Question 1 ‘A 45-year-old woman developed dyspnea with fever over the past week. Sputum culture grows ‘Streptococcus pneumoniae and a chest radiograph shows extensive infiltrates of the right lower lobe and a nodule with air-fluid level. Her serum AST is 277 U/L and ALT 183 U/L. This is the {gross appearance of her liver. Which of the following is most likely to produce this appearance of her liver? OA) Hepatitis A infection OB) Colonic adenocarcinoma ©) Chronic alcoholism OD) Oral contraceptives QE) Alpha-t-antitrypsin deficiency‘Question 2 ‘A27-year-old man has had a chronic diarrhea with weight loss of 5 kg over the past year. On physical examination there are no abnormal findings. His d-xylose absorption is abnormally low. He has elevated anti-endomysial and anti-transglutaminase antibody titers. A jejunal biopsy is performed and shown here in the right panel (compared to the normal jejunum in the left panel). He improves with a change in diet. Which of the following is the most likely diagnosis? OA) Adenocarcinoma OB) Cholera ©) Pseudomembranous enteritis OD) Non-tropical sprue OE) WMipple disease‘Question 3 'A.36-year-old woman develops severe abdominal pain over the past 24 hours. On physical ‘examination her abdominal musculature is rigid, making palpation difficult because of severe tendemess. Laboratory studies show her serum lipase is 1165 U/L. Her total WBC count is 16,390/microliter with 86% granulocytes. The gross appearance of her disease process is shown here. Which of the following is the most probable etiology for this process? OA) Gallstones OB) Cytomegalovirus infection Occ) Adenocarcinoma ©) Diabetes meitus, type I OE) _Oystic fibrosisQuestion 4 ‘35-year-old man has had abdominal pain and tenderness for two months. On physical examination he has a fistulous tract draining onto the skin over his left lower quadrant. At laparotomy an entero-enteric fistula is found and a 30 om long segment of distal ileum is resected. The high power microscopic appearance of the resected bowel is depicted here. Dysregulation involving which of the following which of the following genes is most likely to be found in this man? OA) arc O8) oFTR Qc noveQuestion 5 ‘A.48-year-cold woman has experienced episodes of sharp abdominal pain for the past month. On. physical examination there is tendemess upon palpation of her right upper quadrant. Laparoscopic surgery is performed and the gross appearance of her disease process is depicted here. Which of the following is the most likely risk factor for her disease? A). Gilbert disease OB) Obesity 36) cytomegalovirus infection © Dd) Hemolytic anemia OE) Ulcerative colitis‘Question 6 ‘A 19-year-old man goes to hs physician for a routine check-up. The physical examination is normal ‘excep! that his stool is positive for occult blood. A colonoscopy is performed and there are over 100 lesions of the colonic mucosa and biopsy of one shows findings seen here microscopically. Which of the following is the most lkely diagnosis? CA peretheny eneectyrestsccin earctercat OB) Hyperplastc polyps Oo) Ulcerative colts OD) Ischemic colitis ©) Familial polyposis coltQuestion 7 ‘A 42-year-old man has had episodes of substernal burning pain following meals for the past 4 years. He has no nausea or vomiting. On physical examination his stool guaiac is negative. An upper GI endoscopy is performed, and there are regions of the lower esophageal mucosa 1 to 4 (om above the gastroesophageal junction that appear erythematous. The microscopic appearance of a biopsy from his lower esophagus is shown. Which of the following is the most likely diagnosis? On Oe Oo On OB Gastroesophageal reflux disease CREST syndrome Helicobacter pylon infection Chronic aleaholism Corticosteroid therapyQuestion 8 ‘41-year-old man has had epigastric pain for $ weeks. He tries over-the-counter antacid ‘medications, but the pain persists. On physical examination his stool guaiac is positive. He undergoes upper Gl endoscopy, and a lesion represented by the one seen here grossly is identified. Which ofthe following factors most likely contributed to the development of this lesion? ON ey Oo On O85 Sensitivity o gliaden protein Helicobacter pylo infection Conic alcohol abuse Ahigh fa, low fiber diet Diabetes metus, type I! romQuestion 9 ‘A 54-year-old man is being treated for a pulmonary abscess. He has received broad spectrum antibiotic therapy with nafcilin, clindamycin, and gentamicin for the past 17 days. He has. developed abdominal pain, fever, and diarrhea over the past 3 days. The gross appearance of his, colonic mucosa is seen here, Which of the following is the most likely diagnosis? OA) Uterative colitis © 8) Pseudomembranous colitis O ©) Ischemic bowel disease OD) Crohn disease O®) AmebiasisQuestion 10 ‘A24-year-old man hes experienced lower abdominal pain for the past day. When examined in the emergency room, palpation of the abdomen reveals no masses, and bowel sounds are stil present. He has pain most localized to the right lower quadrant, along with rebound tenderness. His total WBC count is elevated, with left shift. At laparoscopy the specimen shown here is obtained. Which of the following is likely to be the most prominent microscopic finding in this. specimen? OA) Granulomatous inflammation OB) Inftteatng adenocarcinoma ©) Chronic mucosal inflammation OD) Coaguiative necrosie © ©) Acute inflammation ‘VUUUTULLEEUECUEE CTU T TUE TEOE OES ETETETETTEETEEETT TTQuestion 1 ‘AS-year-old child has complained of pain in his abdominal region for the past 2 months. Physical examination reveals a palpable mass in the posterior abdomen. An abdominal GT scan shows a ‘mass involving the left kidney. A nephrectomy is performed and the specimen is shown here. Which of the following is the most likely diagnosis? on Os Oo Op) O®8) wiims tumor Urothelial carcinoma Renal call carcinoma ‘Angiomyolipoma habdomyosarcomaQuestion 2 ‘65-year-old man has had worsening renal failure for the past 10 years. He now requires. hemodialysis. An abdominal ultrasound reveals that both his kidneys are enlarged. Based upon this gross appearance of his kidneys shown here, which of the following conditions is he most. likely to have? On Os Og On O® Systemic pus erythematosus Renal cel carcinoma Urinary tract obstruction Dominant polycystic kidney disease Chronic glomerulonephritisQuestion 3 ‘A12-year-old boy has felt tied for the past 2 months. On physical examination he has periorbital ‘edema. Laboratory studies show his serum urea nitrogen is 26 mg/dL and creatinine 2.4 mg/dL. He is given a course of corticosteroid therapy but does not improve. A renal biopsy is performed, and the microscopic appearance with trichrome stain is shown here. This appearance is 3 of 10 ‘glomeruli present in the biopsy. Immunotluorescence staining is nonspecific. Which of the {ollowing renal diseases is he most likely to have? On O8 Og Op) Minimal change disease Nodular glomerulosclerosis, Aiport’s syndrome Berger's diseaseQuestion 4 ‘63-year-old man with atherosclerotic heart disease has increasing lethargy for the past 5 years. (On examination his blood pressure is 160/110 mm Hg, Laboratory studies show serum creatinine 6 mg/dL and urea nitrogen 64 mg/dL. He has the microscopic appearance in hs kidneys seen here. Which of the following findings on urinalysis is most specific for the underlying disease leading to this appearance? On OB Og Opn WC casts Uric acid erystals (CMV inclusions RBC castsQuestion 5 ‘A35-year-old man notes passing dark urine following a flu-like iliness that has lasted for 10 days. (On physical examination his blood pressure is 140/90 mm Hg. Urinalysis shows hematuria. A week later his serum creatinine is 2.9 mg/dL. A renal biopsy is performed and microscopic examination with immunofluorescence pattem with antibody against human IgA is shown here. Which of the following is the most likely diagnosis? Lupus nephritis Goodpasture syndrome Borger disease Membranoprolferative glomerulonephritis, ‘Membranous nephropathyQuestion 6 ‘61-year-old man has had dull flank pain for 2 months. On physical examination he has left ccostovertebral angle tendemess. He has plethora of his skin. Laboratory studies with urinalysis show 4+ blood. Azdominal CT scan shows hepatic vein thrombosis and liver infarction. The excised lesion from this man is shown here. Which ofthe following laboratory findings is most ikely to be related to this, finding? OA) Polycythemia 8) Hyponatremia Oc) Hyperaldosteronemia OD) tHyperpycema Of) Hyparcholestrolemia‘Question 7 ‘A 26-year-old man has the onset of nausea and lethargy over the past 3 days. On physical ‘examination his blood pressure is 145/95 mm Hg. His serum creatinine is 4.4 mg/dL. Urinalysis shows hematuria and proteinuria. He has ant-glomerular basement membrane antibody. A renal biopsy is performed and the microscopic appearance with H&E stain is shown here. Which of the following historical findings is this patient most likely to provide? OA” Os Poorly controled diabetes mellitus Pharyngitis several weeks ago 100 pack year history of smoking Rapidly progressive loss of renal function Use of NSAIDS for many yearsQuestion 8 ‘A 45-year-old woman has had a severe headache with nausea and vomiting for the past 2 days. On physical examination her blood pressure is 290/160 mm Hg. Laboratory studies show her serum creatinine is 3.7 mg/dL. The representative microscopic appearance of her kidneys is depicted here. Which of the following underlying diseases is she most likely to have? OA) Hepatitis infection OB) Breast carcinoma Oc) systemic sclerosis OD) Secondary gout OE) Diabetes metitus‘Question 9 ‘A10-yeer-old girl was brought to the family physician because of increasing lethargy for 4 days. ‘She had a sore throat 14 days prior to the office visit. On physical examination she has periorbital ‘edema, Initial laboratory studies show a serum BUN of 25 mg/dL and creatinine 2.7 mg/dL. A ‘microscopic urinalysis shows hematuria with dysmorphic RBC's. The light microscopic appearance of her renal biopsy shows hypercellularity, with PMIN's present. The electron ‘microscopic appearance is shown. Which of the following additional laboratory test findings is. ‘most likely to be present in this gir!? On Os Elevated serum glucose Antibody to double stranded DNA Elevated antistreptolysin O titer Antiglomerular basement membrane antibody Positive G3 nephritogenic factorQuestion 10 ‘A 69-year-old man has had recurrent urinary tract infections for the past 13 years, with Escherichia col, Proteus mirabilis, and Staphylococcus saprophyticus cultured on multiple ‘occasions. He now has a serum urea nitrogen of 40 mg/dL and serum creatinine of 3.9 mg/dL. A urinalysis shows no hematuria, proteinuria, or glucosuria. An intravenous pyelogram reveals that, both kidneys are involved with the condition depicted here. Which ofthe following underlying conditions is he most likely to have? OA) Diabetes melitus © 8) Prostatic hyperplasia ©.) Gouty nephropathy © D) Chronic glomerulonephritis © &) Analgesic-induced nephropathy