70yo M dies in a motor vehicle collision. Was undergoing evaluation for occult
blood in the stool. Photo of transverse colon shown. Dx? ~CORRECT
ANSWER~✓✓Tubular adenoma
38yo M with 1-week hx of watery, itchy eyes and a runny nose. Physical shows
inflamed nasal mucosa. No congestion in lower lung. Pharmacotherapy?
~CORRECT ANSWER~✓✓Loratadine
16yo girl with 3-day hx of fever, nonproductive cough, and fatigue. T 38.3, P
88/min, BP 102-70. PE shows pale conjunctivae. CXR shows bilateral interstitial
infiltrates. Blood spontaenously agglutinates while awaiting transport to the
laboratory. Antibody isotypes causing agglutination? ~CORRECT
ANSWER~✓✓IgM
24yo M with small tender blisters on his penis 3 days after unprotected sex.
Photograph shown. Causal agent? ~CORRECT ANSWER~✓✓HSV-2
42yo F with 3-year hx of an intermittent facial rash, including the forehead,
eyelids, nose, and cheeks. Rash seems to be getting worse since she moved from
New York to Florida last year. Spicy foods precipitate a flushing reaction that
seems to exacerbate the rash. PE shows erythema over the nose and cheeks, with
scattered telangiectasias and a few papules. Dx? ~CORRECT
ANSWER~✓✓Rosacea
,53yo M returned from Africa, has fever, headache, and abdominal discomfort.
Received appropriate vaccinations prior to the trip. T 39.4C. A wright-stained
peripheral smear shown. Dx? ~CORRECT ANSWER~✓✓Malaria
68yo F with T2DM and hypertension that has been poorly controlled despite
hydrochlorothiazide treatment. BP 150/96, Labs show serum glucose
concentration of 130 and proteinuria. In addition to current Rx, which is most
appropriate pharmacotherapy? ~CORRECT ANSWER~✓✓Lisinopril
66yo M with stage IV colon cancer with 3-day hx of severe diarrhea after
receiving chemotherapy with fluorouracil, leucovorin, and Irinotecan. prescribed
opioid antidiarrheal agent with no CNS effects. Which med? ~CORRECT
ANSWER~✓✓Loperamide
35yo M in ED with 2-hour hx of sever fatigue and dizziness. Had profuse, watery
diarrhea for 8 hours despite a lack of oral intake. Recently returned from a
medical relief trip to a remove village in Honduras. T 36.7 C, P 122/min, BP
90/50. PE shows dry skin and decreased capillary refill. Stool for occult blood is
negative; stool is gray and turbid. Gram stain shows gram-negative, comma-
shaped bacteria; no erythrocytes of leukocytes. MOA of toxin? ~CORRECT
ANSWER~✓✓Activation of adenylyl cyclase
59yo F with gradual onset of lack of muscle control in her left arm and leg. Sx 1
mo ago after dx with metastatic breast cancer. PE shows ataxia of left upper and
lower extremities. Muscle strength, DTR, sensation, proprioception normal.
Metastatic tumor in which location? ~CORRECT ANSWER~✓✓cerebellum
Newborn delivered at 38 weeks' gestation weighs 1800 g. PE shows petechial
rash, microcephaly, and hepatosplenomegaly. Serologic test for CMV: IgG + in
,mother, + in newborn; IGM - in mother, + in newborn. Explanation? ~CORRECT
ANSWER~✓✓Congenital cytomegalovirus infection
Female newborn is delivered at 38 weeks' gestation. Apgar 8 and 8 at 1/5 min.
PE shows a bulging, fluod0filled mass approximately 5 cm in diameter in the
midline over the lumbosacral region. No spontaneous movements of the lower
extremities. Abnormality most likely occurred because of abnormal development
during which periods of postconception (in days)? ~CORRECT ANSWER~✓✓15
to 40
64yo M in ED 3 hours after SOB with exertion and extreme fatigue. Has ischemic
heart disease. P 125/min, BP 105/60. ECG shows atrial fibrillation. Intravenous
ibutilide is administered. Ten minutes later, ECG shows normal sinus rhythm.
Risk for which drug effect in the next 6 hours? ~CORRECT
ANSWER~✓✓torsades de pointes
65yo F with 20-year hx of osteoarthritis of the hands now has pain radiating
down the distal anterior thigh, knee, medial leg, and food. Bony outgrowth of
vertebrae compressing one of the spinal nerves is suspected. Nerve root in which
intervertebral foramina is effected? ~CORRECT ANSWER~✓✓L3 to L4
38yo M with 3-year hx of T2DM. Taking an oral antihyperglycemic agent, he has
tried diet and exercise. BMI 32. PE normal. Hb A1c is 10%. Physician
recommends initiation of insulin injections. Responds, "I know that insulin
would help control my blood sugar. But a lot of people in my family have
diabetes, and insulin made them really sick at times. Patient is at which stage of
change? ~CORRECT ANSWER~✓✓contemplation
, 24yo M with 2-day history of an itchy rash on his arms and legs. Returned from a
camping trip in the woods 5 days ago. PE shows edematous, erythematous rash
with linear vesicles. Cause is activation of which cell types? ~CORRECT
ANSWER~✓✓T lymphocytes
70yo M from china with poorly differentiated monoclonal carcinoma of the
nasopharynx. DNA probes of neoplastic cells are most likely to detect genome of
which virus? ~CORRECT ANSWER~✓✓EBV
Epidemiologic study of aniline dye, 500 workers with bladder cancer and 200
workers without. Exposed to aniline dyes/Have Bladder cancer: Yes/Yes (250),
Yes/No (50), No/Yes (250), No/No (150). Odds ratio? ~CORRECT
ANSWER~✓✓3
24yo M with hx of IVDA could not be aroused. Friend reports that the patient
injected himself with a drug 6 hours ago. Labs show drug concentration of 0.3.
Assuming first-order one-compartment kinetics, has a half-life of 2 hours, and a
volume of distribution of 200 L in this patient. What is quantity of drug (in mg)
injected? ~CORRECT ANSWER~✓✓480
Compound is taken up by bacterial cells. No energy is necessary for uptake, and
the compound is not concentrated in the cell. Which describes this mechanism of
transport? ~CORRECT ANSWER~✓✓carrier-mediated diffusion
Newborn has male genital ducts but female external genitalia. Cytogenetic
analysis shows a 46,XY karyotype, and genetic testing shows a mutation of the
gene encoding 5alpha-reductase. In absence of this mutation, labia majora would
have been? ~CORRECT ANSWER~✓✓scrotum
blood in the stool. Photo of transverse colon shown. Dx? ~CORRECT
ANSWER~✓✓Tubular adenoma
38yo M with 1-week hx of watery, itchy eyes and a runny nose. Physical shows
inflamed nasal mucosa. No congestion in lower lung. Pharmacotherapy?
~CORRECT ANSWER~✓✓Loratadine
16yo girl with 3-day hx of fever, nonproductive cough, and fatigue. T 38.3, P
88/min, BP 102-70. PE shows pale conjunctivae. CXR shows bilateral interstitial
infiltrates. Blood spontaenously agglutinates while awaiting transport to the
laboratory. Antibody isotypes causing agglutination? ~CORRECT
ANSWER~✓✓IgM
24yo M with small tender blisters on his penis 3 days after unprotected sex.
Photograph shown. Causal agent? ~CORRECT ANSWER~✓✓HSV-2
42yo F with 3-year hx of an intermittent facial rash, including the forehead,
eyelids, nose, and cheeks. Rash seems to be getting worse since she moved from
New York to Florida last year. Spicy foods precipitate a flushing reaction that
seems to exacerbate the rash. PE shows erythema over the nose and cheeks, with
scattered telangiectasias and a few papules. Dx? ~CORRECT
ANSWER~✓✓Rosacea
,53yo M returned from Africa, has fever, headache, and abdominal discomfort.
Received appropriate vaccinations prior to the trip. T 39.4C. A wright-stained
peripheral smear shown. Dx? ~CORRECT ANSWER~✓✓Malaria
68yo F with T2DM and hypertension that has been poorly controlled despite
hydrochlorothiazide treatment. BP 150/96, Labs show serum glucose
concentration of 130 and proteinuria. In addition to current Rx, which is most
appropriate pharmacotherapy? ~CORRECT ANSWER~✓✓Lisinopril
66yo M with stage IV colon cancer with 3-day hx of severe diarrhea after
receiving chemotherapy with fluorouracil, leucovorin, and Irinotecan. prescribed
opioid antidiarrheal agent with no CNS effects. Which med? ~CORRECT
ANSWER~✓✓Loperamide
35yo M in ED with 2-hour hx of sever fatigue and dizziness. Had profuse, watery
diarrhea for 8 hours despite a lack of oral intake. Recently returned from a
medical relief trip to a remove village in Honduras. T 36.7 C, P 122/min, BP
90/50. PE shows dry skin and decreased capillary refill. Stool for occult blood is
negative; stool is gray and turbid. Gram stain shows gram-negative, comma-
shaped bacteria; no erythrocytes of leukocytes. MOA of toxin? ~CORRECT
ANSWER~✓✓Activation of adenylyl cyclase
59yo F with gradual onset of lack of muscle control in her left arm and leg. Sx 1
mo ago after dx with metastatic breast cancer. PE shows ataxia of left upper and
lower extremities. Muscle strength, DTR, sensation, proprioception normal.
Metastatic tumor in which location? ~CORRECT ANSWER~✓✓cerebellum
Newborn delivered at 38 weeks' gestation weighs 1800 g. PE shows petechial
rash, microcephaly, and hepatosplenomegaly. Serologic test for CMV: IgG + in
,mother, + in newborn; IGM - in mother, + in newborn. Explanation? ~CORRECT
ANSWER~✓✓Congenital cytomegalovirus infection
Female newborn is delivered at 38 weeks' gestation. Apgar 8 and 8 at 1/5 min.
PE shows a bulging, fluod0filled mass approximately 5 cm in diameter in the
midline over the lumbosacral region. No spontaneous movements of the lower
extremities. Abnormality most likely occurred because of abnormal development
during which periods of postconception (in days)? ~CORRECT ANSWER~✓✓15
to 40
64yo M in ED 3 hours after SOB with exertion and extreme fatigue. Has ischemic
heart disease. P 125/min, BP 105/60. ECG shows atrial fibrillation. Intravenous
ibutilide is administered. Ten minutes later, ECG shows normal sinus rhythm.
Risk for which drug effect in the next 6 hours? ~CORRECT
ANSWER~✓✓torsades de pointes
65yo F with 20-year hx of osteoarthritis of the hands now has pain radiating
down the distal anterior thigh, knee, medial leg, and food. Bony outgrowth of
vertebrae compressing one of the spinal nerves is suspected. Nerve root in which
intervertebral foramina is effected? ~CORRECT ANSWER~✓✓L3 to L4
38yo M with 3-year hx of T2DM. Taking an oral antihyperglycemic agent, he has
tried diet and exercise. BMI 32. PE normal. Hb A1c is 10%. Physician
recommends initiation of insulin injections. Responds, "I know that insulin
would help control my blood sugar. But a lot of people in my family have
diabetes, and insulin made them really sick at times. Patient is at which stage of
change? ~CORRECT ANSWER~✓✓contemplation
, 24yo M with 2-day history of an itchy rash on his arms and legs. Returned from a
camping trip in the woods 5 days ago. PE shows edematous, erythematous rash
with linear vesicles. Cause is activation of which cell types? ~CORRECT
ANSWER~✓✓T lymphocytes
70yo M from china with poorly differentiated monoclonal carcinoma of the
nasopharynx. DNA probes of neoplastic cells are most likely to detect genome of
which virus? ~CORRECT ANSWER~✓✓EBV
Epidemiologic study of aniline dye, 500 workers with bladder cancer and 200
workers without. Exposed to aniline dyes/Have Bladder cancer: Yes/Yes (250),
Yes/No (50), No/Yes (250), No/No (150). Odds ratio? ~CORRECT
ANSWER~✓✓3
24yo M with hx of IVDA could not be aroused. Friend reports that the patient
injected himself with a drug 6 hours ago. Labs show drug concentration of 0.3.
Assuming first-order one-compartment kinetics, has a half-life of 2 hours, and a
volume of distribution of 200 L in this patient. What is quantity of drug (in mg)
injected? ~CORRECT ANSWER~✓✓480
Compound is taken up by bacterial cells. No energy is necessary for uptake, and
the compound is not concentrated in the cell. Which describes this mechanism of
transport? ~CORRECT ANSWER~✓✓carrier-mediated diffusion
Newborn has male genital ducts but female external genitalia. Cytogenetic
analysis shows a 46,XY karyotype, and genetic testing shows a mutation of the
gene encoding 5alpha-reductase. In absence of this mutation, labia majora would
have been? ~CORRECT ANSWER~✓✓scrotum
