07-24-2014, 02:05 AM
1)An 85 yr old woman is diagnosed with a fracture of the right femur and begins treatment morphine by patient controlled analgesic pump. 3 days later, her resp are 6/min. PE show pinpoint pupils. Her serum conc is 1.8mg/dl. Which of the following best explains this pt's clinical deterioration after the initiation of morphine therapy?
A)Chronic dosing of morphine decreases its bioavailability
B)Morphine bioavailability increses with chronic dosing.
C)Morphine downregulates mu opioid receptors with chronic dosing.
D)Morphine inhibits its own metabolism
E)Morphine is metabolized to active metabolites that accumulat
2) A 35 yr old man comes to the physician becoz of a 3yr h/o enlarging nose, coarseninf of his facial features, muscle weakness and increased hand and foot size. PE shows prognathism and large fleshy nose. Serum studies show increased IGF-1 conc. An MRI of the brain shows a pitutary adenoma. Morphologic analysis of the biopsy specimen of the tumor shows a densely granulated somatotroph adenoma. Further studies show that the G-Alpha S subunit of G proteins in the tumor cells lack GTPase activity. The tumor cells in this pt. most likely have an increased activity of which of the following enzymes?
A)Adenyly cyclase
B)Guanylyl cyclase
C)Janus kinase
D)Phoapho lipase c
E)Tyrosine kinase
3) A 9 year old boy brought to the physician by hiss mother because of a 1 year h/o cough productive of mucoid sputum, wheezing and SOB with exertion. H ehas a h/o recurrent upper resp tract and sinus infection since birth. He is at 25th percentile for ht & wt. The mother says that his younger sibling is beginning to develop similar problems. PE shows mild clubbing of the fingers. Lab studies show markedly increased sweat chloride and sodium conc. A defect of which of the following in this pt's bronchial epithelium is most likely causing these symptoms. A)Adrenoceptors
B)Membrane receptors
C)Nuclear receptors
D)Protein regulation
E)Protein structure
4) A 25-year-old man is brought to the emergency department because of severe abdominal pain, nausea, and vomiting for 1 hour. The pain originates in the left flank and radiates to his groin. His pulse is 100/min, respirations are 18/min, and blood pressure is 150/100 mm Hg. Physical examination shows tenderness of the left flank and the left lower quadrant of the abdomen. Bowel sounds are mildly hypoactive. Test of the stool for occult blood is negative. Which of the following best explains these findings?
A ) Colon neoplasm
B ) Diverticulitis
C ) Epididymitis
D ) Renal infarction
E ) Torsion of the testis
F ) Ureteral calculus
5)A 70-year-old woman is found to have persistent fever despite intravenous broad-spectrum antibiotic therapy 3 days after undergoing operative excision of the anterior pelvic organs for recurrent cervical carcinoma. Her temperature is 38.5°C (101.3°F). Physical examination shows the presence of a central venous catheter that was placed on the day of the operation. There is also a well-healing abdominal wound without erythema and with two drains in place. Blood cultures and cultures of the tip of the central catheter on a sheep blood agar plate grow the organism shown in the photograph. A Gram stain of one of the colonies shows 4-
μm, elliptical, purple, budding organisms. Which of the following is the most likely causal organism?
A-Candida albicans
B-Cryptococcus neoformans
C- Escherichia coli
D- Sporothrix schenckii
E- Staphylococcus aureus
A)Chronic dosing of morphine decreases its bioavailability
B)Morphine bioavailability increses with chronic dosing.
C)Morphine downregulates mu opioid receptors with chronic dosing.
D)Morphine inhibits its own metabolism
E)Morphine is metabolized to active metabolites that accumulat
2) A 35 yr old man comes to the physician becoz of a 3yr h/o enlarging nose, coarseninf of his facial features, muscle weakness and increased hand and foot size. PE shows prognathism and large fleshy nose. Serum studies show increased IGF-1 conc. An MRI of the brain shows a pitutary adenoma. Morphologic analysis of the biopsy specimen of the tumor shows a densely granulated somatotroph adenoma. Further studies show that the G-Alpha S subunit of G proteins in the tumor cells lack GTPase activity. The tumor cells in this pt. most likely have an increased activity of which of the following enzymes?
A)Adenyly cyclase
B)Guanylyl cyclase
C)Janus kinase
D)Phoapho lipase c
E)Tyrosine kinase
3) A 9 year old boy brought to the physician by hiss mother because of a 1 year h/o cough productive of mucoid sputum, wheezing and SOB with exertion. H ehas a h/o recurrent upper resp tract and sinus infection since birth. He is at 25th percentile for ht & wt. The mother says that his younger sibling is beginning to develop similar problems. PE shows mild clubbing of the fingers. Lab studies show markedly increased sweat chloride and sodium conc. A defect of which of the following in this pt's bronchial epithelium is most likely causing these symptoms. A)Adrenoceptors
B)Membrane receptors
C)Nuclear receptors
D)Protein regulation
E)Protein structure
4) A 25-year-old man is brought to the emergency department because of severe abdominal pain, nausea, and vomiting for 1 hour. The pain originates in the left flank and radiates to his groin. His pulse is 100/min, respirations are 18/min, and blood pressure is 150/100 mm Hg. Physical examination shows tenderness of the left flank and the left lower quadrant of the abdomen. Bowel sounds are mildly hypoactive. Test of the stool for occult blood is negative. Which of the following best explains these findings?
A ) Colon neoplasm
B ) Diverticulitis
C ) Epididymitis
D ) Renal infarction
E ) Torsion of the testis
F ) Ureteral calculus
5)A 70-year-old woman is found to have persistent fever despite intravenous broad-spectrum antibiotic therapy 3 days after undergoing operative excision of the anterior pelvic organs for recurrent cervical carcinoma. Her temperature is 38.5°C (101.3°F). Physical examination shows the presence of a central venous catheter that was placed on the day of the operation. There is also a well-healing abdominal wound without erythema and with two drains in place. Blood cultures and cultures of the tip of the central catheter on a sheep blood agar plate grow the organism shown in the photograph. A Gram stain of one of the colonies shows 4-
μm, elliptical, purple, budding organisms. Which of the following is the most likely causal organism?
A-Candida albicans
B-Cryptococcus neoformans
C- Escherichia coli
D- Sporothrix schenckii
E- Staphylococcus aureus