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 sin 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 liely 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 freuent urination and increasing thirst. His random blood sugar is 3/0 mg2d' by fingerstic. Diabetes mellitus is diagnosed and an oral agent is recommended. everal days after starting the medication he complains of bloating and increasing flatulence. #hich of the following is the most liely 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 maredly 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 sy7 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 8eed-ternberg9 '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 taling to himself, feeling paranoid, and staying inside the house because he thins 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 liely 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 liely 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 taes 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
ancomycin
)ottom of "orm ;.A 36-year-old woman presents to her family physician complaining of weaness ofis her eyelids and difficulty swallowing. &hysical e!am significant for bilateralwith ptosis, diplopia, and pronounced weaness 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, freuent 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
Hb H
Hb )art
)ottom of "orm 1*.A *1-year-old man presents to the tudent 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 liely diagnosis$
%op of "orm
Acute tubular necrosis
asculitis
Acute glomerulonephritis
Acute tubulointerstitial disease
Acute pyelonephritis
)ottom of "orm 10. An =0-year-old woman with unnown medical and psychiatric history is brought in because of appro!imately 3 months of decline in functioning. he has had worsening cognition for the past year, but lately has also had problems ambulating, with a widened, unsteady gait. he has had freuent 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 reuirements higher than at any other time during hospital admission. #hat is the most liely diagnosis$
%op of "orm
(ompartments 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. everal wees later he develops persistent, green, watery diarrhea. #hich of the following is the most liely cause of this patientBs diarrhea$
%op of "orm
(ampylobacter ?e?uni
(lostridium difficile
iardia lamblia
almonella 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. he notes that withheat the intolerance, onset of the profuse nec swelling, sheand e!perienced mared sweating, palpitations. )lood tests reveal maredly depressed %H levels. #hich of the following is the most appropriate treatment for this patient$
%op of "orm
&ropylthiouracil
ynthroid
%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, freuent urination, and severe abdominal pain. %he patient has a heart rate of 11@, a
)& of ==, poor sin turgor, and dry mucous membranes. Crinalysis reveals substantial amounts of glucose and etones. erum 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 taing daily aspirin. #hich of the following would be decreased in this patient after 6 months of aspirin therapy$
%op of "orm
'euotriene A/
&rostaglandin :*
Arachidonic acid
0-H&:%:
'euotriene )/
)ottom of "orm *1. A /0-year-old man presents to his primary care physician with complaints of diarrhea. Despite triple therapy for H4 infection his last (D/F count was less than 1@@2mm3. tool 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 breas 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. he 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 7iced 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 7sueeze test7 of the gastrocnemius fails to elicit plantar fle!ion of the foot on the left side. #hat is the most liely 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 phosphoinase. everal hours after admission to the hospital, the patient begins to demonstrate an irregular heartbeat. His : is shown below. #hich of the following is the most appropriate treatment for this patientBs condition$
%op of "orm
4 sodium
4 potassium
pironolactone
4 insulin and glucose
4 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. he is also found to be hypoalemic and severely hypertensive. %he most liely 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 DA and an absence of C-specific endonuclease. %he inheritance pattern of this childBs disease would best be described as
%op of "orm
autosomal dominant
autosomal recessive
!-lined dominant
!-lined 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 ". continuoushypotension. infusion of phenylephrine is instituted forArefractory vasopressor action of phenylephrine is mediated through
%he
%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 attacs 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 ("$
%op of "orm
( 4
(
( 44
( 444
( 4
)ottom of "orm 33. A /*-year-old woman is referred to an endocrinologist for complaints of e!treme weaness, fatigue, chronic diarrhea, and hyperpigmented sin. he 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:2' and potassium of 6.+ m:2'. )lood cortisol is undetectable. %his patientBs disease is liely caused by destruction of her
%op of "orm
thyroid gland
idney
adrenal corte!
adrenal medulla
pancreas )ottom of "orm 3/. icle 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 freuency of individuals homozygous for Hb 8sicle hemoglobin9 in a certain population is /I, then the freuency of individuals heterozygous for Hb 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 hypoglycemicof episode is the due following to endogenous e!ogenous insulin. 5easurement which of willor confirm the diagnosis$
%op of "orm
4nsulin
erum glucose
Crine glucose
erum etone
(-peptide
)ottom of "orm 36. A *@-year-old woman presents to the emergency department after eating at a local (hinese restaurant. he 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 freuency 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, weaness, and fatigue. 'aboratory data show a sodium level of 1** m:2', serum osmolarity of */@ m>sm2', and urine osmolarity of /00 m>sm2'. #hat is the most liely diagnosis$
%op of "orm
eurogenic diabetes insipidus
ephrogenic diabetes insipidus
Diabetes mellitus
yndrome 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 leuocytosis. :lectrocardiogram e!hibits J waves similar to those from the previous myocardial infarction as well as diffuse % segment elevation that is concave up. #hat is the most liely 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 (&. 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 he has taen his medications, haloperidol and fluo!etine. %heif 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 liely$
%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 treptococcus 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 tates after a tour abroad. ince his return, he is wea and fatigued. He has suffered intermittent diarrhea for several months. A stool specimen yields trongyloides 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
itamin
: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 sin and sclerae are noted to be icteric. #hich of the following laboratory findings is liely 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. he 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
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-blocer therapy. #hich of the following would be the most appropriate choice of beta-blocer 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 freuency. He awaens 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. he 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 mared leuocytosis 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
