Note; This material is eopyrighted. All rights reserved.

Edward Goljan,

M.D. 2003




in laboraiorymediCine

qnestions! this I'tlaterial iscoYeted

P:atb61Qgy mg:1)c Yield


GenetalprincipleB s¢;cj:it>ll

in the

Assumi'!1g the 4Si:l .Qf 2 ,stl!'tt4;!r!:!.dew3J:tQIls.I:() (lstablisl1'tJie ('efer'el}beird,eW!l1~f a tellt. 5tta ' teference interval of 10-30 t)tgfdL, 1 standard dev:iationwouldequaLc.

test With







R 20JJ Ans'W1:r:.B'-~ean ufthe test is 20 mg/iIL, 2 So = 1:1) tngldl,then:fote 1 $]) = 5ingl.dL 2" ]f the ptQsf,a,te' f;jelt:iQ@'I;i$el1(PSA) t{:stfotptQS1;att) ~Mcer 'ISIOWm;eq :i'tQm..l:J: :t;!;fl'etMqe ~ jIltewiilof

o.-fO ~s1mI,gQ4~nlVit1L>this will... t A. increase the nuniberot'falsenegatlves

,de¢t¢.a&eth,lM;1t!mht\r (Jffals~po$jtivl;S increase thetesCs:speCtTIc.ity :D. il1¢:tea'$¢ me)'V " E. :inqte<we th.epv+ ~n$w~r.;D-~_l).¢:te!):slJ;r!l§en:si'!:ivio/ (lessFNs) by lowering the reference interval automatically 'lhepremcti:Ve yaluc;ora .n¢;ga'tive. test teS4If 3. Study the J6Ilowmg schematic invdlvinga controlgroup and.disease j{. Normal Disease X






Reference interval which ofthe follOwing correctly describes test.results in the space occupied hy each of the lettered


B.OroupB:ttue negatives + false positives C. GrO\1P C: 1r\le positives, + false positives D. (iFOUP Drtnre positi' fillse negatives AMWC'ri C; .gtQu,pA = ~ll 'l'N.s, gtklpp.13"" TNs + FN~, group C


A; true negatives+

false negatives

== FPs + IPs, grol).PD=all TPs A pregnant.womanin her: first-trimester has an e1evatedscrum T~ and.normal TSH. Physieal.sxam t$n!;ltmat Whi))hefthe folloWing 'b¢~t explainsthe thytoidfunctlol1 stJitl? results? A. Thyroidhirtding,globulin is.increased

C. D.

Free T 4 horinoTielevels

ate increased

Estrogen increased the synthesis of thyroid hormone Progesterone increased the synthesisof thyroidbinding globulin E. Patient has Grave's disease Answer: A~ estrogen increases the synthesis ofthyroid binding globulin, This automatically inbreaslls the total 'f41evel, since TBG hasTd bound to it. However; the fre.e. T41evel remains unchanged, A similarquestion {lo\11dj}ell11.inp):,ea8e in. serurncortisol in a pregnant woman Who has no signs of Cushing's syndrome. Estrogen also increases the synthesis oftranscortincthebinding protein for cortisol, hence the increase in serum cortisol, but no signs of hypercortisolism since free cortisol levels are normal,

Note: 'This material is. CQPyrighted. All rightsTcserved .. (Edward F. <ioljan, M.b.J 2002
Cell Injury questions L.:I;1;ypcrp,lasia

Atrpeatart¢eQftbe at~t;d lddnt(y in rCfiOvasl.\u'lat hypertensiot; B, T!:Ii!,;Kefieqpla;4dj:5tW*1l1 a patienfwith urethralobstruction in C.Barr.etf&~pph:agus in a patient 'With gaslfd¢sQPhag'eal reflux D, E~l!ll:gl'd l¢i.'l;atrilJm:jtt api;ltj~t with, severe mitral s~sis E. Galactorrhea 1n a woman with a prolactinoma

is primarily operati:ve. in which of the fdllowinggroVlfth alterationrl

Answer: E'-- enaocrine. stimulation of target tissues is. invariably hype!;plasia. Choice A isatrophy,cholce .B 'ishypertfpph)'~ tthoi¢6 Q ismetaP)@!A; l;;llolce D is hypertn>Iihy 2.Wh1ch oillie foiiowmgdisorders isan example ofcoagulationnecros1s.1

B, C.


pnel,ij;ijOijia::m @a)pQ:Mlfc

D, E.

"Answer: ~;IIi (SaO ..)?

Dim~tiishedl>t'@in lj,$~iu~ P4ti(lnt wiffl Alz,he:nner~s dis~e m 'Emh.ol1:lStQ the superiQrmesenterlQaitlrrY leading to bcwel i'ntan~tiQn E:-hemorrhagic infarction. Choices fI,,~, aild.C are:HquefMtlvenecrosis.Choice D1:s11.trophy, whiCih pfthr,; i'~l1~w.i'ng,djsea.l>~swoU~Q: )l9Q expect '.~low atte:ria:l J:1Q~'~d··a low PX;fsensatutation

;II¢p!!;j:Jca~ss in ;t patient psellOQn1i\:n;l..l)tlifiQU',Sc,lilltls

ina pll;ti:¢ilt'onatt!piolUin



A. C:afuQtij.nQ1iQ~f!i¢ "PQ~s.Q.tillJ.g $.ltqn ,defi'eieney,anemia D. 4;


E. Cyanide poisoning Answer: .D~.chorce A has a lowSabz,

Wliichoftl1e· fQlln\¥~tJ,~disQrde;t'sis.@eX@lplepfmetaplasia?

choiees'B, 0, and Ehavea

normal PGh and Sa02,·choice


Answer: B~$obletee;11s.ih.the maID.stemhrQuchus are an e;xample ofhypetplasia. terminal 'bronchIOle,it wou[d be metaplasia. :Cllioices·G andDare. hyperplasia, gtfMtdQrt1atQ.llS n:fl~atip'Q, + .

0.. E,lv:I):tl1;it)J+:cl:®fi,!tJ.giaut;

S<{VatnQfi$c iJ;h!;Ii:Ufu lit the ro:ainstem otp.nohll.s ora smokei' ~ l':rQlif~t;Il:ti:v!}.;n<iometrial glands ina woman on unQPpqs¥d 'esttQ"gen. r nyp'!li$ Qfthe'~njj:Ia patient tYlthPsopaM'l

Increased goblet celts in the .mainstem bronchus of a smoker

ee:l1$w a' gt;;u\ulolllll.

If they were in the Choice E represents


A4--yeiiJ;:Colcl,chi19 With r¢'cUiterU S(ri'phyllJiJ.()e~d!lt:¢tl$· i\1feotibnsaftdan
MOST LIK:E.LY'}J,as ~fl)J;., A. defect ia SJi.ecttitUJi.the cell membrane B. defectiamiotQttibul¢ poIY111enzation C. deficiency of IgG gamma globulins D. deficieU¢.Y;of NADPll o~idas¢

.absent respiratory burst

E. deficiencyof myeloperoxidase Answ~r: . Th-. patient with MPOdeficiency would have a. respirat9ry burst but WQ\.tl4 still haVe a·. tnicmbiclc:1al problem ..Ihaddition,tbere<ire no azutophilic gtanulesin .the.cytoplasm ofneutrophils. 2. Which Qftbefollowifig is MOST responsible for the anti-inflammatory activity ofcQriicostefoidS? A. Increased leukocyte adhesion to endothelialcells

B. C.

InhiJ>ition ofphospuQlipa$e,A,2 Destruction.ofeosinophils Inhibition dfcydoox.ygemlse


litis.Unm~ Wl$.Pte.rQi.C$a activate these cells Answer: D-'causes themto releaseprefQ. interstitial tissue.umbilical cora to fan off. 'Thecliuical and histologic findings iuthis case .occus aureus 'Pr~duee§ coagulase.c¢llu.are MOSTCLOSBL'Yassociated with a defectin .Qt)~s p.52-year-old mall with ditoni¢ r:¢nlltJailtJ'tt. Items 7-9 A.ent.of m:yel()p~t>~idase . is uS4!). St<l.:q aP(l 1I11owsthe infectiou' tospread·tirr0ugh.hypovolemio or 3 .serotenin 9.mgesftbiiMgen itjJp fibrih and lbe<iIi. A newborn child has faijlite:o£'s~atatl6it of the ufubill'calcotd.. 3. R C Maorophages It E.llrIDII11ltiOIl' Pseudotn~ll1btru1{tllsinfl$1I:nl('fi:oh Granulomatous 1nflammation B.gtoswelling. the respiratoryburstmechanism an .les. Plasma cells They representfhe-eplfhelinid are activated cells and nnrltinueleated Answer:B-they 8..tJl.i. hence 'th:ey cannot emigrate into tissue •. the ptoduetiOi'I.leti chemicals like histamine and. Golj.fQtlpA ~tr~~~mv¢o llyal\it~n:t~Ill(~preadiu~ fa¢1.N(jt~.hotreit meaol IDflammatiQneXtending around the righfpenotbj&l t1$'suele!ld!n. f\1:. . 4iJ!ieilep$etlcl()m~tii:!i):mn()ti$¢()tiJi$li:a$'a 101o:fsimi1MHes With dlp'htIJ:¢ti3 heard over: the anterior chest Answer: C~ WS is Ii: perj'car(iial mctImxrub att n.wer~]}~n. lnus.ildhesiohmdk¢lile III rte1Jtt.recall that eosinophilshave Flnids and hemodynamics L questions: characterizes early endotoxic crystallinematerial in their red granules by r-interferon giant cells in a granuloma released from helper T celis erystaX1i in the Which of the following cardiogenic shock? A.t1s 'inflammatfon Swppmatiye ~l.®il¢lo~~ Qnh¢~f~ AmWelt aud a sm-afchy3 t:<itfijJQn.For the.subcutaneous tissue.soUnit A febrile' 3-year-oUI child bas a(li!lUse~ralsed.nel1ltdophns¢.llu.1ltiitinl7Mons.reduetion ins.¢ thf~tibtil¢ading f'(O abscesS withdtainjige to ·thc Ilwfacethrongha .phyl(j(. A . Hist6i6gic'seetions ofiIi:e SUrgically removed cord t()y(:'aJ ® :aba~c¢of. which ch. 4. Neutrophils A febrile 8-year"o-Jd plHl(kWho has ::not't'¢ceive[atiyi'!.Dl)2{)02: E.lhe. Warm skin (septic) shock rather tharr.'\. This material iscopyrighted. 'has Ii' gi'ayish-wliite. G. complement system B. 'CelluIitis Fibrlno. D.ot adhere to: the ¢rtdoth¢lial cella JIi the venules. .glnatioh ®dqrmlWlUQu mto flit'..:'basclie$tpa:. A activation of the.yntheswof$othprosta~lan4ins amlleukotrieJ. Thegranules of these cells {.nelitrophi1 hU)t.zestlj.nt). nems3-~ A.ji. s . micr<itubu:l¢ 'PolymcBZ!ttion C.QPliils E.exm'late in the oropliatyn:x )in'd'prominen:t cermQ41IyWIlhiU:l~()p~th)! AJl$. C3a.. Masteefts Eosinophtls 7.nswer: D. it 'must have neutruphilinfiltration QftMtissue leaWIig iOl1eQ(Qsis. 5. E. Inhibition of lipQj{:}!genase Answer: B~ inhibition ofPLA2 ~cadsto a.withoutadhilSiMll1ple'ciJles.¥c9t~Leydeh sputum of'asthmaties Answer: C.. 6. (Edward]!..inteft:aqfiIc Il1aterialthat f(!lm Ch.1\l1 tigbtsres~ed.JQu:t<J.and. C.

D.'!Scin WE. c1. D.t ofthispatieiJ:a A.* clul.A CTse'iiii of thebrainreveals .lesions.increase in hydrQstafip pressurecausinga ua:nsudate .hypcrt¢jjslofi a'iIdadecreas.owing woUld be the MO$TAPPROPRIATE management of the patIent's sodium and wafer C.tletipber.hasdependent of'the arm post-modified in~¢2 A B" G.:g findings BEBT represents this patient's clinical disorder? D. R~ in cirrhosis..e 2. SetLlID ek¢tr~~s ·¢ 'l~O:UStetu1n to the heart .a1eftpleurlJ..11t.:.¢.frotn with a small cell carcinoma D. Decrease i.:3" . since-the 1'BNa ISnormal.itMco4ide.B.x of choice is to restrict water. has a mpturcdabd()lt1Utal aottic aneurysm With ie:ttOPPritQn..ip& a l'~tie)). D. sernm ~bdiuQlQf n.:D¢prelJ'Se Increase Increase ])eilrease N'Q¢hange.sUte.t b.chang!.u1g¢ Decrease Water intake Decrease Increase No .and water.DrriEctlL {U 6~J4$ mEgiL).S.t. pr~::. brgdYki! edema btlll1(j space ocCtipyttig.preS({I1ts a tr~nsudate:.lefft!sion i R Patientw1fu :CDngesnveheart failure with bilateralpleural effusions.l.. DfllIt10nal byponati¢tnia favors ~ PSnlotic gra\. Patientwitheoerila wj.~r.~tr!mt. A"'$". 5. TPR 4 = total peripheral arteriolar resistance) .h.1.aQsoFt>S sQlut¢ftee WaW from the kidneys.R. E.. 'there js llQevit'letice tte.¢Jilt. LVEDP Increased .dlia:Q.rel~iu.l~to'1h¢ del. Nermal B.e.ed~~t w1ri¢hp. Patientwfth pneumonia.ecQndaty Qncotic. G.witba.the patient has inappropriate ADH syndrome.i.). A 62"year~1(J 'iii!I1l.reasein pifting' edema radical masteCtomy p.d(3. whteh otmeas¢$oiJ:cotl. hence these Nodliange NQchange Answer: D.old . status of the following is the BEST :n:Qti:"'Ph~¢()logic B..aY~l1. of pitting edema or volume :depletion. Choice C is iyrnphe:dernll> GhoJce E fsan . Answer. D.1.tos. C. Since ADH rf:.esistau~ DeCt{)a:.t VY)~ri&4t-$t4¢ti:peaJ:t fa.C'hoice~ /\'.trtllJ.J'bnortnalitil.e.e in there are 2 alterationsfn Starlingis ferces. Whi9h oftbefbl1oWin.. 4.all Increase in hydrt1Statfc pressure from pottal -Vein. patient of anaphyJatox1ns) toap .licnt moving water into the lOP who .sodilatlltio:n(l1istllmine.lticreased Decreased cardiac output totaJ. The . No change No .{ncre$le SQ!llUmintake Decrease C. 'IS!. SmJipmintake Watet"intake Np.I). Decrease an excess 01 salt.Q.patients with heart fail ureand pitting edema have mus.ttou wh. A~ d). ceteOl. Which of'tli:e f!)UowitlgedeIThi conditiopste.: LVEDP A. which of the? lung presents with mental.TPR Normal Increased Cardiacoutput Normal Decreased = Decreased Increased Decreased Decreased Decreased Decreased left ventricular end-diastolic pressure).P! A S8"yearc. loite fol.Uur~ who W1s tl¢Pe»~ent pi~f?. pressure? A. the excess wateraistnlJutes in both the ECF and ICFCbrripartments .114 :0 are examples Q't exudates."!'ef\1riqted.changc ~nswer.eal hemorrhage. I)¢crf:as¢ E.ictfrfen. who haaa pleural effusion B.

is a pure vegan 5 who is bulimic .soP'(t.:S.Answer: C~ the patient is in hypo. serum: F$H C. B.).t$ed Decreweij Septlcshaok Which nhhe.onjbocytop¢Iita.1lanQ:y't¢:rt rs 1i¢giitilre. The mechanism tor this patient's clinicalais"QrderismostdcrseJyassociated A.. 'sec. and a hemorrh~~ic diathesis are expected in a patient .lsed Ncrmal ))'ill. returns 't()· your oflIce . bike decreased. wei~ht loss syn&Ome E. A.Qn<i:ary :hW!. PeCl:c. hence the cardiac output is deereased. withdrawal blctilding.. Normal Increased v:a.rr. audl11¢n't:ll'stattlS:~Jmtl~Ii$. Atit:1rte. 'Fortyetght nOl1(s. night blin®.. pneumonia Answer: C-the parienthas NutrUion D. later" he develops a.l'or:der:1..pJ(t Normal Le·ft~ideu. Note the' time delay before symptoms oecnr. 7.ate. A. .t-jIbtm:e fraowres <Ui9multiple pel'Viofl:act:UJ. E. WBC$) . to c. serum TcSH is normal. atidmanarterlalthroml:ius? B. sudde. to osteoporosis. questions: optional. She shouldbe placed on birth control pills.g. nc:iU1failtJte Xaterpri.. low. air:etribolj2atiol):})tiJ)x>$enis present 1n bofhvenous thrombi.iidis1.E. :Malerial in HiJl'b:Yteld L A 2S:year-oldw.pi:'~!'.andinatte«althtoitib:i :(a~gregatM plat~lets'held togeflier byfibriil. Ten days later the.NnenQuhea leaves the patient estrogen deficient rand prone.¢s'front a mountain.ypetkeratosis.Curvy with hypothyroidism .tti(ti).. She is 5' 2" and weighs flO pounds.sin.petechial l«$iQPS. foUowJ:ngis 'aooagumtibh factor 'that is utilized ilibofli ahbcolusi:Ve 'Veit()usthrombus It Normal trlt Inctt. Gll) are Increased.uqiesteyeaI h~0xetriia attn tJn.tlilrirtjectiol1 of progesterone.cMlaromes.and reports that she had no and LUare. (:lIbrihclot trapping RECs. ~T II.omatt hasnotltad 1terperio:d for the last S $tf~ngIy suspect the patienthas . and serum cortis91 and growth hormone>ateiMreased·. D. with '" fatem:l:i". pUlmonary emb()'Hsm C. who. with CYBticfibrosis wi~hl.A" ptima:r.r ()W'ti®. C.llzatfo:h E. disseitliili(te41ntta. n. sm:ceplasmavolume LVEDY Decreased C3filiae 'O)1t.honn:ones (cortisol. She states tha:t she has beefittYing to 'lese we:1gbtJorb:()r upcoJ:!1ing w~din. . Vlatdets. C. Fa~orVn ribpno~en J:i1actor IX FaCtor OX Factor XU ~$wer. patien..Y'ol.t9zyst.Lab\lltatQry'!sfi!iil1sb:ilatet31" fen!. Cushing'ssyrtdtome. A.C'l.em:bollzation. fQ)lowin~p serum prnh'mtinis fl():ttnal. Follicular n. 2.onsefof dy~pnea.!t.~$~Jilat tQ:'l¥gulati~n B.S.Qjse!:ls(: 'Itbypopltuitatlsm D. old :mm. A:49 yt.lthyx~. Note how the stress . serum estradiol is low. Answer: D~auotexia MrIi'Qsa.{ l!altezy :of tests@dgt:vetheP:t1i'ent an in1:famu$. .l1 D. revealtbe.voleruieshock.BaSedt'inth¢s¢ findings.. LaP~t.~dthe $(1 :LV~PP . .TPRis incteased du~ is decreased.

WIUch Df:thl:< signs pr .i'ii:i. mal!lj. m1neral1Zed properly linais s<>f1. HypQcakemia . Metab.c:y. of protein aep:atomegl4Y .a ia¢k.ChQ£ceA is'scurvy. with rtta1d~gestfQtl secoudm:y to' cbtonic :pancreatitis A. E.insnlin recep:t:orsynthesisptedisposing the patient-to type II DMor glucose intolerance.luse fat soluble vitamin deficieuQie$ .choice D is thiamine deficienQy. lIy:p. while.. s(ilublewtathin • I'eripheralti¢utopathy OPh1:J:mltnopleg1!!.iwa~e. <6ahn:ie lntake :0.cin which isfn a bound form tbatcaiiIiot p<l:abso. D~ Qutadeficienc)" whose diet primarily consists of"Com js~·pweYQ&l\J). E. Answer: C~increa:..1S. the latter having an increase in free levels in the urine. who 'is taking isoniazid 6. bulimia...Answer: A~vitamin A defidency.r!l±i~nts vViJh'CE ~i. f:J.vitaminK deficiency accounts fQr the li<:!rrl:ii>rdla.nSW'ex: n':"'comcpd. c:hQ~qe. b. lower lipids E.o:dmgsl'.c.Piloj:nt4tmnatitj$ Reduced. BOllcpajJl<qld tetllny vitamins. "1.Qse D.~.!. Normal serum gonadotropins. choice C .cholc¢ D 1S a bY"PtodUctqr..¢ro .deficiertcy.wi1i. yridoxine deficiency.s. 8.~sulfafe A. '~.ff!~it()g¢tl..ting gllJc. 4. who is taking nicntiillc .explains th~'t¢tiIDy. D.. to:ta11ynipho«Yte . A.causesbonepain and-tetany.Ci$ 13.111. c.vitamiD Ddeficieney . D. B. B.l ai'Pap¢nt with 11):Qtbidobesi'!y? Increased serum 1'SH Increased 24.c.W>iDI'1.I.c6tiJ. cortisol C. since the bone. l.alkalosis pyndO'X:ine deftp1e). malag!>Qrption :al'Id 1l1ek all the fat soluble 3.Pming etle:r:l1a .hr urine for free.accounts for the first 2:symptoms. A urine for free cortisol clearlyseparates (jhesjty frpin C\JSlting!s syndrome. lsnoJ. MOST eXPe:¢t.okalcroili®?:ekwashi()(kQl:'j Wh¢te. B'rMmsti:ck extremities AlJjw~f.\:w.whl:clLOf fuesignsiOI:$ymptoms are.cP9ice::E\: i$ pl'lIJa~ p¢ d~atlll$is.A. D.add to. associated with anorexia nervosa than hu1lnrlanervosa? fi. & all fMothet 15. .fucreil$eu (as. Ascorbic acid .a UQfiI)<[f'tOta). N()®l)llJQdy. Increased 24-:hr urine for 17-ketosteroids E.: and ataxia Hyperpjgrnentationinsun. A.~pwms cbar?¢teriZ¢'a. there is .pl:iril. E. Whichof'the foliowinglaboratory test abnormahtieswould YQlJ.. WhiQh QHhe followmg is :fl1oreo. cliount 5:.moreprom1nently'fonndin maraiimqsth~~)ljQrkot~ C. ill a patient . c.gjt~t®e tofracture. ~p$t¢Q$l~gia}l~.t:hed: 'Choice A is w)1J) Will MOST LIKEL'Yde:velOp.tainsiiia.s.ften. AlIWClJthetfm:(tiJjg$ are more eo:t11iiibfily'seen .gestipn. I:ncreasl':d serum DREA. Which of the followingviramia-deficieneies would you expect in a chtld maihtained (jIluulortified goat's milk? A.edadipose down-regulajes .ex~secl areas Answer: D.Pe1l~gti) A.12 deficien¢y.cnQice E~ ..'.nlacirr. P¢mQl1iculat h¢U1QnlUl:l!¢ B.t soluble ntth¢t than aWjt¢r deficiency? .K.. 0ste()pot(j~js Allsw¢r: E~ due t.

Q(ltille' rny.dehydrogenase. Thiamine Niacin :PyridQXWI:: ~1:t ~n~wer.$Wtr. A.. a Robertsonian translocation. virai.ttiJ.disea:se IS.l(id:tsc. M.t legS' when walking.ce1)tl'CoA Xm).E __gl. Th¢ "pai1rogenesisoT het .¢'s en<. to' 1. Al:1at plateof the abdomen reveals airin the' stomach proximal duodenum and no air in the remainder of the has repeated vomitin:g'ofbUesi:aitted material.lrtg pynivate. R thiamine deficiency C. acute Wemjc.whQ ate pregnatil slIO'elldbe placed :61.dingsite .Note: This B. Thiamine Allrigfitsreserved.iencYofAT:P B.ce$.t'smilk is o~ficientinfQlat~ Md l'yrl<l~~e.go:n i:)9:nfi¥iping % glucose andn(i)tma:lsalitie.. Pwkipje celliH:f9phy D.l.elit. HeMe. Giving. g. and paUl D. 11.K in hl. material is copyrighted. 11. ' Ascorbicacid C.ttism of the c:hild'sdiseaseis:InQsfc1osl:..i$ CO:t\rain:~l)g folateatJ:diron. the pil. Optional L A . nondisjunction inmeiosis D.l.p:f"cQnfusi6n.plate1etdysfunction Answer: C~the patient hasscurvy. C hydroxyjates lyslne .:.Thtaxntne j~ . A 3~O year"Qld man develops an acuteort:>et . B.1.?]-yeaf'.J.1)ofllctpr fot the . ~Qlli.ataxi~. Folate A:u.cdHagen is weakened.ltilYl. J3.ct(On uS.12 I5llPplementsinadCllffon to theusualprenata:l 16. A fi5...In delivers a full-term baby lh.. a point mutation of a nucleotide E..nystagmus. This is fhe bi1. arnicrodeletion disorder and 7 . h~1..)200:Z Niacm D.h~nce precipitating. '. Fe GO:1jan. 5 The-pathogenesis ofthi'spatient's neurologic disordeds A <:¢p.B"".rfl.¢ep1'l. 'hanging upglucose.)a. .gie.Wthiatiiine before.~year-old 'Woman eemplains of bleeding gums 'a'tferbnuihing her teeth. The maternal 'serum o-fetcprotcin level is low.1. (Eaward. A.!.old WQUll. Het phlj:e!ct !{"o\. Always' give . Alcohcilexcess is the M'CCpf:thi¥I1irte deficiehcy.¢).¢phalqpathY..a~p.IJ. acute Wernicke's encephalopathy. Which of the followingvitamins would be. '. AnS. a del1(..ucy in lysyl O. tnsctttVy. .9fl1:U' 'a Mendelian disorder B..Wts . and oplithalmoplegia sh<!rl1Y . D."Mt\lt th:¢ a(im:itlisti"atio:n of an iti1t!iVtmol!S.Ple tej) JJi2defiqiency" 1 Vegans ... asseeiated with .pywwte'to 1j. encephalitis mostcloselyrelated 10•.n6tt:Qal. Genetics questions: material is covered in High Yield E.wes!js.b:cidges that strengthen collagen by creating attipleheIix.tientglucose man Ncauses the restof the thiamine. The met:ha.E~ pme v~s 09 not~'lJ Pleat ox (laiprrn.andproline. lack of hydroxylation oflysine and proline aCQi. MOST i 'CLOSELY related to. deficient in. easybruislnil" .. Vitamin E. a neWborn "hUd with anemia: whose mother is gpltre vegan?' A.~1l<ncy the~ymptom¢tllnplex descubes. The baby has 46 cnromosomes. Qofagmx deficiency in collag¢t)'l!$¢ C. 'vi'UU. C.1'Q1' 'mecross. Riboflavin E.W¢t·. !iS~ii t!p.

.ome have different clinical features.theIngumalcanal :B:.sigp. While examining 'a 13-yeat-<Y14 boYduting a' tl. lie~t.e1qeation on ttJ¢satne chrQrnosj)me.¥Ol. d9min:ant cQn<iitiO:Q.Qna1e) di. therefore cll. hQmQZY$~i.children witha.m E.tnI.(is~e§m'en{)t<lq P ilAPl)th jnguml(l .elltFait. the :extema:1genitaiia remain femaledn appearance.has atresia. 'pt"Qsliategland . o. hetethe 2chrQ:t.@'rete w. aRobertsoniantranslocatien C.. where the mother had 45 Ghr'ow(i)$omc. A.• . Which of the following sfu.ultwotiIdb. A speculum exam of the'laglnainiHcatesaHmd pouch.estexplailt all oftheabnortnaliti~ noteoon the examination? A.linked. abnormal (3-chaih.yatcal exam rcvealsmormal fettu!'test1X 'ChM4~«ltj$ti~J~.ll'l@ j:.MalS. This is an example of. ut~I1l$. ()flheirchildren to: have sickle cell disease E. left unsfinmlatedby DHT. tdentincation of tripletrep. 5'0%. Some genetjcists.1.nt.sinus. M. . seminal vesicles C.tij. k :ll. setniual vellicles.ltQItl. duct structures.ovadesin.o nettransilluminate. Sirmlarly. 5. 2.. Y<Jucall the $choql CQunselor-and imd that the child has a moderately severe attention deficit syndrome. 25% of . generationsin both the affected males and the female carriers..'hea.lQtjllephys~qa.tQ:a5.pp¢ron~~third oft1).sInCI.theit chilMen tQha:Vesi~ld'e (f<.Attsw~r. C:pteSticu11it ferilitii'zati6ti.and a nriQ~:>y!. ani. variable expressivity ]3.pJdid:Y.i. ' " . nan-tender' testicles thatd. B.n'Iit DOWhs.r future. (Eilward F.. of their children to.hroti:\QSQille :$Js. CfuOtnQsolIlestu:dyon.sofdiloden:al Ihdicates a Rober:tsonlan translocation.ltito haxem¢kle ¢elfWlit M$wer:~ :B~.gQn.l:lfotllmM.. n. hcrwevex\ there.3td~ of th~ vagw. This is atril?letrepeatdjllor.sorder with absent androgen receptors. this is ' blind po:uGli. ar:e3fttrtctioual ¢.. You would expect thfsJ~atient fOe als!}have .\s..Q11s. SXR.n~~ chrornesomes.IeXi$iAll.. ".sjc]Q¢ gerti'. C. n~~(jw~t 21.on is the cause of t9~o~¥21.easenas .d)oyi. .lMt¢ 'bllaterally . genetic heterogeneity D.}11atienthasfragi1eXsynOtorrte.D~) 2002 4.$ .. .recesstve disotd. from Mdcty IJ:IIJ body ona bqccaJ~m¢il.Prader-Wl11i and. Echocardiqgp. All miillenan structures are destroyed by apoptosis.. All rights reserved. C. father i\:nswer.wi):h prlmaty>hettce the disease getsworse .ll this aSe.@. :E.based onjhe IQW serum q." A.jse patients donothave mbes.9'e~.!1: it t~r¢setit$ the J)tQg~t\iW .. :fetal testostetQne c@I):pf$hm~late $-e ~e~elQPJ:11pnt :of a. a high arched palate.(.. .d9tro»#1$ n.!adto f()r.c.faptQsJ. genomic imprinting 8 . you would :exp~t .dihydrotestosterone cannot fuse the labia j).:n e.die$ would you .e.. p.ananOtogeti tece'p1ot \1encifupy J). sjjjc.nswerc B-tht1patie.i. . D:..S fot lacking the. However. B:Uc£al Smeat S'li):'U.esic1dec.<1l4is~e D. all the: children s \\dilhalV'e sickle trait 3. B. 1:1:' an Amci\J1 American \YQrnlID with sickle¢ell dis.Noudisjunctl.J:tleljiik followe\! by a shott rnurmur.. however they both share a 'defect atthesam.dey¢ldp. Goljan.ategland..!' the' l:lllIli is hi:)].<i. P:b.tnati:Qti Q.r . .li ext~[\!1 the: :c:l:itorisint!:! ill· penis @nd CmJllO} Il.ree'i):t)::i¢end:onJ:9j:.f<iioprotein aA(1. his.ttI)SCittte218 are fusedinro lcmQtl1Qs(}rtl. 25% of the it cbildrtln to Aayesi¢k1e :oet! f. or vas:deferens fromwolffian.ltolic ej~ffi. 4. o:ther'~cQnsider it asex-linked. hav.fual.e Vi!. 50%.e. ihQ¢ 1:li¢ W9.m..a can.l1 t}f'fheit:!ilhi1dlii. Ailgelman.Note: This materia! is copyrighted. .'ssyndr.s' tQ4Q~ 46 chromosomes A. The ehromosome rrOJR W the mother essentially has 2 chromosome 21s+ the 1 ehromoseme. 17-year-old adolescehtpt¢sertt$.!(ema:lecattiersmay express the disease..

Weitibt1. Which of the following genes regulates kinases. Larynx D. . Cervix. q. E. cancer? 9 . the p.iji@ t$th¢iJ. G.e. They have a IJ4 risk. .jMV. and paffiful p<>$fltutiqulat b"(llphallenopathy. A.l$edm . Adei1OPatcinoma has alsoreplaced squamous cell cancer as thi::MC primary lung cancer. 288 AnsJ'Y¢nC. 1M an B. development of human.lcificatloh D.ouples.m the.)se defQtl:fiity refers: to !congenital sypWlis. Syphiti's genitalis renal tubulatcells A to 100k tor intranuclear inclt1i>ions tn the .1 balanced'trapslocatj<m AnsWer: D. S<!. OtH)' oftlie· foUowingttansplacental 'infections. 'I'oxqplasttiosi$ P'.. 720 E. Craniofaciai abnermalities Answer: C~mother has rubella. Esophagus B.q'eatip. 1440 is~ AA4i.nd peri.= U144 couplesat. if me . loss.S16 D.m1err<tte for 1he sickLe pen ::(bllQm1aliw is J jt).g cystic 'a'¢iie.are C.. therefore.iIa)".cell diSe. E: adenocarcinoma of'the distal esophagus related toBarrett's esophagushas replaced squamous cancer of the mid-esophagus as the MCcancer of the esophagus. B. r at risk.: SELECT 2 A. Answer: K C~.'VerSe df.l. hence assuming an important role in the.. Lung Answers: A. .b hypoplasia Saddle no~e: (lp(o:Q11ity Sensorineural hearing loss E. hl}Sfobetlaiculated.a. U576~lJ~.sensori'neuful hearing.dgleTI(. MOSt CQ'M:MQNprimazycaucer anadenocarcinoma? E.. pel!'lisoQIat¢d' with . Bladder C. 'Fosimp1ifY the eqllatiouFj. .ust work backwards.e:en dis~Me is ~prOxfmately 1 'In. 1/12 x 1/12 "" 1/144 blacb. Forex:unple. '8ensoriheura1hearing loss is !'he lilostcoUllllqnabnqfill<lllty.l1ts tltlsre.rome)..1: VI44 ~ Ij12~ Wliillh. tb'¢tefoi.'l A CytomegaloVirus B. both l?at<.pep)tehtticular ca:lcf!ica:tionto<!.'g·¢~ru. 6.sei!Se ptjlrcm:¢&s.:n1icrpd~l¢ti~n sYndtomeQ'ncwQ1J.ventPcl. .0fhaving a child with $~~k1¢.. hernewlsom 'child? A.. thep~\fa' l.1o$:()J]le 1$.th'i$ in that fhe prevalence is given and the carrier rate. 2.E. g.1!. A pregnant woman during :herfirsttrimester develcped fe¥ mactI1qIlapul::it :f-MlI. llt1Q..chromosome is paternally derived" the patient deveiop8':Praoer Willi syndrome.ffientdeye1opsAngelm 's syndrome C"haPPYPuppet" syuQ. If fu¢c)1rl)1t)J1SQme wasfuat¢mally derived.crll'niof"ciaJ4bfiont}..urine is the best body fluid to culture CMVand Rubella pcm. following: sites is fbI.Mt.·11l44~114= lIS1(j. lS . limb hypoplasia to tMIidqrnide.~ Which of the folloWing complica:tionscOl:i1d potentially occur in. If tM 'c.t1ities tl:1 :iso:tt¢tji)~in~l:.:rrdy . In wmQ:h Qf the. Litn.@<l.t~tis.v:etltricularcalcirrcatiops..ttty th¢ilbliQIit!?l :g$e. Sickle c(il1dj~ease T.

1wtentihlly produceCl1shmg's locatedihthe . .oEthe following sites? A. fIerage )3.E.1t6in.:.~ these tumor markersare always ordered in testicular cancer. Ai:ta.1Os1ttY.. c..and :PItA 1.o·ax~UaP)' .Mil'ir\volYeml.rhe 'TNM$tagiJ:).Testl¢le C. .~.Note: Thismaterialis oCopyrighted. pla.m~t&tip to boih1be :vertebral .tlaan. p-53 suppr.()\)t of..g ~y$~ro. I1tal:!l$ Brain ai?~le Llltlg Stze oTthetumo-\ D. D. A l'thnary paP.swer. A.c-titS B.lymph·tlod~~ !lDd.R:emem"\)t..mQst iWpO!:tantprognorltlc faotor in. proto-oncogene: Pr:oto"<lll¢~gtlne !. Wh.icho.g 'th¢ c!JllinJo the S phase.dfPmeandn)!ponaitehiia .E:U.l:lnlell<md I).··· 'pape.nngqa\ :.p!<tkill~ i. C"Us that <g. .dc<W. :B~ ~llfhe other sites :fisted have raerastasissmoreeomnrcn.g is the secotidwos{ t:pl:'l111)Qll cancer 4h.:lCe pol. LungB. an...Mdlla. ~tD.fiver.'Jxtranogal metastasis is' w:or~~ tha. mortality in both men and women 6.asis·in. .etast)a$i$.:BQ@~d 1~y~r'inYo1y.cep. that 1S 2 cm in size.A.eaneer. . :AIlJights res~nved. An$wct:: C. AFP comes from yolk sac hInJ.kidftey :6..uOt thateQlllij.) 2002 A..nt? . 4.:I'Q.w meidenoe and.E""<ms. L®g'Cill1CCr . A55-y¢llfc~M 'w&ftl1m with owtt$tt.53pr. syt).clltis I1). ." Which oftUe following MoST influences.1S most likely C.acttvecyc1ih Dsdependent klnase.):ffipU than: m¢ lel1$t to. while f3-hCGcomes . PNA before :all()¥tj:p.t priIllaIY '(lIlnQCr. it $nP1lld pe:Q.@j:G\¢t lias anihftltt:a:tlngduclal ci.o: ·men. Both AJ'P and l3-hCG 'are most likely to be elevated in which primary tumor site? E_ thyroid CQlofi E_ Ovary An$w~r:B.E.ors (endoderma1 sinus tumors). 10 n.essorgene p. Lymph node C~:)}jJJl I).c"ro:yc Bpr<l:tti-Qnr. Malignant melanoma .h-l suppressor gene Jh C. This allows the eeHtiJ:tie.. fol1ilwiu.thate. A.(Edward F.metMtiJti¢to' ..? A.e.whichnormaily phQs.oduces a product thatinhlbit<.f the. t which ptogress~$. . Liver .at.ofna.. C.ty'ij. the ultimate prognosis Inthis EMfPR.e111¢pt ~sWl)l":.Iung produce ACTH and ADH 7.I(J WQnimJ.edam~gedbey()nd repair are r~moved by .Q 's.from choriocarcinoma. Malfgnant lyznphoma WQmeli Colorectal cancer.oloti canger is second .5.plitirylatestllEl RhPIQteir't and allows the ceU to enter' the Spfiase.8. havec.A. . 13:.prec()'l'i. Itvet lung Answer: E~ small eel] cancers of the. Eo Answer:E~ 3.urpri:se.:agepe R.iir 4¢fect$ ill. to rep.

r:J:W~9p. 19-y. A.. MV(n is decreased because the patient is in hypovoleI)1i¢ sheekand the tissue can extract more o~ygen from the blood. WIDen. C.OOOcells/ul.JW ftlgh. lID:V. :De.creased·vibratory sensation D.l' ~IDer:grocy roem.ueXtJ'ect1!tthi~pati'Qit If .11Qnna. decreased because.S:a m9tQIfPygl~a. with left shift. plasma volume is C. B' "" ACO. anSWer ljs a ·cl!U.¢sis). ~&. ~a:$ttip' levels).tophils E. tlg'hand Hct !arenonna:i. other di'fferenees. Transitional cell carcinoma 1)'. normal lo~. :4. C' low me low J.·!)IlCQ.E. Physical examin the .¢:$al):dbJgIt RBQ'!i9t1i'it.ia (reason fol'hjgp.13.G:. 'lb.IJIJC :(l@a.normal D. tre1)f..gastrin levels 1r~f(jte 1{aC$.W:~ ettleJigencerooIQT(}veals. E t i Wiially.Mnta lIlt.gja giYe$ . lknE:ltls'eventualIy uncovered. left Iowerribs.l1:lri\t ~)tce.Which of the following. She has.tttlal low ."y~g"'9J:4 J:'!Ja.central venous hydrostatic pressure Deereasedmixed venous oxygen content Decreased.¢'hCif the: io]Io:Wlrig charaCterites 'pemiCiollsanerma. lficreased plasma homocysteine levels . Atltei(i~J) WQbli\nptes¢tit8With..rather fuanBl2defieiencyfrom other cll.e LVEDV is R C..·of the following wmtid yo.fri¢an Amencanchild with sickle cell anemia presents witha high fever and nuchal rigidity. hig.·.celis.f:~i:1t(jrl\lfr!tt.emess over the. Hep:l!t!lccilillax¢atC.cancers ll>' revei1tedbyillm:i1. Giving the patient isotonic.lIi~tiQfi With.<5. theltBG count.. % SaturatipJiRB. Whi.Ni:Li.1Js~1 A...!rmill pm_~li. and' REG cQUllt'Will be low.eBe reveals 11 moderately severe nermocytic anemiaanda WEe count of21.S'otheMC irojjov:er1oad~ note F acute blood 10S8who1eliioo:d ts l(fst.m~~or:t:h'iJ.MI. Normal effectivearterial bloodvolume Increased. Nonnal hetr1og1obihand hematQcrit 4..¢·.et.question 1.1 WBC¢oqnt and a 1it. Pl:istIia is.inelude aeh1orpydi. iron .microcytic .anemla •. D. of 1:lieI~W ·'. A . Be-the explanation for Ais'. Hct. IIigh semm.tUre :is Pt!:lS~t as' Wen ~s t~d. or hepatocellular Cl\t¢'1nQlliiOL(iue ·t~Hl3V K I}.efi~j:lIQ¢y'f¢CQQtiii~ <1%.'lt 1.exm<lrv.!se4!1J:ir1e.utoalltibodiesagainst intrinsic fa:ctot(Ul. CenUcalcarcinoma: Ans'Wer:D-l'latient's IDilnot get HEV. Hypersegmenteo..¢9ftei}te4.~1ltml$t!(lteS'deqrea&esitati$t¢tr:i)1 $YritP.fric@. a 'history Qf menorrhagia. ~Mg.1}iJ.CCnllufFerrifut normal low lQw b.t': thll~p~111itoj)S.eBG revealsa mild .fioP'tia1 ~~Wf:lt~. O •. ofthefol1o:w:ing sets of laboratory data best represents thehelnatolagidindin. r11J).threadypulse. saline immediately uncovers the1IDC deficlt aQdthe Hgb.:c.ri. A.·slnce 2.iigh low Iii. low hi h @:tl<I:.$l. :A .g . A =. fati@~ :and¢x¢tejse intolerance.4e.aweak.aWfiythC'.ansl a blQQdpres~Ute iif·p()/40 M. pI~9d sample Was drawnprior to ins¢rt19tto:f'M in this·J?ll.a low: .CY myolUlg women. PanPTcatic: cittcmotila It Stomaqh c:arc'in(iI. Scleralicterus and hepatosplenomegaly are present.h normal Il.ig}lllb..i.pulmonarycapillary wedgepressure Answ¢rs: A"J).pic:l~llt@ts:~q.·g·h ..ght .ewith. a.d parietal .9%: normal saline1 SELECT :3 c cold.'coi:l1fiioitly'usedvactine1! p A. cl~Y$Jdn.b:y:f.1)i.repl~ced U= Answer: E.. eorreetion ofSchilling':stestwi'th intrinsic factor. A A 4-year-()'ld 11 . A urinalysis is normal. Whien.tientt S(j~llm )toij lt A. Mtmal 119®l11 )1QMal Low . r.

¢il ~amrevea:isexudative tonslLIltis. sickle Gel1 disease. The totalbl1irub'in 153_2 mgldL (O..1ncreasedNormal 'Normal Increased C.s.UyePQccQPaCilli Mswer~ A ~ Sttcl?tQCOC(fi. .l.paIatal :petechia" 'Cervical 1ymphadenopaAty. Jle!presents 'wth'.a blood cplmt¢ to tev~t .gt\>is~~$~1 d RBC Mass Rlasma Volume}eantihodles E. a'rl'¢le¥aiecltptaI biH1lJbin D.and. D.d1i:t:?:best:t~l?re.ii:iv~ Q(. A 28"):'ea:r:'-<il(i womanpresents with fever.of lung). Fh~sl.O:gldL '(l2.with a direct (conj'ygl1te.0-0.l-year:-6Id¢dHegt.a mean corpuscular nemoglobinconcentratlon(MCHG)or a J~%(31-36% Hblcell). depleted) " 7.palpation.loticCfIb.lnltt~~~d B . 1i¢Pat(jspl¢bQmegary~ A C:eCreve.~ l!0sitive di111Q~cci " .1 ~tQl}" :Q:t'~!'>l1tfti.g" renal adenocarcinoma. D ·"":relative. the'importance ofPneumovax and prophylactic antibicties. Calciumbilirubinatestones C. InC'rease. A..~ddert . gral1lpositi'l'e: reds il) the Me c~us'eQfdt.5-1. hemoglohmof to.vqtY4RBGe9Ufit h3$ .rey.ythropoietin A."Ql(l .Y~IJ. bloody dianhea. E.ght !lpper 'gu~at1t piJ\n. c.Qi.T3 A. gt.B "" ectopic EPO production '(e.1.yte$ eXl). co¢dpreSe'l:l1$ With !a::tigueattd diffic. 'I'hpflQniJcl¢p$ls (j. (volume co:rn RBCsWith a defect in sp. gram il:eg~dvediplococci D.060fmm3.i1.ectrin Positive direct Coombs' F.a.b~da:.the pa1rentha. m¢:¢iJSeti I.the patient has congenital spherpcytosis.0-l§.!:f· '2Q% ()ft.a.mU& tb'toQ1PPQ$pP~!1i~·. a..l. '{iJ:t1i l:elidf. scleral.he'J~lroc. ::NormaiDecreased Normal Normal Aliswer: C.uamous 'cancer . fiji· .agility B.ql'(t.. ~ld A. Decreased illlC()njl:lga:tebilirubit.t'f :f~llQWi:ngsyt$Qfll!.rt@!!w.¢~lli·shflmato.5%)" a mean corpuscular vo1ume (Mev..$Qt.@d r¢veal$ 'numerous stones in llie.QQr. The. Th¢¢6mm@ bile duct lsnot·dila.polyc~emi. and QrlUPpj' ri.4. gta1U :PQ~. stainQf a. xrDCrocync Merti1.ngs.d) ftl1lltiolipf {l.als Ii. and.4 fig/dE (0.. nd. mcreased protem. You would expect a 'gram.~ A hemogram: :exht"bitsa:total leukocyte: count of 23. a corrected reticulocyte count of6% (0.iIDtthif1 p. Physicaiexam.:l. Jll9t¢As¢d N9. B.and a.rtn!lJ :Ot~e{lsed ·. which of the apply to this case? SELEc:.s. A febrile .s'PRV. expect thiSipatieriUo haW .tS pneiJftJQi1iaesepsis 5. jcteflJ. AnSwers: A.on~ettifah. 12 .de:xt:rii'vasctila:r hemolysis increases theamount of'bilimbin in bile lead..!l!l~»t .a. M . 'W1iich~f :tli.lQ.i1i.CRf<S?~q pruritus' :a:fterhathilig.>iM~lltypi()aI fea'tgres. 'In the right upper quadrant and mild sl?'1enome.~1I.3 mgldL). other answersare.normal 'serum :rmc femtin $a02 =c o:~gen satlti"ation D.tictca. L-ow serum ferritin u.! Er.. Hence. lymphocytic l'¢Uk~c:Yfosis with·"- '(ott 'WilUlq.~pWa1.nol1iJ.amty .O gfdL). 0.lath in chilQren ·wfib. Q$~. 0S:Fartd.neutrophils.eals.. sq. 9t'~P' JIDl~ t80~lOQ pm~).ulty with swalloWing.Bas¢donth:ese fl:tl4i.s!?UN"Q@al 4iw G. Ihcreased REC ostitoti¢·fi.filpl"evealsturbidity:.ala\¥' B.•.aisenun As't'and AL T titerii AJiswer: D"-" the patieiithas ibf®'tio.gallbladder.1-LO rug/dE) . Serumalanine:aminotTansterase 1s20 ViL {g~20 \IlL).jth.inlftOcaki!lm bilinibinatest'oneS<lIiQcholecy$tit~s. tenderness 'to .ciQmfual pain .fed.. C R gtamMga. Ai= Ol'cyal.

he de:ve"iops.ct Boombi'test .:Note: Thts material is copyrighted. leukocyte . and aharshgrade l11.erapy.O(}:0:400. while those withou] fheenzytile 'are hemplyzed.tevet.. is diagnosed with leprosy.collc and diarrhea.Thet~i$a iikdiypresent lli:eaotrri:nauti.P1O.into the carotid arteries.l1:):e:m eOrPmicultttYQh\m¢(MCV)'of 76 {Illi3 ($0.iv:gthe enzyme remain behind. lt E.O()Q-Aoo.hed . 0.y extt'avascWarhemolysis Heinz:hodiesare B. F-the..patient anemia with schistocyte's..QIychrom[j$ia mrd IWC$ mIsfiing p~tts ·of. Itrthe liPper and which oithe· following. leukocyte count 'Of" .QnlilltL WlJ.gil'1: auailtQrnj')biIe f' murmur with radiation .: $id~obla$tS' .ell$ c... of45'O. A:llSwi~rs.M.1J. P.5%}. Pb. 'WQtlclfj.omal tep({$$:i-Ite 4~s~.>Ji!1 a:2 lQ1. Positivedire.3:~~yeatc.h oftbe. and '!iatkto16redUtfue.!J~lgqe¢ating g\(i p.¢seQf.}.. IncteasedRl3C pwtQpcIJ:phyrih levels Increased.ed..3.m ac:iiiitiPlt.ow . WhtcrJ of'the.n)20ll2 'a pottery factor develop abdominai.The AnW:.5g1dL (B. pulse of 110 l!~tlihliinllte (di1'rliitis. Pi direct and indlrectCbombs'te$t iSl1t!f. {EdwaFdKGoljan.hemoglobin of 7 .oaoimm3). dipstick !or blood.5%).l.OOOtnml)r:and 'a platelet count..ECT 4 A Nonnocytic anemia llibpl'JJ. whe:tt the patient is.ith expirationand.5~n$gldL).of.m~). All rights reserved. lower extremities.count .thefrm~mbtaj:re. inthese.RJ3C~utathione levels . A significant number of empleyees.toty{itiptnetatehatfenes}.Afrieaa-Ameriearr medical mi~siqn[jzy.5. low back pain.e eonectedretioulocyte connr is 15% .aC$ Weltotpt. case? SELECT 4 A.$ ·D. Thrombocytosis is 13 . contains.aoO!mrri] (4500-11. D.tQt:yfi. 1hepetip. 9~ A .-1 O..aint. Lossof'Hgb common in chronic iron deficiency.OQQ/mm" (150:. has aortic stenosis and a macmangiopathicintravascularhemolytic inthe urine has caused iron deficiency. c~ L.OOObnrrh and a platelet eount of 50Q.6PD .Patient ista'kilig dapsone.pain with -exertion that is r!'liieyed by resting. lUng. C. The urine sediment is reported.IV sy.areexpect~ .isease..India.Thereis a positive urtnedip~ti'?k for bloQd but R.ticulocytecount is 18% (Q.. C.compla1n:o£ bU1)l\ng:f'¢et.ese pafi~ts? iSEL.1 .rnm" (4S()O-Ti.pressUre or 100/70 ·mm Hg. followingilppW to this.OOOJ.e biiSOphfliJi iitippling Low serum ferritin Increased blood Pb levels. E.5~11.en bo(!tds i). The intensity of the murmur increases w. Answ¢rs: A.i (150.(0.OOOfnuri. Otherscenarioa 'used. D. Acorrected. Low plasma haptoglobin C. 1. A eBC reveals a beh1og1obinof6 gJaL(13.) With heit19{ysis se. Q. Hemoglobinuria F. following statements apply to thiscilse?SELECT3 A.condary to dapsone.old. lylngtioWfu A cae exbiblts uunederately severe anemia with a. In &.ltln .5-1.plasma homocysteine levels..iJ f. ~afebrile 65~year -oldman presents with fatigue andsubsternal: Qbe&t. ..Answers: B.E.d~ficiency($XR d. whp~ r:eqe~tly te'MD'~d :ih. patient bas G.S..palecotijunctiva.8chistocytes D.llgings :13 C D E E.lietJil smeat~idtibj'tsp.(lead: lined raolatpp. Based on thesefindfugsj in'tb.l1d11'llI$cle We~e$S.they have Pbpoisofilug with PeUPhei1iltieui6j. year positive urine. since only th¢ c.&Unent. Collts.ilitby' and the abdominal cQIHLThe vaint nsed ilrpo:tferr often.onta1t). Aortic regurgitation Low serum ferritin .5'gldt). During acute hemti1ysis enzyme assays are usually normal.latjye. :E}.dtinkingmootlmine.hysiealexam reveals a blood .OOOffturP) The peripheral smear uncovers numerous fragmented RECs..ati1p:li1ilde). 'ChiUs. After 1 week dfili. I).i¢. It few of the employees .

A '6$'. HgbA is decreased due to the lackofJ3. T.lsia at¢! :Pt¢$¢i1tiutl'ie l)!:ltiphentl$mear~ Whi~hQftne f~llpWirtgm(.smear is reported as normal.Year4)Id man :wi~ di!lstolichypertensiondeve1ops fewer. C • ..O(}OimmJ.'gbF 'It Answers: tot 13.the patlentJms.pld Afrjcat1"'Am!ffi~an .w.ilI!qcltHl~~ .s i.e ' the :.c¢ lIglJF.5'~t41__'. Sicldecel1pti:pID.I. Aserunt protein . .eil H.li1pl'e~nts with _f~~J.05g1dL .$¢n~l .the peripheral fhe next A.d'ectrophoresls isrepotted'to be aOnprmaL You -suspeot that the!Itgb electrophoresiS.oumnbil$ aroll!l 'i:J)ji.heparospleaomegaly.7(.¢:e¢Jltrai..1J1.. and fellowingis .?ft/SpfleumOJii}.a) NnW ~nd $)j$hUyelevate:Q. i824%.oses.mrn:J)wfth90%i mature.£hysica:J !eX.coUilt of80. D. Low leukQcykalkaline phosphatasescore E..uiWQIUlln is. Type illbypefsehsftiVityteacti!)ri E.®n~al.sliQw¢il. ~j)t~ Sili~~ ~." The hematocrit "is r.h~ toW$~rttm protein concentration -i$ 4.Q the Nofuttlwr'wotk~ttP Answer: A. It is the Me leukemia and cause of generalized lymphadenopathy afterSf) :yrs6fage 14 .). ~~:{iEC'f ~ A. sick!.tasseO.AfI:icim-cAto. E'St. microscopichetnatmi~QnMothenvj.OOO/mm3). TypeUhypersensithily rea. Renalbi{)p~y Cystoscopy R decreased l{gl1 A 'C. A.~~. It C.l1ai. •.. i:}Qted to have p)l'¥$iqal..· 14..2 gldt(t35---115gldL).futraY"ascuiar :hemolytic anemia .si.C..'exam" :rJleurine uuttme r-eturnsnegativ:e.Psitive for S_tr¢ptgc:ar:. i1i~~@:$.el(:cttophQtelii$ ex. fIg\) S C. normotensive2t.·@itenslon isiow enou:go. A blood cultw:e js:p.aad immatureappearing iymphopytes.hemoiyticanemia.binemia. . increased lIgl:) JI A 4~:.w!eM'a Vli1b fl ~Wl.incteased 6gb Ai D.pount. Bas¢d 'on these l'inQir1~1 stepJll. B.yeaMld tni.0-16. Ret1QuloQyteinue"i$ 4% 1Jncol1jugated byp&bi11n..and a pl~ttiM.CBCreport mdiclltes a hemoglobin of8."Sl!!LtcT p' A inct~$¢n.em.OOO/.~n . the ~a:ti¢p. Leukemoid t:eactiOnseeonda:ry to sepsis . E.twithwi()_roinfll1iPtfonsm the: renal medulta. The: pe~:pheral smearcontains numerous smudgecefls.etibn.ciitofthi~ P1\ti~t'l wlllch of ~12.ria. .E-' lllePatient has eLL witll4YPoganunaglobulinemia. (150·.this ease? SELECT:t .ypogamtnaglobtilihemiil C. Alltoantibodies ~gainst~. sWel's: 13. and scattered p¢< . me manag.i1decch:ym.. D..ns can:combxne wIth o.000'--40(}.HlU~QfmmllDl. leukocyte count of 1{MI()Ofrum~ (4.:eTIalnst() pf~d~¢e: IfgoAi and cortibiM 'Wllb 'Y~haii\s mptoqu. antigel1s -i\. A Hgb.yeat.entrationls12.3c%Jand the uncorrected reticulocyte count.A'renal ultral>bund is r~vprtcd.t'Imli J1~tha. Cs ."cll!. Which of the followingapplyto.)st lil<~IYl\Pl?ly'toWsp:a:ile".8 gldf. gi'dL). !t. MUst correcdbrflleanemia andthe polychromasia.--.500-11..terlor chesLA .~llttQt\ '[e~~~gf:~erali7..lip $)\1fth".lj. chronici.5.year-(ild.1L Anasyp1ptomatic."lition Reticulocyte count best l-lerh~Qglo1>Jppo~". 13 pen m~li'SDancy A)lSWeI'~I H.hipit$ t{ flat )'-globulin pe::!ktlrtd decreased albumin.'l 4~lijfe(llled. K H.!:hili w~tillatQinauc. 12~ A pregnant 21 . $phetooytes and poI)l'chtQtl)l.i)9tk tender lymphadenopathy.0 gldL (6:'0~7.jaundicei and a severe hemolytic anr:wia while takiqg methyldopa.¢Qiil.vmphocytic leukemia D. IJ.-ehalns.

idiQa1ly ta:ki% ferr0ussulfafe ta. . positive Co Acute lymppoblastic leukemia'o this case?'8ELECT :3. positive'bcr-~$lqn gene study ..atosplenomegaly.S.qfl. A Cells are most likely CALLA positiv.O(J()/mni3 (5.Q~1+0gldL).}t.lts.) 2002 15~ A 4:year-'dld boy presents With fever..ll1:t ¢9.OO()1m. (Edward RGj)lj:ll.and :a '}jlatll. hemoglobinof 8 gm/dl. Leukemia deri.Note: This material is copyrighted. Wl:tlcht)f the f6UoWlng addi{ionallaboratozy testabnormalities would you expect in this patielJ.. noil~1enqet l'Ylliphad~Qp.hQWeY@' the'bQl1.Ct)Wlt (1:50. % saturation. and testip1llax: pain.l1t11.athyand massl\>.iachfptUo.teV¢als a mild normocytic anemia.1 REC morphology. He I:.In1Jlrintsof1he biopsy reveal a similar differential ceuntasifbat observed in thepenpherw blood.000-4l}OjOOOfmmJ).\:iep'e~pb.' .' test C.'tep .Pfi :nQTITI(j.egaly. An afebrile 80-year"old man With the myclodysplastic SYJ.I: :In:t.a. The MOST LIKELY cause for only a 1 gmldL rise in the post-transfusion hernog1obinconQcntration is . wei'gl:ttlQf. A bonemarrew asprrat¢tevealss:h¢ets'O:fcells: sim.1s a. setiiiil f6latel'B12 p.). B.and a platelet :of 3tl. hep. GBC repl. hemoglobin.fzy¢ptOirllf!ic w:ith a 7 gm/d].csligl1tJy tel19er.ombooytosls Withgiatit platd(.not conla~n Alier rods (only acute myelogenous leukemia has blasts with Auet tQds) 17'. Which oJ the f~l1owjl}g~ppl.D.. Iow-nornral WEe count.omeswoy E t"8.ICB. an autoimmune hemolytic anemia D.ikpcytecotmt of J50. A 19"year."yeat~ld manpre$eI1~S with fevet.lj.e maTl'9W 'i:l.oldAfricUll American.c .5()Mrtm5). His direct Coombs' test is of packed RECs and on the following: day has a. and sweatJ:n~. 18.. destruction of the REGs in the bone marrow B. a norma! platelet C9M!.y Tdt.eftl8J'fQw biopsy reveals a l1Yl'ereellular marrow with an increase inr~tic[!linfibers. Sickle cell trait does nothave$Mt a'QidPMsphata$'e $:ta'lh Au~ rods in myeloblasts Lowleukocyte alkalirrephosphatase score PositlV'e'l'hilatlelpb. The anemia is first normocytic and then becomes microcytic.~l<:oprte .'.. A45. :aothtesttcle$a!'(?¢nlarged. and widespread. A'bttt).rn3~4i$DU-ll>nOQlmm~). The CBC report indicates a hemoglobin of6 l'ifd~ Ul. Blasts (It). serum ferritin B...blets" A.i :the peripheral blood. llA<ido not transilluminate. She has a history of menorrhagia andspot. All rightsteserved.O(JOJh1. .9rzy. lel.ll.vesrrom tri1iheagf:)myeI6id stem ceU ~nsWers: A. TIDe. C: thespatient has acute lymphoblastic l¢uk¢tUiA 16. E-chf6mc i:ri'ydogel1ous leukemia'.JtrQPpils at :aII stages (If development [I % myelobiastS). M.t? SEll-Eel' '3 A B C D Positivetartrate re. ferritin) areebnormal. nq:lH!)I)d¢( lymphadenopathy.given.~ n!}ll1"9e. Physimtl exam reveals g¢rietal:iz:ed.3 units. l¢.ill:ltWthose )Ji'¢SC:. destruction of the RBCs in spleen Answers: 15 P.lQbtn con~entrationof 7 gAlL (15(J_IO()O~{jQsO(jOltfirt?).1:drQti1t. Coombs.QOo/mn:r exam ci)$t 6£ 6~Q..1It)t of$().e.s .wii'aie i.14 translocation' A. before t}1exeis :any Meti11. Lymphoid leukemoid reaction E.oni.e 'R CeUsarenlostJikd. ·hepatosplen. Hbysical reveals-a 1fotn1oten:siv~ imlMd:ual with generalized. mature and irnrnatureeoslnophilsahd b!!Sophils. a. A. A.. woman presents witlt fatigue and exercise intolerance.. Recall that all the iron studies (iron. and thr.. steaml tendilmes5' to percussion. epistaxis.. the. A corrected reti\lu}ocyte·COunt til <2%.i il.early stage of'iron deficiency. a microangiopathic hemolytic anemia C .·:1!l $m:e~t1em~l:!atr!tt~mO:1.m~ (lS0)OcODc400~(lOD!nmtl.eJ. A dipstick of' urine fo'[ 'blobd is negative. the 'ne~t mos'timpdffll.50(}~t5'. Rgb elecfrephoresis R sicKle cell preparation Answer: A. petechia and ecchymoses.

hepilto$Jllenomegaly.fucreaseo :RI)W fl.. TheHgb shouIdm.t"liry ce. A lo:wL. D. Positive §¢tillIi antir:iu.cy1 SE... scleral tctems.a total WB.thalass. Apo$itive exam rev¢als g~n.due to a 6t .ells/W-.ROW is characteristic 'Qf trQJ:j(l.i~.D.lfll}J1~s«¢iate(l· 'Wl:thp+thal<l'ssc:m).Yl:lic.AP is£hronic E.Yttc. . 2% E.sut~ ~r()graJ1uloc.they have no rnitoohondriaand use anaerobic glycolysis for etleFgy 23. thrombocytopenia. Ap. Jf\ 2~':yeat-'(Jld womanpresents with fever.LllO' . polychromasia.No hy:persegrnented neutrophils are present. utilize gblMse6 .'WJ)j¢hofthe: granul®ytlc l¢tikctn.crease by 1 gtnldL for' everyunit. M. Positiveiiit¢ctCoombs' test ReticulQcyteihdl.ll1p:wmg ]S1l1Ql!¢ f. SELE. and the .the urine-like c~mjllgated bilirubin-The:: 22. UCE cannot be filtered in. AbnormalH'ibeledrophQresis Answers: D. C.estln:atbleed mQst CQl11U1on-lackoT reSJlonse to transfusion IS.t(!!)rmal"blast. E. t{15.aB:gb 01Q ..fici¢l1¢y.slightiy low'WBD count.I7)translocation B. college student cpresents with p¢teenja.:qth h~veaJ()wMCV. E.'OO() e.ea$eby lynipMdenopathy.A~C Ieveals:a l1.lnt'i.the urine Me<m.a. positive.ia. Which :of the follo'Wiltgapply toUtiiioase? .vand . BH~ni:OilJin. f{.:l .MPthtomJ)QC:ytop. .most commonly .gfit(¢ral]zt:lt1 and hepatQ$.otmQcyticanenria.: l\l>-p!(tk:n. A.J3.fu is J.letd C.l t() high ~C 'Pouitt A.tba.teJJs"are. 21.and a normalplateletcount.LoWJetlkQryj:ea1k!rline phosphatase score D. hQsphafase p D. (EdwardF. reti:eulocyteindex ""'45% ¢nn:vert glucose into glycogen utilize pyruvate dehydrogenase K have a llet gain Q{ (2) Nf.s.~a.lx 0<.l?le:ttllnl!l'I@ly.¢le~ .~year~ld agastrQitlf. and Qcua$Ional 'nucle:atedRBCs .matut¢ RBC to. The peripheta.D. qtilize lactate dehydrogenase B. The uncorreci:ydretio.gleIL.. eosinopenia. Increased . {Wljan.a.et1.ytUo$es\ep~stMis. t\ eBC exhibits . Shets not. taking: any prescription orQy:er'·the~counter llletliPlttiQIis·I?)1.t¢! in UeSand Jaundice.Ec.c countof 30. . a slightly increased. A.ndies are normal inmild. You would expe.C:.-dimer test is.. There 16 .'{acM] rash tn. 'Increased senunt'bTttln it Notmll. MOV. which is an extravascular h~QWsis leading to aniIl.lJo·dyfest . AUrlgbts reserved. \:l1. lymphopenia.DIC. B.¢litdemonstFatessp-herocytes.e 10 :tTijjisteti1:l<i:i¢ .ulocyteenuntis 15%. patient 'WtlhSLE anda warm AIHA.'fhePTand PTIare prolonged.o.) 2()J}2 AnSwet:E __think 19.bleed.CT2 A. AnsWljrs. and a .ii [eukemiaendfnvasion fit thegurns is acutemonocyrtc leukemia.ioh.1nvastotJ.PQsmyetartrate'resistantaoidpho$phatasestain 'theta~utic.. and.emia (a or l~). Which ot'tbe folloWing apply tQ tbiscase? SJi:LECT 2 :3%. C. '[ow'MC\l stIlear.AnsWer$. C. UnQ®jU:g:"Ited hyp~r~HiW]:rinei)'ria.f PMkedRBCs and:the &t should in()J.. E. st.te! Uris material is 'CQPytig11~i!id.aniin:Qr than iron'de:p.e¢cb.tby.remember-that iron.. fatigue. oftbe: ~ 2(}. An afebrile patient with SLEhas a mild normocytic anemia with an elevated leukocyte count exhibiting neutrophilic\lf.No. lC:l1k~i~ with.Pand (0) NADH Answers: A.etaJfued painful lymphaQe~()p!j.lS1tl. ' A22. B.

A 6§:-year.autoimmune.I. Which of the following apply to this eMe'(SELEC:t 2 '. syndrome chronic myeiogenoti& le!ikeroj~ a neu1t<ipbi)ic k\l.. 125.f\. GaS. .J l~ft $hilJ9( wxk :granulationptesent in the smear.arepnmarilYdue toexftav:<lS'cUhit'f'Criio.galy.i.and neutropenia.j.Ii.trayascular hemolysis. .22.A bone marrow aspirate reveals numerous ringed si<l¢tQPlltSts·llJjiia. Ile req).macroeyticanemiaamLpancytopenia.keltlpid. f.!f(lqytQ:.t¢pi D.1~9pa.D.atIdhep.Her hematologic findln:g'sare MOST C(:)NSrSn.progranulocytes .¢ty 2. I)¢ct{\as¢dQ~gen~p. .li~etiQn Answer: c. A..tltich~QI. myelogenous leukemia •. There is w no evidert~e..plJfa.dbncenttatiob l¢9uud 10 g1!:lL.E. weekS in order to mairttaib. 17 D.! .. M~t¢. :tJ.ydes:eUQ¢.w4be 'l1(l®)Q.. positive. Warm .-OldmafiptesentS: ith j.Small and large Ringed sideroblasts are also.hM bfllW' cell ~eUlt¢@i1 21..tiQaPt~t':ial wJe¢P'Ql.ite ofcellsWfth ah!1nd{U1t cyt:qp1asm having 'a. a~.PrtlQrpP:ic infilfr..ablepw. Epstein-Batt mS$sOC1atloil Bcellmali$l1an:e.. :B. RagnQgeilicIti~eloid rtl~ta.Opsy r~veals a.. A CBC exhiqits'a.m 'witIt •. corticosterQId fli. G6PDdefleiency :ParoxYsmal nO:ctmD:alheIb. the myelodysplastic. exchange is norrnal.cQunt Uris patient MOST LIKELY has . G..Uy p'rogttlSs into an acute RBGs and blasts are common in the peripheral blood.tle.Qxlli .. a common . C.JtIg!$jta.lsph!.l:s ~.omt pains. 1.y . gramne:gJttlve sepsis'OOple. The SELEcT 2 .sQ thePi102 and SaOi 26. . A.(ItiSlstentJy shows llditMTPhi~ ~RBC popqlaijona:s$ociated with eecasional myeloblasts and. . TiSSueb(9p.. Positive tartrate .man has a iongillstoryoi'a severe sfightiy.orily the Hgb ·tlpficrntmtiofi i~d¢Q(ea$e·. norrnocytieanemla.)translQcation B. LQW JewcQ~Jtegl~lhlE2 pl1p$P:I:!A@se score A.leu'k:e011~ C.>f lymP'hl!'4(lnPF~Uiy.. t(9.:At. Letlshiftea.d destr.. CQld autoimmune :hemolytic anemia Answer. MlID:cl~?. hemo'iytlcanemias.l. A. Ci 'N. ¢Qtrectl.cule isyntl¢l!lsan.:vi\I ofREes? D.1Ul> lIb .QI1. Ans:wers:C.these patieilU.]}-fu~p~trI.. ·. A few "'blasteelIs" with.lites a tttmstUs{onpf packed R:BCs f!<Y. a Yiralinfection stool guaiac is.. :An82~Yt1ar-01d. acute myelogenous leukemia . E.s I..rtIc anemia :B. D.t1trombocxt0penia.. oxygen dlssi'lciatloncurve E.rn~theotheM areprimarlly·in.heffipIyti¢anemi:t C(.oylymp&oqytes and eosinophils _ 4'4.sELECT'.o.reslstant acid phosphatase stain E.. fr¢quei:).dect¢as¢'·adhe:si(. Which ~fthe ()J(Owlqg.ns:w(\r$:~C. .' A MiqtOa).g~ 13.·\Yl1i¢h of1he ibliowfng.)la$ja C. '<friedeggi'appearance~ A special starn IS pending.llmt:llt i. HJ% 'my¢loblast.. Lowm~ygen8aturati:on C. irregUlar :cytoplasmic borders are Iioted in the peripheral bl(iQd"AbOMtfW:::tQW\l:i. .t~il1ia. l'alp.fWspl¢l:\oJ.etapy AnSwer: E"". K feature in the bone marrow.<\g!IJbittutJli $ho.

te!fcti<m Ali.l. .'1)ie . Hgbelectrophoresfs Answer: B~ mostnUctQcytkariemiasii1ehil4rellat~ GUt':()~ bJeedin~Mep~el'$ diYerQ9u)mn t 33. celHrait E.lstt'ati~lJI. do no):.trih¢silfid tissue o. :AMJ.mvade. E.mattoW ao. tbrQmbQ0'1Q$i~.iIifecuoD.. A. Crdhnts .:(lery1:broblastic smearfTom metasta:sls to bQi1e.g.lll:):ift.l. C.t ~'$ ~Qtnm9lityassociated with . 29...· penj¢j1Hn $~li H. SEliECT4 strongylo'1iIiasis E. palpahle left aXiUiuy lYIttph nodes~ and low Qa~1(~Ul isnored to have a mild nortno~¢ ailemJ:a.microcytic' With an underlying 'hemolytic . B.j?iem.#1to lh¢petiphe.ip.. SELECt.the :first ::lare .~l"'looP.iUl.f41·· .r4 . cQP.1..invasive' helminths 'produce eosinophma. and. P lell!. Jeft.. Stool guaiac 18 . .. 'rumotis hematopftieticcells .n:sw¢rs: :8.s .leukemia.fil:tralJvedisease le~exythrob1a:stlPstneat E. l.$Wer:s:C.disease Cl!'94te ilJ..lcleated RHOs. tilaP:pW i. of the following is.old man has ·a..A. in . of Senun fertitin Direct Coombs test : E. and uccasional pro'granulooytesarid:t1lyelQ~es .oY.A..n.s due to. B.f: NOTI:k:·. bt:on*mall\$tbmll C. Stool guaiac Boni:l.A $3-year-db!iwtJtnaIl with an abI1iortliaI ~()~ Qftheleft breast.lKPlJl'a!'>.l:tlatlpn.~nitrPpl1i:llbleWcQc¥to~j$ 'IIJ({· t)xpeeted.chQ]al.~8.thefirst ." . leukemQid..Pffiwonns S(). a peripheraJsineard~mol..QPhilk le\iJ'iJ:lGytq$is irr ..tenalibfeo:tiOi).:opli.colt ilectQ$j$i.O'J.:tl. autoimmune hemolytic anemia Answers: A. PureR13C ap~a. EQt... (e. c.ttrI.. A 55cyr. SELECT it . l.Qro111P m~l()lteno]. D.ijC count.on1¥ ..siatsmostcDmmon1y:associated with . ~q. 1:L R K ameWasiS poisoniVy AQdiS:oit'$j$~e d tlj:sh G·.. G. A:... thymoma' Z2. Qlrrollic mYeJQg<mpus 'leukemia sic!dt. c~ llarv.C. n.ttIcqI'ltis D. acute cholecystitis .f1rststep in the work-up of' the patient? A_ Serum ferritin B. Be. .'lj.wlhg is ilie.Yt:. 9Q~QsjS).~UdjsM~e. f\. asli~4tly ¢l¢vattldw..ers:A. Gate. 31..E. step in thework-up . ~(lute fl!Wcndlcitis B. .i~s.ovlI1lS also produces aplastic aneIbiawpattentsI).ernlll.. R. pinworms D.nicrocytic anemia.2'YT""ldcbiI4·~ the panent?' A. 1. Which ofthe foIio.inJs ..~sickk.1ini'ar9ti9t+ R rheumatoid llrthiltis Answ. anemia. .ll1ll. Tox:k grl. acu'teinlyelagenous lejJ:keMli C..<flIj.X:platti i!¢:\il1:..l¢1.)ari'if p\lsQinJ$normal marrow .. ·SELEcr 2 A paJ:Y.

kb s~gment. wiU be Gortel. alt¢mtlon E.2 kb fragments A. r.38. p::rwm likelyrespohsible1'otthe'patient's & B.{)ndazytoanemia AnSWei'iB~ s. you wouldeXjJecrihe MSTIl endenuelease studies to reveaL .er~e~vessel permeaj.lcytOpenia.have heml. patient C is normal. A. .. D.35 kil segments..cid .are not high enough to induce sickling Hgp A inhjhits sicKling . C. art inctease iI1:ItBC ]!r()lopomh.o4t:rrirtdlevu)iI1ie a. which of t. SlaphyI(ui.lQstlllicrqcytte madult!i oy¢r SO are que to ctl10nqancer 34..llyticoI vasoQcclQstV¢ ~tbUth si1).JiIftylea<liJ1?' rQ'~t~tmtlede1Ua 35.15 kbfragment and H) 02 kb fragment.. C..]!ax. fu aplUierit with sickle cell trait.1>. C NOTE: (gi.bmin an increase iI1.. H-lIgb A IS never ptes.aSkb segment l.ion F'. A. Patient A hassicklecelldfsease.':(}cc in ch:Hdten With()tllsickIec¢lldise~s.2 kb fr~gment (2)-segmentsnone none (L) segment (1) fragment (1 }frag1J:lertt .iisease develops bone the fe-rfiDt .l).15 kb fragmentaand (2)0. while the normal chromosome is cleaved iiito(t) 1. 19 ..sicklecells Answers: A.sfjuebypQxia sec. to removesickle cells E. none (2) fragment (A) fragments AuswertB: the abnormalchromosome has 0) 1.depositing in the.m(Jp1i#us f1iJl@OZM :S. 8/aph:ylO(!()CCiI$ aureus bone disorder is.A radionuelide bone scan reveals a lytic lesion in the metaphysis of the femur.)' nel.meeoi' ir1alcirfg the ·ctJ$¢$ cQrt:e.35 kb segments have been cleaved into (2}1. an. the high concentration Qfijgb F ii1hibits sickling ley~ls of.Ftopriocep1.B. ll.. and both 1.n.c'e. The pathogen most C.ted? A BoO GIQssitis Megaioblasticanemia :C..Mnc~ tl)e jttlJiQtt:. It Streptococcus pneumoniae Salmoneiia paratypl:{i Pseudomonas aeruginosa l!e.yrlrt p(i: . B.kb fragment 0. . !3onemaITOW Direct Coombs test ~ll$W¢tf: :gc. .ol'Qgle -deficitsremaur.QCPus. Dementia ~$Wets::' /1. Vibi:atory sensation in the lower extremities .J. 'J1otBqlmtmelia . 1ll1ead p01soning..1S.3. withsicI4eq¢lIruseasedo It diagnosis .e.. . .l)'t j:6:' Newhorn:. I!plenic1J1acropha:ge~a:re of insufficient number. nelldisease 31. PT.el:itift sickle.t. it w. . with (2) une1eirved 1. lIgb el~ctr()photesi& :an~rmas n.Hgb S.".itrStatlittg's {qtces doseS 'Qffolate.$EL"ECT 2 A.AttsW:¢i.theencephalopathy is directly attributed tv . Jh a patient with BIz deficiency who is being treated whb pharmaetiiQgi'c the foI1o\¥ihg. D. the spleen traps the .yt"Dld AfricaflAnietican man with sickle cell !.. C.omehow. . 44reU$ is the MeG of Qi!t¢OIDY'elitis. 19._.

tubular . (disparity h6tw. 5. Histocytosis X: It c. which. Ite'ms3<J semm. ..ulat¢a:sts in th~ urineiWpl)llh:atacllte. asm1il:fip1::¢: lyti'¢ le~lo.rAY'feveals generalized ~steopenla.fulrolWpbIllcstic IYn. Qcy¢iIr'-Old :girl pr. MaHgttatit~iasmacells in a b.n&in."¢t . antlgloputirts. Radi~):i).in the sediment A ¢hest x. E: an IVP would further exacerbate fuepat1mtis. renal disease.casts are noted .3' c.1. amI: 'bilatetaleonjimctival pallor. . urineflowhas' also decreaseA. Intravenous pyeJdg'tatrt{lVP) A .tb~tips.qres..<llb:®liri~..Lympboproliferatlve. A.iR 'Min~ suJI()'s.(J()U'"-4' biopsy reve~l$.ort4fitY toenti:lilpm¢pt t1f sm~ll~we): ~y :ertlm:g~d lymph.What itdditiotiaItestsshouJd be petfo:t1nedto corUirm thet:liagnQsis? SELECt.Uko:cy-te CQunt 'Of 4.0--<t6.Sezary~drom¢.the A epidermis..11 . itullJJl~ Mqrc. ~.eehtM . A nrinalysis. S¢rtIIn D.scan b . 2.j.CDI is a histiocyte marker. Bas¢d(m. Answer: A-Hand-Scnullet-Christiandiseal.old man presents with multiple vplaque-like lesions onMs likin.lymphocytes with prominent nuclear clefts are noted in his para-aortic E. nodes.z A. Increased light chains ill the urine E. . Nt$w¢r: D: Bcellnmligna:uc.:\¢.luiJ( lJ.. E. Answ¢~s. A bone marrow aspirate'revealsaninfiltrate of neoplastic cells that-sre CDlpositive.ctropn.OOO/mmJ). A 4-year -old.drome :t A.abnornialities Nonnaf erythrocyte: sedlmentatl:onrate JgM .exhibits a 2+ dip~ok fqr pt<1temahQ 4+ :Ptf.and a platelet count of tl$:. peripheralblood. F. and li:eplltQS'pl@plj.OaOll')1fri3 (15.'.ub. . q~estions ltelllS H2 A 65-year-old womanpt¢Seilti{ With fati~i L andj)am mh~t li:'iw~rb.drawilJlcilIlY j':q the' last fi:!W(Jays.g?dt). BOQemarrQw aspirate 'IL Renal. 20 .300/mm3 ('4500.Mk'anil ci15s..lEP i. 'Well.l!dtide q:n:e. polyuria.! the' patient's .lceroia Would 'youexpeot?SELEC:i'". Answers.¢aci4 {SSA} Renal.y witir1:l·t(8..leg!}.C..atypicallynlphQcyte~ infiltrating. while: the fonner· only de:t¢cf$ . andmultiple lytic 1e:s'lo:nsin the . NeoplasticClupositive .Il$j:)u.01Jl1: man:QW~$p&a~ .ith~Qlj¢lgr .oftlle following addltional.D. child presents . .Q. i1flltlW1Qe1e..MOt:nmi:i).:history andpreHminaty:l:aboratory fmdln~s. It is. A seotion: of:iyrnph noderemoved et laparotomy reveals' a ClHfuse neoplastic infiltrate of sm:):ll.lPIl\lm!i Waldenstroirt's macroglobufinemia An$wer: B. A CBC¢Wmif:S' extensive rouleaux.}()~pj~~i.with exophthalmos.genetalized lymphadenopathy. J?hY$j_~l ~xlpllinafii.dert:tlles the abnormal Igand lig'htchaiJj" A. the patient hasmultiple myeloma: 'Netetheurine findings 'that screen :for BJprotein.splkeil1.. called mycosis fungoides if the cells are not in the blood.t(Jund..SA. atom! l¢. s lymphoma Sezazysom. Hodgkin!sdisease rtBtrtkltt.pain '$¢t.dip~1i¢k feT:]5totelff ftild S. llie la:UtitdetecJing' b01itallil)tmti. :$h¢:sU1t(i$ !. a hemoglobin '01' 7!J g/dL (12.sls has already-oecurred. .lymphoqyt¢s With a"statry sky~'appearance.J4)' ofthec"lPY\! pI'9to~ncogene 4_ A 68-year.t~:W.jn reveals sternal and vertebral pereussiontenderness.A.. in 1he ribs and vett:eora.0 .

11~OOiOQ'() tifIr? (I$:Oi:0()0'-40Q~DOO:mm~~ hem9globiri 13AY .spIen(jrne:galy. would be in a life-threateningbleed.Q:$c¢i3:S!!Q tdQt11JQt: wn. (Bdward F. Hemophilia A c.D. factor VIII: CQagulanUO% ($P~l$o.W3:idenstrom~s macroglobulinemia.1j{1:(ltmat Bnding ona .hyp<mi$t( disordereharaeterized by••• A.lpntillit_1¢t~a$en {gtyI i R materialexhibiting-apple. sUpta.4fJ'% ((JO~t5iJ%J.ltsW. VonWillebrand's disease B. neopla:sJic h.opathy" heJ:lllto.AJts\'i'e.' ...sedimentaclon rato.aI:1aI fot m):j.count 'Ristoeetin cofactor assay E.( On the day-prior to the procedutc.n®e .itloh. D.gery.4mijQ~iI. '11gb 15.c:k~t {o11QWJl1g deI). mViltipl¢ OiTiyelolnll aotls no. prate let cptlJ.'l'hi& is.yte. heavy menses that significantly TesQ]ve·when She1S.". neoplastic plasma cells in a bone marrow 'aspirate.l:r9gL9~sia~ ·ooli! n:epw(ltig $YJ:)(J.000 mm3 (150. Factor IX deficiency D.~ .oon~400:.a. :aef1fa.matroWaspiJ1l.5g1dL)..' . whibbpr~lUj)is):lis dentist to order a few.Boljan.tatloi:l pr~o41.istiocytes inabQne. Hemeglobin electrophoresis Sicklecellpreparation .the patient is mostlikely takingaspirin 01' other typeofNS.Dsw~l'. which is certain1y'notindiqa. . ee s (tl ~1. .ie pre.lJ4t $e1~t'oslng '1\r~a)l~soci'li:t!<dWifh 'II.5 gfdL (135.m:pnocytes With a t(&.Rx thatcould correct this problem would be a platelet transfusion.gfdL. C.womanhas an anterior' mediastinal rna5sand non~tender lympnadenQpgthy in the :right o. Hodgkin's 4js~s~. .icltftl(ina$" ~e¢ll t:{kipgpain medication. Serum ferritin Ans. . Which of the following hemostasisabnormalities is rn9~~ Ij:ke)y presentin this patient? A.r: q:]lpilu1arscleJosing HDm women or men. are all f~atures'cifamyloip. R~m!cii. D.1:. .tedin this case but .pamal tbrQrobopla$tU:I til'rle (P'IT) 55 se:\l{28~O Seq).-year"old man has a normocytic anemia.O~lQJ) wdL). If.w~t·.elawcular.he . 23. A.6nnfti'iilig the cause other-bleeding? .A1O.I7. these.cyMd eells and a mQm)¢.Sf$.gums African Ametican w. tl6QPlMtloly. 21 D.A22-yeaI:~Ord .liows.%).fa.laboratory studies. c.piatelet count 200. A B.tUS!litUy ha.:. bleeding time..n4 .. A28-yr"old . :PITJS sec (28"-40 sec)"FT 13-. Answer: F.5 sec). which areas fo.1S min (2~7 min).ye ¢at4iqmyo~a1hy.'. an elevated erytlrroc.q$is llemostasls questions L .Qman'With u6 J)tewQus: bleeding fi{sfQlj' develops' persistent. bleeding lime 16 min(2-7 min).OOO t:rJnt'). . Leukocyte. . .e.en. ami tooth' So.--an Igl\1 monoclonal spike must hazebeen present. B~the patient has-von Willebrand'sdisease 2. lymphopla. A 6o. . af1tig®.t~ B. The onlY. taking hirth Goritrol pHIS and recur jo the $@J. M.e level ofs~verity WheIl. All rights reserved.14) lta:lll. WhiCh Qftlte'(ol1oWlrig laoo:ra:tOr5:tl'.l.) 2002 g¢n!<11l1i~ lYPlpha:d. prbt:ht(l'nfufu ti11le {PTJ 12s¢c (n~ 15 sec). .develops a severenosebleed.t~loIPC s:tudi.problems ble~<ling.. ~c' class.i$Qme )"l}veaI the fdll()wing.sen.E:'.lbi~t()tYt!} bir:efnngence under-polarizedlight A. i~ ~qSfui>e:fuJ 'inc. 'Qfher. Acquired platelet defect Eo Acquired vascular defect Answer.she djscJ)ntin4esthe ro¢4iQ:a:tion.Ml$ related to.senrm'proteirr electrophoresis.-Y¢llN)ldman requires a:r:ooti.Note! This material is copyrighted. 7.suw. spil<.

)"D-. G. f. Response .OOO/mm~).p~ntlii1g.C:3$~jfil'ilfQtoxj¢ i>hocik secondary to desmopressin acetate J\~swers:C. L6W factor VllI:coagulant actiVity C Ab1i~f:ll1altist(}¢etil).S :D. ti:Q)jn(q. R: the patienfhasotd and i.:1imexs ·PQ~itiye(p'eg. fnf)l(:.8mgldL(OJj:":.E. ~1' 1~ !'iCe ~U.oOOln:ttl1').PIT :42s.gfime Lowvne antigen No. mild.E(}cJ.A.. SQf!'ilitQfassay D."dkeep tl:Ie pa.poison and is hemorrhaging 22 Decreased Normal Normal Ble. ~ef:Um ctj.yperpla:o. A Prolonged Normal Normal Proionged Normal NOrmal Normal Prolonged Normal Prolonged Normal Normal 4-yr·old child has eaten '¢ffeptlve treatIn.Q~I$ .i"§1U1pe onipqt tleQteases 'fe-v.i!'t.sllQek ~lIswers:H. F.? SELEb:r. heml:lPhUia A'l Sl!):t'ECT3 A Normal prothrombin time B.s~~ .this. E. Secondary iThool)lys'is' to <49f)l)lLtQ:lW. Disseminated intravascuiat'coawlall:on C' CQnswnptiotlof cQagulati(}l1 fiiPWf.1J1r0tfibotic tht9Irlb9(?ytQPel1h~p*pWl~ B.warm skin and a ):jiQwtlingJj.naS(dL).tic b.:'ZUWdl:) 'WhIch offhe foilowing'aPplY to ihistli.Q4Q)Jj.tient alive utitil the.lC.llw~.)~Mme . Pterel18i azotemia: .:OOO!mm3 (l$(l.()ti!?s ~n.onentsare alsoindicated.·Q'fY~nip@..sin renal failure (BUN/creatinineratio 4.f'me folloWing ·is tl1e '$ia.lrelet concentretes Low (lase hepatin .l fib:t!.alresistance n. partial tmomooplastintime K Ctyopr'¢cipi'tatt PrQlong¢4":PJ~dif!.hem:Q$]: effecjiyil' ~ OC$tQ~ the Q!'iliS¢:9J tl1¢ D.UcpU}iro.:8< C~ IX .ee (208. Platelet count A B.4 from his ij.wse W~tlii.:F1'l~ti¢nt? A Fresh frozen plasma G. tleYelQPSfevex o(anindweITlng catheter. @4¢rlyihg di$¢a$ejse:ta~icat¢"d.OOQI11lIit~ (4. produc~I(>n q.eal the Ibllowing: Hgb It) '~4L {13<~~17.Il.n E.:t1l. 'l. 6. Packed.tetal peripher. E. t:e@:uclIl$e¢o~di:try . F.00Q-40Q.~nt~ fQtthi..~.j)Z4hQut~.tyrno~e$ !ltlpear<.l.C.E. ted blQod cells Pl!.:500-11 .ptateletcount 14Q.'good comparison question Items 6-12 .[.~gldL)."WC ¢Q@t 2.6.'ti:ve). Ifum$l) ).'~ and chills shortlyafterinserrion e. E.UIWtes .e rafueI"tban. Prolonge:d. di"eas.He'$ ttJ.fPliltdef$ <is) .11~IU-.butessential1yfeed the fU'ea'n. Wllich. D. '5.Items: 3-4 A t)3·y¢at'-Q14 man 'With. D~reased F.l.Se..lVer histrunk and extremities.!J.-4Q s¢gJ.4 . .ieJ:lign.hel!¢gins~pzttig ..¢tilfe $iW$ ai). 'Theb}oodcomp.tljl.Y~rlltQryst1J.~:!1b.rmalpliltelet cQ\.lgyt(1:$0 mwdL (:?nO'-4QQ mg1dt!. blood " i. De~~sed Increased .d Prolonged Prolonged PIT "NOlJ11al Prolonged Prolonged Normal PT Norma] Prolonged Normal Ntn:mal Prolonged .emt>ranes..l"!1n) degradati~lJ products :> lQp:gtQ1L «10 MWPJI. Which of the {ollo:wing laboratory test results are more "Often -ass(1oiat:e()'With ¢}assical von WiUe'brand'$:Im. EIlQ.pnyS'lcalexam.¢di~gtini¢ ProlQnge. G. p.blo.ptox:lc.J. C.reveals.~l~&eC'). " .F.

renal f8:ihite ADswet:t A:i. l:i defiOiency'ofia Yitamil1.W$FI:eMme~~. There is .ow. A antibodies directed against watfann B.ate llQttMlptiorto teceivfn:g a standard dQse: 6fheparin The. ]rrothrornh1n. The path(:lgene.hiljtt.'le r. BothP'I' and rtf . and noW: haS a liemolYtic.ilQ.loliPf<llltitibl'ldies a.cytecouut 1s12%. 'a. de:4ci!::'9~.s{dlt)Pll.Q glc.jjdJet.: Pr the patient 'has thromboticthrombocytopenie purpura 13.tllbihIll.if. fibrinogen.1::> n(J~1 hemostasis B.'\i'fi'J''o$I:M1P0'-4l'lO.ntlppertespitatory infection. .lf occult iitld. prdt¢ll) Cd:enciencyin the patient E.tb.Q-l. Q[ his¢Il "is 4() mgfQL(7~n\ :mgf(!t)antlth.ecch~imo.t. Heparin C.f!'t.depeildent AI1sw~r..anenna and.tbe . A'bone truu'l'QWninpS'Yc(Jntafns Yascul<U"chann~iscontaibingplatelet thrombi. Eill PtT !lfidPT .JlJ"cP'li~R.latc without 38""year-'Clld woman presents with :fever.¢.lrt):tiphosp1.~cyQf:lltitithtQ. Physical .le. mentalStatus alteratIons".ll:' ~ffer ini'Ql>iU$ hep:J.s.ts:me c() ()Ulyplate.pctlychtqrnasia.V.~tn:!l:1t plat~:nei ¢Ij'(iht~(lQ})QQ(.Q. pet1. A :l8-yrcoUmanhas oeenen.J. !betels.QOOh1fltr).B:.!kocyteC:f!\uit.(i~1.$ •.l.scs.ogenesfs of'h¢:il1ottha~ic ski'rrnectosis atiSpciateA wfth warfarin therapy is most closely :a.niost intrinSic factors ann tii<i!'. and .S.tiv~. .(ltifiat .At!: W~bdl¢ :g-)!~4J14 lJQyPt(:~!mt..ranUfatl)er.thrombohemorrhagic ''C.anti1:brofUbin ill deficiency In the patient 23 . physieaiexaminationreveals.1~ (4. l'l . path.()l· fPtQc<!tltt hlOfJd is fjega. which neub:aHzes .OO%i(}pen. lnnmmevasculitls secondary to.lim.l\'aminatii:tiIteve~ls :tetii1a:llfemorrha:ges" Wirl.K. are 'asymptomatic ¢atiid:s. MsWtitl 1\". p.l"a. Ao1uld has eaten row hamburgerS.1s warfarin. .t~ ~~s l.)$$Qcjated with . His 'CBCexhibits 'a h¢mpglpQw. scattered .l<. The. " Answer.I~ijUiJ. no lytbpliadeno:Jjalli¥ 1)1'" h¢ ~tm.erll11d maternal g. The pear11s the 'lack of inerease itt the PIT with heparin.nt lws hereditary ATm.9.of'plateleits. E. diteCt~dagaifls:t h¢})atin .. bI~ng ili~{\rd¢t' whJ<lh begtl..IL>IIcl1k:PP'}'iecf):tJ:11j :of'8.f3):t)l1Ylil$t~o:.TheCBC report indicates the presence I:Jratlowalh¢tlijjglQom .~ J1:Q&i'l1Ve ilri(1~4iP~li'ijk i'.week .pathy ur nepalosplenomegaly.2 ' rug/dL). 'The PIT ~eroa.f(¢[el1ti~lc~@l. rat poison ..t\:sptea. .ge:ti¢to '$Q%O:f'tneJt S.~ heparin enhances. w1lli:hblo:cks :ail tbeVitaffiin..Ae ffianhas 1):. Il1il'tlOO'al father tran~rni1's the diseasete.{J¢petxdent fiu::lots.u)11Qt anticoagq. antibOdies.iS.\'lottected:tet1ci. &.~j).il. all his..Q«!1(¢l'i. h¢ncehothllT$ to. and ep1siaxls.Answllr:E..t¢f~t@lstr!ir1hI<.sv. ftawnentedRBCgc.adrughyp:ersef)sitfvity reaction C.his 'ttuhk.ateducednlUljpet intt.p'oU$utf:lillg'platei'et. warfarin nr~ ]}.'Wi'ihPis m.ememberth.QUjll)1).ti..An 18~ye!W4jld sl1it~kitlg U1ItI¢pteitents with de~ venous t!1romb'osis (t)vt} i:ilVdlvingtUe right tower calf.f 1:3 gl:idLCU.veJiomatedbyarattlesnake and is bleeding from all orifices-and all tie:edle st1't\'k~sites A)i$W~ri.ip..ite PtQI~J)~ 7: A 54-yr-oid man is on heparin [0 pr~vent deep venous thrombosis: Ansl' m. fa~tor :.d¢l1i:~I.theQa:l:tgJ:i.1hic thrQ!rt. He bas' a iamily history or recurrent DVTs and pulmonaryemboli in his motn.1¢tQU$ :RBCs ~prt<~¢J:ft in tb~s!'X1iment JiM settlni 1'tll:>. ThereAs no 'lym.petechia and !€:cchymoses ..der l.t <if the {tilal eommon llli.. and :ap(lsitive stool f(. daughter'S' (SXRtrai't) who. A$ki. c:.!):vet .ti!'l.11:t'1J19()$()l}-1$:~(jOtrnni3)wiih .:lpn<ire.§7'l' H7 'lle(ot:Y.'tet ll.l. BrJS d\le"tQ.Q:i.not l(9agulation factors ' lIt .1.tititlt ua.Ql.oth~'s(ath¢t An~¢r: !)iheWgp.cnIl~tj'enilms I) abnormality ismostJikelyfelated disor.e ~etPm\lr¢atini1)e ~s 4mg!dL (().t'hway f@totS. VIII .phadeUo.d.phi\lial smear exhibIts

hemoglobin 7.h. 1'h¢ :mQthl:tt'i:! . 2.t'44hllm:S~A dit¢'et'C~:rl)ml>s' . lllJt .ypetbilit4pifie'lDia in the fitS..Un ltConjugatid tYPe .D.of the A.uL(12.elaye.lbie~sRBCs (J. :n.has 'had a delayea ltTR au~ to .) 2002 ~wl... and loW' 'hack pain. rea¢tion workupon the p).s)J.0s anemia? SELECT 4 ABPm¢om'plltibiIiiy Type B. Physical e~@vea. F Rh negative packed ted. D. MQt}J. -A group ~~ifr{lW: 'i..1~reen rs t:leg.jsatemoted in the nf following best describe the 'pathogenesis peripheral blood smear.r:eac.mpt1Qb#:l .iQth l\ll)g.g b.bQdYl.l._[p¢ntevealsthe following: r Antibody screen negative Dite:ct CQCiirtbs' Plasma Urinalysis ne:glj.she '~tills1:tou14 Glble. l'9$itiyCIditecfCQQihbs IsdJie to ~ti~P¢q~tin.6f'lryperbilin. b fif C.)1ated E.tratiQ:Q15 20 VIL (~'-"2q UlL).iioJ1 t hcpatitls :Bi.n? SELECT 3 ~ A 65~year-Pld man . 'the oabyiSo . Goljan. c.'{he ~trt ~lllnm:e~nQ~q$fetll. dohQt RE. 'Rh negative 32-year-old woman develops fever of 1'031) While receiving .:Qj.. .pIMIffiI' .r: rtPwq. PQm<Jpera.. otthe. Wlilch .m:ildl_y an~c Mddev~!JlJ!s llh-1.tibilijy dQf\sptQtee'j.0 g/dL) Which of thefollowing apply to this case? SELECT 2 24 .C()tdblQcrd!retnms weakly positive . catheter exhlbits'pyuria' 'isl.A bJpo.Ii~ip:qweUillg . }?9!iij:ive" WI) he.T:t:ned on. Cad revealS 'a :3g!dL~dropin his liemoglohinconcenttatiQ'Ii wh~i1 c9mpared tQ .eIl~prior 1:9 .ed libdo:dlinal Mits lJ!i1ii. agajfisJ RhSeD.ali.a~c\llat\ h.A.sample ~n!! tev!li.ypersensitivity.{everot The.Ailrigllts reserv:ed.~te4) p. 'Blood Bank QJles1ions L Il6ttic:aneuzysm. wC'¢lye Rh jIjJI:lillIl~ globqIin.the ~ta. No:w the patient is hypereoagi. Ans. s<>a®~ tnQIteUi th'rcjughoutl.d (.lWcligate.. M.Q.IllC.ilable. stQDli~l:fgtQss.5 g/dL (12.. e.t'i$. An Apt test is' PerfO.of the foilowing apply10tbe p:atienfs'Clinica1 ~ondit.Newbom has aUI bleed nb.Ontbe 5th .e .sititatiQll.B.Q:l~ 'is 4: m:WdL (OJ~Mll'l'rwdq: Witb'g(}jteCj fCQtlj\J. redbl(Jo.l$ ~d!Jl~ 1:t¢moglppw.1binetma 1". the baby's.AaO in:CQmpa.m Qti!¢!'til· s~bilj~ hisbhrod P.a~QUp :dR1inegative·woman witl}' a negatiseantibodyscreen delivers a 'bleedgroup 1). irtteftSiveeilte A Fe'b:rile.Qtiso:lid~tiQfi.l:{b1oQdy.lJ0smper. tjt4)Q ~.l bmtu. Apt: test -distinguishes fetalffomadult.iliml:1ill of QA mwi:IL (IMH'.ers:.ilive day~he develops.$e ~'Ot!ee1J.cs:.h:.Rh .gkeq.. fecoverirtg from surgery' fdi: lJ.>!i:fb~t¢$.8.EX'trav.his.!tnllIle' glpb:y. pai:jept'reql'dt~d ililltis.~. ~l).wefs:. A transfusion..ti:i)j$filstl)l1 . A.:ttive.anti. heterQzygote: carriers for 'fJI"otefu C becomehcmozygote when given warfarin in~8 hrs when the haff-life of previously r~caiboxylated protein C disappears. C.a unit of 0. . the patient . .Gulture. 'The.0 gAlL} Post-transfiision.e(l.ompatibiiity ·Mofu¢r is n'Ot::.n t1.ICSS11r1). Bgb. blood cells at'tet it nyst¢t:eci:Qmy.wm~h. antibody ditecteo-agamstanant!gen F me.Note:Tbis material is. on A.d~h¢bl(flYtiQ :roi'IlsrusiQ'p t¢a¢ti(Sti '~'lIhypersensitiYit.:.rue stobl .Ql1jtlgated . All0 'incompatibilIty protects against:Rh sensitization F.filS>A_ ~te:¢l~ G'QI.ers anti )\. .tiye: normal color dipstick negative for blood Pretransfusion hemoglobin 7g!. ill.¢tn91fc$_i5 . ~.I(l. APIi.h.hah.~9§ttransfusio. The baby has swallowednrommies blood and dees not have a c~ E.3: m$fdL) •.t!:ve l~V.0-16. copyrighted.tiou . IgQ js coating the babies-RHOs.0"-'16.:teac.Spheroe~(.{Edward F.posttive baby. ·fi~lJ'l$..

Rh 'positi~e blood. mism:aft.rii. SELECT 2 Aanti-D n antibodies destroying donor Dantigen positiveRBCs C D patient anti-HLA antibodies reacting against donor leul\:ocy.Q.S.ered. blood gi. due to rultiboQY deSitUctioii oj'.. 100.tUbits·QrO.5. may fl!il"t d¢vel6.Usdoes netaffectthat baby but future babies . An 82"yr-cilil w<'nuan Witn blood groUp A. absence ofisohemagglutii(ins with old aM .and.0 . P~ysf()ale~11Jll..lme with 0.<rr¢' dir¢eted agaiU!J.t $holU~~:t:eeJ..sjons Hemoiytie transfusion reaction. 4 4l::feq1. of . but p It 6.tna:1rtiv.t.lremo)ytiil lRsevcn: With 'W1 ~O. dyspnea.g 4 units are O. N eJdetlyp¢Qple 'lose theitj~ol1ethltggllifjIlms> h¢ncefu!%-.. he develops wheezing. follows: .of tll¢ fO. Donorb1ood contamination with Yersinia enteracolitica Type I: h~rsehsitivity reaction Paij¢ti. He has an estimated blood.0: dilution is given to the l?fl.t$ o.ll' .e~.h.fp~ck¢d l$C$areQ.B.globulinenua A1i.. r ."OUp. .s1. F A.O~ Rh negative 6.t¢ttt.ql~ slPrt. C.'athi:4't4~l$O i:r.tH) Mtipotllqs 1. :Pati@t hlpodpr'essute: j1atientPllllle: Patient plasma: Patient antibody screen: Pat1.p.trts" M1dway" through the seetmd \Illit of blo9<t which is the l1r:s. swelling oflus.·th.e.h~molytic transfnsion ~yti9n.iit'IIl9¢fici:eMy iibsentanti~A 19M titers in the donorunit Nonsldor hemolytic disease-of'the newbomduring..tes apatient IgE-mediated reaction against a donor allergen a type I hypersensitivity. . C 130 bpm clear negative negative 60!4()mm Hg Patient Urine: negative 4ipsti:ckfo(1)1opd rhepath<n~enesisofthis patient's transfustorrreactiorr is most closely related to . He (toes npt dev~loP .s.:1 @Rsf.Q/40 mm Hg. tJ.!l ~AA.till1¢ousmJeQ1ion of a'queaus epin.el. Type II hy.i:velower Ul bleed (hematochezia) . The patient has no history ofa previous' transfusion or-exposure fo'bkin:d pmou. E. Severe.ati:ve.epbtiue at a. laslfew liom.1)n..Qi9.q'(j:ssml¢pb~d. 11100.!lQsi'$ptt.s]qn B.s·Hgb is'blQpql. A. Sp4~1'0~ytes the newhom's peripheral blood in D. A1liritta'Y!'lIiou. '.reaction 25 . whildhe::t:¢.9% normal saline-is inpliiCej while hloOd is b¢mg.kocyt~ poor 01000 for further tral'l$fu.+coiPpatihiliZY? SELE(:T 2 A.sioneaction wO*~llpis ord. Rhpositfve.e()fthe newbOrn. PatitW-tattti'-~ lfQtib(jQl. face.·ih.. E.inadv:errehtIyt¢ceivesl>!oodgtoupBblpod. Thetr®sfu$i(lrtRea:cti(l11c 'Worl\(up 'Qil ffp(lst. D. :transfusion specimen of patient blood is as.> 01d-yeat.thefirStpregnancy' :Positive dit®t CO:Qro:p:s'Ol)_ b~p:iesC:.l. D. celliJ1<1t ii'rJJ:lii1JIljj:y C. loss.liYt: leu..persensiti'vity-reaction Amtwers.. dhe' to ®..rstRh incoJ.:fie.t(ionp)t leultoP)ites A~swe)is: C.\.nt. anemia :requiring bl6odmmsfu.'l.. Thi~ is most likely 'due to. B.tOlltHllting'lS mote ofienassoQiatedwith lth hemolytic-: disell's. Bruton's agannna.swer.l bl¢eds dPdn~:deliv'ery) 4..mly 1 ofthe $Wii.:ct oombs'. 'and a weak pulse with .: A" Pi Uloth¢i'sgetseflSitiz¢4 against Rhantigenin their fi..ttIaman withknown <livel.1:1pii. ilntlft¢Qnih. .(lrd.A.:$cutS with .M4. Which of-the . ~ 'biood pressure:of l'.donof ltBG!. bl~9d papk lIi.'u.arateof129 bpm. The trl'llls@tQnis stOp'p~ ·3 "subcll..'ent <Jjrt. Ii').greater than60(} mL ov:er the.tible re~mwcy. E: febrilereaetion: patient must have been exposed fu blood proouct8at some time in her lite forantibodies tQ de~eJ6p (common it) multiparous women whQ e01nmt:}rdyhave fetoma. Owing to a shortage of <\ RQtlegafi.r~yeal~t:.q()njm~ated l::typerbilirnbinemia F.ture. Rh n. l'ati¢:i:lt teliWe.RBCs the C.iic1.

t}et'>l¢ts'the: prellcnccofpatkM I'IDtil)Q.l:l.ljuga~ali.tetnal .lr1mCan:tigens p.offetalRBCsby . Igu'atitibbdles D.transfuslon re:a:ctlon I).nloMgrott.ot AB.B 19(3 antibodies AU:~Wer: E: the mother is ABO and Rh m(fPlJ:'il'latil'He.Witb her:'biiby.the it. herpregnat1(.j).. of Aw!4en:.mes.l)swer: Agastric adenocarcinomas are usually seen in :group A patients. th~~f(jre~.WhiJethe the blo.B. A 'bloo4gtoup..Wt:I$-val'.oly't:icanemia h Answllrs: C.lmJ a1l. With.od group. AB people . O.e1Ji. dyspnea and extreme faRgue and a lQughi$toty l).E an.1 ulcerwstlase.oup O. II:1a. identifies-the antibody .odgr. AU ef theitchildren 'are either A.cloUOf .. Doesno] prevent pll:lieiJfltti.of associated:with the blMdgrQlJ. back 'typ_etlsing teSt.iaelitifi-e'& chfIdren.1l.l. It¢IJjf.AB. is noted tOllaye dark black..M!5ilti¥~. extravascular hemolysis of fetalR1lCs:'by ant1-A. allergic reaction oJ fetal ~C~hY!ll1t.~Mt-Ol.ri1dt¢O. A patient With this bl(JCid grOUP could develQPa: heil'lQJytlctfahsfusion. or.TIle p..r Qusband bi!. ..etsa blo. PhY'~ica1 ¢exam teV¢J. A:32.REGstosee compatible. .C.Her' 1ft'!sbanl:'iis bloQd group is A. . ."Ctos$rtJ~tl}h'l' S.F'-<i 'major crossmatch jhv()Wes~g patient setiiittWith.!tg<iin&t doiJ. D antigen.: Sh¢ ~nQtQeeb jJt1.ABO h. blood group O'people can only receive hloodgr. A.til?bdJf:S B. .o'WB.tsionf this Pltti<m. extr. hick antibodies. ~¢j. and a wide. pulse pressure. Preventsp!'>sHtansfusi~i1hepatitiadue t. which o. most ftkely p lt~ve'Whiqhoftheabo¥e fQrwardand pa¢kty}1e'41st1lts in !he\llI¥M b~? Ans-wer:..oUSl'y Rll sensitizedto &.:P.:yoll WOWd. 11.odjiO:S C.ular em.t.B.'Ii# tQcltildten.Wisf\.Y.l). uneQJ. tany'W)ois. '. is most ci. P"moJ' hl(}(j!il fot 11. Same ABO group rather than OpackedRBCs~ .a 6: . Labcratory studies reveal .\ls palecPnJtn1ctiva. '9'-U A..Wi.odgroupB lllPOdW()lip AB 0 11)'> liar blood? Answer: ']l: she must he AB to have A.p Blo.Peof peptic ulcer :disease he has woUld.texpla'iD'ihe b~pQ'4.: U.t". positive bahy.baby1s jaundice.D .:gtoul.ntibodtes deS:tfoying.®tilmdY$9t¢ro ®AMllt¢vlmxs administrerion {)fRh irrnnune globulinduring. Basedon his diagnosis.orderh..:the·habies ElI poS:itive:ltB~ B_ :iJttravasquiarhemolysis . D.$ in her i)1..c Wb$cfuofthe fQllowingchatacteri'zesa~jql. !31l)ce they A 49~year'-Old has a gastricadenocarcinoma.(.B IgM autib.RBCs. 12.:wtl:. Rules out the: possibilitY'.areuniversal recipients.oselyrelated fo.Rh Mgative Wonmtl.:lWQn)Iil1 'lij'id lie. 9.. lines ilfit ~!llllilteeIlWvi"'llofthei)'ifi:ised'4QliQrRl3Cs it cannot explain the baby's jaundice.mt1. type \:Yith A 45-year-old manwith exertional.FB.ti1iJ!1ttic$dete1oPtM 1).ofa tebri1e..fthe aboveblQod group types is best for transfusing the patient? .ltliogenesis of'the .ELECl:3 A.emqglogin <md a lpw Mev.expeC)tthe WOQll!.pa:tinsG B.llto have whiCh ofw¢aopYe fOtWl!t1il :and back wetesu1ts on asampJe . lfitravasc:ulathemlYlYBis o. In . .e most lilcelycaMe. reactionafter-receiving AB blood or A blood Answer: C:the patient-must be b100d group B 26 . Remember that the fQrwar4.g$$tcdohlilr EiBC 'E_ Prevents antibodies in-the donorfromdestroyin~p~tient REOg Qrthc newporn ist1!.cY deIiv. A.tbasedon .yp¢rMttuhipetpja a few n()w$ ·roter hifth. H. The baby OOYe!ops.olytipWSea~~ !antigens lftheyare Answets:B. Blood groupA .Hetal RBCs:hyartu-A.o ht. It is:alwaysOest togiye the patient the.glqLb.).

Whiithofthe.c? n.directedagainst.fof thep~tbJ:l.ill.I.'f . .Y'oti . fot¢ontta:ctingl? '4" fPY B.. A phlebofQmistin:ady~ttentl. ~.lP at m&sl.M. Which or the foI1Qw.yPotensi<ll1.. . (Edward F.A72~Y~'"Plli mal)1?:t!iS:!$ts~th a$~d4eniortset ofl¢ft flarlkpa.tlH.getw$is j)fth. All rights reserved. hepatitisB h\. Answer: C. palpated intheabdom:en. HlY A:i :3:0n chance of'becomingHlv positive apauent.n. ·C. E.s D.¢(!1ll. in \}l(lQiLpf gIl ~ses.lSed iI1 ~l)..entwho bas cbrl)tlicnepatitis .) 2002 A. 27 .. copyrighted. H:@atms:A D.eterophile®tibodi.Thls wa.g?' .. 11. CMV Answer: C: HeV isfueMCC B. !).'Nnte:Ihi~ m~teria1is C of transfusion hepatitis find blood that and' bl(lQd .I3· H~atitl'sC Syp.e(eptih.H'IV .jitis A .s¥:phlUs from mostrisk fm contractin.)Qt.ti$l<. Hepatills B l\I(Wlltitis C Sypbifls Bl(jod.".li~ . :fol1owin~ is the most cornmonantibody Ai B.hilis 14.. infections Is the phlebotonUst.epast mostUIc!i:ly has: :tmtib·or.6. A Q.collager1 D.N.j)fihe following. A defeet ift fih:til1ht· patient's condition? A. get .fus~ eucPlnltetedJtLelIttlcaI praet1(. A pulsatile mass is.ttive fer anfibodles~ga)nst CMV. hypotensive. has been tratl$f' neg.I?hlebotomiBt'inad\l~rtcnt1¥ sticks himself with aneedle after drawing bleod frema patient with AlJ)S. Note the rupture tciadof left flank pain. pal. A JJ~". Anti-Ims· AtJ'iHiCY·IgG Antt--CMV .. Long-standing hypertension Eo Immune destrnGtion of elastic tissue Answer.sti¢~ mmselfwjfua ue~ille aiWv dij!. E. an"clpulsatilernass. a~paM~. A~ ruptured abdpi'iiinal aortic lmeurySlll.IA:V-ISG 'Vetif{eQ With the NatiQWiLReo 'Cross: D:it is almost lmpossible'to l. . lhth¢ ®1el'geri!>ytQQfi1~the patient..fttifiJ '\Vhicl1. A.i~g is MOSTte~onsiQlei. .i. Atherosclerosis B. Answer: C. HePll:titi~ A An~W:(\"'iC~l:tB'V Ms:llic' gt¢atest:viral load.. C~ 'I!l E. . Wfl:icb o:fthc f~lI:oWiilg mfepti9ns is 'the pb:lepptd:m:i!.

rrUd_~systQlkeJc¢tiQn c1hd<:ollQw¢l'l hY. Whjch of the.3 . S.$."ectj9).l'hepatieht.atrium E.4o\Vj:l. 2. nterior myocardial fufarctionllas a recurrence of Co. iufeetiveendccarditisin. .U\ the click and murmur r move ()IQ~erto S.: Answer: B~hy. !'.i~Qfh(l_spitl'l1izatiQn fof :af!lic:ti'{e.:tlve acardiacTP. ¢'olla. B.D D" .~2.cardk!. tetrCJstef:1WIeh.lpsl!. a qef¢¢ti:n' A. i. JiuxieJ:yj: the clidk and murmur come closer toSl. 3.:chl)catdiogram 'f¢vcais abnrn.gc. Whenihe LVEDV IS increased {lying.QWJ$l!. . A 26~year-old woman.ilays is the definition Q'fteinfarctipn 6.l$PrQees$ 'E_ an acure. A.D.tnbQtI_i-GKrN:ll ~q j:rQPQhlIi-l @_d_.increaseswith expiration is heard ftn:ffiediatelyafter 82ThWl': is wtdeningl)f tn...ejection.ll v1J_Iyo. q]enclritigftst).a yentr.r aneurysm D.g downand increas!l:. A.Not.All riglltsreserved.:ka].:tiijfi Md 'W:idlm~ng tif'file <jotijqknQb.rupture LiKELY has. murmur-that decreases in. The mechanism .!1.. A. mW1nutof aomcF~gurgita. aJ1q.Wil. Dependent pitting edema 18 '1014mlltihJ.eappeflt..)0(oma of the left.heart sound B. a defect in fibrlllin Ca defect in.J.ient MOST LIKELYhas.e~t pll-ill..an4 ti.basa nt1tml V!lly¢: :.u'Qiacd~fu ~t~}. foltowing. lscQPyrighted .) . a dcfi<ctin.E--'r. val¥111atdisorder is M:Q.mattonthe 5th. 'l1by::.anterior mitral valve leaflet against an asymmetricallythickened intervent1"iclJI~septt11p. c (Edward E GoIjan" M. An r.:t1btillrn AlIsW'e.¢ath in septum has abnormal conduction bundles.arightventrkular infarct paitrwi~r~4m~(w '9(tb'e J)flitl.g"hlStbryof 'cardiac deathinb1s fainily presents with a .~itlnore. a myocardial.gen ~yQtites'i$ proJapse.sudden onset..' A 28~year~oldpati€mthas a familyhistoryQf$Wide!lc.y()tlUg people •.:Ilef1:. wnw tlt~ lyhrg dowu. aninfsctious . . C. D.d. The aSymmetric A 6$·ye@-old.l. Pillow orthopnea Pulmonary edema Neck vein distention E..orpam radiation into the bacK" absent pulse.vl)lvmgt'\iemi'fti.e.clCarnreveaIS a. intensity wihen fue:patient is lyib.presents with a history of chest palpitations p'arlictHm. of s~vere.prolapse hypertrophiccardiomyopathy acongenifal bicuspidaortie v.'in :intefi:.¢J:l. Th¢!p:atienfM()$T '13 . come ¢lQ$ittto $2.prOCI:)SS C ihl.!'ld heart failure? A. iWl" msl!ack..dissecting aortic aneurysm.(.fbrtllls patient's. 4ysfunctiQn E.l'nCecof CK~MB after.r:D~ 4. When tML¥:Bt'-Vi~' deQr'eas!Cld(~tMding..trllmolpgi¢ damage D. Il. CQHagO. Thi{p<.tse .. D.wY€l' present in BOTl. His 1¢~J!lJ.--MC.per1:rQPhJ.m)'Xomatous degeneration E. A higp pitcheddiastoHclilowing murmurthat . reinfarction Auswer: . 'N'ote the type.ghtcsid. tlIe.yst(dic .ls¢is !ibsent.the meciMrnsm for this patient's condit{bh is MOST CL08ELYrelated to.: This material...IIliIlJ.rym4scle .trtalmovertiept ofthe. mitral valve.ity when 'statrding up.liYWlIenatmiQJ. C.rCL.[t!. S.eaQ'tfic wob9t1l1e:lrest 'K-'!"a¥.C \Jfsi.tttil!f:rt:ii.OSELY related to •.myocardial jnfarction Answer: B.wMnthePIlt!ent tSSTI-\'f[cli'jl~ . t'. atherosclerQsis H..). B.2002 A 41-year old mail With .

la.l. then a perfcardiocenteSia f. D.glopathic ·hemolytic anemia.'t)mcle Aorta . $\J= VSD. C'o.Pulmonary vein L!.cle :Flllmonazy art . I:HF.xygensatUfatloum. a "pencai:.l')J:cfl'!..eM¢t.p¢tiq.~i()I11VDl\.amlti).tlem 80. Hepatitis A B. Items 9-11 . 7$ . ti:gptsnwt.lit ~afi:e~t 'P.: 8.s qUem S. A-aottie:stenosis is. has an $3: and $4 heart sound and a pansystolic trtutrtiUJ:' liic"at¢d. mat InPte<iSeS W'iWeXpitap.hoiceB m LJ!iFx choiceCih 7. .ffventricle .ns. Which of'the fo1lowing types of hepatitis is associated with a vasculitis due to classical polyarteritis liod6sa'? A.done.R1'ghtiatrlum .\ in tl1e.riustl'le .el usually 1l1e.gurgitation E. oxygen ' %atqJ.:tic 'S:tenp!. MG valYlllllrle. . with a viral rnyoeatalt1swbo de¥elQPs h~tehSiQni lieck'vem distentiOn. B. A. 'tbellpex. Hepatitis E 29 C. a s:tcipdown.. Note-that a step up ID:o. 'SO :80 '95 ·951 95 95.():dicanenrysm AlI. Hepatitis C D.ltI heaM faiIp..~1jQ1t (~A~ futdings.~rilQi ~.. Miltl:tl$!®o$i$ .'W¢.o::ti~lit X»a.0. obtained nycardiaccathe1enzat1on'i' Normal '1'5 75 Rightventrl.icl1 of·tl. a drop in hlo:bd p'¢$s'!U'~Q1i 1~$p"ii. the MCValwlar lesion asseciated with angina and syncope with-exercise. while.atiQIl 9.. .Ustrl(. 7~ Mitral n.choi¢e lJinRHF.$lged m~u:rs. HepatitisD E.-\ E~ tripuspjG.i\SD.lns:pitation.. A 58-year-old man with lell·sIded heart faih.dialef:ftisiQli E.jr4iti:s ~tt!tatiolJ 'jJjdicates 'aright to left shunt {'cyanotIc' mm~. Hepatitis B C. A 30-year-i01d .ife.~~~'O:''v@.eJt.<ttY'ji'.sw·¢r·: ~ BeQk1il tr:i34ofpet..lcar4ialeffUsion . It~sal$t) IDe MeG ofmicroan.:w:d :lllinoIJ)1al heart sounris. a (ifss~~.~tihg'dl1e to volume nwtlo. 7..First step is to do an echO'CanHogram If positive..tioQ.x~gw:gi114iolli~ the. It1.Q'I1 Answer: b-:filltfitT regurgitation. '. aureus.rthal increases with ittspJtation 4. . d¢f~t~ol):lrv:e w!J. . hypertrophlc ear&omyopat'4y B.tation man.tlroe~h.. A 70~Yeat-oId 111an.eatts~lln4$11l!Jstlltel¥has .a chamber or yess.lpga.. If.l·Quetgsjt~t¢h'itl:g jjftberaltrAlvaIve. 11.= ASD.wjjh .te folIowlD$.~~~r': A~{. A 29-:ye. G '" }IDA.intravenous &ug abuser has f.·pattlmt.£t to. C 75 75 'UE "1'5 75 'JCSSI} 8'0 9S 80. Tnc(1spic1tegrtt@i.•.(s R Annie n~gutgJ.a giant C~Y Wave.anSa It. chO'ic¢E 1u FiH'F) You wowd' eJi. while the reverse-is true for left .Tetralogy.®atri~]i . 9$ ~5 PatieDt z\6 80 80 J?atfe. Je.withdiUrinislIed pulses 311da history of angina and synoope with exercise has an ejectiontypemunnut'raruating into the cato:tidarteries Answer.. 13= transposition. Remember that all right sided murmurs andabnormalheartsounds increase 6n.~~l4J.a.a:hd a :partsystolic rtltlrinilt along th¢ left~~] b()tde..95 95 9S 95 95 95 95 80 80 86 'SO $aQ~'=o~)'g~JI. D "". A.n$'!'f't:t'i B'"" is oatI. h'¥PQV'(JlemicS'hock: .A. 12.

a ll.anincreased . in fuisoase. elevation of 'the diaplupgm.With l.ANCA (microscoplQ>p01Yil.·A1XCA ill seen. describes describes bronehi!)l asthma A 4:5~year old' woman 24hoiJ'tSPdst. (lTP) lt~~sWmiG' Ippll. emphxsema .yspll¢iq Aftic.culitis: a type J1I.. A.oid8.bronchtal asthma. It is not associated with p.te.. tgA R(!s[)Ita.s ·tlUnktbat nSPand. . A 7·y:¢itr~l~bo>.ppt(pd fe-ycm E. ~g. Physical exam 'Qf the lett. This Increases 30 .Q~)'tQPertia:Ilutp:iJ.cholecygb::i'lt6my .respjrat~!:Y if1f~¢ti():tfsl'it\9 . lowerIobe.@Hb. A.d$mok¢l'..Q\-y~.}tt':iit"61d d.ailie.m Wegen:et'S: gtan:wmnatosis.anAmeticati..y¢:at~i)J.1:he.'re9)liring systemic: steroids E. which . atelectasis B.siQhPneiimofuQrax D.1iance.wret\t..fuese IU.deve1ops. The. Ali afe. G.g1ometli1uneI!lhritis' ~()¢kYMf)gp4!m s.ritdnon-smoking!t¢it . stabbing.. sarcQldosis.o.diaphragm is elevated and there isinsprratory lag .tr~ @¢is.1$ ).sc:ertatios'UiYQMng Jra6tm1:S with lIltigd!se-asewoulity. pJeW'!lle@SioD B.~ecrea$eqbi.. pre$eut$ wict!la ~OW-I:1i!4et:¢Yet~~~lgt! f:irihalysis With t¢4bl®d !<~1I UlC! pasts. .Ll.n:~w~)'{A'.y&:i!3'. The patient MOST LJREtv has . a pulmonary infarction E_ spontaneous pneumothorax Answer: E~ in spontaneous pneumothorax. chest.~. Lahoratorystudiesrev:eala.Il~do$a.ctj1e fretriitus.t(lsttieHve lUt1gdism~aer. left-sided.. guaiac-positive ~to61. and a palpable purpuric mshJimitccbo the: lower extremities.ty function :FltVI~JFVCtatio? A.u1!Nillscess 'C.Ni~b?sS9ci.q~sit.' A. ph.t'gery iii p.tll. a ~Qnt@:e9usf>tregro9thor~ broncb:QpneUlllOnlaand lobar pneumonia.~l~ta&:is. increased elasticity. Physical exam reveals 4ettf~fi:s~l:lpe..rI :tin.ou :eXpect studies 'foexhihit decreased®}l.Ltni1qpto.rcl!ssjp111 jnqte®¢g.S: ~ematQ~ ($LEI e . PQstStr«ptocoocal . 1O~ear.apulroon~ ±nfarctiQn E.S.cribeSCQPD. .. which opens and admits air into the pleural cavityduring inspiration and closes during expiration. ti.chest reveals hypertesQiiatice to :percUSSion. andpiatelet.. q¢ficie.S~lJt(jt!'Irea 'IL :tif'the' fl>. 1).on the right side. n descJllJe$( IWnoc'li"8chi:inlelnvas. E~ it is' .4illgS 'of~tl. Remember that fever: In the firsxi4-48hrs.ttiQn wjtl1.coliq1gr aJ:J!IQ~l pi!ill.feMer and dyspnea. A'Jlsw. idy..ll!>wID:gcHni~aJ.QI1:i '¢pl14With .}pr.des Answer: E~the :rfls describe: a. pain with 4yspn¢a. the lung collapses causing the-pressure in the pleural cavity to he the same as that in the atmdsphere. ~dacgC with Q li..i:s.p.y.bronohopneumonia C.tcti1~ fr¢rol.~ L In.Mle i~:"year~1d man develops asudden onset of.(. c.w~si'S M . A tension pneurnothoraxis a tear in the pleura. MQ. and oecteaseq breath sounds. . ChQice A cystic:Hbt()sj~!. .da:tipl.n¢)"~ C des.. it:lifuuilocomplexd. HBsAg.l>at).ir1·:With. :ang . 'whiCh <of the foilowlng is the most Hke1ydiagnosis.Gount.t)'l. ~¢m~fu.iteral hflar b.u:. 2'8:"year-.MOS1' LlKEL Y diagnosis is .tth stJ:@P$ in the tight lower l()be~.:1¢qJ:.isease glQwemlOQ¢pbtitt$.l\.i'i1. 3.Ans'W~r~B~l'0l~tis' .Qgtins iSl~ :c. H~t. 13. Iniopathic tbt:omb. teil. deViation of the tqI(\hea to the left.sPl1ea. decreased ta.tL!'S.apd D 2.:¢ t4§ .'l'h¢yW filtilll<!i:tp¢Qrt$pll.t:ury rqll~bti.!. ptfb:!lQna..wjtn ]'lt9tbJPQvecQUghj makwith bilateral. bronchopneumonia D. ·after $.. Most cliliieilli). il c.

Based.. on.arid .:' iicubadiYing. R ADswer: c~ 1t1!llui.~. the positiv~ pressure in the pleural cavityandshifts the mediastinum and trachea-to the contralateral A. ie.betesrtieUhusaild was in jl\JQf glycemic :control thrQugllQut thef1tegnan!lY.p B streptococcus'pneumonia aspitation'or~Qt. :taG}! aeit\().g.' rocte<iSedariterQPosfehor diameter.. E. suspectthe patient has . A-a: superiorsulcus tumor.ii:)~ tfil$. disease witkmetastatic cancer from another primary site Answer. Physic'a:lex.. A.' The mother 'tl:e¥elQpedg~stationardia.d1."ar Witl.l~ :toM.bilateraLinspiratory crackles" A.!ssi¢ ]fometfs ~yndrome.i"gn.negative. Which fif tbe fOUO..1 CQug' with retention secondary to .1 Interstitial and alveolar innltrates.prostatio.cJj p'Joeoegi B. D_ complications of gram negative l AU$weri C~tlU$ '. reseals a miid lfdHi.. these findings. Jjneuiuoniae.gon. E. gti:!.. A aJ>ancQasttumor ]3. obstructive lung.6icr. Pl)Qr gIY¢I\l. Str¢pi(JCOiR!UJ p:ft?fl'tfim#i1¢'?' D.tQ.. E.D.e.i'nvades the I(lwer partQf thebraYhi~l plexUs ®dde.(jhtamydia C. D-the patient Irasgraranegativesepsis ARDS. n.D.ll'factant syn~hesis. I}th9/.rooil Answer.AcI. "tou: ¢xpe¢t the blood culture reveals . Also 'Occurs when <iSC¢fidmg fi>thesut..:Rt>$and Dlente . D.rodj whichprogressed into this type ()fs~psis.AtI rigllts reserved.002 side." AarcSpltatozy syncytial virusinfection B.i.J.e . atypicai pneumonia A S'&:. scattered sibilant rhonchi throughoutall lung fields Urat . the former m()~t (t(1ep.6ough 6.ev¢lol)s SPiking ft:Y<4'iiUl. 7.gramjl(lsitive.ct'a:ctilnt trachomati8 pneumonia andreleaseolinsulfu.rods gram.JI~WbQIJ. usually squamouscancer. pn!':Ui'nonlal$ 'and the later $.'apjQ o!JHe~$:YJIdtqme thesup¢r1Qtvl'.teM¢d.and an.Jnllwelling urinary cath.{yspnt:a.s!. positive . 1\.lil$Sjq:lUJ$.s material..It.cQcci gram.. coli the MCC of (gram negative. l aft¢[ thiequestion ~omparesao/Pical with typical pneumonia. in 4.ristrat¢ sevete hypo.Note:Thl.superioteetvic.aL gangliou leading to a d.Us E. High fever .tapb.~a~Phy&jc:al examteveals intercostal muscle retraGtipns.6rtm and the hitter a coP.):lllopnttol in c S.. Golran.. grou. tqchYJJTIe.tactilefi'cntiJ. P.qypetI'l}asiic\.¢t Pronuctiv.Is :cqpycighted .lel:>t:&"I'ay:t¢l/ealsi. gram negative diploeoco] urinary C. (Edward F.nterc. .ua' caval Syndrome bPsttu()~ive 'oogdisl:as¢ wttl'lout piimary cancer Neutrophl1itt leukocytosis mc.Qf typIcal p))'eiittionlatiltd wouldfidt beexpected.icflwd ru:cce?sedpr{lqllctio:o: ohll.¢ ful'J!iat ltuJgs.soO¢t'tio):J:t}!p.(J. ahiilterstl"fial pneuti:i.positive. which iil'hibits ~l. M.:th'¢ primary' IDeQhanlS)llforthispatienes respiratory-preblem is. heart failme fi::Qm (jQn~enita:I1emdise.0sta'lmusele retractions.hia" All Di:hel" pIroiccs are thosC.bytyp·c Ulme'Ut)lp((ytelj. Inspiratory stridor tscattunolHy associated with.yeat:-¢ld ·smokel.l.l1.(QYs the.$ With weight toss and cough.1hii~g. The former is.W1):J:g des:6rioes a pneuntc)Uia due t6 MycaplasllUl pneumoniae the: mother Ieadstoh'yperglyc¢mia'ii1tl1e fetus rather than A.. a parainfluenza virusinfection dueto E. the left and a-plnpolnt pupil.evelQ]lst. a:spirin~iI1duced"sthma 31 . A 65-year-old .l¢cnna.lits bilatera. C.:f PP'ew. ehesr x-rayexhi1.mnd . you . <rud ·li1yanO$lli 4qpws c .' prcse(J.etersare 8.) '"apJje:atant.

..present.. abr. since roofingmaterial composition. ' .¢ thM /I$¢ilriOWQ1!i4 Answer.8:.WQ~Q:sjil.. t!iprim.esotheli(jma fl.RsY is the MCC.the patient bas had asbestos exposure. .onchiti~ D E.'YngptJ:a9heobronchi:fis(crcup) therespir-atory distresssynOrome due ~<.histoplasifio$is. y<iu would ¢~pe'¢t a ¢alcitl'edsQlitm'c~i'fi .n.infections ¢UQ.A. gta.yeliT"'Illif man wJiQlivesm copyrighted.most solitary nodules itt the lungs ate granulomas and.Pleuralm.rihUt£lh.ltO fi}¥(lr M!iQjl~ti<tal ' to'. . an old. in. A. well. s)"st¢mic 'lupus. Mesotheliomas take much longer p.aptltnary common thana mesothelioma.ennessee' valley. metastatic. C. .n. .m ~bildf¢jl< c.tty lungcancer K in. 1rachea" which on x-rayappears '9.D.lgiflosa. Whether the patient was asmoker or time had asbestos in its lung cancer would be mote develop than lung cancer and to 32 .lpQr 4tt.ofpueUInorUaand htbut<hl'Qlitis.!)phili~.bsi'e]l« aiZrj..Js.j. like a ..a. In the SouthWest it wouldbec:o.features of P. m with .l'4tn)(iJii1 ttaehomatls and the respirat@ry syncytial virus: are IlOTIi:!.li~~." 'E.carcinoma .J.B.ttesia MS'W¢r.spuJ»m 'G.." '1fiJc}iomatis pt9d!ic~ the lungs with-a pneumoconiosis... hospital-acquired Inosocomial) pneumQnia. j!tf!4uwa:tii. Ch. in :thi$easeeoal worker's pneumoconiosis..ikcufeepl'gloltls due to H. Answer: . 0 I). (njJufJllzae.of the fcllowingcaneers would he be most likely prone todeveleping? A. erythematosus . is the most likely cause. . You suspect the patient . C~p~an~' syn9t:Qln~ ·C.e~'¢Kgl.tiQ!lil1.esent •..13. £ryptococcosls. Answer: 13. a foreign body . Gi'eelkco'lou. Jtll.Southeast. ':in the ~OhiD:f. All rights reserved.It)200l rhinovirus. and in the Northeast. years and a smoker for 10 years.g witlJ..lesion the lung:tjJrep. co~unctivitls: wroeh of 1ht)'following is more often assQciated :with Kllf.has . 11. tmppip:g of'air.' sP:lpli:ajpcotlgh.J!.\l~ virqs. ..nala. D axe..'l . Pancreaticcancer Answer: B.\1l1omll..4~rugiIJosa.A..diseas¢ ])~ E. :lli a j(). Association with cystic fibrosis D.l~¢ls·to: ol. (Edwatd F .ccidiQidomycosis.yngQtra~he:01..l9mmunly associated ari inrerstitill.:old)loD~~moking Worker b:asattIttitis mtd·M. :A.Both haze producti. Upper lObe cavitation :B.j.dtilarleslonil irtth~ lungs.cancer . Laryngeal.liis'PPD skin coal test is negative. PrlWary lung cancer Oral cancer E. alaopro:duc¢~ ihspir!ttQry' stridor. typic'al()()mm\lI\ity"acquire4 pneumonia 'E. A $6~year. A.n. A-chQices 1 1- Producnvecough ..a .'J. metastati'dung. wh¢¢ztI). \ .Note: This material. C.:d.: C. C.l. In 'P~~l®~ClIDC~~ miliary tuberculosis B~ this underscores theassociation of rheumatoid nodules '. blastomycosis.onchialhamartoma Answer:B'--.ltype ofpneum<lrtia ~cough (c'hoice''E). tlte "steeple" of. :M~od#j9n wl~hrespirators is usually. a 6Z~year-ol~ man who 'has been a roofer for 25. the . which ...

i.mogeilsa.f()UijWiIrltiS a hxP'¢rsen$itMtypp:¢l. fue i:\fteli:il :PCPi:is SO mm .. (roijan.1'a0'2 is. have no smoking relationsblp. $a:t'¢'Oido.J. Sfu1.W Iii enter: ¢Qm~ A. is related to nitrogen dioxide is. % Oi_f7.l"atien:ts.e:o:~¢:li¢ te® "Mo:n.S'Uo :fiR~r'sdjse~e . hen:tt'. Ftttm¢t'SJ\m'g :D.!J$~~Jt>'P!)I'&enliitiVi:w tell. :a:isipptwna"g.develops a.Q. B.sbestos is a.ri irtJfti!':diate'reactjon in l:b.. rights r-eserved.Qups. MD.da'Ytn!:l'rt.$'.ct!tm: :in l.N:Q~~efhismaterial ' is.):l'g ByssinQs(s E:. Hi$t9lJi!l'$~Qapsutatwuapd Cl)'I?tojJQPPu~ neoformans.isa hypersensitivity pneumonifis thateemmonly oseura in farmers who a clQ's~'dt~Qmw. of the following .eoJc).y :ca.Silo increaseth~gtad. K CryptQ¢PCcusn..weekend and get dep(csseu (On Monday 1q)Qww:g tha:tlh~Y will be~~k. IS 20. brid~epainter in.) :100:2 Tlw pl«q:4¢.I.l.ryptococcus.a). what isthe.():¢yst~'$aF..calcnlatefhe PAb~ :is Cpcqidi!) rur~w¢r~ BlastotnyceSdennatitldlsanrl Histoplasma capsulatum AsperglllliSfumigamsand Goccidioldes itfitiiitiS Pn~:qm. My Tung disease would he ·et. .it :Bag.g.~ hmgf.. i whlch. .'Qr cotfott'f!r(). Forexample.COPD.. .Bagassosisis.ARDS. . Which:Qf tIi¢. gradient ofth~P~tie.A1:veo:lar -arterial..and As~gUhlst'un:!~gaWs c A.lwg b:1ne. 6{pll.AtI . C.te on yQUf diffe!<i:mtialli$t? />.. t!Q:(IWl::gg.= 0.nii.tlreformula to .improve over the .lJ. Silo fillers disease At t~~ti~W() ? SQ.lns.apsulatum.lihg.. Brooklyn.p¢.u.. imrtnt# D.s". .. D_ e.j. therl¥fQr~~ A-a·=< SQ· 40= lO" Amedic~ly sigilJfii. io .:igamst thermophilic actinomycetes mitin the fields ..ithf¢®eflJing A.iionilJ.A. copyrighted.thing '1:oon:t air' (~l% ~s 41le tQ :a..filler's disease.gradient. Me lung problem associated 'With a.!l:®p:jf!:s':tli.PaCOlO. .?. 17. $atltoidO'$is Answer: D~~vqsm.S 30: A:nsw.11.D.21 {7f3} " $(UQ.l~IlJl)g with 'dyspnea andinfiltrates.i(:ygen).Itl!t the arterial .13) . It causes 3. New York . Which oIthe following gr.reaction against sugar cane.cted. Byssinosis E.. and 'Uotii. 14.roosioii: bridges.Hg.llijlY:QCbJJt~ 4.@l A~a gradient is > .$1I 'B'. carry :a:istop~asma and . hypet$en.. (Edward F. l~>i 'pigeons canyC.duc~.t'p'ffil:j. In this prohiemthe PAcQz ..s. =. .and Cryptococcus n:eofonnans B. BagaMQsi:i l"~er'~ Jll.sitM:\y tellPtion . ..ien:te. h¢tUgn pleutal ~. pulmonary fnflltrate. Hypoxernia due to· q1n4itionsDqt directly in¥oJving the Iungs have a normal.sasls C.$i$: AllSlVee A. 33 . given offpy the fermenting-Gam. pl1etu.a. m..8". C.0 mm :ag. E.. ~amt¢fsb. (A. .lfa patient is P'relJ. s~tcoidosi.

aftengmgphysiciarr .Ctllture th<e fOOd:. E.t¢os pnrohaaedfroma street vendor. human reservoir is involved.lVonPtitlg withQ!lt <liarrl1~ll ~~(). Items7~8 .~~@ 'Sru:~ec!t).simulate UC.i:lOt @.1i's lat~t.e$el. Answ~r. after .shapeaorganisms are noted in the fecal' smear 6:£$too1 ~lQi:lg·'With.Gastrointestinal Items 1---6 qilestions .~. CryptqJ.oli I.Wt the stool .2-2.S. abdominal cramps. a sporozoan.. reC:1Jff¢ij!r profuSe. A febrile l'Ocyellt-61dchild pi'esentsWilhsevefe: tigJit lowerqpadi'ant i?'afrtWttt tsm~eted by the days. q9riUg the: .developswat¢ty di$'i'hea volume depletiotl sJi9ttly nftet Vlsiti!. iml~Top~ly cooked.e 1»'(& ta¢QIl"Grmn .it is a secretory diarrhea due to it heat stable tCixinthafstlrnulatesguanylate cyClase 7.4 l:vJl. the . A 25-year-old medical student during Spring break outside.MycobacteriuTI:! avium-intraeeliuiare StapnylococcusQ. and splenomegaly. F.have.~14 hows after eating a¢.l'ko.y. il:Qil Q~$Q. Ausw.c:<1ttntry. 8itcphyt¢cocaus aureus H. $ll}od!.pic!1ip. WlltqyQlarthca. with..ld l. 1.cJzolerae produces.rder.poisoniQg gram'nega:uveotgiTIi'Ilm.r:E.a'bsolute neutropenia.assQc:fatedw'ithbtadycardia.e.:Xplo.rt3ti. 34 D.ureus Entet1"it()x~gMic J!. is the M:C pathogen in AIDSOlarrnea 8. He recovers uneventfully iil48-72 hours.:tfWg t!tfrieq nC. F~ X/ilrsiaiaisa cause o!m.1ot . .Sai.. :cuisectiotl.1mric with acute appendicitis. Salmonella enteritidis is ttie Me£:of ftmci.$leq:tn the fOQq.lcit. An Entero.. for a Answer: D.$ .:Z~Y¢IIT4)W ·l.11®'~4 $eWlm1other ni'¢r!1~tsgf hi$1lmrlty ideve1oped~t')\(erI. A blood eultwe :is' develops fever. M afehqle f2. Answer: C.<yellt-o!dm.S~CJJI14w~ek of infection. A 2J~yr-olil.ll'ti..Test (string test) reveals oocysts that are partially acid-fast positive: Answer: D.Vibri. G-tbi$ is que to $.i prQQlJ. R C.aul1¢Us prodl.ThW ~ltJ. focal areas of adenitis.ciytesy a:nd mu~. A aCQte'fpp~dipiti~.por}diumparvutiz E. cereus produces a preformed toxin.RiBC$alId le. A:tlaparQtQl1l.dian:he~ ill.i1¢t JlitP. and watery diarrhea .hQL1t"sliJ:erel'ftjn~:PQMo $al:lj:(l~~.. A.MCC9f tnyamve~sttljet1Jt:tilj§. a secretoty:diarr1rea duetotmuh stimula'fioncof'c. Comma tQ8.o onol-era k E.. l1otibloody.n 'pt0!l4ce ¢typl \ abs'cessesand .l.. Coast states..1):f~n~!)l1e>'C<l'drosed b 4i 5.• llsitive P rods are noted in the stooL Answer:: B.the mesenteric lymph nodes are markea~y .eating :chlckenthah~as 2:..Cryptosporidiwn. 3.!'tcre.C4#JP)!!tihtif.agt®uiomatPQ. P.B. It :qq.p_onelt'q o/pli. coli .Vibrio. 6.:"gover¢dtlp~v!<ntf4Uy ~ l .n.:mdeye'lop¢il c.. On a trip Q'Qtside6f the.-3 Answer: nricto~bscess fo~liQtlotl.enlarged iand.. C Bqcill& 'Gct¢tlS S:higefla sonne'" $l:Jl{n(Jne1l4 typhl OampyloDacter jejtmi.AMP. A 29"Y?at"'l.. Jel.)1'otes tl1atth~:ap'pet)(iiX is normal. vomiting. cl~ssio wad.ig fh¢(Mf Answer: A..ces tbi::.UkQ~s.aman develops' a nigh fevet .l$'<iw:iQn Wbjbhis'in.. )!etslni4 MteiyjQf)l(tica A 28-yearcold man with AIl)Spre!i¢nt$With cbrOnlP. YetSimae:ntCtvQ. 1)1::he U.Wi developsvQrniting and. Entetotoxigemq 1&. watery diarrhea..

disaccharidase anda brush borderenzyme.:fl~n®ll. It Answer: C.Gogan. A.rtfl.ciatei:l w. pylori. di'a:ffhea: ~.fuegalQvictfs '&t901guaiae exam are 'bdtbnonna'L Th(fpatient MOSl'LI£<LELYhas . thrush.t(. 10. in MEN I Th~ . It produces an . CiJ»dft!'ft{lll?i~ C D. stomach It Toxic meg.D.ql<c<t.1a.MOST CO:wMONJ. . disease. .QlpR Flstu1a f6rmatibn Dlscontinuous .:yell't~ld met:ll!3l11 $U. enronl'c"app¢n.¢Il.f!. for adenoearetnoma PlIlnilWakeni>th<.ytQ.characterize CD A :3S~year-old Asian woman hasa.1. C. ~s\)MditfgCQIPn It sIgmoid ~ototr recWtn Answer: B-selfexplanafory 13. Au· .ted with. E. Odynophagia .()ryb!)wel ..II"entW1'eSe}lt$ With .. i)v~!tll Me .oh.tUctjon. permeability loss of theabsotptivesutface of the-small bowel Answer: C-Jaetase deficiency.with white plaqucclike matenal Dnhis..tigltildi)illrttib(j<ilcs. Which¢lime' .tnegrea:.fQJlowll). m¢lill:1Qsis cun ceHae.rpes simplgx ¢. mv Kaposi'ssru:.&.of mucoid. lJeliUlUllil fle. -c. E. A.:f? 1L A~ irritahle bowe1syndrome Wbte}t.lQwJ:il.all the.p. in AIDS. Epstein.A1I))S"def1!}ing.ltl$ '1$ J\1l!)S·Qe:fblit!:glesi(iltl·cai:il>edbYi>< A. bltrluSiq bow~hnt'ldH:t1.t lower quadrancabdcmtaalpain and distentiDIlass.@(l$aga.enal pylo1'i. Ei>ophagi. M.:i¢:a:.vethe hi-ghesHticideitceof D. {Edward F.duodena! lllgMsfmpip. The pil1bogenesis ofthispafiertt's diarrhea is MOST CLOSELY related to .)st:as\'iI)I.n's disease? A. 35 D.I(l9Sa MOST LI:Iqi)I.Withl1McoDacter Smallrlsk. periods .es6l'1hagtls D~ E..didtJ's¢Qtil¢2$ :a~ Candid<ris £4<=. osmotic !We of diarrhea.Qrt :l\s8ocia:tJ.rights res~ed. Lactase is a.Yl.d(li1)'prQdlJe~..{l.striC'ftltliett:ha):l.l3aITvlIus " )3. Duod. cartte't itt tirega§®intestiiJ:al thict is the". Answer:B". )3. B. that 'StoQ'ljt'!l~ fl.lJ'atjon wlth If.coma K Mswex.cliat-«ct¢t~e.1U\lj.•¢l1i:litt¢:pJ eomplilll1t~ 951e'ft !I.1ih C.120:02 9. Betlanal diSease Ol>:s(.Qf'the fo1.'$·td~e'ra:tive coUti~·tatlter A :fle:Xlbl!{ stgti'l'QJdQ~i.bill poi .l1d tigh.o:ldJ.&' ~o. otherchoices intraJiJiJUtuil {lsmpHcally active sd'lut¢s mucosal injury with increased.on.i!ij'Jyatid. perforatienand an association withZE. tongue and 'b.~pl'ead rt 14.tid. A.@'d POli&t1P::(~01i.PQIy.tis is .iljj$¥{tsJtM pllin..alidalso &a.ina "-positive.. acti~tion QI:cyclic A:MP c..i1 fotd'ivettico.Note: 'This materiaHs CO.ftmgtW infeeqoj1. a..lm. an. C. . :lil¢l. pylori 12.j$ease d tiisQl'9¢t D.ceofp¢t:fQr:at1.p¥rlghted. Al1.lthaltemafing.\iep:tlit·pigbi R Association with Zoniitger'"Elli~Qn syndrQme An~w~r:C-lmthare associfl.2S"year-.o.rr@tlyd~"S!.1ong history of explosive diarrhea and abdominal distention after eatirig.

is r¢i?btl#l. weight loss.and sYmptoms in this patient? with alonghistoryofchrontcllOnstipationcomplaiJls .~! is A.fue.tfiwl~ !l¢f¢\<.A. Mee of hematoohezia. B." .e~l.((). to sl. lIe has had ftequent attack$ofpain 'in thesamearea.. stomach carclTIQids do not metastasize 11 E. 'n. llli'lg Hver C.:x' is the .o. ii.. blMk stjcl<ystpols.t-old wotnanuomplains of epigasJ. weight loss.' .l{v()t. d. In addition.1:>'ap. '..:.l 'lJ:('it p. colon cancer iSi:. angiodyspJasia 'It D. watery diarrhea. 'mi14Jtepa~Jtle:galy." E.•.loWQ(J air l under-the . small.E"-" ~ 1:6.ticp. .rh¢ MPSTtIElll·Y ¢alJst{fQt:'this patie):if'$ \loU.fac.(j:rt)lIlo:1:i.acute diverti'cul'itj'spresents asat'left-aidedeppendicitis" 19. however. l11311stnok:~pres¢llt.g. A febrile 5.e~<!w: reVeal:.-. SJlcmt<lneously resolved. C I . extetnalhemorrhoids.p(Qximai dUQdm:Unl E..l'J'endlX to the in . 1'he·Fe&tAl~'l<. Th.yAlat old.likely diagnos)s is.£hat hioodc. "Which of the following scenarios besfexplains the sig'iis .'ib!fJ @(:IV¢SYJ:I"iPtpmc.@'@l1g(1)O~()l). Themost.ain. . reG' iiuetQa· disor<J.QJ1~tion and diarrhea. the bariumenema is Is:.f )l¥~f 'tl).4.g.. acutedivcrliculitis E.hctillt elitis e D.quadrantabdonrinal.~·QaJfe.' identit1e. that cannotbe ·1{.!i With weight l<iss~ .diaphragm. the})~ sit.g$i$ A S:0"'Year. The steel guafaopositive~ A complete blood cell eount (CBG) reseals a tmld:miI:!I'Q. tnsWeI. A 62:. in t4e .15.lq~l1t h!i$a.eai li""~F~sQitWQw!.te lI~drome. Primary ovarian cancer with metastasis to the stomach 36 AyolWl® B.le<mpalpation and non-tender.ltt.syndr..)it$.iveJ.~ . tehaMA =tendemessand a palpable mass in the. Qe'1lt:!fIi<wdasc.ii$Wllr. He has ~ternatin.rt~p('b·wJa'sii1.t .(if a.t:uiii.lrt~Q1:!.setisatiollifi bisrignt upper qmt4rMtan:4...crw:n!JY left'lower.c.. .ditil>llj$. left lo:wer abdomen.!llis~iJ. i1..for several months and ol1eepisode of. ]?4ysiclll .i¢¢ilJ. 1S»-:tso:eMiQeQ¢({· loc..HI:5.e:QIQn A.Jipfl.l~FI.p~1'l.Hematochezia elderly' Tb¢t!.ot)1pI¢.p{j'1):ij. st6:.erei$a 'WtUebrand'sdisease.l:IaL . ileum Answer: E:_ tM patient Das the:¢arcliioid.oats and isc nUx:ed in wifuhi&stoQls. sigmoid colon Diverticulostsis fll'latf.f.t:icuIitrs hemorrhoids an anal fissure ~~Il:r E.-oold an presents withoflushingQf fhe.tnaQh .tbltt 1t. c.(lUd dark. ..tq¢yto~isanQ left $1tift.the.8~year-old. barium enema study is most D.pain.l.e4®¢¢t . bloody stools that.ct with .. VQINtirlg ·ofl'tQffee. A eBC e~'I.i$. A58~y. and multiple m mass l~si(\t)sm b11!.dJi"ggmg .l()n41ltQmbosed.miif. hemtes .ground-like matetial. hard left supraclavicular lymph nodes. bowel infarction Answer: D.hffUts of¢ol1.ometimes h. Physjcai exam reveal~epigasWcp~ tQi. Stomachcancer with metastasis to theosaries B.. . B.¢ f(jttb.e. left lower quadrant. steady R<fin ill the. A fiat-ylat<:.s'Pl. termina].lm~v~~s l. . Both ovaries are enlarged and firmon bimanual pelvicexafu. Astonl guaiac is negative.Qti$hipFith aQtti~ ~l¢rt(i$is:and von .the 'p!..

V.f .amall bowel..SheMS lost lS pounds in the past three months and has.cantreP with t11¢tasJ:)i. Physical exam reveals papilledema-and hepatomegaly.9~itt$ .E.itcial fiQIillatiD.negative negative positive positive negative negative 37 negative m:glllive positive negative negative ne.l. .Qw'sn.'vanes .sis.l1lffiQ(:a:tG!I!ottm: the distal e. Bird's~beakappearance on barium study It .l1~c Amylase' is. bloody diarrhea. . absent bowel .':""" nQl~. ~'varicellllotifjf1.'l'hepa:tientMC)ST LIKELYhas . .D-fb.lgM· Anti. Chantit.J:thytlm.YPsin deficiency AIl!lwg1'.ot 'as.}i"1'~!tr"QIQ WJ. illc. acetaminophentoxicity and te. negative positive negative negative C. It could by primaryovarian .tllydiagnosi'sltI:thi~ patie~t.iso do no:fbefoo!ed intQ~a1Un:g thiiheriiottl'lagie p.inGteiiS:in:g p~in~t:td difficulty swallow(ng1iqtri. ~:t.~ 4. Elevation m.Primary pancreatic cancer with metastasis to the . to the superior .gative positive positive .<wd a guaiac PQ5J.lnza infectlons +salicylatesmay B lelid to Reye's: $)lIidr~nne 2. Sl. :Brin:m. vital infection lapses into coma.1)s/w. in this case.stomachwith metastasis to the I. Holjan.l.'~"QOOcI. th(. "Vircl!.' and~o:Jids overthe pastseve.Mtite aj'l:P~nQJQitis witlipeIiQration.erieJ.ofganglion cells in the LESmyen.liquid stool. present in the . no rebound fendeme$s. •.HBt. .t.antibodies ltivQlve&s'tti~ted muscle' inupperesophagus C. abdQ'trJinal distention. Physical exam -reveals hypotension.anti-eentromere. serologic data best represents . lntlUs case.lI1.D. ."HBc"lgG AnticIJBs L A febrile It A.jia ass9ciatedWith' witha chronic atrhythmiawith.olloMng e apply-to this case? SELECT 2 A.? :ElBsAg IJB¢Ag Anti. negative posi.ri31J.Q'ccasionaf1y exp.ondf food into her mouth when :JyIugd6Wfiatnight Esophageal manomefry reseals aperistalsis of'the.$opb.) 2002 'C.ylatt intoxication D. D.ova.i1l1dth¢hi:s1Qty Qf wei~t .PQi'ltt:n«mop~fQ.. B~hemorrhagl:cpancreatitis C~ . 12'J'earcola . .@.set ofsevetea04QniinalJl#n: associiitedwithvomiting.uc.1.tiv:e..1phagealsphincter (LES)._ m~tastasis iii the jjYarleS (Ki. irregularly irregular beat presents: with a sudden on.mesenteric cattery. A. ACQtnplete blood cell.d!. stQrnachcaneer.¢u..Note: This material is copyrighted.zy .iikenbe:rg . All rights ' the supraclavicular lymph-nodel> i\. count exhibits a white blood cell eount of 5. D~ ~$W~r-: 20. with an ilbsp1utel1etitfppgilic lli!uJcOCyt9S1s and left shift. The-serum ammonia and transaminasesare eievaied'an41b.J@ tlblXQ?lains Q.boy witba.A.loss" Ret11embe:tWat ..:1):14epatitis B. A 65-yeaHjld ..ope .rai mouths. saTi\).).cancer. Which of the following. M"D. The BIlJ'UW llll.l1 js theMG il. (Edward:F.e)n is prolong. acute dt'vectictilins·wifu perforation E~ h¢IRouhagiCCinfarction Qftbe small bowel ApsWl'iI':.tUtt:tPf)frPm.tive ..sounds.Reye:':ssyndrome C.apatient whohas recovered from hepatitis B.E~. Which ofthei. D.ll.ovaries Maligpanl J.lyl@e i.ymphoma ofthe.d.\$ i)f AnswetslG.ltgi.kDioS'tlii<.ct¢aJiu$o ' .A.epatient has achalasia R plexus..s elevated. lower 'esophagus and increasedpressure in tl(¢ (QWIi\.sal woman should not have palpable evades.teric . .te $ubste111aJIia.Q¢4 a.

. A.e trom someone who has. "bronze diabetes" describes the skin pigmentation and OM. You. anddiabetes mellitus.which~ 'i!rthls patlen.fferen<.vita'f:n:ih K. amebiasis echinococcosis.. hepatocellular carcinoma B. Choice A (Gilbert's)wou. A..c.haveaCB <20% (decreased uptake and conjugation).. A a:my'loidosis B. Chronic vi:ril'lh¢t'!~bt1s C. Physical exam reveals a palpablegallbladder and a light-colored stool.has vitaminK de-ftgienoy. ~is'p1etrpnid~J¢ ·thePTdoesnot 48~yeat'Qld aIc'qholic with :cirrhosis and ebronie. . 13= acute or chronic HBV.ns:wel'tJ)-:.b.'if tbl'.orption· from: the .iant Themechanism MOSt LIKELY responsibleforthis ¢dnstell:.. alcoholic cirrhosis c:_adefectin iron mtltlfJoJi!ttJ1 D. smoking.A. the patient hM hemochromatosis.anti-H13cclgO . carcinoma of the gallbladder 38 1- . ICdefi:oiency 5.ttitl~ 3:!1Pcoilgu.cholangitis m~tMtapp:e91otic3H(:er A. conclude that the patient 1!.and chronic pancreatitis presents with weight loss.ilIid iight UPp¢f.. pancreatitiS' hassteatorrbea and a p:ruiQIlged PT_ correct 1:ofioffiialaftef gi¥ing lin frrttamusc1. An afebrile 62-yeaNUd roan with" a history of alcoholism. adefectin ¢(ipper:metlibolis:m Answer:. Extrava_scularhemolyticaueJDia Ap.. . D ::.. In ~hiQh of the foilowingdiseases W0J11dyou expect a conjugated bilirubin >$0% of' the total e- bilint"bitt? kaHbert's syndrome 11. one :litliJi "cht6iiic pancreatitisQt bile saitd¢utlefic-y:telated tohis ci'tthQsis45~year-oldmanpresentswith increased skin pigmentation. B.M .lad. due to macrophage destructi()uof RBCs and UCB as the end-productof'Hgb degradation.4. vacdnateU: note: 'the d:i. Stone in the common bile duct E. chronic pancreatitis" restrictive cardiomyopathy~ Serum ferritin is the best screening test Hepatocellular caj'cmoitia IS the Me ca4se.vitamfu a.small bowel.$yn'thesls6Icvagu:la'tion factot$ ~. Mut~{. due -te malabserpticn.. choice E (ElIA) would have a CB <20%.ahsent. 6._. an-isolated factor deficiency irtadeqpa're . :e. :thCinthenatient.tiatt '6f'wt~ K.of <leath.cirrhosis.. and a normocytic anemia.A nswen . The patient MOST LIKELY has .(jUadrantpairt. 4z:~yellt'-91dmigrant worketfrunr A.ld.G. D.itttl'h. The 'term. alphaj-antitrypsin deficiency B.A= serologic gap: not infective since RBeAg and .Y has. choice C (Cfigler-Najjar) would have a CB <20% (deficiency of conjugation enzymes).1QSl'LIKELY1t~s .Ol~(}y$ijti$ ascendmg.CB >50% always indicates obstructive jaundice.!IliII' could be. c.1lar injeo. ..ile.l!feQJ. a slow onset of painless jaundice. 7.. bloody dfarrhea.F.A~wer: 3. 4. PTl.hydroxyl FRs which damage the tissue. Ironintissue generates . HBV DNAare. reoovered. steatorrhea.itio!1 of fitlQings is.I. C.D. choice B would have a CB 20~50% (problem with uptakc/conjugationandneerosis of bile ducts causing release of CB).swer: . CiiglercNajJar syndrome D.:)'Q~epted.defi¢jentO'stcondary trrrnalabserption .ran AR disease with increased iron abS.111e.there' is nQ the border between T exas and Mexico presents with patient MOST UKEl." . D.

'gynecomastia :ls'due to' estrogenexcess and encephalopathy due to an increase in.pns'! SELECT 1 39 .lliPeeied f1ndin~s.sRlt'sigq)' s 8. ser()1ogy tests andbeterophilean:tiblJdy test are both negative.'.percent ltoh saturatiOn C.trV~i. 'djs¢it.. mId a ..tQ.senun alkaline. nver disease. ammon(aand. hj!W.d p(}. phOsphatase is ·$arkedlyeleva.low.1r.ilehtgh sCl1QQlwrestler develops dM¢J. The urine is negative lot Utobifmogen and... AsCites Which Qfthe lollowp. Wh'i!.rrg.itdbiKpatient inc]u&¢•••S.vand mild non'. .-stools.Wer: B.urinol Tetr3.medusae An$wers.oYl.!mdY.itioen:e()pb. l3ililfry . :E:. Esophageal varices D. a stone in the common bile duct B.fQl1QW).B{C~I.cher'ring . . p~$oo¢tiv~ 'sigt)sQf1ig~t c~)t)(ed.ilt¢'a.rf"l' ll"(~ ·ex~c:t¢d.E.l%'C.S'.!:J.ainmation..Il1¢tca. D. 9'.$lQP.ias'WU$@ls'diS~s~.lantibodies bile uuc:ts in. .nfl~gCV JgQ antib<!iiUes positive for bilitilbin.pper levels..[l) smqyof the ~.endoscopic:retrog:radecnolan.scase(Um TgG. A. . Increased.. falSe{ops j'aundfce.d&~"tb'Y"pf.catter.$O% of''bepatom¢_galY.ted.mmYlIDW$fj':l)I:Sj1)i il. A 2$"r¢~i-{)1!l W9.1dn.It wtalQopperjs l~W b¢9. Yoususpect the-patient has •.. :1ightcolored..¢.&¢G())J<iaty to B.slightlyelyw(e.ei'rthp's. A 55-year"Dld woman' j)tesetltswith geflemlize4 px:uritM:. AIl .et! ()v~ h¢r s.lQ). SELECT 1 . :aJc(jhi:i~i'().greenish~bro.Sjlttm&' fQr f "P1tti®tJ :S~{j~(~'1\3 A. dark urine. Gynt)Cpi'Qa$tia C.S':P~ Jl:. D_ AQ'sw¢t!E"" nQ~ tlIe. hiledlicl is U:¢$aJ.~~·ye<lt'l. andchQi:~!'!athetj'Jti~r~wements. A .fle<.. the.qgtiaphy(l3:RC.lll·()f1h¢ .el1i:)W' )j.~ooJ fW.'QlarlesiQij. The'K:~yser-Fleis.d o'fpah'QreM 'c.()ldwomanpresentswith Ail afebr.ELECT 2 n p.?J~.ei'!l·i:l1e len!.. Qrlil ¢p:6t[aqeptiy¢$' Aiis.tender hepatomegaly. ~swers:. 1hf!pli'ti®t .1ijshepa. poi1ll1tt1a-lis-lgNt leVels 'at¢' j1)tlt~eaas· where thereisgranulomatoua destructienot: well <lS'qh:oleste~ol dm~ to' QPstn'le!iQn t\".C..". iCirrhQsis1'SEliECT3 A. A which ofthe· f611owih:gmedicat. D.i.artd 'Y~~l. a~p. E..g '¢Q1rtpXIC'aUoM is !1.ral.on~~()ml !)j]Jtijl1m. C.: A.Jine Acetaminophen . ::8. C. Ni)tei)J. D. lj.iI:i:~i. .thepati'tmt 'hasprimarybiliin:ycirihosis.alop:athY E. fu~ bitldingprotein for copper .lar lll!clei A:ltsw¢r..u..l· s.omm6n.d S(lI'UIl1 .-pft1t¢. ni.i'Y~ ll1(}j'(!l$.l)Cl. The conjugated bilirubinfraetiCitii~ ~.. deposits in the:lim&us of theey~.~.fSeperu. elevation :ofsernm albiHne phosphatase. irth cOhttolpiUs vr!)dJlPei intrahepaticcholesfasis b$Ijsnll~(li 11.. Hypi::rttlglycetiueffiia B. been taki»g anabolic stemi<is B.titis.levels R Granulomatous Infl. low cerulqplasminleve1s Be primary scl¢(Qsll'lg cJtolangitis a stone in the commen bile duct patchioma.lpaJ?lew..~sanri1taSIiS.¢ to~l bilIrubin and theserum allGtlhle phO~batltse isritilrkedly eleVated. ld . a. Pertumbilical.·tQtalt.'rten:..severehyperIlpidenri:a.caput.l. Y(Jususj:Ject the 'patient is taking Isoniazid ' Allop. 1'ke.i!lf P9ttal.~S' AntimifochOl'ldiili.ffi1e has marked.

ith'J)Qs. '6" ti~ml.has a.m. lwtX ttlv.}.cgatiYe.eclJ.)tPr:Qf1. .<I.developsa sudden.An ul:trasQQ.clc He :desliri~s .l¢QffiIiI@ity:in $:oath¢w Anz!)M It)teSel1fS. whilelibe11Ost'With the D.ether. B. Physical exam reveals tenderness in the epigastric area but no t~boood telidmn~ss.s1.§:~ lQW ) pdc fever.butalso produce tumors calkd liver. cause .With'.ycle for the pWasit'¢.dQg'fuat be1~s hnn keep 'the: sheep 'tot.atietit? S:E:IiJilc.S " the· 15.!1 Answer: E~ this is 14.ThI'l MDSTl. m. Whf.$:E'lJPCJ' ~ A_ Anabolic steroids me :K .sp<lfi1:@®l1. AS5'year. Basqlll. enset pi }{p..adults IS the deQrtitive host(clogWh<} a~ .old executive of'an up and coming compufurcompany.dslleep FI1sdog ate art lnfected .i:Qs~rt\fii AI.and a rapm de-velQPment of. he feels nauseous and has vomited non-bile staiaedfluid on two occasions.ttttal <.. eggs. He ate an infl'lcte.yst. t¢ not 'Pt~s¢n:t 0J. 'I.Hv¢r Strainjn~atstool ~n$wJ!r'5:A.loop . . level istlOO nglrrlL (t1o.loss.ofthe intFaabdominal bleed is most Iikelya.S filled 'Up wlthb:lI.frQm the dog who has the-adults that produce.C_ D. luife-Hl¢..)Qd_ The.T. . C- primary gallbladderC:afi:cer lrepatocellular carcinoma metas'tati¢H'v'~ disC$sl'l p~tQl'Ji:ti. ¢hQl¢$fi!.Ye hQ:~t. into ~4e1ya. S"t¢t<6ids! the li"\1et ·WithMlcmcatlonsm :the I:itiIDg bfthe jz.) i!. ritJhtupper An.i$hlgher tb.:til§fl~!'!l..ascite5.tJxe paw .T 1 A.dQtb'ihalp}fi~l alQl1g Wi'tb-h~'oyp~e.steroidsandestmgen not oriiypr{)Quce mtmhel!atic.PPf. The eggs develep mto Jaora :irr th!'l' sh~hef4t.pol>j. of small howe! in the l!}ft ll. the: classk: hist6ty:tbr Note tb~increas".kiran 111ll:l'l .she-ep A. ct. SJ}I~]Jt.the' inl'«te:d ~he~l' The sheephetOetJ~!'ltthe oiSease .ssociatedwifh which of the folloWing? .""siwlartQ qU'l'lstioh U.n.ahd meek'sare·famoJlS '8he~herder:s.r qUadtaht. Anabolic .io¢k. ohQIangioQarcindma flee. non-B hepatitis E.:t is most indicated in.e:al~ aoysncmass.d ba~~tiil-.11devea. c1lo1estasls. There is mild lender hepatomegaly.'i¢et~sjs'\!i~¢o1t9aty t9 !lm:Q1tig. A flat 'plate of the . .&ts ll" A 42"Y¢!it-oJd . steroIds. He isasheepherder and. the irtt¢rIDediate host Basqtie's. The fluid vmc count is norm~l il. is egg to larva tQ'.(s l'>. weight .~tQflUp)~yet~fl!te01\ benigJ..1 16.11Ie a D.his abdominal caY:itYi. .lso. C-alw~ys ~:l:swne.t w~i:g4tli£ters.mJ(..anabolic. In addition..UOiI{"Y' !lli:\gl1Qsi$IS. Whiph oflhe (cHlowmg additiqnal :findi1)Zs WOQ~dYQ~e~pegffit tl).cltronic cholecystitis A-iisw'er:}3.r.abdomen reseals a·d'ilatea.ln<Pqtl~$'Jlhl:!. .ttlilldianieter ·pf thecommon r hile duct. c..lsnb stones inthegalllJ1addet ana a iiof..i. A peritoneaX fapreyealsJ)loo~y as~itic fluid.infeetieusmonenacleosis non A.:rt : quadrantpafu. ulti:i1sound of l\iJ.i ~'f?taitI.a hi'stiJt:r of'tecttt:tent E.C.:l$siQn. A stool guaia¢ .ttSWilJ'.s D.D~ the patierrthas . prQdttq~ mtta:'hepat:i.:in A l"atieJ1t living in' .w.:fp. At surgery. .tetoptotein C. A weightlifter de~eloMa S~dd@. this patient? SELECT 1 A_ B_ C. Hepatocellular-careinoma Liver cell adenoma Cavemoushemangiomain the..6risetof.'fIl:i'?Y haYe<a 'tendency' fo nltrtl1te· and produce' intraperitoneal Th¢ host with the larva is always the intermediate host {mfecfud -sheep. cell adenomas.A. It lIisdog is an ltitetiIledli11¢ host' Ile a <iefmitj. What te:. sheepherder). t!1il. SettQilJ\ n. Upper gastrointestinal endoscopy Serumamylase and/or lipase HIDA (radionuclide) scan to RIO a cystic duct stone 40 .severe epigastric pain with-radiation of the pain.s.

er:._.ell¢.g intc baclcand J<. pros. Ra(i!Qllij¢Ji4e ]:!Qrte :s!<at..ifIc antigen C. flank-pain).Answer:]3. .B. Snrgil. C.Inthi~ the :fllllikrtiliSs indicates the kidne.arpm()rna WiJ:l11Utig'metam.¢lm!:.drug-induced interstitial nephritis E. which WQu[i.>k1nghis.. palpahk ma..and 'increased frequency of to. teveal'!...<1 phiJd tsrtQt~d to:b:av¢ w II p?:ip. A.nmalcancetrITe.ut1tie.Miliary T$invQfvingthe:k1dneyg. lungcancer with metastasis to the' kidney Choriocarcinoma with mefustasls to lUngs and kidneys ..\l1t PIPPSY Answ. WBe casts.tihid~j(jsi'ls .E.h¢ T¢m?fuirrg tes. dysuria. A 25.tto R/OsmaJi bowel obstruction . D.Jess 'm11iitgem~t 0:( c(insu1. Pertinent laboratory data 41 . The ._ at.nottransill:ilnUhate.other tests can then he ordered.. D.. .lQcaliZedilellil).ascendlhg infection C.foty. . with an acute onset of right flank pain. 2:.the patient has acute pyelonephritis (fever.l..g . fuy l"n: ~¢toml silt.l definitelytdentify alconulic CAST'~ ALT):wtthacute sentmelloopdi. Be has periorbitaledema andsmokycolered¢patr~)1t ~.. 'yolk sac tumor E. suprapubic discQlflfou.A.1J1.. '. me4tsti:i:tic.1:1t4)la.ele seminoma Eyen the .er:B.oll()WlP. .pnmary 'E.masses in the J:hie ':£..year-old man presents wIth lower back pain and cOiQi))aiiits )i}tptoblcms:Wifu'V6idiil. f(.soeia~ed . occasional ~Cs.rt:. Jqugs.ggest w. The uririaty sediiftt:nt examination 'teYl.lyer. the levcl of ~e. varicocele.w.Whi~bo( Jhe 'follQwing: tests -or procedures tsindicatedas the l1l'St step In the 'management. presents with..asow\l. Answ.(jJ1glylio. hematogenous spread 'Ofinfectiofi to the kidneys Answer.Acute pyelonephritis withmetastatic abscessesirr the' lung :note the sffil.bJ~h of A..ssin the leff lower quadfunt.A. Both IUl1g and .piliC:1l$.l R Prostate .' Rena:t'. Uis bl~dder' i~ petcqss¢il. tb!.s .d stone A febrile 23-yearcOld woman presents B..of thi$.: 13.asis D.·The:se' f1114in~J> ll!Qsi.ta ADsw¢rtB~ the key 'is theC1)11iO. Thetestic~e:i~ ~ilfged' . w:i'tlr :llq1()king~.itst te.g di<\gt)Jises? c.patlent? '.y uninv()l1(c(j t¢sii¢le 11> risk.n..inunUi). 3. .al~clumpsofleukecytes. AtS-Y!. An :S2. . WBe Renal questions 1. It hY<lrQi:.y as-the s<\'Utce.~year-old male presents with a history of hemoptysis and malaise. :A 66-year-old man with a 45 pack year histm.d i d:6~s..sO.miiltlPle nadular.:t<i. This is due to ascending infection-and vesicoureteral reflux 5.tlC:~i:lf:\. Serumalkaiinepliospilatase C. tnwsre¢tal. Renal metastasis is 4. h:i:lmaturlaand U1:l:PQ:t:®J:'Qti. and a A chest 'iHil) df smoking.$t :i$a:t~gtal. Hepatitis serologies pancreatitis (pain'raoiatln.spec.l}ntQism. .are..:t:iWJ ith It h1$t~ of'femQval(liranghvQl.hematuria.ocomplex disease D.l'P1'Itientili. The mechatii$ffi' oIthis patient's urinary condition is most elosely related to .li. qhotioc:a'(ci~e..QSt fikely liasa. The pe$t f. pigittlreqjal )'l)k~ljM} D. His blood pressure is 140190 mm Hg.)'J?l()).Tlie paulin! Gaucer. Tliereis 'point t¢ude1JlesSovet the Iower }tltripat Vetl.~..aud numerous-motile' bacwria.ultl.

:Jiticet With.rescentic glomerulonephritis ..a. Dysplastickiwey disease Answer: A..i.0 rn:glQL {O.' Now how patients usually . ...tI:e' te$jJQtl$IDJe. Answtlr!E-)?ul:Jertiiigynecomastia.:1}l :mgtAL) and. also has $ever:e·pittin~¢d.'i.6---1.puberty. I!hysi.tris a severe type ofnep1u:ode&yndrome~ A ti}.l'\I!1te:Thi~ material is Cl)p¥rl_gbted. Carcinoid tumor D..e.followiggwl)jJltJ-yoq recommend for this e.. A chest l'adiogmpn demo.. patient? ·A. ~q 11). v liiii'ifatey c@t§:l'tith¢\lrine • E.DlQ!. and RBG casts. acreatinineof 4.ab:aS:i\r~a.lg10metlll9'wl~t(fsi"$ D.. Chrom~someanalysis Serum '(l. at'birth.~tve scetltic' ~N f~ tbemM~c()niiIJ!ilt1~e ·¢(t1" of renal d1sease.start the disease in the then lherenaldisease:6cliul'S .(lmaddi¢t comeS' to lheemergency depamnent'inanaw'tatedstate.entoPY'1lt:esenis 'with :al."llS~QlliJt.Ae.\llswefr~C~ ..h~WQ"ptysi$ :Wt! shortness.. . Uoljan.¢tUlar and pufuionMy capilla.t~ ~p ~ . iendet:$tlba:te61ar mas~.t:(. ~_Qqlllar masses ih tbe JUl1gS. R-enaladenocatcinoma E..l. (Edward F.. lll.Ue is res'miined: and.{)ld. . Pt~!l¢n:y.note multiple needle trac~ (1) bp~h wms. 7. Mem. ~. These findings moststrongly S\lggest which . yeard:)ld. A.note the history of hypertension and a unilateral abdominal mass 42 .. J\j)ti~gJ.yeJiti<j:ild.2 ~PL). . Wilm'!.c~l CX!ltn i~ otherwiseunremarkable.-has generalized .Witb.! :6:.~pnea and 4~rten8iQILPbysipal ex~rev~l§ 'apalp?b'le tight lower quadrant mas-sin fue'abdoroenand scattered sibilant rhonchi in the Iungs. Wirld:l ofthe.esentswith4-y...e'mllj·of -the lower ettte@tl:es.R'BCs too numerous tOCOlIDt.3+ blOOd.. The mechani. C. tgi\: glqme'(')'ilimep:lItitTh. ~SW~l'~B-"-'OlI}jliocfatidti Qf IWl8.~.a:$e}s . type Rh~en!\ttiYity feil. A chest x-ray tevea~$1hul.:ad61esc. A )2"year~ldohild })l'. membranous ON" Which 1sthe Me typo Of G:N . positive for protein and -llh(iWs:fatW·C.cau:shigthe nephrotic syndrome. .~1segmebt. .of the chest demonstrate-a 'left hltar mass .persensitfvity reaction wp¢ lI.2002 mcltide aserumureanitrogen of4Q mgldLt7. ~&e. tumor' B.ih the left breast. of'breath.relates to:bypl:itesirin'isttl.d. .l1l1 gonadotropins . l[ T£Pe l:niemo'tlUlQptdlftefa6Vit' g1d:in¢tUl(i.. :Radio.No treatment B.) . type Thypersensltivity reaction . A 14.dtli4+:pt9J¢41:qdal ~¢ijokst\x()Xetf)jll.ltiillltml.! ¢lQseJy _t:¢~l). tWeII1hy.l$ lungs.l1rina:lf~iS shows 2+ protein..W4W'hyp<rr$ensitivity'reaction A. who· 'is Ii JmoWIi dtil_g $¢ekerillld heJ.branous -glomem:ionephrltis. C. D.11flSlQi1l¢·roJoscl¢tQsi$ts tQ. pld It . Neun>blastoma AIlrjgbtsteserverl.':hC~ J)~ SwgiJ:rlllc. M.on.i¢~ S¢gtti@.iJftbe following diagnoses? A. Urinal~sis is._ R Fi'I(l.D.'o')1§t!.fi¢ @nQQ-ai~s. ..:phdtis type. in adults ..j1 pf 'c~g~eft1i' ~mQki1:iI~ .4rome. Recall that gynecomastia is normal. " oftbls patient'$ Jinig I):fiq·I'~l'ial di~c. fl.j~¢llS¢ i~ IYDA -l'IllJtAJI)S..1 jia:~ !i{$!9}.gr:aphs .I1I. Rapidly :progressiv~c. Items{i'-7 E~ t&Pe IV h~er$ensitivity'f¢a:®.~pinJypf.ctiQh Au~w~ri lJ~ the 'P~tt:¢~t GOi)(Jp~~'s~yn.y basement mentbf:li. ( lIe s. ~Y'l:l.j\1e s~!mt • .eJY1Ct:¢Alil.He alsa.liI.OStral¢SopacitieS:' in -both lung-fields. '1:11.

).l@ pr¢$jf. .I~~nt the' patient.'@qY$plasia 19A. D. $ub. ' A 32-yr"plcl nili:iw1th ny:plltfetr$Jon:lias lU~toty(}f hYPetWt)sjQ.llcatcitiQ):na.wjnlt.i}.. obese 13-Year-old boy pas bilateral gynecomastia. Wbil.l$~a. with a .u~!ibe <1~/1(e.epitheli'al ii..a. Normal High Low 46 C.01.ited torusolstase .QI4 l1etrlQn:llit_ge. t611owinglcibotatQry abnonna1i:ties is most likeIypt.till1M il>cb¢Jl)i¢A' A32-)'t-utd with Wegener'sgranulomatosis. fatty casts.axillary and pubic hair. gtmei:al1ze.UlaqlfJ.. Mitral valve ptol{ip~~i$a'(jommQIl association Jncluding-intracerebral bleedsandeubarachneid hemorrhages-from .e teq). .lg mJQ !Jmonit .t 12. A.OmJ'lq/L ~s:wJitt ~th¢ pline.historyof . upper respiratory infection 1 week it :SYstolic tili¢kt"oW:t' . )tenet! the: family Jftsti)ty.d pitting edema. .now presents with. Within $4 ills of surgery.expeetin this patient? The Whil::h <>fthe Fusion of the podocytes PI£l.LIl Serum te~tQst~rODeChtQmosQ)Ues A.euryStm.15/1 :c tIf'ineOs. Ch~ge$ G Di'tfuse membraria. High Normal Normal 46 fl.ruptured berry :jiJ. ·and oval fat bodi~.'4.Iot!lS wotildyou. urine cytology reveals numerous lmCsandpccasionalatypical transitional ¢.v~a'by amw. :Renal!disease a$soc{at~ilWith Wegener's igran:uJomatQsis G)iemPthetmllY. J3TINkreatfnine ratio >. 13TJN/¢te. gl6me:tulbnepliritis djabeti~1Iepbtopathy Answer. Tile pa1. FIe.tir(lfi¢ 1. 14. arid serum testosterone ]e'veis lseXiYectedjntJUs patient? SeTuttJ. decreased testicular volume for [(ge.r1 at an ~l1.mi1.llt:polycystickidney.k. fQllo.tJ~ APKD is azyAl)disp(:q:et.Lower urinary tract infection Answer: C-cyc1ophosphamlde is the . is ~ng til tr¢[this Q.fia:Ul1t{!Il.ti?' ®e. .R A. High High Low 47 43 c. ad1..high dO$¢sQfcprtico$teroids. (tubular dys:!lnrGlion) or sodium >.e' has a.ebloQg~ell(.the patient has IlpoidriepDtosis 1LA 7.t1a! oe. It produces both hemorrhagiccystitis and t'rallsitio.iit.l. A.d. Which .n.tcmiji. 13'.1\I1.of the. and.!iItety· $!ej}QSIs teIi. Fractional' excretion A..> $QQ:w.. ~.alfjild1ngs and CT scan results.ruprured abdowfua1a.tiej:li? A.tfisn this patient? i man D.Y n.A:~\jno\litI!s infection E. Wbichofthe. and sparse.ririp:g either dialysis or a renal transplant A ~few'of the family members: have died nom.molality.:old ' changes J). serum luteinizing hortnotie{LB.tUilUl:lcdeposits K Suhendothelial imniunedeposits Answer. ESli Serum. died 3 days later. A ViIJ.. .&..the random UNa > 40mEq/L. He has had the usual childhood infections except for mumps. jlo4itU11 <1.eIls.Qs:tXitl<:g D.~im.. B.mU :a:deiiocil.:\entmost Uke1y1'las". following best·e.sei::oo!ilarYtpa.Bas~dQnthe phYS1<.ltpl<iins the.fl). E.r~old ti.eJ. hypQvqlemicsliQ:(.44P shp. A normotensive 8. he develops oliguria. which of the loUowingserum follicie stimulating hormone (FS~.ptQg:t(}~sj:l..9~g (nu concentrating abiiity).UTysm.PQ$m <$SQ m. urinalysis Re.. renaJ. renal In:091~. Hi .2-y.It RandotnUtioe..i jsnQl'l11aL A.J'iil'pen. <::.His ¢Q'il4iti<)tl rap'idly i1i1prQveswith.d11'01l1Qso:mestt.a stroke related to an itlttace(eht:a:lhlee:d tit iitll:fannjht).~l<lm..Rx of choice for WG.severe proteinuria.~$:¢IW B. Act Sca}1 9fthe sella 11llpic.has hematuria.g"SP!8!.rIY!g¢ pfj:en:.this ·pi!.reual faihli.t).')eflt'!lljfeQ1~:V<.ts with.

e .} Low Items 1-4 c.liWPilt ~$tl'i:ry W~1> C!'l~ct.tge 6.Klinefefter)s syndrome. lc\.f mass itt t1ite left upperq'tilldrittll.. Lobular cancer if·the Me caticetthl!t Is'bUil:t¢tal .er oQterquaor.. .rcUlYlillg tell failute.litectlybeneatll the sld. ONott~thalitispainM. D. 4.of smoking has a history of" breastcarrcerin her iIlt>1her. Answ.le. 'Familyh.menses is completeo..~ly given a diagnosis of breast cancer for which she opted for breast conserving therapy. l'ilbn~tllP(! jspopr in fiberand 'rich v.~jll-pajnless.f:it1g ductal carcinoma Lobular caminoma Ftbt<)cystic. p. Answer: A-infiltrating: ductalcarcinoma 18 the Me :primary breast.{Ql1oWing is her gtr::a..impib. masses are w P.' . A 2o"year-old woman Without any family history of breast cancer complains Ellget'sdis¢ase .centi. . $...46 .usandLeyclig cell failure Normal D.iheti ab4u¢oog her tight . A 0'= pur<: seminiferQUllfiipul¢ fa:i1w~!:a"".i\n::fM~ted.inthe lower axillary chain.Ul1()f the nipple.LQw fiber. D. disease of the vulvanPaget's dIsease of'the breast.'n. 1. U'lJ1). s. A. cancer an.alpallie.intraductal papilloma 44 .lltiij. have a w1l:ile clll.s· yeats oi'age· for severe cervical dysplasla and has since had normal cervical Pap smears .mem.t. retraetipn. Age . at 13 yeats ohgec cand. AlIslii.. frrm. A B.ofpainand_ "h.testris}c factor fotbteaErt. MeIiafc::beO¢QUtrM. C.fiQrt if the 'c. A. A 58~year. '$b~has Jntr!1qllctalpapilloma Intraductal carcino. I) =.. Which oJth.isanextension lelIa ductal .Q~¢pqj. Her older sister w:asreCell.. right axiliary lymph . B.c. You would expect It fme needle-aspiration of the mass toreveal... Paget's.tticet? A.istQr'y S'mo!dnghistory Severecervical.4 . rl1~{:f!nm. these' d~¥el(}p' in tlr~lactifc1'. Tnfiltra.t:':~o'n at 2."yr-old woman. a i9-year-old wo l1lll11 notes a moveable. { :( A 2g~year'cOla oman during her breast 'exam is noted to.highsa. There is no skin retraction or nipple discbatge~She is curredtly ~g birth control pills.a. A 65.haa a rash on the nipple and a subareolar mass.Answer: c-this . E.S11turat¢d fats.. Het die.pyringher monthly self-breast exam.No palpable axclHary Iymphnodes are present. .3~emmass is Palpatedi.FCC is the MGG ofa mass ifrihe breast in a 'Woma'iiUfidet 50~Yts:·o1d.t:\u.l)iJdr¢n.4~ Low ."old woman with a 20~year history .essiim her bn$~ts thatprogressivelyIncreases tPtough(jJ_it her metf~ttUijlcycl¢ . ~. an infiltrating ductal. 6~Y~<lt'-\Q14w0li1f!nwith a hisiQzyqfbreast cancer ill her mother is noted to have :rettacijqn Qf sklli id th¢ ngb'tupp.dY alscbarge~ began at 52 yearsof age. paf'nf(II.Mtmal P~I:'SoIiorkstlcqJfIt' f¢mhli7..!.Q~cer intV·t}1e eplthelil. :&o~l KLow Norm.mrated fat diet B~ :Qtstgent:tatiofi relatives (mother or sister) o¥etrides.~w1lr:0". dysplasia Answer.SJj:el1\id (l' .dlltitig U¢v aIijj@icHm1)(\l Oi1C. B.des preseat..&G. sl~ghtlytender mass in the left upper outer quadrant.Qusdm.cancer. E.ei': 'C:.:and is ~elieye4 !~ft~r . .Phystcalexal11reveals a. E= combined seminlfero.

GestatiohaIdtiibetes Abruptioplacenta c.gestation wast10J15 mm H~.estatiQt(al. G.pressure is 15U195 .bumih-H¢r:QlMd:ptiiSswe<1ilthel:flftiaI prenatal visit.gnancy Twinl.PhYsi'caiexaminatiol1 reveals a ~M¢(l':iU!'s$ io tI1ec 'Q:@'¢. A.rti¢e:(. A.l1j:gmwt tumQt woman :presents with abdominal distention despite a. Hermateroalgrandfather has adult-onse) diabetes.e.nt ..rpt~~.y~a:t~ld.ilt~indPI'atiQp: in 'the re¢tai p. P:nil~'Presenmtion mUte tlrsttritnester would be.1% 9.ofDoaglas 'is due to $'eeding from· a vtima~ PW1P~ 'Cmcet. she has 1+ glucose ahd 2+:a}.:ap¢P:te!lis shQwsl.t..cyst fluid It.A thrn..Fol1ic'uiar J).Quch of Douglas. gta. E. A Wl.I1.t tw:s: )?ll. Which ofthe following.ovary with.... They aretbe MCt!:IJnori11.QadenctIDa are stromal tumors that compress ducts. B.~$eJij.r: A.mml:Ig.cer C. M!)la. focal. Whicli..Place. :C)\1'25is'a.lty ren\il disease ~s1.tket for sutfa¢e derived 'O'Wloah cancefs(¢.iWllgn:a.b:rt. l()bu1ar eaneer Answ:~r: D-'tiptQadenomas 35-yrs~i& "I.stomach cancer Answer: C~ In' her'age ' ago. Her mother and. Qf the f<)llt!Wittg is the most likely explanation for the (nnlitIgI> !t.-Old girl presents with a·su&leh onset of1ibd.).g.b.'ll. Benigrrsurface-derivedtumor MalignanlsUrl'"oldnUliiparous: p~ Py§tlt't¢@t9lW1 M..:trian Pritn.t1:ti)1orffIl.Qp. N101at pte.ewa }).. [.poor appetite.34 weeks) gestatiom Jlerblood.rnQlj:le@.t$t()tm:.< and the uf®s' is lai'ge for geststional..¢~.oer E. Metastaucuterifle leiomyosarcomas B.IlllWcJ. 45 . Prc:. E. 1ifl.. c.Oll urine dip suck.age. .H~bl9Q4 pi'~Sspre is 16!}t9$ mrn FIg. rectal . Al). She a fluid wave in the abdomen and 'a le:ftcsided pleural effusion •.at 14 'Wl<eks'. .ntl).ent w:en.: A28"year~o1d woman. 'rj'ara·Q. 6o~y&.~L A l'7-year. d'iitl'!et.Wo¢Ui:5)~~~ D.lHtli.@:. Nf¢~st.12 weekstgestation presents with painless vaginal l)J¢~:djng.c. amolarpregnaney s .4~rw.ti¢nl'()ffic¢f(}r(il'(jutfut}Pi'er:jatal Visit at. WOJi1e~< E.tis. fl:~ga.ti(lPt? :it.eX~mrev. Metastatic . placenta' pa:in.vidli l?paraQ~ at . serous A. Benign getin .cells that sfainpQsitlYe: forCA 12S:Whipho£ the f6110wifig [$the most tike1ydiagnosts? . benign .Y¢AAltiif$' ltl1illss: lesion iifthe l~ Ieft.tliUnps pf .!s!<.matemal '&rlWrlmotber both have elironic hy:peit!IDSlon. in the first trimester is a molar pregnancy.lcenta D~ preeclampsia AnSwer..a.deri".l.. is the most likely diagnosis? A B.e:s An$wf. E.~1.C.static.there is 3+p(QteiMi'ia.17ye.cell tumor 'g~'Ql:i11 cystoffheo¥aty A.areas :0£ caIci1tcation..Qllt)Ji!. .A:bruptio A Z~. Which of the fal1owing: best characterizes 'tlte ov...<lQtnettj~l.'lI'!k Apr¢iW@gy tes. Metastatic (!)var1ancancer pc.tiy¢.induration In: the pouch . She has 10 cystadenocarcinoma) .ectan:wsia B.

dl.Increased. $d tre~tifi:g. ~h.t. 11m. followitl~. $e~ DR.a ~.. 1 l. lel. diabetes mellitUs Q. P.uorolls v:aginal:discbarge.2. ptesetitation asIt gets c.p'ill. W.tYni LJI in¢t¢lCi®:d" sett.:' G eetVicalc1i.gtjlla:O. 55 11 11 53 50 none none cC@1:vo1pills Type' lIdiabetes n1.(ypmension Obe$e. polYQ¥stie OVarlart syndrome D.2. A 51 .sttongiy suspect thatihe patIenlhas.:2 2. E.QlIs pyelo. A:. A ..bil~teraUy enlarged ovaries. :irregularcight .tio >311.lp. Endometrium MothIdity l\'[pmlity 2.ha:· .. obesity.neous bfrth D..1'!UaSS ext!'::ud&tQ'tbe pe1vicsijje W{l11.anc~~ Children A. :Pres.33. defici.mihation. a.2. for ' t. . ¢ar"bld . ]).:!:tig $m{il<in.ilP~p. 3.t~¢riet:l'C¢"S "Vaginal bleeding after . .at. 3.evelQPjjj:g :\.be!ie. 13. tOok W. due ti'> acu. toQk Qitth c:ontrflI 'pills Answer: D-early menarche. E.Qttnll.. . which relates to prolonged eJ(.l1:tej'f fot 'ti:¢a'tI'nootof tignt pyel_queplJrlUs.pyelonep.f:1litU~ Obese. Itl.ie1).. 1.alwa.pifuitll. 5.long l!is~o. A :ilrm.iiritn:tal testOster.eJclribiis .ghMu('Y y ( B.isj:$ fl1ea¥lfili!1il¢> $e. type U TIMan: all -increased risks for endometrial cancer.. Whicjl p{ tliefoUmVingpa. you .alWeKll.Ett~$\lJf~ 1").qrma~>$'eI.entAgeMenarcbe Menopause 4$ l1tiQne B.exa.isceUa. Invasiye d~adeno. I ati. serum fi:ei.istc.. 58.1ndrQgen~sectetil1g j:umo~Qfthe tfvaries An$wgr·(G:"'~r:v:i!l.ortality: 1.H o:ffue vagina andblodks the ureterovesIcal j1.otmpin~sectetin.~$PIMii:\Qn.opin~releas1nghormone 14.Uidautmdr !':hest..oneslightly . During pelvic :examination.tQb. C.utionp.@lJl.l.htitis :B.low. fevealS' M$utism QIlfue fitqe·.ippose.g.W'l1mshpwstighNided l:!ydta'U~ln'fisjs allQ tlditat¢duret¢ 3. Eelvic esam . D.}using: aydr9nephros~~pyefQI1(. :laboratgry.erin~l1rle 'Jiihscess. a.Whatts the most likely dlagnosis-?' A. presents with infertilIty prolii1emsc She has a.if t~.vasjve cerv:i:C'lilbar¢410J.arcfU. Endometriosis invoiYlngthe right:ovazy C.lp1lritisamjd¢ath.4 5612 12 51 50 2 none I.:!)l):lai1wiUi a li.l¢i:i'n.encyofgonadotr.Y ofQligQ:tr!~i<1rthea. Cervix 2. An .llJ.2 1 j$ M1.and fues¢ffith t&H:is. 1 J.SJ' 1 2.22~year"(jld n1oderntelyobese woman. 1. B. \lfll. of the.adrenat Cushing's syndrome E.ubfitial.l11FSR .1 L Place the f'ol1owingnenplasms dMr~iilg m. Invasive endometrial' adenocarcinoma E.1$.l. LHlFSR m. fernal« genital tract in decreasing incidenoe! (moibidiqr) 'andlh Ovary 3.:PhY$ into cancer to«let@ting.jniwveQ.rnulliparity.l.'I'h~ .Ql'l:$Jen owing c before it.Ucer irtf'iltl:ates into the latet.pjti..A" gilatend.tC.d estrogen 46 .sedoil these 'findings.t risk. you neteet amalo.eefif.f·te$to:stenmein¥r~$etl.ty imhOf AinSow¢t: c~ this is as c-lassie a. late .:.lisWer.

weakness.nqi(.6Qes:e. of priInal'y.lent h~y¢tbe gteat~$t tisl< ft)T qo. C.ears otd y 5 On bIrth co. hotoiQne~. A.and probl~ with infertility .0ye~$ ~M 14 years old 1.1lQnsrelatedto pelvic inflammatory.smi1lred r6-year~old girl·p:r. In which of-the c¢hti.ilftoI piUs.1 Obese.:U:ri:.llrtmvenous i An~r: n~e:aiily . the the Me genetic!i} 1U@$i.rsold . N'JUUbei of P:cesenta.S.oue:x:pecHtt tltispatrent?' A short. Which of the fcillowing.a 3 em cyst in the tl'ghloy3zy.~ mM~~ . facfQTs a. iind"pewoetoum!1 ap)'tea:tfng. uoesthe pal.elatedto.@.. D. I)~ . Low 45· FSli '" io1liciestimulatihg.Low l'\TQl' seeding from a primaryozarian tumor endometrial gl!lnasiand.tri:1. .iQnihe u:tetWe ljg<l. .J.meIppi'n~.....ei: <:>the patient has blassic endometriosis E.s¢"'il:a:l¢::mosUt¢3 tny1tiffi1e nighrisk:$I:>~}:lw¢r$. .!tQma . ~pteaq_ofejidol1letri.S·yt~la WdiU@e'pr:es¢l1ts.P~}.cal cancer? 21 years old tQyearsol(1 lO'Y!:ltU:sold 10 4 smoker futravenousdtug E.ht6".abuser. D. at"eaf.sl11okeT 1.nts vo.emipitll a.. amenorrhea. Them(:(lh.l Low Serum·~tradiol Low LQw CbtQ:mo$Oll1()s 45 46 45 NQnnal Low :t'fO. A.~ a. UI ""'luteinizing hormone Answer: D~ wafl'entllaS'1:llilief'SsYndtome. SerumF:SH High Normal High. 17.iJi)'al 46· EudocFinequestions' Items 1~3 ~..til.laboratory test findings 'Would y.rl P:are)'(l!'il1l!l t¢:vetse merls¢1'. on' bMh~ojjtt{)l frli.ismall u:t¢liJ$. smoker. It C.lIkely t.B. paihttil $tQQli11J~dw.. .around both fall'upian tubes.l.hi.Q9ntrql pills are risk: 1''t4 ~jli$tol!y reveals poor breast development and sparse :axillaryand ..ha.fud is .With.i. E..l. SerumLlI Normal High Higb.1:.. . C B.g. Physical exam pubic 'han:: Hel:skin is 're.. . Onset of sesual. . 21 the fli11~plan t4bei:. clll'Ienthoy- smOker..men1ll :and B!'ltQ$al s4I'facl'l I)f'the tttt:fUS. A..fc·'¢ llenvity~~m Pllrm~m$~~<:eU~. n¢¢k.ated L A 45~year:-old()be:$e WomatlPt:t:serttswith a history of weigllt loss.iIitlie myometrial tissue Answ.dr()l:p~n$ l$) yeats old lQ:yeatllQld '2 ~ ·birj:b:<l()114('!lpili~. and palpitations that keep her awake: at night. COPlPhc:\!. fqr this patient's cbnsteiiationot 'prdhi~ms· 'is' most .sno She witlrcli1lw~tbl!0e'din'g·afteraprogesterone challenge.ea1sscarring.Giundant at the Qase ofth".c. lltsfuzy ttrs¢Y~~®Upl<y d)"st11¢UWtUeiJ. . ${. pj11s Obese. oil h'ittb c()j.e. She states that she has lost over 50 pounds the last 8 months while 47 . p. Incr~ased :pr(jrmal Npt i.~us: history :2.!4paroscopYIc:v.biJ$.(l:I<m.followlng cfirticil situatiofls.a..§~ qfp'timazy oameil9rrh~a.~ dmg Sl't.9yeat$ 014 1'2.

tep!!l is..eof 1'00180 fM' be primJUy hypopamthyrpidl$tfi. ~hYi.'c¥eal$ a' 'no lid stare.l).ndprggt~slye wej~htgiM overtne iast6monihsin spl.. The 17 ketQsteroids@)HEA. a normal card"'io:v:ascl. WQ1Jl!J be J!j~b in' Grayell I A 22.nI'l:ff@tp-p: Jncrl'lasing TBG without 'altering the free.Ut is heard at t4ea:e~t4!J. brisk artentlm~a weight1Qs~ clinic.~i!lm a Answer: C-'renal $..and thyroid hormone leaves ADIi unchecked.m.laboratory abnonnal1tl'cs -plttili)'PQ'PlM1a(.yt6idglands from failure qf4evelo!iffiei'lt M the . heart failurel resembHng1he hackof' an envelope. a.eflexes..d.pQ~y. A.A ~o:uld ·a..{'Q'te.nuItIq'{)tis RBCsand S squareorystafs \$~r!lmCaJ.She iscurrent1y takingbhth control pfi1s.t:b¥th}{ ACTH and Il-dCQxycortisol should be. AnsWer. U. .atb.teofhelttg on.A ess G1'3. Low Il-deoxycortisol post-metyrapone test .i.l.t$'t1~al i'alu¢s 4~ .dipstick Jot nitrife. S: =S!'lcQilUaty hyp~xPar. Hyperkalemia E~ LowTSH.mild hyponatremia.2:002.Note: ·TIrisIllll.'\:liepw m~. Mitral valve .pa:ti¢tJ.yroidism. B.anthe' bc::ithofthetn..t is taMttg'¢Jt~s i:hy. occur in-BOTH Addl:son'fsdtsease.liilSa pesitiv::e .CL.lI:ilq leWCo~yt~estexa"$. disease. ACTB is .e1t1attenria D.c Physical .d androstenedion~) would be low .prolapse is an incmenml finding 2:.. i\2$-yeat+91d'WQJlllU. deep tendon f. and 'Nortna:lurine for t 7-k~t()stet()ids G. deep tendon reflexes. Answer.)i(i b'flrm9M. Answer: A~ me:tytap. Both would have hyponatremia. .'Veli9ls.ed skin.ana an abl!¢ni thymic shadoW.ddis{jn.6.non-palpable. stoneinpnmary RPnI .es with ex~irati:on. the loss. ihcteas:e:d if pjtujtary and adrenalcortex are normal. ana blOQdpressur. normal sclera.A.r(. hormone level.9b~e!1.¢:Strq~!l. ·types ()fh~erpalc~a ..:rQ~di$h1.t in9te1l$.stare. normal.·m¢:~quar.respiratory exam.i:~$mt>iYt~<lQmpl~j!lt$Qfq1ltom~ Wln~tipatiQn l. In hypopituitarism.Ism. Diaeotge~dj:'<lme . A xmd~~stQlic c'l:i'Pkand ttltltfil.. neither ACTH or deoxycortisol is increased. de1a:y.·tight gr~in" A iJritial-Y&lS\ teyi.copyrighted ..¢re.In A.pure 'Vegan diet.})resm1Ptlon or Ituffiness. Remember' that ActH has no effect on aldosterone release.y~1Jfi~' W9:ttfiln:wfthp¢tit~tbjtal.dootefl~ii:esi .'i.l.Which has . :Shei$: not ~ngany S. hence the 48 .Wi"d pi'o~iJll\'j.t·atioj) It¥8:m i. . J:.:witll i. ediment !ixam eXbilJil$ '..absenec Qf the thyfililS at1cl-parath. a regular heart rate altOS 'neats/ininute. in Addison:~s!l with :radla:tlQn pf pain .Allnghtsreserved.or exophthalmos. :yeftow-color.I.lmIIJ>cleW~~S's<ifi .:s'¢iU:. '12 =n:ra11gnaucy -induced and 'all other A rtewbomptesebt:s with tetany. tbyrotd gland.tver"fhe. but de('lXycortisol is ~JQli1>its.into .'tdartd. of cortisol.:prit. ~~w:tr.t .ccild WQrtian c()tttrilll-WS (If jht~tn1jttent :fluttetin~ mlt~' :¢hc$t.l)""Mdt(')geu 'l"ff¢At It¢JtiS*"S' B A PTH •• c c D c: N:tlfe.l'larand.~Qti. ~4~~}.if.~ip1tpre$~m with· trsudden cQnS!'!t pfughtfl~p.J' tb.l:liU:yny.? A..exam reveal~JttI . She is currently !.Golj~ Mit).hlood and 'n:e~atiw .dipS-tIck-for . Which o. In hypopituitarism..prM¢fi. there is a 'less of aldosterone.1Ig.JjS"yearcp14WQ. therefore there i~ -a ..t¢tm:e:diqatiI:)Il$.tffiID.ii~ill e~.e:dle¢pten.. normal. systolic hypet'l:etJ.increased. EYP.l).:b:e.l1@e.el"l1e blocks 11hydtoxylilse.. oihe. i i.a. Gh9iee .lllJ. AnsWer1 'E.~lJ$$iv~to·ht.e. .Inno. pte$c~pti9n m:ed.lI-p~l~ . (Edwarrl E'. ChoiceS B and C depot in ileillier condition.thyroid.ll¢flQW"¢t:extr¢mili¢&.fthe iol1owingcllnrcall111d.ry. 4th pharyngeal poubh~.Sitln.andan irregularly irregUiat pul$e.

ut . M:e. other choices are the same in allof'them. hence the amenorrhea.i.ulin is pres¢nt. Serum T4.UO mw.etNeuto16glcai examination reve.order su~p¢ctthe patient I:[aj. hypql1atr~mia is much more severe.. the last 7tn0nths.aSQrte'est and not t in other types 'Of Cushings. j'~ same sample i:eveala high s~hiin ilis)llib and high e-pepide levei¥Based on th~se flndings. E. patient has aprolacfinoma. . S¢l1ll1i: liiol'til\fl. A 22~y(:at"Otd w.. 'Choice D is only present in A'ddison's and choice E:is only present in panhypopitllitllris'll'1.alsdeptei. ~.a:(iditiOfi. The. It w'(j)lld be. Which of the following tests distinguishes pituitary Cushings fromboth~dr:eml'. A. B-when.i¢:i1t t.g'. A 35'::y~ar-61dpbauna:¢ist P'i:'I:. synthesis productiorr qhCfity:l-CoA . it. Answer: Ac" the. Answer:.ititi:. 29 :tnly'tl!_ {7Q·. UJ(A..ii(tcateenolamines.On$ has E!e~m ~m:en~rih~~'P for tl1~ l<r$t (j mQJ!.tp$te. 24-pp1JT tirin.tQ your officewith t:¢¢tifi.1? I$ltMsi~ fattY acids or when.ll-oxidaffon. E..l1 D. She qotnplaitis (if a millqr discharge nom her nippiesthat has been present Since the.ljl{e factor E.ireQli<}ss. Aa'cgnancytest is . The mechanism for this is most closely associated with . it is ap$ent(J)RA) d:ue tpin¢t~S!N a.. Setlttil. osmotic damage 49 B.. fatty acfdsundergo.insulin.7.Jrtcre:ised insuIinandis E..human insulin A»swet: A~ thehighC-:peptjde proy~that. .. surreptitiously injected .e d¢xameth. 10.cilecfetlon (ff.j3. CholC¢' Jj dcclltswhen in8\11i).l. WhiCh of the folIo~£ a}terauQns fu Hp:i.lnsulin is'Ung's!(.~PQn~: test ijU~p:l~entYl Choice AoccuroStnthe presence of C.l diabetes mellitus a benign tumor involving u-islet cells D.. 'rSII IS rtOtmal.aoid. 'Prolactin inhibits GnRII.q mel:abciltsm is expected in.ti'\msW. ~ctqpic Cushing:. · 'You .in. wtQPi. pfc:tlan:tih B. an eariIy phase o. z4·ho\it )1rine·f(Jt free . 'PaJi~~ wi~h diabetic ketoacidosis?· .1 i'$pre. Wliigll <lithefo11oWlJ.raci$: fatty.? ' " .A ·1l~rumgl11:CQ&e teporteg~6l?~.:t m: DKA.:j'Sl<::t cells b. The enzyme]S activated in DkA due to. E.iTs wl):en ins.~!.gat!ive aiidth¢ 'serum TSajs'nQ~. since it would suppress endogenousfnaultn release.t.pis6desbf' forgetfulness and t. A.Sent and :11> j!ihjb.sed Acht1Ies and knee jerk reflexes bilaterally and depreased light touch sensation in both lower extremities. CDecreased D..e-for 17~l5:«. itWbit¢.mt~ Low dose d~atne. A Ac~jv:ation of¢!ipllJaty 11p~pt'pt:e. A 39-year-old type I insulin dependentdiabetic has abumingsensation around his-ankles and on the bottoms of both fe. B.OXidittion ()f FAS.~()te.ltswh¢n insJili'i1 is presentinorder .ntgn1:r!nr61' i»y<ilv:iifg.pdm~hypQthytQidism(lattnot be thecause. suppressed if the patient was surreptitiously ta:lcing human .ed with the lrighdos.. C.lip~!)e mcreased l3"pxi~tjf!lJ qff~tt.eCoqe1. f.the Patient has aniasulinoma. Serum gonadotropins . Inhibition of hormone sensitiv:e lipase.giucagolHi.orli$oli:ss~pPt¢ss.:rrJ r\d~iti6I11:1l ~fu~i(l${)h fu¢. C.ite\i (p.n¢.. Choiqe Eoocl. 11.tbaswe test Se(1ml cortisol h::vel HIgh dose dexamethasone suppression test .c'PxUsol Ahswer: P~ih pituitary cu.flype. 8.

tiQ'l.teitS. thiatnirie pemicieus. (Edward F~Goljan.are.P'¢c~.c'niasswithtnhltiple ca1eHkations. flypokal¢mia. levels (cortiSOl .~P. A CT scan oftl1e)s1W. .sd~eto fibrosedaud 14. Nomal serum.l'¢rl1lt(ew(jp~th~.D.are.Ullli} l'Osm postUOsnipost I. Which of . tow' DO$m (ADH canh{jt coneenttate 'tlieilrirte) and.verted.lliagfl o..An g~year-oldbQy'presen1s autoimmune destruction .lfiiO.fSt<uWi):m:rqellsPNdQ.n .cWl'1tale.d. E. Choiccs'C n PM-the 'illiets . orneJ?hrogenicDI. Ih G.g anliia re®J.D.ip~i<ibehave li\<:eanfjnnalcotitrol.litis 'j.11e}lrly differetitia:tes type lfrQmjypen C. hy aldose reductase-into sorbitol.II'Jw :5etum T 4' It C.Y99Sylate41temQglobin' AnS. '12.ofthef. lfigl'L. Dare In typ:e: with.highPQsm. Whi~h(jf:Uie t()llowitlg1ti()~ti.central. and.eil gl.\(ing tests is the best screening test forJ:b:ispatiei1f? A.~ti!l yper~h'itW.enlargem!O!ntof the sella turcica sec'oildary to a l. inthanhey citt! Go.Qlyutia .m44YJlowtuit!ltism. llrights reserved. !:ii&@.Physlcil exam findings include. K 24-htunire for nretanepbr1n:es 24-hrurine. There is no evidence of thyrome.4~ {j~moti¢ dJl.diQg this patient? in A Lowifi$nliilgtowth.Note: This material is 'C"<myrighw. 15.l eXfl@tiba.DM.anddeoxyct. low serum TSIl. which correlates 'With hypernatretnia. >ot the f<!llowiPgwater deprivation test results would )fQl. often contain amyloid. When ¥'$opt:essmjsg.Utibe V6th water .ysti. <\tid{1alpitlltiOt)S thjlt keep him jlwake at night. (Jlt1¢Qs¢ iscon.D.$fj 1' 'W~tt:l1:'d¢pf. ' '319 t XO·$. the following.rtisol). Pi)st7itisJilin receptor defects wl:.hydrox).An~wer:B~ Ut pattentiswithdther .ve iaJmly'bistory RyPogJyceJwp reactions i'Ha:betesft1elHJ:t1$'? R A.A.responss (chOIce Al Patients with 1!~¢hQgeuicpolyQ. E.l:iilt withp. . . 1I-deoxycortisol after metyrapone Answel"~ A. syringomyelia IQ1l'1l>m d.anxious man with a mean blood pressnre-ef 152/96 mm pllI$.llreveals . is an . 2'8-8 760 780 . headache and bilateralhemianopsia.expectedlaboratoJ1l iJl1. 1GB· lWQuliibe low.W¢f~ . Serum thyroid stimulating hormone :B~:aypjji:J. C.8 t2(} E. Which.~ b ·nNbnnal urine for 17c.anemia deficiency Ans. andS occur'in· bi)th typ¢s. $~~ TSB. a. drenching night sweats.ivllt:ion 1!:a$!Jpre$$iQ :depr:lvatfo.!fter head tral.ii1$_l).d low s~ru:m deoxycortisol after metyrapone would be(jx.IDal "z9Z 7~iJi} 76Q s: 3129. He hal' a family' ltistQryoJ hwertensi(iil.hteJ. waterdepr1vation resu1t$ma.. A 48.e ·of 148 beats/minute.~n. Wbich of the fQll(j\.galy.ke1ls.t to the pfltientjth()se with . Choices Band associatedviith type 'II .Wet.rve Ii. D. Deep tendon -refleses.deprtvation.fheehiid has a cran1:opbaryngiomaw-ithoptic chiasmcompression .corticoids D.brisk. factor-].iSk.. 'lowurine 11·0B.year"old rom withdiastolic hypertensiQnca:mplainsofheaaaches. M. With nephrogenic D1 have less ofa .'emi~ . Insufitis }>(j~iti. for free cortisol Plasmaaldosterone Metyrapone test 50 . levels . which isosmotieailyacthre.. while those.) 2002 A E.lOs'nipost w@'t.central Dl win lil PP$m~~H}%n:QtQthe 'baseline.cesa Se$Qril.

.. Ma:late.:leturn ¢ su<i'den. .mll at~·$11)(1 @tigenpqsitive. tests should be ordered oil thispatieilt? Serum electrolytes J:iM 24br urine for free cortisol 24 hr urine for metanephrine and.abmp:tio placentade¥elops 'hYJXj:volemic shock requiring multiple units' :Q.. otll:W m .]\<aqing nypopiMtarisP.: llal1. 'g'ucose+ Acetyl eoA C coagulation necrosis.consistent willi. 20.n. ...l¢tipl1.of'laetation. l1-Yt'P'Witf."" .rplti.Q:@~~ 'IIJ" pyruvate OxaIQace'fate: .level c.amcietYi.<i. glucose .~e fCitmetm-ephrines give thepatienta.. R Thyroid management of this p:attertt. glucose' '1'>:.Metanephtines. carcinoid tumors.are more. .typ¢ I ai'ii:f>~ti~ q~y~l{)R$ !.. f~llQWlng s1t¢$'? 4. as a $cr~. metastatic disease. A.cessation :ofJacmtiOn.tendettliyromegalyaod. C. gl~¢p$. It infil1ta~ .¢~.. I)Rr\l' ···.~U4ebl)Q.t' P:i1~l¢d:l'edp~qgi1.3:qjAQl!i~? ~ .1 to ~w.w.experierrceaa..·~ "gluc(js. serum P'THzcalcium. .!p: .:e):~ .endes. The ~e11s$'tatn llQsitiYe fQI.IM~ Q.fuio . .Qrder iplasnm llgoMc B.. The historyls classic.ti(}nli wi:th4i!t~~tlC' . The: ftrst. key t.. benign pituitat:Yadenoma withsecr~tionofptQlactlrt E.. He hasa. palpable cervical lymph hOde$ has an elevated ..t¢ .excessive hungerjarid Jight-he'il. frQfJj which !>f'tne.. hypotIJ. Glycogen " " '. 51 .skin Sone n. is ih0id responsible 101'hyperglycemia -in 'a 'Patrent <t :a.~t~ti ha:Yetil<!lt(i$I[Iilli:llQI'ygtanQl~.e DtrAl's'ue~l...NeUf6blastomas ate APlJDtumors.apd renal stones.W:.t(.on!h~ skin. .Yis4~li~te{f " A 2. c~ 'Pii'tli:ll1t P:l}:!1 $h..pepttde .s.yr.¢1l11$.giY~:fw. ~<m~Y examples are ·smail £dl.alan. :alatllne'to.e3cirpp that pmduceshyperglycenU'a p t8.i1.candy bar Answer: E..J.$ th¢.oancers.()1d' of the anterior pituitary D.h01)J.these .andmelancmas. '1'W9' gaYS later.·.ft.f'tli¢ l:eslPits e*hwlts'li.and marrow than VMA the 'Child has' 'a neuroblastoma: withm¢ta$tas)s..therefotethe a~ At~ 19'.. intoapreexistingpiluitary adenoma It l'n¢r:eased'S¢cr¢ti01l9fdqpa. The pathologic process 'most Hkelyresponsib Ie for this.c. Ai5-yr-oldfu3UwithnQti. ¢9mpll¢!." .sensitive. . tlt~.«'QMeq@uce.spiration of the tbyroid is scheduled. .r.sth~:mt9Jie qe. .11 inIiln:li.'QICl.. $JJi>~ :®tig¢lI.pyruvate to glucose is the best answer A :Otl:i:er 11~W1:tiCn l'ifthe fd1l6wmgliio.ess3tlon.lJewJy gis¢!l¥~ 4i@iWlic:QY:l?ertensionhas multiple:nodular Jesions. The pdmaryQJ:~ginof the pat1¢1it'5 skin . rountt~ hYpeI:¢htomaticc~lls. A candy bar will suffice.~ . B. E.. 1..l'C®¢og¢n¢siSi.j.lfhetflical· re:i.le pf.Apswer:B-tbe: 16". order Seil:iJn electrolytes .. .ydto*yacetQt1e p}j(j. P.. hypertensfOn... A. A.. b~7'e@i'-Olli((Mil ~U1.~~fiJ... They d'en. hemorrhage..~hW·iii no. ordera 24m.•• ..mine inPKA.W:~iltii1g.Cl"eaS¢j t~ hence . Lactate' Citrate G~~{J.&~!}ttginneQr9..smaU.e$Y<lil i~ t:ePo~'d tQ~~vemt4tJple hn. A "fblC needle a.era 'S:erum ipsu1inand.ctin is ..··. :tJ. which of the following additional laboratory' D. r-l!'4jut).Q..etp13':pb.are the symptoms ofhypoglyceroiafrom too much insulin.stepin. It Adrenai medui1a Answ.:. Q(d..farrrily' history ofthyr:oiddise!fse.$pl1ate A:nSw.... A biopsy of1)neo.. ~hilii1'l¢' ..

C..&!Qsiis. crystaI$ili¢ fl~gativtly bitemrtgent. A.Whroh is the negativefeedbae'kfor pSH"the PSI£' would 'he incte.s(j$a~jjStatfn levels- .and tefany_ LahoratP'ry'sftl'die$reveal: i:i1ildhyt)e. flints .uc:Hort of mic acid. Is actM: 3(:J. lIis m.i.. NQ®ltl B. SeXWl.e'st>erm 'Cq1Wt. henee fhe presence . The ught toe is swollen. '8\'1'both Qffuesc.tOnta: (¢al¢:1tQfiill 21.l¢@ J.d411t.his problem ismost likely related to: .Ht 2. to measure basal acid output S:erumva'sQ)nt¢stmal pl'.is 'mast commonly due to L ))'P.pheoChromooytoma.. history.:in S¢lJlm A. 52 . meaning that they a:teyellow whynpataUel to the slowray of the compensator. 1.. Bigl1 Nq:r:mgl :li'SH Notm:d N6ti:l1aI lfrghLo'W La :a.@J_ N9t1:l'l. 'joint infl:ataltiation secondary to a positively bitefritlgentctystal B...i~Q the ~b:ove .d l¢ft shift.•. An alk:~epH in:ct~es tlle' TIllr!lberofnegativecharges :onalbl!'ffiin.tap' W!fspetf{jilt!¢~ . noxed to }rot'\1ea large var1QocJ.4~~year-Q19man with diastQ1ic.1tpelief. "Vetllhy :i8 due tometa1:illiljp '\tfl¢. . $e." .i~ ~ Iow. 'Whil.l.ltQsls.. hyperpaxatI1y1"Oim~ro.spread ofstj.yeat. sinceitheydeveiopm theserniniferous tubules.sstm:rinatedg(lllQcoccemta~th·septic .6ka:l¢tUlll'.other disorder has tIns type'of i31el)ttolyteptollk + hyp¢ttetiSt<!b. Which of the followingcharacterises joint disease associated withiheumatoid...ial1~pects '<I. has. 1he·nntl. at Pi...ebl\S· 'I.pnP'e atrd .right big t6.s:iIJ:wethes¢:(lii:iIil"etO'q$ tubule?: ha¥e.$@I:"ei!S E. Cartilage fibrillatiotl.cuunt De(\reased Decreased lOw l)ec'teased .Iikely .l>t)1er ·. A. It .i.tQ relieve P:'Iep§.y.. urine :0. The total calcium remains the same.M:fswti.. lI1m-k:¢r).aS.1'l). pf·tetroJ.~l:::til1r1if(lt()us:llhg LeY:dig-'celI ({ysf'Q#etij)'I1. hot and e.:llh:ll.C. problem With the. e. Ws physic. Thete i.'Sev¢te ~ osteoarthritis. High p. Semmgastrin 'l:thomto13' testresults would you expect in this patient? Serum S~ni. tJl!:I. hyp.qe~ jOlll:"ied caJeiunxcAAbe P!1UI1d to¥f:if¢etl!:lack Witb'LB. ..rtoli cells that synthesize· itiirtb:iit. psteorIJyli:ljtis secondary tciheni.Aside from bushlng~ssyndrome.decreased..tphyZt)'C@(1f:if.tndmtltabplic·a:lk.x:quis'ftely sensitive to touelt. but the ionized calcium .oldmanpi¢s¢l1w with f¢V¢T and PIDU.t)'d.deinthe l~rt:~rot4r site. andgastrlc .e~dtg .. 42.arthritis . arthritis rather than osteoarthritis? A. mnst.( . underexcretion of uric acid in the. no . CLprlrnaryafdosteronlsm been mking a )oqp diwr¢ti¢ E. and. R chtQ~icteMIt'a:ilw-¢ .. r .nou:s. A symrviaJ .jl.e that: Woke: lrim. Answer: C~t4e patient has gout involving the' big toe (podagra). .~vi!ieuce~fpJtti¥gc«lema \'It voil.l.tihQlcecC ts:botb. underexcretion rathertlian overprod. :D.snQ C. Choice13 is Leydig ceU ciLYs-Umetlon. .0.'primary aldosternnism.aking!wpitiP. an HLAB27 pnsitivespondyloarthropathy . (s.e~ '\¥Qt.i).Wedepletion.. JJ. Addison:~s disease .(?ll.analysis.tilatrenna.\WithQl. The. B:~ the: pltti¢tit bas MeN" llawith medun~ C.muscle weakness .~Mg!!.E. seminiferous 'With 'Ithlslb:t5' of tttfcitility is. Which oithe followirtg sets of Setumaldl)ste):tljl¢. LauQratory studies reveal a ncutti'!philic l¢lIkp:c~osis)U1.. ·AQ$W-¢t~ 1\. A 2t-yr·old . A. hypertensioll presents' with. nQt:tmt1.pJ.. type I tena.f)l'j. hj~t. The patient . he:(1cemore 9£'the.t1 N<>tmatlif(ltmal testosteroDeSperm. .<itQge.Itubular1lC1dosis· ~nswer.cijl1ssyntlielllztl testosterone. andA4 hrWiM fotP!)~s~t(ll). d.

N.iJt~.; This ;~teriaJ

i!ioopyrighted~ All rights l'eserved. .(Edward F. GoUan,. MJ'J.) 2002:


B. C.

Subchondral bone cysts Osteophytes .t\hky:losisQftbe.j(;j.QJ:t

Bouchard's nodes

AlI.$ D~j oint fusion due. to. pannus destruction l$TIaUiti inflamtttatOty ~h!:iti$: Allth¢§thtW

both knees, He has a 1J.istoryafewweek$ ag<Jofhavinp; :had It peculiar :rash o~hiS'Tight thfghthat was cirenlar, red colored and had a central ar~ of cIe·m~g. The patrent(s' rlisease:is :most likely A. R C.
¢i111Sed 'hy a.,; gram negatlvediplococ:ous spitOQhetl;l gram positive ooccns

()j\thearticular :cartilage .isa characterisUG!oIRit ClA ~hQil;lWl'ardlQ&1ng$i~Gl1&i. .... . ..... .. ...<rr'-Old man who. works :ina s.wnmer camp In upstate New Y.brkpresents withbi1ateral factal weakness inv6Mttg bOth ' lQW~'fa9jal mus.cleB~lIe a:lsliJcQniplams .!lljoihtpatnsln




E. immune complex.teactien AnsM'er: H- the patienthasctasslct,yme


:(~b~Je.,sexual1y -active ZJ-year~ld.woman_ prcsentswith,ahot, ,swolIendllihlknee:;Wd pw;Mrtr: lesions onthe pabnofher'leftiband. She,i::ecently retUt:tl~ froma.ciulipingtrip ill Colomao; A gram ~t<.tiitQftPesytioVial inthe .:!met :i!lfd:,fi;(5marl~!1pitat~Qf Q@ <>,,tb¢ Pllswlys fccv.ellle'Q II.~ .• A.gram positive diplococcus .

ttatisrrtitredl:\y:the hud¢$ ti{lk. Ih~ I;lJsn'is{etythe)i:l3':<;1\:rQuicl.llilnUS!aTIs. ltt.lsdox,Ycydille:



it IS

C. spirochete,am rtegativA diplQcoec'Us .E. mtranuclear inclusion M$W~ D- the patient has disseminated gonoeoccemia .due to Neisseria gJJnQtrhoeq.i?"a gramlleg::"tiye diplococcus, Some ofthese·patiel1:ts: aredeticlency lncomplement componenfsC5~C9. 5" A. vete~atf .4t'{v¢lops.t~no~oYiti;$ Within :?4.,ht;sQf?n' @@albite., You sjJ$pecl tl!:eQt:(etl,din.g .organism 'is... . . A. Yersinia pestis B. Eikenella corrodens. Pasteurella muttoeida Staphylococcusaureus Answer: Ds-cat.bitcs are tnote likely 'to ,cailsethls than dog, bites. :Pen:lcillints: the Rx ofchoice, Q., Whi(lllofthefoJl!1wmltcHt!i,c()pa;.th{H.lj~C :fjird,4t$'s :is ¢Ql11i;I16Qzyptes~t 14·boUu:llclJffilj.tgiCl 'lIrthtiJ;i$ andankylosing spondylitis? A Sa;(li7QilU,QS, B.Male dominanae Overgrowth ofsynqvial tissue Autoantibodies against immunoglobulins Answer: C- sacroiliitis and male' dominance (liLA B27' positive) characterize AS.. Pannus and rheumatoid fa¢tor (1gM. Mtibodies against IgG:) R'M.ta¢tenze RA, 7, A 3(j-year·old !TKU\, who haslrl:!dproblems with his lower back since his early twenties, presents with blurry vision in his right eye. PhysIcal exam reve.als a ciliary flushand a poorpupillary 'tespons.eto !jghtitl:the righteye. l'h:eitJ;t):aoQulat prl;l$surei,S normal, He also hasredllcedanteti(J( 'flexion and dry inspiratory crackles at both lung bases, The-pafient is presently taking indomethacin for back pain. You would expect an x-ray orthe p.aiiellt's back to reveal, .. A. radiodense lesions in the-vertebra
E. 53




p, E.






Note: This rnateriaf is .coPYrighted. All.rigp'fs reserv:eiL{Edw.ard B.





Ans)Y"!li'; E~ tbepatient

osteophytesat the jointmargins, yert¢.btalcoIhP¢Ssi9n frae:i.utes lytie lesions in. the v.ertebra fusi6ti of the V'eli¢bla

A $&;yw-,old man .~.',a. te!.1 Y@1i 1ris:t91iY ~ttent (If Ij::fU()WW"~4(lWt pain MSO,(;:i4t~fl wi,th blaody diarrhea. Henow ,oomplams, o:fs:Y;mmetrloaljoint palliS in tb:ekriee.s,· wriSts, andJ ankles, as wdl tlie lowe'r ba'¢~ Whichnf'i:h:¢:fQlloW;ing' i!;. tlle· j'il:¢itin:g~<#1t·mqat likely teSJ?Ql')$iblll for
his current rhetunatolqgic, A., Ov'et;ptOd®tiqn,<:I!

lia.s!!~IQs.iftg stmirl.t:ylitis aMl1ve.lp§


C. E.


Invasise gastroenteritisUlcerativecolitis

problems"?' !lripa:Qta



Ct'QItIl'sdistiaSec D- the patienf nas mcemti'Y.e£olltiswnich prQdncin;g. ~1Q:sing:$plJ:t:r4~liti:s. h:epi):t0spl~9ID~gaIyl,a:o.dP.ol~s<
t!;S4 t'herunatotd factor,arrd


G,olotee~J. ~c!lt

hi .anlILA


itidMdual isJhe

'trigger for

A, 3-:,year~.ora girl has an acute onset:of spiking fever, rash, generalized pa1:nfu11ymphadeno,rathy~

urma1ysisare:rqporredas negafive. A CB'Crevellfls an. '!{osol1,lte 'ileU1fQphilk le:1ikocYtQ$l&.fnnld ;Qij:dtim;ync ati¢nlli1;: .iillda Mti:nalplat~l¢tcmmt:Which of the (ol~(lwmgQ¢St.9h:araC~!tJj~ e'i:l~lute. (:I',{:t4ts ~ pgtIf1X1,t'~gi$e~e? A. Non..di:>i'ibthig; l)o;t):.infec:ti.6us,.nfhimmatQryjoint disease l :8. PtQ;gt~ssf:vely disablii:lg,mfe¢ffQlIsJeintdi$~ed,u.e to ,a Qil¢kria C. Progressively dlsa'bllngnon.:mfeetlous -infi'ammatory joint disease. D. Non.-dimibiinginfebt'ious'jolrtt msease pue: to an immtinQIQgi'c reaction against a bacteria E. ~Qg!$hrelydil!I'\:b'lirIg 1J,o:n,"wec:'1;iquS' ,inl;1ilJ:l1ma\oryjoititd.iSel):se ·a$s~¢iateg·w:itll::ap lILA~ A.nswel1: A" R

1'he¢lItWM eX<ai'ii iSUQ®iil.· A


tQ. 'Wb\C.P,o:f tb.e .f(lUOWllg clfttjP'Qril1!1tttlog,tc findings
·arthritis? . ..

c:_ the patienthasjuvenilemeumatotd

BiZT haplotype

arthritis, speoifica1ly Stitl's ,disease.

ihPotli(i$.teoa,rllnitis ®d rhe)lipato~il



Nauow jomt l),Su:bchondralbone


:E. :Metacatpophalan:ge.a:ljomtmvol:v.ement A;rt$wef~ ·C,..,OQili lbse; arncUliif cattitage, bUt:rol' diffenmt reasons. In dA,it Is-worn :down b.y weight and ,isQ1'l{:fl1;i'l),~ 'w1)Ue 'fa.M., 'it 'i$,. !i~(ri);yetl b.,y p(l,l11):1l,$,Only Maff~~ \:he MCP joil;1i. :S~b9b,Qrtdral bone 'q?{sts: re a.reatureQfOA. a 1L A 4fj.;y¢ilt-oldman,ha:s. cbJ;omi:imydllgei1ous leukemia thathasptogt:e.sse6 int& anM:ut:e blast-crlsis. currently beingtreatedwith.multiple antileukemic agents ..Oneweek.inte therapy> he develops <lligu:rlor-en:al failure. A urinalysis reveals an acid pH and nurtJ.etolis crystals. Which of the foIfowing bestexpl~insthelIleqh1i.nism for this ;Patient',s r~'lll; failure? A Drug nephrotoxicity R OvetPl'odiictloU pf.uri.c aGid ,C-L¢!.ike}njp infiltrl1JiQ:tl ~n}:1¢ ldd;neys D. Underactivity of 5.·phosphonlJOsyi-l~pyrophosphate (pRPP) E. {)veJjlctl'Vizy :ofhYPOx;t1ltbifie~guanifiephosphoribo~y,l1'tau$ferase (FtGPRT) Answer: B.- increased destruction ofce:lls ,Jeaos toinereassd' m.etaholismofpurinesmtQ uric acid leading to1lrj:lt~ .nephropathy, The-patient should have been given allopurinol. 12. A '65~year-01d' man enters theexaminfngroem with 'broad ..based ataxia, Positive. neurological findings .include a positive Romb~g test, loss of pain and vibratory sensation in the lower


extremities, a1ldallst}lltdeeptenqOl'l ).;eJ;lexesin the lower: 'extremities.B9thpupils accommodate but do not constrict with. direct light stittiUla:ooIt. The patieni'srigbtkneets sWollehand sofi;tissue swelling is noted around the j ointAtl~-r[l¥rev~llls e~~eJ;l~~ve"1$Ql1'tioll of bone. Which of the t following best-explains the pathoger:tesisQfthlspati!mt:sJoiht'

Lossof pain sensation

Immunecornplex disease D. Upper motor neuron disease E. Cavitary lesion in thec.erviea~ .s,pina:lCQldl AJ(swer~ B~ the patient has tabes dpr-saUs atld 'it. i)¢!lfopa!;hic (ClmtcQt's) joint. The patient iSlihiiPk to
sense paj:n.



Disabling, joint, disease.nodular anA splenomegalycharacterize.a

lesions Jnthe lung assQciated Wit!1; dust bot'lle dillea§¢s, ;xetQ~tomia, :t;hev,:qtg;tQlqgJx;, J,1i?~e w#h W~h Q:Q:eof'tb!:;611QWing ll!.po:(atory f

AJ(swer:E- the symptom/signeomplex eharaeterizes-rhenmatnld arthritis describes associations: with pl:1eumoc()ntosi,'l {<:;aplan's syn4rQme),~jpgtefi'Ii' l>ynj'itQil1¢ (dzy¢Y¢$II:1l'd. .dry motl'lli:iQll¢:(O 'autoimmune destructionof the lacrimal glands andnn'notsalivuryg1amls).,and Felty's syndrome (sPlenomegaly Wit'h'neuttopeniaJ. , , ,', .' 14. A ~2~y~-old pregnant wOman, who is .nnder treatment. for hy:!?eriension with, hy.Qtil)az1:ne, .develops an abrupt onset ofa left-sidedpfetiJ;al effusion,photophobia,and jnmtpamsinbotn of her ha1l,~l.s.Which (li:the foll().Wiug antibodi¢i-; iStt10Sf likelypn:"$(;j]1t' inthi!i>pa,ticntJ ' A. Anti-double strand.edDNA .' B. Anti -'Cc1itf6ri1ete C. Anti-histone

D. E.

abnormalities? A. PQ$l'tiye se:nllil antinuclear antiJroqY' Xlfithartm B. Positive band test on asl'dn biopsy C. Anti -nbonuelcQPl"otein antibodies '


igM antibodies




offending agent. Fr9Cain:a)111Qc is . 15. A 24-year-old woman with a preyiou~,stiffu:es:sofbqth l1<mdspre$~!:$ wjtb" dyspnea, neck vein distention, with jnsplration, and. muffled heart 'sounds. t1rinalysisreveals REG casts; hem~wna .. and: mild tpm.<:iil¢til:fl':)T:t:ii§:iAiJrla. s,~i.l!ro4,1PtiJ,1U¢clt;M'itiiitooqy t¢Sl is PQsi~ve j A and has a.titerof 1: 1280. Based onthesefirrdings" tnepatient mostJikelyha&...' .. A. mixed.,C9hUectlyetissue di$l)i"iJi;:r " B., progressive systertlic soierosis C. systemic Iupuserythematosus D_ juvenile-rheumatoid arthritis E. adult rheumatoid arthritis Answer: C- the patient has SLE with a classic pericardial effusion, 16. Which or the following dinicopatO.dlogic findings ISptesentirl pothsyste)':nic lupus erythefuat()sus another drug,

E. Anti-Sm Answer:C- the patient has drug-induced lupus, with.hydralazineasthe

andSjogren's syndrome?


B. C. D. E.

Sclerodactyly Positive syphilis serology Anti-SS-A eRo) antibodies Non-infectious endocarditis Dysphagia for solids and liquids


2002 . a bl$1.. lie hl:t$ li:a!il. an wcrellseinp0j. There is no historyofph()tosertsitivity~ Yoususpect that her urine would".tb a.. MC cause of tinea capitis. 5. it is Woods lamp positive..pain..of'tinea capitis witha negative 'Wood's lamp ls .sc:m8'. A 30~year~~9 f¢'tnli.Lfis now tI1eMCC iJftinea capitis. (EdwardF. 'atlriazide .iju:r Answer: A~ t: tonsurans invAdes the inner hl1it shaft. Mtar'os/?onJrileanis 4i!dtlllts cough..~ls.AGE is 'also involve. contain an increase incopropotphyrin C.i:l7j..ond contraceptives E.ease ~t): bradykin'i:l. slibcut@e()\! induced.ellwoPQrphytinpgen decarboxylase Answer: E'"'-fhepatient lias Pfitjlh)"ria .eommon fungal cause. P@Qailse it seems to coincide with1..dl'lj:~Qted yW()j)~'$lamp li:g_Qt(UY~li~htJ. lif. rash oft1'l:ie fllQe. !u.Jfigi~ f(JrsoH:9~iql1ids is seen in PSSand CRl3$-Ts. A 42~YeaI'·j)l(f'man has recurrent development of vesicular and. A. bullous leslonsrn sun-. C.diuretic ~::. A.fI (Jini!t4a. Examination reveals numerous surgicalscars on the abdomen. 'w.t¢(lh(l1.Yl)'Prol:fie•. Hence. an ihdrea. 11. cough and sW~llibgi1l.. Sne IS U'!f)$t likely taking ..(iMrease& vess¢lpe:tttieAbilft.Qry of ahdominal pam B.9yspl.syphilis serology due to>anti~car:dionpinantibodies is seen inSLEas wellas':Libman-:Sa~ks ¢n~Q. 1)" 'an AGEjtIbib~t~t aphenothiazine .rights:reserved. long lfjstory Qf alcohol andbarbiturate abqll~ pt:es:ents With ~iftil$e ccliokyabdominal.E.hit. trfcfliop1Jytdltrrth..b. have an excess amount of urobilinogen E. contain an increase in uroporphyrin .:\Qsw~r: c.~!ltdili!h 1.¢utaneiltaniil.J.lwi..e'l-posed m-M:. tum a port wine color after exposure to light 56 ..tlte ([eejlo .:a~ A. Mill(J$sf3z:t'iJ. c.01ites' cannot be .phQJJJUMg#p:jnhis wine D. A.hese.. ttie. JJ.. hY9ra)~fue' doxycycline barbiturates AnsW¢r:C~ 'procairtamide is another drtrgthalis associated with drug-induced SLit An1iC:lristone: ~ntib!:ldi<. be positive for blood D. A S2~year"old man With c(jiigestiv¢ heart failure develops.imn diannel blocker Answer: B. C.y).uta.Qde$i YQu !"yo.h.repatl).mij$t li!:<'elyfakmg. expectthis patient to have ./ujpnY((}/i loitSur4flS B. tQ aY9'i~(l.) . a·ealt. A 43 "Y'cOlI''-QklW()~ll Pl'cscm1:S' with jQIDtpllin.redblppd.bich is:the mechi!bism: fot MIDQedemaaild 2.A false pDsitive. hence the fluorescent me.lupus. M.l.ami:nulevuliuiC acid in his urine C.$¢l¢rQdact~:lY lJUo. AIl. ihia:zities B.cfgtlomoni\. (lJbi~q!1§> E~ D.'1 ®!i'~ butterfly-like.Note: This material -is copyrighted.a. A. . E. an ACE lnh1bitor leads fQ: an itict.d in theimetabelism' of bradykinin. Goljan.fs 4$:ed tolie b the.S a.e. 4. The most. . colorless urine during these attacks E a decrease il:l. •.

6ridylb~ IatUhi.7 rnm . Nlkolsky th~:p:a. 'Rl¢k¢ttSiil C!ll!U'!:l~la Fungus ·of th¢ fQllcrwiligsU&zypes E.otitis mediait1fections. Ereli~i1:'¢eoJ ltmdial gtowth'P)'m.drug assoeiated With pholo$et:isitlirlty is lfk~lN' A AD-yr:>-Q19se~I.suucCxposc{¢it)' . Thechild IS a.coiored '.6~ ~t($w~".t:dip()dies 'i!.s.l1ltse@dYlpm!!l:!gmwooti1. a @¢.CPbSj.t~~ A.Lesio.i:l~Ii J. . ll1e 1:e~ion isma:sked.V~ A~~:Wjl"..seales are present.(!frl1ihlil patb.¢ 'tQ¢ ·P'~~I.i.scales on the surface.hM P.etrac~dine patient has. ~ize..lic!1t. .O..1':s.'1 A Spirochete· It C. :E.chee'ks. Which of the followingmost aeter'mines the prognosis of a superficial-spreading malignant 'Qf ~ilvery .~U AJt$W~t: 9.l~tograpP:ism Wic'kliam1s stria.~¢ MSW"filt. .'vesiculat ~.e.cik .Qf:i.flU bi$:...bM lI. :00.$jjri1{.mouth breather Md.trunk.()gens. The' Ies'£otls . B. Wi¢kbam's stJ/ia i:. A.JqW l. Thta:ztde diurenc . 'basal cellla. sepilfutiMa1:iov¢tb.old infant > A 'baseball playet develQPs :l1.Petlicll1irt ..arta¢.1OOtlli!!.'~is~[l.AnA nionth .lt:l Ma. A.i"yr· J3.Ui(:l 'una . Which of the following characterizes the pathogenesis of this lesion? .(lnIa:?.. notcpnfuse 1hl's with i.~to!l11d the Reck :.have sllveL"'. T()pical'porlophyllin is the: Rxof'choic. wHlchis secoiidazy syphilis.g wliij)1): of the fQ~ll)wj'I1!:l@.l.W(jW>.indepfh have the c&.SqWJ.que-li~ Je.ll:id.. '8:. 'C.lP.posure e fosunli'ght D.'(.lllhyPersens(tivity reaction to me'Wsta$ire.button.>+ tl)~ n~slow i!Yste. Atopy is a characteristic 57 feature in the family.buccal mucosa in lichen planus. i. Which of the following is a Q.@UnU?9¥e ffi!lP.a. soa .l1ow¢vet. to. a.(Qt@ti:lIS til.internrittent p6rpb~a . D. TypeI hypersensitivity reaction c.Jiib1llJ. the vulgaris.ith this skin les'i'On'Z A..slon.ll. acute .sign E. Ib Positive Nikolsl< Al1tQa. a bullous. A'5!$. B.tfim¢astites 4~Pth ofinvaswtl.tous$'. .o16r vanittion . T.ii1. e¢zerna.$Wlll\l of thera5n -is: in '.' has :a weeping.dw.n11y hasa stuffy nose and.v~IJ1I<?oidappearing lesiQno~ the shaft ofhispenisTbe infectious: agent that'is respOnsible :£61'1Us pemleo lesionbelQrigs:to'whkh t Gal!}i'umrcnannel Mocker C-tlliltethatthedlstri. Nail pitting :O!.S !\i:lJilyle$IoflS' ('ln~$.e IV hypersensitivityreaction E~ 'SupeJiici(l1 dermatophyte infection Answer: B~ the patient bas atopic dermatitis. . lesion with. "type .1)¢pJU: piUWII$tQll CO' DQt:ation:o-f .6ilifuott clilllcalfihding associate.k..e.his!.lJlostlikely 'E. lac:y ]eukoplaki~'lesioIlQnthe.. 1" P. D..yei\ Oermatographimt 'is noted iii t1irQIllC'urticaria.tlte:er:yj:hHIiW cat¢iri. ACE fu'hibifqr 0..pJa. ~!1. Ge~iier of'the'pa:tient :a. .. IIei. E~ whiclt ls!ll}e t\)' HPV6 or 11.sQfl..Q sign is noted mpemphigus m¢lan.

hyte thatalsocauses seborrheic dermatitis (dandmff). A .. Onychomycosis: Seborrheic dermatitis Answer: B~ the patient has tinea versicolor. C.thQgen not¢dm the t.ctini¢ (solar) keratpsis.' yl)!J£ fli~t. 'Which Of'th¢fOllowltig p¢st de:SWtles tl1¢.[t¢a pr :elcliilri:t:tg.e'C is type m .tb:atdoliot>tani:litrirtg'lhe: . tineacorpotls ivy tZ. D.ta.ef} B~ thepa:tienfha'sa. Punch Plops¥ .l'Ol'sI)t le$1:QPfor $g].h A'Qs:w:¢.ii::hi$:$imll:!.t~mthe s '<fi. Cboji. Wh.1: J:ll!I:cpJopapular rash on a patient taking penicillin C.1K :a.:f.piithogetiesiS oIthe pCllrly white 'l~iQt1 Qut..'ltj:on~ A.E. which is due to Malassezia furfur.action JIS$oeill.. V{I1ieb IJfthe (dHowiug sholl.J..irnmunocomplex disease..OeA and B area~e !reaction invol:ving histantlne. pr¢!.c#Qn D.l detma':tophyw in(ectiol1. palpablep:utPtirama . and over. I'ru~h~ral blood' :Cl)®t fQ. sc.j!tQIJ rubrutn.ld b't.Ptiyslca1 ~X~lltiQh j::¢vea. a wnealand fiar¢ ro. 'the pathogenesis ofth~skihlesi6n is sImilar to ihepatbQF.R~A po~s lA.Cholc.f:t AT :th¢J2tlJjent M$ m:Qlll~:'iciMtj)rJ.s of4yperpigmMfatiol1:andhyr()ptgmentation .. A 49.feQ$i@pb. thetmnk.¢d with a pee sting 1. d~nnatop.:yt.\y bor:defandacetittal .fl$ Url:ne.. Tinea. D.53-:yr-dld .to'j(tlifhoj1h. which is most ofteil due .lil'lnatfcl? /L Vii'a'{itlfectiM F®galinfection Bactenal infection B..!. Tin. D. Illtraviole:tHght C. 'Type I h~i>¢h$itiyi:ty r:¢aetil).tiQt1 Tzanck preparation .. Bacterial1nfection AnSW.t4"$9hgY~1ik~r Q111pHiggtiotit.l:ppjsQP Answer: D~ the pafient. TyPe:I hypets.-old W6ma.ssoQia't(jd with the pa.has a tYPe' IV cQfi(acJ dilrmatitis to have pnirit1cclrcuiar lesions on heiil~g. c~t¢tjftWro ]¢&ion$ Wj. Dltra'llioletlight C.Veafe~:.~p1e tor porphyrin analysts.pfntultiple ateas of s'kin . A ii~yr-'Qld ~1tUQ l'@'s: mtl1tiple. 'Diey h:a.ffa 'corporis is a:®perficiti.:4 'l~. a DVBrdlltt~. E.Flit1gal jnfe.scu1i6s tlj:er(f$f'i1.a~Qsti¢ wof.ncQ:t'tlpbiIls. " Answer: 'B~thepatienthas 1.small-vessel 'l/1l. pearly-gray lesions nn the dorsum of his hands 'and foreanns. tinea..l.cli ({~c~nOnm..'r E.C_ B.<!( JJ'oisoP'iytanila p(YsiAve~~P.eiJ$itiYityreactiQI1 B.J. A is-yr. as superficial 58 . eezematons-sldn lesionre1ated to the nickel in the metal cHi?on her'lif1.eiJ:esis ~f. 'Which clftJte follow1ng skin di~otd~ g'tIiIl!?!i jsa.fannerhas Taised. A. 15'.l:sil:re.5. most '' herchestaudback_ A KOHpreparatiQn taken from a the border ofa hypopigmented skin lesion reveals yeasts.!'all10Y$ c.:i.qld W{l:J:m:nhasa s~aly. I leslonsfl A.!<:-l'IJrorthis pafi'ent? :A.i:wthe pa!bo:g~:nesi$. l(PHl'n~pat1.giQSIlUJ1W4~dhisa.versicelor Tinea corporis: Onychomycosis PityriasjstQsea : Tinea ye:rsi(:o~. Q~1i aue to' Trl<:hqphylQlt 11tl1J1!ffi.-yr-ola woman: is noted.OH prepat.inf(:¢:tiQI1 B. bestdescobesJhe pathogenesisofthese . Tinea capitis : Pityriasis rosea E. n1qt~rili]ili~¢ ~ii <:i:( Which of the following. 'V®l . corporis. SeWttheicdermatitis.

17-yr-olcl.antibodies. is performed and reveals IIl..ltipni~ Aescpbe~.. E.ibl.s shingles.Gthe ip.9:ftfl. The inclusions..i. The-pathogenesis ·of fhe hypertension and urinalysis finding in the patient is ll. .old rnan whhchroniC'lymphocytic A streptococcus whi. lesions have a nodular-cystic pattern. an' urticarial reaption E.v.fection w to post-streptococcal glomerulonephritis. It begins aethemidl:ine oftheneck and ~xtelldsQ. . anrl:EBV.. the'patient hasehiq~¢r!ppxl whjchjsaDN:AlI~~~rn~ in.nnatiti. folliculitis secondary to Staphylococcus Qureus C: an-immunocomplex disease associated with. yellnw. a superfi~ra1 dermatophytoses pif. varicella a- whi¢1i isc::hi!:ra¢tepstiQofvaric't. a rath develops -outhe. neck.~.ostHk¢'ly hll$" ' The . treated w1th~ light.m(jus ¢ItU~wWr ii:otranu61e~~iI\t. inrmUht)cQID}1h:x. and others arepustular. reaetivafion.oli~a.rlle B':yI"<>ltl bo.)utha.e 'p~tieI)tnlldimpetij?p :i:i)Jc· anephritO'$eniestrain. f.s.. an'iuIIJlUllOCOl)'iplexdisease assoCiated.i:ted with.. Ten days <!fter the rash.l'he patientwQst lils:elyhas..qisease.of'a 'latent-viral infection an.ll:e flat. enisted lesions ovefthe race'. c. The.hest.lla "Christmas tree" distObution.i. 'Pterft'%h ~istr..antibodies agilitisrDNA An~er: ·~th. SepSis dlle S~reptocQi:cuspYQgencs :Q. Yiial'e'X:anth¢rli R vl'ltlola Herpes zoster . ." A.sbap~ )~ionQnthl'\ ®Uk' tl. dfHSVand varicella :lookthe same.erthe erythematous borders and a pale center.lsw¢r.'~ l!.. an ultravioletlighr-related dermatitis it gr61\P A stre.A. while: .~~ijati1ef{ti11il..iasis rosea D.follcws the lines· pf(.A 727'f-.allergiccontact qj:.ptO!l!OCCUS Astreptoco. contact.p. i.yi"old ooypresents With.i:I:Unk fhat!. A l(J. }&.. D.$jpllil.yp:erte.tM manpresems with slightly pruritic ()val. of.E. an:HSV-l infectlbn :n. Some 'of the.a C. 19. and upPer' body. anqstIloky cofored urine with hematuria and R:BC casts.others arevesicular.a:!lget. :D. vesieularrash locatedon the The pathogenesis: of . Note.1ost~lCi$dya$s~j'<itedWith. A1'zanek pre. Pafienrm.. an. A 26~yt ..16. production of lipasesby Propionibacterium acnes E. A. thedifIerent stages of therash. A: felil. behl. 'IUs.ePSi~due tq ~tqp}fyloq(Jccrzyaureus J). C. invafilon of skin.. The pathogmesis of the inflammatory component of the facial lesions in this patient IS most -closely ass()ciat~d with .uliiAtI¢l~ted squa. iinlg te:aetion ~SW~I'. l7. B.dermatitis A.. the patient develops periorbital pufffi:lelis.senscryganglia in the thoracic area.A.ccusiti.ftilJ_I·JilSlI·js cal~ed a herald patch. A' few days later. male has facial lesions characterized by erytheow. follioulitis secondary to Streptococeuspyogenes Answer: D.the patient has acne vulgaris 59 .. againstDNA D. Ieukemiahas 'a<JfJ IlSViC¥V. sepsis due. A. a group A streptocoecalinfecfion B. to Streptococcus ptleumoniae lead fo ~O.ass()ci. the sJ<in lesipn in thispatient is attr}but4ble to .I1siQn..PQeJ(tt:e@tie$.S"o:til. A .b.. virus is in the.Ua.tous papular lesions with white and black "Centers.)' has Ii· 1''Mh on the face. by leukemic cells @SW"(lt:A-.tpepa.

. grampositivediploco.tld be A ..SSa~9Q}J:ollnta1l:e C.uta neurppat'hologist develQpeda "rapidly progressive dementia cand . and a positive gram-stain. .s. C?gnitive With •. MediiJ: .asevere headache associated with unilateral lid lag.ent dq.0sitioil Of'l1em9sla.qbal!.gramJle. c. K ne1. Degeneration nccurs 'in the lenticuiarnuc1ei. nuchal tigidlty.l1(1ll!jlc).amitie denc. Mn:ripaIlismMrnaYel?lellt' 3.1y ~<ige'i.t!':tJ. c.. overall primary eNS tumor. disease. D. An MRJ reveals 60 . and.petechial lesions . and .(benign) is -or~l¢Q}l[~ Uyer dl$. and hemoptysis...p.e .of the cerebellum. develo. devel()ping Jateriu: life .!.tdl. ( }\.2 t1\ tlli.gram stainto reveal..epali. .teasedptolei:t:4 de¢teasedgb::!¢ps¢. .rlisQrd!':t 'isre1ilted to . a.pathi)gel1es!$:ljfl1iS.')pJ.:Ll!.mydriasis..I:.iiJ:d jf rhqyemenJ di:sp~rleI. R fdlllklfeftQiett¢y multiple sclerosis Abs1'f¢t-..818. A 4Q:~year.zfelc(t~Ja:. 6. abnormali1:it. If .s¢ 4> A 15cyearold .boy developsfever.gtlUUneiJll.tclesb. Acoustic neuroma E.¢te). iow ceruloplasmin D.!<hara~teriz¢sii dfsease associated with. and f99t 4t:0I?area~~ai!c$ocja.¢tm.r- prai:l).atl'l4ge a. vitamin Ihl deneieticy' :occurs:ffi vdied.tlye diploqoQci Answer: p (Nei:S~etia 1ftenilJ:gfti4(s~.a child B.deorease.nscwer: R-fue.~..els thiamine den¢iency D. M~\lUQbla~tQ))ja Ma:lignantlympboma 'malignant eNS tumor inchildren. a.. .this.Mf.Is.qg'prious' subM'tit~ .I.e1C9I':.sclerOSl:ngP®et)¢epfurli:tis aeetyidlOl1nele:vels s. -aslow virus disease invJ)lvr.. .ave anora. D. M~l1ingioma Answ¢t: B.gram positive rods p.nY&4gn. Wbith:01:' thelollowlng represens.¢a.a C. ( l bodies andtissueamund theventr.l.gative coccobacilli C. a PMai)' tath~ than an . Yt'!lf would D.ellse bt'l~itll1~ ~t M e<fr..peat ffiutaiio)1· Alzhelln¢i'Sdisease alcoholism PaikiUSQJlii di. Anafebrile 52-year~ld smoker with weight loss.miwas (Streptoc(jlJcuspneamoniae) :5.]nJJ. but a: eystis. patient has Wilson's. 13.a:t&xIf.the Me primary . A.teu A.grampositi've.9Pl1tllil.i.tQ.. A spinal fluid reveals tnc. tumor that would more likely develop .cei B.1fit the $\iQ:tltt]attJi¢' :nU.dt? A.lils. 611o])lastoma multiforme E.myloid 1>)" deficiency f1fdopanrine s: "expect the·OSF .'coccl over tg-yr~"pld.e~~. ophthalmoplegia. the 'answet \V'6. The rliscQlor..s enc~ha1qPathy>R~alltbatth¢ W1!:nrill.the paftl::tlt has C. A.sba$e \ ( 1'\ flimily hjst9~ anli subsequ.t~sedneJ!tt(jp1.ttlpleire. cough.ttiQn~ue to h~Q.ieuqyand Wemi<>k¢1. air oftb.astrocytoma .

.i.henGe M#l¢itr).patI¢. perfC!l.meduUoblastoma C.11'anges{} :desirogn9.on'hagic lesion was noted atth~ p~phezy (.•.lid-la.'fcx.Iia$' Dow ~yndt6ffi. There is an association .lldhesand s¢irile plaqueso.g.nhisWloglc eXanUnation!ofthe tiS!jlle. intracerebral hematoma C..scannmg' speech. Ji'trhytlirtUa died suddenly at horne.Arit':ncaps)ilare<:1 ass )S re'(tJ.multiforme 61 .M aqt(j_. :E.. eIhbQlkstroke.c. .i$ lacunar infarcts d¢creMedQ<5pa'llline D. ®I?al nem'i'atiol'liitlQ¢oliIpresSion or the oeulomotor nerve leading tomydrlas' J3-atii)4oid i"1'.-(Mmanw~fu d.OMSis the MCdePJ. this is a hemorrhagic' infarction (liquefaetl've necrosis). meningioma disease E.Recurrent episodes otblurry v1siQll. A. . that bilateral internuolear . ~ebelJat:h¢i:lljation jntq the :tbramen "lllagnttrn Answ¢r: D~ thepati~nt h:. C]'IS disell:s~ in tf!~s . . ~ dcmyelill1ltin. strokes at.C. .p.paresthesluS:ls: most Ciosely associated willi •.()ma'to~is.chronic.tlte Vth Wernicke'S encephalopathy C. and. tempoI:opanet.unor empolicstrolce cerebral ~edema with uncal herniation M !lntQpsy.~i(]sejyt¢I~tefi . atheroscleroticstroke B.if the tempo:tallobe~ The patient most likely hase/an. slow virusdisease atripletrepeat disotder D.epale infi!.t)¢il. @()i1~tie IJ.tigetpin:al ependymoma B.eUtOt:Ila . co).¢r!$(ij$~$e :atlU'i e. " 7. demyeliaating D.The .tioI1s.•.er: A-the &~ E. atedi1e t«>Vll:rthll¢Ne tutnQI il. oHhe tIlyeHn.¢ljfQm6'"som.$wer.i..i1l.!Wl~fta..! the cerebral.at1y !fS~ levels a.og~esisQf'tbe.m)l1tip~ed~f. j~ tl!!'lst.e. slow virus diseitse 'patient . C.rnultipiesclerosis B. glioblastema. andnphthalrooplegia(eyedeviated down and out} . K-sens:Ot).ovedfromthe t~ght.<}xfro. A. AV malformation Answer: C. .ophthalinQplegia :1spaihqgu:omonic ofM'$. A 4S-yeaT"OId woman wifuabisto. Huntington's dlsease Wilson's4i$ease An.atrial fibrillation is the MC arrhythmia leading to embolic disease.' of lhispatient's neurelogiecondition B.A. A.neuto:fihr. .()ffliebram:r~YeaJs atrophy of the frontal and. At aufopsy.. A.1Xie!1 on·a 40-yeaf.e-ll .t{.[hepi. right-sidedsensorinenral hearing 'lossand f~ciai numbness in theurstrihution of the t. ". D.:i®f:ebeltQPl'lI)tine ow. The pathogenesis most closely relates 'to. .yeHl1ittingdiseMe..metastatic lungcatlc¢i'J9 the 'brain Witb. ~-arti)'loid Pto~i\i R . the patientmost likelyhasaJan .ry ofhlltfatstenosis:ana a .oti. '9.l'jJihgingon. Jt j$ .·:E~tlli!1ati. Answ.ahem.C¢lieb:enopijn{r~¢angle:of~32~(:i'al'"91dmiilewith m Recati E.cbd@s.g disease. nerve.. tPF' A. while atlierosclerotic.of acoustic neuromas witIi. K primary CNStt.

the MCC ofa sp. The patient worked in Ii wild animal park The vector most likely responsible for this patient's disease is a ..uppereK1. Pneumonia in an intensive care unit D~ Dea:tlUn a patient in a burn wit .E. A. A febrlle28-ye"ai-dld mail with AIDs <ind 1:.NO. A '$5~y. a neutrophil dominant cell count Co is the second MCC of neonatal meningitis/sepsis.te:This material is"QldrtlI.Jlb-llis deep tendon reflexes.s fuost. Camyotrop1llc lateralsclerosis n.atrophy of the intrinsic. AGTsqiJll teveal~m~ltiple ring enhanoiag: lesions ~1:).the patient has tabes dorsalis (neurosyphilis).t:wb. A biopsyfindingin the cerebellum from a comatose 28~yr-cijdman revealed Purkinjeoells with an eosinophilic inclusion.J.disseminated MAl AII~yII¢r. Note. Which .n¢lp~t. while syringoIl1yelia. A. GolJan.Allrigbts reserved.ri.shuffliriggaJ.scien)sis. Both-pupils 'accommodate but do not constrict with direct light . orhlt . (:8. dog 62 .sl'ibstaht1a nIgra neurons 12. C. ~4(h{!.l..andal:i!io):'fb}'l il1l<. helper cellcount. muscles.with motor changes.cpUi1t of SO.are normal. A.mA! los~'. Toxo is found in 'cat litter and in.(. 15. Note the Argyll-Roberrson E. Ii likeJyhas .c1osely x¢lafedto ..nSW'~: A... E.b. post-po!iomyeliti:Ssyndr6m€ Answer: D--this Is due to defiCiency of dopamiiie in.lin. Allth¢dth¢rdisorciets chatacterit¢CP.r ~:tQO()QCU!. than Pseudomonas qemgin. atherosclerotic stroke putt: m(lti:Jr stroke ParJcinStJil'Sdisease D.cioesalong.p tefiddn 'teflex~s in the .:ex-awning fQ(. The patient . Answer: E.rnost .) 2002 iL A 62-year4>Id man eernplainsof'weakness in his leftartn..undercooked meat.c~nsiuL' deVelops' focal f\Bjl¢PP9(>cizor:es.Qld \VCim~ states thilt she burns h~r hands without fe~li):1g 4fl:y pam.. Meningitis in a newborn. .rubber footwear Malignant otitis externa in adiabe:ti¢ Patient C.I\>vims A.. Osteomyelitis from. 16. a positive VORL spirochetes xanthochromia Answer: C.Il: hasbr(Ja~Fbase4ataxj!l'.C:'" tQxQplasmosis j~.cn4 of toxoplasmosis n. encapsulated yeast with narrow-based buds B. Youwould e~pect the spina! fluid to exhibit. follQwing 18mbte often a$sQCiat{::Qwith '£s.(Js(ll A. B.tQe 1m. The patienf'Sclinicalfindmgsmostciosely relate to •.herkhia coli.:ano tremor in his hands that prevents him frpmwr:iting leg~bly. tJ.ofpainand temperaturesel1llation in jhe loWer extremities.puncturewounds through. ~.reUdomona. He has a. M. A atljyotropruc lateral sclerosis B.e:Apyillg l~sip:u jtt the.cytOi'Iiegg. (Edward F. the lQW C. . with grQup.of t1fe.ace pc. brain wAJDS.hand. Physical exam reveals deereasedpain 'and temperature seasationin the upper extremities.B :e. . ugataoti:at)1lte Me.ALS 'has no sensory changes.syringomyelia B.:~Jh:e . cryptococcosis 14. Bndeficieney A. TM pathogenesis Ihis-patient's eNS disorder ".en~~s th:l. spii1alc()rdhnrtor E.

s~.lucose and protein B CSF. au insulin dependent. there are fawn cdlored -oval .RupM~~£a ~9j)g¢tiitaliID(lwysm C.the-patient has wltlpeetebtalrnt1connycosis 40. IIlstolpgiC exam . a mi.gluco~e An autopsy perii!tm'¢tt pfia i9"yt'-(lld mail fi. E~ .Protein A (.!:I in acar'a:~¢Qen~. heart ~swer" C~the pa.iith an arterial Meed D.hilS skm:tlni'!irig.ll1ematoma 21.. B. finding:ip 1hls 'p..wl\ot:!it.swer:D. theol'spbstic nevussyruirome .ssiQnmy'inMica D.few 01 the: t'ami):v members. E.diabetic E.the man .. spi. She-died 3 days.attetit7 A ~$wer: B. Skull.ClSF protem is elevated and glucose is low. Ar. skull meture with a.. a cave explorer C.!l!lIDa}l. YoU wotilde~p¢ct wIDchofthe followittggroups !if spmlllfluid reiiml:sin tl!ispa'tien:t? J'{()te.te:v¢als .ti~nthad an ~piduta.lues.ti'n la.iUltiple.ofa cengenital aneurySm Skull fracture with an arterialbleed Skull fracture with a venous bleed 63 . a'pig'fatmcr'who ate tawvac(}l1 Aii.iesions rrotedas wdl . Based (iutl1. a. B. l'jgmenl~d lwlypo1il J¢~oP:S.froetute v.igriQf\ll$ muldple sehorrneiG. Which of the folloWing best explains the autapsyfinding in this patient? A. . V'erto11SleeCl b Cerebral Ischemia with neuronal degeneration B. D.scnilfaetenzedby D. non-septate hyphae .' A lYHIJ¢Ph()l~C. 'bud. A tub~QP~sc~~tQsl$ B.qrph()]pGY the p.xillary fr¢pkling and t:i.. 18.n\lm~Qus wide-angled.later in the hospital. Eni. A l'atientas w-el1asother members ofhts.itspotSc. cpidw-a.dditiotJ. .B:.~th9Eien.]sPaoe overlyingthe left . :md h l7. between the dura and atachnoidmembri'il1eS.e l1)..{~grj.dUJ1GUlaied.full. family . Cerebral ischemia with neuronal degeneration Ruptnre. the of patient. ed :rqUare n~l y".mtl t:ipma28"yr-old with AIDS llasnumerous'yeastformswiih a narrow bas. E. At autopsy. agy. C. C.ilisfll fi()milie left.oleerateses ril'!w~.thepatienchas czyptococcus. hat raecoon mos({uito AnSW(lfl E~ th¢ Pliti<ltttb.tb~~~ th<e InqlU$fO!I j$ ~ ...~SFl{. A.haga large clot in the.' <iclU1tb9iii$'t).mest. D' CSF.el':E=.itUe ]iatientha~ iie(lfQfibtQ'i~lI~tQs:is withn~ut()tib'!)ma$@die:af~..ctt1tic frohtallobe abscess.dclot' overlying the right hemisphere was noted.A ..hemisphere. have hW'ertension and sellsotmelttltl h¢ilring loss~Thi~ pati¢ntmostlikel:yhas. a large bl6o.. Wbich <ilf the following is the most common mechanism responsible for the autopsy 1Q. llkelY was. . elderly patient ina nursery home fell and hit her head.~. A Z?~F'''<.brQ~tQ):>j$: Afisw.

At~lJtop~y> a large blood clot w.' C¢l'¢1tt'llJj$~hettria wi:thnlOltU'onaidege. thedura.:ftQm.roke. 26.netll. Which of the fdl1owmg'hcstdescribe. the ar-aclmoiCi' and dura disease experrenced a severeosoipital headaclreand died. incidental: finding noted at.eti hyp.cO!1getlitalaneurysm .Ill'pti.Araphnoidgral1uJ~tio)ls Answ~rt:E-thepatient had a meningioma.ero~l¢. in this.and trecrotfc mass that traversed fuecorpu$calloSUrtl and. the.e !If!!!! of the})utamenandalobus pallldus.. R.. Ati¢:ti<lv:tmo):~s'i11:l1rormat1lin D. Embolism:ITom the left heart E.(Jll. At i(utoj?sy.plastiG process involving. P. man with !adult poi~cystickidney' ble. A 5~~rr· autopsy performed on a 45-yr-cOld woman was .l(9pSY tttidifig In thi.malformation D.35~yr+91til11lij1With. ErnhPlisro . E. associated with wmch one ofthe following clinical conditions? A. to.. Micfi)g)jal ce.A:ti~:uti.tioJ) B.(}~nQ~¢li illtb. Embolism ftomthe 1eftheart .(jt:E-t1)~l'l!iientl1~dA.!tpatie)it? a. :13.a hal'<\.ooyhe~ o B~ Malignant neoplasm derived fromasttocytes C.panent'l fot A.ed. ¥lb. Astrocytes B. tumor.mmoma bodies arepresent in the J).uptureof'acongenltal aneurysm C.iPM'::f'i:uqmgf'rQ1l1.a sp}>dural hel1Ill'tl>ma with rupture of the bridging' veinabetween . astrocytes Answer: A.Mt)Y'GPntt. :B. 25. QligQdcndiQqytes Al).hemcrrhage from rupture ofcongenitalberqr aneurysm 24. MUltiple scler()si$ D.olc¢ A.the p~tiertr 1.tesPQI1~J.¢< jp. Inqace(ehra} htlUJ.Ue.1'3:$ a glioblastoma Inllitiforme.e leftlleart E. Benign:neoplasilt det\lvec. Uncal herniation C. Alzh¢i!n~J':'¢ the li'l:ttheart pati¢nt h<\d.s".fr9mil.E. 'poIYCOrll shaped Ies.lpn attached.hyper.hypm¢llsive 23. Athctowl(.g~:atPet(j${il¢fQOlis C.disease E.1frortl.$tJ.subarachnoid. . RtIDtureof:a .papilledema implies an increase in intracranial pressure.most likely be. Hgo4endI.WlIich of the fo11owing best explains the roecbanism{ot:tb:e (J). Gl~ucoma B.sthe pathOgimesisof this.itiating.. An.. fh~a"tQpay finding.. the·' s!lJ""fu~~ oi!tlie brain was pov:eted byplood.ic:lJ·Qf tbi.l:b..Totij. ml.IQ1Uadu¢tQ.'!t'evealed abemorthagict .. invclved 'both 'sides of the brain.l1s E.eIi'ensIDi).WNph P{fhe· (QllQwfng is themosl oft¢:t). Ependymalceils Unilateral papilledema would. Itimpfngea on thece.ll. 64 .MCprimary orain tumQr'ifiadlllts.::smellitusdi¢<l. .a.Ero'boUsroitoro An~Wet~ 22~ I}. It is a commoncause offocalnewonset seizures.': following' best describes the' derivation· ofthisb't~in: lesi<)'n? A.mmor in adults. Hypernatremia Answer: B.sev:eteiftQhtal h¢adaphe. s1. Neo.j]. Arteriovenous . whiph is the mest cOttm1Pl1benign primary brain .evefe d. D. Psa.rebml ¢ottexbutdid not invade brain ti$$.!:en$ion..:iibeti.nsw¢:t. c. A $8"Yt~Qld ··~with s. pa:tlet1t's brain 1esloti? A.

B.Whichorthe A.D .p~ineangle . Lacunar infarction D. Horizontal nystagmus is present in the right eye. 'systei. Subarachnoid hemorrhage Answer: B-thepatient bad an atherosclerotic. Which of t~e fdUoWIng patliqlogic processes best explains-the pathogenesis of this patient'sclinicalfirrdings in the past and present? Answer~ B.E. Right middle eat infeeticn B.the virus-itself is responsible fpnhe cancer. Inerease inprion-related cenlral:i]:ervQus.lIizes to the woman comphiinsofrecurrentepisodes. and contralateral hemiparesis' and sensory loss'. Increased endolymph in the inner ear p. otrln:gin..bouts o. OIJpAysicale. Braintumorin theGerebellopo. the. Increase in Epstein-Barrvirusinfections B. B.fhe patient has Guillain-Barre disease." He now present's with a su44en onset of expressive aphasia. Increase-in human irnmunodencienqyvltUs UUe. Definitive host 65 . Demyelinating disease iuvolving'fne acoustic nerve Answ. Her husband has a habitof eating raw bacon. a 25cyear"Old man develops weakness in·lhe lower legs that is progressing into his upper torso. b32-Yeat-01d.ctiortS C. Atherosckrotlp disease C.tates? A. and 2:0~30 lympbQoyt. behind the ear drum.l1. Intermediate host Intermediate host Intermediate-host C. an autoirrunlmedisease::with destruction pfmyel!ll in .· Which the foIl owing best. All rights reserved. Goljan. 2?. a normal glucose. . th~ Weber test lateti. stroke preceded hyamaurosis 31.. pathogenesis of this patient's disorder? A. 2~. Increase in radiation therapy oIrrletaswtic cancers fu the brain following categories of disease Pest explains theolinical and laboratory findings-in tnjs. ear 'atip the 'RiPbc test demonstrates that .ssof'/isiort desctibedas a "curtain suddenly going down and then coming (EdW:<udl".ksagp.for her disease? Husband Pig Wife (patient) Definitive host A.1ilateral10. explains patient has Meniere's disease with sensorineural hearing loss 30. and the patient regarding the pathogen responsible. 27. N\l'oplasticdisease E Infectious disease Answer: C-.husband. A feww~. of 1\.illl'llJSe d D. Which of the followingapplies to the pig.the peti'pheralnervolis sy:. Definitive host Intermediate host Definitive host Intermediate host B. A spinaltaprePQtt indicates increased pmtein. Demyelinating disease D. a:negativegram stain.t¢in . patient? Inborn error ofmetabelism .a 65-year:-c. Tbetympank membrane has a normal light reflex. Tumor of the acoustic nerve C.Note: This material is copyrighted.f'tiiZzfness where "the room seems to spin around".g in thengbJeat@mg WlJh \l'sepse offulin¢ss. Increase in slow virus diseases in i:n:u:nunodeficientpa:tients . .<pefieM¢s . CI'scansof the brain on admission and after 24 hours reveal noevidence of hemorrhage. which is embolization ofatheromatous debris from plaque most commonly located 'at the bifurcation of thecarotid artery A 45-yr-old wife of a pig fanner develops focal new 'Onset epileptic seizures. Erri'P·!ilisrn Atherosclerosis C.)1002 primary central Which of the following clinical scenarios correla:tesJ>estwith the rapid 'increase in nervous system malignant lymphomas in the Unite'd :i. An MlUof her brain reveals multiplenalcified cysts'.Id:Pl1!lJpresented with a painless w.air conduction is longer thanboneconduction in both ears. Jntracerebralbleed E. Orreweek after arrupperrespiratory infection. fugax. She 'Oc()a:s:lon:ally ~. M.

Bat:teria.!.s C. Muscle fasciculationsare noted in the right.<D:a l!tia(:I'¢.drilll:Sl]llWe ellJ!.t'$hUS.t A" R Virtr.t's ptevi(jUs '~lQu diso):"der .(lles of both hands. A normotensive 19~yeat"'-(}1U man With .atea.N!R( Which of the f"oIJowmg pathologic rprooesses best explains the pathogenesis of the patient's neurological findings? A. E-the patienthas LYme'S djse. . Fungus Protozoan. CD4 l'helpercoUllt 15 SO cellslpL . the pediatrician suspects .1. His. PIlij:~J:l. left'risis.the WQt:lUitl tlt~y !ie:yelQped .ijsh deYl.dilatation (jf Ihe th:itd¥enJ.1ations B. J. wj[eis thetintezmcdiate host) Inthe GI tract which.. Bl)uelia b1.I.ticle and lateral ventricles.Note: This materialis. He also notes "twitching" in the muscles of his legs and back . negative.Ri¢kettsia.. TheBabinskiaigrt is. which oftbeJiil1owing eyes. o]'ders M MRL The .) D.fectiotl'Sag¢pJ Fungus.~e~t()ij$'i. Ina few days following removal 6fthe tick.JI'Qllsiblefor this patient'a centri!l n~oiJS$Ys~m subtypesotmicrobiai pathogens!'! !. Spirochete Answer. the right greater than the left and ilbsent deep tendon reflexes the upper extremity and left leg. Itshouldbe.tl1.Retinal exam 'exnibits cottott 'l>'\{661 exudates in both belongs to.ticesweaket. both eyes.iSe with bilaWal Bell's.act.disseminated to thed:mi:in. fos~lltt1etshould bettie!!.anobstmctlve hydrocephalus.Plm.I\ls~d. Sensory funCtiotl is iuJ.tliat sathe .l1u:.and le:ft.lkefsyndtQme.1. A 28-year-"OldlllaJ. AmQld-Cbiarisyndtome D.oh smallerthan those .Qgressive increaseinhead circumference. that is:tes.l1eutoll1~cal fipilings 1:iel(mgs to A. All rights reserved. E. C.l1I:1g in his ability to. following is the-most fikely cause of the patlent'sc:ondition? A.lePtm. Definitive host Intermediate host I11term~dj".hy4roi.d grll't1l. A 4o-YJ""pld man 'lto. '. copyrighted.lTgdorfeci is. Triplet repeat disorder B.forearm. Physica.ttuctiQt1 9nh¢'at1lcI. gl. }l:elmiJ)fh E. open jars withllls right hand. presents: with a sudden onsetof' drooping and rlr()()lipg'out of boUt &~de}.with the muscles on ±he.W' have sf@H1c:mt:'Visual'loss in. Be wbich(lfthe Vtfu. a spirochete transmitted by an Ixodes tick The skin Iesionwas erytl1l':ltIa c):rrOn1PUtnilUgran. Qbs. (Edward F. Goljan"MD. 33. The pati¢!. . 20M. U._palzy .$e Q\'Jtheyes~ :. E. it concentric:.Ithe aqueduct of S:ylviUs Dan:dy.mtt) 'larvae (cysticerci.the patient has ¢ysti9¢i:'~pSis. The:itifectiQus'i1geb. His wife states that a fewweeks agohe removed a ttckfrom hisrigbtthigh. 'who llv:esmthe Northeast.(intennediateihost). IF that does riot work. Intermediatehosr Definitivehost. Which of'the.. A 2-morith-old infimtnas':apt.pafhegens? C_ D.{)nthe right. Sporozoan Answer: A~ ±he-patient has: CMVretiI1itis. Th<:. Tuberous sclerosis Answer: 34.1d eprrc::nt . E.ttbatis te~poPliible fo[ sLqq~d$p~h. Adults that laid :eggs developed in.teated With gancldbw.wapilify 1Q 91Q. inequality in the sizeoi' his calf and thigh tp.solium :in the <meat . The eggsW:t<it tt@.mqi. Degeneration of anterior hom cells D.) .and an.@~tted tl. . t}ljgh.iisQ):"il(.l exam reveals atrophyofthein\riirsic 1.u5ckS. Demyelinatingdisease C.te b'!)$t Int!<ID1e4iat¢h!lst Answer:B. the fanner (defiriitive 'host). Obstrustion o. 35.s following subtypes of mforobial.)!)~edpt)tkwitlt latYa of Taenia . Metabolic disorder involvingeopper in 66 . left cl))f.AJI)S lsoegjnnmg .m~p¢dii:i.

Goljan.rightsreserved. (Edward F.this is classic amyotrophiclateral sclerosis (ALS) 67 . M.tn2002 E. All.Note: This materialis copyrighted. Degenerative changes in the cervicalspinal cord Answer: C.

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