United State Medical Licensing Examination (Step 3) Set 21

A 50-year-old woman with a history of essential hypertension presents to the emergency department with sudden onset of a severe headache, nausea and vomiting, and photophobia. On examination, her BP is 160/100 mmHg. She is mildly confused and has nuchal rigidity, without focal neurologic signs. Which of the following is the most likely diagnosis?

A 50-year-old woman with a history of essential hypertension presents to the emergency department with sudden onset of a severe headache, nausea and vomiting, and photophobia. On examination, her BP is 160/100 mmHg. She is mildly confused and has nuchal rigidity, without focal neurologic signs. Once the diagnosis has been confirmed, which of the following is the next most important step in patient management?

A 47-year-old man with diabetes and hypertension travels with his family to Mexico. The next morning after eating out at a local restaurant and despite drinking bottled water, he develops severe crampy abdominal pain and watery, frequent diarrhea. Which of the following is the best approach for his care?

A dentist asks you to evaluate a 42-year-old woman before tooth extraction. In patients who are not intravenous (IV) drug users and who do not have prosthetic valves, which of the following organisms is the most common cause of bacterial endocarditis?

A 57-year-old man complains of worsening headache, nausea, and vomiting for 2 months. On examination, he is lethargic, confused, and has right-sided weakness. While waiting for a computed tomography (CT) scan, he develops status epilepticus, suffers cardiorespiratory arrest, and dies. His brain at autopsy is shown in the figure below. Which of the following is the most likely diagnosis?

Which of the following is a degenerative disease of the central nervous system (CNS) caused by infectious proteins called prions?

A22-year-old man complains of low back pain and stiffness that is worse on arising and improves with exercise. On examination, he is found to have limited mobility of the sacroiliac joints and lumbar spine. A serum test for histocompatibility antigen HLA-B27 is positive. What is the most common extraskeletal manifestation of this disease?

A 75-year-old man who developed diabetes within the last 6 months was found to be jaundiced. He has remained asymptomatic, except for weight loss of about 10 lbs in 6 months. On physical examination, he is found to have a nontender, globular, right upper quadrant mass that moves with respiration. A CT scan shows enlargement of the head of the pancreas, with no filling defects in the liver. What is the most likely cause of his painless jaundice?

While examining a 46-year-old woman, you hear a diastolic murmur that is increased when the patient is in the left lateral decubitus position. You ask her to run in place for 3 minutes, and the murmur is found to be accentuated as well by exercise. What is the most likely valvular defect?

A54-year-old woman with diabetes is noted to have BP in the range of 140/90 mmHg on several occasions. Which of the following is the best next step in management?