“2 15 a “8 a ne 6 20 '.27-yeac-old woman comesto the emergency department because of icity walking, Her temperatures 3.2°C (38 9°) and blood pressure is 12/68 mm gs her pulses 73/min and regular nation to agit imbalance, her physical examination revels decreased visual actin her eft ae, andshe experiences ‘tingling sensation down her spine whan he physician apples pressure tothe top of herhead, The patient's FLAIR is shown nthe image. lumbar punctures performed, Which ofthe foling lumbar puncture results would offer the trngestcanfimaton of her cease? A. Leukocytosis with high protein and low glucose 8B, Leukocytosis with oligclonal banding of gamma globulins . PCR postnity fran enveloped, double-stranded linear DNAvitus D. Xanthochromia5 ‘18. year-old college student presents for evaluation of persstenty enlarged nontender supractvicular mph nodes. she says shes otherwise healthy and provides no significant mesial istry. he ie expatianing night sete anda had 3 45-g (0b) weigh nes evertn past? months Tree supraclavicular Iymoh nodes arepalpable above her right clavicle No other lymphadenopathy Is noted, Anca ofthe chest reveals mediastinal lymphadenopathy Results of ‘lymph nade biopsy are shown inthe image. i ith eet et aga a © & Button i © oteag et hame =" © rtm ae © D. Hodgkin lymphoma = 6 & tameoote pcs ona van‘A.60,year-old man presets to hs primary care physician, reporting hotness ofbraath and a cough wih copious sputum producion. He has @50-pac.year history of ogarte smokng, Pryscal examination reveals a arel-shapod chest. chest xray shows an increased anforopostror ameter ha ftlenes chaphragm. is S8ea-010 le, who's nonsmoker, aso has Culmonsry sympoms sd presents win proxresive shoriness of breath and an accompanying nonproducive cough On physical xarinaton, increased convoy i nled inher fngemals. End-expraory craciles ar appreciated on auscutabon of the lungs at biaeral bases A CT sean ofthe chest ovens ‘honeyeembng: che ings Wich of he folowing lung velume changes would most kay be present in both of thas patients. onpuimansry function tasting? © A, Decreased functional residual capacity Decreased total lungcapaclty © ©. Decreased vital capacity © D. Increase functional residual apacity ©. creased ial volume F Incteneed vita capacity“2 2 “15 “7 8 8 om _Afall71-year-ld female presents tothe emergoncy department with fatigue, dizziness, and palplatlons. The patient used to eat regularly, but her daughter reports that since her mether vas widowed 5 months ago, she frequently skips meals now that she ies lone, When she does eat her mealsconsis of smal quantities of coe, ice crackers, and jelly. blood craw reveals he following results: Receazs0!% Het 209 00 NCU 0598, This patient mos likely hasa defect in whieh process? © A. Glutathione synthesis Heme synthesis .lsameietion ofmethymalonyl Can © B, One-cahon unit transfers © E. synthesis ofBlobin chains © F. Synthesis of spctinacin oskletonne “15 “7 “20 A year-old man presents to the clinic with complaints of severe headaches which began 3 weeks ago. He describes the headaches as ocuring primal onthe Fight side of hie ese, concentrate aroun hievight eye and right temple Patient mentions that during these epzodes his ight ae turns ean hie greet ‘rope, He reports that he headaches tend to cur vile he isasleep and wake hi repeatedly in the cary moring, They last anywhere fom 20minutes to 2 hours. The patient ie fesrfl that he might have a ran tumor. Results of ophthalmologic examination, including funcoscopy, te normal Whatis the best not step in management ofthis patients condition? © A Computed tomography scan ofthe brain ectroencephalography © ©. Lumbar puncture © D. Nonsteroidal antntammatory agent © E. Verapari“0 0 “10 a 2 5 “7 8 n 0 “a “10 on 2 “14 15 16 “7 8 “20 _AT:.yea-olé woman isbraught tothe emergency department (ED by her daughter ater developing weaknessin her let leg and afc walking, Thee hours prior to admission, the patient went to get the mal and sudden elt that she could net support her weight. The patient has medical history significant for ‘hypertension, whichis currently tested with hyérochlorethiazide(HCTZ), She has smoked 1.5 packs of cigarettes dal forthe past 25 yeas, n neurologic ‘eramination, the patients let and orient but doesnot sam ta emember why she sin the ED, Cranial nerve examination is unremarkable, Motor ‘examination reveals 2/5 stengtvn the left lag and 5/5 stengthin the ight eg, right arm and et arm. Reflexes are 2+ throughout. sensory examinatlon snot performed. Infarction of which ofthe following labeled artriesie mot key the cause ofthe patient's symptoms?40. year-old woman pesants to the emergency department ina confused state, with fever and jaundiced eyes Laboratory tests show: Total bilan: 3.8 mg. Diet ieabinc0.2maia. Hematocit:28% Lpk:6s0 ut Pr:iasee Pr a2sec ‘A peripheral blood smear isshown, Which ofthe folowing laboratory abnormalities wouldalso be expected in this patient? © -. Deceased blood wrearitogen evel Teerese RnoEN © 6, Decreased potassium evel © . Elevated bicarbonate eel © E. Elevate creatinine level0 “10 “yn “0 “0 “10 8 “0 “2 “4 6 “16 9 “a ‘14-year-old hoy i brought to the emergency department ater is parents notice a yellow dlcolraton of his eyes, They say that her son racenty had a case cof md eit, which the family treated with lover antibiotic. Laboratory studies show. Hemoglobin 13 git Hematocit:22% Platelet count: 250,000/mm wc count: 700/m Reticulcyte count: 28% Indic lrubin: 26 mgd Results of Coombstest are negative Peripheral blood smear with staining’ shown below. Which ofthe folowing the most key cause ofthis patient's anemia? > A. Aplastic anemia Autoimmune hemolytic anemia . Glucose & phoepnts cenycragenaeeceiianey D. Hereditary spheroytoss > E, Sie cal iaase5 _A6S.year-cld woman comes othe physician because ofa 2-monthhiscry of cough severe lt ded shoulder pa, an hoarseness. Howe the patlent is rmastconcenned abut the areop cher ete, wich developed duingthe pat few vce. The patient worked ae. teacher betore eirng lst yar Shehae = never smoked and ernks an occasional las of wine at dinner On ocular examination her ight pupil stage than her left ACT stanof the chest reveals a 3m a edulis ncn ung. Complete ood count an elactotyes are within narra init “6 : Which ofthe followings the mest iksly type and location ofthis patents tumor? rs © A. Adenocarcinomalocated in the apexo! the left ung “10 Adenocarcinoma located in the apexo height ang on © . Small cll carcinomloctedin the apexof left, a © D, Squamous cell carcinam leatedn the apexofthe right ing va . Squamous cll carcinomsloctedin the hilum of thee ung “5 “16 on“2 “3 18 28 v2 _AGT-yea-old mans brought othe clinicby his children. They ae concemed because he has been passing siiicant amount of biood nis urine forthe past ‘several days. The patient eluctantto vst physician, tating that he does not feel any pain Hi chien repor that ther father had been an agrcularal ‘worker ther native Eyptbefore immigrating to the United Statos a ew years ago, Hehas aways been a heavy smoker. Findings on physical examination ate normal, Urinalysis reveals hematuria with numerous epithet cals parhighpovsred fil Ultrasound ofthe bladder showsan regulary shapaci mass above the tigone ofthe bladder and several regions of focal cacication inthe bladder wal. Infoction ith which of the following organisms is most kay ta have contbutelto the patient's condition? © A. Dracunculus medinenss © B. Necatoramercanus © . Schistosoma haematobium . Schistosoma mansoni ,Tosnis lim0 “10 ” “10 w a “0 “8 a“ 36 “8 “9 om ‘28-year-old woman comes to the emergency department because of 2.ueelchistory of progressive shortness of breath, fatigue, and cough productive ot foulsmelingyelow sputum, Hermadical history ssinficant foreplepsy since childhood he stopped taking her oxcarbazepie ast month because she has nathad assure formany yee. She ceived thainfuengs vaccine and nas had a sickcontace She nse een inthe emergency dapsrimant’2 weeks ago fora ‘suspected syacopal episode Hr family history is lnticant fora mather with lung cancer anda father with achalas, she has a2 pack-yar smoklnghisory ans drinks ene pass wine every evening. Shes saualy active with her long erm boytend, anathey ues candome consistent. On avslustion tats, her temperatures 100.5 (°C), blood pressures 110/80 Hi, ple 1 98/min, SpO2 Is 2% on room ar; her heights 70 cm an weight 8k, Bl is 20. he hastisehesling uleerson the rigntsice of har tongue, Pulnsanary examination dielaee rakes and dulines to parcutsion inthe rigntowerlung ied Laboratory studies show a leukocyte count af 15000/mn, hemoglobin of 12 gl, and platelet count of 200,000/m?. Serum creatinine concentration i088 ‘me/dl and electolytes are norma. Chest ray is show below. The patients started on the appropriate eatment ‘The patent ska developing his contion was Increased by which ofthe folowing factors? A Excessive aleohalintake 8. Famiyhistoryoflunglisease . immunodeficiency Impaired glttic closure E.Impaiment of mucociary clearance by igarete exposure F, Reflux of stomach contentsSCE) 5 _xtall27-yeaold man comes tothe emergency department because of intense chest pin thatbegan approslmately 1 hour earlier and has now radiated tos back. The patient, io is thin but athletics fearful and reports he's“neverhad anything wrong with ny health before” On pysical examination, hischest resembles the one shown nthe photograph. An xray of chest shows mediastinal widening, Helsimmediatly rushed tothe eperating room, “10 10 10 “10 0 “2 OS Which pathology af the peat vessels most ly predispose the patent to this emergent presentation? ve [A atheroscecass 6 1. cyte medial necress “7 6. Disruption ofthe vasa vasorum 6 2 ©. Granulomatous vascuits , Segmsntalintammatory neerois v25 AGA. year-old man presents this primary care physician for aroutine physical. Me smokes hala pack of egarettes dally. He was dagnosed with hypertension 20 "yee ag0 and has heen extremely noncompliantin aking hi day meclestion He pa sugieal history is notable for femal popliteal bypass an hievihtower fam ry : Temi mrt oom nnd antigen : © A Nistor ats +10 _Angiotensin-converting enzyme inhibitor = © D. Surgical management = ete: otAL.nekeold male neonate inthe neonatal intensive care unithas multiple medical problems. He was born at 30 weeks’ gestation by vaglnal dalvery and weigh 1 kg (221b), Hes receiving mecharical ventilation and continuous nasogastric formula feeds. On physical examination, this neonates lethargic andhas vyllonngof the skin inthe face, upper extremitles, and trunk, Resplatlons areSoymin and pulse oximetry is 36% on 2Loxgen. Laboratory studles showa total Dini ave of mg. Which ofthe follngis most ikely to consbute to thenonate's isk developing lng term sequelae caused by blubin neurotic? © (Increased blrvbin-lbumin ining afinity Increase bilubin- binding capacty © ©. Increased enterohepatic culation of iri © . Increased serum albumin concentration Increased solubility of otal serum bilirubinne “15 “7 “20 830. year-old female brought to the emergency department (ED) after neighbors sa her collapse on he front wn. Blood presureinthe ED 108/54 mm Hg, ule is 105), and hercigen saturation 9%, Onpysical eat, cha patient auskensto pnfl sim Bowe sounds are present anther ie modest ‘Abdominal tenderness to palpation, The remainder ofthe exam isunvemarkabl, nial laboratory analysis revealsthe following: Nos do méa/L Ke:s6meqit crs meq. Hoy: 15 megit ‘rts blood gas p72 Poo 30mm Fg Wich ofthe following is most ely to explain these labortory abnormalities? © A Balin Diabetic hetoacidosis © 6. Diaraatitinese © D, Fuosemideuse © E. Heroin overdose5 ‘A 22.year-ld woman presantstothelocal primary care cnc with symptoms of et sided back pain and hematuria On questioning, the patent denies having ny previous episodes Harfanily history i sigaficen fortype2 diabetes melt is her father She also reports thaehe hae been fling fevereh forthe past - day, Her temperature is 101°F (38°C), pulse is 102/min, blood pressure is 110/80 me Hg, and respiratory rate is 24/min, Her oxygen saturation is 98% on room ca sit Physical examination reveals a young woman in distress, and her abdominal examination ie significant for costovertebral angle tendemess. Findings on 5 ceamination ofthe patent’ jas and sin areca, Uaioe: 6 “” Colo Yellow a opener: Coody = specter. 1010 a pers nat Protein: 2+ “0 Gua: Negative a stabi: 2 - ite negative vetones0 ny Blood: 3+ 7 Urbinege: 02 =p Leos esterase Negathe i squamous ep None ” Hyaline casts: 1 0 actin Present oo noc: 50 fec:so+ ” “10 ‘Complete blood count is significant for a white blood cell (WEC} count of 15,000 cells/mm?. Urine culture is significant for swarming colonies when plated on 8 ae “2 oe ‘Which of the allowing isthe most ely underlying cous othe paints sgt? 4 7 © Ammonium magnesiom phosphate tne) “16 Cakium raat tonal) a Calum phosphate stones) a © D. Cystine stone(s) “9 © E, Uilcacdstone(s) “2“7 ‘A2.year-olé boy isbrought to the emergency department ED) by ambulance ater an episode of sezure-he act. His mother says herson developed a fever of = 108° (40°) earlier that afternoon Ae hous later, he had an episode of "whole-body shaking” that lasted min, where helosteonsciousness.Herecovered withing minstes. when examined nthe ED, ital signs reveal tachycacdla and a temperature of 2; te childs alert an iteractve, Results of neurologic ied ‘examination ae normal, no focal deficits, no puchal igi. Blood work performed in route tothe shows the folowing “20 n Sodium: 140 méq/L 2 Potassium 4.1 meg/L Fy Chloride: 62 meqiL ay Bcorbonate:24 neq : Glucose: 75 mei oe hich ofthefollouing isthe mast appropriate net stp? 2 = © A Acetamlnophen andveassurance an Begin anticonvulsant therapy “2 © ©: tnate apd coating el © D. Obiainanelectroencephalogram ae £. Obtain neuroimagingscaneuv 'A28-year-old woman comes to ho rary care pyscian for nest physical examination sino she was in Nighsehool. Sho has Nt Nad route modal br ‘examinations because se lacked heath surance. She fs curenty sexuslyectve with her husband ofS year. Sho hed mulpe soxusl partners while Ror 208, when she was teed wo fr cama. The pation denies using tobaco, econo, oF Mic tugs. He Pent ual yes ee gua, and ste Nas never Deen et pregnant Mia! nstoreunremarcabl, Her teriperatura e 86°F (27) bl pressure ie 1770 thm Ha, Pues eB, eeprtory rte ie 18min Physical a ‘xamnaton snermal& Pap ts pcormed ano wooks ltr, resus show evdence of severe dysplasia Wh Lnserented neoplas cls spanning more 2 ‘than tet of he apthoium 2 ‘Wtich ofthe folowing bos descibes ho pathogoness ofthis patent's resus? “5 a [Decreased transcription of p21 "7 3. Decreased ubiquinationof p53 “25 . Hypophosphoriation of retinoblastoma protein “29 © D. Inhibition of signal transduction aa . Repaicaf DNA “2 3 35‘ayeacolé boys brought tothe emergency department because ofa persistent non-prodictive cough aushertness of breath durngthe pas ay. Hstather aye that he noticed the ayinptome ar the child returned home fram playset, Pat mesial history isnat signin. Teonperature ie 372°C (98. blond Pressure 36/60 mm Hg, pulse is82/min, and respiratory rates 3/min.Thepatent has no sweling nhs thot,no palpable lymph nodes, and has had no sick contacts He stead with an albuterol inhalerin th emergency department, but hic symptoms donot improve Lung auscultation reveals the riateral finding heard inthe audio clip, > 005/005 ———e 4) Which ofthe foining isthe mest sly location ofthe pathology causing this childs symptom? A. Leftlowerbronehue Leftmain bronchus . Rightlower bronchus © D. Right mainstem bronchus Tracheauv ‘Some undifrentisted neoplastic cells resemble their embryonic enunterpats and may elaborate proteins normally expressed only in embryonic or eta if eT Tartiateresitant ciel phosphatase (TREP) sauce protein, “20 hich ofthe fellowing describes te sigs and symptoms ofthe malignancy that would be most kel to produce TRAP? 2 © A, Easy bruisingand recurrent infections Enlarging moles © ©. Focal weakness . Jaundice “m > Pencittin tools"16 uv 19 +20 2 a 5 a 28 N66. year-old man presets this genera practitioner complaining of new-onse shortness of breath that bgan the previous week. The palent has a 40-pack esr histry of smoking, bute quit morethan 10 years ago. He eports having had watery dares, without bleed or mucus, forthelaet € maths. Hsia signs Include: heart rate, 92; blood pressure 128/76 mm Hg respiratory rate, 20, ‘On physical examination, the patent’ face fs fushed, and his abdomen snontenderto palpation Theresa haloystol murmur on the let stemaborder atthe eurthintercastal space, wich has nat been previously documented, Stool is guaiac negative, The neuotransita that involved in producing this patent’ cisease is decreased in which ofthe following? © A. Alaheimer disease © B. Depression . Huntington disease b. Picksicnase ©. Schizophrenia” ‘60-year-old man comesto the physician because ofa persistent headache that has worsned over the past sveral months. He ls also experiencing worsening eT rete dysfunction, Ha mentions that he feel “clam” attmes He alsa aye that ha epestedy cles ita doar famies bacnuss he cannat sant ofthe comes of his ees. This asl to frequent fal, including one while crying groceries, which edt a pelvic ature, Prsicat examination dscloses dfs in ‘hislateral priphara vision bilaterally ii ‘What additonal symptomis thepatient mos ley to report? e © A, Dropping things wth hisright hand “5 Gynecomastia © - Inability to raise the ight comer of his mouth when siting © D. Paint allowing Urinary incontinence5 28 “a _AGT-yea-old man ith a history of milé hypertension collapses while walking ois car. When hesrives at the emergency department hes pale cod, and ‘sphoretic. On physical examination he stachycardic and hypotensive and his ECG shout ST-segment stevatione in the inferior and lateral leads, Hes treated with oxigen, aspirin and nitogycerin ands sentor let heart catheterization. The following day hes found to have low urine output, blood urea nitrogen evel of 25 mga, and retinineleveloF.2mgid (elevated rom baseline of mg/l his blood pressures 85/55 mm Hg Mis FENa cat, Urinals reveal fe Inalinecast, hat the most kal etclogy ofthis patent’ igi? © A. Acute tubular necrosis © B. Intersiatnephitis © €. Physiologiestress induced oliguria . Renal hypopertton Ueto oberwetionuv _A44. year-old. Caucasian woman presets tothe emergency department with yellow skin discoloration. She eportsthatshehas had cay-colored stols forthe Th astweek. She also reports right upper quadrant pain Physical examination revels jaundice, itricsleae, and right upper quadrant pain Urinalysis reveals Inereasd bilrubin levels and a decreased urobinogen level “20 Significant laboratory test results include the following: os Total btrubin:4.3 mei zs Diet iubln 27 mera 2 _Alalie phosphatase: 750 UL 3a ‘nine aminotransferase: 25 = Aspartate aminotransferase: 52 U/L oe ‘hich ofthe following conditions is mestlhyrespansiblefor this patient's presentation? 2 =i [A Reuter hepatitis “a 1. Galstones = © 6. Gilbert syndrome sat © D. Hematyticanesnia ae ©. Pancreaticcancer"16 on “20 _An&-month old bay isbroughtint the emergency department by his mather de to lethargy, poo: feeding, and abdominal sweling, The mother natsthat his symptoms have become progsesivly morse over the past.2 months, She alsa stats that delivery wasful erm without any complications Review f symptoms as negative, Physical examination reveals growth retardation, hpatosplenomegaly, an jouncice. CBC findings ince the following: Hematocrit: 27% Platelet count: 250,000)? Leukoeytes:,200/mm Bleeding time: normal nena Retleuocyte count 10% ‘Thepyscian orders hemoglobin (Hb) electrophoresis, which shows marked elevation of HDF, ereased HDA, and absence of HD ‘hich ofthe follouing disgnosesis most consistent with this patent's findings? © A. Glucose « phosphate dehycrogenase deficiency 1B HbH disease ©. RBC eataininghb Bate © , aThalassemia minor ©. BeThalassenia major © F. @thalassamia minor126, _A65. year-old man comes for evaluation because of month istry of chronic cough and initation inisthroat His medical history significant for ‘hypertension, andhe has 220-pack year smokinghistoy. As pat af his werkeuptransbronchalbopsys performed. photomicrograph fom a biopsy specimen is shown below. ‘hich ofthefolloing terms best describes thefrdings shown in the photomicrograph? A. Anaplasia sa 8 Dysplasia a ©. Hyperplasia © D. Netapasia © E. Neoplasia'A26. year-old woman comes othe emergency department because of lftlower quadrant abdominal pan and nausea. The patient has ahistory of chlamydial infection that was diagnosed and treated 2 years ago. Her ast mantrual period vas 20 days ago A quantitative serum f-human charinic gonadotropin evelis 200 miUjmL Transvaginal ultrasound shows na signs fable intraterine pregnancy Findings at which ste ie mostly responsible fr the patient symptoms? © . Fallopian tube © D. ovary . Utenis+26 79 20 a “2 Folloningthe vagina delivery of full term baby gr, the newborn noted tobe hypotensive. Immediately Intravenous fui are administered. Her24 year old Primigravda metherveperts that she received regular prenatal care and was net advised ef any complications with her pregnancy. Fllowing adequate fid resuscitation, a basicmetabolicpanel ana sarum steroid levels ordered an the results area allows: No: 127 mEq/L K:SSmegit crss2meg. Hoos: 18méqi _r-ydrexyprogesterone: Markey elevated ‘Which ofthe following i consistent with this patient's most ial clagnosis? © A, Sa Reductase defcency ‘Ambiguous geitlia with an enlarged tri and partly fused labioscrotal folds {. Chromosome analysis shots 947,04 aryabype . Evidence of ovarian dysgenesis on radiographic examination ©. Presence of testlelar tissue on biopsy of gonads‘A28.year-old womnancomes to her primary cre physician because ffl sallowing solids and liquids forthe past s months and regurgitation of her meas ‘Asa el, he has reduced the amount she est nd epart weight les of 209.07 kg since the nso symptoms. The patent concerned because she feelsthat har symptoms have been getting worse, especially during the past months, She denies a prior istry of heartbum ater meals and doesnot smoke or {rink sleohal. On evaluation today, the patient appears thin, ther physical examination otherwise unremarkable and she is eting comfortably, Laboratory studies show no abormaltes, A barium swallow study istered and shows lation and tapering ofthe esophagus anc concentic distal tenoss, Which ofthe fotnsngcrug mechanisms of action mos likely improve the patients symptoms? © A. Blackingsynthess of pyrimidine thymidine Decreasing calcium availabilty in smooth muscle cells . Decreasing proton secretion nt the stomachumen '. Enhancing the phosphorylation of myesinlight chains © &, Generation f freeradicals © F nibiting the degradation of actychotine19 20 19-year-old hoy is brought this family physician because of eeent onset of behavioral issues. The patent's mother states that he hasbeen doing poory in school ihereas ayearagehevisepertorming st thatop ot his lee. adiion, she stats tate seems ta be acting aut, walkingin “opsies manner? and ‘making strange Urstng movements wth his arms, Further questioning revels tha the patlnt hasbeen passing dark rine forthe past 6 months. Iti tysical examination revels a palpable ver2cmbelow the costal margin. In addition, tare eighty of his upper extremities and bicep reflexes. Laboratory testing shows Alkaline phosphatase: 22 U/L ‘Alanine arnatransfeaee: 400 UL Aspartate aminotransferase: 450 U/L ‘Albumin: 2.1 mei Results of it lamp examination are shown nthe image e as Which ofthe followings the mest appropriate restment fortis boy's underlying condition? > A. Deleroxamine Dimercaprat . Ehyleneclaminstetacatc aia . Peniellamine . succimer126 87. yea-olé woman comes or evaluation because of a5.4-4g 121) weight loss during the past2 months. She states that she has lost thls weight despite no ‘changesin her det oc acthity level She has also been experiencing progressively worsering dl, constant abdominal pan, erty stity, and nausez.On a ‘examination she has areguar estate and ryt, lungs are claro auscultation bletrally, and her abdomen tender nd pondlstended. Har examination = is otablefora palpable periumbilcal node and ie supraclavicular adept “29 20 ee ‘hich ofthe folowing the mest ly gnossr 12 = © A Aenocorcinoms ofthe ing, +3 'B. Adenocarcinoma ofthestomech +35 © 6 Ductal exctnomainsit ofthe breast = © . Esophageatcarcnoma 2 .Krshenbergti = ©. rutenbergtumor +0 “2126 AA7-yearold boys brought tothe neurologist by his mother who has been concerned about past months, Laboratory vals areas follows: increase clumsiness nd unsteadiness whe walling forthe n = Naci36 meq 20 keaemeqlL a G:100meqyt “2 BUN: 12mgid crormlal Glucose: 84 mgia Hemoglobin: 18.9 g/L Hematocit 55% SS “ 35 = What chromosomes implicated in thichid'sdeeaee? 38 : [A Chromasome 32 a0 B. Chuomosome 17 “a ©. Chwomosome 22 a ©. ctvomoseme2 “ Chromosomes ve/Ags.year-le man presents to his physician with complaints of recent worsening back pain, jaundice, fever night sweats, and anorela He also reports strange pain and swllingin his arms and lege that ast for 2-2 day ina single spot, which diappears and then aries in anew spot a few days tater, Henasa pack year smoking history and inks 2-2 alcoholic beverages per wesk: Physical examination reveals marked tendemessin the superficial veins of the rghtieg with exthema and sweling, Imaging tudes reveal a metastatic tumor. hich ofthe oiing ie most ikely contributing ta this patien' presentation? ADH © © Erythropoietin © D, Parathyroid hormone-eated peptide Tissue factor126 _A30. year-old woman with aistory of psorass comes to her prima care physkian because ofiregula menstrual perlods. she reports previously having normal periods since er menarche at age 14 years. However, er last five periods have been iregular,n terms of duration and the amounts of menstrual ‘loos, During this time, she eporsfeaing-vary ho, passingloase stoos and having trouble sleeping. She denies recent travel. Her bloodpressure 240/90 mm Hg, pul 196/min and respiratory ates 14min. On psical examination, anterior bulging ofthe eyes and non-itng edema of the lower actrees “79 notes. x ee 7 = = oe a ras i Tosa ee 1 3 Tine ome 7 a eal ae ai a of hng [he = ~ + fs fes | Seems 7 a eon SS a :|A3k.yearold woman gives birth toa baby with ambiguous genial. The baby is admitted to the neonatal intensive care unit for hypotension Chromosomal nati raya that the baby's karyotype is 4,0 Examination ofthe babys genital significant fr labial fusion an ctra engement. There ace no ther abnormalities on physical examination. The baby exhibits poor feeding and persistent hypotension despite multiple treatment measures The Infant’ laboratory values areshown below: Nat: 120 mEq/L K:semtait pr 730 Which ofthe fotowingenaymess most ely deficient this infant? 118 Hydrolase Tatydioase © 2bHydronfase © D. serReductse . Cholestaroldesmmlace‘A72.year-olé woman has a-onth history of ef sided jaw pain when chewing food, as well asheadache, fever, and fatigue. Sheba never experienced this 38 problem before and has na sgnfcant medicslhstry except fr obesity, high cholesterol controlled ith statin an ahystrectomy more than 20 year go 6 Physical examination reveals diminished peripheral pulses. On fundoscopic exam, a swollen pale optic disci noted Laboratory tests reveal an clevated 7 stents semantation at (ES) 38 2 ‘What would be sen ona biopsy specimen of one ofherafietedavtaris? 0 J © A Opstic media necrosis “a © B. Eosinophilic initstion 8 " A . Granulomatous inflammation 5 1. Nycoticancurysme “6 £, Necrotiinggrnulorsstousintlammstion 8 8 +0 +51_A3. year-old gis rought tothe pecatican by her mother because ofa 7-day history of fever The mather thought It wasa simple vial infection but became 35 ‘Worried when thefeverdidrt resolve with acetaminophen, The mother states that her daughter doesnot have any significant madical history and ha shown 36 ‘normal evelopment during regular axams with the pedlarcan. On physical examination, the patents foun to be febite with injected conjunctiva, om edematous hands and fee, cracked and swolen lips, and desquamation of theskin on her fingertips. +38 39 ‘What complication fsmost kel tobe seen in thisinaidua? “0 “a A. peut verte nat 18 Corny sneer a 6. Dilated cardiomyopathy “5 © B. Idiopathic pulmonary hemonthage “46 ©, Renal fale a “0 +2 v8‘A 16 year-ld gi comes te her dermatologist witha kin sion on her forearm chown in the image. She has had numsérous skin lesions similar to thisore ‘removed sins childhood, While inte office, herdermstologet performs brie physical examination tht, inaction tothe sn fining, evesle an unetandy 6 titandsigns of eumbnessin the etremities 6 hich ofthe altowings most ikely tobe found in this patient? [A BRCA mutation 8, DNA mismatch pair . Defective nonhomalogau ed joining “50 +s . Detective nucleotide excision eps “2 p53 mutation v3‘2.2. year-eld woman (gravida pa 1) presents to her physclan with an unintentional weight lass of 15 ever the past 2 months he reports that her appetite has increased, and she hashad to change shits mare often because f frequent perspiration. Physical amination reveals a plvic mass thatis tender topalpation. On further workup, the masssresected and sen or pathologie examination. The specimen fshown in theimage. Which ofthefellowing isthe mos likely diagnosis? © immature teratoma 4 Krukenberg tumor “55 © ©. Ovation cheracarinoma © B, Strumacveri >, Thecom-fbxoma_A3S.year-old man presets with a2-month history of ronbloody, nonmucoid, nonolly watery dlarhea. He statathat the symptomscame on grauallyand a sesociatd nth fer, uehing, ana heavy esting tought te night, He ae alec had an unintentional weight lef spout 10 [Ha ha a temperature of 1004°F (980°C BPs 110/85 mm He, HRs 10, and RRs 1. On physical examination, Neappears pale snd has a holsystole mucur thats loudest at the eft ewer stemal border His fceis warm and appears tobe engorged with biod for several minutes uring the examination His laboratory tues show the alin Yanitlyimandetc ai: mgjday (normal 0-7 mgiéay) _Metanephrine, urine: 250 g/restnine normal 0-200) Homovanilie cd rine: 14 mgday ocmel 0-15 gay) '5 Hi: 28 mg/day (normal 0-8 mgiday) Dctreotie scanoing|s done to localize the primary tumor and any metastatic seas. ‘hich ofthe following ithe mos ike location ofthe primary tumor? > A. Frstpotion of ducdenum £8. Gastroesophageal junction .lsceeel junction © b. Pancreas © E, Splenic texure_AO7 year-old woman vstsher doctor because of fatigue and weightloss. The result of ec acct blood tests pose, and she underges a colonoscopy, ‘which reveals a massin the le sig>oidal colon Subsequentimaging reveals metastazes to har ive. Inthe discussion of treatment options, te physician ‘explain that one possible approach so administra nfson of 2 monoclonal antibody. The manoclonal antody is directed against cellular factor thats also involved in wet agereltes macular degeneration (AMD) and can beused asa treatment fr tis ey condition. ich ofthefolloing this antibody most kel directed against? A. Epicermal growth factor 1. Intetkin- (iL) C-Inesteukin-6 (6) © D. Tumor necrosisfator-a(TNF-a) © €. vascular endothelial growth actorSed ‘An year-old gis brought to the emergency departmentin acute respiratory dress after paying soccer ouside Inthe cold. On examination, she has tachypnea with intereestal trations, har chests hyperresonant to percussion, and epiatory wheezes are heard on auscultation Pulmonary function tests reveal decreased FEvy/FV ati, Shes gen a By agonist van ina, which dramatiealy edes her symptoms, a8 Which ofthe oiowing would ane expect io seein this patients ungs? 6 © A Abnormally elated bronchi with macus nd neutrophils a Difse pulmonary bolas prefration © G. Dilated air spaces wth acolo wall destretion ©. Intra alveolar hyaline membrane composed of rin and celular debris vs ©, Mucod exudateformings cst ofthe airways5 A 12:yeac-old rl who recently emrated rom Nigel presents to th rotheris unaware f anyother significant mesial rani histo. unremarkable, The mass biopsied and results are shown, ince with a G-month history af ntermittant fever fatigue, and eight sweats. Her adoptive large, entender mass on nerrightrsanile, but physics exami ctherwine “48 pens ett tor Prox Be Bae “) fe4 = Adult al ymphoma sa = Cervical adenocarcinema 8 . Hepatocellular carcinoma Nasopharyngeal arcinomasae ‘24 yoar-olf woman comes to emergency department due tothe sudden ost ook sided ches pain and shores afbrtn. Sno has no personal or tamily “5 history of medical nesses and ies trauma before the onset ofher pan. However she has emaked 1 5 packs of cosets pe dy for the pas years On =) ‘examination, sho ta thin woman in moderate respiratory dstess Blood pressures 120175 mm Fp, puso Is 9Smin, and espa at 1s 28min. On ‘examination, she winces when asked ake a deep breath. Auscutaton ofthe ngs reveals decreased brea sounds ver thet ung elds. Theres ro jugular venous dstnsion X:ayof ie chest shown. +e Wich ofthe folowing edatona physical cng i most key f be present? +6 st [A Bronchial breath sounds 3. Hypertesonance an percussion a .Incrasastactie emus on . Symmetrical expansion of chest wall “a Tracheal deviation away fom the affected lung+92 “3 846. year-old multiparous woman presents oa physian wth constant and steady rant upper quadrant (RUQ) pl, along with nauseaand vomiting that ‘began hours ago. Vital ign show her temparaturef90.0°F (272°C), bloodpressure 120/78 mm, heat rate is 10, espirtory rate f220, 2nd funcional ‘oxygen saturation s 98% on room ai Physical examination reveas an obese woman in moderate dscomfor. Plpation inthe RUQelitsinspratory ares. Laboratory tat how the fllating: ‘Wc count: 24500/mm" njhnbeye sedimentation at: nh Serum amyéase eve: 70 U/L Livertunction testing shows the fllowing: AST:201UL Ai301ujL ‘Allie phosphatase: 69 U/L Total rabine mys. Direct irubin: 04 mera hich ofthefellouing isthe most kel undetying etiology of the patent's symptoms? © A. Infection ofthe biliary tact {Inflammation of the glbiadder . lnflsmmtion ofthe panes '. Obstruction of the ampulla of Vater © &. Dbstructionofthe common bile duct ©. Obstzuction witha bilirubin stone3 _Asa.yearle woman cams othe emargency lepariment because ofright upper quant pain forthe past a hows tinal started a an interment sharp palin after eating breakfast but has become constant pain with adiaton to the shoulder She denies faves, cils, nausea, vomiting, ches pain, oF shortness of ieath Heronly medica history inlades to uncomplicated vaginal bres; she takes na mesiations. Her bleod preeeure is 120/80 mii, pul |s92)min respatory rates 14min, temperatures 3C(99.°F), and Bal is 32, Physical examination reveals yellow slerae and right upper quadrant and pipet tenderness without rebound or guaring, There ino abcorinal pin with inspiration. Recut of completablaed count are within norma ints Complete metabolic pane shows: Alina phosphatase: s70U)L ‘Arie aminotransferase: 42 UL ‘aspartate aminotanefarsees24 UL Total protein: 73 g/L Total iirabins3.2 mga Direct irbin:2.8 magi. ‘Asyiase: 28 U/L Lipase: 40 UL ‘Which ofthe following best explains the patient's condition? {A Infectionof common tile duct 8 lnlammation of gallbladder © Inflammation fiver © Inflammation of pancreas > , Obstucion of common bla duct F. Obstruction of etic ductsae _A61- year-old man vss the emergency department 1 hour following the onset of severe chest pain, Fast medical history's significant for hypertension and type 6 2 diabetes melitus, for which he teas hydrechlorthazde,benazerl metformin and gia. En out tothe hospital paramedics denser sublingual “6 ritrogtycerin ith no imorovementin the patents symptoms. Vitslsreva empertur of 37.0 (98.7), pulse of min, respiratory rte of 26min, blood 7 pressure of 154/162 mm Hg and angen saturation o 97s, On physisl examination the medica ntem notes 8 nocmalSy snd, without murmurs gallops. ae The examination i signicantfr asymmetric pulsesin the patient's upper extremities. pulmonary examination evel lear ung elds biateally without theese. Astat ECGs obtained (se bel). 8 bie 7 +50 HEE fear Ed a ees 3 2 ate = Peete bisects: SEE PESSE Sree Peee terre PeteRre hetero Siete ch otholonnlsthe mst Inmettenmnoncas oferty dacs eterno? ags “7 © A, Acute myocarcialnfrtion 58 Aneurysm formation a © ©. Aattic insufficiency “0 va © D. Aretha “a Pericardial tamponade51 +2 2 152 2 8 53 83 56 a +8 “0 ‘6-year. man who works in healthcare presentsto hi physclan with vague abdominal lsomfoct nd fatigue, physical examination reve lives, palpable to Gem Belew the costal margin and seeslictenus. He des nat rake cigarettes, anal consumes two baste per nigh forthe paet 0 yess Laboratory tender Aspartate aminotransferase 200 UL laine aminotranefrace of 450 U/L Total serum bilirubin 28 mga. Direc train 22 mera um altalin phosphatase Normal ACT scanof the abdomen sshown in theimage. Cchoracarcnama Colorectal carcinoma Melanoma 9. Neuroblastoma Prostate carcinoma‘A60-year-ld woman is eferred tan oncologist because of painless lumps in multiple areas of her body. She reports that these lumps have become ager and smaller size during the pass yeas, On pysical examination, peripheral adenopathy isnot inthe caval, sila, inguinal and femoral regions. Ar biopsy and cytogenetic studies, shes clagnosed with leur cal ymphoma, Genetic analysis shows. (448) translocation, hich ef the oliwingie the neal function ofthe protsin preci by the involeioeu on ehvamosonve 18? © A Gallular adhesion B. Immunereguaton > ¢. IntititionoF apoptosis © D. Inhibition of signal transduction ©. Positive regulation of signal transductionwae 26-year-old man presentsto the clnicbecause he s new to town and hopes to establish care in thecnicfor the ist time He complains of occasional 6 hemoptysis, exertional djepnea, and chrenie cough tats productive of purulent sputurs. Sine chichae, the patiant has had rcurtntinfseone nd vine 7 iagnosed witha chvoniclinessasa child, He hasbeen hospitalized several tines nthe past for “breathing problems He denies hering los, posnasal dip, hematuria but reports he anal hi wife haus heen unable to conceive, stooge examination ofthe lunge reveal abnormal altel bench flleduith mucus and neutrophils. Laboratory test show total fecal fat content of 3 i (normal: 6 gi). 0 Which ofthe olioningis the most key pathophysiology ofthis patent's condition? I © A. cotedetect 3 © Defective ion chant 6. bynein arm defect ©, Hereditary apolipoprotein 6-100 deficiency vor E. Lack f reduced nicotinamide adanine dinucleotide phasphate oxidasewae Hepatis 8 surface antigen (sg isa mark of hepatitis B ral infection. HBsAg appears in thepalent'sblood afta exposure tothe virus. In most patients who a ‘recover fromthe ves, Hs gradually decreases until itbecomnes undetectable 4 month ate. During the period known asthe "window period" which ofthe fllowing vial and immunologic markersconslillbe detected? © A. Hepatitis 8 core antibody epats 8 core antigen EI © . Hepatitis # antigen 3 1. Hepaitis8sufaceantibody . Hepatitis 8 surface antigen“52 _A7.yeald boy s brought to his pecatician wth a 3.eck Nistor of fever and weakness. The boy's mother points outa new rash constng of on blanchable reddish purple dot on his amis an leg. The padtrician orders laboratory tests anda psrphral bloc mea, hich reveal the fllowing: Hemoglobin 72 g/d Leukocytes: 6100)rum? Pate: ¢9,000/mex? hich ofthe foing conditions is most closely associated with this patent's probable eiagnorie? © A. Down syndrome © B. Epstein-Barinfection © Hvinfection © D. Immune thrombocytopenic purpura © Tuer syndrome‘18-year-old man presents with week history of fever, wakes, an fatigue Physical examination shows pale conunctiae and petechiae spread dfusely across hs trunk. ches xrays shawn. A biopey eveale cells with ight blue, cant, and nongranular cytoplasm when stained Results ofhis CRC areas follows: Hemoglobin: 7 gt Hematocit:21% Retcuocyte count: 0.195 (normal 58-1555) Plate count: 0,000/mm® ae ee Monocytes: 6% . Which ofthe fotowingis the most key diagnosis? A Bal acute ymphoblasticlymphoms Chronic ymphacyticleukemia .Foticularlymohom . Hodgkin disease . T-call acute lymphoblastic lymphomaoss _A2S.year-olé woman vstsher primary care physician after leaming about an extensive history of colon cancer nha aly. Her masher unde, and ster have al ‘nadcolon cance. Hersiser also had endomtal cancer anda tumor ofthe small intestine. The patent particularly concerned because several years go, her sister developed colon cancer after having colonoscopy. The colonoscopy demonstated few lt polyps in her cecum cei ‘Which ofthe following syndromes would mostly explain thispatien' family ister? 2 © A. Familia adenomatous polyposis “60 © B. Gardner syndrome a © © Lynch syndrome ©. Peutz-eghers syndrome , Turetyndrome_A62. year-old man igadmittad othe hospital fora workup following -month story of fatigue and problems with balance. Hesays that when he ges up in themidcleethe night to goto the bethroom, heeftn stumbles end bumpsints th wal Phyiesl examination reveal an unstesdy gat anletcuty termining ubich to a vibrating tuning forks placed on, Ankle jrkreflres are decreased bilaterally Laboratory tests show: Hematoert: 20% ‘Wecs:ri09jmm Platelets: 240,000} ean corpuscular volume: 123 um’ Peripheral blood smearis shown. Which ofthe folowing the most key cause ofthis patient's low hematocrit level? > A. Anemia of chronic disease 2. Autoimmune hemolytic anemia © €, Folate decency © D. Hereditary spherocytosis © Eon deticlengy anemia © F. Permiciousanemia3 ‘18-year-old college students involved n'a motor vehicle ecient and develops chest pain and shortness of breath immediately aterward Paramedics assess sit sign atthe scene: hear rates 120, and espiratory rate f 20, They ao notice that his breath sounds ar diminished onthe right side an that his trachea's deviated tothe et. fer ransportto the emergency department, the ptlen's mental status deterorates reply, The physician immediatly places large bre nasdleinthe second right intercostal space nthe midelaviular fine ‘hat other fading ld the physician they observe before insertion ofthe large-ore needle? > A. utinessto percussion +1 Sugar venous distention “6 © ©. metaboticallaosis © D, Mafed heart sounds © E. Putsusparedoms“9 a 02 or a 2 ‘An 18-year-old white man comes te the clinic because of bumps that are forming on hisback shoulders, and arms, Physical examination reveal dozen small, bbumpy prominences on his upper Back and shoulders. They are nontendar, ronbile, and frm tothe touch, The physician also notices unusual recting patterns in the patients ala and grin are, as wells four areas of hyperpigmentation on his upper arms and lower back, similar to those showninthe image, Which ofthe allowing abnormalities s most ely tobe found inthis patent? A. Cranial nerve Vil schnannomas B. Misproduction ofthe gene product mein . Mutation inthe tumor suppressor gene on chromoscme22 . 3. Mutation of ps2 gene on enernasom 17 Pigmented naduleson the isa ‘An 85:yearold man des of aspiration pneumonias complication of lzhelmer disease. He had hypertension, diabetes, and amyloidoss of thebidney. ‘Autopsy reveal small (230 ) heat that appears grossly dark broumin col. Hemsteayln and eosin staining of carlac muscle cells shows prominent Intracytopiasmic granules that havea bronn tinge seeimage. liver biopsy stake, and a similar staining pattern Isnoted inthe hepatocytes. The pahologst ‘determines that this phenomenon is due to age and fenot a causative agentin the patients death, hich ofthe oiwsng most ely account forthe brow pigmentationseen inthis specimen? © A. Amyod depostion Choleterot synthesis Glucose polymerization . ron ovetosd Metabolzed heme F. ote pds 6. Tyrosine oxidation‘8. year-old woman (gravid 2,98 1) presents to her gynecologist with a3-month story of ‘ague" abdominal pain wth no signtiant charge in her bowel habit She na nintentionall lst 4 kg (201) of bodyweight curing hist. She enjoys dining with her eit ha has some ity with ower abdominal pressure. On physica examination, bilateral adnexal fullness is oted.Chestxay is normal, CTscan of the abdomen shonsblateraloralan masses na stomach vallthikening. Pathologie examination of surgically excites evasion masses shows rund, mucin-sereting cells a een theimage Inadditon to pathologic amination ofthis patients ovarian masses, evidence of which ofthe following symptoms is mos likly tohelp diagnose this patient? © A, Galactontes Hematecheaia © ©. Palpablegalbladder © D, Pearly papuleson theface ©. Supractavicutarlymphadenopathy‘An unconscious 43-year-old womans brought to the emergency department by paramedics, Shes accompaniod by her daughter, who found her mothering onthe laerott ‘On physica examination the patient i confused and there isch hen Media| recor eves history of hypertension ana palyystie kidney oiaze the pia lsohas ao-pack year history of smoking, lrg. ACT seanof the headis show ich ofthe ong the most sly cause of this patiant'scurent symptoms? A. Blosiage ofa penetrating atey in theinteral eapaule B. Blockage of anenterior cerebral artery . Rupture of bridging vein between the dal and arachnoid meninges . Rupture ofa mide meningeal artery Rupture of anoutpouching ata cerebral arterial branch point70 “73 14 1 16 |A.36-yea-ois Aican-Arpercan woman prosens tothe cnc wi Tatgue, ty cough and shoes of brea othe pas 6 months. Se reports ta, in addon to constant taling trad she lea nae no enaray The patent deseenes ner sarnoss of rest a uneniting, ang raps dry cougn that persist throughout the “dy. On ave of systems se nas also had iim overs and an unntntional weight loss oF4 5 kg (10) dung the past months Physi examinaton reveals ry ales on ung suscuitstin, and theres postive cenical and airy lymphadenopathy. Xray ofthe chestis shown, ‘ich ofthe folowing cutaneous maiestations is mast key associat wth her condiion? [A Erythema nectiosum Erythema margnatum 6. Enytheme migrans 1. Exythema mutiforme . Erythema nodosum_A.22:yet-ié man proses te emergency department wth shorhessofbreah and a persistent cough tal reduces large amounts o ek, oc tnged “0 Sputum When questioned rare pric nosptal admissions, he pation sites hat he hashed several ung infctins in the past. The pint denies any history of va ‘egarato smoking. He ypicay inks one ass of wie about wc por Week He dongs ary recreational dug use. His peratures 101 °F (385°C), Dood @ pressure is 127/90 mm Hg; ear rata is 86; and esis ats 22 Pumonsry examinations ncable forbterl rales and honch on ausculston Examination re of e naes revels nasa poles. v8 6 +66 hich ofthe folowing puimonary diseases mos kay causing tis patents symptoms? a © Asha 70 1. Bronchietais 1 6. Centviacinaremphysems aa 1. Chvoniebroncits oe . Paracinar emphysema “76_A47. year-old man isbeing evaluated for ong standing int pain. He reportsthat It “changes location constanty" and malniyinvols the knees, wrists, and ankles, He teste negative for heumstoid factor, and several immunosuppressive therapies (nchatng anti-tumor necosisfactora) wee tied because seronegative iftammatoy artis was suspected, He ald not experience any improvement wth these vestments Recently, he dovelaped colicky abdominal pain assocatd with intermittent greasy, foul smeling dlanhea. He also descibedunintentonal weight oss of 121 ‘ea cover a6-month pried. The patient was referred toa gastroentrolgist, who performed an upper an lower gastrintestnal (I series ith biopsies of any “04 ‘unusual lesions. photomicrograph of jejunal biopsy specimen shown, “6 “or “8 Tl ‘hich ofthe following isthe mos kel tology ofthis patients symptoms? 7” © A. Abuse ofoverthe-counter medications 2 ‘Autoimmune response 3 > €. Brush bordarenayme deficiency - . Chron pancreatitis 6 © Infection “7 © F. Overgrowth of normal bowel oraa ‘36-year-old woman comes to he physician bacause of recent onset of chest pain and dyspnea. Six weeks erly, the patient hada myocardial infarction. Hee ‘blood pressures 122/71 mm Hgand her ples is 11/min, Cardiac auscultation heard inthe au cp provide, 70 > 001/007 ——-» 4) 2 Which ofthe fotowingisthe most key cause ofthis patent'spresontation? “18 © A. Autoimmune pericrlts e Cardi tamponade ©. Leftventriculardytunction » b. Postintretion peice “73 ©. ventiularrupeure= ‘23-year-old woman whos pregnant foc the fist tne and has had no previous prenatal care vistsa gynacolagst. She hasa youngersibingwho has 3 congenital disease and she wishes to underg prenatal testing Atrple screen reveals anc-fetoprotein level thats half ofthe normal evel 2Bhuman chovionie gonadotropin eve vice the normal level, and an esto level thats three-quarter ofthe normalevel. al From which bith defect te nay most ikely ster? ol © A Aotic conection 73 © B. Endocardial cushion defect » €. Holoproseneephaly © D, Prominent occiput © . Tuitofhaatthe small ofthe back/21-yeac.old woman comesto the einen Apl due to 32-day history of dares. The patient tates that she has dlarhea 8-10 ines a day which has seemed to-slow down frequency. The dae enon blacdy and the toot has na fou co. The patient state that herald brother had similar episodes of arrhe ‘5 days ago but they resolved spontancously, Her medica histarylsurvemathable. The patent has not taken overche-counte drugs forthe dathea and has ‘only been drinking water to stay hycrated On physical examination, her mucous membranes appear dry. There isn tenderness or stention noted on ‘examination ofthe abdomen; bowel signs are good, Laboratory tests show. Natsiz7meq/L Kt:a3 malt crsti2megh Hoy: 15 meqit ‘tata blood gason wom air pH 7.28 Poo: 23mm Hg Pop: 90 mm Hig hich ofthe fellowing mest kay caused ber acidosis? © A. Alte sage aspirin overdose 2, iabeticketoacidosis . Severe diarrhea © , Severe underpertusion afer peripheral muscles ©, uremiav4 v8 ve 4 7 78 ‘0 18-day-old female fant lth ambiguous genitals brought tothe pediatrician with history of vomiting forthe pst 24 hours and lethargy forthe past week. On pysieal exmination, theinfant vial sgne neue a ternperature of 27° (28.7) blons pressure of 9/48 hm He. and pules of 82). The Infant's anterior fontanele eels somentet depressed, and thelnfant has decreased skin turgor. Laboratory staies shou wc count: 900/mm® Hematocit45% Hemoglobin 14.8 g/L Platelet coun: 475,000/mm? Sodium: 129 meq/L Potasslum:6.1 mEq/L Chloride: ame. Carbon divides 16 méq/L flood urea nitrogen:24 mgid Creatinine: 0.3 mera Glucose: 70 mgial Itteting is continued, what other laboratory esut would be expected tobe notedin this patient” © A, Decresed plasma ein Decreased serum dehydroepandostarone © , Eleiated serum LL deorcorticosterone D. Elevated serum 17-hydronprogestrone Elevate serum cortisol9) ‘22-yeac.old woman comesto the physician reporting that lately she has et "move fatigued, especially atthe endat the day Inthe of, she as ifity ‘sing rom herenairta movete the examination tale. prysieal examination the patianthas aymetse crooping other le jai, a subjective falingot "blurred vison” when reading the aye chart onthe wall and facial droop bilaterally Aplin xy of her chest show, % a 5 118 75 leat per terete a hich ofthe fois test te mos ikl to confirm a diagnosisin thie patient? 78 o A. Complete blood cell count +0 Electromyography a . Parathyroid hormone level . Thyrotd stimulating hormone level 8 E. Voltage geted catecholamine nets +85,‘sr year-old former landscapers referred tothe dermatologist fr aeslon ons right forearm. The lesion ialsh colored, shiny lesion approximately 1.5¢m inclametecAbiopeyistaken, and the results ae shown inthe image Which ofthe fooningis the mest sly aiagnese? A Aetniketosis Basalcell carcinoma Dermatitisheretitonmis > B. Melanoms > €, Sebortheic keratosis Squamous celearcinoma9 _A38.year-olé woman presents wth dul constant right upper quadrant abdominal pain that she has had forthe past couple of months. She states thatthe pain isnt ascocated with ating. She denies fever, chill, nauses, vomiting, anorea, and weightloss Her current medications include clecoib, captopril and a = daly ora contraceptive She rinks to ortree glasses cf wine per week and as ot ecetly aveled outside the cour. Family story Isnegaive for ce ‘malignancy. On examination, theres na evidence of jundice and no ight upper quacran tenderness to palpation The liveredge fs paptec2 em below the © ‘costa magi. Liver function studies show 70 asts2uiL a A293 U/L a «cFetoprotein:8 ng/mL (normal <10 ng) 73 I Right upper quadrant ultrasound shows permal hepatic parenchyma with hypoechoic, wel.circumscried lesion theright lobe ofthe iver, appraximately 3 ‘min dmetes, 5 “70 o ‘hich ofthe following would be the most appropriate net step a this time? = © A Colonoscopy vt © B, Discontinue celecoib 2 .biscontinue oral contraceptive a . Invect hemagglutination test , Supical resection9 healthy 5-year-old woman presents to the physician with 5 year history of painless, slonty expanding sling her et check, She denies any Fever oF chil, bloody or purulent escharg, pain on eating, dry mouth or taste alterations. She has naversmoked or used chewingtabscce. Vital signs and resus of “7 Pysical mination are unremarkable excep fo afm, nontencer, wel defined mutilobularsweling nthe et cheek extending fom the2ygomaticarch to ce the ower exge of the mandible. The massie surgically exceed. Histopathologic examination ofthe mate eves a mintureof mesenchymal calls and epithe © ceils ithin a chondromypoid stoma see image, surrounded by frous capsule 70 “3 74 a 5 ve 15 - This patient's symptoms and histopathologic ndings are most consistent with which of the following conatons? 78 : [A Aled cystic carinema “0 8B. Mucoepidermeidcarcinoma a . Pleomerpic enema ce ©. Sialic duct stone 3 . Warthin tumor a8[AS yeaold lis brought tothe emergency department with acute onsto projectile vomiting nd a severe hi che, Her parents also rept that she has 5 had trouble walking ove the past couple of months. She has nt had ay fevers or nuchal gilt, Her medical history isnegative fr seizures Prysical 4 ‘examination Inatable or runcal atari ind paplledems, Magnetic resonance imaging (MR) ofthe head reveals a mass as demonstrated inthe image c hich ofthe flowing is mest key tobe seen on histologic examination of sue rom this mass? 85 A. Cale with round, regular, contralyacatad nucle surrounded by a perinuclear halo 2. Prolific vasculature and foamy cll . Roc-shaped peinuceat inclusions e . Roundesleistons 30 E. smallcellswith high ruclearto-cytplasm rato surrounding a newropl‘An 18-year-old man presentsto the emergency department witha nossbleed that stated 1 our ago. Hehas no significant medial histor but sys that his gums tendo bleed quite bitaterhebrushes his tect, Laboratory tet evel nerensd bess tine ant increase patil thromboplastin tins. Hi miter anve inthe emergency department, anduinan ates about fay history says that she hasbeen anemicin the past and always has“alot of beeding” during her menstrual period. Which ofthe fotowingisthe most key diagnosis? © A, Besmard-ouler syndrome Slaramann disease © G Hemophiiar . Vitamin kK deiency >. Von llbrand sieesserrr Af. year-old woman comes for examination bacuse of a6 month history ord, pan thy rash lth buming sensation Inher lettbest, particu “2 round the nipple ad aeola Shehas no otharsystemic symptoms. Her medical history fe sigficant for hypertension, asthma, anduntreated oid, 74 ‘noncancerous breast lamps dscovead at age 22 Results of biopsy specimen fom the patient’ nipleare shown, @ ‘hich ofthe following the most key dognosis? “8 © A. Intraductal papi Invasive lobular earcinoma > 6. Masti a © b. Pagetaisease ©. Phylades tumor2 +0 “2 8 5 “8 a “30 a 2 “ 85 “6 a 0 1 in 1-year woman who sa colege freshman comes for evaluation because of progressive hearing oss and tints, She has had increasing dificty hesrng na prfessorsin else curing the past fe months Sheuindergoes an HR fhe hee, which sehown nthe nage What other symptom does this patient most ily have on presentation? [A Abnormal Rinne test 8, Blurry cloudy vision 6. Galaterhes . News flammeus E, Plemented nodules ofthe ris2 7 78 AA3k.year-ld woman presants at 25 weeks’ gestation with severe abdominal pain and sclera iterus. Seis lethargic and unable answer simple questions Ltrasonograp reveals a blockage nthe hepatic venous connection t the infeir vena cava and the absence af any waveform inthe hepatic eins. Her ‘actated partial thromboplastin time (aPTT) is prolonged, and arevew ofher records from the lnc shows she has a postive VenerealDscase Research Laboratory UDR test rest. Which ofthe folowing risk factors present, would also predispose thepatlont to develop her curent condon? © A. choles © B. Chronic obstructive pulmonary disease © . Polyythemia vera © D, Primary ily cshosis Renal lure_A3G-year-old man presets this physiclan to dscusshislng history of Severe headaches, which start when he was2¢ years ol, The headaches occur ightly 3 ‘or several weske and usualy lst about 29 minutes, fllones by few onthe without headaches, nd then the symptoms repeat. He ann entity any 8 redpltating factors forthe headaches. He describes the pan as “oxplesive," without variatonsin seve. The pain is alayslocalzd to one side ofhisead. In 3 ‘the past he has tried over-the-counter ibuprten with msimal lief symptoms. After a thorough history and physical examination the physician instructs the I ‘patient to us an oxygen maskat the onset ofthe headaches to helo lieve the pan. 7 78 ‘Which ofthe following symptoms likely accompanies the patient's headaches? = © A Jaw pain “= 8 Lacrimation| aa 1G Nausea @ 7 ©. Photophobia 4s © E. vertigo "6 © F.Visulauras “7 “8_A36.year-old man presents tothe emergency department with a complaint of decreased ung output forthe past2 days. He repos shortness breath, swollen lage’ and nausea during the same period wth worsening of there symptoms ove the past day. The patent has no significant medical history and denies use of any medications, Hehas nokriown drug alrges Physical examination reveals tacycarda and 2+ pitting edema lateral in his ower etreites. ibastar crackles ae nated on auscultation of his lungs. Laboratory test evel significantly elevated blogs ure nitrogen and creatinine level, Utemia, and hypertatemia, The patients admitted to the hospital and hemodialysis sintiated Whilehospitalized thepatient develops hemoptysis and is agnosed wth alveolar hemorrhage. Once his condition s stabilized an ultrasound ane computed tomagrphyscen ofthe Kidney are performed without significant findings. atthe nephrologst' recommendation, a kidney biopsy performed; an immmunofluorescence pattrn shows positivity with antibody tole, shoninga smocth, us, tinearpatem that characteristic forthe deposition of glomerular basement membrane antibody. The patient begins @ combination vestment plan of plasmapheresis and immunasuppressivetherpy and is added tothe transplant it ‘hich ofthe following findings would mast key be ssen on light microscopy ofthe patients kidney biopsy specimen? [A Calla crescent formation an fbrosis |. Difuse thickening of capillaries and glomerular basement membrane , Enlarged and hypercellularglomerulwth neutrophilic introte © . Formation of hyline nodules in capillary loops © E.Hyalinetrombosis of capiary lumen with cpillary “wire looping”/A60-year-le man presents to his primary cae physician wit increased ftgue and lossf appetite or the past month. His past medical histor includes wll controlled hypertension, but the physician nates thatthe patient has loeb since his anna physical last month. On physical exam, he has nontence, enlarged lymph nodes, nd hisspleen is noticably palpable inthe eft upper quadrant. Acompleteblood count is obtained 820,00 mm Hog 2. gia et 25% Plates 105 00/mn® Neutrophils 27% Lymphocytes 396 Eosinopile 15 Basophits Monocytes: peripheral blood smear isshown inthe nage \Watis the normal function ofthe abnormal alls seenin this patient's contin? A. Humoralimmurity © B. Toccivate cytotoxic Thymphocjtes or 8 lymphocyte by costimulation . Tengu bacteria ane kl with an cate respiratory burst © , Torecognze antigens on virus-infected hostels and destroy the infected cells © E. Toserveas the primary mode of oxygen transport in the body= 'A25.year-olé woman presentsto he primary care physican fran annus physical examination. During the st she describes noticing less than a teaspoon of ‘hickuite vaginal aicharge dally. Vaginal pis 40 Sline microscopy of scant clecharge found a the external oe dentifiesepthtia cells ith scarce olymorphonucler leukocytes. a What the best clescrition ofthese clinical findings? "J © A. Bacterial vaginoss +6 © B. Gonococeal crvictis © €. Normal ©. Trichomeniasis £, Wlvovaginal canine= 'A35.year-old woman with aistory of recurtent kidney stones presents toe physician with complaints of pigat pain that wakes her from sleep but goes away aftershe eats She i alzohaving bouts faire, Physical examination reveals thatthe abdomen isnot tender, distended, or enlarged, She drinks 2-2 alcoholic beverages per week and does not smoke, Laboratory tests reveal an elevated serum gastin level of 1400 pgim(normal<100 pg/mL) a Which ofthe follouing ational findings fethis patient mos ikely ta have? "J © A. elevated Ty eels “6 © 6. Elevated serum catecholaminelevels, © ©. Elevated serum prolactin levels © . Increased serum phosphate levels|AS3.yearold man comesto the the emergency department because of “rusting” substemal chest pan. Hes dlaphoretc and has lateral ST elevations on ECS. He's ushed tothe cardiac catheterization laboratory, her wo coronary artry stent replace in the circu artery. Oual antiplatelet therapy with asptn and clopidogrel is stated Sc days ltr, when preparing fr discharge, the patient sudden experiencesintense chest pain and lightheadedness. The following vital sign ae obtained Temperature:275°¢ (905°) Pals: 125/min flood pressure: 5/201mm Hg Respiratory rate: 18/min Cnygen saturation: 97% on roam air /uscutaion of cstinct heart sounds is ficult. The patients neck veins are prominent. No other physical findings are apprecated. Ara ew minutes, the pation lose consciousness. ‘hich ofthe following isthe mos hely mechanism responsibie for thispatient's sudden symptoms? © A. interventricular septum rupture Let ventricular freesval rupture . Papitany muscle rupture © B. Reinfarction ©, Rightvenricularfreenall rupture/AT3:yearoldobese moman presents to the emergency department after 3. das of progressive stomach pan and recent bus vomiting The ptlnt admits feelingnaussste Her temparature 999° [7.2°), blo pressure ie 100/78 mm ig haart rte ie 100, ana repiratery rae 1, ‘on psi examination the patiant ae right upper quadeant tenderness incesponsete palpation. Hyparactiv igh equencybowal sound arenes inthe right toner quadrant. An ultrasound reveals gallstones without evdence of choleystisImaglng reveals multiple ai-fuid levels in the small intestine andar in their ee Which ofthe folowingisthe mest key diagnosis? © A. Calon cancer 8, Galttoneiteus © 6. Gangrenous cholecystitis © b, Gastroenteritis ©. Volulus3 ‘545. year-old man comes tohis primary care physician because fa 1-day history of severeomerbeck pain that began suddenly when te patient as aking 2 sulteaze out ofthe trunk hiecar He denies anyother trauma but admits to recent weight gain. He attributes hie weight gain to nessa flint because hefeels tke he's “pecing al the time His medical history signlican for hypertension, and he current takes hydrochlorothadde. Histermperatureis 374°C (99. bloodpressure i 264/57 mm Hg, pulses 72/min, and respiratory rateis12/min. Physical examination reveals fat accumulation being the neck and ‘point tenderness over the lower lumbar vetabrae. Stalght leg alse tst snegatve bilaterally. magingrevelsa vertebra compression fracture Which ofthe following ithe most appropriate net step inthe diagnoss of this condition? © A. Measure Hate © B. Measure free cortisol on 24hrurinayss ©. Measure evel ofitarin D 1. Measure levels of thyroid hormanes Measure urinary metaneptines= _ATD.yea-olé woman presentsto the emergency department ater having allen while walling Inher house She sholding her right thigh stating the pans 10/20 andsharp, leaving her unable to move the lego: pt pressure on it. On review o systems, the patient notes that ever the past several weeks, she hashad s shortness of breath, feelings of tharg, weakness, and ocasional bone pain. The physclan orders lab tests, which preuce the following ress: “2 Hemoglobin: 7a/a. a Hematcerit: 21% ce Retculoyte count 0.1% {normal 5-1.5%) eI Platelet count: 50,0002 +6 Leukocytes: 1.300/mm® -s7 Neutrophis: 4% _ Eosinophils 298 2 Lymphacyea: 6 Monocytes: 646 ves 24-hr Urine collection: 4gof protein (nova) s Calcium: 32.1 mg/d. “6 “9 ee ich ofthe following findings is most ely in thispatent? “1 oo [A Broken and destroyed lymphocytes 2B. Increased levels of cculating promyelocytes and myeocytes © ©. Mlcroeytosis and hypochromasia © D. Myslobasts with Auer ods ©. Rouleaurformation+86 a a “87 88 Ea 8 +0 2 “9 +5 ‘o7 +38 ‘Apreviously healthy 25 year-old man presents to his primary care physician wth severe darrhesthathasperited for 1 monthslnee his return fromatipte Central America. The iarhea has worsened since onset, and he reports seeing mucus and streaks of bleedin his stl for the pat week. The patient also complains of fave, vlght loss, and ganeralized abdominal pala that is mest cute inthe lg upper quad. He dene any history of lness. computed temograp CT ean i parormes, andthe rest re shown inthemage The causative pathogen for this patients illness can beldentiad onthe bass f which ofthe following findings? [A Gram-negative tin Multinucleated tophozotes 6. Docystsonacid fast stan . Organism growth at 42°C . Trophozoites with phagocytosed red bled callsABT. year-old man presents with a& month history of increasing weakness, gngla bleeding, and welght loss. The patent also complains that his arms. a2 legs ate easily bruisad, Physical examination reveal widespread ecciymoris, a palpable spleen tip, and anlargd iver, slong with aed andenlaged cervical, “33 ‘axa, and inguinal lymph nodes. parpherl blood smear shows increased numbersat damaged lymphocytes. CAC wth ferentiais performed, and the = results ae35 follows: “4S - Hemoglobin: 20 git Hematocrit 35% =a ‘We: 10,500/mn & Platelets: 100,004? 30 Neutrophis:20% ‘2 Lymphocytes: 70 Monocytes: 86 20 Eosinophil: 159% “9 Basophi: 0.58 +0 “2 This patient's disease proces involves clonal expansion of which ype fell 3 “94 > A. Blymphocye es © Netamyelooste +96 ©. dlasma cat I © D, Pronyelocste 9 ©. Tymphoblas.‘A St.yeacold man presentstohisntemist complaining of headaches and vision changes in the pat month, Hehas had two “near misses trac because he a2 id not 89 car coming ut ofa sce street. When asked about hie medication history, he states that he tartedtakngtadalafla few months ago for erectile “33 ‘ystunctio, buon forgets to tkelt cue to lack ofinterest. On physical examination, the patent has dificult seeing on the outer half ofeach eye's visual = field Carciovascular and respiratory examinations ae within normal iit. Laboratory tues show normal elecrljte concentrations and normal hematocit. “4S “6 Which ofthe fotowingisthe most key pathologe mechanism behind ths patients symptoms? 8 > A. Proliferation of cortcaroph cells & © B, Proliferation of gonadotoph cells, “0 a © . Praliferationoflctotogh calls ai © D, Proieaton of somatotroph calls 2 © &, Proliferation of thyrotroph cll “38 +36 37 39'.75:yeac.old man s brought ta the hospital for sudder-onset weakness, Past medical history issgnfcat for dyslipidemia, labates melitus, and Hypertension He azo haea 40 pack years smoking history. On examination hisblond pressures L0S/Ta mmHg and heat ats 90min. Thee isle-sided upper motor nauran ‘weakness affecting the upper and lowe libs. An urgent CT scan shows an amosttotaloclsion of hisright internal arti artery. ints in ich cerebral artery testy ie ly tobe atecel nce the resultant ischemia? © A The teary supplied by the anterior cerebal artery ‘The tenor supplied by the middle cerebral artery > €. The territory supplied bythe posterior cerebralartary . Tha watershed tenitary between the antaicersbral artery andthe mile cerebel atary © E. Thewatershedtertory between the middle cerebral artery andthe posterior cerebral arteryEe 2 @ 85 “7 8 2 a "0 a1 “2 2 95 “7 “6 9 +100 /A62-yeac.old woman presantsto the emergency department with a report of aificulty breathing and a productive cough with green sputum that has been {sing fora couple of months. She hasincreasing pan when she takes a deep breath Medical history isignificant fr several hspitaiationsinthe past 15 yeas fr treatment of lung infections, Soca history significant for smoking 1.5 pack of cgaetes per day forthe past 20 yrs. auscultation demonstrates inspiratory crackles anc expiratory cates ranch alateal lng fds. Digital clubbing apparent onthe patients mall beds. CT scanofthe chests, Performed (seeimage. Which ofthe oliowing would mos hel be found on microscopic examination ofthe patient's ung tissue? ssesting granulomas with central necrosis and Langhans iantlle Dilated bronchus with necotalnginammetion . Iterdihating areas of plnkand red >. Red:purple partial consolidation of parenchyma Small darkblus calls/A25.year-old man presents tothe emergency department de to abdominal psn'andsweling, He denies having bowel movement forthe past week. An “2 lbcomina CT reuesed a significant mae. Biopsy ofthe mass raveals sheet thinly mitotic, basophilic lympheeyts surounding clear zanes of macrophages. Which ofthe folowing diseases is associated with thishistologi picture? © A, Acute ymphoblasticlymphoma Burktlymphoma 3 © © Falleulaiymphoma +0 © D, Multiple myeloma . Palyeythemia vera_A33. year-old woman comes to her physician because of ftgue and joint aches, which sehas had for tepast 2 months. On physeal examination, her doctor “2 notices abnormalities in her skin sce image). Laboratory test results show elevate creatinine. Biopsy confirmsrenalcsesse a “87 8 0 “39 39 8 “9 “9 eee “2 The immunologicmechanism underying this patent's ena diseases most similorto the mechanism undetying which of the oloing conditions? aa ‘A Anophyiais zs) 2, Contact desmatiis +96 . Goodpasture sndiome “37 38 . Graves disease “39 , Palyartets nedosa (PAN)‘AS6-year-ole man srushed tothe emergency department after complaining of crushing chest pain below his sternum, He smorbidly obese, sweating profussy, teething rap, and clutching he chet ntl elctracardiogram (ECG reves ST-segment elevations nthe anterior leads. The patients stabilized and seems tobe doing nal Several hours afte intial presentation, he experiences sudden cardiac arrest nd des shorty thereafter, Which ef the aliwsingie the mostly cause a destin tie pation? © Artythmia Congestive hear faire > €. Formation of ventieular septal defect © Dy Mural thrombosis ©, Rupture ofventicularfiee wall © F. Rupture papillary muscle_A22.year-old woman presentsto the emergency department with complaints of palpitations, sweating, nd feeling too warm forthe pasta week, Shea “2 pharnaytaciniin and ftnasentusass On vi of etme she nate annttons ass of 0h. niin the et 2 month, Physieaeaminton revel ® ‘normal appearing young malo, who als seems tery ritsble and showsa sgh emo buts eterwise nox itl sinsaresiicant for ves tachycatia. sed one presentation, laboratory tents re condtd, and theplysiian ordersa adioactve ane uae (AU) et. The adologst oes s it ton uptake ofthe adlenuele throughout he thy tisue or yao inthe body. 7 Tres ~ em ce cote | EE | ect | aetie “8 * L 4 [deren = . 4 1 t » e | jae b iz ° = 1 | deme si : + vem | ot a ’ t > Joven = Using te table above whats most the ely profile ofthis patents thro hormone evel? +2 “9 “99 sa2 “8 6 +0 28 90 29 0 “9 +0 +30 93 95 96 “6 100 /h35-yeacld man wth n significant medlal history comes this primary care physclan because of 2week history of progressive shortness f breath that ‘esr with sett. He previously erin raul, and hse never ha symptoms ie this befor, Nhe ids that he can vislcony one blcklstore becoming symptomatl. He also reports hat his eas “lookandfeel a” even thaugh his let helthy. He doesnot smoke or use alcoho ori rugs, nd hasnot traveled recently. n sition, hehas no family history of cardiac disease and does not have any sickcantacts, but recalls having anupper respiratory Infection abouta month ago that improved onits own. (n evaluation today his temperatures 37°C (96.6), blood presureis 145/100 mm Hg, pulses 95/in, an respiratory rats 26min, Physical examination reveals races in his lungs bilaterally an an S2 gallop. a ay ofthe chest shown, ‘Which ofthe allowing the most kely mechenism causing hispatient’ heart flue? A. Autoimmune damage to cardiac myocytes 8. Granulomatous inlammation of cardiac myocytes . Hyperadrenergc state leadingto diated cardioeyopathy . Ischemic damage to cardiac myocytes E. Uncontrolled and prolonged elevation ofblood pressure2 3 +35 100 26-year-old arcan-Amercan man presents toa travel clnifra consultation. He explains tat hes going to Uganda as part of amevlcal mission to provide free antivialtherpy for insvguslnfectc ith HI Hae raqusting information cegarding vaccines and prophylactic treatment for infectious deeasashe may be exposed to wile hare The physiclan admins ypholé vaccine, yellow fever vaccine and gies the patent aprescrition for antimalarial ils instructing him to begin the medication several days betore hearrvesin Aca Three days ater beginning the medication the patent begins to fel excessively fatigued and natces that hisurine s much care than usual Which ofthe oltowing represents the pathophysiologic basisfrthis patient's curen condition? © A. Deficient synthesis ofa-lebinchain Increased sensitty of REC to yc activity of complement .lntrsclularsccumltionofperonides © D, Intrinsic REE membrane defect Point mutation nthe hemoglobin gene14-year-old isbrought to the physiclan by her mothe afte the gr experiences multiple episodes of severe shortness of breath during gy dass at school Her mather notes that she looks paler than uel. Theis nohistary of menarthaga.On examination, vital sigs are table. Tharsis nolymphadenopathy or hepatosplenemeealy Complete blood count shows mild anemia. Combs tes is negative; he blood smear i shown. “2 Which ofthe folowing the mest key pathogenesis ofthis gis anemia? > A. Glucase-6 phosphate dehydrogenase deficiency Mutation nthe phosphatiytinostlglycosyltansferase gene +96 © mutation inthe spctin gene ei Physical dsryption of etherwisenormal RBCS 39 © . Pointmutationsafoneafthe & lob genes39 ‘baby aif examined bythe rounding inpatient pedatriclan 2 days after ith, Thelnfant was orn toa 38 year-old mather who admits to having limited access to prenatal care. Physical evaktion of teinfant isnotabefr lw irth weight, small head sive, smallight ye, leftp and palate, ancan exe ight sided digit atthe thumb, Aholoystolic mumuris appreciated over the precortlum, and severe hypotonia Is noted. Which ofthe aliowingis the mechanism forthe disease that most ely produced these indngs? © elect degradation of branchedchain amino sels Delton ofthe short am of cvomosome S 6. itracellarlycogenaccumiation ® , Matema nondsjunction © , Microdeltion on chromosome 22 © F. Uniparenta disomyAs. year-old obese G3P3 woman comesfor evaluation because of heavy menstwal bleeding forthe pas few months. Se denies any nausea, vomiting oF pave or abdominal pan, Untilthe pat few months, she had not had a menstrual period in2 years. Onst of menses was at age 10 Mer medical history is signicant for type 2 dlabetes and hypertension, both of which are managed medial. Her family stor isunremarkable, Shehas a 15:yearsmokinghistory. ‘he occasionally drinks alcohol but doesnot aki rugs. She report havingoly ane saxal partner and denies any previous onsall transmitted iseases, ‘on evaluation today, her temperatures 37°C (98.6, blood pressure is 138/79 mm Hg, pulses 62min and espratory rates 15min, On physical examination, there is abdominal fullness; honever, the abdomen s soft and nontnde, and therels no guarding, Pelvic examination discloses mild tenderness onisetion ofthe speculum. an abnormal, watery, blood-tinged cscharge s noted inthe vaginal canal. manual palpation ofthe ovtles nox. n order to confirm the suspected diagnosis, a hysterectomy is performed. An image ofa specimen s shown. “2 Which ofthe folowing would be most associate with decreased iskfor this patent's agnosis? © A, Cessation of alot consumption Late onset of menopause © . Negative famiy history malignancy es © B, Smoking cessation +35 © Weigntone'A15.yoa-ol gil is brought oho cIniby hor meiner because of primary amenoroa. The moter stals hat ner daughter Nas sated fo Yetuse to change for gym a2 ‘ass wth the cer gts because she fos her bey does nt ook ik the other gis bodies. She repos she has been ma fun of by her classmates who say er 3 ‘iva pats ook ike @ boys. The mother admis fat tbh ner chid had cleromegay, however, inal ora est dung nancy Yeldod a testosterone evel = ‘oF 482 gid (norma 437-707 ng), an astogen val of 12 pL normal: 10-60 pgmL), anda aeeizing harman level cf IU normal 7-28 ILL) No = ‘thor esting was permed ata imo, ane child nas ben ralsed as female On physical examination a this ws, the patent appears tl and very ‘muscultydevetped fora teenage gi Her voices deeper han what would ypcaly be expected She declines 2n examination other genta stating se soo = emiarassed. Chromosomal testing is petomed, which reveals a genotype of XY “6 = ‘nich ofthe folowing orders does ts pati most kt have? “0 ae ‘A Sa-Reductase deficiency “2 © B. Complete andiogen nsensttity > €, Double syndrome 1. Female pseudohermaphroditism , Ovotestiulectonder of sacclevelopment sr ‘Placental aromatase deiiencyFacebook: https://Facebook.com/MedicalBooks VN Website: https://MedicalBooksVN.com Email: MedicalBooksVN@gmail.com.