Uworld 22
He later undergoes outpatient endoscopy, which shows lesions involving his gastric mucosa (see image). These lesions will be defined as erosions if they extend into, but not completely through, which of the following structures?
A) Gastric pits B) Gastric glands C) Muscularis mucosa D) Submucosal layer E) Circumferential smooth muscle
Physical examination shows a pale and thin girl with fine hair around her trunk, but the remainder is otherwise normal. Urine pregnancy test is negative. Which of the following is the most likely mechanism of her amenorrhea?
A) Hyperprolactinemia B) Hyperthyroidism C) Hypothalamic suppression D) Primary ovarian failure E) Primary pituitary dysfunction
Which of the following is the most likely cause of this patient's presentation?
A) Hypoxia-induced vasoconstriction B) Intimal thickening of pulmonary arterioles C) Myocardial amyloid deposition D) Obliteration of the vascular bed E) Pericardial thickening and fibrosis F) Right-sided valvular heart disease
At which of the following locations did this patient most likely receive his injection?
A) Inferolateral quadrant of the left buttock B) Inferomedial quadrant of the left buttock C) Superior portion of the right posterior thigh D) Superolateral quadrant of the left buttock E) Superomedial quadrant of the left buttock
Intracellular synthesis of viral DNA decreases precipitously once the treatment is initiated. Which of the following components of viral genome replication is most likely to be inhibited by zidovudine?
A) Nucleoside phosphorylation B) Folate-dependent uracil methylation C) 3'—5' phosphodiester bond formation D) Proper base pairing and hydrogen bond formation E) Integration of viral DNA into the host genome
26) A 12-year-old Caucasian male is found to have a wide fixed splitting of the second heart sound (S2) on routine physical examination. He denies any symptoms. If present, the congenital heart disease in this patient may require surgical repair to prevent irreversible changes in the:
A) Right ventricle B) Right atrium C) Left ventricle D) Left atrium E) Pulmonary vessels F) Coronary vessels
A) Stool for bacterial toxins B) Blood for liver enzymes C) Blood for viral titers D) Urine for glucose and ketones E) Urine for amino acids
A) Stool for bacterial toxins - *Botulinum* toxin
8) A 65-year-old Caucasian female with poor memory, urinary incontinence, and gait abnormalities is found on MRI to have an enlarged ventricular system and minimal cortical atrophy. Urinary incontinence in this patient is most likely caused by which of the following?
A) Stretching of descending cortical fibers B) Stretching of cerebellar inhibitory fibers C) Impaired basal ganglia signaling D) Impaired reticular formation functioning E) Spinal cord damage
*Right* hip drops
*Left* SuperoMedial quadrant
e) T7
*Pain on neck and back*
**CREST** leads to
*Pulmonary Hypertension*
ASD causes?
*Pulmonary hypertension*
*Left* Superior gluteal nerve is affected?
*Right* hip drops
where is *S*tapes from?
*S*econd pharyngeal arches
*S*econd pharyngeal arch =
*S*tapes
*Amyloidosis** =
*Transthyretin*
**Sarcomere** =
*Z line*
E) Superomedial quadrant of the left buttock
- Contralateral injury
Through this ulcer, he is losing blood and has Anemia
- Low hemoglobin levels
what is the use of *Penicillin* ?
- Need for **Cardiac surgery** prevents *Myocarditis*
**Aspiration pneumonia** is due to?
- dysphagia **Swallowing muscle dysfunction**
28) A collection of tan fat-containing tissue is found around the kidneys and adrenal glands of a newborn during surgery. Surgical removal of the tissue would most likely contribute to.
A) Fasting hypoglycemia B) Hypercholesterolemia C) Fasting ketonemia D) Lactic acidosis E) Hypothermia
CT scan of the chest, abdomen, and pelvis is negative for signs of metastasis. Serum carcinoembryonic antigen assay is ordered. The results of this assay would be most useful for which of the following aspects of this patient's care?
A) Determining the need for surgery B) Determining the type of chemotherapy C) Grading of the tumor D) Monitoring for tumor recurrence E) Staging of the tumor
A) Dihydrofolate polyglutamate B) Folinic acid C) Para-aminobenzoic acid D) Tetrahydrofolate E) Thymidylic acid
A) Dihydrofolate polyglutamate
**Restrictive cardiomyopathy** is due to?
**Amyloidosis**
**Superficial inguinal lymph node**
**Anus**
***Right lower lobe***
**Aspiration pneumonia**
E) Swallowing muscle dysfunction
**Aspiration pneumonia**
*Direct inguinal hernia*
**Breakdown of the transversalis fascia**
D) Monitoring for tumor recurrence
**CEA**
C- Calcionosis R- Raynaud's (*Pain and blueing of tone & fingers on cold* E- Esophageal dysmotility S- Sclerodactly (*Tightening of skin* T- Telangiectasia
**CREST** often leads to *Pulmonary Hypertension*
Diabetes: Pee a lot -> Decreased fluid volume lack of ADH: Increased serum *Osmolarity*
**Central diabetes insipidus** because of *Motor vehicle accident**
Filling defect =
**Diastolic** heart failure
what does *Methotrexate* inhibit?
**Dihydrofolate reductase**
so what accumulates when you use *Methotrexate* ?
**Dihydrofolate**
what accumulates with *Methotrexate* ?
**Dihydrofolate**
**PCOS** causes?
**Endometrial carcinoma**
C) Muscularis mucosa
**Erosions**
*Amenorrhea** is due to?
**Hypothalamic suppression**
**Hemolysis did not occur** why? so an antibody that does NOT cross the placenta is involved such as
**IgM**
c) Diabetes insipidus
**Increased osmolarity **Decreased Fluid volume
F) Throbbing headaches
**Nitrate** side effect
**Diastolic** heart failure is due to?
**Restrictive** cardiomyopathy
increase in left ventricular end-diastolic pressure
**Restrictive** cardiomyopathy
F) Physiologic stress
**Septic-shock**
**Septic-shock** causes?
**Stress ulcer**
what decreases with *Methotrexate* ?
**Tetrahydrofolate**
**CEA** is useful for monitoring?
**Tumor recurrence**
D) lymphatic obstruction
**lymphadenopathy**
E) Hypothermia =
*Brown fat*
what do you look for in **Meningitis**?
*Cerebrospinal fluid*
*Lactic acidosis* =
*Decreased oxidative phosphorylation*
So how does the doctor want the drug to be administered?
*IV push* Hence, the answer I will give 25 mg of diphenhydramine *stat* is the WRONG answer.
The physician discusses adding isosorbide dinitrate to his current therapy but the patient is concerned about adverse effects. Which of the following is most likely to occur in this patient with the add-on therapy?
A) Atrioventricular conduction delay B) Cold extremities C) Constipation D) Joint pains E) Nocturnal wheezing F) Throbbing headaches G) Urinary retention
A) Attempt to contact the patient's sister for consent to intubate B) Consult the hospital ethics committee C) Do not intubate based on the friend's report of the patient's wishes D) Plan to proceed with intubation E) Wait to see if the patient improves on oxygen and can sign consent
A) Attempt to contact the patient's sister for consent to intubate
Nasogastric suctioning reveals bright red blood. This patients bleeding is most likely a result of which of the following processes?
A) Autoimmune parietal cell destruction B) Gastrin-secreting tumor C) Granuloma formation D) Helicobacter pylori infection E) Malignant transformation F) Physiologic stress
A) Bicuspid aortic valve B) Inspissated pancreatic ducts C) Lens displacement D) Mitral valve prolapse E) Vaginal adenosis
A) Bicuspid aortic valve - *Turner's syndrome
A) Breakdown of the transversalis fascia B) Failure of the internal inguinal ring to close C) Patent processus vaginalis D) Weakness of the rectus abdominis muscle E) Widening of the femoral ring
A) Breakdown of the transversalis fascia - *Direct inguinal hernia* MILD Medial- direct Lateral- indirect
To offset cost and avoid losing patients to follow-up, the department is considering recommending the empiric use of penicillin for the treatment of suspected bacterial pharyngitis. Which of the following would be expected to decrease after long-term implementation of this guideline?
A) Deaths associated with diarrheal illness B) Diagnoses of serum sickness-like reactions C) Incidence of nephritic syndrome D) Need for cardiac surgery E) Use of broad-spectrum antibiotics
Chest x-ray demonstrates dense air space opacities in the superior region of the right lower lobe. Which of the following is the most likely underlying etiology of this patient's hospitalization?
A) Decreased enteral feeding B) Extended immobility C) Impaired cellular immunity D) Reduced intercostal muscle strength E) Swallowing muscle dysfunction
The left breast is normal. Which of the following is the most likely cause of this patient's skin changes?
A) Deep venous thrombosis B) Delayed hypersensitivity reaction C) Infectious process D) lymphatic obstruction E) Scar formation
Laboratory studies, including prothrombin time and activated partial thromboplastin time, are normal. Venous Doppler reveals an occluding thrombus in the right femoral and popliteal veins. The patient is started on rivaroxaban. This drug inhibits which of the following?
A) Factor VIII B) Factor Xa C) Glycoprotein IIb-IIIa D) Platelet P2Y12 E) Thrombin
Wide fixed splitting of S2 =
ASD
**Disrupt binding of actin to structural support element**
Actin binds to z-line
C) Hypothalamic suppression
Amenorrhea
d) D Renin Increased Angiotensin 1 Increased Angiotensin 2 Increased Aldosterone Decreased Bradykinin No change
Angiotensin receptor blockers Angiotensin 2 is increased because, the ARB, blocks this receptor, leading to accumulation of angiotensin 2. This inability of angiotensin 2 to act on the receptor prevents formation of aldosterone.
dysphagia causes?
Aspiration pneumonia - in right lower lobe
27) A 34-year-old male presents to your office complaining of recurrent headaches. He describes the pain as constant, "unbearable," and isolated to the right side of his head. Each episode begins with pain around the right eye and nostril and lasts about 30 minutes.
Associated symptoms during each episode include right eye tearing and nasal congestion. The patient reports having had several similar episodes one year ago for which he did not seek medical attention. Most likely diagnosis is.
what is probability that unborn child will inherit one or more mutant alleles from parents?
Autosomal recessive - 75% mutant alleles little *a* is in 75% of the boxes
A) "Preparing 25 mg of diphenhydramine for IV push."
B) "I will give 25 mg of diphenhydramine stat." This answer is WRONG, because *Stat* is the WRONG way of administration. *IV push* is the right way to administer the drug here.
A) Cerebral angiography B) Cerebrospinal fluid analysis C) CT scan of the sinuses D) MRI scan of the head E) Sumatriptan
B) Cerebrospinal fluid analysis **Meningitis**
A) Rhinovirus B) Paramyxovirus C) Togavirus D) Parvovirus E) Calicivirus
B) Paramyxovirus Stridor = Parainfluenza virus = croup
4) A 26-year-old woman comes to the office with her husband for genetic counseling. She is pregnant with their second child, whose gender is unknown.
Both parents are asymptomatic, but their firstborn 3-year-old son has recurrent episodes of anemia, jaundice and painful swelling of the hands and feet. A blood sample is obtained from the boy, and hemoglobin electrophoresis is performed at alkaline pH.
A) "I am unable to sign the form due to my concern about your drug use." B) "I am unable to sign the form due to my concern about inappropriate use of disability benefits."
C) "I can see you are suffering from a painful condition and will sign the form." D) "I can sign the form because I see that you were previously approved and nothing has changed."
A) Tension headache B) Migraine without aura C) Cluster headache D) Subarachnoid hemorrhage E) Arterial hypertension F) Intracranial neoplasm G) Trigeminal neuralgia
C) Cluster headache
The malignant cells found in this patient most likely originated from which of the following sites? A) Dome of the bladder B) Lateral lobe of the prostate C) Orifice of the anal canal D) Upper pole of the testes E) Upper third of the rectum
C) Orifice of the anal canal - Superficial inguinal lymph node
40) A 45-year-old woman is evaluated for progressive exertional dyspnea and fatigue. She also reports episodic pain and bluish discoloration of the fingers and toes on cold exposure that improves with rewarming. Physical examination shows tightening of skin over the fingers.
Cardiac examination reveals an accentuated second heart sound over the upper left sternal border. The abdomen is soft with mild hepatomegaly. There is bilateral lower extremity pitting edema. Pulmonary function test results are as follows:
35) A 23-year-old woman comes to the emergency department with vaginal bleeding and lower abdominal cramps. Her last menstrual period was 6 weeks ago, and a home pregnancy test was positive. She has no medical history and does not use tobacco or alcohol.
Pelvic ultrasonography reveals a gestational sac in the left fallopian tube without evidence of rupture. A single dose of methotrexate is administered to treat her condition. Which of the following substances will most likely accumulate in embryonic tissues as a result of treatment?
Rheumatic fever, treatment?
Penicillin
31) The public health department of a developing country performs an epidemiologic study to assess the nationwide incidence of upper respiratory infections among children. The data show a high rate of childhood bacterial pharyngitis.
Current practice guidelines indicate that a rapid test should be performed in children to identify the presence of bacterial antigens. If this test is negative, a throat culture, the gold standard for definitive diagnosis, is then performed.
A) Adrenal atrophy B) Cushing syndrome C) Diabetes mellitus, type 1 D) Endometrial carcinoma E) Vaginal adenosis
D) Endometrial carcinoma
A) Adding lithium to the dialysis solution B) Decreasing dialysis solution temperature C) Decreasing the membrane pore size D) Increasing surface area of the membrane E) Increasing thickness of the membrane
D) Increasing surface area of the membrane - increase the rate of drug removal
A) Cricoid cartilage B) Glossopharyngeal nerve C) Greater horn of hyoid D) Stapes E) Thyroid cartilage F) Vagus nerve
D) Stapes - Treacher Collin's syndrome
Patient's friend believes the patient would prefer to "go naturally' and would refuse any heroic measures, including "being hooked up to a ventilator." The patient is somnolent and unable to answer questions.
Despite oxygen supplementation, his pulse oximetry shows decreasing oxygen saturation and he may require intubation. Which of the following is the most appropriate course of action?
15) A 40-year-old unemployed man with chronic back pain comes to the office for an appointment with a new physician. The patient injured his back in a work accident years ago and has not worked since.
He uses marijuana daily to "ease the pain" and admits that a portion of his income goes toward its purchase. The patient says that nothing has changed and asks the physician to sign a disability form so he can continue to collect disability benefits.
36) A 72-year-old man is hospitalized due to fatigue, orthopnea, and exertional dyspnea. The patient takes no medications and has not seen a physician in many years. He is a lifelong nonsmoker. His blood pressure is 110/60 mm Hg and pulse is 64/min.
Examination reveals bibasilar crackles, elevated jugular venous pressure, and bilateral lower extremity pitting edema. His left ventricular end- diastolic pressure-volume is shown in the graph below (purple curve).
E) "I cannot consider your request until you are able to control your anger." F) "I cannot sign the form without further history and assessment"
F) "I cannot sign the form without further history and assessment"
21) A researcher is investigating the structure of the sarcomere using skeletal muscle obtained from an experimental animal. He develops monoclonal antibodies directed against a specific skeletal muscle protein.
Finds that these antibodies disrupt the binding of actin to structural support elements within the sarcomere. Electron microscopy of the sarcomere is shown in the image below. Which of the following labeled regions do these antibodies most likely bind?
17) A 31 -year-old man is brought to the emergency department after a motorcycle accident. The patient was texting on his cell phone while driving when he lost control of his bike and fell to the asphalt.
He was found lying in the middle of the road by first responders, who placed him in a rigid cervical collar and put him on a backboard for spinal immobilization. The patient currently has severe pain in his neck and back. On physical examination, he is alert and fully oriented.
a) A b) B c) C d) D e) E
a) A this is the *Z line*
24) The age-adjusted mortality trends for 5 cancers in women in the United States are shown in the graph below Which of the following curves best corresponds to lung cancer?
a) A b) B c) C d) D e) E
There is no periorbital ecchymosis or hemotympanum, but there are several abrasions and lacerations located on the trunk and extremities. Neurologic examination suggests a spinal cord injury corresponding to the level shown in the illustration below.
a) C1 b) C7 c) L5 d) S2 e) T7
7) A 38-year-old man is brought to the emergency department due to progressive nausea, confusion, and unsteady gait. Family members state that symptoms started 4 days ago after he went to the dentist due to a toothache, for which he was prescribed ibuprofen.
He also takes lithium for bipolar disorder. On examination, he is drowsy and ataxic, having slurred speech and coarse tremors. His serum lithium level is 3.86 mEq/L (therapeutic range: 0.8-1.2 mEq/L), and serum creatinine and blood urea nitrogen are elevated.
39) A 43-year-old man comes to the physician due to difficulty walking. He was seen at an outpatient clinic 2 days ago and received a deep intramuscular injection. He had no trouble walking at the time of the appointment but started having problems later that day.
He denies any history of trauma or pain at the injection site. Physical examination is negative for local erythema and swelling. When the patient is asked to walk across the room, his right hip drops every time he raises his right foot off the ground.
6) A 68-year-old man is brought to the emergency department by a friend who saw the patient "pass out" while having drinks and dinner. The patient's medical history includes chronic obstructive pulmonary disease, hypertension, coronary artery disease, alcohol abuse.
He is unmarried and lives alone. The friend says the patient has a sister who lives in the area but is unaware of when they last spoke. The friend has known the patient for 5 years and says that they are "good buddies." He tells the physician that they have discussed dying.
33) A 5-month-old Hispanic boy is brought to the ER with complaints of poor feeding, weakness and complete loss of extremity muscle tone. All of his vaccinations are up to date and there is no significant past medical history.
He receives formula as his sole source of nutrition with the exception of occasional fruit juice and honey. He has also received vitamin D supplementation. Which of the following tests is most likely to establish the diagnosis in this patient?
What is cause of patient's increased anion gap? a) Decreased oxidative phosphorylation b) Impaired hepatic gluconeogenesis c) Impaired renal tubular bicarbonate reabsorption d) Increased lipolysis and ketogenesis e) Increased protein breakdown
a) Decreased oxidative phosphorylation - Lactic acidosis
16) A 30-year-old nulliparous woman comes to the office for evaluation of infertility. She has been attempting to conceive with her partner of 10 years for the past 2 years. Menarche was at age 11, and her menstrual cycles occur 2-3 times per year and last 7-10 days.
Her blood pressure is 128/84 mm Hg and pulse is 84/min. BMI is 35 kg/m2. Physical examination shows mild acne and hair growth on the upper lip and chin. This patient is at greatest risk for which of the following complications?
29) A 32-year-old man comes to the emergency department with pain and swelling involving his left arm. He has a history of intravenous drug abuse. Physical examination shows an extensive area of induration over the lateral arm with central fluctuance.
His infection is treated by incision and drainage and he is started on the appropriate antibiotics. Further evaluation reveals that he is HIV positive with a low CD4 count. During a follow-up visit with an infectious disease specialist, he is started on zidovudine therapy.
18) A 68-year-old man with a recent history of myocardial infarction status post stent placement comes to his primary care physician complaining of black stools and epigastric pain. The pain is moderate in intensity and gnawing in character.
His other medical problems include untreated type 2 diabetes mellitus and chronic lumbar back pain. The patient's medications include daily aspirin, clopidogrel, a multivitamin, and calcium supplements. Testing in the office shows guaiac-positive stool.
ASD =
Left to Right Shunt
When the physician asks about his disability and previous treatment, he replies angrily, "I wouldn't be here re-applying for disability if anything had worked" and slams the disability form down on the table.
Medical records indicates a normal MRI one year earlier and inconsistent adherence with physical rehabilitation appointments. The patient walks normally with no apparent discomfort or limitations. Which of the following is the most appropriate response by the physician?
**Erosions**=
Muscularis mucosa
A) Stretching of descending cortical fibers
Normal pressure hydrocephalus
10) The patient is treated with intravenous fluids and antibiotics, with improvement in fever, leukocytosis, and hypotension. On the third day of hospitalization, temperature is 36.7 C (98 F), blood pressure is 122/78 mm Hg, and pulse is 86/min.
On examination, he is mildly lethargic and his voice is soft and breathy. Rhonchi are still heard over the lower right lung. There is left-sided facial droop and hemiparesis from his previous stroke.
12) A 52-year-old man comes to the office for a painless mass in his right groin. He noticed the mass several weeks ago, and it has slowly enlarged. The patient has a history of HIV for which he takes antiretroviral therapy. He has not had any new sexual partners recently. Temperature is 37.1 C
On examination, several enlarged, hard lymph nodes are palpated in the right inguinal area inferior to the inguinal ligament. An excisional biopsy is performed, and histopathology shows malignant cells.
23) A 38-year-old woman with a history of migraines comes to the emergency department after 2 days of severe headache, nausea, photophobia, and neck pain that was preceded by a flu-like illness. She has taken ibuprofen, but the pain has not improved.
On examination, she appears lethargic. Cardiopulmonary examination is unremarkable. Cranial nerves, sensation, and motor functions are normal. There is no skin rash. Non-contrast CT brain scan is normal. Which of the following is the best next step in management of this patient?
20) A 3-month-old girl is brought to the emergency department with fever, irritability and vomiting for the past 2 days. On examination, she is ill-looking, lethargic; and febrile. Blood cultures grow Mycobacterium tuberculosis.
One of her brothers died from disseminated mycobacterial infection during infancy. Impairment of which of the following protective mechanisms is most likely contributing to this patient's infection?
22) A 16-year-old girl comes to the office for a pre-participatory school sports examination. She plays on her high school soccer team and also frequently competes in local beauty pageants. The patient follows strict dietary limitations and exercises strenuously 2 hours a day.
Onset of menses was at age 13, but her last menstrual period was 8 months ago. She otherwise feels well Her height is 165 cm (5 ft 5 in) and her weight is 45.3 kg (100 1b), with a BMI of 16.6 kg/m2.
**Botulinum toxin**
Prevents the release of *Acetylcholine*
34) A 61 -year-old man comes to the hospital due to 2 days of right leg swelling. He recently flew back to the United States from Japan, where he was visiting his daughter who is spending a semester abroad. The patient has a past medical history of hypertension and hyperlipidemia.
Pulse oximetry shows 99% on room air. Cardiopulmonary examination is within normal limits. There is tenderness and swelling of the right lower extremity up to the midthigh.
D) Need for cardiac surgery
Rheumatic fever
11) A 23-year-old man is brought to the emergency department by paramedics following a motor vehicle accident He was an unrestrained passenger in the front seat.
Several days after hospitalization, his fluid volume and plasma osmolarity are measured and illustrated in the image below (solid line, normal; dotted line, patient). Which of the following conditions is most likely to cause the findings shown in the image?
13) A healthy 6-day-old baby girl is brought to the office for her first well baby checkup. This is the mother's second child. She was born full-term, with a birth weight of 4200 grams (9.3 lb.) and a length of 51 cm (20 mm). APGAR scores were 8 at 1 minute and 9 at 5 minutes.
She was recently discharged from the well baby nursery 3 days ago. The baby's blood type is A negative while the mother is B negative. High circulating levels of anti-A antibodies are found in the mother's blood.
**Ulcers**=
Submucosa
where is *Superior gluteal nerve* ?
Supero*Medial* quadrant
ACE that breaks down bradykinin and NOT ARB. so ARB has no effect on bradykinin
what changes do you see with ARBs? with renin, angiotensin, aldosterone and bradykinin?
Left to Right Shunt
will cause *increased blood flow* via the *pulmonary artery*
19) A 62-year-old man comes to the physician because of intermittent groin pain. He is a construction worker and says that the pain is worse when lifting heaxo,' loads and after a long day of working. Physical examination shows a bulge above the inguinal ligament.
The bulge increases in size when he bears down. A groin ultrasound reveals that the mass originates medial to the inferior epigastric vessels. This patient's condition is most likely caused by which of the following?
25) A newborn is taken to the neonatal intensive care unit after delivery due to respiratory distress. The neonate was born full-term, and there were no significant complications during pregnancy or delivery. Once the patient is stabilized, a detailed physical examination is performed.
The neonate has an underdeveloped mandible and hypoplastic zygomatic bones. Genetic testing confirms a gene mutation that results in abnormal development of the first and second pharyngeal arches. Which of the following structures is also likely abnormal in this patient?
14) A 47-year-old woman comes to the office with a red rash on her chest that has been present for approximately 2 months. The rash is itchy, and the skin feels rough to the touch. The itching has worsened in the past few weeks, and various skin moisturizers have provided no relief.
The patient has a history of surgery for bilateral silicone breast implants 10 years ago. Her temperature is 37.2 C (99 F). Physical examination reveals induration and swelling over the right breast. Further examination reveals right axillary lymphadenopathy without breast masses.
38) A 68-year-old man comes to the office due to fatigue, weight loss, and constipation. He has refused to undergo screening colonoscopy for several years because "nobody in my family had colon cancers." Past medical history is notable for emphysema and stable angina.
The patient has smoked a pack of cigarettes daily for 50 years and drinks alcohol occasionally. Physical examination is unremarkable. He is referred for colonoscopy, which reveals a circumferential mass encircling the sigmoid colon. Pathology is positive for adenocarcinoma.
2) A 45-year-old man with diabetes mellitus is admitted to the intensive care unit for community-acquired pneumonia, septic shock, and respiratory failure. Two days ago, he developed fever, productive cough, and shortness of breath that has progressively worsened.
The patient is intubated and placed on mechanical ventilation. He is also started on intravenous fluids, broad-spectrum antibiotics, and a norepinephrine infusion. On the third day of hospitalization, his hemoglobin level drops from 14 g/dL to 12 g/dL.
30) A 60-year-old man with known coronary artery disease comes to the office due to exertional chest tightness for the last 6 months. The symptoms occur when he walks more than 3 blocks, especially in cold weather.
The patient underwent coronary artery bypass graft surgery 3 years ago for progressive angina. Past medical history also includes asthma, benign prostate hyperplasia, and peripheral artery disease.
9) The following vignette applies to the next 2 items. An 87-year-old nursing home resident is brought to the emergency department with a 2-day history of fever, vomiting, and progressive lethargy.
The patient's past medical history is significant for advanced dementia and stroke. Temperature is 38.3 C (101 F), blood pressure is 88/62 mm Hg, and pulse is 120/min and regular. On examination, he is lethargic but arousable. Coarse rhonchi are heard over the right mid lung.
3) A 46-year-old man comes to the emergency department due to double vision, ptosis, difficulty swallowing, nausea, and dry mouth. Three hours later, his wife begins experiencing similar symptoms.
They attended a community potluck event yesterday and sampled some of the potato salad made from home-canned potatoes. Which of the following steps in neuromuscular transmission is most likely affected?
Here they are making antibodies against *sarcomere*.
This prevents binding of antibodies to the *Z-lines*.
What is side effect of *Nitrates* ?
Throbbing headaches
37) An 18-month-old boy is brought to the physician by his parents for fever, runny nose, and sore throat. The physician reassures the parents and recommends supportive care with plenty of fluids. He sends them home with instructions to follow up if the boy's symptoms worsen.
Two days later, the infant is brought to the emergency department with persistent fever, brassy cough, and difficulty breathing. Physical examination reveals stridor. Which of the following pathogens is most likely responsible for this patients condition?
5) An autopsy was performed on a 17-year-old girl after a fatal motor vehicle collision. Her ovaries appear small and underdeveloped on gross examination. Light microscopic examination shows ovaries primarily composed of connective tissue with no follicles.
Which of the additional abnormalities is most likely to be found on postmortem examination?
While in the emergency department, he develops a generalized tonic-clonic seizure. During emergent hemodialysis treatment, his blood is passed along a semipermeable membrane and allowed to equilibrate with a dialysate solution.
Which of the following is most likely to increase the rate of drug removal?
1) A physician working on a rehabilitation unit discovers that a patient is experiencing an acute allergic reaction to a medication. physician calls for nursing assistance. When the nurse arrives, the physician instructs the nurse to administer "25 mg of diphenhydramine IV push".
Which of the following responses from the nurse ensures a lower risk of communication errors? A) "Preparing 25 mg of diphenhydramine for IV push." B) "I will give 25 mg of diphenhydramine stat." c) "Okay " d) "Order received and completed." e) "Yes, doctor"
a) Antibody production b) Complement production c) Interferon signaling d) Isotype switching e) Leukocyte adhesion
c) Interferon signaling TB = *interferon* gamma
what is probability that unborn child will inherit one or more mutant alleles from parents? a) Near 0 b) 25% c) 50% d) 75% e) 100%
d) 75% - Sickle cell disease Mutant allele = *a* so here you are looking at what percentage has the *a* in them. so if you look the 4 boxes, 75% have atleast 1 *a*
a) A b) B c) C d) D e) E
d) D **Botulinum toxin**
which of the following is the cause of this patient's condition? a) Alcoholic cardiomyopathy b) Doxorubicin c) Selinium deficiency d) Transthyretin deposition e) Viral myocarditis
d) Transthyretin deposition - Restrictive cardiomyopathy due to *Amyloidosis*
**Sarcomere**
distance between 2 Z-lines
Hemolysis did not occur in the baby because these maternal antibodies are most likely of which class? a) IgA b) IgD c) IgE d) IgG e) IgM
e) IgM - ABO incompatibility
32) A 60-year-old man comes to the office for a routine follow-up visit. He feels well overall except for an intermittent, mild, generalized headache. The patient has no known medical problems and takes no medications. He does not smoke, follows a generally healthy diet, and
exercises daily. On examination, his blood pressure is 150/85 mm Hg, and he is started on lisinopril. At a follow-up visit, the patient's blood pressure is 128/78 mm Hg. He also has a dry cough that began a few weeks after starting lisinopril. This drug is stopped and losartan is now prescribed.
MOA of *Zidovudine* ?
inhibits **3'—5' phosphodiester bond formation**
How does *Zidovudine* work?
inhibits *3' - 5' phosphodiester bond formation*
a) A
lung cancer mortality = A
B) Factor Xa
rivaro*x*aban
