[["Question: A 53-year-old man comes to the physician because of a 6-month history of intermittent blood in his stool. He has had no pain with defecation. Physical examination shows a 1-cm, visible anal mass located below the dentate line. A biopsy of the mass is scheduled. If the mass if found to be malignant, it is most appropriate to evaluate which of the following lymph nodes for possible metastasis?\nChoices:\nA. Internal iliac\nB. Popliteal\nC. Sacral\nD. Superficial inguinal\nAnswer:", " Internal iliac"], ["Question: A 53-year-old man comes to the physician because of a 6-month history of intermittent blood in his stool. He has had no pain with defecation. Physical examination shows a 1-cm, visible anal mass located below the dentate line. A biopsy of the mass is scheduled. If the mass if found to be malignant, it is most appropriate to evaluate which of the following lymph nodes for possible metastasis?\nChoices:\nA. Internal iliac\nB. Popliteal\nC. Sacral\nD. Superficial inguinal\nAnswer:", " Popliteal"], ["Question: A 53-year-old man comes to the physician because of a 6-month history of intermittent blood in his stool. He has had no pain with defecation. Physical examination shows a 1-cm, visible anal mass located below the dentate line. A biopsy of the mass is scheduled. If the mass if found to be malignant, it is most appropriate to evaluate which of the following lymph nodes for possible metastasis?\nChoices:\nA. Internal iliac\nB. Popliteal\nC. Sacral\nD. Superficial inguinal\nAnswer:", " Sacral"], ["Question: A 53-year-old man comes to the physician because of a 6-month history of intermittent blood in his stool. He has had no pain with defecation. Physical examination shows a 1-cm, visible anal mass located below the dentate line. A biopsy of the mass is scheduled. If the mass if found to be malignant, it is most appropriate to evaluate which of the following lymph nodes for possible metastasis?\nChoices:\nA. Internal iliac\nB. Popliteal\nC. Sacral\nD. Superficial inguinal\nAnswer:", " Superficial inguinal"], ["Question: Six healthy subjects participate in a study of muscle metabolism during which hyperglycemia and hyperinsulinemia is induced. Muscle biopsy specimens obtained from the subjects during the resting state show significantly increased concentrations of malonyl-CoA. The increased malonyl-CoA concentration most likely directly inhibits which of the following processes in these subjects?\nChoices:\nA. Fatty acid oxidation\nB. Fatty acid synthesis\nC. Gluconeogenesis\nD. Glycogenolysis\nAnswer:", " Fatty acid oxidation"], ["Question: Six healthy subjects participate in a study of muscle metabolism during which hyperglycemia and hyperinsulinemia is induced. Muscle biopsy specimens obtained from the subjects during the resting state show significantly increased concentrations of malonyl-CoA. The increased malonyl-CoA concentration most likely directly inhibits which of the following processes in these subjects?\nChoices:\nA. Fatty acid oxidation\nB. Fatty acid synthesis\nC. Gluconeogenesis\nD. Glycogenolysis\nAnswer:", " Fatty acid synthesis"], ["Question: Six healthy subjects participate in a study of muscle metabolism during which hyperglycemia and hyperinsulinemia is induced. Muscle biopsy specimens obtained from the subjects during the resting state show significantly increased concentrations of malonyl-CoA. The increased malonyl-CoA concentration most likely directly inhibits which of the following processes in these subjects?\nChoices:\nA. Fatty acid oxidation\nB. Fatty acid synthesis\nC. Gluconeogenesis\nD. Glycogenolysis\nAnswer:", " Gluconeogenesis"], ["Question: Six healthy subjects participate in a study of muscle metabolism during which hyperglycemia and hyperinsulinemia is induced. Muscle biopsy specimens obtained from the subjects during the resting state show significantly increased concentrations of malonyl-CoA. The increased malonyl-CoA concentration most likely directly inhibits which of the following processes in these subjects?\nChoices:\nA. Fatty acid oxidation\nB. Fatty acid synthesis\nC. Gluconeogenesis\nD. Glycogenolysis\nAnswer:", " Glycogenolysis"], ["Question: An 18-year-old primigravid woman comes for her initial prenatal visit at 16 weeks' gestation. She is not sure about the date of her last menstrual period but says that the pregnancy probably occurred immediately after she stopped taking oral contraceptives 5 months ago. Maternal serum \u03b1-fetoprotein (MSAFP) concentration is increased to 3 multiples of the median. Which of the following is the most appropriate next step in management?\nChoices:\nA. Repeat measurement of MSAFP concentration\nB. Triple screening for MSAFP, serum \u03b2-hCG, and serum estriol concentrations\nC. Ultrasonography\nD. Amniocentesis for measurement of \u03b1-fetoprotein concentration\nAnswer:", " Repeat measurement of MSAFP concentration"], ["Question: An 18-year-old primigravid woman comes for her initial prenatal visit at 16 weeks' gestation. She is not sure about the date of her last menstrual period but says that the pregnancy probably occurred immediately after she stopped taking oral contraceptives 5 months ago. Maternal serum \u03b1-fetoprotein (MSAFP) concentration is increased to 3 multiples of the median. Which of the following is the most appropriate next step in management?\nChoices:\nA. Repeat measurement of MSAFP concentration\nB. Triple screening for MSAFP, serum \u03b2-hCG, and serum estriol concentrations\nC. Ultrasonography\nD. Amniocentesis for measurement of \u03b1-fetoprotein concentration\nAnswer:", " Triple screening for MSAFP, serum \u03b2-hCG, and serum estriol concentrations"], ["Question: An 18-year-old primigravid woman comes for her initial prenatal visit at 16 weeks' gestation. She is not sure about the date of her last menstrual period but says that the pregnancy probably occurred immediately after she stopped taking oral contraceptives 5 months ago. Maternal serum \u03b1-fetoprotein (MSAFP) concentration is increased to 3 multiples of the median. Which of the following is the most appropriate next step in management?\nChoices:\nA. Repeat measurement of MSAFP concentration\nB. Triple screening for MSAFP, serum \u03b2-hCG, and serum estriol concentrations\nC. Ultrasonography\nD. Amniocentesis for measurement of \u03b1-fetoprotein concentration\nAnswer:", " Ultrasonography"], ["Question: An 18-year-old primigravid woman comes for her initial prenatal visit at 16 weeks' gestation. She is not sure about the date of her last menstrual period but says that the pregnancy probably occurred immediately after she stopped taking oral contraceptives 5 months ago. Maternal serum \u03b1-fetoprotein (MSAFP) concentration is increased to 3 multiples of the median. Which of the following is the most appropriate next step in management?\nChoices:\nA. Repeat measurement of MSAFP concentration\nB. Triple screening for MSAFP, serum \u03b2-hCG, and serum estriol concentrations\nC. Ultrasonography\nD. Amniocentesis for measurement of \u03b1-fetoprotein concentration\nAnswer:", " Amniocentesis for measurement of \u03b1-fetoprotein concentration"], ["Question: A 52-year-old woman has had dyspnea and hemoptysis for 1 month. She has a history of rheumatic fever as a child and has had a cardiac murmur since early adulthood. Her temperature is 36.7\u00b0C (98\u00b0F), pulse is 130/min and irregularly irregular, respirations are 20/min, and blood pressure is 98/60 mm Hg. Jugular venous pressure is not increased. Bilateral crackles are heard at the lung bases. There is an opening snap followed by a low-pitched diastolic murmur at the third left intercostal space. An x-ray of the chest shows left atrial enlargement, a straight left cardiac border, and pulmonary venous engorgement. Which of the following is the most likely explanation for these findings?\nChoices:\nA. Aortic valve insufficiency\nB. Aortic valve stenosis\nC. Mitral valve insufficiency\nD. Mitral valve stenosis\nAnswer:", " Aortic valve insufficiency"], ["Question: A 52-year-old woman has had dyspnea and hemoptysis for 1 month. She has a history of rheumatic fever as a child and has had a cardiac murmur since early adulthood. Her temperature is 36.7\u00b0C (98\u00b0F), pulse is 130/min and irregularly irregular, respirations are 20/min, and blood pressure is 98/60 mm Hg. Jugular venous pressure is not increased. Bilateral crackles are heard at the lung bases. There is an opening snap followed by a low-pitched diastolic murmur at the third left intercostal space. An x-ray of the chest shows left atrial enlargement, a straight left cardiac border, and pulmonary venous engorgement. Which of the following is the most likely explanation for these findings?\nChoices:\nA. Aortic valve insufficiency\nB. Aortic valve stenosis\nC. Mitral valve insufficiency\nD. Mitral valve stenosis\nAnswer:", " Aortic valve stenosis"], ["Question: A 52-year-old woman has had dyspnea and hemoptysis for 1 month. She has a history of rheumatic fever as a child and has had a cardiac murmur since early adulthood. Her temperature is 36.7\u00b0C (98\u00b0F), pulse is 130/min and irregularly irregular, respirations are 20/min, and blood pressure is 98/60 mm Hg. Jugular venous pressure is not increased. Bilateral crackles are heard at the lung bases. There is an opening snap followed by a low-pitched diastolic murmur at the third left intercostal space. An x-ray of the chest shows left atrial enlargement, a straight left cardiac border, and pulmonary venous engorgement. Which of the following is the most likely explanation for these findings?\nChoices:\nA. Aortic valve insufficiency\nB. Aortic valve stenosis\nC. Mitral valve insufficiency\nD. Mitral valve stenosis\nAnswer:", " Mitral valve insufficiency"], ["Question: A 52-year-old woman has had dyspnea and hemoptysis for 1 month. She has a history of rheumatic fever as a child and has had a cardiac murmur since early adulthood. Her temperature is 36.7\u00b0C (98\u00b0F), pulse is 130/min and irregularly irregular, respirations are 20/min, and blood pressure is 98/60 mm Hg. Jugular venous pressure is not increased. Bilateral crackles are heard at the lung bases. There is an opening snap followed by a low-pitched diastolic murmur at the third left intercostal space. An x-ray of the chest shows left atrial enlargement, a straight left cardiac border, and pulmonary venous engorgement. Which of the following is the most likely explanation for these findings?\nChoices:\nA. Aortic valve insufficiency\nB. Aortic valve stenosis\nC. Mitral valve insufficiency\nD. Mitral valve stenosis\nAnswer:", " Mitral valve stenosis"], ["Question: A 31-year-old man with a 5-year history of HIV infection comes to the office because of anal pain, particularly on defecation, for the past 4 months. He says he has seen spots of blood on the toilet tissue but has not had any other noticeable bleeding. He reports no change in bowel habits and has not had recent fever, chills, or rectal drainage. He says he and his partner engage in anal-receptive intercourse. His most recent CD4+ T-lymphocyte count 2 months ago was 350/mm3 ; HIV viral load at that time was undetectable. He currently is being treated with antiretroviral therapy. He has had no opportunistic infections. Medical history is also significant for syphilis and genital herpes treated with penicillin and acyclovir, respectively. He does not smoke cigarettes or drink alcoholic beverages. Vital signs are normal. Physical examination shows small bilateral inguinal lymph nodes, but respiratory, cardiac, and abdominal examinations disclose no abnormalities. There are several tender fleshy lesions around the perianal area. Rectal examination produces tenderness, but there is no rectal discharge. Test of the stool for occult blood is trace positive. Which of the following is the most appropriate pharmacotherapy at this time?\nChoices:\nA. Acyclovir\nB. Imiquimod\nC. Levofloxacin\nD. Metronidazole\nAnswer:", " Acyclovir"], ["Question: A 31-year-old man with a 5-year history of HIV infection comes to the office because of anal pain, particularly on defecation, for the past 4 months. He says he has seen spots of blood on the toilet tissue but has not had any other noticeable bleeding. He reports no change in bowel habits and has not had recent fever, chills, or rectal drainage. He says he and his partner engage in anal-receptive intercourse. His most recent CD4+ T-lymphocyte count 2 months ago was 350/mm3 ; HIV viral load at that time was undetectable. He currently is being treated with antiretroviral therapy. He has had no opportunistic infections. Medical history is also significant for syphilis and genital herpes treated with penicillin and acyclovir, respectively. He does not smoke cigarettes or drink alcoholic beverages. Vital signs are normal. Physical examination shows small bilateral inguinal lymph nodes, but respiratory, cardiac, and abdominal examinations disclose no abnormalities. There are several tender fleshy lesions around the perianal area. Rectal examination produces tenderness, but there is no rectal discharge. Test of the stool for occult blood is trace positive. Which of the following is the most appropriate pharmacotherapy at this time?\nChoices:\nA. Acyclovir\nB. Imiquimod\nC. Levofloxacin\nD. Metronidazole\nAnswer:", " Imiquimod"], ["Question: A 31-year-old man with a 5-year history of HIV infection comes to the office because of anal pain, particularly on defecation, for the past 4 months. He says he has seen spots of blood on the toilet tissue but has not had any other noticeable bleeding. He reports no change in bowel habits and has not had recent fever, chills, or rectal drainage. He says he and his partner engage in anal-receptive intercourse. His most recent CD4+ T-lymphocyte count 2 months ago was 350/mm3 ; HIV viral load at that time was undetectable. He currently is being treated with antiretroviral therapy. He has had no opportunistic infections. Medical history is also significant for syphilis and genital herpes treated with penicillin and acyclovir, respectively. He does not smoke cigarettes or drink alcoholic beverages. Vital signs are normal. Physical examination shows small bilateral inguinal lymph nodes, but respiratory, cardiac, and abdominal examinations disclose no abnormalities. There are several tender fleshy lesions around the perianal area. Rectal examination produces tenderness, but there is no rectal discharge. Test of the stool for occult blood is trace positive. Which of the following is the most appropriate pharmacotherapy at this time?\nChoices:\nA. Acyclovir\nB. Imiquimod\nC. Levofloxacin\nD. Metronidazole\nAnswer:", " Levofloxacin"], ["Question: A 31-year-old man with a 5-year history of HIV infection comes to the office because of anal pain, particularly on defecation, for the past 4 months. He says he has seen spots of blood on the toilet tissue but has not had any other noticeable bleeding. He reports no change in bowel habits and has not had recent fever, chills, or rectal drainage. He says he and his partner engage in anal-receptive intercourse. His most recent CD4+ T-lymphocyte count 2 months ago was 350/mm3 ; HIV viral load at that time was undetectable. He currently is being treated with antiretroviral therapy. He has had no opportunistic infections. Medical history is also significant for syphilis and genital herpes treated with penicillin and acyclovir, respectively. He does not smoke cigarettes or drink alcoholic beverages. Vital signs are normal. Physical examination shows small bilateral inguinal lymph nodes, but respiratory, cardiac, and abdominal examinations disclose no abnormalities. There are several tender fleshy lesions around the perianal area. Rectal examination produces tenderness, but there is no rectal discharge. Test of the stool for occult blood is trace positive. Which of the following is the most appropriate pharmacotherapy at this time?\nChoices:\nA. Acyclovir\nB. Imiquimod\nC. Levofloxacin\nD. Metronidazole\nAnswer:", " Metronidazole"], ["Question: A 49-year-old man, who is recovering in the hospital 2 days after uncomplicated left femoral-popliteal bypass grafting for claudication, has now developed increasing pain in his left foot. Until now, the patient's postoperative course had been unremarkable and he has been treated with low-dose morphine for pain control. Medical history is remarkable for type 2 diabetes mellitus controlled with metformin and diet. Vital signs now are temperature 36.8\u00b0C (98.2\u00b0F), pulse 80/min and regular, respirations 20/min, and blood pressure 150/92 mm Hg. The surgical incision appears clean and well approximated without abnormal erythema or swelling. The left lower extremity and foot appear pale. Palpation of the left lower extremity discloses a strong femoral pulse, a weak popliteal pulse, and a cool, pulseless foot. Which of the following is the most appropriate management?\nChoices:\nA. Bedside compartment pressure measurements\nB. Doppler ultrasonography of the left lower extremity\nC. Intra-arterial tissue plasminogen activator (tPA) therapy\nD. Intraoperative angiography\nAnswer:", " Bedside compartment pressure measurements"], ["Question: A 49-year-old man, who is recovering in the hospital 2 days after uncomplicated left femoral-popliteal bypass grafting for claudication, has now developed increasing pain in his left foot. Until now, the patient's postoperative course had been unremarkable and he has been treated with low-dose morphine for pain control. Medical history is remarkable for type 2 diabetes mellitus controlled with metformin and diet. Vital signs now are temperature 36.8\u00b0C (98.2\u00b0F), pulse 80/min and regular, respirations 20/min, and blood pressure 150/92 mm Hg. The surgical incision appears clean and well approximated without abnormal erythema or swelling. The left lower extremity and foot appear pale. Palpation of the left lower extremity discloses a strong femoral pulse, a weak popliteal pulse, and a cool, pulseless foot. Which of the following is the most appropriate management?\nChoices:\nA. Bedside compartment pressure measurements\nB. Doppler ultrasonography of the left lower extremity\nC. Intra-arterial tissue plasminogen activator (tPA) therapy\nD. Intraoperative angiography\nAnswer:", " Doppler ultrasonography of the left lower extremity"], ["Question: A 49-year-old man, who is recovering in the hospital 2 days after uncomplicated left femoral-popliteal bypass grafting for claudication, has now developed increasing pain in his left foot. Until now, the patient's postoperative course had been unremarkable and he has been treated with low-dose morphine for pain control. Medical history is remarkable for type 2 diabetes mellitus controlled with metformin and diet. Vital signs now are temperature 36.8\u00b0C (98.2\u00b0F), pulse 80/min and regular, respirations 20/min, and blood pressure 150/92 mm Hg. The surgical incision appears clean and well approximated without abnormal erythema or swelling. The left lower extremity and foot appear pale. Palpation of the left lower extremity discloses a strong femoral pulse, a weak popliteal pulse, and a cool, pulseless foot. Which of the following is the most appropriate management?\nChoices:\nA. Bedside compartment pressure measurements\nB. Doppler ultrasonography of the left lower extremity\nC. Intra-arterial tissue plasminogen activator (tPA) therapy\nD. Intraoperative angiography\nAnswer:", " Intra-arterial tissue plasminogen activator (tPA) therapy"], ["Question: A 49-year-old man, who is recovering in the hospital 2 days after uncomplicated left femoral-popliteal bypass grafting for claudication, has now developed increasing pain in his left foot. Until now, the patient's postoperative course had been unremarkable and he has been treated with low-dose morphine for pain control. Medical history is remarkable for type 2 diabetes mellitus controlled with metformin and diet. Vital signs now are temperature 36.8\u00b0C (98.2\u00b0F), pulse 80/min and regular, respirations 20/min, and blood pressure 150/92 mm Hg. The surgical incision appears clean and well approximated without abnormal erythema or swelling. The left lower extremity and foot appear pale. Palpation of the left lower extremity discloses a strong femoral pulse, a weak popliteal pulse, and a cool, pulseless foot. Which of the following is the most appropriate management?\nChoices:\nA. Bedside compartment pressure measurements\nB. Doppler ultrasonography of the left lower extremity\nC. Intra-arterial tissue plasminogen activator (tPA) therapy\nD. Intraoperative angiography\nAnswer:", " Intraoperative angiography"], ["Question: A 55-year-old man who is a business executive is admitted to the hospital for evaluation of abdominal pain. He is polite to the physician but berates the nurses and other staff. The patient's wife and two of his three adult children arrive for a visit. The patient says with disgust that the missing child is and always has been worthless. Which of the following is the most likely explanation for this patient's behavior?\nChoices:\nA. Projection\nB. Projective identification\nC. Reaction formation\nD. Splitting\nAnswer:", " Projection"], ["Question: A 55-year-old man who is a business executive is admitted to the hospital for evaluation of abdominal pain. He is polite to the physician but berates the nurses and other staff. The patient's wife and two of his three adult children arrive for a visit. The patient says with disgust that the missing child is and always has been worthless. Which of the following is the most likely explanation for this patient's behavior?\nChoices:\nA. Projection\nB. Projective identification\nC. Reaction formation\nD. Splitting\nAnswer:", " Projective identification"], ["Question: A 55-year-old man who is a business executive is admitted to the hospital for evaluation of abdominal pain. He is polite to the physician but berates the nurses and other staff. The patient's wife and two of his three adult children arrive for a visit. The patient says with disgust that the missing child is and always has been worthless. Which of the following is the most likely explanation for this patient's behavior?\nChoices:\nA. Projection\nB. Projective identification\nC. Reaction formation\nD. Splitting\nAnswer:", " Reaction formation"], ["Question: A 55-year-old man who is a business executive is admitted to the hospital for evaluation of abdominal pain. He is polite to the physician but berates the nurses and other staff. The patient's wife and two of his three adult children arrive for a visit. The patient says with disgust that the missing child is and always has been worthless. Which of the following is the most likely explanation for this patient's behavior?\nChoices:\nA. Projection\nB. Projective identification\nC. Reaction formation\nD. Splitting\nAnswer:", " Splitting"], ["Question: A 42-year-old man comes to the physician for a follow-up examination 1 week after he passed a renal calculus. X-ray crystallographic analysis of the calculus showed calcium as the primary cation. Physical examination today shows no abnormalities. A 24-hour collection of urine shows increased calcium excretion. Which of the following is the most appropriate pharmacotherapy?\nChoices:\nA. Carbonic anhydrase inhibitor\nB. Na+ \u2013Cl\u2212 symport inhibitor\nC. Na+ \u2013K + \u20132Cl\u2212 symport inhibitor\nD. Osmotic diuretic\nAnswer:", " Carbonic anhydrase inhibitor"], ["Question: A 42-year-old man comes to the physician for a follow-up examination 1 week after he passed a renal calculus. X-ray crystallographic analysis of the calculus showed calcium as the primary cation. Physical examination today shows no abnormalities. A 24-hour collection of urine shows increased calcium excretion. Which of the following is the most appropriate pharmacotherapy?\nChoices:\nA. Carbonic anhydrase inhibitor\nB. Na+ \u2013Cl\u2212 symport inhibitor\nC. Na+ \u2013K + \u20132Cl\u2212 symport inhibitor\nD. Osmotic diuretic\nAnswer:", " Na+ \u2013Cl\u2212 symport inhibitor"], ["Question: A 42-year-old man comes to the physician for a follow-up examination 1 week after he passed a renal calculus. X-ray crystallographic analysis of the calculus showed calcium as the primary cation. Physical examination today shows no abnormalities. A 24-hour collection of urine shows increased calcium excretion. Which of the following is the most appropriate pharmacotherapy?\nChoices:\nA. Carbonic anhydrase inhibitor\nB. Na+ \u2013Cl\u2212 symport inhibitor\nC. Na+ \u2013K + \u20132Cl\u2212 symport inhibitor\nD. Osmotic diuretic\nAnswer:", " Na+ \u2013K + \u20132Cl\u2212 symport inhibitor"], ["Question: A 42-year-old man comes to the physician for a follow-up examination 1 week after he passed a renal calculus. X-ray crystallographic analysis of the calculus showed calcium as the primary cation. Physical examination today shows no abnormalities. A 24-hour collection of urine shows increased calcium excretion. Which of the following is the most appropriate pharmacotherapy?\nChoices:\nA. Carbonic anhydrase inhibitor\nB. Na+ \u2013Cl\u2212 symport inhibitor\nC. Na+ \u2013K + \u20132Cl\u2212 symport inhibitor\nD. Osmotic diuretic\nAnswer:", " Osmotic diuretic"], ["Question: A 72-year-old woman with advanced ovarian cancer metastatic to the liver is brought to the physician by her son because she cries all the time and will not get out of bed. On a 10-point scale, she rates the pain as a 1 to 2. She also has hypertension and major depressive disorder. She has received chemotherapy for 2 years. Current medications also include oxycodone (10 mg twice daily), hydrochlorothiazide (25 mg/d), and fluoxetine (20 mg/d). She is 165 cm (5 ft 5 in) tall and weighs 66 kg (145 lb); BMI is 24 kg/m2 . Her temperature is 37\u00b0C (98.6\u00b0F), pulse is 110/min, respirations are 12/min, and blood pressure is 120/80 mm Hg. Examination shows a firm, distended abdomen with moderate tenderness over the liver. On mental status examination, she is oriented to person, place, and time. She has good eye contact but appears sad and cries easily. Which of the following is the most appropriate next step in management?\nChoices:\nA. Reassurance\nB. Assess for suicidal ideation\nC. Begin dextroamphetamine therapy\nD. Increase oxycodone dosage\nAnswer:", " Reassurance"], ["Question: A 72-year-old woman with advanced ovarian cancer metastatic to the liver is brought to the physician by her son because she cries all the time and will not get out of bed. On a 10-point scale, she rates the pain as a 1 to 2. She also has hypertension and major depressive disorder. She has received chemotherapy for 2 years. Current medications also include oxycodone (10 mg twice daily), hydrochlorothiazide (25 mg/d), and fluoxetine (20 mg/d). She is 165 cm (5 ft 5 in) tall and weighs 66 kg (145 lb); BMI is 24 kg/m2 . Her temperature is 37\u00b0C (98.6\u00b0F), pulse is 110/min, respirations are 12/min, and blood pressure is 120/80 mm Hg. Examination shows a firm, distended abdomen with moderate tenderness over the liver. On mental status examination, she is oriented to person, place, and time. She has good eye contact but appears sad and cries easily. Which of the following is the most appropriate next step in management?\nChoices:\nA. Reassurance\nB. Assess for suicidal ideation\nC. Begin dextroamphetamine therapy\nD. Increase oxycodone dosage\nAnswer:", " Assess for suicidal ideation"], ["Question: A 72-year-old woman with advanced ovarian cancer metastatic to the liver is brought to the physician by her son because she cries all the time and will not get out of bed. On a 10-point scale, she rates the pain as a 1 to 2. She also has hypertension and major depressive disorder. She has received chemotherapy for 2 years. Current medications also include oxycodone (10 mg twice daily), hydrochlorothiazide (25 mg/d), and fluoxetine (20 mg/d). She is 165 cm (5 ft 5 in) tall and weighs 66 kg (145 lb); BMI is 24 kg/m2 . Her temperature is 37\u00b0C (98.6\u00b0F), pulse is 110/min, respirations are 12/min, and blood pressure is 120/80 mm Hg. Examination shows a firm, distended abdomen with moderate tenderness over the liver. On mental status examination, she is oriented to person, place, and time. She has good eye contact but appears sad and cries easily. Which of the following is the most appropriate next step in management?\nChoices:\nA. Reassurance\nB. Assess for suicidal ideation\nC. Begin dextroamphetamine therapy\nD. Increase oxycodone dosage\nAnswer:", " Begin dextroamphetamine therapy"], ["Question: A 72-year-old woman with advanced ovarian cancer metastatic to the liver is brought to the physician by her son because she cries all the time and will not get out of bed. On a 10-point scale, she rates the pain as a 1 to 2. She also has hypertension and major depressive disorder. She has received chemotherapy for 2 years. Current medications also include oxycodone (10 mg twice daily), hydrochlorothiazide (25 mg/d), and fluoxetine (20 mg/d). She is 165 cm (5 ft 5 in) tall and weighs 66 kg (145 lb); BMI is 24 kg/m2 . Her temperature is 37\u00b0C (98.6\u00b0F), pulse is 110/min, respirations are 12/min, and blood pressure is 120/80 mm Hg. Examination shows a firm, distended abdomen with moderate tenderness over the liver. On mental status examination, she is oriented to person, place, and time. She has good eye contact but appears sad and cries easily. Which of the following is the most appropriate next step in management?\nChoices:\nA. Reassurance\nB. Assess for suicidal ideation\nC. Begin dextroamphetamine therapy\nD. Increase oxycodone dosage\nAnswer:", " Increase oxycodone dosage"], ["Question: A 26-year-old male police officer comes to the office for an annual health maintenance examination. He is physically active and feels well, but he notes that his asthma has been more active during the past month. He says that he has had to use his albuterol inhaler one to two times daily for wheezing and chest tightness. He has not had gastroesophageal reflux symptoms, productive cough, or fever. Medical history is remarkable for atopic allergies, especially to pollen and cats. He has had coldand exercise-induced asthma for the past 14 years. He takes no other medications. He is 188 cm (6 ft 2 in) tall and weighs 90 kg (200 lb); BMI is 25 kg/m2 . Vital signs are temperature 37.0\u00b0C (98.6\u00b0F), pulse 70/min, respirations 12/min, and blood pressure 120/76 mm Hg. Physical examination shows no abnormalities except for scattered rhonchi and wheezes with forced expiration. Peak expiratory flow rate is 240 L/min. Which of the following is the most appropriate management?\nChoices:\nA. Chest x-ray\nB. Fexofenadine therapy\nC. Increased use of the albuterol inhaler\nD. Initiation of a daily corticosteroid inhaler\nAnswer:", " Chest x-ray"], ["Question: A 26-year-old male police officer comes to the office for an annual health maintenance examination. He is physically active and feels well, but he notes that his asthma has been more active during the past month. He says that he has had to use his albuterol inhaler one to two times daily for wheezing and chest tightness. He has not had gastroesophageal reflux symptoms, productive cough, or fever. Medical history is remarkable for atopic allergies, especially to pollen and cats. He has had coldand exercise-induced asthma for the past 14 years. He takes no other medications. He is 188 cm (6 ft 2 in) tall and weighs 90 kg (200 lb); BMI is 25 kg/m2 . Vital signs are temperature 37.0\u00b0C (98.6\u00b0F), pulse 70/min, respirations 12/min, and blood pressure 120/76 mm Hg. Physical examination shows no abnormalities except for scattered rhonchi and wheezes with forced expiration. Peak expiratory flow rate is 240 L/min. Which of the following is the most appropriate management?\nChoices:\nA. Chest x-ray\nB. Fexofenadine therapy\nC. Increased use of the albuterol inhaler\nD. Initiation of a daily corticosteroid inhaler\nAnswer:", " Fexofenadine therapy"], ["Question: A 26-year-old male police officer comes to the office for an annual health maintenance examination. He is physically active and feels well, but he notes that his asthma has been more active during the past month. He says that he has had to use his albuterol inhaler one to two times daily for wheezing and chest tightness. He has not had gastroesophageal reflux symptoms, productive cough, or fever. Medical history is remarkable for atopic allergies, especially to pollen and cats. He has had coldand exercise-induced asthma for the past 14 years. He takes no other medications. He is 188 cm (6 ft 2 in) tall and weighs 90 kg (200 lb); BMI is 25 kg/m2 . Vital signs are temperature 37.0\u00b0C (98.6\u00b0F), pulse 70/min, respirations 12/min, and blood pressure 120/76 mm Hg. Physical examination shows no abnormalities except for scattered rhonchi and wheezes with forced expiration. Peak expiratory flow rate is 240 L/min. Which of the following is the most appropriate management?\nChoices:\nA. Chest x-ray\nB. Fexofenadine therapy\nC. Increased use of the albuterol inhaler\nD. Initiation of a daily corticosteroid inhaler\nAnswer:", " Increased use of the albuterol inhaler"], ["Question: A 26-year-old male police officer comes to the office for an annual health maintenance examination. He is physically active and feels well, but he notes that his asthma has been more active during the past month. He says that he has had to use his albuterol inhaler one to two times daily for wheezing and chest tightness. He has not had gastroesophageal reflux symptoms, productive cough, or fever. Medical history is remarkable for atopic allergies, especially to pollen and cats. He has had coldand exercise-induced asthma for the past 14 years. He takes no other medications. He is 188 cm (6 ft 2 in) tall and weighs 90 kg (200 lb); BMI is 25 kg/m2 . Vital signs are temperature 37.0\u00b0C (98.6\u00b0F), pulse 70/min, respirations 12/min, and blood pressure 120/76 mm Hg. Physical examination shows no abnormalities except for scattered rhonchi and wheezes with forced expiration. Peak expiratory flow rate is 240 L/min. Which of the following is the most appropriate management?\nChoices:\nA. Chest x-ray\nB. Fexofenadine therapy\nC. Increased use of the albuterol inhaler\nD. Initiation of a daily corticosteroid inhaler\nAnswer:", " Initiation of a daily corticosteroid inhaler"]]