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Item: 1 of 46

QID: 3041
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118639 : DR. JITENDRA
A.Adductor pollicis
B.Dorsal interossei
C.Lumbricals (3 and 4)
D.Opponens digiti minimi
E.Opponens pollicis
The correct answer is E. 51% chose this.
This woman has carpal tunnel syndrome, which occurs in individuals whose work involves repetitive hand motions. The median nerve is compressed in the carpal tunnel between the flexor tendons and the
flexor retinaculum, leading to decreased sensation on the first three and one-half digits and loss of strength of the thumb due to weakness of the abductor pollicis brevis and opponens pollicis muscles. The
opponens pollicis is supplied by the median nerve and functions to aid in opposition.
A is not correct. 17% chose this.
The adductor pollicis is innervated by a branch of the ulnar nerve and thus would not be affected by carpal tunnel syndrome. It functions to adduct the thumb toward the middle digits.
B is not correct. 11% chose this.
Dorsal interossei muscles are innervated by a branch of the ulnar nerve, which functions to abduct the digits.
C is not correct. 12% chose this.
The third and fourth lumbricals are innervated by a branch of the ulnar nerve.
D is not correct. 9% chose this.
The opponens digiti minimi muscle is innervated by a branch of the ulnar nerve and brings the fifth digit in opposition with the thumb.
A 50-year-old secretary with no significant past medical history comes to the physician because of numbness and tingling in her hands. Physical examination reveals decreased sensation in all of her
fingers except her fifth digit.
Which of the following muscles is most commonly weakened in patients with this condition?
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Item: 2 of 46
QID: 1278
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118639 : DR. JITENDRA
A.Fibrillin-1
B.Keratin 14
C.Type I procollagen
D.Type III procollagen
A previously healthy 30-year-old woman who performs as a contortionist in the circus is found unconscious in her dressing room. By the time she receives medical attention, she cannot be revived. An
autopsy is performed and an abnormality is discovered in the circle of Willis, as shown in the image. The patient was also reported to have a history of easy bruising and bleeding.
Which of the following proteins was most likely defective in this patient?
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Item: 3 of 46
QID: 1118
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118639 : DR. JITENDRA
A.Alcohol
B.Amphetamines
C.Cocaine
D.Lysergic acid diethylamide
E.Nicotine
F. Phencyclidine
The correct answer is F. 53% chose this.
This patient has taken phencyclidine, or PCP. Patients with PCP intoxication show signs of belligerence, impulsiveness, fever, psychomotor agitation, vertical and horizontal nystagmus, tachycardia, ataxia,
homicidality, psychosis, and delirium. On withdrawal, patients may demonstrate a recurrence of intoxication when the PCP, which was trapped in an ionized form in the acidic gastric lumen, is reabsorbed in
the alkaline duodenum. PCP users will have normal or small pupils. Death can result from a variety of causes, including respiratory depression and violent behavior.
A is not correct. 5% chose this.
Patients presenting with acute alcohol intoxication will show symptoms of disinhibition, emotional lability, slurred speech, ataxia, coma, and blackouts. On withdrawal, they will demonstrate a tremor,
tachycardia, hypertension, malaise, nausea, seizures, delirium tremens, tremulousness, agitation, and hallucinations.
B is not correct. 14% chose this.
Patients presenting with amphetamine intoxication will display psychomotor agitation, impaired judgment, pupillary dilation, hypertension, tachycardia, euphoria, prolonged wakefulness and attention,
cardiac arrhythmias, delusions, hallucinations, and fever. On withdrawal, they will show a post-use "crash" that includes depression, lethargy, headache, stomach cramps, hunger, and hypersomnolence.
C is not correct. 16% chose this.
Patients presenting with acute cocaine intoxication will show symptoms of euphoria, psychomotor agitation, impaired judgment, tachycardia, pupillary dilation, hypertension, hallucinations, paranoid
ideations, angina, and sudden cardiac death. On withdrawal, they will show a post-use "crash" that includes severe depression, hypersomnolence, fatigue, malaise, and severe psychological craving.
A 20-year-old man became very agitated at a party, and as a result was brought to the emergency department. In the waiting room he is belligerent and uncooperative. A physical examination reveals
fever, tachycardia, horizontal nystagmus, hyperacusis, and pupils that are 3 mm in diameter bilaterally.
Which of the following substances is most likely causing the behavioral changes and physical findings exhibited by this patient?
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Item: 4 of 46
QID: 2983
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118639 : DR. JITENDRA
A.Metabolic alkalosis and metabolic acidosis
B.Metabolic alkalosis and respiratory acidosis
C.Metabolic alkalosis and respiratory alkalosis
D.Metabolic alkalosis with respiratory compensation
E.Respiratory alkalosis
F. Respiratory alkalosis with metabolic compensation
The correct answer is D. 63% chose this.
This patient is presenting with only slight alkalemia (normal arterial pH is 7.35-7.45). However, the bicarbonate level is substantially elevated, about 11 mEq/L above normal. This implies that a metabolic
alkalosis is occurring, which can be explained by the patient's recent history of severe protracted vomiting. Vomiting causes a loss of hydrochloric acid from the gastrointestinal tract; this acid must be
replaced, which is done by drawing hydrogen from body stores and leaving bicarbonate behind. Normally with this level of bicarbonate elevation alone, a higher pH would be expected. However, this
patient's partial carbon dioxide pressure (PCO
2
) is elevated to 48 mm Hg. This implies that a normal respiratory compensation has occurred in order to normalize the pH by retaining acid by the formation
of carbonic acid from carbon dioxide. The expected compensation is an increase of 0.7 mm Hg of carbon dioxide for every 1-mEq/L increase in bicarbonate. This patient's bicarbonate level has increased by
about 11 mEq/L, and the PCO
2
has increased by about 8 mm Hg, an appropriate compensation.
A is not correct. 3% chose this.
Vomiting typically induces a metabolic alkalosis due to a loss of hydrogen ions from the stomach, leading to an increase in pH. This leaves an increased bicarbonate concentration (generally >24 mEq/L) in
the bloodstream; therefore this patient does indeed have a metabolic alkalosis. However, some patients present with more than one condition causing an acid-base imbalance, which is known as a
complicated or mixed condition. If a metabolic acidosis were occurring simultaneously (such as in ketoacidosis or diarrhea), the bicarbonate level would be closer to normal because the two processes would
have opposing effects on bicarbonate levels and effectively cancel each other out.
B is not correct. 22% chose this.
An 8-year-old boy presents to the emergency department because of 18 hours of severe vomiting. Arterial blood gas analysis reveals a pH of 7.48, a bicarbonate level of 35 mEq/L, and a partial carbon
dioxide pressure of 48 mm Hg.
Which of the following best describes the acid-base disturbance occurring in this patient?
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Item: 5 of 46
QID: 1850
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118639 : DR. JITENDRA
A.Dengue virus
B.Ebola virus
C.Hantavirus
D.Marburg virus
E.Rhabdovirus
The correct answer is C. 71% chose this.
Hantavirus pulmonary syndrome is a rare viral cause of acute respiratory distress syndrome (ARDS). Hantavirus is a Bunyavirus that has been found in rodents throughout the United States. It is thought to
be transmitted via rodent droppings and saliva.
A is not correct. 6% chose this.
Dengue virus is an Aedes mosquito-transmitted virus that causes a hemorrhagic fever. It is found in tropical regions of Asia and has spread to South and Central America. Patients present with rash and
bleeding from mucous membranes.
B is not correct. 8% chose this.
Ebola virus and Marburg virus are members of the Filovirus genus, which cause hemorrhagic fever. Both are found only in central and southern Africa. They have an animal reservoir that has not been
found. Treatment is supportive, and symptoms include massive hemorrhage from the mucous membranes accompanied by high fevers.
D is not correct. 5% chose this.
Ebola virus and Marburg virus are members of the Filovirus genus, which cause hemorrhagic fever. Both are found only in central and southern Africa. They have an animal reservoir that has not been
found. Treatment is supportive, and symptoms include massive hemorrhage from the mucous membranes accompanied by high fevers.
E is not correct. 10% chose this.
Rhabdovirus is the causative agent of rabies. It is possible to become infected with rabies from a rodent; however, the incubation period is much longer (weeks to a year), and the later stages of the
A 27-year-old man dies of acute respiratory distress syndrome 1 day after presenting to the hospital with shortness of breath and a fever of 38C (100.4F). On the second hospital day, he developed
extreme pulmonary edema and hypotension before he died. His family says that he had recently gone hiking and caving in an area known to be heavily populated with rodents.
Which of the following is the most likely cause of death in this patient?
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Item: 6 of 46
QID: 3586
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118639 : DR. JITENDRA
A.Atrioventricular accessory tract
B.Atrioventricular nodal re-entry
C.Tetralogy of Fallot
D.Ventricular hypertrophy
E.Ventricular tachycardia
The correct answer is A. 58% chose this.
The patient likely has an abnormal atrial re-entrant tract that bypasses the atrioventricular (AV) node and goes straight from the atrium to the ventricle. That is why the AV nodal block medication would
not work and instead provided an unopposed pathway for the abnormal tract . The syndrome resulting from the presence of an accessory tract is Wolff-Parkinson-White.
B is not correct. 25% chose this.
An abnormal tract through the AV node likely would be ablated if the patient were given an antiarrhythmic that blocked the AV node.
C is not correct. 7% chose this.
Tetralogy of Fallot usually does not lead to arrhythmias.
D is not correct. 4% chose this.
Hypertrophic cardiomyopathy indeed may lead to ventricular fibrillation and sudden death, but a more common presentation would be a previously healthy adolescent who suddenly collapses under extreme
exertion (eg, during a sports game).
E is not correct. 6% chose this.
Ventricular tachycardia is not a congenital heart defect. Rather, it is usually the result of other heart disorders, such as acute myocardial infarction, scar from an old infarct, long-QT syndrome, or electrolyte
abnormalities.
A 9-year-old girl is brought to the emergency department with an arrhythmia that started while she was sitting in class. Since birth she has had a disorder that predisposes her to arrhythmias, but
because her parents were not present, the hospital staff was unable to determine her medical history. The staff attempts to treat the patient with an atrioventricular nodal block antiarrhythmic, which
does not cure the problem and instead makes it worse.
What congenital pathophysiology could this girl have had?
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Item: 7 of 46
QID: 3088
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118639 : DR. JITENDRA
A.Germinal center
B.Medullary cords
C.Medullary sinuses
D.Paracortex
E.Primary follicle
The correct answer is D. 76% chose this.
The abnormal development of the third and fourth branchial pouches in embryology results in a congenital T-lymphocyte deficiency known as DiGeorge's syndrome. Patients with this syndrome present with
hypoplasia of the thymus and parathyroid glands as well as with facial and cardiac abnormalities. Clinically, patients present with recurrent fungal and viral infections as well as with tetany due to the
hypocalcemia that accompanies hypoparathyroidism. With a deficiency of T lymphocytes, the T cell-dependent lymph node structure is affected as well. Therefore, one would expect to see the paracortex
least developed, as this is the lymph node compartment that houses T lymphocytes as they await antigen presentation and subsequent B lymphocyte activation.
A is not correct. 12% chose this.
A follicle that has a central pale area is called a germinal center and consists of actively proliferating B lymphocytes. The pallor is generated because when actively proliferating, the chromatin of the B
lymphocytes is unraveled, allowing replication, and is therefore lacking the condensed nature that contributes to the dark centers of the dormant follicles. Both primary follicles and germinal centers are B
cell-dependent regions of lymph nodes and are therefore normally developed in people with DiGeorge's syndrome.
B is not correct. 4% chose this.
The medullary cords consist primarily of plasma cells in their final stage of maturation into immunoglobulin-secreting cells. This area, normally devoid of T lymphocytes, would therefore be normally
developed in a patient with DiGeorge syndrome.
C is not correct. 4% chose this.
The patient has evidence of a chromosome 22 deletion, which is associated with DiGeorge's syndrome. This syndrome is characterized by the abnormal development of the third and fourth branchial
pouches during embryogenesis, resulting in a congenital T-lymphocyte deficiency. Patients with DiGeorge's syndrome present with hypoplasia of the thymus and parathyroid glands as well as with facial and
cardiac abnormalities. They also have recurrent fungal and viral infections as well as tetany due to the hypocalcemia that accompanies hypoparathyroidism. With a deficiency of T lymphocytes, the T
A 7-month-old boy presents to the emergency department because of an infection. It is his sixth infection, and further work-up reveals hypocalcemia and a cardiac anomaly.
Which compartment of his lymph nodes is most likely to be the most underdeveloped?
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Item: 8 of 46
QID: 5219
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A patient dies and his colon is examined at autopsy (see image). During his life he had episodes of painless rectal bleeding, as well as one episode of severe left lower quadrant pain requiring
hospitalization. No surgical interventions were performed upon his colon, and he died of nongastrointestinal causes.
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Item: 9 of 46
QID: 4866
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118639 : DR. JITENDRA
A.Anticipation
B.Heteroplasmy
C.Imprinting
D.Incomplete penetrance
E.Locus heterozygosity
F. Mosaicism
G.Uniparental disomy
The correct answer is A. 64% chose this.
This patient has fragile X syndrome, the second most common genetic cause of mental retardation. Physical abnormalities associated with it include macro-orchidism, a long face with a large jaw, and large
everted ears. Fragile X syndrome is caused by an X-linked defect affecting the methylation and expression of the FMR1 gene. The mutation is a triplet repeat (CGG). Like other triplet repeat disorders,
fragile X may show genetic anticipation, the phenomenon in which the severity of a disease worsens in succeeding generations, in this case due to the expanding repeat. Other disorders arising from a
similar mechanism include Huntington''s disease and myotonic dystrophy.
B is not correct. 6% chose this.
Heteroplasmy describes the presence of both normal and mutated mitochondrial DNA. This phenomenon is responsible for the variable expression of mitochondrial inherited diseases.
C is not correct. 5% chose this.
Imprinting is when the phenotype differs depending on whether the mutation is of paternal or maternal origin. This occurs when only one allele is active at a single locus, resulting in disease if the active
allele is deleted. The classic example is Prader-Willi syndrome and Angelman's syndrome. Deletions in Prader-Willi syndrome occur on the paternal chromosome 15, whereas deletions at the same site of
chromosome 15 on the maternal chromosome result in Angelman's syndrome, a phenotypically distinct disorder.
An 11-year-old boy with mental retardation presents for his annual check-up. The physician notes a number of abnormalities on physical examination, including an unusually long face, large jaw, large
everted ears, and macro-orchidism. A family history reveals that the child's uncle has the same condition, but the child's case is more severe than his uncle's.
This is an example of which specific genetic phenomenon?
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Item: 10 of 46
QID: 1547
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118639 : DR. JITENDRA
A.It will be high because of a low prevalence
B.It will be high because of high accuracy
C.It will be low because of a bias
D.It will be low because of a low prevalence
E.It will be low because of low accuracy
The correct answer is D. 65% chose this.
As the disease prevalence decreases, the likelihood of a positive test being a true-positive decreases. In diseases with very low prevalence, a positive test is more likely a false-positive. In this case, if the
prevalence was 1:1,000,000, and the sensitivity and specificity are both 99%, then performing the test on 100,000,000 people will yield 99 true-positives and 999,999 false-positives, for a positive
predictive value of approximately 0.00009.
A is not correct. 13% chose this.
As disease prevalence decreases, the positive predictive value will decrease, not increase.
B is not correct. 18% chose this.
Accuracy measures validity and not reliability, but it changes between different tests instead of between prevalences. Positive predictive value is a measure that changes as prevalence changes.
C is not correct. 3% chose this.
There is no reason to suspect bias in this test. Bias would imply that the information given is inaccurate.
E is not correct. 1% chose this.
Accuracy measures validity and not reliability, but changes between different tests instead of between prevalences. Positive predictive value is a measure that changes as prevalence changes
Kabuki make-up syndrome (KMS, or Niikawa-Kuroki syndrome) is a very rare genetic disorder of unknown cause that presents in neonates as mental retardation, unusual skin ridging in the hands,
fingers, and toes, and an everted lower eyelid. Estimates of worldwide prevalence range from 1:100,000 to 1:10,000,000.
If a new genetic test for KMS were developed that had a sensitivity of 98% and a specificity of 97%, what positive predictive value would be expected of this test?
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Item: 11 of 46
QID: 4045
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118639 : DR. JITENDRA
A.Celiac sprue
B.Crohn's disease
C.MALToma
D.Ulcerative colitis
E.Whipple's disease
The correct answer is E. 80% chose this.
The cause of these four common symptoms (arthralgias, weight loss, diarrhea, and abdominal pain) is Tropheryma whipplei, which can exist throughout the intestinal tract, lymphoreticular system, and
central nervous system as a result of exposure to soil microbes. This is a gram-positive, non-acid-fast, periodic acid-Schiff (PAS)-positive bacillus with a recognizable trilaminar plasma membrane . Biopsy of
the lamina propria shows accumulation of macrophages with brightly stained PAS-positive intracellular material.
A is not correct. 8% chose this.
Celiac sprue is an autoimmune disorder of the small intestine. Patients with the disease make autoantibodies to the gluten in wheat and other grains (gliadin). Symptoms include chronic diarrhea,
abdominal pain, and malabsorption. Biopsy of the small intestine in celiac sprue shows flattened villi, decreased brush border enzymes, and lymphocytic infiltration.
B is not correct. 6% chose this.
Crohn's disease is a type of inflammatory bowel disease that has intestinal complications such as chronic diarrhea, malabsorption, and abdominal pain, as well as extra-intestinal symptoms such as rashes
(erythema nodosum), arthritis, and uveitis. Major findings of intestinal biopsy in Crohn's disease include focal ulcerations as well as acute and chronic inflammation.
C is not correct. 3% chose this.
Gastric MALToma (mucosa-associated lymphoid tissue tumor) is a type of lymphoma that is frequently associated with chronic infection with Helicobacter pylori. On biopsy, dense, monotonous, lymphoid
infiltrate in the lamina propria and pale-staining marginal zone B cells surrounding the epithelium are apparent.
D is not correct. 3% chose this.
A 32-year-old man presents with a 3-month history of arthralgias, weight loss, diarrhea with fatty stools, and abdominal pain. After careful observation and testing, his physician obtains a biopsy of the
lamina propria of the small intestine, which shows periodic acid-Schiff-positive material, particularly in macrophages.
What is the cause of this man's symptoms?
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Item: 12 of 46
QID: 2139
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118639 : DR. JITENDRA
A.Astrocytes
B.Ependymal cells
C.Oligodendrocytes
D.Schwann cells
E.T cells
The correct answer is C. 78% chose this.
Multiple sclerosis is a central nervous system (CNS) demyelinating disorder characterized by lesions that are separated by both time and anatomic location in the CNS. The exact etiology is unknown, but
there is evidence supporting a role of autoimmune antibody attack to the CNS myelin-secreting oligodendrocytes. Oligodendrocytes, which are found in the CNS, are involved in myelination of axons.
A is not correct. 4% chose this.
Astrocytes are found in the central nervous system and are involved in regulating the metabolic and structural environment of neurons, including repair and scar formation. Astrocytes are not the primary
cells affected in multiple sclerosis, but they may proliferate in areas of multiple sclerosis lesions in an effort to repair inflammatory damage.
B is not correct. 3% chose this.
Ependymal cells line the ventricles. Disruptions in this cell barrier can cause proliferation of astrocytes nearby, but is not thought to be related to multiple sclerosis.
D is not correct. 13% chose this.
Schwann cells are found in the peripheral nervous system and are involved in myelination of axons. Schwann cells are not the primary cells affected in multiple sclerosis. The morphologic changes in this
disease are limited to the central nervous system.
E is not correct. 2% chose this.
T cells are the primary cells responsible for cellular immunity. It is likely that they are involved in the putative autoimmune attack on the central nervous system in multiple sclerosis, but they are not the
cells primarily damaged in this disease.
A 32-year-old woman comes to the emergency department complaining of sudden blindness. On obtaining a thorough history, it is learned that the patient's right leg has "given out" from time to time,
causing the patient to have episodes of weakness and falling. Periventricular white matter plaques are found on MRI.
Which of the following cells are primarily damaged in the disease that most likely afflicts this patient?
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Item: 13 of 46
QID: 4534
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118639 : DR. JITENDRA
A.Cimetidine
B.Mifepristone
C.Misoprostol
D.Omeprazole
E.Sucralfate
The correct answer is C. 65% chose this.
This patient is pregnant and unknowingly took misoprostol. Misoprostol is a prostaglandin E
1
analog prescribed for NSAID-induced gastric ulcers. In the gastrointestinal tract, misoprostol increases the
secretion of mucus to protect the mucosal lining. It also induces uterine contractions and cervical ripening in pregnant women, which explains its effects as an abortifacient.
A is not correct. 11% chose this.
Cimetidine, a histamine
2
-receptor antagonist, decreases gastrointestinal acid secretion by parietal cells and is used to treat peptic ulcer disease and gastroesophageal reflux. It is not an abortifacient and
does not cause uterine contractions or vaginal bleeding seen in this patient. The most common adverse effects associated with cimetidine are drug interactions because it inhibits the cytochrome P450
enzymes. In addition, it can also cause galactorrhea in women and gynecomastia in men.
B is not correct. 13% chose this.
Mifepristone is a synthetic steroid that acts as a progesterone receptor antagonist. As a result it blocks progesterone, a hormone necessary in pregnancy; the uterine lining sheds and the cervix softens and
dilates. Mifepristone is prescribed for its abortifacient effects. It is not indicated for other reasons, such as NSAID-induced gastric ulcers.
D is not correct. 8% chose this.
Omeprazole is a proton pump inhibitor used to treat gastroesophageal reflux, peptic ulcer disease, and hypersecretory conditions. Omeprazole binds and inhibits H
+
-K
+
-ATPase in the parietal cells of the
stomach. It is metabolized by the hepatic cytochrome P450 enzymes. The most common adverse effects are gastrointestinal: nausea, constipation, diarrhea, and abdominal pain. Omeprazole is not an
A 35-year-old obese woman with rheumatoid arthritis, well-controlled with nonsteroidal anti-inflammatory drugs (NSAIDs), presents to the emergency department complaining of headache and intense
abdominal pain. These symptoms began yesterday after taking several doses of a medication prescribed for her NSAID-induced gastric ulcers. Physical examination is significant only for firmness and
tenderness in the lower abdomen as well as vaginal bleeding. She cannot recall the date of her last menstrual period. The patient is afebrile and a fecal occult blood test is negative.
Which medication prescribed to treat gastric ulcers can cause the patient's symptoms?
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Item: 14 of 46
QID: 5148
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118639 : DR. JITENDRA
A.Hashimoto's thyroiditis
B.Insulinoma
C.Parathyroid tumor
D.Prolactinoma
E.Zollinger-Ellison syndrome
The correct answer is C. 64% chose this.
Intermittent headaches, sweating, and palpitations in an otherwise healthy man are suggestive of a pheochromocytoma, a catecholamine-secreting tumor most commonly found in the adrenal glands.
Episodes are limited in duration, but blood pressure during these events can reach dangerously high levels. High urinary catecholamines, metanephrine, and vanillylmandelic acid confirm the diagnosis.
Pheochromocytomas are associated with parathyroid tumors as part of the multiple endocrine neoplasia (MEN) type II syndrome, which also includes medullary carcinomas of the thyroid.
A is not correct. 8% chose this.
Hashimoto's thyroiditis is an autoimmune disorder resulting in hypothyroidism. Antimicrosomal and antithyroglobulin antibodies are present and diagnostic. During the initial phase of glandular injury, a
transient state of hyperthyroidism may result from cellular rupture. Hashimoto's thyroiditis is not associated with pheochromocytomas.
B is not correct. 8% chose this.
Insulinomas are associated with parathyroid and pituitary tumors as part of the MEN type I complex. Insulinomas are insulin-secreting tumors of the pancreas that produce symptoms due to hypoglycemia.
They are not associated with pheochromocytomas.
D is not correct. 8% chose this.
Prolacintomas are associated with pancreatic tumors (Zollinger-Ellison syndrome, insulinomas, and VIPomas) and parathyroid tumors as part of the MEN type I syndrome. Prolactinomas cause excessive
secretion of prolactin, resulting in secondary amenorrhea in women and galactorrhea. Prolactinomas are not associated with pheochromocytomas.
E is not correct. 12% chose this.
A 45-year-old man goes to his primary care physician complaining of recent headaches. They rarely persist for more than an hour, but are sporadic and often accompanied by sudden sweating and
palpitations. "Doc," he says, "it feels like my heart is racing." Acetaminophen provides minimal relief from the pain. He is afebrile and his blood pressure is 128/70 mm Hg. His physical examination is
unremarkable with the exception of moist palms and pale skin. A urinalysis is notable for elevated metanephrines.
This patient's most likely diagnosis is often associated with which of the following conditions?
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Item: 15 of 46
QID: 2834
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118639 : DR. JITENDRA
A.Fibrosing stroma around normal glandular tissue
B.Large cells with clear "halos"
C.Branching fibrovascular core extending from a dilated duct
D.Parallel arrays of small, monomorphic cells with scant cytoplasm
E.Sheets of pleomorphic cells infiltrating adjacent stroma
The correct answer is A. 80% chose this.
Fibroadenomas are the most common benign breast tumors and usually occur in young women 20-35 years old. They present as small, firm, mobile masses. They are not associated with malignancy
progression. On histology, fibrosing interlobular stroma is seen around normal duct and gland structures. Fibroadenomas are frequently single, well-circumscribed, rubbery, and painless masses. They are
hormone responsive during the menstrual cycle and often become hyalinized and can calcify, mimicking breast carcinomas on mammography. A stable fibroadenoma in a young woman is usually followed
by ultrasonography; however, cytology is indicated if there is any doubt about malignancy or if mass is growing in size.
B is not correct. 5% chose this.
Paget's disease of the breast is a rare manifestation of breast cancer that presents unilaterally with eczematous skin findings associated with underlying ductal carcinomas. The eczematous nipple is due to
the tumor cells disrupting the tight junctions. Paget's cells (cells of the underlying ductal carcinoma) are large cells with halo-like clearings.
C is not correct. 6% chose this.
Intraductal papillomas are benign solitary lesions that line the lactiferous ducts. These masses present in premenopausal women with serosanguinous (serous fluid and/or blood) and unilateral nipple
discharge. Usually the mass undergoes cytology to rule out invasive papillary carcinoma due to the bloody discharge associated with both. These benign masses rarely undergo malignant transformation
and are treated with ice packs, the cessation of breast-feeding, and tight-fitting support bras. If the mass does not subside in a couple weeks, then excision is warranted to avoid abscess formation.
D is not correct. 5% chose this.
Infiltrating lobular carcinomas are identified as irregular masses on palpation or serendipitously on mammography. These cells are found in clusters or in a linear formation; the histological hallmark is a
A 21-year-old woman with no family or personal history of breast cancer presents to the clinic with a small, firm mass in the lower inner quadrant of her right breast. Palpation of the mass reveals the
mass is firm, nontender, and mobile, with no overlying skin changes and no nipple discharge. There is no associated palpable axillary or supraclavicular lymphadenopathy. A urine pregnancy test is
negative.
Which of the following would most likely be found on histological examination of this mass?
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Item: 16 of 46
QID: 3901
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118639 : DR. JITENDRA
A.Bacillus anthracis
B.Bordetella pertussis
C.Chlamydia trachomatis
D.Clostridium tetani
E.Corynebacterium diphtheriae
F. Legionella pneumophila
G.Neisseria gonorrhoeae
The correct answer is B. 55% chose this.
The causative agent of whooping cough, the gram-negative rod Bordetella pertussis. may be cultured from an infected pharynx. A calcium alginate swab should be used because the bacteria do not transfer
well on cotton. From the swab, the organisms are grown on either potato (Bordet-Gengou) agar or Regan-Lowe medium (which is more commonly used today). Since vaccine development, the incidence of
whooping cough in the United States has dropped from several hundred-thousand cases a year to several thousand. Several recent reports, however, suggest that it is still may be a frequent cause of
bronchitis and chronic cough in adults.
A is not correct. 4% chose this.
Bacillus anthracis does not require special culture conditions. A vaccine has been developed against this gram-positive rod, but it is not given as standard practice.
C is not correct. 3% chose this.
Chlamydia trachomatis is an obligate intracellular species and requires co-culture with eukaryotic cells. Again, there is no effective vaccine.
D is not correct. 9% chose this.
The causative agent of tetanus, Clostridium tetani (as well as all clostridial species), requires anaerobic culture conditions for laboratory growth.
Prior to vaccine development, a particular pathogen was highly prevalent in the United States. Culturing it from a site of infection requires swiping with a calcium alginate swab, followed by plating onto
potato agar or Regan-Lowe medium.
What is the organism described?
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QID: 2786
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118639 : DR. JITENDRA
A.Adenylate cyclase
B.Guanylate cyclase
C.Serine kinases
D.Threonine kinases
E.Tyrosine kinases
The correct answer is E. 72% chose this.
The actions of insulin are mediated at the cellular level by binding of the insulin to its receptor followed by autophosphorylation of tyrosine residues on the insulin receptor; this generates a tyrosine kinase
that participates in an intracellular signaling cascade. Inhibition of tyrosine kinase function would preclude downstream signaling and block the physiologic changes associated with insulin action, regardless
of the amount of insulin present in the blood.
A is not correct. 12% chose this.
Adenylate cyclase and its product, cAMP, are involved in numerous important intracellular signaling systems, including the systems that mediate autonomic sympathetic nervous stimulation, ADH action,
renal calcium and phosphate transport, and glucagon action. However, adenylate cyclase and cAMP are not involved in the system that mediates insulin action.
B is not correct. 6% chose this.
Guanylate cyclase and its product, cGMP, are involved in many intracellular signaling systems, including those that mediate the transduction of visual stimuli into electrical signals in the nervous system,
and the relaxation of vascular smooth muscle throughout the body. However, guanylate cyclase and cGMP are not known to be involved in the system that mediates insulin action.
C is not correct. 6% chose this.
Serine kinases are involved in a number of intracellular signaling cascades, but they are not known to be involved in the signaling cascade that mediates insulin action.
D is not correct. 4% chose this.
Threonine kinases are involved in a number of intracellular signaling cascades, but they are not known to be involved in the signaling cascade that mediates insulin action.
A researcher studying type 2 diabetes mellitus is attempting to induce insulin resistance in normal mice.
Inhibition of which of the following would produce this effect?
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QID: 4007
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118639 : DR. JITENDRA
A.Binding D-ala-D-ala portions of cell-wall precursors
B.Binding of the 30S ribosomal subunit
C.Binding of the 50S ribosomal subunit
D.Block cross-linking of the cell wall
E.Formation of intracellular toxic metabolites in bacteria
The correct answer is E. 46% chose this.
This patient presents with symptoms of bacterial vaginosis caused by Gardnerella vaginalis, a pleomorphic gram-variable rod that causes symptoms of genital burning, itching, and a whitish-gray vaginal
discharge with a fishy smell. It is diagnosed by the presence of clue cells under the microscope, which are vaginal epithelial cells covered with bacteria. Treatment is metronidazole, an antimicrobial and
antiprotozoal that acts by inducing the formation of toxic metabolites within the bacterial or protozoal cell. Both an oral formulation and a gel are available for treatment. Clindamycin is the treatment for
the anerobic variant of the bacterium.
A is not correct. 9% chose this.
Vancomycin is an antimicrobial that acts by inhibiting cell wall mucopeptide formation by binding the D-alanine-D-alanyl portion of cell-wall precursors. It is used for serious, gram-positive multi-drug
resistant organisms, including Staphylococcus aureus and Clostridium difficile. It is not used in the treatment of Gardnerella vaginalis.
B is not correct. 13% chose this.
Tetracycline is a bacteriostatic antimicrobial that acts by binding to the 30S ribosomal subunit and preventing the attachment of aminoacyl-tRNA. It is used to treat infections caused by Vibrio cholerae,
Chlamydia, Ureaplasma, Urealyticum, Mycoplasma pneumoniae, Francisella tularensis, Helicobacter pylori, Borrelia burgdorferi, and Rickettsia. It is not used in the treatment of Gardnerella vaginalis.
C is not correct. 17% chose this.
Clindamycin is a bacteriostatic antimicrobial that acts by blocking peptide bond formation at the 50S ribosomal subunit. It is used to treat anaerobic infections, including Bacteroides fragilis and Clostridium
perfringens. It is not used in the treatment of Gardnerella vaginalis.
D is not correct. 15% chose this.
A 24-year-old sexually active woman presents to her gynecologist with symptoms of genital itching, burning, and foul-smelling discharge. Samples are taken and clue cells are observed on microscopic
wet mount.
What is the mechanism of the drug most appropriate for treating this condition?
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Item: 19 of 46
QID: 3585
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118639 : DR. JITENDRA
A.Anitschkow cells
B.CallExner bodies
C.Howell-Jolly bodies
D.Pseudorosettes
E.Reinke crystals
The correct answer is A. 79% chose this.
This woman likely has rheumatic heart disease (the leading cause of mitral stenosis), and she is experiencing symptoms because it is getting worse. A classic sign of worsening stenosis is the decreasing
volume of heart murmurs, because the valve is getting more stenotic and opens less during each beat. Rheumatic mitral stenosis is histologically associated with Aschoff bodies, which contain
multinucleated giant cells and large Anitschkow cells.
B is not correct. 6% chose this.
CallExner bodies are found in granulosa cell tumors of the ovary.
C is not correct. 4% chose this.
Howell-Jolly bodies are basophilic inclusions in RBCs, usually representing nuclear fragments. They are normally filtered by the spleen and are most common seen in patients with splenectomy or
autosplenectomy in sickle cell disease.
D is not correct. 5% chose this.
Pseudorosettes are typically found in neuroblastomas or other tumors, such as meningioma.
E is not correct. 6% chose this.
Reinke crystals are found in Leydig cell tumors of the testis.
A 54-year-old woman with a heart murmur for 20 years visits her physician complaining of shortness of breath, fatigue, and edema. On physical examination the physician notes that the patient's late
diastolic murmur and her S1 have become fainter than before. Cardiac biopsy reveals the presence of Aschoff bodies.
Which of the following histologic findings would most likely be seen if one viewed the Aschoff bodies at high power?
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Item: 20 of 46
QID: 1580
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118639 : DR. JITENDRA
A.6-Mercaptopurine
B.Bleomycin
C.Cyclophosphamide
D.Doxorubicin
E.Vincristine
The correct answer is A. 64% chose this.
A disease-modifying antirheumatic agent known to cause neural tube defects describes methotrexate, an antifolate. Methotrexate is a folic acid analog that binds to and inactivates dihydrofolate reductase,
thereby inhibiting purine synthesis. As a result, cells are most susceptible to the actions of methotrexate during the S phase of the cell cycle. Cells that have a high proliferation rate, for example, cells of
the immune system, are targeted, thereby decreasing the inflammation exacerbating the disease. Other rapidly proliferating tissues that are adversely affected by an S phase-specific agent such as
methotrexate include the skin, the gastrointestinal mucosa, and bone marrow. Because it is an antifolate, it antagonizes the effects of folate on the embryo, which are essential for proper neural tube
formation.
Of the medications listed, only 6-mercaptopurine (6-MP) also targets cells during the S phase. 6-MP is a purine analog that is taken up into DNA during S phase, halting DNA synthesis and leading to cell
death. It is used commonly as a chemotherapeutic agent for this purpose.
B is not correct. 6% chose this.
Bleomycin is a chemotherapeutic agent that targets cells during G2 phase. This is the phase where all chromosomes have been duplicated. It fragments DNA and therefore is most deleterious when there is
double the normal quantity of DNA available.
C is not correct. 12% chose this.
Cyclophosphamide is an example of a chemotherapeutic agent that is cell cycle phase nonspecific. It is an alkylating agent that bind and cross-links DNA at any phase of the cell cycle. It is used as a cancer
therapy, as well as to treat certain forms of vasculitis.
D is not correct. 7% chose this.
Doxorubicin is an example of an anthracycline. These agents exert their deleterious effects on cells by intercalating into DNA as flat aromatic rings. They are cell cycle phase nonspecific.
A woman of reproductive age who has rheumatoid arthritis starts taking a disease-modifying agent known to cause neural tube defects if taken during pregnancy.
Which of the following medications affects the cell cycle in the same way as the agent this woman is taking?
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Item: 21 of 46
QID: 3234
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118639 : DR. JITENDRA
A.Adenosine diphosphate ribosylation of a G protein, increasing chloride secretion
B.Adenosine diphosphate ribosylation of an elongation factor, disrupting protein synthesis
C.Binding to the major histocompatibility complex type II receptor and T-lymphocyte receptor, causing cytokine synthesis
D.Blocking release of the inhibitory neurotransmitter glycine
E.Blocking the release of acetylcholine
F. Lysis of RBCs
G.Stimulation of guanylate cyclase
The correct answer is D. 80% chose this.
The penetrating wound from the barbed wire puts this patient at risk for infection with Clostridium tetani, the symptoms of which are caused by the tetanus toxin. This toxin blocks the release of glycine
from Renshaw's cells in the spinal cord and results in "lockjaw" and similar symptoms. Had the patient been vaccinated for tetanus, he would not have had these symptoms. Tetanus vaccination is required
approximately every 10 years to ensure adequate blood levels of protective antibodies. The patient is demonstrating risus sardonicus, a muscle spasm-induced grimace, which bodes a poor prognosis. The
patient then exhibited opisthotonos, a severe hyperextension of the head, neck, and back.
A is not correct. 3% chose this.
The Vibrio cholerae toxin adenosine diphosphate-ribosylates a G stimulatory protein in the intestines, increasing adenylate cyclase activity and causing pumping of water and chloride ions into the gut
lumen. Its most characteristic symptom is voluminous "rice water" diarrhea. The heat-labile toxin of Escherichia coli has the same mechanism of action.
B is not correct. 3% chose this.
The Corynebacterium diphtheriae toxin inactivates the elongation factor-2 by adenosine diphosphate ribosylation, disrupting protein synthesis. It causes pharyngitis and a "pseudomembrane" in the
oropharynx. The systemic effects of diphtheria toxin are most commonly seen in cardiac dysfunction, which can present with tachycardia, hypotension, and heart failure.
After scaling the wall of a maximum security penitentiary, a 24-year-old convict steps on barbed wire with his right foot. After hiding from the police for 8 days he starts having muscle spasms and
difficulty swallowing. Within the next 2 days, his sister notices an odd grimace on his face. She urges him to go to the hospital to treat his foot wound, but he refuses, fearing the police will apprehend
him. Within the week he develops total body muscle spasms followed by a tense, back-arching position. He dies several days later.
What is the mechanism of toxicity of the organism responsible for this patient's pathology?
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Item: 22 of 46
QID: 1755
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118639 : DR. JITENDRA
A.Cefazolin
B.Ceftazidime
C.Erythromycin
D.Penicillin
E.Vancomycin
The correct answer is B. 53% chose this.
The organism and culture results described in the vignette are suggestive of Pseudomonas pneumonia. Cephalosporins are -lactam antibiotics that inhibit bacterial cell wall synthesis. They are generally
well tolerated and easy to administer; however, adverse effects include anaphylaxis and nephrotoxicity when combined with aminoglycosides. Three cephalosporins may be used to treat Pseudomonas
aeruginosa infection (and should be memorized): cefoperazone, ceftazidime, and cefepime. Cefoperazone and ceftazidime, third-generation cephalosporins, are similar except that ceftazidime has better
activity against the Enterobacteriaceae family and is more commonly used. Cefepime is a fourth-generation cephalosporin with activity against both gram-positive and gram-negative organisms, including P.
aeruginosa. The extended-spectrum penicillins (ticarcillin, carbenicillin, and piperacillin), given with an aminoglycoside, are also effective against Pseudomonas.
A is not correct. 13% chose this.
Cefazolin is a first-generation cephalosporin that is effective against gram-negative rods including Proteus mirabilis, Escherichia coli, and Klebsiella pneumoniae. Cefazolin is not used for Pseudomonas
infection.
C is not correct. 20% chose this.
Erythromycin is a macrolide that inhibits protein synthesis by blocking translocation. While erythromycin can be used in pneumonias, it is used mainly in atypical pneumonias including Mycoplasma,
Legionella, and Chlamydia pneumonia. Erythromycin is not used for Pseudomonas infection.
D is not correct. 6% chose this.
Penicllin is a bactericidal antibiotic used to treat gram-positive infections as well as infections by gram-negative cocci. It is not effective against gram-negative rods such as P. aeruginosa. Penicillin acts by
A 69-year-old man is hospitalized for an exacerbation of asthma. He is placed on albuterol and an inhaled corticosteroid, but due to low oxygen saturation, he is intubated. After 3 days in the hospital, he
has a temperature of 39.4 C (103.1 F), a blood pressure of 104/63 mm Hg, a pulse of 108/min, and a respiratory rate of 35/min. Physical examination reveal coarse rhonchi at the base of the lung
fields bilaterally. The patient is producing purulent, foul-smelling sputum that grows many oxidase-positive gram-negative rods on culture.
Which of the following agents could be used to treat this infection?
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Item: 23 of 46
QID: 2856
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118639 : DR. JITENDRA
A.Anencephalus
B.Congenital hydrocephalus
C.Oligohydramnios
D.Polyhydramnios
The correct answer is C. 87% chose this.
Oligohydramnios is defined as <0.5 L of amniotic fluid, associated with a defect in fetal urine production or excretion. Prolonged oligohydramnios or anhydramnios during gestation leads to hypoplastic
lungs, flattened facies, and clubbed feet. This condition is called Potter's syndrome when it results in bilateral renal agenesis. It is a lethal condition due to inadequate lung development.
A is not correct. 2% chose this.
Anencephalus is a malformation of the anterior end of the neural tube with absence of the brain and calvarium. It is thought to occur at approximately 28 days' gestation. Forebrain development is
distrupted and all that remains in its place is a flattened remnant of disorganized brain tissue.
B is not correct. 1% chose this.
Congenital hydrocephalus occurs due to an accumulation of excessive cerebrospinal fluid within the ventricular system.
D is not correct. 10% chose this.
Polyhydramnios is defined as <1.5-2 L of amniotic fluid. Polyhydramnios commonly occurs as a result of esophageal, duodenal, or intestinal atresia obstructing fetal swallowing and absorption of amniotic
fluid. Complications associated with polyhydramnios include preterm labor and maternal respiratory compromise.
An infant is born with hypoplastic lungs, flattened facies, and clubbed feet. Further work-up reveals bilateral renal agenesis.
Which pathologic condition during gestation is responsible for this child's condition?
Bottom Line:
for year: (Page Number)
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118639 : DR. JITENDRA
A
B
C
D
E
The correct answer is B. 54% chose this.
Increased anteroposterior diameter and prolonged expiration suggest the patient is suffering from chronic obstructive pulmonary disease (COPD). Reduction of FEV
1
, forced vital capacity (FVC), and the
FEV
1
:FVC ratio are the hallmark of airway obstruction. Total lung capacity (TLC) is increased due to lung hyperinflation, secondary to expiratory flow limitation.
A is not correct. 10% chose this.
A 74-year-old retired shipyard laborer with a 45-pack-year smoking history and previous work in sandblasting and fiberglass operations presents with increasing shortness of breath and peripheral
edema. On physical examination he is a thin, cyanotic man in moderate pulmonary distress. His chest shows an increased anteroposterior diameter, and the breath sounds are faint with a prolonged
expiration. The liver edge is 3 cm below the right costal margin. There is no digital clubbing, but marked peripheral edema is present. Arterial blood gas analysis reveals a partial oxygen pressure of 43
mm Hg, a partial carbon dioxide pressure of 22 mm Hg, and a pH of 7.51.
Which set of laboratory parameters is most likely to be found?
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QID: 3342
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118639 : DR. JITENDRA
A.Burkitt lymphoma
B.Hodgkin lymphoma
C.Mantle cell lymphoma
D.Sarcoidosis
E.Waldenstrm macroglobulinemia
The correct answer is B. 37% chose this.
The patient's presentation and biopsy findings are co nsistent with Hodgkin lymphoma. This lymphoid malignancy commonly occurs in young adults. In the case of the nodular sclerosis form of this disease,
A 26-year-old woman complains of fatigue over the past few months. She is febrile on examination and slightly diaphoretic. Further work-up warrants a lymph node biopsy, which reveals the pathology
shown in the image.
Which of the following is the most likely diagnosis?
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Item: 26 of 46
QID: 2974
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118639 : DR. JITENDRA
A.Celiac trunk
B.Left gastric artery
C.Left gastroepiploic artery embolus
D.Left gastroepiploic artery
A 47-year-old woman with a history of atrial fibrillation and deep venous thrombosis presents to the emergency department because of left upper quadrant abdominal pain, left shoulder pain, and
nausea and vomiting. Results of CT of the abdomen with contrast are shown in the image.
Which of the following gives rise to the involved artery in this scenario?
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QID: 1176
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118639 : DR. JITENDRA
A.Catalyzes -carboxylation of glutamic acid residues
B.Hydroxylates prolyl and lysyl residues
C.Increases intestinal calcium and phosphate absorption
D.Makes up the constituents of the visual pigments
E.Transfers one-carbon intermediates
The correct answer is E. 74% chose this.
This patient's macrocytic megaloblastic anemia without neurologic symptoms is most likely caused by folic acid. Folic acid plays a key role as a coenzyme for one-carbon transfer as seen in methylation
reactions and is essential for the biosynthesis of purines and the pyrimidine thymidine. Deficiency of the vitamin is characterized by macrocytic megaloblastic anemia. The anemia is a result of diminished
DNA synthesis in erythropoietic stem cells leading to continued cell growth without progression to mitosis, which presents as macrocytosis. Large cells are seen with mean cell volumes of 100-150 fL and
reduced levels of hemoglobin. Folic acid is a water-soluble vitamin stored in small amounts by the body; thus a continuous supply is needed from foods such as green, leafy vegetables, lima beans, and
whole-grain cereals. Folate deficiency is usually seen in pregnant women and alcoholics, and is the most common vitamin deficiency in the United States. Folic acid supplementation by pregnant women
reduces the incidence of neural tube defects.
A is not correct. 13% chose this.
Vitamin K serves as a coenzyme in the -carboxylation of glutamic acid residues in blood clotting proteins. A vitamin K deficiency is rarely seen because adequate amounts are generally produced by
intestinal bacteria or easily obtained from the diet. Decreased bacterial production in the gut (as with antibiotics, for example) can lead to hypoprothrombinemia and, subsequently, hemorrhage. Newborns
have sterile intestines and cannot initially synthesize vitamin K. Because human milk fails to provide the adequate daily requirement of vitamin K, it is recommended that all newborns receive a single dose
of vitamin K as prophylaxis against hemorrhagic diseases.
B is not correct. 6% chose this.
Ascorbic acid (vitamin C) acts as a coenzyme in hydroxylation of prolyl- and lysyl- residues of collagen, allowing collagen fibers to crosslink and providing greater tensile strength to the assembled fiber. A
deficiency of ascorbic acid results in scurvy, a disease characterized by sore, spongy gums, loose teeth, fragile blood vessels, swollen joints, anemia, and poor wound healing.
A 44-year-old woman presents with worsening fatigue for the past 2 months. She recently overcame her battle with alcoholism and says her next goal is to improve her "horrible diet." She has no
neurologic symptoms. Physical examination is unremarkable. Laboratory studies are significant for a hemoglobin level of 8 g/dL and a mean corpuscular volume of 110 fL.
Which of the following is the function of the vitamin causing this patient's condition?
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118639 : DR. JITENDRA
A.Choroid plexus papilloma
B.Communicating hydrocephalus
An 80-year-old man is brought to the emergency department by his daughter after his first seizure. For months, he has taken exceptionally short steps, unable to raise his legs. He is incontinent of urine
and does not "know when to go." His recent memory is also impaired, and he denies having fallen despite evidence to the contrary. There is no history of stroke or intracranial mass lesions. Cranial
nerves are intact, muscle strength is normal, and sensorium is normal. The patient sways during Romberg's test with eyes open or closed. A CT scan of the head is shown in the image. Cerebrospinal
fluid pressure is normal.
What is the most likely etiology of the dilated ventricles?
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QID: 1863
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118639 : DR. JITENDRA
A.Disrupts heme synthesis by causing decreased iron absorption from the gut
B.Disrupts heme synthesis by increasing the activity of aminolevulinate dehydratase
C.Disrupts heme synthesis by inhibiting ferrochelatase
D.Disrupts heme synthesis by inhibiting porphobilinogen deaminase
E.Disrupts RBC DNA synthesis, causing megaloblastic changes in RBCs
The correct answer is C. 72% chose this.
Lead inhibits -aminolevulinate (ALA) dehydratase and ferrochelatase, preventing both porphobilinogen formation and the incorporation of iron into protoporphyrin IX, the final step in heme synthesis.
Inhibition of both of these steps results in ineffective heme synthesis and subsequent microcytic (hemoglobin-poor) anemia.
A is not correct. 3% chose this.
Lead poisoning does not affect iron absorption from the gut.
B is not correct. 13% chose this.
Lead inhibits ALA dehydratase, preventing porphyrin synthesis beyond the formation of ALA; it does not increase its actions. This causes ALA to accumulate in the urine.
D is not correct. 10% chose this.
Porphobilinogen deaminase is inhibited in acute intermittent porphyria leading to accumulation of porphobilinogen, ALA, and uroporphyrin.
E is not correct. 2% chose this.
Lead does not interrupt RBC DNA synthesis. Folate and/or vitamin B
12
deficiencies disrupt DNA synthesis, resulting in megaloblastic changes in RBCs.
A child is brought to the pediatrician because her parents are concerned about lead poisoning since their house is known to contain lead-based paint. A complete blood count reveals anemia.
Lead poisoning causes anemia because it does which of the following?
Bottom Line:
ALA dehydratase mediates conversion of ALA to porphobilinogen. Lead poisoning not only prevents this early step in hemoglobin synthesis, but it also prevents iron incorporation into protoporphyrin IX by
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QID: 4483
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118639 : DR. JITENDRA
A.Anopheles mosquito
B.Ixodes tick
C.Phlebotomus sandflies
D.Triatoma (reduviid) bug
E.Tsetse flies
The correct answer is D. 66% chose this.
The patient has myocarditis due to Trypanosoma cruzi. This infectious condition, known as Chagas' disease, is endemic in vast areas of South America and is transmitted from person to person by Triatoma
(reduviid) bugs, also known as "kissing bugs." T. cruzi is an intracellular protozoon that localizes mainly in the heart and nerve cells of the myenteric plexus, leading to myocarditis and dysmotility of hollow
organs such the esophagus, colon, and ureter. Cardiac involvement manifests with ventricular dilatation and congestive heart failure secondary to myocyte necrosis and fibrosis. Intracellular parasites can
be visualized in tissue sections. Chagas' disease is a cause of acquired achalasia, in which the distal third of the esophagus dilates because of loss of its intrinsic innervation. A similar pathologic mechanism
accounts for megacolon and megaureter in Chagas' disease.
A is not correct. 8% chose this.
Malaria caused by Plasmodium falciparum is transmitted through Anopheles mosquitoes.
B is not correct. 8% chose this.
Babesiosis is transmitted through Ixodes ticks.
C is not correct. 8% chose this.
Leishmaniasis is transmitted through Phlebotomus sandflies.
E is not correct. 10% chose this.
African trypanosomiasis caused by Trypanosoma brucei is transmitted by Tsetse flies.
A 10-year-old boy presents to the emergency department because of shortness of breath and palpitations. He and his family recently immigrated from Peru. X-ray of the chest demonstrates pulmonary
congestion. Echocardiography reveals biventricular dilatation with massive cardiac enlargement. Endomyocardial biopsy demonstrates the presence of intracellular protozoan parasites.
Which vector is most likely responsible for transmitting this patient's disease?
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QID: 3108
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118639 : DR. JITENDRA
A.Location for sperm maturation and storage
B.Location for spermatogenesis
C.Production of seminal fluid
D.Secretion of the alkaline component of semen
E.To mediate erectile function
The correct answer is D. 68% chose this.
This patient has benign prostatic hyperplasia, which is a common disorder in men >50 years old. The enlarged size of the prostate infringes on the urethra, resulting in increased urinary frequency,
nocturia, urinary retention, hesitancy, urgency, and a weak urinary stream. The prostate is a walnut-sized gland that surrounds the urethra just below the bladder. It secretes an alkaline fluid containing
proteolytic enzymes and prostate-specific antigen that is a component of semen. The remainder (and majority) of the seminal fluid is produced in the seminal vesicles. The pH of the fluid helps neutralize
the acidity of the vaginal tract, prolonging the lifespan of sperm.
A is not correct. 2% chose this.
The epididymis is a coiled duct continuous with the efferent ductules at the head and with the ductus deferens at the tail. Sperm maturation and storage take place in the epididymis.
B is not correct. 1% chose this.
The testes are the site of spermatogenesis, not the prostate. The testes require the cooler temperature of the scrotal sac to produce sperm. This is why cryptorchidism often results in sterility; the
temperature within the body is too warm for spermatogenesis to take place.
C is not correct. 26% chose this.
Although the prostate does produce some fluid components of semen, the seminal vesicle produces the majority of the seminal fluid . Seminal fluid contains fructose and proteins that nourish the sperm.
E is not correct. 3% chose this.
The prostate has no role in erectile function. Erection is controlled by the parasympathetic nervous system.
A 63-year-old man comes to his primary care physician complaining of increased frequency of urination, requiring him to wake up several times during the night to void. On questioning he reports that
he has difficulty with initiating a stream of urine and that when he does it is not as strong as it was in the past.
The organ responsible for this patient's symptoms serves which of the following natural functions?
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QID: 2875
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118639 : DR. JITENDRA
A.These tumors are associated with fibroma, ascites, and hydrothorax
B.These tumors often are associated with intra-peritoneal accumulation of mucus
C.These tumors sometimes are associated with arrhythmias, notably atrial fibrillation
D.Tumors of this type secrete estrogen and are associated with precocious puberty
E.Tumors of this type usually are benign
The correct answer is E. 52% chose this.
Brenner's tumors are benign ovarian tumors composed of cells that resemble bladder transitional epithelium. Epithelial tumors comprise 85% of ovarian tumors, with serous epithelial tumors being the
most common epithelial tumor and Brenner's tumors being the least common . Other types of epithelial tumors include mucinous, endometrioid, clear cell/mesonephric, and mixed subtypes. Brenner's
tumors are uncommon adenofibromas with an epithelial component of nests of transitional cells that appear like those in the urinary bladder. Uncommonly the nests contain microcysts or glandular spaces
lined by columnar cells that secrete mucin. Sometimes these tumors are found in mucinous cystadenomas.
A is not correct. 22% chose this.
Meigs' syndrome, which is characterized by the classic triad of fibroma, ascites, and hydrothorax, is associated with ovarian fibromas. Histologically these tumors consist of spindle-shaped fibroblasts .
B is not correct. 12% chose this.
Pseudomyxoma peritonei , or intra-peritoneal accumulation of mucus, is a rare presentation of ovarian mucinous cystadenomas (benign) or mucinous cystadenocarcinomas (malignant) .
C is not correct. 4% chose this.
Cardiac arrhythmias associated with thyrotoxicosis/hyperthyroidism can be seen in patients with ectopic thyroid tissue in the ovaries (struma ovarii).
D is not correct. 10% chose this.
Granulosa cell tumors, a subset of sex cord stromal tumors, are estrogen-secreting tumors associated with precocious puberty, endometrial hyperplasia, and endometrial carcinomas. The characteristic
histologic finding is ovarian follicles with eosinophilic material, known as Call-Exner bodies.
Physical examination of a 33-year-old woman with no significant medical history reveals an ovarian mass. A biopsy is obtained, and microscopic examination reveals nests of transitional epithelial-like
cells with bean-shaped nuclei within an abundant fibrous stroma.
Which of the following is true regarding the clinical characteristics of this tumor?
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QID: 2920
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118639 : DR. JITENDRA
A.Increased oral intake of iron
B.Leukemia
C.Multiple blood transfusions
D.Porphyria cutanea tarda
E.Sideroblastic anemia
A patient presents to the clinic complaining of increasing fatigue and inappropriate skin pigmentation. A cardiology work-up reveals dilated cardiomyopathy. Results of liver biopsy are shown in the
image. The patient's medical history includes thalassemia.
What is the most plausible etiology for this patient's presenting symptoms?
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QID: 4822
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118639 : DR. JITENDRA
A.Decreased glucose uptake
B.Increased insulin production
C.Increased insulin sensitivity
D.Increased lipid metabolism
E.Increased translocation of GLUT-3 receptors to the cell surface
The correct answer is C. 66% chose this.
Long-term exercise has been shown to increase the translocation of GLUT-4 from intracellular stores to the cell surface. GLUT-4 is responsible for glucose uptake, thus yielding increased insulin sensitivity.
A is not correct. 3% chose this.
Exercise increases, not decreases, the ability for glucose uptake.
B is not correct. 5% chose this.
Exercise does not result in increased insulin production. Given the increased metabolic needs, it does result in increased hepatic glucose production.
D is not correct. 13% chose this.
Increased lipid metabolism is an effect of exercise, but is probably not the cause of a reduced incidence of type 2 diabetes mellitus.
E is not correct. 13% chose this.
There is increased translocation of GLUT-4 during exercise.
Decreased glucose uptake in muscle tissue and adipose tissue is a hallmark of insulin resistance. Moderate to extensive exercise has been shown to reduce the incidence of type 2 diabetes mellitus.
Which of the following is the most likely underlying mechanism?
Bottom Line:
Long-term exercise has been shown to increase cell surface GLUT-4, which is responsible for glucose uptake, thus yielding increased insulin sensitivity .
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QID: 4202
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118639 : DR. JITENDRA
A.Blocks calcium flux at thalamic T-type calcium channels
B.Blocks sodium channels
C.Increases the duration of chloride channel opening
D.Increases the frequency of chloride channel openings
E.Inhibits the reuptake of serotonin at the presynaptic neuron
The correct answer is B. 68% chose this.
Having been in a seizure for more than 30 minutes, this patient is in status epilepticus, which is a medical emergency. After the emergent administration of intravenous diazepam, the patient can be started
on phenytoin, which is commonly used as prophylaxis of status epilepticus. By impeding sodium channels, phenytoin is able to provide a use-dependent effect, inhibiting sodium conductance and altering
the transmission of the epileptic focus. Phenytoin is also considered first-line treatment for tonic-clonic seizures and can be used in the treatment of simple and complex partial seizures. Adverse effects
include gingival hyperplasia, megaloblastic anemia, teratogenesis, and systemic lupus erythematosus-like symptoms.
A is not correct. 10% chose this.
This describes the mechanism of action of ethosuximide, which is commonly used in the treatment of absence (petite mal) seizures. Common adverse effects include lethargy, headache, urticaria, and
Stevens-Johnson syndrome.
C is not correct. 10% chose this.
This describes the mechanism of action of barbiturates. These medications are commonly used for anxiety, seizures, insomnia, and induction of anesthesia.
D is not correct. 9% chose this.
This describes the mechanism of action of benzodiazepines, which can be used acutely for status epilepticus. Other uses include anxiety, alcohol detoxification (including delirium tremens), night terrors,
and sleepwalking.
E is not correct. 3% chose this.
A 12-year-old child was admitted to the hospital for his third episode of generalized convulsions that have been ongoing for more than 30 minutes. After giving the patient intravenous diazepam, another
chronic antiseizure medication is begun. Months later, the child develops swollen gums, double vision, facial rash, and generalized joint swelling.
Which of the following most accurately describes the mechanism of action of this medication?
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QID: 1445
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118639 : DR. JITENDRA
A.-Aminobutyric acid analogue
B.Increase efflux/decrease influx of sodium channels
C.Increase firing frequency of chloride channels
D.Limit influx of sodium channels
E.T-type calcium channel blocker
The correct answer is E. 62% chose this.
This child is suffering from absence (petit mal) seizures. The typical age range for this disorder is 3-7 years, although it may continue into adolescence before subsiding in adulthood. Absence seizures
usually occur several times per day. During these seizures, the patient experiences an abrupt but momentary episode of lost consciousness followed by resumption of previous activities. Ethosuximide is the
drug of choice for this type of seizure disorder. Its mechanism is to block the T-type calcium channel.
A is not correct. 8% chose this.
Gabapentin, an analogue of -aminobutyric acid, has been approved for the treatment of all seizure types except absence seizures. It is normally used as adjunct therapy for seizures that respond poorly to
single-agent therapy. Gabapentin functions to inhibit high voltage activated Ca
2+
channels.
B is not correct. 11% chose this.
Phenytoin is effective in all seizure types except absence seizures. It is the drug of choice for initial therapy, particularly in adults, but has significant adverse effects, including sedation, ataxia, nystagmus,
hirsutism, and gingival hyperplasia. Its mechanism is to increase sodium channel inactivation by increasing the efflux and decreasing the influx of the channels.
C is not correct. 7% chose this.
Diazepam, a long-acting benzodiazepine, is the first-line agent for treatment of status epilepticus, in which seizure activity occurs for >30 minutes. It is not indicated for the treatment of absence seizures.
It increases the firing frequency of chloride channels, resulting in -aminobutyric acid agonist activity.
D is not correct. 12% chose this.
A concerned mother brings her 7-year-old son to the pediatrician after his teacher reports episodes during which the child becomes inattentive. The teacher states that the child frequently ceases his
activities and "stares blankly into space." He resumes his normal activities shortly thereafter.
What is the mechanism of the agent that will most effectively treat this child's disorder?
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QID: 3207
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118639 : DR. JITENDRA
A.Foramen ovale
B.Foramen rotundum
C.Foramen spinosum
D.Jugular foramen
E.Superior orbital fissure
The correct answer is A. 50% chose this.
The foramina of the trigeminal nerve divisions can be remembered with the mnemonic Standing Room Only ( SRO) for the Superior orbital fissure, foramen Rotundum, and foramen Ovale, which transmit
cranial nerves (CNs) V
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Compression of CN V
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causes numbness over the ipsilateral jaw and lower face.
B is not correct. 17% chose this.
The maxillary division of the trigeminal nerve (CN V
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C is not correct. 14% chose this.
The meningeal (recurrent) branch of the mandibular nerve (CN V
3
) exits the skull through the foramen spinosum, along with the middle meningeal artery. This nerve innervates the dura mater and is
responsible for pain sensation.
D is not correct. 14% chose this.
The jugular foramen transmits the glossopharyngeal (CN IX), vagus (CN X), and spinal accessory (CN XI) nerves. The glossopharyngeal nerve is responsible for motor innervation of the stylopharyngeus
muscle, parasympathetic innervation of the parotid gland, and sensory innervation of the pharynx, middle ear, and posterior third of the tongue. It also innervates the chemoreceptors and baroreceptors of
the carotid body. The vagus nerve is responsible for motor innervation of the pharyngeal and laryngeal muscles, parasympathetic innervation to visceral organs, and sensory innervation to the pharynx and
A 40-year-old man was admitted to the neurology service for evaluation of persistent numbness over his left jaw and lower face. MRI reveals a schwannoma, which is compressing a cranial nerve as the
nerve exits the skull.
The cranial nerve involved in this case exits the skull through which of the following foramina?
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QID: 3816
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118639 : DR. JITENDRA
A.False-negative results of syphilis tests
B.Hemoptysis
C.Hypothyroidism
D.Nonbacterial verrucous endocarditis
E.Temporal arteritis
The correct answer is D. 56% chose this.
The combination of anti-nuclear antibodies and anti-Smith antibodies make systemic lupus erythematosus (SLE) the most likely condition in this patient. Nonbacterial thrombotic endocarditis, often referred
to as Libman-Sacks endocarditis, is sometimes associated with SLE. Libman-Sacks endocarditis takes the form of 1- to 3-mm verrucous deposits distinctly on the edge of either surface of the valve leaflets
on any of the heart valves (more often the mitral, aortic, and tricuspid valves). They consist of accumulations of immune complexes, mononuclear cells, hematoxylin bodies, fibrin, and platelet thrombi.
Healing can result in fibrosis, scarring, and calcification, leading to damage to the valve and valvular regurgitation. Patients are predisposed to developing bacterial endocarditis. Furthermore, the fibrin and
platelet thrombi may embolize systemically.
A is not correct. 26% chose this.
SLE is in fact associated with false-positive results of syphilis tests (rapid plasma reagin and Venereal Disease Research Laboratory tests) due to anti-phospholipid antibodies that cross-react with cardiolipin
used in testing.
B is not correct. 5% chose this.
Wegener's granulomatosis is characterized by necrotizing vasculitis, necrotizing pulmonary lesions (granulomas), and glomerulonephritis. Patients present with hemoptysis, hematuria, and rash. Serologic
results positive for circulating anti-neutrophilic cytoplasmic antibodies are associated with the disease.
C is not correct. 7% chose this.
Hypothyroidism is caused most commonly by an autoimmune disease resulting from a defect in the function of thyroid-specific suppressor T lymphocytes, a disease often referred to as Hashimoto's
thyroiditis, in iodine-sufficient areas of the world. Patients with Hashimoto's usually are middle-aged women who present with thyromegaly, most of whom have anti-thyroid peroxidase antibodies in their
A 34-year-old African-American woman is referred to a rheumatologist for facial rash and proteinuria. On examination, temperature is 99.5F (37.5C), blood pressure is 124/88 mm Hg, heart rate is
82/min, and respiratory rate is 13/min. Serology results are positive for anti-nuclear antibodies and anti-Smith antibodies.
Which of the following is also associated with this condition?
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QID: 3895
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118639 : DR. JITENDRA
A.Disseminated intravascular coagulopathy
B.Hemolytic-uremic syndrome
C.Rocky Mountain spotted fever
D.Staphylococcal toxic shock syndrome
E.Von Willebrand's disease
The correct answer is D. 56% chose this.
The patient demonstrates all the requirements for a diagnosis of staphylococcal toxic shock syndrome. These include fever, hypotension (a common cause of syncope), dermatologic manifestations, and
multisystem organ involvement. At least three of the following organ systems are typically involved: gastrointestinal (nausea/vomiting); muscular (myalgia with elevated creatine phosphokinase level);
A 25-year-old man presents to the emergency department with right lower quadrant abdominal pain, rebound tenderness, and a fever of 38.0C (100.4F). Acute appendicitis is diagnosed and the
patient undergoes appendectomy without any immediate complications. Two days after surgery his fever has diminished to 37.1C (98.8F) and he is discharged. Three days later, however, he returns
to the hospital after experiencing an incidence of syncope. His temperature is now 38.9C (102F) and his blood pressure is 85/60 mm Hg. Physical examination is notable for a sunburn-like rash present
around his abdominal sutures and on his palms. Petechiae are noted on his oral mucosa. Laboratory tests show:
WBC count: 15,000/mm with bands
Hemoglobin: 16.5 g/mL
Hematocrit: 48%
Platelet count: 85,000/mm
Blood urea nitrogen: 40 mg/dL
Aspartate aminotransferase: 95 U/L
Prothrombin time: 13 seconds
Partial thromboplastin time: 27 seconds
Tests for schistocytes and fibrin split products are negative.
Which of the following is the most likely diagnosis?
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QID: 4452
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118639 : DR. JITENDRA
A.Congenital herpes infection
B.Congenital rubella infection
C.Failure to cross-link collagen fibrils
D.Improper protein trafficking
E.Mutations in the structural protein fibrillin
The correct answer is D. 65% chose this.
I-cell disease is an autosomal recessive disorder that results from improper intracellular trafficking. This impaired trafficking results from the failure to add a mannose-6-phosphate residue to proteins that
should be directed to lysosomes. On a cellular level, this results in the presence of numerous intracytoplasmic inclusions in cells of mesenchymal origin. These inclusions are membrane-bound vacuoles that
are filled with fibrillogranular material, including a variety of lipids, mucopolysaccharides, and oligosaccharides. Clinically this deficiency results in a select group of identifying features. Be on the lookout for
coarse facial features in a baby that is developmentally delayed and has restricted joint movement.
A is not correct. 10% chose this.
Congenital herpes infection is characterized by acute central nervous system findings; keratoconjunctivitis; and vesicles on the skin, eyes, and mucous membranes.
B is not correct. 9% chose this.
Congenital rubella infection is a devastating disease. It is characterized by cataracts, glaucoma, pigmented retinopathy, cardiac malformations, and deafness. None of these symptoms is evident in this
child.
C is not correct. 9% chose this.
Ehlers-Danlos syndrome is not explained by this mechanism. This baby does not demonstrate any of the symptoms of this disease; furthermore, this disease is not usually diagnosed until the end of the
first decade of life.
E is not correct. 7% chose this.
An 8-week-old boy is brought to his pediatrician because his mother notes abnormal limb movements. Although both pregnancy and birth were not complicated, and there is an unremarkable family
history and healthy siblings, this child has had developmental delay since birth. On examination the child has normal vital signs, coarse facial features, diffuse joint stiffness, claw hand deformities, and
kyphoscoliosis. Muscle biopsy reveals numerous intracytoplasmic inclusions in cells.
What is the pathophysiology of this disease?
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QID: 1981
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118639 : DR. JITENDRA
A.-Interferon
B.-Interferon
C.-Interferon
D.Tacrolimus
A 45-year-old man who is HIV positive is being treated with highly active antiretroviral therapy. Despite his aggressive medication regimen, he has recently developed the lesions shown in the image. His
examination is also notable for nonpitting edema of the feet and ankles.
Which of the following is most appropriate for treating this patient's lesions?
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QID: 1479
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118639 : DR. JITENDRA
A.Acebutolol
B.Atenolol
C.Esmolol
D.Metoprolol
E.Nadolol
The correct answer is E. 45% chose this.
Nonselective -blockers are contraindicated in patients with lung disease because they can cause bronchoconstriction by blocking
2
-receptors responsible for relaxation of bronchial smooth muscle. Nadolol
is a nonselective -blocker and should not be used in a patient with lung disease. Other nonselective -blockers include propranolol, timolol, and pindolol. Acebutolol, atenolol, esmolol, metoprolol, and
betaxolol are cardioselective
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-blockers that should be favored in patients with lung/airway disease. Although the stem does not specifically state that this patient has lung disease, smoking causes airway
hyperreactivity and bronchoconstriction. Adding a non-selective -blocker could exaggerate these adverse effects of smoking.
A is not correct. 15% chose this.
Acebutolol is cardioselective and can be used in patients with asthma or other obstructive lung diseases.
B is not correct. 11% chose this.
Atenolol is cardioselective and can be used in patients with asthma or other obstructive lung diseases.
C is not correct. 12% chose this.
Esmolol is cardioselective and can be used in patients with asthma or other obstructive lung diseases. However, it has a very short half life (about 9 minutes), and would not be used for long-term
outpatient management.
D is not correct. 17% chose this.
A 57-year-old man presents to his primary care physician for a routine wellness check. He denies any complaints. Social history is significant for a 50-pack-year smoking history. On physical
examination, his vital signs are within normal limits except for his blood pressure which is 170/95 mm Hg. On his previous visit, his blood pressure was 155/90 mm Hg.
Which of the following antihypertensive agents is relatively contraindicated in this patient?
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Item: 43 of 46
QID: 3713
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118639 : DR. JITENDRA
A.0.5
B.2.0
C.1.5
D.0.33
E.0.67
The correct answer is A. 72% chose this.
Relative risk (RR), also known as risk ratio, is the risk of an outcome in one group relative to the risk in another group. This question asks for the risk of influenza in the vaccine group relative to the placebo
group. This can be calculated as the risk of influenza in the vaccine group (9/100) divided by the risk of influenza in the placebo group (18/100), yielding: RR = (9/100) / (18/100) = 0.5. This can be
interpreted as the risk of influenza in the vaccinated group being half that in the placebo group. To find the relative risk in the placebo group relative to the vaccine group, one can simply find the reciprocal
value, in this case: 1/0.5 = 2.0.
B is not correct. 16% chose this.
As demonstrated, the RR in this question can be calculated as 0.50. The risk of influenza in the placebo group relative to the vaccine group, which was not the question asked, was 2.0.
C is not correct. 5% chose this.
As demonstrated, the RR in this question can be calculated as 0.50.
D is not correct. 4% chose this.
As demonstrated, the RR in this question can be calculated as 0.50.
E is not correct. 3% chose this.
As demonstrated, the RR in this question can be calculated as 0.50.
In September, 200 patients are fully informed and consent to a randomized controlled trial testing the effectiveness of a new influenza vaccine. Of them, 100 receive the new vaccine, and 100 receive a
placebo injection. The patients are followed until the following April, at which point they report any influenza-like illness they experienced since entering the study. The data reveal that 18 of the 100
patients who received the placebo and 9 of the 100 patients who received the vaccine had a likely case of influenza.
In this patient sample, what is the risk of influenza in those who received the vaccine relative to those who received placebo?
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Item: 44 of 46
QID: 4875
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118639 : DR. JITENDRA
A
B
C
D
E
The correct answer is B. 43% chose this.
A 75-year-old nursing home resident is brought to the emergency department because of confusion and reduced mental alertness. Caregivers say that the patient had developed a productive cough with
green sputum a few days ago and now has shaking chills and fever. Physical examination reveals an ill-appearing gentleman with a temperature of 38.9C (102F), heart rate of 110/min, blood pressure
of 90/60 mm Hg, and oxygen saturation of 92% on room air. He appears flushed, and his pulses are bounding. Laboratory values are significant for a WBC count of 14,000/mm, a platelet count of
50,000/mm, and elevated serum lactic acid levels.
Which physiologic parameters would the physician expect to find in this patient?
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Item: 45 of 46
QID: 1221
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118639 : DR. JITENDRA
A.Enzyme-linked immunosorbent assay
B.Gel electrophoresis
C.Northern blot
D.Polymerase chain reaction and sequencing
E.Western blot
The correct answer is D. 61% chose this.
Polymerase chain reaction (PCR) and sequencing can be used to determine if this woman and/or her husband is a carrier of the cystic fibrosis gene, the most common single-gene mutation in white people.
This mutation commonly presents with dysfunction of the lungs, pancreas, and other organs due to buildup of thick mucus. PCR is used to amplify the region of interest, and sequencing is used to see if the
cystic fibrosis mutation is present.
A is not correct. 6% chose this.
Enzyme-linked immunosorbent assay is an immunologic technique used in laboratories to determine whether a particular antibody is present in a patient's blood. This test cannot be used to determine
whether the woman and her husband are carriers for the cystic fibrosis gene.
B is not correct. 14% chose this.
Gel electrophoresis uses an electric field to separate molecules based on their sizes. Gel electrophoresis cannot be used alone to determine whether the woman and her husband are carriers for the cystic
fibrosis gene.
C is not correct. 9% chose this.
Northern blots test RNA levels. It cannot be used to determine whether the woman and her husband are carriers for the cystic fibrosis gene.
E is not correct. 10% chose this.
A Western blot is a test for the presence or absence of a protein. This test cannot be used to determine whether the woman and her husband are carriers for the cystic fibrosis gene.
A 31-year-old white woman is trying to get pregnant. She has a niece who suffers from a genetic disease characterized by recurrent respiratory infections and pancreatic failure. She would like to assess
her chances of having a child with this disease.
Which of the following laboratory techniques could be used to determine if this woman and/or her husband is a carrier of the mutant gene?
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Item: 46 of 46
QID: 2633
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118639 : DR. JITENDRA
A.Autoimmune destruction of the adrenal glands
B.Cortisol secretion by an adrenal adenoma
C.Ectopic ACTH production
D.Infarction of the pituitary gland
E.Pituitary corticotropin insufficiency
The correct answer is A. 64% chose this.
This patient's laboratory values are consistent with Addison's disease, a primary deficiency of aldosterone and cortisol due to adrenal hypofunction. This condition leads to hypotension and skin
hyperpigmentation (high ACTH levels stimulate melanocytes). Lack of aldosterone production results in insufficient renal reabsorption of sodium and excretion of potassium, causing the electrolyte
abnormalities seen in this patient. A loss of negative feedback by cortisol drives up ACTH levels. Adrenal insufficiency may result from a number of processes, including autoimmune destruction, infection,
and adrenal hemorrhage (eg, Waterhouse-Friedrichsen syndrome resulting from meningococcemia).
B is not correct. 9% chose this.
An adrenal adenoma producing cortisol would lead to signs and symptoms consistent with Cushing's syndrome (most notably hypertension, low ACTH level, hyperglycemia, weight gain, and moon facies).
This patient, however, has a deficiency of both cortisol and aldosterone.
C is not correct. 16% chose this.
Ectopic ACTH production, as seen in the paraneoplastic syndrome associated with small cell lung cancer, would likely lead to a relative excess (rather than deficiency) of cortisol. This would result in signs
and symptoms consistent with Cushing's syndrome, including hypertension and weight gain.
D is not correct. 4% chose this.
Infarction of the pituitary gland (as might be seen in the setting of severe hemorrhage and resultant hypoperfusion during delivery, known as Sheehan syndrome) would also result in cortisol deficiency.
However, the serum ACTH level in a patient with pituitary infarction would be low rather than high. In addition, pituitary infarction would be unlikely to give rise to skin pigmentation or severe
mineralocorticoid deficiency (aldosterone release being mostly regulated by angiotnesin, not ACTH).
A 34-year-old man comes to the emergency department complaining of progressive fatigue and unintentional weight loss. Physical examination is significant for blood pressure of 92/45 mm Hg and
darkened skin. Laboratory tests show a serum sodium level of 128 mEq/L and serum potassium of 5.9 mEq/L.
Which of the following most likely explains this patient's symptoms, examination findings, and laboratory values?
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