ข้อสอบ MD  NL ชุดที่ 20
Sign in to Google to save your progress. Learn more
ชื่อ - สกุล *
รหัสประจำตัวนิสิต *
1. Heme synthesis occurs in the bone marrow and liver. Defi ciency of δ-aminolevulinic acidhydrase would lead to the accumulation of which of the following? *
1 point
2. A 20-year-old man became very agitated at a party, and as a result was brought to theemergency department, where he is belligerent and uncooperative. A physical examinationreveals fever, tachycardia, horizontal nystagmus, and hyperacusis. Which of the followingsubstances may cause the behavioral changes and physical findings exhibited by this patient? *
1 point
3. Phosphatidylcholine is a major component of red blood cell membranes, myelin, surfactant, and cholesterol. Phosphatidylcholine is synthesized through phosphorylation ofcholine obtained from the diet or with reused choline derived from phospholipid turnover.De novo synthesis requires an addition of three methyl groups, transferred from an amino acid. Without the turnover component, defi ciency in which essential amino acid wouldmake dietary choline essential for phosphatidylcholine synthesis? *
1 point
4. ทารกแรกเกิดน ้าหนัก 3000 กรัม ตัวเหลือง total bilirubin 12 mg/dl ต่อมา 4-5 อาการหายทารกมีEnzyme ใดหายที่ไม่สมบูรณ์ *
1 point
5. เด็กชายอายุ 5ปีเหงือกบวมแดง มีเลือดออกตามไรฟันง่ายมีจุดเลือดออกตามตัว มีประวัติไม่ชอบรับประทานผัก ผลไม้ ความผิกปกติดังกล่าวเกิดจากการบกพร่องของการสังเคราะห์อะไร *
1 point
6. A clinician is concerned that an Rh-negative mother may be pregnant with an Rh-positivefetus. The potential pathology that the clinician is concerned about is classified as whichof the following immune reactions? *
1 point
7. A 50-year-old man presents to the emergency department because of severe pain witheven slight abduction of his arm following a skiing accident. He is diagnosed with a rotatorcuff tear. Which of the following is most commonly injured in a rotator cuff tear? *
1 point
8. A 35-year-old woman who is HIV-positive presents to the physician with jaundice andright upper quadrant abdominal pain. The patient reports having had multiple episodes ofjaundice over the past 10 years. A hepatitis panel is positive for HBsAg and anti-HBc IgM, butnegative for HBsAb and anti-HAV IgM. Which of the following would most likely be lowerthan normal in this patient? *
1 point
9. A 25-year-old woman presents to a primary care clinic complaining of galactorrhea, lossof libido, and vision changes. Further work-up reveals a mass in the sella turcica. Which ofthe following functions will most likely be preserved with normal functioning in thisindividual? *
1 point
10. A physician decides to place a patient on a calcium channel blocker for treatment of herangina. Calcium channel blockers can relax the smooth muscle of blood vessels and canalso have various effects on cardiac contractility, conduction, and heart rate. Which of thefollowing calcium channel blockers would be most effective in reducing heart rate andcontractility? *
1 point
Clear selection
11. A 3-year-old boy comes to the pediatrician with fever, conjunctivitis, erythema in the oral mucosa, and cervical lymphadenopathy. The boy suddenly becomes hypotensive and goes into cardiac arrest and dies shortly thereafter. Autopsy shows aneurysmal dilations of the left circumflex and right coronary arteries. The boy’s disease is characterized as a self-limiting disease that most commonly affects the coronary arteries. Which of the followingdiseases is the correct diagnosis? *
1 point
12. A 40-year-old man has been diagnosed with glioblastoma multiforme. The patient’sneurologist must choose an appropriate cancer drug to treat this tumor. Which of thefollowing can cross the blood–brain barrier for effective treatmentof brain tumors? *
1 point
13. A newborn girl is diagnosed as dysmorphic by a pediatrician in the newborn nursery. Onphysical examination the girl has a broad neck, wide-spaced nipples, and a systolic ejectionmurmur. An echocardiogram is performed and demonstrates coarctation of the aorta. Theechocardiography technologist also runs his transducer across the patient’s abdomen andnotices a renal abnormality associated with this patient’s syndrome. The most likelyobserved renal abnormality increases this patient’s risk for developing which disease? *
1 point
14. A newborn child is exposed to Streptococcus agalactiae and subsequently developsmeningitis. Which of the following could have contributed to this child’s bacterial infection? *
1 point
15. A 30-year-old woman comes to the physician because of a fever of 38.4°C (101.1°F) anda diffuse macular rash on her torso. Her blood pressure is 91/51 mm Hg. The physician obtains a culture from her vagina that shows catalase- positive, gram-positive cocci. Over thenext few days, the rash on her torso desquamates. Which of the following organisms is mostlikely responsible for this patient’s symptoms? *
1 point
16. A 5-year-old girl is brought to her pediatrician because her mother says she is frequentlybumping into stationary objects while playing. Visual field examination shows bilateralperipheral vision defects. CT of the head reveals calcifications in the pituitary fossa. Which ofthe following is the most likely origin of this child’s brain tumor? *
1 point
17. A baby boy dies 2 days after birth. He was born with wrinkled skin, deformed limbs, andabnormal facies. The mother’s pregnancy was complicated by oligohydramnios. Which ofthe following embryologic processes most likely failed in this child? *
1 point
18. A new antihypertensive medication is being investigated in a clinical trial. Investigatorshave noted a decrease in blood pressure in the group treated with the drug compared tothe placebo group. While examining the study’s participants, investigators notice that theexperimental group has a lower mean age. What is this an example of? *
1 point
19. A 53-year-old woman experiences hot flashes associated with menopause. She calls herprimary care physician to ask for advice about the risks and benefits of hormonereplacement therapy (HRT). Which of the following is a potential benefit of HRT? *
1 point
20. A 67-year-old homeless man reports to the physician with a 1-week history of aproductive cough, shortness of breath and high fever. He denies alcohol, drug, or tobaccouse. The patient says that the onset of symptoms was sudden. X-ray of the chest shows alarge left lower lobe opacity. Which of the following antibiotics would best initially treat thispatient’s infection? *
1 point
21. A woman in her seventh month of pregnancy asks her obstetrician why her breasts areenlarging. In which of the following locations is the hormone responsible for breast milkproduction synthesized? *
1 point
22. A 2-month-old infant is found to have a horseshoe kidney. Which structure prevents thisabnormal kidney from occupying its appropriate position? *
1 point
23. A 54-year-old homeless woman is found unconscious on the street. Upon admission tothe emergency department, her laboratory tests show:      Na+: 137 mEq/L        K+: 3.3 mEq/L             Cl–: 112 mEq/L          HCO3–: 15 mEq/L         Arterial blood gas on room air: pH 7.28Partial carbon dioxide pressure: 28 mm HgPartial oxygen pressure: 90 mm HgWhich of the following most likely caused her acidosis? *
1 point
24. A 7-year-old boy is brought to the emergency department after falling from a tree; an x-ray film shows that he has a midshaft fracture of the humerus. Which of the following structures could be injured with this type of fracture? *
1 point
25. A 50-year-old man presents to the emergency department because of severe pain witheven slight abduction of his arm following a skiing accident. He is diagnosed with a rotatorcuff tear. Which of the following is most commonly injured in a rotator cuff tear? *
1 point
26. A 56-year-old man is diagnosed with transitional cell carcinoma and treated with excisionand chemotherapy. Which of the following risk factors most likely led to this patient’s cancer? *
1 point
27. A 45-year-old woman presents to her physician with a 2-day history of right upperquadrant pain, nausea, gas, and vomiting. She reports that her symptoms are worse after sheeats a fatty meal. Which of the following substances inhibits the hormone causing her rightupper quadrant pain? *
1 point
28. A 20-year-old African-American man develops anemia after being treated for a urinarytract infection. A peripheral blood smear shows RBC lysis and precipitates of hemoglobinwithin the RBCs. Which of the following drug classes most likely caused his hemolyticanemia? *
1 point
29. Over the course of embryologic development, the predominant location of hematopoiesis changes several times. Where does this process take place during the 11th week of fetal life? *
1 point
30. A 37-year-old man comes to the physician with recurrent viral infections. Blood studiesshow normal levels of circulating lymphocytes and neutrophils. A defi ciency in which of thefollowing cytokines would most likely lead to this man’s condition? *
1 point
31. A 34-year-old man with moderately severe ulcerative colitis has been taking oralprednisone for 4 months. Which of the following symptoms is the most likely adverse effectof this drug? *
1 point
32. A healthy 25-year-old man comes to the physician for a routine examination. Hislaboratory tests show a serum bilirubin level of 4 mg/dL and a direct bilirubin level of 0.3mg/dL. The patient’s liver function tests are normal. Which of the following best explains this patient’s serum and indirect bilirubin levels? *
1 point
33. A 17-year-old boy presents to the emergency department with severe abdominal pain. Laboratory tests show a defi cit in uroporphyrinogen I synthetase and excess δ- aminolevulinate and porphobilinogen in the urine. Which of the following symptoms would most likely also be present in this patient? *
1 point
34. A 47-year-old man with chronic asthma who has been treated with high-dose steroids formany years develops a productive cough, weight loss, and night sweats. Imaging studies reveal the presence of abscesses in the lungs and brain. Cultures show gram-positive filaments that are weakly acid-fast. Which of the following organisms is responsible for this patient’s condition? *
1 point
35. A new experimental cancer drug for treating acute lymphocytic leukemia has just beendiscovered. The drug is designed to prevent microtubule spindle formation. This new drug’smechanism of action is most similar to that of which of the following? *
1 point
36. A 60-year-old strict vegetarian woman presents with fatigue, loss of appetite and shortness of breath. Physical examination shows moderately pale. Which of the following nutrient is deficient and responsible for these clinical features? *
1 point
37. A newborn girl presents to the neonatologist with an inability to swallow, coughing,choking, and vomiting when fed. Work-up reveals a tracheoesophageal fi stula. Which of thefollowing may have been present during the mother’s pregnancy with this child? *
1 point
38. A 30-year-old male drug user with a history of methylphenyltetrahydropyridine (MTPT)exposure presents to the clinic with a tremor at rest, cogwheel rigidity, and postural instability. Direct innervation from the site of the lesion to which nuclei has been damaged? *
1 point
39. A 60-year-old man is found to have advanced adenocarcinoma of the stomach. The tumor is centered at the pyloric zone just near the pyloric sphincter, on the lesser curvature.By mass effect, the neoplasm impinges on the omental (epiploic) foramen. Which of thefollowing is most likely to be seen in this patient due to the mass effect of the tumor? *
1 point
40. A 40-year-old woman presents with progressive fatigue and bilateral joint inflammationcharacterized by pain, swelling, warmth, and morning stiffness. The patient says that thesymptoms began in her hands over 1 year ago but have now begun to affect her knees.Which of the following agents would be most useful in her treatment? *
1 point
41. A 30-year- old woman has abnormal motility of GI tract. No high propulsiveactivity of stomach and duodenum is found during fasting state. Which of the followinghormone that is deficient in this case? *
1 point
42. หญิงอายุ 40 ปีเหนื่อยง่ายมา 2 เดือน ตรวจร่างกายพบ systolic murmur at 5th intercostal space,5 cm. from left side of sternum ลักษณะดังกล่าวเข้าได้กับ โรคใดต่อไปนี้มากที่สุด *
1 point
43. A 31-year-old white woman is trying to get pregnant. She has a niece who suffers from agenetic disease characterized by recurrent respiratory infections and pancreatic failure. Shewould like to assess her chances of having a child with this disease. Which of the followinglaboratory techniques could be used to determine if this woman and/or her husband is acarrier of the mutant gene? *
1 point
44. Different families of membrane-associated carrier proteins: the glucose transporterfacilitators (GLUT) and the sodium-coupled glucose transporters (SGLT). If a patient has adefect in the non-sodium-coupled glucose transporters, which cell line is still able toacquire glucose? *
1 point
45. 60 years old male, blurred vision while taking amitriptyline due to blockade of whichfollowing receptor *
1 point
46. A 25-year-old man develops acute onset of fever, malaise, muscle pain, hypertension,abdominal pain, bloody stool, and prerenal failure 6 months after recovering from an acutehepatitis B infection. Which of the following disease processes is most likely responsible forthe patient’s fi ndings? *
1 point
47. A 22-year-old woman who is a professional tennis player presents to the physician withpain on the lateral aspect of her elbow radiating down her forearm. Repetitive use of whichof the following muscles most likely lead to this patient’s condition? *
1 point
48. A 20-year-old woman presents to the emergency department with several deeplacerations on the medial side of her wrist after a suicide attempt. She receives promptpsychiatric evaluation. The function of which of the following muscles might be affected bythese injuries? *
1 point
49. A 16-year-old gymnast presents to the emergency department after landing awkwardlyon her ankle. She is diagnosed with a sprained ankle. Which of the following ligaments ismost commonly injured in an ankle sprain? *
1 point
50. A 7-year-old boy is brought to the emergency department after falling from a tree; an x-ray film shows that he has a midshaft fracture of the humerus. Which of the following structures could be injured with this type of fracture? *
1 point
51. A 40-year-old man was admitted to the neurology service for evaluation of persistentnumbness over his left jaw and lower face. MRI reveals a schwannoma, which is compressinga cranial nerve as the nerve exits the skull. The cranial nerve involved in this case exits theskull through which of the following foramina? *
1 point
52. Diuretics are medications that increase the amount of urine flow by inhibiting transportproteins or enzymes in the nephron. Different classes of diuretics affect different parts of thenephron. Which of the following diuretics will also decrease the amount of calcium excreted from the kidney? *
1 point
53. A 48-year-old man is hospitalized for shock after massive blood loss in a motor vehicleaccident. On the patient’s second day in the hospital, his blood urea nitrogen (BUN) andcreatinine levels begin to rise and he develops pitting edema to his knees. A subsequenturinalysis shows numerous granular casts. Which of the following is the most appropriate treatment? *
1 point
54. During hernia surgeries, it is important to isolate important structures in the inguinal canalso that they do not become damaged and cause a functional deficit. Which of the followingstructures lies inside the inguinal canal but outside of the spermatic cord? *
1 point
55. A 53-year-old woman experiences hot flashes associated with menopause. She calls herprimary care physician to ask for advice about the risks and benefits of hormonereplacement therapy (HRT). Which of the following is a potential benefit of HRT? *
1 point
56. A 60-year-old man suffering from depressive disorder for a year gets better withfluoxetine treatment. Which of the following neurotransmitters is affected by thismedication? *
1 point
57. A 41-year-old man is admitted to the hospital for progressive obtundation. On admissionthe patient’s serum sodium level is 114 mEq/L. Treatment is initiated, and 7 hours later thepatient’s serum sodium level is 134 mEq/L. Over the next 4 days the patient’s conditionworsens with the development of dysarthria, dysphagia, and paraparesis. What pathologicprocess is most likely responsible for this patient’s new symptoms? *
1 point
58. An 18-month-old child is brought to the physician by her parents because of a sorethroat, difficulty breathing, and a barking cough for the past day. On physical examinationthe toddler is found to have some respiratory stridor and a runny nose but is not in acutedistress. The rest of the examination is unremarkable. Which of the following is the most appropriate treatment? *
1 point
59. An infant with severe jaundice that is not corrected by phototherapy is in danger ofdeveloping kernicterus. This can occur in infants with Crigler–Najjar syndrome, a geneticdisorder in which there is a near-complete deficiency of glucuronyl transferase. Which of the following laboratory fi ndings would be expected in blood tests in an infant with Crigler–Najjar syndrome? *
1 point
60. A 22-year-old white man with metastatic testicular carcinoma is undergoing treatmentwith high doses of cisplatin. Which class of drugs is most likely to suppress his chemotherapy-related nausea? *
1 point
61. A researcher studying a pedigree of familial type 1 diabetes mellitus discovers a mutation in the potassium channel expressed in the cell membrane of pancreatic islet β cells. This mutation impairs closing of the potassium channel. The efficacy of which of the following agents would be most profoundly affected by this mutation? *
1 point
62. A 50-year- old man presents with sudden onset of severe chest pain radiated to back. His inter-arm blood pressure difference is 30 mmHg.What is the most likely diagnosis? *
1 point
63. A 40-year-old nonsmoking woman comes to the physician complaining of a persistent cough and loss of weight and appetite over the past 3 months. On radiography, a well-demarcated subpleural mass is found on the right lung. Which of the following types of carcinoma does this patient most likely have? *
1 point
64. A 3-year-old girl was in her usual state of good health 1 month ago when she developed an acute viral upper respiratory infection. She now presents to the emergency department with nonblanching purple skin lesions. The rest of her physical examination is unremarkable. The complete blood count demonstrates a low platelet count, while the peripheral blood smear is notable only for large platelets. Which of the following laboratory findings would most likely be present in this patient? *
1 point
65. A type of lymphoma is characterized by onset in middle age and by neoplastic cells that resemble normal germinal center B lymphocytes. Additionally, it is the most common type of non-Hodgkin’s lymphoma in the United States. What is the characteristic chromosomal translocation and protein that is produced by this translocation? *
1 point
66. A 7-year-old African-American boy is brought to see his pediatrician. His father says he has noticed that the boy has been complaining of right knee pain for the past week. On physical exam, multiple ecchymoses are noted on both upper and lower extremities. His father claims that the boy has always bruised easily, and he has recently learned how to ride a bicycle. Which of the following elements of the coagulation cascade is most likely to be missing in this child? *
1 point
67. An 82-year-old woman suffers an ischemic stroke with numerous sequelae, includinguvular deviation to the right side. Assuming the defect is in the lower motor neuron, damage to which of the following cranial nerves is consistent with this abnormality? *
1 point
68. A 70-year-old man is referred to a specialist for evaluation because of progressivememory loss and cognitive decline. His wife reports that he gets lost in their neighborhood and that she now pays the bills because he has become unreliable. She also states that the patient’s appetite, weight, sleeping pattern, and energy have not changed, but he is less interested in hobbies he used to enjoy. The neurologic examination is normal. He scores 19/30 on the Mini-Mental State Examination, with errors in figure drawing, recall, language, and concentration. Laboratory studies are unremarkable. Which of the following symptoms is most likely to develop in this patient over the next 3 months? *
1 point
69. A 76-year-old woman dies at home from sudden cardiac arrest after the onset of ventricular fi brillation. The family consents to an autopsy that reveals several small infarcts throughout the basal ganglia. Assuming that the defects arise from a single vessel within the central nervous system, pathology from which artery would be most consistent with this finding? *
1 point
70. Which of the following types of hepatocellular injury is commonly seen after acetaminophen overdose? *
1 point
71. A 42-year-old woman comes to the physician because of the gradual onset of involuntary limb and facial movements, mood swings, and trouble with her memory. She says that her mother displayed similar symptoms when she was in her 50s. Which of the following changes would most likely be seen in the brain of this patient? *
1 point
72. A 35-year-old woman who is HIV-positive presents to the physician with jaundice andright upper quadrant abdominal pain. The patient reports having had multiple episodes of jaundice over the past 10 years. A hepatitis panel is positive for HbsAg and anti-HBc IgM, but negative for HBsAb and anti-HAV IgM. Which of the following would most likely be lower than normal in this patient? *
1 point
73. A 45-year-old man comes to his primary care physician complaining of back pain. Onquestioning, the patient indicates a recent history of polyuria, polydipsia, hypertension, and weight gain. X-ray of the spine shows an L4-L5 compression fracture. Which of the following is most likely to be elevated in this patient? *
1 point
74. A 53-year-old woman with newly diagnosed type 2 diabetes presents to the emergency department complaining of vomiting, severe headache, dizziness, blurry vision, and difficulty breathing. She says that she had been at a cocktail party when the symptoms began. Her skin is notably fl ushed on physical examination. Which of the following medications is responsible for this reaction? *
1 point
75. A biopsy of one of several red, tender, subcutaneous nodules from the anterior lower legs of a 27-year-old man is obtained by a dermatologist. On histopathology, she sees a panniculitis (inflammation of subcutaneous fat) with widening of tissue septa from edema, increased neutrophils, and fibrin exudation. Which of the following diseases is often present in someone with these nodules? *
1 point
76. A 46, XY infant is born with a nonsense mutation in the SRY gene. Which of the following will be the symptomatic manifestation of this mutation? *
1 point
77. A 31-year-old man comes to the clinic complaining of red and itchy eyes for the past8 hours. The patient has had pain on urination and diffuse joint pain for 1 month, but tested negative for gonorrhea and chlamydia on a previous visit 3 weeks ago. He has also tested negative for rheumatoid factor, and his human leukocyte antigen (HLA) status is HLA-B27.When asked about any recent illnesses, all the patient can recall is going to the emergency department 2 months ago for a bad case of diarrhea. Which of the following is the most likely diagnosis? *
1 point
78. Following a normal pregnancy and labor, a baby is born to a young couple. The babycries immediately and has Apgar scores of 9 at both 1 and 5 minutes. While examining the baby, the pediatrician at delivery notes that the baby has some labial scrotal fusion and a phallus-like organ. The baby is also hypotensive and hypovolemic. Genotyping reveals a karyotype of 46, XX. Which of the following is the most likely cause of the patient’s physical findings and symptoms? *
1 point
79. Which of the following is the function of the androgen-binding globulin? *
1 point
80. Medium-sized bronchi are the major site of airway resistance in the lungs. Bronchialsmooth muscle can change bronchial diameter by contracting or relaxing. Which of the following conditions is associated with dilation of airways? *
1 point
81. Public health investigators looking into several cases of pneumonia that haveoccurred in a community are able to trace the outbreak to a water-mist machineused in the produce section of a supermarket. Patients exposed to the water-mistmachine have presented with cough, high fever, headache, and abdominal pain. Elderly patients present with more severe disease. Which of the following is most likely to have caused this outbreak? *
1 point
82. A 25-year-old medical student presents with a nonproductive cough, low-grade fever,and malaise of 3 weeks’ duration. He says that a few of the people he studies with have been feeling the same way. Sputum cultures come back negative. The patient denies exposure to farm animals, travel, or HIV. The physician decides to treat for an atypical pneumonia. Which of the following methods could identify the organism responsible for such pneumonia? *
1 point
83. Mannitol, an osmotic diuretic, is sometimes used to lower intracranial pressure.Where along the nephron is the primary site of action of mannitol? *
1 point
84. Diuretics are medications that increase the amount of urine flow by inhibitingtransport proteins or enzymes in the nephron. Different classes of diuretics affectdifferent parts of the nephron. Which of the following diuretics will also decrease the amount of calcium excreted from the kidney? *
1 point
85. A 2-month-old infant is found to have a horseshoe kidney. Which structure preventsthis abnormal kidney from occupying its appropriate position? *
1 point
86. Monitoring acid-base status is very important in individuals with kidney pathology.Which of the following diuretics causes metabolic alkalosis? *
1 point
87. A 57-year-old white man presents to his primary care physician with dyspnea. He saysthat he likes to maintain his yard and garden, but that he has recently had trouble doing the work, and becomes short of breath even walking up the one flight of stairs in his house. On further questioning, he says that sometimes he wakes up short of breath in the middle of the night. Physical examination demonstrates pitting ankle edema. Which of the following findings would also be expected in this patient? *
1 point
88. A physician decides to place a patient on a calcium channel blocker for treatment ofher angina. Calcium channel blockers can relax the smooth muscle of blood vessels and can also have various effects on cardiac contractility, conduction, and heart rate. Which of the following calcium channel blockers would be most effective in reducing heart rate and contractility? *
1 point
89. A 30-year-old man presents sudden dyspnea and chest pain during deep inspiration.Chest X-ray: complete lung collapse. Arterial blood gas: hypoxemia and hypercapnia.Which of the following is mostly decreased? *
1 point
90. A 62-year-old breast cancer survivor visits her physician because of weakness, fatigue,fever, and weight gain 5 years following her radiation therapy. The physician also elicits complaints about abdominal discomfort and exertional dyspnea. Physical examination reveals hepatomegaly and jugular venous distention that fails to subside on inspiration, but shows no evidence of hypotension or pulsus paradoxus. An echocardiogram shows reduced end-diastolic volumes and elevated diastolic pressures in both ventricles. Which of the following is the most likely diagnosis? *
1 point
91. A group of oncologists is interested in determining whether a relationship existsbetween alcohol use and pancreatic cancer. The researchers enroll 1,000 patients,and subjects are placed into different groups depending on their level of alcoholconsumption. The subjects are followed for 10 years; the data show no statisticaldifference in the number of pancreatic cancers between the groups. The aboveresearch is an example of which of the following kind of study? *
1 point
92. ถ้าหากต้องการผ่าไส้ติ่ง จะหา root ของไส้ติ่ง ให้ดูจาก structure ใด *
1 point
93. A 45-year-old patient with borderline personality disorder on a psychiatry ward is told by a staff psychiatrist to spend 2 hours in a quiet room after violently disrupting a meeting. The next morning the psychiatrist interviews her. She complains bitterly about how the nursing staff is so mean to her even though she is always nice to them. She says she has no idea why they locked her in the quiet room yesteday. This patient is using which of the following defense mechanisms? *
1 point
94. A 53-year-old woman presents with dyspnea on exertion, orthopnea, paroxysmal nocturnal dyspnea, edema in the legs and feet, and fatigue. She has no history of angina, other signs of coronary artery disease, hypertension, or valvular disease. Echocardiography reveals cardiomegaly, with four-chamber hypertrophy and dilation. Which of the following is the most likely diagnosis? *
1 point
95. A 9-year-old girl is diagnosed with acute rheumatic fever. Instead of recovering as expected, her condition worsens, and she dies. Which of the following is the most likely cause of death? *
1 point
96. On routine examination, it is discovered that a 35-year-old woman had been exposed in utero to diethylstilbestrol administered to her mother, who had had a history of recurrent spontaneous abortion. This history suggests that the patient might be at increased risk of *
1 point
97. A 32-year-old woman has been attempting to become pregnant for the past 2 years without success. She also has had extremely painful menstrual cramping of many years’ duration. An exploratory laparoscopy demonstrated multiple red-blue nodules covering the surface of her ovaries and uterine ligaments. These findings are most likely indicative of which of the following conditions? *
1 point
98. A 23-year-old African-American man who is known to have sickle cell anemia presents to the emergency department with a painful erection. The patient explains that the erection had started 3 hours ago. This condition is referred as *
1 point
99. A 3-year-old girl presents with generalized edema shortly after recovery from an upper respiratory infection. Laboratory studies reveal marked albuminuria, as well as hypoalbuminemia and hyperlipidemia. Prior similar episodes responded to adrenal steroid medication. The most likely diagnosis is *
1 point
100. A 78-year-old man with long-standing prostatic nodular hyperplasia dies of a stroke. At autopsy, both kidneys demonstrate coarse asymmetric renal corticomedullary scarring, deformity of the renal pelvis and calyces, interstitial fibrosis, and atrophic tubules containing eosinophilic proteinaceous casts. These findings are most suggestive of *
1 point
101. A 25-year-old obese woman who denies any history of alcohol abuse presents with severe abdominal pain radiating to the back. Laboratory results indicate an increase in serum amylase and lipase, with a marked decrease in calcium. Which of the following likely has caused this condition? *
1 point
102. A neonate has been persistently jaundiced from birth despite aggressive phototherapy and exchange transfusions. Laboratory studies demonstrate significantly elevated unconjugated bilirubin. Tests from an outside laboratory confirm the total absence of glucuronyl transferase activity. The neonate most likely has which of the following condition? *
1 point
103. A 70-year-old man presents with fatigue, weight loss, abdominal pain, and overt blood in the stools. A complete blood count reveals anemia with hemoglobin of 10.0 g/dL. A colonoscopy and colon biopsy reveal adenocarcinoma. Which of the following is the most likely predisposing lesion that led to this condition? *
1 point
104. A 60-year-old man presents with hematemesis, melena, guaiac-positive stools, and signs of circulatory collapse. He has a 20-year history of burning midepigastric pain and tenderness relieved by food, milk, or antacids. Also, he has been taking high doses of nonsteroidal anti-inflammatory drugs to relieve the pain of long-standing arthritis. Esophagogastroduodenoscopy reveals a peptic ulcer in the upper duodenum. Which of the following is an important association of duodenal peptic ulcer disease? *
1 point
105. A 60-year-old man presents with dyspnea on exertion and a nonproductive cough. He has never smoked, but he worked as a shipbuilder, with known asbestos exposure approximately 20 years ago. To which of the following conditions is this patient especially predisposed? *
1 point
106. A 60-year-old man presents with fever and chills, productive cough with rusty sputum, pleuritic pain, and shortness of breath for the past several days. A complete blood count reveals neutrophilia and an increase in band neutrophils. A chest radiograph reveals consolidation involving the entire left lower lobe. Which of the following microorganisms is the most likely etiologic agent? *
1 point
107. A 3-year-old girl presents to the emergency department with fever, hoarseness, a “seal bark-like” cough, and inspiratory stridor. Her father states that she has had a cold for the past few days, with runny nose, nasal congestion, sore throat, and cough. He is now concerned because her cough has now become loud, harsh, and brassy. Which of the following is the most likely cause of her ailment? *
1 point
108. Several years ago, a 60-year-old woman had presented with bradykinesia, rigidity, a resting pill-rolling tremor in her right hand, and “mask-like,” expressionless facies. She currently presents with gait problems, taking short, shuffling steps and losing her balance easily. Which of the following is the most likely diagnosis? *
1 point
109. A 60-year-old woman with chronic atrial fibrillation is seen in the emergency department because of acute onset of marked weakness of her right arm, drooping of the left side of her face, and verbal aphasia. T2-weighted magnetic resonance imaging reveals a cerebral infarct. Assuming that the lesion has been caused by embolization from the left atrium, which vessel is the most likely site of embolic arrest? *
1 point
110. Following a bar fight, a 22-year-old man is brought unconscious to the emergency department. Several minutes earlier, he had been hit on the head with a heavy iron club and had been briefly unconscious, but had then apparently recovered. One or two minutes later, he had again lost consciousness. Which of the following is the most likely diagnosis? *
1 point
111. A newborn girl is found to have herniation of both the spinal cord and meninges through a defect in the vertebral arch of the spinal column. Her mother had not had prenatal care and had not taken nutritional supplements during pregnancy. Which of the following best describes this defect? *
1 point
112. A 3-year-old boy, an inner city resident, has multiple bony abnormalities, including bowlegs and knock-knees, thickening of the skull with frontal bossing, knobby deformities of the costochondral junctions and, at the ends of the long bones, distortion of the rib cage with flaring over the diaphragm, and pigeon-breast deformity. A decrease in which of the following is characteristic of this condition? *
1 point
113. A 17-year-old boy presents with pain and swelling about the left knee for the past month. He thought that this condition resulted from an old football injury and that it would resolve without incident. The pain, however, has persisted and is severe enough to cause him to limp. Radiographs of the knee demonstrate a lifting of the periosteum and a spiculated “sunburst” pattern in the distal femur. Which of the following is the most likely diagnosis? *
1 point
114. A 40-year-old woman presents with ptosis, diplopia, and dysarthria that fluctuate in intensity and tend to worsen as the day progresses. Edrophonium (an acetylcholinesterase inhibitor) is administered, and, after a minute, there is a striking improvement in muscle strength. Which of the following is characteristic of this disorder? *
1 point
115. An 80-year-old man presents with sharply demarcated, light brown, flat macules varying markedly in size. The lesions have the appearance of being “stuck on” or “pasted on,” and they are particularly numerous on the trunk. Microscopically, sheets of small basaloid cells with some melanin production are seen. Keratin production occurs at the surface, and numerous small keratin filled cysts are apparent. Which of the following is the likely diagnosis? *
1 point
116. A 55-year-old man presents with a large, black-colored, asymmetric skin lesion with ill-defined borders on his back. He reports a family history of malignant melanoma. Which of the following clinical variants of malignant melanoma has the poorest prognosis? *
1 point
117. A 25-year-old woman presents with concern about a mole on her abdomen. The mole is small, round, symmetric, and darkcolored, and has sharply defined borders. It is diagnosed as a common mole. This lesion is properly termed a *
1 point
118. A 26-year-old primigravida develops gestational diabetes and remains hyperglycemic during the remainder of her pregnancy. Which of the following abnormalities in the newborn child is likely related to the maternal hyperglycemia? *
1 point
119. 23-year-old woman presents with tremor, restlessness, heat intolerance, palpitation, and unexplained weight loss. The thyroid is symmetrically enlarged, the pulse is rapid, the skin is moist and warm, and exophthalmos is apparent. This condition is considered to be *
1 point
120. A 28-year-old man is evaluated for recurrent peptic ulcer disease, apparently refractory to pharmacologic intervention. Serum gastrin is markedly elevated. These findings are most characteristic of which of the following? *
1 point
121. A 35-year-old woman is seen 6 months after giving birth to a normal infant. She suffered severe cervical lacerations during delivery, resulting in hemorrhagic shock. Following blood transfusion and surgical repair, postpartum recovery has so far been uneventful. She now complains of continued amenorrhea and loss of weight and muscle strength. Further investigation might be expected to demonstrate which of the following findings? *
1 point
122. A 72-year-old man who has recently had an aortic valve replacement now presents with pallor and fatigue. The red blood cell count is decreased, and schistocytes are reported on examination of a peripheral blood smear. In addition, his indirect (unconjugated) bilirubin is significantly elevated. The cause of the anemia is likely *
1 point
123. A 3-year-old boy presents with epistaxis and fever. Multiple cutaneous petechiae are evident, and there is generalized enlargement of lymph nodes, as well as palpable splenomegaly. The hemoglobin and platelet count are markedly decreased, and the white blood cell count is elevated to 40,000 cells/μL, with a preponderance of lymphoblasts. Which of the following statements best characterizes this disorder? *
1 point
124. Radiographic examination of a 65-year old man with back pain caused by a compression fracture of T12 reveals multiple “punched-out” lytic bone lesions. Which of the following additional abnormalities is likely? *
1 point
125. An 18-year-old man is transported to the emergency department within 20 minutes of sustaining a stab wound to the chest. The patient is poorly responsive. Given that he may have lost as much as 1.5 liters of blood at the scene, which of the following is the most likely finding in this patient? *
1 point
126. A 3 year old presents with difficulty breathing and will not lie down to be examined. You suspect acute bacterial epiglottitis and examine the child’s epiglottis, which is highly inflamed. Which vaccine are you most likely to find that the child is missing *
1 point
127. A 70 year-old male with chronic hypertension. He suddenly fell numbness in his leg and his toe is cold. Normal ECG. Where is the arterial thromboembolism source in this patient? *
1 point
128. A 60-year-old woman has blood leakage from intestinal hemorrhage. Where is the mostlikely location of blood accumulation in quantity when in supine, bedridden position? *
1 point
129. A 23-year-old woman with bone marrow failure is treated with a large dose of rabbitantithymocyte globulin. Ten days later, she develops fever, lymphadenopathy, arthralgias,and erythema on her hands and feet. Which of the following is the most likely cause of these symptoms? *
1 point
130. A 32-year-old woman with type 1 diabetes mellitus has had progressive renal failure over the past 2 years. She has not yet started dialysis. Examination shows no abnormalities. Her hemoglobin concentration is 9 g/dL, hematocrit is 28%, and mean corpuscular volume is 94 μm3. A blood smear shows normochromic, normocytic cells. Which of the following is the most likely cause? *
1 point
131. A 76-year-old man with a history of prostatic hypertrophy has the recent onset ofincreased difficulty urinating. Symptoms began shortly after he started taking a nasal decongestant orally for cold symptoms. Which of the following types of receptors is most likely to be involved in these adverse effects? *
1 point
132. A 62-year-old woman comes to the physician because of low back pain for 1 week.Menopause occurred 10 years ago. Physical examination shows localized tenderness overthe lumbar spine after movement. X-rays of the spine show a compression fracture of L1-2.A DEXA scan shows decreased bone mineral density. Serum calcium and phosphorus concentrations and serum alkaline phosphatase activity are within the reference ranges. A bisphosphonate drug is prescribed. The expected beneficial effect of this drug is most likely due to which of the following actions? *
1 point
133. A 29-year-old man is brought to the physician for removal of a cast from his left leg. Hesustained a fracture of the left lower extremity 6 weeks ago and was immobilized in a castthat extended from just below the knee to the foot. At the time of injury, there was severepain but normal strength in the extremity. When the cast is removed today, physical examination shows a pronounced left footdrop with paresthesia and sensory loss over thedorsum of the left foot and lateral leg. Injury to which of the following nerves is the mostlikely cause of this patient's condition? *
1 point
134. A 48-year-old man with AIDS has chorioretinitis with flame-shaped hemorrhages and large white patches. Three weeks after starting therapy, his vision is improved, but he hasgranulocytopenia. Which of the following antiviral agents is most likely responsible for these findings? *
1 point
135. A 37-year-old woman comes to the physician because of a 2-month history of pain withmovement of her hands and feet. Physical examination shows warmth and swelling of themetacarpophalangeal and metatarsophalangeal joints. Laboratory studies show increasedtiters of antibodies to Fc component of IgG and a negative antinuclear antibody test result. Adrug is prescribed that binds to tumor necrosis factor-α (TNF-α) and blocks its interactionwith cell-surface TNF receptors. Her symptoms improve within 1 month. She is most likelyreceiving treatment with which of the following drugs? *
1 point
136. A 35-year-old man comes to the physician because of pain and swelling of his right armwhere he craped it on a tree branch 2 days ago. His temperature is 38.3°C (101°F). Examination of the right forearm showsedema around a fluctuant erythematous lesion atthe site of trauma. The area is extremely tender to palpation. Which of the following is most likely the primary mechanism of the development of edema in this patient? *
1 point
137. A study of sexually transmitted infections identifies an organism most commonly foundin tropical and subtropical regions. This organism is associated with painful ulcerating genital papules in HIV-infected persons. Microscopic examination of lesional exudate with silverstain shows coccobacilli. Which of the following organisms is most likely to produce thesefindings? *
1 point
138. A 17-year-old boy comes to the emergency department because of severe thirst andweakness and a 4-kg (8.8-lb) weight loss over the past 36 hours. He began having voluminous painless watery diarrhea on the airplane while returning from a trip to Thailand36 hours ago. He has not vomited. While supine, pulse is 110/min and blood pressure is110/60 mm Hg. While standing, pulse is 170/min and blood pressure is 70/40 mm Hg. Hisabdomen is nontender and bowel sounds are increased. Which of the following treatmentsis most appropriate at this time? *
1 point
139. A 74-year-old man with urinary frequency and urgency has benign prostatic hyperplasia.He refuses operative intervention but agrees to a trial of finasteride therapy. During the trial,synthesis of which of the following substances is most likely to be inhibited? *
1 point
140. A 16-year-old boy is admitted to the emergency department because of a knife woundto the left side of his chest. An x-ray of the chest shows an air-fluid level in the left side ofthe chest, partial collapse of the left lung, and elevation of the stomach bubble. Themediastinum is in the midline. Which of the following is the most likely diagnosis? *
1 point
141. A 55-year-old man comes to the physician because of a 2-week history of recurrent,widespread blister formation. Physical examination shows lesions that are most numerous inthe flexural areas including theaxillae and groin. The blisters do not break easily, and thereare no oral lesions. These blisters are most likely the result of adhesion failure involvingwhich of the following? *
1 point
142. A 52-year-old man with recently diagnosed type 2 diabetes mellitus comes to thephysician for a follow-up examination. Physical examination shows no abnormalities. Laboratory studies show an increased hemoglobin A1c despite patient compliance with diet and exercise recommendations. Treatment with a sulfonylurea is started. Which of the following is most likely to occur in this patient? *
1 point
143. A 45-year-old man has abnormal circadian variation in body temperature, disruption ofthe sleep-wake cycle, and an impaired nocturnal surge of secretion of melatonin. An MRI ofthe brain is most likely to show a lesion involving which of the following nuclei? *
1 point
144. A previously healthy 3-month-old boy is brought to the physician because of a runnynose and a dry cough for 2 days. Physical examination shows tachypnea, a nasal discharge,and wheezing. An x-ray of the chest shows hyperexpansion but no infiltrates. The causalvirus was most likely transmitted by which of the following routes? *
1 point
145. A 70-year-old man is brought to the emergency department by his wife because of fever and shortness of breath for 2 days. He underwent an oral surgical procedure 6 weeks ago. His respirations are 22/min, and blood pressure is 140/60 mm Hg. A soft diastolic murmur is heard. The diagnosis of bacterial endocarditis is made. Gentamicin therapy is initiated. This patient is at increased risk for developing which of the following as a result of this therapy? *
1 point
146. An otherwise healthy 26-year-old woman has had petechiae on her legs during the last24 hours. Laboratory studies show: Hemoglobin 13.1 g/dL                            Hematocrit 39.7%                                   Leukocyte count 8500/mm3             Neutrophils 65%                                 Lymphocytes 30%                                Monocytes 5%                                                  Mean corpuscular volume 82.2 μm3         Platelet count 20,000/mm3A                 peripheral blood smear shows normal red cell morphology; a bone marrow smear showsmature megakaryocytic hyperplasia. Which of the following is the most likely diagnosis? *
1 point
147. A 2-year-old girl is brought to the emergency department because of pain in her rightforearm after a fall 1 hour ago. She has a history of fractures of the left femur and right tibia. Physical examination shows blue sclerae. There is tenderness to palpation over the distal right radius. A mutation in which of the following genes is the most likely cause of the recurrent fractures in this patient? *
1 point
148. A 50-year-old man has headache, vertigo, and generalized pruritus. He has the recentonset of angina pectoris. His hematocrit is 65%, leukocyte count is 12,000/mm3, anderythrocyte mass is increased. Erythropoietin concentration is decreased. Which of thefollowing is the most likely diagnosis? *
1 point
149. Warfarin is administered to a 56-year-old man following placement of a prostheticcardiac valve. The warfarin dosage is adjusted to maintain an INR of 2.5. Subsequently,trimethoprim-sulfamethoxazole therapy is begun for a recurring urinary tract infection. Inaddition to monitoring prothrombin time, which of the following actions should thephysician take to maintain adequate anticoagulation? *
1 point
150. A 40-year-old woman has noted pruritic patches on her vulva for the past 4 months. On physical examination there are multiple 1.5- to 3-cm white, scaly plaques on the vulva. A biopsy of one lesion is taken, and on microscopic examination, it shows epidermalthickening with hyperkeratosis and intense dermal inflammation. Mitoses are seen inkeratinocytes, but they exhibit no atypia. What is the most likely diagnosis? *
1 point
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of CPIRD. Report Abuse
Google Forms