21. A3-yoar-old gis brought tothe physician because of a -wook history of easy brusabilly. She has had frequent, large, fou-smeling stools for 3 months. ‘She was found to have cystic frosis atthe age of 18 months. She is below the 3rd percentile for height and weight. Physical examination shows several fecctiymotic areas over the extremities. This patient most ikely has a deficiency of which ofthe following? O A) anttwombi © 8) Platelets O 6) Protein © b) Vitamin 8 (cobalamin) © €) vitamin OF) vitamin k © 6) von Witebrand factor21. A3-yoar-old gis brought tothe physician because of a -wook history of easy brusabilly. She has had frequent, large, fou-smeling stools for 3 months. ‘She was found to have cystic frosis atthe age of 18 months. She is below the 3rd percentile for height and weight. Physical examination shows several fecctiymotic areas over the extremities. This patient most ikely has a deficiency of which ofthe following? O A) anttwombi © 8) Platelets O 6) Protein © b) Vitamin 8 (cobalamin) © €) vitamin OF) vitamin k © 6) von Witebrand factor22. Receptors forall ofthe members of the steroid hormone family share which of the folowing features? © A) Calcium-mediated intracellular effects © 8) GTP-binding proteins © ) Mitochondrial membrane association D) Plasma membrane association © E) Zino-containing DNA-binding domains:23. Ahomoless 45-year-old man comes to the cnc bocause of localized back pain forthe past 3 months. He has not soen a health care provider in more than 20 years. Physical examination shows tendemess over the lower thoracic spine. There are no obvious neurologic deficits. X-rays ofthe spine show hartowing of the disc space between T10 and T11 and destruction of he adjacent T10 vertebral body. Which ofthe folowing isthe most fkely cause of these findings? © A) Hyperparathyroiaism O 8) Muttiple myeloma O ©) Osteitis detormans (Paget disease) O Dd) Sarcoidosis O E) Tuberculosis24. 49-year-old man comes to the physician because of a 1-month history of lower abdominal pain and increased urge to defecate. Capabilty to prevent spontaneous defecation is intact. He sustained nondisplaced multiple fractures ofthe pelis 2 months ago in a motor vehice collision. He inially was on ‘bd rest with pelvic support, progressed to non-weight-bearing crutch waking, and now is partial weight bearing with crutches. Medications now inciude naprosyn three times daly. Physical examination shows an anal wink. Neurologic examination shows intact rectal sphincter tone. Ths patients able to ‘sustain cortical control over defecation via which ofthe following nerves? O A) Conus meduliaris, © 8) Hypogastic nerves O ) Myenteric plexus O D) Pelvic nerves: O E) Pudendal nerves:25. Ina healthy 25-year-old man witha normal dist and Mud intake, which ofthe folowing substances fitored by the kidney has the greatest fraction excreted in urine? © A) Ghucose 8) Magnesium © ©) Sedum © Dd) Urea © &) Water26. 32-year-old woman comes tothe physician because of 3-month history of headaches. Two weeks ago, she moved to an area women's shelter because her husband had been hiting her. She takes no medications. Physical examination shows multiple bruises in diferent stages of healing over the face, ‘neck, and trunk. There is citcumforental brusing on both sides of tho neck. Which of the folowing statoments is most appropiate to gather pertinent Information fom this patient? © A) "bid you bring your records from the emergency room wth you" © 8) "Isee some bruising on your neck. How did that happen?" © €)"Ptease demonstrate to me how this neck bruising occurred." © ) "This looks like you were choked. Is that true?” © E) "What sort of deviee did your husband use on your neck?"27. AS2-year-old man who i inthe hospital wih malignant hypertension, heart falure, and a mild renal impairment is being treated with captopril nitroprusside, and furosemide. After 48 hours of therapy, his blood pressure is controled, but he develops metabolic acidosis, lethargy, and difcuty breathing. Which ofthe following substances most ikely caused these advorse offacts in this patient? O A) Cyanide © 8) tron O ¢) Lead O D) Nitric oxide O E) Selenium28. 78-year-old man comes to the physician with his daughter because of ow back pan for 3 months. He underwent a bilateral rchloctomy 2 years ago for prostate cancer. He speaks French fluent, but he knows only a few English words. His daughter offers to serve as an interpreter. After thanking the ‘daughter for hor offer, its most appropiate forthe physician to state which ofthe following? O A) “Have you interpreted for your father before in a medical capacity” © 8) "Ibotieve it would be awkward for a daughter to interpret for her father © 6) "itis best tat | use @ professional French interpreter.” © ©) "Piease ask your father it he's ready to begin the examination." © E) "That would be fine. Il just ask you to step out ofthe room for the physical examination."29. 16-year-old git is brought othe physician by her mother because ofa 1-year history of increasingly sovere abdominal pain that occurs poridicaly, but ‘not raguarly. Physical examination shows abdominal tenderness thats mest acute around the umbilicus. The physician suspects ectopic endometrial tissue, and an operation is scheduled. During the operation, an 8-om piace of tissue is removed from the eal region on the antimasenteric side ofthe ‘bowel approximately 90 cm proximal to the ileocecal junction. The patient's pain resolves postoperatively. The ectopic tissue was most ikely located in which of the folowing structures? O A) Ascending colon © 8) Featcitorm igament O ©) teat polyp O D) Meckel diverticulum © E) Vermitorm appendix30. A 14-year-old gi is brought othe physician by her mother because of episodes of increasingly severe facial blemishes during the past 6 months. She says that she does not eat high-fat foods or use makeup. Use ofan astringent soap has not resolved her symptoms. Menarche occurred at the age of 12 years. ‘photograph of her face is shown. Which of the following best describes the pathologic mechanism of this patient's condition? © A) Acceleration ofthe proiteraton of cals inthe dermis by increased estogen production © ®) Colonization of apocrine sweat glands by tung O ©) Decreased blood fw to skin captares by overproduction feast thers © ©) Foliar epermalhypereotferaton wth excess production of sebum ©) Thickening ofthe basement membrane in response to increased pubes serum estogen concentrations31. A22.year-old man is admitted tothe hospital for treatment of a ruptured appendix. His temperature is 38.9°C (102°F). Abdominal examination shows. guarding, rebound tenderness, and extreme tendemess ofthe right lower quadrant. He undergoes exploratory laparotomy, and an abscess containing foui-smeling pus i found. A Gram stain of exudate shows numerous segmented neultophis, gram-positive coc, gram-posive rods, and gram-negative reds. Aerobic culture ofthe exudate at 37°C on blood and MacConkey agar plates yields only enterocacc. Which ofthe following bacteria is most likely to ‘be among the gram-negative rods? O A) Bacteroides fragilis O 8) Escherichia colt © ©) Legionetta pneumophita O D) Moraxella catarrhalis O E) Proteus mirabilis32. AS2:yearold man with chronic renal failure receives a cadaveric kidney transplant, Postoperatively, he is ‘iven cyclosporine for immunosuppressive therapy. Six weeks after the operation, he develops hypoxemia With an arterial Po, of 40 mm Hg, Aphotomicrograph ofa ransbronchal Biopsy specimen is shown, \Which of the folowing pathophysiologic mechanisms best explains this patients hypoxemia? © A) Aiveoiar exudation due to Cryptococcus neoformans infection © B) Cytomegalovirus pneumonitis with diffuse alveolar damage © C) Neutrophile alveolar coneolidation due to pneumococcal pneumonia © D) Proumocysts jroveci (lormery P. carn infection with alveolar exudation © E) Vascular invasion by Aspergilus with pulmonary infarction32. AS2:yearold man with chronic renal failure receives a cadaveric kidney transplant, Postoperatively, he is ‘iven cyclosporine for immunosuppressive therapy. Six weeks after the operation, he develops hypoxemia With an arterial Po, of 40 mm Hg, Aphotomicrograph ofa ransbronchal Biopsy specimen is shown, \Which of the folowing pathophysiologic mechanisms best explains this patients hypoxemia? © A) Aiveoiar exudation due to Cryptococcus neoformans infection © B) Cytomegalovirus pneumonitis with diffuse alveolar damage © C) Neutrophile alveolar coneolidation due to pneumococcal pneumonia © D) Proumocysts jroveci (lormery P. carn infection with alveolar exudation © E) Vascular invasion by Aspergilus with pulmonary infarction38, A2-year-old boy i brought tothe physician because of a 6-month history of fallure to thrive. Cardiac examination shows a grade 4/6 systolic murmur caused by increased pulmonic flow, felowed by a fixed, widely spt S Echocardiography shows hypertrophy of the right alum, right ventricle, and pulmonary arteries. This patient most Ikely has which ofthe flowing congenital cardiac anomalies? O A) Atrial soptal detect © 8) Patont ductus arteriosus O 6) Persistent truncus arteriosus O d) Tetralogy of Fallot O E) Transposition of the great arteries O F) Venwicuiar septal dect38, A2-year-old boy i brought tothe physician because of a 6-month history of fallure to thrive. Cardiac examination shows a grade 4/6 systolic murmur caused by increased pulmonic flow, felowed by a fixed, widely spt S Echocardiography shows hypertrophy of the right alum, right ventricle, and pulmonary arteries. This patient most Ikely has which ofthe flowing congenital cardiac anomalies? O A) Atrial soptal detect © 8) Patont ductus arteriosus O 6) Persistent truncus arteriosus O d) Tetralogy of Fallot O E) Transposition of the great arteries O F) Venwicuiar septal dect34. 63-year-old woman comes tothe physician because ofa 5-day history of shortness of breath and swollen logs. Her respirations are 25min and labored ‘and blood pressure is 130/50 mm Hg, She has a lage subclavian arteriovenous fistula caused by a stab wound tothe let supraclavicular area 15 years ‘agp. Physical examination shows 2+ edema of the lower extremities, Which ofthe following findings Is most ikly in this patient? © A) Decreased arterial oxygen saturation © 8) Decreased mixed venous oxygen saturation O 6) Decreased stroke volume © ©) Increased resting cardiac output CO E) Increased systemic vascular resistance£35. Astudy is conducted to assess 32 patients in @ community of 1000 who have developed drug tesistant tuberculosis during a 1-year period. These patients ‘are removed fom the community fo reatment. Assuming that the risk for infection and susceptibility to the disease is constant, which ofthe fllowing best represents the numberof individuals most likely to develop subsequent drug-resistant tuberculosis during the next year? Ona O80 Oops O paz Oe)3336. An 81-year-old woman is admited tothe hospital because ofa massive pulmonary embolism fom a deep venous thrombosis. Her platelet counts 160,000/mm? Appropriate pharmacotherapy Is started. One week later, her platelet count is $5,000imm?. The thrombocytopenia was most Ikely caused by a drug with which ofthe following mechanisms of action? O A) Activates tissue plasminogen © 8B) Intrfores with the carboxylation of coagulation factors O 6) irreversibly inactivates cyclooxygenase O D) Potentiates the action of antithrombin Ill © E) Selectively inhibits factor Xa37. 68-year-old woman comes tothe physician because ofa 1-year history of severe abdominal pain after meals; she also has had an unintentional 844g (20:6) wight loss during this period. The pain is relieved when she decreases the amount of food that she eats. She has a history of atheroscierosis, and underwent triple coronary artery bypass grafing 2 years ago. Physical examination shows a sof, nontender abdomen and an abdominal brit. Pedal pulses are diminished. The most likely cause ofthis patients symptoms is stenosis of which ofthe folowing arteries? O A) Greater pancreatic O 8) Hepatic O ©) Right gastric O D) Superior mesenteric © E) Supraduodenat