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Topics: 11
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34>A 30-year-old pregnant woman of Jewish descent presents to a physician
with painful oral ulcers. Physical examination demonstrates widespread
erosions of her mucous membranes. Close examination reveals a friable
mucosa, but no well-defined aphthous ulcers. Biopsy of perilesional
mucosa demonstrates acantholysis; direct immunofluorescence
demonstrates an intraepidermal band of IgG and C3. Which of
the following is the most likely diagnosis?
A. Bullous pemphigoid
B. Dermatitis herpetiformis
C. Herpes simplex I
D. Herpes simplex II
E. Pemphigus vulgaris
Anwser
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35>A 40-year-old woman presents to the emergency department because of
hematuria. Laboratory analyses show significant proteinuria, bacteria
and white cells in the urine, and a blood urea nitrogen (BUN) of
40 mg/dL with a creatinine of 4.0 mg/dL. Ultrasonography reveals
enlarged kidneys, and she is given a provisional diagnosis of
polycystic renal disease. Which of the following is likely to
be decreased in this patient?
A. Creatinine clearance
B. Extracellular sodium concentration
C. Glucose clearance
D. Plasma creatinine levels
E. Plasma inulin levels
Anwser
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36>During development, the formation of the kidney is induced by which of
the following structures?
A. Allantois
B. Mesonephric duct
C. Mesonephros
D. Metanephric duct
E. Urogenital ridge
Anwser
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37>A premature infant develops progressive difficulty breathing over the first
few days of life. Deficient surfactant synthesis by which of the following
cell types may have contributed to the baby's respiratory problems?
A. Alveolar capillary endothelial cells
B. Bronchial mucous cells
C. Bronchial respiratory epithelium
D. Type I pneumocytes
E. Type II pneumocytes
Anwser
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38>A surgeon performs an exploratory laparotomy, producing a large incision in
the patient's abdomen. Poor blood supply to which of the following is most
likely to cause problems during the healing process?
A. Adipose tissue
B. Aponeuroses
C. Loose connective tissue
D. Muscle
E. Skin
Anwser
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39>Which of the following would be expected to be decreased in a patient with
chronic hypertension secondary to renal artery stenosis?
A. Atrial natriuretic peptide levels
B. Blood urea nitrogen (BUN) levels
C. Glomerular filtration rate in response to captopril
D. Net acid excretion
E. Potassium secretion
Anwser
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40>A patient, who appears to be female, is found to be 46,XY. The patient's
vagina is very shallow, ending in a blind pouch, and there are palpable
masses in the labia. The diagnosis of testicular feminization syndrome
is made. Which of the following was most likely present during the early
fetal life of this individual?
A. A streak ovary
B. A uterus
C. An oviduct
D. Depressed levels of testosterone
E. MIF (Mullerian inhibitory factor)
Anwser
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41>A healthy 42-year-old woman with a history of anxiety attacks sits in the
hospital waiting room as her 3-year-old daughter undergoes open heart
surgery for a septal malformation. The woman experiences a feeling of
suffocation and is obviously hyperventilating. She informs her husband
that she feels faint and has blurred vision. Which of the following is
most likely to relieve the symptoms caused by hyperventilation?
A. Breathing a 10% oxygen/90% nitrogen mixture
B. Breathing 100% nitrogen
C. Breathing in and out of a plastic bag
D. Intravenous administration of bicarbonate
E. Lying down
Anwser
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42>Which of the following occurs at the darkly stained band indicated by the
arrow?
A. Acrosome reaction
B. Aromatase acts on testosterone
C. Capacitation
D. Implantation receptors are exhibited
E. Meiosis is resumed
Anwser
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43>A 38-year-old AIDS patient presents to his physician's office in Kansas
City, Missouri, complaining of fever for the past week and an increasing
headache. He also states that sunlight hurts his eyes and that he has
been feeling nauseated and weak. His past medical history is significant
for Pneumocystis pneumonia and a total CD4 count of 89. Current
medications are trimethoprim/sulfa and indinavir. Cerebrospinal
fluid (CSF) reveals 4 WBC, and budding encapsulated yeast
forms grow on Sabouraud's agar. Which of the following is
an accurate description of the morphology of the infectiou
s form of the organism responsible for the man's illness?
A. Broad-based, budding yeasts
B. Budding yeasts in a "pilot's wheel" arrangement
C. Cylindrical arthroconidia
D. Encapsulated budding yeasts
E. Filamentous molds
F. Septate hyphae with microconidia and macroconidia
Anwser
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44>To which of the following diseases is pyruvate kinase deficiency most
similar clinically?
A. a-thalassemia
B. b-thalassemia
C. Glucose-6-phosphate dehydrogenase deficiency
D. Hereditary spherocytosis
E. Iron deficiency anemia
Anwser
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45>A 60-year-old male with angina comes to the emergency room with severe
chest pain unresponsive to sublingual nitroglycerin. An EKG shows ST
segment elevation in the anterolateral leads, and thrombolytic therapy
is initiated. If streptokinase is given to this patient, it may produce
thrombolysis after binding to which of the following proteins?
A. Antithrombin III
B. Fibrin
C. Plasminogen
D. Protein C
E. Thrombomodulin
Anwser
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46>A child is brought to the pediatrician because of perianal itching, which
has been disturbing the child's sleep. Physical examination reveals scaly
skin in the perianal region. The physician instructs the parents to place
transparent tape on the perianal region the next morning, and then retur
n to the office. In the office, the tape is transferred to a microscope
slide, and low-power examination of the tape reveals oval eggs that are
flattened along one side. The microorganism most likely responsible for
the child's symptoms is
A. Ancylostoma duodenale
B. Ascaris lumbricoides
C. Enterobius vermicularis
D. Necator americanus
E. Trichuris trichiura
Anwser
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47>A healthy, 37-year-old, recently divorced woman loses her job at the auto
factory. She picks up her three young children from the factory day care
center and gets into an automobile accident on the way home. Her
5-year-old son, who was not wearing a seat belt, sustains a severe
head injury. The woman was not hurt in the accident, but is
hyperventilating as she sits in the waiting room at the hospital.
She complains of feeling faint and has blurred vision. Which of
the following is decreased in this woman?
A. Arterial oxygen content
B. Arterial oxygen tension (PO2)
C. Arterial pH
D. Cerebral blood flow
E. Cerebrovascular resistance
Anwser
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48>A 66-year-old man with urinary retention secondary to prostatic hyperplasia
develops a spiking fever and tachypnea. Physical exam reveals intercostal
muscle retractions and bilateral inspiratory crackles. A chest x-ray
exhibits bilateral interstitial and alveolar infiltrates. Arterial blood
gases demonstrate severe hypoxemia. Blood cultures would most likely
reveal
A. gram-negative diplococci
B. gram-negative rods
C. gram-positive cocci
D. gram-positive diplococci
E. gram-positive rods
Anwser
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49>A patient arrives in the emergency room after having attempted suicide by
lacerating his wrist. No major artery was damaged, but the nerve that is
immediately lateral to the flexor digitorum superficialis tendon is cut.
Which of the following actions will no longer be possible?
A. Abduction of the second digit
B. Adduction of the second digit
C. Adduction of the thumb
D. Flexion at the interphalangeal joint of the thumb.
E. Opposition of the thumb
Anwser
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50>A 48-year-old female is being treated for breast carcinoma. Over the past
few days, she has been complaining of dysuria and frequency. Laboratory
examination revealed the presence of microscopic hematuria. The next day
the patient developed gross hematuria. Which of the following agents
most likely caused the development of these signs and symptoms?
A. Cyclophosphamide
B. Mitomycin
C. Paclitaxel
D. Tamoxifen
E. Vincristine
Anwser
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Answers
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1>The correct answer is C. This is a classic presentation
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