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1. A 13-month-old boy is brought to his pediatrician by his parents.

During the past several months, the infant has been suffering from seizures and nausea and vomiting. His mother is also concerned that the infant has not yet begun to wal or tal and e!hibits a musty odor. "urther history reveals that no blood tests were performed on the infant after his birth. #hich of the following would be elevated in this patient$ %op of "orm

%yrosine &henylalanine Homogentisic acid 'eucine (ystine )ottom of "orm

*. A *+-year-old male is referred to an internist for a one-month history of yellow s in and eyes. "urther history reveals that the patient too a two-wee course of sulfametho!azole to treat a severe urinary tract infection that occurred a month and a half ago. A peripheral blood smear reveals ,)(s with Heinz bodies and an abnormally high level of reticulocytes. #hich of the following is most li ely to be decreased in this patient$ %op of "orm

"ADH* -ADH

-AD&H A%& .%& )ottom of "orm 3. A /0-year-old man complains to his physician of fre1uent urination and increasing thirst. His random blood sugar is 3/0 mg2d' by fingerstic . Diabetes mellitus is diagnosed and an oral agent is recommended. 3everal days after starting the medication he complains of bloating and increasing flatulence. #hich of the following is the most li ely agent prescribed by his physician$ %op of "orm

Acarbose .lipizide 4nsulin 5etformin &ioglitazone )ottom of "orm /. A 36-year-old woman begins treatment with methotre!ate for severe rheumatoid arthritis. #hich of the following supplements should accompany the chronic use of methotre!ate$ %op of "orm Ascorbic acid "olic acid

-iacin &yrido!ine %hiamine )ottom of "orm 0. A 10-year-old girl presents with a bowel obstruction. An e!ploratory laparotomy reveals mar edly enlarged para-aortic lymph nodes with entrapment of the small bowel. "rozen sections through the lymph nodes reveal a diffuse neoplastic infiltrate of small, round lymphocytes with a 7starry s y7 appearance on low power. %he cytoplasm of some of the lymphocytes is vacuolated and fat stains are positive. #hich of the following is characteristic of these neoplastic cells$ %op of "orm

'arge multinucleated reticulum cells 8,eed-3ternberg9 'oss of p03 tumor suppressor gene :nhanced e!pression of bcl-* t8;<**9 translocation t8=<1/9 translocation )ottom of "orm 6. A 1+-year-old male is brought to the emergency room because he has been acting strangely. "or the past three months, family members have noted that he has been tal ing to himself, feeling paranoid, and staying inside the house because he thin s people are spying on him. He feels that certain people can read his mind. A physical e!amination is normal. At this time, the most li ely diagnosis is %op of "orm

schizophreniform disorder

schizophrenia

schizoid personality disorder

schizoaffective disorder

psychosis not otherwise specified )ottom of "orm +. A /0-year-old woman complains of a two-wee history of diplopia. >phthalmologic e!amination is significant for normal con?ugate eye movements during left gaze, but left eye lag in adduction during con?ugate right gaze. "undoscopic e!am is normal bilaterally. %he most li ely location of the lesion is the %op of "orm

right optic nerve

left medial lemniscus

right medial lemniscus

right medial longitudinal fasciculus 85'"9

left medial longitudinal fasciculus 85'"9 )ottom of "orm =. A /0-year-old man presents to the emergency department complaining of fever and headache. He received a cadaveric idney transplant two years prior to presentation and ta es cyclosporine and prednisone. His temperature is 1@* ". >n e!amination, he demonstrates meningismus. A lumbar puncture is obtained. .ram stain of his cerebrospinal fluid demonstrates gram positive coccobacilli. #hich of the following is the best treatment$ %op of "orm

Ampicillin

(eftria!one

(hloramphenicol

.entamicin

Aancomycin )ottom of "orm ;.A 36-year-old woman presents to her family physician complaining of wea ness of her eyelids and difficulty with swallowing. &hysical e!am is significant for bilateral ptosis, diplopia, and pronounced wea ness of her nec . )lood tests are positive for acetylcholine-receptor antibodies. #hich of the following interventions could be curative for this patientBs condition$ %op of "orm

-eostigmine

&rednisone

Azathioprine

%hymectomy

&lasmapheresis )ottom of "orm 1@. A ;-year-old female is brought to her pediatrician for recent symptoms of irritability, poor attention span in class, and hyperactivity. Her parents also report that the child has had several episodes of abdominal pain and vomiting. %he nurse notes

that the child has lost 1@ pounds since her last visit four months ago. A peripheral blood smear reveals microcytic and hypochromic erythrocytes. "urther history reveals that the family lives in a house that was built prior to 1;+@. %his patient would be e!pected to have elevated levels of %op of "orm

porphobilinogen

heme

delta-aminolevulinic acid

ferrochelatase

uroporphyrinogen )ottom of "orm 11. A *-month-old male is brought by his parents to a pediatrician after showing symptoms of failure to thrive. His parents report that the infant has been having feeding problems, fre1uent fevers, and diarrhea. >n physical e!am, the doctor notes that the infant has a protruding forehead. )lood tests reveal the child to be severely anemic. &rotein electrophoresis on this patient would demonstrate increased levels of %op of "orm

Hb A

Hb A*

Hb 3

Hb H

Hb )art )ottom of "orm 1*.A *1-year-old man presents to the 3tudent Health (enter with complaints of penile discharge and burning with urination. &olymerase chain reaction confirms the presence of (hlamydia trachomatis. #hich of the following is the most appropriate treatment$ %op of "orm

Azithromycin

(eftria!one

(hloramphenicol

:rythromycin

%etracycline )ottom of "orm 13. A +@-year-old man presents to the emergency department complaining of headache. His )& is **@211@mmHg in both arms. His heart rate is =@. He is confused and disoriented. #hich of the following is the most appropriate treatment for this patientBs hypertensive urgency$ %op of "orm

Atenolol

(lonidine

-ifedipine

-itroprusside

,eserpine

)ottom of "orm 1/. A patient who is being treated for bronchopneumonia develops fever, a diffuse erythematous rash, eosinophilia, oliguria with increasing )C- and creatinine, mild proteinuria, sterile pyuria, and eosinophiluria. %here are no bacteria seen in the urine sediment. #hat is the most li ely diagnosis$ %op of "orm

Acute tubular necrosis

Aasculitis

Acute glomerulonephritis

Acute tubulointerstitial disease

Acute pyelonephritis )ottom of "orm 10. An =0-year-old woman with un nown medical and psychiatric history is brought in because of appro!imately 3 months of decline in functioning. 3he has had worsening cognition for the past year, but lately has also had problems ambulating, with a widened, unsteady gait. 3he has had fre1uent but sporadic periods of urinary incontinence. (% scan shows dilated ventricles and cortical atrophy, but no focal findings. "undoscopic e!amination is normal, with no papilledema. Her symptoms are consistent with

%op of "orm

seizure disorder

AlzheimerBs dementia

normal pressure hydrocephalus

increased intracranial pressure

'ewy body dementia )ottom of "orm 16. A 1*-year-old gymnast sustains a left supracondylar humeral fracture. %welve hours after closed reduction and casting, pain and swelling in the left hand is unbearable and profound, with morphine re1uirements higher than at any other time during hospital admission. #hat is the most li ely diagnosis$ %op of "orm

(ompartmentDs syndrome

Clnar nerve neuroma

,efle! sympathetic dystrophy

Avascular necrosis

%hrombophlebitis )ottom of "orm 1+. A 6+-year-old man is treated for cellulitis with a *1-day course of clindamycin. 3everal wee s later he develops persistent, green, watery diarrhea. #hich of the following is the most li ely cause of this patientBs diarrhea$ %op of "orm

(ampylobacter ?e?uni

(lostridium difficile

.iardia lamblia

3almonella typhi

Eersinia enterocolitica )ottom of "orm 1=. A 3/-year-old woman presents to her family physician with a 3month history of enlargement of the nec with pain and tenderness. 3he notes that with the onset of the nec swelling, she e!perienced mar ed heat intolerance, profuse sweating, and palpitations. )lood tests reveal mar edly depressed %3H levels. #hich of the following is the most appropriate treatment for this patient$ %op of "orm

&ropylthiouracil

3ynthroid

%hyroidectomy

&arathyroid hormone

Adrenalectomy )ottom of "orm 1;. An 1=-year-old female presents to the emergency department with a one-day history of nausea and vomiting, fre1uent urination, and severe abdominal pain. %he patient has a heart rate of 11@, a

)& of ==, poor s in turgor, and dry mucous membranes. Crinalysis reveals substantial amounts of glucose and etones. 3erum blood glucose is 3*0 mg2d', and an arterial blood gas reveals a pH of +.3/. %his patientBs symptoms would be most consistent with an elevation of %op of "orm

insulin

acetoacetate

liver glycogen

triacylglycerol

serum sodium )ottom of "orm *@. A /+-year-old man visits his family physician for his annual physical e!am. )ased on his history of coronary heart disease, the doctor recommends that the patient begin ta ing daily aspirin. #hich of the following would be decreased in this patient after 6 months of aspirin therapy$ %op of "orm

'eu otriene A/

&rostaglandin :*

Arachidonic acid

0-H&:%:

'eu otriene )/ )ottom of "orm *1. A /0-year-old man presents to his primary care physician with complaints of diarrhea. Despite triple therapy for H4A infection his last (D/F count was less than 1@@2mm3. 3tool specimen is obtained and yields many (ryptosporidium. #hich of the following is the treatment of choice$

%op of "orm

Albendazole

(lindamycin

5etronidazole

&aromomycin

%rimethaprim-sulfamethazole )ottom of "orm

**. A *3-year-old man is out hunting in the woods when he is confronted by a bear. His heart begins to race, he brea s into a cold sweat, and his pupils dilate. %hese actions of epinephrine are mediated by

%op of "orm

alpha1 receptors

alpha* receptors

beta1 receptors

beta* receptors

histamine receptors )ottom of "orm *3. A *@-year-old college woman presents to the emergency room with a history of abrupt onset of epigastric and substernal chest pain. %he patient is dyspneic and cyanotic. )lood pressure is stable. 3he is afebrile. %he smell of vomitus is apparent on her breath. Her front teeth e!hibit acid in?ury to the enamel. A crunching sound in the precordium is heard on auscultation. )reath sounds are absent at the left lower base of the lung, and there is dullness to percussion. %here is no tracheal deviation. >n chest G ,ay, there is a hydropneumothora! on the left, and air is present in the mediastinum. %here is no air below the diaphragm. #hat is the pathogenesis of this patientBs problem$ %op of "orm

"oreign body in esophagus with aspiration of gastric contents

,upture of esophagus from vomiting

%ension pneumothora! from vomiting

,upture of a subpleural bleb associated with vomiting

&neumonia with empyema )ottom of "orm */. A *3-year-old man with schizophrenia on haloperidol began to e!perience restlessness< he felt unable to sit still, irritable, and fidgety. %he doctor then prescribed him a second medication to treat this resultant restlessness. A potential effect of this second medication is %op of "orm

reduction in blood pressure

dry mouth

diarrhea

sedation

respiratory depression )ottom of "orm *0. A */-year-old pro football player describes a sudden left calf pain during a football game. He describes the pain as if he had been 7 ic ed in the calf from behind7. &hysical e!amination reveals an athletic young man in no apparent distress< however,

there is a left calf tenderness to palpation, and the 7s1ueeze test7 of the gastrocnemius fails to elicit plantar fle!ion of the foot on the left side. #hat is the most li ely etiology of this patientBs in?ury$ %op of "orm

Achilles tendonitis

Achilles tendon rupture

5eniscal tear

.astrocnemius hematoma

&atellar tendon rupture )ottom of "orm *6. A /@-year-old woman complains of vaginal irritation and discharge. 5icroscopic e!amination of vaginal fluid reveals many clue cells. #hich of the following is the best treatment for this patient$ %op of "orm

Azithromycin

(eftria!one

"luconazole

5etronidazole

&enicillin )ottom of "orm *+. A *0-year-old man is brought to the emergency department after being involved in a motor vehicle accident in which both his legs were crushed. Crinalysis reveals high levels of myoglobin, and blood test reveals significantly elevated levels of creatine phospho inase. 3everal hours after admission to the hospital, the patient begins to demonstrate an irregular heartbeat. His :H. is shown below. #hich of the following is the most appropriate treatment for this patientBs condition$

%op of "orm

4A sodium

4A potassium

3pironolactone

4A insulin and glucose

4A lactate )ottom of "orm *=. A 1;-year-old female is referred to a gynecologist for amenorrhea. After e!amination, the patient is found to have a blind vagina with no evidence of female internal genitalia. 3he is also found to be hypo alemic and severely hypertensive. %he most li ely cause of the symptoms in this patient is a deficiency of %op of "orm

1+-alpha-hydro!ylase

3-beta-hydro!ysteroid dehydrogenase

*1-alpha-hydro!ylase

11-beta-hydro!ylase

10-alpha-hydro!ylase )ottom of "orm *;. A 1/-month-old boy is referred to a dermatologist for e!treme photosensitivity with blistering upon minimal sun e!posure. .enetic analysis on this patient showed high levels of pyrimidine dimers in his D-A and an absence of CA-specific endonuclease. %he inheritance pattern of this childBs disease would best be described as %op of "orm

autosomal dominant

autosomal recessive

!-lin ed dominant

!-lin ed recessive

mitochondrial inheritance

)ottom of "orm 3@. A +3-year-old man is admitted to the 4ntensive (are Cnit with septic shoc from a presumed urinary tract infection. His blood pressure is =02/@ mmHg. His heart rate is 1*@ beats per minute and his temperature is 1@3 ". A continuous infusion of phenylephrine is instituted for refractory hypotension. %he vasopressor action of phenylephrine is mediated through %op of "orm

alpha1 receptors

alpha* receptors

beta1 receptors

beta* receptors

dopamine receptors )ottom of "orm 31. A /0-year-old man with multiple prior heart attac s presents to the emergency department with increasing shortness of breath and edema. &hysical e!amination and chest radiograph confirms recurrent congestive heart failure. #hich of the following agents will provide the greatest increase in this patientBs cardiac output$

%op of "orm

Dopamine

:pinephrine

4soproterenol

-orepinephrine

&henylephrine )ottom of "orm 3*. A /*-year-old movie star suffers a subarachnoid hemorrhage secondary to a berry aneurysm of the (ircle of #illis. -eurologic e!am the following day is significant for bilateral medial deviation of the eyes 87crossed eyes79. #hich of the following cranial nerves has the longest course through the (3"$ %op of "orm

(- 4A

(- A

(- A44

(- 444

(- A4 )ottom of "orm 33. A /*-year-old woman is referred to an endocrinologist for complaints of e!treme wea ness, fatigue, chronic diarrhea, and hyperpigmented s in. 3he reports that she has had e!treme saltcraving over the last few months. Her past medical history is significant for systemic tuberculosis for which she was treated one year ago. Her bp is =02/+. )lood tests reveal sodium of 13@ m:12' and potassium of 6.+ m:12'. )lood cortisol is undetectable. %his patientBs disease is li ely caused by destruction of her %op of "orm

thyroid gland

idney

adrenal corte!

adrenal medulla

pancreas )ottom of "orm 3/. 3ic le cell anemia is an autosomal recessive disease, in which both beta globin genes must be mutated in order for the disease to manifest. 4f the fre1uency of individuals homozygous for Hb 3 8sic le hemoglobin9 in a certain population is /I, then the fre1uency of individuals heterozygous for Hb 3 is %op of "orm

=@I

6/I

3*I

*@I

16I )ottom of "orm

30. A /@-year-old male with a /-year history of diabetes mellitus presents to his family physician complaining of an!iety, palpitations, tremors, and e!cessive sweating. %he patient has been on insulin treatment for the last year but, because of his current hypoglycemic episode, is unable to recall the last time he in?ected insulin. %he doctor wishes to determine whether this hypoglycemic episode is due to endogenous or e!ogenous insulin. 5easurement of which of the following will confirm the diagnosis$ %op of "orm

4nsulin

3erum glucose

Crine glucose

3erum

etone

(-peptide )ottom of "orm 36. A *@-year-old woman presents to the emergency department after eating at a local (hinese restaurant. 3he is short of breath and wheezing. &rior to collapsing she is able to tell the physician she is allergic to peanuts. #hich of the following is the most appropriate treatment for anaphylactic shoc $

%op of "orm

Diphenhydramine

Dopamine

:pinephrine

Histamine

-orephinephrine )ottom of "orm 3+. A /+-year-old presents to his primary care physician with complaints of urinary fre1uency and hesitancy. During his office visit his blood pressure is 1+@2;*mmHg and heart rate +* beats per minute. >n two follow-up readings his blood pressure remains similarly elevated. #hich of the following agents would be most useful for the treatment of his hypertension and symptoms of prostatism$ %op of "orm

Atenolol

5etoprolol

&heno!ybenzamine

%erazosin

Eohimbine )ottom of "orm 3=. A patient presents to the clinic with complaints of headache, wea ness, and fatigue. 'aboratory data show a sodium level of 1** m:12', serum osmolarity of */@ m>sm2', and urine osmolarity of /00 m>sm2'. #hat is the most li ely diagnosis$ %op of "orm

-eurogenic diabetes insipidus

-ephrogenic diabetes insipidus

Diabetes mellitus

3yndrome of inappropriate ADH secretion

1+ a-hydro!ylase deficiency )ottom of "orm 3;. %wo months after an anterior myocardial infarction, a 6*-yearold man presents with fever, continuous substernal chest pain, including pain when leaning forward on inspiration, and generalized myalgia and arthralgia. %he pain is not relieved by nitroglycerin. >n physical e!amination, a substernal, scratchy, three-component sound in atrial systole, ventricular systole, and ventricular diastole is heard. A complete blood count reveals an absolute neutrophilic leu ocytosis. :lectrocardiogram e!hibits J waves similar to those from the previous myocardial infarction as well as diffuse 3% segment elevation that is concave up. #hat is the most li ely cause of this illness$ %op of "orm

-eoplasia

4nfection

Acute myocardial infarction

(ardiomyopathy

Autoimmune disease

)ottom of "orm /@. A *6-year-old man presents to the :, with high fever, sweating, and confusion. 'aboratory investigation reveals elevated #)(s and elevated (&H. During his evaluation, he becomes even more confused and disoriented, and then combative. His mother arrives shortly, and states that the man has a diagnosis of schizophrenia but she is unsure if he has ta en his medications, haloperidol and fluo!etine. %he most appropriate treatment is %op of "orm

haloperidol

broad-spectrum antibiotics

benztropine

dantrolene

acetaminophen )ottom of "orm /1. A professional bo!er sustains a severely superiorly impacted nasal fracture during a fight. :!tension of this fracture into which of the following structures is most li ely$ %op of "orm

:thmoid sinus

5a!illary sinus

"rontal sinus

>ptic nerve

>culomotor nerve )ottom of "orm /*. A 0-year-old boy complains of a sore throat. %hroat culture yields many 3treptococcus pyogenes. #hich of the following is not an acceptable treatment for this child$ %op of "orm

Ampicillin

Azithromycin

:rythromycin

&enicillin

%etracycline )ottom of "orm /3. A 3/-year-old missionary returns to the Cnited 3tates after a tour abroad. 3ince his return, he is wea and fatigued. He has suffered intermittent diarrhea for several months. A stool specimen yields 3trongyloides stercoralis. #hich of the following is the most appropriate treatment$ %op of "orm

Albendazole

4vermectin

5ebendazole

-ifurtimo!

%hiabendazole

)ottom of "orm //. A ++-year-old man who is in the hospital recovering from colon resection for colon cancer demonstrates increased &% and a&%%. %he patient has been on prophylactic, broad-spectrum antibiotics for the last + days. %he patient demonstrates no active bleeding at this time. #hich of the following is contra-indicated in this patient$ %op of "orm

(oumadin

Heparin

Aitamin H

:no!aparin

Aspirin )ottom of "orm /0. A 0@-year-old man presents to his family physician complaining of yellow eyes for the last month. %he patient also reports several episodes of generalized abdominal pain, nausea, bowel movements that produce clay-colored stools, and very dar urine. >n physical e!am, his s in and sclerae are noted to be icteric. #hich of the following laboratory findings is li ely to be found in this patient$

%op of "orm

:levated indirect bilirubin and elevated direct bilirubin

:levated indirect bilirubin and normal direct bilirubin

-ormal indirect bilirubin and elevated direct bilirubin

Decreased indirect bilirubin and decreased direct bilirubin

-ormal indirect bilirubin and direct bilirubin )ottom of "orm /6. A 6=-year-old woman presents to her family physician complaining of chronic fatigue for the last two months. 3he denies any sensations of burning or tingling in her hands or feet. )lood tests reveal a hemoglobin of ;.; and a hematocrit of 30I. A peripheral blood smear reveals macrocytic erythrocytes. Analysis of ,)( precursor cells in this patientBs bone marrow would show them to be arrested in %op of "orm

mitosis

.1 phase

3 phase

.* phase

.@ phase )ottom of "orm /+. A 6+-year-old man with a long history of poorly controlled asthma suffers an acute myocardial infarction. His cardiologist recommends beta-bloc er therapy. #hich of the following would be the most appropriate choice of beta-bloc er for this patient$ %op of "orm

Atenolol

(arvedilol

&indolol

&ropranolol

%imolol )ottom of "orm /=. A /+-year-old man complains to his physician about increasing difficulty with urination, particularly hesitancy and fre1uency. He awa ens several times each night to urinate. His blood pressure is 11@26@mmHg. &hysical e!amination reveals a symmetrically enlarged prostate. #hich of the following is the best choice to treat this patientBs symptoms of benign prostatic hypertrophy$ %op of "orm

Do!azosin

&hentolamine

&razosin

%amsulosin

%erazosin )ottom of "orm

/;. A 0/-year-old woman with severe hypertension has failed multiple pharmacologic treatments for blood pressure control. 3he begins treatment with a new medicine and after the first three doses complains of dry mouth and sedation. #hich of the following is a centrally acting sympatholytic medication$ %op of "orm

(lonidine

.uanethidine

Hydralazine

,eserpine

%rimethaphan )ottom of "orm 0@. A /@-year-old male with a history of multiple myeloma and treatment with cyclophosphamide presents with mar ed leu ocytosis and thrombocytopenia. &eripheral smear shows many immature cells 8blasts9. )one marrow aspirate also shows significantly increased blasts. %he best medication to employ in this scenario is %op of "orm

cytarabine

chlorambucil

melphalan

nitrosourea

vincristine )ottom of "orm

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