Pathophysiology Review

100. In the aforementioned patient, the most effective initial treatment is a. Intravenous Decadron (dexamethasone) b. Orthopedic consultation c. Physical therapy techniques d. Intravenous narcotics

A

118. The principal complication of which condition is susceptibility to infection? a. Chronic lymphocytic leukemia (B cell type) b. Chronic myelocytic leukemia c. Lymphoblastic leukemia d. Hodgkin's disease e. Non-Hodgkin's disease

A

120. Which mechanism is responsible for thrombocytopenia in vitamin B12 deficiency? a. Decreased production b. Maldistribution c. Accelerated destruction d. Decreased survival e. Inherited

A

128. Which is a vitamin K-dependent factor, activated in the presence of thrombin to cleave activated factors V and VIII. a. Protein C b. Protein S c. Antithrombin III (ATIII) d. Plasminogen e. Prekallikrein

A

134. Which one of the following types of bites is more likely to become infected? a. Human b. Dog c. Cat d. Rat

A

136. Gram-negative and gram-positive bacteria each possess which one of the following structures? a. Peptidoglycan b. Lipopolysaccharide c. Matrix protein d. Pili e. Flagella

A

137. Which organism is not a likely cause of left-sided infective endo- carditis? a. Clostridium spp. b. S. aureus c. Streptococcus viridans d. Enterococcus e. Streptococcus bovis

A

141. Which one of the following microorganisms is not a likely cause of pneumonia among persons with human immunodeficiency virus (HIV) infection and AIDS? a. Mycoplasma pneumoniae b. Streptococcus pneumoniae c. Pneumocystis carinii d. Hemophilus influenzae e. Mycobacterium tuberculosis

A

155. Which one of the following causes esophagitis, with substernal pain and dysphagia, in HIV-infected persons? a. Candida albicans b. Cytomegalovirus c. Cryptococcus neoformans d. Herpesvirus varicellae e. Cryptosporidium

A

159. Which one of the following causes localized skin lesion or dissemi- nated visceral lesion characterized by mixed cell population that includes vascular endothelial cells in persons infected with HIV? a. Kaposi's sarcoma b. Pneumocystis carinii c. Mycobacterium tuberculosis d. Mycobacterium avium complex e. Toxoplasma gondii

A

16. Which one of the following complement components binds to antibody to activate the classical pathway? a. C1 b. Factor B c. C3b d. C5a e. C5b6789

A

163. Pneumococcal vaccine is a. Comprised of purified capsular polysaccharides from 23 serotypes b. Precipitated with alum to improve its antigenicity c. Inactivated with formaldehyde d. Prepared by recombinant techniques e. Revised annually based on the predominant serotypes in the U.S.

A

17. A patient with a predisposition for disseminated infections by Neisseria bacteria may have a deficiency in a. Membrane attack complex formation (C5 to C9) b. Classical pathway activation c. C3 d. C1 inhibitor e. C4

A

176. Cardiac output, the volume of blood ejected from the ventricles in 1 minute, is equal to which of the following? a. The product of heart rate and stroke volume b. The product of contractility and preload c. The difference between preload and afterload d. The product of heart rate and preload e. The difference between contractility and afterload

A

179. Curve C corresponds to which of the following? a. A patient in congestive heart failure due to systolic dysfunction b. A normal person whose stroke volume increases as preload increases c. A patient with normal left ventricular function who is receiving intravenous dobutamine as part of a diagnostic study for ischemia d. A patient in congestive heart failure due to diastolic function e. A patient in congestive heart failure treated with a positive inotrope

A

180. Which of the following represent the mitral valve opening? a. Point A b. Line A-B c. Point B d. Line B-C e. Point C

A

184. Which of the following would represent left or right atrial enlarge- ment on a surface electrocardiogram? a. Wide or tall P wave b. Wide or tall T wave c. A prominent U wave d. An elevated J point e. A large QRS voltage

A

190. Influx of sodium ions a. Phase 0 b. Phase 1 c. Phase 2 d. Phase 3 e. Phase 4

A

201. Which of the following heart sounds is low pitched and produced in the ventricle at the termination of rapid filling, heard in normal children and in patients with increased cardiac output? a. S3 b. Opening snap c. S1 d. S2 e. S4

A

21. Toxic shock syndrome toxin-1 is produced by some strains of S. aureus and is thought to be responsible for the clinical manifestations of disease by this organism. This toxin is referred to as a superantigen because it can a. Activate T cells in an antigen-nonspecific manner b. Activate B cells without T cell help c. Become immunogenic when attached to a carrier protein d. Prolong the presence of antigen in a tissue e. Evoke IgE

A

212. Which of the following produces a diastolic murmur? a. Aortic regurgitation b. Aortic stenosis c. Mitral regurgitation d. Supravalvular aortic stenosis e. Tricuspid regurgitation

A

222. Obstructive airway defect is characterized on pulmonary function testing by which one of the following? a. Reduced FEV1/FVC ratio b. Decreased total lung capacity (TLC) c. Reduced residual volume (RV) d. Decreased residual volume /total lung capacity (RV/ TLC) e. Decrease in diffusing capacity (DLCO)

A

224. Which one of the following pathogens is a main cause of bronchiec- tasis? a. Influenza virus b. Rhinovirus c. Mycoplasma pneumoniae d. Enterovirus e. Necrotizing fungal infections

A

265. Growth retardation, hypophosphatemia, and glycosuria may be asso- ciated with a. Type 1 RTA b. Type 2 RTA c. Type 4 RTA d. Diabetic nephropathy

B

227. Which one disease is the single most common indication for single lung transplantation? a. Chronic obstructive pulmonary disease (COPD) either smoking induced or secondary to α-1-antitrypsin deficiency b. Cystic fibrosis c. Lung cancer d. Idiopathic pulmonary fibrosis (IPF) e. Primary pulmonary hypertension (PPH)

A

23. Direct killing of cells infected with virus is usually accomplished by a. CD8-positive T cells b. CD4-positive T helper 1 cells c. CD4-positive T helper 2 cells d. plasma cells e. CD19-positive B cells

A

232. In patients with COPD, long-term oxygen supplementation is pre- scribed if PaO2 is a. 55 mmHg or below b. 65 mmHg c. 70 mmHg d. 75 mmHg e. 80 mmHg or higher

A

237. Which is a common finding in acute glomerulonephritis? a. Pulmonary congestion due to volume expansion b. Hypovolemia due to tubular dysfunction c. Uniformly progresses to chronic renal failure if untreated d. Urine showing leukocytes and eosinophils

A

248. Which of the following serologic finding is associated with linear staining of the glomerulus on immunofluorescence? a. Anti-GBM antibody b. Low complement immune complex glomerulonephritis c. ANCA associated renal disease d. Membranoproliferative glomerulonephritis

A

250. Postinfectious glomerulonephritis is characterized by which of the following? a. Most cases in an epidemic are subclinical b. Hematuria typically develops within a week of infection c. More common with pharyngeal than cutaneous strep infection d. Focal proliferative glomerulonephritis seen on renal biopsy e. Children are often left with residual renal impairment

A

255. Elevated anion gap and osmolar gap in a patient with renal failure suggests a. ethylene glycol ingestion b. isopropanol ingestion c. mannitol infusion d. radiocontrast administration

A

26. During an immune response to pathogens in the intestine, the primary function of M cells along the Peyer's patches is to a. Transport antigen to lymphocytes b. Produce antigen-specific IgA antibody c. Present antigen to lymphocytes d. Secrete cytokines to "help" in antibody production e. Secrete chemokines

A

264. A 25-year-old man with flank pain is found to have three cysts in each kidney, normal hepatic and renal function, and family history is not clear. He is most likely to have a. Autosomal dominant polycystic kidney disease b. Autosomal recessive polycystic kidney disease c. Acquired cystic disease d. Medullary sponge kidney

A

271. Cirrhosis is a cause of a. Hypervolemic hyponatremia b. Isovolemic hyponatremia c. Hypovolemic hyponatremia d. Pseudohyponatremia

A

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

A

277. Hyperkalemia may be caused by a. Trimethoprim b. Albuterol c. Licorice d. Cisplatin

A

284. 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 a. Biopsy the area of the ulcer b. Cauterize the ulcer c. Do nothing further d. Consult a surgeon to do a partial gastrectomy e. Repeat the upper GI endoscopy in 6 months

A

287. 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 a. Biopsy the ulcerated area b. Cauterize the ulcer c. Do nothing further d. Consult a surgeon to do an esophagectomy e. Observe the patient and repeat the upper GI endoscopy in 6 months

A

289. Hepatitis C virus is most commonly transmitted by a. Parenteral routes including intravenous drug abuse and promiscuous sex b. Fecal-oral route c. Ingestion of contaminated food or water d. Living in the same household as an infected person e. Inhalation of infected airborne particles

A

29. Which one of the following tests is used for the assessment of the level of CD4+ T lymphocytes in an HIV-infected patient? a. Flow cytometry (FACS) b. Enzyme-linked immunosorbent assay (ELISA) c. Latex agglutination d. Coombs' test e. Mixed lymphocyte reaction

A

293. Chronic pancreatitis may be reliably diagnosed in a patient present- ing with a. Calcification in the pancreas detected on a flat plate x-ray of the abdomen b. Abdominal pain c. Diarrhea d. Nausea and vomiting e. Jaundice

A

297. 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 a. Achalasia b. Esophageal spasm c. Hypertensive LES d. Hiatal hernia with GERD e. Barrett's esophagus

A

302. Helicobacter pylori is associated with a. Nearly all duodenal ulcers and most gastric ulcers b. Few peptic ulcers c. Most esophageal ulcers, but not many gastric ulcers d. Nearly all gastric ulcers, but very few duodenal ulcers e. Most cases of erosive gastritis

A

305. Which one of these ulcers has the lowest incidence of malignancy? a. Duodenal b. Esophageal c. Gastric d. Colon e. Gastroesophageal junction

A

306. Osmolality of bowel contents under normal circumstances is a. Isotonic in the jejunum, ileum, and colon and variable in the duodenum b. Variable throughout the small and large intestines c. Isotonic in the colon and hypertonic in the small intestine d. Hypertonic throughout the small and large intestines e. Variable in the jejunum, ileum, and colon and isotonic in the duodenum

A

312. In which disorder is malabsorption due to diminished or absent digestive enzymes? a. Chronic pancreatitis b. Crohn's disease c. Gastric surgery d. Small bowel ischemia e. Sigmoid resection

A

315. You suspect a patient may have gallstones as a cause of her chronic nausea and mild RUQ pain. The best imaging study would be a. Upper abdominal ultrasound b. Abdominal CT scan c. Abdominal MRI d. Barium swallow e. KUB (flat-plate x-ray of the abdomen)

A

321. Which of the following laboratory patterns is most consistent with the diagnosis of hemochromatosis? a. Increased iron, increased TIBC (total iron-binding capacity), and increased fer- ritin b. Low iron, low TIBC, and low ferritin c. Low iron, low TIBC, and increased ferritin d. Low iron, increased TIBC, and decreased ferritin e. Increased iron, normal TIBC, and low ferritin

A

323. 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? a. Hepatoma and cirrhosis b. Hepatic adenoma c. Sclerosing cholangitis d. Hemochromatosis e. Lymphoma or leukemia

A

325. Protective vaccines are available for which of the following hepatitis viruses? a. AandB b. AandD c. AandC d. BandC e. CandD

A

327. Serum alkaline phosphatase may be elevated in the diseases of which organ? a. Liver b. Salivary glands c. Spleen d. Heart e. Bladder

A

341. Which of these liver diseases results from an iron disorder? a. Hemochromatosis b. Gaucher's disease c. Biliary cirrhosis d. Wilson's disease e. Type III glycogen storage disease

A

342. Which feature characterizes acetaminophen-induced liver damage? a. Fatal fulminant disease usually is associated with ingestion of 25 g or more of acetaminophen b. Blood levels of acetaminophen fail to correlate with severity of hepatic injury c. Glutathione levels in the liver are increased d. Aminotransferase levels are normal e. N-Acetylcysteine increases renal excretion of acetaminophen

A

343. Which feature is characteristic of chronic hepatitis due to HBV? a. It is more likely to occur if infection occurs in adults. b. Seroconversion from HBeAg positive to HBeAg negative after 4 months of inter- feron-α therapy is 40% c. Long-term therapy with steroids is also effective d. The likelihood of responding to interferon is greater in patients with high lev- els of HBV DNA

A

36. Which hypersensitivity reaction is associated with an anaphylactic reaction after a bee sting? a. Type I: immediate b. Type II: cytotoxic c. Type III: immune complex d. Type IV: cell mediated

A

364. Which hepatitis virus is transmitted almost exclusively by the fecal- oral route? a. HAV b. HBV c. HCV d. HDV e. HGV

A

365. Primary biliary cirrhosis (PBC) typically a. Is characterized by a circulating IgG antimitochondrial antibody present in more than 90% of patients b. Occurs predominantly (90%) in men between the ages of 50 and 70 years with symptomatic disease c. Can be effectively treated with glucocorticoids d. Occurs rarely with pruritus e. Have normal serum lipids

A

366. Hepatocellular adenomas a. Have multiple hepatocellular adenomas associated with glycogen storage dis- ease type I b. Are mostly malignant c. Do not have hormones playing a role in their pathogenesis d. Occur predominantly in the left lobe of the liver e. Occur predominantly in men

A

369. Pretibial myxedema is associated with a. Graves' disease b. Jod-Basedow phenomenon c. Choriocarcinoma d. Struma ovarii e. Toxic multinodular goiter

A

370. Infiltration of orbital soft tissue and extraocular muscles with lym- phocytes, mucopolysaccharides, and fluid is seen with a. Graves' disease b. Jod-Basedow phenomenon c. Choriocarcinoma d. Struma ovarii e. Toxic multinodular goiter

A

373. The most common cause of goiter in developing nations is a. Iodine deficiency b. Lithium c. Hashimoto's thyroiditis d. Propylthiouracil e. Toxic multinodular goiter

A

374. Endemic goiter results from a. Iodine deficiency b. Lithium c. Hashimoto's thyroiditis d. Propylthiouracil e. Toxic multinodular goiter

A

379. A low TSH, high T4, and high T3 suggests a. Hyperthyroidism b. Nonthyroidal illness (sick euthyroidism) c. Estrogen therapy d. Subclinical hypothyroidism e. Familial (euthyroid) dysalbuminenic hyperthyroxinemia

A

381. A patient with a low TSH and high T3 most likely has a. Hyperthyroidism b. Nonthyroidal illness (sick euthyroidism) c. Estrogen therapy d. Subclinical hypothyroidism e. Familial (euthyroid) dysalbuminenic hyperthyroxinemia

A

384. A patient with chronic autoimmune (Hashimoto's) thyroiditis devel- ops a rapidly enlarging thyroid mass. Most likely this is a. Thyroid lymphoma b. Medullary thyroid carcinoma c. Papillary thyroid carcinoma d. Anaplastic thyroid carcinoma e. Follicular thyroid carcinoma

A

389. A 30-year-old woman with thyrotoxicosis has a diffusely enlarged gland on palpation of the neck. Her thyroid scan and 24-h uptake show uniformity of uptake and an increased percentage uptake. This patient has a. Graves' disease b. Subacute thyroiditis c. Toxic multinodular goiter d. Hashimoto's thyroiditis e. Toxic adenoma

A

39. A patient with recurrent infections with yeast and the incapacity to control viral infections may indicate a deficiency in a. Cellular immunity b. Complement c. Granulocytes d. Humoral immunity e. Eosinophils

A

392. You confirm acromegaly in a 58-year-old woman, and a MRI of the pituitary shows a microadenoma. The best choice for treatment is a. Transsphenoidal surgery b. Medical therapy with somatostatin agonist c. Irradiation d. Medical therapy with bromocriptine e. Transfrontal surgery

A

394. A 30-year-old woman presents with a 6-month history of amenor- rhea. Your initial evaluation should include measurement of a. Prolactin b. Estradiol c. Progesterone d. Testosterone e. DHEA-S

A

397. A 28-year-old woman presents with amenorrhea and galactorrhea, after beginning a new medication recently. The most likely medication is a. Haloperidol b. Lisinopril c. Fluoxetine d. Amitriptyline e. Buspirone

A

399. A 26-year-old woman has been amenorrheic for 2.5 months. Your first choice for diagnostic evaluation is a. hCG b. LH c. Estradiol d. Prolactin e. Progesterone

A

4. Which immunoglobulin class is a major component of mucosal secre- tions? a. IgA b. IgG c. IgM d. IgE e. IgD

A

400. A 40-year-old man has erectile dysfunction. He is noted to have hyperprolactinemia (prolactin of 400 μg/L). On MRI a macroadenoma with supersellar extension is found. The best course of therapy for the patient is a. Medical therapy with bromocriptine b. Transsphenoidal surgery c. Transfrontal surgery d. Medical therapy with somatostatin agonist e. Thyroxine

A

403. A 16-year-old boy presents without pubertal development or devel- opment of secondary sexual characteristics. He cannot smell (anosmia). The baseline testosterone and the LH response to LHRH most likely are a. Low testosterone and normal LHRH response b. Normal testosterone and normal LHRH response c. High testosterone and normal LHRH response d. Low testosterone and no LHRH response e. Low testosterone and exaggerated LHRH response

A

411. Patients with pituitary macroadenoma present most commonly with a. Bitemporal hemianopsia b. Unilateral optic atrophy c. Left or right homonymous visual field defect d. Unilateral center scotoma e. Left or right superior temporal defect

A

414. Which of the following organs does not require androgens for proper growth in males? a. Brain b. Prostate c. Epididymis d. Vas deferens e. Long bones

A

421. 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? a. Ovary b. Thyroid gland c. Adrenal gland d. Pituitary gland

A

424. Which of these hormones blocks milk production during pregnancy? a. Progesterone b. Prolactin c. Chorionic somatomammotropin d. Thyroxine e. Insulin

A

429. A 19-year-old woman comes to the office complaining of galactorrhea. She has never been pregnant. Which hormone is the most likely to be responsible for this situation? a. Prolactin b. Estrogen c. Progesterone d. Thyroxine e. Cortisol

A

437. 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? a. Decreased detrusor contractility b. Detrusor instability c. Detrusor failure d. Acute urinary obstruction e. Chronic urinary obstruction

A

440. A 28-year-old previously healthy female, with no medical history is now 28 weeks pregnant. She complains of trouble seeing, polyuria, poly- phagia, and polydipsia. What is her diagnosis? a. Gestational diabetes mellitus b. Deep venous thrombosis c. Urinary tract infection d. Preeclampsia

A

446. In which ovarian compartment is Müllerian-inhibiting substance produced? a. Granulosa b. Theca c. Follicular fluid d. Follicles e. Corpus luteum

A

447. In which ovarian compartment is plasminogen activator produced? a. Granulosa b. Theca c. Follicular fluid d. Follicles e. Corpus luteum

A

45. Which cytokine functions as an activator of macrophages and natural killer (NK) cells? a. IFN-γ (interferon γ) b. IL-2 (interleukin 2) c. IL-4 (interleukin 4) d. TNF-α (tumor necrosis factor α) e. TGF-β (transforming growth factor β)

A

451. 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 a. Pretesticular b. Testicular c. Posttesticular d. Idiopathic

A

454. 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 a. Pretesticular b. Testicular c. Posttesticular d. Idiopathic

A

465. A 64-year-old man complains of a resting tremor that lessens with intentional movement and that causes him substantial embarrassment. What is the likely cause? a. Parkinson's disease b. Essential tremor c. Asterixis d. Hyperthyroidism e. Drug-related tremor

A

476. Excitatory neurotransmitters such as acetylcholine and glutamate perform which of the following functions? a. Open cation channels and allow influx of Na+ or Ca++. b. Generate inhibitory postsynaptic potentials c. Activate mitochondria d. Regulate intracellular K+ e. Carry impulses between peripheral nerves only

A

481. A moderately obese factory worker who stands for long periods of time begins to experience pain and a severe burning sensation that is local- ized over the left anterior lateral thigh. This patient has a a. Mononeuropathy b. Brown-Séquard's syndrome c. Polyneuropathy d. Mononeuropathy multiplex e. Radiculopathy

A

489. 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 ear drum. Her hearing loss is classified as a. Conductive deafness b. Sensorineural deafness c. Central deafness d. Tinnitus e. Presbycusis

A

49. A patient has an X-linked disease. His three sisters do not have the disease. He most likely has a. A mutant recessive gene on the X chromosome b. A mutant dominant gene on the X chromosome c. A mutant recessive gene on the Y chromosome d. A mutant dominant gene on the Y chromosome

A

498. An 8-year-old girl is noted to be having frequent "staring" spells dur- ing 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 finding on a full evaluation would be a. Three per second (3-Hz) spike and wave activity on EEG b. Abnormal reflexes in her lower extremities c. An abnormal CT scan showing an occipital mass d. An abnormal MRI showing demyelination e. An abnormal mental status examination showing disorientation to time

A

53. Mutations that cause a gain in function of the mutated allele are a. Hypermorphic b. Neomorphic c. Amorphic d. Hypomorphic

A

56. 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. A new mutation b. Hypermorphism c. A dominant negative mutation d. Antimorphism

A

59. 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 a. Type I osteogenesis imperfecta b. Type II osteogenesis imperfecta c. Type III osteogenesis imperfecta d. Type IV osteogenesis imperfecta

A

63. 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 a. Genetic mosaicism b. Genetic anticipation c. Fitness d. Dosage compensation

A

65. A premutation allele a. If transmitted by a female expands to a full mutation with a likelihood proportionate to the size of the repeat segment b. If transmitted by a male usually expands to a full mutation regardless of the length of the repeat sequence c. Causes a change in phenotype d. Is present in the "carrier" males

A

70. Most children with Down's syndrome are a. Born to women under 35 b. Born to women over 35 c. Tall d. Underweight

A

73. The dietary treatment of phenylketonuria must be initiated when? a. Before the child is 3 weeks of age b. Thechildis4to6weeksofage c. The child is 7 to 10 weeks of age d. Between 3 and 6 months of age

A

75. Which treatment regimen is appropriate for phenylketonuria? a. Infants are fed a semisynthetic formula low in phenylalanine b. Breast feeding is prohibited c. Infants are fed a diet totally devoid of phenylalanine d. It can be discontinued at age 18

A

8. Compared with a healthy individual, lymph nodes from a person with a deficiency in B lymphocytes would have a. Few or no primary follicles b. Enlarged germinal centers c. Few Howell-Jolly bodies d. No paracortex e. Increased number of Heinz bodies

A

81. A mutation in which the base replacement changes the codon for one amino acid to another is called a a. Missense mutation b. Nonsense mutation c. Silent mutation d. Frameshift mutation

A

84. Sickle cell anemia a. Is due to a single base change in the gene that codes for the β chain of hemoglobin b. Is an example of aneuploidy c. Involves substitution of glutamic acid for valine in the sixth amino acid position d. Is inherited as an X-linked recessive disorder

A

9. A newborn infected with group B streptococcus would produce and secrete antibody of which of the following class(es)? a. IgM only b. IgG only c. IgM and IgG d. Neither IgM nor IgG e. IgA only

A

97. 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 a. Hypercalcemia b. Hypocalcemia c. Hypophosphatemia d. Hyperkalemia

A

211. Which ECG leads represent the inferior cardiac wall? a. V1, V2 b. V3, V4 c. aVR d. I, aVL e. II, III, aVF

E

215. Cardiac output is the product of a. Preload × stroke volume b. Afterload × heart rate c. Heart rate × stroke volume d. Contractility × preload e. Preload × heart rate

C

218. Transudative pleural effusion is caused by which one of the following diseases? a. Bacterial pneumonia b. Malignancy c. Cirrhosis d. Sarcoidosis e. Viral infection

C

140. Which one of the following microorganisms is the most common cause of community acquired pneumonia? a. Mycoplasma pneumoniae b. Streptococcus pneumoniae c. Staphylococcus aureus d. Hemophilus influenzae e. Legionella spp.

B

143. Which microorganism is likely to cause pneumonia in a person with late stages of HIV and AIDS? a. Legionella spp. b. Pneumocystis carinii c. Chlamydia psittaci d. Klebsiella pneumoniae e. Moraxella catarrhalis

B

268. A patient with Crohn's disease passes a kidney stone; the most likely composition is a. Calcium phosphate b. Uric acid c. Struvite d. Calcium oxalate

D

275. A patient with cardiomyopathy on chronic diuretics suffers acute res- piratory arrest from aspiration has which of the following patterns?

D

154. Which one of the following causes a lung infection, the most com- mon opportunistic infection, in HIV-infected persons? a. Kaposi's sarcoma b. Pneumocystis carinii c. Mycobacterium tuberculosis d. Mycobacterium avium complex (MAC) e. Toxoplasma gondii

B

1. The major immunoglobulin class in normal adult human serum is a. IgA b. IgG c. IgM d. IgE e. IgD

B

108. Which of the following causes a leukocytosis without an increase in the number of circulating polymorphonuclear neutrophil leukocytes? a. Acute infection b. Release of epinephrine c. Tissue necrosis d. Myelocytic leukemia e. Collagen vascular disease

B

11. To determine whether a fetus acquired an infection in utero, antigen- specific antibody to which of the following classes should be measured? a. IgA b. IgM c. IgG d. IgD e. IgE

B

114. Which of the following statements concerning the relationship of the neutrophil polymorphonuclear leukocyte (PMN) to infection with bacter- ial pathogens is incorrect? a. The principal functions of the PMN are expressed in the tissues and not usually in the bloodstream, which is simply the transport path of the cells to their required site of action. b. The cytoplasmic granules of PMN are essentially inert, but metabolically have only a vegetative role in maintaining cell viability. c. When the cell numbers of PMN are reduced significantly, the probability of severe bacterial infection can be greatly increased. d. The average duration of the period of circulation of PMN after entering the bloodstream is about 6 to 8 h. e. An increasing need for PMN produced by infection is met in part by large num- bers of immature cells (especially band cells) being released from the marrow pool into the bloodstream.

B

115. Which pathologic cells in a stained blood film have appearances very similar to those of normal mature white cells or their precursors? a. Chronic lymphocytic leukemia (B cell type) b. Chronic myelocytic leukemia c. Lymphoblastic leukemia d. Hodgkin's disease e. Non-Hodgkin's disease

B

116. On karyotyping, a well-defined chromosomal abnormality is patho- gnomonic of which condition? a. Chronic lymphocytic leukemia (B cell type) b. Chronic myelocytic leukemia c. Lymphoblastic leukemia d. Hodgkin's disease e. Non-Hodgkin's disease

B

117. Which condition customarily terminates by transition to a blast cell phase with similarities to acute leukemia? a. Chronic lymphocytic leukemia (B cell type) b. Chronic myelocytic leukemia c. Lymphoblastic leukemia d. Hodgkin's disease e. Non-Hodgkin's disease

B

123. Which mechanism is responsible for thrombocytopenia in any increase in spleen size? a. Decreased production b. Maldistribution c. Accelerated destruction d. Decreased survival e. Inherited

B

131. Bacteria can infect the skin through accidental or deliberate breaks in it or through the hair follicle. Which one bacteria causes one of several dif- fering infections of the skin including necrotizing fasciitis, erysipelas, impetigo contagiosa, and necrotizing myositis? a. Clostridium spp. b. S. pyogenes c. S. aureus d. Anaerobic bacteria e. Pseudomonas aeruginosa

B

135. Among nosocomial (hospital acquired) infections, which one occurs most commonly and also causes the least sequelae? a. Pneumonia b. Urinary tract c. Surgical wound d. Bacteremia

B

138. The subarachnoid space inflammation of bacterial meningitis, which is caused by a gram-negative bacteria, is induced by which one component of the bacteria? a. Matrix protein b. Lipopolysaccharide (LPS) c. Pili d. Inner membrane e. Peptidoglycan

B

160. Which one of the following causes retinitis, with patient complaints of blind spots, and retinal hemorrhages and exudates in persons infected with HIV? a. Candida albicans b. Cytomegalovirus c. Cryptococcus neoformans d. Herpesvirus varicellae e. Cryptosporidium

B

170. The complications of severe infections of falciparum malaria can include anemia that is due predominantly to a. Significant bleeding with disseminated intravascular coagulation b. Accelerated erythrocyte destruction and removal by the spleen c. Inadequate iron storage d. Increased Kuppfer cells in the liver e. Lactic acidosis

B

177. Curve A corresponds to which of the following? a. A patient in congestive heart failure b. A patient with normal left ventricular function who is receiving intravenous dobutamine as part of a diagnostic study for ischemia c. A patient in congestive heart failure due to diastolic dysfunction d. A normal person whose stroke volume increases as preload increases e. A patient with congestive heart failure treated with a positive inotrope

B

181. Which of the following represent the mitral valve closing? a. Line A-B b. Point B c. Point C d. Line B-C e. Point D

B

187. Which of the following would widen if a bundle branch block were present? a. P wave b. QRS complex c. T wave d. J point e. U wave

B

191. May involve chloride ion movement a. Phase 0 b. Phase 1 c. Phase 2 d. Phase 3 e. Phase 4

B

196. Which of the following arteriole pulse waveforms is consistent with aortic stenosis? a. Pulsus alternans b. Pulsus tardus c. Bisferiens pulse d. Dicrotic pulse e. Parvus et tardus pulse

B

203. Which of the following heart sounds is high pitched, early diastolic sound, usually due to mitral stenosis? a. S1 b. Opening snap c. Midsystolic click d. S3 e. S4

B

206. The isoelectric ST segment on surface ECG corresponds to which action potential phase? a. Phase I b. Phase II c. Phase III d. Phase IV e. Phase 0

B

209. Which of the following AV blocks is characterized by progressive PR interval prolongation prior to loss of AV conduction? a. First-degree AV block b. Second-degree AV block type I c. Second-degree AV block type II d. Third-degree AV block

B

217. Which one of the following hemodynamic findings is the main derangement of primary pulmonary hypertension? a. Increased cardiac output early b. Increased resistance to pulmonary blood flow c. Decreased resistance to pulmonary blood flow d. Decreased pulmonary capillary wedge pressure early e. Normal diastolic filling of the left ventricle

B

22. Neutralizing antiviral antibody produced in response to infection by an enveloped virus acts on which one of the following components of the virus? a. Matrix proteins b. One or more surface glycoproteins c. Internal protein components d. Nucleic acid e. Internal nonprotein components

B

223. Which one of the following is the first-line therapy in the manage- ment of an acute asthma attack? a. Steroids b. β2-agonists c. Theophylline d. Antibiotics e. Magnesium sulfate

B

226. ARDS is differentiated from acute lung injury (ALI) on the basis of which one of the following? a. Presence of bilateral interstitial infiltrates on chest x-ray b. Severity of hypoxemia with PaO2/FiO2 ratio of less than 200 mmHg c. Increased pulmonary capillary wedge pressure d. Reduced compliance e. Systemic inflammatory response

B

230. Which one of the following eosinophilic pulmonary syndromes may present without any peripheral eosinophilia? a. Loeffler's syndrome b. Acute eosinophilic pneumonia c. Chronic eosinophilic pneumonia d. Allergic granulomatosis of Churg-Strauss e. Hypereosinophilic syndrome

B

239. Nephrotic syndrome is associated with a. Excessive renal salt and water loss b. Hyperlipidemia due to lipoprotein excess c. Bleeding due to loss of clotting factors d. Hypothyroidism due to loss of thyroid-binding globulin

B

245. Which one of the following statements is true concerning hemato- logic disorders in CRF? a. Resistance to erythropoietin is most commonly due to aluminum overload b. Erythropoietin administration is associated with worsening hypertension c. The major cause of death in CRF is sepsis d. Abnormal bleeding responds best to platelet transfusion e. Leukocyte function is generally unimpaired

B

249. Antineutrophil cytoplasmic antibody (ANCA) is typically present in which systemic disease? a. Goodpasture's syndrome b. Wegener's granulomatosis c. Systemic lupus erythematosus d. Thrombotic thrombocytopenic purpura

B

253. The pathologic findings of predominant small artery involvement with intimal proliferation and sometimes with thrombosis, also termed "thrombotic microangiopathy," is found in which renal disease? a. Membranoproliferative glomerulonephritis b. Hemolytic uremic syndrome c. Microscopic polyarteritis d. Analgesic nephropathy

B

254. Leukocytes and white cell casts in the urine are typically seen in a. Radiocontrast nephropathy b. Methicillin-induced renal insufficiency c. Aminoglycoside nephrotoxicity d. Rhabdomyolysis

B

257. Hyponatremia with a low urine sodium is associated with a. SIADH b. congestive heart failure c. recent thiazide use d. hypothyroidism

B

258. Which disease presents with predominantly tubulointerstitial in- volvement? a. Systemic lupus erythematosus b. Sjögren's syndrome c. Rheumatoid arthritis d. Essential mixed cryoglobulinemia

B

260. Which of the following patients would be better served by undergo- ing continuous ambulatory peritoneal dialysis rather than intermittent hemodialysis as treatment of chronic renal failure? a. Patient with poor vision due to diabetic retinopathy b. Patient with cardiomyopathy sensitive to fluid overload c. Patient with severe COPD d. Very obese patient

B

262. Concerning the association between potassium and bicarbonate abnormalities, which of the following is true? a. The regulation of potassium excretion occurs largely in the loop of Henle, and this is why loop diuretics cause hypokalemia b. Metabolic alkalosis is associated with volume depletion caused by diuretics c. Hypokalemia generally results in the increased production of aldosterone d. Volume depletion inhibits reabsorption of bicarbonate in the proximal tubule

B

266. Which is an accurate statement concerning diabetic nephropathy? a. Most patients with type 2 diabetes will develop this problem b. It is almost always associated with retinopathy in type 1 diabetes c. ACE inhibition is only indicated for patients with hypertension d. Routine dipstick urine should be performed to screen for early disease

B

27. Which one of the following tests is used for the determination of the titer of antihepatitis B antibody? a. Flow cytometry (FACS) b. Enzyme-linked immunosorbent assay (ELISA) c. Latex agglutination d. Coombs' test e. Mixed lymphocyte reaction

B

270. Which of the following would be a characteristic finding in obstruc- tive nephropathy due to benign prostatic hypertrophy? a. Hyperkalemia b. Polyuria and nocturia c. Hematuria d. Suprapubic discomfort

B

272. Which of the following statements characterizes minimal change dis- ease? a. It is associated with renal insufficiency despite treatment b. It is associated with selective proteinuria c. It is the most common cause of nephrotic syndrome in adults d. It is diagnosed on light microscopy after kidney biopsy

B

273. Which of the following findings would favor essential hypertension over secondary hypertension? a. Presence of hypokalemia and alkalosis b. Presence of hyperinsulinemia and obesity c. Presence of grade III fundoscopic findings d. Presence of aortic aneurysm

B

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

B

280. 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? a. Anti-GBM antibody b. Low serum complement levels c. Antineutrophil cytoplasmic antibody d. Elevated IgA levels

B

286. A 70-year-old woman is evaluated with colonoscopy for anemia and intermittently hemoccult-positive stools. A diagnosis of multiple ar- teriovenous malformations (AVMs) is made by which diagnostic proce- dure? a. Biopsy b. Visual inspection c. Arteriography d. Venography e. Lymphangiography

B

295. 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? a. Laparoscopic cholecystectomy b. Endoscopic retrograde cholangiopancreatography (ERCP) c. Modified barium swallow d. Laparoscopic abdominal exploration e. Upper GI endoscopy

B

298. 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 a. Esophageal web b. Esophageal spasm c. Achalasia d. GERD (gastroesophageal reflux disease) e. T-E (tracheoesophageal) fistula

B

309. 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 follow- ing dietary recommendations would you make? a. Avoid high-protein meals because they would increase lower esophageal sphincter (LES) pressure b. Avoid fats, chocolates, and alcohol because they would decrease LES pressure c. Eat high-carbohydrate food to increase overall GI motility d. Eat high-protein meals to decrease LES pressure e. Avoid concentrated carbohydrates to decrease dopamine secretion

B

316. 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 a. Ultrasound b. Abdominal CT scan c. Abdominal MRI d. Barium swallow e. KUB (flat-plate x-ray of the abdomen)

B

32. Which hypersensitivity reaction is associated with Goodpasture's syn- drome? a. Type I: immediate b. Type II: cytotoxic c. Type III: immune complex d. Type IV: cell mediated

B

324. Fatigue, anorexia, orange/brown-colored urine, and an ALT level greater than 10 times normal are clinical features of a. Hepatitis A b. Any viral hepatitis c. Hepatoma d. Hepatitis B and hepatitis C e. Hepatitis B, but not hepatitis C

B

330. Which one of the following enzymes is found primarily in the liver? a. AST b. ALT c. Alkaline phosphatase d. 5′-Nucleotidase e. γ-Glutamyl transpeptidase (GGT)

B

333. Which one of the hepatitis viruses is a DNA virus? a. HAV b. HBV c. HCV d. HEV e. HGV

B

337. The most common cause of fulminant hepatitis is hepatitis a. A b. B c. C d. E e. G

B

338. Mallory bodies found on biopsy of the liver are highly suggestive of which disease? a. Alcoholic fatty liver b. Alcoholic hepatitis c. Alcoholic cirrhosis d. Viral hepatitis e. Primary biliary cirrhosis

B

347. 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 a. Acute hepatitis A b. Acute hepatitis B c. Acute hepatitis A and B d. Chronic hepatitis B e. Acute hepatitis C

B

355. In the treatment of persons with hepatic encephalopathy, which one of the following acts decreases ammonia absorption? a. Sucrose b. Lactulose c. Protein d. Glucose e. Galactose

B

359. Chronic infection with which virus is a risk factor for the develop- ment of hepatocellular carcinoma? a. HAV b. HBV c. HDV d. HEV e. HGV

B

361. Which protein synthesized by the liver is commonly and signifi- cantly elevated in hepatocellular carcinoma? a. Albumin b. α-Fetoprotein c. Thyroxine-binding globulin d. Protein C e. C-reactive protein

B

28. Which one of the following tests is used for the detection of anti-Rh antibody in blood? a. Flow cytometry (FACS) b. Enzyme-linked immunosorbent assay (ELISA) c. Latex agglutination d. Coombs' test e. Mixed lymphocyte reaction

D

367. 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 a. Graves' disease b. Jod-Basedow phenomenon c. Choriocarcinoma d. Struma ovarii e. Toxic multinodular goiter

B

37. Which hypersensitivity reaction is associated with hemolytic disease of the newborn? a. Type I: immediate b. Type II: cytotoxic c. Type III: immune complex d. Type IV: cell mediated

B

378. The pattern of normal TSH, normal T4, and low T3 is most consistent with a. Hyperthyroidism b. Nonthyroidal illness (sick euthyroidism) c. Estrogen therapy d. Subclinical hypothyroidism e. Familial (euthyroid) dysalbuminenic hyperthyroxinemia

B

386. Elevated plasma calcitonin is seen with a. Thyroid lymphoma b. Medullary thyroid carcinoma c. Papillary thyroid carcinoma d. Anaplastic thyroid carcinoma e. Follicular thyroid carcinoma

B

387. A 40-year-old patient with a recent viral infection presents with a sig- nificantly tender gland, low radioiodine uptake, and signs and symptoms of thyrotoxicosis. This presentation is most likely a. Graves' disease b. Subacute thyroiditis c. Toxic multinodular goiter d. Hashimoto's thyroiditis e. Toxic adenoma

B

390. A 45-year-old man presents for frontal bossing and enlarged nose, tongue, and jaw. He has doughy palms and spadelike fingers. The best screening test to establish the diagnosis is a. Random growth hormone b. Insulin-like growth factor type 1 (IGF-1) c. TSH d. Prolactin e. Fasting blood sugar

B

398. A 25-year-old woman presents with amenorrhea and galactorrhea. Thyroid function tests are normal. The prolactin level is 350 μg/L (normal is less than 20). The most likely cause for her hyperprolactinemia is a. Microadenoma b. Macroadenoma c. Antidepressant use d. Exercise induced e. Antihypertensive therapy

B

40. Graft versus host disease can be a complication of which of the following kinds of transplantation? a. Kidney b. Bone marrow c. Liver d. Skin e. Cornea

B

401. A 35-year-old man has a 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? a. Fasting blood sugar b. Serum calcium c. Serum calcitonin d. Urinary metanephrine e. Serum ferritin

B

404. A 58-year-old woman presents as an outpatient with lethargy, fatigue, and cold intolerance. Thyroid function testing 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 a. Thyroid scan and uptake b. MRI of the pituitary c. Prolactin d. Thyroid autoantibodies e. T3

B

405. A 59-year-old man presents with heat intolerance and tremor. Thy- roid function testing reveals a free T4 of 3.0 (0.7 to 2.0) and TSH of 6.0 (0.5 to 5). The next best diagnostic test is a. Thyroid scan and uptake b. MRI of the pituitary c. Prolactin d. Thyroid autoantibodies e. T3

B

409. A 48-year-old woman with a history of pituitary surgery and irradia- tion is scheduled for elective surgery. She currently requires replacement thyroxine, hydrocortisone, estrogen, and progesterone. In the periopera- tive period you will treat her with a. Glucose infusion b. Increased hydrocortisone c. ACTH infusion d. Increased estrogen e. Increased thyroxine

B

41. Which cytokine promotes the proliferation of T and B lymphocytes? a. IFN-γ (interferon γ) b. IL-2 (interleukin 2) c. IL-4 (interleukin 4) d. TNF-α (tumor necrosis factor α) e. TGF-β (transforming growth factor β)

B

413. Which of the following organs is not a major estrogen-dependent tis- sue in women? a. Brain b. Thyroid c. Hypothalamus d. Pituitary e. Ovaries

B

418. 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 workup has oligosper- mia, high LH, high FSH, and a normal karyotype. How do you treat him? a. Do nothing b. Testosterone injections c. Check the partner for causes of infertility d. Infertility counseling

B

427. Which of these findings is the best for diagnosis of a congenital absence of the vas deferens? a. Oligospermia b. Azoospermia c. Normal testosterone d. Normal LH e. Normal FSH

B

428. Which abnormality of adult testicular function (infertility) occurs with normal virilization? a. Hemochromatosis b. Cryptorchidism c. Isolated gonadotropism deficiency d. Klinefelter's syndrome e. XX male

B

433. 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? a. Gastrointestinal bleeding b. Iron or folate deficiencies c. Autoantibodies d. Vitamin B12 deficiency e. Menstrual blood loss

B

436. 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? a. Oligospermia b. Asthenospermia c. Absence of the vas deferens d. Epididymal obstruction e. Undescended testes

B

444. How do varicoceles cause male infertility? a. Decreasing testicular blood flow b. Increasing testicular temperature c. Reduction of testosterone production d. By causing testicular atrophy

B

448. In which ovarian compartment is transforming growth factor-α produced? a. Granulosa b. Theca c. Follicular fluid d. Follicles e. Corpus luteum

B

452. A 41-year-old man comes to your office with his wife because she has been unable to conceive with him. He is married for the first time. His wife has two children by her previous marriage. The patient is well with no risk factors for heart disease. As a child, he had the usual communica- ble diseases, including chickenpox and mumps, and as an adult he received the recommended schedule of immunizations. The likely site of his infertility is a. Pretesticular b. Testicular c. Posttesticular d. Idiopathic

B

375. The conversion of T4 to T3 is inhibited by a. Iodine deficiency b. Lithium c. Hashimoto's thyroiditis d. Propylthiouracil e. Toxic multinodular goiter

D

453. 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 a. Pretesticular b. Testicular c. Posttesticular d. Idiopathic

B

460. A middle-aged female arrives at your office after not seeing a physi- cian 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 a. Argyll Robertson pupil b. Adie's tonic pupil c. Trauma-induced pupil dysfunction d. Horner's syndrome

B

467. The tremor of which condition lessens with consumption of small amounts of alcohol a. Parkinson's disease b. Essential tremor c. Asterixis d. Hyperthyroidism e. Drug-related tremor

B

48. Two patients have the same eye color. They have the same a. HLA type b. Phenotype c. Haplotype d. Mutation

B

482. 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 a. Mononeuropathy b. Brown-Séquard's syndrome c. Polyneuropathy d. Mononeuropathy multiplex e. Radiculopathy

B

485. An amenorrheic 35-year-old woman with galactorrhea is found to have a large prolactin-secreting pituitary tumor compressing her optic chi- asm. Which visual disturbance does she have? a. Left central scotoma b. Bitemporal hemianopsia c. Left nasal hemianopsia d. Left homonymous hemianopsia e. Completely blind left eye

B

486. A 2-year-old boy is brought to your office by his parents who believe he may not have normal hearing. You determine that he has congenital damage to the left cochlea. This is classified as a kind of a. Conductive deafness b. Sensorineural deafness c. Central deafness d. Tinnitus e. Presbycusis

B

492. A 70-year-old man is brought to the ER because of sudden onset of right arm weakness and inability to understand speech. This speech prob- lem is called a. Apraxia b. Aphasia c. Abulia d. Anomia e. Alexia

B

497. Abnormalities in the cytosolic copper-zinc superoxide dismutase (SOD1) gene on chromosome 21 have been identified as factors in the pathophysiology of which degenerative disorder? a. Parkinson's disease b. Amyotrophic lateral sclerosis c. Huntington's chorea d. Alzheimer's Disease e. Tuberous sclerosis

B

5. Which immunoglobulin class can cross the placenta? a. IgA b. IgG c. IgM d. IgE e. IgD

B

50. The fact that type IV osteogenesis imperfecta can be caused by defects on COLIA 1 and COLIA 2 is an example of a. Gonadal mosaicism b. Genetic heterogeneity c. Allelic heterogeneity d. Polymorphism

B

57. 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 a. Autosomal recessive inheritance b. X-linked recessive inheritance c. Semidominant inheritance d. Autosomal dominant inheritance

B

60. An infant with multiple fractures, bony deformity, blue scleras, wormian bones in the skull, and beaded ribs died of respiratory difficulties. He most likely had a. Type I osteogenesis imperfecta b. Type II osteogenesis imperfecta c. Type III osteogenesis imperfecta d. Type IV osteogenesis imperfecta

B

67. In the case of a dominant allele a. Two copies of the allele are needed to produce the altered phenotype b. One copy of the allele is sufficient to produce the phenotype c. An offspring with one parent having a dominant allele has a 25% chance of inheriting the dominant allele d. If two parents have a dominant allele, the offspring has a 50% chance of inher- iting the dominant allele

B

68. The human genome is estimated to contain about how many genes? a. 25,000 b. 50,000 to 100,000 c. 200,000 d. 225,000

B

71. In Down's syndrome, life expectancy is characterized as a. 90% survive to age 30 regardless of the presence of congenital heart disease b. 60% survive to age 10 and 50% survive to age 30 if congenital heart disease is present c. It is the same as unaffected individuals if congenital heart disease is absent d. 90% die of Alzheimer's disease by age 20

B

76. The neurologic deficits of phenylketonuria are due to a. Primarily the metabolites of phenylalanine b. A direct effect of phenylalanine on energy production, protein synthesis, and neurotransmitter homeostasis c. Phenylalanine causing an increased transport of neutral amino acids across the blood-brain barrier d. The increased action of phenylalanine hydroxylase

B

77. In phenylketonuria, phenylalanine is a competitive inhibitor of which enzyme that, when blocked, contributes to the hypopigmentation of hair and skin? a. Cystathionase b. Tyrosinase c. 4-Hydroxyphenylpyruvate dioxygenase d. Sarcosine dehydrogenase e. Histidine ammonia lyase

B

78. The different genetic forms of phenylketonuria illustrate two different pathophysiologic mechanisms by which inborn errors of metabolism cause disease. These are a. End-product overproduction and substrate accumulation b. End-product deficiency and substrate accumulation c. End-product overproduction and substrate deficiency d. End-product deficiency and substrate deficiency

B

79. Regarding the centimorgan a. The human genome is composed of approximately 6000 centimorgans in recombination distance b. It is a measure of genetic distance that reflects the probability of a crossover between two loci during meiosis c. One centimorgan approximates a 5% chance of a crossover during meiosis d. The average chromosome contains about 500 centimorgans of genetic material

B

82. Southern blotting a. Was developed in southern U.S. b. Was named after E.M. Southern c. Is not useful for detecting gross rearrangements of DNA d. Cleaves DNA into large fragments

B

83. Polymerase chain reaction technique for DNA amplification a. Is slow and cumbersome b. Can be used to detect nucleotide sequences of infectious agents c. Is not very specific d. Must be performed on a fresh whole blood sample

B

85. Anticipation refers to a. Waiting for a disease to manifest itself in an individual such as in Huntington's chorea b. Worsening of a disease phenotype over generations within a family c. Birth of a fetus with positive prenatal tests for genetic abnormalities d. Expression of a premutation

B

86. Which method is used to detect unique genomic DNA fragments from an individual starting with DNA from peripheral leukocytes? a. Northern blot b. Southern blot c. Eastern blot d. Western blot

B

88. A key feature of all X-linked inheritance a. Male offspring of carrier females have 0% chance of being affected b. Affected males do not transmit the disease to their sons c. Affected homozygous females occur when any male mates with a carrier female d. 50% of female offspring of affected males are carriers e. Vertical distribution occurs

B

89. Regarding X inactivation a. It occurs late in embryonic development b. Each female is a mosaic with about half of her cells expressing the maternal X and half expressing the paternal X c. The nonfunctional X chromosome cannot be identified d. There is more methylation of DNA in the activated compared with the inacti- vated X chromosome

B

98. A 45-year-old white man with a 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 a. Hypercalcemia b. Paraneoplastic syndrome c. Cerebral vascular accident d. Myasthenia gravis

B

219. When the exudative pleural effusion contains less than 60 mg/dL of glucose, which one of the following diseases is the most likely cause? a. Eosophageal rupture b. Cirrhosis c. Malignant pleural effusion d. Pancreatic pleural effusion e. Diaphragmatic hernia

C

382. The most common variety of thyroid cancer is a. Thyroid lymphoma b. Medullary thyroid carcinoma c. Papillary thyroid carcinoma d. Anaplastic thyroid carcinoma e. Follicular thyroid carcinoma

C

2. The predominant antibody found in a primary immune response is a. IgA b. IgG c. IgM d. IgE e. IgD

C

204. Which of the following heart sounds is often caused by mitral or tri- cuspid valve prolapse? a. S1 b. Opening snap c. Midsystolic click d. S3 e. S4

C

207. The T wave on the surface ECG corresponds to which action poten- tial phase? a. Phase I b. Phase II c. Phase III d. Phase IV e. Phase 0

C

385. Psammoma bodies are a histologic feature of a. Thyroid lymphoma b. Medullary thyroid carcinoma c. Papillary thyroid carcinoma d. Anaplastic thyroid carcinoma e. Follicular thyroid carcinoma

C

101. 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 a. Congestive heart failure b. Lymphatic obstruction of the upper body c. Superior vena cava syndrome d. Deep venous thrombosis

C

104. Which of the following factors complexes with factor VIII, which is activated to factor VIIIa when released from the complex? a. Factor XIII b. High molecular weight kininogen c. Von Willebrand factor (vWF) d. Thromboplastin e. Plasminogen

C

110. Which of the following disorders is associated with thrombocytosis? a. Disseminated intravascular coagulation b. A plastic anemia c. Postsplenectomy d. Hypersplenism e. Prosthetic valves

C

210. Which of the following is the correct sequence for myocardial depolarization? a. AV node → bundle of His → atria b. Bundle of His → AV node → left ventricle → c. Sinoatrial (SA node) → AV node → bundle of His → right and left ventricles d. SA node → left ventricle → bundle of His

C

213. Loss of P waves on surface ECG is consistent with a. First-degree AV block b. Atrial flutter c. Atrial fibrillation d. Sinus bradycardia e. Second-degree AV block type I

C

113. Which of the following statements related to circulating erythrocytes (red cells) is untrue? a. The nuclei of the precursor cells to erythrocytes are extruded from their cells shortly before the red cells leave the bone marrow. Consequently, the presence of nucleated red cells in the peripheral blood should be regarded as abnormal and may indicate an underlying disease state. b. In a thin blood smear stained with Romanowsky's stain (such as Wright's stain), the youngest cells (reticulocytes) can be recognized by a blue coloration (baso- philia) as different from most of the red cells present. c. The average diameter of erythrocytes is about 8 μm; consequently, they cannot flow through the smaller capillaries that have a diameter of 2 to 4 μm. d. The protein of hemoglobin, which is the principal constituent of the red cell contents, is in tetrameric form, with two α and two β subunits. e. The iron atom of the hemoglobin molecule, which is essential to its function of carrying oxygen, is an intrinsic part of the heme complex attached to each sub- unit of protein.

C

121. Which mechanism is responsible for thrombocytopenia in dissemi- nated intravascular coagulation (DIC)? a. Decreased production b. Maldistribution c. Accelerated destruction d. Decreased survival e. Inherited

C

122. Which mechanism is responsible for thrombocytopenia in immune (idiopathic) thrombocytopenic purpura (ITP)? a. Decreased production b. Maldistribution c. Accelerated destruction d. Decreased survival e. Inherited

C

124. Which mechanism is responsible for thrombocytopenia in throm- botic thrombocytopenic purpura (TTP)? a. Decreased production b. Maldistribution c. Accelerated destruction d. Decreased survival e. Inherited

C

126. Which is a protein cofactor that exposes the inactivation site of acti- vated coagulation factor V, which can then be cleaved by a protease? a. Protein C b. Protein S c. Antithrombin III (ATIII) d. Plasminogen e. Prekallikrein

C

127. 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. a. Protein C b. Protein S c. Antithrombin III (ATIII) d. Plasminogen e. Prekallikrein

C

13. Which one of the following complement components enhances phagocytosis of bacteria by opsonization? a. C1 b. Factor B c. C3b d. C5a e. C5b6789

C

133. Infective endocarditis frequently occurs in injection drug users. The valve most often involved is a. Mitral b. Aortic c. Tricuspid d. Pulmonic

C

139. Which one of the following microorganisms is the most common cause of meningitis in children under 1 month of age? a. Neisseria meningitidis b. Streptococcus pneumoniae (pneumococcus) c. Gram-negative bacilli d. Staphylococci e. Hemophilus influenzae

C

145. Which one of the following microorganisms that cause pneumonia is acquired from exposure to an infected animal? a. Legionella spp. b. Pneumocystis carinii c. Chlamydia psittaci d. Klebsiella pneumoniae e. Moraxella catarrhalis

C

149. In the pathogenesis of acute diarrhea, which microorganism charac- teristically penetrates intestinal mucosa of the distal small bowel, multi- plies in Peyer's patches, and then disseminates by the bloodstream? a. Vibrio cholerae b. Enterotoxigenic E. coli c. Salmonella typhi d. Rotavirus e. Clostridium difficile

C

164. 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 agglu- tinin titer is elevated. The organism that is the likely cause of this illness is a. Leptospira b. Influenzavirus c. Mycoplasma pneumoniae d. Legionella spp. e. Coxiella burnetti

C

171. Which one feature characterizes cat-scratch disease? a. 60% of cases occur in adults b. Fever and rash occur within 3 to 5 days of a cat scratch in most cases c. Anorexia, malaise, and weight loss are common d. Painless lymphadenopathy e. Culture of lymph nodes usually is positive for the infecting organism

C

172. 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 papules and then became vesicular and pustular and finally it coalesced in honeycomb-like crusts. The boy does not have fever, but he does have sev- eral insect bites and he is unwashed and dressed in dirty clothes. This rash is likely to be a. Herpes simplex b. Shingles c. Impetigo d. Scarlet fever e. Erysipelas

C

178. Curve B corresponds to which of the following? a. A patient in congestive heart failure treated with a positive inotrope b. A patient in congestive heart failure due to systolic function c. A normal person whose stroke volume increases as preload increases d. A patient with normal left ventricular function who is receiving intravenous dobutamine as part of a diagnostic study for ischemia e. A patient in congestive heart failure due to diastolic dysfunction

C

182. Which of the following represent the aortic valve opening? a. Point A b. Line B-C c. Point C d. Line C-D e. Point D

C

186. Which of the following represent repolarization of the ventricles? a. P wave b. QRS complex c. T wave d. J point e. U wave

C

188. A normal frontal plane QRS axis is a. +90° to +180° b. −30° to −90° c. −30° to +90° d. 0° to +150° e. 0° to +90°

C

19. A person with an abnormality in which one of the following early complement components would most likely experience the most serious clinical manifestations? a. C1 b. C2 c. C3 d. Factor B e. C1 inhibitor

C

193. Mediated via slow conduction channels a. Phase 0 b. Phase 1 c. Phase 2 d. Phase 3 e. Phase 4

C

195. Which of the following arterial pulse waveforms is consistent with severe left ventricular impairment? a. Parvus et tardus pulse b. Bisferiens pulse c. Pulsus alternans d. Hyperkinetic pulse e. Dicrotic pulse

C

199. Which of the following heart sounds is produced by closure of the AV valves? a. S3 b. Opening snap c. S1 d. S2 e. S4

C

221. Which one of the following is true about silicosis? a. Mesothelioma is a complication of silicosis b. It is caused by exposure to asbestos fibers c. An increased risk exists of developing tuberculosis in patients with silicosis d. Silicosis generally presents as a pneumothorax on chest x-ray e. Patients with silicosis should not receive any antituberculous therapy

C

229. 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? a. 20 b. 30 c. 40 d. 50 e. 60

C

233. The most common cause of mass in the posterior mediastinum is a. Vascular b. Esophageal diverticula c. Neurogenic tumors d. Lymphomas e. Bronchogenic cysts

C

234. In obstructive sleep apnea (OSA) which one of the following con- tributes to the negative oropharyngeal pressure characteristic of OSA? a. Pleural blebs b. Laryngeal muscles hyperactivity c. Occlusion of the upper airway at the level of the oropharynx d. Low pharyngeal resistance e. Low upstream (nasal) resistance

C

238. Which finding is fairly specific for chronic renal failure? a. Anemia b. Hyaline casts c. Broad casts in urinalysis d. Proteinuria e. Hypocalcemia

C

24. Mycobacterium tuberculosis results in an intracellular bacterial infection that provokes which one of the following immune responses? a. Natural killer cytotoxic response b. CD8-positive cytotoxic T cell response c. T helper 1 delayed type hypersensitivity response d. Complement mediated lysis of infected cell e. Eosinophilia

C

241. A high fractional excretion of sodium is typically found in a. Heart failure b. Urinary tract obstruction c. Acute tubular necrosis d. Acute glomerulonephritis e. Hepatorenal syndrome

C

247. In patients with chronic renal failure, which of the following adapta- tions are normal? a. Fractional excretion of sodium increases due to suppression of aldosterone b. Metabolic acidosis due to loss of bicarbonate in the urine c. Increased potassium loss through extrarenal mechanisms d. Decreased fractional excretion of water due to ADH resistance

C

25. Which one of the following is a B cell neoplasm? a. Non-Hodgkin's lymphoma b. Acute lymphoblastic leukemia c. Burkitt's lymphoma d. Hodgkin's disease e. Histiocytosis X

C

251. Which of the following is true of anti-GBM (glomerular basement membrane) syndrome? a. The clinical presentation is largely the same in different age groups b. The target antigen in the glomerulus is elastin c. Complement levels are typically normal d. Plasmapheresis enables dialysis-dependent patient to recover renal function e. Transplantation is contraindicated because of disease recurrence

C

261. A patient on long-term lithium comes into your office complaining of polyuria; you would expect his serum sodium to be a. Elevated because he has central diabetes insipidus b. Elevated because he has nephrogenic diabetes insipidus c. Nearly normal because he is drinking increased amounts of water d. Low because he is suffering from psychogenic polydipsia

C

267. Which of the following is a secondary cause for focal segmental scle- rosis? a. Hodgkin's disease b. Colon cancer c. HIV disease d. Hepatitis C infection

C

269. The metabolic disorder induced by diarrhea and by acetazolamide are best differentiated by a. Serum anion gap b. Blood gas analysis c. Urine anion gap d. Urine pH e. Serum potassium

C

279. Whichofthefollowingisacommoncauseofisolatedhematuriawith isomorphic red cells in the urine? a. Alport's syndrome (hereditary nephritis) b. Thin basement membrane disease c. Idiopathic hypercalciuria d. IgA nephropathy

C

285. A 50-year-old woman executive has for the past 3 months experi- enced abdominal pain that often is relieved by antacids. Because of the per- sistent abdominal pain, she consults a gastroenterologist. He does an upper GI endoscopy and visualizes a duodenal ulcer. Now, the gastroenterologist should a. Biopsy the ulcer b. Arrange for a surgeon to operate on the ulcer c. Suggest medical treatment of the ulcer d. Cauterize the ulcer e. Order an abdominal CT scan

C

299. 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 a. GERD (gastroesophageal reflux disease) b. Achalasia c. Hypertensive LES d. Barrett's esophagus e. Esophageal spasm

C

304. A 40-year-old man comes to your office complaining of epigastric pain that is unrelieved by several weeks of antacid therapy. Endoscopy reveals a duodenal ulcer. You recommend a course of treatment. What is the most likely outcome? a. The ulcer may heal but scarring will cause outlet obstruction b. Eventually the patient will require surgery for control of his symptoms c. The ulcer may heal completely after 8 weeks of H2-blocker therapy d. The symptoms will improve with H2-blocker therapy, but the ulcer won't heal e. The ulcer may heal completely after 6 months of H2-blocker therapy

C

308. 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 lab- oratory tests you ordered show a hemoglobin of 10.2 g/dL and an MCV of 110. The most likely cause is a. Autoantibodies to thyroglobulin b. Autoantibodies to histones c. Autoantibodies to gastric parietal cells d. Autoantibodies to dsDNA (double-stranded DNA) e. Autoantibodies to ribosomal P protein

C

31. Which one of the following tests is used for the detection of group A streptococci from a throat swab? a. Flow cytometry (FACS) b. Enzyme-linked immunosorbent assay (ELISA) c. Latex agglutination d. Coombs' test e. Mixed lymphocyte reaction

C

317. 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? a. Upper abdominal ultrasound b. Repeat CT scan with spiral technique c. Abdominal MRI d. Laparoscopy e. Open abdominal exploration

C

326. 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 a. Consistent with cirrhosis b. Essentially normal c. Consistent with alcoholic hepatitis that may revert to normal if he stops drink- ing alcohol d. Consistent with alcoholic hepatitis that will progress to cirrhosis e. Not interpretable because of the presence of degenerating cells and it will need to be repeated

C

328. In parenchymal liver disease, which one of the following tests of liver function likely will be decreased from normal? a. AST (aspartate aminotransferase) and ALT (alanine aminotransferase) b. Alkaline phosphatase c. Albumin d. Prothrombin time e. γ-Glutamyl transpeptidase (GGT)

C

329. In obstructive liver disease, which one of the following tests of liver function likely remains normal? a. AST and ALT b. Alkaline phosphatase c. Albumin d. 5′-Nucleotidase e. γ-Glutamyl transpeptidase (GGT)

C

33. Which hypersensitivity reaction is associated with serum sickness? a. Type I: immediate b. Type II: cytotoxic c. Type III: immune complex d. Type IV: cell mediated

C

332. Transmission of hepatitis A is almost exclusively by a. Blood transfusion b. Intravenous drug abuse c. Fecal-oral route d. Sexual

C

334. In hepatitis B virus infection, which one of the following antibodies is the protective antibody? a. Anti-HBe b. Anti-HBc c. Anti-HBs d. Anti-polymerase e. Anti-HBV DNA

C

336. 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 a. Acute HBV infection, high infectivity b. Late-acute HBV, low infectivity c. Recovered from HBV infection d. Chronic HBV infection, high infectivity e. Immunization with HBsAg vaccine

C

345. Which of the hepatitis viruses most commonly progresses to chronic infection and chronic hepatitis? a. HAV b. HBV c. HCV d. HEV e. HGV

C

346. The clinical symptoms, signs, and outcomes following acute liver injury associated with viral hepatitis are as a consequence of the a. Virus directly cytopathic for liver cells (hepatocytes) b. Virus directly cytopathic to lymphoid cells in the liver c. Immunologic response of the host (the person infected), involving cytolytic T cells d. Primary action of viral polymerase on hepatocytes e. Virus antibody acting on hepatocytes and lymphoid cells

C

348. 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 a. Acute hepatitis A b. Acute hepatitis B c. Acute hepatitis A and B d. Chronic hepatitis B e. Acute hepatitis C

C

351. Which is the most common precipitating event of hepatic encepha- lopathy? a. Constipation b. Hyperkalemia c. Gastrointestinal bleeding d. Hypernatremia e. Acidosis

C

352. A serum-ascitic fluid albumin gradient of more than 1.1 g/dL is con- sistent with ascites caused by a. Tuberculosis b. Peritoneal metastases c. Cirrhosis of the liver d. Trauma

C

354. Which one of the following disorders of bilirubin metabolism shows increased unconjugated bilirubin, increased conjugated bilirubin, and pos- itive bilirubin in the urine? a. Neonatal jaundice b. Crigler-Najjar syndrome, types I and II c. Hepatitis d. Gilbert's syndrome e. Ineffective erythropoiesis

C

358. In the hepatorenal syndrome typically a. Urinary sodium is greater than 5 mmol/L b. A precipitating factor occurs infrequently c. Azotemia, hyponatremia, progressive oliguria, and hypotension are usually present d. The urinary sediment contains a high concentration of RBC casts e. The leukocyte count in ascitic fluid is usually low, less than 100 cells/μL

C

362. 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 biliru- bin is 2.5 mg/dL and his AST and ALT are elevated. Which disease is he likely to have? a. Cirrhosis b. Wilson's disease c. Hepatitis due to HAV d. Hepatitis due to HBV e. Hepatitis due to HCV

C

368. Thyrotoxicosis and uniformly increased radioactive iodine uptake in the thyroid can occur without any thyrotropin receptor antibodies or any thyroid autoimmunity in a. Graves' disease b. Jod-Basedow phenomenon c. Choriocarcinoma d. Struma ovarii e. Toxic multinodular goiter

C

372. The most common cause of spontaneous hypothyroidism in the U.S. is a. Iodine deficiency b. Lithium c. Hashimoto's thyroiditis d. Propylthiouracil e. Toxic multinodular goiter

C

376. High levels of thyroidal peroxidase antibody are found with a. Iodine deficiency b. Lithium c. Hashimoto's thyroiditis d. Propylthiouracil e. Toxic multinodular goiter

C

38. Which hypersensitivity reaction is associated with poststreptococcal glomerulonephritis? a. Type I: immediate b. Type II: cytotoxic c. Type III: immune complex d. Type IV: cell mediated

C

380. The pattern of normal TSH, high T4, and high T3 is seen often with a. Hyperthyroidism b. Nonthyroidal illness (sick euthyroidism) c. Estrogen therapy d. Subclinical hypothyroidism e. Familial (euthyroid) dysalbuminenic hyperthyroxinemia

C

388. A 65-year-old man presents with signs and symptoms of thyrotoxi- cosis. His radioiodine scan and 24-h uptake show a patchy pattern but nor- mal amount of radioiodine uptake. This presentation is most consistent with a. Graves' disease b. Subacute thyroiditis c. Toxic multinodular goiter d. Hashimoto's thyroiditis e. Toxic adenoma

C

395. A 28-year-old woman develops galactorrhea without amenorrhea. Your evaluation should include a. Estradiol b. Progesterone c. Prolactin d. Testosterone e. DHEA-S

C

402. A 45-year-man has decreased libido and decreased sexual function. A large pituitary tumor is found. His prolactin is 20 (less than 15). Testing of his pituitary-gonadal axis most likely will show a. Normal testosterone and low LH b. High testosterone and normal LH c. Low testosterone and low LH d. Normal testosterone and normal LH e. Low testosterone and high LH

C

406. A 25-year-old woman presents with increasing obesity, amenorrhea, hypertension, and abdominal stria. The next best diagnostic test is a. Prolactin b. Free T4 and TSH c. Overnight dexamethasone suppression test d. Random cortisol e. ACTH

C

410. A 23-year-old woman presents with 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 a. Pituitary macroadenoma b. Empty sella syndrome c. Craniopharyngioma d. Optic glioma e. Hypothalamic hamartoma

C

416. Which of these hormones is also produced in significant amounts outside of the gonads? a. Estrone b. Estradiol c. Androstenedione d. Testosterone e. Dihydrotestosterone

C

419. A 28-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 ab- dominal pain? a. Endometriosis b. Urinary tract infection c. Ectopic pregnancy d. Placental abruption e. Premenstrual syndrome

C

423. How does pregnancy increase the risk of diabetes mellitus? a. Causing weight gain b. Insulin resistance c. Placental production of human chorionic somatomammotropin d. Increase of maternal glucocorticoids

C

430. 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? a. Low FSH and LH b. High FSH and LH c. Androgen insensitivity d. Hyperthyroidism e. XXY karyotype

C

435. Which of the following hormones is produced both by the theca and the kidney? a. Inhibin b. Relaxin c. Renin d. Epidermal growth factor-like e. Transforming growth factor-β

C

439. 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? a. Ovarian failure b. Hypothyroidism c. Asherman's syndrome d. Endometriosis e. Prolactinoma

C

44. Which cytokine functions as a promotor of T helper 2 (TH2) development and IgE synthesis? a. IFN-γ (interferon γ) b. IL-2 (interleukin 2) c. IL-4 (interleukin 4) d. TNF-α (tumor necrosis factor α) e. TGF-β (transforming growth factor β)

C

441. A 26-year-old female is about to deliver a baby. She asks you why should she breast-feed. Beyond the obvious issue of child to mother bond- ing, what else must you tell her? a. It's the correct thing to do b. Better nutrition for the baby c. Protect the baby from infections early in life d. Quicker weight loss e. Good contraception

C

450. In which ovarian compartment is angiotensin II produced? a. Granulosa b. Theca c. Follicular fluid d. Follicles e. Corpus luteum

C

455. 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 a. Pretesticular b. Testicular c. Posttesticular d. Idiopathic

C

456. A 35-year-old man comes to your office with a complaint of recent development of headaches that are generalized in nature. He is accompa- nied by his wife who recently returned from a trip. She tells you that her husband has been somewhat confused at times and clumsy. He does not confirm this, but he does report that he has been short of breath at times. On examination, he is mildly tachycardia and there is a reddish appearance to his mucous membranes, which is subtle. The only recent new medical problem identified is that the patient was in a motor vehicle accident in which he was struck in the rear end, and it left him with a sore neck. The most likely diagnosis is a. Acquired spinal stenosis (cervical) b. Normal pressure hydrocephalus c. Carbon monoxide poisoning d. Cocaine toxicity e. Muscle tension

C

46. 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 a. Polymorphism b. Mutation c. Variable expressivity d. Fitness

C

461. In the above patient, what other abnormality on physical would be consistent with the diagnosis? a. Ptosis b. Decreased visual acuity on Snellen's chart c. Hyporeflexia in the lower extremities d. Ataxic gait

C

463. 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 a. Folate deficiency b. Fasting hypoglycemia c. Hypomagnesemia d. Thiamine deficiency e. Vitamin B12 deficiency

C

466. The tremor associated with hepatic encephalopathy is a. Resting tremor b. Essential tremor c. Asterixis d. Very high frequency e. Drug related

C

468. A 65-year-old woman is seen for evaluation of dementia. On exami- nation, 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 a. Titer for Lyme disease b. B12 level c. RPR d. HIV e. Fasting glucose

C

470. 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 a. CT of the region b. CBC c. ESR d. Calcium level e. Carotid duplex

C

473. A 75-year-old man is brought to your office by his son with concerns over developing dementia problems. Previously, the patient had been well and was forced to retire from his job a few months ago because of worsen- ing arthritis symptoms limiting his mobility. He has been a widower for 7 months and he lives alone. His family is worried about his safety in view of these changes. The likely cause of this dementia picture is a. HIV related b. B12 deficiency c. Depression d. Multi-infarct dementia

C

474. A 35-year-old woman comes to your office complaining of weakness in her limbs and fatigability of her muscles, which, it seems to her, lessens after she rests. Sometimes she does not have any muscle weakness, for months at a time, and then she does; all this has been happening to her for the past few years. She tells you that what bothers her most is the "droopi- ness" of her eyelids. Which one procedure provides definitive confirmation of the diagnosis? a. Single-fiber electromyography b. CT scan or MRI of the head c. Antiacetylcholine receptor radioimmunoassay d. Edrophonium chloride test e. Electroencephalogram (EEG)

C

475. 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 accompanied by photophobia and vomiting. Which procedure(s) provide the best chance of making the diagnosis? a. CT scan of the head b. Lumbar puncture c. CT scan of the head and lumbar puncture d. ECG, lumbar puncture, and x-rays of the skull e. Pneumoencephalogram

C

478. Weakness is caused by diseased anterior horn cells in which of the following disorders? a. Myasthenia gravis b. Botulism c. Amyotrophic lateral sclerosis d. Aminoglycoside antibiotic-associated weakness e. Lambert-Eaton myasthenic syndrome

C

479. 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 a. Occipital cortex b. Temporal lobe c. Cerebellum d. Brainstem e. Frontal cortex

C

480. 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 a. Mononeuropathy b. Brown-Séquard's syndrome c. Polyneuropathy d. Mononeuropathy multiplex e. Radiculopathy

C

488. Deafness due to disease of the cochlear nuclei or auditory pathways is classified as a. Conductive deafness b. Sensorineural deafness c. Central deafness d. Tinnitus e. Presbycusis

C

490. Which of the following clinical diagnoses is most often accompanied by coma? a. Transient ischemic strokes b. Creutzfeldt-Jakob disease or multi-infarct dementia c. Cerebral hemorrhage, either subarachnoid or intracerebral d. Amyotrophic lateral sclerosis e. Small lacunar infarcts

C

494. A 50-year-old man who is an alcoholic is severely injured in a bar- room brawl. He sustains a major injury to the frontal lobes of his brain. Subsequently, he always seems apathetic and unemotional. This disorder is called a. Apraxia b. Aphasia c. Abulia d. Anomia e. Alexia

C

52. The increased frequency of the recessive gene for sickle cell anemia in the African population is an example of a. Hypomorphism b. Hypermorphism c. Heterozygote advantage d. Phenotypic heterogeneity

C

54. When two copies of a mutant allele produce a phenotype more severe than one mutant and one normal copy, we have a. Dominant inheritance b. Recessive inheritance c. Semidominant inheritance d. Double dominant inheritance

C

55. Cystic fibrosis a. Occurs mainly in African Americans b. Causes endocrine problems with the pancreas gland c. Is an autosomal recessive disorder d. Is caused by loss of function mutations in a sodium channel

C

58. Which of the following conditions is known to be multifactorial in etiology and not due to a single gene disorder? a. Neurofibromatosis b. Osteogenesis imperfecta c. Atherosclerosis d. Cystic fibrosis

C

6. Which of the following cells are important in an innate immune response to extracellular bacteria? a. T lymphocytes b. B lymphocytes c. Neutrophils d. Eosinophils e. Mast cells

C

61. Fragile X-associated mental retardation syndrome a. Is transmitted from father to son b. Affects females and males equally c. 20% of carrier males show no sign of the syndrome d. Involves a nonrepetitive segment of DNA

C

62. Which is true regarding CpG islands? a. They are less than 100 base pairs in length b. They contain few sites for DNA methylation c. The island at Xq27.3 is normally unmethylated in male cells but methylated in one of the two X chromosomes in female cells d. Unmethylation of the CpG island in males correlates with expression of the fragile X-associated mental retardation syndrome

C

66. Fragile X, spinocerebellar ataxia 1, spinobulbar muscular atrophy, and Huntington's chorea a. All involve synthesis of an altered protein with an expanded polyglutamine region b. All involve failure to synthesize a protein c. All involve amplification of an unstable triplet repeat d. Involve mutation of the FMR1 gene

C

69. Which one of the following genetic diseases is a chromosomal disorder? a. Cystic fibrosis b. Hemochromatosis c. Klinefelter's syndrome d. Hemophilia e. Fragile-X

C

72. Which is true of Down's syndrome? a. 50% of cases are caused by an extra maternal chromosome b. 25% of nondysjunction occur in meiosis I c. Maternal and paternal nondysjunction events are associated with advanced maternal age d. It is impossible to tell whether the extra gene came from the mother or the father

C

74. Newborn screening for phenylketonuria a. Occurs at 7 days after birth b. Confirms the diagnosis in about 5% of those screened c. Has a false-negative rate of 1:70 d. Shows a prevalence in the general population of 1:50,000

C

87. In autosomal recessive genetic disease, the responsible gene must located on a. The X chromosome b. The Y chromosome c. Any one of the 22 autosomes d. The X chromosome and one autosome e. Both X and Y chromosomes

C

90. 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 a. AA b. SA c. SS d. CC e. AC

C

91. 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 a. Assuming that mammography is "diagnostic" b. Assuming that a radiographic lesion seen on mammography is the same as a palpable lesion c. Letting a negative or nonsuspicious mammogram influence the judgment of whether a palpable mass needs to be biopsied d. Assuming that a benign aspiration cytology is definitive

C

93. A 30-year-old man has pain in the left scrotum. What is currently valid concerning types of tumor? a. Alpha fetoprotein (AFP) is only elevated in seminomas. b. The half-life of AFP is 24 to 36 h. c. Lactate dehydrogenase (LDH) is an important marker to follow tumor progres- sion or regression. d. Human chorionic gonadotropin-β subunit (β-hCG) is only elevated in semi- noma.

C

94. In a patient with multiple enlarged lymph nodes, which should be biopsied? a. Groin nodes b. Nodes in the axilla c. Superficial cervical nodes d. Periaortic lymph node with CT guidance

C

162. 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? a. Influenzavirus b. Mycoplasma pneumoniae c. Chlamydia psittaci d. Coxiella burnetii e. Chlamydia pneumoniae

D

165. In clinical infection with E. histolytica, the main finding concerning immunity is a. Clinical infection induces immunity to recurrent colonization b. Repeated episodes of colitis are usual c. Antibody is protective d. Antibody titers correlate with the length of illness e. Antibody titers correlate with the severity of disease

D

278. A middle-aged patient with an elevated serum creatinine, hyperten- sion, and mild anemia comes to you for evaluation. Urine dipstick shows trace protein without red cells or cellular casts. A 24-h urine collection reveals 5 g of protein. The most likely etiology is a. Focal segmental sclerosis b. Hypertensive nephrosclerosis c. Amyloidosis d. Multiple myeloma

D

259. Which disease presents with predominantly glomerular involve- ment? a. Analgesic nephropathy b. Uric acid nephropathy c. Lead nephropathy d. Light chain deposition disease

D

263. Which of the following is characterized by normotension, hypo- kalemia, and metabolic alkalosis? a. Sjögren's syndrome b. Hyperaldosteronism c. Liddle's syndrome d. Barrter's syndrome

D

10. Eosinophils are associated with the defense against infections caused by a. Virus b. Intracellular bacteria c. Extracellular bacteria d. Invasive parasites e. Mycoplasma

D

102. The multistep theory of carcinogenesis can be applied to what form of cancer? a. Head and neck cancer b. Breast cancer c. Lung cancer d. Colorectal cancer

D

103. Platelet production (thrombopoiesis) is affected by more than one cytokine. Which of the following sets seems to be the most important in platelet development? a. IL-3, granulocyte colony-stimulating factor (G-CSF), and granulocytemacro- phage colony-stimulating factor (GM-CSF) b. IL-4, IL-6, and thrombopoietin c. Erythropoietin, thrombopoietin, and IL-6 d. IL-6 and thrombopoietin e. IL-3, IL-4, and IL-6

D

105. Which of the following factors depends on platelets for synthesis? a. Factor II (prothrombin) b. Factor VII (proconvertin) c. Protein S d. Factor XIII (fibrin-stabilizing factor) e. Factor X (Stuart-Prower factor)

D

107. Which of the following causes of an elevated hemoglobin concentra- tion in the blood is characterized by a LOW level of erythropoietin in the blood? a. Chronic tobacco smoking b. Dwelling at high altitudes, such as in the Andes c. Erythrocytosis associated with renal tumors d. Primary polycythemia (polycythemia vera) e. Erythrocytosis secondary to chronic pulmonary insufficiency

D

111. 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 a. Traumatic hemolytic anemia b. Autoimmune anemia c. Blood loss d. Pernicious anemia e. Iron-deficiency anemia

D

112. Most drugs induce thrombocytopenia by which mechanism? a. Marrow-depressing effect b. Directly cytotoxic of platelets c. Depress megakaryoctye production d. Immune response in which the platelet is damaged by complement activation e. Impair megakaryoctye production

D

119. Which disorder presents mainly as a localized new mass or group of superficial lymph nodes? a. Chronic lymphocytic leukemia (B cell type) b. Chronic myelocytic leukemia c. Lymphoblastic leukemia d. Hodgkin's disease e. Non-Hodgkin's disease

D

12. During an immune response, antibodies are made against different structures (usually proteins) on an infectious agent. These structures are referred to as a. Adjuvants b. Allotypes c. Isotypes d. Epitopes e. Alleles

D

129. Acute bacterial infections of the bone characteristically show which one of the following? a. Necrotic bone b. Prolonged clinical course c. Predominantly mononuclear cells d. Congested and thrombosed blood vessels e. Granulation tissue

D

130. Which one of the following organisms accounts for at least 50% of cases of acute hematogenous and contiguous focus osteomyelitis? a. Group A streptococci b. Group B streptococci c. Mycoplasma d. S. aureus e. Pseudomonas aeruginosa

D

132. Which one of the following does not contribute to injection drug users becoming infected? a. Unsterile injection technique b. Immune defects induced by drug use c. Contaminated needles and syringes d. Nonuse of antibiotics e. Poor dental hygiene

D

144. Which microorganism is likely to cause pneumonia in a person who abuses alcohol? a. Legionella spp. b. Pneumocystis carinii c. Chlamydia psittaci d. Klebsiella pneumoniae e. Moraxella catarrhalis

D

147. Which one of the following groups of microorganisms more com- monly causes diarrhea in the United States? a. Bacteria b. Fungi c. Protozoa d. Viruses

D

15. Which one of the following complement components is a chemo- attractant for neutrophils? a. C1 b. Factor B c. C3b d. C5a e. C5b6789

D

151. The principal CD lymphocyte affected in HIV and AIDS is: a. CD28 b. CD27 c. CD8 d. CD4 e. CD3

D

153. Typically HIV progresses from the onset of infection to evidence of immunosuppression over what period of time? a. 1 to 3 months b. 1to3years c. 4to5years d. 5 to 10 years e. 11 to 15 years

D

157. Which one of the following causes painful and crusted lesions that follow the path of an intracostal nerve in persons infected with HIV? a. Candida albicans b. Cytomegalovirus c. Cryptococcus neoformans d. Herpesvirus varicellae e. Cryptosporidium

D

161. Which one of the following causes a wasting disease and cachexia in persons infected with HIV? a. Kaposi's sarcoma b. Pneumocystis carinii c. Mycobacterium tuberculosis d. Mycobacterium avium complex e. Toxoplasma gondii

D

166. The recommendation for poliovirus vaccine in infants and children was changed to inactivated vaccine [Salk inactivated vaccine (IPV)] from live attenuated vaccine [Sabin oral vaccine (OPV)] for which reason? a. Inactivated vaccine is cheaper than attenuated vaccine b. Injection of vaccine is easier than oral administration c. The antibody response is more long lasting with inactivated vaccine d. The chance of vaccine-induced polio illness is unlikely with inactivated vaccine e. Mothers prefer injections for their children

D

167. INH prophylaxis is recommended for which person? a. AmanteacherwithHIVandaPPDof4mm b. A well man truck driver age 25 years with a PPD of 8 mm c. A well woman clerk age 45 years with a PPD of 9 mm d. A well man medical student age 30 years with a PPD of 11 mm e. A well woman actress age 40 years with a PPD of 12 mm

D

168. Among intravenous drug abusers, which is most often the source of the pathogens of infective endocarditis? a. Urine b. Lungs c. Gastrointestinal tract d. Skin e. Contaminated drugs

D

169. Which is the best approach to confirm the diagnosis of an acute cytomegalovirus infection (CMV)? a. Clinically with fever and rash b. Isolation of the virus from urine c. Isolation of virus from saliva d. Isolation of the virus from blood e. Isolation of virus from stool

D

173. Which one of the following ECG components varies with heart rate? a. PR interval b. QRS duration c. ST segment d. QT interval e. QRS voltage

D

175. Which of the following occurs during systole? a. Blood passes from atria into the ventricles b. The atrioventricular (AV) valves are open c. Rapid ventricular filling occurs d. The ventricles contract e. Atrial contraction propels final proportion of blood into ventricles

D

18. Which one of the following complement component deficiencies is associated with individuals with frequent pyogenic bacterial infections? a. Membrane attack complex (C5 to C9) b. C1 inhibitor c. C2 d. C3 e. C4

D

183. Which of the following represent left ventricular ejection? a. Point A b. Point B c. Line B-C d. Line C-D e. Point C

D

185. Which of the following is often noted during hypokalemia? a. Prominent P wave b. Prominent QRS complex c. Long Q-T interval d. Prominent U wave e. J point elevation

D

194. Rapid potassium exit a. Phase 0 b. Phase 1 c. Phase 2 d. Phase 3 e. Phase 4

D

200. Which of the following heart sounds is produced by closure of the semilunar (aortic and pulmonic) valves? a. S3 b. Opening snap c. S1 d. S2 e. S4

D

208. Which of the following is represented by a prolonged PR interval and is due to delayed AV conduction? a. Asystole b. Third-degree AV block type c. Second-degree AV block type I d. First-degree AV block e. Second-degree AV block type II

D

214. The arrow indicates a. R wave b. S wave c. QS wave d. Q wave e. T wave

D

220. 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? a. Obtain a chest x-ray and schedule him to return tomorrow b. Treat his symptoms with antipyretics and cough syrup c. Prescribe an oral antibiotic and also antipyretics and cough syrup and schedule him to return in 2 days d. Admit him to the hospital in the intensive care unit for parenteral antibiotic treatment e. Administer a tuberculin skin test (PPD), treat his symptoms with antipyretics and cough syrup, obtain a chest x-ray, and schedule him to return in 2 days for interpretation of the skin test

D

236. In which one of the following diseases would the occurrence of hemoptysis prompt a search for another disease as the cause of the hemop- tysis? a. Bronchogenic carcinoma b. Acute bronchitis c. Goodpasture's syndrome d. Emphysema e. Bronchiectasis

D

240. A patient with chronic renal failure will be expected to have which of the following findings due to the mechanisms described? a. Hypercalcemic due to elevated PTH hormone b. Prolonged bleeding due to decreased synthesis of clotting factors c. Anemia due to increased red cell destruction d. Hypermagnesemia due to decreased renal excretion

D

242. Which of the following nephron segment is correctly paired with its function? a. Distal tubule and bicarbonate reclamation b. Loop of Henle and potassium regulation c. Proximal tubule and urinary concentration d. Collecting tubule and water regulation

D

243. Which of the following statements is true in the management of acute renal failure? a. Metabolic acidosis is fully corrected with bicarbonate b. Hyperphosphatemia is primarily managed with dialysis c. Low-dose dopamine is used to shorten the duration of renal failure d. Hypervolemia is managed with high-dose loop diuretics e. Hyponatremia is corrected by administration of sodium salts

D

244. Which of the following describes bone abnormalities in patients with chronic renal failure? a. Osteitis fibrosis cystica is a result of oversuppression of PTH b. Adynamic bone disease is associated with myopathy c. Osteomalacia is due to excessive accumulation of magnesium d. Hyperparathyroidism responds well to 1,25 dihydroxyvitamin D e. Amyloidosis is similar in etiology to patients who are not on dialysis

D

246. Which of the following measures has not been shown to retard pro- gression of renal failure? a. Aggressive BP control b. Decrease in protein intake c. ACE inhibitors above other antihypertensives d. Erythropoietin for anemia

D

252. Prerenal azotemia is associated with a. High fractional excretion of sodium b. Granular casts in the urine c. Use of angiotensin-converting enzyme (ACE) inhibitors in unilateral renal artery stenosis d. Evolution to acute tubular necrosis if untreated

D

256. Which may cause acute renal failure in patients with nephrotic syn- drome? a. Dietary protein restriction b. ACE inhibitors c. Lipid-lowering agents d. Loop diuretics

D

281. 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-h urine shows 1 g of protein per day. His crea- tinine clearance is 24 mL/min. About 4 months ago, his serum creatinine was normal. The most likely diagnosis is a. Amyloidosis b. Light chain deposition disease c. Nonsteroidal induced interstitial nephritis d. Vasculitis

D

288. A patient complaining of chest pain, regurgitation, and dysphagia for several months is thought to have achalasia. The gastroenterologist should a. Order a chest CT scan to rule out tracheoesophageal fistula b. Do an endoscopy to biopsy the lower esophageal sphincter c. Do an endoscopy to dilate the esophagus d. Do an endoscopy to inject botulinum toxin into the lower esophageal sphincter e. Order an abdominal CT scan to make the diagnosis of achalasia

D

291. The extent of liver damage done by chronic hepatitis B or C infection can best be gauged by evaluating a. Symptoms b. Elevation of serum transaminases c. Duration of infection d. Liver biopsy e. Presence or absence of ascites

D

3. Which immunoglobulin class is found on the surface of mast cells? a. IgA b. IgG c. IgM d. IgE e. IgD

D

303. When nonsteroidal anti-inflammatory drugs cause ulcers, they are usually a. Esophageal b. Jejunal c. Duodenal d. Gastric e. Anal

D

307. The digestive enzymes amylase and lipase begin to be secreted and begin to act on ingested food a. In the duodenum, after they are secreted by the pancreas b. In the ileum, after they are secreted by the small intestine c. In the duodenum, after they are secreted from the liver d. In the mouth, after secretion from the salivary and lingual glands e. In the stomach, after they are secreted from the pancreas

D

313. 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 a. Normal mucosa b. Patchy inflammatory lesions that extend throughout the bowel wall c. Granulomas and fibrosis d. Continuous inflammatory changes mostly confined to the mucosa e. Patchy inflammation of the mucosa with inflamed mesenteric fat and fibrosis

D

318. 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 a. Ultrasound of the neck b. CT scan of the chest c. MRI of the mediastinum d. Barium swallow e. KUB (flat-plate x-ray of the abdomen)

D

319. Symptoms due to Clostridium difficile infection can be accurately diagnosed by a. Presence of diarrhea b. Stool positive for WBCs c. History of recent antibiotic usage d. Pseudomembranes noted on a sigmoidoscopy e. KUB (flat-plate x-ray of the abdomen)

D

331. 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 a. Extrahepatic biliary tract obstruction b. Alcoholic hepatitis c. Viral hepatitis d. Primary biliary cirrhosis e. Carcinoma of the liver

D

335. 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 a. Acute HBV infection, high infectivity b. Late-acute HBV, low infectivity c. Recovered from HBV infection d. Chronic HBV infection, high infectivity e. Immunization with HBsAg vaccine

D

339. 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 a. Hemochromatosis b. Gaucher's disease c. Biliary cirrhosis d. Wilson's disease e. Type III glycogen storage disease

D

34. Which hypersensitivity reaction is associated with a tuberculin reaction? a. Type I: immediate b. Type II: cytotoxic c. Type III: immune complex d. Type IV: cell mediated

D

340. Which of these liver diseases results from a copper disorder? a. Hemochromatosis b. Gaucher's disease c. Biliary cirrhosis d. Wilson's disease e. Type III glycogen storage disease

D

35. Which hypersensitivity reaction is associated with poison ivy? a. Type I: immediate b. Type II: cytotoxic c. Type III: immune complex d. Type IV: cell mediated

D

350. Ascites forms in patients with cirrhosis when a. Portal hypertension alone is present b. Hepatic lymph flow is decreased c. Hypoalbuminemia alone is present d. Portal hypertension and hypoalbuminemia are present e. Hepatic lymph flow and aldosterone secretion are decreased

D

357. In spontaneous bacterial peritonitis (SBP) typically a. Pneumococcus or other gram-positive bacteria commonly cause this infection b. Ascitic fluid usually has a high concentration of albumin c. Persons with normal livers and persons with advanced liver disease are equally likely to develop SBP d. As many as 70% of patients will experience at least one recurrence within 1 year of the first episode e. The leukocyte count in ascitic fluid is usually low, less than 100 cells/μL

D

360. Which disease is a major risk factor for development of hepatocellu- lar carcinoma? a. Alcoholism b. Coombs' positive hemolytic anemia c. Cholelithiasis d. Cirrhosis e. Amyloidosis

D

371. Thyrotoxicosis with a low uptake of iodine in the thyroid bed but uptake in the pelvis can be seen with a. Graves' disease b. Jod-Basedow phenomenon c. Choriocarcinoma d. Struma ovarii e. Toxic multinodular goiter

D

377. 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 a. Hyperthyroidism b. Nonthyroidal illness (sick euthyroidism) c. Estrogen therapy d. Subclinical hypothyroidism e. Familial (euthyroid) dysalbuminenic hyperthyroxinemia

D

383. 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 this prognosis is a. Thyroid lymphoma b. Medullary thyroid carcinoma c. Papillary thyroid carcinoma d. Anaplastic thyroid carcinoma e. Follicular thyroid carcinoma

D

391. On the basis of physical findings, you suspect a 48-year-old woman has acromegaly. The definitive diagnostic test for acromegaly is measure- ment of growth hormone in which of the following settings? a. Random b. TRH stimulation test c. Insulin tolerance test d. Oral glucose tolerance test e. LHRH stimulation test

D

393. Untreated acromegaly results in decreased life expectancy from a. Prognathism b. Renal hypertrophy c. Skin tags d. Colon carcinoma e. Cervical arthropathy

D

408. A 65-year-old man with a lung mass has increasing skin pigmenta- tion and significant muscle weakness and wasting. Urinary free cortisol is 690 μg/24 h (10 to 80) and is nonsuppressible. Which of the following tests would probably be most diagnostic? a. ACTH stimulation test b. MRI of the pituitary c. CT of the abdomen d. Plasma ACTH e. Parathyroid hormone

D

412. 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 a. Serum TSH b. Serum calcium c. Serum prolactin d. Serum ferritin e. Serum gastrin

D

415. A patient has an excess of 17α-hydroxyprogesterone and 17α- hydroxypregnenolone in the urine, and no androgens. Which enzyme is deficient? a. 20,22-Desmolase b. 3β-Hydroxysteroid dehydrogenase c. 17-Hydroxylase d. 17,20-Desmolase (17,20 lyase) e. 17-Ketoreductase

D

42. Which cytokine promotes various biologic actions associated with inflammation? a. IFN-γ (interferon γ) b. IL-2 (interleukin 2) c. IL-4 (interleukin 4) d. TNF-α (tumor necrosis factor α) e. TGF-β (transforming growth factor β)

D

420. A38-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? a. FSH and LH b. Estrogen levels c. Testosterone level d. TSH e. Cortisol level

D

425. A 40-year-old female presents with amenorrhea and hirsutism. Which hormone is in excess in this woman with polycystic ovary syn- drome? a. Estrogen b. Progesterone c. FSH d. Androgens

D

426. Which of these is the best therapy for preeclampsia? a. Antihypertensive medication b. Antiseizure medication c. Intravenous fluids d. Delivery of the baby e. Anticoagulation

D

431. 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? a. Normal androgen level b. Normal or low estrogen level c. Normal prolactin level d. High FSH and LH e. High androgen level

D

434. Which of the following hormones is produced by both the ovary and uterus? a. Inhibin b. Activin c. Follistatin d. Relaxin e. Enkephalin

D

457. A 40-year-old man is noted to have miosis of the right eye and ipsi- lateral ptosis. He reports that he has noted that this side of his face is not sweating when he is working recently. The most cause of this clinical pic- ture may be a. Pancoast tumor b. Brainstem CVA c. Dissection of the carotid artery d. Idiopathic

D

458. 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 a. Degenerative joint disease b. Degenerative disk disease c. Peripheral vascular disease d. Lumbar spinal stenosis

D

459. 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 mul- tiple complaints including generalized fatigue, left-sided dull boring head- aches 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 a. Glaucoma b. Brain tumor arising anterior to the optic chiasm c. Optic neuritis d. Temporal arteritis

D

462. 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 a. Stop dopamine b. Stop clonidine c. Intravenous phenytoin d. Change antibiotic coverage e. CT of the head

D

464. A 25-year-old man with a high-frequency fine tremor that may be difficult to see grossly has a. Parkinson's disease b. Essential tremor c. Asterixis d. Hyperthyroidism e. Drug-related tremor

D

47. 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 a. Polymorphism b. Mutation c. Variable expressivity d. Reduced penetrance

D

471. Which statement is true regarding the optic neuropathy that occurs with combined use of cigarettes and alcohol? a. It is reversible with B vitamin supplements and abstinence b. Color vision is not impaired c. It is of sudden onset d. Scotomas are present centrally

D

477. A 25-year-old graduate student is injured in a fall during a weekend rock climbing expedition. There is serious damage to the peripheral nerves in his leg. Which of the following can be expected to occur? a. Denervated muscles will hypertrophy b. Individual muscle fibers will not be able to contract spontaneously c. Groups of muscle fibers will not be able to spontaneously discharge d. Normal motor function may never return e. Muscle bulk may increase by one-half within 2 to 3 months

D

483. 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 a. Mononeuropathy b. Brown-Séquard's syndrome c. Polyneuropathy d. Mononeuropathy multiplex e. Radiculopathy

D

487. A 77-year-old man complains to you of an annoying buzzing sound in his right ear that bothers him mostly at night. This is classified as a. Conductive deafness b. Sensorineural deafness c. Central deafness d. Tinnitus e. Presbycusis

D

491. Patients commonly complain of "dizziness." This symptom is a. A well-defined sensation of one's environment spinning around b. Usually accompanied by the physical finding of nystagmus c. Usually accompanied by hearing loss d. A loosely defined and nonspecific symptom of light-headedness or weakness or spinning e. A specific sign of impending stroke

D

493. A patient whom you have diagnosed with Alzheimer's disease is increasingly unable to retrieve from memory or to appropriately use previ- ously learned words. This disorder is called a. Apraxia b. Aphasia c. Abulia d. Anomia e. Alexia

D

499. Which clinical scenario best describes a patient with midstage dementia of the Alzheimer's type? a. A patient has gradually developed memory deficits over the past four or five years; the deficits worsen each time he has a "spell," described by the family as "little strokes that get better in a few days" b. A patient has had Parkinson's disease for years, and after becoming nearly immobile, he is also noted to have memory and language deficits c. A patient has become progressively more withdrawn and shows deficits in short- and long-term memory; these deficits have been noticed by the family since the patient's wife and his last sibling died about 5 months ago d. A patient became socially withdrawn a couple of years ago because he could not keep up with his friends' activities such as golf and bridge; now he is getting lost whenever he leaves his house e. A long-term, often homeless, alcoholic becomes progressively disoriented and confused, and the condition cannot be reversed by a move to a nursing home where he receives adequate nutrition and medical care

D

51. In genetics, fitness refers to a. Strong healthy chromosomes b. Genes fitting together on a single chromosome c. Absence of mutations d. Likelihood of reproduction by the individual with the mutant allele

D

64. 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

D

80. The likelihood of two parents producing two offspring with identical chromosomes (other than by twinning) is a. 1:540,000 b. 1:1,200,000 c. 1:5,800,000 d. 1:8,400,000

D

92. A 55-year-old man has lung cancer in the right middle lobe. Which paraneoplastic syndrome is associated with GHRH secretion and lung cancer? a. Hypocalcemia b. Hypocortisolemia c. Hypophosphatemia d. Acromegaly e. Gynecomastia

D

95. The etiology of chronic lymphocytic leukemia (CLL) is a. Due to radiation b. Due to a retrovirus c. A familial disease d. Unknown

D

96. Which of the following is not a major example of inherited susceptibility to cancer? a. Li-Fraumeni syndrome b. Familial polyposis coli c. Familial retinoblastosis d. Peutz-Jeghers syndrome

D

99. 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 a. Paraneoplastic disorder b. Trauma to the lumbar disk c. Muscular spasm of the intercostal muscles d. Possible spinal cord compression

D

205. The onset of the QRS complex on surface ECG corresponds to which action potential phase? a. Phase I b. Phase II c. Phase III d. Phase IV e. Phase 0

E

106. Which of the following causes of anemia is associated with micro- cytosis? a. Folic acid deficiency b. Therapy with zidovudine (AZT) c. Hypothyroidism d. Alcohol e. Thalassemia

E

109. 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? a. Hemoglobin b. Ferritin c. Hemosiderin d. Myoglobin e. Transferrin

E

125. Which mechanism is responsible for thrombocytopenia in von Willebrand's syndrome? a. Decreased production b. Maldistribution c. Accelerated destruction d. Decreased survival e. Inherited

E

14. Which one of the following complement components mediates cytolysis? a. C1 b. Factor B c. C3b d. C5a e. C5b6789

E

142. Which one of the following bacteria is deposited directly into the lower airways? a. Mycoplasma pneumoniae b. Streptococcus pneumoniae c. Pneumocystis carinii d. Hemophilus influenzae e. Mycobacterium tuberculosis

E

146. Persons with chronic pulmonary disease are more likely to develop pneumonia due to infection which one of the following pathogens? a. Legionella spp. b. Pneumocystis carinii c. Chlamydia psittaci d. Klebsiella pneumoniae e. Moraxella catarrhalis

E

148. The single most important bacteria that causes diarrhea world- wide is: a. Helicobacter pylori b. Staphylococcus aureus c. Salmonella spp. d. Shigella spp. e. E. coli

E

150. Which one of the endogenous mediators of sepsis is most likely to be the mediator of shock? a. Cytokines b. Endorphins c. Arachidonic acid metabolites d. Complement C5a e. Nitric oxide

E

152. The destruction of CD4 lymphocytes in HIV and AIDS involves all of the following except which one feature? a. Direct viral destruction of CD4 lymphocytes b. Apoptosis c. Autoimmunity d. Syncytium formation e. Bone marrow stimulation

E

156. Which one of the following causes biliary tract infection, including sclerosing cholangitis, in HIV-infected persons? a. Candida albicans b. Cytomegalovirus c. Cryptococcus neoformans d. Herpesvirus varicellae e. Cryptosporidium

E

158. Which one of the following causes headache, seizures, altered men- tal status, and a space-occupying lesion in persons infected with HIV? a. Kaposi's sarcoma b. Pneumocystis carinii c. Mycobacterium tuberculosis d. Mycobacterium avium complex e. Toxoplasma gondii

E

174. Which of the following cardiac parameters decreases during preg- nancy? a. Cardiac output b. Stroke volume c. Heart rate d. Blood volume e. Systemic vascular resistance

E

189. Which of the following associations is correct? a. Hypokalemia: shortened Q-T interval b. Hypercalcemia: long Q-T interval c. Hypercalcemia: flattened T waves d. Hypocalcemia: U waves e. Hyperkalemia: peaked T waves

E

192. Resting state a. Phase 0 b. Phase 1 c. Phase 2 d. Phase 3 e. Phase 4

E

197. Which of the following conditions is consistent with a hypokinetic arterial pulse? a. Left ventricular failure b. Hypovolemia c. Restrictive pericardial disease d. Mitral stenosis e. All of these

E

198. Which of the following statements is true of a reversed splitting of the first heart sound? a. The mitral component follows the tricuspid component b. It may be present in severe mitral stenosis c. It may be present with a left atrial myxoma d. It may be present with a left bundle branch block e. All of these

E

20. 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? a. Tetanus toxoid b. Tetanus antitoxin c. Both toxoid and antitoxin at the same site d. Toxoid and antitoxin at different sites e. No treatment

E

202. Which of the following heart sounds is low pitched, presystolic sound of ventricular filling produced by atrial contraction? a. S1 b. Opening snap c. Midsystolic click d. S3 e. S4

E

216. Which of the following is true regarding right ventricular hyper- trophy? a. The hypertrophy may result from aortic valve stenosis b. The hypertrophy is characterized by poor R wave progression in leads V1 to V3 c. The hypertrophy is usually associated with left axis deviation d. There are no associated ST-T wave changes e. The hypertrophy is secondary to an atrial septal defect

E

225. The most frequent inherited disorder of hypercoagulability leading to pulmonary thromboembolism is a. Deficiency in protein C b. Deficiency in protein S c. Deficiency in antithrombin III d. Disorders of plasminogen e. Activated protein C resistance (factor V Leiden)

E

228. Which of the following statements is true about sarcoidosis? a. The first manifestation is an accumulation of B lymphocytes b. The giant cells in the granuloma lack inclusions c. It is characterized by hypoglobulinemia d. Sarcoid fails to clear spontaneously e. It results from an exaggerated immune response

E

231. Exposure to asbestos fibers causes which one of the following x-ray findings? a. Pulmonary vascular prominence b. Pleural blebs c. Enlarged right ventricle d. Acute bronchopneumonia e. Diffuse interstitial pulmonary fibrosis with irregular or linear opacities

E

235. Mycobacterium tuberculosis is spread most effectively by which one of the following persons? a. Persons whose sputum smear is negative for Mycobacterium tuberculosis, but whose culture is AFB-positive b. Persons who are close contacts of tuberculosis patients c. Persons recently infected who are culture-negative d. Persons with proven extrapulmonary tuberculosis e. Persons infected with Mycobacterium tuberculosis whose sputum smear is posi- tive for AFB on microscopy

E

282. A 55-year-old man who is a longtime alcoholic comes to the emer- gency room after vomiting small amounts of bright red blood four times today. Your differential diagnosis is constructed around causes of bleeding from the a. Colon b. Liver and pancreas c. Kidneys d. Lungs e. Upper gastrointestinal (GI) tract

E

283. 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?

E

290. The percentage of patients with acute hepatitis C who go on to have chronic disease is a. 5to10 b. 15to20 c. 25to30 d. 40to50 e. 60to70

E

292. A 45-year-old obese woman with cholelithiasis presents to the emer- gency 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 a. Ruptured abdominal aortic aneurysm b. Hepatitis c. Peptic ulcer disease d. Early phase of acute appendicitis e. Acute pancreatitis

E

294. Acute pancreatitis is caused by a variety of disorders. Which of the following pairs of disorders account for 80 to 90% of cases? a. Diabetes and viral illness b. Trauma and hyperlipidemia c. Trauma and gallstones d. Hyperlipidemia and alcohol e. Alcohol and gallstones

E

296. In which of the following disorders will esophageal manometry reveal a high-pressure nonrelaxing LES and poor motility in the rest of the esophagus? a. Hypertensive LES b. Esophageal spasm c. Obstructive lower esophageal lesion d. Nonspecific motility disorders e. Achalasia

E

30. Which one of the following tests is used for the evaluating the degree of compatibility between donor and patient lymphocytes? a. Flow cytometry (FACS) b. Enzyme-linked immunosorbent assay (ELISA) c. Latex agglutination d. Coombs' test e. Mixed lymphocyte reaction

E

300. The presence of gastroesophageal reflux is best diagnosed by a. Computed tomographic (CT) scan of the chest b. Physical examination c. Laboratory evaluation d. Barium swallow e. Medical history

E

301. The most common location for a gastric ulcer is a. Fundus b. Greater curvature c. Cardia d. Body e. Antrum

E

310. 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? a. Small cell carcinoma of the lung b. Gastric adenocarcinoma c. Small intestinal carcinoid d. Prostate adenocarcinoma e. Gastrinoma

E

311. Which clinical or laboratory finding is most consistently seen in mal- absorption syndromes? a. Hypercalcemia b. Iron overload c. Elevated zinc levels in serum d. Normal small bowel biopsy e. Steatorrhea

E

314. 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 a. Ulcerative colitis b. Appendicitis c. Diverticulitis d. Irritable bowel syndrome e. Crohn's disease

E

320. Which term characterizes the frequency of chronic disease following hepatitis A infection? a. Rare b. Infrequent c. Common d. Typical e. Nonexistent

E

322. Which of the following is seen most commonly in association with primary biliary cirrhosis (PBC)? a. Positive antinuclear antibody (ANA) b. Increased ceruloplasmin c. Increased ferritin d. Positive hepatitis B surface antigen e. Positive antimitochondrial antibody (AMA)

E

344. The most sensitive indicator of infection with hepatitis C virus (HCV) is a. Anti-HCV, first-generation assay against C100-3 b. Anti-HCV, second-generation assay against C200 and C22-3 c. Anti-HCV, third-generation assay against C200, C22-3, and NS5 d. Antienvelope proteins E2/NS1 e. HCV RNA

E

349. The most common cause of portal hypertension is a. Hepatic vein thrombosis b. Hepatic venoocclusive disease c. Noncirrhotic portal fibrosis d. Portal vein obstruction e. Cirrhosis

E

353. Which one of the following disorders of bilirubin metabolism shows increased unconjugated bilirubin, normal conjugated bilirubin, and lack of bilirubin in the urine? a. Neonatal jaundice b. Crigler-Najjar syndrome, types I and II c. Hepatitis d. Partial extrahepatic obstruction e. Intravascular and extravascular hemolysis

E

356. Which one of these drugs is of proven benefit in the treatment of per- sons with hepatic encephalopathy? a. Levodopa b. Bromocriptine c. Keto analogues of essential amino acids d. Branched-chain amino acids e. Tetracycline

E

363. A 31-year-old man with HIV comes to your office because of nausea, fatigue, mild right upper quadrant pain, and anorexia of 3 weeks' duration. He uses intravenous illicit drugs and does so regularly. However, he previ- ously received three doses of hepatitis B vaccine on the appropriate sched- ule, 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 examina- tion, 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 ele- vated. Which disease does he likely have? a. Cirrhosis b. Wilson's disease c. Hepatitis due to HAV d. Hepatitis due to HBV e. Hepatitis due to HCV

E

396. A 47-year-old man presents with headache, impotence, and galac- torrhea for the past 2 months. A likely hormonal profile on this patient would be a. Low testosterone, high LH, and low prolactin b. Low testosterone, low LH, and low prolactin c. Low testosterone, high LH, and high prolactin d. Normal testosterone, normal LH, and normal prolactin e. Low testosterone, low LH, and high prolactin

E

407. A 30-year-old man presents with weight gain, dorsocervical fat pad, and proximal muscle weakness. His urinary free cortisol is significantly ele- vated and does not suppress with dexamethasone. The plasma ACTH is undetectable. Your next best diagnostic test is a. Serum antidiuretic hormone (ADH) b. Chest CT c. MRI of the pituitary d. ACTH stimulation test e. Abdominal CT

E

417. 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? a. Hypothyroidism b. Prolactinoma c. Early menopause d. Resistance to LH and FSH e. Excessive exercise

E

422. Which of these medications treats benign prostatic hyperplasia by 5α-reductase inhibition? a. Leuprolide b. Nafarelin c. Flutamide d. Megesterol e. Finasteride

E

43. Which cytokine antagonizes or suppresses many responses of lymphocytes? a. IFN-γ (interferon γ) b. IL-2 (interleukin 2) c. IL-4 (interleukin 4) d. TNF-α (tumor necrosis factor α) e. TGF-β (transforming growth factor β)

E

432. Which of the following organs does ovarian estrogen production have a stimulatory effect on? a. Ovary b. Brain c. Hypothalamus d. Pituitary e. Vagina

E

438. 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? a. Nafarelin b. Flutamide c. Finasteride d. Megesterol e. Prazosin

E

442. Which of the following is not required for successful breast-feeding? a. Prolactin b. Oxytocin c. Good maternal nutrition d. An intact neurologic axis e. High estrogen levels

E

443. Which of the following hormones in excess causes male infertility? a. FSH b. LH c. Testosterone d. Cortisol e. Prolactin

E

445. A 52-year-old female presents to the office with a chief complaint of postmenopausal bleeding for 2 weeks. Her menopause was 7 years ago, and until 2 weeks ago had no vaginal bleeding of any kind. She was not receiving hormonal replacement. Which of the following tests need not be ordered or performed? a. Pap smear b. TSH c. Prothrombin time d. Smear for vaginal infection e. General blood chemistry evaluation

E

449. In which ovarian compartment is basic fibroblast growth factor produced? a. Granulosa b. Theca c. Follicular fluid d. Follicles e. Corpus luteum

E

469. Which of the following muscle diseases with weakness is an auto- immune disorder? a. Becker muscular dystrophy b. Myotonic dystrophy c. Glycogen storage disorder (acid maltase deficiency) d. Duchenne muscular dystrophy e. Myasthenia gravis

E

472. Entrapment of the median nerve causing carpal tunnel syndrome and if severe, muscle wasting in the thenar eminence of the hand, is asso- ciated with which of the following diseases? a. Hypothyroidism b. Diabetes c. Amyloidosis d. Rheumatoid arthritis e. All of the above

E

484. 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 pos- terolateral thigh and lower aspect of the leg. This is characterized as a. Mononeuropathy b. Brown-Séquard's syndrome c. Polyneuropathy d. Mononeuropathy multiplex e. Radiculopathy

E

495. The inability to read printed words is known as a. Apraxia b. Aphasia c. Abulia d. Anomia e. Alexia

E

500. Which cerebral artery is blocked in an ischemic stroke that presents with the following symptoms: aphasia, right hemiparesis, and right arm numbness? a. Right anterior cerebral b. Right middle cerebral c. Right proximal posterior cerebral d. Left anterior cerebral e. Left middle cerebral

E

7. Which one of the following is the most potent and effective antigen- presenting cell (APC)? a. Monocytes-macrophages b. Mast cells c. T lymphocytes d. B lymphocytes e. Dendritic-Langerhans cells

E

496. A 30-year-old woman undergoes surgery for a very large, but fortu- nately benign, brain tumor. For 2 days after the surgery she is unable to perform certain previously learned motor functions. This disorder is called a. Apraxia b. Aphasia c. Abulia d. Anomia e. Alexia

S