04-30-2011, 07:18 PM
. A 57-year-old woman comes to the physician
because of a 2-year
history of increasing menstrual flow. She has not had
hot flashes,
insomnia, or change in bowel or bladder function. Her
last menstrual period
was 2 weeks ago. Pelvic examination shows a
normal-appearing vulva,
vagina, and cervix. The uterus is consistent in size
with an 8-week
gestation. Bimanual examination shows a 4-cm, firm,
nontender left ovary. An
endometrial biopsy specimen shows atypical complex
endometrial
hyperplasia. Which of the following is the most likely
cause of this patient's
hyperplasia?
A) Adrenal adenoma
B) Brenner tumor
C) Carcinoid tumor
D) Granulosa cell tumor
E) Hyperthecosis
F) Islet cell tumor
G) Sertoli-Leydig cell tumor
11.
A 62-year-old man comes to the emergency department
because ofprogressive shortness of breath for 3 days. He has
not had chest pain, orthopnea, or paroxysmal nocturnal dyspnea. He
completed chemotherapy for small cell carcinoma of the lung 10 months ago. He
has a history of twice nightly nocturia that has resolved over the past 3
days. He smoked two packs of cigarettes daily for 30 years but quit 1 year
ago. His blood pressure is 96/60 mm Hg, and pulse is 116/min. There
is jugular venous distention to the angle of the jaw. The lungs are
clear to auscultation. Cardiac examination shows distant heart
sounds, an S1 and S2, and no
gallops or rubs. The liver has a span of 12 cm and is
tender. There is no pedal edema. Laboratory studies show:
Hemoglobin 10 g/dL
Serum
Na+ 135 mEq/L
Cl– 110 mEq/L
K+ 4.2 m HCO3– 22 mEq/L
Urea nitrogen (BUN) 40 mg/dL
Creatinine 1.6 mg/dL
An ECG shows diminished amplitude of the QRS
complexes. An x-ray film
of the chest shows clear lung fields with an enlarged
cardiac
silhouette. Which of the following findings is most
likely to be accentuated?
A) Cardiac output
B) Fall in systolic arterial pressure with
inspiration
C) Left ventricular end-diastolic pressure
D) Mitral regurgitation
E) Ventricular septal wall motion
18. A 6-year-old boy with cystic fibrosis is
brought to the
physician by his mother because his skin has been cool
and clammy for 30
minutes. Earlier in the day, he had been playing
outdoors, and the
temperature was 99 F. When returning indoors, he was
thirsty and restless. His
blood pressure is 70/40 mm Hg, and pulse is 120/min.
Examination shows
dry mucous membranes. Serum sodium level is 128
mEq/L, and serum
chloride level is 87 mEq/L. Which of the following is
the most likely
explanation for these findings?
A) Excessive sweat electrolyte level
B) Excessive sweat volume
C) Excessive urinary output
D) Excessive vasopressor secretion
E) Inadequate sweat production
26. A 27-year-old woman is brought to the emergency
department by
her mother who found her comatose 30 minutes ago. Her
mother says that
her daughter had been having lower abdominal pain and
vaginal bleeding
over the past week. The patient had an ectopic
pregnancy 2 years ago
and was also treated with doxycycline for pelvic
inflammatory disease at
that time. Her blood pressure is 40/20 mm Hg, pulse
is 160/min, and
respirations are 24/min. The abdomen is distended and
rigid with
decreased bowel sounds. Hemoglobin level is 4.2 g/dL,
and leukocyte count is
12,500/mm3. Culdocentesis is positive. Which of the
following is the
most appropriate next step in management?
A) Bromocriptine therapy
B) Clomiphene therapy
C) Conjugated estrogen therapy
D) Ergot derivative therapy
E) Hysteroscopy
F) Laparoscopy
G) Dilatation and curettage
H) Endometrial ablation
I) Exploratory laparotomy
J) Total abdominal hysterectomy
41. A 1-week-old newborn has had poor feeding,
vomiting, and progressive lethargy over the past 4 days. She was
born at term; pregnancy, labor, and delivery were uncomplicated, and she had no
congenital anomalies. She is being breast-fed. She has a
healthy 2-year-old brother; a sister died at 10 days of age after a full-term birth.
Examination shows decreased muscle tone and poor responsiveness;
reflexes are normal. Serum bicarbonate level is 8 mEq/L, pH is 7.15, and
plasma ammonia level is 10 times the upper limit of normal. Which of
the following is the most likely cause?
A) Mitochondrial disorder
B) Mucopolysaccharidoses disorder
C) Organic acid metabolism disorder
D) Renal tubular acidosis
E) X-linked leukodystrophy
because of a 2-year
history of increasing menstrual flow. She has not had
hot flashes,
insomnia, or change in bowel or bladder function. Her
last menstrual period
was 2 weeks ago. Pelvic examination shows a
normal-appearing vulva,
vagina, and cervix. The uterus is consistent in size
with an 8-week
gestation. Bimanual examination shows a 4-cm, firm,
nontender left ovary. An
endometrial biopsy specimen shows atypical complex
endometrial
hyperplasia. Which of the following is the most likely
cause of this patient's
hyperplasia?
A) Adrenal adenoma
B) Brenner tumor
C) Carcinoid tumor
D) Granulosa cell tumor
E) Hyperthecosis
F) Islet cell tumor
G) Sertoli-Leydig cell tumor
11.
A 62-year-old man comes to the emergency department
because ofprogressive shortness of breath for 3 days. He has
not had chest pain, orthopnea, or paroxysmal nocturnal dyspnea. He
completed chemotherapy for small cell carcinoma of the lung 10 months ago. He
has a history of twice nightly nocturia that has resolved over the past 3
days. He smoked two packs of cigarettes daily for 30 years but quit 1 year
ago. His blood pressure is 96/60 mm Hg, and pulse is 116/min. There
is jugular venous distention to the angle of the jaw. The lungs are
clear to auscultation. Cardiac examination shows distant heart
sounds, an S1 and S2, and no
gallops or rubs. The liver has a span of 12 cm and is
tender. There is no pedal edema. Laboratory studies show:
Hemoglobin 10 g/dL
Serum
Na+ 135 mEq/L
Cl– 110 mEq/L
K+ 4.2 m HCO3– 22 mEq/L
Urea nitrogen (BUN) 40 mg/dL
Creatinine 1.6 mg/dL
An ECG shows diminished amplitude of the QRS
complexes. An x-ray film
of the chest shows clear lung fields with an enlarged
cardiac
silhouette. Which of the following findings is most
likely to be accentuated?
A) Cardiac output
B) Fall in systolic arterial pressure with
inspiration
C) Left ventricular end-diastolic pressure
D) Mitral regurgitation
E) Ventricular septal wall motion
18. A 6-year-old boy with cystic fibrosis is
brought to the
physician by his mother because his skin has been cool
and clammy for 30
minutes. Earlier in the day, he had been playing
outdoors, and the
temperature was 99 F. When returning indoors, he was
thirsty and restless. His
blood pressure is 70/40 mm Hg, and pulse is 120/min.
Examination shows
dry mucous membranes. Serum sodium level is 128
mEq/L, and serum
chloride level is 87 mEq/L. Which of the following is
the most likely
explanation for these findings?
A) Excessive sweat electrolyte level
B) Excessive sweat volume
C) Excessive urinary output
D) Excessive vasopressor secretion
E) Inadequate sweat production
26. A 27-year-old woman is brought to the emergency
department by
her mother who found her comatose 30 minutes ago. Her
mother says that
her daughter had been having lower abdominal pain and
vaginal bleeding
over the past week. The patient had an ectopic
pregnancy 2 years ago
and was also treated with doxycycline for pelvic
inflammatory disease at
that time. Her blood pressure is 40/20 mm Hg, pulse
is 160/min, and
respirations are 24/min. The abdomen is distended and
rigid with
decreased bowel sounds. Hemoglobin level is 4.2 g/dL,
and leukocyte count is
12,500/mm3. Culdocentesis is positive. Which of the
following is the
most appropriate next step in management?
A) Bromocriptine therapy
B) Clomiphene therapy
C) Conjugated estrogen therapy
D) Ergot derivative therapy
E) Hysteroscopy
F) Laparoscopy
G) Dilatation and curettage
H) Endometrial ablation
I) Exploratory laparotomy
J) Total abdominal hysterectomy
41. A 1-week-old newborn has had poor feeding,
vomiting, and progressive lethargy over the past 4 days. She was
born at term; pregnancy, labor, and delivery were uncomplicated, and she had no
congenital anomalies. She is being breast-fed. She has a
healthy 2-year-old brother; a sister died at 10 days of age after a full-term birth.
Examination shows decreased muscle tone and poor responsiveness;
reflexes are normal. Serum bicarbonate level is 8 mEq/L, pH is 7.15, and
plasma ammonia level is 10 times the upper limit of normal. Which of
the following is the most likely cause?
A) Mitochondrial disorder
B) Mucopolysaccharidoses disorder
C) Organic acid metabolism disorder
D) Renal tubular acidosis
E) X-linked leukodystrophy