nhu313/questions.json

## gistfile1.txt
{"question": "",
  "choices": [],
  "answer": "",
  "explaination": ""
 },

## questions.json
[{"question": "A 36-year-old obese Hispanic woman with a history of hypertension, diabetes, and hypercholesterolemia complains of sporadic mild epigastric quadrant pain and fatigue. She also has been trying to conceive for the past three years with no success. Her laboratory studies indicate that her AST and ALT tests are two to three times normal and microcytic anemia. Her abdominal ultrasound shows a normal gallbladder without stones and generalized hyperechogenicity of the liver.",
  "choices": ["Acute appendicitis", "Acute viral hepatitis", "Budd-Chiari syndrome", "Crigler-Najjar syndrome", "Gilbert syndrome", "Hemolysis secondary to G6PD deficiency", "Nonalcoholic fatty liver disease", "Pancreatic carcinoma", "Peptic ulcer disease", "Wilson disease"],
  "answer": "Nonalcoholic fatty liver disease",
  "explaination": "This patient has nonalcoholic fatty liver disease (NAFLD). Nonalcoholic fatty liver disease is a term used to describe the accumulation of fat in the liver of people who drink little or no alcohol. NAFLD is very common and is estimated to affect up to 20% of the U.S. population. The condition is more common in men than women and more common in whites than blacks. The condition is characterized by fat accumulation in the hepatocytes (steatosis). The underlying pathophysiology is closely linked to insulin resistance and hence to obesity, diabetes, hyperlipidemia and the metabolic syndrome. Most cases are discovered incidentally because of elevated transaminases. Patients may have nonspecific right upper quadrant or epigastric discomfort and hepatomegaly. Abdominal ultrasound shows hyperechogenicity consistent with fatty infiltration. CT scan is also sensitive in diagnosing the condition (90%). Patients with NAFLD are at risk for progression to nonalcoholic steatohepatitis (NASH) that can lead to fibrosis and cirrhosis which it is nonreversible. The mainstay of treatment for NAFLD is lifestyle modification with increased exercise (hence increased insulin sensitivity) and weight loss."
 },
 {"question": "A 26-year-old white woman comes to her physician with complains of red papules of the cheeks and nose and occasional pustules. She also appears to have conjunctivitis. She reports frequent flushing and blushing. Drinking margaritas with her friends on the weekends produces a severe flushing of the face. Her family history shows a couple of family members with her same condition. Which of the following is the most likely diagnosis?",
  "choices": ["Acute Complications of Sarcoidosis", "Carcinoid syndrome", "Perioral Dermatitis", "Porphyria cutanea tarda", "Rosacea", "Seborrheic dermatitis", "Systemic lupus erythematosus"],
  "answer": "Rosacea",
  "explaination": "Rosacea is a common condition characterized by symptoms of facial flushing and a spectrum of clinical signs, including erythema, telangiectasia, coarseness of skin, and an inflammatory papulopustular eruption resembling acne. It is a common problem in middle-aged, fair-skinned people. Sun damage appears to play an important role. Stress, alcohol, and heat contribute to the flushing. Men may develop rhinophyma (connective tissue overgrowth, particularly of the nose). Low-dose oral tetracycline, erythromycin, and metronidazole control the symptoms. Topical metronidazole also works well. A daily use of a broad-spectrum sunscreen against both UV-A and UV-B light is recommended for all patients with rosacea."
 },
 {"question": "A 39-year-old white man complains of fatigue, impotence, weight loss, and back and knee pain over last 3 months. He was told at a free clinic visit that his blood sugar was a little higher than normal. His family history includes liver disease on his father’s side. On examination, the patient has mild skin hyperpigmentation and an enlarged palpable liver. He also complains of hair loss during that period. Which of the following test or combination of tests is the best to diagnose this patient?",
  "choices": ["Alpha-1-antitrypsin level", "Comprehensive metabolic panel and Complete blood count with differential", "Hemoglobin A1C", "High dose dexamethasone suppression test", "Iron, total iron-binding capacity, and ferritin", "Liver-spleen scan", "Testosterone serum level"],
  "answer": "Iron, total iron-binding capacity, and ferritin",
  "explaination": "Hemochromatosis is an autosomal recessive condition that causes increased intestinal absorption of iron and excessive total body iron stores. The cause is a defect in the HFE or related gene; it affects Caucasians most frequently at a rate of about 1 in 250 persons. Clinically, the liver is usually enlarged, and excessive skin pigmentation is present in 90% of symptomatic patients at the time of diagnosis. Diabetes occurs secondary to direct damage to the pancreas by iron deposition. Arthropathy develops in 25% to 50% of cases. Initial screening involves transferrin saturation (iron/total iron binding capacity) and ferritin levels. A transferrin saturation of over 45% or a ferritin over 150 would be consistent with the diagnosis and would suggest the need for referral and genetic testing. A simple CBC would not suggest the diagnosis."
 },
 {"question": "A 29 year-old woman comes to her physician with symptoms of fever, headache, pain in the joints, and a rash in her face and extremities. In the patient history, she mentions that she just came back from her honeymoon in South America and that her symptoms did not start until she came back. Further lab testing shows mild elevated white blood count, but the rest of the labs within normal levels. Pregnancy test is negative. The physician suspects infection with the Zika virus and orders more testing to confirm. What is the most likely mode of transmission causing the infection on this patient?",
  "choices": ["Sandfly", "Tsetse fly", "Aedes mosquitoes", "Reduviid bug", "Dermacentor (dog tick)", "Raccoon", "Ixodes tick", "Ambylomma (Lone Star tick)", "Anopheles mosquito"],
  "answer": "Aedes mosquitoes",
  "explaination": "Zika virus is a positive sense, single-stranded RNA virus of the Flaviviridae family, genus Flavivirus. It is an enveloped virus with an isosahedral nucleocaspid. Zika virus is transmitted to people primarily through the bite of an infected Aedes species mosquito (A. aegypti and A. albopictus). These are the same mosquitoes that spread dengue and chikungunya viruses. The most common symptoms of Zika virus disease are fever, rash, joint pain, and conjunctivitis (red eyes). The illness is usually mild with symptoms lasting from several days to a week. Severe disease requiring hospitalization is uncommon. Zika virus is associated with Guillain-Barré syndrome and pregnant women giving birth to babies with birth defects and poor pregnancy outcomes. Currently, there is no vaccine to prevent or specific medicine to treat Zika infections. To treat the symptoms, get plenty of rest, drink fluids to prevent dehydration and take medicine such as acetaminophen to relieve fever and pain. Do not take aspirin and other non-steroidal anti-inflammatory drugs."
 },
 {"question": "A 72-year-old woman with small cell carcinoma of the lung develops respiratory failure and is intubated. She previous named her cousin as durable power of attorney. Her cousin believes the patient would have wanted her life support withdrawn. However, the patient had also made a living will stipulating that all measures should be undertaken to maintain her life. The patient’s daughter believes her mother’s living will reflects her wishes and wants everything done to maintain her life. What should you do in this situation?",
  "choices": ["Appoint the daughter as durable power of attorney since she is the next of kin, and follow her wishes", "Keep the patient on life support in accordance with the patient’s living will", "Respect the decision of the durable power of attorney and withdraw life support", "Use ‘substituted judgment’ to determine what the patient would have wanted in such a case.", "Ask the ethics committee for help in making a decision"],
  "answer": "Respect the decision of the durable power of attorney and withdraw life support",
  "explaination": "Appointed durable power of attorney supersedes a living will. The patient, in good state of mind, believed that her cousin would make decisions with which he would agree. It is always appropriate to facilitate a discussion between people involved in making end of life decisions, but it is unethical to try to make the choice. In the rare circumstance when there are two conflicting documents then the more recent document will offset the previous one. Circumstances may have changed since the patient made his living will (she could have been diagnosed with metastatic disease for instance), therefore the durable power of attorney carries the responsibility of making the decision that she thinks best fits what the patient would have made given the current medical situation."
 }
 ]
	{"question": "",
	"choices": [],
	"answer": "",
	"explaination": ""
	},
	[{"question": "A 36-year-old obese Hispanic woman with a history of hypertension, diabetes, and hypercholesterolemia complains of sporadic mild epigastric quadrant pain and fatigue. She also has been trying to conceive for the past three years with no success. Her laboratory studies indicate that her AST and ALT tests are two to three times normal and microcytic anemia. Her abdominal ultrasound shows a normal gallbladder without stones and generalized hyperechogenicity of the liver.",
	"choices": ["Acute appendicitis", "Acute viral hepatitis", "Budd-Chiari syndrome", "Crigler-Najjar syndrome", "Gilbert syndrome", "Hemolysis secondary to G6PD deficiency", "Nonalcoholic fatty liver disease", "Pancreatic carcinoma", "Peptic ulcer disease", "Wilson disease"],
	"answer": "Nonalcoholic fatty liver disease",
	"explaination": "This patient has nonalcoholic fatty liver disease (NAFLD). Nonalcoholic fatty liver disease is a term used to describe the accumulation of fat in the liver of people who drink little or no alcohol. NAFLD is very common and is estimated to affect up to 20% of the U.S. population. The condition is more common in men than women and more common in whites than blacks. The condition is characterized by fat accumulation in the hepatocytes (steatosis). The underlying pathophysiology is closely linked to insulin resistance and hence to obesity, diabetes, hyperlipidemia and the metabolic syndrome. Most cases are discovered incidentally because of elevated transaminases. Patients may have nonspecific right upper quadrant or epigastric discomfort and hepatomegaly. Abdominal ultrasound shows hyperechogenicity consistent with fatty infiltration. CT scan is also sensitive in diagnosing the condition (90%). Patients with NAFLD are at risk for progression to nonalcoholic steatohepatitis (NASH) that can lead to fibrosis and cirrhosis which it is nonreversible. The mainstay of treatment for NAFLD is lifestyle modification with increased exercise (hence increased insulin sensitivity) and weight loss."
	},
	{"question": "A 26-year-old white woman comes to her physician with complains of red papules of the cheeks and nose and occasional pustules. She also appears to have conjunctivitis. She reports frequent flushing and blushing. Drinking margaritas with her friends on the weekends produces a severe flushing of the face. Her family history shows a couple of family members with her same condition. Which of the following is the most likely diagnosis?",
	"choices": ["Acute Complications of Sarcoidosis", "Carcinoid syndrome", "Perioral Dermatitis", "Porphyria cutanea tarda", "Rosacea", "Seborrheic dermatitis", "Systemic lupus erythematosus"],
	"answer": "Rosacea",
	"explaination": "Rosacea is a common condition characterized by symptoms of facial flushing and a spectrum of clinical signs, including erythema, telangiectasia, coarseness of skin, and an inflammatory papulopustular eruption resembling acne. It is a common problem in middle-aged, fair-skinned people. Sun damage appears to play an important role. Stress, alcohol, and heat contribute to the flushing. Men may develop rhinophyma (connective tissue overgrowth, particularly of the nose). Low-dose oral tetracycline, erythromycin, and metronidazole control the symptoms. Topical metronidazole also works well. A daily use of a broad-spectrum sunscreen against both UV-A and UV-B light is recommended for all patients with rosacea."
	},
	{"question": "A 39-year-old white man complains of fatigue, impotence, weight loss, and back and knee pain over last 3 months. He was told at a free clinic visit that his blood sugar was a little higher than normal. His family history includes liver disease on his father’s side. On examination, the patient has mild skin hyperpigmentation and an enlarged palpable liver. He also complains of hair loss during that period. Which of the following test or combination of tests is the best to diagnose this patient?",
	"choices": ["Alpha-1-antitrypsin level", "Comprehensive metabolic panel and Complete blood count with differential", "Hemoglobin A1C", "High dose dexamethasone suppression test", "Iron, total iron-binding capacity, and ferritin", "Liver-spleen scan", "Testosterone serum level"],
	"answer": "Iron, total iron-binding capacity, and ferritin",
	"explaination": "Hemochromatosis is an autosomal recessive condition that causes increased intestinal absorption of iron and excessive total body iron stores. The cause is a defect in the HFE or related gene; it affects Caucasians most frequently at a rate of about 1 in 250 persons. Clinically, the liver is usually enlarged, and excessive skin pigmentation is present in 90% of symptomatic patients at the time of diagnosis. Diabetes occurs secondary to direct damage to the pancreas by iron deposition. Arthropathy develops in 25% to 50% of cases. Initial screening involves transferrin saturation (iron/total iron binding capacity) and ferritin levels. A transferrin saturation of over 45% or a ferritin over 150 would be consistent with the diagnosis and would suggest the need for referral and genetic testing. A simple CBC would not suggest the diagnosis."
	},
	{"question": "A 29 year-old woman comes to her physician with symptoms of fever, headache, pain in the joints, and a rash in her face and extremities. In the patient history, she mentions that she just came back from her honeymoon in South America and that her symptoms did not start until she came back. Further lab testing shows mild elevated white blood count, but the rest of the labs within normal levels. Pregnancy test is negative. The physician suspects infection with the Zika virus and orders more testing to confirm. What is the most likely mode of transmission causing the infection on this patient?",
	"choices": ["Sandfly", "Tsetse fly", "Aedes mosquitoes", "Reduviid bug", "Dermacentor (dog tick)", "Raccoon", "Ixodes tick", "Ambylomma (Lone Star tick)", "Anopheles mosquito"],
	"answer": "Aedes mosquitoes",
	"explaination": "Zika virus is a positive sense, single-stranded RNA virus of the Flaviviridae family, genus Flavivirus. It is an enveloped virus with an isosahedral nucleocaspid. Zika virus is transmitted to people primarily through the bite of an infected Aedes species mosquito (A. aegypti and A. albopictus). These are the same mosquitoes that spread dengue and chikungunya viruses. The most common symptoms of Zika virus disease are fever, rash, joint pain, and conjunctivitis (red eyes). The illness is usually mild with symptoms lasting from several days to a week. Severe disease requiring hospitalization is uncommon. Zika virus is associated with Guillain-Barré syndrome and pregnant women giving birth to babies with birth defects and poor pregnancy outcomes. Currently, there is no vaccine to prevent or specific medicine to treat Zika infections. To treat the symptoms, get plenty of rest, drink fluids to prevent dehydration and take medicine such as acetaminophen to relieve fever and pain. Do not take aspirin and other non-steroidal anti-inflammatory drugs."
	},
	{"question": "A 72-year-old woman with small cell carcinoma of the lung develops respiratory failure and is intubated. She previous named her cousin as durable power of attorney. Her cousin believes the patient would have wanted her life support withdrawn. However, the patient had also made a living will stipulating that all measures should be undertaken to maintain her life. The patient’s daughter believes her mother’s living will reflects her wishes and wants everything done to maintain her life. What should you do in this situation?",
	"choices": ["Appoint the daughter as durable power of attorney since she is the next of kin, and follow her wishes", "Keep the patient on life support in accordance with the patient’s living will", "Respect the decision of the durable power of attorney and withdraw life support", "Use ‘substituted judgment’ to determine what the patient would have wanted in such a case.", "Ask the ethics committee for help in making a decision"],
	"answer": "Respect the decision of the durable power of attorney and withdraw life support",
	"explaination": "Appointed durable power of attorney supersedes a living will. The patient, in good state of mind, believed that her cousin would make decisions with which he would agree. It is always appropriate to facilitate a discussion between people involved in making end of life decisions, but it is unethical to try to make the choice. In the rare circumstance when there are two conflicting documents then the more recent document will offset the previous one. Circumstances may have changed since the patient made his living will (she could have been diagnosed with metastatic disease for instance), therefore the durable power of attorney carries the responsibility of making the decision that she thinks best fits what the patient would have made given the current medical situation."
	}
	]