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A 68-year-old woman is brought to the emergency department by her husband 3 hours after the onset of severe pain in the middle of her lower back after carrying groceries. She takes no medications and has never received hormone replacement therapy. Physical examination shows tenderness over the lumbosacral spine. Neurologic examination shows no focal findings. Which of the following findings is most likely on an x-ray of the spine?
A ) Compression fracture of L4
B ) Facet joint dislocation at L3-4
C ) Fracture of a lateral process of L1
D ) Herniation of the L5-S1 intervertebral disc
E ) Spinal stenosis
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Q2
A 25-year-old woman (type A, Rh-negative) gives birth to a type A, Rh-positive newborn. Which of the following should be administered to the mother immediately after the birth to prevent hemolytic disease of the newborn in future children?
A ) Active immunization to induce anti-Rh IgG antibodies
B ) Active immunization to induce anti-Rh IgM antibodies
C ) Active immunization to remove Rh antigen
D ) Passive immunization to remove Rh antigen
E ) Treatment with corticosteroids
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Q3
A 50-year-old woman has a 1-year history of recurrent hemorrhages and thrombosis. She has a bruise on the forehead secondary to minor trauma. Evaluation for underlying inflammatory and neoplastic disease is negative. Laboratory studies show:
Hemoglobin
12 g/dL
Leukocyte count
7000/mm3
Segmented neutrophils
60%
Band forms
5%
Lymphocytes
30%
Monocytes
5%
Platelet count 2,000,000/mm3
Erythrocyte morphology normal
Which of the following is the most likely diagnosis?
A ) Chronic myelogenous leukemia
B ) Essential thrombocythemia
C ) Myelofibrosis
D ) Polycythemia vera
E ) Reactive thrombocytosis
Q4
A 17-year-old boy is stabbed in the anterior axilla. He has loss of sensation on the anterolateral surface of the forearm and loss of the biceps reflex. Which of the following nerves is most likely to be damaged?
A ) Axillary
B ) Intercostobrachial
C ) Lateral pectoral
D ) Long thoracic
E ) Medial antebrachial cutaneous
F ) Medial brachial cutaneous
G ) Medial pectoral
H ) Median
I ) Musculocutaneous
Q5
A 50-year-old man comes to the physician because of fever, muscle pain, sore throat, and nonproductive cough for 7 days. He has had two episodes of similar symptoms during the past year. He has smoked 2 packs of cigarettes daily for 30 years. His temperature is 38.9°C (102°F). Rhonchi and crackles are heard on auscultation of the chest. Chest x-ray shows consolidation of the right lower lobe. Which of the following mechanisms is the most likely cause of these clinical findings?
A ) Inactivation of muramyl dipeptide
B ) Induction of acidification of endosomes in alveolar macrophages
C ) Injury to the mucociliary escalator
D ) Stimulation of IgM to IgA switching
E ) Suppression of cough reflex
Q6
A 6-week-old boy is brought to the physician by his mother for a routine well-child examination. He is at the 50th percentile for length and weight and the 90th percentile for head circumference. A CT scan of the head shows an enlarged posterior fossa containing a large midline cyst that is associated with absence of the cerebellar vermis. Which of the following is the most likely diagnosis?
A ) Agenesis of the corpus callosum
B ) Chiari type II malformation
C ) Dandy-Walker syndrome
D ) Down syndrome
E ) Holoprosencephaly
F ) Hydrocephalus ex vacuo
Q7
A 22-year-old woman participates in a clinical study of a putative protein hormone that is synthesized in the liver in response to a decrease in the blood platelet concentration. Injection of the hormone causes an increase in platelet production. Which of the following is the most likely location of the receptor that accounts for the increase in platelet count?
A ) In the cytoplasm of hepatocytes
B ) In the cytoplasm of megakaryocytes
C ) In the nucleus of hepatocytes
D ) In the nucleus of megakaryocytes
E ) On the cell membrane of hepatocytes
F ) On the cell membrane of megakaryocytes
Q8
A 3-month-old boy is brought to the physician by his mother for a well-child examination. He is at the 80th percentile for length and the 60th percentile for weight. Physical examination shows no abnormalities. A Babinski sign is present bilaterally. Which of the following best explains this finding?
A ) Axons of motoneurons have not yet innervated the foot muscles
B ) Corticospinal tracts in the spinal cord are not yet myelinated
C ) Dorsal root ganglia of the lumbar segments have not yet differentiated
D ) Monosynaptic reflexes from the feet are not yet established
E ) Muscles that flex the toes ventrally are not yet mature
Q9
A 74-year-old man is unable to repeat phrases and name objects after having a left-sided stroke. Although reading comprehension is preserved, he has difficulty reading aloud and writing. His speech is fluent, and his comprehension is normal. Which of the following structures is most likely damaged?
A ) Arcuate fasciculus
B ) Auditory association area
C ) Supplementary motor area
D ) Uncinate fasciculus
E ) Word recognition area
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Q1 A
Q2 A
Q3 B
Q4 I
Q5
Q6 D
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A ) Compression fracture of L4
D ) Passive immunization to remove Rh antigen
B ) Essential thrombocythemia ??
I ) Musculocutaneous
B ) Corticospinal tracts in the spinal cord are not yet myelinated
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1) A
2) D
3) E
4) I
5) C
6)C
7) ?
8)B
9)?
Any opinions?
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Q1 A Compression fracture
Q2 D Passive Immunization
Q3 B Essential Thrombocythemia
Q4 Musculocutaneous N.
Q5 C Injury to Mucociliary escalator even one puff of cigarette is enough to cause temporary paralysis of the cilia
Q6 B
Q7 C
Q8 B Cortical tracts not yet fully myelinated
Q9 C Uncinate fasciculs not sure but I know it joins the temporal and frontal lobes
