A 29-year-old man is evaluated in hospital. His father had a history of “anemia” treated with splenectomy and cholecystectomy. MCV is 85 fL. Hemoglobin is 14 g/dL. MCHC is elevated. The patient has a diagnostic modality performed that is abnormal. Below is an imaging result using the same modality from a healthy individual.

Which of the following most likely explains the patient’s abnormal diagnostic result?

A) Coombs test positivity
B) Gallstone ileus
C) Gallstone pancreatitis
D) Increased erythrocyte turnover
E) Increased HbS

A 78-year-old woman is evaluated in hospital for yellow eyes and skin. She has no overt past medical history apart from a cholecystectomy at age 58. She’s a non-smoker. Laboratory studies show:

Total bilirubin                                        4.0 mg/dL
Conjugated bilirubin                         3.0 mg/dL
Pancreatic amylase                            Normal
Pancreatic lipase                                 Normal

Which of the following is the most likely explanation for this patient’s findings?

A) Choledocholithiasis
B) Cholelithiasis
C) Malignancy
D) Reduced activity of hepatic enzyme
E) Sphincter of Oddi dysfunction

A 62-year-old man undergoes elective abdominal surgery for colon cancer. Current medications are opioid analgesics for postoperative pain control. Approximately 24 hours later, he develops a fever of 38 C. He reports mild shortness of breath. He does not have chest pain, cough, or hemoptysis. Physical examination reveals decreased breath sounds at the lung bases bilaterally without crackles or wheezing. Oxygen sats are 95% on room air. Chest x-ray shows mild bibasilar opacities. Which of the following is the most likely cause of this patient’s fever?

A. Atelectasis
B. Postoperative pneumonia
C. Pulmonary embolism
D. Surgical site infection
E. Urinary tract infection

A 59-year-old man is evaluated at a dental clinic prior to undergoing a root canal procedure. His BMI is 45. There is a 2/6 decrescendo holodiastolic murmur auscultated on cardiac examination. Blood pressure is 140/60. Echocardiography confirms the diagnosis. Which of the following is the most appropriate next step in preoperative management?

A) Amoxicillin orally 2 grams
B) Cefoxitin orally
C) No preoperative antibiotics indicated
D) Vancomycin + ceftriaxone
E) Vancomycin + gentamicin

A 54-year-old man comes to the physician for a 3-week history of persistent productive cough, foul-smelling sputum, low-grade fever, and fatigue. For the past 2 days, he now reports night sweats and some sharp chest pain. Past medical history is otherwise unremarkable apart from on-and-off heavy drinking. A chest x-ray and CT are performed.

What is the most appropriate next step in management?

A) Bronchoscopy with transbronchial biopsy
B) CT-guided percutaneous drainage
C) Intravenous clindamycin therapy
D) Lobectomy
E) Sputum cytology for malignant cells

A 22-year-old man comes to the physician for a 3-month history of intermittent abdominal pain and bloody stools. He believes he may have lost around 5 pounds over this time. He reports occasional low-grade fevers and fatigue. He also noticed a painful red bump on his shin that appeared a few weeks ago and has not gone away. Physical examination reveals mild RLQ abdominal tenderness and an erythematous left shin. Hemoglobin is 10 g/dL. MCV is 85 fL. His mother has psoriasis. Which of the following is the most appropriate next step in confirming the diagnosis?

A) Abdominal CT scan
B) Anti-saccharomyces cerevisiae antibody testing
C) Colonoscopy
D) HLA-B27 testing
E) Small bowel capsule endoscopy

A 41-year-old man comes to the physician for a follow-up appointment. He has had a slight yellowish tinge to his eyes the past week. Vitals are normal. Laboratory studies show high total bilirubin and ALP. LDH is not elevated. There is no transaminitis. Pancreatic enzymes are not elevated. There is no history of autoimmune disease in him or his family. An ultrasound is negative. Which of the following is the most appropriate next step in diagnosis?

A) Abdominal x-ray
B) CT of the abdomen
C) Endoscopic retrograde cholangiopancreatography
D) Gastroesophagoduodenoscopy
E) HIDA scan

A 62-year-old man is brought to emergency by his wife several hours after an episode of sudden-onset right arm weakness and difficulty speaking that resolved after 45 minutes. He has a history of hypertension and dyslipidemia but does not take medications consistently. He has a 40-pack-year smoking history. He drinks Scotch. Blood pressure is 160/90. Neurologic exam is unremarkable. A non-contrast CT of the head shows no acute abnormalities. ECG shows sinus rhythm. Which of the following is the most appropriate next diagnostic step to evaluate the cause of this patient’s symptoms?

]]> 28901 https://mehlmanmedical.com/hy-usmle-q-1376-cardio/ Sun, 18 May 2025 11:51:38 +0000 https://mehlmanmedical.com/?p=28869

A 66-year-old man comes to the physician because of a 2-month history of worsening shortness of breath that now has transitioned to him experiencing difficulty climbing a single flight of stairs. He sleeps propped up on two pillows to avoid waking up gasping for air. He also describes episodes of waking up at night feeling like he cannot breathe, which improve after sitting up for several minutes. He has no symptoms at rest. He denies chest pain. He has a 20-year history of hypertension managed with lisinopril. A resting ECG shows a left bundle branch block. Which of the following is the next best step in management?

]]> 28869 https://mehlmanmedical.com/hy-usmle-q-1276-surgery-im/ Fri, 04 Apr 2025 12:34:23 +0000 https://mehlmanmedical.com/?p=25168

A 45-year-old woman presents to the emergency department with a 3-hour history of severe, colicky right upper quadrant abdominal pain radiating to the back. She also has associated nausea, vomiting, and a low-grade fever. On physical examination, she is tachycardic, with tenderness in the right upper quadrant of the abdomen. Murphy sign is positive. Laboratory findings show: WBCs 14,000/μL, ALP 120 IU/L, bilirubin 1.1 mg/dL. Abdominal ultrasound shows a gallbladder wall thickness of 5mm and pericholecystic fluid. Which of the following is the next best step in management?