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1. An adult patient who was previously healthy has malaise, nausea, and lethargy.

He notes that his urine has a darker color. Physical examination reveals no major findings. His blood pressure is 135/90 mm Hg. Laboratory findings reveal a rising serum urea nitrogen and creatinine. Which of the following light microscopic findings on renal biopsy suggests the worst immediate prognosis: A. Renal tubular epithelial cell casts B. Hypercellular glomeruli with neutrophils C. Nodular glomerulosclerosis D. Glomerular crescents E. Chronic interstitial inflammation 2. A 45-year-old male has had a low-grade fever for over a month. He has malaise, but no other complaints. A physical examination reveals no significant findings. A urinalysis reveals that there are many WBC's in the urine, but routine bacterial cultures continue to be negative. What should be suspected: A. Renal cell carcinoma B. Renal tuberculosis C. Renal infarction D. Cystitis cystica E. Renal vein thrombosis 3. A 25 year old male who is otherwise healthy is found to have a urinalysis with sp. gr. 1.016, pH 6, glucose negative, ketones negative, nitrite negative, blood 3+, and protein 2+. The microscopic urinalysis shows RBC's but no casts. He has similar findings 6 months later. A renal biopsy reveals mesangial staining with an immunofluorescent stain utilizing antibody to IgA. Which of the following clinical outcomes is most likely to occur: A. Rapid progression to renal failure B. Slow progression to chronic renal failure C. Increased susceptibility to opportunistic infection D. Complete resolution following corticosteroid therapy E. Deafness 4. An adult patient has a serum urea nitrogen of 50 mg/dL with creatinine 5.8 mg/dL. The presence of which of the following urinalysis findings is most indicative of glomerulonephritis as a cause for these findings: A. Oval fat bodies B. Proteinuria C. Red blood cell casts D. Broad waxy casts E. White blood cell casts 5. Hereditary nephritis (Alport's syndrome) is characterized by all of the following findings EXCEPT: A. Nerve deafness B. Cataracts C. Tubular accumulation of mucopolysaccharides D. Renal failure in infancy E. Male predominance 6. A 40 year old male has severe lower abdominal pain one evening. He notes the presence of bloody urine. Physical examination reveals no abdominal tenderness or masses, and bowel sounds are active. An abdominal CT scan reveals a small bright rounded object in the region of the left ureter. The underlying cause for these findings is most likely to be: A. Hypercalciuria B. Hyperparathyroidism

C. Urinary tract infection D. Gout E. Cystinosis 7. A 57 year old man has been bothered by arthritis for years. As a consequence, without reading the labels on over-the-counter medications, he has consumed large quantities (>3 gm per year) of analgesics (aspirin, phenacitin, acetaminophen) for years. He is most at risk for the development of: A. Acute tubular necrosis B. Transitional cell carcinoma C. Chronic interstitial nephritis D. Diffuse glomerulosclerosis E .Urinary tract lithiasis 8. A 49 year old man has had pain and swelling of several joints, including the 1st metatarosphalangeal joint, knee, elbow, and 2nd proximal interphalangeal joint, episodically for years. He has a mass lesion 2 cm in diameter over his elbow with overlying eroded skin. This mass is excised and is composed of chalky white material. He passes a small calculus along with bloody urine. His blood pressure is 155/100 mm Hg. Laboratory findings include serum urea nitrogen of 55 mg/dL, creatinine 6.1 mg/dL, glucose 110 mg/dL, alkaline phosphatase 22 U/L, and uric acid 18.2 mg/dL. Which of the following pathologic findings is most likely to be present: A. Polycystic change B. Chronic inflammation with plasma cells C. Needle-like interstitial crystals D. Hyperplastic arteriosclerosis E. Glomerular basement membrane thickening 9. In a football (soccer) match, the Italian mid-fielder is victimized by some vicious tackling by the Argentinian defense. Following the game (and several beers at a local bar) a urine sample from the mid-fielder would be most likely to show: A. Proteinuria B. Oval fat bodies C. Hemolyzed RBC's D. Renal tubular epithelial cells E. White blood cells 10. A patient has a history of episodes of dysuria and frequency of urination over the past several years. Each time a urinalysis reveals numerous WBCs microscopically, with positive leukocyte esterase and nitrite on urine dipstick examination. An intravenous urogram demonstrates a 1.5 cm true diverticulum of the bladder. This finding can be characterized by all of the following statements EXCEPT: A. Urine culture can grow E. coli B. Persistent urethral obstruction is the most common etiology C. This can be a congenital condition D. Bladder calculi are more frequent when it is present E. There is a high incidence of carcinoma within it 11. A 60-year-old female has anemia, vertebral bone pain, and sudden onset of renal failure. A renal biopsy shows pink, amorphous, irregular glomerular deposits which by immunohistochemical staining contain only irregular fibrils in a beta-pleated sheet. She has a serum urea nitrogen of 48 mg/dL, creatinine 2.8 mg/dL, total protein 8.5 g/dL, and albumin 3.9 g/dL. The most likely diagnosis is: A. Multiple myeloma B. Systemic lupus erythematosus

C. Metastatic breast carcinoma D. Diabetes mellitus E. Chronic lymphocytic leukemia 12. A ventricular septal defect that is not corrected surgically and does not close spontaneously will predispose the patient to all of the following complications EXCEPT: A. Infective endocarditis B. Pulmonary hypertension C. Congestive heart failure D. Mitral valve stenosis E. Cor pulmonale 13. An 18 year old male was born with a membranous ventricular septal defect that was never repaired. A chest radiograph now reveals a prominent right heart border. His arterial oxygen saturation is now only 88%. Manifestations of his disease are likely to include all of the following EXCEPT: A. Chronic passive congestion of liver B. Splenomegaly C. Peripheral edema D. Pulmonary congestion E. Pleural effusions 14. A 65 year old female presents to the emergency room in the evening with a history of chest pain that started in the morning. This pain has been worsening for several hours. It is a substernal, "crushing" type of pain that radiates down the left arm. Which of the following laboratory tests performed with a blood sample would be most important to perform at this time: A. Sedimentation rate B. White blood cell count C. Creatine kinase-MB D. Antinuclear antibody test E. Glucose 15. A 59-year-old male develops sudden severe anterior chest pain that radiates to his back. Within minutes, he is unconscious. He has a history of hypertension, but a recent treadmill test had revealed no cardiac disease. Which of the following do you suspect: A. Tear in the aortic intima B. Group A streptococcal infection C. Right middle cerebral artery embolus D. Acute viral myocarditis E. Pulmonary embolus 16. A 27 year old male with a history of intravenous drug abuse develops a fever over a couple of days' time. Physical examination reveals a heart murmur. Splinter hemorrhages are seen on nails of his hands. Echocardiography reveals large vegetations involving the aortic valve. The LEAST likely complication to occur in this situation is: A. Congestive heart failure B. Hemopericardium C. Splenic infarct D. Valvular insufficiency E. Acute myocardial infarction 17. A 57 year old male has distant heart sounds on auscultation of the chest. He has poor exercise tolerance. A chest radiograph reveals that there is a thin rim of calcification surrounding the cardiac outline. Which of the following conditions is most likely responsible for these findings:

A. Sarcoidosis B. Tuberculosis C. Rheumatic heart disease D. Uremia E. Metastatic carcinoma 18. A 35 year old healthy female has a faint systolic murmur on physical examination. An echocardiogram is performed, and she is found to have a bicuspid aortic valve. In explaining the meaning of this finding to her, your most appropriate statement is that: A She should be treated with cholesterol-lowering pharmacologic agents B Other family members may have the same condition C An aortic valve prosthesis may eventually need to be placed D This is one manifestation of an underlying autoimmune disease process E The problem resulted from past injection drug usage 19. A 68-year-old male has been very ill for months following the onset of chronic liver disease with hepatitis C infection. He experiences a sudden loss of consciousness and then exhibits paraplegia on the right. A cerebral angiogram reveals lack of perfusion in the left middle cerebral artery distribution. The most likely cardiac lesion to be associated with this finding is: A. Non-bacterial thrombotic endocarditis B. Paradoxical thromboembolus C. Acute rheumatic fever D. Left atrial myxoma E. Libman-Sacks endocarditis 20. A 59-year-old male has had decreasing exercise tolerance for several years. He is found to have decreased cardiac output with diminished diastolic filling on echocardiography, but the heart does not appear to be hypertrophied or dilated. Which of the following pathologic findings would best explain this condition? A. Amyloidosis B. Rheumatic heart disease C. Chronic alcoholism D. Coxsackie B viral infection E. Constrictive pericarditis 21. A 49-year-old female has 4+ pitting edema involving the lower extremities to a level just above the knees. Her jugular venous pulse is visible to the angle of the jaw. A chest radiograph reveals bilateral pleural effusions along with a prominent right heart border. The LEAST likely etiology for these findings is: A. Silicosis B. Tricuspid valve insufficiency C. Panlobular emphysema D. Primary pulmonary hypertension E. Coronary atherosclerosis 22. A 55 year old male has had a blood pressure of 165/105 mm Hg for many years and has not bothered to treat this condition. His most likely cause of death will be from: A. Cerebral hemorrhage (stroke) B. Aortic aneurysm rupture C. Congestive heart failure D. Chronic renal failure E. Intracranial arterial aneurysm rupture

23. A 70 year old female is bothered by left sided headaches for several months. She does not seek medical attention. She then notices decreased visual acuity in her left eye. This is most likely to be a complication of: A. Wegener's granulomatosis B. Polyarteritis nodosa C. Raynaud's disease D. Giant cell arteritis E. Thromboangitis obliterans 24. A 33-year-old male develops a low grade fever. A week later he develops dyspnea and palpitations. He dies suddenly and unexpectedly. The medical examiner finds a diffusely enlarged, flabby heart with no focal lesions. The coronary arteries show minimal atherosclerosis with no narrowing. The most likely etiology is: A. Cocaine overdose B. Acute rheumatic fever C. Viral myocarditis D. Systemic lupus erythematosus E. Endomyocardial fibrosis 25. A 60 year old woman has the sudden onset of severe chest pain. She has had anginal pain in the past, but this time the pain is much worse and not relieved by nitroglycerin. Her vital signs in the emergency room are T 36.1 R 24 P 100 and BP 155/100. A chest radiograph shows a widened mediastinum, with no pulmonary edema or pleural effusion. She loses consciousness. An emergent pericardiocentesis yields blood. Which of the following conditions has probably led to these findings: A. Aortic dissection B. Mitral valve prolapse C. Polyarteritis nodosa D. Rheumatic myocarditis E. Pericardial metastases 26. A 19-year-old male has an aortic valve replaced with a porcine bioprosthesis. He is told that, probably before ten years have elapsed, the valve will have to be replaced because of: A. Infective endocarditis B. Thrombosis with occlusion C. Deterioration with calcification D. Chronic rejection E. Paravalvular leakage with insufficiency 27. A 63-year-old female has suffered a series of transient episodes in which she has lost consciousness for several minutes each time. The LEAST likely etiology for these episodes is: A. Left atrial myxoma with "ball valve" effect in mitral valve B. Carotid artery atherosclerosis with lumenal narrowing C. Non-bacterial thrombotic endocarditis of mitral valve D. Atherosclerotic aortic aneurysm containing mural thrombus E. Chronic rheumatic mitral stenosis with left atrial mural thrombosis 28. A 47-year-old male has increasing abdominal enlargement. Physical examination reveals the presence of no abdominal tenderness, but a fluid wave is present. A paracentesis is performed with removal of 2000 cc of clear, yellow ascitic fluid. This fluid has a protein of 2.1 g/dL. Cytologically, the fluid contains a few mesothelial cells and a few mononuclear cells. Which of the following underlying conditions is he is most likely to have: A. Perforated gastric ulcer

B. Acute pancreatitis C. Micronodular cirrhosis D. Crohn's disease E. Colonic adenocarcinoma 29. A 50 year old male has the onset over one day's time of increasing abdominal pain. He notes abdominal distension. In the emergency room, the examing physician's assistant finds that he has diffuse abdominal pain. An old right lower quadrant 8 cm transverse scar is noted. Bowel sounds are high-pitched, faint, and sporadic. A stool guaiac is negative. An abdominal radiograph reveals dilated loops of bowel with air-fluid levels. Which of the following conditions predisposed this patient to development of his current problem: A. Chronic persistent hepatitis B. Ileal adenocarcinoma C. Entameba histolytica infection D. Adhesions from prior surgery E. Meckel's diverticulum 30. A 30-year-old female goes on a crash diet to lose weight, eating less than 500 calories per day. After two weeks, she notices scleral icterus and sees her physician. Laboratory testing reveals total bilirubin 3.5 mg/dl with direct bilirubin 0.3 mg/dl. The most likely cause for these findings is: A. Fatty metamorphosis of liver B. Biliary atresia C. Rotor syndrome D. Choledocholithiasis E. Gilbert's syndrome 31. Ischemia with infarction of the small intestine is LEAST likely to occur with which of the following conditions: A. Intussusception B. Volvulus C. Regional enteritis D. Incarcerated hernia E. Superior mesenteric artery thrombosis 32. A 27 year old previously healthy male feels nauseated one morning and does not eat breakfast. By mid-morning, he feels worse, with periumbilical abdominal pain. He goes to the emergency room, where physical examination reveals a normal head, neck, and chest exam, but he has a temperature of 38.7 C. However, he has right lower quadrant abdominal pain with rebound tenderness. Bowel sounds are present. His abdomen is not distended. His stool is negative for occult blood. An abdominal radiograph reveals no free air. Which of the following laboratory tests will be most useful to you in this situation: A. White blood cell count B. Sedimentation rate C. Serum amylase D. Stool culture E .Urinalysis 33. All of the following findings are possible consequences of portal hypertension from cirrhosis of the liver in a 49-year-old male EXCEPT: A. Hemorrhoids B. Ascites C. Splenomegaly D. Vasculitis

E. Hepatic encephalopathy 34. A 65 year old woman has increasing dyspnea along with peripheral edema. She is bothered by a chronic arthritis involving both large and small joints. She is found to have a random serum glucose of 168 mg/dL. Two additional fasting serum glucose values are obtained which are 152 mg/dL and 168 mg/dL respectively. A serum ferritin is 6320 ng/mL. Which of the following approaches is most appropriate for you to take: A. Put the patient on corticosteroid therapy B. Tell her to stop using NSAIDS C. Give her interferon therapy D. Get her serum glucose under control E. Screen family members for the same condition 35. A 30 year old male suffers through occasional bouts of bloating and diarrhea. These transient episodes last a few hours and then subside. He has experienced such episodes since childhood. You recommend that he abstain from milk products in his diet for a month, and he experiences no episodes during that time. What is the probable cause for these findings: A. Cystic fibrosis B. Crohn's disease C. Celiac disease D. Short bowel syndrome E. Lactase deficiency 36. A 44 year old female has developed worsening pruritis over the past three months. Laboratory findings include: total protein 5.9 g/dL, albumin 3.4 g/dL, alkaline phosphatase 487 U/L, AST 66 U/L, ALT 55 U/L, total bilirubin 0.9 mg/dL, and direct bilirubin 0.7 mg/dL. A liver biopsy reveals destruction of intrahepatic bile ducts with associated lymphoplasmacytic inflammatory infiltrates of the portal tracts that extend into the adjacent parenchyma. Which of the following disease processes best explains these findings: A. Pancreatic adenocarcinoma B. Viral hepatitis C infection C. Chronic alcoholism D. Congestive heart failure E. Primary biliary cirrhosis 37. A 45-year-old female has noted increasing bronze pigmentation of the skin even though she has not been out in the sun. She is found to have a fasting serum glucose of 160 mg/dl. Physical examination reveals a palpable spleen tip and a firm liver edge. Arrhythmias are noted on electrocardiogram. The best explanation for these findings is: A. Chronic alcoholism B. Wilson's disease C. Budd-Chiari syndrome D. Hemochromatosis E. Gilbert's disease 38. A football team player retired in his 30's after a career of more than a decade. He now finds that he has a lot of stiffness in his right knee in the morning which soon abates, but by the end of the day he is taking non-steroidal anti-inflammatory medications for pain. These findings are most typical for: A. Rheumatoid arthritis B. Ankylosing spondylitis C. Osteoarthritis D. Lyme disease E. Osteomyelitis

39. Slow, progressive erosion of articular cartilage, followed by subchondral sclerosis and formation of osteophytes, has occurred in the joints of the hands as well as the vertebrae of a 69 year old male. There is pain, but no swelling. Ankylosis of the joints has not occurred. The most likely explanation for this is: A. Lyme disease B. Osteoarthritis C. Rheumatoid arthritis D. Remote fractures E. Osteoporosis 40. An otherwise healthy middle-aged male with no prior medical history has had increasing back pain and right hip pain for the past decade. The pain is worse at the end of the day. He has bony enlargement of the distal interphalangeal joints. A radiograph of the spine reveals the presence of prominent osteophytes involving the vertebral bodies. There is sclerosis with narrowing of the joint space at the right acetabulum seen on a radiograph of the pelvis. Which of the following pathologic processes is most likely to be taking place in this patient: A. Gout B. Rheumatoid arthritis C. Osteoarthritis D. Osteomyelitis E. Lyme disease 41. A 58 year old male has the sudden onset late one evening of severe pain in his left great toe. There is no history of trauma. The pain is accompanied by edema with redness, but there is no skin ulceration. A joint aspirate reveals numerous neutrophils. Over the next several weeks, he has two more similar episodes. On physical examination between these attacks, there is minimal loss of joint mobility. Which of the following laboratory test findings is most characteristic for his underlying disease process: A. Hyperglycemia B. Positive antinuclear antibody C. Hyperuricemia D. Hypercalcemia E. High rheumatoid factor titer 42. Which of the following criteria should be met before a patient is given thrombolytic thrapy after the history, physical examination, and ECG ? A. typical chest pain suggestive of myocardial infarction B. ECG changes confirming myocardial infarction C. the absence of other diseases that would explain the symptoms D. all of the above E. none of the above 43. Which of the following statements regarding the use of heparin in patients with acute myocardial infarction is (are) true? A. heparin therapy is now used almost routinely with thrombolytic therapy during the acute phase of myocardial infarction treatment, providing certain criteria are met B. heparin is recommended whenever there is echocardiographic evidence of left ventricular thrombi C. heparin should be administered (unless contraindicated) to all patients with acute anterior wall myocardial infarction D. heparin is contraindicated in patients with uncontrolled hypertension E. all of the above

44. Which of the following is a (are) contraindication(s) to the use of thrombolytic therapy in patients with acute myocardial infarction? A. active gastrointestinal bleeding B. recent surgery (2 weeks postoperatively) C. history of cerebrovascular accident D. atrial fibrillation or mitral stenosis E. all of the above 45. Which of the following statements regarding thrombolytic therapy is (are) false? A. thrombolytic therapy limits myocardial necrosis B. thrombolytic therapy preserves left ventricular function C. thrombolytic therapy reduces mortality D. all of the above statements are false E. none of the above statements is false 46. Which of the following medications has (have) been shown to be of benefit in some postmyocardial infarction patients? A. beta-blockers B. calcium channel blockers C. aspirin D. A and C E. all of the above 47. The best single confirmatory investigation for acute myocardial infarction is: A. ECG B. the height of ST segment elevation in the affected area (in millimeters) and the depth of ST segment depression in the reciprocally affected leads (in millimeters) C. the creatinine kinase isoenzyme MB fraction D. the presence of dysfunctional heart muscle as demonstrated by echocardiography E. measurement of radiolabeled antimyosin antibody fragments 48. Sudden death as a result of myocardial infarction is almost always caused by: A. third-degree heart block resulting from infarction of the atrioventricular (AV) node B. ventricular tachycardia C. ventricular fibrillation D. ventricular standstill E. none of the above 49. The pathophysiology of angina pectoris is best explained by which of the following? A. significantly increased peripheral vascular resistance B. a balance between oxygen supply and oxygen demand C. an imbalance of oxygen supply and oxygen demand plus or minus coronary artery spasm D. significant peripheral venous and arterial vasoconstriction E. none of the above 50. All of the following features suggest acute as opposed to chronic mitral regurgitation (MR) EXCEPT:

A. B. C. D. E. 51. A. B. C. D. E. 52. A. B. C. D. E.

no cardiomegaly on chest x-ray a normal ECG a systolic murmur that radiates to the neck a systolic murmur that clearly ends before S2 normal jugular venous pressure All the following characteristics are typical of hypertensive crisis EXCEPT: diastolic blood pressure >140 mm Hg retinal hemorrhages normal mental status proteinuria and azotemia microangiopathic hemolytic anemia All of the following are primary determinants of cardiac output EXCEPT: heart rate left ventricular preload left ventricular afterload myocardial contractile or inotropic state oxygen-carrying capacity of blood

53. The nonpharmacologic treatment of choice for the early stage of heart failure may include which of the following? A. salt restriction B. fat restriction C. water restriction D. all of the above E. none of the above 54. Which of the following is the primary indication for the use of digitalis in congestive heart failure? A. a dilated left ventricle B. an S3 or S4 gallop C. decreased ejection fraction D. atrial fibrillation with a rapid ventricular rate E. C and D F. all of the above 55. 55. In evaluating a patient for systolic dysfunction, the most important characteristic found on echocardiogram is: A. myocardial hypertrophy B. valvular heart disease C. cor pulmonale D. low ejection fraction E. wall motion abnormalities 56. What is the most common side effect of ACE inhibitors? A. cough

B. constipation C. headache D. skin rash E. depression 57. What is the most common side effect of propranolol? A. cough B. constipation C. headache D. skin rash E. depression 58. Most atrial premature beats discovered on clinical examination are: A. associated with chronic obstructive pulmonary desease (COPD) B. completely benign C. associated with valvular heart disease D. Associated with an increase in cardiovascular mortality E. none of the above 59. Most ventricular premature beats discovered on clinical examination are: A. associated with chronic obstructive pulmonary desease (COPD) B. completely benign C. associated with valvular heart disease D. Associated with an increase in cardiovascular mortality E. none of the above 60. What is the recommended treatment for paroxysmal supraventricular tachycardia (PSVT) with hemodynamic compromise? A. synchronized cardioversion B. countershock C. IV adenosine D. IV verapamil E. IV digoxin 61. Patients with chronic atrial fibrilation are at increased risk mostly for which of the following conditions? A. acute myocardial infarction (MI) B. ventricular tachycardia C. sudden cardiac death D. cerebrovascular accident E. ventricular fibrillation 62. With which of the following conditions is obesity most commonly associated? A. alveolar hypoventilation syndrome B. hypertension C. hyperlipidemia D. diabetes mellitus

E. angina pectoris 63. The use of severe calorie-restricted diets (800 kcal/day) has been responsible for many deaths. What is the most common cause of deaths in these cases? A. sudden cardiac death, secondary to dysrhythmia B. congestive cardiac failure, secondary to anemia C. hepatic failure D. renal failure E. septicemia 64. What is the most common cause of morbidity and mortality among hospitalized patients? A. myocardial infarction B. cerebrovascular accident C. deep venous thrombosis/pulmonary embolism D. nosocomial infection E. none of the above 65. Which of the following is a (are) risk factor(s) for the pulmonary embolism? A. prolonged immobilization B. long leg fractures C. pregnancy D. malignancy E. all of the above 66. What is the most likely cause of chronic obstructive pulmonary disease (COPD)? A. right-sided heart failure B. cor pulmonale C. cigarette smoking D. obstructive sleep apnea E. hypercarbia 67. Which of the following is a (are) consideration(s) in the diagnosis of chronic bronchitis? A. asthma B. postnasal drip from sinusitis C. chronic angiotensin-converting enzyme (ACE) inhibitor therapy D.A and B E. all of the above 68. On a pathophysiologic basis, asthma is primarily: A. a bronchoconstracting process B.an allergenic stimulus process C. an inflammatory process D. a bronchial hyperreactivity process E. an immunoglobulin E (IgE)-mediated antigen-antibody reaction 69. Which of the following is (are) a clinical hallmark of asthma?

A. cough B. nocturnal dyspnea C. wheezing D. shortness of breath E. a,c, and d 70. A 24-year old woman develops wheezing and shortness of breath when she is exposed to cold air or when she is exercising. These symptoms are becoming worse. Which of the following is the prophylactic agent of choice for the treatment of asthma in these circumstances? A. inhaled 2-agonists B. oral aminophylline C. inhaled anticholinergics D. inhaled sodium cromoglycate E. oral coricosteroids 71. Which of the following is the most common abnormality observed on the chest x-ray in a patient with asthma? A. hyperinflation B. increased bronchial markings C. atelectasis D. flattening of the diaphragm E. all of the above are equally common

72. What is the most common abnormality seen on physical examination of an bronchial asthmatic patient? A. increased respiratory rate B. inspiratory rales C. inspiratory ronchi D. expiratory rales E. expiratory wheezes 73. An elderly patient in a long-term care facility develops influenza A pneumonia despite both vaccination and amantadine prophylaxis. What is the organism most likely to complicate influenza pneumonia? A. S.pneumoniae B. H.influenzae C. Chlamidia trachomatis D. Chlamidia pneumoniae E. M. pneumoniae 74. What is the most common cause of nosocomial pneumonia? A. M. pneumoniae B. aerobic gram-negative bacteria C. S. Pneumoniae D. H influenzae E. viral pneumonia 75. What is the most common cause of dysfagia?

A. achalasia B. esophageal spasm C. a lower esophageal ring (Schatzki ring) D. non-specific motor disorders E. an esophageal stricture 76.What is the drug of choice in the treatment of achalasia? A. nitroglycerine B. calcium channel blocker C. benzodiazepine D. antacid E. any of the above 78. Which of the following is (are) a complication(s) of ulcerative colitis? A. toxic megacolon B. colonic cancer C. colonic strictures D. iritis E. all of the above 79. 15 years old female has a 1 month history of abdominal cramping, abdominal bloating, and increased flatulence after the ingestion of milk or milk products. The patient drank three glasses of milk 2 hours ago. On examination the abdomen is tympanic and appears to be slightly distended. No other abnormalities are found on examination. What is the most likely diagnosis in this patient? A. tropical sprue B. celiac sprue C. lactase deficiency D. regional enteritis E. chronic pancreatitis 80. Which of the following drugs show(s) effectiveness against H.pylori? A. bismuth subsalicylate B. metronidazole C. amoxicillin D. b and c E. all of the above 81. What is the mode of action of omeprazole? A. H1 receptor antagonist B. H2 receptor antagonist C. proton pump inhibitor D. cytoprotective agent E. antcholinergic agent 82. Which of the following drugs is classified as an H2 receptor antagonist? A. cimetifdine B. ranitidine C. famotidine

D. A and B E. all of the above 83. Which of the following statements regarding the role of drugs in the development of peptic ulcer is (are) true? A. the incidence of this condition in patients taking indomethacin or ther NSAIDs is increased B. the use of dexamethasone is a risk factor for this condition C. aspirin may precipitate this condition D. some NSAIDs seem more likely to precipitate this condition than others E. all of the above are true 84. A 25 years old schoolteacher complains of nausea, vomiting, anorexia, aversion to her usual twopack-a-day tobacco habit, and right upper quadrant pain. She has been sick for the past 3 days. Two of the students in her class have come down with similar symptoms. She has had no exposure to blood products and has no other significant risk factors for sexually transmitted disease. On examination her sclerae are icteric and her liver edge is tender. She looks acutely ill. What is the most likely diagnosis in this patient? A. hepatitis A B. hepatitis B C. hepatitis C D. atypical infectious mononucleosis E. none of the above 85. Initial screening for hepatitis B should include which of the following? A. anti-hepatitis B surface antigen (HBsAg) and anti_HBc B. hepatitis B early atigen (HBeAg) and anti-HBe C. HBsAg and anti-HBs D. HBsAg and anti-HBc E. anti-HBe and anti-HBc 87. Clinical manifestations of cirrhosis include which of the following? A. fatigue B. jaundice C. splenomegaly D. hypoalbuminemia E. all of the above 88. Which of the following types of viral hepatitis is (are) associated with the development of chronic active hepatitis? A. hepatitis B B. hepatitis C C. hepatitis A D. a and b only E. all of the above 89. The pathophysiology of alcoholic cirrhosis includes which of the following? A. macronodular and micronodular fibrosis B. nodular regeneration

C. increased portal vein pressure D. increase in hepatic size followed by a decrease E. all of the above 90. Which of the following is(are) a complication(s) of alcoholic cirrhosis? A. hpersplenism B. hepatic encephalopathy C. congestive gastropathy D. spontaneous bacterial peritonitis E. all of the above 91. Treatment of the ascites accompanying cirrhosis may include which of the following? A. spironolactone B. hydrochorothiazide C. furosemide D. all of the above E. e and b only 92. Which of the following statements regarding diet and diabetes is false? A. diet is basic in the treatment of all diabetics B. new evidence suggests that diabetics have to avoid foods that contain simple carbohydrates C. the diabetic on insulin therapy must have three meals plus a bedtime snack at fixed times each day D. the diabetic on insulin should have a fixed caloric distribution 93. 42 years old female has the following signs and symptoms: obesity, elevated blood pressure, increased body hair, purple streaks on her abdomen, a fat face and pain in her bones and joints. She is on no medication at present, nor has she been on any medication for the past yer. On examination her blood pressure is 160/110 mm Hg; she has obvious hirsutism over her entire body, and her abdomen has purple striae. Her face is not only plethoric but also demonstrates a double chain. Her thoracic spine shows evidence of what is known as a buffalo hump. Based on the information provided, what is the most likely diagnosis in this patient? A. Conns syndrome B. Cushings syndrome C. Addisons syndrome D. primary hyperparathyroidism E. prolactinoma 94. Of all the possible causes for Cushings syndrome which of the following is the most common? A. adenoma of the adrenal gland B. adenoma of the pituitary land C. hyperplasia of the adrenal gland D. corticosteroid therapy for suppression of inflammation E. small cell carcinoma of the lung 95. 38 years old female complains of sweating, palpitations, weight loss, nervousness, irritability, insomnia, hand tremors and diarrhea. On examination her blood pressure is 160/70 mm Hg. Her pulse

is 120 bpm and regular. She demonstrates mild proptosis. Cardiovascular examination reveals a loud S1 and a loud S2 with an ejection systolic murmur heard lodest along the left sternal edge. What is the most likely diagnosis in this patient? A. toxic multinodular goiter B. Graves disease C. Hashimotos thyroiditis D. pheochromocytoma E. panic disorder 96. 35 years old female has a 4-month history of fatigue. She has noticed that during the past 12 months her menstrual periods have become heavier and longer. On examination the patient appears pale. Her lower eyelids are pale and so is her skin. Her blood pressure is 100/70 mm Hg. Physical examination including a pelvic examination is otherwise normal. Her blood smear reads as follows: red blood cells are microcytic and appear to be hypochromic. Her platelet count is 175 000 mm3. Her haemoglobin is 9,5 g/l. What is the most likely diagnosis for this patient? A. iron deficiency anemia B. haemolytic anemia C. folic acid deficiency anemia D. pernicious anemia E. anemia of chronic disease 97. What is the most characteristic symptom of rheumatoid arthritis? A. early morning joint stiffness B. progressive joint pain C. predilection for the small joints D. joint swelling E. normal cartilage despite arthralgia 98. Feltys syndrome is a complication of rheumatoid arthritis. Which of the following is (are) part of Feltys syndrome? A. splenomegaly B. neutropenia C. positive rheumatoid factor D. a and b E. all of the above 99. Which of the following statements regarding osteoarthritis is false? A. pain is the chief symptom of osteoarthritis and is usually deep and aching in character B. stiffness of the involved joint is common but of relatively brief duration C. the pain of osteoarthritis is characteristically dull and aching D. the major physical finding in osteoarthritis is bony crepitus E. the presence of osteophytes is sufficient for the diagnosis of osteoarthritis 100. Which of the following is a(are) useful treatment modality(ies) in the treatment of osteoarthritis? A. weight loss in obese patients B. canes, crutches and walkers C. the application of heat to involved joints

D. nonsteroidal anti-inflammatory drugs E. all of the above 101. Which of the following statements regarding gout is false? A. the disease is more common in males than in females B. fever is unusual C. more than 50% of the initial attacks of gout are confined to the first metatarsophalageal joint D. peripheral leukocytosis can occur E. involvement is usually asymmetric 102. What is the definitive diagnostic test of choice for gout? A. a plasma level B. a random urine determination C. a 24-hour urine determination D. a synovial fluid analysis E. a Gram stain and culture and sensitivity 103. Which of the following drugs increase(s) the excretion of uric acid? A. sulfinpyrazone B. probenecid C. allopurinol D. a and b only E. all of the above 104. 29 years old female has symptoms of extreme fatigue, no appetite, and bloody urine. She developed a very sore throat 3 weeks ago, but did not have examined or treated. Three days ago she began to have bloody urine and swelling of her hands and feet. On examination she has significant edema of both lower extremities. Her blood pressure is 170/105 mm Hg. What is the most likely diagnosis in this patient? A. hemorrhagic pyelonephritis B. IgA nephropathy (Bergers disease) C. poststreptococcal glomerulonephritis D. hemorrhagic cystitis E. membrnou glomerulonephritis 105. Which of the following is pathognomic of glomerulonephritis? A. macroscopic hematuria B. microscopic hematuria C. eosinophils in the urine D. red blood cell casts E. protein 1,0 g/24h 103. What is the most common cause of chronic renal failure? A. glomerulonephritis B. chronic pyelonephritis C. diabetes mellitus D. renovascular hypertension

E. congenital renal anomalies 104. What is the least common cause of chronic renal failure among the following causes? A. glomerulonephritis (acute to chronic) B. chronic pyelonephritis C. renovascular hypertension D. diabetes mellitus E. congenital renal anomalies 105. What is the major cause of death in patients with chronic rena failure? A. uremia B. malignant hypertension C. hyperkalemia-induced arrythmias D. myocardial infarction E. subarachnoid hemorrhage 106. Which type of anemia is usually associated with chronic renal failure? A. hypochromic B. macrocytic C. normochromic; normocytic D. microcytic E. hypochromic:microcytic 107. Which of the following is (are) associated with nephrotic syndrome? A. proteinuria, 3,5 g/day B. edema C. hypoalbuminemia D. hypercholesterolemia E. all of the above 108. Which of the following statements regarding nephrotic syndrome is false? A. most patients with nephrotic syndrome progress to chronic real failure B. some cases of nephritic syndrome are drug induced C. Hodgkins disease may lead to nephrotic syndrome D. preeclamptic toxemia may lead to nephrotic syndrome E. none of the above statements is false 109. Which of the following statements regarding diabetes mellitus and chronic renal failure is true? A. diabetes mellitus is an uncommon cause of chronic renal failure B. diabetes mellitus type 1 is a more common cause of chronic renal failure than diabetes mellitus type 2 C. diabetes mellitus type 2 is a more common cause of chronic renal failure than diabetes mellitus type 1 D. diabetes mellitus type 2 does not lead to chronic renal failure E. diabetes mellitus type 1 does not lead to chronic renal failure

110. The treatment of nephritic syndrome includes which of the following? A. corticosteroids B. loop diuretics C. thiazide diuretics D. protein restriction E. all of the above 111. 34 years old female has a 3-day history of hematuria, dysuria, increased urinary frequency, and nocturia. She has had no fever, no chills, and no back pain. On examination, she does not look ill. Her temperature is 37,5oC. Her abdomen is nontender. What is the most likely diagnosis? A. Bergers disease (IgA nephropathy) B. acute hemorrhagic cystitis C. acute hemorrhagic urethritis D. acute glomerulonephritis E. acute cystitis with concomitant coagulation disorder