wrong answers NBME 17, 16 & 15 Flashcards
(106 cards)
1
Q
40.
A 70-year-old man is admitted to the hospital for evaluation of the recent loss of mental function. He has a history of weight loss. He is not taking any drugs. Vital signs are normal, and he is not dehydrated. Aside from mild disorientation, findings on neurologic examination are unremarkable. He has mild anemia. Laboratory studies show:
Serum
Na+ 110 mEq/L
Cl− 85 mEq/L
K+ 4.4 mEq/dL
Urea nitrogen (BUN) 15 mg/dL
Creatinine 0.9 mg/dL
Plasma osmolality 250 mOsmol/kg
Urine osmolality 750 mOsmol/kg
Which of the following is the most likely diagnosis?
A
)
Adrenal carcinoma
B
)
Chronic interstitial nephritis
C
)
Diabetes mellitus
D
)
Pneumococcal meningitis
E
)
Pulmonary neoplasm
A
Small cell carcinoma, ACTH,SIADH,Lambert eaton, neuroendocrine tumour
2
Q
A 27-year-old woman is brought to the emergency department 30 minutes after she was ejected through the windshield during a motor vehicle collision. She was the unrestrained front-seat passenger. Physical examination shows marked edema and tenderness of the jaw. A Panorex x-ray of the mouth is shown. Which of the following additional structures is most likely injured by this abnormality?
A
)
Inferior alveolar nerve
B
)
Levator labii superioris
C
)
Maxillary artery
D
)
Parotid gland
E
)
Tongue
A
Inf alveolar nerve
3
Q
A 19-year-old man is admitted to the hospital following a motor vehicle collision. Physical examination shows a penetrating wound to the right cerebral cortex with complete paralysis of the left lower extremity, fracture of the right mid humerus with severing of the radial nerve, and a fracture of the right tibia. Treatment includes cast immobilization of the right upper extremity and right knee and ankle. After 10 weeks, the casts are scheduled to be removed from the right upper and lower extremities. At this point, the deep tendon reflex is most likely to be strongest in which of the following locations in this patient?
A
)
Left Achilles tendon
B
)
Left biceps tendon
C
)
Right brachioradialis tendon
D
)
Right patellar tendon
A
umn everything up, left achilles
4
Q
A 55-year-old man is admitted to the hospital for treatment of sepsis. He appears anxious and confused. Treatment with vancomycin and ceftriaxone was initiated in the emergency department. His temperature is 39.8°C (103.6°F), pulse is 132/min, respirations are 28/min, and blood pressure is 85/48 mm Hg. Physical examination shows warm, flushed skin that is moist with diaphoresis. There is no edema. It is most appropriate to administer which of the following solutions at this time?
A
)
5% Dextrose in water and 0.45% saline
B
)
5% Dextrose in water only
C
)
0.45% Saline only
D
)
0.9% Saline
E
)
3% Saline
A
0.9% saline, bump up bp
5
Q
A previously healthy 72-year-old man is brought to the physician because of weakness and fatigue. His hemoglobin concentration is 9.2 g/dL, leukocyte count is 5400/mm3, and platelet count is 350,000/mm3. A peripheral blood smear is shown. Which of the following is the most likely cause of these findings?
A
)
Aplastic anemia
B
)
Chronic myelogenous leukemia
C
)
Gastrointestinal blood loss
D
)
β-Thalassemia major
E
)
Vitamin B12 (cobalamin) deficiency
A
- C, very common cause of anemia is older person is GI blood loss. Different sizes of RBCs would give a wide red cell distribution width (RDW) which implies blood loss. The other answers do not make sense with the rest of the question stem. (A) would have pancytopenia, (B) would likely have a higher WBC and smear would have leukemia-looking cells, (D) would be severe microcytic anemia and would not be presenting now at age 72, and (E) no history to correlate with B12 deficiency/ no megaloblastic cells.
6
Q
A 27-year-old primigravid woman at 34 weeks' gestation is admitted to the hospital because of nausea and vomiting, and abdominal pain for 12 hours. Her pregnancy has been otherwise unremarkable. Prior laboratory studies, including a complete blood count and serologic tests for HIV and hepatitis, have shown no abnormalities. Her blood pressure now is 164/102 mm Hg. Abdominal examination shows right upper quadrant tenderness. Laboratory studies show:
Hemoglobin 7.4 g/dL
Hematocrit 24%
Platelet count 72,000/mm3
Serum
Creatinine 1.2 mg/dL
Total bilirubin 2.3 mg/dL
AST 112 U/L
ALT 126 U/L
Examination of a peripheral blood smear is most likely to show a predominance of which of the following in this patient?
A
)
Acanthocytes
B
)
Heinz bodies
C
)
Howell-Jolly bodies
D
)
Schistocytes
E
)
Spherocytes
F
)
Target cells
A
probably schistocytes, hellp syndrome
7
Q
A 45-year-old man comes to the physician because of yellow skin for 4 days. He lost his job 10 days ago, and he has been drinking eight to ten 12-ounce cans of beer daily since then. Physical examination shows jaundice. The liver is tender to palpation. Serum studies show: Total bilirubin 5.9 mg/dL Alkaline phosphatase 210 U/L AST 110 U/L ALT 69 U/L γ-Glutamyltransferase 35 U/L (N=0–30)
Histologic examination of a liver biopsy specimen will most likely show which of the following in this patient?
A
)
α1-Antitrypsin globules
B
)
Glycogen
C
)
Hemosiderin
D
)
Lipofuscin
E
)
Mallory hyaline
A
probably mallory hyalin, ALP>AST so alcoholic hep
8
Q
A protein found in the brown adipose tissue of mice causes a leak of H+ ions inward across the inner mitochondrial membrane. Which of the following is the most likely effect of this protein on oxidative phosphorylation and energy metabolism?
A
)
Decreased ratio of oxygen consumption to ATP generation
B
)
Decreased ratio of oxygen consumption to CO2 production
C
)
Increased ratio of oxygen consumption to ATP generation
D
)
Increased ratio of oxygen consumption to CO2 production
E
)
No change in the ratios of oxygen consumption to ATP generation and oxygen consumption to CO2 production
A
C
9
Q
A 63-year-old woman is brought to the emergency department because of a 2-day history of fever, abdominal tenderness, and painful urination. She appears agitated. Her temperature is 38.8°C (101.8°F). Laboratory studies show a leukocyte count of 14,000/mm3. She is admitted to the hospital. Two hours later, the nurses note that she has torn up four breakfast menus because she found them to be too confusing. She is highly educated, and her husband says that she does not behave this way at home. Which of the following is the most likely cause of this patient’s current mental status?
A
)
Amnesia
B
)
Delirium
C
)
Dementia
D
)
Mild cognitive impairment
E
)
Occult cerebral infarction
A
Delirium- most common in recently hospitalised
10
Q
A 62-year-old man with alcohol-induced liver disease develops massive ascites. Infection is ruled out. The most appropriate diuretic treatment, in addition to loop diuretics, includes which of the following drugs?
A
)
Acetazolamide
B
)
Hydrochlorothiazide
C
)
Indapamide
D
)
Metolazone
E
)
Spironolactone
A
Spironolactone to mitigate k wasting
11
Q
20 year old man with suspected appendicitis has periumbilical burning and discomfort, which eventually localize to a region in the lower right quadrant about 5 cm superomedial to the anterior superior iliac spine. The best explanation for this finding is that the periumbilical region of the body wall and appendix are both supplied by afferent fibers with sensory cells bodies located in the dorsal root ganglia of the spinal nerves at which of the following levels? a. T5 B. T10 C. T12 D. L1 E. S2
A
T10
12
Q
Three days after unprotected sex with a new partner, a sexually active 24-year-old man noticed the development of small tender blisters on his penis. Some of the blisters broke and left open sores. He does not use condoms. A photograph of the lesions is shown. Which of the following is the most likely causal agent?
A
)
Calymmatobacterium granulomatis
B
)
Chlamydia trachomatis
C
)
Haemophilus ducreyi
D
)
Herpes simplex virus type 2
E
)
Treponema pallidum
A
HSV 2 photo phone nbme 2
13
Q
A 27-year-old woman comes to the physician because of fever, malaise, abdominal pain, and vaginal discharge for 4 days. Her last menstrual period ended 5 days ago. She had an ectopic pregnancy 1 year ago. Her temperature is 38.3°C (101°F). Abdominal examination shows bilateral lower quadrant tenderness with rebound and guarding. Pelvic examination shows cervical motion tenderness and bilateral adnexal tenderness. Her leukocyte count is 18,000/mm3. A pregnancy test is negative. Which of the following is the most likely diagnosis?
A
)
Appendicitis
B
)
Bacterial vaginosis
C
)
Chancroid
D
)
Diverticulitis
E
)
Gonorrhea
F
)
Herpes genitalis
G
)
Trichomoniasis
A
gonorrhea with s/s PID
14
Q
A 24-year-old man comes to the physician because of a 2-day history of an itchy rash on his arms and legs. He returned from a camping trip in the woods 5 days ago. Examination of the upper and lower extremities shows a widespread edematous, erythematous rash with linear vesicles. The most likely cause of these findings is activation of which of the following cell types?
A
)
B lymphocytes
B
)
Mast cells
C
)
Natural killer cells
D
)
Neutrophils
E
)
T lymphocytes
A
T-cell lymphoctyes—poison ivy..Dealayed T cell mediated type, Mactrophage activation.
15
Q
A 70-year-old man dies in a motor vehicle collision. He had been undergoing evaluation for occult blood in the stool. A photograph of a section of the transverse colon obtained at autopsy is shown. Which of the following is the most likely diagnosis?
A
)
Hyperplastic polyp
B
)
Inflammatory pseudopolyp
C
)
Juvenile polyp
D
)
Peutz-Jeghers syndrome
E
)
Tubular adenoma
A
its pedunculated in the picture—TUBULAR ADENOMA Picure nbme 3
16
Q
An 80-year-old woman is being evaluated for suspected temporal arteritis (TA). Her erythrocyte sedimentation rate (ESR) is 100 mm/h. Treatment of TA involves the use of glucocorticoids, which could have serious adverse effects. The pretest probability for TA is 50% in this patient. In the evaluation of TA, ESR has a sensitivity of 99% and a specificity of 60%. Based on the results of the ESR testing in this patient, which of the following is the most appropriate next step in management?
A
)
Additional testing to confirm the diagnosis of TA
B
)
Corticosteroid therapy, since the diagnosis of TA has been established with 99% certainty
C
)
Elimination of TA from further diagnostic consideration
D
)
Repeat ESR; if again positive, corticosteroid therapy
E
)
Repeat ESR; if normal, additional testing to confirm the diagnosis of TA
A
Additional testing to confirm dx of TA. going for biopsy +/- CRP. It’s extremely unlikely that ESR would be falsely elevated as high as 100, and it commonly reaches levels that high in TA. So a repeat ESR would be useless acutely
17
Q
A 38-year-old man comes to the physician because of a 1-week history of watery, itchy eyes and a runny nose. He works as a crane operator. Physical examination shows inflamed nasal mucosa. There is no congestion in the lower lung. Which of the following is the most appropriate pharmacotherapy?
A
)
Brompheniramine
B
)
Diphenhydramine
C
)
Hydroxyzine
D
)
Loratadine
E
)
Ranitidine
A
d I think because a-c are first gen and could make him sleepy. He works a crane..
18
Q
A 66-year-old man with stage IV colon cancer comes to the physician because of a 3-day history of severe diarrhea after receiving chemotherapy with fluorouracil, leucovorin, and irinotecan. The physician prescribes an opioid antidiarrheal agent with little or no ability to produce central nervous system effects, even when given in relatively high doses. Which of the following agents was most likely prescribed?
A
)
Buprenorphine
B
)
Codeine
C
)
Hydrocodone
D
)
Loperamide
E
)
Morphine
A
loperamide i guess
19
Q
A 28-year-old woman, gravida 1, para 1, comes to the physician because of a 2-day history of a painful mass in her right breast. She delivered a healthy female newborn at term 3 weeks ago, and she has been breast-feeding successfully since then. Her temperature is 37°C (98.6°F). Physical examination shows a 3-cm, tender mass surrounded by an area of erythema beneath the right areola. Which of the following is the most likely causal organism?
A
)
Bacteroides fragilis
B
)
Escherichia coli
C
)
Haemophilus influenzae
D
)
Staphylococcus aureus
E
)
Streptococcus agalactiae (group B)
A
Staph
20
Q
A 45-year-old woman comes to the physician for a follow-up examination 8 weeks after beginning tamoxifen therapy for estrogen- and progesterone-positive invasive ductal carcinoma of the breast. Her 50-year-old sister also has hormone-sensitive breast cancer treated with tamoxifen. Physical examination shows no abnormalities. Serum studies show decreased concentrations of endoxifen, the active metabolite of the prodrug tamoxifen. Genetic analysis shows the homozygous presence of cytochrome P450 2D6*4 alleles. Which of the following best represents the likelihood that this patient’s sister has the same alleles?
A
)
0%
B
)
25%
C
)
50%
D
)
75%
E
)
100%
A
25% AR
21
Q
A 15-year-old girl comes to the physician’s office for a health maintenance examination. Her mother was recently diagnosed with squamous cell carcinoma of the face, and her maternal grandfather died of metastatic melanoma. During the visit, the physician advises her about methods of photoprotection, including daily use of a sunscreen. In a patient of this age, which of the following factors is most likely to predict compliance with photoprotection?
A
)
Ability to tan
B
)
Advice of the physician to wear sunscreen
C
)
Concern about premature aging of skin
D
)
Desire to prevent sunburn
E
)
Family history of skin cancer
F
)
Use of sunscreen by her peers
A
peers
22
Q
A 22-year-old woman, gravida 1, para 1, is brought to the emergency department because of a 2-day history of fever and severe vaginal bleeding. Four days ago, she delivered a healthy male newborn spontaneously at term. Her temperature is 38.1°C (100.6°F). Pelvic examination shows an open cervix and heavy vaginal bleeding. Ultrasonography of the uterus shows no retained placental tissue or large thrombi. If an operation is required to control the bleeding, ligation of a branch of which of the following arteries is most appropriate?
A
)
External iliac
B
)
Internal iliac
C
)
Internal pudendal
D
)
Median sacral
E
)
Obturator
A
external iliac (gives femoral and inferior epigastric artery)
b. internal iliac ( Correct answer I think, bcz Uterine artery is a branch of internal iliac artery)
c. internal pudendal (supplies the external structure, but also a branch of internal iliac)
d. median sacral (supply coccyx)
e. Obturator (gives blood supply to the leg obturator muscles)
23
Q
A physician is sad because he has to inform a patient of recent test results that indicate progression of carcinoma to the terminal phase. When the patient sees the physician’s face, he begins to cry and says, “It’s bad news, isn’t it?” Which of the following responses by the physician is most appropriate?
A
)
“How have you been since the last time I saw you?”
B
)
“Let’s talk about the positive aspects first.”
C
)
“Look on the bright side of things.”
D
)
“Tell me how you are feeling.”
E
)
“There are other people who have it a lot worse than you.”
F
)
“Yes, it is.”
G
)
“You’ve had several years better off than many others with this disease.”
A
yes it is
24
Q
A previously healthy 48-year-old nulligravid woman comes to the physician because of excessive uterine bleeding for 3 months. She says the bleeding occurs both during her menses and at irregular intervals. Menses had occurred at regular 28- to 38-day intervals. She is 165 cm (5 ft 5 in) tall and weighs 72 kg (160 lb); BMI is 27 kg/m2. During pelvic examination, the adnexae are nonpalpable. Endometrial curettage shows abundant tissue. Which of the following is the most likely cause of this patient’s symptoms?
A
)
Adenomyosis
B
)
Endometrial hyperplasia
C
)
Endometrial metaplasia
D
)
Endometriosis
E
)
Endometritis
A
B
This is classic pre-menopausal symptoms. As the ovaries begin to fail, cycles become irregular. Without the estrogen consistently there you lose the surge and the whole luteal phase of the cycle, or it happens at odd times and is delayed. This leads to the endometrium building up further and further until a delayed menstruation, so the periods are much heavier than normal. BB is definitely the right answer.
I should note: If this was a 58 year old woman who hadn’t had a period in 8 years and suddenly had uterine bleeding, we’d be thinking much more along the lines of metaplasia/neoplasia.
25
A 15-year-old girl who recently emigrated from India is brought to the physician because of several lesions on her neck for 2 weeks. Physical examination shows a hypopigmented, hypoesthetic area over the left side of the forehead and 4-cm lesions on the neck. A biopsy specimen of a lesion shows acid-fast bacilli. Which of the following best explains why the causal organism results in dermal rather than in visceral infections?
A
)
CO2 requirement
B
)
Innate antibacterial compounds
C
)
Lipid content
D
)
Oxygen tolerance
E
)
Temperature sensitivity
Temperature sensitivity (this is leporosy)
26
A 16-year-old boy is brought to the physician by his father because he has no signs of puberty. Sexual development is Tanner stage 2. Physical examination shows a circumcised penis. The testes are soft and small with a volume of 5 mL (N=20–30). The prostate is firm, nontender, and of appropriate size. There are no lesions or discharge. His serum testosterone concentration is in the prepubertal range. Measurement of which of the following hormones in serum is most likely to determine whether the decreased serum testosterone concentration is a result of a lack of pituitary hormone stimulus in this patient?
A
)
Adrenocorticotropic hormone
B
)
Estrogen
C
)
Follicle-stimulating hormone
D
)
Inhibin
E
)
Luteinizing hormone
LH
27
An 18-year-old man with Crohn disease is admitted to the hospital because of a 1-day history of severe abdominal pain and intermittent bloody diarrhea. His temperature is 38°C (100.4°F), pulse is 98/min, and respirations are 18/min. Physical examination shows a draining anal fistula. Treatment with broad-spectrum antibiotics and prednisone, along with intravenous hydration and parenteral nutrition, is initiated. He recovers over the next 3 weeks. In addition to resolving the infection, the most likely mechanism of action of this pharmacotherapy is suppression of which of the following?
A
)
Antibody binding
B
)
Complement activity
C
)
Mast cell degranulation
D
)
Neutrophil function
E
)
T-lymphocyte function
E
28
An 81-year-old woman is admitted to the hospital because of a massive pulmonary embolism from a deep venous thrombosis. Her platelet count is 160,000/mm3. Appropriate pharmacotherapy is started. One week later, her platelet count is 55,000/mm3. The thrombocytopenia was most likely caused by a drug with which of the following mechanisms of action?
A
)
Activates tissue plasminogen
B
)
Interferes with the carboxylation of coagulation factors
C
)
Irreversibly inactivates cyclooxygenase
D
)
Potentiates the action of antithrombin III
E
)
Selectively inhibits factor Xa
DVT- heparin - increases antithrombin 3 activity---> decrease thrombin, Xa
29
A 27-year-old woman is admitted to the hospital because of a 12-hour history of fever and abdominal pain. She has a history of recurrent urinary tract infections. Her temperature is 39°C (102.2°F). Abdominal examination shows tenderness of the right flank. Abdominal x-rays show bilateral staghorn renal calculi. Urinalysis shows a pH of 8, many RBCs, WBCs, and bacteria. The calculi are most likely composed of which of the following in this patient?
A
)
Calcium oxalate
B
)
Calcium phosphate
C
)
Cystine
D
)
Hemoglobin
E
)
Struvite
F
)
Uric acid
Also known as STRUVITE
30
A 34-year-old man is evaluated after becoming lightheaded after running 12 miles of a marathon on a hot day. His pulse is 130/min and his blood pressure is 80/60 mm Hg. Which of the following changes in his autonomic nervous system most likely occurred?
Sympathetic Efferent Activity Parasympathetic Efferent Activity
A
)
↑ ↑
B
)
↑ ↓
C
)
↔ ↑
D
)
↔ ↓
E
)
↓ ↑
F
)
↓ ↓
sympathetic increase para decrease
31
A 63-year-old man comes to the physician because of a 3-month history of difficulty sleeping. He indicates that he sleeps better if he sits upright in bed. His pulse is 90/min, and blood pressure is 110/60 mm Hg. Physical examination shows increased jugular venous pressure and mild ankle edema. Which of the following is the most likely cause of the edema in this patient?
A
)
Decreased capillary hydrostatic pressure
B
)
Decreased capillary permeability
C
)
Decreased plasma colloid osmotic pressure
D
)
Increased capillary hydrostatic pressure
E
)
Increased capillary permeability
F
)
Increased plasma colloid osmotic pressure
D, :/
32
A previously healthy 17-year-old girl is brought to the emergency department because of a 1-day history of shortness of breath, weakness, and muscle tenderness. She completed a triathlon the previous day. She appears restless. She is 163 cm (5 ft 4 in) tall and weighs 50 kg (110 lb); BMI is 19 kg/m2. Her temperature is 38°C (100.4°F), respirations are 20/min, and blood pressure is 150/90 mm Hg. Bilateral crackles are heard in the lower lung lobes on auscultation of the chest. Physical examination shows muscle tenderness. Her serum creatinine concentration is 4 mg/dL. Urinalysis shows 3+ protein and 4+ hemoglobin. The most likely cause of this patient's condition is an increased release of which of the following substances?
A
)
Aldolase
B
)
Creatine kinase
C
)
Hemoglobin
D
)
Myoglobin
E
)
Troponin I
myoglobin
33
A 15-year-old girl is brought to the physician by her mother because of a 1-day history of redness and painful skin following sunbathing. She reports that she used sunblock every few hours. She takes no medications. Physical examination shows severe erythema of the back and extremities. There are no blisters. Which of the following best describes her condition?
A
)
Allergic reaction to the sun
B
)
First-degree burn
C
)
Rhus dermatitis
D
)
Second-degree burn
E
)
Third-degree burn
1st degree burn
34
A 5-year-old boy is brought to the physician because of an 8-month history of recurrent middle ear and upper respiratory tract infections. He has a history of impaired motor and cognitive function. Physical examination shows hepatosplenomegaly. Analysis of cultured skin fibroblasts shows the presence of inclusion bodies and a deficiency in the activity of N-acetylglucosamine-1-phosphotransferase. The cells secrete abnormally large amounts of acid hydrolases into the culture medium. These enzymes are unable to target which of the following organelles in this patient?
Lysosomes, I-cell disease
35
A 35-year-old man comes to the physician because of a 3-year history of an enlarging nose, coarsening of his facial features, muscle weakness, and increased hand and foot size. Physical examination shows a large fleshy nose and prognathism. Serum studies show an increased insulin-like growth factor-I concentration. An MRI of the brain shows a pituitary adenoma. Morphologic analysis of a biopsy specimen of the tumor shows a densely granulated somatotroph adenoma. Further studies show that the Gαs subunit of G proteins in the tumor lack GTPase activity. The tumor cells in this patient most likely have an increased activity of which of the following enzymes?
A
)
Adenylyl cyclase
B
)
Guanylyl cyclase
C
)
Janus kinase
D
)
Phospholipase C
E
)
Tyrosine kinase
Adenylyl Cyclase....see gtpase missing so alpha GTP wont breakdown so increased adenylyl cyclase activity
36
A 67-year-old woman comes to the physician for a health maintenance examination. Her brother and mother have a history of colon cancer. The physician recommends colonoscopy, but the patient says that she would prefer only for her stool to be tested for blood. The physician explains that testing the stool for occult blood is not appropriate in this case. The physician is most likely concerned about which of the following regarding this test?
A
)
Low sensitivity
B
)
Low specificity
C
)
Potential for a false-positive result
D
)
Uncertain negative predictive value
E
)
Uncertain positive predictive value
A
37
A 2-year-old boy is brought to the physician because of developmental delay. There is a history of hearing loss in his mother and delayed speech in his older sister. His maternal uncle had stroke-like episodes at the age of 25 years. Physical examination shows ophthalmoplegia and hypotonia. His serum lactic acid concentration is increased. Which of the following best explains the findings in this family?
A
)
Autosomal dominant inheritance
B
)
Decreased penetrance
C
)
Heteroplasmy
D
)
Imprinting
E
)
X-linked recessive inheritance
Answer = C, Heteroplasmy. It's a mitochrondially inherited disorder - the stroke-like episodes and lactic acidosis scattered throughout a family history tip you off. See page 86 of FA 2014.
The specific disorder is probably MELAS -- Mitochondrial Encephalopathy, Lactic Acidosis, and Stroke-like episodes.
38
An animal study is conducted to assess the effects of smoking on pulmonary defense and maintenance mechanisms. For 1 week, normal male rats are exposed to levels of cigarette smoke comparable to those encountered by humans who smoke cigarettes. Results of pulmonary testing are compared with baseline levels obtained the week before the smoke exposure. Which of the following sets of changes is most likely to be observed?
Mucus Alveolar
Production Activity of Macrophage
and Secretion Airway Cilia Function
A
)
↑ ↑ ↑
B
)
↑ ↑ ↓
C
)
↑ ↓ ↓
D
)
↓ ↑ ↑
E
)
↓ ↓ ↑
F
)
↓ ↓ ↓
C
39
A 45-year-old man has fever, chills, dysuria, and a tender, enlarged prostate. Which of the following is the most likely causal organism?
A
)
Adenovirus
B
)
Chlamydia trachomatis
C
)
Escherichia coli
D
)
Pseudomonas aeruginosa
E
)
Ureaplasma urealyticum
C - E. Coli
40
A 4-month-old boy is diagnosed with a rare autosomal recessive skeletal dysplasia involving abnormal endochondral bone formation. Genetic analysis shows null mutations in a gene for a protein that controls the traffic of vesicles into the Golgi complex. Electron microscopy of this patient's cells will most likely show which of the following findings?
A
)
Decreased rough endoplasmic reticulum
B
)
Decreased smooth endoplasmic reticulum
C
)
Dilated rough endoplasmic reticulum
D
)
Increased smooth endoplasmic reticulum
E
)
Large lysosomes
F
)
Small lysosomes
maybe is C since proteins are not able to reach their destination => being degraded in proteasomes. maybe cell will increase synthesis in an attempt to produce the needed proteins
41
A 9-year-old boy is brought to the physician by his mother because of a 1-year history of cough productive of mucoid sputum, wheezing, and shortness of breath with exertion. He has a history of recurrent upper respiratory tract and sinus infections since birth. He is at the 25th percentile for height and weight. The mother says that his younger sibling is beginning to develop similar problems. Physical examination shows mild clubbing of the fingers. Laboratory studies show markedly increased sweat chloride and sodium concentrations. A defect of which of the following in this patient’s bronchial epithelium is most likely causing these symptoms?
A
)
Adrenoreceptors
B
)
Membrane receptors
C
)
Nuclear receptors
D
)
Protein regulation
E
)
Protein structure
CFTR is a PROTEIN (Transmembrane protein) whose structure is altered so Protein Structure
42
A 54-year-old woman with terminal metastatic pancreatic cancer comes to the physician for a follow-up examination. She asks the physician to prescribe her a sufficient quantity of medication to allow her to commit suicide if the pain becomes unbearable. The physician refuses to do so, but he informs the patient that he will do everything he can to manage her pain. The physician's decision in this situation is most consistent with which of the following ethical principles?
A
)
Autonomy
B
)
Beneficence
C
)
Dignity
D
)
Justice
E
)
Nonmaleficence
Nonmaleficience
43
A 20-year-old woman comes to the physician because of severe dysuria and a painful vulvar rash for 2 days. Examination shows vesicular lesions on an erythematous base on the right vulva. Which of the following is the most likely causal organism?
A
)
Candida albicans
G
)
Neisseria gonorrhoeae
B
)
Chlamydia trachomatis
H
)
Parvovirus
C
)
Group B streptococcus
I
)
Treponema pallidum
D
)
Hepatitis B
J
)
Trichomonas vaginalis
E
)
Herpes simplex virus
K
)
Varicella-zoster virus
F
)
Human papillomavirus
HSV
44
A 24-year-old African American man comes to the physician because of a 3-month history of red bumps on his face and chin. He says that the bumps are itchy and painful. Physical examination shows hyperpigmented papules over the cheeks, jawline, and neck. Which of the following is the most likely diagnosis?
A
)
Acne vulgaris
B
)
Cutaneous lupus erythematosus
C
)
Keloids
D
)
Pseudofolliculitis barbae
E
)
Rosacea
Pseudofolliculitis barbae - shaving - africans common
45
A 27-year-old nulligravid woman comes to the physician because of a 24-hour history of pain with urination and increased urinary frequency. She has no history of serious illness and takes no medications. She is sexually active with one partner and takes an oral contraceptive. She does not use condoms. Her temperature is 37°C (98.6°F). Physical examination shows no abnormalities. Pelvic examination shows suprapubic tenderness. Which of the following is the most likely cause of these findings?
A
)
Candida albicans
B
)
Escherichia coli
C
)
Human papillomavirus
D
)
Neisseria gonorrhoeae
E
)
Treponema pallidum
E. coli UTI + PID
46
A 70-year-old woman is found to have persistent fever despite intravenous broad-spectrum antibiotic therapy 3 days after undergoing operative excision of the anterior pelvic organs for recurrent cervical carcinoma. Her temperature is 38.5°C (101.3°F). Physical examination shows the presence of a central venous catheter that was placed on the day of the operation. There is also a well-healing abdominal wound without erythema and with two drains in place. Blood cultures and cultures of the tip of the central catheter on a sheep blood agar plate grow the organism shown in the photograph. A Gram stain of one of the colonies shows 4-μm, elliptical, purple, budding organisms. Which of the following is the most likely causal organism?
A
)
Candida albicans
B
)
Cryptococcus neoformans
C
)
Escherichia coli
D
)
Sporothrix schenckii
E
)
Staphylococcus aureus
CAndida
47
A 32-year-old woman, gravida 4, para 0, aborta 3, delivers a female newborn at term with dysmorphic features and numerous organ anomalies. The mother has had multiple spontaneous abortions, and this is her first liveborn child. Which of the following is the most likely explanation for the abnormalities seen in this newborn?
A
)
Autosomal dominant inheritance
B
)
Autosomal recessive inheritance
C
)
Gonadal mosaicism
D
)
Submicroscopic deletion
E
)
Unbalanced chromosome rearrangement
Unbalanced chromosome rearrangement - trisomies
48
A 39-year-old woman with rheumatoid arthritis comes to the physician for a follow-up examination. Treatment with multiple medications, including prednisone and methotrexate, has not been effective at slowing the progress of her condition. The most appropriate next step in pharmacotherapy is a drug that blocks the effects of which of the following cytokines?
A
)
Interferon gamma
B
)
Interleukin-2 (IL-2)
C
)
IL-4
D
)
IL-10
E
)
Tumor necrosis factor-α
TNF alpha inhibitor - etanercept
49
A 51-year-old woman comes to the physician because of a 6-month history of burning abdominal pain that occurs 1 to 2 hours after eating. She sweats profusely and has light-headedness when she stands. Her blood pressure is 105/70 mm Hg while standing. Physical examination shows epigastric tenderness. A CT scan of the abdomen shows a 2-cm mass on the proximal duodenum. Gastrin released by the tumor cells stimulates which of the following labeled cells in the photomicrograph shown to release hydrogen ions?
CHECK NBME 16 PICS
upcoming, eosinophilic, fried egg, upper layers - was B,
50
A case-control study is conducted to explore a possible association between exposure to an herbicide and the diagnosis of non-Hodgkin lymphoma. Controls are matched to cases by age, gender, and race. Exposure status is determined by interviewing the subjects. On matched-pair analysis, the odds ratio is 3.2 (95% confidence interval: 1.4–5.4). Which of the following is most likely to affect the validity of this study?
A
)
Biased measurement of the condition
B
)
Biased measurement of the exposure
C
)
Confounding by age
D
)
Type I error
E
)
Type II error
B
51
A 16-year-old girl comes to the clinic because of vaginal itching for the past 5 days. She requests that her parents not be informed about the appointment. During the examination, she says she occasionally has unprotected sexual intercourse and asks for oral contraceptives. Preliminary laboratory studies show gram-negative diplococci. Which of the following is the most appropriate next step in patient care?
A
)
Consult a colleague for advice about treating a minor without parental consent
B
)
Discuss with her the need for testing her for other sexually transmitted diseases
C
)
Interview her sexual partners
D
)
Notify her parents of the findings
E
)
Treat her infection and refer her to social services
B
52
A 28-year-old woman is brought to the hospital by her boyfriend because of severe lethargy for 2 hours. Her temperature is 37.1°C (98.7°F), pulse is 110/min, respirations are 24/min, and blood pressure is 126/78 mm Hg. Physical examination shows obtundation. Her serum glucose concentration is 25 mg/dL. She revives immediately upon intravenous administration of 50% dextrose in water. She does not have type 1 or type 2 diabetes mellitus, and she takes no medications. Multiple nonfasting glucose concentration measurements are within the reference range, and results of a 75-g, 2-hour glucose tolerance test show no abnormalities. Corresponding serum insulin concentrations are within the reference range. Six hours later, she is unresponsive. Her serum glucose concentration is 32 mg/dL. She is again resuscitated with 50% dextrose in water. The physician suspects surreptitious use of insulin. Which of the following is the most appropriate next step?
A
)
Confront the patient about the physician's suspicion
B
)
Search the patient's personal belongings for insulin and syringes
C
)
Obtain a psychiatric consultation
D
)
Determine the C-peptide concentration in the latest blood specimen drawn
E
)
Measure hemoglobin A1c
D
53
A 43-year-old man with a 10-year history of alcoholism comes to the physician because of a change in skin color. The patient says that he has been taking two extra-strength acetaminophen tablets every 4 to 6 hours for the past 3 days for a severe headache. Physical examination shows jaundice. Laboratory studies show an increased prothrombin time and a markedly increased serum AST activity. Alteration in which of the following metabolites within hepatocytes is most likely associated with his illness?
A
)
Decreased glucuronide conjugates
B
)
Decreased glutathione
C
)
Decreased NAD+
D
)
Decreased NADH
E
)
Increased glucuronide conjugates
F
)
Increased glutathione
G
)
Increased NAD+
H
)
Increased NADH
B
54
A 32-year-old woman comes to the physician for a follow-up examination after atypical cells were noted on a recent Pap smear. Physical examination shows a 1 x 1-cm area of leukoplakia on the cervix. A biopsy specimen of the lesion shows invasive squamous cell carcinoma. Malignant cells from this site will most likely drain first to which of the following lymph nodes in this patient?
A
)
Femoral
B
)
Inferior mesenteric
C
)
Internal iliac
D
)
Lumbar
E
)
Superficial inguinal
internal iliac
55
A 20-year-old competitive cyclist taking recombinant human erythropoietin has polycythemia. Which of the following is the most likely cause?
A
)
Early release of reticulocytes from bone marrow
B
)
Increased erythrocyte life span
C
)
Proliferation of bone marrow stem cells
D
)
Proliferation of erythroid precursors
D silly
56
A 30-year-old woman with seasonal rhinitis has been treated with therapeutic doses of chlorpheniramine for 4 weeks. Which of the following adverse effects is most likely?
A
)
Atrioventricular block
F
)
Increased blood glucose concentration
B
)
Biliary colic
G
)
Intermittent claudication
C
)
Chronic cough
H
)
Miosis
D
)
Decreased myocardial contractility
I
)
Seizures
E
)
Drowsiness
J
)
Tinnitus
E drowsiness (sedation, muscarinic , alpha blocker)
57
A 71-year-old woman comes to the physician for a follow-up examination. She has a 30-year history of type 2 diabetes mellitus currently treated with insulin. She is 160 cm (5 ft 3 in) tall and weighs 59 kg (130 lb); BMI is 23 kg/m2. Her blood pressure is 116/78 mm Hg. This patient is most likely to have an endogenous fasting serum insulin concentration (N=5–20 μU/mL) closest to which of the following?
A
)
1 μU/mL
B
)
10 μU/mL
C
)
20 μU/mL
D
)
40 μU/mL
E
)
80 μU/mL
A progressive beta cell failure
58
A 47-year-old man is admitted to the hospital for treatment of a myocardial infarction. On admission, pulse oximetry on 30% oxygen shows an oxygen saturation greater than or equal to 95%. Three hours later, the patient develops shortness of breath. Pulse oximetry now shows an oxygen saturation of 90%. Crackles are heard at the lung bases, and a grade 2/6 systolic murmur is heard. Arterial blood gas analysis on 30% oxygen shows:
pH 7.41
Pco2 36 mm Hg
Po2 60 mm Hg
Which of the following is the most likely cause of this patient's hypoxemia?
A
)
Decreased alveolar ventilation
B
)
Decreased erythrocyte transit time in pulmonary capillaries
C
)
Decreased lymphatic drainage
D
)
Increased permeability of pulmonary capillaries
E
)
Increased plasma colloid osmotic pressure
F
)
Increased pulmonary capillary pressure
F
59
A 32-year-old man has a 3-month history of episodic epigastric cramping that awakens him at night and is sometimes relieved by eating. He smokes 1 pack of cigarettes and drinks 3 cups of coffee daily. Serologic testing shows Helicobacter pylori for which he receives antibiotic treatment. Which of the following lifestyle changes is most likely to decrease recurrence of these symptoms?
A
)
Decrease intake of caffeine and fatty foods
B
)
Decrease smoking
C
)
Eliminate dietary lactose
D
)
Eliminate whole wheat bread and cereals
E
)
Increase dietary lactose
F
)
Increase intake of whole wheat bread and cereals
smoking - whenever a patient with peptic ulcer say no smoking
60
An investigator is studying the age of patients when they undergo their first colonoscopy at a local physician's practice. The following are the ages of the first 10 patients analyzed: 50 years, 50 years, 50 years, 51 years, 52 years, 58 years, 65 years, 65 years, 75 years, and 84 years. Which of the following best represents the mean of this subpopulation?
A
)
50 years
B
)
55 years
C
)
60 years
D
)
65 years
E
)
70 years
C (be careful in calculations)
61
A 4-year-old boy is brought to the physician by his father because of a 2-month history of progressive weakness and loss of muscle function. He has had difficulty running, climbing stairs, and rising from a sitting position. Physical examination shows hypertrophy of the calf muscles. Serum studies show a markedly increased creatine kinase activity. The most likely cause of these findings is a defective or absent protein in which of the following areas of muscle?
A
)
Cytoskeleton
B
)
Endoplasmic reticulum
C
)
Golgi apparatus
D
)
Mitochondria
E
)
Nucleolus
F
)
Nucleus
pseudohypertrophy - duchhenne - dystrophin binds cytoskeletal actin to transmembrane proteins alpha and beta dystroglycan
62
A 2-month-old girl is brought to the physician for a follow-up examination 2 days after a complete blood count was found to be abnormal. Her blood group is A, Rh-positive. She was born at term to a healthy 23-year-old woman whose blood group is O, Rh-positive. Birth weight was 3890 g (8 lb 9 oz). Pregnancy and delivery were uncomplicated. The patient has been active and feeding well. Her temperature is 37.6°C (99.7°F), pulse is 120/min, and respirations are 30/min. Physical examination shows no abnormalities. Laboratory studies done since birth are shown.
Patient Age
24 Hours 1 Week 1 Month
Hemoglobin (g/dL) (N=11−15) 16.9 15.7 12.7
Hematocrit (%) (N=28−45) 51 49 39
Leukocyte count (/mm3) (N=5000−19,500) 17,200 15,600 12,900
Segmented neutrophils 4% 3% 5%
Eosinophils 4% 4% 2%
Basophils 4% 2% 1%
Lymphocytes 69% 73% 77%
Monocytes 19% 18% 15%
Platelet count (/mm3) (N=150,000−400,000) 185,000 198,000 205,000
Which of the following is the most likely diagnosis?
A
)
Alloimmune hemolytic disease of the newborn
B
)
Congenital cytomegalovirus infection
C
)
Congenital neutropenia
D
)
DiGeorge syndrome
E
)
Severe combined immunodeficiency
apparently C
63
A 50-year-old man comes to the physician for a routine health maintenance examination. Physical examination shows a firm thyroid nodule. The neoplasm is resected; histologic sections show sheets of granular cells embedded in a hyaline stroma. Immunohistochemical stains show the presence of cytoplasmic calcitonin. Which of the following is the most likely type of carcinoma?
A
)
Anaplastic
B
)
Follicular
C
)
Giant cell
D
)
Medullary
E
)
Papillary
Sheets of cells in amyloid stroma, calcitonin - MEDULLARY - MEN 2A 2B (RET gene)
64
A 75-year-old woman comes to the physician because of a 3-month history of an enlarging lesion on her face. Physical examination shows a 1.5-cm, brown-black, mottled, scaly lesion with irregular borders. Microscopic examination of a biopsy specimen of the lesion shows atypical melanocytes spread along the basilar layer of the epidermis. Which of the following is the most likely cause of these findings?
A
)
Acanthosis nigricans
B
)
Actinic keratosis
C
)
Compound nevus
D
)
Lentigo maligna
E
)
Seborrheic keratosis
Lentigo Maligna - Melanoma - irregular border >6mm, variable colour, superficial spread, sun exposed areas, asymmetry
Resectable
unresectable v600re mutation - vemurefenib
65
A newborn undergoes surgical repair of esophageal atresia. Pathologic examination of resected tissue shows that the esophagus is fibrotic and has no lumen. Which of the following embryonic germ layers is the most likely origin of the cells that fill the lumen?
A
)
Endoderm
B
)
Intermediate mesoderm
C
)
Neural crest
D
)
Paraxial mesoderm
E
)
Surface ectoderm
endoderm produces linings of hollow organs
66
A 50-year-old man comes to the physician because of a 2-week history of progressive shortness of breath while climbing stairs to his office every morning. He reports no other problems, but he is concerned because his father had a major myocardial infarction at the age of 52 years. His pulse is 110/min and regular, respirations are 16/min, and blood pressure is 135/95 mm Hg. The lungs are clear to auscultation. Cardiac examination shows normal heart sounds with a physiologic split of S2. Stress echocardiography shows hypokinesis of the posterior left ventricle with increasing activity levels. Which of the following is the most likely cause of the posterior left ventricular findings in this patient?
A
)
Disruption of the sympathetic nerves to the left ventricle
B
)
Extravascular compression of the coronary arteries
C
)
Increased left ventricular end-diastolic pressure
D
)
Increased myocardial oxygen consumption
E
)
Stenosis of the right coronary artery
E
67
A 20-year-old woman comes to the physician because her menstrual period is 1 week late. Menses had occurred at regular 28-day intervals. She had unprotected sexual intercourse with her boyfriend 20 days ago. A urine pregnancy test result is positive. Which of the following best describes the stage of development of the embryo at this time?
A
)
The cytotrophoblast is present, but the syncytiotrophoblast has not yet formed
B
)
Gastrulation is complete, but there are only two germ layers
C
)
The neural plate is present, but the neural tube is not yet complete
D
)
Placental development is complete, but the embryo is resistant to teratogens
E
)
The sclerotome cells have begun migrating, but the somites have not yet formed
neural tube forms 3- 4weeks completed, neural crest is formed by 3rd week, Gastrulation 3rd week, 3 layers
68
An 18-year-old man comes to the physician because of a 1-year history of progressive headaches. An x-ray of the head shows a cystic tumor above the sella turcica. The serum concentration of which of the following hormones is most likely to be increased in this patient?
A
)
ADH (vasopressin)
B
)
Adrenocorticotropic
C
)
Follicle-stimulating
D
)
Growth
E
)
Luteinizing
F
)
Prolactin
G
)
Thyroid-stimulating
This is a craniopharyngeoma. Slow growing tumor of tissue descended from Rathke's pouch. If they are left to grow, they can eventually compress the pituitary stalk, which can physically block releasing hormones from the hypothalamus from reaching the pituitary. This can result in blocking Dopamine from reaching the anterior pituitary, leading to an overproduction of Prolactin.
69
A 13-year-old boy is scheduled to receive chemotherapy for a leukemia that has the histologic features of malignant lymphocytes. This neoplasm is further typed for cell surface and intracellular markers specific for lymphocyte subsets. The neoplastic cells do not express the following markers: CD4, CD8, surface IgM, surface IgG, cytoplasmic IgM and μ-heavy chain, cytoplasmic IgG, and γ-heavy chain. The leukemic cells express class I MHC molecules and show rearrangement of the T-lymphocyte receptor β-chain gene D and J segments. Which of the following is the normal counterpart of these malignant lymphocytes?
A
)
Activated cytolytic effector T lymphocytes in the circulation
B
)
Mature IgM-secreting B lymphocytes in the lymph node
C
)
Mature immunoglobulin-secreting plasma cells in the lymph node
D
)
Pre-B lymphocyte progenitor of mature B lymphocytes in the bone marrow
E
)
T-lymphocyte thymocytes localized to the thymic cortex
E
70
A 32-year-old man is brought to the emergency department in a coma. Drug overdose is suspected. Pulse is 68/min, respirations are 8/min and shallow, and blood pressure is 130/78 mm Hg. Lung fields are clear on percussion and auscultation. Heart rate is regular with normal heart sounds. Which of the following sets of arterial blood values determined while the patient is breathing room air is most likely?
Po2 Pco2 HCO3−
pH (mm Hg) (mm Hg) (mEq/L)
A
)
7.15 30 30 10
B
)
7.28 50 60 27
C
)
7.40 30 40 24
D
)
7.40 80 70 42
E
)
7.50 80 30 24
B
71
A 4-year-old boy with a karyotype of 47,XY+21 develops pancytopenia, lethargy, numerous bruises, pallor, and fever. Subsequent examination of the bone marrow is most likely to show which of the following?
A
)
Aplasia
B
)
Excess lymphoblasts
C
)
Megaloblastosis
D
)
Parvovirus inclusions
E
)
Ringed sideroblasts
Downs so ALL so excess lympho
72
A male newborn is delivered at term with a right-sided aortic arch. Physical examination shows full cheeks, low-set ears, and a small chin. Serum studies show a decreased calcium concentration. Which of the following is the most likely site of the malformations in this patient?
A
)
First and second branchial arches
B
)
First and second branchial grooves
C
)
First and second branchial pouches
D
)
Third and fourth branchial arches
E
)
Third and fourth branchial grooves
F
)
Third and fourth branchial pouches
F 3 4 branchial pouches digeorge cardiac abnormalities, parathyroid aplasia - calcium decreased
73
A 25-year-old woman comes to the physician because of general malaise and a facial rash for 1 week. She has a 10-year history of episodes of pleurisy and arthritic pain in peripheral joints. Physical examination shows an erythematous malar rash that does not involve the nasolabial folds. Results of cardiolipin antibody, anti-dsDNA, and anti-Sm antibody assays are positive. Which of the following hematologic abnormalities is most likely in this patient?
A
)
Hemolytic uremic syndrome
B
)
Macrocytic anemia
C
)
Multiple nucleated erythrocytes
D
)
Rouleaux formations
E
)
Thrombocytopenia
SLE cytopenias - thrombocytopenia
74
A 27-year-old woman comes to the physician because of a 1-month history of shortness of breath with exertion and swelling of her legs. Her pulse is 90/min, respirations are 22/min, and blood pressure is 120/80 mm Hg. Cardiac examination shows an S3 and a displaced apical impulse. A chest x-ray shows marked cardiomegaly and Kerley B lines. Echocardiography shows an ejection fraction of 29% (N>55%). Which of the following is the most likely diagnosis?
A
)
Amyloidosis
B
)
Aortic insufficiency
C
)
Constrictive pericarditis
D
)
Dilated cardiomyopathy
E
)
Hypertension
Dilated Cardiomyopathy
75
A 45-year-old man comes to the physician for a follow-up examination 2 weeks after beginning treatment with hydrochlorothiazide for hypertension. He says that he feels faint, light-headed, and dizzy when he gets out of bed and when he rises from a seated position too quickly. His pulse is 75/min, respirations are 12/min, and blood pressure is 130/85 mm Hg while supine. Physical examination shows no abnormalities. Which of the following sets of changes best characterizes changes in the cardiovascular system as this man goes from the supine to the standing position?
Carotid Sinus Cerebral
Venous Return Baroreceptor Activity Blood Flow
A
)
↑ ↑ ↑
B
)
↑ ↑ ↓
C
)
↑ ↓ ↑
D
)
↑ ↓ ↓
E
)
↓ ↑ ↑
F
)
↓ ↑ ↓
G
)
↓ ↓ ↑
H
)
↓ ↓ ↓
E, cerebral blood flow is increased
76
A 23-year-old woman comes to the physician because of a 3-day history of a drooping right eyelid. She also has a 2-week history of visual discomfort when in a room with bright lights. On examination, the right pupil is larger than the left; it also seems like the right eye is looking somewhat down and to the right. These findings most likely suggest dysfunction to which of the following structures?
A
)
Abducens nerve
B
)
Medial longitudinal fasciculus
C
)
Oculomotor nerve
D
)
Right superior cervical ganglion
E
)
Trochlear nerve
C - occulomotor
77
An investigator is designing a study to compare a new behavioral program for attention-deficit/hyperactivity disorder (ADHD) with the standard behavioral modification program for this disorder. Because ADHD is more common among boys, girls and boys are randomized into the two treatment groups separately. Which of the following types of treatment allocation is most likely being used in this study?
A
)
Alternation
B
)
Open
C
)
Outcome-adapted
D
)
Simple random assignment
E
)
Stratification
E
78
A 23-year-old woman is brought to the emergency department by her roommate because she was found unresponsive on the living room floor. Examination shows constricted pupils and stupor. Which of the following substances is most likely responsible for these effects?
A
)
Amphetamine
B
)
Androstenedione
C
)
Caffeine
D
)
Cocaine
E
)
Heroin
F
)
LSD
G
)
Marijuana
H
)
Nicotine
I
)
Phencyclidine (PCP)
opiois heroine
79
A previously healthy 26-year-old woman comes to the physician because of a 1-day history of severe rectal pain with no bleeding. She takes no medications and does not smoke cigarettes or drink alcohol. She has been sexually active, and she and her partner use condoms inconsistently. A photograph of the rectal area is shown. Which of the following is the most likely diagnosis?
A
)
Anal carcinoma
B
)
Anal fissure
C
)
External hemorrhoid
D
)
Human papillomavirus infection
E
)
Skin tag
External hemorrhoids
80
A 36-year-old man who is heterozygous for an LDL-receptor deficiency has a total serum cholesterol concentration of 330 mg/dL. After taking a drug that inhibits cholesterol synthesis, his total serum cholesterol concentration decreases to 200 mg/dL. Which of the following proteins would be upregulated as a result of drug therapy?
A
)
Cholesterol acyltransferase
B
)
Hepatic lipase
C
)
LDL receptor
D
)
Lipoprotein lipase
E
)
Lysosomal cholesterol esterase
Answer is C.
Statin drugs upregulate LDL receptors to help increase the Liver take of Cholesterol.
They are only asking about the mechanism of action of Statins, not whether his body would reproduce LDL receptors becasue of Type 2 Hypercholesterolemia.
Also in Type 2... they have either absent of LDL receptors, or decreased LDL receptors.
81
A 65-year-old man with a history of ischemic heart disease comes to the physician because of fatigue and pain and swelling in his legs. His blood pressure is 135/80 mm Hg and pulse is 80/min. End-systolic volume is 80 mL and end-diastolic volume is 120 mL. Which of the following best represents the ejection fraction in this man?
A
)
25%
B
)
33%
C
)
36%
D
)
40%
E
)
50%
F
)
67%
EF= EDV- ESV/EDV so B
82
A healthy 25-year-old man participates in a study of muscle function. The electrophysiologic observations made on a muscle biopsy specimen are shown. Via iontophoresis, 1 μM acetylcholine (ACh) was applied to the muscle surface. Extracellular Ca2+ concentration was decreased to prevent end-plate potentials from acting as a suprathreshold for muscle action potentials.
epp Amplitude mepp Amplitude Response (in mV) to ACh
(in mV) (in mV) (1 μM)
Normal muscle 10 1 1
epp=end-plate potential; mepp= miniature epp
Based on these findings, which of the following electrophysiologic characteristics is expected in a muscle biopsy specimen from a patient with acute botulism?
epp Amplitude mepp Amplitude Response (in mV) to ACh
(in mV) (in mV) (1 μM)
A
)
1 0.5 0.5
B
)
1 1 1
C
)
2 0.2 0.2
D
)
5 0.2 0.1
E
)
15 1 1
botulinum toxin effects the release of ach in response to action potential that is it effects the synaptic vesicle to fuse with the pre synaptic membrane and release its neurotransmitter into the synaptic cleft,therefore in presence of botulinum toxin whatever may be the stimulus there will be no action potential (EPP)
however there is constant leak of ach which occurs in the synaptic which is very small to cause action potential,this potential is called miniature end plate potential(MEPP) which is not affected by the toxin.hence it remains the same in the presence as well as in the absence
so therefore the best choice is bbb
83
A 43-year-old man comes to the physician because of progressive shortness of breath during the past year. He is a stockbroker and has had no environmental exposure to toxins. When asked about his smoking habits, he says he smoked marijuana in college and afterwards, until the age of 28 years. He has not smoked any substance since then. He was adopted as a child and does not know his family history. His respirations are 29/min. Diffuse wheezing is heard on auscultation of the chest. Abdominal examination shows mild hepatomegaly. Pulmonary function tests show a decreased FEV1 and decreased diffusing capacity. A chest x-ray shows hyperinflation consistent with air trapping mostly in the lung bases. A CT scan of the chest is shown. Which of the following is the most likely cause of these findings?
A
)
Asthma
B
)
Continuous marijuana use
C
)
Diffuse idiopathic interstitial fibrosis
D
)
History of smoking marijuana sprayed with a toxic herbicide
E
)
Inherited protease deficiency
Putting my money on the inherited protease deficiecy. Air trapping, decreased FEV1, and decreased diffusion capacity due to reduced surface area make me think of COPD but since he hasn't smoked any tobacco, would expect inherited alpha 1 antitrypsin deficiency. Makes sense with the hepatomegaly too. Can do a PAS stain and look for eosinophilic inclusions
84
A 24-year-old woman is admitted to the hospital because of acute pain in the left lower quadrant of the abdomen. She has leukocytosis and an increased human chorionic gonadotropin concentration. A photograph of the surgically removed specimen is shown. Which of the following is the most likely diagnosis?
A
)
Papillary carcinoma of the ovary
B
)
Ectopic pregnancy
C
)
Hydatidiform mole
D
)
Choriocarcinoma invading myometrium
E
)
Endometriosis
Ectopic, acute pain lower quadrant beta hcg risen so
85
A 67-year-old man comes to the physician because of a 2-month history of pain in his feet. The discomfort is more severe in bed at night and is relieved by taking a hot bath. He has type 2 diabetes mellitus treated with glipizide. His pulse is 60/min, respirations are 12/min, and blood pressure is 130/88 mm Hg. Strength is normal and symmetric in the distal and proximal upper and lower extremities. The Achilles deep tendon reflexes are decreased, and quadriceps deep tendon reflexes are normal. Sensation to pinprick and vibration is decreased from just above the ankles distally. This patient is most likely to describe his pain as which of the following?
A
)
Aching
B
)
Burning
C
)
Colicky
D
)
Cramping
E
)
Sharp
F
)
Squeezing
Aching
86
A 14-year-old boy has had fatigue, intermittent right lower quadrant abdominal pain, diarrhea, and a 5-kg (11-lb) weight loss over the past 6 months. A diagnosis of inflammatory bowel disease limited to the terminal ileum is made. Absorption of which of the following is most likely to be impaired in this patient?
A
)
Folic acid
B
)
Iron
C
)
Vitamin B1 (thiamine)
D
)
Vitamin B2 (riboflavin)
E
)
Vitamin B12 (cobalamin)
B12
87
An investigator wishes to test the hypothesis that a number of CD44 splice variants correlate with aggressive disease progression and risk of relapse in patients with Hodgkin disease, especially if the variant protein CD44v10 is expressed. The investigator plans to retrospectively screen archives of fresh frozen tissue and paraffin-embedded biopsy specimens from documented Hodgkin disease patients. Assuming the necessary reagents are available, which of the following methods would be the most effective in screening the archives for the variant protein?
A
)
Affinity column chromatography
B
)
Density gradient centrifugation
C
)
Immunohistochemistry
D
)
Northern blot
E
)
Polymerase chain reaction (PCR)
F
)
Reverse transcriptase PCR
G
)
Southern blot
Immunohistochemistry or IHC refers to the process of detecting antigens (e.g., proteins) in cells of a tissue section by exploiting the principle of antibodies binding specifically to antigens in biological tissues.[1] IHC takes its name from the roots "immuno," in reference to antibodies used in the procedure, and "histo," meaning tissue (compare to immunocytochemistry). The procedure was conceptualized and first implemented by Dr. Albert Coons in 1941.[2]
Immunohistochemical staining is widely used in the diagnosis of abnormal cells such as those found in cancerous tumors. Specific molecular markers are characteristic of particular cellular events such as proliferation or cell death (apoptosis). IHC is also widely used in basic research to understand the distribution and localization of biomarkers and differentially expressed proteins in different parts of a biological tissue.
88
A 60-year-old man comes to the physician because of a 2-year history of progressive shortness of breath with exertion. His two younger siblings have had similar symptoms. His mother died of dilated cardiomyopathy. Physical examination shows jugular venous distention and ankle edema. There is hepatomegaly. Inspiratory crackles are heard over both lung bases. A chest x-ray shows cardiomegaly and pulmonary congestion; angiography confirms dilated cardiomyopathy. An atrial endocardial biopsy specimen shows abnormal sarcomeres with paracrystalline inclusions in mitochondria. Sequencing of mitochondrial DNA shows a G-to-A transition. This results in an added A:T base pair to the 3′ end of the tRNA, thus shortening the C loop. Which of the following is the most likely effect of this mutation on mitochondrial function?
A
)
Decreased mRNA stability
B
)
Decreased protein synthesis
C
)
Decreased replication
D
)
Increased mRNA stability
E
)
Increased protein synthesis
F
)
Increased replication
T arm or T psi C arm is C loop and T arm helps in trna ribosomal binding so decreased protein sythesis
89
A 22-year-old man comes to the physician because of a 2-year history of episodes of shortness of breath and wheezing. His respirations are 12/min. Physical examination shows no abnormalities. It is found that the symptoms occur after he takes certain over-the-counter medications containing aspirin. Laboratory studies show a serum IgE concentration within the reference range and no eosinophilia. This patient's symptoms are most likely caused by excessive production of which of the following substances?
A
)
Cyclooxygenase
B
)
Hydroxyeicosatetraenoic acid
C
)
Leukotrienes
D
)
Prostacyclin (PGI2)
E
)
Prostaglandins
F
)
Thromboxane A2
Leukotrienes increased
90
An executor of an estate consults with a physician concerning the terms of a will. The deceased woman was a philanthropist who was active in addressing disparities in health care. She designated that a large sum of her money be used to educate the public about the leading cause of death in women. The most appropriate use of this money would be a program addressing which of the following diseases?
A
)
Breast cancer
B
)
Cardiovascular disease
C
)
Cerebral infarction
D
)
Cervical cancer
E
)
Ovarian cancer
CVD is leading cause death, most common cancer in women - breast, fatality Lung>breast>Colo-rectal
91
A 5-year-old boy is brought to the physician by his mother because of progressive clumsiness and fatigue during the past 6 months. He says that his legs are tired. He was delivered at term after an uncomplicated pregnancy. He has met all developmental milestones, although there was some delay compared with other children his age. He is alert. He has difficulty rising from the chair; he uses his arms to push himself into a standing position. He is unable to jump with both feet together. Physical examination shows hypertrophy of the calf muscles. This patient most likely has weak hip adduction as a result of dysfunction of the muscle inserting onto the femur from which of the following locations?
A
)
Anterior sacrum
B
)
Iliac crest
C
)
Iliac spine
D
)
Ischium
E
)
Lateral ilium
ischium
92
A 59-year-old man who has smoked 2 packs of cigarettes daily for 40 years develops an ulcerated laryngeal neoplasm. Examination of tissue obtained on biopsy of the lesion is most likely to show which of the following?
A
)
Adenocarcinoma
B
)
Reactive nodule
C
)
Squamous cell carcinoma
D
)
Squamous papilloma
E
)
Undifferentiated carcinoma
Squamous cell most common laryngeal ca
93
An investigator is studying the human immune response to tumor cell antigens in malignancies. Which of the following sets of cancer types and tumor antigens is most likely to produce the highest antibody titer?
Cancer Type Tumor Antigen
A
)
B-cell lymphoma CD19
B
)
Breast cancer HER2/neu
C
)
Cervical cancer human papillomavirus type 16 E6 protein
D
)
Melanoma tyrosinase
E
)
Prostate cancer prostatic acid phosphatase
only hpv e6 is an example of a foreign protein so will lead to high titre of antibodies rest all are self proteins so poorly immunogenic
94
A screening test is used to detect prostate cancer in a population of 100,000 men. The test has a sensitivity of 70% and a specificity of 90%. The test is then used to screen a second population in which the prevalence of prostate cancer is different. Which of the following is the most likely effect on the positive predictive value of this test?
A
)
Decreases as prevalence increases
B
)
Increases as prevalence decreases
C
)
Increases as prevalence increases
D
)
No change as prevalence changes
increases as prevalance increases
95
A 22-year-old woman comes to the physician 3 months after she noticed a painless, slowly enlarging mass on the left side of her neck. Physical examination shows a freely mobile, soft, cystic mass with a cutaneous surface opening. The physician explains that it is from incomplete fusion during embryonic development. Which of the following is the most likely location of the opening of the duct leading to the mass in this patient?
A
)
Anterior to the sternocleidomastoid muscle
B
)
Midline on the neck
C
)
Postauricular
D
)
Posterior to the parotid gland
E
)
Submental
A - branchial cyst (2nd branchial cleft persists, drains over SCM)
96
A 42-year-old man has an autoimmune disorder resulting in proximal muscle weakness of the lower extremities. Arrows in the photomicrograph shown indicate membranes that contain high concentrations of channels that are targeted by this condition. Which of the following is the most likely diagnosis?
A
)
Multiple sclerosis
B
)
Myasthenia gravis
C
)
Myasthenic (Lambert-Eaton) syndrome
D
)
Periodic paralysis
E
)
Tetany
C
97
A 22-year-old woman comes to the physician for a follow-up examination. One year ago, she was diagnosed with a pulmonary embolism. Two years ago, she delivered a female stillborn at 23 weeks' gestation. Physical examination today shows no abnormalities. Laboratory studies show a platelet count of 250,000/mm3, a prothrombin time within the reference range, and an increased partial thromboplastin time. The findings in this patient are most consistent with which of the following conditions?
A
)
Antiphospholipid antibody syndrome
B
)
Factor V Leiden mutation
C
)
Increased factor VIII (antihemophilic factor) concentration
D
)
Protein C deficiency
E
)
Prothrombin G20210A mutation
AA
Associated with recurrent arterial or venous thrombosis, recurrent spontaneous abortions
98
A 39-year-old woman with end-stage renal disease caused by systemic lupus erythematosus undergoes kidney transplantation from a living, unrelated donor. Despite aggressive immunosuppressive therapy, the transplant is rejected after 6 months. Analysis of a biopsy specimen of the transplant shows numerous infiltrating CD8+ T lymphocytes. Which of the following is the most likely cause of rejection of the transplant in this patient?
A
)
Antibody synthesis
B
)
Complement activation
C
)
Direct cytotoxicity
D
)
Histamine release
E
)
Nitric oxide production
Direct cytotoxicity
99
An 18-year-old woman with mild mental retardation is brought to the physician because of a 3-day history of decreased ability to see in reduced light. She has a lifelong history of chronic diarrhea. Two years ago, she developed a lack of muscle control of her arms and legs, and generalized weakness. Her 16-year-old brother has had similar symptoms. Ophthalmologic examination shows bilateral retinitis pigmentosa. There is ataxia and loss of deep tendon reflexes. Laboratory studies show erythrocytes with spiny projections and a serum total cholesterol concentration of 40 mg/dL. Which of the following apolipoproteins is most likely deficient in this patient?
A
)
Apo A-I
B
)
Apo A-II
C
)
Apo B
D
)
Apo C
E
)
Apo E
c...abetalipoproteinemia ...def of both apoB-48 and apo B-100...leads to def of chylomicron and VLDL and LDL...decreased serum TG and cholesrterol.....malabsorption ----vit A def--night blindness----acanthocytes bcz of vit E def which is a anti oxidant...prevent RBC cell membrane from free radicals...
Report Abuse
100
```
A 51-year-old man comes to the physician because of a 2-week history of cough productive of blood. He also has had a 3-kg (6.6-lb) weight loss during the past month. He has smoked 2 packs of cigarettes daily for 32 years. He has hypertension treated with metoprolol. Physical examination shows clubbing of the fingernails. Wheezes are heard over the right upper lobe anteriorly; there are no crackles. Laboratory studies show:
Serum
Na+ 125 mEq/L
K+ 3.9 mEq/L
Cl– 85 mEq/L
HCO3– 25 mEq/L
Urea nitrogen 8 mg/dL
Creatinine 0.4 mg/dL
Osmolality 262 mOsmol/kg
Urine osmolality 564 mOsmol/kg
```
A CT scan of the chest shows a 2.4 x 1.2-cm, spiculated noncalcified mass in the right upper lobe eroding into the right bronchus. This patient's laboratory findings are most likely caused by an excess of which of the following hormones?
A
)
ADH (vasopressin)
B
)
Adrenocorticotropic hormone
C
)
Brain natriuretic peptide
D
)
Cortisol
E
)
Thyroxine (T4)
A
101
A previously healthy 25-year-old man is admitted to the hospital for treatment of viral pneumonia. He is mechanically ventilated because of respiratory failure due to hypoxemia. An open-lung biopsy specimen is obtained and shows a pattern of acute lung injury. The presence of which of the following in the biopsy specimen most clearly suggests diffuse alveolar damage rather than bronchiolitis obliterans-organizing pneumonia in this patient?
A
)
Alveolar hyaline membrane
B
)
Foamy macrophages
C
)
Interstitial collagen deposition
D
)
Masson bodies
E
)
Uniform fibroblastic proliferation
Alveolar hyaline membranes is indicative of ARDS, which is the only acute process involving diffuse alveolar damage.
102
A 40-year-old woman is brought to the emergency department 30 minutes after sustaining severe chest injuries in a motor vehicle collision. Despite appropriate treatment, she dies 1 hour later. She had a 25-year history of a well-controlled seizure disorder. A photograph of a coronal section of the brain obtained at autopsy is shown. Which of the following is the most likely cause of this patient's seizure disorder?
A
)
Glioblastoma multiforme
B
)
Herpes simplex encephalitis
C
)
Mesial temporal sclerosis
D
)
Neonatal ischemic stroke
E
)
Vascular malformation
Vacular malformation
103
A 49-year-old man with pancreatic cancer undergoes a Whipple procedure to resect the distal stomach, duodenum, and head of the pancreas. During the procedure, the cut end of the remaining stomach is joined to the side of the jejunum (gastrojejunostomy). Which of the following nerve structures can be cut to decrease stomach acid output and decrease the likelihood of ulcers forming in the jejunum at the site of junction with the stomach?
A
)
Celiac plexus
B
)
Iliohypogastric nerves
C
)
Phrenic nerves
D
)
Subcostal nerves
E
)
Sympathetic chain
F
)
Vagal trunks
Vagal trunk
104
A 38-year-old woman at 32 weeks' gestation is brought to the physician because of a 2-day history of fever, nausea, vomiting, and muscle aches. She appears acutely ill. Her temperature is 39°C (102.2°F), pulse is 120/min, and respirations are 20/min. A photomicrograph of a Gram stain of an organism recovered from a blood culture is shown. Which of the following is the most likely causal organism?
A
)
Corynebacterium urealyticum
B
)
Gardnerella vaginalis
C
)
Listeria monocytogenes
D
)
Rhodococcus equi
E
)
Staphylococcus aureus
Listeria :/
105
A 55-year-old man with hepatic encephalopathy is brought to the physician because of confusion and increased lethargy during the past 24 hours. He has a history of cirrhosis of the liver caused by hepatitis C. He is easily arousable despite the lethargy. His temperature is 37°C (98.6°F). Physical examination shows scleral icterus, asterixis, a protuberant abdomen, and ascites. Test of the stool for occult blood is negative. Administration of which of the following drugs is most likely to improve this patient's mental status?
A
)
Bisacodyl
B
)
Docusate
C
)
Lactulose
D
)
Octreotide
E
)
Omeprazole
F
)
Sucralfate
G
)
Ursodiol
Lactulose is used in treating hepatic encephalopathy
106
A 60-year-old man comes to the physician because of weakness and light-headedness for 3 months. His diet consists of a healthy balance of fruits, vegetables, whole grains, and lean chicken and fish. He has a 10-year history of chronic autoimmune (Hashimoto) thyroiditis treated with thyroxine. Physical examination shows pallor. Serum studies show increased concentrations of methylmalonic acid and total homocysteine. A peripheral blood smear shows megaloblastic anemia. Which of the following is the most likely cause of the findings in this patient?
A
)
Cystathionine β-synthase deficiency
B
)
Failure of intrinsic factor production
C
)
Folic acid deficiency
D
)
Helicobacter pylori gastritis
E
)
Methylmalonyl-CoA mutase deficiency
methylmalonyl co a converted to succinyl co A and
Homocystiene to Methionine by VIT B12
So IF def
