1. A 25-year-old female is brought to the emergency department with complaints of fever, malaise, nausea, and diarrhea.

She is hypotensive and has a prominent maculopapular rash. She is currently in the middle of her menstrual period. Which of the following to in-producing bacteria is most li!ely the cause of this patient"s symptoms# $op of %orm

&scherichia coli

'seudomonas aeruginosa

Streptococcus pyogenes

Staphylococcus aureus

Staphylococcus epidermidis (ottom of %orm 2. A 25-year-old depressive male is rushed into the hospital by his boyfriend. $he boyfriend said that the patient would not wa!e up, no matter how hard he was sha!ing him. Arterial blood gases reveal a blood p) of *.+,, bicarbonate of 22, and '-.2 of 25. Which of the following is the most li!ely diagnosis of his condition#

$op of %orm

&thanol into ication

&thylene glycol into ication

Salicylate overdose

-yanide poisoning

/itroglycerin overdose (ottom of %orm 0. A 12-year-old boy presents with polyuria and dysuria. 1rinalysis reveals a 22-hour urinary protein of 0.* gm3dl, no red blood cells, and no casts. Which of the following is the most li!ely cause of the child"s disease# $op of %orm

Acute post-streptococcal glomerulonephritis

4apidly progressive glomerulonephritis

5inimal change disease

Amyloidosis

Acute tubular necrosis (ottom of %orm 2. A patient with bipolar disorder is prescribed lithium, carbama6epine, and citalopram. Serum level of carbama6epine in two wee!s is therapeutic. Appro imately two months later, the patient feels increasingly more euphoric, is sleeping less, and is more impulsive. $he patient insists he has ta!en his medication diligently. $he most li!ely e planation for this is $op of %orm

citalopram precipitating a manic episode

a decrease in serum level of carbama6epine

an increase in serum level of citalopram

a decrease in the level of lithium

lithium induced hyperthyroidism (ottom of %orm 5. A 02-year-old man begins treatment for tuberculosis with a combination of isonia6id and rifampin. Which of the following side effects of isonia6id may be diminished by the concomitant use of pyrido ine# $op of %orm

)epatitis

/ausea

/europathy

4ash

$innitus (ottom of %orm +. A *,-year-old woman comes to her family physician complaining of generali6ed fatigue and numbness and tingling of her legs and feet. .n physical e am, she is noted to have paresthesia of both lower e tremities. )er hemoglobin and hematocrit are 7.2 g3d8 and 029, respectively. A peripheral blood smear shows abnormally

large erythrocytes. $his patient"s symptoms are most li!ely e plained by a deficiency of $op of %orm

biotin

folic acid

thiamine

niacin

cobalamin (ottom of %orm *. A 22-year-old woman presents with diarrhea of 2 months" duration. -olonoscopy reveals dilatation of the colon with some areas that are affected by deep, linear ulcerations. She also has malabsorption of fats. What is the most li!ely diagnosis# $op of %orm

Whipple"s disease

$o ic megacolon

1lcerative colitis

-rohn"s disease

'seudomembranous colitis (ottom of %orm :. A 25-year-old woman complains of decreased vision and pain on eye movements. & amination reveals several bilateral visual field defects with normal pupillary responses. %undoscopic e amination is normal. $he most li!ely cause of her complaints is $op of %orm

multiple sclerosis

cortical infarct

tumor compressing the optic nerve

tumor compressing the &dinger-Westphal nucleus

;uillian-(arre syndrome (ottom of %orm 7. A 12-year-old now presents with fever and leu!ocytosis. A pericardial friction rub is heard on auscultation of the heart sounds. 'ast medical history is significant for a sore throat three wee!s prior to admission. Which of the following would you also e pect to see in this child# $op of %orm

&rythema chronicum migrans

Sydenham"s chorea

8isch nodules

-herry red spot

8ibman-Sac!s endocarditis (ottom of %orm 1,. A 0+-year-old soldier returns from war with a shrapnel in<ury to the left leg. & amination reveals an e tremely tender and foul-

smelling limb with evidence of bubbles under the s!in surface. $emperature is elevated. .ne possible course of therapy is $op of %orm

hyperbaric o ygen

tetracycline

erythromycin

!etocona6ole

amphotericin ( (ottom of %orm 11. A +*-year-old male is brought to the emergency department with complaints of crushing substernal chest pressure. An electrocardiogram reveals changes consistent with an anterolateral myocardial infarction. )e is administered strepto!inase. Which of the following best describes the thrombolytic action of strepto!inase# $op of %orm

Activation of antithrombin ===

Activation of circulating plasminogen

Activation of plasminogen bound to fibrin

-leavage of fibrinogen to fibrin

-ompetitive inhibition of fibrin degradation (ottom of %orm 12. A 52-year-old man is brought to the emergency department after being found unconscious on the street. )e appears to be tachypneic with irregular respirations. An arterial blood gas reveals a p) of *.2, '-.2 of 0: mm)g, '.2 of +: mm)g, and a bicarbonate of 12 m&>38. (lood tests reveal a sodium of 122 m&>38 and a chloride of 1,1 m&>38. Which of the following is the most li!ely etiology of this patient"s condition# $op of %orm

?omiting

Severe diarrhea

5ethanol into ication

-hronic obstructive pulmonary disease

An iety (ottom of %orm 10. A 2:-year-old male arborist is brought to the emergency department by his cowor!er. $he patient lost his balance while atop a tree and slipped, barely avoiding a fall by grasping a limb with his right arm. )e is unable to fle his wrist or move several of his fingers. $here is numbness of the medial arm, forearm, and hand. Which of the following in<uries is most li!ely# $op of %orm

A illary nerve

=nferior trun! of the brachial ple us

8ong thoracic nerve

Superior trun! of the brachial ple us

$horacodorsal nerve (ottom of %orm 12. A 25-year-old male is brought to the emergency department after an automobile accident. )e is hypotensive and complaining of left shoulder pain. 4adiographs of his shoulder are unremar!able. =n<ury to which of the following organs most li!ely e plains his symptoms# $op of %orm

;all bladder

8arge intestine

8eft lung

8iver

Small intestine

Spleen

Stomach (ottom of %orm 15. A 5+-year-old man comes to his family physician for follow-up of his hypertension and hypercholesterolemia. )e is found to have an 8@8 of 2,, mg3d8, an )@8 of 02 mg3d8, and a total cholesterol of 0,, mg3d8. ;iven the patient"s unfavorable cholesterol profile, the doctor recommends that he start drug therapy to lower cholesterol. An appropriate and effective drug would inhibit the activity of which of the following# $op of %orm

)e amethylglutaryl--oA reductase

Acyl--oAAcholesterol acyltransferase

8ipoprotein lipase

8@8 receptor

*-alpha-hydro ylase (ottom of %orm 1+. A patient with severe rapid cycling bipolar disorder is prescribed valproate. )owever, she becomes pregnant. After an informed discussion, she decides she will not stop the medication. $he most significant ris! to the fetus is

$op of %orm

spina bifida

cleft palate

thrombocytopenia

cardiac abnormalities

microcephaly (ottom of %orm 1*. A 2-month-old male is brought to the pediatrician by his mother who is concerned that he is not gaining weight. She also notes that his color is poor, especially when he tries to feed, when he often grunts and turns dus!y. Which of the following cardiac lesions is most li!ely to cause the patient"s symptoms# $op of %orm

Atrial septal defect

'atent ductus arteriosus

'atent foramen ovale

$etralogy of %allot

?entricular septal defect (ottom of %orm 1:. A 1,-month-old male is brought to the pediatrician by his mother who is concerned about his lac! of interaction. )e was previously playful and happy but now hardly ever smiles. .n e am, he is found to have poor muscle tone and a cherry-red macula. @eficiency of which en6yme is most li!ely# $op of %orm

;lucocerebrosidase

;lucose-+-phosphatase

)e osaminidase A

8-iduronidase

$yrosinase (ottom of %orm 17. A *:-year-old hospitali6ed patient refuses to loo! to his left side. $he patient ignores all family members and medical staff when they approach from the left side. $he patient"s wife says he repeatedly puts his dressing gown on the right side only. $he most li!ely etiology of this constellation of symptoms is $op of %orm

stro!e involving the right temporal lobe

stro!e involving the left parietal lobe

stro!e involving the right parietal lobe

stro!e involving the left temporal lobe

stro!e involving the frontal lobe (ottom of %orm

2,. A 2-month-old female is brought to her pediatrician by her mother who is concerned about some photographs she recently had developed. =n the photographs, only the child"s right eye demonstrates a red refle . & amination of the left eye confirms absence of a red refle . Which of the following mechanisms is most li!ely involved# $op of %orm

@eletion in the long arm of chromosome 10

@eletion in the short arm of chromosome 5

@eletion of the short arm of chromosome 11

/ondis<unction of chromosome 1:

/ondis<unction of chromosome 21 (ottom of %orm 21. A 15-year-old male with a history of sic!le cell anemia presents to his family physician for his annual chec!-up. Se>uencing analysis of his beta-globin gene would reveal which of the following# $op of %orm

/onsense mutation

Silent mutation

5issense mutation

%rameshift mutation

@eletion (ottom of %orm 22. A 25-year-old woman received a heart transplant three years ago. She is dependent on the immunosuppressive agents cyclosporine and prednisone. )er other medications includeA furosemide, digo in, and metformin. She develops vaginal candidiasis and is prescribed !etocona6ole. Which of the following will re>uire dose ad<ustment during her use of !etocona6ole to prevent to icity# $op of %orm

-yclosporine

@igo in

%urosemide

5etformin

'rednisone (ottom of %orm 20. A 50-year-old e otic dancer is diagnosed with cervical cancer. $he presence of which of the following organisms in the genital tract could have predisposed her to this condition# $op of %orm

)erpes simple

type =

)erpes simple

type ==

)uman 'apilloma ?irus types + and 11

)uman 'apilloma ?irus types 1+ and 00

)=? virus

(ottom of %orm 22. A +2-year-old male complains to his primary care doctor about a new tremor. & am confirms a new pill-rolling tremor. $here is prominent cog-wheeling rigidity and mas!ed facies. Which of the following most li!ely accounts for this patient"s symptoms# $op of %orm

/euronal degeneration of anterior horn cells

/euronal degeneration of the caudate nuclei

/euronal degeneration of the corticospinal tracts

/euronal degeneration of spinothalamic tracts

/euronal degeneration of the substantia nigra (ottom of %orm 25. A severe chronic intravenous drug abuser attempts heroin into a vein in his face. $he following day he medial deviation of the left eye, and numbness of the the face from the forehead to the upper border of the %undoscopy reveals engorgement of the retinal veins. most li!ely etiology of this disorder# to in<ect has fever, left side of lip. What is the

$op of %orm

Subarachnoid hemorrhage

5eningitis

-avernous sinus thrombosis

$hrombosis of the internal carotid artery

=nfective endocarditis (ottom of %orm 2+. A 02-year-old man receives intraoral lidocaine before undergoing a dental procedure. Which of the following is li!ely to be found in nerves surrounding the site of in<ection# $op of %orm

Absence of action potentials

=ncreased rate of action potentials

)igher amplitude action potentials

@ecreased rate of action potentials

8ower amplitude action potentials (ottom of %orm

2*. A 21-year-old male presents with shortness of breath that has progressively worsened over the last year. Spirometry reveals a decreased forced e piratory volume in one second B%&?1C and an obstructive pattern. )istological specimen from a lung biopsy is shown below. Which of the following is the most li!ely diagnosis#

$op of %orm

-hronic bronchitis

-ystic fibrosis

#1-antitrypsin deficiency

Dartagener"s syndrome

Adult respiratory distress syndrome (ottom of %orm 2:. A 25-year-old man is diagnosed with )=? infection. )is -@2E count is only 5,3mm0. )e begins a triple drug regimen as well as prophyla is against opportunistic infections with didanosine, lamivudine, 6idovudine, and trimethaprim-sulfametho a6ole. Additionally, he has hypertension, for which he ta!es metoprolol. A few wee!s later he presents to the emergency department with severe abdominal pain. 8aboratory tests are obtained, bilirubin, total 1.5 mg3d8, amylase 225+ mg3d8, lipase 1,*+ mg3d8. Which of the following medications is most li!ely to blame for his pancreatitis# $op of %orm

@idanosine

8amivudine

5etoprolol

$rimethaprim-sulfametho a6ole

Fidovudine (ottom of %orm 27. A 1+-year-old boy has declining grades in school and his teachers persistently complain that he fre>uently daydreams in class. After several months the boy is diagnosed with absence sei6ures. Which of the following is the treatment of choice for absence sei6ures# $op of %orm

-arbama6epine

&thosu imide

'henytoin

'rimidone

?alproic acid (ottom of %orm 0,. A 02-year-old woman presents with fatigue and dyspnea on e ertion. .n physical e amination, she appears pale and has a heart rate of 12,. She has a mild =3?= murmur. -omplete blood count reveals a hemoglobin of 7 mg3dl. 'eripheral blood smear is shown below. Which of the following is the most appropriate therapy to be implemented#

$op of %orm

?itamin (12 replacement

%olic acid replacement

=ron therapy

Splenectomy

(one marrow biopsy (ottom of %orm 01. A 15-year-old girl complains of vulvar itching and burning dysuria. A gram stain of vaginal swab reveals gram-negative intracellular diplococci. $he swab should be sent for which of the following diagnostic tests# $op of %orm

$6an! smear

-ulture on $hayer-5artin media

8iving cell culture

-ulture on 8owenstein-Gensen"s media

-ulture on triple sugar ion B$S=C agar (ottom of %orm 02. A 2-year-old boy is brought to his pediatrician because his parents have become increasingly concerned with the child"s recent aggressive and self-in<urious behavior. $hey report that he has been biting his fingers and banging his head on walls. $hey are also worried because the child seems slower than the rest of his peers at pre-school. 8aboratory tests reveal a blood urea nitrogen of 25 mg3d8 and a serum creatinine of 0., mg3d8. $his child"s findings are most li!ely consistent with an elevation of $op of %orm

adenine

hypo anthine

inosine monophosphate

guanosine monophosphate

thymidine (ottom of %orm 00. A 0:-year-old man begins treatment for hypertension with a new medication. Several wee!s later, he complains to his physician about a persistent dry cough. Which of the substances mediates the cough associated with the use of angiotensin-converting en6yme inhibitors# $op of %orm

Acetylcholine

Aldosterone

(rady!inin

Dalli!rein

4enin

(ottom of %orm 02. A 5+-year-old man presents to the emergency room with crushing substernal chest pain, which radiates to his left arm. &lectrocardiogram demonstrates evidence of an inferior wall myocardial infarction. After 0 days in the -oronary -are 1nit, the patient develops cardiogenic shoc! and dies. Which of the following changes is most li!ely seen on histological specimen of the infracted area# $op of %orm

-oagulation necrosis

5acrophage predominance

%ibrosis

-ollagen synthesis

?ascular congestion at the perimeter of the lesion (ottom of %orm 05. A 01-year-old female has several old superficial cuts on her forearms. She states that by cutting herself, she can relieve an iety. She has a history of intense, unstable relationshipsH sometimes she feels her boyfriends were the greatest men she had ever met, and other times she feels Ithey"re lower than dirtI. She has great difficulty controlling her emotions, especially when

she is faced with stress. with $op of %orm

$his description is most consistent

histrionic personality disorder

borderline personality disorder

narcissistic personality disorder

dependent personality disorder

avoidant personality disorder (ottom of %orm 0+. A 21-year-old factory wor!er presents with right upper >uadrant pain of 2 months" duration. $he patient appears yellow. 8aboratory evaluation reveals aspartate transaminase BAS$C level of 17,, alanine transaminase BA8$C level of 2,,, al!aline phosphatase level of 0,,, and a total bilirubin of 2.+ mg3dl. -omputed tomography scan of the abdomen reveals a 0-cm homogeneous lesion of the left lobe of the liver with blood vessels present throughout. Which of the following environmental e posures is most li!ely the cause of the present situation# $op of %orm

Alcohol

Asbestos

/aphthylamine

'olyvinyl chloride

(en6ene (ottom of %orm 0*. A group of teenage boys are brought to the emergency department by the police for blood alcohol testing after they are arrested for rec!less driving. $he boys are confused but deny drin!ing. (lood testing for ethanol is negative. After closer >uestioning, one of the boys admits drin!ing anti-free6e in an effort to get high. Which of the following is a useful antidote of poisoning with ethylene glycol# $op of %orm

Acetylcysteine

%luma6enil

%omepi6ole

/alo one

'ralido ime (ottom of %orm 0:. A 05-year-old man presents to the emergency department complaining of severe abdominal pain and generali6ed muscle wea!ness. $he patient reports that he has <ust returned from a camping trip during which he foraged for and ate some wild mushrooms. $he mushroom is later identified as the species Amanita phalloides. A cellular e tract from this patient would show decreased levels of $op of %orm

@/A

5s ribosomal 4/A

transfer 4/A

messenger 4/A

2:s ribosomal 4/A (ottom of %orm 07. A 2-year-old boy presents with acute onset of muscle spasm of his left triceps muscle. )e has a past medical history of a repaired cleft palate, repeated upper respiratory tract infections and thrush. Which of the following is also li!ely to be affected in this disorder# $op of %orm

$hyroid gland

(-cell development

Aortic arch

(rain development

'latelet count (ottom of %orm 2,. A movie stuntman is involved in a motorcycle accident, and suffers a vertebral fracture. $he e amining neurologist notes a

band-li!e bilateral loss of pain and temperature sensation at the umbilical level, a right-sided loss of vibration and proprioceptive sense below the umbilicus, a right-sided loss of motor strength below the umbilicus, and a loss of left-sided pain and temperature. $he most li!ely location of spinal cord compromise is $op of %orm

right $1, hemisection

left $1, hemisection

right $12 hemisection

left $12 hemisection

spinal cord section at $1, (ottom of %orm 21. A 2+-year-old woman develops hypotension, petechiae, and e cessive bleeding after delivering a 0+,,-gram baby boy. )er prothrombin time is 20 seconds and partial thromboplastin time is 5+ seconds. Which of the following is the most li!ely cause of her current symptoms# $op of %orm

;roup ( streptococcal sepsis

Amniotic fluid embolism

von Willebrand"s disease

)&88' syndrome

)emophilia (ottom of %orm 22. A 2,-year-old male long-distance runner presents to the student health clinic with bloody urine. )e reports having recently recovered from an upper respiratory tract infection 2 days ago that was associated with a mild erythematous rash on his lower e tremities. (1/, creatinine, and liver en6ymes are all normal. 1rinalysis demonstrates greater than 5, red blood cells and no white blood cells. )e has normal hearing. Which of the following is the most li!ely diagnosis# $op of %orm

8yme disease

5arch hemoglobinuria

=gA nephropathy

Alport"s syndrome

'ost-streptococcal glomerulonephritis (ottom of %orm 20. A 05-year-old man comes to his family physician complaining of generali6ed muscle wea!ness and cramping that occurs after he e ercises at the gym. )e reports that the cramping seems to become more severe and that his urine turns reddish-brown when he wor!s out for a longer period of time. (lood tests are performed after an e ercise trial and reveal normal serum glucose and lactate levels. Which of the following is a possible complication of the disease in this patient# $op of %orm

Acute tubular necrosis

)emolytic <aundice

-ardiomegaly

)epatomegaly

%atty liver (ottom of %orm 22. A +5-year-old woman suffered an acute myocardial infarction 2 wee!s ago. Since her hospital discharge, she has made an effort to limit fat and cholesterol in her diet. )er lipid profile is obtained by her primary care physician, total cholesterol 20, mg3d8, triglycerides 15, mg3d8, )@8 2, mg3d8, 8@8 1+, mg3d8. Which of the following acts as an inhibitor of )5;--oA reductase# $op of %orm

-holestyramine

%enofibrate

;emfibro6il

/iacin

Simvastatin

(ottom of %orm 25. A 12-year-old girl presents with intermittent headache for the past + months. She denies fever, visual disturbances, or photophobia. .ver the ne t wee!, she develops repetitive symmetric clonic movements of her upper e tremities. $wo days later, she collapses while wal!ing to class in school and becomes comatose. )er condition >uic!ly deteriorates over the ne t two wee!s, and she dies. Which of the following is most li!ely the cause of her clinical presentation# $op of %orm

4heumatic fever

Subacute sclerosing panencephalitis

(acterial meningitis

'rogressive multifocal leu!oencephalopathy

Status epilepticus (ottom of %orm 2+. A 5,-year-old man is admitted to the hospital when he is found unresponsive at home. )is wife states that he had been in good health until 0 months ago, and then developed rapidly worsening memory loss and confusion, as well as periods of twitching,

especially during sleep. .n e amination, there is evidence of myoclonus, but he is otherwise unresponsive. An &&; shows periodic sharp waves. An 54= shows white matter demyelination, and lumbar puncture shows high-normal protein. $he most li!ely diagnosis is $op of %orm

metabolic encephalopathy

ano ic brain in<ury

stro!e

-reut6feld-Gacob disease

grand mal sei6ure (ottom of %orm 2*. A baby is born to a woman with poorly controlled type = diabetes. Although the pregnancy is relatively uneventful, at delivery, the baby is severely cyanosed. $he attending physician administers prostaglandins to !eep the ductus arteriosus open. What is the most li!ely underlying defect in this child# $op of %orm

Atrial septal defect BAS@C

?entricular septal defect B?S@C

Atrioventricular septal defect BA?S@C

-oarctation of the aorta

$ransposition of the great arteries B$;AC (ottom of %orm 2:. A 02-year-old veterinary student complains of fever, headache, and malaise. Within si wee!s he has become psychotic with massive polydipsia and an inability to swallow. $he most li!ely causative organism is $op of %orm

rabies virus

hantavirus

herpes simple

virus B)S?C

to oplasma gondii

co sac!ie virus ( (ottom of %orm 27. A 1+-year-old girl presents with visual field deficits. She complains that she cannot visuali6e the temporal halves of her fields of vision in both eyes. She also complains of a persistent headache over the last month. 5agnetic resonance imaging of the brain reveals calcification in a 1.5-centimeter mass e tending from the sella turcica. Which of the following is the most li!ely diagnosis# $op of %orm

&pendymoma

;lioblastoma multiforme

'ituitary adenoma

-raniopharyngioma

5edulloblastoma (ottom of %orm 5,. A 15-year-old boy presents with pain in his left upper bac!. )e denies any history of trauma. .n physical e amination, a bony prominence is palpated over the left scapula. 4adiologic films indicate a small 1-cm mass involving the scapula. (one biopsy illustrates multiple layers of superiosteal reactive new bone formation in the presence of lytic destruction, giving rise to an Ionions!inI appearance. Which of the following is the most li!ely diagnosis# $op of %orm

.steosarcoma

.steochondroma

&wing"s sarcoma

;iant cell tumor

-hondrosarcoma (ottom of %orm