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- Jul 11, 2003
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1. A 22 year old man has a 36 hour history of pain/swelling in left testis. One week ago, he had mild dysuria and urethral discharge. Gram stain from urethra shows numerous neutrophils but no organisms. Most likely cause of the patient's symptoms is infection with which of the following?
A. Chlamydia trachomatis
B. Cytomegalovirus
C. E coli
D. Herpesvirus
E. Mumps virus
F. Neisseria gonorrhoea
G. Trichomonas Vaginalis
Cant remember any of these bugs, I havent studied this stuff since last September. I will eliminate B, C, D, and E because those are either not bacteria or they are not associated with STDs. So it could be A, F, or G. I'm guessing its A.
2. 25 year old woman has 3 year history of progressive tremor in her arms that becomes more pronounced when her arms are held outstretched. Muscle tone is diffusely increased. A photograph of cornea is shown (White/blue ring shown around the pupil, taking up about 50% of the iris). Results of liver function studies are abnormal. These findings are most likely caused by excessive accumulation of which of the following?
A. Aluminum
B. Copper
C. Iron
D. Lead
E. Mercury
I couldnt copy/paste the picture, so this one will be hard to answer for you guys, but the description I gave in parentheses should help. My guess is B (wilsons disease) and I'm guessnig that the picture shows the Kayser-Fleischer ring associated with high copper state.
3. A 22 year old woman is evaluated because of recent sinopulmonary infections and diarrhea. Her serum IgG concentration is within reference range. Which of the following immunodeficiency syndromes best explains these findings?
A. AIDS
B. Chronic granulomatous disease
C. Common variable immunodeficiency
D. DiGeorge Syndrome
E. Isolated IgA deficiency
F. Severe Combined Immunodeficiency Disease
G. Wiskott-Aldrich Syndrome
H. X linked agammaglobulinemia
Not sure, maybe E because IgA is commonly associated with mucosal immunity which this patient is lacking. This scenario does not fit A, F, or H so I ruled them out immediately. I have no idea what G is, and I've never heard of C, although I think C should have an altered IgG?
4. A 10 month old infant is brought to the ER on a sweltering day in June. He is listless, cranky, and "floppy as a dishrag." He has no hair or teeth. Over the past 2 weeks, he has not smiled, babbled, rolled over, sat up, or attempted to stand. The mother says that both she and her son cannot tolerate heat and that she has always had thin hair and still has some baby teeth. Which of the following skin structures is most likely to be absent or greatly decreased in number in the mother and the child?
A. Langerhans cells
B. Merkel's cells
C. Pacinian corpuscle
D. Sebaceous glands
E. Sweat glands
Totally clueless on this one. Sebaceous glands are connected to hair shafts, but it has nothing to do with teeth. I dont understand why missing Langerhans cells would cause you to have no teeth or hair. Merkel's cells are involved in touch reception? Not sure what they have to do with anything. Pacinian is pressure receptor. I'm going to guess E, but I dont understand how any of these could cause lack of sweating, no hair, and no teeth. What syndrome is this?
5. A 66 year old man with squamous cell carcinoma of the lung has an increase in serum alkaline phosphatase activity. Metastatic disease is suspected. Measurement of serum activity of which of the following enzymes will be most useful in differentiating bone and hepatic metastases?
A. Acid phosphatase
B. Aldolase
C. Amylase
D. y-Glutamyltransferase
E. Lactate dehydrogenase
I think this is D. GGT is a liver-specific marker to clarify elevated alk phos which can come from either bone or liver. Amylase is pancreas, I dont know what acid phos is, and lactate dehydrogenase is also liver-associated, but it has nothing to do with alk phos.
6. 70 year old woman who lives alone is brought to hospital by concerned neighbor because she is not taking care of herself. On questioning, the patient denies any problems, but her hair and the left side of her face are poorly tended; she has not buttoned the left sleeve of her blouse or tied her left shoe. When asked to copy a drawing of a clock face, she draws only 12 through 6. MRI of the head is most likely to show a lesion in which part of the brain?
A. Left frontal lobe
B. Right frontal lobe
C. Left parietal lobe
D. Righit parietal lobe
E. Left temporal lobe
F. Right temporal lobe
We havent covered neurology in the 2nd year yet, so this is a guess, but I know its got to be on the right side of the brain. I'm going to say B, since I think frontal lobe is more associated with "forgetting" the side of your body like this woman does. Probably wrong though.
7. A 51 year old man who was previously a successful businessman and devoted husband and father now neglects and abuses his family. At his last visit, he confided to the physician that he abuses alcohol. His wife tells the physician that her husband's drinking is destroying their family. Of the following responses, which is likely to be the most effective in initating a discussion about his use of alcohol and its effect on his family?
A. Did you know most patients who drink as much as you do lose their families?
B. Do you feel guilty about what you're doing to your children?
C. Do you realize the damage your use of alcohol is doing to your relationships?
D. What do you think is the impact of your drinking on your family?
E. Your wife says your use of alcohol is destroying your family
This one should be obvious (D). They always teach us to be nonjudgmental and just ask open ended questions. I think its a little ridiculous at times, but whatever.
8. A 56 year old man has had bright red blood in the stool for the past 10 days. Colonoscopy shows a 6 cm, sessile, bleeding polypoid lesion in the descending colon. Examination of tissue obtained on biopsoy of the lesion shows a primary adenocarcinoma of the colon. There is marked mitotic activity and cell differentiation is poor. The neoplasm is resected; metastases are present in regional lymph nodes. A focus of the same neoplasm is present in a liver biopsy specimen. Which of the following indicates the poorest prognosis?
A. Lymphatic invasion
B. Marked mitotic activity
C. Neoplasm in liver
D. Poor cell differentiation
E. Regional lymph node mets
I marked C as correct, because according to what we learned, stage (not grade) is the most important prognostic indicator for colonic adenocarcinoma. So that eliminates answers B and D since those all apply to grading and not staging. Under the Duke and TNM staging system, lymphatic invasion < regional lymph node mets < liver mets. Liver mets should be the worst of the staging indicators.
9. A 58 year old man is scheduled to be discharged from the hospital after treatment of an MI. Therapy with a drug with wich of hte following actions is most likely to decrease his risk for dying over next 6 months?
A. Blockade of B-adrenergic receptors
B. Blockade of Ca2+ channels
C. Blockade of K+ channels
D. Blockade of Na+ channels
I probably got this one wrong, because we are just now taking cardiac pharmacology and I havent had time to really study this yet. However, I think they told us in class that beta blockers improve mortality, so I put down A as correct. This is a guess, because I have no clue if the others improve mortality or not.
10. A neonate is born with ambiguous genitalia. The clitoris is enlarged, there is a single perineal opening anterior to the anus, and no masses are palpable in the labioscrotal pouches or the inguinal canal. Which of the following is the most likely cause of the sexual ambiguity in this neonate?
A. Androgen insensitivity syndrome
B. 21-hydroxylase deficiency
C. Mixed gonadal dysgenesis
D. 5a-reductase deficiency
E. True hemaphroditism
I think D is correct, but I'm confused about A. I thought there were 2 types of AIS, complete and partial, and that partial AIS results in ambiguous genitalia? Since they didnt list PAIS as a separate answer, what does that mean? Can I eliminate A because they werent specific enough in the answer choices? I'm not sure how to handle that.
A. Chlamydia trachomatis
B. Cytomegalovirus
C. E coli
D. Herpesvirus
E. Mumps virus
F. Neisseria gonorrhoea
G. Trichomonas Vaginalis
Cant remember any of these bugs, I havent studied this stuff since last September. I will eliminate B, C, D, and E because those are either not bacteria or they are not associated with STDs. So it could be A, F, or G. I'm guessing its A.
2. 25 year old woman has 3 year history of progressive tremor in her arms that becomes more pronounced when her arms are held outstretched. Muscle tone is diffusely increased. A photograph of cornea is shown (White/blue ring shown around the pupil, taking up about 50% of the iris). Results of liver function studies are abnormal. These findings are most likely caused by excessive accumulation of which of the following?
A. Aluminum
B. Copper
C. Iron
D. Lead
E. Mercury
I couldnt copy/paste the picture, so this one will be hard to answer for you guys, but the description I gave in parentheses should help. My guess is B (wilsons disease) and I'm guessnig that the picture shows the Kayser-Fleischer ring associated with high copper state.
3. A 22 year old woman is evaluated because of recent sinopulmonary infections and diarrhea. Her serum IgG concentration is within reference range. Which of the following immunodeficiency syndromes best explains these findings?
A. AIDS
B. Chronic granulomatous disease
C. Common variable immunodeficiency
D. DiGeorge Syndrome
E. Isolated IgA deficiency
F. Severe Combined Immunodeficiency Disease
G. Wiskott-Aldrich Syndrome
H. X linked agammaglobulinemia
Not sure, maybe E because IgA is commonly associated with mucosal immunity which this patient is lacking. This scenario does not fit A, F, or H so I ruled them out immediately. I have no idea what G is, and I've never heard of C, although I think C should have an altered IgG?
4. A 10 month old infant is brought to the ER on a sweltering day in June. He is listless, cranky, and "floppy as a dishrag." He has no hair or teeth. Over the past 2 weeks, he has not smiled, babbled, rolled over, sat up, or attempted to stand. The mother says that both she and her son cannot tolerate heat and that she has always had thin hair and still has some baby teeth. Which of the following skin structures is most likely to be absent or greatly decreased in number in the mother and the child?
A. Langerhans cells
B. Merkel's cells
C. Pacinian corpuscle
D. Sebaceous glands
E. Sweat glands
Totally clueless on this one. Sebaceous glands are connected to hair shafts, but it has nothing to do with teeth. I dont understand why missing Langerhans cells would cause you to have no teeth or hair. Merkel's cells are involved in touch reception? Not sure what they have to do with anything. Pacinian is pressure receptor. I'm going to guess E, but I dont understand how any of these could cause lack of sweating, no hair, and no teeth. What syndrome is this?
5. A 66 year old man with squamous cell carcinoma of the lung has an increase in serum alkaline phosphatase activity. Metastatic disease is suspected. Measurement of serum activity of which of the following enzymes will be most useful in differentiating bone and hepatic metastases?
A. Acid phosphatase
B. Aldolase
C. Amylase
D. y-Glutamyltransferase
E. Lactate dehydrogenase
I think this is D. GGT is a liver-specific marker to clarify elevated alk phos which can come from either bone or liver. Amylase is pancreas, I dont know what acid phos is, and lactate dehydrogenase is also liver-associated, but it has nothing to do with alk phos.
6. 70 year old woman who lives alone is brought to hospital by concerned neighbor because she is not taking care of herself. On questioning, the patient denies any problems, but her hair and the left side of her face are poorly tended; she has not buttoned the left sleeve of her blouse or tied her left shoe. When asked to copy a drawing of a clock face, she draws only 12 through 6. MRI of the head is most likely to show a lesion in which part of the brain?
A. Left frontal lobe
B. Right frontal lobe
C. Left parietal lobe
D. Righit parietal lobe
E. Left temporal lobe
F. Right temporal lobe
We havent covered neurology in the 2nd year yet, so this is a guess, but I know its got to be on the right side of the brain. I'm going to say B, since I think frontal lobe is more associated with "forgetting" the side of your body like this woman does. Probably wrong though.
7. A 51 year old man who was previously a successful businessman and devoted husband and father now neglects and abuses his family. At his last visit, he confided to the physician that he abuses alcohol. His wife tells the physician that her husband's drinking is destroying their family. Of the following responses, which is likely to be the most effective in initating a discussion about his use of alcohol and its effect on his family?
A. Did you know most patients who drink as much as you do lose their families?
B. Do you feel guilty about what you're doing to your children?
C. Do you realize the damage your use of alcohol is doing to your relationships?
D. What do you think is the impact of your drinking on your family?
E. Your wife says your use of alcohol is destroying your family
This one should be obvious (D). They always teach us to be nonjudgmental and just ask open ended questions. I think its a little ridiculous at times, but whatever.
8. A 56 year old man has had bright red blood in the stool for the past 10 days. Colonoscopy shows a 6 cm, sessile, bleeding polypoid lesion in the descending colon. Examination of tissue obtained on biopsoy of the lesion shows a primary adenocarcinoma of the colon. There is marked mitotic activity and cell differentiation is poor. The neoplasm is resected; metastases are present in regional lymph nodes. A focus of the same neoplasm is present in a liver biopsy specimen. Which of the following indicates the poorest prognosis?
A. Lymphatic invasion
B. Marked mitotic activity
C. Neoplasm in liver
D. Poor cell differentiation
E. Regional lymph node mets
I marked C as correct, because according to what we learned, stage (not grade) is the most important prognostic indicator for colonic adenocarcinoma. So that eliminates answers B and D since those all apply to grading and not staging. Under the Duke and TNM staging system, lymphatic invasion < regional lymph node mets < liver mets. Liver mets should be the worst of the staging indicators.
9. A 58 year old man is scheduled to be discharged from the hospital after treatment of an MI. Therapy with a drug with wich of hte following actions is most likely to decrease his risk for dying over next 6 months?
A. Blockade of B-adrenergic receptors
B. Blockade of Ca2+ channels
C. Blockade of K+ channels
D. Blockade of Na+ channels
I probably got this one wrong, because we are just now taking cardiac pharmacology and I havent had time to really study this yet. However, I think they told us in class that beta blockers improve mortality, so I put down A as correct. This is a guess, because I have no clue if the others improve mortality or not.
10. A neonate is born with ambiguous genitalia. The clitoris is enlarged, there is a single perineal opening anterior to the anus, and no masses are palpable in the labioscrotal pouches or the inguinal canal. Which of the following is the most likely cause of the sexual ambiguity in this neonate?
A. Androgen insensitivity syndrome
B. 21-hydroxylase deficiency
C. Mixed gonadal dysgenesis
D. 5a-reductase deficiency
E. True hemaphroditism
I think D is correct, but I'm confused about A. I thought there were 2 types of AIS, complete and partial, and that partial AIS results in ambiguous genitalia? Since they didnt list PAIS as a separate answer, what does that mean? Can I eliminate A because they werent specific enough in the answer choices? I'm not sure how to handle that.
