05-05-2011, 10:50 AM
A 26 year old woman comes to the physician to be fitted for a new diaphragm. She had an elective abortion for an unplanned and unwanted pregnancy 2 months ago. She and her husband have been using a diaphragm and contraceptive jelly as their only means of contraception. They have a pattern of drinking heavily on weekends and having unprotected sex. Which of the following is the most appropriate next step?
ANSWER - E) Talk to her about a non-barrier method of contraception.
A 23 year old woman with schizophrenia is brought to the emergency room from an inpatient psychiatric facility 30 mins after she accidentaly burned her leg with boiling water while cooking. Physical exam shows an 8cm area of erythema and blistering on the anterior section of the right thigh. The patient refuses treatment. She says, “ I know I have a thought problem I take medication for, but I never know who to trust. I want to wait until my parents get here. I know that my leg could get infected if I wait too long, but I don’t think its going to kill me if I wait a few hours”. Which of the following initial actions by the physician is most appropriate at this time?
ANSWER - A) Do not proceed with treatment and determine if her parents are on their way
A 19 year old college student is brought to the ER by campus police after he was found skateboarding nude around campus with a bucket of paint and brush. The police report that he was emblazoning all the sidewalks and parking lots with literary phrases. He is a creative writing major, and his friends describe him as an intelligent, happy, fun-loving, popular student who avoids drugs and alcohol. His roommate says that he recently had a burst of energy . he has been awake around the clock, wiring furiously at this desk, and announcing that he is “onto something big with his novel”. He has no history of psychiatric illness; family hx is unknown. Toxicology screening is negative, and serum thyroid-stimulating hormone concentration is within normal limits. Which of the following is the most likely diagnosis?
ANSWER - B) Bipolar disorder (manic episode)
16 year old boy is brought to the ER coz of intermittent testicular pain during the past 2 hours. PE shows red, swollen scrotum. Testicular torsion is suspected in this patient. The most appropriate diagnostic test is Doppler ultrasound to show the blood flow to the testicle from which of the following arteries?
ANSWER - C) Direct branch from the aorta
An 8 year old boy is brought to the doctor by his parents’ coz of a 3 month hx of episodes of unusual behavior that interfere with his performance at school. His teacher told the parents that he suddenly stops what he is doing for a few seconds and states into space. The episodes start and end abruptly. Physical and neuro exam shows no abnormalities. Which of the following mechanisms is the most likely cause of these episodes?
ANSWER - E) Synchronized discharge of the thalamocortical neurons.
A 71 year old man comes to the doctor coz of a 4 month hx of decreased force and size of his urine stream. Rectal exam shows a diffusely enlarged prostate. Urinalysis shows microscopic blood. Cytoscopy shows hypertrophy and thickening of the bladder wall. Without treatment, this patient is at greatest risk for which of the following?
ANSWER - E) Urinary tract infection
A 36 year old man comes to the doctor coz of pain in his right lower leg for 3 days. He recently increased his running routine from 12 to 24 miles per week. PE shows tenderness of the right lower extremity. An xray of the lower extremity shows a stress fracture of the right lower tibia. Which of the following is most likely increased in this patient?
ANSWER - A) Osteoblast activity at the fracture
A 14 year old boy is brought to the physician by his mother because of a 3 month history of severe blemishes on his face and back that have been increasing in number. His mother has bought many over the counter meds for the acne, but he has not used any of them. PE shows multiple pustules. Which of the following is the most appropriate next step?
ANSWER - a) Ask the patient if he is concerned about the appearance of his skin
A previously healthy 42yr old man comes to the physician b’cos of fever, chills, non productive cough of 3days.He works in construction. His temp is 39.5C (103.1F). Bilateral inspiratory crackles and diffuse expiratory wheezing are heard on auscultation of the chest. Sputum culture grows legionella pneumophila.Once this organism establishes its presence in this patients alveoli, which of the ff mechanisms is most integral to clearing the organism from his alveoli
E)T- lymphocytes-mediated immunity
A 2 month old girl has asymmetric gluteal folds. If untreated, the underlying pelvic condition will most likely progress to an erosive arthropathy. Which of the following is the most likely diagnosis?
ANSWER - a) Dislocation
A 54 year old male is brought to the ER 15 mins after the abrupt onset of crushing substernal chest pain. Pulse 98. RR 24. BP 104/56. S3 gallop heard. ECG shows ST elevation and isolated premature ventricular contractions. Following placement of a coronary stent and restoration of blood flow, he develops an idioventricular rhythm. Which of the following is the most likely underlying cause of this abnormal rhythm?
ANSWER - c) Generation of reactive oxygen species (result in damaged membrane and subsequent hyper depolarization/easy to depolarize cell)
A 20 month old boy is brought to the doc by his mother coz she is concerned about his language development. She says I don’t understand, his 4 year old sister had no probs with speech when she was his age. He is able to make some sounds like “b” and “p” spontaneously, but he seems slow to imitate words that parents say. He is active, able to run a few steps, and can recognize shapes and do simple puzzles. He is at the 60th percentile for length and weight, and 75th percentile for head circumference. He is friendly and cooperative and has good eye contact. PE shows no abnormalities. Which is most appropriate response?
ANSWER - a) I recommend that he undergo a hearing screening as soon as possible
Which of the following changes in the renal function is a direct result of the abnormal serum aldosterone concentration in this patient?
ANSWER - c) Increased sodium in the urine
A 40 year old man comes to the ER for treatment of a deep wound on his left leg that he sustained while working at a construction site in a rural area 2 days ago. Examiniation of the left lower extremity shows a 12 cm, tender, edematous would that is crepitant upon palpation. A blood-tinged exudates can be expressed from the wound. A gram stain of the exudates shows gram + rods. The would is debrided, and immediate treatment with antibiotics is started. Which of the following methods is most appropriate to successfully culture the causal organism?
ANSWER - c) Incubation under strict anaerobic conditions
A 26 year old man who was stabbed in the right side of the neck has a nerve injury. The physician is unable to detect a muscle stretch reflex in the right biceps. The injury most likely affected the function of which of the following nerves?
ANSWER - c) Musculocutaneous
A 52 year old man with an esophageal tumor near the gastroesophageal junction is scheduled for a total esophagectomy including anastomosis of the stomach into the lower pharynx. During this procedure, which of the following nerves must be severed?
ANSWER - f) Vagus
A 16 year old girl comes to the physician coz of a 10 year hx of a lesion on her left arm. PE shows a 1cm pigmented lesion on the left forearm. Following excision, the edges of the defect are opposed, and the wound is sutured. Increased mitotic activity of which of the following is the most likely to reestablish epidermal continuity in this patient?
ANSWER - a) Basal cells
4 year old boy is brought to the ER coz of generalized tonic-clonic serizures for the past 30 mins. Which of the following drug targets most likely mediates the effect of the most appropriate drug?
ANSWER - b) Ligand-gated ion channels
A 73 year old woman comes to the doctor for a follow-up exam. 6 months ago, she was diagnosed with metastatic small cell lung carcinoma but declined treatment. PE today shows no cardiopulmonary abnormalities. A chest xray shows widening of the angle between the right and left main stem bronchus, with the orientation of the right main stem bronchus being more horizontal. The primary lesion has not increased in size. Which of the following best explains the current xray findings in this patient?
ANSWER - b) Enlarging subcarinal lymph node
Infrarenal aortic aneurysm that extends to the iliac bifurcation. Which of the following arteries is involved in the aneurysm wall?
a) Inferior mesenteric
A guy having aortic aneurysm surgery is receiving 1L more fluid than he loses. Fluid excess is most likely to cause an acute decrease in
a)Angiotensin
A comminuted spiral fracture of the left humerus would cause which of the following?
b) Loss of function of the muscles innervated by the radial nerve
Question talked about a boy with a congenital HIV infection and has been fatigued for 3 weeks. There was lab date and the patient had low hemoglobin and hemacrit, but leukocyte, platelet, and reticulocyte count were normal.
Then a bone marrow smear was shown.
D) Parvovirus B19
Man with more than 50% burns had extensive skin grafting. After the procedure, he refused to leave the ward because
(a) this is a common concern of people receiving facial burns
Most likely site suggesting tophus
(a) ear
The opiod receptors leading to dyspnea are
(a) mu
DIC is due to
(b) decreased thrombin
When a person expires, the linear decrease in airflow in the airways is due to
(a) airway compression
colon cancer at splenic flexure will next spread to
(b) liver
After ARDS resolves, what will you find
(a) increased surfactant
Patient with GBM astrocytoma II most likely has abnormality of(impair)
(b) p53
An IV infusion of angiotensin II is administered for 1 hr. Which of the following is most likely after the hour?
A) Increased Filtration Fraction
A 68-year-old man comes to the physician because of a 5-week history of fatigue, difficulty concentrating, increased appetite, and an increased need for sleep; he has had a 2.0kg (4.4-lb) weight gain during this period. He reports not attending church for the past 4 weeks because he has been tired. He has a 11-year history of type 2 diabetes mellitus well controlled with diet and glyburide therapy. Over the past 2 years, his blood glucose concentrations had been within the reference ranges. He drinks 1 to 2 beers on the weekends and doesn't use illicit drugs. Physical and neurologic examinations show no changes. He makes poor eye contact and has a restricted affect. His serum glucose is 210 mg/dL and HbA1c is 10%. His CBC and metabolic profile are within reference ranges. Which of the following is the most likely cause of this patient's current lack of glycemic control?
f.) Major depressive disorder( olanzapine causes hyperglycemia)
For which of the following drugs is a method for active removal of the blood available using an immunologic strategy?
B- Digoxin (using Fab fragment)
Increased expression of IL-2
E) T-lymphocytes
a 3 year old boy with sickle cell disease is brought to the emergency department because of severe leg pain for 2 hours. Physical examination shows hepatosplenomegaly & tenderness over the lower extremities. His hemoglobin concentration is 7g/dL. A peripheral blood smear shows target cells, poikilocytes, & many sickled erythrocytes. Which of the following best describes the molecular basis for the sickling in this patient?
a) Gain of stabilizing hydrophobic interactions in the deoxygenated form of the hemoglobin S
A questionnaire is mailed to 8000 randomly selected physicians. Of these, 5680 (71%) respond. Which of the following measurements most strongly suggests that the respondents represent a heterogenous population with respect to the number of different procedures performed?
Mean number of procedures performed///////standard deviation
d) 13 .....5.1 if you are looking for a heterogenous population, then you are looking for the answer that shows the greatest standard deviation. This means that there is the greatest variation here among collected data... So the answer is D
a 45 year old man who works at a nuclear power plan is brought to the ER department 1 hour following an accident in which he was exposed to high levels of radiation. The amount of exposure is not believed to be fatal. He appears agitated & fearful, but he currently has no symptoms. This patient is most likely to initially show which of the following types of symptoms?
b) GIT
a 19 year old primigravid woman delievers a healthy male newborn at term. She asks if breast-feeding would be good for her baby. She is told that breast-feeding would result in passive transfer of her immunity to the baby. This would involve the movement of dimeric IgA molecules through polarized epithelial cells to reach the ductal lumen. Which of the following best describes this process?
e) transcytosis
A 54 year old woman comes to the physician for a routine examination. She has had symptoms of menopause for approximately 15 months. She inquires about the risks & benefits of combined hormone replacement therapy. She says she has obtained some information from a web site on the internet & understands the effects of estrogen. However, she is unsure of thepurpose of progesterone in the therapy regimen. She is provided with literature from the women's health initiative trial & the heart & estrogen/progesterone replacement study. After fully explaining the results of the research, which of the following is the most appropriate response by the physician regarding the beneficial effects of progesterone?
d) Prevents endometrial hyperplasia
A 25 year old woman comes to the physician because she has not had a menstrual period for 1 year. Menses began at age 14 years, & until the past year have occurred every 28 days & lasted 5 days. She does not have any children but would like to start a family. Examination is unremarkable. A pregnancy test is negative. Labs show an increased serum prolactin concentration & normal serum thyroid-stimulating hormone & thyroxine concentrations. Cranial imaging shows a pituitary microadenoma. Which of the following agents is likely to be most effective in achieving fertility?
a) Dopamine agonist (Prolactin Inhibitor) Pituitary adenoma causes increase in prolactin, increase in Prolactin decreases GnRH=decrease in FSH and LH thus INHIBITING prolactin with Dopamin can increase GnRH=fertility
A 76 year old man comes to the physician because of shortness of breath for 3 weeks. He has a 20 year history of hypertenstion. His temp is 37C (98.6F), pulse is 118/min, resp are 22/min, & bp is 108/52 mmHg. Bilateral crackles are heard on auscultation of the chest. Cardiac examination shows a normal S1 & S2; an S3 is heard. The point of maximal impulse is locate at the sixth left intercostals space at the anterior axillary line. Which of the following sets of hemodynamic values is most likely in this patient?
Left ventricular stroke volume¦left atrial pressure¦peripheral vascular resistance
c) Decreased¦increased¦increased
Hypertension causes concentric Left Ventricular Hypertrophy which is noncompliant ventricle (diastolic dysfunction) .
--this causes decreased end-diastolic volume and greater end-diastolic pressure
--remember stroke volume is affected by End diastolic Volume directly and in this patient
stroke volume decreases due to a decrease in end diastolic volume (starling law)..
--The increased Left ventricular end diastolic pressure causes an increase in left atrial pressure
--the decreased cardiac output activates RAA and angiotensin II increases the peripheral vascular resistance
Answer is C
A 75 year old man comes to the physician because of a 2 week history of moderate low back pain. Physical exam shows tenderness of the back & down each lower extremity on bending forward; there are no neuromuscular abnormalities. Rectal exam shows an enlarged prostate. Serum studies show a markedly increased prostate-specific antigen concentration. An x-ray of the spine shows vertebral collapse at L1 & patchy areas of increased density, consistent with osteoblastic metastases. Vertebroplasty is done to relieve the patient's pain, & a biopsy specimen of the damaged vertebra is obtained. Histologic exam of the biopsy specimen is most likely to show which of the following findings?
c) Pleomorphic epithelial cells forming duct-like structures(adenocarcinoma mestastasized)
A 65 year old man is brought to the ER coz of shortness of breath for 12 hours.He is in moderate distress. His temp is 36.7C (98F), pulse is 110/min, resp are 22/min, & bp is 90/40mmHg. Physical exam shows pallor & 2+ pitting ankle edema. Crackles are heard on auscultation of the chest. An ECG shows no abnormalities. Cardiac enzyme activities are normal. Which of the following changes in renal function is most likely in this patient?
d) Increased K+ excretion(CHF leading to secondary hyperaldosteronism, and thus increased K+ excretion)
Legionella in 42 male patient with non productive cough. Once in alveoli what is main mech to clear legionella from alveoli?
T-lymphocyte mediated immunity
6-month-old boy has been sickly since birth..severe diarrhea and pneumonia. 5th percentile height and weight. Temp 39C. Physical exam shows diaper rash. Coarse bilateral breath sounds. Diffuse bilateral pulmonary infiltrates. Patient dies 3 days later. At autopsy, Pneumocystitis jiroveci (PCP) pneumonia is identified as cause of death.
D) SCID (not Di George because bacterial infection present)
two chemical reaction are shown chematically ,each with its ΔG˚. C represent a same compound in each reaction. For the reaction shown , which of the following sets of values is most likely for ΔG˚and direction.
ΔG˚ direction
D) -4.7 2 (-G favors a forward reaction)
An investigator is conducting a study of a possible link between the development of breast cancer and an environmental toxin in a particular community. Over a 1 year period, all of the women with established breast ca in a certain zip code are identified. Which of the following best describes this measurement?
D) Period prevalence (1 year period)
A 14 year old girl is admitted to the hospital after sustaining injuries in a house fire. Her temp is 37.2 C (99 F), pulse is 115/min, respirations are 9/min, & bp is 100/65 mmHg. Physical examination shows second-degree burns over 40% of her body surface area. Labs show Urine Na 3 meq/L, osmolarity 1220 mOsmol/kg. Decrease in?
D) glomerular filtration
A 50-year-old man with schizophrenia develops fever, catatonia, and muscle rigidity 48 hours after starting treatment with chlorpromazine. His temperature is 39.2°C (102SF). Laboratory studies show myoglobinemia and an increased serum creatine kinase activity. Which of the following is the most likely diagnosis?
C) Neuroleptic malignant syndrome
A 24-year-old woman with asthma comes to the physician for a follow-up examination. At her last visit, the physician prescribed an inhaled corticosteroid to be used twice daily along with an inhaled adrenergic agonist as needed for acute episodes. The patient has had continued wheezing and shortness of breath twice weekly during the day and two to three times monthly at night. The patient says she stopped using the inhaled corticosteroid because it did not relieve her symptoms. The lungs are clear to auscultation of the chest. In addition to counseling the patient about appropriate inhaler usage technique, it is most appropriate for the physician to encourage inhaled corticosteroid usage by stating which of the following?
E) "Let's review how the inhaled corticosteroid will help in the control of your symptoms."
A 19-year-old man is brought to the emergency department 45 minutes after collapsing at a party. He is agitated and disoriented. His temperature is 39PC (103 SF), pulse is 138/mi n, respirations are 28/mi n, and blood pressure is 160/102 mm Hg. Physical examination shows hot, flushed skin; the pupils are dilated and responsive to light. Which of the following substances is the most likely cause of this patient's symptoms?
A) Ecstasy
A male newborn born at 30 weeks' gestation is admitted to the neonatal intensive care unit. His grandmother insists that the child be given chamomile tea to treat his complications of prematurity. She gets agitated when the nursing staff tries to assure her that he is being cared for appropriately. She requests that her grandson be transferred to another physician at another hospital. At the grandmother's insistence, she and the child's mother meet with the physician to discuss the grandmother's requests. After the physician listens to the grandmother's reason for wanting to use the tea, which of the following approaches is most appropriate?
D) Negotiate a plan to give the tea when the child's gastrointestinal tract will allow administration of liquids
A 44-year-old man comes to the physician to discuss the results of electromyography (EMG) conducted 1 week ago. He has had progressive muscle wasting, frequent muscle twitches at rest, mild difficulty swallowing, and a 6.8-kg (15-lb) weight loss during the past 3 months. He has been concerned that this might represent a seri ous illness. Physi cal exami nati on shows atrophy of the muscles of the ri ght upper extremity and left lower extremity, and bri sk deep tendon reflexes. The results of the EMG are compatible with amyotrophic lateral sclerosis (ALS). Which of the follOWing is the most appropriate way to initiate a discussion about these results with this patient?
B) "You do have a very serious muscle disease called ALS. This cannot be cured, but I will be here to help you with everything I can. Have you heard of ALS?"
A 1 9-year-old college student is brought to the emergency department by campus poli ce after he was found skateboarding nude around campus with a bucket of fluorescent paint and a brush. The police report that he was emblazoning all the sidewalks and parking lots with literary phrases. He is a creative writing major, and his friends describe him as an intelligent, happy, fun-loving, popular student who avoids drugs and alcohol. His roommate says that he recently had a burst of energy. He has been awake around the clock, writing furiously at his desk, and announcing that he is "onto something big with this novel." He has no history of psychiatric illness; family history is unknown. Toxicology screening is negative, and serum thyroid-stimulating hormone concentration is within normal limits. Which of the following is the most likely diagnosis?
B) Bi polar disorder (manic stage)
A US soldier returned from Iraq with a skin lesion on his right upper arm. The lesion was papular then developed into a nodular 4X5 cm crusting with irregular sharp border. Giemsa stain of biopsy showed inclusions with histiocytes. Which is the most likely infecting organism?
A- Leishmania major
A previously healthy 32 year old man is unconscious after an overdose of a sedative drug. His pulse is 90/min, respirations are 6/min, and bp is 80/40 mmHg. Arterial blood gas analysis on room air shows:
pH : 6.8
PCO2 : 80mmHg
PO2 : 40 mmHg
HCO3- : 12 mEq/L
Which of the following best describes this patient's acid-base status?
b) Resp acidosis & metabolic acidosis
61 year old man is brought to the ER because of a 1 hour history of severe chest pain and abdominal pain. He first noticed a sharp pain in his back 3 hours ago while stacking firewood in his backyard. Since that time, the pain has increased in intensity and generalized in distribution. He appears weak and diaphoretic. His temperature is 37C (98.6F), pulse is 100/min, respirations are 40/min and BP is 198/110 mmHg. Breath sounds are mildly decreased in the left lung base. A faint diastolic murmur is heard in the third left intercostals space. Abdominal exam shows guarding but no masses or organomegaly. CT scans of the chest and abdomen with contrast are shown, a Standford type A aortic dissection is indicated by the arrows. The patient is at greatest risk for which of the following?
B) Cardiac tamponade (Aortic insufficiency in the long run)
52-year-old woman has had slowly progressive weakness and weight loss of 9 kg (20 lb) for 4 months. She has never traveled outside of the USA. Her blood pressure is 82/50 mm Hg. Her skin shows diffuse hyperpigmentation. Plasma concentration of ACTH is markedly increased, and the serum concentration of cortisol is decreased. CT scans of the chest and abdomen disclose no mass lesions. Which of the following is the most likely etiology of this patient's disease?
A) Autoimmune (Addisons)
40 year old woman who's HIV positive developed fever and headaches. Budding yeasts are seen in her cerebrospinal fluid (CSF). The virulence of the infecting organism is due to which of the following?
A- Capsular polysaccharides (Cryptococcus neoformans)
A stillborn male newborn is delivered to a 32 yr old primigravida woman at 36 week's gestation. A photograph of newborn is shown. Histologic exam of sacrococcygeal tumor shows a haphazard arrangement of somatic tissues representing derivatives of ectoderm, mesoderm, & endoderm. The pathogenesis of this congenital neoplasm is most likely related to a defect arising during which of the following developmental processes?
e) primordial germ cell migration(teratoma)
A 9 month old girl is brought to ER 30mins after she had generalized tonic-clonic seizures. She has had failure to thrive & developmental delay since birth. She is at the 3rd percentile for length & weight. Physical exam shows microcephaly, tachypnea, & hypotonia. Lab studies show hypoglycemia, hyperalaninemia, & lactic acidosis. After I/V glucose is administered, her serum glucose concentration returns to within the reference range. This patient most likely has a deficiency of which of the following enzyme activities?
d) pyruvate carboxylase
a healthy 54 year old woman undergoes an exercise stress test. During the moderate phase of the exercise, her pulse is 140/min, respirations are 25/min, & bp is 130/90 mmHg. Which of the following is the relative proportion of coronary oxygen delivery during the rest & during the exercise times?
Rest moderate exercise
d) sys < dia sys < dia
a 9 year old girl has had polyuria, polydipsia, & weight loss for the past 3 weeks. She is alert, her breath has a fruity odor, & she has tachypnea. Lab studies show:
Beta-hydroxybutryate/osmolarity/anion gap
e) increase/increase/increase
a 25 year old woman comes to the physician because of increasingly severe pain of the right hip during the past week. She runs 5 miles daily & recently changed her route because of construction. She now runs on uneven ground rather than pavement. Range of motion of the hip is full. The pain is exacerbated by flexion & internal rotation of the hip & by direct palpation over the lateral aspect of the hip. Which of the following structures is most likely involved in her condition?
f) trochanteric bursa
a 29 year old woman comes to the physician because of a 1 week history of nausea, and vomiting in the mornings. Her last menstrual period was 8 weeks ago. Current medications include an oral contraceptive; she has not missed any doses during the past 2 years. Four months ago, she began taking an herbal preparation that was given to her by a friend, but she cannot remember the name of the herb. Physical exam shows a uterus consistent in size with an 8 week gestation. A urine pregnancy test result is positive. This patient has most likely been taking which of the following herbal preparations?
e) st. john's wort (increase p450)
a 42 year old man needs a kidney allograft. His lymphocytes are examined by the mixed lymphocyte reaction with killed stimulator cells from himself & from each of 5 prospective donors. A donor with which of the following thymidine incorporation (cpm) will be most compatible? (the patient has a thymidine value of 425/cpm)
a) 312 (lowest CPM most compatible)
a 72 year old woman comes to the physician because of an 8-month history of burning chest pain & a bitter taste in her mouth; both symptoms occur at night when she lies down. The pain does not radiate & is not associated with shortness of breath. Physical examination shows no abnormalities. Which of the following is most likely to be associated with her symptoms?
d) metaplasia of the esophageal epithelium
a male newborn has abnormal TSH, anterior cervical mass is noted high in the neck; thyroid gland is not palpable increased TSH, T4 and T3 are below normal. What is the reason?
b. lingual thyroid (hypothyroidism)
Mechanism of increased urine output in DM
D) Increased osmolarity of the tubular lumen (increase glucose in urine=increase osmolarity of urine) will lead to polyuria
DNA shows a n A-G mutation within the TATA box of the beta globulin gene promotor.
A) increase HbF/increase HbA2/increase retic count (Beta thalasemia)
Esophageal bleeding. Most likely cause indirect shunting of portal blood to SVC indirectly via which of the following vein?
E) Splenic (splenic and left renal veins / or portal vein to IVC relieves portal hypertension by shunting blood to the systemic circulation)
A 52 year old woman comes to the physician because of nausia, intermittent bloating and diarrhea for 5 days. Had gastric bypass surgery. Most likely cause of her symptoms.
C) rapid emptying of hyperosmolar chyme into small bowel
A troath culture grows Corynebacterium diphteriae. Immunization with which of the following would most likely prevent disease?
E) Toxoid (DTaP are toxoids)
Celecoxib increase risk of MI due to?
D) inhibition of PGI2 without inhibition of thromboxaneA2 in platelets (increased risk of thrombous formation)
Increase in sodium intake from 120 to 300 meq/day for 3 months. Increase?
D) potassium excretion (increase in sodium enhances K and H excretion)
Underwent bone marrow transplant 40 days ago. Maculopapular rash and jaundice. Most likely cause of hypersensitivity reaction?
B) cell mediated (Graft-versus-host = T-cell mediated)
36 year old male with ALL. Black skin lesions. Gram negative rods.
C) Lipopolysaccharide stimulating production of TNF
A 27 year old strict vegetarian. (picture shows megaloblastic anemia) Impairment of which of the following cellular processes?
B) DNA synthesis
A 55 year old male with MI. Initial therapy with anti-platelets ineffective. Most appropriate next pharmacotherapy?
D) Tissue plasminogen Activator (tPA used in early MI and stroke)
ANSWER - E) Talk to her about a non-barrier method of contraception.
A 23 year old woman with schizophrenia is brought to the emergency room from an inpatient psychiatric facility 30 mins after she accidentaly burned her leg with boiling water while cooking. Physical exam shows an 8cm area of erythema and blistering on the anterior section of the right thigh. The patient refuses treatment. She says, “ I know I have a thought problem I take medication for, but I never know who to trust. I want to wait until my parents get here. I know that my leg could get infected if I wait too long, but I don’t think its going to kill me if I wait a few hours”. Which of the following initial actions by the physician is most appropriate at this time?
ANSWER - A) Do not proceed with treatment and determine if her parents are on their way
A 19 year old college student is brought to the ER by campus police after he was found skateboarding nude around campus with a bucket of paint and brush. The police report that he was emblazoning all the sidewalks and parking lots with literary phrases. He is a creative writing major, and his friends describe him as an intelligent, happy, fun-loving, popular student who avoids drugs and alcohol. His roommate says that he recently had a burst of energy . he has been awake around the clock, wiring furiously at this desk, and announcing that he is “onto something big with his novel”. He has no history of psychiatric illness; family hx is unknown. Toxicology screening is negative, and serum thyroid-stimulating hormone concentration is within normal limits. Which of the following is the most likely diagnosis?
ANSWER - B) Bipolar disorder (manic episode)
16 year old boy is brought to the ER coz of intermittent testicular pain during the past 2 hours. PE shows red, swollen scrotum. Testicular torsion is suspected in this patient. The most appropriate diagnostic test is Doppler ultrasound to show the blood flow to the testicle from which of the following arteries?
ANSWER - C) Direct branch from the aorta
An 8 year old boy is brought to the doctor by his parents’ coz of a 3 month hx of episodes of unusual behavior that interfere with his performance at school. His teacher told the parents that he suddenly stops what he is doing for a few seconds and states into space. The episodes start and end abruptly. Physical and neuro exam shows no abnormalities. Which of the following mechanisms is the most likely cause of these episodes?
ANSWER - E) Synchronized discharge of the thalamocortical neurons.
A 71 year old man comes to the doctor coz of a 4 month hx of decreased force and size of his urine stream. Rectal exam shows a diffusely enlarged prostate. Urinalysis shows microscopic blood. Cytoscopy shows hypertrophy and thickening of the bladder wall. Without treatment, this patient is at greatest risk for which of the following?
ANSWER - E) Urinary tract infection
A 36 year old man comes to the doctor coz of pain in his right lower leg for 3 days. He recently increased his running routine from 12 to 24 miles per week. PE shows tenderness of the right lower extremity. An xray of the lower extremity shows a stress fracture of the right lower tibia. Which of the following is most likely increased in this patient?
ANSWER - A) Osteoblast activity at the fracture
A 14 year old boy is brought to the physician by his mother because of a 3 month history of severe blemishes on his face and back that have been increasing in number. His mother has bought many over the counter meds for the acne, but he has not used any of them. PE shows multiple pustules. Which of the following is the most appropriate next step?
ANSWER - a) Ask the patient if he is concerned about the appearance of his skin
A previously healthy 42yr old man comes to the physician b’cos of fever, chills, non productive cough of 3days.He works in construction. His temp is 39.5C (103.1F). Bilateral inspiratory crackles and diffuse expiratory wheezing are heard on auscultation of the chest. Sputum culture grows legionella pneumophila.Once this organism establishes its presence in this patients alveoli, which of the ff mechanisms is most integral to clearing the organism from his alveoli
E)T- lymphocytes-mediated immunity
A 2 month old girl has asymmetric gluteal folds. If untreated, the underlying pelvic condition will most likely progress to an erosive arthropathy. Which of the following is the most likely diagnosis?
ANSWER - a) Dislocation
A 54 year old male is brought to the ER 15 mins after the abrupt onset of crushing substernal chest pain. Pulse 98. RR 24. BP 104/56. S3 gallop heard. ECG shows ST elevation and isolated premature ventricular contractions. Following placement of a coronary stent and restoration of blood flow, he develops an idioventricular rhythm. Which of the following is the most likely underlying cause of this abnormal rhythm?
ANSWER - c) Generation of reactive oxygen species (result in damaged membrane and subsequent hyper depolarization/easy to depolarize cell)
A 20 month old boy is brought to the doc by his mother coz she is concerned about his language development. She says I don’t understand, his 4 year old sister had no probs with speech when she was his age. He is able to make some sounds like “b” and “p” spontaneously, but he seems slow to imitate words that parents say. He is active, able to run a few steps, and can recognize shapes and do simple puzzles. He is at the 60th percentile for length and weight, and 75th percentile for head circumference. He is friendly and cooperative and has good eye contact. PE shows no abnormalities. Which is most appropriate response?
ANSWER - a) I recommend that he undergo a hearing screening as soon as possible
Which of the following changes in the renal function is a direct result of the abnormal serum aldosterone concentration in this patient?
ANSWER - c) Increased sodium in the urine
A 40 year old man comes to the ER for treatment of a deep wound on his left leg that he sustained while working at a construction site in a rural area 2 days ago. Examiniation of the left lower extremity shows a 12 cm, tender, edematous would that is crepitant upon palpation. A blood-tinged exudates can be expressed from the wound. A gram stain of the exudates shows gram + rods. The would is debrided, and immediate treatment with antibiotics is started. Which of the following methods is most appropriate to successfully culture the causal organism?
ANSWER - c) Incubation under strict anaerobic conditions
A 26 year old man who was stabbed in the right side of the neck has a nerve injury. The physician is unable to detect a muscle stretch reflex in the right biceps. The injury most likely affected the function of which of the following nerves?
ANSWER - c) Musculocutaneous
A 52 year old man with an esophageal tumor near the gastroesophageal junction is scheduled for a total esophagectomy including anastomosis of the stomach into the lower pharynx. During this procedure, which of the following nerves must be severed?
ANSWER - f) Vagus
A 16 year old girl comes to the physician coz of a 10 year hx of a lesion on her left arm. PE shows a 1cm pigmented lesion on the left forearm. Following excision, the edges of the defect are opposed, and the wound is sutured. Increased mitotic activity of which of the following is the most likely to reestablish epidermal continuity in this patient?
ANSWER - a) Basal cells
4 year old boy is brought to the ER coz of generalized tonic-clonic serizures for the past 30 mins. Which of the following drug targets most likely mediates the effect of the most appropriate drug?
ANSWER - b) Ligand-gated ion channels
A 73 year old woman comes to the doctor for a follow-up exam. 6 months ago, she was diagnosed with metastatic small cell lung carcinoma but declined treatment. PE today shows no cardiopulmonary abnormalities. A chest xray shows widening of the angle between the right and left main stem bronchus, with the orientation of the right main stem bronchus being more horizontal. The primary lesion has not increased in size. Which of the following best explains the current xray findings in this patient?
ANSWER - b) Enlarging subcarinal lymph node
Infrarenal aortic aneurysm that extends to the iliac bifurcation. Which of the following arteries is involved in the aneurysm wall?
a) Inferior mesenteric
A guy having aortic aneurysm surgery is receiving 1L more fluid than he loses. Fluid excess is most likely to cause an acute decrease in
a)Angiotensin
A comminuted spiral fracture of the left humerus would cause which of the following?
b) Loss of function of the muscles innervated by the radial nerve
Question talked about a boy with a congenital HIV infection and has been fatigued for 3 weeks. There was lab date and the patient had low hemoglobin and hemacrit, but leukocyte, platelet, and reticulocyte count were normal.
Then a bone marrow smear was shown.
D) Parvovirus B19
Man with more than 50% burns had extensive skin grafting. After the procedure, he refused to leave the ward because
(a) this is a common concern of people receiving facial burns
Most likely site suggesting tophus
(a) ear
The opiod receptors leading to dyspnea are
(a) mu
DIC is due to
(b) decreased thrombin
When a person expires, the linear decrease in airflow in the airways is due to
(a) airway compression
colon cancer at splenic flexure will next spread to
(b) liver
After ARDS resolves, what will you find
(a) increased surfactant
Patient with GBM astrocytoma II most likely has abnormality of(impair)
(b) p53
An IV infusion of angiotensin II is administered for 1 hr. Which of the following is most likely after the hour?
A) Increased Filtration Fraction
A 68-year-old man comes to the physician because of a 5-week history of fatigue, difficulty concentrating, increased appetite, and an increased need for sleep; he has had a 2.0kg (4.4-lb) weight gain during this period. He reports not attending church for the past 4 weeks because he has been tired. He has a 11-year history of type 2 diabetes mellitus well controlled with diet and glyburide therapy. Over the past 2 years, his blood glucose concentrations had been within the reference ranges. He drinks 1 to 2 beers on the weekends and doesn't use illicit drugs. Physical and neurologic examinations show no changes. He makes poor eye contact and has a restricted affect. His serum glucose is 210 mg/dL and HbA1c is 10%. His CBC and metabolic profile are within reference ranges. Which of the following is the most likely cause of this patient's current lack of glycemic control?
f.) Major depressive disorder( olanzapine causes hyperglycemia)
For which of the following drugs is a method for active removal of the blood available using an immunologic strategy?
B- Digoxin (using Fab fragment)
Increased expression of IL-2
E) T-lymphocytes
a 3 year old boy with sickle cell disease is brought to the emergency department because of severe leg pain for 2 hours. Physical examination shows hepatosplenomegaly & tenderness over the lower extremities. His hemoglobin concentration is 7g/dL. A peripheral blood smear shows target cells, poikilocytes, & many sickled erythrocytes. Which of the following best describes the molecular basis for the sickling in this patient?
a) Gain of stabilizing hydrophobic interactions in the deoxygenated form of the hemoglobin S
A questionnaire is mailed to 8000 randomly selected physicians. Of these, 5680 (71%) respond. Which of the following measurements most strongly suggests that the respondents represent a heterogenous population with respect to the number of different procedures performed?
Mean number of procedures performed///////standard deviation
d) 13 .....5.1 if you are looking for a heterogenous population, then you are looking for the answer that shows the greatest standard deviation. This means that there is the greatest variation here among collected data... So the answer is D
a 45 year old man who works at a nuclear power plan is brought to the ER department 1 hour following an accident in which he was exposed to high levels of radiation. The amount of exposure is not believed to be fatal. He appears agitated & fearful, but he currently has no symptoms. This patient is most likely to initially show which of the following types of symptoms?
b) GIT
a 19 year old primigravid woman delievers a healthy male newborn at term. She asks if breast-feeding would be good for her baby. She is told that breast-feeding would result in passive transfer of her immunity to the baby. This would involve the movement of dimeric IgA molecules through polarized epithelial cells to reach the ductal lumen. Which of the following best describes this process?
e) transcytosis
A 54 year old woman comes to the physician for a routine examination. She has had symptoms of menopause for approximately 15 months. She inquires about the risks & benefits of combined hormone replacement therapy. She says she has obtained some information from a web site on the internet & understands the effects of estrogen. However, she is unsure of thepurpose of progesterone in the therapy regimen. She is provided with literature from the women's health initiative trial & the heart & estrogen/progesterone replacement study. After fully explaining the results of the research, which of the following is the most appropriate response by the physician regarding the beneficial effects of progesterone?
d) Prevents endometrial hyperplasia
A 25 year old woman comes to the physician because she has not had a menstrual period for 1 year. Menses began at age 14 years, & until the past year have occurred every 28 days & lasted 5 days. She does not have any children but would like to start a family. Examination is unremarkable. A pregnancy test is negative. Labs show an increased serum prolactin concentration & normal serum thyroid-stimulating hormone & thyroxine concentrations. Cranial imaging shows a pituitary microadenoma. Which of the following agents is likely to be most effective in achieving fertility?
a) Dopamine agonist (Prolactin Inhibitor) Pituitary adenoma causes increase in prolactin, increase in Prolactin decreases GnRH=decrease in FSH and LH thus INHIBITING prolactin with Dopamin can increase GnRH=fertility
A 76 year old man comes to the physician because of shortness of breath for 3 weeks. He has a 20 year history of hypertenstion. His temp is 37C (98.6F), pulse is 118/min, resp are 22/min, & bp is 108/52 mmHg. Bilateral crackles are heard on auscultation of the chest. Cardiac examination shows a normal S1 & S2; an S3 is heard. The point of maximal impulse is locate at the sixth left intercostals space at the anterior axillary line. Which of the following sets of hemodynamic values is most likely in this patient?
Left ventricular stroke volume¦left atrial pressure¦peripheral vascular resistance
c) Decreased¦increased¦increased
Hypertension causes concentric Left Ventricular Hypertrophy which is noncompliant ventricle (diastolic dysfunction) .
--this causes decreased end-diastolic volume and greater end-diastolic pressure
--remember stroke volume is affected by End diastolic Volume directly and in this patient
stroke volume decreases due to a decrease in end diastolic volume (starling law)..
--The increased Left ventricular end diastolic pressure causes an increase in left atrial pressure
--the decreased cardiac output activates RAA and angiotensin II increases the peripheral vascular resistance
Answer is C
A 75 year old man comes to the physician because of a 2 week history of moderate low back pain. Physical exam shows tenderness of the back & down each lower extremity on bending forward; there are no neuromuscular abnormalities. Rectal exam shows an enlarged prostate. Serum studies show a markedly increased prostate-specific antigen concentration. An x-ray of the spine shows vertebral collapse at L1 & patchy areas of increased density, consistent with osteoblastic metastases. Vertebroplasty is done to relieve the patient's pain, & a biopsy specimen of the damaged vertebra is obtained. Histologic exam of the biopsy specimen is most likely to show which of the following findings?
c) Pleomorphic epithelial cells forming duct-like structures(adenocarcinoma mestastasized)
A 65 year old man is brought to the ER coz of shortness of breath for 12 hours.He is in moderate distress. His temp is 36.7C (98F), pulse is 110/min, resp are 22/min, & bp is 90/40mmHg. Physical exam shows pallor & 2+ pitting ankle edema. Crackles are heard on auscultation of the chest. An ECG shows no abnormalities. Cardiac enzyme activities are normal. Which of the following changes in renal function is most likely in this patient?
d) Increased K+ excretion(CHF leading to secondary hyperaldosteronism, and thus increased K+ excretion)
Legionella in 42 male patient with non productive cough. Once in alveoli what is main mech to clear legionella from alveoli?
T-lymphocyte mediated immunity
6-month-old boy has been sickly since birth..severe diarrhea and pneumonia. 5th percentile height and weight. Temp 39C. Physical exam shows diaper rash. Coarse bilateral breath sounds. Diffuse bilateral pulmonary infiltrates. Patient dies 3 days later. At autopsy, Pneumocystitis jiroveci (PCP) pneumonia is identified as cause of death.
D) SCID (not Di George because bacterial infection present)
two chemical reaction are shown chematically ,each with its ΔG˚. C represent a same compound in each reaction. For the reaction shown , which of the following sets of values is most likely for ΔG˚and direction.
ΔG˚ direction
D) -4.7 2 (-G favors a forward reaction)
An investigator is conducting a study of a possible link between the development of breast cancer and an environmental toxin in a particular community. Over a 1 year period, all of the women with established breast ca in a certain zip code are identified. Which of the following best describes this measurement?
D) Period prevalence (1 year period)
A 14 year old girl is admitted to the hospital after sustaining injuries in a house fire. Her temp is 37.2 C (99 F), pulse is 115/min, respirations are 9/min, & bp is 100/65 mmHg. Physical examination shows second-degree burns over 40% of her body surface area. Labs show Urine Na 3 meq/L, osmolarity 1220 mOsmol/kg. Decrease in?
D) glomerular filtration
A 50-year-old man with schizophrenia develops fever, catatonia, and muscle rigidity 48 hours after starting treatment with chlorpromazine. His temperature is 39.2°C (102SF). Laboratory studies show myoglobinemia and an increased serum creatine kinase activity. Which of the following is the most likely diagnosis?
C) Neuroleptic malignant syndrome
A 24-year-old woman with asthma comes to the physician for a follow-up examination. At her last visit, the physician prescribed an inhaled corticosteroid to be used twice daily along with an inhaled adrenergic agonist as needed for acute episodes. The patient has had continued wheezing and shortness of breath twice weekly during the day and two to three times monthly at night. The patient says she stopped using the inhaled corticosteroid because it did not relieve her symptoms. The lungs are clear to auscultation of the chest. In addition to counseling the patient about appropriate inhaler usage technique, it is most appropriate for the physician to encourage inhaled corticosteroid usage by stating which of the following?
E) "Let's review how the inhaled corticosteroid will help in the control of your symptoms."
A 19-year-old man is brought to the emergency department 45 minutes after collapsing at a party. He is agitated and disoriented. His temperature is 39PC (103 SF), pulse is 138/mi n, respirations are 28/mi n, and blood pressure is 160/102 mm Hg. Physical examination shows hot, flushed skin; the pupils are dilated and responsive to light. Which of the following substances is the most likely cause of this patient's symptoms?
A) Ecstasy
A male newborn born at 30 weeks' gestation is admitted to the neonatal intensive care unit. His grandmother insists that the child be given chamomile tea to treat his complications of prematurity. She gets agitated when the nursing staff tries to assure her that he is being cared for appropriately. She requests that her grandson be transferred to another physician at another hospital. At the grandmother's insistence, she and the child's mother meet with the physician to discuss the grandmother's requests. After the physician listens to the grandmother's reason for wanting to use the tea, which of the following approaches is most appropriate?
D) Negotiate a plan to give the tea when the child's gastrointestinal tract will allow administration of liquids
A 44-year-old man comes to the physician to discuss the results of electromyography (EMG) conducted 1 week ago. He has had progressive muscle wasting, frequent muscle twitches at rest, mild difficulty swallowing, and a 6.8-kg (15-lb) weight loss during the past 3 months. He has been concerned that this might represent a seri ous illness. Physi cal exami nati on shows atrophy of the muscles of the ri ght upper extremity and left lower extremity, and bri sk deep tendon reflexes. The results of the EMG are compatible with amyotrophic lateral sclerosis (ALS). Which of the follOWing is the most appropriate way to initiate a discussion about these results with this patient?
B) "You do have a very serious muscle disease called ALS. This cannot be cured, but I will be here to help you with everything I can. Have you heard of ALS?"
A 1 9-year-old college student is brought to the emergency department by campus poli ce after he was found skateboarding nude around campus with a bucket of fluorescent paint and a brush. The police report that he was emblazoning all the sidewalks and parking lots with literary phrases. He is a creative writing major, and his friends describe him as an intelligent, happy, fun-loving, popular student who avoids drugs and alcohol. His roommate says that he recently had a burst of energy. He has been awake around the clock, writing furiously at his desk, and announcing that he is "onto something big with this novel." He has no history of psychiatric illness; family history is unknown. Toxicology screening is negative, and serum thyroid-stimulating hormone concentration is within normal limits. Which of the following is the most likely diagnosis?
B) Bi polar disorder (manic stage)
A US soldier returned from Iraq with a skin lesion on his right upper arm. The lesion was papular then developed into a nodular 4X5 cm crusting with irregular sharp border. Giemsa stain of biopsy showed inclusions with histiocytes. Which is the most likely infecting organism?
A- Leishmania major
A previously healthy 32 year old man is unconscious after an overdose of a sedative drug. His pulse is 90/min, respirations are 6/min, and bp is 80/40 mmHg. Arterial blood gas analysis on room air shows:
pH : 6.8
PCO2 : 80mmHg
PO2 : 40 mmHg
HCO3- : 12 mEq/L
Which of the following best describes this patient's acid-base status?
b) Resp acidosis & metabolic acidosis
61 year old man is brought to the ER because of a 1 hour history of severe chest pain and abdominal pain. He first noticed a sharp pain in his back 3 hours ago while stacking firewood in his backyard. Since that time, the pain has increased in intensity and generalized in distribution. He appears weak and diaphoretic. His temperature is 37C (98.6F), pulse is 100/min, respirations are 40/min and BP is 198/110 mmHg. Breath sounds are mildly decreased in the left lung base. A faint diastolic murmur is heard in the third left intercostals space. Abdominal exam shows guarding but no masses or organomegaly. CT scans of the chest and abdomen with contrast are shown, a Standford type A aortic dissection is indicated by the arrows. The patient is at greatest risk for which of the following?
B) Cardiac tamponade (Aortic insufficiency in the long run)
52-year-old woman has had slowly progressive weakness and weight loss of 9 kg (20 lb) for 4 months. She has never traveled outside of the USA. Her blood pressure is 82/50 mm Hg. Her skin shows diffuse hyperpigmentation. Plasma concentration of ACTH is markedly increased, and the serum concentration of cortisol is decreased. CT scans of the chest and abdomen disclose no mass lesions. Which of the following is the most likely etiology of this patient's disease?
A) Autoimmune (Addisons)
40 year old woman who's HIV positive developed fever and headaches. Budding yeasts are seen in her cerebrospinal fluid (CSF). The virulence of the infecting organism is due to which of the following?
A- Capsular polysaccharides (Cryptococcus neoformans)
A stillborn male newborn is delivered to a 32 yr old primigravida woman at 36 week's gestation. A photograph of newborn is shown. Histologic exam of sacrococcygeal tumor shows a haphazard arrangement of somatic tissues representing derivatives of ectoderm, mesoderm, & endoderm. The pathogenesis of this congenital neoplasm is most likely related to a defect arising during which of the following developmental processes?
e) primordial germ cell migration(teratoma)
A 9 month old girl is brought to ER 30mins after she had generalized tonic-clonic seizures. She has had failure to thrive & developmental delay since birth. She is at the 3rd percentile for length & weight. Physical exam shows microcephaly, tachypnea, & hypotonia. Lab studies show hypoglycemia, hyperalaninemia, & lactic acidosis. After I/V glucose is administered, her serum glucose concentration returns to within the reference range. This patient most likely has a deficiency of which of the following enzyme activities?
d) pyruvate carboxylase
a healthy 54 year old woman undergoes an exercise stress test. During the moderate phase of the exercise, her pulse is 140/min, respirations are 25/min, & bp is 130/90 mmHg. Which of the following is the relative proportion of coronary oxygen delivery during the rest & during the exercise times?
Rest moderate exercise
d) sys < dia sys < dia
a 9 year old girl has had polyuria, polydipsia, & weight loss for the past 3 weeks. She is alert, her breath has a fruity odor, & she has tachypnea. Lab studies show:
Beta-hydroxybutryate/osmolarity/anion gap
e) increase/increase/increase
a 25 year old woman comes to the physician because of increasingly severe pain of the right hip during the past week. She runs 5 miles daily & recently changed her route because of construction. She now runs on uneven ground rather than pavement. Range of motion of the hip is full. The pain is exacerbated by flexion & internal rotation of the hip & by direct palpation over the lateral aspect of the hip. Which of the following structures is most likely involved in her condition?
f) trochanteric bursa
a 29 year old woman comes to the physician because of a 1 week history of nausea, and vomiting in the mornings. Her last menstrual period was 8 weeks ago. Current medications include an oral contraceptive; she has not missed any doses during the past 2 years. Four months ago, she began taking an herbal preparation that was given to her by a friend, but she cannot remember the name of the herb. Physical exam shows a uterus consistent in size with an 8 week gestation. A urine pregnancy test result is positive. This patient has most likely been taking which of the following herbal preparations?
e) st. john's wort (increase p450)
a 42 year old man needs a kidney allograft. His lymphocytes are examined by the mixed lymphocyte reaction with killed stimulator cells from himself & from each of 5 prospective donors. A donor with which of the following thymidine incorporation (cpm) will be most compatible? (the patient has a thymidine value of 425/cpm)
a) 312 (lowest CPM most compatible)
a 72 year old woman comes to the physician because of an 8-month history of burning chest pain & a bitter taste in her mouth; both symptoms occur at night when she lies down. The pain does not radiate & is not associated with shortness of breath. Physical examination shows no abnormalities. Which of the following is most likely to be associated with her symptoms?
d) metaplasia of the esophageal epithelium
a male newborn has abnormal TSH, anterior cervical mass is noted high in the neck; thyroid gland is not palpable increased TSH, T4 and T3 are below normal. What is the reason?
b. lingual thyroid (hypothyroidism)
Mechanism of increased urine output in DM
D) Increased osmolarity of the tubular lumen (increase glucose in urine=increase osmolarity of urine) will lead to polyuria
DNA shows a n A-G mutation within the TATA box of the beta globulin gene promotor.
A) increase HbF/increase HbA2/increase retic count (Beta thalasemia)
Esophageal bleeding. Most likely cause indirect shunting of portal blood to SVC indirectly via which of the following vein?
E) Splenic (splenic and left renal veins / or portal vein to IVC relieves portal hypertension by shunting blood to the systemic circulation)
A 52 year old woman comes to the physician because of nausia, intermittent bloating and diarrhea for 5 days. Had gastric bypass surgery. Most likely cause of her symptoms.
C) rapid emptying of hyperosmolar chyme into small bowel
A troath culture grows Corynebacterium diphteriae. Immunization with which of the following would most likely prevent disease?
E) Toxoid (DTaP are toxoids)
Celecoxib increase risk of MI due to?
D) inhibition of PGI2 without inhibition of thromboxaneA2 in platelets (increased risk of thrombous formation)
Increase in sodium intake from 120 to 300 meq/day for 3 months. Increase?
D) potassium excretion (increase in sodium enhances K and H excretion)
Underwent bone marrow transplant 40 days ago. Maculopapular rash and jaundice. Most likely cause of hypersensitivity reaction?
B) cell mediated (Graft-versus-host = T-cell mediated)
36 year old male with ALL. Black skin lesions. Gram negative rods.
C) Lipopolysaccharide stimulating production of TNF
A 27 year old strict vegetarian. (picture shows megaloblastic anemia) Impairment of which of the following cellular processes?
B) DNA synthesis
A 55 year old male with MI. Initial therapy with anti-platelets ineffective. Most appropriate next pharmacotherapy?
D) Tissue plasminogen Activator (tPA used in early MI and stroke)