PATHO FINAL FINAL

Which of the following drugs is correctly paired with its main site of action in the kidney?

Acetazolamide-- proximal tubule

A 70-year-old man complains of a sensation of food sticking in his lower chest area. This happens when he eats either liquids or solids. He also has a slight weight loss. The most likely diagnosis is

Achalasia

In which of the following disorders will esophageal manometry reveal high-pressure non relaxing LES and poor motility in the rest of the esophagus?

Achalasia

A 35-year-old woman comes to your office with complaints of fatigue, anorexia, nausea, and vomiting. She does not have fever. Her urine is dark and her stool is clay colored. On physical examination, her liver is slightly enlarged and minimally tender. She does not have edema or spider angiomata. Laboratory tests show the following: negative HBsAg, positive IgM anti-HAV, positive IgM anti-HBc, and negative anti-HCV. The most likely diagnosis is

Acute hepatitis A and B

A 30-year-old man comes to your office with complaints of fatigue, anorexia, nausea, and vomiting. He does not have fever. His urine is dark. On physical examination, his liver is slightly enlarged and minimally ten- der. He does not have edema or spider angiomata. Laboratory tests show the following: negative HBsAg, negative IgM anti-HAV, positive IgM anti- HBc, and negative anti-HCV. The most likely diagnosis is

Acute hepatitis B

A 45-year-old obese woman with cholelithiasis presents to the emergency room complaining of nausea and vomiting for 2 days, along with severe continuous midabdominal pain. She has a low-grade fever and the ER physician finds that she has a slightly elevated WBC count (12,000) and an elevated serum amylase. The most likely diagnosis is

Acute pancreatitis

A middle-aged female arrives at your office after not seeing a physician for many years to have a general physical performed. Overall, she appears healthy but a poorly reacting left pupil is noted when a pen light is used. Instillation of a weak solution of pilocarpine leads to constriction of the pupil quickly. Your diagnosis is

Adie's tonic pupil

A 76-year-old man comes to your office in January with complaints of abrupt onset of cough, with small amounts of green sputum, worse in the morning, without any blood in it. He also has fever as high as 103°F, very rapid respirations (32/min), and chest pain on his right side, wors- ened with coughing. He exhibits some difficulty remembering the details of his illness. On the basis of these clinical findings, you consider a diagnosis of pneumonia. Which one choice would you make?

Admit him to the hospital in the intensive care unit for parenteral antibiotic treatment

In spontaneous bacterial peritonitis (SBP) typically

As many as 70% of patients will experience at least one occurrence within 1 year of the first episode

A 28-year-old woman presents complaining of infertility. She had a healthy child 3 years ago and has been trying to get pregnant with the child's father for the last 18 months. She does not have dysmenorrhea. Her menses occur regularly, but these show significantly less flow compared with before her pregnancy. She recalls having a curettage performed to remove placental remnants. What is the diagnosis?

Asherman's syndrome

A 54-year-old woman who has had primary biliary cirrhosis for the past 6 years is on the waiting list for a liver transplant. Her husband calls you to report that the "swelling in her stomach" has greatly increased over the past few days and she seems confused. When you admit her to the hospital, you observe (in addition to jaundice and ascites) that she is confused and demonstrates an erratic tremulous movement in her upper extremities. This movement is most likely

Asterixis

A 31-year-old male presents to the office due to infertility. On history, it is revealed that he has Kartagener's syndrome. Why is he infertile?

Asthenospermia

The risk of breast cancer in a an with Klinefelter's syndrome is

Between that of normal men and normal women

A patient in your office tells you that he had an episode of vomiting bright red blood twice in 1 day about 1 week ago, followed the next day by three or four episodes of vomiting material that looked like coffee grounds. He could not afford to seek medical help then and he said that "it got bet- ter except for the pain." The past 3 days he noticed black "sticky" stools and he finally came to see you. What is your first concern?

Bleeding peptic ulcer

A 47-year-old man walks into the emergency room because of feeling very weak, tired, short of breath, and dizzy. He has numbness and tingling of his fingers. He appears pale and sallow. On examination, his heart rate is 132. His sclerae and nailbeds are pale. His heart is enlarged and he has dependent edema of his ankles. Laboratory findings include a negative Coombs' test and a hemoglobin of 4 g/dL. The likely diagnosis is

Pernicious anemia

Which of the following is not a major example of inherited susceptibility to cancer?

Peutz-Jeghers syndrome

A urologist refers a 20-year-old man because of hypospadias and infertility. He has been sexually active since his early teens. Recently, he married and, despite many attempts, his wife has been unable to become pregnant. The likely site of his infertility is

Post-testicular

Which of the following disorders is associated with thrombocytosis?

Postsplenectomy

A 35-year-old woman has had episodes of abdominal pain and bloody diarrhea for 4 to 5 years. Recently, the episodes became increasingly common, and she noted a weight loss of about 10 pounds. She tells you that two of her uncles have had similar symptoms "for years" and recently one of them had colon cancer. On examination, there are no abdominal masses and no fistulas. The most likely findings on colonoscopy with biopsy are

Continuous inflammatory changes mostly confined to the mucosa

A 20-year-old man has complaints of diarrhea and abdominal pain. He often sees some blood in his stool, but not with every episode of diar- rhea. He also complains of easy fatigue and weight loss and for 2 days he has had nausea and vomiting. Two years ago he was treated for a rectal fis- sure. On examination, he has a modestly tender mass in the right lower quadrant. The most likely diagnosis is

Crohn's disease

A 57-year-old man complains of long-standing respiratory distress. He worked for most of his adult life in a locomotive repair shop. On examination, he does not have fever, palpable lymph nodes, or abnormal lung findings. Which one of the following is likely to be found on chest roentgenogram?

Diffuse interstitial pulmonary fibrosis with irregular or linear opacities

A 27-year-old woman with systemic lupus erythematous complains of fatigue of a few days' duration. On physical examination, she is pale and her spleen tip is palpable. On laboratory examination, her hemoglobin is 7 g/dL ad she has spherocytosis on the peripheral blood smear. Which test can make the diagnosis in this case?

Direct Coombs' test

A patient complaining of chest pain, regurgitation, and dysphagia for several months is thought to have achalasia. The gastroenterologist should

Do an endoscopy to inject botulinum toxin into the lower esophageal sphincter

A 15-year-old adolescent man who has suffered frequent respiratory tract infections since childhood and had pneumonia 1 year ago due to S. pneumoniae infection, but no other hospitalizations, complains of long-standing diarrhea, weight loss, and bulky foul-smelling stools that float. He is infertile. On examination, his lungs show bi-basilar rales. No organs or masses are palpable in the abdomen. No testicular masses palpable. Chest roentgenogram shows streaking from both hillier areas. In this patient, the diarrhea is caused by

Hydroxylated fatty acids

A 22-year-old man comes to the emergency room of your hospital because he has a diffuse, erythematous rash involving nearly all of his body. His total WBC count is greater than 100,000 cells/mm3. He also complains of bone pain, severe irritability, weakness, fatigue, nausea and vomiting, constipation, photophobia, and polyuria. His electrocardiogram (ECG) shows shortening of the QT interval, prolongation of the PR interval, and nonspecific T wave changes. The most likely cause of his symptoms is

Hypercalcemia

Which of the following describes bone abnormalities in patients with chronic renal failure?

Hyperparathyroidism responds well to 1,25-dihydroxyvitamin D

A 40-year-old man with occasional dysphagia and who otherwise feels well undergoes esophageal motility studies that show an LES ampli- tude of approximately 60 mmHg. The esophagus relaxes completely when he swallows. The most likely diagnosis is

Hypertensive LES

A 25-year-old man comes to your office with a complaint of nervousness and wight loss. He notices that he sweats a lot with slight exertion, and he has also noticed mid diarrhea. He smokes about a pack per day and has a cough that he attributes to his smoking. He takes occasional OTC cough-and-cld medicines and he denies illicit drug use other than "experimenting" with marijuana while attending college. On examination, you find that he has warm moist skin, and a fine high-frequency tremor that is rather hard to detect. The most likely cause of this tremor is

Hyperthyroidism

A patient with a low TSH and high T3 most likely has

Hyperthyroidism

After resection of the prostate gland, your patient receives postoperative bladder irrigation with hypotonic fluids. He develops a seizure. Serum sodium is 110, whereas it has been normal 2 days earlier. Which treatment would you prescribe?

Hypertonic saline

Which of the following statements applies in the management of acute renal failure?

Hypervolemia is managed with high-dose loop diuretics

Two days after admission, a 57-year-old man suddenly has a seizure. He was undergoing evaluation for substernal chest pain. The nursing staff noted that he seemed to be a little shaky since shortly after arrival on the floor. He has no history of seizures and a stat CT of the head performed during the postictal state was normal. Laboratory results had shown an MCV of 101 (elevated) and his AST was mildly elevated (one and one-half normal). In this patient, the most likely imbalance that would contribute to this event would be

Hypomagnesemia

A 40-year-old man is noted to have miosis of the right eye and ipsilateral ptosis. He reports that he has noted recently that this side of his face does not sweat when he is working. He has no other symptoms. The most likely cause of this clinical picture may be

Idiopathic

Which of the following is a common cause of isolated hematuria with isomorphic red cells in the urine?

Idiopathic hypercalciuria

A 30-year-old woman complains of recent onset of easy bruising without trauma. She has had menometrorrhagia for several years. On physical examination, she has a normal blood pressure and multiple bruises on her upper and lower extremities. On laboratory examination, her platelet count is < 100,000 cells/cm2, hemoglobin 13 g/dL, creatinine 0.9 mg/dL, and blood urea nitrogen (BUN) 15 mg/dL. She likely has

Idiopathic thrombocytopenia purpura (ITP)

A 28-year-old patient is being examined for a pre marathon physical. You hear a systolic murmur and want to further evaluate. You ask the patient to grip both fists to increase systemic arterial pressure and heart rate. Which of the following is true?

If mitral regurgitation is present, hand grip will accentuate the murmur

A premutation allele

If transmitted by a female expands to a full mutation with a likelihood proportionate to the size of the repeat segment

A 29-year-old man who is well and teaches grade school comes to your office for an influenza vaccine. As he meets the criteria for the intranasal attenuated influenza virus vaccine, this is his choice and the nurse administers this vaccine in both of his nostrils. To which immunoglobulin class will he respond locally in the nose?

IgA

A 20-year-old woman, with a history of allergy, complains of an exacerbation of her allergic rhinitis for 1 day with sneezing and rhinorrhea. On physical examination, her blood pressure and temperature are normal and she has bilateral infraorbital edema and congested nasal mucosa. Which immunoglobulin class mediates this hypersensitivity response?

IgE

A 21-year-old woman is 8 months pregnant with her first child. Thus far, her pregnancy is normal. Which is the immunoglobulin class that can cross the placenta and therefore the fetus has more of than any other immunoglobulin class?

IgG

A 66-year-old woman complains of high fever, myalgias, and nonproductive cough of 2 days' duration. She is also fatigued. She says that this is the second time in 2 years that she has become ill with the flu. On examination her temp is 102.2-F. Her lungs are clear to percussion and auscultation. Which immunoglobulin class predominates in the secondary antibody response?

IgG

A 65-year-old man complains of fever and nonproductive cough that developed during the past 8 days. The upper aspect of his chest hurts when he coughs. He appears to have atypical pneumonia. In which immunoglobulin class is the predominant antibody in a primary immune response?

IgM

A newborn infected with group B streptococcus would produce and secrete antibody of which of the following class(es)?

IgM only

Which of the following is the most appropriate for the above patient (woman with chest pain radiating to her jaw)?

Immediate aspirin therapy and transfer to the emergency department

Most drugs induce thrombocytopenia by which mechanism?

Immune response in which the platelet is damaged by complement activation

The clinical symptoms, signs, and outcomes following acute liver injury associated with viral hepatitis are as a consequence of the

Immunologic response of the host (the person infected), involving cytolytic T cells

A 12-year-old boy is brought to your office by his mother because he developed a painless rash on his face and legs. The rash began as red papillose and then became vesicular and pustular and finally it coalesced in honeycomb-like crusts. The boy does not have fever, but he does have several insect bites and he is unwashed and dressed in dirty clothes. This rash is likely to be

Impetigo

The digestive enzymes amylase and lipase begin to be secreted and begin to act on digest food

In the mouth, after secretion from the salivary and lingual glands

You are seeing a 68-year-old woman for the first time in your office. Her husband comes with her and brings records indicating that she has been diagnosed with Alzheimer's disease "with significant anomia." Which speech disturbance do you expect of find on her examination?

Inability to think of common words in the course of her conversations and inability to name common objects

The FMR1 protein a. is expressed in fragile X-associated mental retardation b. is normally found in brain and ovaries c. when defective, is not sufficient to cause the fragile X-associated mental retardation syndrome d. Is coded by the FMR1 gene which has the (5′-CGG-3′)n repeat segments e. is not carried by females

Is coded by the FMR1 gene which has the (5′-CGG-3′)n repeat segments

Sickle cell anemia

Is due to a single base change in the gene that codes for the β chain

A 56-year-old man is sent to a neurologist for evaluation of muscle weakness and occasional "double vision." He has weakness in the limbs that worsens with exertion and improves somewhat with rest, and he says he has noticed he can't chew gum anymore because his "face gets tired." His neurologic examination is normal except for mild ptosis and mild weakness in the proximal limb muscles that worsens after exercise. The neurologist tells him that he needs to do some further examinations and some blood work because he believes that he has an autoimmune disorder. Which diagnosis is the neurologist considering?

Myasthenia gravis

A 44-year-old man has progressive weight loss, tiredness, diarrhea, and night sweats. On examination, he appears gaunt and his temperature is normal, his respiratory rate is 20, and his heart rate is 110 beats/min. A few bilateral crackles are present at the lung bases. His heart is not enlarged and the heart sounds are normal. He has mild dependent edema. His CD4 count is 40 cells/uL and his viral load is 87,000 copies/uL. Blood cultures are positive. Which is the most likely pathogen?

Mycobacterium avium complex

Which one of the following bacteria is deposited directly into the lower airways?

Mycobacterium tuberculosis

A 22-year-old college student comes to your office because of a cold and respiratory symptoms of about 12 days' duration that do not seem to be lessening in intensity. He is anorexic and tired. His respiratory rate is 24/min, and he has a cough productive of small amounts of white sputum, but no hemoptysis or pleuritic chest pain. He chest x-ray shows infiltration in the right lower lobe. He has a leukocytosis of 18,000 and his cold agglutinin titer is elevated. The organism that is the likely

Mycoplasma pneumoniae

Psammoma bodies are a histologic feature of

Papillary thyroid carcinoma

The most common variety of thyroid cancer is

Papillary thyroid carcinoma

A 45-year-old white man with limited small-cell lung cancer presents to the emergency room of a local hospital and exhibits agitation and confusion, ataxia, nystagmus, peripheral sensory loss, and generalized weakness. The most likely etiology of this disorder is

Paraneoplastic syndrome

A 3-year-old girl has developed a nasty wound of her right hand that has been unresponsive to local treatment applied by her mother for several days. The skin is punctured in several places; cellulitis is present, together with a small access. She reluctantly admits that she was bitten by another girl at preschool during play time. You debride the would slightly and prescribe antibiotics for the most likely infecting pathogens, which are

Eikenella corrodens, Streptococcus pyogenes, and Staphylococcus species

Which feature is characteristic of chronic hepatitis due to HBV?

It is more likely to occur if infection occurs in adults

Which one of the following causes localized skin lesion or disseminated visceral lesion characterized by mixed cell population that includes vascular endothelial cells in persons infected with HIV

Kaposi' sarcoma

The preferred screening test for Turner's syndrome is

Karyotype

Which microorganism is likely to cause pneumonia in a person who abuses alcohol?

Klebsiella pneumoniae

Which one of the following genetic diseases is a chromosomal disorder?

Klinefelter's syndrome

A 48-year-old white woman has what she believes is a suspicious lump in her breast, but a mammogram does not reveal any suspicious lesions. Truthful statements concerning potential pitfalls in management and diagnosis include

Letting a negative or nonsuspicious mammogram influence the judgment of whether a palpable mass needs to be biopsied

Which disease presents with predominantly glomerular involvement?

Light-chain deposition disease

The subarachnoid space inflammation of bacterial meningitis, which is caused by a gram-negative bacteria, is induced by which one component of the bacteria?

Lipopolysaccharide (LPS)

Which one of the following tests is used for the determination of the titer of anti hepatitis B antibody?

Enzyme-linked immunosorbent assay (ELISA)

A 45-year-old woman has chest pain for which a cardiac cause has been ruled out. Her esophageal motility study shows pressure waves of a very high amplitude lasting 2 to 3 s. The most likely diagnosis is

Esophageal spasm

A 55-year-old man who is a longtime alcoholic comes to the emergency room after vomiting small amounts of bright red blood four times today. Your diagnosis is

Esophageal varices

The tremor of which condition lessens with consumption of small amounts of alcohol?

Essential tremor

The pattern of normal TSH, high T4, and high T3 is seen often with

Estrogen therapy

Which of these hormones blocks milk production during pregnancy?

Estrogen?

Elevated anion gap and osmolar gap in a patient with renal failure suggests

Ethylene glycol ingestion

A 31-year-old man complains of exposure to a person ill with Mycobacterium tuberculosis about 6 months ago. You do a Mantoux test (intradermal placement) with purified-protein derivative (PPD) and the resulting induration 72 h later is 11 mm in diameter. Your interpretation of this finding is

Evidence of M. tuberculosis infection without active disease

A 22-year-old woman marathon runner comes into the office com- plaining of amenorrhea for 8 months. There has been no weight change, and the serum pregnancy test is negative. She has never been pregnant. Menarche was at 13 years of age, and she had monthly menses until 8 months ago. Physical exam shows a women who is 66 inches tall, 90 pounds, and is otherwise fully normal. Why does she have amenorrhea?

Excessive exercise

Serum alkaline phosphatase may be elevated in the diseases of which organ?

Liver

The extent of liver damage done by chronic hepatitis B or C infection can best be gauged by evaluating

Liver biopsy

A 25-year-old graduate student is injured in a fall during a weekend rock climbing expedition. He sustains serious injury to the peripheral nerves of his leg. Which of the following should you tell him to expect?

Full return of nerve and muscle function may occur with therapy, but could potentially not occur

Which may cause acute renal failure in patients with nephrotic syndrome?

Loop diuretics

A 58-year-old woman is seen as an outpatient with lethargy, fatigue, and cold intolerance. Thyroid function testings reveals a free T4 of 0.5 (0.7 to 2.0) and a TSH of 0.1 (0.5 to 5). The best next diagnostic test is

MRI of the pituitary

A 59-year-old man complains of heat intolerance and terror. Thyroid function testing reveals a free T3 of 3.0 (0.7 to 2.0) and TSH of 6.0 (0.5 to 5). The next best diagnostic test is

MRI of the pituitary

A 25-year-old woman complains of amenorrhea and galactorrhea. Thyroid function tests are normal. The prolactin level is 350 ug/L (normal is less than 20). The most likely cause for her hyperprolactinemia is

Macroadenoma

When the exudative pleural effusion contains less than 60 mg/dL of glucose, which of the following diseases is the most likely cause?

Malignant pleural effusion

Newborn screening for phenylketonuria

Has a false-negative rate of 1:70

High levels of thyroidal peroxidase antibody are found with

Hashimoto's thyroiditis

The most common cause of spontaneous hypothyroidism in the U.S. is

Hashimoto's thyroiditis

You are seeing a 70-year-old man in the emergency department because of sudden onset of weakness and numbness in his right are man leg and a disturbance of his speech. He seems very frustrated, acting as if he can understand you, but being totally unable to speak intelligibly. Which of the following will you report to his primary care physician?

He has expressive aphasia, and probably a middle cerebral artery embolus

A 16-year-old man complains of pain and swelling in his knee joints after playing basketball yesterday. He had a similar episode last summer at the start of basketball season and he stopped playing until yesterday. His laboratory examination shows a normal platelet count, normal bleeding time, normal prothrombin time (PT), and prolonged partial thromboplastin time (PTT). He most likely has what disease?

Hemophilia A

Which is true of Down's syndrome?

Maternal and paternal nondisjunction events are associated with advanced maternal age

The most common cause of trisomy 21 (Down's Syndrome) is

Maternal disjunction at meiosis I

A 20-year-old college student complains of fever, chest pain, and weakness of several weeks' duration. He had acute rheumatic fever when he was 11 years old, but otherwise carries on full activity today. On examination, his temperature is 101.0 F, he has a heart murmur, a few crackles at both lung bases, splinter hemorrhages, and Osler's nodes, and the spleen tip is palpable. He is admitted an his blood cultures are likely positive for which organism?

Streptococcus viridians

A 71-year-old woman develops fever, chills, right-sided chest pain intensified with each breath, and a productive cough with yellowish sputum of 3 days' duration. She has diabetes mellitus, which is controlled on diet, and is otherwise healthy. She received her influenza vaccine only 1 month ago. On examination, her temperature is 102 F, respiratory rate 30/min, and heart rate 112 beats/min, and she appears ill. Her lung show dullness and bronchial breathes at the right base and many fine crackles, but a pleural friction is absent. Chest roentgenogram shows a lobar pneumonia of the right lower lobe. Which one of the following microorganisms is the likely cause?

Streptococcus pneumoniae

Thyrotoxicosis with a low uptake of iodine in the thyroid bed but uptake in the pelvis can be seen with

Struma ovarii

A 40-year-old patient with a recent viral infection presents with a significantly tender gland, low radioiodne uptake, and signs and symptoms of thyrotoxicosis. This presentation is most likely

Subacute thyroiditis

A patient without symptoms and without a recent illness is found to have a normal free T4 and elevated TSH, which are confirmed on repeated measurements. The most likely explanation is

Subclinical hypothyroidism

A 50-year-old woman executive has for the past 3 months experienced abdominal pain that often is relieved by antacids. Because of the persistent abdominal pain, she consults a gastroenterologist. He does an upper GI endoscopy and visualizes a duodenal ulcer. Now, the gastroenterologist should

Suggest medical treatment of the ulcer

A 37-year-old man suffers extensive burns of both lower extremities. He received allografts of skin, but these were rejected starting about 11 days after the graft procedure. The main cause of rejection is

T cell-mediated reaction, mainly CD8-positive cytotoxic T cells

Which of the following represent depolarization of the ventricles?

T wave

Which cytokine antagonizes or suppresses many responses of lymphocytes?

TGF-β (transforming growth factor β)

A 38-year-old woman comes into the office with complaints of amenorrhea for 6 months, with increased cold intolerance, loss of energy, and hair loss. Her menses were normal until this episode started, and she has also gained 22 pounds over these 6 months. Her pregnancy test is negative. Which test would you now order?

TSH

A patient with chronic autoimmune (Hashimoto's) thyroiditis develops a rapidly enlarging thyroid mass. Most likely this is

Thyroid lymphoma

The metabolic disorder induced by diarrhea and by acetazolamide are best differentiated by

Urine anion gap

A patient with a history of cirrhosis and small-cell lung cancer comes to the office for routine bloodworm, which reveals a sodium of 120. Which laboratory test is most useful in determining which of these two diseases is the cause of the hyponatremia?

Urine sodium

A thin young female complains of acute onset of weakness. Blood tests show hypokalemia and elevated serum bicarbonate. Although she denies it, you suspect recent diuretic use or self-induced vomiting. Which will distinguish these two causes?

Urine sodium

A 70-year-old man presents to you because he has not been feeling well for several months. He mainly complains of malaise and achiness. He takes ibuprofen occasionally for these symptoms. His urine shows protein and erythrocyte casts. A 24-hour urine shows 1 g of protein per day. His creatinine clearance is 24 mL/min. About 4 months ago, his serum creatinine was normal. The most likely diagnosis is

Vasculitis

A husband and wife come to your office for genetic counseling because although they want to have a child, they are reluctant to do so as they both suffer from achondroplasia. The likelihood is that they each possess a mutant allele. Their child could possess two copies of a mutant allele and manifest a phenotype more severe than having one mutant and one normal copy. This is referred to as

Semidominant inheritance

A 10-year-old boy is brought to your office by his parents for evaluation of hematuria and moderately abnormal renal function tests. In the course of obtaining a review of systems, you elicit a complaint of moderate hearing loss. You suspect Alport's syndrome and schedule him for an audiogram. The most likely finding on the audiogram is

Sensorineural hearing loss in the high-frequency ranges

A 50-year-old patient complains of hearing loss that is worse in his right ear. He has worked for many years in a garage and has always refused to wear earplugs because he likes to be able to hear the abnormal engine noises his customers want him to check in their vehicles. You screen him in your office with the Rinne and Weber tests, and your findings are: Rinne: air conduction > bone conduction bilaterally, and Weber: tone is louder in his left ear. These findings are consistent with which diagnosis?

Sensorineural hearing loss, worse in the right ear

Which cytokine promotes various biologic actions associated with inflammation?

d. TNF-a (tumor necrosis factor a)

Anticipation refers to

Worsening of a disease phenotype over generations within a family

A patient has muscular weakness. His parents and sister do not have weakness, but his mother's brother has weakness. You suspect Duchenne's muscular dystrophy. This is an example of

X-linked recessive inheritance

Among newborn females gonadal dysgenesis occurs in

1 in 3000

The incidence of Klinefelter's syndrome is

1 in 500 men

A 22-year-old woman comes in with a severe acute attack of asthma. She has wheezing, cough, and shortness of breath. Her chest roentgenogram shows hyperinflation. Which one of the following will likely be present?

1-s forced expiratory volume (FEV1) < 30%

A 35-year-old woman, newly married for the first time and well, comes for advice because she wants to become pregnant. She asks about the chances that her baby would have Down's syndrome. You tell her that her chances are

1/350

An African American couple who have one child plan on having a second child. They want to be tested for sickle hemoglobin and they want their child tested also. The results of the tests indicate that she has sickle cell trait, he has thalassemia trait, and the child has sickle cell trait. What are the chances of their second child having sickle thalassemia?

1/4

A 40-year-old woman and her husband who have a first child with Down's syndrome (trisomy 21) come to discuss their having a second child. They want to know the chances that a second child would have Down's syndrome also. You tell them their chances are

1/50

The human genome is estimated to contain about how many genes?

100,000

The occurrence of abnormalities in phenylalanine metabolism at birth is about

1:10,000

An elderly patient from the nursing home is brought in to the hospital because of fever and cough of 3 days' duration. She weights 50 kg. Her serum sodium is 160. What is her calculated free water deficit?

3.5 liters

A 30-year-old male presents to the emergency room with shortness of breath and right-sided pleuritic chest pain. His chest x-ray in the emer- gency room is normal. An arterial blood gas is obtained while the patient is breathing room air. The results show a pH of 7.48, PaCO2 of 35, PaO2 of 68, and an oxygen saturation of 92%. What is his A-a gradient?

40

About 10% of men with Klinefelter's syndrome are mosaics, but the most common karyotype is

47,XXY

Typically HIV progresses from the onset of infection to evidence of immunosuppression over what period of time?

5 to 10 years

In patients with COPD, long-term oxygen supplementation is prescribed if PaO2 is

55 mmHg or below

The percentage of patients with acute hepatitis C who go on to have chronic disease is

60 to 70

Protective vaccines are available for which of the following hepatitis viruses?

A and B

For the patient in the previous question (elderly woman with vision loss; diagnosis of amaurosis fugax, secondary to a cholesterol embolus to a retina arteriole), the first test you would perform after checking her vital signs and physical examination is

A carotid artery ultrasound

A young female patient comes with 3 days of dysuria and frequency. Her last menstrual period was 1 week ago. Which of the following statements is true about urinary tract infections?

A catheterized urine specimen with 10^3 colonies would be consistent with a urinary tract infection

The neurologic deficits of phenylketonuria are due to

A direct effect on phenyl aline on energy production, protein synthesis, and neurotransmitter homeostasis

A 45-year-old woman, accompanies by her husband, comes to your office for a diagnostic evaluation. Her husband tells you he has noticed several changes in her during the past year, including her fidgeting often, she seems "not as sharp" mentally and occasionally she has sudden irregular jerks of her arms and legs. Genetic testing would show

A gene abnormality of a trinulceotide repeat

Patients commonly complain of "dizziness." This symptom is

A loosely defined and nonspecific symptom of light-headedness or weakness or spinning

In chronic lymphocytic leukemia (CLL) the characteristic lymphocyte cell is

A mantle zone B cell

A parent has an X-linked disease. His three sisters do not have the disease. He most likely has

A mutant recessive gene on the X chromosome

Your patient presents with multiple café au lait spots and neurofibromas. His father and mother do not have neurofibromas. This may be an example of

A new mutation

Which clinical scenario best describes a patient with midstage dementia of the Alzheimer's type?

A patient became socially withdrawn a couple of years ago because he could not keep up with friends' activities such as golf and bridge; now he is getting lost whenever he leaves the house

Curve C corresponds to which of the following?

A patient in congestive heart failure due to systolic dysfunction

A 52-year-old male presents to your office complaining of severe dyspnea on exertion. While sitting in your examining room, he is not short of breath, but you notice that has to stop twice in the hallway while moving to the examining room. Which one of the following history is most consistent with a diagnosis of diastolic dysfunction causing congestive heart failure?

A systolic murmur consistent with hypertrophy cardiomyopathy

INH prophylaxis is recommended for which person?

A well man medical student age 30 years with a PPD of 11 mm

Which one of the following enzymes is found primarily in the liver?

ALT

A high fractional excretion of sodium is typical found in

Acute tubular necrosis

A key feature of all X-linked inheritance

Affected males do not transmit the disease to their sons

In obstructive liver disease, which one of the following tests of liver function likely remains normal?

Albumin

Abnormalities in the cytosolic copper-zinc superoxide dismutase (SOD 1) gene on chromosome 21 have been identified as factors in the pathophysiology of which degenerative disorder?

Amyotrophic lateral sclerosis

A 40-year-old female presents with amenorrhea and hirsutism. Which hormone is in excess in this woman with polycystic ovary syndrome?

Androgens

The renal biopsy of this middle-aged woman was submitted for immunofluorescence and "linear staining of the glomerulus" was seen. Which disease is then most likely?

Anti-GBM antibody

In hepatitis B virus infection, which one of the following antibodies is the protective antibody?

Anti-HBs

A 12-year-old girl complains of very painful joints of both hands and wrists and fever that began 2 days ago, about 2 weeks after she had recovered from a sore throat. On examination, her temperature is 101.8 F and her pulse rate is 120 beats/min. She has swollen, red, and warm joints of the wrists and fingers of both hands and a III/VI systolic murmur heard best at the apex. Which mechanism is the likely cause of her disease?

Antibodies to M protein of S. progenies and to cardiac myosin

The most common location for a gastric ulcer is

Antrum

A 68-year-old male comes to the emergency department with severe chest and back pain that he describes as "tearing" in nature. His only past medical history is hypertension. Physical findings include a diastolic murmur consistent with aortic insufficiency and a large difference in systolic blood pressure measurements between both upper extremities. The most likely diagnosis is

Aortic dissectionn

Which portion of the cerebra circulation is blocked in an ischemic stroke that presents with a rather peculiar blindness in which there is preserved pupillary light reaction and denial of blindness by the patient?

Both posterior cerebral arteries

A patient is referred to you with fatigue and labwork shows advanced renal failure. He has not seen a physician for several years. Which finding would help you decide that the renal failure is chronic?

Broad waxy casts found in the urinalysis

A man who was stabbed in the back during a fight is brought to the emergency room. On examination, you find impaired pain and temperature sensation in one leg and impaired proprioception and vibration sense in the opposite leg. These findings are descriptive of a

Brown-Sequard's syndrome

Primary biliary cirrhosis (PBC) typically is characterized

By a circulating IgG antimitochondrial antibody present in more than 90% of patients

Which one of the following complement components binds to antibody to activate the classical pathway?

C1

A person with an abnormality in which one of the of following early complement components would most likely experience very serious clinical manifestations?

C3

Which one of the following complement component deficiencies is associated with individuals with frequent pyogenic bacterial infections?

C3

Which one of the following complement components enhances phagocytosis of bacteria by opsonization?

C3b

Which one of the following components is the central component of the classic lectin, and alternate pathways of complement?

C3b

Which one of the following complement components is a chemoattractant for neutrophils?

C5a

Which one of the following complement components mediates cytolysis?

C5b6789

Direct killing of cells infected with virus is usually accomplished by

CD8-positive T cells

A patient has an excess of 17α-hydroxyprogesterone and 17α- hydroxypregnenolone in the urine, and no androgens. Which enzyme is deficient?

CYP17 (17,20 lyase)

In reference to the above Frank-Starling curve, Curve B corresponds to a healthy patient with normal cardiac function at rest. Which of the following is true?

Cardiac output will increase as preload increases, i.e., exercise

In which disease do the lymphocytes express CD 5?

Chronic lympocytic leukemia (B cell type)

Untreated acromegaly exhibits a decreased life expectancy from

Colon carcinoma

Pneumococcal vaccine is

Comprised of purified capsular polysaccharides from 23 serotypes

A 74-year-old male presents to the office with trouble urinating for 1 week. The force of the urinary stream is reduced, but there is no difficulty starting the stream. There is no pain. What is the problem?

Decreased detrusor contractility

Which one of the following is the most potent and effective antigen-presenting cell (APC)?

Dendritic-Langerhans' cells

Which one of these ulcers has the lowest incidence of malignancy?

Duodenal

The single most important bacteria that causes diarrhea worldwide

E. coli

When non steroidal anti-inflammatory drugs cause ulcers, they are usually

Gastric

A 24-year-old man complains of a fullness in his right upper quadrant. At an earlier age, he was diagnosed with type I glycogen storage disease. On examination, he has an enlarged liver and some slight bruising. He likely has

Hepatic adenomas

Which of the following associations is correct?

Hyperkalemia: peaked T waves

A low TSH, high T4, and high T3 suggests

Hyperthyroidism

To determine whether a fetus acquired an infection in utero, antigen specific antibody to which of the following classes should be measured?

IgM

How do varicoceles cause infertility?

Increasing testicular temperature

Which treatment regimen is appropriate for phenylketonuria?

Infants are fed a semisynthetic formula low in phenylalanine

The presence of gastroesophageal reflux is best diagnosed by

Medical history

Gram-negative and gram-positive bacteria each possess which one of the following structures?

Peptidoglycan

Ascites forms in patients with cirrhosis when

Portal hypertension and hypoalbuminemia are present

Fragile X-associated mental retardation syndrome

Shows no sign of the syndrome in 20%

Which one of these drugs is of proven benefit in the treatment of persons with hepatic encephalopathy?

Tetracycline

In which ovarian compartment is transforming growth factor-α produced?

Theca

Which hypersensitivity reaction is associated with anaphylactic reaction after a bee sting?

Type I: immediate

Which of the following would represent left or right atrial enlargement on a surface electrocardiogram?

Wide or tall P wave

A 26-year-old woman has been amenorrheic for 2.5 months. Your first choice for diagnostic evaluation is

hCG

Which one of the following groups of microorganisms more commonly causes diarrhea in the United States?

Viruses

Which one of the endogenous mediators of sepsis is most likely to be the mediator of shock?

Nitric oxide

Which mechanism is responsible for thromboctyopenia in splenic enlargement?

Accelerated destruction

The complications of severe infections of falciparum malaria can include anemia that is due predominantly to

Accelerated erythrocyte destruction and removal by the spleen

In autosomal recessive genetic disease, the responsible gene must be located on

Any one of the 22 autosomes

Fatigue, anorexia, orange/brown-colored urine, and an ALT level greater than 10 times normal are clinical features of

Any viral hepatitis

Hypertension in the upper extremities and delayed femoral pulsation in a patient with Turner's syndrome suggests

Aortic coarctation

A middle-aged African American man, without diabetes, presents with lower extremity edema. A 24-hour urine collection shows 10 g of protein. A renal biopsy is performed. The most likely lesion is

Focal segmental glomeruloscerlosis

A middle-aged woman comes in with fatigue and nausea. Laboratory tests show severe renal failure. Kidney biopsy reveals the presence of "crescents." This finding rules out which disorder?

Focal segmental glomerulosclerosis

In which ovarian compartment is angiotensin II produced?

Follicular fluid

The pathologic findings of predominant small artery involvement with intimal proliferation and sometimes with thrombosis, also termed "thrombitic microangiopathy," is found in which renal disease?

Hemolytic uremic syndrome

A 28-year-old man complains of some fatigue and slight RUQ tenderness. His laboratory examination shows the following hepatitis B profile: positive HBsAg, negative HBs, positive anti-HBe, and negative HBeAg. The likely diagnosis is

Late-acute HBV, now infectivity

Which one of the following disorders of bilirubin metabolism increased unconjugated bilirubin, increased conjugated bilirubin, and positive bilirubin in the urine?

Hepatitis

In the pathogenesis of acute diarrhea, which microorganism characteristically penetrates intestinal mucosa of the distal small bowel, multiplies in Peyer's patches, and then disseminates by the bloodstream?

Salmonella typhi

A 70-year-old woman is evaluated with colonoscopy for anemia and intermittently hemoccult-positive stools. A diagnosis of multiple arteriovenous malformations (AVMs) is made by which diagnostic procedure?

Visual inspection

A patient who has been diabetic for 15 years comes to your office complaining of a burning or tingling sensation in both of his feet and the lower aspects of both legs, which bothers him especially at night. His most likely diagnosis is

Polyneuropathy

Which of the following produces a diastolic murmur?

Aortic regurgitation

A 30-year-old woman undergoes surgery for a very large, but fortunately benign, brain tumor. For 2 days after the surgery, she is unable to perform certain previously learned motor functions. This disorder is called

Apraxia

A 30-year-old man is referred to you with weight gain, dorsocervical fat pad, and proximal muscle weakness. His urinary free cortisol is significantly elevated and does not suppress with dexamethasone. The plasma ACTH is undetectable. Your next best diagnostic test is

Abdominal CT

A patient with jaundice complains of RUQ pain. Liver function tests show a bilirubin of 3.0 mg/dL, alkaline phosphatase about four times nor- mal and both AST and ALT increased about 50% above normal. The best imaging test to order first in evaluating this patient would be

Abdominal CT scan

A patient with colon cancer diagnosed about 2 years ago presents with slight jaundice, nausea, and weight loss. An abdominal CT scan is read as "lesions in the liver; unable to distinguish vascular from possible metastatic areas." What is the best imaging study for this patient?

Abdominal MRI

A 50-year-old man who is an alcoholic is severely injured in a barroom brawl. He sustains a major injury to the frontal lobes of his brain. Subsequently, he always seems apathetic and unemotional. This disorder is called.

Abulia

A 55-year-old man has lung cancer in the right middle lobe. Which paraneoplastic syndrome is associated with GHRH secretion and lung cancer?

Acromegaly

The most frequent inherited disorder of hyper coagulability leading to pulmonary thromboembolism is

Activated protein C resistance (factor V Leiden)

A 32-year-old African American man develops nonproductive cough and some slight shortness of breath, of several weeks' duration. On examination, his temperature and heart rate are normal and his respiratory rate is 20 per min. The lung show vesicular breath sounds; no rales or wheezes are audible. The heart sounds are normal and no murmurs are heard. The extremities show several large, violaceous, and extremely tender subcutaneous nodules. His chest x-ray shows bilateral hillier adenopathy. A biopsy of the lung reveals which of the following?

Aggregates of mononuclear phagocytes surrounded by CD4+ T lymphocytes

In parenchymal liver disease, which one of the following tests of liver function likely will be decreased from normal?

Albumin

Acute pancreatitis is caused by a variety of disorders. Which of the following pairs of disorders account for 80 to 90% of cases?

Alcohol and gallstones

Mallory bodies found on biopsy of the liver are highly suggestive of which disease?

Alcoholic hepatitis

Which of the following conditions is consistent with a hypo kinetic arterial pulse?

All of these (LV failure, Hypovolemia, Restrictive pericardial disease, and Mitra stenosis)

A 28-year-old man complains of a painless mass in the left scrotum. His physician orders a CT scan of the pelvis and notes that the retroperitoneal lymph nodes are not involved. The patient has an orchiectomy done and the tumor is categorized as a nonseminoma. Which one of the following is secreted by nonseminoma germ cell tumors (GCT)?

Alpha-fetoprotein (AFP)

A 78-year-old woman is brought to the emergency department because of sudden loss of vision in her right eye. She describes a rapid "fading" of the vision in that eye, which by the time she reached the hospital was resolving. Her medical history includes hypercholesterolemia and episodic atrial fibrillation. Her examination is normal except for an irregular heart rate and a very subtle edematous-appearing area on the right retina. The most likely diagnosis is

Amaurosis fugax, secondary to a cholesterol embolus to a retinal arteriole

Weakness is caused by degeneration of anterior horn cells in which of the following disorders?

Amyotrophic lateral sclerosis

Which one of the following is true about silicosis>

An increased risk exists of developing tuberculosis in patients with silicosis

A patient with thyroid cancer is told that he has a life expectancy of less than 6 months from diagnosis. The variety of thyroid cancer with his prognosis is

Anaplastic thyroid carcinoma

A 15-year-old male comes into the office complaining about a lack of pubic hair growth. He also informs you that his voice has not yet deepened, and he has no interest in sexual activity. He is an only child. Blood drawn reveals a very high testosterone level. What is the problem?

Androgen insensitivity

In clinical infection with E. histolytica, the main finding concerning immunity is

Antibody titers correlate with length of disease

Which is a factor capable of inhibiting the serine protease factors II, IX, X, XI, and XII, a process accelerated by heparin or similar molecules?

Antithrombin III (ATIII)

Loss of P waves on surface ECG is consistent with

Atrial fibrillation

A 27-year-old woman complains of photosensitivity, a malar rash, and joint pains of her fingers, wrists, and knees of several days' duration. These symptoms occurred previously about 1 year ago for which she was treated with steroids. On physical examination, she has a temperature of 100.6 F and fusiform swelling of the PIP and MCP joints and of the wrists. On laboratory examination, she is anemic and neutropenic. Which mechanism is the likely cause of her disease?

Autoantibodies to dsDNA

A 72-year-old woman complains of fatigue, dyspepsia, and shortness of breath. Her daughter tells you that her mother also has some slight memory loss and occasionally complains of numbness in her legs. The laboratory tests you ordered show a hemoglobin of 10.2 g/dL and an MCV of 110. The most likely cause is

Autoantibodies to gastric parietal cells

A 25-year-old man with flank pain is found to have three cysts in each kidney, normal hepatic and renal function, and a family history that is not clear. He is most likely to have

Autosomal dominant polycystic kidney disease

A 45-year-old man complains of frequent "heartburn" and a mild chronic cough. On examination, he has gastroesophageal reflux disease (GERD). In addition to prescribing medications, which one of the following dietary recommendations would you make?

Avoid fats, chocolates, and alcohol because they would decrease LES pressure

Which one of these findings is the best for diagnosis of a congenital absence of the vas deferens?

Azoospermia

In the hepatorenal syndrome typically (what is usually present?)

Azotemia, hyponatremia, progressive oliguria, and hypotension are usually present

A 65-year-old man complains of "trouble swallowing." He is unsure whether his "trouble swallowing" occurs with both liquids and solids because it is intermittent. Sometimes he "chokes" and gets food "in his windpipe." The best imaging study is

Barium swallow

An 11-year-old girl developed a few erythematous pales on the dorm of her right hand 3 weeks ago that regressed without treatment, but then she developed painful lymphadenitis of the right axilla and the cervical area. She is afebrile. She does not remember being bitter by her cat. Her mother had the same findings about 3 months ago for which she was treated with ciprofloxacin. A biopsy of the node from the right villa of the mother failed to grow any microorganism. The likely pathogen of their illness is

Bartonella henselae

Which of the following is characterized by normotension, hypokalemia, and metabolic alkalosis?

Bartter's syndrome

When must the dietary treatment of phenylketonuria be initiated?

Before the child is 3 weeks of age

A 60-year-old patient has epigastric pain and weight loss of a few pounds. The consulting gastroenterologist's evaluation includes upper GI endoscopy, and he discovers a gastric ulcer. Now, the gastroenterologist should

Biopsy the area of the ulcer

A 55-year-old alcoholic man has been losing weight for about 6 months and begins to complain of difficulty swallowing. An upper GI endoscopy reveals an esophageal ulcer. The gastroenterologist should

Biopsy the ulcerated area

An amenorrheic 35-year-old woman with galactorrhea is found to have a large prolactin-secreting pituitary tumor compressing her optic chiasm. Which visual disturbance does she have?

Bitemporal hemianopia

Patients with pituitary macro-adenoma present most commonly with

Bitemporal hemianopsia

The destruction of CD4 lymphocytes in HIV and AIDS involves all of the following except which one?

Bone marrow stimulation

Most children with Down's syndrome are

Born to women under 35

A 55-year-old woman complains of the appearance of enlarged lymph nodes in her neck, axillae, and groin during the last few months that are painless. She is slightly fatigued, but she has no other symptoms. Her laboratory examination reveals B cell immunophenotype, t(14;18), and expression of BCL-2 protein. Which disease is she likely to have?

Follicular lymphoma

A 38-year-old man presents to the emergency room with the sudden onset of a severe headache while chopping wood. This is the worst pain he has ever experienced, and it is accompanies by photophobia and vomiting. Which procedure(s) provide the best chance of making the diagnosis?

CT scan of the head and lumbar puncture

A 35-year-old medical transcriptionist comest to your office complaining of pain in her hands, the right greater than the left. The pain sometimes awakens her at night. She also has a numb feeling in her thumb, index, and middle fingers, which is sometimes partially relieved by shaking her hands or opening and closing her fingers. By your history and physical examination, and appropriate laboratory tests, the most likely diagnosis is

Carpal tunnel syndrome

Chronic pancreatitis may be reliably diagnosed in a patient presenting with

Calcification in the pancreas detected on a flat plate x-ray of the abdomen

Polymerase chain reaction technique for DNA amplification

Can be used to detect nucleotide sequences of infectious agents

A 29-year-old man develops esophagitis, progressive substernal pain and dysphagia over several weeks. He has much difficulty swallowing. On examination, his temperature and respiratory rate are normal. The oropharynx, buccal mucosa, and tongue are covered with a white thick membrane that scrapes off easily with a tongue blade. His CD4 T lymphocyte count is 275 cells/uL and his viral load is 35,000 copies/uL. The microorganism that is the likely cause of his illness is

Candida albicans

A 77-year-old man is brought to your office by his daughter, who visited him at his home today and found him slightly confused and "clumsy." He complains of moderate generalized headache and some shortness of breath, but denies the other symptoms described by his daughter. His only other complaint is a sore neck, present since he slipped on the steps last week while going to his basement to check the furnace, which he thinks hadn't been working correctly. On examination, he is mildly tachycardic, and he has a subtle but discernible reddish appearance to his mucous membranes. The most likely diagnosis is

Carbon monoxide poisoning

A 45-year-old man complains of upper abdominal discomfort, backache, and some weight loss for several months. Recently, he developed jaundice, although he did not notice it, but his friend did and mentioned it to him. On examination, his abdomen is scaphoid and nontender and no organs of masses are palpable. His laboratory findings show increased direct bilirubin, normal indirect bilirubin, and markedly elevated alkaline phosphatase. His urine shows increased bilirubin and decreased urobilinogen. This pattern is consistent with which illness?

Carcinoma of the head of the pancreas

A patient with recurrent infections with yeast and the incapacity to control viral infections may indicate a deficiency in

Cellular immunity

Which of the following clinical situations is most often accompanies by coma?

Cerebral hemorrhage, either subarachnoid or intracerebral

A 45-year-old man who has consumed excess alcohol for at least 20 years is seen for evaluation of progressive difficulty in walking. He has an ataxic gait and his muscles are generally hypotonic. He has an intention tremor in his arms and legs and he also demonstrates "past pointing." His primary brain pathology will be found in the

Cerrebellum

While in the ICU, you are called to your patient's bedside because of the development of seizure activity in a ventilator patient with nosocomial pneumonia. You review the situation including the medication record. The patient is currently receiving dopamine, one-half normal saline, imipenem/ cilastatin, tobramycin, lisinopril, clonidine patch, and famotidine. The lab- oratory test results from this morning show normal electrolytes, except for a mildly elevated creatinine of 2.4 that is chronic, and CBC shows an improving white blood count of 15,000. After stopping the acute seizure event, you determine the next step in preventing further seizures is

Change antibiotic coverage

Which one of the following microorganisms that cause pneumonia is acquired from exposure to an infected animal?

Chlamydia psittaci

Thyrotoxicosis and uniformly increased radioactive iodine uptake in the thyroid can occur without any thyrotropin receptor antibodies or any thyroid autoimmunity in

Choriocarcinoma

A 51-year-old man health care worker whom you examine for the first time feels well. You do a complete physical examination, which is nor- mal except for slight overweight and borderline hypertension. It is inter- esting that his laboratory studies show the following hepatitis B virus profile: positive HBsAg, negative anti-HBs, low levels of IgG anti-HBc, pos- itive anti-HBeAg, and negative anti-HBe. The likely diagnosis is

Chronic HBV infection

A 42-year-old man complains of fatigue and enlarged glands in the neck, both axillae, and the left groin. His blood count shows a lymphocytois. The lymphocytes are monoclonal B cells that show CD5 antigen. On peripheral smear "smudge" cells are present and genetic studies show trisomy 12. What is the likely disorder?

Chronic lymphocytic leukemia

On karyotyping, the well-defined chromosomal abnormality t(9;22) (q34;q11) is virtually pathognomonic of which condition?

Chronic myelocytic leukemia

Which condition customarily terminates by transition to a blast cell phase with similarities to acute leukemia?

Chronic myelocytic leukemia

Which pathologic cells in a stained blood tim have appearances very similar to those of normal mature white cells or their precursors?

Chronic myelocytic leukemia

Which one disease is the single most common indication for single lung transplantation?

Chronic obstructive pulmonary disease (COPD) either smoking induced or secondary to α-1-antitrypsin deficiency

The most common cause of portal hypertension is

Cirrhosis

Transudative pleural effusion is caused by which one of the following diseases?

Cirrhosis

A teenage girl presents for evaluation of hearing loss in her right ear. She has a history of at least 12 episodes of otitis media as a child; at least one time she perforated her eardrum. Her hearing loss is most likely due to

Conductive deafness

A 27-year-old man sustains an injury to the lateral aspect of his left ankle in an accident about 6 weeks ago. The skin, which was lacerated, became erythematous and swollen, and over the few weeks since then, he developed persistent pain in his ankle. His physician recommended local treatment to relieve the swelling, had x-rays of the ankle done, and started him on antibiotics. His physician concluded that he had an acute bacterial infection of the bone; these infections characteristically show which one of the following?

Congested and thrombosed blood vessels.

A man known to be an alcoholic for at least 15 years presents with fever, elevated serum bilirubin, elevated WBC count, and an AST/ALT ratio greater than 2. A liver biopsy shows Mallory bodies, WBCs, and degener- ating cells. You should tell this patient that the biopsy findings are

Consistent with alcoholic hepatitis that may revert to normal if he stops drinking alcohol

Which one of the following tests is used for the detection of anti-Rh antibody in blood?

Coombs' test

In which ovarian compartment is basic fibroblast growth factor produced?

Corpus luteum

A 45-year-old woman veterinarian who is a faculty member at the nearby veterinary school comes to your office with complaints of a flulike syndrome of 9 days' duration, including persistent fever for all 9 days, extreme fatigue, and severe headache. She has a dry cough, an increased white count, and thrombocytopenia. Which one of the following is the likely cause of her infection?

Coxiella burnetti

A 23-year-old woman is seen for weakness and amenorrhea. She is clinically hypothyroid. A CT scan of the pituitary shows an expanded sella with a large cystic component with calcifications. The most likely diagnosis is

Craniopharyngioma

Which abnormality of adult testicular function (infertility) occurs with normal virilization?

Cryptochidism

Which one of the following causes biliary tract infection, including sclerosing cholangitis, in HIV-infected persons?

Cryptosporidium

After completion of bone growth, treatment of Turner's syndrome consists of

Cyclic estrogen and progesterone

A new mother asks you to examine her newborn who is 1-day-old because he developed a gastrointestinal obstruction. Your diagnosis is

Cystic fibrosis

Which one of the following causes retinitis, with patient complaints of blind spots, and retinal hemorrhages and exudates in persons infected with HIV?

Cytomegalovirus

A 75-year-old man is brought to your office by his son with concerns over developing memory problems. Previously, the patient had been well and was forced to retire from his job a few months ago because of worsening arthritis symptoms limiting his mobility. He has been a widower for 7 months and he live alone. His family is worried about his safety in view of these changes. The likely cause of this dementia picture is

Depression

Which term characterizes the frequency of chronic disease following hepatitis A infection?

Nonexistent

A mother brings her 3-year-old child with Down's syndrome to your office for an examination for the first time. You hear a heart murmur and conclude that the child has congenital heart disease. Which one of the following is the child likely to have?

Endocardial cushion defect

The procedure of Southern blotting can be used to

Detect gross rearrangements of DNA and gene deletions

Which one of the following disorders involves multiple gene defects rather than a single gene defect?

Diabetes mellitus

A 70-year-old man with progressive painless jaundice is referred to your office. You order liver function tests that show an abnormal pattern consistent with obstruction. Which procedure will you now suggest?

Endoscopic retrograde cholangiopancrreatography (ERCP)

A 68-year-old man comes to your office with a complaint of right- sided jaw pain that occurs about half way through his meal. He has seen his dentist already and no abnormality was found. X-rays of the area were taken and they also were unremarkable. The next step in his workup should be

ESR

Regarding X inactivation

Each female is a mosaic with about one-half of her cells expressing the maternal X and one-half expressing the paternal X

A 26-year-old woman presents to the office with 2 days of abdominal pain and a positive pregnancy test. Her last menstrual period was 9 weeks ago. She reports no dysuria. She reports a history of two episodes of pelvic inflammatory disease. Which of these is the most likely cause of the abdominal pain?

Ectopic pregnancy

This African American man undergoes additional tests for investigation of the diagnosis. Which one of the following is likely to be found?

Elevated angiotensin-converting enzyme (ACE) level

A middle-aged male comes for swelling of the lower extremities. Urinalysis shows 4+ protein and a 24-hour urine collection confirms that he is spilling 10 g of protein per day. Other expected findings include which one?

Elevated cholesterol levels

A patient comes in with 3 days of nausea and vomiting. BUN and creatinine are both elevated and the ratio is 25:1. Associated findings in this patient would include

Elevated urine osmolarity

In which one of the following disease would the occurrence of hemoptysis prompt a search for another disease as the cause of the hemoptysis

Emphysema

The different genetic forms of phenylketonuria illustrate two different pathophysiologic mechanisms by which inborn errors of metabolism cause disease. These are

End-product deficiency and substrate accumulation

Which of the following is represented by a prolonged PR interval and is due to delayed AV conduction?

First-degree AV block

Your patient has an autosomal dominantly inherited disease. The patient and his grandfather show evidence of disease, but the patient's father is asymptomatic. This is an example of

Fitness

Pretibial myxedema is associated with

Graves' disease

A 35-year-old man with Sjogren's syndrome complains of an enlarged salivary gland in the neck that is painless. He is slightly fatigued. Laboratory examination reveals a monoclonal B small cell lymphocyte that fails to express CD5. Which disease is he likely to have?

Extranodal marginal zone B cell lymphoma of MALT type

A 19-year-old man complains of abdominal pain, loss of appetite, nausea, vomiting, and diarrhea of more than 1-year duration. During this time, he lost weight, about 25 pounds. He does not drink alcohol, not even socially. Examination of the abdomen is normal. No organs or masses are palpable. His complete blood count is normal and his glucose tolerance test (GTT) is marginally normal. He has steatorrhea and his stools float. Which one test will indicate his diagnosis?

Fecal elastase concentration

Transmission of hepatitis A is almost exclusively by

Fecal-oral route

Compared with a healthy individual, lymph nodes from a person with a deficiency of B lymphocytes would have

Few or no primary follicles

Which of these medications treats benign prostatic hyperplasia by 5α-reductase inhibition?

Finasteride

A 32-year-old man is admitted with a bleeding ulcer. This is his fifth episode of bleeding from gastric ulcers and he also has moderate diarrhea. Each time, his ulcers have been difficult to resolve. Which neoplastic lesion is most likely to be found in this man?

Gastrinoma

Which is the most common precipitating event of hepatic encephalopathy?

Gastrointestinal bleeding

A patient has fragile X-associated mental retardation syndrome phenotype. Diagnostic testing of 107 lymphocytes reveals repetition of (5′CGG-3′)n segment of DNA where n > 200, but variable in number. This variation in number is described as

Genetic mosaicism

A 23-year-old woman complains of sever weakness. Her laboratory findings are markedly elevated indirect bilirubin, normal direct bilirubin, normal alkaline phosphatase and cholesterol, and an increase of urobilinogen in the ruins. What disease is she likely to have with this pattern of laboratory findings?

Hemolytic anemia

A 28-year-old previously healthy female, with no medical history is now 28 weeks pregnant. She complains of trouble seeing, polyuria, polyphagia, and polydipsia. What is her diagnosis?

Gestational diabetes mellitus

A 3-week-old child develops fever and lethargy, has a full fontanelle, and just about 1 hour ago had a seizure. Cultures of the blood and of the CSF grew the same organism. The most likely pathogen is

Gram-negative bacilli

In which ovarian compartment is Mullein-inhbiting substance produced?

Granulosa

In which ovarian compartment is plasminogen activator produced?

Granulosa

A 30-year-old woman with thyrotoxicosis has a diffusely enlarged gland of palpation of the neck. Her thyroid scan and 24-hour uptake show uniformity of uptake and an increased percentage uptake. This patient has

Graves' disease

Infiltration of orbital soft tissue and extraocular muscles with lymphocytes, mucopolysaccharides, and fluid is seen with

Graves' disease

Chronic infection with which virus is a risk factor for development of hepatocellular carcinoma?

HBV

Which one of the hepatitis viruses is a DNA virus?

HBV

Persons suffering from which disease are at greatly increased risk for developing hepatocellular carcinoma?

HBV carrier

Which of the hepatitis viruses most commonly progresses to chronic infection and chronic hepatitis?

HCV

The most sensitive indicator of infection with hepatitis C virus (HCV) is

HCV RNA

A patient comes in with acute onset lower extremity swelling. Work-up reveals nephrotic syndrome and renal biopsy shows focal segmental glomerulosclerosis. Which of the following conditions should be ruled out?

HIV disease

A toddler is brought to you with swelling hands and face. The mother says he was well but fell from his bike 2 weeks ago. Examination shows an elevated blood pressure and an infected wound on his shin. Urinalysis shows numbers RBC. Which statement applies?

HTN due to sodium retention

A 28-year-old woman complains of amenorrhea and galactorrhea, after beginning a new medication recently. The most likely medication is

Haloperidol

Cardiac output is the product of

Heart rate x stroke volume

Which of these liver diseases results from an iron disorder?

Hemochromatosis

A 21-year-old college student and varsity football player comes to the emergency room with complaints of nausea, fatigue, mild right upper quadrant pain, and anorexia of several days. He has been at practice with the football team this spring and summer at a substitute practice field near the campus and he drank from a faucet of cold water at the edge of the field and near a farm. He does not use drugs. He drinks an occasional beer. Two other team members were examined recently for similar symptoms. On examination, his liver is minimally enlarged and tender. His serum bilirubin is 2.5 mg/dL and his AST and ALT are elevated. Which disease is he likely to have?

Hepatitis due to HAV

A 31-year-old man with HIV comes to your office because of nausea, fatigue, mild upper right quadrant pain, and anorexia of 3 weeks' duration. He uses intravenous illicit drugs and does so regular. However, he previously received three doses of hepatitis B vaccine on the appropriate schedule, and he regularly takes his three-drug regimen for the treatment of his HIV. He drinks alcohol to excess, mainly for the past 2 years. On examination, he is slightly icteric and his liver is minimally enlarged and tender. His serum bilirubin is 3.0 mg/dL and his AST and ALT are significantly elevated. Which disease does he likely have?

Hepatitis due to HCV

Previously, you treated a 44-year-old man, a former intravenous drug abuser, for acute hepatitis C infection. Several months later, it is clear that the patient has chronic hepatitis and may need therapy with interferon. Which long-term complications of hepatitis C infection must you discuss so that the patient can make an informed decision about treatment?

Hepatoma and cirrhosis

A 32-year-old female, four months pregnant, is referred to your office for evaluation by her obstetrician. Her physical examination reveals a II/IV systolic murmur and third heart sound (S3). Which of the following statements is true?

Her physical findings are normal during pregnancy, and the patient probably requires reassurance and no further testing

A 46-year-old man with progressive AIDS, who is noncompliant in taking his medications, shows a CD4 count of 80 cells/uL and a viral load of 120,000 copies/uL and numerous painful and crusted small round lesions on the skin, some coalescent, along the path of the right trigeminal nerve. Which microorganism is the likely cause of the lesions?

Herpesvirus Varicellae

Which one of the following causes painful and crusted lesions that follow the path of an intracoastal nerve in persons infected with HIV?

Herpesvirus varicellae

A 52-year-old female presents to the office with a complaint of hot flashes. You suspect menopause. Which of the findings below would con- firm your diagnosis?

High FSH and LH

Which one of the following is unnecessary for successful breast-feeding?

High estrogen levels

A 41-year-old man who has otherwise felt well presents only because he has developed a new mass comprised of superficial lymph nodes in the neck that are painless. On chest roentgenogram, he has mediastinal lymphadenopathy. Which disease is he likely to have?

Hodgkin's disease

In the above patient (with Adie's tonic pupil), what other abnormality on physical would be consistent with the diagnosis?

Hyporeflexia in the lower extremities

Endocrine conditions associated with Klinefelter's syndrome include

Hypothyroidism

A patient with type 1 diabetes is admitted for abdominal pain and nausea of 3 days' duration. The BP is 100/50. Serum glucose is 600, serum potassium is 6.0, anion gap is 24, and serum sodium is 130. Serum ketone levels are slightly elevated. Which statement applies to the laboratory abnormalities?

Hypovolemia is due to an osmotic diuresis

Which cytokine functions as an activator of macrophages and natural killer (NK) cells?

IFN-γ (interferon γ)

Which ECG leads represent the inferior cardiac wall?

II, III, aVF

A 33-year-old woman with chronic lymphoid leukemia (CLL) complains of weakness and fatigue of several weeks' duration. On physical examination, she has several palpable nodes in her neck and in both axillae and the tip of her spleen is barely palpable. On laboratory examination, her hemoglobin is 9 g/dL and she has an absolute lymphocytosis of 18,000 cells/cm2. What stage in the disease is she according to the Rai staging system?

III

Which cytokine promotes the proliferation of T and B lymphocytes?

IL-2 (interleukin 2)

Which cytokine functions as a promotor of T helper 2 (TH2) development and IgE synthesis?

IL-4 (interleukin 4)

Platelet production (thrombopoiesis) is affected by more than one cytokine. Which of the following sets seems to be the most important in platelet development?

IL-6 and thrombopoietin

A 48-year-old woman with a history of pituitary surgery and irradiation is scheduled for elective surgery. She currently requires replacement thyroxine, hydrocortisone, estrogen, and progesterone. In the preoperative period, you will treat her with

Increased hydrocortisone

Which of the following laboratory patterns is most consistent with the diagnosis of hemochromatosis?

Increased iron, increased TIBC (total iron-binding capacity), and increased ferritin

Which one of the following hemodynamic findings is the main derangement of primary pulmonary hypertension?

Increased resistance to pulmonary blood flow

Which one of the following pathogens is a main cause of bronchiectasis?

Influenza virus

Which mechanism is responsible for thrombocytopenia in von Willebrand's syndrome?

Inherited

In a patient with iodine-deficiency goiter who moves from an iodine-deficient area to an iodine-replete area, the occurrence of hyperthyroidism most likely represents

Iodine-induced hyperthyroidism

A 19-year-old pregnant female feels tired and out of pep. Her con- junctivae are pale; laboratory tests show she has a mild normocytic, nor- mochromic anemia with a low serum iron and an increased TIBC (transferrin iron-binding capacity). Hemoccult tests are negative. Which is the likely cause of her anemia?

Iron or folate deficiencies

Cystic fibrosis

Is an autosomal recessive disorder

How does pregnancy increase the risk of diabetes mellitus?

Insulin resistance caused by maternal hormones

A 45-year-old man complains of frontal bossing and enlarged nose, tongue, and jaw. He has doughy palms and spade like finger. The best screening test to establish the diagnosis is

Insulin-like growth factor type 1 (IGF-1)

A patient with diabetic nephropathy and baseline creatinine of 2.5 comes in with dysuria and frequency. You prescribe trimethoprimsulfamethoxazole. Five days later, her symptoms are better, but you repeat the blood tests and find serum creatinine to be 4.0. Urinalysis only shows proteinuria. Why as the creatinine become elevated?

Interference with tubular secretion of creatinine

Which one of the following disorders of bilirubin metabolism shows increased unconjugated bilirubin, normal conjugated bilirubin, and lack of bilirubin in the urine?

Intravascular and extravascular hemolysis

In the aforementioned patient (with possible spinal cord compression), the most effective initial treatment is

Intravenous dexamethasone

Fragile X, spinocerebellar ataxia 1, spinobulbar muscular atrophy, and Huntington's chorea

Involve amplification of an unstable triplet repeat

Endemic goiter results from

Iodine deficiency

The most common cause of goiter in developing nations is

Iodine deficiency

Which is the best approach to confirm the diagnosis of an acute cytomegalovirus infection (CMV)?

Isolation of virus from blood

Osmolality of bowel contents under normal circumstances is

Isotonic in the jejunum, ileum, and colon and variable in the duodenum

Which is an accurate statement concerning diabetic nephropathy?

It is almost always associated with retinopathy in type 1 diabetes

Which of the following statements characterizes minimal change disease?

It is associated with selective proteinuria

In the treatment of persons with hepatic encephalopathy, which one of the following decreases ammonia absorption?

Lactulose

Given the above EKG changes, which coronary artery is most likely occluded?

Left anterior descending artery

Hormone studies in this patient with Turner's syndrome reveal

Low estradiol, high FSH, and high LH

A 26-year-old woman with a history of mitral valve prolapse comes in with 1 week of fever that started 3 days after a dental procedure. Her urine contains red cells and her rheumatoid factor is elevated. Which of the following serologic abnormalities is expected to be present?

Low serum complement levels

A 45-year-old man has decreased libido and decreased sexual function. A large pituitary tumor is found. His prolactin is 20 (normal less than 15). Testing of his pituitary-gonadal axis most likely will show

Low testosterone and low LH

A 16-year-old boy is brought by his parents to be evaluated for lack of pubertal development or development of secondary sexual characteristics. He cannon smell (anosmia). The baseline testosterone and the LH response to LHRH most likely are

Low testosterone and normal LHRH response

A man with classic Klinefelter's syndrome should have

Low testosterone, high LH, and high FSH

A 47-year-old man complains of headache, impotence, and galactorrhea for the past 2 months. A likely hormonal profile on this patient would be

Low testosterone, low LH, and high prolactin

A 55-year-old male describes bilateral pain in his lower back and legs with prolonged standing while working on an assembly line. Whenever he sits down and takes a break, he gets some relief, but it recurs when he resumes his job. No other inciting events can be identified. The most likely cause of this problem is

Lumbar spinal stenosis

A 40-year-old man has erectile dysfunction. He is noted to have hyperprolactinemia (prolactin of 400 ug/L). On MRI a macro adenoma with supersellar extension is found. The best course of therapy for the patient is

Medical therapy with bromocriptine

Elevated plasma calcitonin is seen with

Medullary thyroid carcinoma

The chromosomal abnormalities in Klinefelter's syndrome is most often the result of

Meiotic nondisjunction

A patient with a predisposition for disseminated infections by Neisseria bacteria may have a deficiency in

Membrane attack complex formation (C5 to C9)

An elderly male presents with urinary frequency. Laboratory examination shows an elevated serum creatinine. On physical examination, you detect an enlarged prostate. Which other finding is most likely?

Metabolic acidosis

You accompany your nephrology attending on his rounds at the dialysis unit. He asks you to explain various laboratory test abnormalities in hemodialysis patients. Which statement is correct?

Metabolic acidosis is due to decreased renal acid secretion

A patient with chronic renal failure suddenly develop nausea and vomiting from food poisoning. Laboratory examination shows sodium 142, potassium 4.0, chloride 94, bicarbonate 24. What is your conclusion?

Metabolic alkalosis and metabolic acidosis

Concerning the association between potassium and bicarbonate abnormalities, which of the following is true?

Metabolic alkalosis is associated with volume depletion caused by diuretics

Which of the following heart sounds is often caused by mitral or tricuspid valve prolapse?

Midsystolic click

A mutation in which the base replacement changes the codon for one amino acid to another is called a

Missense mutation

A moderatley obese factory worker who stands for long periods of time begins to experience pain and a severe burning sensation that is localized over the left anterior lateral thigh. This patient has

Mononeuropathy

A 38-year-old woman with rheumatoid arthritis develops worse joint pain and also pain and paresthesias in scattered locations in both arms and both legs. Her sedimentation rate increases significantly and you diagnose vasculitis causing

Mononeuropathy multiplex

Persons with chronic pulmonary disease are more likely to develop pneumonia due to infection with which one of the following pathogens?

Moraxella catarrhalis

Hepatocellular adenomas are

Multiple hepatocellular adenomas associated with glycogen storage disease type 1 occur mainly in women

A patient presents with left-sided colicky flank pain and microscopic hematuria. KUB does not show a stone, but ultrasound shows left-sided microscopic hematuria. Which of the following past medical history is compatible?

Myeloproliferative disorder

A patient with long-standing COPD who develops vomiting would have which of the following blood gas and electrolyte patterns?

Na Cl Bicarb pCO2 pH 139 89 35 47 7.49

A patient with diabetic ketoacidosis along with a bout of viral gastroenteritis resulting in diarrhea has which of the following patterns?

Na Cl Bicarb pCO2 pH 140 109 12 26 7.29

A patient with cardiomyopathy on chronic diuretics who suffers from acute respiratory arrest from aspiration has which of the following patterns?

Na Cl Bicarb pCO2 pH 140 96 33 75 7.26

Helicobacter pylori is associated with

Nearly all duodenal ulcers and most gastric ulcers

The most common cause of mass in the posterior mediastinum is

Neurogenic tumors

Which of the following cells are important in an innate immune response to extracellular bacteria?

Neutrophils

A 6-year-old boy has received a deep puncture wound while playing in his neighbor's yard. His records indicate that he has had the standard DPT immunizations and a booster when he entered school. What is the most appropriate therapy for this child?s

No treatment

The pattern of normal TSH, normal T4, and low T3, is most consistent with

Nonthyroidal illness (sick euthyroidism)

Excitatory neurotransmitters such as acetylcholine and glutamate perform which of the following functions?

Open cation channels and allow influx of Na+ or Ca2+.

In obstructive sleep apnea (OSA) which one of the following contributes to the negative oropharyngeal pressure characteristic of OSA?

Occlusion of the upper airway at the level of the oropharynx

In the case of a dominant allele

One copy of the allele is sufficient to produce the phenotype

Neutralizing antiviral antibody produced in response to infection by an enveloped virus acts on which one of the following components of the virus?

One or more surface glycoproteins

Which of the following heart sounds is high pitched, early diastolic sound, usually due to mitral stenosis?

Opening snap

On the basis of physical findings of mandibular enlargement, increased hand and foot size, coarse facial features, you suspect a 48-year-old woman has acromegaly. The definitive diagnostic test for acromegaly is measurement of growth hormone in which of the following settings?

Oral glucose tolerance test

A 29-year-old woman comes into the office after three spontaneous abortions (unplanned). All three occurred at approximately 6 weeks' gesta- tional age. Her physical exam is normal. Which of these may be the cause?

Ovary

A 25-year-old woman complains of increasing obesity, amenorrhea, hypertension, and abdominal stria. The next best diagnostic test is

Overnight dexamethasone suppresion test

Hepatitis C is most commonly transmitted by

Parenteral routes including intravenous drug abuse and promiscuous sex

A 64-year-old man complains of a resting tremor in his right hand. This has caused him substantial embarrassment because he is right-handed, and he feels that everyone stares at this involuntary hand movement. He does admit that the tremor decreases with intentional movement but "it's still noticeable." His wife reports that she has seen a generalized slowing down of his movements and that she things it is getting hard for him to get up from a seated position. The most likely diagnosis is

Parkinson's disease

A 65-year-old man with a lung mass has increasing skin pigmentation and significant muscle weakness and wasting. Urinary free cortisol is 690 ug/24 hour (10 to 80 normal) and is non suppressible. Which of the following tests would probably be most diagnostic?

Plasma ACTH

Which one of the following causes a lung infection, the most common opportunistic infection, in HIV-infected persons?

Pneumocytis carinii

A 32-year-old man develops shortness of breath, fever, and a non-productive cough of several days' duration. On examination, his temperature is 101.6 F, his respiratory rate is 28, and he has a few crackles at both bases and middling fields posteriorly. His total WBC is 5000 cells/uL and his CD4 count is 400 cells/uL. The chest roentgenogram shows diffuse infiltrates in both lungs extending from the perihelia areas. Which one of the following microorganisms is the likely cause?

Pneumonocystis carinii

Which of the following is seen most commonly in association with primary biliary cirrhosis (PBC)?

Positive antimitochondrial antibody (AMA)

A 52-year-old white woman with breast cancer receiving adjuvant therapy presents with back pain that intensifies on movement and pain over the L1 vertebral body when she coughs and that radiates down her left lower extremity to her leg and foot. The most likely etiology of this disorder is

Possible spinal cord compression

A 65-year-old male presents to the office with benign prostatic hypertrophy and new onset hypertension. Which one medication could you give this patient to handle both diagnoses?

Prazosin

Which of the following findings would favor essential hypertension over secondary hypertension?

Presence of hyperinsulinemia and obesity

Which of the following cases of an elevated hemoglobin concentration in the blood is characterized by a low level of erythropoietin in the blood?

Primary polycythemia (polycythemia vera)

The arrow indicates (It's pointing to the first sharp dip, immediately before the spike)

Q wave

Which one of the following ECG components varies with heart rate?

QT interval

Bacteria can infect the skin through accidental or deliberate breaks in it or through the hair follicle. Which one bacteria causes one of several differing infections of the skin including necrotizing fasciitis, erysipelas, impetigo contagiosa, and necrotizing myositis?

S. pyogenes

Which of the following heart sounds is produced by closure of the AV valves?

S1

Which of the following heart sounds is produced by closure of the semilunar (aortic and pulmonic) valves?

S2

Which of the following heart sounds is low pitched and produced in the ventricle at the termination of rapid filling and is heard in normal children and in patients with increased cardiac output?

S3

Which of the following heart sounds is low pitched, presystolic sound of ventricular filling produced by atrial contraction?

S4

A 27-year-old man who suffers seizures controlled with phenytoin comes to your office because his neurologist discovered that the patient has a low FSH level. The patient is infertile. The likely site of his infertility is

Pretesticular

During the course of an evaluation for thyroid function, your patient, a 33-year-old man who is infertile, is found to have very low levels of luteinizing hormone. The likely site of his infertility is

Pretesticular

A 43-year-old woman comes to your office complaining of pruritus, mainly of the soles and palms, and fatigue. She has minimal jaundice and steatorrhea. Laboratory tests show a slightly elevated bilirubin, an elevated alkaline phosphatase, and a positive IgG antimitochondrial antibody test. The likely diagnosis is

Primary biliary cirrhosis

A 65-year-old woman is seen for evaluation of dementia. On examination, you note that her left pupil does not react well to light. When she follows your finger with her eyes, as you approach the bridge of her nose, you note the left pupil to constrict equally as well as the right one. The most important test to order at this point would be

RPR

A 19-year-old woman comes to the office complaining of galactor- rhea. She has never been pregnant. Which hormone is the most likely to be responsible for this situation?

Prolactin

A 28-year-old woman develops galactorrhea without amenorrhea. Your evaluation should include

Prolactin

A 30-year-old woman gives a 6-month history of amenorrhea. Your initial evaluation should include measurement of

Prolactin

A 55-year-old man who has worked for many years as a stevedore develops pain and weakness in the lower back that radiates down the posterolateral thigh and lower aspect of the leg. This is characterized as

Radiculopathy

A 75-year-old female comes to your office complaining of severe diarrhea of 3 days' duration. She appears dehydrated and complains of severe leg cramps. You immediately order electrolytes and not surprisingly find that her potassium level is very low. Which of the following would you expect to find on her surface electrocardiogram?

Prominent U waves

The conversion of T4 to T3 is inhibited by

Propylthiouracil

Which is a protein cofactor that exposes the inactivation site of activated coagulation factor V, which can then be cleaved by a protease?

Protein C

Which is a vitamin K-dependent factor, activated in the presence of thrombin to cleave activated factors V and VIII?

Protein C

Which of the following arterial pulse waveforms is consistent with severe left ventricular impairment?

Pulsus alternans

Which of the following arteriole pulse waveforms is consistent with aortic stenosis?

Pulsus tardus

A 55-year-old woman manager of a regional long-distance telephone office whom you examine for the first time feels well. You do a complete physical examination, which is normal except for a few very small palpable and moveable, nontender nodes in both cervical chains and occasional wheezes in the lungs. However, her laboratory studies show the following hepatitis B virus profile: negative HBsAg, positive anti-HBs, low levels of IgG anti-HBc, negative anti-HBeAg, and positive anti-HBe. The likely diagnosis is

Recovered from HBV infection

Obstructive airway defect is characterized on pulmonary function testing by which of the following?

Reduced FEV1/FVC ratio

Which sleep pattern is most common in normal aging?

Reduced quantity of stage 4 sleep, more spontaneous awakening, similar quantity of REM sleep

A 50-year-old man complains of painless lymph node enlargement in his neck and both axillae. He suffers fevers and night sweats, all about 3 months' duration. On laboratory examination, the pathologist identifies in the lymph node biopsy a few giant cells with multiple nuclei of large size and large inclusion-like nucleoli. These cells are named

Reed-Sternberg cells

Which of the following causes a leukocytosis without an increase in the number of circulating polymorphonuclear neutrophil leukocytes?

Release of epinephrine

A 21-year-old black man comes to your office complaining of joint pains and swelling of both knees of several months duration. He has had frequent similar episodes beginning before he was 10 years old. His father had similar complaints of joint pains and suffered from anemia. However, his mother did not have any of these symptoms and signs. The patient is also anemic. His hemoglobin gene makeup is likely to be

SS

A 45-year-old female comes to the emergency room with crushing chest pain radiating to her neck of 1-hour duration. A surface electrocardiogram is quickly obtained and demonstrates 2 mm of ST elevation in leads II, III, and aVF (inferior leads). Her blood pressure is 80/40, heart rate 45, and respiratory rate 12. Her diagnosis of acute inferior wall injury is made. What additional site of infarction do you suspect based on this clinical picture?

Right ventricle

What EKG finding do you use to confirm the suspected diagnosis in this 45-year-old patient?

ST elevation in right precordial chest leads

Which of the following AV blocks is characterized by progressive PR interval prolongation prior to loss of AV conduction?

Second-degree AV block type I

A 35-year-old man has prolactinoma and a history of severe peptic ulcer disease. There is a family history of pituitary tumors. The findings of what other diagnostic test at this time may be abnormal and potentially useful in diagnosis?

Serum calcium

A 45-year-old man has decreased libido and erectile dysfunction. He has noted increasing pigmentation. He has developed liver disease and arthropathy recently. The next best diagnostic test is

Serum ferritin

A 47-year-old male comes to your office complaining of shortness of breath, particularly with exertion. His vital signs are normal. Upon auscultation, you hear a III/VI holosystolic murmur most prominent at the apex and radiating to the axilla. You make a clinical diagnosis of mitral regurgitation, which is confirmed by echocardiography and quantitated as severe. Which of the following is true?

Severe mitral regurgitation is often associated with a third heart sound

ARDS is differentiated from acute lung injury (ALI) on the basis of which one of the following?

Severity of hypoxemia with PaO2/FIO2 ratio of less than 200 mmHg

Which of the following is the correct sequence for myocardial depolarization?

Sinoatrial (SA node) --> AV node --> bundle of His --> right and left ventricles

Which disease presents with predominantly tubulointerstitial involvement?

Sjogren's syndrome

Among intravenous drug abusers, which is most often the source of the pathogens of infective endocarditis?

Skin

Which feature characterizes acetaminophen-induced liver damage?

Some acetaminophen is metabolized to a hepatoxic metabolite by cytochrome P450 2E1

Which method is used to detect unique genomic DNA fragments from an individual starting with DNA from peripheral leukocytes?

Southern blot

Which of the following statements is true of a reversed splitting of the first heart sound?

Splitting is maximal during inspiration

This injection drug user is admitted to the hospital for confirmation of endocarditis and treatment. Blood cultures are positive. Which one of the following organisms is the most likely pathogen?

Staphylococcus aureus

Which one of the following organisms accounts for at least 50% of cases of acute hematogenous and contiguous focus osteomyelitis?

Staphylococcus aureus

Which clinical or laboratory finding is most consistently seen in malabsorption syndromes?

Steatorrhea

Symptoms due to Clostridium difficile infection can be accurately diagnosed by

Stool toxin assay

A 19-year-old man who suffered a traumatic abdominal injury during a college football game had a splenectomy about 1 year ago. Now, he complains of fever and productive cough. On physical examination, he has dullness and rales of the right lower lung field. It is likely that he has one of the following infections to which he has increased susceptibility?

Streptococcus pneumoniae

Antineutrophil cytoplasmic antibody (ANCA) is typically present in which systemic disease?

Systemic lupus erythematous

A 29-year-old woman complains of fever, diffuse macular erythroderma, vomiting, and myalgias. She is admitted to the hospital. Tow days ago, she had a rhinoplasty with nasal packing. She is not menstruating and she does not use tampons. On physical examination, her blood pressure is 85/40, heart rate is 120 beats/min, and temperature is 102.4 F; she has diffuse macular erythroderma and conjunctival hyperemia. On laboratory examination, her creatinine is 2.1 mg/dL. You would expect to find

Superantigen-mediated massive activation of T cells

A 34-year-old man complains of the appearance of enlarging nodes under his skin in several places during the past few months. They are painless and contender. In a patient with multiple enlarged lymph nodes, which should be biopsied?

Superficial cervical nodes

A 66-year-old white woman with a known history of small cell lung cancer comes to your office because of engorgement of her neck veins on the right side and over her chest wall. She also has cyanosis of the extremities, facial edema, and difficulty with her mentation. Her diagnosis is most likely

Superior vena cava syndrome (SVCS)

An 18-year-old man comes to your office for a diagnostic work-up because of chronic respiratory tract symptoms and signs that include chronic cough, productive of a viscous greenish sputum, and occasionally acute exacerbations characterized by weight loss and an increase in respiratory symptoms. He also has fatty stools. He has never smoked tobacco products of any kind. His chest roentgenogram shows hyperinflation and his complete blood count is normal. Based on his clinical picture, which one laboratory test will confirm the diagnosis?

Sweat chloride value > 70 mEq/L

A 75-year-old man comes to your office for a complete history and physical examination accompanies by his daughter. He takes no medications. Your nurse immediately notices you that his blood pressure is 190/100. He states, "Oh, don't worry about that; I check it at the grocery store and it has been high for 10 years. That's normal for me." Which of the following EKG findings would you expect?

Tall left precordial R waves and deep right precordial S waves consistent with left ventricular hypertrophy

An elderly woman is seen at your office with a complaint of loss of vision in her left eye, which had been transient on a couple of occasions but is now persisting. She has been seen recently at urgent care centers for multiple complaints including generalized fatigue, left-sided dull boring headaches with occasional sharp jabbing sensations, and arthritic complaint in the hips. In addition, she reports some recent loss of 7 to 10 pounds. The only remarkable finding on the routine labs obtained from her prior evalu- ations is an elevated alkaline phosphatase. You determine that the likely cause of her condition is

Temporal neuritis

A 31-year-old man whom you treated for alcoholic intoxication at the emergency room 2 days ago comes to your office because he wants another opinion about his infertility. He has seen other physicians for this condition. Considering his excessive alcoholic intake for the past decade, the likely site of his infertility is

Testicular

A young couple, both in their 20s, have been trying for 2 years to have a baby. The male comes into the office and on work-up has oligospermia, high LH, high FSH, and a normal karyotype. How do you treat him?

Testosterone replacement

Which one of the following cases of anemia is associated with microcytosis?

Thalassemia

A 23-year-old male presents to the emergency department complaining of severe chest pain that is enhanced by inspiration. The pain is somewhat relieved by leaning forward. He reports he had a "cold" about 3 weeks ago, but feels otherwise healthy. You examine the patient and hear a very loud friction rub. Which of the following is true?

The EKG findings include diffuse ST elevation and P-R depression

You are called to the emergency department to examine a patient with cardiogenic shock. Which of the following is true?

The case fatality rate is greater than 70%

The recommendation for poliovirus vaccine in infants and children has changed to inactivated vaccine [Salk inactivated vaccine (IPV)] from live attenuated vaccine [Sabin oral vaccine (OPV)] for which reason?

The chance of vaccine-induced polio illness is unlikely with inactivated vaccine

A 58-year-old patient is referred for preoperative evaluation prior to a scheduled orthopedic procedure and a dobutamine stress echocardiogram is performed. The patient's cardiac function is normal and the dobutamine stress echocardiogram is interpreted as normal with no wall motion abnormalities. Which of the following is true?

This patient corresponds to Curve A on the Frank-Starling curve diagram

A 45-year-old male is seen in your office after discharge from the hospital. He suffered an anterior wall myocardial infarction and is asking you about modifying his risk factors. Which of the following is true?

The goal of LDL-lowering should be to a value less than 100 mg/dL

Which of the following is true regarding right ventricular hypertrophy

The hypertrophy is secondary to an atrial septal defect

You are asked to evaluate a 72-year-old female in the emergency department who presented with syncope. She is now awake, alert, and oriented, and the cardiologist has already evaluated the patient. The echocardiogram shows critical aortic stenosis. Which of the following is true?

The murmur is left-sided, mid systolic, and maximal in the second right intercostal space

A 72-year-old woman comes to your office with chest pain that radiates to her jaw. The pain awakened her at 2 A.M.; the time is now 10 A.M. She has not been pain free since. Her EKG shows ST elevation in the antero-septal leads (V1-V4). Which of the following statements is true?

The myoglobin level will be elevated

A 36-year-old man, homosexual, had experienced an acute infection several months previously, characterized by fever, headache, malaise, and arthralgia. Examination at that time showed only axillary and cervical adenopathy. The chest roentgenogram was clear. Now, his tests for HIV are positive, but he feels well and he does not have AIDS. His physician will start anti-HIV therapy when

The patient experiences any opportunistic infection

Among nosocomial (hospital acquired) infections, which one occurs most commonly and also causes the least sequelae?

Urinary tract

An 8-year-old girl is noted to be having frequent "staring" spells during which she seems oblivious to her surroundings. She seems to suddenly return to awareness without realizing that she has been temporarily "out." The most likely findings on a full evaluation would be

Three per second (3-Hz) spike and wave activity on EEG

A patient with Type 2 diabetes is referred for microalbuminuria and normal serum creatinine. Which of the following measures should you advise to prevent progression to overt nephropathy?

Tight glucose control

A 77-year-old man complains to you of an annoying buzzing sound in his right ear that bothers him mostly at night. His ear examination is normal. This problem is

Tinnitus

A 65-year-old man presents with signs and symptoms of thyrotoxicosis. His radio iodine scan and 24-hour uptake show a patchy pattern but normal amount of radioiodine uptake. This presentation is most consistent with

Toxic multinodular goiter

Which one of the following causes headache, seizures, altered mental status, and a space-occupying lesion in persons infected with HIV?

Toxoplasma gondii

In a typical case of iron deficiency, which of the following molecular forms that contains or can bind to iron increases in the patient's serum?

Transferrin

A 51-year-old man who has had an allogenic bone marrow transplant about 2 months ago complains of anorexia and an erythematous maculopapular rash. On physical examination, he is jaundiced and he has hepatospenomegaly. The cause of his disease is

Transplanted allogenic T cells

During an immune response to pathogens in the intestine, the primary function of M cells along the Peyer's patches is to

Transport antigen to lymphocytes

You confirm acromegaly in a 58-year-old woman, and an MRI of the pituitary shows a microadenoma. The best choice for treatment is

Transsphenoidal surgery

A 34-year-old man complains of fever and tiredness of several weeks' duration. On examination, he has a temperature of 100.6 F. He has a heart murmur, but his spleen is not palpable and Roth's spots, splinter hemorrhages or Osler's nodes are not present. He has needle francs in both arms. He admits to injection drug use and you suspect infective endocarditis most likely involving which valve?

Tricuspid

Growth retardation, hypophosphatemia, and glycosuria may be associated with

Type 2 RTA

A 13-year-old child with blue scleras, mildly short stature, and no deformity, with a history significant for 10 fractured bones, most likely has

Type I osteogenesis imperfecta

An infant with multiple fractures, bony deformity, blue scleras, workman bones in the skull, and beaded ribs died of respiratory difficulties. He most likely had

Type II osteogenesis imperfecta

Which hypersensitivity reaction is associated with Goodpasture's syndrome?

Type II: cytotoxic

Which hypersensitivity reaction is associated with hemolytic disease of the newborn?

Type II: cytotoxic

Which hypersensitivity reaction is associated with poststreptococcal glomerulonephritis?

Type III: immune complex

Which hypersensitivity reaction is associated with serum sickness?

Type III: immune complex

Which hypersensitivity reaction is associated with a tuberculin reaction?

Type IV: cell mediated

Which hypersensitivity reaction is associated with poison ivy?

Type IV: cell mediated

In phenylketonuria, phenylalanine is a competitive inhibitor of which enzyme that, when blocked, contributes to the hypo pigmentation of hair and skin?

Tyrosinase

You suspect a patient may have gallstones as a cause of her chronic nausea and mild RUQ pain. The best imaging study would be

Upper abdominal ultrasound

A patient who has the autosomal dominant gene for type I osteogenesis imperfecta has blue scleras and slightly reduced height, whereas his brother has multiple fractures and deformities. This is an example of

Variable expressivity

A 23-year-old man complains of epistaxis, echymoses of the face and neck, thorax pain, and swelling of the wrist joint of the right hand after a serious fight with another young man. Otherwise, he has felt well except for persistent diarrhea for the past few weeks because of a flare-up of his Crohn's disease. His laboratory examination shows a normal platelet count, normal bleeding time, prolonged prothrombin time (PT), and a normal partial thromboplastin time (PTT). He most likely has which disease?

Vitamin K deficiency

Your patient with type 1 diabetes and several years of bipolar disorder treated with lithium complains of thirst and frequent urination. Serum sodium is 144. Urine osmolarity is low. Which of the following is true?

Water deprivation test should be done.

You are called for a STAT consultation in the intensive care unit because the patient has "EKG changes." The critical care nurse tells you that the patient has developed a new bundle branch block. Which of the following would you expect to see when you evaluate the surface electrocardiogram?

Widened QRS complex

A 26-year-old man comes to your office for an examination because of tremors, spasticity, and drooling. He has headaches and fatigue. On physical examination, he is very slightly icteric, the liver is not palpable, and no spider angiomata are present, but he has resting and intention tremors and spasticity. Laboratory tests show elevated AST and ALT and a ceruloplasmin level of 70 mg/L. The diagnosis is

Wilson's disease

Which of these liver diseases results from a copper disorder?

Wilson's disease

Which protein synthesized by the liver is commonly and significantly elevated in hepatocellular carcinoma?

α-Fetoprotein

Which one of the following is the first-line therapy in the management of acute asthma attack?

β2-agonists

A normal frontal plan QRS axis is

−30° to +90°