An 18-year-old man is rushed to the emergency room in shock following a motor vehicle

accident. He is transfused with 5 U of blood. Following the transfusion the patient complains of
fever, nausea, vomiting, and chest pain. Laboratory data show elevated indirect serum bilirubin,
decreased serum haptoglobin, and a positive Coombs test. Which of the following is the most
likely diagnosis?

Select one:

1. Hemolytic transfusion reaction

A 66-year-old woman collapses while shopping and expires suddenly of cardiac arrest. Her past
medical history is significant for long-standing type 2 diabetes mellitus. Her relatives note that
she had complained of chest heaviness and shortness of breath for the past 2 weeks. Sterile
fibrinous pericarditis and pericardial effusion are observed at autopsy. What additional finding
would be expected during autopsy of this patient?

Select one:

1. Myocardial infarct

A 55-year-old man presents to establish primary care. His medical history is significant only for
40 pack years of smoking. He drinks four beers a night. He is minimally physically active. On
physical examination, the patient's blood pressure is 158/98 mm Hg, and he is moderately obese
(body mass index, 27) the rest of his examination is normal. His laboratory examination is
normal, as is his electrocardiogram. Repeated blood pressure measurements over the next
month are similar to the values first obtained. With respect to this patient's blood pressure, what
therapeutic option should be offered to this patient now?

Select one:

1. Lifestyle modifications, including decreased alcohol consumption,weight loss, smoking

cessation, and moderate exercise for 6 months

A 19-year-old African American man presents to your office with generalized fatigue and frequent
sinus infections. The patient has never seen a physician before and denies any previous history.
He is adopted and does not know anything regarding his family history. When he gets recurrent
sinus infections, he has been taken to urgent care settings, where he gets antibiotics and starts
feeling better. He is generally not active and has frequent joint pains. You get a CBC, which
shows some mild anemia with a Hgb of 9 gm/dL, and is otherwise unremarkable. Among other
testing, you get a peripheral smear which shows Howell-Jolly bodies. The most likely diagnosis
is:

Select one:

1. Sickle cell anemia

What is a major cause of abdominal aortic aneurysm?

Select one:

1. Atherosclerosis

A 45-year-old woman presents with a 4-month history of severe headaches and pain, and
blanching of the hands upon exposure to cold. She is a nonsmoker. Over the past 6 months, she
has noticed progressive difficulty in swallowing solid food. Physical examination reveals smooth
and tight skin over the face and fingers. The serologic test for anti–Scl-70 (anti topoisomerase) is
positive. Painful hands in this patient are best described using which of the following terms?

Select one:

1. Raynaud phenomenon

A 47-year-old woman presents to your office with a complaint of severe fatigue, weakness, and
dyspnea on exertion. She has had these symptoms for 2 days. The patient denies having fever,
chills, weight changes, or dysuria. Her medical history is significant for pernicious anemia and
hypothyroidism. Results of thyroid studies were within normal limits 1 week ago. Her physical
examination is positive for mild icterus and hepatosplenomegaly. CBC is normal, with the
exception of a hematocrit of 21%. Her hematocrit was 36% 3 months ago. A direct Coombs test
is positive. Which of the following statements regarding autoimmune hemolytic anemia is true?

Select one:

1. Autoimmune hemolytic anemia may be idiopathic or secondary to disorders such as systemic

lupus erythematosus, chronic lymphocytic leukemia (CLL), HIV ifection, or hepatitis C
infection
A 4-year-old boy develops severe bleeding into the knee joint. Laboratory studies show that
serum levels of factor IX are reduced, but levels of factor VIII are normal. What is the appropriate
diagnosis?

Select one:

1. Hemophilia B

What does leukocytosis mean?

Select one:

1. Number of circulating white cells may be markedly increased

A 62-year-old man is discovered to have hyperlipidemia on screening tests after a routine

physical examination. Laboratory studies show total serum cholesterol of 285 mg/dL, LDL of 215
mg/dL, HDL of 38 mg/dL, and triglycerides of 300 mg/ dL. This patient is most at risk of
developing an aneurysm in which of the following anatomic locations?

Select one:

1. Abdominal aorta

Which drugs can induce thrombocytopenia?

Select one:

1. Quinine, quinidine and vancomycin

A 23-year-old, previously healthy man of Italian origin develops moderate to severe hemolytic
anemia. The previous evening he had celebrated a Saintâ's day with a feast of beans and pasta.
Urinalysis shows free hemoglobin, and the direct Coombs test is negative. Supravital staining of
the blood smear demonstrates numerous membrane-bound inclusions (Heinz bodies) within
erythrocytes. Which of the following is the most likely diagnosis?

Select one:

1. G6PD deficiency
A 2-week-old girl is found to have a harsh murmur along the left sternal border. The parents
report that the baby gets a blueish when she cries or drinks from her bottle. Echocardiogram
reveals a congenital heart defect associated with pulmonary stenosis, ventricular septal defect,
dextroposition of the aorta, and right ventricular hypertrophy. What is the appropriate diagnosis?

Select one:

1. Tetralogy of Fallot

After undergoing surgical resection for carcinoma of the stomach, a 60-year-old male develops
numbness in his feet. On exam, he has lost proprioception in the lower extremities and has a
wide-based gait and positive Romberg sign. A peripheral blood smear shows macrocytosis and
hypersegmented polymorphonuclear leukocytes. The neurologic dysfunction is secondary to a
deficiency of which vitamin?

Select one:

1. Vitamin B12

What is a modifiable risk factors?4

Select one:

1. Hypertension and hyperlipidemia

A 55-year-old man suffers from an acute myocardial infarction after occlusion of the left anterior
descending coronary artery. The patient undergoes coronary bypass surgery 3 days later. Which
of the following is the most frequent cause of saphenous vein graft failure several years following
coronary bypass surgery?

Select one:

1. Atherosclerosis

Takayasu arteritis classically involves?

Select g one flight of stairs. Blood pressure is 145/90 mm Hg. Laboratory studies show a serum
cholesterol of 320 mg/dL. He neither smokes nor drinks. Bruits are evident upon auscultation of
both femoral arteries. The pathogenesis of intermittent claudication in this patient is most closely
associated with which of the following risk factors?

Select one:

1. Hyperlipidemia
What is most common etiology of ascending aortic aneurysm?

Select one:

1. Hypertension

Which symptoms do we have during superior vena cava syndrome?

Select one:

1. Dilation of the veins of the head, neck and cyanosis

Which type of myeloid neoplasia can you recognize?

Select one:

1. Acute myeloid leukemias, myelodysplastic syndromes and chronic myeloproliferative disorders

A 60-year-old man presents with a 3-week history of lymph node enlargement in his neck and
axillae. A CBC reveals mild anemia, with a leukocytosis of 20,000/mL. The peripheral blood
smear is shown in the image. More than 80% of WBCs are small lymphocytes, but there are also
prominent "smudge cells." Examination of a bone marrow biopsy shows nodular and interstitial
infiltrates of lymphocytes, which demonstrate clonal rearrangement of the IgG light-chain gene.
Which of the following is the appropriate diagnosis?

Select one:

1. Chronic myelogenous leukemia with lymphoid blast crisis

A 60-year-old man presents with a 6-month history of increasing fatigue. Physical examination
reveals marked pallor, and a CBC shows a macrocytic anemia. Which of the following is the most
likely cause of anemia in this patient?

Select one:

1. Alcoholis

During lymphoid neoplasms, which type of classification can you find?

Select one:

1. Precursor B-cell neoplasms (neoplasms of immature B cells); Peripheral B-cell neoplasms

(neoplasms of mature B cells); Precursor T-cell neoplasms (neoplasms of immature T cells);
Peripheral T-cell and NK-cell neoplasms (neoplasms of mature T cells and NK cells);
Hodgkin lymphoma (neoplasms of Reed-Sternberg cells and variants)

What does leukopenia mean?

Select one:

1. Number of circulating white cells may be markedly decreased

An 18-year-old man is rushed to the emergency room in shock following a motor vehicle
accident. He is transfused with 5 U of blood. Following the transfusion the patient complains of
fever, nausea, vomiting, and chest pain. Laboratory data show elevated indirect serum bilirubin,
decreased serum haptoglobin, and a positive Coombs test. Which of the following is the most
likely diagnosis?

Select one:

1. Hemolytic transfusion reaction

autoimmune hymolytic anemia