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A |! homeless |! man |! has |! a |! 3-month |! history |! of |! decreased |! a-peptide, |! generalized |! wasting, |! low |! grade |! fever |! , |! worsening |! cough |! productive |! of |! blood, |! mucopurulent |! sputum. |! He |! has |! a |! 3- year |! history |! of |! alcohol |! abuse. |! Xray |! films |! of |! the |! chest |! show |! consolidation |! and |! cavitary |! lesions |! in |! the |! apices |! of |! the |! lungs. |! Which |! of |! the |! following |! is |! most |! likely |! inflammatory |! and/or |! immune |! response |! in |! the |! lung? A. |! Endothelial |! cell |! proliferation, |! vascular |! budding, |! fibroblasts |! B. |! Epithelioid |! cells, |! multinucleate |! giant |! cells, |! caseation |! necrosis |! C. |! Fibroblasts, |! collagen |! deposition, |! replacement |! of |! intrinsic |! tissue D. |! Macrophages, |! lymphocytes, |! hypergammaglobulinemia |! E. |! Neutrophils, |! vascular |! congestion, |! exudate |! - |! Correct |! answer |! ✔B. |! Epithelioid |! cells, |! multinucleate |! giant |! cells, |! caseation |! necrosis 82 |! year |! old |! man |! comes |! to |! the |! physician |! for |! evaluation |! of |! chest |! pain. |! He |! lives |! with |! his |! daughters |! family. |! He |! has |! numerous |! welts |! and |! abrasions |! and |! appears |! to |! be |! malnourished. |! He |! says |! his |! diet |! is |! fine. |! Which |! of |! the |! following |! is |! the |! most |! appropriate |! next |! step |! in |! patient |! care? A. |! confront |! his |! family |! about |! the |! abuse B. |! enroll |! the |! family |! in |! family |! counseling |! C. |! notify |! social |! services |! of |! potential |! abuse D. |! place |! him |! in |! a |! nursing |! home E. |! refer |! him |! to |! a |! residential |! community |! - |! Correct |! answer |! ✔C. |! notify |! social |! services |! of |! potential |! abuse 67 |! year |! old |! woman |! has |! the |! sudden |! onset |! of |! dyspnea |! and |! chest |! pain |! and |! dies |! within |! minutes. |! Stage |! IV |! ovarian |! cancer |! was |! diagnosed |! 1 |! year |! ago, |! and |! she |! has |! been |! bedridden |! for |! 2 |! months. |! Which |! of |! the |! following |! is |! most |! likely |! to |! be |! found |! on |! autopsy?
A. |! Acute |! myocardial |! infarction |! B. |! Deep |! venous |! thrombosis |! C. |! Dissecting |! aortic |! aneurysm D. |! Renal |! papillary |! necrosis |! E. |! Rupttured |! berry |! aneurysm |! - |! Correct |! answer |! ✔B. |! Deep |! venous |! thrombosis 45 |! year |! old |! man |! has |! a |! 6-month |! history |! of |! burning |! pain |! that |! begins |! in |! the |! epigastric |! area |! and |! ascends |! into |! the |! chest. |! Episodes |! occur |! most |! frequently |! after |! large |! meals |! and |! at |! night. |! Endoscopic |! examination |! shows |! moderately |! severe |! inflammation |! in |! the |! distal |! 3cm |! of |! the |! esophagus. |! Which |! of |! the |! following |! is |! the |! most |! likely |! cause |! of |! this |! condition? A. |! Diffuse |! spasm |! of |! the |! esophageal |! musculature |! B. |! Failure |! of |! the |! lower |! sphincter |! to |! relax |! after |! a |! swallow C. |! Helicobacter |! pylori |! infection |! D. |! Hypersection |! of |! gastric |! acid E. |! Inappropriate |! relaxation |! of |! the |! lower |! esophageal |! sphincter |! - |! Correct |! answer |! ✔E. |! Inappropriate |! relaxation |! of |! the |! lower |! esophageal |! sphincter 45- |! year |! old |! woman |! has |! an |! acute |! coronary |! occlusion. |! Within |! seconds, |! the |! ischemic |! region |! shows |! mitochondrial |! swelling |! and |! depletion |! of |! glycogen |! granules. |! Which |! of |! the |! following |! metabolic |! events |! is |! most |! likely |! cause |! of |! these |! cellular |! changes? A. |! Accumulation |! of |! free |! fatty |! acids |! B. |! ATP |! depletion |! C. |! Degradation |! of |! membrane |! phospholipid |! D. |! Efflux |! of |! K+ E. |! Influx |! of |! Na+ |! - |! Correct |! answer |! ✔C. |! Degradation |! of |! membrane |! phospholipid 65-year |! old |! man |! dies |! of |! bronchopneumonia. |! He |! has |! a |! 6-year |! history |! of |! progressive |! loss |! of |! facial |! expression, |! tremors, |! rigidity, |! and |! slowing |! of |! voluntary |! movement. |! At |! autopsy, |! loss |!
I.S
J. |! Tricuspid |! insufficiency |! - |! Correct |! answer |! ✔I.S in |! gout, |! hyperuricemia |! resulting |! from |! overproduction |! of |! urate |! is |! most |! likely |! to |! result |! from |! a |! lack |! of |! feedback |! inhibition |! by |! ADP |! or |! GDP |! at |! which |! enzyme? A. |! Adenosine |! deaminase |! B. |! Dihydrofolate |! reductase C. |! Glucose |! 6-phosphate |! dehydrogenase |! D. |! Nucleotide |! phosphorylase |! E. |! Phosphoribosylprophosphate |! synthetase |! - |! Correct |! answer |! ✔E. |! Phosphoribosylprophosphate |! synthetase a |! female |! neonate |! has |! profound |! hypotonia. |! the |! only |! known |! complication |! of |! pregnancy |! was |! polyhydramnios. |! The |! mother |! has |! a |! lack |! of |! facial |! expression |! and |! weak |! muscles; |! she |! says |! she |! did |! not |! have |! any |! problems |! as |! an |! infant |! or |! child. |! Which |! of |! the |! following |! best |! explains |! the |! difference |! in |! presentations |! in |! the |! mother |! and |! child? A. |! Anticipation |! B. |! Delayed |! onset C. |! Genetic |! heterogeneity |! D. |! Incomplete |! penetrance |! E. |! Pleiotropy |! - |! Correct |! answer |! ✔A. |! Anticipation An |! alcohol-dependent |! 40 |! year |! old |! woman |! who |! is |! a |! health-care |! worker |! has |! had |! episodic |! symptoms |! of |! hypoglycemia |! for |! the |! past |! year. |! During |! one |! of |! these |! episodes, |! plasma |! glucose |! concentration |! is |! decreased, |! plasma |! insulin |! concentration |! is |! increased, |! and |! serum |! C-peptide |! concentration |! is |! not |! detectable. |! Which |! of |! the |! following |! is |! the |! most |! likely |! cause |! of |! the |! hypoglycemia? A. |! acute |! hepatic |! failure |! B. |! ingestion |! of |! a |! sulfonylurea |!
C. |! Pancreatic |! beta-cell |! neoplasm D. |! Retroperitoneal |! fibrosarcoma |! E. |! Surreptitious |! use |! of |! insulin |! - |! Correct |! answer |! ✔E. |! Surreptitious |! use |! of |! insulin Double-stranded |! DNA |! can |! be |! denatured |! by |! heating |! and |! renatured |! by |! cooling. |! Renaturation |! under |! conditions |! of |! high |! stringency |! has |! which |! of |! the |! following |! effects? A. |! Considerable |! base |! mismatching |! is |! permitted |! B. |! GC |! base |! pairing |! is |! promoted C. |! GT |! base |! pairing |! is |! promoted D. |! Mismatch |! DNA |! hybridization |! is |! preverted |! - |! Correct |! answer |! ✔D. |! Mismatch |! DNA |! hybridization |! is |! preverted 22-year |! old |! woman |! who |! is |! pregnant |! with |! her |! first |! child |! comes |! to |! the |! physicians |! office |! for |! a |! routine |! visit |! at |! 24 |! weeks |! gestation. |! The |! size |! of |! her |! uterus |! has |! increased |! very |! little |! during |! the |! past |! 4 |! weeks. |! Ultrasonography |! shows |! little |! fluid |! in |! the |! amniotic |! sac. |! Which |! of |! the |! following |! fetal |! organ |! systems |! is |! most |! likely |! to |! be |! malfunctioning? A. |! Cardiovascular |! B. |! Central |! nervous |! C. |! Gastrointestinal |! D. |! hepatic |! E. |! Renal |! - |! Correct |! answer |! ✔E. |! Renal 35 |! year |! old |! woman |! comes |! to |! the |! physician |! for |! an |! initial |! visit. |! She |! refuses |! to |! fill |! out |! a |! questionnaire |! form |! about |! personal |! data |! and |! her |! medical |! history. |! When |! the |! physician |! greets |! her |! in |! the |! examination |! room, |! she |! says, |! "lets |! get |! this |! over |! with." |! which |! of |! the |! following |! questions |! is |! most |! likely |! to |! facilitate |! communication |! with |! the |! patient? A. |! "Are |! you |! always |! such |! an |! angry |! person?" B. |! "I |! can |! see |! that |! you |! are |! upset. |! Please |! tell |! me |! what |! is |! bothering |! you."
A. |! Cryptococcus |! neoformans |! B. |! Cytomegalovirus |! C. |! Pneumocystis |! carinii |! D. |! Toxoplasma |! gondii |! E. |! Treponema |! papilldum |! - |! Correct |! answer |! ✔D. |! Toxoplasma |! gondii 50 |! year |! old |! woman |! is |! evaluated |! for |! occult |! blood |! in |! the |! stool. |! Colonoscopy |! shows |! a |! 5cm |! sessile |! mass |! with |! a |! velvety |! surface |! that |! projects |! about |! 2cm |! above |! the |! mucosa |! of |! the |! rectosigmoid. |! Microscopic |! examination |! of |! tissue |! obtained |! on |! biopsy |! of |! the |! mass |! shows |! papillae |! composed |! of |! delicate |! fibrovascular |! cores |! covered |! by |! dysplastic |! columnar |! epithelium. |! This |! patient |! is |! at |! increased |! risk |! for |! which |! of |! the |! following |! colonic |! neoplasms? A. |! Adenocarcinoma |! B. |! Carcinoid |! C. |! Fibrosarcoma D. |! Leiomyosarcoma E. |! Lymphoma |! F. |! Squamous |! carcinoma |! - |! Correct |! answer |! ✔A. |! Adenocarcinoma Relative |! to |! the |! normal |! values |! for |! parameters |! that |! govern |! capillary |! exchange, |! which |! of |! the |! following |! is |! the |! most |! likely |! cause |! of |! the |! edema |! that |! results |! from |! use |! of |! a |! venous |! occlusive |! tourniquet? A. |! Decreased |! interstitial |! fluid |! hydrostatic |! pressure |! B. |! Increased |! mean |! capillary |! hydrostatic |! pressure C. |! Increased |! plasma |! oncotic |! pressure D. |! Increased |! capillary |! filtration |! coefficient E. |! Increased |! capillary |! reflection |! coefficient |! for |! plasma |! proteins |! - |! Correct |! answer |! ✔B. |! Increased |! mean |! capillary |! hydrostatic |! pressure
72 |! year |! old |! man |! comes |! to |! the |! physician |! because |! of |! an |! 8 |! month |! history |! of |! feeling |! light- headed |! when |! he |! stands |! up. |! Bp |! is |! 130/85 |! mmHg |! while |! supine |! and |! 94/64 |! mmHg |! while |! standing. |! High-dose |! fludrocortisone |! therapy |! is |! started. |! After |! 5 |! days |! of |! treatment, |! laboratory |! students |! are |! most |! likely |! to |! show |! what |! changes? A. |! K+ |! decrease, |! Renin |! increase. |! K+ |! excretion |! increase B. |! K+ |! decrease, |! Renin |! increase, |! K+ |! excretion |! decrease C. |! K+ |! decrease, |! Renin |! decrease, |! K+ |! excretion |! increase |! D. |! K+ |! increase, |! Renin |! increase, |! K+ |! excretion |! decrease E. |! K+ |! increase, |! Renin |! decrease, |! K+ |! excretion |! increase F. |! K+ |! increase, |! Renin |! decrease, |! K+ |! excretion |! decrease |! - |! Correct |! answer |! ✔C. |! K+ |! decrease, |! Renin |! decrease, |! K+ |! excretion |! increase Sexually |! active |! 18-year |! old |! woman |! comes |! to |! the |! MD |! office |! because |! of |! a |! fever, |! lower |! abdominal |! pain, |! purulent |! vaginal |! discharge |! for |! the |! last |! 3 |! weeks. |! Tender |! mass |! is |! palpated |! in |! the |! right |! lower |! quadrant |! on |! bimanual |! examination. |! Which |! of |! the |! following |! is |! the |! most |! likely |! site |! of |! the |! mass? A. |! Ovary |! B. |! Fallopian |! tube C. |! Uterine |! fundus D. |! Uterine |! body E. |! Vagina F. |! Bladder G. |! Rectum |! - |! Correct |! answer |! ✔B. |! Fallopian |! tube
C. |! Huntingtons |! disease D. |! Normal |! aging E. |! Pick's |! disease |! - |! Correct |! answer |! ✔E. |! Pick's |! disease 4-month |! old |! boy |! is |! admitted |! to |! the |! hospital |! with |! disseminated |! candidiasis. |! He |! has |! had |! several |! episodes |! of |! upper |! respiratory |! viral |! infections |! and |! has |! a |! history |! of |! tetany. |! Two |! months |! ago, |! his |! serum |! calcium |! concentration |! was |! 2.0mg/dL. |! Truncus |! arterioles |! was |! diagnosed. |! He |! was |! given |! vitamin |! D |! and |! calcium |! supplements |! and |! was |! discharged |! at |! 1 |! month |! of |! age. |! Which |! of |! the |! following |! sets |! of |! laboratory |! findings |! is |! most |! likely |! at |! this |! time? A. |! Gamma |! globulins |! are |! decreased, |! Peripheral |! lymphocytes |! are |! decreased, |! Mediastinal |! shadow |! on |! x-ray |! films |! is |! narrowed |! B. |! Gamma |! globulins |! are |! normal, |! Peripheral |! lymphocytes |! are |! decreased, |! Mediastinal |! shadow |! on |! x-ray |! films |! is |! widened |! C. |! Gamma |! globulins |! are |! normal, |! Peripheral |! lymphocytes |! are |! decreased, |! Mediastinal |! shadow |! on |! x-ray |! films |! is |! narrowed |! D. |! Gamma |! globulins |! are |! increased, |! Peripheral |! lymphocytes |! are |! increased, |! Mediastinal |! shadow |! on |! x-ray |! films |! is |! widened |! E. |! Gamma |! globulins |! are |! increase |! - |! Correct |! answer |! ✔C. |! Gamma |! globulins |! are |! normal, |! Peripheral |! lymphocytes |! are |! decreased, |! Mediastinal |! shadow |! on |! x-ray |! films |! is |! narrowed The |! destruction |! of |! H2O2, |! which |! is |! a |! mildly |! toxic |! reduced |! oxygen |! species, |! is |! catalyzed |! by |! which |! of |! the |! following |! enzymes? A. |! Catalase |! B. |! Cytochrome |! oxidase C. |! Nitric |! oxide |! synthase D. |! Superoxide |! dismutase E. |! Xanthine |! oxidase |! - |! Correct |! answer |! ✔A. |! Catalase
Based |! on |! these |! data, |! what |! is |! the |! relative |! risk |! for |! development |! of |! breast |! cancer |! in |! childless |! women |! compared |! with |! women |! who |! have |! children? A. |! 0. B. |! 1. C. |! 1. D. |! 1.8 |! E. |! 2.25 |! - |! Correct |! answer |! ✔E. |! 2. 55-year |! old |! man |! has |! had |! patchy |! leukoplakia |! of |! the |! anterior |! floor |! of |! his |! mouth |! for |! 4 |! years. |! He |! now |! has |! a |! raised, |! firm |! white |! lesion |! in |! the |! same |! area. |! Examination |! of |! tissue |! obtained |! on |! biopsy |! of |! this |! new |! lesion |! is |! most |! likely |! to |! show: A. |! Aphthous |! ulcer |! B. |! Burkitts |! lymphoma C. |! Candida |! infection |! D. |! Kaposi's |! sarcoma E. |! mixed |! tumor |! of |! the |! parotid |! gland F. |! Squamous |! cell |! carcinoma |! G. |! Warthin's |! tumor |! - |! Correct |! answer |! ✔F. |! Squamous |! cell |! carcinoma 31 |! year |! old |! woman |! is |! admitted |! to |! the |! hospital |! in |! labor |! at |! 28 |! weeks |! gestation. |! Administration |! of |! which |! of |! the |! following |! will |! most |! likely |! enhance |! production |! of |! surfactant |! by |! fetal |! type |! II |! alveolar |! cells? A. |! Corticosteroids |! B. |! Glucagon |! C. |! Growth |! hormone D. |! Insulin |! E. |! Somatostatin |! - |! Correct |! answer |! ✔A. |! Corticosteroids
E. |! Periglomerular |! granuloma |! with |! giant |! cells |! - |! Correct |! answer |! ✔D. |! Narrowing |! of |! the |! capillary |! wall |! by |! fibrin |! deposition The |! developmental |! anomaly |! shown |! in |! this |! stillborn |! fetus |! is |! most |! commonly |! characterized |! by |! which |! type |! of |! inheritance? A. |! Autosomal |! dominant |! B. |! Autosomal |! recessive C. |! Mitochondrial |! D. |! Multifactorial |! E. |! Sex-linked |! - |! Correct |! answer |! ✔D. |! Multifactorial 30-year |! old |! woman |! with |! type |! 1 |! diabetes |! melltius |! has |! increasing |! vulvar |! pruritus |! and |! a |! vaginal |! discharge. |! A |! wet |! mount |! preparation |! of |! the |! discharge |! is |! shown. |! Which |! of |! the |! following |! is |! the |! most |! likely |! causal |! organism? A. |! Candida |! albicans |! B. |! Chlamydia |! trachomatis |! C. |! Herpes |! simplex |! virus |! D. |! Human |! papillomavirus E. |! Trichomonasvaginalis |! - |! Correct |! answer |! ✔A. |! Candida |! albicans The |! presence |! of |! which |! of |! the |! following |! is |! characteristic |! of |! the |! infectious |! agent |! of |! bovine |! spongiform |! encephalopathy? A. |! RNA |! +, |! DNA |! +, |! Protein |! + B. |! RNA |! +, |! DNA |! +, |! Protein |! - C. |! RNA |! +, |! DNA |! -, |! Protein |! + D. |! RNA |! +, |! DNA |! -, |! Protein |! - E. |! RNA |! -, |! DNA |! +, |! Protein |! +
F. |! RNA |! -, |! DNA |! +, |! Protein |! - G. |! RNA |! -, |! DNA |! -, |! Protein |! - H. |! RNA |! -, |! DNA |! -, |! Protein |! + |! - |! Correct |! answer |! ✔H. |! RNA |! -, |! DNA |! -, |! Protein |! + healthy |! 30-year |! old |! man |! is |! participating |! in |! a |! study |! of |! the |! effects |! of |! a |! competitive |! inhibitor |! of |! endothelial |! nitric |! oxide |! synthase. |! After |! intravenous |! infection |! of |! the |! inhibitor, |! blood |! pressure |! immediately |! increases. |! Supplementation |! with |! which |! of |! the |! following |! amino |! acids |! is |! most |! appropriate |! to |! reverse |! this |! increase? A. |! Arginine |! B. |! Aspartic |! acid C. |! Glutamic |! acic D. |! Leucine E. |! Lysine F. |! Methionine G. |! Tyrosine |! - |! Correct |! answer |! ✔A. |! Arginine 48-year |! old |! man |! with |! a |! long |! history |! of |! alcohol |! abuse |! has |! painless |! vomiting |! of |! large |! amounts |! of |! bright |! red |! blood. |! Heart |! rate |! is |! 110/min |! and |! blood |! pressure |! is |! 80/0mmHg. |! He |! dies |! despite |! rapid |! transfusion |! of |! packed |! erythrocytes. |! At |! autopsy, |! the |! source |! of |! the |! hemorrhage |! is |! found |! in |! the |! lower |! esophagus. |! A |! photograph |! of |! the |! site |! is |! shown. |! Which |! of |! the |! following |! mechanisms |! most |! likely |! caused |! the |! hemorrhage? A. |! alcohol |! induced |! esophagitis |! B. |! Deficiency |! in |! hepatic |! synthesis |! of |! vitamin |! K |! dependent |! coagulation |! proteins C. |! Mechanical |! tearing |! of |! the |! esophageal |! mucosa |! during |! vomiting |! D. |! Peptic |! ulceration |! of |! esophageal |! mucosa |! due |! to |! reflux |! of |! gastric |! acid E. |! Transmission |! of |! portal |! hypertension |! to |! esophageal |! veins |! - |! Correct |! answer |! ✔E. |! Transmission |! of |! portal |! hypertension |! to |! esophageal |! veins
42 |! year |! old |! woman |! has |! dizziness |! and |! ringing |! in |! her |! ears |! 7 |! days |! after |! starting |! a |! drug. |! Which |! of |! the |! following |! drugs |! is |! the |! most |! likely |! cause? A. |! Acetaminophen |! B. |! Aspirin |! C. |! Auranofin |! D. |! Methotrexate |! E. |! Prednisone |! - |! Correct |! answer |! ✔B. |! Aspirin Scatter |! diagram |! shown |! records |! the |! height |! and |! weight |! of |! a |! random |! sample |! of |! male |! college |! students/ |! The |! correlation |! (r) |! between |! height |! and |! weight |! is |! closest |! to |! which |! of |! the |! following? A. |! +1. B. |! +0. C. |! 0 D. |! -0. E. |! -1.00 |! - |! Correct |! answer |! ✔B. |! +0. Serious, |! possibly |! fatal, |! adverse |! effects |! of |! a |! new |! drug |! may |! first |! appear |! only |! after |! the |! drug |! is |! approved |! for |! marketing |! by |! the |! FDA. |! The |! failure |! to |! detect |! these |! effects |! if |! best |! explained |! by |! the |! use |! of |! which |! of |! the |! following |! in |! the |! pre |! marketing |! clinical |! trials? A. |! Healthy |! rather |! than |! ill |! subjects |! B. |! Lower |! doses |! of |! the |! drug |! than |! are |! approved |! for |! marketing C. |! Patients |! w/ |! positive |! outcomes |! only D. |! Placebos E. |! Too |! few |! subjects |! to |! detect |! rare |! events |! - |! Correct |! answer |! ✔E. |! Too |! few |! subjects |! to |! detect |! rare |! events
Which |! of |! the |! following |! procedures |! improves |! the |! immunogenicity |! of |! vaccines |! that |! use |! capsular |! polysaccharides |! as |! antigens? |! A. |! Heat |! denaturation B. |! Liposome |! incorporation |! C. |! Oligosaccharide |! redction |! D. |! Protein |! conjugation |! - |! Correct |! answer |! ✔D. |! Protein |! conjugation The |! vertebral |! angiogram |! seen. |! Which |! of |! the |! following |! clinical |! findings |! is |! most |! likely |! to |! be |! present? A. |! aphasia |! B. |! ataxic |! limb |! movements |! C. |! resting |! tremor D. |! spastic |! hemiparesis |! E. |! visual |! field |! defect |! - |! Correct |! answer |! ✔B. |! ataxic |! limb |! movements
- |! on |! doc |! - |! Correct |! answer |! ✔D 45 |! on |! doc |! - |! Correct |! answer |! ✔A 45-year |! old |! man |! who |! has |! 5 |! children |! comes |! to |! the |! physician |! to |! discuss |! a |! vasectomy |! and |! asks |! about |! what |! to |! expect. |! Which |! of |! the |! following |! is |! most |! likely |! to |! occur |! during |! the |! first |! 4 |! weeks |! following |! the |! procedure? A. |! Atrophy |! of |! the |! testes |! B. |! Erectile |! disorder C. |! Numbness |! of |! the |! posterior |! scrotum |! D. |! Presence |! of |! viable |! sperm |! in |! ejaculate
A. |! Cyclooxygenase |! B. |! Lipoxygenase C. |! Myeloperoxidase D. |! Superoxide |! dismutase |! E. |! Xanthine |! oxidase |! - |! Correct |! answer |! ✔D. |! Superoxide |! dismutase 55 |! year |! old |! man |! with |! a |! long |! history |! of |! poorly |! controlled |! hypertension |! suddenly |! develops |! severe |! retrosternal |! chest |! pain |! that |! radiates |! into |! the |! upper |! back |! between |! the |! scapulae. |! On |! examination, |! he |! has |! diaphoresis |! and |! severe |! SOB. |! Pulse |! is |! 125/min |! and |! regular, |! and |! bp |! is |! 130/60mmHg |! in |! the |! left |! arm |! and |! 80/50mmHg |! in |! the |! right |! arm. |! There |! are |! diffuse, |! wet, |! inspiratory |! crackles |! in |! both |! lung |! fields, |! distant |! heart |! sounds, |! and |! previously |! undetected |! grade |! 2/6, |! blowing, |! early |! diastolic |! murmur |! in |! the |! second |! right |! and |! third |! left |! intercostal |! spaces |! adjacent |! to |! the |! sternum. |! The |! most |! likely |! diagnosis |! is: A. |! Dissecting |! aortic |! aneurysm |! B. |! Myocardial |! infarction |! C. |! Pericarditis |! with |! tamponade D. |! Pulmonary |! embolism |! E. |! Ruptured |! chordae |! tendineae F. |! Ventricular |! septal |! rupture |! - |! Correct |! answer |! ✔A. |! Dissecting |! aortic |! aneurysm 40-year |! old |! man |! is |! brought |! to |! the |! ED |! after |! being |! exposed |! to |! ozone |! and |! nitrogen |! dioxide |! at |! a |! factory. |! He |! dies |! shortly |! thereafter. |! At |! autopsy, |! examination |! of |! tissue |! taken |! from |! a |! lung |! biopsy |! suggests |! damage |! to |! his |! alveolar |! epithelium. |! If |! he |! had |! survived, |! this |! layer |! would |! have |! likely |! been |! regenerated |! within |! several |! weeks |! by |! which |! of |! the |! following |! cells? A. |! Clara |! cells |! B. |! Endothelial |! cells C. |! Reticular |! cells D. |! Type |! I |! pneumocytes E. |! Type |! II |! pneumocytes |! - |! Correct |! answer |! ✔E. |! Type |! II |! pneumocytes
32 |! year |! old |! man |! has |! had |! malaise, |! a |! low |! grade |! fever |! and |! a |! 4.5kg |! weight |! loss |! over |! the |! last |! 3 |! months. |! He |! has |! unilateral |! cerivcal |! lymphadenopathy. |! Examination |! of |! tissue |! obtained |! on |! biopsy |! of |! a |! lymph |! node |! shows |! Hodgkin's |! disease, |! nodular |! sclerosing |! type. |! The |! most |! likely |! cause |! of |! the |! anemia |! is: A. |! abnormal |! utilization |! of |! iron B. |! extravascular |! hemolysis C. |! folate |! deficiency D. |! iron |! deficiency E. |! marrow |! aplasia |! - |! Correct |! answer |! ✔A. |! abnormal |! utilization |! of |! iron 25-year |! old |! man |! is |! brought |! to |! the |! ED |! because |! of |! palpitations |! and |! anxiety. |! A |! friend |! says |! the |! patient |! was |! smoking |! "crack" |! earlier |! in |! the |! evening. |! Blood |! pressure |! is |! 180/110mmHg |! and |! pulse |! is |! 120/min. |! ECG |! shows |! sinus |! tachycardia. |! Which |! of |! the |! following |! is |! the |! most |! likely |! cause |! of |! these |! findings? A. |! block |! of |! neurotransmitter |! uptake |! at |! the |! presynaptic |! nerve |! terminal |! B. |! excess |! release |! of |! acetylcholine |! at |! neuromuscular |! junctions C. |! increased |! metabolism |! of |! neurotransmitters |! within |! neuromuscular |! junctions D. |! increased |! release |! of |! neurotransmitters |! at |! the |! presynaptic |! nerve |! terminals E. |! release |! of |! endorphins |! and |! enkephalins |! into |! the |! circulation |! - |! Correct |! answer |! ✔A. |! block |! of |! neurotransmitter |! uptake |! at |! the |! presynaptic |! nerve |! terminal Normal |! healthy |! children |! are |! able |! to |! mount |! diverse |! antibody |! responses |! to |! several |! thousands |! of |! different |! antigens. |! This |! process |! is |! based |! primarily |! on |! which |! of |! the |! following |! DNA |! mechanisms? A. |! Amplification |! B. |! Conformation |! C. |! Recombination |! D. |! Repair
