on physician billing codes. For study purposes, the researchers labeled incident cases at the initial occurrence of SLE diagnosis in the hospital database, while prevalent cases were those that were coded as harboring SLE at any time, with patients maintaining their diagnosis until death. Which statement is true regarding the relationship between incidence and prevalence rates during the time period that might be chosen for this specific study?\nA. Incidence rates will be higher during shorter time periods than longer periods.\nB. The prevalence of SLE during consecutively shorter time windows will be overestimated.\nC. The inclusion of attack rates would increase incidence estimates in longer time periods.\nD. The inclusion of attack rates would decrease incidence estimates in shorter time periods.\n\nA. Incidence rates will be higher during shorter time periods than longer periods.\nB. The prevalence of SLE during consecutively shorter time windows will be overestimated.\nC. The inclusion of attack rates would increase incidence estimates in longer time periods.\nD. The inclusion of attack rates would decrease incidence estimates in shorter time periods.",
"options": [
"A. Incidence rates will be higher during shorter time periods than longer periods.",
"B. The prevalence of SLE during consecutively shorter time windows will be overestimated.",
"C. The inclusion of attack rates would increase incidence estimates in longer time periods.",
"D. The inclusion of attack rates would decrease incidence estimates in shorter time periods."
],
"answer": "Incidence rates will be higher during shorter time periods than longer periods.",
"gen_text_store": "",
"pid": "26",
"query": "A group of researchers decided to explore whether the estimates of incidence and prevalence rates of systemic lupus erythematosus (SLE) were influenced by the number of years it took to examine administrative data. These estimates were not only based on hospital discharges, but also on physician billing codes. For study purposes, the researchers labeled incident cases at the initial occurrence of SLE diagnosis in the hospital database, while prevalent cases were those that were coded as harboring SLE at any time, with patients maintaining their diagnosis until death. Which statement is true regarding the relationship between incidence and prevalence rates during the time period that might be chosen for this specific study?\nA. Incidence rates will be higher during shorter time periods than longer periods.\nB. The prevalence of SLE during consecutively shorter time windows will be overestimated.\nC. The inclusion of attack rates would increase incidence estimates in longer time periods.\nD. The inclusion of attack rates would decrease incidence estimates in shorter time periods.\nChoose the correct option.",
"image": null
},
{
"idx": 27,
"question": "A 76-year-old woman visits a physician for a general medical examination. She is asymptomatic. Six months prior, she had a cerebral stroke with left hemiparesis, from which she has almost completely recovered with physiotherapy. She has a history of hypertension and atrial fibrillation (AF). She has no significant ischemic, valvular, or structural heart disease. She takes metoprolol, amlodipine, warfarin, and atorvastatin. Blood pressure is 125/70 mm Hg, pulse is 75/min with an irregular rhythm. Respirations are 13/min. She has a minor limp and weakness in her left arm and leg. Heart exam shows no abnormalities other than irregular beats. To assess adherence and therapeutic efficacy in this patient, which of the following studies should be ordered?\nA. Echocardiogram\nB. International normalized ratio\nC. Partial thromboplastin time\nD. Serum drug levels\n\nA. Echocardiogram\nB. International normalized ratio\nC. Partial thromboplastin time\nD. Serum drug levels",
"options": [
"A. Echocardiogram",
"B. International normalized ratio",
"C. Partial thromboplastin time",
"D. Serum drug levels"
],
"answer": "International normalized ratio",
"gen_text_store": "",
"pid": "27",
"query": "A 76-year-old woman visits a physician for a general medical examination. She is asymptomatic. Six months prior, she had a cerebral stroke with left hemiparesis, from which she has almost completely recovered with physiotherapy. She has a history of hypertension and atrial fibrillation (AF). She has no significant ischemic, valvular, or structural heart disease. She takes metoprolol, amlodipine, warfarin, and atorvastatin. Blood pressure is 125/70 mm Hg, pulse is 75/min with an irregular rhythm. Respirations are 13/min. She has a minor limp and weakness in her left arm and leg. Heart exam shows no abnormalities other than irregular beats. To assess adherence and therapeutic efficacy in this patient, which of the following studies should be ordered?\nA. Echocardiogram\nB. International normalized ratio\nC. Partial thromboplastin time\nD. Serum drug levels\nChoose the correct option.",
"image": null
},
{
"idx": 28,
"question": "A 16-year-old boy with a seizure disorder and cognitive delay is brought to the physician because of progressively worsening right lower extremity weakness for the past 6 months. He does not make eye contact and sits very close to his mother. Physical examination shows a grade 3/6 holosystolic murmur at the cardiac apex. Neurological examination shows decreased strength in the right lower leg with normal strength in the other extremities. Fundoscopic examination shows several multinodular, calcified lesions in the retina bilaterally. A photograph of his skin findings is shown. This patient's condition is most likely due to a mutation in which of the following?\nA. NF1 gene on chromosome 17\nB. NF2 gene on chromosome 22\nC. TSC1 gene on chromosome 9\nD. VHL gene on chromosome 3\n\nA. NF1 gene on chromosome 17\nB. NF2 gene on chromosome 22\nC. TSC1 gene on chromosome 9\nD. VHL gene on chromosome 3",
"options": [
"A. NF1 gene on chromosome 17",
"B. NF2 gene on chromosome 22",
"C. TSC1 gene on chromosome 9",
"D. VHL gene on chromosome 3"
],
"answer": "TSC1 gene on chromosome 9",
"gen_text_store": "",
"pid": "28",
"query": "A 16-year-old boy with a seizure disorder and cognitive delay is brought to the physician because of progressively worsening right lower extremity weakness for the past 6 months. He does not make eye contact and sits very close to his mother. Physical examination shows a grade 3/6 holosystolic murmur at the cardiac apex. Neurological examination shows decreased strength in the right lower leg with normal strength in the other extremities. Fundoscopic examination shows several multinodular, calcified lesions in the retina bilaterally. A photograph of his skin findings is shown. This patient's condition is most likely due to a mutation in which of the following?\nA. NF1 gene on chromosome 17\nB. NF2 gene on chromosome 22\nC. TSC1 gene on chromosome 9\nD. VHL gene on chromosome 3\nChoose the correct option.",
"image": null
},
{
"idx": 29,
"question": "A 75-year-old woman presents to the emergency department with 30 minutes of slurred speech and arm weakness. On the drive over to the hospital, her symptoms have resolved completely. The patient has a past medical history of hypertension, atrial fibrillation, diabetes, morbid obesity, gout, and vascular claudication. Her temperature is 99.0°F (37.2°C), blood pressure is 184/111 mmHg, pulse is 88/min, respirations are 15/min, and oxygen saturation is 98% on room air. Physical exam reveals cranial nerves II-XII as grossly intact with normal strength and sensation in the patient's upper and lower extremities. The patient's memory is intact and her speech seems normal and fluent. Her gait is stable with no ataxia. An initial head CT demonstrates diffuse atrophy which is consistent with previous head CT scans. Which of the following is the best next step in management?\nA. CT angiogram\nB. Echocardiogram\nC. Heparin\nD. MRI\n\nA. CT angiogram\nB. Echocardiogram\nC. Heparin\nD. MRI",
"options": [
"A. CT angiogram",
"B. Echocardiogram",
"C. Heparin",
"D. MRI"
],
"answer": "CT angiogram",
"gen_text_store": "",
"pid": "29",
"query": "A 75-year-old woman presents to the emergency department with 30 minutes of slurred speech and arm weakness. On the drive over to the hospital, her symptoms have resolved completely. The patient has a past medical history of hypertension, atrial fibrillation, diabetes, morbid obesity, gout, and vascular claudication. Her temperature is 99.0°F (37.2°C), blood pressure is 184/111 mmHg, pulse is 88/min, respirations are 15/min, and oxygen saturation is 98% on room air. Physical exam reveals cranial nerves II-XII as grossly intact with normal strength and sensation in the patient's upper and lower extremities. The patient's memory is intact and her speech seems normal and fluent. Her gait is stable with no ataxia. An initial head CT demonstrates diffuse atrophy which is consistent with previous head CT scans. Which of the following is the best next step in management?\nA. CT angiogram\nB. Echocardiogram\nC. Heparin\nD. MRI\nChoose the correct option.",
"image": null
},
{
"idx": 30,
"question": "An investigator is studying the pattern of glutamate release from presynaptic nerve terminals in human volunteers with Alzheimer disease. The concentration of glutamate in the CA1 region of the hippocampus is measured using magnetic resonance spectroscopy after Schaffer collateral fibers are electrically stimulated. Which of the following events most likely occurs immediately prior to the release of neurotransmitters?\nA. Activation of G protein-coupled receptors\nB. Accumulation of cAMP\nC. Opening of ligand-gated ion channels\nD. Influx of calcium\n\nA. Activation of G protein-coupled receptors\nB. Accumulation of cAMP\nC. Opening of ligand-gated ion channels\nD. Influx of calcium",
"options": [
"A. Activation of G protein-coupled receptors",
"B. Accumulation of cAMP",
"C. Opening of ligand-gated ion channels",
"D. Influx of calcium"
],
"answer": "Influx of calcium",
"gen_text_store": "",
"pid": "30",
"query": "An investigator is studying the pattern of glutamate release from presynaptic nerve terminals in human volunteers with Alzheimer disease. The concentration of glutamate in the CA1 region of the hippocampus is measured using magnetic resonance spectroscopy after Schaffer collateral fibers are electrically stimulated. Which of the following events most likely occurs immediately prior to the release of neurotransmitters?\nA. Activation of G protein-coupled receptors\nB. Accumulation of cAMP\nC. Opening of ligand-gated ion channels\nD. Influx of calcium\nChoose the correct option.",
"image": null
},
{
"idx": 31,
"question": "A 35-year-old woman presents to her primary care provider concerned that she may be pregnant. She has a history of regular menstruation every 4 weeks that lasts about 4 days with mild to moderate bleeding, but she missed her last period 2 weeks ago. A home pregnancy test was positive. She has a 6-year history of hyperthyroidism that is well-controlled with daily methimazole. She is currently asymptomatic and has no complaints or concerns. A blood specimen is taken and confirms the diagnosis. Additionally, her thyroid-stimulating hormone (TSH) is 2.0 μU/mL. Which of the following is the next best step in the management of this patient?\nA. Continue methimazole\nB. Discontinue methimazole, start propylthiouracil\nC. Add glucocorticoids\nD. Refer for radioiodine therapy\n\nA. Continue methimazole\nB. Discontinue methimazole, start propylthiouracil\nC. Add glucocorticoids\nD. Refer for radioiodine therapy",
"options": [
"A. Continue methimazole",
"B. Discontinue methimazole, start propylthiouracil",
"C. Add glucocorticoids",
"D. Refer for radioiodine therapy"
],
"answer": "Discontinue methimazole, start propylthiouracil",
"gen_text_store": "",
"pid": "31",
"query": "A 35-year-old woman presents to her primary care provider concerned that she may be pregnant. She has a history of regular menstruation every 4 weeks that lasts about 4 days with mild to moderate bleeding, but she missed her last period 2 weeks ago. A home pregnancy test was positive. She has a 6-year history of hyperthyroidism that is well-controlled with daily methimazole. She is currently asymptomatic and has no complaints or concerns. A blood specimen is taken and confirms the diagnosis. Additionally, her thyroid-stimulating hormone (TSH) is 2.0 μU/mL. Which of the following is the next best step in the management of this patient?\nA. Continue methimazole\nB. Discontinue methimazole, start propylthiouracil\nC. Add glucocorticoids\nD. Refer for radioiodine therapy\nChoose the correct option.",
"image": null
},
{
"idx": 32,
"question": "A 63-year-old man is aiming to improve his health by eating a well balanced diet, walking daily, and quitting smoking following a 45-year smoking history. While on his daily walks he notices a strong cramping pain in his calves that consistently appears after a mile of walking. He sees his physician and a diagnosis of peripheral artery disease with intermittent claudication is made. To improve his symptoms, cilostazol is prescribed. What is the mechanism of action of this medication?\nA. Irreversible cyclooxygenase inhibitor\nB. Thromboxane synthase inhibitor\nC. Adenosine diphosphate receptor inhibitor\nD. Phosphodiesterase inhibitor\n\nA. Irreversible cyclooxygenase inhibitor\nB. Thromboxane synthase inhibitor\nC. Adenosine diphosphate receptor inhibitor\nD. Phosphodiesterase inhibitor",
"options": [
"A. Irreversible cyclooxygenase inhibitor",
"B. Thromboxane synthase inhibitor",
"C. Adenosine diphosphate receptor inhibitor",
"D. Phosphodiesterase inhibitor"
],
"answer": "Phosphodiesterase inhibitor",
"gen_text_store": "",
"pid": "32",
"query": "A 63-year-old man is aiming to improve his health by eating a well balanced diet, walking daily, and quitting smoking following a 45-year smoking history. While on his daily walks he notices a strong cramping pain in his calves that consistently appears after a mile of walking. He sees his physician and a diagnosis of peripheral artery disease with intermittent claudication is made. To improve his symptoms, cilostazol is prescribed. What is the mechanism of action of this medication?\nA. Irreversible cyclooxygenase inhibitor\nB. Thromboxane synthase inhibitor\nC. Adenosine diphosphate receptor inhibitor\nD. Phosphodiesterase inhibitor\nChoose the correct option.",
"image": null
},
{
"idx": 33,
"question": "A 25-year-old woman comes to the physician because of irregular menstrual bleeding. Menses have occurred at 30- to 90-day intervals since menarche at the age of 12 years. Her last menstrual period was 6 weeks ago. She is sexually active with her husband and they do not use condoms. There is no personal or family history of serious illness. She is 170 cm (5 ft 7 in) tall and weighs 73 kg (161 lb); BMI is 25.3 kg/m2. Her vital signs are within normal limits. Examination shows oily skin and severe acne on the face. There is dark hair on the upper lip and around both nipples. Laboratory studies show:\nDehydroepiandrosterone sulfate 6.2 μg/mL (N=0.5–5.4)\nFollicle-stimulating hormone 20 mIU/mL\nLuteinizing hormone 160 mIU/mL\nTestosterone 4.1 nmol/L (N < 3.5)\nA urine pregnancy test is negative. Which of the following tests is the most appropriate next step in screening for comorbidities in this patient?\"\nA. 17-hydroxyprogesterone and cortisol level measurements\nB. CA-125 level measurement\nC. Blood glucose and cholesterol level measurements\nD. TSH and T4 level measurements\n\nA. 17-hydroxyprogesterone and cortisol level measurements\nB. CA-125 level measurement\nC. Blood glucose and cholesterol level measurements\nD. TSH and T4 level measurements",
"options": [
"A. 17-hydroxyprogesterone and cortisol level measurements",
"B. CA-125 level measurement",
"C. Blood glucose and cholesterol level measurements",
"D. TSH and T4 level measurements"
],
"answer": "Blood glucose and cholesterol level measurements",
"gen_text_store": "",
"pid": "33",
"query": "A 25-year-old woman comes to the physician because of irregular menstrual bleeding. Menses have occurred at 30- to 90-day intervals since menarche at the age of 12 years. Her last menstrual period was 6 weeks ago. She is sexually active with her husband and they do not use condoms. There is no personal or family history of serious illness. She is 170 cm (5 ft 7 in) tall and weighs 73 kg (161 lb); BMI is 25.3 kg/m2. Her vital signs are within normal limits. Examination shows oily skin and severe acne on the face. There is dark hair on the upper lip and around both nipples. Laboratory studies show:\nDehydroepiandrosterone sulfate 6.2 μg/mL (N=0.5–5.4)\nFollicle-stimulating hormone 20 mIU/mL\nLuteinizing hormone 160 mIU/mL\nTestosterone 4.1 nmol/L (N < 3.5)\nA urine pregnancy test is negative. Which of the following tests is the most appropriate next step in screening for comorbidities in this patient?\"\nA. 17-hydroxyprogesterone and cortisol level measurements\nB. CA-125 level measurement\nC. Blood glucose and cholesterol level measurements\nD. TSH and T4 level measurements\nChoose the correct option.",
"image": null
},
{
"idx": 34,
"question": "During the normal catabolism of protein, urea and ammonia are produced as waste products. If these waste products are not cleared by the liver and kidneys, hyperammonemia can occur, leading to confusion and delirium. Fortunately, a healthy liver can clear these waste products via the urea cycle. Which of the following reactions is the rate limiting step in this cycle?\nA. NH3 + HCO3- + 2 ATP --> carbamoyl phosphate + 2 ADP + Pi\nB. Carbamoyl phosphate + ornithine --> citrulline+ Pi\nC. Citrulline + aspartate + ATP --> arginosuccinate + AMP + PPi\nD. Arginine + H20 --> ornithine + urea\n\nA. NH3 + HCO3- + 2 ATP --> carbamoyl phosphate + 2 ADP + Pi\nB. Carbamoyl phosphate + ornithine --> citrulline+ Pi\nC. Citrulline + aspartate + ATP --> arginosuccinate + AMP + PPi\nD. Arginine + H20 --> ornithine + urea",
"options": [
"A. NH3 + HCO3- + 2 ATP --> carbamoyl phosphate + 2 ADP + Pi",
"B. Carbamoyl phosphate + ornithine --> citrulline+ Pi",
"C. Citrulline + aspartate + ATP --> arginosuccinate + AMP + PPi",
"D. Arginine + H20 --> ornithine + urea"
],
"answer": "NH3 + HCO3- + 2 ATP --> carbamoyl phosphate + 2 ADP + Pi",
"gen_text_store": "",
"pid": "34",
"query": "During the normal catabolism of protein, urea and ammonia are produced as waste products. If these waste products are not cleared by the liver and kidneys, hyperammonemia can occur, leading to confusion and delirium. Fortunately, a healthy liver can clear these waste products via the urea cycle. Which of the following reactions is the rate limiting step in this cycle?\nA. NH3 + HCO3- + 2 ATP --> carbamoyl phosphate + 2 ADP + Pi\nB. Carbamoyl phosphate + ornithine --> citrulline+ Pi\nC. Citrulline + aspartate + ATP --> arginosuccinate + AMP + PPi\nD. Arginine + H20 --> ornithine + urea\nChoose the correct option.",
"image": null
},
{
"idx": 35,
"question": "A 65-year-old man with metastatic lung cancer has been experiencing severe, unremitting pain. He has required escalating doses of oral morphine, but is now having dose limiting side-effects. His pain management team recommends using a medication that can reduce his opioid need through interaction with the NMDA-receptor. Which of the following was the most likely recommended agent?\nA. Propofol\nB. Ketamine\nC. Fentanyl\nD. Midazolam\n\nA. Propofol\nB. Ketamine\nC. Fentanyl\nD. Midazolam",
"options": [
"A. Propofol",
"B. Ketamine",
"C. Fentanyl",
"D. Midazolam"
],
"answer": "Ketamine",
"gen_text_store": "",
"pid": "35",
"query": "A 65-year-old man with metastatic lung cancer has been experiencing severe, unremitting pain. He has required escalating doses of oral morphine, but is now having dose limiting side-effects. His pain management team recommends using a medication that can reduce his opioid need through interaction with the NMDA-receptor. Which of the following was the most likely recommended agent?\nA. Propofol\nB. Ketamine\nC. Fentanyl\nD. Midazolam\nChoose the correct option.",
"image": null
},
{
"idx": 36,
"question": "An 81-year-old man is brought to the clinic by his son to be evaluated for memory issues. The patient’s son says he has difficulty remembering recent events and names. He says the patient’s symptoms have progressively worsened over the last several years but became acutely worse just recently. Also, yesterday, the patient complained that he could not see out of his right eye, but today he can. When asked about these concerns, the patient seems to have no insight into the problem and reports feeling well. His medical history is significant for diabetes mellitus type 2 and hypertension. He had a left basal ganglia hemorrhage 12 years ago and a right middle cerebral artery infarction 4 years ago. Current medications are amlodipine, aspirin, clopidogrel, metformin, sitagliptin, and valsartan. He lives with his son and can feed himself and change his clothes. There is no history of urinary or fecal incontinence. His vitals include: blood pressure 137/82 mm Hg, pulse 78/min, respiratory rate 16/min, temperature 37.0°C (98.6°F). On physical examination, the patient is alert and oriented. He is unable to perform simple arithmetic calculations and the mini-mental status exam is inconclusive. He can write his name and comprehend written instructions. Muscle strength is 4/5 on the right side. The tone is also slightly reduced on the right side with exaggerated reflexes. His gait is hemiparetic. Which of the following is the most likely diagnosis in this patient?\nA. Alzheimer's disease\nB. Lewy body dementia\nC. Normal-pressure hydrocephalus\nD. Vascular dementia\n\nA. Alzheimer's disease\nB. Lewy body dementia\nC. Normal-pressure hydrocephalus\nD. Vascular dementia",
"options": [
"A. Alzheimer's disease",
"B. Lewy body dementia",
"C. Normal-pressure hydrocephalus",
"D. Vascular dementia"
],
"answer": "Vascular dementia",
"gen_text_store": "",
"pid": "36",
"query": "An 81-year-old man is brought to the clinic by his son to be evaluated for memory issues. The patient’s son says he has difficulty remembering recent events and names. He says the patient’s symptoms have progressively worsened over the last several years but became acutely worse just recently. Also, yesterday, the patient complained that he could not see out of his right eye, but today he can. When asked about these concerns, the patient seems to have no insight into the problem and reports feeling well. His medical history is significant for diabetes mellitus type 2 and hypertension. He had a left basal ganglia hemorrhage 12 years ago and a right middle cerebral artery infarction 4 years ago. Current medications are amlodipine, aspirin, clopidogrel, metformin, sitagliptin, and valsartan. He lives with his son and can feed himself and change his clothes. There is no history of urinary or fecal incontinence. His vitals include: blood pressure 137/82 mm Hg, pulse 78/min, respiratory rate 16/min, temperature 37.0°C (98.6°F). On physical examination, the patient is alert and oriented. He is unable to perform simple arithmetic calculations and the mini-mental status exam is inconclusive. He can write his name and comprehend written instructions. Muscle strength is 4/5 on the right side. The tone is also slightly reduced on the right side with exaggerated reflexes. His gait is hemiparetic. Which of the following is the most likely diagnosis in this patient?\nA. Alzheimer's disease\nB. Lewy body dementia\nC. Normal-pressure hydrocephalus\nD. Vascular dementia\nChoose the correct option.",
"image": null
},
{
"idx": 37,
"question": "A 28-year-old woman is brought to the emergency room after a motor vehicle accident. On arrival, she is stable and says that she hit a car at an intersection that \"came out of nowhere\". She states that she had similar close encounters with other cars these past few weeks but was able to avoid collisions with those. She has also had intermittent headaches over the last month and has noticed that her shirts have been getting wet unexpectedly. Blood tests reveal an abnormal elevation of a circulating substance. Which of following changes is also associated with the physiologic function of the most likely substance in this case?\nA. Decreased oxytocin\nB. Decreased progesterone\nC. Increased follicle stimulating hormone\nD. Increased progesterone\n\nA. Decreased oxytocin\nB. Decreased progesterone\nC. Increased follicle stimulating hormone\nD. Increased progesterone",
"options": [
"A. Decreased oxytocin",
"B. Decreased progesterone",
"C. Increased follicle stimulating hormone",
"D. Increased progesterone"
],
"answer": "Decreased progesterone",
"gen_text_store": "",
"pid": "37",
"query": "A 28-year-old woman is brought to the emergency room after a motor vehicle accident. On arrival, she is stable and says that she hit a car at an intersection that \"came out of nowhere\". She states that she had similar close encounters with other cars these past few weeks but was able to avoid collisions with those. She has also had intermittent headaches over the last month and has noticed that her shirts have been getting wet unexpectedly. Blood tests reveal an abnormal elevation of a circulating substance. Which of following changes is also associated with the physiologic function of the most likely substance in this case?\nA. Decreased oxytocin\nB. Decreased progesterone\nC. Increased follicle stimulating hormone\nD. Increased progesterone\nChoose the correct option.",
"image": null
},
{
"idx": 38,
"question": "A 25-year-old African American man presents to his primary care provider for routine blood work. He is a well-known case of sickle cell disease treated with hydroxyurea and tramadol as needed for pain. He does not smoke or drink alcohol. The patient asks if his disease can adversely affect his kidneys because his friend was recently diagnosed with end-stage renal failure. Which of the following is a renal complication of sickle cell disease?\nA. Membranous glomerulonephritis\nB. Proximal renal tubular acidosis\nC. Impaired urine diluting ability\nD. Impaired urine concentration ability\n\nA. Membranous glomerulonephritis\nB. Proximal renal tubular acidosis\nC. Impaired urine diluting ability\nD. Impaired urine concentration ability",
"options": [
"A. Membranous glomerulonephritis",
"B. Proximal renal tubular acidosis",
"C. Impaired urine diluting ability",
"D. Impaired urine concentration ability"
],
"answer": "Impaired urine concentration ability",
"gen_text_store": "",
"pid": "38",
"query": "A 25-year-old African American man presents to his primary care provider for routine blood work. He is a well-known case of sickle cell disease treated with hydroxyurea and tramadol as needed for pain. He does not smoke or drink alcohol. The patient asks if his disease can adversely affect his kidneys because his friend was recently diagnosed with end-stage renal failure. Which of the following is a renal complication of sickle cell disease?\nA. Membranous glomerulonephritis\nB. Proximal renal tubular acidosis\nC. Impaired urine diluting ability\nD. Impaired urine concentration ability\nChoose the correct option.",
"image": null
},
{
"idx": 39,
"question": "A 24-year-old woman is brought to the emergency room (ER) by her co-workers after they found her unconscious in her cubicle when they returned from lunch. They tell you that she has diabetes but do not know anything more about her condition. The woman’s vital signs include: pulse 110/min, respiratory rate 24/min, temperature 36.7°C (98.0°F), and blood pressure 90/60 mm Hg. On physical examination, the patient is breathing heavily and gives irrelevant responses to questions. The skin and mucous membranes appear dry. Examination of the abdomen reveals mild diffuse tenderness to palpation. Deep tendon reflexes in the extremities are 1+ bilaterally. Laboratory studies show:\nFinger stick glucose 630 mg/dL\nArterial blood gas analysis:\npH 7.1\nPO2 90 mm Hg\nPCO2 33 mm Hg\nHCO3 8 mEq/L\nSerum:\nSodium 135 mEq/L\nPotassium 3.1 mEq/L\nChloride 136 mEq/L\nBlood urea nitrogen 20 mg/dL\nSerum creatinine 1.2 mg/dL\nUrine examination shows:\nGlucose Positive\nKetones Positive\nLeukocytes Negative\nNitrite Negative\nRBCs Negative\nCasts Negative\nThe patient is immediately started on a bolus of intravenous (IV) 0.9% sodium chloride (NaCl). Which of the following is the next best step in the management of this patient?\nA. Infuse NaHCO3 slowly\nB. Switch fluids to 0.45% NaCl\nC. Start IV insulin infusion\nD. Replace potassium intravenously\n\nA. Infuse NaHCO3 slowly\nB. Switch fluids to 0.45% NaCl\nC. Start IV insulin infusion\nD. Replace potassium intravenously",
"options": [
"A. Infuse NaHCO3 slowly",
"B. Switch fluids to 0.45% NaCl",
"C. Start IV insulin infusion",
"D. Replace potassium intravenously"
],
"answer": "Replace potassium intravenously",
"gen_text_store": "",
"pid": "39",
"query": "A 24-year-old woman is brought to the emergency room (ER) by her co-workers after they found her unconscious in her cubicle when they returned from lunch. They tell you that she has diabetes but do not know anything more about her condition. The woman’s vital signs include: pulse 110/min, respiratory rate 24/min, temperature 36.7°C (98.0°F), and blood pressure 90/60 mm Hg. On physical examination, the patient is breathing heavily and gives irrelevant responses to questions. The skin and mucous membranes appear dry. Examination of the abdomen reveals mild diffuse tenderness to palpation. Deep tendon reflexes in the extremities are 1+ bilaterally. Laboratory studies show:\nFinger stick glucose 630 mg/dL\nArterial blood gas analysis:\npH 7.1\nPO2 90 mm Hg\nPCO2 33 mm Hg\nHCO3 8 mEq/L\nSerum:\nSodium 135 mEq/L\nPotassium 3.1 mEq/L\nChloride 136 mEq/L\nBlood urea nitrogen 20 mg/dL\nSerum creatinine 1.2 mg/dL\nUrine examination shows:\nGlucose Positive\nKetones Positive\nLeukocytes Negative\nNitrite Negative\nRBCs Negative\nCasts Negative\nThe patient is immediately started on a bolus of intravenous (IV) 0.9% sodium chloride (NaCl). Which of the following is the next best step in the management of this patient?\nA. Infuse NaHCO3 slowly\nB. Switch fluids to 0.45% NaCl\nC. Start IV insulin infusion\nD. Replace potassium intravenously\nChoose the correct option.",
"image": null
},
{
"idx": 40,
"question": "A 27-year-old man presents to the emergency department after a motor vehicle accident. The patient has a past medical history of asthma and cocaine use. His current medications include albuterol and ibuprofen. His temperature is 99.5°F (37.5°C), blood pressure is 70/35 mmHg, pulse is 150/min, respirations are 19/min, and oxygen saturation is 98% on room air. On initial trauma evaluation, his airway is intact and he is breathing spontaneously. The patient's dorsalis pedis and radial pulses are palpable bilaterally. His Glasgow Coma Scale is 9. Head to toe examination reveals instability of the pelvis when downwards force is applied. The patient is started on IV fluids and norepinephrine, and a pelvic binder is placed. The patient's vitals are measured again and his temperature is 99.5°F (37.5°C), blood pressure is 100/55 mmHg, pulse is 150/min, respirations are 17/min, and oxygen saturation is 98% on room air. A blood transfusion is started, and the patient is given hydromorphone. The patient suddenly becomes short of breath with notable bilateral wheezing with poor air movement. His blood pressure is 60/35 mmHg and pulse is 160/min. The patient is treated appropriately, intubated, stabilized, and transferred to the surgical intensive care unit. Which of the following is most likely to be found in this patient's history?\nA. Hemolytic anemia and ataxia\nB. Gum disease and poor wound healing\nC. Irregularly irregular heart rhythm\nD. Anti-A, B, or O antibodies in the serum\n\nA. Hemolytic anemia and ataxia\nB. Gum disease and poor wound healing\nC. Irregularly irregular heart rhythm\nD. Anti-A, B, or O antibodies in the serum",
"options": [
"A. Hemolytic anemia and ataxia",
"B. Gum disease and poor wound healing",
"C. Irregularly irregular heart rhythm",
"D. Anti-A, B, or O antibodies in the serum"
],
"answer": "Hemolytic anemia and ataxia",
"gen_text_store": "",
"pid": "40",
"query": "A 27-year-old man presents to the emergency department after a motor vehicle accident. The patient has a past medical history of asthma and cocaine use. His current medications include albuterol and ibuprofen. His temperature is 99.5°F (37.5°C), blood pressure is 70/35 mmHg, pulse is 150/min, respirations are 19/min, and oxygen saturation is 98% on room air. On initial trauma evaluation, his airway is intact and he is breathing spontaneously. The patient's dorsalis pedis and radial pulses are palpable bilaterally. His Glasgow Coma Scale is 9. Head to toe examination reveals instability of the pelvis when downwards force is applied. The patient is started on IV fluids and norepinephrine, and a pelvic binder is placed. The patient's vitals are measured again and his temperature is 99.5°F (37.5°C), blood pressure is 100/55 mmHg, pulse is 150/min, respirations are 17/min, and oxygen saturation is 98% on room air. A blood transfusion is started, and the patient is given hydromorphone. The patient suddenly becomes short of breath with notable bilateral wheezing with poor air movement. His blood pressure is 60/35 mmHg and pulse is 160/min. The patient is treated appropriately, intubated, stabilized, and transferred to the surgical intensive care unit. Which of the following is most likely to be found in this patient's history?\nA. Hemolytic anemia and ataxia\nB. Gum disease and poor wound healing\nC. Irregularly irregular heart rhythm\nD. Anti-A, B, or O antibodies in the serum\nChoose the correct option.",
"image": null
},
{
"idx": 41,
"question": "A 58-year-old man is brought to the emergency department because of sudden-onset right-sided body numbness for 1 hour. He reports that he has a 15-year history of hypertension treated with hydrochlorothiazide. He is alert and oriented to time, place, and person. Neurological examination shows decreased sensation to light pinprick and temperature on the right side of the face and body. Motor strength is 5/5 and deep tendon reflexes are 2+ bilaterally. Perfusion of which of the following structures of the brain is most likely impaired in this patient?\nA. Posterior limb of the internal capsule\nB. Lateral medulla\nC. Basal pons\nD. Ventral thalamus\n\nA. Posterior limb of the internal capsule\nB. Lateral medulla\nC. Basal pons\nD. Ventral thalamus",
"options": [
"A. Posterior limb of the internal capsule",
"B. Lateral medulla",
"C. Basal pons",
"D. Ventral thalamus"
],
"answer": "Ventral thalamus",
"gen_text_store": "",
"pid": "41",
"query": "A 58-year-old man is brought to the emergency department because of sudden-onset right-sided body numbness for 1 hour. He reports that he has a 15-year history of hypertension treated with hydrochlorothiazide. He is alert and oriented to time, place, and person. Neurological examination shows decreased sensation to light pinprick and temperature on the right side of the face and body. Motor strength is 5/5 and deep tendon reflexes are 2+ bilaterally. Perfusion of which of the following structures of the brain is most likely impaired in this patient?\nA. Posterior limb of the internal capsule\nB. Lateral medulla\nC. Basal pons\nD. Ventral thalamus\nChoose the correct option.",
"image": null
},
{
"idx": 42,
"question": "A 50-year-old man with congestive heart failure (CHF) was started on an experimental analog of atrial natriuretic peptide. Which of the following would he expect to experience?\nA. Increased water reabsorption by the renal collecting ducts\nB. Vasoconstriction, increased blood pressure, aldosterone release\nC. Increased glomerular filtration rate, restricted aldosterone release, vascular smooth muscle dilation\nD. Increased plasma calcium and decreased renal reabsorption of phosphate\n\nA. Increased water reabsorption by the renal collecting ducts\nB. Vasoconstriction, increased blood pressure, aldosterone release\nC. Increased glomerular filtration rate, restricted aldosterone release, vascular smooth muscle dilation\nD. Increased plasma calcium and decreased renal reabsorption of phosphate",
"options": [
"A. Increased water reabsorption by the renal collecting ducts",
"B. Vasoconstriction, increased blood pressure, aldosterone release",
"C. Increased glomerular filtration rate, restricted aldosterone release, vascular smooth muscle dilation",
"D. Increased plasma calcium and decreased renal reabsorption of phosphate"
],
"answer": "Increased glomerular filtration rate, restricted aldosterone release, vascular smooth muscle dilation",
"gen_text_store": "",
"pid": "42",
"query": "A 50-year-old man with congestive heart failure (CHF) was started on an experimental analog of atrial natriuretic peptide. Which of the following would he expect to experience?\nA. Increased water reabsorption by the renal collecting ducts\nB. Vasoconstriction, increased blood pressure, aldosterone release\nC. Increased glomerular filtration rate, restricted aldosterone release, vascular smooth muscle dilation\nD. Increased plasma calcium and decreased renal reabsorption of phosphate\nChoose the correct option.",
"image": null
},
{
"idx": 43,
"question": "A 7-year-old boy is rushed to the emergency room after losing consciousness 30 mins ago at home. The patient’s mother says that he has had a “running nose” for the past few days However, he did not receive any treatment for it, and his condition rapidly worsened today. He does not have any significant past medical history. His vaccination records are up to date. His temperature is 38.2°C (100.7°F), blood pressure is 90/50 mm Hg, heart rate is 120/min, and respiratory rate is 22/min. On physical examination, the patient is unresponsive. There is a petechial rash present on his chest, and he has some neck rigidity. Empiric intravenous antibiotics are started, and a lumbar puncture is performed. Which of the following is the most likely cause of this patient’s low blood pressure?\nA. Human immunodeficiency virus infection\nB. Hypertrophic cardiomyopathy\nC. Adrenocortical insufficiency\nD. Pheochromocytoma\n\nA. Human immunodeficiency virus infection\nB. Hypertrophic cardiomyopathy\nC. Adrenocortical insufficiency\nD. Pheochromocytoma",
"options": [
"A. Human immunodeficiency virus infection",
"B. Hypertrophic cardiomyopathy",
"C. Adrenocortical insufficiency",
"D. Pheochromocytoma"
],
"answer": "Adrenocortical insufficiency",
"gen_text_store": "",
"pid": "43",
"query": "A 7-year-old boy is rushed to the emergency room after losing consciousness 30 mins ago at home. The patient’s mother says that he has had a “running nose” for the past few days However, he did not receive any treatment for it, and his condition rapidly worsened today. He does not have any significant past medical history. His vaccination records are up to date. His temperature is 38.2°C (100.7°F), blood pressure is 90/50 mm Hg, heart rate is 120/min, and respiratory rate is 22/min. On physical examination, the patient is unresponsive. There is a petechial rash present on his chest, and he has some neck rigidity. Empiric intravenous antibiotics are started, and a lumbar puncture is performed. Which of the following is the most likely cause of this patient’s low blood pressure?\nA. Human immunodeficiency virus infection\nB. Hypertrophic cardiomyopathy\nC. Adrenocortical insufficiency\nD. Pheochromocytoma\nChoose the correct option.",
"image": null
},
{
"idx": 44,
"question": "A researcher is studying risk factors for open-angle glaucoma in a group of elderly patients at a primary care clinic. He is curious if patients with diabetes (defined as fasting serum glucose ≥126 mg/dL on two separate readings) are at increased risk of developing open-angle glaucoma over time. Which of the following is the best statement of the null hypothesis for this study?\nA. The future risk of open-angle glaucoma is the same in patients with and those without diabetes\nB. Having diabetes will not cause changes in risk of future open-angle glaucoma\nC. Diabetes is not associated with an increased prevalence of open-angle glaucoma\nD. Improved adherence to antidiabetics will not be effective in decreasing future open-angle glaucoma risk\n\nA. The future risk of open-angle glaucoma is the same in patients with and those without diabetes\nB. Having diabetes will not cause changes in risk of future open-angle glaucoma\nC. Diabetes is not associated with an increased prevalence of open-angle glaucoma\nD. Improved adherence to antidiabetics will not be effective in decreasing future open-angle glaucoma risk",
"options": [
"A. The future risk of open-angle glaucoma is the same in patients with and those without diabetes",
"B. Having diabetes will not cause changes in risk of future open-angle glaucoma",
"C. Diabetes is not associated with an increased prevalence of open-angle glaucoma",
"D. Improved adherence to antidiabetics will not be effective in decreasing future open-angle glaucoma risk"
],
"answer": "The future risk of open-angle glaucoma is the same in patients with and those without diabetes",
"gen_text_store": "",
"pid": "44",
"query": "A researcher is studying risk factors for open-angle glaucoma in a group of elderly patients at a primary care clinic. He is curious if patients with diabetes (defined as fasting serum glucose ≥126 mg/dL on two separate readings) are at increased risk of developing open-angle glaucoma over time. Which of the following is the best statement of the null hypothesis for this study?\nA. The future risk of open-angle glaucoma is the same in patients with and those without diabetes\nB. Having diabetes will not cause changes in risk of future open-angle glaucoma\nC. Diabetes is not associated with an increased prevalence of open-angle glaucoma\nD. Improved adherence to antidiabetics will not be effective in decreasing future open-angle glaucoma risk\nChoose the correct option.",
"image": null
},
{
"idx": 45,
"question": "A 67-year-old man comes to the clinic complaining of fatigue and dizziness for the past 2 months. He reports that he gets tired easily compared to his baseline and feels dizzy when he exerts himself (e.g., when he walks long distances). His past medical history is significant for hypertension that is controlled with lisinopril. A physical examination demonstrates moderate hepatomegaly and lymphadenopathy. His laboratory studies are shown below.\n\nLeukocyte count and differential:\nLeukocyte count: 11,500/mm^3\nSegmented neutrophils: 40%\nBands: 3%\nEosinophils: 1%\nBasophils: 0%\nLymphocytes: 50%\nMonocytes: 8%\n\nHemoglobin: 11.2 g/dL\nPlatelet count: 120,000/mm^3\nMean corpuscular hemoglobin concentration: 31%\nMean corpuscular volume: 80 µm^3\nReticulocyte count: 3%\nLactate dehydrogenase: 45 U/L\n\nA subsequent flow cytometry test demonstrates CD20+ cells. What is the most likely finding you would expect in this patient?\nA. Low levels of erythropoietin\nB. Low levels of leukocyte alkaline phosphatase (LAP)\nC. Presence of hairy cells\nD. Presence of smudge cells\n\nA. Low levels of erythropoietin\nB. Low levels of leukocyte alkaline phosphatase (LAP)\nC. Presence of hairy cells\nD. Presence of smudge cells",
"options": [
"A. Low levels of erythropoietin",
"B. Low levels of leukocyte alkaline phosphatase (LAP)",
"C. Presence of hairy cells",
"D. Presence of smudge cells"
],
"answer": "Presence of smudge cells",
"gen_text_store": "",
"pid": "45",
"query": "A 67-year-old man comes to the clinic complaining of fatigue and dizziness for the past 2 months. He reports that he gets tired easily compared to his baseline and feels dizzy when he exerts himself (e.g., when he walks long distances). His past medical history is significant for hypertension that is controlled with lisinopril. A physical examination demonstrates moderate hepatomegaly and lymphadenopathy. His laboratory studies are shown below.\n\nLeukocyte count and differential:\nLeukocyte count: 11,500/mm^3\nSegmented neutrophils: 40%\nBands: 3%\nEosinophils: 1%\nBasophils: 0%\nLymphocytes: 50%\nMonocytes: 8%\n\nHemoglobin: 11.2 g/dL\nPlatelet count: 120,000/mm^3\nMean corpuscular hemoglobin concentration: 31%\nMean corpuscular volume: 80 µm^3\nReticulocyte count: 3%\nLactate dehydrogenase: 45 U/L\n\nA subsequent flow cytometry test demonstrates CD20+ cells. What is the most likely finding you would expect in this patient?\nA. Low levels of erythropoietin\nB. Low levels of leukocyte alkaline phosphatase (LAP)\nC. Presence of hairy cells\nD. Presence of smudge cells\nChoose the correct option.",
"image": null
},
{
"idx": 46,
"question": "Thirty minutes after delivery, a 3600-g (7-lb 15-oz) newborn has noisy breathing, bluish discoloration of her lips, and intermittent respiratory distress. She was born at 38 weeks' gestation and required bag-mask resuscitation immediately after delivery. Pregnancy was uncomplicated. Her mother has noticed the bluish lip discoloration worsen when she fed and improve when she cried. The patient's pulse is 163/min, respirations are 62/min, and blood pressure is 60/30 mm Hg. The crying infant's lungs are clear to auscultation. Further evaluation of this patient is most likely to show which of the following?\nA. Diffuse reticulogranular densities on chest x-ray\nB. Boot-shaped heart on chest x-ray\nC. Passage of a gastric catheter through the mouth not possible\nD. Passage of a catheter through the nasal cavity not possible\n\nA. Diffuse reticulogranular densities on chest x-ray\nB. Boot-shaped heart on chest x-ray\nC. Passage of a gastric catheter through the mouth not possible\nD. Passage of a catheter through the nasal cavity not possible",
"options": [
"A. Diffuse reticulogranular densities on chest x-ray",
"B. Boot-shaped heart on chest x-ray",
"C. Passage of a gastric catheter through the mouth not possible",
"D. Passage of a catheter through the nasal cavity not possible"
],
"answer": "Passage of a catheter through the nasal cavity not possible",
"gen_text_store": "",
"pid": "46",
"query": "Thirty minutes after delivery, a 3600-g (7-lb 15-oz) newborn has noisy breathing, bluish discoloration of her lips, and intermittent respiratory distress. She was born at 38 weeks' gestation and required bag-mask resuscitation immediately after delivery. Pregnancy was uncomplicated. Her mother has noticed the bluish lip discoloration worsen when she fed and improve when she cried. The patient's pulse is 163/min, respirations are 62/min, and blood pressure is 60/30 mm Hg. The crying infant's lungs are clear to auscultation. Further evaluation of this patient is most likely to show which of the following?\nA. Diffuse reticulogranular densities on chest x-ray\nB. Boot-shaped heart on chest x-ray\nC. Passage of a gastric catheter through the mouth not possible\nD. Passage of a catheter through the nasal cavity not possible\nChoose the correct option.",
"image": null
},
{
"idx": 47,
"question": "A 15-year-old girl comes to the physician because of episodic pelvic pain radiating to her back and thighs for 4 months. The pain occurs a few hours before her menstrual period and lasts for 2 days. She has been taking ibuprofen, which has provided some relief. Menses have occurred at regular 28-day intervals since menarche at the age of 12 years and last for 5 to 6 days. She is sexually active with two male partners and uses condoms inconsistently. Vital signs are within normal limits. Physical examination shows no abnormalities. Which of the following is the most likely cause of this patient's symptoms?\nA. Endometrial sloughing and uterine contractions mediated by prostaglandin\nB. Ascending infection of the uterus, fallopian tubes, ovaries, or surrounding tissue\nC. Fluid-filled sac within the ovary\nD. Hormone-sensitive smooth muscle tumor of the myometrium\n\nA. Endometrial sloughing and uterine contractions mediated by prostaglandin\nB. Ascending infection of the uterus, fallopian tubes, ovaries, or surrounding tissue\nC. Fluid-filled sac within the ovary\nD. Hormone-sensitive smooth muscle tumor of the myometrium",
"options": [
"A. Endometrial sloughing and uterine contractions mediated by prostaglandin",
"B. Ascending infection of the uterus, fallopian tubes, ovaries, or surrounding tissue",
"C. Fluid-filled sac within the ovary",
"D. Hormone-sensitive smooth muscle tumor of the myometrium"
],
"answer": "Endometrial sloughing and uterine contractions mediated by prostaglandin",
"gen_text_store": "",
"pid": "47",
"query": "A 15-year-old girl comes to the physician because of episodic pelvic pain radiating to her back and thighs for 4 months. The pain occurs a few hours before her menstrual period and lasts for 2 days. She has been taking ibuprofen, which has provided some relief. Menses have occurred at regular 28-day intervals since menarche at the age of 12 years and last for 5 to 6 days. She is sexually active with two male partners and uses condoms inconsistently. Vital signs are within normal limits. Physical examination shows no abnormalities. Which of the following is the most likely cause of this patient's symptoms?\nA. Endometrial sloughing and uterine contractions mediated by prostaglandin\nB. Ascending infection of the uterus, fallopian tubes, ovaries, or surrounding tissue\nC. Fluid-filled sac within the ovary\nD. Hormone-sensitive smooth muscle tumor of the myometrium\nChoose the correct option.",
"image": null
},
{
"idx": 48,
"question": "A 35-year-old man comes to the physician because of episodes of difficulty swallowing for the past 3 months. He feels solid food getting stuck in his chest behind the sternum when he eats. Drinking does not cause any difficulty swallowing. He has no coughing or nasal regurgitation. He has no hoarseness or weight loss. He has had heartburn for 2 years with no response to high-dose omeprazole. His past medical history is also significant for asthma and eczema. He takes no medications except for omeprazole. His vital signs are within normal limits. Physical examination shows no abnormal findings. Which of the following best explains these findings?\nA. Achalasia\nB. Diffuse esophageal spasm\nC. Eosinophilic esophagitis\nD. Esophageal reflux disease\n\nA. Achalasia\nB. Diffuse esophageal spasm\nC. Eosinophilic esophagitis\nD. Esophageal reflux disease",
"options": [
"A. Achalasia",
"B. Diffuse esophageal spasm",
"C. Eosinophilic esophagitis",
"D. Esophageal reflux disease"
],
"answer": "Eosinophilic esophagitis",
"gen_text_store": "",
"pid": "48",
"query": "A 35-year-old man comes to the physician because of episodes of difficulty swallowing for the past 3 months. He feels solid food getting stuck in his chest behind the sternum when he eats. Drinking does not cause any difficulty swallowing. He has no coughing or nasal regurgitation. He has no hoarseness or weight loss. He has had heartburn for 2 years with no response to high-dose omeprazole. His past medical history is also significant for asthma and eczema. He takes no medications except for omeprazole. His vital signs are within normal limits. Physical examination shows no abnormal findings. Which of the following best explains these findings?\nA. Achalasia\nB. Diffuse esophageal spasm\nC. Eosinophilic esophagitis\nD. Esophageal reflux disease\nChoose the correct option.",
"image": null
},
{
"idx": 49,
"question": "A 68-year-old man presents to the emergency department because of fever, abdominal pain, and rapidly progressive distension of the abdomen. His appendix was removed for an abscess 3 days ago. The complete blood count showed leukocytosis. Anaerobic culture of the peritoneal fluid needle aspirate showed a gram-negative pathogen. Which of the following, in addition to polymicrobial infection, is the most likely cause of this patient’s condition?\nA. Bacteroides fragilis\nB. Campylobacter jejuni\nC. Clostridium perfringens\nD. Shigella sonnei\n\nA. Bacteroides fragilis\nB. Campylobacter jejuni\nC. Clostridium perfringens\nD. Shigella sonnei",
"options": [
"A. Bacteroides fragilis",
"B. Campylobacter jejuni",
"C. Clostridium perfringens",
"D. Shigella sonnei"
],
"answer": "Bacteroides fragilis",
"gen_text_store": "",
"pid": "49",
"query": "A 68-year-old man presents to the emergency department because of fever, abdominal pain, and rapidly progressive distension of the abdomen. His appendix was removed for an abscess 3 days ago. The complete blood count showed leukocytosis. Anaerobic culture of the peritoneal fluid needle aspirate showed a gram-negative pathogen. Which of the following, in addition to polymicrobial infection, is the most likely cause of this patient’s condition?\nA. Bacteroides fragilis\nB. Campylobacter jejuni\nC. Clostridium perfringens\nD. Shigella sonnei\nChoose the correct option.",
"image": null
},
{
"idx": 50,
"question": "A 51-year-old man presents the emergency room with chest pain. He mentions that the pain started several hours ago and radiates to his left neck and shoulder. He also mentions that he has some difficulty in breathing. He says that he has had similar chest pains before, but nothing seemed to be wrong at that time. He was diagnosed with high cholesterol during that episode and was prescribed medication. He also has a 3-year history of gastritis. The blood pressure is 130/80 mm Hg, respirations are 18/min, and the pulse is 110/min. He seems a little anxious. The physical examination reveals no significant abnormalities. An ECG shows slight changes in the leads. His physician talks to him about the benefits of taking low-dose aspirin daily. Which of the following would be a contraindication to the use of aspirin in this patient?\nA. ECG changes\nB. Hypercholesterolemia\nC. Gastritis\nD. Increased pulse rate\n\nA. ECG changes\nB. Hypercholesterolemia\nC. Gastritis\nD. Increased pulse rate",
"options": [
"A. ECG changes",
"B. Hypercholesterolemia",
"C. Gastritis",
"D. Increased pulse rate"
],
"answer": "Gastritis",
"gen_text_store": "",
"pid": "50",
"query": "A 51-year-old man presents the emergency room with chest pain. He mentions that the pain started several hours ago and radiates to his left neck and shoulder. He also mentions that he has some difficulty in breathing. He says that he has had similar chest pains before, but nothing seemed to be wrong at that time. He was diagnosed with high cholesterol during that episode and was prescribed medication. He also has a 3-year history of gastritis. The blood pressure is 130/80 mm Hg, respirations are 18/min, and the pulse is 110/min. He seems a little anxious. The physical examination reveals no significant abnormalities. An ECG shows slight changes in the leads. His physician talks to him about the benefits of taking low-dose aspirin daily. Which of the following would be a contraindication to the use of aspirin in this patient?\nA. ECG changes\nB. Hypercholesterolemia\nC. Gastritis\nD. Increased pulse rate\nChoose the correct option.",
"image": null
},
{
"idx": 51,
"question": "A 22-year-old woman presents to her primary care physician in April for seasonal allergies. She has suffered from seasonal allergies for the past 2 years and takes diphenhydramine as needed when her symptoms worsen. She has not yet seen a physician for her allergies. She reports that diphenhydramine has been helpful in controlling her symptoms, but she does not like feeling drowsy from the medication. Her past medical history is also notable for well-controlled asthma. She uses an albuterol inhaler on an as-needed basis. She smokes marijuana daily. Her temperature is 99.2°F (37.3°C), blood pressure is 120/70 mmHg, pulse is 76/min, and respirations are 16/min. She has a prominent nasal crease. Her nasal turbinates are boggy and bluish-gray. She has copious thin and watery nasal mucus. The physician suggests replacing diphenhydramine with fexofenadine to improve her drowsiness. What characteristic of fexodenadine allows it to be less sedating than diphenhydramine?\nA. Alpha-adrenergic antagonism\nB. Beta-adrenergic antagonism\nC. Relative lipophobicity\nD. Serotonergic antagonism\n\nA. Alpha-adrenergic antagonism\nB. Beta-adrenergic antagonism\nC. Relative lipophobicity\nD. Serotonergic antagonism",
"options": [
"A. Alpha-adrenergic antagonism",
"B. Beta-adrenergic antagonism",
"C. Relative lipophobicity",
"D. Serotonergic antagonism"
],
"answer": "Relative lipophobicity",
"gen_text_store": "",
"pid": "51",
"query": "A 22-year-old woman presents to her primary care physician in April for seasonal allergies. She has suffered from seasonal allergies for the past 2 years and takes diphenhydramine as needed when her symptoms worsen. She has not yet seen a physician for her allergies. She reports that diphenhydramine has been helpful in controlling her symptoms, but she does not like feeling drowsy from the medication. Her past medical history is also notable for well-controlled asthma. She uses an albuterol inhaler on an as-needed basis. She smokes marijuana daily. Her temperature is 99.2°F (37.3°C), blood pressure is 120/70 mmHg, pulse is 76/min, and respirations are 16/min. She has a prominent nasal crease. Her nasal turbinates are boggy and bluish-gray. She has copious thin and watery nasal mucus. The physician suggests replacing diphenhydramine with fexofenadine to improve her drowsiness. What characteristic of fexodenadine allows it to be less sedating than diphenhydramine?\nA. Alpha-adrenergic antagonism\nB. Beta-adrenergic antagonism\nC. Relative lipophobicity\nD. Serotonergic antagonism\nChoose the correct option.",
"image": null
},
{
"idx": 52,
"question": "A 40-year-old businessman who was previously well is brought into the emergency department by his assistant with a complaint of left-sided weakness after a chiropractic neck manipulation. He has never felt like this before. Past medical history is insignificant. His blood pressure is 125/75 mm Hg, pulse 86/min, respiratory rate 13/min, temperature 36.8°C (98.2°F). A T2-weighted MRI shows a left C5 hemicord lesion. The patient is treated with cervical immobilization, a course of steroids, and physical therapy. What other finding will most likely be seen in this patient?\nA. Spastic paralysis at the level of lesion\nB. Right-sided Horner's syndrome\nC. Contralateral corticospinal tract involvement\nD. Right-sided analgesia\n\nA. Spastic paralysis at the level of lesion\nB. Right-sided Horner's syndrome\nC. Contralateral corticospinal tract involvement\nD. Right-sided analgesia",
"options": [
"A. Spastic paralysis at the level of lesion",
"B. Right-sided Horner's syndrome",
"C. Contralateral corticospinal tract involvement",
"D. Right-sided analgesia"
],
"answer": "Right-sided analgesia",
"gen_text_store": "",
"pid": "52",
"query": "A 40-year-old businessman who was previously well is brought into the emergency department by his assistant with a complaint of left-sided weakness after a chiropractic neck manipulation. He has never felt like this before. Past medical history is insignificant. His blood pressure is 125/75 mm Hg, pulse 86/min, respiratory rate 13/min, temperature 36.8°C (98.2°F). A T2-weighted MRI shows a left C5 hemicord lesion. The patient is treated with cervical immobilization, a course of steroids, and physical therapy. What other finding will most likely be seen in this patient?\nA. Spastic paralysis at the level of lesion\nB. Right-sided Horner's syndrome\nC. Contralateral corticospinal tract involvement\nD. Right-sided analgesia\nChoose the correct option.",
"image": null
},
{
"idx": 53,
"question": "A 23-year-old man is admitted to the hospital with fever, chest discomfort, tachypnea, pain, needle-like sensations in the upper extremities, and profuse sweating. He also complains of a gradual decrease in vision over the past 3 months. He is a bodybuilding competitor and has a competition coming up in 1 week. The man reports that his symptoms appeared suddenly, 30 minutes after he took 2 foreign-manufactured fat-burning pills instead of the 1 he usually takes. His blood pressure is 140/90 mm Hg, heart rate is 137/min, respiratory rate is 26/min, and temperature is 39.9°C (103.8°F). Physical examination reveals a reddish maculopapular rash over the patient’s trunk, diminished lung and heart sounds, tenderness to palpation in his abdomen, and rotational bilateral nystagmus with an alternating gaze-dependent fast component. Ophthalmologic examination shows bilateral cataracts. The patient’s total blood count is as follows:\nErythrocytes 4.4 x 109/mm3\nHb 12 g/dL\nTotal leukocyte count 3750/mm3\nNeutrophils 57%\nLymphocyte 37%\nEosinophil 1%\nMonocyte 5%\nBasophil 0%\nPlatelet count 209,000/mm3\nWhich of the following statements best describes the pathogenesis of this patient’s condition?\nA. The patient’s symptoms are caused by an increased concentration of epinephrine released by the adrenal glands in response to the consumed substance.\nB. The drug caused uncoupling of the electron transport chain and oxidative phosphorylation.\nC. The patient has a pyretic reaction due to bacterial contamination of the pills.\nD. The drug has stimulated the hypothalamic temperature center to produce hyperthermia.\n\nA. The patient’s symptoms are caused by an increased concentration of epinephrine released by the adrenal glands in response to the consumed substance.\nB. The drug caused uncoupling of the electron transport chain and oxidative phosphorylation.\nC. The patient has a pyretic reaction due to bacterial contamination of the pills.\nD. The drug has stimulated the hypothalamic temperature center to produce hyperthermia.",
"options": [
"A. The patient’s symptoms are caused by an increased concentration of epinephrine released by the adrenal glands in response to the consumed substance.",
"B. The drug caused uncoupling of the electron transport chain and oxidative phosphorylation.",
"C. The patient has a pyretic reaction due to bacterial contamination of the pills.",
"D. The drug has stimulated the hypothalamic temperature center to produce hyperthermia."
],
"answer": "The drug caused uncoupling of the electron transport chain and oxidative phosphorylation.",
"gen_text_store": "",
"pid": "53",
"query": "A 23-year-old man is admitted to the hospital with fever, chest discomfort, tachypnea, pain, needle-like sensations in the upper extremities, and profuse sweating. He also complains of a gradual decrease in vision over the past 3 months. He is a bodybuilding competitor and has a competition coming up in 1 week. The man reports that his symptoms appeared suddenly, 30 minutes after he took 2 foreign-manufactured fat-burning pills instead of the 1 he usually takes. His blood pressure is 140/90 mm Hg, heart rate is 137/min, respiratory rate is 26/min, and temperature is 39.9°C (103.8°F). Physical examination reveals a reddish maculopapular rash over the patient’s trunk, diminished lung and heart sounds, tenderness to palpation in his abdomen, and rotational bilateral nystagmus with an alternating gaze-dependent fast component. Ophthalmologic examination shows bilateral cataracts. The patient’s total blood count is as follows:\nErythrocytes 4.4 x 109/mm3\nHb 12 g/dL\nTotal leukocyte count 3750/mm3\nNeutrophils 57%\nLymphocyte 37%\nEosinophil 1%\nMonocyte 5%\nBasophil 0%\nPlatelet count 209,000/mm3\nWhich of the following statements best describes the pathogenesis of this patient’s condition?\nA. The patient’s symptoms are caused by an increased concentration of epinephrine released by the adrenal glands in response to the consumed substance.\nB. The drug caused uncoupling of the electron transport chain and oxidative phosphorylation.\nC. The patient has a pyretic reaction due to bacterial contamination of the pills.\nD. The drug has stimulated the hypothalamic temperature center to produce hyperthermia.\nChoose the correct option.",
"image": null
},
{
"idx": 54,
"question": "A 6-month-old boy is brought to the physician by his parents for difficulty breathing and bluish discoloration of the lips for the past hour. During the past 3 months, the patient has had several upper respiratory tract infections and poor weight gain. Physical examination shows crackles over both lung fields and enlargement of the tonsils and cervical lymph nodes. His serum IgA, IgE, and IgG titers are decreased. An x-ray of the chest shows bilateral interstitial infiltrates. Methenamine silver staining of bronchial lavage fluid shows disc-shaped cysts. A defect in which of the following is the most likely underlying cause of this patient's condition?\nA. Actin filament assembly\nB. T-cell receptor signaling\nC. Microtubule polymerization\nD. B-cell maturation\n\nA. Actin filament assembly\nB. T-cell receptor signaling\nC. Microtubule polymerization\nD. B-cell maturation",
"options": [
"A. Actin filament assembly",
"B. T-cell receptor signaling",
"C. Microtubule polymerization",
"D. B-cell maturation"
],
"answer": "T-cell receptor signaling",
"gen_text_store": "",
"pid": "54",
"query": "A 6-month-old boy is brought to the physician by his parents for difficulty breathing and bluish discoloration of the lips for the past hour. During the past 3 months, the patient has had several upper respiratory tract infections and poor weight gain. Physical examination shows crackles over both lung fields and enlargement of the tonsils and cervical lymph nodes. His serum IgA, IgE, and IgG titers are decreased. An x-ray of the chest shows bilateral interstitial infiltrates. Methenamine silver staining of bronchial lavage fluid shows disc-shaped cysts. A defect in which of the following is the most likely underlying cause of this patient's condition?\nA. Actin filament assembly\nB. T-cell receptor signaling\nC. Microtubule polymerization\nD. B-cell maturation\nChoose the correct option.",
"image": null
},
{
"idx": 55,
"question": "A 25-year-old man presents to his primary care physician for pain in his back. The patient describes the pain as feeling worse in the morning. He says it is a general stiffness that improves when he goes to the gym and lifts weights. He also states that his symptoms seem to improve when he leans forward or when he is cycling. The patient is a current smoker and is sexually active. He admits to having unprotected sex with many different partners this past year. The patient has no significant past medical history and is not currently taking any medications. On physical exam, the patient demonstrates notable kyphosis of the thoracic spine and decreased mobility of the back in all 4 directions. The patient’s strength is 5/5 in his upper and lower extremities. The rest of his physical exam is within normal limits. Which of the following findings is associated with this patient’s presentation?\nA. Diminished pulses in the lower extremity\nB. Narrowing of the spinal canal when standing upright\nC. Pain with elevation of his leg while laying down\nD. Punctate bleeding spots when dermatologic scales are removed\n\nA. Diminished pulses in the lower extremity\nB. Narrowing of the spinal canal when standing upright\nC. Pain with elevation of his leg while laying down\nD. Punctate bleeding spots when dermatologic scales are removed",
"options": [
"A. Diminished pulses in the lower extremity",
"B. Narrowing of the spinal canal when standing upright",
"C. Pain with elevation of his leg while laying down",
"D. Punctate bleeding spots when dermatologic scales are removed"
],
"answer": "Punctate bleeding spots when dermatologic scales are removed",
"gen_text_store": "",
"pid": "55",
"query": "A 25-year-old man presents to his primary care physician for pain in his back. The patient describes the pain as feeling worse in the morning. He says it is a general stiffness that improves when he goes to the gym and lifts weights. He also states that his symptoms seem to improve when he leans forward or when he is cycling. The patient is a current smoker and is sexually active. He admits to having unprotected sex with many different partners this past year. The patient has no significant past medical history and is not currently taking any medications. On physical exam, the patient demonstrates notable kyphosis of the thoracic spine and decreased mobility of the back in all 4 directions. The patient’s strength is 5/5 in his upper and lower extremities. The rest of his physical exam is within normal limits. Which of the following findings is associated with this patient’s presentation?\nA. Diminished pulses in the lower extremity\nB. Narrowing of the spinal canal when standing upright\nC. Pain with elevation of his leg while laying down\nD. Punctate bleeding spots when dermatologic scales are removed\nChoose the correct option.",
"image": null
},
{
"idx": 56,
"question": "A 70-year-old man is brought to the emergency department by staff of the group home where he resides because of worsening confusion for the past week. He has a history of major depressive disorder and had an ischemic stroke 4 months ago. Current medications are aspirin and sertraline. He is lethargic and disoriented. His pulse is 78/min, and blood pressure is 135/88 mm Hg. Physical examination shows moist oral mucosa, normal skin turgor, and no peripheral edema. While in the waiting room, he has a generalized, tonic-clonic seizure. Laboratory studies show a serum sodium of 119 mEq/L and an elevated serum antidiuretic hormone concentration. Which of the following sets of additional laboratory findings is most likely in this patient?\n $$$ Serum osmolality %%% Urine sodium %%% Serum aldosterone $$$\nA. ↓ ↓ ↓\nB. ↑ ↓ normal\nC. ↓ ↑ ↑\nD. ↓ ↑ ↓\n\nA. ↓ ↓ ↓\nB. ↑ ↓ normal\nC. ↓ ↑ ↑\nD. ↓ ↑ ↓",
"options": [
"A. ↓ ↓ ↓",
"B. ↑ ↓ normal",
"C. ↓ ↑ ↑",
"D. ↓ ↑ ↓"
],
"answer": "↓ ↑ ↓",
"gen_text_store": "",
"pid": "56",
"query": "A 70-year-old man is brought to the emergency department by staff of the group home where he resides because of worsening confusion for the past week. He has a history of major depressive disorder and had an ischemic stroke 4 months ago. Current medications are aspirin and sertraline. He is lethargic and disoriented. His pulse is 78/min, and blood pressure is 135/88 mm Hg. Physical examination shows moist oral mucosa, normal skin turgor, and no peripheral edema. While in the waiting room, he has a generalized, tonic-clonic seizure. Laboratory studies show a serum sodium of 119 mEq/L and an elevated serum antidiuretic hormone concentration. Which of the following sets of additional laboratory findings is most likely in this patient?\n $$$ Serum osmolality %%% Urine sodium %%% Serum aldosterone $$$\nA. ↓ ↓ ↓\nB. ↑ ↓ normal\nC. ↓ ↑ ↑\nD. ↓ ↑ ↓\nChoose the correct option.",
"image": null
},
{
"idx": 57,
"question": "A 45-year-old woman with hypothyroidism comes to the physician because of progressive fatigue, lethargy, and epigastric pain after eating. Physical examination shows pale conjunctivae. Laboratory studies show decreased serum hemoglobin levels and increased serum gastrin levels. Esophagogastroduodenoscopy shows inflammation of the gastric body and fundus. A photomicrograph of a biopsy specimen taken from the gastric antrum is shown. Which of the following is the most likely cause of this patient's symptoms?\nA. Mucosal cell hyperplasia\nB. Enterochromaffin-like cell hyperplasia\nC. Parietal cell destruction\nD. Chief cell destruction\n\nA. Mucosal cell hyperplasia\nB. Enterochromaffin-like cell hyperplasia\nC. Parietal cell destruction\nD. Chief cell destruction",
"options": [
"A. Mucosal cell hyperplasia",
"B. Enterochromaffin-like cell hyperplasia",
"C. Parietal cell destruction",
"D. Chief cell destruction"
],
"answer": "Parietal cell destruction",
"gen_text_store": "",
"pid": "57",
"query": "A 45-year-old woman with hypothyroidism comes to the physician because of progressive fatigue, lethargy, and epigastric pain after eating. Physical examination shows pale conjunctivae. Laboratory studies show decreased serum hemoglobin levels and increased serum gastrin levels. Esophagogastroduodenoscopy shows inflammation of the gastric body and fundus. A photomicrograph of a biopsy specimen taken from the gastric antrum is shown. Which of the following is the most likely cause of this patient's symptoms?\nA. Mucosal cell hyperplasia\nB. Enterochromaffin-like cell hyperplasia\nC. Parietal cell destruction\nD. Chief cell destruction\nChoose the correct option.",
"image": null
},
{
"idx": 58,
"question": "A 66-year-old man is brought to the emergency room by his wife due to abdominal distension and persistent somnolence for the past 2 weeks. The patient’s wife says that he has been sleeping much more than usual for the past 5 days. His bowel and bladder habit have not changed. His past medical history is significant for alcoholic liver cirrhosis. His vital signs include: pulse 76/min, respiratory rate 15/min, temperature 38.0°C (100.4°F) and blood pressure 122/75 mm Hg. On physical examination, the patient is altered and not responsive to commands. Oriented x 0. The abdomen is significantly distended. Shifting dullness is present and a positive fluid wave can be elicited. Hyperreflexia and asterixis are noted. Laboratory findings are significant for the following:\nLaboratory test\nSodium 140 mEq/L\nPotassium 3.5 mEq/L\nChloride 97 mEq/L\nGlucose 90 mg/dL\nAmmonia 100 µg/dL (ref: 19-60 µg/dL)\nArterial blood gas\npH 7.4\npCO2 40 mm Hg\npO2 90 mm Hg\nHCO3 26 mEq/L\nAn abdominal ultrasound shows surface nodularity compatible with cirrhosis but no other changes aside from ascites. An upper GI endoscopy is performed which shows gastric varices with no signs of active bleeding. An MRI of the brain is insignificant. What is the most likely precipitating factor that led to this patient’s condition?\nA. Spontaneous bacterial peritonitis\nB. Metabolic alkalosis\nC. Portal vein thrombosis\nD. Hypoglycemia\n\nA. Spontaneous bacterial peritonitis\nB. Metabolic alkalosis\nC. Portal vein thrombosis\nD. Hypoglycemia",
"options": [
"A. Spontaneous bacterial peritonitis",
"B. Metabolic alkalosis",
"C. Portal vein thrombosis",
"D. Hypoglycemia"
],
"answer": "Spontaneous bacterial peritonitis",
"gen_text_store": "",
"pid": "58",
"query": "A 66-year-old man is brought to the emergency room by his wife due to abdominal distension and persistent somnolence for the past 2 weeks. The patient’s wife says that he has been sleeping much more than usual for the past 5 days. His bowel and bladder habit have not changed. His past medical history is significant for alcoholic liver cirrhosis. His vital signs include: pulse 76/min, respiratory rate 15/min, temperature 38.0°C (100.4°F) and blood pressure 122/75 mm Hg. On physical examination, the patient is altered and not responsive to commands. Oriented x 0. The abdomen is significantly distended. Shifting dullness is present and a positive fluid wave can be elicited. Hyperreflexia and asterixis are noted. Laboratory findings are significant for the following:\nLaboratory test\nSodium 140 mEq/L\nPotassium 3.5 mEq/L\nChloride 97 mEq/L\nGlucose 90 mg/dL\nAmmonia 100 µg/dL (ref: 19-60 µg/dL)\nArterial blood gas\npH 7.4\npCO2 40 mm Hg\npO2 90 mm Hg\nHCO3 26 mEq/L\nAn abdominal ultrasound shows surface nodularity compatible with cirrhosis but no other changes aside from ascites. An upper GI endoscopy is performed which shows gastric varices with no signs of active bleeding. An MRI of the brain is insignificant. What is the most likely precipitating factor that led to this patient’s condition?\nA. Spontaneous bacterial peritonitis\nB. Metabolic alkalosis\nC. Portal vein thrombosis\nD. Hypoglycemia\nChoose the correct option.",
"image": null
},
{
"idx": 59,
"question": "A 3-week-old newborn is brought to the physician by his parents because of poor feeding, irritability, and frequent vomiting over the past week. The vomitus is greenish in color and smells strange. His parents have tried to feed him every 4 hours, but the patient often spits up or refuses to eat. The patient was born at term and had his first bowel movement at 50 hours of life. He has since had one bowel movement daily. He is at the 50th percentile for length, 10th percentile for weight, and 40th percentile for head circumference. He does not appear to be in acute distress. His temperature is 36.9°C (98.4°F), pulse is 140/min, respirations are 40/min, and blood pressure is 90/60 mm Hg. Physical examination shows that the patient has small, low-set ears, a broad and flat nasal bridge, and a large space between the first and second toes bilaterally. The abdomen is distended. When the finger is removed following a rectal exam, there is an explosive release of stool from the patient's rectum. An x-ray of the abdomen shows a section of dilated colon followed by a segment of colon without stool or air. Which of the following is most likely to confirm the diagnosis?\nA. CT scan of the abdomen\nB. Transabdominal ultrasonography\nC. Anorectal manometry\nD. Rectal suction biopsy\n\nA. CT scan of the abdomen\nB. Transabdominal ultrasonography\nC. Anorectal manometry\nD. Rectal suction biopsy",
"options": [
"A. CT scan of the abdomen",
"B. Transabdominal ultrasonography",
"C. Anorectal manometry",
"D. Rectal suction biopsy"
],
"answer": "Rectal suction biopsy",
"gen_text_store": "",
"pid": "59",
"query": "A 3-week-old newborn is brought to the physician by his parents because of poor feeding, irritability, and frequent vomiting over the past week. The vomitus is greenish in color and smells strange. His parents have tried to feed him every 4 hours, but the patient often spits up or refuses to eat. The patient was born at term and had his first bowel movement at 50 hours of life. He has since had one bowel movement daily. He is at the 50th percentile for length, 10th percentile for weight, and 40th percentile for head circumference. He does not appear to be in acute distress. His temperature is 36.9°C (98.4°F), pulse is 140/min, respirations are 40/min, and blood pressure is 90/60 mm Hg. Physical examination shows that the patient has small, low-set ears, a broad and flat nasal bridge, and a large space between the first and second toes bilaterally. The abdomen is distended. When the finger is removed following a rectal exam, there is an explosive release of stool from the patient's rectum. An x-ray of the abdomen shows a section of dilated colon followed by a segment of colon without stool or air. Which of the following is most likely to confirm the diagnosis?\nA. CT scan of the abdomen\nB. Transabdominal ultrasonography\nC. Anorectal manometry\nD. Rectal suction biopsy\nChoose the correct option.",
"image": null
},
{
"idx": 60,
"question": "An 11-month-old boy is brought to the clinic by his mother for a rash on his trunk, which he has had for the past 2 days. She notes that he is eating less and is more cranky than usual. His birth history is insignificant, and his immunizations are up to date. Vital signs include: temperature is 37.8°C (100.0°F), pulse is 98/min, and respiratory rate is 16/min. The rash features thin-walled, fluid-filled blisters that rupture easily. Fluid samples from the lesions are sent for analysis to a microbiology lab. The results reveal an infection by the gram-positive bacterium Staphylococcus aureus. The patient is diagnosed with staphylococcal scalded skin syndrome. Which of the following is involved with the primary defense in response to the bacteria and toxins produced by this organism?\nA. Immunoglobulin- IgG\nB. Immunoglobulin- IgD\nC. Immunoglobulin- IgA\nD. Immunoglobulin- IgM\n\nA. Immunoglobulin- IgG\nB. Immunoglobulin- IgD\nC. Immunoglobulin- IgA\nD. Immunoglobulin- IgM",
"options": [
"A. Immunoglobulin- IgG",
"B. Immunoglobulin- IgD",
"C. Immunoglobulin- IgA",
"D. Immunoglobulin- IgM"
],
"answer": "Immunoglobulin- IgM",
"gen_text_store": "",
"pid": "60",
"query": "An 11-month-old boy is brought to the clinic by his mother for a rash on his trunk, which he has had for the past 2 days. She notes that he is eating less and is more cranky than usual. His birth history is insignificant, and his immunizations are up to date. Vital signs include: temperature is 37.8°C (100.0°F), pulse is 98/min, and respiratory rate is 16/min. The rash features thin-walled, fluid-filled blisters that rupture easily. Fluid samples from the lesions are sent for analysis to a microbiology lab. The results reveal an infection by the gram-positive bacterium Staphylococcus aureus. The patient is diagnosed with staphylococcal scalded skin syndrome. Which of the following is involved with the primary defense in response to the bacteria and toxins produced by this organism?\nA. Immunoglobulin- IgG\nB. Immunoglobulin- IgD\nC. Immunoglobulin- IgA\nD. Immunoglobulin- IgM\nChoose the correct option.",
"image": null
},
{
"idx": 61,
"question": "A 60-year-old man presents to his local walk-in clinic with 1 week of fever, chills, night sweats, anorexia, malaise, progressive shortness of breath, and sharp chest pain. He is found with a blood pressure of 100/80 mm Hg, a heart rate of 84/min, an elevated respiratory rate, and a holosystolic heart murmur III/VI. His palms and soles show non-tender erythematous lesions. His personal medical history is relevant for frequent visits to the ER for lower gastrointestinal bleeding in the last month with a recent colonoscopy that reported an ulcerative lesion suggestive of colorectal cancer. He has not been subjected to dental procedures recently, and he denies the use of psychoactive drugs. A chest plain film shows clear lungs and mild cardiomegaly, and echocardiography reports the presence of vegetations involving the mitral valve. Which of the following organisms is the most likely causative agent?\nA. Staphylococcus aureus\nB. Escherichia coli\nC. Haemophilus aphrophilus\nD. Streptococcus bovis\n\nA. Staphylococcus aureus\nB. Escherichia coli\nC. Haemophilus aphrophilus\nD. Streptococcus bovis",
"options": [
"A. Staphylococcus aureus",
"B. Escherichia coli",
"C. Haemophilus aphrophilus",
"D. Streptococcus bovis"
],
"answer": "Streptococcus bovis",
"gen_text_store": "",
"pid": "61",
"query": "A 60-year-old man presents to his local walk-in clinic with 1 week of fever, chills, night sweats, anorexia, malaise, progressive shortness of breath, and sharp chest pain. He is found with a blood pressure of 100/80 mm Hg, a heart rate of 84/min, an elevated respiratory rate, and a holosystolic heart murmur III/VI. His palms and soles show non-tender erythematous lesions. His personal medical history is relevant for frequent visits to the ER for lower gastrointestinal bleeding in the last month with a recent colonoscopy that reported an ulcerative lesion suggestive of colorectal cancer. He has not been subjected to dental procedures recently, and he denies the use of psychoactive drugs. A chest plain film shows clear lungs and mild cardiomegaly, and echocardiography reports the presence of vegetations involving the mitral valve. Which of the following organisms is the most likely causative agent?\nA. Staphylococcus aureus\nB. Escherichia coli\nC. Haemophilus aphrophilus\nD. Streptococcus bovis\nChoose the correct option.",
"image": null
},
{
"idx": 62,
"question": "A 53-year-old man comes to the physician because of a 2-month history of multiple episodes of small amounts of blood in his stools. Examination shows pale conjunctivae. His hemoglobin concentration is 8.3 g/dL and mean corpuscular volume is 72μm3. Colonoscopy shows a 2.3-cm polypoid mass in the ascending colon. A photomicrograph of a biopsy specimen of the lesion is shown. Which of the following processes is most likely to be involved in the pathogenesis of this patient's condition?\nA. Underexpression of COX-2\nB. Increased phosphorylation of serine and threonine\nC. Impaired degradation of β-catenin\nD. Abnormal transfer of phosphate to cellular proteins\n\nA. Underexpression of COX-2\nB. Increased phosphorylation of serine and threonine\nC. Impaired degradation of β-catenin\nD. Abnormal transfer of phosphate to cellular proteins",
"options": [
"A. Underexpression of COX-2",
"B. Increased phosphorylation of serine and threonine",
"C. Impaired degradation of β-catenin",
"D. Abnormal transfer of phosphate to cellular proteins"
],
"answer": "Impaired degradation of β-catenin",
"gen_text_store": "",
"pid": "62",
"query": "A 53-year-old man comes to the physician because of a 2-month history of multiple episodes of small amounts of blood in his stools. Examination shows pale conjunctivae. His hemoglobin concentration is 8.3 g/dL and mean corpuscular volume is 72μm3. Colonoscopy shows a 2.3-cm polypoid mass in the ascending colon. A photomicrograph of a biopsy specimen of the lesion is shown. Which of the following processes is most likely to be involved in the pathogenesis of this patient's condition?\nA. Underexpression of COX-2\nB. Increased phosphorylation of serine and threonine\nC. Impaired degradation of β-catenin\nD. Abnormal transfer of phosphate to cellular proteins\nChoose the correct option.",
"image": null
},
{
"idx": 63,
"question": "A 65-year-old male is treated for anal carcinoma with therapy including external beam radiation. How does radiation affect cancer cells?\nA. Induces the formation of thymidine dimers\nB. Induces the formation of disulfide bonds\nC. Induces deamination of cytosine\nD. Induces breaks in double-stranded DNA\n\nA. Induces the formation of thymidine dimers\nB. Induces the formation of disulfide bonds\nC. Induces deamination of cytosine\nD. Induces breaks in double-stranded DNA",
"options": [
"A. Induces the formation of thymidine dimers",
"B. Induces the formation of disulfide bonds",
"C. Induces deamination of cytosine",
"D. Induces breaks in double-stranded DNA"
],
"answer": "Induces breaks in double-stranded DNA",
"gen_text_store": "",
"pid": "63",
"query": "A 65-year-old male is treated for anal carcinoma with therapy including external beam radiation. How does radiation affect cancer cells?\nA. Induces the formation of thymidine dimers\nB. Induces the formation of disulfide bonds\nC. Induces deamination of cytosine\nD. Induces breaks in double-stranded DNA\nChoose the correct option.",
"image": null
},
{
"idx": 64,
"question": "A 17-year-old man presents to his family physician for an evaluation about the size of his penis. He feels increasingly anxious during physical education (PE) class as he has noticed that the size of his penis is significantly smaller when compared to his peers. Based on the physical examination, he is Tanner stage 1. The weight and height are 60 kg (132 lb) and 175 cm (5 ft 9 in), respectively. The cardiopulmonary examination is normal; however, the patient has difficulty identifying coffee grounds by smell. Which of the following explains the pathophysiology underlying this patient’s disorder?\nA. Expansion of a CTG trinucleotide repeat\nB. Isolated gonadotropin-releasing hormone (GnRH) deficiency\nC. Sex-specific epigenetic imprinting\nD. Non-disjunction of sex chromosomes\n\nA. Expansion of a CTG trinucleotide repeat\nB. Isolated gonadotropin-releasing hormone (GnRH) deficiency\nC. Sex-specific epigenetic imprinting\nD. Non-disjunction of sex chromosomes",
"options": [
"A. Expansion of a CTG trinucleotide repeat",
"B. Isolated gonadotropin-releasing hormone (GnRH) deficiency",
"C. Sex-specific epigenetic imprinting",
"D. Non-disjunction of sex chromosomes"
],
"answer": "Isolated gonadotropin-releasing hormone (GnRH) deficiency",
"gen_text_store": "",
"pid": "64",
"query": "A 17-year-old man presents to his family physician for an evaluation about the size of his penis. He feels increasingly anxious during physical education (PE) class as he has noticed that the size of his penis is significantly smaller when compared to his peers. Based on the physical examination, he is Tanner stage 1. The weight and height are 60 kg (132 lb) and 175 cm (5 ft 9 in), respectively. The cardiopulmonary examination is normal; however, the patient has difficulty identifying coffee grounds by smell. Which of the following explains the pathophysiology underlying this patient’s disorder?\nA. Expansion of a CTG trinucleotide repeat\nB. Isolated gonadotropin-releasing hormone (GnRH) deficiency\nC. Sex-specific epigenetic imprinting\nD. Non-disjunction of sex chromosomes\nChoose the correct option.",
"image": null
},
{
"idx": 65,
"question": "A 25-year-old man is brought to the emergency department by police. He was found at a local celebration acting very strangely and was reported by other patrons of the event. The patient is very anxious and initially is hesitant to answer questions. He denies any substance use and states that he was just trying to have a good time. The patient's responses are slightly delayed and he seems to have difficulty processing his thoughts. The patient tells you he feels very anxious and asks for some medication to calm him down. The patient has a past medical history of psoriasis which is treated with topical steroids. His temperature is 99.5°F (37.5°C), blood pressure is 120/75 mmHg, pulse is 110/min, respirations are 15/min, and oxygen saturation is 99% on room air. On physical exam, you note an anxious young man. HEENT exam reveals a dry mouth and conjunctival injection. Neurological exam reveals cranial nerves II-XII as grossly intact with normal strength and sensation in his upper and lower extremities. Cardiac exam reveals tachycardia, and pulmonary exam is within normal limits. Which of the following is the most likely intoxication in this patient?\nA. Alcohol\nB. Marijuana\nC. Cocaine\nD. Phencyclidine\n\nA. Alcohol\nB. Marijuana\nC. Cocaine\nD. Phencyclidine",
"options": [
"A. Alcohol",
"B. Marijuana",
"C. Cocaine",
"D. Phencyclidine"
],
"answer": "Marijuana",
"gen_text_store": "",
"pid": "65",
"query": "A 25-year-old man is brought to the emergency department by police. He was found at a local celebration acting very strangely and was reported by other patrons of the event. The patient is very anxious and initially is hesitant to answer questions. He denies any substance use and states that he was just trying to have a good time. The patient's responses are slightly delayed and he seems to have difficulty processing his thoughts. The patient tells you he feels very anxious and asks for some medication to calm him down. The patient has a past medical history of psoriasis which is treated with topical steroids. His temperature is 99.5°F (37.5°C), blood pressure is 120/75 mmHg, pulse is 110/min, respirations are 15/min, and oxygen saturation is 99% on room air. On physical exam, you note an anxious young man. HEENT exam reveals a dry mouth and conjunctival injection. Neurological exam reveals cranial nerves II-XII as grossly intact with normal strength and sensation in his upper and lower extremities. Cardiac exam reveals tachycardia, and pulmonary exam is within normal limits. Which of the following is the most likely intoxication in this patient?\nA. Alcohol\nB. Marijuana\nC. Cocaine\nD. Phencyclidine\nChoose the correct option.",
"image": null
},
{
"idx": 66,
"question": "A 40-year-old man presents to the clinic with complaints of increased bilateral pain in his knees. The pain developed over time and now limits his mobility. He states that the pain is worse at the end of the day, though he does have some early-morning stiffness lasting about 20 minutes. He used to have some success with over-the-counter NSAIDs; however, they no longer help. The patient also has been taking metformin for the past 2 years and is severely obese, with a BMI of 41 kg/m2. Additionally, he states that he has felt increasingly tired during the day, often dozes off during work, and no longer feels refreshed when he wakes up in the morning. Upon examination, there is no tenderness on palpation or erythema; however, some crepitus is felt. He has no other complaints but has a family history of rheumatoid arthritis (RA) on his mother’s side. Which of the following factors is the underlying cause of the patient’s pain, as well as the rest of his complaints?\nA. Medication side effect\nB. Excess weight\nC. Infection\nD. Occult malignancy\n\nA. Medication side effect\nB. Excess weight\nC. Infection\nD. Occult malignancy",
"options": [
"A. Medication side effect",
"B. Excess weight",
"C. Infection",
"D. Occult malignancy"
],
"answer": "Excess weight",
"gen_text_store": "",
"pid": "66",
"query": "A 40-year-old man presents to the clinic with complaints of increased bilateral pain in his knees. The pain developed over time and now limits his mobility. He states that the pain is worse at the end of the day, though he does have some early-morning stiffness lasting about 20 minutes. He used to have some success with over-the-counter NSAIDs; however, they no longer help. The patient also has been taking metformin for the past 2 years and is severely obese, with a BMI of 41 kg/m2. Additionally, he states that he has felt increasingly tired during the day, often dozes off during work, and no longer feels refreshed when he wakes up in the morning. Upon examination, there is no tenderness on palpation or erythema; however, some crepitus is felt. He has no other complaints but has a family history of rheumatoid arthritis (RA) on his mother’s side. Which of the following factors is the underlying cause of the patient’s pain, as well as the rest of his complaints?\nA. Medication side effect\nB. Excess weight\nC. Infection\nD. Occult malignancy\nChoose the correct option.",
"image": null
},
{
"idx": 67,
"question": "A 32-year-old Caucasian woman is referred to a gastroenterologist by her family physician for 8 months of abdominal pain, foul-smelling diarrhea with floating, bulky stools, weight loss, and macrocytic anemia. Her personal history is relevant for allergic rhinitis. Physical examination shows grouped, erythematous papulovesicular lesions on her arms, torso, and abdomen. Which of the following is the most appropriate approach for the management of this patient?\nA. Amitriptyline\nB. Octreotide\nC. Gluten-free diet\nD. Methysergide maleate\n\nA. Amitriptyline\nB. Octreotide\nC. Gluten-free diet\nD. Methysergide maleate",
"options": [
"A. Amitriptyline",
"B. Octreotide",
"C. Gluten-free diet",
"D. Methysergide maleate"
],
"answer": "Gluten-free diet",
"gen_text_store": "",
"pid": "67",
"query": "A 32-year-old Caucasian woman is referred to a gastroenterologist by her family physician for 8 months of abdominal pain, foul-smelling diarrhea with floating, bulky stools, weight loss, and macrocytic anemia. Her personal history is relevant for allergic rhinitis. Physical examination shows grouped, erythematous papulovesicular lesions on her arms, torso, and abdomen. Which of the following is the most appropriate approach for the management of this patient?\nA. Amitriptyline\nB. Octreotide\nC. Gluten-free diet\nD. Methysergide maleate\nChoose the correct option.",
"image": null
},
{
"idx": 68,
"question": "A 65-year-old man presents to his primary care physician with a neck mass. He first noticed a firm mass on the anterior aspect of his neck approximately 4 months ago. The mass is painless and has not increased in size since then. He has also noticed occasional fatigue and has gained 10 pounds in the past 4 months despite no change in his diet or exercise frequency. His past medical history is notable for gout for which he takes allopurinol. He denies any prior thyroid disorder. He runs 4 times per week and eats a balanced diet of mostly fruits and vegetables. He does not smoke and drinks a glass of wine with dinner. His family history is notable for medullary thyroid cancer in his maternal uncle. His temperature is 97.8°F (36.6°C), blood pressure is 127/72 mmHg, pulse is 87/min, and respirations are 19/min. On exam, he has a firm, symmetric, and stone-firm thyroid. A biopsy of this patient's lesion would most likely demonstrate which of the following findings?\nA. Diffuse infiltrate of lymphoid cells destroying thyroid follicles\nB. Dense fibroinflammatory infiltrate\nC. Pleomorphic undifferentiated infiltrative cells with necrosis\nD. Stromal amyloid deposition\n\nA. Diffuse infiltrate of lymphoid cells destroying thyroid follicles\nB. Dense fibroinflammatory infiltrate\nC. Pleomorphic undifferentiated infiltrative cells with necrosis\nD. Stromal amyloid deposition",
"options": [
"A. Diffuse infiltrate of lymphoid cells destroying thyroid follicles",
"B. Dense fibroinflammatory infiltrate",
"C. Pleomorphic undifferentiated infiltrative cells with necrosis",
"D. Stromal amyloid deposition"
],
"answer": "Dense fibroinflammatory infiltrate",
"gen_text_store": "",
"pid": "68",
"query": "A 65-year-old man presents to his primary care physician with a neck mass. He first noticed a firm mass on the anterior aspect of his neck approximately 4 months ago. The mass is painless and has not increased in size since then. He has also noticed occasional fatigue and has gained 10 pounds in the past 4 months despite no change in his diet or exercise frequency. His past medical history is notable for gout for which he takes allopurinol. He denies any prior thyroid disorder. He runs 4 times per week and eats a balanced diet of mostly fruits and vegetables. He does not smoke and drinks a glass of wine with dinner. His family history is notable for medullary thyroid cancer in his maternal uncle. His temperature is 97.8°F (36.6°C), blood pressure is 127/72 mmHg, pulse is 87/min, and respirations are 19/min. On exam, he has a firm, symmetric, and stone-firm thyroid. A biopsy of this patient's lesion would most likely demonstrate which of the following findings?\nA. Diffuse infiltrate of lymphoid cells destroying thyroid follicles\nB. Dense fibroinflammatory infiltrate\nC. Pleomorphic undifferentiated infiltrative cells with necrosis\nD. Stromal amyloid deposition\nChoose the correct option.",
"image": null
},
{
"idx": 69,
"question": "A 75-year-old man comes to the physician because of a 7-day history of nausea and vomiting. Over the past 2 days, he has also been feeling weak and tired. When standing up after sitting for a while, he feels dizzy. He says he has to go to the bathroom more often than usual, and that he is urinating “a normal amount” each time. He has not had diarrhea. He has hypertension, for which he has been taking hydrochlorothiazide for the past 6 months. He drinks 9 glasses of water per day and takes his medication regularly. He is 168 cm (5 ft 6 in) tall and weighs 90 kg (198 lb); BMI is 32 kg/m2. His temperature is 36.5°C (97.7°F), blood pressure is 106/54 mm Hg, and pulse is 92/min. Physical examination shows whitening of the tongue. Skin that is pinched on the back of the hand retracts after 5 seconds. On mental status examination, his speech is slowed; he is oriented to person, place, and time. Laboratory studies show:\nSerum\nNa+ 150 mEq/L\nCl− 97 mEq/L\nK+ 3.6 mEq/L\nHCO3− 30 mEq/L\nOsmolality 354 mOsm/kg\nHemoglobin A1C 10.5%\nUrine\nOsmolality 400 mOsm/kg\nWhich of the following is the most likely explanation for these findings?\"\nA. Diuretic overdose\nB. Osmotic diuresis\nC. Excess production of aldosterone\nD. Insufficient production of antidiuretic hormone\n\nA. Diuretic overdose\nB. Osmotic diuresis\nC. Excess production of aldosterone\nD. Insufficient production of antidiuretic hormone",
"options": [
"A. Diuretic overdose",
"B. Osmotic diuresis",
"C. Excess production of aldosterone",
"D. Insufficient production of antidiuretic hormone"
],
"answer": "Osmotic diuresis",
"gen_text_store": "",
"pid": "69",
"query": "A 75-year-old man comes to the physician because of a 7-day history of nausea and vomiting. Over the past 2 days, he has also been feeling weak and tired. When standing up after sitting for a while, he feels dizzy. He says he has to go to the bathroom more often than usual, and that he is urinating “a normal amount” each time. He has not had diarrhea. He has hypertension, for which he has been taking hydrochlorothiazide for the past 6 months. He drinks 9 glasses of water per day and takes his medication regularly. He is 168 cm (5 ft 6 in) tall and weighs 90 kg (198 lb); BMI is 32 kg/m2. His temperature is 36.5°C (97.7°F), blood pressure is 106/54 mm Hg, and pulse is 92/min. Physical examination shows whitening of the tongue. Skin that is pinched on the back of the hand retracts after 5 seconds. On mental status examination, his speech is slowed; he is oriented to person, place, and time. Laboratory studies show:\nSerum\nNa+ 150 mEq/L\nCl− 97 mEq/L\nK+ 3.6 mEq/L\nHCO3− 30 mEq/L\nOsmolality 354 mOsm/kg\nHemoglobin A1C 10.5%\nUrine\nOsmolality 400 mOsm/kg\nWhich of the following is the most likely explanation for these findings?\"\nA. Diuretic overdose\nB. Osmotic diuresis\nC. Excess production of aldosterone\nD. Insufficient production of antidiuretic hormone\nChoose the correct option.",
"image": null
},
{
"idx": 70,
"question": "An 18-year-old male is brought in by fire rescue. The patient was an unrestrained passenger in a motor vehicle crash and was ejected from the vehicle after collision. Upon arrival to the trauma bay, the patient has a Glasgow coma scale (GCS) of 6. He is rapidly intubated, and vitals are a temperature of 99.5°F (37.5°C), pulse of 130 bpm, and blood pressure of 83/64 mmHg. He is noted to have multiple ecchymoses over his body, as well as petechiae and purpura. He has a laceration over his clavicle that continues to bleed despite a pressure bandage. Radiographs of his lower extremity show multiple long bone fractures. Two large bore IV lines are placed, and the patient oozes from around the sites of venepuncture. Labs are notable for a WBC of 20,000/mm^3, Hb of 10.1g/dL, platelets of 48,000/mm^3, and prolongation of the PT and aPTT. This patient's presentation can best be explained by which of the following diagnoses?\nA. Air embolization\nB. Tension pneumothorax\nC. Disseminated intravascular coagulation\nD. Coagulopathy of trauma\n\nA. Air embolization\nB. Tension pneumothorax\nC. Disseminated intravascular coagulation\nD. Coagulopathy of trauma",
"options": [
"A. Air embolization",
"B. Tension pneumothorax",
"C. Disseminated intravascular coagulation",
"D. Coagulopathy of trauma"
],
"answer": "Disseminated intravascular coagulation",
"gen_text_store": "",
"pid": "70",
"query": "An 18-year-old male is brought in by fire rescue. The patient was an unrestrained passenger in a motor vehicle crash and was ejected from the vehicle after collision. Upon arrival to the trauma bay, the patient has a Glasgow coma scale (GCS) of 6. He is rapidly intubated, and vitals are a temperature of 99.5°F (37.5°C), pulse of 130 bpm, and blood pressure of 83/64 mmHg. He is noted to have multiple ecchymoses over his body, as well as petechiae and purpura. He has a laceration over his clavicle that continues to bleed despite a pressure bandage. Radiographs of his lower extremity show multiple long bone fractures. Two large bore IV lines are placed, and the patient oozes from around the sites of venepuncture. Labs are notable for a WBC of 20,000/mm^3, Hb of 10.1g/dL, platelets of 48,000/mm^3, and prolongation of the PT and aPTT. This patient's presentation can best be explained by which of the following diagnoses?\nA. Air embolization\nB. Tension pneumothorax\nC. Disseminated intravascular coagulation\nD. Coagulopathy of trauma\nChoose the correct option.",
"image": null
},
{
"idx": 71,
"question": "A 24-year-old woman gravida 2, para 1 at 24 weeks' gestation comes to the physician for a prenatal visit. She feels well. Her earlier pregnancy was uncomplicated. This is her 4th prenatal visit. She had an ultrasound scan 2 weeks ago that showed a live intrauterine pregnancy consistent with a 22-week gestation with no anomalies. She had a normal Pap smear 2 years ago. Vital signs are within normal limits. Pelvic examination shows a uterus consistent in size with a 24-week gestation. Her blood group and type is B positive. Which of the following is the most appropriate next step in management?\nA. Oral glucose challenge test\nB. Cardiotocography\nC. Swab for GBS culture\nD. Tdap vaccination\n\nA. Oral glucose challenge test\nB. Cardiotocography\nC. Swab for GBS culture\nD. Tdap vaccination",
"options": [
"A. Oral glucose challenge test",
"B. Cardiotocography",
"C. Swab for GBS culture",
"D. Tdap vaccination"
],
"answer": "Oral glucose challenge test",
"gen_text_store": "",
"pid": "71",
"query": "A 24-year-old woman gravida 2, para 1 at 24 weeks' gestation comes to the physician for a prenatal visit. She feels well. Her earlier pregnancy was uncomplicated. This is her 4th prenatal visit. She had an ultrasound scan 2 weeks ago that showed a live intrauterine pregnancy consistent with a 22-week gestation with no anomalies. She had a normal Pap smear 2 years ago. Vital signs are within normal limits. Pelvic examination shows a uterus consistent in size with a 24-week gestation. Her blood group and type is B positive. Which of the following is the most appropriate next step in management?\nA. Oral glucose challenge test\nB. Cardiotocography\nC. Swab for GBS culture\nD. Tdap vaccination\nChoose the correct option.",
"image": null
},
{
"idx": 72,
"question": "A 67-year-old man presents with feelings of nervousness and anxiety. He mentions that lately, he has been feeling increasingly restless and is unable to control feelings of nervousness pertaining to all his daily tasks. He noticed that these feelings were more prominent in the last 2 months but have been present on and off for the last year. On many occasions, his mind will be racing with thoughts that keep him up at night. During these moments, he finds his heart racing and feels light-headed and dizzy to the point of blacking out. He has also been experiencing back and neck pain with increased muscle tension in these areas. The patient reports no smoking or alcohol use but mentions that he had tried cocaine and heroin in his 20s and 30s. Which of the following would be the best course of treatment for this patient’s symptoms?\nA. Diazepam\nB. Ramelteon\nC. Buspirone\nD. Alprazolam\n\nA. Diazepam\nB. Ramelteon\nC. Buspirone\nD. Alprazolam",
"options": [
"A. Diazepam",
"B. Ramelteon",
"C. Buspirone",
"D. Alprazolam"
],
"answer": "Buspirone",
"gen_text_store": "",
"pid": "72",
"query": "A 67-year-old man presents with feelings of nervousness and anxiety. He mentions that lately, he has been feeling increasingly restless and is unable to control feelings of nervousness pertaining to all his daily tasks. He noticed that these feelings were more prominent in the last 2 months but have been present on and off for the last year. On many occasions, his mind will be racing with thoughts that keep him up at night. During these moments, he finds his heart racing and feels light-headed and dizzy to the point of blacking out. He has also been experiencing back and neck pain with increased muscle tension in these areas. The patient reports no smoking or alcohol use but mentions that he had tried cocaine and heroin in his 20s and 30s. Which of the following would be the best course of treatment for this patient’s symptoms?\nA. Diazepam\nB. Ramelteon\nC. Buspirone\nD. Alprazolam\nChoose the correct option.",
"image": null
},
{
"idx": 73,
"question": "A 45-year-old man arrives by ambulance to the emergency room after being involved in a very severe construction accident. The patient was found unconscious with a large metal spike protruding from his abdomen by a coworker who was unable to estimate the amount of time the patient went without medical aid. Upon arrival to the ER, the patient was unconscious and unresponsive. His vital signs are BP: 80/40, HR: 120 bpm, RR: 25 bpm, Temperature: 97.1 degrees, and SPO2: 99%.He is taken to the operating room to remove the foreign body and control the bleeding. Although both objectives were accomplished, the patient had an acute drop in his blood pressure during the surgery at which time ST elevations were noted in multiple leads. This resolved with adequate fluid resuscitation and numerous blood transfusions. The patient remained sedated after surgery and continued to have relatively stable vital signs until his third day in the intensive care unit, when he experiences an oxygen desaturation of 85% despite being on a respirator with 100% oxygen at 15 breaths/minute. On auscultation air entry is present bilaterally with the presence of crackles. A 2/6 systolic murmur is hear

Download .txt

gitextract_kqtlwho5/

├── LICENSE
├── README.md
├── __init__.py
├── data/
│   └── medqa.json
├── data.py
├── example_logs/
│   ├── qwen3_14b_humanevalplus_hierarchical.txt
│   └── qwen3_14b_mbppplus_sequential.txt
├── methods/
│   ├── __init__.py
│   ├── baseline.py
│   ├── latent_mas.py
│   └── text_mas.py
├── models.py
├── prompts.py
├── requirements.txt
├── run.py
└── utils.py

Download .txt

SYMBOL INDEX (57 symbols across 9 files)

FILE: data.py
  function load_gsm8k (line 8) | def load_gsm8k(split: str = "test", cache_dir: Optional[str] = None) -> ...
  function load_aime2025 (line 21) | def load_aime2025(split: str = "train", cache_dir: Optional[str] = None)...
  function load_aime2024 (line 34) | def load_aime2024(split: str = "train", cache_dir: Optional[str] = None)...
  function load_gpqa_diamond (line 47) | def load_gpqa_diamond(split: str = "test", cache_dir: Optional[str] = No...
  function load_arc_easy (line 60) | def load_arc_easy(split: str = "test", cache_dir: Optional[str] = None) ...
  function load_arc_challenge (line 97) | def load_arc_challenge(split: str = "test", cache_dir: Optional[str] = N...
  function load_winogrande (line 132) | def load_winogrande(
  function load_mbppplus (line 153) | def load_mbppplus(
  function load_humanevalplus (line 177) | def load_humanevalplus(
  function load_medqa (line 202) | def load_medqa(split=None, subset=None, cache_dir=None):

FILE: methods/__init__.py
  class Agent (line 6) | class Agent:
  function default_agents (line 11) | def default_agents() -> List[Agent]:

FILE: methods/baseline.py
  class BaselineMethod (line 8) | class BaselineMethod:
    method __init__ (line 9) | def __init__(
    method run_batch (line 30) | def run_batch(self, items: List[Dict]) -> List[Dict]:
    method run_item (line 119) | def run_item(self, item: Dict) -> Dict:

FILE: methods/latent_mas.py
  class LatentMASMethod (line 17) | class LatentMASMethod:
    method __init__ (line 18) | def __init__(
    method _slice_tensor (line 54) | def _slice_tensor(tensor: torch.Tensor, tokens_to_keep: int) -> torch....
    method _truncate_past (line 61) | def _truncate_past(self, past_kv: Optional[Tuple], tokens_to_keep: int...
    method run_batch (line 82) | def run_batch(self, items: List[Dict]) -> List[Dict]:
    method run_batch_vllm (line 251) | def run_batch_vllm(self, items: List[Dict]) -> List[Dict]:
    method run_item (line 440) | def run_item(self, item: Dict) -> Dict:

FILE: methods/text_mas.py
  class TextMASMethod (line 11) | class TextMASMethod:
    method __init__ (line 12) | def __init__(
    method run_batch (line 33) | def run_batch(self, items: List[Dict]) -> List[Dict]:
    method run_item (line 179) | def run_item(self, item: Dict) -> Dict:

FILE: models.py
  function _ensure_pad_token (line 15) | def _ensure_pad_token(tokenizer: AutoTokenizer) -> None:
  function _past_length (line 23) | def _past_length(past_key_values: Optional[Tuple]) -> int:
  class ModelWrapper (line 30) | class ModelWrapper:
    method __init__ (line 31) | def __init__(self, model_name: str, device: torch.device, use_vllm: bo...
    method render_chat (line 87) | def render_chat(self, messages: List[Dict], add_generation_prompt: boo...
    method prepare_chat_input (line 102) | def prepare_chat_input(
    method prepare_chat_batch (line 117) | def prepare_chat_batch(
    method vllm_generate_text_batch (line 139) | def vllm_generate_text_batch(
    method _build_latent_realign_matrix (line 158) | def _build_latent_realign_matrix(self, model, device, args) -> Tuple[t...
    method _ensure_latent_realign_matrix (line 187) | def _ensure_latent_realign_matrix(self, model, device, args) -> Tuple[...
    method _apply_latent_realignment (line 204) | def _apply_latent_realignment(self, hidden: torch.Tensor, model: torch...
    method generate_text_batch (line 216) | def generate_text_batch(
    method tokenize_text (line 269) | def tokenize_text(self, text: str) -> torch.Tensor:
    method generate_latent_batch (line 277) | def generate_latent_batch(
    method generate_latent_batch_hidden_state (line 353) | def generate_latent_batch_hidden_state(

FILE: prompts.py
  function build_agent_message_sequential_latent_mas (line 2) | def build_agent_message_sequential_latent_mas(role: str, question: str, ...
  function build_agent_message_hierarchical_latent_mas (line 118) | def build_agent_message_hierarchical_latent_mas(role: str, question: str...
  function build_agent_messages_sequential_text_mas (line 341) | def build_agent_messages_sequential_text_mas(role: str, question: str, c...
  function build_agent_messages_hierarchical_text_mas (line 511) | def build_agent_messages_hierarchical_text_mas(role: str, question: str,...
  function build_agent_messages_single_agent (line 694) | def build_agent_messages_single_agent(question: str, args=None):

FILE: run.py
  function evaluate (line 26) | def evaluate(preds: List[Dict]) -> Tuple[float, int]:
  function process_batch (line 33) | def process_batch(
  function main (line 84) | def main():

FILE: utils.py
  function set_seed (line 10) | def set_seed(seed: int) -> None:
  function auto_device (line 18) | def auto_device(device: Optional[str] = None) -> torch.device:
  function extract_gsm8k_answer (line 26) | def extract_gsm8k_answer(text: str) -> Optional[str]:
  function extract_gold (line 39) | def extract_gold(text: str) -> Optional[str]:
  function normalize_answer (line 44) | def normalize_answer(ans: Optional[str]) -> Optional[str]:
  function extract_markdown_python_block (line 50) | def extract_markdown_python_block(text: str) -> Optional[str]:
  function run_with_timeout (line 61) | def run_with_timeout(code, timeout):

Download .json

Condensed preview — 16 files, each showing path, character count, and a content snippet. Download the .json file or copy for the full structured content (9,623K chars).

[
  {
    "path": "LICENSE",
    "chars": 11357,
    "preview": "                                 Apache License\n                           Version 2.0, January 2004\n                   "
  },
  {
    "path": "README.md",
    "chars": 11576,
    "preview": "<a name=\"readme-top\"></a>\n\n<p align=\"center\">\n  <picture>\n    <source media=\"(prefers-color-scheme: dark)\" srcset=\"asset"
  },
  {
    "path": "__init__.py",
    "chars": 14,
    "preview": "__all__ = []\n\n"
  },
  {
    "path": "data/medqa.json",
    "chars": 686519,
    "preview": "[\n  {\n    \"idx\": 0,\n    \"question\": \"A 34-year-old man comes to the physician because of a 3-week history of colicky abd"
  },
  {
    "path": "data.py",
    "chars": 7371,
    "preview": "from typing import Dict, Iterable, Optional\n\nfrom datasets import load_dataset\n\nfrom utils import extract_gold, normaliz"
  },
  {
    "path": "example_logs/qwen3_14b_mbppplus_sequential.txt",
    "chars": 8680474,
    "preview": "  method: latent_mas\n  model_name: Qwen/Qwen3-14B\n  device: cuda\n  seed: 42\n  max_samples: -1\n  split: test\n  task: mbpp"
  },
  {
    "path": "methods/__init__.py",
    "chars": 394,
    "preview": "from dataclasses import dataclass\nfrom typing import List\n\n\n@dataclass\nclass Agent:\n    name: str\n    role: str\n\n\ndef de"
  },
  {
    "path": "methods/baseline.py",
    "chars": 4433,
    "preview": "from typing import Dict, List\n\nfrom models import ModelWrapper\nfrom prompts import build_agent_messages_single_agent\nfro"
  },
  {
    "path": "methods/latent_mas.py",
    "chars": 19210,
    "preview": "from typing import Dict, List, Optional, Tuple\n\nfrom . import default_agents\nfrom models import ModelWrapper, _past_leng"
  },
  {
    "path": "methods/text_mas.py",
    "chars": 6986,
    "preview": "from typing import Dict, List\n\nfrom . import default_agents\nfrom models import ModelWrapper\n# from prompts import build_"
  },
  {
    "path": "models.py",
    "chars": 17183,
    "preview": "import os\nimport csv\nimport torch\nimport matplotlib.pyplot as plt\nfrom typing import Dict, List, Optional, Tuple\nfrom tr"
  },
  {
    "path": "prompts.py",
    "chars": 27133,
    "preview": "\ndef build_agent_message_sequential_latent_mas(role: str, question: str, context: str = \"\", method=None, args=None):\n\n  "
  },
  {
    "path": "requirements.txt",
    "chars": 50,
    "preview": "transformers\ntorch\nnumpy\ntqdm\naccelerate\ndatasets\n"
  },
  {
    "path": "run.py",
    "chars": 9192,
    "preview": "import argparse\nimport json\nfrom typing import Dict, List, Tuple\n\nfrom tqdm import tqdm\n\nfrom data import (\n    load_aim"
  },
  {
    "path": "utils.py",
    "chars": 2209,
    "preview": "import os\nimport random\nimport re\nfrom typing import Optional\n\nimport numpy as np\nimport torch\n\n\ndef set_seed(seed: int)"
  }
]

// ... and 1 more files (download for full content)

About this extraction

This page contains the full source code of the Gen-Verse/LatentMAS GitHub repository, extracted and formatted as plain text for AI agents and large language models (LLMs). The extraction includes 16 files (21.3 MB), approximately 2.4M tokens, and a symbol index with 57 extracted functions, classes, methods, constants, and types. Use this with OpenClaw, Claude, ChatGPT, Cursor, Windsurf, or any other AI tool that accepts text input. You can copy the full output to your clipboard or download it as a .txt file.

Extracted by GitExtract — free GitHub repo to text converter for AI. Built by Nikandr Surkov.

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