20. Aoalthy 35-year-old woman who wishes to become a regular platelet donor comes to blood donation center. Blood is obtained by venous phlebotomy into sodium vate and processed to yet paletch plasma (PRP) fo pale! uncon stu. Sho has no personal or famiy hisiory of bleeding dsordor. Aliquots ofthe PRP ae subsequently analyzed Using a ight-ransmitance pallet aggrogometer. Adcing a 5 pM soliton of which ofthe folowing reagents othe PRP most ayo cause aap and reverie aggregation pate nthese stiches? © A) Adenosine diphosphate © ®) Collagen monomer O Immune lobutin O 0) Norepinephrine OE) Prostacyetin 61)1. 12-year-old boy is admitted tothe hospital because of lethargy hip pain, and a temperature of 38.4°C (103°F). He has been hospitalized several other {times because of pneumonia. His neonatal period was normal. Complete blood counts are within normal limits, and a test for HIV antibody is negative. Blood cultures grow Staphylococcus aureus. Serum electrophoresis is most ike to show which ofthe folowing patterns? tal Jan OA Os) Oc) Oo) svn) nas -2. Free purine and pyrimidine bases are reutiized in normal metabolism. n children with Lesch-Nyhan syndrome who have intolloctual disability, poor muscle coordination, and sell-mutiation tendencies, there is a defect in the salvage of which ofthe following pars of bases? © A) Aderine and thymine © 8) Guanine and ypoxatine © 6) Guanine and uc acs O D) Ural and otosine OE) xanthine and hypoxanthine3. Ad2-yoar-old man is struck by a moter vehicle. His only injury is @ closed fracture ofthe proximal tba, Inal neurovascular examination shows no deficits. “Twenty-four hours later, he has increased lag pain and paresthesias inthe dorsal space between hs frst and second toes. The patient begins to pass dark ‘od urine and becomes oliguric. Urinalysis posive for blood but no erythrocytes are seen on microscopic examination. Which ofthe following acute lisorders isthe most ikely cause of the renal failure? © A) Glomeruionephriis © 8) Hemotyticuremic syndrome © ©) Intersitia! nephritis © D) Nephrotic syndrome © E) Tubular necrosis4. Amale newbom is found to have a defectin anchoring firs. Which ofthe following skin findings is most likly inthis patient? OA) Bistors O 8) Easy bruising 6) Eczematous rash D) Inability to sweat O E) Thickened skin O F) Ulcers,5. 65-year-old woman has ascltes. Which ofthe flowing additonal findings indicates a diagnosis of constrictive pericarditis rather than cirhosis? © A) Edema of the lower extremities: © 8) Esophageal varices © ©) Hypoatbuminemia © D) Hyponatremia © E) Increased jugular venous pressure OF) Splenomegaly6. 62-year-old man is being evaluated fr rectal bleeding. An xray ofthe gastrointestinal tract with contrast material's shown. Which of the following isthe most Ikely explanation forthe feathery appearance inthe portion ofthe gastrointestinal tract indicated by X when compared with the portion indicated by Y? O A) Absence of circular muscle © 8) Fewer vt © ©) Greater bowel motility D) Greater mucosal surface area © E) Less circular and longitudinal smooth muscle7. A6S-year-old man who has chronic lymphocytic leukemia has the sudden onset of fatigue and shortness of breath, Laboratory studies show Hemoglobin Hematocrit [Leukocyte count Pratoet count Reticulocyte count ‘Serum bliin “otal Conjugated 65 oid 19% '50,000/mm> 470,000imm® 8% 44mg. 0.5 mglat ‘A paripheral blood smear is shown. Which of the folowing is the most likely cause ofthe anemia’? O A) Aplastic anemia © B) Autoimmune hemolysis O ©) Hereditary spherocytosis © 1B) Microangiopathic hemolysis © E) Monoclonal gammopathy ©8. AAT-year-old man with a history of rheumatic valvular disease comes tothe physician because of chest pain and lly breathing forthe past 2 days. An ECG shows an acute myocardial infarction. Examination shows a systolic murmur. Pressure tracings from the aorta, left ventricle (LV), and let atrium (LA) are shown, Which ofthe © 0) Mitra obstcton O€) Riptre ofthe chose tendnese following is the most likely diagnosis? 3 Aortic O A) forte obsreton E O 8) hoe regurgtaton £ © 6) Lon vento aneurysm | é é Time8. After being given an infusion of mannitol (400 mM), a healthy person is mast Ikely to have which of the following changes in plasma osmolality and plasma 'ADH (vasopressin) concentration? o/m. 7 Plasma {ADH( o oD Cc pr ea Plasma osmolality (mOsmoVL) Ocontet eters ntsion Oa Os) Oc) Oo) Oe®10. 37-year-old man comes tothe physician because ofa 1-week history of nausea, vomiting, and abdominal pain. He ate raw oysters while vacationing in ‘Mexico 2 weeks ago. He has smoked 1 pack of cigarettes daly forthe past 15 years but has now lost the desire to smoke. Physical examination shows, ‘dlralctorus and sight enlargement and tendemess of the liver. Which of the following pathogens is most Ikelyresponsibie forthe development of these ‘symptoms in this patient? OA) Epstein-Barr virus O B) Hepatitis A virus O ©) Hepatitis 8 virus © Dd) Hepatitis ¢ virus O E) Vibrio vulnificuswe are taking, and seems tobe always moving, His teacher says he is always talking wth his neighbors, has trouble completing tasks, and refuses to walt his turn whon playing games." Physical examination shows no abnormalltios. I drug thacapy is indicated, administration of a drug with which of tho following mechanisms of action is most appropriate? © Ar Antagonism at f-adrenergic receptors O 8) Block of votage-coted Na channels ©) Enhanced action of aminobutyric acd (GABA) at GABA receptors Ob) inroased release of opamine anc norepnepine © E) Selective inion of uptake of serotonin at nave tonal12, A previously healthy 35-yoar-old woman develops hypoxemia 35 minutes after ingesting a near-ethal dose of barbturetes. She has not aspirated. Which of the folowing sets of arterial blood gas values (in mm Ha) Is most kel n this patent? OA Os Or On Oe eeesssP Pog 50 Cy 28 80 35 (Aa), 35 «0 10 10 2513. AG4-year-old woman develops pain and stiffness ofthe proximal interphalangeal joints andthe right knoe. The pain is made worse by activity and is relieved by rest. X-ays ofthe knee show a narrowed jint space with radiodense subchondral bone and cys formation. Knee fluid aspirate shows: Appearance ‘lear, yellowish [Leukocyte count _250/mm3(N<200) Noutrophis 5% (Ne25%) Gucose 4101 mg/dl. (N=60-100) Which of the following isthe most ikely cause of her condition? O A) Acute gouty arthritis O 8) Osteoarthritis O ¢) Rheumatoid arthritis O ©) Septic arthritis © E) Normal age-related changes in joints15. Aproviously healthy 19-year-old woman comes to student health services because ofa 3-day history of vulvar itching and vaginal discharge. She has ‘ow sexual partner and uses no contraception. Speculum examination shows a profuse yellow-gray discharge inthe vagina. The pH ofthe discharge i 6. Microscopic examination ofthe discharge shows clue cals. Adon of KOH tothe discharge produces a strong amine odor Which of the folowing isthe ‘most likely cause? O A) aca veges © 8) Beco ris © ©) cand abicane O 0) Hoomophtus aerey &) Herpes sing vue O raw © 6) Haman peptone O 1) Prounocyat rove Yomety cae) © 1 reponeme pat © J) netomones vepnls16. A9-year-ld boy is brought to the physician because he told his teacher that his fingers felt “Yunny" afer he swung on the monkey bars 2 hours ago. [Neurologic examination shows numbness and tingling inte ring and small ngers ofthe left hand. The physician conctudes thatthe ulnar nerve may have boon strotched wrile he was hanging from the bars. Which of the following other functons should be checked to assess th intogrt of the ulnar nerve in the let mb? © Ay Abduction ofthe index, mide, ring, and small fingers O 8) Abduction of the thumb O ©) Extension of the index, middle © D) Extension of the thumb © E) Opposition of the thumb ring, and small fingers17. A22.year-old man is brought to the emergency department 20 minutes ater sustaining a knife wound tothe right side of his chest in a fight at a local bar. (On arial, heis short of breath. His pulse is 108/min, respirations are 30/min, and blood pressure is 100/60 mm Hg. Physical examination shows that the trachea is deviatod to the lt. Further physical examination of the traumatized sida is most ikaly to show which of the folowing pulmonary fnaings? O A cracios © 8) Eoenhony © ©) Hypenesonan percussion © b) reass toms O €) stitor © F) veoing © 6) wnepeed pectoromy18. 36-year-old man is brought to the emergency department bocause of multiple injuries sustained in a metor vehicle colsion 45 minutes ago. He is lethargic and confused. The right pupil is sluggshly reactive to light and fs t mm larger than the left pupil. There is mid left hemiparesis. Furter ‘examination shows fracture ofthe right femur, ruptured spleen, and hemorrhagic ploura effusion. ACT scan ofthe head shows a subdural hematoma on the right with mass effect and midline shit. He is intubated and mechanically hyperventiated. Which ofthe following is the mast ikely rationale for bhyperventiation in this patient? O A) Cause cerebral vasoconstriction O 8) Decrease pulmonary atelectasis © 6) Increase cerebral blood flow © D) Increase intracranial pressure © E) Increase oxygenation19, A.S2.year-old woman witha long standing history of generalized anxiety disorder comes to the physician for @foiow-up examination. She has been taking an anaioltic drug for 12 years, but she isnot currenly under a psychiatrist's care because she says she is feeling better and that she prefers this physician to psychiatrists. She has hyperipidemia, hypertension, and miki type 2 diabetes molitus treat with pharmacotherapy. Folowing physical examination and laboratory stuces, the physician makes adjustments tothe patients mecication regimen. Two days later, the physician receives 12 calls fom the patient for Clarification of treatment recommendations: this patter has occured frequent inthe past. In particular, the pation fxates onthe potential toxicities of her ‘medications, She often asks questions that have specifically been answered during the recent afice vst. Wrich ofthe folowing isthe best approach to ‘manage tis patient's needs? © A) Advise the patient that constant questoning of recommendations suggests lack of rst, and that she should seek care from a provid ‘whom she has confidence O 8B) Advise staf to ignore the patient's calls if they are too frequent © ¢) Contact one of the patient's family members to engage his or her help in enforcing more responsible use of the physician's time © 1D) Insist that the patient obtain routine psychiatric care © E) Set conditions and establish limits for phone calls, and set up a regular schedule of office visits