6.

A 30-year-old woman with Marfan syndrome is brought to the emergency department 30 minutes after the onset of tearing chest pain. An echocardiogram obtained 1
year ago showed the aortic root to be 5.5 cm (N«4.0). She stopped faking her prescribed propranolol 1 year ago because of fatigue. Her pulse is 120/min, and blood pressure
is 80/40 mm Hg. Physical examination shows jugular venous distention 6 cm above the stemal angle that does not decrease with inspiration. The point of maximum impulse is
not palpable, and the heart sounds cannot be distinguished. Which of the following sets of findings is most likely on cardiac catheterization of this patient?
Right Atrial Pulmonary Capillary Pulmonary Diastolic SyBtemic VaBcular
Cardiac Index Pressure Wedge PreBBure Aterial Pressure ReBistance
(Mmin/mg ( m Hg) ( m Hg) ( m Hg) (dyn • ^c 9
(N=2.5-4.2) (N=0-8) (N=5-16) (N=12—30) {N=770-1500)
A) 2.0 2 5 6 600
B) 2.0 5 15 15 1200
- C) 2.0 18 18 20 2000
D) 4.0 2 5 6 600
E) 4.0 5 15 15 1200
F) 4.0 18 18 20 2000
27. A 70-year-old man develops a prDgressive disinhibition synd rome characterized
by episodes Df emotional outbursts, inappropriate use Df language, and 5DCiaIIy
inappropriate behavior. Which Df the following labeled structures is most likely
damaged?

L R

A) B) C) D) E) F) G) H) 1) J)
38. A 10-year-old girl has a slightly painful 2-mm subcutaneous nodule on her chin. Ten weeks ago. she required sutures afler
she lacerated her chin playing basketball. A photomicrograph of tissue obtained on biopsy of lhe nodule is shown.
Which of lhe following best describes the pathologic features?
A) Amyloid
B) Granulalion tissue
C) Granuloma
D) Lymphocytic infiltrate
E) Neutrophilic infiltrate
48. A 45-year-old man comes to the physician because of gradually worsening heartburn over the past 3 monlhs.
Physical examination is unremarkable. Endoscopic examination of his stomach shows a thickened. modular mucosa
with no discrete ulcerations. A representative Steiner silver—stained gastric biopsy (400x) is shown. The abnormality
shown is most commonly associated wilh the development of which of the following diseases?
A) Autoimmune gastritis
B) Celiac disease
C) Crohn disease
D) Giardiasis
E) Peptic ulcer disease
F) Reflux esophagitis
50. A sexually active 20-year-old woman has had painful, erythematous, vesicular lesions on the vulva for 2 days. Examination by speculum also shows lesions in the vaginal
vault and on the cervix. A photomicrograph of a scraping of the base of an unroofed vesicle is shown. Which of the following is the most likely diagnosis?
A) Candidal vaginitis
B) Condylomata acuminata
C) Genital herpes
D) Syphilis
E) Trichomonas vagina/is vaginitis
9. A 30-year-old woman is brought to the emergency department because of a 6-hour history of nausea and vomiting. She has had type 1 diabetes mellitus for the past 10 years.
She is confused and sleepy. Pulse is 130/min, respirations are 30/min, and blood pressure is 80/60 mm Hg. Laboratory studies show:
Serum
Na * 134 mEq/L
K• 6.2 mEq/L
HCO t— 7 mEq/L
Glucose 900
mg/dL Urea nitrogen {BUN)
40 mg/dL
Arterial blood
pH 7.14
23 mm Hg

Urine output is scant and urine is dark. She is given insulin and an infusion of isotonic saline. Which of the following changes in laboratory findings are most likely 4 hours aRer the
administration of insulin and saline?
Serum Arterial Blood
K* HCOt- BUN pH Peak
A)
B)
C)
D)
- E)
F)