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20. A 20-year-old man has had increasingly severe muscle weakness and incapacitation. He has used a wheelchair for ambulation since he was 10 years of age. Examination of tissue obtained on biopsy of a calf muscle when he was 6 years old showed a mixed pattern of muscle fiber necrosis alternating with hypertrophy and regeneration of residual muscle fibers. At age 18 years, biopsy findings showed virtually complete replacement of muscle by fibrofatty tissue. Which of the following cellular proteins is most likely to be missing from this patient's muscles?
A ) Actin
B ) Desmin
C ) Dystrophin
D ) Spectrin
E ) Vimentin
31. A 22-year-old woman is concerned about her risk for developing diabetes because her mother has type 2 diabetes mellitus. Which of the following is the primary defect thought to predispose individuals towards the development of type 2 diabetes mellitus?
A ) Anti-insulin receptor antibodies
B ) Autoimmune destruction of pancreatic β cells
C ) Dysregulation of pancreatic β cells
D ) Increased peripheral insulin resistance
E ) Suppressed hepatic glycogen synthesis
35. A 30-year-old woman has a 10-month history of a whitish discharge from both breasts. Her last menstrual period was 9 months ago. She had a bilateral tubal ligation 4 years ago after the birth of her third child. Palpation of the breasts discloses no masses. Whitish fluid is expressed bilaterally on compression of the nipples. The most likely diagnosis is
A ) bilateral mastitis
B ) intraductal carcinoma of the breast
C ) metastatic carcinoma of the breast
D ) pituitary adenoma
E ) premature menopause
39. A 10-year-old girl has fever, fatigue, and easy bruising. Laboratory studies show:
Hemoglobin 6.6 g/dL (N=11.8–15)
Hematocrit 20% (N=36–45%)
Leukocyte count 1300/mm3
Platelet count 12,000/mm3
A photomicrograph of bone marrow obtained on biopsy is shown. The most likely diagnosis is
A ) aleukemic leukemia
B ) aplastic anemia
C ) immune thrombocytopenic purpura
D ) myelofibrosis
E ) vitamin B12 (cyanocobalamin) deficiency
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21)C
31)A
35)D
39)B
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